2019 National Physician Fee Schedule Relative Value File ... · 2019 National Physician Fee...
Transcript of 2019 National Physician Fee Schedule Relative Value File ... · 2019 National Physician Fee...
2019 National Physician Fee Schedule Relative Value File January Release
CPT codes and descriptions only are copyright 2017 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Apply.
Dental codes (D codes) are copyright 2018/19 American Dental Association. All Rights Reserved.
RELEASED 12/13/2018
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
10004 Fna bx w/o img gdn ea addl 1.49 $70.00 $104.30
10005 Fna bx w/us gdn 1st les 3.59 $70.00 $251.30
10006 Fna bx w/us gdn ea addl 1.71 $70.00 $119.70
10007 Fna bx w/fluor gdn 1st les 8.09 $70.00 $566.30
10008 Fna bx w/fluor gdn ea addl 4.56 $70.00 $319.20
10009 Fna bx w/ct gdn 1st les 13.24 $70.00 $926.80
10010 Fna bx w/ct gdn ea addl 7.98 $70.00 $558.60
10011 Fna bx w/mr gdn 1st les 0.00 $70.00 $0.00
10012 Fna bx w/mr gdn ea addl 0.00 $70.00 $0.00
1002F Assess anginal symptom/level 0.00 $70.00 $0.00
10021 Fna bx w/o img gdn 1st les 2.78 $70.00 $194.60
1003F Level of activity assess 0.00 $70.00 $0.00
10030 Guide cathet fluid drainage 16.27 $70.00 $1,138.90
10035 Perq dev soft tiss 1st imag 13.67 $70.00 $956.90
10036 Perq dev soft tiss add imag 11.79 $70.00 $825.30
1004F Clin symp vol ovrld assess 0.00 $70.00 $0.00
10040 Acne surgery 3.09 $70.00 $216.30
1005F Asthma symptoms evaluate 0.00 $70.00 $0.00
1006F Osteoarthritis assess 0.00 $70.00 $0.00
10060 Drainage of skin abscess 3.37 $70.00 $235.90
10061 Drainage of skin abscess 5.87 $70.00 $410.90
1007F Anti-inflm/anlgsc otc assess 0.00 $70.00 $0.00
1008F Gi/renal risk assess 0.00 $70.00 $0.00
10080 Drainage of pilonidal cyst 5.23 $70.00 $366.10
10081 Drainage of pilonidal cyst 7.84 $70.00 $548.80
1010F Severity angina by actvty 0.00 $70.00 $0.00
1011F Angina present 0.00 $70.00 $0.00
1012F Angina absent 0.00 $70.00 $0.00
10120 Remove foreign body 4.32 $70.00 $302.40
10121 Remove foreign body 7.77 $70.00 $543.90
10140 Drainage of hematoma/fluid 4.77 $70.00 $333.90
1015F Copd symptoms assess 0.00 $70.00 $0.00
10160 Puncture drainage of lesion 3.70 $70.00 $259.00
1018F Assess dyspnea not present 0.00 $70.00 $0.00
10180 Complex drainage wound 7.12 $70.00 $498.40
1019F Assess dyspnea present 0.00 $70.00 $0.00
1022F Pneumo imm status assess 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
1026F Co-morbid condition assess 0.00 $70.00 $0.00
1030F Influenza imm status assess 0.00 $70.00 $0.00
1031F Smoking & 2nd hand assessed 0.00 $70.00 $0.00
1032F Smoker/exposed 2nd hnd smoke 0.00 $70.00 $0.00
1033F Tobacco nonsmoker nor 2ndhnd 0.00 $70.00 $0.00
1034F Current tobacco smoker 0.00 $70.00 $0.00
1035F Smokeless tobacco user 0.00 $70.00 $0.00
1036F Tobacco non-user 0.00 $70.00 $0.00
1038F Persistent asthma 0.00 $70.00 $0.00
1039F Intermittent asthma 0.00 $70.00 $0.00
1040F Dsm-5 info mdd docd 0.00 $70.00 $0.00
1050F History of mole changes 0.00 $70.00 $0.00
1052F Type location activityassess 0.00 $70.00 $0.00
1055F Visual funct status assess 0.00 $70.00 $0.00
1060F Doc perm/cont/parox atr fib 0.00 $70.00 $0.00
1061F Doc lack perm+cont+parox fib 0.00 $70.00 $0.00
1065F Ischm stroke symp lt3 hrsb/4 0.00 $70.00 $0.00
1066F Ischm stroke symp ge3 hrsb/4 0.00 $70.00 $0.00
1070F Alarm symp assessed-absent 0.00 $70.00 $0.00
1071F Alarm symp assessed-1+ prsnt 0.00 $70.00 $0.00
1090F Pres/absn urine incon assess 0.00 $70.00 $0.00
1091F Urine incon characterized 0.00 $70.00 $0.00
1100F Ptfalls assess-docd ge2>/yr 0.00 $70.00 $0.00
11000 Debride infected skin 1.57 $70.00 $109.90
11001 Debride infected skin add-on 0.62 $70.00 $43.40
11004 Debride genitalia & perineum 16.69 $70.00 $1,168.30
11005 Debride abdom wall 22.64 $70.00 $1,584.80
11006 Debride genit/per/abdom wall 20.44 $70.00 $1,430.80
11008 Remove mesh from abd wall 7.96 $70.00 $557.20
1101F Pt falls assess-docd le1/yr 0.00 $70.00 $0.00
11010 Debride skin at fx site 13.82 $70.00 $967.40
11011 Debride skin musc at fx site 15.26 $70.00 $1,068.20
11012 Deb skin bone at fx site 19.79 $70.00 $1,385.30
11042 Deb subq tissue 20 sq cm/< 3.46 $70.00 $242.20
11043 Deb musc/fascia 20 sq cm/< 6.57 $70.00 $459.90
11044 Deb bone 20 sq cm/< 8.93 $70.00 $625.10
11045 Deb subq tissue add-on 1.18 $70.00 $82.60
11046 Deb musc/fascia add-on 2.09 $70.00 $146.30
11047 Deb bone add-on 3.53 $70.00 $247.10
11055 Trim skin lesion 1.59 $70.00 $111.30
11056 Trim skin lesions 2 to 4 1.90 $70.00 $133.00
11057 Trim skin lesions over 4 2.11 $70.00 $147.70
1110F Pt lft inpt fac w/in 60 days 0.00 $70.00 $0.00
11102 Tangntl bx skin single les 2.80 $70.00 $196.00
11103 Tangntl bx skin ea sep/addl 1.51 $70.00 $105.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
11104 Punch bx skin single lesion 3.52 $70.00 $246.40
11105 Punch bx skin ea sep/addl 1.73 $70.00 $121.10
11106 Incal bx skn single les 4.26 $70.00 $298.20
11107 Incal bx skn ea sep/addl 2.04 $70.00 $142.80
1111F Dschrg med/current med merge 0.00 $70.00 $0.00
1116F Auric/peri pain assessed 0.00 $70.00 $0.00
1118F Gerd symps assessed 12 month 0.00 $70.00 $0.00
1119F Init eval for condition 0.00 $70.00 $0.00
11200 Removal of skin tags <w/15 2.51 $70.00 $175.70
11201 Remove skin tags add-on 0.54 $70.00 $37.80
1121F Subs eval for condition 0.00 $70.00 $0.00
1123F Acp discuss/dscn mkr docd 0.00 $70.00 $0.00
1124F Acp discuss-no dscnmkr docd 0.00 $70.00 $0.00
1125F Amnt pain noted pain prsnt 0.00 $70.00 $0.00
1126F Amnt pain noted none prsnt 0.00 $70.00 $0.00
1127F New episode for condition 0.00 $70.00 $0.00
1128F Subs episode for condition 0.00 $70.00 $0.00
1130F Bk pain & fxn assessed 0.00 $70.00 $0.00
11300 Shave skin lesion 0.5 cm/< 2.77 $70.00 $193.90
11301 Shave skin lesion 0.6-1.0 cm 3.40 $70.00 $238.00
11302 Shave skin lesion 1.1-2.0 cm 3.98 $70.00 $278.60
11303 Shave skin lesion >2.0 cm 4.39 $70.00 $307.30
11305 Shave skin lesion 0.5 cm/< 2.90 $70.00 $203.00
11306 Shave skin lesion 0.6-1.0 cm 3.45 $70.00 $241.50
11307 Shave skin lesion 1.1-2.0 cm 4.09 $70.00 $286.30
11308 Shave skin lesion >2.0 cm 4.34 $70.00 $303.80
11310 Shave skin lesion 0.5 cm/< 3.23 $70.00 $226.10
11311 Shave skin lesion 0.6-1.0 cm 3.86 $70.00 $270.20
11312 Shave skin lesion 1.1-2.0 cm 4.52 $70.00 $316.40
11313 Shave skin lesion >2.0 cm 5.30 $70.00 $371.00
1134F Epsd bk pain for 6 wks/< 0.00 $70.00 $0.00
1135F Epsd bk pain for >6 wks 0.00 $70.00 $0.00
1136F Epsd bk pain for 12 wks/< 0.00 $70.00 $0.00
1137F Epsd bk pain for >12 wks 0.00 $70.00 $0.00
11400 Exc tr-ext b9+marg 0.5 cm< 3.53 $70.00 $247.10
11401 Exc tr-ext b9+marg 0.6-1 cm 4.30 $70.00 $301.00
11402 Exc tr-ext b9+marg 1.1-2 cm 4.78 $70.00 $334.60
11403 Exc tr-ext b9+marg 2.1-3cm 5.53 $70.00 $387.10
11404 Exc tr-ext b9+marg 3.1-4 cm 6.27 $70.00 $438.90
11406 Exc tr-ext b9+marg >4.0 cm 9.02 $70.00 $631.40
11420 Exc h-f-nk-sp b9+marg 0.5/< 3.53 $70.00 $247.10
11421 Exc h-f-nk-sp b9+marg 0.6-1 4.49 $70.00 $314.30
11422 Exc h-f-nk-sp b9+marg 1.1-2 5.06 $70.00 $354.20
11423 Exc h-f-nk-sp b9+marg 2.1-3 5.77 $70.00 $403.90
11424 Exc h-f-nk-sp b9+marg 3.1-4 6.69 $70.00 $468.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
11426 Exc h-f-nk-sp b9+marg >4 cm 9.59 $70.00 $671.30
11440 Exc face-mm b9+marg 0.5 cm/< 3.91 $70.00 $273.70
11441 Exc face-mm b9+marg 0.6-1 cm 4.83 $70.00 $338.10
11442 Exc face-mm b9+marg 1.1-2 cm 5.39 $70.00 $377.30
11443 Exc face-mm b9+marg 2.1-3 cm 6.42 $70.00 $449.40
11444 Exc face-mm b9+marg 3.1-4 cm 8.05 $70.00 $563.50
11446 Exc face-mm b9+marg >4 cm 11.16 $70.00 $781.20
11450 Removal sweat gland lesion 11.25 $70.00 $787.50
11451 Removal sweat gland lesion 14.15 $70.00 $990.50
11462 Removal sweat gland lesion 10.96 $70.00 $767.20
11463 Removal sweat gland lesion 14.32 $70.00 $1,002.40
11470 Removal sweat gland lesion 12.03 $70.00 $842.10
11471 Removal sweat gland lesion 14.71 $70.00 $1,029.70
1150F Doc pt rsk death w/in 1yr 0.00 $70.00 $0.00
1151F Doc no pt rsk death w/in 1yr 0.00 $70.00 $0.00
1152F Doc advncd dis comfort 1st 0.00 $70.00 $0.00
1153F Doc advncd dis cmfrt not 1st 0.00 $70.00 $0.00
1157F Advnc care plan in rcrd 0.00 $70.00 $0.00
1158F Advnc care plan tlk docd 0.00 $70.00 $0.00
1159F Med list docd in rcrd 0.00 $70.00 $0.00
1160F Rvw meds by rx/dr in rcrd 0.00 $70.00 $0.00
11600 Exc tr-ext mal+marg 0.5 cm/< 5.53 $70.00 $387.10
11601 Exc tr-ext mal+marg 0.6-1 cm 6.52 $70.00 $456.40
11602 Exc tr-ext mal+marg 1.1-2 cm 7.06 $70.00 $494.20
11603 Exc tr-ext mal+marg 2.1-3 cm 8.07 $70.00 $564.90
11604 Exc tr-ext mal+marg 3.1-4 cm 8.95 $70.00 $626.50
11606 Exc tr-ext mal+marg >4 cm 12.85 $70.00 $899.50
11620 Exc h-f-nk-sp mal+marg 0.5/< 5.57 $70.00 $389.90
11621 Exc s/n/h/f/g mal+mrg 0.6-1 6.55 $70.00 $458.50
11622 Exc s/n/h/f/g mal+mrg 1.1-2 7.30 $70.00 $511.00
11623 Exc s/n/h/f/g mal+mrg 2.1-3 8.55 $70.00 $598.50
11624 Exc s/n/h/f/g mal+mrg 3.1-4 9.67 $70.00 $676.90
11626 Exc s/n/h/f/g mal+mrg >4 cm 11.64 $70.00 $814.80
11640 Exc f/e/e/n/l mal+mrg 0.5cm< 5.74 $70.00 $401.80
11641 Exc f/e/e/n/l mal+mrg 0.6-1 6.78 $70.00 $474.60
11642 Exc f/e/e/n/l mal+mrg 1.1-2 7.73 $70.00 $541.10
11643 Exc f/e/e/n/l mal+mrg 2.1-3 9.09 $70.00 $636.30
11644 Exc f/e/e/n/l mal+mrg 3.1-4 11.22 $70.00 $785.40
11646 Exc f/e/e/n/l mal+mrg >4 cm 14.64 $70.00 $1,024.80
1170F Fxnl status assessed 0.00 $70.00 $0.00
11719 Trim nail(s) any number 0.41 $70.00 $28.70
11720 Debride nail 1-5 0.94 $70.00 $65.80
11721 Debride nail 6 or more 1.29 $70.00 $90.30
11730 Removal of nail plate 3.09 $70.00 $216.30
11732 Remove nail plate add-on 0.93 $70.00 $65.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
11740 Drain blood from under nail 1.46 $70.00 $102.20
1175F Function stat assessed rvwd 0.00 $70.00 $0.00
11750 Removal of nail bed 4.41 $70.00 $308.70
11755 Biopsy nail unit 3.47 $70.00 $242.90
11760 Repair of nail bed 5.46 $70.00 $382.20
11762 Reconstruction of nail bed 8.15 $70.00 $570.50
11765 Excision of nail fold toe 4.80 $70.00 $336.00
11770 Remove pilonidal cyst simple 8.10 $70.00 $567.00
11771 Remove pilonidal cyst exten 16.79 $70.00 $1,175.30
11772 Remove pilonidal cyst compl 20.10 $70.00 $1,407.00
1180F Thromboemb risk assessed 0.00 $70.00 $0.00
1181F Neuropsychia sympts assessed 0.00 $70.00 $0.00
1182F Neuropsychi sympt 1+present 0.00 $70.00 $0.00
1183F Neuropsychiatric symp absent 0.00 $70.00 $0.00
11900 Inject skin lesions </w 7 1.54 $70.00 $107.80
11901 Inject skin lesions >7 1.95 $70.00 $136.50
11920 Correct skin color 6.0 cm/< 5.10 $70.00 $357.00
11921 Correct skn color 6.1-20.0cm 5.84 $70.00 $408.80
11922 Correct skin color ea 20.0cm 1.73 $70.00 $121.10
11950 Tx contour defects 1 cc/< 1.95 $70.00 $136.50
11951 Tx contour defects 1.1-5.0cc 2.80 $70.00 $196.00
11952 Tx contour defects 5.1-10cc 3.78 $70.00 $264.60
11954 Tx contour defects >10.0 cc 4.41 $70.00 $308.70
11960 Insert tissue expander(s) 27.71 $70.00 $1,939.70
11970 Replace tissue expander 17.47 $70.00 $1,222.90
11971 Remove tissue expander(s) 13.52 $70.00 $946.40
11976 Remove contraceptive capsule 4.11 $70.00 $287.70
11980 Implant hormone pellet(s) 2.69 $70.00 $188.30
11981 Insert drug implant device 4.05 $70.00 $283.50
11982 Remove drug implant device 4.49 $70.00 $314.30
11983 Remove/insert drug implant 6.56 $70.00 $459.20
1200F Seizure type& frequ docd 0.00 $70.00 $0.00
12001 Rpr s/n/ax/gen/trnk 2.5cm/< 2.53 $70.00 $177.10
12002 Rpr s/n/ax/gen/trnk2.6-7.5cm 3.08 $70.00 $215.60
12004 Rpr s/n/ax/gen/trk7.6-12.5cm 3.61 $70.00 $252.70
12005 Rpr s/n/a/gen/trk12.6-20.0cm 4.69 $70.00 $328.30
12006 Rpr s/n/a/gen/trk20.1-30.0cm 5.54 $70.00 $387.80
12007 Rpr s/n/ax/gen/trnk >30.0 cm 6.37 $70.00 $445.90
12011 Rpr f/e/e/n/l/m 2.5 cm/< 3.09 $70.00 $216.30
12013 Rpr f/e/e/n/l/m 2.6-5.0 cm 3.23 $70.00 $226.10
12014 Rpr f/e/e/n/l/m 5.1-7.5 cm 3.88 $70.00 $271.60
12015 Rpr f/e/e/n/l/m 7.6-12.5 cm 4.69 $70.00 $328.30
12016 Rpr fe/e/en/l/m 12.6-20.0 cm 5.92 $70.00 $414.40
12017 Rpr fe/e/en/l/m 20.1-30.0 cm 4.34 $70.00 $303.80
12018 Rpr f/e/e/n/l/m >30.0 cm 4.92 $70.00 $344.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
12020 Closure of split wound 8.17 $70.00 $571.90
12021 Closure of split wound 4.76 $70.00 $333.20
12031 Intmd rpr s/a/t/ext 2.5 cm/< 6.98 $70.00 $488.60
12032 Intmd rpr s/a/t/ext 2.6-7.5 8.65 $70.00 $605.50
12034 Intmd rpr s/tr/ext 7.6-12.5 9.07 $70.00 $634.90
12035 Intmd rpr s/a/t/ext 12.6-20 10.93 $70.00 $765.10
12036 Intmd rpr s/a/t/ext 20.1-30 12.10 $70.00 $847.00
12037 Intmd rpr s/tr/ext >30.0 cm 13.70 $70.00 $959.00
12041 Intmd rpr n-hf/genit 2.5cm/< 6.97 $70.00 $487.90
12042 Intmd rpr n-hf/genit2.6-7.5 8.41 $70.00 $588.70
12044 Intmd rpr n-hf/genit7.6-12.5 10.41 $70.00 $728.70
12045 Intmd rpr n-hf/genit12.6-20 11.46 $70.00 $802.20
12046 Intmd rpr n-hf/genit20.1-30 13.80 $70.00 $966.00
12047 Intmd rpr n-hf/genit >30.0cm 15.15 $70.00 $1,060.50
1205F Epi etiol synd rvwd and docd 0.00 $70.00 $0.00
12051 Intmd rpr face/mm 2.5 cm/< 7.55 $70.00 $528.50
12052 Intmd rpr face/mm 2.6-5.0 cm 8.55 $70.00 $598.50
12053 Intmd rpr face/mm 5.1-7.5 cm 10.00 $70.00 $700.00
12054 Intmd rpr face/mm 7.6-12.5cm 10.46 $70.00 $732.20
12055 Intmd rpr face/mm 12.6-20 cm 13.57 $70.00 $949.90
12056 Intmd rpr face/mm 20.1-30.0 15.98 $70.00 $1,118.60
12057 Intmd rpr face/mm >30.0 cm 16.93 $70.00 $1,185.10
1220F Pt screened for depression 0.00 $70.00 $0.00
13100 Cmplx rpr trunk 1.1-2.5 cm 9.66 $70.00 $676.20
13101 Cmplx rpr trunk 2.6-7.5 cm 11.39 $70.00 $797.30
13102 Cmplx rpr trunk addl 5cm/< 3.46 $70.00 $242.20
13120 Cmplx rpr s/a/l 1.1-2.5 cm 10.09 $70.00 $706.30
13121 Cmplx rpr s/a/l 2.6-7.5 cm 12.26 $70.00 $858.20
13122 Cmplx rpr s/a/l addl 5 cm/> 3.78 $70.00 $264.60
13131 Cmplx rpr f/c/c/m/n/ax/g/h/f 11.09 $70.00 $776.30
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f 13.66 $70.00 $956.20
13133 Cmplx rpr f/c/c/m/n/ax/g/h/f 5.06 $70.00 $354.20
13151 Cmplx rpr e/n/e/l 1.1-2.5 cm 12.13 $70.00 $849.10
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm 14.48 $70.00 $1,013.60
13153 Cmplx rpr e/n/e/l addl 5cm/< 5.50 $70.00 $385.00
13160 Late closure of wound 22.96 $70.00 $1,607.20
1400F Prkns diag rviewed 0.00 $70.00 $0.00
14000 Tis trnfr trunk 10 sq cm/< 17.80 $70.00 $1,246.00
14001 Tis trnfr trunk 10.1-30sqcm 22.82 $70.00 $1,597.40
14020 Tis trnfr s/a/l 10 sq cm/< 19.87 $70.00 $1,390.90
14021 Tis trnfr s/a/l 10.1-30 sqcm 24.79 $70.00 $1,735.30
14040 Tis trnfr f/c/c/m/n/a/g/h/f 21.70 $70.00 $1,519.00
14041 Tis trnfr f/c/c/m/n/a/g/h/f 26.75 $70.00 $1,872.50
14060 Tis trnfr e/n/e/l 10 sq cm/< 22.11 $70.00 $1,547.70
14061 Tis trnfr e/n/e/l10.1-30sqcm 28.77 $70.00 $2,013.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
14301 Tis trnfr any 30.1-60 sq cm 30.79 $70.00 $2,155.30
14302 Tis trnfr addl 30 sq cm 6.34 $70.00 $443.80
14350 Filleted finger/toe flap 19.62 $70.00 $1,373.40
1450F Symptoms improved/consist 0.00 $70.00 $0.00
1451F Sympt show clin import drop 0.00 $70.00 $0.00
1460F Qual card diag prior 12 mons 0.00 $70.00 $0.00
1461F No qual card diag prior12mon 0.00 $70.00 $0.00
1490F Dem severity classified mild 0.00 $70.00 $0.00
1491F Dem severity classified mod 0.00 $70.00 $0.00
1493F Dem severity class severe 0.00 $70.00 $0.00
1494F Cognit assessed and reviewed 0.00 $70.00 $0.00
1500F Symptom+sign symm polyneuro 0.00 $70.00 $0.00
15002 Wound prep trk/arm/leg 9.94 $70.00 $695.80
15003 Wound prep addl 100 cm 2.11 $70.00 $147.70
15004 Wound prep f/n/hf/g 11.38 $70.00 $796.60
15005 Wnd prep f/n/hf/g addl cm 3.52 $70.00 $246.40
1501F Not initial eval for cond 0.00 $70.00 $0.00
1502F Pt queried pain fxn w/ instr 0.00 $70.00 $0.00
1503F Pt queried symp resp insuff 0.00 $70.00 $0.00
1504F Pt has resp insufficiency 0.00 $70.00 $0.00
15040 Harvest cultured skin graft 7.29 $70.00 $510.30
1505F Pt has no resp insufficiency 0.00 $70.00 $0.00
15050 Skin pinch graft 16.14 $70.00 $1,129.80
15100 Skin splt grft trnk/arm/leg 24.58 $70.00 $1,720.60
15101 Skin splt grft t/a/l add-on 5.31 $70.00 $371.70
15110 Epidrm autogrft trnk/arm/leg 22.82 $70.00 $1,597.40
15111 Epidrm autogrft t/a/l add-on 3.32 $70.00 $232.40
15115 Epidrm a-grft face/nck/hf/g 22.65 $70.00 $1,585.50
15116 Epidrm a-grft f/n/hf/g addl 4.80 $70.00 $336.00
15120 Skn splt a-grft fac/nck/hf/g 24.29 $70.00 $1,700.30
15121 Skn splt a-grft f/n/hf/g add 5.95 $70.00 $416.50
15130 Derm autograft trnk/arm/leg 19.02 $70.00 $1,331.40
15131 Derm autograft t/a/l add-on 2.85 $70.00 $199.50
15135 Derm autograft face/nck/hf/g 24.52 $70.00 $1,716.40
15136 Derm autograft f/n/hf/g add 2.82 $70.00 $197.40
15150 Cult skin grft t/arm/leg 20.05 $70.00 $1,403.50
15151 Cult skin grft t/a/l addl 3.45 $70.00 $241.50
15152 Cult skin graft t/a/l +% 4.25 $70.00 $297.50
15155 Cult skin graft f/n/hf/g 22.84 $70.00 $1,598.80
15156 Cult skin grft f/n/hfg add 4.65 $70.00 $325.50
15157 Cult epiderm grft f/n/hfg +% 5.17 $70.00 $361.90
15200 Skin full graft trunk 23.83 $70.00 $1,668.10
15201 Skin full graft trunk add-on 4.14 $70.00 $289.80
15220 Skin full graft sclp/arm/leg 22.06 $70.00 $1,544.20
15221 Skin full graft add-on 3.87 $70.00 $270.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
15240 Skin full grft face/genit/hf 26.68 $70.00 $1,867.60
15241 Skin full graft add-on 5.22 $70.00 $365.40
15260 Skin full graft een & lips 28.88 $70.00 $2,021.60
15261 Skin full graft add-on 6.05 $70.00 $423.50
15271 Skin sub graft trnk/arm/leg 4.14 $70.00 $289.80
15272 Skin sub graft t/a/l add-on 0.76 $70.00 $53.20
15273 Skin sub grft t/arm/lg child 8.73 $70.00 $611.10
15274 Skn sub grft t/a/l child add 2.15 $70.00 $150.50
15275 Skin sub graft face/nk/hf/g 4.37 $70.00 $305.90
15276 Skin sub graft f/n/hf/g addl 0.98 $70.00 $68.60
15277 Skn sub grft f/n/hf/g child 9.55 $70.00 $668.50
15278 Skn sub grft f/n/hf/g ch add 2.54 $70.00 $177.80
15570 Skin pedicle flap trunk 26.04 $70.00 $1,822.80
15572 Skin pedicle flap arms/legs 25.33 $70.00 $1,773.10
15574 Pedcle fh/ch/ch/m/n/ax/g/h/f 25.85 $70.00 $1,809.50
15576 Pedicle e/n/e/l/ntroral 22.93 $70.00 $1,605.10
15600 Delay flap trunk 9.30 $70.00 $651.00
15610 Delay flap arms/legs 10.16 $70.00 $711.20
15620 Delay flap f/c/c/n/ax/g/h/f 12.52 $70.00 $876.40
15630 Delay flap eye/nos/ear/lip 13.09 $70.00 $916.30
15650 Transfer skin pedicle flap 14.52 $70.00 $1,016.40
15730 Mdfc flap w/prsrv vasc pedcl 43.66 $70.00 $3,056.20
15731 Forehead flap w/vasc pedicle 32.04 $70.00 $2,242.80
15733 Musc myoq/fscq flp h&n pedcl 30.12 $70.00 $2,108.40
15734 Muscle-skin graft trunk 43.47 $70.00 $3,042.90
15736 Muscle-skin graft arm 35.30 $70.00 $2,471.00
15738 Muscle-skin graft leg 37.65 $70.00 $2,635.50
15740 Island pedicle flap graft 28.83 $70.00 $2,018.10
15750 Neurovascular pedicle flap 26.39 $70.00 $1,847.30
15756 Free myo/skin flap microvasc 66.21 $70.00 $4,634.70
15757 Free skin flap microvasc 65.51 $70.00 $4,585.70
15758 Free fascial flap microvasc 66.09 $70.00 $4,626.30
15760 Composite skin graft 24.26 $70.00 $1,698.20
15770 Derma-fat-fascia graft 19.09 $70.00 $1,336.30
15775 Hair trnspl 1-15 punch grfts 8.74 $70.00 $611.80
15776 Hair trnspl >15 punch grafts 12.57 $70.00 $879.90
15777 Acellular derm matrix implt 6.25 $70.00 $437.50
15780 Dermabrasion total face 26.16 $70.00 $1,831.20
15781 Dermabrasion segmental face 15.71 $70.00 $1,099.70
15782 Dermabrasion other than face 16.36 $70.00 $1,145.20
15783 Dermabrasion suprfl any site 13.62 $70.00 $953.40
15786 Abrasion lesion single 6.98 $70.00 $488.60
15787 Abrasion lesions add-on 1.27 $70.00 $88.90
15788 Chemical peel face epiderm 12.75 $70.00 $892.50
15789 Chemical peel face dermal 15.75 $70.00 $1,102.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
15792 Chemical peel nonfacial 11.80 $70.00 $826.00
15793 Chemical peel nonfacial 14.08 $70.00 $985.60
15819 Plastic surgery neck 22.76 $70.00 $1,593.20
15820 Revision of lower eyelid 16.21 $70.00 $1,134.70
15821 Revision of lower eyelid 17.38 $70.00 $1,216.60
15822 Revision of upper eyelid 12.74 $70.00 $891.80
15823 Revision of upper eyelid 17.37 $70.00 $1,215.90
15824 Removal of forehead wrinkles 0.00 $70.00 $0.00
15825 Removal of neck wrinkles 0.00 $70.00 $0.00
15826 Removal of brow wrinkles 0.00 $70.00 $0.00
15828 Removal of face wrinkles 0.00 $70.00 $0.00
15829 Removal of skin wrinkles 0.00 $70.00 $0.00
15830 Exc skin abd 33.75 $70.00 $2,362.50
15832 Excise excessive skin thigh 26.40 $70.00 $1,848.00
15833 Excise excessive skin leg 24.96 $70.00 $1,747.20
15834 Excise excessive skin hip 25.52 $70.00 $1,786.40
15835 Excise excessive skin buttck 26.84 $70.00 $1,878.80
15836 Excise excessive skin arm 22.65 $70.00 $1,585.50
15837 Excise excess skin arm/hand 24.70 $70.00 $1,729.00
15838 Excise excess skin fat pad 18.34 $70.00 $1,283.80
15839 Excise excess skin & tissue 25.27 $70.00 $1,768.90
15840 Nerve palsy fascial graft 28.86 $70.00 $2,020.20
15841 Nerve palsy muscle graft 51.22 $70.00 $3,585.40
15842 Nerve palsy microsurg graft 78.04 $70.00 $5,462.80
15845 Skin and muscle repair face 28.87 $70.00 $2,020.90
15847 Exc skin abd add-on 0.00 $70.00 $0.00
15850 Remove sutures same surgeon 2.56 $70.00 $179.20
15851 Remove sutures diff surgeon 2.85 $70.00 $199.50
15852 Dressing change not for burn 1.33 $70.00 $93.10
15860 Test for blood flow in graft 3.10 $70.00 $217.00
15876 Suction lipectomy head&neck 0.00 $70.00 $0.00
15877 Suction lipectomy trunk 0.00 $70.00 $0.00
15878 Suction lipectomy upr extrem 0.00 $70.00 $0.00
15879 Suction lipectomy lwr extrem 0.00 $70.00 $0.00
15920 Removal of tail bone ulcer 17.84 $70.00 $1,248.80
15922 Removal of tail bone ulcer 22.50 $70.00 $1,575.00
15931 Remove sacrum pressure sore 19.94 $70.00 $1,395.80
15933 Remove sacrum pressure sore 24.58 $70.00 $1,720.60
15934 Remove sacrum pressure sore 27.15 $70.00 $1,900.50
15935 Remove sacrum pressure sore 31.64 $70.00 $2,214.80
15936 Remove sacrum pressure sore 25.72 $70.00 $1,800.40
15937 Remove sacrum pressure sore 29.85 $70.00 $2,089.50
15940 Remove hip pressure sore 20.15 $70.00 $1,410.50
15941 Remove hip pressure sore 26.09 $70.00 $1,826.30
15944 Remove hip pressure sore 25.83 $70.00 $1,808.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
15945 Remove hip pressure sore 28.46 $70.00 $1,992.20
15946 Remove hip pressure sore 46.87 $70.00 $3,280.90
15950 Remove thigh pressure sore 17.32 $70.00 $1,212.40
15951 Remove thigh pressure sore 25.29 $70.00 $1,770.30
15952 Remove thigh pressure sore 25.97 $70.00 $1,817.90
15953 Remove thigh pressure sore 28.66 $70.00 $2,006.20
15956 Remove thigh pressure sore 33.38 $70.00 $2,336.60
15958 Remove thigh pressure sore 34.06 $70.00 $2,384.20
15999 Removal of pressure sore 0.00 $70.00 $0.00
16000 Initial treatment of burn(s) 2.00 $70.00 $140.00
16020 Dress/debrid p-thick burn s 2.32 $70.00 $162.40
16025 Dress/debrid p-thick burn m 4.26 $70.00 $298.20
16030 Dress/debrid p-thick burn l 5.40 $70.00 $378.00
16035 Incision of burn scab initi 5.65 $70.00 $395.50
16036 Escharotomy addl incision 2.36 $70.00 $165.20
17000 Destruct premalg lesion 1.85 $70.00 $129.50
17003 Destruct premalg les 2-14 0.16 $70.00 $11.20
17004 Destroy premal lesions 15/> 4.31 $70.00 $301.70
17106 Destruction of skin lesions 9.78 $70.00 $684.60
17107 Destruction of skin lesions 12.67 $70.00 $886.90
17108 Destruction of skin lesions 18.35 $70.00 $1,284.50
17110 Destruct b9 lesion 1-14 3.13 $70.00 $219.10
17111 Destruct lesion 15 or more 3.71 $70.00 $259.70
17250 Chem caut of granltj tissue 2.31 $70.00 $161.70
17260 Destruction of skin lesions 2.71 $70.00 $189.70
17261 Destruction of skin lesions 4.11 $70.00 $287.70
17262 Destruction of skin lesions 5.01 $70.00 $350.70
17263 Destruction of skin lesions 5.47 $70.00 $382.90
17264 Destruction of skin lesions 5.85 $70.00 $409.50
17266 Destruction of skin lesions 6.66 $70.00 $466.20
17270 Destruction of skin lesions 4.24 $70.00 $296.80
17271 Destruction of skin lesions 4.67 $70.00 $326.90
17272 Destruction of skin lesions 5.33 $70.00 $373.10
17273 Destruction of skin lesions 5.94 $70.00 $415.80
17274 Destruction of skin lesions 7.01 $70.00 $490.70
17276 Destruction of skin lesions 8.11 $70.00 $567.70
17280 Destruction of skin lesions 3.97 $70.00 $277.90
17281 Destruction of skin lesions 5.09 $70.00 $356.30
17282 Destruction of skin lesions 5.84 $70.00 $408.80
17283 Destruction of skin lesions 6.99 $70.00 $489.30
17284 Destruction of skin lesions 7.97 $70.00 $557.90
17286 Destruction of skin lesions 10.22 $70.00 $715.40
17311 Mohs 1 stage h/n/hf/g 18.98 $70.00 $1,328.60
17312 Mohs addl stage 11.26 $70.00 $788.20
17313 Mohs 1 stage t/a/l 17.75 $70.00 $1,242.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
17314 Mohs addl stage t/a/l 10.75 $70.00 $752.50
17315 Mohs surg addl block 2.26 $70.00 $158.20
17340 Cryotherapy of skin 1.49 $70.00 $104.30
17360 Skin peel therapy 3.61 $70.00 $252.70
17380 Hair removal by electrolysis 0.00 $70.00 $0.00
17999 Skin tissue procedure 0.00 $70.00 $0.00
19000 Drainage of breast lesion 3.12 $70.00 $218.40
19001 Drain breast lesion add-on 0.77 $70.00 $53.90
19020 Incision of breast lesion 13.50 $70.00 $945.00
19030 Injection for breast x-ray 4.74 $70.00 $331.80
19081 Bx breast 1st lesion strtctc 18.42 $70.00 $1,289.40
19082 Bx breast add lesion strtctc 15.03 $70.00 $1,052.10
19083 Bx breast 1st lesion us imag 18.04 $70.00 $1,262.80
19084 Bx breast add lesion us imag 14.49 $70.00 $1,014.30
19085 Bx breast 1st lesion mr imag 27.39 $70.00 $1,917.30
19086 Bx breast add lesion mr imag 21.97 $70.00 $1,537.90
19100 Bx breast percut w/o image 4.32 $70.00 $302.40
19101 Biopsy of breast open 9.64 $70.00 $674.80
19105 Cryosurg ablate fa each 80.50 $70.00 $5,635.00
19110 Nipple exploration 13.96 $70.00 $977.20
19112 Excise breast duct fistula 13.15 $70.00 $920.50
19120 Removal of breast lesion 14.30 $70.00 $1,001.00
19125 Excision breast lesion 15.84 $70.00 $1,108.80
19126 Excision addl breast lesion 4.68 $70.00 $327.60
19260 Removal of chest wall lesion 34.34 $70.00 $2,403.80
19271 Revision of chest wall 46.15 $70.00 $3,230.50
19272 Extensive chest wall surgery 50.33 $70.00 $3,523.10
19281 Perq device breast 1st imag 6.90 $70.00 $483.00
19282 Perq device breast ea imag 4.82 $70.00 $337.40
19283 Perq dev breast 1st strtctc 7.73 $70.00 $541.10
19284 Perq dev breast add strtctc 5.87 $70.00 $410.90
19285 Perq dev breast 1st us imag 13.79 $70.00 $965.30
19286 Perq dev breast add us imag 11.91 $70.00 $833.70
19287 Perq dev breast 1st mr guide 23.30 $70.00 $1,631.00
19288 Perq dev breast add mr guide 18.66 $70.00 $1,306.20
19294 Prep tum cav iort prtl mast 4.71 $70.00 $329.70
19296 Place po breast cath for rad 113.15 $70.00 $7,920.50
19297 Place breast cath for rad 2.75 $70.00 $192.50
19298 Place breast rad tube/caths 28.24 $70.00 $1,976.80
19300 Removal of breast tissue 15.35 $70.00 $1,074.50
19301 Partial mastectomy 18.86 $70.00 $1,320.20
19302 P-mastectomy w/ln removal 25.97 $70.00 $1,817.90
19303 Mast simple complete 27.69 $70.00 $1,938.30
19304 Mast subq 16.81 $70.00 $1,176.70
19305 Mast radical 32.73 $70.00 $2,291.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
19306 Mast rad urban type 34.68 $70.00 $2,427.60
19307 Mast mod rad 34.61 $70.00 $2,422.70
19316 Suspension of breast 22.17 $70.00 $1,551.90
19318 Reduction of large breast 31.59 $70.00 $2,211.30
19324 Enlarge breast 15.15 $70.00 $1,060.50
19325 Enlarge breast with implant 18.46 $70.00 $1,292.20
19328 Removal of breast implant 14.27 $70.00 $998.90
19330 Removal of implant material 18.18 $70.00 $1,272.60
19340 Immediate breast prosthesis 28.60 $70.00 $2,002.00
19342 Delayed breast prosthesis 26.53 $70.00 $1,857.10
19350 Breast reconstruction 23.61 $70.00 $1,652.70
19355 Correct inverted nipple(s) 21.53 $70.00 $1,507.10
19357 Breast reconstruction 43.16 $70.00 $3,021.20
19361 Breast reconstr w/lat flap 45.22 $70.00 $3,165.40
19364 Breast reconstruction 79.21 $70.00 $5,544.70
19366 Breast reconstruction 40.38 $70.00 $2,826.60
19367 Breast reconstruction 51.34 $70.00 $3,593.80
19368 Breast reconstruction 63.22 $70.00 $4,425.40
19369 Breast reconstruction 58.68 $70.00 $4,107.60
19370 Surgery of breast capsule 19.73 $70.00 $1,381.10
19371 Removal of breast capsule 22.56 $70.00 $1,579.20
19380 Revise breast reconstruction 22.26 $70.00 $1,558.20
19396 Design custom breast implant 8.23 $70.00 $576.10
19499 Breast surgery procedure 0.00 $70.00 $0.00
2000F Blood pressure measure 0.00 $70.00 $0.00
2001F Weight record 0.00 $70.00 $0.00
2002F Clin sign vol ovrld assess 0.00 $70.00 $0.00
2004F Initial exam involved joints 0.00 $70.00 $0.00
2010F Vital signs recorded 0.00 $70.00 $0.00
20100 Explore wound neck 17.54 $70.00 $1,227.80
20101 Explore wound chest 12.96 $70.00 $907.20
20102 Explore wound abdomen 14.04 $70.00 $982.80
20103 Explore wound extremity 16.61 $70.00 $1,162.70
2014F Mental status assess 0.00 $70.00 $0.00
2015F Asthma impairment assessed 0.00 $70.00 $0.00
20150 Excise epiphyseal bar 29.09 $70.00 $2,036.30
2016F Asthma risk assessed 0.00 $70.00 $0.00
2018F Hydration status assess 0.00 $70.00 $0.00
2019F Dilated macul exam done 0.00 $70.00 $0.00
2020F Dilated fundus eval done 0.00 $70.00 $0.00
20200 Muscle biopsy 5.95 $70.00 $416.50
20205 Deep muscle biopsy 8.35 $70.00 $584.50
20206 Needle biopsy muscle 6.71 $70.00 $469.70
2021F Dilat macular exam done 0.00 $70.00 $0.00
2022F Dil retina exam interp rev 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
20220 Bone biopsy trocar/needle 4.79 $70.00 $335.30
20225 Bone biopsy trocar/needle 14.71 $70.00 $1,029.70
2024F 7 field photo interp doc rev 0.00 $70.00 $0.00
20240 Bone biopsy open superficial 4.31 $70.00 $301.70
20245 Bone biopsy open deep 10.13 $70.00 $709.10
20250 Open bone biopsy 11.50 $70.00 $805.00
20251 Open bone biopsy 12.45 $70.00 $871.50
2026F Eye image valid to dx rev 0.00 $70.00 $0.00
2027F Optic nerve head eval done 0.00 $70.00 $0.00
2028F Foot exam performed 0.00 $70.00 $0.00
2029F Complete phys skin exam done 0.00 $70.00 $0.00
2030F H2o stat docd normal 0.00 $70.00 $0.00
2031F H2o stat docd dehydrated 0.00 $70.00 $0.00
2035F Tymp memb motion examd 0.00 $70.00 $0.00
2040F Bk pn xm on init visit date 0.00 $70.00 $0.00
2044F Doc mntl tst b/4 bk trxmnt 0.00 $70.00 $0.00
2050F Wound char size etc docd 0.00 $70.00 $0.00
20500 Injection of sinus tract 3.09 $70.00 $216.30
20501 Inject sinus tract for x-ray 3.62 $70.00 $253.40
20520 Removal of foreign body 5.87 $70.00 $410.90
20525 Removal of foreign body 13.63 $70.00 $954.10
20526 Ther injection carp tunnel 2.20 $70.00 $154.00
20527 Inj dupuytren cord w/enzyme 2.39 $70.00 $167.30
20550 Inj tendon sheath/ligament 1.51 $70.00 $105.70
20551 Inj tendon origin/insertion 1.53 $70.00 $107.10
20552 Inj trigger point 1/2 muscl 1.57 $70.00 $109.90
20553 Inject trigger points 3/> 1.81 $70.00 $126.70
20555 Place ndl musc/tis for rt 9.49 $70.00 $664.30
2060F Pt talk eval hlthwkr re mdd 0.00 $70.00 $0.00
20600 Drain/inj joint/bursa w/o us 1.38 $70.00 $96.60
20604 Drain/inj joint/bursa w/us 2.10 $70.00 $147.00
20605 Drain/inj joint/bursa w/o us 1.44 $70.00 $100.80
20606 Drain/inj joint/bursa w/us 2.32 $70.00 $162.40
20610 Drain/inj joint/bursa w/o us 1.71 $70.00 $119.70
20611 Drain/inj joint/bursa w/us 2.61 $70.00 $182.70
20612 Aspirate/inj ganglion cyst 1.71 $70.00 $119.70
20615 Treatment of bone cyst 6.95 $70.00 $486.50
20650 Insert and remove bone pin 6.07 $70.00 $424.90
20660 Apply rem fixation device 7.07 $70.00 $494.90
20661 Application of head brace 14.53 $70.00 $1,017.10
20662 Application of pelvis brace 14.75 $70.00 $1,032.50
20663 Application of thigh brace 13.55 $70.00 $948.50
20664 Application of halo 25.32 $70.00 $1,772.40
20665 Removal of fixation device 3.13 $70.00 $219.10
20670 Removal of support implant 10.67 $70.00 $746.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
20680 Removal of support implant 17.62 $70.00 $1,233.40
20690 Apply bone fixation device 17.20 $70.00 $1,204.00
20692 Apply bone fixation device 32.27 $70.00 $2,258.90
20693 Adjust bone fixation device 12.75 $70.00 $892.50
20694 Remove bone fixation device 12.21 $70.00 $854.70
20696 Comp multiplane ext fixation 34.49 $70.00 $2,414.30
20697 Comp ext fixate strut change 58.91 $70.00 $4,123.70
20802 Replantation arm complete 79.69 $70.00 $5,578.30
20805 Replant forearm complete 94.89 $70.00 $6,642.30
20808 Replantation hand complete 114.80 $70.00 $8,036.00
20816 Replantation digit complete 59.68 $70.00 $4,177.60
20822 Replantation digit complete 51.28 $70.00 $3,589.60
20824 Replantation thumb complete 59.78 $70.00 $4,184.60
20827 Replantation thumb complete 52.37 $70.00 $3,665.90
20838 Replantation foot complete 80.69 $70.00 $5,648.30
20900 Removal of bone for graft 11.72 $70.00 $820.40
20902 Removal of bone for graft 8.20 $70.00 $574.00
20910 Remove cartilage for graft 13.46 $70.00 $942.20
20912 Remove cartilage for graft 13.60 $70.00 $952.00
20920 Removal of fascia for graft 11.51 $70.00 $805.70
20922 Removal of fascia for graft 17.02 $70.00 $1,191.40
20924 Removal of tendon for graft 14.55 $70.00 $1,018.50
20926 Removal of tissue for graft 12.07 $70.00 $844.90
20930 Sp bone algrft morsel add-on 0.00 $70.00 $0.00
20931 Sp bone algrft struct add-on 3.26 $70.00 $228.20
20932 Osteoart algrft w/surf & b1 20.54 $70.00 $1,437.80
20933 Hemicrt intrclry algrft prtl 18.84 $70.00 $1,318.80
20934 Intercalary algrft compl 20.53 $70.00 $1,437.10
20936 Sp bone agrft local add-on 0.00 $70.00 $0.00
20937 Sp bone agrft morsel add-on 4.88 $70.00 $341.60
20938 Sp bone agrft struct add-on 5.40 $70.00 $378.00
20939 Bone marrow aspir bone grfg 1.92 $70.00 $134.40
20950 Fluid pressure muscle 7.41 $70.00 $518.70
20955 Fibula bone graft microvasc 71.69 $70.00 $5,018.30
20956 Iliac bone graft microvasc 76.12 $70.00 $5,328.40
20957 Mt bone graft microvasc 79.73 $70.00 $5,581.10
20962 Other bone graft microvasc 77.04 $70.00 $5,392.80
20969 Bone/skin graft microvasc 79.14 $70.00 $5,539.80
20970 Bone/skin graft iliac crest 82.38 $70.00 $5,766.60
20972 Bone/skin graft metatarsal 82.66 $70.00 $5,786.20
20973 Bone/skin graft great toe 87.31 $70.00 $6,111.70
20974 Electrical bone stimulation 2.24 $70.00 $156.80
20975 Electrical bone stimulation 5.18 $70.00 $362.60
20979 Us bone stimulation 1.49 $70.00 $104.30
20982 Ablate bone tumor(s) perq 110.14 $70.00 $7,709.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
20983 Ablate bone tumor(s) perq 163.74 $70.00 $11,461.80
20985 Cptr-asst dir ms px 4.24 $70.00 $296.80
20999 Musculoskeletal surgery 0.00 $70.00 $0.00
21010 Incision of jaw joint 21.99 $70.00 $1,539.30
21011 Exc face les sc <2 cm 10.12 $70.00 $708.40
21012 Exc face les sbq 2 cm/> 9.75 $70.00 $682.50
21013 Exc face tum deep < 2 cm 15.03 $70.00 $1,052.10
21014 Exc face tum deep 2 cm/> 15.01 $70.00 $1,050.70
21015 Resect face/scalp tum < 2 cm 20.30 $70.00 $1,421.00
21016 Resect face/scalp tum 2 cm/> 29.15 $70.00 $2,040.50
21025 Excision of bone lower jaw 24.87 $70.00 $1,740.90
21026 Excision of facial bone(s) 17.02 $70.00 $1,191.40
21029 Contour of face bone lesion 22.08 $70.00 $1,545.60
21030 Excise max/zygoma b9 tumor 14.63 $70.00 $1,024.10
21031 Remove exostosis mandible 11.31 $70.00 $791.70
21032 Remove exostosis maxilla 11.38 $70.00 $796.60
21034 Excise max/zygoma mal tumor 37.50 $70.00 $2,625.00
21040 Excise mandible lesion 14.74 $70.00 $1,031.80
21044 Removal of jaw bone lesion 25.08 $70.00 $1,755.60
21045 Extensive jaw surgery 35.12 $70.00 $2,458.40
21046 Remove mandible cyst complex 31.57 $70.00 $2,209.90
21047 Excise lwr jaw cyst w/repair 37.69 $70.00 $2,638.30
21048 Remove maxilla cyst complex 32.07 $70.00 $2,244.90
21049 Excis uppr jaw cyst w/repair 34.66 $70.00 $2,426.20
21050 Removal of jaw joint 25.92 $70.00 $1,814.40
21060 Remove jaw joint cartilage 23.58 $70.00 $1,650.60
21070 Remove coronoid process 18.32 $70.00 $1,282.40
21073 Mnpj of tmj w/anesth 11.02 $70.00 $771.40
21076 Prepare face/oral prosthesis 27.60 $70.00 $1,932.00
21077 Prepare face/oral prosthesis 68.80 $70.00 $4,816.00
21079 Prepare face/oral prosthesis 46.66 $70.00 $3,266.20
21080 Prepare face/oral prosthesis 52.73 $70.00 $3,691.10
21081 Prepare face/oral prosthesis 48.53 $70.00 $3,397.10
21082 Prepare face/oral prosthesis 45.33 $70.00 $3,173.10
21083 Prepare face/oral prosthesis 43.22 $70.00 $3,025.40
21084 Prepare face/oral prosthesis 49.49 $70.00 $3,464.30
21085 Prepare face/oral prosthesis 21.05 $70.00 $1,473.50
21086 Prepare face/oral prosthesis 51.10 $70.00 $3,577.00
21087 Prepare face/oral prosthesis 51.10 $70.00 $3,577.00
21088 Prepare face/oral prosthesis 0.00 $70.00 $0.00
21089 Prepare face/oral prosthesis 0.00 $70.00 $0.00
21100 Maxillofacial fixation 19.89 $70.00 $1,392.30
21110 Interdental fixation 23.38 $70.00 $1,636.60
21116 Injection jaw joint x-ray 5.08 $70.00 $355.60
21120 Reconstruction of chin 19.31 $70.00 $1,351.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
21121 Reconstruction of chin 20.95 $70.00 $1,466.50
21122 Reconstruction of chin 22.38 $70.00 $1,566.60
21123 Reconstruction of chin 26.12 $70.00 $1,828.40
21125 Augmentation lower jaw bone 82.77 $70.00 $5,793.90
21127 Augmentation lower jaw bone 112.20 $70.00 $7,854.00
21137 Reduction of forehead 21.62 $70.00 $1,513.40
21138 Reduction of forehead 26.41 $70.00 $1,848.70
21139 Reduction of forehead 32.15 $70.00 $2,250.50
21141 Lefort i-1 piece w/o graft 39.46 $70.00 $2,762.20
21142 Lefort i-2 piece w/o graft 40.56 $70.00 $2,839.20
21143 Lefort i-3/> piece w/o graft 42.32 $70.00 $2,962.40
21145 Lefort i-1 piece w/ graft 46.24 $70.00 $3,236.80
21146 Lefort i-2 piece w/ graft 48.08 $70.00 $3,365.60
21147 Lefort i-3/> piece w/ graft 50.84 $70.00 $3,558.80
21150 Lefort ii anterior intrusion 47.68 $70.00 $3,337.60
21151 Lefort ii w/bone grafts 52.48 $70.00 $3,673.60
21154 Lefort iii w/o lefort i 56.46 $70.00 $3,952.20
21155 Lefort iii w/ lefort i 62.64 $70.00 $4,384.80
21159 Lefort iii w/fhdw/o lefort i 75.09 $70.00 $5,256.30
21160 Lefort iii w/fhd w/ lefort i 81.45 $70.00 $5,701.50
21172 Reconstruct orbit/forehead 60.59 $70.00 $4,241.30
21175 Reconstruct orbit/forehead 63.82 $70.00 $4,467.40
21179 Reconstruct entire forehead 43.60 $70.00 $3,052.00
21180 Reconstruct entire forehead 49.06 $70.00 $3,434.20
21181 Contour cranial bone lesion 21.29 $70.00 $1,490.30
21182 Reconstruct cranial bone 61.01 $70.00 $4,270.70
21183 Reconstruct cranial bone 66.75 $70.00 $4,672.50
21184 Reconstruct cranial bone 71.86 $70.00 $5,030.20
21188 Reconstruction of midface 48.06 $70.00 $3,364.20
21193 Reconst lwr jaw w/o graft 36.78 $70.00 $2,574.60
21194 Reconst lwr jaw w/graft 42.39 $70.00 $2,967.30
21195 Reconst lwr jaw w/o fixation 41.01 $70.00 $2,870.70
21196 Reconst lwr jaw w/fixation 42.18 $70.00 $2,952.60
21198 Reconstr lwr jaw segment 33.08 $70.00 $2,315.60
21199 Reconstr lwr jaw w/advance 30.95 $70.00 $2,166.50
21206 Reconstruct upper jaw bone 34.14 $70.00 $2,389.80
21208 Augmentation of facial bones 49.91 $70.00 $3,493.70
21209 Reduction of facial bones 25.75 $70.00 $1,802.50
21210 Face bone graft 60.28 $70.00 $4,219.60
21215 Lower jaw bone graft 114.71 $70.00 $8,029.70
21230 Rib cartilage graft 21.35 $70.00 $1,494.50
21235 Ear cartilage graft 20.77 $70.00 $1,453.90
21240 Reconstruction of jaw joint 32.15 $70.00 $2,250.50
21242 Reconstruction of jaw joint 29.92 $70.00 $2,094.40
21243 Reconstruction of jaw joint 48.92 $70.00 $3,424.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
21244 Reconstruction of lower jaw 30.02 $70.00 $2,101.40
21245 Reconstruction of jaw 34.87 $70.00 $2,440.90
21246 Reconstruction of jaw 25.44 $70.00 $1,780.80
21247 Reconstruct lower jaw bone 47.04 $70.00 $3,292.80
21248 Reconstruction of jaw 31.11 $70.00 $2,177.70
21249 Reconstruction of jaw 44.90 $70.00 $3,143.00
21255 Reconstruct lower jaw bone 40.68 $70.00 $2,847.60
21256 Reconstruction of orbit 35.79 $70.00 $2,505.30
21260 Revise eye sockets 40.19 $70.00 $2,813.30
21261 Revise eye sockets 71.19 $70.00 $4,983.30
21263 Revise eye sockets 65.82 $70.00 $4,607.40
21267 Revise eye sockets 46.85 $70.00 $3,279.50
21268 Revise eye sockets 58.91 $70.00 $4,123.70
21270 Augmentation cheek bone 29.06 $70.00 $2,034.20
21275 Revision orbitofacial bones 24.18 $70.00 $1,692.60
21280 Revision of eyelid 16.40 $70.00 $1,148.00
21282 Revision of eyelid 11.01 $70.00 $770.70
21295 Revision of jaw muscle/bone 5.37 $70.00 $375.90
21296 Revision of jaw muscle/bone 11.64 $70.00 $814.80
21299 Cranio/maxillofacial surgery 0.00 $70.00 $0.00
21310 Closed tx nose fx w/o manj 3.76 $70.00 $263.20
21315 Closed tx nose fx w/o stablj 7.84 $70.00 $548.80
21320 Closed tx nose fx w/ stablj 7.23 $70.00 $506.10
21325 Open tx nose fx uncomplicatd 13.39 $70.00 $937.30
21330 Open tx nose fx w/skele fixj 16.17 $70.00 $1,131.90
21335 Open tx nose & septal fx 20.53 $70.00 $1,437.10
21336 Open tx septal fx w/wo stabj 18.39 $70.00 $1,287.30
21337 Closed tx septal&nose fx 11.62 $70.00 $813.40
21338 Open nasoethmoid fx w/o fixj 18.88 $70.00 $1,321.60
21339 Open nasoethmoid fx w/ fixj 21.38 $70.00 $1,496.60
21340 Perq tx nasoethmoid fx 21.34 $70.00 $1,493.80
21343 Open tx dprsd front sinus fx 30.82 $70.00 $2,157.40
21344 Open tx compl front sinus fx 39.66 $70.00 $2,776.20
21345 Closed tx nose/jaw fx 22.25 $70.00 $1,557.50
21346 Opn tx nasomax fx w/fixj 26.60 $70.00 $1,862.00
21347 Opn tx nasomax fx multple 29.03 $70.00 $2,032.10
21348 Opn tx nasomax fx w/graft 31.05 $70.00 $2,173.50
21355 Perq tx malar fracture 12.19 $70.00 $853.30
21356 Opn tx dprsd zygomatic arch 14.31 $70.00 $1,001.70
21360 Opn tx dprsd malar fracture 14.60 $70.00 $1,022.00
21365 Opn tx complx malar fx 31.95 $70.00 $2,236.50
21366 Opn tx complx malar w/grft 36.59 $70.00 $2,561.30
21385 Opn tx orbit fx transantral 21.65 $70.00 $1,515.50
21386 Opn tx orbit fx periorbital 19.98 $70.00 $1,398.60
21387 Opn tx orbit fx combined 22.58 $70.00 $1,580.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
21390 Opn tx orbit periorbtl implt 22.96 $70.00 $1,607.20
21395 Opn tx orbit periorbt w/grft 29.07 $70.00 $2,034.90
21400 Closed tx orbit w/o manipulj 5.73 $70.00 $401.10
21401 Closed tx orbit w/manipulj 14.75 $70.00 $1,032.50
21406 Opn tx orbit fx w/o implant 16.54 $70.00 $1,157.80
21407 Opn tx orbit fx w/implant 18.53 $70.00 $1,297.10
21408 Opn tx orbit fx w/bone grft 25.95 $70.00 $1,816.50
21421 Treat mouth roof fracture 20.33 $70.00 $1,423.10
21422 Treat mouth roof fracture 18.97 $70.00 $1,327.90
21423 Treat mouth roof fracture 22.22 $70.00 $1,555.40
21431 Treat craniofacial fracture 20.60 $70.00 $1,442.00
21432 Treat craniofacial fracture 20.58 $70.00 $1,440.60
21433 Treat craniofacial fracture 50.17 $70.00 $3,511.90
21435 Treat craniofacial fracture 40.33 $70.00 $2,823.10
21436 Treat craniofacial fracture 58.83 $70.00 $4,118.10
21440 Treat dental ridge fracture 17.33 $70.00 $1,213.10
21445 Treat dental ridge fracture 22.26 $70.00 $1,558.20
21450 Treat lower jaw fracture 16.44 $70.00 $1,150.80
21451 Treat lower jaw fracture 21.75 $70.00 $1,522.50
21452 Treat lower jaw fracture 19.17 $70.00 $1,341.90
21453 Treat lower jaw fracture 27.62 $70.00 $1,933.40
21454 Treat lower jaw fracture 15.69 $70.00 $1,098.30
21461 Treat lower jaw fracture 59.44 $70.00 $4,160.80
21462 Treat lower jaw fracture 63.37 $70.00 $4,435.90
21465 Treat lower jaw fracture 25.87 $70.00 $1,810.90
21470 Treat lower jaw fracture 34.54 $70.00 $2,417.80
21480 Reset dislocated jaw 3.07 $70.00 $214.90
21485 Reset dislocated jaw 23.79 $70.00 $1,665.30
21490 Repair dislocated jaw 25.56 $70.00 $1,789.20
21497 Interdental wiring 19.62 $70.00 $1,373.40
21499 Head surgery procedure 0.00 $70.00 $0.00
21501 Drain neck/chest lesion 13.18 $70.00 $922.60
21502 Drain chest lesion 14.52 $70.00 $1,016.40
21510 Drainage of bone lesion 12.74 $70.00 $891.80
21550 Biopsy of neck/chest 7.46 $70.00 $522.20
21552 Exc neck les sc 3 cm/> 12.86 $70.00 $900.20
21554 Exc neck tum deep 5 cm/> 21.06 $70.00 $1,474.20
21555 Exc neck les sc < 3 cm 12.07 $70.00 $844.90
21556 Exc neck tum deep < 5 cm 15.19 $70.00 $1,063.30
21557 Resect neck thorax tumor<5cm 27.48 $70.00 $1,923.60
21558 Resect neck tumor 5 cm/> 38.76 $70.00 $2,713.20
21600 Partial removal of rib 15.85 $70.00 $1,109.50
21610 Partial removal of rib 34.70 $70.00 $2,429.00
21615 Removal of rib 17.58 $70.00 $1,230.60
21616 Removal of rib and nerves 20.56 $70.00 $1,439.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
21620 Partial removal of sternum 14.52 $70.00 $1,016.40
21627 Sternal debridement 15.49 $70.00 $1,084.30
21630 Extensive sternum surgery 35.44 $70.00 $2,480.80
21632 Extensive sternum surgery 34.89 $70.00 $2,442.30
21685 Hyoid myotomy & suspension 28.21 $70.00 $1,974.70
21700 Revision of neck muscle 10.24 $70.00 $716.80
21705 Revision of neck muscle/rib 15.39 $70.00 $1,077.30
21720 Revision of neck muscle 14.77 $70.00 $1,033.90
21725 Revision of neck muscle 15.58 $70.00 $1,090.60
21740 Reconstruction of sternum 29.72 $70.00 $2,080.40
21742 Repair stern/nuss w/o scope 0.00 $70.00 $0.00
21743 Repair sternum/nuss w/scope 0.00 $70.00 $0.00
21750 Repair of sternum separation 19.71 $70.00 $1,379.70
21811 Optx of rib fx w/fixj scope 17.18 $70.00 $1,202.60
21812 Treatment of rib fracture 21.07 $70.00 $1,474.90
21813 Treatment of rib fracture 28.40 $70.00 $1,988.00
21820 Treat sternum fracture 4.08 $70.00 $285.60
21825 Treat sternum fracture 15.59 $70.00 $1,091.30
21899 Neck/chest surgery procedure 0.00 $70.00 $0.00
21920 Biopsy soft tissue of back 7.30 $70.00 $511.00
21925 Biopsy soft tissue of back 13.10 $70.00 $917.00
21930 Exc back les sc < 3 cm 13.83 $70.00 $968.10
21931 Exc back les sc 3 cm/> 13.56 $70.00 $949.20
21932 Exc back tum deep < 5 cm 19.07 $70.00 $1,334.90
21933 Exc back tum deep 5 cm/> 21.29 $70.00 $1,490.30
21935 Resect back tum < 5 cm 29.65 $70.00 $2,075.50
21936 Resect back tum 5 cm/> 40.96 $70.00 $2,867.20
22010 I&d p-spine c/t/cerv-thor 27.73 $70.00 $1,941.10
22015 I&d abscess p-spine l/s/ls 27.40 $70.00 $1,918.00
22100 Remove part of neck vertebra 24.88 $70.00 $1,741.60
22101 Remove part thorax vertebra 24.80 $70.00 $1,736.00
22102 Remove part lumbar vertebra 23.48 $70.00 $1,643.60
22103 Remove extra spine segment 4.10 $70.00 $287.00
22110 Remove part of neck vertebra 30.29 $70.00 $2,120.30
22112 Remove part thorax vertebra 32.05 $70.00 $2,243.50
22114 Remove part lumbar vertebra 32.44 $70.00 $2,270.80
22116 Remove extra spine segment 4.12 $70.00 $288.40
22206 Incis spine 3 column thorac 71.33 $70.00 $4,993.10
22207 Incis spine 3 column lumbar 69.89 $70.00 $4,892.30
22208 Incis spine 3 column adl seg 17.28 $70.00 $1,209.60
22210 Incis 1 vertebral seg cerv 52.06 $70.00 $3,644.20
22212 Incis 1 vertebral seg thorac 43.22 $70.00 $3,025.40
22214 Incis 1 vertebral seg lumbar 43.40 $70.00 $3,038.00
22216 Incis addl spine segment 10.61 $70.00 $742.70
22220 Incis w/discectomy cervical 47.04 $70.00 $3,292.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
22222 Incis w/discectomy thoracic 50.03 $70.00 $3,502.10
22224 Incis w/discectomy lumbar 45.90 $70.00 $3,213.00
22226 Revise extra spine segment 10.58 $70.00 $740.60
22310 Closed tx vert fx w/o manj 8.82 $70.00 $617.40
22315 Closed tx vert fx w/manj 25.37 $70.00 $1,775.90
22318 Treat odontoid fx w/o graft 47.65 $70.00 $3,335.50
22319 Treat odontoid fx w/graft 52.77 $70.00 $3,693.90
22325 Treat spine fracture 41.97 $70.00 $2,937.90
22326 Treat neck spine fracture 43.47 $70.00 $3,042.90
22327 Treat thorax spine fracture 43.88 $70.00 $3,071.60
22328 Treat each add spine fx 8.25 $70.00 $577.50
22505 Manipulation of spine 3.79 $70.00 $265.30
22510 Perq cervicothoracic inject 49.83 $70.00 $3,488.10
22511 Perq lumbosacral injection 49.33 $70.00 $3,453.10
22512 Vertebroplasty addl inject 25.60 $70.00 $1,792.00
22513 Perq vertebral augmentation 195.55 $70.00 $13,688.50
22514 Perq vertebral augmentation 194.92 $70.00 $13,644.40
22515 Perq vertebral augmentation 113.15 $70.00 $7,920.50
22526 Idet single level 65.01 $70.00 $4,550.70
22527 Idet 1 or more levels 54.63 $70.00 $3,824.10
22532 Lat thorax spine fusion 52.40 $70.00 $3,668.00
22533 Lat lumbar spine fusion 48.12 $70.00 $3,368.40
22534 Lat thor/lumb addl seg 10.52 $70.00 $736.40
22548 Neck spine fusion 56.95 $70.00 $3,986.50
22551 Neck spine fuse&remov bel c2 49.66 $70.00 $3,476.20
22552 Addl neck spine fusion 11.64 $70.00 $814.80
22554 Neck spine fusion 36.40 $70.00 $2,548.00
22556 Thorax spine fusion 48.58 $70.00 $3,400.60
22558 Lumbar spine fusion 44.49 $70.00 $3,114.30
22585 Additional spinal fusion 9.55 $70.00 $668.50
22586 Prescrl fuse w/ instr l5-s1 58.94 $70.00 $4,125.80
22590 Spine & skull spinal fusion 45.99 $70.00 $3,219.30
22595 Neck spinal fusion 43.88 $70.00 $3,071.60
22600 Neck spine fusion 37.48 $70.00 $2,623.60
22610 Thorax spine fusion 36.78 $70.00 $2,574.60
22612 Lumbar spine fusion 46.06 $70.00 $3,224.20
22614 Spine fusion extra segment 11.42 $70.00 $799.40
22630 Lumbar spine fusion 45.80 $70.00 $3,206.00
22632 Spine fusion extra segment 9.40 $70.00 $658.00
22633 Lumbar spine fusion combined 53.85 $70.00 $3,769.50
22634 Spine fusion extra segment 14.48 $70.00 $1,013.60
22800 Post fusion </6 vert seg 39.34 $70.00 $2,753.80
22802 Post fusion 7-12 vert seg 61.11 $70.00 $4,277.70
22804 Post fusion 13/> vert seg 70.64 $70.00 $4,944.80
22808 Ant fusion 2-3 vert seg 53.76 $70.00 $3,763.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
22810 Ant fusion 4-7 vert seg 60.28 $70.00 $4,219.60
22812 Ant fusion 8/> vert seg 63.28 $70.00 $4,429.60
22818 Kyphectomy 1-2 segments 62.49 $70.00 $4,374.30
22819 Kyphectomy 3 or more 71.50 $70.00 $5,005.00
22830 Exploration of spinal fusion 23.62 $70.00 $1,653.40
22840 Insert spine fixation device 22.20 $70.00 $1,554.00
22841 Insert spine fixation device 0.00 $70.00 $0.00
22842 Insert spine fixation device 22.32 $70.00 $1,562.40
22843 Insert spine fixation device 23.87 $70.00 $1,670.90
22844 Insert spine fixation device 28.82 $70.00 $2,017.40
22845 Insert spine fixation device 21.33 $70.00 $1,493.10
22846 Insert spine fixation device 22.15 $70.00 $1,550.50
22847 Insert spine fixation device 23.37 $70.00 $1,635.90
22848 Insert pelv fixation device 10.50 $70.00 $735.00
22849 Reinsert spinal fixation 37.73 $70.00 $2,641.10
22850 Remove spine fixation device 21.04 $70.00 $1,472.80
22852 Remove spine fixation device 20.21 $70.00 $1,414.70
22853 Insj biomechanical device 7.55 $70.00 $528.50
22854 Insj biomechanical device 9.78 $70.00 $684.60
22855 Remove spine fixation device 32.19 $70.00 $2,253.30
22856 Cerv artific diskectomy 47.66 $70.00 $3,336.20
22857 Lumbar artif diskectomy 50.85 $70.00 $3,559.50
22858 Second level cer diskectomy 14.93 $70.00 $1,045.10
22859 Insj biomechanical device 9.78 $70.00 $684.60
22861 Revise cerv artific disc 64.93 $70.00 $4,545.10
22862 Revise lumbar artif disc 54.94 $70.00 $3,845.80
22864 Remove cerv artif disc 59.95 $70.00 $4,196.50
22865 Remove lumb artif disc 56.38 $70.00 $3,946.60
22867 Insj stablj dev w/dcmprn 28.21 $70.00 $1,974.70
22868 Insj stablj dev w/dcmprn 7.06 $70.00 $494.20
22869 Insj stablj dev w/o dcmprn 13.25 $70.00 $927.50
22870 Insj stablj dev w/o dcmprn 3.62 $70.00 $253.40
22899 Spine surgery procedure 0.00 $70.00 $0.00
22900 Exc abdl tum deep < 5 cm 16.24 $70.00 $1,136.80
22901 Exc abdl tum deep 5 cm/> 19.20 $70.00 $1,344.00
22902 Exc abd les sc < 3 cm 12.85 $70.00 $899.50
22903 Exc abd les sc 3 cm/> 12.68 $70.00 $887.60
22904 Radical resect abd tumor<5cm 30.49 $70.00 $2,134.30
22905 Rad resect abd tumor 5 cm/> 38.54 $70.00 $2,697.80
22999 Abdomen surgery procedure 0.00 $70.00 $0.00
23000 Removal of calcium deposits 16.08 $70.00 $1,125.60
23020 Release shoulder joint 19.85 $70.00 $1,389.50
23030 Drain shoulder lesion 12.43 $70.00 $870.10
23031 Drain shoulder bursa 11.44 $70.00 $800.80
23035 Drain shoulder bone lesion 19.48 $70.00 $1,363.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
23040 Exploratory shoulder surgery 20.64 $70.00 $1,444.80
23044 Exploratory shoulder surgery 16.31 $70.00 $1,141.70
23065 Biopsy shoulder tissues 6.34 $70.00 $443.80
23066 Biopsy shoulder tissues 16.18 $70.00 $1,132.60
23071 Exc shoulder les sc 3 cm/> 12.09 $70.00 $846.30
23073 Exc shoulder tum deep 5 cm/> 20.04 $70.00 $1,402.80
23075 Exc shoulder les sc < 3 cm 13.90 $70.00 $973.00
23076 Exc shoulder tum deep < 5 cm 15.60 $70.00 $1,092.00
23077 Resect shoulder tumor < 5 cm 32.81 $70.00 $2,296.70
23078 Resect shoulder tumor 5 cm/> 41.48 $70.00 $2,903.60
23100 Biopsy of shoulder joint 14.40 $70.00 $1,008.00
23101 Shoulder joint surgery 13.14 $70.00 $919.80
23105 Remove shoulder joint lining 18.34 $70.00 $1,283.80
23106 Incision of collarbone joint 14.32 $70.00 $1,002.40
23107 Explore treat shoulder joint 19.01 $70.00 $1,330.70
23120 Partial removal collar bone 16.80 $70.00 $1,176.00
23125 Removal of collar bone 20.32 $70.00 $1,422.40
23130 Remove shoulder bone part 17.62 $70.00 $1,233.40
23140 Removal of bone lesion 15.90 $70.00 $1,113.00
23145 Removal of bone lesion 19.78 $70.00 $1,384.60
23146 Removal of bone lesion 17.63 $70.00 $1,234.10
23150 Removal of humerus lesion 18.94 $70.00 $1,325.80
23155 Removal of humerus lesion 22.70 $70.00 $1,589.00
23156 Removal of humerus lesion 19.46 $70.00 $1,362.20
23170 Remove collar bone lesion 16.16 $70.00 $1,131.20
23172 Remove shoulder blade lesion 16.23 $70.00 $1,136.10
23174 Remove humerus lesion 21.83 $70.00 $1,528.10
23180 Remove collar bone lesion 18.99 $70.00 $1,329.30
23182 Remove shoulder blade lesion 18.95 $70.00 $1,326.50
23184 Remove humerus lesion 21.10 $70.00 $1,477.00
23190 Partial removal of scapula 16.43 $70.00 $1,150.10
23195 Removal of head of humerus 21.47 $70.00 $1,502.90
23200 Resect clavicle tumor 43.64 $70.00 $3,054.80
23210 Resect scapula tumor 51.26 $70.00 $3,588.20
23220 Resect prox humerus tumor 56.33 $70.00 $3,943.10
23330 Remove shoulder foreign body 8.00 $70.00 $560.00
23333 Remove shoulder fb deep 13.27 $70.00 $928.90
23334 Shoulder prosthesis removal 30.88 $70.00 $2,161.60
23335 Shoulder prosthesis removal 36.86 $70.00 $2,580.20
23350 Injection for shoulder x-ray 3.97 $70.00 $277.90
23395 Muscle transfer shoulder/arm 36.97 $70.00 $2,587.90
23397 Muscle transfers 32.67 $70.00 $2,286.90
23400 Fixation of shoulder blade 27.53 $70.00 $1,927.10
23405 Incision of tendon & muscle 17.77 $70.00 $1,243.90
23406 Incise tendon(s) & muscle(s) 22.20 $70.00 $1,554.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
23410 Repair rotator cuff acute 23.64 $70.00 $1,654.80
23412 Repair rotator cuff chronic 24.53 $70.00 $1,717.10
23415 Release of shoulder ligament 20.11 $70.00 $1,407.70
23420 Repair of shoulder 27.98 $70.00 $1,958.60
23430 Repair biceps tendon 21.41 $70.00 $1,498.70
23440 Remove/transplant tendon 21.70 $70.00 $1,519.00
23450 Repair shoulder capsule 27.16 $70.00 $1,901.20
23455 Repair shoulder capsule 28.74 $70.00 $2,011.80
23460 Repair shoulder capsule 31.26 $70.00 $2,188.20
23462 Repair shoulder capsule 30.37 $70.00 $2,125.90
23465 Repair shoulder capsule 32.16 $70.00 $2,251.20
23466 Repair shoulder capsule 32.11 $70.00 $2,247.70
23470 Reconstruct shoulder joint 34.59 $70.00 $2,421.30
23472 Reconstruct shoulder joint 41.93 $70.00 $2,935.10
23473 Revis reconst shoulder joint 46.78 $70.00 $3,274.60
23474 Revis reconst shoulder joint 50.53 $70.00 $3,537.10
23480 Revision of collar bone 23.70 $70.00 $1,659.00
23485 Revision of collar bone 27.50 $70.00 $1,925.00
23490 Reinforce clavicle 24.67 $70.00 $1,726.90
23491 Reinforce shoulder bones 29.26 $70.00 $2,048.20
23500 Treat clavicle fracture 6.24 $70.00 $436.80
23505 Treat clavicle fracture 10.15 $70.00 $710.50
23515 Treat clavicle fracture 20.70 $70.00 $1,449.00
23520 Treat clavicle dislocation 6.72 $70.00 $470.40
23525 Treat clavicle dislocation 11.12 $70.00 $778.40
23530 Treat clavicle dislocation 16.38 $70.00 $1,146.60
23532 Treat clavicle dislocation 17.79 $70.00 $1,245.30
23540 Treat clavicle dislocation 6.54 $70.00 $457.80
23545 Treat clavicle dislocation 9.89 $70.00 $692.30
23550 Treat clavicle dislocation 16.35 $70.00 $1,144.50
23552 Treat clavicle dislocation 18.81 $70.00 $1,316.70
23570 Treat shoulder blade fx 6.62 $70.00 $463.40
23575 Treat shoulder blade fx 11.54 $70.00 $807.80
23585 Treat scapula fracture 28.21 $70.00 $1,974.70
23600 Treat humerus fracture 9.37 $70.00 $655.90
23605 Treat humerus fracture 13.33 $70.00 $933.10
23615 Treat humerus fracture 25.46 $70.00 $1,782.20
23616 Treat humerus fracture 35.73 $70.00 $2,501.10
23620 Treat humerus fracture 7.65 $70.00 $535.50
23625 Treat humerus fracture 10.92 $70.00 $764.40
23630 Treat humerus fracture 22.47 $70.00 $1,572.90
23650 Treat shoulder dislocation 9.10 $70.00 $637.00
23655 Treat shoulder dislocation 11.57 $70.00 $809.90
23660 Treat shoulder dislocation 16.75 $70.00 $1,172.50
23665 Treat dislocation/fracture 12.25 $70.00 $857.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
23670 Treat dislocation/fracture 25.21 $70.00 $1,764.70
23675 Treat dislocation/fracture 15.76 $70.00 $1,103.20
23680 Treat dislocation/fracture 26.74 $70.00 $1,871.80
23700 Fixation of shoulder 5.64 $70.00 $394.80
23800 Fusion of shoulder joint 29.50 $70.00 $2,065.00
23802 Fusion of shoulder joint 36.80 $70.00 $2,576.00
23900 Amputation of arm & girdle 39.97 $70.00 $2,797.90
23920 Amputation at shoulder joint 32.47 $70.00 $2,272.90
23921 Amputation follow-up surgery 13.47 $70.00 $942.90
23929 Shoulder surgery procedure 0.00 $70.00 $0.00
23930 Drainage of arm lesion 10.16 $70.00 $711.20
23931 Drainage of arm bursa 8.19 $70.00 $573.30
23935 Drain arm/elbow bone lesion 14.61 $70.00 $1,022.70
24000 Exploratory elbow surgery 13.71 $70.00 $959.70
24006 Release elbow joint 20.56 $70.00 $1,439.20
24065 Biopsy arm/elbow soft tissue 7.40 $70.00 $518.00
24066 Biopsy arm/elbow soft tissue 18.06 $70.00 $1,264.20
24071 Exc arm/elbow les sc 3 cm/> 11.70 $70.00 $819.00
24073 Ex arm/elbow tum deep 5 cm/> 19.99 $70.00 $1,399.30
24075 Exc arm/elbow les sc < 3 cm 14.45 $70.00 $1,011.50
24076 Ex arm/elbow tum deep < 5 cm 15.67 $70.00 $1,096.90
24077 Resect arm/elbow tum < 5 cm 29.93 $70.00 $2,095.10
24079 Resect arm/elbow tum 5 cm/> 38.24 $70.00 $2,676.80
24100 Biopsy elbow joint lining 11.97 $70.00 $837.90
24101 Explore/treat elbow joint 14.38 $70.00 $1,006.60
24102 Remove elbow joint lining 17.73 $70.00 $1,241.10
24105 Removal of elbow bursa 10.12 $70.00 $708.40
24110 Remove humerus lesion 16.86 $70.00 $1,180.20
24115 Remove/graft bone lesion 21.03 $70.00 $1,472.10
24116 Remove/graft bone lesion 24.80 $70.00 $1,736.00
24120 Remove elbow lesion 15.25 $70.00 $1,067.50
24125 Remove/graft bone lesion 17.89 $70.00 $1,252.30
24126 Remove/graft bone lesion 18.52 $70.00 $1,296.40
24130 Removal of head of radius 14.67 $70.00 $1,026.90
24134 Removal of arm bone lesion 21.49 $70.00 $1,504.30
24136 Remove radius bone lesion 18.19 $70.00 $1,273.30
24138 Remove elbow bone lesion 19.47 $70.00 $1,362.90
24140 Partial removal of arm bone 20.21 $70.00 $1,414.70
24145 Partial removal of radius 17.07 $70.00 $1,194.90
24147 Partial removal of elbow 17.94 $70.00 $1,255.80
24149 Radical resection of elbow 33.86 $70.00 $2,370.20
24150 Resect distal humerus tumor 44.83 $70.00 $3,138.10
24152 Resect radius tumor 38.35 $70.00 $2,684.50
24155 Removal of elbow joint 24.47 $70.00 $1,712.90
24160 Remove elbow joint implant 36.46 $70.00 $2,552.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
24164 Remove radius head implant 20.89 $70.00 $1,462.30
24200 Removal of arm foreign body 6.02 $70.00 $421.40
24201 Removal of arm foreign body 15.82 $70.00 $1,107.40
24220 Injection for elbow x-ray 4.71 $70.00 $329.70
24300 Manipulate elbow w/anesth 12.07 $70.00 $844.90
24301 Muscle/tendon transfer 21.62 $70.00 $1,513.40
24305 Arm tendon lengthening 16.59 $70.00 $1,161.30
24310 Revision of arm tendon 13.43 $70.00 $940.10
24320 Repair of arm tendon 22.30 $70.00 $1,561.00
24330 Revision of arm muscles 20.63 $70.00 $1,444.10
24331 Revision of arm muscles 22.24 $70.00 $1,556.80
24332 Tenolysis triceps 17.66 $70.00 $1,236.20
24340 Repair of biceps tendon 17.60 $70.00 $1,232.00
24341 Repair arm tendon/muscle 21.42 $70.00 $1,499.40
24342 Repair of ruptured tendon 22.34 $70.00 $1,563.80
24343 Repr elbow lat ligmnt w/tiss 20.41 $70.00 $1,428.70
24344 Reconstruct elbow lat ligmnt 31.45 $70.00 $2,201.50
24345 Repr elbw med ligmnt w/tissu 20.25 $70.00 $1,417.50
24346 Reconstruct elbow med ligmnt 31.60 $70.00 $2,212.00
24357 Repair elbow perc 11.96 $70.00 $837.20
24358 Repair elbow w/deb open 15.05 $70.00 $1,053.50
24359 Repair elbow deb/attch open 19.01 $70.00 $1,330.70
24360 Reconstruct elbow joint 25.94 $70.00 $1,815.80
24361 Reconstruct elbow joint 29.03 $70.00 $2,032.10
24362 Reconstruct elbow joint 30.61 $70.00 $2,142.70
24363 Replace elbow joint 41.96 $70.00 $2,937.20
24365 Reconstruct head of radius 18.39 $70.00 $1,287.30
24366 Reconstruct head of radius 19.60 $70.00 $1,372.00
24370 Revise reconst elbow joint 44.72 $70.00 $3,130.40
24371 Revise reconst elbow joint 51.37 $70.00 $3,595.90
24400 Revision of humerus 23.72 $70.00 $1,660.40
24410 Revision of humerus 30.53 $70.00 $2,137.10
24420 Revision of humerus 28.59 $70.00 $2,001.30
24430 Repair of humerus 30.40 $70.00 $2,128.00
24435 Repair humerus with graft 31.02 $70.00 $2,171.40
24470 Revision of elbow joint 19.35 $70.00 $1,354.50
24495 Decompression of forearm 21.27 $70.00 $1,488.90
24498 Reinforce humerus 24.96 $70.00 $1,747.20
24500 Treat humerus fracture 10.21 $70.00 $714.70
24505 Treat humerus fracture 14.27 $70.00 $998.90
24515 Treat humerus fracture 25.27 $70.00 $1,768.90
24516 Treat humerus fracture 24.77 $70.00 $1,733.90
24530 Treat humerus fracture 10.85 $70.00 $759.50
24535 Treat humerus fracture 17.68 $70.00 $1,237.60
24538 Treat humerus fracture 21.51 $70.00 $1,505.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
24545 Treat humerus fracture 26.78 $70.00 $1,874.60
24546 Treat humerus fracture 29.95 $70.00 $2,096.50
24560 Treat humerus fracture 9.29 $70.00 $650.30
24565 Treat humerus fracture 15.33 $70.00 $1,073.10
24566 Treat humerus fracture 20.67 $70.00 $1,446.90
24575 Treat humerus fracture 21.06 $70.00 $1,474.20
24576 Treat humerus fracture 9.80 $70.00 $686.00
24577 Treat humerus fracture 15.80 $70.00 $1,106.00
24579 Treat humerus fracture 24.06 $70.00 $1,684.20
24582 Treat humerus fracture 23.34 $70.00 $1,633.80
24586 Treat elbow fracture 31.23 $70.00 $2,186.10
24587 Treat elbow fracture 31.35 $70.00 $2,194.50
24600 Treat elbow dislocation 10.56 $70.00 $739.20
24605 Treat elbow dislocation 13.59 $70.00 $951.30
24615 Treat elbow dislocation 20.53 $70.00 $1,437.10
24620 Treat elbow fracture 15.88 $70.00 $1,111.60
24635 Treat elbow fracture 19.39 $70.00 $1,357.30
24640 Treat elbow dislocation 2.86 $70.00 $200.20
24650 Treat radius fracture 7.45 $70.00 $521.50
24655 Treat radius fracture 12.66 $70.00 $886.20
24665 Treat radius fracture 18.78 $70.00 $1,314.60
24666 Treat radius fracture 21.09 $70.00 $1,476.30
24670 Treat ulnar fracture 8.28 $70.00 $579.60
24675 Treat ulnar fracture 13.12 $70.00 $918.40
24685 Treat ulnar fracture 18.81 $70.00 $1,316.70
24800 Fusion of elbow joint 23.79 $70.00 $1,665.30
24802 Fusion/graft of elbow joint 28.93 $70.00 $2,025.10
24900 Amputation of upper arm 21.21 $70.00 $1,484.70
24920 Amputation of upper arm 21.16 $70.00 $1,481.20
24925 Amputation follow-up surgery 16.31 $70.00 $1,141.70
24930 Amputation follow-up surgery 22.25 $70.00 $1,557.50
24931 Amputate upper arm & implant 26.94 $70.00 $1,885.80
24935 Revision of amputation 33.63 $70.00 $2,354.10
24940 Revision of upper arm 0.00 $70.00 $0.00
24999 Upper arm/elbow surgery 0.00 $70.00 $0.00
25000 Incision of tendon sheath 9.70 $70.00 $679.00
25001 Incise flexor carpi radialis 9.88 $70.00 $691.60
25020 Decompress forearm 1 space 16.43 $70.00 $1,150.10
25023 Decompress forearm 1 space 31.83 $70.00 $2,228.10
25024 Decompress forearm 2 spaces 22.45 $70.00 $1,571.50
25025 Decompress forearm 2 spaces 34.81 $70.00 $2,436.70
25028 Drainage of forearm lesion 15.13 $70.00 $1,059.10
25031 Drainage of forearm bursa 10.00 $70.00 $700.00
25035 Treat forearm bone lesion 16.81 $70.00 $1,176.70
25040 Explore/treat wrist joint 16.14 $70.00 $1,129.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
25065 Biopsy forearm soft tissues 7.32 $70.00 $512.40
25066 Biopsy forearm soft tissues 10.30 $70.00 $721.00
25071 Exc forearm les sc 3 cm/> 12.23 $70.00 $856.10
25073 Exc forearm tum deep 3 cm/> 15.35 $70.00 $1,074.50
25075 Exc forearm les sc < 3 cm 14.09 $70.00 $986.30
25076 Exc forearm tum deep < 3 cm 14.89 $70.00 $1,042.30
25077 Resect forearm/wrist tum<3cm 25.43 $70.00 $1,780.10
25078 Resect forarm/wrist tum 3cm> 33.68 $70.00 $2,357.60
25085 Incision of wrist capsule 12.90 $70.00 $903.00
25100 Biopsy of wrist joint 9.95 $70.00 $696.50
25101 Explore/treat wrist joint 11.61 $70.00 $812.70
25105 Remove wrist joint lining 13.89 $70.00 $972.30
25107 Remove wrist joint cartilage 17.70 $70.00 $1,239.00
25109 Excise tendon forearm/wrist 15.46 $70.00 $1,082.20
25110 Remove wrist tendon lesion 9.82 $70.00 $687.40
25111 Remove wrist tendon lesion 9.21 $70.00 $644.70
25112 Reremove wrist tendon lesion 11.13 $70.00 $779.10
25115 Remove wrist/forearm lesion 21.80 $70.00 $1,526.00
25116 Remove wrist/forearm lesion 17.25 $70.00 $1,207.50
25118 Excise wrist tendon sheath 10.94 $70.00 $765.80
25119 Partial removal of ulna 14.21 $70.00 $994.70
25120 Removal of forearm lesion 14.30 $70.00 $1,001.00
25125 Remove/graft forearm lesion 16.94 $70.00 $1,185.80
25126 Remove/graft forearm lesion 17.11 $70.00 $1,197.70
25130 Removal of wrist lesion 12.83 $70.00 $898.10
25135 Remove & graft wrist lesion 15.99 $70.00 $1,119.30
25136 Remove & graft wrist lesion 14.06 $70.00 $984.20
25145 Remove forearm bone lesion 14.84 $70.00 $1,038.80
25150 Partial removal of ulna 16.29 $70.00 $1,140.30
25151 Partial removal of radius 16.71 $70.00 $1,169.70
25170 Resect radius/ulnar tumor 42.57 $70.00 $2,979.90
25210 Removal of wrist bone 14.01 $70.00 $980.70
25215 Removal of wrist bones 17.76 $70.00 $1,243.20
25230 Partial removal of radius 12.45 $70.00 $871.50
25240 Partial removal of ulna 12.31 $70.00 $861.70
25246 Injection for wrist x-ray 4.88 $70.00 $341.60
25248 Remove forearm foreign body 11.88 $70.00 $831.60
25250 Removal of wrist prosthesis 15.21 $70.00 $1,064.70
25251 Removal of wrist prosthesis 20.68 $70.00 $1,447.60
25259 Manipulate wrist w/anesthes 12.02 $70.00 $841.40
25260 Repair forearm tendon/muscle 18.10 $70.00 $1,267.00
25263 Repair forearm tendon/muscle 18.02 $70.00 $1,261.40
25265 Repair forearm tendon/muscle 21.47 $70.00 $1,502.90
25270 Repair forearm tendon/muscle 14.06 $70.00 $984.20
25272 Repair forearm tendon/muscle 15.92 $70.00 $1,114.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
25274 Repair forearm tendon/muscle 19.16 $70.00 $1,341.20
25275 Repair forearm tendon sheath 19.25 $70.00 $1,347.50
25280 Revise wrist/forearm tendon 16.19 $70.00 $1,133.30
25290 Incise wrist/forearm tendon 12.53 $70.00 $877.10
25295 Release wrist/forearm tendon 15.11 $70.00 $1,057.70
25300 Fusion of tendons at wrist 19.57 $70.00 $1,369.90
25301 Fusion of tendons at wrist 18.49 $70.00 $1,294.30
25310 Transplant forearm tendon 17.79 $70.00 $1,245.30
25312 Transplant forearm tendon 20.64 $70.00 $1,444.80
25315 Revise palsy hand tendon(s) 22.13 $70.00 $1,549.10
25316 Revise palsy hand tendon(s) 26.40 $70.00 $1,848.00
25320 Repair/revise wrist joint 28.32 $70.00 $1,982.40
25332 Revise wrist joint 24.22 $70.00 $1,695.40
25335 Realignment of hand 27.24 $70.00 $1,906.80
25337 Reconstruct ulna/radioulnar 25.61 $70.00 $1,792.70
25350 Revision of radius 19.39 $70.00 $1,357.30
25355 Revision of radius 21.80 $70.00 $1,526.00
25360 Revision of ulna 18.84 $70.00 $1,318.80
25365 Revise radius & ulna 26.25 $70.00 $1,837.50
25370 Revise radius or ulna 29.09 $70.00 $2,036.30
25375 Revise radius & ulna 27.52 $70.00 $1,926.40
25390 Shorten radius or ulna 22.12 $70.00 $1,548.40
25391 Lengthen radius or ulna 28.72 $70.00 $2,010.40
25392 Shorten radius & ulna 28.49 $70.00 $1,994.30
25393 Lengthen radius & ulna 32.28 $70.00 $2,259.60
25394 Repair carpal bone shorten 22.49 $70.00 $1,574.30
25400 Repair radius or ulna 23.12 $70.00 $1,618.40
25405 Repair/graft radius or ulna 29.90 $70.00 $2,093.00
25415 Repair radius & ulna 27.81 $70.00 $1,946.70
25420 Repair/graft radius & ulna 33.58 $70.00 $2,350.60
25425 Repair/graft radius or ulna 27.67 $70.00 $1,936.90
25426 Repair/graft radius & ulna 32.46 $70.00 $2,272.20
25430 Vasc graft into carpal bone 21.06 $70.00 $1,474.20
25431 Repair nonunion carpal bone 22.65 $70.00 $1,585.50
25440 Repair/graft wrist bone 22.13 $70.00 $1,549.10
25441 Reconstruct wrist joint 26.97 $70.00 $1,887.90
25442 Reconstruct wrist joint 23.23 $70.00 $1,626.10
25443 Reconstruct wrist joint 22.29 $70.00 $1,560.30
25444 Reconstruct wrist joint 23.75 $70.00 $1,662.50
25445 Reconstruct wrist joint 20.78 $70.00 $1,454.60
25446 Wrist replacement 33.83 $70.00 $2,368.10
25447 Repair wrist joints 23.83 $70.00 $1,668.10
25449 Remove wrist joint implant 29.73 $70.00 $2,081.10
25450 Revision of wrist joint 17.75 $70.00 $1,242.50
25455 Revision of wrist joint 20.94 $70.00 $1,465.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
25490 Reinforce radius 20.70 $70.00 $1,449.00
25491 Reinforce ulna 21.33 $70.00 $1,493.10
25492 Reinforce radius and ulna 26.11 $70.00 $1,827.70
25500 Treat fracture of radius 7.87 $70.00 $550.90
25505 Treat fracture of radius 14.29 $70.00 $1,000.30
25515 Treat fracture of radius 19.25 $70.00 $1,347.50
25520 Treat fracture of radius 16.28 $70.00 $1,139.60
25525 Treat fracture of radius 22.69 $70.00 $1,588.30
25526 Treat fracture of radius 27.47 $70.00 $1,922.90
25530 Treat fracture of ulna 7.46 $70.00 $522.20
25535 Treat fracture of ulna 14.03 $70.00 $982.10
25545 Treat fracture of ulna 17.91 $70.00 $1,253.70
25560 Treat fracture radius & ulna 8.03 $70.00 $562.10
25565 Treat fracture radius & ulna 14.72 $70.00 $1,030.40
25574 Treat fracture radius & ulna 19.39 $70.00 $1,357.30
25575 Treat fracture radius/ulna 25.96 $70.00 $1,817.20
25600 Treat fracture radius/ulna 9.40 $70.00 $658.00
25605 Treat fracture radius/ulna 15.45 $70.00 $1,081.50
25606 Treat fx distal radial 19.07 $70.00 $1,334.90
25607 Treat fx rad extra-articul 21.14 $70.00 $1,479.80
25608 Treat fx rad intra-articul 23.72 $70.00 $1,660.40
25609 Treat fx radial 3+ frag 30.19 $70.00 $2,113.30
25622 Treat wrist bone fracture 8.70 $70.00 $609.00
25624 Treat wrist bone fracture 13.78 $70.00 $964.60
25628 Treat wrist bone fracture 20.71 $70.00 $1,449.70
25630 Treat wrist bone fracture 8.69 $70.00 $608.30
25635 Treat wrist bone fracture 13.12 $70.00 $918.40
25645 Treat wrist bone fracture 16.33 $70.00 $1,143.10
25650 Treat wrist bone fracture 9.20 $70.00 $644.00
25651 Pin ulnar styloid fracture 13.94 $70.00 $975.80
25652 Treat fracture ulnar styloid 17.91 $70.00 $1,253.70
25660 Treat wrist dislocation 11.83 $70.00 $828.10
25670 Treat wrist dislocation 17.40 $70.00 $1,218.00
25671 Pin radioulnar dislocation 15.18 $70.00 $1,062.60
25675 Treat wrist dislocation 12.52 $70.00 $876.40
25676 Treat wrist dislocation 18.08 $70.00 $1,265.60
25680 Treat wrist fracture 14.93 $70.00 $1,045.10
25685 Treat wrist fracture 21.17 $70.00 $1,481.90
25690 Treat wrist dislocation 13.87 $70.00 $970.90
25695 Treat wrist dislocation 18.20 $70.00 $1,274.00
25800 Fusion of wrist joint 21.02 $70.00 $1,471.40
25805 Fusion/graft of wrist joint 24.33 $70.00 $1,703.10
25810 Fusion/graft of wrist joint 24.96 $70.00 $1,747.20
25820 Fusion of hand bones 17.81 $70.00 $1,246.70
25825 Fuse hand bones with graft 21.93 $70.00 $1,535.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
25830 Fusion radioulnar jnt/ulna 27.09 $70.00 $1,896.30
25900 Amputation of forearm 20.45 $70.00 $1,431.50
25905 Amputation of forearm 20.09 $70.00 $1,406.30
25907 Amputation follow-up surgery 17.50 $70.00 $1,225.00
25909 Amputation follow-up surgery 19.66 $70.00 $1,376.20
25915 Amputation of forearm 33.83 $70.00 $2,368.10
25920 Amputate hand at wrist 20.20 $70.00 $1,414.00
25922 Amputate hand at wrist 17.74 $70.00 $1,241.80
25924 Amputation follow-up surgery 19.44 $70.00 $1,360.80
25927 Amputation of hand 23.16 $70.00 $1,621.20
25929 Amputation follow-up surgery 17.19 $70.00 $1,203.30
25931 Amputation follow-up surgery 21.33 $70.00 $1,493.10
25999 Forearm or wrist surgery 0.00 $70.00 $0.00
26010 Drainage of finger abscess 7.74 $70.00 $541.80
26011 Drainage of finger abscess 11.49 $70.00 $804.30
26020 Drain hand tendon sheath 12.48 $70.00 $873.60
26025 Drainage of palm bursa 12.11 $70.00 $847.70
26030 Drainage of palm bursas 14.09 $70.00 $986.30
26034 Treat hand bone lesion 15.62 $70.00 $1,093.40
26035 Decompress fingers/hand 24.73 $70.00 $1,731.10
26037 Decompress fingers/hand 16.27 $70.00 $1,138.90
26040 Release palm contracture 8.96 $70.00 $627.20
26045 Release palm contracture 13.49 $70.00 $944.30
26055 Incise finger tendon sheath 16.18 $70.00 $1,132.60
26060 Incision of finger tendon 7.36 $70.00 $515.20
26070 Explore/treat hand joint 9.19 $70.00 $643.30
26075 Explore/treat finger joint 9.59 $70.00 $671.30
26080 Explore/treat finger joint 11.25 $70.00 $787.50
26100 Biopsy hand joint lining 9.64 $70.00 $674.80
26105 Biopsy finger joint lining 9.68 $70.00 $677.60
26110 Biopsy finger joint lining 9.25 $70.00 $647.50
26111 Exc hand les sc 1.5 cm/> 11.98 $70.00 $838.60
26113 Exc hand tum deep 1.5 cm/> 15.74 $70.00 $1,101.80
26115 Exc hand les sc < 1.5 cm 14.85 $70.00 $1,039.50
26116 Exc hand tum deep < 1.5 cm 15.13 $70.00 $1,059.10
26117 Rad resect hand tumor < 3 cm 21.38 $70.00 $1,496.60
26118 Rad resect hand tumor 3 cm/> 30.27 $70.00 $2,118.90
26121 Release palm contracture 17.18 $70.00 $1,202.60
26123 Release palm contracture 24.00 $70.00 $1,680.00
26125 Release palm contracture 7.89 $70.00 $552.30
26130 Remove wrist joint lining 13.19 $70.00 $923.30
26135 Revise finger joint each 15.83 $70.00 $1,108.10
26140 Revise finger joint each 14.52 $70.00 $1,016.40
26145 Tendon excision palm/finger 14.75 $70.00 $1,032.50
26160 Remove tendon sheath lesion 16.66 $70.00 $1,166.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
26170 Removal of palm tendon each 11.67 $70.00 $816.90
26180 Removal of finger tendon 12.78 $70.00 $894.60
26185 Remove finger bone 15.82 $70.00 $1,107.40
26200 Remove hand bone lesion 12.92 $70.00 $904.40
26205 Remove/graft bone lesion 17.36 $70.00 $1,215.20
26210 Removal of finger lesion 12.73 $70.00 $891.10
26215 Remove/graft finger lesion 16.24 $70.00 $1,136.80
26230 Partial removal of hand bone 14.32 $70.00 $1,002.40
26235 Partial removal finger bone 14.15 $70.00 $990.50
26236 Partial removal finger bone 12.67 $70.00 $886.90
26250 Extensive hand surgery 30.85 $70.00 $2,159.50
26260 Resect prox finger tumor 23.06 $70.00 $1,614.20
26262 Resect distal finger tumor 18.15 $70.00 $1,270.50
26320 Removal of implant from hand 9.98 $70.00 $698.60
26340 Manipulate finger w/anesth 9.67 $70.00 $676.90
26341 Manipulat palm cord post inj 2.90 $70.00 $203.00
26350 Repair finger/hand tendon 20.05 $70.00 $1,403.50
26352 Repair/graft hand tendon 23.01 $70.00 $1,610.70
26356 Repair finger/hand tendon 22.81 $70.00 $1,596.70
26357 Repair finger/hand tendon 25.50 $70.00 $1,785.00
26358 Repair/graft hand tendon 28.21 $70.00 $1,974.70
26370 Repair finger/hand tendon 21.29 $70.00 $1,490.30
26372 Repair/graft hand tendon 24.91 $70.00 $1,743.70
26373 Repair finger/hand tendon 23.91 $70.00 $1,673.70
26390 Revise hand/finger tendon 23.65 $70.00 $1,655.50
26392 Repair/graft hand tendon 27.49 $70.00 $1,924.30
26410 Repair hand tendon 15.88 $70.00 $1,111.60
26412 Repair/graft hand tendon 19.10 $70.00 $1,337.00
26415 Excision hand/finger tendon 23.01 $70.00 $1,610.70
26416 Graft hand or finger tendon 25.05 $70.00 $1,753.50
26418 Repair finger tendon 16.25 $70.00 $1,137.50
26420 Repair/graft finger tendon 19.92 $70.00 $1,394.40
26426 Repair finger/hand tendon 14.40 $70.00 $1,008.00
26428 Repair/graft finger tendon 21.31 $70.00 $1,491.70
26432 Repair finger tendon 13.99 $70.00 $979.30
26433 Repair finger tendon 14.88 $70.00 $1,041.60
26434 Repair/graft finger tendon 18.24 $70.00 $1,276.80
26437 Realignment of tendons 17.57 $70.00 $1,229.90
26440 Release palm/finger tendon 17.41 $70.00 $1,218.70
26442 Release palm & finger tendon 27.18 $70.00 $1,902.60
26445 Release hand/finger tendon 16.15 $70.00 $1,130.50
26449 Release forearm/hand tendon 19.96 $70.00 $1,397.20
26450 Incision of palm tendon 11.46 $70.00 $802.20
26455 Incision of finger tendon 11.36 $70.00 $795.20
26460 Incise hand/finger tendon 11.12 $70.00 $778.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
26471 Fusion of finger tendons 17.36 $70.00 $1,215.20
26474 Fusion of finger tendons 16.96 $70.00 $1,187.20
26476 Tendon lengthening 16.75 $70.00 $1,172.50
26477 Tendon shortening 16.36 $70.00 $1,145.20
26478 Lengthening of hand tendon 17.42 $70.00 $1,219.40
26479 Shortening of hand tendon 17.62 $70.00 $1,233.40
26480 Transplant hand tendon 21.14 $70.00 $1,479.80
26483 Transplant/graft hand tendon 23.72 $70.00 $1,660.40
26485 Transplant palm tendon 22.71 $70.00 $1,589.70
26489 Transplant/graft palm tendon 26.36 $70.00 $1,845.20
26490 Revise thumb tendon 22.50 $70.00 $1,575.00
26492 Tendon transfer with graft 25.01 $70.00 $1,750.70
