Third Party Reimbursement Third Party Reimbursement Survey 2006.
Reimbursement by Procedure Codes 70000 - 79999 … · Reimbursement by Procedure Codes 70000 -...
-
Upload
nguyenthuy -
Category
Documents
-
view
245 -
download
0
Transcript of Reimbursement by Procedure Codes 70000 - 79999 … · Reimbursement by Procedure Codes 70000 -...
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
70010 $64.79
70015 $91.23
70030 $17.79
70100 $20.54
70110 $24.53
70120 $21.82
70130 $34.88
70134 $28.72
70140 $18.84
70150 $26.65
70160 $20.55
70170 $33.27
70190 $22.22
70200 $27.49
70210 $19.28
70220 $24.11
70240 $18.41
70250 $23.05
70260 $29.36
70300 $8.92
70310 $23.32
70320 $46.00
70328 $19.27
70330 $30.06
70332 $53.08
70336 $258.43
70350 $13.12
70355 $13.31
70360 $17.15
70370 $36.00
70371 $58.42
70373 $51.16
70380 $24.58
70390 $63.35
70450 $122.42
70460 $159.53
70470 $193.05
70480 $159.73
70481 $227.71
70482 $252.29
70486 $155.50
70487 $196.85
70488 $239.36
70490 $159.73
70491 $192.77
70492 $232.97
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 1 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
70496 $264.49
70498 $264.49
70540 $254.89
70542 $321.65
70543 $397.79
70544 $250.39
70545 $308.96
70546 $387.68
70547 $250.39
70548 $308.96
70549 $387.54
70551 $249.95
70552 $326.78
70553 $401.25
70554 $355.37
70555 $565.00
70557 $157.52
70558 $173.95
70559 $174.62
71010 $14.60
71015 $18.62
71020 $19.25
71021 $23.67
71022 $28.96
71023 $31.00
71030 $28.74
71034 $54.00
71035 $22.03
71100 $20.09
71101 $24.52
71110 $25.37
71111 $32.77
71120 $19.90
71130 $23.28
71250 $151.97
71260 $193.70
71270 $237.97
71275 $269.40
71550 $258.01
71551 $324.76
71552 $401.55
71555 $345.94
72010 $46.13
72020 $14.83
72040 $24.19
72050 $32.84
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 2 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
72052 $41.72
72069 $23.13
72070 $21.16
72072 $23.49
72074 $27.73
72080 $22.70
72090 $30.66
72100 $25.25
72110 $34.54
72114 $46.32
72120 $32.05
72125 $151.97
72126 $193.29
72127 $234.43
72128 $151.97
72129 $193.72
72130 $234.64
72131 $151.97
72132 $193.29
72133 $234.43
72141 $248.07
72142 $330.73
72146 $248.07
72147 $328.19
72148 $248.38
72149 $326.78
72156 $401.61
72157 $401.98
72158 $400.41
72159 $382.67
72170 $16.79
72190 $26.11
72191 $266.21
72192 $151.28
72193 $183.35
72194 $235.10
72195 $258.50
72196 $325.19
72197 $401.34
72198 $344.46
72200 $18.43
72202 $21.60
72220 $18.22
72240 $89.84
72255 $84.40
72265 $85.72
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 3 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
72270 $133.38
72275 $69.21
72285 $91.40
72291 $98.80
72292 $211.81
72295 $80.63
73000 $17.80
73010 $18.92
73020 $14.62
73030 $19.12
73040 $67.01
73050 $23.78
73060 $18.22
73070 $17.59
73080 $21.19
73085 $50.00
73090 $17.37
73092 $19.07
73100 $19.13
73110 $22.67
73115 $50.00
73120 $17.16
73130 $19.91
73140 $19.51
73200 $151.82
73201 $186.53
73202 $238.91
73206 $265.87
73218 $254.97
73219 $321.86
73220 $398.22
73221 $255.59
73222 $321.86
73223 $398.01
73225 $376.55
73500 $16.58
73510 $23.98
73520 $25.23
73525 $62.34
73530 $21.90
73540 $25.27
73550 $17.64
73560 $18.92
73562 $22.73
73564 $26.10
73565 $21.04
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 4 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
73580 $82.00
73590 $17.15
73592 $19.28
73600 $17.59
73610 $20.12
73615 $50.00
73620 $16.94
73630 $19.70
73650 $17.37
73660 $18.24
73700 $151.82
73701 $188.23
73702 $240.19
73706 $268.99
73718 $254.89
73719 $321.65
73720 $398.01
73721 $255.38
73722 $322.21
73723 $398.01
73725 $345.29
74000 $15.45
74010 $23.69
74020 $24.95
74022 $30.01
