Proposed Rule: Medicare: Physicians Fee Schedule (2008 CY) Proposed Revisions To Payment Policies of Ambulance Services, Etc.

Thursday,
July 12, 2007
Part II
Department of
Health and Human
Services
Centers for Medicare & Medicaid Services
42 CFR Parts 409, 410, et al.

Medicare Program; Proposed Revisions to
Payment Policies Under the Physician Fee
Schedule, and Other Part B Payment
Policies for CY 2008; Proposed Revisions
to the Payment Policies of Ambulance
Services Under the Ambulance Fee
Schedule for CY 2008; and the Proposed
Elimination of the E-Prescribing
Exemption for Computer-Generated
Facsimile Transmissions; Proposed Rule
mstockstill on PROD1PC66 with PROPOSALS2
VerDate Aug<31>2005 18:48 Jul 11, 2007 Jkt 211001 PO 00000 Frm 00001 Fmt 4717 Sfmt 4717 E:\FR\FM\12JYP2.SGM 12JYP2
38122 Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules
DEPARTMENT OF HEALTH AND change; technical corrections; issues 7195 in advance to schedule your
HUMAN SERVICES related to therapy services; revisions to arrival with one of our staff members.
the ambulance fee schedule; the Room 445–G, Hubert H. Humphrey
Centers for Medicare & Medicaid ambulance inflation factor for CY 2008; Building, 200 Independence Avenue,
Services and the proposal to eliminate the SW., Washington, DC 20201; or 7500
exemption for computer-generated Security Boulevard, Baltimore, MD
42 CFR Parts 409, 410, 411, 413, 414, facsimile transmissions from the 21244–1850.
415, 418, 423, 424, 482, 484, 485, and National Council for Prescription Drug (Because access to the interior of the
491 Programs (NCPDP) SCRIPT standard for HHH Building is not readily available to
transmitting prescription and certain persons without Federal Government
[CMS–1385–P]
prescription-related information for Part identification, commenters are
RIN 0938–AO65 D eligible individuals. encouraged to leave their comments in
DATES: To be assured consideration, the CMS drop slots located in the main
Medicare Program; Proposed lobby of the building. A stamp-in clock
except for comments on section II.M.10
Revisions to Payment Policies Under is available for persons wishing to retain
of the preamble, comments must be
the Physician Fee Schedule, and Other a proof of filing by stamping in and
received at one of the adresses provided
Part B Payment Policies for CY 2008; retaining an extra copy of the comments
below, no later than 5 p.m. on Friday,
Proposed Revisions to the Payment being filed.)
August 31, 2007.
Policies of Ambulance Services Under Comments mailed to the addresses
Comments on section II.M.10
the Ambulance Fee Schedule for CY indicated as appropriate for hand or
‘‘Alternative Criteria for Satisfying
2008; and the Proposed Elimination of courier delivery may be delayed and
Certain Exceptions’’, of the preamble
the E-Prescribing Exemption for received after the comment period.
must be received by no later than 5 p.m.
Computer-Generated Facsimile Submission of comments on
on Friday, September 7, 2007.
Transmissions paperwork requirements. You may
ADDRESSES: In commenting, please refer
submit comments on this document’s
AGENCY: Centers for Medicare & to file code CMS–1385–P. Because of
paperwork requirements by mailing
Medicaid Services (CMS), HHS. staff and resource limitations, we cannot
your comments to the addresses
ACTION: Proposed rule. accept comments by facsimile (FAX)
provided at the end of the ‘‘Collection
transmission.
SUMMARY: This proposed rule would
of Information Requirements’’ section in
You may submit comments in one of
address certain provisions of the Tax this document.
four ways (no duplicates, please): For information on viewing public
Relief and Health Care Act of 2006, as 1. Electronically. You may submit comments, see the beginning of the
well as make other proposed changes to electronic comments on specific issues SUPPLEMENTARY INFORMATION section.
Medicare Part B payment policy. in this regulation to http://
We are proposing these changes to FOR FURTHER INFORMATION CONTACT: Pam
www.cms.hhs.gov/eRulemaking. Click
ensure that our payment systems are on the link ‘‘Submit electronic West (410) 786–2302 for issues related
updated to reflect changes in medical comments on CMS regulations with an to practice expense and changes to the
practice and the relative value of open comment period.’’ (Attachments comprehensive outpatient rehabilitation
services. This proposed rule also should be in Microsoft Word, facility.
discusses refinements to resource-based Rick Ensor (410) 786–5617 for issues
WordPerfect, or Excel; however, we
practice expense (PE) relative value related to practice expense
prefer Microsoft Word.)
units (RVUs); geographic practice cost methodology.
2. By regular mail. You may mail
Stephanie Monroe (410) 786–6864 for
indices (GPCI) changes; malpractice written comments (one original and two
issues related to the geographic practice
RVUs; requests for additions to the list copies) to the following address ONLY:
cost index and malpractice RVUs.
of telehealth services; several coding Centers for Medicare & Medicaid Craig Dobyski (410) 786–4584 for
issues including additional codes from Services, Department of Health and issues related to list of telehealth
the 5-Year Review; payment for covered Human Services, Attention: CMS–1385– services.
outpatient drugs and biologicals; the P, P.O. Box 8018, Baltimore, MD 21244– Ken Marsalek (410) 786–4502 for
competitive acquisition program (CAP); 8018. issues related to the DRA imaging cap.
clinical lab fee schedule issues; Please allow sufficient time for mailed Catherine Jansto (410) 786–7762 for
payment for renal dialysis services; comments to be received before the issues related to payment for covered
performance standards for independent close of the comment period. outpatient drugs and biologicals.
diagnostic testing facilities; expiration 3. By express or overnight mail. You Edmund Kasaitis (410) 786–0477 for
of the physician scarcity area (PSA) may send written comments (one issues related to the Competitive
bonus payment authorized by section original and two copies) to the following Acquisition Program (CAP) for part B
413 of the Medicare Prescription Drug, address ONLY: Centers for Medicare & drugs.
Improvement and Modernization Act of Medicaid Services, Department of Anita Greenberg (410) 786–4601 for
2003 (MMA); conforming and clarifying Health and Human Services, Attention: issues related to the clinical laboratory
changes for comprehensive outpatient CMS–1385–P, Mail Stop C4–26–05, fee schedule.
rehabilitation facilities (CORFs); a 7500 Security Boulevard, Baltimore, MD Henry Richter (410) 786–4562 for
process for updating the drug 21244–1850. issues related to payments for end-stage
compendia at section 1861(t)(2)(B) of 4. By hand or courier. If you prefer, renal disease facilities.
the Social Security Act (the Act); you may deliver (by hand or courier) August Nemec (410) 786–0612 for
physician self-referral issues; your written comments (one original issues related to independent diagnostic
beneficiary signature for ambulance and two copies) before the close of the testing facilities.
transport services; durable medical comment period to one of the following Karen Rinker (410) 786–0189 for
equipment (DME) update; the addresses. If you intend to deliver your issues related to the drug compendia.
chiropractic services demonstration; a comments to the Baltimore address, David Walczak (410) 786–4475 for
Medicare economic index (MEI) data please call telephone number (410) 786– issues related to reassignment and
Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules 38123
physician self-referral rules for are providing the following table of I. Independent Diagnostic Testing Facility
diagnostic tests and beneficiary contents. Some of the issues discussed (IDTF) Issues
signature for ambulance transport. in this preamble affect the payment 1. Proposed Revisions of Existing IDTF
Lisa Ohrin (410) 786–4565 for issues Performance Standards
policies, but do not require changes to
2. Proposed New IDTF Standards
related to physician self-referral rules. the regulations in the Code of Federal J. Expiration of MMA Section 413
Bob Kuhl (410) 786–4597 for issues Regulations. Information on the Provisions for Physician Scarcity Area
related to the DME update. regulation’s impact appears throughout (PSA)
Rachel Nelson (410) 786–1175 for the preamble and is not exclusively in K. Comprehensive Outpatient
issues related to the quality reporting section VI. Rehabilitation Facility (CORF) Issues
system for physician payment for CY 1. Requirements for Coverage of CORF
2008. Table of Contents Services—Plan of Treatment
Mary Ciccanti (410) 786–3107 for I. Background (§ 410.105(c))
issues related to the reporting of anemia A. Development of the Relative Value 2. Included Services (§ 410.100)
quality indicators. System 3. Physician Services (§ 410.100(a))
James Menas (410) 786–4507 for 1. Work RVUs 4. Clarifications of CORF Respiratory
2. Practice Expense Relative Value Units Therapy Services
issues related to payment for physician 5. Social and Psychological Services
pathology services. (PE RVUs)
3. Resource-Based Malpractice RVUs 6. Nursing Care Services
Dorothy Shannon (410) 786–3396 for 7. Drugs and Biologicals
4. Refinements to the RVUs
issues related to the outpatient therapy 5. Adjustments to RVUs Are Budget 8. Supplies and DME
cap. Neutral 9. Clarifications and Payment Updates for
Drew Morgan (410) 786–2543 for B. Components of the Fee Schedule Other CORF Services
issues related to the E-Prescribing Payment Amounts 10. Cost-Based Payment (§ 413.1)
Exemption for Computer-Generated C. Most Recent Changes to Fee Schedule 11. Payment for Comprehensive Outpatient
Facsimile Transmissions. II. Provisions of the Proposed Regulation Rehabilitation Facility (CORF) Services
Roechel Kujawa (410) 786–9111 or Related to the Physician Fee Schedule 12. Vaccines
A. Resource-Based Practice Expense (PE) L. Compendia for Determination of
Anne Tayloe (410) 786–4546 for issues
Relative Value Units (RVUs) Medically-Accepted Indications for Off-
related to the ambulance fee schedule. Label Uses of Drugs and Biologicals in an
Diane Milstead (410) 786–3355 or 1. Current Methodology
2. PE Proposals for CY 2008 Anti-Cancer Chemotherapeutic Regimen
Gaysha Brooks (410) 786–9649 for all B. Geographic Practice Cost Indices (GPCIs) (§ 414.930)
other issues. 1. GPCI Update 1. Background
SUPPLEMENTARY INFORMATION: 2. Payment Localities 2. Process for Determining Changes to the
Submitting Comments: We welcome C. Malpractice (MP) RVUs (TC/PC Issue) Compendia List
comments from the public on all issues D. Medicare Telehealth Services M. Physician Self-Referral Issues
set forth in this rule to assist us in fully 1. Requests for Adding Services to the List 1. Changes to Reassignment and Physician
of Medicare Telehealth Services Self-Referral Rules Relating to Diagnostic
considering issues and developing
2. Submitted Requests for Addition to the Tests (Anti-Markup Provision)
policies. You can assist us by 2. Burden of Proof
List of Telehealth Services
referencing the file code [CMS–1385–P] E. Specific Coding Issues Related to PFS 3. In-Office Ancillary Services Exception
and the specific ‘‘issue identifier’’ that 1. Reduction in the Technical Component 4. Obstetrical Malpractice Insurance
precedes the section on which you (TC) for Imaging Services Under the PFS Subsidies
choose to comment. to the Outpatient Department (OPD) 5. Unit-of-Service (per click) Payments in
Inspection of Public Comments: All Payment Amount Space and Equipment Leases
comments received before the close of 2. Application of Multiple Procedure 6. Period of Disallowance for
the comment period are available for Reduction for Mohs Micrographic Noncompliant Financial Relationships
viewing by the public, including any Surgery (CPT Codes 17311 Through 7. Ownership or Investment Interest in
17315) Retirement Plans
personally identifiable or confidential
3. Payment for Intravenous Immune 8. ‘‘Set in Advance’’ and Percentage-Based
business information that is included in Globulin (IVIG) Add-On Code for Compensation Arrangements
a comment. We post all comments Preadmission-Related Services 9. Stand in the Shoes
received before the close of the 4. Additional Codes From the 5-Year 10. Alternative Criteria for Satisfying
comment period on the following Web Review of Work RVUs Certain Exceptions
site as soon as possible after they have 5. Anesthesia Coding (Part of 5-Year 11. Services Furnished ‘‘Under
been received: http://www.cms.hhs.gov/ Review) Arrangements’’
eRulemaking. Click on the link 6. Reporting of Cardiac Rehabilitation N. Beneficiary Signature for Ambulance
‘‘Electronic Comments on CMS Services Transport Services
F. Part B Drug Payment O. Update to Fee Schedules for Class III
Regulations’’ on that Web site to view
1. Average Sales Price (ASP) Issues DME for CYs 2007 and 2008
public comments. 2. Competitive Acquisition Program (CAP) 1. Background
Comments received timely will also Issues 2. Proposed Update to Fee Schedule
be available for public inspection as G. Issues Related to the Clinical Lab Fee P. Discussion of Chiropractic Services
they are received, generally beginning Schedule Demonstration
approximately 3 weeks after publication 1. Date of Service for the TC of Physician Q. Technical Corrections
of a document, at the headquarters of Pathology Services (§ 414.510) 1. Particular Services Excluded From
the Centers for Medicare & Medicaid 2. New Clinical Diagnostic Laboratory Test Coverage (§ 411.15(a))
Services, 7500 Security Boulevard, (§ 414.508) 2. Medical Nutrition Therapy (§ 410.132(a))
Baltimore, Maryland 21244, Monday H. Proposed Revisions Related to Payment 3. Payment Exception: Pediatric Patient
for Renal Dialysis Services Furnished by Mix (§ 413.84)
through Friday of each week from 8:30 End-Stage Renal Disease (ESRD) 4. Diagnostic X-Ray Tests, Diagnostic
a.m. to 4 p.m. To schedule an Facilities Laboratory Tests, and Other Diagnostic
appointment to view public comments, 1. CY 2005 Revisions Tests: Conditions (§ 410.32(a)(1))
phone 1–800–743–3951. 2. CY 2006 Revisions R. Percentage Change in the Medicare
To assist readers in referencing 3. CY 2007 Updates Economic Index (MEI)
sections contained in this preamble, we 4. Provisions of This Proposed Rule S. Other Issues
1. Recalls and Replacement Devices acronym in this final rule with comment DHS Designated health services
2. Therapy Standards and Requirements period, we are listing these acronyms and DME Durable medical equipment
3. Proposed Elimination of the Exemption their corresponding terms in alphabetical DMEPOS Durable medical equipment,
for Computer-Generated Facsimile order below: prosthetics, orthotics, and supplies
Transmission From the National Council AAA Abdominal aortic aneurysm DO Doctor of Osteopathy
for Prescription Drug Programs (NCPDP) AAP Average acquisition price DRA Deficit Reduction Act of 2005 (Pub. L.
SCRIPT Standard for Transmitting ACOTE Accreditation Council for 109–432)
Prescription and Certain Prescription Occupational Therapy Education E/M Evaluation and management
Related Information for Part D Eligible ACR American College of Radiology ECI Employment cost index
Individuals AFROC Association of Freestanding EHR Electronic health record
T. Division B of the Tax Relief and Health Radiation Oncology Centers EPC [Duke] Evidence-based Practice
Care Act of 2006—Medicare AHFS–DI American Hospital Formulary Centers
Improvements and Extension Act of 2006 Service-Drug Information EPO Erythopoeitin
(Pub. L. 109–432) (MIEA–TRHCA) AHRQ Agency for Healthcare Research and ESRD End stage renal disease
1. Section 101(b)—Physician Quality Quality (HHS) F&C Facts and Comparisons
Reporting Initiative (PQRI) AIF Ambulance inflation factor FAW Furnish as written
2. Section 110—Reporting of Anemia AMA American Medical Association FAX Facsimile
Quality Indicators (§ 414.707(b)) AMA–DE American Medical Association FDA Food and Drug Administration (HHS)
3. Section 104—Extension of Treatment of Drug Evaluations FMR Fair market rents
Certain Physician Pathology Services AMP Average manufacturer price FQHC Federally qualified health center
Under Medicare AOTA American Occupational Therapy FR Federal Register
4. Section 201—Extension of Therapy Cap Association GAF Geographic adjustment factor
Exception Process APC Ambulatory payment classification GAO General Accounting Office
5. Section 101(d)—Physician Assistance APTA American Physical Therapy GII Global Insight, Inc.
and Quality Initiative (PAQI) Fund Association GPO Group purchasing organization
6. Section 108—Payment Process Under ASA American Society of Anesthesiologists GPCI Geographic practice cost index
the Competitive Acquisition Program ASC Ambulatory surgical center HCPAC Health Care Professional Advisory
(CAP) ASP Average sales price Committee
III. Fee Schedule for Payment of Ambulance ASTRO American Society for Therapeutic HCPCS Healthcare Common Procedure
Services Update for CY 2007; Ambulance Radiology and Oncology Coding System
Inflation Factor Update for CY 2008; and ATA American Telemedicine Association
HCRIS Healthcare Cost Report Information
Proposed Revisions to the Publication of AWP Average wholesale price
System
the Ambulance Fee Schedule (§ 414.620) BBA Balanced Budget Act of 1997 (Pub. L.
HIPAA Health Insurance Portability and
A. History of Medicare Ambulance 105–33)
Accountability Act of 1996 (Pub. L. 104–
Services BBRA [Medicare, Medicaid and State Child
191)
1. Statutory Coverage of Ambulance Health Insurance Program] Balanced
Budget Refinement Act of 1999 (Pub. L. HHA Home health agency
Services
106–113) HHS [Department of] Health and Human
2. Medicare Regulations for Ambulance
BIPA Medicare, Medicaid, and SCHIP Services
Services
Benefits Improvement Protection Act of HIT Health information technology
3. Transition to National Fee Schedule
2000 HMO Health maintenance organization
B. Ambulance Inflation Factor (AIF) During
the Transition Period BLS Bureau of Labor Statistics HPSA Health Professional Shortage Area
C. Ambulance Inflation Factor (AIF) for CY BMD Bone mineral density HRSA Health Resources Services
2008 BMI Body mass index Administration (HHS)
D. Proposed Revisions to the Publication of BMM Bone mass measurement HUD [Department of] Housing and Urban
the Ambulance Fee Schedule (§ 414.620) BN Budget neutrality Development
IV. Collection of Information Requirements BSA Body surface area ICD Implantable cardioverter-defibrillator
V. Response to Comments CAD Computer-aided detection ICF Intermediate care facilities
VI. Regulatory Impact Analysis CAH Critical access hospital IDTF Independent diagnostic testing facility
Regulation Text CAP Competitive acquisition program IFC Interim final rule with comment period
Addendum A—Explanation and Use of CBSA Core-Based Statistical Area IOTED International Occupational Therapy
Addendum B CEM Cardiac event monitoring Eligibility Determination
Addendum B—2008 Relative Value Units CF Conversion factor IPPE Initial preventive physical
and Related Information Used in CFR Code of Federal Regulations examination
Determining Medicare Payments for CMA California Medical Association IPPS Inpatient prospective payment system
2008 CMS Centers for Medicare & Medicaid IV Intravenous
Addendum C—Codes for Which We Services IVIG Intravenous immune globulin
Received PERC Recommendations on PE CNS Clinical nurse specialist IWPUT Intra-service work per unit of time
Direct Inputs CORF Comprehensive Outpatient JCAAI Joint Council of Allergy, Asthma,
Addendum D—Proposed 2008 Geographic Rehabilitation Facility and Immunology
Adjustment Factors (GAFs) COTA Certified Occupational Therapy LPN Licensed practical nurse
Addendum E—Proposed 2008* Geographic Assistant MA Medicare Advantage
Practice Cost Indices (GPCIs) by State CPEP Clinical Practice Expert Panel MA–PD Medicare Advantage-Prescription
and Medicare Locality CPI Consumer Price Index Drug Plans
Addendum F—CPT/HCPCS Imaging Codes CPI–U Consumer price index for urban MD Medical doctor
Defined by Section 5102(b) of the DRA customers MedCAC Medicare Evidence Development
Addendum G—FY 2008 Wage Index for CPT (Physicians’) Current Procedural and Coverage Advisory Committee
Urban Areas Based On CBSA Labor Terminology (4th Edition, 2002, (formerly the Medicare Coverage
Market Areas copyrighted by the American Medical Advisory Committee (MCAC))

Addendum H—FY 2008 Wage Index based Association) MedPAC Medicare Payment Advisory
on CBSA Labor Market Areas for Rural CRT–D Cardiac resynchronization therapy Commission
Areas defibrillator MEI Medicare Economic Index
CT Computed tomography MIEA–TRHCA Medicare Improvements and
Acronyms CTA Computed tomographic angiography Extension Act of 2006 (That is, Division
In addition, because of the many CY Calendar year B of the Tax Relief and Health Care Act
organizations and terms to which we refer by DEXA Dual energy x-ray absorptiometry of 2006 (TRHCA))
MMA Medicare Prescription Drug, TA Technology Assessment obtained input from numerous
Improvement, and Modernization Act of TC Technical Component physician specialty groups.
2003 (Pub. L. 108–173) TENS Transcutaneous electric nerve Section 1848(b)(2)(B) of the Act
MNT Medical nutrition therapy stimulator specifies that the RVUs for anesthesia
MP Malpractice TRHCA Tax Relief and Health Care Act of
2006 (Pub. L. 109–432)
services are based on RVUs from a
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging USP–DI United States Pharmacopoeia-Drug uniform relative value guide. We
MSA Metropolitan statistical area Information established a separate conversion factor
MSP Medicare Secondary Payer WAC Wholesale acquisition cost (CF) for anesthesia services, and we
MSVP Multi-specialty visit package WAMP Widely available market price continue to utilize time units as a factor
NBCOT National Board for Certification in Wet AMD Exudative age-related macular in determining payment for these
Occupational Therapy, Inc. degeneration services. As a result, there is a separate
NCCN National Comprehensive Cancer WFOT World Federation of Occupational payment methodology for anesthesia
Network Therapists
services.
NCPDP National Council for Prescription We establish physician work RVUs for
Drug Programs
I. Background
NCQDIS National Coalition of Quality [If you choose to comment on issues new and revised codes based on
Diagnostic Imaging Services in this section, please include the recommendations received from the
NDC National drug code caption ‘‘BACKGROUND’’ at the American Medical Association’s (AMA)
NEMC New England Medical Center beginning of your comments.] Specialty Society Relative Value Update
NISTA National Institute of Standards and Since January 1, 1992, Medicare has Committee (RUC).
Technology Act
paid for physicians’ services under 2. Practice Expense Relative Value Units
NLA National limitation amount
NP Nurse practitioner section 1848 of the Social Security Act (PE RVUs)
NPP Nonphysician practitioners (the Act), ‘‘Payment for Physicians’
Section 121 of the Social Security Act
NQF National Quality Forum Services.’’ The Act requires that
Amendments of 1994 (Pub. L. 103–432),
NTTAA National Technology Transfer and payments under the physician fee enacted on October 31, 1994, amended
Advancement Act of 1995 (Pub. L. 104– schedule (PFS) be based on national section 1848(c)(2)(C)(ii) of the Act and
113) uniform relative value units (RVUs)
OACT [CMS’] Office of the Actuary required us to develop resource-based
based on the resources used in PE RVUs for each physician’s service
OBRA Omnibus Budget Reconciliation Act furnishing a service. Section 1848(c) of
OIG Office of Inspector General beginning in 1998. We were to consider
the Act requires that national RVUs be general categories of expenses (such as
OMB Office of Management and Budget
OPD Outpatient Department
established for physician work, practice office rent and wages of personnel, but
OPPS Outpatient prospective payment expense (PE), and malpractice expense. excluding malpractice expenses)
system Before the establishment of the comprising PEs.
OPT Outpatient physical therapy resource-based relative value system, Section 4505(a) of the Balanced
OSCAR Online Survey and Certification Medicare payment for physicians’ Budget Act of 1997 (BBA) (Pub. L. 105–
and Reporting services was based on reasonable
PA Physician assistant
33), amended section 1848(c)(2)(C)(ii) of
charges. the Act to delay implementation of the
PC Professional component
PCF Patient compensation fund A. Development of the Relative Value resource-based PE RVU system until
PDP Prescription Drug Plan System January 1, 1999. In addition, section
PE Practice Expense 4505(b) of the BBA provided for a 4-year
PE/HR Practice expense per hour 1. Work RVUs transition period from charge-based PE
PEAC Practice Expense Advisory The concepts and methodology RVUs to resource-based RVUs.
Committee underlying the PFS were enacted as part We established the resource-based PE
PECOS Provider Enrollment, Chain, and of the Omnibus Budget Reconciliation RVUs for each physician’s service in a
Ownership System Act (OBRA) of 1989, Pub. L. 101–239, final rule, published November 2, 1998
PERC Practice Expense Review Committee
PET Positron emission tomography
and OBRA 1990, (Pub. L. 101–508). The (63 FR 58814), effective for services
PFS Physician Fee Schedule final rule, published November 25, 1991 furnished in 1999. Based on the
PLI Professional liability insurance (56 FR 59502), set forth the fee schedule requirement to transition to a resource-
PPI Producer price index for payment for physicians’ services based system for PE over a 4-year
PPS Prospective payment system beginning January 1, 1992. Initially, period, resource-based PE RVUs did not
PQRI Physician Quality Reporting Initiative only the physician work RVUs were become fully effective until 2002.
PRA Paperwork Reduction Act resource-based, and the PE and This resource-based system was based
PSA Physician scarcity areas malpractice RVUs were based on on two significant sources of actual PE
PT Physical therapy average allowable charges. data: The Clinical Practice Expert Panel
PT/INR Prothrombin time, international The physician work RVUs established (CPEP) data and the AMA’s
normalized ratio
RFA Regulatory Flexibility Act
for the implementation of the fee Socioeconomic Monitoring System
RHC Rural health clinic schedule in January 1992 were (SMS) data. The CPEP data were
RIA Regulatory impact analysis developed with extensive input from collected from panels of physicians,
RN Registered nurse the physician community. A research practice administrators, and
RT Respiratory therapist team at the Harvard School of Public nonphysicians (for example, registered
RUC [AMA’s Specialty Society] Relative Health developed the original physician nurses (RNs)) nominated by physician
(Value) Update Committee work RVUs for most codes in a specialty societies and other groups.
RVU Relative value unit cooperative agreement with the The CPEP panels identified the direct
SBA Small Business Administration Department of Health and Human inputs required for each physician’s
SGR Sustainable growth rate
SLP Speech-language pathology
Services (HHS). In constructing the service in both the office setting and
SMS [AMA’s] Socioeconomic Monitoring code-specific vignettes for the original out-of-office setting. We have since
System physician work RVUs, Harvard worked refined and revised these inputs based
SNF Skilled nursing facility with panels of experts, both inside and on recommendations from the RUC. The
STS Society of Thoracic Surgeons outside the Federal government, and AMA’s SMS data provided aggregate
specialty-specific information on hours 4. Refinements to the RVUs B. Components of the Fee Schedule
worked and PEs. Payment Amounts
Separate PE RVUs are established for Section 1848(c)(2)(B)(i) of the Act
requires that we review all RVUs no less To calculate the payment for every
procedures that can be performed in physician service, the components of
both a nonfacility setting, such as a often than every 5 years. The first 5-Year
Review of the physician work RVUs was the fee schedule (physician work, PE,
physician’s office, and a facility setting, and MP RVUs) are adjusted by a
such as a hospital outpatient effective in 1997, published on
geographic practice cost index (GPCI).
department. The difference between the November 22, 1996 (61 FR 59489). The
The GPCIs reflect the relative costs of
facility and nonfacility RVUs reflects second 5-Year Review went into effect
physician work, PE, and malpractice
the fact that a facility typically receives in 2002, published in the CY 2002 PFS insurance in an area compared to the
separate payment from Medicare for its final rule (66 FR 55246). The third 5- national average costs for each
costs of providing the service, apart Year Review of physician work RVUs component.
from payment under the PFS. The went into effect on January 1, 2007 and Payments are converted to dollar
nonfacility RVUs reflect all of the direct was published in the CY 2007 PFS final amounts through the application of a
and indirect PEs of providing a rule with comment period (71 FR CF, which is calculated by the Office of
particular service. 69624) (although we note that this the Actuary (OACT) and is updated
Section 212 of the Balanced Budget proposed rule contains certain annually for inflation.
Refinement Act of 1999 (BBRA) (Pub. L. additional proposals relating to the third The formula for calculating the
106–113) directed the Secretary of 5-Year Review). Medicare fee schedule amount for a
Health and Human Services (the In 1999, the AMA’s RUC established given service and fee schedule area can
Secretary) to establish a process under the Practice Expense Advisory be expressed as:
which we accept and use, to the Committee (PEAC) for the purpose of Payment = [(RVU work × budget
maximum extent practicable and refining the direct PE inputs. Through neutrality adjuster × work GPCI) + (RVU
consistent with sound data practices, March 2004, the PEAC provided PE × PE GPCI) + (MP RVU × MP GPCI)]
data collected or developed by entities recommendations to CMS for over 7,600 × CF.
and organizations to supplement the codes (all but a few hundred of the
data we normally collect in determining C. Most Recent Changes to the Fee
codes currently listed in the AMA’s Schedule
the PE component. On May 3, 2000, we Current Procedural Terminology (CPT)
published the interim final rule (65 FR The CY 2007 PFS final rule with
codes). As part of the CY 2007 PFS final
25664) that set forth the criteria for the comment period (71 FR 69624)
rule with comment period (71 FR
submission of these supplemental PE addressed certain provisions of the
69624), we implemented a new
survey data. The criteria were modified Deficit Reduction Act of 2005 (Pub. L.
methodology for determining resource-
in response to comments received, and 109–432) (DRA) and made other
based PE RVUs and are transitioning
published in the Federal Register (65 changes to Medicare Part B payment
FR 65376) as part of a November 1, 2000 this over a 4-year period.
policy to ensure that our payment
final rule. The PFS final rules published In the CY 2005 PFS final rule with systems are updated to reflect changes
in 2001 and 2003, respectively, (66 FR comment period (69 FR 66236), we in medical practice and the relative
55246 and 68 FR 63196) extended the implemented the first 5-Year Review of value of services. This final rule with
period during which we would accept the malpractice RVUs (69 FR 66263). comment period also discussed GPCI
these supplemental data through March changes; requests for additions to the
5. Adjustments to RVUs Are Budget
1, 2005. list of telehealth services; payment for
Neutral
In CY 2007 PFS final rule with covered outpatient drugs and
comment period (71 FR 69624), we Section 1848(c)(2)(B)(ii)(II) of the Act biologicals; payment for renal dialysis
revised the methodology for calculating provides that adjustments in RVUs for a services; policies related to private
PE RVUs beginning in CY 2007 and year may not cause total PFS payments contracts and opt-out; policies related to
provided for a 4-year transition for the to differ by more than $20 million from bone mass measurement (BMM)
new PE RVUs under this new what they would have been if the services, independent diagnostic testing
methodology. We will continue to adjustments were not made. In facilities (IDTFs), the physician self-
evaluate this policy and proposed accordance with section referral prohibition; laboratory billing
necessary revisions through future 1848(c)(2)(B)(ii)(II) of the Act, if for the technical component (TC) of
rulemaking. adjustments to RVUs cause physician pathology services; the
expenditures to change by more than clinical laboratory fee schedule;
3. Resource-Based Malpractice (MP)
$20 million, we make adjustments to certification of advanced practice
RVUs
ensure that expenditures do not increase nurses; health information technology,
Section 4505(f) of the BBA amended the health care information
or decrease by more than $20 million.
section 1848(c) of the Act to require us transparency initiative; updated the list
to implement resource-based As explained in the CY 2007 PFS final of certain services subject to the
malpractice (MP) RVUs for services rule with comment period (71 FR physician self-referral prohibitions,
furnished on or after 2000. The 69624), due to the increase in work finalized ASP reporting requirements,
resource-based MP RVUs were RVUs resulting from the third 5-Year and codified Medicare’s longstanding
implemented in the PFS final rule Review of physician work RVUs, we are policy that payment of bad debts
published November 2, 1999 (64 FR applying a separate budget neutrality associated with services paid under a
59380). The MP RVUs were based on (BN) adjustor to the work RVUs for fee schedule/charge-based system is not
malpractice insurance premium data services furnished during 2007. This allowable.
collected from commercial and approach is consistent with the method We also finalized the CY 2006 interim
physician-owned insurers from all the we use to make BN adjustments to the RVUs and issued interim RVUs for new
States, the District of Columbia, and PE RVUs to reflect the changes in these and revised procedure codes for CY
Puerto Rico. PE RVUs. 2007.
In addition, the CY 2007 PFS final from January 1, 1998, until January 1, Committee (RUC). For a more detailed
rule with comment period included 1999, by section 4505(a) of the BBA. In explanation of the PE methodology see
revisions to payment policies under the addition, section 4505(b) of the BBA the June 29, 2006 proposed notice (71
fee schedule for ambulance services and required that the new payment FR 37242) and the CY 2007 PFS final
announced the ambulance inflation methodology be phased in over 4 years, rule with comment period (71 FR
factor (AIF) update for CY 2007. effective for services furnished in CY 69629).
In accordance with section 1999, and fully effective in CY 2002.
The first step toward implementation of 1. Current Methodology
1848(d)(1)(E)(i) of the Act, we also
announced that the PFS update for CY the statute was to adjust the PE values a. Data Sources for Calculating Practice
2007 is ¥5.0 percent, the initial for certain services for CY 1998. Section Expense
estimate for the sustainable growth rate 4505(d) of the BBA required that, in The AMA’s SMS survey data and
(SGR) for CY 2007 is 1.8 percent and the developing the resource-based PE RVUs, supplemental survey data from the
CF for CY 2007 is $35.9848. However, the Secretary must: specialties of cardio-thoracic surgery,
subsequent to publication of the CY • Use, to the maximum extent
vascular surgery, physical and
2007 PFS final rule with comment possible, generally-accepted cost
occupational therapy, independent
period, section 101(a) of Division B, accounting principles that recognize all
laboratories, allergy/immunology,
Title I of the Tax Relief and Health Care staff, equipment, supplies, and
cardiology, dermatology,
Act of 2006 (Pub. L. 109–432) (MIEA– expenses, not solely those that can be
gastroenterology, radiology,
TRHCA), which was enacted on linked to specific procedures and actual
independent diagnostic testing facilities
December 22, 2006, amended section data on equipment utilization.
• Develop a refinement method to be (IDTFs), radiation oncology, and urology
1848(d) of the Act. [Division B of the are used to develop the PE per hour (PE/
Tax Relief and Health Care Act of 2006 used during the transition.
• Consider, in the course of notice HR) for each specialty. For those
is entitled Medicare and Other Health specialties for which we do not have
Provisions and its short title is the and comment rulemaking, impact
projections that compare new proposed PE/HR, the appropriate PE/HR is
Medicare Improvements and Extension obtained from a crosswalk to a similar
Act of 2006. Therefore, it is hereinafter payment amounts to data on actual
physician PE. specialty.
referred to as ‘‘MIEA–TRHCA’’.] As a The AMA developed the SMS survey
In CY 1999, we began the 4-year
result of this statutory change the CF of in 1981 and discontinued it in 1999.
transition to resource-based PE RVUs
$37.8975 was maintained for CY 2007. Beginning in 2002, we incorporated the
utilizing a ‘‘top-down’’ methodology
II. Provisions of the Proposed whereby we allocated aggregate 1999 SMS survey data into our
Regulation Related to the Physician Fee specialty-specific practice costs to calculation of the PE RVUs, using a 5-
Schedule individual procedures. The specialty- year average of SMS survey data. (See
specific PEs were derived from the the November 1, 2002 Revisions to
A. Resource-Based Practice Expense American Medical Association’s Payment Policies and Five-Year Review
(PE) Relative Value Units (RVUs) (AMA’s) Socioeconomic Monitoring of and Adjustments to the Relative
[If you choose to comment on issues Survey (SMS). In addition, under Value Units Under the Physician Fee
in this section, please include the section 212 of the BBRA, we established Schedule for CY 2002 final rule (66 FR
caption ‘‘RESOURCE-BASED PE RVUs’’ a process extending through March 2005 55246) (hereinafter referred to as CY
at the beginning of your comments.] to supplement the SMS data with data 2002 PFS final rule).) The SMS PE
Practice expense (PE) is the portion of submitted by a specialty. The aggregate survey data are adjusted to a common
the resources used in furnishing the PEs for a given specialty were then year, 2005. The SMS data provide the
service that reflects the general allocated to the services furnished by following six categories of PE costs:
categories of physician and practitioner that specialty on the basis of the direct • Clinical payroll expenses, which
expenses, such as office rent and input data (that is, the staff time, are payroll expenses (including fringe
personnel wages but excluding equipment, and supplies) and work benefits) for nonphysician clinical
malpractice expenses, as specified in RVUs assigned to each CPT code. personnel.
section 1848(c)(1)(B) of the Act. For CY 2007, we implemented a new • Administrative payroll expenses,
Section 121 of the Social Security methodology for calculating PE RVUs. which are payroll expenses (including
Amendments of 1994 (Pub. L. 103–432), Under this new methodology, we use fringe benefits) for nonphysician
enacted on October 31, 1994, required the same data sources for calculating PE, personnel involved in administrative,
CMS to develop a methodology for a but instead of using the ‘‘top-down’’ secretarial or clerical activities.
resource-based system for determining approach to calculate the direct PE • Office expenses, which include
PE RVUs for each physician’s service. RVUs, under which the aggregate direct expenses for rent, mortgage interest,
Until that time, PE RVUs were based on and indirect costs for each specialty are depreciation on medical buildings,
historical allowed charges. This allocated to each individual service, we utilities and telephones.
legislation stated that the revised PE now utilize a ‘‘bottom-up’’ approach to • Medical material and supply
methodology must consider the staff, calculate the direct costs. Under the expenses, which include expenses for
equipment, and supplies used in the ‘‘bottom up’’ approach, we determine drugs, x-ray films, and disposable
provision of various medical and the direct PE by adding the costs of the medical products.
surgical services in various settings resources (that is, the clinical staff, • Medical equipment expenses,
beginning in 1998. The Secretary has equipment, and supplies) typically which include expenses depreciation,
interpreted this to mean that Medicare required to provide each service. The leases, and rent of medical equipment
payments for each service would be costs of the resources are calculated used in the diagnosis or treatment of
based on the relative PE resources using the refined direct PE inputs patients.
typically involved with furnishing the assigned to each CPT code in our PE • All other expenses, which include
service. database, which are based on our review expenses for legal services, accounting,
The initial implementation of of recommendations received from the office management, professional
resource-based PE RVUs was delayed AMA’s Relative Value Update association memberships, and any
professional expenses not previously b. Allocation of PE to Services Note: For radiation oncology, the data
mentioned in this section. The aggregate level specialty-specific represent the combined survey data
In accordance with section 212 of the PEs are derived from the AMA’s SMS from the American Society for
BBRA, we established a process to survey and supplementary survey data. Therapeutic Radiology and Oncology
supplement the SMS data for a specialty To establish PE RVUs for specific (ASTRO) and the Association of
with data collected by entities and services, it is necessary to establish the Freestanding Radiation Oncology
organizations other than the AMA (that direct and indirect PE associated with Centers (AFROC).) We incorporate this
is, the specialty itself). (See the Criteria each service. PE/HR into the calculation of indirect
for Submitting Supplemental Practice (i) Direct costs. The direct costs are costs using an index which reflects the
Expense Survey Data interim final rule determined by adding the costs of the relationship between each specialty’s
with comment period (65 FR 25664, resources (that is, the clinical staff, indirect scaling factor and the overall
May 3, 2000).) Originally, the deadline equipment, and supplies) typically indirect scaling factor for the entire PFS.
to submit supplementary survey data required to provide the service. The For example, if a specialty had an
was through August 1, 2001. In the CY indirect practice cost index of 2.00, this
costs of these resources are calculated
2002 PFS final rule (66 FR 55246), the specialty would have an indirect scaling
from the refined direct PE inputs in our
factor that was twice the overall average
deadline was extended through August PE database. These direct inputs are
indirect scaling factor. If a specialty had
1, 2003. To ensure maximum then scaled to the current aggregate pool
an indirect practice cost index of 0.50,
opportunity for specialties to submit of direct PE RVUs. The aggregate pool
this specialty would have an indirect
supplementary survey data, we of direct PE RVUs can be derived using
scaling factor that was half the overall
extended the deadline to submit surveys the following formula: (PE RVUs *
average indirect scaling factor.
until March 1, 2005 in the Revisions to physician CF) * (average direct • When the clinical labor portion of
Payment Policies Under the Physician percentage from SMS/(Supplemental the direct PE RVU is greater than the
Fee Schedule for CY 2004 final rule PE/HR data)). physician work RVU for a particular
(November 7, 2003; 68 FR 63196) (ii) Indirect costs. The SMS and service, the indirect costs are allocated
(hereinafter referred to as CY 2004 PFS supplementary survey data are the based upon the direct costs and the
final rule). source for the specialty-specific clinical labor costs. For example, if a
The direct cost data for individual aggregate indirect costs used in our PE service has no physician work and 1.10
services were originally developed by calculations. We then allocate the direct PE RVUs, and the clinical labor
the Clinical Practice Expert Panels indirect costs to the code level on the portion of the direct PE RVUs is 0.65
(CPEP). The CPEP data include the basis of the direct costs specifically RVUs, we would use the 1.10 direct PE
supplies, equipment, and staff times associated with a code and the RVUs and the 0.65 clinical labor
specific to each procedure. The CPEPs maximum of either the clinical labor portions of the direct PE RVUs to
consisted of panels of physicians, costs or the physician work RVUs. For allocate the indirect PE for that service.
practice administrators, and calculation of the 2008 PE RVUs, we are
proposing to use the 2006 procedure- c. Facility/Nonfacility Costs
nonphysicians (for example, RNs) who
were nominated by physician specialty specific utilization data crosswalked to Procedures that can be furnished in a
societies and other groups. There were 2007 services. To arrive at the indirect physician’s office, as well as in a
15 CPEPs consisting of 180 members PE costs: hospital or facility setting, have two PE
from more than 61 specialties and • We apply a specialty-specific RVUs: Facility and nonfacility. The
subspecialties. Approximately 50 indirect percentage factor to the direct nonfacility setting includes physicians’
percent of the panelists were expenses to recognize the varying offices, patients’ homes, freestanding
physicians. proportion that indirect costs represent imaging centers, and independent
of total costs by specialty. For a given pathology labs. Facility settings include
The CPEPs identified specific inputs service, the specific indirect percentage hospitals, ambulatory surgical centers
involved in each physician’s service factor to apply to the direct costs for the (ASCs), and skilled nursing facilities
provided in an office or facility setting. purpose of the indirect allocation is (SNFs). The methodology for calculating
The inputs identified were the quantity calculated as the weighted average of PE RVUs is the same for both, facility
and type of nonphysician labor, medical the ratio of the indirect to direct costs and nonfacility RVUs, but is applied
supplies, and medical equipment. (based on the survey data) for the independently to yield two separate PE
In 1999, the AMA’s RUC established specialties that furnish the service. For RVUs. Because the PEs for services
the Practice Expense Advisory example, if a service is furnished by a provided in a facility setting are
Committee (PEAC). From 1999 to March single specialty with indirect PEs that generally included in the payment to
2004, the PEAC, a multi-specialty were 75 percent of total PEs, the indirect the facility (rather than the payment to
committee, reviewed the original CPEP percentage factor to apply to the direct the physician under the PFS), the PE
inputs and provided us with costs for the purposes of the indirect RVUs are generally lower for services
recommendations for refining these allocation would be (0.75/0.25) = 3.0. provided in the facility setting.
direct PE inputs for existing CPT codes. The indirect percentage factor is then
Through its last meeting in March 2004, applied to the service level adjusted d. Services With Technical Components
the PEAC provided recommendations indirect practice expense allocators. (TCs) and Professional Components
for over 7,600 codes which we have • We use the specialty-specific PE/HR (PCs)
reviewed and accepted. As a result, the from the SMS survey data, as well as the Diagnostic services are generally
current PE inputs differ markedly from supplemental surveys for cardio- comprised of two components; a
those originally recommended by the thoracic surgery, vascular surgery, professional component (PC) and a
CPEPs. The PEAC has now been physical and occupational therapy, technical component (TC), which may
replaced by the Practice Expense independent laboratories, allergy/ be performed independently or by
Review Committee (PERC), which acts immunology, cardiology, dermatology, different providers. When services have
to assist the RUC in recommending PE radiology, gastroenterology, IDTFs, TC, PC, and global components that can
inputs. radiation oncology and urology. be billed separately, the payment for the
global component equals the sum of the is calculated as described at the end of global service), then the indirect
payment for the TC and PCs. This is a this section. allocator is: indirect percentage * (direct
result of using a weighted average of the Apply a BN adjustment to the direct PERVU/direct percentage) + clinical PE
ratio of indirect to direct costs across all inputs. RVU.
the specialties that furnish the global Step 2: Calculate the current aggregate (Note that for global services the
components, TCs, and PCs; that is, we pool of direct PE costs. To do this, indirect allocator is based on both the
apply the same weighted average multiply the current aggregate pool of work RVU and the clinical labor PE
indirect percentage factor to allocate total direct and indirect PE costs (that is, RVU. We do this to recognize that, for
indirect expenses to the global the current aggregate PE RVUs the professional service, indirect PEs
components, PC, and TCs for a service. multiplied by the CF) by the average will be allocated using the work RVUs,
(The direct PE RVUs for the TC and PCs direct PE percentage from the SMS and and for the TC service, indirect PEs will
sum to the global under the bottom-up supplementary specialty survey data. be allocated using the direct PE RVU
methodology.) Step 3: Calculate the aggregate pool of and the clinical labor PE RVU. This also
direct costs. To do this, for all PFS allows the global component RVUs to
e. Transition Period services, sum the product of the direct equal the sum of the PC and TC RVUs.)
As discussed in the CY 2007 PFS final costs for each service from Step 1 and For presentation purposes in the
rule with comment period (71 FR the utilization data for that service. examples in the Table 1, the formulas
69674), we are implementing the change Step 4: Using the results of Step 2 and were divided into two parts for each
in the methodology for calculating PE Step 3 calculate a direct PE BN service. The first part does not vary by
RVUs over a 4-year period. During this adjustment so that the proposed service and is the indirect percentage *
transition period, the PE RVUs will be aggregate direct cost pool does not (direct PE RVU/direct percentage). The
calculated on the basis of a blend of exceed the current aggregate direct cost second part is either the work RVU,
RVUs calculated using our methodology pool and apply it to the direct costs clinical PE RVU, or both depending on
described previously in this section from Step 1 for each service. whether the service is a global service
(weighted by 25 percent during CY Step 5: Convert the results of Step 4 and whether the clinical PE RVU
2007, 50 percent during CY 2008, 75 to an RVU scale for each service. To do exceeds the work RVU (as described
percent during CY 2009, and 100 this, divide the results of Step 4 by the earlier in this step.)
percent thereinafter), and the CY 2006 Medicare PFS CF. Apply a BN adjustment to the indirect
PE RVUs for each existing code. PE (iii) Create the Indirect PE RVUs allocators.
RVUs for codes that are new during this Step 9: Calculate the current aggregate
period will be calculated using only the Create indirect allocators.
pool of indirect PE RVUs by multiplying
current PE methodology, and will be Step 6: Based on the SMS and
the current aggregate pool of PE RVUs
paid at the fully transitioned rate. supplementary specialty survey data,
by the average indirect PE percentage
calculate direct and indirect PE
f. PE RVU Methodology from the physician specialty survey
percentages for each physician
data. This is similar to the Step 2
The following is a description of the specialty.
Step 7: Calculate direct and indirect calculation for the direct PE RVUs.
PE RVU methodology.
PE percentages at the service level by Step 10: Calculate an aggregate pool of
(i) Setup File taking a weighted average of the results proposed indirect PE RVUs for all PFS
First, we create a setup file for the PE of Step 6 for the specialties that furnish services by adding the product of the
methodology. The setup file contains the service. Note that for services with indirect PE allocators for a service from
the direct cost inputs, the utilization for a TC and PCs we are calculating the Step 8 and the utilization data for that
each procedure code at the specialty direct and indirect percentages across service. This is similar to the Step 3
and facility/nonfacility place of service the global components, PCs and TCs. calculation for the direct PE RVUs.
level, and the specialty-specific survey That is, the direct and indirect Step 11: Using the results of Step 9
PE per physician hour data. percentages for a given service (for and Step 10, calculate an indirect PE
example, echocardiogram) do not vary adjustment so that the aggregate indirect
(ii) Calculate the Direct Cost PE RVUs allocation does not exceed the available
by the PC, TC and global component.
Sum the costs of each direct input. Step 8: Calculate the service level aggregate indirect PE RVUs and apply it
Step 1: Sum the direct costs of the allocators for the indirect PEs based on to indirect allocators calculated in Step
inputs for each service. The direct costs the percentages calculated in Step 7. 8. This is similar to the Step 4
consist of the costs of the direct inputs The indirect PEs are allocated based on calculation for the direct PE RVUs.
for clinical labor, medical supplies, and the three components: The direct PE Calculate the Indirect Practice Cost
medical equipment. The clinical labor RVU, the clinical PE RVU and the work Index.
cost is the sum of the cost of all the staff RVU. Step 12: Using the results of Step 11,
types associated with the service; it is For most services the indirect calculate aggregate pools of specialty-
the product of the time for each staff allocator is: specific adjusted indirect PE allocators
type and the wage rate for that staff indirect percentage * (direct PE RVU/ for all PFS services for a specialty by
type. The medical supplies cost is the direct percentage) + work RVU. adding the product of the adjusted
sum of the supplies associated with the There are two situations where this indirect PE allocator for each service
service; it is the product of the quantity formula is modified: and the utilization data for that service.
of each supply and the cost of the • If the service is a global service (that Step 13: Using the specialty-specific
supply. The medical equipment cost is is, a service with global, professional indirect PE/HR data, calculate specialty-
the sum of the cost of the equipment and technical components), then the specific aggregate pools of indirect PE
associated with the service; it is the indirect allocator is: indirect percentage for all PFS services for that specialty by
product of the number of minutes each * (direct PERVU/direct percentage) + adding the product of the indirect PE/
piece of equipment is used in the clinical PE RVU + work RVU. HR for the specialty, the physician time
service and the equipment cost per • If the clinical labor PE RVU exceeds for the service, and the specialty’s
minute. The equipment cost per minute the work RVU (and the service is not a utilization for the service.
Step 14: Using the results of Step 12 PE RVUs. This final BN adjustment is global code for use in creating the
and Step 13, calculate the specialty- required primarily because certain indirect PE RVU. For example, the
specific indirect PE scaling factors as specialties are excluded from the PE professional service code 93010 is
under the current methodology. RVU calculation for rate-setting associated with the global code 93000.
Step 15: Using the results of Step 14, purposes, but all specialties are • Payment modifiers: Payment
calculate an indirect practice cost index included for purposes of calculating the modifiers are accounted for in the
at the specialty level by dividing each final BN adjustment. (See ‘‘Specialties creation of the file. For example,
specialty-specific indirect scaling factor excluded from rate-setting calculation’’ services billed with the assistant at
by the average indirect scaling factor for below in this section.) surgery modifier are paid 16 percent of
the entire PFS. the PFS amount for that service;
Step 16: Calculate the indirect (v) Setup File Information
therefore, the utilization file is modified
practice cost index at the service level • Specialties excluded from rate- to only account for 16 percent of any
to ensure the capture of all indirect setting calculation: For the purposes of service that contains the assistant at
costs. Calculate a weighted average of calculating the PE RVUs, we exclude surgery modifier.
the practice cost index values for the certain specialties such as midlevel • Work RVUs: The setup file contains
specialties that furnish the service. practitioners paid at a percentage of the the work RVUs from this proposed rule.
Note: For services with TC and PCs, we PFS, audiology, and low volume
specialties from the calculation. These (vi) Equipment Cost Per Minute =
calculate the indirect practice cost index
across the global components, PCs and TCs. specialties are included for the purposes The equipment cost per minute is
Under this method, the indirect practice cost of calculating the BN adjustment. calculated as:
index for a given service (for example, • Crosswalk certain low volume
echocardiogram) does not vary by the PC, TC physician specialties: Crosswalk the (1/(minutes per year * usage)) * price *
and global components. utilization of certain specialties with ((interest rate/(1-(1/((1 + interest
relatively low PFS utilization to the rate) * life of equipment)))) +
Step 17: Apply the service level maintenance)
indirect practice cost index calculated associated specialties.
in Step 16 to the service level adjusted • Physical therapy utilization: Where:
indirect allocators calculated in Step 11 Crosswalk the utilization associated minutes per year = maximum minutes per
to get the indirect PE RVU. with all physical therapy services to the year if usage were continuous (that is,
specialty of physical therapy. usage = 1); 150,000 minutes.
(iv) Calculate the Final PE RVUs • Identify professional and technical usage = equipment utilization assumption;
services not identified under the usual 0.5.
Step 18: Add the direct PE RVUs from
price = price of the particular piece of
Step 6 to the indirect PE RVUs from TC and 26 modifier: Flag the services equipment.
Step 17. that are PC and TC services, but do not interest rate = 0.11.
Step 19: Calculate and apply the final use TC and 26 modifiers (for example, life of equipment = useful life of the
PE BN adjustment by comparing the electrocardiograms). This flag associates particular piece of equipment.
results of Step 18 to the current pool of the PC and TC with the associated maintenance = factor for maintenance; 0.05.
TABLE 1.—CALCULATION OF PE RVUS UNDER PROPOSED METHODOLOGY FOR SELECTED CODES

99213 33533 71020 71020TC 7102026 93000 93005 93010
Step Source Formula CABG, arte- ECG, ECG,

Office visit, est Chest x-ray Chest x-ray Chest x-ray ECG, report
VerDate Aug<31>2005
rial, single complete tracing
nonfacility nonfacility nonfacility nonfacility nonfacility
facility nonfacility nonfacility
(1) Labor cost (Lab) ... Step 1 ....................... AMA .......................... ................................... $ 13.44 $ 77.74 $ 5.74 $ 5.65 $ $ 6.12 $ 6.12 $
(2) Supply cost (Sup) Step 1 ....................... AMA .......................... ................................... $ 2.94 $ 7.60 $ 3.39 $ 3.34 $ $ 1.19 $ 1.19 $
(3) Equipment cost Step 1 ....................... AMA .......................... ................................... $ 0.19 $ 0.64 $ 8.18 $ 8.05 $ $ 0.12 $ 0.12 $
(Eqp).
(4) Direct cost (Dir) .... Step 1 ....................... ................................... = (1) + (2) + (3) ........... $ 16.37 $ 85.34 $ 17.31 $ 17.54 $ $ 7.60 $ 7.60 $
18:48 Jul 11, 2007

(5) Direct adjustment Steps 2–4 ................. See footnote* ............ ................................... 0.584 0.584 0.584 0.584 0.584 0.584 0.584 0.584
(Dir Adj).
(6) Adjusted labor ...... Steps 2–4 ................. = Lab*Dir Adj ............. = (1) * (5) .................... $ 7.85 $ 45.40 $ 3.35 $ 3.30 $ $ 3.57 $ 3.57 $
(7) Adjusted supplies Steps 2–4 ................. = Sup*Dir Adj ............ = (2) * (5) .................... $ 1.72 $ 4.44 $ 1.98 $ 1.95 $ $ 0.70 $ 0.70 $
Jkt 211001
(8) Adjusted equip- Steps 2–4 ................. = Eqp*Dir Adj ............ = (3) * (5) .................... $ 0.11 $ 0.37 $ 4.77 $ 4.70 $ $ 0.07 $ 0.07 $
ment.
(9) Adjusted direct ...... Steps 2–4 ................. ................................... = (6) + (7) + (8) ........... $9.56 $ 49.84 $ 10.11 $ 10.24 $ $ 4.44 $ 4.44 $
(10) Conversion Fac- Step 5 ....................... MFS .......................... ................................... $34.1350 $34.1350 $34.1350 $34.1350 $34.1350 $34.1350 $34.1350 $34.1350
PO 00000
tor (CF).
(11) Adj. labor cost Step 5 ....................... = (Lab*Dir Adj)/CF .... = (6)/(10) ................... 0.23 1.33 0.10 0.10 .................... 0.10 0.10 ....................
converted.
(12) Adj. supply cost Step 5 ....................... = (Sup*Dir Adj)/CF .... = (7)/(10) ................... 0.05 0.13 0.06 0.06 .................... 0.02 0.02 ....................
converted.
Frm 00011
(13) Adj. equip cost Step 5 ....................... = (Eqp*Dir Adj)/CF .... = (8)/(10) ................... 0.00 0.01 0.14 0.14 .................... 0.00 0.00 ....................
converted.
(14) Adj. direct cost Step 5 ....................... ................................... = (11) + (12) + (13) ..... 0.28 1.46 0.30 0.30 .................... 0.13 0.13 ....................
converted.
Fmt 4701
(15) Wrk RVU* Wrk Setup File ................. MFS .......................... ................................... 0.81 29.66 0.19 .................... 0.19 0.15 .................... 0.15
Scaler.
(16) Dir_pct ................ Steps 6, 7 ................. Surveys ..................... ................................... 33.8% 32.6% 40.7% 40.7% 40.7% 37.7% 37.7% 37.7%
(17) Ind_pct ................ Steps 6, 7 ................. Surveys ..................... ................................... 66.2% 67.4% 59.4% 59.4% 59.4% 62.3% 62.3% 62.3%
Sfmt 4702
(18) Ind. Alloc. formula Step 8 ....................... See Step 8 ................ ................................... ((14)/ ((14)/ ((14)/ ((14)/ ((14)/ ((14)/ ((14)/ ((14)/
(1st part). (16)) * (17) (16)) * (17) (16)) * (17) (16)) * (17) (16)) * (17) (16)) * (17) (16)) * (17) (16)) * (17)
(19) Ind. Alloc. (1st Step 8 ....................... ................................... See (18) .................... 0.55 3.02 0.43 0.44 .................... 0.21 0.21 ....................
part).
(20) Ind. Alloc. for- Step 8 ....................... See Step 8 ................ ................................... (15) (15) (15) + (11) (11) (15) (15) + (11) (11) (15)
mulas (2nd part).
(21) Ind. Alloc. (2nd Step 8 ....................... ................................... See (20) .................... 0.81 29.66 0.29 0.10 0.19 0.25 0.10 0.15
part).
(22) Indirect Allocator Step 8 ....................... ................................... = (19) + (21) ............... 1.36 32.68 0.72 0.53 0.19 0.47 0.32 0.15
E:\FR\FM\12JYP2.SGM
(1st + 2nd).
(23) Indirect Adjust- Steps 9–11 ............... See footnote** .......... ................................... 0.362 0.362 0.362 0.362 0.362 0.362 0.362 0.362
ment (Ind Adj).
(24) Adjusted Indirect Steps 9–11 ............... = Ind Alloc* Ind Adj ... ................................... 0.49 11.83 0.26 0.19 0.07 0.17 0.12 0.05
12JYP2
Allocator.
(25) Ind. Practice Cost Steps 12–16 ............. See Steps 12–16 ...... ................................... 0.966 0.941 1.060 1.060 1.060 1.237 1.237 1.237
Index (PCI).
(26) Adjusted Indirect Step 17 ..................... = Adj. Ind Alloc*PCI .. = (24) * (25) ................ 0.48 11.13 0.28 0.21 0.07 0.21 0.14 0.07
(27) PE RVU .............. Steps 18–19 ............. = (Adj Dir + Adj Ind) = ((14) + (26)) *budn .. 0.75 12.56 0.57 0.50 0.07 0.34 0.27 0.07
Federal Register / Vol. 72, No. 133 / Thursday, July 12, 2007 / Proposed Rules
*budn.
* The direct adj = [current pe rvus * CF * avg dir pct] / [sum direct inputs] = [Step 2] / [Step 3].
** The indirect adj = [current pe rvus * avg ind pct] / [sum of ind allocators] = [Step 9] / [Step 10.
38131
g. Discussion of Equipment Usage Additionally, we would welcome any percent. Using the same criteria as was
Percentage empirical data that would assist us in used in 1997 (that is, equipment cost
We continue to receive comments these efforts. over $25,000 with a useful life of over
regarding our use of the equipment 7 years), the interest rates ranged from
h. Equipment Interest Rate (Discussion)
usage assumption of 50 percent. 10.1 percent to 13 percent.
MedPAC continues to support an As part of our calculation of the PE Based upon our analysis of the
unspecified higher utilization rate. equipment costs, we take into revised SBA interest rate data, we
Several interested parties, including the consideration several factors, for believe 11 percent continues to be an
AMA RUC, have requested that we example, the useful life of each piece of appropriate assumption; therefore, we
refine this usage percentage to equipment and the typical interest that will retain the interest rate used in the
somewhere in the range of 70 to 80 would be incurred in the purchase of calculation of equipment costs at 11
percent. Other interested parties the equipment. We updated the percent and no proposal is being made
contend that the current utilization rate assigned useful life for all the to adjust this rate.
is too high at 50 percent and should be equipment in our PE input database in
the CY 2005 PFS final rule with 2. PE Proposals for CY 2008
refined downward to a lower usage
percentage. If the equipment usage comment period. However, we have a. Radiology Practice Expense Per Hour
percentage is set too high, the result used the same interest rate of 11 percent
since the inception of the resource- The American College of Radiology
would be insufficient allowance at the
based PE methodology in 1999. There (ACR) presented CMS with information
service level for the practice costs
has been much discussion regarding regarding the PE/HR that was used in
associated with equipment. If the
whether this is still the appropriate the PE methodology for radiology in the
equipment usage percentage is set too
low, the result would be an excessive interest rate to utilize in the calculation CY 2007 PFS final rule with comment
allowance for the PE costs of equipment of the equipment costs. The majority of period. ACR suggested that we change
at the service level. We do not want to comments on the CY 2007 PFS final rule our methodology in a way that would
create disincentives for the use of with comment period requested an weight the survey data to provide an
equipment by arbitrarily increasing the interest rate of prime plus 2 percent alternative method of representing large
equipment usage percentage. while a small number of commenters and small practices. We agreed to take
Conversely, we do not want to create requested an interest rate significantly their approach to our contractor, the
incentives for the acquisition and lower than prime plus 2 percent. Lewin Group, for further analysis. (We
potential over-utilization of equipment The current interest rate of 11 percent note that the Lewin Group, in its initial
by arbitrarily decreasing the equipment was assigned in 1997 based upon analysis of the ACR survey data, had
usage percentage. information provided by the Small also raised concerns about the
Although we acknowledge the across- Business Administration (SBA). This representation of small high cost entities
the-board 50 percent usage rate we prevailing rate was based upon data in the ACR survey data.) The Lewin
currently apply for all equipment does regarding prevailing loan rates for small Group reviewed ACR’s approach and
not capture the actual usage rates for all businesses from both national and concluded that weighting the ACR
equipment, we do not believe that we regional lending associations. Although survey by practice size more
have sufficient empirical evidence to the SBA offered various interest rates, appropriately accounts for the small
justify an alternative proposal on this we believed that the 11 percent interest high cost entities in the final PE/HR.
issue. We are interested in receiving rate was most relevant for fee schedule After reviewing both the ACR inquiry
comments relating to alternative services as this rate was based on and the Lewin response, we also agree
percentages and approaches that equipment cost of over $25,000 with a that ACR’s approach more appropriately
differentially classify equipment into useful life of over 7 years. identifies the PE/HR for radiology.
mutually exclusive categories with We have analyzed 2007 SBA data on For these reasons, we propose to
category-specific usage rate loans and applicable interest rates. revise the PE/HR associated with
assumptions. We are committed to According to the SBA, loans are based radiology using the survey data
continuing our work with the physician on the prime rate plus a fixed weighted by practice size. See Table 2
community to examine equipment usage percentage based upon the amount of which identifies the PE/HR for all
rate assumptions that ensure the loan and the usable life of the specialties, as well as both the current
appropriate payments and encourage equipment purchased. The prime plus and proposed revisions to the PE/HR for
appropriate utilization of equipment. rates ranged from 9.4 percent to 13 radiology.
TABLE 2.—2008 SMS AND SUPPLEMENTAL SURVEY PE/HR INFLATED TO 2005 BASED UPON MEI GROWTH FACTORS
[Includes proposed revision to radiology PE/HR]
Clinical Clerical Office Supplies Equipment Other Total

Specialty labor payroll expense expense expense expense expense
ALL PHYSICIANS .................................... 15.68 19.64 24.74 9.44 4.08 14.66 88.23
ALLERGY/IMMUNOLOGY ....................... 65.88 56.33 65.88 22.49 6.26 31.08 247.93
ANESTHESIOLOGY ................................ 14.41 4.72 7.52 0.51 0.51 7.52 35.19
CARDIAC/THORACIC SURGERY .......... 24.38 22.50 21.50 2.63 2.63 17.75 91.38
CARDIOVASCULAR DISEASE ............... 59.55 53.33 52.67 25.90 18.58 25.02 235.05
DERMATOLOGY ..................................... 40.63 51.45 78.82 15.38 11.03 28.22 225.55
DIAGNOSTIC TESTING FACILITY ......... 111.57 155.49 121.18 54.96 302.47 189.48 935.15
EMERGENCY MEDICINE ....................... 4.21 19.64 2.55 0.89 0.13 14.66 42.08
GASTROENTEROLOGY ......................... 30.16 39.56 48.41 8.20 5.90 13.33 145.55
GENERAL INTERNAL MEDICINE .......... 11.99 18.36 22.82 7.78 2.68 8.42 72.04
GENERAL SURGERY ............................. 9.18 19.89 21.42 4.34 2.55 12.62 70.00
GENERAL/FAMILY PRACTICE ............... 18.87 19.00 22.57 10.07 3.95 11.22 85.68
TABLE 2.—2008 SMS AND SUPPLEMENTAL SURVEY PE/HR INFLATED TO 2005 BASED UPON MEI GROWTH FACTORS—
Continued
[Includes proposed revision to radiology PE/HR]
Clinical Clerical Office Supplies Equipment Other Total

Specialty labor payroll expense expense expense expense expense
INDEPENDENT LAB ............................... 84.79 25.76 19.09 19.84 8.83 21.60 179.93
NEUROLOGICAL SURGERY .................. 10.97 32.64 36.47 2.30 1.79 20.53 104.68
NEUROLOGY .......................................... 10.58 29.33 24.86 6.63 5.61 11.86 88.87
OBSTETRICS/GYNECOLOGY ................ 20.91 23.97 31.49 9.31 4.08 14.28 104.04
ONCOLOGY ............................................ 68.06 44.22 43.86 21.53 9.48 53.76 240.91
OPHTHALMOLOGY ................................ 32.00 32.90 43.48 13.77 10.71 26.90 159.76
ORTHOPEDIC SURGERY ...................... 21.17 36.34 37.87 13.13 4.85 24.35 137.70
OTHER SPECIALTY ................................ 11.86 16.58 24.61 6.25 2.42 11.22 72.93
OTOLARYNGOLOGY .............................. 21.93 32.13 41.95 9.56 7.14 21.93 134.64
PATHOLOGY ........................................... 14.28 17.85 15.17 8.67 2.55 26.78 85.30
PEDIATRICS ............................................ 15.81 16.45 24.10 13.01 2.17 10.97 82.49
PHYS MED/RHEUMATOLOGY ............... 19.00 30.22 39.14 8.29 7.91 15.56 120.11
PHYSICAL THERAPY ............................. 13.25 8.21 17.11 3.05 2.70 9.85 54.15
PLASTIC SURGERY ............................... 19.13 25.88 41.31 23.59 7.27 32.13 149.30
PSYCHIATRY .......................................... 2.17 6.50 13.39 0.51 0.51 9.18 32.26
PULMONARY DISEASE .......................... 8.80 15.81 20.02 3.32 2.04 8.80 58.78
RADIATION ONCOLOGY ........................ 68.82 32.38 48.83 6.38 39.33 32.85 228.59
RADIOLOGY ............................................ 29.07 37.81 23.93 11.26 27.32 44.80 174.18
*RADIOLOGY .......................................... *32.62 *42.29 *28.95 *14.15 *39.62 *47.24 *204.86
UROLOGICAL SURGERY ....................... 27.90 42.33 53.79 14.43 11.25 23.45 173.14
VASCULAR SURGERY ........................... 25.79 23.04 22.56 4.06 5.78 14.50 95.73
*Proposed revision to radiology PE/HR.
b. RUC Recommendations for Direct PE codes in this family. The PERC 93528, 93529, 93530, 93531, 93532,
Inputs and Other PE Input Issues considered the proposed new or 93533, 93561, 93562, 93571, and 93572.
The following discussions are updated PE input recommendations for
Obstetric/Gynecologic PE
proposals concerning direct PE inputs. 13 cardiac catheterization CPT codes.
• Of these 13 codes, 8 were not The PERC recommended changes to
(i) RUC Recommendations previously valued in the nonfacility the content and the price of the pack,
In 2004, the AMA’s Relative Value setting (as recommended at the January pelvic exam (supply code SA051)
Update Committee (RUC) established a 2002 PEAC meeting), including CPT valued at $0.95. We agreed with the
new committee, the Practice Expense codes 93539, 93540, 93542, 93543, recommendation to add a non-sterile
Review Committee (PERC), to assist the 93544, 93545, 93555, and 93556. sheet (drape) 40 in by 60 in (supply
RUC in recommending direct PE inputs • The recommended revised PE code SB006) priced at $0.222 to the
(clinical staff, supplies, and equipment) inputs for the other 5 codes (last valued pelvic exam pack resulting in the new
for new and existing CPT codes. in the nonfacility setting at the January price of $1.172. This change affected
The PERC reviewed the PE inputs for 2004 PEAC meeting), included CPT 236 CPT codes for obstetric/gynecologic
nearly 300 existing codes at its meetings codes: 93501, 93505, 93508, 93510, and services containing the pelvic exam
held in February 2007 and April 2007. 93526. pack. In addition, we accepted the PERC
(A list of these reviewed codes can be We are proposing to accept the PERC recommendations to standardize the
found in Addendum C.) recommendations for the direct PE equipment used in post-operative visits
In the CY 2007 PFS final rule with inputs for the nonfacility setting for the to include both a power table and
comment period, we addressed several CPT codes 93501, 93505, 93508, 93510, fiberoptic light in the PE database for 70
issues concerning direct PE inputs and 93526, 93539, 93540, 93542, 93543, obstetric/gynecologic codes.
encouraged specialty societies to pursue 93544, 93545, 93555, and 93556.
Dual Energy X-Ray Absorptiometry
further review of these inputs through The specialty societies recommended (DEXA)
the RUC/PERC process. The following that the remaining 15 codes in the
discussions summarize the PERC cardiac catheterization family remain The PERC considered revisions to the
recommendations regarding these carrier-priced, or be assigned an ‘‘NA’’ direct PE inputs for CPT codes 77080,
issues: for the practice expense in the office 77081, and 77082 that contained
setting. It was noted that these codes recommendations established by 5
Cardiac Catheterization Procedures were rarely if ever performed in the distinct specialty organizations. These
At the recent April RUC meeting, the office setting and the specialties recommended inputs were revised to
PERC considered recommendations for recommended no direct PE inputs. comply with established PERC
the family of CPT codes 93501 through Assigning these CPT codes as ‘‘NA’’ for standards, such as removing some labor
93556 for cardiac catheterization. The PE in the nonfacility setting would inputs for CPT code 77082 because this
American College of Cardiology, in conform to PFS policy for other services procedure is always performed with
cooperation with the Society of Cardiac without PE inputs. Therefore, we are CPT code 77081 and all revisions were
Angiography and Interventions and the proposing that the PE for the following agreed to by the presenting specialty.
Cardiovascular Outpatient Center CPT codes will not be valued or The resulting recommended inputs
Alliance, developed PE inputs for the applicable to the nonfacility setting: more appropriately reflect the resources
nonfacility setting for 13 of the 28 CPT 93503, 93511, 93514, 93524, 93527, used to furnish these services and were
adopted by the PERC. We agree with the found on the CMS Web site at http:// provision of materials for use in the
PERC and have made adjustments to the cms.hhs.gov/PhysicianFeeSched/ home and reporting pwiof
PE database. PFSFRN/ (under CMS–1385–P). [prothrombin] test results to physician;
Computer-Aided Detection (CAD) Codes (ii) Remote Cardiac Event Monitoring per four tests. Based on comments
received and subsequent discussions
The specialty society for radiological As discussed in the CY 2007 PFS final with entities that furnish these PT/INR
services reviewed the direct inputs for rule with comment period, direct PE services, we have adjusted the time in
CPT codes 77051 and 77052 and inputs for remote cardiac event use for the home monitor equipment for
recommended that no changes to the PE monitoring (CEM) services represented G0249 to 1440 minutes to reflect that
inputs were needed. The PERC by CPT codes 93012, 93225, 93226, the monitor is dedicated for use 24
concurred with this decision and we are 93231, 93232, 93270, 93271, 93733, and hours a day and unavailable for others
in agreement. 93736 were revised on an interim basis receiving this service. We invite
In addition to the above, the PERC to reflect the unique circumstances comments on this change, as well as
also addressed the following issues: surrounding the provision of these comments on any additional direct
services. Unlike most physicians’ inputs which would be appropriate to
Nuclear Medicine Services
services, CEM services are furnished
The specialty society representing this service, along with supporting
primarily by specialized IDTFs that, due
nuclear medicine recommended that the documentation to justify their inclusion
to the nature of CEM services, must
direct PE inputs for 2 CPT codes for PE purposes.
operate on a 24/7 basis. The specialty
contained CPEP inputs and needed to be group which represents suppliers that (iv) Positron Emission Tomography
updated to agree with 2004 PEAC- furnish CEM services believes that these (PET) Codes Clinical Labor Time
approved inputs. The PERC services require additional direct PE
recommended that the PE database inputs, such as telephone line charges We received comments from the
reflect these changes and we agreed. associated with trans-telephonic specialty society representing nuclear
However, we discovered that there were transmissions and fees associated with medicine regarding a discrepancy in the
4 other related codes which also had providing Web access for storage and clinical labor time for CPT codes 78811,
CPEP inputs. We made the appropriate transmission of clinical information to 78812, and 78813 which are PET codes
adjustments to substitute the PEAC the patient’s physician. We continue to for tumor imaging. The specialty noted
inputs for the CPEP for CPT codes work with the specialty group regarding that the clinical labor time indicated in
78600, 78607, 78206, 78647, 78803 and the specific direct PE inputs, as well as the PE database differs by 7 minutes
78807. The specialty society also noted the components for the indirect PE from the time that was previously
that 7 CPT codes required the revision allocation, based on surveys conducted recommended by the PERC in April
of x-ray related supplies, including the by the specialty group. To clarify and 2004. We agree with the specialty
number of x-ray films, developer further the results of our discussions society that the PE database labor inputs
solution, and film jackets. The PERC with and information provided by the for these 3 PET codes are incorrect and
forwarded these recommendations and specialty group, we are asking for have made the appropriate adjustments
we have made the appropriate changes comments on the appropriateness of the to the PE database.
to the PE database for the following CPT above mentioned direct PE inputs. In
codes: 78600, 78601, 78605, 78606, addition, we invite comments on any (v) Nuclear Medicine PE Supplies
78607, 78610 and 78615. additional direct inputs and
The specialty society representing
components of the indirect PE
Transcatheter Placement of Stent(s) nuclear medicine commented that the
allocations which would be appropriate
At the request of the specialty PE database currently contains supply
for these services, along with supporting
societies representing radiology and items that are inappropriate for certain
documentation to justify their inclusion
interventional radiology, the PERC for PE purposes. procedures and provided the
agreed to consider the direct PE inputs information to make the corrections. For
for the nonfacility setting for 3 CPT (iii) Prothrombin Time, International respiratory imaging procedures
codes, 37205, 37206, and 75960, for Normalized Ratio (PT/INR) represented by CPT codes 78587, 78591,
transcatheter placement of stent(s). In the CEM discussion in the CY 2007 78593, 78594, 78630, 78660, 78291, and
These PE inputs to value these PFS final rule with comment period, we 78195, the specialty society noted
procedures in the nonfacility setting included some minor PE revisions on an specific IV supply items to be deleted
were approved by the PERC. Among the interim basis for PT/INR services from procedures where they are not
supplies, a ‘‘vascular stent deployment represented by Healthcare Common required. For a thyroid imaging
system’’, valued at $1,645, was noted by Procedure Coding System (HCPCS) procedure represented by CPT code
the society as the typical stent used for codes, G0248, Demonstration, at initial 78020, x-ray supply items were
CPT codes 37205 and 37206 requiring 2 use, of home INR monitoring for patient recommended for deletion. In addition,
such stents for the placement in the with mechanical heart valve(s) who the society recommended adding supply
initial vessel and 1 stent for each meets Medicare coverage criteria, under items for respiratory imaging
subsequent vessel, respectively. We the direction of a physician; includes: procedures, including nose clips, masks,
reviewed a published clinical research Demonstrating use and care of the INR and nebulizer kits, as appropriate, to
study which was forwarded by the monitor, obtaining at least one blood CPT codes 78584, 78585, 78591, 78593,
specialty society that indicated that 1 sample, provision of instructions for 78594, 78586, 78587, 78588, and 78596.
stent was typical for the procedure of reporting home INR test results, and For a kidney function study represented
CPT code 37205. Absent any further documentation of patient ability to by CPT code 78725, injection supply
verification from the specialty, we have, perform testing and G0249, Provision of items were noted as missing and the
therefore, included only 1 stent in this test materials and equipment for home specialty society requested that these be
code. INR monitoring to patient with added. We propose to accept these
The complete PERC recommendations mechanical heart valve(s) who meets direct PE input corrections and have
and the revised PE database can be Medicare coverage criteria; includes revised our PE database accordingly.
(vi) Arthroscopic Procedure Nonfacility procedures in the office setting, we are (viii) Maxillofacial Prosthetics
Inputs seeking comments regarding the We have been working with the
During the CY 2007 PFS rulemaking, appropriateness of establishing society representing maxillofacial
we noted that at the October 2006 RUC nonfacility PE inputs for these prosthetists since 2005 to establish
meeting a proposal was discussed for arthroscopic procedures when they are nonfacility direct inputs for the
the establishment of nonfacility direct provided in the office setting. We also prosthetic services represented by the
PE inputs for the arthroscopic invite comments as to the specific direct CPT code series, 21076 through 21087.
procedures represented by CPT codes PE inputs, following the RUC-approved The current PE database reflects the
29805, 29830, 29840, 29870, and 29900. standardized format, that are typical in labor, supplies, and equipment needed
At this October 2006 RUC meeting, the the provision of each above listed to perform each procedure. However,
orthopedic specialty society declined to arthroscopic procedure furnished in the we do not have pricing information and
consider the valuation of these physician’s office. We will review these documentation for many supply items.
procedures for the nonfacility setting, comments to determine whether or not The society provided information and
based on the belief that these it is appropriate to propose on an documentation for equipment prices,
procedures are not safely performed in interim basis PE inputs for these codes but because specific time-in-use
the physician office. The RUC agreed at in the nonfacility setting in our final information was not provided, we
that time and no recommendations were rule. developed time-in-use in 2006 for each
issued. Subsequent to the publication of (vii) Nonfacility Inputs for CPT Code equipment item in each procedure. For
the CY 2007 PFS final rule with 52327 CY 2007, these equipment inputs were
comment period in which we supported utilized under the new PE methodology
the RUC recommendation, we again We received comments from the to calculate the nonfacility PE RVUs for
discussed this valuation with society representing urologists these procedures. We have asked the
physicians who are currently requesting that we remove all of the specialty society to provide the supply
performing these procedures in the nonfacility PE inputs for CPT code pricing information with appropriate
office. Because we believe that the RUC 52327, Cystourethroscopy (including documentation and also to provide
process is the most appropriate to ureteral catheterization); with accurate time-in-use data for each
provide these nonfacility inputs, we subureteric injection of implant equipment item for each procedure.
again referred the physicians providing material. The specialty society reasoned However, we have not received the
these services to work with the RUC- that the nonfacility PE value is requested information to date.
represented orthopedic specialty inappropriate since the procedure is Consequently, unless such information
society; however, they informed us that never performed in the physician office; is provided, the PE database will
the orthopedic specialty society had it is specific to the pediatric population; continue to have no prices associated
recently again declined to support them and, as such, is always performed with with these supplies. For each equipment
in bringing the direct PE inputs to the general anesthesia. We agree with the item, we propose to cap each time-in-
April 2007 RUC/PERC meeting for specialty society that this procedure is use to 25 minutes until specific
consideration in valuing these services incorrectly valued for the nonfacility information is received regarding the
in the nonfacility setting. setting and propose to accept their actual time-in-use. See Table 3 for the
Absent specific recommendations recommendation to remove the outstanding supply prices and Table 4
from the RUC and because some nonfacility direct PE inputs and have for the equipment time-in-use
physicians are already performing these revised the PE database accordingly. information that is needed.
TABLE 3.—MAXILLOFACIAL PROSTHESIS SUPPLIES NEEDING PRICING AND SUPPORTING DOCUMENTATION

Supply item CPT codes associated with supply item
paper, articulating ............................................... 21076, 21079, 21081, 21082, 21083, 21084, and 21085.
paste, registration ............................................... 21076, 21079, 21080, 21081, 21082, 21083, 21084, and 21085.
alloy framework, laboratory processing .............. 21076, 21079, 21080, 21081, 21082, 21083, 21084, and 21085.
paste, pressure indicator .................................... 21076, 21079, 21080, 21081, 21082, 21083, 21084, and 21085.
wax, boxing ......................................................... 21076, 21077, 21079, 21081, 21082, 21083, 21084, 21085, 21086 and 21087.
triad tray material ................................................ 21076, 21082, 21083 and 21084.
wire, orthodontic ................................................. 21076, 21079, 21080 and 21085.
reline material, Trusoft ........................................ 21076, 21079, 21081, 21082, 21083 and 21084.
silicone ................................................................ 21077, 21086 and 21087.
adhesive, facial ................................................... 21077, 21080, 21086 and 21087.
wax, baseplate .................................................... 21077, 21079, 21080, 21081, 21082, 21083, 21084, 21085, 21086 and 21087.
impression material, final .................................... 21077, 21080, 21081, 21082, 21083, 21084, 21085, 21086 and 21087.
monoplex eye ..................................................... 21077, 21080, 21086 and 21087.
syringe, impression ............................................. 21077, 21079, 21080, 21081, 21082, 21083, 21084, 21085, 21086 and 21087.
acrylic, dental ...................................................... 21077, 21079, 21080, 21081, 21082, 21082, 21083, 21084, 21085, 21086 and 21087.
polyurethane sheets (quantity as rolls) .............. 21077, 21080, 21086, and 21087.
burs, dental ......................................................... 21079, 21080, 21081, 21082, 21083, 21084 and 21085.
teeth set .............................................................. 21079, 21080 and 21081.
Greenstick compound ......................................... 21080, 21081, 21082, 21083, 21084 and 21085.
* CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
TABLE 4.—EQUIPMENT TIME-IN-USE INFORMATION NEEDED FOR MAXILLOFACIAL PROSTHESIS CODES PROCEDURES
NOTED BELOW WITH AN X
CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT
Equipment Item code code code code code code code code code code code
21076 21077 21079 21080 21081 21082 21083 21084 21085 21086 21087
Articulator ......................................... X X X X X X X X X X X
Chair, dental w-upholstery ............... X X X X X X X X X X X
Compressor air ................................. X X X X X X X X X X X
Convection oven .............................. ............ X ............ ............ ............ ............ ............ ............ ............ X X
Delivery unit ..................................... X X X X X X X X X X X
Dust collecting unit ........................... X X X X X X X X X X X
Grinding and polishing unit .............. X X X X X X X X X X X
Handpiece, highspeed ..................... X ............ X X X X X X X ............ ............
Handpiece, laboratory ...................... X X X X X X X X X X X
Handpiece, slow speed .................... X ............ X X X X X X X ............ ............
Light curing unit ................................ X X X X X X X X X X X
Light, dental, ceiling mount .............. X X X X X X X X X X X
Steamer, portable ............................. X X X X X X X X X X X
Triad unit .......................................... X X X X X X X X X X X
Trimmer, dental model ..................... X X X X X X X X X X X
Ultrasonic cleaning unit .................... X ............ X X X X X X X ............ ............
Washout and curing unit .................. X ............ X X X X X X X ............ ............
Whip mix combo unit ....................... X X X X X X X X X X X
Whip mixer ....................................... X X X X X X X X X X X
(ix) Requests for Increases in Supply due to the changes made in the reflected in the PE RVUs in Addendum
Prices modified model and have made this B of this proposed rule. The items listed
change in the PE database. in Tables 6 and 7 represent the
We received a request from the outstanding items from CY 2007 and
specialty society for obstetrics and (x) Supply and Equipment Items
Needing Specialty Input new items added from the current RUC
gynecology to increase the price of
recommendations. We are requesting
supply item (kit, hysteroscopic tubal We have identified certain supply and that commenters provide pricing
implant for sterilization) for CPT code equipment items for which we were information on items in these tables
58565, Hysteroscopy, surgical; with unable to verify the pricing information
bilateral fallopian tube cannulation to along with acceptable documentation,
(see Table 5: Supply Items Needing
induce occlusion by placement of as noted in the footnote to each table, to
Specialty Input for Pricing and Table 6:
permanent implants for this code which Equipment Items Needing Specialty support recommended prices. We are
was created for CY 2005. This Input for Pricing). During the CY 2007 also requesting that specialty societies
hysteroscopic implant kit is priced at PFS rulemaking, we listed both supply review the direct inputs in PE database
$980 and the specialty is now and equipment items for which pricing for the procedures performed by the
requesting a price of $1,245, providing documentation was needed from the specialty to verify that all supplies and
an invoice for documentation. The medical specialty societies and, for equipment contain prices. For supplies
specialty reports that the higher price is many of these items, we received or equipment that have previously
attributed to a manufacturer change in sufficient documentation containing appeared on this list, and for which we
design and materials and submitted the specific descriptors and pricing received no or inadequate
manufacturer’s documents supporting information in the form of catalog documentation, we are proposing to
these changes that were used to secure listings, vendor Web pages, invoices, delete these items unless we receive
FDA approval. Therefore, we are and manufacturer quotes. We have adequate information to support current
proposing to accept the new price of accepted the documented prices for pricing by the conclusion of the
$1,245 for the hysteroscopic implant kit many of these items and these prices are comment period for this proposed rule.
TABLE 5.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING

2008
Prior item Item
Primary associated Associated Commenter response
Code 2006/7 Description Unit Unit price status on status
specialties *CPT code(s) and CMS action
table refer to
note(s)
SC088 .. Fistula set, dialysis, item .... ................ Dermatology .............. 36522 ............ Yes .......... Specialty to submit B
17g. asap.
SD140 .. pressure bag ............. item .... 8.925 Cardiology ................. 93501, 93508, Yes .......... Specialty to submit B, C
93510, asap.
93526.
SL119 .. Sealant spray ............ oz ....... ................ Radiation Oncology ... 77333 ............ Yes .......... Specialty to submit B
price per ounce,
asap.
TABLE 5.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING—Continued

2008
Prior item Item
Primary associated Associated Commenter response
Code 2006/7 Description Unit Unit price status on status
specialties *CPT code(s) and CMS action
table refer to
note(s)
SD213 .. tubing, sterile, non- item .... 1.99 Cardiology ................. 93501, 93508, Yes .......... Specialty to submit B, C
vented (fluid admin- 93510, asap.
istration). 93526.
Stent, vascular, de- Kit ...... $1,645 Radiology, Inter- 37205, 37206 No ............ Specialty to submit A
ployment system. ventional Radiology. price, kit contents
and typical quantity
needed.
Note: Acceptable documentation includes—Detailed description (including system components), source, and current pricing information, such
as copies of catalog pages, hard copy from specific web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distribu-
tors. Unacceptable documentation includes—phone numbers and addresses of manufacturer, vendors or distributors, website links without pric-
ing information, etc.
Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including
pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or ad-
dresses of manufacturer, vendors or distributors are not acceptable documentation.
Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.
Note C: Submitted price accepted.
Note D: Deleted per comment or CMS.
Note E: 2007/8 price retained on an interim basis. Forward acceptable documentation promptly.
TABLE 6.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS
* CPT 2008 Item
code(s) Prior
2007/8 Primary specialties asso- Commenter response and status
Code 2006/7 Description associ- status
Price ciated with item CMS Action refer to
ated with on table note(s)
item
EQ269 .. Ambulatory blood pres- 3000 Cardiology ........................ 93784, Yes ...... Interim price of $1920 A, E
sure monitor. 93786, basis maintained, pend-
93788. ing receipt of docu-
mentation.
Camera mount-floor ......... 2300 Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E
Cross slide attachment .... 500 Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E
Dermal imaging software 4500 Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E
Dermoscopy attachments 650 Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E
EQ008 .. ECG signal averaging 8,250 Cardiology, IM .................. 93278 ... Yes ...... Interim price of $17,900 A, E
system. basis maintained, pend-
ing receipt of docu-
mentation.
Lens, macro, 35–70mm ... .................. Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E
plasma pheresis machine 37,900 Radiology, Dermatology .. 36481, Yes ...... Specialty to submit, asap A, E
w/UV light source. G0341.
ED039 ... Psychology Testing .................. Psychology ....................... 96101, No ........ Specialty to submit, asap A, E
Equipment. 96102.
ER070 ... Portal imaging system (w/ 377,319 Radiation oncology .......... 77421 ... Yes ...... Specialty to submit, asap A, E
PC work station and
software).
Strobe, 400watts (Stu- 1500 Dermatology ..................... 96904 ... Yes ...... Specialty to submit, asap A, E
dio)(2).
Note: Acceptable documentation includes—Detailed description (including system components), source, and current pricing information, such
as copies of catalog pages, hard copy from specific web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distribu-
tors. Unacceptable documentation includes—phone numbers and addresses of manufacturer, vendors or distributors, website links without pric-
ing information, etc.
Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including
pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or ad-
dresses of manufacturer, vendors or distributors are not acceptable documentation.
Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly.
Note C: Submitted price accepted.
Note D: Deleted per comment or CMS.
Note E: 2007/8 price, where specified, retained on an interim basis. Forward acceptable documentation promptly.
B. Geographic Practice Cost Indices caption ‘‘GEOGRAPHIC PRACTICE We are required by section
(GPCIs) COST INDICES (GPCIs)’’ at the 1848(e)(1)(A) and (C) of the Act to
beginning of your comments.] develop separate Geographic Practice
[If you choose to comment on issues Cost Indices (GPCIs) to measure
in this section, please include the
resource cost differences among in utilization and budget neutrality where subsidized families were highly
localities; and, to review and, if factors; for 2008, Addendum E shows concentrated in certain census tracts,
necessary, adjust the GPCIs at least that there have been small changes in given evidence that affordable housing
every 3 years. We have completed the the physician work GPCI. Section 102 of was not well-distributed. Only
review of GPCIs for CY 2008 and are the MIEA-TRHCA required application metropolitan areas with more than 100
proposing new GPCIs. These proposed of a 1.000 floor on the work GPCI in census tracts are considered for possible
GPCIs are published in Addendum E. payment localities where the work GPCI increase to the 50th percentile rent.
We note that the physician work GPCIs was less than 1.000. This provision FMRs can be moved from 40th to 50th
listed in Addendum E do not reflect the expires on December 31, 2006. The 2008 percentile or back from 50th to 40th
1.000 floor that was in place during proposed physician work GPCI reflects percentile.
2006 and 2007. This floor expires as of the removal of this floor. In the case of the office rent index for
January 1, 2008 in accordance with the PE GPCI, FMRs have been used to
b. Practice Expense capture geographic differences in rental
section 102 of the MIEA–TRHCA.
In developing a GPCI, section The PE GPCI is developed from three costs, in the absence of a consistent
1848(e)(1)(A)(i) and (ii) of the Act data sources: commercial rent index that covers all
require that the PE and malpractice (i) Employee Wages: We use 2000 metropolitan and nonmetropolitan areas
(MP) GPCIs reflect the full relative cost Census median hourly earnings of four in the U.S. It has been used as a measure
difference while section occupation categories. The physician of the ‘‘average rent’’ in a market.
1848(e)(1)(A)(iii) of the Act requires that work GPCI was updated in 2001, 2003, However, since 2000, the FMRs have
the physician work GPCIs reflect only and 2005 using data from the 2000 been a mixture of the 40th percentile
one-quarter of the relative cost Census. and 50th percentile rents. FMR areas
differences. Section 1848(e)(1)(C) of the (ii) Office Rents: We use residential move between the two cutoffs. For
Act also specifies that if more than 1 apartment rental data produced example, in California, 9 counties had
year has elapsed since the last GPCI annually by the Department of Housing FMRs set at the 50th percentile in 2004.
revision, we must phase in the and Urban Development (HUD) as a In 2007, only 2 of these 9 counties were
adjustment over 2 years, applying only proxy for physician office rents. In 2001, still at the 50th percentile level for the
one-half of any adjustment in each year. 2003, and 2005, we used rents in the FMR, out of 4 total counties at the 50th
All GPCIs are developed through a HUD 40th percentile. In 2008, we have percentile level.
comparison to a national average for calculated the GPCI using rents in the As described above in this section
each component, and the RVUs for 50th percentile for the physician office (and as detailed in 65 FR 58870), the
different services uniformly weight each rent proxy. We are proposing to use the criteria for setting the FMR at the 40th
component. 50th percentile because although HUD or 50th percentile are based on
generally allows payment for subsidized concentrations of subsidized
1. GPCI Update housing up to the 40th percentile, in households. There is no reason to
A detailed description of the some areas it allows payment up to the assume that commercial rents would
methodology used to develop and 50th percentile. We made this change to follow the same patterns.
update the GPCIs can be found in the reflect the trend toward higher rents Therefore, we believe the 50th
CY 2004 PFS proposed rule (68 FR across the country. percentile, or median, rents calculated
49039, August 15, 2003). There are three Fair Market Rents (FMRs) are gross by HUD will be a more consistent, fair
components of the GPCIs (physician rent estimates including rent and measure of geographic differences for
work, PE, and MP) and each relies on its utilities. HUD calculates the FMRs the purpose of proxying for commercial
own data source. annually using: (1) Decennial Census rents.
data; (2) American Housing Surveys Rent data produce the most
a. Physician Work
conducted by the Census Bureau for significant changes because they are
The physician work GPCI is HUD to enable HUD to develop based on annual changes in HUD rents
developed using the median hourly revisions between Census years; and (3) and are therefore more volatile than the
earnings from the 2000 Census of random-digit dial surveys to enable wage (Census) data. While commenters
workers in six professional specialty HUD to develop gross rent change have suggested that we explore sources
occupation categories which we use as factors. The American Housing Surveys of commercial rental data for use in the
a proxy for physician wages and cover 11 areas annually, rotating among GPCI, we do not believe there is a
calculate to reflect one-quarter of the the 44 largest metropolitan areas. The national data source better than the
relative cost differences. Physician random-digit dial component surveys 60 HUD data.
wages are not included in the FMR areas annually. (iii) Equipment and Supplies: We
occupation categories because Medicare The FMR is set as a percentile point assume that items such as medical
payments are a key determinant of in the distribution of rents for standard equipment and supplies have a national
physicians’ earnings; therefore, housing occupied by people who moved market and that input prices do not vary
including physician wages in the within the previous 15 months. The among geographic areas. As mentioned
physician work GPCI would, in effect, current FMR definition is the 40th in previous updates, some price
make the index dependent upon percentile rent (the amount below differences may exist, but we believe
Medicare payments. The physician which 40 percent of units are rented). these differences are more likely to be
work GPCI was updated in 2001, 2003, Each year, the 50th percentile rent is based on volume discounts rather than
and 2005 using data from the 2000 also calculated by HUD and available on geographic market differences.
Census; the proposed CY 2008 through the HUDUSER Web site. Equipment and supplies are factored
physician work GPCI is also based on In 2000, HUD changed its FMR policy into the GPCIs with a component index
the 2000 Census data. Because all to increase access to housing for of 1.000.
updates since 2001 have relied on the families receiving Section 8 rent subsidy
2000 Census data, the changes observed vouchers (65 FR 58870). To do so, HUD c. Malpractice
in the physician work GPCI in the increased FMRs from the 40th The MP GPCI is calculated based on
update years are due to minor changes percentile to the 50th percentile in areas insurer rate filings of premium data for
a $1 million to $3 million mature and other expenses. As explained above of lower price localities. If the difference
‘‘claims made’’ policy along with in this section, we do not make a between these GAFs exceeded 5
premium or surcharge data for geographic adjustment relating to percent, the highest locality remained a
mandatory patient compensation funds medical equipment, drugs, and supplies distinct locality. If the GAFs associated
(PCFs). The MP GPCI is the most because there is a national marker for with all the localities in a State did not
volatile of the GPCIs. This GPCI was these items. Thus, only the categories of vary by at least 5 percent, the State
updated in 2001 and 2003 as scheduled nonphysician employee compensation became a statewide locality. If the
with the physician work and PE GPCIs; and rents are geographically adjusted. highest-priced locality remained a
but, there was an unscheduled update of These categories represent, on average, distinct locality, the process was
the MP GPCI in 2004 (68 FR 49043) to 30.862 percentage points of the total PE, repeated for the second highest price
reflect increases in MP premiums and 12.807 percentage points of PEs are locality and so on until the variation
nationwide. The 2008 MP update not geographically adjusted. among remaining localities fell below
reflects the most recent premium data In total, more than half (52.156 the 5 percent threshold. This ensured
available. The physician work and PE percent) of the average PFS amount is a that the statewide or residual State
GPCIs are being updated at the same national payment that is the same in all locality has relatively homogenous
time. areas of the country; that is, 52.156 resource costs. Subsequent to this
The periodic review and adjustment percent of the average fee is not process, 3 additional States with
of GPCIs is mandated by section geographically adjusted. multiple localities were converted to
1848(e)(1)(C) of the Act. At each update, There are two additional points about statewide localities. Currently, there are
the proposed GPCIs are published in our the geographic indices that are 89 separate payment localities of which
PFS proposed rule the year before they important to note. First, as described 34 are statewide. Recognizing that the
would take effect in order to provide an above in this section, the data used to GPCIs are necessarily proxies, this
opportunity for public comment and measure cost differences among revision to the locality structure
further revisions in response to localities are proxies for physician accomplished our major goals of
comments prior to implementation. As work, employee compensation and appropriately paying for services
mentioned above, these proposed GPCIs office rents. That is, wage data for furnished to Medicare beneficiaries, and
are shown in Addendum D. various categories of employees are used simplifying payment areas.
to proxy the actual wages of physician
2. Payment Localities employees. Second, the data used for b. Revision of Payment Localities
a. Background such proxies are based on actual Census Over time, changing demographics
data only for a limited number of and local economic conditions may lead
The Medicare statute requires that counties. The geographic adjustment to increased variations in practice costs
PFS payments be adjusted for certain factors (GAFs) for more than 90 percent within payment locality boundaries. We
differences in the relative costs among of counties are developed using proxies are concerned about the potential
areas. The statute requires an based on larger geographic areas (for impact of these variations and have
adjustment which reflects differences example, data for all rural areas in a been studying this issue and potential
among areas for the relative costs of the State are combined and used to proxy alternatives for a number of years.
mix of goods and services comprising the values for each rural county in a However, because changes to the GPCIs
PEs (other than MP expenses) compared State). This aggregation is necessary for must be applied in a budget neutral
to the national average. The statute also areas where county level data are not manner (and under the current locality
requires adjustment for the relative costs available. Thus, the underlying data are system, BN results in aggregate
of MP expenses among areas compared proxies for actual costs, and the payments within each State remaining
to the national average. Finally, the resulting GPCIs do not measure the same), there are significant
statute requires adjustment for one- perfectly the cost differences among redistributive effects to any change.
quarter of the difference between the localities. Therefore, we are also concerned about
relative value of physicians’ work effort Currently, there are 89 Medicare the potential impact of locality
among areas and the national average of physician payment localities to which revisions.
such work effort. GPCIs are applied. The payment locality For the past several years, we have
The physician work component structure under the PFS was established been involved in discussions with
represents 52.466 percent of the in 1996 and took effect January 1, 1997. California physicians and their
national average fee schedule payment The development of this structure is representatives about recent shifts in
amount. Thus, the statutory requirement described in detail in both the CY 1997 relative demographics and economic
for geographic adjustment of only one- PFS proposed (61 FR 34615) and final conditions among a number of counties
quarter of the differences in the rules (61 FR 59494). Before adoption of within the current California payment
physician work component means that, the current structure, there were 210 locality structure. The California
on average, only 13.117 percentage separate payment localities under the Medical Association (CMA) suggested
points of physician work are PFS. The 1997 payment locality revision that we use our demonstration authority
geographically adjusted, and, on average was based and built upon the prior to adopt an alternative locality
39.349 percentage points of the locality structure. The 22 then-existing configuration and avoid certain
physician work component are not statewide localities remained statewide redistributive effects, but such an
adjusted and represent a national fee localities. Localities were established in approach was not feasible (as discussed
schedule amount. the remaining 28 States by comparing in the CY 2005 PFS final rule with
In addition, the PE component the area cost differences of the localities comment period (70 FR 70151)). In the
represents 43.669 percent of the within these States. We ranked the CY 2006 PFS proposed rule (70 FR
national average fee schedule payment existing localities within these 45784), we proposed to remove two
amount. PEs are comprised of remaining 28 States by costs in counties from the ‘‘Rest of California’’
nonphysician employee compensation, descending order. The GAF of the payment locality and create a new
office expenses (including rent), highest cost locality within a State was payment locality for each county. These
medical equipment, drugs and supplies, compared to the weighted average GAF two counties were the ones with the
largest difference between the county payments within each State remaining phase in of the new GPCI data. The
and locality GAFs. However, there was the same). In considering potential three options are described as follows:
much more opposition than support for changes in payment localities, we Option 1: Using the existing locality
this proposal, in large part because of its believe it is important to evaluate both structure, apply a rule whereby if a
negative effect on payments for the the potential impact of intralocality county GAF is more than 5 percent
counties that would have remained in practice cost variations and the greater that GAF for the locality in
the ‘‘Rest of California’’ locality. For redistributive impacts. Therefore, we which the county resides it would be
example, the CMA commented on this have identified and are soliciting removed from the current locality. A
proposal stating, ‘‘a nationwide comments on three possible locality separate locality would be established
legislative solution that would provide reconfigurations, each of which strikes a for each county that is removed. Based
additional funding * * * is the only different balance between intralocality on the new fully phased-in GPCI data
solution we are supporting at this time.’’ variations and redistributive impacts. (that is, for CY 2009), application of this
We did not finalize the proposal and We are considering adopting one of approach in California would remove
described our reasons in the CY 2006 these approaches for California in the three counties (Santa Cruz, Monterey,
PFS final rule with comment period (70 final rule. Because of the importance of and Sonoma) from the Rest of California
FR 70151). striking an appropriate balance with any payment locality and Marin county from
As indicated previously, we recognize such locality revisions, we want to the Marin/Napa/Solano payment
that changing demographics and local proceed cautiously and evaluate the locality and create separate payment
economic conditions may lead to impacts in California before considering localities for each of these counties.
increased variations in practice costs applying the policy more broadly in the This approach focuses on counties for
within payment locality boundaries. We future. We also seek comments about which there is the biggest difference
are concerned about the potential other potential approaches to locality between the county GAF and the
impact of these variations. But, we are revisions and about using a transition to locality GAF. Since we are considering
also concerned about the redistributive phase-in changes in a new locality applying this approach initially in
effects of locality changes since changes structure blending new and revised California, Table 7 shows the impact for
must be applied in a budget neutral payments. We note that a transition each of the counties and the Rest of
manner (and under the current locality could be complicated to administer, California payment and Marin/Napa/
system, BN results in aggregate particularly with a concurrent 2-year Solano payment localities.
TABLE 7.—OPTION 1—APPLY 5 PERCENT THRESHOLD TO REMOVE COUNTIES FROM THEIR CURRENT PAYMENT
LOCALITIES, CALIFORNIA IMPACT
New CY New CY Percent
2009 GAF, 2009 GAF, change, due
Locality name County name no locality with locality to locality
change change change
Santa Cruz ................................................................................ Santa Cruz ....................................... 1.017 1.100 7.59%

Monterey ................................................................................... Monterey ........................................... 1.017 1.080 5.83%
Sonoma ..................................................................................... Sonoma ............................................ 1.017 1.076 5.51%
Marin ......................................................................................... Marin ................................................. 1.112 1.173 5.19%
Napa/Solano ............................................................................. Solano .............................................. 1.112 1.066 ¥4.33%
Napa/Solano ............................................................................. Napa ................................................. 1.112 1.066 ¥4.33%
Rest of California ...................................................................... ........................................................... 1.017 1.012 ¥0.49%
This proposal is similar to the policy current locality structure with those that counties that are removed from the Rest
we previously proposed in the CY 2006 would occur under option 1. The table of California locality would become one
PFS proposed rule (70 FR 45784) (but, shows that compared to the fully new locality. Marin County would still
as discussed above in this section, we phased-in CY 2009 GAFs that would be removed from the Marin/Napa/
did not adopt in the final rule) to occur under the current locality Solano locality to become its own
address the counties with GAFs that are structure, under this option, the GAFs locality. Application of this approach
most different from their current locality for Santa Cruz, Monterey and Sonoma would remove three counties (Santa
designation. At that time, we only would increase by 7.59 percent, 5.83 Cruz, Sonoma, and Monterey) from the
considered the two counties with the percent, and 5.51 percent respectively, Rest of California payment locality, and
greatest difference between the county and the GAF for the Rest of California Marin County from the existing Marin/
and locality GAF—Santa Cruz and locality would decrease by 0.49 percent. Napa/Solano payment locality. This
Sonoma. Given the new GAF data, we The GAF for Marin would increase by approach groups together counties from
are again considering this approach to 5.19 percent while the GAF for Napa/ the Rest of California locality that have
address locality issues, but we would Solano would decrease by 4.33 percent. the greatest difference between the
make adjustments to any county in The GAFs for all other California county and locality GAF. These three
California in which the county GAF localities would not change. counties have similar cost structures
exceeds the locality GAF by more than Option 2: This approach is similar to and grouping them together into one
5 percent. Table 7 shows the impacts option 1, but the new localities would new locality is consistent with our goal
using fully phased-in CY 2009 GPCIs be structured differently. We would use of homogeneous resource costs within a
that would apply using the new GPCI the same 5 percent threshold locality. In addition, it creates fewer
data discussed in this proposed rule. methodology but instead of creating four localities which is administratively
The table compares the changes that new localities in which each county simpler for both the Medicare program
would occur in CY 2009 under the becomes its own new locality, the three
and for physicians who might practice localities that would remain. The table percent, and the GAF for the Marin
in multiple localities. shows that compared to the fully County locality would increase by 5.19
Again, since we are considering phased-in CY 2009 GAFs that would percent. The GAFs would decrease by
applying this approach initially in occur under the current locality 0.49 percent for the Rest of California
California, Table 8 shows the impact, structure, under this option, the GAFs locality and by 4.33 percent for the
using fully phased-in CY 2009 GPCIs, for the new Santa Cruz/Sonoma/ Napa/Solano locality.
for each of the new localities and for the Monterey locality would increase by 6.3
TABLE 8.—OPTION 2—APPLY FIVE PERCENT THRESHOLD TO REMOVE COUNTIES FROM THEIR CURRENT PAYMENT
LOCALITIES, CALIFORNIA IMPACT, CREATE TWO NEW LOCALITIES
Percent
CY 2009 CY 2009 change, CY
CY 2009 GAF, no GAF, with
Locality name County name 2009 GAF,
county GAF locality locality with locality
change change change
Marin ............................................................. Marin ..................................................... 1.173 1.112 1.173 5.19

Napa/Solano ................................................. Napa ..................................................... 1.080 1.112 1.066 ¥4.33
Napa/Solano ................................................. Solano ................................................... 1.053 1.112 1.066 ¥4.33
Santa Cruz/Monterey/Sonoma ..................... Santa Cruz ............................................ 1.100 1.017 1.082 6.03
Santa Cruz/Monterey/Sonoma ..................... Sonoma ................................................. 1.076 1.017 1.082 6.03
Santa Cruz/Monterey/Sonoma ..................... Monterey ............................................... 1.080 1.017 1.082 6.03
Rest of California .......................................... ............................................................... 1.017 1.017 1.012 ¥0.049
Option 3: Apply a methodology This is a numerical organization of problems such as incentives to relocate
similar to that used in the 1997 locality payment localities based on costs which across county lines would still exist.
revisions, but applied at the county will reduce the number of payment This option is the most
level rather than the ‘‘existing locality’’ localities in California from 9 to 6 administratively burdensome option for
level. That is, we sorted the counties by localities and will create a structure CMS to implement because of the
descending GAFs and compared the where areas with similar costs will be significant systems changes and
highest county to the second highest. If grouped together. This option alleviates provider education that would be
the difference is less than 5 percent, the the greatest variations in cost between required to reconfigure the California
counties were included in the same counties in California. This proposal is localities in this manner. It will also
locality. The third highest is then unique in that the new localities are not place a greater burden on practicing
compared to the highest county GAF. contiguous. Currently, all localities physicians who are more likely to
This iterative process continues until a encompass adjacent geographic areas. experience a change in his or her
However, Table 9 shows that for most of practice’s locality. We are seeking
county has a GAF difference that is
the counties in California, geographic comments on the extent of the
more than 5 percent. When this occurs,
relationships are maintained within administrative burden.
that county becomes the highest county payment groups. Since we are considering applying
in a new payment locality and the While this option groups counties this approach initially in California,
process is repeated for all counties in with similar costs together, it does not Table 9 shows the impact, using fully
the State. This methodology is also address the issue of a county or locality phased-in CY 2009 GPCIs, for each of
described in the CY 2006 PFS final rule that has costs very different from those the California counties. Table 9 shows
with comment period (70 FR 70151). of an adjoining county or locality. that this approach would result in 6
This approach would group counties Under this option, it will still be total California payment localities. The
within a State into localities based on possible for neighboring counties or changes would have a variety of impacts
similarity of GAFs even if the counties localities to have significantly different depending upon the counties involved.
were not geographically contiguous. cost structures and the associated The changes are illustrated in Table 9.
TABLE 9.—OPTION 3—REVISION OF PAYMENT LOCALITIES
Proposed
Current Proposed Current Percent
County Current Medicare locality Medicare
county GAF locality GAF locality GAF difference
locality
San Mateo ........................... San Mateo, CA .................................. 1.204 1 1.197 1.204 ¥0.6
San Francisco ...................... San Francisco, CA ............................ 1.201 1 1.197 1.201 ¥0.3
Marin .................................... Marin/Napa/Solano, CA ..................... 1.170 1 1.197 1.112 7.6
Santa Clara .......................... Santa Clara, CA ................................ 1.148 2 1.119 1.148 ¥2.5
Contra Costa ....................... Oakland/Berkeley, CA ....................... 1.134 2 1.119 1.131 ¥1.0
Alameda ............................... Oakland/Berkeley, CA ....................... 1.129 2 1.119 1.131 ¥1.0
Orange ................................. Anaheim/Santa Ana, CA ................... 1.128 2 1.119 1.128 ¥0.8

Ventura ................................ Ventura, CA ....................................... 1.121 2 1.119 1.121 ¥0.2
Los Angeles ......................... Los Angeles, CA ................................ 1.112 2 1.119 1.112 0.6
Santa Cruz ........................... Rest of California ............................... 1.098 3 1.061 1.012 4.9
Napa .................................... Marin/Napa/Solano, CA ..................... 1.077 3 1.061 1.112 ¥4.6
Monterey .............................. Rest of California ............................... 1.077 3 1.061 1.012 4.9
Sonoma ............................... Rest of California ............................... 1.074 3 1.061 1.012 4.9
San Diego ............................ Rest of California ............................... 1.053 3 1.061 1.012 4.9
TABLE 9.—OPTION 3—REVISION OF PAYMENT LOCALITIES—Continued

Proposed
Current Proposed Current Percent
County Current Medicare locality Medicare
county GAF locality GAF locality GAF difference
locality
Santa Barbara ..................... Rest of California ............................... 1.053 3 1.061 1.012 4.9
Solano .................................. Marin/Napa/Solano, CA ..................... 1.051 3 1.061 1.112 ¥4.6
Sacramento ......................... Rest of California ............................... 1.047 4 1.023 1.012 1.2
El Dorado ............................. Rest of California ............................... 1.033 4 1.023 1.012 1.2
San Bernardino .................... Rest of California ............................... 1.023 4 1.023 1.012 1.2
Placer ................................... Rest of California ............................... 1.021 4 1.023 1.012 1.2
Riverside .............................. Rest of California ............................... 1.017 4 1.023 1.012 1.2
San Luis Obispo .................. Rest of California ............................... 1.015 4 1.023 1.012 1.2
San Joaquin ......................... Rest of California ............................... 1.006 4 1.023 1.012 1.2
Yolo ...................................... Rest of California ............................... 0.995 5 0.962 1.012 ¥4.9
Stanislaus ............................ Rest of California ............................... 0.979 5 0.962 1.012 ¥4.9
Mono .................................... Rest of California ............................... 0.977 5 0.962 1.012 ¥4.9
Nevada ................................ Rest of California ............................... 0.975 5 0.962 1.012 ¥4.9
Kern ..................................... Rest of California ............................... 0.973 5 0.962 1.012 ¥4.9
San Benito ........................... Rest of California ............................... 0.971 5 0.962 1.012 ¥4.9
Sierra ................................... Rest of California ............................... 0.967 5 0.962 1.012 ¥4.9
Amador ................................ Rest of California ............................... 0.967 5 0.962 1.012 ¥4.9
Fresno .................................. Rest of California ............................... 0.963 5 0.962 1.012 ¥4.9
Mendocino ........................... Rest of California ............................... 0.960 5 0.962 1.012 ¥4.9
Madera ................................. Rest of California ............................... 0.960 5 0.962 1.012 ¥4.9
Tuolumne ............................. Rest of California ............................... 0.959 5 0.962 1.012 ¥4.9
Alpine ................................... Rest of California ............................... 0.957 5 0.962 1.012 ¥4.9
Mariposa .............................. Rest of California ............................... 0.956 5 0.962 1.012 ¥4.9
Tulare ................................... Rest of California ............................... 0.950 5 0.962 1.012 ¥4.9
Butte .................................... Rest of California ............................... 0.950 5 0.962 1.012 ¥4.9
Merced ................................. Rest of California ............................... 0.949 5 0.962 1.012 ¥4.9
Calaveras ............................. Rest of California ............................... 0.949 5 0.962 1.012 ¥4.9
Humboldt ............................. Rest of California ............................... 0.947 5 0.962 1.012 ¥4.9
Lake ..................................... Rest of California ............................... 0.947 5 0.962 1.012 ¥4.9
Imperial ................................ Rest of California ............................... 0.945 5 0.962 1.012 ¥4.9
Plumas ................................. Rest of California ............................... 0.945 6 0.938 1.012 ¥7.3
Lassen ................................. Rest of California ............................... 0.944 6 0.938 1.012 ¥7.3
Sutter ................................... Rest of California ............................... 0.942 6 0.938 1.012 ¥7.3
Yuba .................................... Rest of California ............................... 0.942 6 0.938 1.012 ¥7.3
Colusa .................................. Rest of California ............................... 0.940 6 0.938 1.012 ¥7.3
Del Norte ............................. Rest of California ............................... 0.940 6 0.938 1.012 ¥7.3
Modoc .................................. Rest of California ............................... 0.938 6 0.938 1.012 ¥7.3
Shasta .................................. Rest of California ............................... 0.937 6 0.938 1.012 ¥7.3
Kings .................................... Rest of California ............................... 0.935 6 0.938 1.012 ¥7.3
Inyo ...................................... Rest of California ............................... 0.935 6 0.938 1.012 ¥7.3
Siskiyou ............................... Rest of California ............................... 0.934 6 0.938 1.012 ¥7.3
Trinity ................................... Rest of California ............................... 0.933 6 0.938 1.012 ¥7.3
Tehama ................................ Rest of California ............................... 0.932 6 0.938 1.012 ¥7.3
Glenn ................................... Rest of California ............................... 0.930 6 0.938 1.012 ¥7.3
We are soliciting comments on these the MP RVU are then subject to review services that have a technical
options, as well as other approaches to by CMS at 5-year intervals. Reviewing component MP RVU that is greater than
refining localities both from the the MP RVUs every 5 years ensures that the professional component MP RVU.
perspective of implementing one of MP RVU values reflect any marketplace The RUC has asked CMS to change the
these approaches in California in CY changes in the physician community’s technical component MP RVU values,
2008, and also from the perspective of ability to acquire PLI. Alternatively, stating that, as physicians have to pay
their applicability more broadly. there are some technical services which the larger PLI premiums, there should
have assigned MP RVU values that have be higher RVUs associated with the
C. Malpractice (MP) RVUs (TC/PC Issue)
never been part of the review process. professional portions of these services.
[If you choose to comment on issues Consequently, the MP RVU values In the RUC’s comments to CMS, the
in this section, please include the assigned to these technical services have RUC made two alternative suggestions:
caption ‘‘MALPRACTICE’’ at the not been revised since their initial 1. CMS should ‘‘flip’’ the MP RVUs
beginning of your comments.] assignment. The reason these services associated with each of the component
In the CY 1992 PFS final rule (56 FR have never been reviewed is directly parts, so the technical component MP
59527), we described in detail how related to a lack of suitable data on the RVUs are assigned the value of the
malpractice (MP) RVUs are calculated cost of PLI for technical staff or imaging professional component RVUs, and the
for CPT codes and, when professional centers. professional component are assigned the
liability insurance (PLI) is not available, In response to our review of the MP MP RVUs of the technical component
how we crosswalk or assign RVU values RVUs of services, the RUC’s PLI MP RVUs; or
to codes. Following the initial Workgroup brought to our attention the 2. CMS should make the RVUs of the
calculation of resource-based MP RVUs, fact that there are approximately 600 technical component MP RVUs equal to
the MP RVUs of the professional Medicare telehealth services. This neuropsychological testing. The
component. process provides the public an ongoing following is a discussion of the requests
We are not accepting the first opportunity to submit requests for submitted in CY 2006.
suggestion. The professional portion of adding services. We assign any request
the MP RVUs have undergone review a. Subsequent Hospital Care
to make additions to the list of Medicare
and are derived from actual data, and telehealth services to one of the The American Telemedicine
are an integral part of our resource- following categories: Association (ATA) submitted a request
based methodology. We do not believe, • Category #1: Services that are to add subsequent hospital care (as
in the absence of evidence, that our data similar to office and other outpatient represented by HCPCS codes 99231
or conclusions for the professional MP visits, consultation, and office through 99233). The ATA mentioned
RVUs are inaccurate. It would not be psychiatry services. In reviewing these that the AMA CPT panel deleted the
consistent with our resource-based fee requests, we look for similarities codes for follow-up inpatient
schedule methodology to make changes between the proposed and existing consultation (as described by HCPCS
in the professional RVUs that are not telehealth services for the roles of, and codes 99261 through 99263) and that
supported by actual data. interactions among, the beneficiary, the the codes for subsequent hospital care
Because no data have been offered to physician (or other practitioner) at the are used instead of the deleted codes.
demonstrate that the malpractice costs distant site and, if necessary, the The requestor described two scenarios
for the technical portion of these telepresenter. We also look for in which subsequent hospital care
services are the same as for the similarities in the telecommunications services could be furnished as a
professional portion of these services, system used to deliver the proposed telehealth service. The first scenario
we also do not believe it would be service, for example, the use of would involve a specialty physician
appropriate to accept the second interactive audio and video equipment. who furnishes an inpatient consultation
suggestion at this time. To ensure that • Category #2: Services that are not as a telehealth service and follows the
any changes we make to any MP RVUs similar to the current list of telehealth specific problem (for which the
are resource-based, we need more services. Our review of these requests consultation was requested) with
information from the affected includes an assessment of whether the subsequent hospital care (inpatient
community. Specifically, we would like use of a telecommunications system to visits). The second scenario involves an
to better understand how, and if, deliver the service produces similar attending or admitting physician who
technicians employed by facilities diagnostic findings or therapeutic furnishes initial hospital care in-person
purchase PLI or how their professional interventions as compared with the (not as telehealth) and provides
liability is insured. In addition, we are face-to-face ‘‘hands on’’ delivery of the subsequent hospital care as a telehealth
soliciting comments on what types of same service. Requestors should submit service. The requester explained that the
PLI are carried by facilities that perform evidence showing that the use of a ability to provide health care services
technical services. telecommunications system does not when the practitioner is not onsite is
We appreciate the RUC’s affect the diagnosis or treatment plan as critical to the survival of many rural and
recommendation and are interested in compared to a face-to-face delivery of critical access hospitals (CAHs). The
addressing their concerns. Ideally, we the requested service. requestor believes that subsequent
would like to develop a resource-based Since establishing the process, we hospital care should be considered a
methodology for the technical portion of have added the following to the list of category 1 service because it is similar
the MP RVUs. However, at this time we Medicare telehealth services: to an inpatient consultation (which is
do not have data that would support Psychiatric diagnostic interview currently on the list of telehealth
such a change. Therefore, we are examination; ESRD services with two to services) and that an inpatient
soliciting comments on how we could three visits per month and four or more consultation is a more complex service
obtain the necessary data to create visits per month (although we require at than subsequent hospital care.
resource-based RVUs for these services. least one visit a month, in person Additionally, an individual
‘‘hands on’’, by a physician, CNS, NP, practitioner explained that the complete
D. Medicare Telehealth Services or PA to examine the vascular access diagnostic and therapeutic plan cannot
[If you choose to comment on issues site); and individual medical nutrition be established for an infectious disease
in this section, please include the therapy. patient in a single consultation and
caption ‘‘MEDICARE TELEHEALTH Requests to add services to the list of noted that follow-up inpatient
SERVICES’’ at the beginning of your Medicare telehealth services must be consultations were previously allowed
comments.] submitted and received no later than as telehealth services. The practitioner
December 31 of each calendar year to be believes that telehealth is appropriate
1. Requests for Adding Services to the considered for the next rulemaking for allowing the physician or
List of Medicare Telehealth Services cycle. For example, requests submitted practitioner at the distant site to be a
Section 1834(m)(4)(F) of the Act before the end of CY 2006 are ‘‘primary care giver’’ (in the inpatient
defines telehealth services as considered for the CY 2008 proposed hospital setting); however, stated that
professional consultations, office visits, rule. For more information on supporting data is needed.
and office psychiatry services, and any submitting a request for an addition to
additional service specified by the CMS Review
the list of Medicare telehealth services,
Secretary. In addition, the statute visit our Web site at www.cms.hhs.gov/ As mentioned by the requestors, the
required us to establish a process for telehealth/. AMA deleted follow-up inpatient
adding services to or deleting services consultation (as described by CPT codes

from the list of telehealth services on an 2. Submitted Requests for Addition to 99261 through 99263). Effective January
annual basis. the List of Telehealth Services 1, 2006, these CPT codes no longer exist
In the December 31, 2002 Federal We received the following requests for and were removed from the PFS. As
Register (67 FR 79988), we established additional approved services in CY such, a conforming change was made to
a process for adding services to or 2006: (1) Subsequent hospital care; (2) remove these codes from the list of
deleting services from the list of neurobehavioral status exam; and (3) Medicare telehealth services. CPT
instructs physicians and practitioners to codes 96118 through 96120) to the list broad range of brain and nervous system
use subsequent hospital care instead of of Medicare telehealth services. The functioning such as attention span and
the deleted codes. However, subsequent requestor explained that these services memory; visual, auditory, and tactual
hospital care describes a broader set of are provided during testing of the input; verbal communication; spatial
services than the deleted codes (follow- cognitive function of the central nervous perception; the ability to analyze
up inpatient consultation). system (CNS). The requestor believes information, form mental concepts, and
In the CY 2005 PFS proposed rule (69 that the HCPCS codes currently make judgments. The comprehensive
FR 47511), we discussed a previous approved for telehealth are not evaluation and assessment of brain and
request to add subsequent hospital care appropriate for reporting nervous system functioning is typically
to the list of Medicare telehealth neurobehavioral status exam and not a component of the services
services. Given the potential acuity of neuropsychological testing, and that currently on the list of telehealth
the patient (patients tend to be more these services are category 1 services. services. Moreover, neuropsychological
acutely ill in the hospital setting), we The requestor also explained that the testing requires administration by a
concluded that subsequent hospital care neurobehavioral status exam and trained professional and involves a
was not similar to existing telehealth neuropsychological testing are provided unique interactive dynamic between the
services (for example, an office visit, to patients located in a physician’s or physician, practitioner (or technician)
office psychology, or consultation). practitioner’s office, CAH, rural health who administers the test and the
Therefore, we indicated that we clinic (RHC), or Federally qualified patient. For example, to assess tactual
considered subsequent hospital care as health center (FQHC), and that performance the patient may be
a category 2 service. We were not able physicians and clinical psychologists blindfolded for portions of the test; to
to approve subsequent hospital care for are typically the practitioners who assess sensory perception, the
telehealth because no comparative furnish these services. practitioner who administers the test
analyses were submitted indicating that touches the patient’s fingers, assigning a
the use of a telecommunications system CMS Review number to each finger. In some cases a
is an adequate substitute for subsequent Neurobehavioral Status Exam significant amount of time is necessary
hospital care furnished in-person to complete a neuropsychological test
(which is a requirement for category 2 The neurobehavioral status exam is battery (for example, the Halstead-
services). furnished by a physician or psychologist Reitan Neuropsychological Battery
Given the potential acuity level of the and includes an initial assessment and could take up to 5 or 6 hours to
patient in the hospital setting, we evaluation of mental status for a complete).
continue to believe that many services psychiatric patient. In this regard, we Because we consider
furnished within the scope of the believe the neurobehavioral status exam neuropsychological testing to be a
subsequent hospital service codes are is similar to psychiatric diagnostic category 2 service, we need to evaluate
not similar to current telehealth interview examination (which is whether this is a service for which
services. We continue to have concerns currently approved as a Medicare telehealth can be an adequate substitute
about using a telecommunications telehealth service). Therefore, we for a face-to-face encounter. The
system as a substitute for the on-going propose to add neurobehavioral status requestor did not provide any
(in person) evaluation and management exam as represented by HCPCS code comparative analyses illustrating that
(E/M) of a hospital inpatient. Therefore, 96116 to the list of Medicare telehealth the use of a telecommunications system
we propose to not add subsequent services. is an adequate substitute for the in-
hospital care as described by HCPCS We would revise § 410.78 and person administration of
codes 99231 through 99233 to the list of § 414.65 to include neurobehavioral neuropsychological testing. Instead, the
Medicare telehealth services. status exam as a Medicare telehealth requestor submitted various summaries
We recognize that in deleting the service. of studies and case reports addressing
codes for follow-up inpatient Neuropsychological Testing clinical consultation, psychotherapy,
consultation services, CPT instructs enrollment and consent of psychiatric
physicians to use the codes for We believe that neuropsychological research participants, health promotion,
subsequent hospital care instead of testing services are category 2 services and health education. One comparison
those for follow-up inpatient because, as explained further below in study between psychiatric services
consultation. Therefore, we are this section, the roles of and interaction furnished in person and via an
considering the possibility of approving among the physician or practitioner at interactive audio and video
subsequent hospital care with specific the distant site and beneficiary at the telecommunications system was
limitations; for example, approving originating site are not similar to submitted. However, the study focused
subsequent hospital care for telehealth existing telehealth services (for on the use of telehealth to furnish
only when the codes are used for example, office visits, consultation, and consultation and short-term
follow-up inpatient consultation (and office psychiatry). We currently do not psychotherapy (which are currently
not for inpatient visits). As such, we are include the administration of other CNS approved as Medicare telehealth
requesting specific comments as to what tests on the list of telehealth services. services). Therefore, the information
conditions (or requirements) we could Neuropsychological testing is submitted was not sufficient to enable
apply to subsequent hospital care, so typically used to predict the presence us to determine whether the use of a
that subsequent hospital care reflects a and possible causes of brain damage telecommunications system would
follow-up inpatient consultation. using a complex battery of tests such as affect the diagnosis or treatment plan as
the Halstead-Reitan Neuropsychological compared to a face-to-face delivery of

b. Neurobehavioral Status Exam and Battery, Wechsler Memory Scales, and neuropsychological testing services.
Neuropsychological Testing Wisconsin Card Sorting Test. These are In furnishing neuropsychological
The ATA also submitted a request to a unique series of test instruments that testing as a telehealth service, it is our
add neurobehavioral status exam (as are not similar to other services on the understanding that the physician, or
described by HCPCS code 96116) and list of telehealth services. For example, practitioner (or technician) who actually
neuropsychological testing (HCPCS neuropsychological testing evaluates a administers the test would be located at
the distant site (rather than being As required by the statute, for imaging fluoroscopic guidance and CPT code
present with the patient, in-person, and services (described in this section) 43242, upper gastrointestinal endoscopy
‘‘hands on’’ at the originating site). We furnished on or after January 1, 2007, with transendoscopic ultrasound-guided
are interested in receiving comments as we cap the TC of the PFS payment intramural or transmural fine needle
to whether the administration of a amount for the year (prior to geographic aspiration/biopsy(s). In these cases, we
neuropsychological test battery could be adjustment) by the Outpatient are unable to clearly distinguish
furnished adequately when the Prospective Payment System (OPPS) imaging from non-imaging services
practitioner is not physically present payment amount for the service (prior to because, for example, a specific
with the patient. geographic adjustment). We then apply procedure may or may not utilize an
Moreover, we understand that in the PFS geographic adjustment to the imaging modality, or the use of an
some cases neuropsychological testing capped payment amount. imaging technology cannot be
is administered by a computer with a Section 5102(b)(2) of the DRA segregated from the performance of the
qualified health care professional exempts the estimated reduced main procedure. Note that we included
present (for example, in administering expenditures from this provision from carrier-priced services since these
the Wisconsin Card Sorting Test). the PFS BN requirement. Section services are within the statutory
However, we question whether a patient 5102(b)(1) of the DRA defines imaging definition of imaging services and are
with suspected or confirmed brain services as ‘‘imaging and computer-
also within the statutory definition of
damage or mental illness such as assisted imaging services, including X-
PFS services (that is, carrier-priced TCs
schizophrenia can be taught how to use ray, ultrasound (including
of PET scans).
a computer by a practitioner who is in echocardiography), nuclear medicine
a remote location. Therefore, we also (including PET), magnetic resonance Upon further review, we have
request specific comments as to whether imaging (MRI), computed tomography determined that certain ophthalmologic
a neuropsychological patient could be (CT), and fluoroscopy, but excluding procedures meet the DRA definition of
instructed and supervised adequately to diagnostic and screening imaging procedures, but were not
take the Wisconsin Card Sorting Test mammography.’’ included in the original list of imaging
through an interactive audio and video To apply section 5102(b) of the DRA, services subject to the OPPS cap.
telecommunications system. We are we needed to determine the CPT and Therefore, we propose to add the
proposing not to add alpha-numeric HCPCS codes that fall following procedures to the list of
neuropsychological testing (as described within the scope of ‘‘imaging services’’ procedures subject to the OPPS cap,
by HCPCS codes 96118 through and defined by the DRA provision. As we effective January 1, 2008:
99620) to the list of Medicare telehealth indicated in the CY 2007 PFS final rule • 92135, Scanning computerized
services. with comment period (71 FR 69659), in ophthalmic diagnostic imaging (e.g.,
general, we believe that imaging
E. Specific Coding Issues related to PFS scanning laser) with interpretation and
services are those that provide visual
report.
1. Reduction in the Technical information regarding areas of the body
that are not normally visible, thereby • 92235, Fluorscein angioscopy
Component (TC) for Imaging Services (includes multiframe imaging) with
Under the PFS to the Outpatient assisting in the diagnosis or treatment of
illness or injury. We began by interpretation and report.
Department (OPD) Payment Amount
considering the CPT 7XXXX series • 92240, Indocyanine-green
[If you choose to comment on issues codes for radiology services, and then angiography (includes multiframe
in this section, please include the added other CPT codes and alpha- imaging) with interpretation and report.
caption ‘‘CODING—REDUCTION IN TC numeric HCPCS codes that describe
FOR IMAGING SERVICES’’ at the imaging services. We then excluded • 92250, Fundus photography with
beginning of your comments.] nuclear medicine services that were interpretation and report.
As we noted in the CY 2007 PFS final non-imaging diagnostic or treatment • 92285, External ocular photography
rule with comment period (71 FR services. We also excluded all codes for with interpretation and report for
69624), effective January 1, 2007, unlisted procedures since we would not documentation of medical progress (e.g.,
section 5102(b)(1) of the Deficit know in advance of any specific clinical close-up photography, slit lamp
Reduction Act of 2005 (Pub. L. 109–171) scenario whether or not the unlisted photography, goniophotography, stereo-
(DRA) amended section 1848 of the Act procedure was an imaging service. photography).
to require that, for imaging services, if— We excluded all mammography • 92286, Special anterior segment
‘‘(i) The technical component (including services, consistent with the statute. We photography with interpretation and
the technical component portion of a excluded radiation oncology services
report; with specular endothelial
global fee) of the service established for that were not imaging or computer-
microscopy and cell count.
a year under the fee schedule * * * assisted imaging services. We also
without application of the geographic excluded all HCPCS codes for imaging A complete list of codes that identify
adjustment factor * * *, exceeds (ii) services that are not separately paid imaging services defined by the DRA
The Medicare OPD fee schedule amount under the OPPS since there would be no OPPS cap provision was published in
established under the prospective corresponding OPPS payment to serve Addendum F of the CY 2007 PFS
payment system for hospital outpatient as a TC cap. We excluded any service proposed rule (71 FR 49249 through
department services * * * for such where the CPT code describes a 49252). We will update the list through
service for such year, determined procedure for which fluoroscopy, program instructions to our contractors.
without regard to geographic adjustment ultrasound, or another imaging modality To the extent that the same imaging
* * *, the Secretary shall substitute the is included in the code whether or not service is coded differently under the
amount described in clause (ii), adjusted it is used, or for which an imaging PFS and the OPPS, we crosswalked the
by the geographic adjustment factor modality is employed peripherally in code under the PFS to the appropriate
[under the PFS], for the fee schedule the performance of the main procedure, code under the OPPS that could be
amount for such technical component for example, CPT code 31622, reported for the same service provided
for such year.’’ bronchoscopy with or without in the hospital outpatient setting.
2. Application of Multiple Procedure plasma. Since its production depends We acknowledge the finding in the
Payment Reduction for Mohs on plasma collection, there may be OIG report that increasing numbers of
Micrographic Surgery (CPT codes 17311 constraints on the amount produced. physicians are able to purchase IVIG
through 17315) There have been reported fluctuations below the Medicare ASP+6 percent
[If you choose to comment on issues in supply of this product and, in recent payment rates. In the third quarter of
in this section, please include the years, the demand for this product has 2006, 59 percent of sales to physicians
caption ‘‘CODING—MULTIPLE grown because of off-label uses. were at prices lower than the Medicare
We recognize the importance of IVIG payment rate, a substantial increase over
PROCEDURE PAYMENT REDUCTION
to patients who require it and are the prior 3 quarters. We consider this to
FOR MOHS SURGERY’’ at the
concerned about reports of problems be an important development, as it
beginning of your comments.]
with IVIG access and availability. We suggests that although the OIG could not
Under the multiple procedure
have initiated several actions in determine the underlying reasons that
payment reduction policy,
response to the concerns about the physicians have had issues with IVIG
reimbursement for subsequent surgical
supply of IVIG. We have continued to product availability, Medicare payment
procedures performed during the same
improve the codes for reporting IVIG, rates under the ASP+6 percent payment
operative session by the same physician
including creating four new codes for system have, over time, adjusted to
is reduced by 50 percent. The Mohs
liquid non-lyophilized IVIG for use substantial increases in IVIG market
surgery codes have been exempt from
effective July 1, 2007. In addition, as prices.
the multiple procedure payment noted below in this section, we
reduction rules since the inception of We have also requested that the OIG
established a temporary additional
the PFS (56 FR 59602, November 25, payment for IVIG preadministration further study some of the issues we
1991). services to compensate physicians for raised in our comments so that we can
The CPT Editorial Panel reviewed all better understand the IVIG market.
the extra resources required to be
of the codes on the -51 modifier exempt expended due to market conditions in We are concerned that the existence
list to identify which codes should be order to locate and obtain the of the preadministration fee could
exempt from the multiple procedure appropriate IVIG products and to further distort the market and provide
payment reduction rules. Based on the schedule patient infusions. inappropriate incentives for IVIG
revisions to the code descriptors and a In 2006, we created the HCPCS code utilization. Despite these concerns, we
clearer understanding regarding the G0332, Preadministration-related want to ensure that beneficiaries
technical elements of the procedure, the services for intravenous infusion of continue to have access to IVIG.
CPT Editorial Panel removed the Mohs immunoglobulin, per infusion encounter Therefore, we are proposing to continue
procedure from the -51 modifier list. and established RVUs for the code based payment for G0332 only through CY
The code descriptors for Mohs surgery on the nonfacility PE RVUs for code 2008 at the same level of PE RVUs as CY
codes were developed to take into G0319 (1.90 PE RVUs). Code G0319 2007. We invite comments on this
account the different level of physician describes ESRD-related services during policy.
work intensity based on anatomic site. the course of treatment, for patients 20
The RVUs associated with the codes for years of age and over; with one face-to- 4. Additional Codes from the 5-Year
each anatomic location were assigned, face physician visit per month. Review of Work RVUs
as they are for other procedures, after a The rationale for the PE valuation was [If you choose to comment on issues
thorough discussion by the RUC of all that we believed the additional in this section, please include the
aspects of the service. RVUs were physician practice resources expended caption ‘‘CODING—ADDITIONAL
developed for each Mohs surgery base for preadministration-related services, CODES FROM 5-YEAR REVIEW’’ at the
code based on an assumption that each particularly clinical labor, are beginning of your comments.]
code is performed separately. Because comparable to the PE for the ESRD
the RVUs for these services do not take management code. As discussed in the CY 2007 PFS final
into account the efficiencies that occur In 2007, we established RVUs for code rule with comment period, we deferred
when multiple procedures are G0332 based on a blend of the PE RVUs the decisions on proposed changes to
performed in one session, we do not for ESRD codes G0319 and G0318. The the work RVUs for a number of codes
believe that these codes should continue RVUs were set at 1.97, a slight increase from the 5-Year Review for a year, either
to be exempt from the multiple in the PE RVUs assigned to the code. because we had not yet received the
procedure payment reduction. For a discussion of the RVUs RUC recommendation or because we
Therefore, we are proposing to eliminate established for these services, see the were suggesting that the RUC reevaluate
the modifier -51 exemption and apply CY 2007 PFS final rule with comment the original recommendation. As we
the multiple procedure payment period (71 FR 69679). stated in that same rule, these additional
reduction rules to these codes. The OIG recently published a report codes are still considered part of the 5-
in April 2007 titled, ‘‘Intravenous Year Review. Table 10 shows the
3. Payment for Intravenous Immune Immune Globulin: Medicare Payment remaining codes, the requested and
Globulin (IVIG) Add-On Code for and Availability’’ (OEI–03–05–00404). recommended RVUs, and CMS’s
Preadmission-Related Services The CMS comments on this report were proposal on the codes. We are proposing
[If you choose to comment on issues included in Appendix B. We believe to accept all of the RUC
in this section, please include the this report provides information on the recommendations, with the exception of
caption ‘‘CODING—PAYMENT FOR availability and pricing for this product CPT code 93325 which we are
IVIG ADD-ON CODE’’ at the beginning and sets the stage for further review of proposing to bundle (that is, work RVUs
of your comments.] key issues that can bring greater would be increasing for 33 codes,
Intravenous immune globulin (IVIG) understanding of the marketplace for decreasing for 10 codes, and maintained
is a unique product derived from blood this product. for 15 codes).
TABLE 10.—REMAINING CODES FROM FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS
CMS 2008
2007 Requested
CPT 1/ RUC proposal Proposed
Mod Descriptor work work
HCPCS code REC (agree/ work
RVU RVU disagree) RVU 2
19301 ................ ............................ Partial mastectomy ............ 6.03 10.00 10.00 Agree ................ 10.00
33207 ................ ............................ Insertion of heart pace- 9.05 8.00 8.00 Agree ................ 8.00
maker.
45300 ................ ............................ Proctosigmoidoscopy dx .... 0.38 1.00 0.80 Agree ................ 0.80
45303 ................ ............................ Proctosigmoidoscopy dilate 0.44 1.50 1.50 Agree ................ 1.50
45305 ................ ............................ Proctosigmoidoscopy w/bx 1.01 1.25 1.25 Agree ................ 1.25
45307 ................ ............................ Proctosigmoidoscopy fb ..... 0.94 1.70 1.70 Agree ................ 1.70
45308 ................ ............................ Proctosigmoidoscopy re- 0.83 1.40 1.40 Agree ................ 1.40
moval.
moval.
moval.
45317 ................ ............................ Proctosigmoidoscopy bleed 1.50 2.00 2.00 Agree ................ 2.00
45320 ................ ............................ Proctosigmoidoscopy ab- 1.58 1.78 1.78 Agree ................ 1.78
late.
45321 ................ ............................ Proctosigmoidoscopy volvul 1.17 1.75 1.75 Agree ................ 1.75
45327 ................ ............................ Proctosigmoidoscopy w/ 1.65 2.00 2.00 Agree ................ 2.00
stent.
46600 ................ ............................ Diagnostic anoscopy .......... 0.50 0.79 0.55 Agree ................ 0.55
46604 ................ ............................ Anoscopy and dilation ....... 1.31 1.25 1.03 Agree ................ 1.03
46606 ................ ............................ Anoscopy and biopsy ........ 0.81 1.20 1.20 Agree ................ 1.20
46608 ................ ............................ Anoscopy, remove for body 1.51 1.30 1.30 Agree ................ 1.30
46610 ................ ............................ Anoscopy, remove lesion .. 1.32 1.28 1.28 Agree ................ 1.28
46611 ................ ............................ Anoscopy ........................... 1.81 1.30 1.30 Agree ................ 1.30
46612 ................ ............................ Anoscopy, remove lesions 2.34 1.50 1.50 Agree ................ 1.50
46614 ................ ............................ Anoscopy, control bleeding 2.01 1.50 1.00 Agree ................ 1.00
46615 ................ ............................ Anoscopy ........................... 2.68 1.50 1.50 Agree ................ 1.50
92002 ................ ............................ Eye exam, new patient ...... 0.88 0.88 0.88 Agree ................ 0.88
92004 ................ ............................ Eye exam, new patient ...... 1.67 1.82 1.82 Agree ................ 1.82
92012 ................ ............................ Eye exam established pat 0.67 0.92 0.92 Agree ................ 0.92
92014 ................ ............................ Eye exam & treatment ....... 1.10 1.42 1.42 Agree ................ 1.42
92557 ................ ............................ Comprehensive hearing 0.00 0.60 0.60 Agree ................ 0.60
test.
92567 ................ ............................ Tympanometry ................... 0.00 0.20 0.20 Agree ................ 0.20
92568 ................ ............................ Acoustic refl threshold tst .. 0.00 0.29 0.29 Agree ................ 0.29
92569 ................ ............................ Acoustic reflex decay test .. 0.00 0.20 0.20 Agree ................ 0.20
92579 ................ ............................ Visual audiometry (vra) ...... 0.00 0.70 0.70 Agree ................ 0.70
92601 ................ ............................ Cochlear implt f/up exam < 0.00 2.30 2.30 Agree ................ 2.30
7.
92602 ................ ............................ Reprogram cochlear implt 0.00 1.30 1.30 Agree ................ 1.30
< 7.
92603 ................ ............................ Cochlear implt f/up exam 7 0.00 2.25 2.25 Agree ................ 2.25
>.
92604 ................ ............................ Reprogram cochlear implt 0.00 1.25 1.25 Agree ................ 1.25
7 >.
93325 ................ ............................ Doppler color flow add-on 0.07 0.30 CPT Disagree ........... Bundled
99304 ................ ............................ Nursing facility care, init .... 1.20 1.88 1.61 Agree ................ 1.61
99307 ................ ............................ Nursing fac care, subseq ... 0.60 0.76 0.76 Agree ................ 0.76
99318 ................ ............................ Annual nursing fac 1.20 1.88 1.71 Agree ................ 1.71
assessmnt.
99326 ................ ............................ Domicil/r-home visit new 2.27 2.85 2.27 Agree ................ 2.27
pat.
pat.
pat.
99334 ................ ............................ Domicil/r-home visit est pat 0.76 1.25 0.76 Agree ................ 0.76
99343 ................ ............................ Home visit, new patient ..... 2.27 2.65 2.27 Agree ................ 2.27
TABLE 10.—REMAINING CODES FROM FIVE-YEAR REVIEW OF WORK RELATIVE VALUE UNITS—Continued
CMS 2008
2007 Requested
CPT 1/ RUC proposal Proposed
Mod Descriptor work work
HCPCS code REC (agree/ work
RVU RVU disagree) RVU 2
99347 ................ ............................ Home visit, est patient ....... 0.76 1.10 0.76 Agree ................ 0.76
1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
2 Proposed WRVU changes reflect E/M increases.
In Table 10, work RVUs are being determined by multiplying the national services. Since we accepted the AMA
proposed for CPT codes 92557, 92567, average allowed charge for each RUC’s recommendations for increased
92568, 92569, 92579, 92601, 92602, anesthesia service by its anesthesia work values for certain E/M codes for
92603 and 92604. These codes work share and dividing this amount by the third 5-Year Review of work, we
previously had no work RVUs assigned the general PFS conversion factor (CF). recalculated the work of the 19
to them. However, based on surveys This places the work of the anesthesia anesthesia services to incorporate these
conducted by relevant specialty service on the same relative value scale higher work values. The adjustment in
societies, the RUC recommended work as all other physician services. work was reflected by increasing the
RVUs as noted in the table, which we In the second 5-Year Review of anesthesia CF by less than 1 percent.
propose to accept. anesthesia work implemented in 2002, However, on the more significant
We note that CPT code 93325, the AMA RUC and the American issue of the valuation of work in the
Doppler echocardiography color flow Society of Anesthesiologists (ASA) used post-induction anesthesia period, we
velocity mapping (List separately in a building block approach to estimate took no action. Rather, in the CY 2007
addition to codes for echocardiography), the value of anesthesia work and PFS final rule with comment period, we
was submitted by CMS to the RUC as compared this value to the imputed asked the RUC to review and consider
part of the third 5-Year Review. The work value to determine whether the this issue as part of the third 5-Year
RUC 5-Year Review workgroup work of anesthesia services is properly Review of work. We also asked the RUC
recommended sending the code to the valued. Under the building block to consider how increases in the work
CPT Editorial Panel so that it could approach, each anesthesia code was of pre- and post-anesthesia services
bundle CPT code 93325 into doppler uniformly divided into five could cause adjustments to the
echo code 93307. We believe that the components; pre-anesthesia, equipment anesthesia services not specifically
technology of doppler imaging has and supply preparation, induction, post- reviewed by the ASA and the RUC.
evolved over the past 2 decades to induction anesthesia, and post- In January 2007, the ASA requested
enable color flow velocity and spectral anesthesia. Work is determined for each the AMA RUC to review the
analysis, both important components of of the five components and summed to undervaluation of the work of the post-
doppler imaging, to be performed calculate total anesthesia work for the induction anesthesia period and to
concurrently or in concert to obtain anesthesia code. The imputed value for consider also an analytic approach,
more accurate interpretation and the anesthesia code is compared to the based on linear regression analysis,
documentation of the anatomy and building block estimate of work in order which could be used to evaluate the
physiologic function of the structure(s) to assess whether, and if so, to what work of the entire anesthesia service.
and organ being evaluated. Therefore, extent, the anesthesia code is not The linear regression model relates the
we agree with the RUC and since the properly valued. work of the post-induction period time
services described in 93325 have The most significant component of and the work of the entire anesthesia
become intrinsic to the performance of work for the anesthesia service is the service to the base unit value for the
other echocardiography services, we are intensity for the post-induction anesthesia code. Under this model, the
proposing to bundle 93325 into CPT anesthesia time. The ASA thought that work of anesthesia services is
codes 76825, 76826, 76827, 76828, the RUC significantly misvalued this undervalued by approximately 34
93303, 93304, 93307, 93308, 93312, component in the second 5-Year percent.
93314, 93315, 93317, 93320, 93321, Review. In addition, the ASA was The RUC established an anesthesia
93350 and assign CPT code 93325 a dissatisfied that the RUC did not extend workgroup to examine this proposal.
status indicator of ‘‘B’’ (Bundled). the analysis from the 19 high volume The workgroup discussed this proposal
anesthesia codes reviewed by the RUC extensively at its two teleconferences,
5. Anesthesia Coding (Part of 5-Year prior to the April RUC meeting, and at
to all anesthesia codes.
Review) In the CY 2007 PFS final rule with the April RUC meeting itself. In May
Although anesthesia services are paid comment period, we addressed the issue 2007, the AMA RUC, based on the
under the PFS, under section of the work of anesthesia services under analyses and recommendations of its
1848(b)(2)(B) of the Act, they are paid the third 5-Year Review of work. workgroup, submitted a
on the basis of an anesthesia code- As explained in that rule, we made recommendation to CMS for a 32
specific base unit and time units that very modest adjustments to the work of percent increase in the work of
vary based on the actual anesthesia time the 19 anesthesia codes surveyed and anesthesia services.
of the case. Since anesthesia services do analyzed by the RUC in the second 5- The workgroup approved the ASA’s
not have a work RVU per code as do Year Review of work. These adjustments use of the linear regression model to
other medical and surgical services, a were made recognizing that the work of value only the work of the post-
work value must be imputed for each the pre- and post-anesthesia service induction period time. In contrast to the
anesthesia code. The imputed value is components as linked to certain E/M ASA proposal, the workgroup
considered an analytic approach based on a building block approach that than the pos-induction period time. For
different from the regression model could be used to evaluate the work of example, for pre-anesthesia time, the
developed by the ASA. This approach is all anesthesia service components other methodology is as shown in Table 11.
TABLE 11.—PRE-ANESTHESIA TIME

All Anesthesia codes with 3 base units ................................................... linked to the work of 99201.
All Anesthesia codes with 4 base units ................................................... linked to the blend of work for 99201 and 99202.
All Anesthesia codes with 5 to 15 base units .......................................... linked to the work of 99202.
All Anesthesia codes with 16 to 30 base units ........................................ linked to the work of 99252.
Note: The source of the link for work is the pre-anesthesia valuation from the 19 surveyed anesthesia codes whose base units varied from 3
units to 25 units.
Similar approaches are used for each 6. Reporting of Cardiac Rehabilitation generally fall into the following three
anesthesia component: preparation Services categories:
time, induction period time, and post- • Drugs furnished incident to a
anesthesia time. Systematically, codes For CY 2008, we are proposing to physician’s service.
with lower anesthesia base unit values assign a status indicator of ‘‘I’’ (invalid • DME drugs.
have lower work values for each for Medicare purposes, Medicare • Drugs specifically covered by
component of the building block recognizes another code for the billing statute (certain immunosuppressive
approach than do codes with higher of this service) to the current CPT codes drugs, for example).
anesthesia base unit values. For the for cardiac rehabilitation services, CPT Beginning in CY 2005, the vast
given building block component, the codes 93797, Physician services for majority of Medicare Part B drugs not
work value of that component is the outpatient cardiac rehabilitation; paid on a cost or prospective payment
same for all anesthesia services that without continuous ECG monitoring (per basis are paid under the ASP
have the same base unit value. session), and 93798, Physician services methodology. The ASP methodology is
According to the workgroup’s revised for outpatient cardiac rehabilitation; based on data submitted to us quarterly
methodology which is extended from with continuous ECG monitoring (per by manufacturers. In addition to the
the 19 surveyed codes to all 271 session). (There is no definition of ‘‘per payment for the drug, Medicare
anesthesia codes, the work of anesthesia session.’’) Therefore, to clarify the currently pays a furnishing fee for blood
services is undervalued by coding and payment for these services, clotting factors, a dispensing fee for
approximately 32 percent. Thus, based we propose to establish two new Level inhalation drugs, and a supplying fee to
on the acceptance of the workgroup and II HCPCS codes that we believe are more pharmacies for certain Part B drugs.
the RUC’s recommendation, an appropriate for specifically reporting In January 2006, the drug coverage
adjustment of approximately 25 percent cardiac rehabilitation services under the available to Medicare beneficiaries
would be applied to the anesthesia CF. PFS. The proposed HCPCS codes are: expanded with the implementation of
Gxxx1, Physician services for outpatient Medicare Part D. The Medicare Part D
Increases in the work of anesthesia cardiac rehabilitation; without
services would have to be offset by program does not change Medicare Part
continuous ECG monitoring (per hour), B drug coverage.
additional adjustments to the PFS BN and Gxxx2, Physician services for In this section, we discuss proposed
adjustor for work. We estimate that the outpatient cardiac rehabilitation; with changes and issues related to the
increase in the anesthesia CF would continuous ECG monitoring (per hour). determination of the payment amounts
result in an additional 1.0 percent We believe the new codes that use a per for covered Part B drugs and furnishing
increase in the BN adjuster for work. hour descriptor will more accurately blood clotting factor. This section also
Other adjustments also affect the measure the services being provided discusses proposed changes to how
anesthesia CF. For example, an increase and facilitate proper coding and manufacturers calculate and report ASP
in anesthesia work may have payment. The current RVUs associated data to us.
implications for PE because indirect PEs with CPT codes 93797 and 93798 will
are allocated based on the sum of work be crosswalked to HCPCS Codes Gxxx1 a. ASP Payment
and direct PEs. When we ran the PE and Gxxx1, respectively, because 1 hour Section 303(c) of the MMA amended
RVU program, there was no increase in of service was assumed in establishing Title XVIII of the Act by adding section
the aggregate anesthesia PEs. Thus, no the current RVUs. 1847A. This section revised the
adjustment is being made to the PE payment methodology for the vast
share of the anesthesia service or to the F. Part B Drug Payment
majority of drugs and biologicals not
anesthesia CF for this component. 1. Average Sales Price (ASP) Issues paid on a cost or prospective payment
We are proposing to accept the RUC’s basis furnished on or after January 1,
recommendation and increase the work [If you choose to comment on issues 2005. The ASP reporting requirements
of anesthesia services by 32 percent. in this section, please include the are set forth in section 1927(b) of the
Due to the proposed work RVU caption ‘‘ASP ISSUES’’ at the beginning Act. Manufacturers must submit ASP
changes for the codes listed in Table 10 of your comments.] data by 11-digit National Drug Code
and the proposed increases in the work Medicare Part B covers a limited (NDC) to us quarterly. The
of anesthesia services, we are proposing number of prescription drugs and manufacturers’ submissions are due to
to revise the work adjustor to maintain biologicals. For the purposes of this us not later than 30 days after the last
budget neutrality. Based upon the proposed rule, the term ‘‘drugs’’ will day of each calendar quarter. The
increases, the proposed revised work hereafter refer to both drugs and methodology for developing Medicare
adjustor is approximately 0.8816, which biologicals, unless otherwise specified. drug payment allowances based on the
is discussed further in the impact Medicare Part B covered drugs not paid manufacturers’ submitted ASP data is
section of this proposed rule. on a cost or prospective payment basis specified in 42 CFR, part 414, subpart K.
We update the Part B drug payment In its January 2007 Report to drug (or drugs) that the discount is
amounts quarterly based on the data we Congress, ‘‘Impact of Changes in meant to increase. This approach would
receive. Medicare Payments for Part B Drugs’’, result in an ASP that more accurately
In this section of the preamble, we MedPAC discusses the issue of how to reflects the transaction price of drugs
discuss our intent to establish further allocate bundled price concessions for when a discount for one drug or drugs
guidance regarding certain aspects of purposes of calculating the ASP, noting is contingent in whole or in part on the
the calculation of manufacturers’ ASP that ‘‘some manufacturers offer provider purchase of another drug. For example,
data, and seek comments on issues discounts for one of their products if a greater discount on the purchase
related to bundled price concessions. contingent on purchases of one or more price of Drug A is contingent on the
Further information on other products.’’ The full report is purchase (or purchases) of Drug B, this
manufacturers’ submission of ASP data posted on the MedPAC’s Web site at additional discount would be allocated
for Medicare Part B drugs and (http://www.medpac.gov/publications/ to sales of Drug B in the calculation of
biologicals is contained in prior congressional_reports/ ASP.
rulemaking documents and other Jan07_PartB_mandated_report.pdf). In its discussion of bundling,
guidance accessible on the CMS Web MedPAC’s report illustrates the MedPAC states that the goal should be
page at (http://www.cms.hhs.gov/ potential effects that certain methods for to ensure that ASP reflects the average
McrPartBDrugAvgSalesPrice/). allocating bundled price concessions transaction price for drugs. To that end,
Specifically refer to the April 6, 2004 may have on Medicare payment rates, MedPAC recommends that the Secretary
ASP interim final rule with comment physicians’ ability to choose a product clarify the ASP reporting requirements
period (IFC) (69 FR 17935) and the CY based on clinical factors, and market for bundled products to ensure that ASP
2007 PFS final rule with comment availability of products. MedPAC notes calculations allocate discounts to reflect
period (71 FR 69624), which finalized that: the transaction price for each drug.
the ASP calculation and reporting Bundling arrangements take many forms. Further, MedPAC states that we should
requirements of the April 6, 2004 IFC, For example, some bundling arrangements ensure that the reporting requirements
and the Frequently Asked Questions may include only Part B drugs while others for allocating discounts are clear and
available on the Web page. may include both Part B drugs and other that they can be implemented by
products. Similarly, price concessions may manufacturers in a timely fashion.
b. Bundled Price Concessions be structured in numerous ways. For In the December 22, 2006 Medicaid
In the CY 2007 PFS proposed rule and example, a discount on one or more drugs Program: Prescription Drugs proposed
final rule with comment period, we may be contingent on the purchase of other rule (71 FR 77176), for purposes of
solicited and responded to comments drugs or on meeting an aggregate expenditure
target for a group of products. CMS’s policy
calculating the average manufacturer
regarding the issue of how to allocate price (AMP), we proposed that, the
on reporting discounts may need to change
price concessions across drugs that are over time to reflect changing market practices discounts associated with a bundled
sold under bundling arrangements for but that should not slow down action in this sale would be allocated proportionately
purposes of calculating the ASP. We did area. [MedPAC. 2007. Report to Congress: according to the dollar value of the units
not establish a specific methodology Impact of Changes in Medicare Payments for of each drug sold under the bundled
that manufacturers must use for the Part B Drugs. Washington, DC: MedPAC: arrangement. For bundled sales where
treatment of bundled price concessions page 8] multiple drugs are discounted, the
for purposes of the ASP calculation in In its report, MedPAC discusses two aggregate value of all the discounts
the CY 2007 PFS final rule with alternative approaches for allocating would be proportionately allocated
comment period. In the absence of bundled price concessions. According across all of the drugs in the bundle. For
specific guidance, we maintained to MedPAC, one option would be to AMP purposes, a bundled sale would
existing guidance that manufacturers require manufacturers to allocate mean an arrangement regardless of
may make reasonable assumptions in its bundled discounts in proportion to the physical packaging under which the
calculation of ASP, consistent with the sales of each drug sold under the rebate, discount, or other price
general requirements and the intent of bundled arrangement. For example, concession is conditioned upon the
the Act, Federal regulations, and its Drug A and Drug B are sold under a purchase of the same drug or drugs of
customary business practices. Our bundled arrangement and have a different types (that is, at the nine-digit
intent in not being prescriptive in this combined bundled discount equal to NDC level) or some other performance
area in the CY 2007 PFS final rule with $200,000 on total sales of $1 million. If requirement (for example, the
comment period was to allow Drug A has sales of $600,000, the achievement of market share, inclusion
manufacturers the flexibility to adopt a manufacturer would allocate 60 percent or tier placement on a formulary), or
methodology with regard to the of the bundled discount to that drug where the resulting discounts or other
treatment of bundled price concessions when calculating ASP. Forty percent of price concessions are greater than those
in the ASP calculation that, based on the bundled discount would be which would have been available had
their particular circumstances, will best allocated to Drug B. MedPAC states that the bundled drugs been purchased
ensure the accuracy of the ASP this approach would parallel bundling separately or outside of the bundled
calculation and not create inappropriate requirements under Medicaid and arrangement. In the December 22, 2006
financial incentives. We also stated that would be simpler to administer. Medicaid Program: Prescription Drugs
we would be closely monitoring this However, MedPAC notes that this proposed rule, we further proposed that
issue and may provide more specific method might not capture contingent the AMP should be adjusted for bundled
guidance in the future if we determine discounts. sales by determining the total value of
it is warranted. In addition, we The other approach discussed by all the discounts on all drugs in the
encouraged stakeholders and the public MedPAC would be to require bundle and allocating those discounts
to relay additional information or manufacturers to allocate bundled proportionately to the respective AMP
concerns to us on this issue. We discounts to reflect the contingencies in calculations. The aggregate discount is
specifically noted that MedPAC would the contract. That is, manufacturers allocated proportionately to the dollar
be studying this issue, and that we would allocate any additional (or value of the units of each drug sold
looked forward to its work in this area. increased) discount to the sales of the under the bundled arrangement. Where
discounts are offered on multiple discounts for purposes of the AMP the achievement of market share,
products in a bundle, the aggregated calculation. Furthermore, because inclusion or tier placement on a
value of all of the discounts should be section 1847A(d) of the Act, as formulary, purchasing patterns, prior
proportionately allocated across all of discussed elsewhere in this section, purchases), or where the resulting
the drugs in the bundle. permits substitution of 103 percent of discounts or other price concessions are
We received many comments on the the AMP for the ASP-based payment greater than those that would have been
many aspects of the December 22, 2006 limit in certain instances, we believe available had the drugs or biologicals
Medicaid: Prescription Drugs proposed incorporating appropriate consistencies sold under the bundled arrangement
rule. However, our review of those across the calculations of ASP and been purchased separately or outside of
comments and development of the final AMP, as allowable by statute, is the bundled arrangement. We propose
AMP calculation policies and rule are rational. Although we are proceeding to define bundled arrangement at
not complete, and therefore, we will cautiously with such potential § 414.802, and to specify in proposed
respond to those comments in future substitutions, we believe appropriate § 414.804(a)(2)(iii) that all price
rulemaking. consistencies across the calculations of concessions on drugs sold under a
In the CY 2007 PFS final rule with ASP and AMP will result in a lower bundled arrangement must be allocated
comment period, we stated that we may potential for error and more accurate proportionately to the dollar value of
provide more specific guidance on calculations of both prices. the units of each drug sold under the
bundled price concessions in the future Although ASP and AMP serve similar, bundled arrangement.
if we determine it is warranted. In light but not identical, purposes, differences In making this proposal, we seek to
of MedPAC’s recommendation that we between these calculations provide establish a method for treating bundled
clarify the ASP reporting requirements rationale for, and in some instances may price concessions for purposes of ASP
for bundled products and our require, minor differences between that is consistent with the method
discussion of bundled price concessions Medicaid and Medicare proposed proposed for AMP calculations while
in the CY 2007 PFS rulemaking, we regulations. For example, the Medicaid addressing existing program differences.
believe specific guidance in the ASP proposed rule proposes a definition of We believe an overall consistent
context is warranted to provide for ‘‘bundled sales’’ whereas we believe methodology for addressing bundling in
greater consistency in ASP reporting ‘‘bundled arrangement’’ is more both contexts will reduce the burden
across manufacturers and enhancing the appropriate for purposes of the ASP and the likelihood of errors for
accuracy of the ASP payment system. context because, for ASP purposes, manufacturers calculating and reporting
We find MedPAC’s suggestion to not ‘‘bundling’’ is most applicable in the
the ASP. We also believe that our
defer further guidance in this area context of price concessions.
proposed approach balances the need to
compelling with respect to the potential Furthermore, based on our experience
that manufacturers may make differing provide clarification of how bundled
with manufacturers’ ASP reporting, we
assumptions in the absence of specific price concessions are to be treated for
believe other refinements are
guidance on how to allocate bundled purposes of calculating the ASP so that
appropriate for purposes of ASP. We
price concessions in the context of ASP. there is greater consistency across
believe these differences are necessary
As we noted in the CY 2007 PFS final calculations of ASP with concerns that
to clarify certain aspects of a consistent
rule with comment period, there is a a more complex approach would
approach for treatment of bundling, and
potential for great variation in the present complicated implementation
will not result in significant policy
structure of bundling arrangements and differences on how bundling is and monitoring challenges, as discussed
in the characteristics of drugs included addressed in the context of AMP and in by MedPAC and in our response to
in those arrangements. Thus, we believe the context of ASP. comments in the CY 2007 PFS final rule
that, in establishing a specific Therefore, for purposes of calculating with comment period.
methodology for allocating bundled the ASP (beginning with the reporting As discussed previously in this
price concessions for purposes of period for the first calendar quarter of section of the preamble, we propose to
calculating ASP, we should seek to 2008 and thereafter), we propose that establish a method for the treatment of
balance the desirability of a consistent the manufacturer must allocate the total bundled price concessions that is
methodology across manufacturers’ ASP value of all price concessions appropriately consistent with proposed
calculations with the potential proportionately according to the dollar Medicaid policy for bundled sales, and
complexity that may be introduced by value of the units of each drug sold we intend to remain consistent with the
the designated approach. Our intention under a bundled arrangement to ensure final policy adopted in the Medicaid
in proposing to adopt a specified that the ASP is adjusted for bundled final rule on this issue, as appropriate.
approach for allocating bundled price arrangements as defined in the However, we note that the final
concessions in the ASP context is to definition of bundled arrangement we Medicaid AMP final rule is still under
avoid greater computational complexity are proposing at § 414.802. For bundled development, and the Medicaid policies
than necessary at this time primarily arrangement, where multiple drugs are on bundled sales may ultimately differ
because it is unknown whether discounted, the aggregate value of all from our discussion of the topic in this
applicable data may be adequately the discounts would be proportionately section of the preamble. Because of the
known at quarterly reporting intervals allocated across all of the drugs sold timing of the two proposed rules, the
for manufacturers to appropriately under the bundled arrangement. We policy we ultimately adopt in this final
reflect the contingencies in purchasing propose that a bundled arrangement, for rule may reflect the final Medicaid
contracts within their ASP calculations ASP purposes, would mean an policy on bundled sales, but only to the
at the 11-digit NDC level. arrangement, regardless of physical extent that it is appropriate for ASP and
In addition, we believe that it is packaging under which the rebate, the public has had the opportunity to
appropriate at this time to propose a discount, or other price concession is comment on how the final Medicaid
specified method for treating bundled conditioned upon the purchase of the policy for bundled sales, if
price concessions in the calculation of same drug or biological or other drugs appropriately adopted for ASP
ASP which is consistent with our or biologicals or some other purposes, would affect the calculation
proposed approach for treating such performance requirement (for example, of ASP.
We note that the comment period on factor based on the percentage increase for CY 2009 and thereafter until such
the Medicaid proposed rule is closed. in the CPI of 4.1 percent for the 12- time as the update methodology may be
Therefore, comments received in month period ending June 2006. modified, we propose to announce the
response to this proposed rule on the The CPI data for the 12-month period blood clotting furnishing fee using
topic of bundled sales for purposes of ending in June 2007 is not yet available. applicable program instructions and
AMP will be considered untimely for In the CY 2008 PFS final rule with posting on the CMS Web site. We are
the purposes of the Medicaid final rule comment period, we will include the soliciting comments on our proposal to
and outside of the scope of this actual figure for the percent change in announce the updated furnishing fees
rulemaking. the CPI for medical care for the 12 via program instructions.
We are soliciting comments on our month period ending June 2007, and the
proposed approach for requiring updated furnishing fee for CY 2008 d. Widely Available Market Prices
manufacturers to allocate the total value calculated based on that figure. (WAMP) and AMP Threshold
of all price concessions on all drugs sold In the CY 2006 and CY 2007 PFS Section 1847A(d)(1) of the Act states
under a bundled arrangement proposed and final rules, as well as in that ‘‘the Inspector General of HHS shall
proportionately according to the dollar this proposed rule, we have included a conduct studies, which may include
value of the units of each drug sold discussion of the annual update of the surveys to determine the widely
under the bundled arrangement for blood clotting factor furnishing fee as available market prices (WAMP) of
purposes of the calculation of ASP, and specified in section 1842(o)(5)(C) of the drugs and biologicals to which this
on our proposal to specify the method Act. Because the update is based on the section applies, as the Inspector
for treatment of bundling in the ASP percentage increase in the CPI for General, in consultation with the
context that is appropriately consistent medical care for the 12-month period Secretary, determines to be
with the treatment of bundling in the ending with June of the previous year appropriate.’’ Section 1847A(d)(2) of the
AMP context. We are specifically and the Bureau of Labor Statistics Act states that, ‘‘Based upon such
soliciting comments on how our releases the applicable CPI data after our studies and other data for drugs and
proposed approach for treatment of the proposed rule is published, we are biologicals, the Inspector General shall
bundled price concessions for purposes not able to include the actual updated compare the ASP under this section for
of calculating ASP may impact the furnishing fee in the CY 2006 through drugs and biologicals with—
estimation of lagged price concessions, CY 2008 proposed rules. Rather, we • The widely available market price
whether manufacturers believe announced in these proposed rules that (WAMP) for these drugs and biologicals
additional guidance on this topic is we intended to include the actual figure (if any); and
needed, and the nature of the potential for the percent change in the applicable
• The AMP (as determined under
additional guidance. Further, we are CPI, and the updated furnishing fee
section 1927(k)(1) of the Act for such
soliciting comments on potential calculated based on that figure in the
drugs and biologicals.’’
alternative approaches for the treatment associated final rule. Given the timing of
the availability of the applicable data Section 1847A(d)(3)(A) of the Act
of bundled price concessions that are
appropriate for the calculation of ASP, and our timeframe for preparing states that, ‘‘The Secretary may
including the alternative approach proposed rules, this process is disregard the ASP for a drug or
discussed by MedPAC in its recent unavoidable and likely to remain biological that exceeds the WAMP or
report as noted previously in this unchanged in the future. We believe the AMP for such drug or biological by
section of the preamble. In addition, we that including a discussion of the the applicable threshold percentage (as
seek comments on how our proposed furnishing fee update in annual defined in subparagraph (B)).’’ The
approach or an alternative approach rulemaking does not provide an applicable threshold is specified as 5
would result in clear reporting advantage over other means of percent for CY 2005. For CY 2006 and
requirements for allocating discounts announcing this information, so long as subsequent years, section
that can be implemented by the current statutory update 1847A(d)(3)(B) of the Act establishes
manufacturers in a timely fashion. methodology continues in effect. We that the applicable threshold is ‘‘the
believe that the public’s need for percentage applied under this
c. Clotting Factor Furnishing Fee information and adequate notice subparagraph subject to such
Section 303(e)(1) of the MMA added regarding the updated furnishing fee can adjustment as the Secretary may specify
section 1842(o)(5) of the Act which be better met by issuing program for the WAMP or the AMP, or both.’’ In
requires the Secretary, beginning in CY instructions which will eliminate the CY 2006 and CY 2007, we specified an
2005, to pay a furnishing fee, in an discussion of the furnishing fee update applicable threshold percentage of 5
amount the Secretary determines to be annually in rulemaking. In addition, by percent for both the WAMP and AMP.
appropriate, to hemophilia treatment communicating the updated furnishing We based this decision on the limited
centers and homecare companies for the fee in program instruction, the actual data available to support a change in the
items and services associated with the figure for the percent change in the current threshold percentage.
furnishing of blood clotting factor. applicable CPI and the updated For CY 2008, we propose to specify an
Section 1842(o)(5)(C) of the Act furnishing fee calculated based on that applicable threshold percentage of 5
specifies that the furnishing fee for figure can be announced more timely percent for the WAMP and the AMP. At
clotting factor for CY 2006 and than when included as part of the PFS present, the OIG is continuing its
subsequent years will be equal to the fee final rulemaking process. Because the comparison of both the WAMP and the
for the previous year increased by the furnishing fee update process is AMP. Furthermore, information on how
percentage increase in the consumer statutorily determined and is based on recent changes to the calculation of the
price index (CPI) for medical care for an index which is not affected by AMP may affect the comparison of AMP
the 12-month period ending with June administrative discretion or public to ASP is not available at this time.
of the previous year. In the CY 2007 PFS comment, we do not believe a Since we do not have data that suggest
final rule with comment period, we subregulatory means of communicating another level is more appropriate at this
announced that the furnishing fee for the update will adversely affect time, we believe that continuing the 5
CY 2007 is $0.152 per unit clotting stakeholders or the public. Therefore, percent applicable threshold percentage
for both the WAMP and AMP is regulations to reflect provisions of new language that requires that payment
appropriate for CY 2008. section 108 of the MIEA–TRHCA that for drugs and biologicals shall be made
As we noted in the CY 2007 PFS final made changes to the payment process of upon receipt of a claim for a drug or
rule with comment period (71 FR the CAP for Part B Drugs. Section 303(d) biological supplied for administration to
69680), we understand that there are of the MMA required the a beneficiary. This statutory change took
complicated operational issues implementation of a CAP for certain effect on April 1, 2007.
associated with potential payment Medicare Part B drugs and biologicals Section 108(a)(2) of the MIEA–
substitutions. We will continue to not paid on a cost or PPS basis. The TRHCA requires the Secretary to
proceed cautiously in this area and provisions for acquiring and billing establish (by program instruction or
provide stakeholders, particularly drugs under the CAP were described in otherwise) a post-payment review
manufacturers of drugs impacted by the Competitive Acquisition of process (which may include the use of
potential price substitutions with Outpatient Drugs and Biologicals Under statistical sampling) to assure that
adequate notice of our intentions Part B proposed rule and July 6, 2005 payment is made for a drug or biological
regarding such, including the IFC (70 FR 10746 and 70 FR 39022, only if the drug or biological has been
opportunity to provide input with respectively), and certain provisions administered to a beneficiary. The
regard to the processes for substituting were finalized in the CY 2006 PFS final Secretary shall recoup, offset, or collect
the WAMP or the AMP for the ASP. As rule with comment period (70 FR any overpayments determined by the
part of our approach, we intend to 70116). We specified a single CAP drug Secretary under this process.
develop a better understanding of the category to include a defined list of Section 108(b) of the MIEA–TRHCA
issues that may be related to certain drugs furnished incident to a states that nothing in this section shall
drugs for which the WAMP and AMP physician’s service. be construed as requiring the conduct of
may be lower than the ASP over time. The program began on July 1, 2006. At any additional competition under
We welcome comments on our that time, physicians were given a section 1847B(b)(1) of the Act; or
proposal to continue the applicable choice between obtaining these drugs requiring an additional physician
threshold at 5 percent for both the from vendors selected through a election process.
WAMP and AMP for CY 2008. competitive bidding process and Section 108(c) of the MIEA–TRHCA
approved by CMS, or directly states that the amendments of this
2. Competitive Acquisition Program section apply to payments for drugs and
(CAP) Issues purchasing these drugs and being paid
under the ASP system. biologicals supplied (1) on or after April
[If you choose to comment on issues 1, 2007, and (2) on or after July 1, 2006
in this section, please include the a. MMA Operational Provisions and before April 1, 2007, for claims that
caption ‘‘CAP ISSUES’’ at the beginning Prior to the enactment of the MIEA– are unpaid as of April 1, 2007.
of your comments.] TRHCA, section 1847B(a)(3)(A) of the
In this section, we discuss the impact c. CAP Claims Processing
Act set forth specific requirements that
of new legislation on administrative and have a direct impact on the In the July 6, 2005 IFC (70 FR 39042),
operational aspects of the CAP. Topics administrative and operational we initially implemented a claims
include the implementation of a post- parameters for instituting a CAP. This processing system that enables selected
payment review process and the section of the statute requires the approved CAP vendors to bill the
corresponding changes to claims following: Medicare program directly, and to bill
processing procedures. In subsequent (1) Approved CAP vendors bill the the Medicare beneficiary and his or her
subsections, we also seek comments Medicare program for the drug or third party payer after verification that
regarding changes to other operational biological supplied, and collect any the physician has administered the
aspects of the CAP. applicable deductibles and coinsurance drug. When a participating CAP
This proposed rule will also be used from the Medicare beneficiary. (For physician elects to join the program, he
to discuss comments related to purposes of the preamble, the term or she must agree to obtain all drugs on
transporting CAP drugs and the ‘‘approved CAP vendor’’ means the term the CAP list from the approved CAP
administrative burden of the CAP ‘‘contractor’’ as referred to in the vendor, with only a few exceptions. For
submitted in response to the statute.) example in furnish as written (FAW)
Competitive Acquisition of Outpatient (2) Any applicable deductible and situations (that is, where a beneficiary
Drugs and Biologicals Under Part B; coinsurance may not be collected unless needs a particular formulation of a drug
Interim Final Rule with Comment the drug was administered to the not available from the approved CAP
Period published in the July 6, 2005 beneficiary. (For purposes of the vendor) the participating CAP physician
Federal Register (hereinafter referred to preamble, the term ‘‘drug’’ refers to would be allowed to obtain that drug
as the July 6, 2005 IFC). We are drugs and biologicals furnished under outside of the CAP. In the case of
addressing these comments in this the CAP, unless the context specifies Medicare Secondary Payer (MSP) (that
proposed rule because we plan to ask otherwise.) is, where a Medicare beneficiary may
for additional comments on these areas (3) Medicare can make payments only have another payer primary to
to explore areas that might be developed to the approved CAP vendor, and these Medicare), the participating CAP
in future rulemaking efforts. In the payments are conditioned upon the physicians must obtain physician
upcoming PFS final rule with comment, administration of the drug. administered drugs from entities
we intend to finalize the portions of the Section 108 of the MIEA–TRHCA approved by the primary plan and bill
July 6, 2005 IFC that were not finalized amended this third element. the primary payer. Detailed MSP
in the CY 2006 PFS final rule with instructions have been issued by CMS
comment period. We also will respond b. MIEA–TRHCA that allow payment to the physician
to the other timely comments we Section 108 of the MIEA–TRHCA under the ASP methodology in this
received on the July 6, 2005 IFC that we made changes to the CAP payment situation.
have not responded to previously. methodology. Section 108(a)(1) of the Claims processing procedures for the
This proposed rule implements MIEA–TRHCA amended section approved CAP vendor and the
conforming changes to the CAP 1847B(a)(3)(A)(iii) of the Act by adding participating CAP physician, which
remain largely unchanged under the be reviewed for medical necessity before conjunction with Item 12 on the Health
new statutory provision, are as follows: they are paid. Therefore, the post- Insurance Claim Form CMS–1500
Once a shipment is received from the payment review includes verification of which, when signed by a beneficiary,
approved CAP vendor, the participating drug administration and a medical authorizes the release of ‘‘any medical
CAP physician stores the drug until the necessity review of a statistically valid information necessary to process a
date of drug administration. When the sample of CAP claims. We note that in claim.’’
drug is administered to the beneficiary, conducting the post-payment review, When a claim is selected for review
the participating CAP physician places we will continue to monitor for fraud, we notify the approved CAP vendor and
the prescription order number for each waste, and abuse. All CAP transactions request its records to verify
drug administered on the claim form will remain eligible for review for administration. We also notify the
submitted to his or her regular Part B medical necessity and verification of approved CAP vendor that we will be
carrier. Similarly, when the approved administration. We also anticipate that requesting medical records from the
CAP vendor bills Medicare for the drug the post-payment review process will participating CAP physician and ask for
it shipped to the participating CAP provide CMS with additional his or her help in obtaining them. If the
physician, it places the relevant opportunities to monitor for the medical record is not received within 30
prescription order number on the claim appropriate payment of drugs furnished days, the claim is denied because we
form submitted to the designated under this program. will not have sufficient information to
carrier. The use of the prescription order As part of the post-payment review verify drug administration and medical
number on both the participating CAP process, the CAP-designated carrier will necessity. This review process is similar
physician’s claim and the approved use the CMS claims processing system to those used elsewhere in the Medicare
CAP vendor’s claim is intended to verify to look for a match between the CAP program such as clinical laboratory
drug administration to the beneficiary. prescription order number on the payment review or payment of radiology
The participating CAP physician’s claim participating CAP physician’s claim and services. It is also consistent with our
and the approved CAP vendor’s claim the same prescription order number on practice in reviewing claims for
are matched in the Medicare claims the approved CAP vendor’s claim to postoperative treatment. For example, if
processing system so that drug track drug administration on a dose-by- post-operative services have been
administration can be verified and dose basis. If the CAP designated carrier provided by two physicians, and
payment to the approved CAP vendor is able to find a match between the two payment was denied to one physician,
can be made. claims, this assists the carrier in and that physician appeals, the
determining that the beneficiary did Medicare contractor may request
d. Required Changes to CAP Claims receive the drug being billed for. The medical records from the other
Processing participating CAP physician claim may physician that treated the beneficiary to
As originally implemented, the claims also contain information on any document that there was no overlap in
matching process described above was determination of medical necessity and the services provided by each physician.
completed before payment was made. coverage made by the local carrier. If the contractor does not receive the
However, as of April 1, 2007, section To conduct post-payment review of medical record of the other physician
108 of the MIEA–TRHCA requires claims, we may also ask for within a specified amount of time the
payment to be made to the CAP vendor documentation of administration from appeal would be denied because there
for claims upon receipt. The statute also the approved CAP vendor and for was no way to document the services
requires us to establish a post-payment medical records from the participating provided. A similar process is used
review process to assure that payment is CAP physician for any claim that is when durable medical equipment
made for a drug only if the drug has identified for review. While it is (DME) is provided through third party
been administered to a beneficiary. We standard practice for Medicare suppliers. In these cases, the physician
are also charged with recouping, providers to be required to submit ordering the DME is required to provide
offsetting, or collecting any medical records to assist in claims the suppler medical records to support
overpayments found. The statute also review, we reserve the right to also the necessity of the equipment he or she
authorizes us to conduct post-payment specifically request any other records ordered. If the supplier does not obtain
review using statistical sampling and to that verify the administration of a CAP the records, then payment is denied.
implement the post-payment review drug. Furthermore, we want to make it As we specified in the CAP IFC (70
process by program instruction or very clear to the participating CAP FR 39038), the local carrier’s medical
otherwise. We implemented the physician at the time he or she elects to review policies and coverage
necessary changes to our claims join the program that he or she may be determinations will continue to apply in
processing system and initiated the asked to supply medical records for the CAP. Under our previous claims
post-payment review process on April 1, post-payment review. Therefore, we are processing methodology the local carrier
2007 via instructions to the CAP proposing to revise § 414.908(a)(3)(xi) made the coverage determination on the
designated claims processing contractor and the physician election agreement drug ordered by the participating CAP
and questions and answers posted on form to make clear that medical records physician and provided by the approved
the CMS competitive bidding Web site and certain information may be CAP vendor as part of the claim
at http://www.cms.hhs.gov/ requested from CAP physician during matching process prior to payment of
CompetitiveAcquisforBios/ the post-payment review process. The the approved CAP vendor’s claim.
15_Approved_Vendor.asp#TopOfPage. procedures being used to verify valid Under the new methodology, the drug
The post-payment review process claims and ensure proper payment for claim will be paid upon receipt unless
uses statistical sampling to determine drugs supplied under the CAP are based the local carrier has already made a
whether drugs were administered and if on established post-payment review coverage or medical necessity
they were medically necessary. All processes used in other parts of the determination on the drug, and the
Medicare claims are subject to medical Medicare program. The request for match has already occurred showing
necessity determinations; however, medical records as part of the claims that the drug claim should be denied.
under the changes required by the payment process during CAP post- As part of the post-payment review
MIEA–TRHCA, CAP claims may not all payment review is intended to work in process, the CAP designated carrier will
check the CMS central claims remains unchanged. However, because • Identity of the individuals who
processing system to determine whether of the statutory change of section supply and receive the information.
the local carrier has made a coverage or 108(a)(1) of the MIEA–TRHCA and its • Dosage supplied.
medical necessity determination on the resulting impact on our claims • Dosage administered.
CAP drug indicated on the participating processing methodology, the claims Also, as a result of changes mandated
CAP physician’s drug administration processing system no longer provides a by section 108(a)(1) of the MIEA-
claim. If so, the CAP designated carrier way for CMS to verify administration on TRHCA, we propose to revise
will reflect this decision in its post- the approved CAP vendor’s behalf § 414.914(h)(1) to remove the reference
payment review of the claim. If the local before the approved CAP vendor to ‘‘final payment by Medicare’’ and
carrier has not reviewed the drug collects coinsurance from the revise this language to state, ‘‘payment
administration portion of the beneficiary or the supplemental insurer. by Medicare.’’ The original language
participating CAP physician’s claim as Verification of CAP drug administration was written to indicate that an approved
of the date that the designated carrier is also conducted in the post-payment CAP vendor could not bill a
processes the approved CAP vendor’s review process. The approved CAP beneficiary’s supplemental insurer for
drug claim, the CAP designated carrier vendor is expected to make information applicable amounts of cost sharing until
will use the local carrier’s coverage available to verify administration for the CAP drug claim had matched the
determination policies when conducting post-payment review as necessary. corresponding physician’s drug
medical review of the claim. We believe that an approved CAP administration claim. Under the post-
vendor can verify whether a CAP drug payment review process, the final
e. Provisions for Collection of payment would not occur until a
Beneficiary Coinsurance was administered in a variety of ways.
For example, an approved CAP vendor statistical review of the claims was
In the CY 2006 PFS final rule with complete, a process that may take
may enter into a voluntary agreement
comment period, we specified several months. Removing the word
with a participating CAP physician to
§ 414.914(h)(1) that subsequent to final from this section of the regulation
exchange such information as described
receipt of final payment by Medicare, or will clarify that the approved CAP
in the CY 2006 PFS final rule with
the verification of drug administration vendor may bill the supplemental
comment period (70 FR 70251).
by the participating CAP physician, the insurer immediately after the designated
However, if a participating CAP
approved CAP vendor must bill any CAP carrier makes the initial payment
physician is unwilling to enter into a
applicable supplemental insurance on a CAP drug claim. Under our current
voluntary agreement to verify
policies. If a balance remains after the regulations, the approved CAP vendor
administration, the approved CAP
supplemental insurer pays their share of may also bill the beneficiary if drug
vendor may verify that the drug was administration is verified by the
the bill, or if there is no supplemental
administered by contacting the participating CAP physician. This
insurance, the approved CAP vendor
participating CAP physician’s office to provision remains unchanged.
may bill the beneficiary for the balance.
request verbal confirmation. In such an Under the revised CAP claims
In prior practice, a match in the claims
instance, the approved CAP vendor is payment process, the approved CAP
system between the participating CAP
physician’s drug administration claim expected to document the verbal vendor will bill Medicare for the CAP
and the approved CAP vendor’s drug confirmation of CAP drug drug that has been provided. In most
claim and the subsequent payment by administration, the identities of cases Medicare will pay the claim upon
Medicare was used to indicate that the individuals who exchanged the receipt. If the beneficiary has a
beneficiary received the drug. We also information and the date and time that supplemental insurance policy, and the
allowed voluntary information the information was obtained. In supplemental insurer has a crossover
exchanges between the approved CAP addition to verifying administration agreement with Medicare, the claim
vendor and the participating CAP through contact with the physician’s automatically will cross over to the
physician’s office have also been used to office, we also suggest that the approved supplemental insurer for payment. The
verify CAP drug administration. CAP vendor place a statement on supplemental insurer will pay its share.
Additionally, we note that under the beneficiaries’ bills informing them of Upon receipt of payment from the
CAP regulations, the participating CAP the statutory requirement and supplemental insurer the approved CAP
physician has a responsibility to notify suggesting that they contact their vendor may bill the beneficiary for any
the approved CAP vendor when a drug participating CAP physician to verify residual amount. For beneficiaries who
is not administered or a smaller amount that they received the dose of the drug do not have a supplemental insurance
was administered than was originally for which they are being billed prior to policy, the approved CAP vendor may
ordered. paying any cost sharing amount. bill the beneficiary after payment by
Because section 108 of the MIEA– For the reasons described above in Medicare.
TRHCA requires the payment of CAP this section, we believe that the However, in either case, the approved
claims upon receipt, payment of a claim verification of CAP drug administration CAP vendor may not collect any
by Medicare may occur before remains a required element of the CAP coinsurance owed from the beneficiary
administration of the drug has been and we are proposing to clarify or his or her supplemental insurer
verified. However, section § 414.906(a)(6) by specifying that all of unless it has verified that the drug was
1847B(a)(3)(A)(ii) of the Act, which the following elements shall be required administered. If the approved CAP
states that deductible and coinsurance to document the verification of CAP vendor believes that the drug was
shall not be collected unless the drug or drug administration: administered but later learns that it was
biological is administered, remains • Beneficiary’s name. not, the approved CAP vendor must
unchanged. Thus, because we have • Health insurance number. refund any coinsurance collected to the
interpreted this provision as requiring • Expected date of administration. beneficiary and his or her supplemental
verification of administration prior to • Actual date of administration. insurer, as applicable. In addition, in
the collection of applicable cost sharing • Identity of the participating CAP § 414.914(i)(2), we are proposing that
amounts, the requirement for physician. the approved CAP vendor must
verification of administration similarly • Prescription order number. promptly refund any payment made by
CMS if the vendor has been paid for claim was submitted by a participating familiar with the relevant coverage
drugs that were not administered. We CAP physician, the approved CAP policies for that jurisdiction.
are proposing that promptly is defined vendor’s claim and the participating • For the postpayment review
as 2 weeks so that the approved CAP CAP physician’s claim were matched in process, if the designated carrier selects
vendor would have 2 weeks from the the system and the approved CAP the drug claim for review, this
date that they were notified that they vendor’s claim was authorized for constitutes a reopening of the initial
had been paid for a drug that had not payment. determination. If the designated carrier
been administered to the beneficiary to However, changes to the claims cannot verify administration or cannot
refund any payment for the claim made processing requirements and the determine that the drug is covered or
to the designated carrier and refund any addition of a post-payment review medically reasonable and necessary, the
cost sharing collected to the beneficiary process required by section 108(a)(2) of designated carrier issues a revised
and his or her supplemental insurer. the MIEA-TRHCA (discussed above in determination to deny coverage of the
this section) eliminates the approved drug product claim. The designated
f. Approved CAP Vendor Appeals for CAP vendor’s dependency on a carrier then determines whether an
Denied Drug Claims participating CAP physician’s filing of a overpayment exists, and if so, seeks
In the March 4, 2005 proposed rule drug administration claim before the recovery of the overpayment. The
(70 FR 10757 through 10758) and the approved CAP vendor may be paid for approved CAP vendor, as a supplier,
July 6, 2005 IFC (70 FR 39054 through a CAP drug. Accordingly, there is no would then have the right to request a
39057), we discussed the development longer a need to afford party status to redetermination of the revised coverage
of the CAP dispute resolution process the approved CAP vendor for the drug determination, and the overpayment
and the limited applicability of the administration claim submitted by the assessment. The designated carrier will
traditional Medicare fee for service participating CAP physician. Instead, process the redetermination.
appeals process to an approved CAP under the TRHCA legislation, the
vendor’s dispute of CAP drugs claims g. Definition of Exigent Circumstances
approved CAP vendor’s drug claim may
that are denied by the CAP designated be paid by the designated carrier once Sections 1847B(a)(1)(A)(ii) and
carrier. We stated that the approved received. This determination made on 1847B(a)(5)(A)(ii) of the Act require that
CAP vendor could file appeals as a the claim constitutes an initial each physician be given the opportunity
Medicare supplier consistent with the determination as defined in § 405.924. annually to elect to obtain drugs and
rules at 42 CFR Part 405, Subpart I. For The approved CAP vendor is considered biologicals through the CAP and to
the purposes of the appeals regulations a party to this initial determination, and select an approved CAP vendor. Section
at Part 405, Subpart I, we indicated that thus, may request a redetermination and 1847B(a)(5)(A)(i) of the Act allows for
a local carrier’s initial determination of subsequent appeals consistent with the selection of another approved CAP
the participating CAP physician’s drug process established under 42 CFR Part vendor more frequently than annually
administration claim was an initial 405, Subpart I. in exigent circumstances as defined by
determination regarding payment of the The changes proposed to CAP claims CMS.
approved CAP vendor’s drug claim. processing in this proposed rule that In the CY 2006 PFS final rule with
Thus, the approved CAP vendor was to conform to the TRHCA legislation result comment period (70 FR 70258), we
be considered a party to any in two scenarios that create appeals stated that participating CAP physicians
redetermination of the drug rights for the approved CAP vendor would have the option of changing
administration claim by the local with respect to their drug product claim: approved CAP vendors or opting out of
carrier. In addition, the approved CAP (1) Prepayment denials of the approved the CAP program on an annual basis.
vendor would be considered a party to CAP vendor’s claim made by the We also provided the circumstances, as
an initial determination on the claim for designated carrier (based on information specified in § 414.908(a)(2), under
payment for the drug product the from the local carrier that the payment which a participating CAP physician
approved CAP vendor filed with the for the drug should be denied as may choose a different approved CAP
designated carrier. We also specified excluded or non-covered); and (2) post- vendor mid-year or opt-out of the CAP.
that appeals of either initial payment denials by the designated These circumstances are: (1) If the
determination would be filed with the carrier based on the post-payment selected approved CAP vendor ceases to
local carrier. We stated that the local review process established under participate in the CAP; (2) if the
carrier, rather than the designated TRHCA. participating CAP physician leaves the
carrier, possessed all information Therefore, we are proposing the group practice that had selected the
necessary to adjudicate an appeal in this following clarifications regarding the approved CAP vendor; (3) if the
situation. Such information included CAP appeals process for an approved participating CAP physician relocates to
local coverage decisions, medical CAP vendor’s denied drug claims: another competitive acquisition area (if
necessity determinations, and • For prepayment denials, the multiple CAP competitive areas are
information regarding payment of drug approved CAP vendor, as a supplier, has developed) or, (4) for other exigent
administration claims. A dispute a direct right to appeal the initial circumstances defined by CMS. We also
resolution process was set forth in determination made by the designated identified a separate exigent
§ 414.916. carrier on its drug product claim. The circumstance relating to instances in
Under our initial implementation of local carrier will conduct the which an approved CAP vendor
the provision that authorized CAP, this redetermination on prepayment denials. declines to ship CAP drugs (when the
alternative approach, which provided We acknowledge that this process conditions of § 414.914(h) are met) in
party status to the approved CAP vendor differs from a traditional fee-for-service § 414.908(a)(5). We noted that in all
on the participating CAP physician’s appeal since the redetermination will these cases, while there is only one drug
drug administration claim, was not be conducted by the contractor that category for CAP, the participating CAP
necessary because an approved CAP issued the initial determination. physician would be allowed to opt-out
vendor was not permitted to receive However, we believe the local carrier is of the CAP altogether.
payment for a CAP drug until the the most appropriate entity to review The CAP became operational on July
corresponding drug administration the prepayment denial since it is most 1, 2006. Since that time, we have been
contacted by a few participating CAP system despite a good faith effort, or but still prepare a speedy summary of
physicians requesting that they be that the practice relied on misleading the issues involved in the physician’s
permitted to cancel their election information about the program from request. After the 2-day or 4-day period,
agreement. Some of these requests have outside sources when making the as applicable, the designated carrier
come from physician practices that decision to participate and has proof of would forward the physician’s request,
misunderstood the program but found receiving such information. The request along with its recommendation, to CMS.
the program structure workable after would be sent to the CAP-designated We would then review the
further education about the CAP. Other carrier under the dispute resolution recommendation and make a final
requests have come from participating process, and within 1 business day the decision within 2 business days of the
CAP physicians who identified designated carrier would determine date we received the request.
significant concerns within the first few whether the request was related to the If we agree that the participating CAP
weeks of their participation that could service provided by the approved CAP physician has demonstrated that
not be resolved through provider vendor. If so, the CAP designated carrier remaining in the CAP is a significant
education. When we initially would refer the participating CAP burden, we would allow that physician
implemented the CAP, we believed that physician to his or her approved CAP to terminate his or her participation in
most issues raised by participating CAP vendor’s grievance process to further the program. We would inform the CAP-
physicians would relate to quality and determine whether any appropriate and designated carrier of its decision and the
service issues that could be resolved reasonable steps could be taken to decision would be communicated to the
through the approved CAP vendor’s resolve the issue the participating CAP participating CAP physician in writing
grievance process and the dispute physician had identified. The approved by the designated carrier. As part of this
resolution process conducted by the CAP vendor would have 2 business days process, the physician’s termination
designated carrier. However, our to respond to the participating CAP date for his or her CAP election
experience with the initial operation of physician’s concern, consistent with our agreement would be determined and
the CAP has demonstrated that there regulations at § 414.914(f)(5). If the communicated to the all parties
may be other business reasons a practice approved CAP vendor was unable to involved, including the physician’s
might wish to leave the program that are identify a solution, consistent with the local carrier. If we do not believe that
unrelated to the approved CAP vendor’s CAP statute, regulations, contracts and the physician has demonstrated a
performance. Examples of these include guidance, and acceptable to the significant burden, we would not allow
a demonstration of financial hardship physician, for resolving the issue, the the physician to terminate his or her
due to participation in the CAP, the participating CAP physician would be participation in the CAP. We would
practice’s inability to update its billing referred back to the CAP designated inform the physician of such a decision
system despite a good faith effort, or carrier for assistance under the dispute and would include a recommendation
that the practice relied on misleading resolution process. for corrective action (such as education),
information about the program from and the right to request reconsideration
We propose that the participating as specified in § 414.917.
outside sources when making the CAP physician’s request would be If we agree to terminate the
decision to participate. Therefore, while handled under the dispute resolution participating CAP physician’s CAP
we continue to believe that process because procedures and defined election agreement, the physician would
opportunities for leaving the CAP time frames for handling participating be required to continue to cooperate in
outside the annual election process CAP physician and approved CAP any post-payment review and appeals of
should be limited because the CAP was vendor complaints are already claims for drugs that the approved CAP
designed as a program that physicians developed under the CAP dispute vendor had already provided to the
would make a decision to participate in resolution process. If the designated physician and been paid for. The
on an annual basis, consistent with carrier did not believe the participating physician would also have to make
section 1847B(a)(5)(A) of the Act, we are CAP physician’s request was related to arrangements with the approved CAP
proposing to define an additional an issue that could be resolved by the vendor for the return of any unused
exigent circumstance for opting out of approved CAP vendor, then the drugs that had not been administered to
the CAP. Under this proposed exigent designated carrier would seek to resolve the beneficiary prior to the effective date
circumstances exception, a participating any other issues raised by the physician of the physician’s termination from the
CAP physician would be able to submit in the request to terminate CAP CAP. If the approved CAP vendor has
a written request to terminate his or her participation. The designated carrier inadvertently billed CMS for drugs that
CAP physician election agreement would conduct an investigation into the had not been administered to a
within 30 days of its effective date, and physician’s request to terminate his or beneficiary, the vendor would be
CMS would grant such a request if the her CAP election agreement and attempt required to correct the claim and return
participating CAP physician could to resolve any issues. If the designated any overpayment.
demonstrate that remaining in the CAP carrier is unable to resolve the situation
would be a significant burden. to the physician’s satisfaction, within 2 h. Transporting CAP drugs
The participating CAP physician business days, the designated carrier Although section 1847B((b)(4)(E) of
would be required to submit a written can either make a recommendation to the Act provides for the shipment of
request to terminate his or her CMS that the physician be permitted to CAP drugs to settings other than a
participation in the CAP, along with a terminate his or her CAP election participating CAP physician’s office
reason for the request to leave the CAP, agreement or request a 2-day extension under certain conditions, we did not
within 30 days of the effective date of to continue an attempt to resolve the propose to implement the CAP in
the election agreement. Examples of a issue. We believe that 4 business days alternative settings. In the July 6, 2005
significant burden include, but are not would be sufficient to conclude this IFC, we described both comments that
limited to the following: A process because it would give the carrier supported the idea of allowing
demonstration of financial hardship due time to gather information from other participating CAP physicians to
to participation in the CAP, the affected parties, such as the transport drugs to multiple office
practice’s inability to update its billing participating CAP physician’s carrier, locations and comments that raised
concerns about the risk of damaging a regulations. We are also seeking fewer total characters have been used by
drug that has not been kept under comments on whether any agreement the approved CAP vendor.
appropriate conditions while being allowing participating CAP physicians Each prescription order number is
transported. to transport CAP drugs to alternate unique to a dose of a CAP drug that is
As stated in § 414.906(a)(4), we practice locations should be voluntary, being shipped for administration to a
implemented the CAP with a restriction meaning that approved CAP vendors particular beneficiary. The approved
that CAP drugs should be shipped would not be required to offer such an CAP vendor is responsible for
directly to the location where they will agreement and physicians who generating the prescription order
be administered. However, we were participate in the CAP would not be number, and as stated in the July 6,
aware that physicians may desire to required to accept such an offer. Finally, 2005 IFC (70 FR 39042), each dose of a
administer drugs in alternative settings, we are seeking comments on whether CAP drug is required to have a separate
especially in a home. We sought the agreement should be documented in prescription order number to facilitate
comment on how this could be writing, and whether it is necessary to claim matching and approved CAP
accommodated under the CAP in a way create any restrictions on which CAP vendor payment. Although the CAP
that addresses the concerns about drugs could be transported. Again, we prescription order number on the
product integrity and damage to the remind potential commenters that we approved CAP vendor’s claim is no
approved CAP vendors’ property are not making a specific proposal at longer matched to the prescription order
expressed by the potential vendors. this time, but we will use any number on the participating CAP
Several comments submitted in information we receive to structure a physician’s claim prior to claims
response to the July 6, 2005 IFC future proposal, in the event we make payment, the prescription order is still
suggested either narrowing or removing one. used to track each dose of a drug that
the restriction on transporting drugs to is shipped by the approved CAP vendor
other locations. Commenters believed i. Alternatives to the CAP Prescription
Order Number to the participating CAP physician and
that physicians were knowledgeable administered to the beneficiary. Prior to
about drug stability and handling, and paying the approved CAP vendor’s
therefore, were capable of assuming this We received a number of comments
that we responded to in the July 6, 2005 claim for a drug the CAP designated
responsibility. Other commenters
IFC (70 FR 39043 and 39049,) about the carrier uses the prescription order
pointed out that transporting the drug to
administrative burden that the CAP number to check the claims processing
another office location may allow for
ordering and claims payment process system to ascertain whether the local
flexibility in scheduling patient visits. It
imposes upon participating CAP carrier has adjudicated the drug
would allow practices with satellite
physicians; specifically, activities administration claim. If so, the CAP
operations that are not open every
associated with using and tracking the designated carrier will look to see
business day to receive shipments of
prescription order number were whether the local carrier determined
CAP drugs at another practice location
mentioned. In response to the IFC, we that the CAP drug administered by the
and then to administer the drugs in the
satellite office. have received additional comments on participating CAP physician is covered
These comments and our experience this issue. After the close of the and is medically necessary. If the
with the CAP thus far, have caused us comment period we also received an participating CAP physician’s local
to consider changing our position. inquiry from the current approved CAP carrier has not made a determination on
Therefore in this proposed rule, we are vendor about the potential length of the the physician’s claim and the CAP drug
seeking comment on the potential CAP prescription order number and claim, the designated carrier will pay
feasibility of narrowing the restriction whether it could present a burden to the approved CAP vendor’s claim upon
on transporting CAP drugs where this is participating CAP physicians. A 30-byte receipt and use the CAP prescription
permitted by State law and other field is currently available on the order number to help verify drug
applicable laws and regulations. We are electronic claim form for prescription administration on a post-payment basis.
asking commenters to consider how numbers; however, it is not necessary The prescription order number
such a policy could be constructed so for the prescription order number to be accompanies each dose of drug that is
that the approved CAP vendor could 30 bytes long. To meet national sent to a participating CAP physician.
retain control over how drugs that it electronic standards for the automated After the drug is administered, the
owns are handled (we remind transfer of certain health care data participating CAP physician’s drug
commenters that CAP drugs are the mandated by the Health Insurance administration claim is submitted with
approved CAP vendor’s property until Portability and Accountability Act of a no-pay line containing the
they have been administered). We 1996 (Pub. L. 104–191) (HIPAA), prescription order number. The
welcome comments on other issues that Medicare claims that are submitted approved CAP vendor’s claim for the
we should take into account as we electronically must use a specific data CAP drug also contains the prescription
consider the possibility of future format. Within this framework, the CAP order number.
changes to the regulation so that CAP prescription order number is captured Under the claims matching system
drugs may be transported from one in Loop 2410, REF02 (REF01=XZ) of the used when the CAP was implemented,
approved CAP physician’s practice ANSI 4010A1 electronic claims the prescription order number was used
location to another office location that is transaction. This segment is designed to to match an approved CAP vendor’s
listed on the physician’s CAP election capture the assigned prescription CAP drug claim to the participating CAP
agreement form. We also welcome number. The requirements for physician’s drug administration claim
comments on how to structure developing the CAP prescription order in the claims processing system prior to
requirements so that drugs are not number are as follows: the first 9 payment. The presence of a drug
subjected to conditions that will characters are the approved CAP administration claim with a matching
jeopardize their integrity, stability or vendor’s ID and the HCPCS code of the prescription order number indicated
sterility while being transported and drug that is being billed for; the that the drug on the corresponding
steps to keep transportation activities approved CAP vendor sets the approved CAP vendor’s claim had been
consistent with all applicable laws and remaining characters. Typically, 15 or administered and a successful match
allowed the approved CAP vendor to be products in the same form in which and it is consistent with applicable laws
paid for that claim. they are received from the and regulations. We believe that this
At this time, section 108(a)(2) of the manufacturer, without opening approach will minimize the waste
MIEA–TRHCA requires us to make packaging or containers, mixing or associated with using a 100mg single
payment upon receipt of an approved reconstituting vials, or repackaging. use vial for the treatment of wet AMD
CAP vendor’s drug claim and then to Specifically, the commenters were and will increase the flexibility for
conduct a post-payment review of concerned about the capabilities of participating CAP physicians by making
claims. As stated in the MIEA–TRHCA, individuals who mix the drug, as well an alternative quantity of this drug
the post-payment review process is as shipping conditions, storage, and available to participating CAP
intended to ‘‘assure that payment is stability. physicians whose carriers have
made only for a drug or biological * * * We responded by stating that the CAP applicable policies.
if the drug or biological has been is not intended to require approved CAP However, this option is not available
administered to a beneficiary.’’ Under vendors to perform pharmacy admixture in all areas. Therefore, we are
this new process, the prescription order services, (for example, to furnish considering reassessing our policy on
number is still used to establish that the reconstituted or otherwise mixed drugs the use of prefilled syringes to
drug that is being billed for by the repackaged in IV bags, syringes, or other determine whether it would be feasible
approved CAP vendor has been containers that are ready to be to make the option of using prefilling
administered by the participating CAP administered to a patient) when syringes supplied by an approved CAP
physician and that the vendor’s claim is furnishing CAP drugs. Admixture vendor available to all physicians who
payable. Situations such as the services for injectable drugs require participate in the CAP, rather than
frequency of recurring cyclic drug specialized staff, training, and requiring physicians to go outside the
treatment regimens, the possibility of equipment, and these services are CAP in order to obtain CAP drugs in
temporary interruption to these subject to standards such as United prefilled syringes. We are seeking
regimens, and the lack of agreement States Pharmacopoeia Chapter 797, comments on whether allowing
between the approved CAP vendor’s Pharmaceutical Compounding—Sterile approved CAP vendors to repackage
anticipated day of service and the actual Preparations. These requirements have CAP drugs in certain situations may be
date that the drug is administered make significant impact on drug shipping, beneficial to beneficiaries, the program,
the use of an aid to assist accurate storage, and stability requirements, as and to the physicians who participate in
tracking of CAP drugs desirable. We well as system cost and complexity. As it. We are not proposing to make a
believe that the prescription order stated in § 414.906(a)(4), the approved change to our regulations at this time,
remains an appropriate and necessary CAP vendor must deliver ‘‘CAP drugs but we are seeking additional
tool to track the administration of a directly to the participating CAP information that might allow us to
specific dose of a drug and for the physician in unopened vials or other consider making such a change in the
accurate execution of the post-payment original containers as supplied by the future.
review process. manufacturer or from a distributor that In considering whether to propose a
Although we believe that the use of has acquired the products directly from change to our regulations in the future,
the prescription order number is the manufacturer.’’ we seek comments on whether
necessary to facilitate accurate review of Since issuing the July 6, 2005 IFC, we approved CAP vendors are likely to be
CAP claims, we are aware that it may be have become aware that bevacizumab pharmacies or have access to pharmacy
considered an inconvenience by some (Avastin) is being used for the services with trained personnel and
potential CAP-participating physicians treatment of exudative age-related facilities for the small scale preparation
and approved CAP vendors. Therefore, macular degeneration (wet AMD) in of sterile drug products in response to
we are seeking comment on alternative very small doses. Although this is an a specific prescription order for a
methods that could be used to off-label use, it is gaining acceptance specific patient. At this time there is no
accurately track the administration of among ophthalmologists who treat wet specific requirement for approved CAP
specific doses of drugs in order to meet AMD and this use has been the subject vendors to be pharmacies. Also, please
the requirements stated in section of several carriers’ local coverage note we are describing a specialized
108(a)(2) of the MIEA–TRHCA. We are determinations. Bevacizumab is pharmacy function; we are not
not proposing to implement such a considerably less expensive than certain contemplating manufacturing of drug
change at this time, but would like to other drugs used in the treatment of wet products under this program.
receive comments on other methods that AMD. We are also seeking comments on
could be used to track CAP drug The smallest commercially available whether an approved CAP vendor
administration on a dose by dose basis. package of bevacizumab is a 100mg should be given an opportunity to
We may propose a change in future single use vial, while a dose used to supply bevacizumab under the CAP if it
rulemaking. treat wet AMD is approximately 1mg. is repackaged in a patient-specific dose
Some local carriers who have issued consistent with applicable state laws
j. Prefilled Syringes coverage instructions for the use of and regulations upon request from a
In the July 6, 2005 IFC (70 FR 39061), bevacizumab in the treatment of wet participating CAP physician.
we described public comments that AMD allow physicians to obtain these Furthermore, we are seeking comments
stated that participating CAP physicians small doses of drug from a pharmacy on whether this sort of activity should
could not vouch for the quality of that is capable of preparing sterile be restricted to bevacizumab, or
products that were opened by an products. We expect to issue possibly phased-in for other CAP drugs.
approved CAP vendor for repackaging, instructions that will allow participating If we were to apply this sort of policy
for mixing the drug with other drugs or CAP physicians to use the furnish as to other CAP drugs, we would also have
injectable fluids (admixture), or for written option, as appropriate, and to to determine how phasing-in might
removing a part of the contents to obtain small doses of bevacizumab occur, which drugs it should apply to
supply the exact dose for a beneficiary. outside of the CAP in prefilled syringes and whether the preparation of
Several commenters recommended that if their local carrier’s coverage admixtures (including the preparation
approved CAP vendors deliver their determinations allow such a practice of sterile syringes, minibags, and mixing
of drugs and solutions intended for particularly if they provide an testing. Specimens stored 30 days or
intravenous administration) should be opportunity for the approved CAP less have a date of service of the date the
allowed as well. vendor to come into compliance using test was performed only if—
We also seek comments on how this objective goals and a set timeline. (a) The test is ordered by the patient’s
sort of service could be limited to Therefore, we are seeking comments on physician at least 14 days following the
participating CAP physicians who what types of potential contractual date of the patient’s discharge from the
voluntarily agree to use it, and whether provisions that could be used to hospital;
such an agreement should be made in encourage approved CAP vendors to (b) The specimen was collected while
writing between the approved CAP comply with CAP requirements for less the patient was undergoing a hospital
vendor and the participating CAP serious violations, such as missing surgical procedure;
physician. We also seek comment on reporting deadlines, or participation in (c) It would be medically
how such a program could be structured inappropriate promotional strategies. inappropriate to have collected the
so that the service and staff engaged in Given that the CAP statute does not sample other than during the hospital
providing the service would be required provide for the imposition of sanctions procedure for which the patient was
to meet all applicable laws (including such as withholding payment or admitted;
Stark, Anti-kickback, and State imposing other types of monetary (d) The results of the test do not guide
pharmacy laws, as well as regulations penalties, we believe that building treatment provided during the hospital
for the preparation of sterile products, appropriate provisions into the stay; and
(including standards for product approved CAP vendor’s contract to (e) The test was reasonable and
integrity and sterility). We also seek address noncompliance or expanding medically necessary for the treatment of
comments on whether the cost of the approved vendor’s code of conduct an illness.
preparing such product would be by proposing more specific CMS In addition, § 414.510(b)(3) specifies the
included in the CAP vendor’s bid price. requirements could be appropriate conditions for the date of service for a
Finally, we seek comments on whether approaches. We are requesting chemosensitivity test.
any other important elements should be comments on what type of contractual When we added § 414.510, we
evaluated if we consider changing CAP provisions would be suitable, for indicated the provision applies to
policy on prefilled syringes in the example, requests for specific or clinical diagnostic laboratory tests. For
future. targeted reporting and monitoring outpatients, clinical diagnostic
k. Contractual Provisions activities in response to specific laboratory tests are paid under the
violations, etc. We are also looking for Medicare Part B clinical laboratory fee
Section 1847B of the Act is generally comments on whether an approved CAP schedule. Upon further review, we
silent on the subject of disputes vendor’s code of conduct could be used believe the provision should also apply
surrounding the delivery of drugs and to address these types of less serious to the technical component (TC) of
the denial of drug claims. However, situations and how that could be physician pathology services. In
section 1847B(b)(2)(A)(ii)(II) of the Act accomplished. Finally, we invite practice, the collection date for both
states that a grievance process is a comments on whether the CAP clinical laboratory services and the TC
quality and service requirement physician election agreement should be of physician pathology services is
expected of approved CAP vendors. In revised to include provisions to address similar. Therefore, we believe § 414.510
the July 6, 2005 IFC (70 FR 39055 participating CAP physicians’
through 39058), we described the should apply to both types of services.
noncompliance with CAP rules or the This will improve claims processing
process for the resolution of approved CAP election agreement. We will use
CAP vendors’ claims denials and the and adjudication in relation to the
any information that we receive on clarity of dates of service, accuracy of
resolution of participating CAP these issues to possibly develop a future
physicians’ drug quality and service payment, and detection of duplicate
proposal. services. For outpatients, the TC of
complaints. We encouraged
participating CAP physicians, G. Issues Related to the Clinical physician pathology services can be
beneficiaries, approved CAP vendors, Laboratory Fee Schedule paid under the PFS or the hospital
and the designated carrier to use OPPS. As a result, for § 414.510, we are
[If you choose to comment on issues
informal communication as a first step proposing to revise the section heading
to resolve service-related administration and introductory sentence to specify the
caption ‘‘CLINICAL LABORATORY
issues. However, we recognized that provision applies to both clinical
ISSUES’’ at the beginning of your
certain disputes would require a more laboratory and pathology specimens. We
comments.]
structured approach, and therefore, we are also revising § 415.130(d) to include
1. Date of Service for the Technical a reference to § 414.510.
established processes under § 414.916
Component of Physician Pathology
and § 414.917. 2. New Clinical Diagnostic Laboratory
Suspension and termination from the Services (§ 414.510)
Test (§ 414.508)
CAP were the only remedies described In the CY 2007 PFS final rule with
comment period (71 FR 69787), we a. Background
under the CAP dispute resolution
processes. Having gained some added § 414.510 for the date of service In the CY 2007 PFS final rule with
experience with the CAP, we believe of a clinical diagnostic laboratory test comment period (71 FR 69701), we
that having an intermediate level of that uses a stored specimen. Generally, adopted a new subpart G under part 414
remedy is desirable in order to bridge our policy states the date the specimen that implemented section 942(b) of the
the gap between taking no action and is collected is the date of service for MMA requiring that we establish
suspension or termination of an claims review and adjudication. procedures for determining the basis for,
approved CAP vendor for less serious However, for a laboratory test that uses and amount of payment for any clinical
but persistent problems. a stored specimen, the date of service is diagnostic laboratory test for which a
We believe that additional contractual the date the specimen was obtained new or substantially revised HCPCS
obligations, such as additional reporting from the storage for a specimen that is code is assigned on or after January 1,
requirements could be useful, stored for more than 30 days before 2005 (‘‘new tests’’).
Under § 414.508, we use one of two § 162.1003, a code for a new test may be scheduled on July 16, 2007. Although
bases for payment to establish a developed either by the AMA’s CPT we encourage the public to suggest
payment amount for a new test. Under Editorial Panel, which maintains and improvements to our gapfilling process
§ 414.508(a), the first basis, called distributes the CPT codes, or HHS, at the upcoming clinical laboratory
‘‘crosswalking,’’ is used if a new test is which maintains and distributes the public meeting, we recommend that
determined to be comparable to an HCPCS codes. The codes to be included interested parties also submit written
existing test, multiple existing test in the upcoming year’s fee schedule comments on the proposed changes for
codes, or a portion of an existing test (effective January 1) are available as the gapfilling process contained in this
code. If we use crosswalking, we assign early as May. We then list the new rule. Written comments will be
the new test code the local fee schedule clinical laboratory tests codes on our considered in the final rule to the extent
amounts and national limitation amount Web site, usually in June, along with that these comments relate to the issues
(NLA) of the existing test code or codes. registration information for the public discussed in this proposed rule.
If we crosswalk to multiple existing test meeting. Discussions with our contractors and
codes, we determine the local fee The public meeting is held no sooner other interested parties revealed the
schedule amounts and NLA based on a than 30 days after we announce the length of time we allow for a contractor
blend of payment amounts for the meeting in the Federal Register. The to establish a carrier-specific amount
existing test codes. For example, we public meeting is typically held in July. may sometimes be insufficient for
may pay based on 75 percent of the In September, we post our proposed obtaining additional sources and data
payment amounts for one existing test determination of the basis for payment on a new test. However, our contractors
code and 25 percent of the payment for each new code. We also seek public and other interested parties were also
amounts for another existing test code. comment on these proposed concerned that if procedures and
The second basis for payment is determinations of the basis for payment. determinations were permitted to
‘‘gapfilling.’’ Under § 414.508(b), we use The updated clinical laboratory fee extend over too long a time frame, the
gapfilling when no comparable existing schedule is prepared in October for uncertainty of the final payment amount
test is available. We instruct each release to our contractors during the would be detrimental for laboratories,
Medicare carrier to determine a carrier- first week in November. Our contractors practitioners, and patients for
specific amount for use in the 1st year have many information system steps to incorporating new technology tests and
that the new code is effective. The complete during the months of improving patient care.
sources of information that these November and December so that the In addition, in response to the CY
carriers examine in determining carrier- updated clinical laboratory fee schedule 2007 PFS proposed rule, a commenter
specific amounts include: is ready to pay claims effective January requested that we establish a formal
• Charges for the test and routine 1 of the following calendar year. review, or reconsideration process of a
discounts to charges; In response to the CY 2007 PFS payment amount determination. In
• Resources required to perform the proposed rule, we received several response to the comment, we revised
test; comments regarding the level of detail § 414.508(b)(3) to provide that if we
• Payment amounts determined by of information presented during the gapfill a test, but determine after the 1st
other payers; and public meeting process. We responded year of gapfilling that carrier-specific
• Charges, payment amounts, and that we did not believe that gapfilled amounts will not pay for the
resources required for other tests that opportunities for information gathering test appropriately, in the 2nd year we
may be comparable (although not on new tests have been fully utilized may use the crosswalk basis to establish
similar enough to justify crosswalking) within the public meeting process and fees for the test. We also stated that we
or otherwise relevant. that payment recommendations from expected to solicit comments on a
After the first year, the carrier-specific the public have sometimes lacked potential reconsideration process in a
amounts are used to calculate the NLA charge, cost, and clinically detailed future rulemaking.
for subsequent years. Under information for the new clinical At § 414.509, we are proposing a
§ 414.508(b)(2), the test code is paid at laboratory tests. We also stated that reconsideration process for determining
the NLA, rather than the lesser of the when soliciting public input for the the basis for and amount of payment for
NLA and the carrier-specific amounts. meeting we would recommend that all any new test for which a new or
In the CY 2007 PFS final rule with participants in the public meeting substantially revised HCPCS code is
comment period, we also explained that consultation process strive for assigned on or after January 1, 2008. We
we notify our carriers when to use the transparency and try to provide as much have strived to balance additional
gapfill method described with a supporting information as possible to opportunities for public input against
program instruction which lists the assist us in evaluating their the necessity for establishing final fees
specific new test code and the recommendations. for new clinical laboratory test codes.
timeframes to establish carrier-specific We also received some comments that Section 1833(h)(8)(A) of the Act
amounts. Contractors are required to suggested that the method used by provides broad authority to develop
establish carrier-specific amounts on or contractors to determine their price for through regulation procedures for the
before March 31 of the year. Contractors gapfilled tests should be more specific. method for determining the basis for
may revise their payment amounts, if We responded that we would engage in and amount of payment for new tests.
necessary, on or before September 1 of discussions with our carrier contractors We believe that we have authority under
the year. In this manner, a carrier may and laboratory industry representatives section 1833(h)(8)(A) of the Act to
revise its carrier-specific amount based to explore their experiences with the establish procedures under which we
on additional information during the 1st gapfill process. We also agreed to host may reconsider the basis for and amount
year. a forum to listen to suggestions from the of payment for a new test. Furthermore,
In the CY 2007 PFS final rule with public. under section 1833(h)(8)(D) of the Act,
comment period (71 FR 69702), we also We have discussed these issues with the Secretary may convene such other
described the timeframes for our contractors. We also plan to solicit public meetings to receive public
determining the amount of and basis for comments on the gapfill process in the comments on payment amounts for new
payment for new tests. Under 45 CFR clinical laboratory public meeting tests as the Secretary deems appropriate.
We note that, under both section basis for payment. If we elect to comment orally at the next public
1833(h)(8)(B)(v) of the Act and reconsider the basis for payment, we meeting.
§ 414.506(d)(2), the Secretary must make would post our determination as to After considering the comments
available to the public a list of ‘‘final whether we would change of the basis received and the information of the
determinations.’’ We do not believe that for payment on the CMS Web site on or public meeting, we would post our
these provisions preclude us from before January 1 of the next year. Our decision as to whether we had elected
reconsidering our final determinations. decision regarding the basis for payment to reconsider our determination of the
It is not unusual for us to provide for would be final and not subject to further crosswalked code or codes and the
discretionary reopening or reconsideration. resulting amount of payment. If we elect
reconsideration of final agency action. If we change our prior determination to reconsider the amount of payment
For example, under § 405.1885, we may of the basis for payment, the new and had determined that we should
reopen a final agency determination determination would be effective the revise the amount of payment, we
regarding payment to a provider of following January 1. We would not would post a new determination of the
services. reopen or otherwise reprocess claims code or codes to which we would
with dates of service prior to the crosswalk the test on or before January
b. Basis for Payment 1 of the next year. Our decision
effective date of the revised
Under our existing procedures for determination. regarding the amount of payment would
determining the basis for payment of a We note that, under our proposed be final and not subject to further
new test, either to crosswalk or gapfill, reconsideration processes (for both the reconsideration.
we receive comments on the appropriate basis for payment and amount of If we change our prior determination
basis for payment for a new test both at payment), we would make two separate of the amount of payment, the new
the public meeting in July and after we decisions. First, we would decide determination would be effective the
announce our proposed determinations whether to reconsider our prior following January 1. We would not
in September. In November, we post our determination. If we elect to reconsider reopen or otherwise reprocess claims
determination for the basis for payment our prior determination, we would then with dates of service prior to the
for the new test on the CMS Web site. determine whether we should change effective date of the revised
This determination of the basis for our prior determination. determination.
payment is final, except in the case of As discussed in section II.G.2.b., we
a gapfilled test for which we later c. Amount of Payment may also change the basis for payment
determine that gapfilling is not i. Crosswalking for a new test as the result of
appropriate under § 414.508(b)(3). reconsideration. If we change the basis
We are proposing to create a Under our existing procedures, for payment from gapfilling to
reconsideration process for commenters recommend the code or crosswalking, we would also determine
determinations of the basis, either codes to which to crosswalk a new the code or codes to which we would
crosswalking or gapfilling, for payment clinical laboratory test both at the public crosswalk the test. Because we believe
of a new clinical diagnostic laboratory meeting in July and during the comment it is important to establish final
test. Consistent with our existing period after we issue our proposed payment amounts within a reasonable
process, we would make a determination in September. We amount of time, we are proposing that
determination using the information consider the appropriate basis for these determinations of crosswalked
gathered from the public meeting payment and the amount of payment at payment amounts would not be subject
process and post a determination of the the same time. Therefore, commenters to reconsideration.
basis for payment, either to crosswalk or that recommend crosswalking as the
gapfill, on the CMS Web site, likely in basis for payment for a new test also ii. Gapfilling
November. Under § 414.508, claims make recommendations concerning the As discussed in this preamble and in
would be paid using this basis to code or codes to which to crosswalk the accordance with § 414.508(b), after we
calculate fees beginning January 1. We new test. In November, we post the code determine that gapfilling will be the
would accept written comments on this or codes to which we will crosswalk the basis for payment for a new clinical
basis determination for 60 days after we test and the payment amount for the test diagnostic laboratory test, we instruct
posted the determination on the CMS on the CMS Web site. This our contractors to determine carrier-
Web site. If a commenter recommended determination is final. specific gapfill amounts by April 1 and
that we switch from gapfilling to We are proposing to create a finalize carrier-specific amounts by
crosswalking for a new code, the reconsideration process under which we September 30. We include the
commenter would also have the may reevaluate the code or codes and determinations of carrier-specific
opportunity to recommend the code or their corresponding fees to which we amounts and the NLA for the new test
codes to which to crosswalk the new crosswalk a new test’s fees. After we code in the clinical laboratory fee
test code. posted our determination of the code or schedule the following November when
In addition, those members of the codes to which the test would be we post our payment determinations on
public who submitted a written crosswalked on the CMS Web site, we the CMS Web site. Except in the case of
comment within the 60-day comment would pay claims on the basis of this a gapfilled test for which we determine
period would also have the opportunity determination beginning January 1. We that gapfilling was not appropriate
to present their comment orally at the would accept written comments on the under § 414.508(b)(3), these
next clinical laboratory public meeting crosswalked code or codes and the determinations are final.
and hear other comments during the resulting amount of payment for the We are proposing to provide for a
public meeting. new code for 60 days after we posted reconsideration process for gapfilled
After considering the comments the determination on the CMS Web site. payment amounts. Under this process,
received and the information of the In addition, a commenter, who had by April 30, we would post the carrier-
public meeting, we would post our submitted a written comment within the specific amounts on the CMS Web site.
decision as to whether we elected to 60-day comment period, would also be Interested parties would submit written
reconsider our determination of the given the opportunity to present their comments to CMS on the carrier-
specific amounts within 60 days from d. Jurisdiction for Reconsideration and services needed to furnish dialysis
the date of posting the carrier-specific Decisions treatments that include, but not be
amounts. In addition, those We are proposing that jurisdiction for limited to, certain routinely provided
commenters, who had submitted a reconsideration would rest exclusively drugs, laboratory tests, supplies, and
written comment within the 60-day with the Secretary. A decision whether equipment. Unless specifically included
comment period, would be given the in the composite rate, other injectable
to reconsider a determination would be
opportunity to present their comments drugs and laboratory tests medically
committed to the discretion of the
orally at the next clinical laboratory necessary for the care of the dialysis
Secretary. Accordingly, a refusal to
public meeting. patient are separately billable. The base
reconsider an initial determination
Carriers would finalize carrier- composite rates per treatment, effective
would not be subject to administrative
specific amounts by September 30 and on August 1, 1983, were $123 for
or judicial review. We recognize that
we would set the NLA be at the median independent ESRD facilities and $127
parties dissatisfied with an initial
of the carrier-specific amounts. for hospital-based ESRD facilities. The
determination as to the amount of
However, based on the comments Congress has enacted a number of
payment for a particular claim for
received, we would evaluate whether adjustments to the composite rate since
laboratory services may appeal the that time. The current 2007 base
we should reconsider the carrier- initial determination under part 405, composite rates are $132.49 for
specific amounts and NLA. If we elected subpart I of our regulations. Under our independent ESRD facilities and
no to reconsider the carrier-specific proposal, a party could challenge under $136.68 for hospital-based ESRD
amounts and the NLA, we would post part 405, subpart I a determination facilities.
the carrier-specific amounts and NLA regarding the amount of payment for a Section 623 of the MMA amended
on the CMS Web site on or before new test—regardless of whether the section 1881 of the Act to require
January 1 of the next year. These amount of payment was established as changes to the composite rate payment
amounts would be based on the carrier- the result of a reconsideration—but a methodology, as well as to the pricing
specific amounts and NLA we had party could not challenge a decision not methodology for separately billable
posted in September. Payment for the to reconsider. drugs and biologicals furnished by
test would be made at the NLA on ESRD facilities.
January 1 of the next year. This 3. Technical Revisions
Section 1881(b)(12) of the Act, as
determination would be final and not We are also proposing technical added by the MMA, required the
subject to further reconsideration. revisions to § 414.502, § 414.506, and establishment of a basic case-mix
If we elect to reconsider the carrier- § 414.508. Under section 1833(h)(8)(A) adjusted prospective payment system
specific amounts and decide to revise of the Act, the term ‘‘new tests’’ is (PPS) that would include the services
our prior determination, we would defined as any clinical diagnostic comprising the composite rate and an
adjust the NLA based on comments laboratory test for which a new or add-on to the composite rate component
received. We would post the revised substantially revised HCPCS code is for the difference between current
NLA on the CMS Web site and payment assigned on or after January 1, 2005. payments for separately billed drugs
for the test would be made at the NLA However, our regulations do not define and the revised drug pricing specified in
beginning January 1. This determination the term ‘‘new test.’’ Therefore, we are the statute. In addition, section
would be final and not subject to further proposing to define the term ‘‘new test’’ 1881(b)(12) of the Act required that the
reconsideration. under § 414.502 using the statutory composite rate be adjusted for a limited
definition. In addition, under § 414.506 number of patient characteristics (case-
We are also proposing that, if we and § 414.508, we are proposing to mix) and section 1881(b)(12)(D) of the
change the basis of payment from replace references to ‘‘new clinical Act gave the Secretary discretion to
crosswalking to gapfilling as the result diagnostic laboratory test that is revise the wage indices and the urban
of a reconsideration, the new gapfilled assigned a new or substantially revised and rural definitions used to develop
payment amount would be subject to code on or after January 1, 2005’’ with them. Finally, section 1881(b)(12)(E) of
reconsideration under proposed references to ‘‘new test.’’ the Act imposed a budget neutrality
§ 414.509(b)(2). Unlike a crosswalked
H. Proposed Provisions Related to requirement, so that aggregate payments
test, the payment amount for a gapfilled
Payment for Renal Dialysis Services under the basic case-mix adjusted
test is not established when we
Furnished by End-Stage Renal Disease composite payment system for 2005
determine the basis for payment because
(ESRD) Facilities would equal the aggregate payments
it takes approximately 9 months for our that would have been made for the same
contractors to establish carrier-specific [If you choose to comment on issues period if section 1881(b)(12) of the Act
amounts. Thus providing for in this section, please include the did not apply.
reconsideration of gapfilled payment caption ‘‘ESRD PROVISIONS’’ at the Before January 1, 2005, payment to
amounts would not lengthen the period beginning of your comments.] both independent and hospital-based
of time it would take to determine a Since August 1, 1983, payment for facilities for the anti-anemia drug,
final payment amount. dialysis services furnished by ESRD erythropoietin (EPO) was established
In addition, we are proposing to facilities has been based on a composite under section 1881(b)(11) of the Act at
amend § 414.508(b)(3) to provide that rate payment system that provides a $10.00 per 1,000 units. For independent
§ 414.508(b)(3) applies to new tests for fixed, prospectively determined amount ESRD facilities, payment for all other
which a new or substantially revised per dialysis treatment, adjusted for separately billable drugs and biologicals
HCPCS code assigned on or before geographic differences in area wage was based on the lower of actual charges
December 31, 2007. We believe that the levels. In accordance with section or 95 percent of the average wholesale
more comprehensive reconsideration 1881(b)(7) of the Act, separate price (AWP). Hospital-based ESRD
procedures we are proposing should composite rates have been established facilities were paid based on the
apply to new or substantially revised for hospital-based and independent reasonable cost methodology for
HCPCS codes assigned after December ESRD facilities. The composite rate is separately billed drugs and biologicals
31, 2007. designed to cover a package of goods (other than EPO) furnished to dialysis
patients. Changes to the payment payments to ESRD facilities under • A method to annually calculate the
methodology for separately billed ESRD section 623 of the MMA. For CY 2006, growth update to the drug add-on
drugs and biologicals that were we further revised the drug payment adjustment required by section
established by the MMA and were methodology applicable to drugs 1881(b)(12) of the Act, as well as growth
effective January 1, 2005 are described furnished by ESRD facilities. All update to the drug add-on adjustment of
in sections II.H.1. and II.H.2. These separately billed drugs and biologicals 0.5 percent for CY 2007. Therefore,
changes affected payments in both CY furnished by both hospital-based and effective January 1, 2007 the drug add-
2005 and CY 2006. independent ESRD facilities are now on adjustment was increased to 15.1
In addition, section 623(f)(1) of the paid based on ASP+6 percent. percent.
MMA directs the Secretary to submit a We recalculated the 2005 drug add-on In addition, section 103 of the MIEA–
Report to Congress detailing a bundled adjustment to reflect the difference in TRHCA established a 1.6 percent update
PPS for services furnished by ESRD payments between the pre-MMA AWP to the composite rate portion of the
facilities to Medicare beneficiaries. The pricing and the revised pricing based on payment system, effective April 1, 2007.
bundled PPS would be a different way ASP+6 percent. The recalculation did Therefore, the current base composite
of paying for ESRD services since it will not affect the actual add-on adjustment rate is $132.49 for independent facilities
include not only composite rate applied to payments in 2005, but and $136.68 for hospital-based facilities.
services, but would also include provided an estimate of what the Also, the effect of this increase in the
separately billable drugs (including adjustment would have been had the composite rate portion of the payment
EPO), laboratory tests, and other 2006 payment methodology been in system was a reduction in the drug add-
separately billable items into one PPS effect in 2005. The drug add-on on adjustment to 14.9 percent, effective
payment rate. We expect to release the adjustment was then updated to reflect April 1, 2007. Since the statutory
REPORT TO CONGRESS this summer. the expected growth in expenditures for increase only applied to the composite
1. CY 2005 Revisions separately billable drugs in CY 2006. rate, this adjustment to the drug add-on
As of January 1, 2006, we also percent was needed to maintain the
In the CY 2005 PFS final rule with drug add-on amount constant.
comment period (69 FR 66319 through implemented a revised geographic
66334), we implemented section 1881(b) adjustment authorized by section 4. Provisions of This Proposed Rule
of the Act, as amended by section 623 1881(b)(12) of the Act. As part of that
change, we— For CY 2008, we are proposing the
of the MMA, and revised payments to following updates to the composite rate
ESRD facilities. These revisions were • Revised the labor market areas to
payment system:
effective January 1, 2005, included incorporate the new CBSA designations • A growth update to the drug add-on
implementation of a case-mix adjusted established by the Office of Management adjustment to the composite rates; and
payment system that incorporated and Budget (OMB); • An update to the wage adjustment
services that comprise the composite • Eliminated the wage index ceiling to reflect the latest available wage data,
rate; an update of 1.6 percent to the and reduced the floor to 0.8500; and and a revised budget neutrality
composite rate component of the • Revised the labor portion of the adjustment.
payment system; and a drug add-on of composite rate to which the geographic
adjustment is applied. a. Proposed Growth Update to the Drug
8.7 percent to the composite rate for the
We also provided a 4-year transition Add-on Adjustment to the Composite
difference between current payments for
from the previous wage-adjusted Rates
separately billable drugs and payments
based on the revised drug pricing for composite rates to the current wage- Section 623(d) of the MMA added
2005 which used acquisition costs. The adjusted rates. For CY 2006, only 25 section 1881(b)(12)(B)(ii) of the Act
CY 2005 PFS final rule with comment percent of the payment is based on the which required the establishment of an
period also implemented case-mix revised geographic adjustments, and the add-on to the composite rate to account
adjustments to the composite rate for a remaining 75 percent of payment is for changes in the drug payment
limited number of patient based on the old metropolitan statistical methodology stemming from enactment
characteristics (that is, age, low body area-based (MSA-based) payments. of the MMA. Section 1881(b)(12)(c) of
mass index (BMI), and body surface area In addition, section 5106 of the DRA the Act provides that the drug add-on
(BSA)), effective April 1, 2005. provided for a 1.6 percent update to the must reflect the difference in aggregate
In addition, to implement section composite rate component of the basic payments between the revised drug
1881(b)(13) of the Act, we revised case-mix adjusted payment system, payment methodology for separately
payments for drugs billed separately by effective January 1, 2006. As a result, billable ESRD drugs and the AWP
independent ESRD facilities, paying for the base composite rate was increased to payment methodology. In 2005, we
the top 10 ESRD drugs based on $130.40 for independent ESRD facilities generally paid for ESRD drugs based on
acquisition costs (as determined by the and $134.53 for hospital-based facilities. average acquisition costs. Thus the
OIG) and for other separately billed For 2006, the drug add-on adjustment difference from AWP pricing was
drugs at the average sales price +6 (including the growth update) was 14.5 calculated using acquisition costs.
percent (hereafter referred to as ASP+6 percent. However, in 2006 when we moved to
percent). Hospital-based ESRD facilities ASP pricing for ESRD drugs, we
3. CY 2007 Updates
continued to receive cost-based recalculated the difference from AWP
payments for all separately billable In the CY 2007 PFS final rule with pricing using ASP prices.
drugs and biologicals except for EPO comment period (71 FR 69681), we In addition, section 1881(b)(12)(F) of
which was paid based on average implemented the following updates to the Act requires that, beginning in CY
acquisition costs. the basic case-mix adjusted payment 2006, we establish an annual update to
system: the drug add-on to reflect estimated
2. CY 2006 Revisions • An update to the wage index growth in expenditures for separately
In the CY 2006 PFS final rule with adjustments to reflect the latest hospital billable drugs and biologicals furnished
comment period (70 FR 70161), we wage data, including a BN adjustment of by ESRD facilities. This growth update
implemented additional revisions to 1.052818 to the wage index for CY 2007. applies only to the drug add-on portion
of the case-mix adjusted payment expenditure data that do not reflect based ESRD facility data from the
system. current drug payment methodologies. computation of utilization growth
The CY 2007 drug add-on adjustment Therefore, we established a between 2005 and 2006. Under this
to the composite rate is 14.9 percent. mechanism for estimating the annual option, we would impute the same
The drug add-on adjustment for CY growth in expenditures for ESRD drugs utilization growth for hospital-based
2007 incorporates an inflation and biologicals using the PPI for ESRD facilities as estimated for
adjustment of 0.5 percent. This prescription drugs as a measure of price independent ESRD facilities.
computation is explained in detail in increases in conjunction with 2 years of
historical data as a basis for estimating (ii) Estimating Growth in Per Patient
the CY 2007 PFS final rule with Drug Utilization
comment period (71 FR 69682 through utilization growth at the per patient
69684). We note that the drug add-on level. To isolate and project the growth in
adjustment of 15.1 percent that was As discussed in detail below in this per patient utilization of ESRD drugs for
published in the CY 2007 PFS final rule section, we are proposing to estimate CY 2008, we need to remove the
with comment period did not account growth in per patient utilization of enrollment and price growth
for the 1.6 percent update to the drugs for CY 2008 by using historical components from the historical drug
composite rate portion of the basic case- drug expenditure data from CY 2005 expenditure data and consider the
mix adjustment payment system that and CY 2006. However, we are residual utilization growth. As
was subsequently enacted by the MIEA– proposing to use only drug expenditures discussed previously in this section, we
TRHCA, effective April 1, 2007. Since data from independent ESRD facilities propose to use independent ESRD
we compute the drug add-on adjustment because we are unable to determine facility drug expenditure data from CY
utilization change in hospital-based 2005 and CY 2006 to estimate per
as a percentage of the weighted average
dialysis facilities due to the changes in patient utilization growth for CY 2008.
base composite rate, the drug add-on
payment methodology for these types of We first needed to estimate the total
percentage was decreased to account for drug expenditures for independent
dialysis facilities from 2005 to 2006. In
the higher composite payment rate ESRD facilities. For this proposed rule,
2005, payments to hospital-based
resulting in a 14.9 percent add-on we used the final CY 2005 ESRD claims
facilities were based on cost (or a
adjustment beginning April 1, 2007. data and the latest available CY 2006
percentage of charges), whereas
This adjustment was necessary to ESRD facility claims, updated through
payments to hospital-based facilities in
ensure that the total drug add-on dollars December 31, 2006 (that is, claims with
2006 were based on ASP+6 percent.
remained constant. dates of service from January 1 through
Because of the cost payment
(i) Estimating Growth in Expenditures methodology, the ‘‘drug unit’’ fields on December 31, 2006, that were received,
for Drugs and Biologicals for CY 2008 the 2005 hospital-based ESRD facility processed, paid, and passed to the
bills were not used for payment National Claims History File as of
Section 1881(b)(12)(F) of the Act December 31, 2006). For the CY 2008
purposes, and therefore, the data were
specifies that the drug update must PFS final rule, we plan to use more
not accurately reported on those bills.
reflect ‘‘the estimated growth in As such, we are unable to accurately updated CY 2006 claims with dates of
expenditures for drugs and biologicals isolate the per unit payment differential service for the same time period. This
(including erythropoietin) that are for hospital-based ESRD facility drug updated CY 2006 data file will include
separately billable * * * ’’ By referring expenditures between 2005 (cost claims that are received, processed,
to ‘‘expenditures’’, we believe the payments) and 2006 (ASP payments) for paid, and passed to the National Claims
statute contemplates that the update purposes of estimating the residual History File as of June 30, 2007.
would account for both increases in utilization change between years. We While the December 2006 update of
drug prices, as well as increases in considered applying the price CY 2006 claims used in this proposed
utilization of those drugs. differential factor for independent ESRD rule is the most recently available
In the CY 2007 PFS final rule with facilities between 2005 and 2006 to the claims data, we recognize that it is not
comment period (71 FR 69682), we ESRD hospital-based facility data, but a fully complete year as claims with
established a methodology for annually the result was a negative utilization dates of service towards the end of the
estimating the growth in ESRD drugs growth. Because we have no way of year have not all been processed. To
and biological expenditures that uses accurately determining what portion of more accurately estimate the update to
the Producer Price Index (PPI) for the change in drug expenditures for the drug add-on, we need aggregate drug
pharmaceuticals as a proxy for pricing hospital-based facilities between 2005 expenditures. Based on an analysis of
growth in conjunction with 2 years of and 2006 is attributable to price versus the 2005 claims data, we inflated the CY
ESRD drug data to estimate per patient utilization, we do not believe it would 2006 drug expenditures to estimate the
utilization growth. be appropriate to assume that the same June 30, 2007 update of the 2006 claims
For CY 2008, we are proposing to price differential applicable to file. We used the relationship between
continue using this methodology to independent ESRD facility data would the December 2005 and the June 2006
update the drug add-on adjustment. As be indicative of the price change for versions of 2005 claims to estimate the
we indicated in the CY 2007 PFS final hospital-based facilities between 2005 more complete 2006 claims that will be
rule with comment period, we believe and 2006 where expenditures moved available in June 2007. We applied that
the PPI is a reasonable measure of drug from cost-based to fee schedule ratio to the 2006 claims data from the
pricing growth, and when used in payments. Given that the drug December 2006 claims file. We did this
conjunction with an estimate of per expenditure data for hospital-based separately for EPO, the other top ten
patient growth in drug utilization, this ESRD facilities only represent about 9 separately billable drugs, and the
measure provides a simple and accurate percent of the total ESRD drug data, and remaining separately billable drugs for
approach to updating the drug add-on we can more accurately measure the independent and hospital-based ESRD
that could be readily used in subsequent price difference between 2005 and 2006 facilities. All components were then
years. Moreover, using the PPI for the independent ESRD facility combined to estimate aggregate CY 2006
significantly reduces any data bias that expenditure data, we believe the best ESRD drug expenditures. The net
is inherent in using historical drug option would be to exclude the hospital- adjustment to the CY 2006 claims data
was an increase of 12 percent to the 2006. Therefore, we are projecting no $0.72 for CY 2008 or a 0.5 percent
2006 expenditure data. This adjustment growth in per patient utilization for all increase in the CY 2007 drug add-on
allows us to more accurately compare ESRD facilities in CY 2008. percentage. Thus, the total proposed
the 2005 and 2006 data to estimate drug add-on adjustment to the
b. Applying the Proposed Growth
utilization growth. Update to the Drug Add-on Adjustment
composite rate for CY 2008, including
The next step is to remove the the growth update, would be 15.5
enrollment and price growth In CY 2006, we applied the projected percent (1.149 * 1.005 = 1.155).
components from that total. As growth update percentage to the total We propose to continue to use this
discussed previously in this section, in amount of drug add-on dollars method to estimate the growth update to
developing the per patient utilization established for CY 2005 to come up with the drug add-on component of the case-
growth for this proposed rule, we a dollar amount for the CY 2006 growth mix adjusted payment system until we
limited our analysis to the latest 2 years update. In addition, we projected the have at least 3 years worth of ASP-based
of available independent ESRD facility growth in dialysis treatments for CY historical drug expenditure data that
drug data (that is, 2005 and 2006). We 2006 based on the projected growth in could be used to conduct a trend
believe that per patient utilization ESRD enrollment. We divided the analysis to estimate the growth in drug
growth between these years would be a projected total dialysis treatments for
expenditures. Given the time lag in the
better proxy for future growth, as it best CY 2006 into the projected dollar
availability of ASP drug expenditure
represents current utilization trends. amount of the CY 2006 growth to
data, we expect that the earliest we
To calculate the per patient utilization develop the per treatment growth
could consider using trend analysis to
growth, we removed the enrollment update amount. This growth update
update the drug add-on adjustment
component by using the growth in amount, combined with the CY 2005 per
would be CY 2010. We intend to
enrollment data between 2005 and 2006. treatment drug add-on amount, resulted
reevaluate our methodology for
This was approximately 3 percent. To in an average drug add-on amount per
estimating the growth update at that
remove the price effect we calculated treatment of $18.88 (or a 14.5 percent
time.
the weighted difference between 2005 adjustment to the composite rate) for CY
average acquisition price (AAP) and 2006. d. Proposed Update to the Geographic
2006 ASP pricing for the original top ten In the CY 2007 PFS final rule with Adjustments to the Composite Rates
drugs for which we had average comment period (71 FR 69684), we
revised our update methodology by Section 1881(b)(12)(D) of the Act, as
acquisition prices. We weighted the amended by section 623(d) of the MMA,
differences by 2006 independent ESRD applying the growth update to the per
treatment drug add-on amount. That is, gave the Secretary the authority to
facility drug expenditure data. Table 12 revise the wage indexes previously
shows the 2006 weights for each of the for CY 2007, we applied the growth
update factor of 4.03 percent to the applied to the ESRD composite rates.
top ten ESRD drugs billed by The wage indexes are calculated for
independent ESRD facilities. $18.88 per treatment drug add-on
amount for an updated amount of each urban and rural area. The purpose
This process led to an overall 3 of the wage index is to adjust the
percent reduction in price between 2005 $19.64 per treatment (71 FR 69684).
For CY 2008, we are proposing to composite rates for differing wage levels
and 2006. covering the areas in which ESRD
update the per treatment drug add-on
amount of $19.64 established in CY facilities are located.
TABLE 12.—CY 2006 DRUG WEIGHTS
2007 and convert the update to an (i) Updates to Core-Based Statistical
FOR INDEPENDENT FACILITIES
adjustment factor as specified in section Area (CBSA) Definitions
2006
1881(b)(12)(F) of the Act. As explained
Independent drugs Weights in the CY 2007 PFS proposed rule (71 In the CY 2006 PFS final rule with
(percent) FR 49007) and adopted in the CY 2007 comment period (70 FR 70167), we
PFS final rule with comment period (71 announced our adoption of the OMB’s
EPO ............................................ 75.2 FR 69683), we believe this approach is CBSA-based geographic area
Paricalcitol .................................. 11.6 more accurate than using an estimate of designations to develop revised urban/
Sodium-ferric-glut ....................... 2.9 rural definitions and corresponding
growth in treatments to determine the
Iron-sucrose ................................ 5.6 wage index values for purposes of
Levocarnitine .............................. 0.3 per treatment add-on adjustment each
year. calculating ESRD composite rates.
Doxercalciferol ............................ 3.1
Calcitriol ...................................... 0.1 OMB’s CBSA-based geographic area
c. Proposed Update to the Drug Add-on designations were described in OMB
Iron-dextran ................................ 0.0 Adjustment
Vancomycin ................................ 0.1 Bulletin 03–04, originally issued June 6,
Alteplase ..................................... 0.9 As discussed previously in this 2003, and available online at
section, we estimate no growth in per www.whitehouse.gov/omb/bulletins/
After removing the enrollment and patient utilization of ESRD drugs for CY b03–04.html. In addition, OMB
price effects from the expenditure data, 2008. Using the projected CY 2008 PPI published subsequent bulletins
the residual growth would reflect the for prescription drugs of 3.66 percent, regarding CBSA changes, including
per patient utilization growth. To do we are projecting that the combined changes in CBSA numbers and titles.
this, we divided the product of the growth in per patient utilization and We wish to clarify that this and all
enrollment growth of 3 percent (1.03) pricing for CY 2008 would result in an subsequent ESRD rules and notices are
and the price reduction of 3 percent update equal to 3.66 percent (1.0 * considered to incorporate the CBSA
(1.00 ¥ 0.03 = 0.97) into the total drug 1.0366 = 1.0366). This update factor changes published in the most recent
expenditure change between 2005 and would be applied to the CY 2007 OMB bulletin that applies to the
2006 of ¥0.2 percent (1.00 ¥ 0.00 = average per treatment drug add-on hospital wage data used to determine
1.00). The result is a utilization factor amount of $19.64 (reflecting a 14.9 the current ESRD wage index. The OMB
equal to 1.00(1.00/(1.03 * 0.97) = 1.00). percent adjustment in CY 2007), bulletins may be accessed online at
We observed no growth in per patient resulting in a proposed weighted http://www.whitehouse.gov/omb/
utilization of drugs between 2005 and average increase to the composite rate of bulletins/index.html.
(ii) Updated Wage Index Values The wage data are located in the indexes were restricted to values no less
section entitled, ‘‘FY 2008 Proposed than 0.90 and no greater than 1.30,
In the CY 2007 PFS final rule with Rule Occupational Mix Adjusted and meaning that payments to facilities in
comment period (71 FR 69685), we Unadjusted Average Hourly Wage and areas where labor costs fell below 90
stated that we intend to update the Pre-reclassified Wage Index by CBSA’’. percent of the national average, or
ESRD wage index values annually. exceeded 130 percent of that average,
Current ESRD wage index values for CY (A) Third Year of the Transition
were not adjusted beyond the 90 percent
2007 were developed from FY 2003 In the CY 2006 PFS final rule with or 130 percent level. Although we stated
wage and employment data obtained comment period (70 FR 70169), we that the ESRD wage index values should
from the Medicare hospital cost reports. indicated that we would apply a 4-year not be constrained by the application of
The ESRD wage index values are transition period to mitigate the impact floors and ceilings, we also expressed
calculated without regard to geographic on composite rates resulting from our concern that the immediate elimination
reclassifications authorized under adoption of CBSA-based geographic of the floor could adversely affect ESRD
sections 1886(d)(8) and (d)(10) of the designations. Beginning January 1, 2006, beneficiary access to care. Therefore, we
Act and utilize pre-floor hospital data during each year of the transition, an reduced the floor to 0.85 in CY 2006,
that is unadjusted for occupational mix. ESRD facility’s wage-adjusted composite and to 0.80 in CY 2007.
The methodology for calculating the rate (that is, without regard to any case- For CY 2008, we are proposing to
CY 2006 ESRD wage index values was mix adjustments) will be a blend of its reduce the wage index floor to 0.75. As
described in the CY 2006 PFS final rule old MSA-based wage-adjusted payment we stated in the CY 2006 PFS final rule
with comment period (70 FR 70168). We rate and its new CBSA-based wage with comment period (70 FR 70169
propose to use the same methodology adjusted payment rate for the transition through 70170), we intended to reassess
for CY 2008, with the exception that FY year involved. For each transition year, the continuing need for a wage index
2004 hospital data will be used to the share of the blended wage-adjusted floor in CY 2008 and CY 2009. For the
develop the CY 2008 wage index values. base payment rate that is derived from third year of the transition, we believe
For a detailed description of the the MSA-based and CBSA-based wage that a reduction to 0.75 is appropriate as
development of the proposed CY 2008 index values is shown in Table 13. In we continue to reassess the need for a
wage index values based on FY 2004 CY 2006, the first year of the transition, wage index floor for future years. We
hospital data, see the FY 2008 we implemented a 75/25 blend. In CY believe that a gradual reduction to the
‘‘Proposed Changes to the Hospital 2007, the second year of the transition, wage index floor is needed to ensure
Inpatient Prospective Payment Systems we implemented a 50/50 blend. patient access to dialysis in areas that
(IPPS) and Fiscal Year 2008 Rates’’ Consistent with the transition blends have low wage index values, especially
proposed rule (72 FR 24680). Section III announced in the CY 2006 PFS final Puerto Rico, where payments would
G. (Computation of the Proposed FY rule with comment period (70 FR decrease significantly if the floor was
2008 Unadjusted Wage Index) of the 70170), we are proposing a 25/75 blend eliminated.
preamble to that proposed rule between an ESRD facility’s MSA-based The proposed wage index floors, caps,
describes the cost report schedules, line composite rate, and its CY 2008 CBSA- and blended shares of the composite
items, data elements, adjustments, and based rate reflecting its revised wage rates applicable to all ESRD facilities
wage index computations. The wage index values. during CY 2008 through CY 2009 are
index data affecting ESRD composite In CY 2006, we also eliminated the shown in Table 13. They are identical
rates for each urban and rural locale wage index cap of 1.30, and stated that to the values shown in Table 4 of the CY
may also be accessed on the CMS Web we would implement a gradual 2007 PFS final rule with comment
site at http://www.cms.hhs.gov/ reduction in the wage index floor of period (71 FR 69686) for the applicable
AcuteInpatientPPS/WIFN/list.asp 0.90. Prior to January 1, 2006, the wage years.
TABLE 13.—WAGE INDEX TRANSITION BLEND