26494 Hand tendon/muscle transfer 22.53 $70.00 $1,577.10
26496 Revise thumb tendon 24.24 $70.00 $1,696.80
26497 Finger tendon transfer 24.49 $70.00 $1,714.30
26498 Finger tendon transfer 32.47 $70.00 $2,272.90
26499 Revision of finger 23.44 $70.00 $1,640.80
26500 Hand tendon reconstruction 17.46 $70.00 $1,222.20
26502 Hand tendon reconstruction 20.04 $70.00 $1,402.80
26508 Release thumb contracture 17.78 $70.00 $1,244.60
26510 Thumb tendon transfer 16.75 $70.00 $1,172.50
26516 Fusion of knuckle joint 19.75 $70.00 $1,382.50
26517 Fusion of knuckle joints 23.23 $70.00 $1,626.10
26518 Fusion of knuckle joints 23.60 $70.00 $1,652.00
26520 Release knuckle contracture 18.21 $70.00 $1,274.70
26525 Release finger contracture 18.30 $70.00 $1,281.00
26530 Revise knuckle joint 15.44 $70.00 $1,080.80
26531 Revise knuckle with implant 17.96 $70.00 $1,257.20
26535 Revise finger joint 12.34 $70.00 $863.80
26536 Revise/implant finger joint 20.09 $70.00 $1,406.30
26540 Repair hand joint 18.52 $70.00 $1,296.40
26541 Repair hand joint with graft 22.58 $70.00 $1,580.60
26542 Repair hand joint with graft 19.15 $70.00 $1,340.50
26545 Reconstruct finger joint 19.90 $70.00 $1,393.00
26546 Repair nonunion hand 28.13 $70.00 $1,969.10
26548 Reconstruct finger joint 21.41 $70.00 $1,498.70
26550 Construct thumb replacement 46.81 $70.00 $3,276.70
26551 Great toe-hand transfer 94.63 $70.00 $6,624.10
26553 Single transfer toe-hand 93.99 $70.00 $6,579.30
26554 Double transfer toe-hand 109.72 $70.00 $7,680.40
26555 Positional change of finger 38.96 $70.00 $2,727.20
26556 Toe joint transfer 97.69 $70.00 $6,838.30
26560 Repair of web finger 16.51 $70.00 $1,155.70
26561 Repair of web finger 26.73 $70.00 $1,871.10
26562 Repair of web finger 38.18 $70.00 $2,672.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
26565 Correct metacarpal flaw 19.05 $70.00 $1,333.50
26567 Correct finger deformity 19.21 $70.00 $1,344.70
26568 Lengthen metacarpal/finger 25.36 $70.00 $1,775.20
26580 Repair hand deformity 43.09 $70.00 $3,016.30
26587 Reconstruct extra finger 30.00 $70.00 $2,100.00
26590 Repair finger deformity 40.07 $70.00 $2,804.90
26591 Repair muscles of hand 12.36 $70.00 $865.20
26593 Release muscles of hand 16.92 $70.00 $1,184.40
26596 Excision constricting tissue 21.50 $70.00 $1,505.00
26600 Treat metacarpal fracture 8.39 $70.00 $587.30
26605 Treat metacarpal fracture 9.24 $70.00 $646.80
26607 Treat metacarpal fracture 13.45 $70.00 $941.50
26608 Treat metacarpal fracture 13.72 $70.00 $960.40
26615 Treat metacarpal fracture 16.52 $70.00 $1,156.40
26641 Treat thumb dislocation 10.74 $70.00 $751.80
26645 Treat thumb fracture 12.30 $70.00 $861.00
26650 Treat thumb fracture 13.74 $70.00 $961.80
26665 Treat thumb fracture 17.98 $70.00 $1,258.60
26670 Treat hand dislocation 9.86 $70.00 $690.20
26675 Treat hand dislocation 13.11 $70.00 $917.70
26676 Pin hand dislocation 14.45 $70.00 $1,011.50
26685 Treat hand dislocation 16.49 $70.00 $1,154.30
26686 Treat hand dislocation 17.88 $70.00 $1,251.60
26700 Treat knuckle dislocation 9.38 $70.00 $656.60
26705 Treat knuckle dislocation 11.98 $70.00 $838.60
26706 Pin knuckle dislocation 12.67 $70.00 $886.90
26715 Treat knuckle dislocation 16.44 $70.00 $1,150.80
26720 Treat finger fracture each 5.62 $70.00 $393.40
26725 Treat finger fracture each 9.66 $70.00 $676.20
26727 Treat finger fracture each 13.52 $70.00 $946.40
26735 Treat finger fracture each 17.10 $70.00 $1,197.00
26740 Treat finger fracture each 6.56 $70.00 $459.20
26742 Treat finger fracture each 10.62 $70.00 $743.40
26746 Treat finger fracture each 21.34 $70.00 $1,493.80
26750 Treat finger fracture each 5.25 $70.00 $367.50
26755 Treat finger fracture each 8.99 $70.00 $629.30
26756 Pin finger fracture each 11.98 $70.00 $838.60
26765 Treat finger fracture each 14.38 $70.00 $1,006.60
26770 Treat finger dislocation 7.94 $70.00 $555.80
26775 Treat finger dislocation 10.99 $70.00 $769.30
26776 Pin finger dislocation 12.71 $70.00 $889.70
26785 Treat finger dislocation 15.71 $70.00 $1,099.70
26820 Thumb fusion with graft 22.17 $70.00 $1,551.90
26841 Fusion of thumb 20.49 $70.00 $1,434.30
26842 Thumb fusion with graft 22.08 $70.00 $1,545.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
26843 Fusion of hand joint 20.83 $70.00 $1,458.10
26844 Fusion/graft of hand joint 23.14 $70.00 $1,619.80
26850 Fusion of knuckle 19.49 $70.00 $1,364.30
26852 Fusion of knuckle with graft 22.42 $70.00 $1,569.40
26860 Fusion of finger joint 15.91 $70.00 $1,113.70
26861 Fusion of finger jnt add-on 2.98 $70.00 $208.60
26862 Fusion/graft of finger joint 20.47 $70.00 $1,432.90
26863 Fuse/graft added joint 6.62 $70.00 $463.40
26910 Amputate metacarpal bone 20.44 $70.00 $1,430.80
26951 Amputation of finger/thumb 18.42 $70.00 $1,289.40
26952 Amputation of finger/thumb 18.18 $70.00 $1,272.60
26989 Hand/finger surgery 0.00 $70.00 $0.00
26990 Drainage of pelvis lesion 18.33 $70.00 $1,283.10
26991 Drainage of pelvis bursa 20.22 $70.00 $1,415.40
26992 Drainage of bone lesion 27.90 $70.00 $1,953.00
27000 Incision of hip tendon 11.68 $70.00 $817.60
27001 Incision of hip tendon 15.45 $70.00 $1,081.50
27003 Incision of hip tendon 17.08 $70.00 $1,195.60
27005 Incision of hip tendon 20.80 $70.00 $1,456.00
27006 Incision of hip tendons 20.76 $70.00 $1,453.20
27025 Incision of hip/thigh fascia 26.37 $70.00 $1,845.90
27027 Buttock fasciotomy 25.48 $70.00 $1,783.60
27030 Drainage of hip joint 27.02 $70.00 $1,891.40
27033 Exploration of hip joint 28.03 $70.00 $1,962.10
27035 Denervation of hip joint 32.82 $70.00 $2,297.40
27036 Excision of hip joint/muscle 29.16 $70.00 $2,041.20
27040 Biopsy of soft tissues 9.83 $70.00 $688.10
27041 Biopsy of soft tissues 20.11 $70.00 $1,407.70
27043 Exc hip pelvis les sc 3 cm/> 13.54 $70.00 $947.80
27045 Exc hip/pelv tum deep 5 cm/> 21.38 $70.00 $1,496.60
27047 Exc hip/pelvis les sc < 3 cm 13.63 $70.00 $954.10
27048 Exc hip/pelv tum deep < 5 cm 17.60 $70.00 $1,232.00
27049 Resect hip/pelv tum < 5 cm 38.62 $70.00 $2,703.40
27050 Biopsy of sacroiliac joint 11.58 $70.00 $810.60
27052 Biopsy of hip joint 16.59 $70.00 $1,161.30
27054 Removal of hip joint lining 19.74 $70.00 $1,381.80
27057 Buttock fasciotomy w/dbrdmt 29.14 $70.00 $2,039.80
27059 Resect hip/pelv tum 5 cm/> 52.65 $70.00 $3,685.50
27060 Removal of ischial bursa 13.38 $70.00 $936.60
27062 Remove femur lesion/bursa 13.11 $70.00 $917.70
27065 Remove hip bone les super 14.94 $70.00 $1,045.80
27066 Remove hip bone les deep 23.13 $70.00 $1,619.10
27067 Remove/graft hip bone lesion 29.87 $70.00 $2,090.90
27070 Part remove hip bone super 24.68 $70.00 $1,727.60
27071 Part removal hip bone deep 26.67 $70.00 $1,866.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27075 Resect hip tumor 60.56 $70.00 $4,239.20
27076 Resect hip tum incl acetabul 73.30 $70.00 $5,131.00
27077 Resect hip tum w/innom bone 82.07 $70.00 $5,744.90
27078 Rsect hip tum incl femur 59.71 $70.00 $4,179.70
27080 Removal of tail bone 14.73 $70.00 $1,031.10
27086 Remove hip foreign body 8.61 $70.00 $602.70
27087 Remove hip foreign body 17.69 $70.00 $1,238.30
27090 Removal of hip prosthesis 23.94 $70.00 $1,675.80
27091 Removal of hip prosthesis 46.07 $70.00 $3,224.90
27093 Injection for hip x-ray 5.72 $70.00 $400.40
27095 Injection for hip x-ray 7.62 $70.00 $533.40
27096 Inject sacroiliac joint 4.56 $70.00 $319.20
27097 Revision of hip tendon 19.63 $70.00 $1,374.10
27098 Transfer tendon to pelvis 20.01 $70.00 $1,400.70
27100 Transfer of abdominal muscle 23.67 $70.00 $1,656.90
27105 Transfer of spinal muscle 24.91 $70.00 $1,743.70
27110 Transfer of iliopsoas muscle 27.81 $70.00 $1,946.70
27111 Transfer of iliopsoas muscle 25.99 $70.00 $1,819.30
27120 Reconstruction of hip socket 37.33 $70.00 $2,613.10
27122 Reconstruction of hip socket 31.76 $70.00 $2,223.20
27125 Partial hip replacement 32.71 $70.00 $2,289.70
27130 Total hip arthroplasty 39.09 $70.00 $2,736.30
27132 Total hip arthroplasty 48.33 $70.00 $3,383.10
27134 Revise hip joint replacement 55.28 $70.00 $3,869.60
27137 Revise hip joint replacement 42.48 $70.00 $2,973.60
27138 Revise hip joint replacement 44.14 $70.00 $3,089.80
27140 Transplant femur ridge 25.69 $70.00 $1,798.30
27146 Incision of hip bone 36.84 $70.00 $2,578.80
27147 Revision of hip bone 41.98 $70.00 $2,938.60
27151 Incision of hip bones 45.97 $70.00 $3,217.90
27156 Revision of hip bones 48.94 $70.00 $3,425.80
27158 Revision of pelvis 39.79 $70.00 $2,785.30
27161 Incision of neck of femur 35.00 $70.00 $2,450.00
27165 Incision/fixation of femur 39.45 $70.00 $2,761.50
27170 Repair/graft femur head/neck 33.82 $70.00 $2,367.40
27175 Treat slipped epiphysis 19.22 $70.00 $1,345.40
27176 Treat slipped epiphysis 26.40 $70.00 $1,848.00
27177 Treat slipped epiphysis 31.13 $70.00 $2,179.10
27178 Treat slipped epiphysis 26.54 $70.00 $1,857.80
27179 Revise head/neck of femur 27.87 $70.00 $1,950.90
27181 Treat slipped epiphysis 31.56 $70.00 $2,209.20
27185 Revision of femur epiphysis 20.71 $70.00 $1,449.70
27187 Reinforce hip bones 28.65 $70.00 $2,005.50
27197 Clsd tx pelvic ring fx 3.57 $70.00 $249.90
27198 Clsd tx pelvic ring fx 8.67 $70.00 $606.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27200 Treat tail bone fracture 5.26 $70.00 $368.20
27202 Treat tail bone fracture 15.14 $70.00 $1,059.80
27215 Treat pelvic fracture(s) 18.00 $70.00 $1,260.00
27216 Treat pelvic ring fracture 26.72 $70.00 $1,870.40
27217 Treat pelvic ring fracture 25.07 $70.00 $1,754.90
27218 Treat pelvic ring fracture 34.63 $70.00 $2,424.10
27220 Treat hip socket fracture 15.31 $70.00 $1,071.70
27222 Treat hip socket fracture 28.04 $70.00 $1,962.80
27226 Treat hip wall fracture 30.47 $70.00 $2,132.90
27227 Treat hip fracture(s) 47.95 $70.00 $3,356.50
27228 Treat hip fracture(s) 54.36 $70.00 $3,805.20
27230 Treat thigh fracture 13.75 $70.00 $962.50
27232 Treat thigh fracture 21.44 $70.00 $1,500.80
27235 Treat thigh fracture 26.23 $70.00 $1,836.10
27236 Treat thigh fracture 34.49 $70.00 $2,414.30
27238 Treat thigh fracture 13.27 $70.00 $928.90
27240 Treat thigh fracture 27.60 $70.00 $1,932.00
27244 Treat thigh fracture 35.51 $70.00 $2,485.70
27245 Treat thigh fracture 35.49 $70.00 $2,484.30
27246 Treat thigh fracture 11.12 $70.00 $778.40
27248 Treat thigh fracture 21.45 $70.00 $1,501.50
27250 Treat hip dislocation 5.17 $70.00 $361.90
27252 Treat hip dislocation 21.80 $70.00 $1,526.00
27253 Treat hip dislocation 27.18 $70.00 $1,902.60
27254 Treat hip dislocation 36.46 $70.00 $2,552.20
27256 Treat hip dislocation 8.70 $70.00 $609.00
27257 Treat hip dislocation 10.46 $70.00 $732.20
27258 Treat hip dislocation 32.01 $70.00 $2,240.70
27259 Treat hip dislocation 44.82 $70.00 $3,137.40
27265 Treat hip dislocation 11.52 $70.00 $806.40
27266 Treat hip dislocation 16.75 $70.00 $1,172.50
27267 Cltx thigh fx 12.44 $70.00 $870.80
27268 Cltx thigh fx w/mnpj 15.48 $70.00 $1,083.60
27269 Optx thigh fx 35.84 $70.00 $2,508.80
27275 Manipulation of hip joint 5.27 $70.00 $368.90
27279 Arthrodesis sacroiliac joint 19.99 $70.00 $1,399.30
27280 Fusion of sacroiliac joint 39.22 $70.00 $2,745.40
27282 Fusion of pubic bones 24.72 $70.00 $1,730.40
27284 Fusion of hip joint 45.92 $70.00 $3,214.40
27286 Fusion of hip joint 47.75 $70.00 $3,342.50
27290 Amputation of leg at hip 46.91 $70.00 $3,283.70
27295 Amputation of leg at hip 36.36 $70.00 $2,545.20
27299 Pelvis/hip joint surgery 0.00 $70.00 $0.00
27301 Drain thigh/knee lesion 19.37 $70.00 $1,355.90
27303 Drainage of bone lesion 18.43 $70.00 $1,290.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27305 Incise thigh tendon & fascia 13.82 $70.00 $967.40
27306 Incision of thigh tendon 9.89 $70.00 $692.30
27307 Incision of thigh tendons 13.81 $70.00 $966.70
27310 Exploration of knee joint 21.05 $70.00 $1,473.50
27323 Biopsy thigh soft tissues 7.91 $70.00 $553.70
27324 Biopsy thigh soft tissues 11.59 $70.00 $811.30
27325 Neurectomy hamstring 16.00 $70.00 $1,120.00
27326 Neurectomy popliteal 14.76 $70.00 $1,033.20
27327 Exc thigh/knee les sc < 3 cm 13.52 $70.00 $946.40
27328 Exc thigh/knee tum deep <5cm 17.99 $70.00 $1,259.30
27329 Resect thigh/knee tum < 5 cm 29.93 $70.00 $2,095.10
27330 Biopsy knee joint lining 11.97 $70.00 $837.90
27331 Explore/treat knee joint 13.66 $70.00 $956.20
27332 Removal of knee cartilage 18.46 $70.00 $1,292.20
27333 Removal of knee cartilage 16.88 $70.00 $1,181.60
27334 Remove knee joint lining 19.71 $70.00 $1,379.70
27335 Remove knee joint lining 21.97 $70.00 $1,537.90
27337 Exc thigh/knee les sc 3 cm/> 12.06 $70.00 $844.20
27339 Exc thigh/knee tum dep 5cm/> 21.73 $70.00 $1,521.10
27340 Removal of kneecap bursa 10.68 $70.00 $747.60
27345 Removal of knee cyst 13.82 $70.00 $967.40
27347 Remove knee cyst 15.19 $70.00 $1,063.30
27350 Removal of kneecap 18.71 $70.00 $1,309.70
27355 Remove femur lesion 17.40 $70.00 $1,218.00
27356 Remove femur lesion/graft 21.24 $70.00 $1,486.80
27357 Remove femur lesion/graft 23.44 $70.00 $1,640.80
27358 Remove femur lesion/fixation 8.04 $70.00 $562.80
27360 Partial removal leg bone(s) 24.77 $70.00 $1,733.90
27364 Resect thigh/knee tum 5 cm/> 45.22 $70.00 $3,165.40
27365 Resect femur/knee tumor 59.63 $70.00 $4,174.10
27369 Njx cntrst kne arthg/ct/mri 4.06 $70.00 $284.20
27372 Removal of foreign body 17.07 $70.00 $1,194.90
27380 Repair of kneecap tendon 17.18 $70.00 $1,202.60
27381 Repair/graft kneecap tendon 23.03 $70.00 $1,612.10
27385 Repair of thigh muscle 16.61 $70.00 $1,162.70
27386 Repair/graft of thigh muscle 23.99 $70.00 $1,679.30
27390 Incision of thigh tendon 12.86 $70.00 $900.20
27391 Incision of thigh tendons 16.49 $70.00 $1,154.30
27392 Incision of thigh tendons 20.42 $70.00 $1,429.40
27393 Lengthening of thigh tendon 14.68 $70.00 $1,027.60
27394 Lengthening of thigh tendons 18.50 $70.00 $1,295.00
27395 Lengthening of thigh tendons 25.26 $70.00 $1,768.20
27396 Transplant of thigh tendon 17.64 $70.00 $1,234.80
27397 Transplants of thigh tendons 26.33 $70.00 $1,843.10
27400 Revise thigh muscles/tendons 19.83 $70.00 $1,388.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27403 Repair of knee cartilage 18.44 $70.00 $1,290.80
27405 Repair of knee ligament 19.45 $70.00 $1,361.50
27407 Repair of knee ligament 22.59 $70.00 $1,581.30
27409 Repair of knee ligaments 27.69 $70.00 $1,938.30
27412 Autochondrocyte implant knee 47.13 $70.00 $3,299.10
27415 Osteochondral knee allograft 38.97 $70.00 $2,727.90
27416 Osteochondral knee autograft 28.00 $70.00 $1,960.00
27418 Repair degenerated kneecap 23.85 $70.00 $1,669.50
27420 Revision of unstable kneecap 21.39 $70.00 $1,497.30
27422 Revision of unstable kneecap 21.39 $70.00 $1,497.30
27424 Revision/removal of kneecap 21.51 $70.00 $1,505.70
27425 Lat retinacular release open 12.93 $70.00 $905.10
27427 Reconstruction knee 20.49 $70.00 $1,434.30
27428 Reconstruction knee 32.09 $70.00 $2,246.30
27429 Reconstruction knee 36.07 $70.00 $2,524.90
27430 Revision of thigh muscles 21.28 $70.00 $1,489.60
27435 Incision of knee joint 23.27 $70.00 $1,628.90
27437 Revise kneecap 19.02 $70.00 $1,331.40
27438 Revise kneecap with implant 24.17 $70.00 $1,691.90
27440 Revision of knee joint 22.92 $70.00 $1,604.40
27441 Revision of knee joint 23.74 $70.00 $1,661.80
27442 Revision of knee joint 25.03 $70.00 $1,752.10
27443 Revision of knee joint 23.40 $70.00 $1,638.00
27445 Revision of knee joint 36.12 $70.00 $2,528.40
27446 Revision of knee joint 33.42 $70.00 $2,339.40
27447 Total knee arthroplasty 39.07 $70.00 $2,734.90
27448 Incision of thigh 22.37 $70.00 $1,565.90
27450 Incision of thigh 29.30 $70.00 $2,051.00
27454 Realignment of thigh bone 37.37 $70.00 $2,615.90
27455 Realignment of knee 26.99 $70.00 $1,889.30
27457 Realignment of knee 27.69 $70.00 $1,938.30
27465 Shortening of thigh bone 36.16 $70.00 $2,531.20
27466 Lengthening of thigh bone 34.04 $70.00 $2,382.80
27468 Shorten/lengthen thighs 38.81 $70.00 $2,716.70
27470 Repair of thigh 33.94 $70.00 $2,375.80
27472 Repair/graft of thigh 36.42 $70.00 $2,549.40
27475 Surgery to stop leg growth 19.09 $70.00 $1,336.30
27477 Surgery to stop leg growth 21.17 $70.00 $1,481.90
27479 Surgery to stop leg growth 26.57 $70.00 $1,859.90
27485 Surgery to stop leg growth 19.35 $70.00 $1,354.50
27486 Revise/replace knee joint 40.54 $70.00 $2,837.80
27487 Revise/replace knee joint 50.73 $70.00 $3,551.10
27488 Removal of knee prosthesis 34.64 $70.00 $2,424.80
27495 Reinforce thigh 32.51 $70.00 $2,275.70
27496 Decompression of thigh/knee 15.66 $70.00 $1,096.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27497 Decompression of thigh/knee 16.72 $70.00 $1,170.40
27498 Decompression of thigh/knee 18.84 $70.00 $1,318.80
27499 Decompression of thigh/knee 20.10 $70.00 $1,407.00
27500 Treatment of thigh fracture 14.92 $70.00 $1,044.40
27501 Treatment of thigh fracture 14.50 $70.00 $1,015.00
27502 Treatment of thigh fracture 21.85 $70.00 $1,529.50
27503 Treatment of thigh fracture 23.04 $70.00 $1,612.80
27506 Treatment of thigh fracture 38.60 $70.00 $2,702.00
27507 Treatment of thigh fracture 28.04 $70.00 $1,962.80
27508 Treatment of thigh fracture 15.01 $70.00 $1,050.70
27509 Treatment of thigh fracture 18.64 $70.00 $1,304.80
27510 Treatment of thigh fracture 19.64 $70.00 $1,374.80
27511 Treatment of thigh fracture 28.77 $70.00 $2,013.90
27513 Treatment of thigh fracture 35.81 $70.00 $2,506.70
27514 Treatment of thigh fracture 27.93 $70.00 $1,955.10
27516 Treat thigh fx growth plate 14.64 $70.00 $1,024.80
27517 Treat thigh fx growth plate 19.60 $70.00 $1,372.00
27519 Treat thigh fx growth plate 25.73 $70.00 $1,801.10
27520 Treat kneecap fracture 9.21 $70.00 $644.70
27524 Treat kneecap fracture 21.66 $70.00 $1,516.20
27530 Treat knee fracture 8.63 $70.00 $604.10
27532 Treat knee fracture 17.70 $70.00 $1,239.00
27535 Treat knee fracture 25.92 $70.00 $1,814.40
27536 Treat knee fracture 34.29 $70.00 $2,400.30
27538 Treat knee fracture(s) 13.68 $70.00 $957.60
27540 Treat knee fracture 23.44 $70.00 $1,640.80
27550 Treat knee dislocation 14.90 $70.00 $1,043.00
27552 Treat knee dislocation 18.05 $70.00 $1,263.50
27556 Treat knee dislocation 25.27 $70.00 $1,768.90
27557 Treat knee dislocation 30.09 $70.00 $2,106.30
27558 Treat knee dislocation 34.28 $70.00 $2,399.60
27560 Treat kneecap dislocation 10.50 $70.00 $735.00
27562 Treat kneecap dislocation 13.89 $70.00 $972.30
27566 Treat kneecap dislocation 25.68 $70.00 $1,797.60
27570 Fixation of knee joint 4.34 $70.00 $303.80
27580 Fusion of knee 41.58 $70.00 $2,910.60
27590 Amputate leg at thigh 22.95 $70.00 $1,606.50
27591 Amputate leg at thigh 27.81 $70.00 $1,946.70
27592 Amputate leg at thigh 19.65 $70.00 $1,375.50
27594 Amputation follow-up surgery 14.62 $70.00 $1,023.40
27596 Amputation follow-up surgery 20.73 $70.00 $1,451.10
27598 Amputate lower leg at knee 20.51 $70.00 $1,435.70
27599 Leg surgery procedure 0.00 $70.00 $0.00
27600 Decompression of lower leg 11.68 $70.00 $817.60
27601 Decompression of lower leg 12.82 $70.00 $897.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27602 Decompression of lower leg 13.96 $70.00 $977.20
27603 Drain lower leg lesion 15.25 $70.00 $1,067.50
27604 Drain lower leg bursa 13.65 $70.00 $955.50
27605 Incision of achilles tendon 9.88 $70.00 $691.60
27606 Incision of achilles tendon 8.01 $70.00 $560.70
27607 Treat lower leg bone lesion 17.55 $70.00 $1,228.50
27610 Explore/treat ankle joint 18.74 $70.00 $1,311.80
27612 Exploration of ankle joint 16.33 $70.00 $1,143.10
27613 Biopsy lower leg soft tissue 7.19 $70.00 $503.30
27614 Biopsy lower leg soft tissue 16.54 $70.00 $1,157.80
27615 Resect leg/ankle tum < 5 cm 29.57 $70.00 $2,069.90
27616 Resect leg/ankle tum 5 cm/> 36.69 $70.00 $2,568.30
27618 Exc leg/ankle tum < 3 cm 13.24 $70.00 $926.80
27619 Exc leg/ankle tum deep <5 cm 13.33 $70.00 $933.10
27620 Explore/treat ankle joint 13.00 $70.00 $910.00
27625 Remove ankle joint lining 16.42 $70.00 $1,149.40
27626 Remove ankle joint lining 17.52 $70.00 $1,226.40
27630 Removal of tendon lesion 15.95 $70.00 $1,116.50
27632 Exc leg/ankle les sc 3 cm/> 11.92 $70.00 $834.40
27634 Exc leg/ankle tum dep 5 cm/> 19.56 $70.00 $1,369.20
27635 Remove lower leg bone lesion 16.71 $70.00 $1,169.70
27637 Remove/graft leg bone lesion 21.47 $70.00 $1,502.90
27638 Remove/graft leg bone lesion 22.05 $70.00 $1,543.50
27640 Partial removal of tibia 23.97 $70.00 $1,677.90
27641 Partial removal of fibula 19.09 $70.00 $1,336.30
27645 Resect tibia tumor 51.34 $70.00 $3,593.80
27646 Resect fibula tumor 44.36 $70.00 $3,105.20
27647 Resect talus/calcaneus tum 29.34 $70.00 $2,053.80
27648 Injection for ankle x-ray 5.22 $70.00 $365.40
27650 Repair achilles tendon 18.90 $70.00 $1,323.00
27652 Repair/graft achilles tendon 19.37 $70.00 $1,355.90
27654 Repair of achilles tendon 20.41 $70.00 $1,428.70
27656 Repair leg fascia defect 18.22 $70.00 $1,275.40
27658 Repair of leg tendon each 10.69 $70.00 $748.30
27659 Repair of leg tendon each 13.59 $70.00 $951.30
27664 Repair of leg tendon each 10.40 $70.00 $728.00
27665 Repair of leg tendon each 11.92 $70.00 $834.40
27675 Repair lower leg tendons 14.11 $70.00 $987.70
27676 Repair lower leg tendons 17.27 $70.00 $1,208.90
27680 Release of lower leg tendon 12.20 $70.00 $854.00
27681 Release of lower leg tendons 15.78 $70.00 $1,104.60
27685 Revision of lower leg tendon 19.04 $70.00 $1,332.80
27686 Revise lower leg tendons 15.70 $70.00 $1,099.00
27687 Revision of calf tendon 13.07 $70.00 $914.90
27690 Revise lower leg tendon 18.38 $70.00 $1,286.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27691 Revise lower leg tendon 21.46 $70.00 $1,502.20
27692 Revise additional leg tendon 3.02 $70.00 $211.40
27695 Repair of ankle ligament 13.64 $70.00 $954.80
27696 Repair of ankle ligaments 15.94 $70.00 $1,115.80
27698 Repair of ankle ligament 18.34 $70.00 $1,283.80
27700 Revision of ankle joint 17.59 $70.00 $1,231.30
27702 Reconstruct ankle joint 27.71 $70.00 $1,939.70
27703 Reconstruction ankle joint 31.98 $70.00 $2,238.60
27704 Removal of ankle implant 16.51 $70.00 $1,155.70
27705 Incision of tibia 21.88 $70.00 $1,531.60
27707 Incision of fibula 11.51 $70.00 $805.70
27709 Incision of tibia & fibula 33.65 $70.00 $2,355.50
27712 Realignment of lower leg 31.63 $70.00 $2,214.10
27715 Revision of lower leg 30.88 $70.00 $2,161.60
27720 Repair of tibia 25.19 $70.00 $1,763.30
27722 Repair/graft of tibia 25.62 $70.00 $1,793.40
27724 Repair/graft of tibia 36.49 $70.00 $2,554.30
27725 Repair of lower leg 35.09 $70.00 $2,456.30
27726 Repair fibula nonunion 27.71 $70.00 $1,939.70
27727 Repair of lower leg 29.09 $70.00 $2,036.30
27730 Repair of tibia epiphysis 16.91 $70.00 $1,183.70
27732 Repair of fibula epiphysis 12.92 $70.00 $904.40
27734 Repair lower leg epiphyses 18.93 $70.00 $1,325.10
27740 Repair of leg epiphyses 20.43 $70.00 $1,430.10
27742 Repair of leg epiphyses 22.44 $70.00 $1,570.80
27745 Reinforce tibia 21.74 $70.00 $1,521.80
27750 Treatment of tibia fracture 9.87 $70.00 $690.90
27752 Treatment of tibia fracture 15.36 $70.00 $1,075.20
27756 Treatment of tibia fracture 16.61 $70.00 $1,162.70
27758 Treatment of tibia fracture 25.73 $70.00 $1,801.10
27759 Treatment of tibia fracture 28.82 $70.00 $2,017.40
27760 Cltx medial ankle fx 9.50 $70.00 $665.00
27762 Cltx med ankle fx w/mnpj 13.63 $70.00 $954.10
27766 Optx medial ankle fx 17.45 $70.00 $1,221.50
27767 Cltx post ankle fx 8.08 $70.00 $565.60
27768 Cltx post ankle fx w/mnpj 12.67 $70.00 $886.90
27769 Optx post ankle fx 21.02 $70.00 $1,471.40
27780 Treatment of fibula fracture 8.71 $70.00 $609.70
27781 Treatment of fibula fracture 12.30 $70.00 $861.00
27784 Treatment of fibula fracture 20.60 $70.00 $1,442.00
27786 Treatment of ankle fracture 8.97 $70.00 $627.90
27788 Treatment of ankle fracture 12.10 $70.00 $847.00
27792 Treatment of ankle fracture 18.69 $70.00 $1,308.30
27808 Treatment of ankle fracture 9.53 $70.00 $667.10
27810 Treatment of ankle fracture 13.39 $70.00 $937.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
27814 Treatment of ankle fracture 22.15 $70.00 $1,550.50
27816 Treatment of ankle fracture 9.27 $70.00 $648.90
27818 Treatment of ankle fracture 13.91 $70.00 $973.70
27822 Treatment of ankle fracture 24.72 $70.00 $1,730.40
27823 Treatment of ankle fracture 28.02 $70.00 $1,961.40
27824 Treat lower leg fracture 9.02 $70.00 $631.40
27825 Treat lower leg fracture 15.70 $70.00 $1,099.00
27826 Treat lower leg fracture 24.24 $70.00 $1,696.80
27827 Treat lower leg fracture 31.74 $70.00 $2,221.80
27828 Treat lower leg fracture 37.87 $70.00 $2,650.90
27829 Treat lower leg joint 20.00 $70.00 $1,400.00
27830 Treat lower leg dislocation 10.94 $70.00 $765.80
27831 Treat lower leg dislocation 11.58 $70.00 $810.60
27832 Treat lower leg dislocation 21.71 $70.00 $1,519.70
27840 Treat ankle dislocation 10.71 $70.00 $749.70
27842 Treat ankle dislocation 14.07 $70.00 $984.90
27846 Treat ankle dislocation 20.72 $70.00 $1,450.40
27848 Treat ankle dislocation 23.00 $70.00 $1,610.00
27860 Fixation of ankle joint 4.92 $70.00 $344.40
27870 Fusion of ankle joint open 29.56 $70.00 $2,069.20
27871 Fusion of tibiofibular joint 19.80 $70.00 $1,386.00
27880 Amputation of lower leg 26.30 $70.00 $1,841.00
27881 Amputation of lower leg 24.90 $70.00 $1,743.00
27882 Amputation of lower leg 17.20 $70.00 $1,204.00
27884 Amputation follow-up surgery 16.42 $70.00 $1,149.40
27886 Amputation follow-up surgery 18.89 $70.00 $1,322.30
27888 Amputation of foot at ankle 19.06 $70.00 $1,334.20
27889 Amputation of foot at ankle 18.64 $70.00 $1,304.80
27892 Decompression of leg 15.84 $70.00 $1,108.80
27893 Decompression of leg 17.55 $70.00 $1,228.50
27894 Decompression of leg 24.33 $70.00 $1,703.10
27899 Leg/ankle surgery procedure 0.00 $70.00 $0.00
28001 Drainage of bursa of foot 8.03 $70.00 $562.10
28002 Treatment of foot infection 12.79 $70.00 $895.30
28003 Treatment of foot infection 20.14 $70.00 $1,409.80
28005 Treat foot bone lesion 16.62 $70.00 $1,163.40
28008 Incision of foot fascia 12.51 $70.00 $875.70
28010 Incision of toe tendon 6.69 $70.00 $468.30
28011 Incision of toe tendons 9.14 $70.00 $639.80
28020 Exploration of foot joint 15.59 $70.00 $1,091.30
28022 Exploration of foot joint 14.05 $70.00 $983.50
28024 Exploration of toe joint 13.14 $70.00 $919.80
28035 Decompression of tibia nerve 15.29 $70.00 $1,070.30
28039 Exc foot/toe tum sc 1.5 cm/> 14.39 $70.00 $1,007.30
28041 Exc foot/toe tum dep 1.5cm/> 13.08 $70.00 $915.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
28043 Exc foot/toe tum sc < 1.5 cm 11.49 $70.00 $804.30
28045 Exc foot/toe tum deep <1.5cm 14.23 $70.00 $996.10
28046 Resect foot/toe tumor < 3 cm 20.82 $70.00 $1,457.40
28047 Resect foot/toe tumor 3 cm/> 30.18 $70.00 $2,112.60
28050 Biopsy of foot joint lining 12.25 $70.00 $857.50
28052 Biopsy of foot joint lining 12.80 $70.00 $896.00
28054 Biopsy of toe joint lining 10.84 $70.00 $758.80
28055 Neurectomy foot 11.00 $70.00 $770.00
28060 Partial removal foot fascia 15.03 $70.00 $1,052.10
28062 Removal of foot fascia 16.87 $70.00 $1,180.90
28070 Removal of foot joint lining 15.47 $70.00 $1,082.90
28072 Removal of foot joint lining 14.13 $70.00 $989.10
28080 Removal of foot lesion 15.19 $70.00 $1,063.30
28086 Excise foot tendon sheath 15.73 $70.00 $1,101.10
28088 Excise foot tendon sheath 13.04 $70.00 $912.80
28090 Removal of foot lesion 13.59 $70.00 $951.30
28092 Removal of toe lesions 12.32 $70.00 $862.40
28100 Removal of ankle/heel lesion 17.68 $70.00 $1,237.60
28102 Remove/graft foot lesion 17.43 $70.00 $1,220.10
28103 Remove/graft foot lesion 11.25 $70.00 $787.50
28104 Removal of foot lesion 15.41 $70.00 $1,078.70
28106 Remove/graft foot lesion 12.34 $70.00 $863.80
28107 Remove/graft foot lesion 14.88 $70.00 $1,041.60
28108 Removal of toe lesions 12.74 $70.00 $891.80
28110 Part removal of metatarsal 13.45 $70.00 $941.50
28111 Part removal of metatarsal 14.14 $70.00 $989.80
28112 Part removal of metatarsal 14.11 $70.00 $987.70
28113 Part removal of metatarsal 17.02 $70.00 $1,191.40
28114 Removal of metatarsal heads 30.74 $70.00 $2,151.80
28116 Revision of foot 22.06 $70.00 $1,544.20
28118 Removal of heel bone 17.28 $70.00 $1,209.60
28119 Removal of heel spur 15.13 $70.00 $1,059.10
28120 Part removal of ankle/heel 19.57 $70.00 $1,369.90
28122 Partial removal of foot bone 17.27 $70.00 $1,208.90
28124 Partial removal of toe 13.83 $70.00 $968.10
28126 Partial removal of toe 11.43 $70.00 $800.10
28130 Removal of ankle bone 18.36 $70.00 $1,285.20
28140 Removal of metatarsal 17.10 $70.00 $1,197.00
28150 Removal of toe 12.25 $70.00 $857.50
28153 Partial removal of toe 11.96 $70.00 $837.20
28160 Partial removal of toe 12.05 $70.00 $843.50
28171 Resect tarsal tumor 32.20 $70.00 $2,254.00
28173 Resect metatarsal tumor 21.31 $70.00 $1,491.70
28175 Resect phalanx of toe tumor 13.70 $70.00 $959.00
28190 Removal of foot foreign body 7.35 $70.00 $514.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
28192 Removal of foot foreign body 13.53 $70.00 $947.10
28193 Removal of foot foreign body 15.38 $70.00 $1,076.60
28200 Repair of foot tendon 14.27 $70.00 $998.90
28202 Repair/graft of foot tendon 17.51 $70.00 $1,225.70
28208 Repair of foot tendon 13.91 $70.00 $973.70
28210 Repair/graft of foot tendon 17.04 $70.00 $1,192.80
28220 Release of foot tendon 13.09 $70.00 $916.30
28222 Release of foot tendons 14.95 $70.00 $1,046.50
28225 Release of foot tendon 12.16 $70.00 $851.20
28226 Release of foot tendons 17.69 $70.00 $1,238.30
28230 Incision of foot tendon(s) 12.59 $70.00 $881.30
28232 Incision of toe tendon 11.19 $70.00 $783.30
28234 Incision of foot tendon 11.82 $70.00 $827.40
28238 Revision of foot tendon 19.34 $70.00 $1,353.80
28240 Release of big toe 13.20 $70.00 $924.00
28250 Revision of foot fascia 16.69 $70.00 $1,168.30
28260 Release of midfoot joint 19.84 $70.00 $1,388.80
28261 Revision of foot tendon 29.69 $70.00 $2,078.30
28262 Revision of foot and ankle 40.42 $70.00 $2,829.40
28264 Release of midfoot joint 29.10 $70.00 $2,037.00
28270 Release of foot contracture 14.27 $70.00 $998.90
28272 Release of toe joint each 11.34 $70.00 $793.80
28280 Fusion of toes 14.87 $70.00 $1,040.90
28285 Repair of hammertoe 15.50 $70.00 $1,085.00
28286 Repair of hammertoe 12.98 $70.00 $908.60
28288 Partial removal of foot bone 17.60 $70.00 $1,232.00
28289 Corrj halux rigdus w/o implt 21.06 $70.00 $1,474.20
28291 Corrj halux rigdus w/implt 21.01 $70.00 $1,470.70
28292 Correction hallux valgus 21.37 $70.00 $1,495.90
28295 Correction hallux valgus 27.60 $70.00 $1,932.00
28296 Correction hallux valgus 26.32 $70.00 $1,842.40
28297 Correction hallux valgus 30.27 $70.00 $2,118.90
28298 Correction hallux valgus 24.52 $70.00 $1,716.40
28299 Correction hallux valgus 29.19 $70.00 $2,043.30
28300 Incision of heel bone 18.72 $70.00 $1,310.40
28302 Incision of ankle bone 20.57 $70.00 $1,439.90
28304 Incision of midfoot bones 23.69 $70.00 $1,658.30
28305 Incise/graft midfoot bones 19.02 $70.00 $1,331.40
28306 Incision of metatarsal 17.68 $70.00 $1,237.60
28307 Incision of metatarsal 18.59 $70.00 $1,301.30
28308 Incision of metatarsal 16.44 $70.00 $1,150.80
28309 Incision of metatarsals 25.56 $70.00 $1,789.20
28310 Revision of big toe 15.74 $70.00 $1,101.80
28312 Revision of toe 14.54 $70.00 $1,017.80
28313 Repair deformity of toe 15.04 $70.00 $1,052.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
28315 Removal of sesamoid bone 13.93 $70.00 $975.10
28320 Repair of foot bones 17.56 $70.00 $1,229.20
28322 Repair of metatarsals 22.68 $70.00 $1,587.60
28340 Resect enlarged toe tissue 16.68 $70.00 $1,167.60
28341 Resect enlarged toe 19.34 $70.00 $1,353.80
28344 Repair extra toe(s) 12.34 $70.00 $863.80
28345 Repair webbed toe(s) 15.08 $70.00 $1,055.60
28360 Reconstruct cleft foot 31.42 $70.00 $2,199.40
28400 Treatment of heel fracture 7.09 $70.00 $496.30
28405 Treatment of heel fracture 11.23 $70.00 $786.10
28406 Treatment of heel fracture 15.16 $70.00 $1,061.20
28415 Treat heel fracture 32.16 $70.00 $2,251.20
28420 Treat/graft heel fracture 36.70 $70.00 $2,569.00
28430 Treatment of ankle fracture 6.81 $70.00 $476.70
28435 Treatment of ankle fracture 10.43 $70.00 $730.10
28436 Treatment of ankle fracture 12.99 $70.00 $909.30
28445 Treat ankle fracture 30.27 $70.00 $2,118.90
28446 Osteochondral talus autogrft 35.19 $70.00 $2,463.30
28450 Treat midfoot fracture each 6.09 $70.00 $426.30
28455 Treat midfoot fracture each 8.28 $70.00 $579.60
28456 Treat midfoot fracture 9.25 $70.00 $647.50
28465 Treat midfoot fracture each 18.17 $70.00 $1,271.90
28470 Treat metatarsal fracture 6.26 $70.00 $438.20
28475 Treat metatarsal fracture 7.35 $70.00 $514.50
28476 Treat metatarsal fracture 10.11 $70.00 $707.70
28485 Treat metatarsal fracture 15.66 $70.00 $1,096.20
28490 Treat big toe fracture 4.12 $70.00 $288.40
28495 Treat big toe fracture 5.13 $70.00 $359.10
28496 Treat big toe fracture 13.26 $70.00 $928.20
28505 Treat big toe fracture 19.17 $70.00 $1,341.90
28510 Treatment of toe fracture 3.51 $70.00 $245.70
28515 Treatment of toe fracture 4.67 $70.00 $326.90
28525 Treat toe fracture 16.45 $70.00 $1,151.50
28530 Treat sesamoid bone fracture 3.34 $70.00 $233.80
28531 Treat sesamoid bone fracture 9.85 $70.00 $689.50
28540 Treat foot dislocation 5.56 $70.00 $389.20
28545 Treat foot dislocation 8.58 $70.00 $600.60
28546 Treat foot dislocation 16.67 $70.00 $1,166.90
28555 Repair foot dislocation 24.90 $70.00 $1,743.00
28570 Treat foot dislocation 6.54 $70.00 $457.80
28575 Treat foot dislocation 10.58 $70.00 $740.60
28576 Treat foot dislocation 11.26 $70.00 $788.20
28585 Repair foot dislocation 25.04 $70.00 $1,752.80
28600 Treat foot dislocation 6.26 $70.00 $438.20
28605 Treat foot dislocation 9.50 $70.00 $665.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
28606 Treat foot dislocation 11.25 $70.00 $787.50
28615 Repair foot dislocation 23.29 $70.00 $1,630.30
28630 Treat toe dislocation 4.49 $70.00 $314.30
28635 Treat toe dislocation 5.08 $70.00 $355.60
28636 Treat toe dislocation 9.25 $70.00 $647.50
28645 Repair toe dislocation 18.97 $70.00 $1,327.90
28660 Treat toe dislocation 3.38 $70.00 $236.60
28665 Treat toe dislocation 4.45 $70.00 $311.50
28666 Treat toe dislocation 4.53 $70.00 $317.10
28675 Repair of toe dislocation 16.45 $70.00 $1,151.50
28705 Fusion of foot bones 35.54 $70.00 $2,487.80
28715 Fusion of foot bones 27.11 $70.00 $1,897.70
28725 Fusion of foot bones 22.46 $70.00 $1,572.20
28730 Fusion of foot bones 21.15 $70.00 $1,480.50
28735 Fusion of foot bones 22.45 $70.00 $1,571.50
28737 Revision of foot bones 20.03 $70.00 $1,402.10
28740 Fusion of foot bones 24.32 $70.00 $1,702.40
28750 Fusion of big toe joint 23.13 $70.00 $1,619.10
28755 Fusion of big toe joint 14.74 $70.00 $1,031.80
28760 Fusion of big toe joint 22.88 $70.00 $1,601.60
28800 Amputation of midfoot 15.39 $70.00 $1,077.30
28805 Amputation thru metatarsal 20.93 $70.00 $1,465.10
28810 Amputation toe & metatarsal 12.36 $70.00 $865.20
28820 Amputation of toe 16.18 $70.00 $1,132.60
28825 Partial amputation of toe 15.49 $70.00 $1,084.30
28890 Hi enrgy eswt plantar fascia 9.32 $70.00 $652.40
28899 Foot/toes surgery procedure 0.00 $70.00 $0.00
29000 Application of body cast 9.90 $70.00 $693.00
29010 Application of body cast 7.73 $70.00 $541.10
29015 Application of body cast 8.32 $70.00 $582.40
29035 Application of body cast 7.24 $70.00 $506.80
29040 Application of body cast 8.29 $70.00 $580.30
29044 Application of body cast 8.12 $70.00 $568.40
29046 Application of body cast 8.91 $70.00 $623.70
29049 Application of figure eight 2.82 $70.00 $197.40
29055 Application of shoulder cast 6.28 $70.00 $439.60
29058 Application of shoulder cast 3.51 $70.00 $245.70
29065 Application of long arm cast 2.72 $70.00 $190.40
29075 Application of forearm cast 2.46 $70.00 $172.20
29085 Apply hand/wrist cast 2.70 $70.00 $189.00
29086 Apply finger cast 2.24 $70.00 $156.80
29105 Apply long arm splint 2.33 $70.00 $163.10
29125 Apply forearm splint 1.83 $70.00 $128.10
29126 Apply forearm splint 2.18 $70.00 $152.60
29130 Application of finger splint 1.17 $70.00 $81.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
29131 Application of finger splint 1.46 $70.00 $102.20
29200 Strapping of chest 0.91 $70.00 $63.70
29240 Strapping of shoulder 0.87 $70.00 $60.90
29260 Strapping of elbow or wrist 0.85 $70.00 $59.50
29280 Strapping of hand or finger 0.87 $70.00 $60.90
29305 Application of hip cast 7.02 $70.00 $491.40
29325 Application of hip casts 7.75 $70.00 $542.50
29345 Application of long leg cast 3.85 $70.00 $269.50
29355 Application of long leg cast 4.03 $70.00 $282.10
29358 Apply long leg cast brace 4.54 $70.00 $317.80
29365 Application of long leg cast 3.49 $70.00 $244.30
29405 Apply short leg cast 2.30 $70.00 $161.00
29425 Apply short leg cast 2.20 $70.00 $154.00
29435 Apply short leg cast 3.35 $70.00 $234.50
29440 Addition of walker to cast 1.24 $70.00 $86.80
29445 Apply rigid leg cast 3.73 $70.00 $261.10
29450 Application of leg cast 4.15 $70.00 $290.50
29505 Application long leg splint 2.43 $70.00 $170.10
29515 Application lower leg splint 2.03 $70.00 $142.10
29520 Strapping of hip 0.97 $70.00 $67.90
29530 Strapping of knee 0.86 $70.00 $60.20
29540 Strapping of ankle and/or ft 0.82 $70.00 $57.40
29550 Strapping of toes 0.55 $70.00 $38.50
29580 Application of paste boot 1.78 $70.00 $124.60
29581 Apply multlay comprs lwr leg 2.47 $70.00 $172.90
29584 Appl multlay comprs arm/hand 2.29 $70.00 $160.30
29700 Removal/revision of cast 1.82 $70.00 $127.40
29705 Removal/revision of cast 1.85 $70.00 $129.50
29710 Removal/revision of cast 3.51 $70.00 $245.70
29720 Repair of body cast 2.41 $70.00 $168.70
29730 Windowing of cast 1.79 $70.00 $125.30
29740 Wedging of cast 2.82 $70.00 $197.40
29750 Wedging of clubfoot cast 3.07 $70.00 $214.90
29799 Casting/strapping procedure 0.00 $70.00 $0.00
29800 Jaw arthroscopy/surgery 15.21 $70.00 $1,064.70
29804 Jaw arthroscopy/surgery 18.43 $70.00 $1,290.10
29805 Shoulder arthroscopy dx 13.57 $70.00 $949.90
29806 Shoulder arthroscopy/surgery 30.56 $70.00 $2,139.20
29807 Shoulder arthroscopy/surgery 29.88 $70.00 $2,091.60
29819 Shoulder arthroscopy/surgery 16.88 $70.00 $1,181.60
29820 Shoulder arthroscopy/surgery 15.35 $70.00 $1,074.50
29821 Shoulder arthroscopy/surgery 16.84 $70.00 $1,178.80
29822 Shoulder arthroscopy/surgery 16.35 $70.00 $1,144.50
29823 Shoulder arthroscopy/surgery 17.78 $70.00 $1,244.60
29824 Shoulder arthroscopy/surgery 19.17 $70.00 $1,341.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
29825 Shoulder arthroscopy/surgery 16.60 $70.00 $1,162.00
29826 Shoulder arthroscopy/surgery 5.07 $70.00 $354.90
29827 Arthroscop rotator cuff repr 30.36 $70.00 $2,125.20
29828 Arthroscopy biceps tenodesis 26.15 $70.00 $1,830.50
29830 Elbow arthroscopy 13.08 $70.00 $915.60
29834 Elbow arthroscopy/surgery 13.97 $70.00 $977.90
29835 Elbow arthroscopy/surgery 14.48 $70.00 $1,013.60
29836 Elbow arthroscopy/surgery 16.45 $70.00 $1,151.50
29837 Elbow arthroscopy/surgery 15.09 $70.00 $1,056.30
29838 Elbow arthroscopy/surgery 16.93 $70.00 $1,185.10
29840 Wrist arthroscopy 12.94 $70.00 $905.80
29843 Wrist arthroscopy/surgery 13.90 $70.00 $973.00
29844 Wrist arthroscopy/surgery 14.28 $70.00 $999.60
29845 Wrist arthroscopy/surgery 16.60 $70.00 $1,162.00
29846 Wrist arthroscopy/surgery 14.97 $70.00 $1,047.90
29847 Wrist arthroscopy/surgery 15.41 $70.00 $1,078.70
29848 Wrist endoscopy/surgery 14.71 $70.00 $1,029.70
29850 Knee arthroscopy/surgery 17.93 $70.00 $1,255.10
29851 Knee arthroscopy/surgery 26.78 $70.00 $1,874.60
29855 Tibial arthroscopy/surgery 22.56 $70.00 $1,579.20
29856 Tibial arthroscopy/surgery 28.57 $70.00 $1,999.90
29860 Hip arthroscopy dx 19.04 $70.00 $1,332.80
29861 Hip arthro w/fb removal 20.63 $70.00 $1,444.10
29862 Hip arthr0 w/debridement 23.16 $70.00 $1,621.20
29863 Hip arthr0 w/synovectomy 23.20 $70.00 $1,624.00
29866 Autgrft implnt knee w/scope 30.33 $70.00 $2,123.10
29867 Allgrft implnt knee w/scope 36.74 $70.00 $2,571.80
29868 Meniscal trnspl knee w/scpe 48.40 $70.00 $3,388.00
29870 Knee arthroscopy dx 16.43 $70.00 $1,150.10
29871 Knee arthroscopy/drainage 14.82 $70.00 $1,037.40
29873 Knee arthroscopy/surgery 15.14 $70.00 $1,059.80
29874 Knee arthroscopy/surgery 15.44 $70.00 $1,080.80
29875 Knee arthroscopy/surgery 14.26 $70.00 $998.20
29876 Knee arthroscopy/surgery 18.91 $70.00 $1,323.70
29877 Knee arthroscopy/surgery 17.89 $70.00 $1,252.30
29879 Knee arthroscopy/surgery 19.06 $70.00 $1,334.20
29880 Knee arthroscopy/surgery 16.16 $70.00 $1,131.20
29881 Knee arthroscopy/surgery 15.57 $70.00 $1,089.90
29882 Knee arthroscopy/surgery 20.10 $70.00 $1,407.00
29883 Knee arthroscopy/surgery 24.37 $70.00 $1,705.90
29884 Knee arthroscopy/surgery 17.65 $70.00 $1,235.50
29885 Knee arthroscopy/surgery 21.42 $70.00 $1,499.40
29886 Knee arthroscopy/surgery 18.37 $70.00 $1,285.90
29887 Knee arthroscopy/surgery 21.51 $70.00 $1,505.70
29888 Knee arthroscopy/surgery 28.35 $70.00 $1,984.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
29889 Knee arthroscopy/surgery 35.26 $70.00 $2,468.20
29891 Ankle arthroscopy/surgery 19.33 $70.00 $1,353.10
29892 Ankle arthroscopy/surgery 18.85 $70.00 $1,319.50
29893 Scope plantar fasciotomy 17.89 $70.00 $1,252.30
29894 Ankle arthroscopy/surgery 14.21 $70.00 $994.70
29895 Ankle arthroscopy/surgery 13.48 $70.00 $943.60
29897 Ankle arthroscopy/surgery 14.48 $70.00 $1,013.60
29898 Ankle arthroscopy/surgery 16.18 $70.00 $1,132.60
29899 Ankle arthroscopy/surgery 29.80 $70.00 $2,086.00
29900 Mcp joint arthroscopy dx 14.32 $70.00 $1,002.40
29901 Mcp joint arthroscopy surg 15.30 $70.00 $1,071.00
29902 Mcp joint arthroscopy surg 16.37 $70.00 $1,145.90
29904 Subtalar arthro w/fb rmvl 18.18 $70.00 $1,272.60
29905 Subtalar arthro w/exc 14.92 $70.00 $1,044.40
29906 Subtalar arthro w/deb 19.50 $70.00 $1,365.00
29907 Subtalar arthro w/fusion 25.21 $70.00 $1,764.70
29914 Hip arthro w/femoroplasty 28.31 $70.00 $1,981.70
29915 Hip arthro acetabuloplasty 29.19 $70.00 $2,043.30
29916 Hip arthro w/labral repair 29.10 $70.00 $2,037.00
29999 Arthroscopy of joint 0.00 $70.00 $0.00
30000 Drainage of nose lesion 6.83 $70.00 $478.10
30020 Drainage of nose lesion 6.90 $70.00 $483.00
3006F Cxr doc rev 0.00 $70.00 $0.00
3008F Body mass index docd 0.00 $70.00 $0.00
30100 Intranasal biopsy 4.00 $70.00 $280.00
3011F Lipid panel doc rev 0.00 $70.00 $0.00
30110 Removal of nose polyp(s) 6.65 $70.00 $465.50
30115 Removal of nose polyp(s) 12.47 $70.00 $872.90
30117 Removal of intranasal lesion 25.65 $70.00 $1,795.50
30118 Removal of intranasal lesion 22.14 $70.00 $1,549.80
30120 Revision of nose 14.68 $70.00 $1,027.60
30124 Removal of nose lesion 8.19 $70.00 $573.30
30125 Removal of nose lesion 17.57 $70.00 $1,229.90
30130 Excise inferior turbinate 11.02 $70.00 $771.40
3014F Screen mammo doc rev 0.00 $70.00 $0.00
30140 Resect inferior turbinate 7.92 $70.00 $554.40
3015F Cerv cancer screen docd 0.00 $70.00 $0.00
30150 Partial removal of nose 22.07 $70.00 $1,544.90
3016F Pt scrnd unhlthy oh use 0.00 $70.00 $0.00
30160 Removal of nose 22.20 $70.00 $1,554.00
3017F Colorectal ca screen doc rev 0.00 $70.00 $0.00
3018F Pre-prxd rsk et al docd 0.00 $70.00 $0.00
3019F Lvef assess planpost dschrge 0.00 $70.00 $0.00
3020F Lvf assess 0.00 $70.00 $0.00
30200 Injection treatment of nose 3.18 $70.00 $222.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
3021F Lvef mod/sever deprs syst 0.00 $70.00 $0.00
30210 Nasal sinus therapy 4.25 $70.00 $297.50
3022F Lvef >/=40% systolic 0.00 $70.00 $0.00
30220 Insert nasal septal button 8.60 $70.00 $602.00
3023F Spirom doc rev 0.00 $70.00 $0.00
3025F Spirom fev/fvc <70% w/copd 0.00 $70.00 $0.00
3027F Spirom fev/fvc>/=70%/w/ocopd 0.00 $70.00 $0.00
3028F O2 saturation doc rev 0.00 $70.00 $0.00
30300 Remove nasal foreign body 5.26 $70.00 $368.20
30310 Remove nasal foreign body 5.77 $70.00 $403.90
30320 Remove nasal foreign body 13.03 $70.00 $912.10
3035F O2 saturation</=88%/pao</=55 0.00 $70.00 $0.00
3037F O2 saturation >88%/pao>55 hg 0.00 $70.00 $0.00
3038F Pulm fx w/in 12 mon b/4 surg 0.00 $70.00 $0.00
3040F Fev <40% predicted value 0.00 $70.00 $0.00
30400 Reconstruction of nose 30.98 $70.00 $2,168.60
30410 Reconstruction of nose 35.78 $70.00 $2,504.60
3042F Fev >/=40% predicted value 0.00 $70.00 $0.00
30420 Reconstruction of nose 39.42 $70.00 $2,759.40
30430 Revision of nose 27.24 $70.00 $1,906.80
30435 Revision of nose 33.79 $70.00 $2,365.30
3044F Hg a1c level lt 7.0% 0.00 $70.00 $0.00
3045F Hg a1c level 7.0-9.0% 0.00 $70.00 $0.00
30450 Revision of nose 44.91 $70.00 $3,143.70
3046F Hemoglobin a1c level >9.0% 0.00 $70.00 $0.00
30460 Revision of nose 23.51 $70.00 $1,645.70
30462 Revision of nose 45.19 $70.00 $3,163.30
30465 Repair nasal stenosis 28.13 $70.00 $1,969.10
3048F Ldl-c <100 mg/dl 0.00 $70.00 $0.00
3049F Ldl-c 100-129 mg/dl 0.00 $70.00 $0.00
3050F Ldl-c >/= 130 mg/dl 0.00 $70.00 $0.00
30520 Repair of nasal septum 18.04 $70.00 $1,262.80
30540 Repair nasal defect 19.85 $70.00 $1,389.50
30545 Repair nasal defect 27.14 $70.00 $1,899.80
3055F Lvef less than/equal to 35% 0.00 $70.00 $0.00
3056F Lvef greater than 35% 0.00 $70.00 $0.00
30560 Release of nasal adhesions 7.96 $70.00 $557.20
30580 Repair upper jaw fistula 18.33 $70.00 $1,283.10
3060F Pos microalbuminuria rev 0.00 $70.00 $0.00
30600 Repair mouth/nose fistula 16.20 $70.00 $1,134.00
3061F Neg microalbuminuria rev 0.00 $70.00 $0.00
3062F Pos macroalbuminuria rev 0.00 $70.00 $0.00
30620 Intranasal reconstruction 18.24 $70.00 $1,276.80
30630 Repair nasal septum defect 18.07 $70.00 $1,264.90
3066F Nephropathy doc tx 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
3072F Low risk for retinopathy 0.00 $70.00 $0.00
3073F Pre-surg eye measures docd 0.00 $70.00 $0.00
3074F Syst bp lt 130 mm hg 0.00 $70.00 $0.00
3075F Syst bp ge 130 - 139mm hg 0.00 $70.00 $0.00
3077F Syst bp >/= 140 mm hg 0.00 $70.00 $0.00
3078F Diast bp <80 mm hg 0.00 $70.00 $0.00
3079F Diast bp 80-89 mm hg 0.00 $70.00 $0.00
3080F Diast bp >/= 90 mm hg 0.00 $70.00 $0.00
30801 Ablate inf turbinate superf 6.32 $70.00 $442.40
30802 Ablate inf turbinate submuc 8.03 $70.00 $562.10
3082F Kt/v <1.2 0.00 $70.00 $0.00
3083F Kt/v =/> 1.2 & <1.7 0.00 $70.00 $0.00
3084F Kt/v >/= 1.7 0.00 $70.00 $0.00
3085F Suicide risk assessed 0.00 $70.00 $0.00
3088F Mdd mild 0.00 $70.00 $0.00
3089F Mdd moderate 0.00 $70.00 $0.00
3090F Mdd severe w/o psych 0.00 $70.00 $0.00
30901 Control of nosebleed 3.91 $70.00 $273.70
30903 Control of nosebleed 6.16 $70.00 $431.20
30905 Control of nosebleed 9.36 $70.00 $655.20
30906 Repeat control of nosebleed 9.79 $70.00 $685.30
3091F Mdd severe w/psych 0.00 $70.00 $0.00
30915 Ligation nasal sinus artery 16.53 $70.00 $1,157.10
3092F Mdd in remission 0.00 $70.00 $0.00
30920 Ligation upper jaw artery 24.03 $70.00 $1,682.10
3093F Doc new diag 1st/addl mdd 0.00 $70.00 $0.00
30930 Ther fx nasal inf turbinate 3.43 $70.00 $240.10
3095F Central dexa results docd 0.00 $70.00 $0.00
3096F Central dexa ordered 0.00 $70.00 $0.00
30999 Nasal surgery procedure 0.00 $70.00 $0.00
3100F Image test ref carot diam 0.00 $70.00 $0.00
31000 Irrigation maxillary sinus 5.17 $70.00 $361.90
31002 Irrigation sphenoid sinus 5.39 $70.00 $377.30
31020 Exploration maxillary sinus 13.69 $70.00 $958.30
31030 Exploration maxillary sinus 19.14 $70.00 $1,339.80
31032 Explore sinus remove polyps 16.52 $70.00 $1,156.40
31040 Exploration behind upper jaw 22.06 $70.00 $1,544.20
31050 Exploration sphenoid sinus 13.94 $70.00 $975.80
31051 Sphenoid sinus surgery 18.63 $70.00 $1,304.10
31070 Exploration of frontal sinus 12.67 $70.00 $886.90
31075 Exploration of frontal sinus 22.46 $70.00 $1,572.20
31080 Removal of frontal sinus 29.55 $70.00 $2,068.50
31081 Removal of frontal sinus 31.83 $70.00 $2,228.10
31084 Removal of frontal sinus 32.87 $70.00 $2,300.90
31085 Removal of frontal sinus 34.12 $70.00 $2,388.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
31086 Removal of frontal sinus 32.17 $70.00 $2,251.90
31087 Removal of frontal sinus 30.89 $70.00 $2,162.30
31090 Exploration of sinuses 29.68 $70.00 $2,077.60
3110F Pres/absn hmrhg/lesion docd 0.00 $70.00 $0.00
3111F Ct/mri brain done w/in 24hrs 0.00 $70.00 $0.00
3112F Ct/mri brain done 24 hrs 0.00 $70.00 $0.00
3115F Quant results activity &symp 0.00 $70.00 $0.00
3117F Hf assessment tool completed 0.00 $70.00 $0.00
3118F Ny heart assoc class docd 0.00 $70.00 $0.00
3119F No eval activity clin symp 0.00 $70.00 $0.00
3120F 12-lead ecg performed 0.00 $70.00 $0.00
31200 Removal of ethmoid sinus 16.74 $70.00 $1,171.80
31201 Removal of ethmoid sinus 21.48 $70.00 $1,503.60
31205 Removal of ethmoid sinus 26.11 $70.00 $1,827.70
31225 Removal of upper jaw 52.80 $70.00 $3,696.00
31230 Removal of upper jaw 58.35 $70.00 $4,084.50
31231 Nasal endoscopy dx 5.69 $70.00 $398.30
31233 Nasal/sinus endoscopy dx 7.41 $70.00 $518.70
31235 Nasal/sinus endoscopy dx 8.47 $70.00 $592.90
31237 Nasal/sinus endoscopy surg 7.26 $70.00 $508.20
31238 Nasal/sinus endoscopy surg 7.17 $70.00 $501.90
31239 Nasal/sinus endoscopy surg 17.57 $70.00 $1,229.90
31240 Nasal/sinus endoscopy surg 4.56 $70.00 $319.20
31241 Nsl/sins ndsc w/artery lig 12.84 $70.00 $898.80
31253 Nsl/sins ndsc total 14.44 $70.00 $1,010.80
31254 Nsl/sins ndsc w/prtl ethmdct 11.78 $70.00 $824.60
31255 Nsl/sins ndsc w/tot ethmdct 9.33 $70.00 $653.10
31256 Exploration maxillary sinus 5.19 $70.00 $363.30
31257 Nsl/sins ndsc tot w/sphendt 12.88 $70.00 $901.60
31259 Nsl/sins ndsc sphn tiss rmvl 13.64 $70.00 $954.80
3126F Esoph bx rprt w/dyspl info 0.00 $70.00 $0.00
31267 Endoscopy maxillary sinus 7.65 $70.00 $535.50
31276 Nsl/sins ndsc frnt tiss rmvl 10.92 $70.00 $764.40
31287 Nasal/sinus endoscopy surg 5.80 $70.00 $406.00
31288 Nasal/sinus endoscopy surg 6.75 $70.00 $472.50
31290 Nasal/sinus endoscopy surg 32.81 $70.00 $2,296.70
31291 Nasal/sinus endoscopy surg 34.95 $70.00 $2,446.50
31292 Nasal/sinus endoscopy surg 28.36 $70.00 $1,985.20
31293 Nasal/sinus endoscopy surg 30.81 $70.00 $2,156.70
31294 Nasal/sinus endoscopy surg 35.28 $70.00 $2,469.60
31295 Sinus endo w/balloon dil 55.63 $70.00 $3,894.10
31296 Sinus endo w/balloon dil 56.36 $70.00 $3,945.20
31297 Sinus endo w/balloon dil 55.23 $70.00 $3,866.10
31298 Nsl/sins ndsc w/sins dilat 106.61 $70.00 $7,462.70
31299 Sinus surgery procedure 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
3130F Upper gi endoscopy performed 0.00 $70.00 $0.00
31300 Removal of larynx lesion 36.62 $70.00 $2,563.40
3132F Doc ref upper gi endoscopy 0.00 $70.00 $0.00
31360 Removal of larynx 59.80 $70.00 $4,186.00
31365 Removal of larynx 73.82 $70.00 $5,167.40
31367 Partial removal of larynx 63.23 $70.00 $4,426.10
31368 Partial removal of larynx 70.23 $70.00 $4,916.10
31370 Partial removal of larynx 59.46 $70.00 $4,162.20
31375 Partial removal of larynx 56.34 $70.00 $3,943.80
31380 Partial removal of larynx 55.62 $70.00 $3,893.40
31382 Partial removal of larynx 61.02 $70.00 $4,271.40
31390 Removal of larynx & pharynx 81.90 $70.00 $5,733.00
31395 Reconstruct larynx & pharynx 86.42 $70.00 $6,049.40
3140F Upper gi endo shows barrtts 0.00 $70.00 $0.00
31400 Revision of larynx 28.12 $70.00 $1,968.40
3141F Upper gi endo not barrtts 0.00 $70.00 $0.00
3142F Barium swallow test ordered 0.00 $70.00 $0.00
31420 Removal of epiglottis 23.58 $70.00 $1,650.60
3150F Forceps esoph biopsy done 0.00 $70.00 $0.00
31500 Insert emergency airway 4.07 $70.00 $284.90
31502 Change of windpipe airway 1.01 $70.00 $70.70
31505 Diagnostic laryngoscopy 2.40 $70.00 $168.00
31510 Laryngoscopy with biopsy 6.01 $70.00 $420.70
31511 Remove foreign body larynx 6.01 $70.00 $420.70
31512 Removal of larynx lesion 5.92 $70.00 $414.40
31513 Injection into vocal cord 3.76 $70.00 $263.20
31515 Laryngoscopy for aspiration 5.79 $70.00 $405.30
31520 Dx laryngoscopy newborn 4.48 $70.00 $313.60
31525 Dx laryngoscopy excl nb 7.12 $70.00 $498.40
31526 Dx laryngoscopy w/oper scope 4.49 $70.00 $314.30
31527 Laryngoscopy for treatment 5.58 $70.00 $390.60
31528 Laryngoscopy and dilation 4.13 $70.00 $289.10
31529 Laryngoscopy and dilation 4.62 $70.00 $323.40
31530 Laryngoscopy w/fb removal 5.71 $70.00 $399.70
31531 Laryngoscopy w/fb & op scope 6.08 $70.00 $425.60
31535 Laryngoscopy w/biopsy 5.42 $70.00 $379.40
31536 Laryngoscopy w/bx & op scope 6.04 $70.00 $422.80
31540 Laryngoscopy w/exc of tumor 6.91 $70.00 $483.70
31541 Larynscop w/tumr exc + scope 7.55 $70.00 $528.50
31545 Remove vc lesion w/scope 10.39 $70.00 $727.30
31546 Remove vc lesion scope/graft 15.77 $70.00 $1,103.90
3155F Cytogen test marrow b/4 tx 0.00 $70.00 $0.00
31551 Laryngoplasty laryngeal sten 41.20 $70.00 $2,884.00
31552 Laryngoplasty laryngeal sten 41.47 $70.00 $2,902.90
31553 Laryngoplasty laryngeal sten 45.26 $70.00 $3,168.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
31554 Laryngoplasty laryngeal sten 47.36 $70.00 $3,315.20
31560 Laryngoscop w/arytenoidectom 8.97 $70.00 $627.90
31561 Larynscop remve cart + scop 9.82 $70.00 $687.40
31570 Laryngoscope w/vc inj 9.63 $70.00 $674.10
31571 Laryngoscop w/vc inj + scope 7.14 $70.00 $499.80
31572 Largsc w/laser dstrj les 14.41 $70.00 $1,008.70
31573 Largsc w/ther injection 7.61 $70.00 $532.70
31574 Largsc w/njx augmentation 28.79 $70.00 $2,015.30
31575 Diagnostic laryngoscopy 3.31 $70.00 $231.70
31576 Laryngoscopy with biopsy 7.54 $70.00 $527.80
31577 Largsc w/rmvl foreign bdy(s) 7.89 $70.00 $552.30
31578 Largsc w/removal lesion 8.59 $70.00 $601.30
31579 Laryngoscopy telescopic 5.23 $70.00 $366.10
31580 Laryngoplasty laryngeal web 35.78 $70.00 $2,504.60
31584 Laryngoplasty fx rdctj fixj 39.66 $70.00 $2,776.20
31587 Laryngoplasty cricoid split 33.19 $70.00 $2,323.30
31590 Reinnervate larynx 25.07 $70.00 $1,754.90
31591 Laryngoplasty medialization 30.08 $70.00 $2,105.60
31592 Cricotracheal resection 49.24 $70.00 $3,446.80
31599 Larynx surgery procedure 0.00 $70.00 $0.00
3160F Doc fe+ stores b/4 epo thx 0.00 $70.00 $0.00
31600 Incision of windpipe 8.91 $70.00 $623.70
31601 Incision of windpipe 12.98 $70.00 $908.60
31603 Incision of windpipe 9.31 $70.00 $651.70
31605 Incision of windpipe 9.61 $70.00 $672.70
31610 Incision of windpipe 27.24 $70.00 $1,906.80
31611 Surgery/speech prosthesis 15.22 $70.00 $1,065.40
31612 Puncture/clear windpipe 2.39 $70.00 $167.30
31613 Repair windpipe opening 12.67 $70.00 $886.90
31614 Repair windpipe opening 21.06 $70.00 $1,474.20
31615 Visualization of windpipe 4.83 $70.00 $338.10
31622 Dx bronchoscope/wash 6.84 $70.00 $478.80
31623 Dx bronchoscope/brush 7.51 $70.00 $525.70
31624 Dx bronchoscope/lavage 7.10 $70.00 $497.00
31625 Bronchoscopy w/biopsy(s) 9.59 $70.00 $671.30
31626 Bronchoscopy w/markers 23.94 $70.00 $1,675.80
31627 Navigational bronchoscopy 37.82 $70.00 $2,647.40
31628 Bronchoscopy/lung bx each 10.18 $70.00 $712.60
31629 Bronchoscopy/needle bx each 12.59 $70.00 $881.30
31630 Bronchoscopy dilate/fx repr 5.71 $70.00 $399.70
31631 Bronchoscopy dilate w/stent 6.58 $70.00 $460.60
31632 Bronchoscopy/lung bx addl 1.81 $70.00 $126.70
31633 Bronchoscopy/needle bx addl 2.27 $70.00 $158.90
31634 Bronch w/balloon occlusion 49.40 $70.00 $3,458.00
31635 Bronchoscopy w/fb removal 8.03 $70.00 $562.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
31636 Bronchoscopy bronch stents 6.35 $70.00 $444.50
31637 Bronchoscopy stent add-on 2.22 $70.00 $155.40
31638 Bronchoscopy revise stent 7.21 $70.00 $504.70
31640 Bronchoscopy w/tumor excise 7.22 $70.00 $505.40
31641 Bronchoscopy treat blockage 7.39 $70.00 $517.30
31643 Diag bronchoscope/catheter 5.09 $70.00 $356.30
31645 Brnchsc w/ther aspir 1st 7.42 $70.00 $519.40
31646 Brnchsc w/ther aspir sbsq 4.09 $70.00 $286.30
31647 Bronchial valve init insert 6.10 $70.00 $427.00
31648 Bronchial valve remov init 5.80 $70.00 $406.00
31649 Bronchial valve remov addl 1.94 $70.00 $135.80
31651 Bronchial valve addl insert 2.13 $70.00 $149.10
31652 Bronch ebus samplng 1/2 node 27.42 $70.00 $1,919.40
31653 Bronch ebus samplng 3/> node 28.73 $70.00 $2,011.10
31654 Bronch ebus ivntj perph les 3.53 $70.00 $247.10
31660 Bronch thermoplsty 1 lobe 5.62 $70.00 $393.40
31661 Bronch thermoplsty 2/> lobes 5.93 $70.00 $415.10
3170F Flow cyto done b/4 tx 0.00 $70.00 $0.00
31717 Bronchial brush biopsy 7.98 $70.00 $558.60
31720 Clearance of airways 1.43 $70.00 $100.10
31725 Clearance of airways 2.29 $70.00 $160.30
31730 Intro windpipe wire/tube 34.24 $70.00 $2,396.80
31750 Repair of windpipe 39.53 $70.00 $2,767.10
31755 Repair of windpipe 49.99 $70.00 $3,499.30
31760 Repair of windpipe 39.58 $70.00 $2,770.60
31766 Reconstruction of windpipe 51.48 $70.00 $3,603.60
31770 Repair/graft of bronchus 38.29 $70.00 $2,680.30
31775 Reconstruct bronchus 40.48 $70.00 $2,833.60
31780 Reconstruct windpipe 34.30 $70.00 $2,401.00
31781 Reconstruct windpipe 39.89 $70.00 $2,792.30
31785 Remove windpipe lesion 30.91 $70.00 $2,163.70
31786 Remove windpipe lesion 41.74 $70.00 $2,921.80
31800 Repair of windpipe injury 20.62 $70.00 $1,443.40
31805 Repair of windpipe injury 23.42 $70.00 $1,639.40
31820 Closure of windpipe lesion 12.37 $70.00 $865.90
31825 Repair of windpipe defect 17.16 $70.00 $1,201.20
31830 Revise windpipe scar 12.76 $70.00 $893.20
31899 Airways surgical procedure 0.00 $70.00 $0.00
3200F Barium swallow test not req 0.00 $70.00 $0.00
32035 Thoracostomy w/rib resection 20.81 $70.00 $1,456.70
32036 Thoracostomy w/flap drainage 22.39 $70.00 $1,567.30
32096 Open wedge/bx lung infiltr 23.20 $70.00 $1,624.00
32097 Open wedge/bx lung nodule 23.19 $70.00 $1,623.30
32098 Open biopsy of lung pleura 21.97 $70.00 $1,537.90
3210F Grp a strep test performed 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
32100 Exploration of chest 23.39 $70.00 $1,637.30
32110 Explore/repair chest 42.44 $70.00 $2,970.80
32120 Re-exploration of chest 25.17 $70.00 $1,761.90
32124 Explore chest free adhesions 26.71 $70.00 $1,869.70
32140 Removal of lung lesion(s) 28.56 $70.00 $1,999.20
32141 Remove/treat lung lesions 44.05 $70.00 $3,083.50
3215F Pt immunity to hep a docd 0.00 $70.00 $0.00
32150 Removal of lung lesion(s) 28.98 $70.00 $2,028.60
32151 Remove lung foreign body 28.84 $70.00 $2,018.80
3216F Pt immunity to hep b docd 0.00 $70.00 $0.00
32160 Open chest heart massage 22.95 $70.00 $1,606.50
3218F Rna tstng hep c docd done 0.00 $70.00 $0.00
3220F Hep c quant rna tstng docd 0.00 $70.00 $0.00
32200 Drain open lung lesion 32.74 $70.00 $2,291.80
32215 Treat chest lining 22.94 $70.00 $1,605.80
32220 Release of lung 45.79 $70.00 $3,205.30
32225 Partial release of lung 28.68 $70.00 $2,007.60
3230F Note hring tst w/in 6 mon 0.00 $70.00 $0.00
32310 Removal of chest lining 26.33 $70.00 $1,843.10
32320 Free/remove chest lining 46.13 $70.00 $3,229.10
32400 Needle biopsy chest lining 4.41 $70.00 $308.70
32405 Percut bx lung/mediastinum 11.15 $70.00 $780.50
32440 Remove lung pneumonectomy 45.17 $70.00 $3,161.90
32442 Sleeve pneumonectomy 88.90 $70.00 $6,223.00
32445 Removal of lung extrapleural 102.35 $70.00 $7,164.50
32480 Partial removal of lung 42.67 $70.00 $2,986.90
32482 Bilobectomy 45.63 $70.00 $3,194.10
32484 Segmentectomy 41.35 $70.00 $2,894.50
32486 Sleeve lobectomy 68.13 $70.00 $4,769.10
32488 Completion pneumonectomy 69.11 $70.00 $4,837.70
32491 Lung volume reduction 42.49 $70.00 $2,974.30
3250F Nonprim loc anat bx site tum 0.00 $70.00 $0.00
32501 Repair bronchus add-on 7.07 $70.00 $494.90
32503 Resect apical lung tumor 51.92 $70.00 $3,634.40
32504 Resect apical lung tum/chest 59.24 $70.00 $4,146.80
32505 Wedge resect of lung initial 26.88 $70.00 $1,881.60
32506 Wedge resect of lung add-on 4.53 $70.00 $317.10
32507 Wedge resect of lung diag 4.52 $70.00 $316.40
32540 Removal of lung lesion 49.69 $70.00 $3,478.30
32550 Insert pleural cath 21.29 $70.00 $1,490.30
32551 Insertion of chest tube 4.53 $70.00 $317.10
32552 Remove lung catheter 5.26 $70.00 $368.20
32553 Ins mark thor for rt perq 14.89 $70.00 $1,042.30
32554 Aspirate pleura w/o imaging 6.01 $70.00 $420.70
32555 Aspirate pleura w/ imaging 8.51 $70.00 $595.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
32556 Insert cath pleura w/o image 17.41 $70.00 $1,218.70
32557 Insert cath pleura w/ image 16.05 $70.00 $1,123.50
32560 Treat pleurodesis w/agent 7.17 $70.00 $501.90
32561 Lyse chest fibrin init day 2.66 $70.00 $186.20
32562 Lyse chest fibrin subq day 2.38 $70.00 $166.60
3260F Pt cat/pn cat/hist grd docd 0.00 $70.00 $0.00
32601 Thoracoscopy diagnostic 8.90 $70.00 $623.00
32604 Thoracoscopy wbx sac 13.90 $70.00 $973.00
32606 Thoracoscopy w/bx med space 13.35 $70.00 $934.50
32607 Thoracoscopy w/bx infiltrate 8.89 $70.00 $622.30
32608 Thoracoscopy w/bx nodule 10.91 $70.00 $763.70
32609 Thoracoscopy w/bx pleura 7.45 $70.00 $521.50
3265F Rna tstng hepc vir ord/docd 0.00 $70.00 $0.00
32650 Thoracoscopy w/pleurodesis 19.19 $70.00 $1,343.30
32651 Thoracoscopy remove cortex 31.60 $70.00 $2,212.00
32652 Thoracoscopy rem totl cortex 47.97 $70.00 $3,357.90
32653 Thoracoscopy remov fb/fibrin 30.61 $70.00 $2,142.70
32654 Thoracoscopy contrl bleeding 33.29 $70.00 $2,330.30
32655 Thoracoscopy resect bullae 27.57 $70.00 $1,929.90
32656 Thoracoscopy w/pleurectomy 23.09 $70.00 $1,616.30
32658 Thoracoscopy w/sac fb remove 20.54 $70.00 $1,437.80
32659 Thoracoscopy w/sac drainage 21.10 $70.00 $1,477.00
3266F Hepc gn tstng docd b/4txmnt 0.00 $70.00 $0.00
32661 Thoracoscopy w/pericard exc 22.91 $70.00 $1,603.70
32662 Thoracoscopy w/mediast exc 25.75 $70.00 $1,802.50
32663 Thoracoscopy w/lobectomy 40.42 $70.00 $2,829.40
32664 Thoracoscopy w/ th nrv exc 24.45 $70.00 $1,711.50
32665 Thoracoscop w/esoph musc exc 35.29 $70.00 $2,470.30
32666 Thoracoscopy w/wedge resect 25.11 $70.00 $1,757.70
32667 Thoracoscopy w/w resect addl 4.54 $70.00 $317.80
32668 Thoracoscopy w/w resect diag 4.54 $70.00 $317.80
32669 Thoracoscopy remove segment 38.79 $70.00 $2,715.30
3267F Path rprt w/ pt pn cat et al 0.00 $70.00 $0.00
32670 Thoracoscopy bilobectomy 46.28 $70.00 $3,239.60
32671 Thoracoscopy pneumonectomy 51.10 $70.00 $3,577.00
32672 Thoracoscopy for lvrs 44.09 $70.00 $3,086.30
32673 Thoracoscopy w/thymus resect 35.02 $70.00 $2,451.40
32674 Thoracoscopy lymph node exc 6.24 $70.00 $436.80
3268F Psa/t/glsc docd b/4 txmnt 0.00 $70.00 $0.00
3269F Bone scn b/4 txmnt/aftr dx 0.00 $70.00 $0.00
3270F No bone scn b/4 txmnt/aftrdx 0.00 $70.00 $0.00
32701 Thorax stereo rad targetw/tx 6.21 $70.00 $434.70
3271F Low risk prostate cancer 0.00 $70.00 $0.00
3272F Med risk prostate cancer 0.00 $70.00 $0.00
3273F High risk prostate cancer 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
3274F Prost cncr rsk not lw/md/hgh 0.00 $70.00 $0.00
3278F Serum lvls ca/ipth/lpd ord 0.00 $70.00 $0.00
3279F Hgb lvl >/= 13 g/dl 0.00 $70.00 $0.00
3280F Hgb lvl 11-12.9 g/dl 0.00 $70.00 $0.00
32800 Repair lung hernia 27.05 $70.00 $1,893.50
3281F Hgb lvl <11 g/dl 0.00 $70.00 $0.00
32810 Close chest after drainage 25.91 $70.00 $1,813.70
32815 Close bronchial fistula 81.05 $70.00 $5,673.50
32820 Reconstruct injured chest 38.38 $70.00 $2,686.60
3284F Iop down >15% of pre-svc lvl 0.00 $70.00 $0.00
3285F Iop down <15% of pre-svc lvl 0.00 $70.00 $0.00
32850 Donor pneumonectomy 0.00 $70.00 $0.00
32851 Lung transplant single 95.35 $70.00 $6,674.50
32852 Lung transplant with bypass 103.66 $70.00 $7,256.20
32853 Lung transplant double 133.52 $70.00 $9,346.40
32854 Lung transplant with bypass 141.71 $70.00 $9,919.70
32855 Prepare donor lung single 0.00 $70.00 $0.00
32856 Prepare donor lung double 0.00 $70.00 $0.00
3288F Fall risk assessment docd 0.00 $70.00 $0.00
3290F Pt=d(rh)- and unsensitized 0.00 $70.00 $0.00
32900 Removal of rib(s) 40.88 $70.00 $2,861.60
32905 Revise & repair chest wall 38.27 $70.00 $2,678.90
32906 Revise & repair chest wall 47.59 $70.00 $3,331.30
3291F Pt=d(rh)+ or sensitized 0.00 $70.00 $0.00
3292F Hiv tstng asked/docd/revwd 0.00 $70.00 $0.00
3293F Abo rh blood typing docd 0.00 $70.00 $0.00
3294F Grp b strep screening docd 0.00 $70.00 $0.00
32940 Revision of lung 35.42 $70.00 $2,479.40
32960 Therapeutic pneumothorax 3.61 $70.00 $252.70
32994 Ablate pulm tumor perq crybl 159.51 $70.00 $11,165.70
32997 Total lung lavage 9.84 $70.00 $688.80
32998 Ablate pulm tumor perq rf 100.62 $70.00 $7,043.40
32999 Chest surgery procedure 0.00 $70.00 $0.00
3300F Ajcc stage docd b/4 thxpy 0.00 $70.00 $0.00
3301F Cancer stage docd metast 0.00 $70.00 $0.00
33010 Drainage of heart sac 3.11 $70.00 $217.70
33011 Repeat drainage of heart sac 3.13 $70.00 $219.10
33015 Incision of heart sac 14.77 $70.00 $1,033.90
33020 Incision of heart sac 25.38 $70.00 $1,776.60
33025 Incision of heart sac 23.02 $70.00 $1,611.40
33030 Partial removal of heart sac 57.85 $70.00 $4,049.50
33031 Partial removal of heart sac 71.57 $70.00 $5,009.90
33050 Resect heart sac lesion 28.98 $70.00 $2,028.60
33120 Removal of heart lesion 60.67 $70.00 $4,246.90
33130 Removal of heart lesion 39.67 $70.00 $2,776.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33140 Heart revascularize (tmr) 45.17 $70.00 $3,161.90
33141 Heart tmr w/other procedure 3.80 $70.00 $266.00
3315F Er+ or pr+ breast cancer 0.00 $70.00 $0.00
3316F Er- or pr- breast cancer 0.00 $70.00 $0.00
3317F Path rpt malig cancer docd 0.00 $70.00 $0.00
3318F Path rpt malig cancer docd 0.00 $70.00 $0.00
3319F X-ray/ct/ultrsnd et al ord 0.00 $70.00 $0.00
3320F No xray/ct/ et al ordd 0.00 $70.00 $0.00
33202 Insert epicard eltrd open 22.38 $70.00 $1,566.60
33203 Insert epicard eltrd endo 23.44 $70.00 $1,640.80
33206 Insert heart pm atrial 13.15 $70.00 $920.50
33207 Insert heart pm ventricular 13.97 $70.00 $977.90
33208 Insrt heart pm atrial & vent 15.15 $70.00 $1,060.50
3321F Ajcc cncr 0/ia melan docd 0.00 $70.00 $0.00
33210 Insert electrd/pm cath sngl 4.76 $70.00 $333.20
33211 Insert card electrodes dual 4.95 $70.00 $346.50
33212 Insert pulse gen sngl lead 9.31 $70.00 $651.70
33213 Insert pulse gen dual leads 9.74 $70.00 $681.80
33214 Upgrade of pacemaker system 13.90 $70.00 $973.00
33215 Reposition pacing-defib lead 9.02 $70.00 $631.40
33216 Insert 1 electrode pm-defib 10.76 $70.00 $753.20
33217 Insert 2 electrode pm-defib 10.60 $70.00 $742.00
33218 Repair lead pace-defib one 11.25 $70.00 $787.50
3322F Melanomaajcc stage 0 or ia 0.00 $70.00 $0.00
33220 Repair lead pace-defib dual 11.33 $70.00 $793.10
33221 Insert pulse gen mult leads 10.44 $70.00 $730.80
33222 Relocation pocket pacemaker 9.81 $70.00 $686.70
33223 Relocate pocket for defib 11.87 $70.00 $830.90
33224 Insert pacing lead & connect 15.02 $70.00 $1,051.40
33225 L ventric pacing lead add-on 13.67 $70.00 $956.90
33226 Reposition l ventric lead 14.45 $70.00 $1,011.50
33227 Remove&replace pm gen singl 9.82 $70.00 $687.40
33228 Remv&replc pm gen dual lead 10.26 $70.00 $718.20
33229 Remv&replc pm gen mult leads 10.87 $70.00 $760.90
3323F Clin node stgng docdb/4 surg 0.00 $70.00 $0.00
33230 Insrt pulse gen w/dual leads 11.09 $70.00 $776.30
33231 Insrt pulse gen w/mult leads 11.65 $70.00 $815.50
33233 Removal of pm generator 6.68 $70.00 $467.60
33234 Removal of pacemaker system 14.10 $70.00 $987.00
33235 Removal pacemaker electrode 18.52 $70.00 $1,296.40
33236 Remove electrode/thoracotomy 22.41 $70.00 $1,568.70
33237 Remove electrode/thoracotomy 24.19 $70.00 $1,693.30
33238 Remove electrode/thoracotomy 27.09 $70.00 $1,896.30
3324F Mri ct scan ord rvwd rqstd 0.00 $70.00 $0.00
33240 Insrt pulse gen w/singl lead 10.61 $70.00 $742.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33241 Remove pulse generator 6.24 $70.00 $436.80
33243 Remove eltrd/thoracotomy 39.69 $70.00 $2,778.30
33244 Remove elctrd transvenously 25.09 $70.00 $1,756.30
33249 Insj/rplcmt defib w/lead(s) 26.67 $70.00 $1,866.90
3325F Preop asses 4 cataract surg 0.00 $70.00 $0.00
33250 Ablate heart dysrhythm focus 41.79 $70.00 $2,925.30
33251 Ablate heart dysrhythm focus 46.93 $70.00 $3,285.10
33254 Ablate atria lmtd 39.14 $70.00 $2,739.80
33255 Ablate atria w/o bypass ext 47.32 $70.00 $3,312.40
33256 Ablate atria w/bypass exten 56.19 $70.00 $3,933.30
33257 Ablate atria lmtd add-on 16.81 $70.00 $1,176.70
33258 Ablate atria x10sv add-on 18.86 $70.00 $1,320.20
33259 Ablate atria w/bypass add-on 24.41 $70.00 $1,708.70
33261 Ablate heart dysrhythm focus 46.76 $70.00 $3,273.20
33262 Rmvl& replc pulse gen 1 lead 10.82 $70.00 $757.40
33263 Rmvl & rplcmt dfb gen 2 lead 11.27 $70.00 $788.90
33264 Rmvl & rplcmt dfb gen mlt ld 11.76 $70.00 $823.20
33265 Ablate atria lmtd endo 39.30 $70.00 $2,751.00
33266 Ablate atria x10sv endo 53.47 $70.00 $3,742.90
33270 Ins/rep subq defibrillator 16.47 $70.00 $1,152.90
33271 Insj subq impltbl dfb elctrd 13.25 $70.00 $927.50
33272 Rmvl of subq defibrillator 10.08 $70.00 $705.60
33273 Repos prev impltbl subq dfb 11.68 $70.00 $817.60
33274 Tcat insj/rpl perm ldls pm 14.21 $70.00 $994.70
33275 Tcat rmvl perm ldls pm 15.10 $70.00 $1,057.00
3328F Prfrmnc docd 2 wks b/4 surg 0.00 $70.00 $0.00
33285 Insj subq car rhythm mntr 146.07 $70.00 $10,224.90
33286 Rmvl subq car rhythm mntr 3.80 $70.00 $266.00
33289 Tcat impl wrls p-art prs snr 9.51 $70.00 $665.70
3330F Imaging study ordered (bkp) 0.00 $70.00 $0.00
33300 Repair of heart wound 71.02 $70.00 $4,971.40
33305 Repair of heart wound 119.07 $70.00 $8,334.90
3331F Bk imaging tst not ordered 0.00 $70.00 $0.00
33310 Exploratory heart surgery 33.91 $70.00 $2,373.70
33315 Exploratory heart surgery 55.36 $70.00 $3,875.20
33320 Repair major blood vessel(s) 30.54 $70.00 $2,137.80
33321 Repair major vessel 33.97 $70.00 $2,377.90
33322 Repair major blood vessel(s) 40.02 $70.00 $2,801.40
33330 Insert major vessel graft 41.34 $70.00 $2,893.80
33335 Insert major vessel graft 54.61 $70.00 $3,822.70
33340 Perq clsr tcat l atr apndge 23.01 $70.00 $1,610.70
33361 Replace aortic valve perq 39.48 $70.00 $2,763.60
33362 Replace aortic valve open 43.10 $70.00 $3,017.00
33363 Replace aortic valve open 44.64 $70.00 $3,124.80
33364 Replace aortic valve open 46.14 $70.00 $3,229.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33365 Replace aortic valve open 51.83 $70.00 $3,628.10
33366 Trcath replace aortic valve 56.03 $70.00 $3,922.10
33367 Replace aortic valve w/byp 18.29 $70.00 $1,280.30
33368 Replace aortic valve w/byp 21.72 $70.00 $1,520.40
33369 Replace aortic valve w/byp 28.67 $70.00 $2,006.90
33390 Valvuloplasty aortic valve 55.88 $70.00 $3,911.60
33391 Valvuloplasty aortic valve 66.13 $70.00 $4,629.10
3340F Mammo assess inc xray docd 0.00 $70.00 $0.00
33404 Prepare heart-aorta conduit 51.00 $70.00 $3,570.00
33405 Replacement aortic valve opn 65.69 $70.00 $4,598.30
33406 Replacement aortic valve opn 83.20 $70.00 $5,824.00
3341F Mammo assess negative docd 0.00 $70.00 $0.00
33410 Replacement aortic valve opn 73.65 $70.00 $5,155.50
33411 Replacement of aortic valve 97.34 $70.00 $6,813.80
33412 Replacement of aortic valve 91.08 $70.00 $6,375.60
33413 Replacement of aortic valve 92.76 $70.00 $6,493.20
33414 Repair of aortic valve 62.02 $70.00 $4,341.40
33415 Revision subvalvular tissue 58.78 $70.00 $4,114.60
33416 Revise ventricle muscle 58.60 $70.00 $4,102.00
33417 Repair of aortic valve 48.16 $70.00 $3,371.20
33418 Repair tcat mitral valve 52.39 $70.00 $3,667.30
33419 Repair tcat mitral valve 12.37 $70.00 $865.90
3342F Mammo assess bengn docd 0.00 $70.00 $0.00
33420 Revision of mitral valve 42.30 $70.00 $2,961.00
33422 Revision of mitral valve 48.00 $70.00 $3,360.00
33425 Repair of mitral valve 79.04 $70.00 $5,532.80
33426 Repair of mitral valve 68.97 $70.00 $4,827.90
33427 Repair of mitral valve 70.80 $70.00 $4,956.00
3343F Mammo probably bengn docd 0.00 $70.00 $0.00
33430 Replacement of mitral valve 81.06 $70.00 $5,674.20
3344F Mammo assess susp docd 0.00 $70.00 $0.00
33440 Rplcmt a-valve tlcj autol pv 98.10 $70.00 $6,867.00
3345F Mammo assess hghlymalig doc 0.00 $70.00 $0.00
33460 Revision of tricuspid valve 69.47 $70.00 $4,862.90
33463 Valvuloplasty tricuspid 89.51 $70.00 $6,265.70
33464 Valvuloplasty tricuspid 70.71 $70.00 $4,949.70
33465 Replace tricuspid valve 79.91 $70.00 $5,593.70
33468 Revision of tricuspid valve 69.89 $70.00 $4,892.30
33470 Revision of pulmonary valve 35.90 $70.00 $2,513.00
33471 Valvotomy pulmonary valve 38.39 $70.00 $2,687.30
33474 Revision of pulmonary valve 63.29 $70.00 $4,430.30
33475 Replacement pulmonary valve 67.60 $70.00 $4,732.00
33476 Revision of heart chamber 43.21 $70.00 $3,024.70
33477 Implant tcat pulm vlv perq 39.72 $70.00 $2,780.40
33478 Revision of heart chamber 45.36 $70.00 $3,175.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33496 Repair prosth valve clot 48.26 $70.00 $3,378.20
3350F Mammo bx proven malig docd 0.00 $70.00 $0.00
33500 Repair heart vessel fistula 45.07 $70.00 $3,154.90
33501 Repair heart vessel fistula 32.30 $70.00 $2,261.00
33502 Coronary artery correction 36.66 $70.00 $2,566.20
33503 Coronary artery graft 38.44 $70.00 $2,690.80
33504 Coronary artery graft 41.94 $70.00 $2,935.80
33505 Repair artery w/tunnel 58.46 $70.00 $4,092.20
33506 Repair artery translocation 57.80 $70.00 $4,046.00
33507 Repair art intramural 49.71 $70.00 $3,479.70
33508 Endoscopic vein harvest 0.47 $70.00 $32.90
3351F Neg scrn dep symp by deptool 0.00 $70.00 $0.00
33510 Cabg vein single 55.95 $70.00 $3,916.50
33511 Cabg vein two 61.45 $70.00 $4,301.50
33512 Cabg vein three 69.97 $70.00 $4,897.90
33513 Cabg vein four 72.06 $70.00 $5,044.20
33514 Cabg vein five 75.77 $70.00 $5,303.90
33516 Cabg vein six or more 78.13 $70.00 $5,469.10
33517 Cabg artery-vein single 5.41 $70.00 $378.70
33518 Cabg artery-vein two 11.93 $70.00 $835.10
33519 Cabg artery-vein three 15.78 $70.00 $1,104.60
3352F No sig dep symp by dep tool 0.00 $70.00 $0.00
33521 Cabg artery-vein four 18.93 $70.00 $1,325.10
33522 Cabg artery-vein five 21.26 $70.00 $1,488.20
33523 Cabg art-vein six or more 24.00 $70.00 $1,680.00
3353F Mild-mod dep symp by deptool 0.00 $70.00 $0.00
33530 Coronary artery bypass/reop 15.25 $70.00 $1,067.50
33533 Cabg arterial single 54.09 $70.00 $3,786.30
33534 Cabg arterial two 63.62 $70.00 $4,453.40
33535 Cabg arterial three 70.98 $70.00 $4,968.60
33536 Cabg arterial four or more 76.11 $70.00 $5,327.70
3354F Clin sig dep sym by dep tool 0.00 $70.00 $0.00
33542 Removal of heart lesion 76.20 $70.00 $5,334.00
33545 Repair of heart damage 89.33 $70.00 $6,253.10
33548 Restore/remodel ventricle 85.74 $70.00 $6,001.80
33572 Open coronary endarterectomy 6.67 $70.00 $466.90
33600 Closure of valve 49.33 $70.00 $3,453.10
33602 Closure of valve 47.86 $70.00 $3,350.20
33606 Anastomosis/artery-aorta 51.60 $70.00 $3,612.00
33608 Repair anomaly w/conduit 52.26 $70.00 $3,658.20
33610 Repair by enlargement 51.53 $70.00 $3,607.10
33611 Repair double ventricle 56.71 $70.00 $3,969.70
33612 Repair double ventricle 58.23 $70.00 $4,076.10
33615 Repair modified fontan 58.00 $70.00 $4,060.00
33617 Repair single ventricle 61.22 $70.00 $4,285.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33619 Repair single ventricle 79.37 $70.00 $5,555.90
33620 Apply r&l pulm art bands 47.71 $70.00 $3,339.70
33621 Transthor cath for stent 27.00 $70.00 $1,890.00
33622 Redo compl cardiac anomaly 100.01 $70.00 $7,000.70
33641 Repair heart septum defect 47.38 $70.00 $3,316.60
33645 Revision of heart veins 49.89 $70.00 $3,492.30
33647 Repair heart septum defects 52.15 $70.00 $3,650.50
33660 Repair of heart defects 50.58 $70.00 $3,540.60
33665 Repair of heart defects 55.62 $70.00 $3,893.40
33670 Repair of heart chambers 57.40 $70.00 $4,018.00
33675 Close mult vsd 56.34 $70.00 $3,943.80
33676 Close mult vsd w/resection 58.84 $70.00 $4,118.80
33677 Cl mult vsd w/rem pul band 61.11 $70.00 $4,277.70
33681 Repair heart septum defect 53.03 $70.00 $3,712.10
33684 Repair heart septum defect 54.89 $70.00 $3,842.30
33688 Repair heart septum defect 54.80 $70.00 $3,836.00
33690 Reinforce pulmonary artery 34.78 $70.00 $2,434.60
33692 Repair of heart defects 56.91 $70.00 $3,983.70
33694 Repair of heart defects 56.71 $70.00 $3,969.70
33697 Repair of heart defects 59.73 $70.00 $4,181.10
3370F Ajcc brst cncr stage 0 docd 0.00 $70.00 $0.00
33702 Repair of heart defects 44.21 $70.00 $3,094.70
33710 Repair of heart defects 59.65 $70.00 $4,175.50
3372F Ajcc brst cncr stage 1 docd 0.00 $70.00 $0.00
33720 Repair of heart defect 44.67 $70.00 $3,126.90
33722 Repair of heart defect 47.24 $70.00 $3,306.80
33724 Repair venous anomaly 44.21 $70.00 $3,094.70
33726 Repair pul venous stenosis 59.10 $70.00 $4,137.00
33730 Repair heart-vein defect(s) 56.75 $70.00 $3,972.50
33732 Repair heart-vein defect 45.43 $70.00 $3,180.10
33735 Revision of heart chamber 37.57 $70.00 $2,629.90
33736 Revision of heart chamber 39.63 $70.00 $2,774.10
33737 Revision of heart chamber 37.64 $70.00 $2,634.80
3374F Ajcc brst cncr stage 1 docd 0.00 $70.00 $0.00
33750 Major vessel shunt 36.63 $70.00 $2,564.10
33755 Major vessel shunt 38.18 $70.00 $2,672.60
3376F Ajcc brstcncr stage 2 docd 0.00 $70.00 $0.00
33762 Major vessel shunt 37.21 $70.00 $2,604.70
33764 Major vessel shunt & graft 38.18 $70.00 $2,672.60
33766 Major vessel shunt 38.68 $70.00 $2,707.60
33767 Major vessel shunt 41.31 $70.00 $2,891.70
33768 Cavopulmonary shunting 12.10 $70.00 $847.00
33770 Repair great vessels defect 61.57 $70.00 $4,309.90
33771 Repair great vessels defect 63.38 $70.00 $4,436.60
