CHAPTER 6 - CONTESTED CASE PROCEEDINGS
Section 1. Referral for Hearing.
(a) Upon receipt of a request for hearing, the Division shall immediately transmit a copy of the request and a notice of request for hearing to the Office of Administrative Hearings (OAH) or Workers' Compensation Medical Commission as appropriate. For purposes of judicial review of agency inaction under W.S. § 16‑3‑114(a), the Division is deemed to have denied any timely, written request for a hearing pursuant to W.S. § 27‑14‑601(k)(iv) when it has failed to transmit a notice of request for hearing within 30 days after receipt of the request.
(i) For purposes of referring contested cases to the Workers' Compensation Medical Commission for hearing, W.S. § 27‑14‑616(b)(iv), the phrase "medically contested cases" shall include those cases in which the primary issue is:
(A) a claimant's percentage of physical impairment;
(B) whether a claimant is permanently totally disabled;
(C) whether a claimant who has been receiving TTD benefits remains eligible for those benefits under W.S. § 27‑14‑404(c); or,
(D) any other issue, the resolution of which is primarily dependent upon the evaluation of conflicting evidence as to medical diagnosis, medical prognosis, or the reasonableness and appropriateness of medical care.
Section 2. Establishment of Fees for Members of Medical Commission. Members of the medical commission established pursuant to W.S. § 27‑14‑616 shall be compensated at the rate of $150 per hour for their professional services on behalf of the commission, including necessary travel time. In addition, members of the commission shall be reimbursed for necessary travel expenses to the same extent and upon the same conditions as Wyoming State employees are reimbursed under the rules and regulations of the State Auditor.
Section 3. Small Claims. If the Division requests that the matter be resolved as a small claims hearing, the Notice of Referral shall include the following notice:
(a) The Division determines that the amount at issue is less than $2,000 and does not involve an issue of the compensability of the injury. The Division therefore requests that the matter be resolved as a small claims hearing as provided in W.S. § 27‑14‑602(b)(i).
(b) The purpose of a small claims hearing is to provide expedited review by a hearing examiner. In a small claims hearing, the Division will not pay a claimant’s attorney, nor will the Office of the Attorney General represent the Division.
(c) If any party objects to a small claims hearing request within 15 days of the notice, the hearing examiner will decide whether a small claims hearing or a contested case hearing is appropriate.
CHAPTER 9 - FEE SCHEDULES
Section 1. General Guidelines. Pursuant to Wyoming Statutes 27-14-401(b), (e), and (g) medical and or hospital care shall be reviewed for appropriateness and reasonableness and shall be reimbursed according to the adopted schedule(s). The following guidelines are applicable to each section within this chapter.
(a) All claims shall be paid in accordance with the fee schedule in effect at the time of service.
(b) Certain services may be subject to preauthorization pursuant to Chapter 10 of these rules. These guidelines can be found at http://wydoe.state.wy.us/wscd, under subtitle “Medical Procedures”.
(c) The Division shall use accepted medical resources and publications to aid in adjudicating bills. This shall include, but not be limited to, the American Medical Association, (AMA),Current Procedural Terminology codebook, (CPT), the AMA Knowledge Base System, and The American Academy of Orthopaedic Surgeons, Complete Global Values Service Data for Orthopaedic Surgery Guidelines, and the Division’s medical advisors.
(d) The Division may change billed codes to achieve compliance with the current rules and regulations. The provider payment statement shall advise of code changes and the right to appeal.
(e) Codes designated as Relativity Not Establish (RNE), or By Report (BR) shall be assigned the unit value of a comparable procedure or procedures.
(f) In no case shall any provider bill for charges greater than those charged the general public for like services.
(g) The Division shall not pay more than the total billed amount.
Section 2. Fee Schedules. The Administrator adopts the Relative Values for Physicians (RVP), as published by Ingenix Inc., as authored by Relative Value Studies, Inc., insofar as it addresses medical matters under the Act unless otherwise defined in this chapter. The Administrator adopts the Relative Values for Dentists, RVD, as published and authored by Relative Value Studies, Inc., Denver, Colorado insofar as it addresses dental matters under the Act. Adoption of the RVP and RVD shall be the current edition as of the first day of each calendar year. See Chapter 9, Section 1 of these rules for additional guidelines.
(a) Conversion Factors. The Administrator adopts the following conversion factors.
|
SPECIALTY GROUP |
CONVERSION FACTOR |
|
Anesthesia |
$ 51.12 |
|
Surgery |
$120.21 |
|
Radiology/Nuclear Medicine |
$ 21.97 |
|
Pathology/Laboratory |
$ 15.23 |
|
Medicine |
$ 7.91 |
|
Physical Medicine and Chiropractic |
$ 6.39 |
|
Evaluation and Management |
$ 8.34 |
|
Dental |
$ 39.54 |
(b) Fees for Surgery.
(i) Surgical Assistants.
(A) MD assistants shall be paid 20% of the surgical allowance.
(B) Non-MD assistants shall be paid 15% of the surgical allowance.
(ii) Knee Procedure. (Multiple procedure guidelines apply).
|
|
Description |
Unit |
|
|
Extensive Chrondroplasty |
18.0 |
(iii) Capsular Shrinkage Procedure. (Multiple procedure guidelines apply).
|
|
Description |
Unit |
|
|
Shoulder |
16.4 |
|
|
Elbow |
13.8 |
|
|
Wrist |
10.7 |
|
|
Hip |
15.6 |
|
|
Knee |
17.6 |
|
|
Ankle |
12.0 |
(iv) Diskograms. Codes 62290 and 62291 shall be paid per code unit value for the primary level and at 50% of the code unit value for each additional level. Codes 72285 and 72295 shall be paid as a single service.
(v) Neurotomy, Rhizotomy Procedures. The Division recognizes the CPT codes for neurotomy and rhizotomy procedures and has valued those codes as follows. The injection of anesthetic, antispasmodic, contrast or steroids are included.
1st level 4.0
Each additional level and/or bilateral site 2.0
(c) Fees for Services Performed by an Anesthesiologist.
(i) Services where time units are not allowed, as defined in the anesthesia specialty section of the RVP guidelines, shall be paid at the anesthesia conversion rate when an individual anesthesiologist performs the total procedure with the exception of neurotomy and rhizotomy procedures.
(ii) Unit values of these procedures shall revert to those found in the surgery section of the RVP when two health care providers perform the total service.
(d) Fees for Independent Medical Evaluations (IME), Permanent Partial Impairment Ratings (PPI), Medical Testimony and Deposition(s). See Chapter 10, and Chapter 9, Section 1 of these rules for additional guidelines. Bills must indicate time spent.
(i) Independent Medical Evaluations or Impairment Ratings. The Division shall pay according to the following fee schedule:
|
Code |
Time |
Payment |
|
99455-99456 |
1st hour |
$500.00 |
|
|
Each additional 15 minutes |
$ 62.50 |
(ii) Medical Testimony and Deposition Charges. The Division shall pay according to the following fee schedule:
|
Code |
Time |
Payment |
|
99075 |
1st hour |
$500.00 |
|
|
Each additional 15 minutes |
$ 62.50 |
Section 3. Fees for Home Health Nursing. The Division adopts the following fee schedule guidelines for home health nursing. This fee schedule is for long term daily care at home. This is a straight fee, no overtime, holiday rate, or shift differential shall be paid. See Chapter 10, and Chapter 9, Section 1 of these rules for additional guidelines.
|
Type of Nursing |
Hourly Rate |
|
|
RN |
$35.00 |
|
|
LPN |
$35.00 |
|
|
CNA |
$16.00 |
|
|
Attendant* |
*Federal minimum wage |
|
*Attendant care includes personal care for activities of daily living. A physician prescription and time limit is required. Attendant care shall be provided by individuals approved by the primary treating health care provider.
Section 4. Fees for Supplies, Implants, Durable Medical Equipment (DME), Orthotics and Prosthetics. The Division adopts the Wyoming Medicare rate of the Healthcare Common Procedure Coding System (HCPCS) for the payment of supplies, DME, orthotics and prosthetic devices prescribed by a health care provider. Such adoption shall be effective on the first day of each calendar year. See Chapter 9, Section 1 of these rules for additional guidelines. The Division shall not pay for any supplies, DME, orthotics, or prosthetics unless prescribed by the primary health care provider.
(a) Any related charges for supplies, DME, orthotics and prosthetics not listed in the Medicare HCPCS fee schedule shall be paid at eighty percent (80%) of billed charges. Charges deemed excessive shall require additional documentation for justification.
(i) Any single supply / implant charged at $1,000.00 or more shall require a suppliers’ invoice. Reimbursement shall be at 130% of invoice cost. Shipping and handling charges shall not be reimbursed.
(ii) The Division shall not provide direct payment to suppliers or manufacturers for implantable items.
(b) The preceding fees are not intended to address newly developed items or technologies.
Section 5. Fees for Hearing Aids/Prescription Lenses. See Chapter 10, and Chapter 9, Section 1 of these rules for additional guidelines.
(a) The Division shall pay 130% of the supplier’s/manufacturer’s invoice price when the provider submits the invoice to the Division.
(b) The Division adopts the Wyoming Medicare rate for payment of frames and lenses as prescribed for compensable vision loss, or for replacement due to a work-related accident.
