Date Printed: 04/08/2023 @ 09:12:29 Page 1 of 40

Short Descriptor0016T Thermotx choroid vasc lesion Y R2 4.1331 $171.11 $171.110017T Photocoagulat macular drusen Y R2 4.1331 $171.11 $171.110027T Endoscopic epidural lysis Y G2 18.0518 $747.36 $747.360031T Speculoscopy N N10032T Speculoscopy w/direct sample N N10046T Cath lavage, mammary duct(s) Y R2 16.1001 $666.56 $666.560047T Cath lavage, mammary duct(s) Y R2 16.1001 $666.56 $666.560062T Rep intradisc annulus;1 lev Y G2 29.19 $1,208.50 $1,208.500063T Rep intradisc annulus;>1lev Y G2 29.19 $1,208.50 $1,208.500084T Temp prostate urethral stent Y G2 2.0077 $83.12 $83.120088T Rf tongue base vol reduxn Y G2 16.3288 $676.03 $676.030099T* Implant corneal ring Y R2 16.171 $669.50 $669.500100T Prosth retina receive&gen Y G2 37.2078 $1,540.44 $1,540.440101T Extracorp shockwv tx,hi enrg Y G2 29.19 $1,208.50 $1,208.500102T Extracorp shockwv tx,anesth Y G2 29.19 $1,208.50 $1,208.500123T Scleral fistulization Y G2 23.1758 $959.50 $959.500124T* Conjunctival drug placement Y R2 5.1169 $211.84 $211.840137T Prostate saturation sampling Y G2 11.0338 $456.81 $456.810170T Anorectal fistula plug rpr Y G2 30.1606 $1,248.68 $1,248.680176T Aqu canal dilat w/o retent Y A2 $1,339.00 39.7101 $1,644.04 $1,415.260177T Aqu canal dilat w retent Y A2 $1,339.00 39.7101 $1,644.04 $1,415.260186T Suprachoroidal drug delivery Y G2 18.235 $754.95 $754.9510021 Fna w/o image Y P2 1.1097 $45.94 $45.9410022 Fna w/image Y G2 4.327 $179.14 $179.1410040 Acne surgery Y P2 0.793 $32.83 $32.8310060 Drainage of skin abscess Y P3 1.2512 $51.80 $51.8010061 Drainage of skin abscess Y P2 1.4066 $58.23 $58.2310080 Drainage of pilonidal cyst Y P2 1.4066 $58.23 $58.2310081 Drainage of pilonidal cyst Y P3 3.4775 $143.97 $143.9710120 Remove foreign body Y P2 1.4066 $58.23 $58.2310121 Remove foreign body Y A2 $446.00 16.1001 $666.56 $501.1410140 Drainage of hematoma/fluid Y P3 1.8584 $76.94 $76.9410160 Puncture drainage of lesion Y P2 1.4066 $58.23 $58.2310180 Complex drainage, wound Y A2 $446.00 18.3197 $758.45 $524.1111000 Debride infected skin Y P3 0.5981 $24.76 $24.7611001 Debride infected skin add-on Y P3 0.2116 $8.76 $8.7611010 Debride skin, fx Y A2 $251.52 4.3039 $178.19 $233.1911011 Debride skin/muscle, fx Y A2 $251.52 4.3039 $178.19 $233.1911012 Debride skin/muscle/bone, fx Y A2 $251.52 4.3039 $178.19 $233.1911040 Debride skin, partial Y P3 0.5519 $22.85 $22.8511041 Debride skin, full Y P3 0.6348 $26.28 $26.2811042 Debride skin/tissue Y A2 $164.42 2.6604 $110.14 $150.8511043 Debride tissue/muscle Y A2 $164.42 2.6604 $110.14 $150.8511044 Debride tissue/muscle/bone Y A2 $423.10 6.8816 $284.91 $388.5511055 Trim skin lesion Y P3 0.6256 $25.90 $25.9011056 Trim skin lesions, 2 to 4 Y P3 0.6993 $28.95 $28.9511057 Trim skin lesions, over 4 Y P3 0.791 $32.75 $32.7511100 Biopsy, skin lesion Y P2 0.793 $32.83 $32.8311101 Biopsy, skin add-on Y P3 0.3403 $14.09 $14.0911200 Removal of skin tags Y P2 0.793 $32.83 $32.8311201 Remove skin tags add-on Y P3 0.1471 $6.09 $6.0911300 Shave skin lesion Y P2 0.793 $32.83 $32.8311301 Shave skin lesion Y P2 0.793 $32.83 $32.8311302 Shave skin lesion Y P2 0.793 $32.83 $32.8311303 Shave skin lesion Y P2 1.4595 $60.42 $60.4211305 Shave skin lesion Y P2 0.793 $32.83 $32.8311306 Shave skin lesion Y P2 0.793 $32.83 $32.8311307 Shave skin lesion Y P2 0.793 $32.83 $32.8311308 Shave skin lesion Y P2 0.793 $32.83 $32.8311310 Shave skin lesion Y P2 0.793 $32.83 $32.8311311 Shave skin lesion Y P2 0.793 $32.83 $32.8311312 Shave skin lesion Y P2 0.793 $32.83 $32.8311313 Shave skin lesion Y P2 0.793 $32.83 $32.8311400 Exc tr-ext b9+marg 0.5 < cm Y P3 1.7847 $73.89 $73.8911401 Exc tr-ext b9+marg 0.6-1 cm Y P3 1.9502 $80.74 $80.7411402 Exc tr-ext b9+marg 1.1-2 cm Y P3 2.1251 $87.98 $87.9811403 Exc tr-ext b9+marg 2.1-3 cm Y P3 2.2816 $94.46 $94.4611404 Exc tr-ext b9+marg 3.1-4 cm Y A2 $333.00 16.1001 $666.56 $416.3911406 Exc tr-ext b9+marg > 4.0 cm Y A2 $446.00 16.1001 $666.56 $501.1411420 Exc h-f-nk-sp b9+marg 0.5 < Y P3 1.656 $68.56 $68.5611421 Exc h-f-nk-sp b9+marg 0.6-1 Y P3 1.9688 $81.51 $81.5111422 Exc h-f-nk-sp b9+marg 1.1-2 Y P3 2.1618 $89.50 $89.5011423 Exc h-f-nk-sp b9+marg 2.1-3 Y P3 2.4195 $100.17 $100.1711424 Exc h-f-nk-sp b9+marg 3.1-4 Y A2 $446.00 16.1001 $666.56 $501.1411426 Exc h-f-nk-sp b9+marg > 4 cm Y A2 $446.00 21.1098 $873.97 $552.9911440 Exc face-mm b9+marg 0.5 < cm Y P3 1.9318 $79.98 $79.9811441 Exc face-mm b9+marg 0.6-1 cm Y P3 2.1712 $89.89 $89.8911442 Exc face-mm b9+marg 1.1-2 cm Y P3 2.3828 $98.65 $98.6511443 Exc face-mm b9+marg 2.1-3 cm Y P3 2.6678 $110.45 $110.4511444 Exc face-mm b9+marg 3.1-4 cm Y A2 $333.00 8.685 $359.57 $339.6411446 Exc face-mm b9+marg > 4 cm Y A2 $446.00 21.1098 $873.97 $552.9911450 Removal, sweat gland lesion Y A2 $446.00 21.1098 $873.97 $552.9911451 Removal, sweat gland lesion Y A2 $446.00 21.1098 $873.97 $552.99

Addendum AA -- ASC Covered Surgical Procedures for CY 2008 (Including Surgical Procedures for Which Payment is Packaged)

HCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment

Date Printed: 04/08/2023 @ 09:12:29 Page 2 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 11462 Removal, sweat gland lesion Y A2 $446.00 21.1098 $873.97 $552.9911463 Removal, sweat gland lesion Y A2 $446.00 21.1098 $873.97 $552.9911470 Removal, sweat gland lesion Y A2 $446.00 21.1098 $873.97 $552.9911471 Removal, sweat gland lesion Y A2 $446.00 21.1098 $873.97 $552.9911600 Exc tr-ext mlg+marg 0.5 < cm Y P3 2.4746 $102.45 $102.4511601 Exc tr-ext mlg+marg 0.6-1 cm Y P3 2.8243 $116.93 $116.9311602 Exc tr-ext mlg+marg 1.1-2 cm Y P3 3.0726 $127.21 $127.2111603 Exc tr-ext mlg+marg 2.1-3 cm Y P3 3.275 $135.59 $135.5911604 Exc tr-ext mlg+marg 3.1-4 cm Y A2 $418.49 8.685 $359.57 $403.7611606 Exc tr-ext mlg+marg > 4 cm Y A2 $446.00 16.1001 $666.56 $501.1411620 Exc h-f-nk-sp mlg+marg 0.5 < Y P3 2.5024 $103.60 $103.6011621 Exc h-f-nk-sp mlg+marg 0.6-1 Y P3 2.8519 $118.07 $118.0711622 Exc h-f-nk-sp mlg+marg 1.1-2 Y P3 3.1555 $130.64 $130.6411623 Exc h-f-nk-sp mlg+marg 2.1-3 Y P3 3.4313 $142.06 $142.0611624 Exc h-f-nk-sp mlg+marg 3.1-4 Y A2 $446.00 16.1001 $666.56 $501.1411626 Exc h-f-nk-sp mlg+mar > 4 cm Y A2 $446.00 21.1098 $873.97 $552.9911640 Exc face-mm malig+marg 0.5 < Y P3 2.6311 $108.93 $108.9311641 Exc face-mm malig+marg 0.6-1 Y P3 3.0635 $126.83 $126.8311642 Exc face-mm malig+marg 1.1-2 Y P3 3.4221 $141.68 $141.6811643 Exc face-mm malig+marg 2.1-3 Y P3 3.7166 $153.87 $153.8711644 Exc face-mm malig+marg 3.1-4 Y A2 $446.00 16.1001 $666.56 $501.1411646 Exc face-mm mlg+marg > 4 cm Y A2 $446.00 21.1098 $873.97 $552.9911719 Trim nail(s) Y P3 0.2853 $11.81 $11.8111720 Debride nail, 1-5 Y P3 0.3679 $15.23 $15.2311721 Debride nail, 6 or more Y P3 0.4507 $18.66 $18.6611730 Removal of nail plate Y P2 0.793 $32.83 $32.8311732 Remove nail plate, add-on Y P3 0.4507 $18.66 $18.6611740 Drain blood from under nail Y P2 0.2963 $12.27 $12.2711750 Removal of nail bed Y P3 2.355 $97.50 $97.5011752 Remove nail bed/finger tip Y P3 3.2475 $134.45 $134.4511755 Biopsy, nail unit Y P3 1.656 $68.56 $68.5611760 Repair of nail bed Y G2 2.1051 $87.15 $87.1511762 Reconstruction of nail bed Y P3 3.0267 $125.31 $125.3111765 Excision of nail fold, toe Y P2 1.4595 $60.42 $60.4211770 Removal of pilonidal lesion Y A2 $510.00 21.1098 $873.97 $600.9911771 Removal of pilonidal lesion Y A2 $510.00 21.1098 $873.97 $600.9911772 Removal of pilonidal lesion Y A2 $510.00 21.1098 $873.97 $600.9911900 Injection into skin lesions Y P3 0.7176 $29.71 $29.7111901 Added skin lesions injection Y P3 0.7635 $31.61 $31.6111920 Correct skin color defects Y P2 2.1051 $87.15 $87.1511921 Correct skin color defects Y P2 2.1051 $87.15 $87.1511922 Correct skin color defects Y P3 0.9476 $39.23 $39.2311950 Therapy for contour defects Y P3 0.9292 $38.47 $38.4711951 Therapy for contour defects Y P3 1.1038 $45.70 $45.7011952 Therapy for contour defects Y P2 1.2792 $52.96 $52.9611954 Therapy for contour defects Y P2 1.2792 $52.96 $52.9611960 Insert tissue expander(s) Y A2 $446.00 20.2069 $836.59 $543.6511970 Replace tissue expander Y A2 $510.00 42.985 $1,779.62 $827.4111971 Remove tissue expander(s) Y A2 $333.00 21.1098 $873.97 $468.2411976 Removal of contraceptive cap Y P3 1.5823 $65.51 $65.5111980 Implant hormone pellet(s) N P2 0.631 $26.12 $26.1211981 Insert drug implant device N P2 0.631 $26.12 $26.1211982 Remove drug implant device N P2 0.631 $26.12 $26.1211983 Remove/insert drug implant N P2 0.631 $26.12 $26.1212001 Repair superficial wound(s) Y P2 1.2792 $52.96 $52.9612002 Repair superficial wound(s) Y P2 1.2792 $52.96 $52.9612004 Repair superficial wound(s) Y P2 1.2792 $52.96 $52.9612005 Repair superficial wound(s) Y A2 $91.24 1.2792 $52.96 $81.6712006 Repair superficial wound(s) Y A2 $91.24 1.2792 $52.96 $81.6712007 Repair superficial wound(s) Y A2 $91.24 1.2792 $52.96 $81.6712011 Repair superficial wound(s) Y P2 1.2792 $52.96 $52.9612013 Repair superficial wound(s) Y P2 1.2792 $52.96 $52.9612014 Repair superficial wound(s) Y P2 1.2792 $52.96 $52.9612015 Repair superficial wound(s) Y G2 1.2792 $52.96 $52.9612016 Repair superficial wound(s) Y A2 $91.24 1.2792 $52.96 $81.6712017 Repair superficial wound(s) Y A2 $91.24 1.2792 $52.96 $81.6712018 Repair superficial wound(s) Y A2 $91.24 1.2792 $52.96 $81.6712020 Closure of split wound Y A2 $91.24 4.5263 $187.39 $115.2812021 Closure of split wound Y A2 $91.24 4.5263 $187.39 $115.2812031 Layer closure of wound(s) Y P2 2.1051 $87.15 $87.1512032 Layer closure of wound(s) Y P2 2.1051 $87.15 $87.1512034 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212035 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212036 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212037 Layer closure of wound(s) Y A2 $323.28 2.1051 $87.15 $264.2512041 Layer closure of wound(s) Y P2 2.1051 $87.15 $87.1512042 Layer closure of wound(s) Y P2 2.1051 $87.15 $87.1512044 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212045 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212046 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212047 Layer closure of wound(s) Y A2 $323.28 2.1051 $87.15 $264.2512051 Layer closure of wound(s) Y P2 2.1051 $87.15 $87.1512052 Layer closure of wound(s) Y P2 2.1051 $87.15 $87.1512053 Layer closure of wound(s) Y P2 2.1051 $87.15 $87.1512054 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212055 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212056 Layer closure of wound(s) Y A2 $91.24 2.1051 $87.15 $90.2212057 Layer closure of wound(s) Y A2 $323.28 2.1051 $87.15 $264.25

Date Printed: 04/08/2023 @ 09:12:29 Page 3 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 13100 Repair of wound or lesion Y A2 $323.28 4.5263 $187.39 $289.3113101 Repair of wound or lesion Y A2 $323.28 4.5263 $187.39 $289.3113102 Repair wound/lesion add-on Y A2 $91.24 4.5263 $187.39 $115.2813120 Repair of wound or lesion Y A2 $91.24 2.1051 $87.15 $90.2213121 Repair of wound or lesion Y A2 $91.24 4.5263 $187.39 $115.2813122 Repair wound/lesion add-on Y A2 $91.24 2.1051 $87.15 $90.2213131 Repair of wound or lesion Y A2 $91.24 4.5263 $187.39 $115.2813132 Repair of wound or lesion Y A2 $91.24 4.5263 $187.39 $115.2813133 Repair wound/lesion add-on Y A2 $91.24 4.5263 $187.39 $115.2813150 Repair of wound or lesion Y A2 $323.28 4.5263 $187.39 $289.3113151 Repair of wound or lesion Y A2 $323.28 4.5263 $187.39 $289.3113152 Repair of wound or lesion Y A2 $323.28 4.5263 $187.39 $289.3113153 Repair wound/lesion add-on Y A2 $91.24 2.1051 $87.15 $90.2213160 Late closure of wound Y A2 $446.00 20.2069 $836.59 $543.6514000 Skin tissue rearrangement Y A2 $446.00 15.0458 $622.91 $490.2314001 Skin tissue rearrangement Y A2 $510.00 15.0458 $622.91 $538.2314020 Skin tissue rearrangement Y A2 $510.00 15.0458 $622.91 $538.2314021 Skin tissue rearrangement Y A2 $510.00 15.0458 $622.91 $538.2314040 Skin tissue rearrangement Y A2 $446.00 15.0458 $622.91 $490.2314041 Skin tissue rearrangement Y A2 $510.00 15.0458 $622.91 $538.2314060 Skin tissue rearrangement Y A2 $510.00 15.0458 $622.91 $538.2314061 Skin tissue rearrangement Y A2 $510.00 15.0458 $622.91 $538.2314300 Skin tissue rearrangement Y A2 $630.00 20.2069 $836.59 $681.6514350 Skin tissue rearrangement Y A2 $510.00 20.2069 $836.59 $591.6515002 Wnd prep, ch/inf, trk/arm/lg Y A2 $323.28 4.5263 $187.39 $289.3115003 Wnd prep, ch/inf addl 100 cm Y A2 $323.28 4.5263 $187.39 $289.3115004 Wnd prep ch/inf, f/n/hf/g Y A2 $323.28 4.5263 $187.39 $289.3115005 Wnd prep, f/n/hf/g, addl cm Y A2 $323.28 4.5263 $187.39 $289.3115040 Harvest cultured skin graft Y A2 $91.24 2.1051 $87.15 $90.2215050 Skin pinch graft Y A2 $323.28 4.5263 $187.39 $289.3115100 Skin splt grft, trnk/arm/leg Y A2 $446.00 20.2069 $836.59 $543.6515101 Skin splt grft t/a/l, add-on Y A2 $510.00 20.2069 $836.59 $591.6515110 Epidrm autogrft trnk/arm/leg Y A2 $446.00 4.5263 $187.39 $381.3515111 Epidrm autogrft t/a/l add-on Y A2 $333.00 4.5263 $187.39 $296.6015115 Epidrm a-grft face/nck/hf/g Y A2 $446.00 4.5263 $187.39 $381.3515116 Epidrm a-grft f/n/hf/g addl Y A2 $333.00 4.5263 $187.39 $296.6015120 Skn splt a-grft fac/nck/hf/g Y A2 $446.00 20.2069 $836.59 $543.6515121 Skn splt a-grft f/n/hf/g add Y A2 $510.00 20.2069 $836.59 $591.6515130 Derm autograft, trnk/arm/leg Y A2 $446.00 15.0458 $622.91 $490.2315131 Derm autograft t/a/l add-on Y A2 $333.00 15.0458 $622.91 $405.4815135 Derm autograft face/nck/hf/g Y A2 $446.00 15.0458 $622.91 $490.2315136 Derm autograft, f/n/hf/g add Y A2 $333.00 15.0458 $622.91 $405.4815150 Cult epiderm grft t/arm/leg Y A2 $446.00 4.5263 $187.39 $381.3515151 Cult epiderm grft t/a/l addl Y A2 $333.00 4.5263 $187.39 $296.6015152 Cult epiderm graft t/a/l +% Y A2 $333.00 4.5263 $187.39 $296.6015155 Cult epiderm graft, f/n/hf/g Y A2 $446.00 4.5263 $187.39 $381.3515156 Cult epidrm grft f/n/hfg add Y A2 $333.00 4.5263 $187.39 $296.6015157 Cult epiderm grft f/n/hfg +% Y A2 $333.00 4.5263 $187.39 $296.6015200 Skin full graft, trunk Y A2 $510.00 15.0458 $622.91 $538.2315201 Skin full graft trunk add-on Y A2 $323.28 15.0458 $622.91 $398.1915220 Skin full graft sclp/arm/leg Y A2 $446.00 15.0458 $622.91 $490.2315221 Skin full graft add-on Y A2 $323.28 4.5263 $187.39 $289.3115240 Skin full grft face/genit/hf Y A2 $510.00 15.0458 $622.91 $538.2315241 Skin full graft add-on Y A2 $323.28 4.5263 $187.39 $289.3115260 Skin full graft een & lips Y A2 $446.00 15.0458 $622.91 $490.2315261 Skin full graft add-on Y A2 $323.28 15.0458 $622.91 $398.1915300 Apply skinallogrft, t/arm/lg Y A2 $323.28 4.5263 $187.39 $289.3115301 Apply sknallogrft t/a/l addl Y A2 $323.28 4.5263 $187.39 $289.3115320 Apply skin allogrft f/n/hf/g Y A2 $323.28 4.5263 $187.39 $289.3115321 Aply sknallogrft f/n/hfg add Y A2 $323.28 4.5263 $187.39 $289.3115330 Aply acell alogrft t/arm/leg Y A2 $323.28 4.5263 $187.39 $289.3115331 Aply acell grft t/a/l add-on Y A2 $323.28 4.5263 $187.39 $289.3115335 Apply acell graft, f/n/hf/g Y A2 $323.28 4.5263 $187.39 $289.3115336 Aply acell grft f/n/hf/g add Y A2 $323.28 4.5263 $187.39 $289.3115340 Apply cult skin substitute Y G2 2.1051 $87.15 $87.1515341 Apply cult skin sub add-on Y G2 2.1051 $87.15 $87.1515360 Apply cult derm sub, t/a/l Y G2 2.1051 $87.15 $87.1515361 Aply cult derm sub t/a/l add Y G2 2.1051 $87.15 $87.1515365 Apply cult derm sub f/n/hf/g Y G2 2.1051 $87.15 $87.1515366 Apply cult derm f/hf/g add Y G2 2.1051 $87.15 $87.1515400 Apply skin xenograft, t/a/l Y A2 $323.28 4.5263 $187.39 $289.3115401 Apply skn xenogrft t/a/l add Y A2 $323.28 4.5263 $187.39 $289.3115420 Apply skin xgraft, f/n/hf/g Y A2 $323.28 4.5263 $187.39 $289.3115421 Apply skn xgrft f/n/hf/g add Y A2 $323.28 4.5263 $187.39 $289.3115430 Apply acellular xenograft Y A2 $323.28 4.5263 $187.39 $289.3115431 Apply acellular xgraft add Y A2 $323.28 4.5263 $187.39 $289.3115570 Form skin pedicle flap Y A2 $510.00 20.2069 $836.59 $591.6515572 Form skin pedicle flap Y A2 $510.00 20.2069 $836.59 $591.6515574 Form skin pedicle flap Y A2 $510.00 20.2069 $836.59 $591.6515576 Form skin pedicle flap Y A2 $510.00 20.2069 $836.59 $591.6515600 Skin graft Y A2 $510.00 20.2069 $836.59 $591.6515610 Skin graft Y A2 $510.00 20.2069 $836.59 $591.6515620 Skin graft Y A2 $630.00 20.2069 $836.59 $681.6515630 Skin graft Y A2 $510.00 20.2069 $836.59 $591.6515650 Transfer skin pedicle flap Y A2 $717.00 20.2069 $836.59 $746.9015731 Forehead flap w/vasc pedicle Y A2 $510.00 20.2069 $836.59 $591.6515732 Muscle-skin graft, head/neck Y A2 $510.00 20.2069 $836.59 $591.6515734 Muscle-skin graft, trunk Y A2 $510.00 20.2069 $836.59 $591.65

Date Printed: 04/08/2023 @ 09:12:29 Page 4 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 15736 Muscle-skin graft, arm Y A2 $510.00 20.2069 $836.59 $591.6515738 Muscle-skin graft, leg Y A2 $510.00 20.2069 $836.59 $591.6515740 Island pedicle flap graft Y A2 $446.00 15.0458 $622.91 $490.2315750 Neurovascular pedicle graft Y A2 $446.00 20.2069 $836.59 $543.6515760 Composite skin graft Y A2 $446.00 20.2069 $836.59 $543.6515770 Derma-fat-fascia graft Y A2 $510.00 20.2069 $836.59 $591.6515775 Hair transplant punch grafts Y A2 $323.28 1.2792 $52.96 $255.7015776 Hair transplant punch grafts Y A2 $323.28 1.2792 $52.96 $255.7015780 Abrasion treatment of skin Y P3 10.4691 $433.43 $433.4315781 Abrasion treatment of skin Y P2 4.3039 $178.19 $178.1915782 Abrasion treatment of skin Y P2 4.3039 $178.19 $178.1915783 Abrasion treatment of skin Y P2 2.6604 $110.14 $110.1415786 Abrasion, lesion, single Y P2 0.793 $32.83 $32.8315787 Abrasion, lesions, add-on Y P2 0.793 $32.83 $32.8315788 Chemical peel, face, epiderm Y P2 0.793 $32.83 $32.8315789 Chemical peel, face, dermal Y P2 1.4595 $60.42 $60.4215792 Chemical peel, nonfacial Y P2 1.4595 $60.42 $60.4215793 Chemical peel, nonfacial Y P2 0.793 $32.83 $32.8315819 Plastic surgery, neck Y G2 2.1051 $87.15 $87.1515820 Revision of lower eyelid Y A2 $510.00 20.2069 $836.59 $591.6515821 Revision of lower eyelid Y A2 $510.00 20.2069 $836.59 $591.6515822 Revision of upper eyelid Y A2 $510.00 20.2069 $836.59 $591.6515823 Revision of upper eyelid Y A2 $717.00 20.2069 $836.59 $746.9015824 Removal of forehead wrinkles Y A2 $510.00 20.2069 $836.59 $591.6515825 Removal of neck wrinkles Y A2 $510.00 20.2069 $836.59 $591.6515826 Removal of brow wrinkles Y A2 $510.00 20.2069 $836.59 $591.6515828 Removal of face wrinkles Y A2 $510.00 20.2069 $836.59 $591.6515829 Removal of skin wrinkles Y A2 $717.00 20.2069 $836.59 $746.9015830 Exc skin abd Y A2 $510.00 21.1098 $873.97 $600.9915832 Excise excessive skin tissue Y A2 $510.00 21.1098 $873.97 $600.9915833 Excise excessive skin tissue Y A2 $510.00 21.1098 $873.97 $600.9915834 Excise excessive skin tissue Y A2 $510.00 21.1098 $873.97 $600.9915835 Excise excessive skin tissue Y A2 $323.28 21.1098 $873.97 $460.9515836 Excise excessive skin tissue Y A2 $510.00 16.1001 $666.56 $549.1415837 Excise excessive skin tissue Y G2 16.1001 $666.56 $666.5615838 Excise excessive skin tissue Y G2 16.1001 $666.56 $666.5615839 Excise excessive skin tissue Y A2 $510.00 16.1001 $666.56 $549.1415840 Graft for face nerve palsy Y A2 $630.00 20.2069 $836.59 $681.6515841 Graft for face nerve palsy Y A2 $630.00 20.2069 $836.59 $681.6515842 Flap for face nerve palsy Y G2 20.2069 $836.59 $836.5915845 Skin and muscle repair, face Y A2 $630.00 20.2069 $836.59 $681.6515847 Exc skin abd add-on Y A2 $510.00 21.1098 $873.97 $600.9915850 Removal of sutures Y G2 2.6604 $110.14 $110.1415851 Removal of sutures Y P3 1.3891 $57.51 $57.5115852 Dressing change not for burn N G2 0.631 $26.12 $26.1215860 Test for blood flow in graft N G2 0.631 $26.12 $26.1215876 Suction assisted lipectomy Y A2 $510.00 20.2069 $836.59 $591.6515877 Suction assisted lipectomy Y A2 $510.00 20.2069 $836.59 $591.6515878 Suction assisted lipectomy Y A2 $510.00 20.2069 $836.59 $591.6515879 Suction assisted lipectomy Y A2 $510.00 20.2069 $836.59 $591.6515920 Removal of tail bone ulcer Y A2 $251.52 4.3039 $178.19 $233.1915922 Removal of tail bone ulcer Y A2 $630.00 20.2069 $836.59 $681.6515931 Remove sacrum pressure sore Y A2 $510.00 21.1098 $873.97 $600.9915933 Remove sacrum pressure sore Y A2 $510.00 21.1098 $873.97 $600.9915934 Remove sacrum pressure sore Y A2 $510.00 20.2069 $836.59 $591.6515935 Remove sacrum pressure sore Y A2 $630.00 20.2069 $836.59 $681.6515936 Remove sacrum pressure sore Y A2 $630.00 15.0458 $622.91 $628.2315937 Remove sacrum pressure sore Y A2 $630.00 20.2069 $836.59 $681.6515940 Remove hip pressure sore Y A2 $510.00 21.1098 $873.97 $600.9915941 Remove hip pressure sore Y A2 $510.00 21.1098 $873.97 $600.9915944 Remove hip pressure sore Y A2 $510.00 20.2069 $836.59 $591.6515945 Remove hip pressure sore Y A2 $630.00 20.2069 $836.59 $681.6515946 Remove hip pressure sore Y A2 $630.00 20.2069 $836.59 $681.6515950 Remove thigh pressure sore Y A2 $510.00 21.1098 $873.97 $600.9915951 Remove thigh pressure sore Y A2 $630.00 21.1098 $873.97 $690.9915952 Remove thigh pressure sore Y A2 $510.00 15.0458 $622.91 $538.2315953 Remove thigh pressure sore Y A2 $630.00 15.0458 $622.91 $628.2315956 Remove thigh pressure sore Y A2 $510.00 15.0458 $622.91 $538.2315958 Remove thigh pressure sore Y A2 $630.00 15.0458 $622.91 $628.2316000 Initial treatment of burn(s) Y P3 0.7268 $30.09 $30.0916020 Dress/debrid p-thick burn, s Y P3 1.1038 $45.70 $45.7016025 Dress/debrid p-thick burn, m Y A2 $67.11 2.6604 $110.14 $77.8716030 Dress/debrid p-thick burn, l Y A2 $99.83 2.6604 $110.14 $102.4116035 Incision of burn scab, initi Y G2 2.6604 $110.14 $110.1417000 Destruct premalg lesion Y P2 0.793 $32.83 $32.8317003 Destruct premalg les, 2-14 Y P3 0.1012 $4.19 $4.1917004 Destroy premlg lesions 15+ Y P3 2.1804 $90.27 $90.2717106 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417107 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417108 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417110 Destruct b9 lesion, 1-14 Y P2 0.793 $32.83 $32.8317111 Destruct lesion, 15 or more Y P2 1.4595 $60.42 $60.4217250 Chemical cautery, tissue Y P3 1.1683 $48.37 $48.3717260 Destruction of skin lesions Y P3 1.2328 $51.04 $51.0417261 Destruction of skin lesions Y P2 1.4595 $60.42 $60.4217262 Destruction of skin lesions Y P2 1.4595 $60.42 $60.4217263 Destruction of skin lesions Y P2 1.4595 $60.42 $60.4217264 Destruction of skin lesions Y P2 1.4595 $60.42 $60.42

Date Printed: 04/08/2023 @ 09:12:29 Page 5 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 17266 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417270 Destruction of skin lesions Y P2 1.4595 $60.42 $60.4217271 Destruction of skin lesions Y P2 1.4595 $60.42 $60.4217272 Destruction of skin lesions Y P2 1.4595 $60.42 $60.4217273 Destruction of skin lesions Y P3 2.4932 $103.22 $103.2217274 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417276 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417280 Destruction of skin lesions Y P2 1.4595 $60.42 $60.4217281 Destruction of skin lesions Y P3 2.1342 $88.36 $88.3617282 Destruction of skin lesions Y P3 2.4379 $100.93 $100.9317283 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417284 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417286 Destruction of skin lesions Y P2 2.6604 $110.14 $110.1417311 Mohs, 1 stage, h/n/hf/g Y P2 3.6321 $150.37 $150.3717312 Mohs addl stage Y P2 3.6321 $150.37 $150.3717313 Mohs, 1 stage, t/a/l Y P2 3.6321 $150.37 $150.3717314 Mohs, addl stage, t/a/l Y P2 3.6321 $150.37 $150.3717315 Mohs surg, addl block Y P3 1.0488 $43.42 $43.4217340 Cryotherapy of skin Y P3 0.3312 $13.71 $13.7117360 Skin peel therapy Y P2 0.793 $32.83 $32.8317380 Hair removal by electrolysis Y R2 0.793 $32.83 $32.8319000 Drainage of breast lesion Y P3 1.7939 $74.27 $74.2719001 Drain breast lesion add-on Y P3 0.2299 $9.52 $9.5219020 Incision of breast lesion Y A2 $446.00 18.3197 $758.45 $524.1119030 Injection for breast x-ray N N119100 Bx breast percut w/o image Y A2 $240.00 4.327 $179.14 $224.7919101 Biopsy of breast, open Y A2 $446.00 20.6417 $854.59 $548.1519102 Bx breast percut w/image Y A2 $240.00 7.1147 $294.56 $253.6419103 Bx breast percut w/device Y A2 $395.77 13.5764 $562.08 $437.3519105 Cryosurg ablate fa, each Y G2 31.7134 $1,312.97 $1,312.9719110 Nipple exploration Y A2 $446.00 20.6417 $854.59 $548.1519112 Excise breast duct fistula Y A2 $510.00 20.6417 $854.59 $596.1519120 Removal of breast lesion Y A2 $510.00 20.6417 $854.59 $596.1519125 Excision, breast lesion Y A2 $510.00 20.6417 $854.59 $596.1519126 Excision, addl breast lesion Y A2 $510.00 20.6417 $854.59 $596.1519290 Place needle wire, breast N N119291 Place needle wire, breast N N119295 Place breast clip, percut N N119296 Place po breast cath for rad Y A2 $1,339.00 56.5774 $2,342.36 $1,589.8419297 Place breast cath for rad Y A2 $1,339.00 56.5774 $2,342.36 $1,589.8419298 Place breast rad tube/caths Y A2 $1,339.00 56.5774 $2,342.36 $1,589.8419300 Removal of breast tissue Y A2 $630.00 20.6417 $854.59 $686.1519301 Partical mastectomy Y A2 $510.00 20.6417 $854.59 $596.1519302 P-mastectomy w/ln removal Y A2 $995.00 39.8191 $1,648.55 $1,158.3919303 Mast, simple, complete Y A2 $630.00 31.7134 $1,312.97 $800.7419304 Mast, subq Y A2 $630.00 31.7134 $1,312.97 $800.7419316 Suspension of breast Y A2 $630.00 31.7134 $1,312.97 $800.7419318 Reduction of large breast Y A2 $630.00 39.8191 $1,648.55 $884.6419324 Enlarge breast Y A2 $630.00 39.8191 $1,648.55 $884.6419325 Enlarge breast with implant Y A2 $1,339.00 56.5774 $2,342.36 $1,589.8419328 Removal of breast implant Y A2 $333.00 31.7134 $1,312.97 $577.9919330 Removal of implant material Y A2 $333.00 31.7134 $1,312.97 $577.9919340 Immediate breast prosthesis Y A2 $446.00 39.8191 $1,648.55 $746.6419342 Delayed breast prosthesis Y A2 $510.00 56.5774 $2,342.36 $968.0919350 Breast reconstruction Y A2 $630.00 20.6417 $854.59 $686.1519355 Correct inverted nipple(s) Y A2 $630.00 31.7134 $1,312.97 $800.7419357 Breast reconstruction Y A2 $717.00 56.5774 $2,342.36 $1,123.3419366 Breast reconstruction Y A2 $717.00 31.7134 $1,312.97 $865.9919370 Surgery of breast capsule Y A2 $630.00 31.7134 $1,312.97 $800.7419371 Removal of breast capsule Y A2 $630.00 31.7134 $1,312.97 $800.7419380 Revise breast reconstruction Y A2 $717.00 39.8191 $1,648.55 $949.8919396 Design custom breast implant Y G2 31.7134 $1,312.97 $1,312.9720000 Incision of abscess Y P2 1.4066 $58.23 $58.2320005 Incision of deep abscess Y A2 $446.00 21.2689 $880.55 $554.6420103 Explore wound, extremity Y G2 9.6341 $398.86 $398.8620150 Excise epiphyseal bar Y G2 42.985 $1,779.62 $1,779.6220200 Muscle biopsy Y A2 $446.00 16.1001 $666.56 $501.1420205 Deep muscle biopsy Y A2 $510.00 16.1001 $666.56 $549.1420206 Needle biopsy, muscle Y A2 $240.00 7.1147 $294.56 $253.6420220 Bone biopsy, trocar/needle Y A2 $251.52 8.685 $359.57 $278.5320225 Bone biopsy, trocar/needle Y A2 $418.49 8.685 $359.57 $403.7620240 Bone biopsy, excisional Y A2 $446.00 21.1098 $873.97 $552.9920245 Bone biopsy, excisional Y A2 $510.00 21.1098 $873.97 $600.9920250 Open bone biopsy Y A2 $510.00 21.2689 $880.55 $602.6420251 Open bone biopsy Y A2 $510.00 21.2689 $880.55 $602.6420500 Injection of sinus tract Y P3 1.656 $68.56 $68.5620501 Inject sinus tract for x-ray N N120520 Removal of foreign body Y P3 2.5391 $105.12 $105.1220525 Removal of foreign body Y A2 $510.00 21.1098 $873.97 $600.9920526 Ther injection, carp tunnel Y P3 0.8188 $33.90 $33.9020550 Inj tendon sheath/ligament Y P3 0.6164 $25.52 $25.5220551 Inj tendon origin/insertion Y P3 0.6072 $25.14 $25.1420552 Inj trigger point, 1/2 muscl Y P3 0.5981 $24.76 $24.7620553 Inject trigger points, =/> 3 Y P3 0.6715 $27.80 $27.8020555 Place ndl musc/tis for rt Y G2 29.19 $1,208.50 $1,208.5020600 Drain/inject, joint/bursa Y P3 0.6072 $25.14 $25.1420605 Drain/inject, joint/bursa Y P3 0.6901 $28.57 $28.5720610 Drain/inject, joint/bursa Y P3 0.9292 $38.47 $38.47