74150 $153.62
74160 $208.12
74170 $251.05
74174 $349.65
74175 $269.13
74176 $133.34
74177 $210.54
74178 $266.73
74181 $258.01
74182 $324.98
74183 $401.12
74185 $343.82
74190 $45.41
74210 $48.88
74220 $56.09
74230 $56.90
74235 $164.00
74240 $69.47
74241 $73.78
74245 $110.22
74246 $74.98
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 5 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
74247 $74.98
74249 $116.16
74250 $66.28
74251 $109.43
74260 $69.09
74261 $249.66
74262 $379.19
74263 $538.23
74270 $75.20
74280 $118.45
74283 $114.23
74290 $42.53
74291 $39.84
74301 $46.39
74305 $32.99
74320 $67.30
74327 $85.21
74328 $101.34
74329 $75.00
74330 $107.26
74340 $76.12
74355 $142.00
74360 $88.48
74363 $284.00
74400 $69.66
74410 $71.78
74415 $74.00
74420 $77.47
74425 $44.32
74430 $37.86
74440 $39.00
74445 $63.98
74450 $47.18
74455 $55.90
74470 $45.16
74475 $69.63
74480 $69.84
74485 $68.78
74710 $24.48
74740 $49.28
74742 $89.95
74775 $82.00
75557 $278.35
75559 $306.07
75561 $377.44
75563 $427.72
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 6 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
75565 $46.18
75571 $45.77
75572 $181.66
75573 $235.09
75574 $230.50
75600 $168.76
75605 $133.49
75625 $133.48
75630 $155.38
75635 $284.25
75658 $148.60
75705 $176.38
75710 $145.10
75716 $167.40
75726 $143.81
75731 $146.23
75733 $168.27
75736 $143.40
75741 $135.86
75743 $151.85
75746 $139.22
75756 $149.15
75774 $99.23
75791 $150.76
75801 $222.00
75803 $240.00
75805 $245.00
75807 $265.50
75809 $60.76
75810 $479.00
75820 $75.00
75822 $95.34
75825 $127.90
75827 $129.46
75831 $132.44
75833 $149.98
75840 $129.90
75842 $150.40
75860 $132.14
75870 $130.52
75872 $153.38
75880 $106.81
75885 $139.39
75887 $140.68
75889 $130.31
75891 $130.52
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 7 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
75893 $111.16
75894 $648.25
75896 $569.34
75898 $77.96
75901 $85.50
75902 $47.78
75945 $206.52
75946 $118.00
75952 $674.82
75953 $73.91
75954 $121.46
75956 $396.34
75957 $339.56
75958 $226.39
75959 $198.19
75962 $132.44
75964 $82.39
75966 $158.65
75968 $80.92
75970 $313.60
75978 $132.65
75980 $255.00
75982 $276.00
75984 $71.36
75989 $83.95
76000 $48.35
76001 $89.59
76010 $17.15
76080 $38.65
76098 $11.86
76100 $65.85
76101 $109.77
76102 $147.61
76120 $47.65
76125 $45.00
76140 $31.00
76376 $29.22
76377 $57.73
76380 $100.28
76390 $453.89
76506 $58.04
76510 $101.71
76511 $61.48
76512 $56.80
76513 $54.43
76514 $8.45
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 8 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
76516 $44.52
76519 $48.19
76529 $45.42
76536 $73.65
76604 $54.56
76645 $55.12
76700 $84.25
76705 $66.41
76770 $82.17
76775 $66.66
76776 $94.25
76800 $82.58
76801 $80.82
76802 $43.14
76805 $89.74
76810 $60.46
76811 $119.61
76812 $92.30
76813 $78.52
76814 $49.84
76815 $56.77
76816 $64.35
76817 $61.23
76818 $75.91
76819 $56.97
76820 $28.84
76821 $59.98
76825 $134.89
76826 $70.72
76827 $41.11
76828 $30.08
76830 $77.81
76831 $78.01
76856 $77.60
76857 $50.62
76870 $75.29
76872 $81.35
76873 $107.29
76881 $71.22
76882 $18.35
76885 $61.37
76886 $57.63
76930 $56.33
76932 $55.19
76936 $127.77
76937 $21.38
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 9 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
76940 $111.29
76941 $79.17
76942 $74.54
76945 $58.82
76946 $23.39
76948 $23.67
76950 $42.65
76965 $72.61
76970 $50.96
76975 $64.15
76977 $6.40
76998 $106.37
77001 $71.21
77002 $46.71
77003 $38.40
77011 $228.56
77012 $101.23
77013 $529.00
77014 $125.03
77021 $269.57
77022 $631.45
77051 $7.03
77052 $7.03
77053 $42.08
77054 $56.95