(c) The Division shall reimburse an injured worker for the repair or comparable replacement of a hearing aid device or prescription lens damaged or destroyed in a work-related accident.
Section 6. Fees for Pharmacy Items. Pharmaceuticals must be billed with a National Drug Code (NDC). See Chapter 10, and Chapter 9, Section 1 of these rules for additional guidelines.
(a) Pharmaceuticals shall be reimbursed at the lower of:
(i) Average Wholesale Price (AWP) minus 10% plus a $5.00 dispensing fee; or
(ii) The provider’s usual and customary charge. In no case shall any provider bill for charges greater than those charged to the general public for like services. The Division reserves the right to review such charges and reimburse at the usual and customary rate if a discrepancy is found.
(b) Reimbursement shall be decreased by $2.50 per prescription if a paper claim is submitted unless:
(i) The provider has received prior approval from the Division to submit a claim on paper.
(ii) Electronic billing is unavailable at the time of service making it unreasonable to submit the claim through the online process.
(c) Over the counter items that do not have a valid NDC number shall be considered supplies and shall not be paid with an added dispensing fee. See Chapter 9, Section 4 of these rules for additional guidelines.
Section 7. Fees for Compounded Medications. – See Chapter 10, and Chapter 9, Section 1 of these rules for additional guidelines.
(a) Physicians billing for compounded drugs must provide the pharmacy invoice. The Division shall pay 130% of the supplier’s/manufacturer’s invoice price.
(b) Compounding pharmacies who bill directly, shall be compensated for the drugs prescribed and related materials in accordance with Chapter 9, Section 6. The Division shall allow a professional fee for compounding services. Compounding medications shall be reimbursed per line item if each ingredient is determined to be coverable per Chapter 10, Compound Prescription Medications.
Section 8. Fees for Ambulance Services. Ambulance services shall be paid the lesser of the billed charge or the maximum allowable rate for the code appropriate for the documented service. The maximum allowable rates are all-inclusive. Mileage shall be reimbursed per documented loaded statute mile. See Chapter 9, Section 1 of these rules for additional guidelines.
(a) The following codes shall be recognized by the Division:
|
Code |
Short Descriptor |
Maximum Allowable |
|
A0425 |
Mileage, Ground |
$ 8.60 per statute mile |
|
A0426 |
Advance Life Support - 1 |
$ 286.91 |
|
A0427 |
Advance Life Support - 1, Emergent |
$ 454.00 |
|
A0428 |
Basic Life Support |
$ 239.10 |
|
A0429 |
Basic Life Support, Emergent |
$ 382.54 |
|
A0430 |
Air, Fixed Wing |
$3,350.00 |
|
A0431 |
Air, Rotary Wing |
$3,900.66 |
|
A0433 |
Advance Life Support – 2 |
$ 657.50 |
|
A0434 |
Specialty Care Transport |
$ 777.93 |
|
A0435 |
Mileage, Air, Fixed Wing |
$ 10.30 per statute mile |
|
A0436 |
Mileage, Air, Rotary Wing |
$ 27.47 per statute mile |
Section 9. Facility Fees.
(a) Fees for Inpatient Hospital Services.
(i) Services or items shall be paid per usual and customary services pursuant to Chapter 9, Sections 1, 2, 4, 6, and 8 in addition to this section. Required documentation to support billed charges are as follows:
(A) Detailed itemization
(B) Anesthesia graphic
(C) Operative report
(D) History and physical
(E) Discharge summary
(F) Supplier’s invoice for any single supply/implant charged at $1,000.00 or more.
(I) Such items shall be reimbursed at 130% of invoice amount. Shipping and handling charges shall not be reimbursed.
(ii) Bills shall be audited for unidentified and unrelated services and/or items.
(iii) The Division shall provide a copy of the audit upon request.
(iv) Hospital Room Rates. The Division shall pay inpatient hospital room rates based upon an annual survey conducted by the Division. The hospital room rates for a semi‑private and intensive care unit bed shall be at the usual and customary rates charged to the general public. Such rates shall be effective automatically on the first day of each calendar year.
(b) Fees for Injections, Rhizotomies, and IV Sedation. Injection services shall be paid per the listed reimbursement rates shown in Table A. Reimbursement allowables are all inclusive to each procedural code. See Chapter 9, Section 1 of these Rules for additional guidelines.
(i) Refer to Table A for procedures done under fluoroscopy and / or IV sedation.
(ii) The Division shall pay 25% of the facility reimbursement base value for any injection(s) in addition to a primary code from Table A or any code from Table B. Added level codes shall be paid @ 100% of the base value listed on Table A.
(c) Fees for Surgery Centers Other than for Injections. Services shall be paid per the listed reimbursement rates shown in Table B. Reimbursement allowables are all inclusive unless otherwise specifically noted. Providers may note specific bill(s) with a written request for an audit to elect payment under the hospital fee schedule. See Chapter 9, Section 9, (a), Fees for Inpatient Hospital Services for required documentation for such audit. See Chapter 9, Section 1 of these Rules for additional guidelines.
(i) The highest value procedure shall be considered the primary procedure and be paid at 100% of the allowable listed on Table B. Additional procedures shall then be paid at 50% of the allowable. Reimbursement is limited to a maximum of four (4) procedure codes per surgical episode.
(ii) Invoices. The Division has defined a group of procedures that require surgery centers to provide suppliers’ or manufacturers’ invoice(s) for maximum reimbursement. They are distinguished by an asterisk (*) on Table B. The following standards shall be applied:
(A) Maximum reimbursement for asterisked procedures shall be the facility reimbursement allowable listed in Table B plus 130% of invoice amount. Shipping and handling charges shall not be reimbursed.
(B) The Division shall not provide direct payment to suppliers or manufacturers.
(C) The Division shall reimburse invoiced costs of an implant/device for any code marked with an asterisk on Table B and not otherwise recognized for payment.
(v) 23-Hour Stay. Code 19999 is recognized as a 23-hour stay. Documentation supporting the medical necessity for the stay is required for reimbursement. Reimbursement shall be based on half of the average Wyoming semi-private hospital room rate. See, (a), (iv) for guidelines.
|
TABLE A, INJECTIONS |
||||||
|
|
See Chapter 9, Section 9 (b), for detailed guidelines on facility reimbursements. |
|
||||
|
|
and Section 1 for general guidelines for fee schedules. |
|
|
|
||
|
|
* The Division shall pay 25% of the base value for each procedural code unless otherwise specified. |
|||||
|
|
|
FACILITY REIMBURSEMENTS |
||||
|
|
|
A |
B |
|
C |
D |
|
HCPCS / CPT |
SHORT DESCRIPTOR |
WITHOUT FLUOROSCOPY WITHOUT IV SEDATION * |
WITHOUT FLUOROSCOPY WITH IV SEDATION |
|
WITH FLUOROSCOPY WITHOUT IV SEDATION * |
WITH FLUOROSCOPY WITH IV SEDATION |
|
20526 |
Ther injection, carp tunnel |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20550 |
Inj tendon sheath/ligament |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20551 |
