Download CMS Manual System Pub 100-04 Medicare Claims Processing

CMS Manual System
Department of Health & Human
Services (DHHS)
Pub 100-04 Medicare Claims Processing
Centers for Medicare & Medicaid
Services (CMS)
Transmittal 1258
Date: MAY 29, 2007
Change Request 5614
SUBJECT: July Update to the 2007 Medicare Physician Fee Schedule Database
I. SUMMARY OF CHANGES: Payment files were issued to carriers based upon the December 1, 2006,
Medicare Physician Fee Schedule Final Rule. This change request amends those payment files and includes
new/revised codes for the Physician Quality Reporting Initiative.
New / Revised Material
Effective Date: January 1, 2007
Implementation Date: July 2, 2007
Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized
material. Any other material was previously published and remains unchanged. However, if this revision
contains a table of contents, you will receive the new/revised information only, and not the entire table of
contents.
II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)
R=REVISED, N=NEW, D=DELETED-Only One Per Row.
R/N/D
Chapter / Section / Subsection / Title
N/A
III. FUNDING:
No additional funding will be provided by CMS; Contractor activities are to be carried out within their FY
2007 operating budgets.
IV. ATTACHMENTS:
Recurring Update Notification
*Unless otherwise specified, the effective date is the date of service.
Attachment – Recurring Update Notification Pub. 100-04
Transmittal: 1258
Date: May 29, 2007
Change Request: 5614
SUBJECT: July Update to the 2007 Medicare Physician Fee Schedule Database
Effective Date: January 1, 2007
Implementation Date: July 2, 2007
I.
GENERAL INFORMATION
A. Background: Payment files were issued to carriers based upon the December 1, 2006, Medicare
Physician Fee Schedule Final Rule. This change request amends those payment files and includes
new/revised codes for the Physician Quality Reporting Initiative.
B. Policy: Section 1848(c)(4) of the Social Security Act authorizes the Secretary to establish
ancillary policies necessary to implement relative values for physicians’ services.
II.
BUSINESS REQUIREMENTS TABLE
Use “Shall" to denote a mandatory requirement
Number
5614.1
5614.2
5614.3
Requirement
Effective for dates of service on or after
January 1, 2007, contractors shall manually
update their systems to reflect 11 base units
for CPT code 00797.
Contractors shall manually update their
HCPCS file to reflect a coverage indicator of
“C” for new Category II codes included in
this transmittal.
Effective for dates of service on or after July
1, 2007, the following Category II modifier
will be recognized in addition to Category II
modifiers 1P, 2P and 3P. (NOTE: These are
statistical modifiers):
8P – Performance measure reporting modifier
– action not performed, reason not otherwise
specified
(NOTE: Modifier 8P is intended to be used
as a “reporting modifier” to allow the
CMS / CMM / MCMG / DCOM
Change Request Form: Last updated 22 January 2007
Page 1
Responsibility (place an “X” in each applicable
column)
A
/
B
D
M
E
M
A
C
M
A
C
F
I
C
A
R
R
I
E
R
X
X X
X
X
X
X
D
M
E
R
C
R
H
H
I
Shared-System
Maintainers
C
M V
F
C M W
I
F
S
S
S
S
OTHER
Number
Requirement
5614.3.1
5614.4
5614.5
5614.6
5614.7
5614.8
5614.9
III.
Number
reporting of circumstances when an action
described in a measure’s numerator is not
performed and the reason is not otherwise
specified.)
Carriers shall manually update their systems
to reflect this new Category II modifier (8P).
Carriers shall either manually update the
Performance Payment Indicator for the codes
listed in Attachment 3 or load the separate file
and manually re-load any carrier priced fees
they may have established.
Contractors shall, in accordance with Pub
100-4, Chapter 23, Section 30.1, give
providers 30 days notice before implementing
the changes identified in Attachment 1.
Unless otherwise stated in this transmittal,
changes will be retroactive to January 1,
2007.
Contractors need not search their files to
either retract payment for claims already paid
or to retroactively pay claims. However,
contractors shall adjust claims brought to
their attention.
Contractors shall retrieve the revised payment
files, as identified in Attachment 2, from the
CMS Mainframe Telecommunications
System. Files will be available for retrieval
on May 24, 2007.
CMS will send CWF two files to facilitate
duplicate billing edits: 1) Purchased
Diagnostic and 2) Duplicate Radiology
Editing. CWF shall install these files into
their systems. CWF will be notified via email
when these files have been sent to them.
Notification of successful receipt shall be sent
via e-mail to [email protected]
stating the name of the file received and the
entity for which it was received (e.g.,
carrier/fiscal intermediary name and number).
Responsibility (place an “X” in each applicable
column)
A
/
B
D
M
E
M
A
C
M
A
C
F
I
C
A
R
R
I
E
R
X
X
X
X
X
X X
X
X X
X
X X
D
M
E
R
C
R
H
H
I
Shared-System
Maintainers
M V
C
F
C M W
I
S
S
F
S
S
OTHER
X
X
X X
PROVIDER EDUCATION TABLE Requirement
CMS / CMM / MCMG / DCOM
Change Request Form: Last updated 22 January 2007
Page 2
Responsibility (place an “X” in each applicable
column)
5614.10
IV.
A
/
B
D
M
E
M
A
C
M
A
C
A provider education article related to this
X
instruction will be available at
http://www.cms.hhs.gov/MLNMattersArticles/
shortly after the CR is released. You will
receive notification of the article release via the
established "MLN Matters" listserv.
Contractors shall post this article, or a direct
link to this article, on their Web site and include
information about it in a listserv message
within one week of the availability of the
provider education article. In addition, the
provider education article shall be included in
your next regularly scheduled bulletin.
Contractors are free to supplement MLN
Matters articles with localized information that
would benefit their provider community in
billing and administering the Medicare program
correctly.
F
I
C
A
R
R
I
E
R
D
M
E
R
C
R
H
H
I
Shared-System
Maintainers
F
M V
C
I
C M W
S
S
S
F
S
OTHER
X X
SUPPORTING INFORMATION
A. For any recommendations and supporting information associated with listed requirements, use
the box below:
Use "Should" to denote a recommendation.
X-Ref
Recommendations or other supporting information:
Requireme
nt
Number
B. For all other recommendations and supporting information, use this space:
V. CONTACTS
Pre-Implementation Contact(s): Gaysha Brooks, [email protected], (410) 786-9649
Post-Implementation Contact(s): Appropriate Regional Office
VI. FUNDING
A.
CMS / CMM / MCMG / DCOM
Change Request Form: Last updated 22 January 2007
Page 3
No additional funding will be provided by CMS; contractor activities are to be carried out within their
FY 2007 operating budgets.
B.
The contractor is hereby advised that this constitutes technical direction as defined in your contract.
CMS does not construe this as a change to the Statement of Work (SOW). The contractor is not
obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically
authorized by the Contracting Officer. If the contractor considers anything provided, as described above,
to be outside the current scope of work, the contractor shall withhold performance on the part(s) in
question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal
directions regarding continued performance requirements.
