Transcription of Appendix Exhbit 1 Physicians' and ASC Fee Schedules
1 Appendix Exhbit 1 Physicians' and ASC Fee SchedulesAnesANESTHESIA BASE PLATELET STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, , LOOSE BODY + , N110060 DRAIN SKIN SKIN FOREIGN REMOVE FOREIGN , , DRAIN DRAIN DRAIN , , INFECTED DEBRIDE INFECTED SKIN, DEBRIDE SKIN, DEBRIDE SKIN/MUSCLE, DEBRIDE SKIN/MUSCLE/BONE, FX1, , DEBRIDE DEBRIDE TISSUE/ , , SUBQ TISSUE MUSCLE/FASCIA BONE , , SKIN SKIN LESIONS, 2 TO SKIN LESIONS, OVER SKIN SKIN, SKIN SKIN SKIN SKIN SKIN SKIN SKIN SKIN TRT-EXT BENIGN+MARG < TRT-EXT BENIGN+MARG TRT-EXT BENIGN+MARG TRT-EXT BENIGN+MARG TRT-EXT BENIGN+MARG , , TRT-EXT BENIGN+MARG >.
2 H-F-NECK-SP BENIGN+MARG < H-F-NECK-SP BENIGN+MARG H-F-NECK-SP BENIGN+MARG H-F-NECK-SP BENIGN+MARG H-F-NECK-SP BENIGN+MARG , , H-F-NECK-SP BENIGN+MARG > 4 , , FACE-MM BENIGN+MARG < FACE-MM BENIGN+MARG FACE-MM BENIGN+MARG FACE-MM BENIGN+MARG FACE-MM BENIGN+MARG , , NAIL(S) NAIL, NAIL, 6 OR NAIL NAIL PLATE, BLOOD UNDER NAIL NAIL BED/FINGER NAIL Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees North*Current Procedural Terminology (CPT) is copyright 2010 American Medical Association (AMA). All Rights fee Schedules , basic units, relative values, or related listings are included in CPT.
3 The AMA assumes no liabilityfor the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark ofthe American Medical * HCPCSMODDESCRIPTION1 Appendix Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION11762 RECONSTRUCT NAIL NAIL FOLD, INTO SKIN SKIN LESIONS FOR CONTOUR FOR CONTOUR TISSUE EXPANDER(S)1, , , , DRUG IMPLANT DRUG IMPLANT SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S)
4 SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SPLIT SPLIT WOUND REPAIR S/ WOUND REPAIR S/ WOUND REPAIR S/ WOUND REPAIR S/ WOUND REPAIR S/ WOUND REPAIR S/ WOUND REPAIR N- WOUND REPAIR N- WOUND REPAIR N- WOUND REPAIR N- WOUND REPAIR N- WOUND REPAIR N- WOUND REPAIR WOUND REPAIR WOUND REPAIR WOUND REPAIR WOUND REPAIR WOUND REPAIR WOUND REPAIR WOUND OR WOUND OR WOUND/LESION, WOUND OR WOUND OR WOUND/LESION, WOUND OR WOUND OR WOUND/LESION, WOUND OR WOUND OR WOUND OR REPAIR WOUND/LESION, CLOSE WOUND1, , , , TISSUE REARRANGEMENT1, , , TISSUE REARRANGEMENT1, , , , TISSUE REARRANGEMENT1.
5 TISSUE REARRANGEMENT1, , , , TISSUE REARRANGEMENT1, , , , TISSUE REARRANGEMENT1, , , , TISSUE REARRANGEMENT1, , , , TISSUE REARRANGEMENT1, , , , TISSUE REARRANGEMENT1, , , , TISSUE REARRANGE , , PREP, TRUNK/ Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION15003 WOUND PREP, ADDED 100 PREP, F/N/ PREP, F/N/HF/G, ADDED PINCH SPLIT GRAFT, TRUNK/ARM/LEG1, , , , SPLIT GRAFT T/A/L, , , SPLIT A-GRAFT FAC/NECK/HF/G1, , , , SPLIT A-GRAFT F/N/HF/G , , AUTOGRAFT, TRUNK/ARM/LEG1, , , , GRAFT TRUNK/ GRAFT T/ARM/LEG, GRAFT, F/N/ FULL GRAFT SCALP/ARM/LEG1, , , , FULL GRAFT, FULL GRAFT FACE/GENITAL/HF1, , , , FULL GRAFT, SKIN FULL GRAFT EEN & LIPS1, , , , ACELLULAR ALLOGRAFT T/ ACELLULAR GRAFT T/A/L, CULT SKIN CULT SKIN SUB.