Inj tendon origin/insertion |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20552 |
Inj trigger point, 1/2 muscle |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20553 |
Inj trigger points, =?> 3 mu |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20600 |
Drain/inject, joint/bursa |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20605 |
Drain/inject, joint/bursa |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20610 |
Drain/inject, joint/bursa |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
20612 |
Aspirate/inj ganglion cyst |
$173.90 |
$732.52 |
|
$257.39 |
$816.01 |
|
27096 |
Inj sacroiliac joint w/ fluor |
$291.00 |
N/A |
|
$457.99 |
$1016.61 |
|
62264 |
Epidural lysis on single day |
N/A |
N/A |
|
$457.99 |
$1016.61 |
|
62270 |
Spinal fluid tap, diagnostic |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62272 |
Drain cerebro spinal fluid |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62273 |
Inject epidural patch |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62280 |
Treat spinal cord lesion |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62281 |
Treat spinal cord lesion |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62282 |
Treat spinal canal lesion |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62290 |
Use 72295 |
N/A |
N/A |
|
N/A |
N/A |
|
62291 |
Use 72285 |
N/A |
N/A |
|
N/A |
N/A |
|
62310 |
Inject spine c/t |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62311 |
Inject spine l/s (cd) |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62318 |
Inject spine w/cath, c/t |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
62319 |
Inject spine w/cath l/s (cd) |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64400 |
N block inj, trigeminal |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64402 |
N block inj, facial |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64405 |
N block inj, occipital |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64408 |
N block inj, vagus |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64410 |
N block inj, phrenic |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64412 |
N block inj, spinal accessor |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64416 |
N block cont infuse, b plex |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64417 |
N block inj, axillary |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64418 |
N block inj, suprascapular |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64420 |
N block inj, intercost, sng |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64421 |
N block inj, intercost, mlt |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64425 |
N block inj, ilio-ing/hypogi |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64430 |
N block inj, pudendal |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64435 |
N block inj, paracervical |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64445 |
N block inj, sciatic, sng |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
TABLE A, INJECTIONS |
||||||
|
|
See Chapter 9, Section 9 (b), for detailed guidelines on facility reimbursements. |
|
||||
|
|
and Section 1 for general guidelines for fee schedules. |
|
|
|
||
|
|
* The Division shall pay 25% of the base value for each procedural code unless otherwise specified. |
|||||
|
|
|
FACILITY REIMBURSEMENTS |
||||
|
|
|
A |
B |
|
C |
D |
|
HCPCS / CPT |
SHORT DESCRIPTOR |
WITHOUT FLUROSCOPY WITHOUT IV SEDATION * |
WITHOUT FLUROSCOPY WITH IV SEDATION |
|
WITH FLUROSCOPY WITHOUT IV SEDATION * |
WITH FLUOROSCOPY WITH IV SEDATION |
|
64446 |
N blk inj, sciatic, cont inf |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64447 |
N block inj fem, single |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64448 |
N block inj fem, cont inf |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64449 |
N block inj, lumbar plexus |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64450 |
N block, other peripheral |
$291.00 |
N/A |
|
$457.99 |
N/A |
|
64470 |
Inj paravertebral c/t |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64472 |
Inj c/t added level / side |
$72.75 |
N/A |
|
N/A |
N/A |
|
64475 |
Inj paravertebral l/s |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64476 |
Inj l/s added level / side |
$72.75 |
N/A |
|
N/A |
N/A |
|
64479 |
Inj foramen epidural c/t |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64480 |
Inj foramen added level/side |
$72.75 |
N/A |
|
N/A |
N/A |
|
64483 |
Inj foramen epidural l/s |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64484 |
Inj l/s added level / side |
$72.75 |
N/A |
|
N/A |
N/A |
|
64505 |
N block, spenopalatine gangl |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64508 |
N block, carotid sinus s/p |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64510 |
N block, stellate ganglion |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64517 |
N block inj, hypogas plxs |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64520 |
N block, lumbar/thoracic |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64530 |
N block inj, celiac pelus |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64600 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64605 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64610 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64614 |
Destroy nerve, extrem musc |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64620 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64622 |
Destr paravertebrl nerve l/s |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64623 |
Destr l/s added level / side |
$72.75 |
N/A |
|
N/A |
N/A |
|
64626 |
Destr paravertebrl nerve c/t |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64627 |
Destr c/t added level / side |
$72.75 |
N/A |
|
N/A |
N/A |
|
64630 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64640 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64680 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
64681 |
Injection treatment of nerve |
$291.00 |
$849.62 |
|
$457.99 |
$1016.61 |
|
72285 |
X-ray cervical / thoracic spine disk - Discogram -under fluoroscopy. Level |
N/A |
|
$507.84 |
$1066.46 |
|
|
72295 |
X-ray of lower spine disk - Discogram - under fluoroscopy. Level |
N/A |
|
$477.09 |
$1035.71 |
|
|
TABLE B, SURGERY CENTER PROCEDURES |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
10060 |
Drainage of skin abscess |
$115.85 |
|
|
10061 |
Drainage of skin abscess |
$115.85 |
|
|
10120 |
Remove foreign body |
$115.85 |
|
|
10121 |
Remove foreign body |
$1,150.68 |
|
|
10140 |
Drainage of hematoma/fluid |
$895.45 |
|
|
10180 |
Complex drainage, wound |
$1,250.18 |
|
|
11010 |
Debride skin, fx |
$318.24 |
|
|
11011 |
Debride skin/muscle, fx |
$318.24 |
|
|
11012 |
Debride skin/muscle/bone, fx |
$318.24 |
|
|
11040 |
Debride skin, partial |
$125.35 |
|
|
11041 |
Debride skin, full |
$125.35 |
|
|
11042 |
Debride skin/tissue |
$192.41 |
|
|
11043 |
Debride tissue/muscle |
$192.41 |
|
|
11044 |
Debride tissue/muscle/bone |
$516.43 |
|
|
11400 |
Excision, other benign, <0.5cm |
$318.24 |
|
|
11420 |
Exc benign lesion <0.5 cm |
$532.51 |
|
|
11421 |
Exc benign lesion 0.6-1.0 cm |
$532.51 |
|
|
11423 |
Exc benign lesion 2.1-3.0 cm |
$1,150.68 |
|
|
11750 |
Removal of nail bed |
