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Rule

Medicare Program; Changes to Medicare Payment for Drugs and Physician Fee Schedule Payments for Calendar Year 2004

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Information about this document as published in the Federal Register.

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AGENCY:

Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION:

Interim final rule with comment period.

SUMMARY:

This interim final rule implements the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MPDIMA) of 2003, Pub. L. 108-173, which are applicable in 2004 to Medicare payment for covered drugs and physician fee schedule services. These provisions revise the current payment methodology for Part B covered drugs and biologicals that are not paid on a cost or prospective payment basis; make changes to Medicare payment for furnishing or administering drugs and biologicals; revise the geographic practice cost indices and change the physician fee schedule conversion factor. The 2004 physician fee schedule conversion factor will be $37.3374. The 2004 national anesthesia conversion factor (prior to making adjustment for the geographic practice cost indices) will be $17.4969. The information contained in this final rule related to payment under the physician fee schedule supercedes the information contained in the November 7, 2003, final rule to the extent that the two are inconsistent. All other provisions of the November 7, 2003, final rule are unchanged unless otherwise noted. This rule also extends the “opt-out” provisions of 1802(b)(5)(3) of the Social Security Act to dentists, podiatrists, and optometrists.

DATES:

Effective date: These regulations are effective on January 1, 2004.

Comment date: We will consider comments if we receive them at the appropriate address, as provided in the addresses section, no later than 5 p.m. on March 8, 2004.

ADDRESSES:

In commenting, please refer to file code CMS-1372-FC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

Mail written comments (one original and two copies) to the following address only: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1372-FC, P.O. Box 8013, Baltimore, MD 21244-8013.

Please allow sufficient time for us to receive mailed comments on time in the event of delivery delays.

If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) to one of the following addresses: Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-8013.

(Because access to the interior of the HHH Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available if you wish to retain proof of filing by stamping in and retaining an extra copy of the comments being filed.)

Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and could be considered late.

For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.

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FOR FURTHER INFORMATION CONTACT:

Jennifer Fan, (410) 786-0548 regarding Medicare payment for Part B covered drugs and biologicals.

Rick Ensor, (410) 786-5617 regarding provisions related to geographic practice cost indices.

Diane Milstead, (410) 786-3355 for provisions related to the physician fee schedule.

Gaysha Brooks, (410) 786-9649 for questions related to obtaining Medicare physician fee schedule information from the CMS Web site.

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SUPPLEMENTARY INFORMATION:

Inspection of Public Comments: Comments received timely will be available for public inspection as they are processed, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone (410) 786-7197.

Copies: To order copies of the Federal Register containing this document, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders can also be placed by calling the order desk at (202) 512-1800 or by faxing to (202) 512-2250. The cost for each copy is $10. As an alternative, you can view and photocopy the Federal Register document at most libraries designated as Federal Depository Libraries and at many other public and academic libraries throughout the country that receive the Federal Register.

This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. The Web site address is http://www.access.gpo.gov/​nara/​index.html.

Accessing Physician Fee Schedule Web Site and Pricing Information

Information on the physician fee schedule and pricing files can be found on our home page. You can access this data at the following Web site: http://cms.hhs.gov/​physicians/​pfs or you can access this data by using the following directions:

1. Go to the CMS home page (http://www.cms.hhs.gov).

2. Place your cursor over the word “Professionals” in the blue area near the top of the page. Select “Physicians” from the drop-down menu.

3. Scroll down and under “Payment/Billing” select “Physician Fee Schedule”.

The Physician Fee Schedule pricing information is contained in two public use files.

(1) National Physician Fee Schedule Relative Value File—This file contains all CPT/HCPCS (excluding codes beginning with B, E, L, K, and 0), their short descriptions and a status indicator, which denotes whether or not the service is priced under the physician fee schedule. The file also contains the components used in the calculation of the annual pricing amount (that is, the RVUs, GPCIs, and conversion factor), anesthesia conversion factors, and the payment policy indicators used to price the claims with surgical modifiers. This file does not contain the calculated pricing amounts.

(2) Physician Fee Schedule Payment Amount File National/Carrier—This file contains the CPT code and the Medicare price for all services priced under the Physician Fee Schedule. These data can be downloaded for the entire country, or for a selected carrier (in most cases Start Printed Page 1085carriers correlate with States). There is no option of requesting data for selected HCPCS codes. The zip file, which is downloaded, contains a file named “PF04pc”, which explains the data contained in each column. This file also contains a description of pricing localities used in the Physician Fee Schedule. Due to the size of the national file (as well as many of the carrier-specific files), these data are provided in a comma-delimited format, which can be used to populate database applications. Generally speaking, these data are too large for Excel, however if a carrier specific file has 3 or fewer localities, Excel can be used.

Another file that may prove useful is the Zip Code to Carrier Locality file. This file will map ZIP Codes to CMS carriers and localities and map Zip Codes to their State and determine whether the ZIP Code has a rural designation as determined by CMS. You can access this file at the following Web site: http://cms.hhs.gov/​providers/​pufdownload/​default.asp#alphanu or you can access this data by using the following directions:

1. Go to the CMS home page (http://www.cms.hhs.gov).

2. Place your cursor over the word “Professionals” in the blue area near the top of the page. Select “Physicians” from the drop-down menu.

3. Scroll down and under “Payment/Billing” select “Medicare Payment Systems.”

4. Scroll down and under Coding Files select “Zip Code to Carrier Locality File.”

Table of Contents

I. Background

A. Medicare Payment for Part B Covered Drugs and the Furnishing or Administration of Drugs

B. Geographic Practice Cost Indices and Physician Fee Schedule Conversion Factor

II. Provisions of the Final Rule

A. Application of Market-Based Systems of Medicare Payment for Part B Drugs

B. Payment for Inhalation Drugs

C. Pharmacy Supplying Fee for Certain Drugs and Biologicals

D. Physician Fee Schedule Provisions Related to the Administration of Drugs

1. Provisions Related to Budget Neutrality

2. Adjustments in Practice Expense Relative Value Units for Certain Drug Administration Services beginning with 2004

3. Pricing of Clinical Oncology Nurses in the Practice Expense Methodology

4. Work Relative Value Units for Certain Drug Administration Services

5. Adjustments in the Practice Expense Relative Value Units for Certain Drug Administration Services Beginning with 2005

6. Provisions for Appropriate Reporting and Billing for Physicians' Services Associated with the Administration of Covered Outpatient Drugs and Biologicals

7. Treatment of Other Services Currently in the Nonphysician Work Pool

8. Payment for Multiple Chemotherapy Agents Furnished on a Single Day through the Push Technique

9. Transitional Adjustment to Medicare Payment for Certain Drug Administration Services

E. Geographic Practice Cost Indices

F. Adjustments to the Work, Practice Expense and Malpractice Relative Value Units

G. Anesthesia and Physician Fee Schedule Conversion Factors for 2004

H. Publication of Addenda

III. Private Contracting with Medicare Beneficiaries

IV. Waiver of Proposed Rulemaking and Delay in Effective Date

V. Collection of Information Requirements

VI. Response to Comments

VII. Regulatory Impact Analysis

Addendum A—Explanation and Use of Addendum B

Addendum B—Relative Value Units and Related Information Used in Determining Medicare Payments for 2004

Addendum C—Codes with Interim Relative Value Units

Addendum D—2004 Geographic Practice Cost Indices by Medicare Carrier and Locality

Addendum E—2005 Geographic Practice Cost Indices by Medicare Carrier and Locality

Addendum F—List of Medicare Covered Part B Drugs Under Payment Reform

I. Background

A. Medicare Payment for Part B Covered Drugs and the Furnishing or Administration of Drugs

Medicare Part B covers a limited number of prescription drugs and biologicals. For the purposes of this final rule, the term “drugs” will hereafter refer to both drugs and biologicals. Currently, covered Medicare drugs generally fall into three categories: drugs furnished incident to a physician's service, durable medical equipment (DME) drugs, and drugs specifically covered by statute (for example, oral immunosuppressive drugs). Prior to January 1, 2004, drugs not paid on a cost or prospective payment basis are paid based on the lower of the actual charge or 95 percent of the average wholesale price (AWP) (section 1842(o)(1) of the Social Security Act (the Act), as added by section 4556 of the Balanced Budget Act of 1997 (Pub. L. 105-33)). In December 2000, the Congress passed the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA). Section 429(a) of BIPA required the GAO to conduct a study of the current payment methodology. Section 429(b) of BIPA requires the Secretary, notwithstanding any other provision of law, to revise the Medicare payment methodology for drugs based on the GAO study. In September 2001, the GAO presented its study to the Congress in a report titled, “Medicare: Payments for Covered Outpatient Drugs Exceed Providers’ Costs” (GAO-01-1118). Consistent with the recommendations in the report, we published four options for revising the current drug payment system in a proposed rule published August 20, 2003 (68 FR 50428), in the Federal Register. This proposed rule also discussed changes to Medicare payment under the physician fee schedule for furnishing or administering certain drugs and biologicals. However, as discussed in the November 7, 2003, final rule (68 FR 63196), “Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2004”, since the Congress was considering legislation to address these issues, we were reluctant to proceed with finalizing the proposals contained in the August 20, 2003, proposed rule. On November 25, 2003, the Congress enacted the Medicare Prescription Drug, Improvement, and Modernization Act (MPDIMA) of 2003, Pub L. 108-173. The President signed Pub. L. 108-173 into law on December 8, 2003. Sections 303 through 305 of MPDIMA make revisions to payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. Sections 303 and 304 also require the Secretary of Health and Human Services to revise Medicare payments for the administration of drugs made using the physician fee schedule. We are using this final rule to implement those sections of MPDIMA that are effective January 1, 2004, and prior to January 1, 2006, and affect Medicare payment for covered Part B drugs and their administration.

B. Geographic Practice Cost Indices (GPCIs) and Physician Fee Schedule Conversion Factor

Section 1848(e) of the Act requires that payments vary among Medicare physician fee schedule areas according to the extent resource costs vary, as measured by Geographic Practice Cost Indices (GPCIs) for each of the three fee schedule components—work, practice expense and malpractice. As explained later in this document, for services provided on or after January 1, 2004, and prior to January 1, 2007, section 412 of MPDIMA requires that the work GPCI cannot be less than 1.00. Section 602 of MPDIMA requires that work, practice Start Printed Page 1086expense and malpractice GPCIs otherwise calculated cannot be less than 1.67 for services furnished in Alaska on or after January 1, 2004, or prior to January 1, 2006.

Sections 1848(d) and (f) of the Act establish a formula for determining the physician fee schedule update and conversion factor (CF). As indicated in the November 7, 2003, final rule (68 FR 63239), the application of the formula in the statute resulted in a 2004 physician fee CF of $35.1339, a reduction of 4.5 percent. However, section 601 of MPDIMA requires that the update to the physician fee schedule CF for 2004 cannot be less than 1.5 percent. We are using this final rule to announce the CF and GPCIs that will be used to determine physician fee schedule rates in 2004.

II. Provisions of the Final Rule

A. Application of Market-Based Systems of Medicare Payment for Part B Drugs

1. General Rule

Subject to the other provisions of MPDIMA, section 303(b) of MPDIMA specifies that drugs not paid on a cost or prospective payment basis will be paid at 85 percent of the average wholesale price (AWP) determined as of April 1, 2003.

2. Specific Provisions

Section 303(b)(1) of MPDIMA specifies that for CY 2004 the following drugs will be paid at 95 percent of the AWP:

  • Blood clotting factors;
  • A drug or biological furnished during 2004 that was not available for Medicare payment as of April 1, 2003;
  • Pneumococcal and influenza vaccines as well as hepatitis B vaccine that is furnished to individuals at high or intermediate risk of contracting hepatitis B (as determined by the Secretary); and
  • A drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities.

Section 303(b)(1) of MPDIMA also specifies that infusion drugs will be paid at 95 percent of the AWP in effect on October 1, 2003, when furnished through a covered item of durable medical equipment.

Section 303(b)(2) of MPDIMA specifies that the payment for a drug contained in the table entitled “Table 3—Medicare Part B Drugs in the Most Recent GAO and OIG Studies” published in the August 20, 2003, proposed rule (68 FR 50445) will be the percentage of the AWP indicated in the column entitled “Average of the GAO and OIG data (percent)”. This percentage will be applied to the AWP determined as of April 1, 2003. However, in the event that the percentage from Table 3 is less than 80 percent, the percentage applied to the AWP determined as of April 1, 2003, will be 80 percent. Table 1 below is a reprint of Table 3 from the August 20, 2003, proposed rule. Table 2 highlights the relevant column from the August 20, 2003, proposed rule table and applies the 80 percent limit where applicable.

We note that there was a typographical error in Table 3 as published on August 20, 2003, for J1642 “Heparin Sodium Lock Flush”. The percentage in the column specified in MPDIMA is missing for J1642. Given that this column is calculated as the average of the values in the preceding two columns for the drugs in this table, we will treat the missing value as the average of the values in the prior two columns for J1642, namely 66 percent. This is the percentage that would have been in that column in the table in the absence of the typographical error. We believe that this correction is consistent with Congress' intent to revise the percentage based on the average of accurate GAO and OIG data. This percentage will be subject to the 80 percent limitation described above.

We also note that there was another typographical error in Table 3 as published on August 20, 2003, for J9390 “Vinorelbine Tartrate (Navelbine).” The percentage listed under the column titled “GAO Average Widely Available Price as a Percent of AWP (2001)” for J9390 in Table 3 is incorrect and should not have been listed at all since GAO did not include this drug in its study. The percentage under the column titled “OIG Median Catalogue Price as a Percent of AWP (2000)” is correct. Since the column specified in MPDIMA is calculated as the average of the values in the preceding two columns for the drugs in this table, the correct percentage listed for J9390 under this column will be 81 percent based on the data from OIG. We believe that this correction is also consistent with Congress' intent to revise rates based on the average of accurate GAO and OIG data. This is the percentage that would have been in that column in the table in the absence of the typographical error.

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Section 303(b)(2) of MPDIMA also provides an opportunity for the manufacturer of a drug to submit data and information requesting a different percentage from the percentage indicated in Table 1A or the 85 percent general rule. The Secretary may adjust the percentage based on this data and information beginning April 1, 2004. Section 303(b) of MPDIMA specifies that this data and information can be submitted after October 15, 2003, and before January 1, 2004. As required by the statute, manufacturers need to submit this data and information before January 1, 2004. Manufacturers may supplement this data and information; however, any additional supplemental information should be received by CMS before 5 p.m. e.s.t. on January 16, 2004. We will use the supplemental information to help us evaluate the initial submission of data and information.

We expect that the data and information submitted by a manufacturer would include the manufacturer's average sales price for the drug for the most recent quarter available. For the purposes of the exceptions process, the manufacturer's average sales price is calculated as the manufacturer's sales to all purchasers in the United States (excluding sales exempted below) for the quarter divided by the total number of units of such drug or biological sold by the manufacturer in that quarter. The submission should also specify the units used in the calculation (for example, micrograms).

In the calculation of the manufacturer's average sales price, a manufacturer should include volume discounts, prompt pay discounts, cash discounts, free goods that are contingent on any purchase requirement, chargebacks, and rebates (other than rebates under the Medicaid program). To the extent that there is a lag in the availability of this information applicable to the quarter, the manufacturer should apply a methodology based on the most recent 12-month period available to estimate costs attributable to these price concessions. The manufacturer should submit a description of the methodology used to estimate these costs.

In the calculation of the manufacturer's average sales price, a manufacturer should exclude the following sales as defined for the Medicaid best price calculation under section 1827(c)(1)(C)(i) of the Act:

1. Sales to the Indian Health Service, the Department of Veterans Affairs, a state home as defined for the purposes of the Medicaid best price calculation, the Department of Defense, the Public Health Service and entities described in section 340(B)(a)(4) of the Public Health Act;

2. Sales under the Federal Supply Schedule of the General Services Administration;

3. Sales under a State pharmaceutical assistance program; and

4. Any depot sales and single award contract sales as defined for the purposes of the Medicaid best price calculation.

A manufacturer should also exclude sales at a nominal charge. Sales at a nominal charge are defined as sales below 10 percent of the average calculated as described above. In other words, after following the methodology described above, sales below 10 percent of the resulting average should be excluded and the average recalculated. The result of this final calculation is the manufacturer's average sales price for the purpose of the exceptions process.

Note that we would base any changes to the percentage indicated in Table 1 or the 85 percent general rule only on data that we could make available to the public.

Section 303(b)(2) of MPDIMA also specifies that we may adjust the percentage effective January 1, 2004, based on data and information that a manufacturer submitted by October 15, 2003. We accepted data from the manufacturer of two biologicals: imiglucerase and alglucerase. The data and information submitted by the manufacturer indicated that the manufacturer's average sales price was 94 percent of the average wholesale price. Based on this data, we will pay for these two biologicals when furnished in 2004 at 94 percent of the average wholesale price determined as of April 1, 2003.

B. Payment for Inhalation Drugs

Section 305(a) of MPDIMA specifies that inhalation drugs furnished through durable medical equipment covered under 1861(n) of the Act will be paid in accordance with section 1842(o)(4) of the Act, as added by section 303(b)(2) of MPDIMA. The methodology for determining the payment for a drug under section 303(b)(2) of MPDIMA is described above in section II.A.2 of this rule.

C. Pharmacy Supplying Fee for Certain Drugs and Biologicals

Section 303(e)(2) of MPDIMA provides that the Secretary shall pay a pharmacy supplying fee, less applicable deductible and coinsurance, for immunosuppressive drugs described in section 1861(s)(2)(J) and oral anti-cancer and anti-nausea drugs described in subparagraph (Q) and (T) of the same section as determined appropriate by the Secretary. We believe that the payment of this fee should be bundled into the current payment for these drugs and the 2004 payment amounts specified in section 303(b) of MPDIMA. We do not have data indicating that the 85% figure is insufficient to cover the cost of supplying these drugs. However, for 2005, we will re-examine this issue in light of the average sales price (ASP) data that will be submitted by manufacturers.

D. Physician Fee Schedule Provisions Related to the Administration of Drugs

As indicated above, sections 303 and 304 of MPDIMA amend section 1848 of the Act for physician fee schedule payments made beginning January 1, 2004. We are describing our implementation of the parts of sections 303 and 304 which have a January 1, 2004, effective date.

1. Provisions Related to Budget Neutrality

Section 303(a)(1) of MPDIMA amends section 1848(c) of the Act to require changes to the practice expense and physician work relative value units (RVUs) used to determine payment for drug administration services. In general, section 1848(c)(2)(B)(ii)(II) provides that the Secretary shall review and may make adjustments to the RVUs if the changes do not cause the amount of expenditures to increase or decrease by more than $20 million. Section 303(a) of MPDIMA amends section 1848(c)(2)(B) of the Act to add a new clause (iv) that exempts from this limitation, any additional expenditures in 2004 attributable to:

(1) The increase in practice expense RVUs for drug administration services resulting from the use of a practice expense survey meeting specific criteria described in the statute;

(2) The increase in practice expense RVUs resulting from using survey data on the compensation of clinical oncology nurses; and

(3) New physician work RVUs that we are adding to the drug administration services consistent with the new statutory provisions.

In addition, section 303(a)(1) of MPDIMA also modifies section 1848(c)(2)(B) of the Act to provide an exemption from the budget neutrality requirements in 2005 or 2006 for further increases in practice expense RVUs for drug administration services that may result from using additional survey data from physician specialties meeting specific criteria that we will discuss in Start Printed Page 1092more detail later in this document. Furthermore, any increase in spending associated with any coding or policy changes resulting from the Secretary's review of existing drug administration codes is also exempted from budget neutrality requirements of section 1848 (c)(2)(B) by section 303 of MPDIMA. Section 303(a)(3) also requires the Secretary to review the policy in effect for the administration of more than one drug administered by the push technique. This change is also exempt from budget neutrality.

In general, we have met the budget neutrality requirements in the statute by either applying an adjustment to the physician fee schedule CF or to the RVUs themselves. However, section 303(a) of MPDIMA specifically amends the statute to exempt the additional expenditures that result from changes to the RVUs for drug administration services from the budget neutrality requirements. Therefore, we will make no changes to the physician fee schedule CF or physician work RVUs to account for physician work RVUs being added to drug administration services. We will add the additional expenditures as a result of these provisions to the expenditure base in applying our practice expense methodology.

2. Adjustments in Practice Expense Relative Value Units for Certain Drug Administration Services Beginning with 2004

Section 303(a)(1)(B) of MPDIMA amends section 1848(c)(2) of the Act by adding new subparagraph (H), “Adjustments in Practice Expense Relative Value Units for Certain Drug Administration Services beginning in 2004”. Subparagraph (H)(i) requires the Secretary to determine the practice expense RVUs for 2004 using practice expense surveys submitted to the Secretary as of January 1, 2003, by a physician specialty organization in accordance with section 212 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 if the survey: (1) Covers practice expenses for oncology drug administration services; and (2) meets criteria established by the Secretary for acceptance of such surveys.

Section 212 of the BBRA directed the Secretary to establish a process under which we would accept and use, to the maximum extent practicable and consistent with sound data practices, data collected or developed by entities and organizations. In an interim final rule with comment published in the Federal Register on May 3, 2000 (65 FR 25664), we established the criteria under which we would accept supplemental data for use in computing the practice expense RVUs. We subsequently modified those criteria in the November 1, 2000, physician fee schedule final rule (65 FR 65383) and the December 31, 2002, final rule (67 FR 79971).

The American Society of Clinical Oncology (ASCO) provided us with a supplemental survey prior to January 1, 2003, that includes expenses associated with the administration of chemotherapy drugs. While the survey meets the criteria we established, we initially decided not to use the information because of concerns about the data (for more information, see the December 31, 2003, final rule (67 FR 79973)). In a proposed rule published in the Federal Register on August 20, 2003 (68 FR 50437), we described subsequent discussions held with ASCO that resolved our concerns about the data.

Consistent with section 1848(c)(2)(H)(i) of the Act, we are using the ASCO survey to determine the practice expense RVUs for physician fee schedule services furnished on or after January 1, 2004, because it: (1) Was submitted prior to January 1, 2003; (2) includes expenses for drug administration services; and (3) meets criteria we have established for use of surveys.

Section 303(j) of MPDIMA applies the amendments made by section 303 for payments for drugs or biologicals and drug administrative services to physicians in the specialties of hematology, hematology/oncology and medical oncology. Section 304 indicates that: “Notwithstanding section 303(j), the amendments made by section 303 shall also apply to payments for drugs or biologicals and drug administration services furnished by physicians in specialties other than the specialties of hematology, hematology/oncology and medical oncology.”