33774 Repair great vessels defect 52.23 $70.00 $3,656.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33775 Repair great vessels defect 53.84 $70.00 $3,768.80
33776 Repair great vessels defect 54.96 $70.00 $3,847.20
33777 Repair great vessels defect 54.96 $70.00 $3,847.20
33778 Repair great vessels defect 68.30 $70.00 $4,781.00
33779 Repair great vessels defect 67.68 $70.00 $4,737.60
3378F Ajcc brstcncr stage 3 docd 0.00 $70.00 $0.00
33780 Repair great vessels defect 66.46 $70.00 $4,652.20
33781 Repair great vessels defect 67.30 $70.00 $4,711.00
33782 Nikaidoh proc 94.02 $70.00 $6,581.40
33783 Nikaidoh proc w/ostia implt 101.66 $70.00 $7,116.20
33786 Repair arterial trunk 66.21 $70.00 $4,634.70
33788 Revision of pulmonary artery 44.51 $70.00 $3,115.70
3380F Ajcc brstcncr stage 4 docd 0.00 $70.00 $0.00
33800 Aortic suspension 28.32 $70.00 $1,982.40
33802 Repair vessel defect 31.45 $70.00 $2,201.50
33803 Repair vessel defect 33.40 $70.00 $2,338.00
33813 Repair septal defect 34.20 $70.00 $2,394.00
33814 Repair septal defect 44.19 $70.00 $3,093.30
3382F Ajcc cln cncr stage 0 docd 0.00 $70.00 $0.00
33820 Revise major vessel 27.78 $70.00 $1,944.60
33822 Revise major vessel 29.62 $70.00 $2,073.40
33824 Revise major vessel 34.20 $70.00 $2,394.00
3384F Ajcc cln cncr stage 1 docd 0.00 $70.00 $0.00
33840 Remove aorta constriction 35.94 $70.00 $2,515.80
33845 Remove aorta constriction 37.92 $70.00 $2,654.40
33851 Remove aorta constriction 36.90 $70.00 $2,583.00
33852 Repair septal defect 38.58 $70.00 $2,700.60
33853 Repair septal defect 51.86 $70.00 $3,630.20
3386F Ajcc cln cncr stage 2 docd 0.00 $70.00 $0.00
33860 Ascending aortic graft 93.20 $70.00 $6,524.00
33863 Ascending aortic graft 91.38 $70.00 $6,396.60
33864 Ascending aortic graft 93.61 $70.00 $6,552.70
33866 Aortic hemiarch graft 29.85 $70.00 $2,089.50
33870 Transverse aortic arch graft 73.37 $70.00 $5,135.90
33875 Thoracic aortic graft 79.72 $70.00 $5,580.40
33877 Thoracoabdominal graft 105.15 $70.00 $7,360.50
3388F Ajcc cln cncr stage 3 docd 0.00 $70.00 $0.00
33880 Endovasc taa repr incl subcl 52.01 $70.00 $3,640.70
33881 Endovasc taa repr w/o subcl 44.64 $70.00 $3,124.80
33883 Insert endovasc prosth taa 32.32 $70.00 $2,262.40
33884 Endovasc prosth taa add-on 11.41 $70.00 $798.70
33886 Endovasc prosth delayed 27.70 $70.00 $1,939.00
33889 Artery transpose/endovas taa 22.85 $70.00 $1,599.50
33891 Car-car bp grft/endovas taa 27.71 $70.00 $1,939.70
3390F Ajcc cln cncr stage 4 docd 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33910 Remove lung artery emboli 76.22 $70.00 $5,335.40
33915 Remove lung artery emboli 39.75 $70.00 $2,782.50
33916 Surgery of great vessel 123.17 $70.00 $8,621.90
33917 Repair pulmonary artery 42.09 $70.00 $2,946.30
33920 Repair pulmonary atresia 52.61 $70.00 $3,682.70
33922 Transect pulmonary artery 39.91 $70.00 $2,793.70
33924 Remove pulmonary shunt 8.20 $70.00 $574.00
33925 Rpr pul art unifocal w/o cpb 49.91 $70.00 $3,493.70
33926 Repr pul art unifocal w/cpb 70.30 $70.00 $4,921.00
33927 Impltj tot rplcmt hrt sys 74.27 $70.00 $5,198.90
33928 Rmvl & rplcmt tot hrt sys 0.00 $70.00 $0.00
33929 Rmvl rplcmt hrt sys f/trnspl 0.00 $70.00 $0.00
33930 Removal of donor heart/lung 0.00 $70.00 $0.00
33933 Prepare donor heart/lung 0.00 $70.00 $0.00
33935 Transplantation heart/lung 143.90 $70.00 $10,073.00
3394F Quant her2 ihc eval brst cx 0.00 $70.00 $0.00
33940 Removal of donor heart 0.00 $70.00 $0.00
33944 Prepare donor heart 0.00 $70.00 $0.00
33945 Transplantation of heart 141.34 $70.00 $9,893.80
33946 Ecmo/ecls initiation venous 8.99 $70.00 $629.30
33947 Ecmo/ecls initiation artery 9.97 $70.00 $697.90
33948 Ecmo/ecls daily mgmt-venous 6.91 $70.00 $483.70
33949 Ecmo/ecls daily mgmt artery 6.72 $70.00 $470.40
3395F Quant nonher2 ihc brst cx 0.00 $70.00 $0.00
33951 Ecmo/ecls insj prph cannula 12.38 $70.00 $866.60
33952 Ecmo/ecls insj prph cannula 12.43 $70.00 $870.10
33953 Ecmo/ecls insj prph cannula 13.84 $70.00 $968.80
33954 Ecmo/ecls insj prph cannula 13.88 $70.00 $971.60
33955 Ecmo/ecls insj ctr cannula 24.26 $70.00 $1,698.20
33956 Ecmo/ecls insj ctr cannula 24.22 $70.00 $1,695.40
33957 Ecmo/ecls repos perph cnula 5.38 $70.00 $376.60
33958 Ecmo/ecls repos perph cnula 5.37 $70.00 $375.90
33959 Ecmo/ecls repos perph cnula 6.84 $70.00 $478.80
33962 Ecmo/ecls repos perph cnula 6.80 $70.00 $476.00
33963 Ecmo/ecls repos perph cnula 13.68 $70.00 $957.60
33964 Ecmo/ecls repos perph cnula 14.27 $70.00 $998.90
33965 Ecmo/ecls rmvl perph cannula 5.38 $70.00 $376.60
33966 Ecmo/ecls rmvl prph cannula 6.91 $70.00 $483.70
33967 Insert i-aort percut device 7.56 $70.00 $529.20
33968 Remove aortic assist device 0.98 $70.00 $68.60
33969 Ecmo/ecls rmvl perph cannula 7.98 $70.00 $558.60
33970 Aortic circulation assist 10.28 $70.00 $719.60
33971 Aortic circulation assist 20.51 $70.00 $1,435.70
33973 Insert balloon device 15.03 $70.00 $1,052.10
33974 Remove intra-aortic balloon 25.80 $70.00 $1,806.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
33975 Implant ventricular device 37.95 $70.00 $2,656.50
33976 Implant ventricular device 46.27 $70.00 $3,238.90
33977 Remove ventricular device 32.65 $70.00 $2,285.50
33978 Remove ventricular device 38.89 $70.00 $2,722.30
33979 Insert intracorporeal device 56.67 $70.00 $3,966.90
33980 Remove intracorporeal device 51.82 $70.00 $3,627.40
33981 Replace vad pump ext 24.32 $70.00 $1,702.40
33982 Replace vad intra w/o bp 57.03 $70.00 $3,992.10
33983 Replace vad intra w/bp 67.13 $70.00 $4,699.10
33984 Ecmo/ecls rmvl prph cannula 8.25 $70.00 $577.50
33985 Ecmo/ecls rmvl ctr cannula 15.02 $70.00 $1,051.40
33986 Ecmo/ecls rmvl ctr cannula 15.15 $70.00 $1,060.50
33987 Artery expos/graft artery 6.07 $70.00 $424.90
33988 Insertion of left heart vent 22.53 $70.00 $1,577.10
33989 Removal of left heart vent 14.11 $70.00 $987.70
33990 Insert vad artery access 12.40 $70.00 $868.00
33991 Insert vad art&vein access 18.19 $70.00 $1,273.30
33992 Remove vad different session 5.80 $70.00 $406.00
33993 Reposition vad diff session 5.09 $70.00 $356.30
33999 Cardiac surgery procedure 0.00 $70.00 $0.00
34001 Removal of artery clot 27.87 $70.00 $1,950.90
34051 Removal of artery clot 28.65 $70.00 $2,005.50
34101 Removal of artery clot 17.32 $70.00 $1,212.40
34111 Removal of arm artery clot 17.39 $70.00 $1,217.30
34151 Removal of artery clot 40.40 $70.00 $2,828.00
34201 Removal of artery clot 29.78 $70.00 $2,084.60
34203 Removal of leg artery clot 27.53 $70.00 $1,927.10
34401 Removal of vein clot 42.40 $70.00 $2,968.00
34421 Removal of vein clot 21.34 $70.00 $1,493.80
34451 Removal of vein clot 41.09 $70.00 $2,876.30
34471 Removal of vein clot 31.11 $70.00 $2,177.70
34490 Removal of vein clot 18.56 $70.00 $1,299.20
3450F Dyspnea scrnd no-mild dysp 0.00 $70.00 $0.00
34501 Repair valve femoral vein 25.55 $70.00 $1,788.50
34502 Reconstruct vena cava 44.68 $70.00 $3,127.60
3451F Dyspnea scrnd mod-high dysp 0.00 $70.00 $0.00
34510 Transposition of vein valve 29.45 $70.00 $2,061.50
3452F Dyspnea not screened 0.00 $70.00 $0.00
34520 Cross-over vein graft 28.30 $70.00 $1,981.00
34530 Leg vein fusion 25.97 $70.00 $1,817.90
3455F Tb scrng done-interpd 6mon 0.00 $70.00 $0.00
3470F Ra disease activity low 0.00 $70.00 $0.00
34701 Evasc rpr a-ao ndgft 35.85 $70.00 $2,509.50
34702 Evasc rpr a-ao ndgft rpt 53.54 $70.00 $3,747.80
34703 Evasc rpr a-unilac ndgft 40.36 $70.00 $2,825.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
34704 Evasc rpr a-unilac ndgft rpt 67.26 $70.00 $4,708.20
34705 Evac rpr a-biiliac ndgft 44.39 $70.00 $3,107.30
34706 Evasc rpr a-biiliac rpt 66.88 $70.00 $4,681.60
34707 Evasc rpr ilio-iliac ndgft 33.44 $70.00 $2,340.80
34708 Evasc rpr ilio-iliac rpt 53.68 $70.00 $3,757.60
34709 Plmt xtn prosth evasc rpr 9.38 $70.00 $656.60
3471F Ra disease activity mod 0.00 $70.00 $0.00
34710 Dlyd plmt xtn prosth 1st vsl 23.24 $70.00 $1,626.80
34711 Dlyd plmt xtn prosth ea addl 8.66 $70.00 $606.20
34712 Tcat dlvr enhncd fixj dev 19.85 $70.00 $1,389.50
34713 Perq access & clsr fem art 3.73 $70.00 $261.10
34714 Opn fem art expos cndt crtj 7.84 $70.00 $548.80
34715 Opn ax/subcla art expos 8.79 $70.00 $615.30
34716 Opn ax/subcla art expos cndt 10.87 $70.00 $760.90
3472F Ra disease activity high 0.00 $70.00 $0.00
3475F Disease progn ra poor docd 0.00 $70.00 $0.00
3476F Disease progn ra good docd 0.00 $70.00 $0.00
34808 Endovas iliac a device addon 6.11 $70.00 $427.70
34812 Opn fem art expos 6.00 $70.00 $420.00
34813 Femoral endovas graft add-on 6.85 $70.00 $479.50
34820 Opn iliac art expos 10.09 $70.00 $706.30
34830 Open aortic tube prosth repr 50.80 $70.00 $3,556.00
34831 Open aortoiliac prosth repr 55.99 $70.00 $3,919.30
34832 Open aortofemor prosth repr 53.96 $70.00 $3,777.20
34833 Opn ilac art expos cndt crtj 11.72 $70.00 $820.40
34834 Opn brach art expos 3.75 $70.00 $262.50
34839 Plnning pt spec fenest graft 0.00 $70.00 $0.00
34841 Endovasc visc aorta 1 graft 0.00 $70.00 $0.00
34842 Endovasc visc aorta 2 graft 0.00 $70.00 $0.00
34843 Endovasc visc aorta 3 graft 0.00 $70.00 $0.00
34844 Endovasc visc aorta 4 graft 0.00 $70.00 $0.00
34845 Visc & infraren abd 1 prosth 0.00 $70.00 $0.00
34846 Visc & infraren abd 2 prosth 0.00 $70.00 $0.00
34847 Visc & infraren abd 3 prosth 0.00 $70.00 $0.00
34848 Visc & infraren abd 4+ prost 0.00 $70.00 $0.00
3490F History aids-defining cond 0.00 $70.00 $0.00
3491F Hiv unsure baby of hiv+moms 0.00 $70.00 $0.00
3492F History cd4+ cell count <350 0.00 $70.00 $0.00
3493F No hist cd4+ cell count <350 0.00 $70.00 $0.00
3494F Cd4+cell count <200cells/mm3 0.00 $70.00 $0.00
3495F Cd4+cell cnt 200-499 cells 0.00 $70.00 $0.00
3496F Cd4+ cell count >= 500 cells 0.00 $70.00 $0.00
3497F Cd4+ cell percentage <15% 0.00 $70.00 $0.00
3498F Cd4+ cell =15% (hiv) 0.00 $70.00 $0.00
3500F Cd4+cell cnt/% docd as done 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
35001 Repair defect of artery 32.20 $70.00 $2,254.00
35002 Repair artery rupture neck 32.56 $70.00 $2,279.20
35005 Repair defect of artery 28.68 $70.00 $2,007.60
35011 Repair defect of artery 29.05 $70.00 $2,033.50
35013 Repair artery rupture arm 36.35 $70.00 $2,544.50
3502F Hiv rna vrl ld <lmts quantif 0.00 $70.00 $0.00
35021 Repair defect of artery 36.41 $70.00 $2,548.70
35022 Repair artery rupture chest 40.67 $70.00 $2,846.90
3503F Hiv rna vrl ldnot<lmts quntf 0.00 $70.00 $0.00
35045 Repair defect of arm artery 28.45 $70.00 $1,991.50
35081 Repair defect of artery 50.22 $70.00 $3,515.40
35082 Repair artery rupture aorta 63.37 $70.00 $4,435.90
35091 Repair defect of artery 51.82 $70.00 $3,627.40
35092 Repair artery rupture aorta 75.54 $70.00 $5,287.80
3510F Doc tb scrng-rslts interpd 0.00 $70.00 $0.00
35102 Repair defect of artery 54.51 $70.00 $3,815.70
35103 Repair artery rupture aorta 64.99 $70.00 $4,549.30
3511F Chlmyd/gonrh tsts docd done 0.00 $70.00 $0.00
35111 Repair defect of artery 38.11 $70.00 $2,667.70
35112 Repair artery rupture spleen 47.20 $70.00 $3,304.00
3512F Syph scrng docd as done 0.00 $70.00 $0.00
35121 Repair defect of artery 48.30 $70.00 $3,381.00
35122 Repair artery rupture belly 54.63 $70.00 $3,824.10
3513F Hep b scrng docd as done 0.00 $70.00 $0.00
35131 Repair defect of artery 40.22 $70.00 $2,815.40
35132 Repair artery rupture groin 47.01 $70.00 $3,290.70
3514F Hep c scrng docd as done 0.00 $70.00 $0.00
35141 Repair defect of artery 31.97 $70.00 $2,237.90
35142 Repair artery rupture thigh 38.51 $70.00 $2,695.70
3515F Pt has docd immun to hep c 0.00 $70.00 $0.00
35151 Repair defect of artery 35.88 $70.00 $2,511.60
35152 Repair ruptd popliteal art 39.94 $70.00 $2,795.80
3517F Hbv assess&results intrp 1yr 0.00 $70.00 $0.00
35180 Repair blood vessel lesion 25.44 $70.00 $1,780.80
35182 Repair blood vessel lesion 51.91 $70.00 $3,633.70
35184 Repair blood vessel lesion 27.76 $70.00 $1,943.20
35188 Repair blood vessel lesion 37.08 $70.00 $2,595.60
35189 Repair blood vessel lesion 43.22 $70.00 $3,025.40
35190 Repair blood vessel lesion 22.03 $70.00 $1,542.10
3520F Cdifficile testing performed 0.00 $70.00 $0.00
35201 Repair blood vessel lesion 27.28 $70.00 $1,909.60
35206 Repair blood vessel lesion 22.67 $70.00 $1,586.90
35207 Repair blood vessel lesion 21.76 $70.00 $1,523.20
35211 Repair blood vessel lesion 40.04 $70.00 $2,802.80
35216 Repair blood vessel lesion 59.71 $70.00 $4,179.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
35221 Repair blood vessel lesion 42.48 $70.00 $2,973.60
35226 Repair blood vessel lesion 24.15 $70.00 $1,690.50
35231 Repair blood vessel lesion 35.76 $70.00 $2,503.20
35236 Repair blood vessel lesion 29.02 $70.00 $2,031.40
35241 Repair blood vessel lesion 41.69 $70.00 $2,918.30
35246 Repair blood vessel lesion 45.26 $70.00 $3,168.20
35251 Repair blood vessel lesion 50.40 $70.00 $3,528.00
35256 Repair blood vessel lesion 29.69 $70.00 $2,078.30
35261 Repair blood vessel lesion 28.22 $70.00 $1,975.40
35266 Repair blood vessel lesion 25.14 $70.00 $1,759.80
35271 Repair blood vessel lesion 40.02 $70.00 $2,801.40
35276 Repair blood vessel lesion 42.31 $70.00 $2,961.70
35281 Repair blood vessel lesion 46.83 $70.00 $3,278.10
35286 Repair blood vessel lesion 26.98 $70.00 $1,888.60
35301 Rechanneling of artery 32.79 $70.00 $2,295.30
35302 Rechanneling of artery 32.50 $70.00 $2,275.00
35303 Rechanneling of artery 35.95 $70.00 $2,516.50
35304 Rechanneling of artery 37.02 $70.00 $2,591.40
35305 Rechanneling of artery 35.61 $70.00 $2,492.70
35306 Rechanneling of artery 12.85 $70.00 $899.50
35311 Rechanneling of artery 45.09 $70.00 $3,156.30
35321 Rechanneling of artery 25.86 $70.00 $1,810.20
35331 Rechanneling of artery 42.35 $70.00 $2,964.50
35341 Rechanneling of artery 39.94 $70.00 $2,795.80
35351 Rechanneling of artery 37.09 $70.00 $2,596.30
35355 Rechanneling of artery 29.88 $70.00 $2,091.60
35361 Rechanneling of artery 43.80 $70.00 $3,066.00
35363 Rechanneling of artery 46.83 $70.00 $3,278.10
35371 Rechanneling of artery 23.70 $70.00 $1,659.00
35372 Rechanneling of artery 28.37 $70.00 $1,985.90
35390 Reoperation carotid add-on 4.61 $70.00 $322.70
35400 Angioscopy 4.32 $70.00 $302.40
3550F Low rsk thromboembolism 0.00 $70.00 $0.00
35500 Harvest vein for bypass 9.29 $70.00 $650.30
35501 Art byp grft ipsilat carotid 43.34 $70.00 $3,033.80
35506 Art byp grft subclav-carotid 36.64 $70.00 $2,564.80
35508 Art byp grft carotid-vertbrl 37.76 $70.00 $2,643.20
35509 Art byp grft contral carotid 40.64 $70.00 $2,844.80
3551F Intrmed rsk thromboembolism 0.00 $70.00 $0.00
35510 Art byp grft carotid-brchial 35.33 $70.00 $2,473.10
35511 Art byp grft subclav-subclav 31.70 $70.00 $2,219.00
35512 Art byp grft subclav-brchial 34.82 $70.00 $2,437.40
35515 Art byp grft subclav-vertbrl 36.27 $70.00 $2,538.90
35516 Art byp grft subclav-axilary 35.23 $70.00 $2,466.10
35518 Art byp grft axillary-axilry 32.73 $70.00 $2,291.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
3552F Hgh risk for thromboembolism 0.00 $70.00 $0.00
35521 Art byp grft axill-femoral 35.32 $70.00 $2,472.40
35522 Art byp grft axill-brachial 34.97 $70.00 $2,447.90
35523 Art byp grft brchl-ulnr-rdl 37.12 $70.00 $2,598.40
35525 Art byp grft brachial-brchl 33.08 $70.00 $2,315.60
35526 Art byp grft aor/carot/innom 50.50 $70.00 $3,535.00
35531 Art byp grft aorcel/aormesen 56.15 $70.00 $3,930.50
35533 Art byp grft axill/fem/fem 43.34 $70.00 $3,033.80
35535 Art byp grft hepatorenal 54.99 $70.00 $3,849.30
35536 Art byp grft splenorenal 48.83 $70.00 $3,418.10
35537 Art byp grft aortoiliac 59.77 $70.00 $4,183.90
35538 Art byp grft aortobi-iliac 67.05 $70.00 $4,693.50
35539 Art byp grft aortofemoral 62.91 $70.00 $4,403.70
35540 Art byp grft aortbifemoral 70.68 $70.00 $4,947.60
3555F Pt inr measurement performed 0.00 $70.00 $0.00
35556 Art byp grft fem-popliteal 40.52 $70.00 $2,836.40
35558 Art byp grft fem-femoral 35.63 $70.00 $2,494.10
35560 Art byp grft aortorenal 48.57 $70.00 $3,399.90
35563 Art byp grft ilioiliac 38.20 $70.00 $2,674.00
35565 Art byp grft iliofemoral 38.11 $70.00 $2,667.70
35566 Art byp fem-ant-post tib/prl 48.36 $70.00 $3,385.20
35570 Art byp tibial-tib/peroneal 43.73 $70.00 $3,061.10
35571 Art byp pop-tibl-prl-other 38.35 $70.00 $2,684.50
35572 Harvest femoropopliteal vein 10.05 $70.00 $703.50
35583 Vein byp grft fem-popliteal 41.84 $70.00 $2,928.80
35585 Vein byp fem-tibial peroneal 48.47 $70.00 $3,392.90
35587 Vein byp pop-tibl peroneal 39.51 $70.00 $2,765.70
35600 Harvest art for cabg add-on 7.43 $70.00 $520.10
35601 Art byp common ipsi carotid 40.48 $70.00 $2,833.60
35606 Art byp carotid-subclavian 34.01 $70.00 $2,380.70
35612 Art byp subclav-subclavian 29.95 $70.00 $2,096.50
35616 Art byp subclav-axillary 31.65 $70.00 $2,215.50
35621 Art byp axillary-femoral 31.75 $70.00 $2,222.50
35623 Art byp axillary-pop-tibial 37.83 $70.00 $2,648.10
35626 Art byp aorsubcl/carot/innom 46.01 $70.00 $3,220.70
35631 Art byp aor-celiac-msn-renal 53.72 $70.00 $3,760.40
35632 Art byp ilio-celiac 51.72 $70.00 $3,620.40
35633 Art byp ilio-mesenteric 57.81 $70.00 $4,046.70
35634 Art byp iliorenal 50.86 $70.00 $3,560.20
35636 Art byp spenorenal 46.05 $70.00 $3,223.50
35637 Art byp aortoiliac 47.76 $70.00 $3,343.20
35638 Art byp aortobi-iliac 50.92 $70.00 $3,564.40
35642 Art byp carotid-vertebral 28.46 $70.00 $1,992.20
35645 Art byp subclav-vertebrl 27.31 $70.00 $1,911.70
35646 Art byp aortobifemoral 49.74 $70.00 $3,481.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
35647 Art byp aortofemoral 45.03 $70.00 $3,152.10
35650 Art byp axillary-axillary 31.38 $70.00 $2,196.60
35654 Art byp axill-fem-femoral 39.67 $70.00 $2,776.90
35656 Art byp femoral-popliteal 31.34 $70.00 $2,193.80
35661 Art byp femoral-femoral 31.43 $70.00 $2,200.10
35663 Art byp ilioiliac 35.06 $70.00 $2,454.20
35665 Art byp iliofemoral 34.00 $70.00 $2,380.00
35666 Art byp fem-ant-post tib/prl 36.64 $70.00 $2,564.80
35671 Art byp pop-tibl-prl-other 32.29 $70.00 $2,260.30
35681 Composite byp grft pros&vein 2.34 $70.00 $163.80
35682 Composite byp grft 2 veins 10.22 $70.00 $715.40
35683 Composite byp grft 3/> segmt 11.83 $70.00 $828.10
35685 Bypass graft patency/patch 5.76 $70.00 $403.20
35686 Bypass graft/av fist patency 4.64 $70.00 $324.80
35691 Art trnsposj vertbrl carotid 27.27 $70.00 $1,908.90
35693 Art trnsposj subclavian 23.60 $70.00 $1,652.00
35694 Art trnsposj subclav carotid 28.44 $70.00 $1,990.80
35695 Art trnsposj carotid subclav 29.29 $70.00 $2,050.30
35697 Reimplant artery each 4.30 $70.00 $301.00
3570F Rprt bone scint xref w xray 0.00 $70.00 $0.00
35700 Reoperation bypass graft 4.42 $70.00 $309.40
35701 Exploration carotid artery 16.40 $70.00 $1,148.00
3572F Pt consid poss risk fx 0.00 $70.00 $0.00
35721 Exploration femoral artery 13.19 $70.00 $923.30
3573F Pt not consid poss risk fx 0.00 $70.00 $0.00
35741 Exploration popliteal artery 15.00 $70.00 $1,050.00
35761 Exploration of artery/vein 11.38 $70.00 $796.60
35800 Explore neck vessels 20.84 $70.00 $1,458.80
35820 Explore chest vessels 58.32 $70.00 $4,082.40
35840 Explore abdominal vessels 34.64 $70.00 $2,424.80
35860 Explore limb vessels 24.25 $70.00 $1,697.50
35870 Repair vessel graft defect 35.79 $70.00 $2,505.30
35875 Removal of clot in graft 17.25 $70.00 $1,207.50
35876 Removal of clot in graft 27.42 $70.00 $1,919.40
35879 Revise graft w/vein 26.83 $70.00 $1,878.10
35881 Revise graft w/vein 29.48 $70.00 $2,063.60
35883 Revise graft w/nonauto graft 34.81 $70.00 $2,436.70
35884 Revise graft w/vein 35.74 $70.00 $2,501.80
35901 Excision graft neck 13.55 $70.00 $948.50
35903 Excision graft extremity 16.33 $70.00 $1,143.10
35905 Excision graft thorax 48.29 $70.00 $3,380.30
35907 Excision graft abdomen 55.25 $70.00 $3,867.50
36000 Place needle in vein 0.77 $70.00 $53.90
36002 Pseudoaneurysm injection trt 4.49 $70.00 $314.30
36005 Injection ext venography 8.76 $70.00 $613.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
36010 Place catheter in vein 14.28 $70.00 $999.60
36011 Place catheter in vein 24.02 $70.00 $1,681.40
36012 Place catheter in vein 24.50 $70.00 $1,715.00
36013 Place catheter in artery 21.84 $70.00 $1,528.80
36014 Place catheter in artery 23.06 $70.00 $1,614.20
36015 Place catheter in artery 24.98 $70.00 $1,748.60
36100 Establish access to artery 14.81 $70.00 $1,036.70
36140 Intro ndl icath upr/lxtr art 12.73 $70.00 $891.10
36160 Establish access to aorta 14.61 $70.00 $1,022.70
36200 Place catheter in aorta 16.23 $70.00 $1,136.10
36215 Place catheter in artery 29.40 $70.00 $2,058.00
36216 Place catheter in artery 31.68 $70.00 $2,217.60
36217 Place catheter in artery 53.12 $70.00 $3,718.40
36218 Place catheter in artery 6.89 $70.00 $482.30
36221 Place cath thoracic aorta 29.31 $70.00 $2,051.70
36222 Place cath carotid/inom art 34.73 $70.00 $2,431.10
36223 Place cath carotid/inom art 43.95 $70.00 $3,076.50
36224 Place cath carotd art 56.87 $70.00 $3,980.90
36225 Place cath subclavian art 42.34 $70.00 $2,963.80
36226 Place cath vertebral art 53.78 $70.00 $3,764.60
36227 Place cath xtrnl carotid 7.23 $70.00 $506.10
36228 Place cath intracranial art 37.64 $70.00 $2,634.80
36245 Ins cath abd/l-ext art 1st 37.43 $70.00 $2,620.10
36246 Ins cath abd/l-ext art 2nd 23.80 $70.00 $1,666.00
36247 Ins cath abd/l-ext art 3rd 42.60 $70.00 $2,982.00
36248 Ins cath abd/l-ext art addl 4.11 $70.00 $287.70
36251 Ins cath ren art 1st unilat 39.22 $70.00 $2,745.40
36252 Ins cath ren art 1st bilat 42.43 $70.00 $2,970.10
36253 Ins cath ren art 2nd+ unilat 62.60 $70.00 $4,382.00
36254 Ins cath ren art 2nd+ bilat 60.82 $70.00 $4,257.40
36260 Insertion of infusion pump 18.80 $70.00 $1,316.00
36261 Revision of infusion pump 11.64 $70.00 $814.80
36262 Removal of infusion pump 8.90 $70.00 $623.00
36299 Vessel injection procedure 0.00 $70.00 $0.00
36400 Bl draw < 3 yrs fem/jugular 0.75 $70.00 $52.50
36405 Bl draw <3 yrs scalp vein 0.66 $70.00 $46.20
36406 Bl draw <3 yrs other vein 0.47 $70.00 $32.90
36410 Non-routine bl draw 3/> yrs 0.49 $70.00 $34.30
36415 Routine venipuncture 0.00 $70.00 $0.00
36416 Capillary blood draw 0.00 $70.00 $0.00
36420 Vein access cutdown < 1 yr 1.35 $70.00 $94.50
36425 Vein access cutdown > 1 yr 1.16 $70.00 $81.20
36430 Blood transfusion service 0.99 $70.00 $69.30
36440 Bl push transfuse 2 yr/< 1.46 $70.00 $102.20
36450 Bl exchange/transfuse nb 4.94 $70.00 $345.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
36455 Bl exchange/transfuse non-nb 3.68 $70.00 $257.60
36456 Prtl exchange transfuse nb 3.03 $70.00 $212.10
36460 Transfusion service fetal 9.84 $70.00 $688.80
36465 Njx noncmpnd sclrsnt 1 vein 43.64 $70.00 $3,054.80
36466 Njx noncmpnd sclrsnt mlt vn 45.87 $70.00 $3,210.90
36468 Njx sclrsnt spider veins 0.00 $70.00 $0.00
36470 Njx sclrsnt 1 incmptnt vein 3.02 $70.00 $211.40
36471 Njx sclrsnt mlt incmptnt vn 5.47 $70.00 $382.90
36473 Endovenous mchnchem 1st vein 41.40 $70.00 $2,898.00
36474 Endovenous mchnchem add-on 7.87 $70.00 $550.90
36475 Endovenous rf 1st vein 40.60 $70.00 $2,842.00
36476 Endovenous rf vein add-on 8.55 $70.00 $598.50
36478 Endovenous laser 1st vein 32.10 $70.00 $2,247.00
36479 Endovenous laser vein addon 9.03 $70.00 $632.10
36481 Insertion of catheter vein 55.44 $70.00 $3,880.80
36482 Endoven ther chem adhes 1st 57.99 $70.00 $4,059.30
36483 Endoven ther chem adhes sbsq 4.26 $70.00 $298.20
3650F Eeg ordered rvwd reqstd 0.00 $70.00 $0.00
36500 Insertion of catheter vein 5.30 $70.00 $371.00
36510 Insertion of catheter vein 2.34 $70.00 $163.80
36511 Apheresis wbc 3.10 $70.00 $217.00
36512 Apheresis rbc 3.11 $70.00 $217.70
36513 Apheresis platelets 3.16 $70.00 $221.20
36514 Apheresis plasma 20.50 $70.00 $1,435.00
36516 Apheresis immunoads slctv 56.27 $70.00 $3,938.90
36522 Photopheresis 61.22 $70.00 $4,285.40
36555 Insert non-tunnel cv cath 5.33 $70.00 $373.10
36556 Insert non-tunnel cv cath 5.99 $70.00 $419.30
36557 Insert tunneled cv cath 29.06 $70.00 $2,034.20
36558 Insert tunneled cv cath 21.70 $70.00 $1,519.00
36560 Insert tunneled cv cath 37.15 $70.00 $2,600.50
36561 Insert tunneled cv cath 30.61 $70.00 $2,142.70
36563 Insert tunneled cv cath 34.47 $70.00 $2,412.90
36565 Insert tunneled cv cath 24.85 $70.00 $1,739.50
36566 Insert tunneled cv cath 135.77 $70.00 $9,503.90
36568 Insj picc <5 yr w/o imaging 2.65 $70.00 $185.50
36569 Insj picc 5 yr+ w/o imaging 2.72 $70.00 $190.40
36570 Insert picvad cath 40.88 $70.00 $2,861.60
36571 Insert picvad cath 35.88 $70.00 $2,511.60
36572 Insj picc rs&i <5 yr 11.90 $70.00 $833.00
36573 Insj picc rs&i 5 yr+ 11.20 $70.00 $784.00
36575 Repair tunneled cv cath 4.59 $70.00 $321.30
36576 Repair tunneled cv cath 9.31 $70.00 $651.70
36578 Replace tunneled cv cath 13.06 $70.00 $914.20
36580 Replace cvad cath 6.13 $70.00 $429.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
36581 Replace tunneled cv cath 21.48 $70.00 $1,503.60
36582 Replace tunneled cv cath 28.35 $70.00 $1,984.50
36583 Replace tunneled cv cath 35.90 $70.00 $2,513.00
36584 Compl rplcmt picc rs&i 9.78 $70.00 $684.60
36585 Replace picvad cath 30.51 $70.00 $2,135.70
36589 Removal tunneled cv cath 4.71 $70.00 $329.70
36590 Removal tunneled cv cath 6.34 $70.00 $443.80
36591 Draw blood off venous device 0.69 $70.00 $48.30
36592 Collect blood from picc 0.77 $70.00 $53.90
36593 Declot vascular device 0.89 $70.00 $62.30
36595 Mech remov tunneled cv cath 17.30 $70.00 $1,211.00
36596 Mech remov tunneled cv cath 3.57 $70.00 $249.90
36597 Reposition venous catheter 3.69 $70.00 $258.30
36598 Inj w/fluor eval cv device 3.30 $70.00 $231.00
36600 Withdrawal of arterial blood 0.87 $70.00 $60.90
36620 Insertion catheter artery 1.28 $70.00 $89.60
36625 Insertion catheter artery 3.05 $70.00 $213.50
36640 Insertion catheter artery 3.30 $70.00 $231.00
36660 Insertion catheter artery 1.98 $70.00 $138.60
36680 Insert needle bone cavity 1.69 $70.00 $118.30
36800 Insertion of cannula 3.53 $70.00 $247.10
36810 Insertion of cannula 6.05 $70.00 $423.50
36815 Insertion of cannula 3.91 $70.00 $273.70
36818 Av fuse uppr arm cephalic 20.11 $70.00 $1,407.70
36819 Av fuse uppr arm basilic 21.19 $70.00 $1,483.30
36820 Av fusion/forearm vein 21.25 $70.00 $1,487.50
36821 Av fusion direct any site 19.25 $70.00 $1,347.50
36823 Insertion of cannula(s) 40.40 $70.00 $2,828.00
36825 Artery-vein autograft 23.05 $70.00 $1,613.50
36830 Artery-vein nonautograft 19.34 $70.00 $1,353.80
36831 Open thrombect av fistula 17.85 $70.00 $1,249.50
36832 Av fistula revision open 21.90 $70.00 $1,533.00
36833 Av fistula revision 23.54 $70.00 $1,647.80
36835 Artery to vein shunt 13.85 $70.00 $969.50
36838 Dist revas ligation hemo 33.15 $70.00 $2,320.50
36860 External cannula declotting 7.17 $70.00 $501.90
36861 Cannula declotting 4.02 $70.00 $281.40
36901 Intro cath dialysis circuit 18.33 $70.00 $1,283.10
36902 Intro cath dialysis circuit 36.09 $70.00 $2,526.30
36903 Intro cath dialysis circuit 152.21 $70.00 $10,654.70
36904 Thrmbc/nfs dialysis circuit 53.11 $70.00 $3,717.70
36905 Thrmbc/nfs dialysis circuit 66.80 $70.00 $4,676.00
36906 Thrmbc/nfs dialysis circuit 186.56 $70.00 $13,059.20
36907 Balo angiop ctr dialysis seg 20.43 $70.00 $1,430.10
36908 Stent plmt ctr dialysis seg 68.02 $70.00 $4,761.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
36909 Dialysis circuit embolj 54.98 $70.00 $3,848.60
3700F Psych disorders assessed 0.00 $70.00 $0.00
37140 Revision of circulation 67.40 $70.00 $4,718.00
37145 Revision of circulation 62.50 $70.00 $4,375.00
37160 Revision of circulation 64.22 $70.00 $4,495.40
37180 Revision of circulation 61.73 $70.00 $4,321.10
37181 Splice spleen/kidney veins 67.40 $70.00 $4,718.00
37182 Insert hepatic shunt (tips) 23.79 $70.00 $1,665.30
37183 Remove hepatic shunt (tips) 170.36 $70.00 $11,925.20
37184 Prim art m-thrmbc 1st vsl 60.24 $70.00 $4,216.80
37185 Prim art m-thrmbc sbsq vsl 18.56 $70.00 $1,299.20
37186 Sec art thrombectomy add-on 37.46 $70.00 $2,622.20
37187 Venous mech thrombectomy 55.56 $70.00 $3,889.20
37188 Ven mechnl thrmbc repeat tx 46.73 $70.00 $3,271.10
37191 Ins endovas vena cava filtr 69.95 $70.00 $4,896.50
37192 Redo endovas vena cava filtr 37.49 $70.00 $2,624.30
37193 Rem endovas vena cava filter 44.06 $70.00 $3,084.20
37195 Thrombolytic therapy stroke 0.00 $70.00 $0.00
37197 Remove intrvas foreign body 43.40 $70.00 $3,038.00
3720F Cognit impairment assessed 0.00 $70.00 $0.00
37200 Transcatheter biopsy 6.30 $70.00 $441.00
37211 Thrombolytic art therapy 11.21 $70.00 $784.70
37212 Thrombolytic venous therapy 9.81 $70.00 $686.70
37213 Thromblytic art/ven therapy 6.76 $70.00 $473.20
37214 Cessj therapy cath removal 3.57 $70.00 $249.90
37215 Transcath stent cca w/eps 29.21 $70.00 $2,044.70
37216 Transcath stent cca w/o eps 29.29 $70.00 $2,050.30
37217 Stent placemt retro carotid 31.39 $70.00 $2,197.30
37218 Stent placemt ante carotid 23.74 $70.00 $1,661.80
37220 Iliac revasc 83.76 $70.00 $5,863.20
37221 Iliac revasc w/stent 118.87 $70.00 $8,320.90
37222 Iliac revasc add-on 22.64 $70.00 $1,584.80
37223 Iliac revasc w/stent add-on 62.61 $70.00 $4,382.70
37224 Fem/popl revas w/tla 100.68 $70.00 $7,047.60
37225 Fem/popl revas w/ather 345.29 $70.00 $24,170.30
37226 Fem/popl revasc w/stent 299.49 $70.00 $20,964.30
37227 Fem/popl revasc stnt & ather 444.90 $70.00 $31,143.00
37228 Tib/per revasc w/tla 145.94 $70.00 $10,215.80
37229 Tib/per revasc w/ather 345.48 $70.00 $24,183.60
37230 Tib/per revasc w/stent 294.13 $70.00 $20,589.10
37231 Tib/per revasc stent & ather 422.60 $70.00 $29,582.00
37232 Tib/per revasc add-on 31.13 $70.00 $2,179.10
37233 Tibper revasc w/ather add-on 37.93 $70.00 $2,655.10
37234 Revsc opn/prq tib/pero stent 109.75 $70.00 $7,682.50
37235 Tib/per revasc stnt & ather 119.07 $70.00 $8,334.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
37236 Open/perq place stent 1st 101.62 $70.00 $7,113.40
37237 Open/perq place stent ea add 60.34 $70.00 $4,223.80
37238 Open/perq place stent same 102.64 $70.00 $7,184.80
37239 Open/perq place stent ea add 48.97 $70.00 $3,427.90
37241 Vasc embolize/occlude venous 137.34 $70.00 $9,613.80
37242 Vasc embolize/occlude artery 211.50 $70.00 $14,805.00
37243 Vasc embolize/occlude organ 273.62 $70.00 $19,153.40
37244 Vasc embolize/occlude bleed 195.67 $70.00 $13,696.90
37246 Trluml balo angiop 1st art 59.28 $70.00 $4,149.60
37247 Trluml balo angiop addl art 22.59 $70.00 $1,581.30
37248 Trluml balo angiop 1st vein 42.38 $70.00 $2,966.60
37249 Trluml balo angiop addl vein 16.77 $70.00 $1,173.90
3725F Screen depression performed 0.00 $70.00 $0.00
37252 Intrvasc us noncoronary 1st 35.78 $70.00 $2,504.60
37253 Intrvasc us noncoronary addl 5.60 $70.00 $392.00
3750F Ptnotrcvngsteroid>/=10mg/day 0.00 $70.00 $0.00
37500 Endoscopy ligate perf veins 18.30 $70.00 $1,281.00
37501 Vascular endoscopy procedure 0.00 $70.00 $0.00
3751F Electrodiag polyneuro 6 mn 0.00 $70.00 $0.00
3752F No electrodiag polyneuro 6mn 0.00 $70.00 $0.00
3753F Pt has symp&signs neuropathy 0.00 $70.00 $0.00
3754F Screening tests dm done 0.00 $70.00 $0.00
3755F Cog&behav imprmnt scrng done 0.00 $70.00 $0.00
3756F Pt w/pseudobulb affect/als 0.00 $70.00 $0.00
37565 Ligation of neck vein 20.78 $70.00 $1,454.60
3757F Pt w/o pseudobulbaffect/als 0.00 $70.00 $0.00
3758F Pt ref pulm fx test/peakflow 0.00 $70.00 $0.00
3759F Pt scrn dysphag/wt loss/nutr 0.00 $70.00 $0.00
3760F Pt w/ dysphag/wt loss/nutr 0.00 $70.00 $0.00
37600 Ligation of neck artery 21.07 $70.00 $1,474.90
37605 Ligation of neck artery 21.22 $70.00 $1,485.40
37606 Ligation of neck artery 20.44 $70.00 $1,430.80
37607 Ligation of a-v fistula 10.83 $70.00 $758.10
37609 Temporal artery procedure 8.87 $70.00 $620.90
3761F Pt w/o dysphag/wt loss/nutr 0.00 $70.00 $0.00
37615 Ligation of neck artery 15.16 $70.00 $1,061.20
37616 Ligation of chest artery 32.05 $70.00 $2,243.50
37617 Ligation of abdomen artery 38.84 $70.00 $2,718.80
37618 Ligation of extremity artery 11.11 $70.00 $777.70
37619 Ligation of inf vena cava 50.05 $70.00 $3,503.50
3762F Patient is dysarthric 0.00 $70.00 $0.00
3763F Patient is not dysarthric 0.00 $70.00 $0.00
37650 Revision of major vein 13.22 $70.00 $925.40
37660 Revision of major vein 38.07 $70.00 $2,664.90
37700 Revise leg vein 7.07 $70.00 $494.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
37718 Ligate/strip short leg vein 12.45 $70.00 $871.50
37722 Ligate/strip long leg vein 13.72 $70.00 $960.40
37735 Removal of leg veins/lesion 16.75 $70.00 $1,172.50
3775F Adenoma detected screening 0.00 $70.00 $0.00
3776F Adenoma not detect screening 0.00 $70.00 $0.00
37760 Ligate leg veins radical 18.08 $70.00 $1,265.60
37761 Ligate leg veins open 15.65 $70.00 $1,095.50
37765 Stab phleb veins xtr 10-20 18.52 $70.00 $1,296.40
37766 Phleb veins - extrem 20+ 22.01 $70.00 $1,540.70
37780 Revision of leg vein 6.75 $70.00 $472.50
37785 Ligate/divide/excise vein 10.07 $70.00 $704.90
37788 Revascularization penis 36.58 $70.00 $2,560.60
37790 Penile venous occlusion 14.09 $70.00 $986.30
37799 Vascular surgery procedure 0.00 $70.00 $0.00
38100 Removal of spleen total 33.45 $70.00 $2,341.50
38101 Removal of spleen partial 33.54 $70.00 $2,347.80
38102 Removal of spleen total 7.65 $70.00 $535.50
38115 Repair of ruptured spleen 37.04 $70.00 $2,592.80
38120 Laparoscopy splenectomy 30.52 $70.00 $2,136.40
38129 Laparoscope proc spleen 0.00 $70.00 $0.00
38200 Injection for spleen x-ray 3.84 $70.00 $268.80
38204 Bl donor search management 3.03 $70.00 $212.10
38205 Harvest allogeneic stem cell 2.38 $70.00 $166.60
38206 Harvest auto stem cells 2.39 $70.00 $167.30
38207 Cryopreserve stem cells 1.35 $70.00 $94.50
38208 Thaw preserved stem cells 0.86 $70.00 $60.20
38209 Wash harvest stem cells 0.36 $70.00 $25.20
38210 T-cell depletion of harvest 2.40 $70.00 $168.00
38211 Tumor cell deplete of harvst 2.16 $70.00 $151.20
38212 Rbc depletion of harvest 1.43 $70.00 $100.10
38213 Platelet deplete of harvest 0.36 $70.00 $25.20
38214 Volume deplete of harvest 1.23 $70.00 $86.10
38215 Harvest stem cell concentrte 1.43 $70.00 $100.10
38220 Dx bone marrow aspirations 4.71 $70.00 $329.70
38221 Dx bone marrow biopsies 4.39 $70.00 $307.30
38222 Dx bone marrow bx & aspir 4.87 $70.00 $340.90
38230 Bone marrow harvest allogen 5.97 $70.00 $417.90
38232 Bone marrow harvest autolog 5.75 $70.00 $402.50
38240 Transplt allo hct/donor 6.53 $70.00 $457.10
38241 Transplt autol hct/donor 4.88 $70.00 $341.60
38242 Transplt allo lymphocytes 3.45 $70.00 $241.50
38243 Transplj hematopoietic boost 3.47 $70.00 $242.90
38300 Drainage lymph node lesion 9.19 $70.00 $643.30
38305 Drainage lymph node lesion 14.00 $70.00 $980.00
38308 Incision of lymph channels 13.00 $70.00 $910.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
38380 Thoracic duct procedure 16.30 $70.00 $1,141.00
38381 Thoracic duct procedure 23.21 $70.00 $1,624.70
38382 Thoracic duct procedure 19.42 $70.00 $1,359.40
38500 Biopsy/removal lymph nodes 9.58 $70.00 $670.60
38505 Needle biopsy lymph nodes 3.56 $70.00 $249.20
38510 Biopsy/removal lymph nodes 14.95 $70.00 $1,046.50
38520 Biopsy/removal lymph nodes 13.40 $70.00 $938.00
38525 Biopsy/removal lymph nodes 12.64 $70.00 $884.80
38530 Biopsy/removal lymph nodes 16.13 $70.00 $1,129.10
38531 Open bx/exc inguinofem nodes 12.60 $70.00 $882.00
38542 Explore deep node(s) neck 14.89 $70.00 $1,042.30
38550 Removal neck/armpit lesion 14.78 $70.00 $1,034.60
38555 Removal neck/armpit lesion 29.19 $70.00 $2,043.30
38562 Removal pelvic lymph nodes 20.49 $70.00 $1,434.30
38564 Removal abdomen lymph nodes 20.43 $70.00 $1,430.10
38570 Laparoscopy lymph node biop 14.73 $70.00 $1,031.10
38571 Laparoscopy lymphadenectomy 19.16 $70.00 $1,341.20
38572 Laparoscopy lymphadenectomy 26.70 $70.00 $1,869.00
38573 Laps pelvic lymphadec 33.77 $70.00 $2,363.90
38589 Laparoscope proc lymphatic 0.00 $70.00 $0.00
38700 Removal of lymph nodes neck 23.11 $70.00 $1,617.70
38720 Removal of lymph nodes neck 38.60 $70.00 $2,702.00
38724 Removal of lymph nodes neck 41.67 $70.00 $2,916.90
38740 Remove armpit lymph nodes 20.16 $70.00 $1,411.20
38745 Remove armpit lymph nodes 25.44 $70.00 $1,780.80
38746 Remove thoracic lymph nodes 6.23 $70.00 $436.10
38747 Remove abdominal lymph nodes 7.77 $70.00 $543.90
38760 Remove groin lymph nodes 24.37 $70.00 $1,705.90
38765 Remove groin lymph nodes 37.63 $70.00 $2,634.10
38770 Remove pelvis lymph nodes 23.41 $70.00 $1,638.70
38780 Remove abdomen lymph nodes 29.78 $70.00 $2,084.60
38790 Inject for lymphatic x-ray 2.39 $70.00 $167.30
38792 Ra tracer id of sentinl node 2.34 $70.00 $163.80
38794 Access thoracic lymph duct 8.57 $70.00 $599.90
38900 Io map of sent lymph node 4.00 $70.00 $280.00
38999 Blood/lymph system procedure 0.00 $70.00 $0.00
39000 Exploration of chest 14.36 $70.00 $1,005.20
39010 Exploration of chest 22.73 $70.00 $1,591.10
39200 Resect mediastinal cyst 25.08 $70.00 $1,755.60
39220 Resect mediastinal tumor 32.78 $70.00 $2,294.60
39401 Mediastinoscpy w/medstnl bx 8.96 $70.00 $627.20
39402 Mediastinoscpy w/lmph nod bx 11.73 $70.00 $821.10
39499 Chest procedure 0.00 $70.00 $0.00
39501 Repair diaphragm laceration 24.65 $70.00 $1,725.50
39503 Repair of diaphragm hernia 173.79 $70.00 $12,165.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
39540 Repair of diaphragm hernia 25.20 $70.00 $1,764.00
39541 Repair of diaphragm hernia 27.25 $70.00 $1,907.50
39545 Revision of diaphragm 25.71 $70.00 $1,799.70
39560 Resect diaphragm simple 23.18 $70.00 $1,622.60
39561 Resect diaphragm complex 35.93 $70.00 $2,515.10
39599 Diaphragm surgery procedure 0.00 $70.00 $0.00
4000F Tobacco use txmnt counseling 0.00 $70.00 $0.00
4001F Tobacco use txmnt pharmacol 0.00 $70.00 $0.00
4003F Pt ed write/oral pts w/ hf 0.00 $70.00 $0.00
4004F Pt tobacco screen rcvd tlk 0.00 $70.00 $0.00
4005F Pharm thx for op rxd 0.00 $70.00 $0.00
4008F Beta-blocker therapy rxd/tkn 0.00 $70.00 $0.00
4010F Ace/arb therapy rxd/taken 0.00 $70.00 $0.00
4011F Oral antiplatelet therapy rx 0.00 $70.00 $0.00
4012F Warfarin therapy rx 0.00 $70.00 $0.00
4013F Statin therapy/currently tkn 0.00 $70.00 $0.00
4014F Written discharge instr prvd 0.00 $70.00 $0.00
4015F Persist asthma medicine ctrl 0.00 $70.00 $0.00
4016F Anti-inflm/anlgsc agent rx 0.00 $70.00 $0.00
4017F Gi prophylaxis for nsaid rx 0.00 $70.00 $0.00
4018F Therapy exercise joint rx 0.00 $70.00 $0.00
4019F Doc recpt counsl vit d/calc+ 0.00 $70.00 $0.00
4025F Inhaled bronchodilator rx 0.00 $70.00 $0.00
4030F Oxygen therapy rx 0.00 $70.00 $0.00
4033F Pulmonary rehab rec 0.00 $70.00 $0.00
4035F Influenza imm rec 0.00 $70.00 $0.00
4037F Influenza imm order/admin 0.00 $70.00 $0.00
4040F Pneumoc vac/admin/rcvd 0.00 $70.00 $0.00
4041F Doc order cefazolin/cefurox 0.00 $70.00 $0.00
4042F Doc antibio not given 0.00 $70.00 $0.00
4043F Doc order given stop antibio 0.00 $70.00 $0.00
4044F Doc order given vte prophylx 0.00 $70.00 $0.00
4045F Empiric antibiotic rx 0.00 $70.00 $0.00
4046F Doc antibio given b/4 surg 0.00 $70.00 $0.00
4047F Doc antibio given b/4 surg 0.00 $70.00 $0.00
4048F Doc antibio given b/4 surg 0.00 $70.00 $0.00
4049F Doc order given stop antibio 0.00 $70.00 $0.00
40490 Biopsy of lip 3.59 $70.00 $251.30
4050F Ht care plan doc 0.00 $70.00 $0.00
40500 Partial excision of lip 14.65 $70.00 $1,025.50
4051F Referred for an av fistula 0.00 $70.00 $0.00
40510 Partial excision of lip 13.96 $70.00 $977.20
4052F Hemodialysis via av fistula 0.00 $70.00 $0.00
40520 Partial excision of lip 14.16 $70.00 $991.20
40525 Reconstruct lip with flap 15.87 $70.00 $1,110.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
40527 Reconstruct lip with flap 17.71 $70.00 $1,239.70
4053F Hemodialysis via av graft 0.00 $70.00 $0.00
40530 Partial removal of lip 15.55 $70.00 $1,088.50
4054F Hemodialysis via catheter 0.00 $70.00 $0.00
4055F Pt rcvng periton dialysis 0.00 $70.00 $0.00
4056F Approp oral rehyd recommd 0.00 $70.00 $0.00
4058F Ped gastro ed given caregvr 0.00 $70.00 $0.00
4060F Psych svcs provided 0.00 $70.00 $0.00
4062F Pt referral psych docd 0.00 $70.00 $0.00
4063F Antidepres rxthxpy not rxd 0.00 $70.00 $0.00
4064F Antidepressant rx 0.00 $70.00 $0.00
4065F Antipsychotic rx 0.00 $70.00 $0.00
40650 Repair lip 13.02 $70.00 $911.40
40652 Repair lip 14.27 $70.00 $998.90
40654 Repair lip 16.49 $70.00 $1,154.30
4066F Ect provided 0.00 $70.00 $0.00
4067F Pt referral for ect docd 0.00 $70.00 $0.00
4069F Vte prophylaxis rcvd 0.00 $70.00 $0.00
4070F Dvt prophylx recvd day 2 0.00 $70.00 $0.00
40700 Repair cleft lip/nasal 29.08 $70.00 $2,035.60
40701 Repair cleft lip/nasal 34.46 $70.00 $2,412.20
40702 Repair cleft lip/nasal 28.91 $70.00 $2,023.70
40720 Repair cleft lip/nasal 29.71 $70.00 $2,079.70
4073F Oral antiplat thx rx dischrg 0.00 $70.00 $0.00
4075F Anticoag thx rx at dischrg 0.00 $70.00 $0.00
40761 Repair cleft lip/nasal 31.33 $70.00 $2,193.10
4077F Doc t-pa admin considered 0.00 $70.00 $0.00
4079F Doc rehab svcs considered 0.00 $70.00 $0.00
40799 Lip surgery procedure 0.00 $70.00 $0.00
40800 Drainage of mouth lesion 6.08 $70.00 $425.60
40801 Drainage of mouth lesion 8.86 $70.00 $620.20
40804 Removal foreign body mouth 5.47 $70.00 $382.90
40805 Removal foreign body mouth 8.91 $70.00 $623.70
40806 Incision of lip fold 2.91 $70.00 $203.70
40808 Biopsy of mouth lesion 5.37 $70.00 $375.90
40810 Excision of mouth lesion 5.99 $70.00 $419.30
40812 Excise/repair mouth lesion 8.30 $70.00 $581.00
40814 Excise/repair mouth lesion 11.09 $70.00 $776.30
40816 Excision of mouth lesion 11.54 $70.00 $807.80
40818 Excise oral mucosa for graft 10.50 $70.00 $735.00
40819 Excise lip or cheek fold 9.05 $70.00 $633.50
40820 Treatment of mouth lesion 7.54 $70.00 $527.80
40830 Repair mouth laceration 7.78 $70.00 $544.60
40831 Repair mouth laceration 9.95 $70.00 $696.50
4084F Aspirin recvd w/in 24 hrs 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
40840 Reconstruction of mouth 23.56 $70.00 $1,649.20
40842 Reconstruction of mouth 22.80 $70.00 $1,596.00
40843 Reconstruction of mouth 30.12 $70.00 $2,108.40
40844 Reconstruction of mouth 39.25 $70.00 $2,747.50
40845 Reconstruction of mouth 42.21 $70.00 $2,954.70
4086F Aspirin/clopidogrel rxd 0.00 $70.00 $0.00
40899 Mouth surgery procedure 0.00 $70.00 $0.00
4090F Pt rcvng epo thxpy 0.00 $70.00 $0.00
4095F Pt not rcvng epo thxpy 0.00 $70.00 $0.00
4100F Biphos thxpy vein ord/recvd 0.00 $70.00 $0.00
41000 Drainage of mouth lesion 4.65 $70.00 $325.50
41005 Drainage of mouth lesion 6.34 $70.00 $443.80
41006 Drainage of mouth lesion 10.20 $70.00 $714.00
41007 Drainage of mouth lesion 10.01 $70.00 $700.70
41008 Drainage of mouth lesion 11.08 $70.00 $775.60
41009 Drainage of mouth lesion 11.86 $70.00 $830.20
41010 Incision of tongue fold 5.90 $70.00 $413.00
41015 Drainage of mouth lesion 12.06 $70.00 $844.20
41016 Drainage of mouth lesion 12.81 $70.00 $896.70
41017 Drainage of mouth lesion 13.01 $70.00 $910.70
41018 Drainage of mouth lesion 14.73 $70.00 $1,031.10
41019 Place needles h&n for rt 13.77 $70.00 $963.90
4110F Int mam art used for cabg 0.00 $70.00 $0.00
41100 Biopsy of tongue 4.94 $70.00 $345.80
41105 Biopsy of tongue 5.02 $70.00 $351.40
41108 Biopsy of floor of mouth 4.37 $70.00 $305.90
41110 Excision of tongue lesion 6.21 $70.00 $434.70
41112 Excision of tongue lesion 9.65 $70.00 $675.50
41113 Excision of tongue lesion 10.51 $70.00 $735.70
41114 Excision of tongue lesion 18.10 $70.00 $1,267.00
41115 Excision of tongue fold 7.17 $70.00 $501.90
41116 Excision of mouth lesion 9.55 $70.00 $668.50
41120 Partial removal of tongue 30.86 $70.00 $2,160.20
41130 Partial removal of tongue 38.09 $70.00 $2,666.30
41135 Tongue and neck surgery 62.92 $70.00 $4,404.40
41140 Removal of tongue 63.01 $70.00 $4,410.70
41145 Tongue removal neck surgery 79.82 $70.00 $5,587.40
4115F Beta blckr admin w/in 24 hrs 0.00 $70.00 $0.00
41150 Tongue mouth jaw surgery 63.52 $70.00 $4,446.40
41153 Tongue mouth neck surgery 68.85 $70.00 $4,819.50
41155 Tongue jaw & neck surgery 87.23 $70.00 $6,106.10
4120F Antibiot rxd/given 0.00 $70.00 $0.00
4124F Antibiot not rxd/given 0.00 $70.00 $0.00
41250 Repair tongue laceration 7.84 $70.00 $548.80
41251 Repair tongue laceration 8.76 $70.00 $613.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
41252 Repair tongue laceration 9.13 $70.00 $639.10
4130F Topical prep rx aoe 0.00 $70.00 $0.00
4131F Syst antimicrobial thx rx 0.00 $70.00 $0.00
4132F No syst antimicrobial thx rx 0.00 $70.00 $0.00
4133F Antihist/decong rx/recom 0.00 $70.00 $0.00
4134F No antihist/decong rx/recom 0.00 $70.00 $0.00
4135F Systemic corticosteroids rx 0.00 $70.00 $0.00
4136F Syst corticosteroids not rx 0.00 $70.00 $0.00
4140F Inhaled corticosteroids rxd 0.00 $70.00 $0.00
4142F Corticoster sparng thrpy rxd 0.00 $70.00 $0.00
4144F Alt long-term cntrl med rxd 0.00 $70.00 $0.00
4145F 2+ anti-hyprtnsv agents tkn 0.00 $70.00 $0.00
4148F Hep a vac injxn admin/recvd 0.00 $70.00 $0.00
4149F Hep b vac injxn admin/recvd 0.00 $70.00 $0.00
4150F Pt recvng antivir txmnt hepc 0.00 $70.00 $0.00
4151F Pt not recvng antiv hep c 0.00 $70.00 $0.00
41510 Tongue to lip surgery 13.01 $70.00 $910.70
41512 Tongue suspension 18.95 $70.00 $1,326.50
41520 Reconstruction tongue fold 10.11 $70.00 $707.70
4153F Combo pegintf/rib rx 0.00 $70.00 $0.00
41530 Tongue base vol reduction 27.44 $70.00 $1,920.80
4155F Hep a vac series prev recvd 0.00 $70.00 $0.00
4157F Hep b vac series prev recvd 0.00 $70.00 $0.00
4158F Pt edu re alcoh drnkng done 0.00 $70.00 $0.00
4159F Contrcp talk b/4 antiv txmnt 0.00 $70.00 $0.00
41599 Tongue and mouth surgery 0.00 $70.00 $0.00
4163F Pt couns 4 txmnt opt prost 0.00 $70.00 $0.00
4164F Adjv hrmnl thxpy rxd 0.00 $70.00 $0.00
4165F 3d-crt/imrt received 0.00 $70.00 $0.00
4167F Hd bed tilted 1st day vent 0.00 $70.00 $0.00
4168F Pt care icu&vent w/in 24hrs 0.00 $70.00 $0.00
4169F No pt care icu/vent in 24hrs 0.00 $70.00 $0.00
4171F Pt rcvng esa thxpy 0.00 $70.00 $0.00
4172F Pt not rcvng esa thxpy 0.00 $70.00 $0.00
4174F Couns potent glauc impct 0.00 $70.00 $0.00
4175F Vis 20/40/> w/in 90 days 0.00 $70.00 $0.00
4176F Talk re uv light pt/crgvr 0.00 $70.00 $0.00
4177F Talk pt/crgvr re areds prev 0.00 $70.00 $0.00
4178F Antid glbln rcvd w/in 26wks 0.00 $70.00 $0.00
4179F Tamoxifen/ai prescribed 0.00 $70.00 $0.00
4180F Adjv thxpyrxd/rcvd colon ca 0.00 $70.00 $0.00
41800 Drainage of gum lesion 8.29 $70.00 $580.30
41805 Removal foreign body gum 8.27 $70.00 $578.90
41806 Removal foreign body jawbone 11.31 $70.00 $791.70
4181F Conformal radn thxpy rcvd 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
4182F No conformal radn thxpy 0.00 $70.00 $0.00
41820 Excision gum each quadrant 0.00 $70.00 $0.00
41821 Excision of gum flap 0.00 $70.00 $0.00
41822 Excision of gum lesion 8.17 $70.00 $571.90
41823 Excision of gum lesion 12.61 $70.00 $882.70
41825 Excision of gum lesion 6.19 $70.00 $433.30
41826 Excision of gum lesion 9.09 $70.00 $636.30
41827 Excision of gum lesion 12.83 $70.00 $898.10
41828 Excision of gum lesion 9.02 $70.00 $631.40
41830 Removal of gum tissue 11.42 $70.00 $799.40
4185F Continuous ppi or h2ra rcvd 0.00 $70.00 $0.00
41850 Treatment of gum lesion 0.00 $70.00 $0.00
4186F No cont ppi or h2ra rcvd 0.00 $70.00 $0.00
4187F Anti rheum drugthxpyrxd/gvn 0.00 $70.00 $0.00
41870 Gum graft 0.00 $70.00 $0.00
41872 Repair gum 11.21 $70.00 $784.70
41874 Repair tooth socket 11.18 $70.00 $782.60
4188F Approp ace/arb tstng done 0.00 $70.00 $0.00
4189F Approp digoxin tstng done 0.00 $70.00 $0.00
41899 Dental surgery procedure 0.00 $70.00 $0.00
4190F Approp diuretic tstng done 0.00 $70.00 $0.00
4191F Approp anticonvuls tstng 0.00 $70.00 $0.00
4192F Pt not rcvng glucoco thxpy 0.00 $70.00 $0.00
4193F Pt rcvng<10mg daily predniso 0.00 $70.00 $0.00
4194F Pt rcvng10mg daily predniso 0.00 $70.00 $0.00
4195F Pt rcvng anti-rheum thxpy ra 0.00 $70.00 $0.00
4196F Ptnot rcvng anti-rhm thxpyra 0.00 $70.00 $0.00
4200F External beam to prost only 0.00 $70.00 $0.00
42000 Drainage mouth roof lesion 4.44 $70.00 $310.80
4201F Extrnl beam other than prost 0.00 $70.00 $0.00
4210F Ace/arb thxpy for mos/> 0.00 $70.00 $0.00
42100 Biopsy roof of mouth 4.28 $70.00 $299.60
42104 Excision lesion mouth roof 6.20 $70.00 $434.00
42106 Excision lesion mouth roof 7.79 $70.00 $545.30
42107 Excision lesion mouth roof 13.36 $70.00 $935.20
42120 Remove palate/lesion 29.14 $70.00 $2,039.80
42140 Excision of uvula 7.67 $70.00 $536.90
42145 Repair palate pharynx/uvula 19.99 $70.00 $1,399.30
42160 Treatment mouth roof lesion 6.69 $70.00 $468.30
42180 Repair palate 7.07 $70.00 $494.90
42182 Repair palate 9.24 $70.00 $646.80
4220F Digoxin thxpy for 6 mos/> 0.00 $70.00 $0.00
42200 Reconstruct cleft palate 27.26 $70.00 $1,908.20
42205 Reconstruct cleft palate 28.46 $70.00 $1,992.20
4221F Diuretic thxpy for 6 mos/> 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
42210 Reconstruct cleft palate 31.72 $70.00 $2,220.40
42215 Reconstruct cleft palate 20.71 $70.00 $1,449.70
42220 Reconstruct cleft palate 17.07 $70.00 $1,194.90
42225 Reconstruct cleft palate 28.42 $70.00 $1,989.40
42226 Lengthening of palate 25.32 $70.00 $1,772.40
42227 Lengthening of palate 23.85 $70.00 $1,669.50
42235 Repair palate 20.82 $70.00 $1,457.40
42260 Repair nose to lip fistula 23.53 $70.00 $1,647.10
42280 Preparation palate mold 5.10 $70.00 $357.00
42281 Insertion palate prosthesis 6.56 $70.00 $459.20
42299 Palate/uvula surgery 0.00 $70.00 $0.00
4230F Anticonv thxpy for 6 mos/> 0.00 $70.00 $0.00
42300 Drainage of salivary gland 6.02 $70.00 $421.40
42305 Drainage of salivary gland 12.31 $70.00 $861.70
42310 Drainage of salivary gland 5.08 $70.00 $355.60
42320 Drainage of salivary gland 7.24 $70.00 $506.80
42330 Removal of salivary stone 6.65 $70.00 $465.50
42335 Removal of salivary stone 11.14 $70.00 $779.80
42340 Removal of salivary stone 13.82 $70.00 $967.40
4240F Instr xrcz back pain 12 wks 0.00 $70.00 $0.00
42400 Biopsy of salivary gland 2.95 $70.00 $206.50
42405 Biopsy of salivary gland 8.59 $70.00 $601.30
42408 Excision of salivary cyst 14.75 $70.00 $1,032.50
42409 Drainage of salivary cyst 9.99 $70.00 $699.30
42410 Excise parotid gland/lesion 17.91 $70.00 $1,253.70
42415 Excise parotid gland/lesion 30.31 $70.00 $2,121.70
4242F Sprvsd xrcz back pn >12 wks 0.00 $70.00 $0.00
42420 Excise parotid gland/lesion 34.06 $70.00 $2,384.20
42425 Excise parotid gland/lesion 23.98 $70.00 $1,678.60
42426 Excise parotid gland/lesion 38.81 $70.00 $2,716.70
42440 Excise submaxillary gland 11.83 $70.00 $828.10
4245F Pt instr nrml lifest 0.00 $70.00 $0.00
42450 Excise sublingual gland 13.01 $70.00 $910.70
4248F Pt instr no bd rest 4 days/> 0.00 $70.00 $0.00
4250F Wrmng 4 surg normothermia 0.00 $70.00 $0.00
42500 Repair salivary duct 12.49 $70.00 $874.30
42505 Repair salivary duct 15.99 $70.00 $1,119.30
42507 Parotid duct diversion 14.49 $70.00 $1,014.30
42509 Parotid duct diversion 23.96 $70.00 $1,677.20
42510 Parotid duct diversion 17.78 $70.00 $1,244.60
4255F Anesth 60 min/> as docd 0.00 $70.00 $0.00
42550 Injection for salivary x-ray 4.17 $70.00 $291.90
4256F Anesthe <60 min as docd 0.00 $70.00 $0.00
4260F Wound srfc culturetech used 0.00 $70.00 $0.00
42600 Closure of salivary fistula 14.15 $70.00 $990.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
4261F Tech other than surfc cultr 0.00 $70.00 $0.00
4265F Wet-dry dressings rx recmd 0.00 $70.00 $0.00
42650 Dilation of salivary duct 2.31 $70.00 $161.70
4266F No wet-dry drssings rx recmd 0.00 $70.00 $0.00
42660 Dilation of salivary duct 3.61 $70.00 $252.70
42665 Ligation of salivary duct 9.42 $70.00 $659.40
4267F Comprssion thxpy prescribed 0.00 $70.00 $0.00
4268F Pt ed re comp thxpy rcvd 0.00 $70.00 $0.00
4269F Appropos mthd offloading rxd 0.00 $70.00 $0.00
42699 Salivary surgery procedure 0.00 $70.00 $0.00
4270F Pt rcvng anti r-viral thxpy 0.00 $70.00 $0.00
42700 Drainage of tonsil abscess 5.43 $70.00 $380.10
4271F Pt rcvng anti r-viral thxpy 0.00 $70.00 $0.00
42720 Drainage of throat abscess 13.03 $70.00 $912.10
42725 Drainage of throat abscess 23.50 $70.00 $1,645.00
4274F Flu immuno admind rcvd 0.00 $70.00 $0.00
4276F Potent antivir thxpy rxd 0.00 $70.00 $0.00
4279F Pcp prophylaxis rxd 0.00 $70.00 $0.00
4280F Pcp prophylax rxd 3mon low % 0.00 $70.00 $0.00
42800 Biopsy of throat 4.50 $70.00 $315.00
42804 Biopsy of upper nose/throat 5.65 $70.00 $395.50
42806 Biopsy of upper nose/throat 6.32 $70.00 $442.40
42808 Excise pharynx lesion 6.52 $70.00 $456.40
42809 Remove pharynx foreign body 5.75 $70.00 $402.50
42810 Excision of neck cyst 11.06 $70.00 $774.20
42815 Excision of neck cyst 15.79 $70.00 $1,105.30
42820 Remove tonsils and adenoids 8.30 $70.00 $581.00
42821 Remove tonsils and adenoids 8.62 $70.00 $603.40
42825 Removal of tonsils 7.51 $70.00 $525.70
42826 Removal of tonsils 7.21 $70.00 $504.70
42830 Removal of adenoids 5.95 $70.00 $416.50
42831 Removal of adenoids 6.43 $70.00 $450.10
42835 Removal of adenoids 5.53 $70.00 $387.10
42836 Removal of adenoids 6.89 $70.00 $482.30
42842 Extensive surgery of throat 29.06 $70.00 $2,034.20
42844 Extensive surgery of throat 39.95 $70.00 $2,796.50
42845 Extensive surgery of throat 64.32 $70.00 $4,502.40
42860 Excision of tonsil tags 5.39 $70.00 $377.30
42870 Excision of lingual tonsil 17.01 $70.00 $1,190.70
42890 Partial removal of pharynx 41.27 $70.00 $2,888.90
42892 Revision of pharyngeal walls 54.17 $70.00 $3,791.90
42894 Revision of pharyngeal walls 68.55 $70.00 $4,798.50
4290F Pt scrned for inj drug use 0.00 $70.00 $0.00
42900 Repair throat wound 9.65 $70.00 $675.50
4293F Pt scrnd hgh-risk sex behav 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
42950 Reconstruction of throat 23.28 $70.00 $1,629.60
42953 Repair throat esophagus 27.92 $70.00 $1,954.40
42955 Surgical opening of throat 22.06 $70.00 $1,544.20
42960 Control throat bleeding 4.83 $70.00 $338.10
42961 Control throat bleeding 11.98 $70.00 $838.60
42962 Control throat bleeding 14.83 $70.00 $1,038.10
42970 Control nose/throat bleeding 11.79 $70.00 $825.30
42971 Control nose/throat bleeding 13.05 $70.00 $913.50
42972 Control nose/throat bleeding 14.61 $70.00 $1,022.70
42999 Throat surgery procedure 0.00 $70.00 $0.00
4300F Pt rcvng warf thxpy 0.00 $70.00 $0.00
4301F Pt not rcvng warf thxpy 0.00 $70.00 $0.00
43020 Incision of esophagus 16.17 $70.00 $1,131.90
43030 Throat muscle surgery 14.92 $70.00 $1,044.40
43045 Incision of esophagus 37.67 $70.00 $2,636.90
4305F Pt ed re ft care inspct rcvd 0.00 $70.00 $0.00
4306F Pt tlk psych & rx opd addic 0.00 $70.00 $0.00
43100 Excision of esophagus lesion 17.97 $70.00 $1,257.90
43101 Excision of esophagus lesion 29.05 $70.00 $2,033.50
43107 Removal of esophagus 86.50 $70.00 $6,055.00
43108 Removal of esophagus 129.92 $70.00 $9,094.40
43112 Esphg tot w/thrcm 101.65 $70.00 $7,115.50
43113 Removal of esophagus 126.83 $70.00 $8,878.10
43116 Partial removal of esophagus 145.63 $70.00 $10,194.10
43117 Partial removal of esophagus 94.39 $70.00 $6,607.30
43118 Partial removal of esophagus 105.70 $70.00 $7,399.00
43121 Partial removal of esophagus 82.30 $70.00 $5,761.00
43122 Partial removal of esophagus 74.11 $70.00 $5,187.70
43123 Partial removal of esophagus 130.02 $70.00 $9,101.40
43124 Removal of esophagus 110.47 $70.00 $7,732.90
43130 Removal of esophagus pouch 22.63 $70.00 $1,584.10
43135 Removal of esophagus pouch 42.55 $70.00 $2,978.50
43180 Esophagoscopy rigid trnso 15.75 $70.00 $1,102.50
43191 Esophagoscopy rigid trnso dx 4.47 $70.00 $312.90
43192 Esophagoscp rig trnso inject 4.88 $70.00 $341.60
43193 Esophagoscp rig trnso biopsy 4.88 $70.00 $341.60
43194 Esophagoscp rig trnso rem fb 5.58 $70.00 $390.60
43195 Esophagoscopy rigid balloon 5.32 $70.00 $372.40
43196 Esophagoscp guide wire dilat 5.67 $70.00 $396.90
43197 Esophagoscopy flex dx brush 5.34 $70.00 $373.80
43198 Esophagosc flex trnsn biopsy 5.88 $70.00 $411.60
4320F Pt talk psychsoc&rx oh dpnd 0.00 $70.00 $0.00
43200 Esophagoscopy flexible brush 6.50 $70.00 $455.00
43201 Esoph scope w/submucous inj 6.55 $70.00 $458.50
43202 Esophagoscopy flex biopsy 9.16 $70.00 $641.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
43204 Esoph scope w/sclerosis inj 3.96 $70.00 $277.20
43205 Esophagus endoscopy/ligation 4.13 $70.00 $289.10
43206 Esoph optical endomicroscopy 7.85 $70.00 $549.50
43210 Egd esophagogastrc fndoplsty 12.55 $70.00 $878.50
43211 Esophagoscop mucosal resect 6.87 $70.00 $480.90
43212 Esophagoscop stent placement 5.54 $70.00 $387.80
43213 Esophagoscopy retro balloon 33.85 $70.00 $2,369.50
43214 Esophagosc dilate balloon 30 5.61 $70.00 $392.70
43215 Esophagoscopy flex remove fb 10.58 $70.00 $740.60
43216 Esophagoscopy lesion removal 10.63 $70.00 $744.10
43217 Esophagoscopy snare les remv 11.15 $70.00 $780.50
4322F Crgvr prov w/ ed addl rsrcs 0.00 $70.00 $0.00
43220 Esophagoscopy balloon <30mm 29.58 $70.00 $2,070.60
43226 Esoph endoscopy dilation 9.59 $70.00 $671.30
43227 Esophagoscopy control bleed 17.79 $70.00 $1,245.30
43229 Esophagoscopy lesion ablate 19.09 $70.00 $1,336.30
43231 Esophagoscop ultrasound exam 9.79 $70.00 $685.30
43232 Esophagoscopy w/us needle bx 11.89 $70.00 $832.30
43233 Egd balloon dil esoph30 mm/> 6.68 $70.00 $467.60
43235 Egd diagnostic brush wash 7.61 $70.00 $532.70
43236 Uppr gi scope w/submuc inj 10.01 $70.00 $700.70
43237 Endoscopic us exam esoph 5.73 $70.00 $401.10
43238 Egd us fine needle bx/aspir 6.81 $70.00 $476.70
43239 Egd biopsy single/multiple 10.19 $70.00 $713.30
4324F Pt queried prkns complic 0.00 $70.00 $0.00
43240 Egd w/transmural drain cyst 11.50 $70.00 $805.00
43241 Egd tube/cath insertion 4.17 $70.00 $291.90
43242 Egd us fine needle bx/aspir 7.69 $70.00 $538.30
43243 Egd injection varices 6.94 $70.00 $485.80
43244 Egd varices ligation 7.17 $70.00 $501.90
43245 Egd dilate stricture 16.22 $70.00 $1,135.40
43246 Egd place gastrostomy tube 5.86 $70.00 $410.20
43247 Egd remove foreign body 10.24 $70.00 $716.80
43248 Egd guide wire insertion 10.52 $70.00 $736.40
43249 Esoph egd dilation <30 mm 29.99 $70.00 $2,099.30
4325F Med txmnt options rvwd w/pt 0.00 $70.00 $0.00
43250 Egd cautery tumor polyp 11.80 $70.00 $826.00
43251 Egd remove lesion snare 13.04 $70.00 $912.80
43252 Egd optical endomicroscopy 8.96 $70.00 $627.20
43253 Egd us transmural injxn/mark 7.70 $70.00 $539.00
43254 Egd endo mucosal resection 7.91 $70.00 $553.70
43255 Egd control bleeding any 18.77 $70.00 $1,313.90
43257 Egd w/thrml txmnt gerd 6.80 $70.00 $476.00
43259 Egd us exam duodenum/jejunum 6.62 $70.00 $463.40
4326F Pt asked re symp auto dysfxn 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
43260 Ercp w/specimen collection 9.45 $70.00 $661.50
43261 Endo cholangiopancreatograph 9.92 $70.00 $694.40
43262 Endo cholangiopancreatograph 10.46 $70.00 $732.20
43263 Ercp sphincter pressure meas 10.47 $70.00 $732.90
43264 Ercp remove duct calculi 10.66 $70.00 $746.20
43265 Ercp lithotripsy calculi 12.69 $70.00 $888.30
43266 Egd endoscopic stent place 6.39 $70.00 $447.30
43270 Egd lesion ablation 19.65 $70.00 $1,375.50
43273 Endoscopic pancreatoscopy 3.49 $70.00 $244.30
43274 Ercp duct stent placement 13.56 $70.00 $949.20
43275 Ercp remove forgn body duct 11.04 $70.00 $772.80
43276 Ercp stent exchange w/dilate 14.12 $70.00 $988.40
43277 Ercp ea duct/ampulla dilate 11.09 $70.00 $776.30
43278 Ercp lesion ablate w/dilate 12.68 $70.00 $887.60
43279 Lap myotomy heller 37.39 $70.00 $2,617.30
4328F Pt asked re sleep disturb 0.00 $70.00 $0.00
43280 Laparoscopy fundoplasty 31.33 $70.00 $2,193.10
43281 Lap paraesophag hern repair 44.78 $70.00 $3,134.60
43282 Lap paraesoph her rpr w/mesh 50.35 $70.00 $3,524.50
43283 Lap esoph lengthening 4.60 $70.00 $322.00
43284 Laps esophgl sphnctr agmntj 18.68 $70.00 $1,307.60
43285 Rmvl esophgl sphnctr dev 19.00 $70.00 $1,330.00
43286 Esphg tot w/laps moblj 90.99 $70.00 $6,369.30
43287 Esphg dstl 2/3 w/laps moblj 104.14 $70.00 $7,289.80
43288 Esphg thrsc moblj 108.45 $70.00 $7,591.50
43289 Laparoscope proc esoph 0.00 $70.00 $0.00
4330F Cnslng epi spec sfty issues 0.00 $70.00 $0.00
43300 Repair of esophagus 17.65 $70.00 $1,235.50
43305 Repair esophagus and fistula 31.30 $70.00 $2,191.00
43310 Repair of esophagus 42.92 $70.00 $3,004.40
43312 Repair esophagus and fistula 46.14 $70.00 $3,229.80
43313 Esophagoplasty congenital 79.32 $70.00 $5,552.40
43314 Tracheo-esophagoplasty cong 82.46 $70.00 $5,772.20
43320 Fuse esophagus & stomach 40.46 $70.00 $2,832.20
43325 Revise esophagus & stomach 39.36 $70.00 $2,755.20
43327 Esoph fundoplasty lap 23.76 $70.00 $1,663.20
43328 Esoph fundoplasty thor 32.60 $70.00 $2,282.00
43330 Esophagomyotomy abdominal 38.70 $70.00 $2,709.00
43331 Esophagomyotomy thoracic 38.73 $70.00 $2,711.10
43332 Transab esoph hiat hern rpr 33.60 $70.00 $2,352.00
43333 Transab esoph hiat hern rpr 36.58 $70.00 $2,560.60
43334 Transthor diaphrag hern rpr 36.21 $70.00 $2,534.70
43335 Transthor diaphrag hern rpr 38.74 $70.00 $2,711.80
43336 Thorabd diaphr hern repair 43.82 $70.00 $3,067.40
43337 Thorabd diaphr hern repair 44.59 $70.00 $3,121.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
43338 Esoph lengthening 3.37 $70.00 $235.90
43340 Fuse esophagus & intestine 39.87 $70.00 $2,790.90
43341 Fuse esophagus & intestine 40.60 $70.00 $2,842.00
43351 Surgical opening esophagus 37.68 $70.00 $2,637.60
43352 Surgical opening esophagus 30.88 $70.00 $2,161.60
43360 Gastrointestinal repair 65.23 $70.00 $4,566.10
43361 Gastrointestinal repair 78.32 $70.00 $5,482.40
4340F Cnslng chldbrng women epi 0.00 $70.00 $0.00
43400 Ligate esophagus veins 44.24 $70.00 $3,096.80
43401 Esophagus surgery for veins 44.16 $70.00 $3,091.20
43405 Ligate/staple esophagus 41.99 $70.00 $2,939.30
43410 Repair esophagus wound 29.44 $70.00 $2,060.80
43415 Repair esophagus wound 74.66 $70.00 $5,226.20
43420 Repair esophagus opening 29.19 $70.00 $2,043.30
43425 Repair esophagus opening 41.64 $70.00 $2,914.80
43450 Dilate esophagus 1/mult pass 4.70 $70.00 $329.00
43453 Dilate esophagus 25.45 $70.00 $1,781.50
43460 Pressure treatment esophagus 6.22 $70.00 $435.40
43496 Free jejunum flap microvasc 0.00 $70.00 $0.00
43499 Esophagus surgery procedure 0.00 $70.00 $0.00
4350F Cnslng provided symp mngmnt 0.00 $70.00 $0.00
43500 Surgical opening of stomach 22.74 $70.00 $1,591.80
43501 Surgical repair of stomach 39.04 $70.00 $2,732.80
43502 Surgical repair of stomach 44.00 $70.00 $3,080.00
43510 Surgical opening of stomach 27.46 $70.00 $1,922.20
43520 Incision of pyloric muscle 19.95 $70.00 $1,396.50
43605 Biopsy of stomach 24.33 $70.00 $1,703.10
43610 Excision of stomach lesion 28.51 $70.00 $1,995.70
43611 Excision of stomach lesion 35.57 $70.00 $2,489.90
43620 Removal of stomach 57.00 $70.00 $3,990.00
43621 Removal of stomach 65.99 $70.00 $4,619.30
43622 Removal of stomach 67.00 $70.00 $4,690.00
43631 Removal of stomach partial 42.09 $70.00 $2,946.30
43632 Removal of stomach partial 59.08 $70.00 $4,135.60
43633 Removal of stomach partial 55.81 $70.00 $3,906.70
43634 Removal of stomach partial 61.48 $70.00 $4,303.60
43635 Removal of stomach partial 3.26 $70.00 $228.20
43640 Vagotomy & pylorus repair 34.19 $70.00 $2,393.30
43641 Vagotomy & pylorus repair 34.64 $70.00 $2,424.80
43644 Lap gastric bypass/roux-en-y 50.24 $70.00 $3,516.80
43645 Lap gastr bypass incl smll i 53.77 $70.00 $3,763.90
43647 Lap impl electrode antrum 0.00 $70.00 $0.00
43648 Lap revise/remv eltrd antrum 0.00 $70.00 $0.00
43651 Laparoscopy vagus nerve 18.88 $70.00 $1,321.60
43652 Laparoscopy vagus nerve 22.19 $70.00 $1,553.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
43653 Laparoscopy gastrostomy 16.62 $70.00 $1,163.40
43659 Laparoscope proc stom 0.00 $70.00 $0.00
43752 Nasal/orogastric w/tube plmt 1.17 $70.00 $81.90
43753 Tx gastro intub w/asp 0.63 $70.00 $44.10
43754 Dx gastr intub w/asp spec 4.62 $70.00 $323.40
43755 Dx gastr intub w/asp specs 4.43 $70.00 $310.10
43756 Dx duod intub w/asp spec 6.52 $70.00 $456.40
43757 Dx duod intub w/asp specs 9.08 $70.00 $635.60
43761 Reposition gastrostomy tube 3.43 $70.00 $240.10
43762 Rplc gtube no revj trc 6.31 $70.00 $441.70
43763 Rplc gtube revj gstrst trc 9.37 $70.00 $655.90
43770 Lap place gastr adj device 32.58 $70.00 $2,280.60
43771 Lap revise gastr adj device 36.77 $70.00 $2,573.90
43772 Lap rmvl gastr adj device 27.44 $70.00 $1,920.80
43773 Lap replace gastr adj device 36.83 $70.00 $2,578.10
43774 Lap rmvl gastr adj all parts 27.82 $70.00 $1,947.40
43775 Lap sleeve gastrectomy 32.36 $70.00 $2,265.20
43800 Reconstruction of pylorus 26.99 $70.00 $1,889.30
43810 Fusion of stomach and bowel 29.41 $70.00 $2,058.70
43820 Fusion of stomach and bowel 38.97 $70.00 $2,727.90
43825 Fusion of stomach and bowel 37.88 $70.00 $2,651.60
43830 Place gastrostomy tube 20.30 $70.00 $1,421.00
43831 Place gastrostomy tube 17.35 $70.00 $1,214.50
43832 Place gastrostomy tube 30.08 $70.00 $2,105.60
43840 Repair of stomach lesion 39.44 $70.00 $2,760.80
43842 V-band gastroplasty 34.59 $70.00 $2,421.30
43843 Gastroplasty w/o v-band 36.60 $70.00 $2,562.00
43845 Gastroplasty duodenal switch 56.50 $70.00 $3,955.00
43846 Gastric bypass for obesity 47.01 $70.00 $3,290.70
43847 Gastric bypass incl small i 52.10 $70.00 $3,647.00
43848 Revision gastroplasty 55.91 $70.00 $3,913.70
43850 Revise stomach-bowel fusion 46.99 $70.00 $3,289.30
43855 Revise stomach-bowel fusion 46.67 $70.00 $3,266.90
43860 Revise stomach-bowel fusion 47.43 $70.00 $3,320.10
43865 Revise stomach-bowel fusion 49.42 $70.00 $3,459.40
43870 Repair stomach opening 20.60 $70.00 $1,442.00
43880 Repair stomach-bowel fistula 46.18 $70.00 $3,232.60
43881 Impl/redo electrd antrum 0.00 $70.00 $0.00
43882 Revise/remove electrd antrum 0.00 $70.00 $0.00
43886 Revise gastric port open 10.48 $70.00 $733.60
43887 Remove gastric port open 9.44 $70.00 $660.80
43888 Change gastric port open 13.32 $70.00 $932.40
43999 Stomach surgery procedure 0.00 $70.00 $0.00
4400F Rehab thxpy options w/pt 0.00 $70.00 $0.00
44005 Freeing of bowel adhesion 31.76 $70.00 $2,223.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
44010 Incision of small bowel 24.94 $70.00 $1,745.80
44015 Insert needle cath bowel 4.13 $70.00 $289.10
44020 Explore small intestine 28.25 $70.00 $1,977.50
44021 Decompress small bowel 28.30 $70.00 $1,981.00
44025 Incision of large bowel 28.54 $70.00 $1,997.80
44050 Reduce bowel obstruction 27.12 $70.00 $1,898.40
44055 Correct malrotation of bowel 43.40 $70.00 $3,038.00
44100 Biopsy of bowel 3.14 $70.00 $219.80
44110 Excise intestine lesion(s) 24.63 $70.00 $1,724.10
44111 Excision of bowel lesion(s) 28.51 $70.00 $1,995.70
44120 Removal of small intestine 35.48 $70.00 $2,483.60
44121 Removal of small intestine 7.04 $70.00 $492.80
44125 Removal of small intestine 34.20 $70.00 $2,394.00
44126 Enterectomy w/o taper cong 71.32 $70.00 $4,992.40
44127 Enterectomy w/taper cong 82.99 $70.00 $5,809.30
44128 Enterectomy cong add-on 7.10 $70.00 $497.00
44130 Bowel to bowel fusion 38.12 $70.00 $2,668.40
44132 Enterectomy cadaver donor 0.00 $70.00 $0.00
44133 Enterectomy live donor 0.00 $70.00 $0.00
44135 Intestine transplnt cadaver 0.00 $70.00 $0.00
44136 Intestine transplant live 0.00 $70.00 $0.00
44137 Remove intestinal allograft 0.00 $70.00 $0.00
44139 Mobilization of colon 3.51 $70.00 $245.70
44140 Partial removal of colon 38.92 $70.00 $2,724.40
44141 Partial removal of colon 52.92 $70.00 $3,704.40
44143 Partial removal of colon 48.27 $70.00 $3,378.90
44144 Partial removal of colon 51.34 $70.00 $3,593.80
44145 Partial removal of colon 48.05 $70.00 $3,363.50
44146 Partial removal of colon 61.36 $70.00 $4,295.20
44147 Partial removal of colon 56.35 $70.00 $3,944.50
44150 Removal of colon 54.09 $70.00 $3,786.30
44151 Removal of colon/ileostomy 62.66 $70.00 $4,386.20
44155 Removal of colon/ileostomy 60.15 $70.00 $4,210.50
44156 Removal of colon/ileostomy 66.53 $70.00 $4,657.10
44157 Colectomy w/ileoanal anast 63.60 $70.00 $4,452.00
44158 Colectomy w/neo-rectum pouch 65.29 $70.00 $4,570.30
44160 Removal of colon 36.01 $70.00 $2,520.70
44180 Lap enterolysis 26.67 $70.00 $1,866.90
44186 Lap jejunostomy 18.86 $70.00 $1,320.20
44187 Lap ileo/jejuno-stomy 31.88 $70.00 $2,231.60
44188 Lap colostomy 35.46 $70.00 $2,482.20
44202 Lap enterectomy 40.13 $70.00 $2,809.10
44203 Lap resect s/intestine addl 6.96 $70.00 $487.20
44204 Laparo partial colectomy 44.61 $70.00 $3,122.70
44205 Lap colectomy part w/ileum 38.76 $70.00 $2,713.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
44206 Lap part colectomy w/stoma 50.69 $70.00 $3,548.30
44207 L colectomy/coloproctostomy 52.68 $70.00 $3,687.60
44208 L colectomy/coloproctostomy 57.40 $70.00 $4,018.00
44210 Laparo total proctocolectomy 51.50 $70.00 $3,605.00
44211 Lap colectomy w/proctectomy 62.95 $70.00 $4,406.50
44212 Laparo total proctocolectomy 59.16 $70.00 $4,141.20
44213 Lap mobil splenic fl add-on 5.45 $70.00 $381.50
44227 Lap close enterostomy 48.27 $70.00 $3,378.90
44238 Laparoscope proc intestine 0.00 $70.00 $0.00
44300 Open bowel to skin 24.44 $70.00 $1,710.80
44310 Ileostomy/jejunostomy 30.24 $70.00 $2,116.80
44312 Revision of ileostomy 17.13 $70.00 $1,199.10
44314 Revision of ileostomy 29.10 $70.00 $2,037.00
44316 Devise bowel pouch 41.08 $70.00 $2,875.60
44320 Colostomy 34.85 $70.00 $2,439.50
44322 Colostomy with biopsies 28.97 $70.00 $2,027.90
44340 Revision of colostomy 18.04 $70.00 $1,262.80
44345 Revision of colostomy 30.44 $70.00 $2,130.80
44346 Revision of colostomy 34.27 $70.00 $2,398.90
44360 Small bowel endoscopy 4.20 $70.00 $294.00
44361 Small bowel endoscopy/biopsy 4.65 $70.00 $325.50
44363 Small bowel endoscopy 5.62 $70.00 $393.40
44364 Small bowel endoscopy 5.99 $70.00 $419.30
44365 Small bowel endoscopy 5.32 $70.00 $372.40
44366 Small bowel endoscopy 7.02 $70.00 $491.40
44369 Small bowel endoscopy 7.19 $70.00 $503.30
44370 Small bowel endoscopy/stent 7.80 $70.00 $546.00
44372 Small bowel endoscopy 7.02 $70.00 $491.40
44373 Small bowel endoscopy 5.62 $70.00 $393.40
44376 Small bowel endoscopy 8.33 $70.00 $583.10
44377 Small bowel endoscopy/biopsy 8.77 $70.00 $613.90
44378 Small bowel endoscopy 11.28 $70.00 $789.60
44379 S bowel endoscope w/stent 11.99 $70.00 $839.30
44380 Small bowel endoscopy br/wa 4.97 $70.00 $347.90
44381 Small bowel endoscopy br/wa 27.08 $70.00 $1,895.60
44382 Small bowel endoscopy 7.80 $70.00 $546.00
44384 Small bowel endoscopy 4.47 $70.00 $312.90
44385 Endoscopy of bowel pouch 5.60 $70.00 $392.00
44386 Endoscopy bowel pouch/biop 8.36 $70.00 $585.20
44388 Colonoscopy thru stoma spx 8.42 $70.00 $589.40
44388 53 Colonoscopy thru stoma spx 4.20 $70.00 $294.00
44389 Colonoscopy with biopsy 11.08 $70.00 $775.60
44390 Colonoscopy for foreign body 10.96 $70.00 $767.20
44391 Colonoscopy for bleeding 19.31 $70.00 $1,351.70
44392 Colonoscopy & polypectomy 10.25 $70.00 $717.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
44394 Colonoscopy w/snare 11.79 $70.00 $825.30
44401 Colonoscopy with ablation 86.23 $70.00 $6,036.10
44402 Colonoscopy w/stent plcmt 7.66 $70.00 $536.20
44403 Colonoscopy w/resection 8.89 $70.00 $622.30
44404 Colonoscopy w/injection 10.80 $70.00 $756.00
44405 Colonoscopy w/dilation 15.57 $70.00 $1,089.90
44406 Colonoscopy w/ultrasound 6.73 $70.00 $471.10
44407 Colonoscopy w/ndl aspir/bx 8.08 $70.00 $565.60
44408 Colonoscopy w/decompression 6.79 $70.00 $475.30
4450F Self-care ed provided to pt 0.00 $70.00 $0.00
44500 Intro gastrointestinal tube 0.56 $70.00 $39.20
44602 Suture small intestine 40.96 $70.00 $2,867.20
44603 Suture small intestine 47.01 $70.00 $3,290.70
44604 Suture large intestine 30.71 $70.00 $2,149.70
44605 Repair of bowel lesion 37.78 $70.00 $2,644.60
44615 Intestinal stricturoplasty 31.14 $70.00 $2,179.80
44620 Repair bowel opening 25.14 $70.00 $1,759.80
44625 Repair bowel opening 29.43 $70.00 $2,060.10
44626 Repair bowel opening 46.43 $70.00 $3,250.10
44640 Repair bowel-skin fistula 40.65 $70.00 $2,845.50
44650 Repair bowel fistula 41.87 $70.00 $2,930.90
44660 Repair bowel-bladder fistula 38.70 $70.00 $2,709.00
44661 Repair bowel-bladder fistula 44.98 $70.00 $3,148.60
44680 Surgical revision intestine 31.07 $70.00 $2,174.90
4470F Icd counseling provided 0.00 $70.00 $0.00
44700 Suspend bowel w/prosthesis 29.16 $70.00 $2,041.20
44701 Intraop colon lavage add-on 4.94 $70.00 $345.80
44705 Prepare fecal microbiota 3.25 $70.00 $227.50
44715 Prepare donor intestine 0.00 $70.00 $0.00
44720 Prep donor intestine/venous 7.99 $70.00 $559.30
44721 Prep donor intestine/artery 11.17 $70.00 $781.90
44799 Unlisted px small intestine 0.00 $70.00 $0.00
4480F Pt rcvng ace/arb b-blockertx 0.00 $70.00 $0.00
44800 Excision of bowel pouch 22.23 $70.00 $1,556.10
4481F Pt rcvng ace/arb blker >3mos 0.00 $70.00 $0.00
44820 Excision of mesentery lesion 24.27 $70.00 $1,698.90
44850 Repair of mesentery 21.70 $70.00 $1,519.00
44899 Bowel surgery procedure 0.00 $70.00 $0.00
44900 Drain appendix abscess open 22.41 $70.00 $1,568.70
44950 Appendectomy 18.62 $70.00 $1,303.40
44955 Appendectomy add-on 2.45 $70.00 $171.50
44960 Appendectomy 25.41 $70.00 $1,778.70
44970 Laparoscopy appendectomy 17.42 $70.00 $1,219.40
44979 Laparoscope proc app 0.00 $70.00 $0.00
4500F Ref to outpt card rehab prog 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
45000 Drainage of pelvic abscess 12.27 $70.00 $858.90
45005 Drainage of rectal abscess 8.14 $70.00 $569.80
45020 Drainage of rectal abscess 16.58 $70.00 $1,160.60
4510F Prev cardrehab qualcardevent 0.00 $70.00 $0.00
45100 Biopsy of rectum 8.64 $70.00 $604.80
45108 Removal of anorectal lesion 10.70 $70.00 $749.00
45110 Removal of rectum 53.33 $70.00 $3,733.10
45111 Partial removal of rectum 31.48 $70.00 $2,203.60
45112 Removal of rectum 54.02 $70.00 $3,781.40
45113 Partial proctectomy 54.69 $70.00 $3,828.30
45114 Partial removal of rectum 52.61 $70.00 $3,682.70
45116 Partial removal of rectum 45.12 $70.00 $3,158.40
45119 Remove rectum w/reservoir 55.95 $70.00 $3,916.50
45120 Removal of rectum 46.04 $70.00 $3,222.80
45121 Removal of rectum and colon 49.97 $70.00 $3,497.90
45123 Partial proctectomy 32.49 $70.00 $2,274.30
45126 Pelvic exenteration 80.56 $70.00 $5,639.20
45130 Excision of rectal prolapse 31.47 $70.00 $2,202.90
45135 Excision of rectal prolapse 37.69 $70.00 $2,638.30
45136 Excise ileoanal reservior 53.38 $70.00 $3,736.60
45150 Excision of rectal stricture 12.02 $70.00 $841.40
45160 Excision of rectal lesion 29.70 $70.00 $2,079.00
45171 Exc rect tum transanal part 17.43 $70.00 $1,220.10
45172 Exc rect tum transanal full 23.51 $70.00 $1,645.70
45190 Destruction rectal tumor 20.16 $70.00 $1,411.20
4525F Neuropsychia interven order 0.00 $70.00 $0.00
4526F Neuropsychia interven rcvd 0.00 $70.00 $0.00
45300 Proctosigmoidoscopy dx 3.47 $70.00 $242.90
45303 Proctosigmoidoscopy dilate 26.34 $70.00 $1,843.80
45305 Proctosigmoidoscopy w/bx 4.38 $70.00 $306.60
45307 Proctosigmoidoscopy fb 5.03 $70.00 $352.10
45308 Proctosigmoidoscopy removal 4.93 $70.00 $345.10
45309 Proctosigmoidoscopy removal 5.11 $70.00 $357.70
45315 Proctosigmoidoscopy removal 5.61 $70.00 $392.70
45317 Proctosigmoidoscopy bleed 5.52 $70.00 $386.40
45320 Proctosigmoidoscopy ablate 5.47 $70.00 $382.90
45321 Proctosigmoidoscopy volvul 2.99 $70.00 $209.30
45327 Proctosigmoidoscopy w/stent 3.38 $70.00 $236.60
45330 Diagnostic sigmoidoscopy 4.88 $70.00 $341.60
45331 Sigmoidoscopy and biopsy 7.60 $70.00 $532.00
45332 Sigmoidoscopy w/fb removal 7.36 $70.00 $515.20
45333 Sigmoidoscopy & polypectomy 8.67 $70.00 $606.90
45334 Sigmoidoscopy for bleeding 15.37 $70.00 $1,075.90
45335 Sigmoidoscopy w/submuc inj 7.15 $70.00 $500.50
45337 Sigmoidoscopy & decompress 3.37 $70.00 $235.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
45338 Sigmoidoscopy w/tumr remove 7.89 $70.00 $552.30
45340 Sig w/tndsc balloon dilation 12.62 $70.00 $883.40
45341 Sigmoidoscopy w/ultrasound 3.61 $70.00 $252.70
45342 Sigmoidoscopy w/us guide bx 4.96 $70.00 $347.20
45346 Sigmoidoscopy w/ablation 82.38 $70.00 $5,766.60
45347 Sigmoidoscopy w/plcmt stent 4.52 $70.00 $316.40
45349 Sigmoidoscopy w/resection 5.80 $70.00 $406.00
45350 Sgmdsc w/band ligation 16.40 $70.00 $1,148.00
45378 Diagnostic colonoscopy 9.18 $70.00 $642.60
45378 53 Diagnostic colonoscopy 4.59 $70.00 $321.30
45379 Colonoscopy w/fb removal 11.86 $70.00 $830.20
45380 Colonoscopy and biopsy 11.79 $70.00 $825.30
45381 Colonoscopy submucous njx 11.52 $70.00 $806.40
45382 Colonoscopy w/control bleed 20.23 $70.00 $1,416.10
45384 Colonoscopy w/lesion removal 13.13 $70.00 $919.10
45385 Colonoscopy w/lesion removal 12.38 $70.00 $866.60
45386 Colonoscopy w/balloon dilat 17.00 $70.00 $1,190.00
45388 Colonoscopy w/ablation 86.87 $70.00 $6,080.90
45389 Colonoscopy w/stent plcmt 8.49 $70.00 $594.30
45390 Colonoscopy w/resection 9.74 $70.00 $681.80
45391 Colonoscopy w/endoscope us 7.55 $70.00 $528.50
45392 Colonoscopy w/endoscopic fnb 8.91 $70.00 $623.70
45393 Colonoscopy w/decompression 7.41 $70.00 $518.70
45395 Lap removal of rectum 57.13 $70.00 $3,999.10
45397 Lap remove rectum w/pouch 62.15 $70.00 $4,350.50
45398 Colonoscopy w/band ligation 20.87 $70.00 $1,460.90
45399 Unlisted procedure colon 0.00 $70.00 $0.00
4540F Disease modif pharmacothxpy 0.00 $70.00 $0.00
45400 Laparoscopic proc 32.96 $70.00 $2,307.20
45402 Lap proctopexy w/sig resect 43.83 $70.00 $3,068.10
4541F Pt offered tx for pseudobulb 0.00 $70.00 $0.00
45499 Laparoscope proc rectum 0.00 $70.00 $0.00
4550F Noninvas resp support talk 0.00 $70.00 $0.00