$318.24 |
|
|
11752 |
Remove nail bed/finger tip |
$1,501.53 |
|
|
11760 |
Repair of nail bed |
$119.02 |
|
|
11762 |
Reconstruction of nail bed |
$119.02 |
|
|
12001 |
Repair superficial wound(s) |
$119.02 |
|
|
12020 |
Closure of split wound |
$119.02 |
|
|
12042 |
Layer closure of wound(s) |
$119.02 |
|
|
13120 |
Repair of wound or lesion |
$119.02 |
|
|
13121 |
Repair of wound or lesion |
$119.02 |
|
|
13131 |
Repair of wound or lesion |
$119.02 |
|
|
13132 |
Repair of wound or lesion |
$119.02 |
|
|
13160 |
Late closure of wound |
$1,395.97 |
|
|
14000 |
Skin tissue rearrangement |
$1,035.51 |
|
|
15100 |
Skin splt grft, trnk/arm/leg |
$1,395.97 |
|
|
15120 |
Skn splt a-grft fac/nck/hf/g |
$1,395.97 |
|
|
15121 |
Skn splt a-grft f/n/hf/g add |
$1,395.97 |
|
|
15220 |
Skn full graft sclp/arm/leg |
$1,395.97 |
|
|
15240 |
Skin full grft face/genit/hf |
$1,035.51 |
|
|
15620 |
Skin graft |
$1,395.97 |
|
|
15760 |
Composite skin graft |
$1,395.97 |
|
|
15850 |
Removal of sutures |
$192.41 |
|
|
15851 |
Removal of sutures |
$192.41 |
|
|
20100 |
Explore wound, neck |
$365.66 |
|
|
20103 |
Explore wound, extremity |
$365.66 |
|
|
20520 |
Removal of foreign body |
$318.24 |
|
|
20525 |
Removal of foreign body |
$1,501.53 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
20555 |
Place needle musc/tissue radele |
$1,836.42 |
|
|
20670 |
Removal of support implant |
$1,150.68 |
|
|
20680 |
Removal of support implant |
$1,501.53 |
|
|
20690 |
Apply bone fixation device |
$1,836.42 |
|
|
20694 |
Remove bone fixation device |
$1,564.25 |
|
|
20902 |
Removal of bone for graft |
$1,836.42 |
|
|
20930 |
Spinal bone allograft |
Invoice reimbursement only * |
|
|
20931 |
Spinal bone allograft |
Invoice reimbursement only * |
|
|
20936 |
Spinal bone autograft |
$1,836.42 |
|
|
20937 |
Spinal bone autograft |
$1,836.42 |
|
|
20938 |
Spinal bone autograft |
$1,836.42 |
|
|
21325 |
Treatment of nose fracture |
$1,788.45 |
|
|
21330 |
Treatment of nose fracture |
$1,788.45 |
|
|
21335 |
Treatment of nose fracture |
$1,788.45 |
|
|
21407 |
Treat eye socket fracture |
$2,838.64 |
|
|
21408 |
Treat eye socket fracture |
$2,838.64 |
|
|
21555 |
Remove lesion, neck/chest |
$1,501.53 |
|
|
22100 |
Remove part of neck vertebra |
$3,262.13 |
|
|
22520 |
Percut vertebroplasty thor |
$1,836.42 |
|
|
22521 |
Percut vertebroplasty lumb |
$1,836.42 |
|
|
22524 |
Percut kyphoplasty, lumbar |
$3,341.58 |
|
|
22526 |
IDET including fluro per disc |
$2,286.87 |
|
|
22527 |
IDET including fluro per disc added level |
$1,456.27 |
|
|
22554 |
Neck spine fusion |
$3,262.13 |
|
|
22556 |
Thorax spine fusion |
$3,262.13 |
|
|
22585 |
Additional spinal fusion |
$3,262.13 |
|
|
22600 |
Neck spine fusion |
$3,262.13 |
|
|
22610 |
Thorax spine fusion |
$3,262.13 |
|
|
22612 |
Lumbar spine fusion |
$3,262.13 |
|
|
22614 |
Spine fusion, extra segment |
$3,262.13 |
|
|
22630 |
Lumbar spine fusion |
$3,262.13 |
|
|
22632 |
Spine fusion, extra segment |
$3,262.13 |
|
|
22840 |
Insert spine fixation device |
$3,262.13 |
* |
|
22841 |
Insert spine fixation device |
$3,262.13 |
* |
|
22842 |
Insert spine fixation device |
$3,262.13 |
* |
|
22843 |
Insert spine fixation device |
$3,262.13 |
* |
|
22844 |
Insert spine fixation device |
$3,262.13 |
* |
|
22845 |
Insert spine fixation device |
$3,262.13 |
* |
|
22846 |
Insert spine fixation device |
$3,262.13 |
* |
|
22847 |
Insert spine fixation device |
$3,262.13 |
* |
|
22848 |
Insert pelv fixation device |
$3,262.13 |
* |
|
22849 |
Reinsert spinal fixation |
$3,262.13 |
* |
|
22850 |
Remove spine fixation device |
$3,262.13 |
|
|
22851 |
Apply spine prosth device |
$3,262.13 |
* |
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
23020 |
Release shoulder joint |
$2,808.77 |
|
|
23040 |
Exploratory shoulder surgery |
$1,836.42 |
|
|
23044 |
Exploratory shoulder surgery |
$1,836.42 |
|
|
23075 |
Removal of shoulder lesion |
$1,150.68 |
|
|
23076 |
Removal of shoulder lesion |
$1,501.53 |
|
|
23100 |
Biopsy of shoulder joint |
$1,564.25 |
|
|
23101 |
Shoulder joint surgery |
$1,836.42 |
|
|
23105 |
Remove shoulder joint lining |
$1,836.42 |
|
|
23106 |
Incision of collarbone joint |
$1,836.42 |
|
|
23107 |
Explore treat shoulder joint |
$1,836.42 |
|
|
23120 |
Partial removal, collar bone |
$2,808.77 |
|
|
23130 |
Remove shoulder bone, part |
$2,808.77 |
|
|
23140 |
Removal of bone lesion |
$1,564.25 |
|
|
23145 |
Removal of bone lesion |
$1,836.42 |
|
|
23405 |
Incision of tendon & muscle |
$1,836.42 |
|
|
23410 |
Repair rotator cuff, acute |
$3,341.58 |
|
|
23412 |
Repair rotator cuff, chronic |
$3,341.58 |
|
|
23415 |
Release of shoulder ligament |
$2,808.77 |
|
|
23420 |
Repair of shoulder |
$3,341.58 |
|
|
23430 |
Repair biceps tendon |
$3,341.58 |
|
|
23440 |
Remove/transplant tendon |
$3,341.58 |
|
|
23450 |
Repair shoulder capsule |
$3,341.58 |
|
|
23455 |
Repair shoulder capsule |
$3,341.58 |
|
|
23460 |
Repair shoulder capsule |
$3,341.58 |
|
|
23462 |
Repair shoulder capsule |
$3,341.58 |
|
|
23465 |
Repair shoulder capsule |
$3,341.58 |
|
|
23466 |
Repair shoulder capsule |
$3,341.58 |
|
|
23470 |
Reconstruct shoulder joint |
$8,035.28 |
|
|
23485 |
Revision of collar bone |
$2,808.77 |
|
|
23515 |
Treat clavicle fracture |
$4,389.70 |
|
|
23530 |
Treat clavicle dislocation |
$2,879.93 |
|
|
23532 |
Treat clavicle dislocation |
$1,958.40 |
|
|
23550 |
Treat clavicle dislocation |
$2,879.93 |
|
|
23552 |
Treat clavicle dislocation |
$2,879.93 |
|
|
23630 |
Treat humerus fracture |
$4,389.70 |
|
|
23655 |
Treat shoulder dislocation |
$1,100.26 |
|
|
23700 |
Fixation of shoulder |
$1,100.26 |
|
|
23929 |
Shoulder surgery procedure |
$131.96 |
|
|
23930 |
Drainage of arm lesion |
$1,250.18 |
|
|
23931 |
Drainage of arm bursa |
$1,250.18 |
|
|
24000 |
Exploratory elbow surgery |
$1,836.42 |
|
|
24006 |
Release elbow joint |
$1,836.42 |
|
|
24101 |
Explore/treat elbow joint |
$1,836.42 |
|
|
24102 |
Remove elbow joint lining |
$1,836.42 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
24105 |
Removal of elbow bursa |
$1,564.25 |
|
|
24110 |
Remove humerus lesion |
$1,564.25 |
|
|
24130 |
Removal of head of radius |
$1,836.42 |
|
|
24147 |
Partial removal of elbow |
$1,836.42 |
|
|
24200 |
Removal of arm foreign body |
$318.24 |
|
|
24201 |
Removal of arm foreign body |
$1,150.68 |
|
|
24300 |
Manipulate elbow w/anesth |
$1,100.26 |
|
|
24340 |
Repair of biceps tendon |
$2,808.77 |
|
|
24341 |
Repair arm tendon/muscle |
$2,808.77 |
|
|
24342 |
Repair of ruptured tendon |
$2,808.77 |
|
|
24343 |
Repr elbow lat ligmnt w/tiss |
$1,836.42 |
|
|
24344 |
Reconstruct elbow lat ligmnt |
$2,808.77 |
|
|
24345 |
Repr elbw med ligmnt w/tissu |
$1,836.42 |
|
|
24346 |
Reconstruct elbow med ligmnt |
$2,808.77 |
|
|
24357 |
Repair of tennis elbow |
$1,836.42 |
|
|
24358 |
Repair of tennis elbow |
$1,836.42 |
|
|
24359 |
Repair of tennis elbow |
$1,836.42 |
|
|
24360 |
Reconstruct elbow joint |
$2,396.31 |
|
|
24365 |
Reconstruct head of radius |
$2,396.31 |
|
|
24366 |
Reconstruct head of radius / imp |
$8,035.28 |
|
|
24400 |
Revision of humerus |
$1,836.42 |
|
|
24430 |
Repair of humerus |
$2,808.77 |
|
|
24435 |
Repair humerus with graft |
$2,808.77 |
|
|
24545 |
Treat humerus fracture |
$4,389.70 |
|
|
24546 |
Treat humerus fracture |
