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 > , , 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)
2 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. 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) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S) SUPERFICIAL WOUND(S)
3 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, , , , 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, 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.
4 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)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.
5 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, , , , 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, , , , 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.
6 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)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.
7 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, , , , FX RADIUS1, , , , FX RADIUS1, , , , FX FX FX , , FX RADIUS & FX RADIUS & ULNA1, , FX RADIUS & ULNA2, , , , FX RADIUS/ULNA2, , , , FX Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION25605 TREAT FX RADIUS/ULNA1, , FX DISTAL RADIAL2, , , , FX RADIAL EXTRA-ARTICULAR2, , , , FX RADIAL INTRA-ARTICULAR2, , , , FX RADIAL 3+ FRAG3, , , , WRIST BONE WRIST BONE FX1, , WRIST BONE FX2, , , , WRIST BONE WRIST BONE FX1, , WRIST BONE FX1, , , , WRIST BONE FX ULNAR STYLOID1, , , , FX ULNAR STYLOID1, , , , FX ULNAR STYLOID1, , , , WRIST DISLOCATION1, , , , WRIST FX1, , WRIST FX2, , , , FINGER TENDON , , HAND TUMOR DEEP < CM1, , , , FINGER JOINT, EACH1, , , , EXCISE PALM/FINGER2, , , , FINGER HAND TENDON1, , , , FINGER TENDON2, , , , HAND/FINGER TENDON1, , , , HAND TENDON2, , , , FINGER CONTRACTURE2, , , , HAND JOINT2, , , , METACARPAL METACARPAL METACARPAL , , METACARPAL FX1, , , , METACARPAL FX1, , , , FINGER FX, FINGER FX, FINGER FX, , , FINGER FX, , , FINGER FX, FINGER FX, FINGER FX, EACH1.
8 FINGER FX, FINGER FX, HIP JOINT/MUSCLE3, , FOR HIP , N127095 INJECTION FOR HIP , N127096 INJECT SACROILIAC , HIP ARTHROPLASTY5, , HIP ARTHROPLASTY6, , PELVIC RING FX1, , PELVIC RING FX2, , , , HIP FX(S)5, , HIP FX(S)5, , THIGH FX3, , THIGH FX3, , HIP , , KNEE CARTILAGE3, , , , KNEE LIGAMENT3, , , , UNSTABLE KNEECAP2, , , , UNSTABLE KNEECAP2, , , , KNEECAP2, , , , KNEE ARTHROPLASTY4, , KNEE JOINT4, , THIGH FX2, , THIGH FX2, , THIGH FX3, , , , THIGH FX3, , Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION27506 TREAT THIGH FX5, , THIGH FX4, , THIGH FX2, , THIGH FX2, , , , THIGH FX2, , THIGH FX4, , THIGH FX5, , THIGH FX4, , KNEECAP FX1, , KNEECAP FX3, , KNEE FX1, , KNEE FX2, , , , KNEE FX3, , KNEE FX5, , KNEE FX(S)1, , KNEE FX3, , KNEE , , LOWER LEG TENDON2, , , , LOWER LEG TENDONS2, , , , LOWER LEG TENDON2, , , , LOWER LEG TENDON3, , , , ADDEDITIONAL LEG , , ANKLE LIGAMENT1, , , , ANKLE LIGAMENTS1, , , , ANKLE LIGAMENT1, , , , TIBIA FX1, , TIBIA FX2, , , , TIBIA FX3, , , , TIBIA FX4, , , , TREAT MEDIAL ANKLE TREAT MED ANKLE FX W/MANIP1, , , , TREAT MEDIAL ANKLE FX1, , , , ANKLE ANKLE ANKLE FX1, , , , ANKLE ANKLE ANKLE FX1, , , , ANKLE ANKLE ANKLE FX1, , , , ANKLE FX1, , , , LOWER LEG LOWER LEG FX1, , , , LOWER LEG FX2, , , , LOWER LEG FX3, , , , LOWER LEG FX3, , , , LOWER LEG JOINT2, , , , ANKLE DISLOCATION1, , ANKLE DISLOCATION1, , , , ANKLE DISLOCATION2, , , , ANKLE DISLOCATION2, , , , ANKLE , , REMOVE ANKLE/HEEL1, , , , REMOVE FOOT BONE1, , , HEEL HEEL , , HEEL FX1, , , , HEEL FX2, , , , ANKLE ANKLE ANKLE FX1, , , , ANKLE FX2, , , , METATARSAL METATARSAL METATARSAL , , METATARSAL FX1.
9 Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION28725 FUSE FOOT BONES1, , , , FOOT BONES2, , , , FOOT BONES2, , , , BIG TOE JOINT2, , , , LONG ARM FOREARM HAND/WRIST APPLY FINGER LONG ARM FOREARM FOREARM FINGER FINGER STRAP ELBOW OR HAND OR APPLY LONG LEG APPLY LONG LEG LONG LEG SHORT LEG SHORT LEG APPLY LEG LONG LEG LOWER LEG STRAP ANKLE AND/OR PASTE MULTILAY COMPRESS LWR FOOT ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY, DIAG2, , , , SHOULDER ARTHROSCOPY/SURG5, , , , ARTHROSCOPY/SURG5, , , , ARTHROSCOPY/SURG3, , , , SHOULDER ARTHROSCOPY/SURG2, , , , SHOULDER ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , SHOULDER ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , ROTATOR CUFF REPAIR4, , , , BICEPS TENODESIS3, , , , ARTHROSCOPY1, , , , ARTHROSCOPY/SURG2.
10 , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY1, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ENDOSCOPY/SURG2, , , , KNEE ARTHROSCOPY/SURG2, , , , TIBIAL ARTHROSCOPY/SURG3, , , , HIP ARTHROSCOPY, DIAG2, , , , HIP ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , Exhbit 1 Physicians' and ASC Fee SchedulesPayment Indicator (See bottom for codes)ASC Fees SouthPhysicians' Fees North Physicians' Fees South ASC Fees NorthCPT* HCPCSMODDESCRIPTION29870 KNEE ARTHROSCOPY, DIAG2, , , , ARTHROSCOPY/DRAIN2, , , , KNEE ARTHROSCOPY/SURG2, , , , KNEE ARTHROSCOPY/SURG2, , , , KNEE ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG3, , , , KNEE ARTHROSCOPY/SURG3, , , , KNEE ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG3, , , , KNEE ARTHROSCOPY/SURG2, , , , KNEE ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG3, , , , ARTHROSCOPY/SURG4, , , , ARTHROSCOPY/SURG5, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG2, , , , ARTHROSCOPY/SURG4, , , , EXCISE INFERIOR , , RESECT INFERIOR , , TREAT NASAL FOREIGN NASAL FOREIGN , , NASAL SEPTUM1, , , , INF TURBINATE , , CONTROL THERAPEUTIC FX, NASAL INF , , IRRIGATE MAXILLARY MAXILLARY , , ENDOSCOPY.