45500 Repair of rectum 16.16 $70.00 $1,131.20
45505 Repair of rectum 17.16 $70.00 $1,201.20
4551F Nutritional support offered 0.00 $70.00 $0.00
4552F Pt ref for speech lang path 0.00 $70.00 $0.00
45520 Treatment of rectal prolapse 4.41 $70.00 $308.70
4553F Pt asst re end life issues 0.00 $70.00 $0.00
4554F Pt recvd inhal anesthetic 0.00 $70.00 $0.00
45540 Correct rectal prolapse 30.61 $70.00 $2,142.70
45541 Correct rectal prolapse 27.33 $70.00 $1,913.10
4555F Pt recvd no inhal anesthic 0.00 $70.00 $0.00
45550 Repair rectum/remove sigmoid 42.41 $70.00 $2,968.70
4556F Pt w/3+ post-op nausea&vom 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
45560 Repair of rectocele 19.77 $70.00 $1,383.90
45562 Exploration/repair of rectum 32.45 $70.00 $2,271.50
45563 Exploration/repair of rectum 47.73 $70.00 $3,341.10
4557F Pt w/o 3+ post-opnausea&vom 0.00 $70.00 $0.00
4558F Pt recvd 2 rx anti-emet agt 0.00 $70.00 $0.00
4559F 1 bodytemp >=35.5cw/in 30min 0.00 $70.00 $0.00
4560F Anesth w/o gen/neurax anesth 0.00 $70.00 $0.00
4561F Pt w/ coronary artery stent 0.00 $70.00 $0.00
4562F Pt w/o coronary artery stent 0.00 $70.00 $0.00
4563F Pt recvd aspirin w/in 24 hrs 0.00 $70.00 $0.00
45800 Repair rect/bladder fistula 36.49 $70.00 $2,554.30
45805 Repair fistula w/colostomy 42.56 $70.00 $2,979.20
45820 Repair rectourethral fistula 36.70 $70.00 $2,569.00
45825 Repair fistula w/colostomy 44.44 $70.00 $3,110.80
45900 Reduction of rectal prolapse 5.83 $70.00 $408.10
45905 Dilation of anal sphincter 4.87 $70.00 $340.90
45910 Dilation of rectal narrowing 5.53 $70.00 $387.10
45915 Remove rectal obstruction 9.70 $70.00 $679.00
45990 Surg dx exam anorectal 3.09 $70.00 $216.30
45999 Rectum surgery procedure 0.00 $70.00 $0.00
46020 Placement of seton 8.00 $70.00 $560.00
46030 Removal of rectal marker 4.04 $70.00 $282.80
46040 Incision of rectal abscess 15.50 $70.00 $1,085.00
46045 Incision of rectal abscess 12.59 $70.00 $881.30
46050 Incision of anal abscess 5.98 $70.00 $418.60
46060 Incision of rectal abscess 13.84 $70.00 $968.80
46070 Incision of anal septum 7.52 $70.00 $526.40
46080 Incision of anal sphincter 7.41 $70.00 $518.70
46083 Incise external hemorrhoid 5.24 $70.00 $366.80
46200 Removal of anal fissure 13.00 $70.00 $910.00
46220 Excise anal ext tag/papilla 6.22 $70.00 $435.40
46221 Ligation of hemorrhoid(s) 7.77 $70.00 $543.90
46230 Removal of anal tags 8.11 $70.00 $567.70
46250 Remove ext hem groups 2+ 13.44 $70.00 $940.80
46255 Remove int/ext hem 1 group 14.71 $70.00 $1,029.70
46257 Remove in/ex hem grp & fiss 12.24 $70.00 $856.80
46258 Remove in/ex hem grp w/fistu 13.56 $70.00 $949.20
46260 Remove in/ex hem groups 2+ 13.79 $70.00 $965.30
46261 Remove in/ex hem grps & fiss 15.08 $70.00 $1,055.60
46262 Remove in/ex hem grps w/fist 16.01 $70.00 $1,120.70
46270 Remove anal fist subq 14.81 $70.00 $1,036.70
46275 Remove anal fist inter 15.63 $70.00 $1,094.10
46280 Remove anal fist complex 13.65 $70.00 $955.50
46285 Remove anal fist 2 stage 15.56 $70.00 $1,089.20
46288 Repair anal fistula 15.86 $70.00 $1,110.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
46320 Removal of hemorrhoid clot 5.43 $70.00 $380.10
46500 Injection into hemorrhoid(s) 8.23 $70.00 $576.10
46505 Chemodenervation anal musc 8.35 $70.00 $584.50
46600 Diagnostic anoscopy spx 2.72 $70.00 $190.40
46601 Diagnostic anoscopy 3.97 $70.00 $277.90
46604 Anoscopy and dilation 18.30 $70.00 $1,281.00
46606 Anoscopy and biopsy 6.89 $70.00 $482.30
46607 Diagnostic anoscopy & biopsy 5.59 $70.00 $391.30
46608 Anoscopy remove for body 7.26 $70.00 $508.20
46610 Anoscopy remove lesion 6.89 $70.00 $482.30
46611 Anoscopy 5.43 $70.00 $380.10
46612 Anoscopy remove lesions 8.38 $70.00 $586.60
46614 Anoscopy control bleeding 3.97 $70.00 $277.90
46615 Anoscopy 4.34 $70.00 $303.80
46700 Repair of anal stricture 18.98 $70.00 $1,328.60
46705 Repair of anal stricture 16.11 $70.00 $1,127.70
46706 Repr of anal fistula w/glue 5.10 $70.00 $357.00
46707 Repair anorectal fist w/plug 14.19 $70.00 $993.30
46710 Repr per/vag pouch sngl proc 32.12 $70.00 $2,248.40
46712 Repr per/vag pouch dbl proc 64.74 $70.00 $4,531.80
46715 Rep perf anoper fistu 15.77 $70.00 $1,103.90
46716 Rep perf anoper/vestib fistu 35.12 $70.00 $2,458.40
46730 Construction of absent anus 57.05 $70.00 $3,993.50
46735 Construction of absent anus 65.84 $70.00 $4,608.80
46740 Construction of absent anus 62.35 $70.00 $4,364.50
46742 Repair of imperforated anus 72.23 $70.00 $5,056.10
46744 Repair of cloacal anomaly 101.25 $70.00 $7,087.50
46746 Repair of cloacal anomaly 113.07 $70.00 $7,914.90
46748 Repair of cloacal anomaly 122.73 $70.00 $8,591.10
46750 Repair of anal sphincter 21.60 $70.00 $1,512.00
46751 Repair of anal sphincter 19.01 $70.00 $1,330.70
46753 Reconstruction of anus 17.76 $70.00 $1,243.20
46754 Removal of suture from anus 9.03 $70.00 $632.10
46760 Repair of anal sphincter 31.60 $70.00 $2,212.00
46761 Repair of anal sphincter 26.43 $70.00 $1,850.10
46900 Destruction anal lesion(s) 6.76 $70.00 $473.20
46910 Destruction anal lesion(s) 7.39 $70.00 $517.30
46916 Cryosurgery anal lesion(s) 6.83 $70.00 $478.10
46917 Laser surgery anal lesions 12.27 $70.00 $858.90
46922 Excision of anal lesion(s) 8.00 $70.00 $560.00
46924 Destruction anal lesion(s) 15.10 $70.00 $1,057.00
46930 Destroy internal hemorrhoids 6.02 $70.00 $421.40
46940 Treatment of anal fissure 6.79 $70.00 $475.30
46942 Treatment of anal fissure 6.48 $70.00 $453.60
46945 Remove by ligat int hem grp 9.08 $70.00 $635.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
46946 Remove by ligat int hem grps 9.17 $70.00 $641.90
46947 Hemorrhoidopexy by stapling 11.09 $70.00 $776.30
46999 Anus surgery procedure 0.00 $70.00 $0.00
47000 Needle biopsy of liver 8.72 $70.00 $610.40
47001 Needle biopsy liver add-on 3.02 $70.00 $211.40
47010 Open drainage liver lesion 35.17 $70.00 $2,461.90
47015 Inject/aspirate liver cyst 33.79 $70.00 $2,365.30
47100 Wedge biopsy of liver 24.50 $70.00 $1,715.00
47120 Partial removal of liver 67.79 $70.00 $4,745.30
47122 Extensive removal of liver 99.67 $70.00 $6,976.90
47125 Partial removal of liver 89.54 $70.00 $6,267.80
47130 Partial removal of liver 96.20 $70.00 $6,734.00
47133 Removal of donor liver 0.00 $70.00 $0.00
47135 Transplantation of liver 156.30 $70.00 $10,941.00
47140 Partial removal donor liver 103.66 $70.00 $7,256.20
47141 Partial removal donor liver 124.09 $70.00 $8,686.30
47142 Partial removal donor liver 136.54 $70.00 $9,557.80
47143 Prep donor liver whole 0.00 $70.00 $0.00
47144 Prep donor liver 3-segment 0.00 $70.00 $0.00
47145 Prep donor liver lobe split 0.00 $70.00 $0.00
47146 Prep donor liver/venous 9.43 $70.00 $660.10
47147 Prep donor liver/arterial 11.11 $70.00 $777.70
47300 Surgery for liver lesion 32.80 $70.00 $2,296.00
47350 Repair liver wound 39.70 $70.00 $2,779.00
47360 Repair liver wound 54.48 $70.00 $3,813.60
47361 Repair liver wound 88.00 $70.00 $6,160.00
47362 Repair liver wound 42.12 $70.00 $2,948.40
47370 Laparo ablate liver tumor rf 36.29 $70.00 $2,540.30
47371 Laparo ablate liver cryosurg 35.47 $70.00 $2,482.90
47379 Laparoscope procedure liver 0.00 $70.00 $0.00
47380 Open ablate liver tumor rf 41.84 $70.00 $2,928.80
47381 Open ablate liver tumor cryo 42.47 $70.00 $2,972.90
47382 Percut ablate liver rf 130.67 $70.00 $9,146.90
47383 Perq abltj lvr cryoablation 196.18 $70.00 $13,732.60
47399 Liver surgery procedure 0.00 $70.00 $0.00
47400 Incision of liver duct 62.62 $70.00 $4,383.40
47420 Incision of bile duct 38.90 $70.00 $2,723.00
47425 Incision of bile duct 39.71 $70.00 $2,779.70
47460 Incise bile duct sphincter 36.71 $70.00 $2,569.70
47480 Incision of gallbladder 25.42 $70.00 $1,779.40
47490 Incision of gallbladder 9.56 $70.00 $669.20
47531 Injection for cholangiogram 9.89 $70.00 $692.30
47532 Injection for cholangiogram 23.23 $70.00 $1,626.10
47533 Plmt biliary drainage cath 35.24 $70.00 $2,466.80
47534 Plmt biliary drainage cath 41.06 $70.00 $2,874.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
47535 Conversion ext bil drg cath 28.45 $70.00 $1,991.50
47536 Exchange biliary drg cath 19.59 $70.00 $1,371.30
47537 Removal biliary drg cath 11.51 $70.00 $805.70
47538 Perq plmt bile duct stent 121.80 $70.00 $8,526.00
47539 Perq plmt bile duct stent 135.09 $70.00 $9,456.30
47540 Perq plmt bile duct stent 137.40 $70.00 $9,618.00
47541 Plmt access bil tree sm bwl 33.81 $70.00 $2,366.70
47542 Dilate biliary duct/ampulla 13.92 $70.00 $974.40
47543 Endoluminal bx biliary tree 13.38 $70.00 $936.60
47544 Removal duct glbldr calculi 29.28 $70.00 $2,049.60
47550 Bile duct endoscopy add-on 4.80 $70.00 $336.00
47552 Biliary endo perq dx w/speci 9.01 $70.00 $630.70
47553 Biliary endoscopy thru skin 8.91 $70.00 $623.70
47554 Biliary endoscopy thru skin 14.98 $70.00 $1,048.60
47555 Biliary endoscopy thru skin 9.46 $70.00 $662.20
47556 Biliary endoscopy thru skin 10.72 $70.00 $750.40
47562 Laparoscopic cholecystectomy 19.07 $70.00 $1,334.90
47563 Laparo cholecystectomy/graph 20.75 $70.00 $1,452.50
47564 Laparo cholecystectomy/explr 32.27 $70.00 $2,258.90
47570 Laparo cholecystoenterostomy 22.50 $70.00 $1,575.00
47579 Laparoscope proc biliary 0.00 $70.00 $0.00
47600 Removal of gallbladder 30.97 $70.00 $2,167.90
47605 Removal of gallbladder 32.60 $70.00 $2,282.00
47610 Removal of gallbladder 36.39 $70.00 $2,547.30
47612 Removal of gallbladder 36.68 $70.00 $2,567.60
47620 Removal of gallbladder 39.58 $70.00 $2,770.60
47700 Exploration of bile ducts 30.62 $70.00 $2,143.40
47701 Bile duct revision 49.56 $70.00 $3,469.20
47711 Excision of bile duct tumor 45.13 $70.00 $3,159.10
47712 Excision of bile duct tumor 57.88 $70.00 $4,051.60
47715 Excision of bile duct cyst 38.46 $70.00 $2,692.20
47720 Fuse gallbladder & bowel 33.43 $70.00 $2,340.10
47721 Fuse upper gi structures 39.35 $70.00 $2,754.50
47740 Fuse gallbladder & bowel 37.76 $70.00 $2,643.20
47741 Fuse gallbladder & bowel 42.77 $70.00 $2,993.90
47760 Fuse bile ducts and bowel 65.47 $70.00 $4,582.90
47765 Fuse liver ducts & bowel 87.97 $70.00 $6,157.90
47780 Fuse bile ducts and bowel 71.89 $70.00 $5,032.30
47785 Fuse bile ducts and bowel 94.43 $70.00 $6,610.10
47800 Reconstruction of bile ducts 45.55 $70.00 $3,188.50
47801 Placement bile duct support 32.33 $70.00 $2,263.10
47802 Fuse liver duct & intestine 44.35 $70.00 $3,104.50
47900 Suture bile duct injury 39.75 $70.00 $2,782.50
47999 Bile tract surgery procedure 0.00 $70.00 $0.00
48000 Drainage of abdomen 54.69 $70.00 $3,828.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
48001 Placement of drain pancreas 66.67 $70.00 $4,666.90
48020 Removal of pancreatic stone 34.19 $70.00 $2,393.30
48100 Biopsy of pancreas open 25.83 $70.00 $1,808.10
48102 Needle biopsy pancreas 15.22 $70.00 $1,065.40
48105 Resect/debride pancreas 82.44 $70.00 $5,770.80
48120 Removal of pancreas lesion 32.08 $70.00 $2,245.60
48140 Partial removal of pancreas 45.45 $70.00 $3,181.50
48145 Partial removal of pancreas 47.34 $70.00 $3,313.80
48146 Pancreatectomy 54.51 $70.00 $3,815.70
48148 Removal of pancreatic duct 36.18 $70.00 $2,532.60
48150 Partial removal of pancreas 90.60 $70.00 $6,342.00
48152 Pancreatectomy 83.88 $70.00 $5,871.60
48153 Pancreatectomy 90.18 $70.00 $6,312.60
48154 Pancreatectomy 84.39 $70.00 $5,907.30
48155 Removal of pancreas 52.67 $70.00 $3,686.90
48160 Pancreas removal/transplant 0.00 $70.00 $0.00
48400 Injection intraop add-on 3.07 $70.00 $214.90
48500 Surgery of pancreatic cyst 33.42 $70.00 $2,339.40
48510 Drain pancreatic pseudocyst 31.79 $70.00 $2,225.30
48520 Fuse pancreas cyst and bowel 31.58 $70.00 $2,210.60
48540 Fuse pancreas cyst and bowel 37.86 $70.00 $2,650.20
48545 Pancreatorrhaphy 38.91 $70.00 $2,723.70
48547 Duodenal exclusion 51.90 $70.00 $3,633.00
48548 Fuse pancreas and bowel 48.22 $70.00 $3,375.40
48550 Donor pancreatectomy 0.00 $70.00 $0.00
48551 Prep donor pancreas 0.00 $70.00 $0.00
48552 Prep donor pancreas/venous 6.87 $70.00 $480.90
48554 Transpl allograft pancreas 73.90 $70.00 $5,173.00
48556 Removal allograft pancreas 36.95 $70.00 $2,586.50
48999 Pancreas surgery procedure 0.00 $70.00 $0.00
49000 Exploration of abdomen 22.32 $70.00 $1,562.40
49002 Reopening of abdomen 30.34 $70.00 $2,123.80
49010 Exploration behind abdomen 26.90 $70.00 $1,883.00
49020 Drainage abdom abscess open 46.13 $70.00 $3,229.10
49040 Drain open abdom abscess 28.90 $70.00 $2,023.00
49060 Drain open retroperi abscess 31.84 $70.00 $2,228.80
49062 Drain to peritoneal cavity 21.39 $70.00 $1,497.30
49082 Abd paracentesis 5.67 $70.00 $396.90
49083 Abd paracentesis w/imaging 8.44 $70.00 $590.80
49084 Peritoneal lavage 3.13 $70.00 $219.10
49180 Biopsy abdominal mass 4.71 $70.00 $329.70
49185 Sclerotx fluid collection 30.28 $70.00 $2,119.60
49203 Exc abd tum 5 cm or less 34.70 $70.00 $2,429.00
49204 Exc abd tum over 5 cm 44.38 $70.00 $3,106.60
49205 Exc abd tum over 10 cm 51.05 $70.00 $3,573.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
49215 Excise sacral spine tumor 64.28 $70.00 $4,499.60
49220 Multiple surgery abdomen 28.21 $70.00 $1,974.70
49250 Excision of umbilicus 17.07 $70.00 $1,194.90
49255 Removal of omentum 22.93 $70.00 $1,605.10
49320 Diag laparo separate proc 9.43 $70.00 $660.10
49321 Laparoscopy biopsy 9.97 $70.00 $697.90
49322 Laparoscopy aspiration 10.70 $70.00 $749.00
49323 Laparo drain lymphocele 18.30 $70.00 $1,281.00
49324 Lap insert tunnel ip cath 11.20 $70.00 $784.00
49325 Lap revision perm ip cath 11.95 $70.00 $836.50
49326 Lap w/omentopexy add-on 5.47 $70.00 $382.90
49327 Lap ins device for rt 3.77 $70.00 $263.90
49329 Laparo proc abdm/per/oment 0.00 $70.00 $0.00
49400 Air injection into abdomen 3.93 $70.00 $275.10
49402 Remove foreign body adbomen 24.83 $70.00 $1,738.10
49405 Image cath fluid colxn visc 23.93 $70.00 $1,675.10
49406 Image cath fluid peri/retro 23.92 $70.00 $1,674.40
49407 Image cath fluid trns/vgnl 19.43 $70.00 $1,360.10
49411 Ins mark abd/pel for rt perq 13.75 $70.00 $962.50
49412 Ins device for rt guide open 2.41 $70.00 $168.70
49418 Insert tun ip cath perc 36.12 $70.00 $2,528.40
49419 Insert tun ip cath w/port 12.77 $70.00 $893.90
49421 Ins tun ip cath for dial opn 6.64 $70.00 $464.80
49422 Remove tunneled ip cath 6.46 $70.00 $452.20
49423 Exchange drainage catheter 16.14 $70.00 $1,129.80
49424 Assess cyst contrast inject 4.35 $70.00 $304.50
49425 Insert abdomen-venous drain 20.85 $70.00 $1,459.50
49426 Revise abdomen-venous shunt 17.86 $70.00 $1,250.20
49427 Injection abdominal shunt 1.32 $70.00 $92.40
49428 Ligation of shunt 12.51 $70.00 $875.70
49429 Removal of shunt 13.29 $70.00 $930.30
49435 Insert subq exten to ip cath 3.45 $70.00 $241.50
49436 Embedded ip cath exit-site 5.36 $70.00 $375.20
49440 Place gastrostomy tube perc 26.99 $70.00 $1,889.30
49441 Place duod/jej tube perc 30.63 $70.00 $2,144.10
49442 Place cecostomy tube perc 25.49 $70.00 $1,784.30
49446 Change g-tube to g-j perc 25.95 $70.00 $1,816.50
49450 Replace g/c tube perc 18.80 $70.00 $1,316.00
49451 Replace duod/jej tube perc 20.45 $70.00 $1,431.50
49452 Replace g-j tube perc 25.16 $70.00 $1,761.20
49460 Fix g/colon tube w/device 20.44 $70.00 $1,430.80
49465 Fluoro exam of g/colon tube 4.48 $70.00 $313.60
49491 Rpr hern preemie reduc 23.04 $70.00 $1,612.80
49492 Rpr ing hern premie blocked 27.79 $70.00 $1,945.30
49495 Rpr ing hernia baby reduc 11.86 $70.00 $830.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
49496 Rpr ing hernia baby blocked 17.79 $70.00 $1,245.30
49500 Rpr ing hernia init reduce 11.70 $70.00 $819.00
49501 Rpr ing hernia init blocked 17.55 $70.00 $1,228.50
49505 Prp i/hern init reduc >5 yr 15.07 $70.00 $1,054.90
49507 Prp i/hern init block >5 yr 16.97 $70.00 $1,187.90
49520 Rerepair ing hernia reduce 18.31 $70.00 $1,281.70
49521 Rerepair ing hernia blocked 20.77 $70.00 $1,453.90
49525 Repair ing hernia sliding 16.61 $70.00 $1,162.70
49540 Repair lumbar hernia 19.52 $70.00 $1,366.40
49550 Rpr rem hernia init reduce 16.68 $70.00 $1,167.60
49553 Rpr fem hernia init blocked 18.31 $70.00 $1,281.70
49555 Rerepair fem hernia reduce 17.33 $70.00 $1,213.10
49557 Rerepair fem hernia blocked 20.97 $70.00 $1,467.90
49560 Rpr ventral hern init reduc 21.38 $70.00 $1,496.60
49561 Rpr ventral hern init block 26.94 $70.00 $1,885.80
49565 Rerepair ventrl hern reduce 22.26 $70.00 $1,558.20
49566 Rerepair ventrl hern block 27.18 $70.00 $1,902.60
49568 Hernia repair w/mesh 7.77 $70.00 $543.90
49570 Rpr epigastric hern reduce 12.07 $70.00 $844.90
49572 Rpr epigastric hern blocked 14.95 $70.00 $1,046.50
49580 Rpr umbil hern reduc < 5 yr 9.37 $70.00 $655.90
49582 Rpr umbil hern block < 5 yr 13.37 $70.00 $935.90
49585 Rpr umbil hern reduc > 5 yr 12.87 $70.00 $900.90
49587 Rpr umbil hern block > 5 yr 13.76 $70.00 $963.20
49590 Repair spigelian hernia 16.58 $70.00 $1,160.60
49600 Repair umbilical lesion 21.03 $70.00 $1,472.10
49605 Repair umbilical lesion 142.52 $70.00 $9,976.40
49606 Repair umbilical lesion 32.91 $70.00 $2,303.70
49610 Repair umbilical lesion 19.99 $70.00 $1,399.30
49611 Repair umbilical lesion 17.60 $70.00 $1,232.00
49650 Lap ing hernia repair init 12.41 $70.00 $868.70
49651 Lap ing hernia repair recur 16.15 $70.00 $1,130.50
49652 Lap vent/abd hernia repair 21.55 $70.00 $1,508.50
49653 Lap vent/abd hern proc comp 26.91 $70.00 $1,883.70
49654 Lap inc hernia repair 24.49 $70.00 $1,714.30
49655 Lap inc hern repair comp 29.91 $70.00 $2,093.70
49656 Lap inc hernia repair recur 26.56 $70.00 $1,859.20
49657 Lap inc hern recur comp 38.24 $70.00 $2,676.80
49659 Laparo proc hernia repair 0.00 $70.00 $0.00
49900 Repair of abdominal wall 23.64 $70.00 $1,654.80
49904 Omental flap extra-abdom 40.96 $70.00 $2,867.20
49905 Omental flap intra-abdom 10.25 $70.00 $717.50
49906 Free omental flap microvasc 0.00 $70.00 $0.00
49999 Abdomen surgery procedure 0.00 $70.00 $0.00
50010 Exploration of kidney 21.22 $70.00 $1,485.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
50020 Renal abscess open drain 29.30 $70.00 $2,051.00
50040 Drainage of kidney 26.80 $70.00 $1,876.00
50045 Exploration of kidney 26.97 $70.00 $1,887.90
5005F Pt counsld on exam for moles 0.00 $70.00 $0.00
50060 Removal of kidney stone 33.00 $70.00 $2,310.00
50065 Incision of kidney 34.98 $70.00 $2,448.60
50070 Incision of kidney 34.31 $70.00 $2,401.70
50075 Removal of kidney stone 42.13 $70.00 $2,949.10
50080 Removal of kidney stone 25.15 $70.00 $1,760.50
50081 Removal of kidney stone 36.96 $70.00 $2,587.20
5010F Macul result phy/qhp mng dm 0.00 $70.00 $0.00
50100 Revise kidney blood vessels 30.42 $70.00 $2,129.40
50120 Exploration of kidney 27.46 $70.00 $1,922.20
50125 Explore and drain kidney 28.43 $70.00 $1,990.10
50130 Removal of kidney stone 29.87 $70.00 $2,090.90
50135 Exploration of kidney 32.47 $70.00 $2,272.90
5015F Doc fx & test/txmnt for op 0.00 $70.00 $0.00
5020F Txmnts 2 phys/qhp by 1 mon 0.00 $70.00 $0.00
50200 Renal biopsy perq 15.28 $70.00 $1,069.60
50205 Renal biopsy open 21.86 $70.00 $1,530.20
50220 Remove kidney open 30.32 $70.00 $2,122.40
50225 Removal kidney open complex 34.86 $70.00 $2,440.20
50230 Removal kidney open radical 37.11 $70.00 $2,597.70
50234 Removal of kidney & ureter 37.71 $70.00 $2,639.70
50236 Removal of kidney & ureter 42.41 $70.00 $2,968.70
50240 Partial removal of kidney 38.35 $70.00 $2,684.50
50250 Cryoablate renal mass open 35.18 $70.00 $2,462.60
50280 Removal of kidney lesion 27.67 $70.00 $1,936.90
50290 Removal of kidney lesion 25.99 $70.00 $1,819.30
50300 Remove cadaver donor kidney 0.00 $70.00 $0.00
50320 Remove kidney living donor 43.45 $70.00 $3,041.50
50323 Prep cadaver renal allograft 0.00 $70.00 $0.00
50325 Prep donor renal graft 0.00 $70.00 $0.00
50327 Prep renal graft/venous 6.29 $70.00 $440.30
50328 Prep renal graft/arterial 5.51 $70.00 $385.70
50329 Prep renal graft/ureteral 5.24 $70.00 $366.80
50340 Removal of kidney 27.47 $70.00 $1,922.90
50360 Transplantation of kidney 70.07 $70.00 $4,904.90
50365 Transplantation of kidney 83.01 $70.00 $5,810.70
50370 Remove transplanted kidney 34.88 $70.00 $2,441.60
50380 Reimplantation of kidney 57.85 $70.00 $4,049.50
50382 Change ureter stent percut 31.35 $70.00 $2,194.50
50384 Remove ureter stent percut 25.04 $70.00 $1,752.80
50385 Change stent via transureth 30.77 $70.00 $2,153.90
50386 Remove stent via transureth 20.31 $70.00 $1,421.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
50387 Change nephroureteral cath 14.66 $70.00 $1,026.20
50389 Remove renal tube w/fluoro 9.49 $70.00 $664.30
50390 Drainage of kidney lesion 2.78 $70.00 $194.60
50391 Instll rx agnt into rnal tub 3.52 $70.00 $246.40
50396 Measure kidney pressure 3.38 $70.00 $236.60
50400 Revision of kidney/ureter 33.56 $70.00 $2,349.20
50405 Revision of kidney/ureter 40.37 $70.00 $2,825.90
50430 Njx px nfrosgrm &/urtrgrm 14.53 $70.00 $1,017.10
50431 Njx px nfrosgrm &/urtrgrm 6.03 $70.00 $422.10
50432 Plmt nephrostomy catheter 23.52 $70.00 $1,646.40
50433 Plmt nephroureteral catheter 31.25 $70.00 $2,187.50
50434 Convert nephrostomy catheter 24.66 $70.00 $1,726.20
50435 Exchange nephrostomy cath 14.63 $70.00 $1,024.10
50436 Dilat xst trc ndurlgc px 4.37 $70.00 $305.90
50437 Dilat xst trc new access rcs 7.29 $70.00 $510.30
5050F Plan 2 main dr by 1 month 0.00 $70.00 $0.00
50500 Repair of kidney wound 37.32 $70.00 $2,612.40
50520 Close kidney-skin fistula 33.60 $70.00 $2,352.00
50525 Close nephrovisceral fistula 42.64 $70.00 $2,984.80
50526 Close nephrovisceral fistula 45.71 $70.00 $3,199.70
50540 Revision of horseshoe kidney 33.10 $70.00 $2,317.00
50541 Laparo ablate renal cyst 26.59 $70.00 $1,861.30
50542 Laparo ablate renal mass 33.76 $70.00 $2,363.20
50543 Laparo partial nephrectomy 43.07 $70.00 $3,014.90
50544 Laparoscopy pyeloplasty 36.03 $70.00 $2,522.10
50545 Laparo radical nephrectomy 38.77 $70.00 $2,713.90
50546 Laparoscopic nephrectomy 34.85 $70.00 $2,439.50
50547 Laparo removal donor kidney 46.49 $70.00 $3,254.30
50548 Laparo remove w/ureter 38.99 $70.00 $2,729.30
50549 Laparoscope proc renal 0.00 $70.00 $0.00
50551 Kidney endoscopy 10.43 $70.00 $730.10
50553 Kidney endoscopy 11.14 $70.00 $779.80
50555 Kidney endoscopy & biopsy 11.91 $70.00 $833.70
50557 Kidney endoscopy & treatment 12.12 $70.00 $848.40
50561 Kidney endoscopy & treatment 13.72 $70.00 $960.40
50562 Renal scope w/tumor resect 16.81 $70.00 $1,176.70
50570 Kidney endoscopy 14.23 $70.00 $996.10
50572 Kidney endoscopy 15.40 $70.00 $1,078.00
50574 Kidney endoscopy & biopsy 16.38 $70.00 $1,146.60
50575 Kidney endoscopy 20.68 $70.00 $1,447.60
50576 Kidney endoscopy & treatment 16.34 $70.00 $1,143.80
50580 Kidney endoscopy & treatment 17.59 $70.00 $1,231.30
50590 Fragmenting of kidney stone 21.00 $70.00 $1,470.00
50592 Perc rf ablate renal tumor 92.39 $70.00 $6,467.30
50593 Perc cryo ablate renal tum 125.49 $70.00 $8,784.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
5060F Fndngs mammo 2pt w/in 3 days 0.00 $70.00 $0.00
50600 Exploration of ureter 27.16 $70.00 $1,901.20
50605 Insert ureteral support 28.67 $70.00 $2,006.90
50606 Endoluminal bx urtr rnl plvs 18.80 $70.00 $1,316.00
50610 Removal of ureter stone 27.27 $70.00 $1,908.90
5062F Mammo result com to pt 5 day 0.00 $70.00 $0.00
50620 Removal of ureter stone 26.10 $70.00 $1,827.00
50630 Removal of ureter stone 25.83 $70.00 $1,808.10
50650 Removal of ureter 30.03 $70.00 $2,102.10
50660 Removal of ureter 33.05 $70.00 $2,313.50
50684 Injection for ureter x-ray 3.10 $70.00 $217.00
50686 Measure ureter pressure 3.99 $70.00 $279.30
50688 Change of ureter tube/stent 2.25 $70.00 $157.50
50690 Injection for ureter x-ray 2.87 $70.00 $200.90
50693 Plmt ureteral stent prq 28.74 $70.00 $2,011.80
50694 Plmt ureteral stent prq 31.70 $70.00 $2,219.00
50695 Plmt ureteral stent prq 38.71 $70.00 $2,709.70
50700 Revision of ureter 26.77 $70.00 $1,873.90
50705 Ureteral embolization/occl 56.82 $70.00 $3,977.40
50706 Balloon dilate urtrl strix 27.41 $70.00 $1,918.70
50715 Release of ureter 35.25 $70.00 $2,467.50
50722 Release of ureter 29.09 $70.00 $2,036.30
50725 Release/revise ureter 31.90 $70.00 $2,233.00
50727 Revise ureter 14.71 $70.00 $1,029.70
50728 Revise ureter 21.23 $70.00 $1,486.10
50740 Fusion of ureter & kidney 35.48 $70.00 $2,483.60
50750 Fusion of ureter & kidney 33.39 $70.00 $2,337.30
50760 Fusion of ureters 32.64 $70.00 $2,284.80
50770 Splicing of ureters 33.35 $70.00 $2,334.50
50780 Reimplant ureter in bladder 31.98 $70.00 $2,238.60
50782 Reimplant ureter in bladder 31.07 $70.00 $2,174.90
50783 Reimplant ureter in bladder 32.63 $70.00 $2,284.10
50785 Reimplant ureter in bladder 35.14 $70.00 $2,459.80
50800 Implant ureter in bowel 26.86 $70.00 $1,880.20
50810 Fusion of ureter & bowel 40.57 $70.00 $2,839.90
50815 Urine shunt to intestine 35.37 $70.00 $2,475.90
50820 Construct bowel bladder 38.03 $70.00 $2,662.10
50825 Construct bowel bladder 48.08 $70.00 $3,365.60
50830 Revise urine flow 52.15 $70.00 $3,650.50
50840 Replace ureter by bowel 35.56 $70.00 $2,489.20
50845 Appendico-vesicostomy 36.16 $70.00 $2,531.20
50860 Transplant ureter to skin 27.33 $70.00 $1,913.10
50900 Repair of ureter 24.35 $70.00 $1,704.50
50920 Closure ureter/skin fistula 25.38 $70.00 $1,776.60
50930 Closure ureter/bowel fistula 31.89 $70.00 $2,232.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
50940 Release of ureter 25.63 $70.00 $1,794.10
50945 Laparoscopy ureterolithotomy 28.10 $70.00 $1,967.00
50947 Laparo new ureter/bladder 40.18 $70.00 $2,812.60
50948 Laparo new ureter/bladder 36.86 $70.00 $2,580.20
50949 Laparoscope proc ureter 0.00 $70.00 $0.00
50951 Endoscopy of ureter 10.90 $70.00 $763.00
50953 Endoscopy of ureter 11.53 $70.00 $807.10
50955 Ureter endoscopy & biopsy 12.30 $70.00 $861.00
50957 Ureter endoscopy & treatment 12.41 $70.00 $868.70
50961 Ureter endoscopy & treatment 11.19 $70.00 $783.30
50970 Ureter endoscopy 10.72 $70.00 $750.40
50972 Ureter endoscopy & catheter 10.37 $70.00 $725.90
50974 Ureter endoscopy & biopsy 13.69 $70.00 $958.30
50976 Ureter endoscopy & treatment 13.51 $70.00 $945.70
50980 Ureter endoscopy & treatment 10.31 $70.00 $721.70
5100F Rsk fx ref w/n 24 hrs xray 0.00 $70.00 $0.00
51020 Incise & treat bladder 13.51 $70.00 $945.70
51030 Incise & treat bladder 13.61 $70.00 $952.70
51040 Incise & drain bladder 8.36 $70.00 $585.20
51045 Incise bladder/drain ureter 14.20 $70.00 $994.00
51050 Removal of bladder stone 13.66 $70.00 $956.20
51060 Removal of ureter stone 16.82 $70.00 $1,177.40
51065 Remove ureter calculus 16.76 $70.00 $1,173.20
51080 Drainage of bladder abscess 11.81 $70.00 $826.70
51100 Drain bladder by needle 1.84 $70.00 $128.80
51101 Drain bladder by trocar/cath 3.79 $70.00 $265.30
51102 Drain bl w/cath insertion 6.60 $70.00 $462.00
51500 Removal of bladder cyst 18.40 $70.00 $1,288.00
51520 Removal of bladder lesion 17.20 $70.00 $1,204.00
51525 Removal of bladder lesion 24.84 $70.00 $1,738.80
51530 Removal of bladder lesion 22.25 $70.00 $1,557.50
51535 Repair of ureter lesion 22.54 $70.00 $1,577.80
51550 Partial removal of bladder 27.90 $70.00 $1,953.00
51555 Partial removal of bladder 36.69 $70.00 $2,568.30
51565 Revise bladder & ureter(s) 37.55 $70.00 $2,628.50
51570 Removal of bladder 42.64 $70.00 $2,984.80
51575 Removal of bladder & nodes 52.76 $70.00 $3,693.20
51580 Remove bladder/revise tract 54.77 $70.00 $3,833.90
51585 Removal of bladder & nodes 61.05 $70.00 $4,273.50
51590 Remove bladder/revise tract 55.97 $70.00 $3,917.90
51595 Remove bladder/revise tract 63.35 $70.00 $4,434.50
51596 Remove bladder/create pouch 68.17 $70.00 $4,771.90
51597 Removal of pelvic structures 66.36 $70.00 $4,645.20
51600 Injection for bladder x-ray 5.57 $70.00 $389.90
51605 Preparation for bladder xray 1.11 $70.00 $77.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
51610 Injection for bladder x-ray 3.21 $70.00 $224.70
51700 Irrigation of bladder 2.12 $70.00 $148.40
51701 Insert bladder catheter 1.27 $70.00 $88.90
51702 Insert temp bladder cath 1.76 $70.00 $123.20
51703 Insert bladder cath complex 3.78 $70.00 $264.60
51705 Change of bladder tube 2.67 $70.00 $186.90
51710 Change of bladder tube 3.69 $70.00 $258.30
51715 Endoscopic injection/implant 9.07 $70.00 $634.90
51720 Treatment of bladder lesion 2.40 $70.00 $168.00
51725 Simple cystometrogram 5.69 $70.00 $398.30
51725 TC Simple cystometrogram 3.50 $70.00 $245.00
51725 26 Simple cystometrogram 2.19 $70.00 $153.30
51726 Complex cystometrogram 7.94 $70.00 $555.80
51726 TC Complex cystometrogram 5.48 $70.00 $383.60
51726 26 Complex cystometrogram 2.46 $70.00 $172.20
51727 Cystometrogram w/up 9.39 $70.00 $657.30
51727 TC Cystometrogram w/up 6.33 $70.00 $443.10
51727 26 Cystometrogram w/up 3.06 $70.00 $214.20
51728 Cystometrogram w/vp 9.55 $70.00 $668.50
51728 TC Cystometrogram w/vp 6.54 $70.00 $457.80
51728 26 Cystometrogram w/vp 3.01 $70.00 $210.70
51729 Cystometrogram w/vp&up 10.21 $70.00 $714.70
51729 TC Cystometrogram w/vp&up 6.58 $70.00 $460.60
51729 26 Cystometrogram w/vp&up 3.63 $70.00 $254.10
51736 Urine flow measurement 0.40 $70.00 $28.00
51736 TC Urine flow measurement 0.16 $70.00 $11.20
51736 26 Urine flow measurement 0.24 $70.00 $16.80
51741 Electro-uroflowmetry first 0.41 $70.00 $28.70
51741 TC Electro-uroflowmetry first 0.17 $70.00 $11.90
51741 26 Electro-uroflowmetry first 0.24 $70.00 $16.80
51784 Anal/urinary muscle study 1.93 $70.00 $135.10
51784 TC Anal/urinary muscle study 0.85 $70.00 $59.50
51784 26 Anal/urinary muscle study 1.08 $70.00 $75.60
51785 Anal/urinary muscle study 9.17 $70.00 $641.90
51785 TC Anal/urinary muscle study 6.51 $70.00 $455.70
51785 26 Anal/urinary muscle study 2.66 $70.00 $186.20
51792 Urinary reflex study 6.57 $70.00 $459.90
51792 TC Urinary reflex study 4.98 $70.00 $348.60
51792 26 Urinary reflex study 1.59 $70.00 $111.30
51797 Intraabdominal pressure test 3.95 $70.00 $276.50
51797 TC Intraabdominal pressure test 2.79 $70.00 $195.30
51797 26 Intraabdominal pressure test 1.16 $70.00 $81.20
51798 Us urine capacity measure 0.36 $70.00 $25.20
51800 Revision of bladder/urethra 30.39 $70.00 $2,127.30
51820 Revision of urinary tract 31.37 $70.00 $2,195.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
51840 Attach bladder/urethra 19.30 $70.00 $1,351.00
51841 Attach bladder/urethra 22.47 $70.00 $1,572.90
51845 Repair bladder neck 16.83 $70.00 $1,178.10
51860 Repair of bladder wound 21.55 $70.00 $1,508.50
51865 Repair of bladder wound 25.95 $70.00 $1,816.50
51880 Repair of bladder opening 13.51 $70.00 $945.70
51900 Repair bladder/vagina lesion 23.82 $70.00 $1,667.40
51920 Close bladder-uterus fistula 22.08 $70.00 $1,545.60
51925 Hysterectomy/bladder repair 29.53 $70.00 $2,067.10
51940 Correction of bladder defect 47.52 $70.00 $3,326.40
51960 Revision of bladder & bowel 40.05 $70.00 $2,803.50
51980 Construct bladder opening 20.62 $70.00 $1,443.40
51990 Laparo urethral suspension 21.63 $70.00 $1,514.10
51992 Laparo sling operation 24.02 $70.00 $1,681.40
51999 Laparoscope proc bla 0.00 $70.00 $0.00
5200F Eval appros surg thxpy epi 0.00 $70.00 $0.00
52000 Cystoscopy 5.39 $70.00 $377.30
52001 Cystoscopy removal of clots 11.32 $70.00 $792.40
52005 Cystoscopy & ureter catheter 8.05 $70.00 $563.50
52007 Cystoscopy and biopsy 13.18 $70.00 $922.60
52010 Cystoscopy & duct catheter 10.98 $70.00 $768.60
52204 Cystoscopy w/biopsy(s) 10.81 $70.00 $756.70
52214 Cystoscopy and treatment 20.00 $70.00 $1,400.00
52224 Cystoscopy and treatment 20.90 $70.00 $1,463.00
52234 Cystoscopy and treatment 7.12 $70.00 $498.40
52235 Cystoscopy and treatment 8.34 $70.00 $583.80
52240 Cystoscopy and treatment 11.34 $70.00 $793.80
52250 Cystoscopy and radiotracer 6.92 $70.00 $484.40
52260 Cystoscopy and treatment 6.07 $70.00 $424.90
52265 Cystoscopy and treatment 10.63 $70.00 $744.10
52270 Cystoscopy & revise urethra 10.91 $70.00 $763.70
52275 Cystoscopy & revise urethra 14.46 $70.00 $1,012.20
52276 Cystoscopy and treatment 7.65 $70.00 $535.50
52277 Cystoscopy and treatment 9.35 $70.00 $654.50
52281 Cystoscopy and treatment 8.53 $70.00 $597.10
52282 Cystoscopy implant stent 9.76 $70.00 $683.20
52283 Cystoscopy and treatment 8.68 $70.00 $607.60
52285 Cystoscopy and treatment 8.66 $70.00 $606.20
52287 Cystoscopy chemodenervation 9.65 $70.00 $675.50
52290 Cystoscopy and treatment 7.07 $70.00 $494.90
52300 Cystoscopy and treatment 8.09 $70.00 $566.30
52301 Cystoscopy and treatment 8.38 $70.00 $586.60
52305 Cystoscopy and treatment 8.06 $70.00 $564.20
52310 Cystoscopy and treatment 7.68 $70.00 $537.60
52315 Cystoscopy and treatment 12.62 $70.00 $883.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
52317 Remove bladder stone 24.11 $70.00 $1,687.70
52318 Remove bladder stone 13.71 $70.00 $959.70
52320 Cystoscopy and treatment 7.13 $70.00 $499.10
52325 Cystoscopy stone removal 9.27 $70.00 $648.90
52327 Cystoscopy inject material 7.59 $70.00 $531.30
52330 Cystoscopy and treatment 15.46 $70.00 $1,082.20
52332 Cystoscopy and treatment 13.53 $70.00 $947.10
52334 Create passage to kidney 5.30 $70.00 $371.00
52341 Cysto w/ureter stricture tx 8.21 $70.00 $574.70
52342 Cysto w/up stricture tx 8.93 $70.00 $625.10
52343 Cysto w/renal stricture tx 9.96 $70.00 $697.20
52344 Cysto/uretero stricture tx 10.69 $70.00 $748.30
52345 Cysto/uretero w/up stricture 11.41 $70.00 $798.70
52346 Cystouretero w/renal strict 12.92 $70.00 $904.40
52351 Cystouretero & or pyeloscope 8.75 $70.00 $612.50
52352 Cystouretero w/stone remove 10.26 $70.00 $718.20
52353 Cystouretero w/lithotripsy 11.34 $70.00 $793.80
52354 Cystouretero w/biopsy 12.08 $70.00 $845.60
52355 Cystouretero w/excise tumor 13.53 $70.00 $947.10
52356 Cysto/uretero w/lithotripsy 12.05 $70.00 $843.50
52400 Cystouretero w/congen repr 13.83 $70.00 $968.10
52402 Cystourethro cut ejacul duct 7.73 $70.00 $541.10
52441 Cystourethro w/implant 36.17 $70.00 $2,531.90
52442 Cystourethro w/addl implant 27.13 $70.00 $1,899.10
52450 Incision of prostate 13.59 $70.00 $951.30
5250F Asthma discharge plan presnt 0.00 $70.00 $0.00
52500 Revision of bladder neck 14.13 $70.00 $989.10
52601 Prostatectomy (turp) 21.09 $70.00 $1,476.30
52630 Remove prostate regrowth 11.59 $70.00 $811.30
52640 Relieve bladder contracture 9.14 $70.00 $639.80
52647 Laser surgery of prostate 46.29 $70.00 $3,240.30
52648 Laser surgery of prostate 47.74 $70.00 $3,341.80
52649 Prostate laser enucleation 23.84 $70.00 $1,668.80
52700 Drainage of prostate abscess 12.76 $70.00 $893.20
53000 Incision of urethra 4.28 $70.00 $299.60
53010 Incision of urethra 8.51 $70.00 $595.70
53020 Incision of urethra 2.80 $70.00 $196.00
53025 Incision of urethra 1.97 $70.00 $137.90
53040 Drainage of urethra abscess 11.35 $70.00 $794.50
53060 Drainage of urethra abscess 5.24 $70.00 $366.80
53080 Drainage of urinary leakage 12.15 $70.00 $850.50
53085 Drainage of urinary leakage 18.78 $70.00 $1,314.60
53200 Biopsy of urethra 4.55 $70.00 $318.50
53210 Removal of urethra 22.26 $70.00 $1,558.20
53215 Removal of urethra 26.85 $70.00 $1,879.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
53220 Treatment of urethra lesion 13.06 $70.00 $914.20
53230 Removal of urethra lesion 17.51 $70.00 $1,225.70
53235 Removal of urethra lesion 18.29 $70.00 $1,280.30
53240 Surgery for urethra pouch 12.28 $70.00 $859.60
53250 Removal of urethra gland 11.44 $70.00 $800.80
53260 Treatment of urethra lesion 5.83 $70.00 $408.10
53265 Treatment of urethra lesion 6.36 $70.00 $445.20
53270 Removal of urethra gland 5.98 $70.00 $418.60
53275 Repair of urethra defect 7.58 $70.00 $530.60
53400 Revise urethra stage 1 23.13 $70.00 $1,619.10
53405 Revise urethra stage 2 25.27 $70.00 $1,768.90
53410 Reconstruction of urethra 28.30 $70.00 $1,981.00
53415 Reconstruction of urethra 32.70 $70.00 $2,289.00
53420 Reconstruct urethra stage 1 24.34 $70.00 $1,703.80
53425 Reconstruct urethra stage 2 27.10 $70.00 $1,897.00
53430 Reconstruction of urethra 27.95 $70.00 $1,956.50
53431 Reconstruct urethra/bladder 33.38 $70.00 $2,336.60
53440 Male sling procedure 21.78 $70.00 $1,524.60
53442 Remove/revise male sling 22.64 $70.00 $1,584.80
53444 Insert tandem cuff 22.93 $70.00 $1,605.10
53445 Insert uro/ves nck sphincter 21.78 $70.00 $1,524.60
53446 Remove uro sphincter 18.57 $70.00 $1,299.90
53447 Remove/replace ur sphincter 23.37 $70.00 $1,635.90
53448 Remov/replc ur sphinctr comp 36.98 $70.00 $2,588.60
53449 Repair uro sphincter 17.69 $70.00 $1,238.30
53450 Revision of urethra 11.82 $70.00 $827.40
53460 Revision of urethra 13.24 $70.00 $926.80
53500 Urethrlys transvag w/ scope 21.54 $70.00 $1,507.80
53502 Repair of urethra injury 14.06 $70.00 $984.20
53505 Repair of urethra injury 14.05 $70.00 $983.50
53510 Repair of urethra injury 18.26 $70.00 $1,278.20
53515 Repair of urethra injury 23.02 $70.00 $1,611.40
53520 Repair of urethra defect 16.12 $70.00 $1,128.40
53600 Dilate urethra stricture 2.39 $70.00 $167.30
53601 Dilate urethra stricture 2.29 $70.00 $160.30
53605 Dilate urethra stricture 1.87 $70.00 $130.90
53620 Dilate urethra stricture 3.79 $70.00 $265.30
53621 Dilate urethra stricture 3.56 $70.00 $249.20
53660 Dilation of urethra 1.99 $70.00 $139.30
53661 Dilation of urethra 1.96 $70.00 $137.20
53665 Dilation of urethra 1.12 $70.00 $78.40
53850 Prostatic microwave thermotx 45.41 $70.00 $3,178.70
53852 Prostatic rf thermotx 43.97 $70.00 $3,077.90
53854 Trurl dstrj prst8 tiss rf wv 52.05 $70.00 $3,643.50
53855 Insert prost urethral stent 21.78 $70.00 $1,524.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
53860 Transurethral rf treatment 52.72 $70.00 $3,690.40
53899 Urology surgery procedure 0.00 $70.00 $0.00
54000 Slitting of prepuce 4.40 $70.00 $308.00
54001 Slitting of prepuce 5.44 $70.00 $380.80
54015 Drain penis lesion 8.92 $70.00 $624.40
54050 Destruction penis lesion(s) 3.80 $70.00 $266.00
54055 Destruction penis lesion(s) 3.49 $70.00 $244.30
54056 Cryosurgery penis lesion(s) 4.03 $70.00 $282.10
54057 Laser surg penis lesion(s) 3.97 $70.00 $277.90
54060 Excision of penis lesion(s) 5.29 $70.00 $370.30
54065 Destruction penis lesion(s) 6.31 $70.00 $441.70
54100 Biopsy of penis 5.64 $70.00 $394.80
54105 Biopsy of penis 7.68 $70.00 $537.60
54110 Treatment of penis lesion 18.05 $70.00 $1,263.50
54111 Treat penis lesion graft 23.11 $70.00 $1,617.70
54112 Treat penis lesion graft 27.14 $70.00 $1,899.80
54115 Treatment of penis lesion 13.09 $70.00 $916.30
54120 Partial removal of penis 18.29 $70.00 $1,280.30
54125 Removal of penis 23.57 $70.00 $1,649.90
54130 Remove penis & nodes 34.54 $70.00 $2,417.80
54135 Remove penis & nodes 43.76 $70.00 $3,063.20
54150 Circumcision w/regionl block 4.42 $70.00 $309.40
54160 Circumcision neonate 6.32 $70.00 $442.40
54161 Circum 28 days or older 5.70 $70.00 $399.00
54162 Lysis penil circumic lesion 7.42 $70.00 $519.40
54163 Repair of circumcision 6.31 $70.00 $441.70
54164 Frenulotomy of penis 5.60 $70.00 $392.00
54200 Treatment of penis lesion 3.13 $70.00 $219.10
54205 Treatment of penis lesion 15.40 $70.00 $1,078.00
54220 Treatment of penis lesion 5.97 $70.00 $417.90
54230 Prepare penis study 2.82 $70.00 $197.40
54231 Dynamic cavernosometry 4.08 $70.00 $285.60
54235 Penile injection 2.56 $70.00 $179.20
54240 Penis study 2.97 $70.00 $207.90
54240 TC Penis study 1.04 $70.00 $72.80
54240 26 Penis study 1.93 $70.00 $135.10
54250 Penis study 3.50 $70.00 $245.00
54250 TC Penis study 0.34 $70.00 $23.80
54250 26 Penis study 3.16 $70.00 $221.20
54300 Revision of penis 18.65 $70.00 $1,305.50
54304 Revision of penis 21.67 $70.00 $1,516.90
54308 Reconstruction of urethra 20.69 $70.00 $1,448.30
54312 Reconstruction of urethra 23.68 $70.00 $1,657.60
54316 Reconstruction of urethra 28.87 $70.00 $2,020.90
54318 Reconstruction of urethra 20.56 $70.00 $1,439.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
54322 Reconstruction of urethra 22.60 $70.00 $1,582.00
54324 Reconstruction of urethra 28.03 $70.00 $1,962.10
54326 Reconstruction of urethra 27.35 $70.00 $1,914.50
54328 Revise penis/urethra 27.17 $70.00 $1,901.90
54332 Revise penis/urethra 29.34 $70.00 $2,053.80
54336 Revise penis/urethra 34.43 $70.00 $2,410.10
54340 Secondary urethral surgery 16.48 $70.00 $1,153.60
54344 Secondary urethral surgery 27.41 $70.00 $1,918.70
54348 Secondary urethral surgery 29.34 $70.00 $2,053.80
54352 Reconstruct urethra/penis 41.01 $70.00 $2,870.70
54360 Penis plastic surgery 20.84 $70.00 $1,458.80
54380 Repair penis 23.13 $70.00 $1,619.10
54385 Repair penis 26.88 $70.00 $1,881.60
54390 Repair penis and bladder 35.93 $70.00 $2,515.10
54400 Insert semi-rigid prosthesis 15.34 $70.00 $1,073.80
54401 Insert self-contd prosthesis 18.98 $70.00 $1,328.60
54405 Insert multi-comp penis pros 23.40 $70.00 $1,638.00
54406 Remove muti-comp penis pros 21.13 $70.00 $1,479.10
54408 Repair multi-comp penis pros 22.87 $70.00 $1,600.90
54410 Remove/replace penis prosth 24.89 $70.00 $1,742.30
54411 Remov/replc penis pros comp 29.70 $70.00 $2,079.00
54415 Remove self-contd penis pros 15.30 $70.00 $1,071.00
54416 Remv/repl penis contain pros 20.58 $70.00 $1,440.60
54417 Remv/replc penis pros compl 25.97 $70.00 $1,817.90
54420 Revision of penis 20.36 $70.00 $1,425.20
54430 Revision of penis 18.53 $70.00 $1,297.10
54435 Revision of penis 12.03 $70.00 $842.10
54437 Repair corporeal tear 19.48 $70.00 $1,363.60
54438 Replantation of penis 38.73 $70.00 $2,711.10
54440 Repair of penis 0.00 $70.00 $0.00
54450 Preputial stretching 1.99 $70.00 $139.30
54500 Biopsy of testis 2.15 $70.00 $150.50
54505 Biopsy of testis 6.07 $70.00 $424.90
54512 Excise lesion testis 15.61 $70.00 $1,092.70
54520 Removal of testis 9.45 $70.00 $661.50
54522 Orchiectomy partial 17.05 $70.00 $1,193.50
54530 Removal of testis 14.63 $70.00 $1,024.10
54535 Extensive testis surgery 21.49 $70.00 $1,504.30
54550 Exploration for testis 14.23 $70.00 $996.10
54560 Exploration for testis 19.87 $70.00 $1,390.90
54600 Reduce testis torsion 13.10 $70.00 $917.00
54620 Suspension of testis 8.66 $70.00 $606.20
54640 Suspension of testis 13.84 $70.00 $968.80
54650 Orchiopexy (fowler-stephens) 20.57 $70.00 $1,439.90
54660 Revision of testis 10.33 $70.00 $723.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
54670 Repair testis injury 11.75 $70.00 $822.50
54680 Relocation of testis(es) 22.78 $70.00 $1,594.60
54690 Laparoscopy orchiectomy 18.99 $70.00 $1,329.30
54692 Laparoscopy orchiopexy 21.94 $70.00 $1,535.80
54699 Laparoscope proc testis 0.00 $70.00 $0.00
54700 Drainage of scrotum 6.16 $70.00 $431.20
54800 Biopsy of epididymis 3.64 $70.00 $254.80
54830 Remove epididymis lesion 10.78 $70.00 $754.60
54840 Remove epididymis lesion 9.29 $70.00 $650.30
54860 Removal of epididymis 12.12 $70.00 $848.40
54861 Removal of epididymis 16.39 $70.00 $1,147.30
54865 Explore epididymis 10.37 $70.00 $725.90
54900 Fusion of spermatic ducts 23.17 $70.00 $1,621.90
54901 Fusion of spermatic ducts 30.59 $70.00 $2,141.30
55000 Drainage of hydrocele 3.34 $70.00 $233.80
55040 Removal of hydrocele 9.77 $70.00 $683.90
55041 Removal of hydroceles 14.77 $70.00 $1,033.90
55060 Repair of hydrocele 11.01 $70.00 $770.70
55100 Drainage of scrotum abscess 6.28 $70.00 $439.60
55110 Explore scrotum 11.20 $70.00 $784.00
55120 Removal of scrotum lesion 10.23 $70.00 $716.10
55150 Removal of scrotum 14.23 $70.00 $996.10
55175 Revision of scrotum 10.50 $70.00 $735.00
55180 Revision of scrotum 19.92 $70.00 $1,394.40
55200 Incision of sperm duct 12.13 $70.00 $849.10
55250 Removal of sperm duct(s) 10.66 $70.00 $746.20
55300 Prepare sperm duct x-ray 5.42 $70.00 $379.40
55400 Repair of sperm duct 14.39 $70.00 $1,007.30
55500 Removal of hydrocele 11.42 $70.00 $799.40
55520 Removal of sperm cord lesion 13.12 $70.00 $918.40
55530 Revise spermatic cord veins 10.17 $70.00 $711.90
55535 Revise spermatic cord veins 12.44 $70.00 $870.80
55540 Revise hernia & sperm veins 16.00 $70.00 $1,120.00
55550 Laparo ligate spermatic vein 12.39 $70.00 $867.30
55559 Laparo proc spermatic cord 0.00 $70.00 $0.00
55600 Incise sperm duct pouch 12.19 $70.00 $853.30
55605 Incise sperm duct pouch 15.10 $70.00 $1,057.00
55650 Remove sperm duct pouch 20.72 $70.00 $1,450.40
55680 Remove sperm pouch lesion 9.92 $70.00 $694.40
55700 Biopsy of prostate 7.12 $70.00 $498.40
55705 Biopsy of prostate 7.68 $70.00 $537.60
55706 Prostate saturation sampling 10.78 $70.00 $754.60
55720 Drainage of prostate abscess 13.06 $70.00 $914.20
55725 Drainage of prostate abscess 17.18 $70.00 $1,202.60
55801 Removal of prostate 31.64 $70.00 $2,214.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
55810 Extensive prostate surgery 38.02 $70.00 $2,661.40
55812 Extensive prostate surgery 46.58 $70.00 $3,260.60
55815 Extensive prostate surgery 50.87 $70.00 $3,560.90
55821 Removal of prostate 25.28 $70.00 $1,769.60
55831 Removal of prostate 27.35 $70.00 $1,914.50
55840 Extensive prostate surgery 33.91 $70.00 $2,373.70
55842 Extensive prostate surgery 33.94 $70.00 $2,375.80
55845 Extensive prostate surgery 39.48 $70.00 $2,763.60
55860 Surgical exposure prostate 25.33 $70.00 $1,773.10
55862 Extensive prostate surgery 31.74 $70.00 $2,221.80
55865 Extensive prostate surgery 38.38 $70.00 $2,686.60
55866 Laparo radical prostatectomy 41.78 $70.00 $2,924.60
55870 Electroejaculation 5.04 $70.00 $352.80
55873 Cryoablate prostate 176.53 $70.00 $12,357.10
55874 Tprnl plmt biodegrdabl matrl 98.64 $70.00 $6,904.80
55875 Transperi needle place pros 22.14 $70.00 $1,549.80
55876 Place rt device/marker pros 4.05 $70.00 $283.50
55899 Genital surgery procedure 0.00 $70.00 $0.00
55920 Place needles pelvic for rt 13.01 $70.00 $910.70
55970 Sex transformation m to f 0.00 $70.00 $0.00
55980 Sex transformation f to m 0.00 $70.00 $0.00
56405 I & d of vulva/perineum 3.25 $70.00 $227.50
56420 Drainage of gland abscess 3.86 $70.00 $270.20
56440 Surgery for vulva lesion 5.15 $70.00 $360.50
56441 Lysis of labial lesion(s) 4.33 $70.00 $303.10
56442 Hymenotomy 1.34 $70.00 $93.80
56501 Destroy vulva lesions sim 4.10 $70.00 $287.00
56515 Destroy vulva lesion/s compl 6.72 $70.00 $470.40
56605 Biopsy of vulva/perineum 2.43 $70.00 $170.10
56606 Biopsy of vulva/perineum 1.09 $70.00 $76.30
56620 Partial removal of vulva 15.50 $70.00 $1,085.00
56625 Complete removal of vulva 18.58 $70.00 $1,300.60
56630 Extensive vulva surgery 27.26 $70.00 $1,908.20
56631 Extensive vulva surgery 34.47 $70.00 $2,412.90
56632 Extensive vulva surgery 40.68 $70.00 $2,847.60
56633 Extensive vulva surgery 35.36 $70.00 $2,475.20
56634 Extensive vulva surgery 37.89 $70.00 $2,652.30
56637 Extensive vulva surgery 43.93 $70.00 $3,075.10
56640 Extensive vulva surgery 43.60 $70.00 $3,052.00
56700 Partial removal of hymen 5.38 $70.00 $376.60
56740 Remove vagina gland lesion 8.66 $70.00 $606.20
56800 Repair of vagina 6.92 $70.00 $484.40
56805 Repair clitoris 32.50 $70.00 $2,275.00
56810 Repair of perineum 7.49 $70.00 $524.30
56820 Exam of vulva w/scope 3.28 $70.00 $229.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
56821 Exam/biopsy of vulva w/scope 4.36 $70.00 $305.20
57000 Exploration of vagina 5.44 $70.00 $380.80
57010 Drainage of pelvic abscess 12.43 $70.00 $870.10
57020 Drainage of pelvic fluid 2.77 $70.00 $193.90
57022 I & d vaginal hematoma pp 4.86 $70.00 $340.20
57023 I & d vag hematoma non-ob 8.83 $70.00 $618.10
57061 Destroy vag lesions simple 3.52 $70.00 $246.40
57065 Destroy vag lesions complex 5.88 $70.00 $411.60
57100 Biopsy of vagina 2.64 $70.00 $184.80
57105 Biopsy of vagina 4.19 $70.00 $293.30
57106 Remove vagina wall partial 14.54 $70.00 $1,017.80
57107 Remove vagina tissue part 41.93 $70.00 $2,935.10
57109 Vaginectomy partial w/nodes 50.89 $70.00 $3,562.30
57110 Remove vagina wall complete 25.39 $70.00 $1,777.30
57111 Remove vagina tissue compl 50.98 $70.00 $3,568.60
57112 Vaginectomy w/nodes compl 54.73 $70.00 $3,831.10
57120 Closure of vagina 14.60 $70.00 $1,022.00
57130 Remove vagina lesion 5.32 $70.00 $372.40
57135 Remove vagina lesion 5.80 $70.00 $406.00
57150 Treat vagina infection 1.38 $70.00 $96.60
57155 Insert uteri tandem/ovoids 10.68 $70.00 $747.60
57156 Ins vag brachytx device 5.92 $70.00 $414.40
57160 Insert pessary/other device 1.79 $70.00 $125.30
57170 Fitting of diaphragm/cap 1.85 $70.00 $129.50
57180 Treat vaginal bleeding 4.37 $70.00 $305.90
57200 Repair of vagina 8.87 $70.00 $620.90
57210 Repair vagina/perineum 10.63 $70.00 $744.10
57220 Revision of urethra 9.24 $70.00 $646.80
57230 Repair of urethral lesion 11.34 $70.00 $793.80
57240 Anterior colporrhaphy 17.00 $70.00 $1,190.00
57250 Repair rectum & vagina 17.04 $70.00 $1,192.80
57260 Cmbn ant pst colprhy 21.76 $70.00 $1,523.20
57265 Cmbn ap colprhy w/ntrcl rpr 24.43 $70.00 $1,710.10
57267 Insert mesh/pelvic flr addon 7.25 $70.00 $507.50
57268 Repair of bowel bulge 13.94 $70.00 $975.80
57270 Repair of bowel pouch 23.03 $70.00 $1,612.10
57280 Suspension of vagina 27.27 $70.00 $1,908.90
57282 Colpopexy extraperitoneal 14.56 $70.00 $1,019.20
57283 Colpopexy intraperitoneal 19.62 $70.00 $1,373.40
57284 Repair paravag defect open 23.34 $70.00 $1,633.80
57285 Repair paravag defect vag 19.28 $70.00 $1,349.60
57287 Revise/remove sling repair 19.95 $70.00 $1,396.50
57288 Repair bladder defect 20.63 $70.00 $1,444.10
57289 Repair bladder & vagina 21.78 $70.00 $1,524.60
57291 Construction of vagina 15.09 $70.00 $1,056.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
57292 Construct vagina with graft 23.11 $70.00 $1,617.70
57295 Revise vag graft via vagina 13.77 $70.00 $963.90
57296 Revise vag graft open abd 26.90 $70.00 $1,883.00
57300 Repair rectum-vagina fistula 16.48 $70.00 $1,153.60
57305 Repair rectum-vagina fistula 27.34 $70.00 $1,913.80
57307 Fistula repair & colostomy 29.80 $70.00 $2,086.00
57308 Fistula repair transperine 18.98 $70.00 $1,328.60
57310 Repair urethrovaginal lesion 13.57 $70.00 $949.90
57311 Repair urethrovaginal lesion 15.43 $70.00 $1,080.10
57320 Repair bladder-vagina lesion 15.53 $70.00 $1,087.10
57330 Repair bladder-vagina lesion 21.62 $70.00 $1,513.40
57335 Repair vagina 32.81 $70.00 $2,296.70
57400 Dilation of vagina 3.81 $70.00 $266.70
57410 Pelvic examination 3.05 $70.00 $213.50
57415 Remove vaginal foreign body 4.70 $70.00 $329.00
57420 Exam of vagina w/scope 3.45 $70.00 $241.50
57421 Exam/biopsy of vag w/scope 4.62 $70.00 $323.40
57423 Repair paravag defect lap 26.12 $70.00 $1,828.40
57425 Laparoscopy surg colpopexy 27.68 $70.00 $1,937.60
57426 Revise prosth vag graft lap 24.22 $70.00 $1,695.40
57452 Exam of cervix w/scope 3.25 $70.00 $227.50
57454 Bx/curett of cervix w/scope 4.45 $70.00 $311.50
57455 Biopsy of cervix w/scope 4.20 $70.00 $294.00
57456 Endocerv curettage w/scope 3.95 $70.00 $276.50
57460 Bx of cervix w/scope leep 8.30 $70.00 $581.00
57461 Conz of cervix w/scope leep 9.34 $70.00 $653.80
57500 Biopsy of cervix 3.80 $70.00 $266.00
57505 Endocervical curettage 3.19 $70.00 $223.30
57510 Cauterization of cervix 3.90 $70.00 $273.00
57511 Cryocautery of cervix 4.43 $70.00 $310.10
57513 Laser surgery of cervix 4.61 $70.00 $322.70
57520 Conization of cervix 9.16 $70.00 $641.20
57522 Conization of cervix 7.79 $70.00 $545.30
57530 Removal of cervix 10.05 $70.00 $703.50
57531 Removal of cervix radical 47.87 $70.00 $3,350.90
57540 Removal of residual cervix 21.98 $70.00 $1,538.60
57545 Remove cervix/repair pelvis 23.30 $70.00 $1,631.00
57550 Removal of residual cervix 11.67 $70.00 $816.90
57555 Remove cervix/repair vagina 17.11 $70.00 $1,197.70
57556 Remove cervix repair bowel 16.19 $70.00 $1,133.30
57558 D&c of cervical stump 3.80 $70.00 $266.00
57700 Revision of cervix 9.13 $70.00 $639.10
57720 Revision of cervix 8.89 $70.00 $622.30
57800 Dilation of cervical canal 1.85 $70.00 $129.50
58100 Biopsy of uterus lining 2.64 $70.00 $184.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
58110 Bx done w/colposcopy add-on 1.44 $70.00 $100.80
58120 Dilation and curettage 7.66 $70.00 $536.20
58140 Myomectomy abdom method 26.18 $70.00 $1,832.60
58145 Myomectomy vag method 15.78 $70.00 $1,104.60
58146 Myomectomy abdom complex 32.55 $70.00 $2,278.50
58150 Total hysterectomy 29.10 $70.00 $2,037.00
58152 Total hysterectomy 35.59 $70.00 $2,491.30
58180 Partial hysterectomy 27.39 $70.00 $1,917.30
58200 Extensive hysterectomy 39.71 $70.00 $2,779.70
58210 Extensive hysterectomy 53.42 $70.00 $3,739.40
58240 Removal of pelvis contents 84.82 $70.00 $5,937.40
58260 Vaginal hysterectomy 23.48 $70.00 $1,643.60
58262 Vag hyst including t/o 26.10 $70.00 $1,827.00
58263 Vag hyst w/t/o & vag repair 28.06 $70.00 $1,964.20
58267 Vag hyst w/urinary repair 29.85 $70.00 $2,089.50
58270 Vag hyst w/enterocele repair 25.08 $70.00 $1,755.60
58275 Hysterectomy/revise vagina 27.92 $70.00 $1,954.40
58280 Hysterectomy/revise vagina 29.73 $70.00 $2,081.10
58285 Extensive hysterectomy 41.86 $70.00 $2,930.20
58290 Vag hyst complex 32.58 $70.00 $2,280.60
58291 Vag hyst incl t/o complex 35.60 $70.00 $2,492.00
58292 Vag hyst t/o & repair compl 37.01 $70.00 $2,590.70
58293 Vag hyst w/uro repair compl 38.55 $70.00 $2,698.50
58294 Vag hyst w/enterocele compl 34.38 $70.00 $2,406.60
58300 Insert intrauterine device 2.28 $70.00 $159.60
58301 Remove intrauterine device 2.70 $70.00 $189.00
58321 Artificial insemination 2.20 $70.00 $154.00
58322 Artificial insemination 2.47 $70.00 $172.90
58323 Sperm washing 0.43 $70.00 $30.10
58340 Catheter for hysterography 4.47 $70.00 $312.90
58345 Reopen fallopian tube 7.94 $70.00 $555.80
58346 Insert heyman uteri capsule 13.26 $70.00 $928.20
58350 Reopen fallopian tube 3.07 $70.00 $214.90
58353 Endometr ablate thermal 28.06 $70.00 $1,964.20
58356 Endometrial cryoablation 52.14 $70.00 $3,649.80
58400 Suspension of uterus 12.70 $70.00 $889.00
58410 Suspension of uterus 22.79 $70.00 $1,595.30
58520 Repair of ruptured uterus 22.31 $70.00 $1,561.70
58540 Revision of uterus 25.71 $70.00 $1,799.70
58541 Lsh uterus 250 g or less 20.35 $70.00 $1,424.50
58542 Lsh w/t/o ut 250 g or less 23.29 $70.00 $1,630.30
58543 Lsh uterus above 250 g 23.50 $70.00 $1,645.00
58544 Lsh w/t/o uterus above 250 g 25.53 $70.00 $1,787.10
58545 Laparoscopic myomectomy 25.62 $70.00 $1,793.40
58546 Laparo-myomectomy complex 31.62 $70.00 $2,213.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
58548 Lap radical hyst 55.06 $70.00 $3,854.20
58550 Laparo-asst vag hysterectomy 24.92 $70.00 $1,744.40
58552 Laparo-vag hyst incl t/o 28.05 $70.00 $1,963.50
58553 Laparo-vag hyst complex 31.80 $70.00 $2,226.00
58554 Laparo-vag hyst w/t/o compl 37.61 $70.00 $2,632.70
58555 Hysteroscopy dx sep proc 8.40 $70.00 $588.00
58558 Hysteroscopy biopsy 38.87 $70.00 $2,720.90
58559 Hysteroscopy lysis 8.20 $70.00 $574.00
58560 Hysteroscopy resect septum 8.94 $70.00 $625.80
58561 Hysteroscopy remove myoma 10.26 $70.00 $718.20
58562 Hysteroscopy remove fb 10.39 $70.00 $727.30
58563 Hysteroscopy ablation 50.21 $70.00 $3,514.70
58565 Hysteroscopy sterilization 51.80 $70.00 $3,626.00
58570 Tlh uterus 250 g or less 22.42 $70.00 $1,569.40
58571 Tlh w/t/o 250 g or less 25.83 $70.00 $1,808.10
58572 Tlh uterus over 250 g 29.38 $70.00 $2,056.60
58573 Tlh w/t/o uterus over 250 g 35.00 $70.00 $2,450.00
58575 Laps tot hyst resj mal 54.43 $70.00 $3,810.10
58578 Laparo proc uterus 0.00 $70.00 $0.00
58579 Hysteroscope procedure 0.00 $70.00 $0.00
58600 Division of fallopian tube 10.33 $70.00 $723.10
58605 Division of fallopian tube 9.35 $70.00 $654.50
58611 Ligate oviduct(s) add-on 2.17 $70.00 $151.90
58615 Occlude fallopian tube(s) 6.95 $70.00 $486.50
58660 Laparoscopy lysis 19.21 $70.00 $1,344.70
58661 Laparoscopy remove adnexa 18.55 $70.00 $1,298.50
58662 Laparoscopy excise lesions 20.22 $70.00 $1,415.40
58670 Laparoscopy tubal cautery 10.33 $70.00 $723.10
58671 Laparoscopy tubal block 10.34 $70.00 $723.80
58672 Laparoscopy fimbrioplasty 20.70 $70.00 $1,449.00
58673 Laparoscopy salpingostomy 22.44 $70.00 $1,570.80
58674 Laps abltj uterine fibroids 23.01 $70.00 $1,610.70
58679 Laparo proc oviduct-ovary 0.00 $70.00 $0.00
58700 Removal of fallopian tube 22.37 $70.00 $1,565.90
58720 Removal of ovary/tube(s) 21.32 $70.00 $1,492.40
58740 Adhesiolysis tube ovary 25.54 $70.00 $1,787.80
58750 Repair oviduct 25.50 $70.00 $1,785.00
58752 Revise ovarian tube(s) 25.43 $70.00 $1,780.10
58760 Fimbrioplasty 22.94 $70.00 $1,605.80
58770 Create new tubal opening 24.14 $70.00 $1,689.80
58800 Drainage of ovarian cyst(s) 9.34 $70.00 $653.80
58805 Drainage of ovarian cyst(s) 11.61 $70.00 $812.70
58820 Drain ovary abscess open 9.02 $70.00 $631.40
58822 Drain ovary abscess percut 19.81 $70.00 $1,386.70
58825 Transposition ovary(s) 19.67 $70.00 $1,376.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
58900 Biopsy of ovary(s) 11.83 $70.00 $828.10
58920 Partial removal of ovary(s) 19.86 $70.00 $1,390.20
58925 Removal of ovarian cyst(s) 21.46 $70.00 $1,502.20
58940 Removal of ovary(s) 15.31 $70.00 $1,071.70
58943 Removal of ovary(s) 34.19 $70.00 $2,393.30
58950 Resect ovarian malignancy 32.97 $70.00 $2,307.90
58951 Resect ovarian malignancy 42.15 $70.00 $2,950.50
58952 Resect ovarian malignancy 47.82 $70.00 $3,347.40
58953 Tah rad dissect for debulk 58.92 $70.00 $4,124.40
58954 Tah rad debulk/lymph remove 63.98 $70.00 $4,478.60
58956 Bso omentectomy w/tah 39.98 $70.00 $2,798.60
58957 Resect recurrent gyn mal 46.29 $70.00 $3,240.30
58958 Resect recur gyn mal w/lym 51.24 $70.00 $3,586.80
58960 Exploration of abdomen 28.26 $70.00 $1,978.20
58970 Retrieval of oocyte 6.43 $70.00 $450.10
58974 Transfer of embryo 0.00 $70.00 $0.00
58976 Transfer of embryo 7.05 $70.00 $493.50
58999 Genital surgery procedure 0.00 $70.00 $0.00
59000 Amniocentesis diagnostic 3.53 $70.00 $247.10
59001 Amniocentesis therapeutic 5.15 $70.00 $360.50
59012 Fetal cord puncture prenatal 5.82 $70.00 $407.40
59015 Chorion biopsy 4.47 $70.00 $312.90
59020 Fetal contract stress test 1.99 $70.00 $139.30
59020 TC Fetal contract stress test 0.93 $70.00 $65.10
59020 26 Fetal contract stress test 1.06 $70.00 $74.20
59025 Fetal non-stress test 1.37 $70.00 $95.90
59025 TC Fetal non-stress test 0.52 $70.00 $36.40
59025 26 Fetal non-stress test 0.85 $70.00 $59.50
59030 Fetal scalp blood sample 3.25 $70.00 $227.50
59050 Fetal monitor w/report 1.46 $70.00 $102.20
59051 Fetal monitor/interpret only 1.21 $70.00 $84.70
59070 Transabdom amnioinfus w/us 11.53 $70.00 $807.10
59072 Umbilical cord occlud w/us 15.06 $70.00 $1,054.20
59074 Fetal fluid drainage w/us 11.11 $70.00 $777.70
59076 Fetal shunt placement w/us 15.06 $70.00 $1,054.20
59100 Remove uterus lesion 24.19 $70.00 $1,693.30
59120 Treat ectopic pregnancy 23.04 $70.00 $1,612.80
59121 Treat ectopic pregnancy 23.07 $70.00 $1,614.90
59130 Treat ectopic pregnancy 26.89 $70.00 $1,882.30
59135 Treat ectopic pregnancy 26.56 $70.00 $1,859.20
59136 Treat ectopic pregnancy 25.47 $70.00 $1,782.90
59140 Treat ectopic pregnancy 11.65 $70.00 $815.50
59150 Treat ectopic pregnancy 22.33 $70.00 $1,563.10
59151 Treat ectopic pregnancy 21.72 $70.00 $1,520.40
59160 D & c after delivery 6.21 $70.00 $434.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
59200 Insert cervical dilator 2.23 $70.00 $156.10
59300 Episiotomy or vaginal repair 5.77 $70.00 $403.90
59320 Revision of cervix 4.37 $70.00 $305.90
59325 Revision of cervix 6.96 $70.00 $487.20
59350 Repair of uterus 8.08 $70.00 $565.60
59400 Obstetrical care 60.43 $70.00 $4,230.10
59409 Obstetrical care 23.37 $70.00 $1,635.90
59410 Obstetrical care 29.94 $70.00 $2,095.80
59412 Antepartum manipulation 2.95 $70.00 $206.50
59414 Deliver placenta 2.65 $70.00 $185.50
59425 Antepartum care only 13.18 $70.00 $922.60
59426 Antepartum care only 23.52 $70.00 $1,646.40
59430 Care after delivery 5.57 $70.00 $389.90
59510 Cesarean delivery 67.00 $70.00 $4,690.00
59514 Cesarean delivery only 26.33 $70.00 $1,843.10
59515 Cesarean delivery 36.40 $70.00 $2,548.00
59525 Remove uterus after cesarean 13.96 $70.00 $977.20
59610 Vbac delivery 63.41 $70.00 $4,438.70
59612 Vbac delivery only 26.34 $70.00 $1,843.80
59614 Vbac care after delivery 32.66 $70.00 $2,286.20
59618 Attempted vbac delivery 67.88 $70.00 $4,751.60
59620 Attempted vbac delivery only 27.06 $70.00 $1,894.20
59622 Attempted vbac after care 37.49 $70.00 $2,624.30
59812 Treatment of miscarriage 9.37 $70.00 $655.90
59820 Care of miscarriage 11.24 $70.00 $786.80
59821 Treatment of miscarriage 11.25 $70.00 $787.50
59830 Treat uterus infection 12.76 $70.00 $893.20
59840 Abortion 6.50 $70.00 $455.00
59841 Abortion 11.24 $70.00 $786.80
59850 Abortion 10.19 $70.00 $713.30
59851 Abortion 10.98 $70.00 $768.60
59852 Abortion 15.03 $70.00 $1,052.10
59855 Abortion 12.00 $70.00 $840.00
59856 Abortion 14.10 $70.00 $987.00
59857 Abortion 15.06 $70.00 $1,054.20
59866 Abortion (mpr) 6.22 $70.00 $435.40
59870 Evacuate mole of uterus 14.05 $70.00 $983.50
59871 Remove cerclage suture 3.82 $70.00 $267.40
59897 Fetal invas px w/us 0.00 $70.00 $0.00
59898 Laparo proc ob care/deliver 0.00 $70.00 $0.00
59899 Maternity care procedure 0.00 $70.00 $0.00
60000 Drain thyroid/tongue cyst 4.87 $70.00 $340.90
6005F Care level rationale doc 0.00 $70.00 $0.00
6010F Dysphag test done b/4 eating 0.00 $70.00 $0.00
60100 Biopsy of thyroid 3.20 $70.00 $224.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
6015F Dysphag test done b/4 eating 0.00 $70.00 $0.00
6020F Npo (nothing-mouth) ordered 0.00 $70.00 $0.00
60200 Remove thyroid lesion 19.04 $70.00 $1,332.80
60210 Partial thyroid excision 20.37 $70.00 $1,425.90
60212 Partial thyroid excision 29.07 $70.00 $2,034.90
60220 Partial removal of thyroid 20.32 $70.00 $1,422.40
60225 Partial removal of thyroid 26.77 $70.00 $1,873.90
60240 Removal of thyroid 26.47 $70.00 $1,852.90
60252 Removal of thyroid 38.02 $70.00 $2,661.40
60254 Extensive thyroid surgery 48.14 $70.00 $3,369.80
60260 Repeat thyroid surgery 31.46 $70.00 $2,202.20
60270 Removal of thyroid 39.44 $70.00 $2,760.80
60271 Removal of thyroid 30.45 $70.00 $2,131.50
60280 Remove thyroid duct lesion 12.69 $70.00 $888.30
60281 Remove thyroid duct lesion 16.82 $70.00 $1,177.40
6030F Max sterile barriers follwd 0.00 $70.00 $0.00
60300 Aspir/inj thyroid cyst 3.27 $70.00 $228.90
6040F Appro rad ds dvcs techs docd 0.00 $70.00 $0.00
6045F Radxps in end rprt4fluro pxd 0.00 $70.00 $0.00
60500 Explore parathyroid glands 27.87 $70.00 $1,950.90
60502 Re-explore parathyroids 37.29 $70.00 $2,610.30
60505 Explore parathyroid glands 40.16 $70.00 $2,811.20
60512 Autotransplant parathyroid 7.03 $70.00 $492.10
60520 Removal of thymus gland 30.20 $70.00 $2,114.00
60521 Removal of thymus gland 32.41 $70.00 $2,268.70
60522 Removal of thymus gland 39.51 $70.00 $2,765.70
60540 Explore adrenal gland 30.88 $70.00 $2,161.60
60545 Explore adrenal gland 35.35 $70.00 $2,474.50
60600 Remove carotid body lesion 39.63 $70.00 $2,774.10
60605 Remove carotid body lesion 47.96 $70.00 $3,357.20
60650 Laparoscopy adrenalectomy 34.51 $70.00 $2,415.70
60659 Laparo proc endocrine 0.00 $70.00 $0.00
60699 Endocrine surgery procedure 0.00 $70.00 $0.00
6070F Pt asked/cnsld aed effects 0.00 $70.00 $0.00
6080F Pt/caregiver queried falls 0.00 $70.00 $0.00
6090F Pt/caregiver counsel safety 0.00 $70.00 $0.00
6100F Verify pt site pxd docd 0.00 $70.00 $0.00
61000 Remove cranial cavity fluid 3.19 $70.00 $223.30
61001 Remove cranial cavity fluid 3.16 $70.00 $221.20
6101F Safety counseling dementia 0.00 $70.00 $0.00
6102F Safety counseling dem order 0.00 $70.00 $0.00
61020 Remove brain cavity fluid 2.87 $70.00 $200.90
61026 Injection into brain canal 3.05 $70.00 $213.50
61050 Remove brain canal fluid 2.45 $70.00 $171.50
61055 Injection into brain canal 3.62 $70.00 $253.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
61070 Brain canal shunt procedure 1.64 $70.00 $114.80
6110F Counsel prov driving risks 0.00 $70.00 $0.00
61105 Twist drill hole 13.51 $70.00 $945.70
61107 Drill skull for implantation 9.20 $70.00 $644.00
61108 Drill skull for drainage 26.03 $70.00 $1,822.10
61120 Burr hole for puncture 21.76 $70.00 $1,523.20
61140 Pierce skull for biopsy 36.94 $70.00 $2,585.80
61150 Pierce skull for drainage 39.80 $70.00 $2,786.00
61151 Pierce skull for drainage 29.18 $70.00 $2,042.60
61154 Pierce skull & remove clot 37.14 $70.00 $2,599.80
61156 Pierce skull for drainage 36.52 $70.00 $2,556.40
61210 Pierce skull implant device 10.86 $70.00 $760.20
61215 Insert brain-fluid device 14.88 $70.00 $1,041.60
61250 Pierce skull & explore 25.26 $70.00 $1,768.20
61253 Pierce skull & explore 28.88 $70.00 $2,021.60
61304 Open skull for exploration 48.15 $70.00 $3,370.50
61305 Open skull for exploration 58.66 $70.00 $4,106.20
61312 Open skull for drainage 60.89 $70.00 $4,262.30
61313 Open skull for drainage 58.04 $70.00 $4,062.80
61314 Open skull for drainage 53.27 $70.00 $3,728.90
61315 Open skull for drainage 60.43 $70.00 $4,230.10
61316 Implt cran bone flap to abdo 2.60 $70.00 $182.00
61320 Open skull for drainage 55.56 $70.00 $3,889.20
61321 Open skull for drainage 61.70 $70.00 $4,319.00
61322 Decompressive craniotomy 69.75 $70.00 $4,882.50
61323 Decompressive lobectomy 69.82 $70.00 $4,887.40
61330 Decompress eye socket 52.25 $70.00 $3,657.50
61333 Explore orbit/remove lesion 59.64 $70.00 $4,174.80
61340 Subtemporal decompression 41.42 $70.00 $2,899.40
61343 Incise skull (press relief) 64.07 $70.00 $4,484.90
61345 Relieve cranial pressure 59.66 $70.00 $4,176.20
61450 Incise skull for surgery 56.00 $70.00 $3,920.00
61458 Incise skull for brain wound 58.88 $70.00 $4,121.60
61460 Incise skull for surgery 61.71 $70.00 $4,319.70
6150F Pt notrcvng1st antitnf txmnt 0.00 $70.00 $0.00
61500 Removal of skull lesion 38.21 $70.00 $2,674.70
61501 Remove infected skull bone 33.17 $70.00 $2,321.90
61510 Removal of brain lesion 64.09 $70.00 $4,486.30
61512 Remove brain lining lesion 74.81 $70.00 $5,236.70
61514 Removal of brain abscess 55.96 $70.00 $3,917.20
61516 Removal of brain lesion 54.46 $70.00 $3,812.20
61517 Implt brain chemotx add-on 2.59 $70.00 $181.30
61518 Removal of brain lesion 81.04 $70.00 $5,672.80
61519 Remove brain lining lesion 86.75 $70.00 $6,072.50
61520 Removal of brain lesion 110.34 $70.00 $7,723.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
61521 Removal of brain lesion 93.73 $70.00 $6,561.10
61522 Removal of brain abscess 62.95 $70.00 $4,406.50
61524 Removal of brain lesion 60.87 $70.00 $4,260.90
61526 Removal of brain lesion 97.94 $70.00 $6,855.80
61530 Removal of brain lesion 91.08 $70.00 $6,375.60
61531 Implant brain electrodes 35.27 $70.00 $2,468.90
61533 Implant brain electrodes 44.46 $70.00 $3,112.20
61534 Removal of brain lesion 47.44 $70.00 $3,320.80
61535 Remove brain electrodes 29.15 $70.00 $2,040.50
61536 Removal of brain lesion 75.23 $70.00 $5,266.10
61537 Removal of brain tissue 72.46 $70.00 $5,072.20
61538 Removal of brain tissue 78.29 $70.00 $5,480.30
61539 Removal of brain tissue 69.64 $70.00 $4,874.80
61540 Removal of brain tissue 63.07 $70.00 $4,414.90
61541 Incision of brain tissue 62.71 $70.00 $4,389.70
61543 Removal of brain tissue 61.72 $70.00 $4,320.40
61544 Remove & treat brain lesion 56.00 $70.00 $3,920.00
61545 Excision of brain tumor 93.02 $70.00 $6,511.40
61546 Removal of pituitary gland 67.45 $70.00 $4,721.50
61548 Removal of pituitary gland 45.85 $70.00 $3,209.50
61550 Release of skull seams 32.13 $70.00 $2,249.10
61552 Release of skull seams 43.52 $70.00 $3,046.40
61556 Incise skull/sutures 50.17 $70.00 $3,511.90
61557 Incise skull/sutures 49.42 $70.00 $3,459.40
61558 Excision of skull/sutures 55.28 $70.00 $3,869.60
61559 Excision of skull/sutures 66.52 $70.00 $4,656.40
61563 Excision of skull tumor 57.53 $70.00 $4,027.10
61564 Excision of skull tumor 70.95 $70.00 $4,966.50
61566 Removal of brain tissue 64.87 $70.00 $4,540.90
61567 Incision of brain tissue 72.94 $70.00 $5,105.80
61570 Remove foreign body brain 54.51 $70.00 $3,815.70
61571 Incise skull for brain wound 57.33 $70.00 $4,013.10
61575 Skull base/brainstem surgery 73.62 $70.00 $5,153.40
61576 Skull base/brainstem surgery 121.15 $70.00 $8,480.50
61580 Craniofacial approach skull 70.39 $70.00 $4,927.30
61581 Craniofacial approach skull 76.16 $70.00 $5,331.20
61582 Craniofacial approach skull 88.58 $70.00 $6,200.60
61583 Craniofacial approach skull 84.24 $70.00 $5,896.80
61584 Orbitocranial approach/skull 83.72 $70.00 $5,860.40
61585 Orbitocranial approach/skull 95.19 $70.00 $6,663.30
61586 Resect nasopharynx skull 70.54 $70.00 $4,937.80
61590 Infratemporal approach/skull 88.18 $70.00 $6,172.60
61591 Infratemporal approach/skull 89.14 $70.00 $6,239.80
61592 Orbitocranial approach/skull 92.57 $70.00 $6,479.90
61595 Transtemporal approach/skull 68.14 $70.00 $4,769.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
61596 Transcochlear approach/skull 70.10 $70.00 $4,907.00
61597 Transcondylar approach/skull 85.51 $70.00 $5,985.70
61598 Transpetrosal approach/skull 82.90 $70.00 $5,803.00
61600 Resect/excise cranial lesion 61.58 $70.00 $4,310.60
61601 Resect/excise cranial lesion 70.10 $70.00 $4,907.00
61605 Resect/excise cranial lesion 62.15 $70.00 $4,350.50
61606 Resect/excise cranial lesion 85.70 $70.00 $5,999.00
61607 Resect/excise cranial lesion 77.83 $70.00 $5,448.10
61608 Resect/excise cranial lesion 95.70 $70.00 $6,699.00
61611 Transect artery sinus 13.88 $70.00 $971.60
61613 Remove aneurysm sinus 96.98 $70.00 $6,788.60
61615 Resect/excise lesion skull 81.92 $70.00 $5,734.40
61616 Resect/excise lesion skull 97.30 $70.00 $6,811.00
61618 Repair dura 37.56 $70.00 $2,629.20
61619 Repair dura 41.39 $70.00 $2,897.30
61623 Endovasc tempory vessel occl 16.61 $70.00 $1,162.70
61624 Transcath occlusion cns 33.71 $70.00 $2,359.70
61626 Transcath occlusion non-cns 25.57 $70.00 $1,789.90
61630 Intracranial angioplasty 40.64 $70.00 $2,844.80
61635 Intracran angioplsty w/stent 42.61 $70.00 $2,982.70
61640 Dilate ic vasospasm init 14.01 $70.00 $980.70
61641 Dilat ic vspsm ea vsl sm ter 4.92 $70.00 $344.40
61642 Dilat ic vspsm ea diff ter 9.84 $70.00 $688.80
61645 Perq art m-thrombect &/nfs 24.33 $70.00 $1,703.10
61650 Evasc prlng admn rx agnt 1st 16.10 $70.00 $1,127.00
61651 Evasc prlng admn rx agnt add 7.01 $70.00 $490.70
61680 Intracranial vessel surgery 66.10 $70.00 $4,627.00
61682 Intracranial vessel surgery 123.50 $70.00 $8,645.00
61684 Intracranial vessel surgery 83.15 $70.00 $5,820.50
61686 Intracranial vessel surgery 136.43 $70.00 $9,550.10
61690 Intracranial vessel surgery 63.67 $70.00 $4,456.90
61692 Intracranial vessel surgery 108.81 $70.00 $7,616.70
61697 Brain aneurysm repr complx 125.47 $70.00 $8,782.90
61698 Brain aneurysm repr complx 140.01 $70.00 $9,800.70
61700 Brain aneurysm repr simple 100.75 $70.00 $7,052.50
61702 Inner skull vessel surgery 118.29 $70.00 $8,280.30
61703 Clamp neck artery 39.02 $70.00 $2,731.40
61705 Revise circulation to head 73.60 $70.00 $5,152.00
61708 Revise circulation to head 75.18 $70.00 $5,262.60
61710 Revise circulation to head 63.39 $70.00 $4,437.30
61711 Fusion of skull arteries 75.80 $70.00 $5,306.00
61720 Incise skull/brain surgery 37.33 $70.00 $2,613.10
61735 Incise skull/brain surgery 46.80 $70.00 $3,276.00
61750 Incise skull/brain biopsy 41.42 $70.00 $2,899.40
61751 Brain biopsy w/ct/mr guide 40.48 $70.00 $2,833.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
61760 Implant brain electrodes 46.05 $70.00 $3,223.50
61770 Incise skull for treatment 47.78 $70.00 $3,344.60
61781 Scan proc cranial intra 6.94 $70.00 $485.80
61782 Scan proc cranial extra 5.02 $70.00 $351.40
61783 Scan proc spinal 6.80 $70.00 $476.00
61790 Treat trigeminal nerve 25.78 $70.00 $1,804.60
61791 Treat trigeminal tract 33.03 $70.00 $2,312.10
61796 Srs cranial lesion simple 29.74 $70.00 $2,081.80
61797 Srs cran les simple addl 6.48 $70.00 $453.60
61798 Srs cranial lesion complex 40.56 $70.00 $2,839.20
61799 Srs cran les complex addl 8.98 $70.00 $628.60
61800 Apply srs headframe add-on 4.52 $70.00 $316.40
61850 Implant neuroelectrodes 28.18 $70.00 $1,972.60
61860 Implant neuroelectrodes 45.78 $70.00 $3,204.60
61863 Implant neuroelectrode 43.98 $70.00 $3,078.60
61864 Implant neuroelectrde addl 8.36 $70.00 $585.20
61867 Implant neuroelectrode 66.88 $70.00 $4,681.60
61868 Implant neuroelectrde addl 14.73 $70.00 $1,031.10
61870 Implant neuroelectrodes 34.79 $70.00 $2,435.30
61880 Revise/remove neuroelectrode 16.68 $70.00 $1,167.60
61885 Insrt/redo neurostim 1 array 14.97 $70.00 $1,047.90
61886 Implant neurostim arrays 24.77 $70.00 $1,733.90
61888 Revise/remove neuroreceiver 11.57 $70.00 $809.90
62000 Treat skull fracture 30.25 $70.00 $2,117.50
62005 Treat skull fracture 36.64 $70.00 $2,564.80
62010 Treatment of head injury 44.73 $70.00 $3,131.10
62100 Repair brain fluid leakage 46.42 $70.00 $3,249.40
62115 Reduction of skull defect 49.21 $70.00 $3,444.70
62117 Reduction of skull defect 57.84 $70.00 $4,048.80
62120 Repair skull cavity lesion 61.95 $70.00 $4,336.50
62121 Incise skull repair 45.73 $70.00 $3,201.10
62140 Repair of skull defect 29.95 $70.00 $2,096.50
62141 Repair of skull defect 33.19 $70.00 $2,323.30
62142 Remove skull plate/flap 25.80 $70.00 $1,806.00
62143 Replace skull plate/flap 30.38 $70.00 $2,126.60
62145 Repair of skull & brain 41.03 $70.00 $2,872.10
62146 Repair of skull with graft 34.27 $70.00 $2,398.90
62147 Repair of skull with graft 41.97 $70.00 $2,937.90
62148 Retr bone flap to fix skull 3.73 $70.00 $261.10
62160 Neuroendoscopy add-on 5.61 $70.00 $392.70
62161 Dissect brain w/scope 44.14 $70.00 $3,089.80
62162 Remove colloid cyst w/scope 55.35 $70.00 $3,874.50
62163 Zneuroendoscopy w/fb removal 34.42 $70.00 $2,409.40
62164 Remove brain tumor w/scope 61.07 $70.00 $4,274.90
62165 Remove pituit tumor w/scope 44.61 $70.00 $3,122.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
62180 Establish brain cavity shunt 47.07 $70.00 $3,294.90
62190 Establish brain cavity shunt 27.13 $70.00 $1,899.10
62192 Establish brain cavity shunt 28.59 $70.00 $2,001.30
62194 Replace/irrigate catheter 14.17 $70.00 $991.90
62200 Establish brain cavity shunt 40.29 $70.00 $2,820.30
62201 Brain cavity shunt w/scope 35.39 $70.00 $2,477.30
62220 Establish brain cavity shunt 29.28 $70.00 $2,049.60
62223 Establish brain cavity shunt 30.36 $70.00 $2,125.20
62225 Replace/irrigate catheter 15.38 $70.00 $1,076.60
62230 Replace/revise brain shunt 24.55 $70.00 $1,718.50
62252 Csf shunt reprogram 2.34 $70.00 $163.80
62252 TC Csf shunt reprogram 0.99 $70.00 $69.30
62252 26 Csf shunt reprogram 1.35 $70.00 $94.50
62256 Remove brain cavity shunt 17.54 $70.00 $1,227.80
62258 Replace brain cavity shunt 32.56 $70.00 $2,279.20
62263 Epidural lysis mult sessions 17.12 $70.00 $1,198.40
62264 Epidural lysis on single day 12.22 $70.00 $855.40
62267 Interdiscal perq aspir dx 7.34 $70.00 $513.80
62268 Drain spinal cord cyst 7.40 $70.00 $518.00
62269 Needle biopsy spinal cord 7.66 $70.00 $536.20
62270 Spinal fluid tap diagnostic 4.22 $70.00 $295.40
62272 Drain cerebro spinal fluid 5.57 $70.00 $389.90
62273 Inject epidural patch 4.93 $70.00 $345.10
62280 Treat spinal cord lesion 9.45 $70.00 $661.50
62281 Treat spinal cord lesion 6.94 $70.00 $485.80
62282 Treat spinal canal lesion 8.63 $70.00 $604.10
62284 Injection for myelogram 5.61 $70.00 $392.70
62287 Percutaneous diskectomy 16.73 $70.00 $1,171.10
62290 Njx px discography lumbar 9.62 $70.00 $673.40
62291 Njx px discography crv/thrc 9.28 $70.00 $649.60
62292 Njx chemonucleolysis lmbr 16.46 $70.00 $1,152.20
62294 Injection into spinal artery 27.85 $70.00 $1,949.50
62302 Myelography lumbar injection 7.13 $70.00 $499.10
62303 Myelography lumbar injection 7.29 $70.00 $510.30
62304 Myelography lumbar injection 7.04 $70.00 $492.80
62305 Myelography lumbar injection 7.65 $70.00 $535.50
62320 Njx interlaminar crv/thrc 4.68 $70.00 $327.60
62321 Njx interlaminar crv/thrc 7.19 $70.00 $503.30
62322 Njx interlaminar lmbr/sac 4.36 $70.00 $305.20
62323 Njx interlaminar lmbr/sac 7.11 $70.00 $497.70
62324 Njx interlaminar crv/thrc 4.12 $70.00 $288.40
62325 Njx interlaminar crv/thrc 6.67 $70.00 $466.90
62326 Njx interlaminar lmbr/sac 4.28 $70.00 $299.60
62327 Njx interlaminar lmbr/sac 6.69 $70.00 $468.30
62350 Implant spinal canal cath 11.50 $70.00 $805.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
62351 Implant spinal canal cath 24.89 $70.00 $1,742.30
62355 Remove spinal canal catheter 7.73 $70.00 $541.10
62360 Insert spine infusion device 9.13 $70.00 $639.10
62361 Implant spine infusion pump 12.46 $70.00 $872.20
62362 Implant spine infusion pump 11.04 $70.00 $772.80
62365 Remove spine infusion device 8.52 $70.00 $596.40
62367 Analyze spine infus pump 1.14 $70.00 $79.80
62368 Analyze sp inf pump w/reprog 1.57 $70.00 $109.90
62369 Anal sp inf pmp w/reprg&fill 3.34 $70.00 $233.80
62370 Anl sp inf pmp w/mdreprg&fil 3.47 $70.00 $242.90
62380 Ndsc dcmprn 1 ntrspc lumbar 0.00 $70.00 $0.00
63001 Remove spine lamina 1/2 crvl 36.08 $70.00 $2,525.60
63003 Remove spine lamina 1/2 thrc 36.02 $70.00 $2,521.40
63005 Remove spine lamina 1/2 lmbr 34.46 $70.00 $2,412.20
63011 Remove spine lamina 1/2 scrl 31.66 $70.00 $2,216.20
63012 Remove lamina/facets lumbar 34.66 $70.00 $2,426.20
63015 Remove spine lamina >2 crvcl 43.20 $70.00 $3,024.00
63016 Remove spine lamina >2 thrc 44.39 $70.00 $3,107.30
63017 Remove spine lamina >2 lmbr 36.70 $70.00 $2,569.00
63020 Neck spine disk surgery 33.69 $70.00 $2,358.30
63030 Low back disk surgery 28.20 $70.00 $1,974.00