Because the section 303 (a)(1) provisions apply to hematology, hematology/oncology and medical oncology, we will use the supplemental survey submitted by ASCO for CMS specialty codes 82 (hematology), 83 (hematology/oncology) and 90 (medical oncology).

The Conference Report indicates that section 304 requires the Secretary to disregard the (section 303) exemption and apply the adjustments in section 303 to these other specialties. The Conference report further indicates the intent in drafting the provisions in this fashion: “The intent in drafting the two sections in this manner is to segregate the savings achieved from adjustments to payments to oncologists from savings derived from other physician specialties. The specialties to which the provisions apply are the specialties as used by the carriers in administering Medicare.”

The purpose of the separation is only to display the budget scoring effects separately for oncologists from other physician specialties. There is no substantive policy effect at all from the enactment of the amendments in this manner. The combined effect of the amendments made by both section 303(j) and section 304 is that the substantive changes in both payments for drugs and biologicals as well as drug administration services apply to physicians of all specialties.

When we use supplemental survey data, we have generally blended the supplemental survey data with prior survey data from the American Medical Association's Socioeconomic Monitoring Survey (SMS). However, section 1848(c)(2)(H)(i) of the Act indicates that the Secretary should use survey data that meets the specific criteria specified in the statute. We are using the ASCO survey data and are not blending it with the prior SMS data.

Because we are not blending the ASCO survey with the SMS data, we are adopting a consistent policy in 2004 for survey data received in 1999 from the Society for Thoracic Surgery (STS). That is, we will use the STS supplemental survey data without blending it with the SMS data. However, we have not made a final decision and will continue to consider the issue of whether to blend supplemental survey with prior SMS data or to use specialty submitted supplemental surveys without blending. At this time, we are not using the ASCO and STS cases as precedent for our consideration of future survey data. While some may argue that the inclusion of newer, more specific survey data will improve the precision of the data underlying the calculation of the practice expense resource based RVUs, and lead to more stability in the practice expense methodology, it can also be argued that a specialty society would only undertake a survey (arguing that existing SMS data were not sufficiently representative of the specialty's practice expenses) if it believed that higher practice expense payments for that specialty could be achieved by submitting additional data. We do not believe that it would be prudent for the program to commit to the use of supplemental survey data without blending it with the SMS data for any and all future supplementary surveys. We will continue to consider this issue in 2004 when we make proposals for the 2005 physician fee schedule. At this time, we suggest that supplemental Start Printed Page 1093survey data should be used without blending only under certain conditions that would be specified in a future rule. (Note that this issue does not affect specialties that are not included in the SMS sample, and for which we have no other previous survey data. In such cases there would obviously be no SMS survey data to blend.)

We invite comments on this issue and on appropriate criteria for determining when to employ specialty submitted supplemental surveys without blending.

Table 2 shows the revised practice expense per hour for each cost pool for the specialties of cardiac and thoracic surgery and oncology, hematology/oncology and hematology.

Table 2

SpecialtyClin StaffAdmin. StaffOffice ExpenseMed. SuppliesMed. EquipOtherTotal
Cardiac/Thoracic Surgery19.518.017.22.12.114.273.1
Oncology53.434.734.416.97.442.2189.0

3. Pricing of Clinical Oncology Nurses in the Practice Expense Methodology

Section 1848(c)(2)(H)(ii) of the Act (as added by section 303(a)(1) of MPDIMA) specifies that if a survey meets the criteria described above (that is, the survey that is submitted prior to January 1, 2003, meets criteria established by the Secretary, etc.) and includes data on wages, salaries and compensation of clinical oncology nurses, the Secretary will use the data in the methodology for determining the practice expense RVUs. The ASCO survey meets the criteria specified in the statute and also includes data on oncology nursing compensation. For this reason, we are using information from the survey to determine the wage rate per minute for oncology certified nurses (OCN). The OCN is included as a practice expense input for the nonchemotherapy infusion codes (90780 through 90781) and the chemotherapy administration codes (96400 through 96549). Using information from the ASCO survey, we determined a wage rate of 0.79 per minute (increase from the 0.56 per minute we are currently using) for the OCN. We used this revised wage rate to determine the practice expense RVUs for the drug administration services shown in Addendum B.

4. Work Relative Value Units for Certain Drug Administration Services

For services furnished on or after January 1, 2004, section 1848(c)(2)(H)(iii) of the Act (as added by section 303(a)(1) of MPDIMA) requires the Secretary to establish work RVUs for drug administration services equal to the work RVUs for a level 1 office medical visit for an established patient (CPT code 99211). Section 1848(c)(2)(H)(iv) of the Act defines drug administration services as those classified as of October 1, 2003, within any of the following groups: therapeutic or diagnostic infusions (excluding chemotherapy); chemotherapy administration services; and therapeutic, prophylactic, or diagnostic injections for which there are no work RVUs assigned and for which national RVUs have been assigned.

CPT code 99211 is a level 1 established patient office visit with physician work RVUs of 0.17. Consistent with the statute we are adding physician work RVUs of 0.17 to the following drug administration services: CPT codes 90780 through 90781, 90782 through 90788, 96400, 96408 through 96425, 96520, and 96530.

Currently, section 15010 of the Medicare Carriers Manual (MCM) does not allow payment for CPT codes 90782, 90783, 90784 and 90788 unless these are the only physician fee schedule services provided on that day. We do pay separately for cancer chemotherapy injections (CPT codes 96400-96549) in addition to an office visit (CPT codes 99211-99215) furnished on the same day by the same physician. CPT code 99211 does not require a face-to-face encounter between the physician and the patient like other office visit services (CPT codes 99212-99215) and can be used be physicians supervising a nurse performing chemotherapy administration. Currently, physicians typically bill for CPT code 99211 approximately 34 percent of the time that they are also providing a drug administration service. We believe that adding physician work to the drug administration services will subsume the supervision that physicians billing for a 99211 on the same day are typically providing. Therefore, we will no longer allow for 99211 to be billed on the same day as a chemotherapy administration service.

Although less common than CPT 99211, physicians also bill for other office visit (CPT codes 99212-99215) provided on the same day as chemotherapy administration. We will continue to allow other office visits to be billed on the same day as a drug administration service with modifier 25 indicating that a separately identifiable evaluation and management service was provided. This policy will make our practice with chemotherapy administration consistent with all other physician fee schedule services where we require use of modifier 25 if a separately identifiable evaluation and management service is provided on the day as a procedure. Section 15400(D) of the Medicare Carrier Manual (MCM) describes Medicare payment policy with respect to chemotherapy administration and “incident to” services provided on the same day. We will be revising section 15400 of the MCM (in addition to section 15010 that describes “bundled services”) to reflect that CPT code 99211 and a chemotherapy administration service cannot be billed for the same patient on a single day.

5. Adjustments in the Practice Expense Relative Value Units for Certain Drug Administration Services Beginning with 2005

Section 303(a)(1) of MPDIMA also modifies section 1848(c)(2)(B) of the Act to provide an exemption from the budget neutrality requirements in 2005 or 2006 for further increases in practice expense RVUs for drug administration services that may result from using additional survey data from physician specialties meeting specific criteria. Section 1848(c)(2)(I) of the Act specifies that the exemption from budget neutrality will apply for any survey (other than the ASCO survey that meets the exemption requirement specified by another provision of the statute) submitted by a specialty group where 40 percent or more of its payments for Part B services are attributable to the administration of drugs in 2002 as determined by the Secretary. The statute indicates that the survey must include expenses for the administration of drugs and must be received by the Secretary prior to March 1, 2004, to determine the 2005 practice expense RVUs and prior to March 1, 2005, to determine the 2006 practice expense RVUs. Start Printed Page 1094

We have reviewed Medicare allowed charge data for 2002. Based on the 2002 data, we found that the specialties of gynecology/oncology (specialty code 98) rheumatology (specialty code 66) and urology (specialty code 30) received more than 40 percent of total Part B revenues from drugs. We will apply the exemption from budget neutrality specified in section 1848(c)(2)(I) of the Act for additional expenditures that result from the increases in drug administration practice expense RVUs in 2005 or 2006 resulting from use of a survey that is submitted timely by any of these specialties and otherwise meets criteria we have established for use of supplemental surveys. Hematology (specialty 82), hematology/oncology (specialty 83) and medical oncology (specialty 90) also receive more than 40 percent of their Medicare revenues from drugs. However, we are already using the ASCO survey for these specialties and the increase in payment for drug administration is exempt from budget neutrality by another provision of the statute.

6. Provisions for Appropriate Reporting and Billing for Physicians' Services Associated with the Administration of Covered Outpatient Drugs

Section 1848(c)(2)(J) of the Act requires the Secretary to promptly evaluate existing drug administration codes for physicians' services to ensure accurate reporting and billing for such services, taking into account levels of complexity of the administration and resource consumption. The statute further specifies that the Secretary will use existing processes for the consideration of coding changes and, to the extent changes are made, will use the processes to establish relative values for these services. The Secretary is also required to consult with physician specialties affected by the provisions that change Medicare payments for drugs.

We expect to review this issue in the context of all the payment changes being made by the statute to Medicare payment for drug administration in order to assure accurate reporting and billing for such services taking into account levels of complexity of the administration and resource consumption. The existing processes we plan to use include review by our Physician's Regulatory Issues Team (PRIT) and consultation with the AMA's CPT Editorial Committee and physician specialties affected by changes in payment for drugs and drug administration. The PRIT, an internal CMS group that is working to eliminate unnecessary regulations, is reviewing the issue of coding for drug administration services including section 15400 of the Medicare Carriers Manual (MCM) that currently governs Medicare policy with respect to use of CPT codes in the 96400 through 96549 series for chemotherapy administration.

7. Treatment of Other Services Currently in the Nonphysician Work Pool

The nonphysician work pool is a special interim methodology that we use to determine practice expense RVUs for many services that do not have physician work RVUs. The drug administration codes listed above are currently valued using the nonphysician work pool methodology. Because we are now assigning work RVUs to these drug administration codes, they will no longer be included in the nonphysician work pool. Practice expense RVUs for these services will be computed using the standard practice expense methodology that applies to all other physicians' services.

Section 303(a)(2) of MPDIMA requires the Secretary to make adjustments to the nonphysician work pool methodology for the determination of practice expense RVUs under the physician fee schedule so that the practice expense RVUs for services determined under such methodology are not affected relative to the practice expense RVUs of services not determined under such methodology as a result of the amendments made by section 303(a)(2) of MPDIMA. If we made no other changes, removing drug administration codes from the nonphysician work pool would result in a reduction to the practice expense RVUs for services remaining in the nonphysician work pool. Consistent with section 303(a)(1) of MPDIMA, we are making two changes to the nonphysician work pool methodology so that the practice expense RVUs for nonphysician work pool services are not affected relative to other services.

First, we are changing the practice expense per hour assigned to the nonphysician work pool. In place of the “all physician” average, we are using a weighted average practice expense per hour of the specialties that perform the services affected by its calculations. Specifically, we will use the following revised data in the practice expense methodology for services remaining in the nonphysician work pool:

Table 3

SpecialtyClin StaffAdmin. StaffOffice ExpenseMed. SuppliesMed. EquipOtherTotal
Nonphysician Work pool15.817.421.57.94.915.082.6

Second, we are adjusting the clinical staff times used in the creation of the pool. By definition, nonphysician work pool services do not involve the physician and have no physician time. To create the nonphysician work pool, we have used clinical staff time per procedure in the computation. We will now use the total staff time rather than the previously utilized maximum staff time for developing the 2004 physician fee schedule. Consistent with section 303(a)(2) of MPDIMA, the change to the practice expense per hour and staff time will result in no reduction to the practice expense RVUs for the services remaining in the nonphysician work pool once drug administration services are removed. By using the maximum staff time, we are assuming that clinical staff are working concurrently. However, it is possible that clinical staff are working sequentially and it would be appropriate to use the total staff time for each service. We are proposing to use the total staff in place of the maximum staff for developing the 2004 physician fee schedule since each are equally likely to address staff time arrangements for non-physician work pool services and the latter approach will assist in meeting the statutory directive that payment for non-physician work pool services not be affected by the changes we are making to drug administration services.

8. Payment for Multiple Chemotherapy Agents Furnished on a Single Day Through the Push Technique

Section 303(a)(3) of MPDIMA requires the Secretary to review the policy as in effect October 1, 2003, for section 1848 of the Act for the administration of more than one drug or biological to an individual on a single day through the push technique. Subsequent to that review, the Secretary will modify the Start Printed Page 1095payment policy as determined to be appropriate. Section 303(a)(3)(C) of MPDIMA indicates that any change in policy resulting from this review will be treated as additional expenditures attributable to section 1848(c)(2)(H). (This section relates to the additional expenditures that result from use of survey data that includes expenses for drug administration and clinical oncology nurses and requires that we establish work RVUs equal to a level 1 office visit for drug administration services. Currently, a level 1 office has 0.17 work RVUs)

In the November 25, 1991, Federal Register (56 FR 59541), we specified that Medicare will allow CPT code 96408 (Chemotherapy administration, intravenous; push technique) to be reported only once per day even if the physician administers multiple drugs and this policy is contained in Section 15400 of MCM. In the August 20, 2003, proposed rule (68 FR 50439) concerning payment reform for part B drugs under Medicare, we had proposed revising this policy to allow for CPT code 96408 to be reported once per day for each drug administered. This revision was supported by commenters.

Upon review of this issue and in acknowledgement that there are additional resources involved in administering each subsequent drug which should be considered in a resource-based payment system, we are changing our policy and will allow for CPT code 96408 to be reported once per day for each drug administered. The effective date for this change is for services furnished on or after January 1, 2004. We will modify section 15400 of the manual consistent with this change. In addition, as previously mentioned, the PRIT will be reviewing the issue of use of the chemotherapy administration codes in the 96400 CPT code series and Medicare's manual provisions on their use.

9. Transitional Adjustment to Medicare Payment for Certain Drug Administration Services

Section 303(a)(4) of MPDIMA provides for a transitional adjustment to Medicare payment for drug administration services to reflect implementation of the amendments made by section 303 of MPDIMA affecting Medicare's payments for drugs. Specifically, section 303(a)(4) of MPDIMA requires Medicare to increase the physician fee schedule amounts otherwise determined by 32 percent for 2004 and 3 percent for 2005. Thus, we will determine the payment for CPT codes 90780 through 90781, 90782 through 90788, 96400, 96408 through 96425, 96520, and 96530 based on the work, practice expense and malpractice RVUs shown in Addendum B and the 2004 CF of $37.3374. Consistent with section 303(a)(4) of MPDIMA, we will increase the physician fee schedule amount by an additional 32 percent for 2004. (The physician fee schedule amounts applicable in 2005 will be increased by 3 percent.)

C. Geographic Practice Cost Indices (GPCIs)

The Act requires that payments vary among physician fee schedule areas according to the extent that resource costs vary as measured by the Geographic Practice Cost Indices (GPCIs) for each of the three fee schedule components: work, practice expense, and malpractice.

Section 412 of MPDIMA amended section 1848(e)(1) of the Act and establishes a floor of 1.0 for the work geographic index for any locality to be used for purposes of payment for services furnished on or after January 1, 2004, and before January 1, 2007. In addition, section 602 of MPDIMA further amended section 1848(e)(1) of the Act for purposes of payment for services furnished in Alaska under the physician fee schedule on or after January 1, 2004, and before January 1, 2006, and sets the practice expense, malpractice and work indices at 1.67 if the index would otherwise be less than 1.67.

Based on these changes to the Act, we are revising the addenda published in the November 7, 2003, final rule concerning the transitional 2004 and full 2005 GPCIs (Addendum D and Addendum E, respectively). No locality will have a work GPCI of less than 1.00 and the work, practice expense and malpractice GPCIs for Alaska are set at 1.67. Addendum D in the November 7, 2003, final rule listed 58 localities having work GPCIs of less than 1.00. Of these, the range was from 0.881 for Puerto Rico to 0.998 for “Rest of New York” and New Orleans, Louisiana. Addendum D and E that are included in this final rule will replace the addenda previously published November 7, 2003.

D. Adjustments to the Work, Practice Expense and Malpractice Relative Value Units

In the August 15, 2003, proposed rule (68 FR 49058), we proposed to adjust the work, practice expense and malpractice RVUs to match the rebased MEI weights. In the November 7, 2003, final rule (68 FR 63245), we responded to public comments and applied adjustments of −0.57 percent (0.9943) to the physician work RVUs, −0.77 percent (0.9923) to the practice expense RVUs and 19.86 percent (1.1986) to the malpractice RVUs. These adjustments were intended to make the aggregate work, practice expense and malpractice RVUs used to determine payments in 2004 consistent with their respective weights in the rebased MEI.

However, the changes required by MPDIMA change the 2004 work, practice expense and malpractice RVUs. Provisions that require changes to the work and practice expense RVUs and exempt them from budget neutrality will increase the number of work and practice expense RVUs.

As we indicated in the November 7, 2003, final rule, we believe Medicare payment policy will be improved by adjusting the work, practice expense and malpractice RVUs to match the revised MEI weights. By matching the aggregate pools of RVUs to the rebased MEI weights, Medicare's payments for physician work, practice expense and malpractice will more closely match the proportion of expenses incurred by physicians in these categories. Therefore, we are revising the adjustments applied to the RVUs in the November 7, 2003, final rule consistent with our goal of making the work, practice expense and malpractice RVUs match the rebased MEI weights. The revised adjustments are −0.15 percent (0.9985) for physician work, −1.320 percent (0.9868) for practice expense, and 20.61 percent (1.2061) for malpractice. We have incorporated these adjustments into the RVUs shown in Addenda B and C of this final rule.

E. Anesthesia and Physician Fee Schedule Conversion Factors for 2004

The physician fee schedule update is determined under a methodology specified by statute. In the November 7, 2003, final rule (68 FR 63251), we used the formula specified in section 1848(d)(4) of the Act to determine a 4.5 percent reduction to the physician fee schedule CF. However, section 601 of MPDIMA amended section 1848(d) of the Act to specify that the update to the single CF for 2004 and 2005 will not be less than 1.5 percent. Because the statutory formula will yield a 4.5 percent reduction to the physician fee schedule CF and the amendments to the statute indicate that the update for 2004 cannot be less than 1.5 percent, we will increase the physician fee schedule CF by 1.5 percent for 2004.

The specific calculations to determine the physician fee schedule and anesthesia CFs for 2004 are explained below. Start Printed Page 1096

• Physician Fee Schedule Conversion Factor

Under section 1848(d)(1)(A) of the Act, the physician fee schedule CF is equal to the CF for the previous year multiplied by the update determined under section 1848(d)(4) of the Act.

We illustrate the calculation for the 2004 physician fee schedule CF in table 4:

Table 4

2003 Conversion Factor$36.7856
2004 Update1.5% (1.015)
2004 Conversion Factor$37.3374

• Anesthesia Fee Schedule Conversion Factor

As described in the November 7, 2003, final rule (68 FR 63252), anesthesia services do not have RVUs like other physician fee schedule services. For this reason, we are accounting for the adjustments to match the revised MEI weights and changes to anesthesia work and practice expenses through a 1.09 percent 1.0109 adjustment to the anesthesia fee schedule CF. The 1.09 percent increase reflects a 0.15 percent reduction on the work portion (79 percent), a 2.0 percent reduction on the practice expense portion (13.7 percent) and a 20.61 percent increase on the malpractice portion (7.2 percent) of the anesthesia conversion factor. (The adjustment to the practice expense portion is comprised of 1.3 percent for the MEI weights and 0.7 percent for the revisions in the practice expense methodology). To determine the anesthesia fee schedule CF for 2004, we used the following figures:

Table 5

2003 Conversion Factor$17.0522
Adjustments for Work and Practice Expense1.09% (1.0109)
2004 Update1.5% (1.0150)
2004 Conversion Factor$17.4969

F. Publication of Addenda

The addenda included in this final rule concerning RVUs and Related Information Used in Determining Medicare Payments for 2004 (Addenda A, B and C) and GPCIs by Medicare Carrier and Locality (Addenda D and E) replace the addenda published November 7, 2003 (68 FR 63261). The revised addenda reflect changes required by MPDIMA as well as corrections to minor errors contained in the addenda published November 7, 2003.

III. Private Contracting With Medicare Beneficiaries

Section 4507 of the Balanced Budget Act of 1997 added section 1802(b) to the Act. This section provides that physicians and certain nonphysician practitioners may opt out of Medicare and enter into private contracts with Medicare beneficiaries. Under these contracts, no limits apply to what physicians or nonphysician practitioners can charge beneficiaries. Physicians opting out of Medicare file an affidavit with the Medicare carrier in which they agree to opt out of Medicare for a period of 2 years and to meet certain other criteria. In general, the statute requires that during that two-year period, physicians and nonphysician practitioners who have filed affidavits opting out of Medicare have private contracts with all Medicare beneficiaries to whom they furnish Medicare covered services. These contracts may not be entered into at a time when a beneficiary needs emergency or urgent care services.

Moreover, the statute requires that the private contract be in writing and be signed by the Medicare beneficiary before any item or service is provided in accordance with the contract and that:

  • The beneficiary agrees not to submit a claim (or to request that the physician or practitioner submit a claim) with Medicare for Medicare covered services.
  • The beneficiary agrees to be responsible, whether through insurance or otherwise, for services furnished under a private contract.
  • The beneficiary acknowledges that no limits (including the limits under section 1848(g) of the Social Security Act) apply to amounts that are charged under the private contract.
  • The beneficiary acknowledges that no payment will be made under a Medigap plan, and other insurers may elect not to make payment for services furnished under the private contract.
  • The beneficiary acknowledges that Medicare may make payment for covered services if the service was received from a physician or non-physician practitioner with whom the beneficiary has not signed a private contract.

Prior to enactment of MPDIMA, section 1802(b)(5)(B) of the Act limited the types of physicians who could choose to opt out of Medicare to doctors of medicine and doctors of osteopathy. Section 603 of MPDIMA amends section 1802(b)(5)(B) of the Act to include dentists, podiatrists, and optometrists, in certain circumstances, in the definition of physicians who may opt out of Medicare. We are making conforming changes to our regulations to reflect this change in the statute.