CMS / CMM / MCMG / DCOM
Change Request Form: Last updated 22 January 2007
Page 4
Attachment 1
Changes included in the July Update to the 2007 Medicare Physician Fee Schedule
Database are as follows:
The following codes are included in File A (changes retroactive to January 1, 2007):
CPT/HCPCS ACTION
00797
Base Units = 11
0115T
0116T
0117T
Procedure Status = N
Procedure Status = N
Procedure Status = N
19301 Short Descriptor = Partial mastectomy
33208 Work RVUs = 8.72
75635 - TC Diagnostic Indicator = 02
77422 Transitional Non-Facility PE RVU = 2.61
Fully Implemented Non-Facility PE RVU = 5.31 (Informational Only)
Transitional Facility PE RVU = 2.61
Fully Implemented Facility PE RVU = 5.31 (Informational Only)
77423 Transitional Non-Facility PE RVU = 3.57
Fully Implemented Non-Facility PE RVU = 7.51 (Informational Only)
Transitional Facility PE RVU = 3.57
Fully Implemented Facility PE RVU = 7.51 (Informational Only)
G9041 Transitional Non-Facility PE RVU = 0.29
Fully Implemented Non-Facility PE RVU = 0.29 (Informational Only)
Transitional Facility PE RVU = 0.29
Fully Implemented Facility PE RVU = 0.29 (Informational Only)
G9042 Transitional Non-Facility PE RVU = 0.29
Fully Implemented Non-Facility PE RVU = 0.29 (Informational Only)
Transitional Facility PE RVU = 0.29
Fully Implemented Facility PE RVU = 0.29 (Informational Only)
G9043 Transitional Non-Facility PE RVU = 0.29
Fully Implemented Non-Facility PE RVU = 0.29 (Informational Only)
Transitional Facility PE RVU = 0.29
Fully Implemented Facility PE RVU = 0.29 (Informational Only)
G9044 Transitional Non-Facility PE RVU = 0.23
Fully Implemented Non-Facility PE RVU = 0.23 (Informational Only)
Transitional Facility PE RVU = 0.23 Fully Implemented Facility PE RVU = 0.23 (Informational Only) The following codes are included in File B (changes effective for dates of service on
or after July 1, 2007):
0024T
Procedure Status = I
Effective for dates of service on or after July 1, 2007
0133T
Procedure Status = I
Effective for dates of service on or after July 1, 2007
Effective for dates of service on or after July 1, 2007, the following Category II
modifier will be recognized in addition to Category II modifiers 1P, 2P and 3P.
(NOTE: These are statistical modifiers):
8P – Performance measure reporting modifier – action not performed, reason not
otherwise specified
(NOTE: Modifier 8P is intended to be used as a “reporting modifier” to allow the
reporting of circumstances when an action described in a measure’s numerator is not
performed and the reason is not otherwise specified.)
Effective for dates of service on or after July 1, 2007, the following G-codes will no
longer be used for the PQRI program. The status indicator for these G-codes will
be changed to “I” on the MPFSDB.
G8158
G8160
G8161
G8163
G8191
G8192
G8194
G8195
G8197
G8198
G8199
G8201
G8202
G8203
G8205
G8206
G8207
G8208
G8210
G8211
G8212
G8213
G8215
G8216
G8218
G8222
G8224
G8225
G8227
G8228
G8229
G8230
G8232
G8235
G8236
G8237
G8239
G8241
G8242
G8245
G8247
G8249
G8250
G8252
G8253
G8255
G8256
G8258
G8259
G8261
G8262
G8264
G8265
G8267
G8269
G8270
G8272
G8273
G8275
G8277
G8278
G8280
G8281
G8283
G8284
G8286
G8287
G8288
G8290
G8291
G8292
G8294
G8295
G8297
G8300
G8301
G8309
G8311
G8312
G8313
G8315
G8316
G8317
G8319
G8320
G8321
G8323
G8324
G8325
G8327
G8328
G8329
G8331
G8332
G8333
G8335
G8336
G8337
G8339
G8340
G8342
G8343
G8344
G8346
G8347
G8348
G8349
G8350
G8351
G8352
G8353
G8355
G8356
G8358
G8359
G8361
G8363
G8364
G8366
G8368
New Category II codes for the Physician Quality Reporting Initiative (PQRI)
Effective for dates of service on or after July 1, 2007, the following Category II
codes will be added to the MPFSDB with a status indicator of “M”. The payment
indicators are identical for all services. Thus, the payment indicators will only be
listed for the first service (Category II code 0509F).
CPT code:
0509F
Long Descriptor:
Urinary incontinence plan of care
documented (GER)
Urine incon plan doc’d
Short Descriptor: M
Procedure Status:
0.00
WRVU:
0.00
Non-Facility PE RVU: 0.00
Facility PE RVU:
0.00
Malpractice RVU:
9
PC/TC:
9
Site of Service:
XXX
Global Surgery:
9
Multiple Procedure Indicator:
9
Bilateral Surgery Indicator: 9
Assistant at Surgery Indicator: 9
Co-Surgery Indicator:
9
Team Surgery Indicator: Physician Supervision Diagnostic Indicator: 9
Type of Service:
1
Diagnostic Family Imaging Indicator:
99
Effective for services performed on or after July 1, 2007
Code
1060F
Long Descriptor
Documentation of permanent OR persistent OR
paroxysmal atrial fibrillation
Short Descriptor
Doc perm/cont/parox atr.
fib
1061F
Documentation of absence of permanent AND
persistent AND paroxysmal atrial fibrillation
Ischemic stroke symptom onset of less than 3 hours
prior to arrival
Doc lack perm+cont+parox fib
1065F
Ischm stroke symp lt3 hrsb/4
1066F
1070F
1071F
1080F
Ischemic stroke symptom onset greater than or
equal to 3 hours prior to arrival
Alarm symptoms (involuntary weight loss,
dysphagia, or gastrointestinal bleeding) assessed;
none present
Alarm symp assessed-absent
Alarm symptoms (involuntary weight loss,
dysphagia, or gastrointestinal bleeding) assessed;
one or more present
Alarm symp assessed-1+ prsnt
Surrogate decision maker or advance care plan
documented in the medical record
Decis mkr/advncd plan doc’d
1090F
Presence or absence of urinary incontinence assessed
1091F
Urinary incontinence characterized (eg frequency,
volume, timing, type of symptoms, how
bothersome)
Patient screened for future fall risk; documentation
of two or more falls in the past year or any fall with
injury in the past year (GER)
Patient screened for future fall risk; documentation
of no falls in the past year or only one fall without
injury in the past year
1100F
1101F
1110F
1111F
3100F
3110F
3111F
3112F
3120F
3130F
3132F
Ischm stroke symp ge3 hrsb/4
Patient discharged from an inpatient facility (eg
hospital, skilled nursing facility, or rehabilitation
facility) within the last 60 days
Discharge medications reconciled with the current
medication list in outpatient medical record
Carotid imaging study report includes direct or
indirect reference to measurements of distal internal
carotid diameter as the denominator for stenosis
measurement
Presence or absence of hemorrhage and mass lesion
and acute infarction documented in final CT or MRI
report
CT or MRI of the brain performed within 24 hours
of arrival to the hospital
CT or MRI of the brain performed greater than 24
hours after arrival to the hospital
12-Lead ECG Performed
Pres/absn urine incon assess
Urine incon characterized
Ptfalls assess-doc’d ge2+/yr
Pt falls assess-doc’d le1/yr
Pt lft inpt fac w/in 60 days
Dschrg med/current med merge
Image test ref carot diam
Pres/absn hmrhg/lesion doc’d
CT/MRI brain done w/in 24hrs
CT/MRI brain done GT24 hrs
12-Lead ECG performed
Upper gastrointestinal endoscopy performed
Upper GI endoscopy performed
Documentation of referral for upper gastrointestinal
Doc ref. upper GI endoscopy
endoscopy
3140F
3141F
3142F
3150F
Upper gastrointestinal endoscopy report indicates
suspicion of Barrett’s esophagus
Upper GI endo shows barrtt’s
Upper gastrointestinal endoscopy report indicates
no suspicion of Barrett’s esophagus
Upper GI endo not barrtt’s
Barium swallow test ordered
Barium swallow test ordered
Forceps esophageal biopsy performed
Forceps esoph biopsy done
3155F
Cytogenetic testing performed on bone marrow at
time of diagnosis or prior to initiating treatment
Cytogen test marrow b/4 tx
3160F
Documentation of iron stores prior to initiating
erythropoietin therapy
Doc fe+ stores b/4 epo thx
3170F
Flow cytometry studies performed at time of
diagnosis or prior to initiating treatment
Flow cyto done b/4 tx
3200F
Barium swallow test not ordered
Barium swallow test not req
3210F
Group A Strep Test Performed
4041F
Documentation of order for cefazolin OR
cefuroxime for antimicrobial prophylaxis
Grp A strep test performed
Doc order cefazolin/cefurox.