63035 Spinal disk surgery add-on 5.58 $70.00 $390.60
63040 Laminotomy single cervical 40.48 $70.00 $2,833.60
63042 Laminotomy single lumbar 37.63 $70.00 $2,634.10
63043 Laminotomy addl cervical 0.00 $70.00 $0.00
63044 Laminotomy addl lumbar 0.00 $70.00 $0.00
63045 Remove spine lamina 1 crvl 37.39 $70.00 $2,617.30
63046 Remove spine lamina 1 thrc 35.64 $70.00 $2,494.80
63047 Remove spine lamina 1 lmbr 31.97 $70.00 $2,237.90
63048 Remove spinal lamina add-on 6.17 $70.00 $431.90
63050 Cervical laminoplsty 2/> seg 43.50 $70.00 $3,045.00
63051 C-laminoplasty w/graft/plate 49.71 $70.00 $3,479.70
63055 Decompress spinal cord thrc 47.49 $70.00 $3,324.30
63056 Decompress spinal cord lmbr 43.29 $70.00 $3,030.30
63057 Decompress spine cord add-on 9.32 $70.00 $652.40
63064 Decompress spinal cord thrc 51.90 $70.00 $3,633.00
63066 Decompress spine cord add-on 6.03 $70.00 $422.10
63075 Neck spine disk surgery 39.28 $70.00 $2,749.60
63076 Neck spine disk surgery 7.20 $70.00 $504.00
63077 Spine disk surgery thorax 44.24 $70.00 $3,096.80
63078 Spine disk surgery thorax 6.06 $70.00 $424.20
63081 Remove vert body dcmprn crvl 51.14 $70.00 $3,579.80
63082 Remove vertebral body add-on 7.77 $70.00 $543.90
63085 Remove vert body dcmprn thrc 55.99 $70.00 $3,919.30
63086 Remove vertebral body add-on 5.58 $70.00 $390.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
63087 Remov vertbr dcmprn thrclmbr 70.32 $70.00 $4,922.40
63088 Remove vertebral body add-on 7.53 $70.00 $527.10
63090 Remove vert body dcmprn lmbr 56.98 $70.00 $3,988.60
63091 Remove vertebral body add-on 5.18 $70.00 $362.60
63101 Remove vert body dcmprn thrc 67.82 $70.00 $4,747.40
63102 Remove vert body dcmprn lmbr 66.07 $70.00 $4,624.90
63103 Remove vertebral body add-on 8.60 $70.00 $602.00
63170 Incise spinal cord tract(s) 46.43 $70.00 $3,250.10
63172 Drainage of spinal cyst 40.46 $70.00 $2,832.20
63173 Drainage of spinal cyst 50.11 $70.00 $3,507.70
63180 Revise spinal cord ligaments 41.65 $70.00 $2,915.50
63182 Revise spinal cord ligaments 44.03 $70.00 $3,082.10
63185 Incise spine nrv half segmnt 33.24 $70.00 $2,326.80
63190 Incise spine nrv >2 segmnts 35.99 $70.00 $2,519.30
63191 Incise spine accessory nerve 40.52 $70.00 $2,836.40
63194 Incise spine & cord cervical 46.95 $70.00 $3,286.50
63195 Incise spine & cord thoracic 45.15 $70.00 $3,160.50
63196 Incise spine&cord 2 trx crvl 52.42 $70.00 $3,669.40
63197 Incise spine&cord 2 trx thrc 46.16 $70.00 $3,231.20
63198 Incise spin&cord 2 stgs crvl 61.58 $70.00 $4,310.60
63199 Incise spin&cord 2 stgs thrc 64.53 $70.00 $4,517.10
63200 Release spinal cord lumbar 44.71 $70.00 $3,129.70
63250 Revise spinal cord vsls crvl 85.63 $70.00 $5,994.10
63251 Revise spinal cord vsls thrc 89.44 $70.00 $6,260.80
63252 Revise spine cord vsl thrlmb 88.92 $70.00 $6,224.40
63265 Excise intraspinl lesion crv 48.65 $70.00 $3,405.50
63266 Excise intrspinl lesion thrc 50.27 $70.00 $3,518.90
63267 Excise intrspinl lesion lmbr 39.83 $70.00 $2,788.10
63268 Excise intrspinl lesion scrl 41.20 $70.00 $2,884.00
63270 Excise intrspinl lesion crvl 60.43 $70.00 $4,230.10
63271 Excise intrspinl lesion thrc 60.43 $70.00 $4,230.10
63272 Excise intrspinl lesion lmbr 55.18 $70.00 $3,862.60
63273 Excise intrspinl lesion scrl 54.46 $70.00 $3,812.20
63275 Bx/exc xdrl spine lesn crvl 52.61 $70.00 $3,682.70
63276 Bx/exc xdrl spine lesn thrc 52.27 $70.00 $3,658.90
63277 Bx/exc xdrl spine lesn lmbr 45.36 $70.00 $3,175.20
63278 Bx/exc xdrl spine lesn scrl 46.29 $70.00 $3,240.30
63280 Bx/exc idrl spine lesn crvl 61.95 $70.00 $4,336.50
63281 Bx/exc idrl spine lesn thrc 61.23 $70.00 $4,286.10
63282 Bx/exc idrl spine lesn lmbr 57.70 $70.00 $4,039.00
63283 Bx/exc idrl spine lesn scrl 55.33 $70.00 $3,873.10
63285 Bx/exc idrl imed lesn cervl 76.82 $70.00 $5,377.40
63286 Bx/exc idrl imed lesn thrc 75.66 $70.00 $5,296.20
63287 Bx/exc idrl imed lesn thrlmb 80.13 $70.00 $5,609.10
63290 Bx/exc xdrl/idrl lsn any lvl 81.34 $70.00 $5,693.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
63295 Repair laminectomy defect 9.76 $70.00 $683.20
63300 Remove vert xdrl body crvcl 53.62 $70.00 $3,753.40
63301 Remove vert xdrl body thrc 64.17 $70.00 $4,491.90
63302 Remove vert xdrl body thrlmb 63.31 $70.00 $4,431.70
63303 Remov vert xdrl bdy lmbr/sac 63.19 $70.00 $4,423.30
63304 Remove vert idrl body crvcl 67.52 $70.00 $4,726.40
63305 Remove vert idrl body thrc 73.79 $70.00 $5,165.30
63306 Remov vert idrl bdy thrclmbr 70.25 $70.00 $4,917.50
63307 Remov vert idrl bdy lmbr/sac 71.00 $70.00 $4,970.00
63308 Remove vertebral body add-on 9.46 $70.00 $662.20
63600 Remove spinal cord lesion 32.07 $70.00 $2,244.90
63610 Stimulation of spinal cord 17.15 $70.00 $1,200.50
63620 Srs spinal lesion 32.89 $70.00 $2,302.30
63621 Srs spinal lesion addl 7.48 $70.00 $523.60
63650 Implant neuroelectrodes 45.98 $70.00 $3,218.60
63655 Implant neuroelectrodes 24.10 $70.00 $1,687.00
63661 Remove spine eltrd perq aray 17.51 $70.00 $1,225.70
63662 Remove spine eltrd plate 24.40 $70.00 $1,708.00
63663 Revise spine eltrd perq aray 23.44 $70.00 $1,640.80
63664 Revise spine eltrd plate 25.29 $70.00 $1,770.30
63685 Insrt/redo spine n generator 10.40 $70.00 $728.00
63688 Revise/remove neuroreceiver 10.73 $70.00 $751.10
63700 Repair of spinal herniation 37.98 $70.00 $2,658.60
63702 Repair of spinal herniation 41.83 $70.00 $2,928.10
63704 Repair of spinal herniation 46.62 $70.00 $3,263.40
63706 Repair of spinal herniation 51.69 $70.00 $3,618.30
63707 Repair spinal fluid leakage 26.98 $70.00 $1,888.60
63709 Repair spinal fluid leakage 32.05 $70.00 $2,243.50
63710 Graft repair of spine defect 31.60 $70.00 $2,212.00
63740 Install spinal shunt 28.39 $70.00 $1,987.30
63741 Install spinal shunt 19.70 $70.00 $1,379.00
63744 Revision of spinal shunt 19.52 $70.00 $1,366.40
63746 Removal of spinal shunt 17.38 $70.00 $1,216.60
64400 N block inj trigeminal 3.88 $70.00 $271.60
64402 N block inj facial 4.29 $70.00 $300.30
64405 N block inj occipital 2.37 $70.00 $165.90
64408 N block inj vagus 3.35 $70.00 $234.50
64410 N block inj phrenic 4.43 $70.00 $310.10
64413 N block inj cervical plexus 3.60 $70.00 $252.00
64415 N block inj brachial plexus 3.38 $70.00 $236.60
64416 N block cont infuse b plex 2.28 $70.00 $159.60
64417 N block inj axillary 3.76 $70.00 $263.20
64418 N block inj suprascapular 2.71 $70.00 $189.70
64420 N block inj intercost sng 3.15 $70.00 $220.50
64421 N block inj intercost mlt 4.46 $70.00 $312.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
64425 N block inj ilio-ing/hypogi 3.93 $70.00 $275.10
64430 N block inj pudendal 4.14 $70.00 $289.80
64435 N block inj paracervical 4.00 $70.00 $280.00
64445 N block inj sciatic sng 3.89 $70.00 $272.30
64446 N blk inj sciatic cont inf 2.28 $70.00 $159.60
64447 N block inj fem single 3.46 $70.00 $242.20
64448 N block inj fem cont inf 2.05 $70.00 $143.50
64449 N block inj lumbar plexus 2.44 $70.00 $170.80
64450 N block other peripheral 2.19 $70.00 $153.30
64455 N block inj plantar digit 1.36 $70.00 $95.20
64461 Pvb thoracic single inj site 3.96 $70.00 $277.20
64462 Pvb thoracic 2nd+ inj site 2.20 $70.00 $154.00
64463 Pvb thoracic cont infusion 5.13 $70.00 $359.10
64479 Inj foramen epidural c/t 6.95 $70.00 $486.50
64480 Inj foramen epidural add-on 3.42 $70.00 $239.40
64483 Inj foramen epidural l/s 6.44 $70.00 $450.80
64484 Inj foramen epidural add-on 2.79 $70.00 $195.30
64486 Tap block unil by injection 3.12 $70.00 $218.40
64487 Tap block uni by infusion 4.49 $70.00 $314.30
64488 Tap block bi injection 3.83 $70.00 $268.10
64489 Tap block bi by infusion 6.65 $70.00 $465.50
64490 Inj paravert f jnt c/t 1 lev 5.39 $70.00 $377.30
64491 Inj paravert f jnt c/t 2 lev 2.68 $70.00 $187.60
64492 Inj paravert f jnt c/t 3 lev 2.70 $70.00 $189.00
64493 Inj paravert f jnt l/s 1 lev 4.91 $70.00 $343.70
64494 Inj paravert f jnt l/s 2 lev 2.49 $70.00 $174.30
64495 Inj paravert f jnt l/s 3 lev 2.49 $70.00 $174.30
64505 N block spenopalatine gangl 3.36 $70.00 $235.20
64510 N block stellate ganglion 3.78 $70.00 $264.60
64517 N block inj hypogas plxs 5.43 $70.00 $380.10
64520 N block lumbar/thoracic 5.75 $70.00 $402.50
64530 N block inj celiac pelus 5.73 $70.00 $401.10
64553 Implant neuroelectrodes 48.81 $70.00 $3,416.70
64555 Implant neuroelectrodes 44.31 $70.00 $3,101.70
64561 Implant neuroelectrodes 20.92 $70.00 $1,464.40
64566 Neuroeltrd stim post tibial 3.62 $70.00 $253.40
64568 Inc for vagus n elect impl 18.43 $70.00 $1,290.10
64569 Revise/repl vagus n eltrd 22.11 $70.00 $1,547.70
64570 Remove vagus n eltrd 21.29 $70.00 $1,490.30
64575 Implant neuroelectrodes 9.60 $70.00 $672.00
64580 Implant neuroelectrodes 8.86 $70.00 $620.20
64581 Implant neuroelectrodes 19.09 $70.00 $1,336.30
64585 Revise/remove neuroelectrode 7.03 $70.00 $492.10
64590 Insrt/redo pn/gastr stimul 7.60 $70.00 $532.00
64595 Revise/rmv pn/gastr stimul 6.89 $70.00 $482.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
64600 Injection treatment of nerve 12.35 $70.00 $864.50
64605 Injection treatment of nerve 16.89 $70.00 $1,182.30
64610 Injection treatment of nerve 22.09 $70.00 $1,546.30
64611 Chemodenerv saliv glands 3.45 $70.00 $241.50
64612 Destroy nerve face muscle 3.83 $70.00 $268.10
64615 Chemodenerv musc migraine 4.27 $70.00 $298.90
64616 Chemodenerv musc neck dyston 3.80 $70.00 $266.00
64617 Chemodener muscle larynx emg 4.62 $70.00 $323.40
64620 Injection treatment of nerve 5.91 $70.00 $413.70
64630 Injection treatment of nerve 6.77 $70.00 $473.90
64632 N block inj common digit 2.45 $70.00 $171.50
64633 Destroy cerv/thor facet jnt 11.89 $70.00 $832.30
64634 Destroy c/th facet jnt addl 5.34 $70.00 $373.80
64635 Destroy lumb/sac facet jnt 11.76 $70.00 $823.20
64636 Destroy l/s facet jnt addl 4.85 $70.00 $339.50
64640 Injection treatment of nerve 3.86 $70.00 $270.20
64642 Chemodenerv 1 extremity 1-4 4.15 $70.00 $290.50
64643 Chemodenerv 1 extrem 1-4 ea 2.65 $70.00 $185.50
64644 Chemodenerv 1 extrem 5/> mus 4.82 $70.00 $337.40
64645 Chemodenerv 1 extrem 5/> ea 3.33 $70.00 $233.10
64646 Chemodenerv trunk musc 1-5 4.35 $70.00 $304.50
64647 Chemodenerv trunk musc 6/> 5.12 $70.00 $358.40
64650 Chemodenerv eccrine glands 2.25 $70.00 $157.50
64653 Chemodenerv eccrine glands 2.76 $70.00 $193.20
64680 Injection treatment of nerve 9.07 $70.00 $634.90
64681 Injection treatment of nerve 16.43 $70.00 $1,150.10
64702 Revise finger/toe nerve 14.47 $70.00 $1,012.90
64704 Revise hand/foot nerve 9.23 $70.00 $646.10
64708 Revise arm/leg nerve 14.42 $70.00 $1,009.40
64712 Revision of sciatic nerve 16.79 $70.00 $1,175.30
64713 Revision of arm nerve(s) 22.48 $70.00 $1,573.60
64714 Revise low back nerve(s) 20.81 $70.00 $1,456.70
64716 Revision of cranial nerve 15.00 $70.00 $1,050.00
64718 Revise ulnar nerve at elbow 17.04 $70.00 $1,192.80
64719 Revise ulnar nerve at wrist 11.56 $70.00 $809.20
64721 Carpal tunnel surgery 12.45 $70.00 $871.50
64722 Relieve pressure on nerve(s) 10.25 $70.00 $717.50
64726 Release foot/toe nerve 7.80 $70.00 $546.00
64727 Internal nerve revision 5.31 $70.00 $371.70
64732 Incision of brow nerve 12.89 $70.00 $902.30
64734 Incision of cheek nerve 14.57 $70.00 $1,019.90
64736 Incision of chin nerve 10.73 $70.00 $751.10
64738 Incision of jaw nerve 13.37 $70.00 $935.90
64740 Incision of tongue nerve 14.01 $70.00 $980.70
64742 Incision of facial nerve 14.11 $70.00 $987.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
64744 Incise nerve back of head 14.29 $70.00 $1,000.30
64746 Incise diaphragm nerve 12.42 $70.00 $869.40
64755 Incision of stomach nerves 26.31 $70.00 $1,841.70
64760 Incision of vagus nerve 14.78 $70.00 $1,034.60
64763 Incise hip/thigh nerve 14.76 $70.00 $1,033.20
64766 Incise hip/thigh nerve 17.88 $70.00 $1,251.60
64771 Sever cranial nerve 17.09 $70.00 $1,196.30
64772 Incision of spinal nerve 16.25 $70.00 $1,137.50
64774 Remove skin nerve lesion 11.71 $70.00 $819.70
64776 Remove digit nerve lesion 11.18 $70.00 $782.60
64778 Digit nerve surgery add-on 5.30 $70.00 $371.00
64782 Remove limb nerve lesion 13.22 $70.00 $925.40
64783 Limb nerve surgery add-on 6.33 $70.00 $443.10
64784 Remove nerve lesion 20.92 $70.00 $1,464.40
64786 Remove sciatic nerve lesion 28.98 $70.00 $2,028.60
64787 Implant nerve end 6.96 $70.00 $487.20
64788 Remove skin nerve lesion 11.55 $70.00 $808.50
64790 Removal of nerve lesion 24.19 $70.00 $1,693.30
64792 Removal of nerve lesion 31.47 $70.00 $2,202.90
64795 Biopsy of nerve 5.64 $70.00 $394.80
64802 Sympathectomy cervical 24.34 $70.00 $1,703.80
64804 Remove sympathetic nerves 34.19 $70.00 $2,393.30
64809 Remove sympathetic nerves 31.03 $70.00 $2,172.10
64818 Remove sympathetic nerves 22.55 $70.00 $1,578.50
64820 Sympathectomy digital artery 20.58 $70.00 $1,440.60
64821 Remove sympathetic nerves 20.01 $70.00 $1,400.70
64822 Remove sympathetic nerves 20.01 $70.00 $1,400.70
64823 Sympathectomy supfc palmar 22.76 $70.00 $1,593.20
64831 Repair of digit nerve 19.79 $70.00 $1,385.30
64832 Repair nerve add-on 9.73 $70.00 $681.10
64834 Repair of hand or foot nerve 21.39 $70.00 $1,497.30
64835 Repair of hand or foot nerve 23.47 $70.00 $1,642.90
64836 Repair of hand or foot nerve 23.49 $70.00 $1,644.30
64837 Repair nerve add-on 10.65 $70.00 $745.50
64840 Repair of leg nerve 27.82 $70.00 $1,947.40
64856 Repair/transpose nerve 29.23 $70.00 $2,046.10
64857 Repair arm/leg nerve 30.44 $70.00 $2,130.80
64858 Repair sciatic nerve 34.07 $70.00 $2,384.90
64859 Nerve surgery 7.19 $70.00 $503.30
64861 Repair of arm nerves 44.52 $70.00 $3,116.40
64862 Repair of low back nerves 39.31 $70.00 $2,751.70
64864 Repair of facial nerve 24.91 $70.00 $1,743.70
64865 Repair of facial nerve 31.40 $70.00 $2,198.00
64866 Fusion of facial/other nerve 36.79 $70.00 $2,575.30
64868 Fusion of facial/other nerve 28.85 $70.00 $2,019.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
64872 Subsequent repair of nerve 3.39 $70.00 $237.30
64874 Repair & revise nerve add-on 5.06 $70.00 $354.20
64876 Repair nerve/shorten bone 5.75 $70.00 $402.50
64885 Nerve graft head/neck </4 cm 32.14 $70.00 $2,249.80
64886 Nerve graft head/neck >4 cm 37.28 $70.00 $2,609.60
64890 Nerve graft hand/foot </4 cm 31.21 $70.00 $2,184.70
64891 Nerve graft hand/foot >4 cm 33.11 $70.00 $2,317.70
64892 Nerve graft arm/leg <4 cm 30.13 $70.00 $2,109.10
64893 Nerve graft arm/leg >4 cm 32.45 $70.00 $2,271.50
64895 Nerve graft hand/foot </4 cm 38.28 $70.00 $2,679.60
64896 Nerve graft hand/foot >4 cm 41.47 $70.00 $2,902.90
64897 Nerve graft arm/leg </4 cm 36.49 $70.00 $2,554.30
64898 Nerve graft arm/leg >4 cm 39.64 $70.00 $2,774.80
64901 Nerve graft add-on 17.41 $70.00 $1,218.70
64902 Nerve graft add-on 20.15 $70.00 $1,410.50
64905 Nerve pedicle transfer 29.47 $70.00 $2,062.90
64907 Nerve pedicle transfer 37.72 $70.00 $2,640.40
64910 Nerve repair w/allograft 22.89 $70.00 $1,602.30
64911 Neurorraphy w/vein autograft 29.54 $70.00 $2,067.80
64912 Nrv rpr w/nrv algrft 1st 22.32 $70.00 $1,562.40
64913 Nrv rpr w/nrv algrft ea addl 4.50 $70.00 $315.00
64999 Nervous system surgery 0.00 $70.00 $0.00
65091 Revise eye 18.40 $70.00 $1,288.00
65093 Revise eye with implant 18.21 $70.00 $1,274.70
65101 Removal of eye 21.37 $70.00 $1,495.90
65103 Remove eye/insert implant 22.25 $70.00 $1,557.50
65105 Remove eye/attach implant 24.49 $70.00 $1,714.30
65110 Removal of eye 35.05 $70.00 $2,453.50
65112 Remove eye/revise socket 40.58 $70.00 $2,840.60
65114 Remove eye/revise socket 42.52 $70.00 $2,976.40
65125 Revise ocular implant 13.03 $70.00 $912.10
65130 Insert ocular implant 21.17 $70.00 $1,481.90
65135 Insert ocular implant 21.47 $70.00 $1,502.90
65140 Attach ocular implant 23.32 $70.00 $1,632.40
65150 Revise ocular implant 16.80 $70.00 $1,176.00
65155 Reinsert ocular implant 24.40 $70.00 $1,708.00
65175 Removal of ocular implant 19.05 $70.00 $1,333.50
65205 Remove foreign body from eye 1.31 $70.00 $91.70
65210 Remove foreign body from eye 1.60 $70.00 $112.00
65220 Remove foreign body from eye 1.68 $70.00 $117.60
65222 Remove foreign body from eye 1.93 $70.00 $135.10
65235 Remove foreign body from eye 20.26 $70.00 $1,418.20
65260 Remove foreign body from eye 27.41 $70.00 $1,918.70
65265 Remove foreign body from eye 30.79 $70.00 $2,155.30
65270 Repair of eye wound 7.79 $70.00 $545.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
65272 Repair of eye wound 14.56 $70.00 $1,019.20
65273 Repair of eye wound 10.85 $70.00 $759.50
65275 Repair of eye wound 16.55 $70.00 $1,158.50
65280 Repair of eye wound 19.10 $70.00 $1,337.00
65285 Repair of eye wound 31.57 $70.00 $2,209.90
65286 Repair of eye wound 20.07 $70.00 $1,404.90
65290 Repair of eye socket wound 13.96 $70.00 $977.20
65400 Removal of eye lesion 19.44 $70.00 $1,360.80
65410 Biopsy of cornea 4.11 $70.00 $287.70
65420 Removal of eye lesion 14.93 $70.00 $1,045.10
65426 Removal of eye lesion 18.76 $70.00 $1,313.20
65430 Corneal smear 3.31 $70.00 $231.70
65435 Curette/treat cornea 2.32 $70.00 $162.40
65436 Curette/treat cornea 11.05 $70.00 $773.50
65450 Treatment of corneal lesion 9.30 $70.00 $651.00
65600 Revision of cornea 11.38 $70.00 $796.60
65710 Corneal transplant 31.76 $70.00 $2,223.20
65730 Corneal transplant 35.15 $70.00 $2,460.50
65750 Corneal transplant 35.32 $70.00 $2,472.40
65755 Corneal transplant 35.14 $70.00 $2,459.80
65756 Corneal trnspl endothelial 33.65 $70.00 $2,355.50
65757 Prep corneal endo allograft 0.00 $70.00 $0.00
65760 Revision of cornea 0.00 $70.00 $0.00
65765 Revision of cornea 0.00 $70.00 $0.00
65767 Corneal tissue transplant 0.00 $70.00 $0.00
65770 Revise cornea with implant 39.63 $70.00 $2,774.10
65771 Radial keratotomy 0.00 $70.00 $0.00
65772 Correction of astigmatism 12.88 $70.00 $901.60
65775 Correction of astigmatism 15.82 $70.00 $1,107.40
65778 Cover eye w/membrane 40.08 $70.00 $2,805.60
65779 Cover eye w/membrane suture 34.51 $70.00 $2,415.70
65780 Ocular reconst transplant 18.95 $70.00 $1,326.50
65781 Ocular reconst transplant 37.91 $70.00 $2,653.70
65782 Ocular reconst transplant 32.68 $70.00 $2,287.60
65785 Impltj ntrstrml crnl rng seg 69.56 $70.00 $4,869.20
65800 Drainage of eye 3.42 $70.00 $239.40
65810 Drainage of eye 13.23 $70.00 $926.10
65815 Drainage of eye 18.26 $70.00 $1,278.20
65820 Relieve inner eye pressure 21.54 $70.00 $1,507.80
65850 Incision of eye 23.87 $70.00 $1,670.90
65855 Trabeculoplasty laser surg 7.01 $70.00 $490.70
65860 Incise inner eye adhesions 8.81 $70.00 $616.70
65865 Incise inner eye adhesions 13.46 $70.00 $942.20
65870 Incise inner eye adhesions 16.78 $70.00 $1,174.60
65875 Incise inner eye adhesions 17.92 $70.00 $1,254.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
65880 Incise inner eye adhesions 18.86 $70.00 $1,320.20
65900 Remove eye lesion 27.63 $70.00 $1,934.10
65920 Remove implant of eye 22.41 $70.00 $1,568.70
65930 Remove blood clot from eye 18.09 $70.00 $1,266.30
66020 Injection treatment of eye 5.43 $70.00 $380.10
66030 Injection treatment of eye 4.87 $70.00 $340.90
66130 Remove eye lesion 19.95 $70.00 $1,396.50
66150 Glaucoma surgery 24.94 $70.00 $1,745.80
66155 Glaucoma surgery 24.92 $70.00 $1,744.40
66160 Glaucoma surgery 28.10 $70.00 $1,967.00
66170 Glaucoma surgery 31.12 $70.00 $2,178.40
66172 Incision of eye 33.90 $70.00 $2,373.00
66174 Translum dil eye canal 26.94 $70.00 $1,885.80
66175 Trnslum dil eye canal w/stnt 28.22 $70.00 $1,975.40
66179 Aqueous shunt eye w/o graft 30.66 $70.00 $2,146.20
66180 Aqueous shunt eye w/graft 32.35 $70.00 $2,264.50
66183 Insert ant drainage device 29.29 $70.00 $2,050.30
66184 Revision of aqueous shunt 22.34 $70.00 $1,563.80
66185 Revise aqueous shunt eye 24.05 $70.00 $1,683.50
66225 Repair/graft eye lesion 26.48 $70.00 $1,853.60
66250 Follow-up surgery of eye 21.41 $70.00 $1,498.70
66500 Incision of iris 10.20 $70.00 $714.00
66505 Incision of iris 11.17 $70.00 $781.90
66600 Remove iris and lesion 23.94 $70.00 $1,675.80
66605 Removal of iris 30.34 $70.00 $2,123.80
66625 Removal of iris 12.20 $70.00 $854.00
66630 Removal of iris 16.17 $70.00 $1,131.90
66635 Removal of iris 16.33 $70.00 $1,143.10
66680 Repair iris & ciliary body 14.71 $70.00 $1,029.70
66682 Repair iris & ciliary body 18.39 $70.00 $1,287.30
66700 Destruction ciliary body 12.86 $70.00 $900.20
66710 Ciliary transsleral therapy 12.60 $70.00 $882.00
66711 Ciliary endoscopic ablation 18.28 $70.00 $1,279.60
66720 Destruction ciliary body 13.16 $70.00 $921.20
66740 Destruction ciliary body 12.50 $70.00 $875.00
66761 Revision of iris 8.50 $70.00 $595.00
66762 Revision of iris 13.57 $70.00 $949.90
66770 Removal of inner eye lesion 15.07 $70.00 $1,054.90
66820 Incision secondary cataract 11.46 $70.00 $802.20
66821 After cataract laser surgery 9.42 $70.00 $659.40
66825 Reposition intraocular lens 21.85 $70.00 $1,529.50
66830 Removal of lens lesion 20.15 $70.00 $1,410.50
66840 Removal of lens material 19.79 $70.00 $1,385.30
66850 Removal of lens material 22.52 $70.00 $1,576.40
66852 Removal of lens material 23.99 $70.00 $1,679.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
66920 Extraction of lens 21.41 $70.00 $1,498.70
66930 Extraction of lens 24.33 $70.00 $1,703.10
66940 Extraction of lens 22.23 $70.00 $1,556.10
66982 Cataract surgery complex 22.56 $70.00 $1,579.20
66983 Cataract surg w/iol 1 stage 21.09 $70.00 $1,476.30
66984 Cataract surg w/iol 1 stage 18.16 $70.00 $1,271.20
66985 Insert lens prosthesis 21.86 $70.00 $1,530.20
66986 Exchange lens prosthesis 25.83 $70.00 $1,808.10
66990 Ophthalmic endoscope add-on 2.56 $70.00 $179.20
66999 Eye surgery procedure 0.00 $70.00 $0.00
67005 Partial removal of eye fluid 13.43 $70.00 $940.10
67010 Partial removal of eye fluid 15.42 $70.00 $1,079.40
67015 Release of eye fluid 16.58 $70.00 $1,160.60
67025 Replace eye fluid 20.85 $70.00 $1,459.50
67027 Implant eye drug system 24.22 $70.00 $1,695.40
67028 Injection eye drug 2.89 $70.00 $202.30
67030 Incise inner eye strands 15.21 $70.00 $1,064.70
67031 Laser surgery eye strands 11.11 $70.00 $777.70
67036 Removal of inner eye fluid 25.61 $70.00 $1,792.70
67039 Laser treatment of retina 27.43 $70.00 $1,920.10
67040 Laser treatment of retina 29.64 $70.00 $2,074.80
67041 Vit for macular pucker 32.75 $70.00 $2,292.50
67042 Vit for macular hole 32.75 $70.00 $2,292.50
67043 Vit for membrane dissect 34.55 $70.00 $2,418.50
67101 Repair detached retina crtx 9.40 $70.00 $658.00
67105 Repair detached retina pc 8.45 $70.00 $591.50
67107 Repair detached retina 32.19 $70.00 $2,253.30
67108 Repair detached retina 34.10 $70.00 $2,387.00
67110 Repair detached retina 25.09 $70.00 $1,756.30
67113 Repair retinal detach cplx 38.06 $70.00 $2,664.20
67115 Release encircling material 14.19 $70.00 $993.30
67120 Remove eye implant material 18.86 $70.00 $1,320.20
67121 Remove eye implant material 25.81 $70.00 $1,806.70
67141 Treatment of retina 14.92 $70.00 $1,044.40
67145 Treatment of retina 15.02 $70.00 $1,051.40
67208 Treatment of retinal lesion 17.07 $70.00 $1,194.90
67210 Treatment of retinal lesion 14.72 $70.00 $1,030.40
67218 Treatment of retinal lesion 39.38 $70.00 $2,756.60
67220 Treatment of choroid lesion 15.18 $70.00 $1,062.60
67221 Ocular photodynamic ther 8.07 $70.00 $564.90
67225 Eye photodynamic ther add-on 0.84 $70.00 $58.80
67227 Dstrj extensive retinopathy 8.34 $70.00 $583.80
67228 Treatment x10sv retinopathy 9.73 $70.00 $681.10
67229 Tr retinal les preterm inf 33.14 $70.00 $2,319.80
67250 Reinforce eye wall 22.61 $70.00 $1,582.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
67255 Reinforce/graft eye wall 19.42 $70.00 $1,359.40
67299 Eye surgery procedure 0.00 $70.00 $0.00
67311 Revise eye muscle 16.96 $70.00 $1,187.20
67312 Revise two eye muscles 20.23 $70.00 $1,416.10
67314 Revise eye muscle 19.10 $70.00 $1,337.00
67316 Revise two eye muscles 22.74 $70.00 $1,591.80
67318 Revise eye muscle(s) 19.96 $70.00 $1,397.20
67320 Revise eye muscle(s) add-on 9.17 $70.00 $641.90
67331 Eye surgery follow-up add-on 8.70 $70.00 $609.00
67332 Rerevise eye muscles add-on 9.44 $70.00 $660.80
67334 Revise eye muscle w/suture 8.59 $70.00 $601.30
67335 Eye suture during surgery 4.21 $70.00 $294.70
67340 Revise eye muscle add-on 10.19 $70.00 $713.30
67343 Release eye tissue 18.54 $70.00 $1,297.80
67345 Destroy nerve of eye muscle 6.96 $70.00 $487.20
67346 Biopsy eye muscle 5.50 $70.00 $385.00
67399 Unlisted px extraocular musc 0.00 $70.00 $0.00
67400 Explore/biopsy eye socket 26.79 $70.00 $1,875.30
67405 Explore/drain eye socket 22.86 $70.00 $1,600.20
67412 Explore/treat eye socket 24.68 $70.00 $1,727.60
67413 Explore/treat eye socket 24.70 $70.00 $1,729.00
67414 Explr/decompress eye socket 38.12 $70.00 $2,668.40
67415 Aspiration orbital contents 2.97 $70.00 $207.90
67420 Explore/treat eye socket 46.28 $70.00 $3,239.60
67430 Explore/treat eye socket 35.94 $70.00 $2,515.80
67440 Explore/drain eye socket 34.78 $70.00 $2,434.60
67445 Explr/decompress eye socket 40.32 $70.00 $2,822.40
67450 Explore/biopsy eye socket 36.15 $70.00 $2,530.50
67500 Inject/treat eye socket 2.02 $70.00 $141.40
67505 Inject/treat eye socket 2.38 $70.00 $166.60
67515 Inject/treat eye socket 2.24 $70.00 $156.80
67550 Insert eye socket implant 27.82 $70.00 $1,947.40
67560 Revise eye socket implant 28.51 $70.00 $1,995.70
67570 Decompress optic nerve 33.95 $70.00 $2,376.50
67599 Orbit surgery procedure 0.00 $70.00 $0.00
67700 Drainage of eyelid abscess 7.82 $70.00 $547.40
67710 Incision of eyelid 6.56 $70.00 $459.20
67715 Incision of eyelid fold 7.07 $70.00 $494.90
67800 Remove eyelid lesion 3.64 $70.00 $254.80
67801 Remove eyelid lesions 4.64 $70.00 $324.80
67805 Remove eyelid lesions 5.76 $70.00 $403.20
67808 Remove eyelid lesion(s) 10.45 $70.00 $731.50
67810 Biopsy eyelid & lid margin 4.99 $70.00 $349.30
67820 Revise eyelashes 0.93 $70.00 $65.10
67825 Revise eyelashes 3.71 $70.00 $259.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
67830 Revise eyelashes 7.64 $70.00 $534.80
67835 Revise eyelashes 12.47 $70.00 $872.90
67840 Remove eyelid lesion 7.91 $70.00 $553.70
67850 Treat eyelid lesion 6.13 $70.00 $429.10
67875 Closure of eyelid by suture 4.96 $70.00 $347.20
67880 Revision of eyelid 13.12 $70.00 $918.40
67882 Revision of eyelid 16.10 $70.00 $1,127.00
67900 Repair brow defect 18.28 $70.00 $1,279.60
67901 Repair eyelid defect 21.92 $70.00 $1,534.40
67902 Repair eyelid defect 20.54 $70.00 $1,437.80
67903 Repair eyelid defect 16.98 $70.00 $1,188.60
67904 Repair eyelid defect 20.94 $70.00 $1,465.80
67906 Repair eyelid defect 14.44 $70.00 $1,010.80
67908 Repair eyelid defect 14.17 $70.00 $991.90
67909 Revise eyelid defect 15.36 $70.00 $1,075.20
67911 Revise eyelid defect 15.97 $70.00 $1,117.90
67912 Correction eyelid w/implant 25.42 $70.00 $1,779.40
67914 Repair eyelid defect 13.53 $70.00 $947.10
67915 Repair eyelid defect 8.52 $70.00 $596.40
67916 Repair eyelid defect 17.05 $70.00 $1,193.50
67917 Repair eyelid defect 17.36 $70.00 $1,215.20
67921 Repair eyelid defect 13.28 $70.00 $929.60
67922 Repair eyelid defect 8.37 $70.00 $585.90
67923 Repair eyelid defect 17.05 $70.00 $1,193.50
67924 Repair eyelid defect 18.16 $70.00 $1,271.20
67930 Repair eyelid wound 10.43 $70.00 $730.10
67935 Repair eyelid wound 16.96 $70.00 $1,187.20
67938 Remove eyelid foreign body 7.19 $70.00 $503.30
67950 Revision of eyelid 16.39 $70.00 $1,147.30
67961 Revision of eyelid 16.47 $70.00 $1,152.90
67966 Revision of eyelid 21.96 $70.00 $1,537.20
67971 Reconstruction of eyelid 20.58 $70.00 $1,440.60
67973 Reconstruction of eyelid 26.47 $70.00 $1,852.90
67974 Reconstruction of eyelid 26.41 $70.00 $1,848.70
67975 Reconstruction of eyelid 19.47 $70.00 $1,362.90
67999 Revision of eyelid 0.00 $70.00 $0.00
68020 Incise/drain eyelid lining 3.44 $70.00 $240.80
68040 Treatment of eyelid lesions 1.78 $70.00 $124.60
68100 Biopsy of eyelid lining 4.97 $70.00 $347.90
68110 Remove eyelid lining lesion 6.56 $70.00 $459.20
68115 Remove eyelid lining lesion 9.07 $70.00 $634.90
68130 Remove eyelid lining lesion 15.48 $70.00 $1,083.60
68135 Remove eyelid lining lesion 4.49 $70.00 $314.30
68200 Treat eyelid by injection 1.18 $70.00 $82.60
68320 Revise/graft eyelid lining 20.82 $70.00 $1,457.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
68325 Revise/graft eyelid lining 18.69 $70.00 $1,308.30
68326 Revise/graft eyelid lining 18.35 $70.00 $1,284.50
68328 Revise/graft eyelid lining 20.12 $70.00 $1,408.40
68330 Revise eyelid lining 17.39 $70.00 $1,217.30
68335 Revise/graft eyelid lining 18.42 $70.00 $1,289.40
68340 Separate eyelid adhesions 16.03 $70.00 $1,122.10
68360 Revise eyelid lining 15.30 $70.00 $1,071.00
68362 Revise eyelid lining 18.67 $70.00 $1,306.90
68371 Harvest eye tissue alograft 11.74 $70.00 $821.80
68399 Eyelid lining surgery 0.00 $70.00 $0.00
68400 Incise/drain tear gland 8.24 $70.00 $576.80
68420 Incise/drain tear sac 9.28 $70.00 $649.60
68440 Incise tear duct opening 2.92 $70.00 $204.40
68500 Removal of tear gland 27.87 $70.00 $1,950.90
68505 Partial removal tear gland 27.74 $70.00 $1,941.80
68510 Biopsy of tear gland 12.84 $70.00 $898.80
68520 Removal of tear sac 19.60 $70.00 $1,372.00
68525 Biopsy of tear sac 7.52 $70.00 $526.40
68530 Clearance of tear duct 12.26 $70.00 $858.20
68540 Remove tear gland lesion 26.51 $70.00 $1,855.70
68550 Remove tear gland lesion 32.53 $70.00 $2,277.10
68700 Repair tear ducts 17.17 $70.00 $1,201.90
68705 Revise tear duct opening 6.99 $70.00 $489.30
68720 Create tear sac drain 21.60 $70.00 $1,512.00
68745 Create tear duct drain 21.69 $70.00 $1,518.30
68750 Create tear duct drain 22.49 $70.00 $1,574.30
68760 Close tear duct opening 5.92 $70.00 $414.40
68761 Close tear duct opening 4.22 $70.00 $295.40
68770 Close tear system fistula 17.88 $70.00 $1,251.60
68801 Dilate tear duct opening 2.57 $70.00 $179.90
68810 Probe nasolacrimal duct 4.47 $70.00 $312.90
68811 Probe nasolacrimal duct 3.87 $70.00 $270.90
68815 Probe nasolacrimal duct 11.21 $70.00 $784.70
68816 Probe nl duct w/balloon 20.50 $70.00 $1,435.00
68840 Explore/irrigate tear ducts 3.67 $70.00 $256.90
68850 Injection for tear sac x-ray 1.79 $70.00 $125.30
68899 Tear duct system surgery 0.00 $70.00 $0.00
69000 Drain external ear lesion 5.29 $70.00 $370.30
69005 Drain external ear lesion 6.13 $70.00 $429.10
69020 Drain outer ear canal lesion 6.57 $70.00 $459.90
69090 Pierce earlobes 0.00 $70.00 $0.00
69100 Biopsy of external ear 2.79 $70.00 $195.30
69105 Biopsy of external ear canal 3.99 $70.00 $279.30
69110 Remove external ear partial 13.00 $70.00 $910.00
69120 Removal of external ear 11.38 $70.00 $796.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
69140 Remove ear canal lesion(s) 25.02 $70.00 $1,751.40
69145 Remove ear canal lesion(s) 11.14 $70.00 $779.80
69150 Extensive ear canal surgery 29.50 $70.00 $2,065.00
69155 Extensive ear/neck surgery 47.03 $70.00 $3,292.10
69200 Clear outer ear canal 2.32 $70.00 $162.40
69205 Clear outer ear canal 2.82 $70.00 $197.40
69209 Remove impacted ear wax uni 0.40 $70.00 $28.00
69210 Remove impacted ear wax uni 1.34 $70.00 $93.80
69220 Clean out mastoid cavity 2.29 $70.00 $160.30
69222 Clean out mastoid cavity 6.12 $70.00 $428.40
69300 Revise external ear 18.18 $70.00 $1,272.60
69310 Rebuild outer ear canal 31.04 $70.00 $2,172.80
69320 Rebuild outer ear canal 43.55 $70.00 $3,048.50
69399 Outer ear surgery procedure 0.00 $70.00 $0.00
69420 Incision of eardrum 5.36 $70.00 $375.20
69421 Incision of eardrum 4.22 $70.00 $295.40
69424 Remove ventilating tube 3.63 $70.00 $254.10
69433 Create eardrum opening 5.67 $70.00 $396.90
69436 Create eardrum opening 4.51 $70.00 $315.70
69440 Exploration of middle ear 19.55 $70.00 $1,368.50
69450 Eardrum revision 15.47 $70.00 $1,082.90
69501 Mastoidectomy 20.62 $70.00 $1,443.40
69502 Mastoidectomy 27.36 $70.00 $1,915.20
69505 Remove mastoid structures 34.28 $70.00 $2,399.60
69511 Extensive mastoid surgery 35.13 $70.00 $2,459.10
69530 Extensive mastoid surgery 47.13 $70.00 $3,299.10
69535 Remove part of temporal bone 76.71 $70.00 $5,369.70
69540 Remove ear lesion 5.87 $70.00 $410.90
69550 Remove ear lesion 29.65 $70.00 $2,075.50
69552 Remove ear lesion 44.75 $70.00 $3,132.50
69554 Remove ear lesion 71.85 $70.00 $5,029.50
69601 Mastoid surgery revision 29.50 $70.00 $2,065.00
69602 Mastoid surgery revision 30.95 $70.00 $2,166.50
69603 Mastoid surgery revision 35.93 $70.00 $2,515.10
69604 Mastoid surgery revision 31.66 $70.00 $2,216.20
69605 Mastoid surgery revision 44.47 $70.00 $3,112.90
69610 Repair of eardrum 10.83 $70.00 $758.10
69620 Repair of eardrum 19.82 $70.00 $1,387.40
69631 Repair eardrum structures 25.13 $70.00 $1,759.10
69632 Rebuild eardrum structures 30.65 $70.00 $2,145.50
69633 Rebuild eardrum structures 29.71 $70.00 $2,079.70
69635 Repair eardrum structures 35.39 $70.00 $2,477.30
69636 Rebuild eardrum structures 39.34 $70.00 $2,753.80
69637 Rebuild eardrum structures 39.90 $70.00 $2,793.00
69641 Revise middle ear & mastoid 29.62 $70.00 $2,073.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
69642 Revise middle ear & mastoid 38.08 $70.00 $2,665.60
69643 Revise middle ear & mastoid 34.79 $70.00 $2,435.30
69644 Revise middle ear & mastoid 42.18 $70.00 $2,952.60
69645 Revise middle ear & mastoid 41.44 $70.00 $2,900.80
69646 Revise middle ear & mastoid 44.10 $70.00 $3,087.00
69650 Release middle ear bone 22.83 $70.00 $1,598.10
69660 Revise middle ear bone 26.36 $70.00 $1,845.20
69661 Revise middle ear bone 34.35 $70.00 $2,404.50
69662 Revise middle ear bone 32.95 $70.00 $2,306.50
69666 Repair middle ear structures 22.96 $70.00 $1,607.20
69667 Repair middle ear structures 23.05 $70.00 $1,613.50
69670 Remove mastoid air cells 26.82 $70.00 $1,877.40
69676 Remove middle ear nerve 23.60 $70.00 $1,652.00
69700 Close mastoid fistula 19.30 $70.00 $1,351.00
69710 Implant/replace hearing aid 0.00 $70.00 $0.00
69711 Remove/repair hearing aid 24.29 $70.00 $1,700.30
69714 Implant temple bone w/stimul 30.47 $70.00 $2,132.90
69715 Temple bne implnt w/stimulat 37.63 $70.00 $2,634.10
69717 Temple bone implant revision 31.93 $70.00 $2,235.10
69718 Revise temple bone implant 38.01 $70.00 $2,660.70
69720 Release facial nerve 34.16 $70.00 $2,391.20
69725 Release facial nerve 53.56 $70.00 $3,749.20
69740 Repair facial nerve 33.22 $70.00 $2,325.40
69745 Repair facial nerve 35.35 $70.00 $2,474.50
69799 Middle ear surgery procedure 0.00 $70.00 $0.00
69801 Incise inner ear 5.83 $70.00 $408.10
69805 Explore inner ear 29.82 $70.00 $2,087.40
69806 Explore inner ear 26.62 $70.00 $1,863.40
69905 Remove inner ear 26.06 $70.00 $1,824.20
69910 Remove inner ear & mastoid 28.70 $70.00 $2,009.00
69915 Incise inner ear nerve 43.61 $70.00 $3,052.70
69930 Implant cochlear device 34.86 $70.00 $2,440.20
69949 Inner ear surgery procedure 0.00 $70.00 $0.00
69950 Incise inner ear nerve 50.61 $70.00 $3,542.70
69955 Release facial nerve 56.23 $70.00 $3,936.10
69960 Release inner ear canal 54.63 $70.00 $3,824.10
69970 Remove inner ear lesion 61.05 $70.00 $4,273.50
69979 Temporal bone surgery 0.00 $70.00 $0.00
69990 Microsurgery add-on 6.40 $70.00 $448.00
70010 Contrast x-ray of brain 1.73 $70.00 $121.10
70015 Contrast x-ray of brain 4.35 $70.00 $304.50
70015 TC Contrast x-ray of brain 2.65 $70.00 $185.50
70015 26 Contrast x-ray of brain 1.70 $70.00 $119.00
70030 X-ray eye for foreign body 0.83 $70.00 $58.10
70030 TC X-ray eye for foreign body 0.59 $70.00 $41.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
70030 26 X-ray eye for foreign body 0.24 $70.00 $16.80
7010F Pt info into recall system 0.00 $70.00 $0.00
70100 X-ray exam of jaw <4views 0.97 $70.00 $67.90
70100 TC X-ray exam of jaw <4views 0.71 $70.00 $49.70
70100 26 X-ray exam of jaw <4views 0.26 $70.00 $18.20
70110 X-ray exam of jaw 4/> views 1.13 $70.00 $79.10
70110 TC X-ray exam of jaw 4/> views 0.77 $70.00 $53.90
70110 26 X-ray exam of jaw 4/> views 0.36 $70.00 $25.20
70120 X-ray exam of mastoids 0.97 $70.00 $67.90
70120 TC X-ray exam of mastoids 0.71 $70.00 $49.70
70120 26 X-ray exam of mastoids 0.26 $70.00 $18.20
70130 X-ray exam of mastoids 1.61 $70.00 $112.70
70130 TC X-ray exam of mastoids 1.12 $70.00 $78.40
70130 26 X-ray exam of mastoids 0.49 $70.00 $34.30
70134 X-ray exam of middle ear 1.51 $70.00 $105.70
70134 TC X-ray exam of middle ear 1.01 $70.00 $70.70
70134 26 X-ray exam of middle ear 0.50 $70.00 $35.00
70140 X-ray exam of facial bones 0.86 $70.00 $60.20
70140 TC X-ray exam of facial bones 0.57 $70.00 $39.90
70140 26 X-ray exam of facial bones 0.29 $70.00 $20.30
70150 X-ray exam of facial bones 1.23 $70.00 $86.10
70150 TC X-ray exam of facial bones 0.85 $70.00 $59.50
70150 26 X-ray exam of facial bones 0.38 $70.00 $26.60
70160 X-ray exam of nasal bones 0.97 $70.00 $67.90
70160 TC X-ray exam of nasal bones 0.72 $70.00 $50.40
70160 26 X-ray exam of nasal bones 0.25 $70.00 $17.50
70170 X-ray exam of tear duct 0.00 $70.00 $0.00
70170 TC X-ray exam of tear duct 0.00 $70.00 $0.00
70170 26 X-ray exam of tear duct 0.43 $70.00 $30.10
70190 X-ray exam of eye sockets 1.03 $70.00 $72.10
70190 TC X-ray exam of eye sockets 0.72 $70.00 $50.40
70190 26 X-ray exam of eye sockets 0.31 $70.00 $21.70
7020F Mammo assess cat in dbase 0.00 $70.00 $0.00
70200 X-ray exam of eye sockets 1.24 $70.00 $86.80
70200 TC X-ray exam of eye sockets 0.84 $70.00 $58.80
70200 26 X-ray exam of eye sockets 0.40 $70.00 $28.00
70210 X-ray exam of sinuses 0.89 $70.00 $62.30
70210 TC X-ray exam of sinuses 0.64 $70.00 $44.80
70210 26 X-ray exam of sinuses 0.25 $70.00 $17.50
70220 X-ray exam of sinuses 1.10 $70.00 $77.00
70220 TC X-ray exam of sinuses 0.74 $70.00 $51.80
70220 26 X-ray exam of sinuses 0.36 $70.00 $25.20
70240 X-ray exam pituitary saddle 0.89 $70.00 $62.30
70240 TC X-ray exam pituitary saddle 0.61 $70.00 $42.70
70240 26 X-ray exam pituitary saddle 0.28 $70.00 $19.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
7025F Pt infosys alarm 4 nxt mammo 0.00 $70.00 $0.00
70250 X-ray exam of skull 1.07 $70.00 $74.90
70250 TC X-ray exam of skull 0.71 $70.00 $49.70
70250 26 X-ray exam of skull 0.36 $70.00 $25.20
70260 X-ray exam of skull 1.34 $70.00 $93.80
70260 TC X-ray exam of skull 0.84 $70.00 $58.80
70260 26 X-ray exam of skull 0.50 $70.00 $35.00
70300 X-ray exam of teeth 0.40 $70.00 $28.00
70300 TC X-ray exam of teeth 0.24 $70.00 $16.80
70300 26 X-ray exam of teeth 0.16 $70.00 $11.20
70310 X-ray exam of teeth 1.06 $70.00 $74.20
70310 TC X-ray exam of teeth 0.84 $70.00 $58.80
70310 26 X-ray exam of teeth 0.22 $70.00 $15.40
70320 Full mouth x-ray of teeth 1.53 $70.00 $107.10
70320 TC Full mouth x-ray of teeth 1.18 $70.00 $82.60
70320 26 Full mouth x-ray of teeth 0.35 $70.00 $24.50
70328 X-ray exam of jaw joint 0.89 $70.00 $62.30
70328 TC X-ray exam of jaw joint 0.63 $70.00 $44.10
70328 26 X-ray exam of jaw joint 0.26 $70.00 $18.20
70330 X-ray exam of jaw joints 1.39 $70.00 $97.30
70330 TC X-ray exam of jaw joints 1.04 $70.00 $72.80
70330 26 X-ray exam of jaw joints 0.35 $70.00 $24.50
70332 X-ray exam of jaw joint 2.15 $70.00 $150.50
70332 TC X-ray exam of jaw joint 1.38 $70.00 $96.60
70332 26 X-ray exam of jaw joint 0.77 $70.00 $53.90
70336 Magnetic image jaw joint 8.86 $70.00 $620.20
70336 TC Magnetic image jaw joint 6.77 $70.00 $473.90
70336 26 Magnetic image jaw joint 2.09 $70.00 $146.30
70350 X-ray head for orthodontia 0.53 $70.00 $37.10
70350 TC X-ray head for orthodontia 0.25 $70.00 $17.50
70350 26 X-ray head for orthodontia 0.28 $70.00 $19.60
70355 Panoramic x-ray of jaws 0.56 $70.00 $39.20
70355 TC Panoramic x-ray of jaws 0.25 $70.00 $17.50
70355 26 Panoramic x-ray of jaws 0.31 $70.00 $21.70
70360 X-ray exam of neck 0.85 $70.00 $59.50
70360 TC X-ray exam of neck 0.61 $70.00 $42.70
70360 26 X-ray exam of neck 0.24 $70.00 $16.80
70370 Throat x-ray & fluoroscopy 2.27 $70.00 $158.90
70370 TC Throat x-ray & fluoroscopy 1.85 $70.00 $129.50
70370 26 Throat x-ray & fluoroscopy 0.42 $70.00 $29.40
70371 Speech evaluation complex 2.77 $70.00 $193.90
70371 TC Speech evaluation complex 1.56 $70.00 $109.20
70371 26 Speech evaluation complex 1.21 $70.00 $84.70
70380 X-ray exam of salivary gland 0.95 $70.00 $66.50
70380 TC X-ray exam of salivary gland 0.71 $70.00 $49.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
70380 26 X-ray exam of salivary gland 0.24 $70.00 $16.80
70390 X-ray exam of salivary duct 2.90 $70.00 $203.00
70390 TC X-ray exam of salivary duct 2.36 $70.00 $165.20
70390 26 X-ray exam of salivary duct 0.54 $70.00 $37.80
70450 Ct head/brain w/o dye 3.26 $70.00 $228.20
70450 TC Ct head/brain w/o dye 2.05 $70.00 $143.50
70450 26 Ct head/brain w/o dye 1.21 $70.00 $84.70
70460 Ct head/brain w/dye 4.61 $70.00 $322.70
70460 TC Ct head/brain w/dye 2.99 $70.00 $209.30
70460 26 Ct head/brain w/dye 1.62 $70.00 $113.40
70470 Ct head/brain w/o & w/dye 5.39 $70.00 $377.30
70470 TC Ct head/brain w/o & w/dye 3.58 $70.00 $250.60
70470 26 Ct head/brain w/o & w/dye 1.81 $70.00 $126.70
70480 Ct orbit/ear/fossa w/o dye 6.55 $70.00 $458.50
70480 TC Ct orbit/ear/fossa w/o dye 4.73 $70.00 $331.10
70480 26 Ct orbit/ear/fossa w/o dye 1.82 $70.00 $127.40
70481 Ct orbit/ear/fossa w/dye 7.76 $70.00 $543.20
70481 TC Ct orbit/ear/fossa w/dye 5.79 $70.00 $405.30
70481 26 Ct orbit/ear/fossa w/dye 1.97 $70.00 $137.90
70482 Ct orbit/ear/fossa w/o&w/dye 8.45 $70.00 $591.50
70482 TC Ct orbit/ear/fossa w/o&w/dye 6.39 $70.00 $447.30
70482 26 Ct orbit/ear/fossa w/o&w/dye 2.06 $70.00 $144.20
70486 Ct maxillofacial w/o dye 3.92 $70.00 $274.40
70486 TC Ct maxillofacial w/o dye 2.70 $70.00 $189.00
70486 26 Ct maxillofacial w/o dye 1.22 $70.00 $85.40
70487 Ct maxillofacial w/dye 4.71 $70.00 $329.70
70487 TC Ct maxillofacial w/dye 3.11 $70.00 $217.70
70487 26 Ct maxillofacial w/dye 1.60 $70.00 $112.00
70488 Ct maxillofacial w/o & w/dye 5.74 $70.00 $401.80
70488 TC Ct maxillofacial w/o & w/dye 3.93 $70.00 $275.10
70488 26 Ct maxillofacial w/o & w/dye 1.81 $70.00 $126.70
70490 Ct soft tissue neck w/o dye 4.63 $70.00 $324.10
70490 TC Ct soft tissue neck w/o dye 2.81 $70.00 $196.70
70490 26 Ct soft tissue neck w/o dye 1.82 $70.00 $127.40
70491 Ct soft tissue neck w/dye 5.71 $70.00 $399.70
70491 TC Ct soft tissue neck w/dye 3.74 $70.00 $261.80
70491 26 Ct soft tissue neck w/dye 1.97 $70.00 $137.90
70492 Ct sft tsue nck w/o & w/dye 6.88 $70.00 $481.60
70492 TC Ct sft tsue nck w/o & w/dye 4.58 $70.00 $320.60
70492 26 Ct sft tsue nck w/o & w/dye 2.30 $70.00 $161.00
70496 Ct angiography head 8.31 $70.00 $581.70
70496 TC Ct angiography head 5.82 $70.00 $407.40
70496 26 Ct angiography head 2.49 $70.00 $174.30
70498 Ct angiography neck 8.29 $70.00 $580.30
70498 TC Ct angiography neck 5.80 $70.00 $406.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
70498 26 Ct angiography neck 2.49 $70.00 $174.30
70540 Mri orbit/face/neck w/o dye 7.48 $70.00 $523.60
70540 TC Mri orbit/face/neck w/o dye 5.56 $70.00 $389.20
70540 26 Mri orbit/face/neck w/o dye 1.92 $70.00 $134.40
70542 Mri orbit/face/neck w/dye 8.89 $70.00 $622.30
70542 TC Mri orbit/face/neck w/dye 6.58 $70.00 $460.60
70542 26 Mri orbit/face/neck w/dye 2.31 $70.00 $161.70
70543 Mri orbt/fac/nck w/o &w/dye 11.17 $70.00 $781.90
70543 TC Mri orbt/fac/nck w/o &w/dye 8.13 $70.00 $569.10
70543 26 Mri orbt/fac/nck w/o &w/dye 3.04 $70.00 $212.80
70544 Mr angiography head w/o dye 7.84 $70.00 $548.80
70544 TC Mr angiography head w/o dye 6.13 $70.00 $429.10
70544 26 Mr angiography head w/o dye 1.71 $70.00 $119.70
70545 Mr angiography head w/dye 7.78 $70.00 $544.60
70545 TC Mr angiography head w/dye 6.07 $70.00 $424.90
70545 26 Mr angiography head w/dye 1.71 $70.00 $119.70
70546 Mr angiograph head w/o&w/dye 11.50 $70.00 $805.00
70546 TC Mr angiograph head w/o&w/dye 9.40 $70.00 $658.00
70546 26 Mr angiograph head w/o&w/dye 2.10 $70.00 $147.00
70547 Mr angiography neck w/o dye 7.87 $70.00 $550.90
70547 TC Mr angiography neck w/o dye 6.16 $70.00 $431.20
70547 26 Mr angiography neck w/o dye 1.71 $70.00 $119.70
70548 Mr angiography neck w/dye 8.66 $70.00 $606.20
70548 TC Mr angiography neck w/dye 6.52 $70.00 $456.40
70548 26 Mr angiography neck w/dye 2.14 $70.00 $149.80
70549 Mr angiograph neck w/o&w/dye 12.02 $70.00 $841.40
70549 TC Mr angiograph neck w/o&w/dye 9.46 $70.00 $662.20
70549 26 Mr angiograph neck w/o&w/dye 2.56 $70.00 $179.20
70551 Mri brain stem w/o dye 6.38 $70.00 $446.60
70551 TC Mri brain stem w/o dye 4.27 $70.00 $298.90
70551 26 Mri brain stem w/o dye 2.11 $70.00 $147.70
70552 Mri brain stem w/dye 8.86 $70.00 $620.20
70552 TC Mri brain stem w/dye 6.32 $70.00 $442.40
70552 26 Mri brain stem w/dye 2.54 $70.00 $177.80
70553 Mri brain stem w/o & w/dye 10.45 $70.00 $731.50
70553 TC Mri brain stem w/o & w/dye 7.20 $70.00 $504.00
70553 26 Mri brain stem w/o & w/dye 3.25 $70.00 $227.50
70554 Fmri brain by tech 12.40 $70.00 $868.00
70554 TC Fmri brain by tech 9.40 $70.00 $658.00
70554 26 Fmri brain by tech 3.00 $70.00 $210.00
70555 Fmri brain by phys/psych 0.00 $70.00 $0.00
70555 TC Fmri brain by phys/psych 0.00 $70.00 $0.00
70555 26 Fmri brain by phys/psych 3.58 $70.00 $250.60
70557 Mri brain w/o dye 0.00 $70.00 $0.00
70557 TC Mri brain w/o dye 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
70557 26 Mri brain w/o dye 4.44 $70.00 $310.80
70558 Mri brain w/dye 0.00 $70.00 $0.00
70558 TC Mri brain w/dye 0.00 $70.00 $0.00
70558 26 Mri brain w/dye 4.89 $70.00 $342.30
70559 Mri brain w/o & w/dye 0.00 $70.00 $0.00
70559 TC Mri brain w/o & w/dye 0.00 $70.00 $0.00
70559 26 Mri brain w/o & w/dye 4.67 $70.00 $326.90
71045 X-ray exam chest 1 view 0.70 $70.00 $49.00
71045 TC X-ray exam chest 1 view 0.44 $70.00 $30.80
71045 26 X-ray exam chest 1 view 0.26 $70.00 $18.20
71046 X-ray exam chest 2 views 0.89 $70.00 $62.30
71046 TC X-ray exam chest 2 views 0.58 $70.00 $40.60
71046 26 X-ray exam chest 2 views 0.31 $70.00 $21.70
71047 X-ray exam chest 3 views 1.12 $70.00 $78.40
71047 TC X-ray exam chest 3 views 0.72 $70.00 $50.40
71047 26 X-ray exam chest 3 views 0.40 $70.00 $28.00
71048 X-ray exam chest 4+ views 1.21 $70.00 $84.70
71048 TC X-ray exam chest 4+ views 0.75 $70.00 $52.50
71048 26 X-ray exam chest 4+ views 0.46 $70.00 $32.20
71100 X-ray exam ribs uni 2 views 0.97 $70.00 $67.90
71100 TC X-ray exam ribs uni 2 views 0.65 $70.00 $45.50
71100 26 X-ray exam ribs uni 2 views 0.32 $70.00 $22.40
71101 X-ray exam unilat ribs/chest 1.11 $70.00 $77.70
71101 TC X-ray exam unilat ribs/chest 0.72 $70.00 $50.40
71101 26 X-ray exam unilat ribs/chest 0.39 $70.00 $27.30
71110 X-ray exam ribs bil 3 views 1.16 $70.00 $81.20
71110 TC X-ray exam ribs bil 3 views 0.74 $70.00 $51.80
71110 26 X-ray exam ribs bil 3 views 0.42 $70.00 $29.40
71111 X-ray exam ribs/chest4/> vws 1.38 $70.00 $96.60
71111 TC X-ray exam ribs/chest4/> vws 0.91 $70.00 $63.70
71111 26 X-ray exam ribs/chest4/> vws 0.47 $70.00 $32.90
71120 X-ray exam breastbone 2/>vws 0.88 $70.00 $61.60
71120 TC X-ray exam breastbone 2/>vws 0.59 $70.00 $41.30
71120 26 X-ray exam breastbone 2/>vws 0.29 $70.00 $20.30
71130 X-ray strenoclavic jt 3/>vws 1.05 $70.00 $73.50
71130 TC X-ray strenoclavic jt 3/>vws 0.74 $70.00 $51.80
71130 26 X-ray strenoclavic jt 3/>vws 0.31 $70.00 $21.70
71250 Ct thorax w/o dye 4.47 $70.00 $312.90
71250 TC Ct thorax w/o dye 2.81 $70.00 $196.70
71250 26 Ct thorax w/o dye 1.66 $70.00 $116.20
71260 Ct thorax w/dye 5.53 $70.00 $387.10
71260 TC Ct thorax w/dye 3.76 $70.00 $263.20
71260 26 Ct thorax w/dye 1.77 $70.00 $123.90
71270 Ct thorax w/o & w/dye 6.56 $70.00 $459.20
71270 TC Ct thorax w/o & w/dye 4.59 $70.00 $321.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
71270 26 Ct thorax w/o & w/dye 1.97 $70.00 $137.90
71275 Ct angiography chest 8.50 $70.00 $595.00
71275 TC Ct angiography chest 5.91 $70.00 $413.70
71275 26 Ct angiography chest 2.59 $70.00 $181.30
71550 Mri chest w/o dye 11.41 $70.00 $798.70
71550 TC Mri chest w/o dye 9.34 $70.00 $653.80
71550 26 Mri chest w/o dye 2.07 $70.00 $144.90
71551 Mri chest w/dye 12.63 $70.00 $884.10
71551 TC Mri chest w/dye 10.17 $70.00 $711.90
71551 26 Mri chest w/dye 2.46 $70.00 $172.20
71552 Mri chest w/o & w/dye 15.95 $70.00 $1,116.50
71552 TC Mri chest w/o & w/dye 12.74 $70.00 $891.80
71552 26 Mri chest w/o & w/dye 3.21 $70.00 $224.70
71555 Mri angio chest w or w/o dye 11.03 $70.00 $772.10
71555 TC Mri angio chest w or w/o dye 8.49 $70.00 $594.30
71555 26 Mri angio chest w or w/o dye 2.54 $70.00 $177.80
72020 X-ray exam of spine 1 view 0.65 $70.00 $45.50
72020 TC X-ray exam of spine 1 view 0.43 $70.00 $30.10
72020 26 X-ray exam of spine 1 view 0.22 $70.00 $15.40
72040 X-ray exam neck spine 2-3 vw 1.03 $70.00 $72.10
72040 TC X-ray exam neck spine 2-3 vw 0.71 $70.00 $49.70
72040 26 X-ray exam neck spine 2-3 vw 0.32 $70.00 $22.40
72050 X-ray exam neck spine 4/5vws 1.42 $70.00 $99.40
72050 TC X-ray exam neck spine 4/5vws 0.97 $70.00 $67.90
72050 26 X-ray exam neck spine 4/5vws 0.45 $70.00 $31.50
72052 X-ray exam neck spine 6/>vws 1.69 $70.00 $118.30
72052 TC X-ray exam neck spine 6/>vws 1.17 $70.00 $81.90
72052 26 X-ray exam neck spine 6/>vws 0.52 $70.00 $36.40
72070 X-ray exam thorac spine 2vws 0.96 $70.00 $67.20
72070 TC X-ray exam thorac spine 2vws 0.64 $70.00 $44.80
72070 26 X-ray exam thorac spine 2vws 0.32 $70.00 $22.40
72072 X-ray exam thorac spine 3vws 1.02 $70.00 $71.40
72072 TC X-ray exam thorac spine 3vws 0.71 $70.00 $49.70
72072 26 X-ray exam thorac spine 3vws 0.31 $70.00 $21.70
72074 X-ray exam thorac spine4/>vw 1.12 $70.00 $78.40
72074 TC X-ray exam thorac spine4/>vw 0.81 $70.00 $56.70
72074 26 X-ray exam thorac spine4/>vw 0.31 $70.00 $21.70
72080 X-ray exam thoracolmb 2/> vw 0.95 $70.00 $66.50
72080 TC X-ray exam thoracolmb 2/> vw 0.63 $70.00 $44.10
72080 26 X-ray exam thoracolmb 2/> vw 0.32 $70.00 $22.40
72081 X-ray exam entire spi 1 vw 1.14 $70.00 $79.80
72081 TC X-ray exam entire spi 1 vw 0.75 $70.00 $52.50
72081 26 X-ray exam entire spi 1 vw 0.39 $70.00 $27.30
72082 X-ray exam entire spi 2/3 vw 1.83 $70.00 $128.10
72082 TC X-ray exam entire spi 2/3 vw 1.37 $70.00 $95.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
72082 26 X-ray exam entire spi 2/3 vw 0.46 $70.00 $32.20
72083 X-ray exam entire spi 4/5 vw 2.16 $70.00 $151.20
72083 TC X-ray exam entire spi 4/5 vw 1.64 $70.00 $114.80
72083 26 X-ray exam entire spi 4/5 vw 0.52 $70.00 $36.40
72084 X-ray exam entire spi 6/> vw 2.52 $70.00 $176.40
72084 TC X-ray exam entire spi 6/> vw 1.92 $70.00 $134.40
72084 26 X-ray exam entire spi 6/> vw 0.60 $70.00 $42.00
72100 X-ray exam l-s spine 2/3 vws 1.03 $70.00 $72.10
72100 TC X-ray exam l-s spine 2/3 vws 0.71 $70.00 $49.70
72100 26 X-ray exam l-s spine 2/3 vws 0.32 $70.00 $22.40
72110 X-ray exam l-2 spine 4/>vws 1.44 $70.00 $100.80
72110 TC X-ray exam l-2 spine 4/>vws 0.99 $70.00 $69.30
72110 26 X-ray exam l-2 spine 4/>vws 0.45 $70.00 $31.50
72114 X-ray exam l-s spine bending 1.64 $70.00 $114.80
72114 TC X-ray exam l-s spine bending 1.17 $70.00 $81.90
72114 26 X-ray exam l-s spine bending 0.47 $70.00 $32.90
72120 X-ray bend only l-s spine 1.21 $70.00 $84.70
72120 TC X-ray bend only l-s spine 0.89 $70.00 $62.30
72120 26 X-ray bend only l-s spine 0.32 $70.00 $22.40
72125 Ct neck spine w/o dye 5.18 $70.00 $362.60
72125 TC Ct neck spine w/o dye 3.66 $70.00 $256.20
72125 26 Ct neck spine w/o dye 1.52 $70.00 $106.40
72126 Ct neck spine w/dye 6.40 $70.00 $448.00
72126 TC Ct neck spine w/dye 4.66 $70.00 $326.20
72126 26 Ct neck spine w/dye 1.74 $70.00 $121.80
72127 Ct neck spine w/o & w/dye 7.58 $70.00 $530.60
72127 TC Ct neck spine w/o & w/dye 5.78 $70.00 $404.60
72127 26 Ct neck spine w/o & w/dye 1.80 $70.00 $126.00
72128 Ct chest spine w/o dye 5.08 $70.00 $355.60
72128 TC Ct chest spine w/o dye 3.65 $70.00 $255.50
72128 26 Ct chest spine w/o dye 1.43 $70.00 $100.10
72129 Ct chest spine w/dye 6.44 $70.00 $450.80
72129 TC Ct chest spine w/dye 4.70 $70.00 $329.00
72129 26 Ct chest spine w/dye 1.74 $70.00 $121.80
72130 Ct chest spine w/o & w/dye 7.59 $70.00 $531.30
72130 TC Ct chest spine w/o & w/dye 5.79 $70.00 $405.30
72130 26 Ct chest spine w/o & w/dye 1.80 $70.00 $126.00
72131 Ct lumbar spine w/o dye 5.06 $70.00 $354.20
72131 TC Ct lumbar spine w/o dye 3.63 $70.00 $254.10
72131 26 Ct lumbar spine w/o dye 1.43 $70.00 $100.10
72132 Ct lumbar spine w/dye 6.41 $70.00 $448.70
72132 TC Ct lumbar spine w/dye 4.67 $70.00 $326.90
72132 26 Ct lumbar spine w/dye 1.74 $70.00 $121.80
72133 Ct lumbar spine w/o & w/dye 7.56 $70.00 $529.20
72133 TC Ct lumbar spine w/o & w/dye 5.75 $70.00 $402.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
72133 26 Ct lumbar spine w/o & w/dye 1.81 $70.00 $126.70
72141 Mri neck spine w/o dye 6.22 $70.00 $435.40
72141 TC Mri neck spine w/o dye 4.10 $70.00 $287.00
72141 26 Mri neck spine w/o dye 2.12 $70.00 $148.40
72142 Mri neck spine w/dye 9.03 $70.00 $632.10
72142 TC Mri neck spine w/dye 6.48 $70.00 $453.60
72142 26 Mri neck spine w/dye 2.55 $70.00 $178.50
72146 Mri chest spine w/o dye 6.23 $70.00 $436.10
72146 TC Mri chest spine w/o dye 4.11 $70.00 $287.70
72146 26 Mri chest spine w/o dye 2.12 $70.00 $148.40
72147 Mri chest spine w/dye 8.98 $70.00 $628.60
72147 TC Mri chest spine w/dye 6.44 $70.00 $450.80
72147 26 Mri chest spine w/dye 2.54 $70.00 $177.80
72148 Mri lumbar spine w/o dye 6.23 $70.00 $436.10
72148 TC Mri lumbar spine w/o dye 4.11 $70.00 $287.70
72148 26 Mri lumbar spine w/o dye 2.12 $70.00 $148.40
72149 Mri lumbar spine w/dye 8.92 $70.00 $624.40
72149 TC Mri lumbar spine w/dye 6.37 $70.00 $445.90
72149 26 Mri lumbar spine w/dye 2.55 $70.00 $178.50
72156 Mri neck spine w/o & w/dye 10.52 $70.00 $736.40
72156 TC Mri neck spine w/o & w/dye 7.27 $70.00 $508.90
72156 26 Mri neck spine w/o & w/dye 3.25 $70.00 $227.50
72157 Mri chest spine w/o & w/dye 10.55 $70.00 $738.50
72157 TC Mri chest spine w/o & w/dye 7.30 $70.00 $511.00
72157 26 Mri chest spine w/o & w/dye 3.25 $70.00 $227.50
72158 Mri lumbar spine w/o & w/dye 10.50 $70.00 $735.00
72158 TC Mri lumbar spine w/o & w/dye 7.25 $70.00 $507.50
72158 26 Mri lumbar spine w/o & w/dye 3.25 $70.00 $227.50
72159 Mr angio spine w/o&w/dye 11.43 $70.00 $800.10
72159 TC Mr angio spine w/o&w/dye 8.87 $70.00 $620.90
72159 26 Mr angio spine w/o&w/dye 2.56 $70.00 $179.20
72170 X-ray exam of pelvis 0.93 $70.00 $65.10
72170 TC X-ray exam of pelvis 0.68 $70.00 $47.60
72170 26 X-ray exam of pelvis 0.25 $70.00 $17.50
72190 X-ray exam of pelvis 1.12 $70.00 $78.40
72190 TC X-ray exam of pelvis 0.81 $70.00 $56.70
72190 26 X-ray exam of pelvis 0.31 $70.00 $21.70
72191 Ct angiograph pelv w/o&w/dye 8.85 $70.00 $619.50
72191 TC Ct angiograph pelv w/o&w/dye 6.29 $70.00 $440.30
72191 26 Ct angiograph pelv w/o&w/dye 2.56 $70.00 $179.20
72192 Ct pelvis w/o dye 4.10 $70.00 $287.00
72192 TC Ct pelvis w/o dye 2.55 $70.00 $178.50
72192 26 Ct pelvis w/o dye 1.55 $70.00 $108.50
72193 Ct pelvis w/dye 6.59 $70.00 $461.30
72193 TC Ct pelvis w/dye 4.93 $70.00 $345.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
72193 26 Ct pelvis w/dye 1.66 $70.00 $116.20
72194 Ct pelvis w/o & w/dye 7.48 $70.00 $523.60
72194 TC Ct pelvis w/o & w/dye 5.75 $70.00 $402.50
72194 26 Ct pelvis w/o & w/dye 1.73 $70.00 $121.10
72195 Mri pelvis w/o dye 7.62 $70.00 $533.40
72195 TC Mri pelvis w/o dye 5.54 $70.00 $387.80
72195 26 Mri pelvis w/o dye 2.08 $70.00 $145.60
72196 Mri pelvis w/dye 8.90 $70.00 $623.00
72196 TC Mri pelvis w/dye 6.43 $70.00 $450.10
72196 26 Mri pelvis w/dye 2.47 $70.00 $172.90
72197 Mri pelvis w/o & w/dye 11.24 $70.00 $786.80
72197 TC Mri pelvis w/o & w/dye 8.11 $70.00 $567.70
72197 26 Mri pelvis w/o & w/dye 3.13 $70.00 $219.10
72198 Mr angio pelvis w/o & w/dye 11.09 $70.00 $776.30
72198 TC Mr angio pelvis w/o & w/dye 8.56 $70.00 $599.20
72198 26 Mr angio pelvis w/o & w/dye 2.53 $70.00 $177.10
72200 X-ray exam si joints 0.87 $70.00 $60.90
72200 TC X-ray exam si joints 0.62 $70.00 $43.40
72200 26 X-ray exam si joints 0.25 $70.00 $17.50
72202 X-ray exam si joints 3/> vws 0.98 $70.00 $68.60
72202 TC X-ray exam si joints 3/> vws 0.71 $70.00 $49.70
72202 26 X-ray exam si joints 3/> vws 0.27 $70.00 $18.90
72220 X-ray exam sacrum tailbone 0.86 $70.00 $60.20
72220 TC X-ray exam sacrum tailbone 0.61 $70.00 $42.70
72220 26 X-ray exam sacrum tailbone 0.25 $70.00 $17.50
72240 Myelography neck spine 2.94 $70.00 $205.80
72240 TC Myelography neck spine 1.65 $70.00 $115.50
72240 26 Myelography neck spine 1.29 $70.00 $90.30
72255 Myelography thoracic spine 2.99 $70.00 $209.30
72255 TC Myelography thoracic spine 1.64 $70.00 $114.80
72255 26 Myelography thoracic spine 1.35 $70.00 $94.50
72265 Myelography l-s spine 2.75 $70.00 $192.50
72265 TC Myelography l-s spine 1.59 $70.00 $111.30
72265 26 Myelography l-s spine 1.16 $70.00 $81.20
72270 Myelogphy 2/> spine regions 3.82 $70.00 $267.40
72270 TC Myelogphy 2/> spine regions 1.90 $70.00 $133.00
72270 26 Myelogphy 2/> spine regions 1.92 $70.00 $134.40
72275 Epidurography 3.48 $70.00 $243.60
72275 TC Epidurography 2.37 $70.00 $165.90
72275 26 Epidurography 1.11 $70.00 $77.70
72285 Discography cerv/thor spine 3.32 $70.00 $232.40
72285 TC Discography cerv/thor spine 1.63 $70.00 $114.10
72285 26 Discography cerv/thor spine 1.69 $70.00 $118.30
72295 X-ray of lower spine disk 2.90 $70.00 $203.00
72295 TC X-ray of lower spine disk 1.67 $70.00 $116.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
72295 26 X-ray of lower spine disk 1.23 $70.00 $86.10
73000 X-ray exam of collar bone 0.82 $70.00 $57.40
73000 TC X-ray exam of collar bone 0.58 $70.00 $40.60
73000 26 X-ray exam of collar bone 0.24 $70.00 $16.80
73010 X-ray exam of shoulder blade 0.90 $70.00 $63.00
73010 TC X-ray exam of shoulder blade 0.64 $70.00 $44.80
73010 26 X-ray exam of shoulder blade 0.26 $70.00 $18.20
73020 X-ray exam of shoulder 0.67 $70.00 $46.90
73020 TC X-ray exam of shoulder 0.44 $70.00 $30.80
73020 26 X-ray exam of shoulder 0.23 $70.00 $16.10
73030 X-ray exam of shoulder 0.85 $70.00 $59.50
73030 TC X-ray exam of shoulder 0.58 $70.00 $40.60
73030 26 X-ray exam of shoulder 0.27 $70.00 $18.90
73040 Contrast x-ray of shoulder 3.12 $70.00 $218.40
73040 TC Contrast x-ray of shoulder 2.34 $70.00 $163.80
73040 26 Contrast x-ray of shoulder 0.78 $70.00 $54.60
73050 X-ray exam of shoulders 1.05 $70.00 $73.50
73050 TC X-ray exam of shoulders 0.75 $70.00 $52.50
73050 26 X-ray exam of shoulders 0.30 $70.00 $21.00
73060 X-ray exam of humerus 0.85 $70.00 $59.50
73060 TC X-ray exam of humerus 0.61 $70.00 $42.70
73060 26 X-ray exam of humerus 0.24 $70.00 $16.80
73070 X-ray exam of elbow 0.76 $70.00 $53.20
73070 TC X-ray exam of elbow 0.53 $70.00 $37.10
73070 26 X-ray exam of elbow 0.23 $70.00 $16.10
73080 X-ray exam of elbow 0.84 $70.00 $58.80
73080 TC X-ray exam of elbow 0.59 $70.00 $41.30
73080 26 X-ray exam of elbow 0.25 $70.00 $17.50
73085 Contrast x-ray of elbow 2.99 $70.00 $209.30
73085 TC Contrast x-ray of elbow 2.17 $70.00 $151.90
73085 26 Contrast x-ray of elbow 0.82 $70.00 $57.40
73090 X-ray exam of forearm 0.79 $70.00 $55.30
73090 TC X-ray exam of forearm 0.55 $70.00 $38.50
73090 26 X-ray exam of forearm 0.24 $70.00 $16.80
73092 X-ray exam of arm infant 0.81 $70.00 $56.70
73092 TC X-ray exam of arm infant 0.58 $70.00 $40.60
73092 26 X-ray exam of arm infant 0.23 $70.00 $16.10
73100 X-ray exam of wrist 0.90 $70.00 $63.00
73100 TC X-ray exam of wrist 0.66 $70.00 $46.20
73100 26 X-ray exam of wrist 0.24 $70.00 $16.80
73110 X-ray exam of wrist 1.03 $70.00 $72.10
73110 TC X-ray exam of wrist 0.78 $70.00 $54.60
73110 26 X-ray exam of wrist 0.25 $70.00 $17.50
73115 Contrast x-ray of wrist 3.33 $70.00 $233.10
73115 TC Contrast x-ray of wrist 2.52 $70.00 $176.40
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
73115 26 Contrast x-ray of wrist 0.81 $70.00 $56.70
73120 X-ray exam of hand 0.82 $70.00 $57.40
73120 TC X-ray exam of hand 0.58 $70.00 $40.60
73120 26 X-ray exam of hand 0.24 $70.00 $16.80
73130 X-ray exam of hand 0.94 $70.00 $65.80
73130 TC X-ray exam of hand 0.69 $70.00 $48.30
73130 26 X-ray exam of hand 0.25 $70.00 $17.50
73140 X-ray exam of finger(s) 0.95 $70.00 $66.50
73140 TC X-ray exam of finger(s) 0.75 $70.00 $52.50
73140 26 X-ray exam of finger(s) 0.20 $70.00 $14.00
73200 Ct upper extremity w/o dye 5.05 $70.00 $353.50
73200 TC Ct upper extremity w/o dye 3.62 $70.00 $253.40
73200 26 Ct upper extremity w/o dye 1.43 $70.00 $100.10
73201 Ct upper extremity w/dye 6.28 $70.00 $439.60
73201 TC Ct upper extremity w/dye 4.62 $70.00 $323.40
73201 26 Ct upper extremity w/dye 1.66 $70.00 $116.20
73202 Ct uppr extremity w/o&w/dye 7.82 $70.00 $547.40
73202 TC Ct uppr extremity w/o&w/dye 6.08 $70.00 $425.60
73202 26 Ct uppr extremity w/o&w/dye 1.74 $70.00 $121.80
73206 Ct angio upr extrm w/o&w/dye 9.24 $70.00 $646.80
73206 TC Ct angio upr extrm w/o&w/dye 6.69 $70.00 $468.30
73206 26 Ct angio upr extrm w/o&w/dye 2.55 $70.00 $178.50
73218 Mri upper extremity w/o dye 10.12 $70.00 $708.40
73218 TC Mri upper extremity w/o dye 8.19 $70.00 $573.30
73218 26 Mri upper extremity w/o dye 1.93 $70.00 $135.10
73219 Mri upper extremity w/dye 11.11 $70.00 $777.70
73219 TC Mri upper extremity w/dye 8.80 $70.00 $616.00
73219 26 Mri upper extremity w/dye 2.31 $70.00 $161.70
73220 Mri uppr extremity w/o&w/dye 13.75 $70.00 $962.50
73220 TC Mri uppr extremity w/o&w/dye 10.70 $70.00 $749.00
73220 26 Mri uppr extremity w/o&w/dye 3.05 $70.00 $213.50
73221 Mri joint upr extrem w/o dye 6.57 $70.00 $459.90
73221 TC Mri joint upr extrem w/o dye 4.63 $70.00 $324.10
73221 26 Mri joint upr extrem w/o dye 1.94 $70.00 $135.80
73222 Mri joint upr extrem w/dye 10.47 $70.00 $732.90
73222 TC Mri joint upr extrem w/dye 8.15 $70.00 $570.50
73222 26 Mri joint upr extrem w/dye 2.32 $70.00 $162.40
73223 Mri joint upr extr w/o&w/dye 12.99 $70.00 $909.30
73223 TC Mri joint upr extr w/o&w/dye 9.93 $70.00 $695.10
73223 26 Mri joint upr extr w/o&w/dye 3.06 $70.00 $214.20
73225 Mr angio upr extr w/o&w/dye 10.95 $70.00 $766.50
73225 TC Mr angio upr extr w/o&w/dye 8.54 $70.00 $597.80
73225 26 Mr angio upr extr w/o&w/dye 2.41 $70.00 $168.70
73501 X-ray exam hip uni 1 view 0.87 $70.00 $60.90
73501 TC X-ray exam hip uni 1 view 0.60 $70.00 $42.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
73501 26 X-ray exam hip uni 1 view 0.27 $70.00 $18.90
73502 X-ray exam hip uni 2-3 views 1.21 $70.00 $84.70
73502 TC X-ray exam hip uni 2-3 views 0.89 $70.00 $62.30
73502 26 X-ray exam hip uni 2-3 views 0.32 $70.00 $22.40
73503 X-ray exam hip uni 4/> views 1.51 $70.00 $105.70
73503 TC X-ray exam hip uni 4/> views 1.11 $70.00 $77.70
73503 26 X-ray exam hip uni 4/> views 0.40 $70.00 $28.00
73521 X-ray exam hips bi 2 views 1.08 $70.00 $75.60
73521 TC X-ray exam hips bi 2 views 0.76 $70.00 $53.20
73521 26 X-ray exam hips bi 2 views 0.32 $70.00 $22.40
73522 X-ray exam hips bi 3-4 views 1.41 $70.00 $98.70
73522 TC X-ray exam hips bi 3-4 views 0.98 $70.00 $68.60
73522 26 X-ray exam hips bi 3-4 views 0.43 $70.00 $30.10
73523 X-ray exam hips bi 5/> views 1.65 $70.00 $115.50
73523 TC X-ray exam hips bi 5/> views 1.19 $70.00 $83.30
73523 26 X-ray exam hips bi 5/> views 0.46 $70.00 $32.20
73525 Contrast x-ray of hip 3.18 $70.00 $222.60
73525 TC Contrast x-ray of hip 2.35 $70.00 $164.50
73525 26 Contrast x-ray of hip 0.83 $70.00 $58.10
73551 X-ray exam of femur 1 0.80 $70.00 $56.00
73551 TC X-ray exam of femur 1 0.56 $70.00 $39.20
73551 26 X-ray exam of femur 1 0.24 $70.00 $16.80
73552 X-ray exam of femur 2/> 0.94 $70.00 $65.80
73552 TC X-ray exam of femur 2/> 0.68 $70.00 $47.60
73552 26 X-ray exam of femur 2/> 0.26 $70.00 $18.20
73560 X-ray exam of knee 1 or 2 0.91 $70.00 $63.70
73560 TC X-ray exam of knee 1 or 2 0.67 $70.00 $46.90
73560 26 X-ray exam of knee 1 or 2 0.24 $70.00 $16.80
73562 X-ray exam of knee 3 1.05 $70.00 $73.50
73562 TC X-ray exam of knee 3 0.78 $70.00 $54.60
73562 26 X-ray exam of knee 3 0.27 $70.00 $18.90
73564 X-ray exam knee 4 or more 1.17 $70.00 $81.90
73564 TC X-ray exam knee 4 or more 0.85 $70.00 $59.50
73564 26 X-ray exam knee 4 or more 0.32 $70.00 $22.40
73565 X-ray exam of knees 1.05 $70.00 $73.50
73565 TC X-ray exam of knees 0.80 $70.00 $56.00
73565 26 X-ray exam of knees 0.25 $70.00 $17.50
73580 Contrast x-ray of knee joint 3.59 $70.00 $251.30
73580 TC Contrast x-ray of knee joint 2.77 $70.00 $193.90
73580 26 Contrast x-ray of knee joint 0.82 $70.00 $57.40
73590 X-ray exam of lower leg 0.83 $70.00 $58.10
73590 TC X-ray exam of lower leg 0.60 $70.00 $42.00
73590 26 X-ray exam of lower leg 0.23 $70.00 $16.10
73592 X-ray exam of leg infant 0.81 $70.00 $56.70
73592 TC X-ray exam of leg infant 0.58 $70.00 $40.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
73592 26 X-ray exam of leg infant 0.23 $70.00 $16.10
73600 X-ray exam of ankle 0.87 $70.00 $60.90
73600 TC X-ray exam of ankle 0.63 $70.00 $44.10
73600 26 X-ray exam of ankle 0.24 $70.00 $16.80
73610 X-ray exam of ankle 0.94 $70.00 $65.80
73610 TC X-ray exam of ankle 0.69 $70.00 $48.30
73610 26 X-ray exam of ankle 0.25 $70.00 $17.50
73615 Contrast x-ray of ankle 3.34 $70.00 $233.80
73615 TC Contrast x-ray of ankle 2.51 $70.00 $175.70
73615 26 Contrast x-ray of ankle 0.83 $70.00 $58.10
73620 X-ray exam of foot 0.76 $70.00 $53.20
73620 TC X-ray exam of foot 0.54 $70.00 $37.80
73620 26 X-ray exam of foot 0.22 $70.00 $15.40
73630 X-ray exam of foot 0.88 $70.00 $61.60
73630 TC X-ray exam of foot 0.64 $70.00 $44.80
73630 26 X-ray exam of foot 0.24 $70.00 $16.80
73650 X-ray exam of heel 0.76 $70.00 $53.20
73650 TC X-ray exam of heel 0.53 $70.00 $37.10
73650 26 X-ray exam of heel 0.23 $70.00 $16.10
73660 X-ray exam of toe(s) 0.81 $70.00 $56.70
73660 TC X-ray exam of toe(s) 0.62 $70.00 $43.40
73660 26 X-ray exam of toe(s) 0.19 $70.00 $13.30
73700 Ct lower extremity w/o dye 5.06 $70.00 $354.20
73700 TC Ct lower extremity w/o dye 3.63 $70.00 $254.10
73700 26 Ct lower extremity w/o dye 1.43 $70.00 $100.10
73701 Ct lower extremity w/dye 6.36 $70.00 $445.20
73701 TC Ct lower extremity w/dye 4.70 $70.00 $329.00
73701 26 Ct lower extremity w/dye 1.66 $70.00 $116.20
73702 Ct lwr extremity w/o&w/dye 7.70 $70.00 $539.00
73702 TC Ct lwr extremity w/o&w/dye 5.97 $70.00 $417.90
73702 26 Ct lwr extremity w/o&w/dye 1.73 $70.00 $121.10
73706 Ct angio lwr extr w/o&w/dye 10.01 $70.00 $700.70
73706 TC Ct angio lwr extr w/o&w/dye 7.33 $70.00 $513.10
73706 26 Ct angio lwr extr w/o&w/dye 2.68 $70.00 $187.60
73718 Mri lower extremity w/o dye 7.39 $70.00 $517.30
73718 TC Mri lower extremity w/o dye 5.47 $70.00 $382.90
73718 26 Mri lower extremity w/o dye 1.92 $70.00 $134.40
73719 Mri lower extremity w/dye 8.74 $70.00 $611.80
73719 TC Mri lower extremity w/dye 6.43 $70.00 $450.10
73719 26 Mri lower extremity w/dye 2.31 $70.00 $161.70
73720 Mri lwr extremity w/o&w/dye 11.21 $70.00 $784.70
73720 TC Mri lwr extremity w/o&w/dye 8.16 $70.00 $571.20
73720 26 Mri lwr extremity w/o&w/dye 3.05 $70.00 $213.50
73721 Mri jnt of lwr extre w/o dye 6.57 $70.00 $459.90
73721 TC Mri jnt of lwr extre w/o dye 4.63 $70.00 $324.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
73721 26 Mri jnt of lwr extre w/o dye 1.94 $70.00 $135.80
73722 Mri joint of lwr extr w/dye 10.52 $70.00 $736.40
73722 TC Mri joint of lwr extr w/dye 8.20 $70.00 $574.00
73722 26 Mri joint of lwr extr w/dye 2.32 $70.00 $162.40
73723 Mri joint lwr extr w/o&w/dye 12.96 $70.00 $907.20
73723 TC Mri joint lwr extr w/o&w/dye 9.91 $70.00 $693.70
73723 26 Mri joint lwr extr w/o&w/dye 3.05 $70.00 $213.50
73725 Mr ang lwr ext w or w/o dye 11.10 $70.00 $777.00
73725 TC Mr ang lwr ext w or w/o dye 8.55 $70.00 $598.50
73725 26 Mr ang lwr ext w or w/o dye 2.55 $70.00 $178.50
74018 X-ray exam abdomen 1 view 0.80 $70.00 $56.00
74018 TC X-ray exam abdomen 1 view 0.54 $70.00 $37.80
74018 26 X-ray exam abdomen 1 view 0.26 $70.00 $18.20
74019 X-ray exam abdomen 2 views 0.98 $70.00 $68.60
74019 TC X-ray exam abdomen 2 views 0.65 $70.00 $45.50
74019 26 X-ray exam abdomen 2 views 0.33 $70.00 $23.10
74021 X-ray exam abdomen 3+ views 1.13 $70.00 $79.10
74021 TC X-ray exam abdomen 3+ views 0.74 $70.00 $51.80
74021 26 X-ray exam abdomen 3+ views 0.39 $70.00 $27.30
74022 X-ray exam series abdomen 1.31 $70.00 $91.70
74022 TC X-ray exam series abdomen 0.85 $70.00 $59.50
74022 26 X-ray exam series abdomen 0.46 $70.00 $32.20
74150 Ct abdomen w/o dye 4.22 $70.00 $295.40
74150 TC Ct abdomen w/o dye 2.52 $70.00 $176.40
74150 26 Ct abdomen w/o dye 1.70 $70.00 $119.00
74160 Ct abdomen w/dye 6.72 $70.00 $470.40
74160 TC Ct abdomen w/dye 4.91 $70.00 $343.70
74160 26 Ct abdomen w/dye 1.81 $70.00 $126.70
74170 Ct abdomen w/o & w/dye 7.62 $70.00 $533.40
74170 TC Ct abdomen w/o & w/dye 5.63 $70.00 $394.10
74170 26 Ct abdomen w/o & w/dye 1.99 $70.00 $139.30
74174 Ct angio abd&pelv w/o&w/dye 11.16 $70.00 $781.20
74174 TC Ct angio abd&pelv w/o&w/dye 8.06 $70.00 $564.20
74174 26 Ct angio abd&pelv w/o&w/dye 3.10 $70.00 $217.00
74175 Ct angio abdom w/o & w/dye 8.87 $70.00 $620.90
74175 TC Ct angio abdom w/o & w/dye 6.30 $70.00 $441.00
74175 26 Ct angio abdom w/o & w/dye 2.57 $70.00 $179.90
74176 Ct abd & pelvis w/o contrast 5.65 $70.00 $395.50
74176 TC Ct abd & pelvis w/o contrast 3.17 $70.00 $221.90
74176 26 Ct abd & pelvis w/o contrast 2.48 $70.00 $173.60
74177 Ct abd & pelv w/contrast 8.99 $70.00 $629.30
74177 TC Ct abd & pelv w/contrast 6.39 $70.00 $447.30
74177 26 Ct abd & pelv w/contrast 2.60 $70.00 $182.00
74178 Ct abd & pelv 1/> regns 10.15 $70.00 $710.50
74178 TC Ct abd & pelv 1/> regns 7.30 $70.00 $511.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
74178 26 Ct abd & pelv 1/> regns 2.85 $70.00 $199.50
74181 Mri abdomen w/o dye 6.88 $70.00 $481.60
74181 TC Mri abdomen w/o dye 4.80 $70.00 $336.00
74181 26 Mri abdomen w/o dye 2.08 $70.00 $145.60
74182 Mri abdomen w/dye 10.11 $70.00 $707.70
74182 TC Mri abdomen w/dye 7.64 $70.00 $534.80
74182 26 Mri abdomen w/dye 2.47 $70.00 $172.90
74183 Mri abdomen w/o & w/dye 11.25 $70.00 $787.50
74183 TC Mri abdomen w/o & w/dye 8.12 $70.00 $568.40
74183 26 Mri abdomen w/o & w/dye 3.13 $70.00 $219.10
74185 Mri angio abdom w orw/o dye 11.13 $70.00 $779.10
74185 TC Mri angio abdom w orw/o dye 8.59 $70.00 $601.30
74185 26 Mri angio abdom w orw/o dye 2.54 $70.00 $177.80
74190 X-ray exam of peritoneum 0.00 $70.00 $0.00
74190 TC X-ray exam of peritoneum 0.00 $70.00 $0.00
74190 26 X-ray exam of peritoneum 0.66 $70.00 $46.20
74210 Contrst x-ray exam of throat 2.49 $70.00 $174.30
74210 TC Contrst x-ray exam of throat 1.65 $70.00 $115.50
74210 26 Contrst x-ray exam of throat 0.84 $70.00 $58.80
74220 Contrast x-ray esophagus 2.73 $70.00 $191.10
74220 TC Contrast x-ray esophagus 1.77 $70.00 $123.90
74220 26 Contrast x-ray esophagus 0.96 $70.00 $67.20
74230 Cine/vid x-ray throat/esoph 3.59 $70.00 $251.30
74230 TC Cine/vid x-ray throat/esoph 2.83 $70.00 $198.10
74230 26 Cine/vid x-ray throat/esoph 0.76 $70.00 $53.20
74235 Remove esophagus obstruction 0.00 $70.00 $0.00
74235 TC Remove esophagus obstruction 0.00 $70.00 $0.00
74235 26 Remove esophagus obstruction 1.70 $70.00 $119.00
74240 X-ray upper gi delay w/o kub 3.45 $70.00 $241.50
74240 TC X-ray upper gi delay w/o kub 2.46 $70.00 $172.20
74240 26 X-ray upper gi delay w/o kub 0.99 $70.00 $69.30
74241 X-ray upper gi delay w/kub 3.59 $70.00 $251.30
74241 TC X-ray upper gi delay w/kub 2.61 $70.00 $182.70
74241 26 X-ray upper gi delay w/kub 0.98 $70.00 $68.60
74245 X-ray upper gi&small intest 5.24 $70.00 $366.80
74245 TC X-ray upper gi&small intest 3.95 $70.00 $276.50
74245 26 X-ray upper gi&small intest 1.29 $70.00 $90.30
74246 Contrst x-ray uppr gi tract 3.84 $70.00 $268.80
74246 TC Contrst x-ray uppr gi tract 2.86 $70.00 $200.20
74246 26 Contrst x-ray uppr gi tract 0.98 $70.00 $68.60
74247 Contrst x-ray uppr gi tract 4.32 $70.00 $302.40
74247 TC Contrst x-ray uppr gi tract 3.34 $70.00 $233.80
74247 26 Contrst x-ray uppr gi tract 0.98 $70.00 $68.60
74249 Contrst x-ray uppr gi tract 5.62 $70.00 $393.40
74249 TC Contrst x-ray uppr gi tract 4.33 $70.00 $303.10
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
74249 26 Contrst x-ray uppr gi tract 1.29 $70.00 $90.30
74250 X-ray exam of small bowel 3.18 $70.00 $222.60
74250 TC X-ray exam of small bowel 2.51 $70.00 $175.70
74250 26 X-ray exam of small bowel 0.67 $70.00 $46.90
74251 X-ray exam of small bowel 12.16 $70.00 $851.20
74251 TC X-ray exam of small bowel 11.18 $70.00 $782.60
74251 26 X-ray exam of small bowel 0.98 $70.00 $68.60
74260 X-ray exam of small bowel 9.92 $70.00 $694.40
74260 TC X-ray exam of small bowel 9.20 $70.00 $644.00
74260 26 X-ray exam of small bowel 0.72 $70.00 $50.40
74261 Ct colonography dx 13.58 $70.00 $950.60
74261 TC Ct colonography dx 10.16 $70.00 $711.20
74261 26 Ct colonography dx 3.42 $70.00 $239.40
74262 Ct colonography dx w/dye 15.25 $70.00 $1,067.50
74262 TC Ct colonography dx w/dye 11.69 $70.00 $818.30
74262 26 Ct colonography dx w/dye 3.56 $70.00 $249.20
74263 Ct colonography screening 21.30 $70.00 $1,491.00
74263 TC Ct colonography screening 18.08 $70.00 $1,265.60
74263 26 Ct colonography screening 3.22 $70.00 $225.40
74270 Contrast x-ray exam of colon 4.54 $70.00 $317.80
74270 TC Contrast x-ray exam of colon 3.56 $70.00 $249.20
74270 26 Contrast x-ray exam of colon 0.98 $70.00 $68.60
74280 Contrast x-ray exam of colon 6.41 $70.00 $448.70
74280 TC Contrast x-ray exam of colon 5.00 $70.00 $350.00
74280 26 Contrast x-ray exam of colon 1.41 $70.00 $98.70
74283 Ther nma rdctj intus/obstrcj 6.61 $70.00 $462.70
74283 TC Ther nma rdctj intus/obstrcj 3.67 $70.00 $256.90
74283 26 Ther nma rdctj intus/obstrcj 2.94 $70.00 $205.80
74290 Contrast x-ray gallbladder 2.15 $70.00 $150.50
74290 TC Contrast x-ray gallbladder 1.69 $70.00 $118.30
74290 26 Contrast x-ray gallbladder 0.46 $70.00 $32.20
74300 X-ray bile ducts/pancreas 0.00 $70.00 $0.00
74300 TC X-ray bile ducts/pancreas 0.00 $70.00 $0.00
74300 26 X-ray bile ducts/pancreas 0.52 $70.00 $36.40
74301 X-rays at surgery add-on 0.00 $70.00 $0.00
74301 TC X-rays at surgery add-on 0.00 $70.00 $0.00
74301 26 X-rays at surgery add-on 0.30 $70.00 $21.00
74328 X-ray bile duct endoscopy 0.00 $70.00 $0.00
74328 TC X-ray bile duct endoscopy 0.00 $70.00 $0.00
74328 26 X-ray bile duct endoscopy 1.01 $70.00 $70.70
74329 X-ray for pancreas endoscopy 0.00 $70.00 $0.00
74329 TC X-ray for pancreas endoscopy 0.00 $70.00 $0.00
74329 26 X-ray for pancreas endoscopy 1.01 $70.00 $70.70
74330 X-ray bile/panc endoscopy 0.00 $70.00 $0.00
74330 TC X-ray bile/panc endoscopy 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
74330 26 X-ray bile/panc endoscopy 1.29 $70.00 $90.30
74340 X-ray guide for gi tube 0.00 $70.00 $0.00
74340 TC X-ray guide for gi tube 0.00 $70.00 $0.00
74340 26 X-ray guide for gi tube 0.77 $70.00 $53.90
74355 X-ray guide intestinal tube 0.00 $70.00 $0.00
74355 TC X-ray guide intestinal tube 0.00 $70.00 $0.00
74355 26 X-ray guide intestinal tube 1.08 $70.00 $75.60
74360 X-ray guide gi dilation 0.00 $70.00 $0.00
74360 TC X-ray guide gi dilation 0.00 $70.00 $0.00
74360 26 X-ray guide gi dilation 0.80 $70.00 $56.00
74363 X-ray bile duct dilation 0.00 $70.00 $0.00
74363 TC X-ray bile duct dilation 0.00 $70.00 $0.00
74363 26 X-ray bile duct dilation 1.22 $70.00 $85.40
74400 Contrst x-ray urinary tract 3.36 $70.00 $235.20
74400 TC Contrst x-ray urinary tract 2.66 $70.00 $186.20
74400 26 Contrst x-ray urinary tract 0.70 $70.00 $49.00
74410 Contrst x-ray urinary tract 3.41 $70.00 $238.70
74410 TC Contrst x-ray urinary tract 2.72 $70.00 $190.40
74410 26 Contrst x-ray urinary tract 0.69 $70.00 $48.30
74415 Contrst x-ray urinary tract 4.07 $70.00 $284.90
74415 TC Contrst x-ray urinary tract 3.37 $70.00 $235.90
74415 26 Contrst x-ray urinary tract 0.70 $70.00 $49.00
74420 Contrst x-ray urinary tract 2.02 $70.00 $141.40
74420 TC Contrst x-ray urinary tract 1.29 $70.00 $90.30
74420 26 Contrst x-ray urinary tract 0.73 $70.00 $51.10
74425 Contrst x-ray urinary tract 0.00 $70.00 $0.00
74425 TC Contrst x-ray urinary tract 0.00 $70.00 $0.00
74425 26 Contrst x-ray urinary tract 0.50 $70.00 $35.00
74430 Contrast x-ray bladder 1.11 $70.00 $77.70
74430 TC Contrast x-ray bladder 0.65 $70.00 $45.50
74430 26 Contrast x-ray bladder 0.46 $70.00 $32.20
74440 X-ray male genital tract 2.44 $70.00 $170.80
74440 TC X-ray male genital tract 1.92 $70.00 $134.40
74440 26 X-ray male genital tract 0.52 $70.00 $36.40
74445 X-ray exam of penis 0.00 $70.00 $0.00
74445 TC X-ray exam of penis 0.00 $70.00 $0.00
74445 26 X-ray exam of penis 1.57 $70.00 $109.90
74450 X-ray urethra/bladder 0.00 $70.00 $0.00
74450 TC X-ray urethra/bladder 0.00 $70.00 $0.00
74450 26 X-ray urethra/bladder 0.47 $70.00 $32.90
74455 X-ray urethra/bladder 2.55 $70.00 $178.50
74455 TC X-ray urethra/bladder 2.08 $70.00 $145.60
74455 26 X-ray urethra/bladder 0.47 $70.00 $32.90
74470 X-ray exam of kidney lesion 0.00 $70.00 $0.00
74470 TC X-ray exam of kidney lesion 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
74470 26 X-ray exam of kidney lesion 0.75 $70.00 $52.50
74485 Dilation urtr/urt rs&i 3.02 $70.00 $211.40
74485 TC Dilation urtr/urt rs&i 1.88 $70.00 $131.60
74485 26 Dilation urtr/urt rs&i 1.14 $70.00 $79.80
74710 X-ray measurement of pelvis 1.08 $70.00 $75.60
74710 TC X-ray measurement of pelvis 0.59 $70.00 $41.30
74710 26 X-ray measurement of pelvis 0.49 $70.00 $34.30
74712 Mri fetal sngl/1st gestation 13.56 $70.00 $949.20
74712 TC Mri fetal sngl/1st gestation 9.29 $70.00 $650.30
74712 26 Mri fetal sngl/1st gestation 4.27 $70.00 $298.90