Date Printed: 04/08/2023 @ 09:12:29 Page 6 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 20612 Aspirate/inj ganglion cyst Y P3 0.6439 $26.66 $26.6620615 Treatment of bone cyst Y P3 2.861 $118.45 $118.4520650 Insert and remove bone pin Y A2 $510.00 21.2689 $880.55 $602.6420662 Application of pelvis brace Y R2 21.2689 $880.55 $880.5520663 Application of thigh brace Y R2 21.2689 $880.55 $880.5520665 Removal of fixation device N G2 0.631 $26.12 $26.1220670 Removal of support implant Y A2 $333.00 16.1001 $666.56 $416.3920680 Removal of support implant Y A2 $510.00 21.1098 $873.97 $600.9920690 Apply bone fixation device Y A2 $446.00 29.19 $1,208.50 $636.6320692 Apply bone fixation device Y A2 $510.00 29.19 $1,208.50 $684.6320693 Adjust bone fixation device Y A2 $510.00 21.2689 $880.55 $602.6420694 Remove bone fixation device Y A2 $333.00 21.2689 $880.55 $469.8920822 Replantation digit, complete Y G2 26.3105 $1,089.28 $1,089.2820900 Removal of bone for graft Y A2 $510.00 29.19 $1,208.50 $684.6320902 Removal of bone for graft Y A2 $630.00 29.19 $1,208.50 $774.6320910 Remove cartilage for graft Y A2 $510.00 20.2069 $836.59 $591.6520912 Remove cartilage for graft Y A2 $510.00 20.2069 $836.59 $591.6520920 Removal of fascia for graft Y A2 $630.00 15.0458 $622.91 $628.2320922 Removal of fascia for graft Y A2 $510.00 15.0458 $622.91 $538.2320924 Removal of tendon for graft Y A2 $630.00 29.19 $1,208.50 $774.6320926 Removal of tissue for graft Y A2 $630.00 4.5263 $187.39 $519.3520950 Fluid pressure, muscle Y G2 1.4066 $58.23 $58.2320972 Bone/skin graft, metatarsal Y G2 44.2687 $1,832.77 $1,832.7720973 Bone/skin graft, great toe Y R2 44.2687 $1,832.77 $1,832.7720975 Electrical bone stimulation N N120979 Us bone stimulation N P2 0.631 $26.12 $26.1220982 Ablate, bone tumor(s) perq Y G2 42.985 $1,779.62 $1,779.6220985 Cptr-asst dir ms px N N120986 Cptr-asst dir ms px io img N N120987 Cptr-asst dir ms px pre img N N121010 Incision of jaw joint Y A2 $446.00 23.9765 $992.65 $582.6621015 Resection of facial tumor Y A2 $510.00 16.3288 $676.03 $551.5121025 Excision of bone, lower jaw Y A2 $446.00 39.8776 $1,650.97 $747.2421026 Excision of facial bone(s) Y A2 $446.00 39.8776 $1,650.97 $747.2421029 Contour of face bone lesion Y A2 $446.00 39.8776 $1,650.97 $747.2421030 Excise max/zygoma b9 tumor Y P3 6.2189 $257.47 $257.4721031 Remove exostosis, mandible Y P3 5.0965 $211.00 $211.0021032 Remove exostosis, maxilla Y P3 5.2438 $217.10 $217.1021034 Excise max/zygoma mlg tumor Y A2 $510.00 39.8776 $1,650.97 $795.2421040 Excise mandible lesion Y A2 $446.00 23.9765 $992.65 $582.6621044 Removal of jaw bone lesion Y A2 $446.00 39.8776 $1,650.97 $747.2421046 Remove mandible cyst complex Y A2 $446.00 39.8776 $1,650.97 $747.2421047 Excise lwr jaw cyst w/repair Y A2 $446.00 39.8776 $1,650.97 $747.2421048 Remove maxilla cyst complex Y R2 39.8776 $1,650.97 $1,650.9721050 Removal of jaw joint Y A2 $510.00 39.8776 $1,650.97 $795.2421060 Remove jaw joint cartilage Y A2 $446.00 39.8776 $1,650.97 $747.2421070 Remove coronoid process Y A2 $510.00 39.8776 $1,650.97 $795.2421073* Mnpj of tmj w/anesth Y P3 5.0598 $209.48 $209.4821076 Prepare face/oral prosthesis Y P3 9.3744 $388.11 $388.1121077 Prepare face/oral prosthesis Y P3 22.8978 $947.99 $947.9921079 Prepare face/oral prosthesis Y P3 16.3199 $675.66 $675.6621080 Prepare face/oral prosthesis Y P3 18.7027 $774.31 $774.3121081 Prepare face/oral prosthesis Y P3 17.1754 $711.08 $711.0821082 Prepare face/oral prosthesis Y P3 15.7588 $652.43 $652.4321083 Prepare face/oral prosthesis Y P3 15.5105 $642.15 $642.1521084 Prepare face/oral prosthesis Y P3 18.0771 $748.41 $748.4121085 Prepare face/oral prosthesis Y P3 7.0008 $289.84 $289.8421086 Prepare face/oral prosthesis Y P3 16.8721 $698.52 $698.5221087 Prepare face/oral prosthesis Y P3 16.7155 $692.04 $692.0421088 Prepare face/oral prosthesis Y R2 39.8776 $1,650.97 $1,650.9721100 Maxillofacial fixation Y A2 $446.00 39.8776 $1,650.97 $747.2421110 Interdental fixation Y P2 7.4474 $308.33 $308.3321116 Injection, jaw joint x-ray N N121120 Reconstruction of chin Y A2 $995.00 23.9765 $992.65 $994.4121121 Reconstruction of chin Y A2 $995.00 23.9765 $992.65 $994.4121122 Reconstruction of chin Y A2 $995.00 23.9765 $992.65 $994.4121123 Reconstruction of chin Y A2 $995.00 23.9765 $992.65 $994.4121125 Augmentation, lower jaw bone Y A2 $995.00 23.9765 $992.65 $994.4121127 Augmentation, lower jaw bone Y A2 $1,339.00 39.8776 $1,650.97 $1,416.9921137 Reduction of forehead Y G2 23.9765 $992.65 $992.6521138 Reduction of forehead Y G2 39.8776 $1,650.97 $1,650.9721139 Reduction of forehead Y G2 39.8776 $1,650.97 $1,650.9721150 Reconstruct midface, lefort Y G2 39.8776 $1,650.97 $1,650.9721181 Contour cranial bone lesion Y A2 $995.00 23.9765 $992.65 $994.4121198 Reconstr lwr jaw segment Y G2 39.8776 $1,650.97 $1,650.9721199 Reconstr lwr jaw w/advance Y G2 39.8776 $1,650.97 $1,650.9721206 Reconstruct upper jaw bone Y A2 $717.00 39.8776 $1,650.97 $950.4921208 Augmentation of facial bones Y A2 $995.00 39.8776 $1,650.97 $1,158.9921209 Reduction of facial bones Y A2 $717.00 39.8776 $1,650.97 $950.4921210 Face bone graft Y A2 $995.00 39.8776 $1,650.97 $1,158.9921215 Lower jaw bone graft Y A2 $995.00 39.8776 $1,650.97 $1,158.9921230 Rib cartilage graft Y A2 $995.00 39.8776 $1,650.97 $1,158.9921235 Ear cartilage graft Y A2 $995.00 23.9765 $992.65 $994.4121240 Reconstruction of jaw joint Y A2 $630.00 39.8776 $1,650.97 $885.2421242 Reconstruction of jaw joint Y A2 $717.00 39.8776 $1,650.97 $950.4921243 Reconstruction of jaw joint Y A2 $717.00 39.8776 $1,650.97 $950.4921244 Reconstruction of lower jaw Y A2 $995.00 39.8776 $1,650.97 $1,158.9921245 Reconstruction of jaw Y A2 $995.00 39.8776 $1,650.97 $1,158.99

Date Printed: 04/08/2023 @ 09:12:29 Page 7 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 21246 Reconstruction of jaw Y A2 $995.00 39.8776 $1,650.97 $1,158.9921248 Reconstruction of jaw Y A2 $995.00 39.8776 $1,650.97 $1,158.9921249 Reconstruction of jaw Y A2 $995.00 39.8776 $1,650.97 $1,158.9921260 Revise eye sockets Y G2 39.8776 $1,650.97 $1,650.9721267 Revise eye sockets Y A2 $995.00 39.8776 $1,650.97 $1,158.9921270 Augmentation, cheek bone Y A2 $717.00 39.8776 $1,650.97 $950.4921275 Revision, orbitofacial bones Y A2 $995.00 39.8776 $1,650.97 $1,158.9921280 Revision of eyelid Y A2 $717.00 39.8776 $1,650.97 $950.4921282 Revision of eyelid Y A2 $717.00 16.3288 $676.03 $706.7621295 Revision of jaw muscle/bone Y A2 $333.00 7.4474 $308.33 $326.8321296 Revision of jaw muscle/bone Y A2 $333.00 23.9765 $992.65 $497.9121310 Treatment of nose fracture Y A2 $150.72 2.5002 $103.51 $138.9221315 Treatment of nose fracture Y A2 $150.72 2.5002 $103.51 $138.9221320 Treatment of nose fracture Y A2 $446.00 16.3288 $676.03 $503.5121325 Treatment of nose fracture Y A2 $630.00 23.9765 $992.65 $720.6621330 Treatment of nose fracture Y A2 $717.00 23.9765 $992.65 $785.9121335 Treatment of nose fracture Y A2 $995.00 23.9765 $992.65 $994.4121336 Treat nasal septal fracture Y A2 $630.00 26.1592 $1,083.02 $743.2621337 Treat nasal septal fracture Y A2 $446.00 16.3288 $676.03 $503.5121338 Treat nasoethmoid fracture Y A2 $630.00 23.9765 $992.65 $720.6621339 Treat nasoethmoid fracture Y A2 $717.00 23.9765 $992.65 $785.9121340 Treatment of nose fracture Y A2 $630.00 39.8776 $1,650.97 $885.2421345 Treat nose/jaw fracture Y A2 $995.00 23.9765 $992.65 $994.4121355 Treat cheek bone fracture Y A2 $510.00 39.8776 $1,650.97 $795.2421356 Treat cheek bone fracture Y A2 $510.00 23.9765 $992.65 $630.6621360 Treat cheek bone fracture Y G2 23.9765 $992.65 $992.6521390 Treat eye socket fracture Y G2 39.8776 $1,650.97 $1,650.9721400 Treat eye socket fracture Y A2 $446.00 7.4474 $308.33 $411.5821401 Treat eye socket fracture Y A2 $510.00 16.3288 $676.03 $551.5121406 Treat eye socket fracture Y G2 39.8776 $1,650.97 $1,650.9721407 Treat eye socket fracture Y G2 39.8776 $1,650.97 $1,650.9721421 Treat mouth roof fracture Y A2 $630.00 23.9765 $992.65 $720.6621440 Treat dental ridge fracture Y P3 7.9025 $327.17 $327.1721445 Treat dental ridge fracture Y A2 $630.00 23.9765 $992.65 $720.6621450 Treat lower jaw fracture Y A2 $150.72 2.5002 $103.51 $138.9221451 Treat lower jaw fracture Y A2 $464.15 7.4474 $308.33 $425.2021452 Treat lower jaw fracture Y A2 $446.00 16.3288 $676.03 $503.5121453 Treat lower jaw fracture Y A2 $510.00 39.8776 $1,650.97 $795.2421454 Treat lower jaw fracture Y A2 $717.00 23.9765 $992.65 $785.9121461 Treat lower jaw fracture Y A2 $630.00 39.8776 $1,650.97 $885.2421462 Treat lower jaw fracture Y A2 $717.00 39.8776 $1,650.97 $950.4921465 Treat lower jaw fracture Y A2 $630.00 39.8776 $1,650.97 $885.2421480 Reset dislocated jaw Y A2 $150.72 2.5002 $103.51 $138.9221485 Reset dislocated jaw Y A2 $446.00 16.3288 $676.03 $503.5121490 Repair dislocated jaw Y A2 $510.00 39.8776 $1,650.97 $795.2421495 Treat hyoid bone fracture Y G2 16.3288 $676.03 $676.0321497 Interdental wiring Y A2 $446.00 16.3288 $676.03 $503.5121501 Drain neck/chest lesion Y A2 $446.00 18.3197 $758.45 $524.1121502 Drain chest lesion Y A2 $446.00 21.2689 $880.55 $554.6421550 Biopsy of neck/chest Y G2 8.685 $359.57 $359.5721555 Remove lesion, neck/chest Y A2 $446.00 21.1098 $873.97 $552.9921556 Remove lesion, neck/chest Y A2 $446.00 21.1098 $873.97 $552.9921557 Remove tumor, neck/chest Y G2 21.1098 $873.97 $873.9721600 Partial removal of rib Y A2 $446.00 29.19 $1,208.50 $636.6321610 Partial removal of rib Y A2 $446.00 29.19 $1,208.50 $636.6321685 Hyoid myotomy & suspension Y G2 7.4474 $308.33 $308.3321700 Revision of neck muscle Y A2 $446.00 21.2689 $880.55 $554.6421720 Revision of neck muscle Y A2 $510.00 21.2689 $880.55 $602.6421725 Revision of neck muscle Y A2 $88.46 1.4066 $58.23 $80.9021800 Treatment of rib fracture Y A2 $103.62 1.7682 $73.21 $96.0221805 Treatment of rib fracture Y A2 $446.00 26.1592 $1,083.02 $605.2621820 Treat sternum fracture Y A2 $103.62 1.7682 $73.21 $96.0221920 Biopsy soft tissue of back Y P3 3.5511 $147.02 $147.0221925 Biopsy soft tissue of back Y A2 $446.00 21.1098 $873.97 $552.9921930 Remove lesion, back or flank Y A2 $446.00 21.1098 $873.97 $552.9921935 Remove tumor, back Y A2 $510.00 21.1098 $873.97 $600.9922102 Remove part, lumbar vertebra Y G2 46.7724 $1,936.42 $1,936.4222103 Remove extra spine segment Y G2 46.7724 $1,936.42 $1,936.4222305 Treat spine process fracture Y A2 $103.62 1.7682 $73.21 $96.0222310 Treat spine fracture Y A2 $103.62 1.7682 $73.21 $96.0222315 Treat spine fracture Y A2 $103.62 1.7682 $73.21 $96.0222505 Manipulation of spine Y A2 $446.00 14.7658 $611.32 $487.3322520 Percut vertebroplasty thor Y A2 $1,339.00 29.19 $1,208.50 $1,306.3822521 Percut vertebroplasty lumb Y A2 $1,339.00 29.19 $1,208.50 $1,306.3822522 Percut vertebroplasty add’l Y A2 $1,339.00 29.19 $1,208.50 $1,306.3822523 Percut kyphoplasty, thor Y G2 79.4244 $3,288.25 $3,288.2522524 Percut kyphoplasty, lumbar Y G2 79.4244 $3,288.25 $3,288.2522525 Percut kyphoplasty, add-on Y G2 79.4244 $3,288.25 $3,288.2522526 Idet, single level Y G2 29.19 $1,208.50 $1,208.5022527 Idet, 1 or more levels Y G2 29.19 $1,208.50 $1,208.5022900 Remove abdominal wall lesion Y A2 $630.00 21.1098 $873.97 $690.9923000 Removal of calcium deposits Y A2 $446.00 16.1001 $666.56 $501.1423020 Release shoulder joint Y A2 $446.00 42.985 $1,779.62 $779.4123030 Drain shoulder lesion Y A2 $333.00 18.3197 $758.45 $439.3623031 Drain shoulder bursa Y A2 $510.00 18.3197 $758.45 $572.1123035 Drain shoulder bone lesion Y A2 $510.00 21.2689 $880.55 $602.6423040 Exploratory shoulder surgery Y A2 $510.00 29.19 $1,208.50 $684.6323044 Exploratory shoulder surgery Y A2 $630.00 29.19 $1,208.50 $774.63

Date Printed: 04/08/2023 @ 09:12:29 Page 8 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 23065 Biopsy shoulder tissues Y P3 2.5024 $103.60 $103.6023066 Biopsy shoulder tissues Y A2 $446.00 21.1098 $873.97 $552.9923075 Removal of shoulder lesion Y A2 $446.00 16.1001 $666.56 $501.1423076 Removal of shoulder lesion Y A2 $446.00 21.1098 $873.97 $552.9923077 Remove tumor of shoulder Y A2 $510.00 21.1098 $873.97 $600.9923100 Biopsy of shoulder joint Y A2 $446.00 21.2689 $880.55 $554.6423101 Shoulder joint surgery Y A2 $995.00 29.19 $1,208.50 $1,048.3823105 Remove shoulder joint lining Y A2 $630.00 29.19 $1,208.50 $774.6323106 Incision of collarbone joint Y A2 $630.00 29.19 $1,208.50 $774.6323107 Explore treat shoulder joint Y A2 $630.00 29.19 $1,208.50 $774.6323120 Partial removal, collar bone Y A2 $717.00 29.19 $1,208.50 $839.8823125 Removal of collar bone Y A2 $717.00 29.19 $1,208.50 $839.8823130 Remove shoulder bone, part Y A2 $717.00 42.985 $1,779.62 $982.6623140 Removal of bone lesion Y A2 $630.00 21.2689 $880.55 $692.6423145 Removal of bone lesion Y A2 $717.00 29.19 $1,208.50 $839.8823146 Removal of bone lesion Y A2 $717.00 29.19 $1,208.50 $839.8823150 Removal of humerus lesion Y A2 $630.00 29.19 $1,208.50 $774.6323155 Removal of humerus lesion Y A2 $717.00 29.19 $1,208.50 $839.8823156 Removal of humerus lesion Y A2 $717.00 29.19 $1,208.50 $839.8823170 Remove collar bone lesion Y A2 $446.00 29.19 $1,208.50 $636.6323172 Remove shoulder blade lesion Y A2 $446.00 29.19 $1,208.50 $636.6323174 Remove humerus lesion Y A2 $446.00 29.19 $1,208.50 $636.6323180 Remove collar bone lesion Y A2 $630.00 29.19 $1,208.50 $774.6323182 Remove shoulder blade lesion Y A2 $630.00 29.19 $1,208.50 $774.6323184 Remove humerus lesion Y A2 $630.00 29.19 $1,208.50 $774.6323190 Partial removal of scapula Y A2 $630.00 29.19 $1,208.50 $774.6323195 Removal of head of humerus Y A2 $717.00 29.19 $1,208.50 $839.8823330 Remove shoulder foreign body Y A2 $333.00 8.685 $359.57 $339.6423331 Remove shoulder foreign body Y A2 $333.00 21.1098 $873.97 $468.2423350 Injection for shoulder x-ray N N123395 Muscle transfer,shoulder/arm Y A2 $717.00 42.985 $1,779.62 $982.6623397 Muscle transfers Y A2 $995.00 79.4244 $3,288.25 $1,568.3123400 Fixation of shoulder blade Y A2 $995.00 29.19 $1,208.50 $1,048.3823405 Incision of tendon & muscle Y A2 $446.00 29.19 $1,208.50 $636.6323406 Incise tendon(s) & muscle(s) Y A2 $446.00 29.19 $1,208.50 $636.6323410 Repair rotator cuff, acute Y A2 $717.00 42.985 $1,779.62 $982.6623412 Repair rotator cuff, chronic Y A2 $995.00 42.985 $1,779.62 $1,191.1623415 Release of shoulder ligament Y A2 $717.00 42.985 $1,779.62 $982.6623420 Repair of shoulder Y A2 $995.00 42.985 $1,779.62 $1,191.1623430 Repair biceps tendon Y A2 $630.00 42.985 $1,779.62 $917.4123440 Remove/transplant tendon Y A2 $630.00 42.985 $1,779.62 $917.4123450 Repair shoulder capsule Y A2 $717.00 79.4244 $3,288.25 $1,359.8123455 Repair shoulder capsule Y A2 $995.00 79.4244 $3,288.25 $1,568.3123460 Repair shoulder capsule Y A2 $717.00 79.4244 $3,288.25 $1,359.8123462 Repair shoulder capsule Y A2 $995.00 42.985 $1,779.62 $1,191.1623465 Repair shoulder capsule Y A2 $717.00 79.4244 $3,288.25 $1,359.8123466 Repair shoulder capsule Y A2 $995.00 42.985 $1,779.62 $1,191.1623480 Revision of collar bone Y A2 $630.00 42.985 $1,779.62 $917.4123485 Revision of collar bone Y A2 $995.00 79.4244 $3,288.25 $1,568.3123490 Reinforce clavicle Y A2 $510.00 42.985 $1,779.62 $827.4123491 Reinforce shoulder bones Y A2 $510.00 79.4244 $3,288.25 $1,204.5623500 Treat clavicle fracture Y A2 $103.62 1.7682 $73.21 $96.0223505 Treat clavicle fracture Y A2 $103.62 1.7682 $73.21 $96.0223515 Treat clavicle fracture Y A2 $510.00 59.2233 $2,451.90 $995.4823520 Treat clavicle dislocation Y A2 $103.62 1.7682 $73.21 $96.0223525 Treat clavicle dislocation Y A2 $103.62 1.7682 $73.21 $96.0223530 Treat clavicle dislocation Y A2 $510.00 41.1091 $1,701.96 $807.9923532 Treat clavicle dislocation Y A2 $630.00 26.1592 $1,083.02 $743.2623540 Treat clavicle dislocation Y A2 $103.62 1.7682 $73.21 $96.0223545 Treat clavicle dislocation Y A2 $103.62 1.7682 $73.21 $96.0223550 Treat clavicle dislocation Y A2 $510.00 41.1091 $1,701.96 $807.9923552 Treat clavicle dislocation Y A2 $630.00 41.1091 $1,701.96 $897.9923570 Treat shoulder blade fx Y A2 $103.62 1.7682 $73.21 $96.0223575 Treat shoulder blade fx Y A2 $103.62 1.7682 $73.21 $96.0223585 Treat scapula fracture Y A2 $510.00 59.2233 $2,451.90 $995.4823600 Treat humerus fracture Y P2 1.7682 $73.21 $73.2123605 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0223615 Treat humerus fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4823616 Treat humerus fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4823620 Treat humerus fracture Y P2 1.7682 $73.21 $73.2123625 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0223630 Treat humerus fracture Y A2 $717.00 59.2233 $2,451.90 $1,150.7323650 Treat shoulder dislocation Y A2 $103.62 1.7682 $73.21 $96.0223655 Treat shoulder dislocation Y A2 $333.00 14.7658 $611.32 $402.5823660 Treat shoulder dislocation Y A2 $510.00 41.1091 $1,701.96 $807.9923665 Treat dislocation/fracture Y A2 $103.62 1.7682 $73.21 $96.0223670 Treat dislocation/fracture Y A2 $510.00 59.2233 $2,451.90 $995.4823675 Treat dislocation/fracture Y A2 $103.62 1.7682 $73.21 $96.0223680 Treat dislocation/fracture Y A2 $510.00 41.1091 $1,701.96 $807.9923700 Fixation of shoulder Y A2 $333.00 14.7658 $611.32 $402.5823800 Fusion of shoulder joint Y A2 $630.00 79.4244 $3,288.25 $1,294.5623802 Fusion of shoulder joint Y A2 $995.00 42.985 $1,779.62 $1,191.1623921 Amputation follow-up surgery Y A2 $323.28 15.0458 $622.91 $398.1923930 Drainage of arm lesion Y A2 $333.00 18.3197 $758.45 $439.3623931 Drainage of arm bursa Y A2 $446.00 18.3197 $758.45 $524.1123935 Drain arm/elbow bone lesion Y A2 $446.00 21.2689 $880.55 $554.6424000 Exploratory elbow surgery Y A2 $630.00 29.19 $1,208.50 $774.6324006 Release elbow joint Y A2 $630.00 29.19 $1,208.50 $774.63

Date Printed: 04/08/2023 @ 09:12:29 Page 9 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 24065 Biopsy arm/elbow soft tissue Y P3 3.3854 $140.16 $140.1624066 Biopsy arm/elbow soft tissue Y A2 $446.00 16.1001 $666.56 $501.1424075 Remove arm/elbow lesion Y A2 $446.00 16.1001 $666.56 $501.1424076 Remove arm/elbow lesion Y A2 $446.00 21.1098 $873.97 $552.9924077 Remove tumor of arm/elbow Y A2 $510.00 21.1098 $873.97 $600.9924100 Biopsy elbow joint lining Y A2 $333.00 21.2689 $880.55 $469.8924101 Explore/treat elbow joint Y A2 $630.00 29.19 $1,208.50 $774.6324102 Remove elbow joint lining Y A2 $630.00 29.19 $1,208.50 $774.6324105 Removal of elbow bursa Y A2 $510.00 21.2689 $880.55 $602.6424110 Remove humerus lesion Y A2 $446.00 21.2689 $880.55 $554.6424115 Remove/graft bone lesion Y A2 $510.00 29.19 $1,208.50 $684.6324116 Remove/graft bone lesion Y A2 $510.00 29.19 $1,208.50 $684.6324120 Remove elbow lesion Y A2 $510.00 21.2689 $880.55 $602.6424125 Remove/graft bone lesion Y A2 $510.00 29.19 $1,208.50 $684.6324126 Remove/graft bone lesion Y A2 $510.00 29.19 $1,208.50 $684.6324130 Removal of head of radius Y A2 $510.00 29.19 $1,208.50 $684.6324134 Removal of arm bone lesion Y A2 $446.00 29.19 $1,208.50 $636.6324136 Remove radius bone lesion Y A2 $446.00 29.19 $1,208.50 $636.6324138 Remove elbow bone lesion Y A2 $446.00 29.19 $1,208.50 $636.6324140 Partial removal of arm bone Y A2 $510.00 29.19 $1,208.50 $684.6324145 Partial removal of radius Y A2 $510.00 29.19 $1,208.50 $684.6324147 Partial removal of elbow Y A2 $446.00 29.19 $1,208.50 $636.6324149 Radical resection of elbow Y G2 29.19 $1,208.50 $1,208.5024152 Extensive radius surgery Y G2 42.985 $1,779.62 $1,779.6224153 Extensive radius surgery Y G2 79.4244 $3,288.25 $3,288.2524155 Removal of elbow joint Y A2 $510.00 42.985 $1,779.62 $827.4124160 Remove elbow joint implant Y A2 $446.00 29.19 $1,208.50 $636.6324164 Remove radius head implant Y A2 $510.00 29.19 $1,208.50 $684.6324200 Removal of arm foreign body Y P3 2.8335 $117.31 $117.3124201 Removal of arm foreign body Y A2 $446.00 16.1001 $666.56 $501.1424220 Injection for elbow x-ray N N124300 Manipulate elbow w/anesth Y G2 14.7658 $611.32 $611.3224301 Muscle/tendon transfer Y A2 $630.00 29.19 $1,208.50 $774.6324305 Arm tendon lengthening Y A2 $630.00 29.19 $1,208.50 $774.6324310 Revision of arm tendon Y A2 $510.00 21.2689 $880.55 $602.6424320 Repair of arm tendon Y A2 $510.00 42.985 $1,779.62 $827.4124330 Revision of arm muscles Y A2 $510.00 79.4244 $3,288.25 $1,204.5624331 Revision of arm muscles Y A2 $510.00 42.985 $1,779.62 $827.4124332 Tenolysis, triceps Y G2 21.2689 $880.55 $880.5524340 Repair of biceps tendon Y A2 $510.00 42.985 $1,779.62 $827.4124341 Repair arm tendon/muscle Y A2 $510.00 42.985 $1,779.62 $827.4124342 Repair of ruptured tendon Y A2 $510.00 42.985 $1,779.62 $827.4124343 Repr elbow lat ligmnt w/tiss Y G2 29.19 $1,208.50 $1,208.5024344 Reconstruct elbow lat ligmnt Y G2 79.4244 $3,288.25 $3,288.2524345 Repr elbw med ligmnt w/tissu Y A2 $446.00 29.19 $1,208.50 $636.6324346 Reconstruct elbow med ligmnt Y G2 42.985 $1,779.62 $1,779.6224350 Repair of tennis elbow N D524351 Repair of tennis elbow N D524352 Repair of tennis elbow N D524354 Repair of tennis elbow N D524356 Revision of tennis elbow N D524357 Repair elbow, perc Y G2 29.19 $1,208.50 $1,208.5024358 Repair elbow w/deb, open Y G2 29.19 $1,208.50 $1,208.5024359 Repair elbow deb/attch open Y G2 29.19 $1,208.50 $1,208.5024360 Reconstruct elbow joint Y A2 $717.00 35.904 $1,486.46 $909.3724361 Reconstruct elbow joint Y A2 $717.00 122.2057 $5,059.44 $1,802.6124362 Reconstruct elbow joint Y A2 $717.00 50.8876 $2,106.80 $1,064.4524363 Replace elbow joint Y A2 $995.00 122.2057 $5,059.44 $2,011.1124365 Reconstruct head of radius Y A2 $717.00 35.904 $1,486.46 $909.3724366 Reconstruct head of radius Y A2 $717.00 122.2057 $5,059.44 $1,802.6124400 Revision of humerus Y A2 $630.00 29.19 $1,208.50 $774.6324410 Revision of humerus Y A2 $630.00 29.19 $1,208.50 $774.6324420 Revision of humerus Y A2 $510.00 42.985 $1,779.62 $827.4124430 Repair of humerus Y A2 $510.00 79.4244 $3,288.25 $1,204.5624435 Repair humerus with graft Y A2 $630.00 79.4244 $3,288.25 $1,294.5624470 Revision of elbow joint Y A2 $510.00 42.985 $1,779.62 $827.4124495 Decompression of forearm Y A2 $446.00 29.19 $1,208.50 $636.6324498 Reinforce humerus Y A2 $510.00 79.4244 $3,288.25 $1,204.5624500 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224505 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224515 Treat humerus fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4824516 Treat humerus fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4824530 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224535 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224538 Treat humerus fracture Y A2 $446.00 26.1592 $1,083.02 $605.2624545 Treat humerus fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4824546 Treat humerus fracture Y A2 $717.00 59.2233 $2,451.90 $1,150.7324560 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224565 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224566 Treat humerus fracture Y A2 $446.00 26.1592 $1,083.02 $605.2624575 Treat humerus fracture Y A2 $510.00 59.2233 $2,451.90 $995.4824576 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224577 Treat humerus fracture Y A2 $103.62 1.7682 $73.21 $96.0224579 Treat humerus fracture Y A2 $510.00 59.2233 $2,451.90 $995.4824582 Treat humerus fracture Y A2 $446.00 26.1592 $1,083.02 $605.2624586 Treat elbow fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4824587 Treat elbow fracture Y A2 $717.00 59.2233 $2,451.90 $1,150.7324600 Treat elbow dislocation Y A2 $103.62 1.7682 $73.21 $96.02

Date Printed: 04/08/2023 @ 09:12:29 Page 10 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 24605 Treat elbow dislocation Y A2 $446.00 14.7658 $611.32 $487.3324615 Treat elbow dislocation Y A2 $510.00 59.2233 $2,451.90 $995.4824620 Treat elbow fracture Y A2 $103.62 1.7682 $73.21 $96.0224635 Treat elbow fracture Y A2 $510.00 59.2233 $2,451.90 $995.4824640 Treat elbow dislocation Y P3 1.5548 $64.37 $64.3724650 Treat radius fracture Y P2 1.7682 $73.21 $73.2124655 Treat radius fracture Y A2 $103.62 1.7682 $73.21 $96.0224665 Treat radius fracture Y A2 $630.00 41.1091 $1,701.96 $897.9924666 Treat radius fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4824670 Treat ulnar fracture Y A2 $103.62 1.7682 $73.21 $96.0224675 Treat ulnar fracture Y A2 $103.62 1.7682 $73.21 $96.0224685 Treat ulnar fracture Y A2 $510.00 41.1091 $1,701.96 $807.9924800 Fusion of elbow joint Y A2 $630.00 42.985 $1,779.62 $917.4124802 Fusion/graft of elbow joint Y A2 $717.00 42.985 $1,779.62 $982.6624925 Amputation follow-up surgery Y A2 $510.00 21.2689 $880.55 $602.6425000 Incision of tendon sheath Y A2 $510.00 21.2689 $880.55 $602.6425001 Incise flexor carpi radialis Y G2 21.2689 $880.55 $880.5525020 Decompress forearm 1 space Y A2 $510.00 21.2689 $880.55 $602.6425023 Decompress forearm 1 space Y A2 $510.00 29.19 $1,208.50 $684.6325024 Decompress forearm 2 spaces Y A2 $510.00 29.19 $1,208.50 $684.6325025 Decompress forearm 2 spaces Y A2 $510.00 29.19 $1,208.50 $684.6325028 Drainage of forearm lesion Y A2 $333.00 21.2689 $880.55 $469.8925031 Drainage of forearm bursa Y A2 $446.00 21.2689 $880.55 $554.6425035 Treat forearm bone lesion Y A2 $446.00 21.2689 $880.55 $554.6425040 Explore/treat wrist joint Y A2 $717.00 29.19 $1,208.50 $839.8825065 Biopsy forearm soft tissues Y P3 3.4775 $143.97 $143.9725066 Biopsy forearm soft tissues Y A2 $446.00 21.1098 $873.97 $552.9925075 Removal forearm lesion subcu Y A2 $446.00 16.1001 $666.56 $501.1425076 Removal forearm lesion deep Y A2 $510.00 21.1098 $873.97 $600.9925077 Remove tumor, forearm/wrist Y A2 $510.00 21.1098 $873.97 $600.9925085 Incision of wrist capsule Y A2 $510.00 21.2689 $880.55 $602.6425100 Biopsy of wrist joint Y A2 $446.00 21.2689 $880.55 $554.6425101 Explore/treat wrist joint Y A2 $510.00 29.19 $1,208.50 $684.6325105 Remove wrist joint lining Y A2 $630.00 29.19 $1,208.50 $774.6325107 Remove wrist joint cartilage Y A2 $510.00 29.19 $1,208.50 $684.6325109 Excise tendon forearm/wrist Y G2 21.2689 $880.55 $880.5525110 Remove wrist tendon lesion Y A2 $510.00 21.2689 $880.55 $602.6425111 Remove wrist tendon lesion Y A2 $510.00 16.4637 $681.61 $552.9025112 Reremove wrist tendon lesion Y A2 $630.00 16.4637 $681.61 $642.9025115 Remove wrist/forearm lesion Y A2 $630.00 21.2689 $880.55 $692.6425116 Remove wrist/forearm lesion Y A2 $630.00 21.2689 $880.55 $692.6425118 Excise wrist tendon sheath Y A2 $446.00 29.19 $1,208.50 $636.6325119 Partial removal of ulna Y A2 $510.00 29.19 $1,208.50 $684.6325120 Removal of forearm lesion Y A2 $510.00 29.19 $1,208.50 $684.6325125 Remove/graft forearm lesion Y A2 $510.00 29.19 $1,208.50 $684.6325126 Remove/graft forearm lesion Y A2 $510.00 29.19 $1,208.50 $684.6325130 Removal of wrist lesion Y A2 $510.00 29.19 $1,208.50 $684.6325135 Remove & graft wrist lesion Y A2 $510.00 29.19 $1,208.50 $684.6325136 Remove & graft wrist lesion Y A2 $510.00 29.19 $1,208.50 $684.6325145 Remove forearm bone lesion Y A2 $446.00 29.19 $1,208.50 $636.6325150 Partial removal of ulna Y A2 $446.00 29.19 $1,208.50 $636.6325151 Partial removal of radius Y A2 $446.00 29.19 $1,208.50 $636.6325210 Removal of wrist bone Y A2 $510.00 26.3105 $1,089.28 $654.8225215 Removal of wrist bones Y A2 $630.00 26.3105 $1,089.28 $744.8225230 Partial removal of radius Y A2 $630.00 29.19 $1,208.50 $774.6325240 Partial removal of ulna Y A2 $630.00 29.19 $1,208.50 $774.6325246 Injection for wrist x-ray N N125248 Remove forearm foreign body Y A2 $446.00 21.2689 $880.55 $554.6425250 Removal of wrist prosthesis Y A2 $333.00 29.19 $1,208.50 $551.8825251 Removal of wrist prosthesis Y A2 $333.00 29.19 $1,208.50 $551.8825259 Manipulate wrist w/anesthes Y G2 1.7682 $73.21 $73.2125260 Repair forearm tendon/muscle Y A2 $630.00 29.19 $1,208.50 $774.6325263 Repair forearm tendon/muscle Y A2 $446.00 29.19 $1,208.50 $636.6325265 Repair forearm tendon/muscle Y A2 $510.00 29.19 $1,208.50 $684.6325270 Repair forearm tendon/muscle Y A2 $630.00 29.19 $1,208.50 $774.6325272 Repair forearm tendon/muscle Y A2 $510.00 29.19 $1,208.50 $684.6325274 Repair forearm tendon/muscle Y A2 $630.00 29.19 $1,208.50 $774.6325275 Repair forearm tendon sheath Y A2 $630.00 29.19 $1,208.50 $774.6325280 Revise wrist/forearm tendon Y A2 $630.00 29.19 $1,208.50 $774.6325290 Incise wrist/forearm tendon Y A2 $510.00 29.19 $1,208.50 $684.6325295 Release wrist/forearm tendon Y A2 $510.00 21.2689 $880.55 $602.6425300 Fusion of tendons at wrist Y A2 $510.00 29.19 $1,208.50 $684.6325301 Fusion of tendons at wrist Y A2 $510.00 29.19 $1,208.50 $684.6325310 Transplant forearm tendon Y A2 $510.00 42.985 $1,779.62 $827.4125312 Transplant forearm tendon Y A2 $630.00 42.985 $1,779.62 $917.4125315 Revise palsy hand tendon(s) Y A2 $510.00 42.985 $1,779.62 $827.4125316 Revise palsy hand tendon(s) Y A2 $510.00 79.4244 $3,288.25 $1,204.5625320 Repair/revise wrist joint Y A2 $510.00 42.985 $1,779.62 $827.4125332 Revise wrist joint Y A2 $717.00 35.904 $1,486.46 $909.3725335 Realignment of hand Y A2 $510.00 42.985 $1,779.62 $827.4125337 Reconstruct ulna/radioulnar Y A2 $717.00 42.985 $1,779.62 $982.6625350 Revision of radius Y A2 $510.00 79.4244 $3,288.25 $1,204.5625355 Revision of radius Y A2 $510.00 42.985 $1,779.62 $827.4125360 Revision of ulna Y A2 $510.00 29.19 $1,208.50 $684.6325365 Revise radius & ulna Y A2 $510.00 29.19 $1,208.50 $684.6325370 Revise radius or ulna Y A2 $510.00 42.985 $1,779.62 $827.4125375 Revise radius & ulna Y A2 $630.00 42.985 $1,779.62 $917.4125390 Shorten radius or ulna Y A2 $510.00 29.19 $1,208.50 $684.63