6 CULT DERM SUB F/N/ CULT DERM F/HF/G ACELLULAR ACELLULAR XENOGRAFT SKIN PEDICLE FLAP1, , , , SKIN PEDICLE FLAP1, , , , SKIN PEDICLE FLAP1, , , , SKIN PEDICLE FLAP1, , , , , , GRAFT, HEAD/NECK2, , , , GRAFT, TRUNK2, , , , GRAFT, ARM2, , , , GRAFT, LEG2, , , , MYO/SKIN FLAP MICROVASC3, , GRAFT1, , , , TREAT SKIN1, , , , TREAT TREAT , LESION, , LESIONS, UPPER , , SKIN , , EXCESSIVE SKIN , , CHANGE NOT FOR HIP PRESSURE SORE1, , , , HIP PRESSURE SORE1, , , , HIP PRESSURE SORE1, , , , HIP PRESSURE SORE1, , , , HIP PRESSURE SORE2, , , , THIGH PRESSURE , , THIGH PRESSURE SORE1, , , , THIGH PRESSURE SORE1, , , , THIGH PRESSURE SORE1, , , , THIGH PRESSURE SORE1, , , , THIGH PRESSURE SORE1, , , , TREAT BURN(S) P-THICK BURN, P-THICK BURN, P-THICK BURN, PREMALIG PREMALIG LES, PREMALIG LESIONS 15+ SKIN SKIN SKIN LESIONS1, Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)
7 ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION17110 DESTROY B9 LESION, B9 SK TGS/CUTAN VASC 15/> CAUT GRANLTJ TISS PROUD FLESH SKIN SKIN BREAST BREAST , , BREAST , , NEEDLE WIRE, , N120100 EXPLORE WOUND, WOUND, WOUND, WOUND, , , FOREIGN FOREIGN , , INJECTION, CARP TENDON TENDON TRIGGER POINT, 1/2 TRIGGER POINTS, =/> , , , GANGLION BONE & REMOVE BONE , , PELVIS , , THIGH , , FIXATION SUPPORT IMPLANT2, , SUPPORT , , BONE FIXATION DEVICE2, , , , BONE FIXATION DEVICE4, , , , BONE FIXATION DEVICE1, , , , BONE FIXATION DEVICE1, , , , MULTIPLANE EXT FIXATION4, , , , EXT FIXATE STRUT CHANGE7, , , , BONE FOR , , BONE FOR , , CARTILAGE FOR GRAFT1, , , CARTILAGE FOR GRAFT1, , , , FASCIA FOR , , FASCIA FOR GRAFT1, , , , TENDON FOR , , TISSUE FOR BONE ALLOGRAFT STRUCT, PRESSURE, MUSCLE1, , BONE GRAFT, MICROVASC10, , BONE BONE , N120979US BONE DIR MS , N121060 REMOVE JAW JOINT CARTILAGE1, , , , CORONOID PROCESS2, , , , TMJ FACE/ORAL PROSTHESIS1, , , , FIXATION1, , , , JAW JOINT , N121209 REDUCE FACIAL BONES1, , , , BONE GRAFT3, , , , JAW JOINT3.