74713 Mri fetal ea addl gestation 6.60 $70.00 $462.00
74713 TC Mri fetal ea addl gestation 3.95 $70.00 $276.50
74713 26 Mri fetal ea addl gestation 2.65 $70.00 $185.50
74740 X-ray female genital tract 2.32 $70.00 $162.40
74740 TC X-ray female genital tract 1.78 $70.00 $124.60
74740 26 X-ray female genital tract 0.54 $70.00 $37.80
74742 X-ray fallopian tube 0.00 $70.00 $0.00
74742 TC X-ray fallopian tube 0.00 $70.00 $0.00
74742 26 X-ray fallopian tube 0.88 $70.00 $61.60
74775 X-ray exam of perineum 0.00 $70.00 $0.00
74775 TC X-ray exam of perineum 0.00 $70.00 $0.00
74775 26 X-ray exam of perineum 0.89 $70.00 $62.30
75557 Cardiac mri for morph 9.16 $70.00 $641.20
75557 TC Cardiac mri for morph 5.87 $70.00 $410.90
75557 26 Cardiac mri for morph 3.29 $70.00 $230.30
75559 Cardiac mri w/stress img 12.77 $70.00 $893.90
75559 TC Cardiac mri w/stress img 8.72 $70.00 $610.40
75559 26 Cardiac mri w/stress img 4.05 $70.00 $283.50
75561 Cardiac mri for morph w/dye 12.03 $70.00 $842.10
75561 TC Cardiac mri for morph w/dye 8.40 $70.00 $588.00
75561 26 Cardiac mri for morph w/dye 3.63 $70.00 $254.10
75563 Card mri w/stress img & dye 14.26 $70.00 $998.20
75563 TC Card mri w/stress img & dye 10.10 $70.00 $707.00
75563 26 Card mri w/stress img & dye 4.16 $70.00 $291.20
75565 Card mri veloc flow mapping 1.51 $70.00 $105.70
75565 TC Card mri veloc flow mapping 1.16 $70.00 $81.20
75565 26 Card mri veloc flow mapping 0.35 $70.00 $24.50
75571 Ct hrt w/o dye w/ca test 2.92 $70.00 $204.40
75571 TC Ct hrt w/o dye w/ca test 2.10 $70.00 $147.00
75571 26 Ct hrt w/o dye w/ca test 0.82 $70.00 $57.40
75572 Ct hrt w/3d image 7.52 $70.00 $526.40
75572 TC Ct hrt w/3d image 5.05 $70.00 $353.50
75572 26 Ct hrt w/3d image 2.47 $70.00 $172.90
75573 Ct hrt w/3d image congen 10.18 $70.00 $712.60
75573 TC Ct hrt w/3d image congen 6.59 $70.00 $461.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
75573 26 Ct hrt w/3d image congen 3.59 $70.00 $251.30
75574 Ct angio hrt w/3d image 11.04 $70.00 $772.80
75574 TC Ct angio hrt w/3d image 7.68 $70.00 $537.60
75574 26 Ct angio hrt w/3d image 3.36 $70.00 $235.20
75600 Contrast exam thoracic aorta 5.63 $70.00 $394.10
75600 TC Contrast exam thoracic aorta 4.94 $70.00 $345.80
75600 26 Contrast exam thoracic aorta 0.69 $70.00 $48.30
75605 Contrast exam thoracic aorta 3.78 $70.00 $264.60
75605 TC Contrast exam thoracic aorta 2.20 $70.00 $154.00
75605 26 Contrast exam thoracic aorta 1.58 $70.00 $110.60
75625 Contrast exam abdominl aorta 3.73 $70.00 $261.10
75625 TC Contrast exam abdominl aorta 2.15 $70.00 $150.50
75625 26 Contrast exam abdominl aorta 1.58 $70.00 $110.60
75630 X-ray aorta leg arteries 4.68 $70.00 $327.60
75630 TC X-ray aorta leg arteries 2.19 $70.00 $153.30
75630 26 X-ray aorta leg arteries 2.49 $70.00 $174.30
75635 Ct angio abdominal arteries 12.45 $70.00 $871.50
75635 TC Ct angio abdominal arteries 9.08 $70.00 $635.60
75635 26 Ct angio abdominal arteries 3.37 $70.00 $235.90
75705 Artery x-rays spine 7.13 $70.00 $499.10
75705 TC Artery x-rays spine 3.81 $70.00 $266.70
75705 26 Artery x-rays spine 3.32 $70.00 $232.40
75710 Artery x-rays arm/leg 4.73 $70.00 $331.10
75710 TC Artery x-rays arm/leg 2.28 $70.00 $159.60
75710 26 Artery x-rays arm/leg 2.45 $70.00 $171.50
75716 Artery x-rays arms/legs 5.04 $70.00 $352.80
75716 TC Artery x-rays arms/legs 2.31 $70.00 $161.70
75716 26 Artery x-rays arms/legs 2.73 $70.00 $191.10
75726 Artery x-rays abdomen 4.08 $70.00 $285.60
75726 TC Artery x-rays abdomen 2.52 $70.00 $176.40
75726 26 Artery x-rays abdomen 1.56 $70.00 $109.20
75731 Artery x-rays adrenal gland 4.73 $70.00 $331.10
75731 TC Artery x-rays adrenal gland 3.10 $70.00 $217.00
75731 26 Artery x-rays adrenal gland 1.63 $70.00 $114.10
75733 Artery x-rays adrenals 5.09 $70.00 $356.30
75733 TC Artery x-rays adrenals 3.28 $70.00 $229.60
75733 26 Artery x-rays adrenals 1.81 $70.00 $126.70
75736 Artery x-rays pelvis 4.38 $70.00 $306.60
75736 TC Artery x-rays pelvis 2.82 $70.00 $197.40
75736 26 Artery x-rays pelvis 1.56 $70.00 $109.20
75741 Artery x-rays lung 4.13 $70.00 $289.10
75741 TC Artery x-rays lung 2.33 $70.00 $163.10
75741 26 Artery x-rays lung 1.80 $70.00 $126.00
75743 Artery x-rays lungs 4.64 $70.00 $324.80
75743 TC Artery x-rays lungs 2.36 $70.00 $165.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
75743 26 Artery x-rays lungs 2.28 $70.00 $159.60
75746 Artery x-rays lung 4.16 $70.00 $291.20
75746 TC Artery x-rays lung 2.58 $70.00 $180.60
75746 26 Artery x-rays lung 1.58 $70.00 $110.60
75756 Artery x-rays chest 4.79 $70.00 $335.30
75756 TC Artery x-rays chest 3.17 $70.00 $221.90
75756 26 Artery x-rays chest 1.62 $70.00 $113.40
75774 Artery x-ray each vessel 2.33 $70.00 $163.10
75774 TC Artery x-ray each vessel 1.84 $70.00 $128.80
75774 26 Artery x-ray each vessel 0.49 $70.00 $34.30
75801 Lymph vessel x-ray arm/leg 0.00 $70.00 $0.00
75801 TC Lymph vessel x-ray arm/leg 0.00 $70.00 $0.00
75801 26 Lymph vessel x-ray arm/leg 1.27 $70.00 $88.90
75803 Lymph vessel x-ray arms/legs 0.00 $70.00 $0.00
75803 TC Lymph vessel x-ray arms/legs 0.00 $70.00 $0.00
75803 26 Lymph vessel x-ray arms/legs 1.68 $70.00 $117.60
75805 Lymph vessel x-ray trunk 0.00 $70.00 $0.00
75805 TC Lymph vessel x-ray trunk 0.00 $70.00 $0.00
75805 26 Lymph vessel x-ray trunk 1.16 $70.00 $81.20
75807 Lymph vessel x-ray trunk 0.00 $70.00 $0.00
75807 TC Lymph vessel x-ray trunk 0.00 $70.00 $0.00
75807 26 Lymph vessel x-ray trunk 1.60 $70.00 $112.00
75809 Nonvascular shunt x-ray 2.69 $70.00 $188.30
75809 TC Nonvascular shunt x-ray 2.01 $70.00 $140.70
75809 26 Nonvascular shunt x-ray 0.68 $70.00 $47.60
75810 Vein x-ray spleen/liver 0.00 $70.00 $0.00
75810 TC Vein x-ray spleen/liver 0.00 $70.00 $0.00
75810 26 Vein x-ray spleen/liver 1.40 $70.00 $98.00
75820 Vein x-ray arm/leg 3.15 $70.00 $220.50
75820 TC Vein x-ray arm/leg 2.16 $70.00 $151.20
75820 26 Vein x-ray arm/leg 0.99 $70.00 $69.30
75822 Vein x-ray arms/legs 3.68 $70.00 $257.60
75822 TC Vein x-ray arms/legs 2.21 $70.00 $154.70
75822 26 Vein x-ray arms/legs 1.47 $70.00 $102.90
75825 Vein x-ray trunk 3.68 $70.00 $257.60
75825 TC Vein x-ray trunk 2.10 $70.00 $147.00
75825 26 Vein x-ray trunk 1.58 $70.00 $110.60
75827 Vein x-ray chest 3.82 $70.00 $267.40
75827 TC Vein x-ray chest 2.22 $70.00 $155.40
75827 26 Vein x-ray chest 1.60 $70.00 $112.00
75831 Vein x-ray kidney 3.84 $70.00 $268.80
75831 TC Vein x-ray kidney 2.28 $70.00 $159.60
75831 26 Vein x-ray kidney 1.56 $70.00 $109.20
75833 Vein x-ray kidneys 4.55 $70.00 $318.50
75833 TC Vein x-ray kidneys 2.48 $70.00 $173.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
75833 26 Vein x-ray kidneys 2.07 $70.00 $144.90
75840 Vein x-ray adrenal gland 4.08 $70.00 $285.60
75840 TC Vein x-ray adrenal gland 2.45 $70.00 $171.50
75840 26 Vein x-ray adrenal gland 1.63 $70.00 $114.10
75842 Vein x-ray adrenal glands 4.95 $70.00 $346.50
75842 TC Vein x-ray adrenal glands 2.82 $70.00 $197.40
75842 26 Vein x-ray adrenal glands 2.13 $70.00 $149.10
75860 Vein x-ray neck 3.99 $70.00 $279.30
75860 TC Vein x-ray neck 2.39 $70.00 $167.30
75860 26 Vein x-ray neck 1.60 $70.00 $112.00
75870 Vein x-ray skull 5.30 $70.00 $371.00
75870 TC Vein x-ray skull 3.47 $70.00 $242.90
75870 26 Vein x-ray skull 1.83 $70.00 $128.10
75872 Vein x-ray skull epidural 4.08 $70.00 $285.60
75872 TC Vein x-ray skull epidural 2.45 $70.00 $171.50
75872 26 Vein x-ray skull epidural 1.63 $70.00 $114.10
75880 Vein x-ray eye socket 3.44 $70.00 $240.80
75880 TC Vein x-ray eye socket 2.44 $70.00 $170.80
75880 26 Vein x-ray eye socket 1.00 $70.00 $70.00
75885 Vein x-ray liver w/hemodynam 4.29 $70.00 $300.30
75885 TC Vein x-ray liver w/hemodynam 2.37 $70.00 $165.90
75885 26 Vein x-ray liver w/hemodynam 1.92 $70.00 $134.40
75887 Vein x-ray liver w/o hemodyn 4.31 $70.00 $301.70
75887 TC Vein x-ray liver w/o hemodyn 2.38 $70.00 $166.60
75887 26 Vein x-ray liver w/o hemodyn 1.93 $70.00 $135.10
75889 Vein x-ray liver w/hemodynam 3.93 $70.00 $275.10
75889 TC Vein x-ray liver w/hemodynam 2.38 $70.00 $166.60
75889 26 Vein x-ray liver w/hemodynam 1.55 $70.00 $108.50
75891 Vein x-ray liver 3.98 $70.00 $278.60
75891 TC Vein x-ray liver 2.41 $70.00 $168.70
75891 26 Vein x-ray liver 1.57 $70.00 $109.90
75893 Venous sampling by catheter 3.32 $70.00 $232.40
75893 TC Venous sampling by catheter 2.55 $70.00 $178.50
75893 26 Venous sampling by catheter 0.77 $70.00 $53.90
75894 X-rays transcath therapy 0.00 $70.00 $0.00
75894 TC X-rays transcath therapy 0.00 $70.00 $0.00
75894 26 X-rays transcath therapy 2.06 $70.00 $144.20
75898 Follow-up angiography 0.00 $70.00 $0.00
75898 TC Follow-up angiography 0.00 $70.00 $0.00
75898 26 Follow-up angiography 2.57 $70.00 $179.90
75901 Remove cva device obstruct 5.62 $70.00 $393.40
75901 TC Remove cva device obstruct 4.95 $70.00 $346.50
75901 26 Remove cva device obstruct 0.67 $70.00 $46.90
75902 Remove cva lumen obstruct 2.22 $70.00 $155.40
75902 TC Remove cva lumen obstruct 1.68 $70.00 $117.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
75902 26 Remove cva lumen obstruct 0.54 $70.00 $37.80
75956 Xray endovasc thor ao repr 0.00 $70.00 $0.00
75956 TC Xray endovasc thor ao repr 0.00 $70.00 $0.00
75956 26 Xray endovasc thor ao repr 9.82 $70.00 $687.40
75957 Xray endovasc thor ao repr 0.00 $70.00 $0.00
75957 TC Xray endovasc thor ao repr 0.00 $70.00 $0.00
75957 26 Xray endovasc thor ao repr 8.43 $70.00 $590.10
75958 Xray place prox ext thor ao 0.00 $70.00 $0.00
75958 TC Xray place prox ext thor ao 0.00 $70.00 $0.00
75958 26 Xray place prox ext thor ao 5.60 $70.00 $392.00
75959 Xray place dist ext thor ao 0.00 $70.00 $0.00
75959 TC Xray place dist ext thor ao 0.00 $70.00 $0.00
75959 26 Xray place dist ext thor ao 4.88 $70.00 $341.60
75970 Vascular biopsy 0.00 $70.00 $0.00
75970 TC Vascular biopsy 0.00 $70.00 $0.00
75970 26 Vascular biopsy 1.13 $70.00 $79.10
75984 Xray control catheter change 2.89 $70.00 $202.30
75984 TC Xray control catheter change 1.90 $70.00 $133.00
75984 26 Xray control catheter change 0.99 $70.00 $69.30
75989 Abscess drainage under x-ray 3.42 $70.00 $239.40
75989 TC Abscess drainage under x-ray 1.77 $70.00 $123.90
75989 26 Abscess drainage under x-ray 1.65 $70.00 $115.50
76000 Fluoroscopy <1 hr phys/qhp 1.33 $70.00 $93.10
76000 TC Fluoroscopy <1 hr phys/qhp 0.89 $70.00 $62.30
76000 26 Fluoroscopy <1 hr phys/qhp 0.44 $70.00 $30.80
76010 X-ray nose to rectum 0.77 $70.00 $53.90
76010 TC X-ray nose to rectum 0.51 $70.00 $35.70
76010 26 X-ray nose to rectum 0.26 $70.00 $18.20
76080 X-ray exam of fistula 1.61 $70.00 $112.70
76080 TC X-ray exam of fistula 0.87 $70.00 $60.90
76080 26 X-ray exam of fistula 0.74 $70.00 $51.80
76098 X-ray exam surgical specimen 0.47 $70.00 $32.90
76098 TC X-ray exam surgical specimen 0.24 $70.00 $16.80
76098 26 X-ray exam surgical specimen 0.23 $70.00 $16.10
76100 X-ray exam of body section 2.67 $70.00 $186.90
76100 TC X-ray exam of body section 1.78 $70.00 $124.60
76100 26 X-ray exam of body section 0.89 $70.00 $62.30
76101 Complex body section x-ray 2.65 $70.00 $185.50
76101 TC Complex body section x-ray 1.85 $70.00 $129.50
76101 26 Complex body section x-ray 0.80 $70.00 $56.00
76102 Complex body section x-rays 4.88 $70.00 $341.60
76102 TC Complex body section x-rays 3.92 $70.00 $274.40
76102 26 Complex body section x-rays 0.96 $70.00 $67.20
76120 Cine/video x-rays 2.87 $70.00 $200.90
76120 TC Cine/video x-rays 2.35 $70.00 $164.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
76120 26 Cine/video x-rays 0.52 $70.00 $36.40
76125 Cine/video x-rays add-on 0.00 $70.00 $0.00
76125 TC Cine/video x-rays add-on 0.00 $70.00 $0.00
76125 26 Cine/video x-rays add-on 0.40 $70.00 $28.00
76140 X-ray consultation 0.00 $70.00 $0.00
76376 3d render w/intrp postproces 0.65 $70.00 $45.50
76376 TC 3d render w/intrp postproces 0.37 $70.00 $25.90
76376 26 3d render w/intrp postproces 0.28 $70.00 $19.60
76377 3d render w/intrp postproces 2.01 $70.00 $140.70
76377 TC 3d render w/intrp postproces 0.88 $70.00 $61.60
76377 26 3d render w/intrp postproces 1.13 $70.00 $79.10
76380 Cat scan follow-up study 4.07 $70.00 $284.90
76380 TC Cat scan follow-up study 2.69 $70.00 $188.30
76380 26 Cat scan follow-up study 1.38 $70.00 $96.60
76390 Mr spectroscopy 12.31 $70.00 $861.70
76390 TC Mr spectroscopy 10.33 $70.00 $723.10
76390 26 Mr spectroscopy 1.98 $70.00 $138.60
76391 Mr elastography 6.66 $70.00 $466.20
76391 TC Mr elastography 5.08 $70.00 $355.60
76391 26 Mr elastography 1.58 $70.00 $110.60
76496 Fluoroscopic procedure 0.00 $70.00 $0.00
76496 TC Fluoroscopic procedure 0.00 $70.00 $0.00
76496 26 Fluoroscopic procedure 0.00 $70.00 $0.00
76497 Ct procedure 0.00 $70.00 $0.00
76497 TC Ct procedure 0.00 $70.00 $0.00
76497 26 Ct procedure 0.00 $70.00 $0.00
76498 Mri procedure 0.00 $70.00 $0.00
76498 TC Mri procedure 0.00 $70.00 $0.00
76498 26 Mri procedure 0.00 $70.00 $0.00
76499 Radiographic procedure 0.00 $70.00 $0.00
76499 TC Radiographic procedure 0.00 $70.00 $0.00
76499 26 Radiographic procedure 0.00 $70.00 $0.00
76506 Echo exam of head 3.26 $70.00 $228.20
76506 TC Echo exam of head 2.35 $70.00 $164.50
76506 26 Echo exam of head 0.91 $70.00 $63.70
76510 Ophth us b & quant a 3.15 $70.00 $220.50
76510 TC Ophth us b & quant a 1.50 $70.00 $105.00
76510 26 Ophth us b & quant a 1.65 $70.00 $115.50
76511 Ophth us quant a only 1.93 $70.00 $135.10
76511 TC Ophth us quant a only 0.90 $70.00 $63.00
76511 26 Ophth us quant a only 1.03 $70.00 $72.10
76512 Ophth us b w/non-quant a 1.73 $70.00 $121.10
76512 TC Ophth us b w/non-quant a 0.74 $70.00 $51.80
76512 26 Ophth us b w/non-quant a 0.99 $70.00 $69.30
76513 Echo exam of eye water bath 2.78 $70.00 $194.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
76513 TC Echo exam of eye water bath 1.76 $70.00 $123.20
76513 26 Echo exam of eye water bath 1.02 $70.00 $71.40
76514 Echo exam of eye thickness 0.36 $70.00 $25.20
76514 TC Echo exam of eye thickness 0.13 $70.00 $9.10
76514 26 Echo exam of eye thickness 0.23 $70.00 $16.10
76516 Echo exam of eye 1.53 $70.00 $107.10
76516 TC Echo exam of eye 0.88 $70.00 $61.60
76516 26 Echo exam of eye 0.65 $70.00 $45.50
76519 Echo exam of eye 1.87 $70.00 $130.90
76519 TC Echo exam of eye 0.98 $70.00 $68.60
76519 26 Echo exam of eye 0.89 $70.00 $62.30
76529 Echo exam of eye 2.33 $70.00 $163.10
76529 TC Echo exam of eye 1.39 $70.00 $97.30
76529 26 Echo exam of eye 0.94 $70.00 $65.80
76536 Us exam of head and neck 3.25 $70.00 $227.50
76536 TC Us exam of head and neck 2.45 $70.00 $171.50
76536 26 Us exam of head and neck 0.80 $70.00 $56.00
76604 Us exam chest 2.51 $70.00 $175.70
76604 TC Us exam chest 1.74 $70.00 $121.80
76604 26 Us exam chest 0.77 $70.00 $53.90
76641 Ultrasound breast complete 3.02 $70.00 $211.40
76641 TC Ultrasound breast complete 1.98 $70.00 $138.60
76641 26 Ultrasound breast complete 1.04 $70.00 $72.80
76642 Ultrasound breast limited 2.47 $70.00 $172.90
76642 TC Ultrasound breast limited 1.50 $70.00 $105.00
76642 26 Ultrasound breast limited 0.97 $70.00 $67.90
76700 Us exam abdom complete 3.43 $70.00 $240.10
76700 TC Us exam abdom complete 2.28 $70.00 $159.60
76700 26 Us exam abdom complete 1.15 $70.00 $80.50
76705 Echo exam of abdomen 2.56 $70.00 $179.20
76705 TC Echo exam of abdomen 1.73 $70.00 $121.10
76705 26 Echo exam of abdomen 0.83 $70.00 $58.10
76706 Us abdl aorta screen aaa 3.20 $70.00 $224.00
76706 TC Us abdl aorta screen aaa 2.42 $70.00 $169.40
76706 26 Us abdl aorta screen aaa 0.78 $70.00 $54.60
76770 Us exam abdo back wall comp 3.18 $70.00 $222.60
76770 TC Us exam abdo back wall comp 2.13 $70.00 $149.10
76770 26 Us exam abdo back wall comp 1.05 $70.00 $73.50
76775 Us exam abdo back wall lim 1.65 $70.00 $115.50
76775 TC Us exam abdo back wall lim 0.83 $70.00 $58.10
76775 26 Us exam abdo back wall lim 0.82 $70.00 $57.40
76776 Us exam k transpl w/doppler 4.38 $70.00 $306.60
76776 TC Us exam k transpl w/doppler 3.30 $70.00 $231.00
76776 26 Us exam k transpl w/doppler 1.08 $70.00 $75.60
76800 Us exam spinal canal 4.04 $70.00 $282.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
76800 TC Us exam spinal canal 2.36 $70.00 $165.20
76800 26 Us exam spinal canal 1.68 $70.00 $117.60
76801 Ob us < 14 wks single fetus 3.46 $70.00 $242.20
76801 TC Ob us < 14 wks single fetus 2.04 $70.00 $142.80
76801 26 Ob us < 14 wks single fetus 1.42 $70.00 $99.40
76802 Ob us < 14 wks addl fetus 1.81 $70.00 $126.70
76802 TC Ob us < 14 wks addl fetus 0.61 $70.00 $42.70
76802 26 Ob us < 14 wks addl fetus 1.20 $70.00 $84.00
76805 Ob us >/= 14 wks sngl fetus 3.97 $70.00 $277.90
76805 TC Ob us >/= 14 wks sngl fetus 2.54 $70.00 $177.80
76805 26 Ob us >/= 14 wks sngl fetus 1.43 $70.00 $100.10
76810 Ob us >/= 14 wks addl fetus 2.63 $70.00 $184.10
76810 TC Ob us >/= 14 wks addl fetus 1.20 $70.00 $84.00
76810 26 Ob us >/= 14 wks addl fetus 1.43 $70.00 $100.10
76811 Ob us detailed sngl fetus 5.12 $70.00 $358.40
76811 TC Ob us detailed sngl fetus 2.35 $70.00 $164.50
76811 26 Ob us detailed sngl fetus 2.77 $70.00 $193.90
76812 Ob us detailed addl fetus 5.72 $70.00 $400.40
76812 TC Ob us detailed addl fetus 3.10 $70.00 $217.00
76812 26 Ob us detailed addl fetus 2.62 $70.00 $183.40
76813 Ob us nuchal meas 1 gest 3.45 $70.00 $241.50
76813 TC Ob us nuchal meas 1 gest 1.72 $70.00 $120.40
76813 26 Ob us nuchal meas 1 gest 1.73 $70.00 $121.10
76814 Ob us nuchal meas add-on 2.27 $70.00 $158.90
76814 TC Ob us nuchal meas add-on 0.81 $70.00 $56.70
76814 26 Ob us nuchal meas add-on 1.46 $70.00 $102.20
76815 Ob us limited fetus(s) 2.38 $70.00 $166.60
76815 TC Ob us limited fetus(s) 1.45 $70.00 $101.50
76815 26 Ob us limited fetus(s) 0.93 $70.00 $65.10
76816 Ob us follow-up per fetus 3.23 $70.00 $226.10
76816 TC Ob us follow-up per fetus 1.99 $70.00 $139.30
76816 26 Ob us follow-up per fetus 1.24 $70.00 $86.80
76817 Transvaginal us obstetric 2.73 $70.00 $191.10
76817 TC Transvaginal us obstetric 1.65 $70.00 $115.50
76817 26 Transvaginal us obstetric 1.08 $70.00 $75.60
76818 Fetal biophys profile w/nst 3.44 $70.00 $240.80
76818 TC Fetal biophys profile w/nst 1.90 $70.00 $133.00
76818 26 Fetal biophys profile w/nst 1.54 $70.00 $107.80
76819 Fetal biophys profil w/o nst 2.52 $70.00 $176.40
76819 TC Fetal biophys profil w/o nst 1.40 $70.00 $98.00
76819 26 Fetal biophys profil w/o nst 1.12 $70.00 $78.40
76820 Umbilical artery echo 1.35 $70.00 $94.50
76820 TC Umbilical artery echo 0.62 $70.00 $43.40
76820 26 Umbilical artery echo 0.73 $70.00 $51.10
76821 Middle cerebral artery echo 2.61 $70.00 $182.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
76821 TC Middle cerebral artery echo 1.58 $70.00 $110.60
76821 26 Middle cerebral artery echo 1.03 $70.00 $72.10
76825 Echo exam of fetal heart 7.79 $70.00 $545.30
76825 TC Echo exam of fetal heart 5.41 $70.00 $378.70
76825 26 Echo exam of fetal heart 2.38 $70.00 $166.60
76826 Echo exam of fetal heart 4.62 $70.00 $323.40
76826 TC Echo exam of fetal heart 3.45 $70.00 $241.50
76826 26 Echo exam of fetal heart 1.17 $70.00 $81.90
76827 Echo exam of fetal heart 2.11 $70.00 $147.70
76827 TC Echo exam of fetal heart 1.29 $70.00 $90.30
76827 26 Echo exam of fetal heart 0.82 $70.00 $57.40
76828 Echo exam of fetal heart 1.51 $70.00 $105.70
76828 TC Echo exam of fetal heart 0.70 $70.00 $49.00
76828 26 Echo exam of fetal heart 0.81 $70.00 $56.70
76830 Transvaginal us non-ob 3.44 $70.00 $240.80
76830 TC Transvaginal us non-ob 2.45 $70.00 $171.50
76830 26 Transvaginal us non-ob 0.99 $70.00 $69.30
76831 Echo exam uterus 3.35 $70.00 $234.50
76831 TC Echo exam uterus 2.31 $70.00 $161.70
76831 26 Echo exam uterus 1.04 $70.00 $72.80
76856 Us exam pelvic complete 3.09 $70.00 $216.30
76856 TC Us exam pelvic complete 2.11 $70.00 $147.70
76856 26 Us exam pelvic complete 0.98 $70.00 $68.60
76857 Us exam pelvic limited 1.38 $70.00 $96.60
76857 TC Us exam pelvic limited 0.67 $70.00 $46.90
76857 26 Us exam pelvic limited 0.71 $70.00 $49.70
76870 Us exam scrotum 2.97 $70.00 $207.90
76870 TC Us exam scrotum 2.06 $70.00 $144.20
76870 26 Us exam scrotum 0.91 $70.00 $63.70
76872 Us transrectal 3.62 $70.00 $253.40
76872 TC Us transrectal 2.67 $70.00 $186.90
76872 26 Us transrectal 0.95 $70.00 $66.50
76873 Echograp trans r pros study 4.91 $70.00 $343.70
76873 TC Echograp trans r pros study 2.69 $70.00 $188.30
76873 26 Echograp trans r pros study 2.22 $70.00 $155.40
76881 Us compl joint r-t w/img 2.51 $70.00 $175.70
76881 TC Us compl joint r-t w/img 1.61 $70.00 $112.70
76881 26 Us compl joint r-t w/img 0.90 $70.00 $63.00
76882 Us lmtd jt/nonvasc xtr strux 1.62 $70.00 $113.40
76882 TC Us lmtd jt/nonvasc xtr strux 0.92 $70.00 $64.40
76882 26 Us lmtd jt/nonvasc xtr strux 0.70 $70.00 $49.00
76885 Us exam infant hips dynamic 4.05 $70.00 $283.50
76885 TC Us exam infant hips dynamic 2.99 $70.00 $209.30
76885 26 Us exam infant hips dynamic 1.06 $70.00 $74.20
76886 Us exam infant hips static 2.97 $70.00 $207.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
76886 TC Us exam infant hips static 2.08 $70.00 $145.60
76886 26 Us exam infant hips static 0.89 $70.00 $62.30
76930 Echo guide cardiocentesis 0.00 $70.00 $0.00
76930 TC Echo guide cardiocentesis 0.00 $70.00 $0.00
76930 26 Echo guide cardiocentesis 0.94 $70.00 $65.80
76932 Echo guide for heart biopsy 0.00 $70.00 $0.00
76932 TC Echo guide for heart biopsy 0.00 $70.00 $0.00
76932 26 Echo guide for heart biopsy 0.94 $70.00 $65.80
76936 Echo guide for artery repair 7.60 $70.00 $532.00
76936 TC Echo guide for artery repair 4.83 $70.00 $338.10
76936 26 Echo guide for artery repair 2.77 $70.00 $193.90
76937 Us guide vascular access 0.96 $70.00 $67.20
76937 TC Us guide vascular access 0.55 $70.00 $38.50
76937 26 Us guide vascular access 0.41 $70.00 $28.70
76940 Us guide tissue ablation 0.00 $70.00 $0.00
76940 TC Us guide tissue ablation 0.00 $70.00 $0.00
76940 26 Us guide tissue ablation 2.93 $70.00 $205.10
76941 Echo guide for transfusion 0.00 $70.00 $0.00
76941 TC Echo guide for transfusion 0.00 $70.00 $0.00
76941 26 Echo guide for transfusion 1.97 $70.00 $137.90
76942 Echo guide for biopsy 1.61 $70.00 $112.70
76942 TC Echo guide for biopsy 0.70 $70.00 $49.00
76942 26 Echo guide for biopsy 0.91 $70.00 $63.70
76945 Echo guide villus sampling 0.00 $70.00 $0.00
76945 TC Echo guide villus sampling 0.00 $70.00 $0.00
76945 26 Echo guide villus sampling 0.99 $70.00 $69.30
76946 Echo guide for amniocentesis 0.92 $70.00 $64.40
76946 TC Echo guide for amniocentesis 0.37 $70.00 $25.90
76946 26 Echo guide for amniocentesis 0.55 $70.00 $38.50
76948 Echo guide ova aspiration 2.12 $70.00 $148.40
76948 TC Echo guide ova aspiration 1.13 $70.00 $79.10
76948 26 Echo guide ova aspiration 0.99 $70.00 $69.30
76965 Echo guidance radiotherapy 2.62 $70.00 $183.40
76965 TC Echo guidance radiotherapy 0.70 $70.00 $49.00
76965 26 Echo guidance radiotherapy 1.92 $70.00 $134.40
76970 Ultrasound exam follow-up 2.54 $70.00 $177.80
76970 TC Ultrasound exam follow-up 1.99 $70.00 $139.30
76970 26 Ultrasound exam follow-up 0.55 $70.00 $38.50
76975 Gi endoscopic ultrasound 0.00 $70.00 $0.00
76975 TC Gi endoscopic ultrasound 0.00 $70.00 $0.00
76975 26 Gi endoscopic ultrasound 1.20 $70.00 $84.00
76977 Us bone density measure 0.21 $70.00 $14.70
76977 TC Us bone density measure 0.13 $70.00 $9.10
76977 26 Us bone density measure 0.08 $70.00 $5.60
76978 Us trgt dyn mbubb 1st les 9.18 $70.00 $642.60
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
76978 TC Us trgt dyn mbubb 1st les 6.88 $70.00 $481.60
76978 26 Us trgt dyn mbubb 1st les 2.30 $70.00 $161.00
76979 Us trgt dyn mbubb ea addl 6.23 $70.00 $436.10
76979 TC Us trgt dyn mbubb ea addl 5.02 $70.00 $351.40
76979 26 Us trgt dyn mbubb ea addl 1.21 $70.00 $84.70
76981 Use parenchyma 3.04 $70.00 $212.80
76981 TC Use parenchyma 2.19 $70.00 $153.30
76981 26 Use parenchyma 0.85 $70.00 $59.50
76982 Use 1st target lesion 2.72 $70.00 $190.40
76982 TC Use 1st target lesion 1.87 $70.00 $130.90
76982 26 Use 1st target lesion 0.85 $70.00 $59.50
76983 Use ea addl target lesion 1.67 $70.00 $116.90
76983 TC Use ea addl target lesion 0.95 $70.00 $66.50
76983 26 Use ea addl target lesion 0.72 $70.00 $50.40
76998 Us guide intraop 0.00 $70.00 $0.00
76998 TC Us guide intraop 0.00 $70.00 $0.00
76998 26 Us guide intraop 1.81 $70.00 $126.70
76999 Echo examination procedure 0.00 $70.00 $0.00
76999 TC Echo examination procedure 0.00 $70.00 $0.00
76999 26 Echo examination procedure 0.00 $70.00 $0.00
77001 Fluoroguide for vein device 2.55 $70.00 $178.50
77001 TC Fluoroguide for vein device 2.02 $70.00 $141.40
77001 26 Fluoroguide for vein device 0.53 $70.00 $37.10
77002 Needle localization by xray 2.86 $70.00 $200.20
77002 TC Needle localization by xray 2.07 $70.00 $144.90
77002 26 Needle localization by xray 0.79 $70.00 $55.30
77003 Fluoroguide for spine inject 2.77 $70.00 $193.90
77003 TC Fluoroguide for spine inject 1.91 $70.00 $133.70
77003 26 Fluoroguide for spine inject 0.86 $70.00 $60.20
77011 Ct scan for localization 6.47 $70.00 $452.90
77011 TC Ct scan for localization 4.68 $70.00 $327.60
77011 26 Ct scan for localization 1.79 $70.00 $125.30
77012 Ct scan for needle biopsy 4.27 $70.00 $298.90
77012 TC Ct scan for needle biopsy 2.17 $70.00 $151.90
77012 26 Ct scan for needle biopsy 2.10 $70.00 $147.00
77013 Ct guide for tissue ablation 0.00 $70.00 $0.00
77013 TC Ct guide for tissue ablation 0.00 $70.00 $0.00
77013 26 Ct guide for tissue ablation 5.46 $70.00 $382.20
77014 Ct scan for therapy guide 3.41 $70.00 $238.70
77014 TC Ct scan for therapy guide 2.14 $70.00 $149.80
77014 26 Ct scan for therapy guide 1.27 $70.00 $88.90
77021 Mri guidance ndl plmt rs&i 13.44 $70.00 $940.80
77021 TC Mri guidance ndl plmt rs&i 11.36 $70.00 $795.20
77021 26 Mri guidance ndl plmt rs&i 2.08 $70.00 $145.60
77022 Mri gdn parnchyma tiss abltj 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
77022 TC Mri gdn parnchyma tiss abltj 0.00 $70.00 $0.00
77022 26 Mri gdn parnchyma tiss abltj 6.15 $70.00 $430.50
77046 Mri breast c- unilateral 7.02 $70.00 $491.40
77046 TC Mri breast c- unilateral 4.96 $70.00 $347.20
77046 26 Mri breast c- unilateral 2.06 $70.00 $144.20
77047 Mri breast c- bilateral 7.21 $70.00 $504.70
77047 TC Mri breast c- bilateral 4.93 $70.00 $345.10
77047 26 Mri breast c- bilateral 2.28 $70.00 $159.60
77048 Mri breast c-+ w/cad uni 11.15 $70.00 $780.50
77048 TC Mri breast c-+ w/cad uni 8.17 $70.00 $571.90
77048 26 Mri breast c-+ w/cad uni 2.98 $70.00 $208.60
77049 Mri breast c-+ w/cad bi 11.39 $70.00 $797.30
77049 TC Mri breast c-+ w/cad bi 8.13 $70.00 $569.10
77049 26 Mri breast c-+ w/cad bi 3.26 $70.00 $228.20
77053 X-ray of mammary duct 1.62 $70.00 $113.40
77053 TC X-ray of mammary duct 1.11 $70.00 $77.70
77053 26 X-ray of mammary duct 0.51 $70.00 $35.70
77054 X-ray of mammary ducts 2.12 $70.00 $148.40
77054 TC X-ray of mammary ducts 1.47 $70.00 $102.90
77054 26 X-ray of mammary ducts 0.65 $70.00 $45.50
77061 Breast tomosynthesis uni 0.00 $70.00 $0.00
77061 TC Breast tomosynthesis uni 0.00 $70.00 $0.00
77061 26 Breast tomosynthesis uni 0.00 $70.00 $0.00
77062 Breast tomosynthesis bi 0.00 $70.00 $0.00
77062 TC Breast tomosynthesis bi 0.00 $70.00 $0.00
77062 26 Breast tomosynthesis bi 0.00 $70.00 $0.00
77063 Breast tomosynthesis bi 1.55 $70.00 $108.50
77063 TC Breast tomosynthesis bi 0.70 $70.00 $49.00
77063 26 Breast tomosynthesis bi 0.85 $70.00 $59.50
77065 Dx mammo incl cad uni 3.77 $70.00 $263.90
77065 TC Dx mammo incl cad uni 2.61 $70.00 $182.70
77065 26 Dx mammo incl cad uni 1.16 $70.00 $81.20
77066 Dx mammo incl cad bi 4.77 $70.00 $333.90
77066 TC Dx mammo incl cad bi 3.34 $70.00 $233.80
77066 26 Dx mammo incl cad bi 1.43 $70.00 $100.10
77067 Scr mammo bi incl cad 3.84 $70.00 $268.80
77067 TC Scr mammo bi incl cad 2.76 $70.00 $193.20
77067 26 Scr mammo bi incl cad 1.08 $70.00 $75.60
77071 X-ray stress view 1.43 $70.00 $100.10
77072 X-rays for bone age 0.68 $70.00 $47.60
77072 TC X-rays for bone age 0.41 $70.00 $28.70
77072 26 X-rays for bone age 0.27 $70.00 $18.90
77073 X-rays bone length studies 1.06 $70.00 $74.20
77073 TC X-rays bone length studies 0.65 $70.00 $45.50
77073 26 X-rays bone length studies 0.41 $70.00 $28.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
77074 X-rays bone survey limited 1.91 $70.00 $133.70
77074 TC X-rays bone survey limited 1.26 $70.00 $88.20
77074 26 X-rays bone survey limited 0.65 $70.00 $45.50
77075 X-rays bone survey complete 2.60 $70.00 $182.00
77075 TC X-rays bone survey complete 1.83 $70.00 $128.10
77075 26 X-rays bone survey complete 0.77 $70.00 $53.90
77076 X-rays bone survey infant 2.85 $70.00 $199.50
77076 TC X-rays bone survey infant 1.85 $70.00 $129.50
77076 26 X-rays bone survey infant 1.00 $70.00 $70.00
77077 Joint survey single view 1.09 $70.00 $76.30
77077 TC Joint survey single view 0.63 $70.00 $44.10
77077 26 Joint survey single view 0.46 $70.00 $32.20
77078 Ct bone density axial 3.24 $70.00 $226.80
77078 TC Ct bone density axial 2.89 $70.00 $202.30
77078 26 Ct bone density axial 0.35 $70.00 $24.50
77080 Dxa bone density axial 1.13 $70.00 $79.10
77080 TC Dxa bone density axial 0.85 $70.00 $59.50
77080 26 Dxa bone density axial 0.28 $70.00 $19.60
77081 Dxa bone density/peripheral 0.94 $70.00 $65.80
77081 TC Dxa bone density/peripheral 0.65 $70.00 $45.50
77081 26 Dxa bone density/peripheral 0.29 $70.00 $20.30
77084 Magnetic image bone marrow 10.72 $70.00 $750.40
77084 TC Magnetic image bone marrow 8.43 $70.00 $590.10
77084 26 Magnetic image bone marrow 2.29 $70.00 $160.30
77085 Dxa bone density study 1.54 $70.00 $107.80
77085 TC Dxa bone density study 1.11 $70.00 $77.70
77085 26 Dxa bone density study 0.43 $70.00 $30.10
77086 Fracture assessment via dxa 0.99 $70.00 $69.30
77086 TC Fracture assessment via dxa 0.75 $70.00 $52.50
77086 26 Fracture assessment via dxa 0.24 $70.00 $16.80
77261 Radiation therapy planning 2.03 $70.00 $142.10
77262 Radiation therapy planning 3.06 $70.00 $214.20
77263 Radiation therapy planning 4.78 $70.00 $334.60
77280 Set radiation therapy field 7.84 $70.00 $548.80
77280 TC Set radiation therapy field 6.78 $70.00 $474.60
77280 26 Set radiation therapy field 1.06 $70.00 $74.20
77285 Set radiation therapy field 12.97 $70.00 $907.90
77285 TC Set radiation therapy field 11.36 $70.00 $795.20
77285 26 Set radiation therapy field 1.61 $70.00 $112.70
77290 Set radiation therapy field 14.43 $70.00 $1,010.10
77290 TC Set radiation therapy field 12.10 $70.00 $847.00
77290 26 Set radiation therapy field 2.33 $70.00 $163.10
77293 Respirator motion mgmt simul 13.06 $70.00 $914.20
77293 TC Respirator motion mgmt simul 10.07 $70.00 $704.90
77293 26 Respirator motion mgmt simul 2.99 $70.00 $209.30
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
77295 3-d radiotherapy plan 13.94 $70.00 $975.80
77295 TC 3-d radiotherapy plan 7.54 $70.00 $527.80
77295 26 3-d radiotherapy plan 6.40 $70.00 $448.00
77299 Radiation therapy planning 0.00 $70.00 $0.00
77299 TC Radiation therapy planning 0.00 $70.00 $0.00
77299 26 Radiation therapy planning 0.00 $70.00 $0.00
77300 Radiation therapy dose plan 1.89 $70.00 $132.30
77300 TC Radiation therapy dose plan 0.96 $70.00 $67.20
77300 26 Radiation therapy dose plan 0.93 $70.00 $65.10
77301 Radiotherapy dose plan imrt 55.05 $70.00 $3,853.50
77301 TC Radiotherapy dose plan imrt 43.13 $70.00 $3,019.10
77301 26 Radiotherapy dose plan imrt 11.92 $70.00 $834.40
77306 Telethx isodose plan simple 4.25 $70.00 $297.50
77306 TC Telethx isodose plan simple 2.16 $70.00 $151.20
77306 26 Telethx isodose plan simple 2.09 $70.00 $146.30
77307 Telethx isodose plan cplx 8.22 $70.00 $575.40
77307 TC Telethx isodose plan cplx 3.90 $70.00 $273.00
77307 26 Telethx isodose plan cplx 4.32 $70.00 $302.40
77316 Brachytx isodose plan simple 5.78 $70.00 $404.60
77316 TC Brachytx isodose plan simple 3.68 $70.00 $257.60
77316 26 Brachytx isodose plan simple 2.10 $70.00 $147.00
77317 Brachytx isodose intermed 7.57 $70.00 $529.90
77317 TC Brachytx isodose intermed 4.84 $70.00 $338.80
77317 26 Brachytx isodose intermed 2.73 $70.00 $191.10
77318 Brachytx isodose complex 10.88 $70.00 $761.60
77318 TC Brachytx isodose complex 6.56 $70.00 $459.20
77318 26 Brachytx isodose complex 4.32 $70.00 $302.40
77321 Special teletx port plan 2.66 $70.00 $186.20
77321 TC Special teletx port plan 1.24 $70.00 $86.80
77321 26 Special teletx port plan 1.42 $70.00 $99.40
77331 Special radiation dosimetry 1.84 $70.00 $128.80
77331 TC Special radiation dosimetry 0.54 $70.00 $37.80
77331 26 Special radiation dosimetry 1.30 $70.00 $91.00
77332 Radiation treatment aid(s) 1.49 $70.00 $104.30
77332 TC Radiation treatment aid(s) 0.81 $70.00 $56.70
77332 26 Radiation treatment aid(s) 0.68 $70.00 $47.60
77333 Radiation treatment aid(s) 3.10 $70.00 $217.00
77333 TC Radiation treatment aid(s) 1.98 $70.00 $138.60
77333 26 Radiation treatment aid(s) 1.12 $70.00 $78.40
77334 Radiation treatment aid(s) 3.64 $70.00 $254.80
77334 TC Radiation treatment aid(s) 1.92 $70.00 $134.40
77334 26 Radiation treatment aid(s) 1.72 $70.00 $120.40
77336 Radiation physics consult 2.26 $70.00 $158.20
77338 Design mlc device for imrt 14.16 $70.00 $991.20
77338 TC Design mlc device for imrt 7.76 $70.00 $543.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
77338 26 Design mlc device for imrt 6.40 $70.00 $448.00
77370 Radiation physics consult 3.52 $70.00 $246.40
77371 Srs multisource 0.00 $70.00 $0.00
77372 Srs linear based 30.24 $70.00 $2,116.80
77373 Sbrt delivery 36.61 $70.00 $2,562.70
77385 Ntsty modul rad tx dlvr smpl 0.00 $70.00 $0.00
77386 Ntsty modul rad tx dlvr cplx 0.00 $70.00 $0.00
77387 Guidance for radj tx dlvr 0.00 $70.00 $0.00
77399 External radiation dosimetry 0.00 $70.00 $0.00
77399 TC External radiation dosimetry 0.00 $70.00 $0.00
77399 26 External radiation dosimetry 0.00 $70.00 $0.00
77401 Radiation treatment delivery 0.70 $70.00 $49.00
77402 Radiation treatment delivery 0.00 $70.00 $0.00
77407 Radiation treatment delivery 0.00 $70.00 $0.00
77412 Radiation treatment delivery 0.00 $70.00 $0.00
77417 Radiology port images(s) 0.32 $70.00 $22.40
77423 Neutron beam tx complex 0.00 $70.00 $0.00
77424 Io rad tx delivery by x-ray 0.00 $70.00 $0.00
77425 Io rad tx deliver by elctrns 0.00 $70.00 $0.00
77427 Radiation tx management x5 5.37 $70.00 $375.90
77431 Radiation therapy management 2.96 $70.00 $207.20
77432 Stereotactic radiation trmt 12.05 $70.00 $843.50
77435 Sbrt management 18.17 $70.00 $1,271.90
77469 Io radiation tx management 9.00 $70.00 $630.00
77470 Special radiation treatment 3.75 $70.00 $262.50
77470 TC Special radiation treatment 0.72 $70.00 $50.40
77470 26 Special radiation treatment 3.03 $70.00 $212.10
77499 Radiation therapy management 0.00 $70.00 $0.00
77499 TC Radiation therapy management 0.00 $70.00 $0.00
77499 26 Radiation therapy management 0.00 $70.00 $0.00
77520 Proton trmt simple w/o comp 0.00 $70.00 $0.00
77522 Proton trmt simple w/comp 0.00 $70.00 $0.00
77523 Proton trmt intermediate 0.00 $70.00 $0.00
77525 Proton treatment complex 0.00 $70.00 $0.00
77600 Hyperthermia treatment 12.76 $70.00 $893.20
77600 TC Hyperthermia treatment 10.74 $70.00 $751.80
77600 26 Hyperthermia treatment 2.02 $70.00 $141.40
77605 Hyperthermia treatment 22.05 $70.00 $1,543.50
77605 TC Hyperthermia treatment 19.13 $70.00 $1,339.10
77605 26 Hyperthermia treatment 2.92 $70.00 $204.40
77610 Hyperthermia treatment 19.60 $70.00 $1,372.00
77610 TC Hyperthermia treatment 17.66 $70.00 $1,236.20
77610 26 Hyperthermia treatment 1.94 $70.00 $135.80
77615 Hyperthermia treatment 30.09 $70.00 $2,106.30
77615 TC Hyperthermia treatment 27.36 $70.00 $1,915.20
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
77615 26 Hyperthermia treatment 2.73 $70.00 $191.10
77620 Hyperthermia treatment 14.67 $70.00 $1,026.90
77620 TC Hyperthermia treatment 12.21 $70.00 $854.70
77620 26 Hyperthermia treatment 2.46 $70.00 $172.20
77750 Infuse radioactive materials 10.79 $70.00 $755.30
77750 TC Infuse radioactive materials 3.34 $70.00 $233.80
77750 26 Infuse radioactive materials 7.45 $70.00 $521.50
77761 Apply intrcav radiat simple 11.33 $70.00 $793.10
77761 TC Apply intrcav radiat simple 5.58 $70.00 $390.60
77761 26 Apply intrcav radiat simple 5.75 $70.00 $402.50
77762 Apply intrcav radiat interm 15.00 $70.00 $1,050.00
77762 TC Apply intrcav radiat interm 6.39 $70.00 $447.30
77762 26 Apply intrcav radiat interm 8.61 $70.00 $602.70
77763 Apply intrcav radiat compl 21.36 $70.00 $1,495.20
77763 TC Apply intrcav radiat compl 8.40 $70.00 $588.00
77763 26 Apply intrcav radiat compl 12.96 $70.00 $907.20
77767 Hdr rdncl skn surf brachytx 6.60 $70.00 $462.00
77767 TC Hdr rdncl skn surf brachytx 5.03 $70.00 $352.10
77767 26 Hdr rdncl skn surf brachytx 1.57 $70.00 $109.90
77768 Hdr rdncl skn surf brachytx 10.14 $70.00 $709.80
77768 TC Hdr rdncl skn surf brachytx 8.04 $70.00 $562.80
77768 26 Hdr rdncl skn surf brachytx 2.10 $70.00 $147.00
77770 Hdr rdncl ntrstl/icav brchtx 9.36 $70.00 $655.20
77770 TC Hdr rdncl ntrstl/icav brchtx 6.46 $70.00 $452.20
77770 26 Hdr rdncl ntrstl/icav brchtx 2.90 $70.00 $203.00
77771 Hdr rdncl ntrstl/icav brchtx 17.08 $70.00 $1,195.60
77771 TC Hdr rdncl ntrstl/icav brchtx 11.40 $70.00 $798.00
77771 26 Hdr rdncl ntrstl/icav brchtx 5.68 $70.00 $397.60
77772 Hdr rdncl ntrstl/icav brchtx 25.88 $70.00 $1,811.60
77772 TC Hdr rdncl ntrstl/icav brchtx 17.84 $70.00 $1,248.80
77772 26 Hdr rdncl ntrstl/icav brchtx 8.04 $70.00 $562.80
77778 Apply interstit radiat compl 24.07 $70.00 $1,684.90
77778 TC Apply interstit radiat compl 11.00 $70.00 $770.00
77778 26 Apply interstit radiat compl 13.07 $70.00 $914.90
77789 Apply surf ldr radionuclide 3.49 $70.00 $244.30
77789 TC Apply surf ldr radionuclide 1.78 $70.00 $124.60
77789 26 Apply surf ldr radionuclide 1.71 $70.00 $119.70
77790 Radiation handling 0.43 $70.00 $30.10
77799 Radium/radioisotope therapy 0.00 $70.00 $0.00
77799 TC Radium/radioisotope therapy 0.00 $70.00 $0.00
77799 26 Radium/radioisotope therapy 0.00 $70.00 $0.00
78012 Thyroid uptake measurement 2.34 $70.00 $163.80
78012 TC Thyroid uptake measurement 2.07 $70.00 $144.90
78012 26 Thyroid uptake measurement 0.27 $70.00 $18.90
78013 Thyroid imaging w/blood flow 5.54 $70.00 $387.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78013 TC Thyroid imaging w/blood flow 5.02 $70.00 $351.40
78013 26 Thyroid imaging w/blood flow 0.52 $70.00 $36.40
78014 Thyroid imaging w/blood flow 6.95 $70.00 $486.50
78014 TC Thyroid imaging w/blood flow 6.25 $70.00 $437.50
78014 26 Thyroid imaging w/blood flow 0.70 $70.00 $49.00
78015 Thyroid met imaging 6.47 $70.00 $452.90
78015 TC Thyroid met imaging 5.52 $70.00 $386.40
78015 26 Thyroid met imaging 0.95 $70.00 $66.50
78016 Thyroid met imaging/studies 8.12 $70.00 $568.40
78016 TC Thyroid met imaging/studies 7.15 $70.00 $500.50
78016 26 Thyroid met imaging/studies 0.97 $70.00 $67.90
78018 Thyroid met imaging body 9.03 $70.00 $632.10
78018 TC Thyroid met imaging body 7.86 $70.00 $550.20
78018 26 Thyroid met imaging body 1.17 $70.00 $81.90
78020 Thyroid met uptake 2.41 $70.00 $168.70
78020 TC Thyroid met uptake 1.62 $70.00 $113.40
78020 26 Thyroid met uptake 0.79 $70.00 $55.30
78070 Parathyroid planar imaging 8.61 $70.00 $602.70
78070 TC Parathyroid planar imaging 7.50 $70.00 $525.00
78070 26 Parathyroid planar imaging 1.11 $70.00 $77.70
78071 Parathyrd planar w/wo subtrj 10.27 $70.00 $718.90
78071 TC Parathyrd planar w/wo subtrj 8.60 $70.00 $602.00
78071 26 Parathyrd planar w/wo subtrj 1.67 $70.00 $116.90
78072 Parathyrd planar w/spect&ct 11.21 $70.00 $784.70
78072 TC Parathyrd planar w/spect&ct 9.02 $70.00 $631.40
78072 26 Parathyrd planar w/spect&ct 2.19 $70.00 $153.30
78075 Adrenal cortex & medulla img 13.00 $70.00 $910.00
78075 TC Adrenal cortex & medulla img 11.94 $70.00 $835.80
78075 26 Adrenal cortex & medulla img 1.06 $70.00 $74.20
78099 Endocrine nuclear procedure 0.00 $70.00 $0.00
78099 TC Endocrine nuclear procedure 0.00 $70.00 $0.00
78099 26 Endocrine nuclear procedure 0.00 $70.00 $0.00
78102 Bone marrow imaging ltd 4.89 $70.00 $342.30
78102 TC Bone marrow imaging ltd 4.14 $70.00 $289.80
78102 26 Bone marrow imaging ltd 0.75 $70.00 $52.50
78103 Bone marrow imaging mult 6.27 $70.00 $438.90
78103 TC Bone marrow imaging mult 5.27 $70.00 $368.90
78103 26 Bone marrow imaging mult 1.00 $70.00 $70.00
78104 Bone marrow imaging body 7.15 $70.00 $500.50
78104 TC Bone marrow imaging body 6.05 $70.00 $423.50
78104 26 Bone marrow imaging body 1.10 $70.00 $77.00
78110 Plasma volume single 1.99 $70.00 $139.30
78110 TC Plasma volume single 1.76 $70.00 $123.20
78110 26 Plasma volume single 0.23 $70.00 $16.10
78111 Plasma volume multiple 2.11 $70.00 $147.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78111 TC Plasma volume multiple 1.84 $70.00 $128.80
78111 26 Plasma volume multiple 0.27 $70.00 $18.90
78120 Red cell mass single 2.04 $70.00 $142.80
78120 TC Red cell mass single 1.76 $70.00 $123.20
78120 26 Red cell mass single 0.28 $70.00 $19.60
78121 Red cell mass multiple 2.23 $70.00 $156.10
78121 TC Red cell mass multiple 1.84 $70.00 $128.80
78121 26 Red cell mass multiple 0.39 $70.00 $27.30
78122 Blood volume 2.73 $70.00 $191.10
78122 TC Blood volume 2.13 $70.00 $149.10
78122 26 Blood volume 0.60 $70.00 $42.00
78130 Red cell survival study 3.56 $70.00 $249.20
78130 TC Red cell survival study 2.84 $70.00 $198.80
78130 26 Red cell survival study 0.72 $70.00 $50.40
78135 Red cell survival kinetics 8.02 $70.00 $561.40
78135 TC Red cell survival kinetics 7.26 $70.00 $508.20
78135 26 Red cell survival kinetics 0.76 $70.00 $53.20
78140 Red cell sequestration 3.14 $70.00 $219.80
78140 TC Red cell sequestration 2.42 $70.00 $169.40
78140 26 Red cell sequestration 0.72 $70.00 $50.40
78185 Spleen imaging 4.87 $70.00 $340.90
78185 TC Spleen imaging 4.39 $70.00 $307.30
78185 26 Spleen imaging 0.48 $70.00 $33.60
78191 Platelet survival 3.56 $70.00 $249.20
78191 TC Platelet survival 2.84 $70.00 $198.80
78191 26 Platelet survival 0.72 $70.00 $50.40
78195 Lymph system imaging 10.27 $70.00 $718.90
78195 TC Lymph system imaging 8.60 $70.00 $602.00
78195 26 Lymph system imaging 1.67 $70.00 $116.90
78199 Blood/lymph nuclear exam 0.00 $70.00 $0.00
78199 TC Blood/lymph nuclear exam 0.00 $70.00 $0.00
78199 26 Blood/lymph nuclear exam 0.00 $70.00 $0.00
78201 Liver imaging 5.49 $70.00 $384.30
78201 TC Liver imaging 4.89 $70.00 $342.30
78201 26 Liver imaging 0.60 $70.00 $42.00
78202 Liver imaging with flow 5.82 $70.00 $407.40
78202 TC Liver imaging with flow 5.15 $70.00 $360.50
78202 26 Liver imaging with flow 0.67 $70.00 $46.90
78205 Liver imaging (3d) 6.08 $70.00 $425.60
78205 TC Liver imaging (3d) 5.13 $70.00 $359.10
78205 26 Liver imaging (3d) 0.95 $70.00 $66.50
78206 Liver image (3d) with flow 9.78 $70.00 $684.60
78206 TC Liver image (3d) with flow 8.46 $70.00 $592.20
78206 26 Liver image (3d) with flow 1.32 $70.00 $92.40
78215 Liver and spleen imaging 5.61 $70.00 $392.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78215 TC Liver and spleen imaging 4.92 $70.00 $344.40
78215 26 Liver and spleen imaging 0.69 $70.00 $48.30
78216 Liver & spleen image/flow 3.68 $70.00 $257.60
78216 TC Liver & spleen image/flow 2.90 $70.00 $203.00
78216 26 Liver & spleen image/flow 0.78 $70.00 $54.60
78226 Hepatobiliary system imaging 9.52 $70.00 $666.40
78226 TC Hepatobiliary system imaging 8.48 $70.00 $593.60
78226 26 Hepatobiliary system imaging 1.04 $70.00 $72.80
78227 Hepatobil syst image w/drug 12.87 $70.00 $900.90
78227 TC Hepatobil syst image w/drug 11.60 $70.00 $812.00
78227 26 Hepatobil syst image w/drug 1.27 $70.00 $88.90
78230 Salivary gland imaging 5.03 $70.00 $352.10
78230 TC Salivary gland imaging 4.38 $70.00 $306.60
78230 26 Salivary gland imaging 0.65 $70.00 $45.50
78231 Serial salivary imaging 2.98 $70.00 $208.60
78231 TC Serial salivary imaging 2.36 $70.00 $165.20
78231 26 Serial salivary imaging 0.62 $70.00 $43.40
78232 Salivary gland function exam 2.92 $70.00 $204.40
78232 TC Salivary gland function exam 2.36 $70.00 $165.20
78232 26 Salivary gland function exam 0.56 $70.00 $39.20
78258 Esophageal motility study 6.31 $70.00 $441.70
78258 TC Esophageal motility study 5.29 $70.00 $370.30
78258 26 Esophageal motility study 1.02 $70.00 $71.40
78261 Gastric mucosa imaging 5.83 $70.00 $408.10
78261 TC Gastric mucosa imaging 5.01 $70.00 $350.70
78261 26 Gastric mucosa imaging 0.82 $70.00 $57.40
78262 Gastroesophageal reflux exam 6.95 $70.00 $486.50
78262 TC Gastroesophageal reflux exam 6.01 $70.00 $420.70
78262 26 Gastroesophageal reflux exam 0.94 $70.00 $65.80
78264 Gastric emptying imag study 9.65 $70.00 $675.50
78264 TC Gastric emptying imag study 8.55 $70.00 $598.50
78264 26 Gastric emptying imag study 1.10 $70.00 $77.00
78265 Gastric emptying imag study 11.45 $70.00 $801.50
78265 TC Gastric emptying imag study 10.08 $70.00 $705.60
78265 26 Gastric emptying imag study 1.37 $70.00 $95.90
78266 Gastric emptying imag study 13.58 $70.00 $950.60
78266 TC Gastric emptying imag study 12.07 $70.00 $844.90
78266 26 Gastric emptying imag study 1.51 $70.00 $105.70
78267 Breath tst attain/anal c-14 0.00 $70.00 $0.00
78268 Breath test analysis c-14 0.00 $70.00 $0.00
78278 Acute gi blood loss imaging 10.06 $70.00 $704.20
78278 TC Acute gi blood loss imaging 8.67 $70.00 $606.90
78278 26 Acute gi blood loss imaging 1.39 $70.00 $97.30
78282 Gi protein loss exam 0.00 $70.00 $0.00
78282 TC Gi protein loss exam 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78282 26 Gi protein loss exam 0.46 $70.00 $32.20
78290 Meckels divert exam 9.53 $70.00 $667.10
78290 TC Meckels divert exam 8.58 $70.00 $600.60
78290 26 Meckels divert exam 0.95 $70.00 $66.50
78291 Leveen/shunt patency exam 7.39 $70.00 $517.30
78291 TC Leveen/shunt patency exam 6.18 $70.00 $432.60
78291 26 Leveen/shunt patency exam 1.21 $70.00 $84.70
78299 Gi nuclear procedure 0.00 $70.00 $0.00
78299 TC Gi nuclear procedure 0.00 $70.00 $0.00
78299 26 Gi nuclear procedure 0.00 $70.00 $0.00
78300 Bone imaging limited area 6.63 $70.00 $464.10
78300 TC Bone imaging limited area 5.75 $70.00 $402.50
78300 26 Bone imaging limited area 0.88 $70.00 $61.60
78305 Bone imaging multiple areas 8.08 $70.00 $565.60
78305 TC Bone imaging multiple areas 6.91 $70.00 $483.70
78305 26 Bone imaging multiple areas 1.17 $70.00 $81.90
78306 Bone imaging whole body 8.71 $70.00 $609.70
78306 TC Bone imaging whole body 7.51 $70.00 $525.70
78306 26 Bone imaging whole body 1.20 $70.00 $84.00
78315 Bone imaging 3 phase 9.98 $70.00 $698.60
78315 TC Bone imaging 3 phase 8.56 $70.00 $599.20
78315 26 Bone imaging 3 phase 1.42 $70.00 $99.40
78320 Bone imaging (3d) 6.59 $70.00 $461.30
78320 TC Bone imaging (3d) 5.15 $70.00 $360.50
78320 26 Bone imaging (3d) 1.44 $70.00 $100.80
78350 Bone mineral single photon 0.93 $70.00 $65.10
78350 TC Bone mineral single photon 0.61 $70.00 $42.70
78350 26 Bone mineral single photon 0.32 $70.00 $22.40
78351 Bone mineral dual photon 0.44 $70.00 $30.80
78399 Musculoskeletal nuclear exam 0.00 $70.00 $0.00
78399 TC Musculoskeletal nuclear exam 0.00 $70.00 $0.00
78399 26 Musculoskeletal nuclear exam 0.00 $70.00 $0.00
78414 Non-imaging heart function 0.00 $70.00 $0.00
78414 TC Non-imaging heart function 0.00 $70.00 $0.00
78414 26 Non-imaging heart function 0.63 $70.00 $44.10
78428 Cardiac shunt imaging 5.29 $70.00 $370.30
78428 TC Cardiac shunt imaging 4.22 $70.00 $295.40
78428 26 Cardiac shunt imaging 1.07 $70.00 $74.90
78445 Vascular flow imaging 5.38 $70.00 $376.60
78445 TC Vascular flow imaging 4.67 $70.00 $326.90
78445 26 Vascular flow imaging 0.71 $70.00 $49.70
78451 Ht muscle image spect sing 9.77 $70.00 $683.90
78451 TC Ht muscle image spect sing 7.86 $70.00 $550.20
78451 26 Ht muscle image spect sing 1.91 $70.00 $133.70
78452 Ht muscle image spect mult 13.60 $70.00 $952.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78452 TC Ht muscle image spect mult 11.36 $70.00 $795.20
78452 26 Ht muscle image spect mult 2.24 $70.00 $156.80
78453 Ht muscle image planar sing 8.78 $70.00 $614.60
78453 TC Ht muscle image planar sing 7.37 $70.00 $515.90
78453 26 Ht muscle image planar sing 1.41 $70.00 $98.70
78454 Ht musc image planar mult 12.56 $70.00 $879.20
78454 TC Ht musc image planar mult 10.67 $70.00 $746.90
78454 26 Ht musc image planar mult 1.89 $70.00 $132.30
78456 Acute venous thrombus image 8.93 $70.00 $625.10
78456 TC Acute venous thrombus image 7.55 $70.00 $528.50
78456 26 Acute venous thrombus image 1.38 $70.00 $96.60
78457 Venous thrombosis imaging 5.52 $70.00 $386.40
78457 TC Venous thrombosis imaging 4.41 $70.00 $308.70
78457 26 Venous thrombosis imaging 1.11 $70.00 $77.70
78458 Ven thrombosis images bilat 5.92 $70.00 $414.40
78458 TC Ven thrombosis images bilat 4.64 $70.00 $324.80
78458 26 Ven thrombosis images bilat 1.28 $70.00 $89.60
78459 Heart muscle imaging (pet) 0.00 $70.00 $0.00
78459 TC Heart muscle imaging (pet) 0.00 $70.00 $0.00
78459 26 Heart muscle imaging (pet) 2.01 $70.00 $140.70
78466 Heart infarct image 5.67 $70.00 $396.90
78466 TC Heart infarct image 4.68 $70.00 $327.60
78466 26 Heart infarct image 0.99 $70.00 $69.30
78468 Heart infarct image (ef) 5.88 $70.00 $411.60
78468 TC Heart infarct image (ef) 4.76 $70.00 $333.20
78468 26 Heart infarct image (ef) 1.12 $70.00 $78.40
78469 Heart infarct image (3d) 6.50 $70.00 $455.00
78469 TC Heart infarct image (3d) 5.21 $70.00 $364.70
78469 26 Heart infarct image (3d) 1.29 $70.00 $90.30
78472 Gated heart planar single 6.59 $70.00 $461.30
78472 TC Gated heart planar single 5.22 $70.00 $365.40
78472 26 Gated heart planar single 1.37 $70.00 $95.90
78473 Gated heart multiple 8.32 $70.00 $582.40
78473 TC Gated heart multiple 6.30 $70.00 $441.00
78473 26 Gated heart multiple 2.02 $70.00 $141.40
78481 Heart first pass single 5.06 $70.00 $354.20
78481 TC Heart first pass single 3.69 $70.00 $258.30
78481 26 Heart first pass single 1.37 $70.00 $95.90
78483 Heart first pass multiple 6.83 $70.00 $478.10
78483 TC Heart first pass multiple 4.82 $70.00 $337.40
78483 26 Heart first pass multiple 2.01 $70.00 $140.70
78491 Heart image (pet) single 0.00 $70.00 $0.00
78491 TC Heart image (pet) single 0.00 $70.00 $0.00
78491 26 Heart image (pet) single 2.02 $70.00 $141.40
78492 Heart image (pet) multiple 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78492 TC Heart image (pet) multiple 0.00 $70.00 $0.00
78492 26 Heart image (pet) multiple 2.55 $70.00 $178.50
78494 Heart image spect 6.51 $70.00 $455.70
78494 TC Heart image spect 4.86 $70.00 $340.20
78494 26 Heart image spect 1.65 $70.00 $115.50
78496 Heart first pass add-on 1.25 $70.00 $87.50
78496 TC Heart first pass add-on 0.56 $70.00 $39.20
78496 26 Heart first pass add-on 0.69 $70.00 $48.30
78499 Cardiovascular nuclear exam 0.00 $70.00 $0.00
78499 TC Cardiovascular nuclear exam 0.00 $70.00 $0.00
78499 26 Cardiovascular nuclear exam 0.00 $70.00 $0.00
78579 Lung ventilation imaging 5.36 $70.00 $375.20
78579 TC Lung ventilation imaging 4.68 $70.00 $327.60
78579 26 Lung ventilation imaging 0.68 $70.00 $47.60
78580 Lung perfusion imaging 6.87 $70.00 $480.90
78580 TC Lung perfusion imaging 5.83 $70.00 $408.10
78580 26 Lung perfusion imaging 1.04 $70.00 $72.80
78582 Lung ventilat&perfus imaging 9.64 $70.00 $674.80
78582 TC Lung ventilat&perfus imaging 8.14 $70.00 $569.80
78582 26 Lung ventilat&perfus imaging 1.50 $70.00 $105.00
78597 Lung perfusion differential 5.79 $70.00 $405.30
78597 TC Lung perfusion differential 4.78 $70.00 $334.60
78597 26 Lung perfusion differential 1.01 $70.00 $70.70
78598 Lung perf&ventilat diferentl 8.80 $70.00 $616.00
78598 TC Lung perf&ventilat diferentl 7.63 $70.00 $534.10
78598 26 Lung perf&ventilat diferentl 1.17 $70.00 $81.90
78599 Respiratory nuclear exam 0.00 $70.00 $0.00
78599 TC Respiratory nuclear exam 0.00 $70.00 $0.00
78599 26 Respiratory nuclear exam 0.00 $70.00 $0.00
78600 Brain image < 4 views 5.32 $70.00 $372.40
78600 TC Brain image < 4 views 4.69 $70.00 $328.30
78600 26 Brain image < 4 views 0.63 $70.00 $44.10
78601 Brain image w/flow < 4 views 6.25 $70.00 $437.50
78601 TC Brain image w/flow < 4 views 5.53 $70.00 $387.10
78601 26 Brain image w/flow < 4 views 0.72 $70.00 $50.40
78605 Brain image 4+ views 5.74 $70.00 $401.80
78605 TC Brain image 4+ views 4.98 $70.00 $348.60
78605 26 Brain image 4+ views 0.76 $70.00 $53.20
78606 Brain image w/flow 4 + views 9.50 $70.00 $665.00
78606 TC Brain image w/flow 4 + views 8.61 $70.00 $602.70
78606 26 Brain image w/flow 4 + views 0.89 $70.00 $62.30
78607 Brain imaging (3d) 9.99 $70.00 $699.30
78607 TC Brain imaging (3d) 8.31 $70.00 $581.70
78607 26 Brain imaging (3d) 1.68 $70.00 $117.60
78608 Brain imaging (pet) 0.00 $70.00 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78608 TC Brain imaging (pet) 0.00 $70.00 $0.00
78608 26 Brain imaging (pet) 2.04 $70.00 $142.80
78609 Brain imaging (pet) 2.12 $70.00 $148.40
78609 TC Brain imaging (pet) 0.00 $70.00 $0.00
78609 26 Brain imaging (pet) 2.12 $70.00 $148.40
78610 Brain flow imaging only 5.04 $70.00 $352.80
78610 TC Brain flow imaging only 4.61 $70.00 $322.70
78610 26 Brain flow imaging only 0.43 $70.00 $30.10
78630 Cerebrospinal fluid scan 9.74 $70.00 $681.80
78630 TC Cerebrospinal fluid scan 8.78 $70.00 $614.60
78630 26 Cerebrospinal fluid scan 0.96 $70.00 $67.20
78635 Csf ventriculography 9.77 $70.00 $683.90
78635 TC Csf ventriculography 8.89 $70.00 $622.30
78635 26 Csf ventriculography 0.88 $70.00 $61.60
78645 Csf shunt evaluation 9.37 $70.00 $655.90
78645 TC Csf shunt evaluation 8.58 $70.00 $600.60
78645 26 Csf shunt evaluation 0.79 $70.00 $55.30
78647 Cerebrospinal fluid scan 10.03 $70.00 $702.10
78647 TC Cerebrospinal fluid scan 8.75 $70.00 $612.50
78647 26 Cerebrospinal fluid scan 1.28 $70.00 $89.60
78650 Csf leakage imaging 7.89 $70.00 $552.30
78650 TC Csf leakage imaging 7.17 $70.00 $501.90
78650 26 Csf leakage imaging 0.72 $70.00 $50.40
78660 Nuclear exam of tear flow 5.26 $70.00 $368.20
78660 TC Nuclear exam of tear flow 4.51 $70.00 $315.70
78660 26 Nuclear exam of tear flow 0.75 $70.00 $52.50
78699 Nervous system nuclear exam 0.00 $70.00 $0.00
78699 TC Nervous system nuclear exam 0.00 $70.00 $0.00
78699 26 Nervous system nuclear exam 0.00 $70.00 $0.00
78700 Kidney imaging morphol 4.92 $70.00 $344.40
78700 TC Kidney imaging morphol 4.30 $70.00 $301.00
78700 26 Kidney imaging morphol 0.62 $70.00 $43.40
78701 Kidney imaging with flow 6.26 $70.00 $438.20
78701 TC Kidney imaging with flow 5.57 $70.00 $389.90
78701 26 Kidney imaging with flow 0.69 $70.00 $48.30
78707 K flow/funct image w/o drug 6.69 $70.00 $468.30
78707 TC K flow/funct image w/o drug 5.37 $70.00 $375.90
78707 26 K flow/funct image w/o drug 1.32 $70.00 $92.40
78708 K flow/funct image w/drug 5.09 $70.00 $356.30
78708 TC K flow/funct image w/drug 3.41 $70.00 $238.70
78708 26 K flow/funct image w/drug 1.68 $70.00 $117.60
78709 K flow/funct image multiple 10.60 $70.00 $742.00
78709 TC K flow/funct image multiple 8.66 $70.00 $606.20
78709 26 K flow/funct image multiple 1.94 $70.00 $135.80
78710 Kidney imaging (3d) 5.11 $70.00 $357.70
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78710 TC Kidney imaging (3d) 4.33 $70.00 $303.10
78710 26 Kidney imaging (3d) 0.78 $70.00 $54.60
78725 Kidney function study 3.11 $70.00 $217.70
78725 TC Kidney function study 2.59 $70.00 $181.30
78725 26 Kidney function study 0.52 $70.00 $36.40
78730 Urinary bladder retention 2.22 $70.00 $155.40
78730 TC Urinary bladder retention 1.99 $70.00 $139.30
78730 26 Urinary bladder retention 0.23 $70.00 $16.10
78740 Ureteral reflux study 6.29 $70.00 $440.30
78740 TC Ureteral reflux study 5.51 $70.00 $385.70
78740 26 Ureteral reflux study 0.78 $70.00 $54.60
78761 Testicular imaging w/flow 6.08 $70.00 $425.60
78761 TC Testicular imaging w/flow 5.07 $70.00 $354.90
78761 26 Testicular imaging w/flow 1.01 $70.00 $70.70
78799 Genitourinary nuclear exam 0.00 $70.00 $0.00
78799 TC Genitourinary nuclear exam 0.00 $70.00 $0.00
78799 26 Genitourinary nuclear exam 0.00 $70.00 $0.00
78800 Tumor imaging limited area 5.61 $70.00 $392.70
78800 TC Tumor imaging limited area 4.65 $70.00 $325.50
78800 26 Tumor imaging limited area 0.96 $70.00 $67.20
78801 Tumor imaging mult areas 7.42 $70.00 $519.40
78801 TC Tumor imaging mult areas 6.30 $70.00 $441.00
78801 26 Tumor imaging mult areas 1.12 $70.00 $78.40
78802 Tumor imaging whole body 9.29 $70.00 $650.30
78802 TC Tumor imaging whole body 8.11 $70.00 $567.70
78802 26 Tumor imaging whole body 1.18 $70.00 $82.60
78803 Tumor imaging (3d) 9.81 $70.00 $686.70
78803 TC Tumor imaging (3d) 8.33 $70.00 $583.10
78803 26 Tumor imaging (3d) 1.48 $70.00 $103.60
78804 Tumor imaging whole body 16.38 $70.00 $1,146.60
78804 TC Tumor imaging whole body 14.90 $70.00 $1,043.00
78804 26 Tumor imaging whole body 1.48 $70.00 $103.60
78805 Abscess imaging ltd area 5.30 $70.00 $371.00
78805 TC Abscess imaging ltd area 4.28 $70.00 $299.60
78805 26 Abscess imaging ltd area 1.02 $70.00 $71.40
78806 Abscess imaging whole body 9.59 $70.00 $671.30
78806 TC Abscess imaging whole body 8.40 $70.00 $588.00
78806 26 Abscess imaging whole body 1.19 $70.00 $83.30
78807 Nuclear localization/abscess 9.81 $70.00 $686.70
78807 TC Nuclear localization/abscess 8.33 $70.00 $583.10
78807 26 Nuclear localization/abscess 1.48 $70.00 $103.60
78808 Iv inj ra drug dx study 1.12 $70.00 $78.40
78811 Pet image ltd area 0.00 $70.00 $0.00
78811 TC Pet image ltd area 0.00 $70.00 $0.00
78811 26 Pet image ltd area 2.14 $70.00 $149.80
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
78812 Pet image skull-thigh 0.00 $70.00 $0.00
78812 TC Pet image skull-thigh 0.00 $70.00 $0.00
78812 26 Pet image skull-thigh 2.63 $70.00 $184.10
78813 Pet image full body 0.00 $70.00 $0.00
78813 TC Pet image full body 0.00 $70.00 $0.00
78813 26 Pet image full body 2.72 $70.00 $190.40
78814 Pet image w/ct lmtd 0.00 $70.00 $0.00
78814 TC Pet image w/ct lmtd 0.00 $70.00 $0.00
78814 26 Pet image w/ct lmtd 3.02 $70.00 $211.40
78815 Pet image w/ct skull-thigh 0.00 $70.00 $0.00
78815 TC Pet image w/ct skull-thigh 0.00 $70.00 $0.00
78815 26 Pet image w/ct skull-thigh 3.38 $70.00 $236.60
78816 Pet image w/ct full body 0.00 $70.00 $0.00
78816 TC Pet image w/ct full body 0.00 $70.00 $0.00
78816 26 Pet image w/ct full body 3.42 $70.00 $239.40
78999 Nuclear diagnostic exam 0.00 $70.00 $0.00
78999 TC Nuclear diagnostic exam 0.00 $70.00 $0.00
78999 26 Nuclear diagnostic exam 0.00 $70.00 $0.00
79005 Nuclear rx oral admin 3.91 $70.00 $273.70
79005 TC Nuclear rx oral admin 1.41 $70.00 $98.70
79005 26 Nuclear rx oral admin 2.50 $70.00 $175.00
79101 Nuclear rx iv admin 4.18 $70.00 $292.60
79101 TC Nuclear rx iv admin 1.40 $70.00 $98.00
79101 26 Nuclear rx iv admin 2.78 $70.00 $194.60
79200 Nuclear rx intracav admin 3.83 $70.00 $268.10
79200 TC Nuclear rx intracav admin 1.47 $70.00 $102.90
79200 26 Nuclear rx intracav admin 2.36 $70.00 $165.20
79300 Nuclr rx interstit colloid 0.00 $70.00 $0.00
79300 TC Nuclr rx interstit colloid 0.00 $70.00 $0.00
79300 26 Nuclr rx interstit colloid 1.91 $70.00 $133.70
79403 Hematopoietic nuclear tx 5.44 $70.00 $380.80
79403 TC Hematopoietic nuclear tx 2.33 $70.00 $163.10
79403 26 Hematopoietic nuclear tx 3.11 $70.00 $217.70
79440 Nuclear rx intra-articular 3.45 $70.00 $241.50
79440 TC Nuclear rx intra-articular 1.09 $70.00 $76.30
79440 26 Nuclear rx intra-articular 2.36 $70.00 $165.20
79445 Nuclear rx intra-arterial 0.00 $70.00 $0.00
79445 TC Nuclear rx intra-arterial 0.00 $70.00 $0.00
79445 26 Nuclear rx intra-arterial 3.26 $70.00 $228.20
79999 Nuclear medicine therapy 0.00 $70.00 $0.00
79999 TC Nuclear medicine therapy 0.00 $70.00 $0.00
79999 26 Nuclear medicine therapy 0.00 $70.00 $0.00
80047 Metabolic panel ionized ca 0.00 $58.28 $0.00
80048 Metabolic panel total ca 0.00 $58.28 $0.00
80050 General health panel 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
80051 Electrolyte panel 0.00 $58.28 $0.00
80053 Comprehen metabolic panel 0.00 $58.28 $0.00
80055 Obstetric panel 0.00 $58.28 $0.00
80061 Lipid panel 0.00 $58.28 $0.00
80069 Renal function panel 0.00 $58.28 $0.00
80074 Acute hepatitis panel 0.00 $58.28 $0.00
80076 Hepatic function panel 0.00 $58.28 $0.00
80081 Obstetric panel 0.00 $58.28 $0.00
80150 Assay of amikacin 0.00 $58.28 $0.00
80155 Drug assay caffeine 0.00 $58.28 $0.00
80156 Assay carbamazepine total 0.00 $58.28 $0.00
80157 Assay carbamazepine free 0.00 $58.28 $0.00
80158 Drug assay cyclosporine 0.00 $58.28 $0.00
80159 Drug assay clozapine 0.00 $58.28 $0.00
80162 Assay of digoxin total 0.00 $58.28 $0.00
80163 Assay of digoxin free 0.00 $58.28 $0.00
80164 Assay dipropylacetic acd tot 0.00 $58.28 $0.00
80165 Dipropylacetic acid free 0.00 $58.28 $0.00
80168 Assay of ethosuximide 0.00 $58.28 $0.00
80169 Drug assay everolimus 0.00 $58.28 $0.00
80170 Assay of gentamicin 0.00 $58.28 $0.00
80171 Drug screen quant gabapentin 0.00 $58.28 $0.00
80173 Assay of haloperidol 0.00 $58.28 $0.00
80175 Drug screen quan lamotrigine 0.00 $58.28 $0.00
80176 Assay of lidocaine 0.00 $58.28 $0.00
80177 Drug scrn quan levetiracetam 0.00 $58.28 $0.00
80178 Assay of lithium 0.00 $58.28 $0.00
80180 Drug scrn quan mycophenolate 0.00 $58.28 $0.00
80183 Drug scrn quant oxcarbazepin 0.00 $58.28 $0.00
80184 Assay of phenobarbital 0.00 $58.28 $0.00
80185 Assay of phenytoin total 0.00 $58.28 $0.00
80186 Assay of phenytoin free 0.00 $58.28 $0.00
80188 Assay of primidone 0.00 $58.28 $0.00
80190 Assay of procainamide 0.00 $58.28 $0.00
80192 Assay of procainamide 0.00 $58.28 $0.00
80194 Assay of quinidine 0.00 $58.28 $0.00
80195 Assay of sirolimus 0.00 $58.28 $0.00
80197 Assay of tacrolimus 0.00 $58.28 $0.00
80198 Assay of theophylline 0.00 $58.28 $0.00
80199 Drug screen quant tiagabine 0.00 $58.28 $0.00
80200 Assay of tobramycin 0.00 $58.28 $0.00
80201 Assay of topiramate 0.00 $58.28 $0.00
80202 Assay of vancomycin 0.00 $58.28 $0.00
80203 Drug screen quant zonisamide 0.00 $58.28 $0.00
80299 Quantitative assay drug 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
80305 Drug test prsmv dir opt obs 0.00 $58.28 $0.00
80306 Drug test prsmv instrmnt 0.00 $58.28 $0.00
80307 Drug test prsmv chem anlyzr 0.00 $58.28 $0.00
80320 Drug screen quantalcohols 0.00 $58.28 $0.00
80321 Alcohols biomarkers 1or 2 0.00 $58.28 $0.00
80322 Alcohols biomarkers 3/more 0.00 $58.28 $0.00
80323 Alkaloids nos 0.00 $58.28 $0.00
80324 Drug screen amphetamines 1/2 0.00 $58.28 $0.00
80325 Amphetamines 3or 4 0.00 $58.28 $0.00
80326 Amphetamines 5 or more 0.00 $58.28 $0.00
80327 Anabolic steroid 1 or 2 0.00 $58.28 $0.00
80328 Anabolic steroid 3 or more 0.00 $58.28 $0.00
80329 Analgesics non-opioid 1 or 2 0.00 $58.28 $0.00
80330 Analgesics non-opioid 3-5 0.00 $58.28 $0.00
80331 Analgesics non-opioid 6/more 0.00 $58.28 $0.00
80332 Antidepressants class 1 or 2 0.00 $58.28 $0.00
80333 Antidepressants class 3-5 0.00 $58.28 $0.00
80334 Antidepressants class 6/more 0.00 $58.28 $0.00
80335 Antidepressant tricyclic 1/2 0.00 $58.28 $0.00
80336 Antidepressant tricyclic 3-5 0.00 $58.28 $0.00
80337 Tricyclic & cyclicals 6/more 0.00 $58.28 $0.00
80338 Antidepressant not specified 0.00 $58.28 $0.00
80339 Antiepileptics nos 1-3 0.00 $58.28 $0.00
80340 Antiepileptics nos 4-6 0.00 $58.28 $0.00
80341 Antiepileptics nos 7/more 0.00 $58.28 $0.00
80342 Antipsychotics nos 1-3 0.00 $58.28 $0.00
80343 Antipsychotics nos 4-6 0.00 $58.28 $0.00
80344 Antipsychotics nos 7/more 0.00 $58.28 $0.00
80345 Drug screening barbiturates 0.00 $58.28 $0.00
80346 Benzodiazepines1-12 0.00 $58.28 $0.00
80347 Benzodiazepines 13 or more 0.00 $58.28 $0.00
80348 Drug screening buprenorphine 0.00 $58.28 $0.00
80349 Cannabinoids natural 0.00 $58.28 $0.00
80350 Cannabinoids synthetic 1-3 0.00 $58.28 $0.00
80351 Cannabinoids synthetic 4-6 0.00 $58.28 $0.00
80352 Cannabinoid synthetic 7/more 0.00 $58.28 $0.00
80353 Drug screening cocaine 0.00 $58.28 $0.00
80354 Drug screening fentanyl 0.00 $58.28 $0.00
80355 Gabapentin non-blood 0.00 $58.28 $0.00
80356 Heroin metabolite 0.00 $58.28 $0.00
80357 Ketamine and norketamine 0.00 $58.28 $0.00
80358 Drug screening methadone 0.00 $58.28 $0.00
80359 Methylenedioxyamphetamines 0.00 $58.28 $0.00
80360 Methylphenidate 0.00 $58.28 $0.00
80361 Opiates 1 or more 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
80362 Opioids & opiate analogs 1/2 0.00 $58.28 $0.00
80363 Opioids & opiate analogs 3/4 0.00 $58.28 $0.00
80364 Opioid &opiate analog 5/more 0.00 $58.28 $0.00
80365 Drug screening oxycodone 0.00 $58.28 $0.00
80366 Drug screening pregabalin 0.00 $58.28 $0.00
80367 Drug screening propoxyphene 0.00 $58.28 $0.00
80368 Sedative hypnotics 0.00 $58.28 $0.00
80369 Skeletal muscle relaxant 1/2 0.00 $58.28 $0.00
80370 Skel musc relaxant 3 or more 0.00 $58.28 $0.00
80371 Stimulants synthetic 0.00 $58.28 $0.00
80372 Drug screening tapentadol 0.00 $58.28 $0.00
80373 Drug screening tramadol 0.00 $58.28 $0.00
80374 Stereoisomer analysis 0.00 $58.28 $0.00
80375 Drug/substance nos 1-3 0.00 $58.28 $0.00
80376 Drug/substance nos 4-6 0.00 $58.28 $0.00
80377 Drug/substance nos 7/more 0.00 $58.28 $0.00
80400 Acth stimulation panel 0.00 $58.28 $0.00
80402 Acth stimulation panel 0.00 $58.28 $0.00
80406 Acth stimulation panel 0.00 $58.28 $0.00
80408 Aldosterone suppression eval 0.00 $58.28 $0.00
80410 Calcitonin stimul panel 0.00 $58.28 $0.00
80412 Crh stimulation panel 0.00 $58.28 $0.00
80414 Testosterone response 0.00 $58.28 $0.00
80415 Estradiol response panel 0.00 $58.28 $0.00
80416 Renin stimulation panel 0.00 $58.28 $0.00
80417 Renin stimulation panel 0.00 $58.28 $0.00
80418 Pituitary evaluation panel 0.00 $58.28 $0.00
80420 Dexamethasone panel 0.00 $58.28 $0.00
80422 Glucagon tolerance panel 0.00 $58.28 $0.00
80424 Glucagon tolerance panel 0.00 $58.28 $0.00
80426 Gonadotropin hormone panel 0.00 $58.28 $0.00
80428 Growth hormone panel 0.00 $58.28 $0.00
80430 Growth hormone panel 0.00 $58.28 $0.00
80432 Insulin suppression panel 0.00 $58.28 $0.00
80434 Insulin tolerance panel 0.00 $58.28 $0.00
80435 Insulin tolerance panel 0.00 $58.28 $0.00
80436 Metyrapone panel 0.00 $58.28 $0.00
80438 Trh stimulation panel 0.00 $58.28 $0.00
80439 Trh stimulation panel 0.00 $58.28 $0.00
80500 Lab pathology consultation 0.65 $58.28 $37.88
80502 Lab pathology consultation 2.10 $58.28 $122.39
81000 Urinalysis nonauto w/scope 0.00 $58.28 $0.00
81001 Urinalysis auto w/scope 0.00 $58.28 $0.00
81002 Urinalysis nonauto w/o scope 0.00 $58.28 $0.00
81003 Urinalysis auto w/o scope 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
81005 Urinalysis 0.00 $58.28 $0.00
81007 Urine screen for bacteria 0.00 $58.28 $0.00
81015 Microscopic exam of urine 0.00 $58.28 $0.00
81020 Urinalysis glass test 0.00 $58.28 $0.00
81025 Urine pregnancy test 0.00 $58.28 $0.00
81050 Urinalysis volume measure 0.00 $58.28 $0.00
81099 Urinalysis test procedure 0.00 $58.28 $0.00
81105 Hpa-1 genotyping 0.00 $58.28 $0.00
81106 Hpa-2 genotyping 0.00 $58.28 $0.00
81107 Hpa-3 genotyping 0.00 $58.28 $0.00
81108 Hpa-4 genotyping 0.00 $58.28 $0.00
81109 Hpa-5 genotyping 0.00 $58.28 $0.00
81110 Hpa-6 genotyping 0.00 $58.28 $0.00
81111 Hpa-9 genotyping 0.00 $58.28 $0.00
81112 Hpa-15 genotyping 0.00 $58.28 $0.00
81120 Idh1 common variants 0.00 $58.28 $0.00
81121 Idh2 common variants 0.00 $58.28 $0.00
81161 Dmd dup/delet analysis 0.00 $58.28 $0.00
81162 Brca1&2 gen full seq dup/del 0.00 $58.28 $0.00
81163 Brca1&2 gene full seq alys 0.00 $58.28 $0.00
81164 Brca1&2 gen ful dup/del alys 0.00 $58.28 $0.00
81165 Brca1 gene full seq alys 0.00 $58.28 $0.00
81166 Brca1 gene full dup/del alys 0.00 $58.28 $0.00
81167 Brca2 gene full dup/del alys 0.00 $58.28 $0.00
81170 Abl1 gene 0.00 $58.28 $0.00
81171 Aff2 gene detc abnor alleles 0.00 $58.28 $0.00
81172 Aff2 gene charac alleles 0.00 $58.28 $0.00
81173 Ar gene full gene sequence 0.00 $58.28 $0.00
81174 Ar gene known famil variant 0.00 $58.28 $0.00
81175 Asxl1 full gene sequence 0.00 $58.28 $0.00
81176 Asxl1 gene target seq alys 0.00 $58.28 $0.00
81177 Atn1 gene detc abnor alleles 0.00 $58.28 $0.00
81178 Atxn1 gene detc abnor allele 0.00 $58.28 $0.00
81179 Atxn2 gene detc abnor allele 0.00 $58.28 $0.00
81180 Atxn3 gene detc abnor allele 0.00 $58.28 $0.00
81181 Atxn7 gene detc abnor allele 0.00 $58.28 $0.00
81182 Atxn8os gen detc abnor allel 0.00 $58.28 $0.00
81183 Atxn10 gene detc abnor allel 0.00 $58.28 $0.00
81184 Cacna1a gen detc abnor allel 0.00 $58.28 $0.00
81185 Cacna1a gene full gene seq 0.00 $58.28 $0.00
81186 Cacna1a gen known famil vrnt 0.00 $58.28 $0.00
81187 Cnbp gene detc abnor allele 0.00 $58.28 $0.00
81188 Cstb gene detc abnor allele 0.00 $58.28 $0.00
81189 Cstb gene full gene sequence 0.00 $58.28 $0.00
81190 Cstb gene known famil vrnt 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
81200 Aspa gene 0.00 $58.28 $0.00
81201 Apc gene full sequence 0.00 $58.28 $0.00
81202 Apc gene known fam variants 0.00 $58.28 $0.00
81203 Apc gene dup/delet variants 0.00 $58.28 $0.00
81204 Ar gene charac alleles 0.00 $58.28 $0.00
81205 Bckdhb gene 0.00 $58.28 $0.00
81206 Bcr/abl1 gene major bp 0.00 $58.28 $0.00
81207 Bcr/abl1 gene minor bp 0.00 $58.28 $0.00
81208 Bcr/abl1 gene other bp 0.00 $58.28 $0.00
81209 Blm gene 0.00 $58.28 $0.00
81210 Braf gene 0.00 $58.28 $0.00
81212 Brca1&2 185&5385&6174 vrnt 0.00 $58.28 $0.00
81215 Brca1 gene known famil vrnt 0.00 $58.28 $0.00
81216 Brca2 gene full seq alys 0.00 $58.28 $0.00
81217 Brca2 gene known famil vrnt 0.00 $58.28 $0.00
81218 Cebpa gene full sequence 0.00 $58.28 $0.00
81219 Calr gene com variants 0.00 $58.28 $0.00
81220 Cftr gene com variants 0.00 $58.28 $0.00
81221 Cftr gene known fam variants 0.00 $58.28 $0.00
81222 Cftr gene dup/delet variants 0.00 $58.28 $0.00
81223 Cftr gene full sequence 0.00 $58.28 $0.00
81224 Cftr gene intron poly t 0.00 $58.28 $0.00
81225 Cyp2c19 gene com variants 0.00 $58.28 $0.00
81226 Cyp2d6 gene com variants 0.00 $58.28 $0.00
81227 Cyp2c9 gene com variants 0.00 $58.28 $0.00
81228 Cytogen micrarray copy nmbr 0.00 $58.28 $0.00
81229 Cytogen m array copy no&snp 0.00 $58.28 $0.00
81230 Cyp3a4 gene common variants 0.00 $58.28 $0.00
81231 Cyp3a5 gene common variants 0.00 $58.28 $0.00
81232 Dpyd gene common variants 0.00 $58.28 $0.00
81233 Btk gene common variants 0.00 $58.28 $0.00
81234 Dmpk gene detc abnor allele 0.00 $58.28 $0.00
81235 Egfr gene com variants 0.00 $58.28 $0.00
81236 Ezh2 gene full gene sequence 0.00 $58.28 $0.00
81237 Ezh2 gene common variants 0.00 $58.28 $0.00
81238 F9 full gene sequence 0.00 $58.28 $0.00
81239 Dmpk gene charac alleles 0.00 $58.28 $0.00
81240 F2 gene 0.00 $58.28 $0.00
81241 F5 gene 0.00 $58.28 $0.00
81242 Fancc gene 0.00 $58.28 $0.00
81243 Fmr1 gene detection 0.00 $58.28 $0.00
81244 Fmr1 gene charac alleles 0.00 $58.28 $0.00
81245 Flt3 gene 0.00 $58.28 $0.00
81246 Flt3 gene analysis 0.00 $58.28 $0.00
81247 G6pd gene alys cmn variant 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
81248 G6pd known familial variant 0.00 $58.28 $0.00
81249 G6pd full gene sequence 0.00 $58.28 $0.00
81250 G6pc gene 0.00 $58.28 $0.00
81251 Gba gene 0.00 $58.28 $0.00
81252 Gjb2 gene full sequence 0.00 $58.28 $0.00
81253 Gjb2 gene known fam variants 0.00 $58.28 $0.00
81254 Gjb6 gene com variants 0.00 $58.28 $0.00
81255 Hexa gene 0.00 $58.28 $0.00
81256 Hfe gene 0.00 $58.28 $0.00
81257 Hba1/hba2 gene 0.00 $58.28 $0.00
81258 Hba1/hba2 gene fam vrnt 0.00 $58.28 $0.00
81259 Hba1/hba2 full gene sequence 0.00 $58.28 $0.00
81260 Ikbkap gene 0.00 $58.28 $0.00
81261 Igh gene rearrange amp meth 0.00 $58.28 $0.00
81262 Igh gene rearrang dir probe 0.00 $58.28 $0.00
81263 Igh vari regional mutation 0.00 $58.28 $0.00
81264 Igk rearrangeabn clonal pop 0.00 $58.28 $0.00
81265 Str markers specimen anal 0.00 $58.28 $0.00
81266 Str markers spec anal addl 0.00 $58.28 $0.00
81267 Chimerism anal no cell selec 0.00 $58.28 $0.00
81268 Chimerism anal w/cell select 0.00 $58.28 $0.00
81269 Hba1/hba2 gene dup/del vrnts 0.00 $58.28 $0.00
81270 Jak2 gene 0.00 $58.28 $0.00
81271 Htt gene detc abnor alleles 0.00 $58.28 $0.00
81272 Kit gene targeted seq analys 0.00 $58.28 $0.00
81273 Kit gene analys d816 variant 0.00 $58.28 $0.00
81274 Htt gene charac alleles 0.00 $58.28 $0.00
81275 Kras gene variants exon 2 0.00 $58.28 $0.00
81276 Kras gene addl variants 0.00 $58.28 $0.00
81283 Ifnl3 gene 0.00 $58.28 $0.00
81284 Fxn gene detc abnor alleles 0.00 $58.28 $0.00
81285 Fxn gene charac alleles 0.00 $58.28 $0.00
81286 Fxn gene full gene sequence 0.00 $58.28 $0.00
81287 Mgmt gene prmtr mthyltn alys 0.00 $58.28 $0.00
81288 Mlh1 gene 0.00 $58.28 $0.00
81289 Fxn gene known famil variant 0.00 $58.28 $0.00
81290 Mcoln1 gene 0.00 $58.28 $0.00
81291 Mthfr gene 0.00 $58.28 $0.00
81292 Mlh1 gene full seq 0.00 $58.28 $0.00
81293 Mlh1 gene known variants 0.00 $58.28 $0.00
81294 Mlh1 gene dup/delete variant 0.00 $58.28 $0.00
81295 Msh2 gene full seq 0.00 $58.28 $0.00
81296 Msh2 gene known variants 0.00 $58.28 $0.00
81297 Msh2 gene dup/delete variant 0.00 $58.28 $0.00
81298 Msh6 gene full seq 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
81299 Msh6 gene known variants 0.00 $58.28 $0.00
81300 Msh6 gene dup/delete variant 0.00 $58.28 $0.00
81301 Microsatellite instability 0.00 $58.28 $0.00
81302 Mecp2 gene full seq 0.00 $58.28 $0.00
81303 Mecp2 gene known variant 0.00 $58.28 $0.00
81304 Mecp2 gene dup/delet variant 0.00 $58.28 $0.00
81305 Myd88 gene p.leu265pro vrnt 0.00 $58.28 $0.00
81306 Nudt15 gene common variants 0.00 $58.28 $0.00
81310 Npm1 gene 0.00 $58.28 $0.00
81311 Nras gene variants exon 2&3 0.00 $58.28 $0.00
81312 Pabpn1 gene detc abnor allel 0.00 $58.28 $0.00
81313 Pca3/klk3 antigen 0.00 $58.28 $0.00
81314 Pdgfra gene 0.00 $58.28 $0.00
81315 Pml/raralpha com breakpoints 0.00 $58.28 $0.00
81316 Pml/raralpha 1 breakpoint 0.00 $58.28 $0.00
81317 Pms2 gene full seq analysis 0.00 $58.28 $0.00
81318 Pms2 known familial variants 0.00 $58.28 $0.00
81319 Pms2 gene dup/delet variants 0.00 $58.28 $0.00
81320 Plcg2 gene common variants 0.00 $58.28 $0.00
81321 Pten gene full sequence 0.00 $58.28 $0.00
81322 Pten gene known fam variant 0.00 $58.28 $0.00
81323 Pten gene dup/delet variant 0.00 $58.28 $0.00
81324 Pmp22 gene dup/delet 0.00 $58.28 $0.00
81325 Pmp22 gene full sequence 0.00 $58.28 $0.00
81326 Pmp22 gene known fam variant 0.00 $58.28 $0.00
81327 Sept9 gen prmtr mthyltn alys 0.00 $58.28 $0.00
81328 Slco1b1 gene com variants 0.00 $58.28 $0.00
81329 Smn1 gene dos/deletion alys 0.00 $58.28 $0.00
81330 Smpd1 gene common variants 0.00 $58.28 $0.00
81331 Snrpn/ube3a gene 0.00 $58.28 $0.00
81332 Serpina1 gene 0.00 $58.28 $0.00
81333 Tgfbi gene common variants 0.00 $58.28 $0.00
81334 Runx1 gene targeted seq alys 0.00 $58.28 $0.00
81335 Tpmt gene com variants 0.00 $58.28 $0.00
81336 Smn1 gene full gene sequence 0.00 $58.28 $0.00
81337 Smn1 gen nown famil seq vrnt 0.00 $58.28 $0.00
81340 Trb@ gene rearrange amplify 0.00 $58.28 $0.00
81341 Trb@ gene rearrange dirprobe 0.00 $58.28 $0.00
81342 Trg gene rearrangement anal 0.00 $58.28 $0.00
81343 Ppp2r2b gen detc abnor allel 0.00 $58.28 $0.00
81344 Tbp gene detc abnor alleles 0.00 $58.28 $0.00
81345 Tert gene targeted seq alys 0.00 $58.28 $0.00
81346 Tyms gene com variants 0.00 $58.28 $0.00
81350 Ugt1a1 gene 0.00 $58.28 $0.00
81355 Vkorc1 gene 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
81361 Hbb gene com variants 0.00 $58.28 $0.00
81362 Hbb gene known fam variant 0.00 $58.28 $0.00
81363 Hbb gene dup/del variants 0.00 $58.28 $0.00
81364 Hbb full gene sequence 0.00 $58.28 $0.00
81370 Hla i & ii typing lr 0.00 $58.28 $0.00
81371 Hla i & ii type verify lr 0.00 $58.28 $0.00
81372 Hla i typing complete lr 0.00 $58.28 $0.00
81373 Hla i typing 1 locus lr 0.00 $58.28 $0.00
81374 Hla i typing 1 antigen lr 0.00 $58.28 $0.00
81375 Hla ii typing ag equiv lr 0.00 $58.28 $0.00
81376 Hla ii typing 1 locus lr 0.00 $58.28 $0.00
81377 Hla ii type 1 ag equiv lr 0.00 $58.28 $0.00
81378 Hla i & ii typing hr 0.00 $58.28 $0.00
81379 Hla i typing complete hr 0.00 $58.28 $0.00
81380 Hla i typing 1 locus hr 0.00 $58.28 $0.00
81381 Hla i typing 1 allele hr 0.00 $58.28 $0.00
81382 Hla ii typing 1 loc hr 0.00 $58.28 $0.00
81383 Hla ii typing 1 allele hr 0.00 $58.28 $0.00
81400 Mopath procedure level 1 0.00 $58.28 $0.00
81401 Mopath procedure level 2 0.00 $58.28 $0.00
81402 Mopath procedure level 3 0.00 $58.28 $0.00
81403 Mopath procedure level 4 0.00 $58.28 $0.00
81404 Mopath procedure level 5 0.00 $58.28 $0.00
81405 Mopath procedure level 6 0.00 $58.28 $0.00
81406 Mopath procedure level 7 0.00 $58.28 $0.00
81407 Mopath procedure level 8 0.00 $58.28 $0.00
81408 Mopath procedure level 9 0.00 $58.28 $0.00
81410 Aortic dysfunction/dilation 0.00 $58.28 $0.00
81411 Aortic dysfunction/dilation 0.00 $58.28 $0.00
81412 Ashkenazi jewish assoc dis 0.00 $58.28 $0.00
81413 Car ion chnnlpath inc 10 gns 0.00 $58.28 $0.00
81414 Car ion chnnlpath inc 2 gns 0.00 $58.28 $0.00
81415 Exome sequence analysis 0.00 $58.28 $0.00
81416 Exome sequence analysis 0.00 $58.28 $0.00
81417 Exome re-evaluation 0.00 $58.28 $0.00
81420 Fetal chrmoml aneuploidy 0.00 $58.28 $0.00
81422 Fetal chrmoml microdeltj 0.00 $58.28 $0.00
81425 Genome sequence analysis 0.00 $58.28 $0.00
81426 Genome sequence analysis 0.00 $58.28 $0.00
81427 Genome re-evaluation 0.00 $58.28 $0.00
81430 Hearing loss sequence analys 0.00 $58.28 $0.00