Old MSA New CBSA
CY payment Floor Ceiling (percent) (percent)
2006 .............................. 0.85 None ............................................................................................................. 75 25

2007 .............................. 0.80 None ............................................................................................................. 50 50
2008 .............................. *0.75 None ............................................................................................................. 25 75
2009 .............................. Reassess None ............................................................................................................. 0 100
*Each wage index floor is multiplied by a BN adjustment factor. For CY 2008, the BN adjustment is 1.054955 resulting in an actual wage index
floor of 0.7912.
An example of how the wage-adjusted During the remaining 2 years of the 4- for CY 2008 does not change in CY
composite rates would be blended year transition period to the new CBSA 2009. In actuality, the wage-adjusted
during CY 2008 and the additional based wage index values, this facility’s composite rate would change because of
subsequent transition year follows. blended rate through 2009 would be annual revisions to the wage index.
Example: An ESRD facility has a calculated as follows: However, the example serves only to
wage-adjusted composite rate (without CY 2008 0.25 × $135.00 + 0.75 × $145.00 demonstrate the effect on the composite
regard to any case-mix adjustments) of = $142.50 rate of the CBSA-based wage index
$135.00 per treatment in CY 2007. Using CY 2009 0 × $135.00 + 1.0 × $145.00 = values which will be phased-in during
CBSA-based geographic area $145.00 the remaining 2 years of the transition
designations, the facility’s CY 2008 We note that this hypothetical period.
wage-adjusted composite rate, reflecting example assumes that the calculated
its wage index value would be $145.00. wage-adjusted composite rate of $145.00
(B) Wage Index Values for Areas With 2007, we maintained the policies used for the ESRD wage index floor value
No Hospital Data in CY 2006 for establishing ESRD wage because they have wage index values
In CY 2006, while adopting the CBSA index values for rural and urban areas that are below 0.7500. We continue to
designations, we identified a small without hospital data. believe that this approach is an
For CY 2007, the Home Health PPS appropriate proxy for rural Puerto Rico
number of ESRD facilities in both urban
(71 FR 65884 through 65905) adopted because it ensures a rural Puerto Rico
and rural geographic areas where there
an alternative approach using the wage index value consistent with all
is no hospital wage data on which to
average wage index from all contiguous other areas in Puerto Rico. Thus,
base the calculations of the CY 2006
CBSAs to represent a reasonable proxy consistent with previous years, for CY
ESRD wage index values. Our CY 2006
for the rural areas without hospital wage 2008, we propose to continue to apply
policy and CY 2007 proposals for each
index data. Because we have used the the ESRD wage index floor value
area are discussed separately below in
same wage index value (from CY 2005) (0.7500) to rural Puerto Rico.
this section. for rural Massachusetts for both, CY We also propose the following
The first situation is rural
2006 and CY 2007, we believe it is now approach with regard to an urban area
Massachusetts. Because in CY 2006 we
appropriate to consider another lacking hospital wage index data,
had not determined a reasonable proxy
methodology as a proxy for rural areas specifically, Hinesville, GA (CBSA
for rural data within Massachusetts, we lacking hospital wage index data. We 25980). Again, under CBSA
used the prior year’s acute care hospital believe that use of contiguous areas is a designations there are no urban
wage index value for rural valid proxy as it meets our criteria for hospitals within that CBSA. For CY
Massachusetts. For CY 2007, we imputing a wage index. This approach 2006 and CY 2007, we used all of the
continued to use this value and uses pre-floor, pre-reclassified hospital urban areas within the State to serve as
requested public input on an alternative wage data, is easy to evaluate, can be a reasonable proxy for the urban area
methodology as described below in this updated from year-to-year, and uses the without specific hospital wage index
section. We described an alternative most local data available. data. Specifically, we used the average
methodology whereby we would impute Therefore, in cases where there is a wage index value for all urban areas
a rural wage index value by using a rural area without hospital wage data, within the State of Georgia as the urban
simple average CBSA-based rural wage we propose to use the average wage wage index for purposes of calculating
index value at the Census Division index from all contiguous CBSAs to the value for Hinesville for CY 2007.
level. represent a reasonable proxy for that We propose to continue this approach
The second situation involves Puerto rural area. As was the case in previous for urban areas without specific hospital
Rico. Rural Puerto Rico is similar to years, this proposed policy impacts wage index data. Specifically, for CY
rural Massachusetts in that there are no rural Massachusetts. 2008, we are proposing to continue
acute care hospitals, and therefore, no In determining an imputed rural wage using this method for Hinesville, GA
hospital data. However, for ESRD index, we interpret the term (CBSA 25980). Therefore, the wage
facilities in rural Puerto Rico, the CY ‘‘contiguous’’ to mean sharing a border. index for urban CBSA (25980)
2007 ESRD wage index floor value For example, in the case of Hinesville-Fort Stewart, GA is
(0.8000) was applied to rural Puerto Massachusetts, the entire rural area calculated as the average wage index of
Rico ESRD facilities. All areas in Puerto consists of Dukes and Nantucket all urban areas in Georgia.
Rico that have a wage index are eligible counties. We have determined that the We solicit comments on these
for the ESRD wage index floor because borders of Dukes and Nantucket approaches to calculating the wage
they have wage index values that are counties are ‘‘contiguous’’ with index values for areas without hospital
below 0.8000. Accordingly, for CY 2007, Barnstable and Bristol counties. Under wage index data for FY 2008 and
we applied the ESRD wage index floor the proposed methodology, the wage subsequent years. We will also continue
value to rural Puerto Rico. indexes for the counties of Barnstable to evaluate existing hospital wage data
The third situation involves an urban (CBSA 12700, Barnstable Town, MA– and, possibly, wage data from other
area in Hinesville, GA (CBSA 25980). As (1.2539)) and Bristol (CBSA 39300, sources, such as the Bureau of Labor
with the rural areas noted previously in Providence-New Bedford-Fall River, RI– Statistics, to determine if other
this section, there are no available MA–(1.0783)) are averaged, resulting in methodologies of imputing a wage index
hospital wage index data as there are no an imputed rural wage index of 1.1665 value where hospital wage data are not
urban hospitals within that CBSA. For for rural Massachusetts for CY 2008. available may be feasible.
CY 2007, we used a wage index value While we believe that this policy could
based on wage index values in all of the be readily applied to other rural areas (iii) Budget Neutrality (BN) Adjustment
other urban areas within the same State that lack hospital wage data (possibly Section 1881 (b)(12)(E)(i) of the Act,
to serve as a reasonable proxy for the due to hospitals converting to a different as added by section 623(d) of the MMA,
urban areas without hospital wage index provider type, such as a CAH, that does requires that any revisions to the ESRD
data. Specifically, for CY 2007, we used not submit the appropriate wage data), composite rate payment system as a
the average wage index value for all should a similar situation arise in the result of the MMA provision (including
urban areas within the State of Georgia future, we may reexamine this policy. the geographic adjustment) be made in
as the urban wage index for purposes of As we stated previously in this a budget neutral manner. This means
calculating the ESRD wage index value section, rural Puerto Rico is similar to that aggregate payments to ESRD
for Hinesville. rural Massachusetts in that there are no facilities in CY 2007 should be the same
In CY 2007, we received no comments acute care hospitals, and therefore, no as aggregate payments that would have
on maintaining the policies used in CY hospital wage index data. However, for been made if we had not made any
2006 for establishing ESRD wage index ESRD facilities in rural Puerto Rico we changes to the geographic adjusters. We
values for rural and urban areas without propose to use the proposed CY 2008 note that this BN adjustment only
hospitals, or an alternative approach for ESRD wage index floor value (0.7500) as addresses the impact of changes in the
developing wage index values for rural a proxy for the hospital wage index geographic adjustments. A separate BN
areas without hospitals for CY 2007 and data. Accordingly, all areas in Puerto adjustment was developed for the case-
subsequent years. Therefore, for CY Rico that have a wage index are eligible mix adjustments, currently in effect. As
we are not proposing any changes to the of 0.7912(0.7500 × 1.054955) for CY This proposed revision will not
case-mix measures for CY 2008, the 2008. preclude the use of self insurance to
current case-mix BN adjustment will demonstrate compliance with the
(iv) ESRD Wage Index Tables
remain in effect for CY 2008. For CY comprehensive liability insurance
2008, we again propose to apply a BN The proposed 2008 wage index tables policy as long as CMS or our designated
adjustment factor (1.054955) directly to are located in Addenda G and H. contractor can verify the policy and its
the ESRD wage index values, as we did I. Independent Diagnostic Testing coverage provisions with an
in CY 2007. As we explained in the CY Facility (IDTF) Issues independent underwriter.
2007 PFS final rule with comment We believe that we should be able
period (71 FR 69687 through 69688), we [If you choose to comment on issues verify the issuance of a comprehensive
believe this is the simplest approach in this section, please include the liability insurance policy with an
caption ‘‘IDTF ISSUES’’ at the beginning underwriter, as well as an insurance
because it allows us to maintain our
of your comments.] agent. This approach will allow our
base composite rates during the
In the CY 2007 PFS final rule with designated contractors to verify that a
transition from the current wage comment period, we established 14
adjustments to the revised wage comprehensive liability insurance
performance standards and several other policy has been issued and is in effect
adjustments described previously in this provisions at § 410.33(g) associated with
section. Because the ESRD wage index at the time of enrollment and
independent diagnostic testing facilities throughout the enrollment period.
is only applied to the labor-related (IDTFs). In this proposed rule, we are
portion of the composite rate, we Moreover, since 90 days may pass
clarifying our interpretation of several of before the underwriter receives
computed the BN adjustment factor the performance standards at § 410.33(g)
based on that proportion (53.711 notification the policy has been issued
to assist the public in understanding by the insurance agent or broker, we
percent). how we expect our designated
To compute the proposed CY 2008 encourage IDTFs to obtain
contractors to implement these comprehensive liability insurance at
wage index BN adjustment factor standards. In addition, we are proposing
(1.054955), we used the wage index least 90 days prior to filing its Medicare
several new performance standards and enrollment application. This will
values in Addenda G and H, 2006 other provisions associated with IDTFs.
outpatient claims (paid and processed prevent delays in the enrollment
as of December 31, 2006), and 1. Proposed Revisions of Existing IDTF process and will allow our designated
geographic location information for each Performance Standards contractors to verify the issuance of an
facility which may be found through IDTF’s comprehensive liability
a. § 410.33(g)(6) insurance policy on the day an
Dialysis Facility Compare Web page on The supplier standard at
the CMS Web site at http:// application is submitted for review.
§ 410.33(g)(6) states, ‘‘Has a As a result, at § 410.33(g)(6), we are
www.cms.hhs.gov/ comprehensive liability insurance proposing to revise this performance
DialysisFacilityCompare/. policy in the amount of at least standard to include the requirement that
Using treatment counts from the 2006 $300,000 that covers both the supplier’s an IDTF must list our designated
claims and facility-specific CY 2007 place of business and all customers and contractor as a Certificate Holder on the
composite rates, we computed the employees of the supplier. The policy policy. By listing our designated
estimated total dollar amount each must be carried by a nonrelative-owned contractor as a Certificate Holder on the
ESRD provider would have received in company.’’ We are proposing to revise policy, our contractor will be able to
CY 2007 (the 2nd year of the 4-year this standard to read, ‘‘Has a verify coverage with the underwriter at
transition). The total of these payments comprehensive liability insurance the time of enrollment and as the need
became the target amount of policy in the amount of at least arises throughout the year.
expenditures for all ESRD facilities for $300,000 per incident that covers both Therefore, we are also proposing to
CY 2008. Next, we computed the the supplier’s place of business and all revise § 410.33(g)(6) to state that it is the
estimated dollar amount that would customers and employees of the IDTF supplier’s responsibility to: (1)
have been paid to the same ESRD supplier and ensures that this insurance Ensure that the insurance policy must
facilities using the proposed ESRD wage policy must remain in force at all times. remain in force at all times and provide
index for CY 2008 (the 3rd year of the The policy must be carried by a coverage of at least $300,000 per
4-year transition). The total of these nonrelative-owned company. The IDTF incident; and (2) promptly notify the
payments became the third year new must list the Medicare contractor as a CMS designated contractor in writing of
amount of wage-adjusted composite rate Certificate Holder on the policy and any policy changes and cancellations.
expenditures for all ESRD facilities. promptly notify the Medicare contractor
After comparing these two dollar in writing of any policy changes or b. § 410.33(g)(2)
amounts (target amount divided by 3rd cancellations. Failure to maintain Based on feedback that we received
year new amount), we calculated an required insurance at all times will after the implementation of
adjustment factor that, when multiplied result in revocation of the IDTF’s billing § 410.33(g)(2), we believe that several
by the applicable CY 2008 ESRD wage privileges retroactive to the date the changes are necessary to ensure timely
index shown in Addenda G and H, will insurance lapsed. IDTF suppliers are reporting of certain events and less
result in payments to each facility that responsible for providing the contact frequent reporting of reportable events.
will remain within the target amount of information for the issuing insurance Accordingly, we are proposing to
composite rate expenditures when agent and the underwriter.’’ This change § 410.33(g)(2) from, ‘‘Provides
totaled for all ESRD facilities. The proposed rule clarifies how we will complete and accurate information on
proposed BN adjustment factor for the verify whether an IDTF meets this its enrollment application. Any change
CY 2008 wage index is 1.054955. standard to include the provision that in enrollment information must be
To ensure BN, we also must apply the IDTF suppliers are responsible for reported to the designated fee-for-
BN adjustment factor to the proposed providing the contact information of an service contractor on the Medicare
wage index floor of 0.7500 which results individual employed with the enrollment application within 30
in a proposed adjusted wage index floor underwriter, who can verify coverage. calendar days of the change,’’ to
‘‘Provides complete and accurate employed by an IDTF to the supervising with the performance standards at
information on its enrollment physician. This was not our intent. § 410.33(g). Allowing an IDTF to bill
application. Changes in ownership, Moreover, we believe that this Medicare for services furnished prior to
changes of location, changes in general requirement can be interpreted as being being enrolled in the Medicare program,
supervision, and adverse legal actions too restrictive as it is currently written creates a significant risk for the
must be reported within 30 calendar and may convey responsibilities to a Medicare program and its beneficiaries.
days of the change. All other reportable general supervising physician who may Specifically, we believe that allowing an
changes must be reported within 90 not have the administrative authority or IDTF to bill for services furnished prior
days.’’ knowledge to make these decisions. We to enrolling in the Medicare program
are proposing to clarify and expand on allows these facilities to potentially be
c. § 410.33(g)(8)
our meaning of what constitutes three reimbursed for services they are not
We are proposing to revise IDTF sites found at § 410.33(b)(1). We qualified to perform or for which they
§ 410.33(g)(8) from ‘‘Answer believe that limitation on sites applies otherwise may be precluded from
beneficiaries’ questions and respond to to both fixed sites and mobile units.
their complaints,’’ to, ‘‘Answer, billing to the Medicare program.
Accordingly, we believe that a
document, and maintain documentation physician providing general supervision Since Medicare FFS contractors verify
of beneficiaries’ questions and as defined in § 410.32(b)(3)(i) can enrollment information at the time an
responses to their complaints at the oversee a maximum of three sites (that enrollment application is filed, not for
physical site of the IDTF.’’ This change is, fixed or mobile) where concurrent prior periods, we do not believe that it
corrects an oversight in drafting of the operations can be performed. For is appropriate to continue the practice
initial performance standards for IDTFs. example, we believe that a physician of allowing IDTFs to bill the Medicare
In the CY 2007 PFS final rule with providing general supervision could program for services rendered in periods
comment period, we did not include a oversee up to three individual IDTF prior to their enrollment in the
requirement for the documentation of mobile units or three individual fixed Medicare program. Therefore, we are
the complaint process. Thus, by making location IDTFs, or a combination of both proposing to add § 410.33(i) to state that
this proposed change, we are proposing that total up to three separate places Medicare will establish an initial
to require an IDTF to document its which can concurrently run diagnostic enrollment date for an IDTF that would
complaint process. We believe that this tests. This does not change the be the later of: (1) The date of filing of
change is consistent with the requirements found at § 410.32(b)(3) for a Medicare enrollment application that
established practice for durable medical direct and personal supervision. was subsequently approved by FFS
equipment, prosthetics orthotics and contractor; or (2) the date an IDTF first
2. Proposed New IDTF Standards
supplies (DMEPOS) suppliers found in started rendering services at its new
§ 424.57(c)(19). To meet this revised At § 410.33(i), we are proposing to practice location. We also propose to
standard, an IDTF would be responsible add a provision to state that Medicare define the ‘‘date of filing’’ as the date
for maintaining the following will establish an initial enrollment date that the Medicare FFS contractor
information on all written and oral for IDTFs. Currently, IDTFs can receives a signed provider enrollment
beneficiary complaints, including retroactively bill Medicare for services application that the Medicare FFS
telephone complaints, it receives: that are rendered before they submitted contractor is able to process for
• The name, address, telephone a Medicare enrollment application or
approval. If the contractor rejects or
number, and health insurance claim were approved to participate in the
denies and enrollment application, the
number of the beneficiary. Medicare program. This means an IDTF
new date of filing would be established
• A summary of the complaint; the is allowed to bill Medicare for services
when an IDTF submits a new
date it was received; the name of the rendered on dates prior to the date the
enrollment application that the
person receiving the complaint; and a IDTF was enrolled in the Medicare
program. For example, if an IDTF contractor is able to process for
summary of actions taken to resolve the
submits a Medicare enrollment approval. Please note that we expect to
complaint.
• If an investigation was not application in November 2007 and is implement a Web-based enrollment
conducted, the name of the person enrolled in the Medicare program in process known as the Provider
making the decision and the reason for December 2007, then a physician or Enrollment, Chain, and Ownership
the decision. For mobile IDTFs, this supplier could retrospectively bill for System (PECOS) process, to be known
documentation would be stored at their services furnished to Medicare as PECOS Web, in most States during
home office. beneficiaries as far back as October 1, the 2007 calendar year. This internet
2005; indeed, an IDTF may bill enrollment process will permit IDTFs to
d. § 410.33(b)(1) Medicare for services rendered up to 27 complete and submit enrollment
At § 410.33(b)(1), we are proposing to months prior to their Medicare applications online. The date of filing
delete, ‘‘The IDTF supervising physician enrollment date. This means that an for applications submitted through
is responsible for the overall operation IDTF in the example that is enrolled as PECOS Web will be the date the
and administration of the IDTFs, meeting our program requirements in Medicare FFS contractor receives all of
including the employment of personnel December 2007 may not have met those the following: (1) A signed Certification
who are competent to perform test same requirements prior to the date of Statement; (2) an electronic version of
procedures, record and report test enrollment, even though the IDTF could the enrollment application; and (3) a
results promptly, accurately and bill Medicare and receive payments for signature page that the Medicare FFS
proficiently, and for assuring services rendered up to 27 months prior contractor processes to approval.
compliance with the applicable to their enrolling in the Medicare Further, our proposed policy is
regulations’’. We believe that our earlier program. consistent with current Medicare
rulemaking effort had the unintended We are concerned that some IDTFs payment policy of precluding payment
consequence of appearing to shift the may bill Medicare for services when for services until the provider or
overall administrative responsibility they do not meet all of the program supplier of service establishes that they
from owners or administrative staff requirements, including compliance meet enrollment and certification
requirements prior to being eligible to These types of arrangements also raise Act states that the payment basis for
bill the Medicare program. concerns because they may implicate outpatient physical therapy services
While this change limits the the physician self-referral prohibition (including outpatient SLP services),
retrospective payments that an IDTF and the anti-kickback prohibition. outpatient occupational therapy
may obtain from Medicare program, we services, and all other CORF services
believe that this approach is consistent J. Expiration of MMA Section 413
Provisions for Physician Scarcity Areas provided on or after January 1, 1999 will
with our existing requirements for those be 80 percent of the lesser of: (i) The
providers that require a State survey (PSAs)
actual charge for the services; or (ii) the
prior to being enrolled as specified in [If you choose to comment on issues applicable fee schedule amount. The
§ 489.13 and the requirements followed in this section, please include the term ‘‘applicable fee schedule amount’’
by DMEPOS suppliers as established in caption ‘‘PHYSICIAN SCARCITY is defined under section 1834(k)(3) of
section 1834(j)(1) of the Act and AREAS’’ at the beginning of your the Act to mean, for services furnished
§ 424.57(b)(2). Moreover, this change comments.] in a year, the payment amount
would ensure that we are able to verify Section 413(a) of the MMA added a determined under the PFS established
that an IDTF meets all program new section 1833(u) to the Act. That under section 1848 of the Act for such
requirements at the time of filing, section provided a 5 percent incentive services for the year ‘‘or, if there is no
including the performance standards payment to physicians furnishing such fee schedule established for such
outlined in § 410.33(g) before payment services in physician scarcity areas services, the amount determined under
for service occurs. (PSAs) for physicians’ services the fee schedule established for such
We are also proposing a new furnished on or after January 1, 2005, comparable services as the Secretary
performance standard at § 410.33(g)(15), and before January 1, 2008. Specifically, specifies.’’
which states, ‘‘Does not share space, section 1833(u) of the Act provided for
equipment, or staff or sublease its payment of an additional 5 percent of In the CY 1999 PFS final rule (63 FR
operations to another individual or the payment amount for services 58860), we stated that we would base
organization.’’ We believe that it is furnished by primary care physicians in payment for a CORF service on the PFS
inappropriate for a fixed-base (physical a primary care scarcity area and by non- amount for the service when the PFS
site) IDTF to commingle office space, primary care physicians in a specialist established a payment amount for such
staff, and equipment, and that care scarcity area. service. We further explained that we
commingling office space, staff and Because the provisions of section would use the higher PFS amount
equipment or subleases its fixed-base 1833(u) of the Act do not apply to applicable to services furnished in a
(physical site) operation to another services furnished after January 1, 2008, nonfacility setting, rather than the
individual or organization constitutes a we are providing notification that these facility payment amount, because no
significant risk to the Medicare program 5 percent incentive payments will no separate payment will be made for
because it prohibits CMS or our longer be made for services furnished on facility costs. The nonfacility payment
contractors from ensuring that each or after January 1, 2008. rate includes, along with any physician
fixed-base (physical site) IDTF work and MP RVUs, the PE RVUs
K. Comprehensive Outpatient representing nonfacility resources
establishes and maintains Medicare
Rehabilitation Facility (CORF) Issues necessary for the physician to perform
billing privileges consistent with the
provisions at § 424.500 and each IDTF [If you choose to comment on issues each service in the office setting,
meets and maintains all performance in this section, please include the including both direct and indirect PE
standards and other requirements under caption ‘‘CORF ISSUES’’ at the inputs, such as the costs of clinical
§ 410.33. While we believe that this new beginning of your comments.] labor, disposable supplies, personnel
performance standard should only Section 4541(a) of the Balanced salaries, equipment, and overhead
apply to fixed-base (physical site) IDTF Budget Act of 1997 (Pub. L. 105–33) expenses. The facility payment rate is
locations, we are seeking public (BBA), related to prospective payment based primarily on the physician work
comments on establishing a similar for outpatient rehabilitation services, and MP RVUs, although it contains
requirement for mobile IDTFs. This established section 1832(a)(2)(E) of the RVUs for the indirect PE RVUs related
proposed standard, in conjunction with Act for all comprehensive outpatient to the primary providing specialties, but
the existing IDTF performance standard rehabilitation facility (CORF) services, does not include the costs of the direct
three (concerning appropriate sites for not just rehabilitation services of PE inputs (that is, clinical labor,
an IDTF), expands the interpretation of outpatient physical therapy services disposable supplies, and equipment)
these standards to state that a motel, or (including outpatient speech-language that are utilized when the service is
hotel is not an appropriate site for an pathology (SLP) services), and provided in the physician office or
IDTF. While we initially believed that outpatient occupational therapy nonfacility setting. Payment at the
this new performance standard should services. The BBA also amended higher nonfacility payment rate was
apply to only fixed-based (physical site) sections 1833 and 1834 of the Act to already in place prior to CY 1999 for
locations, we also believe it should provide that all CORF services (as physical therapy, occupational therapy,
apply to mobile IDTFs, but we are defined under section 1861(cc)(1) of the and speech-language pathology (SLP)
seeking public comment on establishing Act) furnished on or after January 1, services provided in the physician’s
this requirement. 1999 would no longer be paid on a office and for the services of physical
We believe that allowing fixed-base ‘‘reasonable cost’’ basis but instead therapists (PTs) and occupational
(physical site) IDTFs to commingle would be paid based on the applicable therapists (OTs) in private practice.
office space (including waiting rooms), fee schedule amount (or if less, based on Effective with the CY 1999 PFS final
staff (including supervising physicians, the actual charge for the services). rule, we used the PFS nonfacility
nonphysician personnel, or Where there is no applicable fee amount to make payment for outpatient
receptionists), or equipment through schedule amount, payment would be Part B physical therapy, occupational
subleasing agreements may allow an based on a comparable service or, if less, therapy, and SLP services furnished in
IDTF to circumvent Medicare the CORF’s actual charge for the service. provider settings, including outpatient
enrollment and billing requirements. Specifically, section 1834(k)(1)(B) of the hospitals, SNFs, providers of outpatient
physical therapy (OPT) and SLP provided by a CORF are paid under the We propose to revise § 410.105(c) to
services, also known as rehabilitation DMEPOS fee schedule. clarify our policy that CORF services are
agencies, CORFs, and home health Drugs and biologicals that are not covered only if they relate directly to
agencies (HHAs) (for non-homebound considered to be self-administered are the rehabilitation of injured, disabled, or
patients), as discussed in the CY 1999 specified as CORF services at section sick patients. We believe our policy is
PFS final rule (63 FR 58860). Similarly, 1861(cc)(1)(F) of the Act. However, as consistent with the statutory
we used the PFS nonfacility amount for discussed in section II.K.7., we believe requirements under section 1861(cc) of
all other CORF services when the PFS that drugs and biologicals provided to the Act. Section 1861(cc)(1) of the Act
established a payment amount for such CORF patients are not appropriately specifies that CORF services must be
service. provided as part of a rehabilitation plan furnished under a plan of treatment.
In addition, in CY 1999, we of treatment and, as such, we propose to Section 1861(cc)(1)(H) of the Act further
established a fee schedule amount remove drugs and biologicals from the states that ‘‘other items and services’’
under the PFS for nursing services scope of CORF services as defined at are considered CORF services only if
delivered within a CORF, and created a § 410.100. In addition, because we ‘‘medically necessary for the
new HCPCS code (G0128) for such believe it is appropriate for rehabilitation of the patient.’’ We
services. We defined this code as direct pneumococcal, influenza, and hepatitis believe the implication of this limitation
face-to-face skilled nursing services B vaccines to be administered to CORF for ‘‘other items of services’’ is that all
delivered to a CORF patient by a patients in the CORF setting, even other CORF services (that is, those listed
registered nurse (RN) as part of a though such vaccines fall outside the under sections 1861(cc)(1)(A) through
rehabilitative therapy plan of treatment, scope of CORF services, we propose to (G) of the Act) also must be necessary
billable in 10-minute intervals provided revise the conditions of participation at for the rehabilitation of the patient. In
the initial interval is longer than 5 § 485.51(a) to permit CORFs to provide addition, we note that section
minutes. We stated that the HCPCS code to their patients pneumococcal, 1861(cc)(2)(A) of the Act specifies that
G0128 could be used for RN services influenza, and hepatitis B vaccines in a CORF facility is a facility ‘‘primarily
that are not included in the work or PE addition to CORF services. engaged in providing * * * diagnostic,
of another therapy or physician service. therapeutic, and restorative services to
Because the regulations under 42 CFR
The CORF conditions of participation at outpatients for the rehabilitation of
parts 410 and 413 were never updated
§ 485.58 provide that CORF services injured, disabled, or sick persons’’
to reflect the change in CORF payment
must be provided by personnel that (emphasis added). We believe this
meet the qualifications set forth in methodology from a ‘‘reasonable cost’’
requirement further signals the
§ 485.70. Sections 485.70(b) and (h) basis to 80 percent if the lesser of a
Congress’s intent that the services
require, respectively, that as a condition payment amount under an existing fee
provided in a CORF setting be covered
of coverage of service a licensed schedule or the CORF’s actual charge,
as CORF services only if such services
practical nurse (LPN) be licensed as a we are proposing to add a new subpart
relate directly to the rehabilitation of the
LPN or vocational nurse by the State of M to 42 CFR Part 414 to reflect the
patient.
practice, and that an RN be a graduate change in CORF payment methodology.
of an approved school of nursing and In addition, we propose to revise the 2. Included Services (§ 410.100)
licensed as an RN by the State of following sections of the Medicare Section 410.100 establishes the
practice. In creating the HCPCS code regulations to clarify the CORF benefit. services that are covered under the
G0128 for CORF nursing services, we 1. Requirements for Coverage of CORF CORF services benefit, consistent with
determined that a condition of coverage services—Plan of Treatment section 1861(cc)(1) of the Act. Because
for the service is that it be furnished by (§ 410.105(c)) of the change in payment methodology
an individual who meets the personnel from that based on cost to payment
requirements for an RN because we In accordance with section under the PFS and other existing fee
believe only an RN possesses the 1861(cc)(1) of the Act, requiring that schedules beginning in CY 1999, this
necessary training to provide the CORF services be furnished ‘‘under a section does not reflect our current
clinical nursing services that are plan (for furnishing such items and payment policies. Therefore, we
medically necessary and appropriate for services to such individual) established propose to clarify our payment policy in
CORF patients as they relate to the and periodically reviewed by a the introductory paragraph of this
therapy plan of treatment. physician,’’ § 410.105(c) provides that section by including a cross-reference to
Finally, in the CY 1999 PFS final rule CORF services as defined under proposed § 414.1101, which sets forth
(63 FR 58860), we explained that we § 410.100 are covered only if furnished the payment methodology for CORF
interpret section 1834(k)(3) of the Act, under a written plan of treatment. services, including identifying the
defining the term ‘‘applicable fee Specifically, the plan of treatment must: applicable fee schedule for each CORF
schedule amount,’’ as requiring us to (1) Be established and signed by a service. In addition, we propose to
use the payment amount established by physician prior to the commencement of revise our definitions of physician
an existing fee schedule other than the treatment in the CORF setting; and (2) services to reflect the change in
PFS when the PFS does not establish a Indicate the diagnosis and anticipated payment methodology for CORF
payment amount for the CORF service. rehabilitation goals, and prescribe the services. We also propose to revise the
Specifically, we stated that we would type, amount, frequency, and duration definitions of physician services,
use the existing fee schedules for of the services to be furnished. We respiratory therapy services, social and
prosthetic and orthotic devices, DME interpret these provisions as requiring psychological services, and nursing
and supplies, and drugs and biologicals that the services furnished under the services to ensure that these definitions
for covered prosthetics and orthotics plan of treatment must relate directly to include only those services
devices, durable medical equipment the rehabilitation of injured, disabled, or appropriately provided by qualified
(DME) and supplies, and drugs and sick patients. Services provided in the nonphysician and physician personnel
biologicals, respectively, provided by CORF setting that do not relate directly and related to the rehabilitation plan of
CORFs. Covered DME, orthotic and to such rehabilitation goals are not treatment established under
prosthetic devices, and supplies covered as CORF services. § 410.105(c). In addition, we propose
revisions to the definition of supplies, CORF services, whereas diagnostic and 4. Clarifications of CORF Respiratory
equipment, and appliances to conform therapeutic services provided by a Therapy Services
to the statutory provision at section physician to CORF patients are Section 1861(cc)(1)(B) of the Act
1861(cc)(1)(G) of the Act. Finally, we considered physician services under states that CORF services include
propose to remove the provision for section 1861(q) of that Act. Specifically, respiratory therapy services along with
drugs and biologicals. Although we propose to define CORF physician physical therapy, occupational therapy,
vaccines are not included in the services as those services provided by a and SLP services. Because respiratory
definition of CORF services at section CORF facility physician that are therapists (RTs) are not recognized as
1861(cc)(1) and § 410.100, we propose administrative in nature, such as independent practitioners in the Act or
to make revisions to the CORF consultation with and medical regulations, and respiratory therapy
conditions of participation at § 485.51 to supervision of nonphysician staff, services do not have a statutory benefit
reflect current coverage and payment patient case review conferences, category except as specified in the
policy for vaccines provided in the utilization review, and the review of the CORF services benefit at section
CORF setting. therapy plan of treatment, as 1861(cc)(1)(B) of the Act, separate
3. Physician services (§ 410.100(a)) appropriate. payment is not made for services
Section 410.100(a) defines the Services provided to a CORF patient provided by RTs. Instead, RTs are most
physician services included within the by the CORF facility physician or other often employed in physician offices and
scope of CORF services. Specifically, physician that are not administrative in in facility settings, such as hospitals and
those services of a CORF physician nature but that are diagnostic or SNFs, where payment is made to the RT
described as administrative in nature therapeutic services are considered employer.
are considered CORF services, to the physician services under section The description of CORF respiratory
exclusion of diagnostic and therapeutic 1861(q) of the Act. Where these services therapy services currently includes
services, which are physician services are covered, they are separately payable some services that should be provided
under section 1861(q) of the Act and to the physician as physician services by a physician, and not an RT, and thus
separately billable as physician services under the PFS at the nonfacility are inappropriate to include in a
under 42 CFR part 414, subpart B. payment amount. The physician bills respiratory therapy plan of care.
Section 1861(cc)(1) of the Act excludes the carrier in the same manner as if the Therefore, we are proposing to remove
from the definition of CORF services services were provided in the physician these services from the description of
any item or service that, if furnished to office setting and notes the CORF as the CORF respiratory therapy services
an inpatient of a hospital, would be place of service. under § 410.100(e), and to limit these
excluded under section 1861(b) of the services to those provided by RTs under
In addition, § 410.100(a) currently a respiratory therapy plan of treatment.
Act. Section 1861(b)(4) of the Act provides that physician services
excludes from the definition of Section 410.105(c) requires a physician,
included within the definition of CORF and not the RT, to provide the clinical
‘‘inpatient hospital services’’ the
services are reimbursed on a reasonable diagnosis; establish and sign the
‘‘medical or surgical services provided
cost basis under part 413, and that respiratory therapy plan of treatment for
by a physician,’’ which would include
physician services to CORF patients not each patient that includes the type,
the diagnostic and therapeutic services
included within the definition of CORF amount, frequency and duration of the
of a physician. Consequently, diagnostic
services but billed as physician services services to be furnished; and indicate
and therapeutic services provided in the
CORF setting by a physician are not are paid by the carrier on a reasonable the diagnosis and the patient’s
considered CORF services. In contrast, charge basis subject to the provisions of rehabilitation goals. The physician must
because those services of a CORF subpart E of part 405 of this chapter. also recertify this plan for medical
physician that are of an administrative This description of the payment necessity every 60 days or sooner if
nature are not ‘‘medical’’ services, such methodology for physician services appropriate. However, the description of
services are included in the definition of provided in the CORF setting under respiratory therapy services under
CORF services. § 410.100(a) is inconsistent with the § 410.100(e) includes these services, as
In accordance with section payment methodology set forth under well as other services that under current
1861(cc)(2)(B)(i) of the Act and section 1834(k)(1) of the Act for CORF clinical standards should not be
§ 485.70(a)(1), the CORF physician must services and section 1848 of the Act for provided by RTs, but rather should be
be either a medical doctor (MD) or a physician services, as well as the entrusted to the physician.
Doctor of Osteopathy (DO); and the preamble discussion in the CY 1999 PFS Therefore, we are proposing to revise
conditions of participation at final rule (63 FR 58860). In the CY 1999 § 410.100(e) to limit respiratory therapy
§ 485.70(a)(2) and (3) further require PFS final rule, we stated that we would services to those services appropriately
that the physician have training or base payment for diagnostic and provided to CORF patients by RTs
experience in the medical management therapeutic physician services provided under a physician-established
of patients requiring rehabilitation to individuals in the CORF setting on respiratory therapy plan of treatment in
services. The conditions of participation the PFS amount for the services. accordance with current medical and
at § 485.58(a)(1)(i) also require the CORF Therefore, we are proposing to revise clinical standards. Specifically, we
facility physician to provide, in § 410.100(a) to remove the reference to propose to remove from the definition of
accordance with accepted principles of reasonable cost-based payments for CORF respiratory therapy services the
medical practice, medical direction, CORF physician services and the services of establishing the medical and
medical supervision, medical care reference to reasonable charge based therapy-related diagnosis and the
services and consultation. We are payments for non-CORF physician provision of E/M services because these
proposing to revise § 410.100(a) to services. In place of these references, we services are provided by the physician,
clarify that only those physician propose to revise § 410.100(a) to add a as necessary, to establish the respiratory
services required and provided by the reference to 42 CFR part 414, subpart B, therapy plan of treatment. These
CORF facility physician that are setting forth the payment methodology services may be provided by either the
administrative in nature are considered for non-CORF physician services. CORF facility physician, as CORF
physician services or as non-CORF an individual meeting the educational outside the scope of coverage for CORF
physician services, or by the patient’s and training level of the RT, rather than social and psychological services
referring physician, as appropriate. We the RT technician. For these reasons, we because these services do not relate
also propose to remove diagnostic tests will accept comments on the service directly to a rehabilitation plan of
from the description of CORF description at § 410.100(e), and the treatment and the associated
respiratory therapy services since personnel qualifications at § 485.70(j) rehabilitation goals.
diagnostic tests are covered under the and (k) for a respiratory therapist and a
In addition, we believe it unnecessary
physician services benefit category at respiratory therapy technician,
to distinguish between CORF social
section 1861(s)(2)(C) of the Act when respectively.
services and CORF psychological
provided by the physician to a CORF 5. Social and Psychological Services services given their similarities, and
patient, and accordingly are separately
In accordance with section therefore, we propose to merge the two
billable by the physician under the PFS
1861(cc)(1)(D) of the Act, social and definitions into a single definition of
as previously discussed.
psychological services are included CORF social and psychological services.
In addition to RTs, we note that the As noted at section 1861(cc)(2)(B) of the
within the definition of CORF services
conditions of participation also Act, we believe that CORFs are required
under § 410.100(h) and (i), respectively.
recognize respiratory therapy to provide either social services or
In addition, § 485.58 specifies that the
technicians as CORF personnel; psychological services, and not both
CORF must provide a coordinated
however, during the CY 1999 PFS rehabilitation program that includes, at types of services. We believe that
rulemaking to recognize the 1997 BBA a minimum, social or psychological merging the regulations at § 410.100(h)
payment requirements, we did not services, along with physical therapy and (i) into a single definition of CORF
include services performed by services and physician services, and social and psychological services is
respiratory therapy technicians because that these services must be consistent warranted to clarify the similarities
we believed that current medical with the therapy plan of treatment. between them.
standards for skilled respiratory therapy Currently, the description of social
services provided to patients in the Therefore, we are proposing to clarify
work services considered CORF services
CORF setting required the educational under § 410.100(h) includes (1) the description of social and
requirements possessed by RTs. This Assessment of the social and emotional psychological services at § 410.100(h) to
determination to only recognize the factors related to the individual’s include only those services that address
services of RTs, and not those provided illness, need for care, response to the patient’s response and adjustment to
by respiratory therapy technicians in treatment, and adjustment to care the treatment plan; rate of improvement
carrying out the therapy plan of furnished by the facility; (2) casework and progress towards the rehabilitation
treatment was further supported in the services to assist in resolving social and goals, or other services as they directly
CY 2002 and CY 2003 rulemaking (66 emotional problems that may have an relate to the physical therapy,
FR 55311 and 67 FR 79999), when we adverse effect on the beneficiary’s occupational therapy, SLP, or
developed and discussed G-codes for ability to respond to treatment; and (3) respiratory therapy plan of treatment. In
certain CORF respiratory therapy assessment of the relationship of the addition, we propose to change the
services and specifically recognized the individual’s medical and nursing heading at § 410.100(h) from ‘‘social
RT as the appropriate level of personnel requirements to his or her home services’’ to ‘‘social and psychological
to provide these CORF services. These situation, financial resources, and the services,’’ and to eliminate the separate
G-codes were created to differentiate community resources available upon definition for psychological services
between the CORF services provided discharge from facility care. The current under § 410.100(i).
under a respiratory therapy plan of description of CORF psychological Because we are proposing to revise
treatment from those services provided services under § 410.100(h) includes: (1) the description of social and
under physical and occupational Assessment diagnosis and treatment of psychological services in § 410.100(h),
therapy plans of treatment by PTs and an individual’s mental and emotional we are interested in receiving comments
OTs, respectively, under benefit functioning as it relates to the concerning the CORF personnel
sections 1861(p) and (g) of the Act in the individual’s rehabilitation; (2) qualifications in the conditions of
97XXX CPT code series. Because Psychological evaluations of the participation at § 485.70(l) and (g) for
physical and occupational therapy individual’s response to and rate of social workers and psychologists,
services are subject to the therapy caps, progression under the treatment plan;
respectively, and comments relating to
the services provided under a CORF and (3) Assessment of those aspects of
the appropriate CPT codes to represent
respiratory therapy plan of treatment an individual’s family and home
these CORF services.
needed to be identified by procedure situation that affect the individual’s
codes specific to these services so as not rehabilitation treatment. We believe the Due to the specificity of the purpose
to be attributed to the therapy caps. The current definitions of CORF social and of CORF social and psychological
three HCPCS codes G0237, G0238, and psychological services are too broad. As services requiring these covered services
G0239 are specific to services provided discussed above in this section, we to directly relate to the patient’s
under the respiratory therapy treatment propose to revise § 410.105 to clarify our rehabilitation treatment plan, we are
plan and, as such, are not designated as policy that CORF services are covered inviting comments on which CPT codes
subject to the therapy caps. We are only if they are provided under the would be appropriate for CORF social
proposing to revise the description of rehabilitation plan of treatment and and psychological services. We believe
respiratory therapy services to remove relate directly to the rehabilitation of the that the procedure codes for health and
those services appropriately provided patient. As such, we are concerned that behavior assessment and treatment,
by the physician establishing the the current descriptions of CORF social represented by CPT codes 96150
respiratory therapy plan of treatment. In and psychological services may be through 96154, specific to the patient’s
addition, we have determined that a misconstrued to include social and physical health problems, best describe
condition of coverage for the respiratory psychological services for the treatment the social and psychological services
therapy service is that it be provided by of mental illness, which we believe is required in the CORF setting.
6. Nursing Care Services may be paid to the physician in prosthetics, orthotics, and supplies,
Because the PFS does not contain a accordance with section 1847(A) of the provided in the CORF setting requires
CPT code for nursing services, we Act. Physicians bill the carrier for such the CORF’s participation in the
established in the CY 1999 PFS final incident to services. If such drugs and competitive bidding, where applicable,
rule a new HCPCS code (G0128) for biologicals also considered CORF in accordance with 42 CFR part 414
direct face-to-face skilled nursing services, the CORF could submit a claim subpart F.
services delivered to a CORF patient by for the same drugs and biologicals to the
9. Clarifications and Payment Updates
an RN as part of a rehabilitative therapy fiscal intermediary for payment. If
for Other CORF Services
plan of treatment. In the CORF physicians and CORFs each were able to
bill for drugs and biologicals that are Section 4078 in the Omnibus Budget
conditions of participation at § 485.70(b) Reconciliation Act of 1987 (Pub. L. 100–
provided in the CORF setting, we
and (h), qualified personnel for nursing 203) (OBRA) amended section
believe there is a risk of duplicative
services include an LPN or vocational 1861(cc)(1) of the Act to provide that
payments for the same drugs and
nurse and an RN, respectively. there is no requirement that any item or
biologicals—one payment to the CORF
However, when the HCPCS code G0128 service furnished by a CORF in
and one payment to the physician by
was created for CORF nursing services connection with physical therapy,
the carrier. Such duplicative billing
we determined that a condition for occupational therapy, and speech
would be difficult for us to detect given
coverage is that the nursing service be pathology services under the plan of
that CORFs bill the fiscal intermediary
provided by an individual meeting the treatment be furnished at a single fixed
for CORF services while physicians bill
qualifications of an RN, rather than the the carrier for physician services. location; however, such items and
LPN, for CORF clinical nursing services While we recognize that drugs and services are covered as CORF services
as they relate, or are part of, the therapy biologicals are enumerated as CORF only if payment is not otherwise made
plan of treatment. Because we services at section 1861(cc)(1) of the under Medicare. We note that such
established coverage for CORF nursing Act, we do not believe that drugs and items and services may be covered
services only when provided by an RN, biologicals are appropriately provided under the Medicare home health benefit
we are proposing to revise new under rehabilitation therapy plans of established under sections 1861(g), (m),
§ 410.100(i) (that is, the current treatment. Therefore, we propose to and (p) of the Act. Accordingly,
§ 410.100(j) is redesignated as remove § 410.100(k). physical therapy, occupational therapy,
§ 410.100(i)) to specifically reflect this We invite comments on this proposal. and SLP services provided in the home
coverage decision. Consequently, in We are especially interested in receiving are not covered as CORF services if such
addition to the above proposal, we are comments on the appropriateness of services and related items are covered
also asking for comments on the including drugs and biologicals under a under the Medicare home health
appropriateness of the personnel CORF patient’s rehabilitation plan of benefit. Because the CORF regulations
qualification standards at § 485.79(b) treatment. were not revised to reflect these changes
and (h) for the LPN and for the RN, in coverage and payment methodology,
respectively. 8. Supplies and DME
we propose to do so now.
Payment for supplies and DME as part Therefore, we are proposing to clarify
7. Drugs and Biologicals
of CORF services is specified at the regulations at new § 410.100(l) (that
Section 410.100(k) currently provides § 410.100(l) as ‘‘[s]upplies, appliances is, the current § 410.100(m) is
that drugs and biologicals included and equipment’’ and includes redesignated as § 410.100(l)) and
within the definition of CORF services nonreusable supplies, medical § 410.105(b)(3) to reflect these
includes drugs and biologicals that are equipment and appliances, and DME as requirements.
prescribed by a physician and defined in § 410.38 (except for renal In § 410.105(b)(3), we propose to
administered by a physician or a CORF dialysis systems), is a CORF covered clarify that physical therapy,
RN and not otherwise excluded from service when provided for the patient’s occupational therapy and SLP services
Medicare Part B payment under section use outside the CORF whether can be furnished in the patient’s home
§ 410.29 (relating to self-administered purchased or rented, and is paid under when payment for these therapy
drugs). In addition, in accordance with the DMEPOS fee schedule. We believe services is not otherwise made under
§ 410.105(c), drugs and biologicals that the provision at § 410.100(l) is too the Medicare home health benefit.
administered to a CORF patient will be broad, out of date, and inconsistent with In addition, we propose to revise
covered as CORF services only if current terminology used for covered § 410.100(l) to clarify that the patient
included as part of the rehabilitation services or items. The CORF provision must be present during the home
plan of treatment. However, we are at section 1861(cc)(1)(G) of the Act environment evaluation that is
unable to identify any physician applies only to supplies and DME, yet performed by the PT, OT or speech-
prescribed drugs or biologicals that are the regulatory provision also language pathologist, as appropriate,
not self-administered that would be encompasses medical equipment and because we believe that the patient’s
appropriately provided under a patient’s appliances. Because we believe the presence is necessary to fully evaluate
rehabilitation treatment plan. requirements of § 410.100(l) are the potential impact of the home
In addition, we are concerned about inconsistent with those of section situation on the patient’s rehabilitation
duplicate payment for drugs and 1861(cc)(1)(G) of the Act, we are goals.
biologicals provided to CORF patients proposing to revise both the title and
in the CORF setting. Drugs and description at new § 410.100(k) (that is, 10. Cost-Based Payment (§ 413.1)
biologicals provided to CORF patients the current § 410.100(l) is redesignated Section 413.1(a)(2)(iv) currently
by CORF physicians or RNs under the as § 410.100(k)) by deleting reference to provides for cost-based payment for
supervision of a physician are medical equipment and appliances to CORF services, which reflects the
considered services and supplies reflect the CORF statutory provision by payment methodology provided for
furnished incident to a physician’s including only the items specified under section 1833(a) of the Act,
professional services under section under section 1861(cc)(1)(G) of the Act. requiring payment on the basis of the
1861(s)(2)(A) of the Act, and therefore, We also note that DME, as well as lesser of the provider’s reasonable costs
or customary charges. As discussed for the service when the PFS establishes participation at § 485.58(a), such as
above, this payment methodology is a payment amount for such service. participating in patient case review
inconsistent with section 1834(k) of the Payment for CORF services under the conferences is subsumed within PFS
Act, requiring that the payment basis for PFS is made for physical therapy, payments to CORFs for physical
outpatient physical therapy services occupational therapy, SLP, and therapy, occupational therapy, SLP, and
(including outpatient SLP services), respiratory therapy services, as well as respiratory therapy services, and the
outpatient occupational therapy the related nursing and social and related nursing, and social and
services, and all other CORF services psychological services. In the CY 1999 psychological services. Generally,
provided on or after January 1, 1999 be PFS final rule (63 FR 58860), we administrative costs associated with the
80 percent of the lesser of: (i) The actual explained that we interpret section provision of such services is
charge for the services; or (ii) the 1834(k)(3) of the Act, defining the term incorporated into payment amounts
applicable fee schedule amount. ‘‘applicable fee schedule amount,’’ as established under the PFS through the
Therefore, we are proposing to remove requiring us to use the payment amount PE RVUs representing the resources
§ 413.1(a)(2)(iv) to clarify that cost-based established by an existing fee schedule necessary to perform each service in the
payment is not applicable to services other than the PFS when the PFS does physician office or nonfacility setting.
provided in the CORF setting. We are not establish a payment amount for the Therefore, we believe it unnecessary to
also proposing to remove CORF service. Therefore, we propose at separately compensate CORFs for CORF
§ 413.1(a)(2)(vi) for OPTs or new § 414.1101(c) that we use the physician services given that such
rehabilitation agencies as referenced at existing fee schedules for prosthetic and services are administrative in nature,
section 1861(p) of the Act, because these orthotic devices, DME and supplies for and propose at § 414.1001(b) not to
providers were also affected by the same covered DMEPOS provided by CORFs. separately pay CORFs for CORF
payment changes required by the 1997 Specifically, we propose that payment physician services.
BBA for physical therapy, occupational for covered DME, orthotic and To ensure that CORFs are not paid
therapy, and SLP services effective for prosthetic devices and supplies twice for CORF services, we propose at
CY 1999. provided by a CORF be based on the new § 414.1101 to base payment for a
lesser of 80 percent of actual charges or CORF service on the applicable fee
11. Payment for Comprehensive
the payment amount established under
Outpatient Rehabilitation Facility schedule amount only to the extent that
the DMEPOS fee schedule under
(CORF) Services payment for such service is not
sections 1834 and 1847 of the Act and
We are proposing to establish a new included in the payment amount for
in 42 CFR part 414, subparts D and F.
regulatory subpart M at 42 CFR Part 414 other CORF services. For example,
Finally, we propose at new
to specify the payment methodology for under the PFS, disposable supplies
§ 414.1101(d) that if there is no fee
comprehensive outpatient rehabilitation generally are included in the PE RVUs
schedule amount established for a CORF
services covered under Part B of Title representing the resources necessary to
service, payment shall be based on the
XVIII of the Act that are described at perform the service in the nonfacility
lesser of 80 percent of actual charges or
section 1861(cc)(1) of the Act. setting, and thus are included in the
the amount determined under the fee
Specifically, this proposed subpart schedule established for a comparable payment amount for each service and
would identify and describe how service, as specified by the Secretary. cannot be billed separately.
payment is determined for services As discussed in sections II.K.7. and Accordingly, under proposed
included as CORF services under II.K.12., we propose to remove drugs § 414.1001(c) a CORF could not bill
§ 410.100. and biologicals from the scope of CORF separately for supplies included in the
Proposed § 414.1100 sets forth the services as defined under § 410.100. PE RVU component of the payment
basis and scope for payment for CORF Therefore, we propose not to include amount established for a service under
services. Proposed § 414.1101 sets forth payment for drugs and biologicals under the PFS. However, we note that CORFs
the payment methodology for CORF § 414.1101. could bill separately for certain splint
services, including identifying the As discussed in section II.K.3., and cast supplies for the application of
applicable fee schedule for each type of physician services included within the casts and strapping because these
CORF service identified in § 410.100. definition of CORF services under supplies have been removed from the
Section 1834(k)(1)(B) of the Act § 410.100(a) are limited to those services payment amounts established under the
provides that the payment basis for of a CORF physician described as PFS. These splint and cast supplies are
CORF services is 80 percent of the lesser administrative in nature, to the currently paid using the HCPCS code
of: (i) The actual charge for the services; exclusion of diagnostic and therapeutic series Q4001 through Q4051 which
or (ii) the applicable fee schedule services which are considered were established to make separate
amount. The term ‘‘applicable fee separately billable physician services. payment under section 1861(s)(5) of the
schedule amount’’ is defined under Medicare generally does not permit Act for surgical dressings, and splint
section 1834(k)(3) of the Act to mean, providers to separately bill for their and cast materials. In the CORF setting,
for services furnished in a year, the administrative costs; rather, such costs the splint and cast supplies may be
payment amount determined under the typically are subsumed in the payment applicable for certain cast/strapping
PFS established under section 1848 of amounts for covered medical services application procedures in the CPT code
the Act for such services for the year and items furnished to Medicare series 29000 through 29750. We would
‘‘or, if there is no such fee schedule beneficiaries. Under the PFS these costs note that Medicare makes separate
established for such services, the are included in the payment amount as payment for surgical dressings, which
amount determined under the fee part of the indirect practice expenses are also referenced at section 1861(s)(5)
schedule established for such that are reflected in the PE RVUs for of the Act, only when used by the
comparable services as the Secretary each service and also captured as part beneficiary in his or her home. No
specifies.’’ Accordingly, we propose at of the post-visit work RVU component. separate payment is made when these
new § 414.1101(a) to base payment for a Similarly, we believe payment to CORFs surgical dressings are used in the CORF
CORF service on 80 percent of the lesser for the administrative duties of a CORF setting; rather the dressings costs are
of the actual charge or the PFS amount physician, required as a condition of bundled into the payment amount
established under the PFS for the conditions of participation at § 485.51 to b. Requests To Amend the Compendia
provided services. permit CORFs to provide vaccines to Listings
For CORF services based on the their patients in addition to We received requests from the
payment amount determined under the rehabilitation services. Such vaccines stakeholder community for recognition
PFS, we propose at new § 414.1101(a)(2) would be covered in the CORF setting of additional compendia under the
to use the PFS amount applicable to provided the conditions of coverage following authorities:
services furnished in a nonfacility under § 410.58 and § 410.63 are met. In • Section 1861(t)(2)(B) of the Act
setting, with no separate payment made accordance with sections 1833(a)(1) and which allows the Secretary to identify
for facility costs. The nonfacility 1842(o)(1) of the Act, payment for
payment rate includes, along with any additional authoritative compendia; and
covered pneumococcal, influenza, and • Section 1873 of the Act which
physician work and malpractice RVUs, hepatitis B vaccines provided in the
the PE RVUs representing the resources allows the Secretary to recognize a
CORF setting is based on 95 percent of successor publication if one of the
necessary to perform each service in the the average wholesale price (AWP).
nonfacility setting, such as overhead statutorily named compendia changes
We are interested in receiving its name.
expenses and personnel salaries and the comments on this proposal.
direct costs of clinical labor, disposable In contrast, others have suggested that
supplies, and equipment. In contrast, L. Compendia for Determination of the Secretary consider elimination of
the facility payment rate is based Medically-Accepted Indications for Off- certain listed compendia. However,
primarily on the physician work and Label Uses of Drugs and Biologicals in there is no established regulatory
malpractice RVUs, as well as RVUs for an Anti-cancer Chemotherapeutic process by which the agency can
indirect PE incurred by the physician, Regimen (§ 414.930) currently accept and act definitively on
and does not include the cost of the such requests. In addition, there is
[If you choose to comment on issues
direct PE associated with providing currently no transparency about the
each service in the physician office or criteria upon which we could base a
caption ‘‘DRUG COMPENDIA’’ at the
nonfacility setting. We propose to use decision. Therefore, we are seeking
beginning of your comments.]
the PFS nonfacility amount for CORF public input on this topic.
services in order to offset any costs of 1. Background
c. Technology Assessment of Drug
providing such services in the CORF a. Statutory Requirements Compendia Used to Determine
setting. Medically-Accepted Uses of Drugs and
Section 1861(t)(2)(B)(ii)(I) of the Act
12. Vaccines lists three drug compendia that may be Biologicals in an Anti-cancer
used in determining the medically- Chemotherapeutic Regimen
Section 485.51(a) defines a CORF as a
nonresidential facility that ‘‘is accepted indications of drugs and We commissioned a technology
established and operated exclusively for biologicals used in an anti-cancer assessment (TA) from the Agency for
the purpose of providing’’ rehabilitation chemotherapeutic regimen. The three Healthcare Research and Quality
services by or under the supervision of drug compendia listed are: (AHRQ) on the currently listed
a physician. Because vaccines • American Hospital Formulary compendia (AHFS and USP–DI), as well
administered in the CORF setting are Service-Drug Information (AHFS–DI) as other compendia (that is, National
not rehabilitation services furnished • American Medical Association Drug Comprehensive Cancer Network
under a plan of treatment relating Evaluations (AMA–DE) (NCCN), ClinPharm, DrugDex, Facts &
directly to the rehabilitation of the • United States Pharmacopoeia-Drug Comparisons (F&C)) which might
patient (or, presumably, even medically Information (USP–DI) provide comparable information. AHRQ
necessary for the rehabilitation of the Section 1861(t)(2) of the Act provides contracted the TA to the New England
patient), in accordance with § 485.51(a), the Secretary the authority to revise the Medical Center (NEMC) and Duke
a CORF may not administer vaccines to list of compendia for determining Evidence-based Practice Centers (EPCs)
its patients. However, we note that medically-accepted indications for and found little agreement in the
nothing in the Medicare statute would drugs. Due to changes in the evidence cited among drug compendia.
prohibit a CORF from providing pharmaceutical reference industry, In addition, the TA found little
pneumococcal, influenza, and hepatitis fewer of the statutorily named agreement between the EPC’s
B vaccines to its patients provided the compendia are available for our independent identification of evidence
facility is ‘‘primarily engaged in reference. (That is, AMA–DE is no on 14 example off-label indications and
providing * * * diagnostic, therapeutic, longer in publication; USP–DI has been evidence cited in the drug compendia.
and restorative services to outpatients purchased by Thomson Micromedex The TA can be found at http://
for the rehabilitation of injured, and it is our understanding that the www.cms.hhs.gov/mcd/viewtechassess.
disabled, or sick persons’’ (section name ‘‘USP–DI’’ may not be used after asp?where=index&tid=46.
1861(cc)(2)(A) of the Act). Accordingly, 2007.)
under the statute, such vaccines may be Section 6001(f)(1) of the DRA amends d. Medicare Evidence Development and
covered separately from the CORF both ‘‘sections 1927(g)(1)(B)(i)(II) and Coverage Advisory Committee
services benefit under section 1861(t)(2)(B)(ii)(I) of the Act by inserting (MedCAC)
1861(s)(10) of the Act—defining the ‘(or its successor publications)’ after On March 30, 2006, the MedCAC
term ‘‘medical and other health ‘United States Pharmacopeia-Drug (formerly the Medicare Coverage
services’’ to include the pneumococcal, Information’.’’ We interpret this DRA Advisory Committee (MCAC)) met in
influenza, and hepatitis B vaccines— provision as explicitly authorizing the public session to advise CMS on the
provided the applicable conditions of Secretary to continue recognition of the evidence about the desirable
coverage under § 410.58 and § 410.63 compendium currently known as USP– characteristics of compendia to
are met. In order to include coverage DI after its name change if the Secretary determine medically-accepted
and payment for these vaccines when determines that it is in fact a successor indications of drugs and biologicals in
provided to CORF patients in the CORF publication rather than a substitute anti-cancer therapy and the degree to
setting, we propose to amend the CORF publication. which the currently listed and other
available compendia display those section 1861(t) of the Act. We believe the public to be notified, we will begin
characteristics. All information on this that the notice and comment period of the acceptance process for external
MedCAC meeting can be found on the this proposed rule will provide the requests no sooner than 45 days after
CMS Web site at http:// opportunity for the public to present its publication of the notice. We believe
www.cms.hhs.gov/mcd/ concerns regarding this process. We that this will enhance the administrative
viewmcac.asp?where=index&mid=33. encourage all interested parties to efficiency of this process without
The agenda included a presentation of submit their comments via the process placing a significant burden on the
the TA performed for AHRQ by staff of mentioned in the SUPPLEMENTARY public.
the NEMC and Duke EPCs, scheduled INFORMATION section of this proposed • We will publish a listing of the
stakeholder presentations, as well as an rule. timely complete request(s) received and
opportunity to hear testimony from allow the public 30 days to submit
2. Process for Determining Changes to
members of the audience. As is comments on the request(s). The listing
the Compendia List
customary, the MedCAC panelists will identify the requestor and the
elicited additional information from the A compendium for the purpose of this requested addition or deletion to the list
presenters and discussed the evidence section is defined as a comprehensive of compendia.
in preparation for a formal vote. listing of FDA-approved drugs and • A complete request must include
The MedCAC identified the following biologicals or a comprehensive listing of the following:
desirable characteristics: a specific subset of drugs and + The full name and contact
• Extensive breadth of listings. biologicals in a specialty compendium, information (including the mailing
• Quick throughput from application for example, a compendium of anti- address, e-mail address, and telephone
for inclusion to listing. cancer treatment. A compendium: (1) number) of the requestor. If the
• Detailed description of the evidence Includes a summary of the requestor is not an individual person,
reviewed for every individual listing. pharmacologic characteristics of each the information shall identify the officer
• Use of pre-specified published drug or biological and may include or other representative who is
criteria for weighing evidence. information on dosage, as well as authorized to act for the requestor on all
• Use of prescribed published process recommended or endorsed uses in matters related to the request.
for making recommendations. specific diseases; (2) is indexed by drug + Full identification of the
• Publicly transparent process for or biological; (3) differs from a disease compendium that is the subject of the
evaluating therapies. treatment guideline, which is indexed request, including name, publisher,
• Explicit ‘‘Not recommended’’ listing by disease. We believe that the use of edition if applicable, date of
when validated evidence is appropriate. compendia to determine medically- publication, and any other information
• Explicit listing and accepted indications of drugs and needed for the accurate and precise
recommendations regarding therapies, biologicals in the manner specified in identification of the specific
including sequential use or combination section 1861(t)(2)(B)(ii)(I) of the Act is compendium.
in relation to other therapies. more efficiently accomplished if the + A complete written copy of the
• Explicit ‘‘Equivocal’’ listing when information contained is organized by compendium that is the subject of the
validated evidence is equivocal. the drug or biological and if the listings request. If the complete compendium is
• Process for public identification are comprehensive. available electronically, it may be
and notification of potential conflicts of We propose to create a process submitted electronically in place of hard
interest of the compendia’s parent and incorporating public notice and copy. If the compendium is available
sibling organizations, reviewers, and comment to receive and make online, the requestor may provide us
committee members, with an determinations regarding requests for with electronic access by furnishing at
established procedure to manage changes to the list of compendia used to no cost to the Federal government
recognized conflicts. determine medically-accepted sufficient accounts for the purposes and
The MedCAC concluded that none of indications for drugs and biologicals duration of the review of the application
the compendia fully display the used in anti-cancer treatment as in place of hard copy.
desirable characteristics. The voting described in section 1861(t)(2)(B)(ii)(I) + The specific action that the
results can be viewed at the same Web of the Act. Requests may be for addition requestor wishes CMS to take, for
site provided previously for the or deletion of a compendium from the example to add or delete a specific
MedCAC meeting. In addition the list. compendium.
MedCAC noted significant variability We will use the following process to + Detailed, specific documentation
among the compendia. There was no receive and make determinations that the compendium that is the subject
agreement among the panel members regarding requests for changes to the list of the request does or does not comply
that any particular predetermined of compendia: with the conditions of this rule. Broad,
number of compendia was desirable. • For the purposes of this section, the nonspecific claims without supporting
Participants in the meeting also notice may be accomplished by posting documentation cannot be efficiently
discussed the clinical usefulness of drug the information on the CMS Web site. reviewed; therefore, they will not be
compendia in the treatment of cancer. It This does not preclude us from using accepted.
was reported that oncologists do not other reasonable means at our + A request may have only a single
rely on compendia when making discretion. We believe this will facilitate compendium as its subject. This will
treatment decisions, relying instead on a timely and efficient consideration of provide greater clarity on the scope of
published treatment guidelines, clinical requests. the agency’s review of a given request.
trial protocols, or consultation with • We will issue annually a notice for A requestor may submit multiple
peers. requests to revise the list of compendia. requests, each requesting a different
Prior to this proposed rule, we This notice will be published and will action.
received and reviewed unsolicited specify a 30-day time period within + Requests must be in writing as
comments from professional societies which we will accept any external opposed to verbal.
regarding additions and deletions to the requests that are complete, as defined in • Requests may be submitted in two
listing of compendia for purposes of this section. To allow sufficient time for ways (no duplicates please). Electronic
submissions are encouraged to facilitate • In addition to the annual process, and coinsurance, may not exceed the
administrative efficiency. We will, in we may generate a request for changes lowest of the following amounts:
our solicitation of requests, identify the to the list of compendia at any time. • The physician or other supplier’s
electronic address to be used for net charge to the billing physician or
M. Physician Self-Referral Provisions medical group.
submissions. Hard copy requests can be
sent to the Centers for Medicare & [If you choose to comment on issues • The billing physician’s or medical
Medicaid Services, Coverage and in this section, please include the group’s actual charge.
Analysis Group, Mailstop C1–09–06, caption ‘‘PHYSICIAN SELF-REFERRAL • The fee schedule amount for the
7500 Security Boulevard, Baltimore, PROVISIONS’’ at the beginning of your service that would be allowed if the
MD, 21244. Please allow sufficient time comments.] physician or other supplier billed
for hard copies to be received prior to directly.
1. Changes to Reassignment and We also proposed that, to bill for the
the close of the solicitation period. We
Physician Self-Referral Rules Relating to TC, the billing entity would be required
may internally generate a request to
Diagnostic Tests (Anti-Markup to perform the interpretation. In
change the list of compendia at any
Provision) addition, we considered imposing
time. We believe that this preserves the
agency’s ability to act quickly if we Medicare rules currently prohibit the certain conditions on when a physician
determine that urgent action is needed markup of the technical component of or medical group can bill for a
to protect the interests of the Medicare certain diagnostic tests that are reassigned PC of a diagnostic test. We
program and its beneficiaries. performed by outside suppliers and stated that we were considering the
• We will consider a compendium’s billed to Medicare by a different following conditions (which currently
attainment of the MedCAC- individual or entity (§ 414.50). In appear in manual provisions and are
recommended desirable characteristics addition, Medicare program instructions known as the purchased interpretation
of compendia, listed above in this restrict who may bill for the rules):
• The test must be ordered by a
section, in reviewing requests. We may professional component (the
physician who is financially
consider additional reasonable factors in interpretation) of diagnostic tests (CMS
independent of the person or entity
making a determination. (For example, Pub. 100–04, Chapter 1, 30.2.9.1).
performing the test and also of the
we may consider factors that are likely In the CY 2007 PFS proposed rule (71 physician or medical group performing
to impact the compendium’s suitability FR 48982), we stated that recent changes the interpretation.
for this use, such as a change in to our rules on reassignment concerning • The physician or medical group
ownership or affiliation, the standards the right to receive Medicare payment performing the interpretation does not
applicable to the evidence considered may have led to some confusion as to see the patient.
by the compendium, and any relevant whether the anti-markup and purchased • The physician or medical group
conflicts of interest. We may consider interpretation requirements apply to billing for the interpretation must have
that broad accessibility by the general certain situations where a reassignment performed the TC of the test.
public to the information contained in has occurred under a contractual We stated that, although we
the compendium may assist arrangement. In addition, we expressed welcomed comments on all aspects of
beneficiaries, their treating physicians concern about the existence of certain our proposals, we were particularly
or both in choosing among treatment arrangements that we believe are not interested in receiving comments on
options.) within the intended purpose of the whether: diagnostic imaging tests
• We will also consider a physician self-referral rules, which should be excepted from any of our
compendium’s grading of evidence used permit physician group practices to bill proposed provisions; the proposal in
in making recommendations regarding for certain services furnished by a whole or in part should apply only to
off-label uses and the process by which contractor physician in a ‘‘centralized pathology services; any of the proposed
the compendium grades the evidence. building.’’ We also expressed concern provisions should apply to services
• We may, at our discretion, combine that allowing physician group practices performed on the premises of the billing
and consider multiple requests that refer or other suppliers to purchase or entity and if so, how to define the
to the same compendium, even if those otherwise contract for the provision of premises appropriately. We also
requests are for different actions. This diagnostic testing services and to then requested comments as to whether an
facilitates administrative efficiency in realize a profit when billing Medicare anti-markup provision should apply to
our review of requests. may lead to patient and program abuse the reassignment of the PC of diagnostic
• We will publish our decision in the form of overutilization of services tests performed under a contractual
within 120 days after the close of the and result in higher costs to the arrangement, and if so, how to
public comment period. Medicare program (71 FR 49054). determine the correct amount that
• For each compendium that we In the CY 2007 PFS proposed rule (71 should be billed to the Medicare
determine should be included on the FR 48982), we proposed to amend program.
list, the publisher or its designee must § 424.80 to provide that if the TC of a For our physician self-referral rules,
notify CMS, within 45 days from the diagnostic test (other than clinical we proposed to modify the definition of
publication date of each new edition or diagnostic laboratory tests paid under ‘‘centralized building’’ at § 411.351 to
revision of the compendium, that a new section 1833(a)(2)(D) of the Act, which require a centralized building to consist
edition or version is available. This will are subject to the special rules set forth of at least 350 square feet. We further
ensure that we have the most current in section 1833(h)(5)(A) of the Act) is proposed that the proposed minimum
information for each compendium. This billed by a physician or medical group square footage requirement would not
may be provided electronically or via (the ‘‘billing entity’’) under a apply to space owned or rented in a
online access. We believe that this is reassignment involving a contractual building in which no more than three
necessary to permit us to efficiently arrangement with a physician or other group practices own or lease space in
ensure that the listed compendia supplier who performs the service, the the ‘‘same building,’’ as defined at
continue to meet the conditions set forth amount billed to Medicare by the billing § 411.351 (that is, in a building with the
in this rule. entity, less the applicable deductibles same street address) and share the same
‘‘physician in the group practice’’ (as supplier’s net charge to the billing entity In addition, we are proposing in
defined at § 411.351). We also proposed is inflated to cover the cost of § 414.50 that—(1) The PC of a purchased
that a centralized building must contain, equipment or space that is leased to the test be subject to an anti-markup
on a permanent basis, the necessary performing physician or other supplier, provision; (2) the anti-markup provision
equipment to perform substantially all we would define ‘‘net charge’’ as for the TC and PC apply to all
of the designated health services (DHS) exclusive of any amount that takes into arrangements not involving a
that are performed in the space in order consideration such charges. For reassignment from a full-time employee
to meet the definition of a centralized example, consider the following of the billing entity; (3) the performing
building. We solicited comments as to hypothetical: physician’s or other supplier’s net
whether a centralized building should • The fee schedule amount for the PC charge be calculated exclusive of any
have a minimum square foot of a particular diagnostic test is $100. charge that reflects the cost of space or
requirement, and if so, whether the • Performing Physician A rents office equipment leased to the performing
minimum should be 350 square feet or space and equipment from Group B for physician or other supplier by the
an amount more or less than that. In $50 per test interpretation performed. billing entity; and (4) the anti-markup
addition, we sought comments • Physician A charges Group B $100 provision not apply to independent labs
regarding whether there should be an per test. In this example, pursuant to that have not ordered the TC.
exception to any minimum square foot our proposal, Physician A’s charge of At this time, we are not proposing to
requirement, and if so, the $100 would be deemed to take into make changes to the definition of
circumstances under which an ‘‘centralized building’’ (with the one
account the $50 rental fee imposed by
exception should apply. possible exception noted below in this
Group B (simply by virtue of the rental
For our proposal that the centralized section). We believe that changes to the
arrangement). Therefore, Group B would
building permanently contain the definition may be unnecessary in light
not be allowed to bill the full fee
necessary equipment to perform of our proposals for an anti-markup
schedule amount of $100, but rather,
substantially all of the DHS that is provision on the TC and PC of
would be limited to the lesser of
furnished in the centralized building, diagnostic tests (although if we decide
Physician A’s net charge determined
we sought comments on whether this to impose an anti-markup for TCs
exclusive of the amount that is deemed
test should be imposed, and whether at performed by technicians in a
to have taken into consideration the
least 90 percent or some other minimum centralized building, we may
lease expense, that is $50, or Group B’s
percentage or measurement would be accomplish that through amending the
appropriate. We stated that we were also actual charge for the PC. We are also definition of ‘‘centralized building’’). If
considering whether to require that, for concerned that overutilization of an anti-markup provision is finalized,
space to qualify as a centralized diagnostic tests could continue despite we may evaluate at a later time whether
building, the group practice must our proposal to apply an anti-markup to make any revisions to the definition
employ, in that space, a nonphysician provision to TCs that are reassigned to, of ‘‘centralized building.’’ We also are
employee or independent contractor or outright purchased by, group not proposing to adopt the purchased
who will perform services exclusively practices. That is, our proposal in the test interpretation rules in the context of
for the group for at least 35 hours per CY 2007 PFS proposed rule to impose reassignments because this provision
week. Finally, we sought comments on an anti-markup provision would not may be unnecessary if we impose an
whether a group practice should be have addressed the situation in which anti-markup provision and because the
allowed to maintain a centralized the TC is performed by a part-time or purchased test interpretation rules may
building in a State different from the leased employee of the group practice in be problematic for multi-specialty group
State(s) in which it has an office that a centralized building, and the group practices. Finally, in the CY 2007 PFS
meets the criteria in § 411.355(b)(2)(i), neither receives a reassignment from the proposed rule, we proposed that, in
and if so, whether space that is located employee technician (if the technician order to bill for the TC of the diagnostic
in a different State must be within a is not able to bill for the TC in his or test, the billing physician or medical
certain number of miles from an office her own right), nor purchases the TC group must directly perform the PC.
of the group practice that meets the outright from the technician. Therefore, However, we believe this provision may
criteria in § 411.355(b)(2)(i) in order to we are proposing to apply an anti- be unnecessary if we impose an anti-
qualify as a centralized building. markup provision to TCs that are markup provision and also would be
We received numerous comments on performed in a centralized building, and problematic for independent labs that
these proposals. As a result, we did not are seeking comments on whether we cannot employ physicians due to
finalize our proposals in the CY 2007 should have such a provision and, if so, corporate practice of medicine
PFS final rule with comment period. how we should effect such a provision restrictions.
Based on the comments received and (for example, through amending the
other information that we considered, definition of ‘‘centralized building’’ or 2. Burden of Proof
we are proposing to impose an anti- through some other means. We would We are proposing to add § 411.353(g)
markup provision on the TC and PC of except the anti-markup provision for to clarify that, consistent with our
diagnostic tests. We would apply the PCs ordered by independent policy with respect to claims denials, in
anti-markup provision irrespective of laboratories because we do not believe any appeal of a denial of payment for a
whether the billing physician or that PCs ordered by independent DHS that was made on the basis that the
medical group outright purchases the laboratories pose a significant risk of service was furnished pursuant to a
PC or the TC, or whether the physician program abuse because the independent prohibited referral, the burden is on the
or other supplier performing the TC or lab is not ordering the TC. In States entity submitting the claim for payment
PC reassigns his or her right to bill to where the corporate practice of to establish that the service was not
the billing physician or medical group medicine doctrine is in effect, furnished pursuant to a prohibited
(unless the performing supplier is a full- independent labs that are organized as referral. That is, the burden of proof is
time employee of the billing entity). To corporations are prevented from hiring not on CMS or our contractors to
prevent gaming, whereby the physicians as employees to perform PCs establish that the service was furnished
performing physician’s or other of diagnostic tests. pursuant to a prohibited referral.
3. In-Office Ancillary Services such an arrangement, a staff member In response to Phase II, we received
Exception would take a urine or blood sample to hundreds of letters from physical
One of the most important exceptions the clinical laboratory, create a slide, therapists and occupational therapists
to the physician self-referral perform the test, and obtain the results stating that the in-office ancillary
prohibition, applicable to services for the physician while the patient services exception encourages
furnished by group practices and sole waited. physicians to create physical and
However, services furnished today occupational therapy practices. In
practitioners, is the in-office ancillary
purportedly under the in-office ancillary addition, we have been informed by a
services exception. Section 1877(b)(2) of
services exception are often not as number of physician specialists that the
the Act sets forth an exception for
closely connected to the physician in-office ancillary services exception
certain services (other than durable
practice. For example, pathology enables physicians to order and then
medical equipment and parenteral and
services may be furnished in a building subsequently perform ancillary services
enteral nutrients) that are provided
that is not physically close to any of the instead of making a referral to a
ancillary to medical services provided group practice’s other offices, and the specialist.
by a physician or group practice and professional component of the In the CY 2007 PFS proposed rule (71
that meet certain conditions. The in- pathology services may be furnished by FR 48982), we stated our intent to
office ancillary services exception is contractor pathologists who have address certain types of potentially
codified in § 411.355(b). virtually no relationship with the group abusive arrangements in which group
Among other things, the exception practice (in some cases, the technical practice physicians make a referral for a
allows patients of a sole practitioner or component of the pathology services is DHS to a specialist who is an
physician in a group practice to receive furnished by laboratory technologists independent contractor of the group
ancillary services in the same building who are employed by an entity practice. The specialist then performs
in which the referring physician or his unrelated to the group practice). In other the service for the group practice in a
or her group practice furnishes medical words, the core members of the group ‘‘centralized building’’ and reassigns his
services, including some services practice and their staff are never or her right to Medicare payment to the
unrelated to the furnishing of DHS. The physically present in the contractor group (which then bills Medicare at a
exception provides additional flexibility pathologist’s office. Similarly, the profit).
for patients seen by a physician in a contractor pathologists do not Comments received on the CY 2007
group practice by allowing these participate in any group practice PFS proposed rule stated that, although
patients to receive a test or procedure in activities; they attend no meetings our proposal addressed potential abuses
another building in space owned or (except for phone calls about individual arising from referrals to independent
leased on a full-time, exclusive basis by patients), and do not obtain retirement contractors who perform services in a
a group practice (that is, a ‘‘centralized or health benefits from the group centralized building, it failed to address
building’’ as defined at § 411.351). practice. In sum, these types of abusive arrangements within the
The in-office ancillary services arrangements appear to be nothing more physician’s office. Our review of
exception does not contain certain than enterprises established for the self- industry trade articles and discussions
requirements that are found in other referral of DHS. with trade associations has heightened
compensation exceptions. For example, Even in the case of ancillary services our awareness of the proliferation of in-
the exception for personal service furnished in the same building, there office laboratories and the migration of
arrangements in § 411.357(d), like many may be very little interaction between sophisticated and expensive imaging or
of the compensation exceptions, the physicians who treat patients and other equipment to physician offices.
requires that compensation be set in the staff that provide the ancillary ‘‘Turn-key’’ operations, such as the
advance, consistent with fair market services. For example, an entity with its arrangements described in this section
value, and not determined in a manner own staff located in a large medical for in-office laboratories and other
that takes into account the volume or office building next to a hospital may ventures, are being marketed to
value of referrals or other business furnish an array of diagnostic services, physicians over the internet.
generated by the referring physician. including clinical laboratory services At this time, we decline to issue a
These requirements are not present in and radiology services, to patients of specific proposal for amending the in-
the in-office ancillary services physicians who practice in the building office ancillary services exception.
exception. Also, under the ‘‘special rule and own either the equipment or the Rather, we are soliciting comments as to
for productivity bonuses and profit entity. whether changes are necessary and, if
shares’’ in § 411.352(i), a physician in a Comments received on the Phase I so, what changes should be made. We
group practice may receive a share of and Phase II physician self-referral rules are interested in receiving comments on:
profits or a productivity bonus for (66 FR 856 and 69 FR 16055, (1) Whether certain services should not
referred ancillary services, provided that respectively) stated that the in-office qualify for the exception (for example,
the payment is not directly related to ancillary services exception is any therapy services that are not
the volume or value of referrals. susceptible to abuse. For example, in provided on an incident to basis, and
We believe that the Congress included response to the 1998 physician self- services that are not needed at the time
an exception for in-office ancillary referral proposed rule (66 FR 892), a of the office visit in order to assist the
services to allow for the provision of commenter asserted that the Congress physician in his or her diagnosis or plan
certain services necessary to the did not intend for a group practice to of treatment, or complex laboratory
diagnosis or treatment of the medical have multiple centralized office services); (2) whether and, if so, how we
condition that brought the patient to the locations, except for the provision of should make changes to our definitions
physician’s office. At the time of clinical laboratory services. This of same building and centralized
enactment, a typical in-office ancillary sentiment was reiterated in response to building; (3) whether nonspecialist
services arrangement might have the Phase I final rule when several physicians should be able to use the
involved a clinical laboratory owned by commenters objected to the decision to exception to refer patients for
physicians located on one floor of a allow group practices to have more than specialized services involving the use of
small medical office building. Under one centralized facility (69 FR 16075). equipment owned by the nonspecialists;
and (4) any other restrictions on the • A requirement for a written between the parties. The statute also
ownership or investment in services agreement between the parties. requires that the lease arrangement meet
that would curtail program or patient • Physician certification (or, in such other requirements as the Secretary
abuse. subsequent years, actual data indicating) may impose by regulation as needed to
that a specified percent of the safeguard against program or patient
4. Obstetrical Malpractice Insurance physician’s obstetrical patients treated abuse. We are concerned with lease
Subsidies under the coverage of the subsidized arrangements that are structured so that
We are concerned that our exception malpractice insurance will either reside a physician is rewarded for each referral
for obstetrical malpractice insurance in a HPSA or medically-underserved he or she makes for DHS. Such
subsidies is unnecessarily restrictive; area or be part of a medically- arrangements could take the form of a
that is, that our exception does not underserved population. physician leasing equipment that he or
allow for certain obstetrical malpractice • Location of the entity making the she owns to a hospital, and receiving a
insurance subsidies that may be malpractice insurance premium subsidy per-use (per-click) fee each time a
provided without a risk of program or payment. patient is referred by the physician-
patient abuse. The exception in • Location of the medical practice of owner to the hospital for the use of the
§ 411.357(r) incorporates by reference the physician receiving the malpractice equipment. We are also concerned about
the conditions in the anti-kickback safe insurance subsidy payment. arrangements where the physician is the
harbor in § 1001.952(o). We have • A requirement that the payment not lessee and rents space or equipment
received accounts, through advisory be conditioned on the physician making from a hospital or other DHS entity on
opinion requests and anecdotally, of referrals to, or otherwise generating a per-click basis. For example, if a
patient difficulty obtaining obstetrical business for, the entity. physician rents an MRI machine from a
care in some communities in States in • No restriction on the physician hospital only when the physician refers
which obstetrical malpractice insurance establishing staff privileges at, referring a patient for an MRI and then provides
premiums are relatively high. We have any service to, or otherwise generating the facility portion of the MRI service
also been informed that obstetricians any business for any other entity. under arrangements with the hospital,
• A requirement that the amount of the physician benefits financially and
have left these States for other practice
the payment may not vary based on the the arrangement could provide an
locations where obstetrical malpractice
volume or value of any previous or incentive for overutilization or other
insurance premiums are less expensive,
expected referrals to or business program abuse.
requiring patients to drive long
otherwise generated for the entity by the In the 1998 proposed rule (63 FR
distances to receive obstetrical care. We
physician. 1714), we noted that we had been asked
are seeking comments describing such
• A requirement that the physician about situations in which a physician
problems and recommendations for how
must treat obstetrical patients who rents equipment (such as a magnetic
the exception should be changed
receive medical benefits or assistance resonance imaging (MRI) machine) to an
without creating a risk of program or
under any Federal health care program entity that furnishes a DHS, such as a
patient abuse. For example, the
in a nondiscriminatory manner. hospital, with the physician receiving
exception requires that the physician • A requirement that the insurance is
practice in a primary care HPSA and rental payments on a per-click basis
a bona fide malpractice insurance
that 75 percent of the physician’s (that is, total rental payments increase
policy or program, and the premium, if
obstetrical patients treated under the each time the machine is used). We
any, is calculated based on a bona fide
coverage of the malpractice insurance stated that we believed that this
assessment of the liability risk covered
will either reside in a HPSA or a arrangement would not prohibit the
under the insurance.
medically-underserved area or be part of In addition, we would include the physician from otherwise referring to
a medically-underserved population. requirement that the arrangement not the entity, provided that these kinds of
We are interested in whether the violate the anti-kickback statute (section arrangements were typical and
exception would more effectively 1128B(b) of the Act) or any Federal or complied with the fair market value and
ensure beneficiary access to obstetrical State law or regulation governing billing other requirements included under the
care without risking program abuse if or claims submission (which is a rental exception. However, we added
any of the requirements were changed. requirement of our other compensation that, because a physician’s
In addition, to the extent possible, we exceptions issued under our authority compensation under this exception may
would like to establish bright-line under section 1877(b)(4) of the Act). not reflect the volume or value of the
requirements in the exception. physician’s own referrals, the rental
We are proposing to revise the 5. Unit-of-Service (Per-Click) Payments payments may not reflect per-click
exception in § 411.357(r) to specifically in Space and Equipment Leases payments for patients who are referred
list the conditions that we believe are Section 1877(e)(1) of the Act provides for the service by the lessor physician.
appropriate to safeguard against an exception to the prohibition of In the Phase I rulemaking, we stated
program or patient abuse when physician referrals for space and that we were substantially revising the
remuneration is provided by a hospital equipment leases, provided that certain proposed rule with respect to ‘‘the
to a physician in the form of an requirements are met. Among the volume or value standard.’’ We stated:
obstetrical malpractice insurance requirements, which are incorporated in Most importantly, we are permitting time-
subsidy. As noted previously, the our regulations in § 411.357(a) and (b), based or unit-of-service-based payments,
current exception incorporates the are that the lease be commercially even when the physician receiving the
conditions in the anti-kickback safe reasonable even if no referrals were payment has generated the payment through
harbor in § 1001.952(o). We are seeking made between the parties, and that the a DHS referral. We have reviewed the
legislative history with respect to the
comments with respect to requirements, rental charges be set in advance, be exception for space and equipment leases
such as the following, that would be consistent with market value, and not be and concluded that the Congress intended
appropriate to include in the exception determined in a manner that takes into that time-based or unit-of-service-based
for obstetrical malpractice insurance account the volume or value of any payments be protected, so long as the
subsidies: referrals or other business generated payment per unit is at fair market value at
inception and does not subsequently change beyond the expiration of the lease. We questions concerning whether stock
during the lease term in any manner that are seeking comment whether, with options and other nonvested interests
takes into account DHS referrals. (66 FR 876) respect to types of noncompliance for (such as an interest in retirement funds
After reconsidering the issue, we are which it is not clear when a financial that vests after a certain number of years
proposing that space and equipment relationship ended, we should always worked) in an entity constitutes
leases may not include unit-of-service- employ a case-by-case approach, or ownership in that entity. We replied
based payments to a physician lessor for deem certain types of financial that it was our view that options and
services rendered by an entity lessee to relationships to continue for a nonvested interests are inchoate or
patients who are referred by a physician prescribed period of time. partial ownership interests that qualify
lessor to the entity. We believe that such We are also soliciting comment as to as ‘‘ownership’’ for purposes of the
arrangements are inherently susceptible whether we should allow the period of physician self-referral law. In response
to abuse because the physician lessor disallowance to terminate where the to a comment to the 1998 proposed rule,
has an incentive to profit from referring parties have returned, or paid back the however, we stated in the Phase I final
a higher volume of patients to the value of, the consideration. For rule with comment period that we were
lessee, and we would disallow such per- example, if we were to impose a period withdrawing the statement in the 1998
click payments, using our authority of disallowance for a prescribed period proposed rule that an interest in a
under section 1877(e)(1) of the Act, even of time because it would not be clear retirement plan might be treated as an
if the statute does not expressly forbid when a noncompliant compensation ownership or investment interest for
per-click payments to a lessor for arrangement ended, we might allow the purposes of section 1877 of the Act and
patient referred to the lessee. parties to terminate the period of that, instead, we would consider
Finally, we are soliciting comments disqualification sooner than the contributions (including employer
on whether, using our authority under prescribed period if the prohibited contributions) to retirement plans to be
section 1877(e)(1) of the Act, we should compensation were returned. We part of an employee’s overall
prohibit time-based or unit-of-service- caution that we do not envision compensation arrangement with his or
based payments to an entity lessor by a allowing such an option where the her employer (66 FR 870). As part of the
physician lessee, to the extent that such parties knew or, in our judgment, Phase I rule, we promulgated
payments reflect services rendered to reasonably should have known that the § 411.354(b)(3)(i), which excludes ‘‘[a]n
patients sent to the physician lessee by arrangement did not satisfy the interest in a retirement plan’’ from the
the entity lessor. requirements of an exception. definition of ownership and investment
We are also seeking comment as to interests. We made no changes to this
6. Period of Disallowance for
whether we should impose a period of provision in Phase II (69 FR 16054).
Noncompliant Financial Relationships
disqualification from using an exception We received a comment in response
In response to the Phase II interim where an arrangement has failed to to the Phase II interim final rule (69 FR
final rule with comment period (69 FR satisfy the requirements of that 16054) concerning the exclusion from
16054), we received several comments exception. For example, suppose non- an ownership or investment interest for
that questioned what the period would monetary compensation is given by an retirement plans as specified in
be for which the physician could not entity to a physician that greatly § 411.354(b)(3)(i). The commenter stated
refer DHS to the entity and the entity exceeds the permissible limit prescribed that, contrary to our intent, some
could not bill Medicare for the situation in § 411.357(k). In addition to whatever physicians are using retirement plans to
in which a financial arrangement period of disallowance that would purchase DHS entities to which they
between a referring physician and an apply, we are considering whether the refer patients for DHS. We agree with
entity failed to satisfy the requirements parties should be disqualified, for a the commenter that it was not our intent
of an exception to the general period of time, from relying on this to exclude from the definition of an
prohibition on self-referrals. exception. For example, if an entity ownership or investment interest an
At this time, we are not making gives a piece of equipment to a interest in a DHS entity that results from
proposals for prescribing the period of physician that has a fair market value of a physician’s (or family member’s)
disallowance for various types of $900, we may— participation in a retirement plan that
noncompliance, but rather are seeking • Prohibit one or both of the parties purchases an interest in that DHS entity.
comments on how we might, to the from relying on this exception for a That is, where a physician has an
extent practicable, set forth the period of period of time; interest in a retirement plan offered by
disallowance for arrangements that • Require the parties to ‘‘spend Entity A, through the physician’s (or an
implicate, but fail to satisfy the down’’ in order to use the exception immediate family member’s)
requirements of, one or more of the again (for example, if the permissible employment with Entity A, we intended
various exceptions. As a general matter, year limit is $300 (not taking into to except from the definition of
we believe that the statute contemplates account adjustment for inflation) and ownership or investment interests any
that the period of disallowance should the parties exceeded this limit by $600, interest the physician would have in
begin with the date that a financial the parties would be precluded from Entity A by virtue of his or her interest
arrangement failed to comply with the using the exception during the next 2 in the retirement plan; we did not
statute and the regulations and end with years (not taking into account intend to exclude from the definition of
the date that the arrangement came into adjustment for inflation); or ownership or investment interests any
compliance or ended. However, in some • Require the physician to return or interest the physician may have in
instances it may not be clear when a pay back the value of the excess Entity B through the retirement plan’s
financial arrangement has ended. For compensation in order for one or both purchase of an interest in Entity B.
example, where an entity leases space to of the parties to use the exception again. Accordingly we are proposing to
a physician at a rental price that is revise § 411.354(b)(3)(i) to provide that
substantially below fair market value, it 7. Ownership or Investment Interest in ownership and investment interests do
may raise the inference that the below Retirement Plans not include an interest in a retirement
market rent was in exchange for future In the 1998 proposed rule (63 FR plan offered by the entity to the
referrals, including referrals made 1708), we noted that we had received physician or immediate family member
as a result of the physician’s or to academic medical centers and to compensation arrangements. In the
immediate family member’s hospitals ‘‘which argued that percentage Phase II interim final rule, we solicited
employment with the entity. compensation is commonplace in their comments on this issue, and we may be
physician compensation arrangements’’ addressing this issue in an upcoming
8. ‘‘Set in Advance’’ and Percentage-
(69 FR 16068). We were persuaded that final rule. In this proposed rule, we are
Based Compensation Arrangements
our original position was overly focusing on the DHS entity side of
Several of the compensation restrictive, and accordingly, we deleted physician-DHS entity financial
exceptions in section 1877 of the Act the last sentence in § 411.354(d)(1) and relationships. We propose to amend
require that the compensation be ‘‘set in clarified that the specific formula must § 411.354(c) to provide that, where a
advance’’ (or ‘‘fixed in advance’’). This be set forth in sufficient detail before the DHS entity owns or controls an entity to
requirement has been carried over in furnishing of the items or services and which a physician refers Medicare
our regulations implementing those the formula may not be modified within patients for DHS, the DHS entity would
statutory exceptions, and we have also the time period in any manner that stand in the shoes of the entity that it
included a ‘‘set in advance’’ reflects the volume or value of referrals owns or controls and would be deemed
requirement in some of our regulatory or any other business generated between to have the same compensation
exceptions (that is, exceptions the parties. arrangements with the same parties and
promulgated pursuant to our authority Despite our intent that percentage on the same terms as does the entity that
in section 1877(b)(4) of the Act to create compensation arrangements could be it owns or controls. For example, a
additional exceptions that pose no risk used only for compensating physicians hospital would stand in the shoes of a
of program or patient abuse). In for the physician services they perform, medical foundation that it owns or
§ 411.354(d), Special Rules on it has come to our attention that controls (such as where the hospital is
Compensation, we state that percentage compensation arrangements the sole member of a non-profit
compensation will be considered ‘‘set in are being used for the provision of other corporation). Thus, if a hospital owns or
advance’’ if the aggregate compensation, services and items, such as equipment controls a medical foundation that
a time-based or per unit-of-service-based and office space that is leased on the contracts with a physician to provide
amount, or a specific formula for basis of a percentage of the revenues physician services at a clinic owned by
calculating the compensation, is set raised by the equipment or in the the medical foundation, the hospital
forth in an agreement between the medical office space. We are concerned would stand in the shoes of the medical
parties before the furnishing of the items that percentage compensation foundation, and would be deemed to
or services for which the compensation arrangements in the context of have a direct compensation relationship
is to be paid. Under Phase I (66 FR 959), equipment and office space rentals are with the contractor physician.
the last sentence of § 411.354(d)(1) read, potentially abusive. We note that We believe that it is necessary to
Percentage compensation arrangements do section 1877(e)(1)(A)(vi) of the Act, with collapse the type of relationship
not constitute compensation that is ‘set in respect to office space rentals, and discussed above to safeguard against
advance’ in which the percentage section 1877(e)(1)(B)(vi) of the Act, with program abuse by parties who endeavor
compensation is based on fluctuating or respect to equipment rentals, allow us to to avoid the application of the physician
indeterminate measures or in which the impose requirements on office space self-referral requirements by simply
arrangement results in the seller receiving and equipment rental arrangements as inserting an entity or contract into a
different payment amounts for the same
service from the same purchaser.
needed to protect against program or chain of financial relationships linking
patient abuse. Although we are a DHS entity and a referring physician.
We had explained in that rule, in concerned primarily with percentage We are soliciting comments as to
response to a public comment, that compensation arrangements in the whether and how we would employ a
‘‘[p]ercentage compensation that is context of equipment and office space stand in the shoes approach for the type
determined by calculating a percentage rentals, we believe there is the potential of relationship discussed above, as well
of a fluctuating or indeterminate for percentage compensation to be as for other types of financial
amount, such as revenues, collections or utilized in other areas as well. relationships. In submitting comments,
expenses, is not fixed in advance’’ (66 Therefore, relying on our authority in commenters should be mindful that we
FR 878). Following publication of the sections 1877(e)(1)(A)(vi), finalize (or may already have finalized)
Phase I rule, however, we received 1877(e)(1)(B)(vi), and 1877(b)(4) of the a provision that treats physicians as
anecdotal accounts about contracts for Act, we are proposing to clarify that standing on the shoes of their group
physician services under which percentage compensation arrangements: practices or other physician practices.
payment was calculated based on a (1) May be used only for paying for
percentage of the revenue raised by a 10. Alternative Criteria for Satisfying
personally performed physician
physician’s own professional services. Certain Exceptions
services; and (2) must be based on the
Therefore, we delayed the effective date revenues directly resulting from the We received several comments in
of the final sentence of § 411.354(d)(1) physician services rather than based on response to the Phase II rulemaking that
through four Federal Register notices, to some other factor such as a percentage asserted that even innocent and trivial
allow us to revise the provision ‘‘to of the savings by a hospital department violations of the physician self-referral
avoid unnecessarily disrupting existing (which is not directly or indirectly statute may result in huge penalties to
contractual arrangements for physician related to the physician services an entity that submits claims to
services’’ (68 FR 74491, December 24, provided). Medicare. For example, the failure of a
2003; 68 FR 20347, April 25, 2003; 67 hospital to obtain a signature on a lease
FR 70322, November 22, 2002; 66 FR 9. Stand in the Shoes or a personal services arrangement with
60154 and 60155, December 3, 2001). Commenters to the Phase I final rule a physician could result in the hospital
In the Phase II interim final rule with with comment period proposed that we being required to make repayment for
comment period, in the section on permit physicians to stand in the shoes all services for which it billed Medicare
physician compensation, we explained of their group practices, thereby as a result of prohibited referrals from
that percentage compensation requiring analysis of certain indirect the physician. One commenter stated
arrangements were of particular concern compensation arrangements as direct that we should exercise our discretion
in pursuing minor violations and the prescribed criteria of the exception were would not be able to refer or bill for
failure to meet the procedural not met (consistent with other DHS with the knowledge that the
requirements of an exception (such as exceptions, we would apply the same arrangement did not comply with all of
obtaining all required signatures prior to knowledge standard as that applicable the prescribed criteria of an exception
commencement of the agreement for under the False Claims Act; (5) the and then later claim in response to an
personal services) and technical parties have brought (or will bring as enforcement action that they believed
violations. Another commenter stated soon as possible) the arrangement into that their conduct was proper because,
that we should consider adding an complete compliance with the in their view, the arrangement would
exception that would permit physicians prescribed criteria of the exception or have met the criteria for the alternative
to refer for DHS, and entities to submit have terminated (or will terminate as method for compliance with the
and receive payment for DHS, if, in our soon as possible) the financial prescribed criteria of an exception. In
sole discretion, we determined that relationship between or among them; (6) fact, if our proposal were to be adopted
there was no abuse. The commenter the arrangement did not pose a risk of and a DHS entity were to submit a claim
suggested that such an exception be program or patient abuse; (7) no more for Medicare payment with the
available only after (1) receipt by the than a set amount of time had passed knowledge that its financial relationship
entity of a favorable advisory opinion, since the time of the original with the referring physician (or his or
or (2) a voluntary disclosure by the noncompliance with the prescribed her immediate family member) did not
entity or upon audit or investigation by criteria; and (8) the arrangement at issue meet the prescribed criteria of any
the government. is not the subject of an ongoing Federal exception, and did so in advance of any
Although we do not have discretion to investigation or other proceeding determination from us that the
waive violations of the physician self- (including, but not limited to, an arrangement met the alternative method
referral statute, we are considering enforcement matter). We would of compliance, it could be found liable
whether to amend certain of the consider there to be an ‘‘inadvertent’’ under the False Claims Act.
exceptions that appear in § 411.355 failure to meet all of the prescribed We are especially interested in
through § 411.357 to provide an criteria in an exception only where comments regarding: whether we
alternate method for satisfying the there was an innocent or unintentional should adopt an alternative compliance
exception. We caution that our proposal mistake. We would rely on our authority method policy, and if so, the exceptions
is intended to address only inadvertent, under section 1877(b)(4) of the Act to for which the policy should be
violations in which an agreement fails implement an alternative compliance
to satisfy the procedural of ‘‘form’’ applicable; the conditions that must be
policy, and we would include met in order to obtain a favorable
requirements of an exception of the requirements that are contained in all
statute or regulations. We do not intend determination that an arrangement that
exceptions that we promulgate under does not meet all of the prescribed
to apply the alternative method for that authority (including, but not
compliance to other requirements such criteria of an exception nevertheless
limited to, the requirement that the satisfies the alternative method of
as compensation that is fair market arrangement not violate the anti-
value, not related to volume or value of compliance with the exception; the
kickback statute). manner (for example, advisory opinion)
referrals, or set in advance. What we
have in mind, for example, is a situation We believe that if we were to adopt for making such a determination; the
in which parties are missing a signature an alternative compliance method length of time during which the
but every other requirement of the policy for certain exceptions, with the alternative method option would be
exception for personal service criteria specified above, the available (that is, the length of time that
arrangements is satisfied. In such a case, determination of whether an a party would have to discover that an
provided that there is full disclosure, arrangement meets the terms of an arrangement was out of compliance
the missing signature is inadvertent, and exception despite not meeting all of the with the prescribed criteria of an
other conditions for alternative prescribed criteria of an exception exception and seek protection under the
compliance described here are satisfied, should be at our sole discretion and not alternative compliance method policy);
the alternative method for compliance subject to further administrative or and, whether, having received a
would be met and the parties would judicial review. We caution that we favorable determination that an
comply with the exception. would retain the discretion as to arrangement satisfied the alternative
The alternative method for whether to make such a determination; method of compliance (essentially, that
compliance with the physician self- parties would have no right to receive the arrangement was deemed to have
referral prohibition would provide that, such a determination and no time met the prescribed criteria of an
if an arrangement does not meet all of period by which we would be required exception), an entity should be
the existing prescribed criteria of an to issue a determination. We further precluded for a period of time from
exception, the arrangement nevertheless caution that, because we would retain receiving another favorable
would meet the exception if: (1) The sole authority to determine that an determination with respect to an
facts and circumstances of the arrangement that failed to satisfy all of arrangement that (1) failed to meet the
arrangement are self-disclosed by the the prescribed procedural or ‘‘form’’ prescribed criteria of the same exception
parties to us; (2) we determine that the criteria of an exception that meets the (or similar criteria of another exception)
arrangement satisfied all but the conditions for the alternative method of and (2) that was entered into after the
prescribed procedural or ‘‘form’’ compliance, and because of the date the arrangement that received the
requirements of the exception at the proposed requirements that: (1) The favorable determination was entered
time of the referral for DHS at issue and failure to meet all of the prescribed into by the entity. We are also interested
at the time of the claim for such DHS; criteria of the exception was in comments as to whether each eligible
(3) the failure to meet all the prescribed inadvertent; and (2) the referral for DHS exception should specify which
criteria of the exception was and the claim for DHS were not made criterion or criteria an arrangement can
inadvertent; (4) the referral for DHS and with knowledge that one or more of the fail to meet and nevertheless still
the claim for DHS were not made with prescribed criteria of the exception were qualify under the alternative method
knowledge that one or more of the not met, parties to an arrangement criteria as satisfying the exception (for
example, specifying in several used for temporary noncompliance with Medicare for the DHS, and not the
exceptions that an arrangement that is the exception for nonmonetary person or entity that performs the DHS
missing a signature can nevertheless compensation or medical staff (where the person or entity performing
qualify for the alternative compliance incidental benefits. the DHS is not the person or entity
method), or whether, in addition to or billing for it).
11. Services Furnished ‘‘Under We continue to have concerns with
in lieu thereof, we should provide that
Arrangements’’ services provided under arrangements
an arrangement may qualify for the
alternative compliance method if we Our physician self-referral rules to hospitals and other providers. We
make a determination that the prohibit a physician from making believe that the risk of overutilization
arrangement substantially complied referrals for DHS to an entity with that we identified in the 1998 proposed
with the prescribed criteria and met all which the physician (or an immediate rule has continued, particularly with
of the other alternative criteria. We are family member) has a financial hospital outpatient services for which
specifically seeking comment on what, relationship, and prohibits the entity Medicare pays on a per-service basis.
if any, additional requirements or from billing Medicare for the DHS, That is, we pay a hospital separately for
standards should be met where an unless an exception applies. In the 1998 each clinical laboratory test, for each
arrangement fails to satisfy a procedural proposed rule, we stated that we had therapy service, and for the vast
of ‘‘form’’ requirement of an exception. received questions about which entities majority of radiology and other imaging
For example, we would like comments are the relevant ones for purposes of the services. We have received anecdotal
on whether we should require other prohibition on referrals, given that some reports of hospital and physician joint
documentary proof of the parties’ intent entities only bill for services, whereas ventures that provide hospital imaging
to contract (through memoranda, others actually directly ‘‘furnish’’ the services formerly provided by the
electronic mail, or otherwise) in the case services. We noted that, for example, in hospital directly. There appears to be no
where the parties failed to obtain a an ‘‘under arrangements’’ situation, a legitimate reason for these arranged for
necessary signature to effect the hospital, rural primary care hospital, services other than to allow referring
contractual arrangement. SNF, HHA, or hospice program physicians an opportunity to make
We reiterate that we do not have the contracts with a separate provider to money on referrals for separately
authority to waive violations of the furnish services to the hospital’s, SNF’s, payable services. Many of the services
physician self-referral statute or or other contracting entity’s patients, for furnished by the joint venture were
regulations. We do not mean to suggest which the hospital, SNF or other previously furnished directly by the
that, for financial relationships that contracting entity ultimately bills. hospitals, and in most cases, could
implicate the general prohibition, Sections 1832, 1835(b)(1), 1861(e), and continue to be furnished directly by
anything less than full compliance with 1861(w)(1) of the Act and § 413.65(i) hospitals.
one or more of the exceptions is provide for Medicare payment to We are also concerned that the
sufficient; rather, we are proposing to providers for services furnished ‘‘under services furnished under arrangements
provide additional and alternative arrangements.’’ The Internet-Only to a hospital are furnished in a less
criteria for some of the exceptions Manual (IOM) manual 100–01, Medicare medically-intensive setting than the
themselves so that some arrangements General Information, Eligibility and hospital, but billed at higher outpatient
that otherwise would be noncompliant Entitlement Manual, Pub. 100–01, at hospital PPS rates, which not only costs
as a result of an inadvertent mistake Chapter 5, section 10.3 requires that the the Medicare program more, but also
might satisfy an exception. In effect, we provider must exercise professional costs Medicare beneficiaries more in the
are merely proposing to expand the responsibility over an arranged-for form of higher deductibles and
scope of some exceptions to provide service, using the same quality controls coinsurance. Often, physician
more flexibility. as applied to services furnished by the specialists who order services for their
Finally, we note that our proposal for provider’s salaried employees. Under hospital patients set up joint ventures,
an alternative compliance method § 413.65(i), a provider-based hospital frequently including as an owner a
policy is intended to complement, and department may not provide all of its hospital to which the physicians refer
not replace, the provisions in services under arrangements. Therefore, patients. The joint venture often owns
§ 411.353(f) for certain arrangements a hospital department may not contract an entity that furnishes medically less
involving temporary noncompliance. out all of its patient care services. intensive services than a hospital, such
Among other requirements, in order to We stated in the 1998 proposed rule as an ASC, an IDTF, or a physician
qualify for protection under § 411.353(f), that, absent an exception, the referral office. The entity may even be located
the financial relationship between the prohibition applies to a physician’s DHS in a hospital building in space leased by
entity and the referring physician must referrals to any entity that directly the hospital to the joint venture,
have been in compliance with an furnishes DHS to Medicare or Medicaid whether owned by physicians alone or
exception for at least 180 consecutive patients. We stated that a physician can with the hospital. It appears that the use
calendar days immediately preceding have an incentive to overutilize services of these arrangements may be little more
the date on which the financial if he or she has a financial relationship than a method to share hospital
relationship became noncompliant, and with the entity that directly furnishes revenues with referring physicians in
the financial relationship must have DHS, even if this is not the entity spite of unnecessary costs to the
fallen out of compliance due to reasons ultimately billing for the services. In program and to beneficiaries.
beyond the control of the entity. In these situations, the physician can We believe that more and more
addition, claims are payable only for potentially recognize a profit from each procedures are being performed as
DHS rendered during a maximum of 90 referral based on the fact that the DHS arranged for hospital services. The
consecutive calendar days following the will, in essence, be sold to the entity provider community is well aware that,
date on which the financial relationship that bills (63 FR 1707). Notwithstanding effective for services furnished on or
became noncompliant; the exception our statements in the 1998 proposed after January 1, 2008, Medicare may pay
may be used by an entity only once rule, we have interpreted the definition more for all hospital outpatient surgical
every 3 years for the same referring of ‘‘entity’’ at § 411.351 as including procedures than for the same
physician; and the exception may not be only the person or entity that bills procedures billed by ASCs under the
revised ASC payment system required Although MedPAC recommended that behalf of the beneficiary at the time of
by section 626(b) of the MMA. (In the the definition of physician ownership transport, it is impractical later to locate
CY 2007 OPPS/ASC proposed rule (71 subject to the physician self-referral the beneficiary (or the beneficiary’s
FR 49635), we proposed that payment prohibition be expanded to include any authorized representative) to obtain a
for an ASC surgical procedure would be entity that derives a substantial signature on the claim form before
made at 62 percent of the payment for proportion of its revenue from a submitting it to Medicare for payment.
the same procedure under the OPPS (71 provider of DHS, we are proposing what
We are sympathetic to the concerns of
FR 49656).) we believe is a more straightforward
After the close of the Phase II approach to addressing the issue. That ambulance providers and suppliers
comment period, the Medicare Payment is, we propose to revise our definition insofar as emergency transport services
Advisory Commission (MedPAC), in its of entity at § 411.351 so that a DHS are involved. Therefore, at § 424.36, we
March 2005 Report to Congress, entity includes both the person or entity are proposing that, for emergency
recommended that the Secretary that performs the DHS, as well as the ambulance transport services, where the
‘‘should expand the definition of person or entity that submits claims or ambulance provider or supplier
physician ownership in the physician causes claims to be submitted to documents that the beneficiary was
self-referral law to include interests in Medicare for the DHS. Our proposal is physically or mentally incapable of
an entity that derives a substantial not meant to exclude any persons or signing a claim form at the time the
proportion of its revenue from a entities that presently are considered to service was provided and that none of
provider of designated health services.’’ be DHS entities. (In this regard, we note the individuals listed in § 424.36(b)(1)
Specifically, MedPAC wrote: that we propose to reorganize and delete through (5) was available or willing to
Physician ownership of entities that
some of the material in the current sign a claim on behalf of the beneficiary,
provide services and equipment to imaging definition and are seeking comment on the ambulance provider or supplier may
centers and other providers creates financial our proposed changes to the regulatory submit the claim without a beneficiary
incentives for physicians to refer patients to text.) Although we believe our proposed signature. Such claim submission would
these providers, which could lead to higher approach is sufficient to address abusive be permitted only if: (1) The beneficiary
use of services. Prohibiting these arrangements, we solicit comments on was physically or mentally incapable of
arrangements should help ensure that whether we should implement the signing the claim form at the time the
referrals are based on clinical, rather than MedPAC approach, either in some
financial, considerations. It would also help service was provided; (2) none of the
combination with our proposed individuals listed in § 424.36(b)(1)
ensure that competition among health care approach or instead of our proposed
facilities is based on quality and cost, rather through (5) was available or willing to
approach. We would be particularly
than financial arrangements with entities sign the claim form on behalf of the
owned by physicians who refer patients to interested in comments related to what
beneficiary at the time the service was
the facility. should constitute a ‘‘substantial’’
provided; and (3) the ambulance
proportion of revenue derived from
(See http://www.medpac.gov/ providing DHS. provider or supplier maintains in its
publications/congressional_reports/ files for a period of at least 4 years from
Mar05_EntireReport.pdf, at page 170.) N. Beneficiary Signature for Ambulance the date of service certain
We agree with the concerns of MedPAC Transport Services documentation. Required
and a commenter to the Phase II interim [If you choose to comment on issues documentation would include: (1) A
final rule that arrangements structured in this section, please include the signed contemporaneous statement,
so that referring physicians own leasing, caption ‘‘BENEFICIARY SIGNATURE’’ made by an ambulance employee
staffing, and similar entities that furnish at the beginning of your comments.] present during the trip to the receiving
items and services to entities furnishing Section 424.36 requires that a facility, that the beneficiary was
DHS but do not submit claims, raise beneficiary’s signature must appear on physically or mentally incapable of
significant concerns under the fraud and all claims submitted for Medicare signing a claim form and that none of
abuse laws. We believe such services, unless the beneficiary has the individuals listed in § 424.36(b)(1)
arrangements to be contrary to the plain died, or another exception applies. For through (5) was available or willing to
intent of the physician self-referral law. example, if a beneficiary is physically or sign the claim form on behalf of the
Arrangements so structured are mentally incapable of signing the claim, beneficiary at the time the service was
particularly problematic because the claim may be signed on the provided; (2) the date and time the
referrals by physician-owners of leasing, beneficiary’s behalf by another beneficiary was transported, and the
staffing, and similar entities to a individual listed in § 424.36(b). name and location of the facility where
contracting DHS entity can significantly Ambulance suppliers and providers the beneficiary was received; and (3) a
increase the physician-owned entity’s have stated that, in emergency signed contemporaneous statement from
profits and investor returns, creating situations, it is impossible or a representative of the facility that
incentives for overutilization and impractical for ambulance providers or received the beneficiary, which
corrupting medical decision-making. suppliers to obtain a beneficiary’s or
documents the name of the beneficiary
We are attempting to determine the other authorized person’s signature on a
and the time and date that the
best approach to prohibit certain claim to properly bill Medicare for
beneficiary was received by that facility.
arrangements under which physicians ambulance transport services because:
supply items and services to DHS (1) Many beneficiaries are incapable of For non-emergency ambulance
entities. We note that some of the signing claims due to their medical transport services, the ambulance
arrangements described by MedPAC are condition at the time of transport; and provider or supplier would continue to
subject to the physician self-referral (2) another person authorized to sign the be required to obtain a beneficiary’s
prohibition and more may become claim under § 424.36(b) is not available, signature on a claim form (or the
subject to the physician self-referral or is unwilling to sign the claim at the signature of someone who is authorized
prohibition through provisions we may time of transport; and (3) if an to sign on behalf of the beneficiary
implement in the upcoming Phase III individual listed in § 424.36(b) is not under § 424.36(b)(1) through (5) prior to
final rule. available or willing to sign a claim on submitting claims to Medicare.
O. Update to Fee Schedules for Class III guidelines, recommendations, and any 2007, the 2006 fee schedule amounts for
DME for CYs 2007 and 2008 other appropriate action the FDA deems class III devices are to be updated by the
[If you choose to comment on issues necessary (section 513(a)(1)(B) of the percentage change determined to be
in this section, please include the act). Examples of class II devices are appropriate by the Secretary, taking into
caption ‘‘DME UPDATE’’ at the blood glucose test systems and infusion account recommendations contained in
beginning of your comments.] pumps. a report of the Comptroller General of
Class III devices are those for which the United States under section
1. Background there is insufficient information to 302(c)(1)(B) of the MMA. Also
a. Durable Medical Equipment, support classifying a device into class I mandated by section 1834(a)(14)(I)(i) of
Prosthetics, Orthotics, and Supplies or class II and the device is a life- the Act, for 2008, the 2007 fee schedule
(DMEPOS) Classifications sustaining or life-supporting device or is amounts for class III devices are to be
for a use which is of substantial increased by an annual factor based on
Under § 414.210, for Medicare importance in preventing impairment of the percentage change in the CPI–U, as
payment purposes, fee schedules are human health, or presents a potential applied to the 2007 payment amount
determined for the following classes of unreasonable risk of illness or injury. determined after application of the
equipment and devices: Class III devices paid in accordance percentage change under section
• Inexpensive or routinely purchased with the DME fee schedule payment 1834(a)(14)(H)(i) of the Act.
items as specified in § 414.220. methodology include osteogenesis or As stated above, section
• Items requiring frequent and bone growth stimulators, implantable 1834(a)(14)(H)(i) of the Act mandated
substantial servicing, as specified in infusion pumps, and stair-climbing that the Secretary take into account
§ 414.222. wheelchairs (standard power recommendations by the Comptroller
• Certain customized items, as wheelchair function only). This is not General of the United States, who is the
specified in § 414.224. an inclusive list of class III devices. The head of the Government Accountability
• Oxygen and oxygen equipment, as Medicare DMEPOS suppliers should Office (GAO), when determining the
specified in § 414.226. specify on the Medicare claim form appropriate update percentage for class
• Prosthetic and orthotic devices, as whether the device furnished to a III devices for 2007. On March 1, 2006,
specified in § 414.228. beneficiary is a class III device as
• Other DME (capped rental items), as the GAO published a report, ‘‘Class III
described in section 513(a)(1)(C) of the Devices do not Warrant a Distinct
specified in § 414.229. Federal Food, Drug, and Cosmetic Act
• Transcutaneous electric nerve Annual Payment Update’’ (GAO–06–
(21 U.S.C. 360c(a)(1)(C)). 62). The GAO concluded in that report,
stimulators (TENS), as specified in
§ 414.232. b. DMEPOS Payment ‘‘because the initial payment rates for all
We designate the items in each class classes of devices on the Medicare DME
Section 302(b)(1) of the MMA fee schedule are based on retail prices
of equipment or device through our amended section 1847 of the Act to
program instructions. or an equivalent measure, they account
require the Secretary to establish and for the costs of class III and similar class
Under section 513 of the Federal implement competitive acquisition
Food, Drug, and Cosmetic Act (21 U.S.C. II devices in a consistent manner.
programs for the furnishing under Distinct updates for two different
360c), the Food and Drug Medicare Part B of certain types of
Administration (FDA) must classify classes of devices are unwarranted.’’
DMEPOS. Section 1847(a)(2)(A) of the The GAO recommended that the
devices into one of three regulatory Act provides that devices determined by
classes: class I, class II, or class III. FDA Secretary establish a uniform payment
the FDA to be class III devices under the update to the DME fee schedule for 2007
classification of a device is determined Federal Food, Drug, and Cosmetic Act
by the amount of regulation necessary to for class II and class III devices.
(21 U.S.C. 301) cannot be included in In the May 1, 2006 Federal Register,
provide a reasonable assurance of safety the competitive acquisition programs.
and effectiveness; class III devices we published the Competitive
As part of the transition to competitive Acquisition for Certain Durable Medical
typically posing the greatest risk. acquisition, the Congress mandated in
Devices are to be classified into class I Equipment, Prosthetics, Orthotics, and
sections 1847(a)(14)(G) through (I) of the Supplies (DMEPOS) and Other Issues
if there is information showing that the Act that the fee schedule amounts for
general controls of the act are sufficient proposed rule (71 FR 25660). We
DME, other than class III devices, be solicited comments on how to
to assure safety and effectiveness. frozen at 2003 levels through 2008.
General controls apply to all medical determine the appropriate fee schedule
For class III devices, section percentage change for class III devices
devices and include provisions that 1834(a)(14)(G)(i) of the Act mandates
relate to adulteration, misbranding, for 2007 and 2008. We stated that we
that an annual update factor based on would consider the comments received
device registration and listing, the percentage change in the consumer
notification, including repair, in conjunction with the
price index for urban customers (CPI–U) recommendations in the GAO report in
replacement, or refund, records and be applied to the fee schedule amounts
reports, and good manufacturing determining the appropriate update
for CYs 2004 through 2006. Section percentage for these devices for 2007
practices. Examples of class I devices 1834(a)(14)(H)(i) of the Act, as added by
are canes and crutches. and 2008.
section 302 of the MMA, gives the A majority of the submitted public
Class II devices are those for which Secretary discretion in determining the
general controls, by themselves, are comments indicated that the GAO
appropriate fee schedule update report was flawed since it did not
insufficient to provide reasonable percentage for CY 2007 for DME which
assurance of safety and effectiveness, recommend a specific update factor or

are class III medical devices described take into account changes over time in
but there is sufficient information to in section 513(a)(1)(C) of the Federal
establish special controls to provide the costs of producing, supplying and
Food, Drug, and Cosmetic Act (21
such assurance. Special controls include U.S.C.360c(a)(1)(C)).1 Specifically, for 360c(a)(1)(C). Accordingly, we believe that the
performance standards, postmarket reference to 21 U.S.C. 360 (c)(1)(C) in sections
surveillance, patient registries, 1 Section 513(a)(1)(C) of the Federal Food, Drug, 1834(a)(14)(G)(i), (H)(i), and (I)(i) of the Act is a
development and dissemination of and Cosmetic Act has been codified as 21 U.S.C. scrivener’s error.
servicing class III devices. Several that the aggregate payment made under Act to exclude coverage for
commenters recommended that we the Medicare program does not exceed cardiovascular disease screening tests
continue to use the CPI–U to adjust fee the amount which would be paid in the and diabetes screening tests. This
schedule amounts for class III devices, absence of the demonstration. section provides that items or services
but offered no substantive information Ensuring budget neutrality requires must be reasonable and necessary for
that would otherwise support a distinct that the Secretary develop a strategy for the diagnosis or treatment of illness or
update factor for class III devices. recouping funds should the injury, or to improve the functioning of
Another commenter recommended that demonstration result in costs higher a malformed body member as stated in
the class III proposal be included in a than those that would occur in the § 411.15(k). Since preventive services
separate rulemaking procedure because absence of the demonstration. As we are not provided for diagnosis or
it is not related to competitive stated in the CY 2006 and CY 2007 PFS treatment of illness, injury, or
acquisition. final rules with comment period, we malformation, we determined that these
would make adjustments to the services are not reasonable and
2. Proposed Update to Fee Schedule chiropractor fees under the Medicare necessary within the meaning of the
We believe that the GAO has done a PFS to recover aggregate payments statute.
thorough job in reviewing Medicare under the demonstration in excess of Effective January 1, 2005, Part B
payment rules and methods and issues the amount estimated to yield budget coverage was expanded to include an
associated with the costs of furnishing neutrality. We will assess budget initial preventative physical
class III devices. Accordingly, we agree neutrality by determining the change in examination (IPPE) for certain
with the finding in the report that the costs based on a pre- and post- individuals. Our regulations governing
costs of furnishing class II and class III comparison of aggregate payments and the IPPEs are primarily set forth in
DME devices have been factored into the rate of change for specific diagnoses § 410.16. Additional conforming
the fee schedule amounts calculated for that were treated by chiropractors and changes were made at that time to
these devices. We also agree with the physicians in the demonstration sites § 411.15 to reflect this expansion in
GAO recommendation that a uniform and control sites. Because the aggregate coverage.
payment update be established to the payments under the expanded Sections 612 and 613 of the MMA
DME fee schedule for 2007 for class II chiropractor services may have an added coverage under Part B for
and class III devices. For class II impact on other Medicare expenditures, cardiovascular disease screening tests
devices, the MMA provided for a zero we will not limit our analysis to and diabetes screening tests, effective
percent payment update from 2004 reviewing only chiropractor claims. for services furnished on or after
through 2008. Accordingly, for 2007, we Any needed reduction to chiropractor January 1, 2005, subject to certain
are proposing a zero percent update for fees under the PFS would be made in eligibility and other limitations. These
class III devices. Also, in accordance the CY 2010 and CY 2011 physician fee provisions were implemented in the CY
with the MMA, we are proposing to use schedules as it will take approximately 2005 PFS final rule with comment
the percent change in the CPI–U to 2 years after the demonstration ends to period (69 FR 66236). Those rules are
update the class III device 2007 fee complete the claims analysis. If we codified in § 410.17 and § 410.18,
schedule amounts for 2008. determine that the adjustment for BN is respectively. However, at the time we
P. Discussion of Chiropractic Services greater than 2 percent of spending for neglected to make additional
Demonstration the chiropractor fee schedule codes conforming changes to § 411.15 to
(comprised of the 3 currently covered reflect this expansion in coverage.
[If you choose to comment on issues CPT codes 98940, 98941, and 98942), To conform the regulations to the
in this section, please include the we would implement the adjustment MMA provisions, we are proposing a
caption ‘‘CHIROPRACTIC SERVICES over a 2-year period. However, if the technical correction to the provisions in
DEMONSTRATION’’ at the beginning of adjustment is less than 2 percent of § 411.15 by specifying additional
your comments.] spending under the chiropractor fee exceptions to provide payment for
In the CY 2006 PFS final rule with schedule codes, we would implement cardiovascular disease screening tests
comment period (70 FR 70266) and the the adjustment over a 1-year period. We and diabetes screening tests that meet
CY 2007 PFS final rule with comment will include the detailed analysis of the eligibility limitation and the
period (71 FR 69707), we included a budget neutrality and the proposed conditions for coverage that we
discussion of the 2-year chiropractic offset during the CY 2009 PFS specified under § 410.17, Cardiovascular
services demonstration that ended on rulemaking process. Disease Screening Tests, and § 410.18,
March 31, 2007. This demonstration Diabetes Screening Tests.
was authorized by section 651 of the Q. Technical Corrections
MMA to evaluate the feasibility and [If you choose to comment on issues 2. Medical Nutrition Therapy (MNT)
advisability of covering chiropractic in this section, please include the (§ 410.132)
services under Medicare. These services caption ‘‘TECHNICAL CORRECTIONS’’ In the CY 2006 PFS final rule with
extended beyond the current coverage at the beginning of your comments.] comment period (70 FR 70160), we
for manipulation to care for added individual medical nutrition
neuromusculoskeletal conditions 1. Particular Services Excluded From therapy, as represented by HCPCS codes
typical among eligible beneficiaries, and Coverage (§ 411.15(a)) G0270, 97802 and 97803, to the list of
covered diagnostic and other services Prior to January 1, 2005, Medicare did telehealth services. We are making a
that a chiropractor was legally not pay for routine physical technical correction to § 410.132(a) to
authorized to perform by the State or examinations or checkups. Section conform the regulations to include an
jurisdiction in which the treatment was 1862(a)(7) of the Act states that routine exception for services provided at
provided. The demonstration was physical checkups are excluded § 410.78. This revised paragraph reads
conducted in four sites, two rural and services. This exclusion is described in as follows:
two urban. The demonstration was § 411.15(a), Particular services excluded ‘‘(a) Conditions for coverage of MNT
required to be budget neutral as the from coverage. In addition, we had services. Medicare Part B pays for MNT
statute requires the Secretary to ensure interpreted section 1862(a)(1)(A) of the services provided by a registered
dietitian or nutrition professional as appropriate to continue to permit TABLE 14.—MEDICARE ECONOMIC

defined in § 410.134 when the payment for an x-ray ordered by a non- INDEX EXPENDITURE CATEGORIES
beneficiary is referred for the service by treating physician when a chiropractor, AND WEIGHTS
the treating physician. Except as not the ordering physician, will use that
provided at § 410.78, services covered x-ray. Therefore, we are proposing to 2000
consist of face-to-face nutritional revise § 410.32 by removing paragraph Expenditure category Expense
assessments and interventions in (a)(1) and by redesignating paragraphs weight
accordance with nationally-accepted (a)(2) and (a)(3) as (a)(1) and (a)(2), Physician Compensation ............ 52.466
dietary or nutritional protocols.’’ respectively. Wages and Salaries ............ 42.730
3. Payment Exception: Pediatric Patient R. The Percentage Change in the
Benefits ................................ 9.735
Mix (§ 413.184) Practice Expense ........................ 47.534
Medicare Economic Index (MEI) Nonphysician Compensation 18.653
In the CY 2006 PFS final rule with Nonphysician wages .... 13.808
comment period (70 FR 70214), we [If you choose to comment on issues Prof/Tech Wages .. 5.887
revised § 413.180 through § 413.192 in this section, please include the Manager Wages .... 3.333
regarding criteria and the application caption ‘‘MEI’’ at the beginning of your Clerical Wages ...... 3.892
procedures for requesting an exception comments.] Services Wages .... 0.696
to the ESRD composite rate payment. As Employee Benefits 4.845
The Medicare Economic Index (MEI) Other Practice Expense 18.129
part of the revisions we intended to is authorized by section 1842(b)(3) of
amend the section heading of § 413.184 Office Expenses .... 12.209
the Act, which states that prevailing Prof. Liability Insur-
to reflect that, as specified in the statute, charge levels beginning after June 30, ance ................... 3.865
this exception only pertains to a
1973 may not exceed the level from the Medical equipment 2.055
pediatric ESRD facility. However, this Drugs and Supplies ...... 4.319
previous year except to the extent that
change was not made. Therefore, we are Medical material
proposing to revise the section heading the Secretary finds, on the basis of
and supplies ...... 2.011
of § 413.184 to read as follows: appropriate economic index data, that Prescription Drugs 2.308
‘‘Payment exception: Pediatric patient the higher level is justified by year-to- Other Expenses ........... 6.433
mix.’’ year economic changes. All Other ................ 6.433
The MEI measures the weighted-
4. Diagnostic X-ray Tests, Diagnostic Beginning in April 2007, with their
Laboratory Tests, and Other Diagnostic average annual price change for various
inputs needed to produce physicians’ March 2007 publication, the Bureau of
Tests: Conditions (§ 410.32(a)(1)) Labor Statistics (BLS) will discontinue
services. The MEI is a fixed-weight
Section 1861(r)(5) of the Act was input price index, with an adjustment production and publication of the white
amended by section 4513(a) of the BBA for the change in economy-wide collar occupation employment cost
to allow Medicare payment for a multifactor productivity. This index, index (ECI) series.
chiropractor’s manual manipulation of The white collar benefit ECI for
which has CY 2000 base year weights,
the spine to correct subluxation, private workers has been used as the
is comprised of two broad categories: (1)
without requiring the subluxation to be price proxy for nonphysician benefits in
demonstrated by an x-ray. The BBA Physician’s own time; and (2)
the MEI. There is no other comparable,
provision was effective for services physician’s PE.
published series that is a suitable
furnished on or after January 1, 2000. The physician’s own time component replacement for the white collar benefit
Prior to this statutory change, the represents the net income portion of ECI. Consequently, Global Insight, Inc.
subluxation was required to be business receipts and primarily reflects (GII) and CMS jointly developed a
demonstrated by an x-ray. Because the input of the physician’s own time composite series which is composed of
chiropractors are limited by statute with into the production of physicians’ four published ECI series and weighted
respect to the services they can provide services in physicians’ offices. This by November 2004 National Industry—
under Medicare, it had been necessary category consists of two Specific Occupational Employment and
to create an exception to the subcomponents: (1) Wages and salaries; Wage Estimates for NAICS 6211, Office
requirement that diagnostic services and (2) fringe benefits. of Physicians. Global Insight Inc. is a
(including x-rays) must be ordered by nationally recognized economic and
The physician’s PE category
the treating physician as provided in financial forecasting firm that contracts
represents nonphysician inputs used in
§ 410.32(a). This exception, which with CMS to forecast the components of
the production of services in physicians’
permits a physician who is not a the market baskets.
treating physician to order and receive offices. This category consists of wages
Table 15 lists the four ECI series and
payment for an x-ray that is used by a and salaries and fringe benefits for
corresponding weights used to construct
chiropractor, is specified in nonphysician staff and other nonlabor
the new composite benefit index. We
§ 410.32(a)(1). inputs. The physician’s PE component
are proposing to replace the ECI white
We revised § 410.22 to reflect the BBA also includes the following categories of collar benefit series with this composite
change in the CY 2000 PFS final rule (64 nonlabor inputs: office expense; medical benefit index effective for the CY 2008
FR 59439). (Note: § 410.22 was materials and supplies; professional MEI update.
redesignated as § 410.21 in the CY 2001 liability insurance; medical equipment;
PFS final rule.) However, we neglected prescription drugs; and other expenses. TABLE 15.—CMS COMPOSITE PRICE
to remove the chiropractic exception at The components are adjusted to reflect INDEX FOR NON-PHYSICIAN EM-
§ 410.32 (a)(1). Because of the BBA productivity growth in physicians’
PLOYEE BENEFITS
change, which removed the requirement offices by the 10-year moving average of
that subluxation must be demonstrated productivity in the private nonfarm ECI series Weight
by an x-ray, the chiropractic exception business sector. Table 14 presents a
is no longer warranted. We do not listing of the MEI cost categories with Benefits, Private, Professional,
believe it would be necessary or the associated weights. Scientific, Technical .................. 59.0
TABLE 15.—CMS COMPOSITE PRICE For outpatient hospital costs of the personnel qualifications required under
INDEX FOR NON-PHYSICIAN EM- replacement devices, effective for the HHA Conditions of Participation.
PLOYEE BENEFITS services furnished on or after January 1, Section 484.4 contains requirements
2007, we reduce the ambulatory for persons furnishing services in HHAs
ECI series Weight payment classification (APC) payment that include physical therapists (PTs),
we make to hospitals when the hospital physical therapist assistants (PTAs),
Benefits, Private, Management, receives a replacement device without occupational therapists (OTs),
Business, Financial ................... 6.3 cost or with full credit for the device. occupational therapy assistants (OTAs)
Benefits, Private, Office & Admin- We also proposed a reduction to and speech-language pathologists
istrative Support ........................ 32.6 Medicare payment for inpatient hospital (SLPs). The CY 2005 PFS final rule with
Benefits, Private, Service Occupa- services in the FY 2008 IPPS proposed comment period clarified that the
tions ........................................... 2.1 rule (72 FR 26479). This proposed rule personnel qualifications in § 484.4 are
would reduce payments for hospital applicable to all outpatient PT, OT, and
We compared the historical 4-quarter inpatients when hospitals use a recalled SLP services ‘‘in order to create
moving average percent changes of the or replacement device at no cost or with consistent requirements for therapists
MEI using the ECI white collar benefit partial credit. and therapy assistants’’ (69 FR 66345).
index and the proposed ECI composite While these regulations address We propose to update the personnel
benefit series and in the 5 most recent hospital payment for the devices qualifications in § 484.4 for PTs, PTAs,
calendar years, the difference in the involved, there are also costs associated OTs, and OTAs. We also propose to
overall MEI update is no greater than 0.1 with physician monitoring of patients revise the qualifications for SLPs to
percentage point. This analysis shows treated with recalled devices. remove a reference to audiologists in the
that the new composite benefit index Specifically, the manufacturer of the definition for speech-language
would be expected to have little devices that have been most recently pathologists because a speech-language
material impact on the aggregate MEI recalled recommends that patients with pathologist would not have a Certificate
updates; and therefore, we believe the the recalled device consult with their of Clinical Competence in audiology, as
use of this composite benefit index is physicians in each case and, in some implied by the regulation, unless that
the most technically accurate index for cases, begin a routine of monthly person was dually qualified as an
capturing nonphysician benefits price evaluations. We would expect that not audiologist. Otherwise, we are not
pressures. only could extra visits to physicians’ proposing to update the qualifications
Although we have not done so in the offices or hospital outpatient for SLPs because we believe the
past, we believe it would be beneficial departments be necessary, but qualifications in § 484.4 are currently
to publish a preliminary estimate of the additional diagnostic tests may also be appropriate and address the issues of
expected MEI update. For CY 2008, the needed to care for the beneficiaries who continuing education and
forecasted increase in the MEI is 1.9 have the recalled devices. Thus, even internationally trained SLPs.
percent, which includes a forecasted 1.5 when immediate replacement of the We are proposing these changes for
percent productivity offset based on the device is not required, we are concerned the following several reasons.
10-year moving average of multifactor that the potential greater costs to • The current regulations at § 484.4
productivity. This forecast is based on Medicare and to the beneficiary for contain outdated terminology relating to
GII’s 1st quarter 2007 forecast of the MEI these unforeseen extra services may be several of the relevant professional
market basket. The final update will be substantial and burdensome. organizations.
based on historical data through 2nd We will be actively assessing ways to • The standards that now exist in the
quarter 2007. identify the additional health care costs fields of physical therapy and
and Medicare expenditures associated occupational therapy have changed
S. Other Issues since a substantial portion of these
with device recall actions and exploring
1. Recalls and Replacement Devices what actions would be appropriate in qualification requirements were
the case of these additional monitoring developed.
[If you choose to comment on issues • Some of the current qualification
and related expenses as they relate to
in this section, please include the requirements do not address individuals
both the hospital outpatient and
caption ‘‘RECALLS AND who have been trained outside of the
physician payment systems. We
REPLACEMENT DEVICES’’ at the United States, or refer to outdated
welcome public comments on this issue
beginning of your comments.] requirements.
to inform our future review and
Recently, there has been a recall of analyses. • These revisions would have the
73,000 implantable cardioverter- benefit of establishing consistent
defibrillators (ICDs) and cardiac 2. Therapy Standards and Requirements standards across provider/supplier
resynchronization therapy defibrillators [If you choose to comment on issues lines.
(CRT–Ds) because of a faulty capacitor in this section, please include the Although all States license PTs, some
that can cause the batteries to deplete caption ‘‘THERAPY STANDARDS AND States have no licensing provisions for
sooner than expected. (See the FDA REQUIREMENTS’’ at the beginning of PTAs, OTs, OTAs, and SLPs. In
Web site at www.fda.gov/cdrh/news for your comments.] particular, the qualifications for PTAs
Questions and Answers posted April 20, vary widely among States. According to
2007 on this recall). This follows upon a. Revisions to Personnel Qualification the Federation of State Boards of
the recall of thousands of ICDs and Standards for Therapy Services Physical Therapy Web site (accessed on
pacemakers in CY 2004 and CY 2005. In the CY 2005 PFS final rule with March 29, 2007), the ‘‘Number of states
These recalls raise issues both with comment period (69 FR 66354), we that grandfathered PTAs prior to
regard to the additional costs of amended § 410.59, § 410.60, and regulation = 41.’’ Under the title ‘‘What
replacement devices and with regard to § 410.62 to refer to the qualifications for method does your state use to regulate
the additional physicians’ services and physical therapists (PTs), occupational PTAs?’’ the field contains the word
diagnostic tests that beneficiaries who therapists (OTs) and speech-language ‘‘Licensed,’’ or ‘‘Certified’’, or is blank.
have these devices often need. pathologists at § 484.4, which sets the Therefore, we believe PTAs who have
been licensed and practicing for many 1, 2008 to continue providing services In this proposal, we refer to persons
years may not meet the current without updating their education to who are licensed, certified, and
education requirements in § 484.4. We meet the new requirements. otherwise regulated by a State. We
believe the same is true of occupational We are seeking comment on interpret ‘‘otherwise regulated’’ to mean
therapy assistants who obtained their appropriate grandfathering provisions that, while a State may not regulate a
training prior to application of the relating to qualifications of therapists profession by granting a license or
requirements of the certification and assistants to assure that skilled certifying educational or training
examination for Certified Occupational therapists and assistants with credentials, it may nevertheless regulate
Therapy Assistant (COTA) developed comparable and appropriate education the practice of a profession by
and administered by the National Board and training treat Medicare beneficiaries application of certain other
for Certification in Occupational in all settings. We propose these requirements. For example the use of
Therapy, Inc. (NBCOT). Additionally, grandfathering provisions to § 409.16, the title physical therapy assistant might
we believe some States permitted § 409.23, § 410.43, § 410.59, § 410.60, be limited to those who have passed a
licensure or certification of PTs and OTs § 482.56, § 485.70, § 485.705, § 491.9. course for PTAs in a State-approved
without successful completion of a The proposed revised personnel college, even when the State does not
curriculum in physical therapy or qualifications in § 484.4 for therapists grant graduates a license or certificate to
occupational therapy after 1977 (the and assistants must address minimum practice. By ‘‘otherwise regulated,’’ we
date currently specified under the requirements for the provision of do not mean to refer to State regulations
‘‘grandfather clause’’ in § 484.4 before therapy services by qualified personnel that are generally applicable to all
which a practicing PT or OT need not who have attained the skills of health care or other professionals
have completed a curriculum in therapists with education and training regarding, for example, business
physical therapy or occupational in the specific discipline in which they practices, employment or hygiene.
therapy). We believe there may also be are practicing, but who are not licensed. Rather, we mean to refer to the specific
licensed or certified PTAs and OTAs Also, for therapists and assistants qualifications one must have in order to
who do not meet the educational trained outside the United States or practice within a particular discipline or
requirements in § 484.4. trained by the United States military, we use a particular title.
Therefore, we believe it would be want to consider developing standards We propose to require that OT’s
appropriate to broaden the current comparable to those applied to beginning their practice after January 1,
grandfathering clauses for practicing therapists and assistants trained in the 2008, must be licensed, certified,
PTs, OTs, PTAs, and OTAs. We propose United States. By ‘‘comparable’’ we registered or otherwise regulated as an
to revise our requirements to recognize mean that we would refer to and base OT, and have graduated from an
PTs, OTs, PTAs, or OTAs who meet our standard on a process whereby it is occupational therapist curriculum
their respective State qualifications (or determined (either by the State or by accredited by the Accreditation Council
have received State recognition as PTs, another credentialing authority such as for Occupational Therapy Education
OTs, PTAs or OTAs) before January 1, the NBCOT) that the education, training, (ACOTE) of the American Occupational
2008. Individuals who furnish physical or testing standards obtained outside the Therapy Association (AOTA), and also
or occupational therapy services but United States or in the military are so have successfully completed the
have not met State qualifications (or similar as to be substantially certification examination developed and
received State recognition as PTs, OTs, indistinguishable from standards administered by the NBCOT. By
PTAs and OTAs) before January 1, 2008, applied to those who meet the ‘‘successfully completed’’ we mean the
would be required to meet the updated qualifications for therapists and individual must perform sufficiently
qualifications in § 484.4. assistants trained in the United States. well on the exam to receive (or be
We are not proposing to change the However, we note that we intend to eligible to receive) certification. For
current grandfathering provisions establish standards comparable to those services incident to a physician’s or
relating to the qualifications for PTs, we establish for PTs, OTs, PTAs, OTAs, nonphysician practitioner’s service
OTs, PTAs, and OTAs furnishing and speech-language pathologists, and where the licensure requirement does
services under the Home Health PPS or not to recognize as qualified therapists not apply, the education requirements
the Hospice PPS because the current or therapy assistants individuals trained continue to apply.
regulations in § 484.4 (that is, in other disciplines for purposes of We propose that after January 1, 2008,
occupational therapist (paragraph (c)), furnishing PT, OT, or SLP services to OTAs must be licensed, certified,
OTA (paragraph (b)), physical therapist Medicare beneficiaries. It is not our registered or otherwise regulated as an
(paragraph (c) or (d)), or PTA (paragraph intention to modify the policy that OTA and have graduated from an OTA
(2)) have applied to those settings requires physical therapy, occupational curriculum accredited by the nationally
consistently for almost 20 years. We do therapy, and SLP services furnished recognized organization for
not expect that there are therapists incident to a physicians service to meet accreditation of occupational therapists,
furnishing services in a HHA or hospice all the standards and conditions (except the ACOTE of the AOTA, and
that do not meet either the current or licensure) that apply to therapists, as successfully completed the certification
proposed revised qualifications. this policy is based on the section examination for Certified Occupational
Therefore, we will retain the current 1862(a)(20) of the Act. Rather, it is our Therapy Assistant (COTA) developed
grandfathering clauses for personnel intention to assure that Medicare and administered by the NBCOT.
providing services in those settings payment is made only for physical We are proposing that OTs who are
before 1977. We would not apply to therapy, occupational therapy, and SLP educated outside the United States or by
Home Health and Hospice settings the services provided by personnel who the U.S. Military— (1) Be graduates of
proposed new grandfathering clause meet qualifications, including an occupational therapy curriculum
that would permit those qualified consistent and appropriate education accredited by the World Federation of
professionals who are licensed, and training relevant to the discipline, Occupational Therapists (WFOT); (2)
certified, registered or otherwise so that they are adequately prepared to have successfully completed the
regulated by a State and are furnishing safely and effectively treat Medicare NBCOT International Occupational
services in other settings before January beneficiaries. Therapy Eligibility Determination
(IOTED) review; and (3) have • § 485.705 (Clinics, Rehabilitation most health services. In 1988, in an
successfully completed the certification agencies, Public health agencies). attempt to control the expanding
examination for Registered • § 491.9 (Rural health clinics and utilization of therapy services, we added
Occupational Therapist. We propose to Federally qualified health centers a 30-day recertification requirement for
adopt similar standards for OTAs (but (FQHCs)). outpatient therapy services to our
with an OTA curriculum) and seek We also welcome comments on regulation at § 424.24. This requires that
comments on qualifications for whether the personnel qualifications at a physician certifies a plan of care for
internationally educated occupational § 484.4 should be made applicable in 30 days, regardless of the appropriate
therapy assistants. other settings. length of treatment. To continue
For PTs, we propose the therapist It is our intention that when Medicare treatment past 30 days, the physician is
must be licensed as a physical therapist policies describe physical therapists, required to recertify the plan. After
by the State in which practicing and physical therapist assistants, many years of experience with the
accredited by the Commission on occupational therapists, occupational current recertification requirements, we
Accreditation in Physical Therapy therapy assistants and speech-language now believe that requiring
Education (CAPTE) based on American pathologists, the qualifications for those recertification at 30-day intervals may
Physical Therapy Association (APTA) professions would be the same in all not always provide sufficient flexibility
guidelines. When the licensure settings, without exception. to the physician to order the correct
requirement is not applicable (that is, (2) Application of Consistent Therapy amount of therapy for the patient’s
for services furnished incident to the Standards needs. In some cases, it may impact
services of physicians and NPPs), we utilization by encouraging reevaluations
propose to require that PTs must have In tandem with cross-referencing Part at intervals based on certification
been accredited by the CAPTE. We seek A and Part B therapy personnel timing, rather than on necessity. Since
comment on qualifications for PTs that requirements in the regulations, we the 30-day recertification requirement
include a curriculum and a national believe it would be appropriate to was initiated in 1988, many other means
examination each approved by the clarify our policies to improve of ensuring appropriate utilization of
APTA. consistency in the standards and therapy services have been developed.
We propose that licensure or conditions for Part A and Part B therapy Medicare policies have been clarified to
certification, registration or other services. Many, but not all, of the define skilled services, reasonable and
regulation by the State in which services policies described for therapy services necessary services, and appropriate
are furnished would be required for in Part B settings are also appropriate to documentation. Payments for therapy
PTAs under our regulations. We also Part A settings. services are now limited by annual per
In § 409.17, we propose to clarify that
propose that PTAs be accredited by the beneficiary caps, and there are many
hospital services include physical
CAPTE. We seek comment on local medical review policies and
therapy, occupational therapy and SLP.
appropriate qualifications for PTAs. system edits to monitor extended
We propose to add regulations for
treatment. Therapy services are now
b. Application of Consistent Therapy inpatient hospital services to include a
identified as such on claims, making it
Standards plan of treatment for therapy services
easier to analyze and review
(1) Personnel Qualifications consistent with the plan required for
overutilization of services. Three studies
outpatient therapy services. We invite
We believe therapy services should be on utilization of therapy services are
comment on PT, OT, and SLP plan of
provided according to the same published and available to medical
treatment policies that are appropriately
standards and policies in all settings, to reviewers and providers or suppliers of
applied to all therapy services, whether
the extent possible and consistent with services to help identify typical
provided under Medicare Part A or B.
statute. For example, personnel Since inpatient hospital services are episodes of care. Taken together, these
qualifications for therapists and always provided under the care of a changes may have improved appropriate
assistants should apply equally to all physician, we believe that the utilization and limit errors in billing for
settings in which Medicare pays for physician’s review and certification of therapy services, as evidenced in the
physical therapy, occupational therapy the therapy plan of treatment is implied Improper Medicare Fee-for-Service
and SLP services. Therefore, we propose by the physician’s review and approval Payment Report of May 2007.
to revise our regulations to cross- of a facility plan that includes therapy In 2004 and again in 2006, we
reference the personnel qualifications services and, therefore, we are not engaged a contractor to perform an
for therapists in § 484.4 to the personnel proposing additional therapy extensive analysis of the utilization of
requirements for PTs, OTs, PTAs, OTAs, certification requirements for the therapy services. The analyses indicated
and SLPs in the following sections: hospital setting. that the 30-day recertification
• § 409.10 and § 409.16 (Inpatient requirement has not had the anticipated
hospital services and inpatient critical c. Outpatient Therapy Certification impact on utilization of services and
access hospital services). Requirements does not serve to limit therapy services
• § 409.23 (Posthospital SNF care). The signature of a physician or NPP payments. About 70 percent of episodes
• § 410.43 (Partial hospitalization in the medical record indicating are completed before the first 30-day
services). approval of the plan of care for recertification interval. Although CORFs
• § 410.59 (Outpatient occupational outpatient therapy services certifies the have a 60-day recertification period, and
therapy services). initial need for therapy services SNFs and ORFs have 30-day
• § 410.60 (Outpatient physical furnished under Part B. For other recertification periods, the average
therapy services). covered medical and health services number of treatment days is similar in
• § 410.62 (Outpatient SLP services). furnished by providers and suppliers of these settings. This suggests that the
• § 418.92 (Hospice). outpatient services, certification is interval of the recertification
• § 482.56 (Optional hospital services, required only once, either at the requirement does not affect professional
Rehabilitation services). beginning or at the end of a series of decisions regarding the duration of
• § 485.70 (Specialized providers). visits. Recertification is not required for treatment. In fact, contrary to the pattern
expected if certification impacted § 424.24 to require recertification every Secretary to issue uniform standards for
duration of treatment, the number of 90 days after beginning treatment. the electronic transmission of such data.
physical therapy treatment days is We propose to revise § 424.24 to There is no requirement that
higher in a SNF (30-day recertification remove reference to a certification prescribers or dispensers implement e-
interval) than in a CORF (60-day ‘‘statement’’ and to require that the prescribing. However, prescribers and
recertification interval). continuing need for therapy services be dispensers who electronically transmit
For these reasons, we do not believe documented in the medical record, for prescription and certain other
there is a continued need for example, the plan of treatment. Since information for covered drugs
recertification at the 30-day interval. We each plan must include the duration of prescribed for Medicare Part D eligible
propose that review of the plan of care treatment, the current requirement for beneficiaries, directly or through an
continue to be required at certification an estimate of how much longer the intermediary, would be required to
and recertification. Since the plan of services will be needed is proposed to comply with any applicable final
care may be established by a nurse be omitted as redundant. standards that are in effect.
practitioner, a clinical nurse specialist, We propose to continue to review the Section 1860D–4(e) of the Act
or a physician assistant (nonphysician utilization of therapy services to assess required the Secretary to conduct a pilot
practitioners) as well as a physician, we any changes in practice that might be project to test initial standards
propose to modify the language in related to the proposed changes in our recognized under section 1860D–4(e)(A)
§ 410.61 to include those professionals regulations regarding certification of a of the Act, prior to issuing the final
among those who shall review the plan. plan of care for an appropriate length of standards in accordance with section
Since the certification and treatment. After 2 years, if we determine 1860D–4(e)(D) of the Act. Initial
recertification of the plan requires a that there are changes in practice that standards were recognized by the
signature, we propose to remove the suggest inappropriate utilization of Secretary in 2005 and then tested in a
current redundant requirement at therapy services based on the pilot project during CY 2006. The MMA
§ 410.61(e) to date and sign a review at certification timing, we will consider created an exception to the requirement
the same time as the plan is certified. whether to reinstate the 30-day for pilot testing of standards where, after
We propose to change the plan of recertification requirement. consultation with the National
treatment recertification schedule in Committee on Vital and Health
§ 424.24. Currently, the physician must 3. Proposed Elimination of the
Exemption for Computer-Generated Statistics (NCVHS), the Secretary
initially certify a plan of treatment at the determined that there already was
time the plan is established or as soon Facsimile Transmission from the
National Council for Prescription Drug adequate industry experience with the
thereafter as possible. If the need for standard(s). Such ‘‘foundation
treatment continues beyond 30 days, the Programs (NCPDP) SCRIPT Standard for
Transmitting Prescription and Certain standards’’ were recognized and
plan of treatment must be recertified adopted through notice and comment
every 30 days until discharge. We Prescription Related Information for
Part D Eligible Individuals rulemaking as final standards without
propose that the physician (or NPP, as pilot testing.
appropriate) would continue to review [If you choose to comment on issues Based upon the evaluation of the pilot
and certify the initial plan of care as in this section, please include the project, and not later than April 1, 2008,
soon as possible, but that the caption ‘‘PROPOSED ELIMINATION OF the Secretary is required to issue final
certification would apply for an episode EXEMPTION FOR COMPUTER- uniform standards. These final
length based on the patient’s needs, not GENERATED FACSIMILES’’ at the standards must be effective not later
to exceed 90 days and would be beginning of your comments.] than 1 year after the date of their
recertified every 90 days thereafter. issuance.
Payment would continue to be denied if a. Legislative History
services were provided without a For a complete discussion of the
Section 101 of the MMA amended
certified plan of care. Overutilization of statutory bases for the e-prescribing
title XVIII of the Act to establish a
services would continue to be portions of this proposed rule and the
voluntary prescription drug benefit
monitored, as it is now, by Medicare statutory requirements at section
program. Prescription Drug Plan (PDP)
contractors based on data analysis 1860D–4 of the Act, please refer to the
sponsors, Medicare Advantage (MA)
assisted by system edits. ‘‘Background’’ section of the E-
organizations offering Medicare
Prescribing and the Prescription Drug
We believe adjusting the first Advantage-Prescription Drug Plans
Program proposed rule published in the
recertification interval from 30 to 90 (MA–PD), and other Part D sponsors are
February 4, 2005 Federal Register (70
days would allow the physician to required to establish electronic
FR 6256).
approve a plan of care that represents prescription drug programs to provide
the clinically appropriate length of for electronic transmittal of certain b. Regulatory History
treatment, discourage routine 30-day information to the prescribing provider i. Foundation Standards
plans, encourage professional and dispensing pharmacy and
determination of an appropriate length pharmacist. This would include After consulting with the NCVHS, the
of treatment at the time of the initial information about eligibility, benefits Secretary found that there was adequate
certification, protect the patient’s access (including drugs included in the industry experience with several
to needed treatment when the certifying applicable formulary, any tiered potential e-prescribing standards. Upon
physician or NPP is not available at the formulary structure and any adoption through notice and comment
30-day interval, reduce the requirements for prior authorization), rulemaking, these standards were called
administrative burden on providers, the drug being prescribed or dispensed ‘‘foundation’’ standards, because they
suppliers, physicians, NPPs and and other drugs listed in the medication would be the first set of final standards
Medicare contractors, and provide an history, as well as the availability of adopted for an electronic prescription
appropriate timeline for monitoring the lower cost, therapeutically appropriate drug program. Three standards were
necessity of continuing therapy services. alternatives (if any) for the drug adopted in the E-Prescribing and the
Therefore, we are proposing to amend prescribed. The MMA directed the Prescription Drug Program final rule
published in the November 7, 2005 to revert to paper prescribing. As the prescription-related information.
Federal Register (70 FR 67568). Secretary believed that prescribers/ However, at the same time we
The foundation standards are as dispensers using computer fax encouraged all prescribers and
follows: capabilities would eventually migrate to dispensers using fax technology to move
• For the exchange of eligibility fully functional e-prescribing, possibly as quickly as possible to computer-to-
information between prescribers and at the same time as they implemented computer data interchange via the
Part D sponsors: ASC X12N–270/271— electronic health record (EHR) systems, NCPDP SCRIPT standard.
Health Care Eligibility Benefit Inquiry the November 7, 2005 final rule Since January 2006, we have seen
and Response, Version 4010, May 2000, exempted entities transmitting little reduction in the use of computer-
Washington Publishing Company, computer-generated faxes from having generated fax technology. Based on data
004010X092 and Addenda to Health to comply with the NCPDP SCRIPT provided to CMS by SureScripts, which
Care Eligibility Benefit Inquiry and standard. operates the Pharmacy Health
Response, Version 4010, A1, October Information Exchange, the largest
2002, Washington Publishing Company, c. Proposal of Elimination of Exemption network to link electronic
004010X092A1 (hereafter referred to as We propose to revise § 423.160(a)(3)(i) communications between pharmacies
the ASC X12N 270/271 transaction). to eliminate the computer-generated and physicians, serving more than 95
• For the exchange of eligibility facsimiles (faxes) exemption to the percent of all pharmacies and all major
information between dispensers and NCPDP SCRIPT Standard for the physician technology vendors in the
Part D sponsors: The National Council communication of prescription or United States, it estimates that of the
for Prescription Drug Programs (NCPDP) certain prescription-related information 150,000 prescribers now using software
Telecommunication Standard Guide, between prescribers and dispensers for that is capable of generating SCRIPT
Version 5, Release 1 (Version 5.1), the transactions listed at transactions, only 15 percent are doing
September 1999, and equivalent NCPDP § 423.160(b)(1)(i) through (xii). In the so. The remaining 85 percent are still
Batch Standard Batch Implementation November 7, 2005 final rule (70 FR generating paper faxes. The costs to
Guide, Version 1, Release 1 (Version 67571), we explained that faxes convert to e-prescribing using NCPDP
1.1), January 2000 supporting generated by one computer and SCRIPT for these prescribers would in
Telecommunications Standard, electronically transmitted to another most cases be included in the annual
September 1999, Implementation Guide computer or fax machine would be maintenance fee they pay their software
Version 5, Release 1 (Version 5.1) for included under the e-prescribing vendor. However, the cost of conversion
NCPDP Data Record in the Detail Data definition of electronic media. This for prescribers using e-prescribing
Record (hereafter referred to as the computer-generated fax technology is software that cannot generate SCRIPT
NCPDP Telecommunication Standard). used in some e-prescribing software transactions would be higher, as these
• For the exchange of new products and under the definition of prescribers would have to purchase and
prescriptions, changes, renewals, electronic media, providers and install other software products.
cancellations and certain other dispensers who utilize these products Therefore, we are specifically soliciting
transactions between prescribers and would be required to comply with comments on the impact to providers
dispensers: NCPDP SCRIPT Standard, adopted e-prescribing standards. Our and pharmacies.
Implementation Guide, Version 5, discussion of computer-generated faxing Pharmacy implementation of e-
Release 0 (Version 5.0), May 12, 2004 distinguished between cases where the prescribing is considerably more
(hereafter referred to as NCPDP SCRIPT prescriber’s/dispenser’s software has the widespread. SureScripts reports that all
Standard). ability to generate SCRIPT transactions, chain drug stores and 20 percent of
but the feature is not activated because independent pharmacies are capable of
ii. Exemption to Foundation Standard
the prescriber has not activated the sending and receiving SCRIPT
Requirements for Computer-Generated
feature on their software, and other transactions. Independent pharmacies
Facsimiles
cases where software (such as a word are less likely to perceive a return on
The November 7, 2005 final rule processing program) is used that creates investment for e-prescribing due to low
included an exemption for entities that and sends a fax that results in a paper numbers of practices seeking to move to
transmit prescriptions or prescription- prescription or response at the receiving e-prescribing using the SCRIPT
related information by means of end, but does not have true e- transaction.
computer-generated facsimile (faxes) prescribing (electronic data interchange Since computer-generated faxing
from the requirement to use the adopted using the SCRIPT standard) capabilities. retains some of the disadvantages of
NCPDP SCRIPT standard. ‘‘Electronic We believed that requiring paper prescribing (for example, the
media’’ was already defined by the prescribers/dispensers who already use administrative cost of keying the
HIPAA, so e-prescribing utilized the electronic media to e-prescribe to prescription into the pharmacy system
same definition. As a result, faxes that modify or change their software and and the related potential for data entry
were generated by a prescriber’s/ hardware products to be compliant with errors that may impact patient safety),
dispenser’s computer and sent to a the foundation standards would likely we believe it is important to take steps
provider’s/dispenser’s fax machine result in their simply reverting to paper to encourage prescribers and dispensers
which prints out a hard copy of the prescribing and would be to move toward use of the SCRIPT
original computer-generated fax (that is, counterproductive to achieving standard.
‘‘computer-generated’’ faxes) fell within standardized use of non-fax electronic One concrete step we could take to
the definition of ‘‘electronic media’’ for data interchange for prescribing. Also, increase the use of the SCRIPT
e-prescribing. Absent an exemption, we believed that prescribers and transaction would be to eliminate the
entities transmitting computer- dispensers would begin to migrate to exemption for computer-generated
generated faxes would be required to true e-prescribing in time, and therefore, faxing. This would move prescribers
comply with the adopted foundation adopted an exemption that permitted and dispensers using this technology to
standards. Comments received from the prescribers and dispensers to continue upgrade to software products or to new
health care industry indicated that this to use computer-generated faxes for versions of the products they currently
would cause computer-generated faxers transmitting certain prescriptions and use, that would enable electronic
transmission of SCRIPT transactions. T. Division B of the Tax Relief and (formerly the Ambulatory Care Quality
Because this requirement would fall on Health Care Act of 2006—Medicare Alliance) meeting on January 22, 2007,
prescribers that already use e- Improvements and Extension Act of 8 quality measures were added to the 66
prescribing software, it would increase 2006 (Pub. L. 109–432) (MIEA–TRHCA) measures identified and originally
the number of SCRIPT transactions In addition to the provisions of the posted to the CMS Web site on
fairly significantly in a relatively short MIEA–TRHCA discussed in section II.B. December 5, 2006. The final result is 74
time period, and this could in turn (GPCIs), additional provisions of the ‘‘2007 PQRI Quality Measures.’’ A list
create a ‘‘tipping point’’ that could MIEA–TRHCA are discussed in this and description of these 74 measures is
create an economic incentive for section of the proposed rule. available for download from the PQRI
independent pharmacies to adopt Measures/Codes page of the PQRI
1. Section 101(b)—Physician Quality section of the CMS Web site at
software to begin to exchange SCRIPT
Reporting Initiative (PQRI) www.cms.hhs.gov/PQRI.
transactions with their prescriber
[If you choose to comment on issues Although section 1848(k)(2)(A)(ii) of
partners.
in this section, please include the the Act does not allow for any further
Therefore, we propose to eliminate additions to or deletions from the 2007
caption ‘‘TRHCA—SECTION 101(b):
the computer-generated fax exemption PQRI Quality Measures after January
PQRI’’ at the beginning of your
for all provider/dispenser transactions. comments.] 2007, the statute does allow
We anticipate having this change modifications or refinements (such as
effective 1 year after the effective date a. Background code additions, corrections, or
of the CY 2008 PFS final rule. This will Section 101(b) of the MIEA–TRHCA revisions) to the detailed specifications
provide notice to prescribers and amended section 1848 of the Act by for the 2007 PQRI quality measures
dispensers seeking to implement or adding subsection (k). Section until the beginning date of the reporting
upgrade e-prescribing software to look 1848(k)(1) of the Act requires the period (that is, July 1, 2007). After this
for products and upgrades that are Secretary to implement a system for the date, no further revisions to the
capable of generating and receiving reporting by eligible professionals of specifications for 2007 PQRI measures
NCPDP SCRIPT transactions. It also data on quality measures as described in are allowed by section 1848(k) of the
affords current e-prescribers time to section 1848(k)(2) of the Act. As Act. The specifications for the 2007
work with their trading partners to specified in section 1848(k)(3)(B) of the PQRI quality measures are available as
eventually eliminate computer to fax Act, for the purpose of the quality a download from the Measures/Codes
machine transactions. reporting system, eligible professionals page of the PQRI section of the CMS
include physicians, other practitioners Web site at http://www.cms.hhs.gov/
We now believe that, with the pqri. Additional materials containing
as described in section 1842(b)(18)(C) of
additional phase-in period allotted to the Act, physical and occupational information on the 2007 PQRI,
allow for this transition, with improved therapists, and qualified speech- including but not limited to the
and more readily available standards- language pathologists. Section 101(c) of calculation of eligibility for and amount
based e-prescribing products, and the the MIEA–TRHCA authorizes of bonus payment for satisfactory
apparent ability of e-prescribing ‘‘Transitional Bonus Incentive Payments reporting, are also available on this
networks to now identify which for Quality Reporting’’ in 2007, section of the CMS Web site.
prescribers and dispensers are capable specifically for satisfactory reporting of Section 1848(k)(2)(B) of the Act
of making SCRIPT enabled transactions quality data, as defined by section requires that the Secretary publish in
and which use this information to 101(c)(2) of the MIEA–TRHCA. We have the Federal Register not later than
facilitate successful SCRIPT enabled named this quality reporting system for August 15, 2007, proposed quality
transactions, this elimination of the 2007, including the 2007 bonus measures that would be appropriate for
exemption for computer-generated payment, the ‘‘Physician Quality eligible professionals to use to submit
faxing will encourage e-prescribers and Reporting Initiative (PQRI)’’ for ease of data to the Secretary in 2008. The final
dispensers to move as quickly as reference. 2008 PQRI quality measures must be
possible to use of the SCRIPT standard For 2007, section 1848(k)(2)(A)(i) of determined and published by November
with what we perceive to be minimal the Act, as added by the MIEA–TRHCA, 15, 2007, as specified in section
impact. provides that the quality measures for 1848(k)(2)(B) of the Act as amended by
the PQRI shall be the physician quality the MIEA–TRHCA.
We are soliciting comments on the
measures published as 2007 Physician b. MIEA–TRHCA Requirements for
impact of the proposed elimination of
Voluntary Reporting Program (PVRP) Measures Included in the 2008 PQRI
this exemption, including the total quality measures on the CMS Web site
number of affected practices and as of the date of enactment of this (i) Overview of MIEA–TRHCA
pharmacies and the time required for subsection, except as may be changed Requirements for 2008 PQRI Quality
them to implement SCRIPT-enabled based on the results of a consensus- Measures
software. Specifically, we are soliciting based process in January 2007. The 2007 Section 1848(k)(2)(B)(i) of the Act
information regarding the number of PVRP quality measures consist of the 66 requires, ‘‘for purposes of reporting data
practices that currently use legacy measures that we had identified and on quality measures for covered
versions of software that are not capable posted on the CMS Web site on professional services furnished during
of generating SCRIPT transactions and December 5, 2006 (see ‘‘Transition from 2008, the quality measures specified
the amount of lead time they would 2006 PVRP’’ below in this section). The under this paragraph for covered
need to comply. We are also soliciting statute also allowed for additional professional services shall be measures
comments regarding the extent to which quality measures to be added to the that have been adopted or endorsed by
eliminating the exemption would cause original set as the result of a consensus- a consensus organization (such as the
entities using fax technology to revert to based process in January 2007. As National Quality Forum or AQA), that
paper prescribing rather than update allowed under the statute, and based on include measures that have been
current software. actions approved at the AQA Alliance submitted by a physician specialty, and
that the Secretary identifies as having set of quality measures for eligible maintaining the following attributes: (1)
used a consensus-based process for professionals for use in 2008 and the Openness; (2) Balance of interest; (3)
developing such measures. Such policies we propose to apply in Due process; (4) An appeals process; (5)
measures shall include structural publishing the final set. Consensus; which is defined as general
measures, such as the use of EHRs and agreement, but not necessarily
(ii) Consensus Organizations and
electronic prescribing technology.’’ unanimity, and also includes a process
Section 1848(k)(2)(B)(ii) of the Act Consensus-Based Process for
for attempting to resolve objections by
requires, that ‘‘[n]ot later than August Developing Measures
interested parties. The process requires
15, 2007, the Secretary shall publish in The MIEA–TRHCA requires that that, as long as all comments have been
the Federal Register a proposed set of measures used for 2008 be identified by fairly considered, each objector is
quality measures that the Secretary the Secretary as having been endorsed advised of the disposition of his or her
determines are described in clause (i) or adopted by a consensus organization objection(s) and the reasons for the
and would be appropriate for eligible and having been developed through the disposition, and the consensus body
professionals to use to submit data to use of a consensus-based process. We members are given an opportunity to
the Secretary in 2008. The Secretary believe that these requirements should change their votes after reviewing the
shall provide for a period of public be interpreted in the context of the comments. Voluntary consensus
comment on such set of measures.’’ National Institute of Standards and standards must include provisions
In examining the statutory Technology Act (NISTA) (15 U.S.C. 271 requiring that owners of relevant
requirements of section 1848(k)(2)(B)(i) et seq.) as amended by the National intellectual property have agreed to
of the Act, we believe that the Technology Transfer and Advancement make that intellectual property available
requirement that measures be endorsed Act of 1995 (Pub. L. 104–113) (NTTAA) to all interested parties on a
or adopted by a consensus organization and implemented by OMB Circular No. nondiscriminatory, royalty-free, or
applies to each measure that would be A–119 (OMB A–119) dated February 10, reasonable royalty basis.
included in the measures set for 1998. Other types of standards, that are
submitting quality data on covered Per the NTTAA, except when it is distinct from voluntary consensus
professional services furnished during inconsistent with applicable law or standards include the following: (1)
2008. Likewise, the requirement for otherwise impractical, all Federal Industry standards, company standards,
measures to have been developed using agencies and departments shall use non-consensus standards, or de facto
a consensus-based process (as identified technical standards that are developed standards which are developed in the
by the Secretary) applies to each or adopted by voluntary consensus private sector but not in the full
measure. By contrast, we do not standards bodies and shall also consensus process of a voluntary
interpret the provision requiring participate with such bodies in the consensus standards body; (2)
inclusion of measures submitted by a development of technical standards Government-unique standards which
specialty to apply to each measure. when such participation is in the public are developed by the government for its
Rather, we believe this requirement interest and compatible with the agency own uses; (3) Standards mandated by
means that in endorsing or adopting and departmental missions, authorities, statute such as those contained in the
measures, a consensus organization priorities, and budget resources. United States Pharmacopeia and the
must include in its consideration OMB A–119 provides specific policy National Formulary, as referenced in 21
process at least some measures guidance to agencies on the appropriate U.S.C. 351.
submitted by one physician or interpretation of agency responsibilities The term ‘‘technical standards’’ under
organization representing a particular under the NTTAA. Specifically, OMB 12(d)(4) of the NTTAA, means
specialty. Similarly, we interpret the A–119 establishes as government-wide ‘‘performance-based or design-specific
requirement that 2008 measures include policy that agencies ‘‘must use technical specifications and related
structural measures, such as the use of voluntary consensus standards, both management systems practices’’. When
EHRs and electronic prescribing domestic and international, in its healthcare quality measures are used in
technology, to mean that the 2008 regulatory and procurement activities in a regulatory framework such as
measure set must include at least 2 lieu of government-unique standards, contemplated for the 2008 PQRI quality
structural measures. unless use of such standards would be measures under the MIEA–TRHCA, we
In examining sections 1848(k)(2)(B)(ii inconsistent with applicable law or believe that such measures constitute
through iii) of the Act, we believe that otherwise impractical.’’ OMB A–119 ‘‘technical standards’’ as used in the
the Secretary is given broad discretion explains that in determining whether NTTAA and that NTTAA applies to
to determine which quality measures use of existing voluntary consensus such measures.
meet the statutory requirements and are standards in its regulatory and Two consensus organizations are
appropriate for inclusion in the final set procurement activities is otherwise referenced in MIEA–TRHCA: the
of measures for 2008. We do not impractical, ‘‘ ‘Impractical’ includes National Quality Forum (NQF) and the
interpret the Act to require that all circumstances in which such use would AQA. The NQF has a formal
measures that meet the basic fail to serve the agency’s program needs; organizational structure and established
requirements of section 1848(k)(2)(B)(i) would be infeasible; would be processes that are intentionally
of the Act must be included in the 2008 inadequate, ineffectual, inefficient, or designed to comply with the NTTAA
set of quality measures. inconsistent with agency mission; or and OMB A–119. Membership is open
We discuss in the following section would impose more burdens, or be less and includes physicians and other
the statutory requirements for consensus useful, than the use of another providers, hospital organizations,
organizations and the use of a standard.’’ purchasers, researchers, payers, and

consensus-based process for developing OMB A–119 further provides that employers. In achieving its
quality measures as they relate to the ‘‘voluntary consensus standards’’ are determination of whether or not to
requirements for the set of measures for standards developed or adopted by endorse a standard, the NQF uses a
2008 in the context of other applicable voluntary consensus standards bodies. formal process that consists of five
Federal law and policy. We also discuss OMB A–119 defines ‘‘voluntary principal steps that follow a project’s
the policies used in proposing the initial consensus standards body’’ as conceptualization, prioritization, and
planning. The steps are: (1) Consensus of interest, and consensus based on health care quality measure developers
Standard Development; (2) Widespread voting participation, that is comparable generally use standardized methods that
Review; (3) Member Voting and Member to NQF or AQA, we propose to limit include identification of a quality goal
Council Approval; (4) Board of Directors measures for inclusion as 2008 PQRI to or gap, literature and evidence review,
Action; and (5) Evaluation that includes measures that are endorsed or adopted expert and technical evaluation,
an appeals process. The NQF meets the by NQF or AQA. However, as elaborated specification development, testing,
NTTAA requirements for a voluntary in the policies we set forth below in this organizational review, and that may
consensus standards body within the section, we invite comment as to other include public comment.
meaning of the NTTAA and its endorsed consensus organizations that may have In the framework of the NTTAA, upon
healthcare quality measures constitute a comparable level of consensus completion of the basic development
voluntary consensus standards within organization characteristics. work, healthcare quality measures do
the meaning of NTTAA. Given the overlap of NQF and AQA not constitute voluntary consensus
The AQA, also referenced in section as consensus organizations under the standards, even though they may have
1848(k)(2) of the Act as a consensus MIEA–TRHCA, it is important to utilized consensus as a mechanism of
organization for the purpose of distinguish their roles. As currently achieving agreement among the
identifying measures that have established, the principal purpose of developer’s participants or within the
successfully completed review by a AQA for physician quality measures is developer’s organizational structure.
consensus organization, utilizes certain to select among NQF endorsed measures Rather, to achieve the status as a
essential practices of a voluntary for coordinated implementation. Unlike voluntary consensus standard under
consensus standards body under NQF, AQA is not established to serve as NTTAA, the measure must go through
NTTAA and the OMB A–119 relating to a ‘‘voluntary consensus standards body’’ the additional development that occurs
openness, balance of interest, and under NTTAA. Therefore, the AQA is through the broader consensus process
consensus. Of particular note is the not established as an alternative or of consensus endorsement. During this
breadth of formal participation among substitute for NQF endorsement process, based on the need to achieve
stakeholders that have an interest in processes as an entity organized to agreement, quality measures are often
healthcare quality measures dealing comply with the NTTAA and OMB A– modified in order to achieve the
with physician care. Participants at 119 requirements for a voluntary necessary broad consensus.
AQA may vote without limitation as to consensus standards body. However, Consistent with this in concept but
which stakeholder category into which during a time of rapid physician quality without proposing that 2008 PQRI
they may fall. Voting participation, for measures development and measures be limited to those meeting
example, includes physicians, other implementation, it is impractical to the definition of a voluntary consensus
providers, purchasers, payers, delay implementation of physician standard under NTTAA, we interpret
consumers, accrediting organizations, quality measures until the formal ‘‘consensus-based process for
and employers. However, the AQA does processes of NQF are completed. developing measures’’ as used in MIEA–
not have a defined organizational Therefore, AQA has been able to TRHCA to encompass not only the basic
structure intended to meet the facilitate incorporation of new measures development work of the formal
requirements of the NTTAA and the into the quality reporting system by measure developer, but also to include
OMB A–119 and has no formal due providing consensus review acceptable the achievement of consensus among
process or appeals structure. Therefore, under MIEA–TRHCA for stakeholders in the health care system
the AQA does not meet the implementation of a measure prior to based on at least a level of openness,
requirements of the NTTAA for a actual NQF endorsement. In the event of balance of interest, and consensus
‘‘voluntary consensus standards body’’. a determination by NQF to decline reflected in the structures and processes
By citing AQA as an example of an endorsement of a particular measure of the NQF and AQA as of the date of
acceptable consensus organization, after it had been adopted by AQA, we enactment of MIEA–TRHCA and the
section 1848(k)(2)(B) of the Act anticipate that AQA would withdraw its date of publication of this proposed
establishes that AQA adoption satisfies adoption of such a measure. rule.
the requirement of section 1848(k)(2)(B) Turning to the requirement of a Based on the considerations
of the Act that PQRI quality measures be consensus-based process for developing previously discussed, we propose to
adopted or endorsed by a consensus quality measures, we propose to apply the following policies in
organization. We believe it follows that interpret this requirement in light of the identifying measures that meet the
the Congress did not intend to require NTTAA and the importance of broad MIEA–TRHCA requirements for having
all 2008 quality measures under section consensus for health care quality used a consensus-based process for
1848(k)(2)(B) of the Act to meet the measures used for regulatory purposes. development and the requirement for
requirements to be considered voluntary In this context we will outline the having been endorsed or adopted by a
consensus standards under the NTTAA. process of health care quality consensus organization such as the NQF
However, by giving NQF and AQA as measurement development and or AQA, and that are appropriate for
examples of consensus organizations, distinguish basic development steps inclusion as 2008 measures:
we believe the Congress intended that from the completion of a consensus- (1) We interpret ‘‘a consensus-based
consensus organizations should, in the based development process as required development process’’ as meaning that
context of section 1848(k)(2)(B) of the under MIEA–TRHCA. in addition to the measure development,
Act, have a breadth of stakeholder Many organizations are involved in the measure has achieved adoption or
involvement and voting participation the development of health care quality endorsement by a consensus
substantially comparable to that of the measures including physician organization having at least the basic
NQF or AQA. organizations, health care providers, characteristics of the AQA as a
Inasmuch as we are unaware of any Federal agencies, accreditation consensus organization as of December
other organizations that engage in organizations, disease-focused not-for- 2006, when the MIEA–TRHCA
endorsement or adoption of healthcare profit organizations, research incorporating reference to AQA was
quality measures for physician services organizations, and health plans. The passed and signed into law. Those basic
that have the level of openness, balance basic development processes of leading characteristics include a comparable
level of openness, balance of interest, NTTAA or of organizations other than c. Proposed 2008 PQRI Quality
and consensus based on voting AQA that do not strictly meet the Measures
participation. As discussed above and requirements of the NISTA as amended
further clarified in points (3) and (5), we by the NTTAA but that feature the The identified measures we propose
do not interpret ‘‘consensus-based breadth of stakeholder involvement in for 2008 would be made final as of the
development process’’ per section the consensus process necessary to meet effective date of the final rule, and no
1848(k)(2)(B) of the Act to require that the intent of the MIEA–TRHCA. changes (no additions or deletions of
the consensus organization or process However, the MIEA–TRHCA does not measures) will be made after that date.
meet all of the criteria of the NTTAA limit consensus organizations to the However, as was done for 2007, we may
and OMB A–119 definition of a NQF or the AQA, nor restrict the field make modifications or refinements,
voluntary consensus standards body. of potential consensus organizations. such as code additions, corrections, or
(2) ‘‘Voluntary consensus standard’’ is The MIEA–TRHCA, thereby, maintains revisions, to the detailed specifications
interpreted to mean a voluntary flexibility in potential sources of for the 2008 measures until the
consensus standard that has been measure consensus review, which is, beginning of the reporting period. Such
endorsed as such by a consensus like having multiple sources of measure specification modifications may be
organization that meets the development, key to maintaining a made through the last day preceding the
requirements of the NTTAA, as robust marketplace for development and beginning of the reporting period. The
implemented by OMB A–119, for a review of quality measures. 2008 measures specifications will be
voluntary consensus standards body. (7) The basic steps for developing the available on the PQRI section of the
(3) Where there are available quality physician level measures may be carried CMS Web site at http://
measures, and some of these measures out by a variety of different www.cms.hhs.gov/pqri when they are
meet the definition of ‘‘voluntary organizations. We do not interpret the sufficiently developed or finalized but
consensus standards’’ while others do MIEA–TRHCA to place special in no event later than December 31,
not, those measures that meet the restrictions on the type or make up of 2007. These detailed specifications will
definition of ‘‘voluntary consensus the organizations carrying out this basic include instructions for reporting and
standards’’ are preferred to other development of physician measures, identify the circumstances in which
measures not meeting the requirements such as restricting the initial each measure is applicable.
of the NTTAA. development to physician-controlled
organizations. Any such restriction For 2008, we propose PQRI Quality
(4) In view of the preference for
would unduly limit the basic measures selected from measures listed
voluntary consensus standards, if a
development of physician quality in Tables 16 through 22, which fall into
measure has been specifically
measures and the scope and utility of 7 broad categories as set forth below in
considered by NQF for possible
measures that may be considered for this section. We welcome comments on
endorsement but NQF has declined to
endorsement as voluntary consensus the implications of including any given
endorse it as of November 15, 2007, we
standards. measure or measures proposed herein in
propose not to include it in the final set
(8) The policies we propose are based the final 2008 PQRI quality measures.
of 2008 PQRI Quality Measures.
(5) Although the AQA does not meet on the preference as articulated in (i) Measures Selected From the 2007
the requirements of the NTTAA for a NTTAA and OMB A–119 for ‘‘voluntary PQRI Quality Measures
voluntary consensus standards body, it consensus standards’’ to government
is a consensus organization per section standards, and a preference for quality We propose to retain and include in
1848(k)(2)(B) of the Act. In measures that have achieved broad the final 2008 PQRI measures the
circumstances where no voluntary consensus among stakeholders in the following 2007 PQRI measures in Table
consensus standard (NQF-endorsed) health care system. However, the MIEA– 16 contingent on NQF endorsement of
measure is available, a quality measure TRHCA does not require that quality each such included measure by
that has been adopted by the AQA (or measures meet the NTTAA or OMB A– November 15, 2007. All 2007 PQRI
another consensus organization with 119 definition of ‘‘voluntary consensus measures have been considered or are
comparable consensus-organization standards’’ in order to be used for PQRI. under consideration for endorsement
characteristics, will meet the Thus, though we prefer to use quality under NQF projects. Those 2007 PQRI
requirements of MIEA–TRHCA is we measures meeting the NTTAA and OMB measures that have been declined for
determine that it is appropriate for A–119 criteria for voluntary consensus endorsement are not included in the list
eligible professionals to use to submit standards, neither this CMS preference of proposed measures for 2008. The
data. nor the NTTA or OMB A–119 preclude measures in Table 16 include measures
(6) We are unaware of other CMS from selecting measures for PQRI submitted by specialties, in compliance
consensus organizations that are based upon a lesser degree of consensus with section 1848(k)(2)(B) of the Act, for
comparable to the NQF in terms of when necessary to meet CMS’ program example, the measures for diabetic
meeting the formal requirements of the needs as determined by the Secretary. retinopathy (ophthalmology).
TABLE 16.—2007 PQRI MEASURES
Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus.