IV. Waiver of Proposed Rulemaking and Delay in Effective Date

We ordinarily publish a notice of proposed rulemaking in the Federal Register and invite public comment on a proposed rule. The notice of proposed rulemaking includes a reference to the legal authority under which the rule is proposed, and the terms and substance of the proposed rule or a description of the subjects and issues involved. This procedure can be waived, however, if an agency finds good cause that notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest and incorporates a statement of the finding and its reasons in the rule issued. In addition, the Administrative Procedure Act (APA) normally requires a 30-day delay in the effective date of a final rule. Furthermore, the Congressional Review Act (CRA) generally requires an agency to delay the effective date of a major rule by 60-days in order to allow for congressional review of the agency action.

Section 1871 of the Act provides for publication of a notice of proposed rulemaking and opportunity for public comment before CMS issues a final rule. However, section 1871(b)(2)(B) provides an exception when a law establishes a specific deadline for implementation of a provision and the deadline is less than 150 days after the law's date of enactment. MPDIMA was enacted by Congress on November 25, 2003, and signed into law by the President on December 8, 2003. The provisions of this rule that amend the physician fee schedule and drug payment rate are required to be implemented January 1, 2004. Therefore, these provisions are subject to waiver of proposed rulemaking and public comment in accordance with section 1871(b)(2)(B) of the Act.

Even if section 1871(b)(2)(B) of the Act were not directly applicable here, we would find good cause to waive the requirement for publication of an notice of proposed rulemaking and public comment on the grounds that it is impracticable, unnecessary, and contrary to the public interest. This final rule, with the exception of implementation of billing for a level 1 office visit and pharmacy supplying fee and the technical correction of minor errors in the November rule, merely sets out the non-discretionary provisions of MPDIMA with respect to payment under the physician fee schedule and drug AWP methodology. Because the rule is generally ministerial, we believe that pursuing notice and comment is Start Printed Page 1097unnecessary. Moreover, because such process would prevent congressionally-mandated revisions, updates, and increases in payment under the physician fee schedule for 2004, we find that pursuing such process would be both impracticable and contrary to the public interest.

For these same reasons, we are waiving the 30-day delay in effective date contained in 5 U.S.C. section 553(d).

With respect to the requirement of a 60-day delay in the effective date of any final rule pursuant to the CRA, see 5 U.S.C. section 801, the CRA provides that the 60-day delayed effective date shall not apply to any rule “which an agency for good cause finds . . . that notice and public procedure thereon are impracticable, unnecessary, or contrary to the public interest” (5 U.S.C. section 808(2)). For the reasons set forth above, we believe that additional notice-and-comment rulemaking on this subject would be impracticable, unnecessary, or contrary to the public interest. Therefore, we do not believe that the CRA requires a 60-day delay in the effective date of this final rule.

V. Response to Comments

Because of the large number of items of correspondence we normally receive on Federal Register documents published for comment, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the DATES section of this preamble, and, if we proceed with a subsequent document, we will respond to the major comments in the preamble to that document.

VI. Collection of Information Requirements

Under the Paperwork Reduction Act (PRA) of 1995, we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the PRA of 1995 requires that we solicit comment on the following issues:

The need for the information collection and its usefulness in carrying out the proper functions of our agency.

  • The accuracy of our estimate of the information collection burden.
  • The quality, utility, and clarity of the information to be collected.
  • Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.

Therefore, we are soliciting public comments on each of these issues for the information collection requirement discussed below.

The following information collection requirement and associated burden are subject to the PRA.

§ 414.707 Basis of payment

Under paragraph (a)(7) of this section, a manufacturer requesting a drug payment exception to the default 85 percent used in the general rule or the percentage specified in Table 1 will have to submit data and information including the manufacturer's average sales price for the drug. The burden associated with this requirement is the time involved in providing us the information for the submission due before January 1, 2004, and the optional supplemental submission due by January 16, 2004. We believe that it would take an average of one hour to submit the request and the necessary data and information. Given the universe of approximately 450 Medicare drug codes and assuming an average of 10 manufacturers per drug code, the maximum aggregate burden associated with this activity would be 4500 hours.

We are soliciting public comment on this requirement in conjunction with a request for emergency approval of this information collection so that manufacturers may submit their requests during the statutorily prescribed timeframe. These requirements were submitted to OMB for review and are approved by OMB under OMB control number 0938-0913.

If you comment on any of these information collection and record keeping requirements, please mail copies directly to the following: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Attn: Julie Brown, CMS-1372-FC, Room C5-16-03, 7500 Security Boulevard, Baltimore, MD 21244-1850; and Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn: Brenda Aguilar, CMS Desk Officer.

Comments submitted to OMB may also be emailed to the following address: email: baguilar@omb.eop.gov; or faxed to OMB at (202) 395-6974.

VII. Regulatory Impact Analysis

We have examined the impact of this rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132. Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis must be prepared for final rules with economically significant effects (that is, a final rule that would have an annual effect on the economy of $100 million or more in any 1 year, or would adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities). We estimate that the combined effect of the physician fee schedule update and GPCI provisions included in this final rule will increase Medicare spending by $1.0 billion in FY 2004. We have simulated the effect of both the drug payment and physician fee schedule changes that we are adopting in this final rule. We are making several changes to the physician fee schedule RVUs in this final rule. In general, section 1848(c)(2)(B)(ii)(II) of the Act requires that changes to RVUs cannot increase or decrease expenditures more than $20 million from the amount of expenditures that would have resulted with such adjustments. However, section 303(a)(1) of the MPDIMA specifically exempts the changes we are making to the RVUs in this final rule from the budget neutrality requirements of section 1848(c)(2)(B)(ii)(II) of the Act. Thus, the changes that we are making to the physician fee schedule RVUs will increase aggregate spending for Medicare physician fee schedule services. Because the changes in this final rule will increase Medicare spending by more than $1.0 billion in FY 2004, we are considering this final rule to be economically significant. Therefore, this final rule is a major rule and we have prepared a regulatory impact analysis. The table 6 below shows our estimates of the fiscal year 2004 impact of specific MPDIMA provisions we are implementing in this final rule (rounded to the nearest $0.1 billion). Start Printed Page 1098

Table 6

SectionDescriptionFY 2004 impact ($ in billions)
303Competitive Acquisition of Covered Outpatient Drugs$0.0
304Application to Certain Specialties−0.1
305Payment for Inhalation Drugs−0.1
412Work GPCI Floor for Physicians0.2
601Update Revisions0.8
602Services in Alaska0.0

The RFA requires that we analyze regulatory options for small businesses and other entities. We prepare a Regulatory Flexibility Analysis unless we certify that a rule would not have a significant economic impact on a substantial number of small entities. The analysis must include a justification concerning the reason action is being taken, the kinds and number of small entities the rule affects, and an explanation of any meaningful options that achieve the objectives and less significant adverse economic impact on the small entities.

Section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any proposed rule that may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside a Metropolitan Statistical Area and has fewer than 100 beds.

For purposes of the RFA, physicians, non-physician practitioners, and suppliers are considered small businesses if they generate revenues of $6 million or less. Approximately 95 percent of physicians (except mental health specialists) are considered to be small entities. There are about 875,000 physicians, other practitioners and medical suppliers that receive Medicare payment under the physician fee schedule. There are in excess of 20,000 physicians and other practitioners that receive Medicare payment for drugs. These physicians are concentrated in the specialties of oncology, urology and rheumatology. Of the physicians in these specialties, approximately 40 percent are in oncology and 45 percent in urology.

For purposes of the RFA, approximately 98 percent of suppliers of DME and prosthetic devices are considered small businesses according to the Small Business Administration's (SBA) size standards. We estimate that 106,000 entities bill Medicare for DME, prosthetics, orthotics, surgical dressings, and other equipment and supplies each year. Total Medicare expenditures for DME are approximately $7.7 billion per year, of which approximately $1.4 billion are for DME drugs.

The analysis and discussion provided in this section as well as elsewhere in this final rule complies with the RFA requirements. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditure in any 1 year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. This final rule would not impose unfunded mandates on State, local, or tribal governments, or on the private sector of more than $110 million.

We have examined this final rule in accordance with Executive Order 13132 and have determined that this regulation would not have any significant impact on the rights, roles, or responsibilities of State, local, or tribal governments.

We have prepared the following analysis, which together with the rest of this preamble meets all assessment requirements. It explains the rationale for, and purposes of, the rule, details the costs and benefits of the rule, analyzes alternatives, and presents the measures we propose to use to minimize the burden on small entities. This final rule changes Medicare payment rates for drugs and their administration as well as other physician fee schedule services. We are providing information for each of the policy changes in the relevant sections of this final rule. We are unaware of any relevant Federal rules that duplicate, overlap or conflict with this final rule. The relevant sections of this final rule contain a description of significant alternatives if applicable.

A. Application of Market-Based Systems of Medicare Payment for Part B Drugs

As described in more detail earlier in this final rule, effective January 1, 2004, with some exceptions, section 303(b) of MPDIMA specifies that drugs not paid on a cost or prospective payment basis will be paid at 85 percent of the average wholesale price determined as of April 1, 2003. Section 303(a) directs the Secretary to make changes to the physician fee schedule that will increase Medicare spending for physicians' services. Section 303 applies only to oncology payments while section 304 indicates that identical provisions to those in section 303 apply to other physicians. We have estimated that section 303 of MPDIMA would have no cost in FY 2004 and that section 304 would save $0.1 billion in FY 2004.

B. Payment for Inhalation Drugs

Section 305(a) of MPDIMA specifies that inhalation drugs furnished through durable medical equipment covered under 1861(n) of the Act will be paid at 80 percent of the average wholesale price determined as of April 1, 2003. We estimated savings associated with implementing section 305(a) of the MPDIMA is $0.1 billion in FY 2004.

C. Pharmacy Supplying Fee for Certain Drugs and Biologicals

Section 303(e)(2) provides for payment of a pharmacy supplying fee, less applicable deductible and coinsurance, for immunosuppressive drugs described in subparagraph (J) of section 1861(s)(2) and oral anti-cancer and anti-nausea drugs described in subparagraphs (Q) and (T) of such section. The payment of this fee is bundled into the current payment for these drugs and the 2004 payment amounts specified in section 303(b). This provision has no impact on Medicare expenditures in 2004.

D. Physician Fee Schedule Provisions Related to the Administration of Drugs

As indicated above, we are making changes to the work and practice expense RVUs under the provisions of section 1848(c)(2) of the Act as amended by section 303 of MPDIMA. In general, under section 1848(c)(2) of the Act, adjustments to RVUs may not cause the amount of expenditures to differ by more than $20 million from the amount of expenditures that would have Start Printed Page 1099resulted without such adjustments. However, section 303(a)(1) of the MPDIMA specifically exempts the changes we are making to the RVUs in this final rule from the budget neutrality requirements of section 1848(c)(2)(B)(ii)(II). As described above, consistent with section 303(a)(1), we are making several changes to the physician fee schedule work and practice expense RVUs.

Table 6A shows the specialty level impact on payment of changes being made for CY 2004. The payment impacts reflect averages for each specialty based on Medicare utilization. The payment impact for an individual physician would be different from the average, based on the mix of services the physician provides. The average change in total revenues would be less than the impact displayed here since physicians furnish services to both Medicare and non-Medicare patients and specialties may receive substantial Medicare revenues for services that are not paid under the physician fee schedule. For instance, oncologists receive approximately 20 percent of their Medicare revenues from physician fee schedule services and approximately 77 percent of their Medicare revenues from drugs. Table 6A shows only the payment impact on physician fee schedule services. Table 11 below shows the combined impact of the physician fee schedule and drug payment changes for selected specialties and suppliers that receive a high percentage of their Medicare revenues from drugs.

We modeled the impact of all changes to the relative value units and illustrated their effect in table 6A. The column labeled “Impact 11/7/2003 Final Rule Pre-MEI Weight Adjustments” shows the combined effect of all of the relative value unit changes contained in the August 15, 2003, proposed rule and the November 7, 2003, final rule other than the adjustments to make the aggregate work, practice expense and malpractice RVUs match the MEI weights. (For a description of the impact of the provisions of the August 15, 2003, proposed rule see 68 FR 49060-49065. For a description of the impact of additional impacts resulting from the November 7, 2003, final rule, see 68 FR 63252-63253). As described below, we have revised the MEI weight adjustments and will illustrate their impact once we show the effect of all other provisions that change RVUs.

The column labeled “Section 303 and 304 Changes without Transition Payments” shows the impact of changes made in this final rule implementing section 303 and 304 of MPDIMA other than section 303(a)(4) that requires a “transitional adjustment” that increases payments for specific drug administration services by an additional 32 percent in 2004. This column shows the effect of increases in payments for drug administration services resulting from the higher work and practice expense RVUs required by section 303 and 304 of MPDIMA as well allowing oncologists to bill for multiple drug administrations by the “push” technique on a single day. In addition, because there will be no same day billing of a level 1 office visit and a drug administration service, the impacts shown include the effect of fewer office visit billings by the minority of oncologists who billed for such services. Taken together, these provisions will increase payments to oncologists by an estimated 27 percent. We estimate that payments to other physicians that provide drug administration services (rheumatology, infectious disease, obstetrics/gynecology) will increase by 1 to 2 percent. The revision to the practice expense per hour for cardiac and thoracic surgeons will increase their payments by an estimated 1 percent. All of the other increases shown in the table are a result of changes that we are making to the non-physician work pool. These changes will increase payments to physicians, practitioners and suppliers (Allergy/Immunology, Radiation Oncology, Radiology, Audiology, Diagnostic Testing Facility and Portable X-Ray suppliers) that provide services affected by the non-physician work pool calculations by approximately 1 percent. There will be little or no change in payments for all other specialties from the changes we are making in this interim final rule because the changes to the RVUs resulting from MPDIMA are exempt from the budget neutrality requirements of section 1848(c)(2)(ii)(II) of the Act.

The column labeled “Transition Payments” shows the impact on payment from the 32 percent increase in payment for drug administration services required by section 303(a)(4) of MPDIMA. This provision will have an effect on only those specialties that provide drug administration services and is estimated to increase payments to oncologists by an additional 14 percent. We estimate that payments to other physicians that provide drug administration services (infectious disease, obstetrics/gynecology rheumatology and urology) will increase by 1 to 2 percent.

We also modeled the effect of adjusting the RVUs to match the new MEI weights. Because we are increasing the malpractice RVUs by more than 20 percent, adjusting the RVUs to match the new MEI weights will result in an increase in payment for those specialties that perform services with high malpractice RVUs. Payments to anesthesiology, cardiac surgery, emergency medicine, neurosurgery, orthopedic surgery, thoracic surgery and vascular surgery will increase by approximately 1 percent. There will be a small impact on payment to all other physicians, practitioners and suppliers from the adjustments that reduce physician work and practice expense RVUs to match the new MEI weights. The total change in payment from provisions of the November 7, 2003, final rule and this final rule are shown in the total column.

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In general, the statutory methodology for updating the physician fee schedule conversion factor is specified in section 1848(d)(4) of the Act. However, section 1848(d)(5) specifies that the update to the conversion factor for 2004 and 2005 shall not be less than 1.5 percent. Application of the statutory methodology of section 1848(d)(4) of the Act would reduce the physician fee schedule conversion factor by 4.5 percent. However, because section 1848(d)(5) of the Act indicates that the update can be no less than 1.5 percent, we are increasing the 2004 physician fee schedule conversion factor by 1.5 percent. In table 7, we are showing the estimated change in average payments by specialty based on provisions of this final rule and the estimated physician fee schedule update.

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In the November 7, 2003, final rule, we showed the impact of all RVUs changes and a 4.5 percent reduction in the physician fee schedule conversion factor. In the table below, we are showing the effect of MPDIMA on payment for physician fee schedule services relative to the changes that would have occurred in 2004 under current law had MPDIMA not been enacted. That is, because the physician fee schedule conversion factor would have been reduced by 4.5 percent to $35.1339 and MPDIMA requires that it be increased by 1.5 percent to $37.3374, MPDIMA provisions affecting the update increased average physician fee schedule rates by 6.3 percent ($37.3374/$35.339 − 1 = 1.063 or 6.3 percent). Furthermore, MPDIMA required changes to relative value units that also resulted in further average increases in Medicare payment for physician fee schedule services. The following table also includes the impact of the GPCI provision that does not allow a work GPCI to be less than 1.0 and another one that increases the Alaska GPCI to 1.67. However, the impact on any specific physician, practitioner or supplier will be different than the average depending upon on whether the individual is located in Alaska or an area that would have had a GPCI that is less than 1.0.

The column labeled “Impact 11/7/2003” final rule shows the impacts from table 27 of the November 7, 2003, final rule (68 FR 63256). The next column shows the impacts from table 7 and an estimate of the increase in payments due to the GPCI provisions. The percentage difference between these columns isolates the impact of the MPDIMA provisions we are adopting in this final rule and are shown in the last column.

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Table 9 shows the impact on payments for selected high volume procedures of all of the changes previously discussed. This table shows the combined impact of the change in the work, practice expense and malpractice RVUs and the estimated physician fee schedule update on total payment for the procedure. There are separate columns that show the change in the facility rates and the non-facility rates. For an explanation of facility and non-facility practice expense refer to § 414.22(b)(5)(i). The figures in tables 9 and 10 show the impact of the RVU changes and the physician fee schedule update but do not include the impact of the GPCI changes.

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The next table shows the change in payments from 2003 to 2004 for selected high volume drug administration services. This table shows the impact of the increases in the physician work and practice expense RVUs, the 1.5 percent increase in the physician fee schedule conversion factor and the additional 32 percent “transition adjustment” required by section 303(a)(4) of MPDIMA in 2004.

Table 11 shows the combined impact of changes we are making to Medicare drug and physician fee schedule payments on selected specialties/medical suppliers that receive a significant portion of their total Medicare revenues from drugs. These figures do not include the impact of the legislated increases in the GPCI. The table shows the amount and proportion of total Medicare revenues received from drugs and physician fee schedule services (DME fee schedule services for DME/Other Medical Suppliers). We note that these impacts and percentages represent averages for each specialty or supplier. The percentages and impacts for any individual physician or DME supplier are dependent on the mix of drugs and physician fee schedule services they provide to Medicare beneficiaries. These tables are intended to illustrate the combined payment impact in a single year across all of the services that these specialties or suppliers perform using the most recent data available to us. The first two columns of table 11 list the specialty and its combined Medicare revenues from all sources. The next three columns show estimated total Medicare drug revenues, the proportion of total revenues represented by drugs and the percent change in Medicare drug payments estimated in the first year. The revenue reduction shown includes the effect of limiting decreases in drug payments to 15 percent, the maximum reduction allowed in 2004 consistent with section 1842(o)(4)(D) of the Act (as added by section 303(b) of MPDIMA). The following three columns show analogous information for physician fee schedule services. The last column shows the combined percentage change across all Medicare revenues. For example, as indicated in the table, approximately 77 percent of total Medicare revenues for oncologists are attributed to drugs. As indicated in the next column, we estimate that Medicare revenues from drugs will decline by approximately 12 percent for oncologists as a result of policies adopted in this interim final rule or about $510 million. We are increasing oncology physician fee schedule payments by 47 percent in this interim final rule or about $510 million. We estimated that the one-year decrease in drug payments and increase in physician fee schedule payments resulting from this final rule will produce virtually no net change in total Medicare payments for oncologists.

For DME/Other Medical Suppliers, 42 and 58 percent of Medicare revenues respectively are received from drugs and DME fee schedule services. These suppliers will receive an approximate reduction of 13 percent in their Medicare drug revenues the first year. The total reduction in payment in one year across all of the services they provide will be approximately 6 percent.

In general, the other physician specialties receive a smaller share of their total Medicare revenues from drugs than oncologists. However, they are also less affected by the payment increases for drug administration services. Taken together, we estimate a net change in revenues from the drug and drug administration payment changes for urology (−4 percent), rheumatology (−2 percent), obstetrics/gynecology (+1 percent) and infectious disease (+4 percent).

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C. Geographic Practice Cost Indices (GPCIs) Changes

Section 412 of MPDIMA amended section 1848(e)(1) of the Act and establishes a floor of 1.0 for the work geographic index for any locality to be used for purposes of payment for services furnished on or after January 1, 2004, and before January 1, 2007. In addition, section 602 of MPDIMA further amended 1848 (e)(1) of the Act for purposes of payment for services furnished in Alaska under the physician fee schedule on or after January 1, 2004, and before January 1, 2006, and sets the practice expense, malpractice and work indices at 1.67 if such index would otherwise be less than 1.67. The impact of the MPDIMA provisions on the work GPCI is illustrated in Table 12.

An impact of these legislative changes to the GPCI can also be demonstrated by a comparison of area geographic adjustment factors (GAFs). The GAFs are a weighted composite of each area's work, practice expense, and malpractice expense GPCIs using the national GPCI cost share weights. While we do not actually use the GAFs in computing the fee schedule payment for a specific service, they are useful in comparing overall area costs and payments. The actual effect on payment for any specific service will deviate from the GAF to the extent that the service's proportions of work, practice expenses, and malpractice expense RVUs differ from those of the GAF. Table 13 shows the effects of the legislative revisions to the GPCIs on area GAFs for 2004. As directed by the legislation no locality will have a work GPCI of less than 1.00 and the work, practice expense and malpractice GPCIs for Alaska are set at 1.67. Tables 12 and 13 are sorted by decreasing percent change in work GPCI and GAF respectively.

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We estimate the cost of the provisions affecting the GPCI will increase Medicare spending by 0.2 billion in FY 2004.

E. Alternatives Considered

For the most part, this interim final implements prescriptive provisions of MPDIMA and the statute does not permit us to exercise our discretion. Nevertheless, the preamble identifies ancillary policies and rationale for our decisions.

For instance, the statutory provisions requiring changes to Medicare's payments for drugs were prescriptive. We did not consider any alternatives because of the clear direction in the statute to determine Medicare prices for drugs in 2004. Similarly, the provisions of the statute with respect to the GPCI were also prescriptive and did not allow for us to consider any alternatives. While we considered using the formula contained in section 1848(d)(4) of the Act to update the physician fee schedule conversion factor, its application would result in a reduction of 4.5 percent and would be inconsistent with the MPDIMA provision requiring an update to the physician fee schedule conversion factor for 2004 of not less than 1.5 percent. With respect to the provisions of this final rule that require changes to Medicare payments for the administration of drugs, we generally did not find that the statute permitted discretion. Nevertheless, earlier in the preamble of this final rule, we provided detailed descriptions of the statutory provisions and its requirements and, where possible, of the alternatives we considered.

F. Impact on Beneficiaries

Although changes in physicians' payments were large when the physician fee schedule was implemented in 1992, we detected no problems with beneficiary access to care. We do not believe that there would be any problem with access to care as a result of the changes in this rule. For the most part, we are increasing payments for physicians fee schedule services that otherwise would be reduced. We don't believe the drug payment changes will have an impact on beneficiary access to services but we will continue to monitor this issue.