$4,389.70 |
|
|
24575 |
Treat humerus fracture |
$4,389.70 |
|
|
24579 |
Treat humerus fracture |
$4,389.70 |
|
|
24582 |
Treat humerus fracture |
$1,958.40 |
|
|
24586 |
Treat elbow fracture |
$4,389.70 |
|
|
24605 |
Treat elbow dislocation |
$1,100.26 |
|
|
24615 |
Treat elbow dislocation |
$4,389.70 |
|
|
24655 |
Treat radius fracture |
$131.96 |
|
|
24665 |
Treat radius fracture |
$2,879.93 |
|
|
24685 |
Treat ulnar fracture |
$2,879.93 |
|
|
24800 |
Fusion of elbow joint |
$2,808.77 |
|
|
25000 |
Incision of tendon sheath |
$1,564.25 |
|
|
25001 |
Incise flexor carpi radialis |
$1,564.25 |
|
|
25020 |
Decompress forearm 1 space |
$1,564.25 |
|
|
25023 |
Decompress forearm 1 space |
$1,836.42 |
|
|
25024 |
Decompress forearm 2 spaces |
$1,836.42 |
|
|
25025 |
Decompress forearm 2 spaces |
$1,836.42 |
|
|
25028 |
Drainage of forearm lesion |
$1,564.25 |
|
|
25031 |
Drainage of forearm bursa |
$1,564.25 |
|
|
25040 |
Explore/treat wrist joint |
$1,836.42 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
25066 |
Biopsy forearm soft tissues |
$1,501.53 |
|
|
25075 |
Removal forearm lesion subcu |
$1,150.68 |
|
|
25076 |
Removal forearm lesion deep |
$1,501.53 |
|
|
25085 |
Incision of wrist capsule |
$1,564.25 |
|
|
25100 |
Biopsy of wrist joint |
$1,564.25 |
|
|
25101 |
Explore/treat wrist joint |
$1,836.42 |
|
|
25105 |
Remove wrist joint lining |
$1,836.42 |
|
|
25107 |
Remove wrist joint cartilage |
$1,836.42 |
|
|
25110 |
Remove wrist tendon lesion |
$1,564.25 |
|
|
25111 |
Remove wrist tendon lesion |
$1,199.87 |
|
|
25112 |
Remove wrist tendon lesion |
$1,199.87 |
|
|
25115 |
Remove wrist/forearm lesion |
$1,564.25 |
|
|
25116 |
Remove wrist/forearm lesion |
$1,564.25 |
|
|
25118 |
Excise wrist tendon sheath |
$1,836.42 |
|
|
25120 |
Removal of forearm lesion |
$1,836.42 |
|
|
25136 |
Remove & graft wrist lesion |
$1,836.42 |
|
|
25150 |
Partial removal of ulna |
$1,836.42 |
|
|
25151 |
Partial removal of radius |
$1,836.42 |
|
|
25210 |
Removal of wrist bone |
$1,928.13 |
|
|
25215 |
Removal of wrist bones |
$1,928.13 |
|
|
25230 |
Partial removal of radius |
$1,836.42 |
|
|
25240 |
Partial removal of ulna |
$1,836.42 |
|
|
25248 |
Remove forearm foreign body |
$1,564.25 |
|
|
25259 |
Manipulate wrist w/anesthes |
$131.96 |
|
|
25260 |
Repair forearm tendon/muscle |
$1,836.42 |
|
|
25263 |
Repair forearm tendon/muscle |
$1,836.42 |
|
|
25270 |
Repair forearm tendon/muscle |
$1,836.42 |
|
|
25272 |
Repair forearm tendon/muscle |
$1,836.42 |
|
|
25274 |
Repair forearm tendon/muscle |
$1,836.42 |
|
|
25275 |
Repair forearm tendon sheath |
$1,836.42 |
|
|
25280 |
Revise wrist/forearm tendon |
$1,836.42 |
|
|
25290 |
Incise wrist/forearm tendon |
$1,836.42 |
|
|
25295 |
Release wrist/forearm tendon |
$1,564.25 |
|
|
25300 |
Fusion of tendons at wrist |
$1,836.42 |
|
|
25301 |
Fusion of tendons at wrist |
$1,836.42 |
|
|
25310 |
Transplant forearm tendon |
$2,808.77 |
|
|
25320 |
Repair/revise wrist joint |
$2,808.77 |
|
|
25360 |
Revision of ulna |
$1,836.42 |
|
|
25390 |
Shorten radius or ulna |
$1,836.42 |
|
|
25400 |
Repair radius or ulna |
$1,836.42 |
|
|
25405 |
Repair/graft radius or ulna |
$1,836.42 |
|
|
25415 |
Repair radius & ulna |
$1,836.42 |
|
|
25420 |
Repair/graft radius & ulna |
$2,808.77 |
|
|
25430 |
Vasc graft into carpal bone |
$1,928.13 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
25440 |
Repair/graft wrist bone |
$2,808.77 |
|
|
25447 |
Repair wrist joint(s) |
$2,396.31 |
|
|
25545 |
Treat fracture of ulna |
$2,879.93 |
|
|
25605 |
Treat fracture radius/ulna |
$131.96 |
|
|
25606 |
Treat fracture radius/ulna |
$1,958.40 |
|
|
25608 |
Treat fx rad intra-articul |
$4,543.61 |
|
|
25628 |
Treat wrist bone fracture |
$2,879.93 |
|
|
25645 |
Treat wrist bone fracture |
$2,879.93 |
|
|
25651 |
Pin ulnar styloid fracture |
$1,958.40 |
|
|
25652 |
Treat fracture ulnar styloid |
$2,879.93 |
|
|
25660 |
Treat wrist dislocation |
$131.96 |
|
|
25670 |
Treat wrist dislocation |
$1,958.40 |
|
|
25671 |
Pin radioulnar dislocation |
$1,958.40 |
|
|
25676 |
Treat wrist dislocation |
$1,958.40 |
|
|
25685 |
Treat wrist fracture |
$1,958.40 |
|
|
25695 |
Treat wrist dislocation |
$1,958.40 |
|
|
25800 |
Fusion of wrist joint |
$2,808.77 |
|
|
25810 |
Fusion/graft of wrist joint |
$2,808.77 |
|
|
25820 |
Fusion of hand bones |
$1,199.87 |
|
|
25825 |
Fuse hand bones with graft |
$1,928.13 |
|
|
26011 |
Drainage of finger abscess |
$895.45 |
|
|
26020 |
Drain hand tendon sheath |
$1,199.87 |
|
|
26040 |
Release palm contracture |
$1,928.13 |
|
|
26055 |
Incise finger tendon sheath |
$1,199.87 |
|
|
26060 |
Incision of finger tendon |
$1,199.87 |
|
|
26070 |
Explore/treat hand joint |
$1,199.87 |
|
|
26075 |
Explore/treat finger joint |
$1,199.87 |
|
|
26080 |
Explore/treat finger joint |
$1,199.87 |
|
|
26100 |
Biopsy hand joint lining |
$1,199.87 |
|
|
26105 |
Biopsy finger joint lining |
$1,199.87 |
|
|
26110 |
Biopsy finger joint lining |
$1,199.87 |
|
|
26115 |
Removal hand lesion subcut |
$1,501.53 |
|
|
26116 |
Removal hand lesion, deep |
$1,501.53 |
|
|
26121 |
Release palm contracture |
$1,928.13 |
|
|
26123 |
Release palm contracture |
$1,928.13 |
|
|
26125 |
Release palm contracture |
$1,199.87 |
|
|
26130 |
Remove wrist joint lining |
$1,199.87 |
|
|
26140 |
Revise finger joint, each |
$1,199.87 |
|
|
26145 |
Tendon excision, palm/finger |
$1,199.87 |
|
|
26160 |
Remove tendon sheath lesion |
$1,199.87 |
|
|
26170 |
Removal of palm tendon, each |
$1,199.87 |
|
|
26180 |
Removal of finger tendon |
$1,199.87 |
|
|
26185 |
Remove finger bone |
$1,199.87 |
|
|
26230 |
Partial removal of hand bone |
$1,199.87 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
26235 |
Partial removal, finger bone |
$1,199.87 |
|
|
26236 |
Partial removal, finger bone |
$1,199.87 |
|
|
26320 |
Removal of implant from hand |
$1,150.68 |
|
|
26340 |
Manipulate finger w/anesth |
$131.96 |
|
|
26350 |
Repair finger/hand tendon |
$1,928.13 |
|
|
26352 |
Repair/graft hand tendon |
$1,928.13 |
|
|
26356 |
Repair finger/hand tendon |
$1,928.13 |
|
|
26357 |
Repair finger/hand tendon |
$1,928.13 |
|
|
26358 |
Repair/graft hand tendon |
$1,928.13 |
|
|
26370 |
Repair finger/hand tendon |
$1,928.13 |
|
|
26372 |
Repair/graft hand tendon |
$1,928.13 |
|
|
26373 |
Repair finger/hand tendon |
$1,928.13 |
|
|
26390 |
Revise hand/finger tendon |
$1,928.13 |
|
|
26392 |
Repair/graft hand tendon |
$1,928.13 |
|
|
26410 |
Repair hand tendon |
$1,199.87 |
|
|
26412 |
Repair/graft hand tendon |
$1,928.13 |
|
|
26418 |
Repair finger tendon |
$1,199.87 |
|
|
26420 |
Repair/graft finger tendon |
$1,928.13 |
|
|
26426 |
Repair finger/hand tendon |
$1,928.13 |
|
|
26428 |
Repair/graft finger tendon |
$1,928.13 |
|
|
26432 |
Repair finger tendon |
$1,199.87 |
|
|
26433 |
Repair finger tendon |
$1,199.87 |
|
|
26434 |
Repair/graft finger tendon |
$1,928.13 |
|
|
26437 |
Realignment of tendons |
$1,199.87 |
|
|
26440 |
Release palm/finger tendon |
$1,199.87 |
|
|
26442 |
Release palm & finger tendon |
$1,928.13 |
|
|
26445 |
Release hand/finger tendon |
$1,199.87 |
|
|
26449 |
Release forearm/hand tendon |
$1,928.13 |
|
|
26450 |
Incision of palm tendon |
$1,199.87 |
|
|
26455 |
Incision of finger tendon |
$1,199.87 |
|
|
26460 |
Incise hand/finger tendon |
$1,199.87 |