4042F
Documentation that prophylactic antibiotics were
neither given within 4 hours prior to surgical
incision nor given intraoperatively
4043F
Documentation that an order was given to
discontinue prophylactic antibiotics within 48 hours
of surgical end time, cardiac procedures
4044F
Documentation that an order was given for venous
thromboembolism (VTE) prophylaxis to be given
within 24 hrs prior to incision time or 24 hours after
surgery end time
Doc order given VTE prophylx
4046F
Documentation that prophylactic antibiotics were
given within 4 hours prior to surgical incision or
given intraoperatively
Doc antibio given b/4 surg
4047F
Documentation of order for prophylactic antibiotics
to be given within one hour (if fluoroquinolone or
vancomycin, two hours) prior to surgical incision
(or start of procedure when no incision is required)
Doc antibio given b/4 surg
4048F
Documentation that prophylactic antibiotic was
given within one hour (if fluoroquinolone or
vancomycin, two hours) prior to surgical incision
(or start of procedure when no incision is required)
Doc antibio given b/4 surg
4049F
Documentation that order was given to discontinue
prophylactic antibiotics within 24 hours of surgical
end time, non-cardiac procedure
Doc order given stop antibio
Doc antibio not given
Doc order given stop antibio
4070F
Deep Vein Thrombosis (DVT) prophylaxis received
by end of hospital day 2
DVT prophylx recv’d day 2
4073F
Oral antiplatelet therapy prescribed at discharge
Oral antiplat thx rx dischrg
4075F
Anticoagulant therapy prescribed at discharge
Anticoag thx rx at dischrg
4077F
Documentation that tissue plasminogen activator (tPA) administration was considered
Doc t-pa admin considered
4079F
Documentation that rehabilitation services were
considered
4084F
Aspirin received within 24 hours before emergency
department arrival or during emergency department
stay
Aspirin recv’d w/in 24 hrs
4090F
Patient receiving erythropoietin therapy
Pt rcvng epo thxpy
4095F
Patient not receiving erythropoietin therapy
Pt not rcvng epo thxpy
4100F
Bisphosphonate therapy, intravenous, ordered or
received
Biphos thxpy vein ord/rec’vd
4110F
Internal mammary artery graft performed for
primary, isolated coronary artery bypass graft
procedure
Int. mam art used for cabg
4115F
Beta blocker administered within 24 hours prior to
surgical incision
Beta blckr admin w/in 24 hrs
4120F
Antibiotic prescribed or dispensed
Antibiot rx’d/given
4124F
Antibiotic neither prescribed nor dispensed
Antibiot not rx’d/given
6010F
Dysphagia screening conducted prior to order for or
receipt of any foods, fluids or medication by mouth
Dysphag test done b/4 eating
6015F
Patient receiving or eligible to receive foods, fluids
or medication by mouth
Pt recvng/OK for eating/swal
6020F
NPO (nothing by mouth) ordered
NPO (nothing-mouth) ordered
Doc rehab svcs considered
New G-Codes for PQRI
Effective for dates of service on or after July 1, 2007, the following G-codes (G8370
through G8389) will be added to the MPFSDB with a status indicator of “M”. The
payment indicators are identical for all services in this code range. Thus, the
payment indicators will only be listed for the first service (HCPCS code G8370) in
this range.
HCPCS Code:
Long Descriptor: G8370
Asthma patients with numeric frequency of
symptoms or patient completion of an
asthma assessment tool/survey/questionnaire
not documented
Short Descriptor:
Procedure Status:
WRVU:
Non-Facility PE RVU: Facility PE RVU:
Malpractice RVU:
PC/TC:
Site of Service:
Global Surgery: Multiple Procedure Indicator:
Bilateral Surgery Indicator: Assistant at Surgery Indicator:
Co-Surgery Indicator:
Team Surgery Indicator:
Physician Supervision Diagnostic Indicator:
Type of Service:
Diagnostic Family Imaging Indicator:
Code
G8371
G8372
G8373
G8374
G8375
G8376
G8377
G8378
G8379
G8380
G8381
AMI pt recd aspirin at arriv
M
0.00
0.00
0.00
0.00
9
9
XXX
9
9
9
9
9
9
1
99
Long Descriptor
Chemotherapy documented as not received or
prescribed for Stage III colon cancer patients
Chemotherapy documented as received or
prescribed for Stage III colon cancer patients
Chemotherapy plan documented prior to
chemotherapy administration
Chemotherapy plan not documented prior to
chemotherapy administration
Chronic lymphocytic leukemia (CLL) patient with
no documentation of baseline flow cytometry
performed
Clinician documentation that breast cancer patient
was not eligible for tamoxifen or aromatose
inhibitor therapy measure
Clinician documentation that colon cancer patient is
not eligible for chemotherapy measure
Clinician documentation that patient was not an
eligible candidate for radiation therapy measure
Documentation of radiation therapy recommended
within 12 months of first office visit
For patients with ER or PR positive, Stage IC-III
breast cancer, clinician did not document that the
patient received or was prescribed tamoxifen or
aromatase inhibitor
For patients with ER or PR positive, Stage IC-III
breast cancer, clinician documented or prescribed
Short Descriptor
Chemother not rec stg3 colon
Chemother rec stg 3 colon ca
Chemo plan docum prior chemo
Chemo plan not doc prior che
CLL pt w/o doc flow cytometr
Brst ca pt inelig tamoxifen
MD doc colon ca pt inelig ch
MD doc pt inelig rad therapy
Radiat tx recom doc12mo ov
Pt w stgIC-3Brst ca w/o tam
Pt w stgIC-3Brst ca rec tam
G8382
G8383
G8384
G8385
G8386
G8387
G8388
G8389
G8390
G8391
that the patient is receiving tamoxifen or aromatase
inhibitor
Multiple Myeloma patients with no documentation
of prescribed or received intravenous
bisphosphonate therapy
No documentation of radiation therapy
recommended within 12 months of first office visit
Baseline cytogenetic testing not performed in
patients with Myelodysplastic Syndrome (MDS) or
Acute Leukemias
Diabetic patients with no documentation of
Hemoglobin A1c level (within the last 12 months)
Diabetic patients with no documentation of lowdensity lipoprotein (within the last 12 months)
End-stage renal disease patient with a hematocrit
OR hemoglobin not documented
End-stage renal disease patient with URR OR Kt/V
value not documented, but otherwise eligible for
measure
Myelodysplastic Syndrome (MDS) patients with no
documentation of iron stores prior to receiving
erythropoietin therapy
Diabetic patients with no documentation of blood
pressure measurement (within the last 12 months)
Patients with persistent asthma, no documentation
of preferred long term control medication or
acceptable alternative treatment prescribed
MM pt w/o doc IV bisphophon
Radiation rec not doc 12mo o
MDS pt w/o base cytogen test
Diab pt w nodoc Hgb A1c 12m
Diab pt w nodoc LDL 12m
ESRD pt w Hct/Hgb not docume
ESRD pt w URR/Ktv not doc el
MDS pt no doc Fe prior EPO
Diabetic w/o document BP 12m
