2015 MPFSD - CGS Medicare

1 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule Database2015 The Centers for Medicare & Medicaid Services (CMS) designates the status of HCPCS and CPT codes in the Medicare Physician Fee Schedule Database (MPFSDB). The status of codes may be updated periodically throughout the year and when the calendar year changes. Codes designated as Status A are active codes, are separately payable under the Medicare Physician Fee Schedule (assuming any existing coverage criteria are met), and have associated Relative Value Units (RVUs) and payment amounts. The list of Status A codes is extensive, and these codes are not listed in this 30, 2015 2015 Copyright, CGS Administrators, B 2 Status C 3 Status E 9 Status I 15 Status J 25 Status M 27 Status N 33 Status P 38 Status Q 40 Status R 41 Status T 43 Status X 44 January 30, 2015 2015 Copyright, CGS Administrators, 2 Modifier 26 is a CPT modifier.

2 And modifier TC is a HCPCS TAT U S BStatus B codes are bundled. Payment for these services is always included in payment for other services not specified. There are no RVUs or payment amounts for these codes, and separate payment is not made. CPT CodesModifier158502093020936228413600036 4163820490885908879088992352923539235492 3559235892371925319253292533925349260592 6069261892921929259292992934929389294493 740937709400594150941502694150 TCCPT CodesModifier960409690297010976029896098 9619896299000990019900299024990509905199 0539905699058990609907099071990789908099 0909909199100991169913599140992889933999 3409935899359993639936499366 CPT CodesModifier993679936899374993779937999 3809944699447994489944999485994869948799 489 HCPCS CodesModifierA4262A4263A4270A4300A4550G0 269Q3031R0076 January 30, 2015 2015 Copyright, CGS Administrators, 3 Modifier 26 is a CPT modifier, and modifier TC is a HCPCS TAT U S CStatus C are priced by each contractor.

3 CGS establishes RVUs and payment amounts for these services, generally on an individual basis, based on review of documentation (such as operative reports).CPT CodesModifier158471599917999194992099921 0882108921299214992174221743218992289922 9992392924940249992599926989272992759927 8992889929799299993099931299315993189932 85532856329993393333944 CPT CodesModifier339993483934841348423484334 8443484534846348473484836299371953750137 7993812938589389993949939599407994089941 5994189942299426994299943289434964349943 64743648436594377543881 CPT CodesModifier438824399944137442384471544 8994497945499459994699947143471444714547 3794739947579479994855148999493294965949 9064999950323503255054950949519995389954 44054699555595589955970 CPT CodesModifier559805857858579586795897458 9995989759898598996065960699630436304464 9996575766999672996739967599679996839968 899693996979969949699797017070170TC70555 70555TC7055770557TC7055870558 TCJanuary 30, 2015 2015 Copyright, CGS Administrators.

4 4 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule DatabaseModifier 26 is a CPT modifier, and modifier TC is a HCPCS CodesModifier7055970559TC7353073530TC741 9074190TC7423574235TC7430074300TC7430174 301TC7430574305TC7432874328TC7432974329T C7433074330TC7434074340TC7435574355TC743 6074360TC7436374363TC7442074420TC7442574 425TC7444574445TC7445074450TC7447074470T C74742 CPT CodesModifier74742TC7477574775TC75801758 01TC7580375803TC7580575805TC7580775807TC 7581075810TC7589475894TC7589675896TC7589 875898TC7594575945TC7594675946TC75952759 52TC7595375953TC7595475954TC7595675956TC 7595775957TC7595875958TC7595975959TC7597 075970 TCCPT CodesModifier7598075980TC7598275982TC760 0176001TC7612576125TC76496764962676496TC 76497764972676497TC76498764982676498TC76 499764992676499TC7693076930TC7693276932T C7694076940TC7694176941TC7694576945TC769 7576975TC7699876998TC76999769992676999TC 7701377013 TCCPT