Low Density Lipoprotein Control in Type 1 or 2 Diabetes Mellitus.
High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus.
Screening for Future Fall Risk.

Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dys-
function (LVSD).
Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease.
Beta-blocker Therapy for Coronary Artery Disease Patients with Prior Myocardial Infarction (MI).
Heart Failure: Beta-blocker Therapy for Left Ventricular Systolic Dysfunction.
Antidepressant Medication During Acute Phase for Patients with New Episode of Major Depression.
TABLE 16.—2007 PQRI MEASURES—Continued

Medication Reconciliation.
Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older.
Characterization of Urinary Incontinence in Women Aged 65 Years and Older.
Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older.
Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation.
Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy.
Asthma: Pharmacologic Therapy.
Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports.
Stroke and Stroke Rehabilitation: Carotid Imaging Reports.
Primary Open Angle Glaucoma: Optic Nerve Evaluation.
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy.
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care.
Perioperative Care: Timing of Antibiotic Prophylaxis—Ordering Physician.
Perioperative Care: Selection of Prophylactic Antibiotic—First or Second Generation Cephalosporin.
Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures).
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (when indicated in All patients).
Osteoporosis: Management Following Fracture.
Osteoporosis: Communication with the Physician Managing Ongoing Care Post-Fracture.
Aspirin at Arrival for Acute Myocardial Infarction (AMI).
Electrocardiogram Performed for Non-Traumatic Chest Pain.
Electrocardiogram Performed for Syncope.
Vital Signs for Community-Acquired Bacterial Pneumonia.
Assessment of Oxygen Saturation for Community-Acquired Bacterial Pneumonia.
Assessment of Mental Status for Community-Acquired Bacterial Pneumonia.
Empiric Antibiotic for Community-Acquired Bacterial Pneumonia.
Asthma Assessment.
Perioperative Care: Timing of Prophylactic Antibiotics—Administering Physician.
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage.
Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy.
Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge.
Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered.
Stroke and Stroke Rehabilitation: Screening for Dysphagia.
Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services.
Dialysis Dose in End Stage Renal Disease (ESRD) Patients.
Hematocrit Level in ESRD Patients.
Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older.
Osteoporosis: Pharmacologic Therapy.
Use of Internal Mammary Artery (IMA) in Coronary Artery Bypass Graft (CABG) Surgery.
Preoperative Beta-blocker in Patients with Isolated Coronary Artery Bypass Graft (CABG) Surgery.
Perioperative Care: Discontinuation of Prophylactic Antibiotics (Cardiac Procedures).
Appropriate Treatment for Children with Upper Respiratory Infection (URI).
Appropriate Testing for Children with Pharyngitis.
Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow.
Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy.
Multiple Myeloma: Treatment with Bisphosphonates.
Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry.
Hormonal Therapy for Stage IC–III ER/PR Positive Breast Cancer.
Chemotherapy for Stage III Colon Cancer Patients.
Plan for Chemotherapy Documented Before Chemotherapy Administered.
Radiation Therapy Recommended for Invasive Breast Cancer Patients Who Have Undergone Breast Conserving Surgery.
Advance Care Plan.
Please note that measures (ii) AMA–PCPI Measures would be practical, their importance in
specifications for 2007 PQRI measures relation to quality goals, their
may be updated or modified during the We propose to include measures in meaningfulness as measures of quality,
NQF endorsement process or may the final 2008 PQRI selected from those their utility in the PQRI program such
otherwise be modified prior to 2008. listed in Table 17 that are currently as through augmenting the scope of
The 2008 PQRI measure specifications under development via the AMA– services provided by eligible
for any given measure may, therefore, be Physicians Consortium for Performance practitioners to which PQRI measures
different from specifications for the Improvement (PCPI) provided that they
apply, the degree to which they meet
same measure used for 2007. All achieve NQF endorsement or AQA
the needs of the Medicare program, and
specifications for 2008 measures must adoption by November 15, 2007. We
their functionality in terms of their
be obtained from the specifications propose to select from among these
ability to be collected and calculated in
document for 2008 measures, which measures based upon development

completion in a sufficiently timely the PQRI program.
will be available on the CMS PQRI Web
site on or before December 31, 2007. manner that implementation for 2008
TABLE 17.—AMA/PCPI MEASURES
Prevention of Ventilator-Associated Pneumonia—Head elevation.
TABLE 17.—AMA/PCPI MEASURES—Continued

Stress Ulcer Disease (SUD) Prophylaxis in Ventilated patients.
Prevention of Catheter-Related Bloodstream Infections in Ventilated patients—Catheter Insertion Protocol.
Perioperative Temperature Management for Surgical Procedures Under General Anesthesia.
Assessment of Thromboembolic Risk Factors in patients with Atrial Fibrillation.
Chronic Anticoagulation in patients with Atrial Fibrillation.
Monthly INR Measurements in patients with Atrial Fibrillation.
GFR Calculation in patients with Chronic Kidney Disease (CKD).
Blood Pressure Measurement in patients with CKD.
Plan of Care for patients with CKD and Elevated Blood Pressure.
ACE Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy in patients with CKD.
Calcium, Phosphorus and Intact Parathyroid Hormone Measurement in patients with CKD.
Lipid Profile in patients with CKD.
Hemoglobin Monitoring in patients with CKD.
Erythropoietin Overuse in patients with CKD and normal Hemoglobin.
Influenza Vaccination in patients with End Stage Renal Disease (ESRD).
Vascular Access for patients Undergoing Hemodialysis.
Permanent Catheter Vascular Access for patients Receiving Hemodialysis.
Plan of Care for ESRD patients with Anemia.
Plan of Care for Inadequate Hemodialysis in ESRD patients.
Plan of Care for Inadequate Peritoneal Dialysis.
Assessment of GERD Symptoms in Patients Receiving Chronic Medication for GERD.
Testing of patients with Chronic Hepatitis C (HCV) for Hepatitis C Viremia.
Initial Hepatitis C RNA Testing.
HCV Genotype Testing Prior to Therapy.
Consideration for Antiviral Therapy in HCV Patients.
HCV RNA Testing at Week 12 of Therapy.
Hepatitis A and B Vaccination in patients with HCV.
Counseling patients with HCV Regarding Use of Alcohol.
Counseling of patients Regarding Use of Contraception Prior to Starting Antiviral Therapy.
Patients who have Major Depression Disorder who meet DSM IV Criteria.
Patients who have Major Depression Disorder who are assessed for suicide risks.
Patients with Osteoarthritis who receive Anti-Inflammatory or Analgesia Medication.
Patients with Osteoarthritis who have an assessment of their pain and function.
Patients with Acute Otitis Externa (AOE) or Otitis Media with Effusion (OME) who receive Topical Therapy.
Patients with AOE/OME who have a pain assessment.
Patients with AOE/OME who are inappropriately prescribed antimicrobials.
Patients with AOE/OME who have an assessment of tympanic membrane mobility.
Patients with AOE/OME who undergo hearing testing.
Patients with AOE/OME who inappropriately receive antihistamines/decongestants.
Patients with AOE/OME who inappropriately receive systemic antimicrobials.
Patients with AOE/OME who inappropriately receive systemic steroids.
Breast cancer patients who have a pT and pN category and histologic grade for their cancer.
Colorectal cancer patients who have a pT and pN category and histologic grade for their cancer.
Documentation of hydration status in Pediatric Patients with Acute Gastroenteritis (PAG).
Weight measurement in patients with PAG.
Recommendation of appropriate oral rehydration solution in PAG patients.
Education parents of PAG patients.
Perioperative Cardiac risk assessment (history).
Perioperative Cardiac risk assessment (current symptoms).
Perioperative Cardiac risk assessment (physical examination).
Perioperative Cardiac risk assessment (electrocardiogram).
Perioperative Cardiac risk assessment (continuation of Beta Blockers).
Appropriate initial evaluation of patients with Prostate Cancer.
Inappropriate use of Bone Scan for staging Low-Risk Prostate Cancer patients.
Review of treatment options in patients with clinically localized Prostate Cancer.
Adjuvant Hormonal therapy for High-risk Prostate Cancer patients.
Three-dimensional radiotherapy for patients with Prostate Cancer
(iii) Nonphysician Measures Currently select from among these measures based Medicare program and their
Under Development upon: Development completion in a functionality in terms of ability to be
sufficiently timely manner that collected and calculated in the PQRI
We propose to include measures in implementation for 2008 would be program.
the final 2008 PQRI quality measures practical; their importance in relation to
selected from those listed in Table 18 TABLE 18.—QUALITY INSIGHTS OF
quality goals; their meaningfulness as
that are currently under development by PENNSYLVANIA NONPHYSICIAN

measures of quality; their utility in the
Quality Insights of Pennsylvania (under MEASURES
PQRI program such as through
the Medicare Quality Improvement
augmenting the scope of services
Organization (QIO) contract for the State Universal Weight Screening (BMI).
of Pennsylvania) and that achieve NQF provided by eligible professionals to
Universal Weight Screening Follow-up (BMI).
endorsement or AQA adoption by which PQRI measures apply; the degree
Universal Hypertension Screening.
November 15, 2007. We propose to to which they meet the needs of the Universal Hypertension Screening Follow-up.
TABLE 18.—QUALITY INSIGHTS OF TABLE 19.—QUALITY INSIGHTS OF TABLE 20.—ADDITIONAL AQA

PENNSYLVANIA NONPHYSICIAN PENNSYLVANIA STRUCTURAL MEAS- STARTER-SET MEASURES
MEASURES—Continued URES
Dilated eye exam in diabetic patient.
Universal Influenza Vaccine Screening and Beta-Blocker Therapy (persistent for 6
HIT—Adoption/Use of E-Prescribing
Counseling. months or more)—Post MI.
Universal Documentation and Verification of HIT—Adoption/Use of Health Information
Technology (Electronic Health Records) Screening Mammography.
Current Medications in the Medical Record. Colorectal Cancer Screening.
Screening for Clinical Depression. Inquiry regarding Tobacco Use.
Screening for Cognitive Impairment. (v) Additional AQA Starter-Set Advising Smokers to Quit.
Patient Co-development of Treatment Plan. Measures
Patient Co-development of Plan of Care. (vi) Other NQF-Endorsed Measures
Pain Assessment Prior to Initiation of Patient We propose to include measures in
Treatment. the final 2008 PQRI measures selected We propose to include in the final
from the AQA starter set that were not 2008 PQRI measures other measures
(iv) Structural Measures Currently included in the 2007 PQRI quality endorsed by the NQF that were not
Under Development measures but that are relevant to included in the 2007 PQRI quality
Medicare beneficiaries. Specifications measures but that are relevant to
We propose to include measures in necessary for PQRI reporting of these Medicare beneficiaries, address overuse/
the final 2008 PQRI measures selected measures will be completed for such misuse of pharmacologic therapy, and
from the structural measures listed in measures by November 15, 2007, and that expand the specialty applicability
Table 19 that are currently under and patient population. Specifications
posted on the CMS Web site. Each of the
development by Quality Insights of necessary for PQRI reporting of these
AQA starter-set measures that is
Pennsylvania (under the Medicare QIO measures will be completed for such
identified in Table 20 we propose to
contract for the State of Pennsylvania) measures by November 15, 2007, and
and that achieve NQF endorsement or include in the 2008 PQRI quality posted on the CMS Web site. We
AQA adoption by November 15, 2007. measures provided it retains NQF propose to include in the 2008 PQRI
These measures meet the requirement of endorsement and AQA adoption as of quality measures each of the NQF-
section 1848 (k)(2)(B)(i) of the Act that November 15, 2007. endorsed measures identified in Table
the quality reporting system for 2008 21 provided it retains NQF endorsement
include structural measures. as of November 15, 2007.
TABLE 21.—OTHER NQF-ENDORSED MEASURES

Inappropriate antibiotic treatment for adults with acute bronchitis.
Disease Modifying Anti-rheumatic Drug Therapy in Rheumatoid Arthritis.
Angiotensin Converting Enzyme Inhibitor (ACE) or Angiotensin Receptor Blocker (ARB) Therapy for patients with coronary artery disease and
diabetes and/or left ventricular systolic dysfunction (LSVD).
Urine screening for microalbumin or medical attention for nephropathy in diabetic patients.
Annual Therapeutic monitoring for patients on the following persistent medications:
• Angiotensin Converting Enzyme Inhibitor (ACE)/Angiotensis Receptor Blocker (ARB);
• Digoxin;
• Diuretics;
• Anticonvulsants; and
• Statins.
Influenza vaccination for patients ≥ 50 years old.
Pneumonia vaccination for patients 65 years and older.
(vii) Podiatric Measures TABLE 22.—PODIATRIC MEASURES— on quality measures through an

Continued appropriate medical registry’’.
We propose to include measures in
A medical registry, which is also often
the final 2008 PQRI quality measures Diabetic Foot and Ankle Care, Peripheral Ar-
referred to as a ‘‘clinical registry’’ or
selected from those listed in Table 22 terial Disease: Ankle Brachial Index (ABI)
Measurement. ‘‘clinical data registry’’, henceforth
that are currently under development by ‘‘registry’’, may be broadly defined as a
the American Podiatric Medical Diabetic Foot and Ankle Care, Ulcer Preven-
tion: Evaluation of Footwear. file of documents containing uniform
Association and that achieve NQF information about a defined population
endorsement or AQA adoption by of individual persons or events,
d. Addressing a Mechanism for
November 15, 2007. We propose to collected using an observational study
Submission of Data on Quality Measures
select from among these measures based Via a Medical Registry or Electronic design in a systematic way, in order to
upon development completion of the Health Record serve a predetermined scientific,
measures in a sufficiently timely clinical, or policy purpose. It is
manner that implementation for 2008 Section 1848(k)(4) of the Act, as generally agreed that clinical data
would be practical. amended by the MIEA–TRHCA, requires registries are one potential means to
that ‘‘as part of the publication of measure and report physician and other
TABLE 22.—PODIATRIC MEASURES proposed and final quality measures for eligible professionals’ performance for
2008 under clauses (i) and (iii) of purposes of quality improvement,
Diabetic Foot and Ankle Care, Peripheral paragraph (2)(B), the Secretary shall public reporting, quality based payment,
Neuropathy: Neurological Evaluation. address a mechanism whereby an continuous certification, and
eligible professional may provide data credentialing. Other possible uses of
data collected by a registry include registry, acting as such a data Option 3: Registries calculate the
satisfying requirements for maintenance submission vendor, would submit data reporting and performance rates for
of professional or specialty board to the CMS clinical data warehouse Medicare beneficiaries only, and submit
certification status, and ongoing component of the Quality Reporting these rates to CMS (that is, aggregate
improvement of professional System, using a CMS-specified record information by NPI within a Tax ID). We
performance. layout based on the quality measures’ assume no beneficiary-level information
The MIEA–TRHCA lists the Society of specifications as published by CMS. For will be shared. Registries would be
Thoracic Surgeons (STS) National purposes of this proposed rule, the term, required to add data elements to the
Database registry as an example of a ‘‘CMS clinical data warehouse,’’ is database to allow collection of
registry. The STS registry collects defined as a clinical data warehouse appropriate quality-data codes or
outcomes and quality data on cardiac designated by CMS. clinical data needed to compute the
surgeries. The data output provides an For 2008, we expect to explore at least quality-data codes. Registries would be
analysis of the participant’s adult the five different data submission required to perform the necessary
cardiac surgery outcomes, resulting in a options described below, and to test in calculations to be able to submit
benchmarking of each participant’s data CY 2008 one or more of these options. completed numerator/denominators for
against regional and national outcomes. There are several data formats and both reporting and performance rates.
The STS registry currently collects data analytical options that we see as Option 4: Registries provide all of the
on two PQRI quality measures that have potentially available to fulfill the claims data elements as submitted using
been adapted from existing STS objectives of registry inclusion in PQRI. the Part B claims process. We perform
measures. These two measures are: Use These options vary with regard to all rate calculations.
of Internal Mammary Artery (IMA) in whether individual beneficiary-level Examples of data elements needed
Coronary Artery Bypass Graft (CABG) data is submitted by the registry, as well from a registry include the following:
Surgery; and Pre-operative Beta-blocker as to the number and type of data • Line Item TIN
in Patient with Isolated Coronary Artery elements needed from the registry. • Line Item Individual NPI
Bypass Graft (CABG) Surgery. Option 1: Registries provide the • Line Item Group NPI
To be eligible for the incentive quality-data codes required for a • Claim Beneficiary Claim Account
payment under MIEA–TRHCA, cardiac particular PQRI measure plus Number (CAN)
and thoracic surgeons who report data • Claim Beneficiary Identification
beneficiary/service identifier
to the STS registry will in 2007 and Code (BIC)
information needed to link the registry
2008 still find it necessary under PQRI • Claim Date of Birth
data to Medicare Part B claims. The • Line Item First Expense Date
to report quality data with reference to
beneficiary/service identifiers would be • Line Item Last Expense Date
those same measures through the claims
used to pull in the denominator data by • Line Item Diagnosis Code
process. To avoid duplication of data
CMS. All non-registry analytics • Line Item HCPCS (HCPCS Level 1,
submission and to support the use of
payment information and diagnosis CPT Category I, CPT Category II, HCPCS
registries, generally, we believe that it
would come from claims. Reporting/ Level 2 G Codes)
would be desirable to establish a
mechanism whereby the quality data
performing rates would be calculated • Line Item Initial Modifier Code
relevant to PQRI measures could be
from the registry-submitted data. • Line Item Secondary Modifier Code
reported from the registries, on behalf of Examples of data elements needed • Claim CMS Claims Processing Date
eligible professionals. from a registry are: • Claim Overall Allowable Charges
At this point, it is unclear which • Beneficiary HIC Number • Line Item Allowable Charges
• Beneficiary Date of Birth • Claim Gender
registries currently collect or plan to
• Date of Service • Claim Carrier Number
collect data for PRQI quality measures • Claim Control Number
and which approach or approaches • NPI and Tax ID
• CPT category II and G codes and • Claim Final Action Status
should be utilized to allow registries to • Claim Carrier Claim Receipt Date
report quality data to PQRI. For this modifiers
• Claim Payment Denial Code
reason, in 2008, we anticipate • Clinical data elements required to • Line Item Procedure Indicator Code
evaluating and testing the mechanisms compute the appropriate CPT category II • Line Item Carrier Locality Code
to use registries for the reporting of codes, G codes and modifiers • Line Item Provider State Code
PQRI quality data. We plan to use the Option 2: Registries provide the • Line Item Place of Service
results of this evaluation and testing to quality codes and diagnosis codes. We • Line Processing Indicator Code
determine whether and how to would use claims to capture the Option 5: Registry data dump for
implement the use of registries for the payment information at the NPI/Tax ID Medicare beneficiaries only; for all
reporting of quality data in the future. level. The beneficiary-specific information in the registry for the
In concept, we anticipate that upon information is de-identified. All PQRI service period of interest. There is an
implementation of registry-based quality reporting and performance calculations assumption that the registry is able to
data reporting, eligible professionals would be performed using registry data. submit either: (1) the ICD–9, HCPCS,
would be able to provide data on PQRI Payment information would be and CPT category II codes and
quality measures through an appropriate extracted from Medicare claims. The exclusions as stated in the measures
medical registry by authorizing or registries would be required to add data specifications; or (2) supply the clinical
instructing the registry to submit data elements to the database to allow information needed for CMS to make
on their behalf. Thus, the registry would collection of appropriate codes. those judgments (eligibility and quality
act as a data submission vendor for the Examples of data elements needed of care). We would be required to use
eligible professional. A ‘‘data from a registry: a series of linkage algorithms to attempt
submission vendor’’ is defined as an • Beneficiary/procedure level data to connect the registry data with the
entity that has permission from the (ICD–9 and CPT codes) matching claims.
eligible professional to provide medical • HCPCS codes (G-codes and CPT Examples for linkage of registry data
registry data to the Quality Reporting category II codes and modifiers) to the corresponding Medicare Part B
System developed per the statute. The • NPI and Tax ID claims include some combination of:
• Beneficiary-level identifiers: HIC (or or may need to be limited to some or all marrow suppression.’’ Anemia may also
SSN), DOB, gender of those that already contain key result from blood loss in association
• Procedure-level identifiers: date of minimum data elements on at least a with surgical therapy for the cancer.
service (or procedure date) test basis, depending on the number of Anemia adversely impacts the quality
• Provider identifiers: NPI, Tax ID, or registries falling into these categories of life for beneficiaries being treated for
even UPIN and on the actual level of complexity cancer. Fatigue and reduced
For CMS to maintain compliance with and effort required for the testing from performance capacity are the side effects
applicable statutes, including but not the CMS data infrastructure. of anemia that cancer patients report as
limited to HIPAA, the registry must (Experience with other initiatives has the most disabling and contributing to
maintain compliance with HIPAA suggested that some data submission poor quality of life. The treatment of
requirements for processing, storing, vendors and their software are more anemia in cancer patients commonly
and transmitting data. To be considered easily interfaced and tested with the includes the use of drugs, specifically
an appropriate registry from which we CMS data warehouse EDI than others.) erythropoiesis stimulating agents (ESAs)
can accept and process data for the We invite comments on these plans such as recombinant erythropoietin and
purposes of calculating PQRI measures, for evaluation and testing mechanisms darbepoietin. Although other
a registry must also comply with the for registry-based quality-data reporting pharmacologic interventions are
Consolidated Health Informatics to PQRI with reference to the 5 data available, ESAs have received the
Initiative (CHI) standards adopted by submission options described. We also greatest attention. Notably, recent
the Federal government, and therefore, invite comments on appropriate research has raised concerns that these
applicable to the HHS. A description of validation methodologies for reporting drugs may be associated with significant
the CHI, including its purpose, Federal and performance rates. adverse effects including a higher risk of
member agencies, and the specific In addition to the testing of registry- mortality in some populations, possibly
standards adopted by the Federal based submission of quality data, CMS related to the amount of drug
government, is available on the HHS is considering for 2008 the feasibility administered.
Office of the National Coordinator for and utility of accepting clinical quality
Health Information Technology (ONC) In 2006, we implemented a revised
data submitted from EHRs. For 2008, we
Web site at http://www.hhs.gov/ ESA claims monitoring policy based on
plan to consider accepting EHR-
healthit/chiinitiative.html. the last hemoglobin or hematocrit value
extracted clinical data for a limited
Upon determination of the preferred from the preceding month on Medicare
number of ambulatory-care PQRI
option and conclusion of the testing claims for payment of ESAs
measures for which data may also be
phase for registry-based reporting to administered to beneficiaries with
submitted under the current Doctors
PQRI, we anticipate that all necessary anemia due to ESRD receiving dialysis
Office Quality–Information Technology
information and instructions will be (DOQ–IT) Project. The listing of and treatments in facilities. For many years
made available on the PQRI section of specifications for DOQ–IT ambulatory- prior, we have required the reporting of
the CMS Web site at http:// care measures are available at http:// these red blood cell indicators by ESRD
www.cms.hhs.gov/pqri. This www.qualitynet.org, under the facilities to ensure that the beneficiaries’
information will include at a minimum: subsidiary headings Physician Offices, anemia was addressed.
(a) The exact data elements needed and Doctors Office Quality Information Section 110 of the MIEA–TRHCA
the CMS-specified record layout for Technology (DOQ–IT), Ambulatory-Care amends section 1842 of the Act by
transmitting the data to the CMS clinical Measures. If implemented in 2008, the adding a new subsection (u) that reads
data warehouse; and (b) a detailed EHR-based submission of PQRI/DOQ–IT as follows: ‘‘Each request for payment,
description of the proposed CMS overlapping ambulatory-care measures or bill submitted, for a drug furnished
infrastructure for accepting registry- would serve as an alternative method to to an individual for the treatment of
based submission of PQRI quality data, claims-based reporting of submitting anemia in connection with the
including, but not limited to, electronic quality data for those measures, not a treatment of cancer shall include (in a
data exchange specifications, and required method. form and manner specified by the
applicable processes for authenticating Secretary) information on the
registry users for access to the 2. Section 110—Reporting of Anemia hemoglobin or hematocrit levels for the
warehouse submission interface. Quality Indicators (§ 414.707(b)) individual.’’ Section 110 of the MIEA–
We anticipate requesting that [If you choose to comment on issues TRHCA requires such reporting for
registries interested in participating in in this section, please include the drugs furnished on or after January 1,
the testing of the registry-based quality caption ‘‘TRHCA—SECTION 110: 2008. In addition, subsection (b) directs
data submission mechanism will be ANEMIA QUALITY INDICATORS’’ at the Secretary to use the rulemaking
invited to self-nominate via a simple the beginning of your comments.] process under section 1848 of the Act to
process that will be published on the Medicare Part B provides payment for address the implementation of this
PQRI section of the CMS Web site, and certain drugs used to treat anemia. requirement.
via one or more additional CMS Anemia is common in cancer patients By requiring the reporting of the
communication venues, in the fourth and may be caused by the cancer itself anemia quality indicators in cancer
quarter of 2007. We propose and expect or by various anti-cancer treatments, patients undergoing treatment for
to begin testing with the registries in the including chemotherapy, radiation anemia, we will facilitate assessment of
first quarter of 2008. therapy and surgical therapy. Anemia the quality of care for this condition. We
We plan to select for testing, from the occurs when the number of red blood will use the information reported to
self nominees, a group of registries that cells is reduced by an anti-cancer help determine the prevalence and
are HIPAA and CHI compliant and treatment. This happens due to the severity of anemia associated with
technically capable of interfacing with effect of chemotherapy or radiation cancer therapy, the clinical and
the CMS clinical warehouse electronic therapy on the bone marrow, wherein hematologic responses to the institution
data exchange interface (EDI). The red blood cells are produced by dividing of anti-anemia therapy, and the
number of registries selected for testing precursor cells. This chemotherapy outcomes associated with various doses
may be all that are technically capable effect is commonly referred to as ‘‘bone of anti-anemia therapy.
While not specifically addressing In the CY 2007 PFS final rule with $10, it is rounded to the nearest
other indications, the recent research on comment period (71 FR 69700), we multiple of $10).
the adverse effects of ESAs in patients announced that beginning January 1, Section 5107(a) of the DRA required
with cancer does raise concerns as to 2007, we would no longer allow the the Secretary to develop an exceptions
whether patients receiving ESAs for carriers to pay the independent process for the therapy caps effective for
other conditions, such as in the laboratory for the TC of physician expenses incurred during CY 2006.
treatment of HIV–AIDS and for some pathology services to hospital patients. Details of the CY 2006 exceptions
surgical patients, are also at higher risk. In effect, we would be implementing the process were published in a manual
While not required by this statute, we provisions of the CY 2000 PFS final rule change on February 13, 2006 (CR4364
are requesting public comment on the whose implementation had been consists of Transmittal 855, Transmittal
potential of expanding this regulation to delayed by section 542 of the Medicare, 47, and Transmittal 140). Section 201 of
include all uses of ESAs. Medicaid, and SCHIP Benefits the MIEA–TRHCA extended the
Improvement and Protection Act of exceptions process to apply for
3. Section 104—Extension of Treatment
of Certain Physician Pathology Services 2000 (Pub. L. 106–554) (BIPA) and expenses incurred through December
Under Medicare section 732 of the MMA. 31, 2007. Therapy cap exception
Subsequent to publication of the CY policies for 2007 were specified in
[If you choose to comment on issues 2007 PFS final rule with comment Change Request 5478 which consists of
in this section, please include the period, the MIEA–TRHCA was enacted. three transmittals with current numbers
caption ‘‘TRHCA—SECTION 104: Section 104 of the MIEA–TRHCA of—
PHYSICIAN PATHOLOGY SERVICES’’ provided for an additional 1 year • Transmittal 1145CP, Pub. 100–04;
at the beginning of your comments.] extension to allow carriers to continue • Transmittal 63BP, Pub. 100–02; and
The TC of physician pathology
to pay independent laboratories under • Transmittal 181PI, Pub. 100–08.
services refers to the preparation of the The transmittals are incorporated into
the PFS for the TC portion of physician
slide involving tissue or cells that a the Internet Only Manuals available at
pathologist will interpret. (In contrast, pathology services furnished to patients
http://www.cms.hhs.gov/Manuals and
the pathologist’s interpretation of the of a covered hospital.
are also available on our Web site at
slide is the PC service. If this service is Consistent with this legislative change http://www.cms.hhs.gov/Transmittals/.
furnished by the hospital pathologist for we are amending § 415.130(d) to reflect In accordance with the statute as
a hospital patient, it is separately that for services furnished after amended by the MIEA–TRHCA, we will
billable. If the independent laboratory’s December 31, 2007, an independent continue to implement therapy caps, but
pathologist furnishes the PC service, it laboratory may not bill the carrier for the exceptions process will no longer be
is usually billed with the TC service as physician pathology services furnished applicable, for expenses incurred
a combined service.) to a hospital inpatient or outpatient. beginning on January 1, 2008. The
In the CY 2000 PFS final rule, we 4. Section 201—Extension of Therapy dollar amount of the therapy caps in CY
stated that we would implement a Cap Exception Process 2008 will be the CY 2007 rate ($1,780)
policy to pay only the hospital for the increased by the percentage increase in
TC of physician pathology services [If you choose to comment on issues the MEI.
furnished to hospital patients. Before in this section, please include the As noted previously in this section,
that provision, any independent caption ‘‘TRHCA—SECTION 201: under current law therapy caps will
laboratory could bill the carrier under THERAPY CAPS’’ at the beginning of continue to apply to expenses incurred
the PFS for the TC of physician your comments.] for therapy services after December 31,
pathology services for hospital patients. Section 1833(g)(1) of the Act applies 2007, with one exception. That is, the
As stated in the CY 2000 PFS final rule, an annual per beneficiary combined cap therapy caps will remain inapplicable to
this policy has contributed to the beginning January 1, 1999, on outpatient expenses incurred for therapy services
Medicare program paying twice for the physical therapy and speech-language furnished in the outpatient hospital
TC service, first through the inpatient pathology services, and a similar setting as provided in section 1833(g) of
prospective payment rate to the hospital separate cap on outpatient occupational the Act.
where the patient is an inpatient and therapy services. These caps apply to
again to the independent laboratory that expenses incurred for the respective 5. Section 101(d)—Physician Assistance
bills the carrier, instead of the hospital, therapy services under Medicare Part B, and Quality Initiative (PAQI) Fund
for the TC service. with the exception of outpatient [If you choose to comment on issues
Therefore, in the CY 2000 PFS final hospital services. The caps were in this section, please include the
rule, in § 415.130 we specified that for implemented from January 1, 1999 caption ‘‘TRHCA—SECTION 101(d):
services furnished on or after January 1, through December 31, 1999, from PAQI’’ at the beginning of your
2001, the carriers would no longer pay September 1, 2003 through December 7, comments.]
claims to the independent laboratory 2003, and beginning January 1, 2006 Section 1848(1) of the Act, as added
under the PFS for the TC of physician (with an exception process). In CY 2000 by section 101(d) of the MIEA–TRHCA
pathology services for hospital patients. through CY 2002, and from December 8, requires the Secretary to establish a
Ordinarily, the provisions in the PFS 2003 through December 31, 2005, the Physician Assistance and Quality
final rule are implemented in the Congress placed moratoria on Initiative Fund (PAQI) which shall be
following year. However, in this case, implementation of the caps. Section available for physician payment and
the change to § 415.130 was delayed one 1833(g)(2) of the Act provides that, for quality improvement initiatives, which
year (until January 1, 2001), at the CY 1999 through CY 2001, the caps may include application of an
request of the industry, to allow were $1500, and for the calendar years adjustment to the update of the PFS CF.
independent laboratories and hospitals after 2001, the caps are equal to the The provision makes available $1.35
sufficient time to negotiate preceding year’s cap increased by the billion to the Fund for services
arrangements. Moreover, our full percentage increase in the Medicare furnished during 2008. Specifically, the
implementation of § 415.130 was further Economic Index (MEI) (except that if an provision directs the Secretary to
delayed through CY 2006. increase for a year is not a multiple of provide for expenditures from the Fund
in a manner designed to provide (to the to 2007, we propose that physicians year. While we estimate that the $1.35
maximum extent feasible) for the could report applicable measures for billion would reduce the negative
obligation of the entire $1.35 billion for services furnished from January 1, 2008 update by approximately two
payment for physicians’ services through December 31, 2008, and percentage points, actual spending
furnished during CY 2008. The allowed charges during such period could be above or below the estimate.
provision also requires that if would be the basis for calculating the To insure that we do not exceed the
expenditures from the Fund are applied bonus payments. We propose that the Fund amount, we would have to
to, or otherwise affect, a conversion 2008 measures that we finalize in the estimate an amount to reduce the
factor for a year, the conversion factor PFS final rule would apply for 2008. We update by that is low enough to ensure
for a subsequent year shall be computed also propose to estimate all of the bonus
the $1.35 billion funding cap is not
as if the adjustment to the conversion payments that would be payable to
exceeded. While this approach might
factor had never occurred. physicians using the same method as
As the legislation indicates, this Fund the one used for reporting during 2007 reduce the 2008 negative update, it
can be used to either buy down the and to calculate the amount of the could still leave money in the Fund, and
negative update to the fee schedule or bonus payment, after the close of 2008 we would be faced with the same
for quality improvement initiatives. We reporting period. Given that we are problem of how to spend such
believe it is essential that Medicare proposing to use the PAQI Fund for the remaining funds in the future.
continue to encourage improvement in 2008 PQRI program, we also propose Therefore, as previously stated, we
the efficiency and quality of health care that the bonus payments to individual believe the best use of the Fund is to
delivered to Medicare beneficiaries. physicians be subject to an aggregate apply it to extend PQRI into 2008.
Therefore, we are proposing that the cap of $1.35 billion. Because we are
$1.35 billion be used to fund bonus 6. Section 108—Payment Process Under
proposing to scale aggregate payments
payments to be made during 2009 for to physicians in a manner such that the Competitive Acquisition Program
physician reporting of measures during Medicare would pay $1.35 billion (CAP)
2008. Specifically, we propose that the during 2009 for measures reported for [If you choose to comment on issues
physician quality initiative for 2008 be services furnished during 2008, we are in this section, please include the
structured and implemented in the same unable to provide an exact percentage caption ‘‘TRHCA—SECTION 108: CAP’’
manner as the 2007 PQRI with regard to for the bonus payment at this time.
the professionals eligible to participate at the beginning of your comments.]
However, we anticipate that the bonus
in the program, reporting quality payments will be approximately 1.5 Section 108 of the MIEA–TRHCA
measures via claims submission, and percent of allowed charges for made changes to the CAP Payment
the standards for satisfactory reporting. participating professionals (and we do methodology. Section 108(a)(1) of the
If, as discussed in section II.T.1 of this not expect that the ultimate percentage MIEA–TRHCA amended section
proposed rule, we determine that a amount will exceed 2 percent). 1847B(a)(3)(A)(iii) of the Act by adding
quality measure reporting mechanism Medicare payment systems need to new language which requires that
based on EHRs can be effectively encourage reliable, high quality and payment for drugs and biologicals shall
implemented in 2008, we would plan to efficient care, rather than making be made upon receipt of a claim for a
also offer eligible professionals the payment simply based on the quantity drug or biological supplied for
option of reporting quality measures via of services provided and resources administration to a beneficiary.
such EHR-based mechanism based in consumed. This approach allows CMS
lieu of claims-based reporting. If the to fully expend the $1.35 billion fund Section 108(a)(2) of the MIEA–
EHR-based reporting mechanism is and further the goal of improving TRHCA required the Secretary to
implemented for 2008, we would expect quality and efficiency by utilizing the establish (by program instruction or
to apply to professionals opting to infrastructure that both physicians and otherwise) a post-payment review
report via that mechanism the same Medicare have invested in for the 2007 process (which may include the use of
standards for satisfactory reporting as PQRI. We believe implementing this statistical sampling) to assure that
are applicable to professionals reporting Fund through an extension of the PQRI payment is made for a drug or biological
quality measures via claims. program is the best way to ensure only if the drug or biological has been
The differences between 2007 and physicians get the greatest benefit from administered to a beneficiary. The
2008 that we currently anticipate are the Fund’s resources while ensuring Secretary shall recoup, offset, or collect
noted below in this section. As we that the Fund is being used to increase any overpayments determined by the
monitor the implementation of the 2007 quality and efficiency of care for Secretary under this process.
PQRI and possibly make refinements to Medicare beneficiaries.
the 2007 program, we anticipate that We recognize that there is an Section 108(b) of the MIEA–TRHCA,
such refinements would also apply alternative approach to using this fund. Construction, states that nothing in this
under the 2008 program. Such That is, the $1.35 billion could be used section shall be construed as requiring
refinements, should they be needed, in some manner to reduce the update to the conduct of any additional
will be noted with guidance linked from the PFS of ¥9.9 percent that is competition under section 1847B(b)(1)
the CMS quality reporting Web site at projected for 2008. However, there are of the Act; or requiring an additional
http://www.cms.hhs.gov/PQRI/ fundamental legal and operational physician election process.
01_Overview.asp#TopOfPage. problems with this approach that make Section 108(c) of the MIEA–TRHCA
As with the 2007 PQRI, we are it not feasible. The $1.35 billion is a states that the amendments of this
proposing that eligible professionals fixed dollar amount. Once the amount is section apply to payments for drugs and
who successfully report a designated set reached, there is no authority to pay any biologicals supplied (1) on or after April
of quality measures in 2008 may earn a more than that amount. Medicare is an
1, 2007, and (2) on or after July 1, 2006
bonus payment of a percentage of total entitlement program that covers
and before April 1, 2007, for claims that
allowed charges for covered Medicare medically necessary services for eligible
services, subject to a cap based on the beneficiaries, but such coverage is not are unpaid as of April 1, 2007.
volume of quality reporting. In contrast limited to a fixed dollar amount for a
III. Fee Schedule for Payment of 2. Medicare Regulations for Ambulance the transition period, the ambulance
Ambulance Services Update for CY Services inflation factor (AIF) was applied
2007; Ambulance Inflation Factor Our regulations relating to ambulance separately to both the fee schedule
Update for CY 2008; and Proposed services are set forth at 42 CFR part 410, portion of the blended payment amount
Revisions to the Publication of the subpart B and 42 CFR part 414, subpart (regardless of whether a national or
Ambulance Fee Schedule (§ 414.620) regional fee schedule applied) and to
H. Section 410.10(i) lists ambulance
[If you choose to comment on issues the supplier’s reasonable charge or
services as one of the covered medical
in this section, please include the provider’s reasonable cost portion of the
and other health services under
caption ‘‘AMBULANCE SERVICES’’ at blended payment amount, respectively,
Medicare Part B. Therefore, ambulance
for each ambulance provider or
the beginning of your comments.] services are subject to basic conditions
Under the ambulance fee schedule, supplier. Then, the two amounts were
and limitations set forth at § 410.12 and
the Medicare program pays for added together to determine the total
to specific conditions and limitations as
transportation services for Medicare payment amount for each provider or
specified in § 410.40. Part 414, subpart
supplier.
beneficiaries when other means of H, describes how payment is made for
transportation are contraindicated. ambulance services covered by C. Ambulance Inflation Factor (AIF) for
Ambulance services are classified into Medicare. CY 2008
different levels of ground (including Section 1834(l)(3)(B) of the Act
water) and air ambulance services based 3. Transition to National Fee Schedule
provides the basis for updating payment
on the medically necessary treatment The national fee schedule for amounts for ambulance services.
provided during transport. These ambulance services was phased in over Section 414.610(f) specifies that certain
services include the following levels of a 5-year transitional period beginning components of the ambulance fee
service: April 1, 2002, as specified in § 414.615. schedule are updated by the AIF
For Ground— As of January 1, 2006, the total payment annually, based on the consumer price
• Basic Life Support (BLS) amount for air ambulance providers and index for all urban consumers (CPI-U)
• Advanced Life Support, Level 1 suppliers is based on 100 percent of the (U.S. city average) for the 12-month
(ALS1) national ambulance fee schedule. In period ending with June of the previous
• Advanced Life Support, Level 2 accordance with section 414 of the year. At this time, the CPI-U for the 12-
(ALS2) MMA, we added § 414.617 which month period ending with June 2007 is
• Specialty Care Transport (SCT) specifies that for ambulance services not available. We will announce the AIF
• Paramedic ALS Intercept (PI) furnished during the period July 1, for CY 2008 in the final rule which will
For Air— 2004, through December 31, 2009, the be published in the Federal Register
• Fixed Wing Air Ambulance (FW) ground ambulance base rate is subject to later this year. In addition, as set forth
• Rotary Wing Air Ambulance (RW) a floor amount, which is determined by in Section III.D., we propose to
A. History of Medicare Ambulance establishing nine fee schedules based on announce the AIF for CY 2009 and
Services each of the nine census divisions and subsequent years via CMS instruction
using the same methodology as was and on the CMS Web site.
1. Statutory Coverage of Ambulance used to establish the national fee
Services schedule. If the regional fee schedule D. Proposed Revisions to the Publication
Under sections 1834(l) and 1861(s)(7) methodology for a given census division of the Ambulance Fee Schedule
of the Act, Medicare Part B covers and results in an amount that is lower than (§ 414.620)
pays for ambulance services, to the or equal to the national ground base Currently, section 414.620 specifies
extent prescribed in regulations, when rate, then it is not used, and the national that changes in payment rates resulting
the use of other methods of fee schedule amount applies for all from incorporation of the AIF will be
transportation would be contraindicated providers and suppliers in the census announced by notice in the Federal
by the beneficiary’s medical condition. division. If the regional fee schedule Register without opportunity for prior
The House Ways and Means Committee methodology for a given census division comment. We believe it is unnecessary
and Senate Finance Committee Reports results in an amount that is greater than to undertake notice and comment
that accompanied the 1965 Social the national ground base rate, then the rulemaking to update the AIF because
Security Amendments suggest that the fee schedule portion of the base rate for the statute and regulations specify the
Congress intended that— that census division is equal to a blend methods of computation of annual
• The ambulance benefit cover of the national rate and the regional rate inflation updates, and we have no
transportation services only if other through CY 2009. Thus, as of January 1, discretion in that matter. Thus, the
means of transportation are 2007, the total payment amount for annual AIF notice does not change or
contraindicated by the beneficiary’s ground ambulance providers and establish policy, but merely applies the
medical condition; and suppliers is based on either 100 percent update methods specified in the statute
• Only ambulance service to local of the national ambulance fee schedule and regulations.
facilities be covered unless necessary amount, or a combination of 80 percent By mid-July of each year, we have the
services are not available locally, in of the national ambulance fee schedule CPI–U for the 12-month period ending
which case, transportation to the nearest and 20 percent of the regional with June of such year. Therefore, we
facility furnishing those services is ambulance fee schedule. know what the AIF for the upcoming
covered (H.R. Rep. No. 213, 89th Cong., calendar year will be by mid-July of
1st Sess. 37 and Rep. No. 404, 89th B. Ambulance Inflation Factor (AIF) each year. However, the AIF is not
Cong., 1st Sess. Pt 1, 43 (1965)). During the Transition Period published by CMS until November
The reports indicate that As we noted in the previous section, because § 414.620 currently states that
transportation may also be provided the national fee schedule for ambulance the AIF will be announced in the
from one hospital to another, to the services was phased in over a 5-year Federal Register. Each document
beneficiary’s home, or to an extended transition period beginning April 1, published in the Federal Register
care facility. 2002, as specified in § 414.615. During requires scheduling and a thorough
review by CMS, HHS, and OMB prior to enrollment application. In addition, an furnished to treat anemia resulting from
publication. Therefore, even though we IDTF is required to notify its designated the treatment of cancer must report the
know the AIF by mid-July of each year, fee-for-service contractor within 30 days beneficiary’s most recent hemoglobin or
the final rule announcing the AIF is not of any changes in ownership, location, hematocrit level. The burden associated
published until November. This general supervision, and any adverse with this requirement is the time and
publication timeframe does not allow legal actions. The notification must be effort associated with obtaining the most
Medicare contractors the optimal made on the Medicare enrollment recent hemoglobin or hematocrit levels
amount of time to update their systems application. All of the changes to the and documenting it on the request for
so that they can effectuate the proper enrollment application must be reported payment. The requirement and its
payment on Medicare ambulance claims within 90 days. associated burden are not subject to the
timely. In addition, it does not provide The aforementioned requirements are PRA under 5 CFR 1320.3(h)(5). The
an optimal amount of time for either the not new. The burden associated with interpretation of biological analyses of
Medicare contractors or the ambulance completing the Medicare enrollment body fluids, tissues, or other specimens,
industry to take advantage of testing application is currently approved under or the identification or classification of
practices to make sure that the update OMB control number 0938–0685. The such specimens is not subject to the
is working properly as implemented. collection has an expiration date of PRA.
We believe that announcing the AIF via April 30, 2009.
Section 410.33(g)(6) states the Section 414.914 Term of contract
CMS instructions and on the CMS Web
site would enable the AIF to be released comprehensive liability insurance Section 414.914(h) states that the
earlier in the calendar year, allowing the requirements for IDTFs. Specifically, approved CAP vendor must verify drug
Medicare contractors to test their data § 410.33(g)(6)(1) states that must have a administration prior to the collection of
systems, and to timely effectuate and comprehensive insurance policy or any applicable cost sharing amount. As
provide accurate payments on Medicare notify the CMS designated contractor, in part of the verification process,
ambulance claims. writing, of any policy changes or § 414.914(h)(1) through (2) lists the
Therefore, we are proposing to revise cancellations. The burden associated documentation that is required as part
§ 414.620 to state that we will announce with this requirement is the time and of the verification process. Section
the AIF via CMS instruction and on the effort necessary to draft and submit the 414.914(h)(3) states that the approved
CMS Web site and to remove the written notification to the CMS CAP vendor must provide this
language that states that we will designated contractor. While this information to CMS or the beneficiary
announce the AIF by notice in the requirement is subject to the PRA, we upon request.
believe it is exempt from the PRA as The burden associated with the
Federal Register.
stipulated under 5 CFR 1320.3(h)(6). requirements in § 414.914(1) through (3)
IV. Collection of Information This information will be collected on a is the time and effort needed to verify
Requirements case-by-case basis. the drug administration. When
Under the Paperwork Reduction Act Section 410.33(g)(8) requires an IDTF obtaining written verification, the CAP
of 1995, we are required to provide 60- to answer, document, maintain vendor must document the elements
day notice in the Federal Register and documentation of beneficiaries listed in § 414.914(h)(1)(i) though (vi).
solicit public comment before a questions, and responses to beneficiary When obtaining verbal verification, the
collection of information requirement is complaints at the physical site of the CAP vendor must document the
submitted to the Office of Management IDTF. Sections 410.33(g)(8)(i) through elements listed in § 414.914(h)(2)(i)
and Budget (OMB) for review and (iii) list the minimum amount of though (ii). We believe the requirements
approval. To fairly evaluate whether an documentation needed to comply with and their associated burden are not
information collection should be this requirement. The burden associated subject to the PRA; they are part of the
approved by OMB, section 3506(c)(2)(A) with these requirements is the time and CAP vendor’s usual and customary
of the Paperwork Reduction Act of 1995 effort associated with responding to business practices as stipulated under 5
requires that we solicit comment on the beneficiary questions and complaints, CFR 1320.3(h)(5).
documenting the actions taken in In addition, § 414.914(h)(3) imposes
following issues:
• The need for the information response to the questions and both recordkeeping and reporting
collection and its usefulness in carrying complaints, and maintaining the requirements. We believe that the
out the proper functions of our agency. documentation. While this requirement burden associated with the
• The accuracy of our estimate of the is subject to the PRA, we believe the recordkeeping requirement imposed by
information collection burden. associated burden is exempt under 5 § 414.914(h)(3) is not subject to the PRA
• The quality, utility, and clarity of CFR 1320.3(b)(2). The burden associated under 5 CFR 1320.3(c)(4) because it
the information to be collected. with documenting and maintaining the would affect less than 10 persons.
• Recommendations to minimize the documentation of the corrective actions The reporting requirement places
information collection burden on the is a usual and customary business burden on the CAP vendor to provide
affected public, including automated practice. The time, effort, and financial the information listed in § 414.914(h)(1)
collection techniques. resources necessary to comply this through (2) to a beneficiary upon
We are soliciting public comment on information collection requirement request. We estimate that the CAP
each of these issues for the following would be incurred by persons in the vendor will receive 72 requests per year
sections of this document that contain normal course of their activities (for from beneficiaries. We believe it will
information collection requirements. example, in compiling and maintaining take 15 minutes per request for the
business records) is not subject to the vendor to provide this information to

Section 410.33 Independent diagnostic the beneficiary. The total annual burden
PRA.
testing facility associated with this requirement is 1080
Section 410.33(g)(2) states that an Section 414.707 Basis of payment minutes or 18 burden hours. However,
independent diagnostic testing facility Section 414.707(c) states that effective we believe this information collection
(IDTF) should provide complete and January 1, 2008, each request for requirement and the associated burden
accurate information on its Medicare payment for anti-anemia drugs is not subject to the PRA as defined in
5 CFR 1320.3(c)(4) because it would § 424.36(b), (c), or (d) apply. Section 6,500,000. We note that the total
affect less than 10 persons. 424.36(b) states that if the beneficiary is number of burden hours may be
physically or mentally incapable of overstated, because not every
Section 414.930 Compendia for
signing the claim, the claim may be beneficiary who receives emergency
Determination of Medically-Accepted
signed by one of the persons specified ambulance transport services is unable
Indications for Off-Label Uses of Drugs in § 424.36(b)(1) through (5). Proposed to sign the claim. However, we also note
and Biologicals in an Anti-Cancer § 424.36(b)(6) states that, for emergency that the 6.5 million figure for emergency
Chemotherapeutic Regimen ambulance transport services, if certain transports is the estimated number of
Section 414.930(b) states the process conditions and documentation ALS1-emergency and BLS-emergency
for listing compendia for determining requirements are met, an ambulance ambulance claims processed by Part B
medically-accepted uses of drugs and provider or supplier would be permitted carriers, incurred in 2006 and processed
biologicals in anti-cancer treatment. We to sign the claim on behalf of the through April 2007, and thus, does not
will annually solicit requests for beneficiary. Specifically, include the number of emergency
changes to the list of compendia. As § 424.36(b)(6)(ii)(A) through (C) lists the ambulance transport services billed to
stated in § 414.930(c)(1), we will review documentation that would be required, fiscal intermediaries by ambulance
a complete written request that is all of which would have to be providers (this number is not available
submitted in writing, electronically, or maintained by the ambulance provider to us). In any event, we believe our
via hard copy. A complete written or supplier in its files for a period of at proposal will benefit ambulance
request must contain the following least 4 years from the date of service. An providers and suppliers by allowing
information as stated in ambulance provider or supplier would them an alternative procedure for
§ 414.930(c)(1)(i) through (vi): be required to obtain a signed, submitting claims to Medicare. In the
• Full name and contact information contemporaneous statement from an absence of the proposed procedure for
for the requestor; ambulance employee present during signing claims on behalf of beneficiaries
• Full identification of the transport of the patient that, at the time for emergency ambulance transport
compendium in question; the service was provided, the services, ambulance suppliers and
• A complete written copy of the beneficiary was physically or mentally providers would be required to track
compendium in question; incapable of signing the claim and that down beneficiaries after the emergency
• The specific action requested of none of the other qualified persons transport services have been rendered,
CMS; listed in § 424.36(b)(1) through (5) were in an attempt to have the beneficiary
• Supporting documentation for the available or willing to sign the claim on sign the claim. Moreover, such attempts
requested action; behalf of the beneficiary. may prove fruitless, thereby preventing
• Address a single compendium per The ambulance provider or supplier the ambulance suppliers and providers
request. would also be required to maintain
Section 414.930(d) states that for each from submitting the claim to Medicare.
documentation of the date and time that
compendium that is determined by CMS the beneficiary was transported and the Additional Information Collection
to be included on the list, the publisher name and location of the facility that Requirements
or its designee must notify CMS, within received the beneficiary. In addition, the
45 days of any update or revision, that This proposed rule imposes collection
ambulance provider or supplier would
a new edition or version is available. of information requirements as outlined
be required to obtain and maintain a
The burden associated with the in the regulation text and specified
signed contemporaneous statement from
requirements contained in § 414.930(b) above. However, this proposed rule also
a representative of the facility that
through (d) is the time and effort makes reference to several associated
received the beneficiary. The statement
required to draft and submit to CMS a information collections that are not
would have to contain the name of the
complete written request for changes to discussed in the regulation text. The
beneficiary and the date and time the
the list of compendia. In addition, there following is a discussion of these
beneficiary was received at the facility.
is additional time and effort for each The burden associated with the collections, which have already
compendium that is determined by CMS recordkeeping requirements contained received OMB approval.
to be included on the list; the publisher in § 424.36(b)(6) is the time and effort Part B Drug Payment
or its designee must furnish to CMS, associated with drafting, obtaining, and
within 45 days of listing and within 45 maintaining written statements from Section II.F.1 of the preamble of this
days of any update or revision, a written both employees of the ambulance proposed rule discusses payment for
copy of the current edition or version of provider or supplier transporting the Medicare Part B drugs and biologicals
the compendia, including updates. beneficiary and employees of the facility under the ASP methodology. Drug
While these requirements are subject to receiving the beneficiary. We estimate manufacturers are required to submit
the PRA, we believe the burden is that approximately 9,000 ambulance ASP data to us on a quarterly basis. As
exempt under 5 CFR 1320.3(c)(4) providers or suppliers will comply with stated in section II.F.1.a. of the
because it would affect less than 10 these requirements. We estimate that it preamble, the ASP reporting
persons or entities. There are currently will take no more than 5 minutes for requirements are set forth in section
only 6 compendia that could reasonably each provider or supplier to comply 1927(b) of the Act.
be expected to be the subject of a with the recordkeeping requirements. The collection of ASP data imposes a
request, so 6 requests is a likely Based on the best available data at this reporting requirement on the public.
maximum. time, we estimate the total annual The burden associated with this
burden associated with the requirement is the time and effort

Section 424.36 Signature requirements in § 424.36(b)(6) to be required by manufacturers of Medicare
Requirements 541,667 hours nationwide. The annual Part B drugs and biologicals to calculate,
Section 424.36(a) requires the total number of burden hours was record, and submit the required data to
beneficiary’s signature on a claim for arrived at by multiplying 5 minutes by CMS. While the burden associated with
payment of services unless the the total estimated number of this requirement is subject to the PRA,
beneficiary has died or the provisions of emergency ambulance transports of it is currently approved under OMB
control number 0938–0921, with an has 2 business days to address the measures are applicable to the services
expiration date of May 31, 2009. physician’s concerns. If the CAP vendor that professional furnishes to Medicare
and the physician cannot resolve the beneficiaries. For a majority of the
Competitive Acquisition Program (CAP)
outstanding issues within 2 business eligible professionals, three or more
In section II.F.2.c. of the preamble, we days, the CAP vendor may submit a available measures will be applicable to
propose to revise the CAP physician request to CMS for an extension to allow their practice, and thus, the MIEA–
election agreement. In conjunction with for an additional 2 business days to TRHCA requires that they report on at
post-payment review process, we are resolve the physician’s issues. least three measures at a rate of at least
revising the CAP physician election The burden associated with this 80 percent for each of those three
agreement to reflect the physician’s requirement is the time and effort measures to meet statutory criteria for
obligation to provide medical records to necessary to submit an extension satisfactory reporting and qualify for the
assist with claims review. The CAP request to CMS. While this burden is bonus payment. An eligible professional
physician election agreement is subject to the PRA, we currently have could meet the satisfactory reporting
currently approved under 0938–0955 no way to quantify how many requests requirement, and thus be eligible for the
with an expiration date of August 31, of this type we will receive. Requests bonus incentive payment, by reporting
2009. Under a separate notice, we will from physicians will be reviewed by fewer than three measures only if his or
make the revised instrument available CAP vendors on an individual case-by- her practice has fewer than three
for public comment prior to submitting case basis. Similarly, requests for applicable measures available. The
the revised information collection extensions from the CAP vendors will quality measures are posted and
request to OMB for approval. be reviewed individually, on a case-by- available for download on the CMS Web
Section II.F.2.e. of the preamble case basis. We will continue to monitor site at http://www.cms.hhs.gov/pqri.
discusses details of the CAP. Each year, the process. If we believe that we will The burden associated with this
physicians are given the option to elect receive 10 or more requests, we will requirement is the time and effort
to obtain Medicare Part B drugs and submit an information collection associated with eligible professionals
biologicals through the CAP. In request to OMB. identifying applicable PQRI quality
addition, physicians are also given an measures for which they can report the
opportunity to select an approved CAP Physician Quality Reporting Initiative
(PQRI) necessary information. In addition, they
vendor. The burden associated with must gather the required information,
these election requirements is the time Section II.T.1.a. of the preamble
select the appropriate quality-data
and effort necessary for a physician to discusses the background of the
codes, and include the appropriate
make an election and notify CMS. The reporting initiative and provides
quality-data codes on the claims they
burden associated with election information about the measures
submit for payment.
requirements for participating in the available to eligible professionals who
CAP and selecting an approved CAP choose to participate in PQRI. Section In 2007, the PQRI will collect quality-
vendor is subject to the PRA. However, 1848(k)(1) of the Act requires the data codes exclusively as additional
it is currently approved under OMB Secretary to implement a system for (optional) line items on the existing
control numbers 0938–0955 and 0938– eligible professionals to submit data HIPAA transaction 837–P and CMS
0987 with expiration dates of August 31, pertaining to certain quality measures. Form 1500. There will be no new forms
2009 and April 30, 2009, respectively. As stated in section II.T.1.a., eligible and no modifications to the existing
Section II.F.2.e. of the preamble also professionals, for the purpose of the transaction or form in support of 2007
discusses the exigent circumstances quality reporting system, include PQRI. We also do not anticipate changes
exception for leaving the CAP outside of physicians, other practitioners as to the 837–P or CMS Form 1500 for
the annual election process. A physician described in section 1842(b)(18)(c) of 2008.
may request a release from the CAP the Act, physical and occupational Because this is a voluntary program,
within the first 30 days of its therapists, and qualified speech- it is impossible to estimate with any
participation if it can prove that staying language pathologists. As also stated in degree of accuracy how many eligible
in the program would impose a section II.T.1.a, this is a voluntary professionals will opt to participate in
significant burden. Specifically, the initiative. Eligible professionals may the PQRI in 2007. Moreover, the time
physician must submit a release request choose whether to participate and, to needed for an eligible professional to
to the CAP designated carrier. the extent they satisfactorily submit data review the quality measures and other
While this burden is subject to the on quality measures applicable to information, select measures applicable
PRA, we believe it is exempt under 5 covered professional services they to his or her patients and the services he
CFR 1320.3(h)(6). Facts or opinions furnish to Medicare beneficiaries, they or she furnishes to them, and
collected from a single person or entity can qualify to receive a bonus incentive incorporate the use of quality data codes
are not subject to the PRA. The payment. into the office work flows is expected to
aforementioned information collection Specifically, to qualify to receive a vary along with the number of measures
request will be reviewed individually bonus incentive payment for satisfactory that are potentially applicable to a given
on a case-by-case basis. reporting of quality data on covered professional’s practice. We estimate that
Once the CAP-designated carrier professional services furnished in 2007, the additional time required to put
receives a removal request, they are an eligible professional must submit quality data codes on each claim is not
required to refer the physician to their data on at least 1, 2, or 3 measures a material increment to the time
approved CAP vendor. As part of the selected from the 74 PQRI 2007 quality required to code the claim for payment.
grievance process, the CAP vendor will measures. The minimum number of The total estimated annual burden for
try to work with the physician to measures each professional must report this requirement will also vary along
address their concerns for participation to qualify for the bonus payment is with the volume of claims on which
in the program. Then, the CAP vendor determined by how many available quality data is reported.
TABLE 23.—ESTIMATED ANNUAL REPORTING AND RECORDKEEPING BURDEN

OMB control Total annual
Regulation section(s) Respondents Responses
number burden (hours)
Preamble section II.F.1 .................................................................................... 0938–0921 120 480 17,760

Preamble section II.F.2.f .................................................................................. 0938–0955 12 12 480
0938–0987 10,000 10,000 20,000
§ 410.33 ........................................................................................................... 0938–0685 400,000 400,000 1,000,000
§ 424.36 ........................................................................................................... 0938–New 9,000 6,500,000 541,667
Total .......................................................................................................... ........................ ........................ ........................ 1,579,907
If you comment on these information environmental, public health and safety significant adverse economic impact on
collection and recordkeeping effects, distributive impacts, and the small entities.
requirements, please mail copies equity). A regulatory impact analysis For purposes of the RFA, physicians,
directly to the following: must be prepared for proposed rules NPPs, and suppliers, including IDTFs,
Centers for Medicare & Medicaid with economically significant effects are considered small businesses if they
Services, Office of Strategic Operations (that is, a proposed rule that would have generate revenues of $6.5 million or
and Regulatory Affairs, Regulations an annual effect on the economy of $100 less. Approximately 95 percent of
Development Group, Attn: William N. million or more in any one year, or physicians are considered to be small
Parham, III, CMS–1385–P, Room C4– would adversely affect in a material way entities. There are about 980,000
26–05, 7500 Security Boulevard, the economy, a sector of the economy, physicians, other practitioners and
Baltimore, MD 21244–1850; and Office productivity, competition, jobs, the medical suppliers that receive Medicare
of Information and Regulatory Affairs, environment, public health or safety, or payment under the PFS.
Office of Management and Budget, State, local, or tribal governments or The CAP provides alternatives to
Room 10235, New Executive Office communities). As indicated in more physicians who do not wish to purchase
Building, Washington, DC 20503, Attn: detail below in this regulatory impact drugs directly or collect coinsurance.
Carolyn Lovett, CMS Desk Officer, analysis, we estimate that the PFS The impact of the CAP provisions on an
[CMS–1385–P], provisions included in this proposed individual physician is dependent on
carolyn_lovett@omb.eop.gov. Fax (202) rule will redistribute more than $100 whether the drugs they provide to
395–6974. million in 1 year. We are considering Medicare beneficiaries are included in
V. Response to Comments this proposed rule to be economically the list of CAP drugs, whether the
significant because its provisions are physician chooses to obtain drugs
Because of the large number of public estimated to result in an increase, administered to Medicare beneficiaries
comments we normally receive on
decrease or aggregate redistribution of through the CAP. The proposed CAP
Federal Register documents, we are not
Medicare spending that will exceed provisions in this proposed rule will
able to acknowledge or respond to them
$100 million. Therefore, this proposed also have a potential impact on entities
individually. We will consider all
rule is a major rule and we have that are involved in the dispensing or
comments we receive by the date and
prepared a regulatory impact analysis. distribution of drugs, plan to become
time specified in the DATES section of
The RFA requires agencies to analyze approved CAP vendors, or are approved
this preamble, and, when we proceed
options for regulatory relief of small CAP vendors.
with a subsequent document, we will
respond to the comments in the entities. For purposes of the RFA, small For purposes of the RFA,
preamble to that document. entities include small businesses, approximately 80 percent of clinical
nonprofit organizations, and small diagnostic laboratories are considered
VI. Regulatory Impact Analysis governmental jurisdictions. Most small businesses according to the Small
[If you choose to comment on issues hospitals and most other providers and Business Administration’s size
in this section, please include the suppliers are small entities, either by standards. Ambulance providers and
caption ‘‘IMPACT’’ at the beginning of nonprofit status or by having revenues suppliers for purposes of the RFA are
your comments.] of $6.5 million to $31.5 million in any also considered to be small entities.
We have examined the impact of this 1 year. (For further information, see the In addition, most ESRD facilities are
rule as required by Executive Order Small Business Administration’s considered small entities, either based
12866 (September 1993, Regulatory regulation at 70 FR 72577, December 6, on nonprofit status or by having
Planning and Review), the Regulatory 2003.) Individuals and States are not revenues of $31.5 million or less in any
Flexibility Act (RFA) (September 19, included in the definition of a small year. We consider a substantial number
1980 Pub. L. 96–354), section 1102(b) of entity. The RFA requires that we of entities to be affected if the proposed
the Social Security Act, the Unfunded analyze regulatory options for small rule is estimated to impact more than 5
Mandates Reform Act of 1995 (Pub. L. businesses and other entities. We percent of the total number of small
104–4), and Executive Order 13132. prepare a regulatory flexibility analysis entities. Based on our analysis of the
Executive Order 12866 (as amended unless we certify that a rule would not 930 nonprofit ESRD facilities
by Executive Order 13258, which have a significant economic impact on considered small entities in accordance
merely reassigns responsibilities of a substantial number of small entities. with the above definitions, we estimate
duties) directs agencies to assess all The analysis must include a justification that the combined impact of the
costs and benefits of available regulatory concerning the reason action is being proposed changes to payment for renal
alternatives and, when regulation is taken, the kinds and number of small dialysis services included in this
necessary, to select regulatory entities the rule affects, and an proposed rule would have a 0.8 percent
approaches that maximize net benefits explanation of any meaningful options increase in overall payments relative to
(including potential economic, that achieve the objectives with less current overall payments. The analysis
and discussion provided in this section, we propose to use to minimize the revised work adjustor for 2008, based
as well as elsewhere in this proposed burden on small entities. As indicated upon the proposed work RVUs for these
rule, complies with the RFA elsewhere in this proposed rule, we additional CPT codes and proposed
requirements. propose a variety of changes to our increases in the work of anesthesia
For the e-prescribing provisions, regulations, payments, or payment services, is approximately 0.8816. Table
physician practices and independent policies to ensure that our payment 24 shows the specialty-level impact of
pharmacies are considered small systems reflect changes in medical the work and PE RVU changes.
entities. practice and the relative value of Our estimates of changes in Medicare
Because we acknowledge that many of services. We provide information for revenues for PFS services compare
the affected entities are small entities, each of the policy changes in the payment rates for CY 2007 with
the analysis discussed throughout the relevant sections of this proposed rule. proposed payment rates for CY 2008
preamble of this proposed rule We are unaware of any relevant Federal using CY 2006 Medicare utilization for
constitutes our initial regulatory rules that duplicate, overlap or conflict all years. We are using CY 2006
flexibility analysis for the remaining with this proposed rule. The relevant Medicare claims processed and paid
provisions. Therefore, we are soliciting sections of this proposed rule contain a through March 30, 2007, that we
comments on our estimates and analysis description of significant alternatives if estimate are 98 percent complete. To the
of the impact of this proposed rule on applicable. extent that there are year-to-year
those small entities. changes in the volume and mix of
Section 1102(b) of the Act requires us A. RVU Impacts
services provided by physicians, the
to prepare a regulatory impact analysis 1. Resource-Based Work and PE RVUs actual impact on total Medicare
for any proposed rule that may have a revenues will be different than those
significant impact on the operations of Section 1848(c)(2)(B)(ii) of the Act
requires that increases or decreases in shown in Table 24. The payment
a substantial number of small rural
RVUs may not cause the amount of impacts reflect averages for each
hospitals. This analysis must conform to
expenditures for the year to differ by specialty based on Medicare utilization.
the provisions of section 603 of the
more than $20 million from what The payment impact for an individual
RFA. For purposes of section 1102(b) of
expenditures would have been in the physician would be different from the
the Act, we define a small rural hospital
absence of these changes. If this average, based on the mix of services the
as a hospital that is located outside a
threshold is exceeded, we make physician provides. The average change
Metropolitan Statistical Area and has
adjustments to preserve BN. In the CY in total revenues would be less than the
fewer than 100 beds. We have
2007 PFS final rule with comment impact displayed here because
determined that this proposed rule
period, the $4 billion impact of changes physicians furnish services to both
would have minimal impact on small
hospitals located in rural areas. Of the in work RVUs resulting from the 5-Year Medicare and non-Medicare patients
202 hospital-based ESRD facilities Review required that a BN adjustment and specialties may receive substantial
located in rural areas, only 40 are be made. Medicare revenues for services that are
affiliated with hospitals with fewer than As discussed in section IV.D.3 of the not paid under the PFS. For instance,
100 beds. CY 2007 PFS final rule with comment independent laboratories receive
Section 202 of the Unfunded period (71 FR 69735), we carefully approximately 80 percent of their
Mandates Reform Act of 1995 also reviewed the comments received Medicare revenues from clinical
requires that agencies assess anticipated concerning the BN adjustment needed laboratory services that are not paid
costs and benefits before issuing any to offset the $4 billion impact of changes under the PFS.
rule that may result in expenditures in in work RVUs resulting from the 5-Year Table 24 shows only the payment
any year by State, local, or tribal Review. To meet the requirements set impact on PFS services. The following
governments, in the aggregate, or by the forth in section 1848(c)(2)(B)(ii)(II) of is an explanation of the information
private sector, of $120 million. This the Act, we implemented a BN adjustor represented in Table 24. Note that Table
proposed rule will not mandate any of 0.8994 or 10.1 percent to be applied 24 does not include the impact of the
requirements for State, local, or tribal to the work RVUs. estimated CY 2008 update.
governments. Medicare beneficiaries are Subsequent to the publication of the • Specialty: The physician specialty
considered to be part of the private CY 2007 PFS final rule with comment or type of practitioner/supplier.
sector for this purpose. A discussion period and the announcement of the • Allowed Charges: Allowed charges
concerning the impact of this rule on 0.8994 BN adjustment to the work are the Medicare Fee Schedule amounts
beneficiaries is found later in this RVUs, the AMA RUC supplied work for covered services and include
section. RVU recommendations on additional coinsurance and deductibles (which are
We have examined this proposed rule CPT codes from the 5-Year Review and the financial responsibility of the
in accordance with Executive Order recommendations for an increase in the beneficiary.) These amounts have been
13132 and have determined that this work of anesthesia services. See Table summed across all services provided by
regulation would not have any 10 in Section II.E. for a listing of the physicians, practitioners, or suppliers
significant impact on the rights, roles, or RUC recommendations and CMS with a specialty to arrive at the total
responsibilities of State, local, or tribal decisions on these additional codes allowed charges for the specialty.
governments. reviewed for the 5-Year Review. As • Impact of Work RVU Changes for
We have prepared the following stated in the CY 2007 PFS final rule additional proposed changes in work
analysis, which, together with the with comment period, these additional RVUs from the 5-Year Review.
information provided in the rest of this codes are still considered part of the 5- • Impact of PE RVU changes. The
preamble, meets all assessment Year Review. The impact of these impact is shown for both 2008 which is
requirements. The analysis explains the additional recommendations and the second year of the 4-year transition
rationale for and purposes of this increases in the work of anesthesia using the new methodology and the
proposed rule; details the costs and services on the BN adjustment must be fully implemented 2010 PE RVUs.
benefits of the rule; analyzes accounted for by revising the current • Combined impact of the proposed
alternatives; and presents the measures work adjustor of 0.8994. The proposed work RVUs and PE RVUs for both 2008
and the fully implemented 2010 PE

RVUs.
TABLE 24.—PROPOSED COMBINED TOTAL ALLOWED CHARGE IMPACT FOR WORK AND PRACTICE EXPENSE RVU
CHANGES
Impact of PE RVU changes Combined impact of PE and
(percent) work changes*
Impact of work (percent)
RVU changes
Specialty 2008 2008 2010 2008 2010
(percent) (PE trans. (PE full (PE trans. (PE full
year 2) implement.) year 2) implement.)
TOTAL .................................................................................. 0 0 0 0 0
ALLERGY/IMMUNOLOGY ................................................... 0 1 2 1 3
ANESTHESIOLOGY ............................................................ 15 ¥1 ¥3 14 13
CARDIAC SURGERY .......................................................... ¥1 ¥1 ¥2 ¥2 ¥3
CARDIOLOGY ..................................................................... ¥1 0 0 ¥1 ¥1
COLON AND RECTAL SURGERY ..................................... ¥1 1 2 0 1
CRITICAL CARE .................................................................. ¥1 0 ¥1 ¥1 ¥2
DERMATOLOGY ................................................................. ¥1 2 7 2 6
EMERGENCY MEDICINE ................................................... ¥1 0 ¥1 ¥2 ¥2
ENDOCRINOLOGY ............................................................. ¥1 0 0 ¥1 ¥2
FAMILY PRACTICE ............................................................. 0 0 0 0 0
GASTROENTEROLOGY ..................................................... ¥1 1 4 0 3
GENERAL PRACTICE ......................................................... 0 0 ¥1 0 ¥1
GENERAL SURGERY ......................................................... ¥1 0 0 ¥1 ¥1
GERIATRICS ....................................................................... 2 0 0 2 3
HAND SURGERY ................................................................ ¥1 ¥1 ¥3 ¥2 ¥4
HEMATOLOGY/ONCOLOGY .............................................. ¥1 0 ¥1 ¥1 ¥2
INFECTIOUS DISEASE ....................................................... ¥1 0 1 ¥1 0
INTERNAL MEDICINE ......................................................... 0 0 0 0 ¥1
INTERVENTIONAL RADIOLOGY ....................................... ¥1 ¥1 ¥4 ¥2 ¥4
NEPHROLOGY .................................................................... ¥1 ¥1 ¥4 ¥2 ¥5
NEUROLOGY ...................................................................... ¥1 0 ¥1 ¥1 ¥2
NEUROSURGERY .............................................................. ¥1 ¥1 ¥2 ¥2 ¥3
NUCLEAR MEDICINE ......................................................... ¥1 4 13 4 12
OBSTETRICS/GYNECOLOGY ............................................ ¥1 0 ¥1 ¥1 ¥2
OPHTHALMOLOGY ............................................................ 2 ¥1 ¥3 1 ¥1
ORTHOPEDIC SURGERY .................................................. ¥1 ¥1 ¥2 ¥1 ¥2
OTOLARNGOLOGY ............................................................ 2 ¥1 ¥4 1 ¥2
PATHOLOGY ....................................................................... ¥1 ¥1 ¥3 ¥2 ¥4
PEDIATRICS ........................................................................ 0 0 0 0 ¥1
PHYSICAL MEDICINE ......................................................... 0 ¥1 ¥2 ¥1 ¥2
PLASTIC SURGERY ........................................................... ¥1 0 1 ¥1 0
PSYCHIATRY ...................................................................... ¥1 0 1 0 1
PULMONARY DISEASE ...................................................... ¥1 0 1 ¥1 0
RADIATION ONCOLOGY .................................................... ¥1 0 1 0 1
RADIOLOGY ........................................................................ ¥1 1 2 0 1
RHEUMATOLOGY ............................................................... ¥1 ¥1 ¥2 ¥2 ¥3
THORACIC SURGERY ....................................................... ¥1 ¥1 ¥2 ¥2 ¥3
UROLOGY ........................................................................... ¥1 0 0 ¥1 ¥1
VASCULAR SURGERY ....................................................... ¥1 0 ¥1 ¥1 ¥1
AUDIOLOGIST ..................................................................... 26 ¥14 ¥43 12 ¥17
CHIROPRACTOR ................................................................ ¥1 ¥1 ¥2 ¥2 ¥3
CLINICAL PSYCHOLOGIST ............................................... ¥1 ¥2 ¥6 ¥3 ¥7
CLINICAL SOCIAL WORKER ............................................. ¥1 ¥2 ¥5 ¥3 ¥6
NURSE ANESTHETIST ....................................................... 22 0 0 22 22
NURSE PRACTITIONER ..................................................... 1 0 1 2 2
OPTOMETRY ...................................................................... 4 0 ¥1 4 3
ORAL/MAXILLOFACIAL SURGERY ................................... ¥1 1 3 0 3
PHYSICAL/OCCUPATIONAL THERAPY ............................ ¥1 1 4 1 4
PHYSICIAN ASSISTANT ..................................................... ¥1 0 0 0 0
PODIATRY ........................................................................... ¥1 1 4 1 3
DIAGNOSTIC TESTING FACILITY ..................................... 0 0 0 0 0
INDEPENDENT LABORATORY .......................................... 0 3 9 3 9
PORTABLE X-RAY SUPPLIER ........................................... 0 2 6 2 6
*Components may not sum to total due to rounding.
2. Adjustments for Payments for As indicated in Table 25, our with a specialty to arrive at the total
Imaging Services estimates of changes in Medicare allowed charges for the specialty.
Section 5102 of the Deficit Reduction revenues for PFS services compare • Impact of the 2008 Work and PE
Act of 2005 (Pub. L. 109–171) (DRA) payment rates for CY 2007 with RVU proposed changes using the
exempts the estimated savings from the proposed payment rates for CY 2008 methodology finalized in the CY 2007
application of the OPPS-based payment using CY 2006 Medicare utilization PFS final rule with comment period and
limitation on PFS imaging services from crosswalked to 2007 services. To the the revised data sources discussed in
the PFS BN requirement. We estimate extent that there are year-to-year this proposed rule.
that the combined impact of the current changes in the volume and mix of • Impact of section 5102 of the DRA:
BN exemptions instituted by section services provided by physicians, the The CY 2008 percentage decrease in
5102 of the DRA, the proposed addition actual impact on total Medicare allowed charges attributed to section
of 6 codes to the list of services subject revenues will be different than those 5102 of the DRA with the proposed
to the DRA OPPS cap (discussed in shown in Table 25. The payment addition of six codes to the OPPS cap
section II.E.1.), and the proposed impacts reflect averages for each list.
payment revisions to OPPS cap amounts specialty based on Medicare utilization. • Combined impact of the proposed
would result in no measurable changes The payment impact for an individual work and PE RVUs, section 5102 of the
in the specialty specific impacts of the physician would be different from the DRA and the proposed addition of six
DRA provisions with the exception of average, based on the mix of services the codes to the OPPS cap list, and the
vascular surgery in CY 2008. physician provides. proposed revisions to OPPS payment
Table 25 shows only the payment amounts.
3. Combined Impact • CY 2008 Update: The percentage
impact on PFS services. The following
Table 25 shows the specialty-level is an explanation of the information decrease in allowed charges attributed
impact of the proposed work and PE represented in Table 25. to the estimated CY 2008 PFS
RVU changes, section 5102 of the DRA conversion factor update (¥9.9
(including the additional 6 services that • Specialty: The physician specialty percent).
were added to the list of services subject or type of practitioner/supplier. • Combined impact with CY 2008
to the DRA OPPS cap and the proposed • Allowed Charges: Allowed charges update: The CY 2008 percentage
revision to OPPS payment amounts), are the Medicare Fee Schedule amounts decrease in allowed charges attributed
and our most recent estimate (¥9.9 for covered services and include to the impact of the work and PE RVU
percent) of the CY 2008 Medicare PFS copayments and deductibles (which are changes, section 5102 of the DRA (plus
update. Additionally, the impacts in the financial responsibility of the six proposed additions to OPPS cap
this proposed rule reflect the use of beneficiary.) These amounts have been list), and the proposed revisions to
updated physician time data from the summed across all services provided by OPPS payment amounts, and the CY
AMA–RUC. physicians, practitioners, or suppliers 2008 update.
TABLE 25.—COMBINED CY 2008 TOTAL ALLOWED CHARGE IMPACT FOR THE REMAINING 5-YEAR REVIEW OF WORK
RVUS AND PRACTICE EXPENSE CHANGES, OPPS IMAGING CAP, AND THE CY 2008 UPDATE
Impact of Combined Combined
Allowed work and Impact of impact RVU CY 2008 impact with
Specialty charges PE RVU DRA 5102 and DRA update CY 2008
(mil) changes* (percent) 5102** (percent) update**
(percent) (percent) (percent)
TOTAL .............................................................................. $75,819 0 0 0 ¥10 ¥10

ALLERGY/IMMUNOLOGY ............................................... 172 1 0 1 ¥10 ¥9
ANESTHESIOLOGY ........................................................ 1,600 14 0 14 ¥10 4
CARDIAC SURGERY ...................................................... 393 ¥2 0 ¥2 ¥10 ¥12
CARDIOLOGY ................................................................. 7,447 ¥1 0 ¥1 ¥10 ¥11
COLON AND RECTAL SURGERY ................................. 121 0 0 0 ¥10 ¥10
CRITICAL CARE .............................................................. 197 ¥1 0 ¥1 ¥10 ¥11
DERMATOLOGY ............................................................. 2,237 2 0 2 ¥10 ¥8
EMERGENCY MEDICINE ............................................... 2,170 ¥2 0 ¥2 ¥10 ¥12
ENDOCRINOLOGY ......................................................... 347 ¥1 0 ¥1 ¥10 ¥11
FAMILY PRACTICE ......................................................... 5,011 0 0 0 ¥10 ¥10
GASTROENTEROLOGY ................................................. 1,737 0 0 0 ¥10 ¥10
GENERAL PRACTICE ..................................................... 964 0 0 0 ¥10 ¥10
GENERAL SURGERY ..................................................... 2,282 ¥1 0 ¥1 ¥10 ¥11
GERIATRICS ................................................................... 145 2 0 2 ¥10 ¥8
HAND SURGERY ............................................................ 79 ¥2 0 ¥2 ¥10 ¥12
HEMATOLOGY/ONCOLOGY .......................................... 1,905 ¥1 0 ¥1 ¥10 ¥11
INFECTIOUS DISEASE ................................................... 499 ¥1 0 ¥1 ¥10 ¥11
INTERNAL MEDICINE ..................................................... 9,867 0 0 ¥1 ¥10 ¥11
INTERVENTIONAL RADIOLOGY ................................... 241 ¥2 0 ¥2 ¥10 ¥12
NEPHROLOGY ................................................................ 1,649 ¥2 0 ¥2 ¥10 ¥12

NEUROLOGY .................................................................. 1,385 ¥1 0 ¥1 ¥10 ¥11
NEUROSURGERY .......................................................... 568 ¥2 0 ¥2 ¥10 ¥12
NUCLEAR MEDICINE ..................................................... 77 4 0 4 ¥10 ¥6
OBSTETRICS/GYNECOLOGY ........................................ 621 ¥1 0 ¥1 ¥10 ¥11
OPHTHALMOLOGY ........................................................ 4,642 1 0 1 ¥10 ¥9
ORTHOPEDIC SURGERY .............................................. 3,221 ¥1 0 ¥1 ¥10 ¥11
OTOLARNGOLOGY ........................................................ 906 1 0 0 ¥10 ¥10
TABLE 25.—COMBINED CY 2008 TOTAL ALLOWED CHARGE IMPACT FOR THE REMAINING 5-YEAR REVIEW OF WORK
RVUS AND PRACTICE EXPENSE CHANGES, OPPS IMAGING CAP, AND THE CY 2008 UPDATE—Continued
Impact of Combined Combined
Allowed work and Impact of impact RVU CY 2008 impact with
Specialty charges PE RVU DRA 5102 and DRA update CY 2008
(mil) changes* (percent) 5102** (percent) update**
(percent) (percent) (percent)
PATHOLOGY ................................................................... 939 ¥2 0 ¥2 ¥10 ¥12

PEDIATRICS .................................................................... 72 0 0 ¥1 ¥10 ¥11
PHYSICAL MEDICINE ..................................................... 775 ¥1 0 ¥1 ¥10 ¥11
PLASTIC SURGERY ....................................................... 268 ¥1 0 ¥1 ¥10 ¥11
PSYCHIATRY .................................................................. 1,076 0 0 0 ¥10 ¥10
PULMONARY DISEASE .................................................. 1,679 ¥1 0 ¥1 ¥10 ¥11
RADIATION ONCOLOGY ................................................ 1,599 0 0 0 ¥10 ¥10
RADIOLOGY .................................................................... 5,197 0 0 0 ¥10 ¥10
RHEUMATOLOGY ........................................................... 491 ¥2 0 ¥2 ¥10 ¥12
THORACIC SURGERY ................................................... 432 ¥2 0 ¥2 ¥10 ¥12
UROLOGY ....................................................................... 2,021 ¥1 0 0 ¥10 ¥10
VASCULAR SURGERY ................................................... 634 ¥1 ¥1 ¥2 ¥10 ¥12
AUDIOLOGIST ................................................................. 31 12 0 12 ¥10 2
CHIROPRACTOR ............................................................ 717 ¥2 0 ¥2 ¥10 ¥12
CLINICAL PSYCHOLOGIST ........................................... 521 ¥3 0 ¥3 ¥10 ¥13
CLINICAL SOCIAL WORKER ......................................... 347 ¥3 0 ¥3 ¥10 ¥13
NURSE ANESTHETIST ................................................... 605 22 0 22 ¥10 12
NURSE PRACTITIONER ................................................. 783 2 0 2 ¥10 ¥8
OPTOMETRY .................................................................. 782 4 0 4 ¥10 ¥6
ORAL/MAXILLOFACIAL SURGERY ............................... 36 0 0 0 ¥10 ¥10
PHYSICAL/OCCUPATIONAL THERAPY ........................ 1,371 1 0 1 ¥10 ¥9
PHYSICIAN ASSISTANT ................................................. 591 0 0 0 ¥10 ¥10
PODIATRY ....................................................................... 1,554 1 0 1 ¥10 ¥9
DIAGNOSTIC TESTING FACILITY ................................. 1,162 0 0 0 ¥10 ¥10
INDEPENDENT LABORATORY ...................................... 1,081 3 0 3 ¥10 ¥7
PORTABLE X-RAY SUPPLIER ....................................... 80 2 0 2 ¥10 ¥8
* PE changes are CY 2008 second year transition changes. For fully implemented CY 2010 PE changes see Table 1.
** Components may not sum to total due to rounding.
Table 26 shows the estimated impact procedures because they are the most change in the facility rates and the
on total payments for selected high- commonly provided by a broad nonfacility rates. For an explanation of
volume procedures of all of the changes spectrum of physician specialties. There facility and nonfacility PE refer to
discussed previously. We selected these are separate columns that show the Addendum A of this proposed rule.
TABLE 26.—IMPACT OF PROPOSED RULE AND ESTIMATED PHYSICIAN UPDATE ON PROPOSED 2008 PAYMENT FOR
SELECTED PROCEDURES
Facility Nonfacility
CPT/ MOD Description
HCPCS Proposed Percent Proposed Percent
2007 2007
2008 change 2008 change
11721 ....... .......... Debride nail, 6 or more ............................ $28.80 $24.92 ¥13 $39.03 $35.50 ¥9
17000 ....... .......... Destruct premalg lesion ........................... 44.72 41.64 ¥7 63.29 60.42 ¥5
27130 ....... .......... Total hip arthroplasty ............................... 1,360.52 1,199.16 ¥12 NA NA NA
27244 ....... .......... Treat thigh fracture .................................. 1,100.92 967.04 ¥12 NA NA NA
27447 ....... .......... Total knee arthroplasty ............................ 1,464.74 1,288.25 ¥12 NA NA NA
33533 ....... .......... CABG, arterial, single .............................. 1,908.52 1,664.76 ¥13 NA NA NA
35301 ....... .......... Rechanneling of artery ............................ 1,071.74 938.37 ¥12 NA NA NA
43239 ....... .......... Upper GI endoscopy, biopsy ................... 155.00 140.98 ¥9 325.16 293.90 ¥10
66821 ....... .......... After cataract laser surgery ..................... 253.53 224.61 ¥11 270.97 239.63 ¥12
66984 ....... .......... Cataract surg w/iol, 1 stage ..................... 641.98 563.91 ¥12 NA NA NA
67210 ....... .......... Treatment of retinal lesion ....................... 556.34 491.54 ¥12 580.59 511.68 ¥12
71010 ....... .......... Chest x-ray .............................................. NA NA NA 26.15 22.87 ¥13
71010 ....... 26 Chest x-ray .............................................. 8.72 7.85 ¥10 8.72 7.85 ¥10
77056 ....... .......... Mammogram, both breasts ...................... NA NA NA 97.40 90.46 ¥7
77056 ....... 26 Mammogram, both breasts ...................... 41.31 37.55 ¥9 41.31 37.55 ¥9
77057 ....... .......... Mammogram, screening .......................... NA NA NA 81.86 74.07 ¥10

77057 ....... 26 Mammogram, screening .......................... 33.35 30.38 ¥9 33.35 30.38 ¥9
77427 ....... .......... Radiation tx management, x5 .................. 176.22 159.07 ¥10 176.22 159.07 ¥10
78465 ....... 26 Heart image (3d), multiple ....................... 73.14 66.56 ¥9 73.14 66.56 ¥9
88305 ....... 26 Tissue exam by pathologist ..................... 37.90 32.77 ¥14 37.90 32.77 ¥14
90801 ....... .......... Psy dx interview ....................................... 129.99 112.65 ¥13 145.15 131.76 ¥9
90862 ....... .......... Medication management ......................... 44.72 39.60 ¥11 50.40 46.76 ¥7
90935 ....... .......... Hemodialysis, one evaluation .................. 67.46 59.05 ¥12 NA NA NA
TABLE 26.—IMPACT OF PROPOSED RULE AND ESTIMATED PHYSICIAN UPDATE ON PROPOSED 2008 PAYMENT FOR
SELECTED PROCEDURES—Continued
Facility Nonfacility
CPT/ MOD Description
HCPCS Proposed Percent Proposed Percent
2007 2007
2008 change 2008 change
92012 ....... .......... Eye exam established pat ....................... 34.11 38.23 12 61.77 62.47 1
92014 ....... .......... Eye exam & treatment ............................. 55.71 59.39 7 91.33 91.14 0
92980 ....... .......... Insert intracoronary stent ......................... 795.85 721.61 ¥9 NA NA NA
93000 ....... .......... Electrocardiogram, complete ................... 24.63 20.48 ¥17 24.63 20.48 ¥17
93010 ....... .......... Electrocardiogram report ......................... 8.34 7.51 ¥10 8.34 7.51 ¥10
93015 ....... .......... Cardiovascular stress test ....................... 104.22 92.51 ¥11 104.22 92.51 ¥11
93307 ....... 26 Echo exam of heart ................................. 46.99 42.33 ¥10 46.99 42.33 ¥10
93510 ....... 26 Left heart catheterization ......................... 242.92 215.73 ¥11 242.92 215.73 ¥11
98941 ....... .......... Chiropractic manipulation ........................ 28.80 25.60 ¥11 33.35 29.36 ¥12
99203 ....... .......... Office/outpatient visit, new ....................... 67.08 59.05 ¥12 91.71 81.58 ¥11
99213 ....... .......... Office/outpatient visit, est ........................ 42.07 37.55 ¥11 59.50 53.59 ¥10
99214 ....... .......... Office/outpatient visit, est ........................ 66.32 59.05 ¥11 90.20 80.56 ¥11
99222 ....... .......... Initial hospital care ................................... 119.00 105.48 ¥11 NA NA NA
99223 ....... .......... Initial hospital care ................................... 173.57 154.29 ¥11 NA NA NA
99231 ....... .......... Subsequent hospital care ........................ 35.62 31.75 ¥11 NA NA NA
99236 ....... .......... Observ/hosp same date .......................... 205.40 180.57 ¥12 NA NA NA
99239 ....... .......... Hospital discharge day ............................ 94.74 83.63 ¥12 NA NA NA
99243 ....... .......... Office consultation ................................... 93.23 83.29 ¥11 122.41 109.57 ¥10
99244 ....... .......... Office consultation ................................... 145.91 130.74 ¥10 179.26 160.43 ¥10
99253 ....... .......... Inpatient consultation ............................... 108.77 97.63 ¥10 NA NA NA
99254 ....... .......... Inpatient consultation ............................... 156.52 140.64 ¥10 NA NA NA
99283 ....... .......... Emergency dept visit ............................... 60.64 52.91 ¥13 NA NA NA
99284 ....... .......... Emergency dept visit ............................... 110.28 97.97 ¥11 NA NA NA
99291 ....... .......... Critical care, first hour ............................. 208.82 183.65 ¥12 256.19 224.95 ¥12
99292 ....... .......... Critical care, add’l 30 min ........................ 104.60 92.16 ¥12 114.45 100.70 ¥12
99348 ....... .......... Home visit, est patient ............................. NA NA NA 66.32 58.03 ¥13
99350 ....... .......... Home visit, est patient ............................. NA NA NA 150.83 131.42 ¥13
G0008 ...... .......... Admin influenza virus vac ........................ NA NA NA 18.95 18.43 ¥3
G0317 ...... .......... ESRD related svs 4+mo 20+yrs .............. 283.09 246.45 ¥13 283.09 246.45 ¥13
B. Geographic Practice Cost Index An estimate of the overall effects of GPCI revisions is shown in the 2009
Changes proposed GPCI changes on fee schedule GPCI values of Addendum E.
area payments can be demonstrated by The most significant changes occur in
Section 1848(e)(1)(A) of the Act a comparison of area geographic 11 payment localities where the GAF
requires that payments under the adjustment factors (GAFs). The GAFs moves up by 1 or more percent or down
Medicare PFS vary among payment are a weighted composite of each area’s by more than 2 percent.
areas only to the extent that area costs work, PE, and malpractice expense
vary as reflected by the area GPCIs. The C. Telehealth
GPCIs using the national GPCI cost
GPCIs measure area cost differences in In section II.D of this rule, we are
share weights. While we do not actually
the three components of the PFS: proposing to add neurobehavioral status
use the GAFs in computing the fee
Physician work; PEs (employee wages, exam as represented by HCPCS code
schedule payment for a specific service,
rent, medical supplies, and equipment); 96116 to the list of telehealth services.
they are useful in comparing overall
and malpractice insurance. Section To date, Medicare expenditures for
area costs and payments. The actual
1848(e)(1)(C) of the Act requires that telehealth services have been extremely
effect on payment for any actual service
GPCIs be reviewed and, if necessary, low. For instance, in CY 2006, the total
will deviate from the GAF to the extent
revised at least every 3 years. The first Medicare payment amount for
that the proportions of work, PE, and
GPCI revision was implemented in telehealth services (including the
1993. The second revision was malpractice expense RVUs for the originating site facility fee) was
implemented in 1998, the next in 2001, service differ from those of the GAF. approximately $2 million. Moreover,
and the last in 2005. In section II.C. of Addendum D shows the estimated previous additions to the list of
this proposed rule, we are proposing the effects of the revised GPCIs on area Medicare telehealth services have not
next GPCI update. The proposed GPCI GAFs in descending order. The GAFs resulted in a significant increase in
values are shown in Addendum E. reflect the expiration of the 1.000 floor Medicare program expenditures. For
These values reflect the expiration of on physician work as provided under example, the psychiatric diagnostic
the 1.000 floor on physician work as section 102 of the MIEA–TRHCA. interview examination (as described by
provided under section 102 of the The effects of the 2008 transition year CPT code 90801) was added to the list
MIEA–TRHCA. Section 1848(e)(1)(c) of will be only one-half of the total amount of Medicare telehealth services in CY
the Act also requires that the GPCI of the revisions associated with the 2003. The addition of CPT code 90801
revisions be phased-in equally over a 2- updated GPCI values. As required by resulted in an increase in Medicare
year period if more than 1 year has law, the GPCIs would be phased in over payment amounts of approximately
elapsed since the last adjustment. a 2 year period. The total impact of the $100,000 in CY 2006.
The neurobehavioral status exam perceived as a positive step. Other current 2006 payments and proposed
(CPT code 96116) includes an initial changes which are proposed or are 2007 payments.
assessment and evaluation of the mental being contemplated seek to improve ESRD providers were grouped into the
status for a psychiatric patient. In this service by improving compliance, and categories based on characteristics
regard, the neurobehavioral status exam increasing the services that an approved provided in the Online Survey and
is similar to the psychiatric diagnostic CAP vendor may offer to participating Certification and Reporting (OSCAR)
interview examination (CPT code CAP physicians. At this time we file and the most recent cost report data
90801). However, the utilization rate of anticipate these changes will result in from the Healthcare Cost Report
psychiatric diagnostic interview no significant additional cost savings or Information System (HCRIS). We also
examination is much greater than the increases associated with the CAP, used the December 2006 update of CY
neurobehavioral status exam. For relative to the ASP payment system. 2006 National Claims History file as a
instance, in CY 2006, the total allowed basis for Medicare dialysis treatments
E. Clinical Laboratory Fee Schedule and separately billable drugs and
services for CPT code 90801 was
issues biologicals. While the December 2006
approximately 1.3 million while total
allowed services for neurobehavioral As discussed in section II.G. of this update of the 2006 claims is not
status exam in CY 2006 was preamble, we have proposed two complete, we wanted to use the most
approximately 105,000. Because additions to § 410.508 for determining recent data available, and plan to use an
utilization of neurobehavioral status payment for a new clinical diagnostic updated version of the 2006 claims file
exam is substantially less than the laboratory paid under the Medicare Part for the final rule. Due to data
psychiatric diagnostic interview B clinical laboratory fee schedule. These limitations, we are unable to estimate
examination, we believe the budgetary proposals will not increase or decrease current and proposed payments for 168
impact of adding neurobehavioral status payment amounts for existing clinical of the 4,712 ESRD facilities that bill for
exam to the list of Medicare telehealth diagnostic laboratory tests because the ESRD dialysis treatments.
services will be even less than the Table 27 shows the impact of this
payment amounts are not subject to
previously added psychiatric diagnostic year’s proposed changes to CY 2008
these regulatory changes. For new tests,
interview examination. payments to hospital-based and
the proposals would primarily permit
While we believe that addition of this independent ESRD facilities. The first
additional comment opportunity for
service to the telehealth service list will column of Table 27 identifies the type
establishing a payment amount for a
enable more beneficiaries to access to of ESRD provider, the second column
new test but not result in an increase or
these services, we do not anticipate that indicates the number of ESRD facilities
decrease in payment amounts. Because
this proposed change will have a for each type, and the third column
any new laboratory tests to undergo a indicates the number of dialysis
significant budgetary impact on the reconsideration request of a payment
Medicare program. treatments.
amount are unknown to us at the The fourth column shows the effect of
D. Payment for Covered Outpatient current time, we do not have any data the proposed change to the wage index
Drugs and Biologicals to estimate the impact of our proposal floor as it affects the composite rate
to establish a reconsideration process. payments to ESRD facilities for CY
1. ASP Issues By improving the comment 2008. The fourth column compares
The proposed changes discussed in opportunities and timeframes for aggregate ESRD wage adjusted
section II.F.1. with respect to payment establishing payment amount for new composite rate payments in the third
for covered outpatient drugs and tests, we expect less than five tests per year of the transition (CY 2008) using
biologicals, are estimated to have no year to undergo a subsequent the CY 2008 wage index with a 0.80
impact on Medicare expenditures. reconsideration process with the floor compared to aggregate ESRD wage
However, we believe the changes will resulting adjustments in payment adjusted composite rate payments in the
assist in clarifying existing policy with amounts to be very modest if any. third year of the transition (CY 2008)
respect to ASP payment. F. Provisions Related to Payment for using the CY 2008 wage index with a
Renal Dialysis Services Furnished by 0.75 floor. Note that the fourth column
2. CAP Issues
End State Renal Disease (ESRD) only includes the effect of the proposed
This proposed rule describes a Facilities change to the wage index floor and does
significant change in how CAP drug not include the effects of other wage
claims are paid due to the The ESRD-related provisions in this index changes, such as, moving from the
implementation of section 108(a)(2) of proposed rule are discussed in section second to third year of the transition
the MIEA–TRHCA. This rule also II.H. To understand the impact of the and updated wage index values from CY
contains proposals and seeks comment proposed changes affecting payments to 2007 to CY 2008.
on certain approaches to refining the different categories of ESRD facilities, it The fifth column shows the effect of
CAP seek to improve service by is necessary to compare estimated all proposed changes to the ESRD wage
improving compliance, increasing payments under the current year (CY index for CY 2008 as it affects the
flexibility, and increasing choices 2007 payments) to estimated payments composite rate payments to ESRD
available to participating CAP under the revisions to the composite facilities. It is inclusive of the changes
physicians. The proposed CAP rate payment system (CY 2008 in the fourth column. The fifth column
provisions will also have a potential payments) as discussed in II.H. of this compares aggregate ESRD wage adjusted
impact on entities that are involved in proposed rule. To estimate the impact composite rate payments in the third
the dispensing or distribution of drugs, among various classes of ESRD year of the transition (CY 2008) to
plan to become approved CAP vendors, facilities, it is imperative that the aggregate ESRD wage adjusted
or are approved CAP vendors. Changes estimates of current payments and composite rate payments in the second
associated with section 108(a)(2) of the proposed payments contain similar year of the transition (CY 2007). In the
MIEA–TRHCA, especially the provision inputs. Therefore, we simulated third year of the transition (CY 2008),
for payment to vendors upon receipt of payments only for those ESRD facilities ESRD facilities receive 75 percent of the
a claim, will almost certainly be that we are able to calculate both CBSA wage adjusted composite rate and
25 percent of the MSA wage adjusted index floor, as there were areas in these provider (with the 15.5 percent drug
composite rate. In the second year of the areas with wage index values below the add-on) times dialysis treatments from
transition, ESRD facilities receive 50 proposed floor. CY 2006 claims. The CY 2007 current
percent of the CBSA wage adjusted The sixth column shows the overall payment is the transition year 2 wage-
composite rate and 50 percent of the effect of the proposed changes in adjusted composite rate for each
MSA wage adjusted composite rate. The composite rate payments to ESRD provider (with the current 14.9 percent
overall effect to all ESRD providers in providers. The overall effect is drug add-on) times dialysis treatments
aggregate is zero because the proposed measured as the difference between the from CY 2006 claims.
CY 2008 ESRD wage index has been proposed CY 2008 payment with all
multiplied by a BN adjustment factor to changes as proposed in this rule and The overall impact to ESRD providers
comply with the statutory requirement current CY 2007 payment. This payment in aggregate is 0.5 percent. This increase
that any wage index revisions be done amount is computed by multiplying the corresponds to the proposed 0.5 percent
in a manner that results in the same wage adjusted composite rate with the increase to the drug add-on. The
aggregate amount of expenditures as drug add-on for each provider times the variation shown in column 6 is due to
would have been made without any number of dialysis treatments from the variation in changes in the wage index
changes in the wage index. The CY 2006 claims. The CY 2008 proposed (column 5). All provider types receive
decreases shown among census regions payment is the transition year 3 wage- the same 0.5 percent increase to the
is primarily due to reducing the wage adjusted composite rate for each drug add-on.
TABLE 27.—IMPACT OF CY 2008 PROPOSED CHANGES IN PAYMENTS TO HOSPITAL-BASED AND INDEPENDENT ESRD
FACILITIES
[Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)]
Number of dialy-
Number of Effect of changes Effect of changes Overall effect 3
ESRD provider sis treatments
facilities in floor only 1 in Wage Index 2
(in millions)
All Providers: .................................................... 4,541 31.4 0.0 0.0 0.5

Independent .............................................. 3,958 28.1 0.0 ¥0.1 0.5
Hospital-Based .......................................... 583 3.3 0.0 0.5 1.0
By Facility Size:
Less than 5000 treatments ....................... 1,821 5.4 ¥0.1 ¥0.2 0.3
5000 to 9999 treatments .......................... 1,805 13.0 0.0 0.0 0.6
Greater than 9999 treatments .................. 915 13.0 0.0 0.1 0.6
Type of Ownership:
Profit .......................................................... 3,611 25.6 0.0 ¥0.1 0.4
Nonprofit ................................................... 930 5.9 0.0 0.3 0.8
By Geographic Location:
Rural ......................................................... 1,227 6.5 ¥0.3 ¥0.5 0.0
Urban ........................................................ 3,314 25.0 0.1 0.1 0.6
By Region:
New England ............................................ 154 1.1 0.1 1.6 2.2
Middle Atlantic .......................................... 549 4.0 0.1 0.4 1.0
East North Central .................................... 717 5.1 0.1 ¥0.7 ¥0.2
West North Central ................................... 343 1.7 0.0 ¥0.3 0.3
South Atlantic ............................................ 1,023 7.3 0.0 0.1 0.6
East South Central ................................... 357 2.3 ¥0.3 ¥1.1 ¥0.6
West South Central .................................. 622 4.4 ¥0.1 ¥0.6 ¥0.1
Mountain ................................................... 248 1.4 0.1 0.5 1.0
Pacific ....................................................... 498 3.9 0.1 1.3 1.8
Puerto Rico ............................................... 30 0.4 ¥2.1 ¥3.1 ¥2.6
1 This column only shows the effect of the proposed wage index floor changes on ESRD providers for CY 2008. Composite rate payments
computed using the CY 2008 wage index with a 0.80 floor are compared to composite rate payments using the CY 2008 wage index with a 0.75
floor.
2 This column shows the overall effect of wage index changes on ESRD providers. Composite rate payments computed using the current wage
index are compared to composite rate payments using the CY 2008 wage index changes.
2 This column shows the overall effect of wage index changes on ESRD providers. Composite rate payments computed using the current wage
index are compared to composite rate payments using the CY 2008 wage index changes.
3 This column shows the percent change between CY 2008 and CY 2007 composite rate payments to ESRD facilities. The CY 2008 payments
include the CY 2008 wage adjusted composite rate, and the 15.5 percent drug add-on times treatments. The CY 2007 payments to ESRD facili-
ties includes the CY 2007 wage adjusted composite rate and the 14.9 percent drug add-on times treatments.
G. IDTF Changes help ensure that beneficiaries receive payment rules. These revisions will
quality care. Therefore, we expect to help to clarify payment for CORF
We believe that our proposals have an impact on an unknown number services and are expected to have
regarding IDTFs as discussed in section of persons and entities who will be minimal impact on Medicare
II.I. of this proposed rule would have no denied enrollment into the Medicare expenditures.
budgetary impact. However, we believe program.
that these changes are necessary to
ensure that only legitimate IDTFs are H. CORF Issues
enrolled into the program. In addition, The revisions to the CORF regulations
we believe that the proposed IDTF discussed in section II.K. update the
provisions contained in this rule will regulations for consistency with the PFS
I. Compendia for Determination of days. Certification of the appropriate O. TRHCA 101(d) Physician
Medically-Accepted Indications for Off- length of treatment will discourage the Assistance and Quality Initiative Fund
Label Use of Drugs and Biologicals in an practice of billing for re-evaluations As discussed in section II.T.5. of this
Anti-Cancer Chemotherapeutic Regimen prior to recertification regardless of proposed rule, section 101(d) of the
We anticipate that the proposals need. MIEA–TRHCA created the Physician
related to the compendia discussed in The 30-day recertification allows
Assistance and Quality Initiative Fund
section II.L. of this proposed rule will treatment under a plan of care for 30
(PAQI) which provides $1.35 billion for
have a negligible cost to the Medicare days after initial certification, regardless
physician payment and quality
program. The proposed changes will of the appropriate length of treatment.
The initial certification cannot assure improvement initiatives. The legislation
enable CMS to respond quickly should directs the Secretary to provide for
changes in the number and quality of that a physician reviews the plan or
follows the patient’s progress. expenditures from the Fund in a manner
the compendia indicate a need to amend designed to provide (to the maximum
In 2004 and again in 2006, we
the list. extent feasible) for the obligation of the
received an extensive analysis of the
J. Physician Self-referral Provisions utilization of therapy services. The entire $1.35 billion for payment for
analysis indicates that the recertification physician’s services furnished during
We anticipate that our proposals in 2008.
section II.M. of this proposed rule for has no impact on utilization of services
the reassignment and anti-markup and does not limit payment. About 70 P. TRHCA 110 Reporting of Anemia
provisions, and the physician self- percent of episodes are completed Quality Indicators
referral provisions would result in before the first 30-day recertification
interval. Although CORFs have a 60-day As discussed in section II.T.2. of this
savings to the program by reducing proposed rule, there are no program cost
overutilization and anti-competitive certification period, and SNFs and
outpatient rehabilitation facilities savings or increased expenditure
business arrangements. We cannot associated with this proposed change;
gauge with any certainty the extent of (ORFs) have 30-day certification
periods, the average number of however, we expect that the regulation
these savings to the Medicare program. will have a positive impact on patient
treatment days is similar in these
K. Beneficiary Signature for Ambulance settings. Contrary to the pattern care.
Transport Services expected if certification impacted length Q. Proposed Elimination of Exemption
We believe that our proposal in of care, the number of physical therapy From NCPDP SCRIPT Standard for
section II.N. of this proposed rule for treatment days is higher in SNF than in Computer-Generated Facsimile
allowing the ambulance provider or CORF. Transmissions Under Medicare Part D
supplier to sign the claim on behalf of We propose to review the utilization
of therapy services after a 2-year trial to The proposed elimination of the
the beneficiary with respect to
assess any changes that might be related exemption for computer-generated fax
emergency transport services, provided
to certification of a plan of care for an transactions under Medicare Part D is
that certain conditions are satisfied, will
have no budget impact. appropriate length of treatment. At that discussed in section II.S.3. of this
time, if we determine that this change proposed rule. E-prescribing is
L. Update to Fee Schedules for Class III has caused an increase in inappropriate voluntary for providers and pharmacies.
DME for CYs 2007 and 2008 utilization, we will reconsider the 30- This proposal would affect only
In section II.O. of this proposed rule, day certification requirement. providers and pharmacies that already
we discuss the proposed update to the conduct e-prescribing using products
N. TRHCA 101(b) Physician Quality that generate faxes rather than SCRIPT
fee schedules for class III DME for CYs
Reporting Initiative transactions.
2007 and 2008. Total allowed charges
for class III devices in 2005 were $71 As discussed in section II.T.1. of this We believe that providers and
million. Accordingly, with a zero proposed rule, the proposed 2008 PQRI pharmacies that are now
percent increase for DME, other than measures satisfy the requirement of e-prescribing using products that
class III devices, for 2005 and 2006 and section 1848(k)(2)(B)(ii) of the Act that generate faxes generally already possess
with the proposed establishment of an the Secretary publish in the Federal the hardware necessary to e-prescribe.
update for 2007 of zero percent for class Register by August 15, 2007 a proposed Many would need to obtain software
III devices, rather than 4.3 percent based set of measures that the Secretary upgrades to send and receive the
on the CPI–U, this would result in a determines would be appropriate for SCRIPT transaction. This software will
savings to the Medicare program of eligible professionals to use to submit generally be available to providers
approximately $2 million in FY 2007, data to the Secretary in 2008. We also through automatic version upgrades
$4 million in FY 2008, $4 million in FY expect to address registry-based data built into annual software vendor
2009, $5 million in FY 2010, $5 million submission on a test basis in 2008. As maintenance fees. However, providers
in FY 2011, and $5 million in FY 2012. discussed in section II.T.1. of this currently using software that cannot be
proposed rule, we will also explore and upgraded to generate SCRIPT
M. Therapy Services may offer an option in 2008 for transactions would need to purchase
In section II.S.2., we proposed to reporting some of the 2008 PQRI and install new e-prescribing software
change the certification the plan of care, measures via submission of clinical data or revert to sending paper fax
for outpatient physical therapy, extracted from EHRs. Although there transactions to pharmacies.
occupational therapy and speech- may be some cost incurred for Dispensers that currently e-prescribe
language pathology services from every maintaining the measures and their but have not established the
30 days to an appropriate length, based associated code sets, and for expanding connectivity necessary to receive and
on the patient’s needs, limited to 90 an existing clinical data warehouse to send SCRIPT transactions would need
days. Analysis of Medicare claims data accommodate registry-based data to connect to a network, and may need
shows negative or no impact for this submission, we do not anticipate a to install software upgrades, which will
change. In most cases, the appropriate significant cost impact on the Medicare generally be covered under annual fees.
length of treatment will be less than 30 program. Because pharmacies customarily bear
the cost of transaction fees for the related to specific MMA provisions. The addition, the portion of the 2008
SCRIPT transactions they receive and preamble provides descriptions of the standard monthly Part B premium
send, these costs would increase as the statutory provisions that are addressed, attributable to PFS services is estimated
rate of e-prescribing increases. identifies those policies when discretion to be $38.60.
The proposed elimination of this has been exercised, presents rationale To illustrate this point, as shown in
exemption will have indirect benefits in for our decisions and, where relevant, Table 26, the 2007 national payment
that it will help to encourage e- alternatives that were considered. amount in the nonfacility setting for
prescribing using electronic data CPT code 99203 (Office/outpatient visit,
interchange, which will ultimately T. Impact on Beneficiaries
new), is 91.71 which means that
result in improved patient safety. There are a number of changes made currently a beneficiary is responsible for
Because of the voluntary nature of e- in this proposed rule that would have 20 percent of this amount, or 18.34.
prescribing for physicians and an effect on beneficiaries. In general, we Based on this proposed rule, the 2008
pharmacies, the relatively small number believe these changes, particularly the national payment amount in the
of entities currently e-prescribing, and implementation of the PQRI with its nonfacility setting for CPT code 99203,
the minimal nature of the anticipated continuing focus on measuring, as shown in Table 26, is $81.58 which
costs, we believe this provision does not submitting, and analyzing quality data, means that, in 2008, the beneficiary
constitute a major rule for purposes of will have a positive impact and improve coinsurance for this service would be
this analysis. However, we specifically the quality and value of care provided $16.32.
solicit comments on the impact to to Medicare beneficiaries. Proposed policies discussed in this
providers and pharmacies. We do not believe that beneficiaries rule that do affect overall spending,
R. Revisions to Payment Policies Under will experience drug access issues as a such as the proposed additions to the
the Ambulance Fee Schedule and the result of the proposed changes with list of codes that are subject to section
Ambulance Inflation Factor Update for respect to Part B drugs and CAP. 5102 of the DRA imaging provisions,
CY 2008 As explained in more detail would similarly impact beneficiaries’
Ambulance providers and suppliers subsequently in this section, the coinsurance.
for purposes of the RFA are considered regulatory provisions may affect
U. Accounting Statement
to be small entities. The proposal to beneficiary liability in some cases. Most
remove the requirement that the AIF be changes in aggregate beneficiary liability As required by OMB Circular A–4
published annually via Federal Register from a particular provision would be a (available at http://
notice, as discussed in Section III. of function of the coinsurance (20 percent www.whitehouse.gov/omb/circulars/
this proposed rule has no monetary if applicable for the particular provision a004/a-4.pdf), in Table 28, we have
impact on small entities, or small after the beneficiary has met the prepared an accounting statement
businesses. It merely allows for the deductible) and the effect of the showing the classification of the
earlier dissemination of necessary aggregate cost (savings) of the provision expenditures associated with this
information to the ambulance industry, on the calculation of the Medicare Part proposed rule. This estimate includes
the Medicare contractors, and the B premium rate (generally 25 percent of the incurred benefit impact associated
general public. the provision’s cost or savings). In 2008, with the estimated CY 2008 PFS update,
total cost sharing (coinsurance and shown in this proposed rule, based on
S. Alternatives Considered deductible) per Part B enrollee the 2007 Trustees Report baseline. All
This proposed rule contains a range of associated with physician fee schedule estimated impacts are classified as
policies, including some provisions services is estimated to be $590. In transfers.
TABLE 28.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FROM CY 2007 TO CY 2008

Category Transfers
Annualized Monetized Transfers ........................ Estimated decrease in expenditures of $ 5.9 billion.

From Whom To Whom? ..................................... Physicians, other practitioners and suppliers who receive payment under the Medicare Physi-
cian Fee Schedule; ESRD Medicare Providers; ambulance suppliers, DME suppliers, and
Medicare suppliers billing for Part B drugs to Federal Government.
In accordance with the provisions of 42 CFR Part 411 42 CFR Part 415
Executive Order 12866, this proposed
Kidney diseases, Medicare, Physician Health facilities, Health professions,
rule was reviewed by the Office of Medicare, Reporting and recordkeeping
Management and Budget. Referral, Reporting and recordkeeping
requirements. requirements.
List of Subjects 42 CFR Part 418
42 CFR Part 413
42 CFR Part 409 Health facilities, Hospice care,
Health facilities, Kidney diseases, Medicare, Reporting and recordkeeping
Health facilities, Medicare. Medicare, Reporting and recordkeeping requirements.
42 CFR Part 410 requirements.

42 CFR Part 423
42 CFR Part 414
Health facilities, Health professions, Administrative practice and
Kidney diseases, Laboratories, Administrative practice and procedure, Emergency medical services,
Medicare, Reporting and recordkeeping procedure, Health facilities, Health Health facilities, Health maintenance
requirements, Rural areas, X-rays. professions, Kidney diseases, Medicare, organizations (HMO), Health
Reporting and recordkeeping. Professionals, Medicare, Penalties,
Privacy, Reporting and recordkeeping assistants, occupational therapists, or Subpart C—Posthospital SNF Care
requirements. occupational therapy assistants who
have been licensed, certified, registered 3. Section 409.23 is amended by
42 CFR Part 424 adding paragraph (c) to read as follows:
or otherwise regulated as physical
Emergency medical services, Health therapists, physical therapist assistants, § 409.23 Physical, occupational, and
facilities, Health professions, Medicare, occupational therapists, or occupational speech therapy.
Reporting and recordkeeping therapy assistants by the State in which
requirements. * * * * *
practicing before January 1, 2008 and (c) Except as specified in paragraph
42 CFR Part 482 continue to furnish Medicare services at (c)(1)(ii) of this section, physical
least part time without an interruption therapy, occupational therapy or
Grant programs-health, Hospitals, in furnishing services of more than 2
Medicaid, Medicare, Reporting and speech-language pathology services
years. must be furnished—
recordkeeping requirements. (2) Physical therapy, occupational (1)(i) By qualified physical therapists,
42 CFR Part 484 therapy or speech-language pathology physical therapist assistants,
Grant programs-health, Health services must be furnished under a plan occupational therapists, occupational
facilities, Health professions, Health of treatment that meets the requirements therapy assistants or speech-language
records, Medicaid, Medicare, Nursing of paragraphs (b) through (e) of this pathologists as defined in § 484.4; or
homes, Nutrition, Reporting and section. (ii) By qualified physical therapists,
recordkeeping requirements, Safety. (b) Establishment of the plan. The physical therapist assistants,
plan must be established before occupational therapists, or occupational
42 CFR Part 485 treatment begins by one of the therapy assistants who have been
Grant programs-health, Health following: licensed, certified, registered or
facilities, Medicaid, Medicare, (1) A physician. otherwise recognized by the State in
Reporting and recordkeeping (2) A nurse practitioner, a clinical which practicing before January 1, 2008
requirements. nurse specialist or a physician assistant. and continue to furnish Medicare
(3) The physical therapist furnishing physical therapy or occupational
42 CFR Part 491 the physical therapy services. therapy services at least part time
Grant programs-health, Health (4) A speech-language pathologist without an interruption in furnishing
facilities, Medicaid, Medicare, furnishing the speech-language services of more than 2 years.
Reporting and recordkeeping pathology services. (2) In accordance with a plan of
requirements, Rural areas. (5) An occupational therapist treatment that meets the requirements of
For the reasons set forth in the furnishing the occupational therapy § 409.16(b) through (e) of this part.
preamble, the Centers for Medicare & services.
Medicaid Services proposes to amend (c) Content of the plan. The plan PART 410—SUPPLEMENTARY
42 CFR chapter IV as set forth below: must— MEDICAL INSURANCE (SMI)
(1) Prescribe the type, amount, BENEFITS
PART 409—HOSPITAL INSURANCE frequency, and duration of the physical
BENEFITS therapy, occupational therapy, or 4. The authority citation for part 410
speech-language pathology services to continues to read as follows:
1. The authority citation for part 409
continues to read as follows: be furnished to the individual; and Authority: Secs. 1102, 1834, 1871, and
(2) Indicate the diagnosis and 1893 of the Social Security Act (42 U.S.C.
Authority: Secs. 1102 and 1871 of the 1302, 1395m, 1395hh, and 1395ddd).
Social Security Act (42 U.S.C. 1302 and
anticipated goals.
1395hh). (d) Changes in the plan. Any changes
in the plan must be made in writing, Subpart B—Medical and Other Health
incorporated immediately, and signed Services
Subpart B—Inpatient Hospital Services
and Inpatient Critical Access Hospital by one of the following: § 410.32 [Amended]
Services (1) A physician. 5. Section 410.32 is amended by—
(2) A nurse practitioner, clinical nurse A. Removing paragraph (a)(1).
2. A new § 409.17 is added to read as specialist, or a physician assistant.
follows: B. Redesignating paragraphs (a)(2) and
(3) The physical therapist furnishing (a)(3) as paragraphs (a)(1) and (a)(2).
§ 409.17 Physical therapy, occupational the physical therapy services. 6. Section 410.33 is amended by—
therapy, and speech-language pathology (4) The speech-language pathologist A. Removing the phrase, ‘‘and (h)’’ in
services. furnishing the speech-language the introductory text of paragraph (a)(2)
(a) General rules. (1)(i) Except as pathology services. and adding in its place, ‘‘and (i)’’.
specified in paragraph (a)(1)(ii) of this (5) The occupational therapist B. Revising paragraphs (b)(1), (g)(2),
section, physical therapy, occupational furnishing the occupational therapy (g)(6), and (g)(8).
therapy or speech-language pathology services. C. Adding paragraphs (g)(15) and (i).
services must be furnished by qualified (6) A registered professional nurse or The revisions and additions read as
physical therapists, physical therapist a staff physician, in accordance with follows:
assistants, occupational therapists, verbal orders from one the practitioners
occupational therapy assistants or listed in paragraphs (1) through (5) of § 410.33 Independent diagnostic testing
speech-language pathologists who meet this section. facility.

the requirements specified in § 484.4 of (e) Review of the plan. The physician, * * * * *
this chapter. nurse practitioner, clinical nurse special (b) * * *
(ii) Physical therapy, occupational or physician assistant reviews the plan (1) Each supervising physician must
therapy or speech-language pathology as often as the individual’s condition be limited to providing supervision to
services may be furnished by qualified requires, but at least prior to no more than three IDTF sites. This
physical therapists, physical therapist certification. applies to both fixed sites and mobile
units where three concurrent operations (i) Effective date of billing privileges. 9. Section 410.60 is amended by—
are capable of performing tests. The effective date of billing privileges A. Removing the phrase ‘‘paragraph
* * * * * for a newly enrolled IDTF is the later of (a)(3)(iii)’’ in the introductory text to
(g) * * * the following: paragraph (a) and adding the phrase,
(2) Provides complete and accurate (1) The filing date of the Medicare ‘‘paragraphs (a)(3)(iii) and (iv)’’ in its
information on its enrollment enrollment application that was place.
application. Changes in ownership, subsequently approved by a fee-for- B. Adding a new paragraph (a)(3)(iv).
service contractor; The addition reads as follows:
changes of location, changes in general
supervision, and adverse legal actions (2) The date the IDTF first furnished § 410.60 Outpatient physical therapy
must be reported to the designated fee- services at its new practice location; or services: Conditions.
for-service contractor on the Medicare (3) The filing date of the Medicare
(a) * * *
enrollment application within 30 enrollment application or the date that (3) * * *
calendar days of the change. All other the Medicare fee-for-service contractor (iv) By qualified physical therapists or
changes to the enrollment application receives a signed provider enrollment appropriately supervised physical
must be reported within 90 days. application that it is able to process for therapist assistants who meet the
approval. qualifications in § 484.4 of this chapter
* * * * * 7. Section 410.43 is amended by
(6) Have a comprehensive liability or who have been licensed, certified,
revising paragraph (a)(3)(ii) to read as registered or otherwise recognized by
insurance policy of at least $300,000 per follows:
location that covers both the place of the State in which practicing before
business and all customers and § 410.43 Partial hospitalization services: January 1, 2008 and continue to furnish
employees of the IDTF. The policy must Conditions and exclusions. Medicare physical therapy services at
be carried by a nonrelative-owned (a) * * * least part time without an interruption
company. Failure to maintain required (3) * * * in furnishing services of more than 2
insurance at all times will result in (ii) Occupational therapy requiring years;
revocation of the IDTF’s billing the skills of a qualified occupational * * * * *
privileges retroactive to the date the therapist, provided by an occupational 10. Section 410.61 is amended by
insurance lapsed. IDTF suppliers are therapist, or under appropriate revising paragraph (e)(1) to read as
responsible for providing the contact supervision of a qualified occupational follows:
information for the issuing insurance therapist by an occupational therapy
§ 410.61 Plan of treatment requirements
agent and the underwriter. In addition, assistant— for outpatient rehabilitation services.
the IDTF must— (A) As specified in § 484.4 of this
(i) Ensure that the insurance policy chapter; or * * * * *
(B) Who has been licensed, certified, (e) * * *
must remain in force at all times and (1) The physician, nurse practitioner,
provide coverage of at least $300,000 registered or otherwise recognized as an
clinical nurse specialist or physician’s
per incident; occupational therapist or occupational
assistant reviews the plan as often as the
(ii) Notify the CMS designated therapy assistant by the State in which
individual’s condition requires, but at
contractor in writing of any policy practicing before January 1, 2008 and
least at every certification and
changes or cancellations; and continues to furnish Medicare
recertification.
(iii) List the CMS designated occupational therapy services at least
contractor as a Certificate Holder on the part time without an interruption in * * * * *
furnishing services of more than 2 years. 11. Section 410.78 is amended by
policy.
revising the introductory text of
* * * * * * * * * *
paragraph (b) to read as follows:
(8) Answer, document, and maintain 8. Section 410.59 is amended by—
documentation of all beneficiaries’ A. Removing the phrase ‘‘paragraph § 410.78 Telehealth services.
questions and responses to their (a)(3)(iii)’’ in the introductory text to * * * * *
complaints at the physical site of the paragraph (a) and adding the phrase, (b) General rule. Medicare Part B pays
IDTF. This includes, but is not limited ‘‘paragraphs (a)(3)(iii) and (iv)’’ in its for office and other outpatient visits,
to, the following: place. professional consultation, psychiatric
(i) The name, address, telephone B. Adding a new paragraph (a)(3)(iv). diagnostic interview examination,
number, and health insurance claim The addition reads as follows: individual psychotherapy,
number of the beneficiary. § 410.59 Outpatient occupational therapy pharmacologic management, end stage
(ii) A summary of the complaint; the services: Conditions. renal disease related services included
date it was received; the name of the (a) * * * in the monthly capitation payment
person receiving the complaint; and a (3) * * * (except for one visit per month to
summary of actions taken to resolve the (iv) By qualified occupational examine the access site), individual
complaint. therapists or appropriately supervised medical nutrition therapy, and
(iii) If an investigation was not occupational therapy assistants who neurobehavioral status exam furnished
conducted, the name of the person meet the qualifications in § 484.4 of this by an interactive telecommunications
making the decision and the reason for chapter or who have been licensed, system if the following conditions are
the decision. For mobile IDTFs, this certified, registered or otherwise met:
documentation would be stored at their recognized by the State in which * * * * *

home office. practicing before January 1, 2008 and
* * * * * continue to furnish Medicare Subpart D—Comprehensive Outpatient
(15) Does not share space, equipment, occupational therapy services at least Rehabilitation Facility (CORF) Services
or staff or sublease its operations to part time without an interruption in 12. Section 410.100 is amended by—
another individual or organization. furnishing services of more than 2 years; A. Revising the introductory text and
* * * * * * * * * * paragraphs (a), (e), and (h).
B. Removing paragraphs (i) and (k). (i) Nursing care services. Nursing care services provided by a registered
C. Redesignating paragraphs (j), (l), services include nursing services dietitian or nutrition professional as
and (m) to (i), (j), and (k), respectively. provided by a registered nurse that are defined in § 410.134 when the
D. Revising new paragraphs (i), (j), prescribed by a physician and are beneficiary is referred for the service by
and (k). specified in or directly related to the the treating physician. Except as
The revisions read as follows: rehabilitation treatment plan and provided at § 410.78, services covered
§ 410.100 Included services.
necessary for the attainment of the consist of face-to-face nutritional
rehabilitation goals of the physical assessments and interventions in
Subject to the conditions and
therapy, occupational therapy, speech- accordance with nationally-accepted
limitations set forth in § 410.102 and language pathology, or respiratory dietary or nutritional protocols.
§ 410.105, CORF services means the therapy plan of treatment.
following services furnished to an * * * * *
(j) Supplies and durable medical
outpatient of the CORF by personnel equipment. Supplies and durable PART 411—EXCLUSIONS FROM
that meet the qualifications set forth in medical equipment include the MEDICARE AND LIMITATIONS ON
§ 485.70 of this chapter. Payment for following: MEDICARE PAYMENT
CORF services are made in accordance (1) Disposable supplies.
with § 414.1101 of this chapter. (2) Durable medical equipment of the 15. The authority citation for part 411
(a) Physician’s services. CORF facility type specified in § 410.38 (except for continues to read as follows:
physician services are administrative in renal dialysis systems) for a patient’s
nature and include consultation with Authority: Secs. 1102, 1860D–1 through
use outside the CORF, whether 1860D–42, 1871, and 1877 of the Social
and medical supervision of purchased or rented. Security Act (42 U.S.C. 1302, 1395w–101
nonphysician staff, participate in plan (k) Home environment evaluation. A through 1395w–152, 1395hh, and 1395nn).
of treatment reviews and patient care home environment evaluation—
review conferences, and other medical (1) Is a single home visit to evaluate Subpart A—General Exclusions and
and facility administration activities. the potential impact of the home Exclusion of Particular Services
Diagnostic and therapeutic services situation on the patient’s rehabilitation
furnished to an individual CORF patient goals. 16. Section 411.15 is amended by—
by a physician in a CORF facility are not (2) Requires the presence of the A. Revising paragraph (a)(1).
CORF physician services. These patient and the physical therapist, B. Adding paragraphs (k)(13) and
services, if covered, are physician occupational therapist, or speech- (k)(14).
services under § 410.20 with payment language pathologist, as appropriate. The revision and additions read as
for these services made to the physician 13. Section 410.105 is amended by follows:
in accordance with part 414 subpart B revising paragraphs (b)(3)(i) and (ii),
of this chapter. (c)(1) introductory text, and (c)(1)(ii) to § 411.15 Particular services excluded from
read as follows: coverage.
* * * * *
(e) Respiratory therapy services. (1) * * * * *
§ 410.105 Requirements for coverage of
Respiratory therapy services are for the CORF services. (a) * * *
treatment, and monitoring of patients * * * * * (1) Examinations performed for a
with deficiencies or abnormalities of (b) * * * purpose other than treatment or
cardiopulmonary function. (3) * * * diagnosis of a specific illness,
(2) Respiratory therapy services (i) Physical therapy, occupational symptoms, complaint, or injury, except
include the following: therapy, and speech-language pathology for screening mammography, colorectal
(i) Application of techniques for services may be furnished away from cancer screening tests, screening pelvic
support of oxygenation and ventilation the premises of the CORF including the exams, prostate cancer screening tests,
of the patient. individual’s home when payment is not glaucoma screening exams, initial
(ii) Therapeutic use and monitoring of otherwise made under Title XVIII of the preventive physical exams, ultrasound
gases, mists, and aerosols and related Act. screening for abdominal aortic
equipment. (ii) The single home environment aneurysms (AAA), cardiovascular
(iii) Bronchial hygiene therapy. evaluation visit specified in disease screening tests, or diabetes
(iv) Pulmonary rehabilitation § 410.100(m) is also covered. screening tests that meet the criteria
techniques to develop strength and (c) * * * specified in paragraphs (k)(6) through
endurance of respiratory muscles and (1) The service must be furnished (k)(14) of this section.
other techniques to increase respiratory under a written rehabilitation plan of
function, such as graded activity * * * * *
treatment that—
services; these services include (i) * * * (k) * * *
physiologic monitoring and patient (ii) Indicates the diagnosis and (13) In the case of cardiovascular
education. rehabilitation goals, and prescribes the disease screening tests for the early
* * * * * type, amount, frequency, and duration detection of cardiovascular disease or
(h) Social and psychological services. of the services to be furnished that relate abnormalities associated with an
Social and psychological services directly to such rehabilitation goals. elevated risk for that disease, subject to
include the assessment and treatment of * * * * * the conditions specified in § 410.17 of
an individual’s mental and emotional this chapter.
functioning and the response to and rate Subpart G—Medical Nutrition Therapy (14) In the case of diabetes screening
of progress as it relates to the tests furnished to an individual at risk
14. Section 410.132 is amended by
individual’s rehabilitation plan of for diabetes for the purpose of the early
revising paragraph (a) to read as follows:
treatment, including physical therapy detection of that disease, subject to the
services, occupational therapy services, § 410.132 Medical nutrition therapy. conditions specified in § 410.18 of this
speech-language pathology services and (a) Conditions for coverage of MNT chapter.
respiratory therapy services. services. Medicare Part B pays for MNT * * * * *
Subpart J—Financial Relationships to establish that the service was not (4) The rental charges over the term of
Between Physicians and Entities furnished pursuant to a prohibited the agreement are set in advance, are
Furnishing Designated Health Services referral (and not on CMS or its consistent with fair market value, and
contractors to establish that the service are not determined in a manner that
17. Section 411.351 is amended by was furnished pursuant to a prohibited takes into account the volume or value
revising the definition of ‘‘entity’’ to referral). of any referrals or other business
read as follows: 19. Section 411.354 is amended by generated between the parties. Per unit-
§ 411.351 Definitions. revising paragraphs (b)(3)(i) and (d)(1) to of-service rental charges are not allowed
read as follows: to the extent that such payments reflect
* * * * *
Entity means— services provided to patients referred by
§ 411.354 Financial relationship,
(1) A physician’s sole practice or a compensation, and ownership or
the lessor to the lessee.
practice of multiple physicians or any investment interest. * * * * *
other person, sole proprietorship, public * * * * *
or private agency or trust, corporation, PART 413—PRINCIPLES OF
(b) * * *
partnership, limited liability company, (3) * * * REASONABLE COST
foundation, nonprofit corporation, or (i) An interest in an entity that arises REIMBURSEMENT; PAYMENT FOR
unincorporated association that from a retirement plan offered by that END-STAGE RENAL DISEASE
furnishes DHS. An entity does not entity to the physician or immediate SERVICES; PROSPECTIVELY
include the referring physician himself family member through the physician’s DETERMINED PAYMENT RATES FOR
or herself, but does include his or her or immediate family member’s SKILLED NURSING FACILITIES
medical practice. A person or entity is employment with that entity; 21. The authority citation for part 413
considered to be furnishing DHS if it— * * * * * continues to read as follows:
(i) Is the person or entity that has (d) * * *
performed the DHS, or (1) Compensation will be considered Authority: Secs. 1102, 1812(d), 1814(b),
(ii) Presented a claim or caused a 1815, 1833(a), (i), and (n), 1861(v), 1871,
‘‘set in advance’’ if the aggregate
1881, 1883, and 1886 of the Social Security
claim to be presented for Medicare compensation, a time-based or per unit Act (42 U.S.C. 1302, 1395d(d), 1395f(b),
benefits for the DHS. of service based (whether per-use or per- 1395g, 1395l(a), (i), and (n), 1395x(v),
(2) For purposes of this subpart, service) amount, or a specific formula 1395hh, 1395rr, 1395tt, and 1395ww); and
‘‘entity’’ includes a health plan, for calculating the compensation is set sec. 124 of Pub. L. 106–133 (113 Stat. 1501A–
managed care organization (MCO), in an agreement between the parties 332).
provider sponsored organization (PSO), before the furnishing of the items or
or independent practice association services for which the compensation is Subpart A—Introduction and General
(IPA) that employs a supplier or to be paid. The formula for determining Rules
operates a facility that could accept the compensation must be set forth in § 413.1 [Amended]
reassignment from a supplier pursuant sufficient detail so that it can be
to § 424.80 of this chapter, with respect objectively verified, and the formula 22. Section 413.1 is amended by—
to any designated health services may not be changed or modified during A. Removing paragraphs (a)(2)(iv) and
provided by that supplier; ‘‘entity’’ does the course of the agreement in any (vi).
not include a health care delivery manner that reflects the volume or value B. Redesignating paragraphs (a)(2)(v)
system that is a health plan (as defined of referrals or other business generated and (vii) as paragraphs (a)(2)(iv) and (v),
in § 1001.952(l) of this title), or any by the referring physician. Percentage- respectively.
MCO, PSO or IPA with which a health based compensation, other than
plan contracts for services provided to compensation based on revenues Subpart H—Payment for End-Stage
plan enrollees. directly resulting from personally Renal Disease (ESRD) Services and
(3) For purposes of this subpart, performed physician services (as Organ Procurement Costs
‘‘entity’’ does not include a physician’s defined in § 410.20(a)), is not
practice when it bills Medicare for a considered set in advance. 23. Section 413.184 is amended by
diagnostic testing accordance with * * * * * revising the section heading as set forth
§ 414.50 of this chapter (Physician 20. Section 411.357 is amended by below:
billing for purchased diagnostic tests) revising paragraphs (a)(5) and (b)(4) to § 413.184 Payment exception: Pediatric
and section 30.2.9 of the Internet-Only read as follows: patient mix.
Manual, Pub.100–04, Chapter 1, General
Billing Requirements. § 411.357 Exceptions to the referral * * * * *
prohibition related to compensation
* * * * * arrangements. PART 414—PAYMENT FOR PART B
18. Section 411.353 is amended by MEDICAL AND OTHER HEALTH
adding paragraph (g) to read as follows: * * * * *
(a) * * * SERVICES
§ 411.353 Prohibition on certain referrals (5) The rental charges over the term of 24. The authority citation for part 414
by physicians and limitations on billing. the agreement are not determined in a is revised to read as follows:
* * * * * manner that takes into account the
(g) Denial of payment for services volume or value of any referrals or other Authority: Secs. 1102, 1871, and 1881(b)(l)
business generated between the parties. of the Social Security Act (42 U.S.C. 1302,
furnished under a prohibited referral. 1395hh, and 1395rr(b)(l)).
When payment for a designated health Per unit-of-service rental charges are not
service is denied on the basis that the allowed to the extent that such charges Subpart B—Physicians and Other
service was furnished pursuant to a reflect services provided to patients Practitioners
prohibited referral, and such payment referred by the lessor to the lessee.
denial is appealed, the burden is on the * * * * * 25. Section 414.50 is revised to read
entity submitting the claim for payment (b) * * * as follows:
§ 414.50 Physician billing for purchased § 414.65 Payment for telehealth services. § 414.509 Reconsideration of basis for and
diagnostic tests. amount of payment for a new clinical
(a) * * * diagnostic laboratory test.
(a) General rule. (1) For services
(1) The Medicare payment amount for For a new test for which a new or
covered under section 1861(s)(3) of the
office or other outpatient visits, substantially revised HCPCS code was
Act and paid for under part 414 of this
consultation, individual psychotherapy, assigned on or after January 1, 2008, the
chapter (other than clinical diagnostic
psychiatric diagnostic interview following reconsideration procedures
laboratory tests paid under section
examination, pharmacologic apply:
1833(a)(2)(D) of the Act, which are
management, end stage renal disease (a) Reconsideration of basis for
subject to the special rules set forth in
related services included in the monthly payment. (1) CMS will receive public
section 1833(h)(5)(A) of the Act), if a
capitation payment (except for one visit comments in written format for 60 days
physician or medical group bills for the
per month to examine the access site), after making a determination of the
technical or professional component of
individual medical nutrition therapy, basis for payment under § 414.506(d)(2)
a diagnostic test that was performed by
and neurobehavioral status exam regarding whether CMS should
an outside supplier, the payment to the
furnished via an interactive reconsider the basis for payment and
physician or the medical group (less the
telecommunications system is equal to why a different basis for payment would
applicable deductibles and coinsurance)
the current fee schedule amount be more appropriate. If a commenter
for the technical or professional
applicable for the service of the recommends that the basis for payment
component of the test may not exceed
physician or practitioner. should be changed from gapfilling to
the lowest of the following amounts:
(i) The supplier’s net charge to the * * * * * crosswalking, the commenter may also
physician or medical group. recommend the code or codes to which
Subpart G—Payment for New Clinical to crosswalk the new test.
(ii) The physician’s or medical Diagnostic Laboratory Tests
group’s actual charge. (2) At the meeting convened under
(iii) The fee schedule amount for the § 414.506(c), those commenters who
27. Section § 414.502 is amended by submitted comments within the 60-day
test that would be allowed if the adding the definition, ‘‘New test’’ in
supplier billed directly. comment period may present their
alphabetical order to read as follows: comments.
(2) This provision applies regardless
§ 414.502 Definitions. (3) Considering comments received,
of whether the test or its interpretation
CMS may reconsider its determination
was purchased by the physician or * * * * *
of the basis for payment. As the result
medical group billing for the test or the New test means any clinical of such a reconsideration, CMS may
interpretation, or whether the right to diagnostic laboratory test for which a change the basis for payment from
bill for the test or its interpretation was new or substantially revised Healthcare crosswalking to gapfilling or from
reassigned to the physician or medical Common Procedure Coding System gapfilling to crosswalking.
group billing for the test or the Code is assigned on or after January 1, (4) If the basis for payment is revised
interpretation. 2005. as the result of a reconsideration, the
(3) For purposes of paragraph (a) of * * * * * new basis for payment is final and is not
this section— subject to further reconsideration.
(i) The physician’s or other supplier’s 28. Section 414.506 is amended by
revising the introductory text to read as (b) Reconsideration of amount of
net charge must be determined without payment—(1) Crosswalking. (i) For 60
regard to any charge that is intended to follows:
days after making a determination under
reflect the cost of equipment or space § 414.506 Procedures for public § 414.506(d)(2) of the code or codes to
leased to the outside supplier by or consultation for payment for a new clinical which a new test will be crosswalked,
through the billing physician or medical diagnostic laboratory test. CMS receives public comments in
group. For a new test, CMS determines the written format regarding whether CMS
(ii) An outside supplier is someone basis for and amount of payment after should reconsider its determination and
other than a full-time employee of the performance of the following: the recommended code or codes to
billing physician or medical group. which to crosswalk the new test.
* * * * *
(b) Restriction on payment. (1) The (ii) At the meeting convened under
physician or medical group must 29. Section 414.508 is amended by
§ 414.506(c), those commenters who
identify the supplier and indicate the revising paragraph (b)(3) to read as
submitted comments within the 60-day
supplier’s net charge for the test. If the follows:.
comment period may present their
physician or medical group fails to § 414.508 Payment for a new clinical comments.
provide this information, CMS makes no diagnostic laboratory test. (iii) Considering comments received,
payment to the physician or medical * * * * * CMS may reconsider its determination
group and the physician or medical of the amount of payment. As the result
group may not bill the beneficiary. (b) * * *
of such a reconsideration, CMS may
(2) Physicians and medical groups (3) For a new test for which a new or change the code or codes to which the
that accept Medicare assignment may substantially revised HCPCS code was new test is crosswalked.
bill beneficiaries for only the applicable assigned on or before December 31, (iv) If CMS changes the basis for
deductibles and co-insurance. 2007, after the first year of gapfilling, payment from gapfilling to crosswalking
(3) Physicians and medical groups CMS determines whether the carrier- as a result of a reconsideration, the
that do not accept Medicare assignment specific amounts will pay for the test crosswalked amount of payment is not
may not bill the beneficiary more than appropriately. If CMS determines that subject to reconsideration.
the payment amount described in the carrier-specific amounts will not pay (2) Gapfilling. (i) By April 30 of the
paragraph (a) of this section. for the test appropriately, CMS may year after CMS makes a determination
26. Section 414.65 is amended by crosswalk the test. under § 414.506(d)(2) or § 414.509(a)(3)
revising paragraph (a)(1) to read as 30. Section 414.509 is added to read that the basis for payment for a new test
follows: as follows: will be gapfilling, CMS posts interim
carrier-specific amounts on the CMS Subpart I—Payment for Drugs and § 414.904 Average sales price as the basis
Web site. Biologicals for payment.
(ii) For 60 days after CMS posts * * * * *
33. Section 414.707 is amended by (d) * * *
interim carrier-specific amounts on the adding paragraph (c) to read as follows:
CMS Web site, CMS will receive public (3) Widely available market price and
comments in written format regarding § 414.707 Basis of payment. average manufacturer price. If the
whether CMS should reconsider the Inspector General finds that the average
* * * * * sales price exceeds the widely available
interim payment amounts and the (c) Mandatory reporting of anemia
appropriate national limitation amount market price or the average
quality indicators for Medicare part B
for the new test. manufacturer price by 5 percent or more
cancer anti-anemia drugs. Effective
in calendar year 2008, the payment limit
(iii) Considering comments received, January 1, 2008, each request for
in the quarter following the transmittal
CMS may reconsider its determination payment for anti-anemia drugs
of this information to the Secretary is
of the amount of payment. As the result furnished to treat anemia resulting from
the lesser of the widely available market
of a reconsideration, CMS may revise the treatment of cancer must report the
price or 103 percent of the average
the national limitation amount for the beneficiary’s most recent hemoglobin or
manufacturer price.
new test. hematocrit level in a manner specified
by the Secretary. * * * * *
(3) For both gapfilled and crosswalked 37. Section 414.908 is amended by—
new tests, if CMS revises the amount of Subpart J—Submission of A. Revising paragraph (a)(2)(iv).
payment as the result of a Manufacturer’s Average Sales Price B. Revising paragraph (a)(3)(xi).
reconsideration, the new amount of Data C. Removing paragraph (a)(5).
payment is final and is not subject to The revision reads as follows:
further reconsideration. 34. Section 414.802 is amended by
adding the definition of ‘‘bundled § 414.908 Competitive acquisition
(c) Effective date. If CMS changes a program.
determination as the result of a arrangement’’ in alphabetical order to
read as follows: (a) * * *
reconsideration, the new determination (2) * * *
regarding the basis for or amount of § 414.802 Definitions. (iv) For other exigent circumstances
payment is effective January 1 of the * * * * * defined by CMS, including—
year following reconsideration. Claims Bundled arrangement means an (A) If the approved CAP vendor
for services with dates of service prior arrangement regardless of physical refuses to ship to the participating CAP
to the effective date will not be packaging under which the rebate, physician because the conditions of
reopened or otherwise reprocessed. discount, or other price concession is § 414.914(h) have been met, the
(d) Jurisdiction for Reconsideration conditioned upon the purchase of the physician can withdraw from the CAP
Decisions. Jurisdiction for reconsidering same drug or biological or other drugs category for the remainder of the year
a determination rests exclusively with or biologicals or some other immediately upon notice to CMS and
the Secretary. A decision whether to performance requirement (for example, the approved CAP vendor.
reconsider a determination is committed the achievement of market share, (B) If, during the first 30 days of
to the discretion of the Secretary. A inclusion or tier placement on a participation in the CAP, the
decision not to reconsider an initial formulary, purchasing patterns, prior participating physician can document
determination is not subject to purchases), or where the resulting significant burden to the practice and
administrative or judicial review. discounts or other price concessions are the physician has attempted resolution
31. Section 414.510 is amended by— greater than those that would have been through the vendor’s grievance process,
available had the bundled drugs or the CAP dispute resolution process, and
A. Revising the section heading to biologicals been purchased separately or the request has been approved by CMS.
read as set forth below. outside of the bundled arrangement. (3) * * *
B. Revising the introductory text. * * * * * (xi) Agrees to submit documentation
35. Section 414.804 is amended by such as medical records or certification,
The revisions read as follows:
adding paragraph (a)(2)(iii) to read as as necessary, to support payment for a
§ 414.510 Laboratory date of service for follows: CAP drug;
clinical laboratory and pathology * * * * *
specimens. § 414.804 Basis of payment. 38. Section 414.914 is amended by—
The date of service for either a clinical (a) * * * A. Redesignating paragraph (h) as (i)
laboratory test or the technical (2) * * * B. Adding new paragraph (h).
component of physician pathology (iii) For the purposes of paragraph C. Revising new paragraphs (i)(1) and
service is as follows: (a)(2)(i) of this section, the total value of (2).
all price concessions on all drugs sold The addition and revision reads as
* * * * * follows:
under a bundled arrangement must be
Subpart H—Fee Schedule for allocated proportionately according to
§ 414.914 Terms of contract.
Ambulance Services the dollar value of the units of each drug
sold under the bundled arrangement. * * * * *
(h) The approved CAP vendor must
§ 414.620 [Amended] * * * * * verify drug administration prior to

32. In § 414.620, the phrase ‘‘notice in Subpart K—Payment for Drugs and collection of any applicable cost sharing
the Federal Register without Biologicals Under Part B amount.
opportunity for prior comment’’ is (1) The approved CAP vendor is
removed and the phrase ‘‘CMS by 36. Section 414.904 is amended by expected to document, in writing, the
instruction and on the CMS Web site’’ revising paragraph (d)(3) to read as following information necessary to
is added in its place. follows: verify drug administration:
(i) Beneficiary’s name. terminate his or her participation in the information on dosage, as well as
(ii) Medicare health insurance number CAP. recommended or endorsed uses in
(HIC). (C) Recommend to CMS that the specific diseases. A compendium is
(iii) Expected date of service. physician not be permitted to terminate indexed by drug or biological.
(iv) Actual date of service. his or her participation in the CAP and (b) Process for listing compendia for
(v) Name of the CAP physician. refer to the CAP designated carrier’s determining medically-accepted uses of
(vi) CAP prescription order number. dispute resolution process. drugs and biologicals in anti-cancer
(2) If the information is obtained (2) As a result of the findings as treatment. (1) The process states that
verbally, the approved CAP vendor specified in paragraph (d)(1) of the CMS—
must also maintain the following section, CMS will—: (i) Solicits requests annually for
information: (i) Consider the designated carrier’s changes to the list of compendia. This
(i) The identities of individuals who recommendation and approve or deny solicitation specifies a 30-day time
exchanged the information. the request to terminate participation in
(ii) The date and time that the period within which CMS receives
the CAP within 2 business days of requests, to begin no earlier than 45
information was obtained.
receipt of the recommendation. A denial days after publication of the solicitation.
(3) The approved CAP vendor must
of the participating CAP physician’s (ii) Publishes a listing of the timely
provide this information to CMS or the
request to terminate participation in the complete requests received and solicit
beneficiary upon request.
(i) * * * CAP and will include notification of the public comment on the requests for 30
(1) Subsequent to receipt of payment right to request reconsideration under days. The listing identifies the requestor
by Medicare, or the verification of drug this section. and the requested action.
administration by the participating CAP (ii) Communicate the decision to the (iii) Considers a compendium’s
physician, the approved CAP vendor appropriate Medicare contractors and attainment of the MedCAC (Medicare
must bill any applicable supplemental the participating CAP physician. Evidence Development and Coverage
insurance policies. (3) Upon termination of participation Advisory Committee, previously known
(2) An approved CAP vendor that has in the CAP a physician must agree to the as the MCAC-Medicare Coverage
received payment for the CAP- following: Advisory Committee) recommended
designated carrier for CAP drugs that (i) Continue to submit claims for desirable characteristics of compendia
have not been administered must drugs supplied and administered under in reviewing requests. CMS may
promptly refund payment for such the CAP prior to the effective date of the consider additional reasonable factors.
drugs to the CAP-designated carrier and physician’s termination consistent with (iv) Considers a compendium’s
must refund any coinsurance and § 414.908(a) until all such claims are grading of evidence used in making
deductible collected from the timely submitted. recommendations regarding off-label
beneficiary and his or her supplemental (ii) Return any unused CAP drugs that uses and the process by which the
insurer. had not been administered to the compendium grades the evidence.
beneficiary prior to the effective date of (v) Publishes its decision no later than
* * * * * the physician’s termination from the
39. Section 414.917 is amended by— 120 days after the close of the public
A. Revising the section heading. CAP to the approved CAP vendor comment period.
B. Adding paragraph (d). consistent with applicable law and (2) Exception. In addition to the
The revision and addition reads as regulation and any agreement with the annual process outlined in paragraph
follows: approved CAP vendor. (b)(1) of this section, CMS may generate
(iii) Cooperate in any post-payment a request for changes to the list of
§ 414.917 Dispute resolution and process review activities on claims submitted compendia at any time.
for suspension or termination of approved under the CAP, as required under
CAP contract and termination of physician (c) Written request for review. (1) CMS
section 1847B(a)(3) of the Act. will review a complete, written request
participation under exigent circumstances. (4) An approved CAP vendor that has
* * * * * that is submitted in writing,
billed and been paid for CAP drugs that electronically or via hard copy (no
(d) CAP participating physicians’ have not been administered must refund
exigent circumstances provision. The duplicate submissions) and includes the
any payments made by CMS or the following:
following process must be completed for beneficiary and his or her supplemental
CAP participating physicians’ (i) The full name and contact
insurer in accordance with information of the requestor.
requesting to terminate their § 414.914(h)(3)(i)(2).
participation in the program under (ii) The full identification of the
40. Section 414.930 is added to compendium that is the subject of the
exigent circumstances provisions subpart K to read as follows:
described in § 414.908(a)(2)(iv): request, including name, publisher,
(1) The designated carrier must— § 414.930 Compendia for determination of edition if applicable, date of
(i) Determine whether a request to medically-accepted indications for off-label publication, and any other information
terminate CAP participation was related uses of drugs and biologicals in an anti- needed for the accurate and precise
to approved CAP vendor service and cancer chemotherapeutic regimen. identification of the specific
whether to forward the issue to the (a) Definition. For purposes of this compendium.
approved CAP vendor’s grievance section, compendium means a (iii) A complete written copy of the
process within 1 business day of the comprehensive listing of FDA-approved compendium that is the subject of the
receipt of the request; or, drugs and biologicals or a request.
(ii) Continue to investigate and within comprehensive listing of a specific (iv) The specific action that is
2 business days of receipt, and may do subset of drugs and biologicals in a requested of CMS.
any of the following: specialty compendium, for example a (v) Materials that the requestor must
(A) Request a single, 2-business day compendium of anti-cancer treatment. A submit for CMS review in support of the
extension. compendium includes a summary of the requested action.
(B) Recommend to CMS that the pharmacologic characteristics of each (vi) A single compendium as its
requesting physician be permitted to drug or biological and may include subject.
(2) CMS may at its discretion combine (2) The amount determined under the § 414.510 of this chapter applies for the
and consider multiple requests that refer DMEPOS fee schedule established technical component of specimens for
to the same compendium. under part 414 Subparts D and F for the physician pathology services.
(d) Other provisions. (1) For each item, provided that payment for such
compendium that is determined by CMS item is not included in the payment PART 418—HOSPICE CARE
to be included on the list, the publisher amount for other CORF services paid 44. The authority citation for part 418
or its designee must notify CMS, within under paragraph (a) of this section. continues to read as follows:
45 days of any update or revision that (d) Payment for CORF services when
a new edition or version is available. no fee schedule amount for the service. Authority: Secs. 1102 and 1871 of the
Failure to meet this requirement may If there is no fee schedule amount Social Security Act (42 U.S.C. 1302 and
result in removal of the compendium 1395hh).
established for a CORF service, payment
from the list. for the item or service will be the lesser
(2) For the purposes of this section, Subpart E—Condition of Participation:
of 80 percent of: Other Services
publication by CMS may be (i) The actual charge for the service
accomplished by posting on the CMS provided that payment for such item or 45. Section 418.92 is amended by
Web site. service is not included in the payment revising paragraph (a) to read as follows:
41. Subpart M is added to read as amount for other CORF services paid
follows: under paragraphs (a) or (c) of this § 418.92 Condition of participation—
Physical therapy, occupational therapy, and
section. speech-language pathology.
Subpart M—Payment for (ii) The amount determined under the
Comprehensive Outpatient fee schedule established for a (a) Physical therapy, occupational
Rehabilitation Facility (CORF) Services comparable service as specified by the therapy, and speech-language pathology
Secretary provided that payment for services must be—
§ 414.1100 Basis and Scope.
such item or service is not included in (1) Available, and when provided,
This subpart implements sections offered in a manner consistent with
1834(k)(1) and (k)(3) of the Act by the payment amount for other CORF
services paid under paragraphs (a) or (c) accepted standards of practice; and
specifying the payment methodology for (2) Furnished by personnel who meet
comprehensive outpatient rehabilitation of this section.
the qualifications specified in § 484.4 of
facility services covered under Part B of this chapter.
PART 415—SERVICES FURNISHED BY
Title XVIII of the Act that are described
PHYSICIANS IN PROVIDERS, * * * * *
at section 1861(cc)(1) of the Act.
SUPERVISING PHYSICIANS IN
§ 414.1105 Payment for Comprehensive TEACHING SETTINGS, AND PART 423—VOLUNTARY MEDICARE
Outpatient Rehabilitation Facility (CORF) RESIDENTS IN CERTAIN SETTINGS PRESCRIPTION DRUG BENEFIT
Services.
42. The authority citation for part 415 46. The authority citation for part 423
(a) Payment under the physician fee
continues to read as follows: continues to read as follows:
schedule. Except as otherwise specified
under paragraphs (b), (c), and (d) of this Authority: Secs. 1102 and 1871 of the Authority: Secs 1102, 1860D’1 through
section payment for CORF services, as Social Security Act (42 U.S.C. 1302 and 1860D’42, and 1871 of the Social Security
defined under § 410.100 of this chapter, 1395hh). Act (42 U.S.C. 1302, 1395w’101 through
1395w’152, and 1395hh).
is paid the lesser of 80 percent of the Subpart C—Part B Carrier Payments
following: for Physician Services to Beneficiaries Subpart D—Cost Control and Quality
(1) The actual charge for the item or Improvement Requirements
in Providers
service; or
(2) The nonfacility amount 43. Section 415.130 is amended by § 423.160 [Amended]
determined under the physician fee revising paragraph (d) to read as 47. Section 423.160 is amended by—
schedule established under section follows: A. Removing paragraph (a)(3)(i).
1848(b) of the Act for the item or B. Redesignating paragraphs (a)(3)(ii)
service. § 415.130 Conditions for payment:
Physician pathology services. and (iii) to (a)(3)(i) and (ii), respectively.
(b) Payment for physician services. No
separate payment for physician services * * * * * PART 424—CONDITIONS FOR
that are CORF services under (d) Physician pathology services MEDICARE PAYMENT
§ 410.100(a) of this chapter will be furnished by an independent laboratory.
made. The technical component of physician 48. The authority citation for part 424
(c) Payment for supplies and durable pathology services furnished by an continues to read as follows:
medical equipment, and prosthetic and independent laboratory to a hospital Authority: Secs. 1102 and 1871 of the
orthotic devices. Supplies and durable inpatient or outpatient on or before Social Security Act (42 U.S.C. 1302 and
medical equipment that are CORF December 31, 2007, may be paid to the 1395hh).
services under § 410.100(l) of this laboratory by the carrier under the
chapter, prosthetic device services that physician fee schedule if the Medicare Subpart B—Certification and Plan of
are CORF services under § 410.100(f) beneficiary is a patient of a covered Treatment Requirements
and orthotic devices that are CORF hospital as defined in paragraph (a)(1) of 49. Section 424.24 is amended by
services under § 410.100(g) of this this section. For services furnished after revising paragraphs (c)(2) and (c)(4) to
chapter are paid the lesser of 80 percent December 31, 2007, an independent read as follows:
of the following: laboratory may not bill the carrier for
(1) The actual charge for the service the technical component of physician § 424.24 Requirements for medical and
provided that payment for such item is pathology services furnished to a other health services furnished by
not included in the payment amount for hospital inpatient or outpatient. For providers under Medicare Part B.
other CORF services paid under services furnished on or after January 1, * * * * *
paragraph (a) of this section; or 2008, the date of service policy in (c) * * *
(2) Timing. The certification must be and adding in its place the reference the professional component of the
obtained at the time the plan of ‘‘§ 424.36(b)(1) through (5).’’ service.
treatment is established or as soon
thereafter as possible. Subpart F—Limitations on Assignment PART 482—CONDITIONS OF
(4) Recertification—(i) Timing. and Reassignment of Claims PARTICIPATION FOR HOSPITALS
Recertification is required at least every 52. Section 424.80 is amended by 53. The authority citation for part 482
90 days. adding paragraph (d)(3) to read as
(ii) Content. When it is recertified, the continues to read as follows:
follows: Authority: Secs. 1102 and 1871 of the
plan or other documentation in the
patient’s record must indicate the § 424.80 Prohibition of reassignment of Social Security Act (42 U.S.C. 1302 and
continuing need for physical therapy, claims by suppliers. 1395hh).
occupational therapy or speech- * * * * * Subpart D—Optional Hospital Services
language pathology services. (d) * * *
(iii) Signature. The physician, nurse (3) Reassignment of the technical or 54. Section 482.56 is amended by
practitioner, clinical nurse specialist, or professional component of diagnostic revising paragraphs (a)(2) and (b) to read
physician assistant who reviews the test services. If a physician or medical as follows:
plan of treatment must recertify the plan group bills for the technical or
by signing the medical record. professional component of a diagnostic § 482.56 Condition of participation:
test covered under section 1861(s)(3) of Rehabilitation services.
* * * * *
the Act and paid for under part 414 of (a) * * *
Subpart C—Claims for Payment this chapter (other than clinical (2) Services must be given in
diagnostic laboratory tests paid under accordance with orders of practitioners
50. Section 424.36 is amended by who are authorized by the medical staff
adding paragraph (b)(6) to read as section 1833(a)(2)(D) of the Act, which
are subject to the special rules set forth to order the services, and the orders
follows: must be incorporated in the patient’s
in section 1833(h)(5)(A) of the Act),
§ 424.36 Signature requirements. following a reassignment from a record.
* * * * * physician or other supplier who (b) Standard: Delivery of services. (1)
(b) * * * performed the technical or professional Except as specified in paragraph
(6) An ambulance provider or component and who was not a full-time (c)(1)(ii) of this section, physical
supplier with respect to emergency employee of the billing physician or therapy, occupational therapy, or
ambulance transport services, if the medical group at the time the service speech-language pathology services
following conditions and was performed, each of the following must be furnished—
documentation requirements are met. conditions must be met: (i) By qualified physical therapists,
(i) None of the individuals listed in (i) The payment to the billing physical therapist assistants,
paragraphs (b)(1) through (b)(5) of this physician, or medical group, less the occupational therapists, occupational
section was available or willing to sign applicable deductibles and coinsurance, therapist assistants, speech-language
the claim on behalf of the beneficiary at may not exceed the lowest of the pathologists, or audiologists as defined
the time the service was provided; following amounts: in § 484.4 of this chapter; or
(ii) The ambulance provider or (A) The physician’s or other (ii) By qualified physical therapists,
supplier maintains in its files the supplier’s net charge to the billing physical therapist assistants,
following information and physician or medical group. The occupational therapists, or occupational
documentation for a period of at least 4 physician’s or other supplier’s net therapy assistants who have been
years from the date of service: charge must be determined without licensed, certified, registered, or
(A) A contemporaneous statement, regard to any charge that is intended to otherwise recognized by the State in
signed by an ambulance employee cover or address the cost of equipment which practicing before January 1, 2008
present during the trip to the receiving or space leased to the physician or the and continue to furnish Medicare
facility, that at the time the service was other supplier by or through the billing services at least part time without an
provided the beneficiary was physically physician or medical group. interruption in furnishing services of
or mentally incapable of signing the (B) The billing physician’s or medical more than 2 years.
claim and that none of the individuals group’s actual charge. (2) The physical therapy,
listed in paragraphs (b)(1) through (5) of (C) The fee schedule amount for the occupational therapy, or speech-
this section were available or willing to service that would be allowed if the language pathology must be in
sign the claim on behalf of the physician or other supplier billed accordance with a written plan of
beneficiary. directly. treatment that meets the requirements of
(B) Documentation with the date and (ii) The physician or medical group paragraphs (b)(3)(i) through (b)(3)(iv) of
time the beneficiary was transported, billing for the test must identify the this section.
and the name and location of the facility physician or other supplier that (3) Plan of treatment requirements—
that received the beneficiary. performed the test and indicate the (i) Establishment of the plan. The plan
(C) A signed contemporaneous supplier’s net charge for the test. If the must be established by one of the
statement from a representative of the physician or medical group billing for following before treatment begins:
facility that received the beneficiary, the test fails to provide this information, (A) A physician.
which documents the name of the CMS will not make any payment to the (B) A nurse practitioner, a clinical
beneficiary and the date and time the physician or medical group billing for nurse specialist, or a physician
beneficiary was received by that facility. the test and the billing physician or assistant.
* * * * * medical group can not bill the (C) The physical therapist furnishing
beneficiary. the physical therapy services.
§ 424.37 [Amended] (iii) To bill for the technical (D) The speech-language pathologist
51. Section 424.37(a) is amended by component of the service, the physician furnishing the speech-language
removing the reference to ‘‘§ 424.36(b)’’ or medical group must directly perform pathology services.
(E) The occupational therapist following educational/training therapist, continues to meet all practice
furnishing the occupational therapy requirements on or after January 1, requirements set forth by the State in
services. 2008: which occupational therapy services are
(ii) Content of the plan. The plan (i)(A) Graduated after successful furnished, and meets one of the
must— completion of an occupational therapist educational/training requirements if his
(A) Prescribe the type, amount, curriculum accredited by the or her professional practice begins on or
frequency, and duration of the physical Accreditation Council for Occupational after January 1, 2008:
therapy, occupational therapy, or Therapy Education (ACOTE) of the (i)(A) Graduated after successful
speech-language pathology services to American Occupational Therapy completion of coursework and clinical
be furnished to the individual; and Association, Inc. (AOTA); and field work from an occupational therapy
(B) Indicate the diagnosis and (B) Successfully completed the assistant curriculum accredited by the
anticipated goals. National Registration Examination for Accreditation Council for Occupational
(iii) Changes in the plan. Any changes occupational therapists developed and Therapy Education (ACOTE) of the
in the plan must be made in writing, administered by the National Board for American Occupational Therapy
incorporated immediately, and signed Certification in Occupational Therapy, Association, Inc. (AOTA); and
by one of the following: Inc. (NBCOT). (B) Successfully completed the
(A) A physician. (ii) If educated outside the United certification examination for Certified
(B) A nurse practitioner, clinical States, or trained by the United States Occupational Therapy Assistant
nurse specialist, or a physician military— developed and administered by the
assistant. (A) Graduated after successful National Board for Certification in
(C) The physical therapist furnishing completion of an occupational therapist Occupational Therapy, Inc. (NBCOT).
the physical therapy services. curriculum accredited by the World (ii) If educated outside the United
(D) The speech-language pathologist Federation of Occupational Therapists, States or trained in the United States
furnishing the speech-language (WFOT)); military, graduated after successful
pathology services. (B) Is deemed eligible to test as a completion of an occupational therapy
(E) The occupational therapist result of completing the NBCOT assistant curriculum that by credentials
furnishing the occupational therapy International Occupational Therapy evaluation conducted or approved by
services. Eligibility Determination (IOTED) the American Occupational Therapy
(F) A registered professional nurse or review; and Association is determined to be
a staff physician, in accordance with (C) Successfully completed the
comparable, with respect to
verbal orders from one the practitioners National Registration Examination
occupational therapy assistant entry
listed in paragraphs (b)(3)(iii)(A) developed and administered by the
level education in the United States.
through (iii)(E) of this section. National Board for Certification in
(2) Requirements for individuals
(iv) Review of the plan. The Occupational Therapy, Inc. (NBCOT)).
(2) Requirements for individuals beginning their practice after December
physician, nurse practitioner, clinical
beginning their practice after December 31, 1977 and before January 1, 2008.
nurse specialist, or physician assistant
31, 1977 and before January 1, 2008. Meets the requirements for certification
reviews the plan as often as the
Meets the one following requirements as an occupational therapy assistant
individual’s condition requires, but at
after December 31, 1977 and before established by the American
least at the time of certification and at
January 1, 2008: Occupational Therapy Association after
recertification, if applicable.
(i) Is a graduate of an occupational December 31, 1977 and before January
PART 484—HOME HEALTH SERVICES therapy curriculum accredited jointly by 1, 2008.
the Committee on Allied Health (3) Requirements for individuals
55. The authority citation for part 484 beginning their practice on or before
Education and Accreditation of the
continues to read as follows: December 31, 1977. Has 2 years of
American Medical Association and the
Authority: Secs. 1102 and 1871 of the American Occupational Therapy appropriate experience as an
Social Security Act (42 U.S.C. 1302 and Association. occupational therapy assistant, and has
1395(hh)) unless otherwise indicated. (ii) Is eligible for the National achieved a satisfactory grade on a
Registration Examination of the proficiency examination conducted,
Subpart A—General Provisions approved, or sponsored by the U.S.
American Occupational Therapy
56. Section 484.4 is amended by Association. Public Health Service on or before
revising the definitions of (3) Requirements for individuals December 31, 1977.
‘‘Occupational therapist,’’ beginning their practice on or before Physical therapist. A person who is
‘‘Occupational therapy assistant,’’ December 31, 1977. (i) Has 2 years of licensed by the State in which
‘‘Physical therapist,’’ ‘‘Physical therapist appropriate experience as an practicing and meets one of the
assistant’’ and ‘‘Speech-language occupational therapist; and following requirements:
pathologist’’ to read as follows: (ii) Has achieved a satisfactory grade (1) Requirements for individuals
on a proficiency examination beginning their practice on or after
§ 484.4 Personnel Qualifications. conducted, approved, or sponsored by January 1, 2008. Meets all practice
* * * * * the U.S. Public Health Service on or requirements set forth by the State in
Occupational therapist. A person who before December 31, 1977. which the physical therapy services are
meets one of the one of the following Occupational therapy assistant. A furnished and meets one of the
requirements: person who meets one of the following following educational/training

(1) Requirements for individuals requirements: requirements on or after January 1,
beginning their practice on or after (1) Requirements for individuals 2008:
January 1, 2008. Meets all practice beginning their practice on or after (i)(A) Graduated after successful
requirements set forth by the State in January 1, 2008. Provides certain completion of a college or university
which occupational therapy services are occupational therapy services under the physical therapy curriculum approved
furnished and meets one of the supervision of a qualified occupational by the Commission on Accreditation in
Physical Therapy Education (CAPTE); (5) Requirements for individuals apply with respect to persons initially
and trained outside of the United States licensed by a State or seeking initial
(B) Passed the National Examination before January 1, 2008. If trained qualification as a physical therapist
approved by the American Physical outside the United States before January assistant after December 31, 1977.
Therapy Association. 1, 2008 meets the following * * * * *
(ii) If educated outside the United requirements: Speech-language pathologist. A
States or trained by the United States (i) Was graduated since 1928 from a person who meets either of the
military— physical therapy curriculum approved following requirements:
(A) Graduated after successful in the country in which the curriculum (1) The education and experience
completion of an education program was located and in which there is a requirements for a Certificate of Clinical
that, by a credentials evaluation process member organization of the World Competence in speech-language
approved by the American Physical Confederation for Physical Therapy. pathology granted by the American
Therapy Association, is determined to (ii) Meets the requirements for Speech-Language Hearing Association.
be comparable with respect to physical membership in a member organization (2) The educational requirements for
therapist entry level education in the of the World Confederation for Physical certification and is in the process of
United States; and Therapy. accumulating the supervised experience
(B) Passed the National Examination Physical therapist assistant. A person required for certification.
approved by the American Physical who meets one of the following
Therapy Association. requirements: PART 485—CONDITIONS OF
(1) Requirements for individuals PARTICIPATION: SPECIALIZED
(2) Requirements for individuals
beginning their practice on or after PROVIDERS
beginning their practice after December
January 1, 2008. A person who provides
31, 1977 and before January 1, 2008. 57. The authority citation for part 485
certain physical therapy services under
Has graduated from a physical therapy continues to read as follows:
the supervision of a qualified physical
curriculum approved by one of the
therapist and is licensed, registered, Authority: Secs. 1102 and 1871 of the
following after December 31, 1977 and
certified or otherwise recognized as a Social Security Act (42 U.S.C. 1302 and
before January 1, 2008: 1395(hh)).
physical therapist assistant, if
(i) The American Physical Therapy
applicable, by the State in which
Association. Subpart B—Conditions of
practicing, continues to meet all
(ii) The Committee on Allied Health Participation: Comprehensive
practice requirements set forth by the
Education and Accreditation of the Outpatient Rehabilitation Facilities
State in which physical therapy services
American Medical Association.
are furnished, and meets one of the 58. Section 485.51 is amended by—
(iii) The Council on Medical
following educational/training A. Revising paragraph (a).
Education of the American Medical
requirements: B. Adding paragraph (c).
Association and the American Physical (i) Graduated after successful
Therapy Association. The revision and addition read as
completion of a physical therapist follows:
(3) Requirements for individuals assistant curriculum approved by the
beginning their practice on or after Commission on Accreditation in § 485.51 Definition.
January 1, 1966 and on or before Physical Therapy Education of the * * * * *
December 31, 1977. Had 2 years of American Physical Therapy (a) Is established and operated
appropriate experience as a physical Association. exclusively for the purpose of providing
therapist, and has achieved a (ii) If educated outside the United diagnostic, therapeutic, and restorative
satisfactory grade on a proficiency States or trained in the United States services to outpatients for the
examination conducted, approved, or military, graduated after successful rehabilitation of injured, disabled, or
sponsored by the U.S. Public Health completion of an education program sick persons, at a single fixed location,
Service on or before December 31, 1977. that by a credentials evaluation process by or under the supervision of a
(4) Requirements for individuals approved by the American Physical physician except as provided in
beginning their practice before January Therapy Association, is determined to paragraph (c) of this section;
1, 1966. Meets one of the following be comparable with respect to physical * * * * *
requirements before January 1, 1966: therapist assistant entry level education (c) Exception. May provide influenza,
(i) Was admitted to membership by in the United States. pneumococcal and Hepatitis B vaccines
the American Physical Therapy (2) Requirements for individuals provided the applicable conditions of
Association. beginning their practice before January coverage under § 410.58 and § 410.63 of
(ii) Was admitted to registration by 1, 2008. Is licensed as a physical this chapter are met.
the American Registry of Physical therapist assistant, if applicable, by the 59. Section 485.70 is amended by
Therapists. State in which practicing, meets either revising paragraphs (c), (e), and (m) to
(iii) Graduated from a physical of the following requirements: read as follows:
therapy curriculum in a 4-year college (i) Has graduated from a 2-year
or university approved by a State college-level program approved by the § 485.70 Personnel qualifications.
department of education. American Physical Therapy * * * * *
(iv) Was licensed or registered prior to Association. (c) An occupational therapist and an
January 1, 1966, and prior to January 1, (ii) Has 2 years of appropriate occupational therapy assistant must
1970, had 15 years of full-time experience as a physical therapist meet one of the following qualifications:
experience in the treatment of illness or assistant, and has achieved a (1) As set forth in § 484.4 of this
injury through the practice of physical satisfactory grade on a proficiency chapter.
therapy in which services were examination conducted, approved, or (2) Occupational therapists or
rendered under the order and direction sponsored by the U.S. Public Health occupational therapy assistants must
of attending and referring doctors of Service, except that these have been licensed, certified, registered,
medicine or osteopathy. determinations of proficiency do not or otherwise recognized as occupational
therapists or occupational therapy occupational therapists, or occupational The addenda on the following pages
assistants by the State in which therapy assistants by the State in which provide various data pertaining to the
practicing before January 1, 2008, and practicing before January 1, 2008 and Medicare fee schedule for physicians’
continue to furnish Medicare services at continue to furnish Medicare services at services furnished in 2008.
least part time without an interruption least part time without an interruption
Addendum A: Explanation and Use of
in furnishing services of more than 2 in furnishing services of more than 2 Addendum B
years. years.
* * * * * * * * * * Addendum B contains the RVUs for
(e) A physical therapist and a physical work, non-facility PE, facility PE, and
therapist assistant must meet one of the PART 491—CERTIFICATION OF malpractice expense, and other
following qualifications: CERTAIN HEALTH FACILITIES information for all services included in
(1) As set forth in § 484.4 of this the PFS.
61. The authority citation for part 491 In previous years, we have listed
chapter. continues to read as follows:
(2) Qualified physical therapists or many services in Addendum B that are
Authority: Sec. 1102 of the Social Security not paid under the PFS. To avoid
physical therapist assistants must have
Act (42 U.S.C. 1302); and sec. 353 of the publishing as many pages of codes for
been licensed, certified, registered, or
Public Health Service Act (42 U.S.C. 263a). these services, we are not including
otherwise recognized as physical
clinical laboratory codes or the
therapists or physical therapist Subpart A—Rural Health Clinics: alphanumeric codes (Healthcare
assistants by the State in which Conditions for Certification; and Common Procedure Coding System
practicing before January 1, 2008, and FQHCs Conditions for Coverage (HCPCS) codes not included in CPT) not
continue to furnish Medicare services at
62. Section 491.9 is amended by paid under the PFS in Addendum B.
least part time without an interruption Addendum B contains the following
in furnishing services of more than 2 adding paragraph (c)(4) to read as
follows: information for each CPT code and
years. alphanumeric HCPCS code, except for:
* * * * * § 491.9 Provision of services. alphanumeric codes beginning with B
(m) A speech-language pathologist * * * * * (enteral and parenteral therapy), E
must meet the qualifications set forth in (c) * * * (durable medical equipment), K
§ 484.4 of this chapter. (4) Physical therapy, occupational (temporary codes for nonphysicians’
therapy or speech-language pathology services or items), or L (orthotics); and
Subpart H—Conditions of Participation
services, if provided, must be codes for anesthesiology. Please also
for Clinics, Rehabilitation Agencies,
furnished— note the following:
and Public Health Agencies as (i) By clinicians who meet either of • An ‘‘NA’’ in the ‘‘Non-facility PE
Providers of Outpatient Physical the following qualifications: RVUs’’ column of Addendum B means
Therapy and Speech-Language (A) The qualifications specified in that CMS has not developed a PE RVU
Pathology Services § 484.4 of this subchapter. in the nonfacility setting for the service
60. Section 485.705 is amended by (B) Physical therapists, physical because it is typically performed in the
revising paragraph (a) to read as follows: therapist assistants, occupational hospital (for example, an open heart
therapists, or occupational therapy surgery is generally performed in the
§ 485.705 Personnel qualifications. assistants who have been licensed, hospital setting and not a physician’s
(a) General qualification certified, registered or otherwise office). If there is an ‘‘NA’’ in the
requirements. Except as specified in recognized as physical therapists, nonfacility PE RVU column, and the
paragraphs (b) and (c) of this section, all physical therapist assistants, contractor determines that this service
personnel who are involved in the occupational therapists, or occupational can be performed in the nonfacility
furnishing of outpatient physical therapy assistants by the State in which setting, the service will be paid at the
therapy, occupational therapy and practicing before January 1, 2008 and facility PE RVU rate.
speech-language pathology services continue to furnish Medicare services at • Services that have an ‘‘NA’’ in the
directly by or under arrangements with least part time without an interruption ‘‘Facility PE RVUs’’ column of
an organization must— in furnishing services of more than 2 Addendum B are typically not paid
(1) Be legally authorized (licensed or, years. using the PFS when provided in a
if applicable, certified or registered) to (ii) In accordance with a written plan facility setting. These services (which
practice by the State in which they of treatment as described in § 410.61 of include ‘‘incident to’’ services and the
perform the functions or actions. this chapter. technical portion of diagnostic tests) are
(2) Act only within the scope of their * * * * * generally paid under either the
State license or State certification or outpatient hospital prospective payment
registration. Authority
system or bundled into the hospital
(3) Meet one of the following (Catalog of Federal Domestic Assistance inpatient prospective payment system
requirements: Program No. 93.774, Medicare— payment.
(i) Meet the qualifications specified in Supplementary Medical Insurance Program) 1. CPT/HCPCS code. This is the CPT
§ 484.4 of this chapter. Dated: May 24, 2007. or alphanumeric HCPCS number for the
(ii) Physical therapy, occupational Leslie V. Norwalk, service. Alphanumeric HCPCS codes are
therapy or speech-language pathology Acting Administrator, Centers for Medicare included at the end of this addendum.
services may be furnished by qualified & Medicaid Services. 2. Modifier. A modifier is shown if
physical therapists, physical therapist Approved: June 28, 2007.
there is a technical component (modifier
assistants, occupational therapists, or TC) and a professional component (PC)
Michael O. Leavitt,
occupational therapy assistants who (modifier ¥26) for the service. If there
have been licensed, certified, registered Secretary. is a PC and a TC for the service,
or otherwise recognized as physical Note: These addenda will not appear in the Addendum B contains three entries for
therapists, physical therapist assistants, Code of Federal Regulations. the code. A code for: the global values
(both professional and technical); This indicator is no longer effective ambulance services and clinical
modifier ¥26 (PC); and, modifier TC. beginning with the CY 2005 PFS as of diagnostic laboratory services.)
The global service is not designated by January 1, 2005. 4. Description of code. This is an
a modifier, and physicians must bill G = Code not valid for Medicare abbreviated version of the narrative
using the code without a modifier if the purposes. Medicare uses another code description of the code.
physician furnishes both the PC and the for reporting of, and payment for, these 5. Physician work RVUs. These are the
TC of the service. services. (Codes subject to a 90-day RVUs for the physician work for this
Modifier-53 is shown for a grace period.) This indicator is no service in 2008.
discontinued procedure, for example, a longer effective with the 2005 PFS as of Note: The separate BN adjustor is not
colonoscopy that is not completed. January 1, 2005. reflected in these physician work RVUs.
There will be RVUs for a code with this H* = Deleted modifier. For 2000 and
modifier. later years, either the TC or PC 6. Fully implemented nonfacility
3. Status indicator. This indicator component shown for the code has been practice expense RVUs. These are the
shows whether the CPT/HCPCS code is deleted and the deleted component is fully implemented resource-based PE
in the PFS and whether it is separately shown in the database with the H status RVUs for nonfacility settings.
payable if the service is covered. indicator. 7. Year 2008 Transitional Nonfacility
A = Active code. These codes are I = Not valid for Medicare purposes. practice expense RVUs. These are the
separately payable under the PFS if 2008 resource-based PE RVUs for
Medicare uses another code for the
covered. There will be RVUs for codes nonfacility settings.
reporting of, and the payment for these
with this status. The presence of an ‘‘A’’ 8. Fully implemented facility practice
services. (Codes not subject to a 90-day
indicator does not mean that Medicare expense RVUs. These are the fully
grace period.)
has made a national coverage implemented resource-based PE RVUs
L = Local codes. Carriers will apply
determination regarding the service. for facility settings.
this status to all local codes in effect on
Carriers remain responsible for coverage 9. Year 2008 Transitional facility
January 1, 1998 or subsequently
decisions in the absence of a national practice expense RVUs. These are the
approved by central office for use.
Medicare policy. 2008 resource-based PE RVUs for
B = Bundled code. Payments for Carriers will complete the RVUs and
payment amounts for these codes. facility settings.
covered services are always bundled 10. Malpractice expense RVUs. These
into payment for other services not M = Measurement codes, used for
reporting purposes only. There are no are the RVUs for the malpractice
specified. If RVUs are shown, they are expense for the service for 2006.
not used for Medicare payment. If these RVUs and no payment amounts for
these codes. Medicare uses them to aid 11. Global period. This indicator
services are covered, payment for them shows the number of days in the global
is subsumed by the payment for the with performance measurement.
N = Noncovered service. These codes period for the code (0, 10, or 90 days).
services to which they are incident (an
are noncovered services. Medicare An explanation of the alpha codes
example is a telephone call from a
payment may not be made for these follows:
hospital nurse regarding care of a
codes. If RVUs are shown, they are not MMM = Code describes a service
patient).
C = Carriers price the code. Carriers used for Medicare payment. furnished in uncomplicated maternity
will establish RVUs and payment R = Restricted coverage. Special cases including antepartum care,
amounts for these services, generally on coverage instructions apply. If the delivery, and postpartum care. The
an individual case basis following service is covered and no RVUs are usual global surgical concept does not
review of documentation, such as an shown, it is carrier-priced. apply. See the 1999 Physicians’ Current
operative report. T = There are RVUs for these services, Procedural Terminology for specific
D* = Deleted/discontinued code. but they are only paid if there are no definitions.
E = Excluded from the PFS by other services payable under the PFS XXX = The global concept does not
regulation. These codes are for items billed on the same date by the same apply.
and services that CMS chose to exclude provider. If any other services payable YYY = The global period is to be set
from the fee schedule payment by under the PFS are billed on the same by the carrier (for example, unlisted
regulation. No RVUs are shown, and no date by the same provider, these surgery codes).
payment may be made under the PFS services are bundled into the service(s) ZZZ = Code related to another service
for these codes. Payment for them, when for which payment is made. that is always included in the global
covered, continues under reasonable X = Statutory exclusion. These codes period of the other service. (Note:
charge procedures. represent an item or service that is not Physician work and PE are associated
F = Deleted/discontinued codes. within the statutory definition of with intra-service time and in some
(Code not subject to a 90-day grace ‘‘physicians’ services’’ for PFS payment instances in the post-service time.)
period.) These codes are deleted purposes. No RVUs are shown for these *Codes with these indicators had a
effective with the beginning of the year codes, and no payment may be made 90-day grace period before January 1,
and are never subject to a grace period. under the PFS. (Examples are 2005.
ADDENDUM B.—2008 RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS
FOR 2008
Fully im- Year 2008 Fully im- Year 2008

Physician Mal-
CPT 1/ Mod Status Description work
plemented transitional plemented transitional practice Global
HCPCS 2 RVUs 3
non-facility non-facility facility PE facility PE RVUs 3
PE RVUs 3 PE RVUs 3 RVUs 3 RVUs 3
0016T .... ............ C ........ Thermotx choroid vasc lesion ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0017T .... ............ C ........ Photocoagulat macular drusen ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0019T .... ............ C ........ Extracorp shock wv tx,ms nos ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0026T .... ............ C ........ Measure remnant lipoproteins ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0027T .... ............ C ........ Endoscopic epidural lysis ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0028T .... ............ C ........ Dexa body composition study ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0029T .... ............ C ........ Magnetic tx for incontinence .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0030T .... ............ C ........ Antiprothrombin antibody .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0031T .... ............ C ........ Speculoscopy ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0032T .... ............ C ........ Speculoscopy w/direct sample ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0041T .... ............ C ........ Detect ur infect agnt w/cpas ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0042T .... ............ C ........ Ct perfusion w/contrast, cbf ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0043T .... ............ C ........ Co expired gas analysis ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0046T .... ............ C ........ Cath lavage, mammary duct(s) .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0047T .... ............ C ........ Cath lavage, mammary duct(s) .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0048T .... ............ C ........ Implant ventricular device ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0049T .... ............ C ........ External circulation assist ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0050T .... ............ C ........ Removal circulation assist .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0051T .... ............ C ........ Implant total heart system .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0052T .... ............ C ........ Replace component heart syst ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0053T .... ............ C ........ Replace component heart syst ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0054T .... ............ C ........ Bone surgery using computer ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0058T .... ............ C ........ Cryopreservation, ovary tiss ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0059T .... ............ C ........ Cryopreservation, oocyte .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0060T .... ............ C ........ Electrical impedance scan .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0061T .... ............ C ........ Destruction of tumor, breast ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0062T .... ............ C ........ Rep intradisc annulus;1 lev ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0063T .... ............ C ........ Rep intradisc annulus;>1lev ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0064T .... ............ C ........ Spectroscop eval expired gas ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0065T .... ............ C ........ Ocular photoscreen bilat .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0067T .... ............ C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0067T .... 26 ....... C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0067T .... TC ...... C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0068T .... ............ C ........ Interp/rept heart sound ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0069T .... ............ C ........ Analysis only heart sound .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0070T .... ............ C ........ Interp only heart sound ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0071T .... ............ C ........ U/s leiomyomata ablate <200 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0072T .... ............ C ........ U/s leiomyomata ablate >200 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0073T .... ............ A ........ Delivery, comp imrt ............................. 0.00 13.04 15.55 NA NA 0.13 XXX
0075T .... ............ C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0075T .... 26 ....... C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0075T .... TC ...... C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0076T .... ............ C ........ S&i stent/chest vert art ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0076T .... 26 ....... C ........ S&i stent/chest vert art ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0076T .... TC ...... C ........ S&i stent/chest vert art ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0077T .... ............ C ........ Cereb therm perfusion probe ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0078T .... ............ C ........ Endovasc aort repr w/device .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0079T .... ............ C ........ Endovasc visc extnsn repr ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0080T .... ............ C ........ Endovasc aort repr rad s&i ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0081T .... ............ C ........ Endovasc visc extnsn s&i ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0084T .... ............ C ........ Temp prostate urethral stent .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0085T .... ............ C ........ Breath test heart reject ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0086T .... ............ C ........ L ventricle fill pressure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0087T .... ............ C ........ Sperm eval hyaluronan ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0088T .... ............ C ........ Rf tongue base vol reduxn ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0089T .... ............ C ........ Actigraphy testing, 3-day .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0090T .... ............ C ........ Cervical artific disc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0092T .... ............ C ........ Artific disc addl ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0093T .... ............ C ........ Cervical artific diskectomy .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0095T .... ............ C ........ Artific diskectomy addl ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0096T .... ............ C ........ Rev cervical artific disc ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0098T .... ............ C ........ Rev artific disc addl ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0099T .... ............ C ........ Implant corneal ring ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0100T .... ............ C ........ Prosth retina receive&gen .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0101T .... ............ C ........ Extracorp shockwv tx,hi enrg ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0102T .... ............ C ........ Extracorp shockwv tx,anesth .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0103T .... ............ C ........ Holotranscobalamin ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0104T .... ............ C ........ At rest cardio gas rebreathe ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0105T .... ............ C ........ Exerc cardio gas rebreathe ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0106T .... ............ C ........ Touch quant sensory test ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0107T .... ............ C ........ Vibrate quant sensory test ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
——————————
1 CPTcodes and descriptions are copyright 2007 American Medical Association.
2 Copyright
2007 American Dental Association. All rights reserved.
3 If
values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare
payment.
FOR 2008—Continued