Pt w asthma no doc med or tx
Codes with revised descriptors
The long and/or short descriptors for the following PQRI codes have been revised. Code
2001F
2010F
2014F
3028F
3044F
3073F
3074F
3075F
3082F
4007F
Long Descriptor Change
N/A
Vital signs (temperature, pulse, respiratory rate, and
blood pressure) documented and reviewed
Mental status assessed
Oxygen saturation results documented and
reviewed (includes assessment through pulse
oximetry or arterial blood gas measurement)
N/A
Pre-surgical (cataract) axial length, corneal power
measurement and method of intraocular lens power
calculation documented (must be performed within
six months prior to surgery)
N/A
N/A
Kt/V <1.2 (Clearance of urea (Kt)/volume(V))
Age-Related Eye Disease Study (AREDS)
formulation prescribed or recommended
Short Descriptor Change
Weight recorded
N/A
N/A
N/A
HG a1c level lt 7.0%
Syst bp lt 130 mm hg
Syst bp ge 130 – 139mm hg
N/A
Areds/anitox vit/min rx’d
4045F Appropriate empiric antibiotic prescribed
G8126 Patient with new episode of MDD documented as
being treated with antidepressant medication during
the entire 12 week acute treatment phase
G8127 Patient with new episode of MDD not documented
as being treated with antidepressant medication
during the entire 12 week acute treatment phase
G8128 Clinician documented that patient with a new
episode of MDD was not an eligible candidate for
antidepressant medication treatment or patient did
not have new episode of MDD
G8196 Clinician did not document a prophylactic
antibiotic was administered within one hour (if
fluoroquinolone or vancomycin, two hours) prior to
surgical incision (or start of procedure when no
incision is required)
G8240 Carotid image study report did not include
documentation of reference to measurements of
distal internal carotid diameter as the denominator
for stenosis measurement
G8254 Patients with no documented order for barium
swallow test
N/A
N/A
G8271 Patients with no documentation of screening for
future fall risks (2 or more falls in the past year or
any fall with injury in the past year)
G8310 Patient not documented to have been
prescribed/recommended Age-Related Eye Disease
Study (AREDS) formulation
G8326 Patient not documented to have received dilated
fundus evaluation
G8341 Patient not documented to have had central Dualenergy X-Ray Absorptiometry (DXA)
measurement ordered or performed or
pharmacologic therapy for osteoporosis screening
G8345 Patient not documented to have had central DXA
measurement ordered or performed or
pharmacologic therapy following fracture
G8354 Patient not documented to have received or taken
aspirin within 24 hours before emergency
department arrival or during emergency department
stay
G8357 Patient not documented to have had 12-lead ECG
performed for syncope
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Effective July 1, 2007, the following Category III codes (0178T through 0182T) will
be added to the MPFSDB. These codes are effective for services performed on or
after July 1, 2007.
0178T
Long Descriptor: Electrocardiogram, 64 leads or greater, with graphic presentation and
analysis; with interpretation and report
64 Lead ECG w I&R
Short Descriptor: C
Procedure Status:
0.00
WRVU:
0.00
Non-Facility PE RVU: 0.00
Facility PE RVU:
0.00
Malpractice RVU:
PC/TC:
4
Site of Service:
1
XXX
Global Surgery:
Multiple Procedure Indicator:
9
Bilateral Surgery Indicator: 9
Assistant at Surgery Indicator: 9
Co-Surgery Indicator:
9
Team Surgery Indicator: 9
Physician Supervision Diagnostic Indicator: 01 Type of Service:
5
Diagnostic Family Imaging Indicator:
99 Effective for services performed on or after July 1, 2007 0179T
Long Descriptor: Electrocardiogram, 64 leads or greater, with graphic presentation and
analysis; tracing and graphics only, without interpretation and report
Short Descriptor: Procedure Status:
WRVU:
Non-Facility PE RVU: Facility PE RVU:
Malpractice RVU:
PC/TC:
Site of Service:
Global Surgery:
Multiple Procedure Indicator:
Bilateral Surgery Indicator: Assistant at Surgery Indicator: Co-Surgery Indicator:
Team Surgery Indicator: 64 Lead ECG w tracing
C
0.00
0.00
0.00
0.00
3
1
XXX
9
9
9
9
9
Physician Supervision Diagnostic Indicator: 01 Type of Service:
5
Diagnostic Family Imaging Indicator:
99 Effective for services performed on or after July 1, 2007 0180T
Long Descriptor: Electrocardiogram, 64 leads or greater, with graphic presentation and
analysis; interpretation and report only 64 Lead ECG w i&r only
Short Descriptor: C
Procedure Status:
0.00
WRVU:
0.00
Non-Facility PE RVU: 0.00
Facility PE RVU:
0.00
Malpractice RVU:
PC/TC:
2
Site of Service:
1
XXX
Global Surgery:
Multiple Procedure Indicator:
9
Bilateral Surgery Indicator: 9
Assistant at Surgery Indicator: 9
Co-Surgery Indicator:
9
Team Surgery Indicator: 9
Physician Supervision Diagnostic Indicator: 9 Type of Service:
5
Diagnostic Family Imaging Indicator:
99 Effective for services performed on or after July 1, 2007 0181T Long Descriptor: Corneal hysteresis determination, by air impulse stimulation, bilateral, with interpretation and report Short Descriptor:
Procedure Status:
WRVU:
Non-Facility PE RVU: Facility PE RVU:
Malpractice RVU:
PC/TC:
Site of Service:
Global Surgery:
Multiple Procedure Indicator:
Bilateral Surgery Indicator: Assistant at Surgery Indicator: Co-Surgery Indicator:
Team Surgery Indicator: Corneal hysteresis
C
0.00
0.00
0.00
0.00
0
1
XXX
9
0
9
9
9
Physician Supervision Diagnostic Indicator: 9 Type of Service:
Q
Diagnostic Family Imaging Indicator:
99 Effective for services performed on or after July 1, 2007 0182T
Long Descriptor: High dose rate_electronic brachytherapy, per fraction
HDR elec brachytherapy
Short Descriptor: C
Procedure Status:
0.00
WRVU:
0.00
Non-Facility PE RVU: 0.00
Facility PE RVU:
0.00
Malpractice RVU:
PC/TC:
3
Site of Service:
1
XXX
Global Surgery:
Multiple Procedure Indicator:
9
Bilateral Surgery Indicator: 9
Assistant at Surgery Indicator: 9
Co-Surgery Indicator:
9
Team Surgery Indicator: 9
Physician Supervision Diagnostic Indicator: 9 Type of Service:
6
Diagnostic Family Imaging Indicator:
99 Effective for services performed on or after July 1, 2007 Effective for dates of service on or after July 1, 2007 the status indicator for the
following HCPCS codes will be changed to “I”:
J1567
J7611
J7612
J7613
J7614
Procedure Status = I Procedure Status = I Procedure Status = I Procedure Status = I Procedure Status = I Effective for dates of service on or after July 1, 2007, the following HCPCS codes
(Q4087 through Q4095) will be added to the MPFSDB with a status indicator of
“E”. The payment indicators are identical for all services in this code range. Thus,
the payment indicators will only be listed for the first service (HCPCS code Q4087)
in this range.