5 CodesModifier7702277022TC772997729926772 99TC7737177399773992677399TC774997749926 77499TC775207752277523775257779977799267 7799TC78099780992678099TC781997819926781 99TC7828278282TC78299782992678299TC78399 783992678399TC7841478414TC7845978459TC78 49178491 TCS TAT U S CJanuary 30, 2015 2015 Copyright, CGS Administrators, 5 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule DatabaseModifier 26 is a CPT modifier, and modifier TC is a HCPCS CodesModifier7849278492TC784997849926784 99TC78599785992678599TC7860878608TC78699 786992678699TC78799787992678799TC7881178 811TC7881278812TC7881378813TC7881478814T C7881578815TC7881678816TC789997899926789 99TC7930079300TC7944579445TC799997999926 79999TC86485 CPT CodesModifier88199881992688199TC88299883 99883992688399TC892409086790868908699089 990952909539099991299912992691299TC92499 924992692499TC927009297892978TC929799297 9TC9299292993932999331593315TC9331793317 TC9331893318TC9353093530TC9353193531 TCCPT CodesModifier9353293532TC9353393533TC935 6193561TC9356293562TC9357193571TC9357293 572TC9360093600TC9360293602TC9360393603T C9360993609TC9361093610TC9361293612TC936 1593615TC9361693616TC9361893618TC9361993 619TC9362093620TC9362193621TC9362293622T C93623 CPT

6 CodesModifier93623TC9362493624TC93631936 31TC9364093640TC9364193641TC9366293662TC 93745937452693745TC93799937992693799TC93 9989464294772947722694772TC9477494775947 769477794799947992694799TC95199958249582 4TC95943959432695943TC9595195951TC959659 5965 TCS TAT U S CJanuary 30, 2015 2015 Copyright, CGS Administrators, 6 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule DatabaseModifier 26 is a CPT modifier, and modifier TC is a HCPCS CodesModifier9596695966TC9596795967TC959 999602096020TC96379965499699997039971399 7607976089779999082991439914499145991489 91499915099199994990019T0042T0051T0052T0 053T0054T0055T0058T0071T0072T0075T0075T2 60075 TTC0076T0076T26 CPT CodesModifier0076 TTC0095T0098T0099T0100T0101T0102T0103T01 06T0107T0108T0109T0110T0111T0123T0126T01 59T0159T260159 TTC0163T0164T0165T0169T0171T0172T0174T01 75T0178T0179T0180T0182T0182T260182 TTC0184T0190T0191T0195T0196T0198 TCPT CodesModifier0200T0201T0202T0205T0206T02 07T0208T0209T0210T0211T0212T0213T0214T02 15T0216T0217T0218T0219T0220T0221T0222T02 23T0224T0225T0228T0229T0230T0231T0232T02 33T0234T0235T0236T0237T0238T0240T0240T26 0240 TTC0241 TCPT CodesModifier0241T260241 TTC0243T0243T260243 TTC0244T0244T260244 TTC0249T0253T0254T0255T0255T260255

7 TTC0262T0263T0264T0265T0266T0267T0268T02 69T0270T0271T0272T0273T0274T0278T0281T02 82T0283T0284T0285T0286T0287T0288T0289T02 90T0291TS TAT U S CJanuary 30, 2015 2015 Copyright, CGS Administrators, 7 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule DatabaseModifier 26 is a CPT modifier, and modifier TC is a HCPCS CodesModifier0292T0293T0294T0295T0296T02 97T0298T0299T0300T0301T0302T0303T0304T03 05T0306T0307T0308T0309T0310T0311T0312T03 13T0314T0315T0316T0317T0329T0330T0331T03 32T0333T0335T0336T0337T0338T0339T0340T03 41T0342 TCPT CodesModifier0345T0346T0347T0348T0349T03 50T0351T0352T0353T0354T0355T0356T0357T03 58T0359T0360T0361T0362T0363T0364T0365T03 66T0367T0368T0369T0370T0371T0372T0373T03 74T0375T0376T0377T0378T0379T0380T0381T03 82T0383 THCPCS CodesModifierA9502A9503A9504A9505A9507A9 508A9509A9510A9512A9516A9517A9521A9524A9 526A9527A9528A9529A9530A9531A9532A9536A9 537A9538A9539A9540A9541A9542A9543A9544A9 545A9546A9547A9548A9550A9551A9552A9553A9 554A9555S TAT U S CCPT CodesModifier0384T0385T0386T0387T0388T03 89T0390T0391 TJanuary 30.