We estimate that beneficiary liability will increase in CY 2004 by $1.0 billion for the physician fee schedule provisions relative to current law. Payment changes we are making in this final rule for drug administration will increase beneficiary liability. However, we estimate that the provisions that change Medicare's drug payments to oncologists (section 303 of MPDIMA), other physicians (section 304 of MPDIMA) and inhalation drugs (section 305 of MPDIMA) will offset the additional beneficiary liability for drug administration. We estimate that the net effect of changes to payment for drugs and drug administration will result in savings to beneficiaries of approximately $100 million in CY 2004.

In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.

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List of Subjects

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(Catalog of Federal Domestic Assistance Program No. 93.774, Medicare—Supplementary Medical Insurance Program.)

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Dated: December 15, 2003.

Thomas A Scully,

Administrator, Centers for Medicare & Medicaid Services.

Approved: December 24, 2003.

Tommy G. Thompson,

Secretary.

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For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV as follows:

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PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

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1. The authority citation for part 405 continues to read as follows:

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Authority: Secs. 1102, 1802, and 1871 of the Social Security Act (42 U.S.C. 1302, 1395a, and 1395hh).

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2. Section 405.400 is amended by revising the definition of “physician” to read as follows:

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Definitions.
* * * * *

Physician means a doctor of medicine; doctor of osteopathy; doctor of dental surgery or of dental medicine; doctor of podiatric medicine; or doctor of optometry who is legally authorized to practice medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, or optometry by the State in which he performs such function and who is acting within the scope of his license when he performs such functions.

* * * * *
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3. Section 405.517 is amended by—

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A. Redesignating the text of paragraph (a) as paragraph (a)(1) and adding a heading;

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B. Adding a new paragraph (a)(2).

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Payment for drugs and biologicals that are not paid on a cost or prospective payment basis.

(a) Applicability. (1) Payment for drugs and biologicals before January 1, 2004. * * *

(2) Payment for drugs and biologicals on or after January 1, 2004. Effective January 1, 2004, payment for drugs and biologicals that are not paid on a cost or prospective payment basis are paid in accordance with Part 414, subpart I of this chapter.

* * * * *
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PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

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4. The authority citation for part 414 continues to read as follows:

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Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).

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5. The list in § 414.1 is amended by adding a new entry in numerical order as follows:

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Basis and scope.
* * * * *

1842(o)—Rules for payment of certain drugs and biologicals.

* * * * *
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6. A new subpart I is added to read as follows:

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Subpart I—Payment for Drugs and Biologicals
414.701
Purpose.
414.704
Definitions.
414.707
Basis of payment.
Purpose.

This subpart implements section 1842(o) of the Social Security Act by specifying the methodology for determining the payment allowance limit for drugs and biologicals covered under Part B of Title XVIII of the Act (hereafter in this subpart referred to as the “program”) that are not paid on a cost or prospective payment system basis. Examples of drugs that are subject to the rules contained in this subpart are: drugs furnished incident to a physician's service; durable medical equipment (DME) drugs; separately billable drugs at independent dialysis facilities not under the ESRD composite rate; statutorily covered drugs, for example, influenza, pneumococcal and hepatitis vaccines, antigens, hemophilia blood clotting factor, immunosuppressive drugs and certain oral anti-cancer drugs.

Definitions.

As used in this subpart, the following definition applies. Drug refers to both drugs and biologicals.

Basis of payment.

(a) Method of payment. (1) Payment for a drug in calendar year 2004 is based on the lesser of—

(i) The actual charge on the claim for program benefits; or

(ii) 85 percent of the average wholesale price determined as of April 1, 2003, subject to the exceptions as specified in paragraphs (a)(2) through (a)(8) of this section.

(2) The payment limits for the following drugs are calculated using 95 percent of the average wholesale price:

(i) Blood clotting factors.

(ii) A drug or biological furnished during 2004 that was not available for Medicare payment as of April 1, 2003.

(iii) Pneumococcal and influenza vaccines as well as hepatitis B vaccine that is furnished to individuals at high or intermediate risk of contracting hepatitis B (as determined by the Secretary).

(iv) A drug or biological furnished during 2004 in connection with the furnishing of renal dialysis services if separately billed by renal dialysis facilities.

(3) The payment limits for infusion drugs furnished through a covered item of durable medical equipment are calculated using 95 percent of the average wholesale price in effect on October 1, 2003.

(4) The payments limits for drugs contained in the following table are calculated based on the percentages of the average wholesale price determined as of April 1, 2003 that are specified in the table.

DrugPercentage used to calculate 2004 payment limit
EPOETIN ALFA87
LEUPROLIDE ACETATE81
GOSERELIN ACETATE80
RITUXIMAB81
PACLITAXEL81
DOCETAXEL80
CARBOPLATIN81
IRINOTECAN80
GEMCITABINE HCL80
PAMIDRONATE DISODIUM85
DOLASETRON MESYLATE80
FILGRASTIM81
HYLAN G-F 2082
MYCOPHENOLATE MOFETIL86
GRANISETRON HCL80
ONDANSETRON87
VINORELBINE TARTATE81
SARGRAMOSTIM80
TOPOTECAN84
IPRATROPIUM BROMIDE80
ALBUTEROL SULFATE80
IMMUNE GLOBULIN80
LEUCOVORIN CALCIUM80
DOXORUBICIN HCL80
DEXAMETHOSONE SODIUM PHOSPHATE86
HEPARIN SODIUM LOCK-FLUSH80
CROMOLYN SODIUM80
ACETYLCYSTEINE80

(5) The payment limits for imiglucerase and alglucerase are calculated using 94 percent of the average wholesale price determined as of April 1, 2003.

(6) Exception. The payment limit for a drug otherwise subject to paragraph (a)(1)(ii) or paragraph (a)(4) of this section may be calculated using the percentage of the average wholesale price as the Secretary deems appropriate based on data and information submitted by the drug manufacturer.

(i) The manufacturer must submit data after October 15, 2003 and before January 1, 2004.

(ii) The percentage only applies for drugs furnished on or after April 1, 2004.

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(7) In the case of blood and blood products (other than blood clotting factors), the payment limits shall be determined in the same manner as such payment limit was determined on October 1, 2003.

(b) Mandatory assignment. Effective with services furnished on or after February 1, 2001, payment for any drug covered under Part B of Medicare may be made on an assignment-related basis only. All billers must accept the program allowed charge as payment in full and may not bill nor collect from the beneficiary any amount other than the unmet Part B deductible and Part B coinsurance amounts, if applicable. Violations of this requirement may subject the supplier to sanctions, as provided by the statute (See § 402 of this chapter).

Note:

These addenda will not appear in the Code of Federal Regulations.

Addendum A—Explanation and Use of Addenda B

The addenda on the following pages provide various data pertaining to the Medicare fee schedule for physicians' services furnished in 2004. Addendum B contains the RVUs for work, non-facility practice expense, facility practice expense, and malpractice expense, and other information for all services included in the physician fee schedule.

In previous years, we have listed many services in Addendum B that are not paid under the physician fee schedule. To avoid publishing as many pages of codes for these services, we are not including clinical laboratory codes and most alpha-numeric codes (Healthcare Common Procedure Coding System (HCPCS) codes not included in CPT) in Addendum B.

Addendum B—2004 Relative Value Units and Related Information Used in Determining Medicare Payments for 2004

This addendum contains the following information for each CPT code and alphanumeric HCPCS code, except for alphanumeric codes beginning with B (enteral and parenteral therapy), E (durable medical equipment), K (temporary codes for nonphysicians' services or items), or L (orthotics), and codes for anesthesiology.

1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number for the service. Alphanumeric HCPCS codes are included at the end of this addendum.

2. Modifier. A modifier is shown if there is a technical component (modifier TC) and a professional component (PC) (modifier −26) for the service. If there is a PC and a TC for the service, Addendum B contains three entries for the code: One for the global values (both professional and technical); one for modifier −26 (PC); and one for modifier TC. The global service is not designated by a modifier, and physicians must bill using the code without a modifier if the physician furnishes both the PC and the TC of the service.

Modifier −53 is shown for a discontinued procedure. There will be RVUs for the code (CPT code 45378) with this modifier.

3. Status indicator. This indicator shows whether the CPT/HCPCS code is in the physician fee schedule and whether it is separately payable if the service is covered.

A = Active code. These codes are separately payable under the fee schedule if covered. There will be RVUs for codes with this status. The presence of an “A” indicator does not mean that Medicare has made a national decision regarding the coverage of the service. Carriers remain responsible for coverage decisions in the absence of a national Medicare policy.

B = Bundled code. Payment for covered services is always bundled into payment for other services not specified. If RVUs are shown, they are not used for Medicare payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient.)

C = Carrier-priced code. Carriers will establish RVUs and payment amounts for these services, generally on a case-by-case basis following review of documentation, such as an operative report.

D = Deleted code. These codes are deleted effective with the beginning of the calendar year.

E = Excluded from physician fee schedule by regulation. These codes are for items or services that we chose to exclude from the physician fee schedule payment by regulation. No RVUs are shown, and no payment may be made under the physician fee schedule for these codes. Payment for them, if they are covered, continues under reasonable charge or other payment procedures.

F = Deleted/discontinued codes. Code not subject to a 90-day grace period.

G = Code not valid for Medicare purposes. Medicare does not recognize codes assigned this status. Medicare uses another code for reporting of, and payment for, these services.

H = Deleted modifier. Either the TC or PC component shown for the code has been deleted, and the deleted component is shown in the data base with the H status indicator. (Code subject to a 90-day grace period.)

I = Not valid for Medicare purposes. Medicare uses another code for the reporting of, and the payment for these services. (Code NOT subject to a 90-day grace period.)

N = Noncovered service. These codes are noncovered services. Medicare payment may not be made for these codes. If RVUs are shown, they are not used for Medicare payment.

P = Bundled or excluded code. There are no RVUs for these services. No separate payment should be made for them under the physician fee schedule.

  • If the item or service is covered as incident to a physician's service and is furnished on the same day as a physician's service, payment for it is bundled into the payment for the physician's service to which it is incident (an example is an elastic bandage furnished by a physician incident to a physician's service).
  • If the item or service is covered as other than incident to a physician's service, it is excluded from the physician fee schedule (for example, colostomy supplies) and is paid under the other payment provisions of the Act.

R = Restricted coverage. Special coverage instructions apply. If the service is covered and no RVUs are shown, it is carrier-priced.

T = Injections. There are RVUs for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the service(s) for which payment is made.

X = Exclusion by law. These codes represent an item or service that is not within the definition of “physicians' services” for physician fee schedule payment purposes. No RVUs are shown for these codes, and no payment may be made under the physician fee schedule. (Examples are ambulance services and clinical diagnostic laboratory services.)

4. Description of code. This is an abbreviated version of the narrative description of the code.

5. Physician work RVUs. These are the RVUs for the physician work for this service in 2003. Codes that are not used for Medicare payment are identified with a “+.”

6. Non-facility practice expense RVUs. These are the fully implemented resource-based practice expense RVUs for non-facility settings.

7. Facility practice expense RVUs. These are the fully implemented resource-based practice expense RVUs for facility settings.

8. Malpractice expense RVUs. These are the RVUs for the malpractice expense for the service for 2004.

9. Non-facility total. This is the sum of the work, fully implemented non-facility practice expense, and malpractice expense RVUs.

10. Facility total. This is the sum of the work, fully implemented facility practice expense, and malpractice expense RVUs.

11. Global period. This indicator shows the number of days in the global period for the code (0, 10, or 90 days). An explanation of the alpha codes follows:

MMM = The code describes a service furnished in uncomplicated maternity cases including antepartum care, delivery, and postpartum care. The usual global surgical concept does not apply. See the 1999 Physicians' Current Procedural Terminology for specific definitions.

XXX = The global concept does not apply.

YYY = The global period is to be set by the carrier (for example, unlisted surgery codes).

ZZZ = Code related to another service that is always included in the global period of the other service. (Note: Physician work and practice expense are associated with intra service time and in some instances the post service time.)

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Addendum B.—Relative Value Units (RVUS) and Related Information

