20 Miss. Code R. § 2-VI

Current through June 25, 2024
Section 20-2-VI - NERVE BLOCKS
A.Diagnostic or Therapeutic
1. Please refer to the Pain Management section for guidelines and reimbursement of therapeutic nerve blocks.
2. Medications such as steroids, pain medication, etc., may be separately billed using the appropriate HCPCS code.
a. The name of the medication(s), dosage, and volume must be identified.
b. Medication will be reimbursed according to fees listed in the HCPCS section. If not listed in HCPCS, reimbursement will be according to the Pharmacy section in the General Guidelines.
B.Anesthetic. When a nerve block for anesthesia is provided by the operating room surgeon, the procedure codes listed in the Anesthesia section must be followed.

Code

Description

Amount

PC Amount

TC Amount

FUD

Assist Surg

APC Amount

0232T

NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION

467.36

348.16

+

10004

FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL

178.80

ZZZ

N

*

*

10005

FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION

430.80

XXX

N

822.66

+

*

10006

FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL

205.20

ZZZ

N

*

*

10007

FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION

970.80

XXX

N

822.66

+

*

10008

FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL

547.20

ZZZ

N

*

*

10009

FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION

1588.80

XXX

N

822.66

+

*

10010

FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL

957.60

ZZZ

N

*

*

10011

FINE NEEDLE ASPIRATION BX W/MR GDN 1ST LESION

BR

XXX

N

822.66

+

*

10012

FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL

BR

ZZZ

N

*

*

10021

FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION

333.60

XXX

N

445.99

*

*

10030

IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE

1952.40

000

N

822.66

*

*

10035

PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE

1640.40

000

N

822.66

+

*

10036

PERQ SFT TISS LOC DEVICE PLMT ADD LES W/GDNCE

1414.80

ZZZ

N

*

*

10040

ACNE SURGERY

370.80

010

N

250.56

*

*

10060

INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE

404.40

010

N

250.56

*

*

10061

INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE

704.40

010

N

445.99

*

*

10080

INCISION & DRAINAGE PILONIDAL CYST SIMPLE

627.60

010

N

822.66

*

*

10081

INCISION & DRAINAGE PILONIDAL CYST COMPLICATED

940.80

010

N

822.66

*

*

10120

INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE

518.40

010

N

445.99

*

*

J1

10121

INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL

932.40

010

N

2734.29

*

*

J1

10140

I&D HEMATOMA SEROMA/FLUID COLLECTION

572.40

010

N

2734.29

*

*

10160

PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

444.00

010

N

445.99

*

*

J1

10180

INCISION & DRAINAGE COMPLEX PO WOUND INFECTION

854.40

010

N

4742.07

*

*

11000

DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF

188.40

000

N

685.70

+

*

11001

DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF

74.40

ZZZ

N

*

*

11004

DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT & PR

2002.80

000

N

1634.69

*

*

11005

DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL

2716.80

000

N

3015.60

*

*

11006

DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL

2452.80

000

N

+

*

11008

REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION

955.20

ZZZ

N

1614.53

*

*

11010

DBRDMT W/RMVL FM FX&/DISLC SKIN & SUBQ TISSUS

1658.40

010

N

822.66

*

*

11011

DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC

1831.20

000

N

822.66

*

*

J1

11012

DBRDMT FX&/DISLC SUBQ T/M/F BONE

2374.80

000

N

4742.07

*

*

11042

DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<

415.20

000

N

445.99

*

*

11043

DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<

788.40

000

N

685.70

*

*

J1

11044

DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<

1071.60

000

N

2734.29

+

*

11045

DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM

141.60

ZZZ

N

+

*

11046

DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM

250.80

ZZZ

N

+

*

11047

DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM

423.60

ZZZ

N

*

*

11055

PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1

190.80

000

N

250.56

*

*

11056

PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4

228.00

000

N

250.56

*

*

11057

PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4

253.20

000

N

250.56

*

*

11102

TANGENTIAL BIOPSY SKIN SINGLE LESION

336.00

000

N

250.56

+

*

11103

TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION

181.20

ZZZ

N

*

*

11104

PUNCH BIOPSY SKIN SINGLE LESION

422.40

000

N

250.56

+

*

11105

PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION

207.60

ZZZ

N

*

*

11106

INCISIONAL BIOPSY SKIN SINGLE LESION

511.20

000

N

445.99

+

*

11107

INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION

244.80

ZZZ

N

*

*

11200

REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15

301.20

010

N

250.56

+

*

11201

REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10

64.80

ZZZ

N

*

*

11300

SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<

332.40

000

N

250.56

*

*

11301

SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM

408.00

000

N

250.56

*

*

11302

SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM

477.60

000

N

250.56

*

*

11303

SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM

526.80

000

N

445.99

*

*

11305

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<

348.00

000

N

250.56

*

*

11306

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM

414.00

000

N

250.56

*

*

11307

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM

490.80

000

N

250.56

*

*

11308

SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM

520.80

000

N

445.99

*

*

11310

SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<

387.60

000

N

250.56

*

*

11311

SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM

463.20

000

N

250.56

*

*

11312

SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM

542.40

000

N

445.99

*

*

11313

SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM

636.00

000

N

445.99

*

*

11400

EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<

423.60

010

N

822.66

*

*

11401

EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM

516.00

010

N

445.99

*

*

11402

EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM

573.60

010

N

822.66

*

*

11403

EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM

663.60

010

N

822.66

*

*

J1

11404

EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM

752.40

010

N

2734.29

*

*

J1

11406

EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM

1082.40

010

N

2734.29

*

*

J1

11420

EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<

423.60

010

N

2734.29

*

*

11421

EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM

538.80

010

N

822.66

*

*

J1

11422

EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM

607.20

010

N

2734.29

*

*

J1

11423

EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM

692.40

010

N

2734.29

*

*

J1

11424

EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM

802.80

010

N

2734.29

*

*

J1

11426

EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM

1150.80

010

N

4742.07

*

*

11440

EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<

469.20

010

N

822.66

*

*

11441

EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM

579.60

010

N

822.66

*

*

11442

EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM

646.80

010

N

822.66

*

*

J1

11443

EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM

770.40

010

N

2734.29

*

*

J1

11444

EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM

966.00

010

N

2734.29

*

*

J1

11446

EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM

1339.20

010

N

4742.07

*

*

J1

11450

EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR

1350.00

090

N

4742.07

*

*

J1

11451

EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR

1698.00

090

N

4742.07

*

*

J1

11462

EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR

1315.20

090

N

4742.07

*

*

J1

11463

EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR

1718.40

090

N

4742.07

*

*

J1

11470

EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR

1443.60

090

N

4742.07

*

*

J1

11471

EXCISION H/P/P/U COMPLEX REPAIR

1765.20

090

N

4742.07

*

*

11600

EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<

663.60

010

N

822.66

*

*

11601

EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM

782.40

010

N

822.66

*

*

11602

EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM

847.20

010

N

445.99

*

*

11603

EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM

968.40

010

N

822.66

*

*

11604

EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM

1074.00

010

N

822.66

*

*

J1

11606

EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM

1542.00

010

N

2734.29

*

*

J1

11620

EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<

668.40

010

N

2734.29

*

*

11621

EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM

786.00

010

N

822.66

*

*

11622

EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM

876.00

010

N

822.66

*

*

J1

11623

EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM

1026.00

010

N

2734.29

*

*

J1

11624

EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM

1160.40

010

N

2734.29

*

*

J1

11626

EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM

1396.80

010

N

4742.07

*

*

11640

EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<

688.80

010

N

822.66

*

*

11641

EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM

813.60

010

N

822.66

*

*

11642

EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM

927.60

010

N

822.66

*

*

J1

11643

EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM

1090.80

010

N

2734.29

*

*

J1

11644

EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM

1346.40

010

N

2734.29

*

*

J1

11646

EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM

1756.80

010

N

4742.07

*

*

11719

TRIMMING NONDYSTROPHIC NAILS ANY NUMBER

49.20

000

N

79.38

*

*

11720

DEBRIDEMENT NAIL ANY METHOD 1-5

112.80

000

N

79.38

*

*

11721

DEBRIDEMENT NAIL ANY METHOD 6/>

154.80

000

N

79.38

*

*

11730

AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1

370.80

000

N

250.56

+

*

11732

AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL

111.60

ZZZ

N

*

*

11740

EVACUATION SUBUNGUAL HEMATOMA

175.20

000

N

151.20

*

*

11750

EXCISION NAIL MATRIX PERMANENT REMOVAL

529.20

010

N

445.99

*

*

11755

BIOPSY NAIL UNIT SEPARATE PROCEDURE

416.40

000

N

822.66

*

*

11760

REPAIR NAIL BED

655.20

010

N

685.70

*

*

11762

RECONSTRUCTION NAIL BED W/GRAFT

978.00

010

N

2199.52

*

*

11765

WEDGE EXCISION SKIN NAIL FOLD

576.00

010

N

445.99

*

*

J1

11770

EXCISION PILONIDAL CYST/SINUS SIMPLE

972.00

010

N

4742.07

*

*

J1

11771

EXCISION PILONIDAL CYST/SINUS EXTENSIVE

2014.80

090

N

4742.07

*

*

J1

11772

EXCISION PILONIDAL CYST/SINUS COMPLICATED

2412.00

090

N

4742.07

*

*

11900

INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS

184.80

000

N

250.56

*

*

11901

INJECTION INTRALESIONAL >7 LESIONS

234.00

000

N

250.56

*

*

11920

TATTOOING INCL MICROPIGMENTATION 6.0 CM/<

612.00

000

N

685.70

*

*

11921

TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM

700.80

000

N

685.70

+

*

11922

TATTOOING INCL MICROPIGMENTATION EA 20.0 CM

207.60

ZZZ

N

*

*

11950

SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<

234.00

000

N

250.56

*

*

11951

SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC

336.00

000

N

685.70

*

*

11952

SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC

453.60

000

N

685.70

*

*

11954

SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC

529.20

000

N

445.99

*

*

11960

INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ

3325.20

090

N

3927.90

*

*

J1

11970

REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS

2096.40

090

N

10775.65

*

*

11971

REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS

1622.40

090

N

3377.17

*

*

11976

REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES

493.20

000

N

822.66

*

*

11980

SUBCUTANEOUS HORMONE PELLET IMPLANTATION

322.80

000

N

494.39

*

*

11981

INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

486.00

XXX

N

151.20

*

*

11982

REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

538.80

XXX

N

494.39

*

*

11983

RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT

787.20

XXX

N

494.39

*

*

12001

SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<

303.60

000

N

250.56

*

*

12002

SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM

369.60

000

N

250.56

*

*

12004

SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM

433.20

000

N

250.56

*

*

12005

SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM

562.80

000

N

445.99

*

*

12006

SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM

664.80

000

N

445.99

*

*

12007

SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM

764.40

000

N

250.56

*

*

12011

SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<

370.80

000

N

250.56

*

*

12013

SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM

387.60

000

N

250.56

*

*

12014

SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM

465.60

000

N

250.56

*

*

12015

SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM

562.80

000

N

250.56

*

*

12016

SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM

710.40

000

N

445.99

*

*

12017

SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM

520.80

000

N

445.99

*

*

12018

SIMPLE REPAIR F/E/E/N/L/M >30.0 CM

590.40

000

Y

250.56

*

*

12020

TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE

980.40

010

N

685.70

*

*

12021

TX SUPERFICIAL WOUND DEHISCENCE W/PACKING

571.20

010

N

445.99

*

*

12031

REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<

837.60

010

N

445.99

*

*

12032

REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM

1038.00

010

N

445.99

*

*

12034

REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM

1088.40

010

N

445.99

*

*

12035

REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM

1311.60

010

N

445.99

*

*

12036

REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM

1452.00

010

N

685.70

*

*

12037

REPAIR INTERMEDIATE S/A/T/E >30.0 CM

1644.00

010

N

2199.52

*

*

12041

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<

836.40

010

N

445.99

*

*

12042

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM

1009.20

010

N

445.99

*

*

12044

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM

1249.20

010

N

685.70

*

*

12045

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM

1375.20

010

N

685.70

*

*

12046

RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM

1656.00

010

N

445.99

*

*

12047

REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM

1818.00

010

Y

2199.52

*

*

12051

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<

906.00

010

N

445.99

*

*

12052

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM

1026.00

010

N

445.99

*

*

12053

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM

1200.00

010

N

445.99

*

*

12054

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM

1255.20

010

N

445.99

*

*

12055

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM

1628.40

010

N

445.99

*

*

12056

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM

1917.60

010

N

445.99

*

*

12057

REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM

2031.60

010

Y

445.99

*

*

13100

REPAIR COMPLEX TRUNK 1.1-2.5 CM

1159.20

010

N

685.70

*

*

13101

REPAIR COMPLEX TRUNK 2.6-7.5 CM

1366.80

010

N

685.70

+

*

13102

REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<

415.20

ZZZ

N

*

*

13120

REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM

1210.80

010

N

685.70

*

*

13121

REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM

1471.20

010

N

685.70

+

*

13122

REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<

453.60

ZZZ

N

*

*

13131

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM

1330.80

010

N

445.99

*

*

13132

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM

1639.20

010

N

685.70

+

*

13133

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<

607.20

ZZZ

N

*

*

13151

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM

1455.60

010

N

685.70

*

*

13152

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM

1737.60

010

N

685.70

+

*

13153

REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<

660.00

ZZZ

N

*

*

13160

SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC

2755.20

090

N

2199.52

*

*

14000

ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<

2136.00

090

N

2199.52

*

*

14001

ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM

2738.40

090

N

2199.52

*

*

14020

ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<

2384.40

090

N

2199.52

*

*

14021

ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM

2974.80

090

N

2199.52

*

*

14040

ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<

2604.00

090

N

2199.52

*

*

14041

ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM

3210.00

090

N

2199.52

*

*

14060

ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<

2653.20

090

N

2199.52

*

*

14061

ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM

3452.40

090

N

2199.52

*

*

14301

ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM

3694.80

090

Y

3927.90

+

*

14302

ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM

760.80

ZZZ

Y

*

*

14350

FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE

2354.40

090

N

2199.52

*

*

15002

PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT

1192.80

000

N

2199.52

+

*

15003

PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT

253.20

ZZZ

N

*

*

15004

PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT

1365.60

000

N

685.70

+

*

15005

PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT

422.40

ZZZ

N

*

*

15040

HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

874.80

000

N

2199.52

*

*

15050

PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM

1936.80

090

N

685.70

*

*

15100

SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD

2949.60

090

N

2199.52

+

*

15101

SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD

637.20

ZZZ

N

*

*

15110

EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD

2738.40

090

N

2199.52

+

*

15111

EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD

398.40

ZZZ

N

*

*

15115

EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<

2718.00

090

N

2199.52

+

*

15116

EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM

576.00

ZZZ

N

*

*

15120

SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %

2914.80

090

N

3927.90

+

*

15121

SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %

714.00

ZZZ

N

*

*

15130

DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM

2282.40

090

N

2199.52

+

*

15131

DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA

342.00

ZZZ

N

*

*

15135

DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100

2942.40

090

N

3927.90

+

*

15136

DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA

338.40

ZZZ

N

*

*

15150

CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<

2406.00

090

N

2199.52

+

*

15151

CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM

414.00

ZZZ

N

+

*

15152

CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA

510.00

ZZZ

N

*

*

15155

CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<

2740.80

090

N

3927.90

+

*

15156

CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM

558.00

ZZZ

N

+

*

15157

CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA

620.40

ZZZ

N

*

*

15200

FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<

2859.60

090

N

2199.52

+

*

15201

FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CM/<

496.80

ZZZ

N

*

*

15220

FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<

2647.20

090

N

2199.52

+

*

15221

FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<

464.40

ZZZ

N

*

*

15240

FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<

3201.60

090

N

2199.52

+

*

15241

FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<

626.40

ZZZ

N

*

*

15260

FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<

3465.60

090

N

2199.52

+

*

15261

FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/<

726.00

ZZZ

N

*

*

15271

APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25

496.80

000

N

2199.52

+

*

15272

APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC

91.20

ZZZ

N

*

*

15273

APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM

1047.60

000

N

3927.90

+

*

15274

APP SKN SUB GRFT T/A/L AREA>/=100SCM ADL 100SQCM

258.00

ZZZ

N

*

*

15275

SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM

524.40

000

N

2199.52

+

*

15276

SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM

117.60

ZZZ

N

*

*

15277

SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQ CM

1146.00

000

N

2199.52

+

*

15278

SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM

304.80

ZZZ

N

*

*

15570

FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK

3124.80

090

N

2199.52

*

*

15572

FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS

3039.60

090

N

3927.90

*

*

15574

FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F

3102.00

090

N

2199.52

*

*

15576

FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL

2751.60

090

N

2199.52

*

*

15600

DELAY FLAP/SECTIONING FLAP TRUNK

1116.00

090

N

3927.90

*

*

15610

DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS

1219.20

090

N

2199.52

*

*

15620

DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F

1502.40

090

N

2199.52

*

*

15630

DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS

1570.80

090

N

2199.52

*

*

15650

TRANSFER ANY PEDICLE FLAP ANY LOCATION

1742.40

090

N

2199.52

*

*

15730

MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES

5239.20

090

N

3927.90

*

*

15731

FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE

3844.80

090

N

3927.90

*

*

15733

MUSC MYOQ/FSCQ FLAP HEAD & NECK W/NAMED VASC PEDCL

3614.40

090

N

3927.90

*

*

15734

MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK

5216.40

090

Y

3927.90

*

*

15736

MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR

4236.00

090

N

2199.52

*

*

15738

MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR

4518.00

090

Y

3927.90

*

*

15740

FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY

3459.60

090

N

2199.52

*

*

15750

FLAP NEUROVASCULAR PEDICLE

3166.80

090

Y

3927.90

*

*

15756

FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST

7945.20

090

Y

*

*

15757

FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS

7861.20

090

Y

666.46

*

*

15758

FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS

7930.80

090

Y

*

*

15760

GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA

2911.20

090

N

2199.52

*

*

15770

GRAFT DERMA-FAT-FASCIA

2290.80

090

Y

3927.90

*

*

15775

PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS

1048.80

000

N

445.99

*

*

15776

PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS

1508.40

000

N

445.99

+

*

15777

IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT

750.00

ZZZ

N

*

*

J1

15780

DERMABRASION TOTAL FACE

3139.20

090

N

4742.07

*

*

15781

DERMABRASION SEGMENTAL FACE

1885.20

090

N

822.66

*

*

J1

15782

DERMABRASION REGIONAL OTHER THAN FACE

1963.20

090

N

2734.29

*

*

15783

DERMABRASION SUPERFICIAL ANY SITE

1634.40

090

N

445.99

*

*

15786

ABRASION 1 LESION

837.60

010

N

250.56

+

*

15787

ABRASION EACH ADDITIONAL 4 LESIONS OR LESS

152.40

ZZZ

N

*

*

15788

CHEMICAL PEEL FACIAL EPIDERMAL

1530.00

090

N

250.56

*

*

15789

CHEMICAL PEEL FACIAL DERMAL

1890.00

090

N

685.70

*

*

15792

CHEMICAL PEEL NONFACIAL EPIDERMAL

1416.00

090

N

445.99

*

*

15793

CHEMICAL PEEL NONFACIAL DERMAL

1689.60

090

N

445.99

*

*

15819

CERVICOPLASTY

2731.20

090

N

2199.52

*

*

15820

BLEPHAROPLASTY LOWER EYELID

1945.20

090

N

2199.52

*

*

15821

BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD

2085.60

090

N

2199.52

*

*

15822

BLEPHAROPLASTY UPPER EYELID

1528.80

090

N

2199.52

*

*

15823

BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN

2084.40

090

N

2199.52

*

*

15824

RHYTIDECTOMY FOREHEAD

3634.80

000

N

2199.52

*

*

15825

RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING

6904.80

000

N

3927.90

*

*

15826

RHYTIDECTOMY GLABELLAR FROWN LINES

2175.24

000

N

3927.90

*

*

15828

RHYTIDECTOMY CHEEK CHIN & NECK

10657.20

000

N

3927.90

*

*

15829

RHYTIDECTOMY SMAS FLAP

6728.40

000

N

3927.90

*

*

J1

15830

EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY

4050.00

090

Y

9771.93

*

*

J1

15832

EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH

3168.00

090

Y

4742.07

*

*

J1

15833

EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG

2995.20

090

N

4742.07

*

*

J1

15834

EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP

3062.40

090

N

4742.07

*

*

J1

15835

EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK

3220.80

090

N

4742.07

*

*

J1

15836

EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM

2718.00

090

N

4742.07

*

*

J1

15837

EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND

2964.00

090

N

4742.07

*

*

J1

15838

EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD

2200.80

090

N

4742.07

*

*

J1

15839

EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA

3032.40

090

N

4742.07

*

*

15840

GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT

3463.20

090

N

3927.90

*

*

15841

GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT

6146.40

090

Y

3927.90

*

*

15842

GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG

9364.80

090

Y

2199.52

*

*

15845

GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR

3464.40

090

Y

3927.90

+

*

15847

EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN

2668.80

YYY

Y

*

*

15850

REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON

307.20

XXX

N

685.70

*

*

15851

REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON

342.00

000

N

2199.52

*

*

15852

DRESSING CHANGE UNDER ANESTHESIA

159.60

000

N

685.70

*

*

15860

IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT

372.00

000

N

494.39

*

*

15876

SUCTION ASSISTED LIPECTOMY HEAD & NECK

3015.60

000

N

3927.90

*

*

15877

SUCTION ASSISTED LIPECTOMY TRUNK

4603.20

000

N

3927.90

*

*

15878

SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY

BR

000

N

2199.52

*

*

15879

SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY

5754.00

000

N

3927.90

*

*

J1

15920

EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR

2140.80

090

N

4742.07

*

*

15922

EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR

2700.00

090

Y

3927.90

*

*

J1

15931

EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE

2392.80

090

N

2734.29

*

*

J1

15933

EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY

2949.60

090

N

4742.07

*

*

15934

EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR

3258.00

090

N

3927.90

*

*

15935

EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY

3796.80

090

Y

3927.90

*

*

15936

EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR

3086.40

090

N

2199.52

*

*

15937

EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC

3582.00

090

N

2199.52

*

*

J1

15940

EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE

2418.00

090

N

4742.07

*

*

J1

15941

EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT

3130.80

090

N

4742.07

*

*

15944

EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE

3099.60

090

N

3927.90

*

*

15945

EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY

3415.20

090

N

2199.52

*

*

15946

EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN

5624.40

090

N

2199.52

*

*

J1

15950

EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR

2078.40

090

N

2734.29

*

*

J1

15951

EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY

3034.80

090

N

4742.07

*

*

15952

EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE

3116.40

090

Y

2199.52

*

*

15953

EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY

3439.20

090

N

3927.90

*

*

15956

EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN

4005.60

090

N

2199.52

*

*

15958

EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC

4087.20

090

N

3927.90

*

*

15999

UNLISTED PROCEDURE EXCISION PRESSURE ULCER

BR

YYY

N

822.66

*

*

16000

INITIAL TX 1ST DEGREE BURN LOCAL TX

240.00

000

N

250.56

*

*

16020

DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL

278.40

000

N

250.56

*

*

16025

DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM

511.20

000

N

250.56

*

*

16030

DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE

648.00

000

N

445.99

*

*

16035

ESCHAROTOMY FIRST INCISION

678.00

000

N

445.99

+

*

16036

ESCHAROTOMY EACH ADDITIONAL INCISION

283.20

ZZZ

N

*

*

17000

DESTRUCTION PREMALIGNANT LESION 1ST

222.00

010

N

250.56

+

*

17003

DESTRUCTION PREMALIGNANT LESION 2-14 EA

19.20

ZZZ

N

*

Ø

17004

DESTRUCTION PREMALIGNANT LESION 15/>

517.20

010

N

445.99

*

*

17106

DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM

1173.60

090

N

445.99

*

*

17107

DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM

1520.40

090

N

685.70

*

*

17108

DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM

2202.00

090

N

2199.52

*

*

17110

DESTRUCTION BENIGN LESIONS UP TO 14

375.60

010

N

250.56

*

*

17111

DESTRUCTION BENIGN LESIONS 15/>

445.20

010

N

250.56

*

*

17250

CHEMICAL CAUTERIZATION OF GRANULATION TISSUE

277.20

000

N

250.56

*

*

17260

DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<

325.20

010

N

250.56

*

*

17261

DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM

493.20

010

N

250.56

*

*

17262

DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM

601.20

010

N

250.56

*

*

17263

DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM

656.40

010

N

250.56

*

*

17264

DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM

702.00

010

N

445.99

*

*

17266

DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM

799.20

010

N

445.99

*

*

17270

DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/>

508.80

010

N

250.56

*

*

17271

DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM

560.40

010

N

250.56

*

*

17272

DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM

639.60

010

N

250.56

*

*

17273

DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM

712.80

010

N

445.99

*

*

17274

DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM

841.20

010

N

445.99

*

*

17276

DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM

973.20

010

N

445.99

*

*

17280

DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<

476.40

010

N

250.56

*

*

17281

DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM

610.80

010

N

445.99

*

*

17282

DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM

700.80

010

N

445.99

*

*

17283

DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM

838.80

010

N

445.99

*

*

17284

DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM

956.40

010

N

685.70

*

*

17286

DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM

1226.40

010

N

685.70

*

*

17311

MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS

2277.60

000

N

685.70

+

*

17312

MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE

1351.20

ZZZ

N

*

*

17313

MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS

2130.00

000

N

685.70

+

*

17314

MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE

1290.00

ZZZ

N

+

*

17315

MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE

271.20

ZZZ

N

*

*

17340

CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE

178.80

010

N

45.61

*

*

17360

CHEMICAL EXFOLIATION ACNE

433.20

010

N

250.56

*

*

17380

ELECTROLYSIS EPILATION EACH 30 MINUTES

153.60

000

N

685.70

*

*

17999

UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE

BR

YYY

N

250.56

*

*

19000

PUNCTURE ASPIRATION CYST BREAST

374.40

000

N

822.66

+

*

19001

PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST

92.40

ZZZ

N

*

*

J1

19020

MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP

1620.00

090

N

2734.29

*

*

19030

INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM

568.80

000

N

*

*

J1

19081

BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID

2210.40

000

N

2734.29

+

*

19082

BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID

1803.60

ZZZ

N

*

*

J1

19083

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID

2164.80

000

N

2734.29

+

*

19084

BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID

1738.80

ZZZ

N

*

*

J1

19085

BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID

3286.80

000

N

2734.29

+

*

19086

BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID

2636.40

ZZZ

N

*

*

J1

19100

BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX

518.40

000

N

2734.29

*

*

J1

19101

BIOPSY BREAST OPEN INCISIONAL

1156.80

010

N

5620.48

*

*

J1

19105

ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA

9660.00

000

N

5620.48

*

*

J1

19110

NIPPLE EXPLORATION

1675.20

090

N

5620.48

*

*

J1

19112

EXCISION LACTIFEROUS DUCT FISTULA

1578.00

090

N

5620.48

*

*

J1

19120

EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION

1716.00

090

N

5620.48

*

*

J1

19125

EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES

1900.80

090

N

5620.48

+

*

19126

EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL

561.60

ZZZ

N

*

*

J1

19260

EXCISION CHEST WALL TUMOR INCLUDING RIBS

4120.80

090

Y

4742.07

*

*

19271

EXC CHEST TUMOR W/RCNSTJ W/O MEDSTNL LMPHADEC

5538.00

090

Y

*

*

19272

EXC CHEST TUMOR W/RCNSTJ W/MEDSTNL LMPHADEC

6039.60

090

Y

*

*

19281

PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE

828.00

000

N

822.66

+

*

19282

PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE

578.40

ZZZ

N

*

*

19283

PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE

927.60

000

N

822.66

+

*

19284

PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC

704.40

ZZZ

N

*

*

19285

PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG

1654.80

000

N

822.66

+

*

19286

PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE

1429.20

ZZZ

N

*

*

19287

PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID

2796.00

000

N

822.66

+

*

19288

PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID

2239.20

ZZZ

N

+

*

19294

PREP TUMOR CAVITY IORT W/PARTIAL MASTECTOMY

565.20

ZZZ

N

*

*

J1

19296

PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST

13578.00

000

N

13715.53

+

*

19297

PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST

330.00

ZZZ

N

*

*

J1

19298

PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST

3388.80

000

N

9771.93

*

*

J1

19300

MASTECTOMY GYNECOMASTIA

1842.00

090

N

5620.48

*

*

J1

19301

MASTECTOMY PARTIAL

2263.20

090

N

5620.48

*

*

J1

19302

MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY

3116.40

090

Y

9771.93

*

*

J1

19303

MASTECTOMY SIMPLE COMPLETE

3322.80

090

Y

9771.93

*

*

J1

19304

MASTECTOMY SUBCUTANEOUS

2017.20

090

Y

5620.48

*

*

19305

MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES

3927.60

090

Y

4993.63

*

*

19306

MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES

4161.60

090

Y

*

*

J1

19307

MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN

4153.20

090

Y

9771.93

*

*

J1

19316

MASTOPEXY

2660.40

090

Y

9771.93

*

*

J1

19318

REDUCTION MAMMAPLASTY

3790.80

090

Y

9771.93

*

*

J1

19324

MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT

1818.00

090

N

13715.53

*

*

J1

19325

MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT

2215.20

090

N

13715.53

*

*

19328

REMOVAL INTACT MAMMARY IMPLANT

1712.40

090

N

3998.73

*

*

19330

REMOVAL MAMMARY IMPLANT MATERIAL

2181.60

090

N

3998.73

*

*

J1

19340

IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ

3432.00

090

N

9771.93

*

*

J1

19342

DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ

3183.60

090

N

13715.53

*

*

J1

19350

NIPPLE/AREOLA RECONSTRUCTION

2833.20

090

N

5620.48

*

*

J1

19355

CORRECTION INVERTED NIPPLES

2583.60

090

N

5620.48

*

*

J1

19357

BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ

5179.20

090

Y

22381.25

*

*

19361

BRST RCNSTJ W/LATSMS D/SI FLAP WO PRSTHC IMPL

5426.40

090

Y

4817.70

*

*

19364

BREAST RECONSTRUCTION FREE FLAP

9505.20

090

Y

2934.05

*

*

J1

19366

BREAST RECONSTRUCTION OTHER TECHNIQUE

4845.60

090

Y

9771.93

*

*

19367

BREAST RECONSTRUCTION TRAM FLAP 1 PEDICLE

6160.80

090

Y

*

*

19368

BREAST RECONSTRUCTION TRAM 1 PEDCL MVASC ANAST

7586.40

090

Y

*

*

19369

BREAST RECONSTRUCTION TRAM FLAP DOUBLE PEDICLE

7041.60

090

Y

*

*

J1

19370

OPEN PERIPROSTHETIC CAPSULOTOMY BREAST

2367.60

090

N

5620.48

*

*

J1

19371

PERIPROSTHETIC CAPSULECTOMY BREAST

2707.20

090

N

5620.48

*

*

J1

19380

REVISION RECONSTRUCTED BREAST

2671.20

090

N

9771.93

*

*

J1

19396

PREPARATION MOULAGE CUSTOM BREAST IMPLANT

987.60

000

N

5620.48

*

*

J1

19499

UNLISTED PROCEDURE BREAST

BR

YYY

N

5620.48

*

*

20100

EXPLORATION PENETRATING WOUND SPX NECK

2104.80

010

Y

691.72

*

*

20101

EXPLORATION PENETRATING WOUND SPX CHEST

1555.20

010

N

2199.52

*

*

20102

EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK

1684.80

010

N

2199.52

*

*

20103

EXPLORATION PENETRATING WOUND SPX EXTREMITY

1993.20

010

N

822.66

*

*

J1

20150

EXCISION EPIPHYSEAL BAR

3490.80

090

Y

5184.51

*

*

J1

20200

BIOPSY MUSCLE SUPERFICIAL

714.00

000

N

2734.29

*

*

J1

20205

BIOPSY MUSCLE DEEP

1002.00

000

N

4742.07

*

*

J1

20206

BIOPSY MUSCLE PERCUTANEOUS NEEDLE

805.20

000

N

2734.29

*

*

J1

20220

BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL

574.80

000

N

2734.29

*

*

J1

20225

BIOPSY BONE TROCAR/NEEDLE DEEP

1765.20

000

N

2734.29

*

*

J1

20240

BIOPSY BONE OPEN SUPERFICIAL

517.20

000

N

4742.07

*

*

J1

20245

BIOPSY BONE OPEN DEEP

1215.60

000

N

4742.07

*

*

J1

20250

BIOPSY VERTEBRAL BODY OPEN THORACIC

1380.00

010

N

5184.51

*

*

J1

20251

BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL

1494.00

010

Y

10775.65

*

*

J1

20500

INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC

370.80

010

N

2543.11

*

*

20501

INJECTION SINUS TRACT DIAGNOSTIC