77055 $53.33
77056 $68.23
77057 $49.94
77058 $382.55
77059 $382.55
77071 $26.00
77072 $14.59
77073 $24.09
77074 $43.37
77075 $63.47
77076 $62.24
77077 $25.97
77078 $51.35
77080 $49.99
77081 $17.76
77082 $16.96
77084 $262.87
77261 $74.70
77262 $111.91
77263 $165.18
77280 $171.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 10 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
77285 $272.00
77290 $335.00
77293 $414.48
77295 $488.08
77300 $67.72
77301 $1,514.00
77305 $60.00
77310 $86.52
77315 $136.60
77321 $92.14
77326 $133.00
77327 $196.00
77328 $274.62
77331 $63.79
77332 $80.00
77333 $52.88
77334 $151.58
77336 $76.11
77338 $438.50
77370 $116.38
77371 $1,173.65
77372 $890.69
77373 $1,272.83
77401 $20.35
77402 $72.39
77403 $69.00
77404 $72.39
77406 $72.39
77407 $85.07
77408 $82.00
77409 $82.00
77411 $82.00
77412 $91.00
77413 $91.00
77414 $91.00
77416 $92.00
77417 $14.15
77418 $401.88
77421 $74.96
77422 $42.58
77423 $50.60
77427 $173.59
77431 $98.69
77432 $416.01
77435 $628.46
77469 $298.36
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 11 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
77470 $155.26
77600 $205.00
77605 $255.00
77610 $205.67
77615 $273.79
77620 $210.11
77750 $308.00
77761 $291.00
77762 $420.00
77763 $600.00
77776 $318.75
77777 $542.00
77778 $771.00
77785 $190.22
77786 $488.95
77787 $778.97
77789 $75.00
77790 $75.04
78012 $51.73
78013 $130.95
78014 $151.17
78015 $133.63
78016 $189.43
78018 $198.03
78020 $53.25
78070 $102.56
78071 $225.08
78072 $400.00
78075 $265.09
78102 $103.22
78103 $136.13
78104 $154.78
78110 $34.00
78111 $54.32
78120 $34.00
78121 $62.54
78122 $69.68
78130 $96.03
78135 $187.00
78140 $86.13
78185 $95.00
78190 $140.89
78191 $109.82
78195 $160.00
78201 $115.30
78202 $125.89
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 12 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
78205 $141.25
78206 $193.94
78215 $119.38
78216 $80.92
78226 $204.73
78227 $280.46
78230 $103.06
78231 $79.82
78232 $72.71
78258 $141.73
78261 $155.27
78262 $152.31
78264 $172.40
78267 $6.64
78268 $56.87
78270 $50.45
78271 $53.21
78272 $56.42
78278 $178.85
78282 $67.00
78290 $169.91
78291 $156.77
78300 $109.33
78305 $144.36
78306 $157.29
78315 $183.08
78320 $151.37
78350 $33.21
78351 $15.34
78414 $60.37
78428 $120.27
78445 $62.00
78451 $211.66
78452 $296.75
78453 $181.96
78454 $262.96
78456 $156.08
78457 $121.05
78458 $121.54
78459 $737.03
78466 $112.05
78468 $135.96
78469 $160.09
78472 $156.37
78473 $206.51
78481 $130.49
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 13 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
78483 $180.83
78491 $737.66
78492 $750.03
78494 $166.43
78496 $45.71
78579 $108.68
78580 $111.00
78582 $200.39
78597 $122.44
78598 $188.32
78600 $82.00
78601 $132.53
78605 $122.54
78606 $156.00
78607 $215.00
78608 $695.57
78609 $77.51
78610 $110.30
78630 $194.00
78635 $172.00
78645 $167.08
78647 $215.98
78650 $204.97
78660 $78.00
78700 $80.00
78701 $132.32
78707 $147.47
78708 $111.59
78709 $227.41
78710 $138.32
78725 $63.57
78730 $46.45
78740 $137.59
78761 $131.91
78800 $116.02
78801 $156.91
78802 $203.12
78803 $218.20
78804 $234.00
78805 $114.28
78806 $197.00
78807 $217.85
78808 $26.62
78811 $698.42
78812 $709.37
78813 $711.94
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 14 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
78814 $717.41
78815 $724.97
78816 $726.21
79005 $137.84
79101 $145.71
79200 $160.03
79300 $194.00
79403 $196.13
79440 $147.62
79445 $240.00
7001526 $48.17
7003026 $6.84
7010026 $7.40
7011026 $9.89
7012026 $7.40
7013026 $13.50
7013426 $13.50
7014026 $7.96
7015026 $10.45
7016026 $6.84