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 25391 Lengthen radius or ulna Y A2 $630.00 42.985 $1,779.62 $917.4125392 Shorten radius & ulna Y A2 $510.00 29.19 $1,208.50 $684.6325393 Lengthen radius & ulna Y A2 $630.00 42.985 $1,779.62 $917.4125394 Repair carpal bone, shorten Y G2 16.4637 $681.61 $681.6125400 Repair radius or ulna Y A2 $510.00 79.4244 $3,288.25 $1,204.5625405 Repair/graft radius or ulna Y A2 $630.00 79.4244 $3,288.25 $1,294.5625415 Repair radius & ulna Y A2 $510.00 79.4244 $3,288.25 $1,204.5625420 Repair/graft radius & ulna Y A2 $630.00 79.4244 $3,288.25 $1,294.5625425 Repair/graft radius or ulna Y A2 $510.00 42.985 $1,779.62 $827.4125426 Repair/graft radius & ulna Y A2 $630.00 42.985 $1,779.62 $917.4125430 Vasc graft into carpal bone Y G2 26.3105 $1,089.28 $1,089.2825431 Repair nonunion carpal bone Y G2 26.3105 $1,089.28 $1,089.2825440 Repair/graft wrist bone Y A2 $630.00 79.4244 $3,288.25 $1,294.5625441 Reconstruct wrist joint Y A2 $717.00 122.2057 $5,059.44 $1,802.6125442 Reconstruct wrist joint Y A2 $717.00 122.2057 $5,059.44 $1,802.6125443 Reconstruct wrist joint Y A2 $717.00 50.8876 $2,106.80 $1,064.4525444 Reconstruct wrist joint Y A2 $717.00 50.8876 $2,106.80 $1,064.4525445 Reconstruct wrist joint Y A2 $717.00 50.8876 $2,106.80 $1,064.4525446 Wrist replacement Y A2 $995.00 122.2057 $5,059.44 $2,011.1125447 Repair wrist joint(s) Y A2 $717.00 35.904 $1,486.46 $909.3725449 Remove wrist joint implant Y A2 $717.00 35.904 $1,486.46 $909.3725450 Revision of wrist joint Y A2 $510.00 42.985 $1,779.62 $827.4125455 Revision of wrist joint Y A2 $510.00 42.985 $1,779.62 $827.4125490 Reinforce radius Y A2 $510.00 42.985 $1,779.62 $827.4125491 Reinforce ulna Y A2 $510.00 42.985 $1,779.62 $827.4125492 Reinforce radius and ulna Y A2 $510.00 42.985 $1,779.62 $827.4125500 Treat fracture of radius Y P2 1.7682 $73.21 $73.2125505 Treat fracture of radius Y A2 $103.62 1.7682 $73.21 $96.0225515 Treat fracture of radius Y A2 $510.00 41.1091 $1,701.96 $807.9925520 Treat fracture of radius Y A2 $103.62 1.7682 $73.21 $96.0225525 Treat fracture of radius Y A2 $630.00 41.1091 $1,701.96 $897.9925526 Treat fracture of radius Y A2 $717.00 41.1091 $1,701.96 $963.2425530 Treat fracture of ulna Y P2 1.7682 $73.21 $73.2125535 Treat fracture of ulna Y A2 $103.62 1.7682 $73.21 $96.0225545 Treat fracture of ulna Y A2 $510.00 41.1091 $1,701.96 $807.9925560 Treat fracture radius & ulna Y P2 1.7682 $73.21 $73.2125565 Treat fracture radius & ulna Y A2 $103.62 1.7682 $73.21 $96.0225574 Treat fracture radius & ulna Y A2 $510.00 59.2233 $2,451.90 $995.4825575 Treat fracture radius/ulna Y A2 $510.00 59.2233 $2,451.90 $995.4825600 Treat fracture radius/ulna Y P2 1.7682 $73.21 $73.2125605 Treat fracture radius/ulna Y A2 $103.62 1.7682 $73.21 $96.0225606 Treat fx distal radial Y A2 $510.00 26.1592 $1,083.02 $653.2625607 Treat fx rad extra-articul Y A2 $717.00 59.2233 $2,451.90 $1,150.7325608 Treat fx rad intra-articul Y A2 $717.00 59.2233 $2,451.90 $1,150.7325609 Treat fx radial 3+ frag Y A2 $717.00 59.2233 $2,451.90 $1,150.7325622 Treat wrist bone fracture Y P2 1.7682 $73.21 $73.2125624 Treat wrist bone fracture Y A2 $103.62 1.7682 $73.21 $96.0225628 Treat wrist bone fracture Y A2 $510.00 41.1091 $1,701.96 $807.9925630 Treat wrist bone fracture Y P2 1.7682 $73.21 $73.2125635 Treat wrist bone fracture Y A2 $103.62 1.7682 $73.21 $96.0225645 Treat wrist bone fracture Y A2 $510.00 41.1091 $1,701.96 $807.9925650 Treat wrist bone fracture Y P2 1.7682 $73.21 $73.2125651 Pin ulnar styloid fracture Y G2 26.1592 $1,083.02 $1,083.0225652 Treat fracture ulnar styloid Y G2 41.1091 $1,701.96 $1,701.9625660 Treat wrist dislocation Y A2 $103.62 1.7682 $73.21 $96.0225670 Treat wrist dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2625671 Pin radioulnar dislocation Y A2 $333.00 26.1592 $1,083.02 $520.5125675 Treat wrist dislocation Y A2 $103.62 1.7682 $73.21 $96.0225676 Treat wrist dislocation Y A2 $446.00 26.1592 $1,083.02 $605.2625680 Treat wrist fracture Y A2 $103.62 1.7682 $73.21 $96.0225685 Treat wrist fracture Y A2 $510.00 26.1592 $1,083.02 $653.2625690 Treat wrist dislocation Y A2 $103.62 1.7682 $73.21 $96.0225695 Treat wrist dislocation Y A2 $446.00 26.1592 $1,083.02 $605.2625800 Fusion of wrist joint Y A2 $630.00 79.4244 $3,288.25 $1,294.5625805 Fusion/graft of wrist joint Y A2 $717.00 42.985 $1,779.62 $982.6625810 Fusion/graft of wrist joint Y A2 $717.00 79.4244 $3,288.25 $1,359.8125820 Fusion of hand bones Y A2 $630.00 16.4637 $681.61 $642.9025825 Fuse hand bones with graft Y A2 $717.00 79.4244 $3,288.25 $1,359.8125830 Fusion, radioulnar jnt/ulna Y A2 $717.00 79.4244 $3,288.25 $1,359.8125907 Amputation follow-up surgery Y A2 $510.00 21.2689 $880.55 $602.6425922 Amputate hand at wrist Y A2 $510.00 21.2689 $880.55 $602.6425929 Amputation follow-up surgery Y A2 $510.00 15.0458 $622.91 $538.2325931 Amputation follow-up surgery Y G2 21.2689 $880.55 $880.5526010 Drainage of finger abscess Y P2 1.4066 $58.23 $58.2326011 Drainage of finger abscess Y A2 $333.00 11.5594 $478.57 $369.3926020 Drain hand tendon sheath Y A2 $446.00 16.4637 $681.61 $504.9026025 Drainage of palm bursa Y A2 $333.00 16.4637 $681.61 $420.1526030 Drainage of palm bursa(s) Y A2 $446.00 16.4637 $681.61 $504.9026034 Treat hand bone lesion Y A2 $446.00 16.4637 $681.61 $504.9026035 Decompress fingers/hand Y G2 16.4637 $681.61 $681.6126040 Release palm contracture Y A2 $630.00 26.3105 $1,089.28 $744.8226045 Release palm contracture Y A2 $510.00 26.3105 $1,089.28 $654.8226055 Incise finger tendon sheath Y A2 $446.00 16.4637 $681.61 $504.9026060 Incision of finger tendon Y A2 $446.00 16.4637 $681.61 $504.9026070 Explore/treat hand joint Y A2 $446.00 16.4637 $681.61 $504.9026075 Explore/treat finger joint Y A2 $630.00 16.4637 $681.61 $642.9026080 Explore/treat finger joint Y A2 $630.00 16.4637 $681.61 $642.9026100 Biopsy hand joint lining Y A2 $446.00 16.4637 $681.61 $504.90

Date Printed: 04/08/2023 @ 09:12:29 Page 12 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 26105 Biopsy finger joint lining Y A2 $333.00 16.4637 $681.61 $420.1526110 Biopsy finger joint lining Y A2 $333.00 16.4637 $681.61 $420.1526115 Removal hand lesion subcut Y A2 $446.00 21.1098 $873.97 $552.9926116 Removal hand lesion, deep Y A2 $446.00 21.1098 $873.97 $552.9926117 Remove tumor, hand/finger Y A2 $510.00 21.1098 $873.97 $600.9926121 Release palm contracture Y A2 $630.00 26.3105 $1,089.28 $744.8226123 Release palm contracture Y A2 $630.00 26.3105 $1,089.28 $744.8226125 Release palm contracture Y A2 $630.00 16.4637 $681.61 $642.9026130 Remove wrist joint lining Y A2 $510.00 16.4637 $681.61 $552.9026135 Revise finger joint, each Y A2 $630.00 26.3105 $1,089.28 $744.8226140 Revise finger joint, each Y A2 $446.00 16.4637 $681.61 $504.9026145 Tendon excision, palm/finger Y A2 $510.00 16.4637 $681.61 $552.9026160 Remove tendon sheath lesion Y A2 $510.00 16.4637 $681.61 $552.9026170 Removal of palm tendon, each Y A2 $510.00 16.4637 $681.61 $552.9026180 Removal of finger tendon Y A2 $510.00 16.4637 $681.61 $552.9026185 Remove finger bone Y A2 $630.00 16.4637 $681.61 $642.9026200 Remove hand bone lesion Y A2 $446.00 16.4637 $681.61 $504.9026205 Remove/graft bone lesion Y A2 $510.00 26.3105 $1,089.28 $654.8226210 Removal of finger lesion Y A2 $446.00 16.4637 $681.61 $504.9026215 Remove/graft finger lesion Y A2 $510.00 16.4637 $681.61 $552.9026230 Partial removal of hand bone Y A2 $992.95 16.4637 $681.61 $915.1226235 Partial removal, finger bone Y A2 $510.00 16.4637 $681.61 $552.9026236 Partial removal, finger bone Y A2 $510.00 16.4637 $681.61 $552.9026250 Extensive hand surgery Y A2 $510.00 16.4637 $681.61 $552.9026255 Extensive hand surgery Y A2 $510.00 26.3105 $1,089.28 $654.8226260 Extensive finger surgery Y A2 $510.00 16.4637 $681.61 $552.9026261 Extensive finger surgery Y A2 $510.00 16.4637 $681.61 $552.9026262 Partial removal of finger Y A2 $446.00 16.4637 $681.61 $504.9026320 Removal of implant from hand Y A2 $446.00 16.1001 $666.56 $501.1426340 Manipulate finger w/anesth Y G2 1.7682 $73.21 $73.2126350 Repair finger/hand tendon Y A2 $333.00 26.3105 $1,089.28 $522.0726352 Repair/graft hand tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226356 Repair finger/hand tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226357 Repair finger/hand tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226358 Repair/graft hand tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226370 Repair finger/hand tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226372 Repair/graft hand tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226373 Repair finger/hand tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226390 Revise hand/finger tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226392 Repair/graft hand tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226410 Repair hand tendon Y A2 $510.00 16.4637 $681.61 $552.9026412 Repair/graft hand tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226415 Excision, hand/finger tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226416 Graft hand or finger tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226418 Repair finger tendon Y A2 $630.00 16.4637 $681.61 $642.9026420 Repair/graft finger tendon Y A2 $630.00 26.3105 $1,089.28 $744.8226426 Repair finger/hand tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226428 Repair/graft finger tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226432 Repair finger tendon Y A2 $510.00 16.4637 $681.61 $552.9026433 Repair finger tendon Y A2 $510.00 16.4637 $681.61 $552.9026434 Repair/graft finger tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226437 Realignment of tendons Y A2 $510.00 16.4637 $681.61 $552.9026440 Release palm/finger tendon Y A2 $510.00 16.4637 $681.61 $552.9026442 Release palm & finger tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226445 Release hand/finger tendon Y A2 $510.00 16.4637 $681.61 $552.9026449 Release forearm/hand tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226450 Incision of palm tendon Y A2 $510.00 16.4637 $681.61 $552.9026455 Incision of finger tendon Y A2 $510.00 16.4637 $681.61 $552.9026460 Incise hand/finger tendon Y A2 $510.00 16.4637 $681.61 $552.9026471 Fusion of finger tendons Y A2 $446.00 16.4637 $681.61 $504.9026474 Fusion of finger tendons Y A2 $446.00 16.4637 $681.61 $504.9026476 Tendon lengthening Y A2 $333.00 16.4637 $681.61 $420.1526477 Tendon shortening Y A2 $333.00 16.4637 $681.61 $420.1526478 Lengthening of hand tendon Y A2 $333.00 16.4637 $681.61 $420.1526479 Shortening of hand tendon Y A2 $333.00 16.4637 $681.61 $420.1526480 Transplant hand tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226483 Transplant/graft hand tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226485 Transplant palm tendon Y A2 $446.00 26.3105 $1,089.28 $606.8226489 Transplant/graft palm tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226490 Revise thumb tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226492 Tendon transfer with graft Y A2 $510.00 26.3105 $1,089.28 $654.8226494 Hand tendon/muscle transfer Y A2 $510.00 26.3105 $1,089.28 $654.8226496 Revise thumb tendon Y A2 $510.00 26.3105 $1,089.28 $654.8226497 Finger tendon transfer Y A2 $510.00 26.3105 $1,089.28 $654.8226498 Finger tendon transfer Y A2 $630.00 26.3105 $1,089.28 $744.8226499 Revision of finger Y A2 $510.00 26.3105 $1,089.28 $654.8226500 Hand tendon reconstruction Y A2 $630.00 16.4637 $681.61 $642.9026502 Hand tendon reconstruction Y A2 $630.00 26.3105 $1,089.28 $744.8226508 Release thumb contracture Y A2 $510.00 16.4637 $681.61 $552.9026510 Thumb tendon transfer Y A2 $510.00 26.3105 $1,089.28 $654.8226516 Fusion of knuckle joint Y A2 $333.00 26.3105 $1,089.28 $522.0726517 Fusion of knuckle joints Y A2 $510.00 26.3105 $1,089.28 $654.8226518 Fusion of knuckle joints Y A2 $510.00 26.3105 $1,089.28 $654.8226520 Release knuckle contracture Y A2 $510.00 16.4637 $681.61 $552.9026525 Release finger contracture Y A2 $510.00 16.4637 $681.61 $552.9026530 Revise knuckle joint Y A2 $510.00 35.904 $1,486.46 $754.1226531 Revise knuckle with implant Y A2 $995.00 50.8876 $2,106.80 $1,272.9526535 Revise finger joint Y A2 $717.00 35.904 $1,486.46 $909.37

Date Printed: 04/08/2023 @ 09:12:29 Page 13 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 26536 Revise/implant finger joint Y A2 $717.00 50.8876 $2,106.80 $1,064.4526540 Repair hand joint Y A2 $630.00 16.4637 $681.61 $642.9026541 Repair hand joint with graft Y A2 $995.00 26.3105 $1,089.28 $1,018.5726542 Repair hand joint with graft Y A2 $630.00 16.4637 $681.61 $642.9026545 Reconstruct finger joint Y A2 $630.00 26.3105 $1,089.28 $744.8226546 Repair nonunion hand Y A2 $630.00 26.3105 $1,089.28 $744.8226548 Reconstruct finger joint Y A2 $630.00 26.3105 $1,089.28 $744.8226550 Construct thumb replacement Y A2 $446.00 26.3105 $1,089.28 $606.8226555 Positional change of finger Y A2 $510.00 26.3105 $1,089.28 $654.8226560 Repair of web finger Y A2 $446.00 16.4637 $681.61 $504.9026561 Repair of web finger Y A2 $510.00 26.3105 $1,089.28 $654.8226562 Repair of web finger Y A2 $630.00 26.3105 $1,089.28 $744.8226565 Correct metacarpal flaw Y A2 $717.00 26.3105 $1,089.28 $810.0726567 Correct finger deformity Y A2 $717.00 26.3105 $1,089.28 $810.0726568 Lengthen metacarpal/finger Y A2 $510.00 26.3105 $1,089.28 $654.8226580 Repair hand deformity Y A2 $717.00 16.4637 $681.61 $708.1526587 Reconstruct extra finger Y A2 $717.00 16.4637 $681.61 $708.1526590 Repair finger deformity Y A2 $717.00 16.4637 $681.61 $708.1526591 Repair muscles of hand Y A2 $510.00 26.3105 $1,089.28 $654.8226593 Release muscles of hand Y A2 $510.00 16.4637 $681.61 $552.9026596 Excision constricting tissue Y A2 $446.00 16.4637 $681.61 $504.9026600 Treat metacarpal fracture Y P2 1.7682 $73.21 $73.2126605 Treat metacarpal fracture Y A2 $103.62 1.7682 $73.21 $96.0226607 Treat metacarpal fracture Y A2 $103.62 1.7682 $73.21 $96.0226608 Treat metacarpal fracture Y A2 $630.00 26.1592 $1,083.02 $743.2626615 Treat metacarpal fracture Y A2 $630.00 41.1091 $1,701.96 $897.9926641 Treat thumb dislocation Y P2 1.7682 $73.21 $73.2126645 Treat thumb fracture Y A2 $103.62 1.7682 $73.21 $96.0226650 Treat thumb fracture Y A2 $446.00 26.1592 $1,083.02 $605.2626665 Treat thumb fracture Y A2 $630.00 41.1091 $1,701.96 $897.9926670 Treat hand dislocation Y P2 1.7682 $73.21 $73.2126675 Treat hand dislocation Y A2 $103.62 1.7682 $73.21 $96.0226676 Pin hand dislocation Y A2 $446.00 26.1592 $1,083.02 $605.2626685 Treat hand dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2626686 Treat hand dislocation Y A2 $510.00 59.2233 $2,451.90 $995.4826700 Treat knuckle dislocation Y P2 1.7682 $73.21 $73.2126705 Treat knuckle dislocation Y A2 $103.62 1.7682 $73.21 $96.0226706 Pin knuckle dislocation Y A2 $103.62 1.7682 $73.21 $96.0226715 Treat knuckle dislocation Y A2 $630.00 26.1592 $1,083.02 $743.2626720 Treat finger fracture, each Y P2 1.7682 $73.21 $73.2126725 Treat finger fracture, each Y P2 1.7682 $73.21 $73.2126727 Treat finger fracture, each Y A2 $995.00 26.1592 $1,083.02 $1,017.0126735 Treat finger fracture, each Y A2 $630.00 26.1592 $1,083.02 $743.2626740 Treat finger fracture, each Y P2 1.7682 $73.21 $73.2126742 Treat finger fracture, each Y A2 $103.62 1.7682 $73.21 $96.0226746 Treat finger fracture, each Y A2 $717.00 26.1592 $1,083.02 $808.5126750 Treat finger fracture, each Y P2 1.7682 $73.21 $73.2126755 Treat finger fracture, each Y G2 1.7682 $73.21 $73.2126756 Pin finger fracture, each Y A2 $446.00 26.1592 $1,083.02 $605.2626765 Treat finger fracture, each Y A2 $630.00 26.1592 $1,083.02 $743.2626770 Treat finger dislocation Y G2 1.7682 $73.21 $73.2126775 Treat finger dislocation Y P3 4.517 $187.01 $187.0126776 Pin finger dislocation Y A2 $446.00 26.1592 $1,083.02 $605.2626785 Treat finger dislocation Y A2 $446.00 26.1592 $1,083.02 $605.2626820 Thumb fusion with graft Y A2 $717.00 26.3105 $1,089.28 $810.0726841 Fusion of thumb Y A2 $630.00 26.3105 $1,089.28 $744.8226842 Thumb fusion with graft Y A2 $630.00 26.3105 $1,089.28 $744.8226843 Fusion of hand joint Y A2 $510.00 26.3105 $1,089.28 $654.8226844 Fusion/graft of hand joint Y A2 $510.00 26.3105 $1,089.28 $654.8226850 Fusion of knuckle Y A2 $630.00 26.3105 $1,089.28 $744.8226852 Fusion of knuckle with graft Y A2 $630.00 26.3105 $1,089.28 $744.8226860 Fusion of finger joint Y A2 $510.00 26.3105 $1,089.28 $654.8226861 Fusion of finger jnt, add-on Y A2 $446.00 26.3105 $1,089.28 $606.8226862 Fusion/graft of finger joint Y A2 $630.00 26.3105 $1,089.28 $744.8226863 Fuse/graft added joint Y A2 $510.00 26.3105 $1,089.28 $654.8226910 Amputate metacarpal bone Y A2 $510.00 26.3105 $1,089.28 $654.8226951 Amputation of finger/thumb Y A2 $446.00 16.4637 $681.61 $504.9026952 Amputation of finger/thumb Y A2 $630.00 16.4637 $681.61 $642.9026990 Drainage of pelvis lesion Y A2 $333.00 21.2689 $880.55 $469.8926991 Drainage of pelvis bursa Y A2 $333.00 21.2689 $880.55 $469.8927000 Incision of hip tendon Y A2 $446.00 21.2689 $880.55 $554.6427001 Incision of hip tendon Y A2 $510.00 29.19 $1,208.50 $684.6327003 Incision of hip tendon Y A2 $510.00 29.19 $1,208.50 $684.6327033 Exploration of hip joint Y A2 $510.00 42.985 $1,779.62 $827.4127035 Denervation of hip joint Y A2 $630.00 42.985 $1,779.62 $917.4127040 Biopsy of soft tissues Y A2 $333.00 8.685 $359.57 $339.6427041 Biopsy of soft tissues Y A2 $418.49 8.685 $359.57 $403.7627047 Remove hip/pelvis lesion Y A2 $446.00 21.1098 $873.97 $552.9927048 Remove hip/pelvis lesion Y A2 $510.00 21.1098 $873.97 $600.9927049 Remove tumor, hip/pelvis Y A2 $510.00 21.1098 $873.97 $600.9927050 Biopsy of sacroiliac joint Y A2 $510.00 21.2689 $880.55 $602.6427052 Biopsy of hip joint Y A2 $510.00 21.2689 $880.55 $602.6427060 Removal of ischial bursa Y A2 $717.00 21.2689 $880.55 $757.8927062 Remove femur lesion/bursa Y A2 $717.00 21.2689 $880.55 $757.8927065 Removal of hip bone lesion Y A2 $717.00 21.2689 $880.55 $757.8927066 Removal of hip bone lesion Y A2 $717.00 29.19 $1,208.50 $839.8827067 Remove/graft hip bone lesion Y A2 $717.00 29.19 $1,208.50 $839.8827080 Removal of tail bone Y A2 $446.00 29.19 $1,208.50 $636.63

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 27086 Remove hip foreign body Y A2 $333.00 8.685 $359.57 $339.6427087 Remove hip foreign body Y A2 $510.00 21.2689 $880.55 $602.6427093 Injection for hip x-ray N N127095 Injection for hip x-ray N N127097 Revision of hip tendon Y A2 $510.00 29.19 $1,208.50 $684.6327098 Transfer tendon to pelvis Y A2 $510.00 29.19 $1,208.50 $684.6327100 Transfer of abdominal muscle Y A2 $630.00 42.985 $1,779.62 $917.4127105 Transfer of spinal muscle Y A2 $630.00 42.985 $1,779.62 $917.4127110 Transfer of iliopsoas muscle Y A2 $630.00 42.985 $1,779.62 $917.4127111 Transfer of iliopsoas muscle Y A2 $630.00 42.985 $1,779.62 $917.4127193 Treat pelvic ring fracture Y A2 $103.62 1.7682 $73.21 $96.0227194 Treat pelvic ring fracture Y A2 $446.00 14.7658 $611.32 $487.3327200 Treat tail bone fracture Y P2 1.7682 $73.21 $73.2127202 Treat tail bone fracture Y A2 $446.00 41.1091 $1,701.96 $759.9927220 Treat hip socket fracture Y G2 1.7682 $73.21 $73.2127230 Treat thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227238 Treat thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227246 Treat thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227250 Treat hip dislocation Y A2 $103.62 1.7682 $73.21 $96.0227252 Treat hip dislocation Y A2 $446.00 14.7658 $611.32 $487.3327256 Treat hip dislocation Y G2 1.7682 $73.21 $73.2127257 Treat hip dislocation Y A2 $510.00 14.7658 $611.32 $535.3327265 Treat hip dislocation Y A2 $103.62 1.7682 $73.21 $96.0227266 Treat hip dislocation Y A2 $446.00 14.7658 $611.32 $487.3327267 Cltx thigh fx Y G2 1.7682 $73.21 $73.2127275 Manipulation of hip joint Y A2 $446.00 14.7658 $611.32 $487.3327301 Drain thigh/knee lesion Y A2 $510.00 18.3197 $758.45 $572.1127305 Incise thigh tendon & fascia Y A2 $446.00 21.2689 $880.55 $554.6427306 Incision of thigh tendon Y A2 $510.00 21.2689 $880.55 $602.6427307 Incision of thigh tendons Y A2 $510.00 21.2689 $880.55 $602.6427310 Exploration of knee joint Y A2 $630.00 29.19 $1,208.50 $774.6327323 Biopsy, thigh soft tissues Y A2 $333.00 8.685 $359.57 $339.6427324 Biopsy, thigh soft tissues Y A2 $333.00 21.1098 $873.97 $468.2427325 Neurectomy, hamstring Y A2 $446.00 18.0518 $747.36 $521.3427326 Neurectomy, popliteal Y A2 $446.00 18.0518 $747.36 $521.3427327 Removal of thigh lesion Y A2 $446.00 21.1098 $873.97 $552.9927328 Removal of thigh lesion Y A2 $510.00 21.1098 $873.97 $600.9927329 Remove tumor, thigh/knee Y A2 $630.00 21.1098 $873.97 $690.9927330 Biopsy, knee joint lining Y A2 $630.00 29.19 $1,208.50 $774.6327331 Explore/treat knee joint Y A2 $630.00 29.19 $1,208.50 $774.6327332 Removal of knee cartilage Y A2 $630.00 29.19 $1,208.50 $774.6327333 Removal of knee cartilage Y A2 $630.00 29.19 $1,208.50 $774.6327334 Remove knee joint lining Y A2 $630.00 29.19 $1,208.50 $774.6327335 Remove knee joint lining Y A2 $630.00 29.19 $1,208.50 $774.6327340 Removal of kneecap bursa Y A2 $510.00 21.2689 $880.55 $602.6427345 Removal of knee cyst Y A2 $630.00 21.2689 $880.55 $692.6427347 Remove knee cyst Y A2 $630.00 21.2689 $880.55 $692.6427350 Removal of kneecap Y A2 $630.00 29.19 $1,208.50 $774.6327355 Remove femur lesion Y A2 $510.00 29.19 $1,208.50 $684.6327356 Remove femur lesion/graft Y A2 $630.00 29.19 $1,208.50 $774.6327357 Remove femur lesion/graft Y A2 $717.00 29.19 $1,208.50 $839.8827358 Remove femur lesion/fixation Y A2 $717.00 29.19 $1,208.50 $839.8827360 Partial removal, leg bone(s) Y A2 $717.00 29.19 $1,208.50 $839.8827370 Injection for knee x-ray N N127372 Removal of foreign body Y A2 $995.00 21.1098 $873.97 $964.7427380 Repair of kneecap tendon Y A2 $333.00 21.2689 $880.55 $469.8927381 Repair/graft kneecap tendon Y A2 $510.00 21.2689 $880.55 $602.6427385 Repair of thigh muscle Y A2 $510.00 21.2689 $880.55 $602.6427386 Repair/graft of thigh muscle Y A2 $510.00 21.2689 $880.55 $602.6427390 Incision of thigh tendon Y A2 $333.00 21.2689 $880.55 $469.8927391 Incision of thigh tendons Y A2 $446.00 21.2689 $880.55 $554.6427392 Incision of thigh tendons Y A2 $510.00 21.2689 $880.55 $602.6427393 Lengthening of thigh tendon Y A2 $446.00 29.19 $1,208.50 $636.6327394 Lengthening of thigh tendons Y A2 $510.00 29.19 $1,208.50 $684.6327395 Lengthening of thigh tendons Y A2 $510.00 42.985 $1,779.62 $827.4127396 Transplant of thigh tendon Y A2 $510.00 29.19 $1,208.50 $684.6327397 Transplants of thigh tendons Y A2 $510.00 42.985 $1,779.62 $827.4127400 Revise thigh muscles/tendons Y A2 $510.00 42.985 $1,779.62 $827.4127403 Repair of knee cartilage Y A2 $630.00 29.19 $1,208.50 $774.6327405 Repair of knee ligament Y A2 $630.00 42.985 $1,779.62 $917.4127407 Repair of knee ligament Y A2 $630.00 79.4244 $3,288.25 $1,294.5627409 Repair of knee ligaments Y A2 $630.00 42.985 $1,779.62 $917.4127416 Osteochondral knee autograft Y G2 42.985 $1,779.62 $1,779.6227418 Repair degenerated kneecap Y A2 $510.00 42.985 $1,779.62 $827.4127420 Revision of unstable kneecap Y A2 $510.00 42.985 $1,779.62 $827.4127422 Revision of unstable kneecap Y A2 $995.00 42.985 $1,779.62 $1,191.1627424 Revision/removal of kneecap Y A2 $510.00 42.985 $1,779.62 $827.4127425 Lat retinacular release open Y A2 $995.00 29.19 $1,208.50 $1,048.3827427 Reconstruction, knee Y A2 $510.00 42.985 $1,779.62 $827.4127428 Reconstruction, knee Y A2 $630.00 79.4244 $3,288.25 $1,294.5627429 Reconstruction, knee Y A2 $630.00 79.4244 $3,288.25 $1,294.5627430 Revision of thigh muscles Y A2 $630.00 42.985 $1,779.62 $917.4127435 Incision of knee joint Y A2 $630.00 42.985 $1,779.62 $917.4127437 Revise kneecap Y A2 $630.00 35.904 $1,486.46 $844.1227438 Revise kneecap with implant Y A2 $717.00 50.8876 $2,106.80 $1,064.4527440 Revision of knee joint Y G2 35.904 $1,486.46 $1,486.4627441 Revision of knee joint Y A2 $717.00 35.904 $1,486.46 $909.3727442 Revision of knee joint Y A2 $717.00 35.904 $1,486.46 $909.37

Date Printed: 04/08/2023 @ 09:12:29 Page 15 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 27443 Revision of knee joint Y A2 $717.00 35.904 $1,486.46 $909.3727446 Revision of knee joint Y G2 274.6715 $11,371.67 $11,371.6727496 Decompression of thigh/knee Y A2 $717.00 21.2689 $880.55 $757.8927497 Decompression of thigh/knee Y A2 $510.00 21.2689 $880.55 $602.6427498 Decompression of thigh/knee Y A2 $510.00 21.2689 $880.55 $602.6427499 Decompression of thigh/knee Y A2 $510.00 21.2689 $880.55 $602.6427500 Treatment of thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227501 Treatment of thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227502 Treatment of thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227503 Treatment of thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227508 Treatment of thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227509 Treatment of thigh fracture Y A2 $510.00 26.1592 $1,083.02 $653.2627510 Treatment of thigh fracture Y A2 $103.62 1.7682 $73.21 $96.0227516 Treat thigh fx growth plate Y A2 $103.62 1.7682 $73.21 $96.0227517 Treat thigh fx growth plate Y A2 $103.62 1.7682 $73.21 $96.0227520 Treat kneecap fracture Y A2 $103.62 1.7682 $73.21 $96.0227530 Treat knee fracture Y A2 $103.62 1.7682 $73.21 $96.0227532 Treat knee fracture Y A2 $103.62 1.7682 $73.21 $96.0227538 Treat knee fracture(s) Y A2 $103.62 1.7682 $73.21 $96.0227550 Treat knee dislocation Y A2 $103.62 1.7682 $73.21 $96.0227552 Treat knee dislocation Y A2 $333.00 14.7658 $611.32 $402.5827560 Treat kneecap dislocation Y A2 $103.62 1.7682 $73.21 $96.0227562 Treat kneecap dislocation Y A2 $333.00 14.7658 $611.32 $402.5827566 Treat kneecap dislocation Y A2 $446.00 41.1091 $1,701.96 $759.9927570 Fixation of knee joint Y A2 $333.00 14.7658 $611.32 $402.5827594 Amputation follow-up surgery Y A2 $510.00 21.2689 $880.55 $602.6427600 Decompression of lower leg Y A2 $510.00 21.2689 $880.55 $602.6427601 Decompression of lower leg Y A2 $510.00 21.2689 $880.55 $602.6427602 Decompression of lower leg Y A2 $510.00 21.2689 $880.55 $602.6427603 Drain lower leg lesion Y A2 $446.00 18.3197 $758.45 $524.1127604 Drain lower leg bursa Y A2 $446.00 21.2689 $880.55 $554.6427605 Incision of achilles tendon Y A2 $333.00 20.8284 $862.32 $465.3327606 Incision of achilles tendon Y A2 $333.00 21.2689 $880.55 $469.8927607 Treat lower leg bone lesion Y A2 $446.00 21.2689 $880.55 $554.6427610 Explore/treat ankle joint Y A2 $446.00 29.19 $1,208.50 $636.6327612 Exploration of ankle joint Y A2 $510.00 29.19 $1,208.50 $684.6327613 Biopsy lower leg soft tissue Y P3 3.2842 $135.97 $135.9727614 Biopsy lower leg soft tissue Y A2 $446.00 21.1098 $873.97 $552.9927615 Remove tumor, lower leg Y A2 $510.00 29.19 $1,208.50 $684.6327618 Remove lower leg lesion Y A2 $446.00 16.1001 $666.56 $501.1427619 Remove lower leg lesion Y A2 $510.00 21.1098 $873.97 $600.9927620 Explore/treat ankle joint Y A2 $630.00 29.19 $1,208.50 $774.6327625 Remove ankle joint lining Y A2 $630.00 29.19 $1,208.50 $774.6327626 Remove ankle joint lining Y A2 $630.00 29.19 $1,208.50 $774.6327630 Removal of tendon lesion Y A2 $510.00 21.2689 $880.55 $602.6427635 Remove lower leg bone lesion Y A2 $510.00 29.19 $1,208.50 $684.6327637 Remove/graft leg bone lesion Y A2 $510.00 29.19 $1,208.50 $684.6327638 Remove/graft leg bone lesion Y A2 $510.00 29.19 $1,208.50 $684.6327640 Partial removal of tibia Y A2 $446.00 42.985 $1,779.62 $779.4127641 Partial removal of fibula Y A2 $446.00 29.19 $1,208.50 $636.6327647 Extensive ankle/heel surgery Y A2 $510.00 42.985 $1,779.62 $827.4127648 Injection for ankle x-ray N N127650 Repair achilles tendon Y A2 $510.00 42.985 $1,779.62 $827.4127652 Repair/graft achilles tendon Y A2 $510.00 79.4244 $3,288.25 $1,204.5627654 Repair of achilles tendon Y A2 $510.00 42.985 $1,779.62 $827.4127656 Repair leg fascia defect Y A2 $446.00 21.2689 $880.55 $554.6427658 Repair of leg tendon, each Y A2 $333.00 21.2689 $880.55 $469.8927659 Repair of leg tendon, each Y A2 $446.00 21.2689 $880.55 $554.6427664 Repair of leg tendon, each Y A2 $446.00 21.2689 $880.55 $554.6427665 Repair of leg tendon, each Y A2 $446.00 29.19 $1,208.50 $636.6327675 Repair lower leg tendons Y A2 $446.00 21.2689 $880.55 $554.6427676 Repair lower leg tendons Y A2 $510.00 29.19 $1,208.50 $684.6327680 Release of lower leg tendon Y A2 $510.00 29.19 $1,208.50 $684.6327681 Release of lower leg tendons Y A2 $446.00 29.19 $1,208.50 $636.6327685 Revision of lower leg tendon Y A2 $510.00 29.19 $1,208.50 $684.6327686 Revise lower leg tendons Y A2 $510.00 29.19 $1,208.50 $684.6327687 Revision of calf tendon Y A2 $510.00 29.19 $1,208.50 $684.6327690 Revise lower leg tendon Y A2 $630.00 42.985 $1,779.62 $917.4127691 Revise lower leg tendon Y A2 $630.00 42.985 $1,779.62 $917.4127692 Revise additional leg tendon Y A2 $510.00 42.985 $1,779.62 $827.4127695 Repair of ankle ligament Y A2 $446.00 29.19 $1,208.50 $636.6327696 Repair of ankle ligaments Y A2 $446.00 29.19 $1,208.50 $636.6327698 Repair of ankle ligament Y A2 $446.00 29.19 $1,208.50 $636.6327700 Revision of ankle joint Y A2 $717.00 35.904 $1,486.46 $909.3727704 Removal of ankle implant Y A2 $446.00 21.2689 $880.55 $554.6427705 Incision of tibia Y A2 $446.00 42.985 $1,779.62 $779.4127707 Incision of fibula Y A2 $446.00 21.2689 $880.55 $554.6427709 Incision of tibia & fibula Y A2 $446.00 29.19 $1,208.50 $636.6327726 Repair fibula nonunion Y G2 26.1592 $1,083.02 $1,083.0227730 Repair of tibia epiphysis Y A2 $446.00 29.19 $1,208.50 $636.6327732 Repair of fibula epiphysis Y A2 $446.00 29.19 $1,208.50 $636.6327734 Repair lower leg epiphyses Y A2 $446.00 29.19 $1,208.50 $636.6327740 Repair of leg epiphyses Y A2 $446.00 29.19 $1,208.50 $636.6327742 Repair of leg epiphyses Y A2 $446.00 42.985 $1,779.62 $779.4127745 Reinforce tibia Y A2 $510.00 79.4244 $3,288.25 $1,204.5627750 Treatment of tibia fracture Y A2 $103.62 1.7682 $73.21 $96.0227752 Treatment of tibia fracture Y A2 $103.62 1.7682 $73.21 $96.0227756 Treatment of tibia fracture Y A2 $510.00 26.1592 $1,083.02 $653.26