Q4087
Long Descriptor: Injection, immune globulin, (octagam), intravenous, non-lyophilized,
(e.g. liquid), 500 mg
Short Descriptor:
Octagam Injection
Procedure Status:
E
WRVU:
0.00
Non-Facility PE RVU: 0.00
Facility PE RVU:
0.00
Malpractice RVU:
0.00
PC/TC:
9
Site of Service:
9
Global Surgery:
XXX
Multiple Procedure Indicator:
9
Bilateral Surgery Indicator: 9
Assistant at Surgery Indicator: 9
Co-Surgery Indicator:
9
9
Team Surgery Indicator: Physician Supervision Diagnostic Indicator: 9 Type of Service:
1 and P Diagnostic Family Imaging Indicator:
99 Effective for services performed on or after July 1, 2007 Q4088 Long Descriptor: Injection, immune globulin, (gammagard liquid), intravenous, non-
lyophilized, (e.g. liquid), 500 mg Short Descriptor: Gammagard Liquid injection Q4089 Long Descriptor: Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu Short Descriptor: Rhophylac injection Q4090 Long Descriptor: Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml
Short Descriptor: HepaGam B IM Injection Q4091 Long Descriptor: Injection, immune globulin, (flebogamma), intravenous, non-
lyophilized, (e.g. liquid), 500 mg Short Descriptor: Flebogamma injection Q4092 Long Descriptor: Injection, immune globulin, (gamunex), intravenous, non-lyophilized, (e.g. liquid), 500 mg
Short Descriptor: Gamunex injection Q4093 Long Descriptor: Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg (albuterol) or per 0.5 mg (levalbuterol) Short Descriptor: Albuterol inh non-comp con Q4094 Long Descriptor: Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, per 1 mg (albuterol) or per 0.5 mg (levalbuterol) Short Descriptor: Albuterol inh non-comp u d Q4095 Long Descriptor: Injection, zoledronic acid (reclast), 1 mg Short Descriptor: Reclast injection Attachment 2 Filenames for Revised Payment Files The revised filenames for the July update to the 2007 Medicare Physician Fee Schedule
Database for carriers are:
File A (changes retroactive to January 1, 2007):
[email protected]
File B(changes effective July 1, 2007):
[email protected]
File C (Carrier priced codes with performance payment indicator of “1”):
[email protected]
Purchased Diagnostic File
[email protected]
The revised filenames for the July update to the 2007 Medicare Physician Fee Schedule
Database for intermediaries are:
SNF Abstract File
[email protected]
Therapy/CORF Abstract File
[email protected]
Mammography Abstract File
[email protected]
Therapy/CORF Supplemental File:
[email protected]
Hospice File
[email protected]
Attachment 3
For Informational Purposes Only
The informational Performance Payment Indicator has been changed to ‘1’ for carrier
priced codes identified in the table below.
HCPCS
0016T
Mod
0017T
0019T
0026T
0027T
0028T
0029T
0030T
0031T
0032T
0041T
0042T
0043T
0046T
0047T
0048T
0049T
0050T
0051T
0052T
0053T
0054T
0055T
0056T
0058T
0059T
0060T
0061T
0062T
0063T
0064T
0065T
0067T
26
Short Descriptor
Thermotx choroid vasc lesion
Photocoagulat macular
drusen
Extracorp shock wv tx,ms
nos
Measure remnant
lipoproteins
Endoscopic epidural lysis
Dexa body composition study
Magnetic tx for incontinence
Antiprothrombin antibody
Speculoscopy
Speculoscopy w/direct
sample
Detect ur infect agnt w/cpas
Ct perfusion w/contrast, cbf
Co expired gas analysis
Cath lavage, mammary
duct(s)
Cath lavage, mammary
duct(s)
Implant ventricular device
External circulation assist
Removal circulation assist
Implant total heart system
Replace component heart
syst
Replace component heart
syst
Bone surgery using computer
Bone surgery using computer
Bone surgery using computer
Cryopreservation, ovary tiss
Cryopreservation, oocyte
Electrical impedance scan
Destruction of tumor, breast
Rep intradisc annulus;1 lev
Rep intradisc annulus;>1lev
Spectroscop eval expired gas
Ocular photoscreen bilat
Ct colonography;dx
Status
Indicator
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
0067T
0067T
0068T
0069T
0070T
0071T
0072T
0075T
0075T
0075T
0076T
0076T
0076T
0077T
0078T
0079T
0080T
0081T
0084T
0085T
0086T
0087T
0088T
0089T
0090T
0092T
0093T
0095T
0096T
0098T
0099T
0100T
0101T
0102T
0103T
0104T
0105T
0106T
0107T
0108T
0109T
0110T
0111T
0123T
0124T
0126T
0130T
0135T
TC
26
TC
26
TC
Ct colonography;dx
Ct colonography;dx
Interp/rept heart sound
Analysis only heart sound
Interp only heart sound
U/s leiomyomata ablate <200
U/s leiomyomata ablate >200
Perq stent/chest vert art
Perq stent/chest vert art
Perq stent/chest vert art
S&i stent/chest vert art
S&i stent/chest vert art
S&i stent/chest vert art
Cereb therm perfusion probe
Endovasc aort repr w/device
Endovasc visc extnsn repr
Endovasc aort repr rad s&i
Endovasc visc extnsn s&i
Temp prostate urethral stent
Breath test heart reject
L ventricle fill pressure
Sperm eval hyaluronan
Rf tongue base vol reduxn
Actigraphy testing, 3-day
Cervical artific disc
Artific disc addl
Cervical artific diskectomy
Artific diskectomy addl
Rev cervical artific disc
Rev artific disc addl
Implant corneal ring
Prosth retina receive&gen
Extracorp shockwv tx,hi enrg
Extracorp shockwv tx,anesth
Holotranscobalamin
At rest cardio gas rebreathe
Exerc cardio gas rebreathe
Touch quant sensory test
Vibrate quant sensory test
Cool quant sensory test
Heat quant sensory test
Nos quant sensory test
Rbc membranes fatty acids
Scleral fistulization
Conjunctival drug placement
Chd risk imt study
Chron care drug investigatn
Perq cryoablate renal tumor
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
0137T
0140T
0144T
0144T
0144T
0145T
0145T
0145T
0146T
0146T
0146T
0147T
0147T
0147T
0148T
0148T
0148T
0149T
0149T
0149T
0150T
0150T
0150T
0151T
0151T
0151T
0153T
0154T
0155T
0156T
0157T
0158T
0159T
0159T
0159T
0160T
0161T
0162T
0163T
0164T
0165T
0166T
0167T
0168T
0169T
0170T
0171T
0172T
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
26
TC
Prostate saturation sampling
Exhaled breath condensate
ph
CT heart wo dye; qual calc
CT heart wo dye; qual calc
CT heart wo dye; qual calc
CT heart w/wo dye funct
CT heart w/wo dye funct
CT heart w/wo dye funct
CCTA w/wo dye
CCTA w/wo dye
CCTA w/wo dye
CCTA w/wo, quan calcium
CCTA w/wo, quan calcium
CCTA w/wo, quan calcium