434.40

000

N

*

*

J1

20520

REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE

704.40

010

N

2734.29

*

*

J1

20525

RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP

1635.60

010

N

4742.07

*

*

20526

INJECTION THERAPEUTIC CARPAL TUNNEL

264.00

000

N

351.42

*

*

20527

INJECTION ENZYME PALMAR FASCIAL CORD

286.80

000

N

351.42

*

*

20550

INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

181.20

000

N

351.42

*

*

20551

INJECTION SINGLE TENDON ORIGIN/INSERTION

183.60

000

N

351.42

*

*

20552

INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

188.40

000

N

351.42

*

*

20553

INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES

217.20

000

N

351.42

*

*

J1

20555

PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT

1138.80

000

N

5184.51

*

*

20600

ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US

165.60

000

N

351.42

*

*

20604

ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT

252.00

000

N

351.42

*

*

20605

ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US

172.80

000

N

351.42

*

*

20606

ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US

278.40

000

N

850.31

*

*

20610

ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

205.20

000

N

351.42

*

*

20611

ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

313.20

000

N

351.42

*

*

20612

ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ

205.20

000

N

351.42

*

*

20615

ASPIRATION & INJECTION TREATMENT BONE CYST

834.00

010

N

822.66

*

*

J1

20650

INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX

728.40

010

N

5184.51

*

*

20660

APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX

848.40

000

N

1864.94

*

*

20661

APPLICATION HALO CRANIAL INCLUDING REMOVAL

1743.60

090

N

*

*

J1

20662

APPLICATION HALO PELVIC INCLUDING REMOVAL

1770.00

090

N

2624.38

*

*

J1

20663

APPLICATION HALO FEMORAL INCLUDING REMOVAL

1626.00

090

N

5184.51

*

*

20664

APPL HALO 6/> PINS THIN SKULL OSTEOLOGY

3038.40

090

N

*

*

20665

REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL

375.60

010

N

494.39

*

*

20670

REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE

1280.40

010

N

1953.21

*

*

20680

REMOVAL IMPLANT DEEP

2114.40

090

N

3377.17

*

*

J1

20690

APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM

2064.00

090

N

10775.65

*

*

J1

20692

APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM

3872.40

090

Y

19120.53

*

*

J1

20693

ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES

1530.00

090

N

10775.65

*

*

20694

REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES

1465.20

090

N

1864.94

*

*

J1

20696

XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ

4138.80

090

Y

26078.68

*

Ø

J1

20697

XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT

7069.20

BR

7069.20

000

Y

*

*

20802

REPLANTATION ARM COMPLETE AMPUTATION

9562.80

090

Y

*

*

20805

REPLANTATION FOREARM COMPLETE AMPUTATION

11386.80

090

Y

*

*

20808

REPLANTATION HAND COMPLETE AMPUTATION

13776.00

090

Y

*

*

20816

RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP

7161.60

090

Y

*

*

J1

20822

RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP

6153.60

090

Y

2624.38

*

*

20824

RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION

7173.60

090

Y

*

*

20827

RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION

6284.40

090

Y

*

*

20838

REPLANTATION FOOT COMPLETE AMPUTATION

9682.80

090

Y

*

*

J1

20900

BONE GRAFT ANY DONOR AREA MINOR/SMALL

1406.40

000

Y

10775.65

*

*

J1

20902

BONE GRAFT ANY DONOR AREA MAJOR/LARGE

984.00

000

Y

10775.65

*

*

20910

CARTILAGE GRAFT COSTOCHONDRAL

1615.20

090

N

685.70

*

*

20912

CARTILAGE GRAFT NASAL SEPTUM

1632.00

090

N

3927.90

*

*

20920

FASCIA LATA GRAFT BY STRIPPER

1381.20

090

N

2199.52

*

*

20922

FASCIA LATA GRAFT INCISION & AREA EXPOSURE

2042.40

090

Y

2199.52

*

*

J1

20924

TENDON GRAFT FROM A DISTANCE

1746.00

090

Y

10775.65

*

*

20926

TISSUE GRAFTS OTHER

1448.40

090

N

3927.90

+

*

20930

ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED

920.40

XXX

N

+

*

20931

ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL

391.20

ZZZ

N

+

*

20932

OSTEOARTICULAR ALLOGRAFT W/ARTICULAR SURF & BONE

2464.80

ZZZ

Y

+

*

20933

HEMICORTICAL INTERCALARY ALLOGRAFT PARTIAL

2260.80

ZZZ

Y

+

*

20934

INTERCALARY ALLOGRAFT COMPLETE

2463.60

ZZZ

Y

+

*

20936

AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION

1150.80

XXX

N

+

*

20937

AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION

585.60

ZZZ

Y

+

*

20938

AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC

648.00

ZZZ

Y

+

*

20939

BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY

230.40

ZZZ

N

*

*

20950

MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME

889.20

000

N

822.66

*

*

20955

BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA

8602.80

090

Y

*

*

20956

BONE GRAFT MICROVASCULAR ANAST ILIAC CREST

9134.40

090

Y

*

*

20957

BONE GRAFT MICROVASCULAR ANAST METATARSAL

9567.60

090

Y

*

*

20962

BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR

9244.80

090

Y

*

*

20969

FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE

9496.80

090

Y

*

*

20970

FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST

9885.60

090

Y

*

*

J1

20972

FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL

9919.20

090

Y

10775.65

*

*

J1

20973

FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE

10477.20

090

Y

10775.65

*

Ø

20974

ELECTRICAL STIMULATION BONE HEALING NONINVASIVE

268.80

000

N

*

Ø

20975

ELECTRICAL STIMULATION BONE HEALING INVASIVE

621.60

000

Y

*

*

20979

LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE

178.80

000

N

24.38

*

*

J1

20982

ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE

13216.80

000

N

10775.65

*

*

J1

20983

ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD

19648.80

000

N

10775.65

+

*

20985

CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

508.80

ZZZ

N

*

*

20999

UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL

BR

YYY

N

319.63

*

*

J1

21010

ARTHROTOMY TEMPOROMANDIBULAR JOINT

2638.80

090

N

4449.71

*

*

J1

21011

EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM

1214.40

090

Y

2734.29

*

*

J1

21012

EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>

1170.00

090

Y

2734.29

*

*

J1

21013

EXC TUMOR SOFT TISS FACE & SCALP SUBFASCIAL <2CM

1803.60

090

Y

2734.29

*

*

J1

21014

EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>

1801.20

090

Y

4742.07

*

*

J1

21015

RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM

2436.00

090

N

4742.07

*

*

J1

21016

RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>

3498.00

090

Y

4742.07

*

*

J1

21025

EXCISION BONE MANDIBLE

2984.40

090

N

8765.29

*

*

J1

21026

EXCISION FACIAL BONE

2042.40

090

N

8765.29

*

*

J1

21029

REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE

2649.60

090

N

4449.71

*

*

J1

21030

EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG

1755.60

090

N

8765.29

*

*

J1

21031

EXCISION TORUS MANDIBULARIS

1357.20

090

N

4449.71

*

*

J1

21032

EXCISION MAXILLARY TORUS PALATINUS

1365.60

090

N

4449.71

*

*

J1

21034

EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA

4500.00

090

Y

8765.29

*

*

J1

21040

EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT

1768.80

090

N

4449.71

*

*

J1

21044

EXCISION MALIGNANT TUMOR MANDIBLE

3009.60

090

Y

8765.29

*

*

21045

EXCISION MALIGNANT TUMOR MANDIBLE RADICAL

4214.40

090

Y

*

*

J1

21046

EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT

3788.40

090

N

8765.29

*

*

J1

21047

EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB

4522.80

090

Y

8765.29

*

*

J1

21048

EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT

3848.40

090

N

8765.29

*

*

J1

21049

EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC

4159.20

090

Y

8765.29

*

*

J1

21050

CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX

3110.40

090

N

8765.29

*

*

J1

21060

MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX

2829.60

090

Y

8765.29

*

*

J1

21070

CORONOIDECTOMY SEPARATE PROCEDURE

2198.40

090

N

8765.29

*

*

J1

21073

MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA

1322.40

090

N

2543.11

*

*

J1

21076

IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES

3312.00

010

N

2543.11

*

*

J1

21077

IMPRESSION & PREPARATION ORBITAL PROSTHESIS

8256.00

090

N

8765.29

*

*

J1

21079

IMPRESSION & PREPARATION INTERIM OBTURATOR PROST

5599.20

090

N

4449.71

*

*

J1

21080

IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES

6327.60

090

N

4449.71

*

*

J1

21081

IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES

5823.60

090

N

8765.29

*

*

J1

21082

IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES

5439.60

090

N

4449.71

*

*

J1

21083

IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS

5186.40

090

N

4449.71

*

*

J1

21084

IMPRESSION & PREPARATION SPEECH AID PROSTHESIS

5938.80

090

N

4449.71

*

*

21085

IMPRESSION & PREPARATION ORAL SURGICAL SPLINT

2526.00

010

N

292.72

*

*

J1

21086

IMPRESSION & PREPARATION AURICULAR PROSTHESIS

6132.00

090

N

4449.71

*

*

J1

21087

IMPRESSION & PREPARATION NASAL PROSTHESIS

6132.00

090

N

8765.29

*

*

J1

21088

IMPRESSION & PREPARATION FACIAL PROSTHESIS

5984.40

090

N

4449.71

*

*

21089

UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE

BR

YYY

N

292.72

*

*

J1

21100

APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX

2386.80

090

N

8765.29

*

*

21110

APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC

2805.60

090

N

1816.32

*

*

21116

INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY

609.60

000

N

*

*

J1

21120

GENIOPLASTY AUGMENTATION

2317.20

090

N

8765.29

*

*

J1

21121

GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE

2514.00

090

Y

4449.71

*

*

J1

21122

GENIOPLASTY 2/> SLIDING OSTEOTOMIES

2685.60

090

Y

8765.29

*

*

J1

21123

GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS

3134.40

090

Y

4449.71

*

*

J1

21125

AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL

9932.40

090

Y

8765.29

*

*

J1

21127

AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL

13464.00

090

Y

8765.29

*

*

J1

21137

REDUCTION FOREHEAD CONTOURING ONLY

2594.40

090

Y

4449.71

*

*

J1

21138

RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT

3169.20

090

Y

8765.29

*

*

J1

21139

RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL

3858.00

090

Y

8765.29

*

*

21141

RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT

4735.20

090

Y

8109.22

*

*

21142

RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT

4867.20

090

Y

6151.61

*

*

21143

RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT

5078.40

090

Y

7881.27

*

*

21145

RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS

5548.80

090

Y

9252.92

*

*

21146

RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS

5769.60

090

Y

9590.09

*

*

21147

RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS

6100.80

090

Y

9415.69

*

*

J1

21150

RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION

5721.60

090

Y

8765.29

*

*

21151

RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS

6297.60

090

Y

*

*

21154

RCNSTJ MIDFACE LEFORT III W/O LEFORT I

6775.20

090

Y

*

*

21155

RCNSTJ MIDFACE LEFORT III W/LEFORT I

7516.80

090

Y

*

*

21159

RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I

9010.80

090

Y

*

*

21160

RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I

9774.00

090

Y

*

*

J1

21172

RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD

7270.80

090

Y

8765.29

*

*

J1

21175

RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD

7658.40

090

Y

8765.29

*

*

21179

RCNSTJ FOREHEAD &/ SUPRAORB RIMS W/ALGRF/PROSTC

5232.00

090

Y

*

*

21180

RCNSTJ FOREHEAD &/ SUPRAORBITAL RIMS W/AUTOGRAFT

5887.20

090

Y

*

*

J1

21181

RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC

2554.80

090

N

8765.29

*

*

21182

RCNSTJ ORBIT/FHD/NASETHMD EXCBONE TUM GRF<40SQCM

7321.20

090

Y

*

*

21183

RCNSTJ ORBIT/FHD/NASETHMD EXC BONE GRF>40 <80

8010.00

090

Y

*

*

21184

RCNSTJ ORBIT/FHD/NASETHMD EXC BONE TUM GRF>80SQ

8623.20

090

Y

*

*

21188

RCNSTJ MDFC OTH/THN LEFORT OSTEOT & BONE GRAFTS

5767.20

090

Y

*

*

J1

21193

RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF

4413.60

090

Y

8765.29

*

*

21194

RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT

5086.80

090

Y

*

*

J1

21195

RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD

4921.20

090

Y

8765.29

*

*

21196

RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI

5061.60

090

Y

6822.85

*

*

J1

21198

OSTEOTOMY MANDIBLE SEGMENTAL

3969.60

090

Y

8765.29

*

*

J1

21199

OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT

3714.00

090

Y

8765.29

*

*

J1

21206

OSTEOTOMY MAXILLA SEGMENTAL

4096.80

090

Y

8765.29

*

*

J1

21208

OSTEOPLASTY FACIAL BONES AUGMENTATION

5989.20

090

N

8765.29

*

*

J1

21209

OSTEOPLASTY FACIAL BONES REDUCTION

3090.00

090

Y

8765.29

*

*

J1

21210

GRAFT BONE NASAL/MAXILLARY/MALAR AREAS

7233.60

090

N

8765.29

*

*

J1

21215

GRAFT BONE MANDIBLE

13765.20

090

N

8765.29

*

*

J1

21230

GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR

2562.00

090

N

8765.29

*

*

J1

21235

GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR

2492.40

090

N

8765.29

*

*

J1

21240

ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT

3858.00

090

Y

8765.29

*

*

J1

21242

ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT

3590.40

090

Y

8765.29

*

*

J1

21243

ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT

5870.40

090

Y

26078.68

*

*

J1

21244

RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE

3602.40

090

Y

8765.29

*

*

J1

21245

RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL

4184.40

090

Y

8765.29

*

*

J1

21246

RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE

3052.80

090

Y

8765.29

*

*

21247

RCNSTJ MNDBLR CONDYLE W/BONE CARTLG AUTOGRAFTS

5644.80

090

Y

*

*

J1

21248

RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL

3733.20

090

N

8765.29

*

*

J1

21249

RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE

5388.00

090

N

8765.29

*

*

21255

RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG

4881.60

090

Y

*

*

J1

21256

RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS

4294.80

090

Y

8765.29

*

*

J1

21260

PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL

4822.80

090

Y

8765.29

*

*

J1

21261

PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR

8542.80

090

Y

8765.29

*

*

J1

21263

PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD

7898.40

090

Y

8765.29

*

*

J1

21267

ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL

5622.00

090

Y

8765.29

*

*

21268

ORBITAL REPOSITIONING W/BONE GRAFTS ICRA & XTRC

7069.20

090

Y

*

*

J1

21270

MALAR AUGMENTATION PROSTHETIC MATERIAL

3487.20

090

Y

8765.29

*

*

J1

21275

SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ

2901.60

090

Y

8765.29

*

*

J1

21280

MEDIAL CANTHOPEXY SEPARATE PROCEDURE

1968.00

090

N

4449.71

*

*

J1

21282

LATERAL CANTHOPEXY

1321.20

090

N

4449.71

*

*

J1

21295

REDUCTION MASSETER MUSCLE & BONE EXTRAORAL

644.40

090

N

2543.11

*

*

J1

21296

REDUCTION MASSETER MUSCLE & BONE INTRAORAL

1396.80

090

N

4449.71

*

*

21299

UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE

BR

YYY

N

292.72

*

*

21310

CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION

451.20

000

N

319.63

*

*

J1

21315

CLOSED TX NASAL FRACTURE W/O STABILIZATION

940.80

010

N

2543.11

*

*

J1

21320

CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION

867.60

010

N

4449.71

*

*

J1

21325

OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED

1606.80

090

N

4449.71

*

*

J1

21330

OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI

1940.40

090

N

8765.29

*

*

J1

21335

OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM

2463.60

090

N

4449.71

*

*

J1

21336

OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION

2206.80

090

N

5184.51

*

*

J1

21337

CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION

1394.40

090

N

4449.71

*

*

J1

21338

OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION

2265.60

090

N

8765.29

*

*

J1

21339

OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION

2565.60

090

Y

8765.29

*

*

J1

21340

PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE

2560.80

090

N

4449.71

*

*

21343

OPEN TX DEPRESSED FRONTAL SINUS FRACTURE

3698.40

090

Y

4602.09

*

*

21344

OPEN TX COMPLICATED FRONTAL SINUS FRACTURE

4759.20

090

Y

*

*

J1

21345

CLOSED TX NASOMAXILLARY COMPLEX FRACTURE

2670.00

090

N

2543.11

*

*

J1

21346

OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ

3192.00

090

N

8765.29

*

*

21347

OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN

3483.60

090

Y

*

*

21348

OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT

3726.00

090

Y

*

*

J1

21355

PERCUTANEOUS TX MALAR AREA FRACTURE

1462.80

010

N

4449.71

*

*

J1

21356

OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE

1717.20

010

N

8765.29

*

*

J1

21360

OPEN TX DEPRESSED MALAR FRACTURE

1752.00

090

Y

8765.29

*

*

J1

21365

OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG

3834.00

090

Y

8765.29

*

*

21366

OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT

4390.80

090

Y

*

*

J1

21385

OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL

2598.00

090

Y

8765.29

*

*

J1

21386

OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL

2397.60

090

Y

8765.29

*

*

J1

21387

OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR

2709.60

090

Y

8765.29

*

*

J1

21390

OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC

2755.20

090

Y

8765.29

*

*

J1

21395

OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF

3488.40

090

Y

8765.29

*

*

21400

CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION

687.60

090

N

691.72

*

*

J1

21401

CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION

1770.00

090

Y

2543.11

*

*

J1

21406

OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT

1984.80

090

Y

8765.29

*

*

J1

21407

OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT

2223.60

090

Y

8765.29

*

*

J1

21408

OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT

3114.00

090

Y

8765.29

*

*

J1

21421

CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT

2439.60

090

N

4449.71

*

*

21422

OPEN TREATMENT PALATAL/MAXILLARY FRACTURE

2276.40

090

Y

3579.25

*

*

21423

OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR

2666.40

090

Y

3332.83

*

*

21431

CLOSED TX CRANIOFACIAL SEPARATION

2472.00

090

Y

*

*

21432

OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ

2469.60

090

Y

*

*

21433

OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR

6020.40

090

Y

*

*

21435

OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIX

4839.60

090

Y

*

*

21436

OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE

7059.60

090

Y

*

*

J1

21440

CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX

2079.60

090

N

4449.71

*

*

J1

21445

OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX

2671.20

090

Y

8765.29

*

*

21450

CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION

1972.80

090

N

691.72

*

*

J1

21451

CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION

2610.00

090

N

2543.11

*

*

J1

21452

PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ

2300.40

090

N

8765.29

*

*

J1

21453

CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION

3314.40

090

N

8765.29

*

*

J1

21454

OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION

1882.80

090

N

8765.29

*

*

J1

21461

OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION

7132.80

090

N

8765.29

*

*

J1

21462

OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION

7604.40

090

Y

8765.29

*

*

J1

21465

OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE

3104.40

090

Y

8765.29

*

*

J1

21470

OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION

4144.80

090

Y

8765.29

*

*

21480

CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ

368.40

000

N

319.63

*

*

J1

21485

CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ

2854.80

090

N

2543.11

*

*

J1

21490

OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION

3067.20

090

Y

4449.71

*

*

J1

21497

INTERDENTAL WIRING OTHER THAN FRACTURE

2354.40

090

N

2543.11

*

*

21499

UNLISTED MUSCULOSKELETAL PROCEDURE HEAD

BR

YYY

N

292.72

*

*

J1

21501

I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX

1581.60

090

N

4742.07

*

*

J1

21502

I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI

1742.40

090

Y

5184.51

*

*

21510

INCISION DEEP OPENING BONE CORTEX THORAX

1528.80

090

N

*

*

J1

21550

BIOPSY SOFT TISSUE NECK/THORAX

895.20

010

N

2734.29

*

*

J1

21552

EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>

1543.20

090

Y

4742.07

*

*

J1

21554

EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>

2527.20

090

Y

4742.07

*

*

J1

21555

EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM

1448.40

090

N

2734.29

*

*

J1

21556

EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL GREATER THAN 5CM

1822.80

090

N

4742.07

*

*

J1

21557

RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX GREATER THAN 5CM

3297.60

090

Y

4742.07

*

*

J1

21558

RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>

4651.20

090

Y

4742.07

*

*

J1

21600

EXCISION RIB PARTIAL

1902.00

090

Y

10775.65

*

*

J1

21610

COSTOTRANSVERSECTOMY SEPARATE PROCEDURE

4164.00

090

Y

5184.51

*

*

21615

EXCISION 1ST &/CERVICAL RIB

2109.60

090

Y

8654.28

*

*

21616

EXCISION 1ST &/CERVICAL RIB W/SYMPATHECTOMY

2467.20

090

Y

*

*

21620

OSTECTOMY STERNUM PARTIAL

1742.40

090

Y

3414.42

*

*

21627

STERNAL DEBRIDEMENT

1858.80

090

Y

*

*

21630

RADICAL RESECTION STERNUM

4252.80

090

Y

*

*

21632

RADICAL RESECTION STERNUM W/MEDSTNL LMPHADEC

4186.80

090

Y

*

*

J1

21685

HYOID MYOTOMY & SUSPENSION

3385.20

090

Y

8765.29

*

*

J1

21700

DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB

1228.80

090

Y

5184.51

*

*

21705

DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB

1846.80

090

Y

*

*

J1

21720

DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST

1772.40

090

Y

5184.51

*

*

21725

DIVISION STERNOCLEIDOMASTOID OPEN W/CAST

1869.60

090

Y

822.66

*

*

21740

REPAIR PECTUS EXCAVATUM/CARINATUM OPEN

3566.40

090

Y

*

*

J1

21742

REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC

7196.40

090

Y

5184.51

*

*

J1

21743

REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC

10012.80

090

Y

5184.51

*

*

21750

CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX

2365.20

090

Y

*

*

J1

21811

OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS

2061.60

000

Y

5184.51

*

*

J1

21812

OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS

2528.40

000

Y

5184.51

*

*

J1

21813

OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS

3408.00

000

Y

2624.38

*

*

21820

CLOSED TREATMENT STERNUM FRACTURE

489.60

090

N

319.63

*

*

21825

OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION

1870.80

090

Y

*

*

21899

UNLISTED PROCEDURE NECK/THORAX

BR

YYY

N

292.72

*

*

J1

21920

BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL

876.00

010

N

2734.29

*

*

J1

21925

BIOPSY SOFT TISSUE BACK/FLANK DEEP

1572.00

090

N

2734.29

*

*

J1

21930

EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM

1659.60

090

N

2734.29

*

*

J1

21931

EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>

1627.20

090

Y

2734.29

*

*

J1

21932

EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL GREATER THAN 5CM

2288.40

090

Y

4742.07

*

*

J1

21933

EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>

2554.80

090

Y

4742.07

*

*

J1

21935

RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK GREATER THAN 5CM

3558.00

090

N

4742.07

*

*

J1

21936

RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>

4915.20

090

Y

4742.07

*

*

22010

I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR

3327.60

090

N

*

*

22015

I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC

3288.00

090

N

3708.57

*

*

J1

22100

PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV

2985.60

090

Y

10775.65

*

*

J1

22101

PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC

2976.00

090

Y

5184.51

*

*

J1

22102

PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR

2817.60

090

Y

10775.65

+

*

22103

PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA

492.00

ZZZ

Y

*

*

22110

PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV

3634.80

090

Y

*

*

22112

PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC

3846.00

090

Y

*

*

22114

PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR

3892.80

090

Y

+

*

22116

PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA

494.40

ZZZ

Y

*

*

22206

OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC

8559.60

090

Y

*

*

22207

OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR

8386.80

090

Y

+

*

22208

OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM

2073.60

ZZZ

Y

*

*

22210

OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV

6247.20

090

Y

*

*

22212

OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC

5186.40

090

Y

*

*

22214

OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR

5208.00

090

Y

+

*

22216

OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM

1273.20

ZZZ

Y

*

*

22220

OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM CRV

5644.80

090

Y

*

*

22222

OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC

6003.60

090

Y

*

*

22224

OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR

5508.00

090

Y

+

*

22226

OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM

1269.60

ZZZ

Y

*

*

22310

CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING

1058.40

090

N

319.63

*

*

J1

22315

CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ

3044.40

090

N

5184.51

*

*

22318

OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT

5718.00

090

Y

*

*

22319

OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ

6332.40

090

Y

*

*

22325

OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM

5036.40

090

Y

*

*

22326

OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR

5216.40

090

Y

*

*

22327

OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH

5265.60

090

Y

+

*

22328

OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA

990.00

ZZZ

Y

*

*

J1

22505

MANIPULATION SPINE REQUIRING ANESTHESIA

454.80

010

N

2624.38

*

*

J1

22510

PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC

5979.60

010

N

5184.51

*

*

J1

22511

PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

5919.60

010

N

5184.51

+

*

22512

VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL

3072.00

ZZZ

N

*

*

J1

22513

PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

23466.00

010

N

10775.65

*

*

J1

22514

PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

23390.40

010

N

10775.65

+

*

22515

PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

13578.00

ZZZ

N

*

*

22526

PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL

0.00

010

N

+

*

22527

PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL

0.00

ZZZ

N

*

*

22532

ARTHRODESIS LATERAL EXTRACAVITARY THORACIC

6288.00

090

Y

*

*

22533

ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR

5774.40

090

Y

+

*

22534

ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR

1262.40

ZZZ

Y

*

*

22548

ARTHRD ANT TRANSORL/XTRORAL C1-C2 W/WO EXC ODNTD

6834.00

090

Y

2782.53

*

*

J1

22551

ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2

5959.20

090

Y

19120.53

+

*

22552

ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC

1396.80

ZZZ

Y

*

*

J1

22554

ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2

4368.00

090

Y

19120.53

*

*

22556

ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC

5829.60

090

Y

*

*

22558

ARTHRODESIS ANTERIOR INTERBODY LUMBAR

5338.80

090

Y

3427.37

+

*

22585

ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC

1146.00

ZZZ

Y

2094.83

*

*

22586

ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5-S1

7072.80

090

Y

*

*

22590

ARTHRODESIS POSTERIOR CRANIOCERVICAL

5518.80

090

Y

*

*

22595

ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2

5265.60

090

Y

*

*

22600

ARTHRODESIS PST/PSTLAT CERVICAL BELW C2 SGM

4497.60

090

Y

3383.04

*

*

22610

ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC

4413.60

090

Y

*

*

J1

22612

ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR

5527.20

090

Y

19120.53

+

*

22614

ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL

1370.40

ZZZ

Y

*

*

22630

ARTHRODESIS POSTERIOR INTERBODY LUMBAR

5496.00

090

Y

3087.45

+

*

22632

ARTHRODESIS POSTERIOR INTERBODY EA ADDL

1128.00

ZZZ

Y

2112.44

*

*

22633

ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR

6462.00

090

Y

3554.92

+

*

22634

ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG

1737.60

ZZZ

Y

*

*

22800

ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG

4720.80

090

Y

*

*

22802

ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG

7333.20

090

Y

*

*

22804

ARTHRODESIS POSTERIOR SPINAL DFRM 13/> VRT SEG

8476.80

090

Y

*

*

22808

ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SEG

6451.20

090

Y

*

*

22810

ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SEG

7233.60

090

Y

*

*

22812

ARTHRODESIS ANTERIOR SPINAL DFRM 8/> VRT SEG

7593.60

090

Y

*

*

22818

KYPHECTOMY SINGLE OR TWO SEGMENTS

7498.80

090

Y

*

*

22819

KYPHECTOMY 3 OR MORE SEGMENTS

8580.00

090

Y

*

*

22830

EXPLORATION SPINAL FUSION

2834.40

090

Y

2019.54

+

*

22840

POSTERIOR NON-SEGMENTAL INSTRUMENTATION

2664.00

ZZZ

Y

2310.68

+

*

22841

INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS

3068.40

XXX

N

+

*

22842

POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG

2678.40

ZZZ

Y

2497.29

+

*

22843

POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG

2864.40

ZZZ

Y

+

*

22844

POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE

3458.40

ZZZ

Y

+

*

22845

ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS

2559.60

ZZZ

Y

2152.01

+

*

22846

ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS

2658.00

ZZZ

Y

1587.53

+

*

22847

ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS

2804.40

ZZZ

Y

+

*

22848

PELVIC FIXATION OTHER THAN SACRUM

1260.00

ZZZ

Y

*

*

22849

REINSERTION SPINAL FIXATION DEVICE

4527.60

090

Y

3808.35

*

*

22850

REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION

2524.80

090

Y

4823.38

*

*

22852

REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION

2425.20

090

Y

4443.93

+

*

22853

INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD

906.00

ZZZ

Y

+

*

22854

INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD

1173.60

ZZZ

Y

*

*

22855

REMOVAL ANTERIOR INSTRUMENTATION

3862.80

090

Y

1924.84

*

*

J1

22856

TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV

5719.20

090

Y

26078.68

*

*

22857

TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC LMBR

6102.00

090

Y

3302.84

+

*

22858

TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL

1791.60

ZZZ

Y

3263.95

+

*

22859

INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD

1173.60

ZZZ

Y

*

*

22861

REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV

7791.60

090

Y

7702.96

*

*

22862

REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR

6592.80

090

Y

3033.52

*

*

22864

RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL

7194.00

090

Y

*

*

22865

RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR

6765.60

090

Y

*

*

J1

22867

INSJ STABLJ DEV W/DCMPRN LUMBAR SINGLE LEVEL

3385.20

090

Y

26078.68

+

*

22868

INSJ STABLJ DEV W/DCMPRN LUMBAR SECOND LEVEL

847.20

ZZZ

Y

*

*

J1

22869

INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL

1590.00

090

Y

26078.68

+

*

22870

INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL

434.40

ZZZ

Y

*

*

22899

UNLISTED PROCEDURE SPINE

0.00

YYY

Y

319.63

*

*

J1

22900

EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL GREATER THAN 5CM

1948.80

090

Y

4742.07

*

*

J1

22901

EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>

2304.00

090

Y

4742.07

*

*

J1

22902

EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM

1542.00

090

Y

2734.29

*

*

J1

22903

EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>

1521.60

090

Y

4742.07

*

*

J1

22904

RAD RESECTION TUMOR SOFT TISSUE ABDL WALL GREATER THAN 5CM

3658.80

090

Y

4742.07

*

*

J1

22905

RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>

4624.80

090

Y

4742.07

*

*

22999

UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM

BR

YYY

N

319.63

*

*

J1

23000

REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN

1929.60

090

Y

4742.07

*

*

J1

23020

CAPSULAR CONTRACTURE RELEASE

2382.00

090

Y

5184.51

*

*

J1

23030

I&D SHOULDER DEEP ABSCESS/HEMATOMA

1491.60

010

N

4742.07

*

*

J1

23031

I&D SHOULDER INFECTED BURSA

1372.80

010

N

2734.29

*

*

J1

23035

INCISION BONE CORTEX SHOULDER AREA

2337.60

090

Y

2624.38

*

*

J1

23040

ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB

2476.80

090

Y

5184.51

*

*

J1

23044

ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB

1957.20

090

N

5184.51

*

*

J1

23065

BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL

760.80

010

N

2734.29

*

*

J1

23066

BIOPSY SOFT TISSUE SHOULDER DEEP

1941.60

090

N

4742.07

*

*

J1

23071

EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>

1450.80

090

Y

2734.29

*

*

J1

23073

EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>

2404.80

090

Y

4742.07

*

*

J1

23075

EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM

1668.00

090

N

2734.29

*

*

J1

23076

EXC TUMOR SOFT TISS SHOULDER SUBFASC GREATER THAN 5CM

1872.00

090

N

4742.07

*

*

J1

23077

RAD RESECTION TUMOR SOFT TISSUE SHOULDER GREATER THAN 5CM

3937.20

090

Y

4742.07

*

*

J1

23078

RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>

4977.60

090

Y

4742.07

*

*

J1

23100

ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY

1728.00

090

Y

5184.51

*

*

J1

23101

ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG

1576.80

090

N

5184.51

*

*

J1

23105

ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY

2200.80

090

Y

10775.65

*

*

J1

23106

ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX

1718.40

090

N

5184.51

*

*

J1

23107

ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB

2281.20

090

Y

10775.65

*

*

J1

23120

CLAVICULECTOMY PARTIAL

2016.00

090

Y

5184.51

*

*

J1

23125

CLAVICULECTOMY TOTAL

2438.40

090

Y

5184.51

*

*

J1

23130

PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE

2114.40

090

N

5184.51

*

*

J1

23140

EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA

1908.00

090

N

5184.51

*

*

J1

23145

EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT

2373.60

090

Y

5184.51

*

*

J1

23146

EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT

2115.60

090

N

10775.65

*

*

J1

23150

EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS

2272.80

090

Y

5184.51

*

*

J1

23155

EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT

2724.00

090

Y

10775.65

*

*

J1

23156

EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT

2335.20

090

Y

10775.65

*

*

J1

23170

SEQUESTRECTOMY CLAVICLE

1939.20

090

N

5184.51

*

*

J1

23172

SEQUESTRECTOMY SCAPULA

1947.60

090

Y

5184.51

*

*

J1

23174

SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK

2619.60

090

Y

5184.51

*

*

J1

23180

PARTIAL EXCISION BONE CLAVICLE

2278.80

090

N

5184.51

*

*

J1

23182

PARTIAL EXCISION BONE SCAPULA

2274.00

090

Y

5184.51

*

*

J1

23184

PARTIAL EXCISION BONE PROXIMAL HUMERUS

2532.00

090

Y

10775.65

*

*

J1

23190

OSTECTOMY SCAPULA PARTIAL

1971.60

090

Y

5184.51

*

*

J1

23195

RESECTION HUMERAL HEAD

2576.40

090

Y

10775.65

*

*

23200

RADICAL RESECTION TUMOR CLAVICLE

5236.80

090

Y

*

*

23210

RADICAL RESECTION TUMOR SCAPULA

6151.20

090

Y

*

*

23220

RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS

6759.60

090

Y

*

*

23330

REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS

960.00

010

N

822.66

*

*

J1

23333

REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM

1592.40

090

N

2734.29

*

*

J1

23334

PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT

3705.60

090

N

4742.07

*

*

23335

PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT

4423.20

090

N

*

*

23350

INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG

476.40

000

N

*

*

J1

23395

MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE

4436.40

090

Y

10775.65

*

*

J1

23397

MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE

3920.40

090

Y

10775.65

*

*

J1

23400

SCAPULOPEXY

3303.60

090

Y

10775.65

*

*

J1

23405

TENOTOMY SHOULDER AREA 1 TENDON

2132.40

090

Y

10775.65

*

*

J1

23406

TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION

2664.00

090

Y

5184.51

*

*

J1

23410

OPEN REPAIR OF ROTATOR CUFF ACUTE

2836.80

090

Y

10775.65

*

*

J1

23412

OPEN REPAIR OF ROTATOR CUFF CHRONIC

2943.60

090

Y

10775.65

*

*

J1

23415

CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY

2413.20

090

N

10775.65

*

*

J1

23420

RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC

3357.60

090

Y

10775.65

*

*

J1

23430

TENODESIS LONG TENDON BICEPS

2569.20

090

Y

10775.65

*

*

J1

23440

RESECTION/TRANSPLANTATION LONG TENDON BICEPS

2604.00

090

Y

5184.51

*

*

J1

23450

CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON

3259.20

090

Y

10775.65

*

*

J1

23455

CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR

3448.80

090

Y

10775.65

*

*

J1

23460

CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK

3751.20

090

Y

10775.65

*

*

J1

23462

CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR

3644.40

090

Y

10775.65

*

*

J1

23465

CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK

3859.20

090

Y

10775.65

*

*

J1

23466

CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS

3853.20

090

Y

10775.65

*

*

J1

23470

ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY

4150.80

090

Y

19120.53

*

*

J1*

23472

ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER

5031.60

090

Y

19120.53

*

*

J1

23473

REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT

5613.60

090

Y

19120.53

*

*

23474

REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT

6063.60

090

Y

12384.94

*

*

J1

23480

OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION

2844.00

090

N

10775.65

*

*

J1

23485

OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL

3300.00

090

Y

19120.53

*

*

J1

23490

PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE

2960.40

090

Y

10775.65

*

*

J1

23491

PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS

3511.20

090

Y

19120.53

*

*

23500

CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION

748.80

090

N

319.63

*

*

J1

23505

CLSD TX CLAVICULAR FRACTURE W/MANIPULATION

1218.00

090

N

2624.38

*

*

J1

23515

OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION

2484.00

090

Y

10775.65

*

*

J1

23520

CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION

806.40

090

N

2624.38

*

*

23525

CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION

1334.40

090

N

319.63

*

*

J1

23530

OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC

1965.60

090

Y

10775.65

*

*

J1

23532

OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF

2134.80

090

Y

10775.65

*

*

23540

CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION

784.80

090

N

319.63

*

*

23545

CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION

1186.80

090

N

319.63

*

*

J1

23550

OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC

1962.00

090

Y

10775.65

*

*

J1

23552

OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF

2257.20

090

Y

10775.65

*

*

23570

CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION

794.40

090

N

319.63

*

*

J1

23575

CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION

1384.80

090

N

2624.38

*

*

J1

23585

OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD

3385.20

090

Y

10775.65

*

*

23600

CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION

1124.40

090

N

319.63

*

*

J1

23605

CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ

1599.60

090

N

2624.38

*

*

J1

23615

OPEN TREATMENT PROXIMAL HUMERAL FRACTURE

3055.20

090

Y

19120.53

*

*

J1

23616

OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT

4287.60

090

Y

26078.68

*

*

23620

CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ

918.00

090

N

319.63

*

*

J1

23625

CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION

1310.40

090

N

2624.38

*

*

J1

23630

OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE

2696.40

090

Y

10775.65

*

*

23650

CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES

1092.00

090

N

319.63

*

*

J1

23655

CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES

1388.40

090

N

2624.38

*

*

J1

23660

OPEN TX ACUTE SHOULDER DISLOCATION

2010.00

090

Y

10775.65

*

*

J1

23665

CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ

1470.00

090

N

2624.38

*

*

J1

23670

OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX

3025.20

090

Y

10775.65

*

*

J1

23675

CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ

1891.20

090

N

2624.38

*

*

J1

23680

OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE

3208.80

090

Y

19120.53

*

*

J1

23700

MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS

676.80

010

N

2624.38

*

*

J1

23800

ARTHRODESIS GLENOHUMERAL JOINT

3540.00

090

Y

10775.65

*

*

J1

23802

ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT

4416.00

090

Y

19120.53

*

*

23900

INTERTHORACOSCAPULAR AMPUTATION

4796.40

090

Y

*

*

23920

DISARTICULATION SHOULDER

3896.40

090

Y

*

*

23921

DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION

1616.40

090

N

2199.52

*

*

23929

UNLISTED PROCEDURE SHOULDER

BR

YYY

Y

319.63

*

*

J1

23930

I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA

1219.20

010

N

2734.29

*

*

J1

23931

INCISION&DRAINAGE UPPER ARM/ELBOW BURSA

982.80

010

N

2734.29

*

*

J1

23935

INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW

1753.20

090

N

5184.51

*

*

J1

24000

ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB

1645.20

090

N

5184.51

*

*

J1

24006

ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX

2467.20

090

Y

5184.51

*

*

J1

24065

BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL

888.00

010

N

2734.29

*

*

J1

24066

BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP

2167.20

090

N

4742.07

*

*

J1

24071

EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>

1404.00

090

Y

4742.07

*

*

J1

24073

EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>

2398.80

090

Y

4742.07

*

*

J1

24075

EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM

1734.00

090

N

2734.29

*

*

J1

24076

EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC GREATER THAN 5CM

1880.40

090

N

4742.07

*

*

J1

24077

RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW GREATER THAN 5CM

3591.60

090

N

4742.07

*

*

J1

24079

RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>

4588.80

090

Y

4742.07

*

*

J1

24100

ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY

1436.40

090

Y

5184.51

*

*

J1

24101

ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB

1725.60

090

Y

5184.51

*

*

J1

24102

ARTHROTOMY ELBOW W/SYNOVECTOMY

2127.60

090

Y

5184.51

*

*

J1

24105

EXCISION OLECRANON BURSA

1214.40

090

N

5184.51

*

*

J1

24110

EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS

2023.20

090

N

5184.51

*

*

J1

24115

EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT

2523.60

090

Y

10775.65

*

*

J1

24116

EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT

2976.00

090

Y

10775.65

*

*

J1

24120

EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN

1830.00

090

N

5184.51

*

*

J1

24125

EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT

2146.80

090

Y

5184.51

*

*

J1

24126

EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT

2222.40

090

Y

10775.65

*

*

J1

24130

EXCISION RADIAL HEAD

1760.40

090

N

5184.51

*

*

J1

24134

SEQUESTRECTOMY SHAFT/DISTAL HUMERUS

2578.80

090

Y

10775.65

*

*

J1

24136

SEQUESTRECTOMY RADIAL HEAD OR NECK

2182.80

090

N

5184.51

*

*

J1

24138

SEQUESTRECTOMY OLECRANON PROCESS

2336.40

090

Y

10775.65

*

*

J1

24140

PARTIAL EXCISION BONE HUMERUS

2425.20

090

Y

5184.51

*

*

J1

24145

PARTIAL EXCISION BONE RADIAL HEAD/NECK

2048.40

090

N

10775.65

*

*

J1

24147

PARTIAL EXCISION BONE OLECRANON PROCESS

2152.80

090

N

5184.51

*

*

J1

24149

RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT

4063.20

090

Y

10775.65

*

*

J1

24150

RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS

5379.60

090

Y

10775.65

*

*

J1

24152

RADICAL RESECTION TUMOR RADIAL HEAD/NECK

4602.00

090

Y

10775.65

*

*

J1

24155

RESECTION ELBOW JOINT ARTHRECTOMY

2936.40

090

Y

5184.51

*

*

24160

PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS

4375.20

090

N

3725.14

*

*

24164

PROSTHESIS REMOVAL RADIAL HEAD

2506.80

090

N

3725.14

*

*

J1

24200

RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS

722.40

010

N

2734.29

*

*

J1

24201

REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP

1898.40

090

N

4742.07

*

*

24220

INJECTION ELBOW ARTHROGRAPHY

565.20

000

N

*

*

J1

24300

MANIPULATION ELBOW UNDER ANESTHESIA

1448.40

090

N

2624.38

*

*

J1

24301

MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE

2594.40

090

Y

10775.65

*

*

J1

24305

TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON

1990.80

090

N

5184.51

*

*

J1

24310

TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON

1611.60

090

N

5184.51

*

*

J1

24320

TENOPLASTY ELBOW TO SHOULDER SINGLE

2676.00

090

Y

10775.65

*

*

J1

24330

FLEXOR-PLASTY ELBOW

2475.60

090

Y

5184.51

*

*

J1

24331

FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT

2668.80

090

Y

10775.65

*

*

J1

24332

TENOLYSIS TRICEPS

2119.20

090

N

5184.51

*

*

J1

24340

TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE

2112.00

090

Y

10775.65

*

*

J1

24341

REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA

2570.40

090

Y

10775.65

*

*

J1

24342

RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF

2680.80

090

Y

10775.65

*

*

J1

24343

REPAIR LATERAL COLLATERAL LIGAMENT ELBOW

2449.20

090

Y

5184.51

*

*

J1

24344

RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT

3774.00

090

Y

10775.65

*

*

J1

24345

REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW

2430.00

090

Y

10775.65

*

*

J1

24346

RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF

3792.00

090

Y

19120.53

*

*

J1

24357

TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS

1435.20

090

N

5184.51

*

*

J1

24358

TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN

1806.00

090

N

5184.51

*

*

J1

24359

TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR

2281.20

090

N

5184.51

*

*

J1

24360

ARTHROPLASTY ELBOW W/MEMBRANE

3112.80

090

Y

10775.65

*

*

J1

24361

ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT

3483.60

090

Y

26078.68

*

*

J1

24362

ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ

3673.20

090

Y

19120.53

*

*

J1

24363

ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM

5035.20

090

Y

26078.68

*

*

J1

24365

ARTHROPLASTY RADIAL HEAD

2206.80

090

Y

19120.53

*

*

J1

24366

ARTHROPLASTY RADIAL HEAD W/IMPLANT

2352.00

090

Y

19120.53

*

*

J1

24370

REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT

5366.40

090

Y

19120.53

*

*

J1

24371

REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT

6164.40

090

Y

26078.68

*

*

J1

24400

OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION

2846.40

090

Y

10775.65

*

*

J1

24410

MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT

3663.60

090

Y

19120.53

*

*

J1

24420

OSTEOPLASTY HUMERUS

3430.80

090

Y

10775.65

*

*

J1

24430

REPAIR NON/MALUNION HUMERUS W/O GRAFT

3648.00

090

Y

19120.53

*

*

J1

24435

REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT

3722.40

090

Y

19120.53

*

*

J1

24470

HEMIEPIPHYSEAL ARREST

2322.00

090

Y

5184.51

*

*

J1

24495

DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL

2552.40

090

N

10775.65

*

*

J1

24498

PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT

2995.20

090

Y

19120.53

*

*

24500

CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION

1225.20

090

N

319.63

*

*

J1

24505

CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ

1712.40

090

N

2624.38

*

*

J1

24515

OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE

3032.40

090

Y

19120.53

*

*

J1

24516

TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE

2972.40

090

Y

19120.53

*

*

24530

CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ

1302.00

090

N

319.63

*

*

J1

24535

CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ

2121.60

090

N

2624.38

*

*

J1

24538

PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX

2581.20

090

N

10775.65

*

*

J1

24545

OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN

3213.60

090

Y

19120.53

*

*

J1

24546

OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN

3594.00

090

Y

26078.68

*

*

24560

CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ

1114.80

090

N

319.63

*

*

J1

24565

CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ

1839.60

090

N

2624.38

*

*

J1

24566

PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ

2480.40

090

N

2624.38

*

*

J1

24575

OPEN TX HUMERAL EPICONDYLAR FRACTURE

2527.20

090

Y

19120.53

*

*

24576

CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ

1176.00

090

N

319.63

*

*

J1

24577

CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ

1896.00

090

N

2624.38

*

*

J1

24579

OPEN TREATMENT HUMERAL CONDYLAR FRACTURE

2887.20

090

Y

19120.53

*

*

J1

24582

PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ

2800.80

090

N

5184.51

*

*

J1

24586

OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO

3747.60

090

Y

19120.53

*

*

J1

24587

OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR

3762.00

090

Y

19120.53

*

*

24600

TREATMENT CLOSED ELBOW DISLOCATION W/O ANES

1267.20

090

N

319.63

*

*

J1

24605

TREATMENT CLOSED ELBOW DISLOCATION REQ ANES

1630.80

090

N

2624.38

*

*

J1

24615

OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION

2463.60

090

Y

10775.65

*

*

J1

24620

CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ

1905.60

090

N

2624.38

*

*

J1

24635

OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW

2326.80

090

Y

10775.65

*

*

24640

CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ

343.20

010

N

319.63

*

*

24650

CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION

894.00

090

N

319.63

*

*

J1

24655

CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION

1519.20

090

N

2624.38

*

*

J1

24665

OPEN TX RADIAL HEAD/NECK FRACTURE

2253.60

090

Y

10775.65

*

*

J1

24666

OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC

2530.80

090

Y

19120.53

*

*

24670

CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ

993.60

090

N

319.63

*

*

J1

24675

CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ

1574.40

090

N

2624.38

*

*

J1

24685

OPEN TREATMENT ULNAR FRACTURE PROXIMAL END

2257.20

090

Y

10775.65

*

*

J1

24800

ARTHRODESIS ELBOW JOINT LOCAL

2854.80

090

Y

10775.65

*

*

J1

24802

ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT

3471.60

090

Y

19120.53

*

*

24900

AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE

2545.20

090

Y

*

*

24920

AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR

2539.20

090

Y

*

*

J1

24925

AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ

1957.20

090

Y

5184.51

*

*

24930

AMPUTATION ARM THRU HUMERUS RE-AMPUTATION

2670.00

090

Y

*

*

24931

AMPUTATION ARM THRU HUMERUS W/IMPLANT

3232.80

090

Y

*

*

J1

24935

STUMP ELONGATION UPPER EXTREMITY

4035.60

090

N

10775.65

*

*

24940

CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE

3120.24

090

Y

*

*

24999

UNLISTED PROCEDURE HUMERUS/ELBOW

BR

YYY

N

319.63

*

*

J1

25000

INCISION EXTENSOR TENDON SHEATH WRIST

1164.00

090

N

2624.38

*

*

J1

25001

INCISION FLEXOR TENDON SHEATH WRIST

1185.60

090

N

5184.51

*

*

J1

25020

DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT

1971.60

090

N

2624.38

*

*

J1

25023

DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT

3819.60

090

N

5184.51

*

*

J1

25024

DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB

2694.00

090

N

5184.51

*

*

J1

25025

DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT

4177.20

090

N

2624.38

*

*

J1

25028

I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA

1815.60

090

N

5184.51

*

*

J1

25031

INCISION & DRAINAGE FOREARM&/WRIST BURSA

1200.00

090

N

2624.38

*

*

J1

25035

INCISION DEEP BONE CORTEX FOREARM&/WRIST

2017.20

090

N

10775.65

*

*

J1

25040

ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB

1936.80

090

N

5184.51

*

*

J1

25065

BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL

878.40

010

N

2734.29

*

*

J1

25066

BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP

1236.00

090

N

4742.07

*

*

J1

25071

EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>

1467.60

090

Y

2734.29

*

*

J1

25073

EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>

1842.00

090

Y

4742.07

*

*

J1

25075

EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM

1690.80

090

N

2734.29

*

*

J1

25076

EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM

1786.80

090

N

2734.29

*

*

J1

25077

RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM

3051.60

090

N

2734.29

*

*

J1

25078

RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>

4041.60

090

Y

4742.07

*

*

J1

25085

CAPSULOTOMY WRIST

1548.00

090

Y

5184.51

*

*

J1

25100

ARTHROTOMY WRIST JOINT WITH BIOPSY

1194.00

090

N

5184.51

*

*

J1

25101

ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB

1393.20

090

N

5184.51

*

*

J1

25105

ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY

1666.80

090

N

5184.51

*

*

J1

25107

ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE

2124.00

090

Y

5184.51

*

*

J1

25109

EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA

1855.20

090

N

5184.51

*

*

J1

25110

EXCISION LESION TENDON SHEATH FOREARM&/WRIST

1178.40

090

N

2624.38

*

*

J1

25111

EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY

1105.20

090

N

2624.38

*

*

J1

25112

EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT

1335.60

090

N

2624.38

*

*

J1

25115

RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS

2616.00

090

N

2624.38

*

*

J1

25116

RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS

2070.00

090

N

5184.51

*

*

J1

25118

SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT

1312.80

090

N

2624.38

*

*

J1

25119

SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA

1705.20

090

Y

5184.51

*

*

J1

25120

EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA

1716.00

090

N

5184.51

*

*

J1

25125

EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT

2032.80

090

N

2624.38

*

*

J1

25126

EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT

2053.20

090

Y

5184.51

*

*

J1

25130

EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES

1539.60

090

N

5184.51

*

*

J1

25135

EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT

1918.80

090

Y

5184.51

*

*

J1

25136

EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT

1687.20

090

Y

10775.65

*

*

J1

25145

SEQUESTRECTOMY FOREARM &/WRIST

1780.80

090

Y

5184.51

*

*

J1

25150

PARTIAL EXCISION BONE ULNA

1954.80

090

N

5184.51

*

*

J1

25151

PARTIAL EXCISION BONE RADIUS

2005.20

090

Y

5184.51

*

*

J1

25170

RADICAL RESECTION TUMOR RADIUS OR ULNA

5108.40

090

Y

10775.65

*

*

J1

25210

CARPECTOMY 1 BONE

1681.20

090

N

5184.51

*

*

J1

25215

CARPECTOMY ALL BONES PROXIMAL ROW

2131.20

090

Y

5184.51

*

*

J1

25230

RADICAL STYLOIDECTOMY SEPARATE PROCEDURE

1494.00

090

N

5184.51

*

*

J1

25240

EXCISION DISTAL ULNA PARTIAL/COMPLETE

1477.20

090

N

5184.51

*

*

25246

INJECTION WRIST ARTHROGRAPHY

585.60

000

N

*

*

J1

25248

EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST

1425.60

090

N

2624.38

*

*

25250

REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE

1825.20

090

Y

1864.94

*

*

25251

REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST

2481.60

090

Y

3725.14

*

*

J1

25259

MANIPULATION WRIST UNDER ANESTHESIA

1442.40

090

N

2624.38

*

*

J1

25260

RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU

2172.00

090

N

5184.51

*

*

J1

25263

RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS

2162.40

090

Y

5184.51

*

*

J1

25265

RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA

2576.40

090

Y

5184.51

*

*

J1

25270

RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN

1687.20

090

N

5184.51

*

*

J1

25272

RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU

1910.40

090

N

5184.51

*

*

J1

25274

RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN

2299.20

090

N

5184.51

*

*

J1

25275

RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT

2310.00

090

N

5184.51

*

*

J1

25280

LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN

1942.80

090

N

5184.51

*

*

J1

25290

TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA

1503.60

090

N

5184.51

*

*

J1

25295

TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA

1813.20

090

N

5184.51

*

*

J1

25300

TENODESIS WRIST FLEXORS FINGERS

2348.40

090

Y

5184.51

*

*

J1

25301

TENODESIS WRIST EXTENSORS FINGERS

2218.80

090

Y

5184.51

*

*

J1

25310

TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN

2134.80

090

Y

5184.51

*

*

J1

25312

TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR

2476.80

090

Y

5184.51

*

*

J1

25315

FLEXOR ORIGIN SLIDE FOREARM &/WRIST

2655.60

090

Y

10775.65

*

*

J1

25316

FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE

3168.00

090

Y

10775.65

*

*

J1

25320

CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS

3398.40

090

Y

10775.65

*

*

J1

25332

ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ

2906.40

090

Y

5184.51

*

*

J1

25335

CENTRALIZATION WRST ULNA

3268.80

090

Y

5184.51

*

*

J1

25337

RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ

3073.20

090

N

10775.65

*

*

J1

25350

OSTEOTOMY RADIUS DISTAL THIRD

2326.80

090

Y

10775.65

*

*

J1

25355

OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD

2616.00

090

Y

5184.51

*

*

J1

25360

OSTEOTOMY ULNA

2260.80

090

Y

10775.65

*

*

J1

25365

OSTEOTOMY RADIUS & ULNA

3150.00

090

Y

19120.53

*

*

J1

25370

MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA

3490.80

090

Y

5184.51

*

*

J1

25375

MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA

3302.40

090

Y

5184.51

*

*

J1

25390

OSTEOPLASTY RADIUS/ULNA SHORTENING

2654.40

090

Y

10775.65

*

*

J1

25391

OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT

3446.40

090

Y

19120.53

*

*

J1

25392

OSTEOPLASTY RADIUS & ULNA SHORTENING

3418.80

090

Y

5184.51

*

*

J1

25393

OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF

3873.60

090

Y

5184.51

*

*

J1

25394

OSTEOPLASTY CARPAL BONE SHORTENING

2698.80

090

Y

5184.51

*

*

J1

25400

RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT

2774.40

090

Y

10775.65

*

*

J1

25405

RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT

3588.00

090

Y

10775.65

*

*

J1

25415

RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF

3337.20

090

Y

10775.65

*

*

J1

25420

RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT

4029.60

090

Y

10775.65

*

*

J1

25425

REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA

3320.40

090

Y

10775.65

*

*

J1

25426

REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA

3895.20

090

Y

5184.51

*

*

J1

25430

INSERTION VASCULAR PEDICLE CARPAL BONE

2527.20

090

N

5184.51

*

*

J1

25431

REPAIR NONUNION CARPAL BONE EACH BONE

2718.00

090

Y

10775.65

*

*

J1

25440

RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC

2655.60

090

Y

10775.65

*

*

J1

25441

ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS

3236.40

090

Y

19120.53

*

*

J1

25442

ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA

2787.60

090

Y

26078.68

*

*

J1

25443

ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL

2674.80

090

Y

10775.65

*

*

J1

25444

ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE

2850.00

090

Y

19120.53

*

*

J1

25445

ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM

2493.60

090

N

10775.65

*

*

J1

25446

ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS

4059.60

090

Y

26078.68

*

*

J1

25447

ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS

2859.60

090

Y

5184.51

*

*

J1

25449

REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT

3567.60

090

Y

10775.65

*

*

J1

25450

EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U

2130.00

090

N

5184.51

*

*

J1

25455

EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA

2512.80

090

N

5184.51

*

*

J1

25490

PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS

2484.00

090

Y

10775.65

*

*

J1

25491

PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA

2559.60

090

Y

19120.53

*

*

J1

25492

PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL

3133.20

090

Y

5184.51

*

*

25500

CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION

944.40

090

N

319.63

*

*

J1

25505

CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION

1714.80

090

N

2624.38

*

*

J1

25515

OPEN TREATMENT RADIAL SHAFT FRACTURE

2310.00

090

Y

10775.65

*

*

J1

25520

CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT

1953.60

090

N

2624.38

*

*

J1

25525

OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE

2722.80

090

Y

10775.65

*

*

J1

25526

OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE

3296.40

090

Y

10775.65

*

*

25530

CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION

895.20

090

N

319.63

*

*

25535

CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION

1683.60

090

N

319.63

*

*

J1

25545

OPEN TREATMENT OF ULNAR SHAFT FRACTURE

2149.20

090

Y

10775.65

*

*

25560

CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN

963.60

090

N

319.63

*

*

J1

25565

CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ

1766.40

090

N

2624.38

*

*

J1

25574

OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA

2326.80

090

Y

10775.65

*

*

J1

25575

OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA

3115.20

090

Y

10775.65

*

*

25600

CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ

1128.00

090

N

319.63

*

*

J1

25605

CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF

1854.00

090

N

2624.38

*

*

J1

25606

PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP

2288.40

090

N

5184.51

*

*

J1

25607

OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP

2536.80

090

Y

10775.65

*

*

J1

25608

OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG

2846.40

090

Y

10775.65

*

*

J1

25609

OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG

3622.80

090

Y

10775.65

*

*

25622

CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ

1044.00

090

N

319.63

*

*

J1

25624

CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ

1653.60

090

N

2624.38

*

*

J1

25628

OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE

2485.20

090

Y

10775.65

*

*

25630

CLTX CARPAL BONE FX W/O MANJ EACH BONE

1042.80

090

N

319.63

*

*

J1

25635

CLTX CARPAL BONE FX W/MANJ EACH BONE

1574.40

090

N

2624.38

*

*

J1

25645

OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA

1959.60

090

Y

5184.51

*

*

25650

CLOSED TREATMENT ULNAR STYLOID FRACTURE

1104.00

090

N

319.63

*

*

J1

25651

PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE

1672.80

090

N

5184.51

*

*

J1

25652

OPEN TREATMENT ULNAR STYLOID FRACTURE

2149.20

090

N

10775.65

*

*

25660

CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ

1419.60

090

N

319.63

*

*

J1

25670

OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES

2088.00

090

Y

5184.51

*

*

J1

25671

PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION

1821.60

090

N

5184.51

*

*

25675

CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ

1502.40

090

N

319.63

*

*

J1

25676

OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC

2169.60

090

Y

10775.65

*

*

25680

CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ

1791.60

090

N

319.63

*

*

J1

25685

OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC

2540.40

090

Y

5184.51

*

*

J1

25690

CLOSED TX LUNATE DISLOCATION W/MANIPULATION

1664.40

090

N

2624.38

*

*

J1

25695

OPEN TREATMENT LUNATE DISLOCATION

2184.00

090

Y

10775.65

*

*

J1

25800

ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT

2522.40

090

Y

10775.65

*

*

J1

25805

ARTHRODESIS WRIST W/SLIDING GRAFT

2919.60

090

Y

10775.65

*

*

J1

25810

ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT

2995.20

090

Y

19120.53

*

*

J1

25820

ARTHRODESIS WRIST LIMITED W/O BONE GRAFT

2137.20

090

Y

10775.65

*

*

J1

25825

ARTHRODESIS WRIST LIMITED W/AUTOGRAFT

2631.60

090

Y

10775.65

*

*

J1

25830

ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE

3250.80

090

Y

10775.65

*

*

25900

AMPUTATION FOREARM THROUGH RADIUS & ULNA

2454.00

090

N

*

*

25905

AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR

2410.80

090

Y

*

*

J1

25907

AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE

2100.00

090

Y

5184.51

*

*

J1

25909

AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION

2359.20

090

Y

5184.51

*

*

25915

KRUKENBERG PROCEDURE

4059.60

090

Y

*

*

25920

DISARTICULATION THROUGH WRIST

2424.00

090

N

*

*

J1

25922

DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ

2128.80

090

Y

2624.38

*

*

25924

DISARTICULATION THRU WRIST RE-AMPUTATION

2332.80

090

Y

*

*

25927

TRANSMETACARPAL AMPUTATION

2779.20

090

N

*

*

25929

TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ

2062.80

090

Y

2199.52

*

*

J1

25931

TRANSMETACARPAL AMPUTATION RE-AMPUTATION

2559.60

090

N

5184.51

*

*

25999

UNLISTED PROCEDURE FOREARM/WRIST

BR

YYY

N

319.63

*

*

26010

DRAINAGE FINGER ABSCESS SIMPLE

928.80

010

N

250.56

*

*

J1

26011

DRAINAGE FINGER ABSCESS COMPLICATED

1378.80

010

N

2734.29

*

*

J1

26020

DRAINAGE TENDON SHEATH DIGIT&/PALM EACH

1497.60

090

N

5184.51

*

*

J1

26025

DRAINAGE OF PALMAR BURSA SINGLE BURSA

1453.20

090

N

5184.51

*

*

J1

26030

DRAINAGE OF PALMAR BURSA MULTIPLE BURSA

1690.80

090

N

5184.51

*

*

J1

26034

INCISION BONE CORTEX HAND/FINGER

1874.40

090

N

2624.38

*

*

J1

26035

DECOMPRESSION FINGERS&/HAND INJECTION INJURY

2967.60

090

N

5184.51

*

*

J1

26037

DECOMPRESSIVE FASCIOTOMY HAND

1952.40

090

N

5184.51

*

*

J1

26040

FASCIOTOMY PALMAR PERCUTANEOUS

1075.20

090

N

2624.38

*

*

J1

26045

FASCIOTOMY PALMAR OPEN PARTIAL

1618.80

090

N

5184.51

*

*

J1

26055

TENDON SHEATH INCISION

1941.60

090

N

2624.38

*

*

J1

26060

TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT

883.20

090

N

2624.38

*

*

J1

26070

ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT

1102.80

090

N

2624.38

*

*

J1

26075

ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA

1150.80

090

N

5184.51

*

*

J1

26080

ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA

1350.00

090

N

2624.38

*

*

J1

26100

ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH

1156.80

090

N

5184.51

*

*

J1

26105

ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH

1161.60

090

N

5184.51

*

*

J1

26110

ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH

1110.00

090

N

2624.38

*

*

J1

26111

EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>

1437.60

090

Y

2734.29

*

*

J1

26113

EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>

1888.80

090

Y

2734.29

*

*

J1

26115

EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM

1782.00

090

N

2734.29

*

*

J1

26116

EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM

1815.60

090

N

2734.29

*

*

J1

26117

RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM

2565.60

090

N

4742.07

*

*

J1

26118

RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>

3632.40

090

Y

4742.07

*

*

J1

26121

FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT

2061.60

090

N

5184.51

*

*

J1

26123

FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR

2880.00

090

N

5184.51

+

*

26125

FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR

946.80

ZZZ

N

*

*

J1

26130

SYNOVECTOMY CARPOMETACARPAL JOINT

1582.80

090

N

5184.51

*

*

J1

26135

SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD

1899.60

090

N

5184.51

*

*

J1

26140

SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT

1742.40

090

N

2624.38

*

*

J1

26145

SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN

1770.00

090

N

2624.38

*

*

J1

26160

EXC LESION TDN SHTH/JT CAPSL HAND/FNGR

1999.20

090

N

2624.38

*

*

J1

26170

EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH

1400.40

090

N

2624.38

*

*

J1

26180

EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH

1533.60

090

N

2624.38

*

*

J1

26185

SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE

1898.40

090

Y

2624.38

*

*

J1

26200

EXCISION/CURETTAGE CYST/TUMOR METACARPAL

1550.40

090

N

2624.38

*

*

J1

26205

EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT

2083.20

090

N

10775.65

*

*

J1

26210

EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER

1527.60

090

N

2624.38

*

*

J1

26215

EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT

1948.80

090

N

5184.51

*

*

J1

26230

PARTIAL EXCISION BONE METACARPAL

1718.40

090

N

5184.51

*

*

J1

26235

PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER

1698.00

090

N

2624.38

*

*

J1

26236

PARTIAL EXCISION DISTAL PHALANX FINGER

1520.40

090

N

2624.38

*

*

J1

26250

RADICAL RESECTION TUMOR METACARPAL

3702.00

090

N

5184.51

*

*

J1

26260

RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER

2767.20

090

Y

5184.51

*

*

J1

26262

RADICAL RESECTION TUMOR DISTAL PHALANX FINGER

2178.00

090

Y

2624.38

*

*

26320

REMOVAL IMPLANT FROM FINGER/HAND

1197.60

090

N

1953.21

*

*

J1

26340

MANIPULATION FINGER JOINT UNDER ANES EACH JOINT

1160.40

090

N

2624.38

*

*

26341

MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD

348.00

010

N

319.63

*

*

J1

26350

RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON

2406.00

090

N

5184.51

*

*

J1

26352

RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON

2761.20

090

Y

5184.51

*

*

J1

26356

RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON

2737.20

090

N

5184.51

*

*

J1

26357

RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON

3060.00

090

Y

5184.51

*

*

J1

26358

RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON

3385.20

090

Y

5184.51

*

*

J1

26370

RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN

2554.80

090

N

5184.51

*

*

J1

26372

RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA

2989.20

090

Y

10775.65

*

*

J1

26373

RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA

2869.20

090

Y

5184.51

*

*

J1

26390

EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F

2838.00

090

Y

10775.65

*

*

J1

26392

RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD

3298.80

090

Y

10775.65

*

*

J1

26410

REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH

1905.60

090

N

2624.38

*

*

J1

26412

REPAIR EXTENSOR TENDON HAND W/GRAFT EACH

2292.00

090

N

5184.51

*

*

J1

26415

EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA

2761.20

090

N

5184.51

*

*

J1

26416

RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD

3006.00

090

N

5184.51

*

*

J1

26418

REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH

1950.00

090

N

2624.38

*

*

J1

26420

REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH

2390.40

090

Y

5184.51

*

*

J1

26426

RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR

1728.00

090

N

5184.51

*

*

J1

26428

RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER

2557.20

090

N

5184.51

*

*

J1

26432

CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING

1678.80

090

N

2624.38

*

*

J1

26433

REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF

1785.60

090

N

5184.51

*

*

J1

26434

REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT

2188.80

090

Y

5184.51

*

*

J1

26437

REALIGNMENT EXTENSOR TENDON HAND EACH TENDON

2108.40

090

N

5184.51

*

*

J1

26440

TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON

2089.20

090

N

2624.38

*

*

J1

26442

TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO

3261.60

090

N

5184.51

*

*

J1

26445

TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH

1938.00

090

N

5184.51

*

*

J1

26449

TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA

2395.20

090

N

5184.51

*

*

J1

26450

TENOTOMY FLEXOR PALM OPEN EACH TENDON

1375.20

090

N

5184.51

*

*

J1

26455

TENOTOMY FLEXOR FINGER OPEN EACH TENDON

1363.20

090

N

2624.38

*

*

J1

26460

TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON

1334.40

090

N

2624.38

*

*

J1

26471

TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH

2083.20

090

N

5184.51

*

*

J1

26474

TENODESIS DISTAL JOINT EACH

2035.20

090

Y

2624.38

*

*

J1

26476

LENGTHENING TENDON EXTENSOR HAND/FINGER EACH

2010.00

090

N

5184.51

*

*

J1

26477

SHORTENING TENDON EXTENSOR HAND/FINGER EACH

1963.20

090

N

5184.51

*

*

J1

26478

LENGTHENING TENDON FLEXOR HAND/FINGER EACH

2090.40

090

N

5184.51

*

*

J1

26479

SHORTENING TENDON FLEXOR HAND/FINGER EACH

2114.40

090

Y

5184.51

*

*

J1

26480

TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN

2536.80

090

N

5184.51

*

*

J1

26483

TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT

2846.40

090

Y

5184.51

*

*

J1

26485

TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH

2725.20

090

Y

5184.51

*

*

J1

26489

TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH

3163.20

090

N

5184.51

*

*

J1

26490

OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN

2700.00

090

N

5184.51

*

*

J1

26492

OPPONENSPLASTY TDN TR W/GRF EA TDN

3001.20

090

Y

5184.51

*

*

J1

26494

OPPONENSPLASTY HYPOTHENAR MUSC TR

2703.60

090

Y

5184.51

*

*

J1

26496

OPPONENSPLASTY OTHER METHODS

2908.80

090

N

5184.51

*

*

J1

26497

TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR

2938.80

090

Y

5184.51

*

*

J1

26498

TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS

3896.40

090

Y

5184.51

*

*

J1

26499

CORRECTION CLAW FINGER OTHER METHODS

2812.80

090

Y

5184.51

*

*

J1

26500

RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX

2095.20

090

N

10775.65

*

*

J1

26502

RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX

2404.80

090

Y

5184.51

*

*

J1

26508

RELEASE THENAR MUSCLE

2133.60

090

N

5184.51

*

*

J1

26510

CROSS INTRINSIC TRANSFER EACH TENDON

2010.00

090

N

5184.51

*

*

J1

26516

CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT

2370.00

090

N

5184.51

*

*

J1

26517

CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS

2787.60

090

Y

5184.51

*

*

J1

26518

CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS

2832.00

090

Y

5184.51

*

*

J1

26520

CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH

2185.20

090

N

5184.51

*

*

J1

26525

CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH

2196.00

090

N

2624.38

*

*

J1

26530

ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH

1852.80

090

Y

5184.51

*

*

J1

26531

ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT

2155.20

090

Y

10775.65

*

*

J1

26535

ARTHROPLASTY INTERPHALANGEAL JOINT EACH

1480.80

090

N

5184.51

*

*

J1

26536

ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA

2410.80

090

N

10775.65

*

*

J1

26540

RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT

2222.40

090

N

5184.51

*

*

J1

26541

RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF

2709.60

090

Y

5184.51

*

*

J1

26542

RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS

2298.00

090

N

5184.51

*

*

J1

26545

RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT

2388.00

090

N

5184.51

*

*

J1

26546

RPR NON-UNION MTCRPL/PHALANX

3375.60

090

Y

10775.65

*

*

J1

26548

RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL

2569.20

090

N

5184.51

*

*

J1

26550

POLLICIZATION DIGIT

5617.20

090

Y

5184.51

*

*

26551

TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND

11355.60

090

Y

*

*

26553

TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1

11278.80

090

Y

*

*

26554

TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2

13166.40

090

Y

*

*

J1

26555

TR FNGR AXH POS W/O MVASC ANAST

4675.20

090

Y

10775.65

*

*

26556

TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS

11722.80

090

Y

*

*

J1

26560

REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS

1981.20

090

Y

2624.38

*

*

J1

26561

REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT

3207.60

090

Y

5184.51

*

*

J1

26562

REPAIR SYNDACTYLY EACH SPACE COMPLEX

4581.60

090

Y

5184.51

*

*

J1

26565

OSTEOTOMY METACARPAL EACH

2286.00

090

Y

5184.51

*

*

J1

26567

OSTEOTOMY PHALANX FINGER EACH

2305.20

090

N

5184.51

*

*

J1

26568

OSTEOPLASTY LENGTHENING METACARPAL/PHALANX

3043.20

090

Y

10775.65

*

*

J1

26580

REPAIR CLEFT HAND

5170.80

090

Y

5184.51

*

*

J1

26587

RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE

3600.00

090

Y

5184.51

*

*

J1

26590

REPAIR MACRODACTYLIA EACH DIGIT

4808.40

090

Y

2624.38

*

*

J1

26591

REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE

1483.20

090

N

5184.51

*

*

J1

26593

RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE

2030.40

090

N

5184.51

*

*

J1

26596

EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES

2580.00

090

Y

5184.51

*

*

26600

CLTX METACARPAL FX W/O MANIPULATION EACH BONE

1006.80

090

N

319.63

*

*

26605

CLTX METACARPAL FX W/MANIPULATION EACH BONE

1108.80

090

N

319.63

*

*

J1

26607

CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE

1614.00

090

N

5184.51

*

*

J1

26608

PRQ SKELETAL FIXJ METACARPAL FX EACH BONE

1646.40

090

N

5184.51

*

*

J1

26615

OPEN TX METACARPAL FRACTURE SINGLE EA BONE

1982.40

090

N

5184.51

*

*

26641

CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ

1288.80

090

N

319.63

*

*

J1

26645

CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ

1476.00

090

N

2624.38

*

*

J1

26650

PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB

1648.80

090

N

5184.51

*

*

J1

26665

OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB

2157.60

090

N

5184.51

*

*

26670

CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES

1183.20

090

N

319.63

*

*

J1

26675

CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES

1573.20

090

N

2624.38

*

*

J1

26676

PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT

1734.00

090

N

5184.51

*

*

J1

26685

OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB

1978.80

090

N

5184.51

*

*

J1

26686

OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ

2145.60

090

Y

5184.51

*

*

26700

CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES

1125.60

090

N

319.63

*

*

J1

26705

CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES

1437.60

090

N

2624.38

*

*

J1

26706

PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ

1520.40

090

N

5184.51

*

*

J1

26715

OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION

1972.80

090

N

5184.51

*

*

26720

CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA

674.40

090

N

319.63

*

*

26725

CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA

1159.20

090

N

319.63

*

*

J1

26727

PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T

1622.40

090

N

5184.51

*

*

J1

26735

OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA

2052.00

090

N

5184.51

*

*

26740

CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ

787.20

090

N

319.63

*

*

J1

26742

CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ

1274.40

090

N

2624.38

*

*

J1

26746

OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA

2560.80

090

N

5184.51

*

*

26750

CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA

630.00

090

N

319.63

*

*

26755

CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA

1078.80

090

N

319.63

*

*

J1

26756

PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA

1437.60

090

N

5184.51

*

*

J1

26765

OPEN TX DISTAL PHALANGEAL FRACTURE EACH

1725.60

090

N

5184.51

*

*

26770

CLTX IPHAL JT DISLC W/MANJ W/O ANES

952.80

090

N

319.63

*

*

26775

CLTX IPHAL JT DISLC W/MANJ REQ ANES

1318.80

090

N

334.52

*

*

J1

26776

PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ

1525.20

090

N

5184.51

*

*

J1

26785

OPEN TX INTERPHALANGEAL JOINT DISLOCATION

1885.20

090

N

5184.51

*

*

J1

26820

FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT

2660.40

090

Y

10775.65

*

*

J1

26841

ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ

2458.80

090

N

10775.65

*

*

J1

26842

ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT

2649.60

090

Y

10775.65

*

*

J1

26843

ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH

2499.60

090

Y

10775.65

*

*

J1

26844

ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT

2776.80

090

Y

10775.65

*

*

J1

26850

ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ

2338.80

090

N

10775.65

*

*

J1

26852

ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT

2690.40

090

Y

10775.65

*

*

J1

26860

ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ

1909.20

090

N

5184.51

+

*

26861

ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT

357.60

ZZZ

N

*

*

J1

26862

ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT

2456.40

090

Y

5184.51

+

*

26863

ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT

794.40

ZZZ

Y

*

*

J1

26910

AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER

2452.80

090

N

5184.51

*

*

J1

26951

AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR

2210.40

090

N

5184.51

*

*

J1

26952

AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP

2181.60

090

N

5184.51

*

*

26989

UNLISTED PROCEDURE HANDS/FINGERS

BR

YYY

N

319.63

*

*

J1

26990

I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA

2199.60

090

N

5184.51

*

*

J1

26991

I&D PELVIS/HIP JOINT AREA INFECTED BURSA

2426.40

090

N

2624.38

*

*

26992

INCISION BONE CORTEX PELVIS&/HIP JOINT

3348.00

090

N

*

*

J1

27000

TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX

1401.60

090

N

2624.38

*

*

J1

27001

TENOTOMY ADDUCTOR HIP OPEN

1854.00

090

Y

5184.51

*

*

J1

27003

TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY

2049.60

090

Y

10775.65

*

*

27005

TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE

2496.00

090

Y

3466.63

*

*

J1

27006

TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX

2491.20

090

Y

5184.51

*

*

27025

FASCIOTOMY HIP/THIGH ANY TYPE

3164.40

090

N

2742.03

*

*

J1

27027

DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI

3057.60

090

N

10775.65

*

*

27030

ARTHROTOMY HIP W/DRAINAGE

3242.40

090

Y

*

*

J1

27033

ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY

3363.60

090

Y

5184.51

*

*

J1

27035

DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH

3938.40

090

Y

5184.51

*

*

27036

CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC

3499.20

090

Y

4499.61

*

*

J1

27040

BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL

1179.60

010

N

2734.29

*

*

J1

27041

BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM

2413.20

090

N

2734.29

*

*

J1

27043

EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>

1624.80

090

N

4742.07

*

*

J1

27045

EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>

2565.60

090

Y

4742.07

*

*

J1

27047

EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM

1635.60

090

N

4742.07

*

*

J1

27048

EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC GREATER THAN 5CM

2112.00

090

Y

4742.07

*

*

J1

27049

RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP GREATER THAN 5 CM

4634.40

090

Y

4742.07

*

*

J1

27050

ARTHROTOMY W/BIOPSY SACROILIAC JOINT

1389.60

090

N

2624.38

*

*

J1

27052

ARTHROTOMY W/BIOPSY HIP JOINT

1990.80

090

Y

2624.38

*

*

27054

ARTHROTOMY W/SYNOVECTOMY HIP JOINT

2368.80

090

Y

*

*

J1

27057

DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI

3496.80

090

N

2624.38

*

*

J1

27059

RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>

6318.00

090

Y

4742.07

*

*

J1

27060

EXCISION ISCHIAL BURSA

1605.60

090

N

5184.51

*

*

J1

27062

EXCISION TROCHANTERIC BURSA/CALCIFICATION

1573.20

090

N

5184.51

*

*

J1

27065

EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL

1792.80

090

Y

5184.51

*

*

J1

27066

EXCISION BONE CYST/BENIGN TUMOR DEEP

2775.60

090

Y

5184.51

*

*

J1

27067

EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC

3584.40

090

Y

10775.65

*

*

27070

PARTIAL EXCISION SUPERFICIAL PELVIS

2961.60

090

Y

*

*

27071

PARTIAL EXCISION DEEP PELVIS

3200.40

090

Y

*

*

27075

RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL

7267.20

090

Y

*

*

27076

RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC

8796.00

090

Y

*

*

27077

RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL

9848.40

090

Y

*

*

27078

RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR

7165.20

090

Y

*

*

J1

27080

COCCYGECTOMY PRIMARY

1767.60

090

Y

5184.51

*

*

J1

27086

RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS

1033.20

010

N

2734.29

*

*

J1

27087

REMOVAL FOREIGN BODY PELVIS/HIP DEEP

2122.80

090

Y

5184.51

*

*

27090

REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE

2872.80

090

Y

*

*

27091

RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA

5528.40

090

Y

*

*

27093

INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA

686.40

000

N

*

*

27095

INJECTION HIP ARTHROGRAPHY W/ANESTHESIA

914.40

000

N

*

*

27096

INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA

547.20

000

N

*

*

J1

27097

RELEASE/RECESSION HAMSTRING PROXIMAL

2355.60

090

Y

5184.51

*

*

J1

27098

TRANSFER ADDUCTOR ISCHIUM

2401.20

090

Y

5184.51

*

*

J1

27100

TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF

2840.40

090

Y

10775.65

*

*

J1

27105

TR PARASPI MUSC HIP FASC/TDN XTN GRF

2989.20

090

Y

5184.51

*

*

J1

27110

TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR

3337.20

090

Y

10775.65

*

*

J1

27111

TRANSFER ILIOPSOAS FEMORAL NECK

3118.80

090

Y

5184.51

*

*

27120

ACETABULOPLASTY

4479.60

090

Y

*

*

27122

ACETABULOPLASTY RESECTION FEMORAL HEAD

3811.20

090

Y

*

*

27125

HEMIARTHROPLASTY HIP PARTIAL

3925.20

090

Y

*

*

J1*

27130

ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT

4690.80

090

Y

19120.53

*

*

27132

CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT

5799.60

090

Y

*

*

27134

REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT

6633.60

090

Y

*

*

27137

REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT

5097.60

090

Y

*

*

27138

REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT

5296.80

090

Y

*

*

27140

OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX

3082.80

090

Y

*

*

27146

OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE

4420.80

090

Y

*

*

27147

OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ

5037.60

090

Y

*

*

27151

OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT

5516.40

090

Y

*

*

27156

OSTEOT ILIAC ACTBLR/INNOMINATE BONE OSTEOT RDCTJ

5872.80

090

Y

*

*

27158

OSTEOTOMY PELVIS BILATERAL

4774.80

090

Y

*

*

27161

OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE

4200.00

090

Y

*

*

27165

OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL

4734.00

090

Y

*

*

27170

B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA

4058.40

090

Y

4212.81

*

*

27175

TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION

2306.40

090

N

*

*

27176

TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU

3168.00

090

Y

4437.75

*

*

27177

OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT

3735.60

090

Y

*

*

27178

OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN

3184.80

090

Y

*

*

J1

27179

OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX

3344.40

090

Y

10775.65

*

*

27181

OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ

3787.20

090

Y

*

*

27185

EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR

2485.20

090

N

*

*

27187

PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR

3438.00

090

Y

*

*

27197

CLSD TX PELVIC RING FX W/O MANIPULATION

428.40

000

N

319.63

*

*

27198

CLSD TX PELVIC RING FX W/MANIPULATION W/ANES

1040.40

000

N

319.63

*

*

27200

CLOSED TREATMENT COCCYGEAL FRACTURE

631.20

090

N

319.63

*

*

J1

27202

OPEN TREATMENT COCCYGEAL FRACTURE

1816.80

090

Y

5184.51

*

*

27215

OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD

2160.00

090

N

*

*

27216

PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS

3206.40

090

N

*

*

27217

OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR

3008.40

090

N

5591.08

*

*

27218

OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD

4155.60

090

N

*

*

27220

CLTX ACETABULUM HIP/SOCKT FX W/O MANJ

1837.20

090

N

319.63

*

*

27222

CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ

3364.80

090

N

843.69

*

*

27226

OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ

3656.40

090

Y

*

*

27227

OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT

5754.00

090

Y

*

*

27228

OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT

6523.20

090

Y

*

*

27230

CLTX FEM FX PROX END NCK W/O MANJ

1650.00

090

N

319.63

*

*

27232

CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ

2572.80

090

N

*

*

J1

27235

PRQ SKEL FIXJ FEMORAL FX PROX END NECK

3147.60

090

N

10775.65

*

*

27236

OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT

4138.80

090

Y

4779.77

*

*

J1

27238

CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ

1592.40

090

N

2624.38

*

*

27240

CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ

3312.00

090

N

*

*

27244

TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT

4261.20

090

Y

*

*

27245

TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW

4258.80

090

Y

*

*

27246

CLTX GREATER TROCHANTERIC FX W/O MANJ

1334.40

090

N

319.63

*

*

27248

OPEN TREATMENT GREATER TROCHANTERIC FRACTURE

2574.00

090

Y

*

*

27250

CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA

620.40

000

N

319.63

*

*

J1

27252

CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA

2616.00

090

N

2624.38

*

*

27253

OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ

3261.60

090

Y

*

*

27254

OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD

4375.20

090

Y

*

*

27256

TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES

1044.00

010

N

319.63

*

*

J1

27257

TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES

1255.20

010

N

2624.38

*

*

27258

OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM

3841.20

090

Y

*

*

27259

OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT

5378.40

090

Y

*

*

27265

CLTX POST HIP ARTHRP DISLC W/O ANES

1382.40

090

N

319.63

*

*

J1

27266

CLTX POST HIP ARTHRP DISLC REQ ANES

2010.00

090

N

2624.38

*

*

J1

27267

CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ

1492.80

090

Y

5184.51

*

*

27268

CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ

1857.60

090

Y

*

*

27269

OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD

4300.80

090

Y

*

*

J1

27275

MANIPULATION HIP JOINT GENERAL ANESTHESIA

632.40

010

N

2624.38

*

*

J1

27279

ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS

2398.80

090

Y

26078.68

*

*

27280

ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT

4706.40

090

Y

5826.62

*

*

27282

ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT

2966.40

090

Y

*

*

27284

ARTHRODESIS HIP JOINT W/OBTAINING GRAFT

5510.40

090

Y

*

*

27286

ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT

5730.00

090

Y

*

*

27290

INTERPELVIABDOMINAL AMPUTATION

5629.20

090

Y

*

*

27295

DISARTICULATION HIP

4363.20

090

Y

*

*

27299

UNLISTED PROCEDURE PELVIS/HIP JOINT

BR

YYY

Y

319.63

*

*

J1

27301

I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION

2324.40

090

N

4742.07

*

*

27303

INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE

2211.60

090

Y

*

*

J1

27305

FASCIOTOMY ILIOTIBIAL OPEN

1658.40

090

Y

5184.51

*

*

J1

27306

TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX

1186.80

090

Y

5184.51

*

*

J1

27307

TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON

1657.20

090

N

5184.51

*

*

J1

27310

ARTHRT KNE W/EXPL DRG/RMVL FB

2526.00

090

Y

5184.51

*

*

J1

27323

BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL

949.20

010

N

2734.29

*

*

J1

27324

BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP

1390.80

090

N

4742.07

*

*

J1

27325

NEURECTOMY HAMSTRING MUSCLE

1920.00

090

Y

3259.45

*

*

J1

27326

NEURECTOMY POPLITEAL

1771.20

090

Y

3259.45

*

*

J1

27327

EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM

1622.40

090

N

2734.29

*

*

J1

27328

EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC GREATER THAN 5CM

2158.80

090

N

4742.07

*

*

J1

27329

RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE GREATER THAN 5CM

3591.60

090

Y

4742.07

*

*

J1

27330

ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY

1436.40

090

N

5184.51

*

*

J1

27331

ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB

1639.20

090

Y

5184.51

*

*

J1

27332

ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT

2215.20

090

Y

5184.51

*

*

J1

27333

ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT

2025.60

090

Y

5184.51

*

*

J1

27334

ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR

2365.20

090

Y

5184.51

*

*

J1

27335

ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA

2636.40

090

Y

10775.65

*

*

J1

27337

EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>

1447.20

090

Y

4742.07

*

*

J1

27339

EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/>

2607.60

090

Y

4742.07

*

*

J1

27340

EXCISION PREPATELLAR BURSA

1281.60

090

N

5184.51

*

*

J1

27345

EXCISION SYNOVIAL CYST POPLITEAL SPACE

1658.40

090

Y

5184.51

*

*

J1

27347

EXCISION LESION MENISCUS/CAPSULE KNEE

1822.80

090

Y

5184.51

*

*

J1

27350

PATELLECTOMY/HEMIPATELLECTOMY

2245.20

090

Y

5184.51

*

*

J1

27355

EXCISION/CURETTAGE CYST/TUMOR FEMUR

2088.00

090

Y

5184.51

*

*

J1

27356

EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT

2548.80

090

Y

19120.53

*

*

J1

27357

EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT

2812.80

090

Y

10775.65

+

*

27358

EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION

964.80

ZZZ

Y

*

*

J1

27360

PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA

2972.40

090

Y

5184.51

*

*

J1

27364

RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>

5426.40

090

Y

4742.07

*

*

27365

RADICAL RESECTION TUMOR FEMOR OR KNEE

7155.60

090

Y

3208.13

*

*

27369

NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE

487.20

000

N

*

*

J1

27372

REMOVAL FOREIGN BODY DEEP THIGH/KNEE

2048.40

090

N

4742.07

*

*

J1

27380

SUTURE INFRAPATELLAR TENDON PRIMARY

2061.60

090

Y

10775.65

*

*

J1

27381

SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF

2763.60

090

Y

10775.65

*

*

J1

27385

SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY

1993.20

090

Y

10775.65

*

*

J1

27386

SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ

2878.80

090

Y

10775.65

*

*

J1

27390

TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON

1543.20

090

Y

5184.51

*

*

J1

27391

TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG

1978.80

090

N

5184.51

*

*

J1

27392

TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI

2450.40

090

Y

5184.51

*

*

J1

27393

LENGTHENING HAMSTRING TENDON SINGLE

1761.60

090

Y

5184.51

*

*

J1

27394

LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG

2220.00

090

Y

10775.65

*

*

J1

27395

LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL

3031.20

090

Y

5184.51

*

*

J1

27396

TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON

2116.80

090

Y

10775.65

*

*

J1

27397

TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN

3159.60

090

Y

10775.65

*

*

J1

27400

TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR

2379.60

090

Y

10775.65

*

*

J1

27403

ARTHROTOMY W/MENISCUS REPAIR KNEE

2212.80

090

Y

5184.51

*

*

J1

27405

RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL

2334.00

090

Y

10775.65

*

*

J1

27407

REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT

2710.80

090

Y

10775.65

*

*

J1

27409

RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE

3322.80

090

Y

10775.65

*

*

J1

27412

AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE

5655.60

090

Y

10775.65

*

*

J1

27415

OSTEOCHONDRAL ALLOGRAFT KNEE OPEN

4676.40

090

Y

19120.53

*

*

J1

27416

OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY

3360.00

090

N

10775.65

*

*

J1

27418

ANTERIOR TIBIAL TUBERCLEPLASTY

2862.00

090

Y

10775.65

*

*

J1

27420

RCNSTJ DISLOCATING PATELLA

2566.80

090

Y

10775.65

*

*

J1

27422

RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

2566.80

090

Y

10775.65

*

*

J1

27424

RCNSTJ DISLC PATELLA W/PATELLECTOMY

2581.20

090

Y

10775.65

*

*

J1

27425

LATERAL RETINACULAR RELEASE OPEN

1551.60

090

N

5184.51

*

*

J1

27427

LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR

2458.80

090

Y

10775.65

*

*

J1

27428

LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR

3850.80

090

Y

19120.53

*

*

J1

27429

LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR

4328.40

090

Y

19120.53

*

*

J1

27430

QUADRICEPSPLASTY

2553.60

090

Y

10775.65

*

*

J1

27435

CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE

2792.40

090

Y

5184.51

*

*

J1

27437

ARTHROPLASTY PATELLA W/O PROSTHESIS

2282.40

090

N

10775.65

*

*

J1

27438

ARTHROPLASTY PATELLA W/PROSTHESIS

2900.40

090

Y

19120.53

*

*

J1

27440

ARTHROPLASTY KNEE TIBIAL PLATEAU

2750.40

090

Y

19120.53

*

*

J1

27441

ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT

2848.80

090

Y

19120.53

*

*

J1

27442

ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE

3003.60

090

Y

19120.53

*

*

J1

27443

ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL

2808.00

090

Y

19120.53

*

*

27445

ARTHROPLASTY KNEE HINGE PROSTHESIS

4334.40

090

Y

*

*

J1

27446

ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT

4010.40

090

Y

19120.53

*

*

J1

27447

ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS

4688.40

090

Y

19120.53

*

*

27448

OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION

2684.40

090

Y

*

*

27450

OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION

3516.00

090

Y

6886.32

*

*

27454

OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT

4484.40

090

Y

*

*

27455

OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL

3238.80

090

Y

2908.79

*

*

27457

OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL

3322.80

090

Y

4624.34

*

*

27465

OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876

4339.20

090

Y

*

*

27466

OSTEOPLASTY FEMUR LENGTHENING

4084.80

090

Y

*

*

27468

OSTPL FEMUR CMBN LNGTH&SHRT W/FEMORAL SGM TRNSFR

4657.20

090

Y

*

*

27470

RPR NON/MAL FEMUR DSTL H/N W/O GRF

4072.80

090

Y

6631.21

*

*

27472

RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE

4370.40

090

Y

8169.99

*

*

J1

27475

ARREST EPIPHYSEAL DISTAL FEMUR

2290.80

090

N

10775.65

*

*

J1

27477

ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL

2540.40

090

N

5184.51

*

*

J1

27479

ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB

3188.40

090

Y

10775.65

*

*

J1

27485

ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA

2322.00

090

N

5184.51

*

*

27486

REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT

4864.80

090

Y

5783.72

*

*

27487

REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE

6087.60

090

Y

5029.92

*

*

27488

RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER

4156.80

090

Y

*

*

27495

PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR

3901.20

090

Y

*

*

J1

27496

DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT

1879.20

090

N

5184.51

*

*

J1

27497

DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE

2006.40

090

N

5184.51

*

*

J1

27498

DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS

2260.80

090

Y

2624.38

*

*

J1

27499

DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE

2412.00

090

Y

5184.51

*

*

27500

CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION

1790.40

090

N

319.63

*

*

27501

CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ

1740.00

090

N

319.63

*

*

J1

27502

CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ

2622.00

090

N

2624.38

*

*

J1

27503

CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ

2764.80

090

N

2624.38

*

*

27506

OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW

4632.00

090

Y

5643.63

*

*

27507

OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE

3364.80

090

Y

6178.58

*

*

27508

CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ

1801.20

090

N

319.63

*

*

J1

27509

PRQ SKELETAL FIXJ FEMORAL FX DISTAL END

2236.80

090

N

10775.65

*

*

J1

27510

CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ

2356.80

090

N

2624.38

*

*

27511

OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN

3452.40

090

Y

*

*

27513

OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN

4297.20

090

Y

*

*

27514

OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE

3351.60

090

Y

4287.67

*

*

27516

CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ

1756.80

090

N

319.63

*

*

J1

27517

CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL

2352.00

090

N

2624.38

*

*

27519

OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION

3087.60

090

Y

*

*

27520

CLOSED TX PATELLAR FRACTURE W/O MANIPULATION

1105.20

090

N

319.63

*

*

J1

27524

OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR

2599.20

090

Y

10775.65

*

*

27530

CLTX TIBIAL FX PROXIMAL W/O MANIPULATION

1035.60

090

N

319.63

*

*

J1

27532

CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ

2124.00

090

N

5184.51

*

*

27535

OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR

3110.40

090

Y

5317.90

*

*

27536

OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ

4114.80

090

Y

6107.46

*

*

27538

CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN

1641.60

090

N

319.63

*

*

27540

OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE

2812.80

090

Y

4623.90

*

*

27550

CLOSED TX KNEE DISLOCATION W/O ANESTHESIA

1788.00

090

N

319.63

*

*

J1

27552

CLOSED TX KNEE DISLOCATION W/ANESTHESIA

2166.00

090

N

2624.38

*

*

27556

OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR

3032.40

090

Y

*

*

27557

OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR

3610.80

090

Y

*

*

27558

OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION

4113.60

090

Y

*

*

27560

CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA

1260.00

090

N

319.63

*

*

27562

CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA

1666.80

090

N

319.63

*

*

J1

27566

OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY

3081.60

090

Y

10775.65

*

*

J1

27570

MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA

520.80

010

N

2624.38

*

*

27580

ARTHRODESIS KNEE ANY TECHNIQUE

4989.60

090

Y

*

*

27590

AMPUTATION THIGH THROUGH FEMUR ANY LEVEL

2754.00

090

Y

*

*

27591

AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST

3337.20

090

Y

*

*

27592

AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR

2358.00

090

Y

*

*

J1

27594

AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION

1754.40

090

N

5184.51

*

*

27596

AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION

2487.60

090

N

*

*

27598

DISARTICULATION KNEE

2461.20

090

Y

*

*

27599

UNLISTED PROCEDURE FEMUR/KNEE

BR

YYY

Y

319.63

*

*

J1

27600

DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY

1401.60

090

N

5184.51

*

*

J1

27601

DCMPRN FASCT LEG POST COMPARTMENT ONLY

1538.40

090

N

5184.51

*

*

J1

27602

DCMPRN FASCT LEG ANT&/LAT&PST CMPRT

1675.20

090

Y

5184.51

*

*

J1

27603

INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA

1830.00

090

N

4742.07

*

*

J1

27604

INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA

1638.00

090

N

5184.51

*

*

J1

27605

TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES

1185.60

010

N

2624.38

*

*

J1

27606

TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES

961.20

010

N

5184.51

*

*

J1

27607

INCISION LEG/ANKLE

2106.00

090

N

5184.51

*

*

J1

27610

ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB

2248.80

090

N

5184.51

*

*

J1

27612

ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH

1959.60

090

Y

5184.51

*

*

J1

27613

BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL

862.80

010

N

2734.29

*

*

J1

27614

BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP

1984.80

090

N

4742.07

*

*

J1

27615

RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE GREATER THAN 5CM

3548.40

090

N

4742.07

*

*

J1

27616

RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>

4402.80

090

N

4742.07

*

*

J1

27618

EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM

1588.80

090

N

2734.29

*

*

J1

27619

EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL GREATER THAN 5CM

1599.60

090

N

4742.07

*

*

J1

27620

ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB

1560.00

090

Y

5184.51

*

*

J1

27625

ARTHROTOMY W/SYNOVECTOMY ANKLE

1970.40

090

Y

5184.51

*

*

J1

27626

ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY

2102.40

090

Y

5184.51

*

*

J1

27630

EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK

1914.00

090

N

5184.51

*

*

J1

27632

EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>

1430.40

090

Y

4742.07

*

*

J1

27634

EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>

2347.20

090

Y

4742.07

*

*

J1

27635

EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA

2005.20

090

N

5184.51

*

*

J1

27637

EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT

2576.40

090

Y

10775.65

*

*

J1

27638

EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT

2646.00

090

Y

10775.65

*

*

J1

27640

PARTIAL EXCISION BONE TIBIA

2876.40

090

N

5184.51

*

*

J1

27641

PARTIAL EXCISION BONE FIBULA

2290.80

090

N

5184.51

*

*

27645

RADICAL RESECTION OF TUMOR TIBIA

6160.80

090

Y

3687.35

*

*

27646

RADICAL RESECTION TUMOR BONE FIBULA

5323.20

090

Y

*

*

J1

27647

RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS

3520.80

090

Y

5184.51

*

*

27648

INJECTION ANKLE ARTHROGRAPHY

626.40

000

N

*

*

J1

27650

REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON

2268.00

090

Y

5184.51

*

*

J1

27652

RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT

2324.40

090

N

10775.65

*

*

J1

27654

REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT

2449.20

090

Y

10775.65

*

*

J1

27656

REPAIR FASCIAL DEFECT LEG

2186.40

090

Y

5184.51

*

*

J1

27658

REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH

1282.80

090

Y

5184.51

*

*

J1

27659

RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH

1630.80

090

Y

10775.65

*

*

J1

27664

RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH

1248.00

090

N

10775.65

*

*

J1

27665

RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH

1430.40

090

Y

10775.65

*

*

J1

27675

RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY

1693.20

090

Y

5184.51

*

*

J1

27676

REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT

2072.40

090

Y

10775.65

*

*

J1

27680

TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH

1464.00

090

N

5184.51

*

*

J1

27681

TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN

1893.60

090

N

5184.51

*

*

J1

27685

LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX

2284.80

090

Y

5184.51

*

*

J1

27686

LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA

1884.00

090

N

5184.51

*

*

J1

27687

GASTROCNEMIUS RECESSION

1568.40

090

Y

5184.51

*

*

J1

27690

TR/TRNS PL 1 TDN W/MUSC REDIRION/REROUTING SUPFC

2205.60

090

Y

10775.65

*

*

J1

27691

TR/TRNS PL 1 TDN W/MUSC REDIRION/REROUTING DP

2575.20

090

Y

10775.65

+

*

27692

TR/TRNS PL 1 TDN W/MUSC REDIRION/REROUTING EA TDN

362.40

ZZZ

Y

*

*

J1

27695

RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL

1636.80

090

N

10775.65

*

*

J1

27696

RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS

1912.80

090

N

10775.65

*

*

J1

27698

REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL

2200.80

090

Y

10775.65

*

*

J1

27700

ARTHROPLASTY ANKLE

2110.80

090

Y

10775.65

*

*

27702

ARTHROPLASTY ANKLE W/IMPLANT

3325.20

090

Y

6332.15

*

*

27703

ARTHROPLASTY ANKLE REVISION TOTAL ANKLE

3837.60

090

Y

6249.85

*

*

27704

REMOVAL ANKLE IMPLANT

1981.20

090

N

3725.14

*

*

J1

27705

OSTEOTOMY TIBIA

2625.60

090

Y

10775.65

*

*

J1

27707

OSTEOTOMY FIBULA

1381.20

090

N

5184.51

*

*

J1

27709

OSTEOTOMY TIBIA & FIBULA

4038.00

090

Y

19120.53

*

*

27712

OSTEOT MLT W/RELIGNMT IMED ROD

3795.60

090

Y

*

*

27715

OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN

3705.60

090

Y

*

*

J1

27720

REPAIR NONUNION/MALUNION TIBIA W/O GRAFT

3022.80

090

Y

10775.65

*

*

J1

27722

REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT

3074.40

090

Y

10775.65

*

*

27724

RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT

4378.80

090

Y

5390.32

*

*

27725

RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH

4210.80

090

Y

*

*

J1

27726

REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION

3325.20

090

N

10775.65

*

*

27727

REPAIR CONGENITAL PSEUDARTHROSIS TIBIA

3490.80

090

Y

*

*

J1

27730

ARREST EPIPHYSEAL OPEN DISTAL TIBIA

2029.20

090

N

5184.51

*

*

J1

27732

ARREST EPIPHYSEAL OPEN DISTAL FIBULA

1550.40

090

N

5184.51

*

*

J1

27734

ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA

2271.60

090

N

5184.51

*

*

J1

27740

ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA

2451.60

090

Y

5184.51

*

*

J1

27742

ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR

2692.80

090

Y

5184.51

*

*

J1

27745

PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA

2608.80

090

Y

10775.65

*

*

27750

CLTX TIBIAL SHAFT FX W/O MANIPULATION

1184.40

090

N

319.63

*

*

J1

27752

CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ

1843.20

090

N

2624.38

*

*

J1

27756

PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE

1993.20

090

Y

10775.65

*

*

J1

27758

OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE

3087.60

090

Y

19120.53

*

*

J1

27759

TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA

3458.40

090

Y

19120.53

*

*

27760

CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION

1140.00

090

N

319.63

*

*

J1

27762

CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ

1635.60

090

N

2624.38

*

*

J1

27766

OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE

2094.00

090

N

10775.65

*

*

27767

CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ

969.60

090

N

319.63

*

*

J1

27768

CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ

1520.40

090

N

2624.38

*

*

J1

27769

OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE

2522.40

090

N

10775.65

*

*

27780

CLTX PROX FIBULA/SHFT FX W/O MANJ

1045.20

090

N

319.63

*

*

J1

27781

CLTX PROX FIBULA/SHFT FX W/MANJ

1476.00

090

N

2624.38

*

*

J1

27784

OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE

2472.00

090

N

10775.65

*

*

27786

CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ

1076.40

090

N

319.63

*

*

27788

CLTX DSTL FIBULAR FX LAT MALLS W/MANJ

1452.00

090

N

319.63

*

*

J1

27792

OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS

2242.80

090

N

10775.65

*

*

27808

CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ

1143.60

090

N

319.63

*

*

J1

27810

CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ

1606.80

090

N

2624.38

*

*

J1

27814

OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE

2658.00

090

Y

10775.65

*

*

27816

CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION

1112.40

090

N

319.63

*

*

J1

27818

CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION

1669.20

090

N

2624.38

*

*

J1

27822

OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP

2966.40

090

Y

10775.65

*

*

J1

27823

OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP

3362.40

090

Y

10775.65

*

*

27824

CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ

1082.40

090

N

319.63

*

*

J1

27825

CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ

1884.00

090

N

2624.38

*

*

J1

27826

OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA

2908.80

090

Y

10775.65

*

*

J1

27827

OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY

3808.80

090

Y

19120.53

*

*

J1

27828

OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA

4544.40

090

Y

19120.53

*

*

J1

27829

OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION

2400.00

090

Y

10775.65

*

*

27830

CLTX PROX TIBFIB JT DISLC W/O ANES

1312.80

090

N

319.63

*

*

J1

27831

CLTX PROX TIBFIB JT DISLC REQ ANES

1389.60

090

N

5184.51

*

*

J1

27832

OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB

2605.20

090

Y

10775.65

*

*

27840

CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA

1285.20

090

N

319.63

*

*

J1

27842

CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ

1688.40

090

N

2624.38

*

*

J1

27846

OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ

2486.40

090

Y

10775.65

*

*

J1

27848

OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ

2760.00

090

Y

10775.65

*

*

J1

27860

MANIPULATION ANKLE UNDER GENERAL ANESTHESIA

590.40

010

N

5184.51

*

*

J1

27870

ARTHRODESIS ANKLE OPEN

3547.20

090

Y

19120.53

*

*

J1

27871

ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL

2376.00

090

Y

19120.53

*

*

27880

AMPUTATION LEG THROUGH TIBIA&FIBULA

3156.00

090

Y

*

*

27881

AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST

2988.00

090

Y

*

*

27882

AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR

2064.00

090

N

*

*

J1

27884

AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV

1970.40

090

N

5184.51

*

*

27886

AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION

2266.80

090

N

4039.09

*

*

27888

AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV

2287.20

090

Y

*

*

J1

27889

ANKLE DISARTICULATION

2236.80

090

N

10775.65

*

*

J1

27892

DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE

1900.80

090

N

5184.51

*

*

J1

27893

DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV

2106.00

090

N

10775.65

*

*

J1

27894

DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS

2919.60

090

Y

5184.51

*

*

27899

UNLISTED PROCEDURE LEG/ANKLE

BR

YYY

N

319.63

*

*

J1

28001

INCISION&DRAINAGE BURSA FOOT

963.60

010

N

2734.29

*

*

J1

28002

I&D BELOW FASCIA FOOT 1 BURSAL SPACE

1534.80

010

N

2624.38

*

*

J1

28003

I&D BELOW FASCIA FOOT MULTIPLE AREAS

2416.80

090

N

5184.51

*

*