81431 Hearing loss dup/del analys 0.00 $58.28 $0.00
81432 Hrdtry brst ca-rlatd dsordrs 0.00 $58.28 $0.00
81433 Hrdtry brst ca-rlatd dsordrs 0.00 $58.28 $0.00
81434 Hereditary retinal disorders 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
81435 Hereditary colon ca dsordrs 0.00 $58.28 $0.00
81436 Hereditary colon ca dsordrs 0.00 $58.28 $0.00
81437 Heredtry nurondcrn tum dsrdr 0.00 $58.28 $0.00
81438 Heredtry nurondcrn tum dsrdr 0.00 $58.28 $0.00
81439 Hrdtry cardmypy gene panel 0.00 $58.28 $0.00
81440 Mitochondrial gene 0.00 $58.28 $0.00
81442 Noonan spectrum disorders 0.00 $58.28 $0.00
81443 Genetic tstg severe inh cond 0.00 $58.28 $0.00
81445 Targeted genomic seq analys 0.00 $58.28 $0.00
81448 Hrdtry perph neurphy panel 0.00 $58.28 $0.00
81450 Targeted genomic seq analys 0.00 $58.28 $0.00
81455 Targeted genomic seq analys 0.00 $58.28 $0.00
81460 Whole mitochondrial genome 0.00 $58.28 $0.00
81465 Whole mitochondrial genome 0.00 $58.28 $0.00
81470 X-linked intellectual dblt 0.00 $58.28 $0.00
81471 X-linked intellectual dblt 0.00 $58.28 $0.00
81479 Unlisted molecular pathology 0.00 $58.28 $0.00
81490 Autoimmune rheumatoid arthr 0.00 $58.28 $0.00
81493 Cor artery disease mrna 0.00 $58.28 $0.00
81500 Onco (ovar) two proteins 0.00 $58.28 $0.00
81503 Onco (ovar) five proteins 0.00 $58.28 $0.00
81504 Oncology tissue of origin 0.00 $58.28 $0.00
81506 Endo assay seven anal 0.00 $58.28 $0.00
81507 Fetal aneuploidy trisom risk 0.00 $58.28 $0.00
81508 Ftl cgen abnor two proteins 0.00 $58.28 $0.00
81509 Ftl cgen abnor 3 proteins 0.00 $58.28 $0.00
81510 Ftl cgen abnor three anal 0.00 $58.28 $0.00
81511 Ftl cgen abnor four anal 0.00 $58.28 $0.00
81512 Ftl cgen abnor five anal 0.00 $58.28 $0.00
81518 Onc brst mrna 11 genes 0.00 $58.28 $0.00
81519 Oncology breast mrna 0.00 $58.28 $0.00
81520 Onc breast mrna 58 genes 0.00 $58.28 $0.00
81521 Onc breast mrna 70 genes 0.00 $58.28 $0.00
81525 Oncology colon mrna 0.00 $58.28 $0.00
81528 Oncology colorectal scr 0.00 $58.28 $0.00
81535 Oncology gynecologic 0.00 $58.28 $0.00
81536 Oncology gynecologic 0.00 $58.28 $0.00
81538 Oncology lung 0.00 $58.28 $0.00
81539 Oncology prostate prob score 0.00 $58.28 $0.00
81540 Oncology tum unknown origin 0.00 $58.28 $0.00
81541 Onc prostate mrna 46 genes 0.00 $58.28 $0.00
81545 Oncology thyroid 0.00 $58.28 $0.00
81551 Onc prostate 3 genes 0.00 $58.28 $0.00
81595 Cardiology hrt trnspl mrna 0.00 $58.28 $0.00
81596 Nfct ds chrnc hcv 6 assays 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
81599 Unlisted maaa 0.00 $58.28 $0.00
82009 Test for acetone/ketones 0.00 $58.28 $0.00
82010 Acetone assay 0.00 $58.28 $0.00
82013 Acetylcholinesterase assay 0.00 $58.28 $0.00
82016 Acylcarnitines qual 0.00 $58.28 $0.00
82017 Acylcarnitines quant 0.00 $58.28 $0.00
82024 Assay of acth 0.00 $58.28 $0.00
82030 Assay of adp & amp 0.00 $58.28 $0.00
82040 Assay of serum albumin 0.00 $58.28 $0.00
82042 Other source albumin quan ea 0.00 $58.28 $0.00
82043 Ur albumin quantitative 0.00 $58.28 $0.00
82044 Ur albumin semiquantitative 0.00 $58.28 $0.00
82045 Albumin ischemia modified 0.00 $58.28 $0.00
82075 Assay of breath ethanol 0.00 $58.28 $0.00
82085 Assay of aldolase 0.00 $58.28 $0.00
82088 Assay of aldosterone 0.00 $58.28 $0.00
82103 Alpha-1-antitrypsin total 0.00 $58.28 $0.00
82104 Alpha-1-antitrypsin pheno 0.00 $58.28 $0.00
82105 Alpha-fetoprotein serum 0.00 $58.28 $0.00
82106 Alpha-fetoprotein amniotic 0.00 $58.28 $0.00
82107 Alpha-fetoprotein l3 0.00 $58.28 $0.00
82108 Assay of aluminum 0.00 $58.28 $0.00
82120 Amines vaginal fluid qual 0.00 $58.28 $0.00
82127 Amino acid single qual 0.00 $58.28 $0.00
82128 Amino acids mult qual 0.00 $58.28 $0.00
82131 Amino acids single quant 0.00 $58.28 $0.00
82135 Assay aminolevulinic acid 0.00 $58.28 $0.00
82136 Amino acids quant 2-5 0.00 $58.28 $0.00
82139 Amino acids quan 6 or more 0.00 $58.28 $0.00
82140 Assay of ammonia 0.00 $58.28 $0.00
82143 Amniotic fluid scan 0.00 $58.28 $0.00
82150 Assay of amylase 0.00 $58.28 $0.00
82154 Androstanediol glucuronide 0.00 $58.28 $0.00
82157 Assay of androstenedione 0.00 $58.28 $0.00
82160 Assay of androsterone 0.00 $58.28 $0.00
82163 Assay of angiotensin ii 0.00 $58.28 $0.00
82164 Angiotensin i enzyme test 0.00 $58.28 $0.00
82172 Assay of apolipoprotein 0.00 $58.28 $0.00
82175 Assay of arsenic 0.00 $58.28 $0.00
82180 Assay of ascorbic acid 0.00 $58.28 $0.00
82190 Atomic absorption 0.00 $58.28 $0.00
82232 Assay of beta-2 protein 0.00 $58.28 $0.00
82239 Bile acids total 0.00 $58.28 $0.00
82240 Bile acids cholylglycine 0.00 $58.28 $0.00
82247 Bilirubin total 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
82248 Bilirubin direct 0.00 $58.28 $0.00
82252 Fecal bilirubin test 0.00 $58.28 $0.00
82261 Assay of biotinidase 0.00 $58.28 $0.00
82270 Occult blood feces 0.00 $58.28 $0.00
82271 Occult blood other sources 0.00 $58.28 $0.00
82272 Occult bld feces 1-3 tests 0.00 $58.28 $0.00
82274 Assay test for blood fecal 0.00 $58.28 $0.00
82286 Assay of bradykinin 0.00 $58.28 $0.00
82300 Assay of cadmium 0.00 $58.28 $0.00
82306 Vitamin d 25 hydroxy 0.00 $58.28 $0.00
82308 Assay of calcitonin 0.00 $58.28 $0.00
82310 Assay of calcium 0.00 $58.28 $0.00
82330 Assay of calcium 0.00 $58.28 $0.00
82331 Calcium infusion test 0.00 $58.28 $0.00
82340 Assay of calcium in urine 0.00 $58.28 $0.00
82355 Calculus analysis qual 0.00 $58.28 $0.00
82360 Calculus assay quant 0.00 $58.28 $0.00
82365 Calculus spectroscopy 0.00 $58.28 $0.00
82370 X-ray assay calculus 0.00 $58.28 $0.00
82373 Assay c-d transfer measure 0.00 $58.28 $0.00
82374 Assay blood carbon dioxide 0.00 $58.28 $0.00
82375 Assay carboxyhb quant 0.00 $58.28 $0.00
82376 Assay carboxyhb qual 0.00 $58.28 $0.00
82378 Carcinoembryonic antigen 0.00 $58.28 $0.00
82379 Assay of carnitine 0.00 $58.28 $0.00
82380 Assay of carotene 0.00 $58.28 $0.00
82382 Assay urine catecholamines 0.00 $58.28 $0.00
82383 Assay blood catecholamines 0.00 $58.28 $0.00
82384 Assay three catecholamines 0.00 $58.28 $0.00
82387 Assay of cathepsin-d 0.00 $58.28 $0.00
82390 Assay of ceruloplasmin 0.00 $58.28 $0.00
82397 Chemiluminescent assay 0.00 $58.28 $0.00
82415 Assay of chloramphenicol 0.00 $58.28 $0.00
82435 Assay of blood chloride 0.00 $58.28 $0.00
82436 Assay of urine chloride 0.00 $58.28 $0.00
82438 Assay other fluid chlorides 0.00 $58.28 $0.00
82441 Test for chlorohydrocarbons 0.00 $58.28 $0.00
82465 Assay bld/serum cholesterol 0.00 $58.28 $0.00
82480 Assay serum cholinesterase 0.00 $58.28 $0.00
82482 Assay rbc cholinesterase 0.00 $58.28 $0.00
82485 Assay chondroitin sulfate 0.00 $58.28 $0.00
82495 Assay of chromium 0.00 $58.28 $0.00
82507 Assay of citrate 0.00 $58.28 $0.00
82523 Collagen crosslinks 0.00 $58.28 $0.00
82525 Assay of copper 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
82528 Assay of corticosterone 0.00 $58.28 $0.00
82530 Cortisol free 0.00 $58.28 $0.00
82533 Total cortisol 0.00 $58.28 $0.00
82540 Assay of creatine 0.00 $58.28 $0.00
82542 Col chromotography qual/quan 0.00 $58.28 $0.00
82550 Assay of ck (cpk) 0.00 $58.28 $0.00
82552 Assay of cpk in blood 0.00 $58.28 $0.00
82553 Creatine mb fraction 0.00 $58.28 $0.00
82554 Creatine isoforms 0.00 $58.28 $0.00
82565 Assay of creatinine 0.00 $58.28 $0.00
82570 Assay of urine creatinine 0.00 $58.28 $0.00
82575 Creatinine clearance test 0.00 $58.28 $0.00
82585 Assay of cryofibrinogen 0.00 $58.28 $0.00
82595 Assay of cryoglobulin 0.00 $58.28 $0.00
82600 Assay of cyanide 0.00 $58.28 $0.00
82607 Vitamin b-12 0.00 $58.28 $0.00
82608 B-12 binding capacity 0.00 $58.28 $0.00
82610 Cystatin c 0.00 $58.28 $0.00
82615 Test for urine cystines 0.00 $58.28 $0.00
82626 Dehydroepiandrosterone 0.00 $58.28 $0.00
82627 Dehydroepiandrosterone 0.00 $58.28 $0.00
82633 Desoxycorticosterone 0.00 $58.28 $0.00
82634 Deoxycortisol 0.00 $58.28 $0.00
82638 Assay of dibucaine number 0.00 $58.28 $0.00
82642 Dihydrotestosterone 0.00 $58.28 $0.00
82652 Vit d 1 25-dihydroxy 0.00 $58.28 $0.00
82656 Pancreatic elastase fecal 0.00 $58.28 $0.00
82657 Enzyme cell activity 0.00 $58.28 $0.00
82658 Enzyme cell activity ra 0.00 $58.28 $0.00
82664 Electrophoretic test 0.00 $58.28 $0.00
82668 Assay of erythropoietin 0.00 $58.28 $0.00
82670 Assay of estradiol 0.00 $58.28 $0.00
82671 Assay of estrogens 0.00 $58.28 $0.00
82672 Assay of estrogen 0.00 $58.28 $0.00
82677 Assay of estriol 0.00 $58.28 $0.00
82679 Assay of estrone 0.00 $58.28 $0.00
82693 Assay of ethylene glycol 0.00 $58.28 $0.00
82696 Assay of etiocholanolone 0.00 $58.28 $0.00
82705 Fats/lipids feces qual 0.00 $58.28 $0.00
82710 Fats/lipids feces quant 0.00 $58.28 $0.00
82715 Assay of fecal fat 0.00 $58.28 $0.00
82725 Assay of blood fatty acids 0.00 $58.28 $0.00
82726 Long chain fatty acids 0.00 $58.28 $0.00
82728 Assay of ferritin 0.00 $58.28 $0.00
82731 Assay of fetal fibronectin 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
82735 Assay of fluoride 0.00 $58.28 $0.00
82746 Assay of folic acid serum 0.00 $58.28 $0.00
82747 Assay of folic acid rbc 0.00 $58.28 $0.00
82757 Assay of semen fructose 0.00 $58.28 $0.00
82759 Assay of rbc galactokinase 0.00 $58.28 $0.00
82760 Assay of galactose 0.00 $58.28 $0.00
82775 Assay galactose transferase 0.00 $58.28 $0.00
82776 Galactose transferase test 0.00 $58.28 $0.00
82777 Galectin-3 0.00 $58.28 $0.00
82784 Assay iga/igd/igg/igm each 0.00 $58.28 $0.00
82785 Assay of ige 0.00 $58.28 $0.00
82787 Igg 1 2 3 or 4 each 0.00 $58.28 $0.00
82800 Blood ph 0.00 $58.28 $0.00
82803 Blood gases any combination 0.00 $58.28 $0.00
82805 Blood gases w/o2 saturation 0.00 $58.28 $0.00
82810 Blood gases o2 sat only 0.00 $58.28 $0.00
82820 Hemoglobin-oxygen affinity 0.00 $58.28 $0.00
82930 Gastric analy w/ph ea spec 0.00 $58.28 $0.00
82938 Gastrin test 0.00 $58.28 $0.00
82941 Assay of gastrin 0.00 $58.28 $0.00
82943 Assay of glucagon 0.00 $58.28 $0.00
82945 Glucose other fluid 0.00 $58.28 $0.00
82946 Glucagon tolerance test 0.00 $58.28 $0.00
82947 Assay glucose blood quant 0.00 $58.28 $0.00
82948 Reagent strip/blood glucose 0.00 $58.28 $0.00
82950 Glucose test 0.00 $58.28 $0.00
82951 Glucose tolerance test (gtt) 0.00 $58.28 $0.00
82952 Gtt-added samples 0.00 $58.28 $0.00
82955 Assay of g6pd enzyme 0.00 $58.28 $0.00
82960 Test for g6pd enzyme 0.00 $58.28 $0.00
82962 Glucose blood test 0.00 $58.28 $0.00
82963 Assay of glucosidase 0.00 $58.28 $0.00
82965 Assay of gdh enzyme 0.00 $58.28 $0.00
82977 Assay of ggt 0.00 $58.28 $0.00
82978 Assay of glutathione 0.00 $58.28 $0.00
82979 Assay rbc glutathione 0.00 $58.28 $0.00
82985 Assay of glycated protein 0.00 $58.28 $0.00
83001 Assay of gonadotropin (fsh) 0.00 $58.28 $0.00
83002 Assay of gonadotropin (lh) 0.00 $58.28 $0.00
83003 Assay growth hormone (hgh) 0.00 $58.28 $0.00
83006 Growth stimulation gene 2 0.00 $58.28 $0.00
83009 H pylori (c-13) blood 0.00 $58.28 $0.00
83010 Assay of haptoglobin quant 0.00 $58.28 $0.00
83012 Assay of haptoglobins 0.00 $58.28 $0.00
83013 H pylori (c-13) breath 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
83014 H pylori drug admin 0.00 $58.28 $0.00
83015 Heavy metal qual any anal 0.00 $58.28 $0.00
83018 Heavy metal quant each nes 0.00 $58.28 $0.00
83020 Hemoglobin electrophoresis 0.00 $58.28 $0.00
83020 26 Hemoglobin electrophoresis 0.52 $58.28 $30.31
83021 Hemoglobin chromotography 0.00 $58.28 $0.00
83026 Hemoglobin copper sulfate 0.00 $58.28 $0.00
83030 Fetal hemoglobin chemical 0.00 $58.28 $0.00
83033 Fetal hemoglobin assay qual 0.00 $58.28 $0.00
83036 Glycosylated hemoglobin test 0.00 $58.28 $0.00
83037 Glycosylated hb home device 0.00 $58.28 $0.00
83045 Blood methemoglobin test 0.00 $58.28 $0.00
83050 Blood methemoglobin assay 0.00 $58.28 $0.00
83051 Assay of plasma hemoglobin 0.00 $58.28 $0.00
83060 Blood sulfhemoglobin assay 0.00 $58.28 $0.00
83065 Assay of hemoglobin heat 0.00 $58.28 $0.00
83068 Hemoglobin stability screen 0.00 $58.28 $0.00
83069 Assay of urine hemoglobin 0.00 $58.28 $0.00
83070 Assay of hemosiderin qual 0.00 $58.28 $0.00
83080 Assay of b hexosaminidase 0.00 $58.28 $0.00
83088 Assay of histamine 0.00 $58.28 $0.00
83090 Assay of homocystine 0.00 $58.28 $0.00
83150 Assay of homovanillic acid 0.00 $58.28 $0.00
83491 Assay of corticosteroids 17 0.00 $58.28 $0.00
83497 Assay of 5-hiaa 0.00 $58.28 $0.00
83498 Assay of progesterone 17-d 0.00 $58.28 $0.00
83500 Assay free hydroxyproline 0.00 $58.28 $0.00
83505 Assay total hydroxyproline 0.00 $58.28 $0.00
83516 Immunoassay nonantibody 0.00 $58.28 $0.00
83518 Immunoassay dipstick 0.00 $58.28 $0.00
83519 Ria nonantibody 0.00 $58.28 $0.00
83520 Immunoassay quant nos nonab 0.00 $58.28 $0.00
83525 Assay of insulin 0.00 $58.28 $0.00
83527 Assay of insulin 0.00 $58.28 $0.00
83528 Assay of intrinsic factor 0.00 $58.28 $0.00
83540 Assay of iron 0.00 $58.28 $0.00
83550 Iron binding test 0.00 $58.28 $0.00
83570 Assay of idh enzyme 0.00 $58.28 $0.00
83582 Assay of ketogenic steroids 0.00 $58.28 $0.00
83586 Assay 17- ketosteroids 0.00 $58.28 $0.00
83593 Fractionation ketosteroids 0.00 $58.28 $0.00
83605 Assay of lactic acid 0.00 $58.28 $0.00
83615 Lactate (ld) (ldh) enzyme 0.00 $58.28 $0.00
83625 Assay of ldh enzymes 0.00 $58.28 $0.00
83630 Lactoferrin fecal (qual) 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
83631 Lactoferrin fecal (quant) 0.00 $58.28 $0.00
83632 Placental lactogen 0.00 $58.28 $0.00
83633 Test urine for lactose 0.00 $58.28 $0.00
83655 Assay of lead 0.00 $58.28 $0.00
83661 L/s ratio fetal lung 0.00 $58.28 $0.00
83662 Foam stability fetal lung 0.00 $58.28 $0.00
83663 Fluoro polarize fetal lung 0.00 $58.28 $0.00
83664 Lamellar bdy fetal lung 0.00 $58.28 $0.00
83670 Assay of lap enzyme 0.00 $58.28 $0.00
83690 Assay of lipase 0.00 $58.28 $0.00
83695 Assay of lipoprotein(a) 0.00 $58.28 $0.00
83698 Assay lipoprotein pla2 0.00 $58.28 $0.00
83700 Lipopro bld electrophoretic 0.00 $58.28 $0.00
83701 Lipoprotein bld hr fraction 0.00 $58.28 $0.00
83704 Lipoprotein bld quan part 0.00 $58.28 $0.00
83718 Assay of lipoprotein 0.00 $58.28 $0.00
83719 Assay of blood lipoprotein 0.00 $58.28 $0.00
83721 Assay of blood lipoprotein 0.00 $58.28 $0.00
83722 Lipoprtn dir meas sd ldl chl 0.00 $58.28 $0.00
83727 Assay of lrh hormone 0.00 $58.28 $0.00
83735 Assay of magnesium 0.00 $58.28 $0.00
83775 Assay malate dehydrogenase 0.00 $58.28 $0.00
83785 Assay of manganese 0.00 $58.28 $0.00
83789 Mass spectrometry qual/quan 0.00 $58.28 $0.00
83825 Assay of mercury 0.00 $58.28 $0.00
83835 Assay of metanephrines 0.00 $58.28 $0.00
83857 Assay of methemalbumin 0.00 $58.28 $0.00
83861 Microfluid analy tears 0.00 $58.28 $0.00
83864 Mucopolysaccharides 0.00 $58.28 $0.00
83872 Assay synovial fluid mucin 0.00 $58.28 $0.00
83873 Assay of csf protein 0.00 $58.28 $0.00
83874 Assay of myoglobin 0.00 $58.28 $0.00
83876 Assay myeloperoxidase 0.00 $58.28 $0.00
83880 Assay of natriuretic peptide 0.00 $58.28 $0.00
83883 Assay nephelometry not spec 0.00 $58.28 $0.00
83885 Assay of nickel 0.00 $58.28 $0.00
83915 Assay of nucleotidase 0.00 $58.28 $0.00
83916 Oligoclonal bands 0.00 $58.28 $0.00
83918 Organic acids total quant 0.00 $58.28 $0.00
83919 Organic acids qual each 0.00 $58.28 $0.00
83921 Organic acid single quant 0.00 $58.28 $0.00
83930 Assay of blood osmolality 0.00 $58.28 $0.00
83935 Assay of urine osmolality 0.00 $58.28 $0.00
83937 Assay of osteocalcin 0.00 $58.28 $0.00
83945 Assay of oxalate 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
83950 Oncoprotein her-2/neu 0.00 $58.28 $0.00
83951 Oncoprotein dcp 0.00 $58.28 $0.00
83970 Assay of parathormone 0.00 $58.28 $0.00
83986 Assay ph body fluid nos 0.00 $58.28 $0.00
83987 Exhaled breath condensate 0.00 $58.28 $0.00
83992 Assay for phencyclidine 0.00 $58.28 $0.00
83993 Assay for calprotectin fecal 0.00 $58.28 $0.00
84030 Assay of blood pku 0.00 $58.28 $0.00
84035 Assay of phenylketones 0.00 $58.28 $0.00
84060 Assay acid phosphatase 0.00 $58.28 $0.00
84066 Assay prostate phosphatase 0.00 $58.28 $0.00
84075 Assay alkaline phosphatase 0.00 $58.28 $0.00
84078 Assay alkaline phosphatase 0.00 $58.28 $0.00
84080 Assay alkaline phosphatases 0.00 $58.28 $0.00
84081 Assay phosphatidylglycerol 0.00 $58.28 $0.00
84085 Assay of rbc pg6d enzyme 0.00 $58.28 $0.00
84087 Assay phosphohexose enzymes 0.00 $58.28 $0.00
84100 Assay of phosphorus 0.00 $58.28 $0.00
84105 Assay of urine phosphorus 0.00 $58.28 $0.00
84106 Test for porphobilinogen 0.00 $58.28 $0.00
84110 Assay of porphobilinogen 0.00 $58.28 $0.00
84112 Eval amniotic fluid protein 0.00 $58.28 $0.00
84119 Test urine for porphyrins 0.00 $58.28 $0.00
84120 Assay of urine porphyrins 0.00 $58.28 $0.00
84126 Assay of feces porphyrins 0.00 $58.28 $0.00
84132 Assay of serum potassium 0.00 $58.28 $0.00
84133 Assay of urine potassium 0.00 $58.28 $0.00
84134 Assay of prealbumin 0.00 $58.28 $0.00
84135 Assay of pregnanediol 0.00 $58.28 $0.00
84138 Assay of pregnanetriol 0.00 $58.28 $0.00
84140 Assay of pregnenolone 0.00 $58.28 $0.00
84143 Assay of 17-hydroxypregneno 0.00 $58.28 $0.00
84144 Assay of progesterone 0.00 $58.28 $0.00
84145 Procalcitonin (pct) 0.00 $58.28 $0.00
84146 Assay of prolactin 0.00 $58.28 $0.00
84150 Assay of prostaglandin 0.00 $58.28 $0.00
84152 Assay of psa complexed 0.00 $58.28 $0.00
84153 Assay of psa total 0.00 $58.28 $0.00
84154 Assay of psa free 0.00 $58.28 $0.00
84155 Assay of protein serum 0.00 $58.28 $0.00
84156 Assay of protein urine 0.00 $58.28 $0.00
84157 Assay of protein other 0.00 $58.28 $0.00
84160 Assay of protein any source 0.00 $58.28 $0.00
84163 Pappa serum 0.00 $58.28 $0.00
84165 Protein e-phoresis serum 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
84165 26 Protein e-phoresis serum 0.52 $58.28 $30.31
84166 Protein e-phoresis/urine/csf 0.00 $58.28 $0.00
84166 26 Protein e-phoresis/urine/csf 0.52 $58.28 $30.31
84181 Western blot test 0.00 $58.28 $0.00
84181 26 Western blot test 0.52 $58.28 $30.31
84182 Protein western blot test 0.00 $58.28 $0.00
84182 26 Protein western blot test 0.52 $58.28 $30.31
84202 Assay rbc protoporphyrin 0.00 $58.28 $0.00
84203 Test rbc protoporphyrin 0.00 $58.28 $0.00
84206 Assay of proinsulin 0.00 $58.28 $0.00
84207 Assay of vitamin b-6 0.00 $58.28 $0.00
84210 Assay of pyruvate 0.00 $58.28 $0.00
84220 Assay of pyruvate kinase 0.00 $58.28 $0.00
84228 Assay of quinine 0.00 $58.28 $0.00
84233 Assay of estrogen 0.00 $58.28 $0.00
84234 Assay of progesterone 0.00 $58.28 $0.00
84235 Assay of endocrine hormone 0.00 $58.28 $0.00
84238 Assay nonendocrine receptor 0.00 $58.28 $0.00
84244 Assay of renin 0.00 $58.28 $0.00
84252 Assay of vitamin b-2 0.00 $58.28 $0.00
84255 Assay of selenium 0.00 $58.28 $0.00
84260 Assay of serotonin 0.00 $58.28 $0.00
84270 Assay of sex hormone globul 0.00 $58.28 $0.00
84275 Assay of sialic acid 0.00 $58.28 $0.00
84285 Assay of silica 0.00 $58.28 $0.00
84295 Assay of serum sodium 0.00 $58.28 $0.00
84300 Assay of urine sodium 0.00 $58.28 $0.00
84302 Assay of sweat sodium 0.00 $58.28 $0.00
84305 Assay of somatomedin 0.00 $58.28 $0.00
84307 Assay of somatostatin 0.00 $58.28 $0.00
84311 Spectrophotometry 0.00 $58.28 $0.00
84315 Body fluid specific gravity 0.00 $58.28 $0.00
84375 Chromatogram assay sugars 0.00 $58.28 $0.00
84376 Sugars single qual 0.00 $58.28 $0.00
84377 Sugars multiple qual 0.00 $58.28 $0.00
84378 Sugars single quant 0.00 $58.28 $0.00
84379 Sugars multiple quant 0.00 $58.28 $0.00
84392 Assay of urine sulfate 0.00 $58.28 $0.00
84402 Assay of free testosterone 0.00 $58.28 $0.00
84403 Assay of total testosterone 0.00 $58.28 $0.00
84410 Testosterone bioavailable 0.00 $58.28 $0.00
84425 Assay of vitamin b-1 0.00 $58.28 $0.00
84430 Assay of thiocyanate 0.00 $58.28 $0.00
84431 Thromboxane urine 0.00 $58.28 $0.00
84432 Assay of thyroglobulin 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
84436 Assay of total thyroxine 0.00 $58.28 $0.00
84437 Assay of neonatal thyroxine 0.00 $58.28 $0.00
84439 Assay of free thyroxine 0.00 $58.28 $0.00
84442 Assay of thyroid activity 0.00 $58.28 $0.00
84443 Assay thyroid stim hormone 0.00 $58.28 $0.00
84445 Assay of tsi globulin 0.00 $58.28 $0.00
84446 Assay of vitamin e 0.00 $58.28 $0.00
84449 Assay of transcortin 0.00 $58.28 $0.00
84450 Transferase (ast) (sgot) 0.00 $58.28 $0.00
84460 Alanine amino (alt) (sgpt) 0.00 $58.28 $0.00
84466 Assay of transferrin 0.00 $58.28 $0.00
84478 Assay of triglycerides 0.00 $58.28 $0.00
84479 Assay of thyroid (t3 or t4) 0.00 $58.28 $0.00
84480 Assay triiodothyronine (t3) 0.00 $58.28 $0.00
84481 Free assay (ft-3) 0.00 $58.28 $0.00
84482 T3 reverse 0.00 $58.28 $0.00
84484 Assay of troponin quant 0.00 $58.28 $0.00
84485 Assay duodenal fluid trypsin 0.00 $58.28 $0.00
84488 Test feces for trypsin 0.00 $58.28 $0.00
84490 Assay of feces for trypsin 0.00 $58.28 $0.00
84510 Assay of tyrosine 0.00 $58.28 $0.00
84512 Assay of troponin qual 0.00 $58.28 $0.00
84520 Assay of urea nitrogen 0.00 $58.28 $0.00
84525 Urea nitrogen semi-quant 0.00 $58.28 $0.00
84540 Assay of urine/urea-n 0.00 $58.28 $0.00
84545 Urea-n clearance test 0.00 $58.28 $0.00
84550 Assay of blood/uric acid 0.00 $58.28 $0.00
84560 Assay of urine/uric acid 0.00 $58.28 $0.00
84577 Assay of feces/urobilinogen 0.00 $58.28 $0.00
84578 Test urine urobilinogen 0.00 $58.28 $0.00
84580 Assay of urine urobilinogen 0.00 $58.28 $0.00
84583 Assay of urine urobilinogen 0.00 $58.28 $0.00
84585 Assay of urine vma 0.00 $58.28 $0.00
84586 Assay of vip 0.00 $58.28 $0.00
84588 Assay of vasopressin 0.00 $58.28 $0.00
84590 Assay of vitamin a 0.00 $58.28 $0.00
84591 Assay of nos vitamin 0.00 $58.28 $0.00
84597 Assay of vitamin k 0.00 $58.28 $0.00
84600 Assay of volatiles 0.00 $58.28 $0.00
84620 Xylose tolerance test 0.00 $58.28 $0.00
84630 Assay of zinc 0.00 $58.28 $0.00
84681 Assay of c-peptide 0.00 $58.28 $0.00
84702 Chorionic gonadotropin test 0.00 $58.28 $0.00
84703 Chorionic gonadotropin assay 0.00 $58.28 $0.00
84704 Hcg free betachain test 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
84830 Ovulation tests 0.00 $58.28 $0.00
84999 Clinical chemistry test 0.00 $58.28 $0.00
85002 Bleeding time test 0.00 $58.28 $0.00
85004 Automated diff wbc count 0.00 $58.28 $0.00
85007 Bl smear w/diff wbc count 0.00 $58.28 $0.00
85008 Bl smear w/o diff wbc count 0.00 $58.28 $0.00
85009 Manual diff wbc count b-coat 0.00 $58.28 $0.00
85013 Spun microhematocrit 0.00 $58.28 $0.00
85014 Hematocrit 0.00 $58.28 $0.00
85018 Hemoglobin 0.00 $58.28 $0.00
85025 Complete cbc w/auto diff wbc 0.00 $58.28 $0.00
85027 Complete cbc automated 0.00 $58.28 $0.00
85032 Manual cell count each 0.00 $58.28 $0.00
85041 Automated rbc count 0.00 $58.28 $0.00
85044 Manual reticulocyte count 0.00 $58.28 $0.00
85045 Automated reticulocyte count 0.00 $58.28 $0.00
85046 Reticyte/hgb concentrate 0.00 $58.28 $0.00
85048 Automated leukocyte count 0.00 $58.28 $0.00
85049 Automated platelet count 0.00 $58.28 $0.00
85055 Reticulated platelet assay 0.00 $58.28 $0.00
85060 Blood smear interpretation 0.70 $58.28 $40.80
85097 Bone marrow interpretation 2.11 $58.28 $122.97
85130 Chromogenic substrate assay 0.00 $58.28 $0.00
85170 Blood clot retraction 0.00 $58.28 $0.00
85175 Blood clot lysis time 0.00 $58.28 $0.00
85210 Clot factor ii prothrom spec 0.00 $58.28 $0.00
85220 Blooc clot factor v test 0.00 $58.28 $0.00
85230 Clot factor vii proconvertin 0.00 $58.28 $0.00
85240 Clot factor viii ahg 1 stage 0.00 $58.28 $0.00
85244 Clot factor viii reltd antgn 0.00 $58.28 $0.00
85245 Clot factor viii vw ristoctn 0.00 $58.28 $0.00
85246 Clot factor viii vw antigen 0.00 $58.28 $0.00
85247 Clot factor viii multimetric 0.00 $58.28 $0.00
85250 Clot factor ix ptc/chrstmas 0.00 $58.28 $0.00
85260 Clot factor x stuart-power 0.00 $58.28 $0.00
85270 Clot factor xi pta 0.00 $58.28 $0.00
85280 Clot factor xii hageman 0.00 $58.28 $0.00
85290 Clot factor xiii fibrin stab 0.00 $58.28 $0.00
85291 Clot factor xiii fibrin scrn 0.00 $58.28 $0.00
85292 Clot factor fletcher fact 0.00 $58.28 $0.00
85293 Clot factor wght kininogen 0.00 $58.28 $0.00
85300 Antithrombin iii activity 0.00 $58.28 $0.00
85301 Antithrombin iii antigen 0.00 $58.28 $0.00
85302 Clot inhibit prot c antigen 0.00 $58.28 $0.00
85303 Clot inhibit prot c activity 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
85305 Clot inhibit prot s total 0.00 $58.28 $0.00
85306 Clot inhibit prot s free 0.00 $58.28 $0.00
85307 Assay activated protein c 0.00 $58.28 $0.00
85335 Factor inhibitor test 0.00 $58.28 $0.00
85337 Thrombomodulin 0.00 $58.28 $0.00
85345 Coagulation time lee & white 0.00 $58.28 $0.00
85347 Coagulation time activated 0.00 $58.28 $0.00
85348 Coagulation time otr method 0.00 $58.28 $0.00
85360 Euglobulin lysis 0.00 $58.28 $0.00
85362 Fibrin degradation products 0.00 $58.28 $0.00
85366 Fibrinogen test 0.00 $58.28 $0.00
85370 Fibrinogen test 0.00 $58.28 $0.00
85378 Fibrin degrade semiquant 0.00 $58.28 $0.00
85379 Fibrin degradation quant 0.00 $58.28 $0.00
85380 Fibrin degradj d-dimer 0.00 $58.28 $0.00
85384 Fibrinogen activity 0.00 $58.28 $0.00
85385 Fibrinogen antigen 0.00 $58.28 $0.00
85390 Fibrinolysins screen i&r 0.00 $58.28 $0.00
85390 26 Fibrinolysins screen i&r 1.06 $58.28 $61.78
85396 Clotting assay whole blood 0.58 $58.28 $33.80
85397 Clotting funct activity 0.00 $58.28 $0.00
85400 Fibrinolytic plasmin 0.00 $58.28 $0.00
85410 Fibrinolytic antiplasmin 0.00 $58.28 $0.00
85415 Fibrinolytic plasminogen 0.00 $58.28 $0.00
85420 Fibrinolytic plasminogen 0.00 $58.28 $0.00
85421 Fibrinolytic plasminogen 0.00 $58.28 $0.00
85441 Heinz bodies direct 0.00 $58.28 $0.00
85445 Heinz bodies induced 0.00 $58.28 $0.00
85460 Hemoglobin fetal 0.00 $58.28 $0.00
85461 Hemoglobin fetal 0.00 $58.28 $0.00
85475 Hemolysin acid 0.00 $58.28 $0.00
85520 Heparin assay 0.00 $58.28 $0.00
85525 Heparin neutralization 0.00 $58.28 $0.00
85530 Heparin-protamine tolerance 0.00 $58.28 $0.00
85536 Iron stain peripheral blood 0.00 $58.28 $0.00
85540 Wbc alkaline phosphatase 0.00 $58.28 $0.00
85547 Rbc mechanical fragility 0.00 $58.28 $0.00
85549 Muramidase 0.00 $58.28 $0.00
85555 Rbc osmotic fragility 0.00 $58.28 $0.00
85557 Rbc osmotic fragility 0.00 $58.28 $0.00
85576 Blood platelet aggregation 0.00 $58.28 $0.00
85576 26 Blood platelet aggregation 0.52 $58.28 $30.31
85597 Phospholipid pltlt neutraliz 0.00 $58.28 $0.00
85598 Hexagnal phosph pltlt neutrl 0.00 $58.28 $0.00
85610 Prothrombin time 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
85611 Prothrombin test 0.00 $58.28 $0.00
85612 Viper venom prothrombin time 0.00 $58.28 $0.00
85613 Russell viper venom diluted 0.00 $58.28 $0.00
85635 Reptilase test 0.00 $58.28 $0.00
85651 Rbc sed rate nonautomated 0.00 $58.28 $0.00
85652 Rbc sed rate automated 0.00 $58.28 $0.00
85660 Rbc sickle cell test 0.00 $58.28 $0.00
85670 Thrombin time plasma 0.00 $58.28 $0.00
85675 Thrombin time titer 0.00 $58.28 $0.00
85705 Thromboplastin inhibition 0.00 $58.28 $0.00
85730 Thromboplastin time partial 0.00 $58.28 $0.00
85732 Thromboplastin time partial 0.00 $58.28 $0.00
85810 Blood viscosity examination 0.00 $58.28 $0.00
85999 Hematology procedure 0.00 $58.28 $0.00
86000 Agglutinins febrile antigen 0.00 $58.28 $0.00
86001 Allergen specific igg 0.00 $58.28 $0.00
86003 Allg spec ige crude xtrc ea 0.00 $58.28 $0.00
86005 Allg spec ige multiallg scr 0.00 $58.28 $0.00
86008 Allg spec ige recomb ea 0.00 $58.28 $0.00
86021 Wbc antibody identification 0.00 $58.28 $0.00
86022 Platelet antibodies 0.00 $58.28 $0.00
86023 Immunoglobulin assay 0.00 $58.28 $0.00
86038 Antinuclear antibodies 0.00 $58.28 $0.00
86039 Antinuclear antibodies (ana) 0.00 $58.28 $0.00
86060 Antistreptolysin o titer 0.00 $58.28 $0.00
86063 Antistreptolysin o screen 0.00 $58.28 $0.00
86077 Phys blood bank serv xmatch 1.57 $58.28 $91.50
86078 Phys blood bank serv reactj 1.57 $58.28 $91.50
86079 Phys blood bank serv authrj 1.56 $58.28 $90.92
86140 C-reactive protein 0.00 $58.28 $0.00
86141 C-reactive protein hs 0.00 $58.28 $0.00
86146 Beta-2 glycoprotein antibody 0.00 $58.28 $0.00
86147 Cardiolipin antibody ea ig 0.00 $58.28 $0.00
86148 Anti-phospholipid antibody 0.00 $58.28 $0.00
86152 Cell enumeration & id 0.00 $58.28 $0.00
86153 26 Cell enumeration phys interp 0.98 $58.28 $57.11
86155 Chemotaxis assay 0.00 $58.28 $0.00
86156 Cold agglutinin screen 0.00 $58.28 $0.00
86157 Cold agglutinin titer 0.00 $58.28 $0.00
86160 Complement antigen 0.00 $58.28 $0.00
86161 Complement/function activity 0.00 $58.28 $0.00
86162 Complement total (ch50) 0.00 $58.28 $0.00
86171 Complement fixation each 0.00 $58.28 $0.00
86200 Ccp antibody 0.00 $58.28 $0.00
86215 Deoxyribonuclease antibody 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
86225 Dna antibody native 0.00 $58.28 $0.00
86226 Dna antibody single strand 0.00 $58.28 $0.00
86235 Nuclear antigen antibody 0.00 $58.28 $0.00
86255 Fluorescent antibody screen 0.00 $58.28 $0.00
86255 26 Fluorescent antibody screen 0.52 $58.28 $30.31
86256 Fluorescent antibody titer 0.00 $58.28 $0.00
86256 26 Fluorescent antibody titer 0.52 $58.28 $30.31
86277 Growth hormone antibody 0.00 $58.28 $0.00
86280 Hemagglutination inhibition 0.00 $58.28 $0.00
86294 Immunoassay tumor qual 0.00 $58.28 $0.00
86300 Immunoassay tumor ca 15-3 0.00 $58.28 $0.00
86301 Immunoassay tumor ca 19-9 0.00 $58.28 $0.00
86304 Immunoassay tumor ca 125 0.00 $58.28 $0.00
86305 Human epididymis protein 4 0.00 $58.28 $0.00
86308 Heterophile antibody screen 0.00 $58.28 $0.00
86309 Heterophile antibody titer 0.00 $58.28 $0.00
86310 Heterophile antibody absrbj 0.00 $58.28 $0.00
86316 Immunoassay tumor other 0.00 $58.28 $0.00
86317 Immunoassay infectious agent 0.00 $58.28 $0.00
86318 Immunoassay infectious agent 0.00 $58.28 $0.00
86320 Serum immunoelectrophoresis 0.00 $58.28 $0.00
86320 26 Serum immunoelectrophoresis 0.52 $58.28 $30.31
86325 Other immunoelectrophoresis 0.00 $58.28 $0.00
86325 26 Other immunoelectrophoresis 0.52 $58.28 $30.31
86327 Immunoelectrophoresis assay 0.00 $58.28 $0.00
86327 26 Immunoelectrophoresis assay 0.64 $58.28 $37.30
86329 Immunodiffusion nes 0.00 $58.28 $0.00
86331 Immunodiffusion ouchterlony 0.00 $58.28 $0.00
86332 Immune complex assay 0.00 $58.28 $0.00
86334 Immunofix e-phoresis serum 0.00 $58.28 $0.00
86334 26 Immunofix e-phoresis serum 0.52 $58.28 $30.31
86335 Immunfix e-phorsis/urine/csf 0.00 $58.28 $0.00
86335 26 Immunfix e-phorsis/urine/csf 0.52 $58.28 $30.31
86336 Inhibin a 0.00 $58.28 $0.00
86337 Insulin antibodies 0.00 $58.28 $0.00
86340 Intrinsic factor antibody 0.00 $58.28 $0.00
86341 Islet cell antibody 0.00 $58.28 $0.00
86343 Leukocyte histamine release 0.00 $58.28 $0.00
86344 Leukocyte phagocytosis 0.00 $58.28 $0.00
86352 Cell function assay w/stim 0.00 $58.28 $0.00
86353 Lymphocyte transformation 0.00 $58.28 $0.00
86355 B cells total count 0.00 $58.28 $0.00
86356 Mononuclear cell antigen 0.00 $58.28 $0.00
86357 Nk cells total count 0.00 $58.28 $0.00
86359 T cells total count 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
86360 T cell absolute count/ratio 0.00 $58.28 $0.00
86361 T cell absolute count 0.00 $58.28 $0.00
86367 Stem cells total count 0.00 $58.28 $0.00
86376 Microsomal antibody each 0.00 $58.28 $0.00
86382 Neutralization test viral 0.00 $58.28 $0.00
86384 Nitroblue tetrazolium dye 0.00 $58.28 $0.00
86386 Nuclear matrix protein 22 0.00 $58.28 $0.00
86403 Particle agglut antbdy scrn 0.00 $58.28 $0.00
86406 Particle agglut antbdy titr 0.00 $58.28 $0.00
86430 Rheumatoid factor test qual 0.00 $58.28 $0.00
86431 Rheumatoid factor quant 0.00 $58.28 $0.00
86480 Tb test cell immun measure 0.00 $58.28 $0.00
86481 Tb ag response t-cell susp 0.00 $58.28 $0.00
86485 Skin test candida 0.00 $58.28 $0.00
86486 Skin test nos antigen 0.15 $58.28 $8.74
86490 Coccidioidomycosis skin test 2.49 $58.28 $145.12
86510 Histoplasmosis skin test 0.19 $58.28 $11.07
86580 Tb intradermal test 0.24 $58.28 $13.99
86590 Streptokinase antibody 0.00 $58.28 $0.00
86592 Syphilis test non-trep qual 0.00 $58.28 $0.00
86593 Syphilis test non-trep quant 0.00 $58.28 $0.00
86602 Antinomyces antibody 0.00 $58.28 $0.00
86603 Adenovirus antibody 0.00 $58.28 $0.00
86606 Aspergillus antibody 0.00 $58.28 $0.00
86609 Bacterium antibody 0.00 $58.28 $0.00
86611 Bartonella antibody 0.00 $58.28 $0.00
86612 Blastomyces antibody 0.00 $58.28 $0.00
86615 Bordetella antibody 0.00 $58.28 $0.00
86617 Lyme disease antibody 0.00 $58.28 $0.00
86618 Lyme disease antibody 0.00 $58.28 $0.00
86619 Borrelia antibody 0.00 $58.28 $0.00
86622 Brucella antibody 0.00 $58.28 $0.00
86625 Campylobacter antibody 0.00 $58.28 $0.00
86628 Candida antibody 0.00 $58.28 $0.00
86631 Chlamydia antibody 0.00 $58.28 $0.00
86632 Chlamydia igm antibody 0.00 $58.28 $0.00
86635 Coccidioides antibody 0.00 $58.28 $0.00
86638 Q fever antibody 0.00 $58.28 $0.00
86641 Cryptococcus antibody 0.00 $58.28 $0.00
86644 Cmv antibody 0.00 $58.28 $0.00
86645 Cmv antibody igm 0.00 $58.28 $0.00
86648 Diphtheria antibody 0.00 $58.28 $0.00
86651 Encephalitis californ antbdy 0.00 $58.28 $0.00
86652 Encephaltis east eqne anbdy 0.00 $58.28 $0.00
86653 Encephaltis st louis antbody 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
86654 Encephaltis west eqne antbdy 0.00 $58.28 $0.00
86658 Enterovirus antibody 0.00 $58.28 $0.00
86663 Epstein-barr antibody 0.00 $58.28 $0.00
86664 Epstein-barr nuclear antigen 0.00 $58.28 $0.00
86665 Epstein-barr capsid vca 0.00 $58.28 $0.00
86666 Ehrlichia antibody 0.00 $58.28 $0.00
86668 Francisella tularensis 0.00 $58.28 $0.00
86671 Fungus nes antibody 0.00 $58.28 $0.00
86674 Giardia lamblia antibody 0.00 $58.28 $0.00
86677 Helicobacter pylori antibody 0.00 $58.28 $0.00
86682 Helminth antibody 0.00 $58.28 $0.00
86684 Hemophilus influenza antibdy 0.00 $58.28 $0.00
86687 Htlv-i antibody 0.00 $58.28 $0.00
86688 Htlv-ii antibody 0.00 $58.28 $0.00
86689 Htlv/hiv confirmj antibody 0.00 $58.28 $0.00
86692 Hepatitis delta agent antbdy 0.00 $58.28 $0.00
86694 Herpes simplex nes antbdy 0.00 $58.28 $0.00
86695 Herpes simplex type 1 test 0.00 $58.28 $0.00
86696 Herpes simplex type 2 test 0.00 $58.28 $0.00
86698 Histoplasma antibody 0.00 $58.28 $0.00
86701 Hiv-1antibody 0.00 $58.28 $0.00
86702 Hiv-2 antibody 0.00 $58.28 $0.00
86703 Hiv-1/hiv-2 1 result antbdy 0.00 $58.28 $0.00
86704 Hep b core antibody total 0.00 $58.28 $0.00
86705 Hep b core antibody igm 0.00 $58.28 $0.00
86706 Hep b surface antibody 0.00 $58.28 $0.00
86707 Hepatitis be antibody 0.00 $58.28 $0.00
86708 Hepatitis a antibody 0.00 $58.28 $0.00
86709 Hepatitis a igm antibody 0.00 $58.28 $0.00
86710 Influenza virus antibody 0.00 $58.28 $0.00
86711 John cunningham antibody 0.00 $58.28 $0.00
86713 Legionella antibody 0.00 $58.28 $0.00
86717 Leishmania antibody 0.00 $58.28 $0.00
86720 Leptospira antibody 0.00 $58.28 $0.00
86723 Listeria monocytogenes 0.00 $58.28 $0.00
86727 Lymph choriomeningitis ab 0.00 $58.28 $0.00
86732 Mucormycosis antibody 0.00 $58.28 $0.00
86735 Mumps antibody 0.00 $58.28 $0.00
86738 Mycoplasma antibody 0.00 $58.28 $0.00
86741 Neisseria meningitidis 0.00 $58.28 $0.00
86744 Nocardia antibody 0.00 $58.28 $0.00
86747 Parvovirus antibody 0.00 $58.28 $0.00
86750 Malaria antibody 0.00 $58.28 $0.00
86753 Protozoa antibody nos 0.00 $58.28 $0.00
86756 Respiratory virus antibody 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
86757 Rickettsia antibody 0.00 $58.28 $0.00
86759 Rotavirus antibody 0.00 $58.28 $0.00
86762 Rubella antibody 0.00 $58.28 $0.00
86765 Rubeola antibody 0.00 $58.28 $0.00
86768 Salmonella antibody 0.00 $58.28 $0.00
86771 Shigella antibody 0.00 $58.28 $0.00
86774 Tetanus antibody 0.00 $58.28 $0.00
86777 Toxoplasma antibody 0.00 $58.28 $0.00
86778 Toxoplasma antibody igm 0.00 $58.28 $0.00
86780 Treponema pallidum 0.00 $58.28 $0.00
86784 Trichinella antibody 0.00 $58.28 $0.00
86787 Varicella-zoster antibody 0.00 $58.28 $0.00
86788 West nile virus ab igm 0.00 $58.28 $0.00
86789 West nile virus antibody 0.00 $58.28 $0.00
86790 Virus antibody nos 0.00 $58.28 $0.00
86793 Yersinia antibody 0.00 $58.28 $0.00
86794 Zika virus igm antibody 0.00 $58.28 $0.00
86800 Thyroglobulin antibody 0.00 $58.28 $0.00
86803 Hepatitis c ab test 0.00 $58.28 $0.00
86804 Hep c ab test confirm 0.00 $58.28 $0.00
86805 Lymphocytotoxicity assay 0.00 $58.28 $0.00
86806 Lymphocytotoxicity assay 0.00 $58.28 $0.00
86807 Cytotoxic antibody screening 0.00 $58.28 $0.00
86808 Cytotoxic antibody screening 0.00 $58.28 $0.00
86812 Hla typing a b or c 0.00 $58.28 $0.00
86813 Hla typing a b or c 0.00 $58.28 $0.00
86816 Hla typing dr/dq 0.00 $58.28 $0.00
86817 Hla typing dr/dq 0.00 $58.28 $0.00
86821 Lymphocyte culture mixed 0.00 $58.28 $0.00
86825 Hla x-math non-cytotoxic 0.00 $58.28 $0.00
86826 Hla x-match noncytotoxc addl 0.00 $58.28 $0.00
86828 Hla class i&ii antibody qual 0.00 $58.28 $0.00
86829 Hla class i/ii antibody qual 0.00 $58.28 $0.00
86830 Hla class i phenotype qual 0.00 $58.28 $0.00
86831 Hla class ii phenotype qual 0.00 $58.28 $0.00
86832 Hla class i high defin qual 0.00 $58.28 $0.00
86833 Hla class ii high defin qual 0.00 $58.28 $0.00
86834 Hla class i semiquant panel 0.00 $58.28 $0.00
86835 Hla class ii semiquant panel 0.00 $58.28 $0.00
86849 Immunology procedure 0.00 $58.28 $0.00
86850 Rbc antibody screen 0.00 $58.28 $0.00
86860 Rbc antibody elution 0.00 $58.28 $0.00
86870 Rbc antibody identification 0.00 $58.28 $0.00
86880 Coombs test direct 0.00 $58.28 $0.00
86885 Coombs test indirect qual 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
86886 Coombs test indirect titer 0.00 $58.28 $0.00
86890 Autologous blood process 0.00 $58.28 $0.00
86891 Autologous blood op salvage 0.00 $58.28 $0.00
86900 Blood typing serologic abo 0.00 $58.28 $0.00
86901 Blood typing serologic rh(d) 0.00 $58.28 $0.00
86902 Blood type antigen donor ea 0.00 $58.28 $0.00
86904 Blood typing patient serum 0.00 $58.28 $0.00
86905 Blood typing rbc antigens 0.00 $58.28 $0.00
86906 Bld typing serologic rh phnt 0.00 $58.28 $0.00
86910 Blood typing paternity test 0.00 $58.28 $0.00
86911 Blood typing antigen system 0.00 $58.28 $0.00
86920 Compatibility test spin 0.00 $58.28 $0.00
86921 Compatibility test incubate 0.00 $58.28 $0.00
86922 Compatibility test antiglob 0.00 $58.28 $0.00
86923 Compatibility test electric 0.00 $58.28 $0.00
86927 Plasma fresh frozen 0.00 $58.28 $0.00
86930 Frozen blood prep 0.00 $58.28 $0.00
86931 Frozen blood thaw 0.00 $58.28 $0.00
86932 Frozen blood freeze/thaw 0.00 $58.28 $0.00
86940 Hemolysins/agglutinins auto 0.00 $58.28 $0.00
86941 Hemolysins/agglutinins 0.00 $58.28 $0.00
86945 Blood product/irradiation 0.00 $58.28 $0.00
86950 Leukacyte transfusion 0.00 $58.28 $0.00
86960 Vol reduction of blood/prod 0.00 $58.28 $0.00
86965 Pooling blood platelets 0.00 $58.28 $0.00
86970 Rbc pretx incubatj w/chemicl 0.00 $58.28 $0.00
86971 Rbc pretx incubatj w/enzymes 0.00 $58.28 $0.00
86972 Rbc pretx incubatj w/density 0.00 $58.28 $0.00
86975 Rbc serum pretx incubj drugs 0.00 $58.28 $0.00
86976 Rbc serum pretx id dilution 0.00 $58.28 $0.00
86977 Rbc serum pretx incubj/inhib 0.00 $58.28 $0.00
86978 Rbc pretreatment serum 0.00 $58.28 $0.00
86985 Split blood or products 0.00 $58.28 $0.00
86999 Transfusion procedure 0.00 $58.28 $0.00
87003 Small animal inoculation 0.00 $58.28 $0.00
87015 Specimen infect agnt concntj 0.00 $58.28 $0.00
87040 Blood culture for bacteria 0.00 $58.28 $0.00
87045 Feces culture aerobic bact 0.00 $58.28 $0.00
87046 Stool cultr aerobic bact ea 0.00 $58.28 $0.00
87070 Culture othr specimn aerobic 0.00 $58.28 $0.00
87071 Culture aerobic quant other 0.00 $58.28 $0.00
87073 Culture bacteria anaerobic 0.00 $58.28 $0.00
87075 Cultr bacteria except blood 0.00 $58.28 $0.00
87076 Culture anaerobe ident each 0.00 $58.28 $0.00
87077 Culture aerobic identify 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
87081 Culture screen only 0.00 $58.28 $0.00
87084 Culture of specimen by kit 0.00 $58.28 $0.00
87086 Urine culture/colony count 0.00 $58.28 $0.00
87088 Urine bacteria culture 0.00 $58.28 $0.00
87101 Skin fungi culture 0.00 $58.28 $0.00
87102 Fungus isolation culture 0.00 $58.28 $0.00
87103 Blood fungus culture 0.00 $58.28 $0.00
87106 Fungi identification yeast 0.00 $58.28 $0.00
87107 Fungi identification mold 0.00 $58.28 $0.00
87109 Mycoplasma 0.00 $58.28 $0.00
87110 Chlamydia culture 0.00 $58.28 $0.00
87116 Mycobacteria culture 0.00 $58.28 $0.00
87118 Mycobacteric identification 0.00 $58.28 $0.00
87140 Culture type immunofluoresc 0.00 $58.28 $0.00
87143 Culture typing glc/hplc 0.00 $58.28 $0.00
87147 Culture type immunologic 0.00 $58.28 $0.00
87149 Dna/rna direct probe 0.00 $58.28 $0.00
87150 Dna/rna amplified probe 0.00 $58.28 $0.00
87152 Culture type pulse field gel 0.00 $58.28 $0.00
87153 Dna/rna sequencing 0.00 $58.28 $0.00
87158 Culture typing added method 0.00 $58.28 $0.00
87164 Dark field examination 0.00 $58.28 $0.00
87164 26 Dark field examination 0.57 $58.28 $33.22
87166 Dark field examination 0.00 $58.28 $0.00
87168 Macroscopic exam arthropod 0.00 $58.28 $0.00
87169 Macroscopic exam parasite 0.00 $58.28 $0.00
87172 Pinworm exam 0.00 $58.28 $0.00
87176 Tissue homogenization cultr 0.00 $58.28 $0.00
87177 Ova and parasites smears 0.00 $58.28 $0.00
87181 Microbe susceptible diffuse 0.00 $58.28 $0.00
87184 Microbe susceptible disk 0.00 $58.28 $0.00
87185 Microbe susceptible enzyme 0.00 $58.28 $0.00
87186 Microbe susceptible mic 0.00 $58.28 $0.00
87187 Microbe susceptible mlc 0.00 $58.28 $0.00
87188 Microbe suscept macrobroth 0.00 $58.28 $0.00
87190 Microbe suscept mycobacteri 0.00 $58.28 $0.00
87197 Bactericidal level serum 0.00 $58.28 $0.00
87205 Smear gram stain 0.00 $58.28 $0.00
87206 Smear fluorescent/acid stai 0.00 $58.28 $0.00
87207 Smear special stain 0.00 $58.28 $0.00
87207 26 Smear special stain 0.52 $58.28 $30.31
87209 Smear complex stain 0.00 $58.28 $0.00
87210 Smear wet mount saline/ink 0.00 $58.28 $0.00
87220 Tissue exam for fungi 0.00 $58.28 $0.00
87230 Assay toxin or antitoxin 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
87250 Virus inoculate eggs/animal 0.00 $58.28 $0.00
87252 Virus inoculation tissue 0.00 $58.28 $0.00
87253 Virus inoculate tissue addl 0.00 $58.28 $0.00
87254 Virus inoculation shell via 0.00 $58.28 $0.00
87255 Genet virus isolate hsv 0.00 $58.28 $0.00
87260 Adenovirus ag if 0.00 $58.28 $0.00
87265 Pertussis ag if 0.00 $58.28 $0.00
87267 Enterovirus antibody dfa 0.00 $58.28 $0.00
87269 Giardia ag if 0.00 $58.28 $0.00
87270 Chlamydia trachomatis ag if 0.00 $58.28 $0.00
87271 Cytomegalovirus dfa 0.00 $58.28 $0.00
87272 Cryptosporidium ag if 0.00 $58.28 $0.00
87273 Herpes simplex 2 ag if 0.00 $58.28 $0.00
87274 Herpes simplex 1 ag if 0.00 $58.28 $0.00
87275 Influenza b ag if 0.00 $58.28 $0.00
87276 Influenza a ag if 0.00 $58.28 $0.00
87278 Legion pneumophilia ag if 0.00 $58.28 $0.00
87279 Parainfluenza ag if 0.00 $58.28 $0.00
87280 Respiratory syncytial ag if 0.00 $58.28 $0.00
87281 Pneumocystis carinii ag if 0.00 $58.28 $0.00
87283 Rubeola ag if 0.00 $58.28 $0.00
87285 Treponema pallidum ag if 0.00 $58.28 $0.00
87290 Varicella zoster ag if 0.00 $58.28 $0.00
87299 Antibody detection nos if 0.00 $58.28 $0.00
87300 Ag detection polyval if 0.00 $58.28 $0.00
87301 Adenovirus ag ia 0.00 $58.28 $0.00
87305 Aspergillus ag ia 0.00 $58.28 $0.00
87320 Chylmd trach ag ia 0.00 $58.28 $0.00
87324 Clostridium ag ia 0.00 $58.28 $0.00
87327 Cryptococcus neoform ag ia 0.00 $58.28 $0.00
87328 Cryptosporidium ag ia 0.00 $58.28 $0.00
87329 Giardia ag ia 0.00 $58.28 $0.00
87332 Cytomegalovirus ag ia 0.00 $58.28 $0.00
87335 E coli 0157 ag ia 0.00 $58.28 $0.00
87336 Entamoeb hist dispr ag ia 0.00 $58.28 $0.00
87337 Entamoeb hist group ag ia 0.00 $58.28 $0.00
87338 Hpylori stool ia 0.00 $58.28 $0.00
87339 H pylori ag ia 0.00 $58.28 $0.00
87340 Hepatitis b surface ag ia 0.00 $58.28 $0.00
87341 Hepatitis b surface ag ia 0.00 $58.28 $0.00
87350 Hepatitis be ag ia 0.00 $58.28 $0.00
87380 Hepatitis delta ag ia 0.00 $58.28 $0.00
87385 Histoplasma capsul ag ia 0.00 $58.28 $0.00
87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 0.00 $58.28 $0.00
87390 Hiv-1 ag ia 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
87391 Hiv-2 ag ia 0.00 $58.28 $0.00
87400 Influenza a/b ag ia 0.00 $58.28 $0.00
87420 Resp syncytial ag ia 0.00 $58.28 $0.00
87425 Rotavirus ag ia 0.00 $58.28 $0.00
87427 Shiga-like toxin ag ia 0.00 $58.28 $0.00
87430 Strep a ag ia 0.00 $58.28 $0.00
87449 Ag detect nos ia mult 0.00 $58.28 $0.00
87450 Ag detect nos ia single 0.00 $58.28 $0.00
87451 Ag detect polyval ia mult 0.00 $58.28 $0.00
87471 Bartonella dna amp probe 0.00 $58.28 $0.00
87472 Bartonella dna quant 0.00 $58.28 $0.00
87475 Lyme dis dna dir probe 0.00 $58.28 $0.00
87476 Lyme dis dna amp probe 0.00 $58.28 $0.00
87480 Candida dna dir probe 0.00 $58.28 $0.00
87481 Candida dna amp probe 0.00 $58.28 $0.00
87482 Candida dna quant 0.00 $58.28 $0.00
87483 Cns dna amp probe type 12-25 0.00 $58.28 $0.00
87485 Chylmd pneum dna dir probe 0.00 $58.28 $0.00
87486 Chylmd pneum dna amp probe 0.00 $58.28 $0.00
87487 Chylmd pneum dna quant 0.00 $58.28 $0.00
87490 Chylmd trach dna dir probe 0.00 $58.28 $0.00
87491 Chylmd trach dna amp probe 0.00 $58.28 $0.00
87492 Chylmd trach dna quant 0.00 $58.28 $0.00
87493 C diff amplified probe 0.00 $58.28 $0.00
87495 Cytomeg dna dir probe 0.00 $58.28 $0.00
87496 Cytomeg dna amp probe 0.00 $58.28 $0.00
87497 Cytomeg dna quant 0.00 $58.28 $0.00
87498 Enterovirus probe&revrs trns 0.00 $58.28 $0.00
87500 Vanomycin dna amp probe 0.00 $58.28 $0.00
87501 Influenza dna amp prob 1+ 0.00 $58.28 $0.00
87502 Influenza dna amp probe 0.00 $58.28 $0.00
87503 Influenza dna amp prob addl 0.00 $58.28 $0.00
87505 Nfct agent detection gi 0.00 $58.28 $0.00
87506 Iadna-dna/rna probe tq 6-11 0.00 $58.28 $0.00
87507 Iadna-dna/rna probe tq 12-25 0.00 $58.28 $0.00
87510 Gardner vag dna dir probe 0.00 $58.28 $0.00
87511 Gardner vag dna amp probe 0.00 $58.28 $0.00
87512 Gardner vag dna quant 0.00 $58.28 $0.00
87516 Hepatitis b dna amp probe 0.00 $58.28 $0.00
87517 Hepatitis b dna quant 0.00 $58.28 $0.00
87520 Hepatitis c rna dir probe 0.00 $58.28 $0.00
87521 Hepatitis c probe&rvrs trnsc 0.00 $58.28 $0.00
87522 Hepatitis c revrs trnscrpj 0.00 $58.28 $0.00
87525 Hepatitis g dna dir probe 0.00 $58.28 $0.00
87526 Hepatitis g dna amp probe 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
87527 Hepatitis g dna quant 0.00 $58.28 $0.00
87528 Hsv dna dir probe 0.00 $58.28 $0.00
87529 Hsv dna amp probe 0.00 $58.28 $0.00
87530 Hsv dna quant 0.00 $58.28 $0.00
87531 Hhv-6 dna dir probe 0.00 $58.28 $0.00
87532 Hhv-6 dna amp probe 0.00 $58.28 $0.00
87533 Hhv-6 dna quant 0.00 $58.28 $0.00
87534 Hiv-1 dna dir probe 0.00 $58.28 $0.00
87535 Hiv-1 probe&reverse trnscrpj 0.00 $58.28 $0.00
87536 Hiv-1 quant&revrse trnscrpj 0.00 $58.28 $0.00
87537 Hiv-2 dna dir probe 0.00 $58.28 $0.00
87538 Hiv-2 probe&revrse trnscripj 0.00 $58.28 $0.00
87539 Hiv-2 quant&revrse trnscripj 0.00 $58.28 $0.00
87540 Legion pneumo dna dir prob 0.00 $58.28 $0.00
87541 Legion pneumo dna amp prob 0.00 $58.28 $0.00
87542 Legion pneumo dna quant 0.00 $58.28 $0.00
87550 Mycobacteria dna dir probe 0.00 $58.28 $0.00
87551 Mycobacteria dna amp probe 0.00 $58.28 $0.00
87552 Mycobacteria dna quant 0.00 $58.28 $0.00
87555 M.tuberculo dna dir probe 0.00 $58.28 $0.00
87556 M.tuberculo dna amp probe 0.00 $58.28 $0.00
87557 M.tuberculo dna quant 0.00 $58.28 $0.00
87560 M.avium-intra dna dir prob 0.00 $58.28 $0.00
87561 M.avium-intra dna amp prob 0.00 $58.28 $0.00
87562 M.avium-intra dna quant 0.00 $58.28 $0.00
87580 M.pneumon dna dir probe 0.00 $58.28 $0.00
87581 M.pneumon dna amp probe 0.00 $58.28 $0.00
87582 M.pneumon dna quant 0.00 $58.28 $0.00
87590 N.gonorrhoeae dna dir prob 0.00 $58.28 $0.00
87591 N.gonorrhoeae dna amp prob 0.00 $58.28 $0.00
87592 N.gonorrhoeae dna quant 0.00 $58.28 $0.00
87623 Hpv low-risk types 0.00 $58.28 $0.00
87624 Hpv high-risk types 0.00 $58.28 $0.00
87625 Hpv types 16 & 18 only 0.00 $58.28 $0.00
87631 Resp virus 3-5 targets 0.00 $58.28 $0.00
87632 Resp virus 6-11 targets 0.00 $58.28 $0.00
87633 Resp virus 12-25 targets 0.00 $58.28 $0.00
87634 Rsv dna/rna amp probe 0.00 $58.28 $0.00
87640 Staph a dna amp probe 0.00 $58.28 $0.00
87641 Mr-staph dna amp probe 0.00 $58.28 $0.00
87650 Strep a dna dir probe 0.00 $58.28 $0.00
87651 Strep a dna amp probe 0.00 $58.28 $0.00
87652 Strep a dna quant 0.00 $58.28 $0.00
87653 Strep b dna amp probe 0.00 $58.28 $0.00
87660 Trichomonas vagin dir probe 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
87661 Trichomonas vaginalis amplif 0.00 $58.28 $0.00
87662 Zika virus dna/rna amp probe 0.00 $58.28 $0.00
87797 Detect agent nos dna dir 0.00 $58.28 $0.00
87798 Detect agent nos dna amp 0.00 $58.28 $0.00
87799 Detect agent nos dna quant 0.00 $58.28 $0.00
87800 Detect agnt mult dna direc 0.00 $58.28 $0.00
87801 Detect agnt mult dna ampli 0.00 $58.28 $0.00
87802 Strep b assay w/optic 0.00 $58.28 $0.00
87803 Clostridium toxin a w/optic 0.00 $58.28 $0.00
87804 Influenza assay w/optic 0.00 $58.28 $0.00
87806 Hiv antigen w/hiv antibodies 0.00 $58.28 $0.00
87807 Rsv assay w/optic 0.00 $58.28 $0.00
87808 Trichomonas assay w/optic 0.00 $58.28 $0.00
87809 Adenovirus assay w/optic 0.00 $58.28 $0.00
87810 Chylmd trach assay w/optic 0.00 $58.28 $0.00
87850 N. gonorrhoeae assay w/optic 0.00 $58.28 $0.00
87880 Strep a assay w/optic 0.00 $58.28 $0.00
87899 Agent nos assay w/optic 0.00 $58.28 $0.00
87900 Phenotype infect agent drug 0.00 $58.28 $0.00
87901 Genotype dna hiv reverse t 0.00 $58.28 $0.00
87902 Genotype dna/rna hep c 0.00 $58.28 $0.00
87903 Phenotype dna hiv w/culture 0.00 $58.28 $0.00
87904 Phenotype dna hiv w/clt add 0.00 $58.28 $0.00
87905 Sialidase enzyme assay 0.00 $58.28 $0.00
87906 Genotype dna/rna hiv 0.00 $58.28 $0.00
87910 Genotype cytomegalovirus 0.00 $58.28 $0.00
87912 Genotype dna hepatitis b 0.00 $58.28 $0.00
87999 Microbiology procedure 0.00 $58.28 $0.00
88000 Autopsy (necropsy) gross 0.00 $58.28 $0.00
88005 Autopsy (necropsy) gross 0.00 $58.28 $0.00
88007 Autopsy (necropsy) gross 0.00 $58.28 $0.00
88012 Autopsy (necropsy) gross 0.00 $58.28 $0.00
88014 Autopsy (necropsy) gross 0.00 $58.28 $0.00
88016 Autopsy (necropsy) gross 0.00 $58.28 $0.00
88020 Autopsy (necropsy) complete 0.00 $58.28 $0.00
88025 Autopsy (necropsy) complete 0.00 $58.28 $0.00
88027 Autopsy (necropsy) complete 0.00 $58.28 $0.00
88028 Autopsy (necropsy) complete 0.00 $58.28 $0.00
88029 Autopsy (necropsy) complete 0.00 $58.28 $0.00
88036 Limited autopsy 0.00 $58.28 $0.00
88037 Limited autopsy 0.00 $58.28 $0.00
88040 Forensic autopsy (necropsy) 0.00 $58.28 $0.00
88045 Coroners autopsy (necropsy) 0.00 $58.28 $0.00
88099 Necropsy (autopsy) procedure 0.00 $58.28 $0.00
88104 Cytopath fl nongyn smears 1.98 $58.28 $115.39
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
88104 TC Cytopath fl nongyn smears 1.16 $58.28 $67.60
88104 26 Cytopath fl nongyn smears 0.82 $58.28 $47.79
88106 Cytopath fl nongyn filter 1.81 $58.28 $105.49
88106 TC Cytopath fl nongyn filter 1.25 $58.28 $72.85
88106 26 Cytopath fl nongyn filter 0.56 $58.28 $32.64
88108 Cytopath concentrate tech 1.71 $58.28 $99.66
88108 TC Cytopath concentrate tech 1.06 $58.28 $61.78
88108 26 Cytopath concentrate tech 0.65 $58.28 $37.88
88112 Cytopath cell enhance tech 1.90 $58.28 $110.73
88112 TC Cytopath cell enhance tech 1.09 $58.28 $63.53
88112 26 Cytopath cell enhance tech 0.81 $58.28 $47.21
88120 Cytp urne 3-5 probes ea spec 16.89 $58.28 $984.35
88120 TC Cytp urne 3-5 probes ea spec 15.22 $58.28 $887.02
88120 26 Cytp urne 3-5 probes ea spec 1.67 $58.28 $97.33
88121 Cytp urine 3-5 probes cmptr 13.55 $58.28 $789.69
88121 TC Cytp urine 3-5 probes cmptr 12.13 $58.28 $706.94
88121 26 Cytp urine 3-5 probes cmptr 1.42 $58.28 $82.76
88125 Forensic cytopathology 0.75 $58.28 $43.71
88125 TC Forensic cytopathology 0.35 $58.28 $20.40
88125 26 Forensic cytopathology 0.40 $58.28 $23.31
88130 Sex chromatin identification 0.00 $58.28 $0.00
88140 Sex chromatin identification 0.00 $58.28 $0.00
88141 Cytopath c/v interpret 0.90 $58.28 $52.45
88142 Cytopath c/v thin layer 0.00 $58.28 $0.00
88143 Cytopath c/v thin layer redo 0.00 $58.28 $0.00
88147 Cytopath c/v automated 0.00 $58.28 $0.00
88148 Cytopath c/v auto rescreen 0.00 $58.28 $0.00
88150 Cytopath c/v manual 0.00 $58.28 $0.00
88152 Cytopath c/v auto redo 0.00 $58.28 $0.00
88153 Cytopath c/v redo 0.00 $58.28 $0.00
88155 Cytopath c/v index add-on 0.00 $58.28 $0.00
88160 Cytopath smear other source 2.01 $58.28 $117.14
88160 TC Cytopath smear other source 1.26 $58.28 $73.43
88160 26 Cytopath smear other source 0.75 $58.28 $43.71
88161 Cytopath smear other source 1.87 $58.28 $108.98
88161 TC Cytopath smear other source 1.14 $58.28 $66.44
88161 26 Cytopath smear other source 0.73 $58.28 $42.54
88162 Cytopath smear other source 2.70 $58.28 $157.36
88162 TC Cytopath smear other source 1.59 $58.28 $92.67
88162 26 Cytopath smear other source 1.11 $58.28 $64.69
88164 Cytopath tbs c/v manual 0.00 $58.28 $0.00
88165 Cytopath tbs c/v redo 0.00 $58.28 $0.00
88166 Cytopath tbs c/v auto redo 0.00 $58.28 $0.00
88167 Cytopath tbs c/v select 0.00 $58.28 $0.00
88172 Cytp dx eval fna 1st ea site 1.60 $58.28 $93.25
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
88172 TC Cytp dx eval fna 1st ea site 0.55 $58.28 $32.05
88172 26 Cytp dx eval fna 1st ea site 1.05 $58.28 $61.19
88173 Cytopath eval fna report 4.32 $58.28 $251.77
88173 TC Cytopath eval fna report 2.27 $58.28 $132.30
88173 26 Cytopath eval fna report 2.05 $58.28 $119.47
88174 Cytopath c/v auto in fluid 0.00 $58.28 $0.00
88175 Cytopath c/v auto fluid redo 0.00 $58.28 $0.00
88177 Cytp fna eval ea addl 0.84 $58.28 $48.96
88177 TC Cytp fna eval ea addl 0.20 $58.28 $11.66
88177 26 Cytp fna eval ea addl 0.64 $58.28 $37.30
88182 Cell marker study 3.79 $58.28 $220.88
88182 TC Cell marker study 2.67 $58.28 $155.61
88182 26 Cell marker study 1.12 $58.28 $65.27
88184 Flowcytometry/ tc 1 marker 1.88 $58.28 $109.57
88185 Flowcytometry/tc add-on 0.69 $58.28 $40.21
88187 Flowcytometry/read 2-8 1.08 $58.28 $62.94
88188 Flowcytometry/read 9-15 1.83 $58.28 $106.65
88189 Flowcytometry/read 16 & > 2.45 $58.28 $142.79
88199 Cytopathology procedure 0.00 $58.28 $0.00
88199 TC Cytopathology procedure 0.00 $58.28 $0.00
88199 26 Cytopathology procedure 0.00 $58.28 $0.00
88230 Tissue culture lymphocyte 0.00 $58.28 $0.00
88233 Tissue culture skin/biopsy 0.00 $58.28 $0.00
88235 Tissue culture placenta 0.00 $58.28 $0.00
88237 Tissue culture bone marrow 0.00 $58.28 $0.00
88239 Tissue culture tumor 0.00 $58.28 $0.00
88240 Cell cryopreserve/storage 0.00 $58.28 $0.00
88241 Frozen cell preparation 0.00 $58.28 $0.00
88245 Chromosome analysis 20-25 0.00 $58.28 $0.00
88248 Chromosome analysis 50-100 0.00 $58.28 $0.00
88249 Chromosome analysis 100 0.00 $58.28 $0.00
88261 Chromosome analysis 5 0.00 $58.28 $0.00
88262 Chromosome analysis 15-20 0.00 $58.28 $0.00
88263 Chromosome analysis 45 0.00 $58.28 $0.00
88264 Chromosome analysis 20-25 0.00 $58.28 $0.00
88267 Chromosome analys placenta 0.00 $58.28 $0.00
88269 Chromosome analys amniotic 0.00 $58.28 $0.00
88271 Cytogenetics dna probe 0.00 $58.28 $0.00
88272 Cytogenetics 3-5 0.00 $58.28 $0.00
88273 Cytogenetics 10-30 0.00 $58.28 $0.00
88274 Cytogenetics 25-99 0.00 $58.28 $0.00
88275 Cytogenetics 100-300 0.00 $58.28 $0.00
88280 Chromosome karyotype study 0.00 $58.28 $0.00
88283 Chromosome banding study 0.00 $58.28 $0.00
88285 Chromosome count additional 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
88289 Chromosome study additional 0.00 $58.28 $0.00
88291 Cyto/molecular report 0.94 $58.28 $54.78
88299 Cytogenetic study 0.00 $58.28 $0.00
88300 Surgical path gross 0.45 $58.28 $26.23
88300 TC Surgical path gross 0.32 $58.28 $18.65
88300 26 Surgical path gross 0.13 $58.28 $7.58
88302 Tissue exam by pathologist 0.87 $58.28 $50.70
88302 TC Tissue exam by pathologist 0.67 $58.28 $39.05
88302 26 Tissue exam by pathologist 0.20 $58.28 $11.66
88304 Tissue exam by pathologist 1.14 $58.28 $66.44
88304 TC Tissue exam by pathologist 0.81 $58.28 $47.21
88304 26 Tissue exam by pathologist 0.33 $58.28 $19.23
88305 Tissue exam by pathologist 1.95 $58.28 $113.65
88305 TC Tissue exam by pathologist 0.85 $58.28 $49.54
88305 26 Tissue exam by pathologist 1.10 $58.28 $64.11
88307 Tissue exam by pathologist 7.59 $58.28 $442.35
88307 TC Tissue exam by pathologist 5.18 $58.28 $301.89
88307 26 Tissue exam by pathologist 2.41 $58.28 $140.45
88309 Tissue exam by pathologist 11.53 $58.28 $671.97
88309 TC Tissue exam by pathologist 7.27 $58.28 $423.70
88309 26 Tissue exam by pathologist 4.26 $58.28 $248.27
88311 Decalcify tissue 0.61 $58.28 $35.55
88311 TC Decalcify tissue 0.25 $58.28 $14.57
88311 26 Decalcify tissue 0.36 $58.28 $20.98
88312 Special stains group 1 2.83 $58.28 $164.93
88312 TC Special stains group 1 2.06 $58.28 $120.06
88312 26 Special stains group 1 0.77 $58.28 $44.88
88313 Special stains group 2 2.05 $58.28 $119.47
88313 TC Special stains group 2 1.70 $58.28 $99.08
88313 26 Special stains group 2 0.35 $58.28 $20.40
88314 Histochemical stains add-on 2.60 $58.28 $151.53
88314 TC Histochemical stains add-on 1.95 $58.28 $113.65
88314 26 Histochemical stains add-on 0.65 $58.28 $37.88
88319 Enzyme histochemistry 2.74 $58.28 $159.69
88319 TC Enzyme histochemistry 1.97 $58.28 $114.81
88319 26 Enzyme histochemistry 0.77 $58.28 $44.88
88321 Microslide consultation 2.85 $58.28 $166.10
88323 Microslide consultation 3.28 $58.28 $191.16
88323 TC Microslide consultation 0.75 $58.28 $43.71
88323 26 Microslide consultation 2.53 $58.28 $147.45
88325 Comprehensive review of data 5.12 $58.28 $298.39
88329 Path consult introp 1.47 $58.28 $85.67
88331 Path consult intraop 1 bloc 2.75 $58.28 $160.27
88331 TC Path consult intraop 1 bloc 0.93 $58.28 $54.20
88331 26 Path consult intraop 1 bloc 1.82 $58.28 $106.07
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
88332 Path consult intraop addl 1.51 $58.28 $88.00
88332 TC Path consult intraop addl 0.61 $58.28 $35.55
88332 26 Path consult intraop addl 0.90 $58.28 $52.45
88333 Intraop cyto path consult 1 2.53 $58.28 $147.45
88333 TC Intraop cyto path consult 1 0.71 $58.28 $41.38
88333 26 Intraop cyto path consult 1 1.82 $58.28 $106.07
88334 Intraop cyto path consult 2 1.58 $58.28 $92.08
88334 TC Intraop cyto path consult 2 0.47 $58.28 $27.39
88334 26 Intraop cyto path consult 2 1.11 $58.28 $64.69
88341 Immunohisto antb addl slide 2.62 $58.28 $152.69
88341 TC Immunohisto antb addl slide 1.79 $58.28 $104.32
88341 26 Immunohisto antb addl slide 0.83 $58.28 $48.37
88342 Immunohisto antb 1st stain 3.01 $58.28 $175.42
88342 TC Immunohisto antb 1st stain 1.98 $58.28 $115.39
88342 26 Immunohisto antb 1st stain 1.03 $58.28 $60.03
88344 Immunohisto antibody slide 4.84 $58.28 $282.08
88344 TC Immunohisto antibody slide 3.72 $58.28 $216.80
88344 26 Immunohisto antibody slide 1.12 $58.28 $65.27
88346 Immunofluor antb 1st stain 3.11 $58.28 $181.25
88346 TC Immunofluor antb 1st stain 2.06 $58.28 $120.06
88346 26 Immunofluor antb 1st stain 1.05 $58.28 $61.19
88348 Electron microscopy 10.15 $58.28 $591.54
88348 TC Electron microscopy 7.94 $58.28 $462.74
88348 26 Electron microscopy 2.21 $58.28 $128.80
88350 Immunofluor antb addl stain 2.18 $58.28 $127.05
88350 TC Immunofluor antb addl stain 1.35 $58.28 $78.68
88350 26 Immunofluor antb addl stain 0.83 $58.28 $48.37
88355 Analysis skeletal muscle 3.75 $58.28 $218.55
88355 TC Analysis skeletal muscle 1.38 $58.28 $80.43
88355 26 Analysis skeletal muscle 2.37 $58.28 $138.12
88356 Analysis nerve 6.34 $58.28 $369.50
88356 TC Analysis nerve 2.71 $58.28 $157.94
88356 26 Analysis nerve 3.63 $58.28 $211.56
88358 Analysis tumor 3.61 $58.28 $210.39
88358 TC Analysis tumor 2.16 $58.28 $125.88
88358 26 Analysis tumor 1.45 $58.28 $84.51
88360 Tumor immunohistochem/manual 3.60 $58.28 $209.81
88360 TC Tumor immunohistochem/manual 2.37 $58.28 $138.12
88360 26 Tumor immunohistochem/manual 1.23 $58.28 $71.68
88361 Tumor immunohistochem/comput 3.72 $58.28 $216.80
88361 TC Tumor immunohistochem/comput 2.40 $58.28 $139.87
88361 26 Tumor immunohistochem/comput 1.32 $58.28 $76.93
88362 Nerve teasing preparations 5.92 $58.28 $345.02
88362 TC Nerve teasing preparations 2.70 $58.28 $157.36
88362 26 Nerve teasing preparations 3.22 $58.28 $187.66
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
88363 Xm archive tissue molec anal 0.67 $58.28 $39.05
88364 Insitu hybridization (fish) 3.74 $58.28 $217.97
88364 TC Insitu hybridization (fish) 2.73 $58.28 $159.10
88364 26 Insitu hybridization (fish) 1.01 $58.28 $58.86
88365 Insitu hybridization (fish) 4.99 $58.28 $290.82
88365 TC Insitu hybridization (fish) 3.72 $58.28 $216.80
88365 26 Insitu hybridization (fish) 1.27 $58.28 $74.02
88366 Insitu hybridization (fish) 7.44 $58.28 $433.60
88366 TC Insitu hybridization (fish) 5.64 $58.28 $328.70
88366 26 Insitu hybridization (fish) 1.80 $58.28 $104.90
88367 Insitu hybridization auto 3.08 $58.28 $179.50
88367 TC Insitu hybridization auto 2.08 $58.28 $121.22
88367 26 Insitu hybridization auto 1.00 $58.28 $58.28
88368 Insitu hybridization manual 3.59 $58.28 $209.23
88368 TC Insitu hybridization manual 2.38 $58.28 $138.71
88368 26 Insitu hybridization manual 1.21 $58.28 $70.52
88369 M/phmtrc alysishquant/semiq 3.14 $58.28 $183.00
88369 TC M/phmtrc alysishquant/semiq 2.20 $58.28 $128.22
88369 26 M/phmtrc alysishquant/semiq 0.94 $58.28 $54.78
88371 Protein western blot tissue 0.00 $58.28 $0.00
88371 26 Protein western blot tissue 0.57 $58.28 $33.22
88372 Protein analysis w/probe 0.00 $58.28 $0.00
88372 26 Protein analysis w/probe 0.52 $58.28 $30.31
88373 M/phmtrc alys ishquant/semiq 2.11 $58.28 $122.97
88373 TC M/phmtrc alys ishquant/semiq 1.33 $58.28 $77.51
88373 26 M/phmtrc alys ishquant/semiq 0.78 $58.28 $45.46
88374 M/phmtrc alys ishquant/semiq 9.18 $58.28 $535.01
88374 TC M/phmtrc alys ishquant/semiq 7.90 $58.28 $460.41
88374 26 M/phmtrc alys ishquant/semiq 1.28 $58.28 $74.60
88375 Optical endomicroscpy interp 1.42 $58.28 $82.76
88377 M/phmtrc alys ishquant/semiq 10.93 $58.28 $637.00
88377 TC M/phmtrc alys ishquant/semiq 9.07 $58.28 $528.60
88377 26 M/phmtrc alys ishquant/semiq 1.86 $58.28 $108.40
88380 Microdissection laser 3.78 $58.28 $220.30
88380 TC Microdissection laser 2.19 $58.28 $127.63
88380 26 Microdissection laser 1.59 $58.28 $92.67
88381 Microdissection manual 4.34 $58.28 $252.94
88381 TC Microdissection manual 3.61 $58.28 $210.39
88381 26 Microdissection manual 0.73 $58.28 $42.54
88387 Tiss exam molecular study 1.00 $58.28 $58.28
88387 TC Tiss exam molecular study 0.19 $58.28 $11.07
88387 26 Tiss exam molecular study 0.81 $58.28 $47.21
88388 Tiss ex molecul study add-on 1.00 $58.28 $58.28
88388 TC Tiss ex molecul study add-on 0.31 $58.28 $18.07
88388 26 Tiss ex molecul study add-on 0.69 $58.28 $40.21
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
88399 Surgical pathology procedure 0.00 $58.28 $0.00
88399 TC Surgical pathology procedure 0.00 $58.28 $0.00
88399 26 Surgical pathology procedure 0.00 $58.28 $0.00
88720 Bilirubin total transcut 0.00 $58.28 $0.00
88738 Hgb quant transcutaneous 0.00 $58.28 $0.00
88740 Transcutaneous carboxyhb 0.00 $58.28 $0.00
88741 Transcutaneous methb 0.00 $58.28 $0.00
88749 In vivo lab service 0.00 $58.28 $0.00
89049 Chct for mal hyperthermia 7.06 $58.28 $411.46
89050 Body fluid cell count 0.00 $58.28 $0.00
89051 Body fluid cell count 0.00 $58.28 $0.00
89055 Leukocyte assessment fecal 0.00 $58.28 $0.00
89060 Exam synovial fluid crystals 0.00 $58.28 $0.00
89060 26 Exam synovial fluid crystals 0.52 $58.28 $30.31
89125 Specimen fat stain 0.00 $58.28 $0.00
89160 Exam feces for meat fibers 0.00 $58.28 $0.00
89190 Nasal smear for eosinophils 0.00 $58.28 $0.00
89220 Sputum specimen collection 0.46 $58.28 $26.81
89230 Collect sweat for test 0.08 $58.28 $4.66
89240 Pathology lab procedure 0.00 $58.28 $0.00
89250 Cultr oocyte/embryo <4 days 0.00 $58.28 $0.00
89251 Cultr oocyte/embryo <4 days 0.00 $58.28 $0.00
89253 Embryo hatching 0.00 $58.28 $0.00
89254 Oocyte identification 0.00 $58.28 $0.00
89255 Prepare embryo for transfer 0.00 $58.28 $0.00
89257 Sperm identification 0.00 $58.28 $0.00
89258 Cryopreservation embryo(s) 0.00 $58.28 $0.00
89259 Cryopreservation sperm 0.00 $58.28 $0.00
89260 Sperm isolation simple 0.00 $58.28 $0.00
89261 Sperm isolation complex 0.00 $58.28 $0.00
89264 Identify sperm tissue 0.00 $58.28 $0.00
89268 Insemination of oocytes 0.00 $58.28 $0.00
89272 Extended culture of oocytes 0.00 $58.28 $0.00
89280 Assist oocyte fertilization 0.00 $58.28 $0.00
89281 Assist oocyte fertilization 0.00 $58.28 $0.00
89290 Biopsy oocyte polar body 0.00 $58.28 $0.00
89291 Biopsy oocyte polar body 0.00 $58.28 $0.00
89300 Semen analysis w/huhner 0.00 $58.28 $0.00
89310 Semen analysis w/count 0.00 $58.28 $0.00
89320 Semen anal vol/count/mot 0.00 $58.28 $0.00
89321 Semen anal sperm detection 0.00 $58.28 $0.00
89322 Semen anal strict criteria 0.00 $58.28 $0.00
89325 Sperm antibody test 0.00 $58.28 $0.00
89329 Sperm evaluation test 0.00 $58.28 $0.00
89330 Evaluation cervical mucus 0.00 $58.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
89331 Retrograde ejaculation anal 0.00 $58.28 $0.00
89335 Cryopreserve testicular tiss 0.00 $58.28 $0.00
89337 Cryopreservation oocyte(s) 0.00 $58.28 $0.00
89342 Storage/year embryo(s) 0.00 $58.28 $0.00
89343 Storage/year sperm/semen 0.00 $58.28 $0.00
89344 Storage/year reprod tissue 0.00 $58.28 $0.00
89346 Storage/year oocyte(s) 0.00 $58.28 $0.00
89352 Thawing cryopresrved embryo 0.00 $58.28 $0.00
89353 Thawing cryopresrved sperm 0.00 $58.28 $0.00
89354 Thaw cryoprsvrd reprod tiss 0.00 $58.28 $0.00
89356 Thawing cryopresrved oocyte 0.00 $58.28 $0.00
89398 Unlisted reprod med lab proc 0.00 $58.28 $0.00
9001F Aortic aneurysm<5cm diam ct 0.00 $44.28 $0.00
9002F Aortic aneurysm 5-5.4cm diam 0.00 $44.28 $0.00
9003F Aortic anrysm5.5-5.9cm diam 0.00 $44.28 $0.00
9004F Aortic anrysm 6/> cm diam 0.00 $44.28 $0.00
9005F Asympt carot/vrtbrbas sten 0.00 $44.28 $0.00
9006F Sympt sten-tia/strk<120days 0.00 $44.28 $0.00
9007F Other carot sten 120 days/> 0.00 $44.28 $0.00
90281 Human ig im 0.00 $44.28 $0.00
90283 Human ig iv 0.00 $44.28 $0.00
90284 Human ig sc 0.00 $44.28 $0.00
90287 Botulinum antitoxin 0.00 $44.28 $0.00
90288 Botulism ig iv 0.00 $44.28 $0.00
90291 Cmv ig iv 0.00 $44.28 $0.00
90296 Diphtheria antitoxin 0.00 $44.28 $0.00
90371 Hep b ig im 0.00 $44.28 $0.00
90375 Rabies ig im/sc 0.00 $44.28 $0.00
90376 Rabies ig heat treated 0.00 $44.28 $0.00
90378 Rsv mab im 50mg 0.00 $44.28 $0.00
90384 Rh ig full-dose im 0.00 $44.28 $0.00
90385 Rh ig minidose im 0.00 $44.28 $0.00
90386 Rh ig iv 0.00 $44.28 $0.00
90389 Tetanus ig im 0.00 $44.28 $0.00
90393 Vaccina ig im 0.00 $44.28 $0.00
90396 Varicella-zoster ig im 0.00 $44.28 $0.00
90399 Immune globulin 0.00 $44.28 $0.00
90460 Im admin 1st/only component 0.47 $44.28 $20.81
90461 Im admin each addl component 0.36 $44.28 $15.94
90471 Immunization admin 0.47 $44.28 $20.81
90472 Immunization admin each add 0.36 $44.28 $15.94
90473 Immune admin oral/nasal 0.47 $44.28 $20.81
90474 Immune admin oral/nasal addl 0.36 $44.28 $15.94
90476 Adenovirus vaccine type 4 0.00 $44.28 $0.00
90477 Adenovirus vaccine type 7 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
90581 Anthrax vaccine sc or im 0.00 $44.28 $0.00
90585 Bcg vaccine percut 0.00 $44.28 $0.00
90586 Bcg vaccine intravesical 0.00 $44.28 $0.00
90587 Dengue vacc quad 3 dose subq 0.00 $44.28 $0.00
90620 Menb-4c vacc 2 dose im 0.00 $44.28 $0.00
90621 Menb-fhbp vacc 2/3 dose im 0.00 $44.28 $0.00
90625 Cholera vaccine live oral 0.00 $44.28 $0.00
90630 Flu vacc iiv4 no preserv id 0.00 $44.28 $0.00
90632 Hepa vaccine adult im 0.00 $44.28 $0.00
90633 Hepa vacc ped/adol 2 dose im 0.00 $44.28 $0.00
90634 Hepa vacc ped/adol 3 dose 0.00 $44.28 $0.00
90636 Hep a/hep b vacc adult im 0.00 $44.28 $0.00
90644 Hib-mency vacc 6wk-18m0 im 0.00 $44.28 $0.00
90647 Hib prp-omp vacc 3 dose im 0.00 $44.28 $0.00
90648 Hib prp-t vaccine 4 dose im 0.00 $44.28 $0.00
90649 4vhpv vaccine 3 dose im 0.00 $44.28 $0.00
90650 2vhpv vaccine 3 dose im 0.00 $44.28 $0.00
90651 9vhpv vaccine 2/3 dose im 0.00 $44.28 $0.00
90653 Iiv adjuvant vaccine im 0.00 $44.28 $0.00
90654 Flu vacc iiv3 no preserv id 0.00 $44.28 $0.00
90655 Iiv3 vacc no prsv 0.25 ml im 0.00 $44.28 $0.00
90656 Iiv3 vacc no prsv 0.5 ml im 0.00 $44.28 $0.00
90657 Iiv3 vaccine splt 0.25 ml im 0.00 $44.28 $0.00
90658 Iiv3 vaccine splt 0.5 ml im 0.00 $44.28 $0.00
90660 Laiv3 vaccine intranasal 0.00 $44.28 $0.00
90661 Cciiv3 vac no prsv 0.5 ml im 0.00 $44.28 $0.00
90662 Iiv no prsv increased ag im 0.00 $44.28 $0.00
90664 Laiv vacc pandemic intranasl 0.00 $44.28 $0.00
90666 Flu vac pandem prsrv free im 0.00 $44.28 $0.00
90667 Iiv vacc pandemic adjuvt im 0.00 $44.28 $0.00
90668 Iiv vaccine pandemic im 0.00 $44.28 $0.00
90670 Pcv13 vaccine im 0.00 $44.28 $0.00
90672 Laiv4 vaccine intranasal 0.00 $44.28 $0.00
90673 Riv3 vaccine no preserv im 0.00 $44.28 $0.00
90674 Cciiv4 vac no prsv 0.5 ml im 0.00 $44.28 $0.00
90675 Rabies vaccine im 0.00 $44.28 $0.00
90676 Rabies vaccine id 0.00 $44.28 $0.00
90680 Rv5 vacc 3 dose live oral 0.00 $44.28 $0.00
90681 Rv1 vacc 2 dose live oral 0.00 $44.28 $0.00
90682 Riv4 vacc recombinant dna im 0.00 $44.28 $0.00
90685 Iiv4 vacc no prsv 0.25 ml im 0.00 $44.28 $0.00
90686 Iiv4 vacc no prsv 0.5 ml im 0.00 $44.28 $0.00
90687 Iiv4 vaccine splt 0.25 ml im 0.00 $44.28 $0.00
90688 Iiv4 vaccine splt 0.5 ml im 0.00 $44.28 $0.00
90689 Vacc iiv4 no prsrv 0.25ml im 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
90690 Typhoid vaccine oral 0.00 $44.28 $0.00
90691 Typhoid vaccine im 0.00 $44.28 $0.00
90696 Dtap-ipv vaccine 4-6 yrs im 0.00 $44.28 $0.00
90697 Dtap-ipv-hib-hepb vaccine im 0.00 $44.28 $0.00
90698 Dtap-ipv/hib vaccine im 0.00 $44.28 $0.00
90700 Dtap vaccine < 7 yrs im 0.00 $44.28 $0.00
90702 Dt vaccine under 7 yrs im 0.00 $44.28 $0.00
90707 Mmr vaccine sc 0.00 $44.28 $0.00
90710 Mmrv vaccine sc 0.00 $44.28 $0.00
90713 Poliovirus ipv sc/im 0.00 $44.28 $0.00
90714 Td vacc no presv 7 yrs+ im 0.00 $44.28 $0.00
90715 Tdap vaccine 7 yrs/> im 0.00 $44.28 $0.00
90716 Var vaccine live subq 0.00 $44.28 $0.00
90717 Yellow fever vaccine subq 0.00 $44.28 $0.00
90723 Dtap-hep b-ipv vaccine im 0.00 $44.28 $0.00
90732 Ppsv23 vacc 2 yrs+ subq/im 0.00 $44.28 $0.00
90733 Mpsv4 vaccine subq 0.00 $44.28 $0.00
90734 Mcv4 menacwy vaccine im 0.00 $44.28 $0.00
90736 Hzv vaccine live subq 0.00 $44.28 $0.00
90738 Inactivated je vacc im 0.00 $44.28 $0.00
90739 Hepb vacc 2 dose adult im 0.00 $44.28 $0.00
90740 Hepb vacc 3 dose immunsup im 0.00 $44.28 $0.00
90743 Hepb vacc 2 dose adolesc im 0.00 $44.28 $0.00
90744 Hepb vacc 3 dose ped/adol im 0.00 $44.28 $0.00
90746 Hepb vaccine 3 dose adult im 0.00 $44.28 $0.00
90747 Hepb vacc 4 dose immunsup im 0.00 $44.28 $0.00
90748 Hib-hepb vaccine im 0.00 $44.28 $0.00
90749 Vaccine toxoid 0.00 $44.28 $0.00
90750 Hzv vacc recombinant im 0.00 $44.28 $0.00
90756 Cciiv4 vacc abx free im 0.00 $44.28 $0.00
90785 Psytx complex interactive 0.42 $44.28 $18.60
90791 Psych diagnostic evaluation 3.89 $44.28 $172.25
90792 Psych diag eval w/med srvcs 4.37 $44.28 $193.50
90832 Psytx w pt 30 minutes 1.90 $44.28 $84.13
90833 Psytx w pt w e/m 30 min 1.97 $44.28 $87.23
90834 Psytx w pt 45 minutes 2.53 $44.28 $112.03
90836 Psytx w pt w e/m 45 min 2.49 $44.28 $110.26
90837 Psytx w pt 60 minutes 3.80 $44.28 $168.26
90838 Psytx w pt w e/m 60 min 3.29 $44.28 $145.68
90839 Psytx crisis initial 60 min 3.96 $44.28 $175.35
90840 Psytx crisis ea addl 30 min 1.90 $44.28 $84.13
90845 Psychoanalysis 2.70 $44.28 $119.56
90846 Family psytx w/o pt 50 min 3.06 $44.28 $135.50
90847 Family psytx w/pt 50 min 3.18 $44.28 $140.81
90849 Multiple family group psytx 1.17 $44.28 $51.81
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
90853 Group psychotherapy 0.76 $44.28 $33.65
90863 Pharmacologic mgmt w/psytx 0.74 $44.28 $32.77
90865 Narcosynthesis 4.79 $44.28 $212.10
90867 Tcranial magn stim tx plan 0.00 $44.28 $0.00
90868 Tcranial magn stim tx deli 0.00 $44.28 $0.00
90869 Tcran magn stim redetemine 0.00 $44.28 $0.00
90870 Electroconvulsive therapy 4.96 $44.28 $219.63
90875 Psychophysiological therapy 1.80 $44.28 $79.70
90876 Psychophysiological therapy 3.05 $44.28 $135.05
90880 Hypnotherapy 2.98 $44.28 $131.95
90882 Environmental manipulation 0.00 $44.28 $0.00
90885 Psy evaluation of records 1.41 $44.28 $62.43
90887 Consultation with family 2.48 $44.28 $109.81
90889 Preparation of report 0.00 $44.28 $0.00
90899 Psychiatric service/therapy 0.00 $44.28 $0.00
90901 Biofeedback train any meth 1.13 $44.28 $50.04
90911 Biofeedback peri/uro/rectal 2.47 $44.28 $109.37
90935 Hemodialysis one evaluation 2.07 $44.28 $91.66
90937 Hemodialysis repeated eval 2.95 $44.28 $130.63
90940 Hemodialysis access study 0.00 $44.28 $0.00
90945 Dialysis one evaluation 2.42 $44.28 $107.16
90947 Dialysis repeated eval 3.51 $44.28 $155.42
90951 Esrd serv 4 visits p mo <2yr 26.63 $44.28 $1,179.18
90952 Esrd serv 2-3 vsts p mo <2yr 0.00 $44.28 $0.00
90953 Esrd serv 1 visit p mo <2yrs 0.00 $44.28 $0.00
90954 Esrd serv 4 vsts p mo 2-11 22.96 $44.28 $1,016.67
90955 Esrd srv 2-3 vsts p mo 2-11 12.93 $44.28 $572.54
90956 Esrd srv 1 visit p mo 2-11 9.00 $44.28 $398.52
90957 Esrd srv 4 vsts p mo 12-19 18.18 $44.28 $805.01
90958 Esrd srv 2-3 vsts p mo 12-19 12.34 $44.28 $546.42
90959 Esrd serv 1 vst p mo 12-19 8.40 $44.28 $371.95
90960 Esrd srv 4 visits p mo 20+ 8.02 $44.28 $355.13
90961 Esrd srv 2-3 vsts p mo 20+ 6.74 $44.28 $298.45
90962 Esrd serv 1 visit p mo 20+ 5.21 $44.28 $230.70
90963 Esrd home pt serv p mo <2yrs 15.43 $44.28 $683.24
90964 Esrd home pt serv p mo 2-11 13.47 $44.28 $596.45
90965 Esrd home pt serv p mo 12-19 12.83 $44.28 $568.11
90966 Esrd home pt serv p mo 20+ 6.72 $44.28 $297.56
90967 Esrd svc pr day pt <2 0.51 $44.28 $22.58
90968 Esrd svc pr day pt 2-11 0.45 $44.28 $19.93
90969 Esrd svc pr day pt 12-19 0.43 $44.28 $19.04
90970 Esrd svc pr day pt 20+ 0.22 $44.28 $9.74
90989 Dialysis training complete 0.00 $44.28 $0.00
90993 Dialysis training incompl 0.00 $44.28 $0.00
90997 Hemoperfusion 2.53 $44.28 $112.03
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
90999 Dialysis procedure 0.00 $44.28 $0.00
91010 Esophagus motility study 5.38 $44.28 $238.23
91010 TC Esophagus motility study 3.47 $44.28 $153.65
91010 26 Esophagus motility study 1.91 $44.28 $84.57
91013 Esophgl motil w/stim/perfus 0.73 $44.28 $32.32
91013 TC Esophgl motil w/stim/perfus 0.46 $44.28 $20.37
91013 26 Esophgl motil w/stim/perfus 0.27 $44.28 $11.96
91020 Gastric motility studies 7.01 $44.28 $310.40
91020 TC Gastric motility studies 4.88 $44.28 $216.09
91020 26 Gastric motility studies 2.13 $44.28 $94.32
91022 Duodenal motility study 4.79 $44.28 $212.10
91022 TC Duodenal motility study 2.66 $44.28 $117.78
91022 26 Duodenal motility study 2.13 $44.28 $94.32
91030 Acid perfusion of esophagus 3.91 $44.28 $173.13
91030 TC Acid perfusion of esophagus 2.56 $44.28 $113.36
91030 26 Acid perfusion of esophagus 1.35 $44.28 $59.78
91034 Gastroesophageal reflux test 5.39 $44.28 $238.67
91034 TC Gastroesophageal reflux test 3.94 $44.28 $174.46
91034 26 Gastroesophageal reflux test 1.45 $44.28 $64.21
91035 G-esoph reflx tst w/electrod 13.68 $44.28 $605.75
91035 TC G-esoph reflx tst w/electrod 11.30 $44.28 $500.36
91035 26 G-esoph reflx tst w/electrod 2.38 $44.28 $105.39
91037 Esoph imped function test 4.66 $44.28 $206.34
91037 TC Esoph imped function test 3.21 $44.28 $142.14
91037 26 Esoph imped function test 1.45 $44.28 $64.21
91038 Esoph imped funct test > 1hr 12.56 $44.28 $556.16
91038 TC Esoph imped funct test > 1hr 10.93 $44.28 $483.98
91038 26 Esoph imped funct test > 1hr 1.63 $44.28 $72.18
91040 Esoph balloon distension tst 13.55 $44.28 $599.99
91040 TC Esoph balloon distension tst 12.10 $44.28 $535.79
91040 26 Esoph balloon distension tst 1.45 $44.28 $64.21
91065 Breath hydrogen/methane test 2.13 $44.28 $94.32
91065 TC Breath hydrogen/methane test 1.84 $44.28 $81.48
91065 26 Breath hydrogen/methane test 0.29 $44.28 $12.84
91110 Gi tract capsule endoscopy 24.98 $44.28 $1,106.11
91110 TC Gi tract capsule endoscopy 21.30 $44.28 $943.16
91110 26 Gi tract capsule endoscopy 3.68 $44.28 $162.95
91111 Esophageal capsule endoscopy 22.88 $44.28 $1,013.13
91111 TC Esophageal capsule endoscopy 21.39 $44.28 $947.15
91111 26 Esophageal capsule endoscopy 1.49 $44.28 $65.98
91112 Gi wireless capsule measure 35.81 $44.28 $1,585.67
91112 TC Gi wireless capsule measure 32.71 $44.28 $1,448.40
91112 26 Gi wireless capsule measure 3.10 $44.28 $137.27
91117 Colon motility 6 hr study 3.96 $44.28 $175.35
91120 Rectal sensation test 12.94 $44.28 $572.98
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
91120 TC Rectal sensation test 11.52 $44.28 $510.11
91120 26 Rectal sensation test 1.42 $44.28 $62.88
91122 Anal pressure record 6.85 $44.28 $303.32
91122 TC Anal pressure record 4.27 $44.28 $189.08
91122 26 Anal pressure record 2.58 $44.28 $114.24
91132 Electrogastrography 6.80 $44.28 $301.10
91132 TC Electrogastrography 6.03 $44.28 $267.01
91132 26 Electrogastrography 0.77 $44.28 $34.10
91133 Electrogastrography w/test 7.44 $44.28 $329.44
91133 TC Electrogastrography w/test 6.46 $44.28 $286.05
91133 26 Electrogastrography w/test 0.98 $44.28 $43.39