7017026 $12.20
7019026 $8.50
7020026 $11.28
7021026 $7.13
7022026 $9.89
7024026 $7.67
7025026 $9.90
7026026 $13.50
7030026 $4.63
7031026 $7.14
7032026 $12.13
7032826 $7.40
7033026 $9.90
7033226 $23.05
7033626 $59.16
7035026 $7.69
7035526 $8.51
7036026 $6.84
7037026 $12.94
7037126 $33.28
7037326 $17.10
7038026 $7.41
7039026 $15.54
7045026 $34.02
7046026 $45.30
7047026 $51.22
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 15 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7048026 $51.50
7048126 $55.56
7048226 $58.06
7048626 $45.86
7048726 $52.33
7048826 $56.94
7049026 $51.50
7049126 $55.38
7049226 $58.06
7049626 $70.64
7049826 $70.64
7054026 $54.17
7054226 $65.08
7054326 $85.97
7054426 $48.16
7054526 $48.16
7054626 $72.48
7054726 $48.16
7054826 $48.16
7054926 $72.30
7055126 $59.45
7055226 $71.93
7055326 $94.94
7055426 $85.43
7055526 $104.29
7055726 $141.57
7055826 $131.18
7055926 $132.60
7101026 $7.12
7101526 $8.22
7102026 $8.78
7102126 $10.72
7102226 $12.39
7102326 $15.45
7103026 $12.39
7103426 $12.00
7103526 $7.40
7110026 $8.78
7110126 $10.72
7111026 $10.72
7111126 $12.66
7112026 $7.95
7113026 $8.78
7125026 $41.16
7126026 $50.11
7127026 $55.38
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 16 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7127526 $77.48
7155026 $58.33
7155126 $69.24
7155226 $90.98
7155526 $73.14
7201026 $18.30
7202026 $6.29
7204026 $9.43
7205026 $12.76
7205226 $14.70
7206926 $9.43
7207026 $9.06
7207226 $8.78
7207426 $8.78
7208026 $9.43
7209026 $12.12
7210026 $9.43
7211026 $12.76
7211426 $15.17
7212026 $9.43
7212526 $41.16
7212626 $49.00
7212726 $50.94
7212826 $41.16
7212926 $49.28
7213026 $50.94
7213126 $41.16
7213226 $49.28
7213326 $50.94
7214126 $64.53
7214226 $77.19
7214626 $64.53
7214726 $77.48
7214826 $59.82
7214926 $71.93
7215626 $103.63
7215726 $103.63
7215826 $95.31
7215926 $72.87
7217026 $7.50
7219026 $9.16
7219126 $73.22
7219226 $43.64
7219326 $46.78
7219426 $49.00
7219526 $58.98
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 17 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7219626 $69.80
7219726 $90.70
7219826 $72.30
7220026 $6.84
7220226 $7.67
7222026 $6.84
7224026 $36.70
7225526 $36.24
7226526 $33.47
7227026 $53.44
7227526 $27.00
7228526 $37.00
7229126 $57.35
7229226 $59.19
7229526 $34.04
7300026 $6.57
7301026 $7.50
7302026 $6.01
7303026 $8.05
7304026 $22.10
7305026 $8.88
7306026 $7.13
7307026 $6.29
7308026 $6.84
7308526 $21.00
7309026 $6.57
7309226 $6.57
7310026 $7.22
7311026 $7.13
7311526 $21.00
7312026 $6.57
7313026 $6.84
7314026 $5.46
7320026 $40.97
7320126 $46.78
7320226 $49.00
7320626 $72.77
7321826 $54.27
7321926 $65.36
7322026 $86.54
7322126 $55.10
7322226 $65.36
7322326 $86.26
7322526 $70.10
7350026 $7.50
7351026 $9.16
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 18 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7352026 $10.82
7352526 $22.66
7353026 $11.93
7354026 $8.60
7355026 $7.21
7356026 $7.50
7356226 $8.05
7356426 $9.43
7356526 $7.78
7358026 $23.42
7359026 $6.84
7359226 $6.57
7360026 $6.57
7361026 $6.84
7361526 $21.00
7362026 $6.28
7363026 $6.84
7365026 $6.57
7366026 $5.18
7370026 $40.97
7370126 $46.78
7370226 $49.28
7370626 $76.93
7371826 $54.17
7371926 $65.08
7372026 $86.26
7372126 $54.82
7372226 $65.83
7372326 $86.26
7372526 $73.13
7400026 $7.12
7401026 $9.06
7402026 $10.72
7402226 $12.66
7415026 $47.89
7416026 $51.22
7417026 $56.39
7417526 $76.83
7418126 $58.62
7418226 $69.52
7418326 $90.41
7418526 $72.30
7419026 $19.60
7421026 $14.33
7422026 $18.58
7423026 $21.36
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 19 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7423526 $52.40