Date Printed: 04/08/2023 @ 09:12:29 Page 16 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 27758 Treatment of tibia fracture Y A2 $630.00 41.1091 $1,701.96 $897.9927759 Treatment of tibia fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4827760 Cltx medial ankle fx Y A2 $103.62 1.7682 $73.21 $96.0227762 Cltx med ankle fx w/mnpj Y A2 $103.62 1.7682 $73.21 $96.0227766 Optx medial ankle fx Y A2 $510.00 41.1091 $1,701.96 $807.9927767 Cltx post ankle fx Y G2 1.7682 $73.21 $73.2127768 Cltx post ankle fx w/mnpj Y G2 1.7682 $73.21 $73.2127769 Optx post ankle fx Y G2 41.1091 $1,701.96 $1,701.9627780 Treatment of fibula fracture Y A2 $103.62 1.7682 $73.21 $96.0227781 Treatment of fibula fracture Y A2 $103.62 1.7682 $73.21 $96.0227784 Treatment of fibula fracture Y A2 $510.00 41.1091 $1,701.96 $807.9927786 Treatment of ankle fracture Y A2 $103.62 1.7682 $73.21 $96.0227788 Treatment of ankle fracture Y A2 $103.62 1.7682 $73.21 $96.0227792 Treatment of ankle fracture Y A2 $510.00 41.1091 $1,701.96 $807.9927808 Treatment of ankle fracture Y A2 $103.62 1.7682 $73.21 $96.0227810 Treatment of ankle fracture Y A2 $103.62 1.7682 $73.21 $96.0227814 Treatment of ankle fracture Y A2 $510.00 41.1091 $1,701.96 $807.9927816 Treatment of ankle fracture Y A2 $103.62 1.7682 $73.21 $96.0227818 Treatment of ankle fracture Y A2 $103.62 1.7682 $73.21 $96.0227822 Treatment of ankle fracture Y A2 $510.00 41.1091 $1,701.96 $807.9927823 Treatment of ankle fracture Y A2 $510.00 59.2233 $2,451.90 $995.4827824 Treat lower leg fracture Y A2 $103.62 1.7682 $73.21 $96.0227825 Treat lower leg fracture Y A2 $103.62 1.7682 $73.21 $96.0227826 Treat lower leg fracture Y A2 $510.00 41.1091 $1,701.96 $807.9927827 Treat lower leg fracture Y A2 $510.00 59.2233 $2,451.90 $995.4827828 Treat lower leg fracture Y A2 $630.00 59.2233 $2,451.90 $1,085.4827829 Treat lower leg joint Y A2 $446.00 41.1091 $1,701.96 $759.9927830 Treat lower leg dislocation Y A2 $103.62 1.7682 $73.21 $96.0227831 Treat lower leg dislocation Y A2 $103.62 1.7682 $73.21 $96.0227832 Treat lower leg dislocation Y A2 $446.00 41.1091 $1,701.96 $759.9927840 Treat ankle dislocation Y A2 $103.62 1.7682 $73.21 $96.0227842 Treat ankle dislocation Y A2 $333.00 14.7658 $611.32 $402.5827846 Treat ankle dislocation Y A2 $510.00 41.1091 $1,701.96 $807.9927848 Treat ankle dislocation Y A2 $510.00 41.1091 $1,701.96 $807.9927860 Fixation of ankle joint Y A2 $333.00 14.7658 $611.32 $402.5827870 Fusion of ankle joint, open Y A2 $630.00 79.4244 $3,288.25 $1,294.5627871 Fusion of tibiofibular joint Y A2 $630.00 79.4244 $3,288.25 $1,294.5627884 Amputation follow-up surgery Y A2 $510.00 21.2689 $880.55 $602.6427889 Amputation of foot at ankle Y A2 $510.00 29.19 $1,208.50 $684.6327892 Decompression of leg Y A2 $510.00 21.2689 $880.55 $602.6427893 Decompression of leg Y A2 $510.00 21.2689 $880.55 $602.6427894 Decompression of leg Y A2 $510.00 21.2689 $880.55 $602.6428001 Drainage of bursa of foot Y P3 3.2106 $132.92 $132.9228002 Treatment of foot infection Y A2 $510.00 21.2689 $880.55 $602.6428003 Treatment of foot infection Y A2 $510.00 21.2689 $880.55 $602.6428005 Treat foot bone lesion Y A2 $510.00 20.8284 $862.32 $598.0828008 Incision of foot fascia Y A2 $510.00 20.8284 $862.32 $598.0828010 Incision of toe tendon Y P3 2.4103 $99.79 $99.7928011 Incision of toe tendons Y A2 $510.00 20.8284 $862.32 $598.0828020 Exploration of foot joint Y A2 $446.00 20.8284 $862.32 $550.0828022 Exploration of foot joint Y A2 $446.00 20.8284 $862.32 $550.0828024 Exploration of toe joint Y A2 $446.00 20.8284 $862.32 $550.0828035 Decompression of tibia nerve Y A2 $630.00 18.0518 $747.36 $659.3428043 Excision of foot lesion Y A2 $446.00 21.1098 $873.97 $552.9928045 Excision of foot lesion Y A2 $510.00 20.8284 $862.32 $598.0828046 Resection of tumor, foot Y A2 $510.00 20.8284 $862.32 $598.0828050 Biopsy of foot joint lining Y A2 $446.00 20.8284 $862.32 $550.0828052 Biopsy of foot joint lining Y A2 $446.00 20.8284 $862.32 $550.0828054 Biopsy of toe joint lining Y A2 $446.00 20.8284 $862.32 $550.0828055 Neurectomy, foot Y A2 $630.00 18.0518 $747.36 $659.3428060 Partial removal, foot fascia Y A2 $446.00 20.8284 $862.32 $550.0828062 Removal of foot fascia Y A2 $510.00 20.8284 $862.32 $598.0828070 Removal of foot joint lining Y A2 $510.00 20.8284 $862.32 $598.0828072 Removal of foot joint lining Y A2 $510.00 20.8284 $862.32 $598.0828080 Removal of foot lesion Y A2 $510.00 20.8284 $862.32 $598.0828086 Excise foot tendon sheath Y A2 $446.00 20.8284 $862.32 $550.0828088 Excise foot tendon sheath Y A2 $446.00 20.8284 $862.32 $550.0828090 Removal of foot lesion Y A2 $510.00 20.8284 $862.32 $598.0828092 Removal of toe lesions Y A2 $510.00 20.8284 $862.32 $598.0828100 Removal of ankle/heel lesion Y A2 $446.00 20.8284 $862.32 $550.0828102 Remove/graft foot lesion Y A2 $510.00 44.2687 $1,832.77 $840.6928103 Remove/graft foot lesion Y A2 $510.00 44.2687 $1,832.77 $840.6928104 Removal of foot lesion Y A2 $446.00 20.8284 $862.32 $550.0828106 Remove/graft foot lesion Y A2 $510.00 44.2687 $1,832.77 $840.6928107 Remove/graft foot lesion Y A2 $510.00 44.2687 $1,832.77 $840.6928108 Removal of toe lesions Y A2 $446.00 20.8284 $862.32 $550.0828110 Part removal of metatarsal Y A2 $510.00 20.8284 $862.32 $598.0828111 Part removal of metatarsal Y A2 $510.00 20.8284 $862.32 $598.0828112 Part removal of metatarsal Y A2 $510.00 20.8284 $862.32 $598.0828113 Part removal of metatarsal Y A2 $510.00 20.8284 $862.32 $598.0828114 Removal of metatarsal heads Y A2 $510.00 20.8284 $862.32 $598.0828116 Revision of foot Y A2 $510.00 20.8284 $862.32 $598.0828118 Removal of heel bone Y A2 $630.00 20.8284 $862.32 $688.0828119 Removal of heel spur Y A2 $630.00 20.8284 $862.32 $688.0828120 Part removal of ankle/heel Y A2 $995.00 20.8284 $862.32 $961.8328122 Partial removal of foot bone Y A2 $510.00 20.8284 $862.32 $598.0828124 Partial removal of toe Y P3 5.4093 $223.95 $223.9528126 Partial removal of toe Y A2 $510.00 20.8284 $862.32 $598.08

Date Printed: 04/08/2023 @ 09:12:29 Page 17 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 28130 Removal of ankle bone Y A2 $510.00 20.8284 $862.32 $598.0828140 Removal of metatarsal Y A2 $510.00 20.8284 $862.32 $598.0828150 Removal of toe Y A2 $510.00 20.8284 $862.32 $598.0828153 Partial removal of toe Y A2 $510.00 20.8284 $862.32 $598.0828160 Partial removal of toe Y A2 $510.00 20.8284 $862.32 $598.0828171 Extensive foot surgery Y A2 $510.00 20.8284 $862.32 $598.0828173 Extensive foot surgery Y A2 $510.00 20.8284 $862.32 $598.0828175 Extensive foot surgery Y A2 $510.00 20.8284 $862.32 $598.0828190 Removal of foot foreign body Y P3 3.4038 $140.92 $140.9228192 Removal of foot foreign body Y A2 $446.00 16.1001 $666.56 $501.1428193 Removal of foot foreign body Y A2 $418.49 8.685 $359.57 $403.7628200 Repair of foot tendon Y A2 $510.00 20.8284 $862.32 $598.0828202 Repair/graft of foot tendon Y A2 $510.00 20.8284 $862.32 $598.0828208 Repair of foot tendon Y A2 $510.00 20.8284 $862.32 $598.0828210 Repair/graft of foot tendon Y A2 $510.00 44.2687 $1,832.77 $840.6928220 Release of foot tendon Y P3 5.0965 $211.00 $211.0028222 Release of foot tendons Y A2 $333.00 20.8284 $862.32 $465.3328225 Release of foot tendon Y A2 $333.00 20.8284 $862.32 $465.3328226 Release of foot tendons Y A2 $333.00 20.8284 $862.32 $465.3328230 Incision of foot tendon(s) Y P3 5.0322 $208.34 $208.3428232 Incision of toe tendon Y P3 4.8115 $199.20 $199.2028234 Incision of foot tendon Y A2 $446.00 20.8284 $862.32 $550.0828238 Revision of foot tendon Y A2 $510.00 44.2687 $1,832.77 $840.6928240 Release of big toe Y A2 $446.00 20.8284 $862.32 $550.0828250 Revision of foot fascia Y A2 $510.00 20.8284 $862.32 $598.0828260 Release of midfoot joint Y A2 $510.00 20.8284 $862.32 $598.0828261 Revision of foot tendon Y A2 $510.00 20.8284 $862.32 $598.0828262 Revision of foot and ankle Y A2 $630.00 20.8284 $862.32 $688.0828264 Release of midfoot joint Y A2 $333.00 44.2687 $1,832.77 $707.9428270 Release of foot contracture Y A2 $510.00 20.8284 $862.32 $598.0828272 Release of toe joint, each Y P3 4.6091 $190.82 $190.8228280 Fusion of toes Y A2 $446.00 20.8284 $862.32 $550.0828285 Repair of hammertoe Y A2 $510.00 20.8284 $862.32 $598.0828286 Repair of hammertoe Y A2 $630.00 20.8284 $862.32 $688.0828288 Partial removal of foot bone Y A2 $510.00 20.8284 $862.32 $598.0828289 Repair hallux rigidus Y A2 $510.00 20.8284 $862.32 $598.0828290 Correction of bunion Y A2 $446.00 29.4167 $1,217.88 $638.9728292 Correction of bunion Y A2 $446.00 29.4167 $1,217.88 $638.9728293 Correction of bunion Y A2 $510.00 29.4167 $1,217.88 $686.9728294 Correction of bunion Y A2 $510.00 29.4167 $1,217.88 $686.9728296 Correction of bunion Y A2 $510.00 29.4167 $1,217.88 $686.9728297 Correction of bunion Y A2 $510.00 29.4167 $1,217.88 $686.9728298 Correction of bunion Y A2 $510.00 29.4167 $1,217.88 $686.9728299 Correction of bunion Y A2 $717.00 29.4167 $1,217.88 $842.2228300 Incision of heel bone Y A2 $446.00 44.2687 $1,832.77 $792.6928302 Incision of ankle bone Y A2 $446.00 20.8284 $862.32 $550.0828304 Incision of midfoot bones Y A2 $446.00 44.2687 $1,832.77 $792.6928305 Incise/graft midfoot bones Y A2 $510.00 44.2687 $1,832.77 $840.6928306 Incision of metatarsal Y A2 $630.00 20.8284 $862.32 $688.0828307 Incision of metatarsal Y A2 $630.00 20.8284 $862.32 $688.0828308 Incision of metatarsal Y A2 $446.00 20.8284 $862.32 $550.0828309 Incision of metatarsals Y A2 $630.00 44.2687 $1,832.77 $930.6928310 Revision of big toe Y A2 $510.00 20.8284 $862.32 $598.0828312 Revision of toe Y A2 $510.00 20.8284 $862.32 $598.0828313 Repair deformity of toe Y A2 $446.00 20.8284 $862.32 $550.0828315 Removal of sesamoid bone Y A2 $630.00 20.8284 $862.32 $688.0828320 Repair of foot bones Y A2 $630.00 44.2687 $1,832.77 $930.6928322 Repair of metatarsals Y A2 $630.00 44.2687 $1,832.77 $930.6928340 Resect enlarged toe tissue Y A2 $630.00 20.8284 $862.32 $688.0828341 Resect enlarged toe Y A2 $630.00 20.8284 $862.32 $688.0828344 Repair extra toe(s) Y A2 $630.00 20.8284 $862.32 $688.0828345 Repair webbed toe(s) Y A2 $630.00 20.8284 $862.32 $688.0828400 Treatment of heel fracture Y A2 $103.62 1.7682 $73.21 $96.0228405 Treatment of heel fracture Y A2 $103.62 1.7682 $73.21 $96.0228406 Treatment of heel fracture Y A2 $446.00 26.1592 $1,083.02 $605.2628415 Treat heel fracture Y A2 $510.00 59.2233 $2,451.90 $995.4828420 Treat/graft heel fracture Y A2 $630.00 41.1091 $1,701.96 $897.9928430 Treatment of ankle fracture Y P2 1.7682 $73.21 $73.2128435 Treatment of ankle fracture Y A2 $103.62 1.7682 $73.21 $96.0228436 Treatment of ankle fracture Y A2 $446.00 26.1592 $1,083.02 $605.2628445 Treat ankle fracture Y A2 $510.00 41.1091 $1,701.96 $807.9928446 Osteochondral talus autogrft Y G2 44.2687 $1,832.77 $1,832.7728450 Treat midfoot fracture, each Y P2 1.7682 $73.21 $73.2128455 Treat midfoot fracture, each Y P2 1.7682 $73.21 $73.2128456 Treat midfoot fracture Y A2 $446.00 26.1592 $1,083.02 $605.2628465 Treat midfoot fracture, each Y A2 $510.00 41.1091 $1,701.96 $807.9928470 Treat metatarsal fracture Y P2 1.7682 $73.21 $73.2128475 Treat metatarsal fracture Y P2 1.7682 $73.21 $73.2128476 Treat metatarsal fracture Y A2 $446.00 26.1592 $1,083.02 $605.2628485 Treat metatarsal fracture Y A2 $630.00 41.1091 $1,701.96 $897.9928490 Treat big toe fracture Y P2 1.7682 $73.21 $73.2128495 Treat big toe fracture Y P2 1.7682 $73.21 $73.2128496 Treat big toe fracture Y A2 $446.00 26.1592 $1,083.02 $605.2628505 Treat big toe fracture Y A2 $510.00 26.1592 $1,083.02 $653.2628510 Treatment of toe fracture Y P3 1.4811 $61.32 $61.3228515 Treatment of toe fracture Y P2 1.7682 $73.21 $73.2128525 Treat toe fracture Y A2 $510.00 26.1592 $1,083.02 $653.2628530 Treat sesamoid bone fracture Y P3 1.4075 $58.27 $58.27

Date Printed: 04/08/2023 @ 09:12:29 Page 18 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 28531 Treat sesamoid bone fracture Y A2 $510.00 26.1592 $1,083.02 $653.2628540 Treat foot dislocation Y P2 1.7682 $73.21 $73.2128545 Treat foot dislocation Y A2 $333.00 26.1592 $1,083.02 $520.5128546 Treat foot dislocation Y A2 $446.00 26.1592 $1,083.02 $605.2628555 Repair foot dislocation Y A2 $446.00 41.1091 $1,701.96 $759.9928570 Treat foot dislocation Y P2 1.7682 $73.21 $73.2128575 Treat foot dislocation Y A2 $103.62 1.7682 $73.21 $96.0228576 Treat foot dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2628585 Repair foot dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2628600 Treat foot dislocation Y P2 1.7682 $73.21 $73.2128605 Treat foot dislocation Y A2 $103.62 1.7682 $73.21 $96.0228606 Treat foot dislocation Y A2 $446.00 26.1592 $1,083.02 $605.2628615 Repair foot dislocation Y A2 $510.00 41.1091 $1,701.96 $807.9928630 Treat toe dislocation Y P3 1.5732 $65.13 $65.1328635 Treat toe dislocation Y A2 $333.00 14.7658 $611.32 $402.5828636 Treat toe dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2628645 Repair toe dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2628660 Treat toe dislocation Y P3 1.1775 $48.75 $48.7528665 Treat toe dislocation Y A2 $333.00 14.7658 $611.32 $402.5828666 Treat toe dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2628675 Repair of toe dislocation Y A2 $510.00 26.1592 $1,083.02 $653.2628705 Fusion of foot bones Y A2 $630.00 44.2687 $1,832.77 $930.6928715 Fusion of foot bones Y A2 $630.00 79.4244 $3,288.25 $1,294.5628725 Fusion of foot bones Y A2 $630.00 44.2687 $1,832.77 $930.6928730 Fusion of foot bones Y A2 $630.00 44.2687 $1,832.77 $930.6928735 Fusion of foot bones Y A2 $630.00 44.2687 $1,832.77 $930.6928737 Revision of foot bones Y A2 $717.00 44.2687 $1,832.77 $995.9428740 Fusion of foot bones Y A2 $630.00 44.2687 $1,832.77 $930.6928750 Fusion of big toe joint Y A2 $630.00 44.2687 $1,832.77 $930.6928755 Fusion of big toe joint Y A2 $630.00 20.8284 $862.32 $688.0828760 Fusion of big toe joint Y A2 $630.00 44.2687 $1,832.77 $930.6928810 Amputation toe & metatarsal Y A2 $446.00 20.8284 $862.32 $550.0828820 Amputation of toe Y A2 $446.00 20.8284 $862.32 $550.0828825 Partial amputation of toe Y A2 $446.00 20.8284 $862.32 $550.0828890* High energy eswt, plantar f Y P3 4.7286 $195.77 $195.7729000 Application of body cast N G2 1.0931 $45.26 $45.2629010 Application of body cast N P2 2.291 $94.85 $94.8529015 Application of body cast N P2 2.291 $94.85 $94.8529020 Application of body cast N G2 1.0931 $45.26 $45.2629025 Application of body cast N P2 1.0931 $45.26 $45.2629035 Application of body cast N P2 2.291 $94.85 $94.8529040 Application of body cast N G2 1.0931 $45.26 $45.2629044 Application of body cast N P2 2.291 $94.85 $94.8529046 Application of body cast N G2 2.291 $94.85 $94.8529049 Application of figure eight N P2 1.0931 $45.26 $45.2629055 Application of shoulder cast N P2 2.291 $94.85 $94.8529058 Application of shoulder cast N P2 1.0931 $45.26 $45.2629065 Application of long arm cast N P3 1.1959 $49.51 $49.5129075 Application of forearm cast N P3 1.15 $47.61 $47.6129085 Apply hand/wrist cast N P2 1.0931 $45.26 $45.2629086 Apply finger cast N P3 0.9384 $38.85 $38.8529105 Apply long arm splint N P3 1.0671 $44.18 $44.1829125 Apply forearm splint N P3 0.9108 $37.71 $37.7129126 Apply forearm splint N P3 1.0212 $42.28 $42.2829130 Application of finger splint N P3 0.414 $17.14 $17.1429131 Application of finger splint N P3 0.6072 $25.14 $25.1429200 Strapping of chest N P3 0.6072 $25.14 $25.1429220 Strapping of low back N P3 0.6348 $26.28 $26.2829240 Strapping of shoulder N P3 0.6993 $28.95 $28.9529260 Strapping of elbow or wrist N P3 0.6531 $27.04 $27.0429280 Strapping of hand or finger N P3 0.6715 $27.80 $27.8029305 Application of hip cast N P2 2.291 $94.85 $94.8529325 Application of hip casts N P2 2.291 $94.85 $94.8529345 Application of long leg cast N P3 1.5823 $65.51 $65.5129355 Application of long leg cast N P3 1.527 $63.22 $63.2229358 Apply long leg cast brace N P3 1.8768 $77.70 $77.7029365 Application of long leg cast N P3 1.4903 $61.70 $61.7029405 Apply short leg cast N P3 1.1133 $46.09 $46.0929425 Apply short leg cast N P3 1.1316 $46.85 $46.8529435 Apply short leg cast N P3 1.4166 $58.65 $58.6529440 Addition of walker to cast N P3 0.6164 $25.52 $25.5229445 Apply rigid leg cast N P3 1.5456 $63.99 $63.9929450 Application of leg cast N P2 1.0931 $45.26 $45.2629505 Application, long leg splint N P3 1.0396 $43.04 $43.0429515 Application lower leg splint N P3 0.8372 $34.66 $34.6629520 Strapping of hip N P3 0.6901 $28.57 $28.5729530 Strapping of knee N P3 0.6623 $27.42 $27.4229540 Strapping of ankle and/or ft N P3 0.4415 $18.28 $18.2829550 Strapping of toes N P3 0.4507 $18.66 $18.6629580 Application of paste boot N P3 0.6256 $25.90 $25.9029590 Application of foot splint N P3 0.506 $20.95 $20.9529700 Removal/revision of cast N P3 0.8464 $35.04 $35.0429705 Removal/revision of cast N P3 0.7268 $30.09 $30.0929710 Removal/revision of cast N P3 1.3154 $54.46 $54.4629715 Removal/revision of cast N P2 1.0931 $45.26 $45.2629720 Repair of body cast N P3 1.0671 $44.18 $44.1829730 Windowing of cast N P3 0.7084 $29.33 $29.3329740 Wedging of cast N P3 1.0026 $41.51 $41.51

Date Printed: 04/08/2023 @ 09:12:29 Page 19 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 29750 Wedging of clubfoot cast N P3 0.9751 $40.37 $40.3729800 Jaw arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829804 Jaw arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829805 Shoulder arthroscopy, dx Y A2 $510.00 28.7803 $1,191.53 $680.3829806 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829807 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829819 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829820 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829821 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829822 Shoulder arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829823 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829824 Shoulder arthroscopy/surgery Y A2 $717.00 28.7803 $1,191.53 $835.6329825 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829826 Shoulder arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829827 Arthroscop rotator cuff repr Y A2 $717.00 45.7072 $1,892.32 $1,010.8329828 Arthroscopy biceps tenodesis Y G2 45.7072 $1,892.32 $1,892.3229830 Elbow arthroscopy Y A2 $510.00 28.7803 $1,191.53 $680.3829834 Elbow arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829835 Elbow arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829836 Elbow arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829837 Elbow arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829838 Elbow arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829840 Wrist arthroscopy Y A2 $510.00 28.7803 $1,191.53 $680.3829843 Wrist arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829844 Wrist arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829845 Wrist arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829846 Wrist arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829847 Wrist arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829848 Wrist endoscopy/surgery Y A2 $1,339.00 28.7803 $1,191.53 $1,302.1329850 Knee arthroscopy/surgery Y A2 $630.00 28.7803 $1,191.53 $770.3829851 Knee arthroscopy/surgery Y A2 $630.00 45.7072 $1,892.32 $945.5829855 Tibial arthroscopy/surgery Y A2 $630.00 45.7072 $1,892.32 $945.5829856 Tibial arthroscopy/surgery Y A2 $630.00 45.7072 $1,892.32 $945.5829860 Hip arthroscopy, dx Y A2 $630.00 45.7072 $1,892.32 $945.5829861 Hip arthroscopy/surgery Y A2 $630.00 45.7072 $1,892.32 $945.5829862 Hip arthroscopy/surgery Y A2 $1,339.00 45.7072 $1,892.32 $1,477.3329863 Hip arthroscopy/surgery Y A2 $630.00 45.7072 $1,892.32 $945.5829866 Autgrft implnt, knee w/scope Y G2 45.7072 $1,892.32 $1,892.3229870 Knee arthroscopy, dx Y A2 $510.00 28.7803 $1,191.53 $680.3829871 Knee arthroscopy/drainage Y A2 $510.00 28.7803 $1,191.53 $680.3829873 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829874 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829875 Knee arthroscopy/surgery Y A2 $630.00 28.7803 $1,191.53 $770.3829876 Knee arthroscopy/surgery Y A2 $630.00 28.7803 $1,191.53 $770.3829877 Knee arthroscopy/surgery Y A2 $630.00 28.7803 $1,191.53 $770.3829879 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829880 Knee arthroscopy/surgery Y A2 $630.00 28.7803 $1,191.53 $770.3829881 Knee arthroscopy/surgery Y A2 $630.00 28.7803 $1,191.53 $770.3829882 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829883 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829884 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829885 Knee arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829886 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829887 Knee arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829888 Knee arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829889 Knee arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829891 Ankle arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829892 Ankle arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829893 Scope, plantar fasciotomy Y A2 $1,255.56 20.8284 $862.32 $1,157.2529894 Ankle arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829895 Ankle arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829897 Ankle arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829898 Ankle arthroscopy/surgery Y A2 $510.00 28.7803 $1,191.53 $680.3829899 Ankle arthroscopy/surgery Y A2 $510.00 45.7072 $1,892.32 $855.5829900 Mcp joint arthroscopy, dx Y A2 $510.00 28.7803 $1,191.53 $680.3829901 Mcp joint arthroscopy, surg Y A2 $510.00 28.7803 $1,191.53 $680.3829902 Mcp joint arthroscopy, surg Y A2 $510.00 28.7803 $1,191.53 $680.3829904 Subtalar arthro w/fb rmvl Y G2 28.7803 $1,191.53 $1,191.5329905 Subtalar arthro w/exc Y G2 28.7803 $1,191.53 $1,191.5329906 Subtalar arthro w/deb Y G2 28.7803 $1,191.53 $1,191.5329907 Subtalar arthro w/fusion Y G2 45.7072 $1,892.32 $1,892.3230000 Drainage of nose lesion Y P2 2.5002 $103.51 $103.5130020 Drainage of nose lesion Y P2 2.5002 $103.51 $103.5130100 Intranasal biopsy Y P3 2.0975 $86.84 $86.8430110 Removal of nose polyp(s) Y P3 3.2842 $135.97 $135.9730115 Removal of nose polyp(s) Y A2 $446.00 16.3288 $676.03 $503.5130117 Removal of intranasal lesion Y A2 $510.00 16.3288 $676.03 $551.5130118 Removal of intranasal lesion Y A2 $510.00 23.9765 $992.65 $630.6630120 Revision of nose Y A2 $333.00 16.3288 $676.03 $418.7630124 Removal of nose lesion Y R2 7.4474 $308.33 $308.3330125 Removal of nose lesion Y A2 $446.00 39.8776 $1,650.97 $747.2430130 Excise inferior turbinate Y A2 $510.00 16.3288 $676.03 $551.5130140 Resect inferior turbinate Y A2 $446.00 23.9765 $992.65 $582.6630150 Partial removal of nose Y A2 $510.00 39.8776 $1,650.97 $795.2430160 Removal of nose Y A2 $630.00 39.8776 $1,650.97 $885.2430200 Injection treatment of nose Y P3 1.6744 $69.32 $69.3230210 Nasal sinus therapy Y P3 2.1251 $87.98 $87.9830220 Insert nasal septal button Y A2 $464.15 7.4474 $308.33 $425.20

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 30300 Remove nasal foreign body N P2 0.631 $26.12 $26.1230310 Remove nasal foreign body Y A2 $333.00 16.3288 $676.03 $418.7630320 Remove nasal foreign body Y A2 $446.00 16.3288 $676.03 $503.5130400 Reconstruction of nose Y A2 $630.00 39.8776 $1,650.97 $885.2430410 Reconstruction of nose Y A2 $717.00 39.8776 $1,650.97 $950.4930420 Reconstruction of nose Y A2 $717.00 39.8776 $1,650.97 $950.4930430 Revision of nose Y A2 $510.00 23.9765 $992.65 $630.6630435 Revision of nose Y A2 $717.00 39.8776 $1,650.97 $950.4930450 Revision of nose Y A2 $995.00 39.8776 $1,650.97 $1,158.9930460 Revision of nose Y A2 $995.00 39.8776 $1,650.97 $1,158.9930462 Revision of nose Y A2 $1,339.00 39.8776 $1,650.97 $1,416.9930465 Repair nasal stenosis Y A2 $1,339.00 39.8776 $1,650.97 $1,416.9930520 Repair of nasal septum Y A2 $630.00 23.9765 $992.65 $720.6630540 Repair nasal defect Y A2 $717.00 39.8776 $1,650.97 $950.4930545 Repair nasal defect Y A2 $717.00 39.8776 $1,650.97 $950.4930560 Release of nasal adhesions Y A2 $150.72 2.5002 $103.51 $138.9230580 Repair upper jaw fistula Y A2 $630.00 39.8776 $1,650.97 $885.2430600 Repair mouth/nose fistula Y A2 $630.00 39.8776 $1,650.97 $885.2430620 Intranasal reconstruction Y A2 $995.00 39.8776 $1,650.97 $1,158.9930630 Repair nasal septum defect Y A2 $995.00 23.9765 $992.65 $994.4130801 Ablate inf turbinate, superf Y A2 $333.00 7.4474 $308.33 $326.8330802 Cauterization, inner nose Y A2 $333.00 7.4474 $308.33 $326.8330901 Control of nosebleed Y P2 1.1251 $46.58 $46.5830903 Control of nosebleed Y A2 $72.48 1.1251 $46.58 $66.0130905 Control of nosebleed Y A2 $72.48 1.1251 $46.58 $66.0130906 Repeat control of nosebleed Y A2 $72.48 1.1251 $46.58 $66.0130915 Ligation, nasal sinus artery Y A2 $446.00 25.841 $1,069.84 $601.9630920 Ligation, upper jaw artery Y A2 $510.00 25.841 $1,069.84 $649.9630930 Ther fx, nasal inf turbinate Y A2 $630.00 16.3288 $676.03 $641.5131000 Irrigation, maxillary sinus Y P2 2.5002 $103.51 $103.5131002 Irrigation, sphenoid sinus Y R2 7.4474 $308.33 $308.3331020 Exploration, maxillary sinus Y A2 $446.00 23.9765 $992.65 $582.6631030 Exploration, maxillary sinus Y A2 $510.00 39.8776 $1,650.97 $795.2431032 Explore sinus, remove polyps Y A2 $630.00 39.8776 $1,650.97 $885.2431040 Exploration behind upper jaw Y R2 23.9765 $992.65 $992.6531050 Exploration, sphenoid sinus Y A2 $446.00 39.8776 $1,650.97 $747.2431051 Sphenoid sinus surgery Y A2 $630.00 39.8776 $1,650.97 $885.2431070 Exploration of frontal sinus Y A2 $446.00 23.9765 $992.65 $582.6631075 Exploration of frontal sinus Y A2 $630.00 39.8776 $1,650.97 $885.2431080 Removal of frontal sinus Y A2 $630.00 39.8776 $1,650.97 $885.2431081 Removal of frontal sinus Y A2 $630.00 39.8776 $1,650.97 $885.2431084 Removal of frontal sinus Y A2 $630.00 39.8776 $1,650.97 $885.2431085 Removal of frontal sinus Y A2 $630.00 39.8776 $1,650.97 $885.2431086 Removal of frontal sinus Y A2 $630.00 39.8776 $1,650.97 $885.2431087 Removal of frontal sinus Y A2 $630.00 39.8776 $1,650.97 $885.2431090 Exploration of sinuses Y A2 $717.00 39.8776 $1,650.97 $950.4931200 Removal of ethmoid sinus Y A2 $446.00 39.8776 $1,650.97 $747.2431201 Removal of ethmoid sinus Y A2 $717.00 39.8776 $1,650.97 $950.4931205 Removal of ethmoid sinus Y A2 $510.00 39.8776 $1,650.97 $795.2431231 Nasal endoscopy, dx Y P2 1.6115 $66.72 $66.7231233 Nasal/sinus endoscopy, dx Y A2 $86.39 1.6115 $66.72 $81.4731235 Nasal/sinus endoscopy, dx Y A2 $333.00 17.016 $704.48 $425.8731237 Nasal/sinus endoscopy, surg Y A2 $446.00 17.016 $704.48 $510.6231238 Nasal/sinus endoscopy, surg Y A2 $333.00 17.016 $704.48 $425.8731239 Nasal/sinus endoscopy, surg Y A2 $630.00 22.7191 $940.59 $707.6531240 Nasal/sinus endoscopy, surg Y A2 $446.00 17.016 $704.48 $510.6231254 Revision of ethmoid sinus Y A2 $510.00 22.7191 $940.59 $617.6531255 Removal of ethmoid sinus Y A2 $717.00 22.7191 $940.59 $772.9031256 Exploration maxillary sinus Y A2 $510.00 22.7191 $940.59 $617.6531267 Endoscopy, maxillary sinus Y A2 $510.00 22.7191 $940.59 $617.6531276 Sinus endoscopy, surgical Y A2 $510.00 22.7191 $940.59 $617.6531287 Nasal/sinus endoscopy, surg Y A2 $510.00 22.7191 $940.59 $617.6531288 Nasal/sinus endoscopy, surg Y A2 $510.00 22.7191 $940.59 $617.6531300 Removal of larynx lesion Y A2 $717.00 23.9765 $992.65 $785.9131320 Diagnostic incision, larynx Y A2 $446.00 39.8776 $1,650.97 $747.2431400 Revision of larynx Y A2 $446.00 39.8776 $1,650.97 $747.2431420 Removal of epiglottis Y A2 $446.00 39.8776 $1,650.97 $747.2431500 Insert emergency airway N G2 2.459 $101.81 $101.8131502 Change of windpipe airway N G2 1.3362 $55.32 $55.3231505 Diagnostic laryngoscopy Y P2 0.8224 $34.05 $34.0531510 Laryngoscopy with biopsy Y A2 $446.00 17.016 $704.48 $510.6231511 Remove foreign body, larynx Y A2 $86.39 1.6115 $66.72 $81.4731512 Removal of larynx lesion Y A2 $446.00 17.016 $704.48 $510.6231513 Injection into vocal cord Y A2 $86.39 1.6115 $66.72 $81.4731515 Laryngoscopy for aspiration Y A2 $333.00 17.016 $704.48 $425.8731520 Dx laryngoscopy, newborn Y G2 1.6115 $66.72 $66.7231525 Dx laryngoscopy excl nb Y A2 $333.00 17.016 $704.48 $425.8731526 Dx laryngoscopy w/oper scope Y A2 $446.00 22.7191 $940.59 $569.6531527 Laryngoscopy for treatment Y A2 $333.00 22.7191 $940.59 $484.9031528 Laryngoscopy and dilation Y A2 $446.00 17.016 $704.48 $510.6231529 Laryngoscopy and dilation Y A2 $446.00 17.016 $704.48 $510.6231530 Laryngoscopy w/fb removal Y A2 $446.00 22.7191 $940.59 $569.6531531 Laryngoscopy w/fb & op scope Y A2 $510.00 22.7191 $940.59 $617.6531535 Laryngoscopy w/biopsy Y A2 $446.00 22.7191 $940.59 $569.6531536 Laryngoscopy w/bx & op scope Y A2 $510.00 22.7191 $940.59 $617.6531540 Laryngoscopy w/exc of tumor Y A2 $510.00 22.7191 $940.59 $617.6531541 Larynscop w/tumr exc + scope Y A2 $630.00 22.7191 $940.59 $707.6531545 Remove vc lesion w/scope Y A2 $630.00 22.7191 $940.59 $707.65