CPT1 HCPCS2MODStatusDescriptionPhysician work RVUs3Non- facility PE RVUsFacility PE RVUsMal- practice RVUsNon- facility totalFacility totalGlobal
0001FIBlood pressure, measured0.000.000.000.000.000.00XXX
0001TCEndovas repr abdo ao aneurys0.000.000.000.000.000.00XXX
0002FITobacco use, smoking, assess0.000.000.000.000.000.00XXX
0002TDendo repair abd aa aorto uni0.000.000.000.000.000.00XXX
0003FITobacco use, non-smoking0.000.000.000.000.000.00XXX
0003TCCervicography0.000.000.000.000.000.00XXX
0004FITobacco use txmnt counseling0.000.000.000.000.000.00XXX
0005FITobacco use txmnt, pharmacol0.000.000.000.000.000.00XXX
0005TCPerc cath stent/brain cv art0.000.000.000.000.000.00XXX
0006FIStatin therapy, prescribed0.000.000.000.000.000.00XXX
0006TCPerc cath stent/brain cv art0.000.000.000.000.000.00XXX
0007FIBeta-blocker thx prescribed0.000.000.000.000.000.00XXX
0007TCPerc cath stent/brain cv art0.000.000.000.000.000.00XXX
0008FIAce inhibitor thx prescribed0.000.000.000.000.000.00XXX
0008TCUpper gi endoscopy w/suture0.000.000.000.000.000.00XXX
0009FIAssess anginal symptom/level0.000.000.000.000.000.00XXX
0009TCEndometrial cryoablation0.000.000.000.000.000.00XXX
0010FIAssess anginal symptom/level0.000.000.000.000.000.00XXX
0010TCTb test, gamma interferon0.000.000.000.000.000.00XXX
0011FIOral antiplat thx prescribed0.000.000.000.000.000.00XXX
0012TCOsteochondral knee autograft0.000.000.000.000.000.00XXX
0013TCOsteochondral knee allograft0.000.000.000.000.000.00XXX
0014TCMeniscal transplant, knee0.000.000.000.000.000.00XXX
0016TCThermotx choroid vasc lesion0.000.000.000.000.000.00XXX
0017TCPhotocoagulat macular drusen0.000.000.000.000.000.00XXX
0018TCTranscranial magnetic stimul0.000.000.000.000.000.00XXX
0019TIExtracorp shock wave tx, ms0.000.000.000.000.000.00XXX
0020TCExtracorp shock wave tx, ft0.000.000.000.000.000.00XXX
0021TCFetal oximetry, trnsvag/cerv0.000.000.000.000.000.00XXX
0023TCPhenotype drug test, hiv 10.000.000.000.000.000.00XXX
0024TCTranscath cardiac reduction0.000.000.000.000.000.00XXX
0025TDUltrasonic pachymetry0.000.000.000.000.000.00XXX
0026TCMeasure remnant lipoproteins0.000.000.000.000.000.00XXX
0027TCEndoscopic epidural lysis0.000.000.000.000.000.00XXX
0028TCDexa body composition study0.000.000.000.000.000.00XXX
0029TCMagnetic tx for incontinence0.000.000.000.000.000.00XXX
0030TCAntiprothrombin antibody0.000.000.000.000.000.00XXX
0031TCSpeculoscopy0.000.000.000.000.000.00XXX
0032TCSpeculoscopy w/direct sample0.000.000.000.000.000.00XXX
0033TCEndovasc taa repr incl subcl0.000.000.000.000.000.00XXX
0034TCEndovasc taa repr w/o subcl0.000.000.000.000.000.00XXX
0035TCInsert endovasc prosth, taa0.000.000.000.000.000.00XXX
0036TCEndovasc prosth, taa, add-on0.000.000.000.000.000.00XXX
0037TCArtery transpose/endovas taa0.000.000.000.000.000.00XXX
0038TCRad endovasc taa rpr w/cover0.000.000.000.000.000.00XXX
0039TCRad s/i, endovasc taa repair0.000.000.000.000.000.00XXX
0040TCRad s/i, endovasc taa prosth0.000.000.000.000.000.00XXX
0041TCDetect ur infect agnt w/cpas0.000.000.000.000.000.00XXX
0042TCCt perfusion w/contrast, cbf0.000.000.000.000.000.00XXX
0043TCCo expired gas analysis0.000.000.000.000.000.00XXX
0044TCWhole body photography0.000.000.000.000.000.00XXX
0045TCWhole body photography0.000.000.000.000.000.00XXX
0046TCCath lavage, mammary duct(s0.000.000.000.000.000.00XXX
0047TCCath lavage, mammary duct(s)0.000.000.000.000.000.00XXX
0048TCImplant ventricular device0.000.000.000.000.000.00XXX
0049TCExternal circulation assist0.000.000.000.000.000.00XXX
0050TCRemoval circulation assist0.000.000.000.000.000.00XXX
0051TCImplant total heart system0.000.000.000.000.000.00XXX
0052TCReplace component heart syst0.000.000.000.000.000.00XXX
0053TCReplace component heart syst0.000.000.000.000.000.00XXX
0054TCBone surgery using computer0.000.000.000.000.000.00XXX
0055TCBone surgery using computer0.000.000.000.000.000.00XXX
0056TCBone surgery using computer0.000.000.000.000.000.00XXX
0057TCUppr gi scope w/ thrml txmnt0.000.000.000.000.000.00XXX
0058TCCryopreservation, ovary tiss0.000.000.000.000.000.00XXX
0059TCCryopreservation, oocyte0.000.000.000.000.000.00XXX
0060TCElectrical impedance scan0.000.000.000.000.000.00XXX
0061TCDestruction of tumor, breast0.000.000.000.000.000.00XXX
10021AFna w/o image1.272.200.540.083.551.89XXX
10022AFna w/image1.272.610.420.063.941.75XXX
10040AAcne surgery1.181.020.680.062.261.92010
10060ADrainage of skin abscess1.171.200.940.102.472.21010
10061ADrainage of skin abscess2.401.811.510.214.424.12010
10080ADrainage of pilonidal cyst1.173.131.140.114.412.42010
10081ADrainage of pilonidal cyst2.454.111.510.236.794.19010
Start Printed Page 1119
10120ARemove foreign body1.221.460.410.122.801.75010
10121ARemove foreign body2.693.331.880.306.324.87010
10140ADrainage of hematoma/fluid1.531.510.910.183.222.62010
10160APuncture drainage of lesion1.200.730.460.132.061.79010
10180AComplex drainage, wound2.253.252.080.305.804.63010
11000ADebride infected skin0.600.570.220.061.230.88000
11001ADebride infected skin add-on0.300.230.110.020.550.43ZZZ
11010ADebride skin, fx4.196.742.330.5411.477.06010
11011ADebride skin/muscle, fx4.948.032.370.6413.617.95000
11012ADebride skin/muscle/bone, fx6.8712.013.861.0719.9511.80000
11040ADebride skin, partial0.500.510.210.061.070.77000
11041ADebride skin, full0.820.650.330.071.541.22000
11042ADebride skin/tissue1.120.970.450.112.201.68000
11043ADebride tissue/muscle2.383.412.610.296.085.28010
11044ADebride tissue/muscle/bone3.064.503.770.417.977.24010
11055RTrim skin lesion0.430.550.170.021.000.62000
11056RTrim skin lesions, 2 to 40.610.630.240.041.280.89000
11057RTrim skin lesions, over 40.790.730.310.051.571.15000
11100ABiopsy, skin lesion0.811.260.370.052.121.23000
11101ABiopsy, skin add-on0.410.340.190.020.770.62ZZZ
11200ARemoval of skin tags0.771.060.770.051.881.59010
11201ARemove skin tags add-on0.290.160.120.020.470.43ZZZ
11300AShave skin lesion0.511.000.220.041.550.77000
11301AShave skin lesion0.851.120.370.052.021.27000
11302AShave skin lesion1.051.310.460.062.421.57000
11303AShave skin lesion1.241.590.520.072.901.83000
11305AShave skin lesion0.670.840.270.051.560.99000
11306AShave skin lesion0.991.110.410.062.161.46000
11307AShave skin lesion1.141.290.490.062.491.69000
11308AShave skin lesion1.411.450.590.082.942.08000
11310AShave skin lesion0.731.120.330.051.901.11000
11311AShave skin lesion1.051.240.480.062.351.59000
11312AShave skin lesion1.201.440.550.072.711.82000
11313AShave skin lesion1.621.820.720.113.552.45000
11400AExc tr-ext b9+marg 0.5 < cm0.852.000.890.072.921.81010
11401AExc tr-ext b9+marg 0.6-1 cm1.232.071.030.113.412.37010
11402AExc tr-ext b9+marg 1.1-2 cm1.512.251.100.143.902.75010
11403AExc tr-ext b9+marg 2.1-3 cm1.792.421.330.194.403.31010
11404AExc tr-ext b9+marg 3.1-4 cm2.062.731.410.225.013.69010
11406AExc tr-ext b9+marg > 4.0 cm2.763.101.670.306.164.73010
11420AExc h-f-nk-sp b9+marg 0.5 <0.981.770.940.102.852.02010
11421AExc h-f-nk-sp b9+marg 0.6-11.422.081.120.133.632.67010
11422AExc h-f-nk-sp b9+marg 1.1-21.632.271.340.174.073.14010
11423AExc h-f-nk-sp b9+marg 2.1-32.012.611.460.214.833.68010
11424AExc h-f-nk-sp b9+marg 3.1-42.432.821.610.255.504.29010
11426AExc h-f-nk-sp b9+marg > 4 cm3.773.522.110.417.706.29010
11440AExc face-mm b9+marg 0.5 < cm1.062.281.330.103.442.49010
11441AExc face-mm b9+marg 0.6-1 cm1.482.401.510.134.013.12010
11442AExc face-mm b9+marg 1.1-2 cm1.722.591.580.174.483.47010
11443AExc face-mm b9+marg 2.1-3 cm2.292.971.830.225.484.34010
11444AExc face-mm b9+marg 3.1-4 cm3.143.542.190.306.985.63010
11446AExc face-mm b9+marg > 4 cm4.484.112.780.368.957.62010
11450ARemoval, sweat gland lesion2.735.112.030.318.155.07090
11451ARemoval, sweat gland lesion3.946.742.560.4711.156.97090
11462ARemoval, sweat gland lesion2.515.202.020.287.994.81090
11463ARemoval, sweat gland lesion3.946.962.690.4811.387.11090
11470ARemoval, sweat gland lesion3.255.142.270.368.755.88090
11471ARemoval, sweat gland lesion4.406.852.780.4811.737.66090
11600AExc tr-ext mlg+marg 0.5 < cm1.312.650.980.114.072.40010
11601AExc tr-ext mlg+marg 0.6-1 cm1.802.721.230.144.663.17010
11602AExc tr-ext mlg+marg 1.1-2 cm1.952.861.270.164.973.38010
11603AExc tr-ext mlg+marg 2.1-3 cm2.193.111.330.195.493.71010
11604AExc tr-ext mlg+marg 3.1-4 cm2.403.411.400.226.034.02010
11606AExc tr-ext mlg+marg > 4 cm3.424.111.750.347.875.51010
11620AExc h-f-nk-sp mlg+marg 0.5 <1.192.620.960.113.922.26010
11621AExc h-f-nk-sp mlg+marg 0.6-11.762.731.250.144.633.15010
11622AExc h-f-nk-sp mlg+marg 1.1-22.093.001.390.185.273.66010
11623AExc h-f-nk-sp mlg+marg 2.1-32.613.361.590.246.214.44010
11624AExc h-f-nk-sp mlg+marg 3.1-43.063.791.780.307.155.14010
11626AExc h-f-nk-sp mlg+mar > 4 cm4.294.702.400.429.417.11010
11640AExc face-mm malig+marg 0.5 <1.352.691.120.124.162.59010
11641AExc face-mm malig+marg 0.6-12.163.061.540.185.403.88010
11642AExc face-mm malig+marg 1.1-22.593.441.730.226.254.54010
11643AExc face-mm malig+marg 2.1-33.103.851.960.297.245.35010
11644AExc face-mm malig+marg 3.1-44.024.742.470.409.166.89010
Start Printed Page 1120
11646AExc face-mm mlg+marg > 4 cm5.945.813.490.5512.309.98010
11719RTrim nail(s)0.170.250.070.010.430.25000
11720ADebride nail, 1-50.320.340.130.020.680.47000
11721ADebride nail, 6 or more0.540.430.210.051.020.80000
11730ARemoval of nail plate1.131.020.430.112.261.67000
11732ARemove nail plate, add-on0.570.430.220.061.060.85ZZZ
11740ADrain blood from under nail0.370.850.140.041.260.55000
11750ARemoval of nail bed1.862.131.720.194.183.77010
11752ARemove nail bed/finger tip2.672.952.950.406.026.02010
11755ABiopsy, nail unit1.311.100.540.072.481.92000
11760ARepair of nail bed1.581.841.210.213.633.00010
11762AReconstruction of nail bed2.892.271.830.395.555.11010
11765AExcision of nail fold, toe0.691.140.520.061.891.27010
11770ARemoval of pilonidal lesion2.613.521.510.296.424.41010
11771ARemoval of pilonidal lesion5.735.703.330.6812.119.74090
11772ARemoval of pilonidal lesion6.977.173.870.8214.9611.66090
11900AInjection into skin lesions0.520.650.220.021.190.76000
11901AAdded skin lesions injection0.800.660.360.041.501.20000
11920RCorrect skin color defects1.611.990.780.213.812.60000
11921RCorrect skin color defects1.932.360.980.254.543.16000
11922RCorrect skin color defects0.490.370.250.060.920.80ZZZ
11950RTherapy for contour defects0.841.150.400.072.061.31000
11951RTherapy for contour defects1.191.500.510.122.811.82000
11952RTherapy for contour defects1.691.870.680.213.772.58000
11954RTherapy for contour defects1.852.440.910.234.522.99000
11960AInsert tissue expander(s)9.07NA10.521.06NA20.65090
11970AReplace tissue expander7.05NA6.100.93NA14.08090
11971ARemove tissue expander(s)2.137.104.760.259.487.14090
11975NInsert contraceptive cap+1.481.420.570.173.072.22XXX
11976RRemoval of contraceptive cap1.781.700.680.213.692.67000
11977NRemoval/reinsert contra cap+3.302.271.260.375.944.93XXX
11980AImplant hormone pellet(s)1.481.100.540.122.702.14000
11981AInsert drug implant device1.481.740.680.173.392.33XXX
11982ARemove drug implant device1.781.970.840.213.962.83XXX
11983ARemove/insert drug implant3.302.321.470.375.995.14XXX
12001ARepair superficial wound(s)1.702.000.490.163.862.35010
12002ARepair superficial wound(s)1.862.060.930.184.102.97010
12004ARepair superficial wound(s)2.242.361.050.214.813.50010
12005ARepair superficial wound(s)2.862.851.230.285.994.37010
12006ARepair superficial wound(s)3.663.431.540.377.465.57010
12007ARepair superficial wound(s)4.113.861.840.458.426.40010
12011ARepair superficial wound(s)1.762.160.500.174.092.43010
12013ARepair superficial wound(s)1.992.310.970.194.493.15010
12014ARepair superficial wound(s)2.462.611.090.225.293.77010
12015ARepair superficial wound(s)3.193.191.280.296.674.76010
12016ARepair superficial wound(s)3.923.601.560.397.915.87010
12017ARepair superficial wound(s)4.70NA1.910.47NA7.08010
12018ARepair superficial wound(s)5.52NA2.270.55NA8.34010
12020AClosure of split wound2.622.651.750.295.564.66010
12021AClosure of split wound1.841.741.410.233.813.48010
12031ALayer closure of wound(s)2.152.310.810.184.643.14010
12032ALayer closure of wound(s)2.473.881.840.186.534.49010
12034ALayer closure of wound(s)2.923.171.410.256.344.58010
12035ALayer closure of wound(s)3.425.262.180.369.045.96010
12036ALayer closure of wound(s)4.045.362.380.499.896.91010
12037ALayer closure of wound(s)4.666.412.780.5911.668.03010
12041ALayer closure of wound(s)2.372.470.870.215.053.45010
12042ALayer closure of wound(s)2.743.211.370.216.164.32010
12044ALayer closure of wound(s)3.143.201.560.296.634.99010
12045ALayer closure of wound(s)3.633.672.170.417.716.21010
12046ALayer closure of wound(s)4.246.572.760.4811.297.48010
12047ALayer closure of wound(s)4.646.423.100.4911.558.23010
12051ALayer closure of wound(s)2.473.231.360.195.894.02010
12052ALayer closure of wound(s)2.773.171.340.216.154.32010
12053ALayer closure of wound(s)3.123.221.500.246.584.86010
12054ALayer closure of wound(s)3.453.541.600.307.295.35010
12055ALayer closure of wound(s)4.424.542.140.429.386.98010
12056ALayer closure of wound(s)5.236.763.070.5212.518.82010
12057ALayer closure of wound(s)5.956.103.760.6012.6510.31010
13100ARepair of wound or lesion3.123.511.780.256.885.15010
13101ARepair of wound or lesion3.913.752.220.277.936.40010
13102ARepair wound/lesion add-on1.240.740.570.122.101.93ZZZ
13120ARepair of wound or lesion3.303.611.820.287.195.40010
13121ARepair of wound or lesion4.323.972.320.308.596.94010
13122ARepair wound/lesion add-on1.440.870.630.142.452.21ZZZ
Start Printed Page 1121
13131ARepair of wound or lesion3.783.882.140.307.966.22010
13132ARepair of wound or lesion5.944.683.170.3911.019.50010
13133ARepair wound/lesion add-on2.191.191.030.213.593.43ZZZ
13150ARepair of wound or lesion3.805.502.610.359.656.76010
13151ARepair of wound or lesion4.445.403.030.3410.187.81010
13152ARepair of wound or lesion6.326.083.930.4612.8610.71010
13153ARepair wound/lesion add-on2.381.341.140.223.943.74ZZZ
13160ALate closure of wound10.46NA7.141.44NA19.04090
14000ASkin tissue rearrangement5.888.525.120.5514.9511.55090
14001ASkin tissue rearrangement8.469.946.590.7819.1815.83090
14020ASkin tissue rearrangement6.589.175.990.6016.3513.17090
14021ASkin tissue rearrangement10.0410.457.740.8321.3218.61090
14040ASkin tissue rearrangement7.868.256.860.6616.7715.38090
14041ASkin tissue rearrangement11.4710.648.680.8622.9721.01090
14060ASkin tissue rearrangement8.499.087.690.7118.2816.89090
14061ASkin tissue rearrangement12.2711.669.510.9024.8322.68090
14300ASkin tissue rearrangement11.7411.199.171.0623.9921.97090
14350ASkin tissue rearrangement9.60NA7.121.31NA18.03090
15000ASkin graft3.993.812.200.458.256.64000
15001ASkin graft add-on1.001.360.410.132.491.54ZZZ
15050ASkin pinch graft4.295.974.740.5510.819.58090
15100ASkin split graft9.0412.637.801.1322.8017.97090
15101ASkin split graft add-on1.723.831.660.225.773.60ZZZ
15120ASkin split graft9.8210.787.771.0921.6918.68090
15121ASkin split graft add-on2.674.581.870.337.584.87ZZZ
15200ASkin full graft8.0210.716.000.8819.6114.90090
15201ASkin full graft add-on1.321.040.620.172.532.11ZZZ
15220ASkin full graft7.8610.596.430.8219.2715.11090
15221ASkin full graft add-on1.190.910.560.142.241.89ZZZ
15240ASkin full graft9.0310.157.650.9620.1417.64090
15241ASkin full graft add-on1.861.450.920.213.522.99ZZZ
15260ASkin full graft10.049.888.600.7620.6819.40090
15261ASkin full graft add-on2.232.721.420.215.163.86ZZZ
15342ACultured skin graft, 25 cm1.001.830.550.112.941.66010
15343ACulture skn graft addl 25 cm0.250.270.100.020.540.37ZZZ
15350ASkin homograft3.998.224.830.5112.729.33090
15351ASkin homograft add-on1.000.940.390.132.071.52ZZZ
15400ASkin heterograft3.994.184.100.488.658.57090
15401ASkin heterograft add-on1.001.220.440.132.351.57ZZZ
15570AForm skin pedicle flap9.209.176.681.1619.5317.04090
15572AForm skin pedicle flap9.268.386.251.1218.7616.63090
15574AForm skin pedicle flap9.878.796.951.1119.7717.93090
15576AForm skin pedicle flap8.689.396.420.8718.9415.97090
15600ASkin graft1.917.042.700.239.184.84090
15610ASkin graft2.423.733.030.306.455.75090
15620ASkin graft2.947.463.670.3410.746.95090
15630ASkin graft3.276.843.930.3410.457.54090
15650ATransfer skin pedicle flap3.966.704.020.4311.098.41090
15732AMuscle-skin graft, head/neck17.8118.0512.221.8137.6731.84090
15734AMuscle-skin graft, trunk17.7617.8412.342.3037.9032.40090
15736AMuscle-skin graft, arm16.2518.1611.222.1536.5629.62090
15738AMuscle-skin graft, leg17.8917.9311.742.3538.1731.98090
15740AIsland pedicle flap graft10.239.817.880.7520.7918.86090
15750ANeurovascular pedicle graft11.39NA9.041.40NA21.83090
15756AFree myo/skin flap microvasc35.18NA20.693.75NA59.62090
15757AFree skin flap, microvasc35.18NA21.734.06NA60.97090
15758AFree fascial flap, microvasc35.05NA21.724.25NA61.02090
15760AComposite skin graft8.739.717.020.8719.3116.62090
15770ADerma-fat-fascia graft7.51NA6.690.94NA15.14090
15775RHair transplant punch grafts3.952.781.320.527.255.79000
15776RHair transplant punch grafts5.535.392.810.7211.649.06000
15780AAbrasion treatment of skin7.287.077.070.4914.8414.84090
15781AAbrasion treatment of skin4.845.355.350.3310.5210.52090
15782AAbrasion treatment of skin4.314.304.300.258.868.86090
15783AAbrasion treatment of skin4.284.924.170.319.518.76090
15786AAbrasion, lesion, single2.031.631.270.133.793.43010
15787AAbrasion, lesions, add-on0.330.320.160.020.670.51ZZZ
15788RChemical peel, face, epiderm2.093.342.270.135.564.49090
15789RChemical peel, face, dermal4.916.394.910.3311.6310.15090
15792RChemical peel, nonfacial1.863.162.760.125.144.74090
15793AChemical peel, nonfacial3.73NA4.140.21NA8.08090
15810ASalabrasion4.733.873.870.519.119.11090
15811ASalabrasion5.386.315.520.6312.3211.53090
15819APlastic surgery, neck9.37NA7.200.93NA17.50090
15820ARevision of lower eyelid5.146.855.340.3612.3510.84090
Start Printed Page 1122
15821ARevision of lower eyelid5.717.235.520.3713.3111.60090
15822ARevision of upper eyelid4.445.804.360.2710.519.07090
15823ARevision of upper eyelid7.047.796.240.3915.2213.67090
15824RRemoval of forehead wrinkles0.000.000.000.000.000.00000
15825RRemoval of neck wrinkles0.000.000.000.000.000.00000
15826RRemoval of brow wrinkles0.000.000.000.000.000.00000
15828RRemoval of face wrinkles0.000.000.000.000.000.00000
15829RRemoval of skin wrinkles0.000.000.000.000.000.00000
15831AExcise excessive skin tissue12.38NA8.221.57NA22.17090
15832AExcise excessive skin tissue11.57NA8.381.46NA21.41090
15833AExcise excessive skin tissue10.62NA8.241.41NA20.27090
15834AExcise excessive skin tissue10.83NA7.711.42NA19.96090
15835AExcise excessive skin tissue11.6511.407.631.3624.4120.64090
15836AExcise excessive skin tissue9.33NA6.811.15NA17.29090
15837AExcise excessive skin tissue8.427.907.000.9417.2616.36090
15838AExcise excessive skin tissue7.12NA6.090.70NA13.91090
15839AExcise excessive skin tissue9.377.846.211.0618.2716.64090
15840AGraft for face nerve palsy13.24NA10.051.39NA24.68090
15841AGraft for face nerve palsy23.23NA15.083.20NA41.51090
15842AFlap for face nerve palsy37.90NA23.014.81NA65.72090
15845ASkin and muscle repair, face12.55NA9.360.96NA22.87090
15850BRemoval of sutures+0.781.580.300.052.411.13XXX
15851ARemoval of sutures0.861.720.340.062.641.26000
15852ADressing change not for burn0.861.870.360.082.811.30000
15860ATest for blood flow in graft1.951.280.790.163.392.90000
15876RSuction assisted lipectomy0.000.000.000.000.000.00000
15877RSuction assisted lipectomy0.000.000.000.000.000.00000
15878RSuction assisted lipectomy0.000.000.000.000.000.00000
15879RSuction assisted lipectomy0.000.000.000.000.000.00000
15920ARemoval of tail bone ulcer7.94NA5.611.00NA14.55090