7424026 $27.92
7424126 $27.46
7424526 $36.70
7424626 $27.92
7424726 $27.92
7424926 $36.70
7425026 $18.86
7425126 $27.92
7426026 $19.97
7427026 $27.92
7428026 $39.75
7428326 $52.00
7429026 $12.66
7429126 $7.95
7430126 $8.87
7430526 $17.10
7432026 $21.91
7432726 $29.67
7432826 $28.95
7432926 $28.95
7433026 $37.08
7434026 $22.10
7435526 $31.54
7436026 $23.51
7436326 $36.15
7440026 $19.69
7441026 $19.98
7441526 $19.69
7442026 $14.70
7442526 $14.70
7443026 $12.66
7444026 $15.00
7444526 $47.35
7445026 $13.59
7445526 $13.22
7447026 $20.00
7447526 $21.91
7448026 $21.91
7448526 $21.91
7471026 $13.50
7474026 $15.17
7477526 $25.34
7560026 $20.54
7560526 $46.80
7562526 $46.50
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 20 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7563026 $72.58
7563526 $97.38
7565826 $51.94
7570526 $87.86
7571026 $45.58
7571626 $53.16
7572626 $46.13
7573126 $47.10
7573326 $54.88
7573626 $45.86
7574126 $53.07
7574326 $67.31
7574626 $46.23
7575626 $50.70
7577426 $14.70
7580126 $34.94
7580326 $47.89
7580526 $33.19
7580726 $48.18
7580926 $19.14
7581026 $47.06
7582026 $28.48
7582226 $42.62
7582526 $45.57
7582726 $45.10
7583126 $48.80
7583326 $58.59
7584026 $47.95
7584226 $60.00
7586026 $46.98
7587026 $45.94
7587226 $49.34
7588026 $29.05
7588526 $58.06
7588726 $57.79
7588926 $45.94
7589126 $45.94
7589326 $21.26
7589426 $54.26
7589626 $54.83
7589826 $69.16
7590126 $19.69
7590226 $15.71
7594526 $16.45
7594626 $16.54
7595226 $185.76
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 21 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7595326 $56.54
7595426 $82.00
7595626 $290.96
7595726 $249.02
7595826 $165.32
7595926 $145.24
7596226 $21.63
7596426 $14.60
7596626 $53.74
7596826 $14.62
7597026 $14.00
7597826 $21.35
7598026 $43.00
7598426 $14.00
7598926 $47.52
7600026 $6.84
7600126 $23.00
7601026 $7.40
7608026 $21.91
7609826 $6.57
7610026 $24.80
7610126 $26.77
7610226 $27.14
7612026 $15.25
7612526 $11.66
7637626 $8.23
7637726 $31.81
7638026 $39.30
7639026 $70.96
7650626 $25.42
7651026 $73.74
7651126 $41.60
7651226 $42.16
7651326 $27.68
7651426 $7.69
7651626 $23.81
7651926 $24.46
7652926 $25.86
7653626 $22.46
7660426 $21.90
7664526 $21.82
7670026 $32.35
7670526 $23.58
7677026 $29.58
7677526 $23.58
7677626 $30.42
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 22 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7680026 $44.55
7680126 $39.67
7680226 $33.29
7680526 $39.67
7681026 $39.11
7681126 $76.10
7681226 $71.10
7681326 $47.06
7681426 $39.38
7681526 $25.70
7681626 $34.12
7681726 $29.95
7681826 $42.17
7681926 $31.07
7682026 $19.88
7682126 $28.30
7682526 $66.48
7682626 $33.01
7682726 $22.93
7682826 $22.38
7683026 $27.74
7683126 $28.85
7685626 $27.74
7685726 $15.82
7687026 $25.98
7687226 $28.49
7687326 $63.07
7688526 $29.86
7688626 $25.16
7693026 $27.67
7693226 $28.50
7693626 $81.62
7693726 $12.20
7694026 $83.56
7694126 $55.30
7694226 $27.09
7694526 $27.38
7694626 $15.17
7695026 $23.58
7696526 $55.03
7697026 $16.26
7697526 $34.79
7697726 $2.81
7699826 $51.10
7700126 $15.54
7700226 $22.20
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 23 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7700326 $23.85
7701126 $49.30
7701226 $46.22
7701326 $163.26
7701426 $41.30
7702126 $61.02
7702226 $172.58
7705126 $2.40
7705226 $2.40
7728026 $36.00
7728526 $54.15
7729026 $80.54
7729526 $221.57
7730026 $32.07
7730126 $406.00
7730526 $36.00
7731026 $54.15
7731526 $80.54
7732126 $48.83
7732626 $47.76
7732726 $71.95
7732826 $107.95
7733126 $44.89
7733226 $28.13
7733326 $43.46
7733426 $63.82
7742126 $19.99
7747026 $107.95
7762026 $79.28