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 31546 Remove vc lesion scope/graft Y A2 $630.00 22.7191 $940.59 $707.6531560 Laryngoscop w/arytenoidectom Y A2 $717.00 22.7191 $940.59 $772.9031561 Larynscop, remve cart + scop Y A2 $717.00 22.7191 $940.59 $772.9031570 Laryngoscope w/vc inj Y A2 $446.00 17.016 $704.48 $510.6231571 Laryngoscop w/vc inj + scope Y A2 $446.00 22.7191 $940.59 $569.6531575 Diagnostic laryngoscopy Y P2 1.6115 $66.72 $66.7231576 Laryngoscopy with biopsy Y A2 $446.00 22.7191 $940.59 $569.6531577 Remove foreign body, larynx Y A2 $236.42 3.994 $165.36 $218.6631578 Removal of larynx lesion Y A2 $446.00 22.7191 $940.59 $569.6531579 Diagnostic laryngoscopy Y P3 3.0543 $126.45 $126.4531580 Revision of larynx Y A2 $717.00 39.8776 $1,650.97 $950.4931582 Revision of larynx Y A2 $717.00 39.8776 $1,650.97 $950.4931588 Revision of larynx Y A2 $717.00 39.8776 $1,650.97 $950.4931590 Reinnervate larynx Y A2 $717.00 39.8776 $1,650.97 $950.4931595 Larynx nerve surgery Y A2 $446.00 39.8776 $1,650.97 $747.2431603 Incision of windpipe Y A2 $333.00 7.4474 $308.33 $326.8331605 Incision of windpipe Y G2 7.4474 $308.33 $308.3331611 Surgery/speech prosthesis Y A2 $510.00 23.9765 $992.65 $630.6631612 Puncture/clear windpipe Y A2 $333.00 23.9765 $992.65 $497.9131613 Repair windpipe opening Y A2 $446.00 23.9765 $992.65 $582.6631614 Repair windpipe opening Y A2 $446.00 39.8776 $1,650.97 $747.2431615 Visualization of windpipe Y A2 $333.00 9.9575 $412.25 $352.8131620 Endobronchial us add-on N N131622 Dx bronchoscope/wash Y A2 $333.00 9.9575 $412.25 $352.8131623 Dx bronchoscope/brush Y A2 $446.00 9.9575 $412.25 $437.5631624 Dx bronchoscope/lavage Y A2 $446.00 9.9575 $412.25 $437.5631625 Bronchoscopy w/biopsy(s) Y A2 $446.00 9.9575 $412.25 $437.5631628 Bronchoscopy/lung bx, each Y A2 $446.00 9.9575 $412.25 $437.5631629 Bronchoscopy/needle bx, each Y A2 $446.00 9.9575 $412.25 $437.5631630 Bronchoscopy dilate/fx repr Y A2 $446.00 24.0654 $996.33 $583.5831631 Bronchoscopy, dilate w/stent Y A2 $446.00 24.0654 $996.33 $583.5831632 Bronchoscopy/lung bx, add’l Y G2 9.9575 $412.25 $412.2531633 Bronchoscopy/needle bx add’l Y G2 9.9575 $412.25 $412.2531635 Bronchoscopy w/fb removal Y A2 $446.00 9.9575 $412.25 $437.5631636 Bronchoscopy, bronch stents Y A2 $446.00 24.0654 $996.33 $583.5831637 Bronchoscopy, stent add-on Y A2 $333.00 9.9575 $412.25 $352.8131638 Bronchoscopy, revise stent Y A2 $446.00 24.0654 $996.33 $583.5831640 Bronchoscopy w/tumor excise Y A2 $446.00 24.0654 $996.33 $583.5831641 Bronchoscopy, treat blockage Y A2 $446.00 24.0654 $996.33 $583.5831643 Diag bronchoscope/catheter Y A2 $446.00 9.9575 $412.25 $437.5631645 Bronchoscopy, clear airways Y A2 $333.00 9.9575 $412.25 $352.8131646 Bronchoscopy, reclear airway Y A2 $333.00 9.9575 $412.25 $352.8131656 Bronchoscopy, inj for x-ray Y A2 $333.00 9.9575 $412.25 $352.8131715 Injection for bronchus x-ray N N131717 Bronchial brush biopsy Y A2 $236.42 3.994 $165.36 $218.6631720 Clearance of airways N A2 $47.32 0.3877 $16.05 $39.5031730 Intro, windpipe wire/tube Y A2 $236.42 3.994 $165.36 $218.6631750 Repair of windpipe Y A2 $717.00 39.8776 $1,650.97 $950.4931755 Repair of windpipe Y A2 $446.00 39.8776 $1,650.97 $747.2431820 Closure of windpipe lesion Y A2 $333.00 16.3288 $676.03 $418.7631825 Repair of windpipe defect Y A2 $446.00 23.9765 $992.65 $582.6631830 Revise windpipe scar Y A2 $446.00 23.9765 $992.65 $582.6632000 Drainage of chest N D532002 Treatment of collapsed lung N D532019 Insert pleural catheter N D532400 Needle biopsy chest lining Y A2 $333.00 9.3354 $386.49 $346.3732405 Biopsy, lung or mediastinum Y A2 $333.00 9.3354 $386.49 $346.3732420 Puncture/clear lung Y A2 $222.78 5.2024 $215.38 $220.9332421 Thoracentesis for aspiration Y A2 $222.78 5.2024 $215.38 $220.9332422 Thoracentesis w/tube insert Y G2 5.2024 $215.38 $215.3832550 Insert pleural cath Y G2 30.7096 $1,271.41 $1,271.4132960 Therapeutic pneumothorax Y G2 5.2024 $215.38 $215.3832998 Perq rf ablate tx, pul tumor Y G2 42.998 $1,780.16 $1,780.1633010 Drainage of heart sac Y A2 $222.78 5.2024 $215.38 $220.9333011 Repeat drainage of heart sac Y A2 $222.78 5.2024 $215.38 $220.9333206 Insertion of heart pacemaker Y J8 169.4628 $7,015.93 $7,015.9333207 Insertion of heart pacemaker Y J8 169.4628 $7,015.93 $7,015.9333208 Insertion of heart pacemaker Y J8 196.2967 $8,126.88 $8,126.8833210 Insertion of heart electrode Y J8 90.579 $3,750.06 $3,750.0633211 Insertion of heart electrode Y J8 90.579 $3,750.06 $3,750.0633212 Insertion of pulse generator Y H8 $510.00 142.1043 $5,883.26 $5,514.6433213 Insertion of pulse generator Y H8 $510.00 154.6733 $6,403.63 $6,010.0633214 Upgrade of pacemaker system Y J8 196.2967 $8,126.88 $8,126.8833215 Reposition pacing-defib lead Y G2 23.9802 $992.80 $992.8033216 Insert lead pace-defib, one Y J8 90.579 $3,750.06 $3,750.0633217 Insert lead pace-defib, dual Y J8 90.579 $3,750.06 $3,750.0633218 Repair lead pace-defib, one Y G2 23.9802 $992.80 $992.8033220 Repair lead pace-defib, dual Y G2 23.9802 $992.80 $992.8033222 Revise pocket, pacemaker Y A2 $446.00 15.0458 $622.91 $490.2333223 Revise pocket, pacing-defib Y A2 $446.00 15.0458 $622.91 $490.2333224 Insert pacing lead & connect Y J8 375.1658 $15,532.24 $15,532.2433225 L ventric pacing lead add-on Y J8 375.1658 $15,532.24 $15,532.2433226 Reposition l ventric lead Y G2 23.9802 $992.80 $992.8033233 Removal of pacemaker system Y A2 $446.00 23.9802 $992.80 $582.7033234 Removal of pacemaker system Y G2 23.9802 $992.80 $992.8033235 Removal pacemaker electrode Y G2 23.9802 $992.80 $992.8033240 Insert pulse generator Y J8 493.9803 $20,451.28 $20,451.2833241 Remove pulse generator Y G2 23.9802 $992.80 $992.80

Date Printed: 04/08/2023 @ 09:12:29 Page 22 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 33249 Eltrd/insert pace-defib Y J8 599.3974 $24,815.65 $24,815.6533282 Implant pat-active ht record N J8 98.4186 $4,074.63 $4,074.6333284 Remove pat-active ht record Y G2 8.685 $359.57 $359.5733508 Endoscopic vein harvest N N135188 Repair blood vessel lesion Y A2 $630.00 38.7673 $1,605.00 $873.7535207 Repair blood vessel lesion Y A2 $630.00 38.7673 $1,605.00 $873.7535473 Repair arterial blockage Y G2 45.3845 $1,878.96 $1,878.9635476 Repair venous blockage Y G2 45.3845 $1,878.96 $1,878.9635492 Atherectomy, percutaneous Y G2 87.5137 $3,623.15 $3,623.1535572 Harvest femoropopliteal vein N N135761 Exploration of artery/vein Y G2 29.6965 $1,229.46 $1,229.4635875 Removal of clot in graft Y A2 $1,339.00 38.7673 $1,605.00 $1,405.5035876 Removal of clot in graft Y A2 $1,339.00 38.7673 $1,605.00 $1,405.5036000 Place needle in vein N N136002 Pseudoaneurysm injection trt N G2 2.3792 $98.50 $98.5036005 Injection ext venography N N136010 Place catheter in vein N N136011 Place catheter in vein N N136012 Place catheter in vein N N136013 Place catheter in artery N N136014 Place catheter in artery N N136015 Place catheter in artery N N136100 Establish access to artery N N136120 Establish access to artery N N136140 Establish access to artery N N136145 Artery to vein shunt N N136160 Establish access to aorta N N136200 Place catheter in aorta N N136215 Place catheter in artery N N136216 Place catheter in artery N N136217 Place catheter in artery N N136218 Place catheter in artery N N136245 Place catheter in artery N N136246 Place catheter in artery N N136247 Place catheter in artery N N136248 Place catheter in artery N N136260 Insertion of infusion pump Y A2 $510.00 28.8743 $1,195.42 $681.3636261 Revision of infusion pump Y A2 $446.00 23.9802 $992.80 $582.7036262 Removal of infusion pump Y A2 $333.00 23.9802 $992.80 $497.9536400 Bl draw < 3 yrs fem/jugular N N136405 Bl draw < 3 yrs scalp vein N N136406 Bl draw < 3 yrs other vein N N136410 Non-routine bl draw > 3 yrs N N136416 Capillary blood draw N N136420 Vein access cutdown < 1 yr Y G2 0.2143 $8.87 $8.8736425 Vein access cutdown > 1 yr Y R2 0.2143 $8.87 $8.8736430 Blood transfusion service N P3 0.8922 $36.94 $36.9436440 Bl push transfuse, 2 yr or < N R2 3.3967 $140.63 $140.6336450 Bl exchange/transfuse, nb N R2 3.3967 $140.63 $140.6336468 Injection(s), spider veins Y R2 0.793 $32.83 $32.8336469 Injection(s), spider veins Y R2 0.793 $32.83 $32.8336470 Injection therapy of vein Y P2 0.793 $32.83 $32.8336471 Injection therapy of veins Y P2 0.793 $32.83 $32.8336475 Endovenous rf, 1st vein Y A2 $1,339.00 42.6114 $1,764.15 $1,445.2936476 Endovenous rf, vein add-on Y A2 $1,339.00 25.841 $1,069.84 $1,271.7136478 Endovenous laser, 1st vein Y A2 $1,339.00 25.841 $1,069.84 $1,271.7136479 Endovenous laser vein addon Y A2 $1,339.00 25.841 $1,069.84 $1,271.7136481 Insertion of catheter, vein N N136500 Insertion of catheter, vein N N136510 Insertion of catheter, vein N N136511 Apheresis wbc N G2 11.5058 $476.35 $476.3536512 Apheresis rbc N G2 11.5058 $476.35 $476.3536513 Apheresis platelets N G2 11.5058 $476.35 $476.3536514 Apheresis plasma N G2 11.5058 $476.35 $476.3536515 Apheresis, adsorp/reinfuse N G2 30.6035 $1,267.02 $1,267.0236516 Apheresis, selective N G2 30.6035 $1,267.02 $1,267.0236522 Photopheresis N G2 30.6035 $1,267.02 $1,267.0236540 Collect blood venous device N D536550 Declot vascular device N D536555 Insert non-tunnel cv cath Y A2 $333.00 10.9092 $451.65 $362.6636556 Insert non-tunnel cv cath Y A2 $333.00 10.9092 $451.65 $362.6636557 Insert tunneled cv cath Y A2 $446.00 24.1069 $998.05 $584.0136558 Insert tunneled cv cath Y A2 $446.00 24.1069 $998.05 $584.0136560 Insert tunneled cv cath Y A2 $510.00 28.8743 $1,195.42 $681.3636561 Insert tunneled cv cath Y A2 $510.00 28.8743 $1,195.42 $681.3636563 Insert tunneled cv cath Y A2 $510.00 28.8743 $1,195.42 $681.3636565 Insert tunneled cv cath Y A2 $510.00 28.8743 $1,195.42 $681.3636566 Insert tunneled cv cath Y H8 $510.00 107.6665 $4,457.50 $3,796.2336568 Insert picc cath Y A2 $333.00 10.9092 $451.65 $362.6636569 Insert picc cath Y A2 $333.00 10.9092 $451.65 $362.6636570 Insert picvad cath Y A2 $510.00 24.1069 $998.05 $632.0136571 Insert picvad cath Y A2 $510.00 24.1069 $998.05 $632.0136575 Repair tunneled cv cath Y A2 $446.00 5.6614 $234.39 $393.1036576 Repair tunneled cv cath Y A2 $446.00 10.9092 $451.65 $447.4136578 Replace tunneled cv cath Y A2 $446.00 24.1069 $998.05 $584.0136580 Replace cvad cath Y A2 $333.00 10.9092 $451.65 $362.6636581 Replace tunneled cv cath Y A2 $446.00 24.1069 $998.05 $584.0136582 Replace tunneled cv cath Y A2 $510.00 28.8743 $1,195.42 $681.36

Date Printed: 04/08/2023 @ 09:12:29 Page 23 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 36583 Replace tunneled cv cath Y A2 $510.00 28.8743 $1,195.42 $681.3636584 Replace picc cath Y A2 $333.00 10.9092 $451.65 $362.6636585 Replace picvad cath Y A2 $510.00 24.1069 $998.05 $632.0136589 Removal tunneled cv cath Y A2 $333.00 5.6614 $234.39 $308.3536590 Removal tunneled cv cath Y A2 $333.00 10.9092 $451.65 $362.6636591 Draw blood off venous device N N136592 Collect blood from picc N N136593 Declot vascular device Y P3 0.5519 $22.85 $22.8536595 Mech remov tunneled cv cath Y G2 24.1069 $998.05 $998.0536596 Mech remov tunneled cv cath Y G2 10.9092 $451.65 $451.6536597 Reposition venous catheter Y G2 10.9092 $451.65 $451.6536598 Inj w/fluor, eval cv device Y P3 2.2355 $92.55 $92.5536600 Withdrawal of arterial blood N N136620 Insertion catheter, artery N N136625 Insertion catheter, artery N N136640 Insertion catheter, artery Y A2 $333.00 28.8743 $1,195.42 $548.6136680 Insert needle, bone cavity Y G2 1.1097 $45.94 $45.9436800 Insertion of cannula Y A2 $510.00 29.6965 $1,229.46 $689.8736810 Insertion of cannula Y A2 $510.00 29.6965 $1,229.46 $689.8736815 Insertion of cannula Y A2 $510.00 29.6965 $1,229.46 $689.8736818 Av fuse, uppr arm, cephalic Y A2 $510.00 38.7673 $1,605.00 $783.7536819 Av fuse, uppr arm, basilic Y A2 $510.00 38.7673 $1,605.00 $783.7536820 Av fusion/forearm vein Y A2 $510.00 38.7673 $1,605.00 $783.7536821 Av fusion direct any site Y A2 $510.00 38.7673 $1,605.00 $783.7536825 Artery-vein autograft Y A2 $630.00 38.7673 $1,605.00 $873.7536830 Artery-vein nonautograft Y A2 $630.00 38.7673 $1,605.00 $873.7536831 Open thrombect av fistula Y A2 $1,339.00 38.7673 $1,605.00 $1,405.5036832 Av fistula revision, open Y A2 $630.00 38.7673 $1,605.00 $873.7536833 Av fistula revision Y A2 $630.00 38.7673 $1,605.00 $873.7536834 Repair a-v aneurysm Y A2 $510.00 38.7673 $1,605.00 $783.7536835 Artery to vein shunt Y A2 $630.00 29.6965 $1,229.46 $779.8736860 External cannula declotting Y A2 $127.40 2.4824 $102.77 $121.2436861 Cannula declotting Y A2 $510.00 29.6965 $1,229.46 $689.8736870 Percut thrombect av fistula Y A2 $1,339.00 40.4667 $1,675.36 $1,423.0937184 Prim art mech thrombectomy Y G2 38.7673 $1,605.00 $1,605.0037185 Prim art m-thrombect add-on Y G2 38.7673 $1,605.00 $1,605.0037186 Sec art m-thrombect add-on Y G2 38.7673 $1,605.00 $1,605.0037187 Venous mech thrombectomy Y G2 38.7673 $1,605.00 $1,605.0037188 Venous m-thrombectomy add-on Y G2 38.7673 $1,605.00 $1,605.0037200 Transcatheter biopsy Y G2 28.8743 $1,195.42 $1,195.4237203 Transcatheter retrieval Y G2 28.8743 $1,195.42 $1,195.4237250 Iv us first vessel add-on N N137251 Iv us each add vessel add-on N N137500 Endoscopy ligate perf veins Y A2 $510.00 42.6114 $1,764.15 $823.5437607 Ligation of a-v fistula Y A2 $510.00 25.841 $1,069.84 $649.9637609 Temporal artery procedure Y A2 $446.00 16.1001 $666.56 $501.1437650 Revision of major vein Y A2 $446.00 25.841 $1,069.84 $601.9637700 Revise leg vein Y A2 $446.00 25.841 $1,069.84 $601.9637718 Ligate/strip short leg vein Y A2 $510.00 25.841 $1,069.84 $649.9637722 Ligate/strip long leg vein Y A2 $510.00 42.6114 $1,764.15 $823.5437735 Removal of leg veins/lesion Y A2 $510.00 42.6114 $1,764.15 $823.5437760 Ligation, leg veins, open Y A2 $510.00 25.841 $1,069.84 $649.9637765 Phleb veins extrem 10-20 Y R2 25.841 $1,069.84 $1,069.8437766 Phleb veins extrem 20+ Y R2 25.841 $1,069.84 $1,069.8437780 Revision of leg vein Y A2 $510.00 25.841 $1,069.84 $649.9637785 Ligate/divide/excise vein Y A2 $510.00 25.841 $1,069.84 $649.9637790 Penile venous occlusion Y A2 $510.00 33.9306 $1,404.76 $733.6938200 Injection for spleen x-ray N N138204 Bl donor search management N N138205 Harvest allogenic stem cells N G2 11.5058 $476.35 $476.3538206 Harvest auto stem cells N G2 11.5058 $476.35 $476.3538220 Bone marrow aspiration Y P3 2.9439 $121.88 $121.8838221 Bone marrow biopsy Y P3 3.091 $127.97 $127.9738230 Bone marrow collection N G2 30.6035 $1,267.02 $1,267.0238241 Bone marrow/stem transplant N G2 30.6035 $1,267.02 $1,267.0238242 Lymphocyte infuse transplant N R2 11.5058 $476.35 $476.3538300 Drainage, lymph node lesion Y A2 $333.00 11.5594 $478.57 $369.3938305 Drainage, lymph node lesion Y A2 $446.00 18.3197 $758.45 $524.1138308 Incision of lymph channels Y A2 $446.00 22.9584 $950.50 $572.1338500 Biopsy/removal, lymph nodes Y A2 $446.00 22.9584 $950.50 $572.1338505 Needle biopsy, lymph nodes Y A2 $240.00 7.1147 $294.56 $253.6438510 Biopsy/removal, lymph nodes Y A2 $446.00 22.9584 $950.50 $572.1338520 Biopsy/removal, lymph nodes Y A2 $446.00 22.9584 $950.50 $572.1338525 Biopsy/removal, lymph nodes Y A2 $446.00 22.9584 $950.50 $572.1338530 Biopsy/removal, lymph nodes Y A2 $446.00 22.9584 $950.50 $572.1338542 Explore deep node(s), neck Y A2 $446.00 44.324 $1,835.06 $793.2738550 Removal, neck/armpit lesion Y A2 $510.00 22.9584 $950.50 $620.1338555 Removal, neck/armpit lesion Y A2 $630.00 22.9584 $950.50 $710.1338570 Laparoscopy, lymph node biop Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5238571 Laparoscopy, lymphadenectomy Y A2 $1,339.00 69.6652 $2,884.21 $1,725.3038572 Laparoscopy, lymphadenectomy Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5238700 Removal of lymph nodes, neck Y G2 22.9584 $950.50 $950.5038740 Remove armpit lymph nodes Y A2 $446.00 44.324 $1,835.06 $793.2738745 Remove armpit lymph nodes Y A2 $630.00 44.324 $1,835.06 $931.2738760 Remove groin lymph nodes Y A2 $446.00 22.9584 $950.50 $572.1338790 Inject for lymphatic x-ray N N138792 Identify sentinel node N N138794 Access thoracic lymph duct N N1

Date Printed: 04/08/2023 @ 09:12:29 Page 24 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 40490 Biopsy of lip Y P3 1.7019 $70.46 $70.4640500 Partial excision of lip Y A2 $446.00 16.3288 $676.03 $503.5140510 Partial excision of lip Y A2 $446.00 23.9765 $992.65 $582.6640520 Partial excision of lip Y A2 $446.00 16.3288 $676.03 $503.5140525 Reconstruct lip with flap Y A2 $446.00 23.9765 $992.65 $582.6640527 Reconstruct lip with flap Y A2 $446.00 23.9765 $992.65 $582.6640530 Partial removal of lip Y A2 $446.00 23.9765 $992.65 $582.6640650 Repair lip Y A2 $464.15 7.4474 $308.33 $425.2040652 Repair lip Y A2 $464.15 7.4474 $308.33 $425.2040654 Repair lip Y A2 $464.15 7.4474 $308.33 $425.2040700 Repair cleft lip/nasal Y A2 $995.00 39.8776 $1,650.97 $1,158.9940701 Repair cleft lip/nasal Y A2 $995.00 39.8776 $1,650.97 $1,158.9940702 Repair cleft lip/nasal Y R2 39.8776 $1,650.97 $1,650.9740720 Repair cleft lip/nasal Y A2 $995.00 39.8776 $1,650.97 $1,158.9940761 Repair cleft lip/nasal Y A2 $510.00 39.8776 $1,650.97 $795.2440800 Drainage of mouth lesion Y P2 1.4066 $58.23 $58.2340801 Drainage of mouth lesion Y A2 $446.00 7.4474 $308.33 $411.5840804 Removal, foreign body, mouth N P2 0.631 $26.12 $26.1240805 Removal, foreign body, mouth Y P3 4.425 $183.20 $183.2040806 Incision of lip fold Y P3 1.9596 $81.13 $81.1340808 Biopsy of mouth lesion Y P2 2.5002 $103.51 $103.5140810 Excision of mouth lesion Y P3 3.0267 $125.31 $125.3140812 Excise/repair mouth lesion Y P3 3.7994 $157.30 $157.3040814 Excise/repair mouth lesion Y A2 $446.00 16.3288 $676.03 $503.5140816 Excision of mouth lesion Y A2 $446.00 23.9765 $992.65 $582.6640818 Excise oral mucosa for graft Y A2 $150.72 2.5002 $103.51 $138.9240819 Excise lip or cheek fold Y A2 $333.00 7.4474 $308.33 $326.8340820 Treatment of mouth lesion Y P3 4.2501 $175.96 $175.9640830 Repair mouth laceration Y G2 2.5002 $103.51 $103.5140831 Repair mouth laceration Y A2 $333.00 7.4474 $308.33 $326.8340840 Reconstruction of mouth Y A2 $446.00 23.9765 $992.65 $582.6640842 Reconstruction of mouth Y A2 $510.00 23.9765 $992.65 $630.6640843 Reconstruction of mouth Y A2 $510.00 23.9765 $992.65 $630.6640844 Reconstruction of mouth Y A2 $717.00 39.8776 $1,650.97 $950.4940845 Reconstruction of mouth Y A2 $717.00 39.8776 $1,650.97 $950.4941000 Drainage of mouth lesion Y P3 2.2446 $92.93 $92.9341005 Drainage of mouth lesion Y A2 $150.72 2.5002 $103.51 $138.9241006 Drainage of mouth lesion Y A2 $333.00 23.9765 $992.65 $497.9141007 Drainage of mouth lesion Y A2 $333.00 16.3288 $676.03 $418.7641008 Drainage of mouth lesion Y A2 $333.00 16.3288 $676.03 $418.7641009 Drainage of mouth lesion Y A2 $150.72 2.5002 $103.51 $138.9241010 Incision of tongue fold Y A2 $333.00 7.4474 $308.33 $326.8341015 Drainage of mouth lesion Y A2 $150.72 2.5002 $103.51 $138.9241016 Drainage of mouth lesion Y A2 $333.00 7.4474 $308.33 $326.8341017 Drainage of mouth lesion Y A2 $333.00 7.4474 $308.33 $326.8341018 Drainage of mouth lesion Y A2 $333.00 7.4474 $308.33 $326.8341019 Place needles h&n for rt Y G2 23.9765 $992.65 $992.6541100 Biopsy of tongue Y P3 2.3458 $97.12 $97.1241105 Biopsy of tongue Y P3 2.2908 $94.84 $94.8441108 Biopsy of floor of mouth Y P3 2.1159 $87.60 $87.6041110 Excision of tongue lesion Y P3 3.0543 $126.45 $126.4541112 Excision of tongue lesion Y A2 $446.00 16.3288 $676.03 $503.5141113 Excision of tongue lesion Y A2 $446.00 16.3288 $676.03 $503.5141114 Excision of tongue lesion Y A2 $446.00 23.9765 $992.65 $582.6641115 Excision of tongue fold Y P3 3.4407 $142.45 $142.4541116 Excision of mouth lesion Y A2 $333.00 16.3288 $676.03 $418.7641120 Partial removal of tongue Y A2 $717.00 23.9765 $992.65 $785.9141250 Repair tongue laceration Y A2 $150.72 2.5002 $103.51 $138.9241251 Repair tongue laceration Y A2 $150.72 2.5002 $103.51 $138.9241252 Repair tongue laceration Y A2 $446.00 7.4474 $308.33 $411.5841500 Fixation of tongue Y A2 $333.00 23.9765 $992.65 $497.9141510 Tongue to lip surgery Y A2 $333.00 16.3288 $676.03 $418.7641520 Reconstruction, tongue fold Y A2 $446.00 7.4474 $308.33 $411.5841800 Drainage of gum lesion Y A2 $88.46 1.4066 $58.23 $80.9041805 Removal foreign body, gum Y P3 3.3671 $139.40 $139.4041806 Removal foreign body,jawbone Y P3 4.333 $179.39 $179.3941820 Excision, gum, each quadrant Y R2 7.4474 $308.33 $308.3341821 Excision of gum flap Y G2 7.4474 $308.33 $308.3341822 Excision of gum lesion Y P3 4.0018 $165.68 $165.6841823 Excision of gum lesion Y P3 5.5289 $228.90 $228.9041825 Excision of gum lesion Y P3 3.1093 $128.73 $128.7341826 Excision of gum lesion Y P3 3.4591 $143.21 $143.2141827 Excision of gum lesion Y A2 $446.00 23.9765 $992.65 $582.6641828 Excision of gum lesion Y P3 3.6337 $150.44 $150.4441830 Removal of gum tissue Y P3 5.0322 $208.34 $208.3441850 Treatment of gum lesion Y R2 16.3288 $676.03 $676.0341870 Gum graft Y G2 23.9765 $992.65 $992.6541872 Repair gum Y P3 5.0873 $210.62 $210.6241874 Repair tooth socket Y P3 4.8298 $199.96 $199.9642000 Drainage mouth roof lesion Y A2 $150.72 2.5002 $103.51 $138.9242100 Biopsy roof of mouth Y P3 2.0055 $83.03 $83.0342104 Excision lesion, mouth roof Y P3 2.8151 $116.55 $116.5542106 Excision lesion, mouth roof Y P3 3.5325 $146.25 $146.2542107 Excision lesion, mouth roof Y A2 $446.00 23.9765 $992.65 $582.6642120 Remove palate/lesion Y A2 $630.00 39.8776 $1,650.97 $885.2442140 Excision of uvula Y A2 $446.00 7.4474 $308.33 $411.5842145 Repair palate, pharynx/uvula Y A2 $717.00 23.9765 $992.65 $785.9142160 Treatment mouth roof lesion Y P3 3.689 $152.73 $152.73

Date Printed: 04/08/2023 @ 09:12:29 Page 25 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 42180 Repair palate Y A2 $150.72 2.5002 $103.51 $138.9242182 Repair palate Y A2 $446.00 39.8776 $1,650.97 $747.2442200 Reconstruct cleft palate Y A2 $717.00 39.8776 $1,650.97 $950.4942205 Reconstruct cleft palate Y A2 $717.00 39.8776 $1,650.97 $950.4942210 Reconstruct cleft palate Y A2 $717.00 39.8776 $1,650.97 $950.4942215 Reconstruct cleft palate Y A2 $995.00 39.8776 $1,650.97 $1,158.9942220 Reconstruct cleft palate Y A2 $717.00 39.8776 $1,650.97 $950.4942226 Lengthening of palate Y A2 $717.00 39.8776 $1,650.97 $950.4942235 Repair palate Y A2 $717.00 16.3288 $676.03 $706.7642260 Repair nose to lip fistula Y A2 $630.00 23.9765 $992.65 $720.6642280 Preparation, palate mold Y P3 1.9318 $79.98 $79.9842281 Insertion, palate prosthesis Y G2 16.3288 $676.03 $676.0342300 Drainage of salivary gland Y A2 $333.00 16.3288 $676.03 $418.7642305 Drainage of salivary gland Y A2 $446.00 16.3288 $676.03 $503.5142310 Drainage of salivary gland Y A2 $150.72 2.5002 $103.51 $138.9242320 Drainage of salivary gland Y A2 $150.72 2.5002 $103.51 $138.9242330 Removal of salivary stone Y P3 3.0176 $124.93 $124.9342335 Removal of salivary stone Y P3 4.9124 $203.38 $203.3842340 Removal of salivary stone Y A2 $446.00 16.3288 $676.03 $503.5142400 Biopsy of salivary gland Y P3 1.6744 $69.32 $69.3242405 Biopsy of salivary gland Y A2 $446.00 16.3288 $676.03 $503.5142408 Excision of salivary cyst Y A2 $510.00 16.3288 $676.03 $551.5142409 Drainage of salivary cyst Y A2 $510.00 16.3288 $676.03 $551.5142410 Excise parotid gland/lesion Y A2 $510.00 39.8776 $1,650.97 $795.2442415 Excise parotid gland/lesion Y A2 $995.00 39.8776 $1,650.97 $1,158.9942420 Excise parotid gland/lesion Y A2 $995.00 39.8776 $1,650.97 $1,158.9942425 Excise parotid gland/lesion Y A2 $995.00 39.8776 $1,650.97 $1,158.9942440 Excise submaxillary gland Y A2 $510.00 39.8776 $1,650.97 $795.2442450 Excise sublingual gland Y A2 $446.00 23.9765 $992.65 $582.6642500 Repair salivary duct Y A2 $510.00 23.9765 $992.65 $630.6642505 Repair salivary duct Y A2 $630.00 39.8776 $1,650.97 $885.2442507 Parotid duct diversion Y A2 $510.00 39.8776 $1,650.97 $795.2442508 Parotid duct diversion Y A2 $630.00 39.8776 $1,650.97 $885.2442509 Parotid duct diversion Y A2 $630.00 39.8776 $1,650.97 $885.2442510 Parotid duct diversion Y A2 $630.00 39.8776 $1,650.97 $885.2442550 Injection for salivary x-ray N N142600 Closure of salivary fistula Y A2 $333.00 16.3288 $676.03 $418.7642650 Dilation of salivary duct Y P3 1.0947 $45.32 $45.3242660 Dilation of salivary duct Y P3 1.2879 $53.32 $53.3242665 Ligation of salivary duct Y A2 $995.00 23.9765 $992.65 $994.4142700 Drainage of tonsil abscess Y A2 $150.72 2.5002 $103.51 $138.9242720 Drainage of throat abscess Y A2 $333.00 16.3288 $676.03 $418.7642725 Drainage of throat abscess Y A2 $446.00 39.8776 $1,650.97 $747.2442800 Biopsy of throat Y P3 2.1434 $88.74 $88.7442802 Biopsy of throat Y A2 $333.00 16.3288 $676.03 $418.7642804 Biopsy of upper nose/throat Y A2 $333.00 16.3288 $676.03 $418.7642806 Biopsy of upper nose/throat Y A2 $446.00 23.9765 $992.65 $582.6642808 Excise pharynx lesion Y A2 $446.00 16.3288 $676.03 $503.5142809 Remove pharynx foreign body N G2 0.631 $26.12 $26.1242810 Excision of neck cyst Y A2 $510.00 23.9765 $992.65 $630.6642815 Excision of neck cyst Y A2 $717.00 39.8776 $1,650.97 $950.4942820 Remove tonsils and adenoids Y A2 $510.00 22.2557 $921.41 $612.8542821 Remove tonsils and adenoids Y A2 $717.00 22.2557 $921.41 $768.1042825 Removal of tonsils Y A2 $630.00 22.2557 $921.41 $702.8542826 Removal of tonsils Y A2 $630.00 22.2557 $921.41 $702.8542830 Removal of adenoids Y A2 $630.00 22.2557 $921.41 $702.8542831 Removal of adenoids Y A2 $630.00 22.2557 $921.41 $702.8542835 Removal of adenoids Y A2 $630.00 22.2557 $921.41 $702.8542836 Removal of adenoids Y A2 $630.00 22.2557 $921.41 $702.8542860 Excision of tonsil tags Y A2 $510.00 22.2557 $921.41 $612.8542870 Excision of lingual tonsil Y A2 $510.00 22.2557 $921.41 $612.8542890 Partial removal of pharynx Y A2 $995.00 39.8776 $1,650.97 $1,158.9942892 Revision of pharyngeal walls Y A2 $995.00 39.8776 $1,650.97 $1,158.9942900 Repair throat wound Y A2 $333.00 7.4474 $308.33 $326.8342950 Reconstruction of throat Y A2 $446.00 23.9765 $992.65 $582.6642955 Surgical opening of throat Y A2 $446.00 23.9765 $992.65 $582.6642960 Control throat bleeding Y A2 $72.48 1.1251 $46.58 $66.0142962 Control throat bleeding Y A2 $446.00 39.8776 $1,650.97 $747.2442970 Control nose/throat bleeding Y R2 1.1251 $46.58 $46.5842972 Control nose/throat bleeding Y A2 $510.00 16.3288 $676.03 $551.5143030 Throat muscle surgery Y G2 16.3288 $676.03 $676.0343200 Esophagus endoscopy Y A2 $333.00 8.503 $352.03 $337.7643201 Esoph scope w/submucous inj Y A2 $333.00 8.503 $352.03 $337.7643202 Esophagus endoscopy, biopsy Y A2 $333.00 8.503 $352.03 $337.7643204 Esoph scope w/sclerosis inj Y A2 $333.00 8.503 $352.03 $337.7643205 Esophagus endoscopy/ligation Y A2 $333.00 8.503 $352.03 $337.7643215 Esophagus endoscopy Y A2 $333.00 8.503 $352.03 $337.7643216 Esophagus endoscopy/lesion Y A2 $333.00 8.503 $352.03 $337.7643217 Esophagus endoscopy Y A2 $333.00 8.503 $352.03 $337.7643219 Esophagus endoscopy Y A2 $333.00 24.9814 $1,034.25 $508.3143220 Esoph endoscopy, dilation Y A2 $333.00 8.503 $352.03 $337.7643226 Esoph endoscopy, dilation Y A2 $333.00 8.503 $352.03 $337.7643227 Esoph endoscopy, repair Y A2 $446.00 8.503 $352.03 $422.5143228 Esoph endoscopy, ablation Y A2 $446.00 25.3233 $1,048.41 $596.6043231 Esoph endoscopy w/us exam Y A2 $446.00 8.503 $352.03 $422.5143232 Esoph endoscopy w/us fn bx Y A2 $446.00 8.503 $352.03 $422.5143234 Upper gi endoscopy, exam Y A2 $333.00 8.503 $352.03 $337.7643235 Uppr gi endoscopy, diagnosis Y A2 $333.00 8.503 $352.03 $337.76