|
|
26471 |
Fusion of finger tendons |
$1,199.87 |
|
|
26474 |
Fusion of finger tendons |
$1,199.87 |
|
|
26476 |
Tendon lengthening |
$1,199.87 |
|
|
26477 |
Tendon shortening |
$1,199.87 |
|
|
26478 |
Lengthening of hand tendon |
$1,199.87 |
|
|
26479 |
Shortening of hand tendon |
$1,199.87 |
|
|
26480 |
Transplant hand tendon |
$1,928.13 |
|
|
26483 |
Transplant/graft hand tendon |
$1,928.13 |
|
|
26485 |
Transplant palm tendon |
$1,928.13 |
|
|
26489 |
Transplant/graft palm tendon |
$1,928.13 |
|
|
26500 |
Hand tendon reconstruction |
$1,199.87 |
|
|
26502 |
Hand tendon reconstruction |
$1,928.13 |
|
|
26508 |
Release thumb contracture |
$1,199.87 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
26520 |
Release knuckle contracture |
$1,199.87 |
|
|
26525 |
Release finger contracture |
$1,199.87 |
|
|
26530 |
Revise knuckle joint |
$2,396.31 |
|
|
26535 |
Revise finger joint |
$2,396.31 |
|
|
26540 |
Repair hand joint |
$1,199.87 |
|
|
26541 |
Repair hand joint with graft |
$1,928.13 |
|
|
26542 |
Repair hand joint with graft |
$1,199.87 |
|
|
26545 |
Reconstruct finger joint |
$1,928.13 |
|
|
26546 |
Repair nonunion hand |
$1,928.13 |
|
|
26548 |
Reconstruct finger joint |
$1,928.13 |
|
|
26605 |
Treat metacarpal fracture |
$131.96 |
|
|
26607 |
Treat metacarpal fracture |
$131.96 |
|
|
26608 |
Treat metacarpal fracture |
$1,958.40 |
|
|
26615 |
Treat metacarpal fracture |
$2,879.93 |
|
|
26650 |
Treat thumb fracture |
$1,958.40 |
|
|
26665 |
Treat thumb fracture |
$2,879.93 |
|
|
26676 |
Pin hand dislocation |
$1,958.40 |
|
|
26685 |
Treat hand dislocation |
$1,958.40 |
|
|
26705 |
Treat knuckle dislocation |
$131.96 |
|
|
26706 |
Pin knuckle dislocation |
$131.96 |
|
|
26715 |
Treat knuckle dislocation |
$1,958.40 |
|
|
26725 |
Treat finger fracture, each |
$131.96 |
|
|
26727 |
Treat finger fracture, each |
$1,958.40 |
|
|
26735 |
Treat finger fracture, each |
$1,958.40 |
|
|
26742 |
Treat finger fracture, each |
$131.96 |
|
|
26746 |
Treat finger fracture, each |
$1,958.40 |
|
|
26755 |
Treat finger fracture, each |
$131.96 |
|
|
26756 |
Pin finger fracture, each |
$1,958.40 |
|
|
26765 |
Treat finger fracture, each |
$1,958.40 |
|
|
26775 |
Treat finger dislocation |
$1,100.26 |
|
|
26776 |
Pin finger dislocation |
$1,958.40 |
|
|
26785 |
Treat finger dislocation |
$1,958.40 |
|
|
26841 |
Fusion of thumb |
$1,928.13 |
|
|
26842 |
Thumb fusion with graft |
$1,928.13 |
|
|
26843 |
Fusion of hand joint |
$1,928.13 |
|
|
26844 |
Fusion/graft of hand joint |
$1,928.13 |
|
|
26850 |
Fusion of knuckle |
$1,928.13 |
|
|
26852 |
Fusion of knuckle with graft |
$1,928.13 |
|
|
26860 |
Fusion of finger joint |
$1,928.13 |
|
|
26861 |
Fusion of finger jnt, add-on |
$1,928.13 |
|
|
26862 |
Fusion/graft of finger joint |
$1,928.13 |
|
|
26863 |
Fuse/graft added joint |
$1,928.13 |
|
|
26910 |
Amputate metacarpal bone |
$1,928.13 |
|
|
26951 |
Amputation of finger/thumb |
$1,199.87 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
26952 |
Amputation of finger/thumb |
$1,199.87 |
|
|
27065 |
Removal of hip bone lesion |
$1,564.25 |
|
|
27066 |
Removal of hip bone lesion |
$1,836.42 |
|
|
27267 |
Closed treat femur fracture |
$131.96 |
|
|
27275 |
Manipulation of hip joint |
$1,100.26 |
|
|
27301 |
Drain thigh/knee lesion |
$1,250.18 |
|
|
27306 |
Incision of thigh tendon |
$1,564.25 |
|
|
27310 |
Exploration of knee joint |
$1,836.42 |
|
|
27324 |
Biopsy, thigh soft tissues |
$1,501.53 |
|
|
27327 |
Removal of thigh lesion |
$1,501.53 |
|
|
27328 |
Removal of thigh lesion |
$1,501.53 |
|
|
27331 |
Explore/treat knee joint |
$1,836.42 |
|
|
27332 |
Removal of knee cartilage |
$1,836.42 |
|
|
27333 |
Removal of knee cartilage |
$1,836.42 |
|
|
27334 |
Remove knee joint lining |
$1,836.42 |
|
|
27335 |
Remove knee joint lining |
$1,836.42 |
|
|
27340 |
Removal of kneecap bursa |
$1,564.25 |
|
|
27345 |
Removal of knee cyst |
$1,564.25 |
|
|
27347 |
Remove knee cyst |
$1,564.25 |
|
|
27350 |
Removal of kneecap |
$1,836.42 |
|
|
27360 |
Partial removal, leg bone(s) |
$1,836.42 |
|
|
27372 |
Removal of foreign body |
$1,501.53 |
|
|
27380 |
Repair of kneecap tendon |
$1,564.25 |
|
|
27381 |
Repair/graft kneecap tendon |
$1,564.25 |
|
|
27385 |
Repair of thigh muscle |
$1,564.25 |
|
|
27386 |
Repair/graft of thigh muscle |
$1,564.25 |
|
|
27403 |
Repair of knee cartilage |
$1,836.42 |
|
|
27405 |
Repair of knee ligament |
$2,808.77 |
|
|
27407 |
Repair of knee ligament |
$2,808.77 |
|
|
27409 |
Repair of knee ligaments |
$2,808.77 |
|
|
27415 |
Osteochondral knee allograft |
$3,391.60 |
|
|
27416 |
Osteochondral knee autoograft |
$2,808.77 |
|
|
27418 |
Repair degenerated kneecap |
$2,808.77 |
|
|
27420 |
Revision of unstable kneecap |
$2,808.77 |
|
|
27422 |
Revision of unstable kneecap |
$2,808.77 |
|
|
27424 |
Revision/removal of kneecap |
$2,808.77 |
|
|
27425 |
Lat retinacular release open |
$1,836.42 |
|
|
27427 |
Reconstruction, knee |
$3,341.58 |
|
|
27428 |
Reconstruction, knee |
$3,341.58 |
|
|
27429 |
Reconstruction, knee |
$3,341.58 |
|
|
27446 |
Revision of knee joint |
$2,767.61 |
* |
|
27562 |
Treat kneecap dislocation |
$1,100.26 |
|
|
27570 |
Fixation of knee joint |
$1,100.26 |
|
|
27603 |
Drain lower leg lesion |
$1,250.18 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
27604 |
Drain lower leg bursa |
$1,564.25 |
|
|
27605 |
Incision of achilles tendon |
$1,529.60 |
|
|
27606 |
Incision of achilles tendon |
$1,564.25 |
|
|
27610 |
Explore/treat ankle joint |
$1,836.42 |
|
|
27612 |
Exploration of ankle joint |
$1,836.42 |
|
|
27618 |
Remove lower leg lesion |
$1,150.68 |
|
|
27619 |
Remove lower leg lesion |
$1,501.53 |
|
|
27620 |
Explore/treat ankle joint |
$1,836.42 |
|
|
27625 |
Remove ankle joint lining |
$1,836.42 |
|
|
27626 |
Remove ankle joint lining |
$1,836.42 |
|
|
27630 |
Removal of tendon lesion |
$1,564.25 |
|
|
27640 |
Partial removal of tibia |
$2,808.77 |
|
|
27641 |
Partial removal of fibula |
$1,836.42 |
|
|
27650 |
Repair achilles tendon |
$2,808.77 |
|
|
27652 |
Repair/graft achilles tendon |
$2,808.77 |
|
|
27654 |
Repair of achilles tendon |
$2,808.77 |
|
|
27658 |
Repair of leg tendon, each |
$1,564.25 |
|
|
27659 |
Repair of leg tendon, each |
$1,564.25 |
|
|
27664 |
Repair of leg tendon, each |
$1,564.25 |
|
|
27665 |
Repair of leg tendon, each |
$1,836.42 |
|
|
27675 |
Repair lower leg tendons |
$1,564.25 |
|
|
27676 |
Repair lower leg tendons |
$1,836.42 |
|
|
27680 |
Release of lower leg tendon |
$1,836.42 |
|
|
27685 |
Revision of lower leg tendon |
$1,836.42 |
|
|
27690 |
Revise lower leg tendon |
$2,808.77 |
|
|
27691 |
Revise lower leg tendon |
$2,808.77 |
|
|
27695 |
Repair of ankle ligament |
$1,836.42 |
|
|
27696 |
Repair of ankle ligaments |
$1,836.42 |
|
|
27698 |
Repair of ankle ligament |
$1,836.42 |
|
|
27700 |
Revision of ankle joint |
$2,396.31 |
|
|
27726 |
Repair fibula nonunion |
$1,958.40 |
|
|
27762 |
Treatment of ankle fracture |
$131.96 |
|
|
27766 |
Treatment of ankle fracture |
$2,879.93 |
|
|
27767 |
Closed treat ankle fracture |
$131.96 |
|
|
27768 |
Closed treat ankle fracture |
$131.96 |
|
|
27769 |
Open treatment ankle fracture |
$2,879.93 |
|
|
27784 |
Treatment of fibula fracture |
$2,879.93 |
|
|
27792 |
Treatment of ankle fracture |
$2,879.93 |
|
|
27814 |