CCTA w/wo, strxr
CCTA w/wo, strxr
CCTA w/wo, strxr
CCTA w/wo, strxr quan calc
CCTA w/wo, strxr quan calc
CCTA w/wo, strxr quan calc
CCTA w/wo, disease strxr
CCTA w/wo, disease strxr
CCTA w/wo, disease strxr
CT heart funct add-on
CT heart funct add-on
CT heart funct add-on
Tcath sensor aneurysm sac
Study sensor aneurysm sac
Lap impl gast curve electrd
Lap remv gast curve electrd
Open impl gast curve electrd
Open remv gast curve electrd
Cad breast mri
Cad breast mri
Cad breast mri
Tcranial magn stim tx plan
Tcranial magn stim tx deliv
Anal program gast neurostim
Lumb artif diskectomy addl
Remove lumb artif disc addl
Revise lumb artif disc addl
Tcath vsd close w/o bypass
Tcath vsd close w bypass
Rhinophototx light app bilat
Place stereo cath brain
Anorectal fistula plug rpr
Lumbar spine proces distract
Lumbar spine proces addl
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
0173T
0174T
0175T
0176T
0177T
15431
15847
15999
17999
19499
20999
21088
21089
21299
21499
21742
21743
21899
22899
22999
23929
24940
24999
25999
26989
27299
27599
27899
28899
29799
29999
30999
31299
31599
31899
32855
32856
32999
33933
33944
33999
36299
37195
37501
37799
38129
Iop monit io pressure
Cad cxr with interp
Cad cxr remote
Aqu canal dilat w/o retent
Aqu canal dilat w retent
Apply acellular xgraft add
Exc skin abd add-on
Removal of pressure sore
Skin tissue procedure
Breast surgery procedure
Musculoskeletal surgery
Prepare face/oral prosthesis
Prepare face/oral prosthesis
Cranio/maxillofacial surgery
Head surgery procedure
Repair stern/nuss w/o scope
Repair sternum/nuss
w/scope
Neck/chest surgery
procedure
Spine surgery procedure
Abdomen surgery procedure
Shoulder surgery procedure
Revision of upper arm
Upper arm/elbow surgery
Forearm or wrist surgery
Hand/finger surgery
Pelvis/hip joint surgery
Leg surgery procedure
Leg/ankle surgery procedure
Foot/toes surgery procedure
Casting/strapping procedure
Arthroscopy of joint
Nasal surgery procedure
Sinus surgery procedure
Larynx surgery procedure
Airways surgical procedure
Prepare donor lung, single
Prepare donor lung, double
Chest surgery procedure
Prepare donor heart/lung
Prepare donor heart
Cardiac surgery procedure
Vessel injection procedure
Thrombolytic therapy, stroke
Vascular endoscopy
procedure
Vascular surgery procedure
Laparoscope proc, spleen
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
38589
38999
39499
39599
40799
40899
41599
41899
42299
42699
42999
43289
43496
43499
43647
43648
43659
43881
43882
43999
44137
44238
44715
44799
44899
44979
45499
45999
46999
47143
47144
47145
47379
47399
47579
47999
48551
48999
49329
49659
49906
49999
50323
50325
50549
Laparoscope proc, lymphatic
Blood/lymph system
procedure
Chest procedure
Diaphragm surgery
procedure
Lip surgery procedure
Mouth surgery procedure
Tongue and mouth surgery
Dental surgery procedure
Palate/uvula surgery
Salivary surgery procedure
Throat surgery procedure
Laparoscope proc, esoph
Free jejunum flap, microvasc
Esophagus surgery
procedure
Lap impl electrode, antrum
Lap revise/remv eltrd antrum
Laparoscope proc, stom
Impl/redo electrd, antrum
Revise/remove electrd
antrum
Stomach surgery procedure
Remove intestinal allograft
Laparoscope proc, intestine
Prepare donor intestine
Unlisted procedure intestine
Bowel surgery procedure
Laparoscope proc, app
Laparoscope proc, rectum
Rectum surgery procedure
Anus surgery procedure
Prep donor liver, whole
Prep donor liver, 3-segment
Prep donor liver, lobe split
Laparoscope procedure, liver
Liver surgery procedure
Laparoscope proc, biliary
Bile tract surgery procedure
Prep donor pancreas
Pancreas surgery procedure
Laparo proc,
abdm/per/oment
Laparo proc, hernia repair
Free omental flap, microvasc
Abdomen surgery procedure
Prep cadaver renal allograft
Prep donor renal graft
Laparoscope proc, renal
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
50949
51999
53899
54440
54699
55559
55899
58578
58579
58679
58974
58999
59897
59898
59899
60659
60699
63043
63044
64999
66999
67299
67399
67599
67999
68399
68899
69399
69799
69949
69979
70170
70170
70555
70555
70557
70557
70558
70558
70559
70559
71090
71090
72291
72291
72292
72292
73530
TC
TC
TC
TC
TC
TC
TC
TC
TC
Laparoscope proc, ureter
Laparoscope proc, bla
Urology surgery procedure
Repair of penis
Laparoscope proc, testis
Laparo proc, spermatic cord
Genital surgery procedure
Laparo proc, uterus
Hysteroscope procedure
Laparo proc, oviduct-ovary
Transfer of embryo
Genital surgery procedure
Fetal invas px w/us
Laparo proc, ob care/deliver
Maternity care procedure
Laparo proc, endocrine
Endocrine surgery procedure
Laminotomy, addÆl cervical
Laminotomy, addÆl lumbar
Nervous system surgery
Eye surgery procedure
Eye surgery procedure
Eye muscle surgery
procedure
Orbit surgery procedure
Revision of eyelid
Eyelid lining surgery
Tear duct system surgery
Outer ear surgery procedure
Middle ear surgery procedure
Inner ear surgery procedure
Temporal bone surgery
X-ray exam of tear duct
X-ray exam of tear duct
Fmri brain by phys/psych
Fmri brain by phys/psych
Mri brain w/o dye
Mri brain w/o dye
Mri brain w/dye
Mri brain w/dye
Mri brain w/o & w/dye
Mri brain w/o & w/dye
X-ray & pacemaker insertion
X-ray & pacemaker insertion
Perq vertebroplasty, fluor
Perq vertebroplasty, fluor
Perq vertebroplasty, ct
Perq vertebroplasty, ct
X-ray exam of hip
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
73530
74190
74190
TC
74235
TC
74235
74300
74300
74301
74301
74305
74305
74328
74328
74329
TC
TC
TC
TC
TC
74329
74330
74330
74340
74340
74355
74355
74360
74360
74363
74363
74420
74420
74425
74425
74445
74445
74450
74450
74470
74470
74742
74742
74775
74775
75801
75801
TC
75803
TC
75803
75805
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
X-ray exam of hip
X-ray exam of peritoneum
X-ray exam of peritoneum
Remove esophagus
obstruction
Remove esophagus
obstruction
X-ray bile ducts/pancreas
X-ray bile ducts/pancreas
X-rays at surgery add-on
X-rays at surgery add-on
X-ray bile ducts/pancreas
X-ray bile ducts/pancreas
X-ray bile duct endoscopy
X-ray bile duct endoscopy
X-ray for pancreas
endoscopy
X-ray for pancreas
endoscopy
X-ray bile/panc endoscopy