Physician Mal-
CPT 1/ plemented transitional plemented transitional
Mod Status Description work practice Global
HCPCS 2 non-facility non-facility facility PE facility PE
RVUs 3 PE RVUs 3 PE RVUs 3 RVUs 3 RVUs 3
RVUs 3
0108T .... ............ C ........ Cool quant sensory test ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0109T .... ............ C ........ Heat quant sensory test ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0110T .... ............ C ........ Nos quant sensory test ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0111T .... ............ C ........ Rbc membranes fatty acids ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0123T .... ............ C ........ Scleral fistulization .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0126T .... ............ C ........ Chd risk imt study ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0130T .... ............ C ........ Chron care drug investigatn ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0135T .... ............ C ........ Perq cryoablate renal tumor ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0137T .... ............ C ........ Prostate saturation sampling .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0140T .... ............ C ........ Exhaled breath condensate ph .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0144T .... ............ C ........ CT heart wo dye; qual calc ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0144T .... 26 ....... C ........ CT heart wo dye; qual calc ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0144T .... TC ...... C ........ CT heart wo dye; qual calc ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0145T .... ............ C ........ CT heart w/wo dye funct .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0145T .... 26 ....... C ........ CT heart w/wo dye funct .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0145T .... TC ...... C ........ CT heart w/wo dye funct .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0146T .... ............ C ........ CCTA w/wo dye .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0146T .... 26 ....... C ........ CCTA w/wo dye .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0146T .... TC ...... C ........ CCTA w/wo dye .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0147T .... ............ C ........ CCTA w/wo, quan calcium ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0147T .... 26 ....... C ........ CCTA w/wo, quan calcium ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0147T .... TC ...... C ........ CCTA w/wo, quan calcium ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0148T .... ............ C ........ CCTA w/wo, strxr ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0148T .... 26 ....... C ........ CCTA w/wo, strxr ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0148T .... TC ...... C ........ CCTA w/wo, strxr ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0149T .... ............ C ........ CCTA w/wo, strxr quan calc ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0149T .... 26 ....... C ........ CCTA w/wo, strxr quan calc ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0149T .... TC ...... C ........ CCTA w/wo, strxr quan calc ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0150T .... ............ C ........ CCTA w/wo, disease strxr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0150T .... 26 ....... C ........ CCTA w/wo, disease strxr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0150T .... TC ...... C ........ CCTA w/wo, disease strxr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0151T .... ............ C ........ CT heart funct add-on ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0151T .... 26 ....... C ........ CT heart funct add-on ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0151T .... TC ...... C ........ CT heart funct add-on ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0153T .... ............ C ........ Tcath sensor aneurysm sac ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0154T .... ............ C ........ Study sensor aneurysm sac ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0155T .... ............ C ........ Lap impl gast curve electrd ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0156T .... ............ C ........ Lap remv gast curve electrd ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0157T .... ............ C ........ Open impl gast curve electrd ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0158T .... ............ C ........ Open remv gast curve electrd ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0159T .... ............ C ........ Cad breast mri .................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
0159T .... 26 ....... C ........ Cad breast mri .................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
0159T .... TC ...... C ........ Cad breast mri .................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
0160T .... ............ C ........ Tcranial magn stim tx plan ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0161T .... ............ C ........ Tcranial magn stim tx deliv ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0162T .... ............ C ........ Anal program gast neurostim ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0163T .... ............ C ........ Lumb artif diskectomy addl ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
0164T .... ............ C ........ Remove lumb artif disc addl ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
0165T .... ............ C ........ Revise lumb artif disc addl ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
0166T .... ............ C ........ Tcath vsd close w/o bypass ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0167T .... ............ C ........ Tcath vsd close w bypass .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0168T .... ............ C ........ Rhinophototx light app bilat ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0169T .... ............ C ........ Place stereo cath brain ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0170T .... ............ C ........ Anorectal fistula plug rpr .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0171T .... ............ C ........ Lumbar spine proces distract ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0172T .... ............ C ........ Lumbar spine proces addl .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0173T .... ............ C ........ Iop monit io pressure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0174T .... ............ C ........ Cad cxr with interp ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0175T .... ............ C ........ Cad cxr remote ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0176T .... ............ C ........ Aqu canal dilat w/o retent ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
0177T .... ............ C ........ Aqu canal dilat w retent ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
10021 .... ............ A ........ Fna w/o image .................................... 1.27 2.17 2.15 0.38 0.46 0.10 XXX
10022 .... ............ A ........ Fna w/image ....................................... 1.27 2.14 2.32 0.41 0.40 0.08 XXX
10040 .... ............ A ........ Acne surgery ...................................... 1.19 1.34 1.17 0.98 0.89 0.05 010
10060 .... ............ A ........ Drainage of skin abscess ................... 1.19 1.48 1.35 1.06 1.00 0.12 010
10061 .... ............ A ........ Drainage of skin abscess ................... 2.42 2.03 1.94 1.48 1.50 0.26 010
10080 .... ............ A ........ Drainage of pilonidal cyst ................... 1.19 2.65 2.88 1.10 1.11 0.11 010
10081 .... ............ A ........ Drainage of pilonidal cyst ................... 2.47 3.45 3.76 1.44 1.47 0.24 010
10120 .... ............ A ........ Remove foreign body ......................... 1.23 1.92 2.05 0.93 0.96 0.12 010
10121 .... ............ A ........ Remove foreign body ......................... 2.71 3.45 3.49 1.63 1.71 0.33 010
10140 .... ............ A ........ Drainage of hematoma/fluid ............... 1.55 2.21 2.00 1.27 1.28 0.19 010
10160 .... ............ A ........ Puncture drainage of lesion ............... 1.22 1.82 1.71 1.06 1.07 0.14 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
10180 .... ............ A ........ Complex drainage, wound .................. 2.27 3.22 3.11 1.79 1.89 0.35 010
11000 .... ............ A ........ Debride infected skin .......................... 0.60 0.71 0.65 0.16 0.19 0.07 000
11001 .... ............ A ........ Debride infected skin add-on ............. 0.30 0.23 0.23 0.08 0.09 0.04 ZZZ
11004 .... ............ A ........ Debride genitalia & perineum ............. 10.80 NA NA 3.23 3.56 0.67 000
11005 .... ............ A ........ Debride abdom wall ............................ 14.24 NA NA 3.80 4.75 0.96 000
11006 .... ............ A ........ Debride genit/per/abdom wall ............. 13.10 NA NA 4.00 4.39 1.28 000
11008 .... ............ A ........ Remove mesh from abd wall ............. 5.00 NA NA 1.29 1.67 0.61 ZZZ
11010 .... ............ A ........ Debride skin, fx ................................... 4.19 6.75 6.80 2.34 2.48 0.66 010
11011 .... ............ A ........ Debride skin/muscle, fx ...................... 4.94 6.98 7.58 2.02 2.19 0.74 000
11012 .... ............ A ........ Debride skin/muscle/bone, fx ............. 6.87 8.95 10.53 3.12 3.49 1.16 000
11040 .... ............ A ........ Debride skin, partial ............................ 0.50 0.66 0.59 0.16 0.19 0.06 000
11041 .... ............ A ........ Debride skin, full ................................. 0.60 0.70 0.69 0.18 0.26 0.10 000
11042 .... ............ A ........ Debride skin/tissue ............................. 0.80 0.94 0.96 0.24 0.34 0.13 000
11043 .... ............ A ........ Debride tissue/muscle ........................ 3.04 3.46 3.45 2.57 2.60 0.32 010
11044 .... ............ A ........ Debride tissue/muscle/bone ............... 4.11 4.78 4.65 3.54 3.67 0.43 010
11055 .... ............ R ........ Trim skin lesion .................................. 0.43 0.78 0.68 0.11 0.14 0.05 000
11056 .... ............ R ........ Trim skin lesions, 2 to 4 ..................... 0.61 0.86 0.75 0.15 0.20 0.07 000
11057 .... ............ R ........ Trim skin lesions, over 4 .................... 0.79 0.96 0.86 0.20 0.25 0.10 000
11100 .... ............ A ........ Biopsy, skin lesion .............................. 0.81 1.88 1.57 0.39 0.38 0.03 000
11101 .... ............ A ........ Biopsy, skin add-on ............................ 0.41 0.41 0.37 0.20 0.20 0.02 ZZZ
11200 .... ............ A ........ Removal of skin tags .......................... 0.79 1.23 1.14 0.90 0.83 0.04 010
11201 .... ............ A ........ Remove skin tags add-on .................. 0.29 0.16 0.16 0.11 0.12 0.02 ZZZ
11300 .... ............ A ........ Shave skin lesion ............................... 0.51 1.19 1.09 0.21 0.21 0.03 000
11400 .... ............ A ........ Exc tr-ext b9+marg 0.5 < cm ............. 0.87 1.87 1.93 0.93 0.91 0.06 010
11401 .... ............ A ........ Exc tr-ext b9+marg 0.6–1 cm ............. 1.25 2.18 2.11 1.15 1.08 0.10 010
11406 .... ............ A ........ Exc tr-ext b9+marg > 4.0 cm ............. 3.47 3.51 3.28 2.09 1.87 0.32 010
11420 .... ............ A ........ Exc h-f-nk-sp b9+marg 0.5 < ............. 1.00 1.80 1.79 0.92 0.93 0.09 010
11421 .... ............ A ........ Exc h-f-nk-sp b9+marg 0.6–1 ............. 1.44 2.20 2.13 1.16 1.14 0.13 010
11426 .... ............ A ........ Exc h-f-nk-sp b9+marg > 4 cm .......... 4.04 3.57 3.53 2.30 2.21 0.44 010
11440 .... ............ A ........ Exc face-mm b9+marg 0.5 < cm ........ 1.02 1.99 2.10 1.31 1.31 0.08 010
11441 .... ............ A ........ Exc face-mm b9+marg 0.6–1 cm ....... 1.50 2.37 2.36 1.55 1.52 0.13 010
11446 .... ............ A ........ Exc face-mm b9+marg > 4 cm ........... 4.75 4.09 4.06 2.69 2.73 0.43 010
11450 .... ............ A ........ Removal, sweat gland lesion ............. 3.14 5.07 5.06 2.39 2.21 0.34 090
11600 .... ............ A ........ Exc tr-ext mlg+marg 0.5 < cm ............ 1.58 2.73 2.68 1.14 1.06 0.10 010
11601 .... ............ A ........ Exc tr-ext mlg+marg 0.6–1 cm ........... 2.02 3.43 3.07 1.51 1.37 0.12 010
11606 .... ............ A ........ Exc tr-ext mlg+marg > 4 cm ............... 4.97 5.47 4.77 2.47 2.10 0.36 010
11620 .... ............ A ........ Exc h-f-nk-sp mlg+marg 0.5 < ............ 1.59 2.84 2.72 1.20 1.07 0.09 010
11621 .... ............ A ........ Exc h-f-nk-sp mlg+marg 0.6–1 ........... 2.03 3.49 3.10 1.54 1.39 0.12 010
11626 .... ............ A ........ Exc h-f-nk-sp mlg+mar > 4 cm ........... 4.56 4.95 4.79 2.34 2.37 0.45 010
11640 .... ............ A ........ Exc face-mm malig+marg 0.5 < ......... 1.62 3.04 2.85 1.29 1.20 0.11 010
11641 .... ............ A ........ Exc face-mm malig+marg 0.6–1 ........ 2.12 3.62 3.33 1.62 1.58 0.16 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
11646 .... ............ A ........ Exc face-mm mlg+marg > 4 cm ......... 6.21 5.90 5.82 3.15 3.31 0.61 010
11719 .... ............ R ........ Trim nail(s) .......................................... 0.17 0.37 0.31 0.04 0.06 0.02 000
11720 .... ............ A ........ Debride nail, 1–5 ................................ 0.32 0.45 0.40 0.08 0.10 0.04 000
11721 .... ............ A ........ Debride nail, 6 or more ...................... 0.54 0.53 0.49 0.14 0.18 0.07 000
11730 .... ............ A ........ Removal of nail plate .......................... 1.10 1.29 1.17 0.27 0.36 0.14 000
11732 .... ............ A ........ Remove nail plate, add-on ................. 0.57 0.53 0.49 0.14 0.18 0.07 ZZZ
11740 .... ............ A ........ Drain blood from under nail ................ 0.37 0.78 0.67 0.42 0.39 0.04 000
11750 .... ............ A ........ Removal of nail bed ........................... 2.40 2.88 2.54 1.83 1.80 0.22 010
11752 .... ............ A ........ Remove nail bed/finger tip ................. 3.48 3.97 3.51 2.72 2.87 0.35 010
11755 .... ............ A ........ Biopsy, nail unit .................................. 1.31 1.98 1.79 0.74 0.76 0.14 000
11760 .... ............ A ........ Repair of nail bed ............................... 1.60 3.34 3.00 1.41 1.60 0.21 010
11762 .... ............ A ........ Reconstruction of nail bed .................. 2.91 3.61 3.27 1.64 2.01 0.36 010
11765 .... ............ A ........ Excision of nail fold, toe ..................... 0.71 2.60 2.21 0.98 0.88 0.08 010
11770 .... ............ A ........ Removal of pilonidal lesion ................ 2.63 3.43 3.46 1.51 1.51 0.33 010
11900 .... ............ A ........ Injection into skin lesions ................... 0.52 0.92 0.79 0.25 0.23 0.02 000
11901 .... ............ A ........ Added skin lesions injection ............... 0.80 1.02 0.84 0.40 0.38 0.03 000
11920 .... ............ R ........ Correct skin color defects ................... 1.61 2.34 3.03 1.10 1.11 0.24 000
11921 .... ............ R ........ Correct skin color defects ................... 1.93 2.65 3.32 1.26 1.27 0.29 000
11922 .... ............ R ........ Correct skin color defects ................... 0.49 0.92 1.03 0.22 0.24 0.07 ZZZ
11950 .... ............ R ........ Therapy for contour defects ............... 0.84 0.89 1.01 0.36 0.37 0.06 000
11960 .... ............ A ........ Insert tissue expander(s) .................... 11.01 NA NA 10.53 10.50 1.31 090
11970 .... ............ A ........ Replace tissue expander .................... 7.86 NA NA 6.17 6.18 1.05 090
11971 .... ............ A ........ Remove tissue expander(s) ............... 3.21 7.35 8.25 4.00 3.91 0.32 090
11975 .... ............ N ........ Insert contraceptive cap ..................... 1.48 1.52 1.47 0.34 0.45 0.17 XXX
11976 .... ............ R ........ Removal of contraceptive cap ............ 1.78 1.72 1.72 0.48 0.58 0.21 000
11977 .... ............ N ........ Removal/reinsert contra cap .............. 3.30 1.97 2.12 0.76 1.01 0.37 XXX
11980 .... ............ A ........ Implant hormone pellet(s) ................... 1.48 1.07 1.09 0.49 0.53 0.13 000
11981 .... ............ A ........ Insert drug implant device .................. 1.48 1.90 1.81 0.59 0.64 0.12 XXX
11982 .... ............ A ........ Remove drug implant device .............. 1.78 2.02 1.99 0.71 0.78 0.17 XXX
11983 .... ............ A ........ Remove/insert drug implant ............... 3.30 2.65 2.47 1.34 1.41 0.23 XXX
12001 .... ............ A ........ Repair superficial wound(s) ................ 1.72 1.72 1.85 0.73 0.75 0.15 010
12017 .... ............ A ........ Repair superficial wound(s) ................ 4.72 NA NA 1.52 1.70 0.47 010
12018 .... ............ A ........ Repair superficial wound(s) ................ 5.54 NA NA 1.94 2.11 0.64 010
12020 .... ............ A ........ Closure of split wound ........................ 2.64 3.66 3.75 1.74 1.84 0.30 010
12021 .... ............ A ........ Closure of split wound ........................ 1.86 1.83 1.83 1.32 1.37 0.24 010
12031 .... ............ A ........ Layer closure of wound(s) .................. 2.17 3.88 3.09 1.78 1.37 0.17 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
13100 .... ............ A ........ Repair of wound or lesion .................. 3.14 4.42 4.24 2.47 2.39 0.26 010
13102 .... ............ A ........ Repair wound/lesion add-on ............... 1.24 1.35 1.26 0.53 0.56 0.13 ZZZ
13160 .... ............ A ........ Late closure of wound ........................ 11.84 NA NA 7.00 7.10 1.54 090
14000 .... ............ A ........ Skin tissue rearrangement ................. 6.83 8.93 8.40 6.05 5.77 0.59 090
14350 .... ............ A ........ Skin tissue rearrangement ................. 10.82 NA NA 6.82 7.02 1.34 090
15002 .... ............ A ........ Wnd prep, ch/inf, trk/arm/lg ................ 3.65 4.18 4.14 1.69 1.66 0.49 000
15003 .... ............ A ........ Wnd prep, ch/inf addl 100 cm ............ 0.80 0.90 0.91 0.27 0.28 0.11 ZZZ
15004 .... ............ A ........ Wnd prep ch/inf, f/n/hf/g ..................... 4.58 4.84 4.79 2.02 1.99 0.62 000
15005 .... ............ A ........ Wnd prep, f/n/hf/g, addl cm ................ 1.60 1.23 1.26 0.53 0.55 0.22 ZZZ
15040 .... ............ A ........ Harvest cultured skin graft ................. 2.00 3.89 4.22 1.05 1.09 0.24 000
15050 .... ............ A ........ Skin pinch graft ................................... 5.37 7.52 7.25 4.94 5.05 0.57 090
15100 .... ............ A ........ Skin splt grft, trnk/arm/leg .................. 9.74 9.72 11.18 6.67 7.27 1.28 090
15101 .... ............ A ........ Skin splt grft t/a/l, add-on ................... 1.72 2.46 3.11 0.85 1.02 0.24 ZZZ
15110 .... ............ A ........ Epidrm autogrft trnk/arm/leg ............... 10.88 8.72 9.75 6.36 6.72 1.31 090
15111 .... ............ A ........ Epidrm autogrft t/a/l add-on ................ 1.85 0.87 1.08 0.62 0.71 0.26 ZZZ
15115 .... ............ A ........ Epidrm a-grft face/nck/hf/g ................. 11.19 9.22 9.23 6.75 7.06 1.15 090
15116 .... ............ A ........ Epidrm a-grft f/n/hf/g addl ................... 2.50 1.20 1.40 0.87 1.00 0.33 ZZZ
15120 .... ............ A ........ Skn splt a-grft fac/nck/hf/g .................. 10.96 11.31 11.02 7.46 7.63 1.16 090
15121 .... ............ A ........ Skn splt a-grft f/n/hf/g add .................. 2.67 3.41 3.96 1.30 1.58 0.36 ZZZ
15130 .... ............ A ........ Derm autograft, trnk/arm/leg .............. 7.41 7.91 8.92 5.56 5.97 0.97 090
15131 .... ............ A ........ Derm autograft t/a/l add-on ................ 1.50 0.65 0.87 0.48 0.57 0.21 ZZZ
15135 .... ............ A ........ Derm autograft face/nck/hf/g .............. 10.91 9.47 9.68 7.06 7.61 1.23 090
15136 .... ............ A ........ Derm autograft, f/n/hf/g add ............... 1.50 0.66 0.78 0.52 0.60 0.20 ZZZ
15150 .... ............ A ........ Cult epiderm grft t/arm/leg .................. 9.30 7.02 7.79 5.75 6.14 1.14 090
15151 .... ............ A ........ Cult epiderm grft t/a/l addl .................. 2.00 0.88 1.10 0.68 0.77 0.28 ZZZ
15152 .... ............ A ........ Cult epiderm graft t/a/l +% ................. 2.50 1.07 1.32 0.86 0.97 0.35 ZZZ
15155 .... ............ A ........ Cult epiderm graft, f/n/hf/g .................. 10.05 7.65 7.75 6.31 6.65 1.05 090
15156 .... ............ A ........ Cult epidrm grft f/n/hfg add ................ 2.75 1.15 1.36 0.95 1.10 0.36 ZZZ
15157 .... ............ A ........ Cult epiderm grft f/n/hfg +% ............... 3.00 1.34 1.57 1.04 1.21 0.39 ZZZ
15170 .... ............ A ........ Acell graft trunk/arms/legs .................. 5.99 3.99 3.86 2.60 2.45 0.55 090
15171 .... ............ A ........ Acell graft t/arm/leg add-on ................ 1.55 0.60 0.65 0.47 0.56 0.19 ZZZ
15175 .... ............ A ........ Acellular graft, f/n/hf/g ........................ 7.99 4.40 5.07 3.10 3.67 0.82 090
15176 .... ............ A ........ Acell graft, f/n/hf/g add-on .................. 2.45 1.04 1.08 0.79 0.90 0.29 ZZZ
15200 .... ............ A ........ Skin full graft, trunk ............................ 8.97 9.89 9.66 6.37 6.30 0.98 090
15201 .... ............ A ........ Skin full graft trunk add-on ................. 1.32 2.00 2.30 0.47 0.56 0.19 ZZZ
15220 .... ............ A ........ Skin full graft sclp/arm/leg .................. 7.95 10.45 9.82 6.72 6.70 0.84 090
15221 .... ............ A ........ Skin full graft add-on .......................... 1.19 2.00 2.17 0.51 0.54 0.16 ZZZ
15240 .... ............ A ........ Skin full grft face/genit/hf .................... 10.15 12.02 11.11 8.92 8.44 0.92 090
15260 .... ............ A ........ Skin full graft een & lips ..................... 11.39 13.03 11.63 9.38 8.99 0.69 090
15300 .... ............ A ........ Apply skinallogrft, t/arm/lg .................. 4.65 3.42 3.31 2.15 2.19 0.49 090
15301 .... ............ A ........ Apply sknallogrft t/a/l addl .................. 1.00 0.45 0.46 0.32 0.37 0.14 ZZZ
15320 .... ............ A ........ Apply skin allogrft f/n/hf/g ................... 5.36 3.73 3.68 2.33 2.44 0.58 090
15321 .... ............ A ........ Aply sknallogrft f/n/hfg add ................. 1.50 0.69 0.69 0.51 0.55 0.21 ZZZ
15330 .... ............ A ........ Aply acell alogrft t/arm/leg .................. 3.99 3.48 3.28 2.14 2.15 0.49 090
15331 .... ............ A ........ Aply acell grft t/a/l add-on .................. 1.00 0.49 0.47 0.36 0.38 0.14 ZZZ
15335 .... ............ A ........ Apply acell graft, f/n/hf/g ..................... 4.50 3.28 3.40 1.99 2.23 0.55 090
15336 .... ............ A ........ Aply acell grft f/n/hf/g add .................. 1.43 0.72 0.71 0.49 0.53 0.20 ZZZ
15340 .... ............ A ........ Apply cult skin substitute .................... 3.76 3.62 3.84 2.60 2.70 0.41 010
15341 .... ............ A ........ Apply cult skin sub add-on ................. 0.50 0.63 0.64 0.13 0.17 0.06 ZZZ
15360 .... ............ A ........ Apply cult derm sub, t/a/l .................... 3.93 4.81 4.58 3.51 3.26 0.43 090
15361 .... ............ A ........ Aply cult derm sub t/a/l add ............... 1.15 0.50 0.55 0.32 0.40 0.14 ZZZ
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
15365 .... ............ A ........ Apply cult derm sub f/n/hf/g ............... 4.21 4.11 4.37 3.02 3.14 0.46 090
15366 .... ............ A ........ Apply cult derm f/hf/g add .................. 1.45 0.67 0.69 0.47 0.53 0.17 ZZZ
15400 .... ............ A ........ Apply skin xenograft, t/a/l ................... 4.38 4.92 4.47 3.71 3.87 0.47 090
15401 .... ............ A ........ Apply skn xenogrft t/a/l add ................ 1.00 1.00 1.45 0.33 0.39 0.14 ZZZ
15420 .... ............ A ........ Apply skin xgraft, f/n/hf/g .................... 4.89 5.36 5.03 4.13 3.93 0.52 090
15421 .... ............ A ........ Apply skn xgrft f/n/hf/g add ................ 1.50 1.15 1.24 0.48 0.56 0.21 ZZZ
15430 .... ............ A ........ Apply acellular xenograft .................... 5.93 6.51 6.80 5.97 6.38 0.66 090
15431 .... ............ C ........ Apply acellular xgraft add ................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
15570 .... ............ A ........ Form skin pedicle flap ........................ 10.00 10.03 10.74 6.26 6.56 1.34 090
15600 .... ............ A ........ Skin graft ............................................ 1.95 5.28 6.45 2.74 2.90 0.27 090
15610 .... ............ A ........ Skin graft ............................................ 2.46 5.52 5.12 3.03 3.23 0.35 090
15620 .... ............ A ........ Skin graft ............................................ 3.62 6.43 7.10 3.89 3.88 0.35 090
15630 .... ............ A ........ Skin graft ............................................ 3.95 7.05 7.04 4.31 4.23 0.34 090
15650 .... ............ A ........ Transfer skin pedicle flap ................... 4.64 7.26 7.18 4.39 4.28 0.42 090
15731 .... ............ A ........ Forehead flap w/vasc pedicle ............. 14.12 11.92 12.06 9.38 9.50 1.28 090
15732 .... ............ A ........ Muscle-skin graft, head/neck .............. 19.70 14.70 16.41 11.17 11.73 2.00 090
15734 .... ............ A ........ Muscle-skin graft, trunk ...................... 19.62 15.67 16.94 11.87 12.17 2.62 090
15736 .... ............ A ........ Muscle-skin graft, arm ........................ 16.92 13.37 15.90 9.61 10.51 2.46 090
15738 .... ............ A ........ Muscle-skin graft, leg ......................... 18.92 13.75 15.94 10.21 11.04 2.66 090
15740 .... ............ A ........ Island pedicle flap graft ...................... 11.57 13.59 11.87 9.47 8.88 0.63 090
15750 .... ............ A ........ Neurovascular pedicle graft ................ 12.73 NA NA 8.87 8.98 1.42 090
15756 .... ............ A ........ Free myo/skin flap microvasc ............. 36.74 NA NA 18.66 19.65 4.62 090
15757 .... ............ A ........ Free skin flap, microvasc ................... 36.95 NA NA 17.98 19.63 3.90 090
15758 .... ............ A ........ Free fascial flap, microvasc ................ 36.70 NA NA 17.66 19.49 4.24 090
15760 .... ............ A ........ Composite skin graft ........................... 9.68 10.42 10.21 7.09 7.17 0.85 090
15770 .... ............ A ........ Derma-fat-fascia graft ......................... 8.73 NA NA 6.65 6.67 1.05 090
15775 .... ............ R ........ Hair transplant punch grafts ............... 3.95 2.86 3.65 1.23 1.35 0.52 000
15776 .... ............ R ........ Hair transplant punch grafts ............... 5.53 4.84 4.94 2.15 2.38 0.72 000
15780 .... ............ A ........ Abrasion treatment of skin ................. 8.50 11.44 11.55 6.70 7.51 0.67 090
15786 .... ............ A ........ Abrasion, lesion, single ...................... 2.05 3.89 3.61 1.25 1.29 0.11 010
15787 .... ............ A ........ Abrasion, lesions, add-on ................... 0.33 0.82 0.96 0.08 0.13 0.04 ZZZ
15788 .... ............ R ........ Chemical peel, face, epiderm ............. 2.09 9.40 7.91 4.11 3.53 0.11 090
15789 .... ............ R ........ Chemical peel, face, dermal ............... 4.91 9.43 8.73 5.85 5.31 0.20 090
15792 .... ............ R ........ Chemical peel, nonfacial .................... 1.86 8.88 7.65 4.54 4.32 0.13 090
15793 .... ............ A ........ Chemical peel, nonfacial .................... 3.82 8.08 6.76 4.91 4.38 0.19 090
15819 .... ............ A ........ Plastic surgery, neck .......................... 10.45 NA NA 6.71 6.96 0.97 090
15820 .... ............ A ........ Revision of lower eyelid ..................... 6.09 6.43 6.72 5.24 5.41 0.40 090
15821 .... ............ A ........ Revision of lower eyelid ..................... 6.66 6.61 7.01 5.33 5.54 0.45 090
15822 .... ............ A ........ Revision of upper eyelid ..................... 4.51 5.24 5.56 4.11 4.32 0.37 090
15823 .... ............ A ........ Revision of upper eyelid ..................... 8.12 7.42 7.67 6.15 6.32 0.50 090
15830 .... ............ R ........ Exc skin abd ....................................... 16.90 NA NA 9.82 10.04 2.93 090
15832 .... ............ A ........ Excise excessive skin tissue .............. 12.65 NA NA 8.31 8.34 1.66 090
15837 .... ............ A ........ Excise excessive skin tissue .............. 9.37 8.61 8.61 5.75 6.57 1.18 090
15839 .... ............ A ........ Excise excessive skin tissue .............. 10.32 9.70 9.21 6.44 6.39 1.22 090
15840 .... ............ A ........ Graft for face nerve palsy ................... 14.76 NA NA 8.97 9.44 1.32 090
15841 .... ............ A ........ Graft for face nerve palsy ................... 25.69 NA NA 13.62 14.26 2.55 090
15842 .... ............ A ........ Flap for face nerve palsy .................... 40.68 NA NA 20.89 22.02 4.94 090
15845 .... ............ A ........ Skin and muscle repair, face .............. 14.04 NA NA 8.43 8.94 0.81 090
15847 .... ............ C ........ Exc skin abd add-on ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
15850 .... ............ B ........ Removal of sutures ............................ 0.78 1.19 1.38 0.18 0.24 0.05 XXX
15851 .... ............ A ........ Removal of sutures ............................ 0.86 1.32 1.50 0.24 0.27 0.06 000
15852 .... ............ A ........ Dressing change not for burn ............. 0.86 NA NA 0.26 0.29 0.09 000
15860 .... ............ A ........ Test for blood flow in graft ................. 1.95 NA NA 0.64 0.72 0.27 000
15920 .... ............ A ........ Removal of tail bone ulcer ................. 8.15 NA NA 5.32 5.53 1.04 090
15922 .... ............ A ........ Removal of tail bone ulcer ................. 10.23 NA NA 7.20 7.19 1.42 090
15931 .... ............ A ........ Remove sacrum pressure sore .......... 9.96 NA NA 5.54 5.61 1.25 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
15940 .... ............ A ........ Remove hip pressure sore ................. 10.11 NA NA 5.78 6.00 1.31 090
15950 .... ............ A ........ Remove thigh pressure sore .............. 7.91 NA NA 5.38 5.41 1.04 090
15999 .... ............ C ........ Removal of pressure sore .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
16000 .... ............ A ........ Initial treatment of burn(s) .................. 0.89 0.72 0.79 0.23 0.25 0.08 000
16020 .... ............ A ........ Dress/debrid p-thick burn, s ............... 0.80 1.10 1.20 0.56 0.57 0.08 000
16025 .... ............ A ........ Dress/debrid p-thick burn, m .............. 1.85 1.56 1.67 0.85 0.91 0.19 000
16030 .... ............ A ........ Dress/debrid p-thick burn, l ................ 2.08 2.07 2.10 1.02 1.06 0.24 000
16035 .... ............ A ........ Incision of burn scab, initi ................... 3.74 NA NA 1.22 1.41 0.46 090
16036 .... ............ A ........ Escharotomy; addœl incision .............. 1.50 NA NA 0.45 0.53 0.20 ZZZ
17000 .... ............ A ........ Destruct premalg lesion ...................... 0.62 1.41 1.19 0.74 0.64 0.03 010
17003 .... ............ A ........ Destruct premalg les, 2–14 ................ 0.07 0.10 0.11 0.03 0.05 0.01 ZZZ
17004 .... ............ A ........ Destroy premlg lesions 15+ ............... 1.82 2.45 2.37 1.39 1.49 0.11 010
17106 .... ............ A ........ Destruction of skin lesions ................. 4.62 4.70 4.65 3.30 3.32 0.35 090
17110 .... ............ A ........ Destruct b9 lesion, 1–14 .................... 0.67 1.77 1.70 0.88 0.79 0.05 010
17111 .... ............ A ........ Destruct lesion, 15 or more ................ 0.94 2.24 1.97 1.11 0.96 0.05 010
17250 .... ............ A ........ Chemical cautery, tissue .................... 0.50 1.30 1.27 0.38 0.36 0.06 000
17311 .... ............ A ........ Mohs, 1 stage, h/n/hf/g ....................... 6.20 10.71 10.76 3.10 3.14 0.24 000
17312 .... ............ A ........ Mohs addl stage ................................. 3.30 6.88 6.91 1.65 1.67 0.13 ZZZ
17313 .... ............ A ........ Mohs, 1 stage, t/a/l ............................. 5.56 9.88 9.93 2.78 2.81 0.22 000
17314 .... ............ A ........ Mohs, addl stage, t/a/l ........................ 3.06 6.37 6.40 1.53 1.54 0.12 ZZZ
17315 .... ............ A ........ Mohs surg, addl block ........................ 0.87 1.14 1.15 0.43 0.44 0.03 ZZZ
17340 .... ............ A ........ Cryotherapy of skin ............................ 0.76 0.35 0.36 0.38 0.37 0.05 010
17360 .... ............ A ........ Skin peel therapy ................................ 1.44 1.86 1.65 1.02 0.95 0.06 010
17999 .... ............ C ........ Skin tissue procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
19000 .... ............ A ........ Drainage of breast lesion ................... 0.84 1.89 1.92 0.27 0.28 0.08 000
19001 .... ............ A ........ Drain breast lesion add-on ................. 0.42 0.26 0.25 0.14 0.14 0.04 ZZZ
19020 .... ............ A ........ Incision of breast lesion ...................... 3.74 6.57 6.45 3.02 2.85 0.45 090
19030 .... ............ A ........ Injection for breast x-ray ..................... 1.53 2.65 2.72 0.55 0.50 0.09 000
19100 .... ............ A ........ Bx breast percut w/o image ............... 1.27 2.06 2.07 0.33 0.38 0.16 000
19101 .... ............ A ........ Biopsy of breast, open ....................... 3.20 4.33 4.41 1.77 1.84 0.39 010
19102 .... ............ A ........ Bx breast percut w/image ................... 2.00 3.44 3.60 0.69 0.66 0.14 000
19103 .... ............ A ........ Bx breast percut w/device .................. 3.69 10.02 10.68 1.20 1.19 0.30 000
19105 .... ............ A ........ Cryosurg ablate fa, each .................... 3.69 45.89 45.89 0.99 0.99 0.30 000
19110 .... ............ A ........ Nipple exploration ............................... 4.35 6.15 6.00 3.14 3.02 0.57 090
19112 .... ............ A ........ Excise breast duct fistula ................... 3.72 6.16 6.12 3.10 2.90 0.48 090
19120 .... ............ A ........ Removal of breast lesion .................... 5.84 5.04 4.79 3.35 3.21 0.73 090
19125 .... ............ A ........ Excision, breast lesion ........................ 6.59 5.51 5.15 3.63 3.46 0.80 090
19126 .... ............ A ........ Excision, addl breast lesion ................ 2.93 NA NA 0.75 0.88 0.38 ZZZ
19260 .... ............ A ........ Removal of chest wall lesion .............. 17.60 NA NA 10.08 10.65 2.14 090
19271 .... ............ A ........ Revision of chest wall ......................... 21.86 NA NA 15.73 16.86 2.63 090
19272 .... ............ A ........ Extensive chest wall surgery .............. 24.82 NA NA 16.86 17.92 3.00 090
19290 .... ............ A ........ Place needle wire, breast ................... 1.27 2.87 2.83 0.45 0.42 0.07 000
19291 .... ............ A ........ Place needle wire, breast ................... 0.63 1.13 1.16 0.22 0.21 0.04 ZZZ
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
19295 .... ............ A ........ Place breast clip, percut ..................... 0.00 2.25 2.46 0.00 1.35 0.01 ZZZ
19296 .... ............ A ........ Place po breast cath for rad ............... 3.63 84.88 104.91 1.19 1.36 0.36 000
19297 .... ............ A ........ Place breast cath for rad .................... 1.72 NA NA 0.44 0.55 0.17 ZZZ
19298 .... ............ A ........ Place breast rad tube/caths ............... 6.00 21.81 32.20 2.14 2.29 0.43 000
19300 .... ............ A ........ Removal of breast tissue .................... 5.20 7.97 7.43 3.83 3.54 0.69 090
19301 .... ............ A ........ Partial mastectomy ............................. 10.00 NA NA 4.61 3.82 0.79 090
19302 .... ............ A ........ P-mastectomy w/ln removal ............... 13.88 NA NA 6.12 6.27 1.80 090
19303 .... ............ A ........ Mast, simple, complete ....................... 15.67 NA NA 6.97 5.68 1.18 090
19304 .... ............ A ........ Mast, subq .......................................... 7.81 NA NA 4.91 4.81 1.04 090
19305 .... ............ A ........ Mast, radical ....................................... 17.23 NA NA 8.09 8.02 1.93 090
19306 .... ............ A ........ Mast, rad, urban type ......................... 17.85 NA NA 8.68 8.39 2.08 090
19307 .... ............ A ........ Mast, mod rad .................................... 17.95 NA NA 8.72 8.39 2.13 090
19316 .... ............ A ........ Suspension of breast .......................... 10.98 NA NA 6.96 7.29 1.64 090
19318 .... ............ A ........ Reduction of large breast ................... 15.91 NA NA 9.94 10.61 2.93 090
19324 .... ............ A ........ Enlarge breast .................................... 6.65 NA NA 4.45 4.71 0.84 090
19325 .... ............ A ........ Enlarge breast with implant ................ 8.52 NA NA 6.42 6.51 1.33 090
19328 .... ............ A ........ Removal of breast implant ................. 6.35 NA NA 4.98 5.03 0.91 090
19330 .... ............ A ........ Removal of implant material ............... 8.39 NA NA 5.94 6.05 1.26 090
19340 .... ............ A ........ Immediate breast prosthesis .............. 6.32 NA NA 2.83 2.99 1.06 ZZZ
19342 .... ............ A ........ Delayed breast prosthesis .................. 12.40 NA NA 8.94 8.98 1.84 090
19350 .... ............ A ........ Breast reconstruction .......................... 8.99 9.86 11.89 6.60 6.91 1.41 090
19355 .... ............ A ........ Correct inverted nipple(s) ................... 8.37 7.41 8.90 4.69 4.75 0.92 090
19357 .... ............ A ........ Breast reconstruction .......................... 20.57 NA NA 15.40 15.59 2.94 090
19361 .... ............ A ........ Breast reconstr w/lat flap .................... 23.17 NA NA 16.83 14.71 2.93 090
19370 .... ............ A ........ Surgery of breast capsule .................. 8.99 NA NA 6.79 6.88 1.29 090
19371 .... ............ A ........ Removal of breast capsule ................. 10.42 NA NA 7.69 7.80 1.62 090
19380 .... ............ A ........ Revise breast reconstruction .............. 10.21 NA NA 7.62 7.70 1.44 090
19396 .... ............ A ........ Design custom breast implant ............ 2.17 4.50 2.80 1.29 1.14 0.30 000
19499 .... ............ C ........ Breast surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
20000 .... ............ A ........ Incision of abscess ............................. 2.14 2.74 2.72 1.51 1.62 0.25 010
20005 .... ............ A ........ Incision of deep abscess .................... 3.55 3.62 3.57 1.99 2.13 0.46 010
20100 .... ............ A ........ Explore wound, neck .......................... 10.33 NA NA 3.59 4.04 1.21 010
20101 .... ............ A ........ Explore wound, chest ......................... 3.22 6.53 6.20 1.53 1.57 0.44 010
20102 .... ............ A ........ Explore wound, abdomen ................... 3.95 6.88 7.17 1.83 1.87 0.49 010
20103 .... ............ A ........ Explore wound, extremity ................... 5.31 7.72 8.15 2.77 3.08 0.75 010
20150 .... ............ A ........ Excise epiphyseal bar ........................ 14.60 NA NA 7.67 7.38 2.04 090
20200 .... ............ A ........ Muscle biopsy ..................................... 1.46 3.06 3.06 0.69 0.72 0.23 000
20205 .... ............ A ........ Deep muscle biopsy ........................... 2.35 3.79 3.84 1.10 1.15 0.33 000
20206 .... ............ A ........ Needle biopsy, muscle ....................... 0.99 5.17 5.80 0.57 0.59 0.07 000
20220 .... ............ A ........ Bone biopsy, trocar/needle ................. 1.27 2.69 3.61 0.68 0.73 0.08 000
20225 .... ............ A ........ Bone biopsy, trocar/needle ................. 1.87 11.89 18.29 1.03 1.08 0.22 000
20240 .... ............ A ........ Bone biopsy, excisional ...................... 3.25 NA NA 2.02 2.30 0.44 010
20245 .... ............ A ........ Bone biopsy, excisional ...................... 8.77 NA NA 5.73 6.16 1.31 010
20250 .... ............ A ........ Open bone biopsy .............................. 5.16 NA NA 3.63 3.58 1.02 010
20251 .... ............ A ........ Open bone biopsy .............................. 5.69 NA NA 3.86 4.02 1.15 010
20500 .... ............ A ........ Injection of sinus tract ........................ 1.25 1.32 1.78 0.87 1.20 0.12 010
20501 .... ............ A ........ Inject sinus tract for x-ray ................... 0.76 2.35 2.61 0.28 0.25 0.04 000
20520 .... ............ A ........ Removal of foreign body .................... 1.87 2.58 2.75 1.44 1.60 0.21 010
20526 .... ............ A ........ Ther injection, carp tunnel .................. 0.94 0.81 0.89 0.41 0.47 0.13 000
20550 .... ............ A ........ Inj tendon sheath/ligament ................. 0.75 0.62 0.67 0.28 0.26 0.09 000
20551 .... ............ A ........ Inj tendon origin/insertion ................... 0.75 0.64 0.66 0.29 0.31 0.08 000
20552 .... ............ A ........ Inj trigger point, 1/2 muscl .................. 0.66 0.58 0.65 0.25 0.22 0.05 000
20553 .... ............ A ........ Inject trigger points, =/> 3 .................. 0.75 0.64 0.73 0.27 0.24 0.04 000
20600 .... ............ A ........ Drain/inject, joint/bursa ....................... 0.66 0.65 0.66 0.31 0.33 0.08 000
20612 .... ............ A ........ Aspirate/inj ganglion cyst .................... 0.70 0.69 0.70 0.32 0.34 0.10 000
20615 .... ............ A ........ Treatment of bone cyst ...................... 2.30 2.68 3.10 1.41 1.62 0.20 010
20650 .... ............ A ........ Insert and remove bone pin ............... 2.25 2.41 2.40 1.42 1.50 0.31 010
20660 .... ............ A ........ Apply, rem fixation device .................. 2.51 3.30 3.19 1.49 1.56 0.59 000
20661 .... ............ A ........ Application of head brace ................... 5.14 NA NA 6.05 5.48 1.14 090
20662 .... ............ A ........ Application of pelvis brace ................. 6.26 NA NA 4.91 5.21 0.56 090
20663 .... ............ A ........ Application of thigh brace ................... 5.62 NA NA 4.84 4.89 0.94 090
20664 .... ............ A ........ Halo brace application ........................ 9.86 NA NA 7.83 7.50 1.75 090
20665 .... ............ A ........ Removal of fixation device ................. 1.33 1.37 1.78 0.98 1.17 0.19 010
20670 .... ............ A ........ Removal of support implant ............... 1.76 6.54 9.06 1.65 1.88 0.28 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
20680 .... ............ A ........ Removal of support implant ............... 5.90 8.07 8.44 4.05 3.90 0.56 090
20690 .... ............ A ........ Apply bone fixation device ................. 3.67 NA NA 2.24 2.39 0.59 090
20692 .... ............ A ........ Apply bone fixation device ................. 6.40 NA NA 3.18 3.49 1.05 090
20693 .... ............ A ........ Adjust bone fixation device ................ 5.97 NA NA 4.45 4.96 0.98 090
20694 .... ............ A ........ Remove bone fixation device ............. 4.20 5.27 6.22 3.51 3.78 0.71 090
20802 .... ............ A ........ Replantation, arm, complete .............. 42.30 NA NA 13.20 19.01 3.82 090
20805 .... ............ A ........ Replant forearm, complete ................. 51.14 NA NA 23.87 29.46 4.85 090
20808 .... ............ A ........ Replantation hand, complete .............. 62.77 NA NA 37.05 40.08 6.88 090
20816 .... ............ A ........ Replantation digit, complete ............... 31.74 NA NA 25.24 31.41 4.53 090
20822 .... ............ A ........ Replantation digit, complete ............... 26.42 NA NA 23.69 28.95 4.19 090
20824 .... ............ A ........ Replantation thumb, complete ............ 31.74 NA NA 24.76 30.85 4.62 090
20827 .... ............ A ........ Replantation thumb, complete ............ 27.24 NA NA 23.43 30.06 3.67 090
20838 .... ............ A ........ Replantation foot, complete ................ 42.56 NA NA 14.01 18.06 1.12 090
20900 .... ............ A ........ Removal of bone for graft .................. 5.77 9.15 8.82 4.88 5.29 0.94 090
20902 .... ............ A ........ Removal of bone for graft .................. 7.98 NA NA 5.97 6.41 1.30 090
20910 .... ............ A ........ Remove cartilage for graft .................. 5.41 NA NA 4.55 4.89 0.71 090
20912 .... ............ A ........ Remove cartilage for graft .................. 6.42 NA NA 4.96 5.34 0.69 090
20920 .... ............ A ........ Removal of fascia for graft ................. 5.42 NA NA 4.35 4.30 0.66 090
20922 .... ............ A ........ Removal of fascia for graft ................. 6.84 7.56 7.55 5.02 4.95 0.70 090
20924 .... ............ A ........ Removal of tendon for graft ............... 6.59 NA NA 4.94 5.43 1.04 090
20926 .... ............ A ........ Removal of tissue for graft ................. 5.70 NA NA 4.49 4.61 0.87 090
20931 .... ............ A ........ Spinal bone allograft ........................... 1.81 NA NA 0.69 0.81 0.43 ZZZ
20937 .... ............ A ........ Spinal bone autograft ......................... 2.79 NA NA 1.09 1.28 0.54 ZZZ
20938 .... ............ A ........ Spinal bone autograft ......................... 3.02 NA NA 1.16 1.37 0.64 ZZZ
20950 .... ............ A ........ Fluid pressure, muscle ....................... 1.26 4.18 5.51 0.88 0.93 0.20 000
20955 .... ............ A ........ Fibula bone graft, microvasc .............. 40.02 NA NA 18.61 21.42 4.90 090
20956 .... ............ A ........ Iliac bone graft, microvasc ................. 40.93 NA NA 20.42 22.67 7.03 090
20957 .... ............ A ........ Mt bone graft, microvasc .................... 42.33 NA NA 15.50 17.91 7.07 090
20962 .... ............ A ........ Other bone graft, microvasc ............... 39.21 NA NA 21.53 24.02 6.57 090
20969 .... ............ A ........ Bone/skin graft, microvasc ................. 45.11 NA NA 21.25 23.86 4.80 090
20970 .... ............ A ........ Bone/skin graft, iliac crest .................. 44.26 NA NA 21.03 23.12 6.62 090
20972 .... ............ A ........ Bone/skin graft, metatarsal ................. 44.19 NA NA 14.42 18.07 5.32 090
20973 .... ............ A ........ Bone/skin graft, great toe ................... 46.95 NA NA 14.14 19.83 5.56 090
20974 .... ............ A ........ Electrical bone stimulation .................. 0.62 0.97 0.84 0.48 0.51 0.11 000
20975 .... ............ A ........ Electrical bone stimulation .................. 2.60 NA NA 1.46 1.59 0.51 000
20979 .... ............ A ........ Us bone stimulation ............................ 0.62 0.60 0.70 0.20 0.27 0.09 000
20982 .... ............ A ........ Ablate, bone tumor(s) perq ................ 7.27 79.27 94.26 2.71 2.78 0.69 000
20999 .... ............ C ........ Musculoskeletal surgery ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
21010 .... ............ A ........ Incision of jaw joint ............................. 10.90 NA NA 6.42 6.68 1.11 090
21015 .... ............ A ........ Resection of facial tumor .................... 5.59 NA NA 4.30 4.67 0.70 090
21025 .... ............ A ........ Excision of bone, lower jaw ................ 11.07 12.59 12.41 8.80 9.07 1.32 090
21026 .... ............ A ........ Excision of facial bone(s) ................... 5.54 8.82 8.33 5.94 6.12 0.60 090
21029 .... ............ A ........ Contour of face bone lesion ............... 8.26 9.60 9.44 6.59 6.76 0.94 090
21030 .... ............ A ........ Excise max/zygoma b9 tumor ............ 4.80 7.19 6.76 4.70 4.87 0.54 090
21031 .... ............ A ........ Remove exostosis, mandible ............. 3.26 5.91 5.55 3.48 3.56 0.48 090
21032 .... ............ A ........ Remove exostosis, maxilla ................. 3.28 6.04 5.69 3.37 3.44 0.47 090
21034 .... ............ A ........ Excise max/zygoma mlg tumor .......... 17.17 13.98 14.84 10.19 11.34 1.72 090
21040 .... ............ A ........ Excise mandible lesion ....................... 4.80 7.21 6.81 4.66 4.70 0.54 090
21044 .... ............ A ........ Removal of jaw bone lesion ............... 12.61 NA NA 8.14 8.67 1.12 090
21045 .... ............ A ........ Extensive jaw surgery ........................ 18.13 NA NA 10.87 11.50 1.52 090
21046 .... ............ A ........ Remove mandible cyst complex ........ 13.97 NA NA 11.59 11.77 1.86 090
21047 .... ............ A ........ Excise lwr jaw cyst w/repair ............... 19.83 NA NA 10.32 11.81 2.13 090
21048 .... ............ A ........ Remove maxilla cyst complex ............ 14.47 NA NA 11.45 11.80 1.77 090
21049 .... ............ A ........ Excis uppr jaw cyst w/repair ............... 19.08 NA NA 10.36 11.51 1.59 090
21050 .... ............ A ........ Removal of jaw joint ........................... 11.54 NA NA 8.21 8.84 1.47 090
21060 .... ............ A ........ Remove jaw joint cartilage ................. 10.91 NA NA 7.24 7.99 1.38 090
21070 .... ............ A ........ Remove coronoid process .................. 8.50 NA NA 6.30 6.69 1.27 090
21076 .... ............ A ........ Prepare face/oral prosthesis .............. 13.40 7.83 10.12 4.78 7.41 2.00 010
21088 .... ............ C ........ Prepare face/oral prosthesis .............. 0.00 0.00 0.00 0.00 0.00 0.00 090
21089 .... ............ C ........ Prepare face/oral prosthesis .............. 0.00 0.00 0.00 0.00 0.00 0.00 090
21100 .... ............ A ........ Maxillofacial fixation ............................ 4.56 14.76 12.98 5.52 5.06 0.34 090
21110 .... ............ A ........ Interdental fixation .............................. 5.80 13.02 11.33 9.72 9.07 0.72 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
21116 .... ............ A ........ Injection, jaw joint x-ray ...................... 0.81 2.50 3.39 0.23 0.28 0.06 000
21120 .... ............ A ........ Reconstruction of chin ........................ 4.99 9.59 10.17 6.62 7.11 0.60 090
21121 .... ............ A ........ Reconstruction of chin ........................ 7.70 10.67 10.20 7.63 7.72 0.90 090
21122 .... ............ A ........ Reconstruction of chin ........................ 8.59 NA NA 8.45 8.42 1.07 090
21123 .... ............ A ........ Reconstruction of chin ........................ 11.22 NA NA 6.98 9.42 1.40 090
21125 .... ............ A ........ Augmentation, lower jaw bone ........... 10.68 63.67 60.26 6.47 7.51 0.79 090
21127 .... ............ A ........ Augmentation, lower jaw bone ........... 12.24 84.66 64.16 7.56 8.58 1.52 090
21137 .... ............ A ........ Reduction of forehead ........................ 10.12 NA NA 7.45 7.42 1.32 090
21141 .... ............ A ........ Reconstruct midface, lefort ................. 19.27 NA NA 12.00 12.77 2.36 090
21172 .... ............ A ........ Reconstruct orbit/forehead ................. 28.07 NA NA 13.87 13.81 3.56 090
21175 .... ............ A ........ Reconstruct orbit/forehead ................. 33.43 NA NA 13.63 15.64 4.84 090
21179 .... ............ A ........ Reconstruct entire forehead ............... 22.53 NA NA 11.33 12.70 2.81 090
21180 .... ............ A ........ Reconstruct entire forehead ............... 25.46 NA NA 13.14 14.20 3.49 090
21181 .... ............ A ........ Contour cranial bone lesion ............... 10.18 NA NA 6.85 7.20 1.32 090
21182 .... ............ A ........ Reconstruct cranial bone .................... 32.45 NA NA 15.45 17.10 2.81 090
21188 .... ............ A ........ Reconstruction of midface .................. 22.97 NA NA 15.69 17.16 1.70 090
21193 .... ............ A ........ Reconst lwr jaw w/o graft ................... 18.65 NA NA 9.92 11.29 2.24 090
21194 .... ............ A ........ Reconst lwr jaw w/graft ...................... 21.54 NA NA 12.22 12.86 2.03 090
21195 .... ............ A ........ Reconst lwr jaw w/o fixation ............... 18.88 NA NA 13.15 14.04 1.64 090
21196 .... ............ A ........ Reconst lwr jaw w/fixation .................. 20.55 NA NA 14.03 14.76 2.08 090
21198 .... ............ A ........ Reconstr lwr jaw segment .................. 15.48 NA NA 11.92 12.19 1.44 090
21199 .... ............ A ........ Reconstr lwr jaw w/advance ............... 16.62 NA NA 7.63 8.26 1.39 090
21206 .... ............ A ........ Reconstruct upper jaw bone .............. 15.36 NA NA 10.92 11.83 1.33 090
21208 .... ............ A ........ Augmentation of facial bones ............. 11.15 33.03 27.58 8.06 8.78 1.09 090
21209 .... ............ A ........ Reduction of facial bones ................... 7.58 12.17 11.52 7.41 7.76 0.90 090
21210 .... ............ A ........ Face bone graft .................................. 11.40 43.32 34.16 7.68 8.54 1.30 090
21215 .... ............ A ........ Lower jaw bone graft .......................... 11.94 85.72 63.87 8.02 8.71 1.53 090
21230 .... ............ A ........ Rib cartilage graft ............................... 11.06 NA NA 7.00 7.51 1.29 090
21235 .... ............ A ........ Ear cartilage graft ............................... 7.31 10.10 9.93 6.20 6.28 0.61 090
21240 .... ............ A ........ Reconstruction of jaw joint ................. 15.77 NA NA 9.55 10.82 2.25 090
21244 .... ............ A ........ Reconstruction of lower jaw ............... 13.35 NA NA 11.55 11.74 1.25 090
21245 .... ............ A ........ Reconstruction of jaw ......................... 12.88 14.20 14.18 8.65 9.16 1.19 090
21246 .... ............ A ........ Reconstruction of jaw ......................... 12.78 NA NA 7.48 8.15 1.35 090
21247 .... ............ A ........ Reconstruct lower jaw bone ............... 24.05 NA NA 12.79 14.96 2.84 090
21255 .... ............ A ........ Reconstruct lower jaw bone ............... 18.14 NA NA 13.78 14.91 2.39 090
21256 .... ............ A ........ Reconstruction of orbit ....................... 17.42 NA NA 9.68 10.80 1.50 090
21260 .... ............ A ........ Revise eye sockets ............................ 17.74 NA NA 12.98 12.27 0.97 090
21270 .... ............ A ........ Augmentation, cheek bone ................. 10.52 11.19 11.43 5.96 6.61 0.72 090
21275 .... ............ A ........ Revision, orbitofacial bones ............... 11.65 NA NA 7.19 7.74 1.29 090
21280 .... ............ A ........ Revision of eyelid ............................... 6.92 NA NA 5.68 5.84 0.42 090
21282 .... ............ A ........ Revision of eyelid ............................... 4.11 NA NA 4.17 4.35 0.26 090
21295 .... ............ A ........ Revision of jaw muscle/bone .............. 1.82 NA NA 2.22 2.44 0.16 090
21296 .... ............ A ........ Revision of jaw muscle/bone .............. 4.67 NA NA 4.12 4.75 0.34 090
21299 .... ............ C ........ Cranio/maxillofacial surgery ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
21310 .... ............ A ........ Treatment of nose fracture ................. 0.58 1.97 2.12 0.11 0.13 0.05 000
21325 .... ............ A ........ Treatment of nose fracture ................. 4.07 NA NA 6.91 7.74 0.31 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
21336 .... ............ A ........ Treat nasal septal fracture ................. 6.56 NA NA 8.64 9.06 0.55 090
21337 .... ............ A ........ Treat nasal septal fracture ................. 3.26 6.11 6.08 3.54 3.53 0.28 090
21338 .... ............ A ........ Treat nasoethmoid fracture ................ 6.76 NA NA 9.89 11.93 0.82 090
21339 .... ............ A ........ Treat nasoethmoid fracture ................ 8.39 NA NA 9.78 12.01 0.96 090
21343 .... ............ A ........ Treatment of sinus fracture ................ 14.11 NA NA 12.76 14.10 1.47 090
21344 .... ............ A ........ Treatment of sinus fracture ................ 21.36 NA NA 13.12 14.85 2.44 090
21345 .... ............ A ........ Treat nose/jaw fracture ....................... 8.87 10.33 9.99 6.48 6.76 0.92 090
21346 .... ............ A ........ Treat nose/jaw fracture ....................... 11.29 NA NA 10.85 11.53 1.21 090
21355 .... ............ A ........ Treat cheek bone fracture .................. 4.32 5.89 6.02 3.25 3.33 0.34 010
21356 .... ............ A ........ Treat cheek bone fracture .................. 4.70 6.96 7.02 4.07 4.30 0.46 010
21360 .... ............ A ........ Treat cheek bone fracture .................. 7.03 NA NA 5.41 5.66 0.74 090
21385 .... ............ A ........ Treat eye socket fracture ................... 9.46 NA NA 7.13 7.68 0.97 090
21400 .... ............ A ........ Treat eye socket fracture ................... 1.44 2.70 2.66 1.96 1.92 0.15 090
21401 .... ............ A ........ Treat eye socket fracture ................... 3.57 7.03 7.54 3.06 3.29 0.38 090
21421 .... ............ A ........ Treat mouth roof fracture ................... 5.80 12.43 10.83 9.20 8.73 0.73 090
21422 .... ............ A ........ Treat mouth roof fracture ................... 8.62 NA NA 7.05 7.54 0.99 090
21423 .... ............ A ........ Treat mouth roof fracture ................... 10.71 NA NA 7.43 8.37 1.27 090
21431 .... ............ A ........ Treat craniofacial fracture ................... 7.74 NA NA 10.80 9.93 0.70 090
21440 .... ............ A ........ Treat dental ridge fracture .................. 3.28 10.03 8.61 7.43 6.83 0.38 090
21445 .... ............ A ........ Treat dental ridge fracture .................. 6.04 12.27 11.05 8.47 8.45 0.78 090
21450 .... ............ A ........ Treat lower jaw fracture ...................... 3.55 10.48 8.91 7.70 7.28 0.33 090
21454 .... ............ A ........ Treat lower jaw fracture ...................... 7.17 NA NA 5.77 6.02 0.82 090
21480 .... ............ A ........ Reset dislocated jaw .......................... 0.61 1.50 1.63 0.18 0.19 0.06 000
21485 .... ............ A ........ Reset dislocated jaw .......................... 4.58 12.06 10.16 9.09 8.39 0.51 090
21490 .... ............ A ........ Repair dislocated jaw ......................... 12.71 NA NA 8.23 8.92 1.97 090
21495 .... ............ A ........ Treat hyoid bone fracture ................... 6.55 NA NA 10.43 9.30 0.46 090
21497 .... ............ A ........ Interdental wiring ................................ 4.45 12.20 10.29 9.34 8.47 0.50 090
21499 .... ............ C ........ Head surgery procedure ..................... 0.00 0.00 1.58 0.00 0.17 0.00 YYY
21501 .... ............ A ........ Drain neck/chest lesion ...................... 3.87 6.51 6.44 3.50 3.65 0.43 090
21502 .... ............ A ........ Drain chest lesion ............................... 7.43 NA NA 4.55 5.13 0.97 090
21510 .... ............ A ........ Drainage of bone lesion ..................... 6.06 NA NA 4.77 5.21 0.80 090
21550 .... ............ A ........ Biopsy of neck/chest .......................... 2.08 4.33 3.94 1.79 1.74 0.16 010
21555 .... ............ A ........ Remove lesion, neck/chest ................ 4.40 5.74 5.63 3.42 3.31 0.56 090
21556 .... ............ A ........ Remove lesion, neck/chest ................ 5.63 NA NA 4.12 4.09 0.65 090
21557 .... ............ A ........ Remove tumor, neck/chest ................. 8.91 NA NA 4.51 4.92 1.08 090
21600 .... ............ A ........ Partial removal of rib .......................... 7.14 NA NA 5.92 5.81 0.99 090
21610 .... ............ A ........ Partial removal of rib .......................... 15.76 NA NA 8.90 8.77 3.08 090
21615 .... ............ A ........ Removal of rib .................................... 10.31 NA NA 5.17 5.98 1.45 090
21616 .... ............ A ........ Removal of rib and nerves ................. 12.54 NA NA 6.48 7.36 1.87 090
21620 .... ............ A ........ Partial removal of sternum ................. 7.16 NA NA 4.75 5.38 0.98 090
21627 .... ............ A ........ Sternal debridement ........................... 7.18 NA NA 5.51 5.93 1.02 090
21630 .... ............ A ........ Extensive sternum surgery ................. 19.01 NA NA 10.35 11.16 2.59 090
21632 .... ............ A ........ Extensive sternum surgery ................. 19.51 NA NA 9.28 10.25 2.66 090
21685 .... ............ A ........ Hyoid myotomy & suspension ............ 14.89 NA NA 8.80 9.25 1.06 090
21700 .... ............ A ........ Revision of neck muscle .................... 6.23 NA NA 4.41 4.36 0.32 090
21705 .... ............ A ........ Revision of neck muscle/rib ............... 9.83 NA NA 4.35 5.02 1.43 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
21740 .... ............ A ........ Reconstruction of sternum ................. 17.47 NA NA 8.04 8.41 2.37 090
21742 .... ............ C ........ Repair stern/nuss w/o scope .............. 0.00 0.00 0.00 0.00 0.00 0.00 090
21743 .... ............ C ........ Repair sternum/nuss w/scope ............ 0.00 0.00 0.00 0.00 0.00 0.00 090
21750 .... ............ A ........ Repair of sternum separation ............. 11.35 NA NA 5.30 5.73 1.63 090
21800 .... ............ A ........ Treatment of rib fracture ..................... 0.98 1.35 1.34 1.41 1.36 0.09 090
21805 .... ............ A ........ Treatment of rib fracture ..................... 2.80 NA NA 3.27 3.28 0.38 090
21810 .... ............ A ........ Treatment of rib fracture(s) ................ 6.92 NA NA 5.34 5.13 0.94 090
21820 .... ............ A ........ Treat sternum fracture ........................ 1.31 1.81 1.82 1.88 1.81 0.16 090
21825 .... ............ A ........ Treat sternum fracture ........................ 7.65 NA NA 5.35 5.89 1.11 090
21899 .... ............ C ........ Neck/chest surgery procedure ........... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
21920 .... ............ A ........ Biopsy soft tissue of back .................. 2.08 4.42 3.85 1.89 1.68 0.14 010
21925 .... ............ A ........ Biopsy soft tissue of back .................. 4.54 5.30 5.26 3.34 3.31 0.60 090
21930 .... ............ A ........ Remove lesion, back or flank ............. 5.06 6.00 5.86 3.75 3.58 0.66 090
21935 .... ............ A ........ Remove tumor, back .......................... 18.38 NA NA 8.45 9.06 2.48 090
22010 .... ............ A ........ I&d, p-spine, c/t/cerv-thor ................... 12.57 NA NA 8.35 8.54 1.74 090
22015 .... ............ A ........ I&d, p-spine, l/s/ls ............................... 12.46 NA NA 8.35 8.50 1.72 090
22100 .... ............ A ........ Remove part of neck vertebra ............ 10.80 NA NA 8.20 7.85 2.14 090
22101 .... ............ A ........ Remove part, thorax vertebra ............ 10.88 NA NA 8.10 7.91 1.91 090
22102 .... ............ A ........ Remove part, lumbar vertebra ........... 10.88 NA NA 7.96 7.92 1.88 090
22103 .... ............ A ........ Remove extra spine segment ............ 2.34 NA NA 0.91 1.06 0.44 ZZZ
22110 .... ............ A ........ Remove part of neck vertebra ............ 13.80 NA NA 9.12 9.15 2.77 090
22112 .... ............ A ........ Remove part, thorax vertebra ............ 13.87 NA NA 9.03 9.15 2.53 090
22114 .... ............ A ........ Remove part, lumbar vertebra ........... 13.87 NA NA 8.99 9.14 2.64 090
22116 .... ............ A ........ Remove extra spine segment ............ 2.32 NA NA 0.90 1.03 0.50 ZZZ
22210 .... ............ A ........ Revision of neck spine ....................... 25.13 NA NA 14.61 15.05 5.46 090
22212 .... ............ A ........ Revision of thorax spine ..................... 20.74 NA NA 12.48 12.89 3.91 090
22214 .... ............ A ........ Revision of lumbar spine .................... 20.77 NA NA 12.58 13.21 3.92 090
22216 .... ............ A ........ Revise, extra spine segment .............. 6.03 NA NA 2.35 2.75 1.29 ZZZ
22220 .... ............ A ........ Revision of neck spine ....................... 22.69 NA NA 13.42 13.55 5.08 090
22222 .... ............ A ........ Revision of thorax spine ..................... 22.84 NA NA 10.60 11.15 4.13 090
22224 .... ............ A ........ Revision of lumbar spine .................... 22.84 NA NA 12.98 13.65 4.19 090
22226 .... ............ A ........ Revise, extra spine segment .............. 6.03 NA NA 2.30 2.67 1.29 ZZZ
22305 .... ............ A ........ Treat spine process fracture .............. 2.08 2.14 2.23 1.80 1.86 0.39 090
22310 .... ............ A ........ Treat spine fracture ............................ 3.69 2.98 2.89 2.50 2.43 0.50 090
22315 .... ............ A ........ Treat spine fracture ............................ 9.91 9.88 9.77 7.45 7.39 1.86 090
22318 .... ............ A ........ Treat odontoid fx w/o graft ................. 22.54 NA NA 13.35 13.38 5.30 090
22319 .... ............ A ........ Treat odontoid fx w/graft .................... 25.15 NA NA 13.54 14.23 6.05 090
22325 .... ............ A ........ Treat spine fracture ............................ 19.62 NA NA 12.18 12.11 3.88 090
22326 .... ............ A ........ Treat neck spine fracture ................... 20.64 NA NA 12.11 12.43 4.43 090
22327 .... ............ A ........ Treat thorax spine fracture ................. 20.52 NA NA 12.38 12.37 3.99 090
22328 .... ............ A ........ Treat each add spine fx ..................... 4.60 NA NA 1.78 2.03 0.94 ZZZ
22505 .... ............ A ........ Manipulation of spine ......................... 1.87 NA NA 1.11 1.02 0.36 010
22520 .... ............ A ........ Percut vertebroplasty thor .................. 9.17 43.46 52.37 4.61 4.76 1.72 010
22521 .... ............ A ........ Percut vertebroplasty lumb ................. 8.60 44.62 50.12 4.38 4.59 1.60 010
22522 .... ............ A ........ Percut vertebroplasty add l ............... 4.30 NA NA 1.52 1.57 0.82 ZZZ
22523 .... ............ A ........ Percut kyphoplasty, thor ..................... 9.21 NA NA 4.70 5.30 1.72 010
22524 .... ............ A ........ Percut kyphoplasty, lumbar ................ 8.81 NA NA 4.55 5.12 1.60 010
22525 .... ............ A ........ Percut kyphoplasty, add-on ................ 4.47 NA NA 1.71 1.98 0.82 ZZZ
22526 .... ............ A ........ Idet, single level .................................. 6.07 46.11 46.38 2.04 2.07 1.16 010
22527 .... ............ A ........ Idet, 1 or more levels ......................... 3.03 39.85 39.88 0.70 0.70 0.58 ZZZ
22532 .... ............ A ........ Lat thorax spine fusion ....................... 25.81 NA NA 13.50 14.23 4.35 090
22533 .... ............ A ........ Lat lumbar spine fusion ...................... 24.61 NA NA 13.63 13.59 3.16 090
22534 .... ............ A ........ Lat thor/lumb, addœl seg .................... 5.99 NA NA 2.30 2.67 1.25 ZZZ
22548 .... ............ A ........ Neck spine fusion ............................... 26.86 NA NA 15.03 15.46 5.61 090
22556 .... ............ A ........ Thorax spine fusion ............................ 24.50 NA NA 13.03 13.90 4.35 090
22558 .... ............ A ........ Lumbar spine fusion ........................... 23.33 NA NA 11.47 12.40 3.16 090
22585 .... ............ A ........ Additional spinal fusion ....................... 5.52 NA NA 2.08 2.44 1.25 ZZZ
22590 .... ............ A ........ Spine & skull spinal fusion ................. 21.56 NA NA 13.16 13.25 4.79 090
22595 .... ............ A ........ Neck spinal fusion .............................. 20.44 NA NA 12.73 12.78 4.41 090
22610 .... ............ A ........ Thorax spine fusion ............................ 17.08 NA NA 10.86 11.15 3.53 090
22614 .... ............ A ........ Spine fusion, extra segment ............... 6.43 NA NA 2.48 2.93 1.38 ZZZ
22632 .... ............ A ........ Spine fusion, extra segment ............... 5.22 NA NA 2.01 2.34 1.16 ZZZ
22800 .... ............ A ........ Fusion of spine ................................... 19.30 NA NA 11.19 11.98 3.76 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
22818 .... ............ A ........ Kyphectomy, 1–2 segments ............... 34.18 NA NA 16.71 17.80 6.47 090
22819 .... ............ A ........ Kyphectomy, 3 or more ...................... 39.18 NA NA 18.99 19.62 7.67 090
22830 .... ............ A ........ Exploration of spinal fusion ................ 11.13 NA NA 7.08 7.53 2.30 090
22840 .... ............ A ........ Insert spine fixation device ................. 12.52 NA NA 4.83 5.68 2.79 ZZZ
22848 .... ............ A ........ Insert pelv fixation device ................... 5.99 NA NA 2.36 2.77 1.15 ZZZ
22849 .... ............ A ........ Reinsert spinal fixation ....................... 19.08 NA NA 10.22 11.00 3.90 090
22850 .... ............ A ........ Remove spine fixation device ............ 9.74 NA NA 6.43 6.73 2.05 090
22851 .... ............ A ........ Apply spine prosth device .................. 6.70 NA NA 2.57 2.98 1.49 ZZZ
22857 .... ............ R ........ Lumbar artif diskectomy ..................... 26.93 NA NA 16.22 11.27 3.56 090
22862 .... ............ R ........ Revise lumbar artif disc ...................... 32.43 NA NA 10.05 10.06 5.36 090
22865 .... ............ R ........ Remove lumb artif disc ....................... 31.55 NA NA 9.85 9.86 5.18 090
22899 .... ............ C ........ Spine surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
22900 .... ............ A ........ Remove abdominal wall lesion ........... 6.14 NA NA 3.51 3.37 0.76 090
22999 .... ............ C ........ Abdomen surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
23000 .... ............ A ........ Removal of calcium deposits ............. 4.40 7.83 8.17 3.72 4.07 0.68 090
23020 .... ............ A ........ Release shoulder joint ........................ 9.24 NA NA 6.48 7.03 1.54 090
23030 .... ............ A ........ Drain shoulder lesion .......................... 3.44 6.24 6.82 2.40 2.65 0.57 010
23031 .... ............ A ........ Drain shoulder bursa .......................... 2.76 6.46 7.16 2.21 2.47 0.46 010
23035 .... ............ A ........ Drain shoulder bone lesion ................ 9.04 NA NA 7.02 7.65 1.47 090
23040 .... ............ A ........ Exploratory shoulder surgery ............. 9.63 NA NA 6.74 7.31 1.60 090
23044 .... ............ A ........ Exploratory shoulder surgery ............. 7.48 NA NA 5.51 5.98 1.24 090
23065 .... ............ A ........ Biopsy shoulder tissues ...................... 2.28 2.95 2.72 1.74 1.68 0.20 010
23066 .... ............ A ........ Biopsy shoulder tissues ...................... 4.21 7.69 7.67 3.59 3.78 0.63 090
23075 .... ............ A ........ Removal of shoulder lesion ................ 2.41 3.67 3.67 1.71 1.75 0.34 010
23076 .... ............ A ........ Removal of shoulder lesion ................ 7.77 NA NA 5.30 5.43 1.13 090
23077 .... ............ A ........ Remove tumor of shoulder ................. 18.08 NA NA 9.61 9.95 2.34 090
23100 .... ............ A ........ Biopsy of shoulder joint ...................... 6.09 NA NA 4.98 5.35 1.04 090
23101 .... ............ A ........ Shoulder joint surgery ........................ 5.63 NA NA 4.52 4.93 0.96 090
23105 .... ............ A ........ Remove shoulder joint lining .............. 8.36 NA NA 6.09 6.62 1.42 090
23106 .... ............ A ........ Incision of collarbone joint .................. 6.02 NA NA 4.77 5.21 0.99 090
23107 .... ............ A ........ Explore treat shoulder joint ................ 8.75 NA NA 6.25 6.83 1.49 090
23120 .... ............ A ........ Partial removal, collar bone ................ 7.23 NA NA 5.46 5.97 1.23 090
23125 .... ............ A ........ Removal of collar bone ...................... 9.52 NA NA 6.38 6.97 1.62 090
23130 .... ............ A ........ Remove shoulder bone, part .............. 7.63 NA NA 6.07 6.61 1.30 090
23140 .... ............ A ........ Removal of bone lesion ...................... 7.01 NA NA 4.88 5.04 1.08 090
23150 .... ............ A ........ Removal of humerus lesion ................ 8.79 NA NA 6.25 6.56 1.32 090
23170 .... ............ A ........ Remove collar bone lesion ................. 7.10 NA NA 4.99 5.52 1.12 090
23172 .... ............ A ........ Remove shoulder blade lesion ........... 7.20 NA NA 5.51 5.82 1.01 090
23174 .... ............ A ........ Remove humerus lesion ..................... 9.90 NA NA 7.16 7.79 1.65 090
23180 .... ............ A ........ Remove collar bone lesion ................. 8.85 NA NA 7.00 8.01 1.47 090
23182 .... ............ A ........ Remove shoulder blade lesion ........... 8.47 NA NA 6.97 7.75 1.37 090
23190 .... ............ A ........ Partial removal of scapula .................. 7.36 NA NA 5.30 5.76 1.17 090
23195 .... ............ A ........ Removal of head of humerus ............. 10.24 NA NA 6.91 7.30 1.71 090
23200 .... ............ A ........ Removal of collar bone ...................... 12.69 NA NA 7.09 7.98 1.94 090
23210 .... ............ A ........ Removal of shoulder blade ................ 13.16 NA NA 7.82 8.48 2.03 090
23220 .... ............ A ........ Partial removal of humerus ................ 15.36 NA NA 9.15 9.98 2.49 090
23330 .... ............ A ........ Remove shoulder foreign body .......... 1.87 3.32 3.51 1.50 1.70 0.24 010
23331 .... ............ A ........ Remove shoulder foreign body .......... 7.51 NA NA 5.82 6.32 1.27 090
23332 .... ............ A ........ Remove shoulder foreign body .......... 12.23 NA NA 7.96 8.66 2.03 090
23350 .... ............ A ........ Injection for shoulder x-ray ................. 1.00 2.71 3.06 0.36 0.33 0.06 000
23395 .... ............ A ........ Muscle transfer,shoulder/arm ............. 18.29 NA NA 11.21 12.06 2.94 090
23397 .... ............ A ........ Muscle transfers ................................. 16.62 NA NA 9.55 10.50 2.74 090
23400 .... ............ A ........ Fixation of shoulder blade .................. 13.73 NA NA 8.55 9.32 2.30 090
23405 .... ............ A ........ Incision of tendon & muscle ............... 8.43 NA NA 5.92 6.43 1.45 090
23406 .... ............ A ........ Incise tendon(s) & muscle(s) .............. 10.90 NA NA 6.91 7.64 1.88 090
23410 .... ............ A ........ Repair rotator cuff, acute .................... 12.63 NA NA 7.79 8.61 2.17 090
23412 .... ............ A ........ Repair rotator cuff, chronic ................. 13.55 NA NA 8.17 9.05 2.32 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
23415 .... ............ A ........ Release of shoulder ligament ............. 10.09 NA NA 6.59 7.30 1.74 090
23420 .... ............ A ........ Repair of shoulder .............................. 14.75 NA NA 9.71 10.30 2.32 090
23430 .... ............ A ........ Repair biceps tendon ......................... 10.05 NA NA 6.78 7.45 1.74 090
23440 .... ............ A ........ Remove/transplant tendon ................. 10.53 NA NA 6.78 7.53 1.83 090
23450 .... ............ A ........ Repair shoulder capsule ..................... 13.58 NA NA 8.19 9.02 2.33 090
23470 .... ............ A ........ Reconstruct shoulder joint .................. 17.75 NA NA 10.14 11.21 2.99 090
23472 .... ............ A ........ Reconstruct shoulder joint .................. 22.47 NA NA 12.17 13.32 3.67 090
23480 .... ............ A ........ Revision of collar bone ....................... 11.42 NA NA 7.29 8.05 1.95 090
23485 .... ............ A ........ Revision of collar bone ....................... 13.79 NA NA 8.21 9.08 2.34 090
23490 .... ............ A ........ Reinforce clavicle ............................... 12.04 NA NA 6.77 7.70 1.47 090
23491 .... ............ A ........ Reinforce shoulder bones .................. 14.40 NA NA 8.73 9.76 2.47 090
23500 .... ............ A ........ Treat clavicle fracture ......................... 2.13 2.63 2.75 2.70 2.60 0.30 090
23505 .... ............ A ........ Treat clavicle fracture ......................... 3.74 3.99 4.20 3.60 3.73 0.61 090
23515 .... ............ A ........ Treat clavicle fracture ......................... 7.47 NA NA 5.56 6.07 1.28 090
23520 .... ............ A ........ Treat clavicle dislocation .................... 2.21 2.75 2.78 2.82 2.75 0.34 090
23530 .... ............ A ........ Treat clavicle dislocation .................... 7.37 NA NA 5.31 5.62 1.20 090
23570 .... ............ A ........ Treat shoulder blade fx ...................... 2.28 2.77 2.90 2.91 2.88 0.36 090
23575 .... ............ A ........ Treat shoulder blade fx ...................... 4.12 4.57 4.69 4.07 4.16 0.59 090
23585 .... ............ A ........ Treat scapula fracture ........................ 9.15 NA NA 6.49 7.08 1.54 090
23600 .... ............ A ........ Treat humerus fracture ....................... 3.00 4.05 4.30 3.63 3.60 0.48 090
23615 .... ............ A ........ Treat humerus fracture ....................... 10.93 NA NA 8.27 8.56 1.62 090
23650 .... ............ A ........ Treat shoulder dislocation .................. 3.44 3.26 3.52 2.80 2.78 0.30 090
23655 .... ............ A ........ Treat shoulder dislocation .................. 4.64 NA NA 4.13 4.16 0.69 090
23660 .... ............ A ........ Treat shoulder dislocation .................. 7.55 NA NA 5.68 6.03 1.29 090
23665 .... ............ A ........ Treat dislocation/fracture .................... 4.54 4.83 5.08 4.25 4.49 0.71 090
23670 .... ............ A ........ Treat dislocation/fracture .................... 8.02 NA NA 5.89 6.36 1.36 090
23675 .... ............ A ........ Treat dislocation/fracture .................... 6.13 6.10 6.47 5.11 5.48 1.01 090
23680 .... ............ A ........ Treat dislocation/fracture .................... 10.30 NA NA 6.92 7.53 1.76 090
23700 .... ............ A ........ Fixation of shoulder ............................ 2.54 NA NA 1.90 2.04 0.44 010
23800 .... ............ A ........ Fusion of shoulder joint ...................... 14.59 NA NA 8.75 9.40 2.36 090
23802 .... ............ A ........ Fusion of shoulder joint ...................... 18.17 NA NA 11.21 10.67 2.71 090
23900 .... ............ A ........ Amputation of arm & girdle ................ 20.57 NA NA 10.44 11.13 3.19 090
23920 .... ............ A ........ Amputation at shoulder joint ............... 16.03 NA NA 9.14 9.61 2.47 090
23921 .... ............ A ........ Amputation follow-up surgery ............. 5.61 NA NA 4.84 4.97 0.78 090
23929 .... ............ C ........ Shoulder surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
23930 .... ............ A ........ Drainage of arm lesion ....................... 2.96 4.93 5.63 1.97 2.14 0.43 010
23931 .... ............ A ........ Drainage of arm bursa ....................... 1.81 4.32 5.11 1.75 1.96 0.28 010
23935 .... ............ A ........ Drain arm/elbow bone lesion .............. 6.27 NA NA 5.08 5.51 1.05 090
24000 .... ............ A ........ Exploratory elbow surgery .................. 5.99 NA NA 4.74 5.09 0.97 090
24006 .... ............ A ........ Release elbow joint ............................ 9.62 NA NA 6.58 7.19 1.50 090
24065 .... ............ A ........ Biopsy arm/elbow soft tissue .............. 2.10 4.14 3.68 1.92 1.83 0.17 010
24066 .... ............ A ........ Biopsy arm/elbow soft tissue .............. 5.26 8.20 8.57 3.91 4.02 0.80 090
24075 .... ............ A ........ Remove arm/elbow lesion .................. 3.96 7.12 7.24 3.25 3.33 0.56 090
24076 .... ............ A ........ Remove arm/elbow lesion .................. 6.36 NA NA 4.57 4.72 0.95 090
24077 .... ............ A ........ Remove tumor of arm/elbow .............. 11.95 NA NA 6.86 7.33 1.73 090
24100 .... ............ A ........ Biopsy elbow joint lining ..................... 4.98 NA NA 4.08 4.33 0.85 090
24101 .... ............ A ........ Explore/treat elbow joint ..................... 6.19 NA NA 5.03 5.49 1.03 090
24102 .... ............ A ........ Remove elbow joint lining .................. 8.15 NA NA 5.80 6.34 1.33 090
24105 .... ............ A ........ Removal of elbow bursa ..................... 3.67 NA NA 4.01 4.20 0.61 090
24115 .... ............ A ........ Remove/graft bone lesion .................. 10.00 NA NA 4.30 6.18 1.68 090
24120 .... ............ A ........ Remove elbow lesion ......................... 6.71 NA NA 5.17 5.56 1.10 090
24130 .... ............ A ........ Removal of head of radius ................. 6.31 NA NA 5.12 5.57 1.04 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
24134 .... ............ A ........ Removal of arm bone lesion .............. 10.10 NA NA 7.46 8.17 1.64 090
24136 .... ............ A ........ Remove radius bone lesion ................ 8.29 NA NA 5.77 6.48 1.38 090
24138 .... ............ A ........ Remove elbow bone lesion ................ 8.33 NA NA 6.47 7.17 1.34 090
24140 .... ............ A ........ Partial removal of arm bone ............... 9.43 NA NA 7.13 8.14 1.51 090
24145 .... ............ A ........ Partial removal of radius .................... 7.70 NA NA 6.20 7.15 1.25 090
24147 .... ............ A ........ Partial removal of elbow ..................... 7.69 NA NA 6.83 7.73 1.30 090
24149 .... ............ A ........ Radical resection of elbow ................. 15.92 NA NA 10.74 11.21 2.35 090
24150 .... ............ A ........ Extensive humerus surgery ................ 13.70 NA NA 8.50 9.26 2.33 090
24151 .... ............ A ........ Extensive humerus surgery ................ 16.08 NA NA 9.71 10.63 2.60 090
24152 .... ............ A ........ Extensive radius surgery .................... 10.24 NA NA 6.19 6.99 1.48 090
24153 .... ............ A ........ Extensive radius surgery .................... 11.73 NA NA 4.86 5.22 0.74 090
24155 .... ............ A ........ Removal of elbow joint ....................... 11.97 NA NA 7.40 7.94 1.93 090
24160 .... ............ A ........ Remove elbow joint implant ............... 7.89 NA NA 5.81 6.36 1.30 090
24164 .... ............ A ........ Remove radius head implant ............. 6.34 NA NA 4.88 5.33 1.03 090
24200 .... ............ A ........ Removal of arm foreign body ............. 1.78 2.72 3.07 1.36 1.50 0.20 010
24201 .... ............ A ........ Removal of arm foreign body ............. 4.61 7.76 8.80 3.66 3.95 0.72 090
24220 .... ............ A ........ Injection for elbow x-ray ..................... 1.31 2.65 3.12 0.47 0.44 0.08 000
24300 .... ............ A ........ Manipulate elbow w/anesth ................ 3.86 NA NA 5.13 5.43 0.65 090
24301 .... ............ A ........ Muscle/tendon transfer ....................... 10.26 NA NA 6.83 7.52 1.66 090
24305 .... ............ A ........ Arm tendon lengthening ..................... 7.51 NA NA 5.63 6.18 1.15 090
24310 .... ............ A ........ Revision of arm tendon ...................... 6.03 NA NA 4.72 5.17 0.96 090
24320 .... ............ A ........ Repair of arm tendon ......................... 10.74 NA NA 7.03 7.30 1.74 090
24330 .... ............ A ........ Revision of arm muscles .................... 9.67 NA NA 6.63 7.26 1.60 090
24331 .... ............ A ........ Revision of arm muscles .................... 10.83 NA NA 6.95 7.75 1.78 090
24332 .... ............ A ........ Tenolysis, triceps ................................ 7.77 NA NA 5.91 6.32 1.23 090
24340 .... ............ A ........ Repair of biceps tendon ..................... 7.96 NA NA 5.96 6.48 1.36 090
24341 .... ............ A ........ Repair arm tendon/muscle ................. 9.24 NA NA 7.50 7.72 1.36 090
24342 .... ............ A ........ Repair of ruptured tendon .................. 10.74 NA NA 7.06 7.81 1.86 090
24343 .... ............ A ........ Repr elbow lat ligmnt w/tiss ............... 8.99 NA NA 6.97 7.58 1.43 090
24344 .... ............ A ........ Reconstruct elbow lat ligmnt .............. 14.97 NA NA 9.95 10.76 2.37 090
24345 .... ............ A ........ Repr elbw med ligmnt w/tissu ............ 8.99 NA NA 6.92 7.49 1.44 090
24346 .... ............ A ........ Reconstruct elbow med ligmnt ........... 14.97 NA NA 10.01 10.69 2.34 090
24350 .... ............ A ........ Repair of tennis elbow ........................ 5.32 NA NA 4.85 5.22 0.87 090
24356 .... ............ A ........ Revision of tennis elbow .................... 6.74 NA NA 5.29 5.81 1.11 090
24360 .... ............ A ........ Reconstruct elbow joint ...................... 12.53 NA NA 7.87 8.70 2.06 090
24363 .... ............ A ........ Replace elbow joint ............................ 22.47 NA NA 12.18 12.97 3.02 090
24365 .... ............ A ........ Reconstruct head of radius ................ 8.51 NA NA 5.96 6.58 1.41 090
24366 .... ............ A ........ Reconstruct head of radius ................ 9.25 NA NA 6.29 6.92 1.52 090
24400 .... ............ A ........ Revision of humerus ........................... 11.19 NA NA 7.50 8.20 1.93 090
24430 .... ............ A ........ Repair of humerus .............................. 15.07 NA NA 9.24 9.51 2.22 090
24435 .... ............ A ........ Repair humerus with graft .................. 14.74 NA NA 9.81 10.36 2.28 090
24470 .... ............ A ........ Revision of elbow joint ....................... 8.81 NA NA 5.73 6.84 1.48 090
24495 .... ............ A ........ Decompression of forearm ................. 8.30 NA NA 6.36 7.60 1.18 090
24498 .... ............ A ........ Reinforce humerus ............................. 12.16 NA NA 7.67 8.48 2.07 090
24586 .... ............ A ........ Treat elbow fracture ........................... 15.64 NA NA 9.33 10.30 2.65 090
24600 .... ............ A ........ Treat elbow dislocation ....................... 4.28 3.84 4.35 3.26 3.39 0.50 090
24605 .... ............ A ........ Treat elbow dislocation ....................... 5.50 NA NA 4.89 5.14 0.89 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
24615 .... ............ A ........ Treat elbow dislocation ....................... 9.72 NA NA 6.55 7.20 1.60 090
24640 .... ............ A ........ Treat elbow dislocation ....................... 1.22 1.51 1.67 0.82 0.81 0.12 010
24650 .... ............ A ........ Treat radius fracture ........................... 2.22 3.41 3.60 2.98 2.87 0.35 090
24655 .... ............ A ........ Treat radius fracture ........................... 4.48 5.15 5.56 4.37 4.59 0.70 090
24665 .... ............ A ........ Treat radius fracture ........................... 8.22 NA NA 6.50 7.01 1.41 090
24666 .... ............ A ........ Treat radius fracture ........................... 9.74 NA NA 6.94 7.52 1.62 090
24670 .... ............ A ........ Treat ulnar fracture ............................. 2.60 3.70 3.91 3.13 3.10 0.41 090
24675 .... ............ A ........ Treat ulnar fracture ............................. 4.79 5.35 5.67 4.55 4.76 0.81 090
24685 .... ............ A ........ Treat ulnar fracture ............................. 8.92 NA NA 6.43 6.99 1.52 090
24800 .... ............ A ........ Fusion of elbow joint .......................... 11.27 NA NA 6.86 7.94 1.63 090
24802 .... ............ A ........ Fusion/graft of elbow joint .................. 14.18 NA NA 8.03 9.30 2.38 090
24900 .... ............ A ........ Amputation of upper arm .................... 10.04 NA NA 6.40 6.75 1.53 090
24920 .... ............ A ........ Amputation of upper arm .................... 10.02 NA NA 6.01 6.56 1.61 090
24931 .... ............ A ........ Amputate upper arm & implant .......... 13.32 NA NA 5.06 5.95 1.90 090
24935 .... ............ A ........ Revision of amputation ....................... 16.30 NA NA 10.49 8.99 2.14 090
24940 .... ............ C ........ Revision of upper arm ........................ 0.00 0.00 0.00 0.00 0.00 0.00 090
24999 .... ............ C ........ Upper arm/elbow surgery ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
25000 .... ............ A ........ Incision of tendon sheath ................... 3.44 NA NA 5.03 5.96 0.55 090
25001 .... ............ A ........ Incise flexor carpi radialis ................... 3.68 NA NA 3.92 4.07 0.55 090
25020 .... ............ A ........ Decompress forearm 1 space ............ 5.97 NA NA 6.89 8.23 0.93 090
25023 .... ............ A ........ Decompress forearm 1 space ............ 13.69 NA NA 11.36 13.18 2.04 090
25024 .... ............ A ........ Decompress forearm 2 spaces .......... 10.62 NA NA 7.07 7.30 1.36 090
25025 .... ............ A ........ Decompress forearm 2 spaces .......... 17.77 NA NA 9.63 9.72 1.83 090
25028 .... ............ A ........ Drainage of forearm lesion ................. 5.30 NA NA 6.15 7.17 0.81 090
25031 .... ............ A ........ Drainage of forearm bursa ................. 4.18 NA NA 5.42 6.68 0.63 090
25035 .... ............ A ........ Treat forearm bone lesion .................. 7.54 NA NA 8.74 11.19 1.24 090
25040 .... ............ A ........ Explore/treat wrist joint ....................... 7.41 NA NA 5.85 6.59 1.15 090
25065 .... ............ A ........ Biopsy forearm soft tissues ................ 2.01 4.32 3.77 1.98 1.94 0.15 010
25066 .... ............ A ........ Biopsy forearm soft tissues ................ 4.18 NA NA 5.45 6.26 0.64 090
25075 .... ............ A ........ Removal forearm lesion subcu ........... 3.78 NA NA 4.87 5.38 0.55 090
25076 .... ............ A ........ Removal forearm lesion deep ............ 4.97 NA NA 6.84 8.20 0.74 090
25077 .... ............ A ........ Remove tumor, forearm/wrist ............. 9.90 NA NA 8.81 10.47 1.42 090
25085 .... ............ A ........ Incision of wrist capsule ..................... 5.55 NA NA 5.38 6.27 0.85 090
25100 .... ............ A ........ Biopsy of wrist joint ............................ 3.94 NA NA 4.22 4.76 0.59 090
25101 .... ............ A ........ Explore/treat wrist joint ....................... 4.74 NA NA 4.80 5.35 0.75 090
25105 .... ............ A ........ Remove wrist joint lining .................... 5.91 NA NA 5.75 6.54 0.92 090
25107 .... ............ A ........ Remove wrist joint cartilage ............... 7.50 NA NA 7.00 7.71 0.99 090
25109 .... ............ A ........ Excise tendon forearm/wrist ............... 6.81 NA NA 5.26 5.30 0.96 090
25110 .... ............ A ........ Remove wrist tendon lesion ............... 3.96 NA NA 5.22 6.15 0.62 090
25111 .... ............ A ........ Remove wrist tendon lesion ............... 3.44 NA NA 4.06 4.39 0.53 090
25112 .... ............ A ........ Reremove wrist tendon lesion ............ 4.58 NA NA 4.52 4.89 0.70 090
25115 .... ............ A ........ Remove wrist/forearm lesion .............. 9.89 NA NA 10.13 12.10 1.31 090
25116 .... ............ A ........ Remove wrist/forearm lesion .............. 7.38 NA NA 8.98 11.08 1.11 090
25118 .... ............ A ........ Excise wrist tendon sheath ................ 4.42 NA NA 4.60 5.18 0.68 090
25119 .... ............ A ........ Partial removal of ulna ....................... 6.10 NA NA 5.83 6.72 0.96 090
25120 .... ............ A ........ Removal of forearm lesion ................. 6.16 NA NA 7.90 9.99 1.00 090
25125 .... ............ A ........ Remove/graft forearm lesion .............. 7.55 NA NA 8.68 10.77 1.06 090
25126 .... ............ A ........ Remove/graft forearm lesion .............. 7.62 NA NA 8.69 10.87 1.27 090
25130 .... ............ A ........ Removal of wrist lesion ...................... 5.32 NA NA 5.17 5.80 0.80 090
25135 .... ............ A ........ Remove & graft wrist lesion ............... 6.96 NA NA 6.06 6.81 1.02 090
25136 .... ............ A ........ Remove & graft wrist lesion ............... 6.03 NA NA 5.53 6.06 1.03 090
25145 .... ............ A ........ Remove forearm bone lesion ............. 6.43 NA NA 8.01 10.06 1.01 090
25170 .... ............ A ........ Extensive forearm surgery ................. 11.34 NA NA 10.36 12.79 1.78 090
25210 .... ............ A ........ Removal of wrist bone ........................ 6.01 NA NA 5.49 6.16 0.88 090
25215 .... ............ A ........ Removal of wrist bones ...................... 8.02 NA NA 6.79 7.78 1.19 090
25246 .... ............ A ........ Injection for wrist x-ray ....................... 1.45 2.72 3.05 0.53 0.49 0.09 000
25248 .... ............ A ........ Remove forearm foreign body ............ 5.20 NA NA 6.57 7.54 0.72 090
25250 .... ............ A ........ Removal of wrist prosthesis ............... 6.66 NA NA 5.25 5.70 1.01 090
25251 .... ............ A ........ Removal of wrist prosthesis ............... 9.70 NA NA 6.72 7.33 1.26 090
25259 .... ............ A ........ Manipulate wrist w/anesthes .............. 3.86 NA NA 5.12 5.43 0.62 090
25260 .... ............ A ........ Repair forearm tendon/muscle ........... 7.89 NA NA 9.13 11.24 1.19 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
25275 .... ............ A ........ Repair forearm tendon sheath ........... 8.82 NA NA 6.46 7.04 1.31 090
25280 .... ............ A ........ Revise wrist/forearm tendon ............... 7.28 NA NA 8.36 10.52 1.08 090
25290 .... ............ A ........ Incise wrist/forearm tendon ................ 5.34 NA NA 9.03 12.03 0.82 090
25295 .... ............ A ........ Release wrist/forearm tendon ............ 6.61 NA NA 8.09 10.14 1.00 090
25300 .... ............ A ........ Fusion of tendons at wrist .................. 8.88 NA NA 7.09 7.80 1.26 090
25301 .... ............ A ........ Fusion of tendons at wrist .................. 8.47 NA NA 6.64 7.38 1.29 090
25310 .... ............ A ........ Transplant forearm tendon ................. 8.26 NA NA 8.74 10.91 1.21 090
25312 .... ............ A ........ Transplant forearm tendon ................. 9.70 NA NA 9.52 11.75 1.41 090
25315 .... ............ A ........ Revise palsy hand tendon(s) .............. 10.56 NA NA 9.89 12.18 1.58 090
25316 .... ............ A ........ Revise palsy hand tendon(s) .............. 12.76 NA NA 10.53 13.47 1.75 090
25320 .... ............ A ........ Repair/revise wrist joint ...................... 12.38 NA NA 10.29 10.87 1.61 090
25332 .... ............ A ........ Revise wrist joint ................................ 11.60 NA NA 7.60 8.42 1.84 090
25335 .... ............ A ........ Realignment of hand .......................... 13.25 NA NA 9.11 10.01 1.93 090
25337 .... ............ A ........ Reconstruct ulna/radioulnar ................ 11.44 NA NA 9.38 10.24 1.61 090
25350 .... ............ A ........ Revision of radius ............................... 8.97 NA NA 9.14 11.58 1.46 090
25355 .... ............ A ........ Revision of radius ............................... 10.41 NA NA 9.79 12.25 1.74 090
25360 .... ............ A ........ Revision of ulna .................................. 8.62 NA NA 9.05 11.47 1.41 090
25365 .... ............ A ........ Revise radius & ulna .......................... 12.77 NA NA 11.01 13.34 2.16 090
25370 .... ............ A ........ Revise radius or ulna ......................... 13.93 NA NA 11.86 13.98 2.29 090
25375 .... ............ A ........ Revise radius & ulna .......................... 13.41 NA NA 11.22 13.84 2.27 090
25390 .... ............ A ........ Shorten radius or ulna ........................ 10.58 NA NA 9.88 12.25 1.65 090
25391 .... ............ A ........ Lengthen radius or ulna ..................... 14.14 NA NA 11.47 14.05 2.22 090
25392 .... ............ A ........ Shorten radius & ulna ......................... 14.44 NA NA 11.70 13.86 2.11 090
25393 .... ............ A ........ Lengthen radius & ulna ...................... 16.42 NA NA 12.42 15.17 2.77 090
25394 .... ............ A ........ Repair carpal bone, shorten ............... 10.71 NA NA 6.94 7.49 1.59 090
25400 .... ............ A ........ Repair radius or ulna .......................... 11.16 NA NA 10.08 12.65 1.83 090
25405 .... ............ A ........ Repair/graft radius or ulna .................. 14.87 NA NA 11.75 14.54 2.33 090
25415 .... ............ A ........ Repair radius & ulna ........................... 13.66 NA NA 11.23 13.84 2.18 090
25420 .... ............ A ........ Repair/graft radius & ulna .................. 16.89 NA NA 12.74 15.52 2.62 090
25425 .... ............ A ........ Repair/graft radius or ulna .................. 13.58 NA NA 14.21 17.80 2.09 090
25426 .... ............ A ........ Repair/graft radius & ulna .................. 16.31 NA NA 11.95 14.34 2.55 090
25430 .... ............ A ........ Vasc graft into carpal bone ................ 9.57 NA NA 7.01 7.19 1.27 090
25431 .... ............ A ........ Repair nonunion carpal bone ............. 10.75 NA NA 7.13 7.80 1.91 090
25440 .... ............ A ........ Repair/graft wrist bone ....................... 10.56 NA NA 7.33 8.40 1.63 090
25441 .... ............ A ........ Reconstruct wrist joint ........................ 13.15 NA NA 8.07 9.13 2.08 090
25446 .... ............ A ........ Wrist replacement ............................... 17.16 NA NA 9.96 10.95 2.48 090
25447 .... ............ A ........ Repair wrist joint(s) ............................. 10.95 NA NA 7.83 8.26 1.61 090
25449 .... ............ A ........ Remove wrist joint implant ................. 14.80 NA NA 8.94 9.85 2.22 090
25450 .... ............ A ........ Revision of wrist joint ......................... 7.94 NA NA 5.85 8.26 1.36 090
25455 .... ............ A ........ Revision of wrist joint ......................... 9.57 NA NA 9.69 9.73 0.96 090
25490 .... ............ A ........ Reinforce radius ................................. 9.61 NA NA 9.33 11.56 1.43 090
25491 .... ............ A ........ Reinforce ulna .................................... 10.03 NA NA 9.63 12.06 1.60 090
25492 .... ............ A ........ Reinforce radius and ulna .................. 12.52 NA NA 11.08 13.11 2.15 090
25500 .... ............ A ........ Treat fracture of radius ....................... 2.51 3.29 3.44 2.85 2.79 0.35 090
25515 .... ............ A ........ Treat fracture of radius ....................... 9.37 NA NA 6.69 7.09 1.59 090
25530 .... ............ A ........ Treat fracture of ulna .......................... 2.15 3.46 3.61 2.96 2.91 0.34 090
25535 .... ............ A ........ Treat fracture of ulna .......................... 5.22 5.54 5.80 4.82 5.08 0.89 090
25545 .... ............ A ........ Treat fracture of ulna .......................... 9.09 NA NA 6.61 7.14 1.53 090
25560 .... ............ A ........ Treat fracture radius & ulna ............... 2.50 3.34 3.52 2.83 2.72 0.35 090
25565 .... ............ A ........ Treat fracture radius & ulna ............... 5.71 5.88 6.31 4.91 5.18 0.93 090
25574 .... ............ A ........ Treat fracture radius & ulna ............... 7.47 NA NA 6.58 6.90 1.21 090
25575 .... ............ A ........ Treat fracture radius/ulna ................... 12.02 NA NA 8.92 9.23 1.82 090
25600 .... ............ A ........ Treat fracture radius/ulna ................... 2.69 3.66 3.88 3.15 3.06 0.42 090
25605 .... ............ A ........ Treat fracture radius/ulna ................... 7.02 6.84 7.05 6.12 6.18 1.00 090
25606 .... ............ A ........ Treat fx distal radial ............................ 8.10 NA NA 6.68 8.22 1.26 090
25607 .... ............ A ........ Treat fx rad extra-articul ..................... 9.35 NA NA 7.18 7.23 1.36 090
25608 .... ............ A ........ Treat fx rad intra-articul ...................... 10.86 NA NA 7.78 7.85 1.84 090
25609 .... ............ A ........ Treat fx radial 3+ frag ......................... 14.12 NA NA 9.65 9.73 2.38 090
25622 .... ............ A ........ Treat wrist bone fracture .................... 2.68 3.88 4.08 3.33 3.22 0.41 090
25628 .... ............ A ........ Treat wrist bone fracture .................... 9.50 NA NA 7.29 7.57 1.37 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
25645 .... ............ A ........ Treat wrist bone fracture .................... 7.31 NA NA 5.74 6.20 1.20 090
25651 .... ............ A ........ Pin ulnar styloid fracture ..................... 5.68 NA NA 5.11 5.30 0.86 090
25652 .... ............ A ........ Treat fracture ulnar styloid ................. 7.92 NA NA 6.14 6.59 1.21 090
25660 .... ............ A ........ Treat wrist dislocation ......................... 4.84 NA NA 4.29 4.54 0.58 090
25671 .... ............ A ........ Pin radioulnar dislocation ................... 6.32 NA NA 5.47 5.82 1.00 090
25675 .... ............ A ........ Treat wrist dislocation ......................... 4.75 4.68 5.20 3.97 4.34 0.62 090
25680 .... ............ A ........ Treat wrist fracture ............................. 6.08 NA NA 4.36 4.56 0.78 090
25685 .... ............ A ........ Treat wrist fracture ............................. 9.97 NA NA 6.80 7.29 1.60 090
25800 .... ............ A ........ Fusion of wrist joint ............................ 9.95 NA NA 7.25 8.18 1.57 090
25805 .... ............ A ........ Fusion/graft of wrist joint .................... 11.59 NA NA 8.14 9.21 1.81 090
25810 .... ............ A ........ Fusion/graft of wrist joint .................... 11.75 NA NA 8.49 9.22 1.68 090
25820 .... ............ A ........ Fusion of hand bones ......................... 7.52 NA NA 6.28 7.07 1.22 090
25825 .... ............ A ........ Fuse hand bones with graft ................ 9.54 NA NA 7.50 8.39 1.41 090
25830 .... ............ A ........ Fusion, radioulnar jnt/ulna .................. 10.69 NA NA 10.40 12.42 1.55 090
25900 .... ............ A ........ Amputation of forearm ........................ 9.46 NA NA 9.44 10.97 1.30 090
25920 .... ............ A ........ Amputate hand at wrist ...................... 8.92 NA NA 6.45 7.20 1.35 090
25922 .... ............ A ........ Amputate hand at wrist ...................... 7.54 NA NA 6.12 6.66 1.12 090
25927 .... ............ A ........ Amputation of hand ............................ 8.98 NA NA 8.50 10.11 1.27 090
25999 .... ............ C ........ Forearm or wrist surgery .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
26010 .... ............ A ........ Drainage of finger abscess ................ 1.56 4.02 4.79 1.51 1.57 0.18 010
26011 .... ............ A ........ Drainage of finger abscess ................ 2.21 6.20 7.51 1.95 2.14 0.33 010
26020 .... ............ A ........ Drain hand tendon sheath .................. 4.97 NA NA 4.71 5.04 0.73 090
26025 .... ............ A ........ Drainage of palm bursa ...................... 4.99 NA NA 4.44 4.79 0.76 090
26030 .... ............ A ........ Drainage of palm bursa(s) .................. 6.16 NA NA 4.98 5.36 0.92 090
26034 .... ............ A ........ Treat hand bone lesion ...................... 6.49 NA NA 5.55 5.96 1.01 090
26035 .... ............ A ........ Decompress fingers/hand ................... 11.14 NA NA 8.12 7.99 1.47 090
26037 .... ............ A ........ Decompress fingers/hand ................... 7.48 NA NA 5.49 5.92 1.13 090
26040 .... ............ A ........ Release palm contracture .................. 3.38 NA NA 3.56 3.82 0.53 090
26055 .... ............ A ........ Incise finger tendon sheath ................ 3.00 8.95 11.66 3.80 3.88 0.43 090
26060 .... ............ A ........ Incision of finger tendon ..................... 2.85 NA NA 3.03 3.28 0.45 090
26070 .... ............ A ........ Explore/treat hand joint ...................... 3.73 NA NA 3.04 3.20 0.48 090
26075 .... ............ A ........ Explore/treat finger joint ..................... 3.83 NA NA 3.35 3.58 0.53 090
26080 .... ............ A ........ Explore/treat finger joint ..................... 4.36 NA NA 4.29 4.58 0.66 090
26100 .... ............ A ........ Biopsy hand joint lining ...................... 3.71 NA NA 3.65 3.88 0.54 090
26105 .... ............ A ........ Biopsy finger joint lining ..................... 3.75 NA NA 3.66 3.96 0.59 090
26110 .... ............ A ........ Biopsy finger joint lining ..................... 3.57 NA NA 3.59 3.82 0.53 090
26115 .... ............ A ........ Removal hand lesion subcut .............. 3.92 9.75 11.43 4.21 4.50 0.59 090
26116 .... ............ A ........ Removal hand lesion, deep ................ 5.61 NA NA 5.28 5.65 0.84 090
26117 .... ............ A ........ Remove tumor, hand/finger ................ 8.62 NA NA 6.16 6.63 1.26 090
26125 .... ............ A ........ Release palm contracture .................. 4.60 NA NA 1.88 2.17 0.70 ZZZ
26130 .... ............ A ........ Remove wrist joint lining .................... 5.48 NA NA 4.88 5.11 0.94 090
26135 .... ............ A ........ Revise finger joint, each ..................... 7.02 NA NA 5.44 5.97 1.07 090
26140 .... ............ A ........ Revise finger joint, each ..................... 6.23 NA NA 5.13 5.60 0.92 090
26145 .... ............ A ........ Tendon excision, palm/finger ............. 6.38 NA NA 5.16 5.62 0.97 090
26160 .... ............ A ........ Remove tendon sheath lesion ............ 3.46 8.94 10.67 3.91 4.02 0.49 090
26170 .... ............ A ........ Removal of palm tendon, each .......... 4.82 NA NA 4.35 4.66 0.69 090
26180 .... ............ A ........ Removal of finger tendon ................... 5.24 NA NA 4.68 5.07 0.78 090
26185 .... ............ A ........ Remove finger bone ........................... 6.32 NA NA 5.69 5.88 0.81 090
26200 .... ............ A ........ Remove hand bone lesion ................. 5.56 NA NA 4.53 4.95 0.88 090
26210 .... ............ A ........ Removal of finger lesion ..................... 5.21 NA NA 4.71 5.08 0.79 090
26215 .... ............ A ........ Remove/graft finger lesion ................. 7.16 NA NA 5.51 5.92 0.98 090
26230 .... ............ A ........ Partial removal of hand bone ............. 6.38 NA NA 4.93 5.44 1.01 090
26235 .... ............ A ........ Partial removal, finger bone ............... 6.24 NA NA 4.92 5.38 0.95 090
26236 .... ............ A ........ Partial removal, finger bone ............... 5.37 NA NA 4.55 4.94 0.81 090
26250 .... ............ A ........ Extensive hand surgery ...................... 7.61 NA NA 5.69 5.98 1.07 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
26255 .... ............ A ........ Extensive hand surgery ...................... 12.80 NA NA 8.22 8.85 1.69 090
26260 .... ............ A ........ Extensive finger surgery ..................... 7.09 NA NA 5.45 5.81 1.01 090
26261 .... ............ A ........ Extensive finger surgery ..................... 9.28 NA NA 6.73 6.50 1.14 090
26262 .... ............ A ........ Partial removal of finger ..................... 5.72 NA NA 4.73 5.02 0.88 090
26320 .... ............ A ........ Removal of implant from hand ........... 4.02 NA NA 3.77 4.05 0.59 090
26340 .... ............ A ........ Manipulate finger w/anesth ................ 2.62 NA NA 4.57 4.74 0.39 090
26350 .... ............ A ........ Repair finger/hand tendon .................. 6.07 NA NA 9.35 12.00 0.93 090
26352 .... ............ A ........ Repair/graft hand tendon .................... 7.75 NA NA 9.89 12.65 1.13 090
26390 .... ............ A ........ Revise hand/finger tendon ................. 9.31 NA NA 9.04 11.17 1.40 090
26410 .... ............ A ........ Repair hand tendon ............................ 4.68 NA NA 7.49 9.73 0.73 090
26415 .... ............ A ........ Excision, hand/finger tendon .............. 8.40 NA NA 7.35 9.46 0.98 090
26416 .... ............ A ........ Graft hand or finger tendon ................ 9.44 NA NA 8.90 11.71 0.79 090
26418 .... ............ A ........ Repair finger tendon ........................... 4.33 NA NA 7.98 10.17 0.67 090
26420 .... ............ A ........ Repair/graft finger tendon ................... 6.83 NA NA 8.64 11.15 1.07 090
26437 .... ............ A ........ Realignment of tendons ..................... 5.88 NA NA 7.64 9.62 0.89 090
26440 .... ............ A ........ Release palm/finger tendon ............... 5.07 NA NA 8.31 10.89 0.75 090
26442 .... ............ A ........ Release palm & finger tendon ............ 9.50 NA NA 11.63 13.79 1.20 090
26445 .... ............ A ........ Release hand/finger tendon ............... 4.36 NA NA 8.05 10.60 0.65 090
26449 .... ............ A ........ Release forearm/hand tendon ............ 8.34 NA NA 11.18 13.50 1.06 090
26450 .... ............ A ........ Incision of palm tendon ...................... 3.71 NA NA 5.04 6.20 0.59 090
26455 .... ............ A ........ Incision of finger tendon ..................... 3.68 NA NA 5.00 6.15 0.58 090
26460 .... ............ A ........ Incise hand/finger tendon ................... 3.50 NA NA 4.97 6.06 0.55 090
26471 .... ............ A ........ Fusion of finger tendons ..................... 5.79 NA NA 7.63 9.44 0.88 090
26474 .... ............ A ........ Fusion of finger tendons ..................... 5.38 NA NA 7.44 9.43 0.76 090
26476 .... ............ A ........ Tendon lengthening ............................ 5.24 NA NA 7.17 9.09 0.79 090
26477 .... ............ A ........ Tendon shortening .............................. 5.21 NA NA 7.40 9.25 0.81 090
26478 .... ............ A ........ Lengthening of hand tendon .............. 5.86 NA NA 7.62 9.73 0.90 090
26479 .... ............ A ........ Shortening of hand tendon ................. 5.80 NA NA 7.60 9.60 0.92 090
26480 .... ............ A ........ Transplant hand tendon ..................... 6.76 NA NA 9.47 12.28 1.02 090
26483 .... ............ A ........ Transplant/graft hand tendon ............. 8.36 NA NA 10.06 12.81 1.26 090
26485 .... ............ A ........ Transplant palm tendon ...................... 7.77 NA NA 9.90 12.64 1.15 090
26489 .... ............ A ........ Transplant/graft palm tendon ............. 9.74 NA NA 10.64 11.29 1.26 090
26490 .... ............ A ........ Revise thumb tendon ......................... 8.48 NA NA 8.71 10.80 1.21 090
26492 .... ............ A ........ Tendon transfer with graft .................. 9.70 NA NA 9.66 11.66 1.40 090
26494 .... ............ A ........ Hand tendon/muscle transfer ............. 8.54 NA NA 9.05 11.00 1.28 090
26496 .... ............ A ........ Revise thumb tendon ......................... 9.66 NA NA 9.40 11.33 1.45 090
26497 .... ............ A ........ Finger tendon transfer ........................ 9.64 NA NA 9.38 11.49 1.41 090
26498 .... ............ A ........ Finger tendon transfer ........................ 14.07 NA NA 11.46 13.83 2.11 090
26499 .... ............ A ........ Revision of finger ................................ 9.05 NA NA 8.66 10.87 1.35 090
26500 .... ............ A ........ Hand tendon reconstruction ............... 6.02 NA NA 7.60 9.56 0.90 090
26502 .... ............ A ........ Hand tendon reconstruction ............... 7.20 NA NA 8.18 10.13 1.13 090
26508 .... ............ A ........ Release thumb contracture ................ 6.07 NA NA 7.64 9.68 0.98 090
26510 .... ............ A ........ Thumb tendon transfer ....................... 5.49 NA NA 7.47 9.42 0.79 090
26516 .... ............ A ........ Fusion of knuckle joint ........................ 7.21 NA NA 8.13 10.20 1.10 090
26517 .... ............ A ........ Fusion of knuckle joints ...................... 8.96 NA NA 8.86 11.25 1.41 090
26518 .... ............ A ........ Fusion of knuckle joints ...................... 9.15 NA NA 8.79 11.16 1.35 090
26520 .... ............ A ........ Release knuckle contracture .............. 5.36 NA NA 8.69 11.31 0.80 090
26525 .... ............ A ........ Release finger contracture ................. 5.39 NA NA 8.71 11.36 0.81 090
26530 .... ............ A ........ Revise knuckle joint ............................ 6.76 NA NA 5.39 5.78 1.04 090
26531 .... ............ A ........ Revise knuckle with implant ............... 7.99 NA NA 6.12 6.64 1.17 090
26535 .... ............ A ........ Revise finger joint ............................... 5.30 NA NA 4.03 3.90 0.71 090
26536 .... ............ A ........ Revise/implant finger joint .................. 6.44 NA NA 9.05 9.37 0.96 090
26540 .... ............ A ........ Repair hand joint ................................ 6.49 NA NA 7.89 9.90 0.99 090
26541 .... ............ A ........ Repair hand joint with graft ................ 8.69 NA NA 8.95 11.19 1.28 090
26542 .... ............ A ........ Repair hand joint with graft ................ 6.84 NA NA 8.04 10.05 1.02 090
26545 .... ............ A ........ Reconstruct finger joint ....................... 6.99 NA NA 8.30 10.23 1.05 090
26546 .... ............ A ........ Repair nonunion hand ........................ 10.53 NA NA 11.33 13.20 1.44 090
26548 .... ............ A ........ Reconstruct finger joint ....................... 8.10 NA NA 8.64 10.78 1.20 090
26550 .... ............ A ........ Construct thumb replacement ............ 21.54 NA NA 14.40 16.17 2.46 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
26551 .... ............ A ........ Great toe-hand transfer ...................... 48.23 NA NA 17.12 25.55 7.98 090
26553 .... ............ A ........ Single transfer, toe-hand .................... 47.92 NA NA 27.43 23.93 2.42 090
26554 .... ............ A ........ Double transfer, toe-hand ................... 56.73 NA NA 36.06 34.01 9.44 090
26555 .... ............ A ........ Positional change of finger ................. 16.94 NA NA 13.85 16.03 2.49 090
26556 .... ............ A ........ Toe joint transfer ................................ 49.43 NA NA 17.98 25.63 2.58 090
26560 .... ............ A ........ Repair of web finger ........................... 5.43 NA NA 6.52 8.26 0.85 090
26565 .... ............ A ........ Correct metacarpal flaw ..................... 6.80 NA NA 7.99 9.99 1.00 090
26567 .... ............ A ........ Correct finger deformity ...................... 6.88 NA NA 7.96 9.99 1.04 090
26568 .... ............ A ........ Lengthen metacarpal/finger ................ 9.15 NA NA 10.50 12.91 1.49 090
26580 .... ............ A ........ Repair hand deformity ........................ 19.50 NA NA 9.66 11.93 2.29 090
26587 .... ............ A ........ Reconstruct extra finger ..................... 14.36 NA NA 7.95 8.67 1.53 090
26590 .... ............ A ........ Repair finger deformity ....................... 18.51 NA NA 12.27 12.82 2.78 090
26591 .... ............ A ........ Repair muscles of hand ..................... 3.30 NA NA 6.07 7.88 0.48 090
26593 .... ............ A ........ Release muscles of hand ................... 5.38 NA NA 7.64 9.41 0.78 090
26596 .... ............ A ........ Excision constricting tissue ................ 9.02 NA NA 7.36 8.11 1.43 090
26600 .... ............ A ........ Treat metacarpal fracture ................... 2.48 3.81 3.72 3.47 3.06 0.30 090
26605 .... ............ A ........ Treat metacarpal fracture ................... 2.92 4.06 4.31 3.48 3.57 0.49 090
26607 .... ............ A ........ Treat metacarpal fracture ................... 5.40 NA NA 4.87 5.58 0.87 090
26641 .... ............ A ........ Treat thumb dislocation ...................... 4.01 4.02 4.32 3.39 3.48 0.39 090
26645 .... ............ A ........ Treat thumb fracture ........................... 4.47 4.58 4.88 3.90 4.05 0.67 090
26650 .... ............ A ........ Treat thumb fracture ........................... 5.80 NA NA 5.07 5.98 0.94 090
26665 .... ............ A ........ Treat thumb fracture ........................... 7.72 NA NA 5.84 6.24 0.90 090
26670 .... ............ A ........ Treat hand dislocation ........................ 3.74 3.59 3.92 3.01 2.97 0.39 090
26675 .... ............ A ........ Treat hand dislocation ........................ 4.71 5.22 5.29 4.49 4.43 0.77 090
26676 .... ............ A ........ Pin hand dislocation ........................... 5.60 NA NA 5.54 6.13 0.91 090
26685 .... ............ A ........ Treat hand dislocation ........................ 7.09 NA NA 5.35 5.76 1.09 090
26686 .... ............ A ........ Treat hand dislocation ........................ 8.06 NA NA 6.05 6.50 1.24 090
26700 .... ............ A ........ Treat knuckle dislocation .................... 3.74 3.27 3.52 2.91 2.90 0.35 090
26705 .... ............ A ........ Treat knuckle dislocation .................... 4.26 4.73 5.04 4.03 4.18 0.66 090
26706 .... ............ A ........ Pin knuckle dislocation ....................... 5.19 NA NA 4.68 4.89 0.81 090
26715 .... ............ A ........ Treat knuckle dislocation .................... 5.79 NA NA 4.86 5.20 0.91 090
26720 .... ............ A ........ Treat finger fracture, each .................. 1.70 2.56 2.67 2.29 2.18 0.24 090
26727 .... ............ A ........ Treat finger fracture, each .................. 5.30 NA NA 5.15 5.70 0.84 090
26756 .... ............ A ........ Pin finger fracture, each ..................... 4.46 NA NA 4.83 5.28 0.71 090
26770 .... ............ A ........ Treat finger dislocation ....................... 3.07 2.90 3.17 2.53 2.47 0.27 090
26775 .... ............ A ........ Treat finger dislocation ....................... 3.78 4.60 4.89 3.86 3.83 0.54 090
26776 .... ............ A ........ Pin finger dislocation .......................... 4.87 NA NA 4.95 5.49 0.77 090
26785 .... ............ A ........ Treat finger dislocation ....................... 4.25 NA NA 4.03 4.29 0.68 090
26820 .... ............ A ........ Thumb fusion with graft ...................... 8.33 NA NA 8.81 11.02 1.30 090
26841 .... ............ A ........ Fusion of thumb .................................. 7.21 NA NA 8.61 10.94 1.18 090
26842 .... ............ A ........ Thumb fusion with graft ...................... 8.37 NA NA 8.87 11.14 1.32 090
26843 .... ............ A ........ Fusion of hand joint ............................ 7.67 NA NA 8.40 10.34 1.15 090
26844 .... ............ A ........ Fusion/graft of hand joint .................... 8.86 NA NA 9.01 11.22 1.33 090
26850 .... ............ A ........ Fusion of knuckle ............................... 7.03 NA NA 8.20 10.22 1.06 090
26852 .... ............ A ........ Fusion of knuckle with graft ............... 8.59 NA NA 9.06 10.99 1.22 090
26860 .... ............ A ........ Fusion of finger joint ........................... 4.76 NA NA 7.47 9.34 0.73 090
26861 .... ............ A ........ Fusion of finger jnt, add-on ................ 1.74 NA NA 0.70 0.82 0.27 ZZZ
26862 .... ............ A ........ Fusion/graft of finger joint ................... 7.44 NA NA 8.59 10.49 1.10 090
26863 .... ............ A ........ Fuse/graft added joint ......................... 3.89 NA NA 1.59 1.86 0.56 ZZZ
26910 .... ............ A ........ Amputate metacarpal bone ................ 7.67 NA NA 8.23 9.74 1.16 090
26951 .... ............ A ........ Amputation of finger/thumb ................ 5.85 NA NA 8.33 9.25 0.71 090
26952 .... ............ A ........ Amputation of finger/thumb ................ 6.37 NA NA 7.86 9.78 0.95 090
26989 .... ............ C ........ Hand/finger surgery ............................ 0.00 0.00 8.41 0.00 8.41 0.00 YYY
26990 .... ............ A ........ Drainage of pelvis lesion .................... 7.84 NA NA 6.19 6.72 1.22 090
26991 .... ............ A ........ Drainage of pelvis bursa .................... 6.97 8.57 9.86 4.87 5.15 1.11 090
27000 .... ............ A ........ Incision of hip tendon ......................... 5.66 NA NA 4.51 4.90 0.98 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
27006 .... ............ A ........ Incision of hip tendons ....................... 9.99 NA NA 6.77 7.39 1.70 090
27025 .... ............ A ........ Incision of hip/thigh fascia .................. 12.66 NA NA 8.23 8.37 1.85 090
27030 .... ............ A ........ Drainage of hip joint ........................... 13.54 NA NA 8.05 8.86 2.27 090
27033 .... ............ A ........ Exploration of hip joint ........................ 13.99 NA NA 8.40 9.17 2.33 090
27035 .... ............ A ........ Denervation of hip joint ...................... 17.23 NA NA 8.56 10.09 2.16 090
27036 .... ............ A ........ Excision of hip joint/muscle ................ 14.18 NA NA 8.93 9.48 2.27 090
27040 .... ............ A ........ Biopsy of soft tissues ......................... 2.89 5.16 5.17 1.87 1.92 0.27 010
27041 .... ............ A ........ Biopsy of soft tissues ......................... 10.07 NA NA 5.74 6.19 1.35 090
27047 .... ............ A ........ Remove hip/pelvis lesion .................... 7.51 6.97 7.06 4.48 4.64 1.03 090
27048 .... ............ A ........ Remove hip/pelvis lesion .................... 6.44 NA NA 4.59 4.70 0.92 090
27049 .... ............ A ........ Remove tumor, hip/pelvis ................... 15.20 NA NA 8.17 8.30 2.07 090
27050 .... ............ A ........ Biopsy of sacroiliac joint ..................... 4.65 NA NA 3.00 3.84 0.60 090
27052 .... ............ A ........ Biopsy of hip joint ............................... 7.27 NA NA 5.64 5.77 1.08 090
27054 .... ............ A ........ Removal of hip joint lining .................. 9.09 NA NA 6.49 6.92 1.47 090
27060 .... ............ A ........ Removal of ischial bursa .................... 5.78 NA NA 4.36 4.38 0.80 090
27062 .... ............ A ........ Remove femur lesion/bursa ............... 5.66 NA NA 4.59 4.90 0.93 090
27065 .... ............ A ........ Removal of hip bone lesion ................ 6.44 NA NA 4.99 5.24 1.01 090
27066 .... ............ A ........ Removal of hip bone lesion ................ 11.06 NA NA 7.43 7.94 1.80 090
27067 .... ............ A ........ Remove/graft hip bone lesion ............ 14.57 NA NA 8.85 9.76 1.85 090
27070 .... ............ A ........ Partial removal of hip bone ................ 11.44 NA NA 8.03 8.57 1.75 090
27071 .... ............ A ........ Partial removal of hip bone ................ 12.25 NA NA 8.47 9.31 1.93 090
27075 .... ............ A ........ Extensive hip surgery ......................... 36.77 NA NA 16.17 17.78 5.66 090
27080 .... ............ A ........ Removal of tail bone .......................... 6.80 NA NA 4.56 4.73 0.93 090
27086 .... ............ A ........ Remove hip foreign body ................... 1.89 3.58 4.09 1.46 1.65 0.25 010
27087 .... ............ A ........ Remove hip foreign body ................... 8.72 NA NA 5.64 6.15 1.35 090
27090 .... ............ A ........ Removal of hip prosthesis .................. 11.57 NA NA 7.41 8.10 1.95 090
27091 .... ............ A ........ Removal of hip prosthesis .................. 24.15 NA NA 12.95 13.50 3.85 090
27093 .... ............ A ........ Injection for hip x-ray .......................... 1.30 3.13 3.77 0.48 0.47 0.13 000
27095 .... ............ A ........ Injection for hip x-ray .......................... 1.50 3.69 4.69 0.51 0.51 0.14 000
27096 .... ............ A ........ Inject sacroiliac joint ........................... 1.40 2.50 3.42 0.33 0.33 0.08 000
27097 .... ............ A ........ Revision of hip tendon ........................ 9.16 NA NA 6.33 6.38 1.57 090
27098 .... ............ A ........ Transfer tendon to pelvis .................... 9.20 NA NA 4.92 5.97 0.95 090
27100 .... ............ A ........ Transfer of abdominal muscle ............ 11.21 NA NA 7.39 8.03 1.86 090
27105 .... ............ A ........ Transfer of spinal muscle ................... 11.90 NA NA 7.35 8.36 1.73 090
27110 .... ............ A ........ Transfer of iliopsoas muscle .............. 13.63 NA NA 8.28 8.76 2.19 090
27111 .... ............ A ........ Transfer of iliopsoas muscle .............. 12.46 NA NA 8.08 8.62 1.95 090
27120 .... ............ A ........ Reconstruction of hip socket .............. 19.10 NA NA 10.83 11.34 3.09 090
27122 .... ............ A ........ Reconstruction of hip socket .............. 15.95 NA NA 9.45 10.26 2.62 090
27125 .... ............ A ........ Partial hip replacement ....................... 16.46 NA NA 9.61 10.14 2.55 090
27130 .... ............ A ........ Total hip arthroplasty .......................... 21.61 NA NA 11.80 12.57 3.51 090
27132 .... ............ A ........ Total hip arthroplasty .......................... 25.49 NA NA 13.47 14.58 4.05 090
27134 .... ............ A ........ Revise hip joint replacement .............. 30.13 NA NA 14.75 16.30 4.95 090
27140 .... ............ A ........ Transplant femur ridge ....................... 12.66 NA NA 7.88 8.64 2.12 090
27146 .... ............ A ........ Incision of hip bone ............................ 18.72 NA NA 10.70 11.43 2.97 090
27147 .... ............ A ........ Revision of hip bone ........................... 21.87 NA NA 12.04 12.65 3.58 090
27151 .... ............ A ........ Incision of hip bones .......................... 23.92 NA NA 12.92 10.37 3.92 090
27156 .... ............ A ........ Revision of hip bones ......................... 26.03 NA NA 13.76 14.89 4.22 090
27158 .... ............ A ........ Revision of pelvis ............................... 20.89 NA NA 11.55 10.52 3.17 090
27161 .... ............ A ........ Incision of neck of femur .................... 17.74 NA NA 10.38 11.25 2.95 090
27165 .... ............ A ........ Incision/fixation of femur ..................... 20.06 NA NA 11.60 12.29 3.11 090
27170 .... ............ A ........ Repair/graft femur head/neck ............. 17.46 NA NA 9.78 10.55 2.82 090
27175 .... ............ A ........ Treat slipped epiphysis ....................... 9.29 NA NA 5.16 6.03 1.46 090
27179 .... ............ A ........ Revise head/neck of femur ................ 13.83 NA NA 8.58 9.29 2.26 090
27185 .... ............ A ........ Revision of femur epiphysis ............... 9.67 NA NA 6.64 7.09 2.40 090
27187 .... ............ A ........ Reinforce hip bones ........................... 14.09 NA NA 8.70 9.52 2.38 090
27193 .... ............ A ........ Treat pelvic ring fracture .................... 5.98 4.62 4.86 4.75 4.90 0.96 090
27194 .... ............ A ........ Treat pelvic ring fracture .................... 10.08 NA NA 6.63 7.14 1.65 090
27200 .... ............ A ........ Treat tail bone fracture ....................... 1.87 2.06 2.15 2.21 2.16 0.28 090
27202 .... ............ A ........ Treat tail bone fracture ....................... 7.25 NA NA 10.28 13.71 1.06 090
27215 .... ............ A ........ Treat pelvic fracture(s) ....................... 10.45 NA NA 6.58 6.83 1.98 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
27220 .... ............ A ........ Treat hip socket fracture .................... 6.72 5.23 5.48 5.14 5.39 1.07 090
27222 .... ............ A ........ Treat hip socket fracture .................... 13.97 NA NA 8.52 9.25 2.20 090
27226 .... ............ A ........ Treat hip wall fracture ......................... 15.45 NA NA 8.94 8.39 2.49 090
27227 .... ............ A ........ Treat hip fracture(s) ............................ 25.21 NA NA 13.42 14.43 4.06 090
27228 .... ............ A ........ Treat hip fracture(s) ............................ 29.13 NA NA 14.90 16.29 4.67 090
27230 .... ............ A ........ Treat thigh fracture ............................. 5.69 4.92 5.23 4.85 4.99 0.95 090
27232 .... ............ A ........ Treat thigh fracture ............................. 11.66 NA NA 6.11 6.62 1.86 090
27246 .... ............ A ........ Treat thigh fracture ............................. 4.75 3.90 4.19 3.94 4.18 0.81 090
27250 .... ............ A ........ Treat hip dislocation ........................... 7.21 NA NA 4.26 4.45 0.62 090
27256 .... ............ A ........ Treat hip dislocation ........................... 4.25 2.50 2.99 1.40 1.74 0.46 010
27275 .... ............ A ........ Manipulation of hip joint ..................... 2.29 NA NA 1.85 1.98 0.39 010
27280 .... ............ A ........ Fusion of sacroiliac joint ..................... 14.49 NA NA 8.89 9.61 2.54 090
27282 .... ............ A ........ Fusion of pubic bones ........................ 11.71 NA NA 7.78 7.91 1.87 090
27284 .... ............ A ........ Fusion of hip joint ............................... 24.91 NA NA 12.00 13.53 3.93 090
27286 .... ............ A ........ Fusion of hip joint ............................... 24.97 NA NA 12.65 14.37 3.13 090
27290 .... ............ A ........ Amputation of leg at hip ..................... 24.38 NA NA 12.14 13.17 3.44 090
27295 .... ............ A ........ Amputation of leg at hip ..................... 19.54 NA NA 9.61 10.50 2.96 090
27299 .... ............ C ........ Pelvis/hip joint surgery ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
27301 .... ............ A ........ Drain thigh/knee lesion ....................... 6.67 8.15 9.12 4.64 4.89 1.04 090
27305 .... ............ A ........ Incise thigh tendon & fascia ............... 6.09 NA NA 4.68 4.92 1.01 090
27306 .... ............ A ........ Incision of thigh tendon ...................... 4.66 NA NA 4.07 4.40 0.85 090
27307 .... ............ A ........ Incision of thigh tendons .................... 5.97 NA NA 4.73 5.07 1.04 090
27310 .... ............ A ........ Exploration of knee joint ..................... 9.88 NA NA 6.78 7.19 1.61 090
27323 .... ............ A ........ Biopsy, thigh soft tissues .................... 2.30 4.17 3.83 1.93 1.90 0.24 010
27324 .... ............ A ........ Biopsy, thigh soft tissues .................... 4.95 NA NA 3.81 4.00 0.75 090
27325 .... ............ A ........ Neurectomy, hamstring ...................... 7.09 NA NA 4.97 4.96 1.09 090
27326 .... ............ A ........ Neurectomy, popliteal ......................... 6.36 NA NA 5.11 5.20 1.06 090
27327 .... ............ A ........ Removal of thigh lesion ...................... 4.52 5.98 5.99 3.55 3.64 0.64 090
27328 .... ............ A ........ Removal of thigh lesion ...................... 5.62 NA NA 4.05 4.21 0.84 090
27329 .... ............ A ........ Remove tumor, thigh/knee ................. 15.68 NA NA 8.47 8.76 2.15 090
27330 .... ............ A ........ Biopsy, knee joint lining ...................... 5.02 NA NA 4.25 4.39 0.86 090
27331 .... ............ A ........ Explore/treat knee joint ....................... 5.93 NA NA 4.79 5.16 1.02 090
27332 .... ............ A ........ Removal of knee cartilage .................. 8.34 NA NA 6.12 6.63 1.43 090
27333 .... ............ A ........ Removal of knee cartilage .................. 7.43 NA NA 5.68 6.19 1.26 090
27334 .... ............ A ........ Remove knee joint lining .................... 9.07 NA NA 6.43 6.94 1.51 090
27335 .... ............ A ........ Remove knee joint lining .................... 10.43 NA NA 7.02 7.63 1.75 090
27340 .... ............ A ........ Removal of kneecap bursa ................ 4.23 NA NA 4.02 4.29 0.72 090
27345 .... ............ A ........ Removal of knee cyst ......................... 5.98 NA NA 4.87 5.25 1.00 090
27347 .... ............ A ........ Remove knee cyst .............................. 6.58 NA NA 5.24 5.33 0.98 090
27350 .... ............ A ........ Removal of kneecap ........................... 8.54 NA NA 6.24 6.75 1.41 090
27355 .... ............ A ........ Remove femur lesion ......................... 7.89 NA NA 5.81 6.30 1.32 090
27356 .... ............ A ........ Remove femur lesion/graft ................. 9.97 NA NA 6.83 7.35 1.65 090
27357 .... ............ A ........ Remove femur lesion/graft ................. 11.02 NA NA 7.48 8.11 1.96 090
27358 .... ............ A ........ Remove femur lesion/fixation ............. 4.73 NA NA 1.81 2.18 0.82 ZZZ
27360 .... ............ A ........ Partial removal, leg bone(s) ............... 11.34 NA NA 8.04 8.81 1.84 090
27365 .... ............ A ........ Extensive leg surgery ......................... 17.93 NA NA 10.43 11.08 2.80 090
27370 .... ............ A ........ Injection for knee x-ray ....................... 0.96 2.98 3.31 0.36 0.33 0.08 000
27380 .... ............ A ........ Repair of kneecap tendon .................. 7.34 NA NA 6.04 6.67 1.24 090
27381 .... ............ A ........ Repair/graft kneecap tendon .............. 10.64 NA NA 7.56 8.33 1.80 090
27385 .... ............ A ........ Repair of thigh muscle ....................... 8.00 NA NA 6.30 6.98 1.36 090
27386 .... ............ A ........ Repair/graft of thigh muscle ............... 10.99 NA NA 7.92 8.73 1.86 090
27390 .... ............ A ........ Incision of thigh tendon ...................... 5.44 NA NA 4.46 4.81 0.92 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
27393 .... ............ A ........ Lengthening of thigh tendon ............... 6.50 NA NA 4.95 5.40 1.10 090
27394 .... ............ A ........ Lengthening of thigh tendons ............. 8.68 NA NA 6.14 6.69 1.47 090
27395 .... ............ A ........ Lengthening of thigh tendons ............. 12.10 NA NA 7.93 8.64 2.05 090
27396 .... ............ A ........ Transplant of thigh tendon ................. 8.04 NA NA 5.83 6.44 1.34 090
27397 .... ............ A ........ Transplants of thigh tendons .............. 12.46 NA NA 8.35 8.71 1.83 090
27400 .... ............ A ........ Revise thigh muscles/tendons ............ 9.21 NA NA 6.49 6.82 1.31 090
27403 .... ............ A ........ Repair of knee cartilage ..................... 8.51 NA NA 6.02 6.61 1.44 090
27405 .... ............ A ........ Repair of knee ligament ..................... 8.96 NA NA 6.38 6.95 1.51 090
27407 .... ............ A ........ Repair of knee ligament ..................... 10.71 NA NA 6.84 7.56 1.79 090
27409 .... ............ A ........ Repair of knee ligaments ................... 13.57 NA NA 8.26 9.14 2.25 090
27412 .... ............ A ........ Autochondrocyte implant knee ........... 24.53 NA NA 13.69 14.25 4.36 090
27415 .... ............ A ........ Osteochondral knee allograft ............. 19.79 NA NA 11.80 12.19 4.36 090
27418 .... ............ A ........ Repair degenerated kneecap ............. 11.46 NA NA 7.57 8.25 1.89 090
27420 .... ............ A ........ Revision of unstable kneecap ............ 10.14 NA NA 6.91 7.52 1.72 090
27422 .... ............ A ........ Revision of unstable kneecap ............ 10.09 NA NA 6.88 7.51 1.71 090
27424 .... ............ A ........ Revision/removal of kneecap ............. 10.12 NA NA 6.90 7.50 1.71 090
27425 .... ............ A ........ Lat retinacular release open ............... 5.28 NA NA 4.69 5.11 0.90 090
27427 .... ............ A ........ Reconstruction, knee .......................... 9.67 NA NA 6.69 7.25 1.63 090
27430 .... ............ A ........ Revision of thigh muscles .................. 10.04 NA NA 6.84 7.43 1.70 090
27435 .... ............ A ........ Incision of knee joint ........................... 10.68 NA NA 7.58 8.05 1.70 090
27437 .... ............ A ........ Revise kneecap .................................. 8.82 NA NA 6.19 6.72 1.49 090
27438 .... ............ A ........ Revise kneecap with implant .............. 11.77 NA NA 7.51 8.04 1.96 090
27440 .... ............ A ........ Revision of knee joint ......................... 10.97 NA NA 7.01 6.53 1.82 090
27447 .... ............ A ........ Total knee arthroplasty ....................... 23.04 NA NA 12.61 13.63 3.80 090
27448 .... ............ A ........ Incision of thigh .................................. 11.48 NA NA 7.32 7.99 1.95 090
27450 .... ............ A ........ Incision of thigh .................................. 14.47 NA NA 8.85 9.72 2.43 090
27454 .... ............ A ........ Realignment of thigh bone ................. 18.97 NA NA 10.74 11.63 3.13 090
27455 .... ............ A ........ Realignment of knee .......................... 13.24 NA NA 8.31 9.12 2.25 090
27457 .... ............ A ........ Realignment of knee .......................... 13.92 NA NA 8.24 9.09 2.35 090
27465 .... ............ A ........ Shortening of thigh bone .................... 18.44 NA NA 10.31 10.28 2.48 090
27466 .... ............ A ........ Lengthening of thigh bone .................. 17.13 NA NA 10.08 10.97 2.78 090
27468 .... ............ A ........ Shorten/lengthen thighs ...................... 19.82 NA NA 11.20 11.80 3.31 090
27470 .... ............ A ........ Repair of thigh .................................... 16.97 NA NA 10.18 11.00 2.80 090
27472 .... ............ A ........ Repair/graft of thigh ............................ 18.57 NA NA 10.66 11.69 3.08 090
27475 .... ............ A ........ Surgery to stop leg growth ................. 8.82 NA NA 6.20 6.82 1.36 090
27486 .... ............ A ........ Revise/replace knee joint ................... 20.92 NA NA 11.66 12.60 3.37 090
27487 .... ............ A ........ Revise/replace knee joint ................... 26.91 NA NA 14.02 15.32 4.40 090
27488 .... ............ A ........ Removal of knee prosthesis ............... 17.40 NA NA 10.27 11.00 2.75 090
27495 .... ............ A ........ Reinforce thigh ................................... 16.40 NA NA 9.61 10.53 2.72 090
27496 .... ............ A ........ Decompression of thigh/knee ............. 6.66 NA NA 4.95 5.29 0.99 090
27500 .... ............ A ........ Treatment of thigh fracture ................. 6.21 5.34 5.75 4.57 4.80 1.02 090
27502 .... ............ A ........ Treatment of thigh fracture ................. 11.24 NA NA 6.86 7.50 1.79 090
27516 .... ............ A ........ Treat thigh fx growth plate ................. 5.45 5.69 6.02 5.05 5.28 0.81 090
27517 .... ............ A ........ Treat thigh fx growth plate ................. 8.98 NA NA 6.41 6.88 1.22 090
27519 .... ............ A ........ Treat thigh fx growth plate ................. 15.80 NA NA 9.80 10.71 2.56 090
27520 .... ............ A ........ Treat kneecap fracture ....................... 2.93 4.07 4.31 3.51 3.48 0.47 090
27524 .... ............ A ........ Treat kneecap fracture ....................... 10.25 NA NA 6.94 7.59 1.75 090
27530 .... ............ A ........ Treat knee fracture ............................. 3.97 4.80 5.06 4.24 4.33 0.65 090
27532 .... ............ A ........ Treat knee fracture ............................. 7.43 6.38 6.88 5.62 6.05 1.26 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
27535 .... ............ A ........ Treat knee fracture ............................. 11.80 NA NA 8.20 9.17 2.01 090
27538 .... ............ A ........ Treat knee fracture(s) ......................... 4.95 5.49 5.82 4.87 5.04 0.84 090
27550 .... ............ A ........ Treat knee dislocation ........................ 5.84 5.20 5.63 4.50 4.73 0.76 090
27552 .... ............ A ........ Treat knee dislocation ........................ 8.04 NA NA 6.08 6.53 1.36 090
27560 .... ............ A ........ Treat kneecap dislocation .................. 3.88 4.21 4.48 3.68 3.39 0.40 090
27562 .... ............ A ........ Treat kneecap dislocation .................. 5.86 NA NA 4.59 4.66 0.94 090
27566 .... ............ A ........ Treat kneecap dislocation .................. 12.59 NA NA 7.89 8.60 2.13 090
27570 .... ............ A ........ Fixation of knee joint .......................... 1.76 NA NA 1.61 1.69 0.30 010
27580 .... ............ A ........ Fusion of knee .................................... 20.90 NA NA 12.21 13.54 3.38 090
27590 .... ............ A ........ Amputate leg at thigh ......................... 13.35 NA NA 6.00 6.35 1.75 090
27598 .... ............ A ........ Amputate lower leg at knee ............... 11.08 NA NA 6.18 6.63 1.65 090
27599 .... ............ C ........ Leg surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
27600 .... ............ A ........ Decompression of lower leg ............... 5.94 NA NA 3.78 4.17 0.86 090
27603 .... ............ A ........ Drain lower leg lesion ......................... 5.12 6.97 7.24 3.88 4.03 0.74 090
27604 .... ............ A ........ Drain lower leg bursa ......................... 4.51 6.40 6.25 3.39 3.68 0.69 090
27605 .... ............ A ........ Incision of achilles tendon .................. 2.89 5.06 6.41 1.71 2.03 0.41 010
27606 .... ............ A ........ Incision of achilles tendon .................. 4.15 NA NA 2.62 3.00 0.69 010
27607 .... ............ A ........ Treat lower leg bone lesion ................ 8.51 NA NA 5.68 5.95 1.31 090
27610 .... ............ A ........ Explore/treat ankle joint ...................... 9.01 NA NA 6.08 6.56 1.40 090
27612 .... ............ A ........ Exploration of ankle joint .................... 8.01 NA NA 5.10 5.65 1.13 090
27613 .... ............ A ........ Biopsy lower leg soft tissue ................ 2.19 3.87 3.55 1.76 1.78 0.20 010
27614 .... ............ A ........ Biopsy lower leg soft tissue ................ 5.71 7.66 7.43 3.90 4.19 0.78 090
27615 .... ............ A ........ Remove tumor, lower leg ................... 12.93 NA NA 7.93 8.69 1.84 090
27618 .... ............ A ........ Remove lower leg lesion .................... 5.14 6.37 6.19 3.77 3.88 0.72 090
27619 .... ............ A ........ Remove lower leg lesion .................... 8.47 9.91 9.74 5.24 5.61 1.25 090
27620 .... ............ A ........ Explore/treat ankle joint ...................... 6.04 NA NA 4.54 5.01 0.97 090
27625 .... ............ A ........ Remove ankle joint lining ................... 8.37 NA NA 5.45 5.98 1.28 090
27626 .... ............ A ........ Remove ankle joint lining ................... 8.98 NA NA 5.73 6.37 1.48 090
27630 .... ............ A ........ Removal of tendon lesion ................... 4.85 7.88 7.73 3.77 4.08 0.74 090
27635 .... ............ A ........ Remove lower leg bone lesion ........... 7.91 NA NA 5.61 6.19 1.31 090
27637 .... ............ A ........ Remove/graft leg bone lesion ............ 10.17 NA NA 6.96 7.67 1.66 090
27638 .... ............ A ........ Remove/graft leg bone lesion ............ 10.87 NA NA 7.04 7.66 1.85 090
27640 .... ............ A ........ Partial removal of tibia ........................ 12.10 NA NA 8.13 9.24 1.89 090
27641 .... ............ A ........ Partial removal of fibula ...................... 9.73 NA NA 6.71 7.54 1.46 090
27645 .... ............ A ........ Extensive lower leg surgery ............... 14.78 NA NA 9.42 10.75 2.42 090
27646 .... ............ A ........ Extensive lower leg surgery ............... 13.21 NA NA 8.25 9.68 2.06 090
27647 .... ............ A ........ Extensive ankle/heel surgery ............. 12.85 NA NA 6.44 7.07 1.76 090
27648 .... ............ A ........ Injection for ankle x-ray ...................... 0.96 2.85 3.15 0.34 0.33 0.08 000
27650 .... ............ A ........ Repair achilles tendon ........................ 9.94 NA NA 6.13 6.86 1.59 090
27652 .... ............ A ........ Repair/graft achilles tendon ................ 10.64 NA NA 6.37 7.22 1.72 090
27654 .... ............ A ........ Repair of achilles tendon .................... 10.32 NA NA 5.93 6.55 1.58 090
27656 .... ............ A ........ Repair leg fascia defect ...................... 4.62 7.88 8.23 3.56 3.69 0.69 090
27658 .... ............ A ........ Repair of leg tendon, each ................. 5.03 NA NA 3.85 4.22 0.79 090
27675 .... ............ A ........ Repair lower leg tendons ................... 7.24 NA NA 4.61 5.20 1.11 090
27676 .... ............ A ........ Repair lower leg tendons ................... 8.61 NA NA 5.68 6.23 1.37 090
27680 .... ............ A ........ Release of lower leg tendon .............. 5.79 NA NA 4.12 4.66 0.93 090
27681 .... ............ A ........ Release of lower leg tendons ............. 6.94 NA NA 5.07 5.44 1.15 090
27685 .... ............ A ........ Revision of lower leg tendon .............. 6.57 8.62 7.99 4.50 5.01 0.97 090
27686 .... ............ A ........ Revise lower leg tendons ................... 7.64 NA NA 5.25 5.90 1.24 090
27687 .... ............ A ........ Revision of calf tendon ....................... 6.30 NA NA 4.42 4.89 1.00 090
27690 .... ............ A ........ Revise lower leg tendon ..................... 8.96 NA NA 5.30 5.87 1.33 090
27691 .... ............ A ........ Revise lower leg tendon ..................... 10.28 NA NA 6.63 7.22 1.64 090
27692 .... ............ A ........ Revise additional leg tendon .............. 1.87 NA NA 0.71 0.82 0.32 ZZZ
27695 .... ............ A ........ Repair of ankle ligament .................... 6.58 NA NA 4.83 5.38 1.05 090
27696 .... ............ A ........ Repair of ankle ligaments ................... 8.46 NA NA 5.19 5.86 1.28 090
27698 .... ............ A ........ Repair of ankle ligament .................... 9.49 NA NA 5.81 6.40 1.47 090
27700 .... ............ A ........ Revision of ankle joint ........................ 9.54 NA NA 5.10 5.41 1.30 090
27702 .... ............ A ........ Reconstruct ankle joint ....................... 14.28 NA NA 8.65 9.58 2.38 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
27703 .... ............ A ........ Reconstruction, ankle joint ................. 16.79 NA NA 9.78 10.53 2.77 090
27704 .... ............ A ........ Removal of ankle implant ................... 7.69 NA NA 5.59 5.61 1.27 090
27705 .... ............ A ........ Incision of tibia .................................... 10.74 NA NA 6.94 7.56 1.81 090
27707 .... ............ A ........ Incision of fibula .................................. 4.67 NA NA 4.46 4.71 0.76 090
27709 .... ............ A ........ Incision of tibia & fibula ...................... 17.32 NA NA 9.99 9.06 1.74 090
27712 .... ............ A ........ Realignment of lower leg .................... 15.67 NA NA 9.63 10.12 2.48 090
27715 .... ............ A ........ Revision of lower leg .......................... 15.36 NA NA 9.08 9.92 2.50 090
27720 .... ............ A ........ Repair of tibia ..................................... 12.22 NA NA 7.92 8.67 2.05 090
27722 .... ............ A ........ Repair/graft of tibia ............................. 12.31 NA NA 7.88 8.54 2.06 090
27724 .... ............ A ........ Repair/graft of tibia ............................. 19.18 NA NA 10.31 11.35 3.17 090
27725 .... ............ A ........ Repair of lower leg ............................. 17.15 NA NA 10.58 11.25 2.72 090
27727 .... ............ A ........ Repair of lower leg ............................. 14.69 NA NA 9.07 9.64 2.44 090
27730 .... ............ A ........ Repair of tibia epiphysis ..................... 7.59 NA NA 5.30 5.87 1.73 090
27732 .... ............ A ........ Repair of fibula epiphysis ................... 5.37 NA NA 4.12 4.62 0.77 090
27734 .... ............ A ........ Repair lower leg epiphyses ................ 8.72 NA NA 6.16 6.23 1.35 090
27740 .... ............ A ........ Repair of leg epiphyses ...................... 9.49 NA NA 6.60 7.31 1.62 090
27742 .... ............ A ........ Repair of leg epiphyses ...................... 10.49 NA NA 4.58 5.29 1.80 090
27745 .... ............ A ........ Reinforce tibia ..................................... 10.37 NA NA 6.99 7.59 1.76 090
27750 .... ............ A ........ Treatment of tibia fracture .................. 3.26 4.30 4.53 3.72 3.79 0.55 090
27752 .... ............ A ........ Treatment of tibia fracture .................. 6.15 5.92 6.29 5.09 5.39 1.01 090
27756 .... ............ A ........ Treatment of tibia fracture .................. 7.33 NA NA 5.75 6.11 1.17 090
27760 .... ............ A ........ Treatment of ankle fracture ................ 3.09 4.25 4.47 3.65 3.63 0.48 090
27766 .... ............ A ........ Treatment of ankle fracture ................ 8.73 NA NA 6.24 6.74 1.44 090
27780 .... ............ A ........ Treatment of fibula fracture ................ 2.72 3.84 4.02 3.29 3.26 0.41 090
27781 .... ............ A ........ Treatment of fibula fracture ................ 4.47 4.85 5.19 4.24 4.46 0.73 090
27784 .... ............ A ........ Treatment of fibula fracture ................ 7.41 NA NA 5.56 6.03 1.23 090
27824 .... ............ A ........ Treat lower leg fracture ...................... 3.20 3.63 3.86 3.44 3.52 0.45 090
27825 .... ............ A ........ Treat lower leg fracture ...................... 6.60 5.76 6.20 4.75 5.08 1.02 090
27826 .... ............ A ........ Treat lower leg fracture ...................... 8.97 NA NA 7.00 7.91 1.47 090
27829 .... ............ A ........ Treat lower leg joint ............................ 5.68 NA NA 5.47 6.14 0.95 090
27830 .... ............ A ........ Treat lower leg dislocation ................. 3.85 4.06 4.27 3.54 3.73 0.54 090
27831 .... ............ A ........ Treat lower leg dislocation ................. 4.62 NA NA 4.04 4.25 0.73 090
27832 .... ............ A ........ Treat lower leg dislocation ................. 6.67 NA NA 5.11 5.58 1.03 090
27840 .... ............ A ........ Treat ankle dislocation ....................... 4.65 NA NA 3.62 3.69 0.46 090
27860 .... ............ A ........ Fixation of ankle joint ......................... 2.36 NA NA 1.68 1.83 0.39 010
27870 .... ............ A ........ Fusion of ankle joint, open ................. 15.21 NA NA 9.06 9.82 2.37 090
27871 .... ............ A ........ Fusion of tibiofibular joint ................... 9.42 NA NA 6.52 7.05 1.59 090
27880 .... ............ A ........ Amputation of lower leg ...................... 15.24 NA NA 6.63 6.90 1.76 090
27888 .... ............ A ........ Amputation of foot at ankle ................ 10.23 NA NA 5.96 6.78 1.51 090
27889 .... ............ A ........ Amputation of foot at ankle ................ 10.72 NA NA 5.41 5.93 1.46 090
27892 .... ............ A ........ Decompression of leg ......................... 7.82 NA NA 5.10 5.31 1.10 090
27899 .... ............ C ........ Leg/ankle surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
28001 .... ............ A ........ Drainage of bursa of foot ................... 2.75 3.89 3.46 1.56 1.77 0.33 010
28002 .... ............ A ........ Treatment of foot infection ................. 5.78 6.52 5.80 3.49 3.66 0.61 010
28003 .... ............ A ........ Treatment of foot infection ................. 8.95 7.62 6.97 4.47 4.88 1.12 090
28005 .... ............ A ........ Treat foot bone lesion ........................ 9.30 NA NA 5.27 5.70 1.16 090
28008 .... ............ A ........ Incision of foot fascia .......................... 4.50 6.03 5.32 2.93 3.09 0.57 090
28010 .... ............ A ........ Incision of toe tendon ......................... 2.89 2.79 2.60 2.29 2.34 0.36 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
28011 .... ............ A ........ Incision of toe tendons ....................... 4.19 3.71 3.53 2.96 3.15 0.59 090
28020 .... ............ A ........ Exploration of foot joint ....................... 5.06 7.22 6.67 3.52 3.86 0.72 090
28022 .... ............ A ........ Exploration of foot joint ....................... 4.72 6.77 6.01 3.25 3.57 0.62 090
28024 .... ............ A ........ Exploration of toe joint ........................ 4.43 6.40 5.86 3.05 3.52 0.58 090
28035 .... ............ A ........ Decompression of tibia nerve ............. 5.14 7.13 6.56 3.48 3.83 0.70 090
28043 .... ............ A ........ Excision of foot lesion ........................ 3.58 4.67 4.27 2.67 2.94 0.46 090
28045 .... ............ A ........ Excision of foot lesion ........................ 4.77 6.86 6.16 3.17 3.41 0.63 090
28046 .... ............ A ........ Resection of tumor, foot ..................... 10.55 10.19 9.53 5.67 6.11 1.36 090
28050 .... ............ A ........ Biopsy of foot joint lining .................... 4.30 6.81 5.87 3.23 3.42 0.60 090
28052 .... ............ A ........ Biopsy of foot joint lining .................... 3.98 6.16 5.59 2.81 3.15 0.53 090
28054 .... ............ A ........ Biopsy of toe joint lining ..................... 3.49 6.10 5.43 2.73 3.00 0.46 090
28055 .... ............ A ........ Neurectomy, foot ................................ 6.20 NA NA 3.34 3.55 0.74 090
28060 .... ............ A ........ Partial removal, foot fascia ................. 5.29 6.90 6.23 3.45 3.69 0.70 090
28062 .... ............ A ........ Removal of foot fascia ........................ 6.58 7.61 7.12 3.71 3.90 0.83 090
28070 .... ............ A ........ Removal of foot joint lining ................. 5.15 7.21 6.22 3.47 3.65 0.73 090
28072 .... ............ A ........ Removal of foot joint lining ................. 4.63 7.46 6.52 3.56 3.95 0.68 090
28080 .... ............ A ........ Removal of foot lesion ........................ 4.65 7.49 6.34 4.09 3.92 0.47 090
28086 .... ............ A ........ Excise foot tendon sheath .................. 4.83 7.75 7.88 3.77 4.24 0.76 090
28088 .... ............ A ........ Excise foot tendon sheath .................. 3.90 6.89 6.34 3.15 3.53 0.61 090
28092 .... ............ A ........ Removal of toe lesions ....................... 3.69 6.32 5.81 2.92 3.24 0.49 090
28100 .... ............ A ........ Removal of ankle/heel lesion ............. 5.72 7.96 8.01 3.94 4.35 0.82 090
28102 .... ............ A ........ Remove/graft foot lesion .................... 7.80 NA NA 4.76 5.39 1.14 090
28107 .... ............ A ........ Remove/graft foot lesion .................... 5.62 7.52 7.09 3.57 3.92 0.74 090
28108 .... ............ A ........ Removal of toe lesions ....................... 4.21 6.18 5.43 2.91 3.10 0.53 090
28110 .... ............ A ........ Part removal of metatarsal ................. 4.13 6.77 6.03 2.99 3.13 0.54 090
28114 .... ............ A ........ Removal of metatarsal heads ............ 11.61 13.18 12.44 8.18 8.31 1.42 090
28116 .... ............ A ........ Revision of foot ................................... 8.94 9.24 8.07 5.23 5.24 1.03 090
28118 .... ............ A ........ Removal of heel bone ........................ 6.02 7.77 7.04 3.95 4.17 0.84 090
28119 .... ............ A ........ Removal of heel spur ......................... 5.45 7.03 6.27 3.48 3.63 0.70 090
28120 .... ............ A ........ Part removal of ankle/heel ................. 5.64 7.94 7.65 3.90 4.17 0.77 090
28122 .... ............ A ........ Partial removal of foot bone ............... 7.56 8.27 7.60 4.67 5.00 0.98 090
28124 .... ............ A ........ Partial removal of toe ......................... 4.88 6.59 5.84 3.36 3.53 0.60 090
28130 .... ............ A ........ Removal of ankle bone ...................... 9.30 NA NA 6.06 6.37 1.26 090
28140 .... ............ A ........ Removal of metatarsal ....................... 7.03 7.66 7.48 4.04 4.43 0.92 090
28150 .... ............ A ........ Removal of toe ................................... 4.14 6.20 5.56 2.90 3.12 0.53 090
28171 .... ............ A ........ Extensive foot surgery ........................ 9.85 NA NA 4.98 5.27 1.33 090
28173 .... ............ A ........ Extensive foot surgery ........................ 9.05 8.55 8.13 4.51 4.89 1.12 090
28175 .... ............ A ........ Extensive foot surgery ........................ 6.17 6.95 6.37 3.52 3.64 0.73 090
28190 .... ............ A ........ Removal of foot foreign body ............. 1.98 3.92 3.67 1.31 1.40 0.22 010
28200 .... ............ A ........ Repair of foot tendon .......................... 4.65 6.72 5.95 3.16 3.38 0.61 090
28202 .... ............ A ........ Repair/graft of foot tendon ................. 6.96 7.53 7.46 3.81 4.20 0.91 090
28208 .... ............ A ........ Repair of foot tendon .......................... 4.42 6.54 5.71 3.11 3.22 0.58 090
28210 .... ............ A ........ Repair/graft of foot tendon ................. 6.41 7.42 6.85 3.82 3.95 0.81 090
28220 .... ............ A ........ Release of foot tendon ....................... 4.58 6.24 5.49 2.99 3.23 0.57 090
28222 .... ............ A ........ Release of foot tendons ..................... 5.67 6.74 6.03 3.25 3.71 0.69 090
28225 .... ............ A ........ Release of foot tendon ....................... 3.70 5.86 5.11 2.64 2.79 0.46 090
28226 .... ............ A ........ Release of foot tendons ..................... 4.58 6.74 5.81 3.19 3.50 0.58 090
28230 .... ............ A ........ Incision of foot tendon(s) .................... 4.28 6.10 5.43 2.80 3.26 0.55 090
28232 .... ............ A ........ Incision of toe tendon ......................... 3.43 5.77 5.18 2.60 2.97 0.44 090
28234 .... ............ A ........ Incision of foot tendon ........................ 3.43 6.14 5.44 2.98 3.19 0.44 090
28238 .... ............ A ........ Revision of foot tendon ...................... 7.85 8.21 7.76 4.28 4.63 1.06 090
28240 .... ............ A ........ Release of big toe .............................. 4.40 6.19 5.46 2.87 3.20 0.58 090
28250 .... ............ A ........ Revision of foot fascia ........................ 5.97 7.40 6.53 3.75 3.95 0.82 090
28260 .... ............ A ........ Release of midfoot joint ...................... 8.08 8.28 7.37 4.53 4.80 1.14 090
28261 .... ............ A ........ Revision of foot tendon ...................... 12.91 10.42 9.59 6.18 6.79 1.57 090
28262 .... ............ A ........ Revision of foot and ankle .................. 17.01 15.42 14.52 9.71 10.34 2.60 090
28264 .... ............ A ........ Release of midfoot joint ...................... 10.53 10.12 8.99 5.85 6.61 1.54 090
28270 .... ............ A ........ Release of foot contracture ................ 4.82 6.75 5.86 3.36 3.57 0.62 090
28272 .... ............ A ........ Release of toe joint, each .................. 3.84 5.67 4.96 2.57 2.73 0.46 090
28280 .... ............ A ........ Fusion of toes ..................................... 5.24 7.14 6.73 3.47 4.00 0.73 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
28285 .... ............ A ........ Repair of hammertoe .......................... 4.65 6.54 5.74 3.26 3.37 0.59 090
28286 .... ............ A ........ Repair of hammertoe .......................... 4.61 6.35 5.60 2.97 3.13 0.57 090
28288 .... ............ A ........ Partial removal of foot bone ............... 5.81 8.42 7.22 4.60 4.77 0.65 090
28289 .... ............ A ........ Repair hallux rigidus ........................... 8.11 9.25 8.66 5.24 5.53 1.02 090
28290 .... ............ A ........ Correction of bunion ........................... 5.72 8.02 7.17 3.89 4.33 0.82 090
28300 .... ............ A ........ Incision of heel bone .......................... 9.61 NA NA 5.99 6.54 1.54 090
28302 .... ............ A ........ Incision of ankle bone ........................ 9.62 NA NA 6.18 6.47 1.42 090
28304 .... ............ A ........ Incision of midfoot bones ................... 9.29 9.38 8.70 4.99 5.39 1.27 090
28305 .... ............ A ........ Incise/graft midfoot bones .................. 10.63 NA NA 5.68 6.21 1.27 090
28306 .... ............ A ........ Incision of metatarsal ......................... 5.91 8.26 7.57 3.82 4.01 0.84 090
28309 .... ............ A ........ Incision of metatarsals ........................ 13.96 NA NA 7.62 7.83 2.05 090
28310 .... ............ A ........ Revision of big toe .............................. 5.48 7.35 6.58 3.33 3.46 0.70 090
28312 .... ............ A ........ Revision of toe .................................... 4.60 7.19 6.35 3.16 3.41 0.63 090
28313 .... ............ A ........ Repair deformity of toe ....................... 5.06 7.13 6.24 3.54 4.21 0.73 090
28315 .... ............ A ........ Removal of sesamoid bone ................ 4.91 6.51 5.74 3.14 3.26 0.63 090
28320 .... ............ A ........ Repair of foot bones ........................... 9.25 NA NA 5.63 6.20 1.43 090
28322 .... ............ A ........ Repair of metatarsals ......................... 8.41 9.61 9.46 5.26 5.84 1.27 090
28340 .... ............ A ........ Resect enlarged toe tissue ................. 7.04 7.90 7.21 3.98 4.14 0.84 090
28341 .... ............ A ........ Resect enlarged toe ........................... 8.60 8.36 7.71 4.29 4.60 1.01 090
28344 .... ............ A ........ Repair extra toe(s) .............................. 4.31 6.28 6.10 2.87 3.30 0.51 090
28345 .... ............ A ........ Repair webbed toe(s) ......................... 5.98 7.45 6.88 3.70 4.23 0.80 090
28360 .... ............ A ........ Reconstruct cleft foot .......................... 14.67 NA NA 6.31 8.40 2.29 090
28400 .... ............ A ........ Treatment of heel fracture .................. 2.22 3.33 3.49 2.89 2.98 0.35 090
28405 .... ............ A ........ Treatment of heel fracture .................. 4.63 4.36 4.63 3.62 4.15 0.73 090
28406 .... ............ A ........ Treatment of heel fracture .................. 6.44 NA NA 5.52 6.19 1.11 090
28415 .... ............ A ........ Treat heel fracture .............................. 17.54 NA NA 10.92 12.11 2.67 090
28420 .... ............ A ........ Treat/graft heel fracture ...................... 17.07 NA NA 9.59 11.36 2.81 090
28445 .... ............ A ........ Treat ankle fracture ............................ 17.07 NA NA 9.72 10.39 2.59 090
28450 .... ............ A ........ Treat midfoot fracture, each ............... 1.95 2.87 3.00 2.38 2.43 0.28 090
28455 .... ............ A ........ Treat midfoot fracture, each ............... 3.15 3.69 3.56 3.06 3.24 0.44 090
28456 .... ............ A ........ Treat midfoot fracture ......................... 2.75 NA NA 3.51 3.85 0.44 090
28465 .... ............ A ........ Treat midfoot fracture, each ............... 7.13 NA NA 5.04 5.69 1.10 090
28470 .... ............ A ........ Treat metatarsal fracture .................... 1.99 2.77 2.96 2.34 2.40 0.30 090
28475 .... ............ A ........ Treat metatarsal fracture .................... 2.97 3.08 3.22 2.47 2.86 0.44 090
28476 .... ............ A ........ Treat metatarsal fracture .................... 3.46 NA NA 4.27 4.64 0.54 090
28485 .... ............ A ........ Treat metatarsal fracture .................... 5.77 NA NA 4.48 4.98 0.83 090
28490 .... ............ A ........ Treat big toe fracture .......................... 1.12 2.05 2.04 1.64 1.65 0.14 090
28510 .... ............ A ........ Treatment of toe fracture .................... 1.12 1.65 1.60 1.58 1.56 0.14 090
28515 .... ............ A ........ Treatment of toe fracture .................... 1.50 2.17 2.04 1.78 1.85 0.18 090
28525 .... ............ A ........ Treat toe fracture ................................ 3.37 6.82 7.18 2.89 3.17 0.49 090
28530 .... ............ A ........ Treat sesamoid bone fracture ............ 1.08 1.58 1.52 1.31 1.38 0.14 090
28531 .... ............ A ........ Treat sesamoid bone fracture ............ 2.51 6.42 6.75 2.38 2.18 0.34 090
28540 .... ............ A ........ Treat foot dislocation .......................... 2.10 2.68 2.56 2.25 2.34 0.26 090
28555 .... ............ A ........ Repair foot dislocation ........................ 6.42 9.38 9.71 4.75 5.25 1.04 090
28576 .... ............ A ........ Treat foot dislocation .......................... 4.48 NA NA 4.01 4.10 0.69 090
28585 .... ............ A ........ Repair foot dislocation ........................ 8.17 9.70 8.55 5.10 5.51 1.25 090
28606 .... ............ A ........ Treat foot dislocation .......................... 4.97 NA NA 4.10 4.43 0.82 090
28615 .... ............ A ........ Repair foot dislocation ........................ 8.96 NA NA 6.87 7.48 1.30 090
28630 .... ............ A ........ Treat toe dislocation ........................... 1.72 1.81 1.72 0.90 0.96 0.20 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
28645 .... ............ A ........ Repair toe dislocation ......................... 4.27 6.72 5.87 3.13 3.22 0.57 090
28666 .... ............ A ........ Treat toe dislocation ........................... 2.66 NA NA 1.80 2.21 0.43 010
28675 .... ............ A ........ Repair of toe dislocation ..................... 2.97 6.61 6.89 2.84 3.10 0.45 090
28705 .... ............ A ........ Fusion of foot bones ........................... 20.12 NA NA 10.61 11.56 3.09 090
28737 .... ............ A ........ Revision of foot bones ........................ 10.83 NA NA 5.99 6.43 1.47 090
28740 .... ............ A ........ Fusion of foot bones ........................... 9.09 10.71 10.83 5.91 6.22 1.22 090
28750 .... ............ A ........ Fusion of big toe joint ......................... 8.37 10.62 11.31 5.82 6.27 1.13 090
28800 .... ............ A ........ Amputation of midfoot ........................ 8.65 NA NA 4.93 5.39 1.15 090
28805 .... ............ A ........ Amputation thru metatarsal ................ 12.55 NA NA 5.83 5.77 1.18 090
28810 .... ............ A ........ Amputation toe & metatarsal .............. 6.52 NA NA 4.01 4.26 0.86 090
28820 .... ............ A ........ Amputation of toe ............................... 4.89 7.51 7.57 3.49 3.66 0.61 090
28825 .... ............ A ........ Partial amputation of toe .................... 3.71 7.00 7.03 3.07 3.29 0.50 090
28890 .... ............ A ........ High energy eswt, plantar f ................ 3.36 4.43 5.13 2.13 2.14 0.41 090
28899 .... ............ C ........ Foot/toes surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
29000 .... ............ A ........ Application of body cast ..................... 2.25 3.94 3.58 1.63 1.72 0.41 000
29049 .... ............ A ........ Application of figure eight ................... 0.89 1.11 1.21 0.59 0.56 0.13 000
29055 .... ............ A ........ Application of shoulder cast ............... 1.78 2.79 2.90 1.22 1.36 0.30 000
29058 .... ............ A ........ Application of shoulder cast ............... 1.31 1.25 1.40 0.67 0.70 0.17 000
29065 .... ............ A ........ Application of long arm cast ............... 0.87 1.27 1.30 0.70 0.73 0.15 000
29075 .... ............ A ........ Application of forearm cast ................. 0.77 1.23 1.24 0.66 0.67 0.13 000
29085 .... ............ A ........ Apply hand/wrist cast ......................... 0.87 1.25 1.27 0.68 0.66 0.14 000
29086 .... ............ A ........ Apply finger cast ................................. 0.62 1.07 1.01 0.55 0.52 0.07 000
29105 .... ............ A ........ Apply long arm splint .......................... 0.87 1.08 1.16 0.53 0.52 0.12 000
29125 .... ............ A ........ Apply forearm splint ............................ 0.59 0.96 0.99 0.42 0.41 0.07 000
29126 .... ............ A ........ Apply forearm splint ............................ 0.77 1.01 1.11 0.48 0.47 0.07 000
29130 .... ............ A ........ Application of finger splint .................. 0.50 0.43 0.45 0.18 0.18 0.06 000
29131 .... ............ A ........ Application of finger splint .................. 0.55 0.59 0.67 0.24 0.25 0.03 000
29200 .... ............ A ........ Strapping of chest .............................. 0.65 0.60 0.66 0.34 0.34 0.04 000
29220 .... ............ A ........ Strapping of low back ......................... 0.64 0.64 0.67 0.38 0.38 0.04 000
29240 .... ............ A ........ Strapping of shoulder ......................... 0.71 0.68 0.77 0.40 0.38 0.06 000
29260 .... ............ A ........ Strapping of elbow or wrist ................. 0.55 0.67 0.70 0.37 0.34 0.05 000
29280 .... ............ A ........ Strapping of hand or finger ................ 0.51 0.66 0.73 0.37 0.34 0.03 000
29305 .... ............ A ........ Application of hip cast ........................ 2.03 3.26 3.32 1.55 1.66 0.35 000
29325 .... ............ A ........ Application of hip casts ...................... 2.32 3.32 3.49 1.59 1.80 0.40 000
29345 .... ............ A ........ Application of long leg cast ................ 1.40 1.65 1.71 0.94 1.00 0.24 000
29358 .... ............ A ........ Apply long leg cast brace ................... 1.43 1.99 2.04 0.91 1.00 0.25 000
29405 .... ............ A ........ Apply short leg cast ............................ 0.86 1.18 1.21 0.65 0.68 0.14 000
29440 .... ............ A ........ Addition of walker to cast ................... 0.57 0.63 0.66 0.26 0.27 0.08 000
29445 .... ............ A ........ Apply rigid leg cast ............................. 1.78 1.54 1.69 0.88 0.93 0.27 000
29450 .... ............ A ........ Application of leg cast ........................ 2.08 1.56 1.51 0.88 0.99 0.27 000
29505 .... ............ A ........ Application, long leg splint .................. 0.69 1.06 1.12 0.45 0.45 0.08 000
29515 .... ............ A ........ Application lower leg splint ................. 0.73 0.94 0.91 0.45 0.46 0.09 000
29520 .... ............ A ........ Strapping of hip .................................. 0.54 0.65 0.76 0.37 0.42 0.03 000
29530 .... ............ A ........ Strapping of knee ............................... 0.57 0.65 0.72 0.36 0.35 0.05 000
29540 .... ............ A ........ Strapping of ankle and/or ft ................ 0.51 0.53 0.48 0.30 0.31 0.06 000
29550 .... ............ A ........ Strapping of toes ................................ 0.47 0.54 0.49 0.29 0.29 0.06 000
29580 .... ............ A ........ Application of paste boot .................... 0.55 0.70 0.68 0.33 0.34 0.07 000
29590 .... ............ A ........ Application of foot splint ..................... 0.76 0.58 0.55 0.25 0.28 0.09 000
29700 .... ............ A ........ Removal/revision of cast .................... 0.57 0.94 0.92 0.25 0.27 0.08 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
29720 .... ............ A ........ Repair of body cast ............................ 0.68 1.16 1.16 0.35 0.37 0.12 000
29730 .... ............ A ........ Windowing of cast .............................. 0.75 0.73 0.78 0.33 0.34 0.12 000
29740 .... ............ A ........ Wedging of cast .................................. 1.12 1.03 1.10 0.47 0.48 0.18 000
29750 .... ............ A ........ Wedging of clubfoot cast .................... 1.26 1.05 1.04 0.52 0.54 0.21 000
29799 .... ............ C ........ Casting/strapping procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
29800 .... ............ A ........ Jaw arthroscopy/surgery .................... 6.73 NA NA 4.64 5.86 0.99 090
29804 .... ............ A ........ Jaw arthroscopy/surgery .................... 8.71 NA NA 5.77 6.68 1.38 090
29805 .... ............ A ........ Shoulder arthroscopy, dx ................... 5.94 NA NA 4.70 5.19 1.02 090
29806 .... ............ A ........ Shoulder arthroscopy/surgery ............ 14.95 NA NA 9.37 10.28 2.50 090
29827 .... ............ A ........ Arthroscop rotator cuff repr ................ 15.44 NA NA 9.33 10.45 2.67 090
29830 .... ............ A ........ Elbow arthroscopy .............................. 5.80 NA NA 4.48 4.92 0.99 090
29834 .... ............ A ........ Elbow arthroscopy/surgery ................. 6.33 NA NA 4.85 5.35 1.08 090
29840 .... ............ A ........ Wrist arthroscopy ................................ 5.59 NA NA 4.60 4.97 0.84 090
29843 .... ............ A ........ Wrist arthroscopy/surgery ................... 6.06 NA NA 4.78 5.23 0.92 090
29848 .... ............ A ........ Wrist endoscopy/surgery .................... 6.24 NA NA 5.25 5.44 0.86 090
29850 .... ............ A ........ Knee arthroscopy/surgery .................. 8.18 NA NA 4.71 4.97 1.25 090
29855 .... ............ A ........ Tibial arthroscopy/surgery .................. 10.60 NA NA 7.28 8.04 1.85 090
29856 .... ............ A ........ Tibial arthroscopy/surgery .................. 14.12 NA NA 8.71 9.70 2.40 090
29860 .... ............ A ........ Hip arthroscopy, dx ............................ 8.85 NA NA 6.25 6.60 1.36 090
29861 .... ............ A ........ Hip arthroscopy/surgery ..................... 9.95 NA NA 6.39 6.91 1.59 090
29866 .... ............ A ........ Autgrft implnt, knee w/scope .............. 14.48 NA NA 9.48 10.43 2.40 090
29867 .... ............ A ........ Allgrft implnt, knee w/scope ............... 18.18 NA NA 11.16 12.21 2.79 090
29868 .... ............ A ........ Meniscal trnspl, knee w/scpe ............. 24.89 NA NA 13.83 15.34 4.36 090
29870 .... ............ A ........ Knee arthroscopy, dx ......................... 5.11 NA NA 4.17 4.54 0.85 090
29871 .... ............ A ........ Knee arthroscopy/drainage ................ 6.60 NA NA 5.05 5.46 1.14 090
29891 .... ............ A ........ Ankle arthroscopy/surgery .................. 9.47 NA NA 6.62 7.08 1.39 090
29893 .... ............ A ........ Scope, plantar fasciotomy .................. 6.08 8.59 7.49 4.53 4.30 0.63 090
29900 .... ............ A ........ Mcp joint arthroscopy, dx ................... 5.74 NA NA 4.67 5.29 0.94 090
29901 .... ............ A ........ Mcp joint arthroscopy, surg ................ 6.45 NA NA 5.05 5.74 1.06 090
29902 .... ............ A ........ Mcp joint arthroscopy, surg ................ 7.02 NA NA 4.72 5.46 1.12 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
29999 .... ............ C ........ Arthroscopy of joint ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
30000 .... ............ A ........ Drainage of nose lesion ..................... 1.45 3.98 3.98 1.34 1.35 0.12 010
30020 .... ............ A ........ Drainage of nose lesion ..................... 1.45 4.15 3.66 1.39 1.41 0.12 010
30100 .... ............ A ........ Intranasal biopsy ................................ 0.94 2.57 2.24 0.75 0.78 0.07 000
30110 .... ............ A ........ Removal of nose polyp(s) .................. 1.65 3.88 3.52 1.45 1.49 0.14 010
30115 .... ............ A ........ Removal of nose polyp(s) .................. 4.38 NA NA 5.97 5.79 0.41 090
30117 .... ............ A ........ Removal of intranasal lesion .............. 3.20 18.04 15.41 4.90 4.71 0.26 090
30118 .... ............ A ........ Removal of intranasal lesion .............. 9.81 NA NA 8.55 8.76 0.78 090
30120 .... ............ A ........ Revision of nose ................................. 5.31 7.06 6.75 5.09 5.52 0.52 090
30124 .... ............ A ........ Removal of nose lesion ...................... 3.14 NA NA 3.68 3.64 0.25 090
30125 .... ............ A ........ Removal of nose lesion ...................... 7.21 NA NA 7.40 7.80 0.63 090
30130 .... ............ A ........ Excise inferior turbinate ...................... 3.41 NA NA 5.62 5.55 0.31 090
30140 .... ............ A ........ Resect inferior turbinate ..................... 3.48 NA NA 7.07 6.55 0.35 090
30150 .... ............ A ........ Partial removal of nose ...................... 9.44 NA NA 9.03 9.96 0.93 090
30160 .... ............ A ........ Removal of nose ................................ 9.88 NA NA 8.88 9.43 0.88 090
30200 .... ............ A ........ Injection treatment of nose ................. 0.78 2.01 1.80 0.67 0.70 0.06 000
30210 .... ............ A ........ Nasal sinus therapy ............................ 1.10 2.50 2.27 1.27 1.28 0.09 010
30220 .... ............ A ........ Insert nasal septal button ................... 1.56 5.78 4.95 1.43 1.46 0.12 010
30300 .... ............ A ........ Remove nasal foreign body ............... 1.06 4.27 4.43 1.86 1.87 0.08 010
30310 .... ............ A ........ Remove nasal foreign body ............... 1.98 NA NA 2.90 2.97 0.16 010
30320 .... ............ A ........ Remove nasal foreign body ............... 4.56 NA NA 6.33 6.63 0.39 090
30400 .... ............ R ........ Reconstruction of nose ....................... 10.58 NA NA 13.86 14.67 1.04 090
30430 .... ............ R ........ Revision of nose ................................. 7.96 NA NA 13.20 14.55 0.77 090
30460 .... ............ A ........ Revision of nose ................................. 10.24 NA NA 7.49 8.68 1.03 090
30462 .... ............ A ........ Revision of nose ................................. 20.12 NA NA 14.68 17.44 2.54 090
30465 .... ............ A ........ Repair nasal stenosis ......................... 12.20 NA NA 11.07 11.41 1.06 090
30520 .... ............ A ........ Repair of nasal septum ...................... 6.85 NA NA 8.03 7.24 0.46 090
30540 .... ............ A ........ Repair nasal defect ............................ 7.81 NA NA 8.53 8.66 0.67 090
30545 .... ............ A ........ Repair nasal defect ............................ 11.50 NA NA 11.08 11.33 1.71 090
30560 .... ............ A ........ Release of nasal adhesions ............... 1.28 5.25 4.96 2.02 2.05 0.10 010
30580 .... ............ A ........ Repair upper jaw fistula ...................... 6.76 8.17 7.98 4.73 5.26 0.89 090
30600 .... ............ A ........ Repair mouth/nose fistula ................... 6.07 7.67 7.57 4.20 4.59 0.70 090
30620 .... ............ A ........ Intranasal reconstruction .................... 6.04 NA NA 8.64 8.65 0.57 090
30630 .... ............ A ........ Repair nasal septum defect ............... 7.18 NA NA 7.72 7.74 0.61 090
30801 .... ............ A ........ Ablate inf turbinate, superf ................. 1.11 4.27 4.16 2.11 1.99 0.09 010
30802 .... ............ A ........ Cauterization, inner nose ................... 2.05 4.95 4.72 2.51 2.40 0.16 010
30901 .... ............ A ........ Control of nosebleed .......................... 1.21 1.27 1.30 0.31 0.31 0.11 000
30906 .... ............ A ........ Repeat control of nosebleed .............. 2.45 4.27 4.03 0.77 0.97 0.20 000
30915 .... ............ A ........ Ligation, nasal sinus artery ................ 7.36 NA NA 6.46 6.48 0.58 090
30920 .... ............ A ........ Ligation, upper jaw artery ................... 11.03 NA NA 8.97 8.85 0.80 090
30930 .... ............ A ........ Ther fx, nasal inf turbinate ................. 1.28 NA NA 1.64 1.61 0.12 010
30999 .... ............ C ........ Nasal surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
31000 .... ............ A ........ Irrigation, maxillary sinus .................... 1.17 3.19 2.98 1.33 1.35 0.09 010
31002 .... ............ A ........ Irrigation, sphenoid sinus ................... 1.93 NA NA 2.67 2.93 0.15 010
31020 .... ............ A ........ Exploration, maxillary sinus ................ 2.99 8.56 8.47 5.52 5.29 0.29 090
31030 .... ............ A ........ Exploration, maxillary sinus ................ 5.95 10.38 10.84 6.44 6.49 0.60 090
31032 .... ............ A ........ Explore sinus, remove polyps ............ 6.61 NA NA 7.00 7.04 0.59 090
31040 .... ............ A ........ Exploration behind upper jaw ............. 9.66 NA NA 7.38 8.59 0.87 090
31050 .... ............ A ........ Exploration, sphenoid sinus ............... 5.31 NA NA 6.50 6.37 0.49 090
31051 .... ............ A ........ Sphenoid sinus surgery ...................... 7.16 NA NA 8.31 8.18 0.62 090
31070 .... ............ A ........ Exploration of frontal sinus ................. 4.32 NA NA 6.17 5.98 0.38 090
31075 .... ............ A ........ Exploration of frontal sinus ................. 9.40 NA NA 9.29 9.40 0.75 090
31080 .... ............ A ........ Removal of frontal sinus ..................... 12.54 NA NA 10.75 12.10 1.23 090
31090 .... ............ A ........ Exploration of sinuses ........................ 10.88 NA NA 13.38 12.80 0.94 090
31200 .... ............ A ........ Removal of ethmoid sinus .................. 5.03 NA NA 7.44 8.33 0.29 090
31225 .... ............ A ........ Removal of upper jaw ........................ 26.44 NA NA 17.94 17.65 1.59 090
31230 .... ............ A ........ Removal of upper jaw ........................ 30.56 NA NA 19.56 19.08 1.78 090
31231 .... ............ A ........ Nasal endoscopy, dx .......................... 1.10 3.57 3.44 0.77 0.82 0.09 000
31233 .... ............ A ........ Nasal/sinus endoscopy, dx ................. 2.18 4.25 4.22 1.13 1.29 0.20 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
31235 .... ............ A ........ Nasal/sinus endoscopy, dx ................. 2.64 4.63 4.72 1.27 1.48 0.26 000
31237 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 2.98 4.89 4.98 1.40 1.61 0.28 000
31238 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 3.26 4.81 4.96 1.49 1.76 0.27 000
31239 .... ............ A ........ Nasal/sinus endoscopy, surg ............. 9.23 NA NA 6.46 7.21 0.62 010
31254 .... ............ A ........ Revision of ethmoid sinus .................. 4.64 NA NA 1.95 2.36 0.45 000
31256 .... ............ A ........ Exploration maxillary sinus ................. 3.29 NA NA 1.50 1.78 0.33 000
31267 .... ............ A ........ Endoscopy, maxillary sinus ................ 5.45 NA NA 2.22 2.71 0.55 000
31276 .... ............ A ........ Sinus endoscopy, surgical .................. 8.84 NA NA 3.35 4.17 0.92 000
31299 .... ............ C ........ Sinus surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
31300 .... ............ A ........ Removal of larynx lesion .................... 15.71 NA NA 14.58 14.61 1.17 090
31320 .... ............ A ........ Diagnostic incision, larynx .................. 5.62 NA NA 10.11 10.06 0.46 090
31360 .... ............ A ........ Removal of larynx ............................... 29.57 NA NA 20.13 18.12 1.38 090
31365 .... ............ A ........ Removal of larynx ............................... 38.47 NA NA 23.08 21.36 1.98 090
31367 .... ............ A ........ Partial removal of larynx ..................... 30.23 NA NA 22.55 21.88 1.79 090
31390 .... ............ A ........ Removal of larynx & pharynx ............. 42.17 NA NA 26.07 24.82 2.24 090
31395 .... ............ A ........ Reconstruct larynx & pharynx ............ 43.46 NA NA 28.60 28.01 2.49 090
31400 .... ............ A ........ Revision of larynx ............................... 11.48 NA NA 12.47 12.96 0.83 090
31420 .... ............ A ........ Removal of epiglottis .......................... 11.32 NA NA 8.59 8.96 0.83 090
31500 .... ............ A ........ Insert emergency airway .................... 2.33 NA NA 0.42 0.49 0.17 000
31502 .... ............ A ........ Change of windpipe airway ................ 0.65 NA NA 0.21 0.24 0.05 000
31505 .... ............ A ........ Diagnostic laryngoscopy ..................... 0.61 1.42 1.42 0.59 0.60 0.05 000
31510 .... ............ A ........ Laryngoscopy with biopsy .................. 1.92 3.21 3.22 1.01 1.12 0.16 000
31511 .... ............ A ........ Remove foreign body, larynx ............. 2.16 2.92 2.99 1.03 1.03 0.19 000
31512 .... ............ A ........ Removal of larynx lesion .................... 2.07 2.95 3.04 1.06 1.19 0.18 000
31513 .... ............ A ........ Injection into vocal cord ...................... 2.10 NA NA 1.09 1.26 0.17 000
31515 .... ............ A ........ Laryngoscopy for aspiration ............... 1.80 3.17 3.34 0.88 0.97 0.14 000
31520 .... ............ A ........ Dx laryngoscopy, newborn ................. 2.56 NA NA 1.22 1.37 0.20 000
31525 .... ............ A ........ Dx laryngoscopy excl nb .................... 2.63 3.44 3.51 1.24 1.43 0.21 000
31526 .... ............ A ........ Dx laryngoscopy w/oper scope .......... 2.57 NA NA 1.26 1.47 0.21 000
31527 .... ............ A ........ Laryngoscopy for treatment ................ 3.27 NA NA 1.39 1.62 0.26 000
31528 .... ............ A ........ Laryngoscopy and dilation .................. 2.37 NA NA 1.10 1.26 0.19 000
31529 .... ............ A ........ Laryngoscopy and dilation .................. 2.68 NA NA 1.26 1.46 0.22 000
31530 .... ............ A ........ Laryngoscopy w/fb removal ................ 3.38 NA NA 1.46 1.68 0.29 000
31531 .... ............ A ........ Laryngoscopy w/fb & op scope .......... 3.58 NA NA 1.60 1.91 0.29 000
31535 .... ............ A ........ Laryngoscopy w/biopsy ...................... 3.16 NA NA 1.45 1.70 0.26 000
31536 .... ............ A ........ Laryngoscopy w/bx & op scope ......... 3.55 NA NA 1.59 1.89 0.29 000
31540 .... ............ A ........ Laryngoscopy w/exc of tumor ............ 4.12 NA NA 1.77 2.12 0.33 000
31541 .... ............ A ........ Larynscop w/tumr exc + scope .......... 4.52 NA NA 1.91 2.31 0.37 000
31545 .... ............ A ........ Remove vc lesion w/scope ................. 6.30 NA NA 2.54 2.96 0.37 000
31546 .... ............ A ........ Remove vc lesion scope/graft ............ 9.73 NA NA 3.47 4.27 0.78 000
31560 .... ............ A ........ Laryngoscop w/arytenoidectom .......... 5.45 NA NA 2.17 2.62 0.43 000
31561 .... ............ A ........ Larynscop, remve cart + scop ............ 5.99 NA NA 2.35 2.82 0.49 000
31570 .... ............ A ........ Laryngoscope w/vc inj ........................ 3.86 4.25 4.91 1.66 1.99 0.31 000
31571 .... ............ A ........ Laryngoscop w/vc inj + scope ............ 4.26 NA NA 1.83 2.18 0.35 000
31576 .... ............ A ........ Laryngoscopy with biopsy .................. 1.97 3.50 3.55 1.05 1.16 0.14 000
31577 .... ............ A ........ Remove foreign body, larynx ............. 2.47 3.36 3.54 1.17 1.34 0.21 000
31578 .... ............ A ........ Removal of larynx lesion .................... 2.84 3.98 4.08 1.35 1.41 0.23 000
31584 .... ............ A ........ Treat larynx fracture ........................... 20.35 NA NA 15.29 16.56 1.72 090
31590 .... ............ A ........ Reinnervate larynx .............................. 7.63 NA NA 12.73 14.02 0.84 090
31595 .... ............ A ........ Larynx nerve surgery .......................... 8.75 NA NA 9.62 9.97 0.68 090
31599 .... ............ C ........ Larynx surgery procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
31600 .... ............ A ........ Incision of windpipe ............................ 7.17 NA NA 2.30 2.73 0.80 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
31611 .... ............ A ........ Surgery/speech prosthesis ................. 5.92 NA NA 7.06 6.97 0.46 090
31612 .... ............ A ........ Puncture/clear windpipe ..................... 0.91 1.08 1.09 0.26 0.31 0.08 000
31613 .... ............ A ........ Repair windpipe opening .................... 4.63 NA NA 6.11 6.00 0.42 090
31614 .... ............ A ........ Repair windpipe opening .................... 8.47 NA NA 9.56 9.03 0.58 090
31615 .... ............ A ........ Visualization of windpipe .................... 2.09 2.37 2.46 1.05 1.11 0.16 000
31620 .... ............ A ........ Endobronchial us add-on ................... 1.40 5.96 5.81 0.33 0.44 0.11 ZZZ
31622 .... ............ A ........ Dx bronchoscope/wash ...................... 2.78 5.19 5.43 0.90 0.98 0.18 000
31623 .... ............ A ........ Dx bronchoscope/brush ...................... 2.88 5.92 6.19 0.90 0.98 0.13 000
31624 .... ............ A ........ Dx bronchoscope/lavage .................... 2.88 5.29 5.54 0.90 0.98 0.13 000
31625 .... ............ A ........ Bronchoscopy w/biopsy(s) .................. 3.36 5.43 5.63 1.02 1.12 0.18 000
31628 .... ............ A ........ Bronchoscopy/lung bx, each .............. 3.80 6.90 6.98 1.11 1.21 0.18 000
31629 .... ............ A ........ Bronchoscopy/needle bx, each .......... 4.09 11.90 13.10 1.18 1.29 0.16 000
31630 .... ............ A ........ Bronchoscopy dilate/fx repr ................ 3.81 NA NA 1.27 1.50 0.32 000
31631 .... ............ A ........ Bronchoscopy, dilate w/stent .............. 4.36 NA NA 1.42 1.59 0.34 000
31632 .... ............ A ........ Bronchoscopy/lung bx, addœl ............. 1.03 0.85 0.84 0.24 0.28 0.18 ZZZ
31633 .... ............ A ........ Bronchoscopy/needle bx addœl .......... 1.32 0.98 0.95 0.31 0.36 0.16 ZZZ
31635 .... ............ A ........ Bronchoscopy w/fb removal ............... 3.67 5.16 5.64 1.14 1.29 0.24 000
31636 .... ............ A ........ Bronchoscopy, bronch stents ............. 4.30 NA NA 1.35 1.56 0.31 000
31637 .... ............ A ........ Bronchoscopy, stent add-on ............... 1.58 NA NA 0.41 0.49 0.13 ZZZ
31638 .... ............ A ........ Bronchoscopy, revise stent ................ 4.88 NA NA 1.54 1.76 0.22 000
31640 .... ............ A ........ Bronchoscopy w/tumor excise ............ 4.93 NA NA 1.54 1.81 0.46 000
31641 .... ............ A ........ Bronchoscopy, treat blockage ............ 5.02 NA NA 1.50 1.69 0.35 000
31643 .... ............ A ........ Diag bronchoscope/catheter ............... 3.49 NA NA 1.04 1.14 0.20 000
31645 .... ............ A ........ Bronchoscopy, clear airways .............. 3.16 4.69 4.93 0.97 1.05 0.16 000
31646 .... ............ A ........ Bronchoscopy, reclear airway ............ 2.72 4.38 4.63 0.85 0.93 0.14 000
31656 .... ............ A ........ Bronchoscopy, inj for x-ray ................. 2.17 5.69 6.42 0.69 0.76 0.15 000
31715 .... ............ A ........ Injection for bronchus x-ray ................ 1.11 NA NA 0.25 0.30 0.07 000
31717 .... ............ A ........ Bronchial brush biopsy ....................... 2.12 5.78 7.03 0.72 0.77 0.14 000
31720 .... ............ A ........ Clearance of airways .......................... 1.06 NA NA 0.27 0.30 0.07 000
31725 .... ............ A ........ Clearance of airways .......................... 1.96 NA NA 0.41 0.50 0.14 000
31730 .... ............ A ........ Intro, windpipe wire/tube .................... 2.85 25.45 13.80 0.75 0.88 0.21 000
31750 .... ............ A ........ Repair of windpipe .............................. 15.19 NA NA 17.43 17.29 1.05 090
31766 .... ............ A ........ Reconstruction of windpipe ................ 31.58 NA NA 11.72 12.64 4.53 090
31770 .... ............ A ........ Repair/graft of bronchus ..................... 23.48 NA NA 8.55 9.44 2.84 090
31775 .... ............ A ........ Reconstruct bronchus ......................... 24.51 NA NA 9.46 10.53 3.02 090
31780 .... ............ A ........ Reconstruct windpipe ......................... 19.70 NA NA 8.84 9.83 1.65 090
31781 .... ............ A ........ Reconstruct windpipe ......................... 24.77 NA NA 9.67 10.83 2.25 090
31785 .... ............ A ........ Remove windpipe lesion .................... 18.29 NA NA 7.75 8.61 1.59 090
31786 .... ............ A ........ Remove windpipe lesion .................... 25.34 NA NA 9.65 11.40 3.30 090
31800 .... ............ A ........ Repair of windpipe injury .................... 8.10 NA NA 8.64 8.89 0.79 090
31805 .... ............ A ........ Repair of windpipe injury .................... 13.34 NA NA 6.21 6.73 1.83 090
31820 .... ............ A ........ Closure of windpipe lesion ................. 4.58 5.83 5.68 3.27 3.42 0.38 090
31825 .... ............ A ........ Repair of windpipe defect ................... 6.98 7.43 7.45 4.49 4.86 0.53 090
31830 .... ............ A ........ Revise windpipe scar ......................... 4.54 5.91 5.79 3.55 3.74 0.44 090
31899 .... ............ C ........ Airways surgical procedure ................ 0.00 0.00 1.44 0.00 0.45 0.00 YYY
32000 .... ............ A ........ Drainage of chest ............................... 1.54 2.39 2.70 0.47 0.46 0.08 000
32002 .... ............ A ........ Treatment of collapsed lung ............... 2.19 2.86 3.01 1.04 1.03 0.12 000
32005 .... ............ A ........ Treat lung lining chemically ................ 2.19 5.01 5.74 0.59 0.64 0.23 000
32019 .... ............ A ........ Insert pleural catheter ......................... 4.17 15.00 17.51 1.52 1.57 0.42 000
32020 .... ............ A ........ Insertion of chest tube ........................ 3.29 NA NA 0.97 1.16 0.43 000
32035 .... ............ A ........ Exploration of chest ............................ 11.20 NA NA 6.04 5.95 1.26 090
32095 .... ............ A ........ Biopsy through chest wall .................. 10.06 NA NA 5.08 5.24 1.22 090
32100 .... ............ A ........ Exploration/biopsy of chest ................ 16.08 NA NA 6.99 7.42 2.24 090
32110 .... ............ A ........ Explore/repair chest ............................ 25.15 NA NA 9.86 10.32 3.22 090
32120 .... ............ A ........ Re-exploration of chest ...................... 14.27 NA NA 6.76 6.93 1.63 090
32124 .... ............ A ........ Explore chest free adhesions ............. 15.33 NA NA 6.95 7.10 1.90 090
32140 .... ............ A ........ Removal of lung lesion(s) ................... 16.54 NA NA 7.37 7.54 1.97 090
32141 .... ............ A ........ Remove/treat lung lesions .................. 27.10 NA NA 10.18 8.89 2.01 090
32150 .... ............ A ........ Removal of lung lesion(s) ................... 16.70 NA NA 7.49 7.55 2.01 090
32151 .... ............ A ........ Remove lung foreign body ................. 16.82 NA NA 7.86 8.08 2.04 090
32160 .... ............ A ........ Open chest heart massage ................ 13.02 NA NA 5.83 5.55 1.31 090
32200 .... ............ A ........ Drain, open, lung lesion ..................... 18.48 NA NA 8.76 8.69 2.14 090
32201 .... ............ A ........ Drain, percut, lung lesion ................... 3.99 19.70 20.04 1.45 1.32 0.24 000
32215 .... ............ A ........ Treat chest lining ................................ 12.93 NA NA 6.20 6.58 1.69 090
32220 .... ............ A ........ Release of lung .................................. 26.41 NA NA 11.88 12.45 3.57 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
32225 .... ............ A ........ Partial release of lung ........................ 16.63 NA NA 7.43 7.56 2.07 090
32310 .... ............ A ........ Removal of chest lining ...................... 15.16 NA NA 6.93 7.16 2.00 090
32320 .... ............ A ........ Free/remove chest lining .................... 27.04 NA NA 11.44 11.82 3.52 090
32400 .... ............ A ........ Needle biopsy chest lining ................. 1.76 2.14 2.11 0.57 0.54 0.10 000
32402 .... ............ A ........ Open biopsy chest lining .................... 8.89 NA NA 4.68 4.91 1.07 090
32405 .... ............ A ........ Biopsy, lung or mediastinum .............. 1.93 0.70 0.66 0.70 0.64 0.11 000
32420 .... ............ A ........ Puncture/clear lung ............................. 2.18 NA NA 0.72 0.68 0.12 000
32440 .... ............ A ........ Removal of lung ................................. 27.17 NA NA 10.91 11.93 3.69 090
32442 .... ............ A ........ Sleeve pneumonectomy ..................... 56.37 NA NA 18.84 16.75 3.85 090
32445 .... ............ A ........ Removal of lung ................................. 63.60 NA NA 22.86 18.49 3.72 090
32480 .... ............ A ........ Partial removal of lung ....................... 25.71 NA NA 10.19 11.15 3.50 090
32482 .... ............ A ........ Bilobectomy ........................................ 27.28 NA NA 11.08 12.01 3.67 090
32484 .... ............ A ........ Segmentectomy .................................. 25.30 NA NA 9.58 10.49 3.04 090
32486 .... ............ A ........ Sleeve lobectomy ............................... 42.80 NA NA 14.66 14.04 3.52 090
32488 .... ............ A ........ Completion pneumonectomy .............. 42.83 NA NA 15.59 14.70 3.81 090
32491 .... ............ R ........ Lung volume reduction ....................... 25.09 NA NA 10.44 11.57 2.99 090
32500 .... ............ A ........ Partial removal of lung ....................... 24.48 NA NA 10.26 11.33 3.26 090
32501 .... ............ A ........ Repair bronchus add-on ..................... 4.68 NA NA 1.35 1.45 0.65 ZZZ
32503 .... ............ A ........ Resect apical lung tumor .................... 31.61 NA NA 12.10 13.61 4.38 090
32504 .... ............ A ........ Resect apical lung tum/chest ............. 36.41 NA NA 13.49 15.12 5.09 090
32540 .... ............ A ........ Removal of lung lesion ....................... 30.22 NA NA 11.49 10.68 2.08 090
32601 .... ............ A ........ Thoracoscopy, diagnostic ................... 5.45 NA NA 2.07 2.22 0.80 000
32650 .... ............ A ........ Thoracoscopy, surgical ....................... 10.77 NA NA 5.23 6.00 1.58 090
32800 .... ............ A ........ Repair lung hernia .............................. 15.59 NA NA 6.86 7.17 1.99 090
32810 .... ............ A ........ Close chest after drainage ................. 14.83 NA NA 6.98 7.27 1.94 090
32815 .... ............ A ........ Close bronchial fistula ........................ 49.79 NA NA 18.63 14.86 3.28 090
32820 .... ............ A ........ Reconstruct injured chest ................... 22.33 NA NA 10.56 11.57 2.53 090
32851 .... ............ A ........ Lung transplant, single ....................... 40.94 NA NA 20.18 24.04 5.58 090
32852 .... ............ A ........ Lung transplant with bypass ............... 44.65 NA NA 22.54 28.05 6.02 090
32853 .... ............ A ........ Lung transplant, double ...................... 50.11 NA NA 22.79 27.36 7.07 090
32854 .... ............ A ........ Lung transplant with bypass ............... 53.88 NA NA 25.79 30.38 7.22 090
32855 .... ............ C ........ Prepare donor lung, single ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
32856 .... ............ C ........ Prepare donor lung, double ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
32900 .... ............ A ........ Removal of rib(s) ................................ 23.69 NA NA 9.62 9.78 2.94 090
32905 .... ............ A ........ Revise & repair chest wall .................. 23.17 NA NA 9.54 9.85 3.16 090
32906 .... ............ A ........ Revise & repair chest wall .................. 29.18 NA NA 11.04 11.60 3.98 090
32940 .... ............ A ........ Revision of lung .................................. 21.22 NA NA 8.50 9.01 2.89 090
32960 .... ............ A ........ Therapeutic pneumothorax ................. 1.84 1.61 1.66 0.69 0.62 0.16 000
32997 .... ............ A ........ Total lung lavage ................................ 7.31 NA NA 1.85 1.88 0.55 000
32998 .... ............ A ........ Perq rf ablate tx, pul tumor ................ 5.68 69.54 68.94 2.00 1.85 0.36 000
32999 .... ............ C ........ Chest surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
33010 .... ............ A ........ Drainage of heart sac ......................... 2.24 NA NA 1.00 0.90 0.14 000
33011 .... ............ A ........ Repeat drainage of heart sac ............. 2.24 NA NA 1.09 0.96 0.15 000
33015 .... ............ A ........ Incision of heart sac ........................... 8.44 NA NA 5.04 5.00 0.65 090
33030 .... ............ A ........ Partial removal of heart sac ............... 22.27 NA NA 9.11 9.34 2.84 090
33031 .... ............ A ........ Partial removal of heart sac ............... 25.30 NA NA 9.58 9.87 3.14 090
33050 .... ............ A ........ Removal of heart sac lesion ............... 16.85 NA NA 7.37 7.64 2.15 090
33120 .... ............ A ........ Removal of heart lesion ..................... 27.33 NA NA 10.56 11.10 3.70 090
33140 .... ............ A ........ Heart revascularize (tmr) .................... 28.26 NA NA 10.32 10.65 2.86 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
33141 .... ............ A ........ Heart tmr w/other procedure .............. 2.54 NA NA 0.78 1.19 0.69 ZZZ
33202 .... ............ A ........ Insert epicard eltrd, open ................... 13.15 NA NA 6.03 6.16 1.71 090
33203 .... ............ A ........ Insert epicard eltrd, endo ................... 13.92 NA NA 6.09 6.22 1.39 090
33206 .... ............ A ........ Insertion of heart pacemaker ............. 7.31 NA NA 4.96 4.75 0.52 090
33210 .... ............ A ........ Insertion of heart electrode ................ 3.30 NA NA 1.60 1.45 0.18 000
33211 .... ............ A ........ Insertion of heart electrode ................ 3.39 NA NA 1.54 1.45 0.21 000
33212 .... ............ A ........ Insertion of pulse generator ............... 5.51 NA NA 3.59 3.50 0.43 090
33213 .... ............ A ........ Insertion of pulse generator ............... 6.36 NA NA 4.07 3.94 0.45 090
33214 .... ............ A ........ Upgrade of pacemaker system .......... 7.78 NA NA 5.19 5.08 0.58 090
33215 .... ............ A ........ Reposition pacing-defib lead .............. 4.89 NA NA 3.36 3.30 0.37 090
33216 .... ............ A ........ Insert lead pace-defib, one ................. 5.81 NA NA 4.38 4.33 0.36 090
33217 .... ............ A ........ Insert lead pace-defib, dual ................ 5.78 NA NA 4.29 4.30 0.39 090
33218 .... ............ A ........ Repair lead pace-defib, one ............... 5.97 NA NA 4.66 4.51 0.37 090
33220 .... ............ A ........ Repair lead pace-defib, dual .............. 6.05 NA NA 4.62 4.50 0.37 090
33222 .... ............ A ........ Revise pocket, pacemaker ................. 5.01 NA NA 4.18 4.27 0.42 090
33223 .... ............ A ........ Revise pocket, pacing-defib ............... 6.49 NA NA 4.71 4.70 0.45 090
33224 .... ............ A ........ Insert pacing lead & connect .............. 9.04 NA NA 4.73 4.43 0.54 000
33225 .... ............ A ........ L ventric pacing lead add-on .............. 8.33 NA NA 4.18 3.77 0.45 ZZZ
33226 .... ............ A ........ Reposition l ventric lead ..................... 8.68 NA NA 4.57 4.26 0.59 000
33233 .... ............ A ........ Removal of pacemaker system .......... 3.33 NA NA 3.16 3.25 0.22 090
33234 .... ............ A ........ Removal of pacemaker system .......... 7.85 NA NA 5.30 5.15 0.56 090
33235 .... ............ A ........ Removal pacemaker electrode ........... 9.93 NA NA 7.01 6.98 0.73 090
33236 .... ............ A ........ Remove electrode/thoracotomy .......... 12.64 NA NA 6.36 6.95 1.69 090
33240 .... ............ A ........ Insert pulse generator ........................ 7.61 NA NA 5.06 4.88 0.41 090
33241 .... ............ A ........ Remove pulse generator .................... 3.26 NA NA 2.89 2.96 0.18 090
33243 .... ............ A ........ Remove eltrd/thoracotomy ................. 23.42 NA NA 10.84 11.18 2.10 090
33244 .... ............ A ........ Remove eltrd, transven ...................... 13.84 NA NA 9.12 9.09 0.99 090
33249 .... ............ A ........ Eltrd/insert pace-defib ......................... 15.02 NA NA 9.78 9.19 0.77 090
33250 .... ............ A ........ Ablate heart dysrhythm focus ............. 25.78 NA NA 10.80 10.80 3.19 090
33254 .... ............ A ........ Ablate atria, lmtd ................................ 23.58 NA NA 9.76 9.88 3.35 090
33255 .... ............ A ........ Ablate atria w/o bypass, ext ............... 28.91 NA NA 11.36 11.50 3.94 090
33256 .... ............ A ........ Ablate atria w/bypass, exten .............. 34.77 NA NA 13.11 13.28 4.95 090
33265 .... ............ A ........ Ablate atria w/bypass, endo ............... 23.58 NA NA 9.76 9.88 3.35 090
33266 .... ............ A ........ Ablate atria w/o bypass endo ............. 32.91 NA NA 12.55 12.72 4.80 090
33282 .... ............ A ........ Implant pat-active ht record ................ 4.70 NA NA 4.08 4.09 0.23 090
33284 .... ............ A ........ Remove pat-active ht record .............. 3.04 NA NA 3.26 3.42 0.14 090
33300 .... ............ A ........ Repair of heart wound ........................ 44.89 NA NA 15.08 12.25 2.66 090
33305 .... ............ A ........ Repair of heart wound ........................ 76.85 NA NA 25.16 17.89 3.13 090
33310 .... ............ A ........ Exploratory heart surgery ................... 20.22 NA NA 8.36 9.05 2.59 090
33315 .... ............ A ........ Exploratory heart surgery ................... 26.05 NA NA 10.35 10.63 3.28 090
33320 .... ............ A ........ Repair major blood vessel(s) ............. 18.46 NA NA 7.93 8.20 2.08 090
33321 .... ............ A ........ Repair major vessel ............................ 20.71 NA NA 8.38 9.40 2.91 090
33322 .... ............ A ........ Repair major blood vessel(s) ............. 24.30 NA NA 9.55 10.00 2.86 090
33330 .... ............ A ........ Insert major vessel graft ..................... 25.17 NA NA 9.49 9.92 2.82 090
33400 .... ............ A ........ Repair of aortic valve ......................... 41.37 NA NA 14.60 15.23 4.11 090
33401 .... ............ A ........ Valvuloplasty, open ............................ 24.41 NA NA 10.28 11.81 3.57 090
33403 .... ............ A ........ Valvuloplasty, w/cp bypass ................ 25.39 NA NA 12.17 12.96 3.55 090
33404 .... ............ A ........ Prepare heart-aorta conduit ............... 31.25 NA NA 12.02 13.31 4.33 090
33405 .... ............ A ........ Replacement of aortic valve ............... 41.19 NA NA 15.12 16.76 5.33 090
33415 .... ............ A ........ Revision, subvalvular tissue ............... 37.19 NA NA 13.15 12.56 4.14 090
33416 .... ............ A ........ Revise ventricle muscle ...................... 36.43 NA NA 13.26 13.43 4.57 090
33420 .... ............ A ........ Revision of mitral valve ...................... 25.67 NA NA 9.47 9.44 1.82 090
33425 .... ............ A ........ Repair of mitral valve ......................... 49.83 NA NA 17.63 15.38 4.07 090
33430 .... ............ A ........ Replacement of mitral valve ............... 50.75 NA NA 18.57 18.00 5.10 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
33460 .... ............ A ........ Revision of tricuspid valve .................. 44.62 NA NA 14.77 13.16 3.45 090
33463 .... ............ A ........ Valvuloplasty, tricuspid ....................... 56.95 NA NA 19.74 16.33 3.87 090
33464 .... ............ A ........ Valvuloplasty, tricuspid ....................... 44.49 NA NA 15.85 14.75 4.15 090
33465 .... ............ A ........ Replace tricuspid valve ...................... 50.59 NA NA 17.67 15.33 4.39 090
33468 .... ............ A ........ Revision of tricuspid valve .................. 32.82 NA NA 14.95 14.37 4.07 090
33470 .... ............ A ........ Revision of pulmonary valve .............. 21.32 NA NA 7.93 9.44 1.03 090
33471 .... ............ A ........ Valvotomy, pulmonary valve .............. 22.83 NA NA 11.33 9.94 3.39 090
33475 .... ............ A ........ Replacement, pulmonary valve .......... 42.27 NA NA 15.11 15.34 4.93 090
33476 .... ............ A ........ Revision of heart chamber ................. 26.41 NA NA 10.39 11.35 2.42 090
33496 .... ............ A ........ Repair, prosth valve clot ..................... 29.71 NA NA 11.12 11.99 4.13 090
33500 .... ............ A ........ Repair heart vessel fistula .................. 27.82 NA NA 11.00 11.24 3.87 090
33501 .... ............ A ........ Repair heart vessel fistula .................. 19.43 NA NA 8.17 8.24 1.91 090
33502 .... ............ A ........ Coronary artery correction .................. 21.69 NA NA 9.31 10.18 3.00 090
33503 .... ............ A ........ Coronary artery graft .......................... 22.29 NA NA 11.18 10.37 1.78 090
33504 .... ............ A ........ Coronary artery graft .......................... 25.30 NA NA 10.57 11.12 3.36 090
33505 .... ............ A ........ Repair artery w/tunnel ........................ 38.35 NA NA 14.84 13.45 2.19 090
33506 .... ............ A ........ Repair artery, translocation ................ 37.80 NA NA 12.76 14.13 4.66 090
33507 .... ............ A ........ Repair art, intramural .......................... 31.35 NA NA 11.10 12.48 4.06 090
33508 .... ............ A ........ Endoscopic vein harvest .................... 0.31 NA NA 0.09 0.10 0.04 ZZZ
33510 .... ............ A ........ CABG, vein, single ............................. 34.87 NA NA 12.91 14.67 4.41 090
33511 .... ............ A ........ CABG, vein, two ................................. 38.34 NA NA 14.16 15.67 4.56 090
33512 .... ............ A ........ CABG, vein, three .............................. 43.87 NA NA 15.94 16.82 4.67 090
33513 .... ............ A ........ CABG, vein, four ................................ 45.26 NA NA 16.36 17.15 4.88 090
33514 .... ............ A ........ CABG, vein, five ................................. 47.97 NA NA 17.32 17.74 4.77 090
33516 .... ............ A ........ Cabg, vein, six or more ...................... 49.65 NA NA 17.93 18.47 5.13 090
33517 .... ............ A ........ CABG, artery-vein, single ................... 3.61 NA NA 1.08 0.97 0.39 ZZZ
33518 .... ............ A ........ CABG, artery-vein, two ....................... 7.93 NA NA 2.37 1.98 0.73 ZZZ
33519 .... ............ A ........ CABG, artery-vein, three .................... 10.49 NA NA 3.15 2.74 1.04 ZZZ
33521 .... ............ A ........ CABG, artery-vein, four ...................... 12.59 NA NA 3.78 3.44 1.37 ZZZ
33522 .... ............ A ........ CABG, artery-vein, five ....................... 14.14 NA NA 4.25 4.04 1.78 ZZZ
33523 .... ............ A ........ Cabg, art-vein, six or more ................. 16.08 NA NA 4.80 4.69 2.13 ZZZ
33530 .... ............ A ........ Coronary artery, bypass/reop ............. 10.13 NA NA 2.96 2.46 0.88 ZZZ
33533 .... ............ A ........ CABG, arterial, single ......................... 33.64 NA NA 12.56 14.55 4.56 090
33534 .... ............ A ........ CABG, arterial, two ............................. 39.77 NA NA 14.74 16.27 4.70 090
33535 .... ............ A ........ CABG, arterial, three .......................... 44.64 NA NA 16.28 17.26 5.03 090
33536 .... ............ A ........ Cabg, arterial, four or more ................ 48.32 NA NA 17.31 17.84 5.44 090
33545 .... ............ A ........ Repair of heart damage ..................... 56.93 NA NA 20.10 17.93 5.21 090
33548 .... ............ A ........ Restore/remodel, ventricle .................. 53.96 NA NA 19.36 19.44 5.53 090
33572 .... ............ A ........ Open coronary endarterectomy .......... 4.44 NA NA 1.32 1.39 0.65 ZZZ
33600 .... ............ A ........ Closure of valve .................................. 30.15 NA NA 12.08 12.36 4.42 090
33602 .... ............ A ........ Closure of valve .................................. 29.18 NA NA 11.26 12.24 3.82 090
33606 .... ............ A ........ Anastomosis/artery-aorta .................... 31.37 NA NA 11.94 12.83 4.41 090
33608 .... ............ A ........ Repair anomaly w/conduit .................. 31.72 NA NA 12.80 13.55 4.74 090
33610 .... ............ A ........ Repair by enlargement ....................... 31.24 NA NA 13.56 13.20 4.56 090
33611 .... ............ A ........ Repair double ventricle ....................... 35.49 NA NA 12.41 13.30 4.37 090
33612 .... ............ A ........ Repair double ventricle ....................... 36.49 NA NA 14.19 14.46 5.30 090
33615 .... ............ A ........ Repair, modified fontan ...................... 35.76 NA NA 13.70 13.23 4.32 090
33617 .... ............ A ........ Repair single ventricle ........................ 38.96 NA NA 14.02 15.41 5.66 090
33619 .... ............ A ........ Repair single ventricle ........................ 48.60 NA NA 18.07 19.46 6.46 090
33641 .... ............ A ........ Repair heart septum defect ................ 29.50 NA NA 10.89 10.25 3.23 090
33645 .... ............ A ........ Revision of heart veins ....................... 27.98 NA NA 10.71 11.28 3.79 090
33647 .... ............ A ........ Repair heart septum defects .............. 29.37 NA NA 12.61 13.14 3.32 090
33660 .... ............ A ........ Repair of heart defects ....................... 31.75 NA NA 11.76 12.57 4.49 090
33670 .... ............ A ........ Repair of heart chambers ................... 36.58 NA NA 15.34 13.74 4.65 090
33675 .... ............ A ........ Close mult vsd .................................... 35.87 NA NA 15.47 17.04 4.95 090
33676 .... ............ A ........ Close mult vsd w/resection ................ 36.87 NA NA 15.78 17.37 5.44 090
33677 .... ............ A ........ Cl mult vsd w/rem pul band ............... 38.37 NA NA 16.34 17.99 5.68 090
33690 .... ............ A ........ Reinforce pulmonary artery ................ 20.20 NA NA 8.64 9.39 1.97 090
33720 .... ............ A ........ Repair of heart defect ......................... 27.13 NA NA 10.68 11.55 3.84 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
33722 .... ............ A ........ Repair of heart defect ......................... 29.05 NA NA 10.66 11.92 1.30 090
33724 .... ............ A ........ Repair venous anomaly ...................... 27.55 NA NA 10.37 10.50 4.00 090
33726 .... ............ A ........ Repair pul venous stenosis ................ 37.04 NA NA 13.22 13.38 5.03 090
33730 .... ............ A ........ Repair heart-vein defect(s) ................. 36.01 NA NA 12.82 13.55 5.03 090
33732 .... ............ A ........ Repair heart-vein defect ..................... 28.80 NA NA 12.55 13.34 3.68 090
33750 .... ............ A ........ Major vessel shunt ............................. 22.06 NA NA 9.61 10.21 1.16 090
33764 .... ............ A ........ Major vessel shunt & graft ................. 22.44 NA NA 8.94 9.63 3.01 090
33768 .... ............ A ........ Cavopulmonary shunting .................... 8.00 NA NA 1.84 2.31 1.19 ZZZ
33770 .... ............ A ........ Repair great vessels defect ................ 39.02 NA NA 11.91 13.07 5.74 090
33786 .... ............ A ........ Repair arterial trunk ............................ 41.74 NA NA 14.15 14.98 5.71 090
33788 .... ............ A ........ Revision of pulmonary artery ............. 27.26 NA NA 8.23 10.34 4.03 090
33800 .... ............ A ........ Aortic suspension ............................... 17.23 NA NA 6.84 7.55 2.46 090
33802 .... ............ A ........ Repair vessel defect ........................... 18.24 NA NA 7.96 8.52 2.27 090
33803 .... ............ A ........ Repair vessel defect ........................... 20.18 NA NA 6.38 8.33 3.20 090
33813 .... ............ A ........ Repair septal defect ........................... 21.23 NA NA 8.82 9.89 3.13 090
33820 .... ............ A ........ Revise major vessel ........................... 16.61 NA NA 6.98 7.91 2.35 090
33840 .... ............ A ........ Remove aorta constriction .................. 21.21 NA NA 9.36 9.76 2.16 090
33860 .... ............ A ........ Ascending aortic graft ......................... 59.33 NA NA 20.24 18.40 5.76 090
33870 .... ............ A ........ Transverse aortic arch graft ............... 45.93 NA NA 16.30 17.40 6.62 090
33875 .... ............ A ........ Thoracic aortic graft ............................ 35.68 NA NA 12.91 13.54 4.89 090
33877 .... ............ A ........ Thoracoabdominal graft ...................... 68.85 NA NA 21.04 18.79 5.94 090
33880 .... ............ A ........ Endovasc taa repr incl subcl .............. 34.48 NA NA 10.90 12.12 2.75 090
33881 .... ............ A ........ Endovasc taa repr w/o subcl .............. 29.48 NA NA 9.65 10.74 2.33 090
33883 .... ............ A ........ Insert endovasc prosth, taa ................ 20.99 NA NA 7.21 8.15 2.11 090
33884 .... ............ A ........ Endovasc prosth, taa, add-on ............ 8.20 NA NA 2.09 2.32 0.86 ZZZ
33886 .... ............ A ........ Endovasc prosth, delayed .................. 17.99 NA NA 6.29 7.24 1.80 090
33889 .... ............ A ........ Artery transpose/endovas taa ............ 15.92 NA NA 3.97 4.60 2.18 000
33891 .... ............ A ........ Car-car bp grft/endovas taa ............... 20.00 NA NA 5.80 6.47 2.73 000
33910 .... ............ A ........ Remove lung artery emboli ................ 29.59 NA NA 11.34 11.37 3.70 090
33915 .... ............ A ........ Remove lung artery emboli ................ 24.83 NA NA 9.16 9.44 1.44 090
33916 .... ............ A ........ Surgery of great vessel ...................... 28.30 NA NA 10.90 11.11 3.67 090
33917 .... ............ A ........ Repair pulmonary artery ..................... 25.14 NA NA 10.04 11.17 3.70 090
33920 .... ............ A ........ Repair pulmonary atresia ................... 32.58 NA NA 9.46 11.95 4.38 090
33922 .... ............ A ........ Transect pulmonary artery ................. 24.09 NA NA 10.19 10.76 3.10 090
33924 .... ............ A ........ Remove pulmonary shunt .................. 5.49 NA NA 1.61 1.82 0.82 ZZZ
33925 .... ............ A ........ Rpr pul art unifocal w/o cpb ............... 31.25 NA NA 15.94 14.34 4.61 090
33926 .... ............ A ........ Repr pul art, unifocal w/cpb ............... 44.68 NA NA 14.86 16.18 6.22 090
33933 .... ............ C ........ Prepare donor heart/lung ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
33935 .... ............ R ........ Transplantation, heart/lung ................. 61.68 NA NA 22.99 25.92 9.06 090
33944 .... ............ C ........ Prepare donor heart ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
33945 .... ............ R ........ Transplantation of heart ..................... 89.08 NA NA 30.44 25.97 6.26 090
33960 .... ............ A ........ External circulation assist ................... 19.33 NA NA 5.42 5.20 2.67 000
33961 .... ............ A ........ External circulation assist ................... 10.91 NA NA 2.97 3.29 0.88 ZZZ
33967 .... ............ A ........ Insert ia percut device ........................ 4.84 NA NA 2.32 2.11 0.35 000
33968 .... ............ A ........ Remove aortic assist device .............. 0.64 NA NA 0.25 0.24 0.07 000
33970 .... ............ A ........ Aortic circulation assist ....................... 6.74 NA NA 2.49 2.40 0.82 000
33971 .... ............ A ........ Aortic circulation assist ....................... 11.91 NA NA 5.92 5.99 1.25 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
33973 .... ............ A ........ Insert balloon device .......................... 9.75 NA NA 3.85 3.59 1.26 000
33974 .... ............ A ........ Remove intra-aortic balloon ............... 14.93 NA NA 7.59 7.77 1.74 090
33975 .... ............ A ........ Implant ventricular device ................... 20.97 NA NA 6.33 6.36 3.07 XXX
33976 .... ............ A ........ Implant ventricular device ................... 22.97 NA NA 7.59 7.62 3.26 XXX
33977 .... ............ A ........ Remove ventricular device ................. 20.07 NA NA 9.40 10.23 2.81 090
33978 .... ............ A ........ Remove ventricular device ................. 22.51 NA NA 10.41 11.09 3.31 090
33979 .... ............ A ........ Insert intracorporeal device ................ 45.93 NA NA 13.34 14.31 6.97 XXX
33980 .... ............ A ........ Remove intracorporeal device ............ 64.86 NA NA 23.15 24.50 8.59 090
33999 .... ............ C ........ Cardiac surgery procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
34001 .... ............ A ........ Removal of artery clot ........................ 17.78 NA NA 6.35 6.58 1.85 090
34111 .... ............ A ........ Removal of arm artery clot ................. 10.85 NA NA 4.27 4.84 1.40 090
34203 .... ............ A ........ Removal of leg artery clot .................. 17.73 NA NA 6.36 7.24 2.36 090
34401 .... ............ A ........ Removal of vein clot ........................... 26.41 NA NA 9.28 10.02 3.10 090
34501 .... ............ A ........ Repair valve, femoral vein .................. 16.74 NA NA 6.41 7.54 2.35 090
34502 .... ............ A ........ Reconstruct vena cava ....................... 27.86 NA NA 10.51 11.44 3.63 090
34510 .... ............ A ........ Transposition of vein valve ................. 19.80 NA NA 7.55 8.43 2.33 090
34520 .... ............ A ........ Cross-over vein graft .......................... 19.05 NA NA 7.00 8.10 2.29 090
34530 .... ............ A ........ Leg vein fusion ................................... 17.77 NA NA 6.75 7.87 1.74 090
34800 .... ............ A ........ Endovas aaa repr w/sm tube ............. 21.46 NA NA 7.23 8.22 2.46 090
34802 .... ............ A ........ Endovas aaa repr w/2-p part .............. 23.71 NA NA 8.14 8.97 2.33 090
34803 .... ............ A ........ Endovas aaa repr w/3-p part .............. 24.74 NA NA 8.00 9.12 2.01 090
34804 .... ............ A ........ Endovas aaa repr w/1–p part ............. 23.71 NA NA 8.04 8.93 2.30 090
34805 .... ............ A ........ Endovas aaa repr w/long tube ........... 22.59 NA NA 7.25 8.44 2.01 090
34808 .... ............ A ........ Endovas iliac a device addon ............ 4.12 NA NA 1.05 1.22 0.59 ZZZ
34812 .... ............ A ........ Xpose for endoprosth, femorl ............. 6.74 NA NA 1.67 1.96 1.18 000
34813 .... ............ A ........ Femoral endovas graft add-on ........... 4.79 NA NA 1.16 1.37 0.67 ZZZ
34820 .... ............ A ........ Xpose for endoprosth, iliac ................. 9.74 NA NA 2.46 2.85 1.50 000
34825 .... ............ A ........ Endovasc extend prosth, init .............. 12.72 NA NA 5.12 5.63 1.28 090
34826 .... ............ A ........ Endovasc exten prosth, add-l ............. 4.12 NA NA 1.13 1.25 0.44 ZZZ
34830 .... ............ A ........ Open aortic tube prosth repr .............. 35.10 NA NA 10.35 12.09 4.55 090
34831 .... ............ A ........ Open aortoiliac prosth repr ................. 37.85 NA NA 11.29 11.64 4.89 090
34832 .... ............ A ........ Open aortofemor prosth repr .............. 37.85 NA NA 11.78 13.17 4.85 090
34833 .... ............ A ........ Xpose for endoprosth, iliac ................. 11.98 NA NA 3.29 3.86 1.70 000
34834 .... ............ A ........ Xpose, endoprosth, brachial ............... 5.34 NA NA 1.55 1.88 0.76 000
34900 .... ............ A ........ Endovasc iliac repr w/graft ................. 16.77 NA NA 6.04 6.84 2.00 090
35001 .... ............ A ........ Repair defect of artery ........................ 20.70 NA NA 7.69 8.61 2.81 090
35002 .... ............ A ........ Repair artery rupture, neck ................ 22.12 NA NA 7.44 8.63 3.00 090
35013 .... ............ A ........ Repair artery rupture, arm .................. 23.10 NA NA 7.73 8.74 3.10 090
35022 .... ............ A ........ Repair artery rupture, chest ............... 25.62 NA NA 10.45 9.98 3.17 090
35045 .... ............ A ........ Repair defect of arm artery ................ 17.94 NA NA 6.26 6.93 2.45 090
35082 .... ............ A ........ Repair artery rupture, aorta ................ 41.93 NA NA 12.78 14.09 5.44 090
35092 .... ............ A ........ Repair artery rupture, aorta ................ 50.81 NA NA 14.51 16.16 6.40 090
35103 .... ............ A ........ Repair artery rupture, groin ................ 43.49 NA NA 12.64 14.34 5.76 090
35112 .... ............ A ........ Repair artery rupture,spleen ............... 32.44 NA NA 10.07 11.08 4.08 090
35122 .... ............ A ........ Repair artery rupture, belly ................. 37.76 NA NA 11.57 12.77 4.75 090
35132 .... ............ A ........ Repair artery rupture, groin ................ 32.44 NA NA 10.30 11.33 4.30 090
35142 .... ............ A ........ Repair artery rupture, thigh ................ 25.03 NA NA 8.23 9.32 3.36 090
35152 .... ............ A ........ Repair artery rupture, knee ................ 27.53 NA NA 9.09 10.22 3.61 090
35180 .... ............ A ........ Repair blood vessel lesion ................. 15.01 NA NA 6.28 6.52 1.00 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
35301 .... ............ A ........ Rechanneling of artery ....................... 19.53 NA NA 6.68 7.59 2.68 090
35306 .... ............ A ........ Rechanneling of artery ....................... 9.25 NA NA 2.28 2.35 1.34 ZZZ
35390 .... ............ A ........ Reoperation, carotid add-on ............... 3.19 NA NA 0.82 0.95 0.46 ZZZ
35400 .... ............ A ........ Angioscopy ......................................... 3.00 NA NA 0.72 0.92 0.43 ZZZ
35450 .... ............ A ........ Repair arterial blockage ..................... 10.05 NA NA 2.96 3.30 1.25 000
35460 .... ............ A ........ Repair venous blockage ..................... 6.03 NA NA 1.75 2.02 0.83 000
35470 .... ............ A ........ Repair arterial blockage ..................... 8.62 59.93 74.50 3.39 3.38 0.69 000
35475 .... ............ R ........ Repair arterial blockage ..................... 9.48 48.02 51.97 3.38 3.45 0.62 000
35476 .... ............ A ........ Repair venous blockage ..................... 6.03 36.79 40.56 2.25 2.26 0.34 000
35480 .... ............ A ........ Atherectomy, open ............................. 11.06 NA NA 3.98 4.01 1.28 000
35490 .... ............ A ........ Atherectomy, percutaneous ................ 11.06 NA NA 5.04 5.09 0.71 000
35500 .... ............ A ........ Harvest vein for bypass ...................... 6.44 NA NA 1.60 1.83 0.93 ZZZ
35501 .... ............ A ........ Artery bypass graft ............................. 28.99 NA NA 11.04 9.83 4.10 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
35572 .... ............ A ........ Harvest femoropopliteal vein .............. 6.81 NA NA 1.92 2.07 0.99 ZZZ
35583 .... ............ A ........ Vein bypass graft ................................ 27.62 NA NA 8.64 9.45 3.17 090
35600 .... ............ A ........ Harvest artery for cabg ....................... 4.94 NA NA 1.53 1.58 0.73 ZZZ
35623 .... ............ A ........ Bypass graft, not vein ......................... 25.79 NA NA 8.43 9.49 3.46 090
35681 .... ............ A ........ Composite bypass graft ...................... 1.60 NA NA 0.40 0.47 0.23 ZZZ
35685 .... ............ A ........ Bypass graft patency/patch ................ 4.04 NA NA 0.96 1.16 0.58 ZZZ
35686 .... ............ A ........ Bypass graft/av fist patency ............... 3.34 NA NA 0.84 0.99 0.47 ZZZ
35691 .... ............ A ........ Arterial transposition ........................... 18.32 NA NA 5.88 7.21 2.59 090
35697 .... ............ A ........ Reimplant artery each ........................ 3.00 NA NA 0.74 0.89 0.41 ZZZ
35700 .... ............ A ........ Reoperation, bypass graft .................. 3.08 NA NA 0.77 0.90 0.44 ZZZ
35701 .... ............ A ........ Exploration, carotid artery .................. 9.11 NA NA 4.31 4.72 1.12 090
35721 .... ............ A ........ Exploration, femoral artery ................. 7.66 NA NA 3.79 4.10 1.03 090
35741 .... ............ A ........ Exploration popliteal artery ................. 8.61 NA NA 3.86 4.28 1.12 090
35761 .... ............ A ........ Exploration of artery/vein .................... 5.84 NA NA 3.42 3.73 0.75 090
35800 .... ............ A ........ Explore neck vessels .......................... 7.99 NA NA 3.94 4.30 0.95 090
35820 .... ............ A ........ Explore chest vessels ......................... 36.81 NA NA 12.92 10.11 1.95 090
35840 .... ............ A ........ Explore abdominal vessels ................. 10.87 NA NA 4.79 5.05 1.34 090
35860 .... ............ A ........ Explore limb vessels ........................... 6.72 NA NA 3.36 3.71 0.78 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
35870 .... ............ A ........ Repair vessel graft defect .................. 24.39 NA NA 7.90 8.88 3.01 090
35875 .... ............ A ........ Removal of clot in graft ...................... 10.64 NA NA 4.27 4.74 1.41 090
35876 .... ............ A ........ Removal of clot in graft ...................... 17.74 NA NA 5.94 6.75 2.40 090
35879 .... ............ A ........ Revise graft w/vein ............................. 17.28 NA NA 5.96 6.85 2.28 090
35883 .... ............ A ........ Revise graft w/nonauto graft .............. 23.07 NA NA 8.45 8.79 3.19 090
35901 .... ............ A ........ Excision, graft, neck ........................... 8.26 NA NA 4.23 4.78 1.15 090
35903 .... ............ A ........ Excision, graft, extremity .................... 9.44 NA NA 4.58 5.39 1.30 090
35905 .... ............ A ........ Excision, graft, thorax ......................... 33.39 NA NA 10.65 11.93 4.44 090
35907 .... ............ A ........ Excision, graft, abdomen .................... 37.14 NA NA 10.89 12.59 4.92 090
36000 .... ............ A ........ Place needle in vein ........................... 0.18 0.45 0.51 0.06 0.05 0.01 XXX
36002 .... ............ A ........ Pseudoaneurysm injection trt ............. 1.96 2.23 2.53 0.86 0.90 0.17 000
36005 .... ............ A ........ Injection ext venography .................... 0.95 8.31 7.97 0.38 0.34 0.05 000
36010 .... ............ A ........ Place catheter in vein ......................... 2.43 10.97 15.10 0.79 0.78 0.20 XXX
36013 .... ............ A ........ Place catheter in artery ...................... 2.52 18.38 19.98 0.91 0.81 0.25 XXX
36100 .... ............ A ........ Establish access to artery .................. 3.02 10.95 11.54 1.18 1.15 0.26 XXX
36145 .... ............ A ........ Artery to vein shunt ............................ 2.01 10.19 11.31 0.66 0.65 0.11 XXX
36160 .... ............ A ........ Establish access to aorta ................... 2.52 11.30 12.43 1.04 0.89 0.26 XXX
36200 .... ............ A ........ Place catheter in aorta ....................... 3.02 13.45 14.95 1.01 1.00 0.24 XXX
36218 .... ............ A ........ Place catheter in artery ...................... 1.01 3.72 4.39 0.39 0.36 0.07 ZZZ
36248 .... ............ A ........ Place catheter in artery ...................... 1.01 3.12 3.58 0.38 0.36 0.07 ZZZ
36260 .... ............ A ........ Insertion of infusion pump .................. 9.82 NA NA 4.63 4.79 1.29 090
36261 .... ............ A ........ Revision of infusion pump .................. 5.55 NA NA 3.04 3.37 0.70 090
36262 .... ............ A ........ Removal of infusion pump .................. 4.05 NA NA 2.69 2.72 0.54 090
36299 .... ............ C ........ Vessel injection procedure ................. 0.00 0.00 6.30 0.00 6.30 0.00 YYY
36400 .... ............ A ........ Bl draw < 3 yrs fem/jugular ................ 0.38 0.28 0.29 0.09 0.10 0.03 XXX
36405 .... ............ A ........ Bl draw < 3 yrs scalp vein .................. 0.31 0.27 0.27 0.08 0.08 0.03 XXX
36406 .... ............ A ........ Bl draw < 3 yrs other vein .................. 0.18 0.24 0.27 0.04 0.05 0.01 XXX
36410 .... ............ A ........ Non-routine bl draw > 3 yrs ............... 0.18 0.31 0.30 0.05 0.05 0.01 XXX
36420 .... ............ A ........ Vein access cutdown < 1 yr ............... 1.01 NA NA 0.21 0.24 0.07 XXX
36425 .... ............ A ........ Vein access cutdown > 1 yr ............... 0.76 NA NA 0.20 0.21 0.06 XXX
36430 .... ............ A ........ Blood transfusion service ................... 0.00 0.93 0.97 0.00 0.51 0.06 XXX
36440 .... ............ A ........ Bl push transfuse, 2 yr or < ............... 1.03 NA NA 0.25 0.30 0.10 XXX
36450 .... ............ A ........ Bl exchange/transfuse, nb .................. 2.23 NA NA 0.77 0.74 0.21 XXX
36455 .... ............ A ........ Bl exchange/transfuse non-nb ............ 2.43 NA NA 0.67 0.86 0.15 XXX
36460 .... ............ A ........ Transfusion service, fetal ................... 6.58 NA NA 1.84 2.01 0.79 XXX
36470 .... ............ A ........ Injection therapy of vein ..................... 1.09 2.38 2.54 0.64 0.69 0.12 010
36471 .... ............ A ........ Injection therapy of veins ................... 1.60 2.54 2.81 0.79 0.88 0.19 010
36475 .... ............ A ........ Endovenous rf, 1st vein ...................... 6.72 35.43 43.52 1.88 2.22 0.37 000
36476 .... ............ A ........ Endovenous rf, vein add-on ............... 3.38 6.09 6.96 0.83 1.00 0.18 ZZZ
36478 .... ............ A ........ Endovenous laser, 1st vein ................ 6.72 26.65 36.69 2.05 2.29 0.37 000
36479 .... ............ A ........ Endovenous laser vein addon ............ 3.38 6.29 7.16 0.95 1.05 0.18 ZZZ
36481 .... ............ A ........ Insertion of catheter, vein ................... 6.98 NA NA 2.35 2.42 0.55 000
36500 .... ............ A ........ Insertion of catheter, vein ................... 3.51 NA NA 1.26 1.30 0.20 000
36510 .... ............ A ........ Insertion of catheter, vein ................... 1.09 1.05 2.48 0.29 0.46 0.10 000
36511 .... ............ A ........ Apheresis wbc .................................... 1.74 NA NA 0.58 0.65 0.08 000
36512 .... ............ A ........ Apheresis rbc ...................................... 1.74 NA NA 0.61 0.68 0.08 000
36513 .... ............ A ........ Apheresis platelets ............................. 1.74 NA NA 0.55 0.64 0.17 000
36514 .... ............ A ........ Apheresis plasma ............................... 1.74 10.41 13.69 0.54 0.63 0.08 000
36515 .... ............ A ........ Apheresis, adsorp/reinfuse ................. 1.74 45.00 55.61 0.48 0.58 0.08 000
36516 .... ............ A ........ Apheresis, selective ............................ 1.22 48.74 66.49 0.39 0.44 0.08 000
36522 .... ............ A ........ Photopheresis ..................................... 1.67 37.04 34.36 0.94 0.94 0.13 000
36550 .... ............ A ........ Declot vascular device ....................... 0.00 0.32 0.35 0.06 0.23 0.37 XXX
36555 .... ............ A ........ Insert non-tunnel cv cath .................... 2.68 3.77 4.82 0.59 0.70 0.11 000
36556 .... ............ A ........ Insert non-tunnel cv cath .................... 2.50 2.83 4.23 0.56 0.65 0.19 000
36557 .... ............ A ........ Insert tunneled cv cath ....................... 5.11 14.84 17.90 2.26 2.45 0.57 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
36568 .... ............ A ........ Insert picc cath ................................... 1.92 5.81 6.62 0.60 0.58 0.11 000
36569 .... ............ A ........ Insert picc cath ................................... 1.82 4.44 5.85 0.67 0.60 0.19 000
36570 .... ............ A ........ Insert picvad cath ............................... 5.33 20.99 27.31 2.10 2.44 0.57 010
36571 .... ............ A ........ Insert picvad cath ............................... 5.31 24.25 28.75 2.44 2.56 0.57 010
36575 .... ............ A ........ Repair tunneled cv cath ..................... 0.67 3.27 3.65 0.23 0.24 0.20 000
36576 .... ............ A ........ Repair tunneled cv cath ..................... 3.21 5.86 6.37 1.56 1.69 0.19 010
36578 .... ............ A ........ Replace tunneled cv cath ................... 3.51 9.10 10.05 2.00 2.12 0.19 010
36580 .... ............ A ........ Replace cvad cath .............................. 1.31 3.93 5.42 0.43 0.42 0.19 000
36584 .... ............ A ........ Replace picc cath ............................... 1.20 3.94 5.42 0.62 0.57 0.19 000
36585 .... ............ A ........ Replace picvad cath ........................... 4.81 22.31 24.96 2.44 2.54 0.19 010
36589 .... ............ A ........ Removal tunneled cv cath .................. 2.27 1.85 2.04 1.23 1.30 0.24 010
36590 .... ............ A ........ Removal tunneled cv cath .................. 3.32 3.60 3.48 1.60 1.65 0.44 010
36595 .... ............ A ........ Mech remov tunneled cv cath ............ 3.59 10.76 13.92 1.39 1.39 0.21 000
36596 .... ............ A ........ Mech remov tunneled cv cath ............ 0.75 2.56 3.11 0.43 0.46 0.05 000
36597 .... ............ A ........ Reposition venous catheter ................ 1.21 2.03 2.20 0.46 0.44 0.07 000
36598 .... ............ T ......... Inj w/fluor, eval cv device ................... 0.74 2.19 2.41 0.27 1.45 0.05 000
36600 .... ............ A ........ Withdrawal of arterial blood ................ 0.32 0.49 0.49 0.07 0.08 0.02 XXX
36620 .... ............ A ........ Insertion catheter, artery .................... 1.15 NA NA 0.15 0.20 0.07 000
36680 .... ............ A ........ Insert needle, bone cavity .................. 1.20 NA NA 0.28 0.39 0.11 000
36800 .... ............ A ........ Insertion of cannula ............................ 2.43 NA NA 1.52 1.67 0.25 000
36818 .... ............ A ........ Av fuse, uppr arm, cephalic ............... 11.81 NA NA 4.48 5.31 1.90 090
36819 .... ............ A ........ Av fuse, uppr arm, basilic ................... 14.39 NA NA 5.11 5.76 1.96 090
36820 .... ............ A ........ Av fusion/forearm vein ........................ 14.39 NA NA 5.24 5.82 1.95 090
36821 .... ............ A ........ Av fusion direct any site ..................... 9.15 NA NA 3.93 4.30 1.23 090
36822 .... ............ A ........ Insertion of cannula(s) ........................ 5.51 NA NA 3.73 4.06 0.79 090
36823 .... ............ A ........ Insertion of cannula(s) ........................ 22.82 NA NA 8.63 9.03 2.89 090
36825 .... ............ A ........ Artery-vein autograft ........................... 10.00 NA NA 4.21 4.65 1.35 090
36830 .... ............ A ........ Artery-vein nonautograft ..................... 12.00 NA NA 4.12 4.69 1.66 090
36831 .... ............ A ........ Open thrombect av fistula .................. 8.01 NA NA 3.18 3.57 1.09 090
36832 .... ............ A ........ Av fistula revision, open ..................... 10.50 NA NA 3.74 4.25 1.44 090
36833 .... ............ A ........ Av fistula revision ............................... 11.95 NA NA 4.11 4.68 1.65 090
36834 .... ............ A ........ Repair A–V aneurysm ........................ 11.11 NA NA 4.20 4.52 1.37 090
36835 .... ............ A ........ Artery to vein shunt ............................ 7.43 NA NA 3.73 4.05 0.98 090
36838 .... ............ A ........ Dist revas ligation, hemo .................... 21.59 NA NA 7.03 8.22 3.02 090
36860 .... ............ A ........ External cannula declotting ................ 2.01 3.33 2.55 0.63 0.66 0.11 000
36861 .... ............ A ........ Cannula declotting .............................. 2.52 NA NA 1.22 1.35 0.27 000
36870 .... ............ A ........ Percut thrombect av fistula ................. 5.17 40.42 46.50 2.77 2.92 0.29 090
37140 .... ............ A ........ Revision of circulation ........................ 25.12 NA NA 8.95 9.70 2.02 090
37181 .... ............ A ........ Splice spleen/kidney veins ................. 28.26 NA NA 8.83 10.00 3.41 090
37182 .... ............ A ........ Insert hepatic shunt (tips) ................... 16.97 NA NA 6.41 6.02 1.00 000
37183 .... ............ A ........ Remove hepatic shunt (tips) .............. 7.99 NA NA 3.12 2.97 0.47 000
37184 .... ............ A ........ Prim art mech thrombectomy ............. 8.66 49.36 60.20 3.24 3.22 0.55 000
37185 .... ............ A ........ Prim art m-thrombect add-on ............. 3.28 16.17 19.40 1.12 1.09 0.21 ZZZ
37186 .... ............ A ........ Sec art m-thrombect add-on .............. 4.92 34.32 41.56 1.78 1.66 0.32 ZZZ
37187 .... ............ A ........ Venous mech thrombectomy .............. 8.03 47.81 58.74 3.02 3.01 0.51 000
37188 .... ............ A ........ Venous m-thrombectomy add-on ....... 5.71 41.84 51.67 2.20 2.23 0.37 000
37195 .... ............ C ........ Thrombolytic therapy, stroke .............. 0.00 0.00 4.03 0.00 4.03 0.00 XXX
37200 .... ............ A ........ Transcatheter biopsy .......................... 4.55 NA NA 1.67 1.53 0.27 000
37201 .... ............ A ........ Transcatheter therapy infuse .............. 4.99 NA NA 2.33 2.40 0.33 000
37202 .... ............ A ........ Transcatheter therapy infuse .............. 5.67 NA NA 3.28 3.18 0.43 000
37203 .... ............ A ........ Transcatheter retrieval ........................ 5.02 29.76 31.17 2.08 2.01 0.29 000
37204 .... ............ A ........ Transcatheter occlusion ..................... 18.11 NA NA 6.29 5.93 1.48 000
37205 .... ............ A ........ Transcath iv stent, percut ................... 8.27 73.69 27.08 3.20 3.58 0.60 000
37206 .... ............ A ........ Transcath iv stent/perc addl ............... 4.12 62.08 21.67 1.55 1.49 0.31 ZZZ
37207 .... ............ A ........ Transcath iv stent, open ..................... 8.27 NA NA 2.38 2.78 1.17 000
37208 .... ............ A ........ Transcath iv stent/open addl .............. 4.12 NA NA 1.01 1.20 0.59 ZZZ
37209 .... ............ A ........ Change iv cath at thromb tx ............... 2.27 NA NA 0.78 0.74 0.15 000
37210 .... ............ A ........ Embolization uterine fibroid ................ 10.60 82.44 80.73 3.71 3.32 0.60 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
37215 .... ............ R ........ Transcath stent, cca w/eps ................ 19.58 NA NA 9.70 9.46 1.09 090
37216 .... ............ N ........ Transcath stent, cca w/o eps ............. 18.85 NA NA 5.75 7.28 1.04 090
37250 .... ............ A ........ Iv us first vessel add-on ..................... 2.10 NA NA 0.75 0.76 0.21 ZZZ
37251 .... ............ A ........ Iv us each add vessel add-on ............ 1.60 NA NA 0.49 0.52 0.19 ZZZ
37500 .... ............ A ........ Endoscopy ligate perf veins ............... 11.54 NA NA 5.34 6.11 1.54 090
37501 .... ............ C ........ Vascular endoscopy procedure .......... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
37565 .... ............ A ........ Ligation of neck vein .......................... 11.97 NA NA 5.15 5.38 1.33 090
37600 .... ............ A ........ Ligation of neck artery ........................ 12.34 NA NA 4.92 5.76 1.41 090
37607 .... ............ A ........ Ligation of a-v fistula .......................... 6.19 NA NA 3.01 3.30 0.85 090
37609 .... ............ A ........ Temporal artery procedure ................. 3.02 4.17 4.34 1.82 1.89 0.36 010
37616 .... ............ A ........ Ligation of chest artery ....................... 18.89 NA NA 7.92 8.00 2.33 090
37617 .... ............ A ........ Ligation of abdomen artery ................ 23.71 NA NA 7.91 8.54 2.98 090
37618 .... ............ A ........ Ligation of extremity artery ................. 5.95 NA NA 3.35 3.48 0.67 090
37620 .... ............ A ........ Revision of major vein ........................ 11.49 NA NA 5.45 5.50 0.91 090
37700 .... ............ A ........ Revise leg vein ................................... 3.76 NA NA 2.37 2.59 0.53 090
37718 .... ............ A ........ Ligate/strip short leg vein ................... 7.05 NA NA 3.46 3.77 0.14 090
37722 .... ............ A ........ Ligate/strip long leg vein .................... 8.08 NA NA 3.67 4.06 0.86 090
37735 .... ............ A ........ Removal of leg veins/lesion ............... 10.81 NA NA 4.67 5.08 1.48 090
37760 .... ............ A ........ Ligation, leg veins, open .................... 10.69 NA NA 4.47 4.92 1.44 090
37765 .... ............ A ........ Phleb veins—extrem—to 20 ............... 7.63 NA NA 3.57 4.10 0.48 090
37766 .... ............ A ........ Phleb veins—extrem 20+ ................... 9.58 NA NA 4.12 4.71 0.48 090
37780 .... ............ A ........ Revision of leg vein ............................ 3.87 NA NA 2.37 2.63 0.53 090
37785 .... ............ A ........ Ligate/divide/excise vein ..................... 3.87 4.87 5.04 2.56 2.65 0.54 090
37788 .... ............ A ........ Revascularization, penis ..................... 23.21 NA NA 12.19 10.63 2.26 090
37790 .... ............ A ........ Penile venous occlusion ..................... 8.37 NA NA 5.16 4.76 0.59 090
37799 .... ............ C ........ Vascular surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
38100 .... ............ A ........ Removal of spleen, total ..................... 19.47 NA NA 6.83 6.51 1.92 090
38101 .... ............ A ........ Removal of spleen, partial .................. 19.47 NA NA 6.93 6.79 2.05 090
38102 .... ............ A ........ Removal of spleen, total ..................... 4.79 NA NA 1.23 1.44 0.63 ZZZ
38115 .... ............ A ........ Repair of ruptured spleen ................... 21.80 NA NA 7.43 7.06 2.09 090
38120 .... ............ A ........ Laparoscopy, splenectomy ................. 16.97 NA NA 6.91 7.15 2.25 090
38129 .... ............ C ........ Laparoscope proc, spleen .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
38200 .... ............ A ........ Injection for spleen x-ray .................... 2.64 NA NA 1.11 0.98 0.14 000
38204 .... ............ B ........ Bl donor search management ............ 2.00 0.46 0.76 0.46 0.76 0.06 XXX
38205 .... ............ R ........ Harvest allogenic stem cells ............... 1.50 NA NA 0.54 0.61 0.07 000
38206 .... ............ R ........ Harvest auto stem cells ...................... 1.50 NA NA 0.55 0.61 0.07 000
38207 .... ............ I .......... Cryopreserve stem cells ..................... 0.89 0.40 0.41 0.40 0.41 0.01 XXX
38208 .... ............ I .......... Thaw preserved stem cells ................ 0.56 0.25 0.25 0.25 0.25 0.02 XXX
38209 .... ............ I .......... Wash harvest stem cells .................... 0.24 0.11 0.11 0.11 0.11 0.01 XXX
38210 .... ............ I .......... T-cell depletion of harvest .................. 1.57 0.71 0.72 0.71 0.72 0.03 XXX
38211 .... ............ I .......... Tumor cell deplete of harvst ............... 1.42 0.65 0.65 0.65 0.65 0.02 XXX
38212 .... ............ I .......... Rbc depletion of harvest .................... 0.94 0.43 0.43 0.43 0.43 0.02 XXX
38213 .... ............ I .......... Platelet deplete of harvest .................. 0.24 0.11 0.11 0.11 0.11 0.01 XXX
38214 .... ............ I .......... Volume deplete of harvest ................. 0.81 0.37 0.37 0.37 0.37 0.01 XXX
38215 .... ............ I .......... Harvest stem cell concentrte .............. 0.94 0.43 0.43 0.43 0.43 0.02 XXX
38220 .... ............ A ........ Bone marrow aspiration ..................... 1.08 2.66 3.19 0.45 0.48 0.05 XXX
38221 .... ............ A ........ Bone marrow biopsy ........................... 1.37 2.77 3.35 0.58 0.61 0.07 XXX
38230 .... ............ R ........ Bone marrow collection ...................... 4.80 NA NA 3.14 3.13 0.48 010
38240 .... ............ R ........ Bone marrow/stem transplant ............ 2.24 NA NA 0.95 0.99 0.11 XXX
38241 .... ............ R ........ Bone marrow/stem transplant ............ 2.24 NA NA 0.95 1.00 0.11 XXX
38242 .... ............ A ........ Lymphocyte infuse transplant ............. 1.71 NA NA 0.69 0.74 0.08 000
38300 .... ............ A ........ Drainage, lymph node lesion .............. 2.28 4.18 4.14 2.02 1.99 0.25 010
38305 .... ............ A ........ Drainage, lymph node lesion .............. 6.55 NA NA 4.19 4.18 0.88 090
38308 .... ............ A ........ Incision of lymph channels ................. 6.73 NA NA 3.53 3.64 0.85 090
38380 .... ............ A ........ Thoracic duct procedure ..................... 8.34 NA NA 5.04 5.31 0.74 090
38500 .... ............ A ........ Biopsy/removal, lymph nodes ............ 3.76 3.72 3.71 2.02 2.05 0.49 010
38505 .... ............ A ........ Needle biopsy, lymph nodes .............. 1.14 2.10 2.06 0.74 0.75 0.09 000
38510 .... ............ A ........ Biopsy/removal, lymph nodes ............ 6.69 5.36 5.43 3.09 3.27 0.72 010
38520 .... ............ A ........ Biopsy/removal, lymph nodes ............ 6.95 NA NA 3.74 3.89 0.84 090
38542 .... ............ A ........ Explore deep node(s), neck ............... 6.08 NA NA 3.97 4.19 0.60 090
38550 .... ............ A ........ Removal, neck/armpit lesion .............. 6.99 NA NA 4.25 4.08 0.88 090
38555 .... ............ A ........ Removal, neck/armpit lesion .............. 15.42 NA NA 7.45 7.96 1.76 090
38562 .... ............ A ........ Removal, pelvic lymph nodes ............ 10.92 NA NA 5.77 5.77 1.20 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
38564 .... ............ A ........ Removal, abdomen lymph nodes ....... 11.29 NA NA 5.21 5.23 1.32 090
38570 .... ............ A ........ Laparoscopy, lymph node biop .......... 9.28 NA NA 4.06 4.01 1.13 010
38571 .... ............ A ........ Laparoscopy, lymphadenectomy ........ 14.70 NA NA 6.90 6.28 1.15 010
38572 .... ............ A ........ Laparoscopy, lymphadenectomy ........ 16.86 NA NA 5.99 6.57 1.91 010
38589 .... ............ C ........ Laparoscope proc, lymphatic ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
38700 .... ............ A ........ Removal of lymph nodes, neck .......... 12.68 NA NA 6.54 6.30 0.72 090
38740 .... ............ A ........ Remove armpit lymph nodes ............. 10.57 NA NA 4.98 4.97 1.32 090
38745 .... ............ A ........ Remove armpit lymph nodes ............. 13.71 NA NA 6.04 6.06 1.74 090
38746 .... ............ A ........ Remove thoracic lymph nodes ........... 4.88 NA NA 1.43 1.52 0.72 ZZZ
38747 .... ............ A ........ Remove abdominal lymph nodes ....... 4.88 NA NA 1.27 1.47 0.64 ZZZ
38760 .... ............ A ........ Remove groin lymph nodes ............... 13.49 NA NA 5.91 6.03 1.72 090
38765 .... ............ A ........ Remove groin lymph nodes ............... 21.78 NA NA 8.38 8.64 2.48 090
38770 .... ............ A ........ Remove pelvis lymph nodes .............. 13.98 NA NA 6.77 6.29 1.40 090
38780 .... ............ A ........ Remove abdomen lymph nodes ........ 17.56 NA NA 8.03 8.12 1.89 090
38790 .... ............ A ........ Inject for lymphatic x-ray .................... 1.29 NA NA 0.75 0.75 0.13 000
38792 .... ............ A ........ Identify sentinel node ......................... 0.52 NA NA 0.49 0.46 0.06 000
38794 .... ............ A ........ Access thoracic lymph duct ................ 4.51 NA NA 3.18 3.26 0.32 090
38999 .... ............ C ........ Blood/lymph system procedure .......... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
39200 .... ............ A ........ Removal chest lesion ......................... 15.04 NA NA 6.20 6.87 2.03 090
39220 .... ............ A ........ Removal chest lesion ......................... 19.47 NA NA 8.00 8.69 2.46 090
39400 .... ............ A ........ Visualization of chest .......................... 8.00 NA NA 4.14 4.50 0.82 010
39499 .... ............ C ........ Chest procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
39501 .... ............ A ........ Repair diaphragm laceration .............. 13.89 NA NA 5.81 6.15 1.78 090
39502 .... ............ A ........ Repair paraesophageal hernia ........... 17.09 NA NA 6.57 6.86 2.17 090
39503 .... ............ A ........ Repair of diaphragm hernia ................ 108.67 NA NA 26.87 30.78 10.98 090
39545 .... ............ A ........ Revision of diaphragm ........................ 14.58 NA NA 6.87 7.26 1.84 090
39560 .... ............ A ........ Resect diaphragm, simple .................. 12.97 NA NA 5.52 5.91 1.59 090
39561 .... ............ A ........ Resect diaphragm, complex ............... 19.75 NA NA 9.30 9.33 2.45 090
39599 .... ............ C ........ Diaphragm surgery procedure ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
40490 .... ............ A ........ Biopsy of lip ........................................ 1.22 2.09 1.86 0.59 0.60 0.05 000
40500 .... ............ A ........ Partial excision of lip .......................... 4.35 7.88 7.37 4.36 4.33 0.38 090
40525 .... ............ A ........ Reconstruct lip with flap ..................... 7.61 NA NA 5.35 5.82 0.85 090
40527 .... ............ A ........ Reconstruct lip with flap ..................... 9.20 NA NA 6.16 6.73 0.97 090
40530 .... ............ A ........ Partial removal of lip ........................... 5.45 7.57 7.66 4.27 4.40 0.55 090
40650 .... ............ A ........ Repair lip ............................................ 3.69 5.93 6.36 3.15 3.22 0.38 090
40652 .... ............ A ........ Repair lip ............................................ 4.32 7.23 7.46 4.11 4.18 0.52 090
40654 .... ............ A ........ Repair lip ............................................ 5.37 8.06 8.34 4.68 4.81 0.60 090
40700 .... ............ A ........ Repair cleft lip/nasal ........................... 13.97 NA NA 8.71 8.99 0.95 090
40799 .... ............ C ........ Lip surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
40800 .... ............ A ........ Drainage of mouth lesion ................... 1.19 3.83 3.40 1.88 1.83 0.13 010
40804 .... ............ A ........ Removal, foreign body, mouth ........... 1.26 3.77 3.56 1.83 1.83 0.11 010
40805 .... ............ A ........ Removal, foreign body, mouth ........... 2.73 5.12 4.79 2.66 2.73 0.32 010
40806 .... ............ A ........ Incision of lip fold ................................ 0.31 2.41 2.12 0.51 0.50 0.04 000
40808 .... ............ A ........ Biopsy of mouth lesion ....................... 0.98 3.59 3.11 1.62 1.55 0.10 010
40810 .... ............ A ........ Excision of mouth lesion .................... 1.33 3.67 3.26 1.72 1.68 0.13 010
40812 .... ............ A ........ Excise/repair mouth lesion ................. 2.33 4.54 4.13 2.29 2.34 0.28 010
40814 .... ............ A ........ Excise/repair mouth lesion ................. 3.45 5.69 5.30 3.70 3.79 0.41 090
40818 .... ............ A ........ Excise oral mucosa for graft .............. 2.72 5.81 5.48 3.74 3.85 0.21 090
40819 .... ............ A ........ Excise lip or cheek fold ...................... 2.45 4.93 4.50 3.11 3.10 0.29 090
40820 .... ............ A ........ Treatment of mouth lesion ................. 1.30 5.28 4.58 2.93 2.67 0.11 010
40830 .... ............ A ........ Repair mouth laceration ..................... 1.78 4.01 3.88 1.99 2.04 0.19 010
40831 .... ............ A ........ Repair mouth laceration ..................... 2.50 5.21 4.96 2.69 2.88 0.30 010
40840 .... ............ R ........ Reconstruction of mouth .................... 9.03 10.03 9.91 5.63 6.30 1.08 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
40899 .... ............ C ........ Mouth surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
41010 .... ............ A ........ Incision of tongue fold ........................ 1.08 3.86 3.56 1.56 1.55 0.07 010
41100 .... ............ A ........ Biopsy of tongue ................................. 1.39 2.68 2.53 1.18 1.29 0.15 010
41105 .... ............ A ........ Biopsy of tongue ................................. 1.44 2.67 2.47 1.20 1.25 0.13 010
41108 .... ............ A ........ Biopsy of floor of mouth ..................... 1.07 2.51 2.27 1.08 1.10 0.10 010
41110 .... ............ A ........ Excision of tongue lesion ................... 1.53 3.64 3.28 1.64 1.63 0.13 010
41114 .... ............ A ........ Excision of tongue lesion ................... 8.71 NA NA 6.33 6.71 0.83 090
41115 .... ............ A ........ Excision of tongue fold ....................... 1.76 4.19 3.75 1.73 1.80 0.18 010
41120 .... ............ A ........ Partial removal of tongue ................... 10.91 NA NA 14.29 14.64 0.79 090
41130 .... ............ A ........ Partial removal of tongue ................... 15.51 NA NA 15.88 15.83 0.93 090
41135 .... ............ A ........ Tongue and neck surgery .................. 29.83 NA NA 21.89 22.26 1.89 090
41140 .... ............ A ........ Removal of tongue ............................. 28.81 NA NA 23.58 24.79 2.27 090
41145 .... ............ A ........ Tongue removal, neck surgery ........... 37.59 NA NA 28.85 29.32 2.55 090
41150 .... ............ A ........ Tongue, mouth, jaw surgery ............... 29.52 NA NA 23.06 23.60 1.95 090
41153 .... ............ A ........ Tongue, mouth, neck surgery ............ 33.28 NA NA 23.98 24.19 2.01 090
41155 .... ............ A ........ Tongue, jaw, & neck surgery ............. 43.96 NA NA 27.67 26.88 2.34 090
41250 .... ............ A ........ Repair tongue laceration .................... 1.93 3.83 3.28 1.60 1.39 0.18 010
41500 .... ............ A ........ Fixation of tongue ............................... 3.74 NA NA 7.49 7.31 0.30 090
41510 .... ............ A ........ Tongue to lip surgery ......................... 3.45 NA NA 6.42 7.28 0.20 090
41520 .... ............ A ........ Reconstruction, tongue fold ................ 2.77 5.77 5.19 3.25 3.43 0.27 090
41599 .... ............ C ........ Tongue and mouth surgery ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
41800 .... ............ A ........ Drainage of gum lesion ...................... 1.21 4.77 3.68 2.11 1.70 0.12 010
41805 .... ............ A ........ Removal foreign body, gum ............... 1.28 4.61 3.66 2.69 2.46 0.13 010
41806 .... ............ A ........ Removal foreign body,jawbone .......... 2.73 5.82 4.71 3.35 3.20 0.37 010
41822 .... ............ R ........ Excision of gum lesion ....................... 2.35 4.80 4.32 1.86 1.85 0.31 010
41825 .... ............ A ........ Excision of gum lesion ....................... 1.35 3.68 3.36 1.47 1.85 0.15 010
41830 .... ............ R ........ Removal of gum tissue ....................... 3.38 5.98 5.48 3.13 3.38 0.44 010
41872 .... ............ R ........ Repair gum ......................................... 2.90 6.02 5.50 3.30 3.38 0.30 090
41874 .... ............ R ........ Repair tooth socket ............................ 3.13 5.67 5.27 2.73 2.96 0.45 090
41899 .... ............ C ........ Dental surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
42000 .... ............ A ........ Drainage mouth roof lesion ................ 1.25 2.47 2.50 1.20 1.22 0.12 010
42100 .... ............ A ........ Biopsy roof of mouth .......................... 1.33 2.27 2.16 1.26 1.31 0.13 010
42104 .... ............ A ........ Excision lesion, mouth roof ................ 1.66 3.56 3.03 1.67 1.60 0.16 010
42120 .... ............ A ........ Remove palate/lesion ......................... 11.70 NA NA 12.27 11.90 0.52 090
42140 .... ............ A ........ Excision of uvula ................................ 1.65 4.55 4.08 2.11 2.08 0.13 090
42145 .... ............ A ........ Repair palate, pharynx/uvula .............. 9.63 NA NA 7.50 7.39 0.65 090
42160 .... ............ A ........ Treatment mouth roof lesion .............. 1.82 3.77 3.99 1.69 1.98 0.17 010
42180 .... ............ A ........ Repair palate ...................................... 2.52 3.36 3.19 1.86 1.97 0.21 010
42182 .... ............ A ........ Repair palate ...................................... 3.84 3.99 3.94 2.41 2.72 0.40 010
42200 .... ............ A ........ Reconstruct cleft palate ...................... 12.41 NA NA 8.64 9.36 1.27 090
42226 .... ............ A ........ Lengthening of palate ......................... 10.24 NA NA 11.88 13.22 1.01 090
42227 .... ............ A ........ Lengthening of palate ......................... 9.81 NA NA 11.19 13.13 0.98 090
42235 .... ............ A ........ Repair palate ...................................... 7.92 NA NA 10.31 11.09 0.72 090
42260 .... ............ A ........ Repair nose to lip fistula ..................... 10.10 9.75 9.96 6.08 6.55 1.26 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
42280 .... ............ A ........ Preparation, palate mold .................... 1.56 2.23 2.10 0.84 0.99 0.19 010
42281 .... ............ A ........ Insertion, palate prosthesis ................ 1.95 3.02 2.79 1.69 1.76 0.17 010
42299 .... ............ C ........ Palate/uvula surgery ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
42300 .... ............ A ........ Drainage of salivary gland .................. 1.95 3.12 2.94 1.74 1.75 0.16 010
42305 .... ............ A ........ Drainage of salivary gland .................. 6.23 NA NA 4.00 4.31 0.51 090
42330 .... ............ A ........ Removal of salivary stone .................. 2.23 3.40 3.24 1.74 1.77 0.19 010
42400 .... ............ A ........ Biopsy of salivary gland ..................... 0.78 1.99 1.80 0.65 0.68 0.06 000
42405 .... ............ A ........ Biopsy of salivary gland ..................... 3.31 3.96 3.95 2.16 2.28 0.28 010
42408 .... ............ A ........ Excision of salivary cyst ..................... 4.58 6.41 6.11 3.28 3.41 0.45 090
42409 .... ............ A ........ Drainage of salivary cyst .................... 2.85 5.30 4.87 2.54 2.63 0.27 090
42410 .... ............ A ........ Excise parotid gland/lesion ................. 9.46 NA NA 5.38 5.73 0.91 090
42440 .... ............ A ........ Excise submaxillary gland .................. 7.05 NA NA 3.88 4.28 0.59 090
42450 .... ............ A ........ Excise sublingual gland ...................... 4.66 6.37 6.06 4.03 4.08 0.42 090
42500 .... ............ A ........ Repair salivary duct ............................ 4.34 6.11 5.85 3.87 3.99 0.41 090
42505 .... ............ A ........ Repair salivary duct ............................ 6.23 7.27 7.12 4.73 4.99 0.55 090
42507 .... ............ A ........ Parotid duct diversion ......................... 6.16 NA NA 6.33 6.37 0.49 090
42550 .... ............ A ........ Injection for salivary x-ray .................. 1.25 2.27 2.71 0.45 0.42 0.07 000
42600 .... ............ A ........ Closure of salivary fistula ................... 4.86 6.55 6.56 3.43 3.77 0.43 090
42650 .... ............ A ........ Dilation of salivary duct ...................... 0.77 1.28 1.18 0.66 0.68 0.07 000
42660 .... ............ A ........ Dilation of salivary duct ...................... 1.13 1.46 1.40 0.75 0.80 0.09 000
42665 .... ............ A ........ Ligation of salivary duct ...................... 2.57 4.98 4.53 2.40 2.47 0.23 090
42699 .... ............ C ........ Salivary surgery procedure ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
42700 .... ............ A ........ Drainage of tonsil abscess ................. 1.64 2.96 2.77 1.65 1.66 0.13 010
42720 .... ............ A ........ Drainage of throat abscess ................ 6.31 4.72 4.71 3.20 3.45 0.44 010
42725 .... ............ A ........ Drainage of throat abscess ................ 12.28 NA NA 7.07 7.58 0.91 090
42800 .... ............ A ........ Biopsy of throat .................................. 1.41 2.46 2.29 1.30 1.33 0.11 010
42802 .... ............ A ........ Biopsy of throat .................................. 1.56 4.11 4.39 1.67 1.84 0.12 010
42804 .... ............ A ........ Biopsy of upper nose/throat ............... 1.26 3.56 3.61 1.49 1.59 0.10 010
42806 .... ............ A ........ Biopsy of upper nose/throat ............... 1.60 3.81 3.90 1.61 1.75 0.13 010
42808 .... ............ A ........ Excise pharynx lesion ......................... 2.32 3.22 3.12 1.61 1.75 0.19 010
42809 .... ............ A ........ Remove pharynx foreign body ........... 1.83 2.22 2.26 1.31 1.31 0.16 010
42810 .... ............ A ........ Excision of neck cyst .......................... 3.30 6.19 5.88 3.72 3.58 0.29 090
42815 .... ............ A ........ Excision of neck cyst .......................... 7.23 NA NA 6.25 6.25 0.61 090
42820 .... ............ A ........ Remove tonsils and adenoids ............ 4.17 NA NA 2.86 3.03 0.31 090
42821 .... ............ A ........ Remove tonsils and adenoids ............ 4.31 NA NA 3.00 3.21 0.35 090
42825 .... ............ A ........ Removal of tonsils .............................. 3.45 NA NA 2.90 2.96 0.25 090
42826 .... ............ A ........ Removal of tonsils .............................. 3.40 NA NA 2.69 2.82 0.27 090
42830 .... ............ A ........ Removal of adenoids .......................... 2.60 NA NA 2.43 2.46 0.20 090
42842 .... ............ A ........ Extensive surgery of throat ................ 12.02 NA NA 12.03 11.35 0.71 090
42860 .... ............ A ........ Excision of tonsil tags ......................... 2.25 NA NA 2.30 2.32 0.18 090
42870 .... ............ A ........ Excision of lingual tonsil ..................... 5.44 NA NA 8.68 8.51 0.44 090
42890 .... ............ A ........ Partial removal of pharynx ................. 18.92 NA NA 15.27 14.50 1.05 090
42892 .... ............ A ........ Revision of pharyngeal walls .............. 25.77 NA NA 19.24 17.93 1.28 090
42894 .... ............ A ........ Revision of pharyngeal walls .............. 33.61 NA NA 23.59 22.44 1.87 090
42900 .... ............ A ........ Repair throat wound ........................... 5.26 NA NA 2.96 3.27 0.50 010
42950 .... ............ A ........ Reconstruction of throat ..................... 8.16 NA NA 11.04 11.33 0.72 090
42953 .... ............ A ........ Repair throat, esophagus ................... 9.33 NA NA 13.73 15.40 0.88 090
42955 .... ............ A ........ Surgical opening of throat .................. 7.92 NA NA 10.07 10.25 0.80 090
42960 .... ............ A ........ Control throat bleeding ....................... 2.35 NA NA 1.72 1.82 0.19 010
42970 .... ............ A ........ Control nose/throat bleeding .............. 5.76 NA NA 3.57 3.87 0.39 090
42999 .... ............ C ........ Throat surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43020 .... ............ A ........ Incision of esophagus ......................... 8.14 NA NA 4.55 4.95 0.87 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
43030 .... ............ A ........ Throat muscle surgery ........................ 7.91 NA NA 4.53 4.96 0.70 090
43045 .... ............ A ........ Incision of esophagus ......................... 21.70 NA NA 9.31 10.13 2.59 090
43100 .... ............ A ........ Excision of esophagus lesion ............. 9.55 NA NA 5.21 5.70 0.93 090
43101 .... ............ A ........ Excision of esophagus lesion ............. 16.99 NA NA 7.17 7.54 2.32 090
43107 .... ............ A ........ Removal of esophagus ....................... 43.97 NA NA 16.27 17.32 5.24 090
43116 .... ............ A ........ Partial removal of esophagus ............. 92.78 NA NA 30.90 23.47 3.06 090
43130 .... ............ A ........ Removal of esophagus pouch ............ 12.41 NA NA 6.40 6.91 1.16 090
43135 .... ............ A ........ Removal of esophagus pouch ............ 26.09 NA NA 9.93 9.02 2.34 090
43200 .... ............ A ........ Esophagus endoscopy ....................... 1.59 3.70 3.89 0.98 1.02 0.13 000
43201 .... ............ A ........ Esoph scope w/submucous inj ........... 2.09 5.58 5.10 1.20 1.15 0.15 000
43202 .... ............ A ........ Esophagus endoscopy, biopsy ........... 1.89 5.14 5.34 0.99 0.96 0.15 000
43204 .... ............ A ........ Esoph scope w/sclerosis inj ............... 3.76 NA NA 2.02 1.76 0.30 000
43205 .... ............ A ........ Esophagus endoscopy/ligation ........... 3.78 NA NA 2.07 1.80 0.28 000
43215 .... ............ A ........ Esophagus endoscopy ....................... 2.60 NA NA 1.29 1.24 0.22 000
43216 .... ............ A ........ Esophagus endoscopy/lesion ............. 2.40 3.10 2.07 1.28 1.16 0.20 000
43217 .... ............ A ........ Esophagus endoscopy ....................... 2.90 6.53 6.74 1.39 1.30 0.26 000
43219 .... ............ A ........ Esophagus endoscopy ....................... 2.80 NA NA 1.56 1.45 0.24 000
43220 .... ............ A ........ Esoph endoscopy, dilation ................. 2.10 NA NA 1.13 1.05 0.17 000
43227 .... ............ A ........ Esoph endoscopy, repair .................... 3.59 NA NA 1.77 1.62 0.28 000
43228 .... ............ A ........ Esoph endoscopy, ablation ................ 3.76 NA NA 1.90 1.72 0.34 000
43231 .... ............ A ........ Esoph endoscopy w/us exam ............ 3.19 NA NA 1.77 1.54 0.23 000
43232 .... ............ A ........ Esoph endoscopy w/us fn bx ............. 4.47 NA NA 2.40 2.11 0.34 000
43234 .... ............ A ........ Upper GI endoscopy, exam ............... 2.01 4.94 5.13 1.02 0.95 0.17 000
43235 .... ............ A ........ Uppr gi endoscopy, diagnosis ............ 2.39 5.26 5.21 1.36 1.19 0.19 000
43236 .... ............ A ........ Uppr gi scope w/submuc inj ............... 2.92 6.67 6.54 1.66 1.44 0.21 000
43237 .... ............ A ........ Endoscopic us exam, esoph .............. 3.98 NA NA 2.18 1.89 0.43 000
43238 .... ............ A ........ Uppr gi endoscopy w/us fn bx ............ 5.02 NA NA 2.59 2.27 0.43 000
43239 .... ............ A ........ Upper GI endoscopy, biopsy .............. 2.87 6.01 5.86 1.56 1.38 0.22 000
43240 .... ............ A ........ Esoph endoscope w/drain cyst .......... 6.85 NA NA 3.30 2.98 0.56 000
43241 .... ............ A ........ Upper GI endoscopy with tube ........... 2.59 NA NA 1.41 1.26 0.21 000
43242 .... ............ A ........ Uppr gi endoscopy w/us fn bx ............ 7.30 NA NA 3.70 3.22 0.53 000
43243 .... ............ A ........ Upper gi endoscopy & inject .............. 4.56 NA NA 2.37 2.08 0.33 000
43244 .... ............ A ........ Upper GI endoscopy/ligation .............. 5.04 NA NA 2.66 2.31 0.37 000
43245 .... ............ A ........ Uppr gi scope dilate strictr ................. 3.18 NA NA 1.64 1.47 0.26 000
43246 .... ............ A ........ Place gastrostomy tube ...................... 4.32 NA NA 2.12 1.91 0.34 000
43247 .... ............ A ........ Operative upper GI endoscopy .......... 3.38 NA NA 1.79 1.58 0.27 000
43248 .... ............ A ........ Uppr gi endoscopy/guide wire ............ 3.15 NA NA 1.78 1.55 0.23 000
43250 .... ............ A ........ Upper GI endoscopy/tumor ................ 3.20 NA NA 1.62 1.47 0.26 000
43256 .... ............ A ........ Uppr gi endoscopy w/stent ................. 4.34 NA NA 2.27 1.99 0.32 000
43257 .... ............ A ........ Uppr gi scope w/thrml txmnt .............. 5.50 NA NA 2.15 2.16 0.36 000
43259 .... ............ A ........ Endoscopic ultrasound exam ............. 5.19 NA NA 2.71 2.35 0.35 000
43260 .... ............ A ........ Endo cholangiopancreatograph .......... 5.95 NA NA 3.08 2.69 0.43 000
43280 .... ............ A ........ Laparoscopy, fundoplasty ................... 18.00 NA NA 6.64 6.97 2.28 090
43289 .... ............ C ........ Laparoscope proc, esoph ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43300 .... ............ A ........ Repair of esophagus .......................... 9.21 NA NA 5.38 5.85 1.12 090
43305 .... ............ A ........ Repair esophagus and fistula ............. 17.98 NA NA 8.39 9.42 1.54 090
43312 .... ............ A ........ Repair esophagus and fistula ............. 29.23 NA NA 10.28 11.03 4.01 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
43313 .... ............ A ........ Esophagoplasty congenital ................. 48.17 NA NA 17.46 18.11 5.47 090
43314 .... ............ A ........ Tracheo-esophagoplasty cong ........... 53.15 NA NA 17.17 18.38 6.65 090
43320 .... ............ A ........ Fuse esophagus & stomach ............... 23.18 NA NA 8.66 8.96 2.74 090
43324 .... ............ A ........ Revise esophagus & stomach ............ 22.86 NA NA 8.33 8.56 2.76 090
43340 .... ............ A ........ Fuse esophagus & intestine ............... 22.86 NA NA 9.29 9.09 2.46 090
43341 .... ............ A ........ Fuse esophagus & intestine ............... 24.10 NA NA 9.63 9.90 2.92 090
43350 .... ............ A ........ Surgical opening, esophagus ............. 19.31 NA NA 8.77 8.48 1.42 090
43360 .... ............ A ........ Gastrointestinal repair ........................ 39.90 NA NA 14.92 15.15 4.97 090
43361 .... ............ A ........ Gastrointestinal repair ........................ 45.50 NA NA 17.70 17.15 4.50 090
43400 .... ............ A ........ Ligate esophagus veins ...................... 25.47 NA NA 13.65 11.56 1.96 090
43401 .... ............ A ........ Esophagus surgery for veins .............. 26.36 NA NA 9.56 9.50 3.05 090
43405 .... ............ A ........ Ligate/staple esophagus ..................... 24.55 NA NA 10.62 10.06 2.84 090
43410 .... ............ A ........ Repair esophagus wound ................... 16.28 NA NA 7.67 7.63 1.72 090
43415 .... ............ A ........ Repair esophagus wound ................... 28.70 NA NA 11.82 11.80 3.53 090
43420 .... ............ A ........ Repair esophagus opening ................ 16.65 NA NA 7.52 7.37 1.43 090
43425 .... ............ A ........ Repair esophagus opening ................ 24.91 NA NA 10.47 10.20 3.03 090
43450 .... ............ A ........ Dilate esophagus ................................ 1.38 2.66 2.65 0.93 0.81 0.11 000
43460 .... ............ A ........ Pressure treatment esophagus .......... 3.79 NA NA 1.77 1.62 0.31 000
43496 .... ............ C ........ Free jejunum flap, microvasc ............. 2.20 0.00 0.00 0.00 0.00 0.00 090
43499 .... ............ C ........ Esophagus surgery procedure ........... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43500 .... ............ A ........ Surgical opening of stomach .............. 12.71 NA NA 5.27 5.12 1.45 090
43501 .... ............ A ........ Surgical repair of stomach ................. 22.47 NA NA 8.08 8.20 2.65 090
43502 .... ............ A ........ Surgical repair of stomach ................. 25.56 NA NA 8.95 9.21 3.10 090
43510 .... ............ A ........ Surgical opening of stomach .............. 15.01 NA NA 9.10 7.47 1.48 090
43520 .... ............ A ........ Incision of pyloric muscle ................... 11.21 NA NA 4.82 5.04 1.36 090
43600 .... ............ A ........ Biopsy of stomach .............................. 1.91 NA NA 0.78 0.73 0.14 000
43605 .... ............ A ........ Biopsy of stomach .............................. 13.64 NA NA 5.35 5.33 1.58 090
43610 .... ............ A ........ Excision of stomach lesion ................. 16.26 NA NA 6.02 6.09 1.94 090
43611 .... ............ A ........ Excision of stomach lesion ................. 20.25 NA NA 7.47 7.53 2.36 090
43620 .... ............ A ........ Removal of stomach ........................... 33.91 NA NA 11.10 11.45 3.96 090
43631 .... ............ A ........ Removal of stomach, partial ............... 24.38 NA NA 8.58 8.87 2.99 090
43635 .... ............ A ........ Removal of stomach, partial ............... 2.06 NA NA 0.52 0.61 0.27 ZZZ
43640 .... ............ A ........ Vagotomy & pylorus repair ................. 19.43 NA NA 7.33 7.30 2.26 090
43641 .... ............ A ........ Vagotomy & pylorus repair ................. 19.68 NA NA 7.60 7.50 2.25 090
43644 .... ............ A ........ Lap gastric bypass/roux-en-y ............. 29.24 NA NA 10.09 10.68 3.16 090
43645 .... ............ A ........ Lap gastr bypass incl smll i ................ 31.37 NA NA 10.46 11.35 3.54 090
43647 .... ............ C ........ Lap impl electrode, antrum ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43648 .... ............ C ........ Lap revise/remv eltrd antrum ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43651 .... ............ A ........ Laparoscopy, vagus nerve ................. 10.13 NA NA 4.60 4.69 1.33 090
43652 .... ............ A ........ Laparoscopy, vagus nerve ................. 12.13 NA NA 5.20 5.47 1.55 090
43653 .... ............ A ........ Laparoscopy, gastrostomy ................. 8.38 NA NA 4.44 4.30 1.01 090
43659 .... ............ C ........ Laparoscope proc, stom ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43752 .... ............ A ........ Nasal/orogastric w/stent ..................... 0.81 NA NA 0.27 0.26 0.02 000
43760 .... ............ A ........ Change gastrostomy tube .................. 1.10 12.86 7.47 0.40 0.43 0.09 000
43761 .... ............ A ........ Reposition gastrostomy tube .............. 2.01 1.04 1.09 0.71 0.66 0.13 000
43770 .... ............ A ........ Lap, place gastr adjust band .............. 17.85 NA NA 7.38 7.56 2.19 090
43771 .... ............ A ........ Lap, revise adjust gast band .............. 20.64 NA NA 8.10 8.35 2.55 090
43772 .... ............ A ........ Lap, remove adjust gast band ............ 15.62 NA NA 5.98 6.20 1.93 090
43773 .... ............ A ........ Lap, change adjust gast band ............ 20.64 NA NA 8.09 8.35 2.56 090
43774 .... ............ A ........ Lap remov adj gast band/port ............ 15.66 NA NA 6.17 6.36 1.85 090
43800 .... ............ A ........ Reconstruction of pylorus ................... 15.35 NA NA 5.80 5.86 1.82 090
43810 .... ............ A ........ Fusion of stomach and bowel ............ 16.80 NA NA 6.14 6.18 1.94 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
43840 .... ............ A ........ Repair of stomach lesion .................... 22.70 NA NA 8.13 7.46 2.06 090
43842 .... ............ N ........ V-band gastroplasty ............................ 20.90 NA NA 6.74 7.27 2.45 090
43843 .... ............ A ........ Gastroplasty w/o v-band ..................... 21.08 NA NA 7.82 7.79 2.46 090
43845 .... ............ A ........ Gastroplasty duodenal switch ............ 33.12 NA NA 12.93 11.77 4.06 090
43846 .... ............ A ........ Gastric bypass for obesity .................. 27.23 NA NA 9.95 10.00 3.19 090
43847 .... ............ A ........ Gastric bypass incl small i .................. 30.10 NA NA 10.50 10.73 3.56 090
43848 .... ............ A ........ Revision gastroplasty ......................... 32.57 NA NA 11.28 11.56 3.88 090
43850 .... ............ A ........ Revise stomach-bowel fusion ............. 27.45 NA NA 9.50 9.65 3.28 090
43870 .... ............ A ........ Repair stomach opening .................... 11.36 NA NA 4.94 4.74 1.27 090
43880 .... ............ A ........ Repair stomach-bowel fistula ............. 27.05 NA NA 9.26 9.59 3.27 090
43881 .... ............ C ........ Impl/redo electrd, antrum ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43882 .... ............ C ........ Revise/remove electrd antrum ........... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
43886 .... ............ A ........ Revise gastric port, open ................... 4.54 NA NA 3.43 3.27 0.25 090
43887 .... ............ A ........ Remove gastric port, open ................. 4.24 NA NA 3.04 2.89 0.51 090
43888 .... ............ A ........ Change gastric port, open .................. 6.34 NA NA 4.00 3.86 0.70 090
43999 .... ............ C ........ Stomach surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
44005 .... ............ A ........ Freeing of bowel adhesion ................. 18.38 NA NA 6.57 6.65 2.15 090
44010 .... ............ A ........ Incision of small bowel ....................... 14.18 NA NA 5.52 5.49 1.64 090
44015 .... ............ A ........ Insert needle cath bowel .................... 2.62 NA NA 0.68 0.78 0.35 ZZZ
44020 .... ............ A ........ Explore small intestine ....................... 16.14 NA NA 6.00 5.97 1.86 090
44021 .... ............ A ........ Decompress small bowel ................... 16.23 NA NA 6.14 6.08 1.87 090
44025 .... ............ A ........ Incision of large bowel ........................ 16.43 NA NA 6.04 6.05 1.90 090
44050 .... ............ A ........ Reduce bowel obstruction .................. 15.44 NA NA 5.81 5.89 1.86 090
44055 .... ............ A ........ Correct malrotation of bowel .............. 25.53 NA NA 8.50 8.62 2.91 090
44100 .... ............ A ........ Biopsy of bowel .................................. 2.01 NA NA 0.92 0.81 0.17 000
44110 .... ............ A ........ Excise intestine lesion(s) .................... 13.96 NA NA 5.51 5.38 1.55 090
44111 .... ............ A ........ Excision of bowel lesion(s) ................. 16.44 NA NA 6.09 6.11 1.87 090
44120 .... ............ A ........ Removal of small intestine ................. 20.74 NA NA 7.14 7.12 2.25 090
44121 .... ............ A ........ Removal of small intestine ................. 4.44 NA NA 1.12 1.33 0.58 ZZZ
44125 .... ............ A ........ Removal of small intestine ................. 19.93 NA NA 7.02 7.15 2.27 090
44126 .... ............ A ........ Enterectomy w/o taper, cong ............. 42.02 NA NA 13.59 13.90 4.69 090
44127 .... ............ A ........ Enterectomy w/taper, cong ................. 49.09 NA NA 15.65 15.54 5.77 090
44128 .... ............ A ........ Enterectomy cong, add-on ................. 4.44 NA NA 1.22 1.35 0.61 ZZZ
44130 .... ............ A ........ Bowel to bowel fusion ........................ 21.98 NA NA 7.96 7.09 1.88 090
44137 .... ............ C ........ Remove intestinal allograft ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44139 .... ............ A ........ Mobilization of colon ........................... 2.23 NA NA 0.56 0.66 0.28 ZZZ
44140 .... ............ A ........ Partial removal of colon ...................... 22.46 NA NA 8.06 8.37 2.71 090
44150 .... ............ A ........ Removal of colon ................................ 29.99 NA NA 12.57 12.32 3.04 090
44151 .... ............ A ........ Removal of colon/ileostomy ............... 34.73 NA NA 13.89 13.68 3.49 090
44157 .... ............ A ........ Colectomy w/ileoanal anast ................ 35.49 NA NA 17.13 16.16 3.93 090
44158 .... ............ A ........ Colectomy w/neo-rectum pouch ......... 36.49 NA NA 17.47 16.47 4.06 090
44160 .... ............ A ........ Removal of colon ................................ 20.78 NA NA 7.51 7.64 2.37 090
44180 .... ............ A ........ Lap, enterolysis .................................. 15.19 NA NA 5.79 5.99 1.86 090
44186 .... ............ A ........ Lap, jejunostomy ................................ 10.30 NA NA 4.57 4.66 1.27 090
44187 .... ............ A ........ Lap, ileo/jejuno-stomy ......................... 17.27 NA NA 8.10 8.20 1.96 090
44188 .... ............ A ........ Lap, colostomy ................................... 19.20 NA NA 8.65 8.76 2.24 090
44202 .... ............ A ........ Lap, enterectomy ................................ 23.26 NA NA 8.30 8.62 2.85 090
44203 .... ............ A ........ Lap resect s/intestine, addl ................ 4.44 NA NA 1.12 1.31 0.57 ZZZ
44204 .... ............ A ........ Laparo partial colectomy .................... 26.29 NA NA 8.88 9.43 3.11 090
44205 .... ............ A ........ Lap colectomy part w/ileum ................ 22.86 NA NA 7.81 8.34 2.75 090
44206 .... ............ A ........ Lap part colectomy w/stoma .............. 29.63 NA NA 10.46 10.87 3.46 090
44207 .... ............ A ........ L colectomy/coloproctostomy ............. 31.79 NA NA 10.12 10.82 3.67 090
44208 .... ............ A ........ L colectomy/coloproctostomy ............. 33.86 NA NA 12.02 12.60 3.88 090
44210 .... ............ A ........ Laparo total proctocolectomy ............. 29.88 NA NA 11.17 11.54 3.42 090
44211 .... ............ A ........ Lap colectomy w/proctectomy ............ 36.87 NA NA 13.56 14.17 4.17 090
44212 .... ............ A ........ Laparo total proctocolectomy ............. 34.37 NA NA 13.04 13.40 3.78 090
44213 .... ............ A ........ Lap, mobil splenic fl add-on ............... 3.50 NA NA 0.87 1.05 0.44 ZZZ
44227 .... ............ A ........ Lap, close enterostomy ...................... 28.49 NA NA 9.49 10.07 3.38 090
44238 .... ............ C ........ Laparoscope proc, intestine ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
44300 .... ............ A ........ Open bowel to skin ............................. 13.65 NA NA 5.54 5.52 1.60 090
44310 .... ............ A ........ Ileostomy/jejunostomy ........................ 17.49 NA NA 6.40 6.55 1.99 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
44312 .... ............ A ........ Revision of ileostomy ......................... 9.33 NA NA 4.66 4.33 0.92 090
44314 .... ............ A ........ Revision of ileostomy ......................... 16.61 NA NA 6.77 6.68 1.75 090
44316 .... ............ A ........ Devise bowel pouch ........................... 23.46 NA NA 8.89 8.79 2.38 090
44320 .... ............ A ........ Colostomy ........................................... 19.75 NA NA 7.58 7.63 2.26 090
44322 .... ............ A ........ Colostomy with biopsies ..................... 13.15 NA NA 9.04 8.87 1.54 090
44340 .... ............ A ........ Revision of colostomy ........................ 9.12 NA NA 4.91 4.60 0.99 090
44360 .... ............ A ........ Small bowel endoscopy ...................... 2.59 NA NA 1.50 1.31 0.19 000
44361 .... ............ A ........ Small bowel endoscopy/biopsy .......... 2.87 NA NA 1.63 1.42 0.21 000
44370 .... ............ A ........ Small bowel endoscopy/stent ............. 4.79 NA NA 2.57 2.27 0.37 000
44377 .... ............ A ........ Small bowel endoscopy/biopsy .......... 5.52 NA NA 2.78 2.47 0.40 000
44379 .... ............ A ........ S bowel endoscope w/stent ............... 7.46 NA NA 3.95 3.33 0.62 000
44383 .... ............ A ........ Ileoscopy w/stent ................................ 2.94 NA NA 1.63 1.45 0.21 000
44385 .... ............ A ........ Endoscopy of bowel pouch ................ 1.82 4.86 4.11 0.89 0.82 0.15 000
44386 .... ............ A ........ Endoscopy, bowel pouch/biop ............ 2.12 6.60 6.64 1.02 0.96 0.20 000
44388 .... ............ A ........ Colonoscopy ....................................... 2.82 6.08 5.59 1.36 1.26 0.26 000
44389 .... ............ A ........ Colonoscopy with biopsy .................... 3.13 7.06 6.84 1.58 1.43 0.27 000
44390 .... ............ A ........ Colonoscopy for foreign body ............ 3.82 8.29 7.64 1.93 1.69 0.32 000
44391 .... ............ A ........ Colonoscopy for bleeding ................... 4.31 8.88 8.81 2.23 1.96 0.34 000
44392 .... ............ A ........ Colonoscopy & polypectomy .............. 3.81 7.31 6.96 1.72 1.61 0.34 000
44393 .... ............ A ........ Colonoscopy, lesion removal ............. 4.83 7.99 7.42 2.15 1.99 0.42 000
44394 .... ............ A ........ Colonoscopy w/snare ......................... 4.42 8.45 8.13 2.09 1.90 0.38 000
44397 .... ............ A ........ Colonoscopy w/stent .......................... 4.70 NA NA 2.17 2.01 0.39 000
44500 .... ............ A ........ Intro, gastrointestinal tube .................. 0.49 NA NA 0.17 0.16 0.03 000
44602 .... ............ A ........ Suture, small intestine ........................ 24.64 NA NA 7.62 7.02 2.12 090
44603 .... ............ A ........ Suture, small intestine ........................ 28.03 NA NA 8.97 8.14 2.42 090
44604 .... ............ A ........ Suture, large intestine ........................ 18.06 NA NA 6.07 6.27 2.12 090
44605 .... ............ A ........ Repair of bowel lesion ........................ 22.00 NA NA 7.82 8.13 2.52 090
44615 .... ............ A ........ Intestinal stricturoplasty ...................... 18.08 NA NA 6.53 6.62 2.07 090
44620 .... ............ A ........ Repair bowel opening ......................... 14.35 NA NA 5.50 5.42 1.51 090
44640 .... ............ A ........ Repair bowel-skin fistula .................... 24.12 NA NA 8.01 8.31 2.78 090
44650 .... ............ A ........ Repair bowel fistula ............................ 25.04 NA NA 8.30 8.61 2.93 090
44660 .... ............ A ........ Repair bowel-bladder fistula ............... 23.83 NA NA 9.84 9.08 2.14 090
44661 .... ............ A ........ Repair bowel-bladder fistula ............... 27.27 NA NA 9.43 9.50 2.81 090
44680 .... ............ A ........ Surgical revision, intestine .................. 17.88 NA NA 6.66 6.54 2.00 090
44700 .... ............ A ........ Suspend bowel w/prosthesis .............. 17.40 NA NA 6.17 6.44 1.84 090
44701 .... ............ A ........ Intraop colon lavage add-on ............... 3.10 NA NA 0.76 0.91 0.37 ZZZ
44715 .... ............ C ........ Prepare donor intestine ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
44720 .... ............ A ........ Prep donor intestine/venous ............... 5.00 NA NA 1.27 1.49 0.37 XXX
44721 .... ............ A ........ Prep donor intestine/artery ................. 7.00 NA NA 1.77 2.09 0.97 XXX
44799 .... ............ C ........ Unlisted procedure intestine ............... 0.00 0.00 7.75 0.00 7.75 0.00 YYY
44800 .... ............ A ........ Excision of bowel pouch ..................... 11.94 NA NA 5.48 5.44 1.47 090
44820 .... ............ A ........ Excision of mesentery lesion .............. 13.63 NA NA 5.56 5.53 1.59 090
44850 .... ............ A ........ Repair of mesentery ........................... 12.03 NA NA 5.00 5.01 1.39 090
44899 .... ............ C ........ Bowel surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
44900 .... ............ A ........ Drain app abscess, open ................... 12.44 NA NA 5.01 4.86 1.33 090
44901 .... ............ A ........ Drain app abscess, percut ................. 3.37 19.64 23.62 1.21 1.12 0.22 000
44950 .... ............ A ........ Appendectomy .................................... 10.52 NA NA 4.03 4.18 1.31 090
44955 .... ............ A ........ Appendectomy add-on ....................... 1.53 NA NA 0.40 0.47 0.20 ZZZ
44960 .... ............ A ........ Appendectomy .................................... 14.39 NA NA 5.39 5.37 1.63 090
44970 .... ............ A ........ Laparoscopy, appendectomy ............. 9.35 NA NA 4.18 4.13 1.14 090
44979 .... ............ C ........ Laparoscope proc, app ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
45000 .... ............ A ........ Drainage of pelvic abscess ................ 6.20 NA NA 3.56 3.25 0.52 090
45005 .... ............ A ........ Drainage of rectal abscess ................. 2.00 3.95 4.00 1.58 1.58 0.25 010
45020 .... ............ A ........ Drainage of rectal abscess ................. 8.43 NA NA 4.54 3.90 0.55 090
45100 .... ............ A ........ Biopsy of rectum ................................. 3.96 NA NA 2.80 2.59 0.44 090
45108 .... ............ A ........ Removal of anorectal lesion ............... 5.04 NA NA 3.09 2.92 0.59 090
45110 .... ............ A ........ Removal of rectum ............................. 30.57 NA NA 11.84 12.14 3.36 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
45111 .... ............ A ........ Partial removal of rectum ................... 17.89 NA NA 6.99 7.08 2.07 090
45113 .... ............ A ........ Partial proctectomy ............................. 33.09 NA NA 11.59 12.10 3.49 090
45119 .... ............ A ........ Remove rectum w/reservoir ............... 33.35 NA NA 11.55 12.04 3.36 090
45121 .... ............ A ........ Removal of rectum and colon ............ 28.93 NA NA 10.04 10.62 3.25 090
45123 .... ............ A ........ Partial proctectomy ............................. 18.70 NA NA 6.95 6.93 1.86 090
45126 .... ............ A ........ Pelvic exenteration ............................. 48.89 NA NA 18.00 18.50 4.33 090
45130 .... ............ A ........ Excision of rectal prolapse ................. 18.37 NA NA 6.67 6.74 1.80 090
45135 .... ............ A ........ Excision of rectal prolapse ................. 22.15 NA NA 8.62 8.64 2.36 090
45136 .... ............ A ........ Excise ileoanal reservior .................... 30.63 NA NA 11.94 12.23 2.82 090
45150 .... ............ A ........ Excision of rectal stricture .................. 5.77 NA NA 3.34 3.17 0.61 090
45160 .... ............ A ........ Excision of rectal lesion ...................... 16.17 NA NA 6.43 6.56 1.68 090
45170 .... ............ A ........ Excision of rectal lesion ...................... 12.48 NA NA 5.35 5.30 1.35 090
45190 .... ............ A ........ Destruction, rectal tumor .................... 10.29 NA NA 5.51 5.08 1.13 090
45300 .... ............ A ........ Proctosigmoidoscopy dx ..................... 0.80 1.95 1.74 0.45 0.35 0.04 000
45303 .... ............ A ........ Proctosigmoidoscopy dilate ................ 1.50 19.71 19.14 0.66 0.45 0.05 000
45305 .... ............ A ........ Proctosigmoidoscopy w/bx ................. 1.25 3.16 2.91 0.59 0.54 0.11 000
45307 .... ............ A ........ Proctosigmoidoscopy fb ..................... 1.70 3.22 3.14 0.70 0.56 0.11 000
45308 .... ............ A ........ Proctosigmoidoscopy removal ............ 1.40 3.37 2.66 0.63 0.51 0.09 000
45317 .... ............ A ........ Proctosigmoidoscopy bleed ................ 2.00 3.35 2.91 0.77 0.70 0.15 000
45320 .... ............ A ........ Proctosigmoidoscopy ablate ............... 1.78 3.37 3.24 0.80 0.75 0.16 000
45321 .... ............ A ........ Proctosigmoidoscopy volvul ............... 1.75 NA NA 0.86 0.67 0.13 000
45327 .... ............ A ........ Proctosigmoidoscopy w/stent ............. 2.00 NA NA 0.91 0.78 0.16 000
45330 .... ............ A ........ Diagnostic sigmoidoscopy .................. 0.96 2.50 2.39 0.62 0.56 0.08 000
45331 .... ............ A ........ Sigmoidoscopy and biopsy ................. 1.15 3.25 3.16 0.79 0.69 0.09 000
45332 .... ............ A ........ Sigmoidoscopy w/fb removal .............. 1.79 5.49 5.26 1.00 0.91 0.16 000
45333 .... ............ A ........ Sigmoidoscopy & polypectomy .......... 1.79 5.62 5.25 0.99 0.90 0.15 000
45334 .... ............ A ........ Sigmoidoscopy for bleeding ............... 2.73 NA NA 1.55 1.34 0.20 000
45335 .... ............ A ........ Sigmoidoscopy w/submuc inj ............. 1.46 5.30 4.26 0.90 0.80 0.11 000
45337 .... ............ A ........ Sigmoidoscopy & decompress ........... 2.36 NA NA 1.25 1.12 0.21 000
45338 .... ............ A ........ Sigmoidoscopy w/tumr remove .......... 2.34 5.86 5.53 1.28 1.14 0.19 000
45339 .... ............ A ........ Sigmoidoscopy w/ablate tumr ............ 3.14 5.70 4.59 1.67 1.48 0.26 000
45340 .... ............ A ........ Sig w/balloon dilation .......................... 1.89 10.17 8.18 1.04 0.94 0.15 000
45341 .... ............ A ........ Sigmoidoscopy w/ultrasound .............. 2.60 NA NA 1.48 1.27 0.19 000
45342 .... ............ A ........ Sigmoidoscopy w/us guide bx ............ 4.05 NA NA 2.18 1.87 0.30 000
45345 .... ............ A ........ Sigmoidoscopy w/stent ....................... 2.92 NA NA 1.51 1.34 0.23 000
45355 .... ............ A ........ Surgical colonoscopy .......................... 3.51 NA NA 1.59 1.48 0.36 000
45378 .... ............ A ........ Diagnostic colonoscopy ...................... 3.69 6.35 6.25 1.83 1.66 0.30 000
45378 .... 53 ....... A ........ Diagnostic colonoscopy ...................... 0.96 2.50 2.39 0.62 0.56 0.08 000
45379 .... ............ A ........ Colonoscopy w/fb removal ................. 4.68 8.03 7.86 2.18 2.01 0.39 000
45380 .... ............ A ........ Colonoscopy and biopsy .................... 4.43 7.71 7.46 2.25 2.00 0.35 000
45381 .... ............ A ........ Colonoscopy, submucous inj .............. 4.19 7.68 7.40 2.17 1.92 0.30 000
45382 .... ............ A ........ Colonoscopy/control bleeding ............ 5.68 10.30 10.13 2.90 2.55 0.41 000
45383 .... ............ A ........ Lesion removal colonoscopy .............. 5.86 8.51 8.22 2.65 2.44 0.48 000
45384 .... ............ A ........ Lesion remove colonoscopy ............... 4.69 7.15 6.98 2.19 2.02 0.38 000
45385 .... ............ A ........ Lesion removal colonoscopy .............. 5.30 8.33 8.07 2.60 2.32 0.42 000
45386 .... ............ A ........ Colonoscopy dilate stricture ............... 4.57 12.27 12.34 2.19 1.99 0.39 000
45387 .... ............ A ........ Colonoscopy w/stent .......................... 5.90 NA NA 2.81 2.60 0.48 000
45391 .... ............ A ........ Colonoscopy w/endoscope us ............ 5.09 NA NA 2.62 2.29 0.42 000
45392 .... ............ A ........ Colonoscopy w/endoscopic fnb .......... 6.54 NA NA 3.23 2.84 0.42 000
45395 .... ............ A ........ Lap, removal of rectum ...................... 32.79 NA NA 12.94 13.32 3.63 090
45397 .... ............ A ........ Lap, remove rectum w/pouch ............. 36.29 NA NA 13.40 13.87 3.67 090
45400 .... ............ A ........ Laparoscopic proc .............................. 19.31 NA NA 7.09 7.48 2.03 090
45402 .... ............ A ........ Lap proctopexy w/sig resect ............... 26.38 NA NA 8.76 9.39 2.82 090
45499 .... ............ C ........ Laparoscope proc, rectum .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
45500 .... ............ A ........ Repair of rectum ................................. 7.64 NA NA 4.45 3.98 0.75 090
45505 .... ............ A ........ Repair of rectum ................................. 8.20 NA NA 5.02 4.45 0.86 090
45520 .... ............ A ........ Treatment of rectal prolapse .............. 0.55 2.83 2.27 0.38 0.38 0.05 000
45540 .... ............ A ........ Correct rectal prolapse ....................... 18.02 NA NA 5.83 6.31 1.85 090
45541 .... ............ A ........ Correct rectal prolapse ....................... 14.72 NA NA 6.58 6.27 1.55 090
45550 .... ............ A ........ Repair rectum/remove sigmoid .......... 24.67 NA NA 8.96 9.10 2.62 090
45560 .... ............ A ........ Repair of rectocele ............................. 11.42 NA NA 5.55 5.30 1.13 090
45562 .... ............ A ........ Exploration/repair of rectum ............... 17.82 NA NA 8.12 7.56 1.84 090
45563 .... ............ A ........ Exploration/repair of rectum ............... 26.22 NA NA 10.74 10.66 3.11 090
45800 .... ............ A ........ Repair rect/bladder fistula .................. 20.18 NA NA 9.24 8.34 1.86 090
45805 .... ............ A ........ Repair fistula w/colostomy .................. 23.19 NA NA 9.94 9.61 2.03 090
45820 .... ............ A ........ Repair rectourethral fistula ................. 20.24 NA NA 9.14 8.42 1.58 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
45825 .... ............ A ........ Repair fistula w/colostomy .................. 24.01 NA NA 9.49 9.91 2.32 090
45900 .... ............ A ........ Reduction of rectal prolapse .............. 2.96 NA NA 1.65 1.58 0.30 010
45905 .... ............ A ........ Dilation of anal sphincter .................... 2.32 NA NA 1.60 1.53 0.27 010
45910 .... ............ A ........ Dilation of rectal narrowing ................. 2.82 NA NA 1.85 1.75 0.30 010
45915 .... ............ A ........ Remove rectal obstruction .................. 3.16 4.18 4.26 2.01 2.06 0.30 010
45990 .... ............ A ........ Surg dx exam, anorectal .................... 1.80 NA NA 0.72 0.77 0.17 000
45999 .... ............ C ........ Rectum surgery procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
46020 .... ............ A ........ Placement of seton ............................. 2.94 3.24 2.79 2.33 2.10 0.31 010
46030 .... ............ A ........ Removal of rectal marker ................... 1.24 1.87 1.61 0.81 0.76 0.14 010
46040 .... ............ A ........ Incision of rectal abscess ................... 5.26 6.48 5.99 3.96 3.77 0.62 090
46045 .... ............ A ........ Incision of rectal abscess ................... 5.79 NA NA 3.92 3.41 0.54 090
46050 .... ............ A ........ Incision of anal abscess ..................... 1.21 3.16 2.85 0.97 0.91 0.14 010
46060 .... ............ A ........ Incision of rectal abscess ................... 6.24 NA NA 4.39 3.82 0.67 090
46070 .... ............ A ........ Incision of anal septum ...................... 2.74 NA NA 2.33 2.08 0.36 090
46080 .... ............ A ........ Incision of anal sphincter .................... 2.50 3.04 2.70 1.12 1.13 0.30 010
46083 .... ............ A ........ Incise external hemorrhoid ................. 1.42 2.34 2.43 0.95 0.94 0.15 010
46200 .... ............ A ........ Removal of anal fissure ...................... 3.48 6.24 5.05 3.70 3.29 0.39 090
46210 .... ............ A ........ Removal of anal crypt ........................ 2.73 5.77 5.47 3.27 2.96 0.31 090
46211 .... ............ A ........ Removal of anal crypts ....................... 4.31 7.79 6.48 4.64 3.98 0.48 090
46220 .... ............ A ........ Removal of anal tag ........................... 1.58 2.99 2.64 1.09 1.02 0.17 010
46221 .... ............ A ........ Ligation of hemorrhoid(s) ................... 2.31 3.70 3.17 1.99 1.87 0.23 010
46230 .... ............ A ........ Removal of anal tags ......................... 2.59 3.48 3.28 1.33 1.31 0.30 010
46250 .... ............ A ........ Hemorrhoidectomy ............................. 4.17 5.90 5.61 2.82 2.72 0.48 090
46255 .... ............ A ........ Hemorrhoidectomy ............................. 4.88 6.28 6.07 3.05 2.95 0.58 090
46257 .... ............ A ........ Remove hemorrhoids & fissure .......... 5.68 NA NA 3.83 3.35 0.64 090
46258 .... ............ A ........ Remove hemorrhoids & fistula ........... 6.28 NA NA 3.94 3.62 0.68 090
46260 .... ............ A ........ Hemorrhoidectomy ............................. 6.65 NA NA 4.04 3.61 0.76 090
46261 .... ............ A ........ Remove hemorrhoids & fissure .......... 7.63 NA NA 4.28 3.95 0.79 090
46262 .... ............ A ........ Remove hemorrhoids & fistula ........... 7.80 NA NA 4.62 4.19 0.83 090
46270 .... ............ A ........ Removal of anal fistula ....................... 4.81 6.33 5.65 3.88 3.35 0.46 090
46280 .... ............ A ........ Removal of anal fistula ....................... 6.28 NA NA 4.25 3.76 0.66 090
46288 .... ............ A ........ Repair anal fistula ............................... 7.68 NA NA 4.66 4.17 0.79 090
46320 .... ............ A ........ Removal of hemorrhoid clot ............... 1.62 2.39 2.26 0.88 0.87 0.18 010
46500 .... ............ A ........ Injection into hemorrhoid(s) ................ 1.64 3.58 2.85 1.24 1.20 0.16 010
46505 .... ............ A ........ Chemodenervation anal musc ............ 3.13 3.26 3.15 2.27 2.12 0.14 010
46600 .... ............ A ........ Diagnostic anoscopy .......................... 0.55 1.36 1.47 0.38 0.36 0.05 000
46604 .... ............ A ........ Anoscopy and dilation ........................ 1.03 12.39 10.78 0.51 0.58 0.12 000
46606 .... ............ A ........ Anoscopy and biopsy ......................... 1.20 3.84 3.82 0.58 0.49 0.09 000
46608 .... ............ A ........ Anoscopy, remove for body ............... 1.30 3.73 4.10 0.58 0.62 0.16 000
46610 .... ............ A ........ Anoscopy, remove lesion ................... 1.28 3.76 3.95 0.59 0.62 0.15 000
46611 .... ............ A ........ Anoscopy ............................................ 1.30 2.52 2.97 0.57 0.70 0.19 000
46612 .... ............ A ........ Anoscopy, remove lesions ................. 1.50 4.66 5.02 0.72 0.89 0.28 000
46614 .... ............ A ........ Anoscopy, control bleeding ................ 1.00 1.92 2.23 0.52 0.73 0.20 000
46615 .... ............ A ........ Anoscopy ............................................ 1.50 1.76 2.21 0.64 0.91 0.33 000
46700 .... ............ A ........ Repair of anal stricture ....................... 9.68 NA NA 5.14 4.68 0.94 090
46705 .... ............ A ........ Repair of anal stricture ....................... 7.32 NA NA 4.04 3.86 0.91 090
46706 .... ............ A ........ Repr of anal fistula w/glue .................. 2.41 NA NA 1.48 1.36 0.28 010
46710 .... ............ A ........ Repr per/vag pouch sngl proc ............ 17.01 NA NA 7.54 7.69 1.38 090
46712 .... ............ A ........ Repr per/vag pouch dbl proc .............. 36.32 NA NA 14.06 14.59 3.67 090
46715 .... ............ A ........ Rep perf anoper fistu .......................... 7.54 NA NA 3.73 3.65 0.92 090
46716 .... ............ A ........ Rep perf anoper/vestib fistu ............... 17.14 NA NA 9.53 8.76 1.58 090
46730 .... ............ A ........ Construction of absent anus .............. 30.17 NA NA 12.51 12.10 2.47 090
46742 .... ............ A ........ Repair of imperforated anus ............... 39.66 NA NA 13.72 15.95 3.20 090
46744 .... ............ A ........ Repair of cloacal anomaly .................. 58.46 NA NA 18.11 20.16 6.40 090
46750 .... ............ A ........ Repair of anal sphincter ..................... 12.02 NA NA 5.77 5.42 1.10 090
46753 .... ............ A ........ Reconstruction of anus ....................... 8.81 NA NA 4.57 4.22 0.94 090
46754 .... ............ A ........ Removal of suture from anus ............. 2.88 3.60 3.61 2.20 1.95 0.19 010
46762 .... ............ A ........ Implant artificial sphincter ................... 14.66 NA NA 7.09 6.26 1.24 090
46900 .... ............ A ........ Destruction, anal lesion(s) .................. 1.91 3.63 3.10 1.31 1.29 0.17 010
46916 .... ............ A ........ Cryosurgery, anal lesion(s) ................ 1.88 3.76 3.46 1.59 1.50 0.11 010
46917 .... ............ A ........ Laser surgery, anal lesions ................ 1.88 8.72 8.91 1.22 1.17 0.21 010
46922 .... ............ A ........ Excision of anal lesion(s) ................... 1.88 4.10 3.69 1.19 1.13 0.22 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
46934 .... ............ A ........ Destruction of hemorrhoids ................ 3.79 5.53 5.28 2.87 2.90 0.32 090
46937 .... ............ A ........ Cryotherapy of rectal lesion ............... 2.70 3.39 3.21 1.43 1.40 0.14 010
46938 .... ............ A ........ Cryotherapy of rectal lesion ............... 4.70 5.58 4.82 3.53 3.31 0.58 090
46940 .... ............ A ........ Treatment of anal fissure ................... 2.33 2.83 2.41 1.04 1.07 0.23 010
46942 .... ............ A ........ Treatment of anal fissure ................... 2.05 2.78 2.31 0.96 0.99 0.19 010
46945 .... ............ A ........ Ligation of hemorrhoids ...................... 2.13 4.76 4.02 2.96 2.72 0.19 090
46946 .... ............ A ........ Ligation of hemorrhoids ...................... 2.60 4.60 4.17 2.63 2.52 0.27 090
46947 .... ............ A ........ Hemorrhoidopexy by stapling ............. 5.49 NA NA 3.09 2.90 0.75 090
46999 .... ............ C ........ Anus surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
47000 .... ............ A ........ Needle biopsy of liver ......................... 1.90 7.61 5.28 0.71 0.65 0.12 000
47001 .... ............ A ........ Needle biopsy, liver add-on ................ 1.90 NA NA 0.49 0.57 0.25 ZZZ
47010 .... ............ A ........ Open drainage, liver lesion ................ 19.27 NA NA 8.31 8.32 1.81 090
47011 .... ............ A ........ Percut drain, liver lesion ..................... 3.69 NA NA 1.33 1.22 0.22 000
47015 .... ............ A ........ Inject/aspirate liver cyst ...................... 18.37 NA NA 8.16 7.76 1.84 090
47100 .... ............ A ........ Wedge biopsy of liver ......................... 12.78 NA NA 6.29 6.17 1.53 090
47120 .... ............ A ........ Partial removal of liver ........................ 38.82 NA NA 14.07 14.61 4.66 090
47122 .... ............ A ........ Extensive removal of liver .................. 59.35 NA NA 18.78 20.12 7.21 090
47135 .... ............ R ........ Transplantation of liver ....................... 83.29 NA NA 27.72 29.63 9.96 090
47136 .... ............ R ........ Transplantation of liver ....................... 70.39 NA NA 24.50 25.63 8.44 090
47140 .... ............ A ........ Partial removal, donor liver ................ 59.22 NA NA 21.57 21.95 5.19 090
47143 .... ............ C ........ Prep donor liver, whole ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
47144 .... ............ C ........ Prep donor liver, 3-segment ............... 0.00 0.00 0.00 0.00 0.00 0.00 090
47145 .... ............ C ........ Prep donor liver, lobe split ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
47146 .... ............ A ........ Prep donor liver/venous ..................... 6.00 NA NA 1.52 1.79 0.83 XXX
47147 .... ............ A ........ Prep donor liver/arterial ...................... 7.00 NA NA 1.78 2.09 0.97 XXX
47300 .... ............ A ........ Surgery for liver lesion ....................... 18.01 NA NA 7.72 7.46 1.99 090
47350 .... ............ A ........ Repair liver wound .............................. 22.36 NA NA 8.75 8.83 2.59 090
47370 .... ............ A ........ Laparo ablate liver tumor rf ................ 20.67 NA NA 7.67 7.90 2.56 090
47371 .... ............ A ........ Laparo ablate liver cryosurg ............... 20.67 NA NA 7.90 8.06 2.61 090
47379 .... ............ C ........ Laparoscope procedure, liver ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
47380 .... ............ A ........ Open ablate liver tumor rf .................. 24.43 NA NA 8.60 8.96 2.87 090
47381 .... ............ A ........ Open ablate liver tumor cryo .............. 24.72 NA NA 9.34 9.41 2.85 090
47382 .... ............ A ........ Percut ablate liver rf ........................... 15.19 NA NA 6.26 5.97 0.96 010
47399 .... ............ C ........ Liver surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
47400 .... ............ A ........ Incision of liver duct ............................ 36.23 NA NA 13.02 13.24 3.08 090
47420 .... ............ A ........ Incision of bile duct ............................. 21.92 NA NA 8.53 8.66 2.63 090
47425 .... ............ A ........ Incision of bile duct ............................. 22.20 NA NA 8.63 8.71 2.62 090
47460 .... ............ A ........ Incise bile duct sphincter .................... 20.41 NA NA 9.13 8.72 2.21 090
47480 .... ............ A ........ Incision of gallbladder ......................... 13.12 NA NA 6.61 6.26 1.42 090
47490 .... ............ A ........ Incision of gallbladder ......................... 8.05 NA NA 5.31 5.32 0.43 090
47500 .... ............ A ........ Injection for liver x-rays ...................... 1.96 NA NA 0.72 0.65 0.12 000
47505 .... ............ A ........ Injection for liver x-rays ...................... 0.76 NA NA 0.28 0.25 0.04 000
47510 .... ............ A ........ Insert catheter, bile duct ..................... 7.94 NA NA 4.65 4.72 0.46 090
47511 .... ............ A ........ Insert bile duct drain ........................... 10.74 NA NA 5.08 4.94 0.62 090
47525 .... ............ A ........ Change bile duct catheter .................. 5.55 14.76 14.79 2.71 2.68 0.33 010
47530 .... ............ A ........ Revise/reinsert bile tube ..................... 5.96 30.34 31.82 3.46 3.51 0.37 090
47550 .... ............ A ........ Bile duct endoscopy add-on ............... 3.02 NA NA 0.78 0.90 0.40 ZZZ
47552 .... ............ A ........ Biliary endoscopy thru skin ................ 6.03 NA NA 2.50 2.37 0.42 000
47560 .... ............ A ........ Laparoscopy w/cholangio ................... 4.88 NA NA 1.24 1.46 0.65 000
47561 .... ............ A ........ Laparo w/cholangio/biopsy ................. 5.17 NA NA 1.59 1.74 0.66 000
47562 .... ............ A ........ Laparoscopic cholecystectomy ........... 11.63 NA NA 5.25 5.12 1.46 090
47563 .... ............ A ........ Laparo cholecystectomy/graph ........... 12.03 NA NA 5.05 5.18 1.58 090
47564 .... ............ A ........ Laparo cholecystectomy/explr ............ 14.21 NA NA 5.40 5.68 1.89 090
47570 .... ............ A ........ Laparo cholecystoenterostomy ........... 12.56 NA NA 4.95 5.17 1.65 090
47579 .... ............ C ........ Laparoscope proc, biliary ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
47600 .... ............ A ........ Removal of gallbladder ....................... 17.35 NA NA 7.20 6.67 1.80 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
47630 .... ............ A ........ Remove bile duct stone ...................... 9.57 NA NA 4.75 4.72 0.65 090
47700 .... ............ A ........ Exploration of bile ducts ..................... 16.39 NA NA 7.28 7.34 2.07 090
47701 .... ............ A ........ Bile duct revision ................................ 28.62 NA NA 10.62 10.96 3.68 090
47711 .... ............ A ........ Excision of bile duct tumor ................. 25.77 NA NA 9.64 9.77 3.05 090
47712 .... ............ A ........ Excision of bile duct tumor ................. 33.59 NA NA 11.65 12.02 3.93 090
47715 .... ............ A ........ Excision of bile duct cyst .................... 21.42 NA NA 8.58 8.50 2.49 090
47719 .... ............ A ........ Fusion of bile duct cyst ...................... 19.07 NA NA 7.93 7.86 2.15 090
47720 .... ............ A ........ Fuse gallbladder & bowel ................... 18.21 NA NA 7.71 7.59 2.11 090
47721 .... ............ A ........ Fuse upper gi structures .................... 21.86 NA NA 8.53 8.56 2.53 090
47760 .... ............ A ........ Fuse bile ducts and bowel ................. 38.14 NA NA 13.03 11.95 3.42 090
47765 .... ............ A ........ Fuse liver ducts & bowel .................... 52.01 NA NA 16.94 13.87 3.30 090
47800 .... ............ A ........ Reconstruction of bile ducts ............... 26.04 NA NA 9.75 9.90 3.08 090
47801 .... ............ A ........ Placement, bile duct support .............. 17.47 NA NA 8.47 8.16 1.16 090
47802 .... ............ A ........ Fuse liver duct & intestine .................. 24.80 NA NA 9.66 9.63 2.86 090
47900 .... ............ A ........ Suture bile duct injury ......................... 22.31 NA NA 8.83 8.83 2.65 090
47999 .... ............ C ........ Bile tract surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
48000 .... ............ A ........ Drainage of abdomen ......................... 31.82 NA NA 10.86 11.18 3.48 090
48001 .... ............ A ........ Placement of drain, pancreas ............ 39.56 NA NA 12.77 13.31 4.69 090
48020 .... ............ A ........ Removal of pancreatic stone .............. 18.96 NA NA 7.57 7.44 2.13 090
48100 .... ............ A ........ Biopsy of pancreas, open ................... 14.38 NA NA 5.95 5.76 1.62 090
48102 .... ............ A ........ Needle biopsy, pancreas .................... 4.68 9.56 8.66 1.93 1.88 0.28 010
48105 .... ............ A ........ Resect/debride pancreas .................... 49.05 NA NA 15.77 16.32 5.56 090
48120 .... ............ A ........ Removal of pancreas lesion ............... 18.33 NA NA 6.85 6.86 2.10 090
48140 .... ............ A ........ Partial removal of pancreas ............... 26.19 NA NA 9.37 9.45 3.03 090
48146 .... ............ A ........ Pancreatectomy .................................. 30.42 NA NA 11.91 11.94 3.50 090
48148 .... ............ A ........ Removal of pancreatic duct ................ 20.26 NA NA 8.20 7.88 2.30 090
48155 .... ............ A ........ Removal of pancreas ......................... 29.27 NA NA 11.93 11.80 3.27 090
48400 .... ............ A ........ Injection, intraop add-on ..................... 1.95 NA NA 0.67 0.68 0.15 ZZZ
48500 .... ............ A ........ Surgery of pancreatic cyst .................. 18.03 NA NA 7.64 7.55 2.03 090
48510 .... ............ A ........ Drain pancreatic pseudocyst .............. 17.06 NA NA 7.58 7.50 1.83 090
48511 .... ............ A ........ Drain pancreatic pseudocyst .............. 3.99 20.03 20.30 1.45 1.33 0.24 000
48520 .... ............ A ........ Fuse pancreas cyst and bowel .......... 18.07 NA NA 6.82 6.75 2.06 090
48540 .... ............ A ........ Fuse pancreas cyst and bowel .......... 21.86 NA NA 7.79 7.94 2.61 090
48545 .... ............ A ........ Pancreatorrhaphy ............................... 22.10 NA NA 8.40 8.14 2.38 090
48547 .... ............ A ........ Duodenal exclusion ............................ 30.25 NA NA 10.28 10.38 3.42 090
48548 .... ............ A ........ Fuse pancreas and bowel .................. 27.96 NA NA 9.88 10.07 3.28 090
48551 .... ............ C ........ Prep donor pancreas .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
48552 .... ............ A ........ Prep donor pancreas/venous ............. 4.30 NA NA 1.15 1.30 0.31 XXX
48554 .... ............ R ........ Transpl allograft pancreas .................. 37.03 NA NA 20.43 19.36 4.19 090
48556 .... ............ A ........ Removal, allograft pancreas ............... 19.24 NA NA 9.18 8.66 2.08 090
48999 .... ............ C ........ Pancreas surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
49000 .... ............ A ........ Exploration of abdomen ..................... 12.44 NA NA 5.20 5.29 1.52 090
49002 .... ............ A ........ Reopening of abdomen ...................... 17.55 NA NA 6.38 5.71 1.37 090
49010 .... ............ A ........ Exploration behind abdomen .............. 15.98 NA NA 6.21 6.07 1.51 090
49020 .... ............ A ........ Drain abdominal abscess ................... 26.46 NA NA 9.88 10.03 2.85 090
49021 .... ............ A ........ Drain abdominal abscess ................... 3.37 19.48 20.11 1.23 1.12 0.20 000
49040 .... ............ A ........ Drain, open, abdom abscess ............. 16.41 NA NA 6.50 6.46 1.70 090
49041 .... ............ A ........ Drain, percut, abdom abscess ........... 3.99 19.76 19.47 1.45 1.33 0.24 000
49060 .... ............ A ........ Drain, open, retrop abscess ............... 18.42 NA NA 7.25 7.32 1.75 090
49061 .... ............ A ........ Drain, percut, retroper absc ............... 3.69 19.59 19.45 1.34 1.23 0.22 000
49062 .... ............ A ........ Drain to peritoneal cavity .................... 12.12 NA NA 5.12 5.29 1.39 090
49080 .... ............ A ........ Puncture, peritoneal cavity ................. 1.35 2.71 3.32 0.49 0.46 0.08 000
49081 .... ............ A ........ Removal of abdominal fluid ................ 1.26 2.92 2.74 0.47 0.44 0.09 000
49180 .... ............ A ........ Biopsy, abdominal mass .................... 1.73 2.47 2.75 0.63 0.58 0.10 000
49200 .... ............ A ........ Removal of abdominal lesion ............. 10.94 NA NA 4.85 4.94 1.24 090
49201 .... ............ A ........ Remove abdom lesion, complex ........ 15.67 NA NA 6.42 6.73 1.88 090
49215 .... ............ A ........ Excise sacral spine tumor .................. 37.66 NA NA 12.75 13.40 4.38 090
49220 .... ............ A ........ Multiple surgery, abdomen ................. 15.70 NA NA 6.48 6.51 1.89 090
49250 .... ............ A ........ Excision of umbilicus .......................... 8.93 NA NA 4.34 4.29 1.08 090
49255 .... ............ A ........ Removal of omentum ......................... 12.41 NA NA 5.61 5.61 1.43 090
49320 .... ............ A ........ Diag laparo separate proc .................. 5.09 NA NA 2.44 2.54 0.65 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
49321 .... ............ A ........ Laparoscopy, biopsy ........................... 5.39 NA NA 2.56 2.60 0.70 010
49322 .... ............ A ........ Laparoscopy, aspiration ..................... 5.96 NA NA 2.63 2.81 0.71 010
49323 .... ............ A ........ Laparo drain lymphocele .................... 10.13 NA NA 4.68 4.59 1.20 090
49324 .... ............ A ........ Lap insertion perm ip cath .................. 6.27 NA NA 2.78 2.79 0.73 010
49325 .... ............ A ........ Lap revision perm ip cath ................... 6.77 NA NA 2.90 2.92 0.86 010
49326 .... ............ A ........ Lap w/omentopexy add-on ................. 3.50 NA NA 0.92 0.92 0.44 ZZZ
49329 .... ............ C ........ Laparo proc, abdm/per/oment ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
49400 .... ............ A ........ Air injection into abdomen .................. 1.88 2.46 2.74 0.62 0.61 0.15 000
49402 .... ............ A ........ Remove foreign body, adbomen ........ 14.01 NA NA 5.51 5.51 1.62 090
49419 .... ............ A ........ Insrt abdom cath for chemotx ............ 7.03 NA NA 3.44 3.49 0.81 090
49420 .... ............ A ........ Insert abdom drain, temp ................... 2.22 NA NA 1.19 1.14 0.21 000
49421 .... ............ A ........ Insert abdom drain, perm ................... 5.87 NA NA 3.10 3.13 0.74 090
49422 .... ............ A ........ Remove perm cannula/catheter ......... 6.26 NA NA 2.60 2.75 0.83 010
49423 .... ............ A ........ Exchange drainage catheter .............. 1.46 12.97 13.44 0.57 0.53 0.09 000
49424 .... ............ A ........ Assess cyst, contrast inject ................ 0.76 3.06 3.36 0.31 0.29 0.04 000
49425 .... ............ A ........ Insert abdomen-venous drain ............. 12.13 NA NA 5.29 5.44 1.54 090
49426 .... ............ A ........ Revise abdomen-venous shunt .......... 10.33 NA NA 4.55 4.65 1.28 090
49427 .... ............ A ........ Injection, abdominal shunt .................. 0.89 NA NA 0.32 0.30 0.07 000
49428 .... ............ A ........ Ligation of shunt ................................. 6.79 NA NA 2.99 3.47 0.80 010
49429 .... ............ A ........ Removal of shunt ............................... 7.41 NA NA 2.99 3.20 1.02 010
49435 .... ............ A ........ Insert subq exten to ip cath ................ 2.25 NA NA 0.62 0.61 0.28 ZZZ
49436 .... ............ A ........ Embedded ip cath exit-site ................. 2.69 NA NA 1.66 1.64 0.28 010
49491 .... ............ A ........ Rpr hern preemie reduc ..................... 12.42 NA NA 4.60 4.97 1.40 090
49492 .... ............ A ........ Rpr ing hern premie, blocked ............. 15.32 NA NA 6.21 6.10 1.81 090
49495 .... ............ A ........ Rpr ing hernia baby, reduc ................. 6.15 NA NA 3.04 2.99 0.74 090
49496 .... ............ A ........ Rpr ing hernia baby, blocked ............. 9.32 NA NA 4.42 4.33 1.07 090
49500 .... ............ A ........ Rpr ing hernia, init, reduce ................. 5.76 NA NA 3.69 3.39 0.71 090
49501 .... ............ A ........ Rpr ing hernia, init blocked ................ 9.28 NA NA 4.25 4.22 1.12 090
49505 .... ............ A ........ Prp i/hern init reduc >5 yr .................. 7.88 NA NA 3.86 3.81 1.03 090
49507 .... ............ A ........ Prp i/hern init block >5 yr ................... 9.97 NA NA 4.43 4.45 1.27 090
49520 .... ............ A ........ Rerepair ing hernia, reduce ................ 9.91 NA NA 4.36 4.40 1.28 090
49521 .... ............ A ........ Rerepair ing hernia, blocked .............. 12.36 NA NA 4.97 5.11 1.59 090
49525 .... ............ A ........ Repair ing hernia, sliding .................... 8.85 NA NA 4.10 4.09 1.13 090
49540 .... ............ A ........ Repair lumbar hernia .......................... 10.66 NA NA 4.56 4.67 1.37 090
49550 .... ............ A ........ Rpr rem hernia, init, reduce ............... 8.91 NA NA 4.09 4.11 1.14 090
49553 .... ............ A ........ Rpr fem hernia, init blocked ............... 9.84 NA NA 4.39 4.40 1.24 090
49555 .... ............ A ........ Rerepair fem hernia, reduce .............. 9.31 NA NA 4.19 4.23 1.20 090
49557 .... ............ A ........ Rerepair fem hernia, blocked ............. 11.54 NA NA 4.81 4.90 1.47 090
49560 .... ............ A ........ Rpr ventral hern init, reduc ................. 11.84 NA NA 4.86 5.01 1.52 090
49561 .... ............ A ........ Rpr ventral hern init, block ................. 15.30 NA NA 5.78 5.93 1.89 090
49565 .... ............ A ........ Rerepair ventrl hern, reduce .............. 12.29 NA NA 5.07 5.15 1.52 090
49566 .... ............ A ........ Rerepair ventrl hern, block ................. 15.45 NA NA 5.83 5.98 1.91 090
49568 .... ............ A ........ Hernia repair w/mesh ......................... 4.88 NA NA 1.25 1.46 0.64 ZZZ
49570 .... ............ A ........ Rpr epigastric hern, reduce ................ 5.97 NA NA 3.36 3.26 0.75 090
49572 .... ............ A ........ Rpr epigastric hern, blocked .............. 7.79 NA NA 3.81 3.64 0.88 090
49580 .... ............ A ........ Rpr umbil hern, reduc < 5 yr .............. 4.39 NA NA 2.91 2.76 0.54 090
49582 .... ............ A ........ Rpr umbil hern, block < 5 yr .............. 7.05 NA NA 3.67 3.56 0.88 090
49585 .... ............ A ........ Rpr umbil hern, reduc > 5 yr .............. 6.51 NA NA 3.49 3.40 0.82 090
49587 .... ............ A ........ Rpr umbil hern, block > 5 yr .............. 7.96 NA NA 3.84 3.79 0.99 090
49590 .... ............ A ........ Repair spigelian hernia ....................... 8.82 NA NA 4.07 4.08 1.13 090
49600 .... ............ A ........ Repair umbilical lesion ....................... 11.47 NA NA 5.39 5.32 1.32 090
49650 .... ............ A ........ Laparo hernia repair initial .................. 6.30 NA NA 3.32 3.26 0.93 090
49651 .... ............ A ........ Laparo hernia repair recur .................. 8.29 NA NA 4.21 4.13 1.14 090
49659 .... ............ C ........ Laparo proc, hernia repair .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
49900 .... ............ A ........ Repair of abdominal wall .................... 12.26 NA NA 6.26 6.25 1.62 090
49904 .... ............ A ........ Omental flap, extra-abdom ................. 22.16 NA NA 11.89 13.62 2.70 090
49905 .... ............ A ........ Omental flap, intra-abdom .................. 6.54 NA NA 1.71 2.01 0.75 ZZZ
49906 .... ............ C ........ Free omental flap, microvasc ............. 2.08 0.00 0.00 0.00 0.00 0.00 090
49999 .... ............ C ........ Abdomen surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
50010 .... ............ A ........ Exploration of kidney .......................... 12.13 NA NA 6.79 6.02 0.93 090
50020 .... ............ A ........ Renal abscess, open drain ................. 17.88 NA NA 8.52 8.13 1.34 090
50021 .... ............ A ........ Renal abscess, percut drain ............... 3.37 20.92 21.13 1.23 1.12 0.20 000
50040 .... ............ A ........ Drainage of kidney ............................. 16.48 NA NA 8.94 7.87 1.03 090
50060 .... ............ A ........ Removal of kidney stone .................... 20.80 NA NA 10.95 9.44 1.36 090
50065 .... ............ A ........ Incision of kidney ................................ 22.17 NA NA 11.67 8.90 1.59 090
50070 .... ............ A ........ Incision of kidney ................................ 21.70 NA NA 11.47 9.87 1.44 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
50100 .... ............ A ........ Revise kidney blood vessels .............. 17.30 NA NA 6.37 7.22 2.07 090
50125 .... ............ A ........ Explore and drain kidney .................... 17.67 NA NA 9.83 8.42 1.43 090
50200 .... ............ A ........ Biopsy of kidney ................................. 2.63 NA NA 1.19 1.22 0.16 000
50205 .... ............ A ........ Biopsy of kidney ................................. 12.19 NA NA 5.52 5.28 1.30 090
50220 .... ............ A ........ Remove kidney, open ......................... 18.53 NA NA 9.62 8.45 1.35 090
50225 .... ............ A ........ Removal kidney open, complex ......... 21.73 NA NA 11.15 9.66 1.50 090
50230 .... ............ A ........ Removal kidney open, radical ............ 23.68 NA NA 11.80 10.21 1.55 090
50234 .... ............ A ........ Removal of kidney & ureter ................ 23.90 NA NA 12.19 10.54 1.59 090
50236 .... ............ A ........ Removal of kidney & ureter ................ 26.74 NA NA 14.08 12.19 1.77 090
50240 .... ............ A ........ Partial removal of kidney .................... 24.01 NA NA 12.76 10.91 1.55 090
50250 .... ............ A ........ Cryoablate renal mass open .............. 22.06 NA NA 11.63 10.25 1.39 090
50280 .... ............ A ........ Removal of kidney lesion ................... 16.94 NA NA 9.15 7.96 1.19 090
50290 .... ............ A ........ Removal of kidney lesion ................... 16.00 NA NA 7.78 7.20 1.41 090
50320 .... ............ A ........ Remove kidney, living donor .............. 22.28 NA NA 12.27 11.49 2.36 090
50323 .... ............ C ........ Prep cadaver renal allograft ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
50325 .... ............ C ........ Prep donor renal graft ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
50327 .... ............ A ........ Prep renal graft/venous ...................... 4.00 NA NA 1.10 1.23 0.29 XXX
50328 .... ............ A ........ Prep renal graft/arterial ....................... 3.50 NA NA 0.99 1.08 0.26 XXX
50329 .... ............ A ........ Prep renal graft/ureteral ..................... 3.34 NA NA 1.07 1.08 0.25 XXX
50340 .... ............ A ........ Removal of kidney .............................. 13.86 NA NA 7.86 7.14 1.65 090
50360 .... ............ A ........ Transplantation of kidney ................... 40.45 NA NA 18.64 17.09 3.82 090
50365 .... ............ A ........ Transplantation of kidney ................... 45.68 NA NA 19.28 18.78 4.43 090
50370 .... ............ A ........ Remove transplanted kidney .............. 18.68 NA NA 9.18 8.18 1.68 090
50380 .... ............ A ........ Reimplantation of kidney .................... 29.66 NA NA 16.13 14.12 2.51 090
50382 .... ............ A ........ Change ureter stent, percut ............... 5.50 26.17 30.92 2.08 1.90 0.34 000
50384 .... ............ A ........ Remove ureter stent, percut ............... 5.00 20.53 27.71 1.88 1.73 0.31 000
50387 .... ............ A ........ Change ext/int ureter stent ................. 2.00 12.51 15.28 0.74 0.68 0.12 000
50389 .... ............ A ........ Remove renal tube w/fluoro ............... 1.10 6.63 9.64 0.41 0.38 0.07 000
50390 .... ............ A ........ Drainage of kidney lesion ................... 1.96 NA NA 0.72 0.65 0.12 000
50391 .... ............ A ........ Instll rx agnt into rnal tub .................... 1.96 1.39 1.50 0.73 0.69 0.14 000
50392 .... ............ A ........ Insert kidney drain .............................. 3.37 NA NA 1.53 1.48 0.20 000
50393 .... ............ A ........ Insert ureteral tube ............................. 4.15 NA NA 1.82 1.75 0.25 000
50394 .... ............ A ........ Injection for kidney x-ray .................... 0.76 1.86 2.25 0.58 0.61 0.05 000
50395 .... ............ A ........ Create passage to kidney .................. 3.37 NA NA 1.58 1.51 0.21 000
50396 .... ............ A ........ Measure kidney pressure ................... 2.09 NA NA 1.09 1.06 0.13 000
50398 .... ............ A ........ Change kidney tube ........................... 1.46 11.74 13.95 0.57 0.53 0.09 000
50400 .... ............ A ........ Revision of kidney/ureter .................... 21.12 NA NA 11.08 9.51 1.38 090
50405 .... ............ A ........ Revision of kidney/ureter .................... 25.68 NA NA 13.07 11.09 1.79 090
50500 .... ............ A ........ Repair of kidney wound ...................... 21.07 NA NA 8.75 8.66 2.02 090
50520 .... ............ A ........ Close kidney-skin fistula ..................... 18.73 NA NA 9.33 8.41 1.49 090
50525 .... ............ A ........ Repair renal-abdomen fistula ............. 24.21 NA NA 11.91 10.31 1.84 090
50526 .... ............ A ........ Repair renal-abdomen fistula ............. 26.13 NA NA 8.14 9.00 1.97 090
50540 .... ............ A ........ Revision of horseshoe kidney ............ 20.95 NA NA 10.74 9.56 1.36 090
50541 .... ............ A ........ Laparo ablate renal cyst ..................... 16.76 NA NA 8.81 7.66 1.13 090
50542 .... ............ A ........ Laparo ablate renal mass ................... 21.18 NA NA 11.32 9.73 1.39 090
50543 .... ............ A ........ Laparo partial nephrectomy ................ 27.18 NA NA 14.27 12.25 1.81 090
50544 .... ............ A ........ Laparoscopy, pyeloplasty ................... 23.27 NA NA 11.59 10.07 1.58 090
50545 .... ............ A ........ Laparo radical nephrectomy ............... 24.93 NA NA 12.31 10.78 1.71 090
50546 .... ............ A ........ Laparoscopic nephrectomy ................ 21.69 NA NA 11.42 9.91 1.57 090
50547 .... ............ A ........ Laparo removal donor kidney ............. 26.24 NA NA 12.54 11.85 2.77 090
50548 .... ............ A ........ Laparo remove w/ureter ..................... 25.26 NA NA 12.29 10.76 1.73 090
50549 .... ............ C ........ Laparoscope proc, renal ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
50551 .... ............ A ........ Kidney endoscopy .............................. 5.59 4.62 4.38 2.69 2.33 0.40 000
50553 .... ............ A ........ Kidney endoscopy .............................. 5.98 4.51 4.40 2.66 2.39 0.39 000
50555 .... ............ A ........ Kidney endoscopy & biopsy ............... 6.52 5.13 4.97 3.07 2.70 0.45 000
50557 .... ............ A ........ Kidney endoscopy & treatment .......... 6.61 5.30 4.94 3.12 2.71 0.47 000
50561 .... ............ A ........ Kidney endoscopy & treatment .......... 7.58 5.84 5.45 3.46 3.05 0.54 000
50562 .... ............ A ........ Renal scope w/tumor resect ............... 10.90 NA NA 5.43 4.88 0.73 090
50570 .... ............ A ........ Kidney endoscopy .............................. 9.53 NA NA 4.21 3.73 0.68 000
50574 .... ............ A ........ Kidney endoscopy & biopsy ............... 11.00 NA NA 4.87 4.30 0.77 000
50576 .... ............ A ........ Kidney endoscopy & treatment .......... 10.97 NA NA 4.85 4.27 0.78 000
50580 .... ............ A ........ Kidney endoscopy & treatment .......... 11.84 NA NA 5.17 4.58 0.83 000
50590 .... ............ A ........ Fragmenting of kidney stone .............. 9.64 17.08 14.76 6.18 5.16 0.65 090
50592 .... ............ A ........ Perc rf ablate renal tumor .................. 6.77 74.72 111.68 3.03 2.94 0.43 010
50600 .... ............ A ........ Exploration of ureter ........................... 17.04 NA NA 8.60 7.65 1.13 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
50605 .... ............ A ........ Insert ureteral support ........................ 16.66 NA NA 7.94 7.35 1.45 090
50610 .... ............ A ........ Removal of ureter stone ..................... 17.12 NA NA 9.01 8.02 1.43 090
50650 .... ............ A ........ Removal of ureter ............................... 18.67 NA NA 10.11 8.69 1.23 090
50660 .... ............ A ........ Removal of ureter ............................... 20.87 NA NA 10.85 9.42 1.38 090
50684 .... ............ A ........ Injection for ureter x-ray ..................... 0.76 3.94 4.47 0.63 0.55 0.05 000
50686 .... ............ A ........ Measure ureter pressure .................... 1.51 2.28 2.82 0.82 0.80 0.11 000
50688 .... ............ A ........ Change of ureter tube/stent ............... 1.18 NA NA 0.95 0.99 0.07 010
50690 .... ............ A ........ Injection for ureter x-ray ..................... 1.16 1.45 1.62 0.75 0.72 0.07 000
50700 .... ............ A ........ Revision of ureter ............................... 16.54 NA NA 8.86 7.91 1.27 090
50715 .... ............ A ........ Release of ureter ................................ 20.49 NA NA 8.63 8.70 2.14 090
50725 .... ............ A ........ Release/revise ureter ......................... 20.05 NA NA 8.89 8.61 1.52 090
50727 .... ............ A ........ Revise ureter ...................................... 8.17 NA NA 5.76 5.02 0.61 090
50728 .... ............ A ........ Revise ureter ...................................... 12.00 NA NA 6.79 6.25 1.00 090
50740 .... ............ A ........ Fusion of ureter & kidney ................... 19.92 NA NA 8.99 8.38 1.97 090
50750 .... ............ A ........ Fusion of ureter & kidney ................... 21.07 NA NA 11.22 9.38 1.38 090
50760 .... ............ A ........ Fusion of ureters ................................ 19.92 NA NA 9.98 8.81 1.55 090
50770 .... ............ A ........ Splicing of ureters ............................... 21.07 NA NA 11.01 9.46 1.45 090
50780 .... ............ A ........ Reimplant ureter in bladder ................ 19.80 NA NA 10.22 8.91 1.51 090
50800 .... ............ A ........ Implant ureter in bowel ....................... 16.23 NA NA 9.25 7.88 1.19 090
50810 .... ............ A ........ Fusion of ureter & bowel .................... 22.38 NA NA 10.64 9.69 2.32 090
50815 .... ............ A ........ Urine shunt to intestine ...................... 22.06 NA NA 11.59 10.04 1.54 090
50820 .... ............ A ........ Construct bowel bladder ..................... 23.89 NA NA 11.97 10.33 1.90 090
50825 .... ............ A ........ Construct bowel bladder ..................... 30.48 NA NA 15.08 13.13 2.08 090
50830 .... ............ A ........ Revise urine flow ................................ 33.57 NA NA 15.78 14.03 2.38 090
50840 .... ............ A ........ Replace ureter by bowel .................... 22.19 NA NA 12.06 10.25 1.47 090
50845 .... ............ A ........ Appendico-vesicostomy ...................... 22.21 NA NA 12.35 10.66 1.57 090
50860 .... ............ A ........ Transplant ureter to skin .................... 16.93 NA NA 9.31 7.94 1.29 090
50900 .... ............ A ........ Repair of ureter .................................. 14.89 NA NA 8.06 7.11 1.14 090
50920 .... ............ A ........ Closure ureter/skin fistula ................... 15.66 NA NA 8.60 7.57 1.01 090
50930 .... ............ A ........ Closure ureter/bowel fistula ................ 20.04 NA NA 9.56 8.90 1.28 090
50945 .... ............ A ........ Laparoscopy ureterolithotomy ............ 17.87 NA NA 9.40 8.13 1.36 090
50947 .... ............ A ........ Laparo new ureter/bladder ................. 25.63 NA NA 12.42 11.09 2.17 090
50948 .... ............ A ........ Laparo new ureter/bladder ................. 23.69 NA NA 11.31 10.14 1.71 090
50949 .... ............ C ........ Laparoscope proc, ureter ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
50951 .... ............ A ........ Endoscopy of ureter ........................... 5.83 4.85 4.58 2.80 2.43 0.41 000
50953 .... ............ A ........ Endoscopy of ureter ........................... 6.23 4.95 4.69 3.25 2.82 0.43 000
50955 .... ............ A ........ Ureter endoscopy & biopsy ................ 6.74 5.17 5.80 3.49 3.09 0.48 000
50957 .... ............ A ........ Ureter endoscopy & treatment ........... 6.78 5.41 4.98 3.19 2.78 0.48 000
50961 .... ............ A ........ Ureter endoscopy & treatment ........... 6.04 4.77 4.57 2.82 2.49 0.41 000
50970 .... ............ A ........ Ureter endoscopy ............................... 7.13 NA NA 3.29 2.88 0.52 000
50972 .... ............ A ........ Ureter endoscopy & catheter ............. 6.88 NA NA 3.10 2.77 0.49 000
50974 .... ............ A ........ Ureter endoscopy & biopsy ................ 9.16 NA NA 3.82 3.49 0.64 000
50976 .... ............ A ........ Ureter endoscopy & treatment ........... 9.03 NA NA 3.91 3.45 0.66 000
50980 .... ............ A ........ Ureter endoscopy & treatment ........... 6.84 NA NA 3.17 2.76 0.48 000
51000 .... ............ A ........ Drainage of bladder ............................ 0.78 0.92 1.43 0.27 0.26 0.05 000
51020 .... ............ A ........ Incise & treat bladder ......................... 7.56 NA NA 5.42 4.63 0.47 090
51030 .... ............ A ........ Incise & treat bladder ......................... 7.68 NA NA 4.78 4.39 0.58 090
51040 .... ............ A ........ Incise & drain bladder ........................ 4.43 NA NA 3.71 3.24 0.31 090
51045 .... ............ A ........ Incise bladder/drain ureter .................. 7.68 NA NA 5.18 4.57 0.52 090
51050 .... ............ A ........ Removal of bladder stone .................. 7.87 NA NA 5.37 4.52 0.49 090
51065 .... ............ A ........ Remove ureter calculus ...................... 9.82 NA NA 6.30 5.35 0.63 090
51080 .... ............ A ........ Drainage of bladder abscess ............. 6.61 NA NA 4.67 4.04 0.43 090
51500 .... ............ A ........ Removal of bladder cyst ..................... 10.92 NA NA 5.76 5.40 1.03 090
51520 .... ............ A ........ Removal of bladder lesion .................. 10.08 NA NA 6.37 5.56 0.69 090
51535 .... ............ A ........ Repair of ureter lesion ........................ 13.77 NA NA 7.43 6.80 1.23 090
51550 .... ............ A ........ Partial removal of bladder .................. 17.10 NA NA 8.79 7.79 1.31 090
51555 .... ............ A ........ Partial removal of bladder .................. 23.03 NA NA 11.48 10.09 1.70 090
51565 .... ............ A ........ Revise bladder & ureter(s) ................. 23.50 NA NA 12.26 10.60 1.63 090
51570 .... ............ A ........ Removal of bladder ............................ 27.31 NA NA 13.65 11.68 1.72 090
51575 .... ............ A ........ Removal of bladder & nodes .............. 34.00 NA NA 16.66 14.40 2.17 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
51580 .... ............ A ........ Remove bladder/revise tract .............. 35.14 NA NA 17.81 15.16 2.25 090
51585 .... ............ A ........ Removal of bladder & nodes .............. 39.41 NA NA 19.51 16.67 2.49 090
51596 .... ............ A ........ Remove bladder/create pouch ........... 44.01 NA NA 21.49 18.38 2.78 090
51597 .... ............ A ........ Removal of pelvic structures .............. 42.61 NA NA 20.44 17.62 2.82 090
51600 .... ............ A ........ Injection for bladder x-ray ................... 0.88 4.21 4.61 0.33 0.30 0.06 000
51605 .... ............ A ........ Preparation for bladder xray ............... 0.64 NA NA 0.43 0.39 0.04 000
51610 .... ............ A ........ Injection for bladder x-ray ................... 1.05 1.91 2.09 0.71 0.65 0.07 000
51700 .... ............ A ........ Irrigation of bladder ............................ 0.88 1.50 1.55 0.35 0.32 0.06 000
51701 .... ............ A ........ Insert bladder catheter ....................... 0.50 1.03 1.31 0.25 0.22 0.04 000
51702 .... ............ A ........ Insert temp bladder cath .................... 0.50 1.52 1.80 0.34 0.29 0.04 000
51703 .... ............ A ........ Insert bladder cath, complex .............. 1.47 2.26 2.50 0.81 0.69 0.10 000
51705 .... ............ A ........ Change of bladder tube ...................... 1.03 2.02 2.15 0.85 0.73 0.07 010
51710 .... ............ A ........ Change of bladder tube ...................... 1.50 2.72 3.03 1.18 0.98 0.11 010
51715 .... ............ A ........ Endoscopic injection/implant .............. 3.73 4.42 4.17 1.75 1.56 0.29 000
51720 .... ............ A ........ Treatment of bladder lesion ............... 1.50 1.62 1.69 0.75 0.72 0.14 000
51725 .... ............ A ........ Simple cystometrogram ...................... 1.51 4.22 4.91 4.22 4.91 0.16 000
51725 .... 26 ....... A ........ Simple cystometrogram ...................... 1.51 0.56 0.53 0.56 0.53 0.12 000
51725 .... TC ...... A ........ Simple cystometrogram ...................... 0.00 3.66 4.39 3.66 4.39 0.04 000
51726 .... ............ A ........ Complex cystometrogram ................... 1.71 7.08 7.30 7.08 7.30 0.18 000
51726 .... 26 ....... A ........ Complex cystometrogram ................... 1.71 0.65 0.61 0.65 0.61 0.13 000
51726 .... TC ...... A ........ Complex cystometrogram ................... 0.00 6.43 6.69 6.43 6.69 0.05 000
51736 .... ............ A ........ Urine flow measurement .................... 0.61 0.94 0.76 0.94 0.76 0.06 000
51736 .... 26 ....... A ........ Urine flow measurement .................... 0.61 0.24 0.22 0.24 0.22 0.05 000
51736 .... TC ...... A ........ Urine flow measurement .................... 0.00 0.70 0.54 0.70 0.54 0.01 000
51741 .... ............ A ........ Electro-uroflowmetry, first ................... 1.14 1.28 1.03 1.28 1.03 0.11 000
51741 .... 26 ....... A ........ Electro-uroflowmetry, first ................... 1.14 0.45 0.41 0.45 0.41 0.09 000
51741 .... TC ...... A ........ Electro-uroflowmetry, first ................... 0.00 0.82 0.62 0.82 0.62 0.02 000
51772 .... ............ A ........ Urethra pressure profile ...................... 1.61 5.03 5.30 5.03 5.30 0.20 000
51772 .... 26 ....... A ........ Urethra pressure profile ...................... 1.61 0.55 0.55 0.55 0.55 0.15 000
51772 .... TC ...... A ........ Urethra pressure profile ...................... 0.00 4.48 4.75 4.48 4.75 0.05 000
51784 .... ............ A ........ Anal/urinary muscle study .................. 1.53 4.11 4.00 4.11 4.00 0.16 000
51784 .... 26 ....... A ........ Anal/urinary muscle study .................. 1.53 0.57 0.53 0.57 0.53 0.12 000
51784 .... TC ...... A ........ Anal/urinary muscle study .................. 0.00 3.54 3.47 3.54 3.47 0.04 000
51785 .... ............ A ........ Anal/urinary muscle study .................. 1.53 4.54 4.49 4.54 4.49 0.15 000
51785 .... 26 ....... A ........ Anal/urinary muscle study .................. 1.53 0.57 0.54 0.57 0.54 0.11 000
51785 .... TC ...... A ........ Anal/urinary muscle study .................. 0.00 3.97 3.95 3.97 3.95 0.04 000
51792 .... ............ A ........ Urinary reflex study ............................ 1.10 5.07 5.52 5.07 5.52 0.20 000
51792 .... 26 ....... A ........ Urinary reflex study ............................ 1.10 0.40 0.41 0.40 0.41 0.07 000
51792 .... TC ...... A ........ Urinary reflex study ............................ 0.00 4.67 5.11 4.67 5.11 0.13 000
51795 .... ............ A ........ Urine voiding pressure study .............. 1.53 6.69 7.00 6.69 7.00 0.22 000
51795 .... 26 ....... A ........ Urine voiding pressure study .............. 1.53 0.58 0.54 0.58 0.54 0.12 000
51795 .... TC ...... A ........ Urine voiding pressure study .............. 0.00 6.11 6.46 6.11 6.46 0.10 000
51797 .... ............ A ........ Intraabdominal pressure test .............. 1.60 4.82 5.31 4.82 5.31 0.17 000
51797 .... 26 ....... A ........ Intraabdominal pressure test .............. 1.60 0.60 0.57 0.60 0.57 0.12 000
51797 .... TC ...... A ........ Intraabdominal pressure test .............. 0.00 4.22 4.74 4.22 4.74 0.05 000
51798 .... ............ A ........ Us urine capacity measure ................. 0.00 0.59 0.46 NA NA 0.08 XXX
51800 .... ............ A ........ Revision of bladder/urethra ................ 18.74 NA NA 9.83 8.76 1.32 090
51820 .... ............ A ........ Revision of urinary tract ..................... 19.41 NA NA 9.75 9.16 1.75 090
51840 .... ............ A ........ Attach bladder/urethra ........................ 11.28 NA NA 5.80 5.68 1.06 090
51841 .... ............ A ........ Attach bladder/urethra ........................ 13.60 NA NA 6.95 6.65 1.24 090
51845 .... ............ A ........ Repair bladder neck ........................... 10.07 NA NA 5.94 5.34 0.79 090
51860 .... ............ A ........ Repair of bladder wound .................... 12.49 NA NA 6.76 6.27 1.16 090
51865 .... ............ A ........ Repair of bladder wound .................... 15.69 NA NA 8.41 7.56 1.23 090
51880 .... ............ A ........ Repair of bladder opening .................. 7.81 NA NA 4.75 4.35 0.72 090
51900 .... ............ A ........ Repair bladder/vagina lesion .............. 14.48 NA NA 8.07 7.07 1.21 090
51920 .... ............ A ........ Close bladder-uterus fistula ................ 13.26 NA NA 8.12 6.83 1.18 090
51925 .... ............ A ........ Hysterectomy/bladder repair .............. 17.35 NA NA 11.93 10.01 2.04 090
51940 .... ............ A ........ Correction of bladder defect ............... 30.48 NA NA 11.80 11.89 2.15 090
51960 .... ............ A ........ Revision of bladder & bowel .............. 25.20 NA NA 13.02 11.37 1.63 090
51980 .... ............ A ........ Construct bladder opening ................. 12.44 NA NA 7.12 6.29 0.86 090
51990 .... ............ A ........ Laparo urethral suspension ................ 13.26 NA NA 5.97 6.06 1.39 090
51992 .... ............ A ........ Laparo sling operation ........................ 14.77 NA NA 6.57 6.40 1.41 090
51999 .... ............ C ........ Laparoscope proc, bla ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
52000 .... ............ A ........ Cystoscopy ......................................... 2.23 3.66 3.49 1.33 1.05 0.14 000
52001 .... ............ A ........ Cystoscopy, removal of clots ............. 5.44 5.07 5.08 2.60 2.24 0.39 000
52005 .... ............ A ........ Cystoscopy & ureter catheter ............. 2.37 5.72 5.65 1.38 1.14 0.17 000
52007 .... ............ A ........ Cystoscopy and biopsy ...................... 3.02 10.67 13.56 1.63 1.40 0.22 000
52010 .... ............ A ........ Cystoscopy & duct catheter ............... 3.02 8.02 9.41 1.63 1.40 0.21 000
52204 .... ............ A ........ Cystoscopy w/biopsy(s) ...................... 2.59 8.28 11.41 1.39 1.15 0.17 000
52214 .... ............ A ........ Cystoscopy and treatment .................. 3.70 19.80 28.97 1.85 1.60 0.26 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
52234 .... ............ A ........ Cystoscopy and treatment .................. 4.62 NA NA 2.30 1.99 0.33 000
52250 .... ............ A ........ Cystoscopy and radiotracer ................ 4.49 NA NA 2.33 2.00 0.32 000
52270 .... ............ A ........ Cystoscopy & revise urethra .............. 3.36 7.01 9.03 1.76 1.51 0.24 000
52275 .... ............ A ........ Cystoscopy & revise urethra .............. 4.69 9.28 12.43 2.30 1.99 0.33 000
52282 .... ............ A ........ Cystoscopy, implant stent .................. 6.39 NA NA 3.00 2.63 0.45 000
52317 .... ............ A ........ Remove bladder stone ....................... 6.71 17.02 23.00 3.04 2.67 0.48 000
52318 .... ............ A ........ Remove bladder stone ....................... 9.18 NA NA 4.10 3.61 0.65 000
52325 .... ............ A ........ Cystoscopy, stone removal ................ 6.15 NA NA 2.82 2.48 0.44 000
52327 .... ............ A ........ Cystoscopy, inject material ................. 5.18 18.03 24.89 2.41 2.11 0.37 000
52334 .... ............ A ........ Create passage to kidney .................. 4.82 NA NA 2.36 2.05 0.35 000
52341 .... ............ A ........ Cysto w/ureter stricture tx .................. 6.11 NA NA 3.08 2.65 0.43 000
52342 .... ............ A ........ Cysto w/up stricture tx ........................ 6.61 NA NA 3.30 2.83 0.46 000
52343 .... ............ A ........ Cysto w/renal stricture tx .................... 7.31 NA NA 3.53 3.07 0.51 000
52344 .... ............ A ........ Cysto/uretero, stricture tx ................... 7.81 NA NA 3.95 3.38 0.55 000
52345 .... ............ A ........ Cysto/uretero w/up stricture ............... 8.31 NA NA 4.16 3.57 0.58 000
52346 .... ............ A ........ Cystouretero w/renal strict .................. 9.34 NA NA 4.57 3.94 0.65 000
52351 .... ............ A ........ Cystouretero & or pyeloscope ............ 5.85 NA NA 2.99 2.57 0.41 000
52352 .... ............ A ........ Cystouretero w/stone remove ............ 6.87 NA NA 3.51 3.02 0.49 000
52353 .... ............ A ........ Cystouretero w/lithotripsy ................... 7.96 NA NA 3.95 3.41 0.57 000
52354 .... ............ A ........ Cystouretero w/biopsy ........................ 7.33 NA NA 3.69 3.19 0.52 000
52355 .... ............ A ........ Cystouretero w/excise tumor .............. 8.81 NA NA 4.30 3.73 0.63 000
52400 .... ............ A ........ Cystouretero w/congen repr ............... 10.06 NA NA 5.45 4.60 0.68 090
52402 .... ............ A ........ Cystourethro cut ejacul duct ............... 5.27 NA NA 2.19 1.96 0.40 000
52450 .... ............ A ........ Incision of prostate ............................. 7.63 NA NA 5.52 4.61 0.54 090
52500 .... ............ A ........ Revision of bladder neck .................... 9.39 NA NA 6.23 5.09 0.60 090
52510 .... ............ A ........ Dilation prostatic urethra .................... 7.49 NA NA 4.94 4.03 0.48 090
52601 .... ............ A ........ Prostatectomy (TURP) ....................... 15.13 NA NA 8.52 6.83 0.87 090
52606 .... ............ A ........ Control postop bleeding ..................... 8.84 NA NA 5.53 4.56 0.57 090
52612 .... ............ A ........ Prostatectomy, first stage ................... 9.07 NA NA 5.93 4.84 0.56 090
52614 .... ............ A ........ Prostatectomy, second stage ............. 7.81 NA NA 5.41 4.39 0.48 090
52620 .... ............ A ........ Remove residual prostate .................. 7.19 NA NA 4.66 3.83 0.47 090
52630 .... ............ A ........ Remove prostate regrowth ................. 7.65 NA NA 4.84 4.03 0.51 090
52640 .... ............ A ........ Relieve bladder contracture ............... 6.89 NA NA 4.45 3.72 0.47 090
52647 .... ............ A ........ Laser surgery of prostate ................... 11.15 41.80 57.91 6.96 5.76 0.73 090
52648 .... ............ A ........ Laser surgery of prostate ................... 12.00 42.34 58.18 7.29 6.06 0.79 090
52700 .... ............ A ........ Drainage of prostate abscess ............ 7.39 NA NA 4.94 4.08 0.48 090
53000 .... ............ A ........ Incision of urethra ............................... 2.30 NA NA 1.78 1.67 0.16 010
53040 .... ............ A ........ Drainage of urethra abscess .............. 6.49 NA NA 4.43 3.94 0.45 090
53060 .... ............ A ........ Drainage of urethra abscess .............. 2.65 2.10 2.07 1.55 1.44 0.28 010
53080 .... ............ A ........ Drainage of urinary leakage ............... 6.82 NA NA 5.00 5.47 0.52 090
53085 .... ............ A ........ Drainage of urinary leakage ............... 11.05 NA NA 4.43 5.94 0.92 090
53200 .... ............ A ........ Biopsy of urethra ................................ 2.59 1.71 1.52 1.31 1.15 0.20 000
53210 .... ............ A ........ Removal of urethra ............................. 13.59 NA NA 7.76 6.81 0.89 090
53215 .... ............ A ........ Removal of urethra ............................. 16.72 NA NA 9.23 7.94 1.10 090
53220 .... ............ A ........ Treatment of urethra lesion ................ 7.53 NA NA 5.03 4.38 0.49 090
53230 .... ............ A ........ Removal of urethra lesion .................. 10.31 NA NA 6.43 5.59 0.73 090
53235 .... ............ A ........ Removal of urethra lesion .................. 10.86 NA NA 6.97 5.95 0.72 090
53240 .... ............ A ........ Surgery for urethra pouch .................. 6.98 NA NA 4.90 4.20 0.52 090
53250 .... ............ A ........ Removal of urethra gland ................... 6.42 NA NA 4.41 3.91 0.49 090
53260 .... ............ A ........ Treatment of urethra lesion ................ 3.00 2.46 2.35 1.85 1.64 0.25 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
53265 .... ............ A ........ Treatment of urethra lesion ................ 3.14 2.95 2.84 2.00 1.71 0.24 010
53270 .... ............ A ........ Removal of urethra gland ................... 3.11 2.47 2.31 1.86 1.68 0.30 010
53275 .... ............ A ........ Repair of urethra defect ..................... 4.54 NA NA 2.79 2.52 0.32 010
53400 .... ............ A ........ Revise urethra, stage 1 ...................... 13.98 NA NA 8.28 7.15 0.98 090
53405 .... ............ A ........ Revise urethra, stage 2 ...................... 15.51 NA NA 8.78 7.59 1.10 090
53410 .... ............ A ........ Reconstruction of urethra ................... 17.53 NA NA 9.77 8.44 1.16 090
53420 .... ............ A ........ Reconstruct urethra, stage 1 .............. 15.04 NA NA 7.07 6.60 0.96 090
53425 .... ............ A ........ Reconstruct urethra, stage 2 .............. 16.94 NA NA 9.10 8.05 1.13 090
53431 .... ............ A ........ Reconstruct urethra/bladder ............... 21.03 NA NA 11.11 9.60 1.41 090
53440 .... ............ A ........ Male sling procedure .......................... 15.34 NA NA 9.27 7.64 0.96 090
53442 .... ............ A ........ Remove/revise male sling .................. 13.29 NA NA 8.43 6.95 0.82 090
53444 .... ............ A ........ Insert tandem cuff ............................... 14.06 NA NA 8.11 7.00 0.94 090
53445 .... ............ A ........ Insert uro/ves nck sphincter ............... 15.21 NA NA 8.85 7.98 0.99 090
53446 .... ............ A ........ Remove uro sphincter ........................ 10.89 NA NA 7.06 6.15 0.72 090
53447 .... ............ A ........ Remove/replace ur sphincter ............. 14.15 NA NA 8.46 7.46 0.95 090
53448 .... ............ A ........ Remov/replc ur sphinctr comp ........... 23.26 NA NA 12.47 10.79 1.50 090
53449 .... ............ A ........ Repair uro sphincter ........................... 10.43 NA NA 6.67 5.71 0.68 090
53450 .... ............ A ........ Revision of urethra ............................. 6.67 NA NA 4.79 4.05 0.43 090
53500 .... ............ A ........ Urethrlys, transvag w/ scope .............. 12.87 NA NA 7.49 6.85 0.90 090
53502 .... ............ A ........ Repair of urethra injury ....................... 8.16 NA NA 5.11 4.54 0.62 090
53520 .... ............ A ........ Repair of urethra defect ..................... 9.35 NA NA 6.25 5.36 0.61 090
53600 .... ............ A ........ Dilate urethra stricture ........................ 1.21 1.16 1.15 0.58 0.51 0.09 000
53605 .... ............ A ........ Dilate urethra stricture ........................ 1.28 NA NA 0.52 0.47 0.09 000
53660 .... ............ A ........ Dilation of urethra ............................... 0.71 1.32 1.31 0.46 0.39 0.05 000
53661 .... ............ A ........ Dilation of urethra ............................... 0.72 1.29 1.30 0.42 0.36 0.05 000
53665 .... ............ A ........ Dilation of urethra ............................... 0.76 NA NA 0.27 0.26 0.06 000
53850 .... ............ A ........ Prostatic microwave thermotx ............ 9.98 49.02 71.59 5.93 4.95 0.67 090
53852 .... ............ A ........ Prostatic rf thermotx ........................... 10.68 46.18 67.53 6.72 5.56 0.70 090
53853 .... ............ A ........ Prostatic water thermother ................. 5.54 28.96 42.18 4.37 3.62 0.37 090
53899 .... ............ C ........ Urology surgery procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
54000 .... ............ A ........ Slitting of prepuce ............................... 1.56 2.70 2.81 1.49 1.21 0.11 010
54001 .... ............ A ........ Slitting of prepuce ............................... 2.21 3.06 3.12 1.68 1.40 0.15 010
54015 .... ............ A ........ Drain penis lesion ............................... 5.33 NA NA 3.24 2.89 0.38 010
54050 .... ............ A ........ Destruction, penis lesion(s) ................ 1.26 2.09 1.88 1.40 1.21 0.08 010
54056 .... ............ A ........ Cryosurgery, penis lesion(s) ............... 1.26 2.37 2.03 1.54 1.33 0.06 010
54057 .... ............ A ........ Laser surg, penis lesion(s) ................. 1.26 2.62 2.41 1.37 1.10 0.09 010
54060 .... ............ A ........ Excision of penis lesion(s) .................. 1.95 3.09 3.10 1.64 1.35 0.13 010
54100 .... ............ A ........ Biopsy of penis ................................... 1.90 3.35 3.08 1.38 1.10 0.10 000
54105 .... ............ A ........ Biopsy of penis ................................... 3.51 3.98 4.14 2.45 2.20 0.25 010
54110 .... ............ A ........ Treatment of penis lesion ................... 10.79 NA NA 6.78 5.75 0.72 090
54111 .... ............ A ........ Treat penis lesion, graft ...................... 14.29 NA NA 8.12 6.96 0.96 090
54112 .... ............ A ........ Treat penis lesion, graft ...................... 16.83 NA NA 9.41 8.12 1.11 090
54115 .... ............ A ........ Treatment of penis lesion ................... 6.82 5.78 5.09 4.97 4.23 0.43 090
54120 .... ............ A ........ Partial removal of penis ...................... 10.88 NA NA 6.79 5.75 0.68 090
54125 .... ............ A ........ Removal of penis ................................ 14.43 NA NA 8.16 7.02 0.95 090
54130 .... ............ A ........ Remove penis & nodes ...................... 21.66 NA NA 11.72 9.92 1.52 090
54135 .... ............ A ........ Remove penis & nodes ...................... 27.99 NA NA 14.29 12.26 1.88 090
54150 .... ............ A ........ Circumcision w/regionl block .............. 1.90 2.40 3.38 0.75 0.73 0.16 000
54160 .... ............ A ........ Circumcision, neonate ........................ 2.50 3.80 3.95 1.49 1.29 0.19 010
54161 .... ............ A ........ Circum 28 days or older ..................... 3.29 NA NA 2.22 1.89 0.23 010
54162 .... ............ A ........ Lysis penil circumic lesion .................. 3.27 4.01 4.33 2.28 1.86 0.21 010
54163 .... ............ A ........ Repair of circumcision ........................ 3.27 NA NA 2.86 2.44 0.21 010
54164 .... ............ A ........ Frenulotomy of penis .......................... 2.77 NA NA 2.66 2.25 0.18 010
54205 .... ............ A ........ Treatment of penis lesion ................... 8.84 NA NA 6.10 5.41 0.56 090
54230 .... ............ A ........ Prepare penis study ........................... 1.34 1.41 1.24 0.91 0.77 0.09 000
54231 .... ............ A ........ Dynamic cavernosometry ................... 2.04 1.98 1.66 1.26 1.05 0.16 000
54235 .... ............ A ........ Penile injection ................................... 1.19 1.39 1.18 0.90 0.74 0.08 000
54240 .... ............ A ........ Penis study ......................................... 1.31 1.51 1.28 1.51 1.28 0.17 000
54240 .... 26 ....... A ........ Penis study ......................................... 1.31 0.49 0.46 0.49 0.46 0.11 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
54240 .... TC ...... A ........ Penis study ......................................... 0.00 1.02 0.81 1.02 0.81 0.06 000
54250 .... ............ A ........ Penis study ......................................... 2.22 1.23 1.08 1.23 1.08 0.18 000
54250 .... 26 ....... A ........ Penis study ......................................... 2.22 0.87 0.80 0.87 0.80 0.16 000
54250 .... TC ...... A ........ Penis study ......................................... 0.00 0.37 0.28 0.37 0.28 0.02 000
54300 .... ............ A ........ Revision of penis ................................ 11.07 NA NA 6.76 6.18 0.76 090
54328 .... ............ A ........ Revise penis/urethra ........................... 16.74 NA NA 9.58 8.46 0.98 090
54340 .... ............ A ........ Secondary urethral surgery ................ 9.58 NA NA 6.41 5.74 0.63 090
54352 .... ............ A ........ Reconstruct urethra/penis .................. 25.95 NA NA 14.13 12.61 2.25 090
54360 .... ............ A ........ Penis plastic surgery .......................... 12.65 NA NA 7.52 6.79 0.84 090
54380 .... ............ A ........ Repair penis ....................................... 14.03 NA NA 8.04 6.93 0.93 090
54385 .... ............ A ........ Repair penis ....................................... 16.38 NA NA 11.34 9.31 0.86 090
54390 .... ............ A ........ Repair penis and bladder ................... 22.59 NA NA 7.40 8.40 1.54 090
54400 .... ............ A ........ Insert semi-rigid prosthesis ................ 9.09 NA NA 5.80 5.08 0.64 090
54401 .... ............ A ........ Insert self-contd prosthesis ................ 10.26 NA NA 8.20 6.97 0.73 090
54405 .... ............ A ........ Insert multi-comp penis pros .............. 14.39 NA NA 8.20 7.07 0.95 090
54406 .... ............ A ........ Remove muti-comp penis pros .......... 12.76 NA NA 7.68 6.57 0.86 090
54408 .... ............ A ........ Repair multi-comp penis pros ............ 13.73 NA NA 8.32 7.03 0.90 090
54410 .... ............ A ........ Remove/replace penis prosth ............. 16.48 NA NA 9.45 8.05 1.10 090
54411 .... ............ A ........ Remov/replc penis pros, comp ........... 18.14 NA NA 10.51 8.79 1.13 090
54415 .... ............ A ........ Remove self-contd penis pros ............ 8.75 NA NA 6.05 5.13 0.58 090
54416 .... ............ A ........ Remv/repl penis contain pros ............. 11.87 NA NA 7.96 6.67 0.77 090
54417 .... ............ A ........ Remv/replc penis pros, compl ............ 15.94 NA NA 9.19 7.70 1.00 090
54440 .... ............ C ........ Repair of penis ................................... 0.42 NA NA 0.00 0.00 0.00 090
54450 .... ............ A ........ Preputial stretching ............................. 1.12 0.86 0.91 0.49 0.46 0.08 000
54500 .... ............ A ........ Biopsy of testis ................................... 1.31 NA NA 0.77 0.67 0.10 000
54505 .... ............ A ........ Biopsy of testis ................................... 3.47 NA NA 2.46 2.18 0.27 010
54512 .... ............ A ........ Excise lesion testis ............................. 9.23 NA NA 5.72 4.93 0.67 090
54520 .... ............ A ........ Removal of testis ................................ 5.25 NA NA 3.74 3.27 0.50 090
54522 .... ............ A ........ Orchiectomy, partial ............................ 10.15 NA NA 5.59 5.26 0.89 090
54530 .... ............ A ........ Removal of testis ................................ 9.31 NA NA 6.11 5.18 0.66 090
54535 .... ............ A ........ Extensive testis surgery ..................... 13.06 NA NA 6.95 6.36 0.95 090
54550 .... ............ A ........ Exploration for testis ........................... 8.31 NA NA 5.24 4.55 0.59 090
54560 .... ............ A ........ Exploration for testis ........................... 11.97 NA NA 6.92 5.94 0.90 090
54600 .... ............ A ........ Reduce testis torsion .......................... 7.54 NA NA 5.15 4.36 0.51 090
54620 .... ............ A ........ Suspension of testis ........................... 5.16 NA NA 3.25 2.85 0.37 010
54640 .... ............ A ........ Suspension of testis ........................... 7.57 NA NA 5.38 4.58 0.62 090
54650 .... ............ A ........ Orchiopexy (Fowler-Stephens) ........... 12.24 NA NA 5.68 5.89 1.16 090
54660 .... ............ A ........ Revision of testis ................................ 5.64 NA NA 4.37 3.70 0.44 090
54670 .... ............ A ........ Repair testis injury .............................. 6.57 NA NA 4.81 4.18 0.47 090
54680 .... ............ A ........ Relocation of testis(es) ....................... 13.91 NA NA 7.74 6.96 1.16 090
54690 .... ............ A ........ Laparoscopy, orchiectomy .................. 11.60 NA NA 5.60 5.37 1.02 090
54692 .... ............ A ........ Laparoscopy, orchiopexy .................... 13.64 NA NA 7.64 6.55 1.30 090
54699 .... ............ C ........ Laparoscope proc, testis .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
54700 .... ............ A ........ Drainage of scrotum ........................... 3.44 NA NA 2.39 2.16 0.28 010
54800 .... ............ A ........ Biopsy of epididymis ........................... 2.33 NA NA 1.24 1.03 0.23 000
54830 .... ............ A ........ Remove epididymis lesion .................. 5.91 NA NA 4.46 3.75 0.41 090
54840 .... ............ A ........ Remove epididymis lesion .................. 5.22 NA NA 3.82 3.31 0.37 090
54860 .... ............ A ........ Removal of epididymis ....................... 6.85 NA NA 4.91 4.12 0.45 090
54861 .... ............ A ........ Removal of epididymis ....................... 9.57 NA NA 6.30 5.31 0.63 090
54865 .... ............ A ........ Explore epididymis ............................. 5.67 NA NA 4.28 3.39 0.40 090
54900 .... ............ A ........ Fusion of spermatic ducts .................. 14.05 NA NA 5.23 5.50 0.93 090
54901 .... ............ A ........ Fusion of spermatic ducts .................. 18.92 NA NA 10.63 8.40 1.83 090
55000 .... ............ A ........ Drainage of hydrocele ........................ 1.43 1.85 1.96 0.92 0.79 0.11 000
55040 .... ............ A ........ Removal of hydrocele ......................... 5.39 NA NA 3.97 3.44 0.43 090
55041 .... ............ A ........ Removal of hydroceles ....................... 8.41 NA NA 5.72 4.85 0.60 090
55060 .... ............ A ........ Repair of hydrocele ............................ 6.05 NA NA 4.48 3.78 0.46 090
55100 .... ............ A ........ Drainage of scrotum abscess ............. 2.40 3.49 3.58 2.11 1.84 0.17 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
55110 .... ............ A ........ Explore scrotum .................................. 6.23 NA NA 4.51 3.82 0.43 090
55120 .... ............ A ........ Removal of scrotum lesion ................. 5.62 NA NA 4.23 3.60 0.39 090
55150 .... ............ A ........ Removal of scrotum ........................... 8.01 NA NA 5.49 4.67 0.56 090
55175 .... ............ A ........ Revision of scrotum ............................ 5.77 NA NA 4.36 3.69 0.37 090
55180 .... ............ A ........ Revision of scrotum ............................ 11.63 NA NA 7.33 6.36 0.90 090
55200 .... ............ A ........ Incision of sperm duct ........................ 4.50 7.99 10.19 3.34 2.87 0.33 090
55250 .... ............ A ........ Removal of sperm duct(s) .................. 3.32 7.83 9.63 3.08 2.63 0.25 090
55300 .... ............ A ........ Prepare, sperm duct x-ray .................. 3.50 NA NA 1.77 1.52 0.25 000
55400 .... ............ A ........ Repair of sperm duct .......................... 8.53 NA NA 5.46 4.77 0.64 090
55450 .... ............ A ........ Ligation of sperm duct ........................ 4.38 5.46 6.31 2.58 2.27 0.29 010
55500 .... ............ A ........ Removal of hydrocele ......................... 6.12 NA NA 4.21 3.66 0.55 090
55520 .... ............ A ........ Removal of sperm cord lesion ........... 6.56 NA NA 3.80 3.53 0.75 090
55530 .... ............ A ........ Revise spermatic cord veins .............. 5.69 NA NA 4.11 3.57 0.45 090
55535 .... ............ A ........ Revise spermatic cord veins .............. 7.09 NA NA 4.86 4.13 0.47 090
55540 .... ............ A ........ Revise hernia & sperm veins ............. 8.20 NA NA 4.23 4.02 0.94 090
55550 .... ............ A ........ Laparo ligate spermatic vein .............. 7.10 NA NA 4.57 3.94 0.57 090
55559 .... ............ C ........ Laparo proc, spermatic cord .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
55600 .... ............ A ........ Incise sperm duct pouch .................... 6.91 NA NA 4.94 4.14 0.62 090
55605 .... ............ A ........ Incise sperm duct pouch .................... 8.63 NA NA 4.60 4.50 0.64 090
55650 .... ............ A ........ Remove sperm duct pouch ................ 12.52 NA NA 7.47 6.35 0.92 090
55680 .... ............ A ........ Remove sperm pouch lesion .............. 5.59 NA NA 3.95 3.45 0.47 090
55700 .... ............ A ........ Biopsy of prostate ............................... 2.58 3.71 3.96 1.34 0.99 0.11 000
55705 .... ............ A ........ Biopsy of prostate ............................... 4.58 NA NA 2.88 2.59 0.32 010
55801 .... ............ A ........ Removal of prostate ........................... 19.62 NA NA 10.44 9.08 1.34 090
55810 .... ............ A ........ Extensive prostate surgery ................. 24.14 NA NA 12.49 10.74 1.60 090
55860 .... ............ A ........ Surgical exposure, prostate ................ 15.71 NA NA 8.64 7.55 1.02 090
55866 .... ............ A ........ Laparo radical prostatectomy ............. 32.25 NA NA 16.16 13.97 2.17 090
55870 .... ............ A ........ Electroejaculation ............................... 2.58 2.49 2.01 1.47 1.28 0.16 000
55873 .... ............ A ........ Cryoablate prostate ............................ 20.25 NA NA 11.41 10.20 1.38 090
55875 .... ............ A ........ Transperi needle place, pros .............. 13.31 NA NA 7.91 6.54 0.89 090
55876 .... ............ A ........ Place rt device/marker, pros .............. 1.73 2.07 2.05 1.06 1.04 0.28 000
55899 .... ............ C ........ Genital surgery procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
56405 .... ............ A ........ I & D of vulva/perineum ...................... 1.46 1.17 1.25 1.16 1.15 0.17 010
56420 .... ............ A ........ Drainage of gland abscess ................. 1.41 1.51 1.89 0.78 0.91 0.16 010
56440 .... ............ A ........ Surgery for vulva lesion ...................... 2.86 NA NA 1.57 1.64 0.34 010
56441 .... ............ A ........ Lysis of labial lesion(s) ....................... 1.99 1.71 1.76 1.56 1.49 0.20 010
56442 .... ............ A ........ Hymenotomy ....................................... 0.68 NA NA 0.52 0.51 0.08 000
56501 .... ............ A ........ Destroy, vulva lesions, sim ................. 1.55 1.63 1.70 1.22 1.23 0.18 010
56515 .... ............ A ........ Destroy vulva lesion/s compl .............. 3.03 2.39 2.46 1.74 1.77 0.33 010
56605 .... ............ A ........ Biopsy of vulva/perineum ................... 1.10 0.92 0.99 0.35 0.40 0.13 000
56606 .... ............ A ........ Biopsy of vulva/perineum ................... 0.55 0.36 0.43 0.15 0.18 0.07 ZZZ
56620 .... ............ A ........ Partial removal of vulva ...................... 8.44 NA NA 4.41 4.60 0.90 090
56625 .... ............ A ........ Complete removal of vulva ................. 9.55 NA NA 4.83 5.06 1.02 090
56630 .... ............ A ........ Extensive vulva surgery ..................... 14.67 NA NA 6.32 6.57 1.49 090
56700 .... ............ A ........ Partial removal of hymen ................... 2.79 NA NA 1.77 1.80 0.30 010
56740 .... ............ A ........ Remove vagina gland lesion .............. 4.83 NA NA 2.34 2.45 0.56 010
56800 .... ............ A ........ Repair of vagina ................................. 3.90 NA NA 1.97 2.08 0.44 010
56805 .... ............ A ........ Repair clitoris ...................................... 19.75 NA NA 7.75 8.84 2.15 090
56810 .... ............ A ........ Repair of perineum ............................. 4.26 NA NA 2.05 2.17 0.49 010
56820 .... ............ A ........ Exam of vulva w/scope ...................... 1.50 1.19 1.25 0.53 0.59 0.18 000
56821 .... ............ A ........ Exam/biopsy of vulva w/scope ........... 2.05 1.53 1.64 0.69 0.80 0.25 000
57000 .... ............ A ........ Exploration of vagina .......................... 2.99 NA NA 1.77 1.74 0.31 010
57010 .... ............ A ........ Drainage of pelvic abscess ................ 6.74 NA NA 3.80 3.81 0.71 090
57020 .... ............ A ........ Drainage of pelvic fluid ....................... 1.50 0.78 0.85 0.46 0.52 0.18 000
57022 .... ............ A ........ I & d vaginal hematoma, pp ............... 2.70 NA NA 1.43 1.46 0.26 010
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
57023 .... ............ A ........ I & d vag hematoma, non-ob ............. 5.13 NA NA 2.38 2.48 0.58 010
57061 .... ............ A ........ Destroy vag lesions, simple ............... 1.27 1.52 1.58 1.11 1.12 0.15 010
57065 .... ............ A ........ Destroy vag lesions, complex ............ 2.63 2.03 2.16 1.50 1.59 0.31 010
57100 .... ............ A ........ Biopsy of vagina ................................. 1.20 0.95 1.01 0.37 0.42 0.14 000
57105 .... ............ A ........ Biopsy of vagina ................................. 1.71 1.59 1.69 1.33 1.38 0.20 010
57106 .... ............ A ........ Remove vagina wall, partial ............... 7.35 NA NA 4.28 4.23 0.73 090
57107 .... ............ A ........ Remove vagina tissue, part ................ 24.43 NA NA 9.14 9.79 2.72 090
57109 .... ............ A ........ Vaginectomy partial w/nodes ............. 28.25 NA NA 10.36 10.81 3.22 090
57110 .... ............ A ........ Remove vagina wall, complete .......... 15.38 NA NA 6.24 6.75 1.74 090
57111 .... ............ A ........ Remove vagina tissue, compl ............ 28.25 NA NA 10.53 11.52 3.18 090
57112 .... ............ A ........ Vaginectomy w/nodes, compl ............. 30.37 NA NA 10.71 11.56 3.08 090
57120 .... ............ A ........ Closure of vagina ............................... 8.18 NA NA 4.21 4.40 0.89 090
57130 .... ............ A ........ Remove vagina lesion ........................ 2.44 1.96 2.06 1.47 1.51 0.29 010
57135 .... ............ A ........ Remove vagina lesion ........................ 2.68 2.03 2.14 1.54 1.59 0.31 010
57150 .... ............ A ........ Treat vagina infection ......................... 0.55 0.58 0.84 0.15 0.18 0.07 000
57155 .... ............ A ........ Insert uteri tandems/ovoids ................ 6.79 NA NA 3.52 4.04 0.43 090
57160 .... ............ A ........ Insert pessary/other device ................ 0.89 1.04 1.03 0.26 0.30 0.10 000
57170 .... ............ A ........ Fitting of diaphragm/cap ..................... 0.91 0.57 1.02 0.25 0.29 0.11 000
57180 .... ............ A ........ Treat vaginal bleeding ........................ 1.60 1.85 2.00 0.93 1.10 0.19 010
57210 .... ............ A ........ Repair vagina/perineum ..................... 5.63 NA NA 3.28 3.35 0.62 090
57230 .... ............ A ........ Repair of urethral lesion ..................... 6.22 NA NA 3.66 3.55 0.54 090
57240 .... ............ A ........ Repair bladder & vagina ..................... 11.42 NA NA 5.53 4.66 0.62 090
57250 .... ............ A ........ Repair rectum & vagina ...................... 11.42 NA NA 5.07 4.31 0.65 090
57265 .... ............ A ........ Extensive repair of vagina .................. 15.86 NA NA 6.37 6.19 1.32 090
57267 .... ............ A ........ Insert mesh/pelvic flr addon ............... 4.88 NA NA 1.52 1.75 0.64 ZZZ
57268 .... ............ A ........ Repair of bowel bulge ........................ 7.47 NA NA 4.35 4.26 0.79 090
57270 .... ............ A ........ Repair of bowel pouch ....................... 13.57 NA NA 5.89 6.03 1.42 090
57280 .... ............ A ........ Suspension of vagina ......................... 16.62 NA NA 7.03 7.19 1.68 090
57282 .... ............ A ........ Colpopexy, extraperitoneal ................. 7.84 NA NA 4.51 4.49 1.02 090
57283 .... ............ A ........ Colpopexy, intraperitoneal .................. 11.58 NA NA 5.15 5.54 1.02 090
57284 .... ............ A ........ Repair paravaginal defect .................. 13.51 NA NA 6.92 7.00 1.41 090
57287 .... ............ A ........ Revise/remove sling repair ................. 11.49 NA NA 6.40 5.95 0.90 090
57288 .... ............ A ........ Repair bladder defect ......................... 14.01 NA NA 7.09 6.50 1.12 090
57289 .... ............ A ........ Repair bladder & vagina ..................... 12.69 NA NA 6.72 6.29 1.21 090
57291 .... ............ A ........ Construction of vagina ........................ 8.54 NA NA 4.91 4.82 0.93 090
57292 .... ............ A ........ Construct vagina with graft ................. 13.91 NA NA 5.95 6.46 1.58 090
57295 .... ............ A ........ Revise vag graft via vagina ................ 7.74 NA NA 4.11 4.26 0.91 090
57296 .... ............ A ........ Revise vag graft, open abd ................ 16.46 NA NA 6.73 6.74 1.68 090
57300 .... ............ A ........ Repair rectum-vagina fistula ............... 8.58 NA NA 4.44 4.37 0.87 090
57305 .... ............ A ........ Repair rectum-vagina fistula ............... 15.24 NA NA 6.19 6.22 1.73 090
57307 .... ............ A ........ Fistula repair & colostomy .................. 17.02 NA NA 6.91 6.97 2.02 090
57308 .... ............ A ........ Fistula repair, transperine ................... 10.48 NA NA 4.97 5.02 1.14 090
57310 .... ............ A ........ Repair urethrovaginal lesion ............... 7.55 NA NA 5.03 4.44 0.54 090
57311 .... ............ A ........ Repair urethrovaginal lesion ............... 8.81 NA NA 5.56 4.78 0.65 090
57320 .... ............ A ........ Repair bladder-vagina lesion .............. 8.78 NA NA 5.32 4.85 0.69 090
57330 .... ............ A ........ Repair bladder-vagina lesion .............. 13.11 NA NA 7.28 6.49 1.06 090
57335 .... ............ A ........ Repair vagina ..................................... 19.87 NA NA 7.89 8.65 1.92 090
57400 .... ............ A ........ Dilation of vagina ................................ 2.27 NA NA 1.01 1.06 0.26 000
57410 .... ............ A ........ Pelvic examination .............................. 1.75 NA NA 0.92 0.91 0.18 000
57415 .... ............ A ........ Remove vaginal foreign body ............. 2.44 NA NA 1.50 1.46 0.24 010
57420 .... ............ A ........ Exam of vagina w/scope .................... 1.60 1.23 1.29 0.56 0.62 0.19 000
57421 .... ............ A ........ Exam/biopsy of vag w/scope .............. 2.20 1.59 1.72 0.73 0.84 0.27 000
57425 .... ............ A ........ Laparoscopy, surg, colpopexy ............ 16.93 NA NA 6.97 6.80 1.76 090
57452 .... ............ A ........ Exam of cervix w/scope ..................... 1.50 1.18 1.23 0.74 0.75 0.18 000
57454 .... ............ A ........ Bx/curett of cervix w/scope ................ 2.33 1.39 1.52 0.95 1.05 0.28 000
57455 .... ............ A ........ Biopsy of cervix w/scope .................... 1.99 1.50 1.61 0.66 0.77 0.24 000
57456 .... ............ A ........ Endocerv curettage w/scope .............. 1.85 1.45 1.55 0.63 0.72 0.22 000
57460 .... ............ A ........ Bx of cervix w/scope, leep ................. 2.83 4.26 5.05 1.10 1.24 0.34 000
57461 .... ............ A ........ Conz of cervix w/scope, leep ............. 3.43 4.55 5.32 1.06 1.27 0.41 000
57500 .... ............ A ........ Biopsy of cervix .................................. 1.20 2.00 2.27 0.64 0.63 0.12 000
57505 .... ............ A ........ Endocervical curettage ....................... 1.16 1.32 1.39 1.06 1.08 0.14 010
57510 .... ............ A ........ Cauterization of cervix ........................ 1.90 1.31 1.44 0.90 0.97 0.23 010
57511 .... ............ A ........ Cryocautery of cervix .......................... 1.92 1.60 1.71 1.27 1.32 0.23 010
57513 .... ............ A ........ Laser surgery of cervix ....................... 1.92 1.57 1.64 1.28 1.34 0.23 010
57520 .... ............ A ........ Conization of cervix ............................ 4.06 3.37 3.65 2.51 2.69 0.49 090
57522 .... ............ A ........ Conization of cervix ............................ 3.62 2.77 2.96 2.25 2.35 0.41 090
57530 .... ............ A ........ Removal of cervix ............................... 5.19 NA NA 3.11 3.24 0.58 090
57531 .... ............ A ........ Removal of cervix, radical .................. 29.77 NA NA 10.96 12.03 3.35 090
57540 .... ............ A ........ Removal of residual cervix ................. 13.19 NA NA 5.47 5.88 1.49 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
57545 .... ............ A ........ Remove cervix/repair pelvis ............... 14.00 NA NA 5.74 6.29 1.52 090
57550 .... ............ A ........ Removal of residual cervix ................. 6.24 NA NA 3.62 3.72 0.67 090
57555 .... ............ A ........ Remove cervix/repair vagina .............. 9.84 NA NA 4.78 4.93 1.09 090
57556 .... ............ A ........ Remove cervix, repair bowel .............. 9.26 NA NA 4.64 4.75 0.92 090
57558 .... ............ A ........ D&c of cervical stump ........................ 1.69 1.34 1.43 1.05 1.11 0.20 010
57700 .... ............ A ........ Revision of cervix ............................... 4.22 NA NA 3.27 3.18 0.41 090
57800 .... ............ A ........ Dilation of cervical canal .................... 0.77 0.72 0.74 0.41 0.44 0.09 000
58100 .... ............ A ........ Biopsy of uterus lining ........................ 1.53 1.14 1.23 0.58 0.65 0.18 000
58110 .... ............ A ........ Bx done w/colposcopy add-on ........... 0.77 0.40 0.47 0.21 0.26 0.09 ZZZ
58120 .... ............ A ........ Dilation and curettage ........................ 3.54 2.70 2.50 1.66 1.77 0.39 010
58140 .... ............ A ........ Myomectomy abdom method ............. 15.69 NA NA 6.21 6.66 1.82 090
58145 .... ............ A ........ Myomectomy vag method .................. 8.81 NA NA 4.25 4.52 0.97 090
58146 .... ............ A ........ Myomectomy abdom complex ............ 20.24 NA NA 7.40 8.19 2.33 090
58150 .... ............ A ........ Total hysterectomy ............................. 17.21 NA NA 6.61 7.04 1.85 090
58152 .... ............ A ........ Total hysterectomy ............................. 21.73 NA NA 8.10 8.98 2.48 090
58180 .... ............ A ........ Partial hysterectomy ........................... 16.50 NA NA 6.38 6.91 1.64 090
58200 .... ............ A ........ Extensive hysterectomy ...................... 23.00 NA NA 8.23 9.10 2.55 090
58240 .... ............ A ........ Removal of pelvis contents ................ 49.02 NA NA 17.79 17.70 4.23 090
58260 .... ............ A ........ Vaginal hysterectomy ......................... 14.02 NA NA 5.82 6.25 1.57 090
58262 .... ............ A ........ Vag hyst including t/o ......................... 15.81 NA NA 6.28 6.83 1.80 090
58263 .... ............ A ........ Vag hyst w/t/o & vag repair ................ 17.10 NA NA 6.69 7.28 1.95 090
58267 .... ............ A ........ Vag hyst w/urinary repair ................... 18.23 NA NA 7.02 7.69 2.07 090
58270 .... ............ A ........ Vag hyst w/enterocele repair .............. 15.20 NA NA 5.98 6.51 1.74 090
58275 .... ............ A ........ Hysterectomy/revise vagina ............... 16.90 NA NA 6.66 7.21 1.92 090
58280 .... ............ A ........ Hysterectomy/revise vagina ............... 18.20 NA NA 7.01 7.64 2.07 090
58290 .... ............ A ........ Vag hyst complex ............................... 20.17 NA NA 7.41 8.26 2.30 090
58291 .... ............ A ........ Vag hyst incl t/o, complex .................. 21.96 NA NA 7.89 8.87 2.53 090
58292 .... ............ A ........ Vag hyst t/o & repair, compl ............... 23.25 NA NA 8.29 9.32 2.68 090
58293 .... ............ A ........ Vag hyst w/uro repair, compl ............. 24.23 NA NA 8.60 9.61 2.79 090
58294 .... ............ A ........ Vag hyst w/enterocele, compl ............ 21.45 NA NA 7.57 8.50 2.40 090
58300 .... ............ N ........ Insert intrauterine device .................... 1.01 0.63 1.02 0.23 0.30 0.12 XXX
58301 .... ............ A ........ Remove intrauterine device ................ 1.27 1.04 1.18 0.35 0.42 0.15 000
58321 .... ............ A ........ Artificial insemination .......................... 0.92 0.93 1.04 0.23 0.30 0.10 000
58322 .... ............ A ........ Artificial insemination .......................... 1.10 1.03 1.12 0.31 0.36 0.13 000
58323 .... ............ A ........ Sperm washing ................................... 0.23 0.16 0.35 0.07 0.08 0.03 000
58340 .... ............ A ........ Catheter for hysterography ................. 0.88 2.14 2.65 0.57 0.61 0.09 000
58345 .... ............ A ........ Reopen fallopian tube ........................ 4.67 NA NA 2.13 2.26 0.41 010
58346 .... ............ A ........ Insert heyman uteri capsule ............... 7.48 NA NA 3.76 3.85 0.56 090
58350 .... ............ A ........ Reopen fallopian tube ........................ 1.03 1.35 1.42 0.88 0.90 0.12 010
58353 .... ............ A ........ Endometr ablate, thermal ................... 3.57 22.66 29.16 1.72 1.89 0.43 010
58356 .... ............ A ........ Endometrial cryoablation .................... 6.36 43.03 52.21 1.88 2.28 0.82 010
58400 .... ............ A ........ Suspension of uterus .......................... 7.06 NA NA 3.88 3.89 0.75 090
58410 .... ............ A ........ Suspension of uterus .......................... 13.70 NA NA 5.61 6.06 1.45 090
58520 .... ............ A ........ Repair of ruptured uterus ................... 13.38 NA NA 5.53 5.77 1.47 090
58540 .... ............ A ........ Revision of uterus ............................... 15.61 NA NA 6.19 6.57 1.79 090
58541 .... ............ A ........ Lsh, uterus 250 g or less ................... 14.57 NA NA 6.17 6.15 1.68 090
58542 .... ............ A ........ Lsh w/t/o ut 250 g or less ................... 16.43 NA NA 6.68 6.67 1.69 090
58543 .... ............ A ........ Lsh uterus above 250 g ..................... 16.74 NA NA 6.76 6.74 1.73 090
58544 .... ............ A ........ Lsh w/t/o uterus above 250 g ............. 18.24 NA NA 7.18 7.17 1.89 090
58545 .... ............ A ........ Laparoscopic myomectomy ................ 15.45 NA NA 5.91 6.55 1.78 090
58546 .... ............ A ........ Laparo-myomectomy, complex .......... 19.84 NA NA 7.12 8.01 2.31 090
58548 .... ............ A ........ Lap radical hyst .................................. 31.45 NA NA 12.62 12.70 3.52 090
58550 .... ............ A ........ Laparo-asst vag hysterectomy ........... 14.97 NA NA 6.17 6.73 1.73 090
58552 .... ............ A ........ Laparo-vag hyst incl t/o ...................... 16.78 NA NA 6.61 7.31 1.73 090
58553 .... ............ A ........ Laparo-vag hyst, complex .................. 19.96 NA NA 7.15 8.03 2.31 090
58554 .... ............ A ........ Laparo-vag hyst w/t/o, compl ............. 22.98 NA NA 8.33 9.36 2.28 090
58555 .... ............ A ........ Hysteroscopy, dx, sep proc ................ 3.33 2.75 2.46 1.24 1.39 0.40 000
58558 .... ............ A ........ Hysteroscopy, biopsy ......................... 4.74 3.62 2.89 1.67 1.92 0.57 000
58559 .... ............ A ........ Hysteroscopy, lysis ............................. 6.16 NA NA 2.06 2.39 0.74 000
58560 .... ............ A ........ Hysteroscopy, resect septum ............. 6.99 NA NA 2.34 2.70 0.84 000
58561 .... ............ A ........ Hysteroscopy, remove myoma ........... 9.99 NA NA 3.15 3.72 1.21 000
58562 .... ............ A ........ Hysteroscopy, remove fb .................... 5.20 3.53 2.93 1.77 2.06 0.63 000
58563 .... ............ A ........ Hysteroscopy, ablation ....................... 6.16 36.96 46.57 2.06 2.41 0.74 000
58565 .... ............ A ........ Hysteroscopy, sterilization .................. 7.06 41.68 44.35 3.39 3.64 1.19 090
58578 .... ............ C ........ Laparo proc, uterus ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
58579 .... ............ C ........ Hysteroscope procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
58600 .... ............ A ........ Division of fallopian tube .................... 5.86 NA NA 2.93 3.13 0.66 090
58605 .... ............ A ........ Division of fallopian tube .................... 5.25 NA NA 2.72 2.91 0.59 090
58611 .... ............ A ........ Ligate oviduct(s) add-on ..................... 1.45 NA NA 0.40 0.49 0.18 ZZZ
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
58615 .... ............ A ........ Occlude fallopian tube(s) .................... 3.91 NA NA 2.04 2.36 0.47 010
58660 .... ............ A ........ Laparoscopy, lysis .............................. 11.54 NA NA 4.52 4.89 1.40 090
58661 .... ............ A ........ Laparoscopy, remove adnexa ............ 11.30 NA NA 4.02 4.57 1.34 010
58662 .... ............ A ........ Laparoscopy, excise lesions .............. 12.08 NA NA 4.79 5.28 1.43 090
58670 .... ............ A ........ Laparoscopy, tubal cautery ................ 5.86 NA NA 2.96 3.11 0.67 090
58671 .... ............ A ........ Laparoscopy, tubal block .................... 5.86 NA NA 2.95 3.11 0.68 090
58672 .... ............ A ........ Laparoscopy, fimbrioplasty ................. 12.88 NA NA 4.82 5.49 1.60 090
58673 .... ............ A ........ Laparoscopy, salpingostomy .............. 13.99 NA NA 5.16 5.87 1.70 090
58679 .... ............ C ........ Laparo proc, oviduct-ovary ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
58700 .... ............ A ........ Removal of fallopian tube ................... 12.84 NA NA 5.50 5.75 1.51 090
58720 .... ............ A ........ Removal of ovary/tube(s) ................... 12.08 NA NA 5.11 5.44 1.39 090
58740 .... ............ A ........ Revise fallopian tube(s) ...................... 14.79 NA NA 6.08 6.61 1.72 090
58750 .... ............ A ........ Repair oviduct ..................................... 15.56 NA NA 6.09 6.72 1.85 090
58752 .... ............ A ........ Revise ovarian tube(s) ....................... 15.56 NA NA 5.97 6.46 1.81 090
58760 .... ............ A ........ Remove tubal obstruction ................... 13.85 NA NA 5.62 6.17 1.80 090
58770 .... ............ A ........ Create new tubal opening .................. 14.69 NA NA 5.79 6.34 1.74 090
58800 .... ............ A ........ Drainage of ovarian cyst(s) ................ 4.54 3.21 3.41 2.69 2.78 0.43 090
58805 .... ............ A ........ Drainage of ovarian cyst(s) ................ 6.34 NA NA 3.50 3.49 0.69 090
58820 .... ............ A ........ Drain ovary abscess, open ................. 4.62 NA NA 2.90 3.09 0.52 090
58822 .... ............ A ........ Drain ovary abscess, percut ............... 11.71 NA NA 5.16 5.17 1.16 090
58823 .... ............ A ........ Drain pelvic abscess, percut .............. 3.37 19.80 20.43 1.17 1.11 0.24 000
58825 .... ............ A ........ Transposition, ovary(s) ....................... 11.70 NA NA 4.86 5.35 1.32 090
58900 .... ............ A ........ Biopsy of ovary(s) ............................... 6.51 NA NA 3.55 3.54 0.69 090
58920 .... ............ A ........ Partial removal of ovary(s) ................. 11.87 NA NA 5.08 5.35 1.43 090
58925 .... ............ A ........ Removal of ovarian cyst(s) ................. 12.33 NA NA 5.26 5.47 1.41 090
58940 .... ............ A ........ Removal of ovary(s) ........................... 8.12 NA NA 4.04 4.07 0.91 090
58943 .... ............ A ........ Removal of ovary(s) ........................... 19.42 NA NA 7.22 7.93 2.23 090
58950 .... ............ A ........ Resect ovarian malignancy ................ 18.24 NA NA 7.30 7.85 2.05 090
58953 .... ............ A ........ Tah, rad dissect for debulk ................. 33.97 NA NA 11.75 13.14 3.84 090
58954 .... ............ A ........ Tah rad debulk/lymph remove ............ 36.97 NA NA 12.63 14.16 4.18 090
58956 .... ............ A ........ Bso, omentectomy w/tah .................... 22.65 NA NA 8.65 9.48 4.01 090
58957 .... ............ A ........ Resect recurrent gyn mal ................... 26.06 NA NA 9.58 9.61 2.95 090
58958 .... ............ A ........ Resect recur gyn mal w/lym ............... 29.06 NA NA 10.39 10.42 3.29 090
58960 .... ............ A ........ Exploration of abdomen ..................... 15.68 NA NA 6.29 6.82 1.80 090
58970 .... ............ A ........ Retrieval of oocyte .............................. 3.52 1.85 2.08 1.28 1.38 0.43 000
58974 .... ............ C ........ Transfer of embryo ............................. 0.00 0.00 0.00 0.00 0.00 0.00 000
58976 .... ............ A ........ Transfer of embryo ............................. 3.82 1.93 2.30 1.20 1.51 0.47 000
58999 .... ............ C ........ Genital surgery procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
59000 .... ............ A ........ Amniocentesis, diagnostic .................. 1.30 1.74 1.90 0.55 0.61 0.31 000
59001 .... ............ A ........ Amniocentesis, therapeutic ................ 3.00 NA NA 1.08 1.25 0.71 000
59012 .... ............ A ........ Fetal cord puncture,prenatal .............. 3.44 NA NA 1.14 1.34 0.82 000
59015 .... ............ A ........ Chorion biopsy .................................... 2.20 1.43 1.49 0.80 0.92 0.52 000
59020 .... ............ A ........ Fetal contract stress test .................... 0.66 1.07 0.92 1.07 0.92 0.26 000
59020 .... 26 ....... A ........ Fetal contract stress test .................... 0.66 0.18 0.22 0.18 0.22 0.16 000
59020 .... TC ...... A ........ Fetal contract stress test .................... 0.00 0.88 0.70 0.88 0.70 0.10 000
59025 .... ............ A ........ Fetal non-stress test ........................... 0.53 0.63 0.54 0.63 0.54 0.15 000
59025 .... 26 ....... A ........ Fetal non-stress test ........................... 0.53 0.15 0.18 0.15 0.18 0.13 000
59025 .... TC ...... A ........ Fetal non-stress test ........................... 0.00 0.48 0.35 0.48 0.35 0.02 000
59030 .... ............ A ........ Fetal scalp blood sample ................... 1.99 NA NA 0.46 0.63 0.47 000
59050 .... ............ A ........ Fetal monitor w/report ........................ 0.89 NA NA 0.27 0.31 0.21 XXX
59051 .... ............ A ........ Fetal monitor/interpret only ................. 0.74 NA NA 0.20 0.25 0.17 XXX
59070 .... ............ A ........ Transabdom amnioinfus w/us ............ 5.24 4.38 4.76 1.78 2.04 0.28 000
59072 .... ............ A ........ Umbilical cord occlud w/us ................. 8.99 NA NA 2.39 2.84 0.16 000
59074 .... ............ A ........ Fetal fluid drainage w/us .................... 5.24 3.58 4.12 1.53 1.95 0.28 000
59076 .... ............ A ........ Fetal shunt placement, w/us .............. 8.99 NA NA 2.39 2.76 0.16 000
59100 .... ............ A ........ Remove uterus lesion ......................... 13.26 NA NA 5.57 6.05 2.95 090
59120 .... ............ A ........ Treat ectopic pregnancy ..................... 12.56 NA NA 5.43 5.84 2.73 090
59160 .... ............ A ........ D & c after delivery ............................. 2.73 1.99 2.64 1.18 1.65 0.64 010
59200 .... ............ A ........ Insert cervical dilator .......................... 0.79 0.94 1.07 0.22 0.26 0.19 000
59300 .... ............ A ........ Episiotomy or vaginal repair ............... 2.41 2.19 2.18 1.01 0.99 0.57 000
59350 .... ............ A ........ Repair of uterus .................................. 4.94 NA NA 1.22 1.57 1.17 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
59400 .... ............ A ........ Obstetrical care .................................. 26.80 NA NA 14.13 14.75 5.50 MMM
59412 .... ............ A ........ Antepartum manipulation .................... 1.71 NA NA 0.65 0.73 0.40 MMM
59414 .... ............ A ........ Deliver placenta .................................. 1.61 NA NA 0.44 0.54 0.38 MMM
59425 .... ............ A ........ Antepartum care only ......................... 6.22 4.24 4.22 1.70 1.77 1.14 MMM
59426 .... ............ A ........ Antepartum care only ......................... 11.04 7.78 7.66 3.03 3.12 1.98 MMM
59430 .... ............ A ........ Care after delivery .............................. 2.13 1.08 1.15 0.72 0.83 0.50 MMM
59510 .... ............ A ........ Cesarean delivery ............................... 30.34 NA NA 16.03 16.62 6.25 MMM
59514 .... ............ A ........ Cesarean delivery only ....................... 15.95 NA NA 4.49 5.35 3.80 MMM
59515 .... ............ A ........ Cesarean delivery ............................... 18.26 NA NA 6.20 7.02 4.13 MMM
59525 .... ............ A ........ Remove uterus after cesarean ........... 8.53 NA NA 2.28 2.81 1.95 ZZZ
59610 .... ............ A ........ Vbac delivery ...................................... 28.21 NA NA 14.99 15.34 5.87 MMM
59612 .... ............ A ........ Vbac delivery only .............................. 15.04 NA NA 4.25 5.15 3.59 MMM
59614 .... ............ A ........ Vbac care after delivery ..................... 16.59 NA NA 5.18 6.05 3.89 MMM
59618 .... ............ A ........ Attempted vbac delivery ..................... 31.78 NA NA 16.40 17.29 6.61 MMM
59620 .... ............ A ........ Attempted vbac delivery only ............. 17.50 NA NA 4.70 5.75 4.17 MMM
59622 .... ............ A ........ Attempted vbac after care .................. 19.70 NA NA 6.76 7.68 4.50 MMM
59812 .... ............ A ........ Treatment of miscarriage ................... 4.39 3.10 2.82 2.36 2.45 0.95 090
59820 .... ............ A ........ Care of miscarriage ............................ 4.68 4.07 4.24 3.46 3.51 0.95 090
59821 .... ............ A ........ Treatment of miscarriage ................... 4.97 3.91 4.07 3.24 3.31 1.06 090
59830 .... ............ A ........ Treat uterus infection .......................... 6.51 NA NA 3.45 3.72 1.44 090
59840 .... ............ R ........ Abortion .............................................. 3.01 2.00 2.06 1.77 1.95 0.71 010
59841 .... ............ R ........ Abortion .............................................. 5.57 3.12 3.31 2.56 2.77 1.24 010
59850 .... ............ R ........ Abortion .............................................. 5.90 NA NA 2.44 2.88 1.28 090
59851 .... ............ R ........ Abortion .............................................. 5.92 NA NA 3.30 3.52 1.28 090
59852 .... ............ R ........ Abortion .............................................. 8.23 NA NA 3.80 4.42 1.81 090
59855 .... ............ R ........ Abortion .............................................. 6.38 NA NA 3.09 3.30 1.45 090
59856 .... ............ R ........ Abortion .............................................. 7.74 NA NA 3.33 3.78 1.79 090
59857 .... ............ R ........ Abortion .............................................. 9.30 NA NA 3.67 4.10 2.02 090
59866 .... ............ R ........ Abortion (mpr) ..................................... 3.99 NA NA 1.37 1.61 0.87 000
59870 .... ............ A ........ Evacuate mole of uterus .................... 6.40 NA NA 4.38 4.41 1.42 090
59871 .... ............ A ........ Remove cerclage suture .................... 2.13 NA NA 0.91 1.02 0.50 000
59897 .... ............ C ........ Fetal invas px w/us ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
59898 .... ............ C ........ Laparo proc, ob care/deliver .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
59899 .... ............ C ........ Maternity care procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
60000 .... ............ A ........ Drain thyroid/tongue cyst .................... 1.78 2.04 1.98 1.66 1.69 0.15 010
60001 .... ............ A ........ Aspirate/inject thyriod cyst .................. 0.97 1.93 1.66 0.31 0.32 0.07 000
60100 .... ............ A ........ Biopsy of thyroid ................................. 1.56 1.32 1.34 0.53 0.52 0.10 000
60200 .... ............ A ........ Remove thyroid lesion ........................ 9.91 NA NA 5.50 5.70 1.01 090
60210 .... ............ A ........ Partial thyroid excision ....................... 11.15 NA NA 5.23 5.40 1.23 090
60212 .... ............ A ........ Partial thyroid excision ....................... 16.32 NA NA 6.95 7.28 1.95 090
60220 .... ............ A ........ Partial removal of thyroid ................... 12.29 NA NA 5.67 5.86 1.32 090
60225 .... ............ A ........ Partial removal of thyroid ................... 14.67 NA NA 6.92 7.12 1.64 090
60240 .... ............ A ........ Removal of thyroid ............................. 16.18 NA NA 6.41 6.96 1.86 090
60254 .... ............ A ........ Extensive thyroid surgery ................... 28.29 NA NA 11.28 12.57 2.61 090
60260 .... ............ A ........ Repeat thyroid surgery ....................... 18.18 NA NA 7.43 7.97 1.94 090
60280 .... ............ A ........ Remove thyroid duct lesion ................ 6.05 NA NA 4.48 4.51 0.54 090
60281 .... ............ A ........ Remove thyroid duct lesion ................ 8.71 NA NA 5.33 5.47 0.73 090
60500 .... ............ A ........ Explore parathyroid glands ................. 16.69 NA NA 6.85 7.10 2.01 090
60502 .... ............ A ........ Re-explore parathyroids ..................... 21.01 NA NA 8.61 8.96 2.54 090
60505 .... ............ A ........ Explore parathyroid glands ................. 22.91 NA NA 9.40 10.13 2.65 090
60512 .... ............ A ........ Autotransplant parathyroid ................. 4.44 NA NA 1.21 1.41 0.53 ZZZ
60520 .... ............ A ........ Removal of thymus gland ................... 17.07 NA NA 7.00 7.63 2.20 090
60540 .... ............ A ........ Explore adrenal gland ........................ 17.91 NA NA 8.28 7.91 1.75 090
60545 .... ............ A ........ Explore adrenal gland ........................ 20.82 NA NA 8.96 8.73 2.08 090
60600 .... ............ A ........ Remove carotid body lesion ............... 24.99 NA NA 8.84 9.89 2.20 090
60605 .... ............ A ........ Remove carotid body lesion ............... 31.86 NA NA 12.12 12.21 2.50 090
60650 .... ............ A ........ Laparoscopy adrenalectomy .............. 20.63 NA NA 8.12 8.07 2.29 090
60659 .... ............ C ........ Laparo proc, endocrine ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
60699 .... ............ C ........ Endocrine surgery procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
61000 .... ............ A ........ Remove cranial cavity fluid ................ 1.58 NA NA 1.23 1.09 0.13 000
61001 .... ............ A ........ Remove cranial cavity fluid ................ 1.49 NA NA 1.06 1.09 0.16 000
61020 .... ............ A ........ Remove brain cavity fluid ................... 1.51 NA NA 1.63 1.48 0.34 000
61026 .... ............ A ........ Injection into brain canal .................... 1.69 NA NA 1.30 1.38 0.33 000
61050 .... ............ A ........ Remove brain canal fluid .................... 1.51 NA NA 1.15 1.20 0.11 000
61055 .... ............ A ........ Injection into brain canal .................... 2.10 NA NA 1.33 1.36 0.17 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
61070 .... ............ A ........ Brain canal shunt procedure .............. 0.89 NA NA 1.15 1.08 0.17 000
61105 .... ............ A ........ Twist drill hole ..................................... 5.40 NA NA 4.95 4.44 1.32 090
61107 .... ............ A ........ Drill skull for implantation ................... 4.99 NA NA 1.86 2.20 1.29 000
61108 .... ............ A ........ Drill skull for drainage ......................... 11.51 NA NA 8.40 7.79 2.64 090
61120 .... ............ A ........ Burr hole for puncture ........................ 9.52 NA NA 6.81 6.39 2.10 090
61140 .... ............ A ........ Pierce skull for biopsy ........................ 17.10 NA NA 10.49 10.19 4.12 090
61150 .... ............ A ........ Pierce skull for drainage ..................... 18.80 NA NA 10.75 10.58 4.32 090
61154 .... ............ A ........ Pierce skull & remove clot .................. 16.92 NA NA 10.90 10.19 4.21 090
61210 .... ............ A ........ Pierce skull, implant device ................ 5.83 NA NA 2.18 2.55 1.50 000
61215 .... ............ A ........ Insert brain-fluid device ...................... 5.77 NA NA 5.47 4.74 1.26 090
61250 .... ............ A ........ Pierce skull & explore ......................... 11.41 NA NA 7.43 7.18 2.77 090
61253 .... ............ A ........ Pierce skull & explore ......................... 13.41 NA NA 7.63 7.72 2.62 090
61304 .... ............ A ........ Open skull for exploration .................. 23.31 NA NA 12.63 12.76 5.63 090
61305 .... ............ A ........ Open skull for exploration .................. 28.51 NA NA 15.08 15.23 6.09 090
61312 .... ............ A ........ Open skull for drainage ...................... 30.07 NA NA 15.38 15.24 6.36 090
61316 .... ............ A ........ Implt cran bone flap to abdo .............. 1.39 NA NA 0.52 0.56 0.35 ZZZ
61322 .... ............ A ........ Decompressive craniotomy ................ 34.08 NA NA 17.72 16.75 7.63 090
61323 .... ............ A ........ Decompressive lobectomy ................. 34.93 NA NA 17.48 16.75 8.03 090
61330 .... ............ A ........ Decompress eye socket ..................... 25.17 NA NA 11.70 12.77 2.32 090
61332 .... ............ A ........ Explore/biopsy eye socket .................. 28.50 NA NA 13.06 14.43 4.83 090
61333 .... ............ A ........ Explore orbit/remove lesion ................ 29.17 NA NA 13.09 14.41 3.92 090
61334 .... ............ A ........ Explore orbit/remove object ................ 19.50 NA NA 9.15 9.91 1.75 090
61340 .... ............ A ........ Subtemporal decompression .............. 20.01 NA NA 11.77 11.41 4.84 090
61343 .... ............ A ........ Incise skull (press relief) ..................... 31.73 NA NA 16.12 16.51 7.64 090
61345 .... ............ A ........ Relieve cranial pressure ..................... 29.10 NA NA 14.98 15.27 7.04 090
61440 .... ............ A ........ Incise skull for surgery ....................... 28.53 NA NA 15.37 14.60 6.90 090
61458 .... ............ A ........ Incise skull for brain wound ................ 28.71 NA NA 15.02 15.30 7.03 090
61500 .... ............ A ........ Removal of skull lesion ...................... 19.05 NA NA 10.77 10.78 4.11 090
61501 .... ............ A ........ Remove infected skull bone ............... 16.22 NA NA 9.53 9.39 3.22 090
61510 .... ............ A ........ Removal of brain lesion ...................... 30.63 NA NA 17.09 16.93 7.35 090
61512 .... ............ A ........ Remove brain lining lesion ................. 36.99 NA NA 18.64 19.19 9.08 090
61514 .... ............ A ........ Removal of brain abscess .................. 27.10 NA NA 14.53 14.52 6.54 090
61517 .... ............ A ........ Implt brain chemotx add-on ................ 1.38 NA NA 0.52 0.58 0.35 ZZZ
61519 .... ............ A ........ Remove brain lining lesion ................. 43.28 NA NA 20.91 21.82 10.63 090
61522 .... ............ A ........ Removal of brain abscess .................. 31.41 NA NA 15.95 16.15 7.62 090
61531 .... ............ A ........ Implant brain electrodes ..................... 16.28 NA NA 10.52 9.80 3.79 090
61535 .... ............ A ........ Remove brain electrodes ................... 13.05 NA NA 8.89 8.18 3.02 090
61537 .... ............ A ........ Removal of brain tissue ...................... 36.35 NA NA 17.21 16.08 6.94 090
61541 .... ............ A ........ Incision of brain tissue ........................ 30.81 NA NA 16.23 16.24 6.60 090
61544 .... ............ A ........ Remove & treat brain lesion ............... 27.26 NA NA 14.41 14.15 5.97 090
61545 .... ............ A ........ Excision of brain tumor ....................... 46.23 NA NA 23.05 23.58 10.63 090
61546 .... ............ A ........ Removal of pituitary gland .................. 33.31 NA NA 16.90 17.19 7.67 090
61548 .... ............ A ........ Removal of pituitary gland .................. 23.27 NA NA 11.74 12.23 3.43 090
61550 .... ............ A ........ Release of skull seams ...................... 15.44 NA NA 5.63 6.28 0.98 090
61552 .... ............ A ........ Release of skull seams ...................... 20.27 NA NA 12.24 9.74 1.06 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
61556 .... ............ A ........ Incise skull/sutures ............................. 24.00 NA NA 13.40 12.31 4.65 090
61557 .... ............ A ........ Incise skull/sutures ............................. 23.16 NA NA 13.74 13.71 5.80 090
61558 .... ............ A ........ Excision of skull/sutures ..................... 26.35 NA NA 14.82 13.39 1.36 090
61559 .... ............ A ........ Excision of skull/sutures ..................... 33.82 NA NA 18.54 19.07 8.51 090
61563 .... ............ A ........ Excision of skull tumor ....................... 28.35 NA NA 13.20 14.45 5.17 090
61564 .... ............ A ........ Excision of skull tumor ....................... 34.59 NA NA 18.07 17.92 8.78 090
61567 .... ............ A ........ Incision of brain tissue ........................ 36.84 NA NA 19.25 19.60 6.54 090
61570 .... ............ A ........ Remove foreign body, brain ............... 26.38 NA NA 14.11 14.06 5.88 090
61571 .... ............ A ........ Incise skull for brain wound ................ 28.29 NA NA 14.77 15.06 6.79 090
61575 .... ............ A ........ Skull base/brainstem surgery ............. 36.43 NA NA 16.33 17.91 5.34 090
61576 .... ............ A ........ Skull base/brainstem surgery ............. 55.11 NA NA 28.10 31.11 5.58 090
61580 .... ............ A ........ Craniofacial approach, skull ............... 34.34 NA NA 22.87 23.92 3.37 090
61584 .... ............ A ........ Orbitocranial approach/skull ............... 37.61 NA NA 26.18 25.29 8.18 090
61586 .... ............ A ........ Resect nasopharynx, skull ................. 27.28 NA NA 22.71 22.89 4.37 090
61590 .... ............ A ........ Infratemporal approach/skull .............. 46.87 NA NA 24.91 26.54 5.31 090
61591 .... ............ A ........ Infratemporal approach/skull .............. 46.87 NA NA 24.75 27.05 5.66 090
61595 .... ............ A ........ Transtemporal approach/skull ............ 33.57 NA NA 21.25 21.52 3.98 090
61596 .... ............ A ........ Transcochlear approach/skull ............. 39.31 NA NA 20.95 22.34 3.40 090
61597 .... ............ A ........ Transcondylar approach/skull ............. 40.73 NA NA 23.27 23.11 8.84 090
61598 .... ............ A ........ Transpetrosal approach/skull ............. 36.41 NA NA 22.34 22.61 5.70 090
61600 .... ............ A ........ Resect/excise cranial lesion ............... 29.84 NA NA 19.82 19.59 3.79 090
61609 .... ............ A ........ Transect artery, sinus ......................... 9.88 NA NA 3.30 4.16 2.56 ZZZ
61613 .... ............ A ........ Remove aneurysm, sinus ................... 44.94 NA NA 27.55 26.96 8.45 090
61615 .... ............ A ........ Resect/excise lesion, skull ................. 35.63 NA NA 21.37 21.75 4.73 090
61616 .... ............ A ........ Resect/excise lesion, skull ................. 46.60 NA NA 27.46 27.97 8.26 090
61618 .... ............ A ........ Repair dura ......................................... 18.58 NA NA 10.51 10.43 3.72 090
61619 .... ............ A ........ Repair dura ......................................... 22.01 NA NA 11.76 11.90 3.95 090
61623 .... ............ A ........ Endovasc tempory vessel occl ........... 9.95 NA NA 3.77 3.82 1.05 000
61624 .... ............ A ........ Transcath occlusion, cns .................... 20.12 NA NA 7.39 6.96 1.96 000
61626 .... ............ A ........ Transcath occlusion, non-cns ............. 16.60 NA NA 6.05 5.59 1.24 000
61630 .... ............ N ........ Intracranial angioplasty ....................... 22.07 NA NA 6.43 9.46 2.02 090
61635 .... ............ N ........ Intracran angioplsty w/stent ................ 24.28 NA NA 6.94 10.24 2.21 090
61640 .... ............ N ........ Dilate ic vasospasm, init ..................... 12.32 NA NA 2.84 2.85 0.71 000
61641 .... ............ N ........ Dilate ic vasospasm add-on ............... 4.33 NA NA 1.00 1.00 0.25 ZZZ
61642 .... ............ N ........ Dilate ic vasospasm add-on ............... 8.66 NA NA 2.00 2.00 0.50 ZZZ
61680 .... ............ A ........ Intracranial vessel surgery ................. 32.40 NA NA 16.89 17.20 7.95 090
61697 .... ............ A ........ Brain aneurysm repr, complx ............. 63.22 NA NA 28.96 28.54 12.85 090
61698 .... ............ A ........ Brain aneurysm repr, complx ............. 69.45 NA NA 31.15 28.97 12.54 090
61700 .... ............ A ........ Brain aneurysm repr, simple .............. 50.44 NA NA 24.27 26.06 13.02 090
61702 .... ............ A ........ Inner skull vessel surgery ................... 59.86 NA NA 27.80 27.02 10.79 090
61703 .... ............ A ........ Clamp neck artery .............................. 18.70 NA NA 10.17 10.45 4.06 090
61705 .... ............ A ........ Revise circulation to head .................. 37.97 NA NA 18.51 18.78 8.87 090
61711 .... ............ A ........ Fusion of skull arteries ....................... 38.10 NA NA 18.79 19.31 9.42 090
61720 .... ............ A ........ Incise skull/brain surgery .................... 17.52 NA NA 7.97 9.02 2.79 090
61735 .... ............ A ........ Incise skull/brain surgery .................... 22.22 NA NA 9.22 11.07 2.73 090
61750 .... ............ A ........ Incise skull/brain biopsy ..................... 19.73 NA NA 11.03 10.84 4.72 090
61751 .... ............ A ........ Brain biopsy w/ct/mr guide ................. 18.64 NA NA 11.45 11.16 4.56 090
61770 .... ............ A ........ Incise skull for treatment .................... 23.09 NA NA 10.05 11.15 3.55 090
61790 .... ............ A ........ Treat trigeminal nerve ........................ 11.50 NA NA 7.74 6.85 2.82 090
61791 .... ............ A ........ Treat trigeminal tract .......................... 15.31 NA NA 8.27 8.50 3.40 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
61793 .... ............ A ........ Focus radiation beam ......................... 17.75 NA NA 9.62 9.93 4.46 090
61795 .... ............ A ........ Brain surgery using computer ............ 4.03 NA NA 1.45 1.73 0.79 ZZZ
61850 .... ............ A ........ Implant neuroelectrodes ..................... 13.26 NA NA 7.94 7.42 3.22 090
61863 .... ............ A ........ Implant neuroelectrode ....................... 20.56 NA NA 12.51 12.16 5.43 090
61864 .... ............ A ........ Implant neuroelectrde, addl ................ 4.49 NA NA 1.70 1.99 5.43 ZZZ
61867 .... ............ A ........ Implant neuroelectrode ....................... 32.88 NA NA 16.50 17.33 5.43 090
61868 .... ............ A ........ Implant neuroelectrde, addœl .............. 7.91 NA NA 2.98 3.50 5.43 ZZZ
61880 .... ............ A ........ Revise/remove neuroelectrode ........... 6.87 NA NA 5.19 4.94 1.66 090
61885 .... ............ A ........ Insrt/redo neurostim 1 array ............... 7.37 NA NA 7.07 6.26 1.59 090
61886 .... ............ A ........ Implant neurostim arrays .................... 9.73 NA NA 8.53 7.49 1.97 090
61888 .... ............ A ........ Revise/remove neuroreceiver ............. 5.20 NA NA 3.48 3.60 1.33 010
62000 .... ............ A ........ Treat skull fracture .............................. 13.83 NA NA 7.69 6.53 1.06 090
62005 .... ............ A ........ Treat skull fracture .............................. 17.53 NA NA 9.67 9.22 3.87 090
62010 .... ............ A ........ Treatment of head injury .................... 21.30 NA NA 11.91 11.84 5.14 090
62100 .... ............ A ........ Repair brain fluid leakage .................. 23.40 NA NA 12.18 12.46 4.84 090
62115 .... ............ A ........ Reduction of skull defect .................... 22.71 NA NA 13.99 12.84 5.51 090
62120 .... ............ A ........ Repair skull cavity lesion .................... 24.39 NA NA 17.26 17.65 3.00 090
62121 .... ............ A ........ Incise skull repair ................................ 22.93 NA NA 14.26 14.85 4.17 090
62140 .... ............ A ........ Repair of skull defect .......................... 14.45 NA NA 8.70 8.51 3.47 090
62141 .... ............ A ........ Repair of skull defect .......................... 15.97 NA NA 9.41 9.23 3.76 090
62142 .... ............ A ........ Remove skull plate/flap ...................... 11.73 NA NA 7.84 7.41 2.73 090
62143 .... ............ A ........ Replace skull plate/flap ...................... 14.05 NA NA 8.79 8.43 3.37 090
62145 .... ............ A ........ Repair of skull & brain ........................ 19.99 NA NA 10.33 10.62 4.50 090
62146 .... ............ A ........ Repair of skull with graft ..................... 17.18 NA NA 9.59 9.55 3.62 090
62147 .... ............ A ........ Repair of skull with graft ..................... 20.57 NA NA 11.07 11.13 4.32 090
62148 .... ............ A ........ Retr bone flap to fix skull ................... 2.00 NA NA 0.75 0.81 0.48 ZZZ
62160 .... ............ A ........ Neuroendoscopy add-on .................... 3.00 NA NA 1.12 1.33 0.77 ZZZ
62161 .... ............ A ........ Dissect brain w/scope ........................ 21.10 NA NA 12.25 12.18 5.19 090
62162 .... ............ A ........ Remove colloid cyst w/scope ............. 26.67 NA NA 14.77 14.69 5.91 090
62163 .... ............ A ........ Neuroendoscopy w/fb removal ........... 16.40 NA NA 9.31 9.84 4.01 090
62164 .... ............ A ........ Remove brain tumor w/scope ............ 29.27 NA NA 16.35 15.45 5.38 090
62165 .... ............ A ........ Remove pituit tumor w/scope ............. 23.10 NA NA 11.86 12.59 3.01 090
62180 .... ............ A ........ Establish brain cavity shunt ................ 22.45 NA NA 12.63 12.38 4.98 090
62194 .... ............ A ........ Replace/irrigate catheter .................... 5.68 NA NA 3.17 2.90 0.92 010
62201 .... ............ A ........ Brain cavity shunt w/scope ................. 15.89 NA NA 10.41 9.96 3.68 090
62225 .... ............ A ........ Replace/irrigate catheter .................... 6.11 NA NA 5.50 4.80 1.39 090
62230 .... ............ A ........ Replace/revise brain shunt ................. 11.35 NA NA 7.26 6.89 2.71 090
62252 .... ............ A ........ Csf shunt reprogram ........................... 0.74 1.76 1.62 NA NA 0.21 XXX
62252 .... 26 ....... A ........ Csf shunt reprogram ........................... 0.74 0.27 0.32 0.27 0.32 0.19 XXX
62252 .... TC ...... A ........ Csf shunt reprogram ........................... 0.00 1.49 1.30 NA NA 0.02 XXX
62256 .... ............ A ........ Remove brain cavity shunt ................. 7.30 NA NA 5.92 5.31 1.72 090
62258 .... ............ A ........ Replace brain cavity shunt ................. 15.54 NA NA 9.37 9.04 3.74 090
62263 .... ............ A ........ Epidural lysis mult sessions ............... 6.41 9.42 10.99 2.99 3.07 0.41 010
62264 .... ............ A ........ Epidural lysis on single day ................ 4.42 5.61 6.67 1.26 1.34 0.27 010
62268 .... ............ A ........ Drain spinal cord cyst ......................... 4.73 6.65 9.06 1.82 1.95 0.43 000
62269 .... ............ A ........ Needle biopsy, spinal cord ................. 5.01 6.24 10.53 1.50 1.75 0.37 000
62270 .... ............ A ........ Spinal fluid tap, diagnostic ................. 1.37 2.38 2.67 0.58 0.56 0.08 000
62272 .... ............ A ........ Drain cerebro spinal fluid ................... 1.35 3.11 3.35 0.62 0.66 0.18 000
62273 .... ............ A ........ Inject epidural patch ........................... 2.15 1.66 2.19 0.58 0.65 0.13 000
62280 .... ............ A ........ Treat spinal cord lesion ...................... 2.63 4.62 5.71 1.16 1.07 0.30 010
62281 .... ............ A ........ Treat spinal cord lesion ...................... 2.66 4.05 4.79 1.03 0.94 0.19 010
62282 .... ............ A ........ Treat spinal canal lesion .................... 2.33 4.06 6.19 1.12 1.01 0.17 010
62284 .... ............ A ........ Injection for myelogram ...................... 1.54 3.77 4.34 0.72 0.69 0.13 000
62287 .... ............ A ........ Percutaneous diskectomy .................. 8.88 NA NA 4.30 4.89 0.58 090
62290 .... ............ A ........ Inject for spine disk x-ray ................... 3.00 4.48 5.78 1.16 1.26 0.23 000
62291 .... ............ A ........ Inject for spine disk x-ray ................... 2.91 4.20 5.05 1.09 1.15 0.26 000
62292 .... ............ A ........ Injection into disk lesion ..................... 9.14 NA NA 2.90 3.73 0.82 090
62294 .... ............ A ........ Injection into spinal artery .................. 12.77 NA NA 6.54 5.90 1.24 090
62310 .... ............ A ........ Inject spine c/t .................................... 1.91 2.98 3.89 0.57 0.61 0.12 000
62311 .... ............ A ........ Inject spine l/s (cd) ............................. 1.54 2.64 3.78 0.53 0.56 0.09 000
62318 .... ............ A ........ Inject spine w/cath, c/t ........................ 2.04 3.07 4.42 0.43 0.55 0.12 000
62319 .... ............ A ........ Inject spine w/cath l/s (cd) .................. 1.87 2.78 3.89 0.44 0.53 0.11 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
62350 .... ............ A ........ Implant spinal canal cath .................... 8.04 NA NA 4.01 4.00 1.02 090
62351 .... ............ A ........ Implant spinal canal cath .................... 11.54 NA NA 7.66 7.41 2.25 090
62355 .... ............ A ........ Remove spinal canal catheter ............ 6.60 NA NA 3.54 3.36 0.71 090
62360 .... ............ A ........ Insert spine infusion device ................ 3.68 NA NA 3.15 2.96 0.34 090
62361 .... ............ A ........ Implant spine infusion pump .............. 6.59 NA NA 4.06 3.98 0.80 090
62362 .... ............ A ........ Implant spine infusion pump .............. 8.58 NA NA 4.68 4.53 1.18 090
62365 .... ............ A ........ Remove spine infusion device ........... 6.57 NA NA 3.73 3.68 0.86 090
62367 .... ............ A ........ Analyze spine infusion pump ............. 0.48 0.42 0.51 0.12 0.11 0.03 XXX
62368 .... ............ A ........ Analyze spine infusion pump ............. 0.75 0.58 0.64 0.18 0.17 0.06 XXX
63001 .... ............ A ........ Removal of spinal lamina ................... 17.51 NA NA 9.83 9.70 3.77 090
63020 .... ............ A ........ Neck spine disk surgery ..................... 16.05 NA NA 9.94 9.83 3.72 090
63030 .... ............ A ........ Low back disk surgery ........................ 13.03 NA NA 8.64 8.55 3.01 090
63035 .... ............ A ........ Spinal disk surgery add-on ................. 3.15 NA NA 1.21 1.40 0.79 ZZZ
63040 .... ............ A ........ Laminotomy, single cervical ............... 20.18 NA NA 11.11 11.32 4.68 090
63042 .... ............ A ........ Laminotomy, single lumbar ................ 18.61 NA NA 10.64 11.01 4.26 090
63043 .... ............ C ........ Laminotomy, addœl cervical ................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
63044 .... ............ C ........ Laminotomy, addœlumbar ................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
63048 .... ............ A ........ Remove spinal lamina add-on ............ 3.47 NA NA 1.33 1.50 0.72 ZZZ
63050 .... ............ A ........ Cervical laminoplasty .......................... 21.88 NA NA 11.89 11.37 4.67 090
63051 .... ............ A ........ C-laminoplasty w/graft/plate ............... 25.38 NA NA 13.15 13.08 4.67 090
63055 .... ............ A ........ Decompress spinal cord ..................... 23.42 NA NA 12.55 12.84 5.29 090
63057 .... ............ A ........ Decompress spine cord add-on ......... 5.25 NA NA 2.01 2.32 1.22 ZZZ
63066 .... ............ A ........ Decompress spine cord add-on ......... 3.26 NA NA 1.23 1.45 0.69 ZZZ
63075 .... ............ A ........ Neck spine disk surgery ..................... 19.47 NA NA 11.07 11.60 4.63 090
63076 .... ............ A ........ Neck spine disk surgery ..................... 4.04 NA NA 1.53 1.80 0.96 ZZZ
63077 .... ............ A ........ Spine disk surgery, thorax .................. 22.75 NA NA 11.15 11.99 3.99 090
63078 .... ............ A ........ Spine disk surgery, thorax .................. 3.28 NA NA 1.22 1.43 0.66 ZZZ
63081 .... ............ A ........ Removal of vertebral body ................. 25.97 NA NA 13.59 13.99 5.56 090
63082 .... ............ A ........ Remove vertebral body add-on .......... 4.36 NA NA 1.66 1.95 1.02 ZZZ
63170 .... ............ A ........ Incise spinal cord tract(s) ................... 22.08 NA NA 10.52 11.57 4.87 090
63172 .... ............ A ........ Drainage of spinal cyst ....................... 19.66 NA NA 11.15 10.94 4.49 090
63173 .... ............ A ........ Drainage of spinal cyst ....................... 24.18 NA NA 13.68 13.22 5.70 090
63180 .... ............ A ........ Revise spinal cord ligaments ............. 20.40 NA NA 11.04 11.00 3.96 090
63182 .... ............ A ........ Revise spinal cord ligaments ............. 22.69 NA NA 7.17 9.06 5.32 090
63185 .... ............ A ........ Incise spinal column/nerves ............... 16.36 NA NA 10.19 9.14 2.80 090
63194 .... ............ A ........ Incise spinal column & cord ............... 21.97 NA NA 11.28 11.10 3.27 090
63200 .... ............ A ........ Release of spinal cord ........................ 21.31 NA NA 12.18 11.69 4.97 090
63250 .... ............ A ........ Revise spinal cord vessels ................. 43.73 NA NA 21.13 20.58 9.04 090
63265 .... ............ A ........ Excise intraspinal lesion ..................... 23.69 NA NA 13.11 12.96 5.45 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
63275 .... ............ A ........ Biopsy/excise spinal tumor ................. 25.73 NA NA 13.84 13.77 5.82 090
63295 .... ............ A ........ Repair of laminectomy defect ............. 5.25 NA NA 1.99 1.96 1.03 ZZZ
63600 .... ............ A ........ Remove spinal cord lesion ................. 15.02 NA NA 4.08 4.81 1.52 090
63610 .... ............ A ........ Stimulation of spinal cord ................... 8.72 13.66 36.72 1.46 1.87 0.86 000
63615 .... ............ A ........ Remove lesion of spinal cord ............. 17.22 NA NA 8.59 8.50 2.85 090
63660 .... ............ A ........ Revise/remove neuroelectrode ........... 6.87 NA NA 3.45 3.51 0.78 090
63685 .... ............ A ........ Insrt/redo spine n generator ............... 7.87 NA NA 3.68 3.91 1.05 090
63688 .... ............ A ........ Revise/remove neuroreceiver ............. 6.10 NA NA 3.54 3.55 0.89 090
63700 .... ............ A ........ Repair of spinal herniation ................. 17.32 NA NA 9.95 10.12 3.53 090
63707 .... ............ A ........ Repair spinal fluid leakage ................. 12.52 NA NA 7.87 7.80 2.52 090
63709 .... ............ A ........ Repair spinal fluid leakage ................. 15.52 NA NA 9.02 9.23 3.10 090
63710 .... ............ A ........ Graft repair of spine defect ................ 15.27 NA NA 9.25 9.16 3.41 090
63740 .... ............ A ........ Install spinal shunt .............................. 12.50 NA NA 8.31 7.83 2.94 090
63741 .... ............ A ........ Install spinal shunt .............................. 9.02 NA NA 4.96 4.84 1.66 090
63744 .... ............ A ........ Revision of spinal shunt ..................... 8.86 NA NA 5.82 5.59 1.90 090
63746 .... ............ A ........ Removal of spinal shunt ..................... 7.25 NA NA 5.69 4.58 1.53 090
64400 .... ............ A ........ N block inj, trigeminal ......................... 1.11 1.40 1.65 0.44 0.44 0.07 000
64402 .... ............ A ........ N block inj, facial ................................ 1.25 1.40 1.51 0.50 0.55 0.09 000
64405 .... ............ A ........ N block inj, occipital ............................ 1.32 1.15 1.31 0.50 0.48 0.08 000
64408 .... ............ A ........ N block inj, vagus ............................... 1.41 1.44 1.51 0.71 0.78 0.10 000
64410 .... ............ A ........ N block inj, phrenic ............................. 1.43 1.91 2.19 0.56 0.51 0.09 000
64412 .... ............ A ........ N block inj, spinal accessor ................ 1.18 2.12 2.37 0.59 0.50 0.08 000
64413 .... ............ A ........ N block inj, cervical plexus ................. 1.40 1.30 1.57 0.48 0.49 0.08 000
64415 .... ............ A ........ N block inj, brachial plexus ................ 1.48 1.40 2.11 0.31 0.39 0.09 000
64416 .... ............ A ........ N block cont infuse, b plex ................. 3.85 NA NA 0.47 0.65 0.31 010
64417 .... ............ A ........ N block inj, axillary ............................. 1.44 1.42 2.24 0.32 0.41 0.11 000
64418 .... ............ A ........ N block inj, suprascapular .................. 1.32 1.89 2.25 0.52 0.48 0.07 000
64420 .... ............ A ........ N block inj, intercost, sng ................... 1.18 2.38 3.13 0.45 0.44 0.08 000
64421 .... ............ A ........ N block inj, intercost, mlt .................... 1.68 3.53 4.80 0.53 0.52 0.11 000
64425 .... ............ A ........ N block inj, ilio-ing/hypogi ................... 1.75 1.29 1.48 0.53 0.54 0.13 000
64430 .... ............ A ........ N block inj, pudendal .......................... 1.46 2.39 2.45 0.78 0.67 0.10 000
64435 .... ............ A ........ N block inj, paracervical ..................... 1.45 1.99 2.25 0.56 0.63 0.16 000
64445 .... ............ A ........ N block inj, sciatic, sng ....................... 1.48 1.62 2.15 0.51 0.51 0.10 000
64446 .... ............ A ........ N blk inj, sciatic, cont inf .................... 3.61 NA NA 0.49 0.76 0.20 010
64447 .... ............ A ........ N block inj fem, single ........................ 1.50 NA NA 0.18 0.31 0.09 000
64448 .... ............ A ........ N block inj fem, cont inf ...................... 3.36 NA NA 0.40 0.62 0.18 010
64449 .... ............ A ........ N block inj, lumbar plexus .................. 3.24 NA NA 0.42 0.70 0.15 010
64450 .... ............ A ........ N block, other peripheral .................... 1.27 1.25 1.25 0.48 0.49 0.13 000
64470 .... ............ A ........ Inj paravertebral c/t ............................. 1.85 3.79 5.51 0.70 0.71 0.11 000
64472 .... ............ A ........ Inj paravertebral c/t add-on ................ 1.29 1.21 1.77 0.33 0.34 0.08 ZZZ
64475 .... ............ A ........ Inj paravertebral l/s ............................. 1.41 3.62 5.25 0.58 0.61 0.10 000
64476 .... ............ A ........ Inj paravertebral l/s add-on ................ 0.98 1.10 1.61 0.23 0.24 0.07 ZZZ
64479 .... ............ A ........ Inj foramen epidural c/t ....................... 2.20 3.73 5.61 0.81 0.85 0.12 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
64480 .... ............ A ........ Inj foramen epidural add-on ............... 1.54 1.54 2.18 0.40 0.43 0.10 ZZZ
64483 .... ............ A ........ Inj foramen epidural l/s ....................... 1.90 3.80 5.84 0.75 0.79 0.11 000
64484 .... ............ A ........ Inj foramen epidural add-on ............... 1.33 1.62 2.45 0.33 0.35 0.08 ZZZ
64505 .... ............ A ........ N block, spenopalatine gangl ............. 1.36 1.13 1.18 0.74 0.70 0.10 000
64508 .... ............ A ........ N block, carotid sinus s/p ................... 1.12 2.00 2.64 0.55 0.64 0.07 000
64510 .... ............ A ........ N block, stellate ganglion ................... 1.22 1.89 2.67 0.43 0.47 0.07 000
64517 .... ............ A ........ N block inj, hypogas plxs ................... 2.20 1.72 2.21 0.69 0.77 0.11 000
64520 .... ............ A ........ N block, lumbar/thoracic ..................... 1.35 2.56 3.85 0.51 0.53 0.08 000
64530 .... ............ A ........ N block inj, celiac pelus ...................... 1.58 2.78 3.58 0.66 0.64 0.10 000
64550 .... ............ A ........ Apply neurostimulator ......................... 0.18 0.20 0.24 0.05 0.05 0.01 000
64553 .... ............ A ........ Implant neuroelectrodes ..................... 2.33 2.67 2.72 1.46 1.64 0.18 010
64585 .... ............ A ........ Revise/remove neuroelectrode ........... 2.08 5.89 8.56 2.29 2.20 0.20 010
64590 .... ............ A ........ Insrt/redo pn/gastr stimul .................... 2.42 6.38 6.76 2.46 2.37 0.19 010
64595 .... ............ A ........ Revise/rmv pn/gastr stimul ................. 1.75 6.41 8.41 2.17 2.05 0.19 010
64600 .... ............ A ........ Injection treatment of nerve ................ 3.46 5.41 7.35 1.65 1.64 0.34 010
64612 .... ............ A ........ Destroy nerve, face muscle ................ 1.98 1.59 2.04 1.34 1.34 0.11 010
64613 .... ............ A ........ Destroy nerve, neck muscle ............... 1.98 1.37 2.15 1.14 1.18 0.11 010
64614 .... ............ A ........ Destroy nerve, extrem musc .............. 2.20 1.61 2.42 1.31 1.31 0.10 010
64622 .... ............ A ........ Destr paravertebrl nerve l/s ................ 3.02 4.04 5.89 1.26 1.31 0.18 010
64623 .... ............ A ........ Destr paravertebral n add-on ............. 0.99 1.67 2.30 0.22 0.22 0.06 ZZZ
64626 .... ............ A ........ Destr paravertebrl nerve c/t ................ 3.82 4.72 6.23 1.88 1.91 0.20 010
64627 .... ............ A ........ Destr paravertebral n add-on ............. 1.16 2.36 3.44 0.25 0.26 0.07 ZZZ
64650 .... ............ A ........ Chemodenerv eccrine glands ............. 0.70 0.71 0.80 0.16 0.23 0.06 000
64653 .... ............ A ........ Chemodenerv eccrine glands ............. 0.88 0.75 0.85 0.19 0.29 0.08 000
64702 .... ............ A ........ Revise finger/toe nerve ...................... 6.10 NA NA 5.15 4.54 0.61 090
64704 .... ............ A ........ Revise hand/foot nerve ...................... 4.61 NA NA 3.05 3.21 0.61 090
64708 .... ............ A ........ Revise arm/leg nerve ......................... 6.22 NA NA 4.16 4.54 0.96 090
64712 .... ............ A ........ Revision of sciatic nerve .................... 7.98 NA NA 4.34 4.69 0.95 090
64713 .... ............ A ........ Revision of arm nerve(s) .................... 11.29 NA NA 6.05 6.04 1.83 090
64714 .... ............ A ........ Revise low back nerve(s) ................... 10.44 NA NA 4.37 4.38 1.19 090
64716 .... ............ A ........ Revision of cranial nerve .................... 6.86 NA NA 5.47 5.68 0.63 090
64718 .... ............ A ........ Revise ulnar nerve at elbow ............... 7.06 NA NA 6.18 6.10 1.05 090
64719 .... ............ A ........ Revise ulnar nerve at wrist ................. 4.89 NA NA 4.12 4.33 0.77 090
64721 .... ............ A ........ Carpal tunnel surgery ......................... 4.84 4.69 5.04 4.63 5.00 0.73 090
64722 .... ............ A ........ Relieve pressure on nerve(s) ............. 4.74 NA NA 2.98 2.99 0.48 090
64726 .... ............ A ........ Release foot/toe nerve ....................... 4.21 NA NA 2.59 2.72 0.54 090
64727 .... ............ A ........ Internal nerve revision ........................ 3.10 NA NA 1.19 1.36 0.48 ZZZ
64732 .... ............ A ........ Incision of brow nerve ........................ 4.81 NA NA 3.67 3.70 0.98 090
64734 .... ............ A ........ Incision of cheek nerve ...................... 5.45 NA NA 4.45 4.29 0.89 090
64736 .... ............ A ........ Incision of chin nerve ......................... 5.13 NA NA 3.74 3.91 0.52 090
64738 .... ............ A ........ Incision of jaw nerve ........................... 6.26 NA NA 4.67 4.58 1.08 090
64740 .... ............ A ........ Incision of tongue nerve ..................... 6.12 NA NA 5.02 4.97 0.69 090
64742 .... ............ A ........ Incision of facial nerve ........................ 6.75 NA NA 4.31 4.52 0.73 090
64744 .... ............ A ........ Incise nerve, back of head ................. 5.64 NA NA 4.08 4.01 1.16 090
64746 .... ............ A ........ Incise diaphragm nerve ...................... 6.46 NA NA 3.86 4.18 0.82 090
64752 .... ............ A ........ Incision of vagus nerve ...................... 7.59 NA NA 3.78 4.07 0.93 090
64755 .... ............ A ........ Incision of stomach nerves ................. 14.97 NA NA 5.50 5.61 1.84 090
64760 .... ............ A ........ Incision of vagus nerve ...................... 7.49 NA NA 3.76 3.62 0.81 090
64761 .... ............ A ........ Incision of pelvis nerve ....................... 6.94 NA NA 4.28 3.85 0.53 090
64763 .... ............ A ........ Incise hip/thigh nerve ......................... 7.46 NA NA 3.89 4.75 0.94 090
64766 .... ............ A ........ Incise hip/thigh nerve ......................... 9.34 NA NA 4.55 5.02 1.06 090
64771 .... ............ A ........ Sever cranial nerve ............................ 8.02 NA NA 5.65 5.55 1.23 090
64772 .... ............ A ........ Incision of spinal nerve ....................... 7.74 NA NA 5.09 5.05 1.40 090
64774 .... ............ A ........ Remove skin nerve lesion .................. 5.70 NA NA 4.00 3.91 0.74 090
64776 .... ............ A ........ Remove digit nerve lesion .................. 5.52 NA NA 3.69 3.70 0.76 090
64778 .... ............ A ........ Digit nerve surgery add-on ................. 3.11 NA NA 1.21 1.36 0.46 ZZZ
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
64782 .... ............ A ........ Remove limb nerve lesion .................. 6.76 NA NA 4.01 3.91 0.86 090
64783 .... ............ A ........ Limb nerve surgery add-on ................ 3.71 NA NA 1.37 1.61 0.51 ZZZ
64784 .... ............ A ........ Remove nerve lesion .......................... 10.49 NA NA 6.38 6.47 1.38 090
64786 .... ............ A ........ Remove sciatic nerve lesion .............. 16.12 NA NA 8.46 9.25 2.61 090
64787 .... ............ A ........ Implant nerve end ............................... 4.29 NA NA 1.64 1.88 0.58 ZZZ
64788 .... ............ A ........ Remove skin nerve lesion .................. 5.14 NA NA 4.05 3.73 0.73 090
64790 .... ............ A ........ Removal of nerve lesion ..................... 11.97 NA NA 6.97 7.07 2.11 090
64792 .... ............ A ........ Removal of nerve lesion ..................... 15.71 NA NA 8.31 8.60 2.49 090
64795 .... ............ A ........ Biopsy of nerve ................................... 3.01 NA NA 1.43 1.50 0.52 000
64802 .... ............ A ........ Remove sympathetic nerves .............. 10.24 NA NA 3.51 4.44 1.29 090
64831 .... ............ A ........ Repair of digit nerve ........................... 10.23 NA NA 6.60 6.87 1.41 090
64832 .... ............ A ........ Repair nerve add-on ........................... 5.65 NA NA 2.31 2.64 0.85 ZZZ
64834 .... ............ A ........ Repair of hand or foot nerve .............. 10.71 NA NA 6.43 6.80 1.54 090
64837 .... ............ A ........ Repair nerve add-on ........................... 6.25 NA NA 2.62 2.95 0.97 ZZZ
64840 .... ............ A ........ Repair of leg nerve ............................. 13.87 NA NA 7.44 7.47 1.37 090
64856 .... ............ A ........ Repair/transpose nerve ...................... 14.94 NA NA 8.47 8.87 2.13 090
64857 .... ............ A ........ Repair arm/leg nerve .......................... 15.69 NA NA 8.75 9.24 2.22 090
64858 .... ............ A ........ Repair sciatic nerve ............................ 17.69 NA NA 9.59 10.32 3.34 090
64859 .... ............ A ........ Nerve surgery ..................................... 4.25 NA NA 1.76 2.01 0.67 ZZZ
64861 .... ............ A ........ Repair of arm nerves .......................... 20.74 NA NA 10.02 10.92 4.09 090
64862 .... ............ A ........ Repair of low back nerves .................. 20.94 NA NA 9.78 10.35 4.32 090
64864 .... ............ A ........ Repair of facial nerve ......................... 13.31 NA NA 7.50 8.08 1.26 090
64865 .... ............ A ........ Repair of facial nerve ......................... 15.96 NA NA 11.55 12.29 1.50 090
64866 .... ............ A ........ Fusion of facial/other nerve ................ 16.70 NA NA 11.13 12.36 2.05 090
64872 .... ............ A ........ Subsequent repair of nerve ................ 1.99 NA NA 0.78 0.94 0.29 ZZZ
64874 .... ............ A ........ Repair & revise nerve add-on ............ 2.98 NA NA 1.27 1.40 0.42 ZZZ
64876 .... ............ A ........ Repair nerve/shorten bone ................. 3.37 NA NA 1.44 1.48 0.47 ZZZ
64885 .... ............ A ........ Nerve graft, head or neck .................. 17.50 NA NA 9.00 10.31 1.63 090
64886 .... ............ A ........ Nerve graft, head or neck .................. 20.72 NA NA 10.45 11.92 2.09 090
64890 .... ............ A ........ Nerve graft, hand or foot .................... 16.11 NA NA 8.96 9.52 2.30 090
64892 .... ............ A ........ Nerve graft, arm or leg ....................... 15.61 NA NA 9.14 8.99 2.48 090
64901 .... ............ A ........ Nerve graft add-on ............................. 10.20 NA NA 3.55 4.47 1.37 ZZZ
64902 .... ............ A ........ Nerve graft add-on ............................. 11.81 NA NA 4.68 5.27 1.55 ZZZ
64905 .... ............ A ........ Nerve pedicle transfer ........................ 14.98 NA NA 7.01 7.75 2.01 090
64907 .... ............ A ........ Nerve pedicle transfer ........................ 19.90 NA NA 6.34 9.43 3.17 090
64910 .... ............ A ........ Nerve repair w/allograft ...................... 11.21 NA NA 4.63 5.02 1.74 090
64911 .... ............ A ........ Neurorraphy w/vein autograft ............. 14.21 NA NA 5.29 5.74 1.91 090
64999 .... ............ C ........ Nervous system surgery ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
65091 .... ............ A ........ Revise eye .......................................... 7.13 NA NA 6.76 7.59 0.32 090
65093 .... ............ A ........ Revise eye with implant ..................... 6.93 NA NA 6.82 7.80 0.34 090
65101 .... ............ A ........ Removal of eye .................................. 8.10 NA NA 7.99 8.79 0.35 090
65103 .... ............ A ........ Remove eye/insert implant ................. 8.64 NA NA 8.16 8.99 0.37 090
65105 .... ............ A ........ Remove eye/attach implant ................ 9.70 NA NA 8.81 9.69 0.42 090
65110 .... ............ A ........ Removal of eye .................................. 15.42 NA NA 11.50 12.62 0.81 090
65112 .... ............ A ........ Remove eye/revise socket ................. 18.18 NA NA 13.29 14.70 1.30 090
65114 .... ............ A ........ Remove eye/revise socket ................. 19.32 NA NA 13.58 15.01 1.02 090
65125 .... ............ A ........ Revise ocular implant ......................... 3.18 6.69 7.76 3.17 3.39 0.19 090
65130 .... ............ A ........ Insert ocular implant ........................... 8.22 NA NA 7.71 8.49 0.35 090
65135 .... ............ A ........ Insert ocular implant ........................... 8.40 NA NA 7.78 8.59 0.36 090
65140 .... ............ A ........ Attach ocular implant .......................... 9.23 NA NA 8.42 9.19 0.40 090
65150 .... ............ A ........ Revise ocular implant ......................... 6.32 NA NA 6.31 7.18 0.31 090
65155 .... ............ A ........ Reinsert ocular implant ....................... 9.87 NA NA 8.81 9.66 0.50 090
65175 .... ............ A ........ Removal of ocular implant .................. 7.22 NA NA 7.07 7.82 0.31 090
65205 .... ............ A ........ Remove foreign body from eye .......... 0.71 0.57 0.61 0.32 0.31 0.03 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
65235 .... ............ A ........ Remove foreign body from eye .......... 8.78 NA NA 6.83 6.82 0.37 090
65270 .... ............ A ........ Repair of eye wound .......................... 1.92 3.82 4.53 1.21 1.30 0.09 010
65273 .... ............ A ........ Repair of eye wound .......................... 5.03 NA NA 3.34 3.48 0.22 090
65290 .... ............ A ........ Repair of eye socket wound ............... 6.35 NA NA 4.43 4.62 0.31 090
65400 .... ............ A ........ Removal of eye lesion ........................ 7.27 7.47 7.94 5.88 6.03 0.30 090
65410 .... ............ A ........ Biopsy of cornea ................................. 1.47 1.67 1.90 0.87 0.92 0.07 000
65430 .... ............ A ........ Corneal smear .................................... 1.47 1.10 1.20 0.87 0.93 0.07 000
65435 .... ............ A ........ Curette/treat cornea ............................ 0.92 0.86 0.93 0.65 0.68 0.04 000
65436 .... ............ A ........ Curette/treat cornea ............................ 4.72 3.78 3.96 3.45 3.58 0.21 090
65450 .... ............ A ........ Treatment of corneal lesion ................ 3.35 3.68 3.89 3.61 3.79 0.16 090
65600 .... ............ A ........ Revision of cornea .............................. 4.07 4.44 4.75 3.40 3.40 0.17 090
65710 .... ............ A ........ Corneal transplant .............................. 14.09 NA NA 10.22 10.77 0.61 090
65770 .... ............ A ........ Revise cornea with implant ................ 19.41 NA NA 11.77 12.56 0.87 090
65772 .... ............ A ........ Correction of astigmatism ................... 4.96 4.86 5.22 3.94 4.06 0.21 090
65775 .... ............ A ........ Correction of astigmatism ................... 6.73 NA NA 5.33 5.67 0.28 090
65780 .... ............ A ........ Ocular reconst, transplant .................. 10.43 NA NA 8.98 9.69 0.44 090
65800 .... ............ A ........ Drainage of eye .................................. 1.91 1.40 1.61 1.03 1.12 0.09 000
65805 .... ............ A ........ Drainage of eye .................................. 1.91 1.70 1.95 1.03 1.12 0.09 000
65810 .... ............ A ........ Drainage of eye .................................. 5.67 NA NA 4.69 4.72 0.24 090
65815 .... ............ A ........ Drainage of eye .................................. 5.85 7.92 9.00 4.61 4.74 0.25 090
65820 .... ............ A ........ Relieve inner eye pressure ................ 8.72 NA NA 7.68 8.41 0.40 090
65850 .... ............ A ........ Incision of eye .................................... 11.24 NA NA 7.39 7.96 0.52 090
65855 .... ............ A ........ Laser surgery of eye .......................... 3.90 3.51 3.93 2.65 2.89 0.19 010
65860 .... ............ A ........ Incise inner eye adhesions ................. 3.56 3.27 3.68 2.10 2.31 0.18 090
65865 .... ............ A ........ Incise inner eye adhesions ................. 5.66 NA NA 4.72 5.20 0.28 090
65900 .... ............ A ........ Remove eye lesion ............................. 12.26 NA NA 8.95 9.65 0.54 090
65920 .... ............ A ........ Remove implant of eye ...................... 9.74 NA NA 7.51 7.89 0.41 090
65930 .... ............ A ........ Remove blood clot from eye .............. 8.24 NA NA 5.81 6.36 0.37 090
66020 .... ............ A ........ Injection treatment of eye ................... 1.61 2.42 2.78 1.28 1.37 0.08 010
66030 .... ............ A ........ Injection treatment of eye ................... 1.27 2.29 2.64 1.15 1.22 0.06 010
66130 .... ............ A ........ Remove eye lesion ............................. 7.74 7.54 8.62 4.91 5.30 0.38 090
66150 .... ............ A ........ Glaucoma surgery .............................. 10.18 NA NA 8.85 9.17 0.46 090
66172 .... ............ A ........ Incision of eye .................................... 18.26 NA NA 14.72 15.05 0.74 090
66180 .... ............ A ........ Implant eye shunt ............................... 16.02 NA NA 9.78 10.34 0.71 090
66185 .... ............ A ........ Revise eye shunt ................................ 9.35 NA NA 7.09 7.28 0.40 090
66220 .... ............ A ........ Repair eye lesion ................................ 8.98 NA NA 7.20 7.17 0.40 090
66225 .... ............ A ........ Repair/graft eye lesion ....................... 12.38 NA NA 8.18 8.51 0.55 090
66250 .... ............ A ........ Follow-up surgery of eye .................... 6.92 9.25 10.52 5.28 5.41 0.30 090
66500 .... ............ A ........ Incision of iris ...................................... 3.75 NA NA 3.96 4.32 0.18 090
66505 .... ............ A ........ Incision of iris ...................................... 4.13 NA NA 4.32 4.68 0.20 090
66600 .... ............ A ........ Remove iris and lesion ....................... 9.89 NA NA 8.33 8.32 0.43 090
66605 .... ............ A ........ Removal of iris .................................... 13.99 NA NA 9.54 9.77 0.77 090
66680 .... ............ A ........ Repair iris & ciliary body .................... 6.24 NA NA 5.09 5.21 0.27 090
66682 .... ............ A ........ Repair iris & ciliary body .................... 7.15 NA NA 6.73 6.71 0.31 090
66700 .... ............ A ........ Destruction, ciliary body ..................... 5.06 4.80 5.05 3.61 3.80 0.24 090
66710 .... ............ A ........ Ciliary transsleral therapy ................... 5.06 4.62 4.92 3.62 3.75 0.23 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
66711 .... ............ A ........ Ciliary endoscopic ablation ................. 7.70 NA NA 6.32 6.43 0.30 090
66761 .... ............ A ........ Revision of iris .................................... 4.87 5.03 5.34 4.21 4.28 0.20 090
66762 .... ............ A ........ Revision of iris .................................... 5.25 5.12 5.41 4.09 4.22 0.23 090
66770 .... ............ A ........ Removal of inner eye lesion ............... 5.98 5.55 5.85 4.61 4.74 0.26 090
66820 .... ............ A ........ Incision, secondary cataract ............... 3.93 NA NA 4.63 5.24 0.19 090
66821 .... ............ A ........ After cataract laser surgery ................ 3.32 3.84 3.98 3.43 3.54 0.11 090
66825 .... ............ A ........ Reposition intraocular lens ................. 8.82 NA NA 7.81 8.48 0.40 090
66830 .... ............ A ........ Removal of lens lesion ....................... 9.27 NA NA 6.42 6.73 0.36 090
66840 .... ............ A ........ Removal of lens material .................... 8.98 NA NA 6.34 6.64 0.39 090
66920 .... ............ A ........ Extraction of lens ................................ 9.93 NA NA 6.70 7.04 0.44 090
66982 .... ............ A ........ Cataract surgery, complex ................. 14.83 NA NA 9.04 9.51 0.63 090
66983 .... ............ A ........ Cataract surg w/iol, 1 stage ............... 10.20 NA NA 6.57 6.31 0.14 090
66984 .... ............ A ........ Cataract surg w/iol, 1 stage ............... 10.36 NA NA 6.51 7.00 0.39 090
66985 .... ............ A ........ Insert lens prosthesis ......................... 9.73 NA NA 7.18 7.35 0.36 090
66986 .... ............ A ........ Exchange lens prosthesis .................. 12.26 NA NA 8.12 8.70 0.60 090
66990 .... ............ A ........ Ophthalmic endoscope add-on .......... 1.51 NA NA 0.55 0.62 0.07 ZZZ
66999 .... ............ C ........ Eye surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
67005 .... ............ A ........ Partial removal of eye fluid ................. 5.77 NA NA 4.60 4.76 0.28 090
67010 .... ............ A ........ Partial removal of eye fluid ................. 6.94 NA NA 5.03 5.25 0.34 090
67015 .... ............ A ........ Release of eye fluid ............................ 7.00 NA NA 5.73 6.12 0.34 090
67025 .... ............ A ........ Replace eye fluid ................................ 7.91 7.89 8.60 5.95 6.12 0.34 090
67027 .... ............ A ........ Implant eye drug system .................... 11.43 NA NA 7.43 7.76 0.54 090
67028 .... ............ A ........ Injection eye drug ............................... 2.52 2.16 2.45 1.26 1.37 0.12 000
67030 .... ............ A ........ Incise inner eye strands ..................... 5.91 NA NA 5.62 5.77 0.24 090
67031 .... ............ A ........ Laser surgery, eye strands ................. 4.34 4.11 4.38 3.45 3.56 0.18 090
67036 .... ............ A ........ Removal of inner eye fluid ................. 13.09 NA NA 8.13 8.68 0.58 090
67038 .... ............ A ........ Strip retinal membrane ....................... 23.30 NA NA 13.59 14.64 1.04 090
67039 .... ............ A ........ Laser treatment of retina .................... 16.39 NA NA 10.80 11.56 0.71 090
67040 .... ............ A ........ Laser treatment of retina .................... 19.23 NA NA 12.11 12.98 0.85 090
67101 .... ............ A ........ Repair detached retina ....................... 8.60 8.52 8.87 6.22 6.41 0.37 090
67107 .... ............ A ........ Repair detached retina ....................... 16.35 NA NA 10.44 10.94 0.73 090
67108 .... ............ A ........ Repair detached retina ....................... 22.49 NA NA 13.08 13.84 1.02 090
67112 .... ............ A ........ Rerepair detached retina .................... 18.45 NA NA 10.97 11.46 0.83 090
67115 .... ............ A ........ Release encircling material ................ 5.93 NA NA 4.96 5.05 0.25 090
67120 .... ............ A ........ Remove eye implant material ............. 6.92 7.37 8.02 5.31 5.45 0.29 090
67121 .... ............ A ........ Remove eye implant material ............. 12.00 NA NA 8.02 8.33 0.53 090
67141 .... ............ A ........ Treatment of retina ............................. 6.00 5.44 5.68 4.68 4.80 0.26 090
67145 .... ............ A ........ Treatment of retina ............................. 6.17 5.37 5.58 4.74 4.87 0.27 090
67208 .... ............ A ........ Treatment of retinal lesion .................. 7.50 5.69 5.94 5.24 5.41 0.33 090
67218 .... ............ A ........ Treatment of retinal lesion .................. 20.22 NA NA 10.74 11.53 0.92 090
67220 .... ............ A ........ Treatment of choroid lesion ................ 14.19 9.30 9.92 8.25 8.68 0.65 090
67221 .... ............ R ........ Ocular photodynamic ther .................. 3.45 2.93 3.65 1.40 1.61 0.20 000
67225 .... ............ A ........ Eye photodynamic ther add-on .......... 0.47 0.23 0.24 0.17 0.19 0.02 ZZZ
67250 .... ............ A ........ Reinforce eye wall .............................. 9.46 NA NA 7.71 8.48 0.47 090
67255 .... ............ A ........ Reinforce/graft eye wall ...................... 9.97 NA NA 8.47 9.23 0.44 090
67299 .... ............ C ........ Eye surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
67311 .... ............ A ........ Revise eye muscle ............................. 7.59 NA NA 5.54 5.81 0.37 090
67312 .... ............ A ........ Revise two eye muscles ..................... 9.48 NA NA 6.25 6.54 0.43 090
67314 .... ............ A ........ Revise eye muscle ............................. 8.59 NA NA 6.20 6.41 0.39 090
67316 .... ............ A ........ Revise two eye muscles ..................... 10.73 NA NA 6.98 7.29 0.49 090
67318 .... ............ A ........ Revise eye muscle(s) ......................... 8.92 NA NA 6.56 6.79 0.41 090
67320 .... ............ A ........ Revise eye muscle(s) add-on ............. 5.40 NA NA 1.96 1.97 0.22 ZZZ
67331 .... ............ A ........ Eye surgery follow-up add-on ............ 5.13 NA NA 1.85 1.86 0.21 ZZZ
67332 .... ............ A ........ Rerevise eye muscles add-on ............ 5.56 NA NA 2.01 2.04 0.23 ZZZ
67334 .... ............ A ........ Revise eye muscle w/suture .............. 5.05 NA NA 1.84 1.83 0.20 ZZZ
67335 .... ............ A ........ Eye suture during surgery .................. 2.49 NA NA 0.91 1.02 0.13 ZZZ
67340 .... ............ A ........ Revise eye muscle add-on ................. 6.00 NA NA 2.18 2.21 0.25 ZZZ
67343 .... ............ A ........ Release eye tissue ............................. 8.29 NA NA 6.11 6.34 0.37 090
67345 .... ............ A ........ Destroy nerve of eye muscle ............. 2.98 2.18 2.40 1.71 1.88 0.17 010
67346 .... ............ A ........ Biopsy, eye muscle ............................ 2.87 NA NA 1.64 1.80 0.15 000
67399 .... ............ C ........ Eye muscle surgery procedure .......... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
67405 .... ............ A ........ Explore/drain eye socket .................... 9.00 NA NA 8.36 9.09 0.44 090
67412 .... ............ A ........ Explore/treat eye socket ..................... 10.17 NA NA 8.58 9.81 0.48 090
67414 .... ............ A ........ Explr/decompress eye socket ............ 17.78 NA NA 11.73 11.95 0.65 090
67415 .... ............ A ........ Aspiration, orbital contents ................. 1.76 NA NA 0.63 0.70 0.09 000
67440 .... ............ A ........ Explore/drain eye socket .................... 14.56 NA NA 11.94 13.15 0.70 090
67445 .... ............ A ........ Explr/decompress eye socket ............ 18.96 NA NA 12.26 13.16 0.90 090
67500 .... ............ A ........ Inject/treat eye socket ........................ 1.44 0.58 0.63 0.45 0.38 0.05 000
67550 .... ............ A ........ Insert eye socket implant ................... 11.52 NA NA 9.88 10.63 0.72 090
67560 .... ............ A ........ Revise eye socket implant ................. 11.93 NA NA 9.84 10.66 0.60 090
67570 .... ............ A ........ Decompress optic nerve ..................... 14.21 NA NA 11.10 12.39 0.68 090
67599 .... ............ C ........ Orbit surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
67700 .... ............ A ........ Drainage of eyelid abscess ................ 1.37 4.29 5.18 1.18 1.23 0.07 010
67710 .... ............ A ........ Incision of eyelid ................................. 1.04 3.69 4.54 1.08 1.15 0.05 010
67715 .... ............ A ........ Incision of eyelid fold .......................... 1.24 3.82 4.61 1.16 1.23 0.06 010
67800 .... ............ A ........ Remove eyelid lesion ......................... 1.39 1.40 1.52 0.91 0.98 0.07 010
67801 .... ............ A ........ Remove eyelid lesions ....................... 1.89 1.68 1.83 1.09 1.18 0.09 010
67805 .... ............ A ........ Remove eyelid lesions ....................... 2.24 2.19 2.37 1.42 1.55 0.11 010
67808 .... ............ A ........ Remove eyelid lesion(s) ..................... 4.47 NA NA 3.62 3.71 0.19 090
67810 .... ............ A ........ Biopsy of eyelid .................................. 1.48 3.93 3.64 0.69 0.69 0.06 000
67820 .... ............ A ........ Revise eyelashes ............................... 0.71 0.44 0.53 0.51 0.53 0.04 000
67835 .... ............ A ........ Revise eyelashes ............................... 5.61 NA NA 4.15 4.40 0.28 090
67840 .... ............ A ........ Remove eyelid lesion ......................... 2.06 3.90 4.70 1.46 1.57 0.10 010
67850 .... ............ A ........ Treat eyelid lesion .............................. 1.71 3.28 3.33 1.45 1.46 0.07 010
67875 .... ............ A ........ Closure of eyelid by suture ................ 1.35 2.38 2.85 0.84 0.89 0.07 000
67880 .... ............ A ........ Revision of eyelid ............................... 4.47 5.44 6.05 3.59 3.72 0.19 090
67900 .... ............ A ........ Repair brow defect ............................. 6.69 7.38 8.25 4.64 4.97 0.38 090
67901 .... ............ A ........ Repair eyelid defect ............................ 7.47 9.00 7.25 5.32 5.39 0.54 090
67902 .... ............ A ........ Repair eyelid defect ............................ 9.68 NA NA 6.39 5.97 0.60 090
67906 .... ............ A ........ Repair eyelid defect ............................ 6.84 NA NA 4.51 4.80 0.46 090
67909 .... ............ A ........ Revise eyelid defect ........................... 5.46 6.19 7.15 4.19 4.60 0.31 090
67911 .... ............ A ........ Revise eyelid defect ........................... 7.38 NA NA 5.09 4.97 0.31 090
67912 .... ............ A ........ Correction eyelid w/implant ................ 6.23 13.10 16.03 4.76 5.15 0.28 090
67930 .... ............ A ........ Repair eyelid wound ........................... 3.62 4.37 5.06 1.80 2.00 0.19 010
67935 .... ............ A ........ Repair eyelid wound ........................... 6.27 6.78 7.69 3.62 4.04 0.39 090
67938 .... ............ A ........ Remove eyelid foreign body ............... 1.35 3.81 4.62 1.22 1.25 0.06 010
67971 .... ............ A ........ Reconstruction of eyelid ..................... 9.87 NA NA 6.23 6.80 0.53 090
67999 .... ............ C ........ Revision of eyelid ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
68020 .... ............ A ........ Incise/drain eyelid lining ..................... 1.39 1.24 1.33 1.06 1.14 0.06 010
68040 .... ............ A ........ Treatment of eyelid lesions ................ 0.85 0.61 0.66 0.36 0.40 0.04 000
68100 .... ............ A ........ Biopsy of eyelid lining ......................... 1.35 2.36 2.81 0.87 0.92 0.07 000
68110 .... ............ A ........ Remove eyelid lining lesion ................ 1.79 3.07 3.60 1.49 1.58 0.09 010
68200 .... ............ A ........ Treat eyelid by injection ..................... 0.49 0.45 0.50 0.29 0.31 0.02 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
68320 .... ............ A ........ Revise/graft eyelid lining .................... 6.44 9.17 10.27 5.34 5.46 0.27 090
68325 .... ............ A ........ Revise/graft eyelid lining .................... 8.43 NA NA 6.15 6.36 0.44 090
68330 .... ............ A ........ Revise eyelid lining ............................. 5.63 7.42 8.45 4.47 4.62 0.24 090
68340 .... ............ A ........ Separate eyelid adhesions ................. 4.84 6.88 7.91 3.89 4.02 0.21 090
68360 .... ............ A ........ Revise eyelid lining ............................. 5.04 6.44 7.27 3.98 4.10 0.22 090
68362 .... ............ A ........ Revise eyelid lining ............................. 8.41 NA NA 6.02 6.25 0.36 090
68371 .... ............ A ........ Harvest eye tissue, alograft ................ 4.97 NA NA 4.08 4.43 0.44 010
68399 .... ............ C ........ Eyelid lining surgery ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
68400 .... ............ A ........ Incise/drain tear gland ........................ 1.71 4.41 5.16 1.22 1.53 0.08 010
68420 .... ............ A ........ Incise/drain tear sac ........................... 2.32 4.59 5.41 1.43 1.78 0.11 010
68440 .... ............ A ........ Incise tear duct opening ..................... 0.96 1.25 1.67 1.19 1.24 0.05 010
68500 .... ............ A ........ Removal of tear gland ........................ 12.49 NA NA 9.55 9.56 0.55 090
68505 .... ............ A ........ Partial removal, tear gland ................. 12.41 NA NA 8.97 9.85 0.55 090
68510 .... ............ A ........ Biopsy of tear gland ........................... 4.60 5.23 6.30 2.06 2.09 0.23 000
68520 .... ............ A ........ Removal of tear sac ........................... 8.58 NA NA 6.53 7.01 0.37 090
68525 .... ............ A ........ Biopsy of tear sac ............................... 4.42 NA NA 1.60 1.83 0.22 000
68530 .... ............ A ........ Clearance of tear duct ........................ 3.67 5.60 6.91 2.10 2.38 0.18 010
68540 .... ............ A ........ Remove tear gland lesion .................. 11.93 NA NA 8.55 9.02 0.52 090
68550 .... ............ A ........ Remove tear gland lesion .................. 14.86 NA NA 9.74 10.69 0.80 090
68700 .... ............ A ........ Repair tear ducts ................................ 7.67 NA NA 5.60 5.83 0.32 090
68705 .... ............ A ........ Revise tear duct opening ................... 2.08 3.04 3.62 1.59 1.70 0.10 010
68720 .... ............ A ........ Create tear sac drain .......................... 9.78 NA NA 6.93 7.44 0.44 090
68745 .... ............ A ........ Create tear duct drain ........................ 9.70 NA NA 7.03 7.53 0.52 090
68750 .... ............ A ........ Create tear duct drain ........................ 9.87 NA NA 7.48 7.91 0.43 090
68760 .... ............ A ........ Close tear duct opening ..................... 1.75 2.59 3.08 1.46 1.55 0.09 010
68761 .... ............ A ........ Close tear duct opening ..................... 1.38 1.83 2.06 1.25 1.29 0.06 010
68770 .... ............ A ........ Close tear system fistula .................... 8.09 NA NA 5.79 4.51 0.35 090
68801 .... ............ A ........ Dilate tear duct opening ..................... 0.96 1.77 1.86 1.41 1.46 0.05 010
68810 .... ............ A ........ Probe nasolacrimal duct ..................... 2.63 3.39 3.54 2.69 2.70 0.10 010
68811 .... ............ A ........ Probe nasolacrimal duct ..................... 2.39 NA NA 2.13 2.28 0.13 010
68815 .... ............ A ........ Probe nasolacrimal duct ..................... 3.24 6.41 7.35 2.45 2.64 0.17 010
68840 .... ............ A ........ Explore/irrigate tear ducts .................. 1.27 1.51 1.56 1.28 1.21 0.06 010
68850 .... ............ A ........ Injection for tear sac x-ray .................. 0.80 0.72 0.79 0.60 0.63 0.04 000
68899 .... ............ C ........ Tear duct system surgery ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69000 .... ............ A ........ Drain external ear lesion .................... 1.47 2.87 2.85 1.34 1.34 0.12 010
69005 .... ............ A ........ Drain external ear lesion .................... 2.13 2.98 2.92 1.61 1.70 0.17 010
69020 .... ............ A ........ Drain outer ear canal lesion ............... 1.50 4.07 4.00 1.90 1.96 0.12 010
69100 .... ............ A ........ Biopsy of external ear ........................ 0.81 1.84 1.78 0.40 0.40 0.03 000
69105 .... ............ A ........ Biopsy of external ear canal ............... 0.85 2.62 2.46 0.71 0.73 0.07 000
69110 .... ............ A ........ Remove external ear, partial .............. 3.47 7.80 7.24 4.44 4.43 0.30 090
69120 .... ............ A ........ Removal of external ear ..................... 4.08 NA NA 5.34 5.72 0.38 090
69140 .... ............ A ........ Remove ear canal lesion(s) ............... 8.03 NA NA 13.17 13.10 0.65 090
69145 .... ............ A ........ Remove ear canal lesion(s) ............... 2.65 6.99 6.31 3.36 3.29 0.21 090
69150 .... ............ A ........ Extensive ear canal surgery ............... 13.49 NA NA 11.45 12.30 1.22 090
69155 .... ............ A ........ Extensive ear/neck surgery ................ 23.06 NA NA 16.99 17.94 1.93 090
69200 .... ............ A ........ Clear outer ear canal .......................... 0.77 2.14 2.24 0.61 0.58 0.06 000
69205 .... ............ A ........ Clear outer ear canal .......................... 1.20 NA NA 1.24 1.29 0.10 010
69210 .... ............ A ........ Remove impacted ear wax ................. 0.61 0.58 0.60 0.17 0.20 0.05 000
69220 .... ............ A ........ Clean out mastoid cavity .................... 0.83 2.55 2.43 0.68 0.69 0.07 000
69222 .... ............ A ........ Clean out mastoid cavity .................... 1.42 3.95 3.86 1.89 1.95 0.12 010
69300 .... ............ R ........ Revise external ear ............................ 6.69 10.69 7.30 5.20 4.63 0.72 YYY
69310 .... ............ A ........ Rebuild outer ear canal ...................... 10.85 NA NA 15.45 15.68 0.85 090
69320 .... ............ A ........ Rebuild outer ear canal ...................... 17.03 NA NA 20.02 20.65 1.37 090
69399 .... ............ C ........ Outer ear surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69400 .... ............ A ........ Inflate middle ear canal ...................... 0.83 2.80 2.45 0.68 0.67 0.07 000
69401 .... ............ A ........ Inflate middle ear canal ...................... 0.63 1.52 1.37 0.60 0.62 0.05 000
69405 .... ............ A ........ Catheterize middle ear canal ............. 2.65 3.65 3.54 1.97 2.12 0.21 010
69420 .... ............ A ........ Incision of eardrum ............................. 1.35 3.30 3.19 1.55 1.55 0.11 010
69421 .... ............ A ........ Incision of eardrum ............................. 1.75 NA NA 1.85 1.98 0.15 010
69424 .... ............ A ........ Remove ventilating tube ..................... 0.85 2.32 2.23 0.68 0.67 0.07 000
69433 .... ............ A ........ Create eardrum opening .................... 1.54 3.30 3.16 1.59 1.60 0.13 010
69436 .... ............ A ........ Create eardrum opening .................... 1.98 NA NA 1.90 2.07 0.19 010
69440 .... ............ A ........ Exploration of middle ear ................... 7.62 NA NA 9.10 8.82 0.61 090
69450 .... ............ A ........ Eardrum revision ................................ 5.61 NA NA 7.59 7.22 0.45 090
69501 .... ............ A ........ Mastoidectomy .................................... 9.12 NA NA 8.65 8.70 0.73 090
69502 .... ............ A ........ Mastoidectomy .................................... 12.44 NA NA 11.04 11.17 1.00 090
69505 .... ............ A ........ Remove mastoid structures ................ 13.05 NA NA 16.10 16.45 1.05 090
69511 .... ............ A ........ Extensive mastoid surgery ................. 13.58 NA NA 16.29 16.67 1.09 090
69530 .... ............ A ........ Extensive mastoid surgery ................. 20.24 NA NA 19.65 20.40 1.54 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
69535 .... ............ A ........ Remove part of temporal bone .......... 37.27 NA NA 26.82 29.01 2.93 090
69540 .... ............ A ........ Remove ear lesion ............................. 1.22 3.88 3.77 1.85 1.89 0.10 010
69550 .... ............ A ........ Remove ear lesion ............................. 11.04 NA NA 14.24 14.37 0.89 090
69601 .... ............ A ........ Mastoid surgery revision .................... 13.31 NA NA 11.92 12.14 1.07 090
69610 .... ............ A ........ Repair of eardrum .............................. 4.44 4.90 5.16 2.59 2.89 0.36 010
69620 .... ............ A ........ Repair of eardrum .............................. 5.94 10.87 10.87 5.83 5.98 0.48 090
69631 .... ............ A ........ Repair eardrum structures .................. 9.93 NA NA 11.50 11.20 0.80 090
69632 .... ............ A ........ Rebuild eardrum structures ................ 12.82 NA NA 13.30 13.21 1.03 090
69635 .... ............ A ........ Repair eardrum structures .................. 13.39 NA NA 16.26 16.29 1.08 090
69641 .... ............ A ........ Revise middle ear & mastoid ............. 12.77 NA NA 12.47 12.46 1.03 090
69650 .... ............ A ........ Release middle ear bone ................... 9.71 NA NA 9.52 9.59 0.78 090
69660 .... ............ A ........ Revise middle ear bone ..................... 11.94 NA NA 10.50 10.70 0.96 090
69666 .... ............ A ........ Repair middle ear structures .............. 9.80 NA NA 9.79 9.75 0.79 090
69667 .... ............ A ........ Repair middle ear structures .............. 9.81 NA NA 9.83 9.76 0.79 090
69670 .... ............ A ........ Remove mastoid air cells ................... 11.62 NA NA 11.24 11.31 0.93 090
69676 .... ............ A ........ Remove middle ear nerve .................. 9.58 NA NA 10.60 10.53 0.81 090
69700 .... ............ A ........ Close mastoid fistula .......................... 8.28 NA NA 8.67 8.80 0.67 090
69711 .... ............ A ........ Remove/repair hearing aid ................. 10.50 NA NA 10.40 10.45 0.83 090
69714 .... ............ A ........ Implant temple bone w/stimul ............. 14.31 NA NA 11.81 12.06 1.13 090
69715 .... ............ A ........ Temple bne implnt w/stimulat ............. 18.80 NA NA 13.36 13.99 1.48 090
69717 .... ............ A ........ Temple bone implant revision ............ 15.29 NA NA 11.98 13.13 0.90 090
69718 .... ............ A ........ Revise temple bone implant ............... 19.05 NA NA 13.44 15.53 3.22 090
69720 .... ............ A ........ Release facial nerve ........................... 14.57 NA NA 14.02 14.09 1.16 090
69740 .... ............ A ........ Repair facial nerve ............................. 16.18 NA NA 11.56 12.45 1.27 090
69745 .... ............ A ........ Repair facial nerve ............................. 16.91 NA NA 9.87 12.78 1.14 090
69799 .... ............ C ........ Middle ear surgery procedure ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69801 .... ............ A ........ Incise inner ear ................................... 8.61 NA NA 9.60 9.41 0.69 090
69802 .... ............ A ........ Incise inner ear ................................... 13.39 NA NA 11.86 11.89 1.06 090
69805 .... ............ A ........ Explore inner ear ................................ 14.55 NA NA 10.92 11.24 1.12 090
69806 .... ............ A ........ Explore inner ear ................................ 12.52 NA NA 10.40 10.57 1.00 090
69820 .... ............ A ........ Establish inner ear window ................ 10.40 NA NA 10.25 10.68 0.90 090
69840 .... ............ A ........ Revise inner ear window .................... 10.32 NA NA 11.39 12.34 0.79 090
69905 .... ............ A ........ Remove inner ear ............................... 11.15 NA NA 11.03 11.05 0.90 090
69910 .... ............ A ........ Remove inner ear & mastoid ............. 13.80 NA NA 10.90 11.25 1.07 090
69915 .... ............ A ........ Incise inner ear nerve ......................... 22.65 NA NA 14.86 15.45 1.70 090
69930 .... ............ A ........ Implant cochlear device ...................... 17.60 NA NA 13.13 13.75 1.36 090
69949 .... ............ C ........ Inner ear surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69950 .... ............ A ........ Incise inner ear nerve ......................... 27.44 NA NA 16.94 17.69 2.29 090
69960 .... ............ A ........ Release inner ear canal ..................... 29.22 NA NA 17.99 18.64 2.18 090
69970 .... ............ A ........ Remove inner ear lesion .................... 32.21 NA NA 19.60 21.18 2.42 090
69979 .... ............ C ........ Temporal bone surgery ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
69990 .... ............ R ........ Microsurgery add-on ........................... 3.46 NA NA 1.29 1.54 0.89 ZZZ
70010 .... ............ A ........ Contrast x-ray of brain ........................ 1.19 2.80 3.73 NA NA 0.27 XXX
70010 .... 26 ....... A ........ Contrast x-ray of brain ........................ 1.19 0.42 0.39 0.42 0.39 0.05 XXX
70010 .... TC ...... A ........ Contrast x-ray of brain ........................ 0.00 2.37 3.34 NA NA 0.22 XXX
70015 .... ............ A ........ Contrast x-ray of brain ........................ 1.19 2.90 2.29 NA NA 0.16 XXX
70015 .... 26 ....... A ........ Contrast x-ray of brain ........................ 1.19 0.43 0.40 0.43 0.40 0.08 XXX
70015 .... TC ...... A ........ Contrast x-ray of brain ........................ 0.00 2.47 1.89 NA NA 0.08 XXX
70030 .... ............ A ........ X-ray eye for foreign body .................. 0.17 0.60 0.54 NA NA 0.03 XXX
70030 .... 26 ....... A ........ X-ray eye for foreign body .................. 0.17 0.06 0.06 0.06 0.06 0.01 XXX
70030 .... TC ...... A ........ X-ray eye for foreign body .................. 0.00 0.54 0.48 NA NA 0.02 XXX
70100 .... ............ A ........ X-ray exam of jaw .............................. 0.18 0.63 0.60 NA NA 0.03 XXX
70100 .... 26 ....... A ........ X-ray exam of jaw .............................. 0.18 0.06 0.06 0.06 0.06 0.01 XXX
70100 .... TC ...... A ........ X-ray exam of jaw .............................. 0.00 0.58 0.55 NA NA 0.02 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
70110 .... ............ A ........ X-ray exam of jaw .............................. 0.25 0.80 0.75 NA NA 0.05 XXX
70110 .... 26 ....... A ........ X-ray exam of jaw .............................. 0.25 0.09 0.08 0.09 0.08 0.01 XXX
70110 .... TC ...... A ........ X-ray exam of jaw .............................. 0.00 0.71 0.66 NA NA 0.04 XXX
70120 .... ............ A ........ X-ray exam of mastoids ..................... 0.18 0.69 0.68 NA NA 0.05 XXX
70120 .... 26 ....... A ........ X-ray exam of mastoids ..................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX
70120 .... TC ...... A ........ X-ray exam of mastoids ..................... 0.00 0.63 0.62 NA NA 0.04 XXX
70130 .... ............ A ........ X-ray exam of mastoids ..................... 0.34 1.14 1.01 NA NA 0.07 XXX
70130 .... 26 ....... A ........ X-ray exam of mastoids ..................... 0.34 0.11 0.11 0.11 0.11 0.02 XXX
70130 .... TC ...... A ........ X-ray exam of mastoids ..................... 0.00 1.03 0.90 NA NA 0.05 XXX
70134 .... ............ A ........ X-ray exam of middle ear ................... 0.34 0.91 0.87 NA NA 0.07 XXX
70134 .... 26 ....... A ........ X-ray exam of middle ear ................... 0.34 0.12 0.11 0.12 0.11 0.02 XXX
70134 .... TC ...... A ........ X-ray exam of middle ear ................... 0.00 0.79 0.76 NA NA 0.05 XXX
70140 .... ............ A ........ X-ray exam of facial bones ................ 0.19 0.54 0.61 NA NA 0.05 XXX
70140 .... 26 ....... A ........ X-ray exam of facial bones ................ 0.19 0.05 0.06 0.05 0.06 0.01 XXX
70140 .... TC ...... A ........ X-ray exam of facial bones ................ 0.00 0.49 0.55 NA NA 0.04 XXX
70150 .... ............ A ........ X-ray exam of facial bones ................ 0.26 0.85 0.85 NA NA 0.06 XXX
70150 .... 26 ....... A ........ X-ray exam of facial bones ................ 0.26 0.08 0.08 0.08 0.08 0.01 XXX
70150 .... TC ...... A ........ X-ray exam of facial bones ................ 0.00 0.76 0.77 NA NA 0.05 XXX
70160 .... ............ A ........ X-ray exam of nasal bones ................ 0.17 0.70 0.63 NA NA 0.03 XXX
70160 .... 26 ....... A ........ X-ray exam of nasal bones ................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX
70160 .... TC ...... A ........ X-ray exam of nasal bones ................ 0.00 0.64 0.57 NA NA 0.02 XXX
70170 .... ............ C ........ X-ray exam of tear duct ...................... 0.30 NA NA NA NA 0.07 XXX
70170 .... 26 ....... A ........ X-ray exam of tear duct ...................... 0.30 0.11 0.10 0.11 0.10 0.01 XXX
70170 .... TC ...... C ........ X-ray exam of tear duct ...................... 0.00 NA NA NA NA 0.06 XXX
70190 .... ............ A ........ X-ray exam of eye sockets ................. 0.21 0.72 0.70 NA NA 0.05 XXX
70190 .... 26 ....... A ........ X-ray exam of eye sockets ................. 0.21 0.07 0.07 0.07 0.07 0.01 XXX
70190 .... TC ...... A ........ X-ray exam of eye sockets ................. 0.00 0.65 0.63 NA NA 0.04 XXX
70200 .... ............ A ........ X-ray exam of eye sockets ................. 0.28 0.87 0.86 NA NA 0.06 XXX
70200 .... 26 ....... A ........ X-ray exam of eye sockets ................. 0.28 0.10 0.09 0.10 0.09 0.01 XXX
70200 .... TC ...... A ........ X-ray exam of eye sockets ................. 0.00 0.78 0.77 NA NA 0.05 XXX
70210 .... ............ A ........ X-ray exam of sinuses ........................ 0.17 0.58 0.63 NA NA 0.05 XXX
70210 .... 26 ....... A ........ X-ray exam of sinuses ........................ 0.17 0.05 0.06 0.05 0.06 0.01 XXX
70210 .... TC ...... A ........ X-ray exam of sinuses ........................ 0.00 0.52 0.57 NA NA 0.04 XXX
70220 .... ............ A ........ X-ray exam of sinuses ........................ 0.25 0.72 0.79 NA NA 0.06 XXX
70220 .... 26 ....... A ........ X-ray exam of sinuses ........................ 0.25 0.08 0.08 0.08 0.08 0.01 XXX
70220 .... TC ...... A ........ X-ray exam of sinuses ........................ 0.00 0.65 0.71 NA NA 0.05 XXX
70240 .... ............ A ........ X-ray exam, pituitary saddle ............... 0.19 0.60 0.54 NA NA 0.03 XXX
70240 .... 26 ....... A ........ X-ray exam, pituitary saddle ............... 0.19 0.06 0.06 0.06 0.06 0.01 XXX
70240 .... TC ...... A ........ X-ray exam, pituitary saddle ............... 0.00 0.54 0.48 NA NA 0.02 XXX
70250 .... ............ A ........ X-ray exam of skull ............................. 0.24 0.69 0.70 NA NA 0.05 XXX
70250 .... 26 ....... A ........ X-ray exam of skull ............................. 0.24 0.07 0.08 0.07 0.08 0.01 XXX
70250 .... TC ...... A ........ X-ray exam of skull ............................. 0.00 0.62 0.62 NA NA 0.04 XXX
70260 .... ............ A ........ X-ray exam of skull ............................. 0.34 0.87 0.93 NA NA 0.08 XXX
70260 .... 26 ....... A ........ X-ray exam of skull ............................. 0.34 0.11 0.11 0.11 0.11 0.02 XXX
70260 .... TC ...... A ........ X-ray exam of skull ............................. 0.00 0.77 0.82 NA NA 0.06 XXX
70300 .... ............ A ........ X-ray exam of teeth ............................ 0.10 0.24 0.28 NA NA 0.03 XXX
70300 .... 26 ....... A ........ X-ray exam of teeth ............................ 0.10 0.03 0.04 0.03 0.04 0.01 XXX
70300 .... TC ...... A ........ X-ray exam of teeth ............................ 0.00 0.21 0.24 NA NA 0.02 XXX
70310 .... ............ A ........ X-ray exam of teeth ............................ 0.16 0.81 0.66 NA NA 0.03 XXX
70310 .... 26 ....... A ........ X-ray exam of teeth ............................ 0.16 0.05 0.06 0.05 0.06 0.01 XXX
70310 .... TC ...... A ........ X-ray exam of teeth ............................ 0.00 0.76 0.59 NA NA 0.02 XXX
70320 .... ............ A ........ Full mouth x-ray of teeth .................... 0.22 1.06 0.95 NA NA 0.06 XXX
70320 .... 26 ....... A ........ Full mouth x-ray of teeth .................... 0.22 0.07 0.08 0.07 0.08 0.01 XXX
70320 .... TC ...... A ........ Full mouth x-ray of teeth .................... 0.00 0.99 0.87 NA NA 0.05 XXX
70328 .... ............ A ........ X-ray exam of jaw joint ....................... 0.18 0.62 0.58 NA NA 0.03 XXX
70328 .... 26 ....... A ........ X-ray exam of jaw joint ....................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX
70328 .... TC ...... A ........ X-ray exam of jaw joint ....................... 0.00 0.56 0.52 NA NA 0.02 XXX
70330 .... ............ A ........ X-ray exam of jaw joints ..................... 0.24 1.00 0.95 NA NA 0.06 XXX
70330 .... 26 ....... A ........ X-ray exam of jaw joints ..................... 0.24 0.08 0.08 0.08 0.08 0.01 XXX
70330 .... TC ...... A ........ X-ray exam of jaw joints ..................... 0.00 0.92 0.87 NA NA 0.05 XXX
70332 .... ............ A ........ X-ray exam of jaw joint ....................... 0.54 1.45 1.87 NA NA 0.14 XXX
70332 .... 26 ....... A ........ X-ray exam of jaw joint ....................... 0.54 0.17 0.18 0.17 0.18 0.02 XXX
70332 .... TC ...... A ........ X-ray exam of jaw joint ....................... 0.00 1.28 1.69 NA NA 0.12 XXX
70336 .... ............ A ........ Magnetic image, jaw joint ................... 1.48 12.06 11.80 NA NA 0.66 XXX
70336 .... 26 ....... A ........ Magnetic image, jaw joint ................... 1.48 0.51 0.48 0.51 0.48 0.07 XXX
70336 .... TC ...... A ........ Magnetic image, jaw joint ................... 0.00 11.55 11.32 NA NA 0.59 XXX
70350 .... ............ A ........ X-ray head for orthodontia ................. 0.17 0.33 0.39 NA NA 0.03 XXX
70350 .... 26 ....... A ........ X-ray head for orthodontia ................. 0.17 0.06 0.07 0.06 0.07 0.01 XXX
70350 .... TC ...... A ........ X-ray head for orthodontia ................. 0.00 0.27 0.32 NA NA 0.02 XXX
70355 .... ............ A ........ Panoramic x-ray of jaws ..................... 0.20 0.30 0.47 NA NA 0.05 XXX
70355 .... 26 ....... A ........ Panoramic x-ray of jaws ..................... 0.20 0.07 0.07 0.07 0.07 0.01 XXX
70355 .... TC ...... A ........ Panoramic x-ray of jaws ..................... 0.00 0.23 0.40 NA NA 0.04 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
70360 .... ............ A ........ X-ray exam of neck ............................ 0.17 0.56 0.52 NA NA 0.03 XXX
70360 .... 26 ....... A ........ X-ray exam of neck ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX
70360 .... TC ...... A ........ X-ray exam of neck ............................ 0.00 0.50 0.46 NA NA 0.02 XXX
70370 .... ............ A ........ Throat x-ray & fluoroscopy ................. 0.32 1.63 1.52 NA NA 0.08 XXX
70370 .... 26 ....... A ........ Throat x-ray & fluoroscopy ................. 0.32 0.10 0.10 0.10 0.10 0.01 XXX
70370 .... TC ...... A ........ Throat x-ray & fluoroscopy ................. 0.00 1.53 1.42 NA NA 0.07 XXX
70371 .... ............ A ........ Speech evaluation, complex .............. 0.84 1.46 1.91 NA NA 0.16 XXX
70371 .... 26 ....... A ........ Speech evaluation, complex .............. 0.84 0.26 0.27 0.26 0.27 0.04 XXX
70371 .... TC ...... A ........ Speech evaluation, complex .............. 0.00 1.20 1.65 NA NA 0.12 XXX
70373 .... ............ A ........ Contrast x-ray of larynx ...................... 0.44 1.56 1.74 NA NA 0.13 XXX
70373 .... 26 ....... A ........ Contrast x-ray of larynx ...................... 0.44 0.11 0.12 0.11 0.12 0.02 XXX
70373 .... TC ...... A ........ Contrast x-ray of larynx ...................... 0.00 1.45 1.62 NA NA 0.11 XXX
70380 .... ............ A ........ X-ray exam of salivary gland .............. 0.17 0.82 0.77 NA NA 0.05 XXX
70380 .... 26 ....... A ........ X-ray exam of salivary gland .............. 0.17 0.06 0.06 0.06 0.06 0.01 XXX
70380 .... TC ...... A ........ X-ray exam of salivary gland .............. 0.00 0.76 0.71 NA NA 0.04 XXX
70390 .... ............ A ........ X-ray exam of salivary duct ................ 0.38 2.32 2.09 NA NA 0.13 XXX
70390 .... 26 ....... A ........ X-ray exam of salivary duct ................ 0.38 0.14 0.13 0.14 0.13 0.02 XXX
70390 .... TC ...... A ........ X-ray exam of salivary duct ................ 0.00 2.18 1.97 NA NA 0.11 XXX
70450 .... ............ A ........ Ct head/brain w/o dye ........................ 0.85 4.88 4.90 NA NA 0.29 XXX
70450 .... 26 ....... A ........ Ct head/brain w/o dye ........................ 0.85 0.31 0.28 0.31 0.28 0.04 XXX
70450 .... TC ...... A ........ Ct head/brain w/o dye ........................ 0.00 4.57 4.62 NA NA 0.25 XXX
70460 .... ............ A ........ Ct head/brain w/dye ........................... 1.13 6.46 6.19 NA NA 0.35 XXX
70460 .... 26 ....... A ........ Ct head/brain w/dye ........................... 1.13 0.41 0.38 0.41 0.38 0.05 XXX
70460 .... TC ...... A ........ Ct head/brain w/dye ........................... 0.00 6.05 5.82 NA NA 0.30 XXX
70470 .... ............ A ........ Ct head/brain w/o & w/dye ................. 1.27 7.86 7.61 NA NA 0.43 XXX
70470 .... 26 ....... A ........ Ct head/brain w/o & w/dye ................. 1.27 0.45 0.42 0.45 0.42 0.06 XXX
70470 .... TC ...... A ........ Ct head/brain w/o & w/dye ................. 0.00 7.41 7.19 NA NA 0.37 XXX
70480 .... ............ A ........ Ct orbit/ear/fossa w/o dye .................. 1.28 8.41 6.71 NA NA 0.31 XXX
70480 .... 26 ....... A ........ Ct orbit/ear/fossa w/o dye .................. 1.28 0.45 0.42 0.45 0.42 0.06 XXX
70480 .... TC ...... A ........ Ct orbit/ear/fossa w/o dye .................. 0.00 7.96 6.29 NA NA 0.25 XXX
70481 .... ............ A ........ Ct orbit/ear/fossa w/dye ...................... 1.38 9.88 7.93 NA NA 0.36 XXX
70481 .... 26 ....... A ........ Ct orbit/ear/fossa w/dye ...................... 1.38 0.49 0.46 0.49 0.46 0.06 XXX
70481 .... TC ...... A ........ Ct orbit/ear/fossa w/dye ...................... 0.00 9.39 7.47 NA NA 0.30 XXX
70482 .... ............ A ........ Ct orbit/ear/fossa w/o&w/dye .............. 1.45 11.30 9.34 NA NA 0.43 XXX
70482 .... 26 ....... A ........ Ct orbit/ear/fossa w/o&w/dye .............. 1.45 0.51 0.48 0.51 0.48 0.06 XXX
70482 .... TC ...... A ........ Ct orbit/ear/fossa w/o&w/dye .............. 0.00 10.79 8.86 NA NA 0.37 XXX
70486 .... ............ A ........ Ct maxillofacial w/o dye ...................... 1.14 6.74 5.86 NA NA 0.30 XXX
70486 .... 26 ....... A ........ Ct maxillofacial w/o dye ...................... 1.14 0.40 0.37 0.40 0.37 0.05 XXX
70486 .... TC ...... A ........ Ct maxillofacial w/o dye ...................... 0.00 6.33 5.48 NA NA 0.25 XXX
70487 .... ............ A ........ Ct maxillofacial w/dye ......................... 1.30 8.28 7.13 NA NA 0.36 XXX
70487 .... 26 ....... A ........ Ct maxillofacial w/dye ......................... 1.30 0.47 0.44 0.47 0.44 0.06 XXX
70487 .... TC ...... A ........ Ct maxillofacial w/dye ......................... 0.00 7.81 6.69 NA NA 0.30 XXX
70488 .... ............ A ........ Ct maxillofacial w/o & w/dye .............. 1.42 10.31 8.84 NA NA 0.43 XXX
70488 .... 26 ....... A ........ Ct maxillofacial w/o & w/dye .............. 1.42 0.50 0.47 0.50 0.47 0.06 XXX
70488 .... TC ...... A ........ Ct maxillofacial w/o & w/dye .............. 0.00 9.81 8.38 NA NA 0.37 XXX
70490 .... ............ A ........ Ct soft tissue neck w/o dye ................ 1.28 6.44 5.74 NA NA 0.31 XXX
70490 .... 26 ....... A ........ Ct soft tissue neck w/o dye ................ 1.28 0.46 0.43 0.46 0.43 0.06 XXX
70490 .... TC ...... A ........ Ct soft tissue neck w/o dye ................ 0.00 5.98 5.31 NA NA 0.25 XXX
70491 .... ............ A ........ Ct soft tissue neck w/dye ................... 1.38 7.97 6.98 NA NA 0.36 XXX
70491 .... 26 ....... A ........ Ct soft tissue neck w/dye ................... 1.38 0.50 0.46 0.50 0.46 0.06 XXX
70491 .... TC ...... A ........ Ct soft tissue neck w/dye ................... 0.00 7.48 6.52 NA NA 0.30 XXX
70492 .... ............ A ........ Ct sft tsue nck w/o & w/dye ............... 1.45 9.94 8.67 NA NA 0.43 XXX
70492 .... 26 ....... A ........ Ct sft tsue nck w/o & w/dye ............... 1.45 0.51 0.48 0.51 0.48 0.06 XXX
70492 .... TC ...... A ........ Ct sft tsue nck w/o & w/dye ............... 0.00 9.43 8.20 NA NA 0.37 XXX
70496 .... ............ A ........ Ct angiography, head ......................... 1.75 16.92 13.93 NA NA 0.66 XXX
70496 .... 26 ....... A ........ Ct angiography, head ......................... 1.75 0.64 0.59 0.64 0.59 0.08 XXX
70496 .... TC ...... A ........ Ct angiography, head ......................... 0.00 16.28 13.34 NA NA 0.58 XXX
70498 .... ............ A ........ Ct angiography, neck ......................... 1.75 17.03 13.98 NA NA 0.66 XXX
70498 .... 26 ....... A ........ Ct angiography, neck ......................... 1.75 0.65 0.59 0.65 0.59 0.08 XXX
70498 .... TC ...... A ........ Ct angiography, neck ......................... 0.00 16.38 13.39 NA NA 0.58 XXX
70540 .... ............ A ........ Mri orbit/face/neck w/o dye ................ 1.35 14.05 12.76 NA NA 0.45 XXX
70540 .... 26 ....... A ........ Mri orbit/face/neck w/o dye ................ 1.35 0.47 0.44 0.47 0.44 0.06 XXX
70540 .... TC ...... A ........ Mri orbit/face/neck w/o dye ................ 0.00 13.58 12.31 NA NA 0.39 XXX
70542 .... ............ A ........ Mri orbit/face/neck w/dye .................... 1.62 15.16 14.45 NA NA 0.54 XXX
70542 .... 26 ....... A ........ Mri orbit/face/neck w/dye .................... 1.62 0.57 0.53 0.57 0.53 0.07 XXX
70542 .... TC ...... A ........ Mri orbit/face/neck w/dye .................... 0.00 14.59 13.92 NA NA 0.47 XXX
70543 .... ............ A ........ Mri orbt/fac/nck w/o & w/dye .............. 2.15 18.60 21.97 NA NA 0.94 XXX
70543 .... 26 ....... A ........ Mri orbt/fac/nck w/o & w/dye .............. 2.15 0.75 0.71 0.75 0.71 0.10 XXX
70543 .... TC ...... A ........ Mri orbt/fac/nck w/o & w/dye .............. 0.00 17.85 21.26 NA NA 0.84 XXX
70544 .... ............ A ........ Mr angiography head w/o dye ............ 1.20 15.70 13.54 NA NA 0.64 XXX
70544 .... 26 ....... A ........ Mr angiography head w/o dye ............ 1.20 0.42 0.40 0.42 0.40 0.05 XXX
70544 .... TC ...... A ........ Mr angiography head w/o dye ............ 0.00 15.28 13.14 NA NA 0.59 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
70545 .... ............ A ........ Mr angiography head w/dye ............... 1.20 15.58 13.49 NA NA 0.64 XXX
70545 .... 26 ....... A ........ Mr angiography head w/dye ............... 1.20 0.42 0.39 0.42 0.39 0.05 XXX
70545 .... TC ...... A ........ Mr angiography head w/dye ............... 0.00 15.15 13.09 NA NA 0.59 XXX
70546 .... ............ A ........ Mr angiograph head w/o&w/dye ......... 1.80 23.80 23.25 NA NA 0.67 XXX
70546 .... 26 ....... A ........ Mr angiograph head w/o&w/dye ......... 1.80 0.63 0.59 0.63 0.59 0.08 XXX
70546 .... TC ...... A ........ Mr angiograph head w/o&w/dye ......... 0.00 23.17 22.66 NA NA 0.59 XXX
70547 .... ............ A ........ Mr angiography neck w/o dye ............ 1.20 15.64 13.51 NA NA 0.64 XXX
70547 .... 26 ....... A ........ Mr angiography neck w/o dye ............ 1.20 0.42 0.39 0.42 0.39 0.05 XXX
70547 .... TC ...... A ........ Mr angiography neck w/o dye ............ 0.00 15.22 13.12 NA NA 0.59 XXX
70548 .... ............ A ........ Mr angiography neck w/dye ............... 1.20 16.49 13.93 NA NA 0.64 XXX
70548 .... 26 ....... A ........ Mr angiography neck w/dye ............... 1.20 0.43 0.40 0.43 0.40 0.05 XXX
70548 .... TC ...... A ........ Mr angiography neck w/dye ............... 0.00 16.06 13.53 NA NA 0.59 XXX
70549 .... ............ A ........ Mr angiograph neck w/o&w/dye ......... 1.80 23.81 23.24 NA NA 0.67 XXX
70549 .... 26 ....... A ........ Mr angiograph neck w/o&w/dye ......... 1.80 0.64 0.59 0.64 0.59 0.08 XXX
70549 .... TC ...... A ........ Mr angiograph neck w/o&w/dye ......... 0.00 23.18 22.65 NA NA 0.59 XXX
70551 .... ............ A ........ Mri brain w/o dye ................................ 1.48 14.30 12.90 NA NA 0.66 XXX
70551 .... 26 ....... A ........ Mri brain w/o dye ................................ 1.48 0.52 0.49 0.52 0.49 0.07 XXX
70551 .... TC ...... A ........ Mri brain w/o dye ................................ 0.00 13.79 12.42 NA NA 0.59 XXX
70552 .... ............ A ........ Mri brain w/dye ................................... 1.78 15.45 14.63 NA NA 0.78 XXX
70552 .... 26 ....... A ........ Mri brain w/dye ................................... 1.78 0.63 0.59 0.63 0.59 0.08 XXX
70552 .... TC ...... A ........ Mri brain w/dye ................................... 0.00 14.82 14.04 NA NA 0.70 XXX
70553 .... ............ A ........ Mri brain w/o & w/dye ......................... 2.36 17.92 21.66 NA NA 1.41 XXX
70553 .... 26 ....... A ........ Mri brain w/o & w/dye ......................... 2.36 0.83 0.78 0.83 0.78 0.10 XXX
70553 .... TC ...... A ........ Mri brain w/o & w/dye ......................... 0.00 17.09 20.88 NA NA 1.31 XXX
70554 .... ............ A ........ Fmri brain by tech .............................. 2.11 15.22 14.07 NA NA 0.92 XXX
70554 .... 26 ....... A ........ Fmri brain by tech .............................. 2.11 0.70 0.63 0.70 0.63 0.10 XXX
70554 .... TC ...... A ........ Fmri brain by tech .............................. 0.00 14.53 13.44 NA NA 0.82 XXX
70555 .... ............ C ........ Fmri brain by phys/psych ................... 0.00 NA NA NA NA 0.11 XXX
70555 .... 26 ....... A ........ Fmri brain by phys/psych ................... 2.54 0.89 0.78 0.89 0.78 0.11 XXX
70555 .... TC ...... C ........ Fmri brain by phys/psych ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70557 .... ............ C ........ Mri brain w/o dye ................................ 2.90 0.00 0.71 0.00 0.71 0.08 XXX
70557 .... 26 ....... A ........ Mri brain w/o dye ................................ 2.90 1.05 1.06 1.05 1.06 0.08 XXX
70557 .... TC ...... C ........ Mri brain w/o dye ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70558 .... ............ C ........ Mri brain w/dye ................................... 3.20 0.00 0.79 0.00 0.79 0.10 XXX
70558 .... 26 ....... A ........ Mri brain w/dye ................................... 3.20 1.11 1.16 1.11 1.16 0.10 XXX
70558 .... TC ...... C ........ Mri brain w/dye ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
70559 .... ............ C ........ Mri brain w/o & w/dye ......................... 3.20 0.00 0.78 0.00 0.78 0.12 XXX
70559 .... 26 ....... A ........ Mri brain w/o & w/dye ......................... 3.20 1.15 1.16 1.15 1.16 0.12 XXX
70559 .... TC ...... C ........ Mri brain w/o & w/dye ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
71010 .... ............ A ........ Chest x-ray ......................................... 0.18 0.43 0.48 NA NA 0.03 XXX
71010 .... 26 ....... A ........ Chest x-ray ......................................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX
71010 .... TC ...... A ........ Chest x-ray ......................................... 0.00 0.37 0.42 NA NA 0.02 XXX
71015 .... 26 ....... A ........ Chest x-ray ......................................... 0.21 0.07 0.07 0.07 0.07 0.01 XXX
71020 .... 26 ....... A ........ Chest x-ray ......................................... 0.22 0.07 0.07 0.07 0.07 0.01 XXX
71021 .... 26 ....... A ........ Chest x-ray ......................................... 0.27 0.09 0.09 0.09 0.09 0.01 XXX
71022 .... 26 ....... A ........ Chest x-ray ......................................... 0.31 0.10 0.10 0.10 0.10 0.01 XXX
71023 .... ............ A ........ Chest x-ray and fluoroscopy .............. 0.38 1.52 1.21 NA NA 0.06 XXX
71023 .... 26 ....... A ........ Chest x-ray and fluoroscopy .............. 0.38 0.14 0.13 0.14 0.13 0.01 XXX
71023 .... TC ...... A ........ Chest x-ray and fluoroscopy .............. 0.00 1.37 1.08 NA NA 0.05 XXX
71030 .... 26 ....... A ........ Chest x-ray ......................................... 0.31 0.10 0.10 0.10 0.10 0.01 XXX
71034 .... ............ A ........ Chest x-ray and fluoroscopy .............. 0.46 2.07 1.82 NA NA 0.10 XXX
71034 .... 26 ....... A ........ Chest x-ray and fluoroscopy .............. 0.46 0.20 0.17 0.20 0.17 0.02 XXX
71034 .... TC ...... A ........ Chest x-ray and fluoroscopy .............. 0.00 1.86 1.64 NA NA 0.08 XXX
71035 .... 26 ....... A ........ Chest x-ray ......................................... 0.18 0.07 0.06 0.07 0.06 0.01 XXX
71040 .... ............ A ........ Contrast x-ray of bronchi .................... 0.58 2.04 1.84 NA NA 0.11 XXX
71040 .... 26 ....... A ........ Contrast x-ray of bronchi .................... 0.58 0.18 0.18 0.18 0.18 0.03 XXX
71040 .... TC ...... A ........ Contrast x-ray of bronchi .................... 0.00 1.86 1.66 NA NA 0.08 XXX
71060 .... ............ A ........ Contrast x-ray of bronchi .................... 0.74 3.07 2.73 NA NA 0.16 XXX
71060 .... 26 ....... A ........ Contrast x-ray of bronchi .................... 0.74 0.26 0.24 0.26 0.24 0.03 XXX
71060 .... TC ...... A ........ Contrast x-ray of bronchi .................... 0.00 2.81 2.49 NA NA 0.13 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
71090 .... ............ C ........ X-ray & pacemaker insertion .............. 0.54 NA NA NA NA 0.13 XXX
71090 .... 26 ....... A ........ X-ray & pacemaker insertion .............. 0.54 0.27 0.24 0.27 0.24 0.02 XXX
71090 .... TC ...... C ........ X-ray & pacemaker insertion .............. 0.00 NA NA NA NA 0.11 XXX
71100 .... ............ A ........ X-ray exam of ribs .............................. 0.22 0.61 0.62 NA NA 0.05 XXX
71100 .... 26 ....... A ........ X-ray exam of ribs .............................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX
71100 .... TC ...... A ........ X-ray exam of ribs .............................. 0.00 0.54 0.55 NA NA 0.04 XXX
71101 .... ............ A ........ X-ray exam of ribs/chest .................... 0.27 0.76 0.75 NA NA 0.05 XXX
71101 .... 26 ....... A ........ X-ray exam of ribs/chest .................... 0.27 0.09 0.09 0.09 0.09 0.01 XXX
71101 .... TC ...... A ........ X-ray exam of ribs/chest .................... 0.00 0.67 0.66 NA NA 0.04 XXX
71110 .... ............ A ........ X-ray exam of ribs .............................. 0.27 0.77 0.82 NA NA 0.06 XXX
71110 .... 26 ....... A ........ X-ray exam of ribs .............................. 0.27 0.08 0.09 0.08 0.09 0.01 XXX
71110 .... TC ...... A ........ X-ray exam of ribs .............................. 0.00 0.68 0.73 NA NA 0.05 XXX
71111 .... ............ A ........ X-ray exam of ribs/chest .................... 0.32 1.05 1.02 NA NA 0.07 XXX
71111 .... 26 ....... A ........ X-ray exam of ribs/chest .................... 0.32 0.10 0.10 0.10 0.10 0.01 XXX
71111 .... TC ...... A ........ X-ray exam of ribs/chest .................... 0.00 0.95 0.92 NA NA 0.06 XXX
71120 .... ............ A ........ X-ray exam of breastbone .................. 0.20 0.63 0.67 NA NA 0.05 XXX
71120 .... 26 ....... A ........ X-ray exam of breastbone .................. 0.20 0.07 0.07 0.07 0.07 0.01 XXX
71120 .... TC ...... A ........ X-ray exam of breastbone .................. 0.00 0.56 0.60 NA NA 0.04 XXX
71130 .... ............ A ........ X-ray exam of breastbone .................. 0.22 0.75 0.76 NA NA 0.05 XXX
71130 .... 26 ....... A ........ X-ray exam of breastbone .................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX
71130 .... TC ...... A ........ X-ray exam of breastbone .................. 0.00 0.67 0.69 NA NA 0.04 XXX
71250 .... ............ A ........ Ct thorax w/o dye ............................... 1.16 6.39 6.29 NA NA 0.36 XXX
71250 .... 26 ....... A ........ Ct thorax w/o dye ............................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX
71250 .... TC ...... A ........ Ct thorax w/o dye ............................... 0.00 5.98 5.91 NA NA 0.31 XXX
71260 .... ............ A ........ Ct thorax w/dye .................................. 1.24 7.93 7.64 NA NA 0.42 XXX
71260 .... 26 ....... A ........ Ct thorax w/dye .................................. 1.24 0.44 0.41 0.44 0.41 0.05 XXX
71260 .... TC ...... A ........ Ct thorax w/dye .................................. 0.00 7.48 7.23 NA NA 0.37 XXX
71270 .... ............ A ........ Ct thorax w/o & w/dye ........................ 1.38 9.95 9.56 NA NA 0.52 XXX
71270 .... 26 ....... A ........ Ct thorax w/o & w/dye ........................ 1.38 0.49 0.46 0.49 0.46 0.06 XXX
71270 .... TC ...... A ........ Ct thorax w/o & w/dye ........................ 0.00 9.47 9.10 NA NA 0.46 XXX
71275 .... ............ A ........ Ct angiography, chest ........................ 1.92 11.65 12.24 NA NA 0.48 XXX
71275 .... 26 ....... A ........ Ct angiography, chest ........................ 1.92 0.70 0.64 0.70 0.64 0.09 XXX
71275 .... TC ...... A ........ Ct angiography, chest ........................ 0.00 10.95 11.60 NA NA 0.39 XXX
71550 .... ............ A ........ Mri chest w/o dye ............................... 1.46 16.21 13.84 NA NA 0.51 XXX
71550 .... 26 ....... A ........ Mri chest w/o dye ............................... 1.46 0.51 0.48 0.51 0.48 0.06 XXX
71550 .... TC ...... A ........ Mri chest w/o dye ............................... 0.00 15.70 13.36 NA NA 0.45 XXX
71551 .... ............ A ........ Mri chest w/dye .................................. 1.73 17.75 15.76 NA NA 0.60 XXX
71551 .... 26 ....... A ........ Mri chest w/dye .................................. 1.73 0.61 0.57 0.61 0.57 0.08 XXX
71551 .... TC ...... A ........ Mri chest w/dye .................................. 0.00 17.15 15.19 NA NA 0.52 XXX
71552 .... ............ A ........ Mri chest w/o & w/dye ........................ 2.26 22.34 23.82 NA NA 0.78 XXX
71552 .... 26 ....... A ........ Mri chest w/o & w/dye ........................ 2.26 0.81 0.75 0.81 0.75 0.10 XXX
71552 .... TC ...... A ........ Mri chest w/o & w/dye ........................ 0.00 21.52 23.07 NA NA 0.68 XXX
71555 .... ............ R ........ Mri angio chest w or w/o dye ............. 1.81 15.13 13.39 NA NA 0.67 XXX
71555 .... 26 ....... R ........ Mri angio chest w or w/o dye ............. 1.81 0.66 0.61 0.66 0.61 0.08 XXX
71555 .... TC ...... R ........ Mri angio chest w or w/o dye ............. 0.00 14.47 12.78 NA NA 0.59 XXX
72010 .... ............ A ........ X-ray exam of spine ........................... 0.45 1.42 1.29 NA NA 0.08 XXX
72010 .... 26 ....... A ........ X-ray exam of spine ........................... 0.45 0.13 0.14 0.13 0.14 0.02 XXX
72010 .... TC ...... A ........ X-ray exam of spine ........................... 0.00 1.29 1.16 NA NA 0.06 XXX
72020 .... ............ A ........ X-ray exam of spine ........................... 0.15 0.47 0.46 NA NA 0.03 XXX
72020 .... 26 ....... A ........ X-ray exam of spine ........................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX
72020 .... TC ...... A ........ X-ray exam of spine ........................... 0.00 0.41 0.41 NA NA 0.02 XXX
72040 .... ............ A ........ X-ray exam of neck spine .................. 0.22 0.76 0.71 NA NA 0.05 XXX
72040 .... 26 ....... A ........ X-ray exam of neck spine .................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX
72040 .... TC ...... A ........ X-ray exam of neck spine .................. 0.00 0.69 0.64 NA NA 0.04 XXX
72069 .... ............ A ........ X-ray exam of trunk spine .................. 0.22 0.75 0.66 NA NA 0.03 XXX
72069 .... 26 ....... A ........ X-ray exam of trunk spine .................. 0.22 0.08 0.08 0.08 0.08 0.01 XXX
72069 .... TC ...... A ........ X-ray exam of trunk spine .................. 0.00 0.67 0.58 NA NA 0.02 XXX
72070 .... ............ A ........ X-ray exam of thoracic spine ............. 0.22 0.63 0.67 NA NA 0.05 XXX
72070 .... 26 ....... A ........ X-ray exam of thoracic spine ............. 0.22 0.07 0.07 0.07 0.07 0.01 XXX
72070 .... TC ...... A ........ X-ray exam of thoracic spine ............. 0.00 0.56 0.60 NA NA 0.04 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
72100 .... ............ A ........ X-ray exam of lower spine ................. 0.22 0.80 0.77 NA NA 0.05 XXX
72100 .... 26 ....... A ........ X-ray exam of lower spine ................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX
72100 .... TC ...... A ........ X-ray exam of lower spine ................. 0.00 0.73 0.70 NA NA 0.04 XXX
72125 .... ............ A ........ Ct neck spine w/o dye ........................ 1.16 6.41 6.30 NA NA 0.36 XXX
72125 .... 26 ....... A ........ Ct neck spine w/o dye ........................ 1.16 0.41 0.38 0.41 0.38 0.05 XXX
72125 .... TC ...... A ........ Ct neck spine w/o dye ........................ 0.00 6.00 5.91 NA NA 0.31 XXX
72126 .... ............ A ........ Ct neck spine w/dye ........................... 1.22 7.93 7.64 NA NA 0.42 XXX
72126 .... 26 ....... A ........ Ct neck spine w/dye ........................... 1.22 0.44 0.41 0.44 0.41 0.05 XXX
72126 .... TC ...... A ........ Ct neck spine w/dye ........................... 0.00 7.49 7.23 NA NA 0.37 XXX
72127 .... ............ A ........ Ct neck spine w/o & w/dye ................. 1.27 9.95 9.52 NA NA 0.52 XXX
72127 .... 26 ....... A ........ Ct neck spine w/o & w/dye ................. 1.27 0.44 0.42 0.44 0.42 0.06 XXX
72127 .... TC ...... A ........ Ct neck spine w/o & w/dye ................. 0.00 9.51 9.10 NA NA 0.46 XXX
72128 .... ............ A ........ Ct chest spine w/o dye ....................... 1.16 6.40 6.29 NA NA 0.36 XXX
72128 .... 26 ....... A ........ Ct chest spine w/o dye ....................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX
72128 .... TC ...... A ........ Ct chest spine w/o dye ....................... 0.00 5.98 5.91 NA NA 0.31 XXX
72129 .... ............ A ........ Ct chest spine w/dye .......................... 1.22 7.94 7.64 NA NA 0.42 XXX
72129 .... 26 ....... A ........ Ct chest spine w/dye .......................... 1.22 0.44 0.41 0.44 0.41 0.05 XXX
72129 .... TC ...... A ........ Ct chest spine w/dye .......................... 0.00 7.50 7.23 NA NA 0.37 XXX
72130 .... ............ A ........ Ct chest spine w/o & w/dye ................ 1.27 9.89 9.49 NA NA 0.52 XXX
72130 .... 26 ....... A ........ Ct chest spine w/o & w/dye ................ 1.27 0.45 0.42 0.45 0.42 0.06 XXX
72130 .... TC ...... A ........ Ct chest spine w/o & w/dye ................ 0.00 9.44 9.07 NA NA 0.46 XXX
72131 .... ............ A ........ Ct lumbar spine w/o dye .................... 1.16 6.38 6.29 NA NA 0.36 XXX
72131 .... 26 ....... A ........ Ct lumbar spine w/o dye .................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX
72131 .... TC ...... A ........ Ct lumbar spine w/o dye .................... 0.00 5.97 5.90 NA NA 0.31 XXX
72132 .... ............ A ........ Ct lumbar spine w/dye ........................ 1.22 7.91 7.63 NA NA 0.42 XXX
72132 .... 26 ....... A ........ Ct lumbar spine w/dye ........................ 1.22 0.44 0.41 0.44 0.41 0.05 XXX
72132 .... TC ...... A ........ Ct lumbar spine w/dye ........................ 0.00 7.47 7.22 NA NA 0.37 XXX
72133 .... ............ A ........ Ct lumbar spine w/o & w/dye ............. 1.27 9.93 9.54 NA NA 0.52 XXX
72133 .... 26 ....... A ........ Ct lumbar spine w/o & w/dye ............. 1.27 0.45 0.42 0.45 0.42 0.06 XXX
72133 .... TC ...... A ........ Ct lumbar spine w/o & w/dye ............. 0.00 9.48 9.11 NA NA 0.46 XXX
72141 .... ............ A ........ Mri neck spine w/o dye ...................... 1.60 12.35 11.96 NA NA 0.66 XXX
72141 .... 26 ....... A ........ Mri neck spine w/o dye ...................... 1.60 0.56 0.53 0.56 0.53 0.07 XXX
72141 .... TC ...... A ........ Mri neck spine w/o dye ...................... 0.00 11.79 11.43 NA NA 0.59 XXX
72142 .... ............ A ........ Mri neck spine w/dye .......................... 1.92 15.48 14.67 NA NA 0.79 XXX
72142 .... 26 ....... A ........ Mri neck spine w/dye .......................... 1.92 0.67 0.64 0.67 0.64 0.09 XXX
72142 .... TC ...... A ........ Mri neck spine w/dye .......................... 0.00 14.81 14.03 NA NA 0.70 XXX
72146 .... ............ A ........ Mri chest spine w/o dye ..................... 1.60 12.37 12.58 NA NA 0.71 XXX
72146 .... 26 ....... A ........ Mri chest spine w/o dye ..................... 1.60 0.56 0.53 0.56 0.53 0.07 XXX
72146 .... TC ...... A ........ Mri chest spine w/o dye ..................... 0.00 11.81 12.06 NA NA 0.64 XXX
72147 .... ............ A ........ Mri chest spine w/dye ......................... 1.92 13.46 13.66 NA NA 0.79 XXX
72147 .... 26 ....... A ........ Mri chest spine w/dye ......................... 1.92 0.68 0.63 0.68 0.63 0.09 XXX
72147 .... TC ...... A ........ Mri chest spine w/dye ......................... 0.00 12.78 13.03 NA NA 0.70 XXX
72148 .... ............ A ........ Mri lumbar spine w/o dye ................... 1.48 12.30 12.54 NA NA 0.71 XXX
72148 .... 26 ....... A ........ Mri lumbar spine w/o dye ................... 1.48 0.51 0.49 0.51 0.49 0.07 XXX
72148 .... TC ...... A ........ Mri lumbar spine w/o dye ................... 0.00 11.79 12.05 NA NA 0.64 XXX
72149 .... ............ A ........ Mri lumbar spine w/dye ...................... 1.78 15.38 14.61 NA NA 0.78 XXX
72149 .... 26 ....... A ........ Mri lumbar spine w/dye ...................... 1.78 0.63 0.60 0.63 0.60 0.08 XXX
72149 .... TC ...... A ........ Mri lumbar spine w/dye ...................... 0.00 14.75 14.02 NA NA 0.70 XXX
72156 .... ............ A ........ Mri neck spine w/o & w/dye ............... 2.57 17.62 21.55 NA NA 1.42 XXX
72156 .... 26 ....... A ........ Mri neck spine w/o & w/dye ............... 2.57 0.90 0.85 0.90 0.85 0.11 XXX
72156 .... TC ...... A ........ Mri neck spine w/o & w/dye ............... 0.00 16.72 20.71 NA NA 1.31 XXX
72157 .... ............ A ........ Mri chest spine w/o & w/dye .............. 2.57 16.07 20.77 NA NA 1.42 XXX
72157 .... 26 ....... A ........ Mri chest spine w/o & w/dye .............. 2.57 0.91 0.84 0.91 0.84 0.11 XXX
72157 .... TC ...... A ........ Mri chest spine w/o & w/dye .............. 0.00 15.16 19.93 NA NA 1.31 XXX
72158 .... ............ A ........ Mri lumbar spine w/o & w/dye ............ 2.36 17.54 21.48 NA NA 1.41 XXX
72158 .... 26 ....... A ........ Mri lumbar spine w/o & w/dye ............ 2.36 0.83 0.78 0.83 0.78 0.10 XXX
72158 .... TC ...... A ........ Mri lumbar spine w/o & w/dye ............ 0.00 16.71 20.70 NA NA 1.31 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
72159 .... ............ N ........ Mr angio spine w/o&w/dye ................. 1.80 14.47 13.70 NA NA 0.74 XXX
72159 .... 26 ....... N ........ Mr angio spine w/o&w/dye ................. 1.80 0.42 0.55 0.42 0.55 0.10 XXX
72159 .... TC ...... N ........ Mr angio spine w/o&w/dye ................. 0.00 14.06 13.15 NA NA 0.64 XXX
72170 .... ............ A ........ X-ray exam of pelvis ........................... 0.17 0.49 0.54 NA NA 0.03 XXX
72170 .... 26 ....... A ........ X-ray exam of pelvis ........................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
72170 .... TC ...... A ........ X-ray exam of pelvis ........................... 0.00 0.43 0.48 NA NA 0.02 XXX
72190 .... ............ A ........ X-ray exam of pelvis ........................... 0.21 0.84 0.79 NA NA 0.05 XXX
72190 .... 26 ....... A ........ X-ray exam of pelvis ........................... 0.21 0.08 0.07 0.08 0.07 0.01 XXX
72190 .... TC ...... A ........ X-ray exam of pelvis ........................... 0.00 0.77 0.72 NA NA 0.04 XXX
72191 .... ............ A ........ Ct angiograph pelv w/o&w/dye ........... 1.81 11.23 11.84 NA NA 0.47 XXX
72191 .... 26 ....... A ........ Ct angiograph pelv w/o&w/dye ........... 1.81 0.66 0.61 0.66 0.61 0.08 XXX
72191 .... TC ...... A ........ Ct angiograph pelv w/o&w/dye ........... 0.00 10.57 11.24 NA NA 0.39 XXX
72192 .... ............ A ........ Ct pelvis w/o dye ................................ 1.09 5.98 6.07 NA NA 0.36 XXX
72192 .... 26 ....... A ........ Ct pelvis w/o dye ................................ 1.09 0.39 0.36 0.39 0.36 0.05 XXX
72192 .... TC ...... A ........ Ct pelvis w/o dye ................................ 0.00 5.59 5.71 NA NA 0.31 XXX
72193 .... ............ A ........ Ct pelvis w/dye ................................... 1.16 7.49 7.30 NA NA 0.41 XXX
72193 .... 26 ....... A ........ Ct pelvis w/dye ................................... 1.16 0.42 0.39 0.42 0.39 0.05 XXX
72193 .... TC ...... A ........ Ct pelvis w/dye ................................... 0.00 7.07 6.91 NA NA 0.36 XXX
72194 .... ............ A ........ Ct pelvis w/o & w/dye ......................... 1.22 10.04 9.39 NA NA 0.48 XXX
72194 .... 26 ....... A ........ Ct pelvis w/o & w/dye ......................... 1.22 0.44 0.41 0.44 0.41 0.05 XXX
72194 .... TC ...... A ........ Ct pelvis w/o & w/dye ......................... 0.00 9.60 8.98 NA NA 0.43 XXX
72195 .... ............ A ........ Mri pelvis w/o dye ............................... 1.46 14.30 12.89 NA NA 0.51 XXX
72195 .... 26 ....... A ........ Mri pelvis w/o dye ............................... 1.46 0.51 0.48 0.51 0.48 0.06 XXX
72195 .... TC ...... A ........ Mri pelvis w/o dye ............................... 0.00 13.79 12.41 NA NA 0.45 XXX
72196 .... ............ A ........ Mri pelvis w/dye .................................. 1.73 15.39 14.58 NA NA 0.60 XXX
72196 .... 26 ....... A ........ Mri pelvis w/dye .................................. 1.73 0.62 0.57 0.62 0.57 0.08 XXX
72196 .... TC ...... A ........ Mri pelvis w/dye .................................. 0.00 14.77 14.01 NA NA 0.52 XXX
72197 .... ............ A ........ Mri pelvis w/o & w/dye ....................... 2.26 18.79 22.07 NA NA 1.02 XXX
72197 .... 26 ....... A ........ Mri pelvis w/o & w/dye ....................... 2.26 0.80 0.75 0.80 0.75 0.10 XXX
72197 .... TC ...... A ........ Mri pelvis w/o & w/dye ....................... 0.00 18.00 21.33 NA NA 0.92 XXX
72198 .... ............ A ........ Mr angio pelvis w/o & w/dye .............. 1.80 14.94 13.25 NA NA 0.67 XXX
72198 .... 26 ....... A ........ Mr angio pelvis w/o & w/dye .............. 1.80 0.65 0.60 0.65 0.60 0.08 XXX
72198 .... TC ...... A ........ Mr angio pelvis w/o & w/dye .............. 0.00 14.30 12.66 NA NA 0.59 XXX
72200 .... ............ A ........ X-ray exam sacroiliac joints ............... 0.17 0.59 0.58 NA NA 0.03 XXX
72200 .... 26 ....... A ........ X-ray exam sacroiliac joints ............... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
72200 .... TC ...... A ........ X-ray exam sacroiliac joints ............... 0.00 0.54 0.53 NA NA 0.02 XXX
72202 .... ............ A ........ X-ray exam sacroiliac joints ............... 0.19 0.73 0.70 NA NA 0.05 XXX
72202 .... 26 ....... A ........ X-ray exam sacroiliac joints ............... 0.19 0.07 0.06 0.07 0.06 0.01 XXX
72202 .... TC ...... A ........ X-ray exam sacroiliac joints ............... 0.00 0.67 0.64 NA NA 0.04 XXX
72220 .... ............ A ........ X-ray exam of tailbone ....................... 0.17 0.57 0.60 NA NA 0.05 XXX
72220 .... 26 ....... A ........ X-ray exam of tailbone ....................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
72220 .... TC ...... A ........ X-ray exam of tailbone ....................... 0.00 0.52 0.54 NA NA 0.04 XXX
72240 .... ............ A ........ Contrast x-ray of neck spine .............. 0.91 2.55 3.76 NA NA 0.29 XXX
72240 .... 26 ....... A ........ Contrast x-ray of neck spine .............. 0.91 0.32 0.29 0.32 0.29 0.04 XXX
72240 .... TC ...... A ........ Contrast x-ray of neck spine .............. 0.00 2.24 3.47 NA NA 0.25 XXX
72255 .... ............ A ........ Contrast x-ray, thorax spine ............... 0.91 2.23 3.40 NA NA 0.26 XXX
72255 .... 26 ....... A ........ Contrast x-ray, thorax spine ............... 0.91 0.29 0.27 0.29 0.27 0.04 XXX
72255 .... TC ...... A ........ Contrast x-ray, thorax spine ............... 0.00 1.94 3.13 NA NA 0.22 XXX
72265 .... ............ A ........ Contrast x-ray, lower spine ................ 0.83 2.51 3.39 NA NA 0.26 XXX
72265 .... 26 ....... A ........ Contrast x-ray, lower spine ................ 0.83 0.29 0.26 0.29 0.26 0.04 XXX
72265 .... TC ...... A ........ Contrast x-ray, lower spine ................ 0.00 2.22 3.13 NA NA 0.22 XXX
72270 .... ............ A ........ Contrast x-ray, spine .......................... 1.33 3.97 5.20 NA NA 0.39 XXX
72270 .... 26 ....... A ........ Contrast x-ray, spine .......................... 1.33 0.48 0.43 0.48 0.43 0.06 XXX
72270 .... TC ...... A ........ Contrast x-ray, spine .......................... 0.00 3.49 4.76 NA NA 0.33 XXX
72275 .... ............ A ........ Epidurography .................................... 0.76 1.71 2.00 NA NA 0.26 XXX
72275 .... 26 ....... A ........ Epidurography .................................... 0.76 0.20 0.20 0.20 0.20 0.04 XXX
72275 .... TC ...... A ........ Epidurography .................................... 0.00 1.51 1.80 NA NA 0.22 XXX
72285 .... ............ A ........ X-ray c/t spine disk ............................. 1.16 1.43 5.08 NA NA 0.50 XXX
72285 .... 26 ....... A ........ X-ray c/t spine disk ............................. 1.16 0.30 0.33 0.30 0.33 0.07 XXX
72285 .... TC ...... A ........ X-ray c/t spine disk ............................. 0.00 1.13 4.75 NA NA 0.43 XXX
72291 .... ............ C ........ Perq vertebroplasty, fluor ................... 1.31 0.00 0.00 0.00 0.00 0.10 XXX
72291 .... 26 ....... A ........ Perq vertebroplasty, fluor ................... 1.31 0.48 0.47 0.48 0.47 0.10 XXX
72291 .... TC ...... C ........ Perq vertebroplasty, fluor ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
72292 .... ............ C ........ Perq vertebroplasty, ct ....................... 1.38 0.00 0.00 0.00 0.00 0.07 XXX
72292 .... 26 ....... A ........ Perq vertebroplasty, ct ....................... 1.38 0.51 0.49 0.51 0.49 0.07 XXX
72292 .... TC ...... C ........ Perq vertebroplasty, ct ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
72295 .... ............ A ........ X-ray of lower spine disk .................... 0.83 1.45 4.78 NA NA 0.46 XXX
72295 .... 26 ....... A ........ X-ray of lower spine disk .................... 0.83 0.25 0.26 0.25 0.26 0.06 XXX
72295 .... TC ...... A ........ X-ray of lower spine disk .................... 0.00 1.20 4.52 NA NA 0.40 XXX
73000 .... ............ A ........ X-ray exam of collar bone .................. 0.16 0.55 0.56 NA NA 0.03 XXX
73000 .... 26 ....... A ........ X-ray exam of collar bone .................. 0.16 0.05 0.05 0.05 0.05 0.01 XXX
73000 .... TC ...... A ........ X-ray exam of collar bone .................. 0.00 0.50 0.51 NA NA 0.02 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
73010 .... ............ A ........ X-ray exam of shoulder blade ............ 0.17 0.58 0.58 NA NA 0.03 XXX
73010 .... 26 ....... A ........ X-ray exam of shoulder blade ............ 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73010 .... TC ...... A ........ X-ray exam of shoulder blade ............ 0.00 0.52 0.52 NA NA 0.02 XXX
73020 .... ............ A ........ X-ray exam of shoulder ...................... 0.15 0.44 0.48 NA NA 0.03 XXX
73020 .... 26 ....... A ........ X-ray exam of shoulder ...................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX
73020 .... TC ...... A ........ X-ray exam of shoulder ...................... 0.00 0.39 0.43 NA NA 0.02 XXX
73030 .... ............ A ........ X-ray exam of shoulder ...................... 0.18 0.57 0.60 NA NA 0.05 XXX
73030 .... 26 ....... A ........ X-ray exam of shoulder ...................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX
73030 .... TC ...... A ........ X-ray exam of shoulder ...................... 0.00 0.50 0.53 NA NA 0.04 XXX
73040 .... ............ A ........ Contrast x-ray of shoulder .................. 0.54 2.23 2.24 NA NA 0.14 XXX
73040 .... 26 ....... A ........ Contrast x-ray of shoulder .................. 0.54 0.19 0.18 0.19 0.18 0.02 XXX
73040 .... TC ...... A ........ Contrast x-ray of shoulder .................. 0.00 2.04 2.05 NA NA 0.12 XXX
73050 .... ............ A ........ X-ray exam of shoulders .................... 0.20 0.73 0.73 NA NA 0.05 XXX
73050 .... 26 ....... A ........ X-ray exam of shoulders .................... 0.20 0.08 0.07 0.08 0.07 0.01 XXX
73050 .... TC ...... A ........ X-ray exam of shoulders .................... 0.00 0.65 0.66 NA NA 0.04 XXX
73060 .... ............ A ........ X-ray exam of humerus ...................... 0.17 0.57 0.60 NA NA 0.05 XXX
73060 .... 26 ....... A ........ X-ray exam of humerus ...................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73060 .... TC ...... A ........ X-ray exam of humerus ...................... 0.00 0.51 0.54 NA NA 0.04 XXX
73070 .... ............ A ........ X-ray exam of elbow .......................... 0.15 0.55 0.56 NA NA 0.03 XXX
73070 .... 26 ....... A ........ X-ray exam of elbow .......................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX
73070 .... TC ...... A ........ X-ray exam of elbow .......................... 0.00 0.50 0.51 NA NA 0.02 XXX
73080 .... ............ A ........ X-ray exam of elbow .......................... 0.17 0.75 0.69 NA NA 0.05 XXX
73080 .... 26 ....... A ........ X-ray exam of elbow .......................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73080 .... TC ...... A ........ X-ray exam of elbow .......................... 0.00 0.69 0.63 NA NA 0.04 XXX
73085 .... ............ A ........ Contrast x-ray of elbow ...................... 0.54 1.82 2.04 NA NA 0.14 XXX
73085 .... 26 ....... A ........ Contrast x-ray of elbow ...................... 0.54 0.18 0.18 0.18 0.18 0.02 XXX
73085 .... TC ...... A ........ Contrast x-ray of elbow ...................... 0.00 1.64 1.86 NA NA 0.12 XXX
73090 .... ............ A ........ X-ray exam of forearm ....................... 0.16 0.55 0.56 NA NA 0.03 XXX
73090 .... 26 ....... A ........ X-ray exam of forearm ....................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX
73090 .... TC ...... A ........ X-ray exam of forearm ....................... 0.00 0.50 0.51 NA NA 0.02 XXX
73092 .... ............ A ........ X-ray exam of arm, infant ................... 0.16 0.57 0.56 NA NA 0.03 XXX
73092 .... 26 ....... A ........ X-ray exam of arm, infant ................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX
73092 .... TC ...... A ........ X-ray exam of arm, infant ................... 0.00 0.52 0.51 NA NA 0.02 XXX
73100 .... ............ A ........ X-ray exam of wrist ............................ 0.16 0.60 0.57 NA NA 0.03 XXX
73100 .... 26 ....... A ........ X-ray exam of wrist ............................ 0.16 0.06 0.05 0.06 0.05 0.01 XXX
73100 .... TC ...... A ........ X-ray exam of wrist ............................ 0.00 0.54 0.51 NA NA 0.02 XXX
73110 .... ............ A ........ X-ray exam of wrist ............................ 0.17 0.77 0.68 NA NA 0.03 XXX
73110 .... 26 ....... A ........ X-ray exam of wrist ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73110 .... TC ...... A ........ X-ray exam of wrist ............................ 0.00 0.71 0.62 NA NA 0.02 XXX
73115 .... ............ A ........ Contrast x-ray of wrist ........................ 0.54 2.31 2.03 NA NA 0.12 XXX
73115 .... 26 ....... A ........ Contrast x-ray of wrist ........................ 0.54 0.19 0.18 0.19 0.18 0.02 XXX
73115 .... TC ...... A ........ Contrast x-ray of wrist ........................ 0.00 2.12 1.85 NA NA 0.10 XXX
73120 .... ............ A ........ X-ray exam of hand ............................ 0.16 0.55 0.54 NA NA 0.03 XXX
73120 .... 26 ....... A ........ X-ray exam of hand ............................ 0.16 0.05 0.05 0.05 0.05 0.01 XXX
73120 .... TC ...... A ........ X-ray exam of hand ............................ 0.00 0.50 0.49 NA NA 0.02 XXX
73130 .... ............ A ........ X-ray exam of hand ............................ 0.17 0.65 0.62 NA NA 0.03 XXX
73130 .... 26 ....... A ........ X-ray exam of hand ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73130 .... TC ...... A ........ X-ray exam of hand ............................ 0.00 0.60 0.56 NA NA 0.02 XXX
73140 .... ............ A ........ X-ray exam of finger(s) ....................... 0.13 0.67 0.56 NA NA 0.03 XXX
73140 .... 26 ....... A ........ X-ray exam of finger(s) ....................... 0.13 0.04 0.04 0.04 0.04 0.01 XXX
73140 .... TC ...... A ........ X-ray exam of finger(s) ....................... 0.00 0.63 0.52 NA NA 0.02 XXX
73200 .... ............ A ........ Ct upper extremity w/o dye ................ 1.09 6.34 5.78 NA NA 0.30 XXX
73200 .... 26 ....... A ........ Ct upper extremity w/o dye ................ 1.09 0.39 0.36 0.39 0.36 0.05 XXX
73200 .... TC ...... A ........ Ct upper extremity w/o dye ................ 0.00 5.96 5.42 NA NA 0.25 XXX
73201 .... ............ A ........ Ct upper extremity w/dye ................... 1.16 7.84 7.00 NA NA 0.36 XXX
73201 .... 26 ....... A ........ Ct upper extremity w/dye ................... 1.16 0.41 0.38 0.41 0.38 0.05 XXX
73201 .... TC ...... A ........ Ct upper extremity w/dye ................... 0.00 7.43 6.62 NA NA 0.31 XXX
73202 .... ............ A ........ Ct uppr extremity w/o&w/dye ............. 1.22 10.46 9.07 NA NA 0.44 XXX
73202 .... 26 ....... A ........ Ct uppr extremity w/o&w/dye ............. 1.22 0.43 0.40 0.43 0.40 0.05 XXX
73202 .... TC ...... A ........ Ct uppr extremity w/o&w/dye ............. 0.00 10.03 8.67 NA NA 0.39 XXX
73206 .... ............ A ........ Ct angio upr extrm w/o&w/dye ........... 1.81 10.81 11.08 NA NA 0.47 XXX
73206 .... 26 ....... A ........ Ct angio upr extrm w/o&w/dye ........... 1.81 0.68 0.61 0.68 0.61 0.08 XXX
73206 .... TC ...... A ........ Ct angio upr extrm w/o&w/dye ........... 0.00 10.13 10.47 NA NA 0.39 XXX
73218 .... ............ A ........ Mri upper extremity w/o dye ............... 1.35 14.51 13.00 NA NA 0.45 XXX
73218 .... 26 ....... A ........ Mri upper extremity w/o dye ............... 1.35 0.46 0.44 0.46 0.44 0.06 XXX
73218 .... TC ...... A ........ Mri upper extremity w/o dye ............... 0.00 14.05 12.56 NA NA 0.39 XXX
73219 .... ............ A ........ Mri upper extremity w/dye .................. 1.62 15.26 14.52 NA NA 0.54 XXX
73219 .... 26 ....... A ........ Mri upper extremity w/dye .................. 1.62 0.57 0.54 0.57 0.54 0.07 XXX
73219 .... TC ...... A ........ Mri upper extremity w/dye .................. 0.00 14.69 13.98 NA NA 0.47 XXX
73220 .... ............ A ........ Mri uppr extremity w/o&w/dye ............ 2.15 18.88 22.11 NA NA 0.94 XXX
73220 .... 26 ....... A ........ Mri uppr extremity w/o&w/dye ............ 2.15 0.76 0.71 0.76 0.71 0.10 XXX
73220 .... TC ...... A ........ Mri uppr extremity w/o&w/dye ............ 0.00 18.13 21.40 NA NA 0.84 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
73221 .... ............ A ........ Mri joint upr extrem w/o dye ............... 1.35 13.43 12.46 NA NA 0.45 XXX
73221 .... 26 ....... A ........ Mri joint upr extrem w/o dye ............... 1.35 0.47 0.44 0.47 0.44 0.06 XXX
73221 .... TC ...... A ........ Mri joint upr extrem w/o dye ............... 0.00 12.96 12.02 NA NA 0.39 XXX
73222 .... ............ A ........ Mri joint upr extrem w/dye .................. 1.62 14.17 13.98 NA NA 0.54 XXX
73222 .... 26 ....... A ........ Mri joint upr extrem w/dye .................. 1.62 0.57 0.54 0.57 0.54 0.07 XXX
73222 .... TC ...... A ........ Mri joint upr extrem w/dye .................. 0.00 13.61 13.45 NA NA 0.47 XXX
73223 .... ............ A ........ Mri joint upr extr w/o&w/dye ............... 2.15 17.42 21.39 NA NA 0.94 XXX
73223 .... 26 ....... A ........ Mri joint upr extr w/o&w/dye ............... 2.15 0.75 0.71 0.75 0.71 0.10 XXX
73223 .... TC ...... A ........ Mri joint upr extr w/o&w/dye ............... 0.00 16.67 20.68 NA NA 0.84 XXX
73225 .... ............ N ........ Mr angio upr extr w/o&w/dye ............. 1.73 14.46 13.07 NA NA 0.69 XXX
73225 .... 26 ....... N ........ Mr angio upr extr w/o&w/dye ............. 1.73 0.40 0.53 0.40 0.53 0.10 XXX
73225 .... TC ...... N ........ Mr angio upr extr w/o&w/dye ............. 0.00 14.06 12.54 NA NA 0.59 XXX
73500 .... ............ A ........ X-ray exam of hip ............................... 0.17 0.49 0.51 NA NA 0.03 XXX
73500 .... 26 ....... A ........ X-ray exam of hip ............................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73500 .... TC ...... A ........ X-ray exam of hip ............................... 0.00 0.42 0.45 NA NA 0.02 XXX
73510 .... ............ A ........ X-ray exam of hip ............................... 0.21 0.77 0.70 NA NA 0.05 XXX
73510 .... TC ...... A ........ X-ray exam of hip ............................... 0.00 0.70 0.63 NA NA 0.04 XXX
73520 .... ............ A ........ X-ray exam of hips ............................. 0.26 0.78 0.77 NA NA 0.05 XXX
73520 .... 26 ....... A ........ X-ray exam of hips ............................. 0.26 0.09 0.09 0.09 0.09 0.01 XXX
73520 .... TC ...... A ........ X-ray exam of hips ............................. 0.00 0.69 0.68 NA NA 0.04 XXX
73525 .... ............ A ........ Contrast x-ray of hip ........................... 0.54 1.81 2.04 NA NA 0.15 XXX
73525 .... 26 ....... A ........ Contrast x-ray of hip ........................... 0.54 0.18 0.18 0.18 0.18 0.03 XXX
73525 .... TC ...... A ........ Contrast x-ray of hip ........................... 0.00 1.63 1.86 NA NA 0.12 XXX
73530 .... ............ C ........ X-ray exam of hip ............................... 0.29 NA NA NA NA 0.03 XXX
73530 .... TC ...... C ........ X-ray exam of hip ............................... 0.00 NA NA NA NA 0.02 XXX
73540 .... ............ A ........ X-ray exam of pelvis & hips ............... 0.20 0.81 0.72 NA NA 0.05 XXX
73540 .... 26 ....... A ........ X-ray exam of pelvis & hips ............... 0.20 0.07 0.07 0.07 0.07 0.01 XXX
73540 .... TC ...... A ........ X-ray exam of pelvis & hips ............... 0.00 0.73 0.65 NA NA 0.04 XXX
73542 .... ............ A ........ X-ray exam, sacroiliac joint ................ 0.59 1.12 1.69 NA NA 0.15 XXX
73542 .... 26 ....... A ........ X-ray exam, sacroiliac joint ................ 0.59 0.14 0.15 0.14 0.15 0.03 XXX
73542 .... TC ...... A ........ X-ray exam, sacroiliac joint ................ 0.00 0.98 1.54 NA NA 0.12 XXX
73550 .... ............ A ........ X-ray exam of thigh ............................ 0.17 0.54 0.59 NA NA 0.05 XXX
73550 .... 26 ....... A ........ X-ray exam of thigh ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73550 .... TC ...... A ........ X-ray exam of thigh ............................ 0.00 0.48 0.53 NA NA 0.04 XXX
73560 .... ............ A ........ X-ray exam of knee, 1 or 2 ................ 0.17 0.58 0.58 NA NA 0.03 XXX
73560 .... 26 ....... A ........ X-ray exam of knee, 1 or 2 ................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73560 .... TC ...... A ........ X-ray exam of knee, 1 or 2 ................ 0.00 0.52 0.52 NA NA 0.02 XXX
73562 .... ............ A ........ X-ray exam of knee, 3 ........................ 0.18 0.72 0.67 NA NA 0.05 XXX
73562 .... 26 ....... A ........ X-ray exam of knee, 3 ........................ 0.18 0.07 0.06 0.07 0.06 0.01 XXX
73562 .... TC ...... A ........ X-ray exam of knee, 3 ........................ 0.00 0.66 0.61 NA NA 0.04 XXX
73564 .... ............ A ........ X-ray exam, knee, 4 or more ............. 0.22 0.86 0.77 NA NA 0.05 XXX
73564 .... 26 ....... A ........ X-ray exam, knee, 4 or more ............. 0.22 0.08 0.07 0.08 0.07 0.01 XXX
73564 .... TC ...... A ........ X-ray exam, knee, 4 or more ............. 0.00 0.78 0.70 NA NA 0.04 XXX
73565 .... ............ A ........ X-ray exam of knees .......................... 0.17 0.65 0.60 NA NA 0.03 XXX
73565 .... 26 ....... A ........ X-ray exam of knees .......................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73565 .... TC ...... A ........ X-ray exam of knees .......................... 0.00 0.58 0.53 NA NA 0.02 XXX
73580 .... ............ A ........ Contrast x-ray of knee joint ................ 0.54 2.54 2.63 NA NA 0.17 XXX
73580 .... 26 ....... A ........ Contrast x-ray of knee joint ................ 0.54 0.20 0.18 0.20 0.18 0.03 XXX
73580 .... TC ...... A ........ Contrast x-ray of knee joint ................ 0.00 2.35 2.45 NA NA 0.14 XXX
73590 .... ............ A ........ X-ray exam of lower leg ..................... 0.17 0.53 0.56 NA NA 0.03 XXX
73590 .... 26 ....... A ........ X-ray exam of lower leg ..................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73590 .... TC ...... A ........ X-ray exam of lower leg ..................... 0.00 0.48 0.50 NA NA 0.02 XXX
73592 .... ............ A ........ X-ray exam of leg, infant .................... 0.16 0.57 0.56 NA NA 0.03 XXX
73592 .... 26 ....... A ........ X-ray exam of leg, infant .................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX
73592 .... TC ...... A ........ X-ray exam of leg, infant .................... 0.00 0.52 0.51 NA NA 0.02 XXX
73600 .... ............ A ........ X-ray exam of ankle ........................... 0.16 0.55 0.54 NA NA 0.03 XXX
73600 .... 26 ....... A ........ X-ray exam of ankle ........................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX
73600 .... TC ...... A ........ X-ray exam of ankle ........................... 0.00 0.50 0.49 NA NA 0.02 XXX
73610 .... ............ A ........ X-ray exam of ankle ........................... 0.17 0.67 0.63 NA NA 0.03 XXX
73610 .... 26 ....... A ........ X-ray exam of ankle ........................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX
73610 .... TC ...... A ........ X-ray exam of ankle ........................... 0.00 0.61 0.57 NA NA 0.02 XXX
73615 .... ............ A ........ Contrast x-ray of ankle ....................... 0.54 1.98 2.11 NA NA 0.15 XXX
73615 .... 26 ....... A ........ Contrast x-ray of ankle ....................... 0.54 0.18 0.18 0.18 0.18 0.03 XXX
73615 .... TC ...... A ........ Contrast x-ray of ankle ....................... 0.00 1.80 1.93 NA NA 0.12 XXX
73620 .... ............ A ........ X-ray exam of foot .............................. 0.16 0.52 0.53 NA NA 0.03 XXX
73620 .... 26 ....... A ........ X-ray exam of foot .............................. 0.16 0.04 0.05 0.04 0.05 0.01 XXX
73620 .... TC ...... A ........ X-ray exam of foot .............................. 0.00 0.47 0.48 NA NA 0.02 XXX
73630 .... ............ A ........ X-ray exam of foot .............................. 0.17 0.65 0.62 NA NA 0.03 XXX
73630 .... 26 ....... A ........ X-ray exam of foot .............................. 0.17 0.05 0.06 0.05 0.06 0.01 XXX
73630 .... TC ...... A ........ X-ray exam of foot .............................. 0.00 0.59 0.56 NA NA 0.02 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
73650 .... ............ A ........ X-ray exam of heel ............................. 0.16 0.54 0.53 NA NA 0.03 XXX
73650 .... 26 ....... A ........ X-ray exam of heel ............................. 0.16 0.05 0.05 0.05 0.05 0.01 XXX
73650 .... TC ...... A ........ X-ray exam of heel ............................. 0.00 0.49 0.48 NA NA 0.02 XXX
73660 .... ............ A ........ X-ray exam of toe(s) ........................... 0.13 0.63 0.54 NA NA 0.03 XXX
73660 .... 26 ....... A ........ X-ray exam of toe(s) ........................... 0.13 0.04 0.04 0.04 0.04 0.01 XXX
73660 .... TC ...... A ........ X-ray exam of toe(s) ........................... 0.00 0.59 0.50 NA NA 0.02 XXX
73700 .... ............ A ........ Ct lower extremity w/o dye ................. 1.09 6.35 5.78 NA NA 0.30 XXX
73700 .... 26 ....... A ........ Ct lower extremity w/o dye ................. 1.09 0.39 0.36 0.39 0.36 0.05 XXX
73700 .... TC ...... A ........ Ct lower extremity w/o dye ................. 0.00 5.97 5.42 NA NA 0.25 XXX
73701 .... ............ A ........ Ct lower extremity w/dye .................... 1.16 7.90 7.03 NA NA 0.36 XXX
73701 .... 26 ....... A ........ Ct lower extremity w/dye .................... 1.16 0.42 0.39 0.42 0.39 0.05 XXX
73701 .... TC ...... A ........ Ct lower extremity w/dye .................... 0.00 7.49 6.65 NA NA 0.31 XXX
73702 .... ............ A ........ Ct lwr extremity w/o&w/dye ................ 1.22 10.62 9.14 NA NA 0.44 XXX
73702 .... 26 ....... A ........ Ct lwr extremity w/o&w/dye ................ 1.22 0.45 0.41 0.45 0.41 0.05 XXX
73702 .... TC ...... A ........ Ct lwr extremity w/o&w/dye ................ 0.00 10.17 8.73 NA NA 0.39 XXX
73706 .... ............ A ........ Ct angio lwr extr w/o&w/dye ............... 1.90 12.19 11.80 NA NA 0.47 XXX
73706 .... 26 ....... A ........ Ct angio lwr extr w/o&w/dye ............... 1.90 0.72 0.65 0.72 0.65 0.08 XXX
73706 .... TC ...... A ........ Ct angio lwr extr w/o&w/dye ............... 0.00 11.47 11.15 NA NA 0.39 XXX
73718 .... ............ A ........ Mri lower extremity w/o dye ............... 1.35 14.13 12.80 NA NA 0.45 XXX
73718 .... 26 ....... A ........ Mri lower extremity w/o dye ............... 1.35 0.47 0.44 0.47 0.44 0.06 XXX
73718 .... TC ...... A ........ Mri lower extremity w/o dye ............... 0.00 13.66 12.36 NA NA 0.39 XXX
73719 .... ............ A ........ Mri lower extremity w/dye ................... 1.62 15.26 14.50 NA NA 0.54 XXX
73719 .... 26 ....... A ........ Mri lower extremity w/dye ................... 1.62 0.57 0.53 0.57 0.53 0.07 XXX
73719 .... TC ...... A ........ Mri lower extremity w/dye ................... 0.00 14.69 13.97 NA NA 0.47 XXX
73720 .... ............ A ........ Mri lwr extremity w/o&w/dye ............... 2.15 18.82 22.07 NA NA 0.94 XXX
73720 .... 26 ....... A ........ Mri lwr extremity w/o&w/dye ............... 2.15 0.76 0.71 0.76 0.71 0.10 XXX
73720 .... TC ...... A ........ Mri lwr extremity w/o&w/dye ............... 0.00 18.06 21.37 NA NA 0.84 XXX
73721 .... ............ A ........ Mri jnt of lwr extre w/o dye ................. 1.35 13.74 12.61 NA NA 0.45 XXX
73721 .... 26 ....... A ........ Mri jnt of lwr extre w/o dye ................. 1.35 0.47 0.44 0.47 0.44 0.06 XXX
73721 .... TC ...... A ........ Mri jnt of lwr extre w/o dye ................. 0.00 13.27 12.17 NA NA 0.39 XXX
73722 .... ............ A ........ Mri joint of lwr extr w/dye ................... 1.62 14.36 14.09 NA NA 0.54 XXX
73722 .... 26 ....... A ........ Mri joint of lwr extr w/dye ................... 1.62 0.57 0.54 0.57 0.54 0.07 XXX
73722 .... TC ...... A ........ Mri joint of lwr extr w/dye ................... 0.00 13.79 13.55 NA NA 0.47 XXX
73723 .... ............ A ........ Mri joint lwr extr w/o&w/dye ............... 2.15 17.40 21.38 NA NA 0.94 XXX
73723 .... 26 ....... A ........ Mri joint lwr extr w/o&w/dye ............... 2.15 0.75 0.71 0.75 0.71 0.10 XXX
73723 .... TC ...... A ........ Mri joint lwr extr w/o&w/dye ............... 0.00 16.64 20.67 NA NA 0.84 XXX
73725 .... ............ R ........ Mr ang lwr ext w or w/o dye ............... 1.82 14.98 13.29 NA NA 0.67 XXX
73725 .... 26 ....... R ........ Mr ang lwr ext w or w/o dye ............... 1.82 0.65 0.60 0.65 0.60 0.08 XXX
73725 .... TC ...... R ........ Mr ang lwr ext w or w/o dye ............... 0.00 14.33 12.68 NA NA 0.59 XXX
74000 .... ............ A ........ X-ray exam of abdomen ..................... 0.18 0.46 0.52 NA NA 0.03 XXX
74000 .... 26 ....... A ........ X-ray exam of abdomen ..................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX
74000 .... TC ...... A ........ X-ray exam of abdomen ..................... 0.00 0.40 0.46 NA NA 0.02 XXX
74022 .... ............ A ........ X-ray exam series, abdomen ............. 0.32 0.98 0.89 NA NA 0.06 XXX
74022 .... 26 ....... A ........ X-ray exam series, abdomen ............. 0.32 0.11 0.10 0.11 0.10 0.01 XXX
74022 .... TC ...... A ........ X-ray exam series, abdomen ............. 0.00 0.87 0.79 NA NA 0.05 XXX
74150 .... ............ A ........ Ct abdomen w/o dye .......................... 1.19 6.02 5.99 NA NA 0.35 XXX
74150 .... 26 ....... A ........ Ct abdomen w/o dye .......................... 1.19 0.43 0.40 0.43 0.40 0.05 XXX
74150 .... TC ...... A ........ Ct abdomen w/o dye .......................... 0.00 5.59 5.59 NA NA 0.30 XXX
74160 .... ............ A ........ Ct abdomen w/dye ............................. 1.27 8.75 7.94 NA NA 0.42 XXX
74160 .... 26 ....... A ........ Ct abdomen w/dye ............................. 1.27 0.46 0.43 0.46 0.43 0.06 XXX
74160 .... TC ...... A ........ Ct abdomen w/dye ............................. 0.00 8.29 7.51 NA NA 0.36 XXX
74170 .... ............ A ........ Ct abdomen w/o & w/dye ................... 1.40 12.08 10.43 NA NA 0.49 XXX
74170 .... 26 ....... A ........ Ct abdomen w/o & w/dye ................... 1.40 0.50 0.47 0.50 0.47 0.06 XXX
74170 .... TC ...... A ........ Ct abdomen w/o & w/dye ................... 0.00 11.58 9.96 NA NA 0.43 XXX
74175 .... ............ A ........ Ct angio abdom w/o & w/dye ............. 1.90 12.15 12.31 NA NA 0.47 XXX
74175 .... 26 ....... A ........ Ct angio abdom w/o & w/dye ............. 1.90 0.70 0.64 0.70 0.64 0.08 XXX
74175 .... TC ...... A ........ Ct angio abdom w/o & w/dye ............. 0.00 11.46 11.67 NA NA 0.39 XXX
74181 .... ............ A ........ Mri abdomen w/o dye ......................... 1.46 12.34 11.92 NA NA 0.51 XXX
74181 .... 26 ....... A ........ Mri abdomen w/o dye ......................... 1.46 0.52 0.48 0.52 0.48 0.06 XXX
74181 .... TC ...... A ........ Mri abdomen w/o dye ......................... 0.00 11.82 11.44 NA NA 0.45 XXX
74182 .... ............ A ........ Mri abdomen w/dye ............................ 1.73 17.28 15.51 NA NA 0.60 XXX
74182 .... 26 ....... A ........ Mri abdomen w/dye ............................ 1.73 0.62 0.57 0.62 0.57 0.08 XXX
74182 .... TC ...... A ........ Mri abdomen w/dye ............................ 0.00 16.67 14.94 NA NA 0.52 XXX
74183 .... ............ A ........ Mri abdomen w/o & w/dye .................. 2.26 18.82 22.09 NA NA 1.02 XXX
74183 .... 26 ....... A ........ Mri abdomen w/o & w/dye .................. 2.26 0.80 0.75 0.80 0.75 0.10 XXX
74183 .... TC ...... A ........ Mri abdomen w/o & w/dye .................. 0.00 18.02 21.34 NA NA 0.92 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
74185 .... ............ R ........ Mri angio, abdom w orw/o dye ........... 1.80 14.94 13.26 NA NA 0.67 XXX
74185 .... 26 ....... R ........ Mri angio, abdom w orw/o dye ........... 1.80 0.64 0.59 0.64 0.59 0.08 XXX
74185 .... TC ...... R ........ Mri angio, abdom w orw/o dye ........... 0.00 14.30 12.67 NA NA 0.59 XXX
74190 .... ............ C ........ X-ray exam of peritoneum .................. 0.48 NA NA NA NA 0.09 XXX
74190 .... 26 ....... A ........ X-ray exam of peritoneum .................. 0.48 0.17 0.16 0.17 0.16 0.02 XXX
74190 .... TC ...... C ........ X-ray exam of peritoneum .................. 0.00 NA NA NA NA 0.07 XXX
74210 .... ............ A ........ Contrst x-ray exam of throat .............. 0.36 1.76 1.52 NA NA 0.08 XXX
74210 .... 26 ....... A ........ Contrst x-ray exam of throat .............. 0.36 0.13 0.12 0.13 0.12 0.02 XXX
74210 .... TC ...... A ........ Contrst x-ray exam of throat .............. 0.00 1.63 1.40 NA NA 0.06 XXX
74220 .... ............ A ........ Contrast x-ray, esophagus ................. 0.46 2.00 1.65 NA NA 0.08 XXX
74220 .... 26 ....... A ........ Contrast x-ray, esophagus ................. 0.46 0.16 0.15 0.16 0.15 0.02 XXX
74220 .... TC ...... A ........ Contrast x-ray, esophagus ................. 0.00 1.83 1.50 NA NA 0.06 XXX
74230 .... ............ A ........ Cine/vid x-ray, throat/esoph ............... 0.53 1.94 1.69 NA NA 0.09 XXX
74230 .... 26 ....... A ........ Cine/vid x-ray, throat/esoph ............... 0.53 0.19 0.18 0.19 0.18 0.02 XXX
74230 .... TC ...... A ........ Cine/vid x-ray, throat/esoph ............... 0.00 1.75 1.52 NA NA 0.07 XXX
74235 .... ............ C ........ Remove esophagus obstruction ......... 1.19 0.00 0.26 0.00 0.26 0.05 XXX
74235 .... 26 ....... A ........ Remove esophagus obstruction ......... 1.19 0.46 0.41 0.46 0.41 0.05 XXX
74235 .... TC ...... C ........ Remove esophagus obstruction ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74240 .... ............ A ........ X-ray exam, upper gi tract .................. 0.69 2.29 1.96 NA NA 0.11 XXX
74240 .... 26 ....... A ........ X-ray exam, upper gi tract .................. 0.69 0.25 0.23 0.25 0.23 0.03 XXX
74240 .... TC ...... A ........ X-ray exam, upper gi tract .................. 0.00 2.04 1.73 NA NA 0.08 XXX
74246 .... ............ A ........ Contrst x-ray uppr gi tract .................. 0.69 2.78 2.30 NA NA 0.13 XXX
74246 .... 26 ....... A ........ Contrst x-ray uppr gi tract .................. 0.69 0.25 0.23 0.25 0.23 0.03 XXX
74246 .... TC ...... A ........ Contrst x-ray uppr gi tract .................. 0.00 2.53 2.07 NA NA 0.10 XXX
74250 .... ............ A ........ X-ray exam of small bowel ................. 0.47 2.46 1.94 NA NA 0.09 XXX
74250 .... 26 ....... A ........ X-ray exam of small bowel ................. 0.47 0.17 0.16 0.17 0.16 0.02 XXX
74250 .... TC ...... A ........ X-ray exam of small bowel ................. 0.00 2.30 1.79 NA NA 0.07 XXX
74270 .... ............ A ........ Contrast x-ray exam of colon ............. 0.69 3.56 2.71 NA NA 0.14 XXX
74270 .... 26 ....... A ........ Contrast x-ray exam of colon ............. 0.69 0.25 0.23 0.25 0.23 0.03 XXX
74270 .... TC ...... A ........ Contrast x-ray exam of colon ............. 0.00 3.31 2.48 NA NA 0.11 XXX
74290 .... ............ A ........ Contrast x-ray, gallbladder ................. 0.32 1.57 1.18 NA NA 0.06 XXX
74290 .... 26 ....... A ........ Contrast x-ray, gallbladder ................. 0.32 0.11 0.10 0.11 0.10 0.01 XXX
74290 .... TC ...... A ........ Contrast x-ray, gallbladder ................. 0.00 1.46 1.08 NA NA 0.05 XXX
74291 .... ............ A ........ Contrast x-rays, gallbladder ............... 0.20 1.54 1.02 NA NA 0.03 XXX
74291 .... 26 ....... A ........ Contrast x-rays, gallbladder ............... 0.20 0.07 0.07 0.07 0.07 0.01 XXX
74291 .... TC ...... A ........ Contrast x-rays, gallbladder ............... 0.00 1.47 0.95 NA NA 0.02 XXX
74300 .... ............ C ........ X-ray bile ducts/pancreas ................... 0.36 0.00 0.08 0.00 0.08 0.02 XXX
74300 .... 26 ....... A ........ X-ray bile ducts/pancreas ................... 0.36 0.13 0.12 0.13 0.12 0.02 XXX
74300 .... TC ...... C ........ X-ray bile ducts/pancreas ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74301 .... ............ C ........ X-rays at surgery add-on .................... 0.21 0.00 0.05 0.00 0.05 0.01 ZZZ
74301 .... 26 ....... A ........ X-rays at surgery add-on .................... 0.21 0.08 0.07 0.08 0.07 0.01 ZZZ
74301 .... TC ...... C ........ X-rays at surgery add-on .................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
74305 .... ............ C ........ X-ray bile ducts/pancreas ................... 0.42 NA NA NA NA 0.07 XXX
74305 .... 26 ....... A ........ X-ray bile ducts/pancreas ................... 0.42 0.15 0.14 0.15 0.14 0.02 XXX
74305 .... TC ...... C ........ X-ray bile ducts/pancreas ................... 0.00 NA NA NA NA 0.05 XXX
74320 .... ............ A ........ Contrast x-ray of bile ducts ................ 0.54 2.12 2.71 NA NA 0.19 XXX
74320 .... 26 ....... A ........ Contrast x-ray of bile ducts ................ 0.54 0.20 0.19 0.20 0.19 0.02 XXX
74320 .... TC ...... A ........ Contrast x-ray of bile ducts ................ 0.00 1.92 2.52 NA NA 0.17 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
74327 .... ............ A ........ X-ray bile stone removal .................... 0.70 2.95 2.44 NA NA 0.14 XXX
74327 .... 26 ....... A ........ X-ray bile stone removal .................... 0.70 0.26 0.23 0.26 0.23 0.03 XXX
74327 .... TC ...... A ........ X-ray bile stone removal .................... 0.00 2.69 2.21 NA NA 0.11 XXX
74328 .... ............ C ........ X-ray bile duct endoscopy .................. 0.70 NA NA NA NA 0.20 XXX
74328 .... 26 ....... A ........ X-ray bile duct endoscopy .................. 0.70 0.26 0.24 0.26 0.24 0.03 XXX
74328 .... TC ...... C ........ X-ray bile duct endoscopy .................. 0.00 NA NA NA NA 0.17 XXX
74329 .... ............ C ........ X-ray for pancreas endoscopy ........... 0.70 0.00 1.73 0.00 1.73 0.03 XXX
74329 .... 26 ....... A ........ X-ray for pancreas endoscopy ........... 0.70 0.27 0.24 0.27 0.24 0.03 XXX
74329 .... TC ...... C ........ X-ray for pancreas endoscopy ........... 0.00 0.00 1.58 0.00 1.58 0.00 XXX
74330 .... ............ C ........ X-ray bile/panc endoscopy ................. 0.90 NA NA NA NA 0.21 XXX
74330 .... 26 ....... A ........ X-ray bile/panc endoscopy ................. 0.90 0.33 0.30 0.33 0.30 0.04 XXX
74330 .... TC ...... C ........ X-ray bile/panc endoscopy ................. 0.00 NA NA NA NA 0.17 XXX
74340 .... ............ C ........ X-ray guide for GI tube ....................... 0.54 NA NA NA NA 0.16 XXX
74340 .... 26 ....... A ........ X-ray guide for GI tube ....................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX
74340 .... TC ...... C ........ X-ray guide for GI tube ....................... 0.00 0.00 1.75 0.00 1.75 0.14 XXX
74350 .... ............ A ........ X-ray guide, stomach tube ................. 0.76 2.21 2.78 NA NA 0.20 XXX
74350 .... 26 ....... A ........ X-ray guide, stomach tube ................. 0.76 0.28 0.25 0.28 0.25 0.03 XXX
74350 .... TC ...... A ........ X-ray guide, stomach tube ................. 0.00 1.93 2.53 NA NA 0.17 XXX
74355 .... ............ C ........ X-ray guide, intestinal tube ................. 0.76 NA NA NA NA 0.17 XXX
74355 .... 26 ....... A ........ X-ray guide, intestinal tube ................. 0.76 0.28 0.25 0.28 0.25 0.03 XXX
74355 .... TC ...... C ........ X-ray guide, intestinal tube ................. 0.00 0.00 1.75 0.00 1.75 0.14 XXX
74360 .... ............ C ........ X-ray guide, GI dilation ....................... 0.54 NA NA NA NA 0.19 XXX
74360 .... 26 ....... A ........ X-ray guide, GI dilation ....................... 0.54 0.24 0.21 0.24 0.21 0.02 XXX
74360 .... TC ...... C ........ X-ray guide, GI dilation ....................... 0.00 NA NA NA NA 0.17 XXX
74363 .... ............ C ........ X-ray, bile duct dilation ....................... 0.88 0.00 0.19 0.00 0.19 0.04 XXX
74363 .... 26 ....... A ........ X-ray, bile duct dilation ....................... 0.88 0.32 0.29 0.32 0.29 0.04 XXX
74363 .... TC ...... C ........ X-ray, bile duct dilation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74400 .... ............ A ........ Contrst x-ray, urinary tract .................. 0.49 2.59 2.20 NA NA 0.13 XXX
74400 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.49 0.18 0.17 0.18 0.17 0.02 XXX
74400 .... TC ...... A ........ Contrst x-ray, urinary tract .................. 0.00 2.41 2.03 NA NA 0.11 XXX
74420 .... ............ C ........ Contrst x-ray, urinary tract .................. 0.36 NA NA NA NA 0.16 XXX
74420 .... TC ...... C ........ Contrst x-ray, urinary tract .................. 0.00 NA NA NA NA 0.14 XXX
74425 .... ............ C ........ Contrst x-ray, urinary tract .................. 0.36 NA NA NA NA 0.09 XXX
74425 .... TC ...... C ........ Contrst x-ray, urinary tract .................. 0.00 NA NA NA NA 0.07 XXX
74430 .... ............ A ........ Contrast x-ray, bladder ....................... 0.32 1.94 1.53 NA NA 0.08 XXX
74430 .... 26 ....... A ........ Contrast x-ray, bladder ....................... 0.32 0.12 0.11 0.12 0.11 0.02 XXX
74430 .... TC ...... A ........ Contrast x-ray, bladder ....................... 0.00 1.83 1.43 NA NA 0.06 XXX
74440 .... ............ A ........ X-ray, male genital tract ..................... 0.38 2.11 1.69 NA NA 0.08 XXX
74440 .... 26 ....... A ........ X-ray, male genital tract ..................... 0.38 0.15 0.14 0.15 0.14 0.02 XXX
74440 .... TC ...... A ........ X-ray, male genital tract ..................... 0.00 1.96 1.55 NA NA 0.06 XXX
74445 .... ............ C ........ X-ray exam of penis ........................... 1.14 NA NA NA NA 0.13 XXX
74445 .... 26 ....... A ........ X-ray exam of penis ........................... 1.14 0.46 0.41 0.46 0.41 0.07 XXX
74445 .... TC ...... C ........ X-ray exam of penis ........................... 0.00 NA NA NA NA 0.06 XXX
74450 .... ............ C ........ X-ray, urethra/bladder ......................... 0.33 NA NA NA NA 0.10 XXX
74450 .... 26 ....... A ........ X-ray, urethra/bladder ......................... 0.33 0.12 0.11 0.12 0.11 0.02 XXX
74450 .... TC ...... C ........ X-ray, urethra/bladder ......................... 0.00 NA NA NA NA 0.08 XXX
74455 .... ............ A ........ X-ray, urethra/bladder ......................... 0.33 2.17 1.92 NA NA 0.12 XXX
74455 .... 26 ....... A ........ X-ray, urethra/bladder ......................... 0.33 0.13 0.12 0.13 0.12 0.02 XXX
74455 .... TC ...... A ........ X-ray, urethra/bladder ......................... 0.00 2.04 1.80 NA NA 0.10 XXX
74470 .... ............ C ........ X-ray exam of kidney lesion ............... 0.54 NA NA NA NA 0.09 XXX
74470 .... 26 ....... A ........ X-ray exam of kidney lesion ............... 0.54 0.17 0.17 0.17 0.17 0.02 XXX
74470 .... TC ...... C ........ X-ray exam of kidney lesion ............... 0.00 NA NA NA NA 0.07 XXX
74475 .... ............ A ........ X-ray control, cath insert .................... 0.54 2.10 3.16 NA NA 0.24 XXX
74475 .... 26 ....... A ........ X-ray control, cath insert .................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX
74475 .... TC ...... A ........ X-ray control, cath insert .................... 0.00 1.90 2.97 NA NA 0.22 XXX
74480 .... ............ A ........ X-ray control, cath insert .................... 0.54 2.11 3.16 NA NA 0.24 XXX
74480 .... 26 ....... A ........ X-ray control, cath insert .................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX
74480 .... TC ...... A ........ X-ray control, cath insert .................... 0.00 1.91 2.98 NA NA 0.22 XXX
74485 .... ............ A ........ X-ray guide, GU dilation ..................... 0.54 2.26 2.77 NA NA 0.20 XXX
74485 .... 26 ....... A ........ X-ray guide, GU dilation ..................... 0.54 0.21 0.18 0.21 0.18 0.03 XXX
74485 .... TC ...... A ........ X-ray guide, GU dilation ..................... 0.00 2.06 2.59 NA NA 0.17 XXX
74710 .... ............ A ........ X-ray measurement of pelvis ............. 0.34 0.64 0.90 NA NA 0.08 XXX
74710 .... 26 ....... A ........ X-ray measurement of pelvis ............. 0.34 0.12 0.11 0.12 0.11 0.02 XXX
74710 .... TC ...... A ........ X-ray measurement of pelvis ............. 0.00 0.52 0.79 NA NA 0.06 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
74740 .... ............ A ........ X-ray, female genital tract .................. 0.38 1.75 1.58 NA NA 0.09 XXX
74740 .... 26 ....... A ........ X-ray, female genital tract .................. 0.38 0.13 0.13 0.13 0.13 0.02 XXX
74740 .... TC ...... A ........ X-ray, female genital tract .................. 0.00 1.62 1.45 NA NA 0.07 XXX
74742 .... ............ C ........ X-ray, fallopian tube ........................... 0.61 0.00 0.13 0.00 0.13 0.03 XXX
74742 .... 26 ....... A ........ X-ray, fallopian tube ........................... 0.61 0.19 0.19 0.19 0.19 0.03 XXX
74742 .... TC ...... C ........ X-ray, fallopian tube ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
74775 .... ............ C ........ X-ray exam of perineum ..................... 0.62 NA NA NA NA 0.11 XXX
74775 .... 26 ....... A ........ X-ray exam of perineum ..................... 0.62 0.23 0.21 0.23 0.21 0.03 XXX
74775 .... TC ...... C ........ X-ray exam of perineum ..................... 0.00 0.00 0.97 0.00 0.97 0.08 XXX
75552 .... ............ A ........ Heart mri for morph w/o dye .............. 1.60 18.93 15.23 NA NA 0.66 XXX
75552 .... 26 ....... A ........ Heart mri for morph w/o dye .............. 1.60 0.62 0.56 0.62 0.56 0.07 XXX
75552 .... TC ...... A ........ Heart mri for morph w/o dye .............. 0.00 18.31 14.67 NA NA 0.59 XXX
75553 .... ............ A ........ Heart mri for morph w/dye ................. 2.00 23.11 17.57 NA NA 0.66 XXX
75553 .... 26 ....... A ........ Heart mri for morph w/dye ................. 2.00 0.84 0.76 0.84 0.76 0.07 XXX
75553 .... TC ...... A ........ Heart mri for morph w/dye ................. 0.00 22.27 16.81 NA NA 0.59 XXX
75554 .... ............ A ........ Cardiac MRI/function .......................... 1.83 26.43 19.14 NA NA 0.66 XXX
75554 .... 26 ....... A ........ Cardiac MRI/function .......................... 1.83 0.82 0.73 0.82 0.73 0.07 XXX
75554 .... TC ...... A ........ Cardiac MRI/function .......................... 0.00 25.61 18.42 NA NA 0.59 XXX
75555 .... ............ A ........ Cardiac MRI/limited study .................. 1.74 25.66 18.98 NA NA 0.66 XXX
75555 .... 26 ....... A ........ Cardiac MRI/limited study .................. 1.74 0.76 0.71 0.76 0.71 0.07 XXX
75555 .... TC ...... A ........ Cardiac MRI/limited study .................. 0.00 24.90 18.27 NA NA 0.59 XXX
75600 .... ............ A ........ Contrast x-ray exam of aorta ............. 0.49 6.22 9.54 NA NA 0.67 XXX
75600 .... 26 ....... A ........ Contrast x-ray exam of aorta ............. 0.49 0.23 0.22 0.23 0.22 0.02 XXX
75600 .... TC ...... A ........ Contrast x-ray exam of aorta ............. 0.00 5.99 9.32 NA NA 0.65 XXX
75630 .... ............ A ........ X-ray aorta, leg arteries ...................... 1.79 3.67 8.72 NA NA 0.80 XXX
75630 .... 26 ....... A ........ X-ray aorta, leg arteries ...................... 1.79 0.70 0.66 0.70 0.66 0.11 XXX
75630 .... TC ...... A ........ X-ray aorta, leg arteries ...................... 0.00 2.98 8.06 NA NA 0.69 XXX
75635 .... ............ A ........ Ct angio abdominal arteries ............... 2.40 12.76 14.63 NA NA 0.50 XXX
75635 .... 26 ....... A ........ Ct angio abdominal arteries ............... 2.40 0.92 0.83 0.92 0.83 0.11 XXX
75635 .... TC ...... A ........ Ct angio abdominal arteries ............... 0.00 11.84 13.80 NA NA 0.39 XXX
75650 .... ............ A ........ Artery x-rays, head & neck ................. 1.49 3.46 8.26 NA NA 0.72 XXX
75650 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.49 0.57 0.52 0.57 0.52 0.07 XXX
75650 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 2.90 7.74 NA NA 0.65 XXX
75658 .... ............ A ........ Artery x-rays, arm ............................... 1.31 3.67 8.38 NA NA 0.72 XXX
75658 .... 26 ....... A ........ Artery x-rays, arm ............................... 1.31 0.44 0.46 0.44 0.46 0.07 XXX
75658 .... TC ...... A ........ Artery x-rays, arm ............................... 0.00 3.23 7.92 NA NA 0.65 XXX
75676 .... ............ A ........ Artery x-rays, neck ............................. 1.31 3.81 8.41 NA NA 0.72 XXX
75676 .... 26 ....... A ........ Artery x-rays, neck ............................. 1.31 0.48 0.45 0.48 0.45 0.07 XXX
75676 .... TC ...... A ........ Artery x-rays, neck ............................. 0.00 3.32 7.95 NA NA 0.65 XXX
75680 .... ............ A ........ Artery x-rays, neck ............................. 1.66 4.53 8.82 NA NA 0.72 XXX
75680 .... 26 ....... A ........ Artery x-rays, neck ............................. 1.66 0.65 0.59 0.65 0.59 0.07 XXX
75680 .... TC ...... A ........ Artery x-rays, neck ............................. 0.00 3.88 8.23 NA NA 0.65 XXX
75685 .... ............ A ........ Artery x-rays, spine ............................ 1.31 3.83 8.41 NA NA 0.71 XXX
75685 .... 26 ....... A ........ Artery x-rays, spine ............................ 1.31 0.50 0.46 0.50 0.46 0.06 XXX
75685 .... TC ...... A ........ Artery x-rays, spine ............................ 0.00 3.33 7.95 NA NA 0.65 XXX
75705 .... ............ A ........ Artery x-rays, spine ............................ 2.18 4.15 8.68 NA NA 0.78 XXX
75705 .... 26 ....... A ........ Artery x-rays, spine ............................ 2.18 0.81 0.74 0.81 0.74 0.13 XXX
75705 .... TC ...... A ........ Artery x-rays, spine ............................ 0.00 3.35 7.94 NA NA 0.65 XXX
75710 .... ............ A ........ Artery x-rays, arm/leg ......................... 1.14 3.88 8.44 NA NA 0.72 XXX
75710 .... 26 ....... A ........ Artery x-rays, arm/leg ......................... 1.14 0.42 0.41 0.42 0.41 0.07 XXX
75710 .... TC ...... A ........ Artery x-rays, arm/leg ......................... 0.00 3.45 8.03 NA NA 0.65 XXX
75716 .... ............ A ........ Artery x-rays, arms/legs ..................... 1.31 4.82 8.91 NA NA 0.72 XXX
75716 .... 26 ....... A ........ Artery x-rays, arms/legs ..................... 1.31 0.49 0.46 0.49 0.46 0.07 XXX
75716 .... TC ...... A ........ Artery x-rays, arms/legs ..................... 0.00 4.33 8.46 NA NA 0.65 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
75722 .... ............ A ........ Artery x-rays, kidney ........................... 1.14 3.76 8.39 NA NA 0.70 XXX
75722 .... 26 ....... A ........ Artery x-rays, kidney ........................... 1.14 0.47 0.44 0.47 0.44 0.05 XXX
75722 .... TC ...... A ........ Artery x-rays, kidney ........................... 0.00 3.29 7.95 NA NA 0.65 XXX
75724 .... ............ A ........ Artery x-rays, kidneys ......................... 1.49 4.96 9.09 NA NA 0.70 XXX
75724 .... 26 ....... A ........ Artery x-rays, kidneys ......................... 1.49 0.71 0.64 0.71 0.64 0.05 XXX
75724 .... TC ...... A ........ Artery x-rays, kidneys ......................... 0.00 4.25 8.44 NA NA 0.65 XXX
75726 .... ............ A ........ Artery x-rays, abdomen ...................... 1.14 3.73 8.32 NA NA 0.70 XXX
75726 .... 26 ....... A ........ Artery x-rays, abdomen ...................... 1.14 0.43 0.39 0.43 0.39 0.05 XXX
75726 .... TC ...... A ........ Artery x-rays, abdomen ...................... 0.00 3.31 7.93 NA NA 0.65 XXX
75731 .... ............ A ........ Artery x-rays, adrenal gland ............... 1.14 4.00 8.44 NA NA 0.71 XXX
75731 .... 26 ....... A ........ Artery x-rays, adrenal gland ............... 1.14 0.50 0.42 0.50 0.42 0.06 XXX
75731 .... TC ...... A ........ Artery x-rays, adrenal gland ............... 0.00 3.51 8.02 NA NA 0.65 XXX
75733 .... ............ A ........ Artery x-rays, adrenals ....................... 1.31 5.30 9.14 NA NA 0.71 XXX
75733 .... 26 ....... A ........ Artery x-rays, adrenals ....................... 1.31 0.63 0.53 0.63 0.53 0.06 XXX
75733 .... TC ...... A ........ Artery x-rays, adrenals ....................... 0.00 4.66 8.61 NA NA 0.65 XXX
75736 .... ............ A ........ Artery x-rays, pelvis ............................ 1.14 3.81 8.38 NA NA 0.71 XXX
75736 .... 26 ....... A ........ Artery x-rays, pelvis ............................ 1.14 0.43 0.40 0.43 0.40 0.06 XXX
75736 .... TC ...... A ........ Artery x-rays, pelvis ............................ 0.00 3.38 7.98 NA NA 0.65 XXX
75741 .... ............ A ........ Artery x-rays, lung .............................. 1.31 3.14 8.06 NA NA 0.71 XXX
75741 .... 26 ....... A ........ Artery x-rays, lung .............................. 1.31 0.49 0.45 0.49 0.45 0.06 XXX
75741 .... TC ...... A ........ Artery x-rays, lung .............................. 0.00 2.65 7.61 NA NA 0.65 XXX
75743 .... ............ A ........ Artery x-rays, lungs ............................ 1.66 3.53 8.30 NA NA 0.72 XXX
75743 .... 26 ....... A ........ Artery x-rays, lungs ............................ 1.66 0.62 0.56 0.62 0.56 0.07 XXX
75743 .... TC ...... A ........ Artery x-rays, lungs ............................ 0.00 2.90 7.73 NA NA 0.65 XXX
75746 .... ............ A ........ Artery x-rays, lung .............................. 1.14 3.49 8.20 NA NA 0.70 XXX
75746 .... 26 ....... A ........ Artery x-rays, lung .............................. 1.14 0.40 0.38 0.40 0.38 0.05 XXX
75746 .... TC ...... A ........ Artery x-rays, lung .............................. 0.00 3.08 7.82 NA NA 0.65 XXX
75756 .... ............ A ........ Artery x-rays, chest ............................ 1.14 4.21 8.66 NA NA 0.69 XXX
75756 .... 26 ....... A ........ Artery x-rays, chest ............................ 1.14 0.56 0.51 0.56 0.51 0.04 XXX
75756 .... TC ...... A ........ Artery x-rays, chest ............................ 0.00 3.65 8.14 NA NA 0.65 XXX
75774 .... ............ A ........ Artery x-ray, each vessel .................... 0.36 2.46 7.59 2.46 7.59 0.67 ZZZ
75774 .... 26 ....... A ........ Artery x-ray, each vessel .................... 0.36 0.14 0.13 0.14 0.13 0.02 ZZZ
75774 .... TC ...... A ........ Artery x-ray, each vessel .................... 0.00 2.32 7.46 2.32 7.46 0.65 ZZZ
75790 .... ............ A ........ Visualize A–V shunt ........................... 1.84 3.10 2.50 NA NA 0.17 XXX
75790 .... 26 ....... A ........ Visualize A–V shunt ........................... 1.84 0.60 0.59 0.60 0.59 0.09 XXX
75790 .... TC ...... A ........ Visualize A–V shunt ........................... 0.00 2.50 1.91 NA NA 0.08 XXX
75801 .... ............ C ........ Lymph vessel x-ray, arm/leg .............. 0.81 0.00 0.17 0.00 0.17 0.37 XXX
75801 .... 26 ....... A ........ Lymph vessel x-ray, arm/leg .............. 0.81 0.22 0.25 0.22 0.25 0.08 XXX
75801 .... TC ...... C ........ Lymph vessel x-ray, arm/leg .............. 0.00 0.00 3.62 0.00 3.62 0.29 XXX
75803 .... ............ C ........ Lymph vessel x-ray,arms/legs ............ 1.17 NA NA NA NA 0.34 XXX
75803 .... 26 ....... A ........ Lymph vessel x-ray,arms/legs ............ 1.17 0.42 0.38 0.42 0.38 0.05 XXX
75803 .... TC ...... C ........ Lymph vessel x-ray,arms/legs ............ 0.00 0.00 3.62 0.00 3.62 0.29 XXX
75805 .... ............ C ........ Lymph vessel x-ray, trunk .................. 0.81 0.00 0.17 0.00 0.17 0.38 XXX
75805 .... 26 ....... A ........ Lymph vessel x-ray, trunk .................. 0.81 0.28 0.27 0.28 0.27 0.05 XXX
75805 .... TC ...... C ........ Lymph vessel x-ray, trunk .................. 0.00 0.00 4.08 0.00 4.08 0.33 XXX
75807 .... ............ C ........ Lymph vessel x-ray, trunk .................. 1.17 0.00 0.25 0.00 0.25 0.05 XXX
75807 .... 26 ....... A ........ Lymph vessel x-ray, trunk .................. 1.17 0.40 0.38 0.40 0.38 0.05 XXX
75807 .... TC ...... C ........ Lymph vessel x-ray, trunk .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75809 .... ............ A ........ Nonvascular shunt, x-ray .................... 0.47 2.15 1.53 NA NA 0.07 XXX
75809 .... 26 ....... A ........ Nonvascular shunt, x-ray .................... 0.47 0.16 0.15 0.16 0.15 0.02 XXX
75809 .... TC ...... A ........ Nonvascular shunt, x-ray .................... 0.00 1.99 1.38 NA NA 0.05 XXX
75810 .... ............ C ........ Vein x-ray, spleen/liver ....................... 1.14 NA NA NA NA 0.70 XXX
75810 .... 26 ....... A ........ Vein x-ray, spleen/liver ....................... 1.14 0.41 0.38 0.41 0.38 0.05 XXX
75810 .... TC ...... C ........ Vein x-ray, spleen/liver ....................... 0.00 0.00 8.43 0.00 8.43 0.65 XXX
75820 .... ............ A ........ Vein x-ray, arm/leg ............................. 0.70 2.95 2.06 NA NA 0.09 XXX
75820 .... 26 ....... A ........ Vein x-ray, arm/leg ............................. 0.70 0.28 0.25 0.28 0.25 0.03 XXX
75820 .... TC ...... A ........ Vein x-ray, arm/leg ............................. 0.00 2.66 1.81 NA NA 0.06 XXX
75822 .... ............ A ........ Vein x-ray, arms/legs .......................... 1.06 3.15 2.46 NA NA 0.13 XXX
75822 .... 26 ....... A ........ Vein x-ray, arms/legs .......................... 1.06 0.38 0.35 0.38 0.35 0.05 XXX
75822 .... TC ...... A ........ Vein x-ray, arms/legs .......................... 0.00 2.77 2.11 NA NA 0.08 XXX
75825 .... ............ A ........ Vein x-ray, trunk ................................. 1.14 2.91 7.92 NA NA 0.72 XXX
75825 .... 26 ....... A ........ Vein x-ray, trunk ................................. 1.14 0.39 0.37 0.39 0.37 0.07 XXX
75825 .... TC ...... A ........ Vein x-ray, trunk ................................. 0.00 2.52 7.55 NA NA 0.65 XXX
75827 .... ............ A ........ Vein x-ray, chest ................................. 1.14 2.93 7.93 NA NA 0.70 XXX
75827 .... 26 ....... A ........ Vein x-ray, chest ................................. 1.14 0.38 0.37 0.38 0.37 0.05 XXX
75827 .... TC ...... A ........ Vein x-ray, chest ................................. 0.00 2.56 7.57 NA NA 0.65 XXX
75831 .... ............ A ........ Vein x-ray, kidney ............................... 1.14 3.03 7.98 NA NA 0.71 XXX
75831 .... 26 ....... A ........ Vein x-ray, kidney ............................... 1.14 0.38 0.37 0.38 0.37 0.06 XXX
75831 .... TC ...... A ........ Vein x-ray, kidney ............................... 0.00 2.64 7.61 NA NA 0.65 XXX
75833 .... ............ A ........ Vein x-ray, kidneys ............................. 1.49 3.65 8.35 NA NA 0.74 XXX
75833 .... 26 ....... A ........ Vein x-ray, kidneys ............................. 1.49 0.51 0.49 0.51 0.49 0.09 XXX
75833 .... TC ...... A ........ Vein x-ray, kidneys ............................. 0.00 3.14 7.86 NA NA 0.65 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
75840 .... ............ A ........ Vein x-ray, adrenal gland ................... 1.14 2.92 7.99 NA NA 0.72 XXX
75840 .... 26 ....... A ........ Vein x-ray, adrenal gland ................... 1.14 0.36 0.38 0.36 0.38 0.07 XXX
75840 .... TC ...... A ........ Vein x-ray, adrenal gland ................... 0.00 2.56 7.61 NA NA 0.65 XXX
75842 .... ............ A ........ Vein x-ray, adrenal glands ................. 1.49 3.73 8.36 NA NA 0.72 XXX
75842 .... 26 ....... A ........ Vein x-ray, adrenal glands ................. 1.49 0.56 0.50 0.56 0.50 0.07 XXX
75842 .... TC ...... A ........ Vein x-ray, adrenal glands ................. 0.00 3.17 7.86 NA NA 0.65 XXX
75860 .... ............ A ........ Vein x-ray, neck .................................. 1.14 3.32 8.17 NA NA 0.69 XXX
75860 .... 26 ....... A ........ Vein x-ray, neck .................................. 1.14 0.48 0.44 0.48 0.44 0.04 XXX
75860 .... TC ...... A ........ Vein x-ray, neck .................................. 0.00 2.84 7.73 NA NA 0.65 XXX
75870 .... ............ A ........ Vein x-ray, skull .................................. 1.14 3.27 8.10 NA NA 0.70 XXX
75870 .... 26 ....... A ........ Vein x-ray, skull .................................. 1.14 0.41 0.40 0.41 0.40 0.05 XXX
75870 .... TC ...... A ........ Vein x-ray, skull .................................. 0.00 2.86 7.71 NA NA 0.65 XXX
75872 .... ............ A ........ Vein x-ray, skull .................................. 1.14 4.02 8.47 NA NA 0.79 XXX
75872 .... 26 ....... A ........ Vein x-ray, skull .................................. 1.14 0.45 0.41 0.45 0.41 0.14 XXX
75872 .... TC ...... A ........ Vein x-ray, skull .................................. 0.00 3.57 8.06 NA NA 0.65 XXX
75880 .... ............ A ........ Vein x-ray, eye socket ........................ 0.70 3.16 2.13 NA NA 0.09 XXX
75880 .... 26 ....... A ........ Vein x-ray, eye socket ........................ 0.70 0.27 0.24 0.27 0.24 0.03 XXX
75880 .... TC ...... A ........ Vein x-ray, eye socket ........................ 0.00 2.89 1.88 NA NA 0.06 XXX
75885 .... ............ A ........ Vein x-ray, liver ................................... 1.44 3.16 8.08 NA NA 0.71 XXX
75885 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.44 0.52 0.48 0.52 0.48 0.06 XXX
75885 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.63 7.60 NA NA 0.65 XXX
75893 .... ............ A ........ Venous sampling by catheter ............. 0.54 2.83 7.79 NA NA 0.67 XXX
75893 .... 26 ....... A ........ Venous sampling by catheter ............. 0.54 0.20 0.19 0.20 0.19 0.02 XXX
75893 .... TC ...... A ........ Venous sampling by catheter ............. 0.00 2.64 7.61 NA NA 0.65 XXX
75894 .... ............ C ........ X-rays, transcath therapy ................... 1.31 NA NA NA NA 1.35 XXX
75894 .... 26 ....... A ........ X-rays, transcath therapy ................... 1.31 0.46 0.43 0.46 0.43 0.08 XXX
75894 .... TC ...... C ........ X-rays, transcath therapy ................... 0.00 NA NA NA NA 1.27 XXX
75896 .... ............ C ........ X-rays, transcath therapy ................... 1.31 NA NA NA NA 1.15 XXX
75896 .... 26 ....... A ........ X-rays, transcath therapy ................... 1.31 0.51 0.48 0.51 0.48 0.05 XXX
75896 .... TC ...... C ........ X-rays, transcath therapy ................... 0.00 NA NA NA NA 1.10 XXX
75898 .... ............ C ........ Follow-up angiography ....................... 1.65 NA NA NA NA 0.13 XXX
75898 .... 26 ....... A ........ Follow-up angiography ....................... 1.65 0.63 0.58 0.63 0.58 0.07 XXX
75898 .... TC ...... C ........ Follow-up angiography ....................... 0.00 NA NA NA NA 0.06 XXX
75900 .... ............ C ........ Intravascular cath exchange .............. 0.49 0.00 10.60 0.00 10.60 0.03 XXX
75900 .... 26 ....... A ........ Intravascular cath exchange .............. 0.49 0.17 0.16 0.17 0.16 0.03 XXX
75900 .... TC ...... C ........ Intravascular cath exchange .............. 0.00 0.00 10.49 0.00 10.49 0.00 XXX
75901 .... ............ A ........ Remove cva device obstruct .............. 0.49 4.11 2.76 NA NA 0.85 XXX
75901 .... 26 ....... A ........ Remove cva device obstruct .............. 0.49 0.17 0.16 0.17 0.16 0.02 XXX
75901 .... TC ...... A ........ Remove cva device obstruct .............. 0.00 3.94 2.60 NA NA 0.83 XXX
75902 .... ............ A ........ Remove cva lumen obstruct ............... 0.39 1.62 1.52 NA NA 0.85 XXX
75902 .... 26 ....... A ........ Remove cva lumen obstruct ............... 0.39 0.14 0.13 0.14 0.13 0.02 XXX
75902 .... TC ...... A ........ Remove cva lumen obstruct ............... 0.00 1.49 1.39 NA NA 0.83 XXX
75940 .... ............ C ........ X-ray placement, vein filter ................. 0.54 NA NA NA NA 0.69 XXX
75940 .... 26 ....... A ........ X-ray placement, vein filter ................. 0.54 0.19 0.18 0.19 0.18 0.04 XXX
75940 .... TC ...... C ........ X-ray placement, vein filter ................. 0.00 NA NA NA NA 0.65 XXX
75945 .... ............ C ........ Intravascular us .................................. 0.40 NA NA NA NA 0.28 XXX
75945 .... 26 ....... A ........ Intravascular us .................................. 0.40 0.14 0.14 0.14 0.14 0.04 XXX
75945 .... TC ...... C ........ Intravascular us .................................. 0.00 NA NA NA NA 0.24 XXX
75946 .... ............ C ........ Intravascular us add-on ...................... 0.40 0.00 0.09 0.00 0.09 0.05 ZZZ
75946 .... 26 ....... A ........ Intravascular us add-on ...................... 0.40 0.12 0.13 0.12 0.13 0.05 ZZZ
75946 .... TC ...... C ........ Intravascular us add-on ...................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
75952 .... ............ C ........ Endovasc repair abdom aorta ............ 4.49 0.00 0.96 0.00 0.96 0.43 XXX
75952 .... 26 ....... A ........ Endovasc repair abdom aorta ............ 4.49 1.30 1.39 1.30 1.39 0.43 XXX
75952 .... TC ...... C ........ Endovasc repair abdom aorta ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75953 .... ............ C ........ Abdom aneurysm endovas rpr ........... 1.36 0.00 0.29 0.00 0.29 0.13 XXX
75953 .... 26 ....... A ........ Abdom aneurysm endovas rpr ........... 1.36 0.40 0.43 0.40 0.43 0.13 XXX
75953 .... TC ...... C ........ Abdom aneurysm endovas rpr ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75954 .... ............ C ........ Iliac aneurysm endovas rpr ................ 2.25 0.00 0.50 0.00 0.50 0.15 XXX
75954 .... 26 ....... A ........ Iliac aneurysm endovas rpr ................ 2.25 0.63 0.71 0.63 0.71 0.15 XXX
75954 .... TC ...... C ........ Iliac aneurysm endovas rpr ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75956 .... ............ C ........ Xray, endovasc thor ao repr ............... 7.00 0.00 1.65 0.00 1.65 0.69 XXX
75956 .... 26 ....... A ........ Xray, endovasc thor ao repr ............... 7.00 1.87 2.27 1.87 2.27 0.69 XXX
75956 .... TC ...... C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
75957 .... ............ C ........ Xray, endovasc thor ao repr ............... 6.00 0.00 1.41 0.00 1.41 0.59 XXX
75957 .... 26 ....... A ........ Xray, endovasc thor ao repr ............... 6.00 1.64 1.96 1.64 1.96 0.59 XXX
75957 .... TC ...... C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75958 .... ............ C ........ Xray, place prox ext thor ao ............... 4.00 0.00 0.94 0.00 0.94 0.39 XXX
75958 .... 26 ....... A ........ Xray, place prox ext thor ao ............... 4.00 1.05 1.29 1.05 1.29 0.39 XXX
75958 .... TC ...... C ........ Xray, place prox ext thor ao ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75959 .... ............ C ........ Xray, place dist ext thor ao ................ 3.50 0.00 0.83 0.00 0.83 0.34 XXX
75959 .... 26 ....... A ........ Xray, place dist ext thor ao ................ 3.50 0.91 1.13 0.91 1.13 0.34 XXX
75959 .... TC ...... C ........ Xray, place dist ext thor ao ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75960 .... ............ C ........ Transcath iv stent rs&i ........................ 0.82 0.00 0.19 0.00 0.19 0.82 XXX
75960 .... 26 ....... A ........ Transcath iv stent rs&i ........................ 0.82 0.31 0.30 0.31 0.30 0.05 XXX
75960 .... TC ...... C ........ Transcath iv stent rs&i ........................ 0.00 0.00 9.96 0.00 9.96 0.77 XXX
75961 .... ............ A ........ Retrieval, broken catheter .................. 4.24 4.64 8.21 NA NA 0.73 XXX
75961 .... 26 ....... A ........ Retrieval, broken catheter .................. 4.24 1.50 1.41 1.50 1.41 0.18 XXX
75961 .... TC ...... A ........ Retrieval, broken catheter .................. 0.00 3.15 6.80 NA NA 0.55 XXX
75962 .... ............ A ........ Repair arterial blockage ..................... 0.54 3.43 9.68 NA NA 0.86 XXX
75962 .... 26 ....... A ........ Repair arterial blockage ..................... 0.54 0.20 0.19 0.20 0.19 0.03 XXX
75962 .... TC ...... A ........ Repair arterial blockage ..................... 0.00 3.23 9.49 NA NA 0.83 XXX
75964 .... ............ A ........ Repair artery blockage, each ............. 0.36 2.31 5.41 2.31 5.41 0.46 ZZZ
75964 .... 26 ....... A ........ Repair artery blockage, each ............. 0.36 0.13 0.12 0.13 0.12 0.03 ZZZ
75964 .... TC ...... A ........ Repair artery blockage, each ............. 0.00 2.18 5.29 2.18 5.29 0.43 ZZZ
75966 .... ............ A ........ Repair arterial blockage ..................... 1.31 4.06 10.14 NA NA 0.89 XXX
75966 .... 26 ....... A ........ Repair arterial blockage ..................... 1.31 0.55 0.51 0.55 0.51 0.06 XXX
75966 .... TC ...... A ........ Repair arterial blockage ..................... 0.00 3.50 9.63 NA NA 0.83 XXX
75968 .... ............ A ........ Repair artery blockage, each ............. 0.36 2.35 5.44 2.35 5.44 0.45 ZZZ
75968 .... 26 ....... A ........ Repair artery blockage, each ............. 0.36 0.15 0.14 0.15 0.14 0.02 ZZZ
75968 .... TC ...... A ........ Repair artery blockage, each ............. 0.00 2.19 5.30 2.19 5.30 0.43 ZZZ
75970 .... ............ C ........ Vascular biopsy .................................. 0.83 NA NA NA NA 0.64 XXX
75970 .... 26 ....... A ........ Vascular biopsy .................................. 0.83 0.31 0.29 0.31 0.29 0.04 XXX
75970 .... TC ...... C ........ Vascular biopsy .................................. 0.00 NA NA NA NA 0.60 XXX
75978 .... ............ A ........ Repair venous blockage ..................... 0.54 3.23 9.56 NA NA 0.85 XXX
75978 .... 26 ....... A ........ Repair venous blockage ..................... 0.54 0.18 0.18 0.18 0.18 0.02 XXX
75978 .... TC ...... A ........ Repair venous blockage ..................... 0.00 3.05 9.38 NA NA 0.83 XXX
75980 .... ............ C ........ Contrast xray exam bile duct ............. 1.44 NA NA NA NA 0.35 XXX
75980 .... 26 ....... A ........ Contrast xray exam bile duct ............. 1.44 0.53 0.48 0.53 0.48 0.06 XXX
75980 .... TC ...... C ........ Contrast xray exam bile duct ............. 0.00 0.00 3.62 0.00 3.62 0.29 XXX
75982 .... ............ C ........ Contrast xray exam bile duct ............. 1.44 0.00 0.31 0.00 0.31 0.06 XXX
75982 .... 26 ....... A ........ Contrast xray exam bile duct ............. 1.44 0.53 0.48 0.53 0.48 0.06 XXX
75982 .... TC ...... C ........ Contrast xray exam bile duct ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
75984 .... ............ A ........ Xray control catheter change ............. 0.72 2.30 2.22 NA NA 0.14 XXX
75984 .... 26 ....... A ........ Xray control catheter change ............. 0.72 0.26 0.24 0.26 0.24 0.03 XXX
75984 .... TC ...... A ........ Xray control catheter change ............. 0.00 2.03 1.98 NA NA 0.11 XXX
75989 .... ............ A ........ Abscess drainage under x-ray ........... 1.19 2.23 2.86 NA NA 0.22 XXX
75989 .... 26 ....... A ........ Abscess drainage under x-ray ........... 1.19 0.43 0.40 0.43 0.40 0.05 XXX
75989 .... TC ...... A ........ Abscess drainage under x-ray ........... 0.00 1.80 2.47 NA NA 0.17 XXX
75992 .... ............ C ........ Atherectomy, x-ray exam ................... 0.54 NA NA NA NA 0.86 XXX
75992 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 0.54 0.22 0.21 0.22 0.21 0.03 XXX
75992 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 10.53 0.00 10.53 0.83 XXX
75993 .... ............ C ........ Atherectomy, x-ray exam ................... 0.36 0.00 4.29 0.00 4.29 0.02 ZZZ
75993 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 0.36 0.14 0.14 0.14 0.14 0.02 ZZZ
75993 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 4.20 0.00 4.20 0.00 ZZZ
75994 .... ............ C ........ Atherectomy, x-ray exam ................... 1.31 0.00 8.21 0.00 8.21 0.07 XXX
75995 .... ............ C ........ Atherectomy, x-ray exam ................... 1.31 0.00 8.19 0.00 8.19 0.05 XXX
75996 .... ............ C ........ Atherectomy, x-ray exam ................... 0.36 0.00 4.29 0.00 4.29 0.02 ZZZ
75996 .... 26 ....... A ........ Atherectomy, x-ray exam ................... 0.36 0.12 0.13 0.12 0.13 0.02 ZZZ
75996 .... TC ...... C ........ Atherectomy, x-ray exam ................... 0.00 0.00 4.20 0.00 4.20 0.00 ZZZ
76000 .... ............ A ........ Fluoroscope examination ................... 0.17 2.74 2.03 NA NA 0.08 XXX
76000 .... 26 ....... A ........ Fluoroscope examination ................... 0.17 0.06 0.05 0.06 0.05 0.01 XXX
76000 .... TC ...... A ........ Fluoroscope examination ................... 0.00 2.68 1.98 NA NA 0.07 XXX
76001 .... ............ C ........ Fluoroscope exam, extensive ............. 0.67 NA NA NA NA 0.19 XXX
76001 .... 26 ....... A ........ Fluoroscope exam, extensive ............. 0.67 0.24 0.23 0.24 0.23 0.05 XXX
76001 .... TC ...... C ........ Fluoroscope exam, extensive ............. 0.00 NA NA NA NA 0.14 XXX
76010 .... ............ A ........ X-ray, nose to rectum ......................... 0.18 0.54 0.56 NA NA 0.03 XXX
76010 .... 26 ....... A ........ X-ray, nose to rectum ......................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX
76010 .... TC ...... A ........ X-ray, nose to rectum ......................... 0.00 0.47 0.50 NA NA 0.02 XXX
76080 .... ............ A ........ X-ray exam of fistula .......................... 0.54 1.09 1.15 NA NA 0.08 XXX
76080 .... 26 ....... A ........ X-ray exam of fistula .......................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX
76080 .... TC ...... A ........ X-ray exam of fistula .......................... 0.00 0.89 0.96 NA NA 0.06 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
76098 .... ............ A ........ X-ray exam, breast specimen ............ 0.16 0.32 0.39 NA NA 0.03 XXX
76098 .... 26 ....... A ........ X-ray exam, breast specimen ............ 0.16 0.06 0.05 0.06 0.05 0.01 XXX
76098 .... TC ...... A ........ X-ray exam, breast specimen ............ 0.00 0.27 0.34 NA NA 0.02 XXX
76100 .... ............ A ........ X-ray exam of body section ............... 0.58 3.53 2.46 NA NA 0.10 XXX
76100 .... 26 ....... A ........ X-ray exam of body section ............... 0.58 0.21 0.20 0.21 0.20 0.03 XXX
76100 .... TC ...... A ........ X-ray exam of body section ............... 0.00 3.33 2.27 NA NA 0.07 XXX
76101 .... ............ A ........ Complex body section x-ray ............... 0.58 5.44 3.48 NA NA 0.11 XXX
76101 .... 26 ....... A ........ Complex body section x-ray ............... 0.58 0.19 0.19 0.19 0.19 0.03 XXX
76101 .... TC ...... A ........ Complex body section x-ray ............... 0.00 5.25 3.29 NA NA 0.08 XXX
76102 .... ............ A ........ Complex body section x-rays ............. 0.58 7.60 4.77 NA NA 0.14 XXX
76102 .... 26 ....... A ........ Complex body section x-rays ............. 0.58 0.18 0.19 0.18 0.19 0.03 XXX
76102 .... TC ...... A ........ Complex body section x-rays ............. 0.00 7.41 4.58 NA NA 0.11 XXX
76120 .... ............ A ........ Cine/video x-rays ................................ 0.38 1.84 1.51 NA NA 0.08 XXX
76120 .... 26 ....... A ........ Cine/video x-rays ................................ 0.38 0.13 0.13 0.13 0.13 0.02 XXX
76120 .... TC ...... A ........ Cine/video x-rays ................................ 0.00 1.71 1.38 NA NA 0.06 XXX
76125 .... ............ C ........ Cine/video x-rays add-on ................... 0.27 NA NA NA NA 0.06 ZZZ
76125 .... 26 ....... A ........ Cine/video x-rays add-on ................... 0.27 0.11 0.10 0.11 0.10 0.01 ZZZ
76125 .... TC ...... C ........ Cine/video x-rays add-on ................... 0.00 0.00 0.52 0.00 0.52 0.05 ZZZ
76150 .... ............ A ........ X-ray exam, dry process .................... 0.00 0.67 0.54 NA NA 0.02 XXX
76350 .... ............ C ........ Special x-ray contrast study ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76376 .... ............ A ........ 3d render w/o postprocess ................. 0.20 1.39 2.43 NA NA 0.10 XXX
76376 .... 26 ....... A ........ 3d render w/o postprocess ................. 0.20 0.07 0.07 0.07 0.07 0.02 XXX
76376 .... TC ...... A ........ 3d render w/o postprocess ................. 0.00 1.32 2.36 NA NA 0.08 XXX
76377 .... ............ A ........ 3d rendering w/postprocess ............... 0.79 1.40 2.53 NA NA 0.39 XXX
76377 .... 26 ....... A ........ 3d rendering w/postprocess ............... 0.79 0.28 0.27 0.28 0.27 0.08 XXX
76377 .... TC ...... A ........ 3d rendering w/postprocess ............... 0.00 1.11 2.26 NA NA 0.31 XXX
76380 .... ............ A ........ CAT scan follow-up study .................. 0.98 4.68 4.21 NA NA 0.22 XXX
76380 .... 26 ....... A ........ CAT scan follow-up study .................. 0.98 0.34 0.32 0.34 0.32 0.04 XXX
76380 .... TC ...... A ........ CAT scan follow-up study .................. 0.00 4.33 3.89 NA NA 0.18 XXX
76390 .... ............ N ........ Mr spectroscopy ................................. 1.40 9.31 10.40 NA NA 0.66 XXX
76390 .... 26 ....... N ........ Mr spectroscopy ................................. 1.40 0.32 0.39 0.32 0.39 0.07 XXX
76390 .... TC ...... N ........ Mr spectroscopy ................................. 0.00 8.99 10.00 NA NA 0.59 XXX
76496 .... ............ C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76496 .... 26 ....... C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76496 .... TC ...... C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76497 .... ............ C ........ Ct procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76497 .... 26 ....... C ........ Ct procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76497 .... TC ...... C ........ Ct procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76498 .... ............ C ........ Mri procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76498 .... 26 ....... C ........ Mri procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76498 .... TC ...... C ........ Mri procedure ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76499 .... ............ C ........ Radiographic procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76499 .... 26 ....... C ........ Radiographic procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76499 .... TC ...... C ........ Radiographic procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76506 .... ............ A ........ Echo exam of head ............................ 0.63 2.75 2.20 NA NA 0.14 XXX
76506 .... 26 ....... A ........ Echo exam of head ............................ 0.63 0.21 0.22 0.21 0.22 0.06 XXX
76506 .... TC ...... A ........ Echo exam of head ............................ 0.00 2.54 1.97 NA NA 0.08 XXX
76510 .... ............ A ........ Ophth us, b & quant a ........................ 1.55 2.25 2.57 NA NA 0.10 XXX
76510 .... 26 ....... A ........ Ophth us, b & quant a ........................ 1.55 0.56 0.63 0.56 0.63 0.03 XXX
76510 .... TC ...... A ........ Ophth us, b & quant a ........................ 0.00 1.69 1.94 NA NA 0.07 XXX
76511 .... ............ A ........ Ophth us, quant a only ....................... 0.94 1.35 1.90 NA NA 0.10 XXX
76511 .... 26 ....... A ........ Ophth us, quant a only ....................... 0.94 0.33 0.37 0.33 0.37 0.03 XXX
76511 .... TC ...... A ........ Ophth us, quant a only ....................... 0.00 1.01 1.52 NA NA 0.07 XXX
76512 .... ............ A ........ Ophth us, b w/non-quant a ................. 0.94 1.16 1.70 NA NA 0.12 XXX
76512 .... 26 ....... A ........ Ophth us, b w/non-quant a ................. 0.94 0.33 0.38 0.33 0.38 0.02 XXX
76512 .... TC ...... A ........ Ophth us, b w/non-quant a ................. 0.00 0.82 1.32 NA NA 0.10 XXX
76513 .... ............ A ........ Echo exam of eye, water bath ........... 0.66 1.52 1.67 NA NA 0.12 XXX
76513 .... 26 ....... A ........ Echo exam of eye, water bath ........... 0.66 0.24 0.27 0.24 0.27 0.02 XXX
76513 .... TC ...... A ........ Echo exam of eye, water bath ........... 0.00 1.29 1.41 NA NA 0.10 XXX
76514 .... ............ A ........ Echo exam of eye, thickness ............. 0.17 0.16 0.15 NA NA 0.02 XXX
76514 .... 26 ....... A ........ Echo exam of eye, thickness ............. 0.17 0.06 0.07 0.06 0.07 0.01 XXX
76514 .... TC ...... A ........ Echo exam of eye, thickness ............. 0.00 0.10 0.08 NA NA 0.01 XXX
76516 .... ............ A ........ Echo exam of eye .............................. 0.54 1.16 1.31 NA NA 0.08 XXX
76516 .... 26 ....... A ........ Echo exam of eye .............................. 0.54 0.19 0.22 0.19 0.22 0.01 XXX
76516 .... TC ...... A ........ Echo exam of eye .............................. 0.00 0.97 1.10 NA NA 0.07 XXX
76536 .... ............ A ........ Us exam of head and neck ................ 0.56 2.65 2.10 NA NA 0.10 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
76536 .... 26 ....... A ........ Us exam of head and neck ................ 0.56 0.18 0.17 0.18 0.17 0.02 XXX
76536 .... TC ...... A ........ Us exam of head and neck ................ 0.00 2.47 1.93 NA NA 0.08 XXX
76604 .... ............ A ........ Us exam, chest ................................... 0.55 1.82 1.63 NA NA 0.09 XXX
76604 .... 26 ....... A ........ Us exam, chest ................................... 0.55 0.19 0.18 0.19 0.18 0.02 XXX
76604 .... TC ...... A ........ Us exam, chest ................................... 0.00 1.63 1.46 NA NA 0.07 XXX
76645 .... ............ A ........ Us exam, breast(s) ............................. 0.54 2.10 1.64 NA NA 0.08 XXX
76645 .... 26 ....... A ........ Us exam, breast(s) ............................. 0.54 0.19 0.18 0.19 0.18 0.02 XXX
76645 .... TC ...... A ........ Us exam, breast(s) ............................. 0.00 1.91 1.46 NA NA 0.06 XXX
76700 .... ............ A ........ Us exam, abdom, complete ............... 0.81 3.00 2.59 NA NA 0.15 XXX
76700 .... 26 ....... A ........ Us exam, abdom, complete ............... 0.81 0.28 0.27 0.28 0.27 0.04 XXX
76700 .... TC ...... A ........ Us exam, abdom, complete ............... 0.00 2.72 2.33 NA NA 0.11 XXX
76705 .... ............ A ........ Echo exam of abdomen ..................... 0.59 2.33 1.96 NA NA 0.11 XXX
76705 .... 26 ....... A ........ Echo exam of abdomen ..................... 0.59 0.21 0.20 0.21 0.20 0.03 XXX
76705 .... TC ...... A ........ Echo exam of abdomen ..................... 0.00 2.13 1.76 NA NA 0.08 XXX
76770 .... ............ A ........ Us exam abdo back wall, comp ......... 0.74 2.91 2.54 NA NA 0.14 XXX
76770 .... 26 ....... A ........ Us exam abdo back wall, comp ......... 0.74 0.26 0.25 0.26 0.25 0.03 XXX
76770 .... TC ...... A ........ Us exam abdo back wall, comp ......... 0.00 2.65 2.30 NA NA 0.11 XXX
76775 .... ............ A ........ Us exam abdo back wall, lim ............. 0.58 2.40 1.98 NA NA 0.11 XXX
76775 .... 26 ....... A ........ Us exam abdo back wall, lim ............. 0.58 0.21 0.20 0.21 0.20 0.03 XXX
76775 .... TC ...... A ........ Us exam abdo back wall, lim ............. 0.00 2.19 1.78 NA NA 0.08 XXX
76776 .... ............ A ........ Us exam k transpl w/doppler .............. 0.76 3.41 2.62 NA NA 0.14 XXX
76776 .... 26 ....... A ........ Us exam k transpl w/doppler .............. 0.76 0.27 0.25 0.27 0.25 0.03 XXX
76776 .... TC ...... A ........ Us exam k transpl w/doppler .............. 0.00 3.13 2.36 NA NA 0.11 XXX
76800 .... ............ A ........ Us exam, spinal canal ........................ 1.13 2.30 2.03 NA NA 0.13 XXX
76800 .... 26 ....... A ........ Us exam, spinal canal ........................ 1.13 0.29 0.32 0.29 0.32 0.05 XXX
76800 .... TC ...... A ........ Us exam, spinal canal ........................ 0.00 2.01 1.71 NA NA 0.08 XXX
76801 .... ............ A ........ Ob us < 14 wks, single fetus ............. 0.99 2.45 2.44 NA NA 0.16 XXX
76801 .... 26 ....... A ........ Ob us < 14 wks, single fetus ............. 0.99 0.31 0.32 0.31 0.32 0.04 XXX
76801 .... TC ...... A ........ Ob us < 14 wks, single fetus ............. 0.00 2.14 2.11 NA NA 0.12 XXX
76802 .... ............ A ........ Ob us < 14 wks, addœl fetus .............. 0.83 0.97 1.15 0.97 1.15 0.16 ZZZ
76802 .... 26 ....... A ........ Ob us < 14 wks, addœl fetus .............. 0.83 0.27 0.28 0.27 0.28 0.04 ZZZ
76802 .... TC ...... A ........ Ob us < 14 wks, addœl fetus .............. 0.00 0.70 0.87 0.70 0.87 0.12 ZZZ
76805 .... ............ A ........ Ob us >/= 14 wks, sngl fetus ............. 0.99 3.02 2.71 NA NA 0.16 XXX
76805 .... 26 ....... A ........ Ob us >/= 14 wks, sngl fetus ............. 0.99 0.31 0.32 0.31 0.32 0.04 XXX
76805 .... TC ...... A ........ Ob us >/= 14 wks, sngl fetus ............. 0.00 2.71 2.39 NA NA 0.12 XXX
76810 .... ............ A ........ Ob us >/= 14 wks, addl fetus ............. 0.98 1.64 1.51 1.64 1.51 0.26 ZZZ
76810 .... 26 ....... A ........ Ob us >/= 14 wks, addl fetus ............. 0.98 0.30 0.31 0.30 0.31 0.04 ZZZ
76810 .... TC ...... A ........ Ob us >/= 14 wks, addl fetus ............. 0.00 1.34 1.19 1.34 1.19 0.22 ZZZ
76811 .... ............ A ........ Ob us, detailed, sngl fetus ................. 1.90 3.04 3.63 NA NA 0.52 XXX
76811 .... 26 ....... A ........ Ob us, detailed, sngl fetus ................. 1.90 0.55 0.63 0.55 0.63 0.09 XXX
76811 .... TC ...... A ........ Ob us, detailed, sngl fetus ................. 0.00 2.49 3.00 NA NA 0.43 XXX
76812 .... ............ A ........ Ob us, detailed, addl fetus ................. 1.78 3.96 2.82 3.96 2.82 0.49 ZZZ
76812 .... 26 ....... A ........ Ob us, detailed, addl fetus ................. 1.78 0.51 0.58 0.51 0.58 0.08 ZZZ
76812 .... TC ...... A ........ Ob us, detailed, addl fetus ................. 0.00 3.45 2.24 3.45 2.24 0.41 ZZZ
76813 .... ............ A ........ Ob us nuchal meas, 1 gest ................ 1.18 2.20 2.11 NA NA 0.19 XXX
76813 .... 26 ....... A ........ Ob us nuchal meas, 1 gest ................ 1.18 0.40 0.35 0.40 0.35 0.05 XXX
76813 .... TC ...... A ........ Ob us nuchal meas, 1 gest ................ 0.00 1.80 1.75 NA NA 0.14 XXX
76814 .... ............ A ........ Ob us nuchal meas, add-on ............... 0.99 1.15 1.12 NA NA 0.19 XXX
76814 .... 26 ....... A ........ Ob us nuchal meas, add-on ............... 0.99 0.29 0.28 0.29 0.28 0.05 XXX
76814 .... TC ...... A ........ Ob us nuchal meas, add-on ............... 0.00 0.85 0.84 NA NA 0.14 XXX
76815 .... ............ A ........ Ob us, limited, fetus(s) ....................... 0.65 1.79 1.71 NA NA 0.11 XXX
76815 .... 26 ....... A ........ Ob us, limited, fetus(s) ....................... 0.65 0.20 0.21 0.20 0.21 0.03 XXX
76815 .... TC ...... A ........ Ob us, limited, fetus(s) ....................... 0.00 1.59 1.50 NA NA 0.08 XXX
76816 .... ............ A ........ Ob us, follow-up, per fetus ................. 0.85 2.36 1.89 NA NA 0.10 XXX
76816 .... 26 ....... A ........ Ob us, follow-up, per fetus ................. 0.85 0.25 0.28 0.25 0.28 0.04 XXX
76816 .... TC ...... A ........ Ob us, follow-up, per fetus ................. 0.00 2.11 1.61 NA NA 0.06 XXX
76817 .... ............ A ........ Transvaginal us, obstetric .................. 0.75 2.01 1.88 NA NA 0.09 XXX
76817 .... 26 ....... A ........ Transvaginal us, obstetric .................. 0.75 0.23 0.24 0.23 0.24 0.03 XXX
76817 .... TC ...... A ........ Transvaginal us, obstetric .................. 0.00 1.78 1.64 NA NA 0.06 XXX
76818 .... ............ A ........ Fetal biophys profile w/nst .................. 1.05 2.21 2.10 NA NA 0.15 XXX
76818 .... 26 ....... A ........ Fetal biophys profile w/nst .................. 1.05 0.31 0.35 0.31 0.35 0.05 XXX
76818 .... TC ...... A ........ Fetal biophys profile w/nst .................. 0.00 1.90 1.75 NA NA 0.10 XXX
76819 .... ............ A ........ Fetal biophys profil w/o nst ................ 0.77 1.62 1.75 NA NA 0.13 XXX
76819 .... 26 ....... A ........ Fetal biophys profil w/o nst ................ 0.77 0.23 0.25 0.23 0.25 0.03 XXX
76819 .... TC ...... A ........ Fetal biophys profil w/o nst ................ 0.00 1.39 1.50 NA NA 0.10 XXX
76820 .... ............ A ........ Umbilical artery echo .......................... 0.50 0.56 1.18 NA NA 0.15 XXX
76820 .... 26 ....... A ........ Umbilical artery echo .......................... 0.50 0.14 0.17 0.14 0.17 0.03 XXX
76820 .... TC ...... A ........ Umbilical artery echo .......................... 0.00 0.42 1.01 NA NA 0.12 XXX
76821 .... ............ A ........ Middle cerebral artery echo ................ 0.70 1.86 1.87 NA NA 0.15 XXX
76821 .... 26 ....... A ........ Middle cerebral artery echo ................ 0.70 0.21 0.24 0.21 0.24 0.03 XXX
76821 .... TC ...... A ........ Middle cerebral artery echo ................ 0.00 1.65 1.63 NA NA 0.12 XXX
76825 .... ............ A ........ Echo exam of fetal heart .................... 1.67 4.31 3.44 NA NA 0.18 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
76825 .... 26 ....... A ........ Echo exam of fetal heart .................... 1.67 0.50 0.55 0.50 0.55 0.07 XXX
76825 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 3.82 2.89 NA NA 0.11 XXX
76830 .... ............ A ........ Transvaginal us, non-ob ..................... 0.69 2.74 2.23 NA NA 0.13 XXX
76830 .... 26 ....... A ........ Transvaginal us, non-ob ..................... 0.69 0.23 0.22 0.23 0.22 0.03 XXX
76830 .... TC ...... A ........ Transvaginal us, non-ob ..................... 0.00 2.52 2.01 NA NA 0.10 XXX
76831 .... ............ A ........ Echo exam, uterus ............................. 0.72 2.71 2.24 NA NA 0.13 XXX
76831 .... 26 ....... A ........ Echo exam, uterus ............................. 0.72 0.21 0.23 0.21 0.23 0.03 XXX
76831 .... TC ...... A ........ Echo exam, uterus ............................. 0.00 2.50 2.01 NA NA 0.10 XXX
76856 .... ............ A ........ Us exam, pelvic, complete ................. 0.69 2.77 2.25 NA NA 0.13 XXX
76856 .... 26 ....... A ........ Us exam, pelvic, complete ................. 0.69 0.24 0.23 0.24 0.23 0.03 XXX
76856 .... TC ...... A ........ Us exam, pelvic, complete ................. 0.00 2.53 2.02 NA NA 0.10 XXX
76857 .... ............ A ........ Us exam, pelvic, limited ..................... 0.38 2.48 2.15 NA NA 0.08 XXX
76857 .... 26 ....... A ........ Us exam, pelvic, limited ..................... 0.38 0.15 0.14 0.15 0.14 0.02 XXX
76857 .... TC ...... A ........ Us exam, pelvic, limited ..................... 0.00 2.33 2.02 NA NA 0.06 XXX
76870 .... ............ A ........ Us exam, scrotum .............................. 0.64 2.80 2.25 NA NA 0.13 XXX
76870 .... 26 ....... A ........ Us exam, scrotum .............................. 0.64 0.23 0.22 0.23 0.22 0.03 XXX
76870 .... TC ...... A ........ Us exam, scrotum .............................. 0.00 2.57 2.03 NA NA 0.10 XXX
76872 .... ............ A ........ Us, transrectal .................................... 0.69 3.39 2.81 NA NA 0.14 XXX
76872 .... 26 ....... A ........ Us, transrectal .................................... 0.69 0.27 0.24 0.27 0.24 0.04 XXX
76872 .... TC ...... A ........ Us, transrectal .................................... 0.00 3.12 2.57 NA NA 0.10 XXX
76873 .... ............ A ........ Echograp trans r, pros study .............. 1.55 3.39 3.00 NA NA 0.25 XXX
76873 .... 26 ....... A ........ Echograp trans r, pros study .............. 1.55 0.56 0.53 0.56 0.53 0.09 XXX
76873 .... TC ...... A ........ Echograp trans r, pros study .............. 0.00 2.83 2.47 NA NA 0.16 XXX
76880 .... ............ A ........ Us exam, extremity ............................. 0.59 3.14 2.36 NA NA 0.11 XXX
76880 .... 26 ....... A ........ Us exam, extremity ............................. 0.59 0.18 0.18 0.18 0.18 0.03 XXX
76880 .... TC ...... A ........ Us exam, extremity ............................. 0.00 2.96 2.18 NA NA 0.08 XXX
76885 .... ............ A ........ Us exam infant hips, dynamic ............ 0.74 3.23 2.46 NA NA 0.13 XXX
76885 .... 26 ....... A ........ Us exam infant hips, dynamic ............ 0.74 0.25 0.24 0.25 0.24 0.03 XXX
76885 .... TC ...... A ........ Us exam infant hips, dynamic ............ 0.00 2.98 2.23 NA NA 0.10 XXX
76886 .... ............ A ........ Us exam infant hips, static ................. 0.62 2.24 1.92 NA NA 0.11 XXX
76886 .... 26 ....... A ........ Us exam infant hips, static ................. 0.62 0.22 0.20 0.22 0.20 0.03 XXX
76886 .... TC ...... A ........ Us exam infant hips, static ................. 0.00 2.02 1.72 NA NA 0.08 XXX
76930 .... ............ A ........ Echo guide, cardiocentesis ................ 0.67 2.01 1.90 NA NA 0.12 XXX
76930 .... 26 ....... A ........ Echo guide, cardiocentesis ................ 0.67 0.33 0.29 0.33 0.29 0.02 XXX
76930 .... TC ...... A ........ Echo guide, cardiocentesis ................ 0.00 1.68 1.61 NA NA 0.10 XXX
76932 .... ............ C ........ Echo guide for heart biopsy ............... 0.67 NA NA NA NA 0.12 XXX
76932 .... 26 ....... A ........ Echo guide for heart biopsy ............... 0.67 0.33 0.30 0.33 0.30 0.02 XXX
76932 .... TC ...... C ........ Echo guide for heart biopsy ............... 0.00 NA NA NA NA 0.10 XXX
76936 .... ............ A ........ Echo guide for artery repair ............... 1.99 6.03 6.46 NA NA 0.47 XXX
76936 .... 26 ....... A ........ Echo guide for artery repair ............... 1.99 0.71 0.68 0.71 0.68 0.13 XXX
76936 .... TC ...... A ........ Echo guide for artery repair ............... 0.00 5.33 5.78 NA NA 0.34 XXX
76937 .... ............ A ........ Us guide, vascular access ................. 0.30 0.61 0.54 0.61 0.54 0.13 ZZZ
76937 .... 26 ....... A ........ Us guide, vascular access ................. 0.30 0.10 0.10 0.10 0.10 0.03 ZZZ
76937 .... TC ...... A ........ Us guide, vascular access ................. 0.00 0.51 0.44 0.51 0.44 0.10 ZZZ
76940 .... ............ C ........ Us guide, tissue ablation .................... 2.00 NA NA NA NA 0.60 XXX
76940 .... 26 ....... A ........ Us guide, tissue ablation .................... 2.00 0.65 0.64 0.65 0.64 0.31 XXX
76940 .... TC ...... C ........ Us guide, tissue ablation .................... 0.00 NA NA NA NA 0.29 XXX
76941 .... ............ C ........ Echo guide for transfusion ................. 1.34 NA NA NA NA 0.15 XXX
76941 .... 26 ....... A ........ Echo guide for transfusion ................. 1.34 0.39 0.44 0.39 0.44 0.07 XXX
76941 .... TC ...... C ........ Echo guide for transfusion ................. 0.00 0.00 1.02 0.00 1.02 0.08 XXX
76942 .... ............ A ........ Echo guide for biopsy ......................... 0.67 4.76 3.87 NA NA 0.13 XXX
76942 .... 26 ....... A ........ Echo guide for biopsy ......................... 0.67 0.24 0.23 0.24 0.23 0.03 XXX
76942 .... TC ...... A ........ Echo guide for biopsy ......................... 0.00 4.52 3.65 NA NA 0.10 XXX
76945 .... ............ C ........ Echo guide, villus sampling ................ 0.67 NA NA NA NA 0.11 XXX
76945 .... 26 ....... A ........ Echo guide, villus sampling ................ 0.67 0.20 0.21 0.20 0.21 0.03 XXX
76945 .... TC ...... C ........ Echo guide, villus sampling ................ 0.00 0.00 1.02 0.00 1.02 0.08 XXX
76946 .... ............ A ........ Echo guide for amniocentesis ............ 0.38 0.45 1.05 NA NA 0.12 XXX
76946 .... 26 ....... A ........ Echo guide for amniocentesis ............ 0.38 0.11 0.12 0.11 0.12 0.02 XXX
76946 .... TC ...... A ........ Echo guide for amniocentesis ............ 0.00 0.34 0.93 NA NA 0.10 XXX
76948 .... ............ A ........ Echo guide, ova aspiration ................. 0.38 0.44 1.04 NA NA 0.12 XXX
76948 .... 26 ....... A ........ Echo guide, ova aspiration ................. 0.38 0.10 0.11 0.10 0.11 0.02 XXX
76948 .... TC ...... A ........ Echo guide, ova aspiration ................. 0.00 0.34 0.93 NA NA 0.10 XXX
76950 .... ............ A ........ Echo guidance radiotherapy ............... 0.58 1.21 1.36 NA NA 0.10 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
76950 .... 26 ....... A ........ Echo guidance radiotherapy ............... 0.58 0.19 0.19 0.19 0.19 0.03 XXX
76950 .... TC ...... A ........ Echo guidance radiotherapy ............... 0.00 1.01 1.16 NA NA 0.07 XXX
76965 .... ............ A ........ Echo guidance radiotherapy ............... 1.34 1.20 3.60 NA NA 0.37 XXX
76965 .... 26 ....... A ........ Echo guidance radiotherapy ............... 1.34 0.50 0.47 0.50 0.47 0.08 XXX
76965 .... TC ...... A ........ Echo guidance radiotherapy ............... 0.00 0.70 3.13 NA NA 0.29 XXX
76970 .... ............ A ........ Ultrasound exam follow-up ................. 0.40 1.96 1.59 NA NA 0.08 XXX
76970 .... 26 ....... A ........ Ultrasound exam follow-up ................. 0.40 0.11 0.12 0.11 0.12 0.02 XXX
76970 .... TC ...... A ........ Ultrasound exam follow-up ................. 0.00 1.85 1.47 NA NA 0.06 XXX
76975 .... ............ C ........ GI endoscopic ultrasound ................... 0.81 NA NA NA NA 0.14 XXX
76975 .... 26 ....... A ........ GI endoscopic ultrasound ................... 0.81 0.31 0.29 0.31 0.29 0.04 XXX
76975 .... TC ...... C ........ GI endoscopic ultrasound ................... 0.00 NA NA NA NA 0.10 XXX
76977 .... ............ A ........ Us bone density measure .................. 0.05 0.10 0.47 NA NA 0.06 XXX
76977 .... 26 ....... A ........ Us bone density measure .................. 0.05 0.01 0.02 0.01 0.02 0.01 XXX
76977 .... TC ...... A ........ Us bone density measure .................. 0.00 0.09 0.46 NA NA 0.05 XXX
76998 .... ............ C ........ Us guide, intraop ................................ 0.00 NA NA NA NA 0.13 XXX
76998 .... 26 ....... A ........ Us guide, intraop ................................ 1.20 0.35 0.38 0.35 0.38 0.13 XXX
76998 .... TC ...... C ........ Us guide, intraop ................................ 0.00 0.00 1.75 0.00 1.75 0.00 XXX
76999 .... ............ C ........ Echo examination procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76999 .... 26 ....... C ........ Echo examination procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
76999 .... TC ...... C ........ Echo examination procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77001 .... ............ A ........ Fluoroguide for vein device ................ 0.38 2.70 1.86 NA NA 0.11 ZZZ
77001 .... 26 ....... A ........ Fluoroguide for vein device ................ 0.38 0.13 0.13 0.13 0.13 0.01 ZZZ
77001 .... TC ...... A ........ Fluoroguide for vein device ................ 0.00 2.57 1.73 NA NA 0.10 ZZZ
77002 .... ............ A ........ Needle localization by xray ................ 0.54 1.21 1.39 NA NA 0.09 XXX
77002 .... 26 ....... A ........ Needle localization by xray ................ 0.54 0.16 0.17 0.16 0.17 0.02 XXX
77002 .... TC ...... A ........ Needle localization by xray ................ 0.00 1.06 1.23 NA NA 0.07 XXX
77003 .... ............ A ........ Fluoroguide for spine inject ................ 0.60 0.75 1.22 NA NA 0.10 XXX
77003 .... 26 ....... A ........ Fluoroguide for spine inject ................ 0.60 0.14 0.15 0.14 0.15 0.03 XXX
77003 .... TC ...... A ........ Fluoroguide for spine inject ................ 0.00 0.61 1.08 NA NA 0.07 XXX
77011 .... ............ A ........ Ct scan for localization ....................... 1.21 20.09 12.48 NA NA 0.47 XXX
77011 .... 26 ....... A ........ Ct scan for localization ....................... 1.21 0.40 0.40 0.40 0.40 0.05 XXX
77011 .... TC ...... A ........ Ct scan for localization ....................... 0.00 19.68 12.08 NA NA 0.42 XXX
77012 .... ............ A ........ Ct scan for needle biopsy .................. 1.16 2.31 6.54 NA NA 0.47 XXX
77012 .... 26 ....... A ........ Ct scan for needle biopsy .................. 1.16 0.42 0.39 0.42 0.39 0.05 XXX
77012 .... TC ...... A ........ Ct scan for needle biopsy .................. 0.00 1.90 6.15 NA NA 0.42 XXX
77013 .... ............ C ........ Ct guide for tissue ablation ................ 0.00 NA NA NA NA 0.18 XXX
77013 .... 26 ....... A ........ Ct guide for tissue ablation ................ 3.99 1.43 1.34 1.43 1.34 0.18 XXX
77013 .... TC ...... C ........ Ct guide for tissue ablation ................ 0.00 0.00 5.52 0.00 5.52 0.00 XXX
77014 .... ............ A ........ Ct scan for therapy guide ................... 0.85 4.44 3.64 NA NA 0.20 XXX
77014 .... 26 ....... A ........ Ct scan for therapy guide ................... 0.85 0.29 0.28 0.29 0.28 0.04 XXX
77014 .... TC ...... A ........ Ct scan for therapy guide ................... 0.00 4.16 3.36 NA NA 0.16 XXX
77021 .... ............ A ........ Mr guidance for needle place ............. 1.50 9.63 11.03 NA NA 0.64 XXX
77021 .... 26 ....... A ........ Mr guidance for needle place ............. 1.50 0.53 0.51 0.53 0.51 0.09 XXX
77021 .... TC ...... A ........ Mr guidance for needle place ............. 0.00 9.10 10.52 NA NA 0.55 XXX
77022 .... ............ C ........ Mri for tissue ablation ......................... 0.00 NA NA NA NA 0.24 XXX
77022 .... 26 ....... A ........ Mri for tissue ablation ......................... 4.24 1.61 1.46 1.61 1.46 0.24 XXX
77022 .... TC ...... C ........ Mri for tissue ablation ......................... 0.00 0.00 7.49 0.00 7.49 0.00 XXX
77031 .... ............ A ........ Stereotact guide for brst bx ................ 1.59 1.86 5.75 NA NA 0.46 XXX
77031 .... 26 ....... A ........ Stereotact guide for brst bx ................ 1.59 0.54 0.53 0.54 0.53 0.09 XXX
77031 .... TC ...... A ........ Stereotact guide for brst bx ................ 0.00 1.32 5.23 NA NA 0.37 XXX
77032 .... ............ A ........ Guidance for needle, breast ............... 0.56 0.62 1.20 NA NA 0.09 XXX
77032 .... 26 ....... A ........ Guidance for needle, breast ............... 0.56 0.20 0.19 0.20 0.19 0.02 XXX
77032 .... TC ...... A ........ Guidance for needle, breast ............... 0.00 0.42 1.01 NA NA 0.07 XXX
77051 .... ............ A ........ Computer dx mammogram add-on .... 0.06 0.20 0.36 0.20 0.36 0.02 ZZZ
77051 .... 26 ....... A ........ Computer dx mammogram add-on .... 0.06 0.02 0.02 0.02 0.02 0.01 ZZZ
77051 .... TC ...... A ........ Computer dx mammogram add-on .... 0.00 0.18 0.34 0.18 0.34 0.01 ZZZ
77052 .... ............ A ........ Comp screen mammogram add-on ... 0.06 0.20 0.36 0.20 0.36 0.02 ZZZ
77052 .... 26 ....... A ........ Comp screen mammogram add-on ... 0.06 0.02 0.02 0.02 0.02 0.01 ZZZ
77052 .... TC ...... A ........ Comp screen mammogram add-on ... 0.00 0.18 0.34 0.18 0.34 0.01 ZZZ
77053 .... ............ A ........ X-ray of mammary duct ...................... 0.36 0.65 2.05 NA NA 0.16 XXX
77053 .... 26 ....... A ........ X-ray of mammary duct ...................... 0.36 0.13 0.12 0.13 0.12 0.02 XXX
77053 .... TC ...... A ........ X-ray of mammary duct ...................... 0.00 0.52 1.93 NA NA 0.14 XXX
77054 .... ............ A ........ X-ray of mammary ducts .................... 0.45 1.66 3.10 NA NA 0.21 XXX
77054 .... 26 ....... A ........ X-ray of mammary ducts .................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX
77054 .... TC ...... A ........ X-ray of mammary ducts .................... 0.00 1.50 2.95 NA NA 0.19 XXX
77055 .... ............ A ........ Mammogram, one breast ................... 0.70 1.64 1.40 NA NA 0.09 XXX
77055 .... 26 ....... A ........ Mammogram, one breast ................... 0.70 0.25 0.24 0.25 0.24 0.03 XXX
77055 .... TC ...... A ........ Mammogram, one breast ................... 0.00 1.39 1.16 NA NA 0.06 XXX
77056 .... ............ A ........ Mammogram, both breasts ................ 0.87 2.13 1.77 NA NA 0.11 XXX
77056 .... 26 ....... A ........ Mammogram, both breasts ................ 0.87 0.31 0.29 0.31 0.29 0.04 XXX
77056 .... TC ...... A ........ Mammogram, both breasts ................ 0.00 1.82 1.48 NA NA 0.07 XXX
77057 .... ............ A ........ Mammogram, screening ..................... 0.70 1.44 1.45 NA NA 0.10 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
77057 .... 26 ....... A ........ Mammogram, screening ..................... 0.70 0.25 0.24 0.25 0.24 0.03 XXX
77057 .... TC ...... A ........ Mammogram, screening ..................... 0.00 1.19 1.22 NA NA 0.07 XXX
77058 .... ............ A ........ Mri, one breast ................................... 1.63 21.44 19.28 NA NA 0.99 XXX
77058 .... 26 ....... A ........ Mri, one breast ................................... 1.63 0.57 0.54 0.57 0.54 0.07 XXX
77058 .... TC ...... A ........ Mri, one breast ................................... 0.00 20.87 18.74 NA NA 0.92 XXX
77059 .... ............ A ........ Mri, both breasts ................................. 1.63 21.37 23.46 NA NA 1.31 XXX
77059 .... 26 ....... A ........ Mri, both breasts ................................. 1.63 0.57 0.54 0.57 0.54 0.07 XXX
77059 .... TC ...... A ........ Mri, both breasts ................................. 0.00 20.80 22.92 NA NA 1.24 XXX
77071 .... ............ A ........ X-ray stress view ................................ 0.41 0.76 0.37 0.76 0.37 0.06 XXX
77072 .... ............ A ........ X-rays for bone age ............................ 0.19 0.42 0.18 NA NA 0.03 XXX
77072 .... 26 ....... A ........ X-rays for bone age ............................ 0.19 0.07 0.06 0.07 0.06 0.01 XXX
77072 .... TC ...... A ........ X-rays for bone age ............................ 0.00 0.36 0.35 NA NA 0.02 XXX
77073 .... ............ A ........ X-rays, bone length studies ................ 0.27 0.67 0.80 NA NA 0.06 XXX
77073 .... 26 ....... A ........ X-rays, bone length studies ................ 0.27 0.10 0.09 0.10 0.09 0.01 XXX
77073 .... TC ...... A ........ X-rays, bone length studies ................ 0.00 0.57 0.71 NA NA 0.05 XXX
77074 .... ............ A ........ X-rays, bone survey, limited ............... 0.45 1.44 1.25 NA NA 0.08 XXX
77074 .... 26 ....... A ........ X-rays, bone survey, limited ............... 0.45 0.16 0.15 0.16 0.15 0.02 XXX
77074 .... TC ...... A ........ X-rays, bone survey, limited ............... 0.00 1.27 1.09 NA NA 0.06 XXX
77075 .... ............ A ........ X-rays, bone survey complete ............ 0.54 2.28 1.84 NA NA 0.10 XXX
77075 .... 26 ....... A ........ X-rays, bone survey complete ............ 0.54 0.20 0.19 0.20 0.19 0.02 XXX
77075 .... TC ...... A ........ X-rays, bone survey complete ............ 0.00 2.08 1.65 NA NA 0.08 XXX
77076 .... ............ A ........ X-rays, bone survey, infant ................ 0.70 2.12 1.35 NA NA 0.08 XXX
77076 .... 26 ....... A ........ X-rays, bone survey, infant ................ 0.70 0.23 0.23 0.23 0.23 0.03 XXX
77076 .... TC ...... A ........ X-rays, bone survey, infant ................ 0.00 1.89 1.12 NA NA 0.05 XXX
77077 .... ............ A ........ Joint survey, single view .................... 0.31 0.65 1.02 NA NA 0.08 XXX
77077 .... 26 ....... A ........ Joint survey, single view .................... 0.31 0.11 0.10 0.11 0.10 0.02 XXX
77077 .... TC ...... A ........ Joint survey, single view .................... 0.00 0.54 0.92 NA NA 0.06 XXX
77078 .... ............ A ........ Ct bone density, axial ......................... 0.25 4.69 3.59 NA NA 0.17 XXX
77078 .... 26 ....... A ........ Ct bone density, axial ......................... 0.25 0.09 0.08 0.09 0.08 0.01 XXX
77078 .... TC ...... A ........ Ct bone density, axial ......................... 0.00 4.61 3.51 NA NA 0.16 XXX
77079 .... ............ A ........ Ct bone density, peripheral ................ 0.22 0.81 2.29 NA NA 0.06 XXX
77079 .... 26 ....... A ........ Ct bone density, peripheral ................ 0.22 0.08 0.07 0.08 0.07 0.01 XXX
77079 .... TC ...... A ........ Ct bone density, peripheral ................ 0.00 0.73 2.22 NA NA 0.05 XXX
77080 .... ............ A ........ Dxa bone density, axial ...................... 0.20 0.87 2.42 NA NA 0.18 XXX
77080 .... 26 ....... A ........ Dxa bone density, axial ...................... 0.20 0.06 0.09 0.06 0.09 0.01 XXX
77080 .... TC ...... A ........ Dxa bone density, axial ...................... 0.00 0.81 2.34 NA NA 0.17 XXX
77081 .... ............ A ........ Dxa bone density/peripheral ............... 0.22 0.47 0.71 NA NA 0.06 XXX
77081 .... 26 ....... A ........ Dxa bone density/peripheral ............... 0.22 0.06 0.07 0.06 0.07 0.01 XXX
77081 .... TC ...... A ........ Dxa bone density/peripheral ............... 0.00 0.40 0.63 NA NA 0.05 XXX
77082 .... ............ A ........ Dxa bone density, vert fx ................... 0.17 0.52 0.71 NA NA 0.06 XXX
77082 .... 26 ....... A ........ Dxa bone density, vert fx ................... 0.17 0.05 0.06 0.05 0.06 0.01 XXX
77082 .... TC ...... A ........ Dxa bone density, vert fx ................... 0.00 0.47 0.66 NA NA 0.05 XXX
77083 .... ............ A ........ Radiographic absorptiometry .............. 0.20 0.36 0.67 NA NA 0.06 XXX
77083 .... 26 ....... A ........ Radiographic absorptiometry .............. 0.20 0.05 0.06 0.05 0.06 0.01 XXX
77083 .... TC ...... A ........ Radiographic absorptiometry .............. 0.00 0.31 0.60 NA NA 0.05 XXX
77084 .... ............ A ........ Magnetic image, bone marrow ........... 1.60 13.43 12.31 NA NA 0.66 XXX
77084 .... 26 ....... A ........ Magnetic image, bone marrow ........... 1.60 0.53 0.52 0.53 0.52 0.07 XXX
77084 .... TC ...... A ........ Magnetic image, bone marrow ........... 0.00 12.90 11.79 NA NA 0.59 XXX
77261 .... ............ A ........ Radiation therapy planning ................. 1.39 0.49 0.50 0.49 0.50 0.07 XXX
77280 .... ............ A ........ Set radiation therapy field .................. 0.70 4.40 4.06 NA NA 0.22 XXX
77280 .... 26 ....... A ........ Set radiation therapy field .................. 0.70 0.23 0.23 0.23 0.23 0.04 XXX
77280 .... TC ...... A ........ Set radiation therapy field .................. 0.00 4.16 3.83 NA NA 0.18 XXX
77299 .... ............ C ........ Radiation therapy planning ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77299 .... 26 ....... C ........ Radiation therapy planning ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77299 .... TC ...... C ........ Radiation therapy planning ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77300 .... ............ A ........ Radiation therapy dose plan .............. 0.62 1.18 1.36 NA NA 0.10 XXX
77300 .... 26 ....... A ........ Radiation therapy dose plan .............. 0.62 0.21 0.20 0.21 0.20 0.03 XXX
77300 .... TC ...... A ........ Radiation therapy dose plan .............. 0.00 0.97 1.16 NA NA 0.07 XXX
77301 .... ............ A ........ Radiotherapy dose plan, imrt ............. 7.99 57.00 43.83 NA NA 1.88 XXX
77301 .... 26 ....... A ........ Radiotherapy dose plan, imrt ............. 7.99 2.66 2.61 2.66 2.61 0.40 XXX
77301 .... TC ...... A ........ Radiotherapy dose plan, imrt ............. 0.00 54.35 41.22 NA NA 1.48 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
77305 .... ............ A ........ Teletx isodose plan simple ................. 0.70 0.90 1.49 NA NA 0.15 XXX
77305 .... 26 ....... A ........ Teletx isodose plan simple ................. 0.70 0.23 0.23 0.23 0.23 0.04 XXX
77305 .... TC ...... A ........ Teletx isodose plan simple ................. 0.00 0.66 1.26 NA NA 0.11 XXX
77310 .... ............ A ........ Teletx isodose plan intermed ............. 1.05 1.25 1.96 NA NA 0.18 XXX
77310 .... 26 ....... A ........ Teletx isodose plan intermed ............. 1.05 0.35 0.34 0.35 0.34 0.05 XXX
77310 .... TC ...... A ........ Teletx isodose plan intermed ............. 0.00 0.90 1.62 NA NA 0.13 XXX
77315 .... ............ A ........ Teletx isodose plan complex .............. 1.56 2.08 2.63 NA NA 0.22 XXX
77315 .... 26 ....... A ........ Teletx isodose plan complex .............. 1.56 0.52 0.51 0.52 0.51 0.08 XXX
77315 .... TC ...... A ........ Teletx isodose plan complex .............. 0.00 1.56 2.11 NA NA 0.14 XXX
77321 .... ............ A ........ Special teletx port plan ....................... 0.95 1.50 2.93 NA NA 0.26 XXX
77321 .... 26 ....... A ........ Special teletx port plan ....................... 0.95 0.32 0.31 0.32 0.31 0.05 XXX
77321 .... TC ...... A ........ Special teletx port plan ....................... 0.00 1.19 2.62 NA NA 0.21 XXX
77326 .... ............ A ........ Brachytx isodose calc simp ................ 0.93 2.97 2.82 NA NA 0.18 XXX
77326 .... 26 ....... A ........ Brachytx isodose calc simp ................ 0.93 0.31 0.31 0.31 0.31 0.05 XXX
77326 .... TC ...... A ........ Brachytx isodose calc simp ................ 0.00 2.66 2.51 NA NA 0.13 XXX
77327 .... ............ A ........ Brachytx isodose calc interm ............. 1.39 4.07 4.00 NA NA 0.25 XXX
77327 .... 26 ....... A ........ Brachytx isodose calc interm ............. 1.39 0.46 0.45 0.46 0.45 0.07 XXX
77327 .... TC ...... A ........ Brachytx isodose calc interm ............. 0.00 3.61 3.55 NA NA 0.18 XXX
77328 .... ............ A ........ Brachytx isodose plan compl ............. 2.09 5.22 5.43 NA NA 0.36 XXX
77328 .... 26 ....... A ........ Brachytx isodose plan compl ............. 2.09 0.70 0.69 0.70 0.69 0.11 XXX
77328 .... TC ...... A ........ Brachytx isodose plan compl ............. 0.00 4.53 4.75 NA NA 0.25 XXX
77331 .... ............ A ........ Special radiation dosimetry ................ 0.87 0.80 0.79 NA NA 0.06 XXX
77331 .... 26 ....... A ........ Special radiation dosimetry ................ 0.87 0.29 0.28 0.29 0.28 0.04 XXX
77331 .... TC ...... A ........ Special radiation dosimetry ................ 0.00 0.51 0.51 NA NA 0.02 XXX
77332 .... ............ A ........ Radiation treatment aid(s) .................. 0.54 1.54 1.53 NA NA 0.10 XXX
77332 .... 26 ....... A ........ Radiation treatment aid(s) .................. 0.54 0.18 0.18 0.18 0.18 0.03 XXX
77332 .... TC ...... A ........ Radiation treatment aid(s) .................. 0.00 1.36 1.35 NA NA 0.07 XXX
77336 .... ............ A ........ Radiation physics consult ................... 0.00 1.13 2.06 NA NA 0.16 XXX
77370 .... ............ A ........ Radiation physics consult ................... 0.00 3.02 3.26 NA NA 0.18 XXX
77371 .... ............ A ........ Srs, multisource .................................. 0.00 29.82 30.11 NA NA 0.13 XXX
77372 .... ............ A ........ Srs, linear based ................................ 0.00 22.61 22.82 NA NA 0.13 XXX
77373 .... ............ A ........ Sbrt delivery ........................................ 0.00 42.26 42.67 NA NA 0.13 XXX
77399 .... ............ C ........ External radiation dosimetry ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77399 .... 26 ....... C ........ External radiation dosimetry ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77399 .... TC ...... C ........ External radiation dosimetry ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77401 .... ............ A ........ Radiation treatment delivery ............... 0.00 0.47 1.12 NA NA 0.11 XXX
77417 .... ............ A ........ Radiology port film(s) ......................... 0.00 0.36 0.47 NA NA 0.04 XXX
77418 .... ............ A ........ Radiation tx delivery, imrt ................... 0.00 13.04 15.55 NA NA 0.13 XXX
77421 .... ............ A ........ Stereoscopic x-ray guidance .............. 0.39 1.98 2.73 NA NA 0.12 XXX
77421 .... 26 ....... A ........ Stereoscopic x-ray guidance .............. 0.39 0.13 0.13 0.13 0.13 0.02 XXX
77421 .... TC ...... A ........ Stereoscopic x-ray guidance .............. 0.00 1.85 2.60 NA NA 0.10 XXX
77422 .... ............ A ........ Neutron beam tx, simple .................... 0.00 5.37 4.84 NA NA 0.13 XXX
77423 .... ............ A ........ Neutron beam tx, complex ................. 0.00 7.41 5.03 NA NA 0.13 XXX
77427 .... ............ A ........ Radiation tx management, x5 ............ 3.70 1.40 1.23 1.40 1.23 0.17 XXX
77431 .... ............ A ........ Radiation therapy management ......... 1.81 0.79 0.74 0.79 0.74 0.09 XXX
77432 .... ............ A ........ Stereotactic radiation trmt .................. 7.92 2.64 2.78 2.64 2.78 0.41 XXX
77435 .... ............ A ........ Sbrt management ............................... 13.00 4.75 4.75 NA NA 0.67 XXX
77470 .... ............ A ........ Special radiation treatment ................. 2.09 1.93 6.88 NA NA 0.70 XXX
77470 .... 26 ....... A ........ Special radiation treatment ................. 2.09 0.69 0.68 0.69 0.68 0.11 XXX
77470 .... TC ...... A ........ Special radiation treatment ................. 0.00 1.23 6.19 NA NA 0.59 XXX
77499 .... ............ C ........ Radiation therapy management ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77499 .... 26 ....... C ........ Radiation therapy management ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77499 .... TC ...... C ........ Radiation therapy management ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77520 .... ............ C ........ Proton trmt, simple w/o comp ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
77522 .... ............ C ........ Proton trmt, simple w/comp ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77523 .... ............ C ........ Proton trmt, intermediate .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77525 .... ............ C ........ Proton treatment, complex ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77600 .... ............ R ........ Hyperthermia treatment ...................... 1.56 10.16 6.78 NA NA 0.24 XXX
77600 .... 26 ....... R ........ Hyperthermia treatment ...................... 1.56 0.51 0.49 0.51 0.49 0.08 XXX
77600 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 9.65 6.29 NA NA 0.16 XXX
77750 .... ............ A ........ Infuse radioactive materials ................ 4.94 4.56 3.74 4.56 3.74 0.32 090
77750 .... 26 ....... A ........ Infuse radioactive materials ................ 4.94 1.65 1.62 1.65 1.62 0.25 090
77750 .... TC ...... A ........ Infuse radioactive materials ................ 0.00 2.91 2.12 2.91 2.12 0.07 090
77761 .... ............ A ........ Apply intrcav radiat simple ................. 3.82 6.33 4.96 6.33 4.96 0.33 090
77761 .... 26 ....... A ........ Apply intrcav radiat simple ................. 3.82 1.27 1.18 1.27 1.18 0.19 090
77761 .... TC ...... A ........ Apply intrcav radiat simple ................. 0.00 5.06 3.78 5.06 3.78 0.14 090
77762 .... ............ A ........ Apply intrcav radiat interm .................. 5.73 7.60 6.54 7.60 6.54 0.48 090
77762 .... 26 ....... A ........ Apply intrcav radiat interm .................. 5.73 1.90 1.87 1.90 1.87 0.29 090
77762 .... TC ...... A ........ Apply intrcav radiat interm .................. 0.00 5.70 4.67 5.70 4.67 0.19 090
77763 .... ............ A ........ Apply intrcav radiat compl .................. 8.60 10.33 8.80 10.33 8.80 0.66 090
77763 .... 26 ....... A ........ Apply intrcav radiat compl .................. 8.60 2.86 2.81 2.86 2.81 0.43 090
77763 .... TC ...... A ........ Apply intrcav radiat compl .................. 0.00 7.46 5.99 7.46 5.99 0.23 090
77776 .... ............ A ........ Apply interstit radiat simpl .................. 4.67 7.45 5.30 7.45 5.30 0.57 090
77776 .... 26 ....... A ........ Apply interstit radiat simpl .................. 4.67 1.70 1.33 1.70 1.33 0.44 090
77776 .... TC ...... A ........ Apply interstit radiat simpl .................. 0.00 5.75 3.98 5.75 3.98 0.13 090
77777 .... ............ A ........ Apply interstit radiat inter .................... 7.49 7.91 7.25 7.91 7.25 0.61 090
77777 .... 26 ....... A ........ Apply interstit radiat inter .................... 7.49 2.48 2.43 2.48 2.43 0.39 090
77777 .... TC ...... A ........ Apply interstit radiat inter .................... 0.00 5.43 4.82 5.43 4.82 0.22 090
77778 .... ............ A ........ Apply interstit radiat compl ................. 11.23 11.32 10.03 11.32 10.03 0.84 090
77778 .... 26 ....... A ........ Apply interstit radiat compl ................. 11.23 3.75 3.67 3.75 3.67 0.57 090
77778 .... TC ...... A ........ Apply interstit radiat compl ................. 0.00 7.57 6.36 7.57 6.36 0.27 090
77781 .... ............ A ........ High intensity brachytherapy .............. 1.21 4.37 12.61 NA NA 1.14 XXX
77781 .... 26 ....... A ........ High intensity brachytherapy .............. 1.21 0.40 0.47 0.40 0.47 0.08 XXX
77781 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 3.97 12.14 NA NA 1.06 XXX
77789 .... ............ A ........ Apply surface radiation ....................... 1.14 2.02 1.43 2.02 1.43 0.08 000
77789 .... 26 ....... A ........ Apply surface radiation ....................... 1.14 0.39 0.38 0.39 0.38 0.06 000
77789 .... TC ...... A ........ Apply surface radiation ....................... 0.00 1.63 1.05 1.63 1.05 0.02 000
77790 .... ............ A ........ Radiation handling .............................. 1.05 1.47 1.16 NA NA 0.07 XXX
77790 .... 26 ....... A ........ Radiation handling .............................. 1.05 0.35 0.34 0.35 0.34 0.05 XXX
77790 .... TC ...... A ........ Radiation handling .............................. 0.00 1.11 0.81 NA NA 0.02 XXX
77799 .... ............ C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77799 .... 26 ....... C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
77799 .... TC ...... C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78000 .... ............ A ........ Thyroid, single uptake ........................ 0.19 1.83 1.42 NA NA 0.07 XXX
78000 .... 26 ....... A ........ Thyroid, single uptake ........................ 0.19 0.06 0.06 0.06 0.06 0.01 XXX
78000 .... TC ...... A ........ Thyroid, single uptake ........................ 0.00 1.77 1.36 NA NA 0.06 XXX
78001 .... ............ A ........ Thyroid, multiple uptakes ................... 0.26 2.28 1.82 NA NA 0.08 XXX
78001 .... 26 ....... A ........ Thyroid, multiple uptakes ................... 0.26 0.09 0.09 0.09 0.09 0.01 XXX
78001 .... TC ...... A ........ Thyroid, multiple uptakes ................... 0.00 2.19 1.73 NA NA 0.07 XXX
78003 .... ............ A ........ Thyroid suppress/stimul ...................... 0.33 1.92 1.48 NA NA 0.07 XXX
78003 .... 26 ....... A ........ Thyroid suppress/stimul ...................... 0.33 0.12 0.11 0.12 0.11 0.01 XXX
78003 .... TC ...... A ........ Thyroid suppress/stimul ...................... 0.00 1.81 1.37 NA NA 0.06 XXX
78006 .... ............ A ........ Thyroid imaging with uptake .............. 0.49 6.16 4.31 NA NA 0.15 XXX
78006 .... 26 ....... A ........ Thyroid imaging with uptake .............. 0.49 0.17 0.16 0.17 0.16 0.02 XXX
78006 .... TC ...... A ........ Thyroid imaging with uptake .............. 0.00 5.99 4.14 NA NA 0.13 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
78007 .... ............ A ........ Thyroid image, mult uptakes .............. 0.50 3.03 2.85 NA NA 0.16 XXX
78007 .... 26 ....... A ........ Thyroid image, mult uptakes .............. 0.50 0.17 0.16 0.17 0.16 0.02 XXX
78007 .... TC ...... A ........ Thyroid image, mult uptakes .............. 0.00 2.86 2.69 NA NA 0.14 XXX
78010 .... ............ A ........ Thyroid imaging .................................. 0.39 4.14 3.01 NA NA 0.13 XXX
78010 .... 26 ....... A ........ Thyroid imaging .................................. 0.39 0.13 0.13 0.13 0.13 0.02 XXX
78010 .... TC ...... A ........ Thyroid imaging .................................. 0.00 4.01 2.88 NA NA 0.11 XXX
78011 .... ............ A ........ Thyroid imaging with flow ................... 0.45 4.48 3.49 NA NA 0.15 XXX
78011 .... 26 ....... A ........ Thyroid imaging with flow ................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX
78011 .... TC ...... A ........ Thyroid imaging with flow ................... 0.00 4.32 3.33 NA NA 0.13 XXX
78015 .... ............ A ........ Thyroid met imaging ........................... 0.67 5.28 4.01 NA NA 0.17 XXX
78015 .... 26 ....... A ........ Thyroid met imaging ........................... 0.67 0.23 0.22 0.23 0.22 0.03 XXX
78015 .... TC ...... A ........ Thyroid met imaging ........................... 0.00 5.06 3.79 NA NA 0.14 XXX
78016 .... ............ A ........ Thyroid met imaging/studies .............. 0.82 8.42 6.04 NA NA 0.21 XXX
78016 .... 26 ....... A ........ Thyroid met imaging/studies .............. 0.82 0.28 0.27 0.28 0.27 0.03 XXX
78016 .... TC ...... A ........ Thyroid met imaging/studies .............. 0.00 8.14 5.77 NA NA 0.18 XXX
78018 .... ............ A ........ Thyroid met imaging, body ................. 0.86 7.84 6.72 NA NA 0.33 XXX
78018 .... 26 ....... A ........ Thyroid met imaging, body ................. 0.86 0.30 0.29 0.30 0.29 0.04 XXX
78018 .... TC ...... A ........ Thyroid met imaging, body ................. 0.00 7.54 6.43 NA NA 0.29 XXX
78020 .... ............ A ........ Thyroid met uptake ............................. 0.60 1.78 1.63 1.78 1.63 0.16 ZZZ
78020 .... 26 ....... A ........ Thyroid met uptake ............................. 0.60 0.20 0.20 0.20 0.20 0.02 ZZZ
78020 .... TC ...... A ........ Thyroid met uptake ............................. 0.00 1.57 1.43 1.57 1.43 0.14 ZZZ
78070 .... ............ A ........ Parathyroid nuclear imaging ............... 0.82 3.45 3.96 NA NA 0.15 XXX
78070 .... 26 ....... A ........ Parathyroid nuclear imaging ............... 0.82 0.28 0.27 0.28 0.27 0.04 XXX
78070 .... TC ...... A ........ Parathyroid nuclear imaging ............... 0.00 3.17 3.68 NA NA 0.11 XXX
78075 .... ............ A ........ Adrenal nuclear imaging ..................... 0.74 11.47 8.50 NA NA 0.32 XXX
78075 .... 26 ....... A ........ Adrenal nuclear imaging ..................... 0.74 0.25 0.25 0.25 0.25 0.03 XXX
78075 .... TC ...... A ........ Adrenal nuclear imaging ..................... 0.00 11.22 8.25 NA NA 0.29 XXX
78099 .... ............ C ........ Endocrine nuclear procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78099 .... 26 ....... C ........ Endocrine nuclear procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78099 .... TC ...... C ........ Endocrine nuclear procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78102 .... ............ A ........ Bone marrow imaging, ltd .................. 0.55 4.13 3.14 NA NA 0.14 XXX
78102 .... 26 ....... A ........ Bone marrow imaging, ltd .................. 0.55 0.19 0.18 0.19 0.18 0.02 XXX
78102 .... TC ...... A ........ Bone marrow imaging, ltd .................. 0.00 3.94 2.96 NA NA 0.12 XXX
78103 .... ............ A ........ Bone marrow imaging, mult ............... 0.75 5.37 4.36 NA NA 0.20 XXX
78103 .... 26 ....... A ........ Bone marrow imaging, mult ............... 0.75 0.26 0.25 0.26 0.25 0.03 XXX
78103 .... TC ...... A ........ Bone marrow imaging, mult ............... 0.00 5.11 4.10 NA NA 0.17 XXX
78104 .... ............ A ........ Bone marrow imaging, body .............. 0.80 6.15 5.22 NA NA 0.25 XXX
78104 .... 26 ....... A ........ Bone marrow imaging, body .............. 0.80 0.30 0.28 0.30 0.28 0.03 XXX
78104 .... TC ...... A ........ Bone marrow imaging, body .............. 0.00 5.86 4.94 NA NA 0.22 XXX
78110 .... ............ A ........ Plasma volume, single ....................... 0.19 2.10 1.55 NA NA 0.07 XXX
78110 .... 26 ....... A ........ Plasma volume, single ....................... 0.19 0.07 0.07 0.07 0.07 0.01 XXX
78110 .... TC ...... A ........ Plasma volume, single ....................... 0.00 2.04 1.49 NA NA 0.06 XXX
78111 .... ............ A ........ Plasma volume, multiple .................... 0.22 2.11 2.37 NA NA 0.15 XXX
78111 .... 26 ....... A ........ Plasma volume, multiple .................... 0.22 0.07 0.08 0.07 0.08 0.01 XXX
78111 .... TC ...... A ........ Plasma volume, multiple .................... 0.00 2.04 2.29 NA NA 0.14 XXX
78120 .... ............ A ........ Red cell mass, single ......................... 0.23 2.07 1.92 NA NA 0.12 XXX
78120 .... 26 ....... A ........ Red cell mass, single ......................... 0.23 0.08 0.08 0.08 0.08 0.01 XXX
78120 .... TC ...... A ........ Red cell mass, single ......................... 0.00 1.99 1.84 NA NA 0.11 XXX
78121 .... ............ A ........ Red cell mass, multiple ...................... 0.32 2.17 2.58 NA NA 0.15 XXX
78121 .... 26 ....... A ........ Red cell mass, multiple ...................... 0.32 0.10 0.11 0.10 0.11 0.01 XXX
78121 .... TC ...... A ........ Red cell mass, multiple ...................... 0.00 2.07 2.48 NA NA 0.14 XXX
78122 .... ............ A ........ Blood volume ...................................... 0.45 2.22 3.47 NA NA 0.26 XXX
78122 .... 26 ....... A ........ Blood volume ...................................... 0.45 0.15 0.15 0.15 0.15 0.02 XXX
78122 .... TC ...... A ........ Blood volume ...................................... 0.00 2.07 3.32 NA NA 0.24 XXX
78130 .... ............ A ........ Red cell survival study ....................... 0.61 3.47 3.24 NA NA 0.17 XXX
78130 .... 26 ....... A ........ Red cell survival study ....................... 0.61 0.21 0.20 0.21 0.20 0.03 XXX
78130 .... TC ...... A ........ Red cell survival study ....................... 0.00 3.26 3.03 NA NA 0.14 XXX
78135 .... ............ A ........ Red cell survival kinetics .................... 0.64 8.59 6.76 NA NA 0.28 XXX
78135 .... 26 ....... A ........ Red cell survival kinetics .................... 0.64 0.22 0.21 0.22 0.21 0.03 XXX
78135 .... TC ...... A ........ Red cell survival kinetics .................... 0.00 8.37 6.54 NA NA 0.25 XXX
78140 .... ............ A ........ Red cell sequestration ........................ 0.61 2.92 3.49 NA NA 0.24 XXX
78140 .... 26 ....... A ........ Red cell sequestration ........................ 0.61 0.22 0.20 0.22 0.20 0.03 XXX
78140 .... TC ...... A ........ Red cell sequestration ........................ 0.00 2.70 3.29 NA NA 0.21 XXX
78185 .... ............ A ........ Spleen imaging ................................... 0.40 5.13 3.78 NA NA 0.15 XXX
78185 .... 26 ....... A ........ Spleen imaging ................................... 0.40 0.14 0.13 0.14 0.13 0.02 XXX
78185 .... TC ...... A ........ Spleen imaging ................................... 0.00 4.99 3.64 NA NA 0.13 XXX
78190 .... ............ A ........ Platelet survival, kinetics .................... 1.09 8.27 7.27 NA NA 0.38 XXX
78190 .... 26 ....... A ........ Platelet survival, kinetics .................... 1.09 0.25 0.34 0.25 0.34 0.08 XXX
78190 .... TC ...... A ........ Platelet survival, kinetics .................... 0.00 8.02 6.93 NA NA 0.30 XXX
78191 .... ............ A ........ Platelet survival .................................. 0.61 3.49 5.47 NA NA 0.40 XXX
78191 .... 26 ....... A ........ Platelet survival .................................. 0.61 0.22 0.20 0.22 0.20 0.03 XXX
78191 .... TC ...... A ........ Platelet survival .................................. 0.00 3.27 5.27 NA NA 0.37 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
78195 .... ............ A ........ Lymph system imaging ....................... 1.20 8.60 6.47 NA NA 0.28 XXX
78195 .... 26 ....... A ........ Lymph system imaging ....................... 1.20 0.42 0.40 0.42 0.40 0.06 XXX
78195 .... TC ...... A ........ Lymph system imaging ....................... 0.00 8.18 6.07 NA NA 0.22 XXX
78199 .... ............ C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78199 .... 26 ....... C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78199 .... TC ...... C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78201 .... ............ A ........ Liver imaging ...................................... 0.44 4.55 3.52 NA NA 0.15 XXX
78201 .... 26 ....... A ........ Liver imaging ...................................... 0.44 0.13 0.14 0.13 0.14 0.02 XXX
78201 .... TC ...... A ........ Liver imaging ...................................... 0.00 4.42 3.38 NA NA 0.13 XXX
78202 .... ............ A ........ Liver imaging with flow ....................... 0.51 5.28 4.13 NA NA 0.16 XXX
78202 .... 26 ....... A ........ Liver imaging with flow ....................... 0.51 0.17 0.16 0.17 0.16 0.02 XXX
78202 .... TC ...... A ........ Liver imaging with flow ....................... 0.00 5.10 3.96 NA NA 0.14 XXX
78205 .... ............ A ........ Liver imaging (3D) .............................. 0.71 5.21 5.64 NA NA 0.34 XXX
78205 .... 26 ....... A ........ Liver imaging (3D) .............................. 0.71 0.25 0.24 0.25 0.24 0.03 XXX
78205 .... TC ...... A ........ Liver imaging (3D) .............................. 0.00 4.96 5.40 NA NA 0.31 XXX
78206 .... ............ A ........ Liver image (3d) with flow .................. 0.96 8.52 8.25 NA NA 0.15 XXX
78206 .... 26 ....... A ........ Liver image (3d) with flow .................. 0.96 0.34 0.33 0.34 0.33 0.04 XXX
78206 .... TC ...... A ........ Liver image (3d) with flow .................. 0.00 8.18 7.93 NA NA 0.11 XXX
78215 .... ............ A ........ Liver and spleen imaging ................... 0.49 4.78 3.90 NA NA 0.16 XXX
78215 .... 26 ....... A ........ Liver and spleen imaging ................... 0.49 0.17 0.16 0.17 0.16 0.02 XXX
78215 .... TC ...... A ........ Liver and spleen imaging ................... 0.00 4.60 3.73 NA NA 0.14 XXX
78216 .... ............ A ........ Liver & spleen image/flow .................. 0.57 2.82 3.21 NA NA 0.20 XXX
78216 .... 26 ....... A ........ Liver & spleen image/flow .................. 0.57 0.20 0.19 0.20 0.19 0.02 XXX
78216 .... TC ...... A ........ Liver & spleen image/flow .................. 0.00 2.62 3.03 NA NA 0.18 XXX
78220 .... ............ A ........ Liver function study ............................ 0.49 3.05 3.44 NA NA 0.21 XXX
78220 .... 26 ....... A ........ Liver function study ............................ 0.49 0.17 0.16 0.17 0.16 0.02 XXX
78220 .... TC ...... A ........ Liver function study ............................ 0.00 2.88 3.27 NA NA 0.19 XXX
78223 .... ............ A ........ Hepatobiliary imaging ......................... 0.84 8.43 6.11 NA NA 0.23 XXX
78223 .... 26 ....... A ........ Hepatobiliary imaging ......................... 0.84 0.30 0.28 0.30 0.28 0.04 XXX
78223 .... TC ...... A ........ Hepatobiliary imaging ......................... 0.00 8.13 5.83 NA NA 0.19 XXX
78230 .... ............ A ........ Salivary gland imaging ....................... 0.45 4.13 3.19 NA NA 0.15 XXX
78230 .... 26 ....... A ........ Salivary gland imaging ....................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX
78230 .... TC ...... A ........ Salivary gland imaging ....................... 0.00 3.97 3.04 NA NA 0.13 XXX
78231 .... ............ A ........ Serial salivary imaging ....................... 0.52 2.75 3.03 NA NA 0.19 XXX
78231 .... 26 ....... A ........ Serial salivary imaging ....................... 0.52 0.16 0.17 0.16 0.17 0.02 XXX
78231 .... TC ...... A ........ Serial salivary imaging ....................... 0.00 2.58 2.86 NA NA 0.17 XXX
78232 .... ............ A ........ Salivary gland function exam ............. 0.47 2.74 3.19 NA NA 0.20 XXX
78232 .... 26 ....... A ........ Salivary gland function exam ............. 0.47 0.15 0.15 0.15 0.15 0.02 XXX
78232 .... TC ...... A ........ Salivary gland function exam ............. 0.00 2.59 3.04 NA NA 0.18 XXX
78258 .... ............ A ........ Esophageal motility study ................... 0.74 5.48 4.32 NA NA 0.17 XXX
78258 .... 26 ....... A ........ Esophageal motility study ................... 0.74 0.27 0.26 0.27 0.26 0.03 XXX
78258 .... TC ...... A ........ Esophageal motility study ................... 0.00 5.21 4.06 NA NA 0.14 XXX
78261 .... ............ A ........ Gastric mucosa imaging ..................... 0.69 5.94 5.10 NA NA 0.25 XXX
78261 .... 26 ....... A ........ Gastric mucosa imaging ..................... 0.69 0.24 0.23 0.24 0.23 0.03 XXX
78261 .... TC ...... A ........ Gastric mucosa imaging ..................... 0.00 5.70 4.87 NA NA 0.22 XXX
78262 .... ............ A ........ Gastroesophageal reflux exam .......... 0.68 5.89 5.14 NA NA 0.25 XXX
78262 .... 26 ....... A ........ Gastroesophageal reflux exam .......... 0.68 0.22 0.22 0.22 0.22 0.03 XXX
78262 .... TC ...... A ........ Gastroesophageal reflux exam .......... 0.00 5.67 4.92 NA NA 0.22 XXX
78264 .... ............ A ........ Gastric emptying study ....................... 0.78 7.10 5.69 NA NA 0.25 XXX
78264 .... 26 ....... A ........ Gastric emptying study ....................... 0.78 0.28 0.26 0.28 0.26 0.03 XXX
78264 .... TC ...... A ........ Gastric emptying study ....................... 0.00 6.82 5.43 NA NA 0.22 XXX
78270 .... ............ A ........ Vit B–12 absorption exam .................. 0.20 1.92 1.75 NA NA 0.11 XXX
78270 .... 26 ....... A ........ Vit B–12 absorption exam .................. 0.20 0.07 0.07 0.07 0.07 0.01 XXX
78270 .... TC ...... A ........ Vit B–12 absorption exam .................. 0.00 1.85 1.68 NA NA 0.10 XXX
78271 .... ............ A ........ Vit b–12 absrp exam, int fac .............. 0.20 1.87 1.79 NA NA 0.11 XXX
78271 .... 26 ....... A ........ Vit b–12 absrp exam, int fac .............. 0.20 0.05 0.06 0.05 0.06 0.01 XXX
78271 .... TC ...... A ........ Vit b–12 absrp exam, int fac .............. 0.00 1.81 1.72 NA NA 0.10 XXX
78272 .... ............ A ........ Vit B–12 absorp, combined ................ 0.27 2.04 2.21 NA NA 0.14 XXX
78272 .... 26 ....... A ........ Vit B–12 absorp, combined ................ 0.27 0.07 0.08 0.07 0.08 0.01 XXX
78272 .... TC ...... A ........ Vit B–12 absorp, combined ................ 0.00 1.96 2.13 NA NA 0.13 XXX
78278 .... ............ A ........ Acute GI blood loss imaging .............. 0.99 8.52 6.79 NA NA 0.29 XXX
78278 .... 26 ....... A ........ Acute GI blood loss imaging .............. 0.99 0.35 0.33 0.35 0.33 0.04 XXX
78278 .... TC ...... A ........ Acute GI blood loss imaging .............. 0.00 8.17 6.46 NA NA 0.25 XXX
78282 .... ............ C ........ GI protein loss exam .......................... 0.38 0.00 0.08 NA NA 0.02 XXX
78282 .... 26 ....... A ........ GI protein loss exam .......................... 0.38 0.13 0.12 0.13 0.12 0.02 XXX
78282 .... TC ...... C ........ GI protein loss exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78290 .... ............ A ........ Meckelœs divert exam ........................ 0.68 8.44 5.78 NA NA 0.19 XXX
78290 .... 26 ....... A ........ Meckelœs divert exam ........................ 0.68 0.24 0.23 0.24 0.23 0.03 XXX
78290 .... TC ...... A ........ Meckelœs divert exam ........................ 0.00 8.19 5.55 NA NA 0.16 XXX
78291 .... ............ A ........ Leveen/shunt patency exam .............. 0.88 6.09 4.68 NA NA 0.20 XXX
78291 .... 26 ....... A ........ Leveen/shunt patency exam .............. 0.88 0.31 0.30 0.31 0.30 0.04 XXX
78291 .... TC ...... A ........ Leveen/shunt patency exam .............. 0.00 5.78 4.39 NA NA 0.16 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
78299 .... ............ C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78299 .... 26 ....... C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78299 .... TC ...... C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78300 .... ............ A ........ Bone imaging, limited area ................. 0.62 4.19 3.40 NA NA 0.17 XXX
78300 .... 26 ....... A ........ Bone imaging, limited area ................. 0.62 0.22 0.21 0.22 0.21 0.03 XXX
78300 .... TC ...... A ........ Bone imaging, limited area ................. 0.00 3.97 3.19 NA NA 0.14 XXX
78305 .... ............ A ........ Bone imaging, multiple areas ............. 0.83 5.42 4.63 NA NA 0.23 XXX
78305 .... 26 ....... A ........ Bone imaging, multiple areas ............. 0.83 0.28 0.27 0.28 0.27 0.04 XXX
78305 .... TC ...... A ........ Bone imaging, multiple areas ............. 0.00 5.14 4.36 NA NA 0.19 XXX
78306 .... ............ A ........ Bone imaging, whole body ................. 0.86 6.01 5.23 NA NA 0.26 XXX
78306 .... 26 ....... A ........ Bone imaging, whole body ................. 0.86 0.30 0.29 0.30 0.29 0.04 XXX
78306 .... TC ...... A ........ Bone imaging, whole body ................. 0.00 5.71 4.94 NA NA 0.22 XXX
78315 .... ............ A ........ Bone imaging, 3 phase ...................... 1.02 8.51 6.74 NA NA 0.29 XXX
78315 .... 26 ....... A ........ Bone imaging, 3 phase ...................... 1.02 0.36 0.34 0.36 0.34 0.04 XXX
78315 .... TC ...... A ........ Bone imaging, 3 phase ...................... 0.00 8.15 6.40 NA NA 0.25 XXX
78320 .... ............ A ........ Bone imaging (3D) ............................. 1.04 5.29 5.73 NA NA 0.35 XXX
78320 .... 26 ....... A ........ Bone imaging (3D) ............................. 1.04 0.36 0.35 0.36 0.35 0.04 XXX
78320 .... TC ...... A ........ Bone imaging (3D) ............................. 0.00 4.93 5.38 NA NA 0.31 XXX
78350 .... ............ N ........ Bone mineral, single photon ............... 0.22 0.51 0.72 NA NA 0.06 XXX
78350 .... 26 ....... N ........ Bone mineral, single photon ............... 0.22 0.05 0.06 0.05 0.06 0.01 XXX
78350 .... TC ...... N ........ Bone mineral, single photon ............... 0.00 0.46 0.65 NA NA 0.05 XXX
78351 .... ............ N ........ Bone mineral, dual photon ................. 0.30 0.07 0.96 0.07 0.10 0.01 XXX
78399 .... ............ C ........ Musculoskeletal nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78399 .... 26 ....... C ........ Musculoskeletal nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78399 .... TC ...... C ........ Musculoskeletal nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78414 .... ............ C ........ Non-imaging heart function ................ 0.45 0.00 0.11 NA NA 0.02 XXX
78414 .... 26 ....... A ........ Non-imaging heart function ................ 0.45 0.16 0.16 0.16 0.16 0.02 XXX
78414 .... TC ...... C ........ Non-imaging heart function ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78428 .... ............ A ........ Cardiac shunt imaging ........................ 0.78 5.11 3.85 NA NA 0.16 XXX
78428 .... 26 ....... A ........ Cardiac shunt imaging ........................ 0.78 0.35 0.32 0.35 0.32 0.03 XXX
78428 .... TC ...... A ........ Cardiac shunt imaging ........................ 0.00 4.76 3.53 NA NA 0.13 XXX
78445 .... ............ A ........ Vascular flow imaging ........................ 0.49 4.42 3.21 NA NA 0.13 XXX
78445 .... 26 ....... A ........ Vascular flow imaging ........................ 0.49 0.17 0.17 0.17 0.17 0.02 XXX
78445 .... TC ...... A ........ Vascular flow imaging ........................ 0.00 4.25 3.04 NA NA 0.11 XXX
78456 .... ............ A ........ Acute venous thrombus image ........... 1.00 9.10 6.84 NA NA 0.33 XXX
78456 .... 26 ....... A ........ Acute venous thrombus image ........... 1.00 0.42 0.39 0.42 0.39 0.04 XXX
78456 .... TC ...... A ........ Acute venous thrombus image ........... 0.00 8.68 6.45 NA NA 0.29 XXX
78457 .... ............ A ........ Venous thrombosis imaging ............... 0.77 4.60 3.75 NA NA 0.17 XXX
78457 .... 26 ....... A ........ Venous thrombosis imaging ............... 0.77 0.25 0.25 0.25 0.25 0.03 XXX
78457 .... TC ...... A ........ Venous thrombosis imaging ............... 0.00 4.35 3.50 NA NA 0.14 XXX
78458 .... ............ A ........ Ven thrombosis images, bilat ............. 0.90 4.44 4.37 NA NA 0.25 XXX
78458 .... 26 ....... A ........ Ven thrombosis images, bilat ............. 0.90 0.29 0.30 0.29 0.30 0.04 XXX
78458 .... TC ...... A ........ Ven thrombosis images, bilat ............. 0.00 4.15 4.07 NA NA 0.21 XXX
78459 .... ............ C ........ Heart muscle imaging (PET) .............. 1.50 0.00 0.37 0.00 0.37 0.05 XXX
78459 .... 26 ....... A ........ Heart muscle imaging (PET) .............. 1.50 0.59 0.57 0.59 0.57 0.05 XXX
78459 .... TC ...... C ........ Heart muscle imaging (PET) .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78460 .... ............ A ........ Heart muscle blood, single ................. 0.86 4.60 3.60 NA NA 0.17 XXX
78460 .... 26 ....... A ........ Heart muscle blood, single ................. 0.86 0.32 0.30 0.32 0.30 0.04 XXX
78460 .... TC ...... A ........ Heart muscle blood, single ................. 0.00 4.29 3.30 NA NA 0.13 XXX
78461 .... ............ A ........ Heart muscle blood, multiple .............. 1.23 4.02 4.55 NA NA 0.30 XXX
78461 .... 26 ....... A ........ Heart muscle blood, multiple .............. 1.23 0.46 0.43 0.46 0.43 0.05 XXX
78461 .... TC ...... A ........ Heart muscle blood, multiple .............. 0.00 3.56 4.11 NA NA 0.25 XXX
78464 .... ............ A ........ Heart image (3d), single ..................... 1.09 5.71 6.59 NA NA 0.41 XXX
78464 .... 26 ....... A ........ Heart image (3d), single ..................... 1.09 0.49 0.44 0.49 0.44 0.04 XXX
78464 .... TC ...... A ........ Heart image (3d), single ..................... 0.00 5.22 6.15 NA NA 0.37 XXX
78465 .... ............ A ........ Heart image (3d), multiple .................. 1.46 11.11 11.76 NA NA 0.67 XXX
78465 .... 26 ....... A ........ Heart image (3d), multiple .................. 1.46 0.69 0.61 0.69 0.61 0.05 XXX
78465 .... TC ...... A ........ Heart image (3d), multiple .................. 0.00 10.42 11.15 NA NA 0.62 XXX
78466 .... ............ A ........ Heart infarct image ............................. 0.69 4.47 3.64 NA NA 0.17 XXX
78466 .... 26 ....... A ........ Heart infarct image ............................. 0.69 0.28 0.25 0.28 0.25 0.03 XXX
78466 .... TC ...... A ........ Heart infarct image ............................. 0.00 4.19 3.39 NA NA 0.14 XXX
78468 .... ............ A ........ Heart infarct image (ef) ...................... 0.80 5.70 4.87 NA NA 0.22 XXX
78468 .... 26 ....... A ........ Heart infarct image (ef) ...................... 0.80 0.39 0.34 0.39 0.34 0.03 XXX
78468 .... TC ...... A ........ Heart infarct image (ef) ...................... 0.00 5.31 4.53 NA NA 0.19 XXX
78469 .... ............ A ........ Heart infarct image (3D) ..................... 0.92 6.09 5.83 NA NA 0.31 XXX
78469 .... 26 ....... A ........ Heart infarct image (3D) ..................... 0.92 0.43 0.37 0.43 0.37 0.03 XXX
78469 .... TC ...... A ........ Heart infarct image (3D) ..................... 0.00 5.66 5.46 NA NA 0.28 XXX
78472 .... ............ A ........ Gated heart, planar, single ................. 0.98 5.90 5.88 NA NA 0.34 XXX
78472 .... 26 ....... A ........ Gated heart, planar, single ................. 0.98 0.40 0.37 0.40 0.37 0.04 XXX
78472 .... TC ...... A ........ Gated heart, planar, single ................. 0.00 5.50 5.51 NA NA 0.30 XXX
78473 .... ............ A ........ Gated heart, multiple .......................... 1.47 7.56 8.16 NA NA 0.48 XXX
78473 .... 26 ....... A ........ Gated heart, multiple .......................... 1.47 0.63 0.56 0.63 0.56 0.06 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
78473 .... TC ...... A ........ Gated heart, multiple .......................... 0.00 6.93 7.60 NA NA 0.42 XXX
78478 .... ............ A ........ Heart wall motion add-on ................... 0.50 0.78 1.29 NA NA 0.12 XXX
78478 .... 26 ....... A ........ Heart wall motion add-on ................... 0.50 0.23 0.23 0.23 0.23 0.02 XXX
78478 .... TC ...... A ........ Heart wall motion add-on ................... 0.00 0.54 1.05 NA NA 0.10 XXX
78480 .... ............ A ........ Heart function add-on ......................... 0.30 0.68 1.23 NA NA 0.12 XXX
78480 .... 26 ....... A ........ Heart function add-on ......................... 0.30 0.14 0.18 0.14 0.18 0.02 XXX
78480 .... TC ...... A ........ Heart function add-on ......................... 0.00 0.54 1.05 NA NA 0.10 XXX
78481 .... ............ A ........ Heart first pass, single ........................ 0.98 4.90 5.27 NA NA 0.31 XXX
78481 .... 26 ....... A ........ Heart first pass, single ........................ 0.98 0.47 0.42 0.47 0.42 0.03 XXX
78481 .... TC ...... A ........ Heart first pass, single ........................ 0.00 4.43 4.85 NA NA 0.28 XXX
78483 .... ............ A ........ Heart first pass, multiple ..................... 1.47 6.64 7.56 NA NA 0.46 XXX
78483 .... 26 ....... A ........ Heart first pass, multiple ..................... 1.47 0.75 0.65 0.75 0.65 0.05 XXX
78483 .... TC ...... A ........ Heart first pass, multiple ..................... 0.00 5.89 6.91 NA NA 0.41 XXX
78491 .... ............ C ........ Heart image (pet), single .................... 1.50 0.00 0.39 0.00 0.39 0.06 XXX
78491 .... 26 ....... A ........ Heart image (pet), single .................... 1.50 0.62 0.60 0.62 0.60 0.06 XXX
78491 .... TC ...... C ........ Heart image (pet), single .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78492 .... ............ C ........ Heart image (pet), multiple ................. 1.87 0.00 0.52 0.00 0.52 0.07 XXX
78492 .... 26 ....... A ........ Heart image (pet), multiple ................. 1.87 0.88 0.81 0.88 0.81 0.07 XXX
78492 .... TC ...... C ........ Heart image (pet), multiple ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78494 .... ............ A ........ Heart image, spect ............................. 1.19 6.05 6.80 NA NA 0.35 XXX
78494 .... 26 ....... A ........ Heart image, spect ............................. 1.19 0.53 0.48 0.53 0.48 0.05 XXX
78494 .... TC ...... A ........ Heart image, spect ............................. 0.00 5.52 6.32 NA NA 0.30 XXX
78496 .... ............ A ........ Heart first pass add-on ....................... 0.50 0.86 4.07 0.86 4.07 0.32 ZZZ
78496 .... 26 ....... A ........ Heart first pass add-on ....................... 0.50 0.22 0.21 0.22 0.21 0.02 ZZZ
78496 .... TC ...... A ........ Heart first pass add-on ....................... 0.00 0.63 3.86 0.63 3.86 0.30 ZZZ
78499 .... ............ C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78499 .... 26 ....... C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78499 .... TC ...... C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78580 .... ............ A ........ Lung perfusion imaging ...................... 0.74 5.08 4.34 NA NA 0.21 XXX
78580 .... 26 ....... A ........ Lung perfusion imaging ...................... 0.74 0.26 0.25 0.26 0.25 0.03 XXX
78580 .... TC ...... A ........ Lung perfusion imaging ...................... 0.00 4.81 4.09 NA NA 0.18 XXX
78584 .... ............ A ........ Lung V/Q image single breath ........... 0.99 3.00 3.23 NA NA 0.21 XXX
78584 .... 26 ....... A ........ Lung V/Q image single breath ........... 0.99 0.35 0.33 0.35 0.33 0.04 XXX
78584 .... TC ...... A ........ Lung V/Q image single breath ........... 0.00 2.65 2.90 NA NA 0.17 XXX
78585 .... ............ A ........ Lung V/Q imaging ............................... 1.09 8.55 7.20 NA NA 0.35 XXX
78585 .... 26 ....... A ........ Lung V/Q imaging ............................... 1.09 0.39 0.36 0.39 0.36 0.05 XXX
78585 .... TC ...... A ........ Lung V/Q imaging ............................... 0.00 8.16 6.84 NA NA 0.30 XXX
78586 .... ............ A ........ Aerosol lung image, single ................. 0.40 4.13 3.39 NA NA 0.16 XXX
78586 .... 26 ....... A ........ Aerosol lung image, single ................. 0.40 0.14 0.13 0.14 0.13 0.02 XXX
78586 .... TC ...... A ........ Aerosol lung image, single ................. 0.00 3.99 3.26 NA NA 0.14 XXX
78587 .... ............ A ........ Aerosol lung image, multiple .............. 0.49 5.37 4.13 NA NA 0.16 XXX
78587 .... 26 ....... A ........ Aerosol lung image, multiple .............. 0.49 0.17 0.16 0.17 0.16 0.02 XXX
78587 .... TC ...... A ........ Aerosol lung image, multiple .............. 0.00 5.20 3.97 NA NA 0.14 XXX
78588 .... ............ A ........ Perfusion lung image .......................... 1.09 8.58 5.99 NA NA 0.23 XXX
78588 .... 26 ....... A ........ Perfusion lung image .......................... 1.09 0.38 0.36 0.38 0.36 0.05 XXX
78588 .... TC ...... A ........ Perfusion lung image .......................... 0.00 8.19 5.63 NA NA 0.18 XXX
78591 .... ............ A ........ Vent image, 1 breath, 1 proj .............. 0.40 4.13 3.52 NA NA 0.16 XXX
78591 .... 26 ....... A ........ Vent image, 1 breath, 1 proj .............. 0.40 0.14 0.13 0.14 0.13 0.02 XXX
78591 .... TC ...... A ........ Vent image, 1 breath, 1 proj .............. 0.00 3.99 3.38 NA NA 0.14 XXX
78593 .... ............ A ........ Vent image, 1 proj, gas ...................... 0.49 4.77 4.15 NA NA 0.20 XXX
78593 .... 26 ....... A ........ Vent image, 1 proj, gas ...................... 0.49 0.17 0.16 0.17 0.16 0.02 XXX
78593 .... TC ...... A ........ Vent image, 1 proj, gas ...................... 0.00 4.60 3.99 NA NA 0.18 XXX
78594 .... ............ A ........ Vent image, mult proj, gas ................. 0.53 5.22 5.15 NA NA 0.27 XXX
78594 .... 26 ....... A ........ Vent image, mult proj, gas ................. 0.53 0.18 0.17 0.18 0.17 0.02 XXX
78594 .... TC ...... A ........ Vent image, mult proj, gas ................. 0.00 5.05 4.98 NA NA 0.25 XXX
78596 .... ............ A ........ Lung differential function .................... 1.27 8.59 8.00 NA NA 0.42 XXX
78596 .... 26 ....... A ........ Lung differential function .................... 1.27 0.39 0.40 0.39 0.40 0.05 XXX
78596 .... TC ...... A ........ Lung differential function .................... 0.00 8.19 7.60 NA NA 0.37 XXX
78599 .... ............ C ........ Respiratory nuclear exam .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78599 .... 26 ....... C ........ Respiratory nuclear exam .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78599 .... TC ...... C ........ Respiratory nuclear exam .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78600 .... ............ A ........ Brain imaging, ltd static ...................... 0.44 4.33 4.10 NA NA 0.16 XXX
78600 .... 26 ....... A ........ Brain imaging, ltd static ...................... 0.44 0.15 0.14 0.15 0.14 0.02 XXX
78600 .... TC ...... A ........ Brain imaging, ltd static ...................... 0.00 4.18 3.95 NA NA 0.14 XXX
78601 .... ............ A ........ Brain imaging, ltd w/flow .................... 0.51 5.33 4.40 NA NA 0.20 XXX
78601 .... 26 ....... A ........ Brain imaging, ltd w/flow .................... 0.51 0.18 0.17 0.18 0.17 0.02 XXX
78601 .... TC ...... A ........ Brain imaging, ltd w/flow .................... 0.00 5.15 4.23 NA NA 0.18 XXX
78605 .... ............ A ........ Brain imaging, complete ..................... 0.53 4.79 4.13 NA NA 0.20 XXX
78605 .... 26 ....... A ........ Brain imaging, complete ..................... 0.53 0.19 0.18 0.19 0.18 0.02 XXX
78605 .... TC ...... A ........ Brain imaging, complete ..................... 0.00 4.60 3.95 NA NA 0.18 XXX
78606 .... ............ A ........ Brain imaging, compl w/flow ............... 0.64 8.44 6.20 NA NA 0.24 XXX
78606 .... 26 ....... A ........ Brain imaging, compl w/flow ............... 0.64 0.22 0.21 0.22 0.21 0.03 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
78606 .... TC ...... A ........ Brain imaging, compl w/flow ............... 0.00 8.22 5.99 NA NA 0.21 XXX
78607 .... ............ A ........ Brain imaging (3D) ............................. 1.23 8.53 8.73 NA NA 0.40 XXX
78607 .... 26 ....... A ........ Brain imaging (3D) ............................. 1.23 0.41 0.41 0.41 0.41 0.05 XXX
78607 .... TC ...... A ........ Brain imaging (3D) ............................. 0.00 8.12 8.32 NA NA 0.35 XXX
78608 .... ............ C ........ Brain imaging (PET) ........................... 1.50 0.00 0.33 0.00 0.33 0.06 XXX
78608 .... 26 ....... A ........ Brain imaging (PET) ........................... 1.50 0.50 0.49 0.50 0.49 0.06 XXX
78608 .... TC ...... C ........ Brain imaging (PET) ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78609 .... ............ C ........ Brain imaging (PET) ........................... 1.50 0.00 0.33 0.00 0.33 0.06 XXX
78609 .... 26 ....... A ........ Brain imaging (PET) ........................... 1.50 0.52 0.50 0.52 0.50 0.06 XXX
78609 .... TC ...... C ........ Brain imaging (PET) ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78610 .... ............ A ........ Brain flow imaging only ...................... 0.30 4.36 3.00 NA NA 0.11 XXX
78610 .... 26 ....... A ........ Brain flow imaging only ...................... 0.30 0.10 0.11 0.10 0.11 0.01 XXX
78610 .... TC ...... A ........ Brain flow imaging only ...................... 0.00 4.25 2.89 NA NA 0.10 XXX
78615 .... ............ A ........ Cerebral vascular flow image ............. 0.42 5.44 4.65 NA NA 0.23 XXX
78615 .... 26 ....... A ........ Cerebral vascular flow image ............. 0.42 0.15 0.14 0.15 0.14 0.02 XXX
78615 .... TC ...... A ........ Cerebral vascular flow image ............. 0.00 5.29 4.51 NA NA 0.21 XXX
78630 .... ............ A ........ Cerebrospinal fluid scan ..................... 0.68 8.57 6.84 NA NA 0.30 XXX
78630 .... 26 ....... A ........ Cerebrospinal fluid scan ..................... 0.68 0.24 0.23 0.24 0.23 0.03 XXX
78630 .... TC ...... A ........ Cerebrospinal fluid scan ..................... 0.00 8.33 6.62 NA NA 0.27 XXX
78635 .... ............ A ........ CSF ventriculography ......................... 0.61 8.70 5.63 NA NA 0.16 XXX
78635 .... 26 ....... A ........ CSF ventriculography ......................... 0.61 0.21 0.22 0.21 0.22 0.02 XXX
78635 .... TC ...... A ........ CSF ventriculography ......................... 0.00 8.49 5.42 NA NA 0.14 XXX
78645 .... ............ A ........ CSF shunt evaluation ......................... 0.57 8.38 5.93 NA NA 0.20 XXX
78645 .... 26 ....... A ........ CSF shunt evaluation ......................... 0.57 0.20 0.19 0.20 0.19 0.02 XXX
78645 .... TC ...... A ........ CSF shunt evaluation ......................... 0.00 8.18 5.75 NA NA 0.18 XXX
78647 .... ............ A ........ Cerebrospinal fluid scan ..................... 0.90 8.41 8.18 NA NA 0.35 XXX
78647 .... 26 ....... A ........ Cerebrospinal fluid scan ..................... 0.90 0.29 0.29 0.29 0.29 0.04 XXX
78647 .... TC ...... A ........ Cerebrospinal fluid scan ..................... 0.00 8.12 7.89 NA NA 0.31 XXX
78650 .... ............ A ........ CSF leakage imaging ......................... 0.61 8.47 6.61 NA NA 0.27 XXX
78650 .... 26 ....... A ........ CSF leakage imaging ......................... 0.61 0.21 0.20 0.21 0.20 0.03 XXX
78650 .... TC ...... A ........ CSF leakage imaging ......................... 0.00 8.26 6.41 NA NA 0.24 XXX
78660 .... ............ A ........ Nuclear exam of tear flow .................. 0.53 4.22 3.23 NA NA 0.14 XXX
78660 .... 26 ....... A ........ Nuclear exam of tear flow .................. 0.53 0.19 0.18 0.19 0.18 0.02 XXX
78660 .... TC ...... A ........ Nuclear exam of tear flow .................. 0.00 4.03 3.05 NA NA 0.12 XXX
78699 .... ............ C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78699 .... 26 ....... C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78699 .... TC ...... C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78700 .... ............ A ........ Kidney imaging, morphol .................... 0.45 4.35 3.76 NA NA 0.18 XXX
78700 .... 26 ....... A ........ Kidney imaging, morphol .................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX
78700 .... TC ...... A ........ Kidney imaging, morphol .................... 0.00 4.19 3.61 NA NA 0.16 XXX
78701 .... ............ A ........ Kidney imaging with flow .................... 0.49 5.33 4.48 NA NA 0.20 XXX
78701 .... 26 ....... A ........ Kidney imaging with flow .................... 0.49 0.17 0.16 0.17 0.16 0.02 XXX
78701 .... TC ...... A ........ Kidney imaging with flow .................... 0.00 5.16 4.32 NA NA 0.18 XXX
78707 .... ............ A ........ K flow/funct image w/o drug ............... 0.96 5.43 5.06 NA NA 0.27 XXX
78707 .... 26 ....... A ........ K flow/funct image w/o drug ............... 0.96 0.34 0.32 0.34 0.32 0.04 XXX
78707 .... TC ...... A ........ K flow/funct image w/o drug ............... 0.00 5.09 4.74 NA NA 0.23 XXX
78708 .... ............ A ........ K flow/funct image w/drug .................. 1.21 3.45 4.12 NA NA 0.28 XXX
78708 .... 26 ....... A ........ K flow/funct image w/drug .................. 1.21 0.43 0.40 0.43 0.40 0.05 XXX
78708 .... TC ...... A ........ K flow/funct image w/drug .................. 0.00 3.02 3.71 NA NA 0.23 XXX
78709 .... ............ A ........ K flow/funct image, multiple ............... 1.41 8.80 6.79 NA NA 0.29 XXX
78709 .... 26 ....... A ........ K flow/funct image, multiple ............... 1.41 0.50 0.47 0.50 0.47 0.06 XXX
78709 .... TC ...... A ........ K flow/funct image, multiple ............... 0.00 8.30 6.33 NA NA 0.23 XXX
78710 .... ............ A ........ Kidney imaging (3D) ........................... 0.66 5.22 5.64 NA NA 0.34 XXX
78710 .... 26 ....... A ........ Kidney imaging (3D) ........................... 0.66 0.22 0.21 0.22 0.21 0.03 XXX
78710 .... TC ...... A ........ Kidney imaging (3D) ........................... 0.00 5.00 5.43 NA NA 0.31 XXX
78725 .... ............ A ........ Kidney function study ......................... 0.38 2.33 2.11 NA NA 0.13 XXX
78725 .... 26 ....... A ........ Kidney function study ......................... 0.38 0.13 0.13 0.13 0.13 0.02 XXX
78725 .... TC ...... A ........ Kidney function study ......................... 0.00 2.20 1.98 NA NA 0.11 XXX
78730 .... ............ A ........ Urinary bladder retention .................... 0.15 1.97 1.78 NA NA 0.10 ZZZ
78730 .... 26 ....... A ........ Urinary bladder retention .................... 0.15 0.06 0.09 0.06 0.09 0.02 ZZZ
78730 .... TC ...... A ........ Urinary bladder retention .................... 0.00 1.92 1.69 NA NA 0.08 ZZZ
78740 .... ............ A ........ Ureteral reflux study ........................... 0.57 5.61 3.88 NA NA 0.15 XXX
78740 .... 26 ....... A ........ Ureteral reflux study ........................... 0.57 0.20 0.19 0.20 0.19 0.03 XXX
78740 .... TC ...... A ........ Ureteral reflux study ........................... 0.00 5.42 3.70 NA NA 0.12 XXX
78761 .... ............ A ........ Testicular imaging w/flow ................... 0.71 5.01 4.16 NA NA 0.20 XXX
78761 .... 26 ....... A ........ Testicular imaging w/flow ................... 0.71 0.25 0.24 0.25 0.24 0.03 XXX
78761 .... TC ...... A ........ Testicular imaging w/flow ................... 0.00 4.76 3.92 NA NA 0.17 XXX
78799 .... ............ C ........ Genitourinary nuclear exam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78799 .... 26 ....... C ........ Genitourinary nuclear exam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78799 .... TC ...... C ........ Genitourinary nuclear exam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78800 .... ............ A ........ Tumor imaging, limited area ............... 0.66 4.29 3.92 NA NA 0.22 XXX
78800 .... 26 ....... A ........ Tumor imaging, limited area ............... 0.66 0.21 0.21 0.21 0.21 0.04 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
78800 .... TC ...... A ........ Tumor imaging, limited area ............... 0.00 4.08 3.71 NA NA 0.18 XXX
78801 .... ............ A ........ Tumor imaging, mult areas ................ 0.79 5.99 5.20 NA NA 0.27 XXX
78801 .... 26 ....... A ........ Tumor imaging, mult areas ................ 0.79 0.27 0.26 0.27 0.26 0.05 XXX
78801 .... TC ...... A ........ Tumor imaging, mult areas ................ 0.00 5.72 4.94 NA NA 0.22 XXX
78802 .... ............ A ........ Tumor imaging, whole body ............... 0.86 8.05 6.88 NA NA 0.34 XXX
78802 .... 26 ....... A ........ Tumor imaging, whole body ............... 0.86 0.30 0.29 0.30 0.29 0.04 XXX
78802 .... TC ...... A ........ Tumor imaging, whole body ............... 0.00 7.75 6.59 NA NA 0.30 XXX
78803 .... ............ A ........ Tumor imaging (3D) ........................... 1.09 8.44 8.63 NA NA 0.40 XXX
78803 .... 26 ....... A ........ Tumor imaging (3D) ........................... 1.09 0.38 0.37 0.38 0.37 0.05 XXX
78803 .... TC ...... A ........ Tumor imaging (3D) ........................... 0.00 8.06 8.27 NA NA 0.35 XXX
78804 .... ............ A ........ Tumor imaging, whole body ............... 1.07 14.68 12.95 NA NA 0.34 XXX
78804 .... 26 ....... A ........ Tumor imaging, whole body ............... 1.07 0.37 0.36 0.37 0.36 0.04 XXX
78804 .... TC ...... A ........ Tumor imaging, whole body ............... 0.00 14.31 12.59 NA NA 0.30 XXX
78805 .... ............ A ........ Abscess imaging, ltd area .................. 0.73 4.18 3.88 NA NA 0.21 XXX
78805 .... 26 ....... A ........ Abscess imaging, ltd area .................. 0.73 0.25 0.24 0.25 0.24 0.03 XXX
78805 .... TC ...... A ........ Abscess imaging, ltd area .................. 0.00 3.93 3.64 NA NA 0.18 XXX
78806 .... ............ A ........ Abscess imaging, whole body ............ 0.86 8.27 7.43 NA NA 0.39 XXX
78806 .... 26 ....... A ........ Abscess imaging, whole body ............ 0.86 0.30 0.29 0.30 0.29 0.04 XXX
78806 .... TC ...... A ........ Abscess imaging, whole body ............ 0.00 7.97 7.14 NA NA 0.35 XXX
78807 .... ............ A ........ Nuclear localization/abscess .............. 1.09 8.40 8.51 NA NA 0.39 XXX
78807 .... 26 ....... A ........ Nuclear localization/abscess .............. 1.09 0.37 0.37 0.37 0.37 0.04 XXX
78807 .... TC ...... A ........ Nuclear localization/abscess .............. 0.00 8.03 8.14 NA NA 0.35 XXX
78811 .... ............ C ........ Tumor imaging (pet), limited .............. 1.54 0.00 0.34 NA NA 0.11 XXX
78811 .... 26 ....... A ........ Tumor imaging (pet), limited .............. 1.54 0.54 0.52 0.54 0.52 0.11 XXX
78811 .... TC ...... C ........ Tumor imaging (pet), limited .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78812 .... ............ C ........ Tumor image (pet)/skul-thigh ............. 1.93 0.00 0.43 NA NA 0.11 XXX
78812 .... 26 ....... A ........ Tumor image (pet)/skul-thigh ............. 1.93 0.67 0.65 0.67 0.65 0.11 XXX
78812 .... TC ...... C ........ Tumor image (pet)/skul-thigh ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78813 .... ............ C ........ Tumor image (pet) full body ............... 2.00 0.00 0.44 NA NA 0.11 XXX
78813 .... 26 ....... A ........ Tumor image (pet) full body ............... 2.00 0.69 0.67 0.69 0.67 0.11 XXX
78813 .... TC ...... C ........ Tumor image (pet) full body ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78814 .... ............ C ........ Tumor image pet/ct, limited ................ 2.20 0.00 0.49 NA NA 0.11 XXX
78814 .... 26 ....... A ........ Tumor image pet/ct, limited ................ 2.20 0.74 0.73 0.74 0.73 0.11 XXX
78814 .... TC ...... C ........ Tumor image pet/ct, limited ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78815 .... ............ C ........ Tumorimage pet/ct skul-thigh ............. 2.44 0.00 0.54 NA NA 0.11 XXX
78815 .... 26 ....... A ........ Tumorimage pet/ct skul-thigh ............. 2.44 0.84 0.82 0.84 0.82 0.11 XXX
78815 .... TC ...... C ........ Tumorimage pet/ct skul-thigh ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78816 .... ............ C ........ Tumor image pet/ct full body .............. 2.50 0.00 0.55 NA NA 0.11 XXX
78816 .... 26 ....... A ........ Tumor image pet/ct full body .............. 2.50 0.86 0.84 0.86 0.84 0.11 XXX
78816 .... TC ...... C ........ Tumor image pet/ct full body .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78890 .... ............ B ........ Nuclear medicine data proc ............... 0.05 0.38 0.86 NA NA 0.07 XXX
78890 .... 26 ....... B ........ Nuclear medicine data proc ............... 0.05 0.01 0.02 0.01 0.02 0.01 XXX
78890 .... TC ...... B ........ Nuclear medicine data proc ............... 0.00 0.37 0.84 NA NA 0.06 XXX
78891 .... ............ B ........ Nuclear med data proc ....................... 0.10 0.87 1.77 NA NA 0.14 XXX
78891 .... 26 ....... B ........ Nuclear med data proc ....................... 0.10 0.02 0.03 0.02 0.03 0.01 XXX
78891 .... TC ...... B ........ Nuclear med data proc ....................... 0.00 0.85 1.74 NA NA 0.13 XXX
78999 .... ............ C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78999 .... 26 ....... C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
78999 .... TC ...... C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79005 .... ............ A ........ Nuclear rx, oral admin ........................ 1.80 1.84 2.51 NA NA 0.22 XXX
79005 .... 26 ....... A ........ Nuclear rx, oral admin ........................ 1.80 0.59 0.58 0.59 0.58 0.08 XXX
79005 .... TC ...... A ........ Nuclear rx, oral admin ........................ 0.00 1.25 1.93 NA NA 0.14 XXX
79101 .... ............ A ........ Nuclear rx, iv admin ........................... 1.96 2.14 2.70 NA NA 0.22 XXX
79101 .... 26 ....... A ........ Nuclear rx, iv admin ........................... 1.96 0.74 0.69 0.74 0.69 0.08 XXX
79101 .... TC ...... A ........ Nuclear rx, iv admin ........................... 0.00 1.41 2.01 NA NA 0.14 XXX
79200 .... ............ A ........ Nuclear rx, intracav admin ................. 1.99 2.21 2.74 NA NA 0.23 XXX
79200 .... 26 ....... A ........ Nuclear rx, intracav admin ................. 1.99 0.66 0.66 0.66 0.66 0.09 XXX
79200 .... TC ...... A ........ Nuclear rx, intracav admin ................. 0.00 1.55 2.08 NA NA 0.14 XXX
79300 .... ............ C ........ Nuclr rx, interstit colloid ...................... 1.60 0.00 0.37 NA NA 0.13 XXX
79300 .... 26 ....... A ........ Nuclr rx, interstit colloid ...................... 1.60 0.52 0.55 0.52 0.55 0.13 XXX
79300 .... TC ...... C ........ Nuclr rx, interstit colloid ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79403 .... ............ A ........ Hematopoietic nuclear tx .................... 2.25 2.90 4.01 NA NA 0.24 XXX
79403 .... 26 ....... A ........ Hematopoietic nuclear tx .................... 2.25 0.76 0.81 0.76 0.81 0.10 XXX
79403 .... TC ...... A ........ Hematopoietic nuclear tx .................... 0.00 2.14 3.20 NA NA 0.14 XXX
79440 .... ............ A ........ Nuclear rx, intra-articular .................... 1.99 1.82 2.55 NA NA 0.22 XXX
79440 .... 26 ....... A ........ Nuclear rx, intra-articular .................... 1.99 0.68 0.68 0.68 0.68 0.08 XXX
79440 .... TC ...... A ........ Nuclear rx, intra-articular .................... 0.00 1.14 1.87 NA NA 0.14 XXX
79445 .... ............ C ........ Nuclear rx, intra-arterial ...................... 2.40 0.00 0.53 0.00 0.53 0.12 XXX
79445 .... 26 ....... A ........ Nuclear rx, intra-arterial ...................... 2.40 0.87 0.82 0.87 0.82 0.12 XXX
79445 .... TC ...... C ........ Nuclear rx, intra-arterial ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79999 .... ............ C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
79999 .... 26 ....... C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
79999 .... TC ...... C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
80500 .... ............ A ........ Lab pathology consultation ................. 0.37 0.20 0.21 0.12 0.14 0.01 XXX
80502 .... ............ A ........ Lab pathology consultation ................. 1.33 0.31 0.42 0.25 0.40 0.04 XXX
83020 .... 26 ....... A ........ Hemoglobin electrophoresis ............... 0.37 0.12 0.13 0.12 0.13 0.01 XXX
83912 .... 26 ....... A ........ Genetic examination ........................... 0.37 0.11 0.12 0.11 0.12 0.01 XXX
84165 .... 26 ....... A ........ Protein e-phoresis, serum .................. 0.37 0.12 0.13 0.12 0.13 0.01 XXX
84166 .... 26 ....... A ........ Protein e-phoresis/urine/csf ................ 0.37 0.12 0.13 0.12 0.13 0.01 XXX
84181 .... 26 ....... A ........ Western blot test ................................ 0.37 0.12 0.13 0.12 0.13 0.01 XXX
84182 .... 26 ....... A ........ Protein, western blot test .................... 0.37 0.12 0.14 0.12 0.14 0.02 XXX
85060 .... ............ A ........ Blood smear interpretation ................. 0.45 0.14 0.16 0.14 0.16 0.02 XXX
85097 .... ............ A ........ Bone marrow interpretation ................ 0.94 1.24 1.59 0.27 0.34 0.04 XXX
85390 .... 26 ....... A ........ Fibrinolysins screen ............................ 0.37 0.13 0.13 0.13 0.13 0.01 XXX
85396 .... ............ A ........ Clotting assay, whole blood ............... 0.37 NA NA 0.10 0.12 0.04 XXX
85576 .... 26 ....... A ........ Blood platelet aggregation .................. 0.37 0.12 0.14 0.12 0.14 0.01 XXX
86077 .... ............ A ........ Physician blood bank service ............. 0.94 0.39 0.39 0.30 0.35 0.03 XXX
86255 .... 26 ....... A ........ Fluorescent antibody, screen ............. 0.37 0.12 0.13 0.12 0.13 0.01 XXX
86256 .... 26 ....... A ........ Fluorescent antibody, titer .................. 0.37 0.12 0.13 0.12 0.13 0.01 XXX
86320 .... 26 ....... A ........ Serum immunoelectrophoresis ........... 0.37 0.12 0.13 0.12 0.13 0.01 XXX
86325 .... 26 ....... A ........ Other immunoelectrophoresis ............ 0.37 0.12 0.13 0.12 0.13 0.01 XXX
86327 .... 26 ....... A ........ Immunoelectrophoresis assay ............ 0.42 0.13 0.16 0.13 0.16 0.02 XXX
86334 .... 26 ....... A ........ Immunofix e-phoresis, serum ............. 0.37 0.12 0.13 0.12 0.13 0.01 XXX
86335 .... 26 ....... A ........ Immunfix e-phorsis/urine/csf ............... 0.37 0.12 0.13 0.12 0.13 0.01 XXX
86485 .... ............ C ........ Skin test, candida ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
86490 .... ............ A ........ Coccidioidomycosis skin test .............. 0.00 0.13 0.21 NA NA 0.02 XXX
86510 .... ............ A ........ Histoplasmosis skin test ..................... 0.00 0.12 0.23 NA NA 0.02 XXX
86580 .... ............ A ........ TB intradermal test ............................. 0.00 0.16 0.21 NA NA 0.02 XXX
87164 .... 26 ....... A ........ Dark field examination ........................ 0.37 0.12 0.12 0.12 0.12 0.01 XXX
87207 .... 26 ....... A ........ Smear, special stain ........................... 0.37 0.12 0.14 0.12 0.14 0.01 XXX
88104 .... ............ A ........ Cytopath fl nongyn, smears ............... 0.56 1.18 1.01 NA NA 0.04 XXX
88104 .... 26 ....... A ........ Cytopath fl nongyn, smears ............... 0.56 0.16 0.20 0.16 0.20 0.02 XXX
88104 .... TC ...... A ........ Cytopath fl nongyn, smears ............... 0.00 1.02 0.81 NA NA 0.02 XXX
88106 .... ............ A ........ Cytopath fl nongyn, filter .................... 0.56 1.52 1.43 NA NA 0.04 XXX
88106 .... 26 ....... A ........ Cytopath fl nongyn, filter .................... 0.56 0.15 0.20 0.15 0.20 0.02 XXX
88106 .... TC ...... A ........ Cytopath fl nongyn, filter .................... 0.00 1.36 1.23 NA NA 0.02 XXX
88107 .... ............ A ........ Cytopath fl nongyn, sm/fltr ................. 0.76 1.98 1.77 NA NA 0.05 XXX
88107 .... 26 ....... A ........ Cytopath fl nongyn, sm/fltr ................. 0.76 0.23 0.28 0.23 0.28 0.03 XXX
88107 .... TC ...... A ........ Cytopath fl nongyn, sm/fltr ................. 0.00 1.75 1.48 NA NA 0.02 XXX
88108 .... ............ A ........ Cytopath, concentrate tech ................ 0.56 1.46 1.33 NA NA 0.04 XXX
88108 .... 26 ....... A ........ Cytopath, concentrate tech ................ 0.56 0.16 0.20 0.16 0.20 0.02 XXX
88108 .... TC ...... A ........ Cytopath, concentrate tech ................ 0.00 1.31 1.14 NA NA 0.02 XXX
88112 .... ............ A ........ Cytopath, cell enhance tech ............... 1.18 1.47 1.72 NA NA 0.04 XXX
88112 .... 26 ....... A ........ Cytopath, cell enhance tech ............... 1.18 0.30 0.41 0.30 0.41 0.02 XXX
88112 .... TC ...... A ........ Cytopath, cell enhance tech ............... 0.00 1.17 1.32 NA NA 0.02 XXX
88125 .... ............ A ........ Forensic cytopathology ....................... 0.26 0.29 0.28 NA NA 0.02 XXX
88125 .... 26 ....... A ........ Forensic cytopathology ....................... 0.26 0.07 0.09 0.07 0.09 0.01 XXX
88125 .... TC ...... A ........ Forensic cytopathology ....................... 0.00 0.22 0.19 NA NA 0.01 XXX
88141 .... ............ A ........ Cytopath, c/v, interpret ....................... 0.42 0.37 0.26 0.37 0.26 0.02 XXX
88160 .... ............ A ........ Cytopath smear, other source ............ 0.50 0.90 0.87 NA NA 0.04 XXX
88160 .... 26 ....... A ........ Cytopath smear, other source ............ 0.50 0.13 0.17 0.13 0.17 0.02 XXX
88160 .... TC ...... A ........ Cytopath smear, other source ............ 0.00 0.77 0.70 NA NA 0.02 XXX
88172 .... ............ A ........ Cytopathology eval of fna ................... 0.60 0.81 0.78 NA NA 0.04 XXX
88172 .... 26 ....... A ........ Cytopathology eval of fna ................... 0.60 0.17 0.22 0.17 0.22 0.02 XXX
88172 .... TC ...... A ........ Cytopathology eval of fna ................... 0.00 0.63 0.56 NA NA 0.02 XXX
88173 .... ............ A ........ Cytopath eval, fna, report ................... 1.39 2.19 2.18 NA NA 0.07 XXX
88173 .... 26 ....... A ........ Cytopath eval, fna, report ................... 1.39 0.39 0.49 0.39 0.49 0.05 XXX
88173 .... TC ...... A ........ Cytopath eval, fna, report ................... 0.00 1.80 1.69 NA NA 0.02 XXX
88182 .... ............ A ........ Cell marker study ............................... 0.77 1.99 1.98 NA NA 0.07 XXX
88182 .... 26 ....... A ........ Cell marker study ............................... 0.77 0.14 0.23 0.14 0.23 0.03 XXX
88182 .... TC ...... A ........ Cell marker study ............................... 0.00 1.85 1.74 NA NA 0.04 XXX
88184 .... ............ A ........ Flowcytometry/ tc, 1 marker ............... 0.00 2.44 1.88 NA NA 0.02 XXX
88185 .... ............ A ........ Flowcytometry/tc, add-on ................... 0.00 1.48 1.06 NA NA 0.02 ZZZ
88187 .... ............ A ........ Flowcytometry/read, 2–8 .................... 1.36 0.40 0.43 0.40 0.43 0.01 XXX
88188 .... ............ A ........ Flowcytometry/read, 9–15 .................. 1.69 0.45 0.51 0.45 0.51 0.01 XXX
88189 .... ............ A ........ Flowcytometry/read, 16 & > ............... 2.23 0.48 0.61 0.48 0.61 0.01 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
88199 .... ............ C ........ Cytopathology procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88199 .... 26 ....... C ........ Cytopathology procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88199 .... TC ...... C ........ Cytopathology procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88291 .... ............ A ........ Cyto/molecular report ......................... 0.52 0.27 0.22 0.27 0.22 0.02 XXX
88299 .... ............ C ........ Cytogenetic study ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88300 .... ............ A ........ Surgical path, gross ............................ 0.08 0.56 0.51 NA NA 0.02 XXX
88300 .... 26 ....... A ........ Surgical path, gross ............................ 0.08 0.02 0.03 0.02 0.03 0.01 XXX
88300 .... TC ...... A ........ Surgical path, gross ............................ 0.00 0.53 0.48 NA NA 0.01 XXX
88302 .... ............ A ........ Tissue exam by pathologist ................ 0.13 1.28 1.16 NA NA 0.03 XXX
88302 .... 26 ....... A ........ Tissue exam by pathologist ................ 0.13 0.04 0.05 0.04 0.05 0.01 XXX
88302 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 1.24 1.11 NA NA 0.02 XXX
88311 .... ............ A ........ Decalcify tissue ................................... 0.24 0.24 0.23 NA NA 0.02 XXX
88311 .... 26 ....... A ........ Decalcify tissue ................................... 0.24 0.07 0.08 0.07 0.08 0.01 XXX
88311 .... TC ...... A ........ Decalcify tissue ................................... 0.00 0.17 0.15 NA NA 0.01 XXX
88312 .... ............ A ........ Special stains ..................................... 0.54 2.27 1.93 NA NA 0.03 XXX
88312 .... 26 ....... A ........ Special stains ..................................... 0.54 0.14 0.19 0.14 0.19 0.02 XXX
88312 .... TC ...... A ........ Special stains ..................................... 0.00 2.13 1.74 NA NA 0.01 XXX
88313 .... ............ A ........ Special stains ..................................... 0.24 1.93 1.59 NA NA 0.02 XXX
88313 .... 26 ....... A ........ Special stains ..................................... 0.24 0.06 0.08 0.06 0.08 0.01 XXX
88313 .... TC ...... A ........ Special stains ..................................... 0.00 1.87 1.51 NA NA 0.01 XXX
88314 .... ............ A ........ Histochemical stain ............................. 0.45 1.94 2.01 NA NA 0.04 XXX
88314 .... 26 ....... A ........ Histochemical stain ............................. 0.45 0.14 0.17 0.14 0.17 0.02 XXX
88314 .... TC ...... A ........ Histochemical stain ............................. 0.00 1.80 1.84 NA NA 0.02 XXX
88318 .... ............ A ........ Chemical histochemistry ..................... 0.42 2.93 2.30 NA NA 0.03 XXX
88318 .... 26 ....... A ........ Chemical histochemistry ..................... 0.42 0.12 0.15 0.12 0.15 0.02 XXX
88318 .... TC ...... A ........ Chemical histochemistry ..................... 0.00 2.80 2.14 NA NA 0.01 XXX
88319 .... ............ A ........ Enzyme histochemistry ....................... 0.53 3.20 3.31 NA NA 0.04 XXX
88319 .... 26 ....... A ........ Enzyme histochemistry ....................... 0.53 0.15 0.18 0.15 0.18 0.02 XXX
88319 .... TC ...... A ........ Enzyme histochemistry ....................... 0.00 3.04 3.12 NA NA 0.02 XXX
88321 .... ............ A ........ Microslide consultation ....................... 1.63 0.72 0.76 0.47 0.52 0.05 XXX
88323 .... ............ A ........ Microslide consultation ....................... 1.83 2.20 1.99 NA NA 0.07 XXX
88323 .... 26 ....... A ........ Microslide consultation ....................... 1.83 0.47 0.52 0.47 0.52 0.05 XXX
88323 .... TC ...... A ........ Microslide consultation ....................... 0.00 1.73 1.47 NA NA 0.02 XXX
88325 .... ............ A ........ Comprehensive review of data ........... 2.50 2.39 2.64 0.70 0.81 0.07 XXX
88329 .... ............ A ........ Path consult introp .............................. 0.67 0.66 0.66 0.20 0.25 0.02 XXX
88331 .... ............ A ........ Path consult intraop, 1 bloc ................ 1.19 1.20 1.16 NA NA 0.08 XXX
88331 .... 26 ....... A ........ Path consult intraop, 1 bloc ................ 1.19 0.37 0.44 0.37 0.44 0.04 XXX
88331 .... TC ...... A ........ Path consult intraop, 1 bloc ................ 0.00 0.83 0.72 NA NA 0.04 XXX
88332 .... ............ A ........ Path consult intraop, addœl ................ 0.59 0.48 0.47 NA NA 0.04 XXX
88332 .... 26 ....... A ........ Path consult intraop, addœl ................ 0.59 0.18 0.21 0.18 0.21 0.02 XXX
88332 .... TC ...... A ........ Path consult intraop, addœl ................ 0.00 0.29 0.25 NA NA 0.02 XXX
88333 .... ............ A ........ Intraop cyto path consult, 1 ................ 1.20 1.31 1.20 NA NA 0.08 XXX
88333 .... 26 ....... A ........ Intraop cyto path consult, 1 ................ 1.20 0.37 0.45 0.37 0.45 0.04 XXX
88333 .... TC ...... A ........ Intraop cyto path consult, 1 ................ 0.00 0.94 0.75 NA NA 0.04 XXX
88334 .... ............ A ........ Intraop cyto path consult, 2 ................ 0.73 0.78 0.69 NA NA 0.04 XXX
88334 .... 26 ....... A ........ Intraop cyto path consult, 2 ................ 0.73 0.22 0.24 0.22 0.24 0.02 XXX
88334 .... TC ...... A ........ Intraop cyto path consult, 2 ................ 0.00 0.56 0.45 NA NA 0.02 XXX
88342 .... ............ A ........ Immunohistochemistry ........................ 0.85 1.98 1.73 NA NA 0.05 XXX
88342 .... 26 ....... A ........ Immunohistochemistry ........................ 0.85 0.23 0.30 0.23 0.30 0.03 XXX
88342 .... TC ...... A ........ Immunohistochemistry ........................ 0.00 1.75 1.43 NA NA 0.02 XXX
88346 .... ............ A ........ Immunofluorescent study ................... 0.86 1.89 1.74 NA NA 0.05 XXX
88346 .... 26 ....... A ........ Immunofluorescent study ................... 0.86 0.23 0.30 0.23 0.30 0.03 XXX
88346 .... TC ...... A ........ Immunofluorescent study ................... 0.00 1.66 1.45 NA NA 0.02 XXX
88347 .... ............ A ........ Immunofluorescent study ................... 0.86 1.31 1.29 NA NA 0.05 XXX
88347 .... 26 ....... A ........ Immunofluorescent study ................... 0.86 0.19 0.27 0.19 0.27 0.03 XXX
88347 .... TC ...... A ........ Immunofluorescent study ................... 0.00 1.12 1.02 NA NA 0.02 XXX
88348 .... ............ A ........ Electron microscopy ........................... 1.51 18.10 13.69 NA NA 0.13 XXX
88348 .... 26 ....... A ........ Electron microscopy ........................... 1.51 0.42 0.53 0.42 0.53 0.06 XXX
88348 .... TC ...... A ........ Electron microscopy ........................... 0.00 17.68 13.16 NA NA 0.07 XXX
88349 .... ............ A ........ Scanning electron microscopy ........... 0.76 9.38 6.38 NA NA 0.09 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
88349 .... 26 ....... A ........ Scanning electron microscopy ........... 0.76 0.23 0.28 0.23 0.28 0.03 XXX
88349 .... TC ...... A ........ Scanning electron microscopy ........... 0.00 9.15 6.10 NA NA 0.06 XXX
88355 .... ............ A ........ Analysis, skeletal muscle ................... 1.85 3.19 6.00 NA NA 0.13 XXX
88355 .... 26 ....... A ........ Analysis, skeletal muscle ................... 1.85 0.37 0.58 0.37 0.58 0.07 XXX
88355 .... TC ...... A ........ Analysis, skeletal muscle ................... 0.00 2.82 5.42 NA NA 0.06 XXX
88356 .... ............ A ........ Analysis, nerve ................................... 3.02 5.33 4.97 NA NA 0.19 XXX
88356 .... 26 ....... A ........ Analysis, nerve ................................... 3.02 0.59 0.96 0.59 0.96 0.12 XXX
88356 .... TC ...... A ........ Analysis, nerve ................................... 0.00 4.74 4.01 NA NA 0.07 XXX
88358 .... ............ A ........ Analysis, tumor ................................... 0.95 1.09 0.97 NA NA 0.17 XXX
88358 .... 26 ....... A ........ Analysis, tumor ................................... 0.95 0.16 0.28 0.16 0.28 0.10 XXX
88358 .... TC ...... A ........ Analysis, tumor ................................... 0.00 0.93 0.69 NA NA 0.07 XXX
88360 .... ............ A ........ Tumor immunohistochem/manual ...... 1.10 2.21 1.98 NA NA 0.08 XXX
88360 .... 26 ....... A ........ Tumor immunohistochem/manual ...... 1.10 0.27 0.37 0.27 0.37 0.06 XXX
88360 .... TC ...... A ........ Tumor immunohistochem/manual ...... 0.00 1.93 1.61 NA NA 0.02 XXX
88361 .... ............ A ........ Tumor immunohistochem/comput ...... 1.18 2.77 2.88 NA NA 0.17 XXX
88361 .... 26 ....... A ........ Tumor immunohistochem/comput ...... 1.18 0.27 0.38 0.27 0.38 0.10 XXX
88361 .... TC ...... A ........ Tumor immunohistochem/comput ...... 0.00 2.50 2.51 NA NA 0.07 XXX
88362 .... ............ A ........ Nerve teasing preparations ................ 2.17 4.95 4.87 NA NA 0.15 XXX
88362 .... 26 ....... A ........ Nerve teasing preparations ................ 2.17 0.58 0.75 0.58 0.75 0.09 XXX
88362 .... TC ...... A ........ Nerve teasing preparations ................ 0.00 4.37 4.12 NA NA 0.06 XXX
88365 .... ............ A ........ Insitu hybridization (fish) ..................... 1.20 3.30 2.65 NA NA 0.05 XXX
88365 .... 26 ....... A ........ Insitu hybridization (fish) ..................... 1.20 0.30 0.39 0.30 0.39 0.03 XXX
88365 .... TC ...... A ........ Insitu hybridization (fish) ..................... 0.00 3.00 2.25 NA NA 0.02 XXX
88367 .... ............ A ........ Insitu hybridization, auto ..................... 1.30 5.11 4.58 NA NA 0.12 XXX
88367 .... 26 ....... A ........ Insitu hybridization, auto ..................... 1.30 0.23 0.38 0.23 0.38 0.06 XXX
88367 .... TC ...... A ........ Insitu hybridization, auto ..................... 0.00 4.88 4.19 NA NA 0.06 XXX
88368 .... ............ A ........ Insitu hybridization, manual ................ 1.40 4.93 3.62 NA NA 0.12 XXX
88368 .... 26 ....... A ........ Insitu hybridization, manual ................ 1.40 0.26 0.42 0.26 0.42 0.06 XXX
88368 .... TC ...... A ........ Insitu hybridization, manual ................ 0.00 4.67 3.20 NA NA 0.06 XXX
88371 .... 26 ....... A ........ Protein, western blot tissue ................ 0.37 0.10 0.11 0.10 0.11 0.01 XXX
88372 .... 26 ....... A ........ Protein analysis w/probe .................... 0.37 0.12 0.14 0.12 0.14 0.01 XXX
88380 .... ............ C ........ Microdissection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88380 .... 26 ....... C ........ Microdissection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88380 .... TC ...... C ........ Microdissection ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88384 .... ............ C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88384 .... 26 ....... C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88384 .... TC ...... C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88385 .... ............ A ........ Eval molecul probes, 51–250 ............. 1.50 15.07 10.96 NA NA 0.12 XXX
88385 .... 26 ....... A ........ Eval molecul probes, 51–250 ............. 1.50 0.27 0.45 0.27 0.45 0.06 XXX
88385 .... TC ...... A ........ Eval molecul probes, 51–250 ............. 0.00 14.79 10.50 NA NA 0.06 XXX
88386 .... ............ A ........ Eval molecul probes, 251–500 ........... 1.88 14.98 10.89 NA NA 0.16 XXX
88386 .... 26 ....... A ........ Eval molecul probes, 251–500 ........... 1.88 0.35 0.58 0.35 0.58 0.08 XXX
88386 .... TC ...... A ........ Eval molecul probes, 251–500 ........... 0.00 14.63 10.31 NA NA 0.08 XXX
88399 .... ............ C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88399 .... 26 ....... C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
88399 .... TC ...... C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
89049 .... ............ A ........ Chct for mal hyperthermia .................. 1.40 3.53 3.57 0.20 0.24 0.06 XXX
89060 .... 26 ....... A ........ Exam,synovial fluid crystals ............... 0.37 0.12 0.14 0.12 0.14 0.01 XXX
89100 .... ............ A ........ Sample intestinal contents ................. 0.60 7.87 5.01 0.54 0.39 0.03 XXX
89105 .... ............ A ........ Sample intestinal contents ................. 0.50 7.78 4.97 0.46 0.31 0.02 XXX
89130 .... ............ A ........ Sample stomach contents .................. 0.45 6.47 4.17 0.37 0.26 0.02 XXX
89220 .... ............ A ........ Sputum specimen collection ............... 0.00 0.37 0.40 NA NA 0.02 XXX
89230 .... ............ A ........ Collect sweat for test .......................... 0.00 0.07 0.09 NA NA 0.02 XXX
89240 .... ............ C ........ Pathology lab procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90465 .... ............ A ........ Immune admin 1 inj, < 8 yrs .............. 0.17 0.44 0.38 NA NA 0.01 XXX
90466 .... ............ A ........ Immune admin addl inj, < 8 y ............ 0.15 0.11 0.12 0.04 0.09 0.01 ZZZ
90467 .... ............ R ........ Immune admin o or n, < 8 yrs ........... 0.17 0.17 0.17 0.07 0.08 0.01 XXX
90468 .... ............ R ........ Immune admin o/n, addl < 8 y ........... 0.15 0.11 0.11 0.04 0.05 0.01 ZZZ
90471 .... ............ A ........ Immunization admin ........................... 0.17 0.44 0.38 NA NA 0.01 XXX
90472 .... ............ A ........ Immunization admin, each add .......... 0.15 0.12 0.13 0.04 0.09 0.01 ZZZ
90473 .... ............ R ........ Immune admin oral/nasal ................... 0.17 0.17 0.18 0.04 0.05 0.01 XXX
90474 .... ............ R ........ Immune admin oral/nasal addl ........... 0.15 0.08 0.09 0.04 0.05 0.01 ZZZ
90760 .... ............ A ........ Hydration iv infusion, init .................... 0.17 1.31 1.37 NA NA 0.07 XXX
90761 .... ............ A ........ Hydrate iv infusion, add-on ................ 0.09 0.31 0.36 NA NA 0.04 ZZZ
90765 .... ............ A ........ Ther/proph/diag iv inf, init ................... 0.21 1.60 1.68 NA NA 0.07 XXX
90766 .... ............ A ........ Ther/proph/dg iv inf, add-on ............... 0.18 0.37 0.42 NA NA 0.04 ZZZ
90767 .... ............ A ........ Tx/proph/dg addl seq iv inf ................. 0.19 0.68 0.79 NA NA 0.04 ZZZ
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
90768 .... ............ A ........ Ther/diag concurrent inf ..................... 0.17 0.33 0.38 NA NA 0.04 ZZZ
90772 .... ............ A ........ Ther/proph/diag inj, sc/im ................... 0.17 0.44 0.38 NA NA 0.01 XXX
90773 .... ............ A ........ Ther/proph/diag inj, ia ......................... 0.17 0.30 0.31 NA NA 0.02 XXX
90774 .... ............ A ........ Ther/proph/diag inj, iv push ................ 0.18 1.32 1.31 NA NA 0.04 XXX
90775 .... ............ A ........ Ther/proph/diag inj add-on ................. 0.10 0.51 0.54 NA NA 0.04 ZZZ
90779 .... ............ C ........ Ther/prop/diag inj/inf proc ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90801 .... ............ A ........ Psy dx interview ................................. 2.80 1.49 1.33 0.60 0.77 0.06 XXX
90802 .... ............ A ........ Intac psy dx interview ......................... 3.01 1.53 1.36 0.68 0.83 0.07 XXX
90804 .... ............ A ........ Psytx, office, 20–30 min ..................... 1.21 0.56 0.53 0.22 0.30 0.03 XXX
90805 .... ............ A ........ Psytx, off, 20–30 min w/e&m ............. 1.37 0.60 0.55 0.24 0.33 0.03 XXX
90806 .... ............ A ........ Psytx, off, 45–50 min .......................... 1.86 0.53 0.62 0.33 0.46 0.04 XXX
90807 .... ............ A ........ Psytx, off, 45–50 min w/e&m ............. 2.02 0.70 0.70 0.36 0.49 0.05 XXX
90808 .... ............ A ........ Psytx, office, 75–80 min ..................... 2.79 0.69 0.86 0.50 0.70 0.06 XXX
90809 .... ............ A ........ Psytx, off, 75–80, w/e&m ................... 2.95 0.86 0.93 0.53 0.72 0.07 XXX
90810 .... ............ A ........ Intac psytx, off, 20–30 min ................. 1.32 0.53 0.52 0.23 0.33 0.04 XXX
90811 .... ............ A ........ Intac psytx, 20–30, w/e&m ................. 1.48 0.72 0.65 0.26 0.36 0.04 XXX
90813 .... ............ A ........ Intac psytx, 45–50 min w/e&m ........... 2.13 0.83 0.80 0.37 0.52 0.05 XXX
90815 .... ............ A ........ Intac psytx, 75–80 w/e&m .................. 3.06 1.00 1.03 0.54 0.75 0.07 XXX
90816 .... ............ A ........ Psytx, hosp, 20–30 min ...................... 1.25 NA NA 0.33 0.40 0.03 XXX
90817 .... ............ A ........ Psytx, hosp, 20–30 min w/e&m .......... 1.41 NA NA 0.35 0.41 0.03 XXX
90823 .... ............ A ........ Intac psytx, hosp, 20–30 min ............. 1.36 NA NA 0.35 0.42 0.03 XXX
90824 .... ............ A ........ Intac psytx, hsp 20–30 w/e&m ........... 1.52 NA NA 0.37 0.43 0.04 XXX
90845 .... ............ A ........ Psychoanalysis ................................... 1.79 0.39 0.48 0.32 0.43 0.04 XXX
90846 .... ............ R ........ Family psytx w/o patient ..................... 1.83 0.51 0.58 0.43 0.54 0.04 XXX
90847 .... ............ R ........ Family psytx w/patient ........................ 2.21 0.74 0.78 0.50 0.63 0.05 XXX
90849 .... ............ R ........ Multiple family group psytx ................. 0.59 0.33 0.30 0.21 0.22 0.02 XXX
90853 .... ............ A ........ Group psychotherapy ......................... 0.59 0.26 0.26 0.20 0.21 0.01 XXX
90857 .... ............ A ........ Intac group psytx ................................ 0.63 0.38 0.33 0.21 0.23 0.01 XXX
90862 .... ............ A ........ Medication management .................... 0.95 0.62 0.51 0.27 0.30 0.02 XXX
90865 .... ............ A ........ Narcosynthesis ................................... 2.84 1.17 1.27 0.63 0.78 0.12 XXX
90870 .... ............ A ........ Electroconvulsive therapy ................... 1.88 1.91 1.92 0.38 0.49 0.04 000
90875 .... ............ N ........ Psychophysiological therapy .............. 1.20 0.52 0.71 0.28 0.37 0.04 XXX
90876 .... ............ N ........ Psychophysiological therapy .............. 1.90 0.67 0.92 0.44 0.59 0.05 XXX
90880 .... ............ A ........ Hypnotherapy ..................................... 2.19 0.58 0.81 0.39 0.54 0.05 XXX
90885 .... ............ B ........ Psy evaluation of records ................... 0.97 0.22 0.29 0.22 0.29 0.02 XXX
90887 .... ............ B ........ Consultation with family ...................... 1.48 0.61 0.72 0.34 0.45 0.04 XXX
90899 .... ............ C ........ Psychiatric service/therapy ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
90901 .... ............ A ........ Biofeedback train, any meth ............... 0.41 0.46 0.56 0.10 0.12 0.02 000
90911 .... ............ A ........ Biofeedback peri/uro/rectal ................. 0.89 1.37 1.46 0.30 0.31 0.06 000
90918 .... ............ I .......... ESRD related services, month ........... 11.16 4.68 5.39 3.73 4.92 0.36 XXX
90922 .... ............ I .......... ESRD related services, day ............... 0.37 0.16 0.19 0.12 0.17 0.01 XXX
90923 .... ............ I .......... Esrd related services, day .................. 0.28 0.10 0.11 0.08 0.11 0.01 XXX
90935 .... ............ A ........ Hemodialysis, one evaluation ............. 1.22 NA NA 0.54 0.61 0.04 000
90937 .... ............ A ........ Hemodialysis, repeated eval .............. 2.11 NA NA 0.77 0.88 0.07 000
90945 .... ............ A ........ Dialysis, one evaluation ...................... 1.28 NA NA 0.55 0.62 0.04 000
90947 .... ............ A ........ Dialysis, repeated eval ....................... 2.16 NA NA 0.79 0.89 0.07 000
90997 .... ............ A ........ Hemoperfusion ................................... 1.84 NA NA 0.50 0.58 0.06 000
90999 .... ............ C ........ Dialysis procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91000 .... ............ A ........ Esophageal intubation ........................ 0.73 2.11 1.24 2.11 1.24 0.04 000
91000 .... 26 ....... A ........ Esophageal intubation ........................ 0.73 0.22 0.24 0.22 0.24 0.03 000
91000 .... TC ...... A ........ Esophageal intubation ........................ 0.00 1.88 0.99 1.88 0.99 0.01 000
91010 .... ............ A ........ Esophagus motility study .................... 1.25 3.64 4.03 3.64 4.03 0.12 000
91010 .... 26 ....... A ........ Esophagus motility study .................... 1.25 0.55 0.50 0.55 0.50 0.06 000
91010 .... TC ...... A ........ Esophagus motility study .................... 0.00 3.09 3.53 3.09 3.53 0.06 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
91020 .... ............ A ........ Gastric motility studies ....................... 1.44 4.77 4.64 4.77 4.64 0.13 000
91020 .... 26 ....... A ........ Gastric motility studies ....................... 1.44 0.61 0.55 0.61 0.55 0.07 000
91020 .... TC ...... A ........ Gastric motility studies ....................... 0.00 4.16 4.09 4.16 4.09 0.06 000
91022 .... ............ A ........ Duodenal motility study ...................... 1.44 3.11 3.76 3.11 3.76 0.13 000
91022 .... 26 ....... A ........ Duodenal motility study ...................... 1.44 0.62 0.57 0.62 0.57 0.07 000
91022 .... TC ...... A ........ Duodenal motility study ...................... 0.00 2.49 3.19 2.49 3.19 0.06 000
91030 .... ............ A ........ Acid perfusion of esophagus .............. 0.91 2.87 2.66 2.87 2.66 0.06 000
91030 .... 26 ....... A ........ Acid perfusion of esophagus .............. 0.91 0.42 0.37 0.42 0.37 0.04 000
91030 .... TC ...... A ........ Acid perfusion of esophagus .............. 0.00 2.45 2.28 2.45 2.28 0.02 000
91034 .... ............ A ........ Gastroesophageal reflux test ............. 0.97 4.12 4.68 4.12 4.68 0.12 000
91034 .... 26 ....... A ........ Gastroesophageal reflux test ............. 0.97 0.43 0.38 0.43 0.38 0.06 000
91034 .... TC ...... A ........ Gastroesophageal reflux test ............. 0.00 3.69 4.30 3.69 4.30 0.06 000
91035 .... ............ A ........ G-esoph reflx tst w/electrod ............... 1.59 11.28 11.04 11.28 11.04 0.12 000
91035 .... 26 ....... A ........ G-esoph reflx tst w/electrod ............... 1.59 0.71 0.64 0.71 0.64 0.06 000
91035 .... TC ...... A ........ G-esoph reflx tst w/electrod ............... 0.00 10.57 10.40 10.57 10.40 0.06 000
91037 .... ............ A ........ Esoph imped function test .................. 0.97 3.45 3.18 3.45 3.18 0.12 000
91037 .... 26 ....... A ........ Esoph imped function test .................. 0.97 0.45 0.39 0.45 0.39 0.06 000
91037 .... TC ...... A ........ Esoph imped function test .................. 0.00 3.00 2.79 3.00 2.79 0.06 000
91038 .... ............ A ........ Esoph imped funct test > 1h .............. 1.10 2.79 2.50 2.79 2.50 0.12 000
91038 .... 26 ....... A ........ Esoph imped funct test > 1h .............. 1.10 0.51 0.45 0.51 0.45 0.06 000
91038 .... TC ...... A ........ Esoph imped funct test > 1h .............. 0.00 2.28 2.05 2.28 2.05 0.06 000
91040 .... ............ A ........ Esoph balloon distension tst .............. 0.97 7.63 9.66 7.63 9.66 0.12 000
91040 .... 26 ....... A ........ Esoph balloon distension tst .............. 0.97 0.28 0.33 0.28 0.33 0.06 000
91040 .... TC ...... A ........ Esoph balloon distension tst .............. 0.00 7.35 9.33 7.35 9.33 0.06 000
91052 .... ............ A ........ Gastric analysis test ........................... 0.79 2.93 2.70 2.93 2.70 0.05 000
91052 .... 26 ....... A ........ Gastric analysis test ........................... 0.79 0.37 0.33 0.37 0.33 0.03 000
91052 .... TC ...... A ........ Gastric analysis test ........................... 0.00 2.56 2.37 2.56 2.37 0.02 000
91055 .... ............ A ........ Gastric intubation for smear ............... 0.94 2.56 2.73 2.56 2.73 0.07 000
91055 .... 26 ....... A ........ Gastric intubation for smear ............... 0.94 0.29 0.28 0.29 0.28 0.05 000
91055 .... TC ...... A ........ Gastric intubation for smear ............... 0.00 2.27 2.45 2.27 2.45 0.02 000
91065 .... ............ A ........ Breath hydrogen test .......................... 0.20 1.33 1.39 1.33 1.39 0.03 000
91065 .... 26 ....... A ........ Breath hydrogen test .......................... 0.20 0.06 0.07 0.06 0.07 0.01 000
91065 .... TC ...... A ........ Breath hydrogen test .......................... 0.00 1.26 1.32 1.26 1.32 0.02 000
91100 .... ............ A ........ Pass intestine bleeding tube .............. 1.08 2.12 2.46 0.32 0.31 0.07 000
91105 .... ............ A ........ Gastric intubation treatment ............... 0.37 1.65 1.89 0.07 0.08 0.03 000
91110 .... ............ A ........ Gi tract capsule endoscopy ................ 3.64 20.46 21.33 NA NA 0.16 XXX
91110 .... 26 ....... A ........ Gi tract capsule endoscopy ................ 3.64 1.68 1.49 1.68 1.49 0.09 XXX
91110 .... TC ...... A ........ Gi tract capsule endoscopy ................ 0.00 18.78 19.85 NA NA 0.07 XXX
91111 .... ............ A ........ Esophageal capsule endoscopy ......... 1.00 18.64 18.65 NA NA 0.05 XXX
91111 .... 26 ....... A ........ Esophageal capsule endoscopy ......... 1.00 0.45 0.46 0.45 0.46 0.03 XXX
91111 .... TC ...... A ........ Esophageal capsule endoscopy ......... 0.00 18.19 18.19 NA NA 0.02 XXX
91120 .... ............ A ........ Rectal sensation test .......................... 0.97 8.81 9.93 8.81 9.93 0.11 XXX
91120 .... 26 ....... A ........ Rectal sensation test .......................... 0.97 0.28 0.31 0.28 0.31 0.07 XXX
91120 .... TC ...... A ........ Rectal sensation test .......................... 0.00 8.53 9.62 8.53 9.62 0.04 XXX
91122 .... ............ A ........ Anal pressure record .......................... 1.77 4.29 4.60 4.29 4.60 0.21 000
91122 .... 26 ....... A ........ Anal pressure record .......................... 1.77 0.63 0.60 0.63 0.60 0.13 000
91122 .... TC ...... A ........ Anal pressure record .......................... 0.00 3.66 4.01 3.66 4.01 0.08 000
91132 .... ............ C ........ Electrogastrography ............................ 0.52 0.00 0.13 NA NA 0.02 XXX
91132 .... 26 ....... A ........ Electrogastrography ............................ 0.52 0.26 0.22 0.26 0.22 0.02 XXX
91132 .... TC ...... C ........ Electrogastrography ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91133 .... ............ C ........ Electrogastrography w/test ................. 0.66 0.00 0.17 NA NA 0.03 XXX
91133 .... 26 ....... A ........ Electrogastrography w/test ................. 0.66 0.32 0.27 0.32 0.27 0.03 XXX
91133 .... TC ...... C ........ Electrogastrography w/test ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91299 .... ............ C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91299 .... 26 ....... C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91299 .... TC ...... C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92002 .... ............ A ........ Eye exam, new patient ....................... 0.88 0.94 0.96 0.26 0.31 0.02 XXX
92004 .... ............ A ........ Eye exam, new patient ....................... 1.82 1.58 1.64 0.56 0.62 0.04 XXX
92012 .... ............ A ........ Eye exam established pat .................. 0.92 0.99 1.00 0.32 0.29 0.02 XXX
92014 .... ............ A ........ Eye exam & treatment ........................ 1.42 1.38 1.39 0.47 0.46 0.03 XXX
92015 .... ............ N ........ Refraction ........................................... 0.38 0.10 0.79 0.09 0.12 0.01 XXX
92018 .... ............ A ........ New eye exam & treatment ................ 2.50 NA NA 0.87 0.98 0.07 XXX
92019 .... ............ A ........ Eye exam & treatment ........................ 1.31 NA NA 0.36 0.47 0.03 XXX
92020 .... ............ A ........ Special eye evaluation ....................... 0.37 0.25 0.30 0.13 0.14 0.01 XXX
92025 .... ............ A ........ Corneal topography ............................ 0.35 0.43 0.44 0.43 0.44 0.02 XXX
92025 .... 26 ....... A ........ Corneal topography ............................ 0.35 0.12 0.12 0.12 0.12 0.01 XXX
92025 .... TC ...... A ........ Corneal topography ............................ 0.00 0.31 0.32 0.31 0.32 0.01 XXX
92060 .... ............ A ........ Special eye evaluation ....................... 0.69 0.77 0.76 NA NA 0.03 XXX
92060 .... 26 ....... A ........ Special eye evaluation ....................... 0.69 0.23 0.26 0.23 0.26 0.02 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
92060 .... TC ...... A ........ Special eye evaluation ....................... 0.00 0.54 0.49 NA NA 0.01 XXX
92065 .... ............ A ........ Orthoptic/pleoptic training ................... 0.37 0.85 0.70 NA NA 0.02 XXX
92065 .... 26 ....... A ........ Orthoptic/pleoptic training ................... 0.37 0.09 0.12 0.09 0.12 0.01 XXX
92065 .... TC ...... A ........ Orthoptic/pleoptic training ................... 0.00 0.76 0.57 NA NA 0.01 XXX
92070 .... ............ A ........ Fitting of contact lens ......................... 0.70 0.90 0.99 0.23 0.28 0.02 XXX
92081 .... ............ A ........ Visual field examination(s) ................. 0.36 0.95 0.95 NA NA 0.02 XXX
92081 .... 26 ....... A ........ Visual field examination(s) ................. 0.36 0.11 0.13 0.11 0.13 0.01 XXX
92081 .... TC ...... A ........ Visual field examination(s) ................. 0.00 0.84 0.82 NA NA 0.01 XXX
92100 .... ............ A ........ Serial tonometry exam(s) ................... 0.92 1.24 1.30 0.28 0.33 0.02 XXX
92120 .... ............ A ........ Tonography & eye evaluation ............ 0.81 0.97 1.02 0.25 0.29 0.02 XXX
92130 .... ............ A ........ Water provocation tonography ........... 0.81 1.18 1.23 0.28 0.33 0.02 XXX
92135 .... ............ A ........ Opthalmic dx imaging ......................... 0.35 0.79 0.79 NA NA 0.02 XXX
92135 .... 26 ....... A ........ Opthalmic dx imaging ......................... 0.35 0.12 0.13 0.12 0.13 0.01 XXX
92135 .... TC ...... A ........ Opthalmic dx imaging ......................... 0.00 0.67 0.66 NA NA 0.01 XXX
92136 .... ............ A ........ Ophthalmic biometry ........................... 0.54 1.42 1.54 NA NA 0.08 XXX
92136 .... 26 ....... A ........ Ophthalmic biometry ........................... 0.54 0.20 0.22 0.20 0.22 0.01 XXX
92136 .... TC ...... A ........ Ophthalmic biometry ........................... 0.00 1.22 1.32 NA NA 0.07 XXX
92140 .... ............ A ........ Glaucoma provocative tests ............... 0.50 0.88 0.94 0.14 0.18 0.01 XXX
92225 .... ............ A ........ Special eye exam, initial ..................... 0.38 0.24 0.23 0.13 0.14 0.01 XXX
92226 .... ............ A ........ Special eye exam, subsequent .......... 0.33 0.23 0.22 0.12 0.13 0.01 XXX
92230 .... ............ A ........ Eye exam with photos ........................ 0.60 0.68 1.11 0.19 0.20 0.02 XXX
92235 .... ............ A ........ Eye exam with photos ........................ 0.81 2.25 2.44 NA NA 0.08 XXX
92235 .... 26 ....... A ........ Eye exam with photos ........................ 0.81 0.29 0.34 0.29 0.34 0.02 XXX
92235 .... TC ...... A ........ Eye exam with photos ........................ 0.00 1.96 2.11 NA NA 0.06 XXX
92240 .... ............ A ........ Icg angiography .................................. 1.10 4.37 5.26 NA NA 0.09 XXX
92240 .... 26 ....... A ........ Icg angiography .................................. 1.10 0.40 0.45 0.40 0.45 0.03 XXX
92240 .... TC ...... A ........ Icg angiography .................................. 0.00 3.97 4.80 NA NA 0.06 XXX
92250 .... ............ A ........ Eye exam with photos ........................ 0.44 1.29 1.42 NA NA 0.02 XXX
92250 .... 26 ....... A ........ Eye exam with photos ........................ 0.44 0.14 0.17 0.14 0.17 0.01 XXX
92250 .... TC ...... A ........ Eye exam with photos ........................ 0.00 1.15 1.25 NA NA 0.01 XXX
92260 .... ............ A ........ Ophthalmoscopy/dynamometry .......... 0.20 0.23 0.24 0.07 0.08 0.01 XXX
92265 .... ............ A ........ Eye muscle evaluation ....................... 0.81 0.99 1.24 NA NA 0.06 XXX
92265 .... 26 ....... A ........ Eye muscle evaluation ....................... 0.81 0.24 0.26 0.24 0.26 0.04 XXX
92265 .... TC ...... A ........ Eye muscle evaluation ....................... 0.00 0.75 0.98 NA NA 0.02 XXX
92270 .... ............ A ........ Electro-oculography ............................ 0.81 1.31 1.44 NA NA 0.05 XXX
92270 .... 26 ....... A ........ Electro-oculography ............................ 0.81 0.23 0.28 0.23 0.28 0.03 XXX
92270 .... TC ...... A ........ Electro-oculography ............................ 0.00 1.08 1.15 NA NA 0.02 XXX
92275 .... ............ A ........ Electroretinography ............................. 1.01 2.41 2.19 NA NA 0.05 XXX
92275 .... 26 ....... A ........ Electroretinography ............................. 1.01 0.35 0.40 0.35 0.40 0.03 XXX
92275 .... TC ...... A ........ Electroretinography ............................. 0.00 2.06 1.79 NA NA 0.02 XXX
92283 .... ............ A ........ Color vision examination .................... 0.17 0.98 0.92 NA NA 0.02 XXX
92283 .... 26 ....... A ........ Color vision examination .................... 0.17 0.05 0.06 0.05 0.06 0.01 XXX
92283 .... TC ...... A ........ Color vision examination .................... 0.00 0.93 0.86 NA NA 0.01 XXX
92284 .... ............ A ........ Dark adaptation eye exam ................. 0.24 1.12 1.52 NA NA 0.02 XXX
92284 .... 26 ....... A ........ Dark adaptation eye exam ................. 0.24 0.07 0.08 0.07 0.08 0.01 XXX
92284 .... TC ...... A ........ Dark adaptation eye exam ................. 0.00 1.05 1.44 NA NA 0.01 XXX
92285 .... ............ A ........ Eye photography ................................ 0.20 0.79 0.90 NA NA 0.02 XXX
92285 .... 26 ....... A ........ Eye photography ................................ 0.20 0.07 0.08 0.07 0.08 0.01 XXX
92285 .... TC ...... A ........ Eye photography ................................ 0.00 0.72 0.81 NA NA 0.01 XXX
92286 .... ............ A ........ Internal eye photography .................... 0.66 2.08 2.58 NA NA 0.04 XXX
92286 .... 26 ....... A ........ Internal eye photography .................... 0.66 0.22 0.26 0.22 0.26 0.02 XXX
92286 .... TC ...... A ........ Internal eye photography .................... 0.00 1.85 2.32 NA NA 0.02 XXX
92287 .... ............ A ........ Internal eye photography .................... 0.81 1.90 2.15 0.28 0.30 0.02 XXX
92310 .... ............ N ........ Contact lens fitting .............................. 1.17 1.05 1.08 0.27 0.36 0.04 XXX
92311 .... ............ A ........ Contact lens fitting .............................. 1.08 1.27 1.18 0.31 0.34 0.03 XXX
92314 .... ............ N ........ Prescription of contact lens ................ 0.69 1.12 1.03 0.16 0.21 0.01 XXX
92315 .... ............ A ........ Prescription of contact lens ................ 0.45 1.30 1.08 0.13 0.15 0.01 XXX
92325 .... ............ A ........ Modification of contact lens ................ 0.00 0.83 0.62 NA NA 0.01 XXX
92326 .... ............ A ........ Replacement of contact lens .............. 0.00 0.72 1.18 NA NA 0.06 XXX
92340 .... ............ N ........ Fitting of spectacles ............................ 0.37 0.44 0.57 0.09 0.12 0.01 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
92352 .... ............ B ........ Special spectacles fitting .................... 0.37 0.56 0.62 0.09 0.12 0.01 XXX
92353 .... ............ B ........ Special spectacles fitting .................... 0.50 0.59 0.66 0.12 0.15 0.02 XXX
92354 .... ............ B ........ Special spectacles fitting .................... 0.00 0.28 4.57 NA NA 0.10 XXX
92355 .... ............ B ........ Special spectacles fitting .................... 0.00 0.44 2.39 NA NA 0.01 XXX
92358 .... ............ B ........ Eye prosthesis service ....................... 0.00 0.23 0.60 NA NA 0.05 XXX
92370 .... ............ N ........ Repair & adjust spectacles ................. 0.32 0.39 0.47 0.07 0.10 0.02 XXX
92371 .... ............ B ........ Repair & adjust spectacles ................. 0.00 0.24 0.43 NA NA 0.02 XXX
92499 .... ............ C ........ Eye service or procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92499 .... 26 ....... C ........ Eye service or procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92499 .... TC ...... C ........ Eye service or procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92502 .... ............ A ........ Ear and throat examination ................ 1.51 NA NA 0.91 0.99 0.05 000
92504 .... ............ A ........ Ear microscopy examination .............. 0.18 0.59 0.54 0.06 0.07 0.01 XXX
92506 .... ............ A ........ Speech/hearing evaluation ................. 0.86 3.47 3.00 0.28 0.33 0.03 XXX
92507 .... ............ A ........ Speech/hearing therapy ..................... 0.52 1.22 1.16 0.16 0.19 0.02 XXX
92508 .... ............ A ........ Speech/hearing therapy ..................... 0.26 0.55 0.52 0.09 0.10 0.01 XXX
92511 .... ............ A ........ Nasopharyngoscopy ........................... 0.84 3.10 3.17 0.67 0.72 0.03 000
92512 .... ............ A ........ Nasal function studies ........................ 0.55 0.99 1.06 0.18 0.18 0.02 XXX
92516 .... ............ A ........ Facial nerve function test ................... 0.43 1.23 1.20 0.14 0.18 0.01 XXX
92520 .... ............ A ........ Laryngeal function studies .................. 0.75 0.93 0.71 0.24 0.31 0.03 XXX
92526 .... ............ A ........ Oral function therapy .......................... 0.55 1.69 1.66 0.17 0.18 0.02 XXX
92541 .... ............ A ........ Spontaneous nystagmus test ............. 0.40 1.14 1.08 NA NA 0.04 XXX
92541 .... 26 ....... A ........ Spontaneous nystagmus test ............. 0.40 0.11 0.15 0.11 0.15 0.02 XXX
92541 .... TC ...... A ........ Spontaneous nystagmus test ............. 0.00 1.03 0.93 NA NA 0.02 XXX
92542 .... ............ A ........ Positional nystagmus test ................... 0.33 1.28 1.20 NA NA 0.03 XXX
92542 .... 26 ....... A ........ Positional nystagmus test ................... 0.33 0.09 0.12 0.09 0.12 0.01 XXX
92542 .... TC ...... A ........ Positional nystagmus test ................... 0.00 1.19 1.08 NA NA 0.02 XXX
92543 .... ............ A ........ Caloric vestibular test ......................... 0.10 0.64 0.61 NA NA 0.02 XXX
92543 .... 26 ....... A ........ Caloric vestibular test ......................... 0.10 0.03 0.04 0.03 0.04 0.01 XXX
92543 .... TC ...... A ........ Caloric vestibular test ......................... 0.00 0.62 0.57 NA NA 0.01 XXX
92544 .... ............ A ........ Optokinetic nystagmus test ................ 0.26 1.02 0.96 NA NA 0.03 XXX
92544 .... 26 ....... A ........ Optokinetic nystagmus test ................ 0.26 0.07 0.10 0.07 0.10 0.01 XXX
92544 .... TC ...... A ........ Optokinetic nystagmus test ................ 0.00 0.95 0.86 NA NA 0.02 XXX
92545 .... ............ A ........ Oscillating tracking test ...................... 0.23 0.99 0.90 NA NA 0.03 XXX
92545 .... 26 ....... A ........ Oscillating tracking test ...................... 0.23 0.06 0.09 0.06 0.09 0.01 XXX
92545 .... TC ...... A ........ Oscillating tracking test ...................... 0.00 0.93 0.81 NA NA 0.02 XXX
92546 .... ............ A ........ Sinusoidal rotational test .................... 0.29 1.79 1.89 NA NA 0.03 XXX
92546 .... 26 ....... A ........ Sinusoidal rotational test .................... 0.29 0.08 0.11 0.08 0.11 0.01 XXX
92546 .... TC ...... A ........ Sinusoidal rotational test .................... 0.00 1.72 1.79 NA NA 0.02 XXX
92547 .... ............ A ........ Supplemental electrical test ............... 0.00 0.11 0.10 0.11 0.10 0.06 ZZZ
92548 .... ............ A ........ Posturography .................................... 0.50 1.68 1.96 NA NA 0.15 XXX
92548 .... 26 ....... A ........ Posturography .................................... 0.50 0.14 0.20 0.14 0.20 0.02 XXX
92548 .... TC ...... A ........ Posturography .................................... 0.00 1.55 1.76 NA NA 0.13 XXX
92551 .... ............ N ........ Pure tone hearing test, air .................. 0.00 0.25 0.25 NA NA 0.01 XXX
92552 .... ............ A ........ Pure tone audiometry, air ................... 0.00 0.60 0.51 NA NA 0.04 XXX
92553 .... ............ A ........ Audiometry, air & bone ....................... 0.00 0.76 0.70 NA NA 0.06 XXX
92555 .... ............ A ........ Speech threshold audiometry ............. 0.00 0.41 0.39 NA NA 0.04 XXX
92556 .... ............ A ........ Speech audiometry, complete ............ 0.00 0.51 0.54 NA NA 0.06 XXX
92557 .... ............ A ........ Comprehensive hearing test .............. 0.60 0.30 0.91 0.30 0.91 0.12 XXX
92561 .... ............ A ........ Bekesy audiometry, diagnosis ............ 0.00 0.69 0.70 NA NA 0.06 XXX
92562 .... ............ A ........ Loudness balance test ....................... 0.00 0.61 0.52 NA NA 0.04 XXX
92563 .... ............ A ........ Tone decay hearing test ..................... 0.00 0.54 0.45 NA NA 0.04 XXX
92564 .... ............ A ........ Sisi hearing test .................................. 0.00 0.48 0.47 NA NA 0.05 XXX
92565 .... ............ A ........ Stenger test, pure tone ....................... 0.00 0.25 0.32 NA NA 0.04 XXX
92567 .... ............ A ........ Tympanometry .................................... 0.20 0.13 0.38 0.13 0.38 0.06 XXX
92568 .... ............ A ........ Acoustic refl threshold tst ................... 0.29 0.10 0.25 0.10 0.25 0.04 XXX
92569 .... ............ A ........ Acoustic reflex decay test .................. 0.20 0.07 0.26 0.07 0.26 0.04 XXX
92571 .... ............ A ........ Filtered speech hearing test ............... 0.00 0.44 0.41 NA NA 0.04 XXX
92572 .... ............ A ........ Staggered spondaic word test ............ 0.00 0.58 0.34 NA NA 0.01 XXX
92575 .... ............ A ........ Sensorineural acuity test .................... 0.00 1.14 0.71 NA NA 0.02 XXX
92576 .... ............ A ........ Synthetic sentence test ...................... 0.00 0.58 0.51 NA NA 0.05 XXX
92577 .... ............ A ........ Stenger test, speech .......................... 0.00 0.26 0.49 NA NA 0.07 XXX
92579 .... ............ A ........ Visual audiometry (vra) ...................... 0.70 0.35 0.62 0.35 0.62 0.06 XXX
92582 .... ............ A ........ Conditioning play audiometry ............. 0.00 1.16 0.93 NA NA 0.06 XXX
92583 .... ............ A ........ Select picture audiometry ................... 0.00 0.73 0.80 NA NA 0.08 XXX
92584 .... ............ A ........ Electrocochleography ......................... 0.00 1.35 1.88 NA NA 0.21 XXX
92585 .... ............ A ........ Auditor evoke potent, compre ............ 0.50 2.09 2.04 NA NA 0.17 XXX
92585 .... 26 ....... A ........ Auditor evoke potent, compre ............ 0.50 0.15 0.18 0.15 0.18 0.03 XXX
92585 .... TC ...... A ........ Auditor evoke potent, compre ............ 0.00 1.93 1.86 NA NA 0.14 XXX
92586 .... ............ A ........ Auditor evoke potent, limit .................. 0.00 1.40 1.63 NA NA 0.14 XXX
92587 .... ............ A ........ Evoked auditory test ........................... 0.13 0.65 1.01 NA NA 0.12 XXX
92587 .... 26 ....... A ........ Evoked auditory test ........................... 0.13 0.04 0.05 0.04 0.05 0.01 XXX
92587 .... TC ...... A ........ Evoked auditory test ........................... 0.00 0.61 0.96 NA NA 0.11 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
92588 .... ............ A ........ Evoked auditory test ........................... 0.36 1.11 1.36 NA NA 0.14 XXX
92588 .... 26 ....... A ........ Evoked auditory test ........................... 0.36 0.11 0.14 0.11 0.14 0.01 XXX
92588 .... TC ...... A ........ Evoked auditory test ........................... 0.00 1.00 1.22 NA NA 0.13 XXX
92596 .... ............ A ........ Ear protector evaluation ..................... 0.00 1.01 0.79 NA NA 0.06 XXX
92597 .... ............ A ........ Oral speech device eval ..................... 0.86 1.81 1.73 0.29 0.36 0.03 XXX
92601 .... ............ A ........ Cochlear implt f/up exam < 7 ............. 2.30 4.87 3.84 NA NA 0.07 XXX
92602 .... ............ A ........ Reprogram cochlear implt < 7 ............ 1.30 0.89 2.04 NA NA 0.07 XXX
92603 .... ............ A ........ Cochlear implt f/up exam 7 > ............. 2.25 1.19 2.00 0.74 1.85 0.07 XXX
92604 .... ............ A ........ Reprogram cochlear implt 7 > ............ 1.25 0.78 1.29 0.41 1.16 0.07 XXX
92607 .... ............ A ........ Ex for speech device rx, 1hr .............. 0.00 4.59 3.78 NA NA 0.05 XXX
92608 .... ............ A ........ Ex for speech device rx addl .............. 0.00 0.87 0.71 NA NA 0.05 XXX
92609 .... ............ A ........ Use of speech device service ............ 0.00 2.43 1.99 NA NA 0.04 XXX
92610 .... ............ A ........ Evaluate swallowing function ............. 0.00 1.69 2.55 NA NA 0.08 XXX
92611 .... ............ A ........ Motion fluoroscopy/swallow ................ 0.00 1.93 2.67 NA NA 0.08 XXX
92612 .... ............ A ........ Endoscopy swallow tst (fees) ............. 1.27 2.95 2.81 0.42 0.53 0.04 XXX
92613 .... ............ A ........ Endoscopy swallow tst (fees) ............. 0.71 0.24 0.32 0.24 0.31 0.05 XXX
92614 .... ............ A ........ Laryngoscopic sensory test ................ 1.27 2.41 2.43 0.42 0.53 0.04 XXX
92615 .... ............ A ........ Eval laryngoscopy sense tst ............... 0.63 0.21 0.28 0.21 0.28 0.05 XXX
92616 .... ............ A ........ Fees w/laryngeal sense test ............... 1.88 3.15 3.23 0.62 0.79 0.06 XXX
92617 .... ............ A ........ Interprt fees/laryngeal test .................. 0.79 0.27 0.35 0.26 0.35 0.05 XXX
92620 .... ............ A ........ Auditory function, 60 min .................... 0.00 1.92 1.52 NA NA 0.06 XXX
92621 .... ............ A ........ Auditory function, + 15 min ................ 0.00 0.43 0.34 NA NA 0.06 ZZZ
92625 .... ............ A ........ Tinnitus assessment ........................... 0.00 1.92 1.51 1.92 1.51 0.06 XXX
92626 .... ............ A ........ Eval aud rehab status ........................ 0.00 1.99 2.07 NA NA 0.06 XXX
92627 .... ............ A ........ Eval aud status rehab add-on ............ 0.00 0.45 0.50 0.45 0.50 0.02 ZZZ
92640 .... ............ A ........ Aud brainstem implt programg ........... 0.00 1.32 1.37 1.32 1.37 0.01 XXX
92700 .... ............ C ........ Ent procedure/service ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92950 .... ............ A ........ Heart/lung resuscitation cpr ................ 3.79 3.21 3.71 0.77 0.88 0.28 000
92953 .... ............ A ........ Temporary external pacing ................. 0.23 NA NA 0.07 0.07 0.02 000
92960 .... ............ A ........ Cardioversion electric, ext .................. 2.25 4.22 5.29 1.39 1.30 0.07 000
92961 .... ............ A ........ Cardioversion, electric, int .................. 4.59 NA NA 2.35 2.24 0.29 000
92970 .... ............ A ........ Cardioassist, internal .......................... 3.51 NA NA 1.44 1.28 0.16 000
92971 .... ............ A ........ Cardioassist, external ......................... 1.77 NA NA 1.06 0.96 0.06 000
92973 .... ............ A ........ Percut coronary thrombectomy .......... 3.28 NA NA 1.69 1.51 0.23 ZZZ
92974 .... ............ A ........ Cath place, cardio brachytx ................ 3.00 NA NA 1.55 1.39 0.21 ZZZ
92975 .... ............ A ........ Dissolve clot, heart vessel .................. 7.24 NA NA 3.68 3.29 0.50 000
92977 .... ............ A ........ Dissolve clot, heart vessel .................. 0.00 1.68 4.87 NA NA 0.46 XXX
92978 .... ............ C ........ Intravasc us, heart add-on ................. 1.80 NA NA NA NA 0.30 ZZZ
92978 .... 26 ....... A ........ Intravasc us, heart add-on ................. 1.80 0.92 0.83 0.92 0.83 0.06 ZZZ
92978 .... TC ...... C ........ Intravasc us, heart add-on ................. 0.00 NA NA NA NA 0.24 ZZZ
92979 .... ............ C ........ Intravasc us, heart add-on ................. 1.44 NA NA NA NA 0.19 ZZZ
92979 .... 26 ....... A ........ Intravasc us, heart add-on ................. 1.44 0.74 0.66 0.74 0.66 0.06 ZZZ
92979 .... TC ...... C ........ Intravasc us, heart add-on ................. 0.00 NA NA NA NA 0.13 ZZZ
92980 .... ............ A ........ Insert intracoronary stent .................... 14.82 NA NA 7.80 7.03 1.03 000
92981 .... ............ A ........ Insert intracoronary stent .................... 4.16 NA NA 2.14 1.91 0.29 ZZZ
92982 .... ............ A ........ Coronary artery dilation ...................... 10.96 NA NA 5.82 5.25 0.76 000
92984 .... ............ A ........ Coronary artery dilation ...................... 2.97 NA NA 1.52 1.36 0.21 ZZZ
92986 .... ............ A ........ Revision of aortic valve ...................... 22.70 NA NA 14.75 13.48 1.51 090
92992 .... ............ C ........ Revision of heart chamber ................. 0.00 0.00 0.00 0.00 0.00 0.00 090
92993 .... ............ C ........ Revision of heart chamber ................. 0.00 0.00 0.00 0.00 0.00 0.00 090
92995 .... ............ A ........ Coronary atherectomy ........................ 12.07 NA NA 6.38 5.76 0.84 000
92996 .... ............ A ........ Coronary atherectomy add-on ............ 3.26 NA NA 1.68 1.50 0.10 ZZZ
92997 .... ............ A ........ Pul art balloon repr, percut ................. 11.98 NA NA 5.52 5.13 0.40 000
92998 .... ............ A ........ Pul art balloon repr, percut ................. 5.99 NA NA 2.91 2.54 0.28 ZZZ
93000 .... ............ A ........ Electrocardiogram, complete .............. 0.17 0.33 0.42 0.33 0.42 0.03 XXX
93005 .... ............ A ........ Electrocardiogram, tracing .................. 0.00 0.27 0.36 NA NA 0.02 XXX
93010 .... ............ A ........ Electrocardiogram report .................... 0.17 0.07 0.06 0.07 0.06 0.01 XXX
93012 .... ............ A ........ Transmission of ecg ........................... 0.00 4.10 5.07 NA NA 0.18 XXX
93014 .... ............ A ........ Report on transmitted ecg .................. 0.52 0.22 0.21 0.22 0.21 0.02 XXX
93015 .... ............ A ........ Cardiovascular stress test .................. 0.75 1.84 1.91 1.84 1.91 0.14 XXX
93017 .... ............ A ........ Cardiovascular stress test .................. 0.00 1.48 1.59 NA NA 0.11 XXX
93024 .... ............ A ........ Cardiac drug stress test ..................... 1.17 2.31 1.96 NA NA 0.12 XXX
93024 .... 26 ....... A ........ Cardiac drug stress test ..................... 1.17 0.55 0.51 0.55 0.51 0.04 XXX
93024 .... TC ...... A ........ Cardiac drug stress test ..................... 0.00 1.75 1.45 NA NA 0.08 XXX
93025 .... ............ A ........ Microvolt t-wave assess ..................... 0.75 3.81 5.72 NA NA 0.14 XXX
93025 .... 26 ....... A ........ Microvolt t-wave assess ..................... 0.75 0.37 0.33 0.37 0.33 0.03 XXX
93025 .... TC ...... A ........ Microvolt t-wave assess ..................... 0.00 3.44 5.39 NA NA 0.11 XXX
93040 .... ............ A ........ Rhythm ECG with report .................... 0.16 0.19 0.20 0.19 0.20 0.02 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
93041 .... ............ A ........ Rhythm ECG, tracing ......................... 0.00 0.14 0.15 NA NA 0.01 XXX
93042 .... ............ A ........ Rhythm ECG, report ........................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX
93224 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.52 1.88 2.82 1.88 2.82 0.24 XXX
93225 .... ............ A ........ ECG monitor/record, 24 hrs ............... 0.00 0.83 1.04 NA NA 0.08 XXX
93226 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.00 1.15 1.67 NA NA 0.14 XXX
93227 .... ............ A ........ ECG monitor/review, 24 hrs ............... 0.52 0.26 0.23 0.26 0.23 0.02 XXX
93230 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.52 1.70 2.89 1.70 2.89 0.26 XXX
93231 .... ............ A ........ Ecg monitor/record, 24 hrs ................. 0.00 0.70 1.11 NA NA 0.11 XXX
93232 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.00 1.31 1.75 NA NA 0.13 XXX
93235 .... ............ C ........ ECG monitor/report, 24 hrs ................ 0.45 0.00 1.43 NA NA 0.16 XXX
93236 .... ............ C ........ ECG monitor/report, 24 hrs ................ 0.00 0.00 1.31 NA NA 0.14 XXX
93268 .... ............ A ........ ECG record/review ............................. 0.52 0.75 4.93 0.75 4.93 0.28 XXX
93270 .... ............ A ........ ECG recording .................................... 0.00 0.28 0.76 NA NA 0.08 XXX
93271 .... ............ A ........ Ecg/monitoring and analysis .............. 0.00 5.15 5.60 NA NA 0.18 XXX
93272 .... ............ A ........ Ecg/review, interpret only ................... 0.52 0.21 0.20 0.21 0.20 0.02 XXX
93278 .... ............ A ........ ECG/signal-averaged ......................... 0.25 0.61 0.93 NA NA 0.12 XXX
93278 .... 26 ....... A ........ ECG/signal-averaged ......................... 0.25 0.10 0.10 0.10 0.10 0.01 XXX
93278 .... TC ...... A ........ ECG/signal-averaged ......................... 0.00 0.51 0.83 NA NA 0.11 XXX
93303 .... ............ A ........ Echo transthoracic .............................. 1.30 4.37 4.40 NA NA 0.27 XXX
93303 .... 26 ....... A ........ Echo transthoracic .............................. 1.30 0.52 0.51 0.52 0.51 0.04 XXX
93303 .... TC ...... A ........ Echo transthoracic .............................. 0.00 3.86 3.89 NA NA 0.23 XXX
93307 .... ............ A ........ Echo exam of heart ............................ 0.92 3.61 3.94 NA NA 0.26 XXX
93307 .... 26 ....... A ........ Echo exam of heart ............................ 0.92 0.44 0.40 0.44 0.40 0.03 XXX
93307 .... TC ...... A ........ Echo exam of heart ............................ 0.00 3.18 3.54 NA NA 0.23 XXX
93308 .... ............ A ........ Echo exam of heart ............................ 0.53 2.53 2.35 NA NA 0.15 XXX
93308 .... 26 ....... A ........ Echo exam of heart ............................ 0.53 0.26 0.23 0.26 0.23 0.02 XXX
93308 .... TC ...... A ........ Echo exam of heart ............................ 0.00 2.28 2.12 NA NA 0.13 XXX
93312 .... ............ A ........ Echo transesophageal ........................ 2.20 7.17 5.93 NA NA 0.37 XXX
93312 .... 26 ....... A ........ Echo transesophageal ........................ 2.20 0.94 0.88 0.94 0.88 0.08 XXX
93312 .... TC ...... A ........ Echo transesophageal ........................ 0.00 6.23 5.05 NA NA 0.29 XXX
93313 .... ............ A ........ Echo transesophageal ........................ 0.95 NA NA 0.13 0.17 0.06 XXX
93314 .... ............ A ........ Echo transesophageal ........................ 1.25 7.00 5.66 NA NA 0.33 XXX
93314 .... TC ...... A ........ Echo transesophageal ........................ 0.00 6.46 5.15 NA NA 0.29 XXX
93315 .... ............ C ........ Echo transesophageal ........................ 2.78 NA NA NA NA 0.09 XXX
93315 .... TC ...... C ........ Echo transesophageal ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93316 .... ............ A ........ Echo transesophageal ........................ 0.95 NA NA 0.25 0.25 0.05 XXX
93317 .... ............ C ........ Echo transesophageal ........................ 1.83 NA NA NA NA 0.08 XXX
93317 .... TC ...... C ........ Echo transesophageal ........................ 0.00 0.00 1.79 0.00 1.79 0.00 XXX
93318 .... ............ C ........ Echo transesophageal intraop ............ 2.20 0.00 0.39 0.00 0.39 0.14 XXX
93318 .... 26 ....... A ........ Echo transesophageal intraop ............ 2.20 0.83 0.67 0.83 0.67 0.14 XXX
93318 .... TC ...... C ........ Echo transesophageal intraop ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93320 .... ............ A ........ Doppler echo exam, heart .................. 0.38 1.62 1.75 1.62 1.75 0.13 ZZZ
93320 .... 26 ....... A ........ Doppler echo exam, heart .................. 0.38 0.18 0.17 0.18 0.17 0.01 ZZZ
93320 .... TC ...... A ........ Doppler echo exam, heart .................. 0.00 1.44 1.59 1.44 1.59 0.12 ZZZ
93321 .... ............ A ........ Doppler echo exam, heart .................. 0.15 0.59 0.89 0.59 0.89 0.09 ZZZ
93321 .... 26 ....... A ........ Doppler echo exam, heart .................. 0.15 0.07 0.07 0.07 0.07 0.01 ZZZ
93321 .... TC ...... A ........ Doppler echo exam, heart .................. 0.00 0.52 0.82 0.52 0.82 0.08 ZZZ
93325 .... ............ B ........ Doppler color flow add-on .................. 0.07 0.64 1.79 0.64 1.79 0.22 ZZZ
93325 .... 26 ....... B ........ Doppler color flow add-on .................. 0.07 0.03 0.03 0.03 0.03 0.01 ZZZ
93325 .... TC ...... B ........ Doppler color flow add-on .................. 0.00 0.61 1.76 0.61 1.76 0.21 ZZZ
93501 .... ............ A ........ Right heart catheterization ................. 3.02 18.09 15.33 NA NA 1.26 000
93501 .... 26 ....... A ........ Right heart catheterization ................. 3.02 1.51 1.35 1.51 1.35 0.21 000
93501 .... TC ...... A ........ Right heart catheterization ................. 0.00 16.58 13.98 NA NA 1.05 000
93503 .... ............ A ........ Insert/place heart catheter .................. 2.91 NA NA 0.43 0.56 0.20 000
93505 .... ............ A ........ Biopsy of heart lining .......................... 4.37 20.23 8.97 NA NA 0.46 000
93505 .... 26 ....... A ........ Biopsy of heart lining .......................... 4.37 2.19 1.96 2.19 1.96 0.30 000
93505 .... TC ...... A ........ Biopsy of heart lining .......................... 0.00 18.03 7.00 NA NA 0.16 000
93508 .... ............ A ........ Cath placement, angiography ............ 4.09 27.89 17.02 NA NA 0.93 000
93508 .... 26 ....... A ........ Cath placement, angiography ............ 4.09 2.09 2.12 2.09 2.12 0.28 000
93508 .... TC ...... A ........ Cath placement, angiography ............ 0.00 25.80 14.90 NA NA 0.65 000
93510 .... ............ A ........ Left heart catheterization .................... 4.32 27.22 29.03 NA NA 2.62 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
93510 .... 26 ....... A ........ Left heart catheterization .................... 4.32 2.19 2.21 2.19 2.21 0.30 000
93510 .... TC ...... A ........ Left heart catheterization .................... 0.00 25.03 26.82 NA NA 2.32 000
93511 .... ............ A ........ Left heart catheterization .................... 5.02 NA NA NA NA 2.60 000
93511 .... TC ...... A ........ Left heart catheterization .................... 0.00 NA NA NA NA 2.25 000
93524 .... TC ...... A ........ Left heart catheterization .................... 0.00 NA NA NA NA 2.96 000
93526 .... ............ A ........ Rt & Lt heart catheters ....................... 5.98 33.97 37.42 NA NA 3.47 000
93526 .... 26 ....... A ........ Rt & Lt heart catheters ....................... 5.98 3.04 2.97 3.04 2.97 0.42 000
93526 .... TC ...... A ........ Rt & Lt heart catheters ....................... 0.00 30.93 34.46 NA NA 3.05 000
93527 .... ............ A ........ Rt & Lt heart catheters ....................... 7.27 NA NA NA NA 3.47 000
93527 .... TC ...... A ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 2.96 000
93528 .... ............ A ........ Rt & Lt heart catheters ....................... 8.99 NA NA NA NA 3.58 000
93528 .... TC ...... A ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 2.96 000
93529 .... ............ A ........ Rt, lt heart catheterization .................. 4.79 NA NA NA NA 3.29 000
93529 .... 26 ....... A ........ Rt, lt heart catheterization .................. 4.79 2.44 2.39 2.44 2.39 0.33 000
93529 .... TC ...... A ........ Rt, lt heart catheterization .................. 0.00 NA NA NA NA 2.96 000
93530 .... ............ A ........ Rt heart cath, congenital .................... 4.22 NA NA NA NA 1.34 000
93530 .... 26 ....... A ........ Rt heart cath, congenital .................... 4.22 1.77 1.87 1.77 1.87 0.29 000
93530 .... TC ...... A ........ Rt heart cath, congenital .................... 0.00 NA NA NA NA 1.05 000
93531 .... ............ A ........ R & l heart cath, congenital ................ 8.34 NA NA NA NA 3.63 000
93531 .... 26 ....... A ........ R & l heart cath, congenital ................ 8.34 2.76 3.34 2.76 3.34 0.58 000
93531 .... TC ...... A ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 3.05 000
93539 .... ............ A ........ Injection, cardiac cath ......................... 0.40 2.39 0.92 NA NA 0.01 000
93540 .... ............ A ........ Injection, cardiac cath ......................... 0.43 0.67 0.35 NA NA 0.01 000
93541 .... ............ A ........ Injection for lung angiogram ............... 0.29 NA NA 0.15 0.13 0.01 000
93542 .... ............ A ........ Injection for heart x-rays ..................... 0.29 0.46 0.23 NA NA 0.01 000
93543 .... ............ A ........ Injection for heart x-rays ..................... 0.29 2.54 0.93 NA NA 0.01 000
93544 .... ............ A ........ Injection for aortography ..................... 0.25 1.78 0.67 NA NA 0.01 000
93545 .... ............ A ........ Inject for coronary x-rays .................... 0.40 5.67 2.01 NA NA 0.01 000
93555 .... ............ A ........ Imaging, cardiac cath ......................... 0.81 0.57 3.56 NA NA 0.37 XXX
93555 .... 26 ....... A ........ Imaging, cardiac cath ......................... 0.81 0.41 0.37 0.41 0.37 0.03 XXX
93555 .... TC ...... A ........ Imaging, cardiac cath ......................... 0.00 0.16 3.19 NA NA 0.34 XXX
93556 .... ............ A ........ Imaging, cardiac cath ......................... 0.83 0.84 5.47 NA NA 0.54 XXX
93556 .... 26 ....... A ........ Imaging, cardiac cath ......................... 0.83 0.42 0.38 0.42 0.38 0.03 XXX
93556 .... TC ...... A ........ Imaging, cardiac cath ......................... 0.00 0.42 5.09 NA NA 0.51 XXX
93561 .... ............ A ........ Cardiac output measurement ............. 0.50 NA NA NA NA 0.08 000
93561 .... 26 ....... A ........ Cardiac output measurement ............. 0.50 0.14 0.15 0.14 0.15 0.02 000
93561 .... TC ...... A ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.06 000
93562 .... ............ A ........ Cardiac output measurement ............. 0.16 NA NA NA NA 0.05 000
93562 .... 26 ....... A ........ Cardiac output measurement ............. 0.16 0.03 0.04 0.03 0.04 0.01 000
93562 .... TC ...... A ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.04 000
93571 .... ............ A ........ Heart flow reserve measure ............... 1.80 NA NA NA NA 0.30 ZZZ
93571 .... 26 ....... A ........ Heart flow reserve measure ............... 1.80 0.92 0.81 0.92 0.81 0.06 ZZZ
93571 .... TC ...... A ........ Heart flow reserve measure ............... 0.00 . 4.57 . 4.57 0.24 ZZZ
93572 .... ............ A ........ Heart flow reserve measure ............... 1.44 0.71 0.61 0.71 0.61 0.04 ZZZ
93572 .... 26 ....... A ........ Heart flow reserve measure ............... 1.44 0.71 0.61 0.71 0.61 0.04 ZZZ
93580 .... ............ A ........ Transcath closure of asd .................... 17.97 NA NA 9.05 8.33 1.25 000
93581 .... ............ A ........ Transcath closure of vsd .................... 24.39 NA NA 10.89 10.56 1.72 000
93600 .... ............ C ........ Bundle of His recording ...................... 2.12 NA NA NA NA 0.29 000
93600 .... 26 ....... A ........ Bundle of His recording ...................... 2.12 1.04 0.95 1.04 0.95 0.16 000
93600 .... TC ...... C ........ Bundle of His recording ...................... 0.00 0.00 1.31 0.00 1.31 0.13 000
93602 .... ............ C ........ Intra-atrial recording ........................... 2.12 NA NA NA NA 0.24 000
93602 .... 26 ....... A ........ Intra-atrial recording ........................... 2.12 1.01 0.93 1.01 0.93 0.17 000
93602 .... TC ...... C ........ Intra-atrial recording ........................... 0.00 0.00 0.74 0.00 0.74 0.07 000
93603 .... ............ C ........ Right ventricular recording ................. 2.12 NA NA NA NA 0.29 000
93603 .... 26 ....... A ........ Right ventricular recording ................. 2.12 1.00 0.92 1.00 0.92 0.18 000
93603 .... TC ...... C ........ Right ventricular recording ................. 0.00 0.00 1.12 0.00 1.12 0.11 000
93609 .... ............ C ........ Map tachycardia, add-on .................... 4.99 NA NA NA NA 0.52 ZZZ
93609 .... 26 ....... A ........ Map tachycardia, add-on .................... 4.99 2.51 2.27 2.51 2.27 0.35 ZZZ
93609 .... TC ...... C ........ Map tachycardia, add-on .................... 0.00 0.00 1.82 0.00 1.82 0.17 ZZZ
93610 .... ............ C ........ Intra-atrial pacing ................................ 3.02 NA NA NA NA 0.34 000
93610 .... 26 ....... A ........ Intra-atrial pacing ................................ 3.02 1.41 1.30 1.41 1.30 0.24 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
93610 .... TC ...... C ........ Intra-atrial pacing ................................ 0.00 NA NA NA NA 0.10 000
93612 .... ............ C ........ Intraventricular pacing ........................ 3.02 NA NA NA NA 0.36 000
93612 .... 26 ....... A ........ Intraventricular pacing ........................ 3.02 1.37 1.28 1.37 1.28 0.25 000
93612 .... TC ...... C ........ Intraventricular pacing ........................ 0.00 0.00 1.07 0.00 1.07 0.11 000
93613 .... ............ A ........ Electrophys map 3d, add-on .............. 6.99 NA NA 3.54 3.20 0.49 ZZZ
93615 .... ............ C ........ Esophageal recording ......................... 0.99 NA NA NA NA 0.05 000
93615 .... 26 ....... A ........ Esophageal recording ......................... 0.99 0.51 0.39 0.51 0.39 0.03 000
93615 .... TC ...... C ........ Esophageal recording ......................... 0.00 0.00 0.21 0.00 0.21 0.02 000
93616 .... ............ C ........ Esophageal recording ......................... 1.49 0.00 0.45 0.00 0.45 0.09 000
93616 .... 26 ....... A ........ Esophageal recording ......................... 1.49 0.26 0.37 0.26 0.37 0.09 000
93616 .... TC ...... C ........ Esophageal recording ......................... 0.00 0.00 0.16 0.00 0.16 0.00 000
93618 .... ............ C ........ Heart rhythm pacing ........................... 4.25 NA NA NA NA 0.54 000
93618 .... 26 ....... A ........ Heart rhythm pacing ........................... 4.25 2.19 1.96 2.19 1.96 0.30 000
93618 .... TC ...... C ........ Heart rhythm pacing ........................... 0.00 0.00 2.65 0.00 2.65 0.24 000
93619 .... ............ C ........ Electrophysiology evaluation .............. 7.31 NA NA NA NA 0.98 000
93619 .... 26 ....... A ........ Electrophysiology evaluation .............. 7.31 3.71 3.48 3.71 3.48 0.51 000
93619 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 5.15 0.00 5.15 0.47 000
93620 .... ............ C ........ Electrophysiology evaluation .............. 11.57 NA NA 0.00 7.91 0.80 000
93621 .... ............ C ........ Electrophysiology evaluation .............. 2.10 0.00 0.60 0.00 0.60 0.15 ZZZ
93621 .... 26 ....... A ........ Electrophysiology evaluation .............. 2.10 1.06 0.95 1.06 0.95 0.15 ZZZ
93621 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93622 .... ............ C ........ Electrophysiology evaluation .............. 3.10 0.00 0.89 0.00 0.89 0.22 ZZZ
93622 .... 26 ....... A ........ Electrophysiology evaluation .............. 3.10 1.50 1.39 1.50 1.39 0.22 ZZZ
93622 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93623 .... ............ C ........ Stimulation, pacing heart .................... 2.85 0.00 0.81 0.00 0.81 0.20 ZZZ
93623 .... 26 ....... A ........ Stimulation, pacing heart .................... 2.85 1.43 1.29 1.43 1.29 0.20 ZZZ
93623 .... TC ...... C ........ Stimulation, pacing heart .................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93624 .... ............ C ........ Electrophysiologic study ..................... 4.80 NA NA 0.00 1.54 0.46 000
93624 .... 26 ....... A ........ Electrophysiologic study ..................... 4.80 2.49 2.37 2.49 2.37 0.33 000
93624 .... TC ...... C ........ Electrophysiologic study ..................... 0.00 0.00 1.33 0.00 1.33 0.13 000
93631 .... ............ C ........ Heart pacing, mapping ....................... 7.59 0.00 4.92 0.00 4.92 0.97 000
93631 .... 26 ....... A ........ Heart pacing, mapping ....................... 7.59 2.75 2.76 2.75 2.76 0.97 000
93631 .... TC ...... C ........ Heart pacing, mapping ....................... 0.00 0.00 3.07 0.00 3.07 0.00 000
93640 .... ............ C ........ Evaluation heart device ...................... 3.51 NA NA NA NA 0.66 000
93640 .... 26 ....... A ........ Evaluation heart device ...................... 3.51 1.74 1.58 1.74 1.58 0.24 000
93640 .... TC ...... C ........ Evaluation heart device ...................... 0.00 0.00 4.79 0.00 4.79 0.42 000
93641 .... ............ C ........ Electrophysiology evaluation .............. 5.92 NA NA NA NA 0.83 000
93642 .... ............ A ........ Electrophysiology evaluation .............. 4.88 7.08 8.29 7.08 8.29 0.57 000
93642 .... TC ...... A ........ Electrophysiology evaluation .............. 0.00 4.60 5.91 4.60 5.91 0.42 000
93660 .... ............ A ........ Tilt table evaluation ............................ 1.89 2.90 2.69 2.90 2.69 0.08 000
93660 .... 26 ....... A ........ Tilt table evaluation ............................ 1.89 0.94 0.85 0.94 0.85 0.06 000
93660 .... TC ...... A ........ Tilt table evaluation ............................ 0.00 1.97 1.84 1.97 1.84 0.02 000
93662 .... ............ C ........ Intracardiac ecg (ice) .......................... 2.80 0.00 0.81 0.00 0.81 0.09 ZZZ
93662 .... 26 ....... A ........ Intracardiac ecg (ice) .......................... 2.80 1.41 1.28 1.41 1.28 0.09 ZZZ
93662 .... TC ...... C ........ Intracardiac ecg (ice) .......................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
93668 .... ............ N ........ Peripheral vascular rehab .................. 0.00 0.40 0.40 NA NA 0.01 XXX
93701 .... ............ A ........ Bioimpedance, thoracic ...................... 0.17 0.68 0.83 NA NA 0.02 XXX
93701 .... 26 ....... A ........ Bioimpedance, thoracic ...................... 0.17 0.06 0.07 0.06 0.07 0.01 XXX
93701 .... TC ...... A ........ Bioimpedance, thoracic ...................... 0.00 0.62 0.77 NA NA 0.01 XXX
93720 .... ............ A ........ Total body plethysmography .............. 0.17 1.26 1.00 1.26 1.00 0.07 XXX
93721 .... ............ A ........ Plethysmography tracing .................... 0.00 1.12 0.92 NA NA 0.06 XXX
93722 .... ............ A ........ Plethysmography report ..................... 0.17 0.04 0.05 0.04 0.05 0.01 XXX
93724 .... ............ A ........ Analyze pacemaker system ............... 4.88 3.04 4.54 3.04 4.54 0.39 000
93724 .... 26 ....... A ........ Analyze pacemaker system ............... 4.88 2.21 2.13 2.21 2.13 0.15 000
93724 .... TC ...... A ........ Analyze pacemaker system ............... 0.00 0.84 2.41 0.84 2.41 0.24 000
93727 .... ............ A ........ Analyze ilr system .............................. 0.52 0.61 0.41 0.61 0.41 0.02 XXX
93731 .... ............ A ........ Analyze pacemaker system ............... 0.45 0.76 0.72 NA NA 0.05 XXX
93731 .... 26 ....... A ........ Analyze pacemaker system ............... 0.45 0.23 0.20 0.23 0.20 0.01 XXX
93731 .... TC ...... A ........ Analyze pacemaker system ............... 0.00 0.53 0.52 NA NA 0.04 XXX
93733 .... ............ A ........ Telephone analy, pacemaker ............. 0.17 0.90 0.85 NA NA 0.07 XXX
93733 .... 26 ....... A ........ Telephone analy, pacemaker ............. 0.17 0.08 0.07 0.08 0.07 0.01 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
93733 .... TC ...... A ........ Telephone analy, pacemaker ............. 0.00 0.82 0.78 NA NA 0.06 XXX
93736 .... ............ A ........ Telephonic analy, pacemaker ............ 0.15 0.88 0.79 NA NA 0.07 XXX
93736 .... 26 ....... A ........ Telephonic analy, pacemaker ............ 0.15 0.07 0.06 0.07 0.06 0.01 XXX
93736 .... TC ...... A ........ Telephonic analy, pacemaker ............ 0.00 0.82 0.73 NA NA 0.06 XXX
93740 .... ............ B ........ Temperature gradient studies ............ 0.16 0.04 0.11 NA NA 0.02 XXX
93740 .... 26 ....... B ........ Temperature gradient studies ............ 0.16 0.04 0.04 0.04 0.04 0.01 XXX
93740 .... TC ...... B ........ Temperature gradient studies ............ 0.00 0.00 0.07 NA NA 0.01 XXX
93741 .... ............ A ........ Analyze ht pace device sngl .............. 0.80 0.98 0.99 NA NA 0.07 XXX
93741 .... 26 ....... A ........ Analyze ht pace device sngl .............. 0.80 0.41 0.36 0.41 0.36 0.03 XXX
93741 .... TC ...... A ........ Analyze ht pace device sngl .............. 0.00 0.57 0.62 NA NA 0.04 XXX
93742 .... ............ A ........ Analyze ht pace device sngl .............. 0.91 1.11 1.08 NA NA 0.07 XXX
93742 .... 26 ....... A ........ Analyze ht pace device sngl .............. 0.91 0.46 0.42 0.46 0.42 0.03 XXX
93742 .... TC ...... A ........ Analyze ht pace device sngl .............. 0.00 0.65 0.66 NA NA 0.04 XXX
93743 .... ............ A ........ Analyze ht pace device dual .............. 1.03 1.15 1.15 NA NA 0.07 XXX
93743 .... 26 ....... A ........ Analyze ht pace device dual .............. 1.03 0.52 0.47 0.52 0.47 0.03 XXX
93743 .... TC ...... A ........ Analyze ht pace device dual .............. 0.00 0.62 0.68 NA NA 0.04 XXX
93744 .... ............ A ........ Analyze ht pace device dual .............. 1.18 1.29 1.22 NA NA 0.08 XXX
93744 .... 26 ....... A ........ Analyze ht pace device dual .............. 1.18 0.60 0.54 0.60 0.54 0.04 XXX
93744 .... TC ...... A ........ Analyze ht pace device dual .............. 0.00 0.69 0.68 NA NA 0.04 XXX
93745 .... ............ C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93745 .... 26 ....... C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93745 .... TC ...... C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93770 .... ............ B ........ Measure venous pressure .................. 0.16 0.04 0.06 NA NA 0.02 XXX
93770 .... 26 ....... B ........ Measure venous pressure .................. 0.16 0.04 0.05 0.04 0.05 0.01 XXX
93770 .... TC ...... B ........ Measure venous pressure .................. 0.00 0.00 0.01 NA NA 0.01 XXX
93784 .... ............ A ........ Ambulatory BP monitoring .................. 0.38 1.13 1.40 1.13 1.40 0.03 XXX
93786 .... ............ A ........ Ambulatory BP recording ................... 0.00 0.86 0.89 NA NA 0.01 XXX
93788 .... ............ A ........ Ambulatory BP analysis ..................... 0.00 0.51 0.51 NA NA 0.01 XXX
93790 .... ............ A ........ Review/report BP recording ............... 0.38 0.14 0.13 0.14 0.13 0.01 XXX
93797 .... ............ I .......... Cardiac rehab ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 000
93798 .... ............ I .......... Cardiac rehab/monitor ........................ 0.00 0.00 0.00 0.00 0.00 0.00 000
93799 .... ............ C ........ Cardiovascular procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93799 .... 26 ....... C ........ Cardiovascular procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93799 .... TC ...... C ........ Cardiovascular procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
93875 .... ............ A ........ Extracranial study ............................... 0.22 2.50 2.42 NA NA 0.12 XXX
93875 .... 26 ....... A ........ Extracranial study ............................... 0.22 0.07 0.08 0.07 0.08 0.01 XXX
93875 .... TC ...... A ........ Extracranial study ............................... 0.00 2.44 2.35 NA NA 0.11 XXX
93886 .... ............ A ........ Intracranial study ................................ 0.94 6.94 6.83 NA NA 0.45 XXX
93886 .... 26 ....... A ........ Intracranial study ................................ 0.94 0.28 0.33 0.28 0.33 0.06 XXX
93886 .... TC ...... A ........ Intracranial study ................................ 0.00 6.66 6.50 NA NA 0.39 XXX
93888 .... ............ A ........ Intracranial study ................................ 0.62 4.83 4.52 NA NA 0.32 XXX
93888 .... 26 ....... A ........ Intracranial study ................................ 0.62 0.20 0.21 0.20 0.21 0.05 XXX
93888 .... TC ...... A ........ Intracranial study ................................ 0.00 4.63 4.30 NA NA 0.27 XXX
93890 .... ............ A ........ Tcd, vasoreactivity study .................... 1.00 6.35 5.58 NA NA 0.45 XXX
93890 .... 26 ....... A ........ Tcd, vasoreactivity study .................... 1.00 0.31 0.36 0.31 0.36 0.06 XXX
93890 .... TC ...... A ........ Tcd, vasoreactivity study .................... 0.00 6.04 5.23 NA NA 0.39 XXX
93892 .... ............ A ........ Tcd, emboli detect w/o inj .................. 1.15 6.77 5.94 NA NA 0.45 XXX
93892 .... 26 ....... A ........ Tcd, emboli detect w/o inj .................. 1.15 0.32 0.39 0.32 0.39 0.06 XXX
93892 .... TC ...... A ........ Tcd, emboli detect w/o inj .................. 0.00 6.44 5.54 NA NA 0.39 XXX
93893 .... ............ A ........ Tcd, emboli detect w/inj ...................... 1.15 6.92 5.87 NA NA 0.45 XXX
93893 .... 26 ....... A ........ Tcd, emboli detect w/inj ...................... 1.15 0.33 0.40 0.33 0.40 0.06 XXX
93893 .... TC ...... A ........ Tcd, emboli detect w/inj ...................... 0.00 6.59 5.47 NA NA 0.39 XXX
93922 .... ............ A ........ Extremity study ................................... 0.25 3.05 2.87 NA NA 0.15 XXX
93922 .... 26 ....... A ........ Extremity study ................................... 0.25 0.08 0.08 0.08 0.08 0.02 XXX
93922 .... TC ...... A ........ Extremity study ................................... 0.00 2.97 2.79 NA NA 0.13 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
93925 .... ............ A ........ Lower extremity study ........................ 0.58 7.88 7.33 NA NA 0.39 XXX
93925 .... 26 ....... A ........ Lower extremity study ........................ 0.58 0.19 0.20 0.19 0.20 0.04 XXX
93925 .... TC ...... A ........ Lower extremity study ........................ 0.00 7.70 7.13 NA NA 0.35 XXX
93926 .... ............ A ........ Lower extremity study ........................ 0.39 5.07 4.56 NA NA 0.27 XXX
93926 .... 26 ....... A ........ Lower extremity study ........................ 0.39 0.11 0.12 0.11 0.12 0.04 XXX
93926 .... TC ...... A ........ Lower extremity study ........................ 0.00 4.96 4.44 NA NA 0.23 XXX
93930 .... ............ A ........ Upper extremity study ........................ 0.46 6.16 5.75 NA NA 0.41 XXX
93930 .... 26 ....... A ........ Upper extremity study ........................ 0.46 0.15 0.16 0.15 0.16 0.04 XXX
93930 .... TC ...... A ........ Upper extremity study ........................ 0.00 6.01 5.59 NA NA 0.37 XXX
93931 .... ............ A ........ Upper extremity study ........................ 0.31 4.11 3.80 NA NA 0.27 XXX
93931 .... 26 ....... A ........ Upper extremity study ........................ 0.31 0.10 0.10 0.10 0.10 0.03 XXX
93931 .... TC ...... A ........ Upper extremity study ........................ 0.00 4.02 3.70 NA NA 0.24 XXX
93975 .... ............ A ........ Vascular study .................................... 1.80 8.32 7.96 NA NA 0.56 XXX
93975 .... 26 ....... A ........ Vascular study .................................... 1.80 0.62 0.61 0.62 0.61 0.13 XXX
93975 .... TC ...... A ........ Vascular study .................................... 0.00 7.69 7.35 NA NA 0.43 XXX
93980 .... ............ A ........ Penile vascular study ......................... 1.25 3.45 3.16 NA NA 0.42 XXX
93980 .... 26 ....... A ........ Penile vascular study ......................... 1.25 0.47 0.44 0.47 0.44 0.08 XXX
93980 .... TC ...... A ........ Penile vascular study ......................... 0.00 2.99 2.72 NA NA 0.34 XXX
93981 .... ............ A ........ Penile vascular study ......................... 0.44 2.82 2.84 NA NA 0.33 XXX
93981 .... 26 ....... A ........ Penile vascular study ......................... 0.44 0.16 0.15 0.16 0.15 0.02 XXX
93981 .... TC ...... A ........ Penile vascular study ......................... 0.00 2.66 2.69 NA NA 0.31 XXX
93990 .... ............ A ........ Doppler flow testing ............................ 0.25 5.16 4.57 NA NA 0.26 XXX
93990 .... 26 ....... A ........ Doppler flow testing ............................ 0.25 0.06 0.07 0.06 0.07 0.03 XXX
93990 .... TC ...... A ........ Doppler flow testing ............................ 0.00 5.09 4.50 NA NA 0.23 XXX
94002 .... ............ A ........ Vent mgmt inpat, init day ................... 1.99 NA NA 0.36 0.33 0.09 XXX
94003 .... ............ A ........ Vent mgmt inpat, subq day ................ 1.37 NA NA 0.32 0.33 0.06 XXX
94004 .... ............ A ........ Vent mgmt nf per day ......................... 1.00 NA NA 0.23 0.24 0.04 XXX
94005 .... ............ B ........ Home vent mgmt supervision ............. 1.50 0.69 0.69 NA NA 0.06 XXX
94010 .... ............ A ........ Breathing capacity test ....................... 0.17 0.73 0.70 NA NA 0.03 XXX
94010 .... 26 ....... A ........ Breathing capacity test ....................... 0.17 0.04 0.05 0.04 0.05 0.01 XXX
94010 .... TC ...... A ........ Breathing capacity test ....................... 0.00 0.69 0.66 NA NA 0.02 XXX
94014 .... ............ A ........ Patient recorded spirometry ............... 0.52 0.80 0.78 0.80 0.78 0.03 XXX
94015 .... ............ A ........ Patient recorded spirometry ............... 0.00 0.66 0.63 NA NA 0.01 XXX
94016 .... ............ A ........ Review patient spirometry .................. 0.52 0.14 0.15 0.14 0.15 0.02 XXX
94060 .... ............ A ........ Evaluation of wheezing ...................... 0.31 1.30 1.19 1.30 1.19 0.07 XXX
94060 .... 26 ....... A ........ Evaluation of wheezing ...................... 0.31 0.08 0.09 0.08 0.09 0.01 XXX
94060 .... TC ...... A ........ Evaluation of wheezing ...................... 0.00 1.22 1.10 1.22 1.10 0.06 XXX
94070 .... ............ A ........ Evaluation of wheezing ...................... 0.60 0.99 0.90 NA NA 0.13 XXX
94070 .... 26 ....... A ........ Evaluation of wheezing ...................... 0.60 0.15 0.16 0.15 0.16 0.03 XXX
94070 .... TC ...... A ........ Evaluation of wheezing ...................... 0.00 0.84 0.74 NA NA 0.10 XXX
94150 .... ............ B ........ Vital capacity test ............................... 0.07 0.47 0.48 NA NA 0.02 XXX
94150 .... 26 ....... B ........ Vital capacity test ............................... 0.07 0.02 0.03 0.02 0.03 0.01 XXX
94150 .... TC ...... B ........ Vital capacity test ............................... 0.00 0.46 0.45 NA NA 0.01 XXX
94200 .... ............ A ........ Lung function test (MBC/MVV) ........... 0.11 0.50 0.47 NA NA 0.03 XXX
94200 .... 26 ....... A ........ Lung function test (MBC/MVV) ........... 0.11 0.03 0.03 0.03 0.03 0.01 XXX
94200 .... TC ...... A ........ Lung function test (MBC/MVV) ........... 0.00 0.47 0.44 NA NA 0.02 XXX
94240 .... ............ A ........ Residual lung capacity ....................... 0.26 0.81 0.74 NA NA 0.06 XXX
94240 .... 26 ....... A ........ Residual lung capacity ....................... 0.26 0.06 0.07 0.06 0.07 0.01 XXX
94240 .... TC ...... A ........ Residual lung capacity ....................... 0.00 0.75 0.66 NA NA 0.05 XXX
94250 .... ............ A ........ Expired gas collection ........................ 0.11 0.51 0.58 NA NA 0.02 XXX
94250 .... 26 ....... A ........ Expired gas collection ........................ 0.11 0.03 0.03 0.03 0.03 0.01 XXX
94250 .... TC ...... A ........ Expired gas collection ........................ 0.00 0.48 0.55 NA NA 0.01 XXX
94260 .... ............ A ........ Thoracic gas volume .......................... 0.13 0.75 0.67 NA NA 0.05 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
94260 .... 26 ....... A ........ Thoracic gas volume .......................... 0.13 0.03 0.04 0.03 0.04 0.01 XXX
94260 .... TC ...... A ........ Thoracic gas volume .......................... 0.00 0.72 0.63 NA NA 0.04 XXX
94350 .... ............ A ........ Lung nitrogen washout curve ............. 0.26 0.61 0.69 NA NA 0.05 XXX
94350 .... 26 ....... A ........ Lung nitrogen washout curve ............. 0.26 0.06 0.07 0.06 0.07 0.01 XXX
94350 .... TC ...... A ........ Lung nitrogen washout curve ............. 0.00 0.55 0.62 NA NA 0.04 XXX
94360 .... ............ A ........ Measure airflow resistance ................. 0.26 0.94 0.83 NA NA 0.07 XXX
94360 .... 26 ....... A ........ Measure airflow resistance ................. 0.26 0.06 0.07 0.06 0.07 0.01 XXX
94360 .... TC ...... A ........ Measure airflow resistance ................. 0.00 0.88 0.75 NA NA 0.06 XXX
94370 .... ............ A ........ Breath airway closing volume ............ 0.26 0.60 0.66 NA NA 0.03 XXX
94370 .... 26 ....... A ........ Breath airway closing volume ............ 0.26 0.07 0.08 0.07 0.08 0.01 XXX
94370 .... TC ...... A ........ Breath airway closing volume ............ 0.00 0.53 0.58 NA NA 0.02 XXX
94375 .... ............ A ........ Respiratory flow volume loop ............. 0.31 0.71 0.66 NA NA 0.03 XXX
94375 .... 26 ....... A ........ Respiratory flow volume loop ............. 0.31 0.08 0.09 0.08 0.09 0.01 XXX
94375 .... TC ...... A ........ Respiratory flow volume loop ............. 0.00 0.64 0.57 NA NA 0.02 XXX
94400 .... ............ A ........ CO2 breathing response curve .......... 0.40 1.02 0.93 NA NA 0.09 XXX
94400 .... 26 ....... A ........ CO2 breathing response curve .......... 0.40 0.10 0.11 0.10 0.11 0.03 XXX
94400 .... TC ...... A ........ CO2 breathing response curve .......... 0.00 0.92 0.82 NA NA 0.06 XXX
94450 .... ............ A ........ Hypoxia response curve ..................... 0.40 1.00 0.93 NA NA 0.04 XXX
94450 .... 26 ....... A ........ Hypoxia response curve ..................... 0.40 0.09 0.10 0.09 0.10 0.02 XXX
94450 .... TC ...... A ........ Hypoxia response curve ..................... 0.00 0.91 0.82 NA NA 0.02 XXX
94452 .... ............ A ........ Hast w/report ...................................... 0.31 1.26 1.12 NA NA 0.04 XXX
94452 .... 26 ....... A ........ Hast w/report ...................................... 0.31 0.07 0.08 0.07 0.08 0.02 XXX
94452 .... TC ...... A ........ Hast w/report ...................................... 0.00 1.18 1.03 NA NA 0.02 XXX
94453 .... ............ A ........ Hast w/oxygen titrate .......................... 0.40 1.67 1.58 NA NA 0.04 XXX
94453 .... 26 ....... A ........ Hast w/oxygen titrate .......................... 0.40 0.10 0.11 0.10 0.11 0.02 XXX
94453 .... TC ...... A ........ Hast w/oxygen titrate .......................... 0.00 1.57 1.46 NA NA 0.02 XXX
94610 .... ............ A ........ Surfactant admin thru tube ................. 1.16 0.34 0.35 0.34 0.35 0.26 XXX
94620 .... ............ A ........ Pulmonary stress test/simple ............. 0.64 0.79 1.64 NA NA 0.13 XXX
94620 .... 26 ....... A ........ Pulmonary stress test/simple ............. 0.64 0.17 0.18 0.17 0.18 0.03 XXX
94620 .... TC ...... A ........ Pulmonary stress test/simple ............. 0.00 0.62 1.45 NA NA 0.10 XXX
94621 .... ............ A ........ Pulm stress test/complex ................... 1.42 3.11 2.67 NA NA 0.16 XXX
94621 .... 26 ....... A ........ Pulm stress test/complex ................... 1.42 0.44 0.45 0.44 0.45 0.06 XXX
94621 .... TC ...... A ........ Pulm stress test/complex ................... 0.00 2.67 2.22 NA NA 0.10 XXX
94640 .... ............ A ........ Airway inhalation treatment ................ 0.00 0.37 0.34 NA NA 0.02 XXX
94642 .... ............ C ........ Aerosol inhalation treatment ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94644 .... ............ A ........ Cbt, 1st hour ....................................... 0.00 0.95 0.93 NA NA 0.02 XXX
94645 .... ............ A ........ Cbt, each addl hour ............................ 0.00 0.34 0.34 NA NA 0.02 XXX
94660 .... ............ A ........ Pos airway pressure, CPAP ............... 0.76 0.80 0.73 0.19 0.21 0.04 XXX
94662 .... ............ A ........ Neg press ventilation, cnp .................. 0.76 NA NA 0.20 0.21 0.03 XXX
94664 .... ............ A ........ Evaluate pt use of inhaler .................. 0.00 0.40 0.35 NA NA 0.04 XXX
94667 .... ............ A ........ Chest wall manipulation ..................... 0.00 0.53 0.53 NA NA 0.05 XXX
94668 .... ............ A ........ Chest wall manipulation ..................... 0.00 0.50 0.47 NA NA 0.02 XXX
94680 .... ............ A ........ Exhaled air analysis, o2 ..................... 0.26 1.05 1.46 1.05 1.46 0.07 XXX
94680 .... 26 ....... A ........ Exhaled air analysis, o2 ..................... 0.26 0.07 0.08 0.07 0.08 0.01 XXX
94680 .... TC ...... A ........ Exhaled air analysis, o2 ..................... 0.00 0.98 1.39 0.98 1.39 0.06 XXX
94681 .... ............ A ........ Exhaled air analysis, o2/co2 .............. 0.20 1.06 1.79 NA NA 0.13 XXX
94681 .... 26 ....... A ........ Exhaled air analysis, o2/co2 .............. 0.20 0.05 0.06 0.05 0.06 0.01 XXX
94681 .... TC ...... A ........ Exhaled air analysis, o2/co2 .............. 0.00 1.01 1.74 NA NA 0.12 XXX
94690 .... ............ A ........ Exhaled air analysis ........................... 0.07 1.03 1.51 NA NA 0.05 XXX
94690 .... 26 ....... A ........ Exhaled air analysis ........................... 0.07 0.02 0.02 0.02 0.02 0.01 XXX
94690 .... TC ...... A ........ Exhaled air analysis ........................... 0.00 1.01 1.49 NA NA 0.04 XXX
94720 .... ............ A ........ Monoxide diffusing capacity ............... 0.26 1.14 1.07 NA NA 0.07 XXX
94720 .... 26 ....... A ........ Monoxide diffusing capacity ............... 0.26 0.06 0.07 0.06 0.07 0.01 XXX
94720 .... TC ...... A ........ Monoxide diffusing capacity ............... 0.00 1.08 1.00 NA NA 0.06 XXX
94725 .... ............ A ........ Membrane diffusion capacity .............. 0.26 0.97 1.94 NA NA 0.13 XXX
94725 .... 26 ....... A ........ Membrane diffusion capacity .............. 0.26 0.07 0.08 0.07 0.08 0.01 XXX
94725 .... TC ...... A ........ Membrane diffusion capacity .............. 0.00 0.90 1.87 NA NA 0.12 XXX
94750 .... ............ A ........ Pulmonary compliance study ............. 0.23 1.75 1.54 NA NA 0.05 XXX
94750 .... 26 ....... A ........ Pulmonary compliance study ............. 0.23 0.06 0.07 0.06 0.07 0.01 XXX
94750 .... TC ...... A ........ Pulmonary compliance study ............. 0.00 1.69 1.47 NA NA 0.04 XXX
94760 .... ............ T ......... Measure blood oxygen level .............. 0.00 0.06 0.05 NA NA 0.02 XXX
94761 .... ............ T ......... Measure blood oxygen level .............. 0.00 0.11 0.09 NA NA 0.06 XXX
94762 .... ............ A ........ Measure blood oxygen level .............. 0.00 0.84 0.65 NA NA 0.10 XXX
94770 .... ............ A ........ Exhaled carbon dioxide test ............... 0.15 0.80 0.77 NA NA 0.08 XXX
94770 .... 26 ....... A ........ Exhaled carbon dioxide test ............... 0.15 0.04 0.04 0.04 0.04 0.01 XXX
94770 .... TC ...... A ........ Exhaled carbon dioxide test ............... 0.00 0.76 0.73 NA NA 0.07 XXX
94772 .... ............ C ........ Breath recording, infant ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94772 .... 26 ....... C ........ Breath recording, infant ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94772 .... TC ...... C ........ Breath recording, infant ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94774 .... ............ C ........ Ped home apnea rec, compl .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
94775 .... ............ C ........ Ped home apnea rec, hk-up ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY
94776 .... ............ C ........ Ped home apnea rec, downld ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
94777 .... ............ C ........ Ped home apnea rec, report .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY
94799 .... ............ C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94799 .... 26 ....... C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
94799 .... TC ...... C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95004 .... ............ A ........ Percut allergy skin tests ..................... 0.00 0.15 0.13 NA NA 0.01 XXX
95010 .... ............ A ........ Percut allergy titrate test .................... 0.15 0.31 0.31 0.05 0.06 0.01 XXX
95012 .... ............ A ........ Exhaled nitric oxide meas .................. 0.00 0.48 0.48 NA NA 0.01 XXX
95015 .... ............ A ........ Id allergy titrate-drug/bug ................... 0.15 0.21 0.18 0.05 0.06 0.01 XXX
95024 .... ............ A ........ Id allergy test, drug/bug ...................... 0.00 0.17 0.17 NA NA 0.01 XXX
95027 .... ............ A ........ Id allergy titrate-airborne .................... 0.00 0.10 0.15 NA NA 0.01 XXX
95028 .... ............ A ........ Id allergy test-delayed type ................ 0.00 0.31 0.27 NA NA 0.01 XXX
95044 .... ............ A ........ Allergy patch tests .............................. 0.00 0.15 0.18 NA NA 0.01 XXX
95052 .... ............ A ........ Photo patch test ................................. 0.00 0.15 0.20 NA NA 0.01 XXX
95056 .... ............ A ........ Photosensitivity tests .......................... 0.00 1.24 0.70 NA NA 0.01 XXX
95060 .... ............ A ........ Eye allergy tests ................................. 0.00 0.72 0.53 0.72 0.53 0.02 XXX
95065 .... ............ A ........ Nose allergy test ................................. 0.00 0.68 0.43 0.68 0.43 0.01 XXX
95070 .... ............ A ........ Bronchial allergy tests ........................ 0.00 0.80 1.54 NA NA 0.02 XXX
95071 .... ............ A ........ Bronchial allergy tests ........................ 0.00 0.96 1.93 NA NA 0.02 XXX
95075 .... ............ A ........ Ingestion challenge test ...................... 0.95 0.66 0.74 0.26 0.32 0.03 XXX
95115 .... ............ A ........ Immunotherapy, one injection ............ 0.00 0.22 0.31 0.00 0.19 0.02 XXX
95117 .... ............ A ........ Immunotherapy injections ................... 0.00 0.28 0.39 0.00 0.25 0.02 XXX
95144 .... ............ A ........ Antigen therapy services .................... 0.06 0.26 0.23 0.02 0.02 0.01 XXX
95180 .... ............ A ........ Rapid desensitization ......................... 2.01 1.61 1.82 0.74 0.83 0.04 XXX
95199 .... ............ C ........ Allergy immunology services .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95250 .... ............ A ........ Glucose monitoring, cont .................... 0.00 3.46 3.79 NA NA 0.01 XXX
95251 .... ............ A ........ Gluc monitor, cont, phys i&r ............... 0.85 0.26 0.23 0.26 0.23 0.02 XXX
95805 .... ............ A ........ Multiple sleep latency test .................. 1.88 6.93 12.11 NA NA 0.43 XXX
95805 .... 26 ....... A ........ Multiple sleep latency test .................. 1.88 0.51 0.58 0.51 0.58 0.09 XXX
95805 .... TC ...... A ........ Multiple sleep latency test .................. 0.00 6.42 11.53 NA NA 0.34 XXX
95806 .... ............ A ........ Sleep study, unattended ..................... 1.66 3.87 3.60 NA NA 0.39 XXX
95806 .... 26 ....... A ........ Sleep study, unattended ..................... 1.66 0.47 0.51 0.47 0.51 0.08 XXX
95806 .... TC ...... A ........ Sleep study, unattended ..................... 0.00 3.40 3.09 NA NA 0.31 XXX
95807 .... ............ A ........ Sleep study, attended ......................... 1.66 12.21 11.95 NA NA 0.50 XXX
95807 .... 26 ....... A ........ Sleep study, attended ......................... 1.66 0.41 0.48 0.41 0.48 0.08 XXX
95807 .... TC ...... A ........ Sleep study, attended ......................... 0.00 11.80 11.47 NA NA 0.42 XXX
95808 .... ............ A ........ Polysomnography, 1–3 ....................... 2.65 15.60 14.39 NA NA 0.55 XXX
95808 .... 26 ....... A ........ Polysomnography, 1–3 ....................... 2.65 0.71 0.82 0.71 0.82 0.13 XXX
95808 .... TC ...... A ........ Polysomnography, 1–3 ....................... 0.00 14.89 13.58 NA NA 0.42 XXX
95810 .... ............ A ........ Polysomnography, 4 or more ............. 3.52 17.52 17.53 NA NA 0.59 XXX
95810 .... 26 ....... A ........ Polysomnography, 4 or more ............. 3.52 0.90 1.05 0.90 1.05 0.17 XXX
95810 .... TC ...... A ........ Polysomnography, 4 or more ............. 0.00 16.62 16.49 NA NA 0.42 XXX
95811 .... ............ A ........ Polysomnography w/cpap .................. 3.79 19.51 19.38 NA NA 0.61 XXX
95811 .... 26 ....... A ........ Polysomnography w/cpap .................. 3.79 0.96 1.12 0.96 1.12 0.18 XXX
95811 .... TC ...... A ........ Polysomnography w/cpap .................. 0.00 18.54 18.26 NA NA 0.43 XXX
95812 .... ............ A ........ Eeg, 41–60 minutes ........................... 1.08 5.84 4.94 NA NA 0.17 XXX
95812 .... 26 ....... A ........ Eeg, 41–60 minutes ........................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX
95812 .... TC ...... A ........ Eeg, 41–60 minutes ........................... 0.00 5.54 4.56 NA NA 0.11 XXX
95813 .... ............ A ........ Eeg, over 1 hour ................................. 1.73 6.46 5.75 NA NA 0.20 XXX
95813 .... 26 ....... A ........ Eeg, over 1 hour ................................. 1.73 0.49 0.60 0.49 0.60 0.09 XXX
95813 .... TC ...... A ........ Eeg, over 1 hour ................................. 0.00 5.97 5.16 NA NA 0.11 XXX
95816 .... ............ A ........ Eeg, awake and drowsy ..................... 1.08 5.23 4.48 NA NA 0.16 XXX
95816 .... 26 ....... A ........ Eeg, awake and drowsy ..................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX
95816 .... TC ...... A ........ Eeg, awake and drowsy ..................... 0.00 4.92 4.09 NA NA 0.10 XXX
95819 .... ............ A ........ Eeg, awake and asleep ...................... 1.08 6.07 4.53 NA NA 0.16 XXX
95819 .... 26 ....... A ........ Eeg, awake and asleep ...................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX
95819 .... TC ...... A ........ Eeg, awake and asleep ...................... 0.00 5.77 4.15 NA NA 0.10 XXX
95822 .... ............ A ........ Eeg, coma or sleep only .................... 1.08 5.47 5.04 NA NA 0.19 XXX
95822 .... 26 ....... A ........ Eeg, coma or sleep only .................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX
95822 .... TC ...... A ........ Eeg, coma or sleep only .................... 0.00 5.16 4.65 NA NA 0.13 XXX
95824 .... ............ C ........ Eeg, cerebral death only .................... 0.74 0.00 0.23 0.00 0.23 0.04 XXX
95824 .... 26 ....... A ........ Eeg, cerebral death only .................... 0.74 0.21 0.26 0.21 0.26 0.04 XXX
95824 .... TC ...... C ........ Eeg, cerebral death only .................... 0.00 0.00 0.03 0.00 0.03 0.00 XXX
95827 .... ............ A ........ Eeg, all night recording ...................... 1.08 11.40 7.06 NA NA 0.19 XXX
95827 .... 26 ....... A ........ Eeg, all night recording ...................... 1.08 0.30 0.35 0.30 0.35 0.05 XXX
95827 .... TC ...... A ........ Eeg, all night recording ...................... 0.00 11.10 6.71 NA NA 0.14 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
95829 .... ............ A ........ Surgery electrocorticogram ................ 6.20 20.92 26.68 NA NA 0.50 XXX
95829 .... 26 ....... A ........ Surgery electrocorticogram ................ 6.20 1.59 1.99 1.59 1.99 0.48 XXX
95829 .... TC ...... A ........ Surgery electrocorticogram ................ 0.00 19.32 24.69 NA NA 0.02 XXX
95830 .... ............ A ........ Insert electrodes for EEG ................... 1.70 2.94 3.12 0.42 0.58 0.11 XXX
95831 .... ............ A ........ Limb muscle testing, manual .............. 0.28 0.40 0.43 0.09 0.11 0.01 XXX
95832 .... ............ A ........ Hand muscle testing, manual ............. 0.29 0.37 0.35 0.10 0.11 0.02 XXX
95833 .... ............ A ........ Body muscle testing, manual ............. 0.47 0.49 0.53 0.14 0.19 0.02 XXX
95834 .... ............ A ........ Body muscle testing, manual ............. 0.60 0.54 0.59 0.17 0.23 0.03 XXX
95851 .... ............ A ........ Range of motion measurements ........ 0.16 0.26 0.31 0.04 0.06 0.01 XXX
95852 .... ............ A ........ Range of motion measurements ........ 0.11 0.23 0.24 0.04 0.05 0.01 XXX
95857 .... ............ A ........ Tensilon test ....................................... 0.53 0.58 0.59 0.16 0.20 0.02 XXX
95860 .... ............ A ........ Muscle test, one limb ......................... 0.96 1.15 1.29 NA NA 0.07 XXX
95860 .... 26 ....... A ........ Muscle test, one limb ......................... 0.96 0.32 0.37 0.32 0.37 0.05 XXX
95860 .... TC ...... A ........ Muscle test, one limb ......................... 0.00 0.83 0.92 NA NA 0.02 XXX
95861 .... ............ A ........ Muscle test, 2 limbs ............................ 1.54 1.65 1.54 NA NA 0.13 XXX
95861 .... 26 ....... A ........ Muscle test, 2 limbs ............................ 1.54 0.51 0.60 0.51 0.60 0.07 XXX
95861 .... TC ...... A ........ Muscle test, 2 limbs ............................ 0.00 1.14 0.94 NA NA 0.06 XXX
95865 .... ............ A ........ Muscle test, larynx .............................. 1.57 1.40 1.42 NA NA 0.11 XXX
95865 .... 26 ....... A ........ Muscle test, larynx .............................. 1.57 0.50 0.63 0.50 0.63 0.08 XXX
95865 .... TC ...... A ........ Muscle test, larynx .............................. 0.00 0.90 0.79 NA NA 0.03 XXX
95866 .... ............ A ........ Muscle test, hemidiaphragm .............. 1.25 1.31 1.04 NA NA 0.10 XXX
95866 .... 26 ....... A ........ Muscle test, hemidiaphragm .............. 1.25 0.39 0.48 0.39 0.48 0.07 XXX
95866 .... TC ...... A ........ Muscle test, hemidiaphragm .............. 0.00 0.92 0.56 NA NA 0.03 XXX
95867 .... ............ A ........ Muscle test cran nerv unilat ............... 0.79 1.15 1.04 NA NA 0.07 XXX
95867 .... 26 ....... A ........ Muscle test cran nerv unilat ............... 0.79 0.24 0.29 0.24 0.29 0.03 XXX
95867 .... TC ...... A ........ Muscle test cran nerv unilat ............... 0.00 0.90 0.74 NA NA 0.04 XXX
95868 .... ............ A ........ Muscle test cran nerve bilat ............... 1.18 1.47 1.33 NA NA 0.10 XXX
95868 .... 26 ....... A ........ Muscle test cran nerve bilat ............... 1.18 0.37 0.44 0.37 0.44 0.05 XXX
95868 .... TC ...... A ........ Muscle test cran nerve bilat ............... 0.00 1.10 0.89 NA NA 0.05 XXX
95869 .... ............ A ........ Muscle test, thor paraspinal ............... 0.37 1.02 0.69 NA NA 0.04 XXX
95869 .... 26 ....... A ........ Muscle test, thor paraspinal ............... 0.37 0.12 0.14 0.12 0.14 0.02 XXX
95869 .... TC ...... A ........ Muscle test, thor paraspinal ............... 0.00 0.90 0.55 NA NA 0.02 XXX
95870 .... ............ A ........ Muscle test, nonparaspinal ................. 0.37 0.98 0.68 NA NA 0.04 XXX
95870 .... 26 ....... A ........ Muscle test, nonparaspinal ................. 0.37 0.12 0.14 0.12 0.14 0.02 XXX
95870 .... TC ...... A ........ Muscle test, nonparaspinal ................. 0.00 0.86 0.54 NA NA 0.02 XXX
95872 .... ............ A ........ Muscle test, one fiber ......................... 2.88 1.63 1.44 NA NA 0.13 XXX
95872 .... 26 ....... A ........ Muscle test, one fiber ......................... 2.88 0.88 0.77 0.88 0.77 0.08 XXX
95872 .... TC ...... A ........ Muscle test, one fiber ......................... 0.00 0.75 0.68 NA NA 0.05 XXX
95873 .... ............ A ........ Guide nerv destr, elec stim ................ 0.37 1.01 0.68 1.01 0.68 0.04 ZZZ
95873 .... 26 ....... A ........ Guide nerv destr, elec stim ................ 0.37 0.14 0.15 0.14 0.15 0.02 ZZZ
95873 .... TC ...... A ........ Guide nerv destr, elec stim ................ 0.00 0.87 0.53 0.87 0.53 0.02 ZZZ
95874 .... ............ A ........ Guide nerv destr, needle emg ............ 0.37 0.95 0.66 0.95 0.66 0.04 ZZZ
95874 .... 26 ....... A ........ Guide nerv destr, needle emg ............ 0.37 0.12 0.15 0.12 0.15 0.02 ZZZ
95874 .... TC ...... A ........ Guide nerv destr, needle emg ............ 0.00 0.83 0.52 0.83 0.52 0.02 ZZZ
95875 .... ............ A ........ Limb exercise test .............................. 1.10 1.46 1.43 NA NA 0.11 XXX
95875 .... 26 ....... A ........ Limb exercise test .............................. 1.10 0.39 0.42 0.39 0.42 0.05 XXX
95875 .... TC ...... A ........ Limb exercise test .............................. 0.00 1.07 1.01 NA NA 0.06 XXX
95900 .... ............ A ........ Motor nerve conduction test ............... 0.42 0.91 1.09 NA NA 0.04 XXX
95900 .... 26 ....... A ........ Motor nerve conduction test ............... 0.42 0.14 0.16 0.14 0.16 0.02 XXX
95900 .... TC ...... A ........ Motor nerve conduction test ............... 0.00 0.77 0.93 NA NA 0.02 XXX
95903 .... ............ A ........ Motor nerve conduction test ............... 0.60 0.99 1.10 NA NA 0.05 XXX
95903 .... 26 ....... A ........ Motor nerve conduction test ............... 0.60 0.17 0.22 0.17 0.22 0.03 XXX
95903 .... TC ...... A ........ Motor nerve conduction test ............... 0.00 0.82 0.88 NA NA 0.02 XXX
95904 .... ............ A ........ Sense nerve conduction test .............. 0.34 0.84 0.97 NA NA 0.04 XXX
95904 .... 26 ....... A ........ Sense nerve conduction test .............. 0.34 0.10 0.13 0.10 0.13 0.02 XXX
95904 .... TC ...... A ........ Sense nerve conduction test .............. 0.00 0.74 0.84 NA NA 0.02 XXX
95920 .... ............ A ........ Intraop nerve test add-on ................... 2.11 1.72 1.99 1.72 1.99 0.23 ZZZ
95920 .... 26 ....... A ........ Intraop nerve test add-on ................... 2.11 0.63 0.79 0.63 0.79 0.16 ZZZ
95920 .... TC ...... A ........ Intraop nerve test add-on ................... 0.00 1.09 1.20 1.09 1.20 0.07 ZZZ
95921 .... ............ A ........ Autonomic nerv function test .............. 0.90 1.14 0.93 NA NA 0.06 XXX
95921 .... 26 ....... A ........ Autonomic nerv function test .............. 0.90 0.24 0.29 0.24 0.29 0.04 XXX
95921 .... TC ...... A ........ Autonomic nerv function test .............. 0.00 0.90 0.64 NA NA 0.02 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
95925 .... ............ A ........ Somatosensory testing ....................... 0.54 3.04 2.10 NA NA 0.10 XXX
95925 .... 26 ....... A ........ Somatosensory testing ....................... 0.54 0.15 0.19 0.15 0.19 0.04 XXX
95925 .... TC ...... A ........ Somatosensory testing ....................... 0.00 2.88 1.91 NA NA 0.06 XXX
95928 .... ............ A ........ C motor evoked, uppr limbs ............... 1.50 3.90 3.47 NA NA 0.09 XXX
95928 .... 26 ....... A ........ C motor evoked, uppr limbs ............... 1.50 0.44 0.55 0.44 0.55 0.06 XXX
95928 .... TC ...... A ........ C motor evoked, uppr limbs ............... 0.00 3.46 2.92 NA NA 0.03 XXX
95929 .... ............ A ........ C motor evoked, lwr limbs .................. 1.50 4.22 3.73 NA NA 0.09 XXX
95929 .... 26 ....... A ........ C motor evoked, lwr limbs .................. 1.50 0.45 0.56 0.45 0.56 0.06 XXX
95929 .... TC ...... A ........ C motor evoked, lwr limbs .................. 0.00 3.78 3.17 NA NA 0.03 XXX
95930 .... ............ A ........ Visual evoked potential test ............... 0.35 2.62 2.43 NA NA 0.03 XXX
95930 .... 26 ....... A ........ Visual evoked potential test ............... 0.35 0.10 0.13 0.10 0.13 0.02 XXX
95930 .... TC ...... A ........ Visual evoked potential test ............... 0.00 2.52 2.31 NA NA 0.01 XXX
95933 .... ............ A ........ Blink reflex test ................................... 0.59 1.10 1.06 NA NA 0.10 XXX
95933 .... 26 ....... A ........ Blink reflex test ................................... 0.59 0.17 0.20 0.17 0.20 0.04 XXX
95933 .... TC ...... A ........ Blink reflex test ................................... 0.00 0.93 0.86 NA NA 0.06 XXX
95934 .... ............ A ........ H-reflex test ........................................ 0.51 0.85 0.65 NA NA 0.04 XXX
95934 .... 26 ....... A ........ H-reflex test ........................................ 0.51 0.16 0.19 0.16 0.19 0.02 XXX
95934 .... TC ...... A ........ H-reflex test ........................................ 0.00 0.70 0.46 NA NA 0.02 XXX
95936 .... ............ A ........ H-reflex test ........................................ 0.55 0.59 0.52 NA NA 0.05 XXX
95936 .... 26 ....... A ........ H-reflex test ........................................ 0.55 0.16 0.20 0.16 0.20 0.03 XXX
95936 .... TC ...... A ........ H-reflex test ........................................ 0.00 0.42 0.32 NA NA 0.02 XXX
95937 .... ............ A ........ Neuromuscular junction test ............... 0.65 0.91 0.76 NA NA 0.10 XXX
95937 .... 26 ....... A ........ Neuromuscular junction test ............... 0.65 0.20 0.23 0.20 0.23 0.08 XXX
95937 .... TC ...... A ........ Neuromuscular junction test ............... 0.00 0.71 0.52 NA NA 0.02 XXX
95950 .... ............ A ........ Ambulatory eeg monitoring ................ 1.51 4.88 4.41 NA NA 0.51 XXX
95950 .... 26 ....... A ........ Ambulatory eeg monitoring ................ 1.51 0.43 0.54 0.43 0.54 0.08 XXX
95950 .... TC ...... A ........ Ambulatory eeg monitoring ................ 0.00 4.45 3.88 NA NA 0.43 XXX
95951 .... ............ C ........ EEG monitoring/videorecord .............. 5.99 0.00 20.01 0.00 20.01 0.32 XXX
95951 .... 26 ....... A ........ EEG monitoring/videorecord .............. 5.99 1.69 2.12 1.69 2.12 0.32 XXX
95951 .... TC ...... C ........ EEG monitoring/videorecord .............. 0.00 0.00 18.45 0.00 18.45 0.00 XXX
95953 .... ............ A ........ EEG monitoring/computer .................. 3.30 7.16 7.40 NA NA 0.60 XXX
95953 .... 26 ....... A ........ EEG monitoring/computer .................. 3.30 0.93 1.12 0.93 1.12 0.17 XXX
95953 .... TC ...... A ........ EEG monitoring/computer .................. 0.00 6.23 6.28 NA NA 0.43 XXX
95954 .... ............ A ........ EEG monitoring/giving drugs .............. 2.45 4.34 4.37 NA NA 0.19 XXX
95954 .... 26 ....... A ........ EEG monitoring/giving drugs .............. 2.45 0.43 0.75 0.43 0.75 0.13 XXX
95954 .... TC ...... A ........ EEG monitoring/giving drugs .............. 0.00 3.91 3.62 NA NA 0.06 XXX
95955 .... ............ A ........ EEG during surgery ............................ 1.01 2.73 2.53 2.73 2.53 0.22 XXX
95955 .... 26 ....... A ........ EEG during surgery ............................ 1.01 0.28 0.32 0.28 0.32 0.05 XXX
95955 .... TC ...... A ........ EEG during surgery ............................ 0.00 2.45 2.21 2.45 2.21 0.17 XXX
95956 .... ............ A ........ Eeg monitoring, cable/radio ................ 3.08 16.14 15.69 NA NA 0.59 XXX
95956 .... 26 ....... A ........ Eeg monitoring, cable/radio ................ 3.08 0.87 1.09 0.87 1.09 0.16 XXX
95956 .... TC ...... A ........ Eeg monitoring, cable/radio ................ 0.00 15.27 14.60 NA NA 0.43 XXX
95957 .... ............ A ........ EEG digital analysis ........................... 1.98 5.80 4.18 NA NA 0.23 XXX
95957 .... 26 ....... A ........ EEG digital analysis ........................... 1.98 0.56 0.71 0.56 0.71 0.11 XXX
95957 .... TC ...... A ........ EEG digital analysis ........................... 0.00 5.24 3.47 NA NA 0.12 XXX
95958 .... ............ A ........ EEG monitoring/function test .............. 4.24 6.66 5.05 NA NA 0.34 XXX
95958 .... 26 ....... A ........ EEG monitoring/function test .............. 4.24 1.24 1.49 1.24 1.49 0.21 XXX
95958 .... TC ...... A ........ EEG monitoring/function test .............. 0.00 5.42 3.57 NA NA 0.13 XXX
95961 .... ............ A ........ Electrode stimulation, brain ................ 2.97 3.04 2.85 NA NA 0.55 XXX
95961 .... 26 ....... A ........ Electrode stimulation, brain ................ 2.97 0.88 1.11 0.88 1.11 0.48 XXX
95961 .... TC ...... A ........ Electrode stimulation, brain ................ 0.00 2.16 1.74 NA NA 0.07 XXX
95962 .... ............ A ........ Electrode stim, brain add-on .............. 3.21 2.20 2.46 2.20 2.46 0.39 ZZZ
95962 .... 26 ....... A ........ Electrode stim, brain add-on .............. 3.21 0.91 1.16 0.91 1.16 0.32 ZZZ
95962 .... TC ...... A ........ Electrode stim, brain add-on .............. 0.00 1.28 1.30 1.28 1.30 0.07 ZZZ
95965 .... ............ C ........ Meg, spontaneous .............................. 7.99 0.00 2.09 0.00 2.09 0.46 XXX
95965 .... 26 ....... A ........ Meg, spontaneous .............................. 7.99 2.31 2.86 2.31 2.86 0.46 XXX
95965 .... TC ...... C ........ Meg, spontaneous .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95966 .... ............ C ........ Meg, evoked, single ........................... 3.99 0.00 1.05 0.00 1.05 0.19 XXX
95966 .... 26 ....... A ........ Meg, evoked, single ........................... 3.99 1.17 1.44 1.17 1.44 0.19 XXX
95966 .... TC ...... C ........ Meg, evoked, single ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
95967 .... ............ C ........ Meg, evoked, each addœl ................... 3.49 0.00 0.75 0.00 0.75 0.16 ZZZ
95967 .... 26 ....... A ........ Meg, evoked, each addœl ................... 3.49 1.01 1.09 1.01 1.09 0.16 ZZZ
95967 .... TC ...... C ........ Meg, evoked, each addœl ................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
95970 .... ............ A ........ Analyze neurostim, no prog ............... 0.45 0.89 0.87 0.13 0.14 0.03 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
95971 .... ............ A ........ Analyze neurostim, simple ................. 0.78 0.58 0.63 0.19 0.21 0.07 XXX
95972 .... ............ A ........ Analyze neurostim, complex .............. 1.50 1.15 1.19 0.45 0.47 0.14 XXX
95973 .... ............ A ........ Analyze neurostim, complex .............. 0.92 0.49 0.57 0.22 0.29 0.07 ZZZ
95974 .... ............ A ........ Cranial neurostim, complex ................ 3.00 1.44 1.58 0.79 1.06 0.16 XXX
95975 .... ............ A ........ Cranial neurostim, complex ................ 1.70 0.73 0.82 0.47 0.60 0.12 ZZZ
95978 .... ............ A ........ Analyze neurostim brain/1h ................ 3.50 1.86 1.89 1.04 1.17 0.18 XXX
95979 .... ............ A ........ Analyz neurostim brain add-on .......... 1.64 0.73 0.80 0.47 0.58 0.08 ZZZ
95990 .... ............ A ........ Spin/brain pump refil & main .............. 0.00 1.61 1.56 NA NA 0.06 XXX
95991 .... ............ A ........ Spin/brain pump refil & main .............. 0.77 1.60 1.55 0.18 0.17 0.06 XXX
95999 .... ............ C ........ Neurological procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
96000 .... ............ A ........ Motion analysis, video/3d ................... 1.80 NA NA 0.44 0.51 0.11 XXX
96001 .... ............ A ........ Motion test w/ft press meas ............... 2.15 NA NA 0.55 0.60 0.10 XXX
96002 .... ............ A ........ Dynamic surface emg ......................... 0.41 NA NA 0.10 0.13 0.02 XXX
96003 .... ............ A ........ Dynamic fine wire emg ....................... 0.37 NA NA 0.09 0.12 0.02 XXX
96004 .... ............ A ........ Phys review of motion tests ............... 2.14 0.65 0.78 0.65 0.78 0.11 XXX
96020 .... ............ C ........ Functional brain mapping ................... 0.00 NA NA NA NA 0.17 XXX
96020 .... 26 ....... A ........ Functional brain mapping ................... 3.43 1.05 0.92 1.05 0.92 0.17 XXX
96020 .... TC ...... C ........ Functional brain mapping ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
96040 .... ............ B ........ Genetic counseling, 30 min ................ 0.00 0.97 0.97 NA NA 0.01 XXX
96101 .... ............ A ........ Psycho testing by psych/phys ............ 1.86 0.35 0.50 0.33 0.48 0.05 XXX
96102 .... ............ A ........ Psycho testing by technician .............. 0.50 1.09 0.90 0.10 0.13 0.01 XXX
96103 .... ............ A ........ Psycho testing admin by comp .......... 0.51 0.91 0.63 0.10 0.13 0.02 XXX
96105 .... ............ A ........ Assessment of aphasia ...................... 0.00 1.64 1.77 NA NA 0.18 XXX
96110 .... ............ A ........ Developmental test, lim ...................... 0.00 0.18 0.18 NA NA 0.18 XXX
96111 .... ............ A ........ Developmental test, extend ................ 2.60 0.69 0.87 0.58 0.81 0.18 XXX
96116 .... ............ A ........ Neurobehavioral status exam ............. 1.86 0.53 0.68 0.41 0.53 0.18 XXX
96118 .... ............ A ........ Neuropsych tst by psych/phys ........... 1.86 0.83 1.11 0.33 0.48 0.18 XXX
96119 .... ............ A ........ Neuropsych testing by tec .................. 0.55 1.51 1.27 0.10 0.15 0.18 XXX
96120 .... ............ A ........ Neuropsych tst admin w/comp ........... 0.51 1.67 1.25 0.10 0.13 0.02 XXX
96150 .... ............ A ........ Assess hlth/behave, init ...................... 0.50 0.10 0.14 0.09 0.14 0.01 XXX
96151 .... ............ A ........ Assess hlth/behave, subseq ............... 0.48 0.10 0.14 0.09 0.13 0.01 XXX
96152 .... ............ A ........ Intervene hlth/behave, indiv ............... 0.46 0.09 0.13 0.08 0.12 0.01 XXX
96153 .... ............ A ........ Intervene hlth/behave, group .............. 0.10 0.02 0.03 0.02 0.03 0.01 XXX
96154 .... ............ A ........ Interv hlth/behav, fam w/pt ................. 0.45 0.09 0.13 0.08 0.12 0.01 XXX
96155 .... ............ N ........ Interv hlth/behav fam no pt ................ 0.44 0.10 0.14 0.10 0.13 0.02 XXX
96401 .... ............ A ........ Chemo, anti-neopl, sq/im ................... 0.21 1.84 1.51 NA NA 0.01 XXX
96402 .... ............ A ........ Chemo hormon antineopl sq/im ......... 0.19 0.77 0.88 NA NA 0.01 XXX
96405 .... ............ A ........ Chemo intralesional, up to 7 .............. 0.52 3.67 3.03 0.24 0.24 0.03 000
96406 .... ............ A ........ Chemo intralesional over 7 ................ 0.80 3.58 3.25 0.33 0.30 0.03 000
96409 .... ............ A ........ Chemo, iv push, sngl drug ................. 0.24 2.77 2.84 NA NA 0.06 XXX
96411 .... ............ A ........ Chemo, iv push, addl drug ................. 0.20 1.49 1.55 NA NA 0.06 ZZZ
96413 .... ............ A ........ Chemo, iv infusion, 1 hr ..................... 0.28 3.61 3.90 NA NA 0.08 XXX
96415 .... ............ A ........ Chemo, iv infusion, addl hr ................ 0.19 0.65 0.71 NA NA 0.07 ZZZ
96416 .... ............ A ........ Chemo prolong infuse w/pump .......... 0.21 4.05 4.33 NA NA 0.08 XXX
96417 .... ............ A ........ Chemo iv infus each addl seq ............ 0.21 1.71 1.83 NA NA 0.07 ZZZ
96420 .... ............ A ........ Chemo, ia, push tecnique .................. 0.17 2.77 2.70 NA NA 0.08 XXX
96422 .... ............ A ........ Chemo ia infusion up to 1 hr .............. 0.17 4.46 4.53 NA NA 0.08 XXX
96423 .... ............ A ........ Chemo ia infuse each addl hr ............ 0.17 1.98 1.92 NA NA 0.02 ZZZ
96425 .... ............ A ........ Chemotherapy, infusion method ........ 0.17 4.64 4.53 NA NA 0.08 XXX
96440 .... ............ A ........ Chemotherapy, intracavitary ............... 2.37 5.46 6.81 0.97 1.10 0.17 000
96445 .... ............ A ........ Chemotherapy, intracavitary ............... 2.20 5.39 6.72 0.97 1.07 0.14 000
96450 .... ............ A ........ Chemotherapy, into CNS ................... 1.53 4.95 5.95 0.84 1.07 0.09 000
96521 .... ............ A ........ Refill/maint, portable pump ................. 0.21 3.13 3.44 NA NA 0.06 XXX
96522 .... ............ A ........ Refill/maint pump/resvr syst ............... 0.21 2.76 2.69 NA NA 0.06 XXX
96523 .... ............ T ......... Irrig drug delivery device .................... 0.04 0.64 0.67 NA NA 0.01 XXX
96542 .... ............ A ........ Chemotherapy injection ...................... 0.75 3.53 3.89 0.33 0.50 0.07 XXX
96549 .... ............ C ........ Chemotherapy, unspecified ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
96567 .... ............ A ........ Photodynamic tx, skin ........................ 0.00 3.72 2.84 NA NA 0.04 XXX
96570 .... ............ A ........ Photodynamic tx, 30 min .................... 1.10 0.40 0.39 0.40 0.39 0.11 ZZZ
96571 .... ............ A ........ Photodynamic tx, addl 15 min ............ 0.55 0.20 0.19 0.20 0.19 0.03 ZZZ
96900 .... ............ A ........ Ultraviolet light therapy ....................... 0.00 0.56 0.50 NA NA 0.02 XXX
96902 .... ............ B ........ Trichogram .......................................... 0.41 0.11 0.14 0.09 0.13 0.01 XXX
96904 .... ............ R ........ Whole body photography ................... 0.00 1.89 1.89 NA NA 0.01 XXX
96910 .... ............ A ........ Photochemotherapy with UV–B ......... 0.00 2.00 1.49 NA NA 0.04 XXX
96912 .... ............ A ........ Photochemotherapy with UV–A ......... 0.00 2.57 1.92 NA NA 0.05 XXX
96913 .... ............ A ........ Photochemotherapy, UV–A or B ........ 0.00 3.45 2.60 NA NA 0.10 XXX
96920 .... ............ A ........ Laser tx, skin < 250 sq cm ................. 1.15 3.57 3.06 0.57 0.57 0.02 000
96921 .... ............ A ........ Laser tx, skin 250–500 sq cm ............ 1.17 3.32 2.99 0.52 0.55 0.03 000
96922 .... ............ A ........ Laser tx, skin > 500 sq cm ................. 2.10 4.63 4.06 1.05 0.84 0.04 000
96999 .... ............ C ........ Dermatological procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
97001 .... ............ A ........ Pt evaluation ....................................... 1.20 0.66 0.71 NA NA 0.05 XXX
97002 .... ............ A ........ Pt re-evaluation .................................. 0.60 0.41 0.42 NA NA 0.02 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
97003 .... ............ A ........ Ot evaluation ...................................... 1.20 0.76 0.83 NA NA 0.06 XXX
97004 .... ............ A ........ Ot re-evaluation .................................. 0.60 0.54 0.61 NA NA 0.02 XXX
97010 .... ............ B ........ Hot or cold packs therapy .................. 0.06 0.07 0.06 NA NA 0.01 XXX
97012 .... ............ A ........ Mechanical traction therapy ............... 0.25 0.14 0.13 NA NA 0.01 XXX
97014 .... ............ I .......... Electric stimulation therapy ................ 0.18 0.18 0.19 NA NA 0.01 XXX
97016 .... ............ A ........ Vasopneumatic device therapy .......... 0.18 0.24 0.21 NA NA 0.01 XXX
97018 .... ............ A ........ Paraffin bath therapy .......................... 0.06 0.16 0.13 NA NA 0.01 XXX
97022 .... ............ A ........ Whirlpool therapy ................................ 0.17 0.33 0.27 NA NA 0.01 XXX
97024 .... ............ A ........ Diathermy eg, microwave ................... 0.06 0.08 0.07 NA NA 0.01 XXX
97026 .... ............ A ........ Infrared therapy .................................. 0.06 0.07 0.06 NA NA 0.01 XXX
97028 .... ............ A ........ Ultraviolet therapy ............................... 0.08 0.08 0.07 NA NA 0.01 XXX
97032 .... ............ A ........ Electrical stimulation ........................... 0.25 0.20 0.18 NA NA 0.01 XXX
97033 .... ............ A ........ Electric current therapy ...................... 0.26 0.44 0.35 NA NA 0.01 XXX
97034 .... ............ A ........ Contrast bath therapy ......................... 0.21 0.20 0.17 NA NA 0.01 XXX
97035 .... ............ A ........ Ultrasound therapy ............................. 0.21 0.10 0.10 NA NA 0.01 XXX
97036 .... ............ A ........ Hydrotherapy ...................................... 0.28 0.44 0.38 NA NA 0.01 XXX
97039 .... ............ C ........ Physical therapy treatment ................. 0.00 0.00 0.05 NA NA 0.00 XXX
97110 .... ............ A ........ Therapeutic exercises ........................ 0.45 0.32 0.29 NA NA 0.02 XXX
97112 .... ............ A ........ Neuromuscular reeducation ............... 0.45 0.34 0.33 NA NA 0.01 XXX
97113 .... ............ A ........ Aquatic therapy/exercises .................. 0.44 0.53 0.46 NA NA 0.01 XXX
97116 .... ............ A ........ Gait training therapy ........................... 0.40 0.28 0.26 NA NA 0.01 XXX
97124 .... ............ A ........ Massage therapy ................................ 0.35 0.27 0.25 NA NA 0.01 XXX
97139 .... ............ C ........ Physical medicine procedure ............. 0.00 0.00 0.10 NA NA 0.00 XXX
97140 .... ............ A ........ Manual therapy ................................... 0.43 0.29 0.27 NA NA 0.01 XXX
97150 .... ............ A ........ Group therapeutic procedures ............ 0.27 0.22 0.20 NA NA 0.01 XXX
97530 .... ............ A ........ Therapeutic activities .......................... 0.44 0.38 0.35 NA NA 0.01 XXX
97532 .... ............ A ........ Cognitive skills development .............. 0.44 0.22 0.21 NA NA 0.01 XXX
97533 .... ............ A ........ Sensory integration ............................. 0.44 0.27 0.26 NA NA 0.01 XXX
97535 .... ............ A ........ Self care mngment training ................ 0.45 0.37 0.35 NA NA 0.01 XXX
97537 .... ............ A ........ Community/work reintegration ............ 0.45 0.28 0.27 NA NA 0.01 XXX
97542 .... ............ A ........ Wheelchair mngment training ............. 0.45 0.29 0.28 NA NA 0.01 XXX
97597 .... ............ A ........ Active wound care/20 cm or < ........... 0.58 1.09 0.88 0.12 0.39 0.05 XXX
97598 .... ............ A ........ Active wound care > 20 cm ............... 0.80 1.27 1.03 0.17 0.48 0.05 XXX
97605 .... ............ A ........ Neg press wound tx, < 50 cm ............ 0.55 0.40 0.37 0.12 0.17 0.02 XXX
97606 .... ............ A ........ Neg press wound tx, > 50 cm ............ 0.60 0.42 0.39 0.13 0.18 0.03 XXX
97750 .... ............ A ........ Physical performance test .................. 0.45 0.33 0.32 NA NA 0.02 XXX
97755 .... ............ A ........ Assistive technology assess ............... 0.62 0.28 0.28 NA NA 0.02 XXX
97760 .... ............ A ........ Orthotic mgmt and training ................. 0.45 0.42 0.38 NA NA 0.03 XXX
97761 .... ............ A ........ Prosthetic training ............................... 0.45 0.33 0.30 NA NA 0.02 XXX
97762 .... ............ A ........ C/o for orthotic/prosth use .................. 0.25 0.73 0.58 NA NA 0.02 XXX
97799 .... ............ C ........ Physical medicine procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
97802 .... ............ A ........ Medical nutrition, indiv, in ................... 0.45 0.14 0.31 0.11 0.29 0.01 XXX
97803 .... ............ A ........ Med nutrition, indiv, subseq ............... 0.37 0.12 0.29 0.09 0.28 0.01 XXX
97804 .... ............ A ........ Medical nutrition, group ...................... 0.25 0.08 0.13 0.07 0.12 0.01 XXX
97810 .... ............ N ........ Acupunct w/o stimul 15 min ............... 0.60 0.26 0.32 0.14 0.19 0.03 XXX
97811 .... ............ N ........ Acupunct w/o stimul addl 15m ........... 0.50 0.15 0.20 0.12 0.15 0.03 ZZZ
97813 .... ............ N ........ Acupunct w/stimul 15 min .................. 0.65 0.27 0.34 0.15 0.20 0.03 XXX
97814 .... ............ N ........ Acupunct w/stimul addl 15m .............. 0.55 0.19 0.24 0.13 0.17 0.03 ZZZ
98925 .... ............ A ........ Osteopathic manipulation ................... 0.45 0.29 0.30 0.12 0.13 0.02 000
98940 .... ............ A ........ Chiropractic manipulation ................... 0.45 0.21 0.22 0.12 0.12 0.01 000
98943 .... ............ N ........ Chiropractic manipulation ................... 0.40 0.17 0.20 0.09 0.12 0.01 XXX
98960 .... ............ B ........ Self-mgmt educ & train, 1 pt .............. 0.00 0.58 0.57 NA NA 0.01 XXX
98961 .... ............ B ........ Self-mgmt educ/train, 2–4 pt .............. 0.00 0.28 0.27 NA NA 0.01 XXX
98962 .... ............ B ........ Self-mgmt educ/train, 5–8 pt .............. 0.00 0.20 0.20 NA NA 0.01 XXX
99082 .... ............ C ........ Unusual physician travel .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
99091 .... ............ B ........ Collect/review data from pt ................. 1.10 0.25 0.25 NA NA 0.04 XXX
99143 .... ............ C ........ Mod cs by same phys, < 5 yrs ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
99144 .... ............ C ........ Mod cs by same phys, 5 yrs + ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
99145 .... ............ C ........ Mod cs by same phys add-on ............ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
99148 .... ............ C ........ Mod cs diff phys < 5 yrs ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
99149 .... ............ C ........ Mod cs diff phys 5 yrs + ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
99150 .... ............ C ........ Mod cs diff phys add-on ..................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ
99170 .... ............ A ........ Anogenital exam, child ....................... 1.75 1.82 1.74 0.61 0.56 0.08 000
99173 .... ............ N ........ Visual acuity screen ........................... 0.00 0.06 0.06 NA NA 0.01 XXX
99175 .... ............ A ........ Induction of vomiting .......................... 0.00 0.37 0.88 NA NA 0.10 XXX
99183 .... ............ A ........ Hyperbaric oxygen therapy ................ 2.34 2.58 2.91 0.58 0.65 0.16 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
99185 .... ............ A ........ Regional hypothermia ......................... 0.00 1.63 1.14 NA NA 0.04 XXX
99186 .... ............ A ........ Total body hypothermia ...................... 0.00 1.61 1.66 NA NA 0.45 XXX
99195 .... ............ A ........ Phlebotomy ......................................... 0.00 2.54 1.50 NA NA 0.02 XXX
99199 .... ............ C ........ Special service/proc/report ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
99201 .... ............ A ........ Office/outpatient visit, new ................. 0.45 0.55 0.52 0.16 0.15 0.03 XXX
99211 .... ............ A ........ Office/outpatient visit, est ................... 0.17 0.32 0.35 0.06 0.06 0.01 XXX
99217 .... ............ A ........ Observation care discharge ............... 1.28 NA NA 0.49 0.52 0.06 XXX
99218 .... ............ A ........ Observation care ................................ 1.28 NA NA 0.38 0.41 0.06 XXX
99221 .... ............ A ........ Initial hospital care .............................. 1.88 NA NA 0.54 0.50 0.07 XXX
99231 .... ............ A ........ Subsequent hospital care ................... 0.76 NA NA 0.24 0.23 0.03 XXX
99234 .... ............ A ........ Observ/hosp same date ..................... 2.56 NA NA 0.78 0.84 0.13 XXX
99238 .... ............ A ........ Hospital discharge day ....................... 1.28 NA NA 0.49 0.52 0.05 XXX
99239 .... ............ A ........ Hospital discharge day ....................... 1.90 NA NA 0.67 0.70 0.07 XXX
99241 .... ............ A ........ Office consultation .............................. 0.64 0.66 0.65 0.22 0.22 0.05 XXX
99251 .... ............ A ........ Inpatient consultation .......................... 1.00 NA NA 0.31 0.28 0.05 XXX
99281 .... ............ A ........ Emergency dept visit .......................... 0.45 NA NA 0.09 0.09 0.02 XXX
99289 .... ............ A ........ Ped crit care transport ........................ 4.79 NA NA 1.08 1.27 0.24 XXX
99290 .... ............ A ........ Ped crit care transport addl ................ 2.40 NA NA 0.87 0.80 0.12 ZZZ
99291 .... ............ A ........ Critical care, first hour ........................ 4.50 2.24 2.41 1.10 1.20 0.21 XXX
99292 .... ............ A ........ Critical care, addœl 30 min ................. 2.25 0.79 0.86 0.56 0.61 0.11 ZZZ
99293 .... ............ A ........ Ped critical care, initial ....................... 15.98 NA NA 3.78 4.25 1.12 XXX
99294 .... ............ A ........ Ped critical care, subseq .................... 7.99 NA NA 1.66 2.05 0.45 XXX
99295 .... ............ A ........ Neonate crit care, initial ...................... 18.46 NA NA 4.61 4.96 1.16 XXX
99296 .... ............ A ........ Neonate critical care subseq .............. 7.99 NA NA 2.07 2.26 0.32 XXX
99298 .... ............ A ........ Ic for lbw infant < 1500 gm ................ 2.75 NA NA 0.68 0.81 0.17 XXX
99299 .... ............ A ........ Ic, lbw infant 1500–2500 gm .............. 2.50 NA NA 0.59 0.76 0.16 XXX
99300 .... ............ A ........ Ic, infant pbw 2501–5000 gm ............. 2.40 NA NA 0.71 0.78 0.15 XXX
99304 .... ............ A ........ Nursing facility care, init ..................... 1.61 0.57 0.51 0.57 0.51 0.05 XXX
99307 .... ............ A ........ Nursing fac care, subseq ................... 0.76 0.31 0.28 0.31 0.28 0.03 XXX
99315 .... ............ A ........ Nursing fac discharge day .................. 1.13 0.41 0.43 0.41 0.43 0.05 XXX
99316 .... ............ A ........ Nursing fac discharge day .................. 1.50 0.51 0.55 0.51 0.55 0.06 XXX
99318 .... ............ A ........ Annual nursing fac assessmnt ........... 1.71 0.56 0.51 0.56 0.51 0.05 XXX
99324 .... ............ A ........ Domicil/r-home visit new pat .............. 1.01 0.42 0.46 NA NA 0.05 XXX
99334 .... ............ A ........ Domicil/r-home visit est pat ................ 0.76 0.35 0.38 NA NA 0.04 XXX
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
99339 .... ............ B ........ Domicil/r-home care supervis ............. 1.25 0.58 0.58 NA NA 0.06 XXX
99340 .... ............ B ........ Domicil/r-home care supervis ............. 1.80 0.76 0.76 NA NA 0.07 XXX
99341 .... ............ A ........ Home visit, new patient ...................... 1.01 0.42 0.45 NA NA 0.05 XXX
99347 .... ............ A ........ Home visit, est patient ........................ 0.76 0.35 0.38 NA NA 0.04 XXX
99354 .... ............ A ........ Prolonged service, office .................... 1.77 0.65 0.71 0.50 0.58 0.08 ZZZ
99355 .... ............ A ........ Prolonged service, office .................... 1.77 0.62 0.69 0.47 0.56 0.07 ZZZ
99356 .... ............ A ........ Prolonged service, inpatient ............... 1.71 NA NA 0.50 0.57 0.07 ZZZ
99357 .... ............ A ........ Prolonged service, inpatient ............... 1.71 NA NA 0.50 0.57 0.08 ZZZ
99358 .... ............ B ........ Prolonged serv, w/o contact ............... 2.10 0.51 0.51 0.51 0.51 0.09 ZZZ
99359 .... ............ B ........ Prolonged serv, w/o contact ............... 1.00 0.26 0.26 0.26 0.26 0.04 ZZZ
99360 .... ............ X ........ Physician standby services ................ 1.20 0.28 0.28 0.28 0.28 0.05 XXX
99363 .... ............ B ........ Anticoag mgmt, init ............................. 1.65 1.29 1.29 0.38 0.38 0.07 XXX
99364 .... ............ B ........ Anticoag mgmt, subseq ...................... 0.63 0.38 0.38 0.15 0.15 0.04 XXX
99374 .... ............ B ........ Home health care supervision ............ 1.10 0.54 0.62 0.25 0.34 0.05 XXX
99375 .... ............ I .......... Home health care supervision ............ 1.73 0.75 1.15 0.40 0.97 0.07 XXX
99377 .... ............ B ........ Hospice care supervision ................... 1.10 0.54 0.62 0.25 0.34 0.05 XXX
99378 .... ............ I .......... Hospice care supervision ................... 1.73 0.75 1.34 0.40 1.17 0.07 XXX
99379 .... ............ B ........ Nursing fac care supervision .............. 1.10 0.54 0.62 0.25 0.34 0.04 XXX
99380 .... ............ B ........ Nursing fac care supervision .............. 1.73 0.75 0.87 0.40 0.53 0.06 XXX
99381 .... ............ N ........ Init pm e/m, new pat, inf ..................... 1.19 0.99 1.24 0.27 0.36 0.05 XXX
99382 .... ............ N ........ Init pm e/m, new pat 1–4 yrs ............. 1.36 1.03 1.28 0.31 0.42 0.05 XXX
99383 .... ............ N ........ Prev visit, new, age 5–11 ................... 1.36 1.02 1.25 0.31 0.42 0.05 XXX
99384 .... ............ N ........ Prev visit, new, age 12–17 ................. 1.53 1.06 1.31 0.35 0.47 0.06 XXX
99387 .... ............ N ........ Init pm e/m, new pat 65+ yrs ............. 2.06 1.27 1.57 0.48 0.63 0.07 XXX
99391 .... ............ N ........ Per pm reeval, est pat, inf .................. 1.02 0.85 0.94 0.24 0.31 0.04 XXX
99392 .... ............ N ........ Prev visit, est, age 1–4 ....................... 1.19 0.89 0.99 0.27 0.36 0.05 XXX
99393 .... ............ N ........ Prev visit, est, age 5–11 ..................... 1.19 0.89 0.98 0.27 0.36 0.05 XXX
99394 .... ............ N ........ Prev visit, est, age 12–17 ................... 1.36 0.93 1.03 0.31 0.42 0.05 XXX
99397 .... ............ N ........ Per pm reeval est pat 65+ yr ............. 1.71 1.11 1.24 0.39 0.53 0.06 XXX
99401 .... ............ N ........ Preventive counseling, indiv ............... 0.48 0.36 0.49 0.11 0.15 0.01 XXX
99411 .... ............ N ........ Preventive counseling, group ............. 0.15 0.22 0.20 0.03 0.04 0.01 XXX
99412 .... ............ N ........ Preventive counseling, group ............. 0.25 0.24 0.25 0.06 0.08 0.01 XXX
99420 .... ............ N ........ Health risk assessment test ............... 0.00 0.22 0.22 NA NA 0.01 XXX
99431 .... ............ A ........ Initial care, normal newborn ............... 1.17 NA NA 0.27 0.32 0.05 XXX
99432 .... ............ A ........ Newborn care, not in hosp ................. 1.26 1.00 0.97 0.29 0.34 0.07 XXX
99433 .... ............ A ........ Normal newborn care/hospital ............ 0.62 NA NA 0.17 0.18 0.02 XXX
99435 .... ............ A ........ Newborn discharge day hosp ............. 1.50 NA NA 0.50 0.54 0.06 XXX
99436 .... ............ A ........ Attendance, birth ................................ 1.50 NA NA 0.33 0.40 0.06 XXX
99440 .... ............ A ........ Newborn resuscitation ........................ 2.93 NA NA 0.67 0.80 0.12 XXX
99499 .... ............ C ........ Unlisted e&m service .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
G0101 ... ............ A ........ CA screen;pelvic/breast exam ............ 0.45 0.48 0.50 NA NA 0.02 XXX
G0102 ... ............ A ........ Prostate ca screening; dre ................. 0.17 0.32 0.35 0.06 0.06 0.01 XXX
G0104 ... ............ A ........ CA screen;flexi sigmoidscope ............ 0.96 2.50 2.39 0.62 0.56 0.08 000
G0105 ... ............ A ........ Colorectal scrn; hi risk ind .................. 3.69 6.35 6.25 1.83 1.66 0.30 000
G0105 ... 53 ....... A ........ Colorectal scrn; hi risk ind .................. 0.96 2.50 2.39 0.62 0.56 0.08 000
G0106 ... ............ A ........ Colon CA screen;barium enema ........ 0.99 4.91 3.68 NA NA 0.17 XXX
G0106 ... 26 ....... A ........ Colon CA screen;barium enema ........ 0.99 0.35 0.32 0.35 0.32 0.04 XXX
G0106 ... TC ...... A ........ Colon CA screen;barium enema ........ 0.00 4.55 3.36 NA NA 0.13 XXX
G0108 ... ............ A ........ Diab manage trn per indiv .................. 0.00 0.58 0.71 NA NA 0.01 XXX
G0109 ... ............ A ........ Diab manage trn ind/group ................. 0.00 0.31 0.40 NA NA 0.01 XXX
G0117 ... ............ T ......... Glaucoma scrn hgh risk direc ............ 0.45 0.76 0.75 NA NA 0.01 XXX
G0118 ... ............ T ......... Glaucoma scrn hgh risk direc ............ 0.17 0.71 0.64 NA NA 0.01 XXX
G0120 ... ............ A ........ Colon ca scrn; barium enema ............ 0.99 4.91 3.68 NA NA 0.17 XXX
G0120 ... 26 ....... A ........ Colon ca scrn; barium enema ............ 0.99 0.35 0.32 0.35 0.32 0.04 XXX
G0120 ... TC ...... A ........ Colon ca scrn; barium enema ............ 0.00 4.55 3.36 NA NA 0.13 XXX
G0121 ... ............ A ........ Colon ca scrn not hi rsk ind ............... 3.69 6.35 6.25 1.83 1.66 0.30 000
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
G0121 ... 53 ....... A ........ Colon ca scrn not hi rsk ind ............... 0.96 2.50 2.39 0.62 0.56 0.08 000
G0122 ... ............ N ........ Colon ca scrn; barium enema ............ 0.99 5.57 4.07 NA NA 0.18 XXX
G0122 ... 26 ....... N ........ Colon ca scrn; barium enema ............ 0.99 0.23 0.30 0.23 0.30 0.05 XXX
G0122 ... TC ...... N ........ Colon ca scrn; barium enema ............ 0.00 5.34 3.77 NA NA 0.13 XXX
G0124 ... ............ A ........ Screen c/v thin layer by MD ............... 0.42 0.37 0.26 0.37 0.26 0.02 XXX
G0127 ... ............ R ........ Trim nail(s) .......................................... 0.17 0.37 0.31 0.04 0.06 0.01 000
G0128 ... ............ R ........ CORF skilled nursing service ............. 0.08 0.02 0.03 0.02 0.03 0.01 XXX
G0130 ... ............ A ........ Single energy x-ray study ................... 0.22 0.55 0.71 NA NA 0.06 XXX
G0130 ... 26 ....... A ........ Single energy x-ray study ................... 0.22 0.06 0.07 0.06 0.07 0.01 XXX
G0130 ... TC ...... A ........ Single energy x-ray study ................... 0.00 0.49 0.64 NA NA 0.05 XXX
G0141 ... ............ A ........ Scr c/v cyto,autosys and md .............. 0.42 0.37 0.26 0.37 0.26 0.02 XXX
G0166 ... ............ A ........ Extrnl counterpulse, per tx ................. 0.07 4.35 3.99 NA NA 0.01 XXX
G0168 ... ............ A ........ Wound closure by adhesive ............... 0.45 1.56 1.75 0.21 0.22 0.03 000
G0179 ... ............ A ........ MD recertification HHA PT ................. 0.45 0.47 0.75 NA NA 0.02 XXX
G0180 ... ............ A ........ MD certification HHA patient .............. 0.67 0.55 0.91 NA NA 0.03 XXX
G0181 ... ............ A ........ Home health care supervision ............ 1.73 0.80 1.15 NA NA 0.07 XXX
G0182 ... ............ A ........ Hospice care supervision ................... 1.73 0.82 1.25 NA NA 0.07 XXX
G0186 ... ............ C ........ Dstry eye lesn,fdr vssl tech ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY
G0202 ... ............ A ........ Screeningmammographydigital .......... 0.70 2.81 2.76 NA NA 0.10 XXX
G0202 ... 26 ....... A ........ Screeningmammographydigital .......... 0.70 0.24 0.23 0.24 0.23 0.03 XXX
G0202 ... TC ...... A ........ Screeningmammographydigital .......... 0.00 2.57 2.54 NA NA 0.07 XXX
G0204 ... ............ A ........ Diagnosticmammographydigital .......... 0.87 3.41 3.05 NA NA 0.11 XXX
G0204 ... 26 ....... A ........ Diagnosticmammographydigital .......... 0.87 0.30 0.28 0.30 0.28 0.04 XXX
G0204 ... TC ...... A ........ Diagnosticmammographydigital .......... 0.00 3.11 2.77 NA NA 0.07 XXX
G0206 ... ............ A ........ Diagnosticmammographydigital .......... 0.70 2.67 2.43 NA NA 0.09 XXX
G0206 ... 26 ....... A ........ Diagnosticmammographydigital .......... 0.70 0.24 0.23 0.24 0.23 0.03 XXX
G0206 ... TC ...... A ........ Diagnosticmammographydigital .......... 0.00 2.43 2.20 NA NA 0.06 XXX
G0237 ... ............ A ........ Therapeutic procd strg endur ............. 0.00 0.21 0.34 NA NA 0.02 XXX
G0238 ... ............ A ........ Oth resp proc, indiv ............................ 0.00 0.23 0.36 NA NA 0.02 XXX
G0239 ... ............ A ........ Oth resp proc, group .......................... 0.00 0.31 0.32 NA NA 0.02 XXX
G0245 ... ............ R ........ Initial foot exam pt lops ...................... 0.88 0.84 0.81 0.30 0.31 0.04 XXX
G0246 ... ............ R ........ Followup eval of foot pt lop ................ 0.45 0.55 0.54 0.15 0.16 0.02 XXX
G0247 ... ............ R ........ Routine footcare pt w lops ................. 0.50 0.66 0.59 0.16 0.19 0.02 ZZZ
G0248 ... ............ R ........ Demonstrate use home inr mon ......... 0.00 3.37 4.99 NA NA 0.01 XXX
G0249 ... ............ R ........ Provide test material,equipm .............. 0.00 2.72 3.29 NA NA 0.01 XXX
G0250 ... ............ R ........ MD review interpret of test ................. 0.18 0.08 0.07 NA NA 0.01 XXX
G0252 ... 26 ....... N ........ PET imaging initial dx ......................... 1.50 0.35 0.52 0.35 0.52 0.04 XXX
G0268 ... ............ A ........ Removal of impacted wax md ............ 0.61 0.66 0.64 0.20 0.22 0.02 000
G0270 ... ............ A ........ MNT subs tx for change dx ................ 0.37 0.12 0.29 0.09 0.28 0.01 XXX
G0271 ... ............ A ........ Group MNT 2 or more 30 mins .......... 0.25 0.08 0.13 0.07 0.12 0.01 XXX
G0275 ... ............ A ........ Renal angio, cardiac cath ................... 0.25 NA NA 0.13 0.12 0.01 ZZZ
G0278 ... ............ A ........ Iliac art angio,cardiac cath ................. 0.25 NA NA 0.13 0.12 0.01 ZZZ
G0281 ... ............ A ........ Elec stim unattend for press .............. 0.18 0.14 0.13 NA NA 0.01 XXX
G0283 ... ............ A ........ Elec stim other than wound ................ 0.18 0.14 0.13 NA NA 0.01 XXX
G0288 ... ............ A ........ Recon, CTA for surg plan .................. 0.00 1.02 5.81 NA NA 0.18 XXX
G0289 ... ............ A ........ Arthro, loose body + chondro ............. 1.48 NA NA 0.59 0.70 0.26 ZZZ
G0308 ... ............ A ........ ESRD related svc 4+mo < 2yrs ......... 12.74 5.62 7.07 5.62 7.07 0.42 XXX
G0309 ... ............ A ........ ESRD related svc 2–3mo <2yrs ......... 10.61 4.16 5.75 4.16 5.75 0.36 XXX
G0310 ... ............ A ........ ESRD related svc 1 vst <2yrs ............ 8.49 2.78 4.25 2.78 4.25 0.28 XXX
G0311 ... ............ A ........ ESRD related svs 4+mo 2–11yr ........ 9.73 3.55 4.15 3.55 4.15 0.34 XXX
G0312 ... ............ A ........ ESRD relate svs 2–3 mo 2–11y ......... 8.11 2.71 3.32 2.71 3.32 0.29 XXX
G0313 ... ............ A ........ ESRD related svs 1 mon 2–11y ......... 6.49 1.84 2.50 1.84 2.50 0.22 XXX
G0314 ... ............ A ........ ESRD related svs 4+ mo 12–19 ........ 8.28 3.39 3.92 3.39 3.92 0.27 XXX
G0315 ... ............ A ........ ESRD related svs 2–3mo/12–19 ........ 6.90 2.56 3.13 2.56 3.13 0.23 XXX
G0316 ... ............ A ........ ESRD related svs 1vis/12–19y ........... 5.52 1.67 2.31 1.67 2.31 0.17 XXX
G0317 ... ............ A ........ ESRD related svs 4+mo 20+yrs ......... 5.09 2.25 2.56 2.25 2.56 0.17 XXX
G0318 ... ............ A ........ ESRD related svs 2–3 mo 20+y ........ 4.24 1.70 2.05 1.70 2.05 0.14 XXX
G0319 ... ............ A ........ ESRD related svs 1visit 20+y ............ 3.39 1.14 1.53 1.14 1.53 0.11 XXX
G0320 ... ............ A ........ ESD related svs home undr 2 ............ 10.61 2.71 4.91 2.71 4.91 0.36 XXX
G0321 ... ............ A ........ ESRDrelatedsvs home mo 2–11y ...... 8.11 2.00 2.97 2.00 2.97 0.29 XXX
G0322 ... ............ A ........ ESRD related svs hom mo12–19 ....... 6.90 1.72 2.70 1.72 2.70 0.23 XXX
G0323 ... ............ A ........ ESRD related svs home mo 20+ ....... 4.24 1.15 1.77 1.15 1.77 0.14 XXX
G0324 ... ............ A ........ ESRD relate svs home/dy <2yr .......... 0.35 0.16 0.20 0.16 0.20 0.01 XXX
G0325 ... ............ A ........ ESRD relate home/day/ 2–11yr ......... 0.23 0.09 0.10 0.09 0.10 0.01 XXX
G0326 ... ............ A ........ ESRD relate home/dy 12–19yr .......... 0.27 0.10 0.11 0.10 0.11 0.01 XXX
G0327 ... ............ A ........ ESRD relate home/dy 20+yrs ............ 0.14 0.06 0.07 0.06 0.07 0.01 XXX
G0329 ... ............ A ........ Electromagntic tx for ulcers ................ 0.06 0.15 0.14 NA NA 0.01 XXX
G0337 ... ............ X ........ Hospice evaluation preelecti .............. 1.34 0.31 0.41 0.31 0.41 0.09 XXX
G0339 ... ............ C ........ Robot lin-radsurg com, first ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
G0340 ... ............ C ........ Robt lin-radsurg fractx 2–5 ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX
G0341 ... ............ A ........ Percutaneous islet celltrans ............... 6.98 NA NA 2.35 2.42 0.48 000
G0342 ... ............ A ........ Laparoscopy islet cell trans ................ 11.92 NA NA 5.05 5.18 1.46 090
——————————
2 Copyright
3 If
payment.