Treatment of ankle fracture |
$2,879.93 |
|
|
27818 |
Treatment of ankle fracture |
$131.96 |
|
|
27822 |
Treatment of ankle fracture |
$2,879.93 |
|
|
27825 |
Treat lower leg fracture |
$131.96 |
|
|
27827 |
Treat lower leg fracture |
$4,389.70 |
|
|
27828 |
Treat lower leg fracture |
$4,389.70 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
27829 |
Treat lower leg joint |
$2,879.93 |
|
|
27842 |
Treat ankle dislocation |
$1,100.26 |
|
|
27870 |
Fusion of ankle joint, open |
$2,808.77 |
|
|
28008 |
Incision of foot fascia |
$1,529.60 |
|
|
28020 |
Exploration of foot joint |
$1,529.60 |
|
|
28022 |
Exploration of foot joint |
$1,529.60 |
|
|
28024 |
Exploration of toe joint |
$1,529.60 |
|
|
28035 |
Decompression of tibia nerve |
$1,328.81 |
|
|
28060 |
Partial removal, foot fascia |
$1,529.60 |
|
|
28070 |
Removal of foot joint lining |
$1,529.60 |
|
|
28072 |
Removal of foot joint lining |
$1,529.60 |
|
|
28080 |
Removal of foot lesion |
$1,529.60 |
|
|
28086 |
Excise foot tendon sheath |
$1,529.60 |
|
|
28088 |
Excise foot tendon sheath |
$1,529.60 |
|
|
28090 |
Removal of foot lesion |
$1,529.60 |
|
|
28092 |
Removal of toe lesions |
$1,529.60 |
|
|
28111 |
Part removal of metatarsal |
$1,529.60 |
|
|
28112 |
Part removal of metatarsal |
$1,529.60 |
|
|
28113 |
Part removal of metatarsal |
$1,529.60 |
|
|
28118 |
Removal of heel bone |
$1,529.60 |
|
|
28119 |
Removal of heel spur |
$1,529.60 |
|
|
28120 |
Part removal of ankle/heel |
$1,529.60 |
|
|
28122 |
Partial removal of foot bone |
$1,529.60 |
|
|
28124 |
Partial removal of toe |
$1,529.60 |
|
|
28200 |
Repair of foot tendon |
$1,529.60 |
|
|
28202 |
Repair/graft of foot tendon |
$1,529.60 |
|
|
28208 |
Repair of foot tendon |
$1,529.60 |
|
|
28210 |
Repair/graft of foot tendon |
$3,110.50 |
|
|
28220 |
Release of foot tendon |
$1,529.60 |
|
|
28222 |
Release of foot tendons |
$1,529.60 |
|
|
28225 |
Release of foot tendon |
$1,529.60 |
|
|
28226 |
Release of foot tendons |
$1,529.60 |
|
|
28230 |
Incision of foot tendon(s) |
$1,529.60 |
|
|
28232 |
Incision of toe tendon |
$1,529.60 |
|
|
28234 |
Incision of foot tendon |
$1,529.60 |
|
|
28238 |
Revision of foot tendon |
$3,110.50 |
|
|
28270 |
Release of foot contracture |
$1,529.60 |
|
|
28272 |
Release of toe joint, each |
$1,529.60 |
|
|
28285 |
Repair of hammertoe |
$1,529.60 |
|
|
28289 |
Repair hallux rigidus |
$1,529.60 |
|
|
28300 |
Incision of heel bone |
$3,110.50 |
|
|
28302 |
Incision of ankle bone |
$1,529.60 |
|
|
28304 |
Incision of midfoot bones |
$3,110.50 |
|
|
28305 |
Incise/graft midfoot bones |
$3,110.50 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
28306 |
Incision of metatarsal |
$1,529.60 |
|
|
28307 |
Incision of metatarsal |
$1,529.60 |
|
|
28308 |
Incision of metatarsal |
$1,529.60 |
|
|
28315 |
Removal of sesamoid bone |
$1,529.60 |
|
|
28320 |
Repair of foot bones |
$3,110.50 |
|
|
28322 |
Repair of metatarsals |
$3,110.50 |
|
|
28415 |
Treat heel fracture |
$4,389.70 |
|
|
28446 |
Osteochondral talus autograft |
$3,110.50 |
|
|
28465 |
Treatment of ankle fracture |
$2,879.93 |
|
|
28476 |
Treat metatarsal fracture |
$1,958.40 |
|
|
28485 |
Treat metatarsal fracture |
$2,879.93 |
|
|
28496 |
Treat big toe fracture |
$1,958.40 |
|
|
28505 |
Treat big toe fracture |
$1,958.40 |
|
|
28515 |
Treatment of toe fracture |
$131.96 |
|
|
28525 |
Treat toe fracture |
$1,958.40 |
|
|
28531 |
Treat sesamoid bone fracture |
$1,958.40 |
|
|
28546 |
Treat foot dislocation |
$1,958.40 |
|
|
28555 |
Repair foot dislocation |
$2,879.93 |
|
|
28576 |
Treat foot dislocation |
$1,958.40 |
|
|
28585 |
Repair foot dislocation |
$1,958.40 |
|
|
28606 |
Treat foot dislocation |
$1,958.40 |
|
|
28615 |
Repair foot dislocation |
$2,879.93 |
|
|
28636 |
Treat toe dislocation |
$1,958.40 |
|
|
28645 |
Repair toe dislocation |
$1,958.40 |
|
|
28666 |
Treat toe dislocation |
$1,958.40 |
|
|
28675 |
Repair of toe dislocation |
$1,958.40 |
|
|
28725 |
Fusion of foot bones |
$3,110.50 |
|
|
28740 |
Fusion of foot bones |
$3,110.50 |
|
|
28750 |
Fusion of big toe joint |
$3,110.50 |
|
|
28755 |
Fusion of big toe joint |
$1,529.60 |
|
|
28825 |
Partial amputation of toe |
$1,529.60 |
|
|
29800 |
Jaw arthroscopy/surgery |
$2,153.42 |
|
|
29804 |
Jaw arthroscopy/surgery |
$2,153.42 |
|
|
29805 |
Shoulder arthroscopy, dx |
$2,153.42 |
|
|
29806 |
Shoulder arthroscopy/surgery |
$3,391.60 |
|
|
29807 |
Shoulder arthroscopy/surgery |
$3,391.60 |
|
|
29819 |
Shoulder arthroscopy/surgery |
$2,153.42 |
|
|
29820 |
Shoulder arthroscopy/surgery |
$2,153.42 |
|
|
29821 |
Shoulder arthroscopy/surgery |
$2,153.42 |
|
|
29822 |
Shoulder arthroscopy/surgery |
$2,153.42 |
|
|
29823 |
Shoulder arthroscopy/surgery |
$2,153.42 |
|
|
29824 |
Shoulder arthroscopy/surgery |
$2,153.42 |
|
|
29825 |
Shoulder arthroscopy/surgery |
$2,153.42 |
|
|
29826 |
Shoulder arthroscopy/surgery |
$3,391.60 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
29827 |
Arthroscope rotator cuff repr |
$3,391.60 |
|
|
29828 |
Arthroscopy biceps tenodesis |
$3,391.60 |
|
|
29830 |
Elbow arthroscopy |
$2,153.42 |
|
|
29834 |
Elbow arthroscopy/surgery |
$2,153.42 |
|
|
29835 |
Elbow arthroscopy/surgery |
$2,153.42 |
|
|
29836 |
Elbow arthroscopy/surgery |
$2,153.42 |
|
|
29837 |
Elbow arthroscopy/surgery |
$2,153.42 |
|
|
29838 |
Elbow arthroscopy/surgery |
$2,153.42 |
|
|
29840 |
Wrist arthroscopy |
$2,153.42 |
|
|
29843 |
Wrist arthroscopy/surgery |
$2,153.42 |
|
|
29844 |
Wrist arthroscopy/surgery |
$2,153.42 |
|
|
29845 |
Wrist arthroscopy/surgery |
$2,153.42 |
|
|
29846 |
Wrist arthroscopy/surgery |
$2,153.42 |
|
|
29847 |
Wrist arthroscopy/surgery |
$2,153.42 |
|
|
29848 |
Wrist endoscopy/surgery |
$2,153.42 |
|
|
29850 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29851 |
Knee arthroscopy/surgery |
$3,391.60 |
|
|
29855 |
Tibial arthroscopy/surgery |
$3,391.60 |
|
|
29856 |
Tibial arthroscopy/surgery |
$2,153.42 |
|
|
29860 |
Hip arthroscopy, dx |
$2,153.42 |
|
|
29861 |
Hip arthroscopy/surgery |
$2,153.42 |
|
|
29862 |
Hip arthroscopy/surgery |
$3,391.60 |
|
|
29863 |
Hip arthroscopy/surgery |
$3,391.60 |
|
|
29866 |
Autgrft implnt, knee w/scope |
$3,391.60 |
|
|
29867 |
Allgrft implnt, knee w/scope |
$3,391.60 |
|
|
29868 |
Meniscal trnspl, knee w/scpe |
$3,391.60 |
|
|
29870 |
Knee arthroscopy, dx |
$2,153.42 |
|
|
29871 |
Knee arthroscopy/drainage |
$2,153.42 |
|
|
29873 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29874 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29875 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29876 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29877 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29879 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29880 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29881 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29882 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29883 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29884 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29885 |
Knee arthroscopy/surgery |
$3,391.60 |
|
|
29886 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29887 |
Knee arthroscopy/surgery |
$2,153.42 |
|
|
29888 |
Knee arthroscopy/surgery |
$3,391.60 |
|
|
29889 |
Knee arthroscopy/surgery |