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 43236 Uppr gi scope w/submuc inj Y A2 $446.00 8.503 $352.03 $422.5143237 Endoscopic us exam, esoph Y A2 $446.00 8.503 $352.03 $422.5143238 Uppr gi endoscopy w/us fn bx Y A2 $446.00 8.503 $352.03 $422.5143239 Upper gi endoscopy, biopsy Y A2 $446.00 8.503 $352.03 $422.5143240 Esoph endoscope w/drain cyst Y A2 $446.00 8.503 $352.03 $422.5143241 Upper gi endoscopy with tube Y A2 $446.00 8.503 $352.03 $422.5143242 Uppr gi endoscopy w/us fn bx Y A2 $446.00 8.503 $352.03 $422.5143243 Upper gi endoscopy & inject Y A2 $446.00 8.503 $352.03 $422.5143244 Upper gi endoscopy/ligation Y A2 $446.00 8.503 $352.03 $422.5143245 Uppr gi scope dilate strictr Y A2 $446.00 8.503 $352.03 $422.5143246 Place gastrostomy tube Y A2 $446.00 8.503 $352.03 $422.5143247 Operative upper gi endoscopy Y A2 $446.00 8.503 $352.03 $422.5143248 Uppr gi endoscopy/guide wire Y A2 $446.00 8.503 $352.03 $422.5143249 Esoph endoscopy, dilation Y A2 $446.00 8.503 $352.03 $422.5143250 Upper gi endoscopy/tumor Y A2 $446.00 8.503 $352.03 $422.5143251 Operative upper gi endoscopy Y A2 $446.00 8.503 $352.03 $422.5143255 Operative upper gi endoscopy Y A2 $446.00 8.503 $352.03 $422.5143256 Uppr gi endoscopy w/stent Y A2 $510.00 24.9814 $1,034.25 $641.0643257 Uppr gi scope w/thrml txmnt Y A2 $510.00 25.3233 $1,048.41 $644.6043258 Operative upper gi endoscopy Y A2 $510.00 8.503 $352.03 $470.5143259 Endoscopic ultrasound exam Y A2 $510.00 8.503 $352.03 $470.5143260 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543261 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543262 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543263 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543264 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543265 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543267 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543268 Endo cholangiopancreatograph Y A2 $446.00 24.9814 $1,034.25 $593.0643269 Endo cholangiopancreatograph Y A2 $446.00 24.9814 $1,034.25 $593.0643271 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543272 Endo cholangiopancreatograph Y A2 $446.00 20.951 $867.39 $551.3543450 Dilate esophagus Y A2 $333.00 5.8431 $241.91 $310.2343453 Dilate esophagus Y A2 $333.00 5.8431 $241.91 $310.2343456 Dilate esophagus Y A2 $335.41 5.8431 $241.91 $312.0443458 Dilate esophagus Y A2 $335.41 8.503 $352.03 $339.5743600 Biopsy of stomach Y A2 $333.00 8.503 $352.03 $337.7643653 Laparoscopy, gastrostomy Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5243750 Place gastrostomy tube N D543760 Change gastrostomy tube Y A2 $144.98 3.2383 $134.07 $142.2543761 Reposition gastrostomy tube Y A2 $333.00 8.503 $352.03 $337.7643870 Repair stomach opening Y A2 $333.00 8.503 $352.03 $337.7643886 Revise gastric port, open Y G2 20.2069 $836.59 $836.5943887 Remove gastric port, open Y G2 4.5263 $187.39 $187.3943888 Change gastric port, open Y G2 20.2069 $836.59 $836.5944100 Biopsy of bowel Y A2 $333.00 8.503 $352.03 $337.7644312 Revision of ileostomy Y A2 $333.00 20.2069 $836.59 $458.9044340 Revision of colostomy Y A2 $510.00 20.2069 $836.59 $591.6544360 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344361 Small bowel endoscopy/biopsy Y A2 $446.00 9.5292 $394.52 $433.1344363 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344364 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344365 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344366 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344369 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344370 Small bowel endoscopy/stent Y A2 $1,339.00 24.9814 $1,034.25 $1,262.8144372 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344373 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344376 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344377 Small bowel endoscopy/biopsy Y A2 $446.00 9.5292 $394.52 $433.1344378 Small bowel endoscopy Y A2 $446.00 9.5292 $394.52 $433.1344379 S bowel endoscope w/stent Y A2 $1,339.00 24.9814 $1,034.25 $1,262.8144380 Small bowel endoscopy Y A2 $333.00 9.5292 $394.52 $348.3844382 Small bowel endoscopy Y A2 $333.00 9.5292 $394.52 $348.3844383 Ileoscopy w/stent Y A2 $1,339.00 24.9814 $1,034.25 $1,262.8144385 Endoscopy of bowel pouch Y A2 $333.00 8.8486 $366.34 $341.3444386 Endoscopy, bowel pouch/biop Y A2 $333.00 8.8486 $366.34 $341.3444388 Colonoscopy Y A2 $333.00 8.8486 $366.34 $341.3444389 Colonoscopy with biopsy Y A2 $333.00 8.8486 $366.34 $341.3444390 Colonoscopy for foreign body Y A2 $333.00 8.8486 $366.34 $341.3444391 Colonoscopy for bleeding Y A2 $333.00 8.8486 $366.34 $341.3444392 Colonoscopy & polypectomy Y A2 $333.00 8.8486 $366.34 $341.3444393 Colonoscopy, lesion removal Y A2 $333.00 8.8486 $366.34 $341.3444394 Colonoscopy w/snare Y A2 $333.00 8.8486 $366.34 $341.3444397 Colonoscopy w/stent Y A2 $333.00 24.9814 $1,034.25 $508.3144500 Intro, gastrointestinal tube Y G2 3.2383 $134.07 $134.0744701 Intraop colon lavage add-on N N145000 Drainage of pelvic abscess Y A2 $312.07 10.9132 $451.82 $347.0145005 Drainage of rectal abscess Y A2 $446.00 10.9132 $451.82 $447.4645020 Drainage of rectal abscess Y A2 $446.00 10.9132 $451.82 $447.4645100 Biopsy of rectum Y A2 $333.00 22.7451 $941.67 $485.1745108 Removal of anorectal lesion Y A2 $446.00 22.7451 $941.67 $569.9245150 Excision of rectal stricture Y A2 $446.00 22.7451 $941.67 $569.9245160 Excision of rectal lesion Y A2 $446.00 22.7451 $941.67 $569.9245170 Excision of rectal lesion Y A2 $446.00 22.7451 $941.67 $569.9245190 Destruction, rectal tumor Y A2 $1,339.00 22.7451 $941.67 $1,239.6745300 Proctosigmoidoscopy dx Y P3 1.6007 $66.27 $66.2745303 Proctosigmoidoscopy dilate Y P2 8.7031 $360.32 $360.32

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 45305 Proctosigmoidoscopy w/bx Y A2 $333.00 8.7031 $360.32 $339.8345307 Proctosigmoidoscopy fb Y A2 $333.00 21.4632 $888.60 $471.9045308 Proctosigmoidoscopy removal Y A2 $333.00 8.7031 $360.32 $339.8345309 Proctosigmoidoscopy removal Y A2 $333.00 8.7031 $360.32 $339.8345315 Proctosigmoidoscopy removal Y A2 $333.00 8.7031 $360.32 $339.8345317 Proctosigmoidoscopy bleed Y A2 $333.00 8.7031 $360.32 $339.8345320 Proctosigmoidoscopy ablate Y A2 $333.00 21.4632 $888.60 $471.9045321 Proctosigmoidoscopy volvul Y A2 $333.00 21.4632 $888.60 $471.9045327 Proctosigmoidoscopy w/stent Y A2 $333.00 24.9814 $1,034.25 $508.3145330 Diagnostic sigmoidoscopy Y P3 2.2079 $91.41 $91.4145331 Sigmoidoscopy and biopsy Y A2 $299.24 5.0972 $211.03 $277.1945332 Sigmoidoscopy w/fb removal Y A2 $299.24 5.0972 $211.03 $277.1945333 Sigmoidoscopy & polypectomy Y A2 $333.00 8.7031 $360.32 $339.8345334 Sigmoidoscopy for bleeding Y A2 $333.00 8.7031 $360.32 $339.8345335 Sigmoidoscopy w/submuc inj Y A2 $299.24 5.0972 $211.03 $277.1945337 Sigmoidoscopy & decompress Y A2 $299.24 5.0972 $211.03 $277.1945338 Sigmoidoscopy w/tumr remove Y A2 $333.00 8.7031 $360.32 $339.8345339 Sigmoidoscopy w/ablate tumr Y A2 $333.00 8.7031 $360.32 $339.8345340 Sig w/balloon dilation Y A2 $333.00 8.7031 $360.32 $339.8345341 Sigmoidoscopy w/ultrasound Y A2 $333.00 8.7031 $360.32 $339.8345342 Sigmoidoscopy w/us guide bx Y A2 $333.00 8.7031 $360.32 $339.8345345 Sigmoidoscopy w/stent Y A2 $333.00 24.9814 $1,034.25 $508.3145355 Surgical colonoscopy Y A2 $333.00 8.8486 $366.34 $341.3445378 Diagnostic colonoscopy Y A2 $446.00 8.8486 $366.34 $426.0945379 Colonoscopy w/fb removal Y A2 $446.00 8.8486 $366.34 $426.0945380 Colonoscopy and biopsy Y A2 $446.00 8.8486 $366.34 $426.0945381 Colonoscopy, submucous inj Y A2 $446.00 8.8486 $366.34 $426.0945382 Colonoscopy/control bleeding Y A2 $446.00 8.8486 $366.34 $426.0945383 Lesion removal colonoscopy Y A2 $446.00 8.8486 $366.34 $426.0945384 Lesion remove colonoscopy Y A2 $446.00 8.8486 $366.34 $426.0945385 Lesion removal colonoscopy Y A2 $446.00 8.8486 $366.34 $426.0945386 Colonoscopy dilate stricture Y A2 $446.00 8.8486 $366.34 $426.0945387 Colonoscopy w/stent Y A2 $333.00 24.9814 $1,034.25 $508.3145391 Colonoscopy w/endoscope us Y A2 $446.00 8.8486 $366.34 $426.0945392 Colonoscopy w/endoscopic fnb Y A2 $446.00 8.8486 $366.34 $426.0945500 Repair of rectum Y A2 $446.00 22.7451 $941.67 $569.9245505 Repair of rectum Y A2 $446.00 30.1606 $1,248.68 $646.6745520 Treatment of rectal prolapse Y P2 0.793 $32.83 $32.8345560 Repair of rectocele Y A2 $446.00 30.1606 $1,248.68 $646.6745900 Reduction of rectal prolapse Y A2 $312.07 4.7935 $198.46 $283.6745905 Dilation of anal sphincter Y A2 $333.00 22.7451 $941.67 $485.1745910 Dilation of rectal narrowing Y A2 $333.00 22.7451 $941.67 $485.1745915 Remove rectal obstruction Y A2 $312.07 10.9132 $451.82 $347.0145990 Surg dx exam, anorectal Y A2 $312.07 22.7451 $941.67 $469.4746020 Placement of seton Y A2 $510.00 22.7451 $941.67 $617.9246030 Removal of rectal marker Y A2 $312.07 4.7935 $198.46 $283.6746040 Incision of rectal abscess Y A2 $510.00 22.7451 $941.67 $617.9246045 Incision of rectal abscess Y A2 $446.00 22.7451 $941.67 $569.9246050 Incision of anal abscess Y A2 $312.07 10.9132 $451.82 $347.0146060 Incision of rectal abscess Y A2 $446.00 22.7451 $941.67 $569.9246070 Incision of anal septum Y G2 10.9132 $451.82 $451.8246080 Incision of anal sphincter Y A2 $510.00 22.7451 $941.67 $617.9246083 Incise external hemorrhoid Y P2 2.0077 $83.12 $83.1246200 Removal of anal fissure Y A2 $446.00 22.7451 $941.67 $569.9246210 Removal of anal crypt Y A2 $446.00 22.7451 $941.67 $569.9246211 Removal of anal crypts Y A2 $446.00 22.7451 $941.67 $569.9246220 Removal of anal tag Y A2 $333.00 22.7451 $941.67 $485.1746221 Ligation of hemorrhoid(s) Y P3 2.9347 $121.50 $121.5046230 Removal of anal tags Y A2 $333.00 22.7451 $941.67 $485.1746250 Hemorrhoidectomy Y A2 $510.00 22.7451 $941.67 $617.9246255 Hemorrhoidectomy Y A2 $510.00 22.7451 $941.67 $617.9246257 Remove hemorrhoids & fissure Y A2 $510.00 22.7451 $941.67 $617.9246258 Remove hemorrhoids & fistula Y A2 $510.00 22.7451 $941.67 $617.9246260 Hemorrhoidectomy Y A2 $510.00 22.7451 $941.67 $617.9246261 Remove hemorrhoids & fissure Y A2 $630.00 22.7451 $941.67 $707.9246262 Remove hemorrhoids & fistula Y A2 $630.00 22.7451 $941.67 $707.9246270 Removal of anal fistula Y A2 $510.00 22.7451 $941.67 $617.9246275 Removal of anal fistula Y A2 $510.00 22.7451 $941.67 $617.9246280 Removal of anal fistula Y A2 $630.00 22.7451 $941.67 $707.9246285 Removal of anal fistula Y A2 $333.00 22.7451 $941.67 $485.1746288 Repair anal fistula Y A2 $630.00 22.7451 $941.67 $707.9246320 Removal of hemorrhoid clot Y P3 2.0884 $86.46 $86.4646500 Injection into hemorrhoid(s) Y P3 2.6311 $108.93 $108.9346505 Chemodenervation anal musc Y G2 4.7935 $198.46 $198.4646600 Diagnostic anoscopy N P2 0.631 $26.12 $26.1246604 Anoscopy and dilation Y P2 8.7031 $360.32 $360.3246606 Anoscopy and biopsy Y P3 3.5233 $145.87 $145.8746608 Anoscopy, remove for body Y A2 $333.00 8.7031 $360.32 $339.8346610 Anoscopy, remove lesion Y A2 $333.00 21.4632 $888.60 $471.9046611 Anoscopy Y A2 $333.00 8.7031 $360.32 $339.8346612 Anoscopy, remove lesions Y A2 $333.00 21.4632 $888.60 $471.9046614 Anoscopy, control bleeding Y P3 1.9596 $81.13 $81.1346615 Anoscopy Y A2 $446.00 21.4632 $888.60 $556.6546700 Repair of anal stricture Y A2 $510.00 22.7451 $941.67 $617.9246706 Repr of anal fistula w/glue Y A2 $333.00 30.1606 $1,248.68 $561.9246750 Repair of anal sphincter Y A2 $510.00 30.1606 $1,248.68 $694.6746753 Reconstruction of anus Y A2 $510.00 22.7451 $941.67 $617.9246754 Removal of suture from anus Y A2 $446.00 22.7451 $941.67 $569.92

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 46760 Repair of anal sphincter Y A2 $446.00 30.1606 $1,248.68 $646.6746761 Repair of anal sphincter Y A2 $510.00 30.1606 $1,248.68 $694.6746762 Implant artificial sphincter Y A2 $995.00 30.1606 $1,248.68 $1,058.4246900 Destruction, anal lesion(s) Y P2 2.6604 $110.14 $110.1446910 Destruction, anal lesion(s) Y P3 3.1185 $129.11 $129.1146916 Cryosurgery, anal lesion(s) Y P2 1.4595 $60.42 $60.4246917 Laser surgery, anal lesions Y A2 $333.00 19.9041 $824.05 $455.7646922 Excision of anal lesion(s) Y A2 $333.00 19.9041 $824.05 $455.7646924 Destruction, anal lesion(s) Y A2 $333.00 19.9041 $824.05 $455.7646934 Destruction of hemorrhoids Y P3 4.8941 $202.62 $202.6246935 Destruction of hemorrhoids Y P3 3.3671 $139.40 $139.4046936 Destruction of hemorrhoids Y P3 5.1149 $211.76 $211.7646937 Cryotherapy of rectal lesion Y A2 $446.00 22.7451 $941.67 $569.9246938 Cryotherapy of rectal lesion Y A2 $446.00 30.1606 $1,248.68 $646.6746940 Treatment of anal fissure Y P3 2.2263 $92.17 $92.1746942 Treatment of anal fissure Y P3 2.1342 $88.36 $88.3646945 Ligation of hemorrhoids Y P3 3.7074 $153.49 $153.4946946 Ligation of hemorrhoids Y A2 $333.00 10.9132 $451.82 $362.7146947 Hemorrhoidopexy by stapling Y A2 $995.00 30.1606 $1,248.68 $1,058.4247000 Needle biopsy of liver Y A2 $333.00 9.3354 $386.49 $346.3747001 Needle biopsy, liver add-on N N147382 Percut ablate liver rf Y G2 42.998 $1,780.16 $1,780.1647500 Injection for liver x-rays N N147505 Injection for liver x-rays N N147510 Insert catheter, bile duct Y A2 $446.00 28.6884 $1,187.73 $631.4347511 Insert bile duct drain Y A2 $1,245.85 28.6884 $1,187.73 $1,231.3247525 Change bile duct catheter Y A2 $333.00 15.3545 $635.69 $408.6747530 Revise/reinsert bile tube Y A2 $333.00 15.3545 $635.69 $408.6747552 Biliary endoscopy thru skin Y A2 $446.00 28.6884 $1,187.73 $631.4347553 Biliary endoscopy thru skin Y A2 $510.00 28.6884 $1,187.73 $679.4347554 Biliary endoscopy thru skin Y A2 $510.00 28.6884 $1,187.73 $679.4347555 Biliary endoscopy thru skin Y A2 $510.00 28.6884 $1,187.73 $679.4347556 Biliary endoscopy thru skin Y A2 $1,245.85 28.6884 $1,187.73 $1,231.3247560 Laparoscopy w/cholangio Y A2 $510.00 34.3958 $1,424.02 $738.5147561 Laparo w/cholangio/biopsy Y A2 $510.00 34.3958 $1,424.02 $738.5147562 Laparoscopic cholecystectomy Y G2 45.5317 $1,885.06 $1,885.0647563 Laparo cholecystectomy/graph Y G2 45.5317 $1,885.06 $1,885.0647564 Laparo cholecystectomy/explr Y G2 45.5317 $1,885.06 $1,885.0647630 Remove bile duct stone Y A2 $510.00 28.6884 $1,187.73 $679.4348102 Needle biopsy, pancreas Y A2 $333.00 9.3354 $386.49 $346.3749080 Puncture, peritoneal cavity Y A2 $222.78 5.2024 $215.38 $220.9349081 Removal of abdominal fluid Y A2 $222.78 5.2024 $215.38 $220.9349180 Biopsy, abdominal mass Y A2 $333.00 9.3354 $386.49 $346.3749250 Excision of umbilicus Y A2 $630.00 25.6947 $1,063.79 $738.4549320 Diag laparo separate proc Y A2 $510.00 34.3958 $1,424.02 $738.5149321 Laparoscopy, biopsy Y A2 $630.00 34.3958 $1,424.02 $828.5149322 Laparoscopy, aspiration Y A2 $630.00 34.3958 $1,424.02 $828.5149400 Air injection into abdomen N N149402 Remove foreign body, adbomen Y A2 $446.00 25.6947 $1,063.79 $600.4549419 Insrt abdom cath for chemotx Y A2 $333.00 29.6965 $1,229.46 $557.1249420 Insert abdom drain, temp Y A2 $333.00 30.7096 $1,271.41 $567.6049421 Insert abdom drain, perm Y A2 $333.00 30.7096 $1,271.41 $567.6049422 Remove perm cannula/catheter Y A2 $333.00 23.9802 $992.80 $497.9549423 Exchange drainage catheter Y G2 15.3545 $635.69 $635.6949424 Assess cyst, contrast inject N N149426 Revise abdomen-venous shunt Y A2 $446.00 25.6947 $1,063.79 $600.4549427 Injection, abdominal shunt N N149429 Removal of shunt Y G2 23.9802 $992.80 $992.8049440 Place gastrostomy tube perc Y G2 8.503 $352.03 $352.0349441 Place duod/jej tube perc Y G2 8.503 $352.03 $352.0349446 Change g-tube to g-j perc Y G2 8.503 $352.03 $352.0349450 Replace g/c tube perc Y G2 3.2383 $134.07 $134.0749451 Replace duod/jej tube perc Y G2 3.2383 $134.07 $134.0749452 Replace g-j tube perc Y G2 3.2383 $134.07 $134.0749460 Fix g/colon tube w/device Y G2 3.2383 $134.07 $134.0749465 Fluoro exam of g/colon tube N N149495 Rpr ing hernia baby, reduc Y A2 $630.00 30.6788 $1,270.13 $790.0349496 Rpr ing hernia baby, blocked Y A2 $630.00 30.6788 $1,270.13 $790.0349500 Rpr ing hernia, init, reduce Y A2 $630.00 30.6788 $1,270.13 $790.0349501 Rpr ing hernia, init blocked Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849505 Prp i/hern init reduc >5 yr Y A2 $630.00 30.6788 $1,270.13 $790.0349507 Prp i/hern init block >5 yr Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849520 Rerepair ing hernia, reduce Y A2 $995.00 30.6788 $1,270.13 $1,063.7849521 Rerepair ing hernia, blocked Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849525 Repair ing hernia, sliding Y A2 $630.00 30.6788 $1,270.13 $790.0349540 Repair lumbar hernia Y A2 $446.00 30.6788 $1,270.13 $652.0349550 Rpr rem hernia, init, reduce Y A2 $717.00 30.6788 $1,270.13 $855.2849553 Rpr fem hernia, init blocked Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849555 Rerepair fem hernia, reduce Y A2 $717.00 30.6788 $1,270.13 $855.2849557 Rerepair fem hernia, blocked Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849560 Rpr ventral hern init, reduc Y A2 $630.00 30.6788 $1,270.13 $790.0349561 Rpr ventral hern init, block Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849565 Rerepair ventrl hern, reduce Y A2 $630.00 30.6788 $1,270.13 $790.0349566 Rerepair ventrl hern, block Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849568 Hernia repair w/mesh Y A2 $995.00 30.6788 $1,270.13 $1,063.7849570 Rpr epigastric hern, reduce Y A2 $630.00 30.6788 $1,270.13 $790.0349572 Rpr epigastric hern, blocked Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849580 Rpr umbil hern, reduc < 5 yr Y A2 $630.00 30.6788 $1,270.13 $790.03

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 49582 Rpr umbil hern, block < 5 yr Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849585 Rpr umbil hern, reduc > 5 yr Y A2 $630.00 30.6788 $1,270.13 $790.0349587 Rpr umbil hern, block > 5 yr Y A2 $1,339.00 30.6788 $1,270.13 $1,321.7849590 Repair spigelian hernia Y A2 $510.00 30.6788 $1,270.13 $700.0349600 Repair umbilical lesion Y A2 $630.00 30.6788 $1,270.13 $790.0349650 Laparo hernia repair initial Y A2 $630.00 45.5317 $1,885.06 $943.7749651 Laparo hernia repair recur Y A2 $995.00 45.5317 $1,885.06 $1,217.5250200 Biopsy of kidney Y A2 $333.00 9.3354 $386.49 $346.3750382 Change ureter stent, percut Y G2 24.7749 $1,025.71 $1,025.7150384 Remove ureter stent, percut Y G2 17.942 $742.82 $742.8250385 Change stent via transureth Y G2 17.942 $742.82 $742.8250386 Remove stent via transureth Y G2 5.9735 $247.31 $247.3150387 Change ext/int ureter stent Y G2 15.3545 $635.69 $635.6950389 Remove renal tube w/fluoro Y G2 5.9735 $247.31 $247.3150390 Drainage of kidney lesion Y A2 $333.00 9.3354 $386.49 $346.3750391 Instll rx agnt into rnal tub Y P2 1.0356 $42.87 $42.8750392 Insert kidney drain Y A2 $333.00 17.942 $742.82 $435.4650393 Insert ureteral tube Y A2 $333.00 24.7749 $1,025.71 $506.1850394 Injection for kidney x-ray N N150395 Create passage to kidney Y A2 $333.00 17.942 $742.82 $435.4650396 Measure kidney pressure Y A2 $131.50 2.0077 $83.12 $119.4150398 Change kidney tube Y A2 $333.00 15.3545 $635.69 $408.6750551 Kidney endoscopy Y A2 $333.00 5.9735 $247.31 $311.5850553 Kidney endoscopy Y A2 $333.00 24.7749 $1,025.71 $506.1850555 Kidney endoscopy & biopsy Y A2 $333.00 5.9735 $247.31 $311.5850557 Kidney endoscopy & treatment Y A2 $333.00 24.7749 $1,025.71 $506.1850561 Kidney endoscopy & treatment Y A2 $333.00 24.7749 $1,025.71 $506.1850562 Renal scope w/tumor resect Y G2 5.9735 $247.31 $247.3150570 Kidney endoscopy Y G2 5.9735 $247.31 $247.3150572 Kidney endoscopy Y G2 5.9735 $247.31 $247.3150574 Kidney endoscopy & biopsy Y G2 5.9735 $247.31 $247.3150575 Kidney endoscopy Y G2 36.0774 $1,493.64 $1,493.6450576 Kidney endoscopy & treatment Y G2 17.942 $742.82 $742.8250580 Kidney endoscopy & treatment Y G2 17.942 $742.82 $742.8250590 Fragmenting of kidney stone Y G2 41.5299 $1,719.38 $1,719.3850592 Perc rf ablate renal tumor Y G2 42.998 $1,780.16 $1,780.1650684 Injection for ureter x-ray N N150686 Measure ureter pressure Y P2 1.0356 $42.87 $42.8750688 Change of ureter tube/stent Y A2 $333.00 15.3545 $635.69 $408.6750690 Injection for ureter x-ray N N150947 Laparo new ureter/bladder Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5250948 Laparo new ureter/bladder Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5250951 Endoscopy of ureter Y A2 $333.00 5.9735 $247.31 $311.5850953 Endoscopy of ureter Y A2 $333.00 5.9735 $247.31 $311.5850955 Ureter endoscopy & biopsy Y A2 $333.00 24.7749 $1,025.71 $506.1850957 Ureter endoscopy & treatment Y A2 $333.00 24.7749 $1,025.71 $506.1850961 Ureter endoscopy & treatment Y A2 $333.00 24.7749 $1,025.71 $506.1850970 Ureter endoscopy Y A2 $333.00 5.9735 $247.31 $311.5850972 Ureter endoscopy & catheter Y A2 $333.00 5.9735 $247.31 $311.5850974 Ureter endoscopy & biopsy Y A2 $333.00 17.942 $742.82 $435.4650976 Ureter endoscopy & treatment Y A2 $333.00 17.942 $742.82 $435.4650980 Ureter endoscopy & treatment Y A2 $333.00 24.7749 $1,025.71 $506.1851000 Drainage of bladder N D551005 Drainage of bladder N D551010 Drainage of bladder N D551020 Incise & treat bladder Y A2 $630.00 24.7749 $1,025.71 $728.9351030 Incise & treat bladder Y A2 $630.00 24.7749 $1,025.71 $728.9351040 Incise & drain bladder Y A2 $630.00 24.7749 $1,025.71 $728.9351045 Incise bladder/drain ureter Y A2 $399.24 5.9735 $247.31 $361.2651050 Removal of bladder stone Y A2 $630.00 24.7749 $1,025.71 $728.9351065 Remove ureter calculus Y A2 $630.00 24.7749 $1,025.71 $728.9351080 Drainage of bladder abscess Y A2 $333.00 18.3197 $758.45 $439.3651100 Drain bladder by needle Y P3 0.8464 $35.04 $35.0451101 Drain bladder by trocar/cath Y P2 1.0356 $42.87 $42.8751102 Drain bl w/cath insertion Y A2 $333.00 19.3414 $800.75 $449.9451500 Removal of bladder cyst Y A2 $630.00 30.6788 $1,270.13 $790.0351520 Removal of bladder lesion Y A2 $630.00 24.7749 $1,025.71 $728.9351600 Injection for bladder x-ray N N151605 Preparation for bladder xray N N151610 Injection for bladder x-ray N N151700 Irrigation of bladder Y P3 1.4258 $59.03 $59.0351701 Insert bladder catheter N P2 0.631 $26.12 $26.1251702 Insert temp bladder cath N P2 0.631 $26.12 $26.1251703 Insert bladder cath, complex Y P2 1.0356 $42.87 $42.8751705 Change of bladder tube Y P3 1.978 $81.89 $81.8951710 Change of bladder tube Y A2 $333.00 15.3545 $635.69 $408.6751715 Endoscopic injection/implant Y A2 $510.00 29.7864 $1,233.19 $690.8051720 Treatment of bladder lesion Y P3 1.5456 $63.99 $63.9951725 Simple cystometrogram Y P2 3.0469 $126.14 $126.1451726 Complex cystometrogram Y A2 $209.48 3.0469 $126.14 $188.6551736 Urine flow measurement Y P3 0.4968 $20.57 $20.5751741 Electro-uroflowmetry, first Y P3 0.5703 $23.61 $23.6151772 Urethra pressure profile Y A2 $131.50 2.0077 $83.12 $119.4151784 Anal/urinary muscle study Y P2 1.0356 $42.87 $42.8751785 Anal/urinary muscle study Y A2 $66.92 2.0077 $83.12 $70.9751792 Urinary reflex study Y P2 1.0356 $42.87 $42.8751795 Urine voiding pressure study Y P2 2.0077 $83.12 $83.1251797 Intraabdominal pressure test Y P2 2.0077 $83.12 $83.12

Date Printed: 04/08/2023 @ 09:12:30 Page 30 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 51798 Us urine capacity measure N P3 0.4324 $17.90 $17.9051880 Repair of bladder opening Y A2 $333.00 24.7749 $1,025.71 $506.1851992 Laparo sling operation Y A2 $717.00 45.5317 $1,885.06 $1,009.0252000 Cystoscopy Y A2 $333.00 5.9735 $247.31 $311.5852001 Cystoscopy, removal of clots Y A2 $399.24 17.942 $742.82 $485.1452005 Cystoscopy & ureter catheter Y A2 $446.00 17.942 $742.82 $520.2152007 Cystoscopy and biopsy Y A2 $446.00 24.7749 $1,025.71 $590.9352010 Cystoscopy & duct catheter Y A2 $399.24 5.9735 $247.31 $361.2652204 Cystoscopy w/biopsy(s) Y A2 $446.00 17.942 $742.82 $520.2152214 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352224 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352234 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352235 Cystoscopy and treatment Y A2 $510.00 24.7749 $1,025.71 $638.9352240 Cystoscopy and treatment Y A2 $510.00 24.7749 $1,025.71 $638.9352250 Cystoscopy and radiotracer Y A2 $630.00 24.7749 $1,025.71 $728.9352260 Cystoscopy and treatment Y A2 $446.00 17.942 $742.82 $520.2152265 Cystoscopy and treatment Y P2 5.9735 $247.31 $247.3152270 Cystoscopy & revise urethra Y A2 $446.00 17.942 $742.82 $520.2152275 Cystoscopy & revise urethra Y A2 $446.00 24.7749 $1,025.71 $590.9352276 Cystoscopy and treatment Y A2 $510.00 24.7749 $1,025.71 $638.9352277 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352281 Cystoscopy and treatment Y A2 $446.00 17.942 $742.82 $520.2152282 Cystoscopy, implant stent Y A2 $1,339.00 36.0774 $1,493.64 $1,377.6652283 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352285 Cystoscopy and treatment Y A2 $446.00 17.942 $742.82 $520.2152290 Cystoscopy and treatment Y A2 $446.00 17.942 $742.82 $520.2152300 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352301 Cystoscopy and treatment Y A2 $510.00 24.7749 $1,025.71 $638.9352305 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352310 Cystoscopy and treatment Y A2 $399.24 17.942 $742.82 $485.1452315 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352317 Remove bladder stone Y A2 $333.00 24.7749 $1,025.71 $506.1852318 Remove bladder stone Y A2 $446.00 24.7749 $1,025.71 $590.9352320 Cystoscopy and treatment Y A2 $717.00 24.7749 $1,025.71 $794.1852325 Cystoscopy, stone removal Y A2 $630.00 24.7749 $1,025.71 $728.9352327 Cystoscopy, inject material Y A2 $446.00 24.7749 $1,025.71 $590.9352330 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352332 Cystoscopy and treatment Y A2 $446.00 24.7749 $1,025.71 $590.9352334 Create passage to kidney Y A2 $510.00 24.7749 $1,025.71 $638.9352341 Cysto w/ureter stricture tx Y A2 $510.00 24.7749 $1,025.71 $638.9352342 Cysto w/up stricture tx Y A2 $510.00 24.7749 $1,025.71 $638.9352343 Cysto w/renal stricture tx Y A2 $510.00 24.7749 $1,025.71 $638.9352344 Cysto/uretero, stricture tx Y A2 $510.00 24.7749 $1,025.71 $638.9352345 Cysto/uretero w/up stricture Y A2 $510.00 24.7749 $1,025.71 $638.9352346 Cystouretero w/renal strict Y A2 $510.00 24.7749 $1,025.71 $638.9352351 Cystouretero & or pyeloscope Y A2 $510.00 24.7749 $1,025.71 $638.9352352 Cystouretero w/stone remove Y A2 $630.00 24.7749 $1,025.71 $728.9352353 Cystouretero w/lithotripsy Y A2 $630.00 36.0774 $1,493.64 $845.9152354 Cystouretero w/biopsy Y A2 $630.00 24.7749 $1,025.71 $728.9352355 Cystouretero w/excise tumor Y A2 $630.00 24.7749 $1,025.71 $728.9352400 Cystouretero w/congen repr Y A2 $510.00 24.7749 $1,025.71 $638.9352402 Cystourethro cut ejacul duct Y A2 $510.00 24.7749 $1,025.71 $638.9352450 Incision of prostate Y A2 $510.00 24.7749 $1,025.71 $638.9352500 Revision of bladder neck Y A2 $510.00 24.7749 $1,025.71 $638.9352510 Dilation prostatic urethra N D552601 Prostatectomy (turp) Y A2 $630.00 36.0774 $1,493.64 $845.9152606 Control postop bleeding Y A2 $333.00 24.7749 $1,025.71 $506.1852612 Prostatectomy, first stage Y A2 $446.00 36.0774 $1,493.64 $707.9152614 Prostatectomy, second stage Y A2 $333.00 36.0774 $1,493.64 $623.1652620 Remove residual prostate Y A2 $333.00 36.0774 $1,493.64 $623.1652630 Remove prostate regrowth Y A2 $446.00 36.0774 $1,493.64 $707.9152640 Relieve bladder contracture Y A2 $446.00 24.7749 $1,025.71 $590.9352647 Laser surgery of prostate Y A2 $1,339.00 45.2042 $1,871.50 $1,472.1352648 Laser surgery of prostate Y A2 $1,339.00 45.2042 $1,871.50 $1,472.1352700 Drainage of prostate abscess Y A2 $446.00 24.7749 $1,025.71 $590.9353000 Incision of urethra Y A2 $333.00 19.1505 $792.85 $447.9653010 Incision of urethra Y A2 $333.00 19.1505 $792.85 $447.9653020 Incision of urethra Y A2 $333.00 19.1505 $792.85 $447.9653025 Incision of urethra Y R2 19.1505 $792.85 $792.8553040 Drainage of urethra abscess Y A2 $446.00 19.1505 $792.85 $532.7153060 Drainage of urethra abscess Y P3 1.9227 $79.60 $79.6053080 Drainage of urinary leakage Y A2 $510.00 19.1505 $792.85 $580.7153085 Drainage of urinary leakage Y G2 19.1505 $792.85 $792.8553200 Biopsy of urethra Y A2 $333.00 19.1505 $792.85 $447.9653210 Removal of urethra Y A2 $717.00 29.7864 $1,233.19 $846.0553215 Removal of urethra Y A2 $717.00 19.1505 $792.85 $735.9653220 Treatment of urethra lesion Y A2 $446.00 29.7864 $1,233.19 $642.8053230 Removal of urethra lesion Y A2 $446.00 29.7864 $1,233.19 $642.8053235 Removal of urethra lesion Y A2 $510.00 19.1505 $792.85 $580.7153240 Surgery for urethra pouch Y A2 $446.00 29.7864 $1,233.19 $642.8053250 Removal of urethra gland Y A2 $446.00 19.1505 $792.85 $532.7153260 Treatment of urethra lesion Y A2 $446.00 19.1505 $792.85 $532.7153265 Treatment of urethra lesion Y A2 $446.00 19.1505 $792.85 $532.7153270 Removal of urethra gland Y A2 $446.00 19.1505 $792.85 $532.7153275 Repair of urethra defect Y A2 $446.00 19.1505 $792.85 $532.7153400 Revise urethra, stage 1 Y A2 $510.00 29.7864 $1,233.19 $690.8053405 Revise urethra, stage 2 Y A2 $446.00 29.7864 $1,233.19 $642.8053410 Reconstruction of urethra Y A2 $446.00 29.7864 $1,233.19 $642.80