Physician Mal-
RVUs 3
G0343 ... ............ A ........ Laparotomy islet cell transp ............... 19.85 NA NA 8.53 8.66 2.07 090
G0344 ... ............ A ........ Initial preventive exam ........................ 1.34 1.10 1.12 0.43 0.46 0.10 XXX
G0364 ... ............ A ........ Bone marrow aspirate &biopsy .......... 0.16 0.16 0.15 0.07 0.06 0.04 ZZZ
G0365 ... ............ A ........ Vessel mapping hemo access ........... 0.25 5.16 4.57 NA NA 0.25 XXX
G0365 ... 26 ....... A ........ Vessel mapping hemo access ........... 0.25 0.06 0.07 0.06 0.07 0.02 XXX
G0365 ... TC ...... A ........ Vessel mapping hemo access ........... 0.00 5.09 4.50 NA NA 0.23 XXX
G0366 ... ............ A ........ EKG for initial prevent exam .............. 0.17 0.33 0.42 0.33 0.42 0.03 XXX
G0367 ... ............ A ........ EKG tracing for initial prev ................. 0.00 0.27 0.36 NA NA 0.02 XXX
G0368 ... ............ A ........ EKG interpret & report preve ............. 0.17 0.07 0.06 0.07 0.06 0.01 XXX
G0372 ... ............ A ........ MD service required for PMD ............. 0.17 0.05 0.22 0.05 0.06 0.01 XXX
G0375 ... ............ A ........ Smoke/tobacco counselng 3–10 ........ 0.24 0.07 0.08 0.07 0.08 0.01 XXX
G0376 ... ............ A ........ Smoke/tobacco counseling >10 ......... 0.48 0.13 0.16 0.13 0.15 0.01 XXX
G0389 ... ............ A ........ Ultrasound exam AAA screen ............ 0.58 2.40 1.98 NA NA 0.11 XXX
G0389 ... 26 ....... A ........ Ultrasound exam AAA screen ............ 0.58 0.21 0.20 0.21 0.20 0.03 XXX
G0389 ... TC ...... A ........ Ultrasound exam AAA screen ............ 0.00 2.19 1.78 NA NA 0.08 XXX
G0392 ... ............ A ........ AV fistula or graft arterial ................... 9.48 48.02 51.97 NA NA 0.62 000
G0393 ... ............ A ........ AV fistula or graft venous ................... 6.03 36.79 40.56 NA NA 0.34 000
G9041 ... ............ A ........ Low vision rehab occupationa ............ 0.44 0.10 0.19 0.10 0.19 0.01 XXX
G9042 ... ............ A ........ Low vision rehab orient/mobi ............. 0.10 0.02 0.15 0.02 0.15 0.01 XXX
G9043 ... ............ A ........ Low vision lowvision therapi ............... 0.10 0.02 0.15 0.02 0.15 0.01 XXX
G9044 ... ............ A ........ Low vision rehabilate teache .............. 0.10 0.02 0.13 0.02 0.13 0.01 XXX
Gxxx1 .... ............ A ........ MD serv cardiac rehab wo ECG ........ 0.18 0.31 0.31 0.09 0.08 0.01 000
Gxxx2 .... ............ A ........ MD serv cardiac rehab w ECG .......... 0.28 0.43 0.45 0.13 0.12 0.01 000
M0064 ... ............ A ........ Visit for drug monitoring ..................... 0.37 0.90 0.62 0.07 0.10 0.01 XXX
P3001 .... ............ A ........ Screening pap smear by phys ........... 0.42 0.37 0.26 0.37 0.26 0.02 XXX
Q0035 ... ............ A ........ Cardiokymography .............................. 0.17 0.30 0.38 NA NA 0.03 XXX
Q0035 ... 26 ....... A ........ Cardiokymography .............................. 0.17 0.05 0.06 0.05 0.06 0.01 XXX
Q0035 ... TC ...... A ........ Cardiokymography .............................. 0.00 0.25 0.32 NA NA 0.02 XXX
Q0091 ... ............ A ........ Obtaining screen pap smear .............. 0.37 0.75 0.71 0.10 0.12 0.02 XXX
Q0092 ... ............ A ........ Set up port xray equipment ................ 0.00 0.47 0.39 0.47 0.39 0.01 XXX
Q3001 ... ............ C ........ Brachytherapy Radioelements ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
R0070 ... ............ C ........ Transport portable x-ray ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
R0075 ... ............ C ........ Transport port x-ray multipl ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX
1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
2 Copyright2007 American Dental Association. All rights reserved.
3 If
values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not
used for Medicare payment.
ADDENDUM C.—CODES FOR WHICH WE RECEIVED PERC RECOMMENDATIONS ON PE DIRECT INPUTS