8 2015 2015 Copyright, CGS Administrators, 8 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule DatabaseModifier 26 is a CPT modifier, and modifier TC is a HCPCS CodesModifierA9556A9557A9558A9559A9560A9 561A9562A9563A9564A9566A9567A9568A9569A9 570A9571A9572A9580A9586A9599A9600A9699G0 186G0339G0340G0398G039826G0398 TCG0399G039926G0399 TCG0400G040026G0400 TCG0460G6017G6021G6027G6028Q3001S TAT U S CHCPCS CodesModifierR0070R0075 January 30, 2015 2015 Copyright, CGS Administrators, 9 Modifier 26 is a CPT modifier, and modifier TC is a HCPCS TAT U S EStatus E are excluded from the MPFS by regulation. There are no RVUs or payment amounts for these codes, and separate payment is not CodesModifier902969037190375903769038590 3939039690476904779058190585905869063290 6339063490636906459064690647906489064990 6509067590676906809068190690906919069290 69390696906989070090702 CPT CodesModifier907039070490705907069070790 7089071090712907139071490715907169071790 7199072090721907259072790733907349073590 73690749 HCPCS CodesModifierA9150A9700G0157G0158G0159G0 160G0161G0162G0163G0164G0257G0259G0260G0 293G0294G0448G0458J0120J0129J0130J0131J0 132J0133J0135J0150J0151J0153J0171J0178J0 180J0190J0200J0205J0207 HCPCS CodesModifierJ0210J0215J0220J0221J0256J0 257J0270J0275J0278J0280J0282J0285J0287J0 288J0289J0290J0295J0300J0330J0348J0350J0 360J0364J0365J0380J0390J0395J0400J0401J0 456J0461J0470J0475J0476 January 30, 2015 2015 Copyright.

9 CGS Administrators, 10 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule DatabaseModifier 26 is a CPT modifier, and modifier TC is a HCPCS CodesModifierJ0480J0485J0490J0500J0515J0 520J0558J0561J0571J0572J0573J0574J0575J0 583J0585J0586J0587J0588J0592J0594J0595J0 597J0598J0600J0610J0620J0630J0636J0637J0 638J0640J0641J0670J0690J0692J0694J0696J0 697J0698S TAT U S EHCPCS CodesModifierJ0702J0706J0710J0712J0713J0 715J0716J0717J0720J0725J0735J0740J0743J0 744J0745J0760J0770J0775J0780J0795J0800J0 833J0834J0840J0850J0878J0881J0882J0885J0 886J0887J0888J0890J0894J0895J0897J0900J0 945J1000 HCPCS CodesModifierJ1020J1030J1040J1050J1060J1 070J1071J1080J1094J1100J1110J1120J1160J1 162J1165J1170J1180J1190J1200J1205J1212J1 230J1240J1245J1250J1260J1265J1267J1270J1 290J1300J1320J1322J1324J1325J1327J1330J1 335J1364 HCPCS

10 CodesModifierJ1380J1410J1430J1435J1436J1 438J1439J1442J1446J1450J1451J1452J1453J1 455J1457J1458J1459J1460J1556J1557J1559J1 560J1561J1562J1566J1568J1569J1570J1571J1 572J1573J1580J1590J1595J1599J1600J1602J1 610J1620 January 30, 2015 2015 Copyright, CGS Administrators, 11 Bundled, Inactive, and Non-Payable Codes for 2015 : Medicare Physician Fee Schedule DatabaseModifier 26 is a CPT modifier, and modifier TC is a HCPCS CodesModifierJ1626J1630J1631J1640J1642J1 644J1645J1650J1652J1655J1670J1675J1700J1 710J1720J1725J1730J1740J1741J1742J1743J1 744J1745J1750J1756J1786J1790J1800J1810J1 815J1817J1830J1835J1840J1850J1885J1890J1 930J1931 HCPCS CodesModifierJ1940J1945J1950J1953J1955J1 956J1960J1980J1990J2001J2010J2020J2060J2 150J2170J2175J2180J2185J2210J2212J2248J2 250J2260J2265J2270J2274J2278J2280J2300J2 310J2315J2320J2323J2325J2353J2354J2355J2 357J2358 HCPCS CodesModifierJ2360J2370J2400J2405J2410J2 425J2426J2430J2440J2460J2469J2501J2503J2 504J2505J2507J2510J2513J2515J2540J2543J2 545J2550J2560J2562J2590J2597J2650J2670J2 675J2680J2690J2700J2704J2710J2720J2724J2 725J2730 HCPCS