Date Printed: 04/08/2023 @ 09:12:30 Page 31 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 53420 Reconstruct urethra, stage 1 Y A2 $510.00 29.7864 $1,233.19 $690.8053425 Reconstruct urethra, stage 2 Y A2 $446.00 29.7864 $1,233.19 $642.8053430 Reconstruction of urethra Y A2 $446.00 29.7864 $1,233.19 $642.8053431 Reconstruct urethra/bladder Y A2 $446.00 29.7864 $1,233.19 $642.8053440 Male sling procedure N H8 $446.00 106.8568 $4,423.98 $3,500.5053442 Remove/revise male sling Y A2 $333.00 29.7864 $1,233.19 $558.0553444 Insert tandem cuff N H8 $446.00 106.8568 $4,423.98 $3,500.5053445 Insert uro/ves nck sphincter N H8 $333.00 193.4277 $8,008.10 $6,625.7553446 Remove uro sphincter Y A2 $333.00 29.7864 $1,233.19 $558.0553447 Remove/replace ur sphincter N H8 $333.00 193.4277 $8,008.10 $6,625.7553449 Repair uro sphincter Y A2 $333.00 29.7864 $1,233.19 $558.0553450 Revision of urethra Y A2 $333.00 29.7864 $1,233.19 $558.0553460 Revision of urethra Y A2 $333.00 19.1505 $792.85 $447.9653502 Repair of urethra injury Y A2 $446.00 19.1505 $792.85 $532.7153505 Repair of urethra injury Y A2 $446.00 29.7864 $1,233.19 $642.8053510 Repair of urethra injury Y A2 $446.00 19.1505 $792.85 $532.7153515 Repair of urethra injury Y A2 $446.00 29.7864 $1,233.19 $642.8053520 Repair of urethra defect Y A2 $446.00 29.7864 $1,233.19 $642.8053600 Dilate urethra stricture Y P3 1.0488 $43.42 $43.4253601 Dilate urethra stricture Y P2 1.0356 $42.87 $42.8753605 Dilate urethra stricture Y A2 $446.00 17.942 $742.82 $520.2153620 Dilate urethra stricture Y P3 1.7019 $70.46 $70.4653621 Dilate urethra stricture Y P3 1.7847 $73.89 $73.8953660 Dilation of urethra Y P2 1.0356 $42.87 $42.8753661 Dilation of urethra Y P2 1.0356 $42.87 $42.8753665 Dilation of urethra Y A2 $333.00 19.1505 $792.85 $447.9653850 Prostatic microwave thermotx Y P2 45.2042 $1,871.50 $1,871.5053852 Prostatic rf thermotx Y P2 45.2042 $1,871.50 $1,871.5053853 Prostatic water thermother Y P2 24.7749 $1,025.71 $1,025.7154000 Slitting of prepuce Y A2 $446.00 19.1505 $792.85 $532.7154001 Slitting of prepuce Y A2 $446.00 19.1505 $792.85 $532.7154015 Drain penis lesion Y A2 $630.00 18.3197 $758.45 $662.1154050 Destruction, penis lesion(s) Y P2 1.4595 $60.42 $60.4254055 Destruction, penis lesion(s) Y P3 1.6282 $67.41 $67.4154056 Cryosurgery, penis lesion(s) Y P2 0.793 $32.83 $32.8354057 Laser surg, penis lesion(s) Y A2 $333.00 19.9041 $824.05 $455.7654060 Excision of penis lesion(s) Y A2 $333.00 19.9041 $824.05 $455.7654065 Destruction, penis lesion(s) Y A2 $333.00 19.9041 $824.05 $455.7654100 Biopsy of penis Y A2 $333.00 16.1001 $666.56 $416.3954105 Biopsy of penis Y A2 $333.00 21.1098 $873.97 $468.2454110 Treatment of penis lesion Y A2 $446.00 33.9306 $1,404.76 $685.6954111 Treat penis lesion, graft Y A2 $446.00 33.9306 $1,404.76 $685.6954112 Treat penis lesion, graft Y A2 $446.00 33.9306 $1,404.76 $685.6954115 Treatment of penis lesion Y A2 $333.00 18.3197 $758.45 $439.3654120 Partial removal of penis Y A2 $446.00 33.9306 $1,404.76 $685.6954150 Circumcision w/regionl block Y A2 $333.00 22.3251 $924.28 $480.8254160 Circumcision, neonate Y A2 $446.00 22.3251 $924.28 $565.5754161 Circum 28 days or older Y A2 $446.00 22.3251 $924.28 $565.5754162 Lysis penil circumic lesion Y A2 $446.00 22.3251 $924.28 $565.5754163 Repair of circumcision Y A2 $446.00 22.3251 $924.28 $565.5754164 Frenulotomy of penis Y A2 $446.00 22.3251 $924.28 $565.5754200 Treatment of penis lesion Y P3 1.7572 $72.75 $72.7554205 Treatment of penis lesion Y A2 $630.00 33.9306 $1,404.76 $823.6954220 Treatment of penis lesion Y A2 $131.50 2.0077 $83.12 $119.4154230 Prepare penis study N N154231 Dynamic cavernosometry Y P3 1.5364 $63.61 $63.6154235 Penile injection Y P3 1.0763 $44.56 $44.5654240 Penis study Y P3 0.7452 $30.85 $30.8554250 Penis study Y P3 0.2575 $10.66 $10.6654300 Revision of penis Y A2 $510.00 33.9306 $1,404.76 $733.6954304 Revision of penis Y A2 $510.00 33.9306 $1,404.76 $733.6954308 Reconstruction of urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954312 Reconstruction of urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954316 Reconstruction of urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954318 Reconstruction of urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954322 Reconstruction of urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954324 Reconstruction of urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954326 Reconstruction of urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954328 Revise penis/urethra Y A2 $510.00 33.9306 $1,404.76 $733.6954340 Secondary urethral surgery Y A2 $510.00 33.9306 $1,404.76 $733.6954344 Secondary urethral surgery Y A2 $510.00 33.9306 $1,404.76 $733.6954348 Secondary urethral surgery Y A2 $510.00 33.9306 $1,404.76 $733.6954352 Reconstruct urethra/penis Y A2 $510.00 33.9306 $1,404.76 $733.6954360 Penis plastic surgery Y A2 $510.00 33.9306 $1,404.76 $733.6954380 Repair penis Y A2 $510.00 33.9306 $1,404.76 $733.6954385 Repair penis Y A2 $510.00 33.9306 $1,404.76 $733.6954400 Insert semi-rigid prosthesis N H8 $510.00 106.8568 $4,423.98 $3,548.5054401 Insert self-contd prosthesis N H8 $510.00 193.4277 $8,008.10 $6,758.5054405 Insert multi-comp penis pros N H8 $510.00 193.4277 $8,008.10 $6,758.5054406 Remove muti-comp penis pros Y A2 $510.00 33.9306 $1,404.76 $733.6954408 Repair multi-comp penis pros Y A2 $510.00 33.9306 $1,404.76 $733.6954410 Remove/replace penis prosth N H8 $510.00 193.4277 $8,008.10 $6,758.5054415 Remove self-contd penis pros Y A2 $510.00 33.9306 $1,404.76 $733.6954416 Remv/repl penis contain pros N H8 $510.00 193.4277 $8,008.10 $6,758.5054420 Revision of penis Y A2 $630.00 33.9306 $1,404.76 $823.6954435 Revision of penis Y A2 $630.00 33.9306 $1,404.76 $823.6954440 Repair of penis Y A2 $630.00 33.9306 $1,404.76 $823.6954450 Preputial stretching Y A2 $209.48 3.0469 $126.14 $188.65

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 54500 Biopsy of testis Y A2 $333.00 13.5764 $562.08 $390.2754505 Biopsy of testis Y A2 $333.00 22.3251 $924.28 $480.8254512 Excise lesion testis Y A2 $446.00 22.3251 $924.28 $565.5754520 Removal of testis Y A2 $510.00 22.3251 $924.28 $613.5754522 Orchiectomy, partial Y A2 $510.00 22.3251 $924.28 $613.5754530 Removal of testis Y A2 $630.00 30.6788 $1,270.13 $790.0354550 Exploration for testis Y A2 $630.00 30.6788 $1,270.13 $790.0354560 Exploration for testis Y G2 22.3251 $924.28 $924.2854600 Reduce testis torsion Y A2 $630.00 22.3251 $924.28 $703.5754620 Suspension of testis Y A2 $510.00 22.3251 $924.28 $613.5754640 Suspension of testis Y A2 $630.00 30.6788 $1,270.13 $790.0354660 Revision of testis Y A2 $446.00 22.3251 $924.28 $565.5754670 Repair testis injury Y A2 $510.00 22.3251 $924.28 $613.5754680 Relocation of testis(es) Y A2 $510.00 22.3251 $924.28 $613.5754690 Laparoscopy, orchiectomy Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5254692 Laparoscopy, orchiopexy Y G2 69.6652 $2,884.21 $2,884.2154700 Drainage of scrotum Y A2 $446.00 22.3251 $924.28 $565.5754800 Biopsy of epididymis Y A2 $127.16 4.327 $179.14 $140.1654830 Remove epididymis lesion Y A2 $510.00 22.3251 $924.28 $613.5754840 Remove epididymis lesion Y A2 $630.00 22.3251 $924.28 $703.5754860 Removal of epididymis Y A2 $510.00 22.3251 $924.28 $613.5754861 Removal of epididymis Y A2 $630.00 22.3251 $924.28 $703.5754865 Explore epididymis Y A2 $333.00 22.3251 $924.28 $480.8254900 Fusion of spermatic ducts Y A2 $630.00 22.3251 $924.28 $703.5754901 Fusion of spermatic ducts Y A2 $630.00 22.3251 $924.28 $703.5755000 Drainage of hydrocele Y P3 1.8031 $74.65 $74.6555040 Removal of hydrocele Y A2 $510.00 30.6788 $1,270.13 $700.0355041 Removal of hydroceles Y A2 $717.00 30.6788 $1,270.13 $855.2855060 Repair of hydrocele Y A2 $630.00 22.3251 $924.28 $703.5755100 Drainage of scrotum abscess Y A2 $333.00 11.5594 $478.57 $369.3955110 Explore scrotum Y A2 $446.00 22.3251 $924.28 $565.5755120 Removal of scrotum lesion Y A2 $446.00 22.3251 $924.28 $565.5755150 Removal of scrotum Y A2 $333.00 22.3251 $924.28 $480.8255175 Revision of scrotum Y A2 $333.00 22.3251 $924.28 $480.8255180 Revision of scrotum Y A2 $446.00 22.3251 $924.28 $565.5755200 Incision of sperm duct Y A2 $446.00 22.3251 $924.28 $565.5755250 Removal of sperm duct(s) Y A2 $446.00 22.3251 $924.28 $565.5755300 Prepare, sperm duct x-ray N N155400 Repair of sperm duct Y A2 $333.00 22.3251 $924.28 $480.8255450 Ligation of sperm duct Y P3 5.7313 $237.28 $237.2855500 Removal of hydrocele Y A2 $510.00 22.3251 $924.28 $613.5755520 Removal of sperm cord lesion Y A2 $630.00 22.3251 $924.28 $703.5755530 Revise spermatic cord veins Y A2 $630.00 22.3251 $924.28 $703.5755535 Revise spermatic cord veins Y A2 $630.00 30.6788 $1,270.13 $790.0355540 Revise hernia & sperm veins Y A2 $717.00 30.6788 $1,270.13 $855.2855550 Laparo ligate spermatic vein Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5255600 Incise sperm duct pouch Y R2 22.3251 $924.28 $924.2855680 Remove sperm pouch lesion Y A2 $333.00 22.3251 $924.28 $480.8255700 Biopsy of prostate Y A2 $345.83 11.0338 $456.81 $373.5855705 Biopsy of prostate Y A2 $345.83 11.0338 $456.81 $373.5855720 Drainage of prostate abscess Y A2 $333.00 24.7749 $1,025.71 $506.1855725 Drainage of prostate abscess Y A2 $446.00 24.7749 $1,025.71 $590.9355860 Surgical exposure, prostate Y G2 19.3414 $800.75 $800.7555870 Electroejaculation Y P3 1.849 $76.55 $76.5555873 Cryoablate prostate Y H8 $1,339.00 162.5379 $6,729.23 $6,219.6355875 Transperi needle place, pros N A2 $1,339.00 36.0774 $1,493.64 $1,377.6655876* Place rt device/marker, pros Y P3 1.9043 $78.84 $78.8455920 Place needles pelvic for rt Y G2 25.6947 $1,063.79 $1,063.7956405 I & d of vulva/perineum Y P3 1.15 $47.61 $47.6156420 Drainage of gland abscess Y P2 1.352 $55.97 $55.9756440 Surgery for vulva lesion Y A2 $446.00 19.0203 $787.46 $531.3756441 Lysis of labial lesion(s) Y A2 $333.00 19.0203 $787.46 $446.6256442 Hymenotomy Y A2 $333.00 19.0203 $787.46 $446.6256501 Destroy, vulva lesions, sim Y P3 1.5732 $65.13 $65.1356515 Destroy vulva lesion/s compl Y A2 $510.00 19.9041 $824.05 $588.5156605 Biopsy of vulva/perineum Y P3 0.92 $38.09 $38.0956606 Biopsy of vulva/perineum Y P3 0.3956 $16.38 $16.3856620 Partial removal of vulva Y A2 $717.00 19.0203 $787.46 $734.6256625 Complete removal of vulva Y A2 $995.00 19.0203 $787.46 $943.1256700 Partial removal of hymen Y A2 $333.00 19.0203 $787.46 $446.6256740 Remove vagina gland lesion Y A2 $510.00 19.0203 $787.46 $579.3756800 Repair of vagina Y A2 $510.00 19.0203 $787.46 $579.3756805 Repair clitoris Y G2 19.0203 $787.46 $787.4656810 Repair of perineum Y A2 $717.00 19.0203 $787.46 $734.6256820 Exam of vulva w/scope Y P3 1.15 $47.61 $47.6156821 Exam/biopsy of vulva w/scope Y P2 1.352 $55.97 $55.9757000 Exploration of vagina Y A2 $333.00 19.0203 $787.46 $446.6257010 Drainage of pelvic abscess Y A2 $446.00 19.0203 $787.46 $531.3757020 Drainage of pelvic fluid Y A2 $409.33 6.0783 $251.65 $369.9157022 I & d vaginal hematoma, pp Y G2 11.5594 $478.57 $478.5757023 I & d vag hematoma, non-ob Y A2 $333.00 18.3197 $758.45 $439.3657061 Destroy vag lesions, simple Y P3 1.4628 $60.56 $60.5657065 Destroy vag lesions, complex Y A2 $333.00 19.0203 $787.46 $446.6257100 Biopsy of vagina Y P3 0.9384 $38.85 $38.8557105 Biopsy of vagina Y A2 $446.00 19.0203 $787.46 $531.3757130 Remove vagina lesion Y A2 $446.00 19.0203 $787.46 $531.3757135 Remove vagina lesion Y A2 $446.00 19.0203 $787.46 $531.3757150 Treat vagina infection Y P3 0.7727 $31.99 $31.99

Date Printed: 04/08/2023 @ 09:12:30 Page 33 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 57155 Insert uteri tandems/ovoids Y A2 $409.33 6.0783 $251.65 $369.9157160 Insert pessary/other device Y P3 0.9476 $39.23 $39.2357170 Fitting of diaphragm/cap Y P2 0.1309 $5.42 $5.4257180 Treat vaginal bleeding Y A2 $178.05 1.352 $55.97 $147.5357200 Repair of vagina Y A2 $333.00 19.0203 $787.46 $446.6257210 Repair vagina/perineum Y A2 $446.00 19.0203 $787.46 $531.3757220 Revision of urethra Y A2 $510.00 42.7099 $1,768.23 $824.5657230 Repair of urethral lesion Y A2 $510.00 32.4237 $1,342.37 $718.0957240 Repair bladder & vagina Y A2 $717.00 32.4237 $1,342.37 $873.3457250 Repair rectum & vagina Y A2 $717.00 32.4237 $1,342.37 $873.3457260 Repair of vagina Y A2 $717.00 32.4237 $1,342.37 $873.3457265 Extensive repair of vagina Y A2 $995.00 42.7099 $1,768.23 $1,188.3157267 Insert mesh/pelvic flr addon Y A2 $995.00 32.4237 $1,342.37 $1,081.8457268 Repair of bowel bulge Y A2 $510.00 32.4237 $1,342.37 $718.0957287 Revise/remove sling repair Y G2 32.4237 $1,342.37 $1,342.3757288 Repair bladder defect Y A2 $717.00 42.7099 $1,768.23 $979.8157289 Repair bladder & vagina Y A2 $717.00 32.4237 $1,342.37 $873.3457291 Construction of vagina Y A2 $717.00 32.4237 $1,342.37 $873.3457300 Repair rectum-vagina fistula Y A2 $510.00 32.4237 $1,342.37 $718.0957320 Repair bladder-vagina lesion Y G2 32.4237 $1,342.37 $1,342.3757400 Dilation of vagina Y A2 $446.00 19.0203 $787.46 $531.3757410 Pelvic examination Y A2 $446.00 19.0203 $787.46 $531.3757415 Remove vaginal foreign body Y A2 $446.00 19.0203 $787.46 $531.3757420 Exam of vagina w/scope Y P3 1.1867 $49.13 $49.1357421 Exam/biopsy of vag w/scope Y P3 1.5823 $65.51 $65.5157452 Exam of cervix w/scope Y P3 1.1316 $46.85 $46.8557454 Bx/curett of cervix w/scope Y P3 1.3983 $57.89 $57.8957455 Biopsy of cervix w/scope Y P3 1.4811 $61.32 $61.3257456 Endocerv curettage w/scope Y P3 1.4258 $59.03 $59.0357460 Bx of cervix w/scope, leep Y P3 4.655 $192.72 $192.7257461 Conz of cervix w/scope, leep Y P3 4.9124 $203.38 $203.3857500 Biopsy of cervix Y P3 2.0975 $86.84 $86.8457505 Endocervical curettage Y P3 1.2787 $52.94 $52.9457510 Cauterization of cervix Y P3 1.3154 $54.46 $54.4657511 Cryocautery of cervix Y P2 1.352 $55.97 $55.9757513 Laser surgery of cervix Y A2 $446.00 19.0203 $787.46 $531.3757520 Conization of cervix Y A2 $446.00 19.0203 $787.46 $531.3757522 Conization of cervix Y A2 $446.00 19.0203 $787.46 $531.3757530 Removal of cervix Y A2 $510.00 32.4237 $1,342.37 $718.0957550 Removal of residual cervix Y A2 $510.00 32.4237 $1,342.37 $718.0957556 Remove cervix, repair bowel Y A2 $717.00 42.7099 $1,768.23 $979.8157558 D&c of cervical stump Y A2 $510.00 19.0203 $787.46 $579.3757700 Revision of cervix Y A2 $333.00 19.0203 $787.46 $446.6257720 Revision of cervix Y A2 $510.00 19.0203 $787.46 $579.3757800 Dilation of cervical canal Y P3 0.6807 $28.18 $28.1858100 Biopsy of uterus lining Y P3 1.1316 $46.85 $46.8558110 Bx done w/colposcopy add-on N N158120 Dilation and curettage Y A2 $446.00 19.0203 $787.46 $531.3758145 Myomectomy vag method Y A2 $717.00 32.4237 $1,342.37 $873.3458301 Remove intrauterine device Y P3 1.0855 $44.94 $44.9458321 Artificial insemination Y P3 0.9567 $39.61 $39.6158322 Artificial insemination Y P3 1.0304 $42.66 $42.6658323 Sperm washing Y P3 0.3128 $12.95 $12.9558340 Catheter for hysterography N N158345 Reopen fallopian tube Y R2 19.0203 $787.46 $787.4658346 Insert heyman uteri capsule Y A2 $446.00 19.0203 $787.46 $531.3758350 Reopen fallopian tube Y A2 $510.00 32.4237 $1,342.37 $718.0958353 Endometr ablate, thermal Y A2 $995.00 32.4237 $1,342.37 $1,081.8458356 Endometrial cryoablation Y P2 42.7099 $1,768.23 $1,768.2358545 Laparoscopic myomectomy Y A2 $1,339.00 34.3958 $1,424.02 $1,360.2658546 Laparo-myomectomy, complex Y A2 $1,339.00 45.5317 $1,885.06 $1,475.5258550 Laparo-asst vag hysterectomy Y A2 $1,339.00 69.6652 $2,884.21 $1,725.3058552 Laparo-vag hyst incl t/o Y G2 45.5317 $1,885.06 $1,885.0658555 Hysteroscopy, dx, sep proc Y A2 $333.00 21.6576 $896.65 $473.9158558 Hysteroscopy, biopsy Y A2 $510.00 21.6576 $896.65 $606.6658559 Hysteroscopy, lysis Y A2 $446.00 21.6576 $896.65 $558.6658560 Hysteroscopy, resect septum Y A2 $510.00 34.2048 $1,416.11 $736.5358561 Hysteroscopy, remove myoma Y A2 $510.00 34.2048 $1,416.11 $736.5358562 Hysteroscopy, remove fb Y A2 $510.00 21.6576 $896.65 $606.6658563 Hysteroscopy, ablation Y A2 $1,339.00 34.2048 $1,416.11 $1,358.2858565 Hysteroscopy, sterilization Y A2 $1,339.00 42.7099 $1,768.23 $1,446.3158600 Division of fallopian tube Y G2 32.4237 $1,342.37 $1,342.3758615 Occlude fallopian tube(s) Y G2 19.0203 $787.46 $787.4658660 Laparoscopy, lysis Y A2 $717.00 45.5317 $1,885.06 $1,009.0258661 Laparoscopy, remove adnexa Y A2 $717.00 45.5317 $1,885.06 $1,009.0258662 Laparoscopy, excise lesions Y A2 $717.00 45.5317 $1,885.06 $1,009.0258670 Laparoscopy, tubal cautery Y A2 $510.00 45.5317 $1,885.06 $853.7758671 Laparoscopy, tubal block Y A2 $510.00 45.5317 $1,885.06 $853.7758672 Laparoscopy, fimbrioplasty Y A2 $717.00 45.5317 $1,885.06 $1,009.0258673 Laparoscopy, salpingostomy Y A2 $717.00 45.5317 $1,885.06 $1,009.0258800 Drainage of ovarian cyst(s) Y A2 $510.00 19.0203 $787.46 $579.3758805 Drainage of ovarian cyst(s) Y G2 32.4237 $1,342.37 $1,342.3758820 Drain ovary abscess, open Y A2 $510.00 32.4237 $1,342.37 $718.0958900 Biopsy of ovary(s) Y A2 $510.00 19.0203 $787.46 $579.3758970 Retrieval of oocyte Y A2 $245.92 2.7584 $114.20 $212.9958974 Transfer of embryo Y A2 $245.92 2.7584 $114.20 $212.9958976 Transfer of embryo Y A2 $245.92 2.7584 $114.20 $212.9959000 Amniocentesis, diagnostic Y P3 1.7572 $72.75 $72.75

Date Printed: 04/08/2023 @ 09:12:30 Page 34 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 59001 Amniocentesis, therapeutic Y R2 6.0783 $251.65 $251.6559012 Fetal cord puncture,prenatal Y G2 2.7584 $114.20 $114.2059015 Chorion biopsy Y P3 1.3616 $56.37 $56.3759020 Fetal contract stress test Y P3 0.6439 $26.66 $26.6659025 Fetal non-stress test Y P3 0.3312 $13.71 $13.7159070 Transabdom amnioinfus w/us Y G2 2.7584 $114.20 $114.2059072 Umbilical cord occlud w/us Y G2 2.7584 $114.20 $114.2059076 Fetal shunt placement, w/us Y G2 2.7584 $114.20 $114.2059100 Remove uterus lesion Y R2 32.4237 $1,342.37 $1,342.3759150 Treat ectopic pregnancy Y G2 45.5317 $1,885.06 $1,885.0659151 Treat ectopic pregnancy Y G2 45.5317 $1,885.06 $1,885.0659160 D & c after delivery Y A2 $510.00 19.0203 $787.46 $579.3759200 Insert cervical dilator Y P3 0.9751 $40.37 $40.3759300 Episiotomy or vaginal repair Y P3 2.0055 $83.03 $83.0359320 Revision of cervix Y A2 $333.00 19.0203 $787.46 $446.6259412 Antepartum manipulation Y G2 19.0203 $787.46 $787.4659414 Deliver placenta Y G2 19.0203 $787.46 $787.4659812 Treatment of miscarriage Y A2 $717.00 19.0203 $787.46 $734.6259820 Care of miscarriage Y A2 $717.00 19.0203 $787.46 $734.6259821 Treatment of miscarriage Y A2 $717.00 19.0203 $787.46 $734.6259840 Abortion Y A2 $717.00 19.0203 $787.46 $734.6259841 Abortion Y A2 $717.00 19.0203 $787.46 $734.6259866 Abortion (mpr) Y G2 2.7584 $114.20 $114.2059870 Evacuate mole of uterus Y A2 $717.00 19.0203 $787.46 $734.6259871 Remove cerclage suture Y A2 $717.00 19.0203 $787.46 $734.6260000 Drain thyroid/tongue cyst Y A2 $333.00 7.4474 $308.33 $326.8360001 Aspirate/inject thyriod cyst N D560100 Biopsy of thyroid Y P3 1.2512 $51.80 $51.8060200 Remove thyroid lesion Y A2 $446.00 44.324 $1,835.06 $793.2760280 Remove thyroid duct lesion Y A2 $630.00 44.324 $1,835.06 $931.2760281 Remove thyroid duct lesion Y A2 $630.00 44.324 $1,835.06 $931.2760300 Aspir/inj thyroid cyst Y P3 1.5364 $63.61 $63.6161000 Remove cranial cavity fluid Y R2 8.5263 $353.00 $353.0061001 Remove cranial cavity fluid Y R2 8.5263 $353.00 $353.0061020 Remove brain cavity fluid Y A2 $183.83 8.5263 $353.00 $226.1261026 Injection into brain canal Y A2 $183.83 8.5263 $353.00 $226.1261050 Remove brain canal fluid Y A2 $183.83 8.5263 $353.00 $226.1261055 Injection into brain canal Y A2 $183.83 8.5263 $353.00 $226.1261070 Brain canal shunt procedure Y A2 $183.83 3.2383 $134.07 $171.3961215 Insert brain-fluid device Y A2 $510.00 36.2768 $1,501.90 $757.9861330 Decompress eye socket Y G2 39.8776 $1,650.97 $1,650.9761334 Explore orbit/remove object Y G2 39.8776 $1,650.97 $1,650.9761790 Treat trigeminal nerve Y A2 $510.00 18.0518 $747.36 $569.3461791 Treat trigeminal tract Y A2 $351.92 14.4879 $599.81 $413.8961795 Brain surgery using computer N N161880 Revise/remove neuroelectrode Y G2 22.4734 $930.42 $930.4261885 Insrt/redo neurostim 1 array N H8 $446.00 269.543 $11,159.35 $10,493.8961886 Implant neurostim arrays N H8 $510.00 395.2777 $16,364.89 $15,586.1661888 Revise/remove neuroreceiver Y A2 $333.00 34.4166 $1,424.88 $605.9762194 Replace/irrigate catheter Y A2 $333.00 8.5263 $353.00 $338.0062225 Replace/irrigate catheter Y A2 $333.00 15.3545 $635.69 $408.6762230 Replace/revise brain shunt Y A2 $446.00 36.2768 $1,501.90 $709.9862252 Csf shunt reprogram N P3 1.1959 $49.51 $49.5162263 Epidural lysis mult sessions Y A2 $333.00 14.4879 $599.81 $399.7062264 Epidural lysis on single day Y A2 $333.00 14.4879 $599.81 $399.7062268 Drain spinal cord cyst Y A2 $183.83 8.5263 $353.00 $226.1262269 Needle biopsy, spinal cord Y A2 $333.00 9.3354 $386.49 $346.3762270 Spinal fluid tap, diagnostic Y A2 $139.00 4.0964 $169.60 $146.6562272 Drain cerebro spinal fluid Y A2 $139.00 4.0964 $169.60 $146.6562273 Inject epidural patch Y A2 $333.00 4.0964 $169.60 $292.1562280 Treat spinal cord lesion Y A2 $333.00 7.0546 $292.07 $322.7762281 Treat spinal cord lesion Y A2 $333.00 7.0546 $292.07 $322.7762282 Treat spinal canal lesion Y A2 $333.00 7.0546 $292.07 $322.7762284 Injection for myelogram N N162287 Percutaneous diskectomy Y A2 $1,339.00 33.2707 $1,377.44 $1,348.6162290 Inject for spine disk x-ray N N162291 Inject for spine disk x-ray N N162292 Injection into disk lesion Y R2 8.5263 $353.00 $353.0062294 Injection into spinal artery Y A2 $183.83 8.5263 $353.00 $226.1262310 Inject spine c/t Y A2 $333.00 7.0546 $292.07 $322.7762311 Inject spine l/s (cd) Y A2 $333.00 7.0546 $292.07 $322.7762318 Inject spine w/cath, c/t Y A2 $333.00 7.0546 $292.07 $322.7762319 Inject spine w/cath l/s (cd) Y A2 $333.00 7.0546 $292.07 $322.7762350 Implant spinal canal cath Y A2 $446.00 36.2768 $1,501.90 $709.9862355 Remove spinal canal catheter Y A2 $446.00 14.4879 $599.81 $484.4562360 Insert spine infusion device Y A2 $446.00 36.2768 $1,501.90 $709.9862361 Implant spine infusion pump Y H8 $446.00 263.8315 $10,922.89 $10,157.0762362 Implant spine infusion pump Y H8 $446.00 263.8315 $10,922.89 $10,157.0762365 Remove spine infusion device Y A2 $446.00 33.2707 $1,377.44 $678.8662367 Analyze spine infusion pump N P3 0.4785 $19.81 $19.8162368 Analyze spine infusion pump N P3 0.5795 $23.99 $23.9963600 Remove spinal cord lesion Y A2 $446.00 18.0518 $747.36 $521.3463610 Stimulation of spinal cord Y A2 $333.00 18.0518 $747.36 $436.5963615 Remove lesion of spinal cord Y R2 18.0518 $747.36 $747.3663650 Implant neuroelectrodes N H8 $446.00 83.1135 $3,440.98 $2,909.3663655 Implant neuroelectrodes N J8 109.8976 $4,549.87 $4,549.8763660 Revise/remove neuroelectrode Y A2 $333.00 22.4734 $930.42 $482.3663685 Insrt/redo spine n generator N H8 $446.00 350.8302 $14,524.72 $13,727.20

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 63688 Revise/remove neuroreceiver Y A2 $333.00 34.4166 $1,424.88 $605.9763744 Revision of spinal shunt Y A2 $510.00 36.2768 $1,501.90 $757.9863746 Removal of spinal shunt Y A2 $446.00 5.6614 $234.39 $393.1064400 N block inj, trigeminal Y P3 1.527 $63.22 $63.2264402 N block inj, facial Y P3 1.3891 $57.51 $57.5164405 N block inj, occipital Y P3 1.205 $49.89 $49.8964408 N block inj, vagus Y P3 1.3891 $57.51 $57.5164410 N block inj, phrenic Y A2 $333.00 7.0546 $292.07 $322.7764412 N block inj, spinal accessor Y P3 2.1987 $91.03 $91.0364413 N block inj, cervical plexus Y P3 1.4536 $60.18 $60.1864415 N block inj, brachial plexus Y A2 $139.00 4.0964 $169.60 $146.6564416 N block cont infuse, b plex Y G2 7.0546 $292.07 $292.0764417 N block inj, axillary Y A2 $139.00 4.0964 $169.60 $146.6564418 N block inj, suprascapular Y P3 2.0792 $86.08 $86.0864420 N block inj, intercost, sng Y A2 $139.00 4.0964 $169.60 $146.6564421 N block inj, intercost, mlt Y A2 $333.00 4.0964 $169.60 $292.1564425 N block inj, ilio-ing/hypogi Y P3 1.3524 $55.99 $55.9964430 N block inj, pudendal Y A2 $139.00 7.0546 $292.07 $177.2764435 N block inj, paracervical Y P3 2.0792 $86.08 $86.0864445 N block inj, sciatic, sng Y P3 1.978 $81.89 $81.8964446 N blk inj, sciatic, cont inf Y G2 14.4879 $599.81 $599.8164447 N block inj fem, single Y R2 4.0964 $169.60 $169.6064450 N block, other peripheral Y P3 1.1592 $47.99 $47.9964470 Inj paravertebral c/t Y A2 $333.00 7.0546 $292.07 $322.7764472 Inj paravertebral c/t add-on Y A2 $333.00 4.0964 $169.60 $292.1564475 Inj paravertebral l/s Y A2 $333.00 7.0546 $292.07 $322.7764476 Inj paravertebral l/s add-on Y A2 $333.00 2.3213 $96.10 $273.7864479 Inj foramen epidural c/t Y A2 $333.00 7.0546 $292.07 $322.7764480 Inj foramen epidural add-on Y A2 $333.00 4.0964 $169.60 $292.1564483 Inj foramen epidural l/s Y A2 $333.00 7.0546 $292.07 $322.7764484 Inj foramen epidural add-on Y A2 $333.00 4.0964 $169.60 $292.1564505 N block, spenopalatine gangl Y P3 1.0855 $44.94 $44.9464508 N block, carotid sinus s/p Y P2 2.3213 $96.10 $96.1064510 N block, stellate ganglion Y A2 $333.00 7.0546 $292.07 $322.7764517 N block inj, hypogas plxs Y A2 $139.00 7.0546 $292.07 $177.2764520 N block, lumbar/thoracic Y A2 $333.00 7.0546 $292.07 $322.7764530 N block inj, celiac pelus Y A2 $333.00 7.0546 $292.07 $322.7764553 Implant neuroelectrodes N H8 $333.00 316.5407 $13,105.10 $12,022.9564555 Implant neuroelectrodes N J8 83.1135 $3,440.98 $3,440.9864560 Implant neuroelectrodes N J8 83.1135 $3,440.98 $3,440.9864561 Implant neuroelectrodes N H8 $510.00 83.1135 $3,440.98 $2,957.3664565 Implant neuroelectrodes N J8 83.1135 $3,440.98 $3,440.9864573 Implant neuroelectrodes N H8 $333.00 316.5407 $13,105.10 $12,022.9564575 Implant neuroelectrodes N H8 $333.00 109.8976 $4,549.87 $3,785.9264577 Implant neuroelectrodes N H8 $333.00 109.8976 $4,549.87 $3,785.9264580 Implant neuroelectrodes N H8 $333.00 109.8976 $4,549.87 $3,785.9264581 Implant neuroelectrodes N H8 $510.00 109.8976 $4,549.87 $3,918.6764585 Revise/remove neuroelectrode Y A2 $333.00 22.4734 $930.42 $482.3664590 Insrt/redo pn/gastr stimul N H8 $446.00 269.543 $11,159.35 $10,493.8964595 Revise/rmv pn/gastr stimul Y A2 $333.00 34.4166 $1,424.88 $605.9764600 Injection treatment of nerve Y A2 $333.00 14.4879 $599.81 $399.7064605 Injection treatment of nerve Y A2 $333.00 14.4879 $599.81 $399.7064610 Injection treatment of nerve Y A2 $333.00 14.4879 $599.81 $399.7064612 Destroy nerve, face muscle Y P3 1.8676 $77.32 $77.3264613 Destroy nerve, neck muscle Y P3 1.978 $81.89 $81.8964614 Destroy nerve, extrem musc Y P3 2.2263 $92.17 $92.1764620 Injection treatment of nerve Y A2 $333.00 7.0546 $292.07 $322.7764622 Destr paravertebrl nerve l/s Y A2 $333.00 14.4879 $599.81 $399.7064623 Destr paravertebral n add-on Y A2 $333.00 7.0546 $292.07 $322.7764626 Destr paravertebrl nerve c/t Y A2 $333.00 14.4879 $599.81 $399.7064627 Destr paravertebral n add-on Y A2 $333.00 2.3213 $96.10 $273.7864630 Injection treatment of nerve Y A2 $351.92 7.0546 $292.07 $336.9664640 Injection treatment of nerve Y P3 3.0359 $125.69 $125.6964650 Chemodenerv eccrine glands Y P3 0.7268 $30.09 $30.0964653 Chemodenerv eccrine glands Y P3 0.7635 $31.61 $31.6164680 Injection treatment of nerve Y A2 $390.95 14.4879 $599.81 $443.1764681 Injection treatment of nerve Y A2 $446.00 14.4879 $599.81 $484.4564702 Revise finger/toe nerve Y A2 $333.00 18.0518 $747.36 $436.5964704 Revise hand/foot nerve Y A2 $333.00 18.0518 $747.36 $436.5964708 Revise arm/leg nerve Y A2 $446.00 18.0518 $747.36 $521.3464712 Revision of sciatic nerve Y A2 $446.00 18.0518 $747.36 $521.3464713 Revision of arm nerve(s) Y A2 $446.00 18.0518 $747.36 $521.3464714 Revise low back nerve(s) Y A2 $446.00 18.0518 $747.36 $521.3464716 Revision of cranial nerve Y A2 $510.00 18.0518 $747.36 $569.3464718 Revise ulnar nerve at elbow Y A2 $446.00 18.0518 $747.36 $521.3464719 Revise ulnar nerve at wrist Y A2 $446.00 18.0518 $747.36 $521.3464721 Carpal tunnel surgery Y A2 $446.00 18.0518 $747.36 $521.3464722 Relieve pressure on nerve(s) Y A2 $333.00 18.0518 $747.36 $436.5964726 Release foot/toe nerve Y A2 $333.00 18.0518 $747.36 $436.5964727 Internal nerve revision Y A2 $333.00 18.0518 $747.36 $436.5964732 Incision of brow nerve Y A2 $446.00 18.0518 $747.36 $521.3464734 Incision of cheek nerve Y A2 $446.00 18.0518 $747.36 $521.3464736 Incision of chin nerve Y A2 $446.00 18.0518 $747.36 $521.3464738 Incision of jaw nerve Y A2 $446.00 18.0518 $747.36 $521.3464740 Incision of tongue nerve Y A2 $446.00 18.0518 $747.36 $521.3464742 Incision of facial nerve Y A2 $446.00 18.0518 $747.36 $521.3464744 Incise nerve, back of head Y A2 $446.00 18.0518 $747.36 $521.3464746 Incise diaphragm nerve Y A2 $446.00 18.0518 $747.36 $521.34