7775026 $257.33
7776126 $194.21
7776226 $296.29
7776326 $447.07
7777626 $219.77
7777726 $364.23
7777826 $583.35
7778926 $58.00
7779026 $53.48
7801526 $26.52
7801626 $30.46
7801826 $33.73
7802026 $23.28
7807026 $32.63
7807526 $29.02
7810226 $21.62
7810326 $29.29
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 24 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7810426 $31.51
7811026 $7.67
7811126 $8.50
7812026 $9.34
7812126 $12.66
7812226 $17.38
7813026 $24.87
7813526 $25.98
7814026 $24.59
7818526 $16.00
7819026 $43.17
7819126 $24.59
7819526 $47.88
7820126 $17.37
7820226 $19.30
7820526 $28.19
7820626 $37.90
7821526 $19.69
7821626 $22.46
7823026 $18.02
7823126 $20.43
7823226 $17.73
7825826 $29.68
7826126 $27.92
7826226 $26.53
7826426 $30.97
7827026 $7.95
7827126 $7.95
7827226 $10.44
7827826 $39.47
7828226 $15.54
7829026 $27.37
7829126 $35.03
7830026 $24.97
7830526 $32.90
7830626 $34.30
7831526 $40.58
7832026 $41.13
7835026 $11.03
7841426 $18.02
7842826 $31.91
7844526 $19.04
7845626 $41.36
7845726 $30.69
7845826 $34.45
7845926 $60.65
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 25 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7846626 $28.30
7846826 $33.31
7846926 $38.59
7847226 $39.86
7847326 $60.31
7848126 $41.09
7848326 $62.02
7849126 $61.50
7849226 $77.98
7849426 $49.03
7849626 $20.45
7858026 $29.40
7858226 $40.35
7860026 $17.66
7860126 $20.24
7860526 $21.64
7860626 $25.14
7860726 $48.06
7860826 $59.70
7860926 $77.51
7861026 $12.11
7863026 $27.18
7863526 $24.32
7864526 $22.74
7864726 $35.30
7865026 $24.30
7866026 $16.00
7870026 $18.30
7870126 $19.69
7870726 $37.90
7870826 $48.07
7870926 $55.92
7871026 $25.42
7872526 $14.88
7873026 $6.58
7874026 $23.30
7876126 $28.75
7880026 $26.25
7880126 $31.52
7880226 $34.02
7880326 $42.79
7880426 $42.24
7880526 $29.02
7880626 $34.02
7880726 $42.32
7881126 $63.50
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 26 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
7881226 $78.11
7881326 $81.54
7881426 $88.82
7881526 $98.90
7881626 $100.55
7900526 $88.34
7910126 $95.48
7920026 $97.15
7930026 $81.20
7940326 $113.00
7944026 $97.60
7944526 $117.73
70015TC $55.00
70030TC $12.66
70100TC $14.99
70110TC $17.12
70120TC $16.27
70130TC $24.76
70134TC $18.60
70140TC $12.87
70150TC $18.82
70160TC $15.42
70190TC $15.84
70200TC $19.03
70210TC $13.93
70220TC $16.69
70240TC $12.66
70250TC $15.63
70260TC $19.24
70300TC $5.44
70310TC $17.96
70320TC $33.00
70328TC $13.72
70330TC $22.63
70332TC $35.79
70336TC $214.05
70350TC $7.36
70355TC $6.93
70360TC $12.02
70370TC $16.00
70371TC $33.46
70373TC $38.34
70380TC $19.03
70390TC $51.71
70450TC $83.39
70460TC $115.46
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 27 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
70470TC $142.79
70480TC $121.10
70481TC $186.04
70482TC $208.75
70486TC $121.10
70487TC $157.60
70488TC $196.65
70490TC $121.10
70491TC $151.24
70492TC $189.44
70496TC $211.51
70498TC $211.51
70540TC $214.27
70542TC $272.84
70543TC $333.32
70544TC $214.27
70545TC $272.84
70546TC $333.32
70547TC $214.27
70548TC $272.84
70549TC $333.32
70551TC $175.22
70552TC $249.56
70553TC $285.27
70554TC $291.30
71010TC $9.26
71015TC $12.44
71020TC $12.66
71021TC $15.63
71022TC $19.66
71023TC $15.00
71030TC $19.45
71034TC $41.09
71035TC $16.48
71100TC $13.51
71101TC $16.48
71110TC $17.33
71111TC $23.27
71120TC $13.93
71130TC $16.69
71250TC $121.10
71260TC $156.12
71270TC $196.44
71275TC $211.30
71550TC $214.27
71551TC $272.84
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 28 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
71552TC $333.32
71555TC $291.09
72010TC $32.39