J1

28005

INCISION BONE CORTEX FOOT

1994.40

090

N

5184.51

*

*

J1

28008

FASCIOTOMY FOOT&/TOE

1501.20

090

N

5184.51

*

*

J1

28010

TENOTOMY PERCUTANEOUS TOE SINGLE TENDON

802.80

090

N

2624.38

*

*

J1

28011

TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON

1096.80

090

N

2624.38

*

*

J1

28020

ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT

1870.80

090

N

5184.51

*

*

J1

28022

ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT

1686.00

090

N

5184.51

*

*

J1

28024

ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT

1576.80

090

N

2624.38

*

*

J1

28035

RELEASE TARSAL TUNNEL

1834.80

090

N

3259.45

*

*

J1

28039

EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>

1726.80

090

Y

4742.07

*

*

J1

28041

EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>

1569.60

090

N

4742.07

*

*

J1

28043

EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM

1378.80

090

N

2734.29

*

*

J1

28045

EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM

1707.60

090

N

4742.07

*

*

J1

28046

RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM

2498.40

090

N

4742.07

*

*

J1

28047

RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/>

3621.60

090

Y

4742.07

*

*

J1

28050

ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT

1470.00

090

N

5184.51

*

*

J1

28052

ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT

1536.00

090

N

5184.51

*

*

J1

28054

ARTHRTOMY W/BX INTERPHALANGEAL JOINT

1300.80

090

N

5184.51

*

*

J1

28055

NEURECTOMY INTRINSIC MUSCULATURE OF FOOT

1320.00

090

N

3259.45

*

*

J1

28060

FASCIECTOMY PLANTAR FASCIA PARTIAL SPX

1803.60

090

N

5184.51

*

*

J1

28062

FASCIOTOMY PLANTAR FASCIA RADICAL SPX

2024.40

090

N

5184.51

*

*

J1

28070

SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX

1856.40

090

N

5184.51

*

*

J1

28072

SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH

1695.60

090

N

5184.51

*

*

J1

28080

EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH

1822.80

090

N

2624.38

*

*

J1

28086

SYNOVECTOMY TENDON SHEATH FOOT FLEXOR

1887.60

090

Y

5184.51

*

*

J1

28088

SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR

1564.80

090

N

5184.51

*

*

J1

28090

EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT

1630.80

090

N

2624.38

*

*

J1

28092

EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA

1478.40

090

N

2624.38

*

*

J1

28100

EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS

2121.60

090

Y

5184.51

*

*

J1

28102

EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT

2091.60

090

Y

10775.65

*

*

J1

28103

EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT

1350.00

090

Y

10775.65

*

*

J1

28104

EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL

1849.20

090

Y

5184.51

*

*

J1

28106

EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT

1480.80

090

Y

10775.65

*

*

J1

28107

EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT

1785.60

090

Y

10775.65

*

*

J1

28108

EXC/CURTG CST/B9 TUM PHALANGES FOOT

1528.80

090

N

2624.38

*

*

J1

28110

OSTECTOMY PRTL 5TH METAR HEAD SPX

1614.00

090

N

5184.51

*

*

J1

28111

OSTECTOMY COMPLETE 1ST METATARSAL HEAD

1696.80

090

N

5184.51

*

*

J1

28112

OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4

1693.20

090

N

5184.51

*

*

J1

28113

OSTECTOMY COMPLETE 5TH METATARSAL HEAD

2042.40

090

N

5184.51

*

*

J1

28114

OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC

3688.80

090

Y

5184.51

*

*

J1

28116

OSTECTOMY TARSAL COALITION

2647.20

090

N

5184.51

*

*

J1

28118

OSTECTOMY CALCANEUS

2073.60

090

Y

5184.51

*

*

J1

28119

OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS

1815.60

090

N

5184.51

*

*

J1

28120

PARTIAL EXCISION BONE TALUS/CALCANEUS

2348.40

090

N

5184.51

*

*

J1

28122

PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS

2072.40

090

Y

5184.51

*

*

J1

28124

PARTICAL EXCISION BONE PHALANX TOE

1659.60

090

N

5184.51

*

*

J1

28126

RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH

1371.60

090

N

5184.51

*

*

J1

28130

TALECTOMY ASTRAGALECTOMY

2203.20

090

Y

5184.51

*

*

J1

28140

METATARSECTOMY

2052.00

090

N

5184.51

*

*

J1

28150

PHALANGECTOMY TOE EACH TOE

1470.00

090

N

5184.51

*

*

J1

28153

RESECTION CONDYLE DISTAL END PHALANX EACH TOE

1435.20

090

N

5184.51

*

*

J1

28160

HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE

1446.00

090

N

5184.51

*

*

J1

28171

RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS

3864.00

090

Y

5184.51

*

*

J1

28173

RADICAL RESECTION TUMOR METATARSAL

2557.20

090

N

5184.51

*

*

J1

28175

RADICAL RESECTION TUMOR PHALANX OR TOE

1644.00

090

N

2624.38

*

*

28190

REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS

882.00

010

N

822.66

*

*

J1

28192

REMOVAL FOREIGN BODY FOOT DEEP

1623.60

090

N

2734.29

*

*

J1

28193

REMOVAL FOREIGN BODY FOOT COMPLICATED

1845.60

090

N

2734.29

*

*

J1

28200

RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON

1712.40

090

N

5184.51

*

*

J1

28202

RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON

2101.20

090

Y

10775.65

*

*

J1

28208

REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON

1669.20

090

N

5184.51

*

*

J1

28210

RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON

2044.80

090

Y

10775.65

*

*

J1

28220

TENOLYSIS FLEXOR FOOT SINGLE TENDON

1570.80

090

N

2624.38

*

*

J1

28222

TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS

1794.00

090

N

5184.51

*

*

J1

28225

TENOLYSIS EXTENSOR FOOT SINGLE TENDON

1459.20

090

N

5184.51

*

*

J1

28226

TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON

2122.80

090

N

5184.51

*

*

J1

28230

TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX

1510.80

090

N

2624.38

*

*

J1

28232

TX OPEN TENDON FLEXOR TOE 1 TENDON SPX

1342.80

090

N

2624.38

*

*

J1

28234

TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON

1418.40

090

N

2624.38

*

*

J1

28238

RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR

2320.80

090

Y

10775.65

*

*

J1

28240

TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC

1584.00

090

N

5184.51

*

*

J1

28250

DIVISION PLANTAR FASCIA & MUSCLE SPX

2002.80

090

Y

5184.51

*

*

J1

28260

CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX

2380.80

090

Y

5184.51

*

*

J1

28261

CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING

3562.80

090

N

2624.38

*

*

J1

28262

CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH

4850.40

090

Y

10775.65

*

*

J1

28264

CAPSULOTOMY MIDTARSAL

3492.00

090

Y

2624.38

*

*

J1

28270

CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX

1712.40

090

N

5184.51

*

*

J1

28272

CAPSULOTOMY IPHAL JOINT EACH JOINT SPX

1360.80

090

N

2624.38

*

*

J1

28280

SYNDACTYLIZATION TOES

1784.40

090

N

5184.51

*

*

J1

28285

CORRECTION HAMMERTOE

1860.00

090

N

5184.51

*

*

J1

28286

CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE

1557.60

090

N

5184.51

*

*

J1

28288

OSTC PRTL EXOSTC/CONDYLC METAR HEAD

2112.00

090

N

5184.51

*

*

J1

28289

HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT

2527.20

090

Y

5184.51

*

*

J1

28291

HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT

2521.20

090

Y

10775.65

*

*

J1

28292

CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL

2564.40

090

Y

5184.51

*

*

J1

28295

CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT

3312.00

090

Y

5184.51

*

*

J1

28296

CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT

3158.40

090

Y

5184.51

*

*

J1

28297

CORRJ HALLUX VALGUS W/SESMDC W/1METAR MEDIAL CNF

3632.40

090

Y

10775.65

*

*

J1

28298

CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX OSTEOT

2942.40

090

Y

10775.65

*

*

J1

28299

CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT

3502.80

090

Y

5184.51

*

*

J1

28300

OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION

2246.40

090

Y

10775.65

*

*

J1

28302

OSTEOTOMY TALUS

2468.40

090

Y

10775.65

*

*

J1

28304

OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS

2842.80

090

Y

10775.65

*

*

J1

28305

OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT

2282.40

090

Y

10775.65

*

*

J1

28306

OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR

2121.60

090

Y

10775.65

*

*

J1

28307

OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE

2230.80

090

N

5184.51

*

*

J1

28308

OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA

1972.80

090

Y

5184.51

*

*

J1

28309

OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT

3067.20

090

N

10775.65

*

*

J1

28310

OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE

1888.80

090

N

5184.51

*

*

J1

28312

OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE

1744.80

090

N

5184.51

*

*

J1

28313

RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY

1804.80

090

N

5184.51

*

*

J1

28315

SESAMOIDECTOMY FIRST TOE SPX

1671.60

090

N

5184.51

*

*

J1

28320

REPAIR NONUNION/MALUNION TARSAL BONES

2107.20

090

Y

19120.53

*

*

J1

28322

RPR NON/MALUNION METARSAL W/WO BONE GRAFT

2721.60

090

Y

10775.65

*

*

J1

28340

RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION

2001.60

090

N

5184.51

*

*

J1

28341

RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION

2320.80

090

N

5184.51

*

*

J1

28344

RECONSTRUCTION TOE POLYDACTYLY

1480.80

090

N

5184.51

*

*

J1

28345

RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB

1809.60

090

N

2624.38

*

*

J1

28360

RECONSTRUCTION CLEFT FOOT

3770.40

090

Y

10775.65

*

*

28400

CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION

850.80

090

N

319.63

*

*

28405

CLOSED TX CALCANEAL FRACTURE W/MANIPULATION

1347.60

090

N

319.63

*

*

J1

28406

PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ

1819.20

090

N

10775.65

*

*

J1

28415

OPEN TREATMENT CALCANEAL FRACTURE

3859.20

090

Y

10775.65

*

*

J1

28420

OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT

4404.00

090

Y

19120.53

*

*

28430

CLOSED TX TALUS FRACTURE W/O MANIPULATION

817.20

090

N

319.63

*

*

J1

28435

CLOSED TX TALUS FRACTURE W/MANIPULATION

1251.60

090

N

2624.38

*

*

J1

28436

PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ

1558.80

090

N

10775.65

*

*

J1

28445

OPEN TREATMENT TALUS FRACTURE

3632.40

090

Y

10775.65

*

*

J1

28446

OPEN OSTEOCHONDRAL AUTOGRAFT TALUS

4222.80

090

Y

10775.65

*

*

28450

TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ

730.80

090

N

319.63

*

*

J1

28455

TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ

993.60

090

N

2624.38

*

*

J1

28456

PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ

1110.00

090

N

10775.65

*

*

J1

28465

OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA

2180.40

090

N

10775.65

*

*

28470

CLOSED TX METATARSAL FRACTURE W/O MANIPULATION

751.20

090

N

319.63

*

*

28475

CLTX METAR FX W/MANJ

882.00

090

N

319.63

*

*

J1

28476

PRQ SKEL FIXJ METAR FX W/MANJ

1213.20

090

N

5184.51

*

*

J1

28485

OPEN TREATMENT METATARSAL FRACTURE EACH

1879.20

090

N

10775.65

*

*

28490

CLTX FX GRT TOE PHLX/PHLG W/O MANJ

494.40

090

N

319.63

*

*

28495

CLTX FX GRT TOE PHLX/PHLG W/MANJ

615.60

090

N

319.63

*

*

J1

28496

PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ

1591.20

090

N

5184.51

*

*

J1

28505

OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES

2300.40

090

N

5184.51

*

*

28510

CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ

421.20

090

N

319.63

*

*

28515

CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ

560.40

090

N

319.63

*

*

J1

28525

OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE

1974.00

090

N

5184.51

*

*

28530

CLOSED TREATMENT SESAMOID FRACTURE

400.80

090

N

319.63

*

*

J1

28531

OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION

1182.00

090

N

10775.65

*

*

28540

CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES

667.20

090

N

319.63

*

*

J1

28545

CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES

1029.60

090

N

5184.51

*

*

J1

28546

PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ

2000.40

090

N

2624.38

*

*

J1

28555

OPEN TREATMENT TARSAL BONE DISLOCATION

2988.00

090

Y

10775.65

*

*

28570

CLOSED TX TALOTARSAL JOINT DISLC W/O ANES

784.80

090

N

319.63

*

*

J1

28575

CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES

1269.60

090

N

5184.51

*

*

J1

28576

PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ

1351.20

090

N

5184.51

*

*

J1

28585

OPEN TREATMENT TALOTARSAL JOINT DISLOCATION

3004.80

090

Y

10775.65

*

*

28600

CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES

751.20

090

N

319.63

*

*

28605

CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES

1140.00

090

N

319.63

*

*

J1

28606

PRQ SKEL FIXJ TARS JT DISLC W/MANJ

1350.00

090

N

5184.51

*

*

J1

28615

OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION

2794.80

090

Y

10775.65

*

*

28630

CLTX METATARSOPHLNGL JT DISLC W/O ANES

538.80

010

N

319.63

*

*

J1

28635

CLTX METATARSOPHLNGL JT DISLC REQ ANES

609.60

010

N

2624.38

*

*

J1

28636

PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ

1110.00

010

N

5184.51

*

*

J1

28645

OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION

2276.40

090

N

5184.51

*

*

28660

CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES

405.60

010

N

319.63

*

*

28665

CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES

534.00

010

N

334.52

*

*

J1

28666

PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ

543.60

010

N

5184.51

*

*

J1

28675

OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION

1974.00

090

N

5184.51

*

*

J1

28705

ARTHRODESIS PANTALAR

4264.80

090

Y

26078.68

*

*

J1

28715

ARTHRODESIS TRIPLE

3253.20

090

Y

19120.53

*

*

J1

28725

ARTHRODESIS SUBTALAR

2695.20

090

Y

19120.53

*

*

J1

28730

ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS

2538.00

090

Y

19120.53

*

*

J1

28735

ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT

2694.00

090

Y

19120.53

*

*

J1

28737

ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR

2403.60

090

Y

19120.53

*

*

J1

28740

ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT

2918.40

090

Y

10775.65

*

*

J1

28750

ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT

2775.60

090

N

10775.65

*

*

J1

28755

ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT

1768.80

090

N

10775.65

*

*

J1

28760

ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK

2745.60

090

Y

10775.65

*

*

28800

AMPUTATION FOOT MIDTARSAL

1846.80

090

Y

*

*

J1

28805

AMPUTATION FOOT TRANSMETARSAL

2511.60

090

N

5184.51

*

*

J1

28810

AMPUTATION METATARSAL W/TOE SINGLE

1483.20

090

N

5184.51

*

*

J1

28820

AMPUTATION TOE METATARSOPHALANGEAL JOINT

1941.60

090

N

5184.51

*

*

J1

28825

AMPUTATION TOE INTERPHALANGEAL JOINT

1858.80

090

N

5184.51

*

*

J1

28890

ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA

1118.40

090

N

2624.38

*

*

28899

UNLISTED PROCEDURE FOOT/TOES

BR

YYY

N

319.63

*

*

29000

APPLICATION HALO TYPE BODY CAST

1188.00

000

N

334.52

*

*

29010

APPLICATION RISSER JACKET LOCALIZER BODY ONLY

927.60

000

N

334.52

*

*

29015

APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD

998.40

000

N

334.52

*

*

29035

APPLICATION BODY CAST SHOULDER HIPS

868.80

000

N

334.52

*

*

29040

APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA

994.80

000

N

334.52

*

*

29044

APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH

974.40

000

N

191.16

*

*

29046

APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS

1069.20

000

N

334.52

*

*

29049

APPLICATION CAST FIGURE-OF-8

338.40

000

N

334.52

*

*

29055

APPLICATION CAST SHOULDER SPICA

753.60

000

N

334.52

*

*

29058

APPLICATION CAST PLASTER VELPEAU

421.20

000

N

334.52

*

*

29065

APPLICATION CAST SHOULDER HAND LONG ARM

326.40

000

N

334.52

*

*

29075

APPLICATION CAST ELBOW FINGER SHORT ARM

295.20

000

N

334.52

*

*

29085

APPLICATION CAST HAND & LOWER FOREARM GAUNTLET

324.00

000

N

191.16

*

*

29086

APPLICATION CAST FINGER

268.80

000

N

191.16

*

*

29105

APPLICATION LONG ARM SPLINT SHOULDER HAND

279.60

000

N

191.16

*

*

29125

APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC

219.60

000

N

151.20

*

*

29126

APPLICATION SHORT ARM SPLINT DYNAMIC

261.60

000

N

151.20

*

*

29130

APPLICATION FINGER SPLINT STATIC

140.40

000

N

79.38

*

*

29131

APPLICATION FINGER SPLINT DYNAMIC

175.20

000

N

79.38

*

*

29200

STRAPPING THORAX

109.20

000

N

191.16

*

*

29240

STRAPPING SHOULDER

104.40

000

N

151.20

*

*

29260

STRAPPING ELBOW/WRIST

102.00

000

N

45.61

*

*

29280

STRAPPING HAND/FINGER

104.40

000

N

45.61

*

*

29305

APPLICATION HIP SPICA CAST 1 LEG

842.40

000

N

334.52

*

*

29325

APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS

930.00

000

N

334.52

*

*

29345

APPLICATION LONG LEG CAST THIGH-TOE

462.00

000

N

334.52

*

*

29355

APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE

483.60

000

N

334.52

*

*

29358

APPLICATION LONG LEG CAST BRACE

544.80

000

N

334.52

*

*

29365

APPLICATION CYLINDER CAST THIGH ANKLE

418.80

000

N

334.52

*

*

29405

APPLICATION SHORT LEG CAST BELOW KNEE-TOE

276.00

000

N

334.52

*

*

29425

APPLICATION SHORT LEG CAST WALKING/AMBULATORY

264.00

000

N

334.52

*

*

29435

APPLICATION PATELLAR TENDON BEARING CAST

402.00

000

N

334.52

*

*

29440

ADDING WALKER PREVIOUSLY APPLIED CAST

148.80

000

N

191.16

*

*

29445

APPLICATION RIGID TOTAL CONTACT LEG CAST

447.60

000

N

334.52

*

*

29450

APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG

498.00

000

N

191.16

*

*

29505

APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES

291.60

000

N

191.16

*

*

29515

APPLICATION SHORT LEG SPLINT CALF FOOT

243.60

000

N

191.16

*

*

29520

STRAPPING HIP

116.40

000

N

79.38

*

*

29530

STRAPPING KNEE

103.20

000

N

151.20

*

*

29540

STRAPPING ANKLE &/FOOT

98.40

000

N

191.16

*

*

29550

STRAPPING TOES

66.00

000

N

79.38

*

*

29580

STRAPPING UNNA BOOT

213.60

000

N

191.16

*

*

29581

APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT

296.40

000

N

191.16

*

*

29584

APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING

274.80

000

N

191.16

*

*

29700

REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST

218.40

000

N

334.52

*

*

29705

REMOVAL/BIVALVING FULL ARM/FULL LEG CAST

222.00

000

N

334.52

*

*

29710

RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET

421.20

000

N

334.52

*

*

29720

REPAIR SPICA BODY CAST/JACKET

289.20

000

N

191.16

*

*

29730

WINDOWING CAST

214.80

000

N

191.16

*

*

29740

WEDGING CAST EXCEPT CLUBFOOT CASTS

338.40

000

N

334.52

*

*

29750

WEDGING CLUBFOOT CAST

368.40

000

N

334.52

*

*

29799

UNLISTED PROCEDURE CASTING/STRAPPING

BR

YYY

N

191.16

*

*

J1

29800

ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX

1825.20

090

N

5184.51

*

*

J1

29804

ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL

2211.60

090

Y

5184.51

*

*

J1

29805

ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX

1628.40

090

N

5184.51

*

*

J1

29806

ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY

3667.20

090

N

10775.65

*

*

J1

29807

ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION

3585.60

090

N

10775.65

*

*

J1

29819

ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB

2025.60

090

N

5184.51

*

*

J1

29820

ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL

1842.00

090

Y

10775.65

*

*

J1

29821

ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE

2020.80

090

Y

5184.51

*

*

J1

29822

ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED

1962.00

090

Y

5184.51

*

*

J1

29823

ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE

2133.60

090

Y

5184.51

*

*

J1

29824

ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY

2300.40

090

Y

5184.51

*

*

J1

29825

ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ

1992.00

090

Y

5184.51

+

*

29826

ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE

608.40

ZZZ

Y

*

*

J1

29827

ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR

3643.20

090

Y

10775.65

*

*

J1

29828

ARTHROSCOPY SHOULDER BICEPS TENODESIS

3138.00

090

Y

10775.65

*

*

J1

29830

ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX

1569.60

090

N

5184.51

*

*

J1

29834

ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB

1676.40

090

Y

5184.51

*

*

J1

29835

ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL

1737.60

090

Y

5184.51

*

*

J1

29836

ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE

1974.00

090

Y

10775.65

*

*

J1

29837

ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED

1810.80

090

Y

5184.51

*

*

J1

29838

ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE

2031.60

090

N

5184.51

*

*

J1

29840

ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX

1552.80

090

N

5184.51

*

*

J1

29843

ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE

1668.00

090

Y

5184.51

*

*

J1

29844

ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL

1713.60

090

Y

5184.51

*

*

J1

29845

ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE

1992.00

090

Y

5184.51

*

*

J1

29846

ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT

1796.40

090

N

5184.51

*

*

J1

29847

ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY

1849.20

090

Y

10775.65

*

*

J1

29848

NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM

1765.20

090

N

2624.38

*

*

J1

29850

ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ

2151.60

090

N

2624.38

*

*

J1

29851

ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ

3213.60

090

Y

2624.38

*

*

J1

29855

ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR

2707.20

090

Y

10775.65

*

*

J1

29856

ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR

3428.40

090

Y

19120.53

*

*

J1

29860

ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX

2284.80

090

Y

10775.65

*

*

J1

29861

ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB

2475.60

090

Y

5184.51

*

*

J1

29862

ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG

2779.20

090

Y

10775.65

*

*

J1

29863

ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY

2784.00

090

Y

5184.51

*

*

J1

29866

ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST

3639.60

090

N

10775.65

*

*

J1

29867

ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT

4408.80

090

N

19120.53

*

*

J1

29868

ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT

5808.00

090

N

10775.65

*

*

J1

29870

ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX

1971.60

090

N

5184.51

*

*

J1

29871

ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE

1778.40

090

N

5184.51

*

*

J1

29873

ARTHROSCOPY KNEE LATERAL RELEASE

1816.80

090

N

5184.51

*

*

J1

29874

ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY

1852.80

090

N

5184.51

*

*

J1

29875

ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX

1711.20

090

N

5184.51

*

*

J1

29876

ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS

2269.20

090

N

5184.51

*

*

J1

29877

ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG

2146.80

090

N

5184.51

*

*

J1

29879

ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX

2287.20

090

N

5184.51

*

*

J1

29880

ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING

1939.20

090

N

5184.51

*

*

J1

29881

ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG

1868.40

090

N

5184.51

*

*

J1

29882

ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL

2412.00

090

N

5184.51

*

*

J1

29883

ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL

2924.40

090

N

5184.51

*

*

J1

29884

ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX

2118.00

090

Y

5184.51

*

*

J1

29885

ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG

2570.40

090

Y

10775.65

*

*

J1

29886

ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION

2204.40

090

N

5184.51

*

*

J1

29887

ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ

2581.20

090

Y

10775.65

*

*

J1

29888

ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ

3402.00

090

Y

10775.65

*

*

J1

29889

ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ

4231.20

090

Y

19120.53

*

*

J1

29891

ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT

2319.60

090

Y

5184.51

*

*

J1

29892

ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX

2262.00

090

Y

10775.65

*

*

J1

29893

ENDOSCOPIC PLANTAR FASCIOTOMY

2146.80

090

N

5184.51

*

*

J1

29894

ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY

1705.20

090

Y

5184.51

*

*

J1

29895

ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL

1617.60

090

Y

5184.51

*

*

J1

29897

ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED

1737.60

090

Y

5184.51

*

*

J1

29898

ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE

1941.60

090

Y

5184.51

*

*

J1

29899

ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS

3576.00

090

Y

10775.65

*

*

J1

29900

ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY

1718.40

090

N

5184.51

*

*

J1

29901

ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT

1836.00

090

N

5184.51

*

*

J1

29902

ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM

1964.40

090

N

2624.38

*

*

J1

29904

ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY

2181.60

090

Y

5184.51

*

*

J1

29905

ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY

1790.40

090

Y

5184.51

*

*

J1

29906

ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT

2340.00

090

Y

5184.51

*

*

J1

29907

ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS

3025.20

090

Y

19120.53

*

*

J1

29914

ARTHROSCOPY HIP W/FEMOROPLASTY

3397.20

090

Y

10775.65

*

*

J1

29915

ARTHROSCOPY HIP W/ACETABULOPLASTY

3502.80

090

Y

10775.65

*

*

J1

29916

ARTHROSCOPY HIP W/LABRAL REPAIR

3492.00

090

Y

10775.65

*

*

29999

UNLISTED PROCEDURE ARTHROSCOPY

BR

YYY

N

319.63

*

*

30000

DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH

819.60

010

N

292.72

*

*

30020

DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM

828.00

010

N

691.72

*

*

J1

30100

BIOPSY INTRANASAL

480.00

000

N

2543.11

*

*

J1

30110

EXCISION NASAL POLYP SIMPLE

798.00

010

N

2543.11

*

*

J1

30115

EXCISION NASAL POLYP EXTENSIVE

1496.40

090

N

4449.71

*

*

J1

30117

EXCISION/DESTRUCTION INTRANASAL LESION INT APPR

3078.00

090

N

4449.71

*

*

J1

30118

EXCISION/DESTRUCTION INTRANASAL LESION XTRNL

2656.80

090

N

4449.71

*

*

J1

30120

EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA

1761.60

090

N

4449.71

*

*

J1

30124

EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS

982.80

090

N

2543.11

*

*

J1

30125

EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG

2108.40

090

Y

8765.29

*

*

J1

30130

EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE

1322.40

090

N

4449.71

*

*

J1

30140

SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL

950.40

000

N

4449.71

*

*

J1

30150

RHINECTOMY PARTIAL

2648.40

090

N

8765.29

*

*

J1

30160

RHINECTOMY TOTAL

2664.00

090

Y

8765.29

*

*

30200

INJECTION TURBINATE THERAPEUTIC

381.60

000

N

691.72

*

*

J1

30210

DISPLACEMENT THERAPY PROETZ TYPE

510.00

010

N

2543.11

*

*

J1

30220

INSERTION NASAL SEPTAL PROSTHESIS BUTTON

1032.00

010

N

2543.11

*

*

30300

REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE

631.20

010

N

151.20

*

*

J1

30310

REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES

692.40

010

N

4449.71

*

*

J1

30320

RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY

1563.60

090

N

2543.11

*

*

J1

30400

RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI

3717.60

090

N

8765.29

*

*

J1

30410

RHINP PRIM COMPLETE XTRNL PARTS

4293.60

090

Y

8765.29

*

*

J1

30420

RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR

4730.40

090

N

8765.29

*

*

J1

30430

RHINOPLASTY SECONDARY MINOR REVISION

3268.80

090

Y

8765.29

*

*

J1

30435

RHINOPLASTY SECONDARY INTERMEDIATE REVISION

4054.80

090

Y

8765.29

*

*

J1

30450

RHINOPLASTY SECONDARY MAJOR REVISION

5389.20

090

Y

8765.29

*

*

J1

30460

RHINP DFRM W/COLUM LNGTH TIP ONLY

2821.20

090

Y

8765.29

*

*

J1

30462

RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT

5422.80

090

Y

8765.29

*

*

J1

30465

REPAIR NASAL VESTIBULAR STENOSIS

3375.60

090

N

8765.29

*

*

J1

30520

SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF

2164.80

090

N

4449.71

*

*

J1

30540

REPAIR CHOANAL ATRESIA INTRANASAL

2382.00

090

Y

8765.29

*

*

J1

30545

REPAIR CHOANAL ATRESIA TRANSPALATINE

3256.80

090

Y

8765.29

*

*

30560

LYSIS INTRANASAL SYNECHIA

955.20

010

N

691.72

*

*

J1

30580

REPAIR FISTULA OROMAXILLARY

2199.60

090

N

8765.29

*

*

J1

30600

REPAIR FISTULA ORONASAL

1944.00

090

N

8765.29

*

*

J1

30620

SEPTAL/OTHER INTRANASAL DERMATOPLASTY

2188.80

090

N

8765.29

*

*

J1

30630

REPAIR NASAL SEPTAL PERFORATIONS

2168.40

090

N

4449.71

*

*

J1

30801

ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC

758.40

010

N

2543.11

*

*

J1

30802

ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL

963.60

010

N

2543.11

*

*

30901

CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE

469.20

000

N

151.20

*

*

30903

CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX

739.20

000

N

151.20

*

*

30905

CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST

1123.20

000

N

151.20

*

*

30906

CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ

1174.80

000

N

292.72

*

*

J1

30915

LIGATION ARTERIES ETHMOIDAL

1983.60

090

N

5022.59

*

*

J1

30920

LIGATION ARTERIES INT MAXILLARY TRANSANTRAL

2883.60

090

N

5022.59

*

*

J1

30930

FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC

411.60

010

N

4449.71

*

*

30999

UNLISTED PROCEDURE NOSE

BR

YYY

N

292.72

*

*

31000

LAVAGE CANNULATION MAXILLARY SINUS

620.40

010

N

292.72

*

*

J1

31002

LAVAGE CANNULATION SPHENOID SINUS

646.80

010

N

2543.11

*

*

J1

31020

SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL

1642.80

090

N

4449.71

*

*

J1

31030

SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS

2296.80

090

N

8765.29

*

*

J1

31032

SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS

1982.40

090

N

8765.29

*

*

J1

31040

PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH

2647.20

090

N

8765.29

*

*

J1

31050

SINUSOTOMY SPHENOID W/WO BIOPSY

1672.80

090

N

8765.29

*

*

J1

31051

SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP

2235.60

090

N

8765.29

*

*

J1

31070

SINUSOTOMY FRONTAL EXTERNAL SIMPLE

1520.40

090

N

8765.29

*

*

J1

31075

SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL

2695.20

090

Y

8765.29

*

*

J1

31080

SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC

3546.00

090

Y

8765.29

*

*

J1

31081

SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC

3819.60

090

Y

8765.29

*

*

J1

31084

SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC

3944.40

090

Y

8765.29

*

*

J1

31085

SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC

4094.40

090

Y

8765.29

*

*

J1

31086

SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC

3860.40

090

Y

8765.29

*

*

J1

31087

SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC

3706.80

090

Y

8765.29

*

*

J1

31090

SINUSOT UNI 3/> PARANSL SINUSES

3561.60

090

N

8765.29

*

*

J1

31200

ETHMOIDECTOMY INTRANASAL ANTERIOR

2008.80

090

N

8765.29

*

*

J1

31201

ETHMOIDECTOMY INTRANASAL TOTAL

2577.60

090

N

4449.71

*

*

J1

31205

ETHMOIDECTOMY EXTRANASAL TOTAL

3133.20

090

Y

4449.71

*

*

31225

MAXILLECTOMY W/O ORBITAL EXENTERATION

6336.00

090

Y

*

*

31230

MAXILLECTOMY W/ORBITAL EXENTERATION

7002.00

090

Y

*

*

31231

NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX

682.80

000

N

232.84

*

*

31233

NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY

889.20

000

N

548.83

*

*

J1

31235

NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY

1016.40

000

N

2734.34

*

*

J1

31237

NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX

871.20

000

N

2734.34

*

*

J1

31238

NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG

860.40

000

N

2734.34

*

*

J1

31239

NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY

2108.40

010

N

5449.67

*

*

J1

31240

NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION

547.20

000

N

2734.34

*

*

J1

31241

NASAL/SINUS NDSC W/LIG SPHENOPALATINE ARTERY

1540.80

000

N

2734.34

*

*

J1

31253

NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL

1732.80

000

N

9954.12

*

*

J1

31254

NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY

1413.60

000

N

9954.12

*

*

J1

31255

NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY

1119.60

000

N

9954.12

*

*

J1

31256

NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY

622.80

000

N

5449.67

*

*

J1

31257

NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY

1545.60

000

N

9954.12

*

*

J1

31259

NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL

1636.80

000

N

9954.12

*

*

J1

31267

NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS

918.00

000

N

9954.12

*

*

J1

31276

NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS

1310.40

000

N

9954.12

*

*

J1

31287

NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY

696.00

000

N

9954.12

*

*

J1

31288

NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS

810.00

000

N

9954.12

*

*

31290

NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID

3937.20

010

N

1397.21

*

*

31291

NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID

4194.00

010

N

*

*

J1

31292

NSL/SINUS NDSC SURG W/MEDIAL/INF ORB WALL DCMPRN

3403.20

010

N

9954.12

*

*

J1

31293

NASAL/SINUS NDSC MEDIAL ORB&NF ORB WALL DCMPR

3697.20

010

N

9954.12

*

*

J1

31294

NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN

4233.60

010

N

9954.12

*

*

J1

31295

NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS

6675.60

000

Y

9954.12

*

*

J1

31296

NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS

6763.20

000

Y

9954.12

*

*

J1

31297

NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS

6627.60

000

N

9954.12

*

*

J1

31298

NASAL/SINUS NDSC W/FRONTAL & SPHEN SINS DILATION

12793.20

000

N

9954.12

*

*

31299

UNLISTED PROCEDURE ACCESSORY SINUSES

BR

YYY

N

292.72

*

*

J1

31300

LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY

4394.40

090

Y

4449.71

*

*

31360

LARYNGECTOMY TOTAL W/O RADICAL NECK DISSECTION

7176.00

090

Y

*

*

31365

LARYNGECTOMY TOTAL W/RADICAL NECK DISSECTION

8858.40

090

Y

*

*

31367

LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ

7587.60

090

Y

*

*

31368

LARYNGECTOMY STOT SUPRAGLOTTIC W/RAD NCK DSJ

8427.60

090

Y

*

*

31370

PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL

7135.20

090

Y

*

*

31375

PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL

6760.80

090

Y

*

*

31380

PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL

6674.40

090

Y

*

*

31382

PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL

7322.40

090

Y

*

*

31390

PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ

9828.00

090

Y

*

*

31395

PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ

10370.40

090

Y

*

*

J1

31400

ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH

3374.40

090

Y

8765.29

*

*

J1

31420

EPIGLOTTIDECTOMY

2829.60

090

Y

8765.29

*

Ø

31500

INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE

488.40

000

N

292.72

*

*

31502

TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT

121.20

000

N

292.72

*

*

31505

LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX

288.00

000

N

232.84

*

*

J1

31510

LARYNGOSCOPY INDIRECT W/BIOPSY

721.20

000

N

5449.67

*

*

31511

LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY

721.20

000

N

232.84

*

*

J1

31512

LARYNGOSCOPY INDIRECT W/REMOVAL LESION

710.40

000

N

5449.67

*

*

31513

LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION

451.20

000

N

548.83

*

*

31515

LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION

694.80

000

N

548.83

*

*

31520

LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN

537.60

000

N

548.83

*

*

J1

31525

LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN

854.40

000

N

2734.34

*

*

J1

31526

LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE

538.80

000

N

2734.34

*

*

J1

31527

LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR

669.60

000

N

5449.67

*

*

J1

31528

LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN

495.60

000

N

5449.67

*

*

J1

31529

LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ

554.40

000

N

5449.67

*

*

J1

31530

LARYNGOSCOPY W/FOREIGN BODY REMOVAL

685.20

000

N

2734.34

*

*

J1

31531

LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE

729.60

000

N

5449.67

*

*

J1

31535

LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY

650.40

000

N

5449.67

*

*

J1

31536

LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE

724.80

000

N

5449.67

*

*

J1

31540

LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT

829.20

000

N

5449.67

*

*

J1

31541

LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP

906.00

000

N

5449.67

*

*

J1

31545

LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP

1246.80

000

N

5449.67

*

*

J1

31546

LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT

1892.40

000

N

9954.12

*

*

J1

31551

LARYNGOPLASTY LARYNGEAL STEN W/O STENT < 12 YRS

4944.00

090

N

8765.29

*

*

J1

31552

LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS >

4976.40

090

N

8765.29

*

*

J1

31553

LARYNGOPLASTY LARYNGEAL STEN W/STENT < 12 YRS

5431.20

090

N

8765.29

*

*

J1

31554

LARYNGOPLASTY LARYNGEAL STEN W/STENT 12 YRS >

5683.20

090

N

8765.29

*

*

J1

31560

LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY

1076.40

000

N

9954.12

*

*

J1

31561

LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE

1178.40

000

N

9954.12

*

*

J1

31570

LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC

1155.60

000

N

5449.67

*

*

J1

31571

LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE

856.80

000

N

5449.67

*

*

J1

31572

LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI

1729.20

000

N

5449.67

*

*

J1

31573

LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI

913.20

000

N

2734.34

*

*

J1

31574

LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI

3454.80

000

N

2734.34

*

*

31575

LARYNGOSCOPY FLEXIBLE DIAGNOSTIC

397.20

000

N

232.84

*

*

J1

31576

LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES)

904.80

000

N

2734.34

*

*

31577

LARYNGOSCOPY FLX RMVL FOREIGN BODY(S)