CPT 1 code Description CPT 1 code Description
37205 ..................................... Transcath iv stent, percut .................... 58542 ..................................... Lsh w/t/o ut 250 g or less.
37206 ..................................... Transcath iv stent/perc addl ................. 58543 ..................................... Lsh uterus above 250 g.
38570 ..................................... Laparoscopy, lymph node biop ............ 58544 ..................................... Lsh w/t/o uterus above 250 g.
38571 ..................................... Laparoscopy, lymphadenectomy ......... 58545 ..................................... Laparoscopic myomectomy.
38572 ..................................... Laparoscopy, lymphadenectomy ......... 58546 ..................................... Laparo-myomectomy, complex.
51840 ..................................... Attach bladder/urethra .......................... 58548 ..................................... Lap radical hyst.
51841 ..................................... Attach bladder/urethra .......................... 58550 ..................................... Laparo-asst vag hysterectomy.
51925 ..................................... Hysterectomy/bladder repair ................ 58552 ..................................... Laparo-vag hyst incl t/o.
56405 ..................................... I & D of vulva/perineum ....................... 58553 ..................................... Laparo-vag hyst, complex.
56420 ..................................... Drainage of gland abscess .................. 58554 ..................................... Laparo-vag hyst w/t/o, compl.
56441 ..................................... Lysis of labial lesion(s) ......................... 58555 ..................................... Hysteroscopy, dx, sep proc.
56501 ..................................... Destroy, vulva lesions, sim .................. 58558 ..................................... Hysteroscopy, biopsy.
56515 ..................................... Destroy vulva lesion/s compl ............... 58562 ..................................... Hysteroscopy, remove fb.
56605 ..................................... Biopsy of vulva/perineum ..................... 58563 ..................................... Hysteroscopy, ablation.
56606 ..................................... Biopsy of vulva/perineum ..................... 58565 ..................................... Hysteroscopy, sterilization.
56620 ..................................... Partial removal of vulva ....................... 58600 ..................................... Division of fallopian tube.
56625 ..................................... Complete removal of vulva .................. 58605 ..................................... Division of fallopian tube.
56630 ..................................... Extensive vulva surgery ....................... 58615 ..................................... Occlude fallopian tube(s).
56631 ..................................... Extensive vulva surgery ....................... 58660 ..................................... Laparoscopy, lysis.
56632 ..................................... Extensive vulva surgery ....................... 58661 ..................................... Laparoscopy, remove adnexa.
56633 ..................................... Extensive vulva surgery ....................... 58662 ..................................... Laparoscopy, excise lesions.
56634 ..................................... Extensive vulva surgery ....................... 58670 ..................................... Laparoscopy, tubal cautery.
56637 ..................................... Extensive vulva surgery ....................... 58671 ..................................... Laparoscopy, tubal block.
56640 ..................................... Extensive vulva surgery ....................... 58672 ..................................... Laparoscopy, fimbrioplasty.
56700 ..................................... Partial removal of hymen ..................... 58673 ..................................... Laparoscopy, salpingostomy.
56740 ..................................... Remove vagina gland lesion ................ 58700 ..................................... Removal of fallopian tube.
56800 ..................................... Repair of vagina ................................... 58720 ..................................... Removal of ovary/tube(s).
56805 ..................................... Repair clitoris ....................................... 58740 ..................................... Revise fallopian tube(s).
56810 ..................................... Repair of perineum .............................. 58750 ..................................... Repair oviduct.
56820 ..................................... Exam of vulva w/scope ........................ 58752 ..................................... Revise ovarian tube(s).
56821 ..................................... Exam/biopsy of vulva w/scope ............. 58760 ..................................... Remove tubal obstruction.
57000 ..................................... Exploration of vagina ........................... 58770 ..................................... Create new tubal opening.
57010 ..................................... Drainage of pelvic abscess .................. 58800 ..................................... Drainage of ovarian cyst(s).
57020 ..................................... Drainage of pelvic fluid ........................ 58805 ..................................... Drainage of ovarian cyst(s).
57022 ..................................... I & vaginal hematoma, pp .................... 58820 ..................................... Drain ovary abscess, open.
57023 ..................................... I & vag hematoma, non-ob .................. 58822 ..................................... Drain ovary abscess, percut.
57061 ..................................... Destroy vag lesions, simple ................. 58825 ..................................... Transposition, ovary(s).
57065 ..................................... Destroy vag lesions, complex .............. 58900 ..................................... Biopsy of ovary(s).
57100 ..................................... Biopsy of vagina ................................... 58920 ..................................... Partial removal of ovary(s).
57105 ..................................... Biopsy of vagina ................................... 58925 ..................................... Removal of ovarian cyst(s).
57106 ..................................... Remove vagina wall, partial ................. 58940 ..................................... Removal of ovary(s).
57107 ..................................... Remove vagina tissue, part ................. 58943 ..................................... Removal of ovary(s).
57109 ..................................... Vaginectomy partial w/nodes ............... 58950 ..................................... Resect ovarian malignancy.
57110 ..................................... Remove vagina wall, complete ............ 58951 ..................................... Resect ovarian malignancy.
57111 ..................................... Remove vagina tissue, compl .............. 58952 ..................................... Resect ovarian malignancy.
57112 ..................................... Vaginectomy w/nodes, compl .............. 58953 ..................................... Tah, rad dissect for debulk.
57120 ..................................... Closure of vagina ................................. 58954 ..................................... Tah rad debulk/lymph remove.
57130 ..................................... Remove vagina lesion .......................... 58956 ..................................... Bso, omentectomy w/tah.
57135 ..................................... Remove vagina lesion .......................... 58957 ..................................... Resect recurrent gyn mal.
57150 ..................................... Treat vagina infection ........................... 58958 ..................................... Resect recur gyn mal w/lym.
57155 ..................................... Insert uteri tandems/ovoids .................. 58960 ..................................... Exploration of abdomen.
57160 ..................................... Insert pessary/other device .................. 58970 ..................................... Retrieval of oocyte.
57170 ..................................... Fitting of diaphragm/cap ...................... 58974 ..................................... Transfer of embryo.
57180 ..................................... Treat vaginal bleeding .......................... 58976 ..................................... Transfer of embryo.
57200 ..................................... Repair of vagina ................................... 59000 ..................................... Amniocentesis, diagnostic.
57210 ..................................... Repair vagina/perineum ....................... 59015 ..................................... Chorion biopsy.
57220 ..................................... Revision of urethra ............................... 59100 ..................................... Remove uterus lesion.
57230 ..................................... Repair of urethral lesion ....................... 59120 ..................................... Treat ectopic pregnancy.
57240 ..................................... Repair bladder & vagina ...................... 59121 ..................................... Treat ectopic pregnancy.
57250 ..................................... Repair rectum & vagina ....................... 59130 ..................................... Treat ectopic pregnancy.
57260 ..................................... Repair of vagina ................................... 59135 ..................................... Treat ectopic pregnancy.
57265 ..................................... Extensive repair of vagina ................... 59136 ..................................... Treat ectopic pregnancy.
57268 ..................................... Repair of bowel bulge .......................... 59140 ..................................... Treat ectopic pregnancy.
57270 ..................................... Repair of bowel pouch ......................... 59150 ..................................... Treat ectopic pregnancy.
57280 ..................................... Suspension of vagina ........................... 59151 ..................................... Treat ectopic pregnancy.
57282 ..................................... Colpopexy, extraperitoneal .................. 59160 ..................................... D & c after delivery.
57283 ..................................... Colpopexy, intraperitoneal ................... 59200 ..................................... Insert cervical dilator.
57284 ..................................... Repair paravaginal defect .................... 59300 ..................................... Episiotomy or vaginal repair.
57287 ..................................... Revise/remove sling repair .................. 59400 ..................................... Obstetrical care.
57288 ..................................... Repair bladder defect ........................... 59410 ..................................... Obstetrical care.
57289 ..................................... Repair bladder & vagina ...................... 59425 ..................................... Antepartum care only.
57291 ..................................... Construction of vagina ......................... 59426 ..................................... Antepartum care only.
ADDENDUM C.—CODES FOR WHICH WE RECEIVED PERC RECOMMENDATIONS ON PE DIRECT INPUTS—Continued