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 64761 Incision of pelvis nerve Y G2 18.0518 $747.36 $747.3664763 Incise hip/thigh nerve Y G2 18.0518 $747.36 $747.3664766 Incise hip/thigh nerve Y G2 33.2707 $1,377.44 $1,377.4464771 Sever cranial nerve Y A2 $446.00 18.0518 $747.36 $521.3464772 Incision of spinal nerve Y A2 $446.00 18.0518 $747.36 $521.3464774 Remove skin nerve lesion Y A2 $446.00 18.0518 $747.36 $521.3464776 Remove digit nerve lesion Y A2 $510.00 18.0518 $747.36 $569.3464778 Digit nerve surgery add-on Y A2 $446.00 18.0518 $747.36 $521.3464782 Remove limb nerve lesion Y A2 $510.00 18.0518 $747.36 $569.3464783 Limb nerve surgery add-on Y A2 $446.00 18.0518 $747.36 $521.3464784 Remove nerve lesion Y A2 $510.00 18.0518 $747.36 $569.3464786 Remove sciatic nerve lesion Y A2 $510.00 33.2707 $1,377.44 $726.8664787 Implant nerve end Y A2 $446.00 18.0518 $747.36 $521.3464788 Remove skin nerve lesion Y A2 $510.00 18.0518 $747.36 $569.3464790 Removal of nerve lesion Y A2 $510.00 18.0518 $747.36 $569.3464792 Removal of nerve lesion Y A2 $510.00 33.2707 $1,377.44 $726.8664795 Biopsy of nerve Y A2 $446.00 18.0518 $747.36 $521.3464802 Remove sympathetic nerves Y A2 $446.00 18.0518 $747.36 $521.3464820 Remove sympathetic nerves Y G2 18.0518 $747.36 $747.3664821 Remove sympathetic nerves Y A2 $630.00 26.3105 $1,089.28 $744.8264822 Remove sympathetic nerves Y G2 26.3105 $1,089.28 $1,089.2864823 Remove sympathetic nerves Y G2 26.3105 $1,089.28 $1,089.2864831 Repair of digit nerve Y A2 $630.00 33.2707 $1,377.44 $816.8664832 Repair nerve add-on Y A2 $333.00 33.2707 $1,377.44 $594.1164834 Repair of hand or foot nerve Y A2 $446.00 33.2707 $1,377.44 $678.8664835 Repair of hand or foot nerve Y A2 $510.00 33.2707 $1,377.44 $726.8664836 Repair of hand or foot nerve Y A2 $510.00 33.2707 $1,377.44 $726.8664837 Repair nerve add-on Y A2 $333.00 33.2707 $1,377.44 $594.1164840 Repair of leg nerve Y A2 $446.00 33.2707 $1,377.44 $678.8664856 Repair/transpose nerve Y A2 $446.00 33.2707 $1,377.44 $678.8664857 Repair arm/leg nerve Y A2 $446.00 33.2707 $1,377.44 $678.8664858 Repair sciatic nerve Y A2 $446.00 33.2707 $1,377.44 $678.8664859 Nerve surgery Y A2 $333.00 33.2707 $1,377.44 $594.1164861 Repair of arm nerves Y A2 $510.00 33.2707 $1,377.44 $726.8664862 Repair of low back nerves Y A2 $510.00 33.2707 $1,377.44 $726.8664864 Repair of facial nerve Y A2 $510.00 33.2707 $1,377.44 $726.8664865 Repair of facial nerve Y A2 $630.00 33.2707 $1,377.44 $816.8664870 Fusion of facial/other nerve Y A2 $630.00 33.2707 $1,377.44 $816.8664872 Subsequent repair of nerve Y A2 $446.00 33.2707 $1,377.44 $678.8664874 Repair & revise nerve add-on Y A2 $510.00 33.2707 $1,377.44 $726.8664876 Repair nerve/shorten bone Y A2 $510.00 33.2707 $1,377.44 $726.8664885 Nerve graft, head or neck Y A2 $446.00 33.2707 $1,377.44 $678.8664886 Nerve graft, head or neck Y A2 $446.00 33.2707 $1,377.44 $678.8664890 Nerve graft, hand or foot Y A2 $446.00 33.2707 $1,377.44 $678.8664891 Nerve graft, hand or foot Y A2 $446.00 33.2707 $1,377.44 $678.8664892 Nerve graft, arm or leg Y A2 $446.00 33.2707 $1,377.44 $678.8664893 Nerve graft, arm or leg Y A2 $446.00 33.2707 $1,377.44 $678.8664895 Nerve graft, hand or foot Y A2 $510.00 33.2707 $1,377.44 $726.8664896 Nerve graft, hand or foot Y A2 $510.00 33.2707 $1,377.44 $726.8664897 Nerve graft, arm or leg Y A2 $510.00 33.2707 $1,377.44 $726.8664898 Nerve graft, arm or leg Y A2 $510.00 33.2707 $1,377.44 $726.8664901 Nerve graft add-on Y A2 $446.00 33.2707 $1,377.44 $678.8664902 Nerve graft add-on Y A2 $446.00 33.2707 $1,377.44 $678.8664905 Nerve pedicle transfer Y A2 $446.00 33.2707 $1,377.44 $678.8664907 Nerve pedicle transfer Y A2 $333.00 33.2707 $1,377.44 $594.1164910 Nerve repair w/allograft Y G2 18.0518 $747.36 $747.3665091 Revise eye Y A2 $510.00 37.7243 $1,561.82 $772.9665093 Revise eye with implant Y A2 $510.00 37.7243 $1,561.82 $772.9665101 Removal of eye Y A2 $510.00 37.7243 $1,561.82 $772.9665103 Remove eye/insert implant Y A2 $510.00 37.7243 $1,561.82 $772.9665105 Remove eye/attach implant Y A2 $630.00 37.7243 $1,561.82 $862.9665110 Removal of eye Y A2 $717.00 37.7243 $1,561.82 $928.2165112 Remove eye/revise socket Y A2 $995.00 37.7243 $1,561.82 $1,136.7165114 Remove eye/revise socket Y A2 $995.00 37.7243 $1,561.82 $1,136.7165125 Revise ocular implant Y G2 18.7307 $775.47 $775.4765130 Insert ocular implant Y A2 $510.00 24.3077 $1,006.36 $634.0965135 Insert ocular implant Y A2 $446.00 24.3077 $1,006.36 $586.0965140 Attach ocular implant Y A2 $510.00 37.7243 $1,561.82 $772.9665150 Revise ocular implant Y A2 $446.00 24.3077 $1,006.36 $586.0965155 Reinsert ocular implant Y A2 $510.00 37.7243 $1,561.82 $772.9665175 Removal of ocular implant Y A2 $333.00 18.7307 $775.47 $443.6265205 Remove foreign body from eye N P3 0.5519 $22.85 $22.8565210 Remove foreign body from eye N P3 0.6993 $28.95 $28.9565220 Remove foreign body from eye N G2 0.8696 $36.00 $36.0065222 Remove foreign body from eye N P3 0.7635 $31.61 $31.6165235 Remove foreign body from eye Y A2 $446.00 16.171 $669.50 $501.8865260 Remove foreign body from eye Y A2 $510.00 18.235 $754.95 $571.2465265 Remove foreign body from eye Y A2 $630.00 27.845 $1,152.81 $760.7065270 Repair of eye wound Y A2 $446.00 18.7307 $775.47 $528.3765272 Repair of eye wound Y A2 $446.00 23.1758 $959.50 $574.3865275 Repair of eye wound Y A2 $630.00 23.1758 $959.50 $712.3865280 Repair of eye wound Y A2 $630.00 18.235 $754.95 $661.2465285 Repair of eye wound Y A2 $630.00 37.2078 $1,540.44 $857.6165286 Repair of eye wound Y P2 5.1169 $211.84 $211.8465290 Repair of eye socket wound Y A2 $510.00 24.1291 $998.97 $632.2465400 Removal of eye lesion Y A2 $333.00 16.171 $669.50 $417.1365410 Biopsy of cornea Y A2 $446.00 16.171 $669.50 $501.8865420 Removal of eye lesion Y A2 $446.00 16.171 $669.50 $501.88

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 65426 Removal of eye lesion Y A2 $717.00 23.1758 $959.50 $777.6365430 Corneal smear N P2 0.8696 $36.00 $36.0065435 Curette/treat cornea Y P3 0.8555 $35.42 $35.4265436 Curette/treat cornea Y G2 16.171 $669.50 $669.5065450 Treatment of corneal lesion N G2 2.179 $90.21 $90.2165600 Revision of cornea Y P3 4.3422 $179.77 $179.7765710 Corneal transplant Y A2 $995.00 37.4896 $1,552.11 $1,134.2865730 Corneal transplant Y A2 $995.00 37.4896 $1,552.11 $1,134.2865750 Corneal transplant Y A2 $995.00 37.4896 $1,552.11 $1,134.2865755 Corneal transplant Y A2 $995.00 37.4896 $1,552.11 $1,134.2865770 Revise cornea with implant Y A2 $995.00 84.8039 $3,510.97 $1,623.9965772 Correction of astigmatism Y A2 $630.00 16.171 $669.50 $639.8865775 Correction of astigmatism Y A2 $630.00 16.171 $669.50 $639.8865780 Ocular reconst, transplant Y A2 $717.00 37.4896 $1,552.11 $925.7865781 Ocular reconst, transplant Y A2 $717.00 37.4896 $1,552.11 $925.7865782 Ocular reconst, transplant Y A2 $717.00 37.4896 $1,552.11 $925.7865800 Drainage of eye Y A2 $333.00 16.171 $669.50 $417.1365805 Drainage of eye Y A2 $333.00 16.171 $669.50 $417.1365810 Drainage of eye Y A2 $510.00 23.1758 $959.50 $622.3865815 Drainage of eye Y A2 $446.00 23.1758 $959.50 $574.3865820 Relieve inner eye pressure Y A2 $333.00 5.1169 $211.84 $302.7165850 Incision of eye Y A2 $630.00 23.1758 $959.50 $712.3865855 Laser surgery of eye Y P3 3.5878 $148.54 $148.5465860 Incise inner eye adhesions Y P3 3.3579 $139.02 $139.0265865 Incise inner eye adhesions Y A2 $333.00 16.171 $669.50 $417.1365870 Incise inner eye adhesions Y A2 $630.00 23.1758 $959.50 $712.3865875 Incise inner eye adhesions Y A2 $630.00 23.1758 $959.50 $712.3865880 Incise inner eye adhesions Y A2 $630.00 16.171 $669.50 $639.8865900 Remove eye lesion Y A2 $717.00 16.171 $669.50 $705.1365920 Remove implant of eye Y A2 $995.00 23.1758 $959.50 $986.1365930 Remove blood clot from eye Y A2 $717.00 23.1758 $959.50 $777.6366020 Injection treatment of eye Y A2 $333.00 16.171 $669.50 $417.1366030 Injection treatment of eye Y A2 $333.00 5.1169 $211.84 $302.7166130 Remove eye lesion Y A2 $995.00 23.1758 $959.50 $986.1366150 Glaucoma surgery Y A2 $630.00 23.1758 $959.50 $712.3866155 Glaucoma surgery Y A2 $630.00 23.1758 $959.50 $712.3866160 Glaucoma surgery Y A2 $446.00 23.1758 $959.50 $574.3866165 Glaucoma surgery Y A2 $630.00 23.1758 $959.50 $712.3866170 Glaucoma surgery Y A2 $630.00 23.1758 $959.50 $712.3866172 Incision of eye Y A2 $630.00 23.1758 $959.50 $712.3866180 Implant eye shunt Y A2 $717.00 39.7101 $1,644.04 $948.7666185 Revise eye shunt Y A2 $446.00 39.7101 $1,644.04 $745.5166220 Repair eye lesion Y A2 $510.00 37.2078 $1,540.44 $767.6166225 Repair/graft eye lesion Y A2 $630.00 39.7101 $1,644.04 $883.5166250 Follow-up surgery of eye Y A2 $446.00 16.171 $669.50 $501.8866500 Incision of iris Y A2 $333.00 5.1169 $211.84 $302.7166505 Incision of iris Y A2 $333.00 5.1169 $211.84 $302.7166600 Remove iris and lesion Y A2 $510.00 23.1758 $959.50 $622.3866605 Removal of iris Y A2 $510.00 23.1758 $959.50 $622.3866625 Removal of iris Y A2 $372.94 5.1169 $211.84 $332.6766630 Removal of iris Y A2 $510.00 23.1758 $959.50 $622.3866635 Removal of iris Y A2 $510.00 23.1758 $959.50 $622.3866680 Repair iris & ciliary body Y A2 $510.00 23.1758 $959.50 $622.3866682 Repair iris & ciliary body Y A2 $446.00 23.1758 $959.50 $574.3866700 Destruction, ciliary body Y A2 $446.00 16.171 $669.50 $501.8866710 Ciliary transsleral therapy Y A2 $446.00 16.171 $669.50 $501.8866711 Ciliary endoscopic ablation Y A2 $446.00 16.171 $669.50 $501.8866720 Destruction, ciliary body Y A2 $446.00 16.171 $669.50 $501.8866740 Destruction, ciliary body Y A2 $446.00 23.1758 $959.50 $574.3866761 Revision of iris Y P3 4.8849 $202.24 $202.2466762 Revision of iris Y P3 4.9494 $204.91 $204.9166770 Removal of inner eye lesion Y P2 5.2001 $215.29 $215.2966820 Incision, secondary cataract Y G2 5.1169 $211.84 $211.8466821 After cataract laser surgery Y A2 $312.50 5.2001 $215.29 $288.2066825 Reposition intraocular lens Y A2 $630.00 23.1758 $959.50 $712.3866830 Removal of lens lesion Y A2 $372.94 5.1169 $211.84 $332.6766840 Removal of lens material Y A2 $630.00 14.9171 $617.58 $626.9066850 Removal of lens material Y A2 $995.00 28.7035 $1,188.35 $1,043.3466852 Removal of lens material Y A2 $630.00 28.7035 $1,188.35 $769.5966920 Extraction of lens Y A2 $630.00 28.7035 $1,188.35 $769.5966930 Extraction of lens Y A2 $717.00 28.7035 $1,188.35 $834.8466940 Extraction of lens Y A2 $717.00 14.9171 $617.58 $692.1566982 Cataract surgery, complex Y A2 $973.00 23.8649 $988.03 $976.7666983 Cataract surg w/iol, 1 stage Y A2 $973.00 23.8649 $988.03 $976.7666984 Cataract surg w/iol, 1 stage Y A2 $973.00 23.8649 $988.03 $976.7666985 Insert lens prosthesis Y A2 $826.00 23.8649 $988.03 $866.5166986 Exchange lens prosthesis Y A2 $826.00 23.8649 $988.03 $866.5166990 Ophthalmic endoscope add-on N N167005 Partial removal of eye fluid Y A2 $630.00 27.845 $1,152.81 $760.7067010 Partial removal of eye fluid Y A2 $630.00 27.845 $1,152.81 $760.7067015 Release of eye fluid Y A2 $333.00 27.845 $1,152.81 $537.9567025 Replace eye fluid Y A2 $333.00 27.845 $1,152.81 $537.9567027 Implant eye drug system Y A2 $630.00 37.2078 $1,540.44 $857.6167028 Injection eye drug N P2 2.179 $90.21 $90.2167030 Incise inner eye strands Y A2 $333.00 18.235 $754.95 $438.4967031 Laser surgery, eye strands Y A2 $312.50 5.2001 $215.29 $288.2067036 Removal of inner eye fluid Y A2 $630.00 37.2078 $1,540.44 $857.6167038 Strip retinal membrane N D5

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Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 67039 Laser treatment of retina Y A2 $995.00 37.2078 $1,540.44 $1,131.3667040 Laser treatment of retina Y A2 $995.00 37.2078 $1,540.44 $1,131.3667041 Vit for macular pucker Y G2 37.2078 $1,540.44 $1,540.4467042 Vit for macular hole Y G2 37.2078 $1,540.44 $1,540.4467043 Vit for membrane dissect Y G2 37.2078 $1,540.44 $1,540.4467101 Repair detached retina Y P3 8.1049 $335.55 $335.5567105 Repair detached retina Y P2 5.2001 $215.29 $215.2967107 Repair detached retina Y A2 $717.00 37.2078 $1,540.44 $922.8667108 Repair detached retina Y A2 $995.00 37.2078 $1,540.44 $1,131.3667110 Repair detached retina Y P3 8.8131 $364.87 $364.8767112 Rerepair detached retina Y A2 $995.00 37.2078 $1,540.44 $1,131.3667113 Repair retinal detach, cplx Y G2 37.2078 $1,540.44 $1,540.4467115 Release encircling material Y A2 $446.00 18.235 $754.95 $523.2467120 Remove eye implant material Y A2 $446.00 18.235 $754.95 $523.2467121 Remove eye implant material Y A2 $446.00 27.845 $1,152.81 $622.7067141 Treatment of retina Y A2 $241.77 4.1331 $171.11 $224.1167145 Treatment of retina Y P3 5.0873 $210.62 $210.6267208 Treatment of retinal lesion Y P3 5.4185 $224.33 $224.3367210 Treatment of retinal lesion Y P2 5.2001 $215.29 $215.2967218 Treatment of retinal lesion Y A2 $717.00 18.235 $754.95 $726.4967220 Treatment of choroid lesion Y P2 4.1331 $171.11 $171.1167221 Ocular photodynamic ther Y P3 3.3301 $137.87 $137.8767225 Eye photodynamic ther add-on Y P3 0.2208 $9.14 $9.1467227 Treatment of retinal lesion Y A2 $333.00 27.845 $1,152.81 $537.9567228 Treatment of retinal lesion Y P2 5.2001 $215.29 $215.2967229* Tr retinal les preterm inf Y R2 5.2001 $215.29 $215.2967250 Reinforce eye wall Y A2 $510.00 18.7307 $775.47 $576.3767255 Reinforce/graft eye wall Y A2 $510.00 27.845 $1,152.81 $670.7067311 Revise eye muscle Y A2 $510.00 24.1291 $998.97 $632.2467312 Revise two eye muscles Y A2 $630.00 24.1291 $998.97 $722.2467314 Revise eye muscle Y A2 $630.00 24.1291 $998.97 $722.2467316 Revise two eye muscles Y A2 $630.00 24.1291 $998.97 $722.2467318 Revise eye muscle(s) Y A2 $630.00 24.1291 $998.97 $722.2467320 Revise eye muscle(s) add-on Y A2 $630.00 24.1291 $998.97 $722.2467331 Eye surgery follow-up add-on Y A2 $630.00 24.1291 $998.97 $722.2467332 Rerevise eye muscles add-on Y A2 $630.00 24.1291 $998.97 $722.2467334 Revise eye muscle w/suture Y A2 $630.00 24.1291 $998.97 $722.2467335 Eye suture during surgery Y A2 $630.00 24.1291 $998.97 $722.2467340 Revise eye muscle add-on Y A2 $630.00 24.1291 $998.97 $722.2467343 Release eye tissue Y A2 $995.00 24.1291 $998.97 $995.9967345 Destroy nerve of eye muscle Y P3 2.1896 $90.65 $90.6567346 Biopsy, eye muscle Y A2 $333.00 13.7453 $569.07 $392.0267400 Explore/biopsy eye socket Y A2 $510.00 24.3077 $1,006.36 $634.0967405 Explore/drain eye socket Y A2 $630.00 24.3077 $1,006.36 $724.0967412 Explore/treat eye socket Y A2 $717.00 24.3077 $1,006.36 $789.3467413 Explore/treat eye socket Y A2 $717.00 24.3077 $1,006.36 $789.3467414 Explr/decompress eye socket Y G2 37.7243 $1,561.82 $1,561.8267415 Aspiration, orbital contents Y A2 $333.00 18.7307 $775.47 $443.6267420 Explore/treat eye socket Y A2 $717.00 37.7243 $1,561.82 $928.2167430 Explore/treat eye socket Y A2 $717.00 37.7243 $1,561.82 $928.2167440 Explore/drain eye socket Y A2 $717.00 37.7243 $1,561.82 $928.2167445 Explr/decompress eye socket Y A2 $717.00 37.7243 $1,561.82 $928.2167450 Explore/biopsy eye socket Y A2 $717.00 37.7243 $1,561.82 $928.2167500 Inject/treat eye socket N G2 2.179 $90.21 $90.2167505 Inject/treat eye socket Y G2 2.9022 $120.15 $120.1567515 Inject/treat eye socket Y P3 0.6256 $25.90 $25.9067550 Insert eye socket implant Y A2 $630.00 37.7243 $1,561.82 $862.9667560 Revise eye socket implant Y A2 $446.00 24.3077 $1,006.36 $586.0967570 Decompress optic nerve Y A2 $630.00 37.7243 $1,561.82 $862.9667700 Drainage of eyelid abscess Y P2 2.9022 $120.15 $120.1567710 Incision of eyelid Y P3 4.1765 $172.91 $172.9167715 Incision of eyelid fold Y A2 $333.00 18.7307 $775.47 $443.6267800 Remove eyelid lesion Y P3 1.3799 $57.13 $57.1367801 Remove eyelid lesions Y P3 1.6744 $69.32 $69.3267805 Remove eyelid lesions Y P3 2.1618 $89.50 $89.5067808 Remove eyelid lesion(s) Y A2 $446.00 18.7307 $775.47 $528.3767810 Biopsy of eyelid Y P2 2.9022 $120.15 $120.1567820 Revise eyelashes N P3 0.4785 $19.81 $19.8167825 Revise eyelashes Y P3 1.4444 $59.80 $59.8067830 Revise eyelashes Y A2 $446.00 7.2847 $301.59 $409.9067835 Revise eyelashes Y A2 $446.00 18.7307 $775.47 $528.3767840 Remove eyelid lesion Y P3 4.3146 $178.63 $178.6367850 Treat eyelid lesion Y P3 3.0635 $126.83 $126.8367875 Closure of eyelid by suture Y G2 7.2847 $301.59 $301.5967880 Revision of eyelid Y A2 $510.00 16.171 $669.50 $549.8867882 Revision of eyelid Y A2 $510.00 18.7307 $775.47 $576.3767900 Repair brow defect Y A2 $630.00 18.7307 $775.47 $666.3767901 Repair eyelid defect Y A2 $717.00 18.7307 $775.47 $731.6267902 Repair eyelid defect Y A2 $717.00 18.7307 $775.47 $731.6267903 Repair eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767904 Repair eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767906 Repair eyelid defect Y A2 $717.00 18.7307 $775.47 $731.6267908 Repair eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767909 Revise eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767911 Revise eyelid defect Y A2 $510.00 18.7307 $775.47 $576.3767912 Correction eyelid w/implant Y A2 $510.00 18.7307 $775.47 $576.3767914 Repair eyelid defect Y A2 $510.00 18.7307 $775.47 $576.3767915 Repair eyelid defect Y P3 4.7378 $196.15 $196.15

Date Printed: 04/08/2023 @ 09:12:30 Page 39 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 67916 Repair eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767917 Repair eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767921 Repair eyelid defect Y A2 $510.00 18.7307 $775.47 $576.3767922 Repair eyelid defect Y P3 4.6366 $191.96 $191.9667923 Repair eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767924 Repair eyelid defect Y A2 $630.00 18.7307 $775.47 $666.3767930 Repair eyelid wound Y P3 4.6366 $191.96 $191.9667935 Repair eyelid wound Y A2 $446.00 18.7307 $775.47 $528.3767938 Remove eyelid foreign body N P2 2.179 $90.21 $90.2167950 Revision of eyelid Y A2 $446.00 18.7307 $775.47 $528.3767961 Revision of eyelid Y A2 $510.00 18.7307 $775.47 $576.3767966 Revision of eyelid Y A2 $510.00 18.7307 $775.47 $576.3767971 Reconstruction of eyelid Y A2 $510.00 24.3077 $1,006.36 $634.0967973 Reconstruction of eyelid Y A2 $510.00 24.3077 $1,006.36 $634.0967974 Reconstruction of eyelid Y A2 $510.00 24.3077 $1,006.36 $634.0967975 Reconstruction of eyelid Y A2 $510.00 18.7307 $775.47 $576.3768020 Incise/drain eyelid lining Y P3 1.2142 $50.27 $50.2768040 Treatment of eyelid lesions N P3 0.6072 $25.14 $25.1468100 Biopsy of eyelid lining Y P3 2.585 $107.02 $107.0268110 Remove eyelid lining lesion Y P3 3.3026 $136.73 $136.7368115 Remove eyelid lining lesion Y A2 $446.00 18.7307 $775.47 $528.3768130 Remove eyelid lining lesion Y A2 $446.00 16.171 $669.50 $501.8868135 Remove eyelid lining lesion Y P3 1.564 $64.75 $64.7568200 Treat eyelid by injection N P3 0.4507 $18.66 $18.6668320 Revise/graft eyelid lining Y A2 $630.00 18.7307 $775.47 $666.3768325 Revise/graft eyelid lining Y A2 $630.00 24.3077 $1,006.36 $724.0968326 Revise/graft eyelid lining Y A2 $630.00 24.3077 $1,006.36 $724.0968328 Revise/graft eyelid lining Y A2 $630.00 24.3077 $1,006.36 $724.0968330 Revise eyelid lining Y A2 $630.00 23.1758 $959.50 $712.3868335 Revise/graft eyelid lining Y A2 $630.00 24.3077 $1,006.36 $724.0968340 Separate eyelid adhesions Y A2 $630.00 18.7307 $775.47 $666.3768360 Revise eyelid lining Y A2 $446.00 23.1758 $959.50 $574.3868362 Revise eyelid lining Y A2 $446.00 23.1758 $959.50 $574.3868371 Harvest eye tissue, alograft Y A2 $446.00 16.171 $669.50 $501.8868400 Incise/drain tear gland Y P2 2.9022 $120.15 $120.1568420 Incise/drain tear sac Y P3 4.9586 $205.29 $205.2968440 Incise tear duct opening Y P3 1.5364 $63.61 $63.6168500 Removal of tear gland Y A2 $510.00 24.3077 $1,006.36 $634.0968505 Partial removal, tear gland Y A2 $510.00 24.3077 $1,006.36 $634.0968510 Biopsy of tear gland Y A2 $333.00 18.7307 $775.47 $443.6268520 Removal of tear sac Y A2 $510.00 24.3077 $1,006.36 $634.0968525 Biopsy of tear sac Y A2 $333.00 18.7307 $775.47 $443.6268530 Clearance of tear duct Y P3 6.3385 $262.42 $262.4268540 Remove tear gland lesion Y A2 $510.00 24.3077 $1,006.36 $634.0968550 Remove tear gland lesion Y A2 $510.00 24.3077 $1,006.36 $634.0968700 Repair tear ducts Y A2 $446.00 24.3077 $1,006.36 $586.0968705 Revise tear duct opening Y P2 2.9022 $120.15 $120.1568720 Create tear sac drain Y A2 $630.00 24.3077 $1,006.36 $724.0968745 Create tear duct drain Y A2 $630.00 24.3077 $1,006.36 $724.0968750 Create tear duct drain Y A2 $630.00 24.3077 $1,006.36 $724.0968760 Close tear duct opening N P2 2.179 $90.21 $90.2168761 Close tear duct opening N P3 1.8859 $78.08 $78.0868770 Close tear system fistula Y A2 $630.00 18.7307 $775.47 $666.3768801 Dilate tear duct opening N P2 0.8696 $36.00 $36.0068810 Probe nasolacrimal duct N A2 $131.86 2.179 $90.21 $121.4568811 Probe nasolacrimal duct Y A2 $446.00 18.7307 $775.47 $528.3768815 Probe nasolacrimal duct Y A2 $446.00 18.7307 $775.47 $528.3768816* Probe nl duct w/balloon Y P3 11.7294 $485.61 $485.6168840 Explore/irrigate tear ducts N P3 1.4258 $59.03 $59.0368850 Injection for tear sac x-ray N N169000 Drain external ear lesion Y P2 1.4066 $58.23 $58.2369005 Drain external ear lesion Y P3 2.7231 $112.74 $112.7469020 Drain outer ear canal lesion Y P2 1.4066 $58.23 $58.2369100 Biopsy of external ear Y P3 1.6374 $67.79 $67.7969105 Biopsy of external ear canal Y P3 2.2908 $94.84 $94.8469110 Remove external ear, partial Y A2 $333.00 16.1001 $666.56 $416.3969120 Removal of external ear Y A2 $446.00 23.9765 $992.65 $582.6669140 Remove ear canal lesion(s) Y A2 $446.00 23.9765 $992.65 $582.6669145 Remove ear canal lesion(s) Y A2 $446.00 16.1001 $666.56 $501.1469150 Extensive ear canal surgery Y A2 $464.15 7.4474 $308.33 $425.2069200 Clear outer ear canal N P2 0.631 $26.12 $26.1269205 Clear outer ear canal Y A2 $333.00 21.1098 $873.97 $468.2469210 Remove impacted ear wax N P3 0.5519 $22.85 $22.8569220 Clean out mastoid cavity Y P2 0.793 $32.83 $32.8369222 Clean out mastoid cavity Y P3 3.597 $148.92 $148.9269300 Revise external ear Y A2 $510.00 23.9765 $992.65 $630.6669310 Rebuild outer ear canal Y A2 $510.00 39.8776 $1,650.97 $795.2469320 Rebuild outer ear canal Y A2 $995.00 39.8776 $1,650.97 $1,158.9969400 Inflate middle ear canal Y P3 2.2908 $94.84 $94.8469401 Inflate middle ear canal Y P3 1.2695 $52.56 $52.5669405 Catheterize middle ear canal Y P3 3.2934 $136.35 $136.3569420 Incision of eardrum Y P2 2.5002 $103.51 $103.5169421 Incision of eardrum Y A2 $510.00 16.3288 $676.03 $551.5169424 Remove ventilating tube Y P3 2.0792 $86.08 $86.0869433 Create eardrum opening Y P3 2.9531 $122.26 $122.2669436 Create eardrum opening Y A2 $510.00 16.3288 $676.03 $551.5169440 Exploration of middle ear Y A2 $510.00 23.9765 $992.65 $630.6669450 Eardrum revision Y A2 $333.00 39.8776 $1,650.97 $662.49

Date Printed: 04/08/2023 @ 09:12:30 Page 40 of 40

Short DescriptorHCPCS Code

Subject To Multiple

Procedure Discounting

Payment Indicator

CY 2007 ASC Payment Rate

CY 2008 Fully Implemented

Payment Weight CY 2008 Fully

Implemented Payment CY 2008 First Transition

Year Payment 69501 Mastoidectomy Y A2 $995.00 39.8776 $1,650.97 $1,158.9969502 Mastoidectomy Y A2 $995.00 23.9765 $992.65 $994.4169505 Remove mastoid structures Y A2 $995.00 39.8776 $1,650.97 $1,158.9969511 Extensive mastoid surgery Y A2 $995.00 39.8776 $1,650.97 $1,158.9969530 Extensive mastoid surgery Y A2 $995.00 39.8776 $1,650.97 $1,158.9969540 Remove ear lesion Y P3 3.5142 $145.49 $145.4969550 Remove ear lesion Y A2 $717.00 39.8776 $1,650.97 $950.4969552 Remove ear lesion Y A2 $995.00 39.8776 $1,650.97 $1,158.9969601 Mastoid surgery revision Y A2 $995.00 39.8776 $1,650.97 $1,158.9969602 Mastoid surgery revision Y A2 $995.00 39.8776 $1,650.97 $1,158.9969603 Mastoid surgery revision Y A2 $995.00 39.8776 $1,650.97 $1,158.9969604 Mastoid surgery revision Y A2 $995.00 39.8776 $1,650.97 $1,158.9969605 Mastoid surgery revision Y A2 $995.00 39.8776 $1,650.97 $1,158.9969610 Repair of eardrum Y P3 4.8207 $199.58 $199.5869620 Repair of eardrum Y A2 $446.00 23.9765 $992.65 $582.6669631 Repair eardrum structures Y A2 $717.00 39.8776 $1,650.97 $950.4969632 Rebuild eardrum structures Y A2 $717.00 39.8776 $1,650.97 $950.4969633 Rebuild eardrum structures Y A2 $717.00 39.8776 $1,650.97 $950.4969635 Repair eardrum structures Y A2 $995.00 39.8776 $1,650.97 $1,158.9969636 Rebuild eardrum structures Y A2 $995.00 39.8776 $1,650.97 $1,158.9969637 Rebuild eardrum structures Y A2 $995.00 39.8776 $1,650.97 $1,158.9969641 Revise middle ear & mastoid Y A2 $995.00 39.8776 $1,650.97 $1,158.9969642 Revise middle ear & mastoid Y A2 $995.00 39.8776 $1,650.97 $1,158.9969643 Revise middle ear & mastoid Y A2 $995.00 39.8776 $1,650.97 $1,158.9969644 Revise middle ear & mastoid Y A2 $995.00 39.8776 $1,650.97 $1,158.9969645 Revise middle ear & mastoid Y A2 $995.00 39.8776 $1,650.97 $1,158.9969646 Revise middle ear & mastoid Y A2 $995.00 39.8776 $1,650.97 $1,158.9969650 Release middle ear bone Y A2 $995.00 23.9765 $992.65 $994.4169660 Revise middle ear bone Y A2 $717.00 39.8776 $1,650.97 $950.4969661 Revise middle ear bone Y A2 $717.00 39.8776 $1,650.97 $950.4969662 Revise middle ear bone Y A2 $717.00 39.8776 $1,650.97 $950.4969666 Repair middle ear structures Y A2 $630.00 39.8776 $1,650.97 $885.2469667 Repair middle ear structures Y A2 $630.00 39.8776 $1,650.97 $885.2469670 Remove mastoid air cells Y A2 $510.00 39.8776 $1,650.97 $795.2469676 Remove middle ear nerve Y A2 $510.00 39.8776 $1,650.97 $795.2469700 Close mastoid fistula Y A2 $510.00 39.8776 $1,650.97 $795.2469711 Remove/repair hearing aid Y A2 $333.00 39.8776 $1,650.97 $662.4969714 Implant temple bone w/stimul Y A2 $1,339.00 39.8776 $1,650.97 $1,416.9969715 Temple bne implnt w/stimulat Y A2 $1,339.00 39.8776 $1,650.97 $1,416.9969717 Temple bone implant revision Y A2 $1,339.00 39.8776 $1,650.97 $1,416.9969718 Revise temple bone implant Y A2 $1,339.00 39.8776 $1,650.97 $1,416.9969720 Release facial nerve Y A2 $717.00 39.8776 $1,650.97 $950.4969740 Repair facial nerve Y A2 $717.00 39.8776 $1,650.97 $950.4969745 Repair facial nerve Y A2 $717.00 39.8776 $1,650.97 $950.4969801 Incise inner ear Y A2 $717.00 39.8776 $1,650.97 $950.4969802 Incise inner ear Y A2 $995.00 39.8776 $1,650.97 $1,158.9969805 Explore inner ear Y A2 $995.00 39.8776 $1,650.97 $1,158.9969806 Explore inner ear Y A2 $995.00 39.8776 $1,650.97 $1,158.9969820 Establish inner ear window Y A2 $717.00 39.8776 $1,650.97 $950.4969840 Revise inner ear window Y A2 $717.00 39.8776 $1,650.97 $950.4969905 Remove inner ear Y A2 $995.00 39.8776 $1,650.97 $1,158.9969910 Remove inner ear & mastoid Y A2 $995.00 39.8776 $1,650.97 $1,158.9969915 Incise inner ear nerve Y A2 $995.00 39.8776 $1,650.97 $1,158.9969930 Implant cochlear device Y H8 $995.00 568.8394 $23,550.52 $22,213.7669990 Microsurgery add-on N N1C9716 Radiofrequency energy to anu Y G2 30.1606 $1,248.68 $1,248.68C9724 EPS gast cardia plic Y G2 25.3233 $1,048.41 $1,048.41C9725 Place endorectal app N G2 8.6351 $357.50 $357.50C9726 Rxt breast appl place/remov N G2 10.2051 $422.50 $422.50C9727 Insert palate implants N G2 13.3451 $552.50 $552.50C9728 Place device/marker, non pro Y R2 3.0469 $126.14 $126.14G0104 CA screen;flexi sigmoidscope N P3 2.2079 $91.41 $91.41G0105 Colorectal scrn; hi risk ind Y A2 $446.00 7.8504 $325.01 $415.75G0121 Colon ca scrn not hi rsk ind Y A2 $446.00 7.8504 $325.01 $415.75G0127 Trim nail(s) Y P3 0.2944 $12.19 $12.19G0186 Dstry eye lesn,fdr vssl tech Y R2 4.1331 $171.11 $171.11G0247 Routine footcare pt w lops Y P3 0.5519 $22.85 $22.85G0259 Inject for sacroiliac joint N N1G0260 Inj for sacroiliac jt anesth Y A2 $333.00 7.0546 $292.07 $322.77G0268 Removal of impacted wax md N N1G0269 Occlusive device in vein art N N1G0289 Arthro, loose body + chondro N N1G0364 Bone marrow aspirate &biopsy Y P3 0.1379 $5.71 $5.71G0392 AV fistula or graft arterial Y A2 $1,339.00 45.3845 $1,878.96 $1,473.99G0393 AV fistula or graft venous Y A2 $1,339.00 45.3845 $1,878.96 $1,473.99

NOTE: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount, except for screening flexible sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent.

*Refers to codes designated as “office-based,” whose designation as office-based is temporary because we have insufficient claims data. We will reconsider this designation when new claims data become available.