72020TC $10.11
72040TC $17.12
72050TC $23.27
72052TC $30.70
72069TC $15.00
72070TC $14.36
72072TC $16.90
72074TC $21.15
72080TC $3.00
72090TC $21.57
72100TC $18.17
72110TC $24.97
72114TC $34.94
72120TC $24.97
72125TC $121.10
72126TC $156.54
72127TC $196.22
72128TC $121.10
72129TC $156.76
72130TC $196.44
72131TC $121.10
72132TC $156.33
72133TC $196.22
72141TC $172.68
72142TC $251.02
72146TC $172.68
72147TC $247.73
72148TC $172.68
72149TC $246.28
72156TC $285.64
72157TC $286.00
72158TC $283.82
72159TC $351.96
72170TC $11.17
72190TC $19.24
72191TC $211.30
72192TC $99.06
72193TC $148.27
72194TC $198.35
72195TC $214.27
72196TC $272.84
72197TC $333.32
72198TC $290.24
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 29 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
72200TC $9.00
72202TC $15.84
72220TC $13.09
72240TC $45.00
72255TC $45.00
72265TC $60.62
72270TC $93.30
72275TC $46.19
72285TC $55.69
72295TC $55.10
73000TC $12.87
73010TC $13.30
73020TC $10.11
73030TC $13.09
73040TC $50.44
73050TC $17.12
73060TC $12.87
73070TC $12.87
73080TC $16.06
73085TC $29.00
73090TC $12.44
73092TC $14.14
73100TC $13.72
73110TC $17.33
73115TC $29.00
73120TC $12.23
73130TC $14.78
73140TC $13.00
73200TC $121.10
73201TC $151.45
73202TC $202.17
73206TC $211.30
73218TC $214.27
73219TC $272.84
73220TC $333.32
73221TC $190.16
73222TC $272.84
73223TC $333.32
73225TC $323.98
73500TC $10.96
73510TC $17.12
73520TC $17.12
73525TC $45.34
73540TC $18.82
73550TC $12.23
73560TC $13.30
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 30 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
73562TC $16.69
73564TC $19.03
73565TC $15.20
73580TC $53.00
73590TC $12.02
73592TC $14.36
73600TC $12.66
73610TC $14.99
73615TC $29.00
73620TC $12.23
73630TC $14.57
73650TC $12.44
73660TC $14.36
73700TC $121.10
73701TC $153.14
73702TC $203.23
73706TC $211.30
73718TC $214.27
73719TC $272.84
73720TC $333.32
73721TC $190.53
73722TC $272.84
73723TC $333.32
73725TC $290.45
74000TC $10.11
74010TC $16.90
74020TC $16.90
74022TC $20.51
74150TC $96.87
74160TC $169.70
74170TC $208.75
74175TC $211.51
74181TC $214.05
74182TC $272.84
74183TC $333.32
74185TC $289.60
74210TC $38.12
74220TC $42.16
74230TC $40.88
74240TC $48.52
74241TC $53.19
74245TC $82.69
74246TC $54.04
74247TC $54.04
74249TC $88.63
74250TC $52.13
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 31 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
74251TC $88.49
74260TC $54.11
74270TC $54.25
74280TC $88.63
74283TC $54.04
74290TC $33.03
74291TC $33.88
74320TC $22.00
74327TC $60.50
74400TC $41.00
74410TC $51.00
74415TC $26.00
74430TC $26.55
74440TC $24.00
74455TC $37.00
74475TC $49.00
74480TC $49.00
74485TC $49.00
74710TC $14.36
74740TC $37.91
75600TC $153.36
75605TC $98.39
75625TC $97.97
75630TC $97.24
75635TC $211.22
75658TC $109.64
75705TC $110.49
75710TC $110.92
75716TC $127.53
75726TC $109.22
75731TC $110.92
75733TC $127.11
75736TC $109.01
75741TC $96.06
75743TC $101.36
75746TC $104.55
75756TC $111.13
75774TC $82.66
75809TC $46.40
75820TC $33.00
75822TC $33.00
75825TC $92.86
75827TC $95.41
75831TC $95.85
75833TC $106.03
75840TC $93.94
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 32 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
75842TC $105.40
75860TC $96.91
75870TC $96.06
75872TC $101.62
75880TC $70.00
75885TC $95.85
75887TC $97.33
75889TC $95.85
75891TC $96.06
75893TC $95.21
75901TC $62.00
75902TC $36.00
75962TC $116.22
75964TC $71.44
75966TC $113.64
75968TC $69.96
75978TC $116.65
75984TC $49.58
75989TC $48.31
76000TC $43.22
76010TC $11.60
76080TC $22.21
76098TC $6.93
76100TC $47.25
76101TC $89.69
76102TC $127.25
76120TC $36.22