15922ARemoval of tail bone ulcer9.89NA7.311.28NA18.48090
15931ARemove sacrum pressure sore9.23NA5.751.15NA16.13090
15933ARemove sacrum pressure sore10.83NA7.941.37NA20.14090
15934ARemove sacrum pressure sore12.67NA8.151.63NA22.45090
15935ARemove sacrum pressure sore14.55NA10.401.88NA26.83090
15936ARemove sacrum pressure sore12.36NA8.361.59NA22.31090
15937ARemove sacrum pressure sore14.19NA9.961.82NA25.97090
15940ARemove hip pressure sore9.33NA6.231.18NA16.74090
15941ARemove hip pressure sore11.41NA9.581.48NA22.47090
15944ARemove hip pressure sore11.44NA8.701.46NA21.60090
15945ARemove hip pressure sore12.67NA9.741.66NA24.07090
15946ARemove hip pressure sore21.54NA14.412.80NA38.75090
15950ARemove thigh pressure sore7.53NA5.470.96NA13.96090
15951ARemove thigh pressure sore10.70NA7.951.37NA20.02090
15952ARemove thigh pressure sore11.37NA7.831.44NA20.64090
15953ARemove thigh pressure sore12.61NA9.071.66NA23.34090
15956ARemove thigh pressure sore15.50NA10.851.98NA28.33090
15958ARemove thigh pressure sore15.46NA11.132.00NA28.59090
15999CRemoval of pressure sore0.000.000.000.000.000.00YYY
16000AInitial treatment of burn(s)0.890.860.270.071.821.23000
16010ATreatment of burn(s)0.870.660.630.081.611.58000
16015ATreatment of burn(s)2.35NA1.150.27NA3.77000
16020ATreatment of burn(s)0.801.310.610.072.181.48000
16025ATreatment of burn(s)1.851.790.970.193.833.01000
16030ATreatment of burn(s)2.082.201.120.224.503.42000
16035AIncision of burn scab, initi3.74NA1.470.43NA5.64090
16036AEscharotomy; add'l incision1.50NA0.600.13NA2.23ZZZ
17000ADestroy benign/premlg lesion0.600.980.320.041.620.96010
17003ADestroy lesions, 2-140.150.110.070.010.270.23ZZZ
17004ADestroy lesions, 15 or more2.792.321.290.145.254.22010
17106ADestruction of skin lesions4.584.873.340.349.798.26090
17107ADestruction of skin lesions9.157.525.450.6417.3115.24090
17108ADestruction of skin lesions13.189.687.681.0723.9321.93090
17110ADestruct lesion, 1-140.651.630.490.052.331.19010
17111ADestruct lesion, 15 or more0.921.680.590.052.651.56010
17250AChemical cautery, tissue0.501.230.350.051.780.90000
17260ADestruction of skin lesions0.911.280.440.052.241.40010
17261ADestruction of skin lesions1.171.620.590.062.851.82010
17262ADestruction of skin lesions1.581.890.780.083.552.44010
17263ADestruction of skin lesions1.792.070.860.103.962.75010
17264ADestruction of skin lesions1.942.230.890.104.272.93010
17266ADestruction of skin lesions2.342.530.990.135.003.46010
17270ADestruction of skin lesions1.321.710.640.073.102.03010
17271ADestruction of skin lesions1.491.790.740.073.352.30010
17272ADestruction of skin lesions1.772.000.880.083.852.73010
Start Printed Page 1123
17273ADestruction of skin lesions2.052.210.990.114.373.15010
17274ADestruction of skin lesions2.592.581.200.135.303.92010
17276ADestruction of skin lesions3.202.971.440.186.354.82010
17280ADestruction of skin lesions1.171.620.570.062.851.80010
17281ADestruction of skin lesions1.721.910.860.083.712.66010
17282ADestruction of skin lesions2.042.171.010.114.323.16010
17283ADestruction of skin lesions2.642.561.250.135.334.02010
17284ADestruction of skin lesions3.212.941.520.176.324.90010
17286ADestruction of skin lesions4.433.712.190.278.416.89010
17304A1 stage mohs, up to 5 spec7.598.093.570.3716.0511.53000
17305A2 stage mohs, up to 5 spec2.853.811.340.146.804.33000
17306A3 stage mohs, up to 5 spec2.853.831.350.146.824.34000
17307AMohs addl stage up to 5 spec2.853.781.370.146.774.36000
17310AMohs any stage > 5 spec each0.951.650.460.062.661.47ZZZ
17340ACryotherapy of skin0.760.370.310.051.181.12010
17360ASkin peel therapy1.431.460.750.072.962.25010
17380RHair removal by electrolysis0.000.000.000.000.000.00000
17999CSkin tissue procedure0.000.000.000.000.000.00YYY
19000ADrainage of breast lesion0.842.030.360.082.951.28000
19001ADrain breast lesion add-on0.420.790.140.041.250.60ZZZ
19020AIncision of breast lesion3.566.002.770.429.986.75090
19030AInjection for breast x-ray1.533.370.500.084.982.11000
19100ABx breast percut w/o image1.272.150.420.123.541.81000
19101ABiopsy of breast, open3.184.691.680.248.115.10010
19102ABx breast percut w/image2.003.980.660.166.142.82000
19103ABx breast percut w/device3.6912.071.230.1915.955.11000
19110ANipple exploration4.295.823.060.5310.647.88090
19112AExcise breast duct fistula3.665.802.680.469.926.80090
19120ARemoval of breast lesion5.554.583.080.6810.819.31090
19125AExcision, breast lesion6.054.833.300.7411.6210.09090
19126AExcision, addl breast lesion2.93NA1.010.36NA4.30ZZZ
19140ARemoval of breast tissue5.137.293.420.6313.059.18090
19160ARemoval of breast tissue5.98NA3.450.74NA10.17090
19162ARemove breast tissue, nodes13.51NA6.381.66NA21.55090
19180ARemoval of breast8.79NA5.061.06NA14.91090
19182ARemoval of breast7.72NA4.810.95NA13.48090
19200ARemoval of breast15.47NA8.041.82NA25.33090
19220ARemoval of breast15.70NA8.301.88NA25.88090
19240ARemoval of breast15.98NA8.281.95NA26.21090
19260ARemoval of chest wall lesion15.42NA11.301.98NA28.70090
19271ARevision of chest wall18.87NA18.232.74NA39.84090
19272AExtensive chest wall surgery21.52NA19.183.06NA43.76090
19290APlace needle wire, breast1.273.010.410.074.351.75000
19291APlace needle wire, breast0.631.750.210.042.420.88ZZZ
19295APlace breast clip, percut0.002.77NA0.012.78NAZZZ
19316ASuspension of breast10.67NA7.591.39NA19.65090
19318AReduction of large breast15.60NA11.202.04NA28.84090
19324AEnlarge breast5.84NA4.920.76NA11.52090
19325AEnlarge breast with implant8.44NA6.591.09NA16.12090
19328ARemoval of breast implant5.67NA5.070.74NA11.48090
19330ARemoval of implant material7.58NA6.070.98NA14.63090
19340AImmediate breast prosthesis6.32NA3.120.82NA10.26ZZZ
19342ADelayed breast prosthesis11.18NA8.971.46NA21.61090
19350ABreast reconstruction8.9114.207.111.1524.2617.17090
19355ACorrect inverted nipple(s)7.5612.805.000.9621.3213.52090
19357ABreast reconstruction18.13NA13.852.36NA34.34090
19361ABreast reconstruction19.23NA11.782.51NA33.52090
19364ABreast reconstruction40.94NA23.644.72NA69.30090
19366ABreast reconstruction21.25NA11.232.74NA35.22090
19367ABreast reconstruction25.69NA16.573.35NA45.61090
19368ABreast reconstruction32.37NA20.264.23NA56.86090
19369ABreast reconstruction29.78NA19.793.91NA53.48090
19370ASurgery of breast capsule8.04NA6.951.04NA16.03090
19371ARemoval of breast capsule9.34NA7.871.22NA18.43090
19380ARevise breast reconstruction9.13NA7.761.18NA18.07090
19396ADesign custom breast implant2.175.780.990.288.233.44000
19499CBreast surgery procedure0.000.000.000.000.000.00YYY
20000AIncision of abscess2.122.361.610.214.693.94010
20005AIncision of deep abscess3.413.342.120.417.165.94010
20100AExplore wound, neck10.065.794.381.1917.0415.63010
20101AExplore wound, chest3.222.961.610.296.475.12010
20102AExplore wound, abdomen3.933.511.800.427.866.15010
20103AExplore wound, extremity5.294.143.230.6910.129.21010
20150AExcise epiphyseal bar13.67NA7.211.16NA22.04090
20200AMuscle biopsy1.463.190.780.214.862.45000
Start Printed Page 1124
20205ADeep muscle biopsy2.354.141.210.286.773.84000
20206ANeedle biopsy, muscle0.993.170.350.074.231.41000
20220ABone biopsy, trocar/needle1.274.732.690.076.074.03000
20225ABone biopsy, trocar/needle1.874.922.960.136.924.96000
20240ABone biopsy, excisional3.23NA2.600.40NA6.23010
20245ABone biopsy, excisional7.77NA6.360.53NA14.66010
20250AOpen bone biopsy5.02NA4.540.60NA10.16010
20251AOpen bone biopsy5.55NA5.170.95NA11.67010
20500AInjection of sinus tract1.235.883.890.127.235.24010
20501AInject sinus tract for x-ray0.763.030.250.043.831.05000
20520ARemoval of foreign body1.852.251.810.214.313.87010
20525ARemoval of foreign body3.493.432.660.487.406.63010
20526ATher injection, carp tunnel0.940.970.510.071.981.52000
20550AInj tendon sheath/ligament0.750.710.240.071.531.06000
20551AInj tendon origin/insertion0.750.680.340.071.501.16000
20552AInj trigger point, 1/2 muscl0.660.730.210.071.460.94000
20553AInject trigger points, =/> 30.750.840.230.071.661.05000
20600ADrain/inject, joint/bursa0.660.640.360.071.371.09000
20605ADrain/inject, joint/bursa0.680.750.370.071.501.12000
20610ADrain/inject, joint/bursa0.790.940.410.101.831.30000
20612AAspirate/inj ganglion cyst0.700.710.340.071.481.11000
20615ATreatment of bone cyst2.282.541.830.235.054.34010
20650AInsert and remove bone pin2.232.421.940.344.994.51010
20660AApply, rem fixation device2.513.071.700.586.164.79000
20661AApplication of head brace4.88NA4.951.11NA10.94090
20662AApplication of pelvis brace6.06NA5.430.98NA12.47090
20663AApplication of thigh brace5.42NA4.760.93NA11.11090
20664AHalo brace application8.05NA7.031.80NA16.88090
20665ARemoval of fixation device1.312.051.300.213.572.82010
20670ARemoval of support implant1.746.693.930.288.715.95010
20680ARemoval of support implant3.343.223.220.557.117.11090
20690AApply bone fixation device3.51NA2.470.57NA6.55090
20692AApply bone fixation device6.40NA3.730.72NA10.85090
20693AAdjust bone fixation device5.85NA5.541.03NA12.42090
20694ARemove bone fixation device4.156.864.490.6911.709.33090
20802AReplantation, arm, complete41.09NA21.407.01NA69.50090
20805AReplant forearm, complete49.93NA35.064.76NA89.75090
20808AReplantation hand, complete61.56NA43.437.83NA112.82090
20816AReplantation digit, complete30.89NA39.173.63NA73.69090
20822AReplantation digit, complete25.55NA35.903.70NA65.15090
20824AReplantation thumb, complete30.89NA38.124.20NA73.21090
20827AReplantation thumb, complete26.37NA37.953.87NA68.19090
20838AReplantation foot, complete41.35NA22.707.06NA71.11090
20900ARemoval of bone for graft5.577.315.790.9313.8112.29090
20902ARemoval of bone for graft7.54NA6.861.28NA15.68090
20910ARemove cartilage for graft5.337.115.440.6013.0411.37090
20912ARemove cartilage for graft6.34NA6.090.66NA13.09090
20920ARemoval of fascia for graft5.30NA4.370.65NA10.32090
20922ARemoval of fascia for graft6.606.735.061.0614.3912.72090
20924ARemoval of tendon for graft6.47NA5.920.99NA13.38090
20926ARemoval of tissue for graft5.52NA4.930.88NA11.33090
20930BSpinal bone allograft0.000.000.000.000.000.00XXX
20931ASpinal bone allograft1.81NA0.930.41NA3.15ZZZ
20936BSpinal bone autograft0.000.000.000.000.000.00XXX
20937ASpinal bone autograft2.79NA1.460.52NA4.77ZZZ
20938ASpinal bone autograft3.02NA1.560.63NA5.21ZZZ
20950AFluid pressure, muscle1.261.361.010.192.812.46000
20955AFibula bone graft, microvasc39.15NA25.015.25NA69.41090
20956AIliac bone graft, microvasc39.21NA24.866.96NA71.03090
20957AMt bone graft, microvasc40.59NA19.086.92NA66.59090
20962AOther bone graft, microvasc39.21NA26.416.26NA71.88090
20969ABone/skin graft, microvasc43.85NA27.485.23NA76.56090
20970ABone/skin graft, iliac crest43.00NA25.845.60NA74.44090
20972ABone/skin graft, metatarsal42.9321.7920.147.3272.0470.39090
20973ABone/skin graft, great toe45.69NA25.295.61NA76.59090
20974AElectrical bone stimulation0.620.620.550.111.351.28000
20975AElectrical bone stimulation2.60NA1.730.51NA4.84000
20979AUs bone stimulation0.620.770.340.051.441.01000
20982AAblate, bone tumor(s) perq7.27105.352.990.69113.3110.95000
20999CMusculoskeletal surgery0.000.000.000.000.000.00YYY
21010AIncision of jaw joint10.12NA7.250.65NA18.02090
21015AResection of facial tumor5.28NA5.530.63NA11.44090
21025AExcision of bone, lower jaw10.0410.208.210.9521.1919.20090
21026AExcision of facial bone(s)4.846.945.530.4812.2610.85090
21029AContour of face bone lesion7.708.606.270.8917.1914.86090
Start Printed Page 1125
21030AExcise max/zygoma b9 tumor4.496.844.310.7212.059.52090
21031ARemove exostosis, mandible3.244.583.140.348.166.72090
21032ARemove exostosis, maxilla3.244.633.250.338.206.82090
21034AExcise max/zygoma mlg tumor16.1513.5611.321.6531.3629.12090
21040AExcise mandible lesion4.496.874.140.2311.598.86090
21044ARemoval of jaw bone lesion11.84NA8.681.05NA21.57090
21045AExtensive jaw surgery16.15NA11.431.45NA29.03090
21046ARemove mandible cyst complex12.98NA12.691.22NA26.89090
21047AExcise lwr jaw cyst w/repair18.72NA13.441.85NA34.01090
21048ARemove maxilla cyst complex13.48NA12.971.22NA27.67090
21049AExcis uppr jaw cyst w/repair17.97NA13.031.22NA32.22090
21050ARemoval of jaw joint10.75NA10.261.01NA22.02090
21060ARemove jaw joint cartilage10.21NA9.801.40NA21.41090
21070ARemove coronoid process8.19NA7.030.81NA16.03090
21076APrepare face/oral prosthesis13.4012.7110.171.6427.7525.21010
21077APrepare face/oral prosthesis33.7032.2026.204.1470.0464.04090
21079APrepare face/oral prosthesis22.3122.2117.491.9246.4441.72090
21080APrepare face/oral prosthesis25.0625.2219.773.0853.3647.91090
21081APrepare face/oral prosthesis22.8522.9517.792.2648.0642.90090
21082APrepare face/oral prosthesis20.8419.8815.991.7642.4838.59090
21083APrepare face/oral prosthesis19.2719.3514.732.3640.9836.36090
21084APrepare face/oral prosthesis22.4822.7117.681.8947.0842.05090
21085APrepare face/oral prosthesis8.998.526.880.7818.2916.65010
21086APrepare face/oral prosthesis24.8824.3019.602.2451.4246.72090
21087APrepare face/oral prosthesis24.8823.8919.412.6851.4546.97090
21088CPrepare face/oral prosthesis0.000.000.000.000.000.00090
21089CPrepare face/oral prosthesis0.000.000.000.000.000.00090
21100AMaxillofacial fixation4.215.624.620.2210.059.05090
21110AInterdental fixation5.207.025.660.3412.5611.20090
21116AInjection, jaw joint x-ray0.817.320.340.068.191.21000
21120AReconstruction of chin4.928.835.300.3514.1010.57090
21121AReconstruction of chin7.6310.436.650.6818.7414.96090
21122AReconstruction of chin8.51NA7.080.71NA16.30090
21123AReconstruction of chin11.14NA8.261.40NA20.80090
21125AAugmentation, lower jaw bone10.6011.828.280.8723.2919.75090
21127AAugmentation, lower jaw bone11.1014.529.110.9226.5421.13090
21137AReduction of forehead9.81NA7.440.64NA17.89090
21138AReduction of forehead12.17NA9.311.77NA23.25090
21139AReduction of forehead14.59NA9.781.23NA25.60090
21141AReconstruct midface, lefort18.07NA13.881.97NA33.92090
21142AReconstruct midface, lefort18.78NA13.081.40NA33.26090
21143AReconstruct midface, lefort19.55NA14.091.09NA34.73090
21145AReconstruct midface, lefort19.91NA14.152.52NA36.58090
21146AReconstruct midface, lefort20.68NA15.592.57NA38.84090
21147AReconstruct midface, lefort21.74NA15.291.83NA38.86090
21150AReconstruct midface, lefort25.20NA14.121.31NA40.63090
21151AReconstruct midface, lefort28.26NA17.922.39NA48.57090
21154AReconstruct midface, lefort30.47NA20.185.86NA56.51090
21155AReconstruct midface, lefort34.40NA22.306.61NA63.31090
21159AReconstruct midface, lefort42.32NA24.478.13NA74.92090
21160AReconstruct midface, lefort46.37NA24.415.29NA76.07090
21172AReconstruct orbit/forehead27.76NA14.072.30NA44.13090
21175AReconstruct orbit/forehead33.12NA18.316.22NA57.65090
21179AReconstruct entire forehead22.22NA14.862.99NA40.07090
21180AReconstruct entire forehead25.15NA16.072.59NA43.81090
21181AContour cranial bone lesion9.89NA7.811.17NA18.87090
21182AReconstruct cranial bone32.14NA19.663.05NA54.85090
21183AReconstruct cranial bone35.26NA21.363.32NA59.94090
21184AReconstruct cranial bone38.18NA22.554.97NA65.70090
21188AReconstruction of midface22.43NA15.182.23NA39.84090
21193AReconst lwr jaw w/o graft17.12NA12.971.85NA31.94090
21194AReconst lwr jaw w/graft19.81NA14.061.68NA35.55090
21195AReconst lwr jaw w/o fixation17.21NA13.261.45NA31.92090
21196AReconst lwr jaw w/fixation18.88NA13.881.95NA34.71090
21198AReconstr lwr jaw segment14.14NA10.901.27NA26.31090
21199AReconstr lwr jaw w/advance15.98NA9.191.52NA26.69090
21206AReconstruct upper jaw bone14.08NA10.811.22NA26.11090
21208AAugmentation of facial bones10.2114.499.281.1125.8120.60090
21209AReduction of facial bones6.7111.897.230.7219.3214.66090
21210AFace bone graft10.2113.699.411.0624.9620.68090
21215ALower jaw bone graft10.7513.489.611.2525.4821.61090
21230ARib cartilage graft10.75NA8.571.16NA20.48090
21235AEar cartilage graft6.7111.377.100.6318.7114.44090
21240AReconstruction of jaw joint14.03NA12.701.39NA28.12090
21242AReconstruction of jaw joint12.93NA12.211.69NA26.83090
Start Printed Page 1126
21243AReconstruction of jaw joint20.76NA17.872.23NA40.86090
21244AReconstruction of lower jaw11.84NA10.061.15NA23.05090
21245AReconstruction of jaw11.8416.109.731.0629.0022.63090
21246AReconstruction of jaw12.4514.559.851.4628.4623.76090
21247AReconstruct lower jaw bone22.60NA17.932.67NA43.20090
21248AReconstruction of jaw11.4613.029.311.2225.7021.99090
21249AReconstruction of jaw17.4916.5812.661.6835.7531.83090
21255AReconstruct lower jaw bone16.69NA12.781.36NA30.83090
21256AReconstruction of orbit16.17NA12.171.25NA29.59090
21260ARevise eye sockets16.50NA8.961.51NA26.97090
21261ARevise eye sockets31.44NA19.212.65NA53.30090
21263ARevise eye sockets28.38NA12.862.61NA43.85090
21267ARevise eye sockets18.87NA13.221.63NA33.72090
21268ARevise eye sockets24.44NA15.320.95NA40.71090
21270AAugmentation, cheek bone10.2111.908.100.8822.9919.19090
21275ARevision, orbitofacial bones11.22NA8.741.24NA21.20090
21280ARevision of eyelid6.02NA6.070.33NA12.42090
21282ARevision of eyelid3.48NA4.680.25NA8.41090
21295ARevision of jaw muscle/bone1.53NA2.820.16NA4.51090
21296ARevision of jaw muscle/bone4.24NA4.430.36NA9.03090
21299CCranio/maxillofacial surgery0.000.000.000.000.000.00YYY
21300ATreatment of skull fracture0.722.380.260.113.211.09000
21310ATreatment of nose fracture0.582.340.150.062.980.79000
21315ATreatment of nose fracture1.513.031.270.144.682.92010
21320ATreatment of nose fracture1.854.251.840.186.283.87010
21325ATreatment of nose fracture3.76NA3.750.37NA7.88090
21330ATreatment of nose fracture5.37NA5.280.58NA11.23090
21335ATreatment of nose fracture8.60NA6.810.77NA16.18090
21336ATreat nasal septal fracture5.71NA6.070.54NA12.32090
21337ATreat nasal septal fracture2.705.113.690.278.086.66090
21338ATreat nasoethmoid fracture6.45NA5.990.64NA13.08090
21339ATreat nasoethmoid fracture8.08NA6.750.92NA15.75090
21340ATreatment of nose fracture10.75NA8.701.03NA20.48090
21343ATreatment of sinus fracture12.93NA10.141.28NA24.35090
21344ATreatment of sinus fracture19.69NA13.712.07NA35.47090
21345ATreat nose/jaw fracture8.1511.547.900.7220.4116.77090
21346ATreat nose/jaw fracture10.5913.189.031.0324.8020.65090
21347ATreat nose/jaw fracture12.67NA9.771.37NA23.81090
21348ATreat nose/jaw fracture16.66NA11.311.81NA29.78090
21355ATreat cheek bone fracture3.764.702.370.358.816.48010
21356ATreat cheek bone fracture4.1411.673.220.4316.247.79010
21360ATreat cheek bone fracture6.4513.896.190.6320.9713.27090
21365ATreat cheek bone fracture14.93NA11.771.57NA28.27090
21366ATreat cheek bone fracture17.74NA11.641.70NA31.08090
21385ATreat eye socket fracture9.15NA7.070.77NA16.99090
21386ATreat eye socket fracture9.15NA7.480.92NA17.55090
21387ATreat eye socket fracture9.69NA7.540.94NA18.17090
21390ATreat eye socket fracture10.11NA8.010.84NA18.96090
21395ATreat eye socket fracture12.66NA9.321.31NA23.29090
21400ATreat eye socket fracture1.403.722.100.145.263.64090
21401ATreat eye socket fracture3.265.053.870.418.727.54090
21406ATreat eye socket fracture7.00NA6.350.71NA14.06090
21407ATreat eye socket fracture8.60NA7.140.81NA16.55090
21408ATreat eye socket fracture12.36NA9.211.50NA23.07090
21421ATreat mouth roof fracture5.139.926.160.5115.5611.80090
21422ATreat mouth roof fracture8.3111.287.100.8320.4216.24090
21423ATreat mouth roof fracture10.38NA8.491.15NA20.02090
21431ATreat craniofacial fracture7.0410.666.840.7018.4014.58090
21432ATreat craniofacial fracture8.60NA6.190.66NA15.45090
21433ATreat craniofacial fracture25.31NA16.832.97NA45.11090
21435ATreat craniofacial fracture17.22NA12.962.00NA32.18090
21436ATreat craniofacial fracture28.00NA18.422.80NA49.22090
21440ATreat dental ridge fracture2.708.054.110.2711.027.08090
21445ATreat dental ridge fracture5.3710.456.280.6616.4812.31090
21450ATreat lower jaw fracture2.9710.653.760.2813.907.01090