8 JAW JOINT3, , , , JAW JOINT5, , , , LOWER JAW1, , , , JAW1, , , , JAW1, , , , LOWER JAW BONE2, , , , Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION21248 RECONSTRUCT JAW1, , , , JAW2, , , , NOSE NOSE , , TREAT NOSE , , NOSE , , NOSE , , NOSE FX1, , , , CHEEK BONE FX2, , , , CHEEK BONE FX2, , , , CHEEK BONE FX4, , CHEEK BONE FX5, , EYE SOCKET FX3, , EYE SOCKET FX2, , EYE SOCKET FX3, , , , EYE SOCKET FX4, , EYE SOCKET , EYE SOCKET FX2, , , , EYE SOCKET FX2, , , , EYE SOCKET FX2, , , , EYE SOCKET FX3, , LOWER JAW LOWER JAW FX1, , , LOWER JAW , , TREAT LOWER JAW FX1, , , , LOWER JAW , , LOWER JAW FX3.
9 LOWER JAW FX3, , , , LOWER JAW FX1, , , , LOWER JAW FX1, , TREAT RIB STERNUM STERNUM SPINE PROCESS SPINE SPINE FX3, , , , , , VERTEBROPLASTY THORACIC4, , VERTEBROPLASTY LUMBAR4, , VERTEBROPLASTY ADDED4, , SPINE FUSION6, , SPINAL FUSION1, , SPINE FIXATION DEVICE4, , SPINE PROSTH DEVICE2, , REMOVE COLLAR BONE3, , , , COLLAR BONE4, , , , SHOULDER BONE, PART3, , , , SHOULDER FOREIGN BODY3, , , , SHOULDER FOREIGN BODY5, , FOR SHOULDER , N123405TX SHO AREA 1 , , SHO AREA MLT TDN THRU SM INC1, , , , REPAIR OF ROTATOR CUFF, RECENT3, , , , REPAIR OF ROTATOR CUFF, OLD3, , , , LIGM RLS +-ACROMP1, , , , ROTATOR CUFF, OLD4, , , , LONG TDN BICEPS1, , , , LONG TDN BICEPS1, , , , SHOULDER JOINT5, , SHOULDER JOINT6, , COLLAR BONE3, , , , COLLAR BONE4, , , , TREAT CLAVICLE TREAT CLAVICLE , , CLAVICLE FX2, , , , CLAVICLE CLAVICLE Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)
10 ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION23530 TREAT CLAVICLE DISLOCATION1, , , , CLAVICLE CLAVICLE CLAVICLE DISLOCATION1, , , , CLAVICLE DISLOCATION1, , , , SHOULDER BLADE TREAT HUMERUS TREAT HUMERUS FX1, , , HUMERUS FX3, , , , HUMERUS FX4, , , , HUMERUS HUMERUS , , HUMERUS FX2, , , , TREAT SHOULDER TREAT SHOULDER , , , , FOR ELBOW , N124300 MANIPULATE ELBOW , , TENDON , , BICEPS TENDON2, , , , ARM TENDON/MUSCLE3, , , , RUPTURED TENDON3, , , , ELBOW LAT LIGAMENT W/TISS2, , , , HUMERUS HUMERUS HUMERUS FX1, , , , HUMERUS FX1, , , , HUMERUS HUMERUS HUMERUS FX1, , , , HUMERUS FX1, , , , HUMERUS HUMERUS HUMERUS FX1, , , , HUMERUS HUMERUS HUMERUS FX1, , , , TENDON , , FLEXOR CARPI , , FOREARM 1 SPACE1, , , , FOREARM 1 SPACE3, , , , FOREARM 2 SPACES2, , , , FOREARM 2 SPACES3, , , , WRIST TENDON , , WRIST BONES1, , , , FOR WRIST , N125259 MANIPULATE WRIST , , FOREARM TENDON/MUSCLE2, , , , FOREARM TENDON/MUSCLE1, , , , FOREARM TENDON/MUSCLE2, , , , FOREARM TENDON/MUSCLE1, , , , FOREARM TENDON/MUSCLE1, , , , FOREARM TENDON/MUSCLE2, , , , WRIST/FOREARM , , FX FX FX RADIUS1.