$3,391.60 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
29891 |
Ankle arthroscopy/surgery |
$2,153.42 |
|
|
29892 |
Ankle arthroscopy/surgery |
$2,153.42 |
|
|
29893 |
Scope, plantar fasciotomy |
$1,529.60 |
|
|
29894 |
Ankle arthroscopy/surgery |
$2,153.42 |
|
|
29895 |
Ankle arthroscopy/surgery |
$2,153.42 |
|
|
29897 |
Ankle arthroscopy/surgery |
$2,153.42 |
|
|
29898 |
Ankle arthroscopy/surgery |
$2,153.42 |
|
|
29904 |
Subtalar arthro w/ removal |
$2,153.42 |
|
|
29905 |
Subtalar arthro w/ exc |
$2,153.42 |
|
|
29906 |
Subtalar arthro w/ debl |
$2,153.42 |
|
|
29907 |
subtalar arthro w/ fusion |
$3,391.60 |
|
|
30130 |
Excise inferior turbinate |
$1,233.20 |
|
|
30140 |
Resect inferior turbinate |
$1,788.45 |
|
|
30520 |
Repair of nasal septum |
$1,788.45 |
|
|
30930 |
Ther fx, nasal inf turbinate |
$1,233.20 |
|
|
31254 |
Revision of ethmoid sinus |
$1,628.44 |
|
|
31256 |
Exploration maxillary sinus |
$1,628.44 |
|
|
42145 |
Repair palate, pharynx/uvula |
$1,788.45 |
|
|
43220 |
Esoph endoscopy, dilation |
$618.84 |
|
|
43235 |
Uppr gi endoscopy, diagnosis |
$618.84 |
|
|
43239 |
Upper GI endoscopy, biopsy |
$618.84 |
|
|
43248 |
Uppr gi endoscopy/guide wire |
$618.84 |
|
|
45330 |
Diagnostic sigmoidoscopy |
$361.24 |
|
|
45378 |
Diagnostic colonoscopy |
$656.63 |
|
|
45380 |
Colonoscopy and biopsy |
$656.63 |
|
|
45385 |
Lesion removal colonoscopy |
$656.63 |
|
|
46221 |
Ligation of hemorrhoid(s) |
$268.88 |
|
|
46260 |
Hemorrhoidectomy |
$1,831.58 |
|
|
49505 |
Prp i/hern init reduc >5 yr |
$2,197.51 |
|
|
49507 |
Prp i/hern init block >5 yr |
$2,197.51 |
|
|
49520 |
Rerepair ing hernia, reduce |
$2,197.51 |
|
|
49521 |
Rerepair ing hernia, blocked |
$2,197.51 |
|
|
49525 |
Repair ing hernia, sliding |
$2,197.51 |
|
|
49550 |
Rpr rem hernia, init, reduce |
$2,197.51 |
|
|
49553 |
Rpr fem hernia, init blocked |
$2,197.51 |
|
|
49560 |
Rpr ventral hern init, reduc |
$2,197.51 |
|
|
49561 |
Rpr ventral hern init, block |
$2,197.51 |
|
|
49565 |
Rerepair ventrl hern, reduce |
$2,197.51 |
|
|
49566 |
Rerepair ventrl hern, block |
$2,197.51 |
|
|
49568 |
Hernia repair w/mesh |
$2,197.51 |
|
|
49570 |
Rpr epigastric hern, reduce |
$2,197.51 |
|
|
49572 |
Rpr epigastric hern, blocked |
$2,197.51 |
|
|
49585 |
Rpr umbil hern, reduc > 5 yr |
$2,197.51 |
|
|
49587 |
Rpr umbil hern, block > 5 yr |
$2,197.51 |
|
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
49650 |
Laparo hernia repair initial |
$3,302.78 |
|
|
49651 |
Laparo hernia repair recur |
$3,302.78 |
|
|
52000 |
Cystoscopy |
$532.34 |
|
|
52276 |
Cystoscopy and treatment |
$1,425.49 |
|
|
52281 |
Cystoscopy and treatment |
$1,425.49 |
|
|
55520 |
Removal of sperm cord lesion |
$1,791.41 |
|
|
55530 |
Revise spermatic cord veins |
$1,791.41 |
|
|
61885 |
Insrt/redo neurostim 1 array |
$3,163.62 |
* |
|
61886 |
Implant neurostim arrays |
$5,744.74 |
* |
|
62287 |
Percutaneous diskectomy |
$2,382.43 |
|
|
62292 |
Injection into disk lesion |
$212.61 |
|
|
62350 |
Implant spinal canal cath w/o laminectomy |
$2,191.40 |
|
|
62351 |
Implant spinal canal cath |
$3,262.13 |
|
|
62355 |
Remove spinal canal catheter |
$774.60 |
|
|
62361 |
Implant spine infusion pump |
$2,346.87 |
* |
|
62362 |
Implant spine infusion pump |
$2,346.87 |
* |
|
62365 |
Remove spine infusion device |
$2,382.43 |
|
|
62367 |
Analyze spine infusion pump |
$195.36 |
|
|
62368 |
Analyze spine infusion pump |
$195.36 |
|
|
63020 |
Neck spine disk surgery |
$3,262.13 |
|
|
63030 |
Low back disk surgery |
$3,262.13 |
|
|
63035 |
Spinal disk surgery add-on |
$3,262.13 |
|
|
63040 |
Laminotomy, single cervical |
$3,262.13 |
|
|
63042 |
Laminotomy, single lumbar |
$3,262.13 |
|
|
63045 |
Removal of spinal lamina |
$3,262.13 |
|
|
63046 |
Removal of spinal lamina |
$3,262.13 |
|
|
63047 |
Removal of spinal lamina |
$3,262.13 |
|
|
63048 |
Remove spinal lamina add-on |
$3,262.13 |
|
|
63075 |
Neck spine disk surgery |
$3,262.13 |
|
|
63650 |
Impant neuroelectrodes, percutaneous, array |
$1,791.59 |
* |
|
63655 |
Implant neuroelectrodes, laminectomy, plate/paddle |
$2,862.15 |
* |
|
63660 |
Revise/remove neuroelectrode |
$1,472.73 |
|
|
63685 |
Insrt/redo spine n generator |
$3,300.70 |
* |
|
63688 |
Revise/remove neuroreceiver |
$3,288.13 |
|
|
64555 |
Implant neuroelectrodes, peripheral nerve |
$1,791.59 |
* |
|
64560 |
Implant neuroelectrodes, autonomic nerve |
$1,791.59 |
* |
|
64561 |
Implant neuroelectrodes, sacral nerve |
$1,791.59 |
* |
|
64565 |
Implant neuroelectrodes, neuromusclar |
$1,791.59 |
* |
|
64573 |
Implant neuroelectrodes, cranial nerve |
$4,033.77 |
* |
|
64575 |
Implant neuroelectrodes, peripheral nerve |
$2,862.15 |
* |
|
64577 |
Implant neuroelectrodes, autonomic nerve |
$2,862.15 |
* |
|
64580 |
Implant neuroelectrodes, neuromusclar |
$2,862.15 |
* |
|
64581 |
Implant neuroelectrodes, sacral nerve |
$2,862.15 |
* |
|
64590 |
Insrt/redo perph n generator |
$3,300.70 |
* |
|
|
|
|
|
|
TABLE B, SURGERY CENTER PROCEDURES CONTINUE |
|||
|
See Chapter 9, Section 9 (c), for detailed information on facility reimbursements and |
|||
|
Section 1 for general guidelines. |
|
|
|
|
|
|
B |
|
|
HCPCS/CPT |
Short Descriptor |
Facility Reimbursement |
Invoice Required |
|
64702 |
Revise finger/toe nerve |
$1,328.81 |
|
|
64704 |
Revise hand/foot nerve |
$1,328.81 |
|
|
64708 |
Revise arm/leg nerve |
$1,328.81 |
|
|
64712 |
Revision of sciatic nerve |
$1,328.81 |
|
|
64718 |
Revise ulnar nerve at elbow |
$1,328.81 |
|
|
64719 |
Revise ulnar nerve at wrist |
$1,328.81 |
|
|
64721 |
Carpal tunnel surgery |
$1,328.81 |
|
|
64722 |
Relieve pressure on nerve(s) |
$1,328.81 |
|
|
64776 |
Remove digit nerve lesion |
$1,328.81 |
|
|
64778 |
Digit nerve surgery add-on |
$1,328.81 |
|
|
64782 |
Remove limb nerve lesion |
$1,328.81 |
|
|
64783 |
Limb nerve surgery add-on |
$1,328.81 |
|
|
64784 |
Remove nerve lesion |
$1,328.81 |
|
|
64787 |
Implant nerve end |
$1,328.81 |
|
|
64831 |
Repair of digit nerve |
$2,382.43 |
|
|
64832 |
Repair nerve add-on |
$2,382.43 |
|
|
64834 |
Repair of hand or foot nerve |
$2,382.43 |
|
|
64836 |
Repair of hand or foot nerve |
$2,382.43 |
|
|
64837 |
Repair nerve add-on |
$2,382.43 |
|
|
64856 |
Repair/transpose nerve |
$2,382.43 |
|
|
64890 |
Nerve graft, hand or foot |
$2,382.43 |
|
|
64898 |
Nerve graft, arm or leg |
$2,382.43 |
|
|
65235 |
Remove foreign body from eye |
$1,125.06 |
|
|
65285 |
Repair of eye wound |
$2,829.23 |
|
|
65710 |
Corneal transplant |
$2,933.07 |
|
|
65730 |
Corneal transplant |
$2,933.07 |
|
|
65750 |
Corneal transplant |
$2,933.07 |
|
|
65755 |
Corneal transplant |
$2,933.07 |
|
|
66250 |
Follow-up surgery of eye |
$1,125.06 |
|
|
66825 |
Reposition intraocular lens |
$1,691.84 |
|
|
66830 |
Removal of lens lesion |
$530.93 |
|
|
66840 |
Removal of lens material |
$1,000.00 |
|
|
66852 |
Removal of lens material |
$2,120.45 |
|
|
66920 |
Extraction of lens |
$2,120.45 |
|
|
66982 |
Cataract surgery, complex |
$1,789.00 |
|
|
66983 |
Cataract surg w/iol, 1 stage |
$1,789.00 |
|
|
66984 |
Cataract surg w/iol, 1 stage |
$1,789.00 |
|
|
67036 |
Removal of inner eye fluid |
$2,829.23 |
|
|
67038 |
Strip retinal membrane |
$2,829.23 |
|
|
67950 |
Revision of eyelid |
$1,382.45 |
|
|
69620 |
Repair of eardrum |
$1,788.45 |
|
|
69631 |
Repair eardrum structures |
$2,838.64 |
|