21451ATreat lower jaw fracture4.868.775.760.4714.1011.09090
21452ATreat lower jaw fracture1.987.853.560.1710.005.71090
21453ATreat lower jaw fracture5.5310.506.830.5916.6212.95090
21454ATreat lower jaw fracture6.45NA6.540.66NA13.65090
21461ATreat lower jaw fracture8.0812.528.300.8821.4817.26090
21462ATreat lower jaw fracture9.7814.069.020.9624.8019.76090
21465ATreat lower jaw fracture11.89NA10.051.01NA22.95090
21470ATreat lower jaw fracture15.32NA12.241.64NA29.20090
21480AReset dislocated jaw0.611.950.190.062.620.86000
21485AReset dislocated jaw3.985.944.800.3710.299.15090
Start Printed Page 1127
21490ARepair dislocated jaw11.84NA9.901.58NA23.32090
21493ATreat hyoid bone fracture1.27NA2.840.12NA4.23090
21494ATreat hyoid bone fracture6.27NA5.700.53NA12.50090
21495ATreat hyoid bone fracture5.68NA5.990.49NA12.16090
21497AInterdental wiring3.856.545.010.3710.769.23090
21499CHead surgery procedure0.000.000.000.000.000.00YYY
21501ADrain neck/chest lesion3.804.703.950.438.938.18090
21502ADrain chest lesion7.11NA5.700.95NA13.76090
21510ADrainage of bone lesion5.73NA5.720.81NA12.26090
21550ABiopsy of neck/chest2.063.641.740.165.863.96010
21555ARemove lesion, neck/chest4.345.063.170.499.898.00090
21556ARemove lesion, neck/chest5.56NA4.110.62NA10.29090
21557ARemove tumor, neck/chest8.87NA5.441.03NA15.34090
21600APartial removal of rib6.88NA5.800.98NA13.66090
21610APartial removal of rib14.59NA9.042.23NA25.86090
21615ARemoval of rib9.86NA6.731.45NA18.04090
21616ARemoval of rib and nerves12.02NA8.051.58NA21.65090
21620APartial removal of sternum6.78NA6.070.93NA13.78090
21627ASternal debridement6.80NA6.460.99NA14.25090
21630AExtensive sternum surgery17.35NA11.992.35NA31.69090
21632AExtensive sternum surgery18.11NA11.182.61NA31.90090
21685AHyoid myotomy & suspension12.98NA10.091.52NA24.59090
21700ARevision of neck muscle6.186.084.860.3712.6311.41090
21705ARevision of neck muscle/rib9.59NA5.631.11NA16.33090
21720ARevision of neck muscle5.675.474.640.9612.1011.27090
21725ARevision of neck muscle6.98NA5.521.09NA13.59090
21740AReconstruction of sternum16.48NA8.602.45NA27.53090
21742CRepair stern/nuss w/o scope0.000.000.000.000.000.00090
21743CRepair sternum/nuss w/scope0.000.000.000.000.000.00090
21750ARepair of sternum separation10.75NA6.141.63NA18.52090
21800ATreatment of rib fracture0.962.101.400.113.172.47090
21805ATreatment of rib fracture2.75NA3.350.35NA6.45090
21810ATreatment of rib fracture(s)6.85NA5.030.72NA12.60090
21820ATreat sternum fracture1.282.631.830.184.093.29090
21825ATreat sternum fracture7.40NA6.691.01NA15.10090
21899CNeck/chest surgery procedure0.000.000.000.000.000.00YYY
21920ABiopsy soft tissue of back2.063.281.490.145.483.69010
21925ABiopsy soft tissue of back4.486.633.350.5311.648.36090
21930ARemove lesion, back or flank4.995.483.460.5911.069.04090
21935ARemove tumor, back17.93NA10.202.26NA30.39090
22100ARemove part of neck vertebra9.72NA7.631.87NA19.22090
22101ARemove part, thorax vertebra9.80NA7.871.82NA19.49090
22102ARemove part, lumbar vertebra9.80NA8.081.76NA19.64090
22103ARemove extra spine segment2.34NA1.210.45NA4.00ZZZ
22110ARemove part of neck vertebra12.72NA9.272.65NA24.64090
22112ARemove part, thorax vertebra12.79NA9.332.36NA24.48090
22114ARemove part, lumbar vertebra12.79NA9.312.39NA24.49090
22116ARemove extra spine segment2.32NA1.170.48NA3.97ZZZ
22210ARevision of neck spine23.78NA15.515.10NA44.39090
22212ARevision of thorax spine19.39NA13.273.35NA36.01090
22214ARevision of lumbar spine19.42NA13.783.35NA36.55090
22216ARevise, extra spine segment6.03NA3.141.18NA10.35ZZZ
22220ARevision of neck spine21.34NA13.794.40NA39.53090
22222ARevision of thorax spine21.49NA11.613.71NA36.81090
22224ARevision of lumbar spine21.49NA14.243.86NA39.59090
22226ARevise, extra spine segment6.03NA3.111.22NA10.36ZZZ
22305ATreat spine process fracture2.053.192.390.355.594.79090
22310ATreat spine fracture2.614.884.110.457.947.17090
22315ATreat spine fracture8.8313.427.531.6523.9018.01090
22318ATreat odontoid fx w/o graft21.47NA13.525.14NA40.13090
22319ATreat odontoid fx w/graft23.96NA14.905.74NA44.60090
22325ATreat spine fracture18.27NA12.153.15NA33.57090
22326ATreat neck spine fracture19.56NA12.834.27NA36.66090
22327ATreat thorax spine fracture19.17NA12.443.32NA34.93090
22328ATreat each add spine fx4.60NA2.280.80NA7.68ZZZ
22505AManipulation of spine1.87NA0.940.33NA3.14010
22520APercut vertebroplasty thor8.90101.624.341.19111.7114.43010
22521APercut vertebroplasty lumb8.3389.474.181.1298.9213.63010
22522APercut vertebroplasty add'l4.30NA1.690.40NA6.39ZZZ
22532ALat thorax spine fusion23.96NA14.824.56NA43.34090
22533ALat lumbar spine fusion23.09NA13.483.84NA40.41090
22534ALat thor/lumb, add'l seg5.99NA3.041.18NA10.21ZZZ
22548ANeck spine fusion25.78NA15.836.01NA47.62090
22554ANeck spine fusion18.59NA12.324.23NA35.14090
22556AThorax spine fusion23.42NA14.684.56NA42.66090
Start Printed Page 1128
22558ALumbar spine fusion22.25NA13.243.84NA39.33090
22585AAdditional spinal fusion5.52NA2.801.18NA9.50ZZZ
22590ASpine & skull spinal fusion20.48NA13.294.60NA38.37090
22595ANeck spinal fusion19.36NA12.804.37NA36.53090
22600ANeck spine fusion16.12NA11.143.49NA30.75090
22610AThorax spine fusion16.00NA11.323.21NA30.53090
22612ALumbar spine fusion20.97NA14.093.96NA39.02090
22614ASpine fusion, extra segment6.43NA3.361.25NA11.04ZZZ
22630ALumbar spine fusion20.81NA13.554.57NA38.93090
22632ASpine fusion, extra segment5.22NA2.671.09NA8.98ZZZ
22800AFusion of spine18.22NA12.643.27NA34.13090
22802AFusion of spine30.83NA19.485.33NA55.64090
22804AFusion of spine36.22NA22.586.31NA65.11090
22808AFusion of spine26.23NA16.255.26NA47.74090
22810AFusion of spine30.22NA18.295.42NA53.93090
22812AFusion of spine32.65NA19.955.63NA58.23090
22818AKyphectomy, 1-2 segments31.78NA18.866.04NA56.68090
22819AKyphectomy, 3 or more36.39NA20.036.27NA62.69090
22830AExploration of spinal fusion10.83NA7.892.09NA20.81090
22840AInsert spine fixation device12.52NA6.512.45NA21.48ZZZ
22841BInsert spine fixation device0.000.000.000.000.000.00XXX
22842AInsert spine fixation device12.56NA6.532.46NA21.55ZZZ
22843AInsert spine fixation device13.44NA6.632.53NA22.60ZZZ
22844AInsert spine fixation device16.42NA8.782.92NA28.12ZZZ
22845AInsert spine fixation device11.94NA6.112.68NA20.73ZZZ
22846AInsert spine fixation device12.40NA6.362.73NA21.49ZZZ
22847AInsert spine fixation device13.78NA7.062.85NA23.69ZZZ
22848AInsert pelv fixation device5.99NA3.201.06NA10.25ZZZ
22849AReinsert spinal fixation18.48NA11.763.46NA33.70090
22850ARemove spine fixation device9.51NA7.001.82NA18.33090
22851AApply spine prosth device6.70NA3.371.34NA11.41ZZZ
22852ARemove spine fixation device9.00NA6.791.69NA17.48090
22855ARemove spine fixation device15.11NA9.723.30NA28.13090
22899CSpine surgery procedure0.000.000.000.000.000.00YYY
22900ARemove abdominal wall lesion5.79NA3.280.70NA9.77090
22999CAbdomen surgery procedure0.000.000.000.000.000.00YYY
23000ARemoval of calcium deposits4.355.184.160.6010.139.11090
23020ARelease shoulder joint8.92NA7.581.48NA17.98090
23030ADrain shoulder lesion3.423.012.930.516.946.86010
23031ADrain shoulder bursa2.742.692.690.405.835.83010
23035ADrain shoulder bone lesion8.60NA8.511.44NA18.55090
23040AExploratory shoulder surgery9.19NA7.851.54NA18.58090
23044AExploratory shoulder surgery7.11NA6.501.17NA14.78090
23065ABiopsy shoulder tissues2.272.811.540.175.253.98010
23066ABiopsy shoulder tissues4.155.104.070.609.858.82090
23075ARemoval of shoulder lesion2.392.241.820.304.934.51010
23076ARemoval of shoulder lesion7.62NA5.781.05NA14.45090
23077ARemove tumor of shoulder16.07NA10.762.18NA29.01090
23100ABiopsy of shoulder joint6.02NA5.690.98NA12.69090
23101AShoulder joint surgery5.57NA5.390.93NA11.89090
23105ARemove shoulder joint lining8.22NA7.171.36NA16.75090
23106AIncision of collarbone joint5.95NA5.770.99NA12.71090
23107AExplore treat shoulder joint8.61NA7.391.44NA17.44090
23120APartial removal, collar bone7.10NA6.481.19NA14.77090
23125ARemoval of collar bone9.38NA7.631.53NA18.54090
23130ARemove shoulder bone, part7.54NA7.101.28NA15.92090
23140ARemoval of bone lesion6.88NA5.410.99NA13.28090
23145ARemoval of bone lesion9.08NA7.581.50NA18.16090
23146ARemoval of bone lesion7.82NA7.131.34NA16.29090
23150ARemoval of humerus lesion8.47NA6.971.37NA16.81090
23155ARemoval of humerus lesion10.33NA8.461.45NA20.24090
23156ARemoval of humerus lesion8.67NA7.381.42NA17.47090
23170ARemove collar bone lesion6.85NA6.361.01NA14.22090
23172ARemove shoulder blade lesion6.89NA6.411.15NA14.45090
23174ARemove humerus lesion9.50NA8.371.57NA19.44090
23180ARemove collar bone lesion8.52NA9.211.42NA19.15090
23182ARemove shoulder blade lesion8.14NA8.891.30NA18.33090
23184ARemove humerus lesion9.37NA9.541.50NA20.41090
23190APartial removal of scapula7.23NA6.231.17NA14.63090
23195ARemoval of head of humerus9.80NA7.761.66NA19.22090
23200ARemoval of collar bone12.06NA8.971.79NA22.82090
23210ARemoval of shoulder blade12.47NA9.301.94NA23.71090
23220APartial removal of humerus14.54NA10.872.45NA27.86090
23221APartial removal of humerus17.71NA11.843.03NA32.58090
23222APartial removal of humerus23.88NA15.854.06NA43.79090
Start Printed Page 1129
23330ARemove shoulder foreign body1.851.981.910.224.053.98010
23331ARemove shoulder foreign body7.37NA6.791.23NA15.39090
23332ARemove shoulder foreign body11.60NA9.311.95NA22.86090
23350AInjection for shoulder x-ray1.003.850.330.064.911.39000
23395AMuscle transfer,shoulder/arm16.82NA12.742.76NA32.32090
23397AMuscle transfers16.11NA11.402.70NA30.21090
23400AFixation of shoulder blade13.52NA10.162.30NA25.98090
23405AIncision of tendon & muscle8.36NA7.011.35NA16.72090
23406AIncise tendon(s) & muscle(s)10.77NA8.411.79NA20.97090
23410ARepair rotator cuff, acute12.43NA9.402.07NA23.90090
23412ARepair rotator cuff, chronic13.29NA9.902.24NA25.43090
23415ARelease of shoulder ligament9.96NA7.971.68NA19.61090
23420ARepair of shoulder13.28NA10.782.24NA26.30090
23430ARepair biceps tendon9.97NA8.111.69NA19.77090
23440ARemove/transplant tendon10.46NA8.291.77NA20.52090
23450ARepair shoulder capsule13.38NA9.872.24NA25.49090
23455ARepair shoulder capsule14.35NA10.452.42NA27.22090
23460ARepair shoulder capsule15.35NA11.372.62NA29.34090
23462ARepair shoulder capsule15.28NA10.782.61NA28.67090
23465ARepair shoulder capsule15.83NA11.301.94NA29.07090
23466ARepair shoulder capsule14.20NA11.272.41NA27.88090
23470AReconstruct shoulder joint17.12NA12.132.89NA32.14090
23472AReconstruct shoulder joint21.07NA14.272.86NA38.20090
23480ARevision of collar bone11.16NA8.771.88NA21.81090
23485ARevision of collar bone13.41NA9.912.22NA25.54090
23490AReinforce clavicle11.84NA8.811.34NA21.99090
23491AReinforce shoulder bones14.19NA10.702.41NA27.30090
23500ATreat clavicle fracture2.083.662.570.316.054.96090
23505ATreat clavicle fracture3.685.333.760.609.618.04090
23515ATreat clavicle fracture7.40NA6.521.24NA15.16090
23520ATreat clavicle dislocation2.163.652.710.316.125.18090
23525ATreat clavicle dislocation3.595.273.880.539.398.00090
23530ATreat clavicle dislocation7.30NA6.031.03NA14.36090
23532ATreat clavicle dislocation8.00NA6.921.36NA16.28090
23540ATreat clavicle dislocation2.234.262.460.296.784.98090
23545ATreat clavicle dislocation3.254.503.380.478.227.10090
23550ATreat clavicle dislocation7.23NA6.381.13NA14.74090
23552ATreat clavicle dislocation8.44NA7.261.42NA17.12090
23570ATreat shoulder blade fx2.233.672.870.356.255.45090
23575ATreat shoulder blade fx4.055.764.240.6410.458.93090
23585ATreat scapula fracture8.95NA7.601.51NA18.06090
23600ATreat humerus fracture2.935.733.820.479.137.22090
23605ATreat humerus fracture4.866.594.960.8112.2610.63090
23615ATreat humerus fracture9.34NA8.691.58NA19.61090
23616ATreat humerus fracture21.24NA14.133.59NA38.96090
23620ATreat humerus fracture2.405.203.230.397.996.02090
23625ATreat humerus fracture3.926.334.560.6410.899.12090
23630ATreat humerus fracture7.34NA6.591.24NA15.17090
23650ATreat shoulder dislocation3.384.692.880.378.446.63090
23655ATreat shoulder dislocation4.56NA4.160.63NA9.35090
23660ATreat shoulder dislocation7.48NA6.361.22NA15.06090
23665ATreat islocation/fracture4.466.584.930.7211.7610.11090
23670ATreat dislocation/fracture7.89NA6.821.33NA16.04090
23675ATreat dislocation/fracture6.047.566.061.0014.6013.10090
23680ATreat dislocation/fracture10.04NA8.091.68NA19.81090
23700AFixation of shoulder2.52NA2.300.42NA5.24010
23800AFusion of shoulder joint14.14NA10.462.38NA26.98090
23802AFusion of shoulder joint16.58NA10.232.82NA29.63090
23900AAmputation of arm & girdle19.69NA11.912.98NA34.58090
23920AAmputation at shoulder joint14.59NA10.092.32NA27.00090
23921AAmputation follow-up surgery5.485.165.160.9411.5811.58090
23929CShoulder surgery procedure0.000.000.000.000.000.00YYY
23930ADrainage of arm lesion2.942.712.350.396.045.68010
23931ADrainage of arm bursa1.792.432.190.254.474.23010
23935ADrain arm/elbow bone lesion6.08NA6.131.01NA13.22090
24000AExploratory elbow surgery5.81NA5.360.93NA12.10090
24006ARelease elbow joint9.30NA7.691.53NA18.52090
24065ABiopsy arm/elbow soft tissue2.082.101.780.174.354.03010
24066ABiopsy arm/elbow soft tissue5.205.764.270.7411.7010.21090
24075ARemove arm/elbow lesion3.915.053.670.529.488.10090
24076ARemove arm/elbow lesion6.29NA5.090.84NA12.22090
24077ARemove tumor of arm/elbow11.74NA8.651.59NA21.98090
24100ABiopsy elbow joint lining4.92NA4.490.75NA10.16090
24101AExplore/treat elbow joint6.12NA5.861.01NA12.99090
24102ARemove elbow joint lining8.02NA6.831.31NA16.16090
Start Printed Page 1130
24105ARemoval of elbow bursa3.60NA4.350.59NA8.54090
24110ARemove humerus lesion7.38NA6.711.19NA15.28090
24115ARemove/graft bone lesion9.62NA7.351.39NA18.36090
24116ARemove/graft bone lesion11.79NA9.112.00NA22.90090
24120ARemove elbow lesion6.64NA5.881.05NA13.57090
24125ARemove/graft bone lesion7.88NA6.181.06NA15.12090
24126ARemove/graft bone lesion8.30NA6.971.09NA16.36090
24130ARemoval of head of radius6.24NA5.951.05NA13.24090
24134ARemoval of arm bone lesion9.72NA9.181.58NA20.48090
24136ARemove radius bone lesion7.98NA7.411.03NA16.42090
24138ARemove elbow bone lesion8.04NA7.671.35NA17.06090
24140APartial removal of arm bone9.17NA9.491.48NA20.14090
24145APartial removal of radius7.57NA8.151.22NA16.94090
24147APartial removal of elbow7.53NA8.641.25NA17.42090
24149ARadical resection of elbow14.18NA11.412.29NA27.88090
24150AExtensive humerus surgery13.25NA10.102.18NA25.53090
24151AExtensive humerus surgery15.56NA11.672.64NA29.87090
24152AExtensive radius surgery10.04NA7.851.44NA19.33090
24153AExtensive radius surgery11.52NA5.830.77NA18.12090
24155ARemoval of elbow joint11.71NA8.411.71NA21.83090
24160ARemove elbow joint implant7.82NA6.771.29NA15.88090
24164ARemove radius head implant6.22NA5.661.01NA12.89090
24200ARemoval of arm foreign body1.761.971.670.183.913.61010
24201ARemoval of arm foreign body4.555.684.340.6810.919.57090
24220AInjection for elbow x-ray1.3110.320.440.0811.711.83000
24300AManipulate elbow w/anesth3.74NA5.480.59NA9.81090
24301AMuscle/tendon transfer10.18NA8.181.57NA19.93090
24305AArm tendon lengthening7.44NA6.681.18NA15.30090
24310ARevision of arm tendon5.97NA5.720.89NA12.58090
24320ARepair of arm tendon10.54NA7.741.21NA19.49090
24330ARevision of arm muscles9.59NA7.861.46NA18.91090
24331ARevision of arm muscles10.63NA8.601.70NA20.93090
24332ATenolysis, triceps7.44NA6.580.93NA14.95090
24340ARepair of biceps tendon7.88NA6.911.30NA16.09090
24341ARepair arm tendon/muscle7.89NA7.751.30NA16.94090
24342ARepair of ruptured tendon10.60NA8.461.79NA20.85090
24343ARepr elbow lat ligmnt w/tiss8.64NA7.931.36NA17.93090
24344AReconstruct elbow lat ligmnt13.98NA11.312.21NA27.50090
24345ARepr elbw med ligmnt w/tissu8.64NA7.831.36NA17.83090
24346AReconstruct elbow med ligmnt13.98NA11.172.21NA27.36090
24350ARepair of tennis elbow5.24NA5.520.87NA11.63090
24351ARepair of tennis elbow5.90NA5.860.99NA12.75090
24352ARepair of tennis elbow6.42NA6.121.09NA13.63090
24354ARepair of tennis elbow6.47NA6.081.06NA13.61090
24356ARevision of tennis elbow6.67NA6.261.09NA14.02090
24360AReconstruct elbow joint12.32NA9.352.04NA23.71090
24361AReconstruct elbow joint14.06NA10.442.35NA26.85090
24362AReconstruct elbow joint14.97NA9.972.32NA27.26090
24363AReplace elbow joint18.46NA13.533.04NA35.03090
24365AReconstruct head of radius8.38NA7.091.34NA16.81090
24366AReconstruct head of radius9.12NA7.431.54NA18.09090
24400ARevision of humerus11.04NA8.911.85NA21.80090
24410ARevision of humerus14.80NA10.432.28NA27.51090
24420ARevision of humerus13.42NA10.662.20NA26.28090
24430ARepair of humerus12.79NA9.752.17NA24.71090
24435ARepair humerus with graft13.15NA10.832.22NA26.20090
24470ARevision of elbow joint8.73NA7.621.48NA17.83090
24495ADecompression of forearm8.11NA9.051.11NA18.27090
24498AReinforce humerus11.90NA9.282.01NA23.19090
24500ATreat humerus fracture3.215.403.610.499.107.31090
24505ATreat humerus fracture5.167.295.280.8713.3211.31090
24515ATreat humerus fracture11.63NA9.341.97NA22.94090
24516ATreat humerus fracture11.63NA9.111.97NA22.71090
24530ATreat humerus fracture3.495.393.940.579.458.00090
24535ATreat humerus fracture6.868.396.401.1616.4114.42090
24538ATreat humerus fracture9.42NA8.691.51NA19.62090
24545ATreat humerus fracture10.44NA8.421.77NA20.63090
24546ATreat humerus fracture15.67NA11.312.63NA29.61090
24560ATreat humerus fracture2.805.073.210.428.296.43090
24565ATreat humerus fracture5.557.285.400.8913.7211.84090
24566ATreat humerus fracture7.78NA8.111.33NA17.22090
24575ATreat humerus fracture10.64NA8.301.74NA20.68090
24576ATreat humerus fracture2.864.943.590.468.266.91090
24577ATreat humerus fracture5.787.565.690.9814.3212.45090
24579ATreat humerus fracture11.58NA8.831.95NA22.36090
Start Printed Page 1131
24582ATreat humerus fracture8.54NA9.011.45NA19.00090
24586ATreat elbow fracture15.19NA11.112.56NA28.86090
24587ATreat elbow fracture15.14NA10.912.58NA28.63090
24600ATreat elbow dislocation4.225.573.520.5910.388.33090
24605ATreat elbow dislocation5.41NA5.250.87NA11.53090
24615ATreat elbow dislocation9.41NA7.731.58NA18.72090
24620ATreat elbow fracture6.97NA6.111.09NA14.17090
24635ATreat elbow fracture13.17NA14.212.22NA29.60090
24640ATreat elbow dislocation1.201.930.870.133.262.20010
24650ATreat radius fracture2.164.552.730.347.055.23090
24655ATreat radius fracture4.396.764.690.7011.859.78090
24665ATreat radius fracture8.13NA7.481.36NA16.97090
24666ATreat radius fracture9.48NA8.051.59NA19.12090
24670ATreat ulnar fracture2.544.443.010.407.385.95090
24675ATreat ulnar fracture4.716.724.820.7812.2110.31090
24685ATreat ulnar fracture8.79NA7.521.48NA17.79090
24800AFusion of elbow joint11.18NA8.711.70NA21.59090
24802AFusion/graft of elbow joint13.67NA10.322.28NA26.27090
24900AAmputation of upper arm9.59NA7.351.42NA18.36090
24920AAmputation of upper arm9.53NA7.521.47NA18.52090
24925AAmputation follow-up surgery7.06NA6.271.15NA14.48090
24930AAmputation follow-up surgery10.23NA7.521.48NA19.23090
24931AAmputate upper arm & implant12.70NA6.111.88NA20.69090
24935ARevision of amputation15.54NA8.421.91NA25.87090
24940CRevision of upper arm0.000.000.000.000.000.00090
24999CUpper arm/elbow surgery0.000.000.000.000.000.00YYY
25000AIncision of tendon sheath3.37NA6.950.54NA10.86090
25001AIncise flexor carpi radialis3.37NA4.090.54NA8.00090
25020ADecompress forearm 1 space5.91NA9.940.92NA16.77090
25023ADecompress forearm 1 space12.94NA15.451.83NA30.22090
25024ADecompress forearm 2 spaces9.49NA7.521.50NA18.51090
25025ADecompress forearm 2 spaces16.52NA10.002.63NA29.15090
25028ADrainage of forearm lesion5.24NA8.480.74NA14.46090
25031ADrainage of forearm bursa4.13NA8.250.60NA12.98090
25035ATreat forearm bone lesion7.35NA14.031.18NA22.56090
25040AExplore/treat wrist joint7.17NA7.341.16NA15.67090