91200 Liver elastography 1.10 $44.28 $48.71
91200 TC Liver elastography 0.70 $44.28 $31.00
91200 26 Liver elastography 0.40 $44.28 $17.71
91299 Gastroenterology procedure 0.00 $44.28 $0.00
91299 TC Gastroenterology procedure 0.00 $44.28 $0.00
91299 26 Gastroenterology procedure 0.00 $44.28 $0.00
92002 Eye exam new patient 2.37 $44.28 $104.94
92004 Eye exam new patient 4.26 $44.28 $188.63
92012 Eye exam establish patient 2.49 $44.28 $110.26
92014 Eye exam&tx estab pt 1/>vst 3.57 $44.28 $158.08
92015 Determine refractive state 0.56 $44.28 $24.80
92018 New eye exam & treatment 4.13 $44.28 $182.88
92019 Eye exam & treatment 2.05 $44.28 $90.77
92020 Special eye evaluation 0.78 $44.28 $34.54
92025 Corneal topography 1.07 $44.28 $47.38
92025 TC Corneal topography 0.50 $44.28 $22.14
92025 26 Corneal topography 0.57 $44.28 $25.24
92060 Special eye evaluation 1.82 $44.28 $80.59
92060 TC Special eye evaluation 0.74 $44.28 $32.77
92060 26 Special eye evaluation 1.08 $44.28 $47.82
92065 Orthoptic/pleoptic training 1.51 $44.28 $66.86
92065 TC Orthoptic/pleoptic training 1.00 $44.28 $44.28
92065 26 Orthoptic/pleoptic training 0.51 $44.28 $22.58
92071 Contact lens fitting for tx 1.07 $44.28 $47.38
92072 Fit contac lens for managmnt 3.72 $44.28 $164.72
92081 Visual field examination(s) 0.96 $44.28 $42.51
92081 TC Visual field examination(s) 0.50 $44.28 $22.14
92081 26 Visual field examination(s) 0.46 $44.28 $20.37
92082 Visual field examination(s) 1.35 $44.28 $59.78
92082 TC Visual field examination(s) 0.74 $44.28 $32.77
92082 26 Visual field examination(s) 0.61 $44.28 $27.01
92083 Visual field examination(s) 1.81 $44.28 $80.15
92083 TC Visual field examination(s) 1.02 $44.28 $45.17
92083 26 Visual field examination(s) 0.79 $44.28 $34.98
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
92100 Serial tonometry exam(s) 2.32 $44.28 $102.73
92132 Cmptr ophth dx img ant segmt 0.89 $44.28 $39.41
92132 TC Cmptr ophth dx img ant segmt 0.42 $44.28 $18.60
92132 26 Cmptr ophth dx img ant segmt 0.47 $44.28 $20.81
92133 Cmptr ophth img optic nerve 1.05 $44.28 $46.49
92133 TC Cmptr ophth img optic nerve 0.42 $44.28 $18.60
92133 26 Cmptr ophth img optic nerve 0.63 $44.28 $27.90
92134 Cptr ophth dx img post segmt 1.16 $44.28 $51.36
92134 TC Cptr ophth dx img post segmt 0.43 $44.28 $19.04
92134 26 Cptr ophth dx img post segmt 0.73 $44.28 $32.32
92136 Ophthalmic biometry 1.98 $44.28 $87.67
92136 TC Ophthalmic biometry 1.09 $44.28 $48.27
92136 26 Ophthalmic biometry 0.89 $44.28 $39.41
92145 Corneal hysteresis deter 0.49 $44.28 $21.70
92145 TC Corneal hysteresis deter 0.22 $44.28 $9.74
92145 26 Corneal hysteresis deter 0.27 $44.28 $11.96
92225 Special eye exam initial 0.78 $44.28 $34.54
92226 Special eye exam subsequent 0.72 $44.28 $31.88
92227 Remote dx retinal imaging 0.40 $44.28 $17.71
92228 Remote retinal imaging mgmt 0.97 $44.28 $42.95
92228 TC Remote retinal imaging mgmt 0.38 $44.28 $16.83
92228 26 Remote retinal imaging mgmt 0.59 $44.28 $26.13
92230 Eye exam with photos 1.83 $44.28 $81.03
92235 Fluorescein angrph uni/bi 2.59 $44.28 $114.69
92235 TC Fluorescein angrph uni/bi 1.36 $44.28 $60.22
92235 26 Fluorescein angrph uni/bi 1.23 $44.28 $54.46
92240 Icg angiography uni/bi 5.83 $44.28 $258.15
92240 TC Icg angiography uni/bi 4.48 $44.28 $198.37
92240 26 Icg angiography uni/bi 1.35 $44.28 $59.78
92242 Fluorescein icg angiography 6.51 $44.28 $288.26
92242 TC Fluorescein icg angiography 4.95 $44.28 $219.19
92242 26 Fluorescein icg angiography 1.56 $44.28 $69.08
92250 Eye exam with photos 1.43 $44.28 $63.32
92250 TC Eye exam with photos 0.81 $44.28 $35.87
92250 26 Eye exam with photos 0.62 $44.28 $27.45
92260 Ophthalmoscopy/dynamometry 0.55 $44.28 $24.35
92265 Eye muscle evaluation 2.48 $44.28 $109.81
92265 TC Eye muscle evaluation 1.15 $44.28 $50.92
92265 26 Eye muscle evaluation 1.33 $44.28 $58.89
92270 Electro-oculography 2.70 $44.28 $119.56
92270 TC Electro-oculography 1.50 $44.28 $66.42
92270 26 Electro-oculography 1.20 $44.28 $53.14
92273 Full field erg w/i&r 3.78 $44.28 $167.38
92273 TC Full field erg w/i&r 2.72 $44.28 $120.44
92273 26 Full field erg w/i&r 1.06 $44.28 $46.94
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
92274 Multifocal erg w/i&r 2.56 $44.28 $113.36
92274 TC Multifocal erg w/i&r 1.62 $44.28 $71.73
92274 26 Multifocal erg w/i&r 0.94 $44.28 $41.62
92283 Color vision examination 1.52 $44.28 $67.31
92283 TC Color vision examination 1.26 $44.28 $55.79
92283 26 Color vision examination 0.26 $44.28 $11.51
92284 Dark adaptation eye exam 1.74 $44.28 $77.05
92284 TC Dark adaptation eye exam 1.38 $44.28 $61.11
92284 26 Dark adaptation eye exam 0.36 $44.28 $15.94
92285 Eye photography 0.61 $44.28 $27.01
92285 TC Eye photography 0.52 $44.28 $23.03
92285 26 Eye photography 0.09 $44.28 $3.99
92286 Internal eye photography 1.10 $44.28 $48.71
92286 TC Internal eye photography 0.47 $44.28 $20.81
92286 26 Internal eye photography 0.63 $44.28 $27.90
92287 Internal eye photography 4.13 $44.28 $182.88
92287 TC Internal eye photography 2.80 $44.28 $123.98
92287 26 Internal eye photography 1.33 $44.28 $58.89
92310 Contact lens fitting 2.80 $44.28 $123.98
92311 Contact lens fitting 2.94 $44.28 $130.18
92312 Contact lens fitting 3.40 $44.28 $150.55
92313 Contact lens fitting 2.78 $44.28 $123.10
92314 Prescription of contact lens 2.36 $44.28 $104.50
92315 Rx cntact lens aphakia 1 eye 2.19 $44.28 $96.97
92316 Rx cntact lens aphakia 2 eye 2.72 $44.28 $120.44
92317 Rx corneoscleral cntact lens 2.29 $44.28 $101.40
92325 Modification of contact lens 1.24 $44.28 $54.91
92326 Replacement of contact lens 1.05 $44.28 $46.49
92340 Fit spectacles monofocal 0.99 $44.28 $43.84
92341 Fit spectacles bifocal 1.14 $44.28 $50.48
92342 Fit spectacles multifocal 1.23 $44.28 $54.46
92352 Fit aphakia spectcl monofocl 1.17 $44.28 $51.81
92353 Fit aphakia spectcl multifoc 1.36 $44.28 $60.22
92354 Fit spectacles single system 0.38 $44.28 $16.83
92355 Fit spectacles compound lens 0.59 $44.28 $26.13
92358 Aphakia prosth service temp 0.32 $44.28 $14.17
92370 Repair & adjust spectacles 0.88 $44.28 $38.97
92371 Repair & adjust spectacles 0.33 $44.28 $14.61
92499 Eye service or procedure 0.00 $44.28 $0.00
92499 TC Eye service or procedure 0.00 $44.28 $0.00
92499 26 Eye service or procedure 0.00 $44.28 $0.00
92502 Ear and throat examination 2.73 $44.28 $120.88
92504 Ear microscopy examination 0.83 $44.28 $36.75
92507 Speech/hearing therapy 2.23 $44.28 $98.74
92508 Speech/hearing therapy 0.67 $44.28 $29.67
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
92511 Nasopharyngoscopy 3.15 $44.28 $139.48
92512 Nasal function studies 1.68 $44.28 $74.39
92516 Facial nerve function test 1.94 $44.28 $85.90
92520 Laryngeal function studies 2.23 $44.28 $98.74
92521 Evaluation of speech fluency 3.21 $44.28 $142.14
92522 Evaluate speech production 2.60 $44.28 $115.13
92523 Speech sound lang comprehen 5.54 $44.28 $245.31
92524 Behavral qualit analys voice 2.51 $44.28 $111.14
92526 Oral function therapy 2.44 $44.28 $108.04
92531 Spontaneous nystagmus study 0.00 $44.28 $0.00
92532 Positional nystagmus test 0.00 $44.28 $0.00
92533 Caloric vestibular test 0.00 $44.28 $0.00
92534 Optokinetic nystagmus test 0.00 $44.28 $0.00
92537 Caloric vstblr test w/rec 1.16 $44.28 $51.36
92537 TC Caloric vstblr test w/rec 0.26 $44.28 $11.51
92537 26 Caloric vstblr test w/rec 0.90 $44.28 $39.85
92538 Caloric vstblr test w/rec 0.60 $44.28 $26.57
92538 TC Caloric vstblr test w/rec 0.15 $44.28 $6.64
92538 26 Caloric vstblr test w/rec 0.45 $44.28 $19.93
92540 Basic vestibular evaluation 2.95 $44.28 $130.63
92540 TC Basic vestibular evaluation 0.70 $44.28 $31.00
92540 26 Basic vestibular evaluation 2.25 $44.28 $99.63
92541 Spontaneous nystagmus test 0.71 $44.28 $31.44
92541 TC Spontaneous nystagmus test 0.11 $44.28 $4.87
92541 26 Spontaneous nystagmus test 0.60 $44.28 $26.57
92542 Positional nystagmus test 0.82 $44.28 $36.31
92542 TC Positional nystagmus test 0.10 $44.28 $4.43
92542 26 Positional nystagmus test 0.72 $44.28 $31.88
92544 Optokinetic nystagmus test 0.49 $44.28 $21.70
92544 TC Optokinetic nystagmus test 0.08 $44.28 $3.54
92544 26 Optokinetic nystagmus test 0.41 $44.28 $18.15
92545 Oscillating tracking test 0.46 $44.28 $20.37
92545 TC Oscillating tracking test 0.08 $44.28 $3.54
92545 26 Oscillating tracking test 0.38 $44.28 $16.83
92546 Sinusoidal rotational test 2.95 $44.28 $130.63
92546 TC Sinusoidal rotational test 2.52 $44.28 $111.59
92546 26 Sinusoidal rotational test 0.43 $44.28 $19.04
92547 Supplemental electrical test 0.21 $44.28 $9.30
92548 Posturography 2.72 $44.28 $120.44
92548 TC Posturography 1.98 $44.28 $87.67
92548 26 Posturography 0.74 $44.28 $32.77
92550 Tympanometry & reflex thresh 0.62 $44.28 $27.45
92551 Pure tone hearing test air 0.33 $44.28 $14.61
92552 Pure tone audiometry air 0.89 $44.28 $39.41
92553 Audiometry air & bone 1.08 $44.28 $47.82
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
92555 Speech threshold audiometry 0.68 $44.28 $30.11
92556 Speech audiometry complete 1.07 $44.28 $47.38
92557 Comprehensive hearing test 1.08 $44.28 $47.82
92558 Evoked auditory test qual 0.28 $44.28 $12.40
92559 Group audiometric testing 0.00 $44.28 $0.00
92560 Bekesy audiometry screen 0.00 $44.28 $0.00
92561 Bekesy audiometry diagnosis 1.10 $44.28 $48.71
92562 Loudness balance test 1.28 $44.28 $56.68
92563 Tone decay hearing test 0.87 $44.28 $38.52
92564 Sisi hearing test 0.71 $44.28 $31.44
92565 Stenger test pure tone 0.43 $44.28 $19.04
92567 Tympanometry 0.43 $44.28 $19.04
92568 Acoustic refl threshold tst 0.45 $44.28 $19.93
92570 Acoustic immitance testing 0.92 $44.28 $40.74
92571 Filtered speech hearing test 0.76 $44.28 $33.65
92572 Staggered spondaic word test 1.21 $44.28 $53.58
92575 Sensorineural acuity test 1.79 $44.28 $79.26
92576 Synthetic sentence test 1.03 $44.28 $45.61
92577 Stenger test speech 0.39 $44.28 $17.27
92579 Visual audiometry (vra) 1.31 $44.28 $58.01
92582 Conditioning play audiometry 2.06 $44.28 $91.22
92583 Select picture audiometry 1.35 $44.28 $59.78
92584 Electrocochleography 2.09 $44.28 $92.55
92585 Auditor evoke potent compre 3.81 $44.28 $168.71
92585 TC Auditor evoke potent compre 3.05 $44.28 $135.05
92585 26 Auditor evoke potent compre 0.76 $44.28 $33.65
92586 Auditor evoke potent limit 2.61 $44.28 $115.57
92587 Evoked auditory test limited 0.62 $44.28 $27.45
92587 TC Evoked auditory test limited 0.10 $44.28 $4.43
92587 26 Evoked auditory test limited 0.52 $44.28 $23.03
92588 Evoked auditory tst complete 0.94 $44.28 $41.62
92588 TC Evoked auditory tst complete 0.12 $44.28 $5.31
92588 26 Evoked auditory tst complete 0.82 $44.28 $36.31
92590 Hearing aid exam one ear 0.00 $44.28 $0.00
92591 Hearing aid exam both ears 0.00 $44.28 $0.00
92592 Hearing aid check one ear 0.00 $44.28 $0.00
92593 Hearing aid check both ears 0.00 $44.28 $0.00
92594 Electro hearng aid test one 0.00 $44.28 $0.00
92595 Electro hearng aid tst both 0.00 $44.28 $0.00
92596 Ear protector evaluation 1.89 $44.28 $83.69
92597 Oral speech device eval 2.06 $44.28 $91.22
92601 Cochlear implt f/up exam <7 4.68 $44.28 $207.23
92602 Reprogram cochlear implt <7 2.92 $44.28 $129.30
92603 Cochlear implt f/up exam 7/> 4.37 $44.28 $193.50
92604 Reprogram cochlear implt 7/> 2.60 $44.28 $115.13
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
92605 Ex for nonspeech device rx 2.65 $44.28 $117.34
92606 Non-speech device service 2.35 $44.28 $104.06
92607 Ex for speech device rx 1hr 3.69 $44.28 $163.39
92608 Ex for speech device rx addl 1.47 $44.28 $65.09
92609 Use of speech device service 3.08 $44.28 $136.38
92610 Evaluate swallowing function 2.45 $44.28 $108.49
92611 Motion fluoroscopy/swallow 2.55 $44.28 $112.91
92612 Endoscopy swallow (fees) vid 5.42 $44.28 $240.00
92613 Endoscopy swallow (fees) i&r 1.07 $44.28 $47.38
92614 Laryngoscopic sensory vid 4.03 $44.28 $178.45
92615 Laryngoscopic sensory i&r 0.94 $44.28 $41.62
92616 Fees w/laryngeal sense test 5.85 $44.28 $259.04
92617 Fees w/laryngeal sense i&r 1.18 $44.28 $52.25
92618 Ex for nonspeech dev rx add 0.96 $44.28 $42.51
92620 Auditory function 60 min 2.67 $44.28 $118.23
92621 Auditory function + 15 min 0.64 $44.28 $28.34
92625 Tinnitus assessment 1.99 $44.28 $88.12
92626 Eval aud rehab status 2.55 $44.28 $112.91
92627 Eval aud status rehab add-on 0.64 $44.28 $28.34
92630 Aud rehab pre-ling hear loss 0.00 $44.28 $0.00
92633 Aud rehab postling hear loss 0.00 $44.28 $0.00
92640 Aud brainstem implt programg 3.25 $44.28 $143.91
92700 Ent procedure/service 0.00 $44.28 $0.00
92920 Prq cardiac angioplast 1 art 15.49 $44.28 $685.90
92921 Prq cardiac angio addl art 0.00 $44.28 $0.00
92924 Prq card angio/athrect 1 art 18.48 $44.28 $818.29
92925 Prq card angio/athrect addl 0.00 $44.28 $0.00
92928 Prq card stent w/angio 1 vsl 17.24 $44.28 $763.39
92929 Prq card stent w/angio addl 0.00 $44.28 $0.00
92933 Prq card stent/ath/angio 19.34 $44.28 $856.38
92934 Prq card stent/ath/angio 0.00 $44.28 $0.00
92937 Prq revasc byp graft 1 vsl 17.23 $44.28 $762.94
92938 Prq revasc byp graft addl 0.00 $44.28 $0.00
92941 Prq card revasc mi 1 vsl 19.39 $44.28 $858.59
92943 Prq card revasc chronic 1vsl 19.38 $44.28 $858.15
92944 Prq card revasc chronic addl 0.00 $44.28 $0.00
92950 Heart/lung resuscitation cpr 8.92 $44.28 $394.98
92953 Temporary external pacing 0.03 $44.28 $1.33
92960 Cardioversion electric ext 4.51 $44.28 $199.70
92961 Cardioversion electric int 7.23 $44.28 $320.14
92970 Cardioassist internal 5.52 $44.28 $244.43
92971 Cardioassist external 2.91 $44.28 $128.85
92973 Prq coronary mech thrombect 5.15 $44.28 $228.04
92974 Cath place cardio brachytx 4.72 $44.28 $209.00
92975 Dissolve clot heart vessel 10.98 $44.28 $486.19
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
92977 Dissolve clot heart vessel 1.56 $44.28 $69.08
92978 Endoluminl ivus oct c 1st 0.00 $44.28 $0.00
92978 TC Endoluminl ivus oct c 1st 0.00 $44.28 $0.00
92978 26 Endoluminl ivus oct c 1st 2.79 $44.28 $123.54
92979 Endoluminl ivus oct c ea 0.00 $44.28 $0.00
92979 TC Endoluminl ivus oct c ea 0.00 $44.28 $0.00
92979 26 Endoluminl ivus oct c ea 2.22 $44.28 $98.30
92986 Revision of aortic valve 38.38 $44.28 $1,699.47
92987 Revision of mitral valve 39.59 $44.28 $1,753.05
92990 Revision of pulmonary valve 31.62 $44.28 $1,400.13
92992 Revision of heart chamber 0.00 $44.28 $0.00
92993 Revision of heart chamber 0.00 $44.28 $0.00
92997 Pul art balloon repr percut 19.09 $44.28 $845.31
92998 Pul art balloon repr percut 9.44 $44.28 $418.00
93000 Electrocardiogram complete 0.48 $44.28 $21.25
93005 Electrocardiogram tracing 0.24 $44.28 $10.63
93010 Electrocardiogram report 0.24 $44.28 $10.63
93015 Cardiovascular stress test 2.01 $44.28 $89.00
93016 Cardiovascular stress test 0.63 $44.28 $27.90
93017 Cardiovascular stress test 0.96 $44.28 $42.51
93018 Cardiovascular stress test 0.42 $44.28 $18.60
93024 Cardiac drug stress test 3.12 $44.28 $138.15
93024 TC Cardiac drug stress test 1.50 $44.28 $66.42
93024 26 Cardiac drug stress test 1.62 $44.28 $71.73
93025 Microvolt t-wave assess 4.23 $44.28 $187.30
93025 TC Microvolt t-wave assess 3.18 $44.28 $140.81
93025 26 Microvolt t-wave assess 1.05 $44.28 $46.49
93040 Rhythm ecg with report 0.36 $44.28 $15.94
93041 Rhythm ecg tracing 0.16 $44.28 $7.08
93042 Rhythm ecg report 0.20 $44.28 $8.86
93050 Art pressure waveform analys 0.46 $44.28 $20.37
93050 TC Art pressure waveform analys 0.22 $44.28 $9.74
93050 26 Art pressure waveform analys 0.24 $44.28 $10.63
93224 Ecg monit/reprt up to 48 hrs 2.51 $44.28 $111.14
93225 Ecg monit/reprt up to 48 hrs 0.73 $44.28 $32.32
93226 Ecg monit/reprt up to 48 hrs 1.03 $44.28 $45.61
93227 Ecg monit/reprt up to 48 hrs 0.75 $44.28 $33.21
93228 Remote 30 day ecg rev/report 0.74 $44.28 $32.77
93229 Remote 30 day ecg tech supp 19.95 $44.28 $883.39
93260 Prgrmg dev eval impltbl sys 1.93 $44.28 $85.46
93260 TC Prgrmg dev eval impltbl sys 0.71 $44.28 $31.44
93260 26 Prgrmg dev eval impltbl sys 1.22 $44.28 $54.02
93261 Interrogate subq defib 1.77 $44.28 $78.38
93261 TC Interrogate subq defib 0.71 $44.28 $31.44
93261 26 Interrogate subq defib 1.06 $44.28 $46.94
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93264 Rem mntr wrls p-art prs snr 1.44 $44.28 $63.76
93268 Ecg record/review 5.70 $44.28 $252.40
93270 Remote 30 day ecg rev/report 0.26 $44.28 $11.51
93271 Ecg/monitoring and analysis 4.72 $44.28 $209.00
93272 Ecg/review interpret only 0.72 $44.28 $31.88
93278 Ecg/signal-averaged 0.87 $44.28 $38.52
93278 TC Ecg/signal-averaged 0.51 $44.28 $22.58
93278 26 Ecg/signal-averaged 0.36 $44.28 $15.94
93279 Prgrmg dev eval pm/ldls pm 1.56 $44.28 $69.08
93279 TC Prgrmg dev eval pm/ldls pm 0.64 $44.28 $28.34
93279 26 Prgrmg dev eval pm/ldls pm 0.92 $44.28 $40.74
93280 Pm device progr eval dual 1.83 $44.28 $81.03
93280 TC Pm device progr eval dual 0.74 $44.28 $32.77
93280 26 Pm device progr eval dual 1.09 $44.28 $48.27
93281 Pm device progr eval multi 1.97 $44.28 $87.23
93281 TC Pm device progr eval multi 0.75 $44.28 $33.21
93281 26 Pm device progr eval multi 1.22 $44.28 $54.02
93282 Prgrmg eval implantable dfb 1.90 $44.28 $84.13
93282 TC Prgrmg eval implantable dfb 0.69 $44.28 $30.55
93282 26 Prgrmg eval implantable dfb 1.21 $44.28 $53.58
93283 Prgrmg eval implantable dfb 2.39 $44.28 $105.83
93283 TC Prgrmg eval implantable dfb 0.75 $44.28 $33.21
93283 26 Prgrmg eval implantable dfb 1.64 $44.28 $72.62
93284 Prgrmg eval implantable dfb 2.59 $44.28 $114.69
93284 TC Prgrmg eval implantable dfb 0.80 $44.28 $35.42
93284 26 Prgrmg eval implantable dfb 1.79 $44.28 $79.26
93285 Prgrmg dev eval scrms ip 1.37 $44.28 $60.66
93285 TC Prgrmg dev eval scrms ip 0.62 $44.28 $27.45
93285 26 Prgrmg dev eval scrms ip 0.75 $44.28 $33.21
93286 Peri-px eval pm/ldls pm ip 0.99 $44.28 $43.84
93286 TC Peri-px eval pm/ldls pm ip 0.56 $44.28 $24.80
93286 26 Peri-px eval pm/ldls pm ip 0.43 $44.28 $19.04
93287 Peri-px device eval & prgr 1.22 $44.28 $54.02
93287 TC Peri-px device eval & prgr 0.56 $44.28 $24.80
93287 26 Peri-px device eval & prgr 0.66 $44.28 $29.22
93288 Interrog evl pm/ldls pm ip 1.25 $44.28 $55.35
93288 TC Interrog evl pm/ldls pm ip 0.64 $44.28 $28.34
93288 26 Interrog evl pm/ldls pm ip 0.61 $44.28 $27.01
93289 Interrog device eval heart 1.70 $44.28 $75.28
93289 TC Interrog device eval heart 0.64 $44.28 $28.34
93289 26 Interrog device eval heart 1.06 $44.28 $46.94
93290 Interrog dev eval icpms ip 1.19 $44.28 $52.69
93290 TC Interrog dev eval icpms ip 0.57 $44.28 $25.24
93290 26 Interrog dev eval icpms ip 0.62 $44.28 $27.45
93291 Interrog dev eval scrms ip 1.07 $44.28 $47.38
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93291 TC Interrog dev eval scrms ip 0.55 $44.28 $24.35
93291 26 Interrog dev eval scrms ip 0.52 $44.28 $23.03
93292 Wcd device interrogate 1.14 $44.28 $50.48
93292 TC Wcd device interrogate 0.53 $44.28 $23.47
93292 26 Wcd device interrogate 0.61 $44.28 $27.01
93293 Pm phone r-strip device eval 1.48 $44.28 $65.53
93293 TC Pm phone r-strip device eval 1.05 $44.28 $46.49
93293 26 Pm phone r-strip device eval 0.43 $44.28 $19.04
93294 Rem interrog evl pm/ldls pm 0.87 $44.28 $38.52
93295 Dev interrog remote 1/2/mlt 1.26 $44.28 $55.79
93296 Rem interrog evl pm/ids 0.72 $44.28 $31.88
93297 Rem interrog dev eval icpms 0.75 $44.28 $33.21
93298 Rem interrog dev eval scrms 0.75 $44.28 $33.21
93299 Interrog eval icpms/scrms 0.00 $44.28 $0.00
93303 Echo transthoracic 6.65 $44.28 $294.46
93303 TC Echo transthoracic 4.84 $44.28 $214.32
93303 26 Echo transthoracic 1.81 $44.28 $80.15
93304 Echo transthoracic 4.53 $44.28 $200.59
93304 TC Echo transthoracic 3.49 $44.28 $154.54
93304 26 Echo transthoracic 1.04 $44.28 $46.05
93306 Tte w/doppler complete 5.84 $44.28 $258.60
93306 TC Tte w/doppler complete 3.76 $44.28 $166.49
93306 26 Tte w/doppler complete 2.08 $44.28 $92.10
93307 Tte w/o doppler complete 3.97 $44.28 $175.79
93307 TC Tte w/o doppler complete 2.69 $44.28 $119.11
93307 26 Tte w/o doppler complete 1.28 $44.28 $56.68
93308 Tte f-up or lmtd 2.78 $44.28 $123.10
93308 TC Tte f-up or lmtd 2.05 $44.28 $90.77
93308 26 Tte f-up or lmtd 0.73 $44.28 $32.32
93312 Echo transesophageal 6.97 $44.28 $308.63
93312 TC Echo transesophageal 3.86 $44.28 $170.92
93312 26 Echo transesophageal 3.11 $44.28 $137.71
93313 Echo transesophageal 0.33 $44.28 $14.61
93314 Echo transesophageal 6.73 $44.28 $298.00
93314 TC Echo transesophageal 4.12 $44.28 $182.43
93314 26 Echo transesophageal 2.61 $44.28 $115.57
93315 Echo transesophageal 0.00 $44.28 $0.00
93315 TC Echo transesophageal 0.00 $44.28 $0.00
93315 26 Echo transesophageal 3.66 $44.28 $162.06
93316 Echo transesophageal 0.79 $44.28 $34.98
93317 Echo transesophageal 0.00 $44.28 $0.00
93317 TC Echo transesophageal 0.00 $44.28 $0.00
93317 26 Echo transesophageal 2.64 $44.28 $116.90
93318 Echo transesophageal intraop 0.00 $44.28 $0.00
93318 TC Echo transesophageal intraop 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93318 26 Echo transesophageal intraop 2.98 $44.28 $131.95
93320 Doppler echo exam heart 1.51 $44.28 $66.86
93320 TC Doppler echo exam heart 0.99 $44.28 $43.84
93320 26 Doppler echo exam heart 0.52 $44.28 $23.03
93321 Doppler echo exam heart 0.76 $44.28 $33.65
93321 TC Doppler echo exam heart 0.55 $44.28 $24.35
93321 26 Doppler echo exam heart 0.21 $44.28 $9.30
93325 Doppler color flow add-on 0.71 $44.28 $31.44
93325 TC Doppler color flow add-on 0.62 $44.28 $27.45
93325 26 Doppler color flow add-on 0.09 $44.28 $3.99
93350 Stress tte only 5.31 $44.28 $235.13
93350 TC Stress tte only 3.29 $44.28 $145.68
93350 26 Stress tte only 2.02 $44.28 $89.45
93351 Stress tte complete 6.57 $44.28 $290.92
93351 TC Stress tte complete 4.15 $44.28 $183.76
93351 26 Stress tte complete 2.42 $44.28 $107.16
93352 Admin ecg contrast agent 0.95 $44.28 $42.07
93355 Echo transesophageal (tee) 6.57 $44.28 $290.92
93451 Right heart cath 22.14 $44.28 $980.36
93451 TC Right heart cath 18.35 $44.28 $812.54
93451 26 Right heart cath 3.79 $44.28 $167.82
93452 Left hrt cath w/ventrclgrphy 24.60 $44.28 $1,089.29
93452 TC Left hrt cath w/ventrclgrphy 17.69 $44.28 $783.31
93452 26 Left hrt cath w/ventrclgrphy 6.91 $44.28 $305.97
93453 R&l hrt cath w/ventriclgrphy 31.92 $44.28 $1,413.42
93453 TC R&l hrt cath w/ventriclgrphy 22.64 $44.28 $1,002.50
93453 26 R&l hrt cath w/ventriclgrphy 9.28 $44.28 $410.92
93454 Coronary artery angio s&i 24.85 $44.28 $1,100.36
93454 TC Coronary artery angio s&i 17.84 $44.28 $789.96
93454 26 Coronary artery angio s&i 7.01 $44.28 $310.40
93455 Coronary art/grft angio s&i 28.64 $44.28 $1,268.18
93455 TC Coronary art/grft angio s&i 20.47 $44.28 $906.41
93455 26 Coronary art/grft angio s&i 8.17 $44.28 $361.77
93456 R hrt coronary artery angio 31.47 $44.28 $1,393.49
93456 TC R hrt coronary artery angio 22.36 $44.28 $990.10
93456 26 R hrt coronary artery angio 9.11 $44.28 $403.39
93457 R hrt art/grft angio 35.18 $44.28 $1,557.77
93457 TC R hrt art/grft angio 24.94 $44.28 $1,104.34
93457 26 R hrt art/grft angio 10.24 $44.28 $453.43
93458 L hrt artery/ventricle angio 29.50 $44.28 $1,306.26
93458 TC L hrt artery/ventricle angio 20.85 $44.28 $923.24
93458 26 L hrt artery/ventricle angio 8.65 $44.28 $383.02
93459 L hrt art/grft angio 32.40 $44.28 $1,434.67
93459 TC L hrt art/grft angio 22.61 $44.28 $1,001.17
93459 26 L hrt art/grft angio 9.79 $44.28 $433.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93460 R&l hrt art/ventricle angio 35.40 $44.28 $1,567.51
93460 TC R&l hrt art/ventricle angio 24.45 $44.28 $1,082.65
93460 26 R&l hrt art/ventricle angio 10.95 $44.28 $484.87
93461 R&l hrt art/ventricle angio 40.07 $44.28 $1,774.30
93461 TC R&l hrt art/ventricle angio 27.95 $44.28 $1,237.63
93461 26 R&l hrt art/ventricle angio 12.12 $44.28 $536.67
93462 L hrt cath trnsptl puncture 6.11 $44.28 $270.55
93463 Drug admin & hemodynmic meas 2.82 $44.28 $124.87
93464 Exercise w/hemodynamic meas 7.04 $44.28 $311.73
93464 TC Exercise w/hemodynamic meas 4.54 $44.28 $201.03
93464 26 Exercise w/hemodynamic meas 2.50 $44.28 $110.70
93503 Insert/place heart catheter 2.55 $44.28 $112.91
93505 Biopsy of heart lining 19.95 $44.28 $883.39
93505 TC Biopsy of heart lining 13.55 $44.28 $599.99
93505 26 Biopsy of heart lining 6.40 $44.28 $283.39
93530 Rt heart cath congenital 0.00 $44.28 $0.00
93530 TC Rt heart cath congenital 0.00 $44.28 $0.00
93530 26 Rt heart cath congenital 5.97 $44.28 $264.35
93531 R & l heart cath congenital 0.00 $44.28 $0.00
93531 TC R & l heart cath congenital 0.00 $44.28 $0.00
93531 26 R & l heart cath congenital 12.39 $44.28 $548.63
93532 R & l heart cath congenital 0.00 $44.28 $0.00
93532 TC R & l heart cath congenital 0.00 $44.28 $0.00
93532 26 R & l heart cath congenital 15.47 $44.28 $685.01
93533 R & l heart cath congenital 0.00 $44.28 $0.00
93533 TC R & l heart cath congenital 0.00 $44.28 $0.00
93533 26 R & l heart cath congenital 10.33 $44.28 $457.41
93561 Cardiac output measurement 0.00 $44.28 $0.00
93561 TC Cardiac output measurement 0.00 $44.28 $0.00
93561 26 Cardiac output measurement 1.31 $44.28 $58.01
93562 Card output measure subsq 0.00 $44.28 $0.00
93562 TC Card output measure subsq 0.00 $44.28 $0.00
93562 26 Card output measure subsq 1.06 $44.28 $46.94
93563 Inject congenital card cath 1.69 $44.28 $74.83
93564 Inject hrt congntl art/grft 1.79 $44.28 $79.26
93565 Inject l ventr/atrial angio 1.31 $44.28 $58.01
93566 Inject r ventr/atrial angio 4.38 $44.28 $193.95
93567 Inject suprvlv aortography 3.71 $44.28 $164.28
93568 Inject pulm art hrt cath 3.97 $44.28 $175.79
93571 Heart flow reserve measure 0.00 $44.28 $0.00
93571 TC Heart flow reserve measure 0.00 $44.28 $0.00
93571 26 Heart flow reserve measure 2.24 $44.28 $99.19
93572 Heart flow reserve measure 0.00 $44.28 $0.00
93572 TC Heart flow reserve measure 0.00 $44.28 $0.00
93572 26 Heart flow reserve measure 1.81 $44.28 $80.15
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93580 Transcath closure of asd 28.45 $44.28 $1,259.77
93581 Transcath closure of vsd 38.77 $44.28 $1,716.74
93582 Perq transcath closure pda 19.42 $44.28 $859.92
93583 Perq transcath septal reduxn 21.64 $44.28 $958.22
93590 Perq transcath cls mitral 31.20 $44.28 $1,381.54
93591 Perq transcath cls aortic 25.70 $44.28 $1,138.00
93592 Perq transcath closure each 11.39 $44.28 $504.35
93600 Bundle of his recording 0.00 $44.28 $0.00
93600 TC Bundle of his recording 0.00 $44.28 $0.00
93600 26 Bundle of his recording 3.45 $44.28 $152.77
93602 Intra-atrial recording 0.00 $44.28 $0.00
93602 TC Intra-atrial recording 0.00 $44.28 $0.00
93602 26 Intra-atrial recording 3.38 $44.28 $149.67
93603 Right ventricular recording 0.00 $44.28 $0.00
93603 TC Right ventricular recording 0.00 $44.28 $0.00
93603 26 Right ventricular recording 3.39 $44.28 $150.11
93609 Map tachycardia add-on 0.00 $44.28 $0.00
93609 TC Map tachycardia add-on 0.00 $44.28 $0.00
93609 26 Map tachycardia add-on 8.10 $44.28 $358.67
93610 Intra-atrial pacing 0.00 $44.28 $0.00
93610 TC Intra-atrial pacing 0.00 $44.28 $0.00
93610 26 Intra-atrial pacing 4.77 $44.28 $211.22
93612 Intraventricular pacing 0.00 $44.28 $0.00
93612 TC Intraventricular pacing 0.00 $44.28 $0.00
93612 26 Intraventricular pacing 4.72 $44.28 $209.00
93613 Electrophys map 3d add-on 8.63 $44.28 $382.14
93615 Esophageal recording 0.00 $44.28 $0.00
93615 TC Esophageal recording 0.00 $44.28 $0.00
93615 26 Esophageal recording 1.09 $44.28 $48.27
93616 Esophageal recording 0.00 $44.28 $0.00
93616 TC Esophageal recording 0.00 $44.28 $0.00
93616 26 Esophageal recording 1.71 $44.28 $75.72
93618 Heart rhythm pacing 0.00 $44.28 $0.00
93618 TC Heart rhythm pacing 0.00 $44.28 $0.00
93618 26 Heart rhythm pacing 6.43 $44.28 $284.72
93619 Electrophysiology evaluation 0.00 $44.28 $0.00
93619 TC Electrophysiology evaluation 0.00 $44.28 $0.00
93619 26 Electrophysiology evaluation 11.37 $44.28 $503.46
93620 Electrophysiology evaluation 0.00 $44.28 $0.00
93620 TC Electrophysiology evaluation 0.00 $44.28 $0.00
93620 26 Electrophysiology evaluation 18.28 $44.28 $809.44
93621 Electrophysiology evaluation 0.00 $44.28 $0.00
93621 TC Electrophysiology evaluation 0.00 $44.28 $0.00
93621 26 Electrophysiology evaluation 3.39 $44.28 $150.11
93622 Electrophysiology evaluation 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93622 TC Electrophysiology evaluation 0.00 $44.28 $0.00
93622 26 Electrophysiology evaluation 5.02 $44.28 $222.29
93623 Stimulation pacing heart 0.00 $44.28 $0.00
93623 TC Stimulation pacing heart 0.00 $44.28 $0.00
93623 26 Stimulation pacing heart 4.61 $44.28 $204.13
93624 Electrophysiologic study 0.00 $44.28 $0.00
93624 TC Electrophysiologic study 0.00 $44.28 $0.00
93624 26 Electrophysiologic study 7.04 $44.28 $311.73
93631 Heart pacing mapping 0.00 $44.28 $0.00
93631 TC Heart pacing mapping 0.00 $44.28 $0.00
93631 26 Heart pacing mapping 11.49 $44.28 $508.78
93640 Evaluation heart device 0.00 $44.28 $0.00
93640 TC Evaluation heart device 0.00 $44.28 $0.00
93640 26 Evaluation heart device 5.20 $44.28 $230.26
93641 Electrophysiology evaluation 0.00 $44.28 $0.00
93641 TC Electrophysiology evaluation 0.00 $44.28 $0.00
93641 26 Electrophysiology evaluation 9.10 $44.28 $402.95
93642 Electrophysiology evaluation 9.78 $44.28 $433.06
93642 TC Electrophysiology evaluation 2.32 $44.28 $102.73
93642 26 Electrophysiology evaluation 7.46 $44.28 $330.33
93644 Electrophysiology evaluation 5.65 $44.28 $250.18
93644 TC Electrophysiology evaluation 1.47 $44.28 $65.09
93644 26 Electrophysiology evaluation 4.18 $44.28 $185.09
93650 Ablate heart dysrhythm focus 17.20 $44.28 $761.62
93653 Ep & ablate supravent arrhyt 24.36 $44.28 $1,078.66
93654 Ep & ablate ventric tachy 32.60 $44.28 $1,443.53
93655 Ablate arrhythmia add on 12.40 $44.28 $549.07
93656 Tx atrial fib pulm vein isol 32.70 $44.28 $1,447.96
93657 Tx l/r atrial fib addl 12.38 $44.28 $548.19
93660 Tilt table evaluation 4.51 $44.28 $199.70
93660 TC Tilt table evaluation 1.84 $44.28 $81.48
93660 26 Tilt table evaluation 2.67 $44.28 $118.23
93662 Intracardiac ecg (ice) 0.00 $44.28 $0.00
93662 TC Intracardiac ecg (ice) 0.00 $44.28 $0.00
93662 26 Intracardiac ecg (ice) 4.07 $44.28 $180.22
93668 Peripheral vascular rehab 0.50 $44.28 $22.14
93701 Bioimpedance cv analysis 0.71 $44.28 $31.44
93702 Bis xtracell fluid analysis 3.57 $44.28 $158.08
93724 Analyze pacemaker system 7.89 $44.28 $349.37
93724 TC Analyze pacemaker system 0.94 $44.28 $41.62
93724 26 Analyze pacemaker system 6.95 $44.28 $307.75
93740 Temperature gradient studies 0.23 $44.28 $10.18
93745 Set-up cardiovert-defibrill 0.00 $44.28 $0.00
93745 TC Set-up cardiovert-defibrill 0.00 $44.28 $0.00
93745 26 Set-up cardiovert-defibrill 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93750 Interrogation vad in person 1.58 $44.28 $69.96
93770 Measure venous pressure 0.23 $44.28 $10.18
93784 Ambulatory bp monitoring 1.51 $44.28 $66.86
93786 Ambulatory bp recording 0.83 $44.28 $36.75
93788 Ambulatory bp analysis 0.15 $44.28 $6.64
93790 Review/report bp recording 0.53 $44.28 $23.47
93792 Pt/caregiver trainj home inr 1.48 $44.28 $65.53
93793 Anticoag mgmt pt warfarin 0.34 $44.28 $15.06
93797 Cardiac rehab 0.46 $44.28 $20.37
93798 Cardiac rehab/monitor 0.72 $44.28 $31.88
93799 Cardiovascular procedure 0.00 $44.28 $0.00
93799 TC Cardiovascular procedure 0.00 $44.28 $0.00
93799 26 Cardiovascular procedure 0.00 $44.28 $0.00
93880 Extracranial bilat study 5.70 $44.28 $252.40
93880 TC Extracranial bilat study 4.56 $44.28 $201.92
93880 26 Extracranial bilat study 1.14 $44.28 $50.48
93882 Extracranial uni/ltd study 3.64 $44.28 $161.18
93882 TC Extracranial uni/ltd study 2.93 $44.28 $129.74
93882 26 Extracranial uni/ltd study 0.71 $44.28 $31.44
93886 Intracranial complete study 7.67 $44.28 $339.63
93886 TC Intracranial complete study 6.33 $44.28 $280.29
93886 26 Intracranial complete study 1.34 $44.28 $59.34
93888 Intracranial limited study 4.47 $44.28 $197.93
93888 TC Intracranial limited study 3.73 $44.28 $165.16
93888 26 Intracranial limited study 0.74 $44.28 $32.77
93890 Tcd vasoreactivity study 7.82 $44.28 $346.27
93890 TC Tcd vasoreactivity study 6.36 $44.28 $281.62
93890 26 Tcd vasoreactivity study 1.46 $44.28 $64.65
93892 Tcd emboli detect w/o inj 8.81 $44.28 $390.11
93892 TC Tcd emboli detect w/o inj 7.10 $44.28 $314.39
93892 26 Tcd emboli detect w/o inj 1.71 $44.28 $75.72
93893 Tcd emboli detect w/inj 9.81 $44.28 $434.39
93893 TC Tcd emboli detect w/inj 8.10 $44.28 $358.67
93893 26 Tcd emboli detect w/inj 1.71 $44.28 $75.72
93895 Carotid intima atheroma eval 0.00 $44.28 $0.00
93895 TC Carotid intima atheroma eval 0.00 $44.28 $0.00
93895 26 Carotid intima atheroma eval 0.00 $44.28 $0.00
93922 Upr/l xtremity art 2 levels 2.44 $44.28 $108.04
93922 TC Upr/l xtremity art 2 levels 2.08 $44.28 $92.10
93922 26 Upr/l xtremity art 2 levels 0.36 $44.28 $15.94
93923 Upr/lxtr art stdy 3+ lvls 3.78 $44.28 $167.38
93923 TC Upr/lxtr art stdy 3+ lvls 3.15 $44.28 $139.48
93923 26 Upr/lxtr art stdy 3+ lvls 0.63 $44.28 $27.90
93924 Lwr xtr vasc stdy bilat 4.67 $44.28 $206.79
93924 TC Lwr xtr vasc stdy bilat 3.97 $44.28 $175.79
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
93924 26 Lwr xtr vasc stdy bilat 0.70 $44.28 $31.00
93925 Lower extremity study 7.25 $44.28 $321.03
93925 TC Lower extremity study 6.13 $44.28 $271.44
93925 26 Lower extremity study 1.12 $44.28 $49.59
93926 Lower extremity study 4.26 $44.28 $188.63
93926 TC Lower extremity study 3.57 $44.28 $158.08
93926 26 Lower extremity study 0.69 $44.28 $30.55
93930 Upper extremity study 5.82 $44.28 $257.71
93930 TC Upper extremity study 4.69 $44.28 $207.67
93930 26 Upper extremity study 1.13 $44.28 $50.04
93931 Upper extremity study 3.63 $44.28 $160.74
93931 TC Upper extremity study 2.93 $44.28 $129.74
93931 26 Upper extremity study 0.70 $44.28 $31.00
93970 Extremity study 5.52 $44.28 $244.43
93970 TC Extremity study 4.54 $44.28 $201.03
93970 26 Extremity study 0.98 $44.28 $43.39
93971 Extremity study 3.42 $44.28 $151.44
93971 TC Extremity study 2.78 $44.28 $123.10
93971 26 Extremity study 0.64 $44.28 $28.34
93975 Vascular study 7.88 $44.28 $348.93
93975 TC Vascular study 6.24 $44.28 $276.31
93975 26 Vascular study 1.64 $44.28 $72.62
93976 Vascular study 4.64 $44.28 $205.46
93976 TC Vascular study 3.51 $44.28 $155.42
93976 26 Vascular study 1.13 $44.28 $50.04
93978 Vascular study 5.34 $44.28 $236.46
93978 TC Vascular study 4.22 $44.28 $186.86
93978 26 Vascular study 1.12 $44.28 $49.59
93979 Vascular study 3.40 $44.28 $150.55
93979 TC Vascular study 2.70 $44.28 $119.56
93979 26 Vascular study 0.70 $44.28 $31.00
93980 Penile vascular study 3.53 $44.28 $156.31
93980 TC Penile vascular study 1.77 $44.28 $78.38
93980 26 Penile vascular study 1.76 $44.28 $77.93
93981 Penile vascular study 2.15 $44.28 $95.20
93981 TC Penile vascular study 1.53 $44.28 $67.75
93981 26 Penile vascular study 0.62 $44.28 $27.45
93990 Doppler flow testing 4.42 $44.28 $195.72
93990 TC Doppler flow testing 3.72 $44.28 $164.72
93990 26 Doppler flow testing 0.70 $44.28 $31.00
93998 Noninvas vasc dx study proc 0.00 $44.28 $0.00
94002 Vent mgmt inpat init day 2.64 $44.28 $116.90
94003 Vent mgmt inpat subq day 1.89 $44.28 $83.69
94004 Vent mgmt nf per day 1.40 $44.28 $61.99
94005 Home vent mgmt supervision 2.61 $44.28 $115.57
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
94010 Breathing capacity test 1.00 $44.28 $44.28
94010 TC Breathing capacity test 0.76 $44.28 $33.65
94010 26 Breathing capacity test 0.24 $44.28 $10.63
94011 Spirometry up to 2 yrs old 2.48 $44.28 $109.81
94012 Spirmtry w/brnchdil inf-2 yr 4.02 $44.28 $178.01
94013 Meas lung vol thru 2 yrs 0.55 $44.28 $24.35
94014 Patient recorded spirometry 1.58 $44.28 $69.96
94015 Patient recorded spirometry 0.86 $44.28 $38.08
94016 Review patient spirometry 0.72 $44.28 $31.88
94060 Evaluation of wheezing 1.68 $44.28 $74.39
94060 TC Evaluation of wheezing 1.31 $44.28 $58.01
94060 26 Evaluation of wheezing 0.37 $44.28 $16.38
94070 Evaluation of wheezing 1.69 $44.28 $74.83
94070 TC Evaluation of wheezing 0.87 $44.28 $38.52
94070 26 Evaluation of wheezing 0.82 $44.28 $36.31
94150 Vital capacity test 0.72 $44.28 $31.88
94150 TC Vital capacity test 0.61 $44.28 $27.01
94150 26 Vital capacity test 0.11 $44.28 $4.87
94200 Lung function test (mbc/mvv) 0.78 $44.28 $34.54
94200 TC Lung function test (mbc/mvv) 0.62 $44.28 $27.45
94200 26 Lung function test (mbc/mvv) 0.16 $44.28 $7.08
94250 Expired gas collection 0.78 $44.28 $34.54
94250 TC Expired gas collection 0.62 $44.28 $27.45
94250 26 Expired gas collection 0.16 $44.28 $7.08
94375 Respiratory flow volume loop 1.12 $44.28 $49.59
94375 TC Respiratory flow volume loop 0.70 $44.28 $31.00
94375 26 Respiratory flow volume loop 0.42 $44.28 $18.60
94400 Co2 breathing response curve 1.61 $44.28 $71.29
94400 TC Co2 breathing response curve 1.05 $44.28 $46.49
94400 26 Co2 breathing response curve 0.56 $44.28 $24.80
94450 Hypoxia response curve 2.06 $44.28 $91.22
94450 TC Hypoxia response curve 1.49 $44.28 $65.98
94450 26 Hypoxia response curve 0.57 $44.28 $25.24
94452 Hast w/report 1.55 $44.28 $68.63
94452 TC Hast w/report 1.14 $44.28 $50.48
94452 26 Hast w/report 0.41 $44.28 $18.15
94453 Hast w/oxygen titrate 2.14 $44.28 $94.76
94453 TC Hast w/oxygen titrate 1.60 $44.28 $70.85
94453 26 Hast w/oxygen titrate 0.54 $44.28 $23.91
94610 Surfactant admin thru tube 1.59 $44.28 $70.41
94617 Exercise tst brncspsm 2.66 $44.28 $117.78
94617 TC Exercise tst brncspsm 1.71 $44.28 $75.72
94617 26 Exercise tst brncspsm 0.95 $44.28 $42.07
94618 Pulmonary stress testing 0.96 $44.28 $42.51
94618 TC Pulmonary stress testing 0.31 $44.28 $13.73
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
94618 26 Pulmonary stress testing 0.65 $44.28 $28.78
94621 Cardiopulm exercise testing 4.54 $44.28 $201.03
94621 TC Cardiopulm exercise testing 2.58 $44.28 $114.24
94621 26 Cardiopulm exercise testing 1.96 $44.28 $86.79
94640 Airway inhalation treatment 0.51 $44.28 $22.58
94642 Aerosol inhalation treatment 0.00 $44.28 $0.00
94644 Cbt 1st hour 1.40 $44.28 $61.99
94645 Cbt each addl hour 0.47 $44.28 $20.81
94660 Pos airway pressure cpap 1.81 $44.28 $80.15
94662 Neg press ventilation cnp 1.03 $44.28 $45.61
94664 Evaluate pt use of inhaler 0.48 $44.28 $21.25
94667 Chest wall manipulation 0.71 $44.28 $31.44
94668 Chest wall manipulation 0.92 $44.28 $40.74
94669 Mechanical chest wall oscill 0.90 $44.28 $39.85
94680 Exhaled air analysis o2 1.57 $44.28 $69.52
94680 TC Exhaled air analysis o2 1.21 $44.28 $53.58
94680 26 Exhaled air analysis o2 0.36 $44.28 $15.94
94681 Exhaled air analysis o2/co2 1.55 $44.28 $68.63
94681 TC Exhaled air analysis o2/co2 1.26 $44.28 $55.79
94681 26 Exhaled air analysis o2/co2 0.29 $44.28 $12.84
94690 Exhaled air analysis 1.49 $44.28 $65.98
94690 TC Exhaled air analysis 1.38 $44.28 $61.11
94690 26 Exhaled air analysis 0.11 $44.28 $4.87
94726 Pulm funct tst plethysmograp 1.52 $44.28 $67.31
94726 TC Pulm funct tst plethysmograp 1.17 $44.28 $51.81
94726 26 Pulm funct tst plethysmograp 0.35 $44.28 $15.50
94727 Pulm function test by gas 1.23 $44.28 $54.46
94727 TC Pulm function test by gas 0.88 $44.28 $38.97
94727 26 Pulm function test by gas 0.35 $44.28 $15.50
94728 Pulm funct test oscillometry 1.15 $44.28 $50.92
94728 TC Pulm funct test oscillometry 0.79 $44.28 $34.98
94728 26 Pulm funct test oscillometry 0.36 $44.28 $15.94
94729 Co/membane diffuse capacity 1.56 $44.28 $69.08
94729 TC Co/membane diffuse capacity 1.30 $44.28 $57.56
94729 26 Co/membane diffuse capacity 0.26 $44.28 $11.51
94750 Pulmonary compliance study 2.40 $44.28 $106.27
94750 TC Pulmonary compliance study 2.09 $44.28 $92.55
94750 26 Pulmonary compliance study 0.31 $44.28 $13.73
94760 Measure blood oxygen level 0.07 $44.28 $3.10
94761 Measure blood oxygen level 0.12 $44.28 $5.31
94762 Measure blood oxygen level 0.71 $44.28 $31.44
94770 Exhaled carbon dioxide test 0.21 $44.28 $9.30
94772 Breath recording infant 0.00 $44.28 $0.00
94772 TC Breath recording infant 0.00 $44.28 $0.00
94772 26 Breath recording infant 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
94774 Ped home apnea rec compl 0.00 $44.28 $0.00
94775 Ped home apnea rec hk-up 0.00 $44.28 $0.00
94776 Ped home apnea rec downld 0.00 $44.28 $0.00
94777 Ped home apnea rec report 0.00 $44.28 $0.00
94780 Cars/bd tst inft-12mo 60 min 1.45 $44.28 $64.21
94781 Cars/bd tst inft-12mo +30min 0.57 $44.28 $25.24
94799 Pulmonary service/procedure 0.00 $44.28 $0.00
94799 TC Pulmonary service/procedure 0.00 $44.28 $0.00
94799 26 Pulmonary service/procedure 0.00 $44.28 $0.00
95004 Percut allergy skin tests 0.12 $44.28 $5.31
95012 Exhaled nitric oxide meas 0.57 $44.28 $25.24
95017 Perq & icut allg test venoms 0.23 $44.28 $10.18
95018 Perq&ic allg test drugs/biol 0.61 $44.28 $27.01
95024 Icut allergy test drug/bug 0.23 $44.28 $10.18
95027 Icut allergy titrate-airborn 0.13 $44.28 $5.76
95028 Icut allergy test-delayed 0.37 $44.28 $16.38
95044 Allergy patch tests 0.16 $44.28 $7.08
95052 Photo patch test 0.19 $44.28 $8.41
95056 Photosensitivity tests 1.31 $44.28 $58.01
95060 Eye allergy tests 0.99 $44.28 $43.84
95065 Nose allergy test 0.74 $44.28 $32.77
95070 Bronchial allergy tests 0.90 $44.28 $39.85
95071 Bronchial allergy tests 1.05 $44.28 $46.49
95076 Ingest challenge ini 120 min 3.43 $44.28 $151.88
95079 Ingest challenge addl 60 min 2.42 $44.28 $107.16
95115 Immunotherapy one injection 0.26 $44.28 $11.51
95117 Immunotherapy injections 0.30 $44.28 $13.28
95120 Immunotherapy one injection 0.00 $44.28 $0.00
95125 Immunotherapy 2/> injections 0.00 $44.28 $0.00
95130 Immntx 1 sting insect 0.00 $44.28 $0.00
95131 Immntx 2 sting insects 0.00 $44.28 $0.00
95132 Immntx 3 sting insects 0.00 $44.28 $0.00
95133 Immntx 4 sting insects 0.00 $44.28 $0.00
95134 Immntx 5 sting insects 0.00 $44.28 $0.00
95144 Antigen therapy services 0.41 $44.28 $18.15
95145 Antigen therapy services 0.81 $44.28 $35.87
95146 Antigen therapy services 1.50 $44.28 $66.42
95147 Antigen therapy services 1.55 $44.28 $68.63
95148 Antigen therapy services 2.23 $44.28 $98.74
95149 Antigen therapy services 2.97 $44.28 $131.51
95165 Antigen therapy services 0.40 $44.28 $17.71
95170 Antigen therapy services 0.30 $44.28 $13.28
95180 Rapid desensitization 3.92 $44.28 $173.58
95199 Allergy immunology services 0.00 $44.28 $0.00
95249 Cont gluc mntr pt prov eqp 1.56 $44.28 $69.08
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
95250 Cont gluc mntr phys/qhp eqp 4.26 $44.28 $188.63
95251 Cont gluc mntr analysis i&r 1.01 $44.28 $44.72
95782 Polysom <6 yrs 4/> paramtrs 25.65 $44.28 $1,135.78
95782 TC Polysom <6 yrs 4/> paramtrs 22.07 $44.28 $977.26
95782 26 Polysom <6 yrs 4/> paramtrs 3.58 $44.28 $158.52
95783 Polysom <6 yrs cpap/bilvl 27.31 $44.28 $1,209.29
95783 TC Polysom <6 yrs cpap/bilvl 23.41 $44.28 $1,036.59
95783 26 Polysom <6 yrs cpap/bilvl 3.90 $44.28 $172.69
95800 Slp stdy unattended 4.79 $44.28 $212.10
95800 TC Slp stdy unattended 3.59 $44.28 $158.97
95800 26 Slp stdy unattended 1.20 $44.28 $53.14
95801 Slp stdy unatnd w/anal 2.57 $44.28 $113.80
95801 TC Slp stdy unatnd w/anal 1.38 $44.28 $61.11
95801 26 Slp stdy unatnd w/anal 1.19 $44.28 $52.69
95803 Actigraphy testing 4.06 $44.28 $179.78
95803 TC Actigraphy testing 2.81 $44.28 $124.43
95803 26 Actigraphy testing 1.25 $44.28 $55.35
95805 Multiple sleep latency test 11.87 $44.28 $525.60
95805 TC Multiple sleep latency test 10.19 $44.28 $451.21
95805 26 Multiple sleep latency test 1.68 $44.28 $74.39
95806 Sleep study unatt&resp efft 3.90 $44.28 $172.69
95806 TC Sleep study unatt&resp efft 2.49 $44.28 $110.26
95806 26 Sleep study unatt&resp efft 1.41 $44.28 $62.43
95807 Sleep study attended 12.15 $44.28 $538.00
95807 TC Sleep study attended 10.39 $44.28 $460.07
95807 26 Sleep study attended 1.76 $44.28 $77.93
95808 Polysom any age 1-3> param 18.96 $44.28 $839.55
95808 TC Polysom any age 1-3> param 16.46 $44.28 $728.85
95808 26 Polysom any age 1-3> param 2.50 $44.28 $110.70
95810 Polysom 6/> yrs 4/> param 17.35 $44.28 $768.26
95810 TC Polysom 6/> yrs 4/> param 13.90 $44.28 $615.49
95810 26 Polysom 6/> yrs 4/> param 3.45 $44.28 $152.77
95811 Polysom 6/>yrs cpap 4/> parm 18.19 $44.28 $805.45
95811 TC Polysom 6/>yrs cpap 4/> parm 14.61 $44.28 $646.93
95811 26 Polysom 6/>yrs cpap 4/> parm 3.58 $44.28 $158.52
95812 Eeg 41-60 minutes 9.19 $44.28 $406.93
95812 TC Eeg 41-60 minutes 7.54 $44.28 $333.87
95812 26 Eeg 41-60 minutes 1.65 $44.28 $73.06
95813 Eeg over 1 hour 11.42 $44.28 $505.68
95813 TC Eeg over 1 hour 8.94 $44.28 $395.86
95813 26 Eeg over 1 hour 2.48 $44.28 $109.81
95816 Eeg awake and drowsy 10.27 $44.28 $454.76
95816 TC Eeg awake and drowsy 8.62 $44.28 $381.69
95816 26 Eeg awake and drowsy 1.65 $44.28 $73.06
95819 Eeg awake and asleep 12.08 $44.28 $534.90
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
95819 TC Eeg awake and asleep 10.43 $44.28 $461.84
95819 26 Eeg awake and asleep 1.65 $44.28 $73.06
95822 Eeg coma or sleep only 10.90 $44.28 $482.65
95822 TC Eeg coma or sleep only 9.24 $44.28 $409.15
95822 26 Eeg coma or sleep only 1.66 $44.28 $73.50
95824 Eeg cerebral death only 0.00 $44.28 $0.00
95824 TC Eeg cerebral death only 0.00 $44.28 $0.00
95824 26 Eeg cerebral death only 1.13 $44.28 $50.04
95827 Eeg all night recording 17.20 $44.28 $761.62
95827 TC Eeg all night recording 15.59 $44.28 $690.33
95827 26 Eeg all night recording 1.61 $44.28 $71.29
95829 Surgery electrocorticogram 53.66 $44.28 $2,376.06
95829 TC Surgery electrocorticogram 43.97 $44.28 $1,946.99
95829 26 Surgery electrocorticogram 9.69 $44.28 $429.07
95830 Insert electrodes for eeg 10.97 $44.28 $485.75
95831 Limb muscle testing manual 0.92 $44.28 $40.74
95832 Hand muscle testing manual 0.91 $44.28 $40.29
95833 Body muscle testing manual 1.20 $44.28 $53.14
95834 Body muscle testing manual 1.57 $44.28 $69.52
95836 Ecog impltd brn npgt <30 d 3.14 $44.28 $139.04
95851 Range of motion measurements 0.59 $44.28 $26.13
95852 Range of motion measurements 0.53 $44.28 $23.47
95857 Cholinesterase challenge 1.54 $44.28 $68.19
95860 Muscle test one limb 3.43 $44.28 $151.88
95860 TC Muscle test one limb 1.96 $44.28 $86.79
95860 26 Muscle test one limb 1.47 $44.28 $65.09
95861 Muscle test 2 limbs 4.90 $44.28 $216.97
95861 TC Muscle test 2 limbs 2.54 $44.28 $112.47
95861 26 Muscle test 2 limbs 2.36 $44.28 $104.50
95863 Muscle test 3 limbs 6.15 $44.28 $272.32
95863 TC Muscle test 3 limbs 3.30 $44.28 $146.12
95863 26 Muscle test 3 limbs 2.85 $44.28 $126.20
95864 Muscle test 4 limbs 7.07 $44.28 $313.06
95864 TC Muscle test 4 limbs 4.02 $44.28 $178.01
95864 26 Muscle test 4 limbs 3.05 $44.28 $135.05
95865 Muscle test larynx 4.25 $44.28 $188.19
95865 TC Muscle test larynx 1.87 $44.28 $82.80
95865 26 Muscle test larynx 2.38 $44.28 $105.39
95866 Muscle test hemidiaphragm 3.90 $44.28 $172.69
95866 TC Muscle test hemidiaphragm 1.96 $44.28 $86.79
95866 26 Muscle test hemidiaphragm 1.94 $44.28 $85.90
95867 Muscle test cran nerv unilat 3.00 $44.28 $132.84
95867 TC Muscle test cran nerv unilat 1.79 $44.28 $79.26
95867 26 Muscle test cran nerv unilat 1.21 $44.28 $53.58
95868 Muscle test cran nerve bilat 3.93 $44.28 $174.02
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
95868 TC Muscle test cran nerve bilat 2.12 $44.28 $93.87
95868 26 Muscle test cran nerve bilat 1.81 $44.28 $80.15
95869 Muscle test thor paraspinal 2.67 $44.28 $118.23
95869 TC Muscle test thor paraspinal 2.10 $44.28 $92.99
95869 26 Muscle test thor paraspinal 0.57 $44.28 $25.24
95870 Muscle test nonparaspinal 2.58 $44.28 $114.24
95870 TC Muscle test nonparaspinal 2.01 $44.28 $89.00
95870 26 Muscle test nonparaspinal 0.57 $44.28 $25.24
95872 Muscle test one fiber 5.64 $44.28 $249.74
95872 TC Muscle test one fiber 1.23 $44.28 $54.46
95872 26 Muscle test one fiber 4.41 $44.28 $195.27
95873 Guide nerv destr elec stim 2.13 $44.28 $94.32
95873 TC Guide nerv destr elec stim 1.56 $44.28 $69.08
95873 26 Guide nerv destr elec stim 0.57 $44.28 $25.24
95874 Guide nerv destr needle emg 2.18 $44.28 $96.53
95874 TC Guide nerv destr needle emg 1.61 $44.28 $71.29
95874 26 Guide nerv destr needle emg 0.57 $44.28 $25.24
95875 Limb exercise test 3.75 $44.28 $166.05
95875 TC Limb exercise test 2.06 $44.28 $91.22
95875 26 Limb exercise test 1.69 $44.28 $74.83
95885 Musc tst done w/nerv tst lim 1.73 $44.28 $76.60
95885 TC Musc tst done w/nerv tst lim 1.19 $44.28 $52.69
95885 26 Musc tst done w/nerv tst lim 0.54 $44.28 $23.91
95886 Musc test done w/n test comp 2.68 $44.28 $118.67
95886 TC Musc test done w/n test comp 1.36 $44.28 $60.22
95886 26 Musc test done w/n test comp 1.32 $44.28 $58.45
95887 Musc tst done w/n tst nonext 2.33 $44.28 $103.17
95887 TC Musc tst done w/n tst nonext 1.25 $44.28 $55.35
95887 26 Musc tst done w/n tst nonext 1.08 $44.28 $47.82
95905 Motor &/ sens nrve cndj test 1.80 $44.28 $79.70
95905 TC Motor &/ sens nrve cndj test 1.72 $44.28 $76.16
95905 26 Motor &/ sens nrve cndj test 0.08 $44.28 $3.54
95907 Nvr cndj tst 1-2 studies 2.72 $44.28 $120.44
95907 TC Nvr cndj tst 1-2 studies 1.19 $44.28 $52.69
95907 26 Nvr cndj tst 1-2 studies 1.53 $44.28 $67.75
95908 Nrv cndj tst 3-4 studies 3.52 $44.28 $155.87
95908 TC Nrv cndj tst 3-4 studies 1.59 $44.28 $70.41
95908 26 Nrv cndj tst 3-4 studies 1.93 $44.28 $85.46
95909 Nrv cndj tst 5-6 studies 4.20 $44.28 $185.98
95909 TC Nrv cndj tst 5-6 studies 1.90 $44.28 $84.13
95909 26 Nrv cndj tst 5-6 studies 2.30 $44.28 $101.84
95910 Nrv cndj test 7-8 studies 5.51 $44.28 $243.98
95910 TC Nrv cndj test 7-8 studies 2.44 $44.28 $108.04
95910 26 Nrv cndj test 7-8 studies 3.07 $44.28 $135.94
95911 Nrv cndj test 9-10 studies 6.62 $44.28 $293.13
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
95911 TC Nrv cndj test 9-10 studies 2.79 $44.28 $123.54
95911 26 Nrv cndj test 9-10 studies 3.83 $44.28 $169.59
95912 Nrv cndj test 11-12 studies 7.44 $44.28 $329.44
95912 TC Nrv cndj test 11-12 studies 2.88 $44.28 $127.53
95912 26 Nrv cndj test 11-12 studies 4.56 $44.28 $201.92
95913 Nrv cndj test 13/> studies 8.59 $44.28 $380.37
95913 TC Nrv cndj test 13/> studies 3.19 $44.28 $141.25
95913 26 Nrv cndj test 13/> studies 5.40 $44.28 $239.11
95921 Autonomic nrv parasym inervj 2.36 $44.28 $104.50
95921 TC Autonomic nrv parasym inervj 1.07 $44.28 $47.38
95921 26 Autonomic nrv parasym inervj 1.29 $44.28 $57.12
95922 Autonomic nrv adrenrg inervj 2.70 $44.28 $119.56
95922 TC Autonomic nrv adrenrg inervj 1.33 $44.28 $58.89
95922 26 Autonomic nrv adrenrg inervj 1.37 $44.28 $60.66
95923 Autonomic nrv syst funj test 3.64 $44.28 $161.18
95923 TC Autonomic nrv syst funj test 2.33 $44.28 $103.17
95923 26 Autonomic nrv syst funj test 1.31 $44.28 $58.01
95924 Ans parasymp & symp w/tilt 4.25 $44.28 $188.19
95924 TC Ans parasymp & symp w/tilt 1.71 $44.28 $75.72
95924 26 Ans parasymp & symp w/tilt 2.54 $44.28 $112.47
95925 Somatosensory testing 3.73 $44.28 $165.16
95925 TC Somatosensory testing 2.94 $44.28 $130.18
95925 26 Somatosensory testing 0.79 $44.28 $34.98
95926 Somatosensory testing 3.61 $44.28 $159.85
95926 TC Somatosensory testing 2.83 $44.28 $125.31
95926 26 Somatosensory testing 0.78 $44.28 $34.54
95927 Somatosensory testing 3.74 $44.28 $165.61
95927 TC Somatosensory testing 2.96 $44.28 $131.07
95927 26 Somatosensory testing 0.78 $44.28 $34.54
95928 C motor evoked uppr limbs 6.20 $44.28 $274.54
95928 TC C motor evoked uppr limbs 3.93 $44.28 $174.02
95928 26 C motor evoked uppr limbs 2.27 $44.28 $100.52
95929 C motor evoked lwr limbs 6.35 $44.28 $281.18
95929 TC C motor evoked lwr limbs 4.07 $44.28 $180.22
95929 26 C motor evoked lwr limbs 2.28 $44.28 $100.96
95930 Visual ep test cns w/i&r 1.94 $44.28 $85.90
95930 TC Visual ep test cns w/i&r 1.40 $44.28 $61.99
95930 26 Visual ep test cns w/i&r 0.54 $44.28 $23.91
95933 Blink reflex test 2.30 $44.28 $101.84
95933 TC Blink reflex test 1.40 $44.28 $61.99
95933 26 Blink reflex test 0.90 $44.28 $39.85
95937 Neuromuscular junction test 2.48 $44.28 $109.81
95937 TC Neuromuscular junction test 1.50 $44.28 $66.42
95937 26 Neuromuscular junction test 0.98 $44.28 $43.39
95938 Somatosensory testing 9.79 $44.28 $433.50
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
95938 TC Somatosensory testing 8.47 $44.28 $375.05
95938 26 Somatosensory testing 1.32 $44.28 $58.45
95939 C motor evoked upr&lwr limbs 14.55 $44.28 $644.27
95939 TC C motor evoked upr&lwr limbs 11.13 $44.28 $492.84
95939 26 C motor evoked upr&lwr limbs 3.42 $44.28 $151.44
95940 Ionm in operatng room 15 min 0.93 $44.28 $41.18
95941 Ionm remote/>1 pt or per hr 0.00 $44.28 $0.00
95943 Parasymp&symp hrt rate test 0.00 $44.28 $0.00
95943 TC Parasymp&symp hrt rate test 0.00 $44.28 $0.00
95943 26 Parasymp&symp hrt rate test 0.00 $44.28 $0.00
95950 Ambulatory eeg monitoring 8.27 $44.28 $366.20
95950 TC Ambulatory eeg monitoring 6.03 $44.28 $267.01
95950 26 Ambulatory eeg monitoring 2.24 $44.28 $99.19
95951 Eeg monitoring/videorecord 0.00 $44.28 $0.00
95951 TC Eeg monitoring/videorecord 0.00 $44.28 $0.00
95951 26 Eeg monitoring/videorecord 9.14 $44.28 $404.72
95953 Eeg monitoring/computer 12.56 $44.28 $556.16
95953 TC Eeg monitoring/computer 7.88 $44.28 $348.93
95953 26 Eeg monitoring/computer 4.68 $44.28 $207.23
95954 Eeg monitoring/giving drugs 11.32 $44.28 $501.25
95954 TC Eeg monitoring/giving drugs 8.02 $44.28 $355.13
95954 26 Eeg monitoring/giving drugs 3.30 $44.28 $146.12
95955 Eeg during surgery 5.95 $44.28 $263.47
95955 TC Eeg during surgery 4.40 $44.28 $194.83
95955 26 Eeg during surgery 1.55 $44.28 $68.63
95956 Eeg monitor technol attended 41.21 $44.28 $1,824.78
95956 TC Eeg monitor technol attended 35.78 $44.28 $1,584.34
95956 26 Eeg monitor technol attended 5.43 $44.28 $240.44
95957 Eeg digital analysis 7.62 $44.28 $337.41
95957 TC Eeg digital analysis 4.67 $44.28 $206.79
95957 26 Eeg digital analysis 2.95 $44.28 $130.63
95958 Eeg monitoring/function test 16.34 $44.28 $723.54
95958 TC Eeg monitoring/function test 9.86 $44.28 $436.60
95958 26 Eeg monitoring/function test 6.48 $44.28 $286.93
95961 Electrode stimulation brain 8.69 $44.28 $384.79
95961 TC Electrode stimulation brain 4.05 $44.28 $179.33
95961 26 Electrode stimulation brain 4.64 $44.28 $205.46
95962 Electrode stim brain add-on 7.46 $44.28 $330.33
95962 TC Electrode stim brain add-on 2.51 $44.28 $111.14
95962 26 Electrode stim brain add-on 4.95 $44.28 $219.19
95965 Meg spontaneous 0.00 $44.28 $0.00
95965 TC Meg spontaneous 0.00 $44.28 $0.00
95965 26 Meg spontaneous 12.07 $44.28 $534.46
95966 Meg evoked single 0.00 $44.28 $0.00
95966 TC Meg evoked single 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
95966 26 Meg evoked single 6.11 $44.28 $270.55
95967 Meg evoked each addl 0.00 $44.28 $0.00
95967 TC Meg evoked each addl 0.00 $44.28 $0.00
95967 26 Meg evoked each addl 5.34 $44.28 $236.46
95970 Alys npgt w/o prgrmg 0.54 $44.28 $23.91
95971 Alys smpl sp/pn npgt w/prgrm 1.44 $44.28 $63.76
95972 Alys cplx sp/pn npgt w/prgrm 1.62 $44.28 $71.73
95976 Alys smpl cn npgt prgrmg 1.16 $44.28 $51.36
95977 Alys cplx cn npgt prgrmg 1.54 $44.28 $68.19
95980 Io anal gast n-stim init 1.32 $44.28 $58.45
95981 Io anal gast n-stim subsq 0.97 $44.28 $42.95
95982 Io ga n-stim subsq w/reprog 1.55 $44.28 $68.63
95983 Alys brn npgt prgrmg 15 min 1.46 $44.28 $64.65
95984 Alys brn npgt prgrmg addl 15 1.27 $44.28 $56.24
95990 Spin/brain pump refil & main 2.62 $44.28 $116.01
95991 Spin/brain pump refil & main 3.30 $44.28 $146.12
95992 Canalith repositioning proc 1.25 $44.28 $55.35
95999 Neurological procedure 0.00 $44.28 $0.00
96000 Motion analysis video/3d 2.72 $44.28 $120.44
96001 Motion test w/ft press meas 3.65 $44.28 $161.62
96002 Dynamic surface emg 0.63 $44.28 $27.90
96003 Dynamic fine wire emg 0.49 $44.28 $21.70
96004 Phys review of motion tests 3.27 $44.28 $144.80
96020 Functional brain mapping 0.00 $44.28 $0.00
96020 TC Functional brain mapping 0.00 $44.28 $0.00
96020 26 Functional brain mapping 4.67 $44.28 $206.79
96040 Genetic counseling 30 min 1.30 $44.28 $57.56
96105 Assessment of aphasia 2.96 $44.28 $131.07
96110 Developmental screen w/score 0.28 $44.28 $12.40
96112 Devel tst phys/qhp 1st hr 3.83 $44.28 $169.59
96113 Devel tst phys/qhp ea addl 1.71 $44.28 $75.72
96116 Nubhvl xm phys/qhp 1st hr 2.70 $44.28 $119.56
96121 Nubhvl xm phy/qhp ea addl hr 2.32 $44.28 $102.73
96125 Cognitive test by hc pro 3.12 $44.28 $138.15
96127 Brief emotional/behav assmt 0.15 $44.28 $6.64
96130 Psycl tst eval phys/qhp 1st 3.30 $44.28 $146.12
96131 Psycl tst eval phys/qhp ea 2.51 $44.28 $111.14
96132 Nrpsyc tst eval phys/qhp 1st 3.71 $44.28 $164.28
96133 Nrpsyc tst eval phys/qhp ea 2.83 $44.28 $125.31
96136 Psycl/nrpsyc tst phy/qhp 1st 1.33 $44.28 $58.89
96137 Psycl/nrpsyc tst phy/qhp ea 1.23 $44.28 $54.46
96138 Psycl/nrpsyc tech 1st 1.08 $44.28 $47.82
96139 Psycl/nrpsyc tst tech ea 1.08 $44.28 $47.82
96146 Psycl/nrpsyc tst auto result 0.06 $44.28 $2.66
96150 Assess hlth/behave init 0.65 $44.28 $28.78
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
96151 Assess hlth/behave subseq 0.64 $44.28 $28.34
96152 Intervene hlth/behave indiv 0.59 $44.28 $26.13
96153 Intervene hlth/behave group 0.14 $44.28 $6.20
96154 Interv hlth/behav fam w/pt 0.58 $44.28 $25.68
96155 Interv hlth/behav fam no pt 0.64 $44.28 $28.34
96160 Pt-focused hlth risk assmt 0.09 $44.28 $3.99
96161 Caregiver health risk assmt 0.09 $44.28 $3.99
96360 Hydration iv infusion init 1.07 $44.28 $47.38
96361 Hydrate iv infusion add-on 0.38 $44.28 $16.83
96365 Ther/proph/diag iv inf init 2.02 $44.28 $89.45
96366 Ther/proph/diag iv inf addon 0.61 $44.28 $27.01
96367 Tx/proph/dg addl seq iv inf 0.88 $44.28 $38.97
96368 Ther/diag concurrent inf 0.59 $44.28 $26.13
96369 Sc ther infusion up to 1 hr 4.69 $44.28 $207.67
96370 Sc ther infusion addl hr 0.44 $44.28 $19.48
96371 Sc ther infusion reset pump 1.84 $44.28 $81.48
96372 Ther/proph/diag inj sc/im 0.47 $44.28 $20.81
96373 Ther/proph/diag inj ia 0.53 $44.28 $23.47
96374 Ther/proph/diag inj iv push 1.10 $44.28 $48.71
96375 Tx/pro/dx inj new drug addon 0.47 $44.28 $20.81
96376 Tx/pro/dx inj same drug adon 0.00 $44.28 $0.00
96377 Applicaton on-body injector 0.57 $44.28 $25.24
96379 Ther/prop/diag inj/inf proc 0.00 $44.28 $0.00
96401 Chemo anti-neopl sq/im 2.24 $44.28 $99.19
96402 Chemo hormon antineopl sq/im 0.87 $44.28 $38.52
96405 Chemo intralesional up to 7 2.31 $44.28 $102.29
96406 Chemo intralesional over 7 3.46 $44.28 $153.21
96409 Chemo iv push sngl drug 3.05 $44.28 $135.05
96411 Chemo iv push addl drug 1.65 $44.28 $73.06
96413 Chemo iv infusion 1 hr 3.97 $44.28 $175.79
96415 Chemo iv infusion addl hr 0.86 $44.28 $38.08
96416 Chemo prolong infuse w/pump 3.98 $44.28 $176.23
96417 Chemo iv infus each addl seq 1.92 $44.28 $85.02
96420 Chemo ia push tecnique 2.95 $44.28 $130.63
96422 Chemo ia infusion up to 1 hr 4.85 $44.28 $214.76
96423 Chemo ia infuse each addl hr 2.24 $44.28 $99.19
96425 Chemotherapy infusion method 5.14 $44.28 $227.60
96440 Chemotherapy intracavitary 23.69 $44.28 $1,048.99
96446 Chemotx admn prtl cavity 5.78 $44.28 $255.94
96450 Chemotherapy into cns 5.13 $44.28 $227.16
96521 Refill/maint portable pump 4.13 $44.28 $182.88
96522 Refill/maint pump/resvr syst 3.39 $44.28 $150.11
96523 Irrig drug delivery device 0.77 $44.28 $34.10
96542 Chemotherapy injection 3.77 $44.28 $166.94
96549 Chemotherapy unspecified 0.00 $44.28 $0.00
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
96567 Pdt dstr prmlg les skn 3.50 $44.28 $154.98
96570 Photodynmc tx 30 min add-on 1.48 $44.28 $65.53
96571 Photodynamic tx addl 15 min 0.83 $44.28 $36.75
96573 Pdt dstr prmlg les phys/qhp 5.70 $44.28 $252.40
96574 Dbrdmt prmlg les w/pdt 7.25 $44.28 $321.03
96900 Ultraviolet light therapy 0.61 $44.28 $27.01
96902 Trichogram 0.62 $44.28 $27.45
96904 Whole body photography 1.82 $44.28 $80.59
96910 Photochemotherapy with uv-b 3.24 $44.28 $143.47
96912 Photochemotherapy with uv-a 2.75 $44.28 $121.77
96913 Photochemotherapy uv-a or b 3.91 $44.28 $173.13
96920 Laser tx skin < 250 sq cm 4.64 $44.28 $205.46
96921 Laser tx skin 250-500 sq cm 5.09 $44.28 $225.39
96922 Laser tx skin >500 sq cm 6.91 $44.28 $305.97
96931 Rcm celulr subcelulr img skn 4.81 $44.28 $212.99
96932 Rcm celulr subcelulr img skn 3.51 $44.28 $155.42
96933 Rcm celulr subcelulr img skn 1.32 $44.28 $58.45
96934 Rcm celulr subcelulr img skn 2.74 $44.28 $121.33
96935 Rcm celulr subcelulr img skn 1.26 $44.28 $55.79
96936 Rcm celulr subcelulr img skn 1.26 $44.28 $55.79
96999 Dermatological procedure 0.00 $44.28 $0.00
97010 Hot or cold packs therapy 0.18 $44.28 $7.97
97012 Mechanical traction therapy 0.42 $44.28 $18.60
97014 Electric stimulation therapy 0.42 $44.28 $18.60
97016 Vasopneumatic device therapy 0.36 $44.28 $15.94
97018 Paraffin bath therapy 0.20 $44.28 $8.86
97022 Whirlpool therapy 0.51 $44.28 $22.58
97024 Diathermy eg microwave 0.20 $44.28 $8.86
97026 Infrared therapy 0.18 $44.28 $7.97
97028 Ultraviolet therapy 0.23 $44.28 $10.18
97032 Electrical stimulation 0.42 $44.28 $18.60
97033 Electric current therapy 0.59 $44.28 $26.13
97034 Contrast bath therapy 0.43 $44.28 $19.04
97035 Ultrasound therapy 0.39 $44.28 $17.27
97036 Hydrotherapy 0.99 $44.28 $43.84
97039 Physical therapy treatment 0.00 $44.28 $0.00
97110 Therapeutic exercises 0.87 $44.28 $38.52
97112 Neuromuscular reeducation 0.99 $44.28 $43.84
97113 Aquatic therapy/exercises 1.10 $44.28 $48.71
97116 Gait training therapy 0.86 $44.28 $38.08
97124 Massage therapy 0.81 $44.28 $35.87
97127 Ther ivntj w/focus cog funcj 0.00 $44.28 $0.00
97139 Physical medicine procedure 0.00 $44.28 $0.00
97140 Manual therapy 1/> regions 0.79 $44.28 $34.98
97150 Group therapeutic procedures 0.52 $44.28 $23.03
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
97151 Bhv id assmt by phys/qhp 0.00 $44.28 $0.00
97152 Bhv id suprt assmt by 1 tech 0.00 $44.28 $0.00
97153 Adaptive behavior tx by tech 0.00 $44.28 $0.00
97154 Grp adapt bhv tx by tech 0.00 $44.28 $0.00
97155 Adapt behavior tx phys/qhp 0.00 $44.28 $0.00
97156 Fam adapt bhv tx gdn phy/qhp 0.00 $44.28 $0.00
97157 Mult fam adapt bhv tx gdn 0.00 $44.28 $0.00
97158 Grp adapt bhv tx by phy/qhp 0.00 $44.28 $0.00
97161 Pt eval low complex 20 min 2.40 $44.28 $106.27
97162 Pt eval mod complex 30 min 2.40 $44.28 $106.27
97163 Pt eval high complex 45 min 2.40 $44.28 $106.27
97164 Pt re-eval est plan care 1.63 $44.28 $72.18
97165 Ot eval low complex 30 min 2.58 $44.28 $114.24
97166 Ot eval mod complex 45 min 2.58 $44.28 $114.24
97167 Ot eval high complex 60 min 2.58 $44.28 $114.24
97168 Ot re-eval est plan care 1.77 $44.28 $78.38
97169 Athletic trn eval low cmplx 0.00 $44.28 $0.00
97170 Athletic trn eval mod cmplx 0.00 $44.28 $0.00
97171 Athletic trn eval high cmplx 0.00 $44.28 $0.00
97172 Athletic trn re-eval plan cr 0.00 $44.28 $0.00
97530 Therapeutic activities 1.13 $44.28 $50.04
97533 Sensory integration 1.21 $44.28 $53.58
97535 Self care mngment training 0.97 $44.28 $42.95
97537 Community/work reintegration 0.93 $44.28 $41.18
97542 Wheelchair mngment training 0.94 $44.28 $41.62
97545 Work hardening 0.00 $44.28 $0.00
97546 Work hardening add-on 0.00 $44.28 $0.00
97597 Rmvl devital tis 20 cm/< 2.52 $44.28 $111.59
97598 Rmvl devital tis addl 20cm/< 0.79 $44.28 $34.98
97602 Wound(s) care non-selective 0.00 $44.28 $0.00
97605 Neg press wound tx </=50 cm 1.24 $44.28 $54.91
97606 Neg press wound tx >50 cm 1.46 $44.28 $64.65
97607 Neg press wnd tx </=50 sq cm 0.00 $44.28 $0.00
97608 Neg press wound tx >50 cm 0.00 $44.28 $0.00
97610 Low frequency non-thermal us 6.39 $44.28 $282.95
97750 Physical performance test 0.99 $44.28 $43.84
97755 Assistive technology assess 1.08 $44.28 $47.82
97760 Orthotic mgmt&trainj 1st enc 1.35 $44.28 $59.78
97761 Prosthetic trainj 1st enc 1.16 $44.28 $51.36
97763 Orthc/prostc mgmt sbsq enc 1.43 $44.28 $63.32
97799 Physical medicine procedure 0.00 $44.28 $0.00
97802 Medical nutrition indiv in 1.05 $44.28 $46.49
97803 Med nutrition indiv subseq 0.91 $44.28 $40.29
97804 Medical nutrition group 0.48 $44.28 $21.25
97810 Acupunct w/o stimul 15 min 1.03 $44.28 $45.61
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
97811 Acupunct w/o stimul addl 15m 0.78 $44.28 $34.54
97813 Acupunct w/stimul 15 min 1.13 $44.28 $50.04
97814 Acupunct w/stimul addl 15m 0.91 $44.28 $40.29
98925 Osteopath manj 1-2 regions 0.89 $44.28 $39.41
98926 Osteopath manj 3-4 regions 1.28 $44.28 $56.68
98927 Osteopath manj 5-6 regions 1.68 $44.28 $74.39
98928 Osteopath manj 7-8 regions 2.04 $44.28 $90.33
98929 Osteopath manj 9-10 regions 2.44 $44.28 $108.04
98940 Chiropract manj 1-2 regions 0.80 $44.28 $35.42
98941 Chiropract manj 3-4 regions 1.16 $44.28 $51.36
98942 Chiropractic manj 5 regions 1.50 $44.28 $66.42
98943 Chiropract manj xtrspinl 1/> 0.77 $44.28 $34.10
98960 Self-mgmt educ & train 1 pt 0.77 $44.28 $34.10
98961 Self-mgmt educ/train 2-4 pt 0.38 $44.28 $16.83
98962 Self-mgmt educ/train 5-8 pt 0.28 $44.28 $12.40
98966 Hc pro phone call 5-10 min 0.39 $44.28 $17.27
98967 Hc pro phone call 11-20 min 0.76 $44.28 $33.65
98968 Hc pro phone call 21-30 min 1.12 $44.28 $49.59
98969 Online service by hc pro 0.00 $44.28 $0.00
99000 Specimen handling office-lab 0.00 $44.28 $0.00
99001 Specimen handling pt-lab 0.00 $44.28 $0.00
99002 Device handling phys/qhp 0.00 $44.28 $0.00
99024 Postop follow-up visit 0.00 $44.28 $0.00
99026 In-hospital on call service 0.00 $44.28 $0.00
99027 Out-of-hosp on call service 0.00 $44.28 $0.00
99050 Medical services after hrs 0.00 $44.28 $0.00
99051 Med serv eve/wkend/holiday 0.00 $44.28 $0.00
99053 Med serv 10pm-8am 24 hr fac 0.00 $44.28 $0.00
99056 Med service out of office 0.00 $44.28 $0.00
99058 Office emergency care 0.00 $44.28 $0.00
99060 Out of office emerg med serv 0.00 $44.28 $0.00
99070 Special supplies phys/qhp 0.00 $44.28 $0.00
99071 Patient education materials 0.00 $44.28 $0.00
99075 Medical testimony 0.00 $44.28 $0.00
99078 Group health education 0.00 $44.28 $0.00
99080 Special reports or forms 0.00 $44.28 $0.00
99082 Unusual physician travel 0.00 $44.28 $0.00
99091 Collj & interpj data ea 30 d 1.62 $44.28 $71.73
99100 Special anesthesia service 0.00 $44.28 $0.00
99116 Anesthesia with hypothermia 0.00 $44.28 $0.00
99135 Special anesthesia procedure 0.00 $44.28 $0.00
99140 Emergency anesthesia 0.00 $44.28 $0.00
99151 Mod sed same phys/qhp <5 yrs 2.12 $44.28 $93.87
99152 Mod sed same phys/qhp 5/>yrs 1.44 $44.28 $63.76
99153 Mod sed same phys/qhp ea 0.30 $44.28 $13.28
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
99155 Mod sed oth phys/qhp <5 yrs 2.54 $44.28 $112.47
99156 Mod sed oth phys/qhp 5/>yrs 2.24 $44.28 $99.19
99157 Mod sed other phys/qhp ea 1.82 $44.28 $80.59
99170 Anogenital exam child w imag 4.48 $44.28 $198.37
99172 Ocular function screen 0.00 $44.28 $0.00
99173 Visual acuity screen 0.08 $44.28 $3.54
99174 Ocular instrumnt screen bil 0.16 $44.28 $7.08
99175 Induction of vomiting 0.73 $44.28 $32.32
99177 Ocular instrumnt screen bil 0.13 $44.28 $5.76
99183 Hyperbaric oxygen therapy 3.12 $44.28 $138.15
99184 Hypothermia ill neonate 6.33 $44.28 $280.29
99188 App topical fluoride varnish 0.35 $44.28 $15.50
99190 Special pump services 0.00 $44.28 $0.00
99191 Special pump services 0.00 $44.28 $0.00
99192 Special pump services 0.00 $44.28 $0.00
99195 Phlebotomy 2.86 $44.28 $126.64
99199 Special service/proc/report 0.00 $44.28 $0.00
99201 Office/outpatient visit new 1.29 $44.28 $57.12
99202 Office/outpatient visit new 2.15 $44.28 $95.20
99203 Office/outpatient visit new 3.05 $44.28 $135.05
99204 Office/outpatient visit new 4.63 $44.28 $205.02
99205 Office/outpatient visit new 5.82 $44.28 $257.71
99211 Office/outpatient visit est 0.64 $44.28 $28.34
99212 Office/outpatient visit est 1.27 $44.28 $56.24
99213 Office/outpatient visit est 2.09 $44.28 $92.55
99214 Office/outpatient visit est 3.06 $44.28 $135.50
99215 Office/outpatient visit est 4.10 $44.28 $181.55
99217 Observation care discharge 2.06 $44.28 $91.22
99218 Initial observation care 2.81 $44.28 $124.43
99219 Initial observation care 3.83 $44.28 $169.59
99220 Initial observation care 5.23 $44.28 $231.58
99221 Initial hospital care 2.86 $44.28 $126.64
99222 Initial hospital care 3.86 $44.28 $170.92
99223 Initial hospital care 5.70 $44.28 $252.40
99224 Subsequent observation care 1.12 $44.28 $49.59
99225 Subsequent observation care 2.06 $44.28 $91.22
99226 Subsequent observation care 2.95 $44.28 $130.63
99231 Subsequent hospital care 1.11 $44.28 $49.15
99232 Subsequent hospital care 2.05 $44.28 $90.77
99233 Subsequent hospital care 2.93 $44.28 $129.74
99234 Observ/hosp same date 3.75 $44.28 $166.05
99235 Observ/hosp same date 4.77 $44.28 $211.22
99236 Observ/hosp same date 6.13 $44.28 $271.44
99238 Hospital discharge day 2.06 $44.28 $91.22
99239 Hospital discharge day 3.02 $44.28 $133.73
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
99241 Office consultation 1.34 $44.28 $59.34
99242 Office consultation 2.52 $44.28 $111.59
99243 Office consultation 3.45 $44.28 $152.77
99244 Office consultation 5.16 $44.28 $228.48
99245 Office consultation 6.29 $44.28 $278.52
99251 Inpatient consultation 1.38 $44.28 $61.11
99252 Inpatient consultation 2.11 $44.28 $93.43
99253 Inpatient consultation 3.25 $44.28 $143.91
99254 Inpatient consultation 4.72 $44.28 $209.00
99255 Inpatient consultation 5.68 $44.28 $251.51
99281 Emergency dept visit 0.60 $44.28 $26.57
99282 Emergency dept visit 1.17 $44.28 $51.81
99283 Emergency dept visit 1.75 $44.28 $77.49
99284 Emergency dept visit 3.32 $44.28 $147.01
99285 Emergency dept visit 4.89 $44.28 $216.53
99288 Direct advanced life support 0.00 $44.28 $0.00
99291 Critical care first hour 7.82 $44.28 $346.27
99292 Critical care addl 30 min 3.46 $44.28 $153.21
99304 Nursing facility care init 2.54 $44.28 $112.47
99305 Nursing facility care init 3.67 $44.28 $162.51
99306 Nursing facility care init 4.70 $44.28 $208.12
99307 Nursing fac care subseq 1.24 $44.28 $54.91
99308 Nursing fac care subseq 1.94 $44.28 $85.90
99309 Nursing fac care subseq 2.58 $44.28 $114.24
99310 Nursing fac care subseq 3.82 $44.28 $169.15
99315 Nursing fac discharge day 2.07 $44.28 $91.66
99316 Nursing fac discharge day 2.98 $44.28 $131.95
99318 Annual nursing fac assessmnt 2.70 $44.28 $119.56
99324 Domicil/r-home visit new pat 1.56 $44.28 $69.08
99325 Domicil/r-home visit new pat 2.26 $44.28 $100.07
99326 Domicil/r-home visit new pat 3.92 $44.28 $173.58
99327 Domicil/r-home visit new pat 5.26 $44.28 $232.91
99328 Domicil/r-home visit new pat 6.19 $44.28 $274.09
99334 Domicil/r-home visit est pat 1.70 $44.28 $75.28
99335 Domicil/r-home visit est pat 2.68 $44.28 $118.67
99336 Domicil/r-home visit est pat 3.82 $44.28 $169.15
99337 Domicil/r-home visit est pat 5.47 $44.28 $242.21
99339 Domicil/r-home care supervis 2.17 $44.28 $96.09
99340 Domicil/r-home care supervis 3.05 $44.28 $135.05
99341 Home visit new patient 1.56 $44.28 $69.08
99342 Home visit new patient 2.25 $44.28 $99.63
99343 Home visit new patient 3.67 $44.28 $162.51
99344 Home visit new patient 5.14 $44.28 $227.60
99345 Home visit new patient 6.25 $44.28 $276.75
99347 Home visit est patient 1.56 $44.28 $69.08
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
99348 Home visit est patient 2.37 $44.28 $104.94
99349 Home visit est patient 3.64 $44.28 $161.18
99350 Home visit est patient 5.05 $44.28 $223.61
99354 Prolong e&m/psyctx serv o/p 3.67 $44.28 $162.51
99355 Prolong e&m/psyctx serv o/p 2.80 $44.28 $123.98
99356 Prolonged service inpatient 2.60 $44.28 $115.13
99357 Prolonged service inpatient 2.61 $44.28 $115.57
99358 Prolong service w/o contact 3.15 $44.28 $139.48
99359 Prolong serv w/o contact add 1.52 $44.28 $67.31
99360 Physician standby services 1.73 $44.28 $76.60
99366 Team conf w/pat by hc prof 1.21 $44.28 $53.58
99367 Team conf w/o pat by phys 1.60 $44.28 $70.85
99368 Team conf w/o pat by hc pro 1.04 $44.28 $46.05
99374 Home health care supervision 1.96 $44.28 $86.79
99375 Home health care supervision 2.94 $44.28 $130.18
99377 Hospice care supervision 1.96 $44.28 $86.79
99378 Hospice care supervision 2.94 $44.28 $130.18
99379 Nursing fac care supervision 1.96 $44.28 $86.79
99380 Nursing fac care supervision 2.94 $44.28 $130.18
99381 Init pm e/m new pat infant 3.13 $44.28 $138.60
99382 Init pm e/m new pat 1-4 yrs 3.28 $44.28 $145.24
99383 Prev visit new age 5-11 3.41 $44.28 $150.99
99384 Prev visit new age 12-17 3.85 $44.28 $170.48
99385 Prev visit new age 18-39 3.72 $44.28 $164.72
99386 Prev visit new age 40-64 4.32 $44.28 $191.29
99387 Init pm e/m new pat 65+ yrs 4.68 $44.28 $207.23
99391 Per pm reeval est pat infant 2.82 $44.28 $124.87
99392 Prev visit est age 1-4 3.01 $44.28 $133.28
99393 Prev visit est age 5-11 3.00 $44.28 $132.84
99394 Prev visit est age 12-17 3.29 $44.28 $145.68
99395 Prev visit est age 18-39 3.36 $44.28 $148.78
99396 Prev visit est age 40-64 3.58 $44.28 $158.52
99397 Per pm reeval est pat 65+ yr 3.85 $44.28 $170.48
99401 Preventive counseling indiv 1.10 $44.28 $48.71
99402 Preventive counseling indiv 1.81 $44.28 $80.15
99403 Preventive counseling indiv 2.51 $44.28 $111.14
99404 Preventive counseling indiv 3.21 $44.28 $142.14
99406 Behav chng smoking 3-10 min 0.42 $44.28 $18.60
99407 Behav chng smoking > 10 min 0.80 $44.28 $35.42
99408 Audit/dast 15-30 min 1.01 $44.28 $44.72
99409 Audit/dast over 30 min 1.95 $44.28 $86.35
99411 Preventive counseling group 0.55 $44.28 $24.35
99412 Preventive counseling group 0.69 $44.28 $30.55
99415 Prolong clincl staff svc 0.28 $44.28 $12.40
99416 Prolong clincl staff svc add 0.12 $44.28 $5.31
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
99429 Unlisted preventive service 0.00 $44.28 $0.00
99441 Phone e/m phys/qhp 5-10 min 0.39 $44.28 $17.27
99442 Phone e/m phys/qhp 11-20 min 0.76 $44.28 $33.65
99443 Phone e/m phys/qhp 21-30 min 1.12 $44.28 $49.59
99444 Online e/m by phys/qhp 0.00 $44.28 $0.00
99446 Ntrprof ph1/ntrnet/ehr 5-10 0.51 $44.28 $22.58
99447 Ntrprof ph1/ntrnet/ehr 11-20 1.01 $44.28 $44.72
99448 Ntrprof ph1/ntrnet/ehr 21-30 1.52 $44.28 $67.31
99449 Ntrprof ph1/ntrnet/ehr 31/> 2.02 $44.28 $89.45
99450 Basic life disability exam 0.00 $44.28 $0.00
99451 Ntrprof ph1/ntrnet/ehr 5/> 1.04 $44.28 $46.05
99452 Ntrprof ph1/ntrnet/ehr rfrl 1.04 $44.28 $46.05
99453 Rem mntr physiol param setup 0.54 $44.28 $23.91
99454 Rem mntr physiol param dev 1.78 $44.28 $78.82
99455 Work related disability exam 0.00 $44.28 $0.00
99456 Disability examination 0.00 $44.28 $0.00
99457 Rem physiol mntr 20 min mo 1.43 $44.28 $63.32
99460 Init nb em per day hosp 2.71 $44.28 $120.00
99461 Init nb em per day non-fac 2.58 $44.28 $114.24
99462 Sbsq nb em per day hosp 1.19 $44.28 $52.69
99463 Same day nb discharge 3.13 $44.28 $138.60
99464 Attendance at delivery 2.12 $44.28 $93.87
99465 Nb resuscitation 4.13 $44.28 $182.88
99466 Ped crit care transport 6.75 $44.28 $298.89
99467 Ped crit care transport addl 3.37 $44.28 $149.22
99468 Neonate crit care initial 26.00 $44.28 $1,151.28
99469 Neonate crit care subsq 11.24 $44.28 $497.71
99471 Ped critical care initial 22.51 $44.28 $996.74
99472 Ped critical care subsq 11.53 $44.28 $510.55
99475 Ped crit care age 2-5 init 15.84 $44.28 $701.40
99476 Ped crit care age 2-5 subsq 9.86 $44.28 $436.60
99477 Init day hosp neonate care 9.85 $44.28 $436.16
99478 Ic lbw inf < 1500 gm subsq 3.87 $44.28 $171.36
99479 Ic lbw inf 1500-2500 g subsq 3.52 $44.28 $155.87
99480 Ic inf pbw 2501-5000 g subsq 3.37 $44.28 $149.22
99483 Assmt & care pln pt cog imp 7.32 $44.28 $324.13
99484 Care mgmt svc bhvl hlth cond 1.35 $44.28 $59.78
99485 Suprv interfacilty transport 2.17 $44.28 $96.09
99486 Suprv interfac trnsport addl 1.88 $44.28 $83.25
99487 Cmplx chron care w/o pt vsit 2.58 $44.28 $114.24
99489 Cmplx chron care addl 30 min 1.29 $44.28 $57.12
99490 Chron care mgmt srvc 20 min 1.17 $44.28 $51.81
99491 Chrnc care mgmt svc 30 min 2.33 $44.28 $103.17
99492 1st psyc collab care mgmt 4.50 $44.28 $199.26
99493 Sbsq psyc collab care mgmt 3.59 $44.28 $158.97
NON-FACILITY
HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL
99494 1st/sbsq psyc collab care 1.86 $44.28 $82.36
99495 Trans care mgmt 14 day disch 4.62 $44.28 $204.57
99496 Trans care mgmt 7 day disch 6.52 $44.28 $288.71
99497 Advncd care plan 30 min 2.40 $44.28 $106.27
99498 Advncd care plan addl 30 min 2.11 $44.28 $93.43
99499 Unlisted e&m service 0.00 $44.28 $0.00
99500 Home visit prenatal 0.00 $44.28 $0.00
99501 Home visit postnatal 0.00 $44.28 $0.00
99502 Home visit nb care 0.00 $44.28 $0.00
99503 Home visit resp therapy 0.00 $44.28 $0.00
99504 Home visit mech ventilator 0.00 $44.28 $0.00
99505 Home visit stoma care 0.00 $44.28 $0.00
99506 Home visit im injection 0.00 $44.28 $0.00
99507 Home visit cath maintain 0.00 $44.28 $0.00
99509 Home visit day life activity 0.00 $44.28 $0.00
99510 Home visit sing/m/fam couns 0.00 $44.28 $0.00
99511 Home visit fecal/enema mgmt 0.00 $44.28 $0.00
99512 Home visit for hemodialysis 0.00 $44.28 $0.00
99600 Home visit nos 0.00 $44.28 $0.00
99601 Home infusion/visit 2 hrs 0.00 $44.28 $0.00
99602 Home infusion each addtl hr 0.00 $44.28 $0.00
99605 Mtms by pharm np 15 min 0.00 $44.28 $0.00
99606 Mtms by pharm est 15 min 0.00 $44.28 $0.00
99607 Mtms by pharm addl 15 min 0.00 $44.28 $0.00