946.80

000

N

548.83

*

*

J1

31578

LARYNGOSCOPY FLEXIBLE RMVL LESION(S) NON-LASER

1030.80

000

N

5449.67

*

*

31579

LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY

627.60

000

N

548.83

*

*

J1

31580

LARYNGOPLASTY LARYN WEB W/KEEL STENT INSERTION

4293.60

090

N

8765.29

*

*

J1

31584

LARYNGOPLASTY W/OPEN REDUCTION FRACTURE W/TRACHS

4759.20

090

N

8765.29

*

*

J1

31587

LARYNGOPLASTY CRICOID SPLIT W/O GRAFT PLACEMENT

3982.80

090

N

8765.29

*

*

J1

31590

LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE

3008.40

090

Y

8765.29

*

*

J1

31591

LARYNGOPLASTY MEDIALIZATION UNLIATERAL

3609.60

090

N

8765.29

*

*

J1

31592

CRICOTRACHEAL RESECTION

5908.80

090

N

8765.29

*

*

31599

UNLISTED PROCEDURE LARYNX

BR

YYY

N

292.72

*

*

J1

31600

TRACHEOSTOMY PLANNED SEPARATE PROCEDURE

1069.20

000

N

4449.71

*

*

J1

31601

TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX

1557.60

000

Y

8765.29

*

*

J1

31603

TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL

1117.20

000

N

2543.11

*

*

31605

TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE

1153.20

000

N

292.72

*

*

J1

31610

TRACHEOSTOMY FENESTRATION W/SKIN FLAPS

3268.80

090

N

8765.29

*

*

J1

31611

CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH

1826.40

090

Y

4449.71

*

*

J1

31612

TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX

286.80

000

N

4449.71

*

*

J1

31613

TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION

1520.40

090

N

4449.71

*

*

J1

31614

TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION

2527.20

090

N

8765.29

*

*

31615

TRACHEOBRNCHSC THRU EST TRACHS INC

579.60

000

N

691.72

*

*

J1

31622

BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX

820.80

000

N

2734.34

*

*

J1

31623

BRNCHSC BRUSHING/PROTECTED BRUSHINGS

901.20

000

N

2734.34

*

*

J1

31624

BRNCHSC W/BRNCL ALVEOLAR LAVAGE

852.00

000

N

2734.34

*

*

J1

31625

BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES

1150.80

000

N

2734.34

*

*

J1

31626

BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT

2872.80

000

N

9954.12

+

*

31627

BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION

4538.40

ZZZ

N

*

*

J1

31628

BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE

1221.60

000

N

5449.67

*

*

J1

31629

BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON

1510.80

000

N

5449.67

*

*

J1

31630

BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX

685.20

000

N

5449.67

*

*

J1

31631

BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT

789.60

000

N

9954.12

+

*

31632

BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE

217.20

ZZZ

N

+

*

31633

BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE

272.40

ZZZ

N

*

*

J1

31634

BRONCHOSCOPY BALLOON OCCLUSION

5928.00

000

Y

9954.12

*

*

J1

31635

BRONCHOSCOPY W/REMOVAL FOREIGN BODY

963.60

000

N

2734.34

*

*

J1

31636

BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS

762.00

000

N

9954.12

+

*

31637

BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED

266.40

ZZZ

N

*

*

J1

31638

BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS

865.20

000

N

9954.12

*

*

J1

31640

BRONCHOSCOPY W/EXCISION TUMOR

866.40

000

N

5449.67

*

*

J1

31641

BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC

886.80

000

N

5449.67

*

*

J1

31643

BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL

610.80

000

N

2734.34

*

*

J1

31645

BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST

890.40

000

N

2734.34

*

*

31646

BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ

490.80

000

N

548.83

*

*

J1

31647

BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE

732.00

000

N

9954.12

*

*

J1

31648

BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL

696.00

000

N

5449.67

+

*

31649

BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL

232.80

ZZZ

N

1944.39

+

*

31651

BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE

255.60

ZZZ

N

*

*

J1

31652

BRNCHSC EBUS GUIDED SAM PL 1 /2 NODE STATION/STRUX

3290.40

000

N

5449.67

*

*

J1

31653

BRNCHSC EBUS GUIDED SAM PL 3 /> NODE STATION/STRUX

3447.60

000

N

5449.67

+

*

31654

BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES

423.60

ZZZ

N

*

*

J1

31660

BRONCHOSCOPIC THERMOPLASTY ONE LOBE

674.40

000

N

9954.12

*

*

J1

31661

BRONCHOSCOPIC THERMOPLASTY 2/> LOBES

711.60

000

N

9954.12

*

*

31717

CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY

957.60

000

N

548.83

*

*

31720

CATHETER ASPIRATION NASOTRACHEAL SPX

171.60

000

N

272.07

*

*

31725

CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX

274.80

000

N

*

*

J1

31730

TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER

4108.80

000

N

2734.34

*

*

J1

31750

TRACHEOPLASTY CERVICAL

4743.60

090

Y

8765.29

*

*

J1

31755

TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG

5998.80

090

Y

8765.29

*

*

31760

TRACHEOPLASTY INTRATHORACIC

4749.60

090

Y

*

*

31766

CARINAL RECONSTRUCTION

6177.60

090

Y

*

*

31770

BRONCHOPLASTY GRAFT REPAIR

4594.80

090

Y

*

*

31775

BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS

4857.60

090

Y

*

*

31780

EXCISION TRACHEAL STENOSIS&ANASTOMOSIS CERVICA

4116.00

090

Y

*

*

31781

EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC

4786.80

090

Y

*

*

J1

31785

EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL

3709.20

090

Y

8765.29

*

*

31786

EXCISION TRACHEAL TUMOR/CARCINOMA THORACIC

5008.80

090

Y

*

*

31800

SUTURE TRACHEAL WOUND/INJURY CERVICAL

2474.40

090

N

*

*

31805

SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC

2810.40

090

Y

*

*

J1

31820

SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR

1484.40

090

N

4449.71

*

*

J1

31825

SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR

2059.20

090

N

4449.71

*

*

J1

31830

REVISION TRACHEOSTOMY SCAR

1531.20

090

N

4449.71

*

*

31899

UNLISTED PROCEDURE TRACHEA BRONCHI

BR

YYY

N

232.84

*

*

32035

THORACOSTOMY W/RIB RESECTION EMPYEMA

2497.20

090

Y

*

*

32036

THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA

2686.80

090

Y

*

*

32096

THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL

2784.00

090

Y

*

*

32097

THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL

2782.80

090

Y

*

*

32098

THORACOTOMY W/BIOPSY OF PLEURA

2636.40

090

Y

*

*

32100

THORACOTOMY WITH EXPLORATION

2806.80

090

Y

*

*

32110

THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR

5092.80

090

Y

*

*

32120

THORACOTOMY POSTOPERATIVE COMPLICATIONS

3020.40

090

Y

*

*

32124

THORACOTOMY OPN INTRAPLEURAL PNEUMONOLYSIS

3205.20

090

Y

*

*

32140

THORCOM W/REMOVAL OF CYST

3427.20

090

Y

*

*

32141

THORACOTOMY W/RESECTION BULLAE

5286.00

090

Y

*

*

32150

THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP

3477.60

090

Y

*

*

32151

THORCOM W/RMVL IPUL FB

3460.80

090

Y

*

*

32160

THORACOTOMY W/CARDIAC MASSAGE

2754.00

090

Y

2660.50

*

*

32200

PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST

3928.80

090

Y

*

*

32215

PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX

2752.80

090

Y

*

*

32220

DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE

5494.80

090

Y

*

*

32225

DECORTICATION PULMONARY PARTIAL SEPARATE PROC

3441.60

090

Y

*

*

32310

PLEURECTOMY PARIETAL SEPARATE PROCEDURE

3159.60

090

Y

*

*

32320

DECORTICATION & PARIETAL PLEURECTOMY

5535.60

090

Y

*

*

J1

32400

BIOPSY PLEURA PERCUTANEOUS NEEDLE

529.20

000

N

2734.29

*

*

J1

32405

BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE

1338.00

000

N

2734.29

*

*

32440

REMOVAL OF LUNG PNEUMONECTOMY

5420.40

090

Y

*

*

32442

REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA

10668.00

090

Y

*

*

32445

REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL

12282.00

090

Y

*

*

32480

RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT

5120.40

090

Y

*

*

32482

RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC

5475.60

090

Y

*

*

32484

RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY

4962.00

090

Y

*

*

32486

RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY

8175.60

090

Y

*

*

32488

RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC

8293.20

090

Y

*

*

32491

RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG

5098.80

090

Y

+

*

32501

RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY

848.40

ZZZ

Y

*

*

32503

RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ

6230.40

090

Y

*

*

32504

RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ

7108.80

090

Y

*

*

32505

THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL

3225.60

090

Y

+

*

32506

THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL

543.60

ZZZ

Y

+

*

32507

THORACOTOMY W/DX WEDGE RESEXN & ANTOM LUNG RESE

542.40

ZZZ

Y

*

*

32540

EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY

5962.80

090

Y

*

*

J1

32550

INSERTION INDWELLING TUNNELED PLEURAL CATHETER

2554.80

000

N

5716.03

*

*

32551

TUBE THORACOSTOMY INCLUDES WATER SEAL

543.60

000

N

1552.95

*

*

32552

RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF

631.20

010

N

880.41

*

*

32553

PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT

1786.80

000

Y

1692.53

*

*

32554

THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING

721.20

000

N

880.41

*

*

32555

THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING

1021.20

000

N

880.41

*

*

J1

32556

PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING

2089.20

000

N

2902.55

*

*

32557

PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING

1926.00

000

N

1552.95

*

*

32560

INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS

860.40

000

N

880.41

*

*

32561

INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY

319.20

000

Y

880.41

*

*

32562

INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY

285.60

000

Y

880.41

*

*

J1

32601

THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX

1068.00

000

N

9076.35

*

*

J1

32604

THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX

1668.00

000

N

9076.35

*

*

J1

32606

THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX

1602.00

000

N

9076.35

*

*

J1

32607

THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL

1066.80

000

N

9076.35

*

*

J1

32608

THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL

1309.20

000

N

9076.35

*

*

J1

32609

THORACOSCOPY WITH BIOPSYIES OF PLEURA

894.00

000

N

9076.35

*

*

32650

THORACOSCOPY W/PLEURODESIS

2302.80

090

Y

*

*

32651

THORACOSCOPY W/PARTIAL PULMONARY DECORTICATION

3792.00

090

Y

*

*

32652

THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS

5756.40

090

Y

*

*

32653

THORACOSCOPY RMVL INTRAPLEURAL FB/FIBRIN DEPOSIT

3673.20

090

Y

*

*

32654

THORACOSCOPY CONTROL TRAUMATIC HEMORRHAGE

3994.80

090

Y

*

*

32655

THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX

3308.40

090

Y

*

*

32656

THORACOSCOPY W/PARIETAL PLEURECTOMY

2770.80

090

Y

*

*

32658

THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC

2464.80

090

Y

*

*

32659

THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC

2532.00

090

Y

*

*

32661

THORACOSCOPY W/EXC PERICARDIAL CYST TUMOR/MASS

2749.20

090

Y

*

*

32662

THORACOSCOPY W/EXC MEDIASTINAL CYST TUMOR/MASS

3090.00

090

Y

*

*

32663

THORACOSCOPY W/LOBECTOMY SINGLE LOBE

4850.40

090

Y

*

*

32664

THORACOSCOPY W/THORACIC SYMPATHECTOMY

2934.00

090

Y

5660.97

*

*

32665

THORACOSCOPY W/ESOPHAGOMYOTOMY HELLER TYPE

4234.80

090

Y

*

*

32666

THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT

3013.20

090

Y

4643.74

+

*

32667

THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL

544.80

ZZZ

Y

2569.50

+

*

32668

THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN

544.80

ZZZ

Y

*

*

32669

THORACOSCOPY W/SEGMENTECTOMY

4654.80

090

Y

*

*

32670

THORACOSCOPY W/BILOBECTOMY

5553.60

090

Y

*

*

32671

THORACOSCOPY W/PNEUMONECTOMY

6132.00

090

Y

*

*

32672

THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL

5290.80

090

Y

*

*

32673

THORACOSCOPY RESEXN THYMUS UNI/BILATERAL

4202.40

090

Y

+

*

32674

THORCOSCPY W/MEDIASTINL & REGIONL LYMPHDENECTOMY

748.80

ZZZ

Y

*

*

32701

THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE

745.20

745.20

BR

XXX

N

*

*

32800

REPAIR LUNG HERNIA THROUGH CHEST WALL

3246.00

090

Y

*

*

32810

CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA

3109.20

090

Y

*

*

32815

OPEN CLOSURE MAJOR BRONCHIAL FISTULA

9726.00

090

Y

*

*

32820

MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC

4605.60

090

Y

*

*

32850

DONOR PNEUMONECTOMY FROM CADAVER DONOR

5648.40

XXX

N

*

*

32851

LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS

11442.00

090

Y

*

*

32852

LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS

12439.20

090

Y

*

*

32853

LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS

16022.40

090

Y

*

*

32854

LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS

17005.20

090

Y

*

*

32855

BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI

2448.00

XXX

Y

*

*

32856

BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT BI

3068.40

XXX

Y

*

*

32900

RESECTION RIBS EXTRAPLEURAL ALL STAGES

4905.60

090

Y

*

*

32905

THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL

4592.40

090

Y

*

*

32906

THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL

5710.80

090

Y

*

*

32940

PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX

4250.40

090

Y

*

*

32960

PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR

433.20

000

N

880.41

*

*

J1

32994

ABLATION THER 1+ PULM TUMORS PERQ CRYOABLATION

19141.20

000

Y

9076.35

*

*

32997

TOTAL LUNG LAVAGE UNILATERAL

1180.80

000

N

*

*

J1

32998

ABLATION THER 1+ PULM TUMORS PERQ RADIOFREQUENCY

12074.40

000

Y

9076.35

*

*

32999

UNLISTED PROCEDURE LUNGS & PLEURA

BR

YYY

N

880.41

*

*

33010

PERICARDIOCENTESIS INITIAL

373.20

000

N

1552.95

*

*

33011

PERICARDIOCENTESIS SUBSEQUENT

375.60

000

N

1552.95

*

*

33015

TUBE PERICARDIOSTOMY

1772.40

090

N

*

*

33020

PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY

3045.60

090

Y

*

*

33025

CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX

2762.40

090

Y

*

*

33030

PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS

6942.00

090

Y

*

*

33031

PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS

8588.40

090

Y

*

*

33050

RESECTION PERICARDIAL CYST/TUMOR

3477.60

090

Y

*

*

33120

EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP

7280.40

090

Y

*

*

33130

RESECTION EXTERNAL CARDIAC TUMOR

4760.40

090

Y

*

*

33140

TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX

5420.40

090

Y

+

*

33141

TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX

456.00

ZZZ

Y

*

*

33202

INSERTION EPICARDIAL ELECTRODE OPEN

2685.60

090

N

*

*

33203

INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC

2812.80

090

N

*

*

J1

33206

INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL

1578.00

090

N

16628.91

*

*

J1

33207

INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR

1676.40

090

N

16628.91

*

*

J1

33208

INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT

1818.00

090

N

16628.91

*

*

J1

33210

INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH

571.20

000

N

12106.09

*

*

J1

33211

INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX

594.00

000

N

12106.09

*

*

J1

33212

INS PM PLS GEN W/EXIST SINGLE LEAD

1117.20

090

N

12106.09

*

*

J1

33213

INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS

1168.80

090

N

16628.91

*

*

J1

33214

UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS

1668.00

090

N

16628.91

*

*

J1

33215

RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE

1082.40

090

N

5022.59

*

*

J1

33216

INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

1291.20

090

N

12106.09

*

*

J1

33217

INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

1272.00

090

N

12106.09

*

*

33218

RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB

1350.00

090

N

4445.35

*

*

33220

RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB

1359.60

090

N

4445.35

*

*

J1

33221

INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS

1252.80

090

N

29527.49

*

*

33222

RELOCATION OF SKIN POCKET FOR PACEMAKER

1177.20

090

N

2199.52

*

*

33223

RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR

1424.40

090

N

2199.52

*

*

J1

33224

INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN

1802.40

000

N

16628.91

+

*

33225

INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN

1640.40

ZZZ

N

*

*

J1

33226

RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD

1734.00

000

N

5022.59

*

*

J1

33227

REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD

1178.40

090

N

12106.09

*

*

J1

33228

REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS

1231.20

090

N

16628.91

*

*

J1

33229

REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD

1304.40

090

N

29527.49

*

*

J1

33230

INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS

1330.80

090

N

35813.54

*

*

J1

33231

INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS

1398.00

090

N

49739.98

*

*

33233

REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY

801.60

090

N

10513.84

*

*

33234

RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR

1692.00

090

N

4445.35

*

*

33235

RMVL TRANSVNS PM ELTRD DUAL LEAD SYS

2222.40

090

N

4445.35

*

*

33236

RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS

2689.20

090

N

*

*

33237

RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY

2902.80

090

N

*

*

33238

RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY

3250.80

090

N

*

*

J1

33240

INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD

1273.20

090

N

35813.54

*

*

33241

REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY

748.80

090

N

4445.35

*

*

33243

RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM

4762.80

090

Y

*

*

33244

RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ

3010.80

090

N

4445.35

*

*

J1

33249

INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR

3200.40

090

N

49739.98

*

*

33250

ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/O BYPASS

5014.80

090

Y

*

*

33251

ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/BYPASS

5631.60

090

Y

*

*

33254

ABLATION & RECONSTRUCTION ATRIA LIMITED

4696.80

090

Y

*

*

33255

ABLATION & RCNSTJ ATRIA EXTNSV W/O BYPASS

5678.40

090

Y

*

*

33256

ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS

6742.80

090

Y

+

*

33257

ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE

2017.20

ZZZ

Y

+

*

33258

ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTENSIV W/O BYP

2263.20

ZZZ

Y

+

*

33259

ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS

2929.20

ZZZ

Y

*

*

33261

OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS

5611.20

090

Y

*

*

J1

33262

RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD

1298.40

090

N

35813.54

*

*

J1

33263

RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD

1352.40

090

N

35813.54

*

*

J1

33264

RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD

1411.20

090

N

49739.98

*

*

33265

NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPAS

4716.00

090

Y

*

*

33266

NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS

6416.40

090

Y

*

*

J1

33270

INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD

1976.40

090

N

49739.98

*

*

J1

33271

INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE

1590.00

090

N

12106.09

*

*

33272

RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE

1209.60

090

N

4445.35

*

*

33273

REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB

1401.60

090

N

4445.35

*

*

J1

33274

TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG

1705.20

090

N

26888.04

*

*

33275

TCAT REMOVAL PERM LEADLESS PACEMAKER R VENTR

1812.00

090

N

3750.96

*

*

J1

33285

INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG

17528.40

000

N

12106.09

*

*

33286

REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR

456.00

000

N

822.66

*

*

J1

33289

TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR

1141.20

000

N

45731.93

*

*

33300

REPAIR CARDIAC WOUND W/O BYPASS

8522.40

090

Y

*

*

33305

REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS

14288.40

090

Y

*

*

33310

CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP

4069.20

090

Y

*

*

33315

CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP

6643.20

090

Y

*

*

33320

SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP

3664.80

090

Y

*

*

33321

SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS

4076.40

090

Y

*

*

33322

SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS

4802.40

090

Y

*

*

33330

INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS

4960.80

090

Y

*

*

33335

INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS

6553.20

090

Y

*

*

33340

PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT

2761.20

000

N

*

*

33361

REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH

4737.60

000

N

*

*

33362

REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH

5172.00

000

N

*

*

33363

REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH

5356.80

000

N

*

*

33364

REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH

5536.80

000

N

*

*

33365

REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH

6219.60

000

N

*

*

33366

TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE

6723.60

000

N

+

*

33367

REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH

2194.80

ZZZ

N

+

*

33368

REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH

2606.40

ZZZ

N

+

*

33369

REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH

3440.40

ZZZ

N

*

*

33390

VALVULOPLASTY AORTIC VALVE OPEN CARD BYP SIMPLE

6705.60

090

Y

*

*

33391

VALVULOPLASTY AORTIC VALVE OPEN CARD BYP COMPLEX

7935.60

090

Y

*

*

33404

CONSTRUCTION APICAL-AORTIC CONDUIT

6120.00

090

Y

*

*

33405

RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT

7882.80

090

Y

*

*

33406

RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND

9984.00

090

Y

*

*

33410

RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE

8838.00

090

Y

*

*

33411

RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS

11680.80

090

Y

*

*

33412

REPLACEMENT AORTIC VALVE KONNO PROCEDURE

10929.60

090

Y

*

*

33413

REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR

11131.20

090

Y

*

*

33414

RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC

7442.40

090

Y

*

*

33415

RESECTION/INCISION SUBVALVULAR TISSUE

7053.60

090

Y

*

*

33416

VENTRICULOMYOTOMY-MYECTOMY

7032.00

090

Y

*

*

33417

AORTOPLASTY SUPRAVALVULAR STENOSIS

5779.20

090

Y

*

*

33418

TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS

6286.80

090

Y

+

*

33419

TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS

1484.40

ZZZ

Y

*

*

33420

VALVOTOMY MITRAL VALVE CLOSED HEART

5076.00

090

N

*

*

33422

VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS

5760.00

090

Y

*

*

33425

VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS

9484.80

090

Y

*

*

33426

VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING

8276.40

090

Y

*

*

33427

VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING

8496.00

090

Y

*

*

33430

REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP

9727.20

090

Y

*

*

33440

RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE

11772.00

090

Y

*

*

33460

VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP

8336.40

090

Y

*

*

33463

VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION

10741.20

090

Y

*

*

33464

VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION

8485.20

090

Y

*

*

33465

REPLACEMENT TRICUSPID VALVE W/CARD BYPASS

9589.20

090

Y

*

*

33468

TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY

8386.80

090

Y

*

*

33470

VALVOTOMY PULMONARY VALVE CLSD HEART TRANSVENTR

4308.00

090

Y

*

*

33471

VALVOTOMY PULM VALVE CLSD HEART VIA PULM ARTERY

4606.80

090

Y

*

*

33474

VALVOTOMY PULMONARY VALVE OPEN HEART W/BYPASS

7594.80

090

Y

*

*

33475

REPLACEMENT PULMONARY VALVE

8112.00

090

Y

*

*

33476

R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY

5185.20

090

Y

*

*

33477

TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH

4766.40

000

N

*

*

33478

OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ

5443.20

090

Y

*

*

33496

RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS

5791.20

090

Y

*

*

33500

RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS

5408.40

090

Y

*

*

33501

RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS

3876.00

090

Y

*

*

33502

RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION

4399.20

090

Y

*

*

33503

RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT

4612.80

090

N

*

*

33504

RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP

5032.80

090

Y

*

*

33505

RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL

7015.20

090

Y

*

*

33506

RPR ANOM CORONARY ART FROM PULM ART TO AORTA

6936.00

090

Y

*

*

33507

RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ

5965.20

090

Y

+

*

33508

NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG

56.40

ZZZ

Y

*

*

33510

CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT

6714.00

090

Y

*

*

33511

CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS

7374.00

090

Y

*

*

33512

CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS

8396.40

090

Y

*

*

33513

CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS

8647.20

090

Y

*

*

33514

CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS

9092.40

090

Y

*

*

33516

CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT

9375.60

090

Y

+

*

33517

CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN

649.20

ZZZ

Y

+

*

33518

CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN

1431.60

ZZZ

Y

+

*

33519

CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN

1893.60

ZZZ

Y

+

*

33521

CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN

2271.60

ZZZ

Y

+

*

33522

CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN

2551.20

ZZZ

Y

+

*

33523

CORONARY ARTERY BYP W/VEIN &ARTERY GRAFT 6 VEIN

2880.00

ZZZ

Y

+

*

33530

ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ

1830.00

ZZZ

Y

*

*

33533

CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT

6490.80

090

Y

*

*

33534

CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS

7634.40

090

Y

*

*

33535

CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS

8517.60

090

Y

*

*

33536

CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS

9133.20

090

Y

*

*

33542

MYOCARDIAL RESECTION

9144.00

090

Y

*

*

33545

RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT

10719.60

090

Y

*

*

33548

SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD

10288.80

090

Y

+

*

33572

CORONARY ENDARTERCOMY OPEN ANY METHOD

800.40

ZZZ

Y

*

*

33600

CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH

5919.60

090

Y

*

*

33602

CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH

5743.20

090

Y

*

*

33606

ANAST PULMONARY ART AORTA DAMUS-KAYE-STANSEL PX

6192.00

090

Y

*

*

33608

RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT

6271.20

090

Y

*

*

33610

RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT

6183.60

090

Y

*

*

33611

RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR

6805.20

090

Y

*

*

33612

RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ

6987.60

090

Y

*

*

33615

RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX

6960.00

090

Y

*

*

33617

RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX

7346.40

090

Y

*

*

33619

RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLAS

9524.40

090

Y

*

*

33620

APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND

5725.20

090

Y

*

*

33621

TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT

3240.00

090

Y

*

*

33622

RECONSTRUCTION COMPLEX CARDIAC ANOMALY

12001.20

090

Y

*

*

33641

RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH

5685.60

090

Y

*

*

33645

DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG

5986.80

090

Y

*

*

33647

RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLS

6258.00

090

Y

*

*

33660

RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR

6069.60

090

Y

*

*

33665

RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR

6674.40

090

Y

*

*

33670

RPR COMPL AV CANAL W/WO PROSTC VALVE

6888.00

090

Y

*

*

33675

CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS

6760.80

090

Y

*

*

33676

CLOSURE MULTIPLE VSD W/RESECTION

7060.80

090

Y

*

*

33677

CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND

7333.20

090

Y

*

*

33681

CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH

6363.60

090

Y

*

*

33684

CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ

6586.80

090

Y

*

*

33688

CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET

6576.00

090

Y

*

*

33690

BANDING PULMONARY ARTERY

4173.60

090

Y

*

*

33692

COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA

6829.20

090

Y

*

*

33694

COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH

6805.20

090

Y

*

*

33697

COMPL RPR T-FALLOT W/PULM ATRESIA

7167.60

090

Y

*

*

33702

RPR SINUS VALSALVA FISTULA

5305.20

090

Y

*

*

33710

RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT

7158.00

090

Y

*

*

33720

RPR SINUS VALSALVA ANEURYSM

5360.40

090

Y

*

*

33722

CLOSURE AORTICO-LEFT VENTRICULAR TUNNEL

5668.80

090

Y

*

*

33724

REPAIR ISOLATED PARTIAL PULM VENOUS RETURN

5305.20

090

Y

*

*

33726

REPAIR PULMONARY VENOUS STENOSIS

7092.00

090

Y

*

*

33730

COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN

6810.00

090

Y

*

*

33732

RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB

5451.60

090

Y

*

*

33735

ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART

4508.40

090

Y

*

*

33736

ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS

4755.60

090

Y

*

*

33737

ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION

4516.80

090

Y

*

*

33750

SHUNT SUBCLAVIAN PULMONARY ARTERY

4395.60

090

Y

*

*

33755

SHUNT ASCENDING AORTA PULMONARY ARTERY

4581.60

090

Y

*

*

33762

SHUNT DESCENDING AORTA PULMONARY ARTERY

4465.20

090

Y

*

*

33764

SHUNT CENTRAL W/PROSTHETIC GRAFT

4581.60

090

Y

*

*

33766

SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG

4641.60

090

Y

*

*

33767

SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS

4957.20

090

Y

+

*

33768

ANASTOMOSIS CAVOPULMARY 2ND SUPRIOR VENA CAVA

1452.00

ZZZ

Y

*

*

33770

RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT

7388.40

090

Y

*

*

33771

RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT

7605.60

090

Y

*

*

33774

RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS

6267.60

090

Y

*

*

33775

RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND

6460.80

090

Y

*

*

33776

RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT

6595.20

090

Y

*

*

33777

RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC

6595.20

090

Y

*

*

33778

RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ

8196.00

090

Y

*

*

33779

RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND

8121.60

090

Y

*

*

33780

RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT

7975.20

090

Y

*

*

33781

RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ

8076.00

090

Y

*

*

33782

A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ

11282.40

090

Y

*

*

33783

A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA

12199.20

090

Y

*

*

33786

TOTAL REPAIR TRUNCUS ARTERIOSUS

7945.20

090

Y

*

*

33788

REIMPLANTATION ANOMALOUS PULMONARY ARTERY

5341.20

090

Y

*

*

33800

AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX

3398.40

090

Y

*

*

33802

DIVISION ABERRANT VESSEL VASCULAR RING

3774.00

090

Y

*

*

33803

DIVISION ABERRANT VESSEL W/REANASTOMOSIS

4008.00

090

Y

*

*

33813

OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS

4104.00

090

Y

*

*

33814

OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS

5302.80

090

Y

*

*

33820

REPAIR PATENT DUCTUS ARTERIOSUS LIGATION

3333.60

090

Y

*

*

33822

RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR

3554.40

090

Y

*

*

33824

RPR PATENT DUXUS ARTERIOSUS DIV 18 YR & OLDER

4104.00

090

Y

*

*

33840

EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS

4312.80

090

Y

*

*

33845

EXCISION COARCTATION AORTA W/WO PDA W/GRAFT

4550.40

090

Y

*

*

33851

EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET

4428.00

090

Y

*

*

33852

RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS

4629.60

090

Y

*

*

33853

RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS

6223.20

090

Y

*

*

33860

ASCENDING AORTA GRF W/CARD BYP & VALVE SSP

11184.00

090

Y

*

*

33863

AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT

10965.60

090

Y

*

*

33864

ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL

11233.20

090

Y

+

*

33866

AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS

3582.00

ZZZ

N

*

*

33870

TRANSVERSE ARCH GRAFT W/CARDIOPULMONARY BYPASS

8804.40

090

Y

*

*

33875

DESCENDING THORACIC AORTA GRAFT W/WO BYPASS

9566.40

090

Y

*

*

33877

RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS

12618.00

090

Y

*

*

33880

EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH

6241.20

090

Y

*

*

33881

EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN

5356.80

090

Y

*

*

33883

PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN

3878.40

090

Y

+

*

33884

PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN

1369.20

ZZZ

Y

*

*

33886

PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA

3324.00

090

Y

*

*

33889

OPN SUBCLA CRTD ART TRPOS NCK INC ULAT

2742.00

000

Y

*

*

33891

BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC

3325.20

000

Y

*

*

33910

PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS

9146.40

090

Y

*

*

33915

PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS

4770.00

090

Y

*

*

33916

PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS

14780.40

090

Y

*

*

33917

RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT

5050.80

090

Y

*

*

33920

RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT

6313.20

090

Y

*

*

33922

TRANSECTION PULMONARY ARTERY W/CARD BYPASS

4789.20

090

Y

+

*

33924

LIG&TKDN SYSIC-TO-PULM ART SHUNT W/CGEN HEART

984.00

ZZZ

Y

*

*

33925

RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS

5989.20

090

Y

*

*

33926

RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/BYPASS

8436.00

090

Y

*

*

33927

IMPLTJ TOTAL RPLCMT HEART SYS W/RCP CARDIECTOMY

8912.40

XXX

Y

*

*

33928

REMOVAL & RPLCMT TOTAL RPLCMT HEART SYS

BR

XXX

Y

+

*

33929

REMOVAL TOTAL RPLCMT HEART SYS FOR HEART TRNSPL

BR

ZZZ

Y

*

*

33930

DONOR CARDIECTOMY-PNEUMONECTOMY

BR

XXX

N

*

*

33933

BKBENCH PREPJ CADAVER DONOR HEART/LUNG ALLOGRAFT

BR

XXX

Y

*

*

33935

HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC

17268.00

090

Y

*

*

33940

DONOR CARDIECTOMY

BR

XXX

N

*

*

33944

BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT

1938.00

XXX

Y

*

*

33945

HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY

16960.80

090

Y

*

*

33946

ECMO/ECLS INITIATION VENO-VENOUS

1078.80

XXX

N

*

*

33947

ECMO/ECLS INITIATION VENO-ARTERIAL

1196.40

XXX

N

*

*

33948

ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS

829.20

XXX

N

*

*

33949

ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL

806.40

XXX

N

*

*

33951

ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ

1485.60

000

N

*

*

33952

ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ

1491.60

000

N

*

*

33953

ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN

1660.80

000

N

*

*

33954

ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN

1665.60

000

N

*

*

33955

ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS

2911.20

000

N

*

*

33956

ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER

2906.40

000

N

*

*

33957

ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS

645.60

000

N

*

*

33958

ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER

644.40

000

N

*

*

33959

ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS

820.80

000

N

*

*

33962

ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER

816.00

000

N

*

*

33963

ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS

1641.60

000

N

*

*

33964

ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER

1712.40

000

N

*

*

33965

ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS

645.60

000

N

*

*

33966

ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER

829.20

000

N

*

*

33967

INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ

907.20

000

N

2237.37

*

*

33968

REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ

117.60

000

N

*

*

33969

ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS

957.60

000

N

*

*

33970

INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN

1233.60

000

Y

*

*

33971

RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF

2461.20

090

N

*

*

33973

INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA

1803.60

000

Y

*

*

33974

RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA

3096.00

090

N

*

*

33975

INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE

4554.00

XXX

Y

*

*

33976

INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR

5552.40

XXX

Y

*

*

33977

REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE

3918.00

XXX

Y

*

*

33978

REMOVAL VENTR ASSIST DEVICE XTRCORP BIVENTR

4666.80

XXX

Y

*

*

33979

INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC

6800.40

XXX

Y

*

*

33980

RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC

6218.40

XXX

Y

*

*

33981

RPLCMT XTRCORP VAD 1/BIVENTR PUMP 1/EA PUMP

2918.40

XXX

Y

*

*

33982

PLCMT VAD PMP IMPLTBL ICORP 1 VENTR W/O BYPASS

6843.60

XXX

Y

*

*

33983

RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/BYPASS

8055.60

XXX

Y

*

*

33984

ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER

990.00

000

N

*

*

33985

ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS

1802.40

000

N

*

*

33986

ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER

1818.00

000

N

+

*

33987

ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS

728.40

ZZZ

N

*

*

33988

INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS

2703.60

000

N

*

*

33989

RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS

1693.20

000

N

*

*

33990

INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY

1488.00

XXX

Y

4915.73

*

*

33991

INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS

2182.80

XXX

Y

*

*

33992

REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION

696.00

XXX

Y

*

*

33993

REPOSITION VAD W/IMAGING DIFFERENT SESSION

610.80

XXX

Y

*

*

33999

UNLISTED CARDIAC SURGERY

BR

YYY

Y

880.41

*

*

34001

EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART

3344.40

090

Y

*

*

34051

EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY

3438.00

090

Y

*

*

J1

34101

EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART

2078.40

090

Y

8407.95

*

*

J1

34111

EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC

2086.80

090

Y

8407.95

*

*

34151

EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART

4848.00

090

Y

*

*

J1

34201

EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART

3573.60

090

Y

8407.95

*

*

J1

34203

EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC

3303.60

090

Y

8407.95

*

*

34401

THRMBC DIR/W/CATH VENA CAVA ILIAC VEIN ABDL INC

5088.00

090

Y

*

*

J1

34421

THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC

2560.80

090

Y

5022.59

*

*

34451

THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG

4930.80

090

Y

*

*

34471

THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC

3733.20

090

N

880.41

*

*

J1

34490

THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN

2227.20

090

N

5022.59

*

*

J1

34501

VALVULOPLASTY FEMORAL VEIN

3066.00

090

Y

8407.95

*

*

34502

RECONSTRUCTION VENA CAVA ANY METHOD

5361.60

090

Y

*

*

J1

34510

VENOUS VALVE TRANSPOSITION ANY VEIN DONOR

3534.00

090

Y

8407.95

*

*

J1

34520

CROSS-OVER VEIN GRAFT VENOUS SYSTEM

3396.00

090

Y

8407.95

*

*

J1

34530

SAPHENOPOPLITEAL VEIN ANASTOMOSIS

3116.40

090

Y

5022.59

*

*

34701

EVASC RPR DPLMNT AORTO-AORTIC NDGFT

4302.00

090

Y

*

*

34702

EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT

6424.80

090

Y

*

*

34703

EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT

4843.20

090

Y

*

*

34704

EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT

8071.20

090

Y

*

*

34705

EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT

5326.80

090

Y

*

*

34706

EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT

8025.60

090

Y

*

*

34707

EVASC RPR DPLMNT ILIO-ILIAC NDGFT

4012.80

090

Y

*

*

34708

EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT

6441.60

090

Y

+

*

34709

PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR

1125.60

ZZZ

Y

*

*

34710

DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL

2788.80

090

Y

+

*

34711

DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL

1039.20

ZZZ

Y

*

*

34712

TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I

2382.00

090

Y

+

*

34713

PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT

447.60

ZZZ

Y

+

*

34714

OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH

940.80

ZZZ

Y

+

*

34715

OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI

1054.80

ZZZ

Y

+

*

34716

OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ

1304.40

ZZZ

Y

+

*

34808

EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE

733.20

ZZZ

Y

+

*

34812

OPN FEM ART EXPOS DLVR EVASC PROSTH UNI

720.00

ZZZ

Y

+

*

34813

PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR

822.00

ZZZ

Y

+

*

34820

OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI

1210.80

ZZZ

Y

*

*

34830

OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH

6096.00

090

Y

*

*

34831

OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH

6718.80

090

Y

*

*

34832

OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH

6475.20

090

Y

+

*

34833

OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP

1406.40

ZZZ

Y

+

*

34834

OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI

450.00

ZZZ

Y

*

*

34839

PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT

BR

YYY

N

*

*

34841

ENDOVASC VISCER AORTA REPAIR FENEST 1 ENDOGRAFT

BR

YYY

Y

*

*

34842

ENDOVASC VISCER AORTA REPAIR FENEST 2 ENDOGRAFT

BR

YYY

Y

*

*

34843

ENDOVASC VISCER AORTA REPAIR FENEST 3 ENDOGRAFT

BR

YYY

Y

*

*

34844

ENDOVASC VISCER AORTA REPR FENEST 4+ ENDOGRAFT

BR

YYY

Y

*

*

34845

VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS

8288.40

YYY

Y

*

*

34846

VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS

9424.80

YYY

Y

*

*

34847

VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS

16011.60

YYY

Y

*

*

34848

VISCER AND INFRARENAL ABDOM AORTA 4+ PROSTHESIS

27577.20

YYY

Y

*

*

35001

DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY

3864.00

090

Y

*

*

35002

DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY

3907.20

090

Y

*

*

35005

DIR RPR ANEURYSM VERTEBRAL ARTERY

3441.60

090

Y

*

*

J1

35011

DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION

3486.00

090

Y

8407.95

*

*

35013

DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS

4362.00

090

Y

*

*

35021

DIR RPR ANEURYSM INNOMINATE/SUBCLAVIAN ARTERY

4369.20

090

Y

*

*

35022

DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN

4880.40

090

Y

*

*

J1

35045

DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY

3414.00

090

Y

8407.95

*

*

35081

DIR RPR ANEURYSM ABDOMINAL AORTA

6026.40

090

Y

*

*

35082

DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA

7604.40

090

Y

*

*

35091

DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS

6218.40

090

Y

*

*

35092

DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS

9064.80

090

Y