25065ABiopsy forearm soft tissues1.992.792.790.144.924.92010
25066ABiopsy forearm soft tissues4.12NA7.240.59NA11.95090
25075ARemovel forearm lesion subcu3.73NA6.130.48NA10.34090
25076ARemovel forearm lesion deep4.91NA9.980.71NA15.60090
25077ARemove tumor, forearm/wrist9.75NA12.681.33NA23.76090
25085AIncision of wrist capsule5.49NA7.300.86NA13.65090
25100ABiopsy of wrist joint3.89NA5.410.60NA9.90090
25101AExplore/treat wrist joint4.68NA5.960.72NA11.36090
25105ARemove wrist joint lining5.84NA7.480.93NA14.25090
25107ARemove wrist joint cartilage6.42NA8.410.99NA15.82090
25110ARemove wrist tendon lesion3.91NA7.260.58NA11.75090
25111ARemove wrist tendon lesion3.38NA4.830.51NA8.72090
25112AReremove wrist tendon lesion4.52NA5.430.65NA10.60090
25115ARemove wrist/forearm lesion8.81NA14.441.34NA24.59090
25116ARemove wrist/forearm lesion7.10NA13.531.09NA21.72090
25118AExcise wrist tendon sheath4.36NA5.880.66NA10.90090
25119APartial removal of ulna6.03NA7.770.96NA14.76090
25120ARemoval of forearm lesion6.09NA12.440.98NA19.51090
25125ARemove/graft forearm lesion7.47NA13.211.23NA21.91090
25126ARemove/graft forearm lesion7.54NA13.311.21NA22.06090
25130ARemoval of wrist lesion5.25NA6.510.80NA12.56090
25135ARemove & graft wrist lesion6.88NA7.531.07NA15.48090
25136ARemove & graft wrist lesion5.96NA6.680.70NA13.34090
25145ARemove forearm bone lesion6.36NA12.470.99NA19.82090
25150APartial removal of ulna7.08NA8.411.16NA16.65090
25151APartial removal of radius7.38NA13.081.12NA21.58090
25170AExtensive forearm surgery11.07NA15.461.83NA28.36090
25210ARemoval of wrist bone5.94NA6.900.88NA13.72090
25215ARemoval of wrist bones7.88NA8.891.23NA18.00090
25230APartial removal of radius5.22NA6.220.80NA12.24090
25240APartial removal of ulna5.16NA7.090.83NA13.08090
25246AInjection for wrist x-ray1.4510.050.480.0811.582.01000
25248ARemove forearm foreign body5.13NA8.750.65NA14.53090
25250ARemoval of wrist prosthesis6.59NA6.001.01NA13.60090
25251ARemoval of wrist prosthesis9.56NA7.821.39NA18.77090
25259AManipulate wrist w/anesthes3.74NA5.480.60NA9.82090
25260ARepair forearm tendon/muscle7.79NA13.901.17NA22.86090
25263ARepair forearm tendon/muscle7.81NA13.811.13NA22.75090
25265ARepair forearm tendon/muscle9.87NA14.701.44NA26.01090
Start Printed Page 1132
25270ARepair forearm tendon/muscle5.99NA12.600.92NA19.51090
25272ARepair forearm tendon/muscle7.03NA13.301.07NA21.40090
25274ARepair forearm tendon/muscle8.74NA14.021.37NA24.13090
25275ARepair forearm tendon sheath8.49NA7.471.36NA17.32090
25280ARevise wrist/forearm tendon7.21NA13.031.10NA21.34090
25290AIncise wrist/forearm tendon5.28NA15.530.80NA21.61090
25295ARelease wrist/forearm tendon6.54NA12.591.04NA20.17090
25300AFusion of tendons at wrist8.79NA8.521.29NA18.60090
25301AFusion of tendons at wrist8.39NA8.161.30NA17.85090
25310ATransplant forearm tendon8.13NA13.441.22NA22.79090
25312ATransplant forearm tendon9.56NA14.321.47NA25.35090
25315ARevise palsy hand tendon(s)10.18NA14.891.52NA26.59090
25316ARevise palsy hand tendon(s)12.31NA16.662.10NA31.07090
25320ARepair/revise wrist joint10.75NA11.211.59NA23.55090
25332ARevise wrist joint11.39NA9.061.76NA22.21090
25335ARealignment of hand12.86NA11.722.00NA26.58090
25337AReconstruct ulna/radioulnar10.15NA11.071.58NA22.80090
25350ARevision of radius8.77NA14.281.41NA24.46090
25355ARevision of radius10.15NA14.901.74NA26.79090
25360ARevision of ulna8.42NA14.171.41NA24.00090
25365ARevise radius & ulna12.38NA15.932.01NA30.32090
25370ARevise radius or ulna13.34NA16.302.27NA31.91090
25375ARevise radius & ulna13.02NA16.722.22NA31.96090
25390AShorten radius or ulna10.38NA14.911.66NA26.95090
25391ALengthen radius or ulna13.63NA16.872.09NA32.59090
25392AShorten radius & ulna13.93NA16.242.09NA32.26090
25393ALengthen radius & ulna15.85NA17.882.26NA35.99090
25394ARepair carpal bone, shorten10.38NA8.231.69NA20.30090
25400ARepair radius or ulna10.90NA15.491.81NA28.20090
25405ARepair/graft radius or ulna14.36NA17.582.35NA34.29090
25415ARepair radius & ulna13.33NA16.812.26NA32.40090
25420ARepair/graft radius & ulna16.31NA18.562.65NA37.52090
25425ARepair/graft radius or ulna13.19NA22.081.94NA37.21090
25426ARepair/graft radius & ulna15.80NA17.292.69NA35.78090
25430AVasc graft into carpal bone9.24NA7.281.29NA17.81090
25431ARepair nonunion carpal bone10.42NA8.230.68NA19.33090
25440ARepair/graft wrist bone10.42NA9.411.70NA21.53090
25441AReconstruct wrist joint12.88NA9.882.21NA24.97090
25442AReconstruct wrist joint10.83NA8.771.50NA21.10090
25443AReconstruct wrist joint10.37NA8.651.57NA20.59090
25444AReconstruct wrist joint11.13NA9.071.72NA21.92090
25445AReconstruct wrist joint9.68NA7.871.52NA19.07090
25446AWrist replacement16.53NA11.812.65NA30.99090
25447ARepair wrist joint(s)10.35NA8.541.62NA20.51090
25449ARemove wrist joint implant14.47NA10.572.13NA27.17090
25450ARevision of wrist joint7.86NA10.411.06NA19.33090
25455ARevision of wrist joint9.48NA11.331.29NA22.10090
25490AReinforce radius9.53NA14.031.44NA25.00090
25491AReinforce ulna9.95NA14.791.70NA26.44090
25492AReinforce radius and ulna12.31NA15.581.95NA29.84090
25500ATreat fracture of radius2.453.992.710.346.785.50090
25505ATreat fracture of radius5.207.225.250.8313.2511.28090
25515ATreat fracture of radius9.17NA7.471.47NA18.11090
25520ATreat fracture of radius6.257.445.871.0314.7213.15090
25525ATreat fracture of radius12.22NA9.942.03NA24.19090
25526ATreat fracture of radius12.96NA13.592.17NA28.72090
25530ATreat fracture of ulna2.094.142.800.336.565.22090
25535ATreat fracture of ulna5.136.855.170.8212.8011.12090
25545ATreat fracture of ulna8.89NA7.651.48NA18.02090
25560ATreat fracture radius & ulna2.444.042.640.336.815.41090
25565ATreat fracture radius & ulna5.627.355.320.9213.8911.86090
25574ATreat fracture radius & ulna7.00NA7.131.16NA15.29090
25575ATreat fracture radius/ulna10.43NA9.391.76NA21.58090
25600ATreat fracture radius/ulna2.634.472.940.417.515.98090
25605ATreat fracture radius/ulna5.808.036.010.9814.8112.79090
25611ATreat fracture radius/ulna7.76NA8.841.30NA17.90090
25620ATreat fracture radius/ulna8.54NA7.281.41NA17.23090
25622ATreat wrist bone fracture2.614.643.120.407.656.13090
25624ATreat wrist bone fracture4.526.984.900.7412.2410.16090
25628ATreat wrist bone fracture8.42NA7.811.37NA17.60090
25630ATreat wrist bone fracture2.884.572.940.457.906.27090
25635ATreat wrist bone fracture4.386.753.890.4711.608.74090
25645ATreat wrist bone fracture7.24NA6.791.12NA15.15090
25650ATreat wrist bone fracture3.054.833.220.458.336.72090
25651APin ulnar styloid fracture5.35NA5.390.87NA11.61090
Start Printed Page 1133
25652ATreat fracture ulnar styloid7.59NA6.851.23NA15.67090
25660ATreat wrist dislocation4.75NA4.660.71NA10.12090
25670ATreat wrist dislocation7.91NA7.081.29NA16.28090
25671APin radioulnar dislocation5.99NA5.980.98NA12.95090
25675ATreat wrist dislocation4.666.494.610.6911.849.96090
25676ATreat wrist dislocation8.03NA7.321.33NA16.68090
25680ATreat wrist fracture5.98NA4.750.74NA11.47090
25685ATreat wrist fracture9.77NA7.871.51NA19.15090
25690ATreat wrist dislocation5.49NA5.390.94NA11.82090
25695ATreat wrist dislocation8.33NA7.191.29NA16.81090
25800AFusion of wrist joint9.75NA9.101.57NA20.42090
25805AFusion/graft of wrist joint11.26NA10.241.82NA23.32090
25810AFusion/graft of wrist joint10.55NA9.881.65NA22.08090
25820AFusion of hand bones7.44NA7.881.16NA16.48090
25825AFuse hand bones with graft9.26NA9.221.45NA19.93090
25830AFusion, radioulnar jnt/ulna10.04NA14.691.53NA26.26090
25900AAmputation of forearm9.00NA12.891.30NA23.19090
25905AAmputation of forearm9.11NA12.821.28NA23.21090
25907AAmputation follow-up surgery7.79NA12.211.22NA21.22090
25909AAmputation follow-up surgery8.95NA12.761.29NA23.00090
25915AAmputation of forearm17.05NA19.512.91NA39.47090
25920AAmputate hand at wrist8.67NA8.001.28NA17.95090
25922AAmputate hand at wrist7.41NA7.251.12NA15.78090
25924AAmputation follow-up surgery8.45NA8.221.29NA17.96090
25927AAmputation of hand8.79NA12.151.23NA22.17090
25929AAmputation follow-up surgery7.58NA6.061.07NA14.71090
25931AAmputation follow-up surgery7.80NA12.061.06NA20.92090
25999CForearm or wrist surgery0.000.000.000.000.000.00YYY
26010ADrainage of finger abscess1.545.671.660.177.383.37010
26011ADrainage of finger abscess2.199.082.310.3011.574.80010
26020ADrain hand tendon sheath4.66NA5.570.71NA10.94090
26025ADrainage of palm bursa4.81NA5.360.72NA10.89090
26030ADrainage of palm bursa(s)5.92NA6.000.87NA12.79090
26034ATreat hand bone lesion6.22NA6.270.95NA13.44090
26035ADecompress fingers/hand9.50NA8.101.35NA18.95090
26037ADecompress fingers/hand7.24NA6.601.05NA14.89090
26040ARelease palm contracture3.33NA3.990.54NA7.86090
26045ARelease palm contracture5.55NA5.560.89NA12.00090
26055AIncise finger tendon sheath2.6914.543.850.4317.666.97090
26060AIncision of finger tendon2.81NA3.450.42NA6.68090
26070AExplore/treat hand joint3.68NA3.360.42NA7.46090
26075AExplore/treat finger joint3.78NA3.760.48NA8.02090
26080AExplore/treat finger joint4.23NA4.780.63NA9.64090
26100ABiopsy hand joint lining3.66NA4.100.54NA8.30090
26105ABiopsy finger joint lining3.70NA4.170.54NA8.41090
26110ABiopsy finger joint lining3.52NA3.980.53NA8.03090
26115ARemovel hand lesion subcut3.8513.334.670.5817.769.10090
26116ARemovel hand lesion, deep5.52NA5.920.83NA12.27090
26117ARemove tumor, hand/finger8.54NA7.031.22NA16.79090
26121ARelease palm contracture7.53NA6.901.13NA15.56090
26123ARelease palm contracture9.28NA8.741.41NA19.43090
26125ARelease palm contracture4.60NA2.460.69NA7.75ZZZ
26130ARemove wrist joint lining5.41NA5.300.78NA11.49090
26135ARevise finger joint, each6.95NA6.391.05NA14.39090
26140ARevise finger joint, each6.16NA5.970.92NA13.05090
26145ATendon excision, palm/finger6.31NA5.980.93NA13.22090
26160ARemove tendon sheath lesion3.1512.694.040.4716.317.66090
26170ARemoval of palm tendon, each4.76NA4.880.72NA10.36090
26180ARemoval of finger tendon5.17NA5.350.77NA11.29090
26185ARemove finger bone5.24NA5.910.81NA11.96090
26200ARemove hand bone lesion5.50NA5.290.86NA11.65090
26205ARemove/graft bone lesion7.69NA6.841.15NA15.68090
26210ARemoval of finger lesion5.14NA5.360.77NA11.27090
26215ARemove/graft finger lesion7.09NA6.260.93NA14.28090
26230APartial removal of hand bone6.32NA5.851.01NA13.18090
26235APartial removal, finger bone6.18NA5.750.94NA12.87090
26236APartial removal, finger bone5.31NA5.280.80NA11.39090
26250AExtensive hand surgery7.54NA6.381.11NA15.03090
26255AExtensive hand surgery12.41NA9.351.27NA23.03090
26260AExtensive finger surgery7.02NA6.141.00NA14.16090
26261AExtensive finger surgery9.08NA6.231.01NA16.32090
26262APartial removal of finger5.66NA5.290.84NA11.79090
26320ARemoval of implant from hand3.97NA4.250.59NA8.81090
26340AManipulate finger w/anesth2.50NA4.740.36NA7.60090
26350ARepair finger/hand tendon5.98NA15.490.88NA22.35090
Start Printed Page 1134
26352ARepair/graft hand tendon7.67NA16.081.12NA24.87090
26356ARepair finger/hand tendon8.06NA18.911.19NA28.16090
26357ARepair finger/hand tendon8.57NA16.531.23NA26.33090
26358ARepair/graft hand tendon9.13NA17.431.29NA27.85090
26370ARepair finger/hand tendon7.10NA15.951.09NA24.14090
26372ARepair/graft hand tendon8.75NA17.321.28NA27.35090
26373ARepair finger/hand tendon8.15NA16.871.18NA26.20090
26390ARevise hand/finger tendon9.18NA13.921.31NA24.41090
26392ARepair/graft hand tendon10.24NA17.661.52NA29.42090
26410ARepair hand tendon4.62NA12.590.69NA17.90090
26412ARepair/graft hand tendon6.30NA13.920.96NA21.18090
26415AExcision, hand/finger tendon8.33NA12.280.93NA21.54090
26416AGraft hand or finger tendon9.36NA15.211.45NA26.02090
26418ARepair finger tendon4.24NA12.950.60NA17.79090
26420ARepair/graft finger tendon6.76NA14.261.00NA22.02090
26426ARepair finger/hand tendon6.14NA13.780.93NA20.85090
26428ARepair/graft finger tendon7.20NA14.581.01NA22.79090
26432ARepair finger tendon4.01NA10.690.58NA15.28090
26433ARepair finger tendon4.55NA11.370.68NA16.60090
26434ARepair/graft finger tendon6.08NA12.060.86NA19.00090
26437ARealignment of tendons5.81NA11.980.89NA18.68090
26440ARelease palm/finger tendon5.01NA14.180.75NA19.94090
26442ARelease palm & finger tendon8.15NA16.611.13NA25.89090
26445ARelease hand/finger tendon4.30NA13.930.65NA18.88090
26449ARelease forearm/hand tendon6.99NA16.391.01NA24.39090
26450AIncision of palm tendon3.66NA7.580.55NA11.79090
26455AIncision of finger tendon3.63NA7.500.57NA11.70090
26460AIncise hand/finger tendon3.45NA7.320.53NA11.30090
26471AFusion of finger tendons5.72NA11.650.88NA18.25090
26474AFusion of finger tendons5.31NA11.840.83NA17.98090
26476ATendon lengthening5.17NA11.370.75NA17.29090
26477ATendon shortening5.14NA11.540.72NA17.40090
26478ALengthening of hand tendon5.79NA12.240.93NA18.96090
26479AShortening of hand tendon5.73NA12.080.92NA18.73090
26480ATransplant hand tendon6.68NA15.681.01NA23.37090
26483ATransplant/graft hand tendon8.28NA16.121.24NA25.64090
26485ATransplant palm tendon7.69NA16.011.13NA24.83090
26489ATransplant/graft palm tendon9.54NA12.541.18NA23.26090
26490ARevise thumb tendon8.40NA13.161.27NA22.83090
26492ATendon transfer with graft9.61NA13.971.44NA25.02090
26494AHand tendon/muscle transfer8.46NA13.611.36NA23.43090
26496ARevise thumb tendon9.58NA13.611.41NA24.60090
26497AFinger tendon transfer9.56NA13.961.41NA24.93090
26498AFinger tendon transfer13.98NA16.552.10NA32.63090
26499ARevision of finger8.97NA13.501.13NA23.60090
26500AHand tendon reconstruction5.95NA12.120.80NA18.87090
26502AHand tendon reconstruction7.13NA12.581.05NA20.76090
26504AHand tendon reconstruction7.46NA13.011.01NA21.48090
26508ARelease thumb contracture6.00NA12.110.92NA19.03090
26510AThumb tendon transfer5.42NA11.790.86NA18.07090
26516AFusion of knuckle joint7.14NA12.651.09NA20.88090
26517AFusion of knuckle joints8.82NA13.961.16NA23.94090
26518AFusion of knuckle joints9.01NA13.771.36NA24.14090
26520ARelease knuckle contracture5.29NA14.630.78NA20.70090
26525ARelease finger contracture5.32NA14.740.80NA20.86090
26530ARevise knuckle joint6.68NA6.021.04NA13.74090
26531ARevise knuckle with implant7.90NA6.991.22NA16.11090
26535ARevise finger joint5.23NA3.690.80NA9.72090
26536ARevise/implant finger joint6.36NA9.740.96NA17.06090
26540ARepair hand joint6.42NA12.350.98NA19.75090
26541ARepair hand joint with graft8.61NA13.831.35NA23.79090
26542ARepair hand joint with graft6.77NA12.391.05NA20.21090
26545AReconstruct finger joint6.91NA12.790.95NA20.65090
26546ARepair nonunion hand8.91NA15.201.37NA25.48090
26548AReconstruct finger joint8.02NA13.391.18NA22.59090
26550AConstruct thumb replacement21.21NA18.162.17NA41.54090
26551AGreat toe-hand transfer46.51NA33.717.92NA88.14090
26553ASingle transfer, toe-hand46.20NA23.222.40NA71.82090
26554ADouble transfer, toe-hand54.87NA38.029.36NA102.25090
26555APositional change of finger16.61NA18.672.57NA37.85090
26556AToe joint transfer47.19NA34.508.04NA89.73090
26560ARepair of web finger5.37NA10.280.72NA16.37090
26561ARepair of web finger10.90NA12.930.83NA24.66090
26562ARepair of web finger14.98NA17.591.18NA33.75090
26565ACorrect metacarpal flaw6.73NA12.461.01NA20.20090
Start Printed Page 1135
26567ACorrect finger deformity6.81NA12.391.01NA20.21090
26568ALengthen metacarpal/finger9.07NA16.091.33NA26.49090
26580ARepair hand deformity18.15NA13.981.76NA33.89090
26587AReconstruct extra finger14.03NA9.051.35NA24.43090
26590ARepair finger deformity17.93NA14.401.59NA33.92090
26591ARepair muscles of hand3.25NA10.440.45NA14.14090
26593ARelease muscles of hand5.30NA11.510.77NA17.58090
26596AExcision constricting tissue8.94NA9.011.05NA19.00090
26600ATreat metacarpal fracture1.964.082.640.306.344.90090
26605ATreat metacarpal fracture2.855.253.580.468.566.89090
26607ATreat metacarpal fracture5.35NA6.350.84NA12.54090
26608ATreat metacarpal fracture5.35NA6.350.88NA12.58090
26615ATreat metacarpal fracture5.32NA5.530.84NA11.69090
26641ATreat thumb dislocation3.935.403.580.519.848.02090
26645ATreat thumb fracture4.406.104.170.6511.159.22090
26650ATreat thumb fracture5.71NA6.760.93NA13.40090
26665ATreat thumb fracture7.59NA6.801.17NA15.56090
26670ATreat hand dislocation3.684.893.030.439.007.14090
26675ATreat hand dislocation4.636.234.410.6811.549.72090
26676APin hand dislocation5.51NA6.790.92NA13.22090
26685ATreat hand dislocation6.97NA6.261.15NA14.38090
26686ATreat hand dislocation7.93NA7.031.27NA16.23090
26700ATreat knuckle dislocation3.684.652.960.428.757.06090
26705ATreat knuckle dislocation4.186.034.240.6010.819.02090
26706APin knuckle dislocation5.11NA5.090.77NA10.97090
26715ATreat knuckle dislocation5.73NA5.710.90NA12.34090
26720ATreat finger fracture, each1.663.892.600.245.794.50090
26725ATreat finger fracture, each3.336.094.040.529.947.89090
26727ATreat finger fracture, each5.22NA6.400.83NA12.45090
26735ATreat finger fracture, each5.97NA5.860.93NA12.76090
26740ATreat finger fracture, each1.943.562.690.295.794.92090
26742ATreat finger fracture, each3.845.813.850.5910.248.28090
26746ATreat finger fracture, each5.80NA5.910.89NA12.60090
26750ATreat finger fracture, each1.703.142.080.235.074.01090
26755ATreat finger fracture, each3.104.813.050.458.366.60090
26756APin finger fracture, each4.38NA6.040.68NA11.10090
26765ATreat finger fracture, each4.16NA4.780.62NA9.56090
26770ATreat finger dislocation3.024.402.550.337.755.90090
26775ATreat finger dislocation3.705.853.820.5210.078.04090
26776APin finger dislocation4.79NA6.210.76NA11.76090
26785ATreat finger dislocation4.20NA4.810.65NA9.66090
26820AThumb fusion with graft8.25NA13.631.34NA23.22090
26841AFusion of thumb7.12NA13.531.17NA21.82090
26842AThumb fusion with graft8.23NA13.711.33NA23.27090
26843AFusion of hand joint7.60NA12.681.19NA21.47090
26844AFusion/graft of hand joint8.72NA13.681.35NA23.75090
26850AFusion of knuckle6.96NA12.561.07NA20.59090
26852AFusion of knuckle with graft8.45NA13.251.27NA22.97090
26860AFusion of finger joint4.68NA11.550.72NA16.95090
26861AFusion of finger jnt, add-on1.74NA0.930.27NA2.94ZZZ
26862AFusion/graft of finger joint7.36NA12.751.11NA21.22090
26863AFuse/graft added joint3.89NA2.120.62NA6.63ZZZ
26910AAmputate metacarpal bone7.59NA11.701.09NA20.38090
26951AAmputation of finger/thumb4.58NA10.620.68NA15.88090
26952AAmputation of finger/thumb6.30NA12.230.89NA19.42090
26989CHand/finger surgery0.000.000.000.000.000.00YYY
26990ADrainage of pelvis lesion7.47NA7.631.11NA16.21090
26991ADrainage of pelvis bursa6.677.475.941.0315.1713.64090
26992ADrainage of bone lesion13.00NA10.862.11NA25.97090
27000AIncision of hip tendon5.61NA5.290.92NA11.82090
27001AIncision of hip tendon6.93NA6.151.15NA14.23090
27003AIncision of hip tendon7.33NA6.551.12NA15.00090
27005AIncision of hip tendon9.65NA7.851.64NA19.14090
27006AIncision of hip tendons9.67NA7.991.60NA19.26090
27025AIncision of hip/thigh fascia11.14NA8.601.66NA21.40090
27030ADrainage of hip joint12.99NA9.662.18NA24.83090
27033AExploration of hip joint13.37NA9.932.26NA25.56090
27035ADenervation of hip joint16.66NA12.332.05NA31.04090
27036AExcision of hip joint/muscle12.86NA10.032.17NA25.06090
27040ABiopsy of soft tissues2.872.622.050.255.745.17010
27041ABiopsy of soft tissues9.88NA6.731.22NA17.83090
27047ARemove hip/pelvis lesion7.446.554.990.9514.9413.38090
27048ARemove hip/pelvis lesion6.24NA5.040.88NA12.16090
27049ARemove tumor, hip/pelvis13.64NA8.811.93NA24.38090
27050ABiopsy of sacroiliac joint4.35NA4.480.64NA9.47090
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27052ABiopsy of hip joint6.22NA5.891.03NA13.14090
27054ARemoval of hip joint lining8.53NA7.361.41NA17.30090
27060ARemoval of ischial bursa5.42NA4.840.72NA10.98090
27062ARemove femur lesion/bursa5.36NA5.220.89NA11.47090
27065ARemoval of hip bone lesion5.89NA5.540.92NA12.35090
27066ARemoval of hip bone lesion10.31NA8.511.71NA20.53090
27067ARemove/graft hip bone lesion13.81NA10.672.35NA26.83090
27070