X-ray bile/panc endoscopy
X-ray guide for GI tube
X-ray guide for GI tube
X-ray guide, intestinal tube
X-ray guide, intestinal tube
X-ray guide, GI dilation
X-ray guide, GI dilation
X-ray, bile duct dilation
X-ray, bile duct dilation
Contrst x-ray, urinary tract
Contrst x-ray, urinary tract
Contrst x-ray, urinary tract
Contrst x-ray, urinary tract
X-ray exam of penis
X-ray exam of penis
X-ray, urethra/bladder
X-ray, urethra/bladder
X-ray exam of kidney lesion
X-ray exam of kidney lesion
X-ray, fallopian tube
X-ray, fallopian tube
X-ray exam of perineum
X-ray exam of perineum
Lymph vessel x-ray, arm/leg
Lymph vessel x-ray, arm/leg
Lymph vessel x­
ray,arms/legs
Lymph vessel x­
ray,arms/legs
Lymph vessel x-ray, trunk
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
75805
75807
75807
75810
75810
75894
75894
75896
75896
75898
75898
75900
75900
75940
75940
75945
75945
75946
75946
75952
75952
75953
75953
75954
75954
75956
75956
75957
75957
75958
75958
75959
75959
75960
75960
75970
75970
75980
75980
75982
75982
75992
75992
75993
75993
75994
75994
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
Lymph vessel x-ray, trunk
Lymph vessel x-ray, trunk
Lymph vessel x-ray, trunk
Vein x-ray, spleen/liver
Vein x-ray, spleen/liver
X-rays, transcath therapy
X-rays, transcath therapy
X-rays, transcath therapy
X-rays, transcath therapy
Follow-up angiography
Follow-up angiography
Intravascular cath exchange
Intravascular cath exchange
X-ray placement, vein filter
X-ray placement, vein filter
Intravascular us
Intravascular us
Intravascular us add-on
Intravascular us add-on
Endovasc repair abdom aorta
Endovasc repair abdom aorta
Abdom aneurysm endovas
rpr
Abdom aneurysm endovas
rpr
Iliac aneurysm endovas rpr
Iliac aneurysm endovas rpr
Xray, endovasc thor ao repr
Xray, endovasc thor ao repr
Xray, endovasc thor ao repr
Xray, endovasc thor ao repr
Xray, place prox ext thor ao
Xray, place prox ext thor ao
Xray, place dist ext thor ao
Xray, place dist ext thor ao
Transcath iv stent rs&i
Transcath iv stent rs&i
Vascular biopsy
Vascular biopsy
Contrast xray exam bile duct
Contrast xray exam bile duct
Contrast xray exam bile duct
Contrast xray exam bile duct
Atherectomy, x-ray exam
Atherectomy, x-ray exam
Atherectomy, x-ray exam
Atherectomy, x-ray exam
Atherectomy, x-ray exam
Atherectomy, x-ray exam
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
75995
75995
75996
75996
76001
76001
76125
76125
76350
76496
76496
76496
76497
76497
76497
76498
76498
76498
76499
76499
76499
76932
76932
76940
76940
76941
76941
76945
76945
76975
76975
76998
76998
76999
76999
76999
77013
77013
77022
77022
77299
77299
77299
77399
77399
77399
77499
77499
TC
TC
TC
TC
26
TC
26
TC
26
TC
26
TC
TC
TC
TC
TC
TC
TC
26
TC
TC
TC
26
TC
26
TC
26
TC
Atherectomy, x-ray exam
Atherectomy, x-ray exam
Atherectomy, x-ray exam
Atherectomy, x-ray exam
Fluoroscope exam, extensive
Fluoroscope exam, extensive
Cine/video x-rays add-on
Cine/video x-rays add-on
Special x-ray contrast study
Fluoroscopic procedure
Fluoroscopic procedure
Fluoroscopic procedure
Ct procedure
Ct procedure
Ct procedure
Mri procedure
Mri procedure
Mri procedure
Radiographic procedure
Radiographic procedure
Radiographic procedure
Echo guide for heart biopsy
Echo guide for heart biopsy
Us guide, tissue ablation
Us guide, tissue ablation
Echo guide for transfusion
Echo guide for transfusion
Echo guide, villus sampling
Echo guide, villus sampling
GI endoscopic ultrasound
GI endoscopic ultrasound
Us guide, intraop
Us guide, intraop
Echo examination procedure
Echo examination procedure
Echo examination procedure
Ct guide for tissue ablation
Ct guide for tissue ablation
Mri for tissue ablation
Mri for tissue ablation
Radiation therapy planning
Radiation therapy planning
Radiation therapy planning
External radiation dosimetry
External radiation dosimetry
External radiation dosimetry
Radiation therapy
management
Radiation therapy
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
77499
77520
77522
77523
77525
77799
77799
77799
78099
78099
78099
78199
78199
78199
78282
78282
78299
78299
78299
26
TC
26
TC
26
TC
TC
26
TC
78399
26
78399
TC
78399
78414
78414
78459
78459
78491
78491
78492
78492
78499
78499
78499
78599
78599
78599
78608
78608
78609
78609
TC
TC
TC
TC
26
TC
26
TC
TC
TC
78699
26
78699
78699
TC
management
Radiation therapy
management
Proton trmt, simple w/o comp
Proton trmt, simple w/comp
Proton trmt, intermediate
Proton treatment, complex
Radium/radioisotope therapy
Radium/radioisotope therapy
Radium/radioisotope therapy
Endocrine nuclear procedure
Endocrine nuclear procedure
Endocrine nuclear procedure
Blood/lymph nuclear exam
Blood/lymph nuclear exam
Blood/lymph nuclear exam
GI protein loss exam
GI protein loss exam
GI nuclear procedure
GI nuclear procedure
GI nuclear procedure
Musculoskeletal nuclear
exam
Musculoskeletal nuclear
exam
Musculoskeletal nuclear
exam
Non-imaging heart function
Non-imaging heart function
Heart muscle imaging (PET)
Heart muscle imaging (PET)
Heart image (pet), single
Heart image (pet), single
Heart image (pet), multiple
Heart image (pet), multiple
Cardiovascular nuclear exam
Cardiovascular nuclear exam
Cardiovascular nuclear exam
Respiratory nuclear exam
Respiratory nuclear exam
Respiratory nuclear exam
Brain imaging (PET)
Brain imaging (PET)
Brain imaging (PET)
Brain imaging (PET)
Nervous system nuclear
exam
Nervous system nuclear
exam
Nervous system nuclear
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
78799
78799
78799
78811
78811
78812
78812
78813
78813
78814
78814
78815
78815
78816
78816
78999
78999
78999
79300
79300
79445
79445
79999
79999
79999
86485
88199
88199
88199
88299
88380
88380
88380
88384
88384
88384
88399
88399
88399
89240
90779
90899
90999
91132
91132
91133
91133
26
TC
TC
TC
TC
TC
TC
TC
26
TC
TC
TC
26
TC
26
TC
26
TC
26
TC
26
TC
TC
TC
exam
Genitourinary nuclear exam
Genitourinary nuclear exam
Genitourinary nuclear exam
Tumor imaging (pet), limited
Tumor imaging (pet), limited
Tumor image (pet)/skul-thigh
Tumor image (pet)/skul-thigh
Tumor image (pet) full body
Tumor image (pet) full body
Tumor image pet/ct, limited
Tumor image pet/ct, limited