76376TC $19.26
76377TC $33.88
76380TC $70.81
76390TC $382.94
76506TC $38.98
76510TC $46.40
76511TC $30.27
76512TC $25.18
76513TC $33.67
76514TC $2.68
76516TC $26.66
76519TC $29.85
76529TC $26.03
76536TC $56.80
76604TC $38.12
76645TC $38.76
76700TC $59.98
76705TC $48.00
76770TC $59.98
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 33 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
76775TC $37.48
76776TC $71.44
76800TC $49.16
76801TC $51.07
76802TC $18.17
76805TC $59.98
76810TC $31.12
76811TC $62.53
76812TC $38.98
76813TC $43.22
76814TC $20.30
76815TC $37.49
76816TC $38.76
76817TC $38.76
76818TC $44.28
76819TC $33.67
76820TC $13.93
76821TC $38.76
76825TC $85.03
76826TC $26.02
76827TC $23.90
76828TC $13.30
76830TC $57.01
76831TC $56.38
76856TC $56.80
76857TC $35.65
76870TC $42.94
76872TC $45.56
76873TC $59.98
76885TC $38.98
76886TC $38.76
76930TC $35.58
76936TC $66.56
76937TC $12.23
76942TC $40.76
76946TC $12.02
76950TC $21.81
76965TC $23.99
76970TC $38.76
76977TC $4.31
77001TC $56.00
77002TC $30.06
77003TC $20.51
77011TC $166.47
77012TC $66.56
77014TC $81.20
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 34 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
77021TC $223.81
77051TC $5.23
77052TC $5.23
77280TC $135.00
77285TC $217.00
77290TC $254.00
77295TC $266.52
77300TC $35.65
77301TC $1,091.00
77305TC $23.99
77310TC $32.38
77315TC $56.07
77321TC $43.31
77326TC $92.00
77327TC $133.56
77328TC $166.67
77331TC $18.89
77332TC $52.00
77333TC $9.42
77334TC $87.77
77421TC $54.97
77470TC $47.31
77620TC $123.46
77750TC $53.68
77761TC $98.00
77762TC $146.08
77763TC $131.00
77776TC $88.88
77777TC $171.00
77778TC $202.00
77789TC $18.00
77790TC $19.97
78015TC $113.74
78016TC $166.58
78018TC $172.73
78020TC $35.79
78070TC $78.08
78075TC $243.33
78102TC $65.00
78103TC $84.00
78104TC $105.00
78110TC $21.00
78111TC $47.95
78120TC $21.00
78121TC $53.05
78130TC $58.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 35 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
78135TC $143.00
78140TC $67.69
78185TC $54.00
78190TC $108.50
78191TC $91.38
78195TC $111.00
78201TC $89.00
78202TC $111.40
78205TC $120.10
78206TC $165.52
78215TC $104.61
78216TC $64.08
78230TC $89.54
78231TC $64.51
78232TC $59.41
78258TC $119.47
78261TC $134.32
78262TC $132.41
78264TC $149.18
78270TC $44.49
78271TC $47.25
78272TC $48.59
78278TC $149.25
78290TC $149.39
78291TC $130.51
78300TC $90.61
78305TC $119.68
78306TC $131.56
78315TC $152.65
78320TC $120.53
78428TC $96.34
78445TC $30.00
78456TC $125.06
78457TC $98.03
78458TC $95.70
78466TC $90.82
78468TC $110.98
78469TC $131.14
78472TC $126.47
78473TC $161.27
78481TC $99.67
78483TC $134.32
78494TC $129.65
78496TC $21.08
78580TC $51.00
78600TC $23.00
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 36 of 37
Reimbursement by Procedure Codes 70000 - 79999
Effective Jan. 1, 2015
CPT Code Reimbursement
78601TC $85.00
78605TC $68.00
78606TC $82.00
78607TC $133.00
78610TC $74.00
78630TC $30.00
78635TC $86.00
78645TC $86.00
78647TC $189.50
78650TC $125.00
78660TC $62.00
78700TC $34.00
78701TC $117.56
78707TC $119.05
78708TC $75.54
78709TC $185.47
78710TC $119.26
78725TC $45.00
78730TC $41.52
78740TC $84.00
78761TC $110.34
78800TC $96.34
78801TC $133.26
78802TC $177.62
78803TC $186.10
78804TC $184.00
78805TC $92.51
78806TC $120.00
78807TC $186.10
79005TC $49.50
79101TC $50.23
79200TC $56.79
79403TC $82.56
79440TC $48.41
Confidential
These rates are provided for informational purposes only
and are not to be considered a guarantee of payment.
Actual payment will be based on Health Options policies,
procedures, and Customer Benefit Plans. 37 of 37