57292 ..................................... Construct vagina with graft .................. 59430 ..................................... Care after delivery.
57295 ..................................... Revise vag graft via vagina ................. 59510 ..................................... Cesarean delivery.
57296 ..................................... Revise vag graft, open abd .................. 59515 ..................................... Cesarean delivery.
57300 ..................................... Repair rectum-vagina fistula ................ 59610 ..................................... Vbac delivery.
57305 ..................................... Repair rectum-vagina fistula ................ 59614 ..................................... Vbac care after delivery.
57307 ..................................... Fistula repair & colostomy ................... 59618 ..................................... Attempted vbac delivery.
57310 ..................................... Repair urethrovaginal lesion ................ 59622 ..................................... Attempted vbac after care.
57311 ..................................... Repair urethrovaginal lesion ................ 59812 ..................................... Vbac delivery only.
57320 ..................................... Repair bladder-vagina lesion ............... 59820 ..................................... Care of miscarriage.
57330 ..................................... Repair bladder-vagina lesion ............... 59821 ..................................... Treatment of miscarriage.
57335 ..................................... Repair vagina ....................................... 59830 ..................................... Treat uterus infection.
57415 ..................................... Remove vaginal foreign body .............. 59840 ..................................... Abortion.
57420 ..................................... Exam of vagina w/scope ...................... 59841 ..................................... Abortion.
57421 ..................................... Exam/biopsy of vag w/scope ............... 59850 ..................................... Abortion.
57425 ..................................... Laparoscopy, surg, colpopexy ............. 59851 ..................................... Abortion.
57452 ..................................... Exam of cervix w/scope ....................... 59852 ..................................... Abortion.
57454 ..................................... Bx/curett of cervix w/scope .................. 59855 ..................................... Abortion.
57455 ..................................... Biopsy of cervix w/scope ..................... 59856 ..................................... Abortion.
57456 ..................................... Endocerv curettage w/scope ................ 59857 ..................................... Abortion.
57460 ..................................... Bx of cervix w/scope, leep ................... 59870 ..................................... Evacuate mole of uterus.
57461 ..................................... Conz of cervix w/scope, leep ............... 64430 ..................................... N block inj, pudendal.
57500 ..................................... Biopsy of cervix .................................... 64435 ..................................... N block inj, paracervical.
57505 ..................................... Endocervical curettage ......................... 64360 ..................................... Injection treatment of nerve.
57510 ..................................... Cauterization of cervix ......................... 75960 ..................................... Transcath iv stent rs&i.
57511 ..................................... Cryocautery of cervix ........................... 77051 ..................................... Computer dx mammogram add-on.
57513 ..................................... Laser surgery of cervix ........................ 77052 ..................................... Comp screen mammogram add-on.
57520 ..................................... Conization of cervix .............................. 77080 ..................................... Dxa bone density, axial.
57522 ..................................... Conization of cervix .............................. 77081 ..................................... Dxa bone density/peripheral.
57530 ..................................... Removal of cervix ................................ 77082 ..................................... Dxa bone density, vert fx.
57531 ..................................... Removal of cervix, radical .................... 78206 ..................................... Liver image (3d) with flow.
57540 ..................................... Removal of residual cervix ................... 78600 ..................................... Brain imaging, ltd static.
57545 ..................................... Remove cervix/repair pelvis ................. 78601 ..................................... Brain imaging, ltd w/flow.
57550 ..................................... Removal of residual cervix ................... 78605 ..................................... Brain imaging, complete.
57555 ..................................... Remove cervix/repair vagina ............... 78606 ..................................... Brain imaging, compl w/flow.
57556 ..................................... Remove cervix, repair bowel ................ 78607 ..................................... Brain imaging (3D).
57558 ..................................... D&c of cervical stump .......................... 78610 ..................................... Brain flow imaging only.
57700 ..................................... Revision of cervix ................................. 78615 ..................................... Cerebral vascular flow image.
57720 ..................................... Revision of cervix ................................. 78647 ..................................... Cerebrospinal fluid scan.
57800 ..................................... Dilation of cervical canal ...................... 78803 ..................................... Tumor imaging (3D).
58100 ..................................... Biopsy of uterus lining .......................... 78807 ..................................... Nuclear localization/abscess.
58110 ..................................... Bx done w/colposcopy add-on ............. 93501 ..................................... Right heart catheterization.
58120 ..................................... Dilation and curettage .......................... 93503 ..................................... Insert/place heart catheter.
58140 ..................................... Myomectomy abdom method ............... 93505 ..................................... Biopsy of heart lining.
58145 ..................................... Myomectomy vag method .................... 93508 ..................................... Cath placement, angiography.
58146 ..................................... Myomectomy abdom complex ............. 93510 ..................................... Left heart catheterization.
58150 ..................................... Total hysterectomy ............................... 93511 ..................................... Left heart catheterization.
58152 ..................................... Total hysterectomy ............................... 93514 ..................................... Left heart catheterization.
58180 ..................................... Partial hysterectomy ............................. 93524 ..................................... Left heart catheterization.
58200 ..................................... Extensive hysterectomy ....................... 93526 ..................................... Rt & Lt heart catheters.
58210 ..................................... Extensive hysterectomy ....................... 93527 ..................................... Rt & Lt heart catheters.
58240 ..................................... Removal of pelvis contents .................. 93528 ..................................... Rt & Lt heart catheters.
58260 ..................................... Vaginal hysterectomy ........................... 93529 ..................................... Rt, lt heart catheterization.
58262 ..................................... Vag hyst including t/o ........................... 93530 ..................................... Rt heart cath, congenital.
58263 ..................................... Vag hyst w/t/o & vag repair ................. 93531 ..................................... R & l heart cath, congenital.
58267 ..................................... Vag hyst w/urinary repair ..................... 93532 ..................................... R & l heart cath, congenital.
58270 ..................................... Vag hyst w/enterocele repair ............... 93533 ..................................... R & l heart cath, congenital.
58275 ..................................... Hysterectomy/revise vagina ................. 93539 ..................................... Injection, cardiac cath.
58280 ..................................... Hysterectomy/revise vagina ................. 93540 ..................................... Injection, cardiac cath.
58285 ..................................... Extensive hysterectomy ....................... 93541 ..................................... Injection for lung angiogram.
58290 ..................................... Vag hyst complex ................................. 93542 ..................................... Injection for heart x-rays.
58291 ..................................... Vag hyst incl t/o, complex .................... 93543 ..................................... Injection for heart x-rays.
58292 ..................................... Vag hyst t/o & repair, compl ................ 93544 ..................................... Injection for aortography.
58293 ..................................... Vag hyst w/uro repair, compl ............... 93545 ..................................... Inject for coronary x-rays.
58294 ..................................... Vag hyst w/enterocele, compl .............. 93555 ..................................... Imaging, cardiac cath.
58340 ..................................... Catheter for hysterography .................. 93556 ..................................... Imaging, cardiac cath.
58345 ..................................... Reopen fallopian tube .......................... 93561 ..................................... Cardiac output measurement.
58346 ..................................... Insert heyman uteri capsule ................. 93562 ..................................... Cardiac output measurement.
58350 ..................................... Reopen fallopian tube .......................... 93571 ..................................... Heart flow reserve measure.
58353 ..................................... Endometr ablate, thermal ..................... 93572 ..................................... Heart flow reserve measure.
58555 ..................................... Hysteroscopy, dx, sep proc.
58356 ..................................... Endometrial cryoablation.
58400 ..................................... Suspension of uterus.
ADDENDUM C.—CODES FOR WHICH WE RECEIVED PERC RECOMMENDATIONS ON PE DIRECT INPUTS—Continued