Tumorimage pet/ct skul-thigh
Tumorimage pet/ct skul-thigh
Tumor image pet/ct full body
Tumor image pet/ct full body
Nuclear diagnostic exam
Nuclear diagnostic exam
Nuclear diagnostic exam
Nuclr rx, interstit colloid
Nuclr rx, interstit colloid
Nuclear rx, intra-arterial
Nuclear rx, intra-arterial
Nuclear medicine therapy
Nuclear medicine therapy
Nuclear medicine therapy
Skin test, candida
Cytopathology procedure
Cytopathology procedure
Cytopathology procedure
Cytogenetic study
Microdissection
Microdissection
Microdissection
Eval molecular probes, 11-50
Eval molecular probes, 11-50
Eval molecular probes, 11-50
Surgical pathology procedure
Surgical pathology procedure
Surgical pathology procedure
Pathology lab procedure
Ther/prop/diag inj/inf proc
Psychiatric service/therapy
Dialysis procedure
Electrogastrography
Electrogastrography
Electrogastrography w/test
Electrogastrography w/test
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
91299
91299
91299
92499
92499
92499
92700
92978
92978
92979
92979
92992
92993
93235
93236
93315
93315
93317
93317
93318
93318
93501
93501
93505
93505
93508
93508
93510
93510
93511
93511
93514
93514
93524
93524
93526
93526
93527
93527
93528
93528
93529
93529
93530
93530
93531
93531
26
TC
26
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
Gastroenterology procedure
Gastroenterology procedure
Gastroenterology procedure
Eye service or procedure
Eye service or procedure
Eye service or procedure
Ent procedure/service
Intravasc us, heart add-on
Intravasc us, heart add-on
Intravasc us, heart add-on
Intravasc us, heart add-on
Revision of heart chamber
Revision of heart chamber
ECG monitor/report, 24 hrs
ECG monitor/report, 24 hrs
Echo transesophageal
Echo transesophageal
Echo transesophageal
Echo transesophageal
Echo transesophageal
intraop
Echo transesophageal
intraop
Right heart catheterization
Right heart catheterization
Biopsy of heart lining
Biopsy of heart lining
Cath placement, angiography
Cath placement, angiography
Left heart catheterization
Left heart catheterization
Left heart catheterization
Left heart catheterization
Left heart catheterization
Left heart catheterization
Left heart catheterization
Left heart catheterization
Rt & Lt heart catheters
Rt & Lt heart catheters
Rt & Lt heart catheters
Rt & Lt heart catheters
Rt & Lt heart catheters
Rt & Lt heart catheters
Rt, lt heart catheterization
Rt, lt heart catheterization
Rt heart cath, congenital
Rt heart cath, congenital
R & l heart cath, congenital
R & l heart cath, congenital
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
93532
93532
93533
93533
93555
93555
93556
93556
93561
93561
93562
93562
93571
93571
93572
93572
93600
93600
93602
93602
93603
93603
93609
93609
93610
93610
93612
93612
93615
93615
93616
93616
93618
93618
93619
93619
93620
93620
93621
93621
93622
93622
93623
93623
93624
93624
93631
93631
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
R & l heart cath, congenital
R & l heart cath, congenital
R & l heart cath, congenital
R & l heart cath, congenital
Imaging, cardiac cath
Imaging, cardiac cath
Imaging, cardiac cath
Imaging, cardiac cath
Cardiac output measurement
Cardiac output measurement
Cardiac output measurement
Cardiac output measurement
Heart flow reserve measure
Heart flow reserve measure
Heart flow reserve measure
Heart flow reserve measure
Bundle of His recording
Bundle of His recording
Intra-atrial recording
Intra-atrial recording
Right ventricular recording
Right ventricular recording
Map tachycardia, add-on
Map tachycardia, add-on
Intra-atrial pacing
Intra-atrial pacing
Intraventricular pacing
Intraventricular pacing
Esophageal recording
Esophageal recording
Esophageal recording
Esophageal recording
Heart rhythm pacing
Heart rhythm pacing
Electrophysiology evaluation
Electrophysiology evaluation
Electrophysiology evaluation
Electrophysiology evaluation
Electrophysiology evaluation
Electrophysiology evaluation
Electrophysiology evaluation
Electrophysiology evaluation
Stimulation, pacing heart
Stimulation, pacing heart
Electrophysiologic study
Electrophysiologic study
Heart pacing, mapping
Heart pacing, mapping
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
93640
93640
93641
93641
93662
93662
93745
93745
93745
93799
93799
93799
94642
94772
94772
94772
94774
94775
94776
94777
94799
94799
94799
95199
95824
95824
95951
95951
95965
95965
95966
95966
95967
95967
95999
96020
96020
96549
96999
97039
97139
97799
99082
99143
99144
99145
99148
TC
TC
TC
26
TC
26
TC
26
TC
26
TC
TC
TC
TC
TC
TC
TC
Evaluation heart device
Evaluation heart device
Electrophysiology evaluation
Electrophysiology evaluation
Intracardiac ecg (ice)
Intracardiac ecg (ice)
Set-up cardiovert-defibrill
Set-up cardiovert-defibrill
Set-up cardiovert-defibrill
Cardiovascular procedure
Cardiovascular procedure
Cardiovascular procedure
Aerosol inhalation treatment
Breath recording, infant
Breath recording, infant
Breath recording, infant
Ped home apnea rec, compl
Ped home apnea rec, hk-up
Ped home apnea rec, downld
Ped home apnea rec, report
Pulmonary service/procedure
Pulmonary service/procedure
Pulmonary service/procedure
Allergy immunology services
Eeg, cerebral death only
Eeg, cerebral death only
EEG monitoring/videorecord
EEG monitoring/videorecord
Meg, spontaneous
Meg, spontaneous
Meg, evoked, single
Meg, evoked, single
Meg, evoked, each addÆl
Meg, evoked, each addÆl
Neurological procedure
Functional brain mapping
Functional brain mapping
Chemotherapy, unspecified
Dermatological procedure
Physical therapy treatment
Physical medicine procedure
Physical medicine procedure
Unusual physician travel
Mod cs by same phys, < 5
yrs
Mod cs by same phys, 5 yrs
+
Mod cs by same phys add-on
Mod cs diff phys < 5 yrs
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
C
99149
99150
99199
99499
G0186
G0339
G0340
Q3001
R0070
R0075
Mod cs diff phys 5 yrs +
Mod cs diff phys add-on
Special service/proc/report
Unlisted e&m service
Dstry eye lesn,fdr vssl tech
Robot lin-radsurg com, first
Robt lin-radsurg fractx 2-5
Brachytherapy
Radioelements
Transport portable x-ray
Transport port x-ray multipl
C
C
C
C
C
C
C
C
C
C