58410 ..................................... Suspension of uterus.

58520 ..................................... Repair of ruptured uterus.
58540 ..................................... Revision of uterus.
58541 ..................................... Lsh, uterus 250 g or less.
ADDENDUM D.—PROPOSED 2008 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS)

2008 2007
Carrier Locality Locality name % change
GAF GAF
31140 ....... 06 San Mateo, CA .......................................................................................................... 1.231 1.259 ¥2.19%

31140 ....... 05 San Francisco, CA .................................................................................................... 1.228 1.256 ¥2.19%
31140 ....... 09 Santa Clara, CA ........................................................................................................ 1.206 1.265 ¥4.63%
00803 ....... 01 Manhattan, NY ........................................................................................................... 1.174 1.184 ¥0.84%
00803 ....... 02 NYC Suburbs/Long I., NY ......................................................................................... 1.171 1.18 ¥0.73%
31140 ....... 07 Oakland/Berkley, CA ................................................................................................. 1.154 1.177 ¥1.94%
31143 ....... 01 Metropolitan Boston ................................................................................................... 1.143 1.153 ¥0.85%
14330 ....... 04 Queens, NY ............................................................................................................... 1.137 1.144 ¥0.62%
31140 ....... 03 Marin/Napa/Solano, CA ............................................................................................. 1.133 1.154 ¥1.84%
00805 ....... 01 Northern NJ ............................................................................................................... 1.130 1.126 0.39%
00903 ....... 01 DC + MD/VA Suburbs ............................................................................................... 1.127 1.132 ¥0.47%
31146 ....... 26 Anaheim/Santa Ana, CA ........................................................................................... 1.124 1.12 0.35%
31146 ....... 17 Ventura, CA ............................................................................................................... 1.102 1.084 1.69%
31146 ....... 18 Los Angeles, CA ........................................................................................................ 1.100 1.088 1.14%
00591 ....... 00 Connecticut ................................................................................................................ 1.096 1.091 0.42%
00952 ....... 12 Chicago, IL ................................................................................................................ 1.093 1.102 ¥0.78%
00590 ....... 04 Miami, FL ................................................................................................................... 1.092 1.069 2.17%
00953 ....... 01 Detroit, MI .................................................................................................................. 1.091 1.11 ¥1.71%
00805 ....... 99 Rest of New Jersey ................................................................................................... 1.078 1.074 0.37%
00952 ....... 16 Suburban Chicago, IL ................................................................................................ 1.074 1.085 ¥0.99%
00865 ....... 01 Metropolitan Philadelphia, PA ................................................................................... 1.072 1.069 0.30%
00836 ....... 02 Seattle (King Cnty), WA ............................................................................................ 1.046 1.058 ¥1.17%
00831 ....... 01 Alaska ........................................................................................................................ 1.045 1.055 ¥0.94%
00833 ....... 01 Hawaii/Guam ............................................................................................................. 1.044 1.044 ¥0.03%
31143 ....... 99 Rest of Massachusetts .............................................................................................. 1.042 1.042 ¥0.03%
00803 ....... 03 Poughkpsie/N NYC Suburbs, NY .............................................................................. 1.040 1.046 ¥0.54%
00901 ....... 01 Baltimore/Surr. Cntys, MD ......................................................................................... 1.037 1.039 ¥0.21%
00590 ....... 03 Fort Lauderdale, FL ................................................................................................... 1.033 1.015 1.79%
00524 ....... 01 Rhode Island ............................................................................................................. 1.031 1.016 1.44%
00511 ....... 01 Atlanta, GA ................................................................................................................ 1.024 1.043 ¥1.82%
00900 ....... 11 Dallas, TX .................................................................................................................. 1.022 1.035 ¥1.24%
00900 ....... 18 Houston, TX ............................................................................................................... 1.021 1.026 ¥0.49%
00834 ....... 00 Nevada ...................................................................................................................... 1.020 1.023 ¥0.32%
31140 ....... 99 Rest of California* ..................................................................................................... 1.014 1.017 ¥0.28%
31146 ....... 99 Rest of California* ..................................................................................................... 1.014 1.017 ¥0.28%
00902 ....... 01 Delaware .................................................................................................................... 1.012 1.011 0.10%
00900 ....... 31 Austin, TX .................................................................................................................. 1.001 1.015 ¥1.40%
00835 ....... 01 Portland, OR .............................................................................................................. 0.996 1.005 ¥0.88%
00900 ....... 09 Brazoria, TX ............................................................................................................... 0.995 1.005 ¥0.98%
00528 ....... 01 New Orleans, LA ....................................................................................................... 0.993 0.976 1.76%
31144 ....... 40 New Hampshire ......................................................................................................... 0.993 1 ¥0.69%
00952 ....... 15 East St. Louis, IL ....................................................................................................... 0.993 0.995 ¥0.24%
00900 ....... 28 Fort Worth, TX ........................................................................................................... 0.989 0.996 ¥0.65%
00973 ....... 50 Virgin Islands ............................................................................................................. 0.989 0.989 ¥0.03%
00900 ....... 15 Galveston, TX ............................................................................................................ 0.986 0.985 0.07%
00824 ....... 01 Colorado .................................................................................................................... 0.983 0.991 ¥0.81%
00901 ....... 99 Rest of Maryland ....................................................................................................... 0.981 0.978 0.31%
31142 ....... 03 Southern Maine ......................................................................................................... 0.981 0.981 ¥0.03%
03102 ....... 00 Arizona ....................................................................................................................... 0.980 0.993 ¥1.29%
00523 ....... 01 Metropolitan Kansas City, MO .................................................................................. 0.980 0.982 ¥0.23%
00590 ....... 99 Rest of Florida ........................................................................................................... 0.978 0.968 0.98%
00953 ....... 99 Rest of Michigan ........................................................................................................ 0.976 0.984 ¥0.81%
00836 ....... 99 Rest of Washington ................................................................................................... 0.973 0.977 ¥0.37%
00740 ....... 02 Metropolitan St. Louis, MO ........................................................................................ 0.971 0.974 ¥0.27%
00883 ....... 00 Ohio ........................................................................................................................... 0.969 0.965 0.46%
00954 ....... 00 Minnesota .................................................................................................................. 0.967 0.975 ¥0.85%
00865 ....... 99 Rest of Pennsylvania ................................................................................................. 0.956 0.946 1.08%
31145 ....... 50 Vermont ..................................................................................................................... 0.953 0.951 0.22%
00904 ....... 00 Virginia ....................................................................................................................... 0.950 0.948 0.19%
03502 ....... 09 Utah ........................................................................................................................... 0.948 0.947 0.08%
00900 ....... 20 Beaumont, TX ............................................................................................................ 0.946 0.942 0.44%
00801 ....... 99 Rest of New York ...................................................................................................... 0.946 0.95 ¥0.45%
00884 ....... 16 Wisconsin .................................................................................................................. 0.943 0.95 ¥0.77%
00952 ....... 99 Rest of Illinois ............................................................................................................ 0.941 0.938 0.29%

05535 ....... 00 North Carolina ........................................................................................................... 0.937 0.936 0.13%
00521 ....... 05 New Mexico ............................................................................................................... 0.937 0.932 0.49%
00630 ....... 00 Indiana ....................................................................................................................... 0.935 0.93 0.58%
00511 ....... 99 Rest of Georgia ......................................................................................................... 0.932 0.932 ¥0.03%
00900 ....... 99 Rest of Texas ............................................................................................................ 0.931 0.929 0.23%
00835 ....... 99 Rest of Oregon .......................................................................................................... 0.930 0.929 0.09%
00951 ....... 00 West Virginia ............................................................................................................. 0.926 0.927 ¥0.09%
ADDENDUM D.—PROPOSED 2008 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS)—Continued

2008 2007
Carrier Locality Locality name % change
GAF GAF
00528 ....... 99 Rest of Louisiana ....................................................................................................... 0.923 0.919 0.45%

05440 ....... 35 Tennessee ................................................................................................................. 0.923 0.921 0.20%
00880 ....... 01 South Carolina ........................................................................................................... 0.920 0.917 0.37%
00650 ....... 00 Kansas* ..................................................................................................................... 0.917 0.919 ¥0.20%
00740 ....... 04 Kansas* ..................................................................................................................... 0.917 0.919 ¥0.20%
31142 ....... 99 Rest of Maine ............................................................................................................ 0.915 0.916 ¥0.15%
00660 ....... 00 Kentucky .................................................................................................................... 0.912 0.915 ¥0.31%
00510 ....... 00 Alabama ..................................................................................................................... 0.910 0.914 ¥0.41%
05130 ....... 00 Idaho .......................................................................................................................... 0.909 0.905 0.47%
03602 ....... 21 Wyoming .................................................................................................................... 0.907 0.91 ¥0.32%
00826 ....... 00 Iowa ........................................................................................................................... 0.906 0.905 0.10%
00512 ....... 00 Mississippi ................................................................................................................. 0.903 0.898 0.54%
00655 ....... 00 Nebraska ................................................................................................................... 0.902 0.903 ¥0.15%
03202 ....... 01 Montana ..................................................................................................................... 0.898 0.902 ¥0.45%
00522 ....... 00 Oklahoma .................................................................................................................. 0.898 0.894 0.40%
00740 ....... 99 Rest of Missouri* ....................................................................................................... 0.890 0.883 0.78%
03402 ....... 02 South Dakota ............................................................................................................. 0.890 0.891 ¥0.17%
00523 ....... 99 Rest of Missouri* ....................................................................................................... 0.889 0.883 0.71%
03302 ....... 01 North Dakota ............................................................................................................. 0.888 0.895 ¥0.82%
00520 ....... 13 Arkansas .................................................................................................................... 0.887 0.884 0.39%
00973 ....... 20 Puerto Rico ................................................................................................................ 0.789 0.79 ¥0.18%
GAF equation: (0.52466*work GPCI)+(0.43669*pe GPCI)+(0.03865*mp GPCI)
* designates multiple carriers
GAF values do not contain a 1.000 floor on physician work GPCI.
ADDENDUM E.—PROPOSED 2008 *** GEOGRAPHIC PRACTICE COST INDICES (GPCIS) BY STATE AND MEDICARE LOCALITY
2007 2008 2009 2007 2008 2009 2007 2008 2009
Carrier Locality Locality name Work Work Work PE PE PE MP MP MP
GPCI ** GPCI GPCI GPCI GPCI GPCI GPCI GPCI GPCI
00510 ..... 00 ........... Alabama ................................................................... 0.982 0.982 0.982 0.847 0.850 0.852 0.740 0.622 0.504
00831 ..... 01 ........... Alaska ...................................................................... 1.017 1.018 1.018 1.105 1.097 1.088 1.013 0.835 0.657
03102 ..... 00 ........... Arizona ..................................................................... 0.987 0.988 0.988 0.994 0.975 0.955 1.052 0.944 0.836
00520 ..... 13 ........... Arkansas .................................................................. 0.961 0.961 0.961 0.832 0.839 0.845 0.431 0.443 0.454
31146 ..... 26 ........... Anaheim/Santa Ana, CA ......................................... 1.034 1.035 1.035 1.238 1.253 1.267 0.939 0.882 0.825
31146 ..... 18 ........... Los Angeles, CA ...................................................... 1.041 1.042 1.042 1.158 1.191 1.223 0.939 0.879 0.818
31140 ..... 03 ........... Marin/Napa/Solano, CA ........................................... 1.035 1.035 1.035 1.342 1.303 1.263 0.640 0.540 0.439
31140 ..... 07 ........... Oakland/Berkley, CA ............................................... 1.054 1.055 1.055 1.373 1.329 1.284 0.640 0.536 0.432
31140 ..... 05 ........... San Francisco, CA .................................................. 1.060 1.060 1.060 1.546 1.493 1.439 0.640 0.531 0.421
31140 ..... 06 ........... San Mateo, CA ........................................................ 1.073 1.073 1.073 1.539 1.485 1.431 0.629 0.515 0.401
31140 ..... 09 ........... Santa Clara, CA ...................................................... 1.083 1.084 1.084 1.543 1.418 1.292 0.595 0.489 0.383
31146 ..... 17 ........... Ventura, CA ............................................................. 1.028 1.028 1.028 1.181 1.222 1.263 0.732 0.756 0.779
31140 ..... 99 ........... Rest of California * ................................................... 1.007 1.008 1.008 1.054 1.055 1.056 0.721 0.640 0.558
31146 ..... 99 ........... Rest of California * ................................................... 1.007 1.008 1.008 1.054 1.055 1.056 0.721 0.640 0.558
00824 ..... 01 ........... Colorado .................................................................. 0.986 0.986 0.986 1.015 1.003 0.990 0.790 0.721 0.652
00591 ..... 00 ........... Connecticut .............................................................. 1.038 1.039 1.039 1.172 1.178 1.183 0.886 0.942 0.997
00903 ..... 01 ........... DC + MD/VA Suburbs ............................................. 1.048 1.048 1.048 1.252 1.234 1.216 0.911 0.981 1.050
00902 ..... 01 ........... Delaware .................................................................. 1.012 1.012 1.012 1.020 1.032 1.044 0.877 0.784 0.690
00590 ..... 03 ........... Fort Lauderdale, FL ................................................. 0.988 0.989 0.989 0.990 1.003 1.016 1.675 1.982 2.288
00590 ..... 04 ........... Miami, FL ................................................................. 1.000 1.001 1.001 1.048 1.058 1.067 2.233 2.727 3.221
00590 ..... 99 ........... Rest of Florida ......................................................... 0.973 0.973 0.973 0.936 0.937 0.937 1.251 1.502 1.753
00511 ..... 01 ........... Atlanta, GA .............................................................. 1.010 1.010 1.010 1.091 1.052 1.012 0.950 0.900 0.850
00511 ..... 99 ........... Rest of Georgia ....................................................... 0.979 0.979 0.979 0.874 0.878 0.882 0.950 0.897 0.843
00833 ..... 01 ........... Hawaii/Guam ........................................................... 1.005 0.990 0.975 1.113 1.136 1.158 0.787 0.732 0.676
05130 ..... 00 ........... Idaho ........................................................................ 0.968 0.967 0.967 0.869 0.876 0.882 0.452 0.504 0.555
00952 ..... 12 ........... Chicago, IL .............................................................. 1.025 1.026 1.026 1.128 1.103 1.078 1.837 1.905 1.973
00952 ..... 15 ........... East St. Louis, IL ..................................................... 0.988 0.989 0.989 0.940 0.929 0.917 1.722 1.773 1.824
00952 ..... 16 ........... Suburban Chicago, IL .............................................. 1.018 1.018 1.018 1.117 1.092 1.066 1.626 1.642 1.657
00952 ..... 99 ........... Rest of Illinois .......................................................... 0.974 0.975 0.975 0.874 0.877 0.879 1.174 1.207 1.240
00630 ..... 00 ........... Indiana ..................................................................... 0.985 0.986 0.986 0.908 0.912 0.916 0.429 0.519 0.609
00826 ..... 00 ........... Iowa ......................................................................... 0.967 0.966 0.965 0.869 0.869 0.869 0.579 0.510 0.441
00650 ..... 00 ........... Kansas * ................................................................... 0.968 0.968 0.969 0.880 0.881 0.881 0.709 0.638 0.567
00740 ..... 04 ........... Kansas * ................................................................... 0.968 0.968 0.969 0.880 0.881 0.881 0.709 0.638 0.567
00660 ..... 00 ........... Kentucky .................................................................. 0.970 0.969 0.969 0.855 0.857 0.859 0.859 0.761 0.663
00528 ..... 01 ........... New Orleans, LA ..................................................... 0.986 0.986 0.986 0.947 0.995 1.042 1.178 1.075 0.972
00528 ..... 99 ........... Rest of Louisiana ..................................................... 0.970 0.970 0.970 0.848 0.863 0.877 1.041 0.974 0.907
31142 ..... 03 ........... Southern Maine ....................................................... 0.980 0.980 0.980 1.014 1.019 1.023 0.626 0.563 0.500
31142 ..... 99 ........... Rest of Maine .......................................................... 0.962 0.962 0.962 0.887 0.889 0.891 0.626 0.563 0.500
00901 ..... 01 ........... Baltimore/Surr. Cntys, MD ....................................... 1.012 1.013 1.013 1.080 1.068 1.055 0.932 1.019 1.105
00901 ..... 99 ........... Rest of Maryland ..................................................... 0.993 0.994 0.994 0.981 0.981 0.980 0.748 0.819 0.889
31143 ..... 01 ........... Metropolitan Boston ................................................. 1.030 1.030 1.030 1.331 1.310 1.289 0.810 0.794 0.777
31143 ..... 99 ........... Rest of Massachusetts ............................................ 1.007 1.008 1.008 1.105 1.105 1.104 0.810 0.794 0.777
00953 ..... 01 ........... Detroit, MI ................................................................ 1.037 1.037 1.037 1.056 1.047 1.038 2.700 2.320 1.939
00953 ..... 99 ........... Rest of Michigan ...................................................... 0.997 0.998 0.998 0.922 0.922 0.921 1.494 1.298 1.101
00954 ..... 00 ........... Minnesota ................................................................ 0.991 0.992 0.992 1.006 0.994 0.981 0.404 0.327 0.249
00512 ..... 00 ........... Mississippi ............................................................... 0.960 0.959 0.959 0.841 0.847 0.853 0.711 0.767 0.822
00523 ..... 01 ........... Metropolitan Kansas City, MO ................................ 0.989 0.990 0.990 0.977 0.960 0.943 0.931 1.070 1.208
00740 ..... 02 ........... Metropolitan St. Louis, MO ...................................... 0.992 0.993 0.993 0.956 0.943 0.929 0.926 1.010 1.093
00523 ..... 99 ........... Rest of Missouri * ..................................................... 0.950 0.950 0.950 0.803 0.812 0.820 0.878 0.946 1.014
00740 ..... 99 ........... Rest of Missouri * ..................................................... 0.950 0.951 0.952 0.803 0.812 0.820 0.878 0.946 1.014
03202 ..... 01 ........... Montana ................................................................... 0.950 0.950 0.950 0.845 0.846 0.846 0.889 0.787 0.685
00655 ..... 00 ........... Nebraska ................................................................. 0.959 0.959 0.959 0.876 0.882 0.888 0.447 0.348 0.249
00834 ..... 00 ........... Nevada .................................................................... 1.003 1.003 1.003 1.045 1.035 1.024 1.050 1.076 1.102
31144 ..... 40 ........... New Hampshire ....................................................... 0.981 0.982 0.982 1.029 1.033 1.037 0.927 0.699 0.470
00805 ..... 01 ........... Northern NJ ............................................................. 1.058 1.059 1.059 1.222 1.224 1.226 0.958 1.047 1.135
00805 ..... 99 ........... Rest of New Jersey ................................................. 1.043 1.043 1.043 1.121 1.123 1.124 0.958 1.047 1.135
00521 ..... 05 ........... New Mexico ............................................................. 0.972 0.973 0.973 0.888 0.888 0.888 0.880 0.998 1.115
00803 ..... 01 ........... Manhattan, NY ......................................................... 1.065 1.065 1.065 1.300 1.298 1.296 1.480 1.254 1.027
00803 ..... 02 ........... NYC Suburbs/Long I., NY ....................................... 1.052 1.052 1.052 1.283 1.285 1.287 1.756 1.506 1.256
00803 ..... 03 ........... Poughkpsie/N NYC Suburbs, NY ............................ 1.014 1.015 1.015 1.076 1.076 1.075 1.148 0.992 0.836
14330 ..... 04 ........... Queens, NY ............................................................. 1.032 1.033 1.033 1.230 1.234 1.237 1.682 1.462 1.241
00801 ..... 99 ........... Rest of New York .................................................... 0.997 0.997 0.997 0.919 0.919 0.919 0.666 0.549 0.432
05535 ..... 00 ........... North Carolina ......................................................... 0.971 0.972 0.972 0.922 0.923 0.923 0.630 0.638 0.645
03302 ..... 01 ........... North Dakota ........................................................... 0.946 0.946 0.947 0.861 0.852 0.843 0.593 0.494 0.394
00883 ..... 00 ........... Ohio ......................................................................... 0.992 0.993 0.993 0.934 0.930 0.925 0.960 1.107 1.253
00522 ..... 00 ........... Oklahoma ................................................................ 0.964 0.964 0.964 0.856 0.853 0.849 0.376 0.507 0.638
00835 ..... 01 ........... Portland, OR ............................................................ 1.002 1.003 1.003 1.059 1.036 1.013 0.434 0.457 0.480
00835 ..... 99 ........... Rest of Oregon ........................................................ 0.968 0.968 0.968 0.927 0.926 0.925 0.434 0.457 0.480
00865 ..... 01 ........... Metropolitan Philadelphia, PA ................................. 1.016 1.017 1.017 1.106 1.101 1.095 1.364 1.505 1.645
00865 ..... 99 ........... Rest of Pennsylvania ............................................... 0.992 0.993 0.993 0.904 0.914 0.923 0.793 0.946 1.099
00973 ..... 20 ........... Puerto Rico .............................................................. 0.906 0.905 0.904 0.699 0.696 0.693 0.257 0.256 0.254
00524 ..... 01 ........... Rhode Island ........................................................... 1.045 1.030 1.014 0.991 1.039 1.086 0.895 0.954 1.013
00880 ..... 01 ........... South Carolina ......................................................... 0.975 0.975 0.975 0.894 0.899 0.904 0.388 0.421 0.454
03402 ..... 02 ........... South Dakota ........................................................... 0.943 0.942 0.942 0.877 0.870 0.863 0.359 0.393 0.427
05440 ..... 35 ........... Tennessee ............................................................... 0.977 0.978 0.978 0.881 0.884 0.887 0.621 0.620 0.618
00900 ..... 31 ........... Austin, TX ................................................................ 0.991 0.991 0.991 1.048 1.015 0.981 0.970 0.978 0.986
00900 ..... 20 ........... Beaumont, TX .......................................................... 0.983 0.984 0.984 0.862 0.868 0.874 1.277 1.323 1.369
00900 ..... 09 ........... Brazoria, TX ............................................................. 1.020 1.020 1.020 0.963 0.942 0.920 1.277 1.261 1.244
00900 ..... 11 ........... Dallas, TX ................................................................ 1.009 1.010 1.010 1.064 1.032 0.999 1.044 1.087 1.129
00900 ..... 28 ........... Fort Worth, TX ......................................................... 0.997 0.998 0.998 0.991 0.971 0.951 1.044 1.087 1.129
ADDENDUM E.—PROPOSED 2008 *** GEOGRAPHIC PRACTICE COST INDICES (GPCIS) BY STATE AND MEDICARE
LOCALITY—Continued
2007 2008 2009 2007 2008 2009 2007 2008 2009
Carrier Locality Locality name Work Work Work PE PE PE MP MP MP
GPCI ** GPCI GPCI GPCI GPCI GPCI GPCI GPCI GPCI
00900 ..... 15 ........... Galveston, TX .......................................................... 0.990 0.991 0.991 0.954 0.956 0.957 1.277 1.261 1.244
00900 ..... 18 ........... Houston, TX ............................................................. 1.016 1.017 1.017 1.016 1.000 0.983 1.276 1.322 1.368
00900 ..... 99 ........... Rest of Texas .......................................................... 0.968 0.968 0.968 0.866 0.872 0.878 1.120 1.102 1.083
03502 ..... 09 ........... Utah ......................................................................... 0.977 0.977 0.977 0.938 0.922 0.905 0.651 0.848 1.044
31145 ..... 50 ........... Vermont ................................................................... 0.968 0.968 0.968 0.970 0.976 0.981 0.505 0.501 0.497
00904 ..... 00 ........... Virginia ..................................................................... 0.981 0.982 0.982 0.942 0.941 0.940 0.569 0.619 0.668
00973 ..... 50 ........... Virgin Islands ........................................................... 0.967 0.982 0.997 1.015 0.996 0.976 0.987 1.007 1.026
00836 ..... 02 ........... Seattle (King Cnty), WA .......................................... 1.014 1.015 1.015 1.133 1.108 1.083 0.805 0.762 0.718
00836 ..... 99 ........... Rest of Washington ................................................. 0.987 0.987 0.988 0.980 0.976 0.972 0.805 0.755 0.705
00951 ..... 00 ........... West Virginia ........................................................... 0.973 0.974 0.974 0.820 0.823 0.826 1.522 1.449 1.376
00884 ..... 16 ........... Wisconsin ................................................................ 0.987 0.988 0.988 0.920 0.920 0.919 0.777 0.597 0.416
03602 ..... 21 ........... Wyoming .................................................................. 0.956 0.956 0.956 0.855 0.848 0.841 0.920 0.912 0.904
* Indicates multiple carriers.
** 2007 work GPCI does not reflect the 1.000 floor.
*** 2008 GPCIs are the first year of the update transition, 2009 GPCIs are the fully implemented updated GPCI.
2008 GPCIs: 1⁄2 the difference between 2007 and 2009 GPCIs.
ADDENDUM F—CPT/HCPCS IMAG- ADDENDUM F—CPT/HCPCS IMAG- ADDENDUM F—CPT/HCPCS IMAG-

ING CODES DEFINED BY SECTION ING CODES DEFINED BY SECTION ING CODES DEFINED BY SECTION
5102(B) OF THE DRA 5102(B) OF THE DRA—Continued 5102(B) OF THE DRA—Continued
HCPCS/ HCPCS/ HCPCS/
Short Descriptor Short Descriptor Short Descriptor
CPT* CPT* CPT*
31620 ........ Endobronchial us add-on. 71010 ........ Chest x-ray. 72198 ........ Mr angio pelvis w/o & w/dye.
37250 ........ Iv us first vessel add-on. 71015 ........ Chest x-ray. 72200 ........ X-ray exam sacroiliac joints.
37251 ........ Iv us each add vessel add-on. 71020 ........ Chest x-ray. 72202 ........ X-ray exam sacroiliac joints.
51798 ........ Us urine capacity measure. 71021 ........ Chest x-ray. 72220 ........ X-ray exam of tailbone.
70010 ........ Contrast x-ray of brain. 71022 ........ Chest x-ray. 72240 ........ Contrast x-ray of neck spine.
70015 ........ Contrast x-ray of brain. 71023 ........ Chest x-ray and fluoroscopy. 72255 ........ Contrast x-ray, thorax spine.
70030 ........ X-ray eye for foreign body. 71030 ........ Chest x-ray. 72265 ........ Contrast x-ray, lower spine.
70100 ........ X-ray exam of jaw. 71034 ........ Chest x-ray and fluoroscopy. 72270 ........ Contrast x-ray, spine.
70110 ........ X-ray exam of jaw. 71035 ........ Chest x-ray. 72275 ........ Epidurography.
70120 ........ X-ray exam of mastoids. 71040 ........ Contrast x-ray of bronchi. 72285 ........ X-ray c/t spine disk.
70130 ........ X-ray exam of mastoids. 71060 ........ Contrast x-ray of bronchi. 72291 ........ Percut vertebroplasty fluor.
70134 ........ X-ray exam of middle ear. 71090 ........ X-ray & pacemaker insertion. 72293 ........ Percut vertebroplasty, ct.
70140 ........ X-ray exam of facial bones. 71100 ........ X-ray exam of ribs. 72295 ........ X-ray of lower spine disk.
70150 ........ X-ray exam of facial bones. 71101 ........ X-ray exam of ribs/chest. 73000 ........ X-ray exam of collar bone.
70160 ........ X-ray exam of nasal bones. 71110 ........ X-ray exam of ribs. 73010 ........ X-ray exam of shoulder blade.
70170 ........ X-ray exam of tear duct. 71111 ........ X-ray exam of ribs/chest. 73020 ........ X-ray exam of shoulder.
70190 ........ X-ray exam of eye sockets. 71120 ........ X-ray exam of breastbone. 73030 ........ X-ray exam of shoulder.
70200 ........ X-ray exam of eye sockets. 71130 ........ X-ray exam of breastbone. 73040 ........ Contrast x-ray of shoulder.
70210 ........ X-ray exam of sinuses. 71250 ........ Ct thorax w/o dye. 73050 ........ X-ray exam of shoulders.
70220 ........ X-ray exam of sinuses. 71260 ........ Ct thorax w/dye. 73060 ........ X-ray exam of humerus.
70240 ........ X-ray exam, pituitary saddle. 71270 ........ Ct thorax w/o & w/dye. 73070 ........ X-ray exam of elbow.
70250 ........ X-ray exam of skull. 71275 ........ Ct angiography, chest. 73080 ........ X-ray exam of elbow.
70260 ........ X-ray exam of skull. 71550 ........ Mri chest w/o dye. 73085 ........ Contrast x-ray of elbow.
70300 ........ X-ray exam of teeth. 71551 ........ Mri chest w/dye. 73090 ........ X-ray exam of forearm.
70310 ........ X-ray exam of teeth. 71552 ........ Mri chest w/o & w/dye. 73092 ........ X-ray exam of arm, infant.
70320 ........ Full mouth x-ray of teeth. 71555 ........ Mri angio chest w or w/o dye. 73100 ........ X-ray exam of wrist.
70328 ........ X-ray exam of jaw joint. 72010 ........ X-ray exam of spine. 73110 ........ X-ray exam of wrist.
70330 ........ X-ray exam of jaw joints. 72020 ........ X-ray exam of spine. 73115 ........ Contrast x-ray of wrist.
70332 ........ X-ray exam of jaw joint. 72040 ........ X-ray exam of neck spine. 73120 ........ X-ray exam of hand.
70336 ........ Magnetic image, jaw joint. 72050 ........ X-ray exam of neck spine. 73130 ........ X-ray exam of hand.
70350 ........ X-ray head for orthodontia. 72052 ........ X-ray exam of neck spine. 73140 ........ X-ray exam of finger(s).
70355 ........ Panoramic x-ray of jaws. 72069 ........ X-ray exam of trunk spine. 73200 ........ Ct upper extremity w/o dye.
70360 ........ X-ray exam of neck. 72070 ........ X-ray exam of thoracic spine. 73201 ........ Ct upper extremity w/dye.
70370 ........ Throat x-ray & fluoroscopy. 72072 ........ X-ray exam of thoracic spine. 73202 ........ Ct uppr extremity w/o&w/dye.
70371 ........ Speech evaluation, complex. 72074 ........ X-ray exam of thoracic spine. 73206 ........ Ct angio upr extrm w/o&w/dye.
70373 ........ Contrast x-ray of larynx. 72080 ........ X-ray exam of trunk spine. 73218 ........ Mri upper extremity w/o dye.
70380 ........ X-ray exam of salivary gland. 72090 ........ X-ray exam of trunk spine. 73219 ........ Mri upper extremity w/dye.
70390 ........ X-ray exam of salivary duct. 72100 ........ X-ray exam of lower spine. 73220 ........ Mri uppr extremity w/o&w/dye.
70450 ........ Ct head/brain w/o dye. 72110 ........ X-ray exam of lower spine. 73221 ........ Mri joint upr extrem w/o dye.
70460 ........ Ct head/brain w/dye. 72114 ........ X-ray exam of lower spine. 73222 ........ Mri joint upr extrem w/dye.
70470 ........ Ct head/brain w/o & w/dye. 72120 ........ X-ray exam of lower spine. 73223 ........ Mri joint upr extr w/o&w/dye.
70480 ........ Ct orbit/ear/fossa w/o dye. 72125 ........ Ct neck spine w/o dye. 73225 ........ Mr angio upr extr w/o&w/dye.
70481 ........ Ct orbit/ear/fossa w/dye. 72126 ........ Ct neck spine w/dye. 73500 ........ X-ray exam of hip.
70482 ........ Ct orbit/ear/fossa w/o&w/dye. 72127 ........ Ct neck spine w/o & w/dye. 73510 ........ X-ray exam of hip.
70486 ........ Ct maxillofacial w/o dye. 72128 ........ Ct chest spine w/o dye. 73520 ........ X-ray exam of hips.
70487 ........ Ct maxillofacial w/dye. 72129 ........ Ct chest spine w/dye. 73525 ........ Contrast x-ray of hip.
70488 ........ Ct maxillofacial w/o & w/dye. 72130 ........ Ct chest spine w/o & w/dye. 73530 ........ X-ray exam of hip.
70490 ........ Ct soft tissue neck w/o dye. 72131 ........ Ct lumbar spine w/o dye. 73540 ........ X-ray exam of pelvis & hips.
70491 ........ Ct soft tissue neck w/dye. 72132 ........ Ct lumbar spine w/dye. 73542 ........ X-ray exam, sacroiliac joint.
70492 ........ Ct sft tsue nck w/o & w/dye. 72133 ........ Ct lumbar spine w/o & w/dye. 73550 ........ X-ray exam of thigh.
70496 ........ Ct angiography, head. 72141 ........ Mri neck spine w/o dye. 73560 ........ X-ray exam of knee, 1 or 2.
70498 ........ Ct angiography, neck. 72142 ........ Mri neck spine w/dye. 73562 ........ X-ray exam of knee, 3.
70540 ........ Mri orbit/face/neck w/o dye. 72146 ........ Mri chest spine w/o dye. 73564 ........ X-ray exam, knee, 4 or more.
70542 ........ Mri orbit/face/neck w/dye. 72147 ........ Mri chest spine w/dye. 73565 ........ X-ray exam of knees.
70543 ........ Mri orbt/fac/nck w/o & w/dye. 72148 ........ Mri lumbar spine w/o dye. 73580 ........ Contrast x-ray of knee joint.
70544 ........ Mr angiography head w/o dye. 72149 ........ Mri lumbar spine w/dye. 73590 ........ X-ray exam of lower leg.
70545 ........ Mr angiography head w/dye. 72156 ........ Mri neck spine w/o & w/dye. 73592 ........ X-ray exam of leg, infant.
70546 ........ Mr angiograph head w/o&w/ 72157 ........ Mri chest spine w/o & w/dye. 73600 ........ X-ray exam of ankle.
dye. 72158 ........ Mri lumbar spine w/o & w/dye. 73610 ........ X-ray exam of ankle.
70547 ........ Mr angiography neck w/o dye. 72159 ........ Mr angio spine w/o&w/dye. 73615 ........ Contrast x-ray of ankle.
70548 ........ Mr angiography neck w/dye. 72170 ........ X-ray exam of pelvis. 73620 ........ X-ray exam of foot.
70549 ........ Mr angiograph neck w/o&w/ 72190 ........ X-ray exam of pelvis. 73630 ........ X-ray exam of foot.
dye. 72191 ........ Ct angiograph pelv w/o&w/dye. 73650 ........ X-ray exam of heel.
70551 ........ Mri brain w/o dye. 72192 ........ Ct pelvis w/o dye. 73660 ........ X-ray exam of toe(s).
70552 ........ Mri brain w/dye. 72193 ........ Ct pelvis w/dye. 73700 ........ Ct lower extremity w/o dye.
70553 ........ Mri brain w/o & w/dye. 72194 ........ Ct pelvis w/o & w/dye. 73701 ........ Ct lower extremity w/dye.
70557 ........ Mri brain w/o dye. 72195 ........ Mri pelvis w/o dye. 73702 ........ Ct lwr extremity w/o&w/dye.
70558 ........ Mri brain w/dye. 72196 ........ Mri pelvis w/dye. 73706 ........ Ct angio lwr extr w/o&w/dye.
70559 ........ Mri brain w/o & w/dye. 72197 ........ Mri pelvis w/o & w/dye. 73718 ........ Mri lower extremity w/o dye.

5102(B) OF THE DRA—Continued 5102(B) OF THE DRA—Continued 5102(B) OF THE DRA—Continued
CPT* CPT* CPT*
73719 ........ Mri lower extremity w/dye. 75552 ........ Heart mri for morph w/o dye. 75958 ........ Xray, place prox ext thor ao.
73720 ........ Mri lwr extremity w/o&w/dye. 75553 ........ Heart mri for morph w/dye. 75959 ........ Xray, place dist ext thor ao.
73721 ........ Mri jnt of lwr extre w/o dye. 75554 ........ Cardiac MRI/function. 75960 ........ Transcath iv stent rs&i.
73722 ........ Mri joint of lwr extr w/dye. 75555 ........ Cardiac MRI/limited study. 75961 ........ Retrieval, broken catheter.
73723 ........ Mri joint lwr extr w/o&w/dye. 75556 ........ Cardiac MRI/flow mapping. 75962 ........ Repair arterial blockage.
73725 ........ Mr ang lwr ext w or w/o dye. 75600 ........ Contrast x-ray exam of aorta. 75964 ........ Repair artery blockage, each.
74000 ........ X-ray exam of abdomen. 75605 ........ Contrast x-ray exam of aorta. 75966 ........ Repair arterial blockage.
74010 ........ X-ray exam of abdomen. 75625 ........ Contrast x-ray exam of aorta. 75968 ........ Repair artery blockage, each.
74020 ........ X-ray exam of abdomen. 75630 ........ X-ray aorta, leg arteries. 75970 ........ Vascular biopsy.
74022 ........ X-ray exam series, abdomen. 75635 ........ Ct angio abdominal arteries. 75978 ........ Repair venous blockage.
74150 ........ Ct abdomen w/o dye. 75650 ........ Artery x-rays, head & neck. 75980 ........ Contrast xray exam bile duct.
74160 ........ Ct abdomen w/dye. 75658 ........ Artery x-rays, arm. 75982 ........ Contrast xray exam bile duct.
74170 ........ Ct abdomen w/o & w/dye. 75660 ........ Artery x-rays, head & neck. 75984 ........ Xray control catheter change.
74175 ........ Ct angio abdom w/o & w/dye. 75662 ........ Artery x-rays, head & neck. 75989 ........ Abscess drainage under x-ray.
74181 ........ Mri abdomen w/o dye. 75665 ........ Artery x-rays, head & neck. 75992 ........ Atherectomy, x-ray exam.
74182 ........ Mri abdomen w/dye. 75671 ........ Artery x-rays, head & neck. 76000 ........ Fluoroscope examination.
74183 ........ Mri abdomen w/o & w/dye. 75676 ........ Artery x-rays, neck. 76001 ........ Fluoroscope exam, extensive.
74185 ........ Mri angio, abdom w orw/o dye. 75680 ........ Artery x-rays, neck. 76010 ........ X-ray, nose to rectum.
74190 ........ X-ray exam of peritoneum. 75685 ........ Artery x-rays, spine. 76080 ........ X-ray exam of fistula.
74210 ........ Contrst x-ray exam of throat. 75705 ........ Artery x-rays, spine. 76098 ........ X-ray exam, breast specimen.
74220 ........ Contrast x-ray, esophagus. 75710 ........ Artery x-rays, arm/leg. 76100 ........ X-ray exam of body section.
74230 ........ Cine/vid x-ray, throat/esoph. 75716 ........ Artery x-rays, arms/legs. 76101 ........ Complex body section x-ray.
74235 ........ Remove esophagus obstruc- 75722 ........ Artery x-rays, kidney. 76102 ........ Complex body section x-rays.
tion. 75724 ........ Artery x-rays, kidneys. 76120 ........ Cine/video x-rays.
74240 ........ X-ray exam, upper gi tract. 75726 ........ Artery x-rays, abdomen. 76125 ........ Cine/video x-rays add-on.
74241 ........ X-ray exam, upper gi tract. 75731 ........ Artery x-rays, adrenal gland. 76140 ........ X-ray consultation.
74245 ........ X-ray exam, upper gi tract. 75733 ........ Artery x-rays, adrenals. 76150 ........ X-ray exam, dry process.
74246 ........ Contrst x-ray uppr gi tract. 75736 ........ Artery x-rays, pelvis. 76350 ........ Special x-ray contrast study.
74247 ........ Contrst x-ray uppr gi tract. 75741 ........ Artery x-rays, lung. 76376 ........ 3d render w/o postprocess.
74249 ........ Contrst x-ray uppr gi tract. 75743 ........ Artery x-rays, lungs. 76377 ........ 3d rendering w/postprocess.
74250 ........ X-ray exam of small bowel. 75746 ........ Artery x-rays, lung. 76380 ........ CAT scan follow-up study.
74251 ........ X-ray exam of small bowel. 75756 ........ Artery x-rays, chest. 76390 ........ Mr spectroscopy.
74260 ........ X-ray exam of small bowel. 75774 ........ Artery x-ray, each vessel. 76496 ........ Fluoroscopic procedure.
74270 ........ Contrast x-ray exam of colon. 75790 ........ Visualize A-V shunt. 76497 ........ Ct procedure.
74280 ........ Contrast x-ray exam of colon. 75801 ........ Lymph vessel x-ray, arm/leg. 76498 ........ Mri procedure.
74283 ........ Contrast x-ray exam of colon. 75803 ........ Lymph vessel x-ray,arms/legs. 76506 ........ Echo exam of head.
74290 ........ Contrast x-ray, gallbladder. 75805 ........ Lymph vessel x-ray, trunk. 76510 ........ Ophth us, b & quant a.
74291 ........ Contrast x-rays, gallbladder. 75807 ........ Lymph vessel x-ray, trunk. 76511 ........ Ophth us, quant a only.
74300 ........ X-ray bile ducts/pancreas. 75809 ........ Nonvascular shunt, x-ray. 76512 ........ Ophth us, b w/non-quant a.
74301 ........ X-rays at surgery add-on. 75810 ........ Vein x-ray, spleen/liver. 76513 ........ Echo exam of eye, water bath.
74305 ........ X-ray bile ducts/pancreas. 75820 ........ Vein x-ray, arm/leg. 76514 ........ Echo exam of eye, thickness.
74320 ........ Contrast x-ray of bile ducts. 75822 ........ Vein x-ray, arms/legs. 76516 ........ Echo exam of eye.
74327 ........ X-ray bile stone removal. 75825 ........ Vein x-ray, trunk. 76519 ........ Echo exam of eye.
74328 ........ X-ray bile duct endoscopy. 75827 ........ Vein x-ray, chest. 76529 ........ Echo exam of eye.
74329 ........ X-ray for pancreas endoscopy. 75831 ........ Vein x-ray, kidney. 76536 ........ Us exam of head and neck.
74330 ........ X-ray bile/panc endoscopy. 75833 ........ Vein x-ray, kidneys. 76604 ........ Us exam, chest, b-scan.
74340 ........ X-ray guide for GI tube. 75840 ........ Vein x-ray, adrenal gland. 76645 ........ Us exam, breast(s).
74350 ........ X-ray guide, stomach tube. 75842 ........ Vein x-ray, adrenal glands. 76700 ........ Us exam, abdom, complete.
74355 ........ X-ray guide, intestinal tube. 75860 ........ Vein x-ray, neck. 76705 ........ Echo exam of abdomen.
74360 ........ X-ray guide, GI dilation. 75870 ........ Vein x-ray, skull. 76770 ........ Us exam abdo back wall,
74363 ........ X-ray, bile duct dilation. 75872 ........ Vein x-ray, skull. comp.
74400 ........ Contrst x-ray, urinary tract. 75880 ........ Vein x-ray, eye socket. 76775 ........ Us exam abdo back wall, lim.
74410 ........ Contrst x-ray, urinary tract. 75885 ........ Vein x-ray, liver. 76778 ........ Us exam kidney transplant.
74415 ........ Contrst x-ray, urinary tract. 75887 ........ Vein x-ray, liver. 76800 ........ Us exam, spinal canal.
74420 ........ Contrst x-ray, urinary tract. 75889 ........ Vein x-ray, liver. 76801 ........ Ob us < 14 wks, single fetus.
74425 ........ Contrst x-ray, urinary tract. 75891 ........ Vein x-ray, liver. 76802 ........ Ob us < 14 wks, add?l fetus.
74430 ........ Contrast x-ray, bladder. 75893 ........ Venous sampling by catheter. 76805 ........ Ob us ≥ 14 wks, sngl fetus.
74440 ........ X-ray, male genital tract. 75894 ........ X-rays, transcath therapy. 76810 ........ Ob us ≥ 14 wks, addl fetus.
74445 ........ X-ray exam of penis. 75896 ........ X-rays, transcath therapy. 76811 ........ Ob us, detailed, sngl fetus.
74450 ........ X-ray, urethra/bladder. 75898 ........ Follow-up angiography. 76812 ........ Ob us, detailed, addl fetus.
74455 ........ X-ray, urethra/bladder. 75900 ........ Intravascular cath exchange. 76815 ........ Ob us, limited, fetus(s).
74470 ........ X-ray exam of kidney lesion. 75901 ........ Remove cva device obstruct. 76816 ........ Ob us, follow-up, per fetus.
74475 ........ X-ray control, cath insert. 75902 ........ Remove cva lumen obstruct. 76817 ........ Transvaginal us, obstetric.
74480 ........ X-ray control, cath insert. 75940 ........ X-ray placement, vein filter. 76818 ........ Fetal biophys profile w/nst.
74485 ........ X-ray guide, GU dilation. 75945 ........ Intravascular us. 76819 ........ Fetal biophys profil w/o nst.
74710 ........ X-ray measurement of pelvis. 75946 ........ Intravascular us add-on. 76820 ........ Umbilical artery echo.
74740 ........ X-ray, female genital tract. 75953 ........ Abdom aneurysm endovas rpr. 76821 ........ Middle cerebral artery echo.
74742 ........ X-ray, fallopian tube. 75956 ........ Xray, endovasc thor ao repr. 76825 ........ Echo exam of fetal heart.
74775 ........ X-ray exam of perineum. 75957 ........ Xray, endovasc thor ao repr. 76826 ........ Echo exam of fetal heart.

CPT* CPT* CPT*
76827 ........ Echo exam of fetal heart. 78102 ........ Bone marrow imaging, ltd. 78605 ........ Brain imaging, complete.
76828 ........ Echo exam of fetal heart. 78103 ........ Bone marrow imaging, mult. 78606 ........ Brain imaging, compl w/flow.
76830 ........ Transvaginal us, non-ob. 78104 ........ Bone marrow imaging, body. 78607 ........ Brain imaging (3D).
76831 ........ Echo exam, uterus. 78135 ........ Red cell survival kinetics. 78608 ........ Brain imaging (PET).
76856 ........ Us exam, pelvic, complete. 78140 ........ Red cell sequestration. 78609 ........ Brain imaging (PET).
76857 ........ Us exam, pelvic, limited. 78185 ........ Spleen imaging. 78610 ........ Brain flow imaging only.
76870 ........ Us exam, scrotum. 78190 ........ Platelet survival, kinetics. 78615 ........ Cerebral vascular flow image.
76872 ........ Us, transrectal. 78195 ........ Lymph system imaging. 78630 ........ Cerebrospinal fluid scan.
76873 ........ Echograp trans r, pros study. 78201 ........ Liver imaging. 78635 ........ CSF ventriculography.
76880 ........ Us exam, extremity. 78202 ........ Liver imaging with flow. 78645 ........ CSF shunt evaluation.
76885 ........ Us exam infant hips, dynamic. 78205 ........ Liver imaging (3D). 78647 ........ Cerebrospinal fluid scan.
76886 ........ Us exam infant hips, static. 78206 ........ Liver image (3d) with flow. 78650 ........ CSF leakage imaging.
76930 ........ Echo guide, cardiocentesis. 78215 ........ Liver and spleen imaging. 78660 ........ Nuclear exam of tear flow.
76932 ........ Echo guide for heart biopsy. 78216 ........ Liver & spleen image/flow. 78700 ........ Kidney imaging, static.
76936 ........ Echo guide for artery repair. 78220 ........ Liver function study. 78701 ........ Kidney imaging with flow.
76937 ........ Us guide, vascular access. 78223 ........ Hepatobiliary imaging. 78704 ........ Imaging renogram.
76940 ........ Us guide, tissue ablation. 78230 ........ Salivary gland imaging. 78707 ........ Kidney flow/function image.
76941 ........ Echo guide for transfusion. 78231 ........ Serial salivary imaging. 78708 ........ Kidney flow/function image.
76942 ........ Echo guide for biopsy. 78232 ........ Salivary gland function exam. 78709 ........ Kidney flow/function image.
76945 ........ Echo guide, villus sampling. 78258 ........ Esophageal motility study. 78710 ........ Kidney imaging (3D).
76946 ........ Echo guide for amniocentesis. 78261 ........ Gastric mucosa imaging. 78715 ........ Renal vascular flow exam.
76948 ........ Echo guide, ova aspiration. 78262 ........ Gastroesophageal reflux exam. 78730 ........ Urinary bladder retention.
76950 ........ Echo guidance radiotherapy. 78264 ........ Gastric emptying study. 78740 ........ Ureteral reflux study.
76965 ........ Echo guidance radiotherapy. 78278 ........ Acute GI blood loss imaging. 78760 ........ Testicular imaging.
76970 ........ Ultrasound exam follow-up. 78282 ........ GI protein loss exam. 78761 ........ Testicular imaging/flow.
76975 ........ GI endoscopic ultrasound. 78290 ........ Meckel?s divert exam. 78800 ........ Tumor imaging, limited area.
76977 ........ Us bone density measure. 78291 ........ Leveen/shunt patency exam. 78801 ........ Tumor imaging, mult areas.
76998 ........ Ultrasound guide intraoper. 78300 ........ Bone imaging, limited area. 78802 ........ Tumor imaging, whole body.
77001 ........ Fluoroguide for vein device. 78305 ........ Bone imaging, multiple areas. 78803 ........ Tumor imaging (3D).
77002 ........ Needle localization by x-ray. 78306 ........ Bone imaging, whole body. 78804 ........ Tumor imaging, whole body.
77003 ........ Fluoroguide for spine inject. 78315 ........ Bone imaging, 3 phase. 78805 ........ Abscess imaging, ltd area.
77011 ........ Ct scan for localization. 78320 ........ Bone imaging (3D). 78806 ........ Abscess imaging, whole body.
77012 ........ Ct scan for needle biopsy. 78350 ........ Bone mineral, single photon. 78807 ........ Nuclear localization/abscess.
77013 ........ Ct guide for tissue ablation. 78351 ........ Bone mineral, dual photon. 78811 ........ Tumor imaging (pet), limited.
77014 ........ Ct scan for therapy guide. 78428 ........ Cardiac shunt imaging. 78812 ........ Tumor image (pet)/skul-thigh.
77021 ........ Mr guidance for needle place. 78445 ........ Vascular flow imaging. 78813 ........ Tumor image (pet) full body.
77022 ........ Mri for tissue ablation. 78456 ........ Acute venous thrombus image. 78814 ........ Tumor image pet/ct, limited.
77031 ........ Stereotactic breast biopsy. 78457 ........ Venous thrombosis imaging. 78815 ........ Tumorimage pet/ct skul-thigh.
77032 ........ X-ray of needle wire, breast. 78458 ........ Ven thrombosis images, bilat. 78816 ........ Tumor image pet/ct full body.
77053 ........ X-ray of mammary duct. 78459 ........ Heart muscle imaging (PET). 78890 ........ Nuclear medicine data proc.
77054 ........ X-ray of mammary ducts. 78460 ........ Heart muscle blood, single. 78891 ........ Nuclear med data proc.
77058 ........ Magnetic image, breast. 78461 ........ Heart muscle blood, multiple. 92135 ........ Opthalmic dx imagingt.
77059 ........ Magnetic image, both breasts. 78464 ........ Heart image (3d), single. 92235 ........ Eye exam with photos.
77071 ........ X-ray stress view. 78465 ........ Heart image (3d), multiple. 92240 ........ Icg angiography.
77072 ........ X-rays for bone age. 78466 ........ Heart infarct image. 92250 ........ Eye exam with photos.
77073 ........ X-rays, bone evaluation. 78468 ........ Heart infarct image (ef). 92285 ........ Eye photography.
77074 ........ X-rays, bone survey. 78469 ........ Heart infarct image (3D). 92286 ........ Internal eye photography.
77075 ........ X-rays, bone survey. 78472 ........ Gated heart, planar, single. 93303 ........ Echo transthoracic.
77076 ........ X-rays, bone evaluation. 78473 ........ Gated heart, multiple. 93304 ........ Echo transthoracic.
77077 ........ Joint survey, single view. 78478 ........ Heart wall motion add-on. 93307 ........ Echo exam of heart.
77078 ........ Ct bone density, axial. 78480 ........ Heart function add-on. 93308 ........ Echo exam of heart.
77079 ........ Ct bone density, peripheral. 78481 ........ Heart first pass, single. 93312 ........ Echo transesophageal.
77080 ........ Dxa bone density, axial. 78483 ........ Heart first pass, multiple. 93313 ........ Echo transesophageal.
77081 ........ Dxa bone density/peripheral. 78491 ........ Heart image (pet), single. 93314 ........ Echo transesophageal.
77082 ........ Dxa bone density/v-fracture. 78492 ........ Heart image (pet), multiple. 93315 ........ Echo transesophageal.
77083 ........ Radiographic absorptiometry. 78494 ........ Heart image, spect. 93316 ........ Echo transesophageal.
77084 ........ Magnetic image, bone marrow. 78496 ........ Heart first pass add-on. 93317 ........ Echo transesophageal.
77417 ........ Radiology port film(s). 78580 ........ Lung perfusion imaging. 93318 ........ Echo transesophageal intraop.
77421 ........ Stereoscopic x-ray guidance. 78584 ........ Lung V/Q image single breath. 93320 ........ Doppler echo exam, heart.
78006 ........ Thyroid imaging with uptake. 78585 ........ Lung V/Q imaging. 93321 ........ Doppler echo exam, heart.
78007 ........ Thyroid image, mult uptakes. 78586 ........ Aerosol lung image, single. 93325 ........ Doppler color flow add-on.
78010 ........ Thyroid imaging. 78587 ........ Aerosol lung image, multiple. 93350 ........ Echo transthoracic.
78011 ........ Thyroid imaging with flow. 78588 ........ Perfusion lung image. 93555 ........ Imaging, cardiac cath.
78015 ........ Thyroid met imaging. 78591 ........ Vent image, 1 breath, 1 proj. 93556 ........ Imaging, cardiac cath.
78016 ........ Thyroid met imaging/studies. 78593 ........ Vent image, 1 proj, gas. 93571 ........ Heart flow reserve measure.
78018 ........ Thyroid met imaging, body. 78594 ........ Vent image, mult proj, gas. 93572 ........ Heart flow reserve measure.
78020 ........ Thyroid met uptake. 78596 ........ Lung differential function. 93880 ........ Extracranial study.
78070 ........ Parathyroid nuclear imaging. 78600 ........ Brain imaging, ltd static. 93882 ........ Extracranial study.
78075 ........ Adrenal nuclear imaging. 78601 ........ Brain imaging, ltd w/flow. 93886 ........ Intracranial study.

CPT* CPT* CPT*
93888 ........ Intracranial study. 93990 ........ Doppler flow testing. G0120 ........ Colon ca scrn; barium enema.
93890 ........ Tcd, vasoreactivity study. 0028T ........ Dexa body composition study. G0122 ........ Colon ca scrn; barium enema.
93892 ........ Tcd, emboli detect w/o inj. 0042T ........ Ct perfusion w/contrast, cbf. G0130 ........ Single energy x-ray study.
93893 ........ Tcd, emboli detect w/inj. 0066T ........ Ct colonography;screen.
G0219 ........ PET img wholbod melano
93925 ........ Lower extremity study. 0067T ........ Ct colonography;dx.
nonco.
93926 ........ Lower extremity study. 0080T ........ Endovasc aort repr rad s&i.
93930 ........ Upper extremity study. 0081T ........ Endovasc visc extnsn s&i. G0235 ........ PET not otherwise specified.
93931 ........ Upper extremity study. 0144T ........ CT heart wo dye; qual calc. G0275 ........ Renal angio, cardiac cath.
93970 ........ Extremity study. 0145T ........ CT heart w/wo dye funct. G0278 ........ Iliac art angio,cardiac cath.
93971 ........ Extremity study. 0146T ........ CCTA w/wo dye. G0288 ........ Recon, CTA for surg plan.
93975 ........ Vascular study. 0147T ........ CCTA w/wo, quan calcium. G0365 ........ Vessel mapping hemo access.
93976 ........ Vascular study. 0148T ........ CCTA w/wo, strxr.
93978 ........ Vascular study. 0149T ........ CCTA w/wo, strxr quan calc. *CPT codes and descriptions only are copy-
93979 ........ Vascular study. 0150T ........ CCTA w/wo, disease strxr. right 2006 American Medical Association. All
93980 ........ Penile vascular study. 0151T ........ CT heart funct add-on. rights reserved. Applicable FARS/DFARS
apply.
93981 ........ Penile vascular study. 0152T ........ Computer chest add-on.
ADDENDUM G.—FY 2008 WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS
CBSA Urban area Wage
code (constituent counties) index
10180 ....... Abilene, TX ................................................................................................................................................................................ 0.8395

Callahan County, TX.
Jones County, TX.
Taylor County, TX.
10380 ....... Aguadilla-Isabela-San Sebastián, PR ....................................................................................................................................... 0.7912
Aguada Municipio, PR.
Aguadilla Municipio, PR.
Añasco Municipio, PR.
Isabela Municipio, PR.
Lares Municipio, PR.
Moca Municipio, PR.
Rincón Municipio, PR.
San Sebastián Municipio, PR.
10420 ....... Akron, OH .................................................................................................................................................................................. 0.9278
Portage County, OH.
Summit County, OH.
10500 ....... Albany, GA ................................................................................................................................................................................ 0.8983
Baker County, GA.
Dougherty County, GA.
Lee County, GA.
Terrell County, GA.
Worth County, GA.
10580 ....... Albany-Schenectady-Troy, NY .................................................................................................................................................. 0.9061
Albany County, NY.
Rensselaer County, NY.
Saratoga County, NY.
Schenectady County, NY.
Schoharie County, NY.
10740 ....... Albuquerque, NM ...................................................................................................................................................................... 1.0095
Bernalillo County, NM.
Sandoval County, NM.
Torrance County, NM.
Valencia County, NM.
10780 ....... Alexandria, LA ........................................................................................................................................................................... 0.8420
Grant Parish, LA.
Rapides Parish, LA.
10900 ....... Allentown-Bethlehem-Easton, PA-NJ ........................................................................................................................................ 1.0410
Warren County, NJ.
Carbon County, PA.
Lehigh County, PA.
Northampton County, PA.
11020 ....... Altoona, PA ............................................................................................................................................................................... 0.9094
Blair County, PA.
11100 ....... Amarillo, TX ............................................................................................................................................................................... 0.9601
Armstrong County, TX.
Carson County, TX.
Potter County, TX.
Randall County, TX.
11180 ....... Ames, IA .................................................................................................................................................................................... 1.0600
Story County, IA.
11260 ....... Anchorage, AK .......................................................................................................................................................................... 1.2570
Anchorage Municipality, AK.
Matanuska-Susitna Borough, AK.
11300 ....... Anderson, IN ............................................................................................................................................................................. 0.9313
Madison County, IN.
11340 ....... Anderson, SC ............................................................................................................................................................................ 0.9587
Anderson County, SC.
11460 ....... Ann Arbor, MI ............................................................................................................................................................................ 1.1120
Washtenaw County, MI.
11500 ....... Anniston-Oxford, AL .................................................................................................................................................................. 0.8363
Calhoun County, AL.
11540 ....... Appleton, WI .............................................................................................................................................................................. 1.0161
Calumet County, WI.
Outagamie County, WI.

11700 ....... Asheville, NC ............................................................................................................................................................................. 0.9695
Buncombe County, NC.
Haywood County, NC.
Henderson County, NC.
Madison County, NC.
12020 ....... Athens-Clarke County, GA ........................................................................................................................................................ 1.1695
Clarke County, GA.
ADDENDUM G.—FY 2008 WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued
Madison County, GA.

Oconee County, GA.
Oglethorpe County, GA.
12060 ....... Atlanta-Sandy Springs-Marietta, GA ......................................................................................................................................... 1.0401
Barrow County, GA.
Bartow County, GA.
Butts County, GA.
Carroll County, GA.
Cherokee County, GA.
Clayton County, GA.
Cobb County, GA.
Coweta County, GA.
Dawson County, GA.
DeKalb County, GA.
Douglas County, GA.
Fayette County, GA.
Forsyth County, GA.
Fulton County, GA.
Gwinnett County, GA.
Haralson County, GA.
Heard County, GA.
Henry County, GA.
Jasper County, GA.
Lamar County, GA.
Meriwether County, GA.
Newton County, GA.
Paulding County, GA.
Pickens County, GA.
Pike County, GA.
Rockdale County, GA.
Spalding County, GA.
Walton County, GA.
12100 ....... Atlantic City, NJ ......................................................................................................................................................................... 1.2870
Atlantic County, NJ.
12220 ....... Auburn-Opelika, AL ................................................................................................................................................................... 0.8544
Lee County, AL.
12260 ....... Augusta-Richmond County, GA-SC .......................................................................................................................................... 1.0173
Burke County, GA.
Columbia County, GA.
McDuffie County, GA.
Richmond County, GA.
Aiken County, SC.
Edgefield County, SC.
12420 ....... Austin-Round Rock, TX ............................................................................................................................................................. 1.0082
Bastrop County, TX.
Caldwell County, TX.
Hays County, TX.
Travis County, TX.
Williamson County, TX.
12540 ....... Bakersfield, CA .......................................................................................................................................................................... 1.1840
Kern County, CA.
12580 ....... Baltimore-Towson, MD .............................................................................................................................................................. 1.0770
Anne Arundel County, MD.
Baltimore County, MD.
Carroll County, MD.
Harford County, MD.
Howard County, MD.
Queen Anne’s County, MD.
Baltimore City, MD.
12620 ....... Bangor, ME ............................................................................................................................................................................... 1.0499
Penobscot County, ME.
12700 ....... Barnstable Town, MA ................................................................................................................................................................ 1.3298
Barnstable County, MA.
12940 ....... Baton Rouge, LA ....................................................................................................................................................................... 0.8478

Ascension Parish, LA.
East Baton Rouge Parish, LA.
East Feliciana Parish, LA.
Iberville Parish, LA.
Livingston Parish, LA.
Pointe Coupee Parish, LA.
St. Helena Parish, LA.
West Baton Rouge Parish, LA.

West Feliciana Parish, LA.
12980 ....... Battle Creek, MI ........................................................................................................................................................................ 1.0723
Calhoun County, MI.
13020 ....... Bay City, MI ............................................................................................................................................................................... 0.9388
Bay County, MI.
13140 ....... Beaumont-Port Arthur, TX ......................................................................................................................................................... 0.8966
Hardin County, TX.
Jefferson County, TX.
Orange County, TX.
13380 ....... Bellingham, WA ......................................................................................................................................................................... 1.2107
Whatcom County, WA.
13460 ....... Bend, OR ................................................................................................................................................................................... 1.1545
Deschutes County, OR.
13644 ....... Bethesda-Frederick-Gaithersburg, MD ..................................................................................................................................... 1.1091
Frederick County, MD.
Montgomery County, MD.
13740 ....... Billings, MT ................................................................................................................................................................................ 0.9146
Carbon County, MT.
Yellowstone County, MT.
13780 ....... Binghamton, NY ........................................................................................................................................................................ 0.9443
Broome County, NY.
Tioga County, NY.
13820 ....... Birmingham-Hoover, AL ............................................................................................................................................................ 0.9401
Bibb County, AL.
Blount County, AL.
Chilton County, AL.
Jefferson County, AL.
St. Clair County, AL.
Shelby County, AL.
Walker County, AL.
13900 ....... Bismarck, ND ............................................................................................................................................................................ 0.7912
Burleigh County, ND.
Morton County, ND.
13980 ....... Blacksburg-Christiansburg-Radford, VA ................................................................................................................................... 0.8583
Giles County, VA.
Montgomery County, VA.
Pulaski County, VA.
Radford City, VA.
14020 ....... Bloomington, IN ......................................................................................................................................................................... 0.9406
Greene County, IN.
Monroe County, IN.
Owen County, IN.
14060 ....... Bloomington-Normal, IL ............................................................................................................................................................. 0.9839
McLean County, IL.
14260 ....... Boise City-Nampa, ID ................................................................................................................................................................ 0.9987
Ada County, ID.
Boise County, ID.
Canyon County, ID.
Gem County, ID.
Owyhee County, ID.
14484 ....... Boston-Quincy, MA ................................................................................................................................................................... 1.2289
Norfolk County, MA.
Plymouth County, MA.
Suffolk County, MA.
14500 ....... Boulder, CO ............................................................................................................................................................................... 1.1004
Boulder County, CO.
14540 ....... Bowling Green, KY .................................................................................................................................................................... 0.8608
Edmonson County, KY.
Warren County, KY.
14740 ....... Bremerton-Silverdale, WA ......................................................................................................................................................... 1.1505
Kitsap County, WA.
14860 ....... Bridgeport-Stamford-Norwalk, CT ............................................................................................................................................. 1.3544
Fairfield County, CT.

15180 ....... Brownsville-Harlingen, TX ......................................................................................................................................................... 0.9794
Cameron County, TX.
15260 ....... Brunswick, GA ........................................................................................................................................................................... 0.9997
Brantley County, GA.
Glynn County, GA.
McIntosh County, GA.
15380 ....... Buffalo-Niagara Falls, NY .......................................................................................................................................................... 1.0089
Erie County, NY.

Niagara County, NY.
15500 ....... Burlington, NC ........................................................................................................................................................................... 0.9229
Alamance County, NC.
15540 ....... Burlington-South Burlington, VT ................................................................................................................................................ 1.0193
Chittenden County, VT.
Franklin County, VT.
Grand Isle County, VT.
15764 ....... Cambridge-Newton-Framingham, MA ....................................................................................................................................... 1.1783
Middlesex County, MA.
15804 ....... Camden, NJ .............................................................................................................................................................................. 1.0967
Burlington County, NJ.
Camden County, NJ.
Gloucester County, NJ.
15940 ....... Canton-Massillon, OH ............................................................................................................................................................... 0.9426
Carroll County, OH.
Stark County, OH.
15980 ....... Cape Coral-Fort Myers, FL ....................................................................................................................................................... 0.9913
Lee County, FL.
16180 ....... Carson City, NV ........................................................................................................................................................................ 0.9868
Carson City, NV.
16220 ....... Casper, WY ............................................................................................................................................................................... 0.9902
Natrona County, WY.
16300 ....... Cedar Rapids, IA ....................................................................................................................................................................... 0.9340
Benton County, IA.
Jones County, IA.
Linn County, IA.
16580 ....... Champaign-Urbana, IL .............................................................................................................................................................. 0.9908
Champaign County, IL.
Ford County, IL.
Piatt County, IL.
16620 ....... Charleston, WV ......................................................................................................................................................................... 0.8746
Boone County, WV.
Clay County, WV.
Kanawha County, WV.
Lincoln County, WV.
Putnam County, WV.
16700 ....... Charleston-North Charleston, SC ............................................................................................................................................. 0.9662
Berkeley County, SC.
Charleston County, SC.
Dorchester County, SC.
16740 ....... Charlotte-Gastonia-Concord, NC-SC ........................................................................................................................................ 1.0046
Anson County, NC.
Cabarrus County, NC.
Gaston County, NC.
Mecklenburg County, NC.
Union County, NC.
York County, SC.
16820 ....... Charlottesville, VA ..................................................................................................................................................................... 1.0206
Albemarle County, VA.
Fluvanna County, VA.
Greene County, VA.
Nelson County, VA.
Charlottesville City, VA.
16860 ....... Chattanooga, TN-GA ................................................................................................................................................................. 0.9489
Catoosa County, GA.
Dade County, GA.
Walker County, GA.
Hamilton County, TN.
Marion County, TN.
Sequatchie County, TN.
16940 ....... Cheyenne, WY .......................................................................................................................................................................... 0.9821
Laramie County, WY.
16974 ....... Chicago-Naperville-Joliet, IL ..................................................................................................................................................... 1.1156

Cook County, IL.
DeKalb County, IL.
DuPage County, IL.
Grundy County, IL.
Kane County, IL.
Kendall County, IL.
McHenry County, IL.
Will County, IL.

17020 ....... Chico, CA .................................................................................................................................................................................. 1.1911
Butte County, CA.
17140 ....... Cincinnati-Middletown, OH-KY-IN ............................................................................................................................................. 1.0310
Dearborn County, IN.
Franklin County, IN.
Ohio County, IN.
Boone County, KY.
Bracken County, KY.
Campbell County, KY.
Gallatin County, KY.
Grant County, KY.
Kenton County, KY.
Pendleton County, KY.
Brown County, OH.
Butler County, OH.
Clermont County, OH.
Hamilton County, OH.
Warren County, OH.
17300 ....... Clarksville, TN-KY ..................................................................................................................................................................... 0.8705
Christian County, KY.
Trigg County, KY.
Montgomery County, TN.
Stewart County, TN.
17420 ....... Cleveland, TN ............................................................................................................................................................................ 0.8497
Bradley County, TN.
Polk County, TN.
17460 ....... Cleveland-Elyria-Mentor, OH .................................................................................................................................................... 0.9869
Cuyahoga County, OH.
Geauga County, OH.
Lake County, OH.
Lorain County, OH.
Medina County, OH.
17660 ....... Coeur d’Alene, ID ...................................................................................................................................................................... 1.0057
Kootenai County, ID.
17780 ....... College Station-Bryan, TX ......................................................................................................................................................... 0.9873
Brazos County, TX.
Burleson County, TX.
Robertson County, TX.
17820 ....... Colorado Springs, CO ............................................................................................................................................................... 1.0255
El Paso County, CO.
Teller County, CO.
17860 ....... Columbia, MO ........................................................................................................................................................................... 0.9138
Boone County, MO.
Howard County, MO.
17900 ....... Columbia, SC ............................................................................................................................................................................ 0.9239
Calhoun County, SC.
Fairfield County, SC.
Kershaw County, SC.
Lexington County, SC.
Richland County, SC.
Saluda County, SC.
17980 ....... Columbus, GA-AL ..................................................................................................................................................................... 0.9211
Russell County, AL.
Chattahoochee County, GA.
Harris County, GA.
Marion County, GA.
Muscogee County, GA.
18020 ....... Columbus, IN ............................................................................................................................................................................. 1.0063
Bartholomew County, IN.
18140 ....... Columbus, OH ........................................................................................................................................................................... 1.0660
Delaware County, OH.
Fairfield County, OH.
Franklin County, OH.

Licking County, OH.
Madison County, OH.
Morrow County, OH.
Pickaway County, OH.
Union County, OH.
18580 ....... Corpus Christi, TX ..................................................................................................................................................................... 0.9061
Aransas County, TX.
Nueces County, TX.

San Patricio County, TX.
18700 ....... Corvallis, OR ............................................................................................................................................................................. 1.1563
Benton County, OR.
19060 ....... Cumberland, MD-WV ................................................................................................................................................................ 0.8752
Allegany County, MD.
Mineral County, WV.
19124 ....... Dallas-Plano-Irving, TX ............................................................................................................................................................. 1.0467
Collin County, TX.
Dallas County, TX.
Delta County, TX.
Denton County, TX.
Ellis County, TX.
Hunt County, TX.
Kaufman County, TX.
Rockwall County, TX.
19140 ....... Dalton, GA ................................................................................................................................................................................. 0.9242
Murray County, GA.
Whitfield County, GA.
19180 ....... Danville, IL ................................................................................................................................................................................. 0.9452
Vermilion County, IL.
19260 ....... Danville, VA ............................................................................................................................................................................... 0.8889
Pittsylvania County, VA.
Danville City, VA.
19340 ....... Davenport-Moline-Rock Island, IA-IL ........................................................................................................................................ 0.9316
Henry County, IL.
Mercer County, IL.
Rock Island County, IL.
Scott County, IA.
19380 ....... Dayton, OH ................................................................................................................................................................................ 0.9697
Greene County, OH.
Miami County, OH.
Montgomery County, OH.
Preble County, OH.
19460 ....... Decatur, AL ............................................................................................................................................................................... 0.8431
Lawrence County, AL.
Morgan County, AL.
19500 ....... Decatur, IL ................................................................................................................................................................................. 0.8519
Macon County, IL.
19660 ....... Deltona-Daytona Beach-Ormond Beach, FL ............................................................................................................................ 0.9529
Volusia County, FL.
19740 ....... Denver-Aurora, CO ................................................................................................................................................................... 1.1340
Adams County, CO.
Arapahoe County, CO.
Broomfield County, CO.
Clear Creek County, CO.
Denver County, CO.
Douglas County, CO.
Elbert County, CO.
Gilpin County, CO.
Jefferson County, CO.
Park County, CO.
19780 ....... Des Moines-West Des Moines, IA ............................................................................................................................................ 0.9735
Dallas County, IA.
Guthrie County, IA.
Madison County, IA.
Polk County, IA.
Warren County, IA.
19804 ....... Detroit-Livonia-Dearborn, MI ..................................................................................................................................................... 1.0539
Wayne County, MI.
20020 ....... Dothan, AL ................................................................................................................................................................................ 0.7912
Geneva County, AL.
Henry County, AL.
Houston County, AL.

20100 ....... Dover, DE .................................................................................................................................................................................. 1.0656
Kent County, DE.
20220 ....... Dubuque, IA .............................................................................................................................................................................. 0.9551
Dubuque County, IA.
20260 ....... Duluth, MN-WI ........................................................................................................................................................................... 1.0592
Carlton County, MN.
St. Louis County, MN.
Douglas County, WI.

20500 ....... Durham, NC .............................................................................................................................................................................. 1.0432
Chatham County, NC.
Durham County, NC.
Orange County, NC.
Person County, NC.
20740 ....... Eau Claire, WI ........................................................................................................................................................................... 0.9982
Chippewa County, WI.
Eau Claire County, WI.
20764 ....... Edison, NJ ................................................................................................................................................................................. 1.1789
Middlesex County, NJ.
Monmouth County, NJ.
Ocean County, NJ.
Somerset County, NJ.
20940 ....... El Centro, CA ............................................................................................................................................................................ 0.9405
Imperial County, CA.
21060 ....... Elizabethtown, KY ..................................................................................................................................................................... 0.9191
Hardin County, KY.
Larue County, KY.
21140 ....... Elkhart-Goshen, IN .................................................................................................................................................................... 1.0026
Elkhart County, IN.
21300 ....... Elmira, NY ................................................................................................................................................................................. 0.8719
Chemung County, NY.
21340 ....... El Paso, TX ............................................................................................................................................................................... 0.9485
El Paso County, TX.
21500 ....... Erie, PA ..................................................................................................................................................................................... 0.8964
Erie County, PA.
21660 ....... Eugene-Springfield, OR ............................................................................................................................................................ 1.1535
Lane County, OR.
21780 ....... Evansville, IN-KY ....................................................................................................................................................................... 0.9139
Gibson County, IN.
Posey County, IN.
Vanderburgh County, IN.
Warrick County, IN.
Henderson County, KY.
Webster County, KY.
21820 ....... Fairbanks, AK ............................................................................................................................................................................ 1.1659
Fairbanks North Star Borough, AK.
21940 ....... Fajardo, PR ............................................................................................................................................................................... 0.7912
Ceiba Municipio, PR.
Fajardo Municipio, PR.
Luquillo Municipio, PR.
22020 ....... Fargo, ND-MN ........................................................................................................................................................................... 0.8485
Cass County, ND.
Clay County, MN.
22140 ....... Farmington, NM ......................................................................................................................................................................... 1.0118
San Juan County, NM.
22180 ....... Fayetteville, NC ......................................................................................................................................................................... 0.9889
Cumberland County, NC.
Hoke County, NC.
22220 ....... Fayetteville-Springdale-Rogers, AR-MO ................................................................................................................................... 0.9225
Benton County, AR.
Madison County, AR.
Washington County, AR.
McDonald County, MO.
22380 ....... Flagstaff, AZ .............................................................................................................................................................................. 1.2330
Coconino County, AZ.
22420 ....... Flint, MI ...................................................................................................................................................................................... 1.1903
Genesee County, MI.
22500 ....... Florence, SC ............................................................................................................................................................................. 0.8689
Darlington County, SC.
Florence County, SC.
22520 ....... Florence-Muscle Shoals, AL ..................................................................................................................................................... 0.8433
Colbert County, AL.

Lauderdale County, AL.
22540 ....... Fond du Lac, WI ........................................................................................................................................................................ 1.0200
Fond du Lac County, WI.
22660 ....... Fort Collins-Loveland, CO ......................................................................................................................................................... 1.0442
Larimer County, CO.
22744 ....... Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ............................................................................................................ 1.0793
Broward County, FL.
22900 ....... Fort Smith, AR-OK .................................................................................................................................................................... 0.8370

Crawford County, AR.
Franklin County, AR.
Sebastian County, AR.
Le Flore County, OK.
Sequoyah County, OK.
23020 ....... Fort Walton Beach-Crestview-Destin, FL .................................................................................................................................. 0.9222
Okaloosa County, FL.
23060 ....... Fort Wayne, IN .......................................................................................................................................................................... 0.9795
Allen County, IN.
Wells County, IN.
Whitley County, IN.
23104 ....... Fort Worth-Arlington, TX ........................................................................................................................................................... 1.0232
Johnson County, TX.
Parker County, TX.
Tarrant County, TX.
Wise County, TX.
23420 ....... Fresno, CA ................................................................................................................................................................................ 1.1597
Fresno County, CA.
23460 ....... Gadsden, AL ............................................................................................................................................................................. 0.8590
Etowah County, AL.
23540 ....... Gainesville, FL ........................................................................................................................................................................... 0.9702
Alachua County, FL.
Gilchrist County, FL.
23580 ....... Gainesville, GA .......................................................................................................................................................................... 0.9725
Hall County, GA.
23844 ....... Gary, IN ..................................................................................................................................................................................... 0.9732
Jasper County, IN.
Lake County, IN.
Newton County, IN.
Porter County, IN.
24020 ....... Glens Falls, NY ......................................................................................................................................................................... 0.8711
Warren County, NY.
Washington County, NY.
24140 ....... Goldsboro, NC ........................................................................................................................................................................... 0.9801
Wayne County, NC.
24220 ....... Grand Forks, ND-MN ................................................................................................................................................................ 0.8316
Polk County, MN.
Grand Forks County, ND.
24300 ....... Grand Junction, CO .................................................................................................................................................................. 1.0407
Mesa County, CO.
24340 ....... Grand Rapids-Wyoming, MI ...................................................................................................................................................... 0.9828
Barry County, MI.
Ionia County, MI.
Kent County, MI.
Newaygo County, MI.
24500 ....... Great Falls, MT ......................................................................................................................................................................... 0.9151
Cascade County, MT.
24540 ....... Greeley, CO .............................................................................................................................................................................. 1.0191
Weld County, CO.
24580 ....... Green Bay, WI ........................................................................................................................................................................... 1.0263
Brown County, WI.
Kewaunee County, WI.
Oconto County, WI.
24660 ....... Greensboro-High Point, NC ...................................................................................................................................................... 0.9507
Guilford County, NC.
Randolph County, NC.
Rockingham County, NC.
24780 ....... Greenville, NC ........................................................................................................................................................................... 0.9920
Greene County, NC.
Pitt County, NC.
24860 ....... Greenville, SC ........................................................................................................................................................................... 1.0456
Greenville County, SC.
Laurens County, SC.

Pickens County, SC.
25020 ....... Guayama, PR ............................................................................................................................................................................ 0.7912
Arroyo Municipio, PR.
Guayama Municipio, PR.
Patillas Municipio, PR.
25060 ....... Gulfport-Biloxi, MS .................................................................................................................................................................... 0.9263
Hancock County, MS.
Harrison County, MS.

Stone County, MS.
25180 ....... Hagerstown-Martinsburg, MD-WV ............................................................................................................................................ 0.9510
Washington County, MD.
Berkeley County, WV.
Morgan County, WV.
25260 ....... Hanford-Corcoran, CA ............................................................................................................................................................... 1.1074
Kings County, CA.
25420 ....... Harrisburg-Carlisle, PA .............................................................................................................................................................. 0.9797
Cumberland County, PA.
Dauphin County, PA.
Perry County, PA.
25500 ....... Harrisonburg, VA ....................................................................................................................................................................... 0.9436
Rockingham County, VA.
Harrisonburg City, VA.
25540 ....... Hartford-West Hartford-East Hartford, CT ................................................................................................................................ 1.1487
Hartford County, CT.
Litchfield County, CT.
Middlesex County, CT.
Tolland County, CT.
25620 ....... Hattiesburg, MS ......................................................................................................................................................................... 0.7912
Forrest County, MS.
Lamar County, MS.
Perry County, MS.
25860 ....... Hickory-Lenoir-Morganton, NC .................................................................................................................................................. 0.9526
Alexander County, NC.
Burke County, NC.
Caldwell County, NC.
Catawba County, NC.
25980 ....... Hinesville-Fort Stewart, GA 1 ..................................................................................................................................................... 0.9745
Liberty County, GA.
Long County, GA.
26100 ....... Holland-Grand Haven, MI ......................................................................................................................................................... 0.9501
Ottawa County, MI.
26180 ....... Honolulu, HI ............................................................................................................................................................................... 1.2169
Honolulu County, HI.
26300 ....... Hot Springs, AR ........................................................................................................................................................................ 0.9611
Garland County, AR.
26380 ....... Houma-Bayou Cane-Thibodaux, LA ......................................................................................................................................... 0.8327
Lafourche Parish, LA.
Terrebonne Parish, LA.
26420 ....... Houston-Sugar Land-Baytown, TX ........................................................................................................................................... 1.0536
Austin County, TX.
Brazoria County, TX.
Chambers County, TX.
Fort Bend County, TX.
Galveston County, TX.
Harris County, TX.
Liberty County, TX.
Montgomery County, TX.
San Jacinto County, TX.
Waller County, TX.
26580 ....... Huntington-Ashland, WV-KY-OH .............................................................................................................................................. 0.9499
Boyd County, KY.
Greenup County, KY.
Lawrence County, OH.
Cabell County, WV.
Wayne County, WV.
26620 ....... Huntsville, AL ............................................................................................................................................................................ 0.9814
Limestone County, AL.
Madison County, AL.
26820 ....... Idaho Falls, ID ........................................................................................................................................................................... 0.9774
Bonneville County, ID.
Jefferson County, ID.

26900 ....... Indianapolis-Carmel, IN ............................................................................................................................................................. 1.0387
Boone County, IN.
Brown County, IN.
Hamilton County, IN.
Hancock County, IN.
Hendricks County, IN.
Johnson County, IN.
Marion County, IN.

Morgan County, IN.
Putnam County, IN.
Shelby County, IN.
26980 ....... Iowa City, IA .............................................................................................................................................................................. 1.0095
Johnson County, IA.
Washington County, IA.
27060 ....... Ithaca, NY .................................................................................................................................................................................. 1.0149
Tompkins County, NY.
27100 ....... Jackson, MI ............................................................................................................................................................................... 0.9844
Jackson County, MI.
27140 ....... Jackson, MS .............................................................................................................................................................................. 0.8546
Copiah County, MS.
Hinds County, MS.
Madison County, MS.
Rankin County, MS.
Simpson County, MS.
27180 ....... Jackson, TN .............................................................................................................................................................................. 0.9149
Chester County, TN.
Madison County, TN.
27260 ....... Jacksonville, FL ......................................................................................................................................................................... 0.9535
Baker County, FL.
Clay County, FL.
Duval County, FL.
Nassau County, FL.
St. Johns County, FL.
27340 ....... Jacksonville, NC ........................................................................................................................................................................ 0.8525
Onslow County, NC.
27500 ....... Janesville, WI ............................................................................................................................................................................ 1.0190
Rock County, WI.
27620 ....... Jefferson City, MO .................................................................................................................................................................... 0.8945
Callaway County, MO.
Cole County, MO.
Moniteau County, MO.
Osage County, MO.
27740 ....... Johnson City, TN ....................................................................................................................................................................... 0.8152
Carter County, TN.
Unicoi County, TN.
Washington County, TN.
27780 ....... Johnstown, PA .......................................................................................................................................................................... 0.7959
Cambria County, PA.
27860 ....... Jonesboro, AR ........................................................................................................................................................................... 0.8219
Craighead County, AR.
Poinsett County, AR.
27900 ....... Joplin, MO ................................................................................................................................................................................. 0.9547
Jasper County, MO.
Newton County, MO.
28020 ....... Kalamazoo-Portage, MI ............................................................................................................................................................. 1.1008
Kalamazoo County, MI.
Van Buren County, MI.
28100 ....... Kankakee-Bradley, IL ................................................................................................................................................................ 1.2428
Kankakee County, IL.
28140 ....... Kansas City, MO-KS ................................................................................................................................................................. 1.0025
Franklin County, KS.
Johnson County, KS.
Leavenworth County, KS.
Linn County, KS.
Miami County, KS.
Wyandotte County, KS.
Bates County, MO.
Caldwell County, MO.
Cass County, MO.
Clay County, MO.
Clinton County, MO.

Jackson County, MO.
Lafayette County, MO.
Platte County, MO.
Ray County, MO.
28420 ....... Kennewick-Richland-Pasco, WA ............................................................................................................................................... 1.0630
Benton County, WA.
Franklin County, WA.
28660 ....... Killeen-Temple-Fort Hood, TX .................................................................................................................................................. 0.8703

Bell County, TX.
Coryell County, TX.
Lampasas County, TX.
28700 ....... Kingsport-Bristol-Bristol, TN-VA ................................................................................................................................................ 0.8099
Hawkins County, TN.
Sullivan County, TN.
Bristol City, VA.
Scott County, VA.
Washington County, VA.
28740 ....... Kingston, NY ............................................................................................................................................................................. 1.0014
Ulster County, NY.
28940 ....... Knoxville, TN ............................................................................................................................................................................. 0.8508
Anderson County, TN.
Blount County, TN.
Knox County, TN.
Loudon County, TN.
Union County, TN.
29020 ....... Kokomo, IN ................................................................................................................................................................................ 1.0119
Howard County, IN.
Tipton County, IN.
29100 ....... La Crosse, WI-MN ..................................................................................................................................................................... 1.0218
Houston County, MN.
La Crosse County, WI.
29140 ....... Lafayette, IN .............................................................................................................................................................................. 0.9357
Benton County, IN.
Carroll County, IN.
Tippecanoe County, IN.
29180 ....... Lafayette, LA ............................................................................................................................................................................. 0.8698
Lafayette Parish, LA.
St. Martin Parish, LA.
29340 ....... Lake Charles, LA ....................................................................................................................................................................... 0.8205
Calcasieu Parish, LA.
Cameron Parish, LA.
29404 ....... Lake County-Kenosha County, IL-WI ....................................................................................................................................... 1.0857
Lake County, IL.
Kenosha County, WI.
29420 ....... Lake Havasu City—Kingman, AZ ............................................................................................................................................. 0.9847
Mohave, County, AZ.
29460 ....... Lakeland, FL .............................................................................................................................................................................. 0.9139
Polk County, FL.
29540 ....... Lancaster, PA ............................................................................................................................................................................ 0.9768
Lancaster County, PA.
29620 ....... Lansing-East Lansing, MI .......................................................................................................................................................... 1.0676
Clinton County, MI.
Eaton County, MI.
Ingham County, MI.
29700 ....... Laredo, TX ................................................................................................................................................................................. 0.8520
Webb County, TX.
29740 ....... Las Cruces, NM ........................................................................................................................................................................ 0.9154
Dona Ana County, NM.
29820 ....... Las Vegas-Paradise, NV ........................................................................................................................................................... 1.2426
Clark County, NV.
29940 ....... Lawrence, KS ............................................................................................................................................................................ 0.8716
Douglas County, KS.
30020 ....... Lawton, OK ................................................................................................................................................................................ 0.8465
Comanche County, OK.
30140 ....... Lebanon, PA .............................................................................................................................................................................. 0.8644
Lebanon County, PA.
30300 ....... Lewiston, ID-WA ........................................................................................................................................................................ 0.9976
Nez Perce County, ID.
Asotin County, WA.
30340 ....... Lewiston-Auburn, ME ................................................................................................................................................................ 0.9700
Androscoggin County, ME.

30460 ....... Lexington-Fayette, KY ............................................................................................................................................................... 0.9719
Bourbon County, KY.
Clark County, KY.
Fayette County, KY.
Jessamine County, KY.
Scott County, KY.
Woodford County, KY.
30620 ....... Lima, OH ................................................................................................................................................................................... 0.9944

Allen County, OH.
30700 ....... Lincoln, NE ................................................................................................................................................................................ 1.0560
Lancaster County, NE.
Seward County, NE.
30780 ....... Little Rock-North Little Rock, AR .............................................................................................................................................. 0.9351
Faulkner County, AR.
Grant County, AR.
Lonoke County, AR.
Perry County, AR.
Pulaski County, AR.
Saline County, AR.
30860 ....... Logan, UT-ID ............................................................................................................................................................................. 0.9689
Franklin County, ID.
Cache County, UT.
30980 ....... Longview, TX ............................................................................................................................................................................. 0.9196
Gregg County, TX.
Rusk County, TX.
Upshur County, TX.
31020 ....... Longview, WA ........................................................................................................................................................................... 1.1424
Cowlitz County, WA.
31084 ....... Los Angeles-Long Beach-Glendale, CA ................................................................................................................................... 1.2399
Los Angeles County, CA.
31140 ....... Louisville, KY-IN ........................................................................................................................................................................ 0.9576
Clark County, IN.
Floyd County, IN.
Harrison County, IN.
Washington County, IN.
Bullitt County, KY.
Henry County, KY.
Jefferson County, KY.
Meade County, KY.
Nelson County, KY.
Oldham County, KY.
Shelby County, KY.
Spencer County, KY.
Trimble County, KY.
31180 ....... Lubbock, TX .............................................................................................................................................................................. 0.9193
Crosby County, TX.
Lubbock County, TX.
31340 ....... Lynchburg, VA ........................................................................................................................................................................... 0.9065
Amherst County, VA.
Appomattox County, VA.
Bedford County, VA.
Campbell County, VA.
Bedford City, VA.
Lynchburg City, VA.
31420 ....... Macon, GA ................................................................................................................................................................................ 1.0064
Bibb County, GA.
Crawford County, GA.
Jones County, GA.
Monroe County, GA.
Twiggs County, GA.
31460 ....... Madera, CA ............................................................................................................................................................................... 0.8515
Madera County, CA.
31540 ....... Madison, WI .............................................................................................................................................................................. 1.1538
Columbia County, WI.
Dane County, WI.
Iowa County, WI.
31700 ....... Manchester-Nashua, NH ........................................................................................................................................................... 1.0622
Hillsborough County, NH.
Merrimack County, NH.
31900 ....... Mansfield, OH 1 ......................................................................................................................................................................... 0.9783
Richland County, OH.

32420 ....... Mayaguáez, PR ......................................................................................................................................................................... 0.7912
Hormigueros Municipio, PR.
Mayagüez Municipio, PR.
32580 ....... McAllen-Edinburg-Pharr, TX ..................................................................................................................................................... 0.9625
Hidalgo County, TX.
32780 ....... Medford, OR .............................................................................................................................................................................. 1.0887
Jackson County, OR.
32820 ....... Memphis, TN-MS-AR ................................................................................................................................................................ 0.9731

Crittenden County, AR.
DeSoto County, MS.
Marshall County, MS.
Tate County, MS.
Tunica County, MS.
Fayette County, TN.
Shelby County, TN.
Tipton County, TN.
32900 ....... Merced, CA ............................................................................................................................................................................... 1.2766
Merced County, CA.
33124 ....... Miami-Miami Beach-Kendall, FL ............................................................................................................................................... 1.0553
Miami-Dade County, FL.
33140 ....... Michigan City-La Porte, IN ........................................................................................................................................................ 0.9406
LaPorte County, IN.
33260 ....... Midland, TX ............................................................................................................................................................................... 1.0893
Midland County, TX.
33340 ....... Milwaukee-Waukesha-West Allis, WI ........................................................................................................................................ 1.0772
Milwaukee County, WI.
Ozaukee County, WI.
Washington County, WI.
Waukesha County, WI.
33460 ....... Minneapolis-St. Paul-Bloomington, MN-WI ............................................................................................................................... 1.1767
Anoka County, MN.
Carver County, MN.
Chisago County, MN.
Dakota County, MN.
Hennepin County, MN.
Isanti County, MN.
Ramsey County, MN.
Scott County, MN.
Sherburne County, MN.
Washington County, MN.
Wright County, MN.
Pierce County, WI.
St. Croix County, WI.
33540 ....... Missoula, MT ............................................................................................................................................................................. 0.9439
Missoula County, MT.
33660 ....... Mobile, AL ................................................................................................................................................................................. 0.8473
Mobile County, AL.
33700 ....... Modesto, CA .............................................................................................................................................................................. 1.2581
Stanislaus County, CA.
33740 ....... Monroe, LA ................................................................................................................................................................................ 0.8263
Ouachita Parish, LA.
Union Parish, LA.
33780 ....... Monroe, MI ................................................................................................................................................................................ 0.9932
Monroe County, MI.
33860 ....... Montgomery, AL ........................................................................................................................................................................ 0.8793
Autauga County, AL.
Elmore County, AL.
Lowndes County, AL.
Montgomery County, AL.
34060 ....... Morgantown, WV ....................................................................................................................................................................... 0.8779
Monongalia County, WV.
Preston County, WV.
34100 ....... Morristown, TN .......................................................................................................................................................................... 0.7912
Grainger County, TN.
Hamblen County, TN.
Jefferson County, TN.
34580 ....... Mount Vernon-Anacortes, WA .................................................................................................................................................. 1.1110
Skagit County, WA.
34620 ....... Muncie, IN ................................................................................................................................................................................. 0.8666
Delaware County, IN.
34740 ....... Muskegon-Norton Shores, MI ................................................................................................................................................... 1.0338

Muskegon County, MI.
34820 ....... Myrtle Beach-Conway-North Myrtle Beach, SC ........................................................................................................................ 0.9112
Horry County, SC.
34900 ....... Napa, CA ................................................................................................................................................................................... 1.5120
Napa County, CA.
34940 ....... Naples-Marco Island, FL ........................................................................................................................................................... 1.0148
Collier County, FL.
34980 ....... Nashville-Davidson-Murfreesboro, TN ...................................................................................................................................... 1.0278

Cannon County, TN.
Cheatham County, TN.
Davidson County, TN.
Dickson County, TN.
Hickman County, TN.
Macon County, TN.
Robertson County, TN.
Rutherford County, TN.
Smith County, TN.
Sumner County, TN.
Trousdale County, TN.
Williamson County, TN.
Wilson County, TN.
35004 ....... Nassau-Suffolk, NY ................................................................................................................................................................... 1.3260
Nassau County, NY.
Suffolk County, NY.
35084 ....... Newark-Union, NJ-PA ............................................................................................................................................................... 1.2516
Essex County, NJ.
Hunterdon County, NJ.
Morris County, NJ.
Sussex County, NJ.
Union County, NJ.
Pike County, PA.
35300 ....... New Haven-Milford, CT ............................................................................................................................................................. 1.2530
New Haven County, CT.
35380 ....... New Orleans-Metairie-Kenner, LA ............................................................................................................................................ 0.9405
Jefferson Parish, LA.
Orleans Parish, LA.
Plaquemines Parish, LA.
St. Bernard Parish, LA.
St. Charles Parish, LA.
St. John the Baptist Parish, LA.
St. Tammany Parish, LA.
35644 ....... New York-Wayne-White Plains, NY-NJ .................................................................................................................................... 1.3817
Bergen County, NJ.
Hudson County, NJ.
Passaic County, NJ.
Bronx County, NY.
Kings County, NY.
New York County, NY.
Putnam County, NY.
Queens County, NY.
Richmond County, NY.
Rockland County, NY.
Westchester County, NY.
35660 ....... Niles-Benton Harbor, MI ............................................................................................................................................................ 0.9645
Berrien County, MI.
35980 ....... Norwich-New London, CT ......................................................................................................................................................... 1.2125
New London County, CT.
36084 ....... Oakland-Fremont-Hayward, CA ................................................................................................................................................ 1.6478
Alameda County, CA.
Contra Costa County, CA.
36100 ....... Ocala, FL ................................................................................................................................................................................... 0.9102
Marion County, FL.
36140 ....... Ocean City, NJ .......................................................................................................................................................................... 1.1246
Cape May County, NJ.
36220 ....... Odessa, TX ............................................................................................................................................................................... 1.0596
Ector County, TX.
36260 ....... Ogden-Clearfield, UT ................................................................................................................................................................ 0.9501
Davis County, UT.
Morgan County, UT.
Weber County, UT.
36420 ....... Oklahoma City, OK ................................................................................................................................................................... 0.9307

Canadian County, OK.
Cleveland County, OK.
Grady County, OK.
Lincoln County, OK.
Logan County, OK.
McClain County, OK.
Oklahoma County, OK.
36500 ....... Olympia, WA ............................................................................................................................................................................. 1.2187

Thurston County, WA.
36540 ....... Omaha-Council Bluffs, NE-IA .................................................................................................................................................... 1.0025
Harrison County, IA.
Mills County, IA.
Pottawattamie County, IA.
Cass County, NE.
Douglas County, NE.
Sarpy County, NE.
Saunders County, NE.
Washington County, NE.
36740 ....... Orlando, FL ............................................................................................................................................................................... 0.9832
Lake County, FL.
Orange County, FL.
Osceola County, FL.
Seminole County, FL.
36780 ....... Oshkosh-Neenah, WI ................................................................................................................................................................ 1.0094
Winnebago County, WI.
36980 ....... Owensboro, KY ......................................................................................................................................................................... 0.9233
Daviess County, KY.
Hancock County, KY.
McLean County, KY.
37100 ....... Oxnard-Thousand Oaks-Ventura, CA ....................................................................................................................................... 1.2478
Ventura County, CA.
37340 ....... Palm Bay-Melbourne-Titusville, FL ........................................................................................................................................... 0.9839
Brevard County, FL.
37380 ....... Palm Coast, FL ......................................................................................................................................................................... 0.9438
Flagler County, FL.
37460 ....... Panama City-Lynn Haven, FL ................................................................................................................................................... 0.8620
Bay County, FL.
37620 ....... Parkersburg-Marietta, WV-OH .................................................................................................................................................. 0.8548
Washington County, OH.
Pleasants County, WV.
Wirt County, WV.
Wood County, WV.
37700 ....... Pascagoula, MS ........................................................................................................................................................................ 0.9124
George County, MS.
Jackson County, MS.
37764 ....... Peabody, MA ............................................................................................................................................................................. 1.0822
Essex County, MA.
37860 ....... Pensacola-Ferry Pass-Brent, FL ............................................................................................................................................... 0.8738
Escambia County, FL.
Santa Rosa County, FL.
37900 ....... Peoria, IL ................................................................................................................................................................................... 0.9795
Marshall County, IL.
Peoria County, IL.
Stark County, IL.
Tazewell County, IL.
Woodford County, IL.
37964 ....... Philadelphia, PA ........................................................................................................................................................................ 1.1536
Bucks County, PA.
Chester County, PA.
Delaware County, PA.
Montgomery County, PA.
Philadelphia County, PA.
38060 ....... Phoenix-Mesa-Scottsdale, AZ ................................................................................................................................................... 1.0832
Maricopa County, AZ.
Pinal County, AZ.
38220 ....... Pine Bluff, AR ............................................................................................................................................................................ 0.8271
Cleveland County, AR.
Jefferson County, AR.
Lincoln County, AR.
38300 ....... Pittsburgh, PA ........................................................................................................................................................................... 0.8988
Allegheny County, PA.

Armstrong County, PA.
Beaver County, PA.
Butler County, PA.
Fayette County, PA.
Washington County, PA.
Westmoreland County, PA.
38340 ....... Pittsfield, MA ............................................................................................................................................................................. 1.0661
Berkshire County, MA.

38540 ....... Pocatello, ID .............................................................................................................................................................................. 0.9946
Bannock County, ID.
Power County, ID.
38660 ....... Ponce, PR ................................................................................................................................................................................. 0.7912
Juana Dı́az Municipio, PR.
Ponce Municipio, PR.
Villalba Municipio, PR.
38860 ....... Portland-South Portland-Biddeford, ME .................................................................................................................................... 1.0596
Cumberland County, ME.
Sagadahoc County, ME.
York County, ME.
38900 ....... Portland-Vancouver-Beaverton, OR-WA ................................................................................................................................... 1.2132
Clackamas County, OR.
Columbia County, OR.
Multnomah County, OR.
Washington County, OR.
Yamhill County, OR.
Clark County, WA.
Skamania County, WA.
38940 ....... Port St. Lucie-Fort Pierce, FL ................................................................................................................................................... 1.0569
Martin County, FL.
St. Lucie County, FL.
39100 ....... Poughkeepsie-Newburgh-Middletown, NY ................................................................................................................................ 1.1445
Dutchess County, NY.
Orange County, NY.
39140 ....... Prescott, AZ ............................................................................................................................................................................... 1.0572
Yavapai County, AZ.
39300 ....... Providence-New Bedford-Fall River, RI-MA ............................................................................................................................. 1.1314
Bristol County, MA.
Bristol County, RI.
Kent County, RI.
Newport County, RI.
Providence County, RI.
Washington County, RI.
39340 ....... Provo-Orem, UT ........................................................................................................................................................................ 1.0083
Juab County, UT.
Utah County, UT.
39380 ....... Pueblo, CO ................................................................................................................................................................................ 0.9338
Pueblo County, CO.
39460 ....... Punta Gorda, FL ........................................................................................................................................................................ 0.9764
Charlotte County, FL.
39540 ....... Racine, WI ................................................................................................................................................................................. 1.0022
Racine County, WI.
39580 ....... Raleigh-Cary, NC ...................................................................................................................................................................... 1.0060
Franklin County, NC.
Johnston County, NC.
Wake County, NC.
39660 ....... Rapid City, SD ........................................................................................................................................................................... 0.9296
Meade County, SD.
Pennington County, SD.
39740 ....... Reading, PA .............................................................................................................................................................................. 0.9871
Berks County, PA.
39820 ....... Redding, CA .............................................................................................................................................................................. 1.4298
Shasta County, CA.
39900 ....... Reno-Sparks, NV ...................................................................................................................................................................... 1.1556
Storey County, NV.
Washoe County, NV.
40060 ....... Richmond, VA ........................................................................................................................................................................... 0.9945
Amelia County, VA.
Caroline County, VA.
Charles City County, VA.
Chesterfield County, VA.
Cumberland County, VA.

Dinwiddie County, VA.
Goochland County, VA.
Hanover County, VA.
Henrico County, VA.
King and Queen County, VA.
King William County, VA.
Louisa County, VA.
New Kent County, VA.

Powhatan County, VA.
Prince George County, VA.
Sussex County, VA.
Colonial Heights City, VA.
Hopewell City, VA.
Petersburg City, VA.
Richmond City, VA.
40140 ....... Riverside-San Bernardino-Ontario, CA ..................................................................................................................................... 1.1532
Riverside County, CA.
San Bernardino County, CA.
40220 ....... Roanoke, VA ............................................................................................................................................................................. 0.9092
Botetourt County, VA.
Craig County, VA.
Franklin County, VA.
Roanoke County, VA.
Roanoke City, VA.
Salem City, VA.
40340 ....... Rochester, MN .......................................................................................................................................................................... 1.1639
Dodge County, MN.
Olmsted County, MN.
Wabasha County, MN.
40380 ....... Rochester, NY ........................................................................................................................................................................... 0.9322
Livingston County, NY.
Monroe County, NY.
Ontario County, NY.
Orleans County, NY.
Wayne County, NY.
40420 ....... Rockford, IL ............................................................................................................................................................................... 1.0191
Boone County, IL.
Winnebago County, IL.
40484 ....... Rockingham County-Strafford County, NH ............................................................................................................................... 1.0669
Rockingham County, NH.
Strafford County, NH.
40580 ....... Rocky Mount, NC ...................................................................................................................................................................... 0.9503
Edgecombe County, NC.
Nash County, NC.
40660 ....... Rome, GA .................................................................................................................................................................................. 0.9537
Floyd County, GA.
40900 ....... Sacramento-Arden-Arcade-Roseville, CA ................................................................................................................................. 1.4166
El Dorado County, CA.
Placer County, CA.
Sacramento County, CA.
Yolo County, CA.
40980 ....... Saginaw-Saginaw Township North, MI ..................................................................................................................................... 0.9297
Saginaw County, MI.
41060 ....... St. Cloud, MN ............................................................................................................................................................................ 1.1131
Benton County, MN.
Stearns County, MN.
41100 ....... St. George, UT .......................................................................................................................................................................... 0.9880
Washington County, UT.
41140 ....... St. Joseph, MO-KS ................................................................................................................................................................... 0.9246
Doniphan County, KS.
Andrew County, MO.
Buchanan County, MO.
DeKalb County, MO.
41180 ....... St. Louis, MO-IL ........................................................................................................................................................................ 0.9413
Bond County, IL.
Calhoun County, IL.
Clinton County, IL.
Jersey County, IL.
Macoupin County, IL.
Madison County, IL.
Monroe County, IL.

St. Clair County, IL.
Crawford County, MO.
Franklin County, MO.
Jefferson County, MO.
Lincoln County, MO.
St. Charles County, MO.
St. Louis County, MO.
Warren County, MO.

Washington County, MO.
St. Louis City, MO.
41420 ....... Salem, OR ................................................................................................................................................................................. 1.1154
Marion County, OR.
Polk County, OR.
41500 ....... Salinas, CA ................................................................................................................................................................................ 1.5382
Monterey County, CA.
41540 ....... Salisbury, MD ............................................................................................................................................................................ 0.9489
Somerset County, MD.
Wicomico County, MD.
41620 ....... Salt Lake City, UT ..................................................................................................................................................................... 0.9921
Salt Lake County, UT.
Summit County, UT.
Tooele County, UT.
41660 ....... San Angelo, TX ......................................................................................................................................................................... 0.9053
Irion County, TX.
Tom Green County, TX.
41700 ....... San Antonio, TX ........................................................................................................................................................................ 0.9337
Atascosa County, TX.
Bandera County, TX.
Bexar County, TX.
Comal County, TX.
Guadalupe County, TX.
Kendall County, TX.
Medina County, TX.
Wilson County, TX.
41740 ....... San Diego-Carlsbad-San Marcos, CA ...................................................................................................................................... 1.2045
San Diego County, CA.
41780 ....... Sandusky, OH ........................................................................................................................................................................... 0.9309
Erie County, OH.
41884 ....... San Francisco-San Mateo-Redwood City, CA .......................................................................................................................... 1.5987
Marin County, CA.
San Francisco County, CA.
San Mateo County, CA.
41900 ....... San Germaán-Cabo Rojo, PR .................................................................................................................................................. 0.7912
Cabo Rojo Municipio, PR.
Lajas Municipio, PR.
Sabana Grande Municipio, PR.
San Germı́n Municipio, PR.
41940 ....... San Jose-Sunnyvale-Santa Clara, CA ...................................................................................................................................... 1.6498
San Benito County, CA.
Santa Clara County, CA.
41980 ....... San Juan-Caguas-Guaynabo, PR ............................................................................................................................................. 0.7912
Aguas Buenas Municipio, PR.
Aibonito Municipio, PR.
Arecibo Municipio, PR.
Barceloneta Municipio, PR.
Barranquitas Municipio, PR.
Bayamón Municipio, PR.
Caguas Municipio, PR.
Camuy Municipio, PR.
Canóvanas Municipio, PR.
Carolina Municipio, PR.
Cataño Municipio, PR.
Cayey Municipio, PR.
Ciales Municipio, PR.
Cidra Municipio, PR.
Comerı́o Municipio, PR.
Corozal Municipio, PR.
Dorado Municipio, PR.
Florida Municipio, PR.
Guaynabo Municipio, PR.
Gurabo Municipio, PR.

Hatillo Municipio, PR.
Humacao Municipio, PR.
Juncos Municipio, PR.
Las Piedras Municipio, PR.
Loı́za Municipio, PR.
Manatı́ Municipio, PR.
Maunabo Municipio, PR.
Morovis Municipio, PR.

Naguabo Municipio, PR.
Naranjito Municipio, PR.
Orocovis Municipio, PR.
Quebradillas Municipio, PR.
Rı́o Grande Municipio, PR.
San Juan Municipio, PR.
San Lorenzo Municipio, PR.
Toa Alta Municipio, PR.
Toa Baja Municipio, PR.
Trujillo Alto Municipio, PR.
Vega Alta Municipio, PR.
Vega Baja Municipio, PR.
Yabucoa Municipio, PR.
42020 ....... San Luis Obispo-Paso Robles, CA ........................................................................................................................................... 1.3126
San Luis Obispo County, CA.
42044 ....... Santa Ana-Anaheim-Irvine, CA ................................................................................................................................................. 1.2390
Orange County, CA.
42060 ....... Santa Barbara-Santa Maria-Goleta, CA ................................................................................................................................... 1.2340
Santa Barbara County, CA.
42100 ....... Santa Cruz-Watsonville, CA ...................................................................................................................................................... 1.7003
Santa Cruz County, CA.
42140 ....... Santa Fe, NM ............................................................................................................................................................................ 1.1325
Santa Fe County, NM.
42220 ....... Santa Rosa-Petaluma, CA ........................................................................................................................................................ 1.5278
Sonoma County, CA.
42260 ....... Sarasota-Bradenton-Venice, FL ................................................................................................................................................ 1.0462
Manatee County, FL.
Sarasota County, FL.
42340 ....... Savannah, GA ........................................................................................................................................................................... 0.9733
Bryan County, GA.
Chatham County, GA.
Effingham County, GA.
42540 ....... Scranton–Wilkes-Barre, PA ....................................................................................................................................................... 0.8924
Lackawanna County, PA.
Luzerne County, PA.
Wyoming County, PA.
42644 ....... Seattle-Bellevue-Everett, WA .................................................................................................................................................... 1.2191
King County, WA.
Snohomish County, WA.
42680 ....... Sebastian-Vero Beach, FL ........................................................................................................................................................ 0.9931
Indian River County, FL.
43100 ....... Sheboygan, WI .......................................................................................................................................................................... 0.9470
Sheboygan County, WI.
43300 ....... Sherman-Denison, TX ............................................................................................................................................................... 0.8778
Grayson County, TX.
43340 ....... Shreveport-Bossier City, LA ...................................................................................................................................................... 0.9004
Bossier Parish, LA.
Caddo Parish, LA.
De Soto Parish, LA.
43580 ....... Sioux City, IA-NE-SD ................................................................................................................................................................ 0.9899
Woodbury County, IA.
Dakota County, NE.
Dixon County, NE.
Union County, SD.
43620 ....... Sioux Falls, SD .......................................................................................................................................................................... 1.0091
Lincoln County, SD.
McCook County, SD.
Minnehaha County, SD.
Turner County, SD.
43780 ....... South Bend-Mishawaka, IN-MI ................................................................................................................................................. 1.0147
St. Joseph County, IN.
Cass County, MI.
43900 ....... Spartanburg, SC ........................................................................................................................................................................ 0.9942

Spartanburg County, SC.
44060 ....... Spokane, WA ............................................................................................................................................................................ 1.1018
Spokane County, WA.
44100 ....... Springfield, IL ............................................................................................................................................................................ 0.9437
Menard County, IL.
Sangamon County, IL.
44140 ....... Springfield, MA .......................................................................................................................................................................... 1.0709
Franklin County, MA.

Hampden County, MA.
Hampshire County, MA.
44180 ....... Springfield, MO .......................................................................................................................................................................... 0.9595
Christian County, MO.
Dallas County, MO.
Greene County, MO.
Polk County, MO.
Webster County, MO.
44220 ....... Springfield, OH .......................................................................................................................................................................... 0.9141
Clark County, OH.
44300 ....... State College, PA ...................................................................................................................................................................... 0.9252
Centre County, PA.
44700 ....... Stockton, CA ............................................................................................................................................................................. 1.2422
San Joaquin County, CA.
44940 ....... Sumter, SC ................................................................................................................................................................................ 0.9073
Sumter County, SC.
45060 ....... Syracuse, NY ............................................................................................................................................................................ 1.0410
Madison County, NY.
Onondaga County, NY.
Oswego County, NY.
45104 ....... Tacoma, WA .............................................................................................................................................................................. 1.1664
Pierce County, WA.
45220 ....... Tallahassee, FL ......................................................................................................................................................................... 0.9522
Gadsden County, FL.
Jefferson County, FL.
Leon County, FL.
Wakulla County, FL.
45300 ....... Tampa-St. Petersburg-Clearwater, FL ...................................................................................................................................... 0.9516
Hernando County, FL.
Hillsborough County, FL.
Pasco County, FL.
Pinellas County, FL.
45460 ....... Terre Haute, IN ......................................................................................................................................................................... 0.9290
Clay County, IN.
Sullivan County, IN.
Vermillion County, IN.
Vigo County, IN.
45500 ....... Texarkana, TX-Texarkana, AR ................................................................................................................................................. 0.8574
Miller County, AR.
Bowie County, TX.
45780 ....... Toledo, OH ................................................................................................................................................................................ 0.9954
Fulton County, OH.
Lucas County, OH.
Ottawa County, OH.
Wood County, OH.
45820 ....... Topeka, KS ................................................................................................................................................................................ 0.9009
Jackson County, KS.
Jefferson County, KS.
Osage County, KS.
Shawnee County, KS.
Wabaunsee County, KS.
45940 ....... Trenton-Ewing, NJ ..................................................................................................................................................................... 1.1288
Mercer County, NJ.
46060 ....... Tucson, AZ ................................................................................................................................................................................ 0.9824
Pima County, AZ.
46140 ....... Tulsa, OK .................................................................................................................................................................................. 0.8801
Creek County, OK.
Okmulgee County, OK.
Osage County, OK.
Pawnee County, OK.
Rogers County, OK.
Tulsa County, OK.
Wagoner County, OK.

46220 ....... Tuscaloosa, AL .......................................................................................................................................................................... 0.8760
Greene County, AL.
Hale County, AL.
Tuscaloosa County, AL.
46340 ....... Tyler, TX .................................................................................................................................................................................... 0.9261
Smith County, TX.
46540 ....... Utica-Rome, NY ........................................................................................................................................................................ 0.8949
Herkimer County, NY.

Oneida County, NY.
46660 ....... Valdosta, GA ............................................................................................................................................................................. 0.8544
Brooks County, GA.
Echols County, GA.
Lanier County, GA.
Lowndes County, GA.
46700 ....... Vallejo-Fairfield, CA ................................................................................................................................................................... 1.5432
Solano County, CA.
47020 ....... Victoria, TX ................................................................................................................................................................................ 0.8762
Calhoun County, TX.
Goliad County, TX.
Victoria County, TX.
47220 ....... Vineland-Millville-Bridgeton, NJ ................................................................................................................................................. 1.0691
Cumberland County, NJ.
47260 ....... Virginia Beach-Norfolk-Newport News, VA-NC ........................................................................................................................ 0.9308
Currituck County, NC.
Gloucester County, VA.
Isle of Wight County, VA.
James City County, VA.
Mathews County, VA.
Surry County, VA.
York County, VA.
Chesapeake City, VA.
Hampton City, VA.
Newport News City, VA.
Norfolk City, VA.
Poquoson City, VA.
Portsmouth City, VA.
Suffolk City, VA.
Virginia Beach City, VA.
Williamsburg City, VA.
47300 ....... Visalia-Porterville, CA ................................................................................................................................................................ 1.0647
Tulare County, CA.
47380 ....... Waco, TX ................................................................................................................................................................................... 0.8988
McLennan County, TX.
47580 ....... Warner Robins, GA ................................................................................................................................................................... 0.9632
Houston County, GA.
47644 ....... Warren-Troy-Farmington Hills, MI ............................................................................................................................................. 1.0554
Lapeer County, MI.
Livingston County, MI.
Macomb County, MI.
Oakland County, MI.
St. Clair County, MI.
47894 ....... Washington-Arlington-Alexandria, DC-VA-MD-WV ................................................................................................................... 1.1441
District of Columbia, DC.
Calvert County, MD.
Charles County, MD.
Prince George’s County, MD.
Arlington County, VA.
Clarke County, VA.
Fairfax County, VA.
Fauquier County, VA.
Loudoun County, VA.
Prince William County, VA.
Spotsylvania County, VA.
Stafford County, VA.
Warren County, VA.
Alexandria City, VA.
Fairfax City, VA.
Falls Church City, VA.
Fredericksburg City, VA.
Manassas City, VA.
Manassas Park City, VA.

Jefferson County, WV.
47940 ....... Waterloo-Cedar Falls, IA ........................................................................................................................................................... 0.8988
Black Hawk County, IA.
Bremer County, IA.
Grundy County, IA.
48140 ....... Wausau, WI ............................................................................................................................................................................... 1.0212
Marathon County, WI.
48260 ....... Weirton-Steubenville, WV-OH ................................................................................................................................................... 0.8361

Jefferson County, OH.
Brooke County, WV.
Hancock County, WV.
48300 ....... Wenatchee, WA ........................................................................................................................................................................ 1.2101
Chelan County, WA.
Douglas County, WA.
48424 ....... West Palm Beach-Boca Raton-Boynton Beach, FL ................................................................................................................. 1.0270
Palm Beach County, FL.
48540 ....... Wheeling, WV-OH ..................................................................................................................................................................... 0.7912
Belmont County, OH.
Marshall County, WV.
Ohio County, WV.
48620 ....... Wichita, KS ................................................................................................................................................................................ 0.9631
Butler County, KS.
Harvey County, KS.
Sedgwick County, KS.
Sumner County, KS.
48660 ....... Wichita Falls, TX ....................................................................................................................................................................... 0.8642
Archer County, TX.
Clay County, TX.
Wichita County, TX.
48700 ....... Williamsport, PA ........................................................................................................................................................................ 0.8486
Lycoming County, PA.
48864 ....... Wilmington, DE-MD-NJ ............................................................................................................................................................. 1.1419
New Castle County, DE.
Cecil County, MD.
Salem County, NJ.
48900 ....... Wilmington, NC ......................................................................................................................................................................... 0.9937
Brunswick County, NC.
New Hanover County, NC.
Pender County, NC.
49020 ....... Winchester, VA-WV ................................................................................................................................................................... 1.0459
Frederick County, VA.
Winchester City, VA.
Hampshire County, WV.
49180 ....... Winston-Salem, NC ................................................................................................................................................................... 0.9621
Davie County, NC.
Forsyth County, NC.
Stokes County, NC.
Yadkin County, NC.
49340 ....... Worcester, MA ........................................................................................................................................................................... 1.1887
Worcester County, MA.
49420 ....... Yakima, WA ............................................................................................................................................................................... 1.0832
Yakima County, WA.
49500 ....... Yauco, PR ................................................................................................................................................................................. 0.7912
Guı́nica Municipio, PR.
Guayanilla Municipio, PR.
Peñuelas Municipio, PR.
Yauco Municipio, PR.
49620 ....... York-Hanover, PA ..................................................................................................................................................................... 0.9499
York County, PA.
0.9745.
49660 ....... Youngstown-Warren-Boardman, OH-PA .................................................................................................................................. 0.9499
Mahoning County, OH.
Trumbull County, OH.
Mercer County, PA.
49700 ....... Yuba City, CA ............................................................................................................................................................................ 1.1349
Sutter County, CA.
Yuba County, CA.
49740 ....... Yuma, AZ .................................................................................................................................................................................. 1.0010
Yuma County, AZ.
1At this time, there are no hospitals located in this urban area on which to base a wage index.
ADDENDUM H.— FY 2008 WAGE ADDENDUM H.— FY 2008 WAGE ADDENDUM H.— FY 2008 WAGE
INDEX BASED ON CBSA LABOR INDEX BASED ON CBSA LABOR INDEX BASED ON CBSA LABOR
MARKET AREAS FOR RURAL AREAS MARKET AREAS FOR RURAL MARKET AREAS FOR RURAL
AREAS—Continued AREAS—Continued
CBSA Wage
Nonurban area
code index CBSA Wage
Nonurban area CBSA Wage
code index Nonurban area
code index
1 ......... Alabama ....................... 0.7975
2 ......... Alaska .......................... 1.2476 25 ....... Mississippi .................... 0.8305 46 ....... Utah ............................. 0.8635
3 ......... Arizona ......................... 0.9131 26 ....... Missouri ........................ 0.8319 47 ....... Vermont ....................... 1.0463
4 ......... Arkansas ...................... 0.7912 27 ....... Montana ....................... 0.8838
5 ......... California ...................... 1.2540 48 ....... Virgin Islands ............... 0.7912
28 ....... Nebraska ...................... 0.9334 49 ....... Virginia ......................... 0.8350
6 ......... Colorado ...................... 1.0236
29 ....... Nevada ......................... 0.9763 50 ....... Washington .................. 1.0826
7 ......... Connecticut .................. 1.2106
30 ....... New Hampshire ........... 1.1462 51 ....... West Virginia ................ 0.7912
8 ......... Delaware ...................... 1.0190
10 ....... Florida .......................... 0.8935 31 ....... New Jersey1 ................ ------ 52 ....... Wisconsin ..................... 1.0142
11 ....... Georgia ........................ 0.8080 32 ....... New Mexico ................. 0.9428
53 ....... Wyoming ...................... 0.9798
12 ....... Hawaii .......................... 1.1202 33 ....... New York ..................... 0.8715
65 ....... Guam ........................... 0.9611
13 ....... Idaho ............................ 0.8420 34 ....... North Carolina .............. 0.9077
14 ....... Illinois ........................... 0.8800 35 ....... North Dakota ................ 0.7912 1 All counties within the State are classified
15 ....... Indiana ......................... 0.9077 36 ....... Ohio ............................. 0.9194 as urban, with the exception of Massachusetts
16 ....... Iowa ............................. 0.9039 37 ....... Oklahoma ..................... 0.7912 and Puerto Rico. Massachusetts and Puerto
17 ....... Kansas ......................... 0.8423 38 ....... Oregon ......................... 1.0439 Rico have areas designated as rural; however,
18 ....... Kentucky ...................... 0.8220 39 ....... Pennsylvania ................ 0.8852 no short-term, acute care hospitals are located
40 ....... Puerto Rico1 ................ 0.7912 in the area(s) for FY 2008. The rural Massa-
19 ....... Louisiana ...................... 0.7912 chusetts wage index is calculated as the aver-
20 ....... Maine ........................... 0.8942 41 ....... Rhode Island 1 ............. ------ age of all contiguous CBSAs. The Puerto Rico
21 ....... Maryland ...................... 0.9532 42 ....... South Carolina ............. 0.9225 wage index is the same as FY 2007.
22 ....... Massachusetts1 ........... 1.2306 43 ....... South Dakota ............... 0.9007
23 ....... Michigan ....................... 0.9432 44 ....... Tennessee ................... 0.8142 [FR Doc. 07–3274 Filed 7–2–07; 8:55 am]
24 ....... Minnesota .................... 0.9690 45 ....... Texas ........................... 0.8408 BILLING CODE 4120–01–P

Proposed Rule: Medicare: Physicians Fee Schedule (2008 CY) Proposed Revisions To Payment Policies of Ambulance Services, Etc.

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Proposed Rule: Medicare: Physicians Fee Schedule (2008 CY) Proposed Revisions To Payment Policies of Ambulance Services, Etc.

Uploaded by

Copyright:

Available Formats

Thursday,

July 12, 2007

42 CFR Parts 409, 410, et al.

Market Areas copyrighted by the American Medical Advisory Committee (MCAC))

TABLE 1.—CALCULATION OF PE RVUS UNDER PROPOSED METHODOLOGY FOR SELECTED CODES

Step Source Formula CABG, arte- ECG, ECG,

18:48 Jul 11, 2007

Clinical Clerical Office Supplies Equipment Other Total

Clinical Clerical Office Supplies Equipment Other Total

TABLE 3.—MAXILLOFACIAL PROSTHESIS SUPPLIES NEEDING PRICING AND SUPPORTING DOCUMENTATION

TABLE 5.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING

TABLE 5.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING—Continued

Santa Cruz ................................................................................ Santa Cruz ....................................... 1.017 1.100 7.59%

Marin ............................................................. Marin ..................................................... 1.173 1.112 1.173 5.19

Orange ................................. Anaheim/Santa Ana, CA ................... 1.128 2 1.119 1.128 ¥0.8

TABLE 9.—OPTION 3—REVISION OF PAYMENT LOCALITIES—Continued

adding services to or deleting services consultation (as described by CPT codes

the Halstead-Reitan Neuropsychological compared to a face-to-face delivery of

TABLE 11.—PRE-ANESTHESIA TIME

TABLE 13.—WAGE INDEX TRANSITION BLEND

2006 .............................. 0.85 None ............................................................................................................. 75 25

assurance of safety and effectiveness, recommend a specific update factor or

dietitian or nutrition professional as appropriate to continue to permit TABLE 14.—MEDICARE ECONOMIC

organizations and the use of a standard.’’ purchasers, researchers, payers, and

TABLE 16.—2007 PQRI MEASURES

Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus.

Screening for Future Fall Risk.

TABLE 16.—2007 PQRI MEASURES—Continued

document for 2008 measures, which measures based upon development

TABLE 17.—AMA/PCPI MEASURES

Prevention of Ventilator-Associated Pneumonia—Head elevation.

TABLE 17.—AMA/PCPI MEASURES—Continued

that are currently under development by PENNSYLVANIA NONPHYSICIAN

TABLE 18.—QUALITY INSIGHTS OF TABLE 19.—QUALITY INSIGHTS OF TABLE 20.—ADDITIONAL AQA

TABLE 21.—OTHER NQF-ENDORSED MEASURES

(vii) Podiatric Measures TABLE 22.—PODIATRIC MEASURES— on quality measures through an

business records) is not subject to the vendor to provide this information to

burden associated with the requirement is the time and effort

TABLE 23.—ESTIMATED ANNUAL REPORTING AND RECORDKEEPING BURDEN

Preamble section II.F.1 .................................................................................... 0938–0921 120 480 17,760

Total .......................................................................................................... ........................ ........................ ........................ 1,579,907

and the fully implemented 2010 PE

*Components may not sum to total due to rounding.

TOTAL .............................................................................. $75,819 0 0 0 ¥10 ¥10

NEPHROLOGY ................................................................ 1,649 ¥2 0 ¥2 ¥10 ¥12

PATHOLOGY ................................................................... 939 ¥2 0 ¥2 ¥10 ¥12

77057 ....... .......... Mammogram, screening .......................... NA NA NA 81.86 74.07 ¥10

All Providers: .................................................... 4,541 31.4 0.0 0.0 0.5

TABLE 28.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FROM CY 2007 TO CY 2008

Annualized Monetized Transfers ........................ Estimated decrease in expenditures of $ 5.9 billion.

42 CFR Part 410 requirements.

speech-language pathologists who meet this section. facility.

documentation would be stored at their recognized by the State in which * * * * *

§ 414.620 [Amended] * * * * * verify drug administration prior to

requirements: person who meets one of the following following educational/training

Fully im- Year 2008 Fully im- Year 2008

Fully im- Year 2008 Fully im- Year 2008

Fully im- Year 2008 Fully im- Year 2008

Fully im- Year 2008 Fully im- Year 2008

Fully im- Year 2008 Fully im- Year 2008

Fully im- Year 2008 Fully im- Year 2008

Fully im- Year 2008 Fully im- Year 2008

Fully im- Year 2008 Fully im- Year 2008