*

*

35102

DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS

6541.20

090

Y

*

*

35103

DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS

7798.80

090

Y

*

*

35111

DIR RPR ANEURYSM SPLENIC ARTERY

4573.20

090

Y

*

*

35112

DIR RPR RUPTD ANEURYSM SPLENIC ARTERY

5664.00

090

Y

*

*

35121

DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC

5796.00

090

Y

*

*

35122

DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN

6555.60

090

Y

*

*

35131

DIR RPR ANEURYSM & GRAFT ILIAC ARTERY

4826.40

090

Y

*

*

35132

DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY

5641.20

090

Y

*

*

35141

DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY

3836.40

090

Y

*

*

35142

DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART

4621.20

090

Y

*

*

35151

DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY

4305.60

090

Y

*

*

35152

DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY

4792.80

090

Y

*

*

35180

REPAIR CONGENITAL AV FISTULA HEAD & NECK

3052.80

090

Y

880.41

*

*

35182

RPR CONGENITAL AV FISTULA THORAX & ABDOMEN

6229.20

090

Y

*

*

J1

35184

RPR CONGENITAL AV FISTULA EXTREMITIES

3331.20

090

Y

5022.59

*

*

J1

35188

RPR/TRAUMATIC AV FISTULA HEAD & NECK

4449.60

090

Y

8407.95

*

*

35189

RPR/TRAUMATIC AV FISTULA THORAX & ABDOMEN

5186.40

090

Y

*

*

J1

35190

RPR/TRAUMATIC AV FISTULA EXTREMITIES

2643.60

090

Y

8407.95

*

*

J1

35201

REPAIR BLOOD VESSEL DIRECT NECK

3273.60

090

Y

8407.95

*

*

J1

35206

REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY

2720.40

090

Y

5022.59

*

*

J1

35207

REPAIR BLOOD VESSEL DIRECT HAND FINGER

2611.20

090

N

5022.59

*

*

35211

RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS

4804.80

090

Y

*

*

35216

RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS

7165.20

090

Y

*

*

35221

RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL

5097.60

090

Y

*

*

35226

RPR BLOOD VESSEL DIRECT LOWER EXTREMITY

2898.00

090

Y

822.66

*

*

J1

35231

REPAIR BLOOD VESSEL W/VEIN GRAFT NECK

4291.20

090

Y

5022.59

*

*

J1

35236

REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY

3482.40

090

Y

8407.95

*

*

35241

RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP

5002.80

090

Y

*

*

35246

RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP

5431.20

090

Y

*

*

35251

REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL

6048.00

090

Y

*

*

J1

35256

REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY

3562.80

090

Y

8407.95

*

*

J1

35261

REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK

3386.40

090

Y

5022.59

*

*

J1

35266

RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY

3016.80

090

Y

8407.95

*

*

35271

RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP

4802.40

090

Y

*

*

35276

RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP

5077.20

090

Y

*

*

35281

RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL

5619.60

090

Y

*

*

J1

35286

RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY

3237.60

090

Y

8407.95

*

*

35301

TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC

3934.80

090

Y

6767.28

*

*

35302

TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY

3900.00

090

Y

*

*

35303

TEAEC W/GRAFT POPLITEAL ARTERY

4314.00

090

Y

*

*

35304

TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY

4442.40

090

Y

*

*

35305

TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL

4273.20

090

Y

+

*

35306

TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART

1542.00

ZZZ

Y

*

*

35311

TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC

5410.80

090

Y

*

*

J1

35321

TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL

3103.20

090

Y

8407.95

*

*

35331

TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA

5082.00

090

Y

*

*

35341

TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL

4792.80

090

Y

*

*

35351

TEAEC W/WO PATCH GRAFT ILIAC

4450.80

090

Y

*

*

35355

TEAEC W/WO PATCH GRAFT ILIOFEMORAL

3585.60

090

Y

*

*

35361

TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC

5256.00

090

Y

*

*

35363

TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL

5619.60

090

Y

*

*

35371

TEAEC W/WO PATCH GRAFT COMMON FEMORAL

2844.00

090

Y

*

*

35372

TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL

3404.40

090

Y

+

*

35390

ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO

553.20

ZZZ

Y

+

*

35400

ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ

518.40

ZZZ

N

+

*

35500

HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

1114.80

ZZZ

Y

*

*

35501

BYPASS W/VEIN COMMON-IPSILATERAL CAROTID

5200.80

090

Y

*

*

35506

BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID

4396.80

090

Y

*

*

35508

BYPASS W/VEIN CAROTID-VERTEBRAL

4531.20

090

Y

*

*

35509

BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID

4876.80

090

Y

*

*

35510

BYPASS W/VEIN CAROTID-BRACHIAL

4239.60

090

Y

*

*

35511

BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN

3804.00

090

Y

*

*

35512

BYPASS W/VEIN SUBCLAVIAN-BRACHIAL

4178.40

090

Y

*

*

35515

BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL

4352.40

090

Y

*

*

35516

BYPASS W/VEIN SUBCLAVIAN-AXILLARY

4227.60

090

Y

*

*

35518

BYPASS W/VEIN AXILLARY-AXILLARY

3927.60

090

Y

*

*

35521

BYPASS W/VEIN AXILLARY-FEMORAL

4238.40

090

Y

*

*

35522

BYPASS W/VEIN AXILLARY-BRACHIAL

4196.40

090

Y

*

*

35523

BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL

4454.40

090

Y

*

*

35525

BYPASS W/VEIN BRACHIAL-BRACHIAL

3969.60

090

Y

*

*

35526

BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE

6060.00

090

Y

*

*

35531

BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC

6738.00

090

Y

*

*

35533

BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL

5200.80

090

Y

*

*

35535

BYPASS W/VEIN HEPATORENAL

6598.80

090

Y

*

*

35536

BYPASS W/VEIN SPLENORENAL

5859.60

090

Y

*

*

35537

BYPASS W/VEIN AORTOILIAC

7172.40

090

Y

*

*

35538

BYPASS W/VEIN AORTOBI-ILIAC

8046.00

090

Y

*

*

35539

BYPASS W/VEIN AORTOFEMORAL

7549.20

090

Y

*

*

35540

BYPASS W/VEIN AORTOBIFEMORAL

8481.60

090

N

*

*

35556

BYPASS W/VEIN FEMORAL-POPLITEAL

4862.40

090

Y

*

*

35558

BYPASS W/VEIN FEMORAL-FEMORAL

4275.60

090

Y

*

*

35560

BYPASS W/VEIN AORTORENAL

5828.40

090

Y

*

*

35563

BYPASS W/VEIN ILIOILIAC

4584.00

090

Y

*

*

35565

BYPASS W/VEIN ILIOFEMORAL

4573.20

090

Y

*

*

35566

BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL

5803.20

090

Y

*

*

35570

BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL

5247.60

090

Y

*

*

35571

BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL

4602.00

090

Y

+

*

35572

HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

1206.00

ZZZ

Y

*

*

35583

IN-SITU VEIN BYPASS FEMORAL-POPLITEAL

5020.80

090

Y

*

*

35585

IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART

5816.40

090

Y

*

*

35587

IN-SITU VEIN BYP POP-TIBL PRONEAL

4741.20

090

Y

+

*

35600

HARVEST UPPER EXTREMITY ARTERY 1 SEGMENT CABG

891.60

ZZZ

Y

*

*

35601

BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID

4857.60

090

Y

*

*

35606

BYP OTH/THN VEIN CAROTID-SUBCLAVIAN

4081.20

090

Y

*

*

35612

BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN

3594.00

090

Y

*

*

35616

BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY

3798.00

090

Y

*

*

35621

BYP OTH/THN VEIN AXILLARY-FEMORAL

3810.00

090

Y

*

*

35623

BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL

4539.60

090

Y

*

*

35626

BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE

5521.20

090

Y

*

*

35631

BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL

6446.40

090

Y

*

*

35632

BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC

6206.40

090

Y

*

*

35633

BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC

6937.20

090

Y

*

*

35634

BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL

6103.20

090

Y

*

*

35636

BYP OTH/THN VEIN SPLENORENAL

5526.00

090

Y

*

*

35637

BYP OTH/THN VEIN AORTOILIAC

5731.20

090

Y

*

*

35638

BYP OTH/THN VEIN AORTOBI-ILIAC

6110.40

090

Y

*

*

35642

BYP OTH/THN VEIN CAROTID-VERTEBRAL

3415.20

090

Y

*

*

35645

BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL

3277.20

090

Y

*

*

35646

BYP OTH/THN VEIN AORTOBIFEMORAL

5968.80

090

Y

*

*

35647

BYP OTH/THN VEIN AORTOFEMORAL

5403.60

090

Y

*

*

35650

BYP OTH/THN VEIN AXILLARY-AXILLARY

3765.60

090

Y

*

*

35654

BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL

4760.40

090

Y

*

*

35656

BYP OTH/THN VEIN FEMORAL-POPLITEAL

3760.80

090

Y

*

*

35661

BYP OTH/THN VEIN FEMORAL-FEMORAL

3771.60

090

Y

*

*

35663

BYP OTH/THN VEIN ILIOILIAC

4207.20

090

Y

*

*

35665

BYP OTH/THN VEIN ILIOFEMORAL

4080.00

090

Y

*

*

35666

BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL

4396.80

090

Y

*

*

35671

BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART

3874.80

090

Y

+

*

35681

BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN

280.80

ZZZ

Y

+

*

35682

BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS

1226.40

ZZZ

N

+

*

35683

BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION

1419.60

ZZZ

N

+

*

35685

PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT

691.20

ZZZ

Y

+

*

35686

CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO

556.80

ZZZ

Y

*

*

35691

TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART

3272.40

090

Y

*

*

35693

TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART

2832.00

090

Y

*

*

35694

TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART

3412.80

090

Y

*

*

35695

TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART

3514.80

090

Y

+

*

35697

RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART

516.00

ZZZ

Y

+

*

35700

ROPRTJ > 1 MO AFTER ORIGINAL OPRATION

530.40

ZZZ

Y

*

*

35701

EXPL N/FLWD SURG RPR W/WO LYSIS CAROTID ARTERY

1968.00

090

Y

*

*

35721

EXPL N/FLWD SURG RPR W/WO LYSIS FEMORAL ARTERY

1582.80

090

Y

*

*

35741

EXPL N/FLWD SURG RPR W/WO LYSIS POPLITEAL ARTERY

1800.00

090

Y

*

*

J1

35761

EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY

1365.60

090

Y

5022.59

*

*

35800

EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK

2500.80

090

Y

6048.77

*

*

35820

EXPL PO HEMRRG THROMBOSIS/INFCTJ CH

6998.40

090

Y

*

*

35840

EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD

4156.80

090

Y

3962.26

*

*

J1

35860

EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR

2910.00

090

Y

5022.59

*

*

35870

RPR GRF-ENTERIC FSTL

4294.80

090

Y

*

*

J1

35875

THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL

2070.00

090

N

8407.95

*

*

J1

35876

THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF

3290.40

090

Y

8407.95

*

*

J1

35879

REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP

3219.60

090

Y

8407.95

*

*

J1

35881

REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS

3537.60

090

Y

8407.95

*

*

J1

35883

REVISION FEMORAL ANAST OPEN NONAUTOG GRAFT

4177.20

090

Y

8407.95

*

*

J1

35884

REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT

4288.80

090

Y

8407.95

*

*

35901

EXCISION INFECTED NECK GRAFT

1626.00

090

Y

*

*

J1

35903

EXCISION INFECTED GRAFT EXTREMITY

1959.60

090

Y

5022.59

*

*

35905

EXCISION INFECTED GRAFT THORAX

5794.80

090

Y

*

*

35907

EXCISION INFECTED GRAFT ABDOMEN

6630.00

090

Y

*

*

36000

INTRODUCTION NEEDLE/INTRACATHETER VEIN

92.40

XXX

N

*

*

36002

INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM

538.80

000

N

880.41

*

*

36005

NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH

1051.20

000

N

*

*

36010

INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA

1713.60

XXX

N

*

*

36011

SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH

2882.40

XXX

N

*

*

36012

SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC

2940.00

XXX

N

*

*

36013

INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY

2620.80

XXX

N

*

*

36014

SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY

2767.20

XXX

N

*

*

36015

SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART

2997.60

XXX

N

*

*

36100

INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY

1777.20

XXX

N

*

*

36140

INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY

1527.60

XXX

N

*

*

36160

INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR

1753.20

XXX

N

*

*

36200

INTRODUCTION CATHETER AORTA

1947.60

000

N

*

*

36215

SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH

3528.00

000

N

*

*

36216

SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH

3801.60

000

N

*

*

36217

SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH

6374.40

000

N

+

*

36218

SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH

826.80

ZZZ

N

*

*

36221

NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART

3517.20

000

N

3750.96

*

*

36222

SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART

4167.60

000

N

3750.96

*

*

36223

SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART

5274.00

000

N

6214.66

*

*

36224

SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART

6824.40

000

N

6214.66

*

*

36225

SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY

5080.80

000

N

3750.96

*

*

36226

SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY

6453.60

000

N

6214.66

+

*

36227

SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC

867.60

ZZZ

N

+

*

36228

SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT

4516.80

ZZZ

N

*

*

36245

SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH

4491.60

XXX

N

*

*

36246

SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH

2856.00

000

N

*

*

36247

SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH

5112.00

000

N

+

*

36248

SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH

493.20

ZZZ

N

*

*

36251

SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN

4706.40

000

N

3750.96

*

*

36252

SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL

5091.60

000

N

3750.96

*

*

36253

SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I

7512.00

000

N

6214.66

*

*

36254

SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I

7298.40

000

N

3750.96

*

*

J1

36260

INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM

2256.00

090

N

8407.95

*

*

36261

REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP

1396.80

090

Y

4445.35

*

*

36262

REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP

1068.00

090

N

4445.35

*

*

36299

UNLISTED PROCEDURE VASCULAR INJECTION

BR

YYY

N

*

*

36400

VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN

90.00

XXX

N

*

*

36405

VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN

79.20

XXX

N

*

*

36406

VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN

56.40

XXX

N

*

*

36410

VNPNXR 3 YEARS/> PHYS/QHP SKILL

58.80

XXX

N

*

*

36415

COLLECTION VENOUS BLOOD VENIPUNCTURE

9.99

XXX

N

*

*

36416

COLLECTION CAPILLARY BLOOD SPECIMEN

22.80

XXX

N

*

*

36420

VENIPUNCTURE CUTDOWN UNDER AGE 1 YR

162.00

XXX

N

79.38

*

*

36425

VENIPUNCTURE CUTDOWN AGE 1 YR/>

139.20

XXX

N

494.39

*

*

36430

TRANSFUSION BLOOD/BLOOD COMPONENTS

118.80

XXX

N

543.72

*

*

36440

PUSH TRANSFUSION BLOOD 2 YR/UNDER

175.20

XXX

N

543.72

*

*

36450

EXCHNG TRANSFUSION BLOOD NEWBORN

592.80

XXX

N

543.72

*

*

36455

EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN

441.60

XXX

N

543.72

*

*

36456

PRTL EXCHANGE TRANSFUSE BLOOD/PLSM/CRYST NEWBORN

363.60

XXX

N

543.72

*

*

36460

TRANSFUSION INTRAUTERINE FETAL

1180.80

XXX

Y

543.72

*

*

36465

NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN

5236.80

000

N

2199.52

*

*

36466

NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS

5504.40

000

N

2199.52

*

*

36468

INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK

460.80

000

N

250.56

*

*

36470

INJECTION SCLEROSANT SINGLE INCMPTNT VEIN

362.40

000

N

445.99

*

*

36471

INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

656.40

000

N

445.99

*

*

J1

36473

ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN

4968.00

000

N

5022.59

+

*

36474

ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS

944.40

ZZZ

N

*

*

J1

36475

ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN

4872.00

000

N

5022.59

+

*

36476

ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS

1026.00

ZZZ

N

*

*

J1

36478

ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN

3852.00

000

N

5022.59

+

*

36479

ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS

1083.60

ZZZ

N

*

*

36481

PRQ PORTAL VEIN CATHETERIZATION ANY METHOD

6652.80

000

N

*

*

J1

36482

ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN

6958.80

000

N

8407.95

+

*

36483

ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN

511.20

ZZZ

N

*

*

36500

VEN CATHJ SLCTV ORGAN BLD SAMPLING

636.00

000

N

*

*

36510

CATHJ UMBILICAL VEIN DX/THER NB

280.80

000

N

*

*

36511

THERAPEUTIC APHERESIS WHITE BLOOD CELLS

372.00

000

N

1770.74

*

*

36512

THERAPEUTIC APHERESIS RED BLOOD CELLS

373.20

000

N

1770.74

*

*

36513

THERAPEUTIC APHERESIS PLATELETS

379.20

000

N

543.72

*

*

36514

THERAPEUTIC APHERESIS PLASMA PHERESIS

2460.00

000

N

1770.74

*

*

36516

THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION

6752.40

000

N

5569.95

*

*

36522

PHOTOPHERESIS EXTRACORPOREAL

7346.40

000

N

5569.95

*

*

36555

INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y

639.60

000

N

1552.95

*

*

36556

INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>

718.80

000

N

1552.95

*

*

J1

36557

INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE GREATER THAN 5 YR

3487.20

010

N

8407.95

*

*

J1

36558

INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>

2604.00

010

N

5022.59

*

*

J1

36560

INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR

4458.00

010

N

5022.59

*

*

J1

36561

INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>

3673.20

010

N

5022.59

*

*

J1

36563

INSJ TUNNELED CTR VAD W/SUBQ PUMP

4136.40

010

N

8407.95

*

*

J1

36565

INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP

2982.00

010

N

5022.59

*

*

J1

36566

INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT

16292.40

010

N

8407.95

*

*

36568

INSERTION PICC W/O IMG GDN < 5 YR

318.00

000

N

880.41

*

*

36569

INSERTION PICC W/O IMG GDN 5 YR/>

326.40

000

N

1552.95

*

*

J1

36570

INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR

4905.60

010

N

5022.59

*

*

J1

36571

INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>

4305.60

010

N

5022.59

*

*

36572

INSERTION PICC W/RS&I < 5 YR

1428.00

000

N

880.41

*

*

36573

INSERTION PICC W/RS&I 5 YR/>

1344.00

000

N

1552.95

*

*

36575

RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP

550.80

000

N

880.41

*

*

36576

RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT

1117.20

010

N

1552.95

*

*

J1

36578

RPLCMT CATH CTR VAD SUBQ PORT/PMP

1567.20

010

N

5022.59

*

*

36580

RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP

735.60

000

N

1552.95

*

*

J1

36581

RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP

2577.60

010

N

5022.59

*

*

J1

36582

RPLCMT COMPL TUN CTR VAD W/SUBQ PORT

3402.00

010

N

5022.59

*

*

J1

36583

RPLCMT COMPL TUN CTR VAD W/SUBQ PMP

4308.00

010

N

8407.95

*

*

36584

COMPLETE REPLACEMENT PICC RS&I

1173.60

000

N

1552.95

*

*

J1

36585

RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT

3661.20

010

N

5022.59

*

*

36589

RMVL TUN CVC W/O SUBQ PORT/PMP

565.20

010

N

880.41

*

*

36590

RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ

760.80

010

N

880.41

*

*

36591

COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE

82.80

BR

82.80

XXX

N

*

*

36592

COLLECT BLOOD FROM CATHETER VENOUS NOS

92.40

BR

92.40

XXX

N

*

*

36593

DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH

106.80

BR

106.80

XXX

N

*

*

J1

36595

MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS

2076.00

000

N

5022.59

*

*

36596

MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN

428.40

000

N

1552.95

*

*

36597

RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE

442.80

000

N

1552.95

*

*

36598

CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT

396.00

000

N

265.80

*

*

36600

ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX

104.40

XXX

N

151.20

*

Ø

36620

ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ

153.60

000

N

*

*

36625

ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN

366.00

000

N

*

*

J1

36640

ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN

396.00

000

N

5022.59

*

*

36660

CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY

237.60

000

N

*

*

36680

PLACEMENT NEEDLE INTRAOSSEOUS INFUSION

202.80

000

N

494.39

*

*

J1

36800

INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN

423.60

000

N

8407.95

*

*

J1

36810

INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL

726.00

000

N

5022.59

*

*

J1

36815

INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR

469.20

000

N

8407.95

*

*

J1

36818

ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS

2413.20

090

Y

8407.95

*

*

J1

36819

ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS

2542.80

090

Y

8407.95

*

*

J1

36820

ARVEN ANAST OPN F/ARM VEIN TRPOS

2550.00

090

Y

8407.95

*

*

J1

36821

ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT

2310.00

090

Y

5022.59

*

*

36823

INSJ CNULA ISLTD XC-CIRCJ REG CHEMOTX XTR RMVL

4848.00

090

N

*

*

J1

36825

CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF

2766.00

090

Y

8407.95

*

*

J1

36830

CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF

2320.80

090

Y

8407.95

*

*

J1

36831

THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF

2142.00

090

Y

8407.95

*

*

J1

36832

REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF

2628.00

090

Y

8407.95

*

*

J1

36833

REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF

2824.80

090

Y

8407.95

*

*

J1

36835

INSERTION THOMAS SHUNT SEPARATE PROCEDURE

1662.00

090

N

5022.59

*

*

J1

36838

DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS

3978.00

090

Y

8407.95

*

*

36860

XTRNL CANNULA DECLTNG SPX W/O BALO CATH

860.40

000

N

880.41

*

*

J1

36861

XTRNL CANNULA DECLTNG SPX W/BALO CATH

482.40

000

N

8407.95

*

*

36901

INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I

2199.60

000

N

1552.95

*

*

J1

36902

INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP

4330.80

000

N

8736.46

*

*

J1

36903

INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT

18265.20

000

N

17440.05

*

*

J1

36904

PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH

6373.20

000

N

8736.46

*

*

J1

36905

PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP

8016.00

000

N

17440.05

*

*

J1

36906

PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT

22387.20

000

N

26888.04

+

*

36907

TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I

2451.60

ZZZ

N

+

*

36908

STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR

8162.40

ZZZ

N

+

*

36909

DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

6597.60

ZZZ

N

*

*

37140

VENOUS ANASTOMOSIS OPEN PORTOCAVAL

8088.00

090

N

*

*

37145

VENOUS ANASTOMOSIS OPEN RENOPORTAL

7500.00

090

Y

*

*

37160

VENOUS ANASTOMOSIS OPEN CAVAL-MESENTERIC

7706.40

090

Y

*

*

37180

VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL

7407.60

090

Y

*

*

37181

VENOUS ANASTOMOSIS OPEN SPLENORENAL DISTAL

8088.00

090

Y

*

*

37182

INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT

2854.80

000

N

4435.97

*

*

J1

37183

REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT

20443.20

000

N

8736.46

*

*

J1

37184

PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST

7228.80

000

N

8736.46

+

*

37185

PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ

2227.20

ZZZ

N

+

*

37186

SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL

4495.20

ZZZ

N

*

*

J1

37187

PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN

6667.20

000

N

8736.46

*

*

J1

37188

PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX

5607.60

000

N

5022.59

*

*

J1

37191

INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I

8394.00

000

N

8407.95

*

*

J1

37192

REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I

4498.80

000

N

5022.59

*

*

J1

37193

RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I

5287.20

000

N

5022.59

*

*

37195

THROMBOLYSIS CEREBRAL IV INFUSION

2464.80

XXX

N

409.50

*

*

J1

37197

PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING

5208.00

000

N

5022.59

*

*

J1

37200

TRANSCATHETER BIOPSY

756.00

000

N

8407.95

*

*

J1

37211

THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX

1345.20

000

N

8407.95

*

*

J1

37212

THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX

1177.20

000

N

5022.59

*

*

37213

THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX

811.20

000

N

1552.95

*

*

37214

CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL

428.40

000

N

1552.95

*

*

37215

TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ

3505.20

090

N

5148.62

*

*

37216

TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ

3514.80

090

N

*

*

37217

TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE

3766.80

090

N

*

*

37218

TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE

2848.80

090

N

*

*

J1

37220

REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL

10051.20

000

N

8736.46

*

*

J1

37221

REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY

14264.40

000

N

17440.05

+

*

37222

REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL

2716.80

ZZZ

N

+

*

37223

REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL

7513.20

ZZZ

N

*

*

J1

37224

REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI

12081.60

000

N

8736.46

*

*

J1

37225

REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL

41434.80

000

N

17440.05

*

*

J1

37226

REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL

35938.80

000

N

17440.05

*

*

J1

37227

REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL

53388.00

000

N

26888.04

*

*

J1

37228

REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI

17512.80

000

N

17440.05

*

*

J1

37229

REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL

41457.60

000

N

26888.04

*

*

J1

37230

REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL

35295.60

000

N

26888.04

*

*

J1

37231

REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL

50712.00

000

N

26888.04

+

*

37232

REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL

3735.60

ZZZ

N

+

*

37233

REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL

4551.60

ZZZ

N

+

*

37234

REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL

13170.00

ZZZ

N

+

*

37235

REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL

14288.40

ZZZ

N

*

*

J1

37236

OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL

12194.40

000

N

17440.05

+

*

37237

OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL

7240.80

ZZZ

N

*

*

J1

37238

OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST

12316.80

000

N

17440.05

+

*

37239

OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL

5876.40

ZZZ

N

*

*

J1

37241

VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I

16480.80

000

N

17440.05

*

*

J1

37242

VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I

25380.00

000

N

17440.05

*

*

J1

37243

VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT

32834.40

000

N

17440.05

*

*

J1

37244

VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE

23480.40

000

N

17440.05

*

*

J1

37246

TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART

7113.60

000

N

8736.46

+

*

37247

TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART

2710.80

ZZZ

N

*

*

J1

37248

TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN

5085.60

000

N

8736.46

+

*

37249

TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN

2012.40

ZZZ

N

+

*

37252

INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL

4293.60

ZZZ

N

+

*

37253

INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL

672.00

ZZZ

N

*

*

J1

37500

VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX

2196.00

090

N

8407.95

*

*

37501

UNLISTED VASCULAR ENDOSCOPY PROCEDURE

BR

YYY

N

880.41

*

*

37565

LIGATION INTERNAL JUGULAR VEIN

2493.60

090

N

1552.95

*

*

J1

37600

LIGATION EXTERNAL CAROTID ARTERY

2528.40

090

Y

5022.59

*

*

J1

37605

LIGATION INTERNAL/COMMON CAROTID ARTERY

2546.40

090

Y

5022.59

*

*

J1

37606

LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION

2452.80

090

Y

5022.59

*

*

J1

37607

LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA

1299.60

090

N

5022.59

*

*

J1

37609

LIGATION/BIOPSY TEMPORAL ARTERY

1064.40

010

N

2734.29

*

*

37615

LIGATION MAJOR ARTERY NECK

1819.20

090

Y

1552.95

*

*

37616

LIGATION MAJOR ARTERY CHEST

3846.00

090

Y

*

*

37617

LIGATION MAJOR ARTERY ABDOMEN

4660.80

090

Y

3642.72

*

*

37618

LIGATION MAJOR ARTERY EXTREMITY

1333.20

090

Y

2650.75

*

*

J1

37619

INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I

6006.00

090

Y

8407.95

*

*

J1

37650

LIGATION OF FEMORAL VEIN

1586.40

090

N

5022.59

*

*

37660

LIGATION OF COMMON ILIAC VEIN

4568.40

090

Y

*

*

J1

37700

LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ

848.40

090

N

5022.59

*

*

J1

37718

LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN

1494.00

090

N

5022.59

*

*

J1

37722

LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW

1646.40

090

N

5022.59

*

*

J1

37735

LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS

2010.00

090

N

5022.59

*

*

J1

37760

LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG

2169.60

090

N

5022.59

*

*

37761

LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG

1878.00

090

Y

1552.95

*

*

J1

37765

STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS

2222.40

090

N

5022.59

*

*

J1

37766

STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS

2641.20

090

N

5022.59

*

*

37780

LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX

810.00

090

N

1552.95

*

*

J1

37785

LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG

1208.40

090

N

5022.59

*

*

37788

PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT

4389.60

090

Y

*

*

J1

37790

PENILE VENOUS OCCLUSIVE PROCEDURE

1690.80

090

N

5757.14

*

*

37799

UNLISTED PROCEDURE VASCULAR SURGERY

BR

YYY

N

880.41

*

*

38100

SPLENECTOMY TOTAL SEPARATE PROCEDURE

4014.00

090

Y

*

*

38101

SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE

4024.80

090

Y

+

*

38102

SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX

918.00

ZZZ

Y

*

*

38115

RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT

4444.80

090

Y

*

*

J1

38120

LAPAROSCOPIC SURGICAL SPLENECTOMY

3662.40

090

Y

15106.63

*

*

J1

38129

UNLISTED LAPAROSCOPY PROCEDURE SPLEEN

BR

YYY

Y

9076.35

*

*

38200

INJECTION PROCEDURE SPLENOPORTOGRAPY

460.80

000

N

*

*

38204

MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ

363.60

XXX

N

*

*

38205

BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC

285.60

000

N

*

*

38206

BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL

286.80

000

N

1770.74

*

*

38207

TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR

162.00

XXX

N

543.72

*

*

38208

TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR

103.20

XXX

N

543.72

*

*

38209

TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR

43.20

XXX

N

543.72

*

*

38210

TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL

288.00

XXX

N

543.72

*

*

38211

TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ

259.20

XXX

N

543.72

*

*

38212

TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL

171.60

XXX

N

543.72

*

*

38213

TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ

43.20

XXX

N

543.72

*

*

38214

TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ

147.60

XXX

N

543.72

*

*

38215

TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM

171.60

XXX

N

543.72

*

*

J1

38220

DIAGNOSTIC BONE MARROW ASPIRATIONS

565.20

XXX

N

2734.29

*

*

J1

38221

DIAGNOSTIC BONE MARROW BIOPSIES

526.80

XXX

N

2734.29

*

*

J1

38222

DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

584.40

XXX

N

2734.29

*

*

38230

BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC

716.40

000

N

1770.74

*

*

38232

BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS

690.00

000

N

5569.95

*

*

J1

38240

TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR

783.60

XXX

N

75776.05

*

*

38241

TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR

585.60

XXX

N

1770.74

*

*

38242

ALLOGENEIC LYMPHOCYTE INFUSIONS

414.00

000

N

1770.74

*

*

38243

TRNSPLJ HEMATOPOIETIC CELL BOOST

416.40

000

N

1770.74

*

*

J1

38300

DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL

1102.80

010

N

2734.29

*

*

J1

38305

DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV

1680.00

090

N

2734.29

*

*

J1

38308

LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS

1560.00

090

Y

5620.48

*

*

38380

SUTR&/LIG THORACIC DUCT CERVICAL APPROACH

1956.00

090

Y

*

*

38381

SUTR&/LIG THORACIC DUCT THORACIC APPROACH

2785.20

090

Y

*

*

38382

SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH

2330.40

090

Y

*

*

J1

38500

BX/EXC LYMPH NODE OPEN SUPERFICIAL

1149.60

010

N

5620.48

*

*

J1

38505

BX/EXC LYMPH NODE NEEDLE SUPERFICIAL

427.20

000

N

2734.29

*

*

J1

38510

BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE

1794.00

010

N

5620.48

*

*

J1

38520

BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD

1608.00

090

N

5620.48

*

*

J1

38525

BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE

1516.80

090

N

5620.48

*

*

J1

38530

BX/EXC LYMPH NODE OPEN INT MAMMARY NODE

1935.60

090

Y

5620.48

*

*

J1

38531

OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

1512.00

090

N

5620.48

*

*

J1

38542

DISSECTION DEEP JUGULAR NODE

1786.80

090

Y

9076.35

*

*

J1

38550

EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ

1773.60

090

N

5620.48

*

*

J1

38555

EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ

3502.80

090

Y

9771.93

*

*

38562

LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC

2458.80

090

Y

5288.53

*

*

38564

LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC

2451.60

090

Y

*

*

J1

38570

LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT

1767.60

010

Y

9076.35

*

*

J1

38571

LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY

2299.20

010

Y

15106.63

*

*

J1

38572

LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1

3204.00

010

Y

15106.63

*

*

J1

38573

LAPS W/BI TOT PEL LMPHADEC & OMNTC LYMPH BX

4052.40

010

Y

15106.63

*

*

J1

38589

UNLISTED LAPAROSCOPY PX LYMPHATIC SYSTEM

BR

YYY

Y

9076.35

*

*

J1

38700

SUPRAHYOID LYMPHADENECTOMY

2773.20

090

Y

9771.93

*

*

J1

38720

CERVICAL LYMPHADENECTOMY

4632.00

090

Y

13715.53

*

*

38724

CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ

5000.40

090

Y

5449.71

*

*

J1

38740

AXILLARY LYMPHADENECTOMY SUPERFICIAL

2419.20

090

Y

9076.35

*

*

J1

38745

AXILLARY LYMPHADENECTOMY COMPLETE

3052.80

090

Y

9076.35

+

*

38746

THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC

747.60

ZZZ

Y

+

*

38747

ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC

932.40

ZZZ

Y

*

*

J1

38760

INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX

2924.40

090

Y

9771.93

*

*

38765

INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC

4515.60

090

Y

*

*

38770

PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR

2809.20

090

Y

*

*

38780

RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL

3573.60

090

Y

*

*

38790

INJECTION PROCEDURE LYMPHANGIOGRAPHY

286.80

000

N

*

*

38792

INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE

280.80

000

N

501.96

*

*

38794

CANNULATION THORACIC DUCT

1028.40

090

N

+

*

38900

INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION

480.00

ZZZ

Y

*

*

38999

UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM

BR

YYY

N

543.72

*

*

39000

MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR

1723.20

090

Y

3481.53

*

*

39010

MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR

2727.60

090

Y

3017.81

*

*

39200

RESECTION OF MEDIASTINAL CYST

3009.60

090

Y

*

*

39220

RESECTION MEDIASTINAL TUMOR

3933.60

090

Y

*

*

J1

39401

MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY

1075.20

000

N

9076.35

*

*

J1

39402

MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES

1407.60

000

N

9076.35

*

*

39499

UNLISTED PROCEDURE MEDIASTINUM

BR

YYY

Y

*

*

39501

REPAIR LACERATION DIAPHRAGM ANY APPROACH

2958.00

090

Y

*

*

39503

RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ

20854.80

090

Y

*

*

39540

RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT

3024.00

090

Y

*

*

39541

RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC

3270.00

090

Y

*

*

39545

IMBRICATION DIAPHRAGM EVENTRATION

3085.20

090

Y

*

*

39560

RESCJ DIAPHRAGM W/SIMPLE REPAIR

2781.60

090

Y

*

*

39561

RESCJ DIAPHRAGM W/COMPLEX REPAIR

4311.60

090

Y

*

*

39599

UNLISTED PROCEDURE DIAPHRAGM

BR

YYY

Y

5571.53

*

*

40490

BIOPSY OF LIP

430.80

000

N

292.72

*

*

J1

40500

VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT

1758.00

090

N

4449.71

*

*

J1

40510

EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR

1675.20

090

N

4449.71

*

*

J1

40520

EXC LIP V-EXC W/PRIM DIR LINR CLSR

1699.20

090

N

4449.71

*

*

J1

40525

EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP

1904.40

090

N

4449.71

*

*

J1

40527

EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP

2125.20

090

N

8765.29

*

*

J1

40530

RESCJ LIP > ONE-FOURTH W/O RCNSTJ

1866.00

090

N

4449.71

*

*

40650

RPR LIP FULL THICKNESS VERMILION ONLY

1562.40

090

N

691.72

*

*

40652

RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT

1712.40

090

N

691.72

*

*

J1

40654

RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE

1978.80

090

N

2543.11

*

*

J1

40700

PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI

3489.60

090

N

8765.29

*

*

J1

40701

PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX

4135.20

090

Y

8765.29

*

*

J1

40702

PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS

3469.20

090

Y

8765.29

*

*

J1

40720

PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL

3565.20

090

N

4449.71

*

*

J1

40761

PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP

3759.60

090

N

8765.29

*

*

40799

UNLISTED PROCEDURE LIPS

BR

YYY

Y

292.72

*

*

40800

DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL

729.60

010

N

822.66

*

*

40801

DRG ABSC CST HMTMA VESTIBULE MOUTH COMP

1063.20

010

N

691.72

*

*

40804

RMVL EMBEDDED FB VESTIBULE MOUTH SMPL

656.40

010

N

1081.40

*

*

40805

RMVL EMBEDDED FB VESTIBULE MOUTH COMP

1069.20

010

N

691.72

*

*

40806

INCISION LABIAL FRENUM FRENOTOMY

349.20

000

N

691.72

*

*

40808

BIOPSY VESTIBULE MOUTH

644.40

010

N

691.72

*

*

J1

40810

EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR

718.80

010

N

4449.71

*

*

J1

40812

EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR

996.00

010

N

4449.71

*

*

J1

40814

EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR

1330.80

090

N

4449.71

*

*

J1

40816

EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC

1384.80

090

N

4449.71

*

*

40818

EXC MUCOSA VESTIBULE MOUTH AS DON GRF

1260.00

090

N

691.72

*

*

J1

40819

EXC FRENUM LABIAL/BUCCAL

1086.00

090

N

2543.11

*

*

J1

40820

DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS

904.80

010

N

4449.71

*

*

40830

CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<

933.60

010

N

292.72

*

*

40831

CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL

1194.00

010

N

691.72

*

*

J1

40840

VESTIBULOPLASTY ANTERIOR

2827.20

090

Y

8765.29

*

*

J1

40842

VESTIBULOPLASTY POSTERIOR UNILATERAL

2736.00

090

N

8765.29

*

*

J1

40843

VESTIBULOPLASTY POSTERIOR BILATERAL

3614.40

090

Y

8765.29

*

*

J1

40844

VESTIBULOPLASTY ENTIRE ARCH

4710.00

090

Y

8765.29

*

*

J1

40845

VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG

5065.20

090

N

8765.29

*

*

40899

UNLISTED PROCEDURE VESTIBULE MOUTH

BR

YYY

N

292.72

*

*

41000

INTRAORAL I&D TONGUE/FLOOR LINGUAL

558.00

010

N

691.72

*

*

41005

INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC

760.80

010

N

292.72

*

*

J1

41006

INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD

1224.00

090

N

2543.11

*

*

J1

41007

INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE

1201.20

090

N

2543.11

*

*

J1

41008

INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE

1329.60

090

N

4449.71

*

*

41009

INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE

1423.20

090

N

691.72

*

*

J1

41010

INCISION LINGUAL FRENUM FRENOTOMY

708.00

010

N

2543.11

*

*

41015

XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL

1447.20

090

N

691.72

*

*

J1

41016

XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT

1537.20

090

N

8765.29

*

*

J1

41017

XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB

1561.20

090

N

4449.71

*

*

J1

41018

XTRORAL I&D FLOOR MASTICATOR SPACE

1767.60

090

N

2543.11

*

*

J1

41019

PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT

1652.40

000

N

8765.29

*

*

41100

BIOPSY TONGUE ANTERIOR TWO-THIRDS

592.80

010

N

691.72

*

*

J1

41105

BIOPSY TONGUE POSTERIOR ONE-THIRD

602.40

010

N

4449.71

*

*

J1

41108

BIOPSY FLOOR MOUTH

524.40

010

N

2734.29

*

*

J1

41110

EXCISION LESION TONGUE W/O CLOSURE

745.20

010

N

4449.71

*

*

J1

41112

EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS

1158.00

090

N

4449.71

*

*

J1

41113

EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD

1261.20

090

N

4449.71

*

*

J1

41114

EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP

2172.00

090

N

4449.71

*

*

J1

41115

EXCISION LINGUAL FRENUM FRENECTOMY

860.40

010

N

2543.11

*

*

J1

41116

EXCISION LESION FLOOR MOUTH

1146.00

090

N

4449.71

*

*

J1

41120

GLOSSECTOMY

3703.20

090

Y

8765.29

*

*

41130

GLOSSECTOMY HEMIGLOSSECTOMY

4570.80

090

Y

4813.80

*

*

41135

GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ

7550.40

090

Y

*

*

41140

GLSSC COMPL/TOT W/WOTRACHS W/O RAD NECK DSJ

7561.20

090

Y

*

*

41145

GLSSC COMPL/TOT W/WO TRACHS W/UNI RAD NECK DSJ

9578.40

090

Y

*

*

41150

GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ

7622.40

090

Y

*

*

41153

GLSSC COMPOSIT RESCJ FLOOR SUPRAHYOID NCK DSJ

8262.00

090

Y

*

*

41155

GLSSC COMPOSIT RESCJ FLR MNDBLR RESCJ & RAD NECK

10467.60

090

Y

*

*

41250

RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG

940.80

010

N

151.20

*

*

41251

RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE

1051.20

010

N

292.72

*

*

41252

RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX

1095.60

010

N

292.72

*

*

J1

41510

SUTURE TONGUE LIP MICROGNATHIA

1561.20

090

N

4449.71

*

*

J1

41512

TONGUE BASE SUSPENSION PERMANENT SUTURE TQ

2274.00

090

N

8765.29

*

*

J1

41520

FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY

1213.20

090

N

4449.71

*

*

J1

41530

SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION

3292.80

000

N

4449.71

*

*

41599

UNLISTED PROCEDURE TONGUE FLOOR MOUTH

BR

YYY

N

292.72

*

*

41800

DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS

994.80

010

N

151.20

*

*

J1

41805

RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS

992.40

010

N

2543.11

*

*

J1

41806

RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE

1357.20

010

N

2543.11

*

*

J1

41820

GINGIVECTOMY EXC GINGIVA EACH QUADRANT

2724.00

000

N

4449.71

*

*

J1

41821

OPRCULECTOMY EXC PRICORONAL TISSUE

422.40

000

N

2543.11

*

*

J1

41822

EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS

980.40

010

N

2543.11

*

*

J1

41823

EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS

1513.20

090

N

8765.29

*

*

J1

41825

EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR

742.80

010

N

4449.71

*

*

J1

41826

EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR

1090.80

010

N

4449.71

*

*

J1

41827

EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR

1539.60

090

N

8765.29

*

*

J1

41828

EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC

1082.40

010

N

4449.71

*

*

J1

41830

ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY

1370.40

010

N

4449.71

*

*

J1

41850

DESTRUCTION LESION DENTOALVEOLAR STRUCTURES

651.60

000

N

2543.11

*

*

J1

41870

PERIODONTAL MUCOSAL GRAFTING

1342.80

000

N

4449.71

*

*

J1

41872

GINGIVOPLASTY EACH QUADRANT SPECIFY

1345.20

090

N

4449.71

*

*

J1

41874

ALVEOLOPLASTY EACH QUADRANT SPECIFY

1341.60

090

N

4449.71

*

*

41899

UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES

BR

YYY

N

292.72

*

*

42000

DRAINAGE ABSCESS PALATE UVULA

532.80

010

N

292.72

*

*

J1

42100

BIOPSY PALATE UVULA

513.60

010

N

2543.11

*

*

J1

42104

EXC LESION PALATE UVULA W/O CLOSURE

744.00

010

N

4449.71

*

*

J1

42106

EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE

934.80

010

N

4449.71

*

*

J1

42107

EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE

1603.20

090

N

8765.29

*

*

J1

42120

RESCJ PALATE/EXTENSIVE RESCJ LESION

3496.80

090

Y

8765.29

*

*

J1

42140

UVULECTOMY EXCISION UVULA

920.40

090

N

4449.71

*

*

J1

42145

PALATOPHARYNGOPLASTY

2398.80

090

N

8765.29

*

*

J1

42160

DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM

802.80

010

N

4449.71

*

*

42180

REPAIR LACERATION PALATE </2 CM

848.40

010

N

691.72

*

*

J1

42182

REPAIR LACERATION PALATE >2 CM/COMPLEX

1108.80

010

N

8765.29

*

*

J1

42200

PALATOP CL PALATE SOFT&/HARD PALATE ONLY

3271.20

090

Y

8765.29

*

*

J1

42205

PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE

3415.20

090

Y

4449.71

*

*

J1

42210

PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE

3806.40

090

Y

8765.29

*

*

J1

42215

PALATOPLASTY CLEFT PALATE MAJOR REVJ

2485.20

090

Y

8765.29

*

*

J1

42220

PALATOPLASTY CLEFT PALATE SEC LNGTH PX

2048.40

090

Y

8765.29

*

*

J1

42225

PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP

3410.40

090

Y

8765.29

*

*

J1

42226

LENGTHENING PALATE & PHARYNGEAL FLAP

3038.40

090

Y

8765.29

*

*

J1

42227

LENGTHENING PALATE W/ISLAND FLAP

2862.00

090

Y

8765.29

*

*

J1

42235

REPAIR ANTERIOR PALATE W/VOMER FLAP

2498.40

090

Y

8765.29

*

*

J1

42260

REPAIR NASOLABIAL FISTULA

2823.60

090

Y

8765.29

*

*

42280

MAXILLARY IMPRESJ PALATAL PROSTHESIS

612.00

010

N

691.72

*

*

J1

42281

INSJ PIN-RETAINED PALATAL PROSTHESIS

787.20

010

N

8765.29

*

*

42299

UNLISTED PROCEDURE PALATE UVULA

BR

YYY

Y

292.72

*

*

J1

42300

DRAINAGE ABSCESS PAROTID SIMPLE

722.40

010

N

2543.11

*

*

J1

42305

DRAINAGE ABSCESS PAROTID COMPLICATED

1477.20

090

N

4449.71

*

*

42310

DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL

609.60

010

N

691.72

*

*

42320

DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL

868.80

010

N

691.72

*

*

J1

42330

SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL

798.00

010

N

4449.71

*

*

J1

42335

SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL

1336.80

090

N

4449.71

*

*

J1

42340

SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL

1658.40

090

N

4449.71

*

*

42400

BIOPSY SALIVARY GLAND NEEDLE

354.00

000

N

822.66

*

*

J1

42405

BIOPSY SALIVARY GLAND INCISIONAL

1030.80

010

N

4449.71

*

*

J1

42408

EXC SUBLINGUAL SALIVARY CYST RANULA

1770.00

090

N

4449.71

*

*

J1

42409

MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA

1198.80

090

Y

4449.71

*

*

J1

42410

EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ

2149.20

090

Y

8765.29

*

*

J1

42415

EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR

3637.20

090

Y

8765.29

*

*

J1

42420

EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR

4087.20

090

Y

8765.29

*

*

J1

42425

EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL

2877.60

090

Y

8765.29

*

*

42426

EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ

4657.20

090

Y

5565.45

*

*

J1

42440

EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND

1419.60

090

Y

8765.29

*

*

J1

42450

EXISION OF SUBLINGUAL GLAND

1561.20

090

N

8765.29

*

*

J1

42500

PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM

1498.80

090

N

8765.29

*

*

J1

42505

PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP

1918.80

090

N

8765.29

*

*

J1

42507

PAROTID DUCT DIVERSION BILATERAL WILKE PX

1738.80

090

Y

8765.29

*

*

J1

42509

PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS

2875.20

090

N

8765.29

*

*

J1

42510

PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS

2133.60

090

Y

4449.71

*

*

42550

INJECTION PROCEDURE SIALOGRAPHY

500.40

000

N

*

*

J1

42600

CLOSURE SALIVARY FISTULA

1698.00

090

N

4449.71

*

*

J1

42650

DILATION SALIVARY DUCT

277.20

000

N

2543.11

*

*

42660

DILAT&CATHJ SALIVARY DUCT W/WO INJECTION

433.20

000

N

691.72

*

*

J1

42665

LIGATION SALIVARY DUCT INTRAORAL

1130.40

090

N

4449.71

*

*

42699

UNLISTED PX SALIVARY GLANDS/DUCTS

BR

YYY

Y

292.72

*

*

42700

I&D ABSCESS PERITONSILLAR

651.60

010

N

292.72

*

*

J1

42720

I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL

1563.60

010

N

4449.71

*

*

J1

42725

I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR

2820.00

090

Y

8765.29

*

*

J1

42800

BIOPSY OROPHARYNX

540.00

010

N

4449.71

*

*

J1

42804

BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE

678.00

010

N

4449.71

*

*

J1

42806

BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION

758.40

010

N

4449.71

*

*

J1

42808

EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD

782.40

010

N

4449.71

*

*

42809

REMOVAL FOREIGN BODY PHARYNX

690.00

010

N

494.39

*

*

J1

42810

EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS

1327.20

090

Y

4449.71

*

*

J1

42815

EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX

1894.80

090

Y

8765.29

*

*

J1

42820

TONSILLECTOMY & ADENOIDECTOMY

996.00

090

N

8765.29

*

*

J1

42821

TONSILLECTOMY & ADENOIDECTOMY AGE 12/>

1034.40

090

N

4449.71

*

*

J1

42825

TONSILLECTOMY PRIMARY/SECONDARY

901.20

090

N

8765.29

*

*

J1

42826

TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>

865.20

090

N

4449.71

*

*

J1

42830

ADENOIDECTOMY PRIMARY

714.00

090

N

4449.71

*

*

J1

42831

ADENOIDECTOMY PRIMARY AGE 12/>

771.60

090

N

4449.71

*

*

J1

42835

ADENOIDECTOMY SECONDARY

663.60

090

N

4449.71

*

*

J1

42836

ADENOIDECTOMY SECONDARY AGE 12/>

826.80

090

N

4449.71

*

*

J1

42842

RADICAL RESECTION TONSIL W/O CLOSURE

3487.20

090

N

8765.29

*

*

J1

42844

RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP

4794.00

090

Y

8765.29

*

*

42845

RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP

7718.40

090

Y

*

*

J1

42860

EXCISION TONSIL TAGS

646.80

090

N

4449.71

*

*

J1

42870

EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX

2041.20

090

N

8765.29

*

*

J1

42890

LIMITED PHARYNGECTOMY

4952.40

090

Y

8765.29

*

*

J1

42892

RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR

6500.40

090

Y

8765.29

*

*

42894

RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS

8226.00

090

Y

*

*

J1

42900

SUTURE PHARYNX WOUND/INJURY

1158.00

010

N

2543.11

*

*

J1

42950

PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX

2793.60

090

Y

8765.29

*

*

42953

PHARYNGOESOPHAGEAL REPAIR

3350.40

090

Y

*

*

J1

42955

PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING

2647.20

090

Y

2543.11

*

*

42960

CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE

579.60

010

N

691.72

*

*

42961

CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ

1437.60

090

Y

2198.40

*

*

J1

42962

CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

1779.60

090

N

4449.71

*

*

42970

CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS

1414.80

090

N

292.72

*

*

42971

CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION

1566.00

090

Y

*

*

J1

42972

CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

1753.20

090

Y

4449.71

*

*

42999

UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS

BR

YYY

N

292.72

*

*

J1

43020

ESOPHAGOTOMY CERVICAL APPR W/RMVL FB

1940.40

090

Y

2543.11

*

*

J1

43030

CRICOPHARYNGEAL MYOTOMY

1790.40

090

Y

8765.29

*

*

43045

ESOPHAGOTOMY THORACIC APPR W/RMVL FB

4520.40

090

Y

*

*

43100

EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR

2156.40

090

Y

*

*

43101

EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR

3486.00

090

Y

*

*

43107

TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY

10380.00

090

Y

*

*

43108

TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ

15590.40

090

Y

*

*

43112

TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY

12198.00

090

Y

*

*

43113

TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ

15219.60

090

Y

*

*

43116

PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF

17475.60

090

Y

*

*

43117

PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY

11326.80

090

Y

*

*

43118

PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ

12684.00

090

Y

*

*

43121

PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY

9876.00

090

Y

*

*

43122

PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL

8893.20

090

Y

*

*

43123

PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ

15602.40

090

Y

*

*

43124

TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY

13256.40

090

Y

*

*

J1

43130

DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR

2715.60

090

Y

8765.29

*

*

43135

DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR

5106.00

090

Y

*

*

J1

43180

ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH

1890.00

090

N

8765.29

*

*

J1

43191

ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH

536.40

000

N

2902.55

*

*

J1

43192

ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL

585.60

000

N

2902.55

*

*

J1

43193

ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY

585.60

000

N

2902.55

*

*

J1

43194

ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY

669.60

000

N

2902.55

*

*

J1

43195

ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION

638.40

000

N

5470.86

*

*

J1

43196

ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION

680.40

000

N

5470.86

*

*

43197

ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC

640.80

000

N

1081.40

*

*

43198

ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY

705.60

000

N

1081.40

*

*

43200

ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC

780.00

000

N

1081.40

*

*

J1

43201

ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ

786.00

000

N

2902.55

*

*

J1

43202

ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

1099.20

000

N

2902.55

*

*

J1

43204

ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES

475.20

000

N

2902.55

*

*

J1

43205

ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES

495.60

000

N

2902.55

*

*

J1

43206

ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY

942.00

000

N

2902.55

*

*

J1

43210

EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY

1506.00

000

N

15106.63

*

*

J1

43211

ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN

824.40

000

N

2902.55

*

*

J1

43212

ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT

664.80

000

N

8373.03

*

*

J1

43213

ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER

4062.00

000

N

2902.55

*

*

J1

43214

ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM

673.20

000

N

2902.55

*

*

J1

43215

ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

1269.60

000

N

2902.55

*

*

J1

43216

ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS

1275.60

000

N

2902.55

*

*

J1

43217

ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE

1338.00

000

N

2902.55

*

*

J1

43220

ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM

3549.60

000

N

2902.55

*

*

J1

43226

ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION

1150.80

000

N

2902.55

*

*

J1

43227

ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL

2134.80

000

N

2902.55

*

*

J1

43229

ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION

2290.80

000

N

5470.86

*

*

J1

43231

ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM

1174.80

000

N

2902.55

*

*

J1

43232

ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX

1426.80

000

N

2902.55

*

*

J1

43233

EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER

801.60

000

N

2902.55

*

*

43235

ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

913.20

000

N

1081.40

*

*

43236

ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION

1201.20

000

N

1081.40

*

*

J1

43237

ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS

687.60

000

N

2902.55

*

*

J1

43238

EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS

817.20

000

N

2902.55

*

*

43239

EGD TRANSORAL BIOPSY SINGLE/MULTIPLE

1222.80

000

N

1081.40

*

*

J1

43240

EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST

1380.00

000

N

5470.86

*

*

J1

43241

EGD INTRALUMINAL TUBE/CATHETER INSERTION

500.40

000

N

2902.55

*

*

J1

43242

EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY

922.80

000

N

2902.55

*

*

J1

43243

EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES

832.80

000

N

2902.55

*

*

J1

43244

EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES

860.40

000

N

2902.55

*

*

J1

43245

EGD DILATION GASTRIC/DUODENAL STRICTURE

1946.40

000

N

2902.55

*

*

J1

43246

EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE

703.20

000

N

2902.55

*

*

43247

EGD FLEXIBLE FOREIGN BODY REMOVAL

1228.80

000

N

1081.40

*

*

43248

EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS

1262.40

000

N

1081.40

*

*

J1

43249

EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM

3598.80

000

N

2902.55

*

*

J1

43250

EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

1416.00

000

N

2902.55

*

*

J1

43251

EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH

1564.80

000

N

2902.55

*

*

J1

43252

EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY

1075.20

000

N

5470.86

*

*

J1

43253

EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER

924.00

000

N

2902.55

*

*

J1

43254

EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION

949.20

000

N

2902.55

*

*

J1

43255

EGD TRANSORAL CONTROL BLEEDING ANY METHOD

2252.40

000

N

2902.55

*

*

J1

43257

EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD

816.00

000

N

5470.86

*

*

J1

43259

EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM

794.40

000

N

2902.55

*

*

J1

43260

ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING

1134.00

000

N

5470.86

*

*

J1

43261

ERCP W/BIOPSY SINGLE/MULTIPLE

1190.40

000

N

5470.86

*

*

J1

43262

ERCP W/SPHINCTEROTOMY/PAPILLOTOMY

1255.20

000

N

5470.86

*

*

J1

43263

ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI

1256.40

000

N

5470.86

*

*

J1

43264

ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT

1279.20

000

N

5470.86

*

*

J1

43265

ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD

1522.80

000

N

8373.03

*

*

J1

43266

EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION

766.80

000

N

8373.03

*

*

J1

43270

EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE

2358.00

000

N

2902.55

+

*

43273

ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC

418.80

ZZZ

N

*

*

J1

43274

ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT

1627.20

000

N

8373.03

*

*

J1

43275

ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT

1324.80

000

N

5470.86

*

*

J1

43276

ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE

1694.40

000

N

8373.03

*

*

J1

43277

ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA

1330.80

000

N

5470.86

*

*

J1

43278

ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE

1521.60

000

N

5470.86

*

*

43279

LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED

4486.80

090

Y

7557.06

*

*

J1

43280

LAPS SURG ESOPG/GSTR FUNDOPLASTY

3759.60

090

Y

15106.63

*

*

J1

43281

LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH

5373.60

090

Y

15106.63

*

*

J1

43282

LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH

6042.00

090

Y

15106.63

+

*

43283

LAPS ESOPHAGEAL LENGTHENING ADDL

552.00

ZZZ

Y

2511.61

*

*

J1

43284

LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL

2241.60

090

Y

15106.63

*

*

43285

REMOVAL ESOPHAGEAL SPHINCTER AGMNTJ DEVICE

2280.00

090

Y

6526.11

*

*

43286

ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ

10918.80

090

Y

*

*

43287

ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ

12496.80

090

Y

*

*

43288

ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ

13014.00

090

Y

*

*

J1

43289

UNLISTED LAPAROSCOPIC PROCEDURE ESOPHAGUS

BR

YYY

Y

9076.35

*

*

43300

ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL

2118.00

090

Y

*

*

43305

ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL

3756.00

090

Y

*

*

43310

ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL

5150.40

090

Y

*

*

43312

ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL

5536.80

090

Y

*

*

43313

ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL

9518.40

090

Y

*

*

43314

ESPHGP CGEN DFCT THRC APPR W/RPR FSTL

9895.20

090

Y

*

*

43320

EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC AP

4855.20

090

Y

*

*

43325

ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH

4723.20

090

Y

*

*

43327

ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY

2851.20

090

Y

*

*

43328

ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY

3912.00

090

Y

*

*

43330

ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH

4644.00

090

Y

*

*

43331

ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH

4647.60

090

Y

*

*

43332

RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH

4032.00

090

Y

4533.59

*

*

43333

LAPT RPR PARAESOPH HIATAL HERNIA W/MESH

4389.60

090

Y

*

*

43334

RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH

4345.20

090

Y

*

*

43335

RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH

4648.80

090

Y

*

*

43336

RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH

5258.40

090

Y

*

*

43337

RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH

5350.80

090

Y

+

*

43338

ESOPHAGUS LENGTHENING

404.40

ZZZ

Y

*

*

43340

ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR

4784.40

090

Y

*

*

43341

ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR

4872.00

090

Y

*

*

43351

ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR

4521.60

090

Y

*

*

43352

ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR

3705.60

090

Y

*

*

43360

GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH

7827.60

090

Y

*

*

43361

GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT

9398.40

090

Y

*

*

43400

LIGATION DIRECT ESOPHAGEAL VARICES

5308.80

090

Y

*

*

43401

TRNSXJ ESOPH W/RPR ESOPHAGEAL VARICES

5299.20

090

Y

*

*

43405

LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J

5038.80

090

Y

*

*

43410

SUTR ESOPHGL WND/INJ CRV APPR

3532.80

090

Y

*

*

43415

SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR

8959.20

090

Y

*

*

J1

43420

CLSR ESOPHAGOSTOMY/FSTL CRV APPR

3502.80

090

N

4449.71

*

*

43425

CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR

4996.80

090

Y

*

*

43450

DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

564.00

000

N

1081.40

*

*

J1

43453

DILATION ESOPHAGUS GUIDE WIRE

3054.00

000

N

2902.55

*

*

43460

ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE

746.40

000

N

*

*

43496

FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS

BR

090

Y

*

*

43499

UNLISTED PROCEDURE ESOPHAGUS

BR

YYY

N

1081.40

*

*

43500

GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL

2728.80

090

Y

*

*

43501

GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER

4684.80

090

Y

*

*

43502

GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC

5280.00

090

Y

*

*

43510

GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE

3295.20

090

Y

1081.40

*

*

43520

PYLOROMYOTOMY CUTTING PYLORIC MUSC

2394.00

090

Y

4224.83

*

*

43605

BIOPSY STOMACH LAPAROTOMY

2919.60

090

Y

*

*

43610

EXC LOCAL ULCER/BENIGN TUMOR STOMACH

3421.20

090

Y

5316.58

*

*

43611

EXC LOCAL MALIGNANT TUMOR STOMACH

4268.40

090

Y

*

*

43620

GSTRCT TOT W/ESOPHAGOENTEROSTOMY

6840.00

090

Y

*

*

43621

GSTRCT TOT W/ROUX-EN-Y RCNSTJ

7918.80

090

Y

*

*

43622

GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE

8040.00

090

Y

*

*

43631

GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY

5050.80

090

Y

*

*

43632

GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY

7089.60

090

Y

*

*

43633

GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ

6697.20

090

Y

*

*

43634

GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH

7377.60

090

Y

+

*

43635

VAGOTOMY PFRMD W/PRTL DSTL GSTRCT

391.20

ZZZ

Y

*

*

43640

VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV

4102.80

090

Y

*

*

43641

VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL

4156.80

090

Y

*

*

43644

LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM

6028.80

090

Y

7037.08

*

*

43645

LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ

6452.40

090

Y

*

*

J1

43647

LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM

3054.00

YYY

Y

10355.35

*

*

J1

43648

LAPS REVISION/RMVL GASTRIC NSTIM ELTRD ANTRUM

1792.80

YYY

Y

9076.35

*

*

J1

43651

LAPS SURG TRNSXJ VAGUS NRV TRUNCAL

2265.60

090

Y

9076.35

*

*

J1

43652

LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV

2662.80

090

Y

9076.35

*

*

J1

43653

LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX

1994.40

090

Y

9076.35

*

*

J1

43659

UNLISTED LAPAROSCOPIC PROCEDURE STOMACH

BR

YYY

Y

9076.35

*

*

43752

NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE

140.40

000

N

494.39

*

*

43753

GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE

75.60

000

Y

358.28

*

*

43754

GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN

554.40

000

Y

358.28

*

*

43755

GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC

531.60

000

Y

193.05

*

*

43756

DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN

782.40

000

Y

1081.40

*

*

43757

DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN

1089.60

000

Y

1081.40

*

*

43761

REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO

411.60

000

N

328.62

*

*

43762

PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC

757.20

000

N

328.62

*

*

43763

PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC

1124.40

000

N

328.62

*

*

J1

43770

LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE

3909.60

090

Y

15106.63

*

*

43771

LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE

4412.40

090

Y

3900.04

*

*

J1

43772

LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE

3292.80

090

Y

5470.86

*

*

J1

43773

LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE

4419.60

090

Y

9076.35

*

*

J1

43774

LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT

3338.40

090

Y

5470.86

*

*

43775

LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY

3883.20

090

Y

5368.79

*

*

43800

PYLOROPLASTY

3238.80

090

Y

*

*

43810

GASTRODUODENOSTOMY

3529.20

090

Y

*

*

43820

GASTROJEJUNOSTOMY W/O VAGOTOMY

4676.40

090

Y

*

*

43825

GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE

4545.60

090

Y

*

*

J1

43830

GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX

2436.00

090

Y

2902.55

*

*

43831

GASTROSTOMY OPN NEONATAL FEEDING

2082.00

090

Y

1081.40

*

*

43832

GASTROSTOMY OPN W/CONSTJ GSTR TUBE

3609.60

090

Y

*

*

43840

GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ

4732.80

090

Y

*

*

43842

GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY

4150.80

090

N

*

*

43843

GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP

4392.00

090

Y

*

*

43845

GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM

6780.00

090

Y

*

*

43846

GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<

5641.20

090

Y

*

*

43847

GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ

6252.00

090

Y

*

*

43848

REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE

6709.20

090

Y

*

*

43850

REVJ GASTRODUOL ANAST W/RCNSTJ W/O VAGOTOMY

5638.80

090

Y

*

*

43855

REVJ GASTRODUOL ANAST W/RCNSTJ W/VGTMY

5600.40

090

Y

*

*

43860

REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY

5691.60

090

Y

*

*

43865

REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY

5930.40

090

Y

*

*

J1

43870

CLOSURE GASTROSTOMY SURG

2472.00

090

Y

5470.86

*

*

43880

CLOSURE GASTROCOLIC FISTULA

5541.60

090

Y

*

*

43881

IMPLTJ/RPLCMT GASTRIC NSTIM ELTRDE ANTRUM OPEN

2323.20

YYY

Y

*

*

43882

REVISION/RMVL GASTRIC NSTIM ELTRDE ANTRUM OPEN

2710.80

YYY

Y

*

*

43886

GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY

1257.60

090

Y

3927.90

*

*

43887

GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY

1132.80

090

Y

2199.52

*

*

43888

GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT

1598.40

090

Y

3927.90

*

*

43999

UNLISTED PROCEDURE STOMACH

BR

YYY

N

1081.40

*

*

44005

ENTEROLSS FRING INTSTINAL ADHESION SPX

3811.20

090

Y

3628.53

*

*

44010

DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL

2992.80

090

Y

+

*

44015

TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD

495.60

ZZZ

Y

*

*

44020

ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL

3390.00

090

Y

*

*

44021

ENTEROTOMY SM INT OTH/THN DUO DCMPRN

3396.00

090

Y

*

*

44025

COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL

3424.80

090

Y

*

*

44050

RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT

3254.40

090

Y

2801.72

*

*

44055

CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS

5208.00

090

Y

*

*

44100

BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS

376.80

000

N

1081.40

*

*

44110

EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM

2955.60

090

Y

3573.07

*

*

44111

EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE

3421.20

090

Y

*

*

44120

ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST

4257.60

090

Y

4219.22

+

*

44121

ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA

844.80

ZZZ

Y

*

*

44125

ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY

4104.00

090

Y

*

*

44126

ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING

8558.40

090

Y

*

*

44127

ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING

9958.80

090

Y

+

*

44128

ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS

852.00

ZZZ

Y

*

*

44130

ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX

4574.40

090

Y

*

*

44132

DONOR ENTERECTOMY OPEN CADAVER DONOR

BR

XXX

N

*

*

44133

DONOR ENTERECTOMY OPEN LIVING DONOR

BR

XXX

N

*

*

44135

INTESTINAL ALLOTRANSPLANTATION CADAVER DONOR

BR

XXX

N

*

*

44136

INTESTINAL ALLOTRANSPLANTATION LIVING DONOR

BR

XXX

N

*

*

44137

RMVL TRNSPLED INTESTINAL ALLOGRAFT COMPL

BR

XXX

Y

+

*

44139

MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT

421.20

ZZZ

Y

*

*

44140

COLECTOMY PARTIAL W/ANASTOMOSIS

4670.40

090

Y

3212.14

*

*

44141

COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY

6350.40

090

Y

*

*

44143

COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT

5792.40

090

Y

*

*

44144

COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA

6160.80

090

Y

*

*

44145

COLECTOMY PRTL W/COLOPROCTOSTOMY

5766.00

090

Y

*

*

44146

COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY

7363.20

090

Y

*

*

44147

COLECTOMY PRTL ABDOMINAL & TRANSANAL APPROACH

6762.00

090

Y

*

*

44150

COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS

6490.80

090

Y

*

*

44151

COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST

7519.20

090

Y

*

*

44155

COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY

7218.00

090

Y

*

*

44156

COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST

7983.60

090

Y

*

*

44157

COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST

7632.00

090

Y

*

*

44158

COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR

7834.80

090

Y

*

*

44160

COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS

4321.20

090

Y

*

*

J1

44180

LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE

3200.40

090

Y

9076.35

*

*

J1

44186

LAPAROSCOPY SURGICAL JEJUNOSTOMY

2263.20

090

Y

9076.35

*

*

44187

LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE

3825.60

090

Y

*

*

44188

LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY

4255.20

090

Y

*

*

44202

LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA

4815.60

090

Y

3829.98

+

*

44203

LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS

835.20

ZZZ

Y

*

*

44204

LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS

5353.20

090

Y

4377.54

*

*

44205

LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM

4651.20

090

Y

4438.55

*

*

44206

LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM

6082.80

090

Y

*

*

44207

LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST

6321.60

090

Y

*

*

44208

LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST

6888.00

090

Y

*

*

44210

LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS

6180.00

090

Y

*

*

44211

LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS

7554.00

090

Y

*

*

44212

LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY

7099.20

090

Y

+

*

44213

LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY

654.00

ZZZ

Y

*

*

44227

LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS

5792.40

090

Y

*

*

J1

44238

UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM

BR

YYY

Y

9076.35

*

*

44300

PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN

2932.80

090

Y

*

*

44310

ILEOSTOMY/JEJUNOSTOMY NON-TUBE

3628.80

090

Y

*

*

44312

REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX

2055.60

090

N

3927.90

*

*

44314

REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX

3492.00

090

Y

*

*

44316

CONTINENT ILEOSTOMY KOCK PROCEDURE SPX

4929.60

090

Y

*

*

44320

COLOSTOMY/SKIN LEVEL CECOSTOMY

4182.00

090

Y

*

*

44322

COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX

3476.40

090

Y

*

*

44340

REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX

2164.80

090

N

3927.90

*

*

44345

REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX

3652.80

090

Y

*

*

44346

REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX

4112.40

090

Y

*

*

J1

44360

ENDOSCOPY UPPER SMALL INTESTINE

504.00

000

N

2902.55

*

*

J1

44361

ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY

558.00

000

N

2902.55

*

*

J1

44363

ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY

674.40

000

N

2902.55

*

*

J1

44364

ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE

718.80

000

N

2902.55

*

*

J1

44365

ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY

638.40

000

N

2902.55

*

*

J1

44366

ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING

842.40

000

N

2902.55

*

*

J1

44369

ENTEROSCOPY > 2ND PRTN ABLTJ LESION

862.80

000

N

2902.55

*

*

J1

44370

ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT

936.00

000

N

8373.03

*

*

J1

44372

ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE

842.40

000

N

2902.55

*

*

J1

44373

ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE

674.40

000

N

2902.55

*

*

J1

44376

ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX

999.60

000

N

2902.55

*

*

J1

44377

ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE

1052.40

000

N

2902.55

*

*

J1

44378

ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING

1353.60

000

N

2902.55

*

*

J1

44379

ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT

1438.80

000

N

8373.03

*

*

44380

ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD

596.40

000

N

1081.40

*

*

J1

44381

ILEOSCOPY STOMA W/BALLOON DILATION

3249.60

000

N

2902.55

*

*

44382

ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE

936.00

000

N

1081.40

*

*

J1

44384

ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT

536.40

000

N

5470.86

*

*

44385

NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX

672.00

000

N

1057.74

*

*

44386

NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE

1003.20

000

N

1057.74

*

*

44388

COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX

1010.40

000

N

1057.74

*

*

44389

COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE

1329.60

000

N

1391.30

*

*

44390

COLONOSCOPY STOMA W/RMVL FOREIGN BODY

1315.20

000

N

1391.30

*

*

44391

COLONOSCOPY STOMA CONTROL BLEEDING

2317.20

000

N

1391.30

*

*

44392

COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS

1230.00

000

N

1391.30

*

*

44394

COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE

1414.80

000

N

1391.30

*

*

44401

COLONOSCOPY STOMA ABLATION LESION

10347.60

000

N

1391.30

*

*

J1

44402

COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT

919.20

000

N

8373.03

*

*

44403

COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ

1066.80

000

N

1391.30

*

*

44404

COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION

1296.00

000

N

1391.30

*

*

44405

COLONOSCOPY STOMA W/BALLOON DILATION

1868.40

000

N

1391.30

*

*

44406

COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM

807.60

000

N

1391.30

*

*

44407

COLONOSCOPY STOMA W/US GID NDL ASPIR/BX

969.60

000

N

1391.30

*

*

44408

COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION

814.80

000

N

1057.74

*

Ø

44500

INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE

67.20

000

N

1081.40

*

*

44602

ENTERORRHAPHY 1PERFORATION

4915.20

090

Y

3993.49

*

*

44603

ENTERORRHAPHY MULTIPLE PERFORATIONS

5641.20

090

Y

*

*

44604

SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY

3685.20

090

Y

3565.87

*

*

44605

SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY

4533.60

090

Y

*

*

44615

INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ

3736.80

090

Y

*

*

44620

CLOSURE ENTEROSTOMY LG/SMALL INTESTINE

3016.80

090

Y

3340.64

*

*

44625

CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT

3531.60

090

Y

*

*

44626

CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS

5571.60

090

Y

*

*

44640

CLOSURE INTESTINAL CUTANEOUS FISTULA

4878.00

090

Y

*

*

44650

CLSR ENTEROENTERIC/ENTEROCOLIC FSTL

5024.40

090

Y

*

*

44660

CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ

4644.00

090

Y

*

*

44661

CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ

5397.60

090

Y

*

*

44680

INTESTINAL PLICATION SEPARATE PROCEDURE

3728.40

090

Y

*

*

44700

EXCLUSION SM INT FROM PELVIS MESH/PROSTH/TISS

3499.20

090

Y

+

*

44701

INTRAOPERATIVE COLONIC LAVAGE

592.80

ZZZ

Y

*

*

44705

PREPARE FECAL MICROBIOTA FOR INSTILLATION

390.00

XXX

N

*

*

44715

BKBENCH PREP CADAVER/LIVING DONOR INTESTINE

2790.00

XXX

Y

*

*

44720

BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA

958.80

XXX

Y

*

*

44721

BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA

1340.40

XXX

Y

*

*

44799

UNLISTED PROCEDURE SMALL INTESTINE

BR

YYY

N

1081.40

*

*

44800

EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT

2667.60

090

Y

2711.48

*

*

44820

EXCISION LESION MESENTERY SEPARATE PROCEDURE

2912.40

090

Y

*

*

44850

SUTURE MESENTERY SEPARATE PROCEDURE

2604.00

090

Y

*

*

44899

UNLISTED PX MECKEL'S DIVERTICULUM & MESENTERY

BR

YYY

Y

*

*

44900

INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN

2689.20

090

Y

*

*

J1

44950

APPENDECTOMY

2234.40

090

Y

5716.03

+

*

44955

APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX

294.00

ZZZ

Y

*

*

44960

APPENDEC RPTD APPENDIX ABSC/PRITONITIS

3049.20

090

Y

4010.51

*

*

J1

44970

LAPAROSCOPIC APPENDECTOMY

2090.40

090

Y

9076.35

*

*

J1

44979

UNLISTED LAPAROSCOPY PROCEDURE APPENDIX

BR

YYY

Y

9076.35

*

*

45000

TRANSRECTAL DRAINAGE OF PELVIC ABSCESS

1472.40

090

N

1391.30

*

*

45005

I&D SUBMUCOSAL ABSCESS RECTUM

976.80

010

N

1391.30

*

*

J1

45020

I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC

1989.60

090

N

4663.33

*

*

J1

45100

BX ANORECTAL WALL ANAL APPROACH

1036.80

090

N

4663.33

*

*

J1

45108

ANORECTAL MYOMECTOMY

1284.00

090

N

4663.33

*

*

45110

PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST

6399.60

090

Y

*

*

45111

PRCTECT PRTL RESCJ RECTUM TABDL APPR

3777.60

090

Y

*

*

45112

PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX

6482.40

090

Y

*

*

45113

PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR

6562.80

090

Y

*

*

45114

PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH

6313.20

090

Y

*

*

45116

PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY

5414.40

090

Y

*

*

45119

PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM

6714.00

090

Y

*

*

45120

PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS

5524.80

090

Y

*

*

45121

PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS

5996.40

090

Y

*

*

45123

PRCTECT PRTL W/O ANAST PRNL APPR

3898.80

090

Y

*

*

45126

PELVIC EXENTERATION COLORECTAL MALIGNANCY

9667.20

090

Y

*

*

45130

EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH

3776.40

090

Y

*

*

45135

EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH

4522.80

090

Y

*

*

45136

EXC ILEOANAL RSVR W/ILEOSTOMY

6405.60

090

Y

*

*

45150

DIVISION STRICTURE RECTUM

1442.40

090

N

1391.30

*

*

J1

45160

EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL

3564.00

090

Y

4663.33

*

*

J1

45171

EXC RCT TUM NOT INCL MUSCULARIS PROPRIA

2091.60

090

Y

4663.33

*

*

J1

45172

EXC RCT TUM INCL MUSCULARIS PROPRIA

2821.20

090

Y

4663.33

*

*

J1

45190

DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH

2419.20

090

N

4663.33

*

*

45300

PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX

416.40

000

N

1057.74

*

*

45303

PROCTOSGMDSC RIGID W/DILATION

3160.80

000

N

1391.30

*

*

45305

PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE

525.60

000

N

1391.30

*

*

J1

45307

PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY

603.60

000

N

4663.33

*

*

J1

45308

PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY

591.60

000

N

4663.33

*

*

45309

PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ

613.20

000

N

1391.30

*

*

45315

PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE

673.20

000

N

1391.30

*

*

45317

PROCTOSGMDSC RIGID CONTROL BLEEDING

662.40

000

N

1391.30

*

*

J1

45320

PROCTOSGMDSC RIGID ABLATION LESION

656.40

000

N

4663.33

*

*

J1

45321

PROCTOSGMDSC RIGID DCMPRN VOLVULUS

358.80

000

N

4663.33

*

*

J1

45327

PROCTOSGMDSC RIGID TNDSC STENT PLMT

405.60

000

N

8373.03

*

*

45330

SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

585.60

000

N

1057.74

*

*

45331

SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

912.00

000

N

1057.74

*

*

45332

SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY

883.20

000

N

1391.30

*

*

45333

SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

1040.40

000

N

1057.74

*

*

45334

SIGMOIDOSCOPY FLX CONTROL BLEEDING

1844.40

000

N

1391.30

*

*

45335

SGMDSC FLX DIRED SBMCSL NJX ANY SBST

858.00

000

N

1057.74

*

*

45337

SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE

404.40

000

N

1391.30

*

*

45338

SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ

946.80

000

N

1391.30

*

*

45340

SIGMOIDOSCOPY FLX TNDSC BALO DILAT

1514.40

000

N

1391.30

*

*

45341

SIGMOIDOSCOPY FLX NDSC US XM

433.20

000

N

1391.30

*

*

45342

SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX

595.20

000

N

1391.30

*

*

45346

SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES

9885.60

000

N

1391.30

*

*

J1

45347

SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT

542.40

000

N

8373.03

*

*

45349

SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION

696.00

000

N

1391.30

*

*

45350

SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)

1968.00

000

N

1391.30

*

*

45378

COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD

1101.60

000

N

1057.74

*

*

45379

COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)

1423.20

000

N

1391.30

*

*

45380

COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE

1414.80

000

N

1391.30

*

*

45381

COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST

1382.40

000

N

1391.30

*

*

45382

COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD

2427.60

000

N

1391.30

*

*

45384

COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS

1575.60

000

N

1391.30

*

*

45385

COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ

1485.60

000

N

1391.30

*

*

45386

COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT

2040.00

000

N

1391.30

*

*

45388

COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES

10424.40

000

N

1391.30

*

*

J1

45389

COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT

1018.80

000

N

8373.03

*

*

45390

COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION

1168.80

000

N

1391.30

*

*

45391

COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX

906.00

000

N

1391.30

*

*

45392

COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL

1069.20

000

N

1391.30

*

*

45393

COLONOSCOPY FLEXIBLE WITH DECOMPRESSION

889.20

000

N

1391.30

*

*

45395

LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY

6855.60

090

Y

*

*

45397

LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR

7458.00

090

Y

*

*

45398

COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)

2504.40

000

N

1391.30

*

*

45399

UNLISTED PROCEDURE COLON

BR

YYY

N

1057.74

*

*

45400

LAPAROSCOPY PROCTOPEXY PROLAPSE

3955.20

090

Y

5285.73

*

*

45402

LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ

5259.60

090

Y

*

*

J1

45499

UNLISTED LAPAROSCOPY PROCEDURE RECTUM

BR

YYY

Y

9076.35

*

*

J1

45500

PROCTOPLASTY STENOSIS

1939.20

090

N

4663.33

*

*

J1

45505

PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE

2059.20

090

N

4663.33

*

*

45520

PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE

529.20

000

N

1057.74

*

*

45540

PROCTOPEXY ABDOMINAL APPROACH

3673.20

090

Y

*

*

J1

45541

PROCTOPEXY PERINEAL APPROACH

3279.60

090

Y

4663.33

*

*

45550

PROCTOPEXY W/SIGMOID RESCJ ABDL APPR

5089.20

090

Y

*

*

J1

45560

REPAIR RECTOCELE SEPARATE PROCEDURE

2372.40

090

Y

4663.33

*

*

45562

EXPL RPR & PRESACRAL DRG RECTAL INJURY

3894.00

090

Y

*

*

45563

EXPL RPR & PRESACRAL DRG RECTAL INJ W/COLOSTOMY

5727.60

090

Y

*

*

45800

CLOSURE RECTOVESICAL FISTULA

4378.80

090

Y

*

*

45805

CLSR RECTOVESICAL FISTULA W/COLOSTOMY

5107.20

090

Y

*

*

45820

CLOSURE RECTOURETHRAL FISTULA

4404.00

090

Y

*

*

45825

CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY

5332.80

090

Y

*

*

45900

RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE

699.60

010

N

1057.74

*

*

45905

DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL

584.40

010

N

1391.30

*

*

45910

DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL

663.60

010

N

1391.30

*

*

45915

RMVL FECAL IMPACTION/FB SPX UNDER ANES

1164.00

010

N

1391.30

*

*

J1

45990

ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX

370.80

000

N

4663.33

*

*

45999

UNLISTED PROCEDURE RECTUM

BR

YYY

N

1057.74

*

*

J1

46020

PLACEMENT SETON

960.00

010

N

4663.33

*

*

46030

REMOVAL ANAL SETON OTHER MARKER

484.80

010

N

1391.30

*

*

46040

I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

1860.00

090

N

1391.30

*

*

J1

46045

I&D INTRAMURAL IM/ABSC TRANSANAL ANES

1510.80

090

N

4663.33

*

*

46050

I&D PERIANAL ABSCESS SUPERFICIAL

717.60

010

N

1057.74

*

*

J1

46060

I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON

1660.80

090

N

4663.33

*

*

J1

46070

INCISION ANAL SEPTUM INFANT

902.40

090

N

4663.33

*

*

J1

46080

SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX

889.20

010

N

4663.33

*

*

46083

INCISION THROMBOSED HEMORRHOID EXTERNAL

628.80

010

N

328.62

*

*

J1

46200

FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED

1560.00

090

N

4663.33

*

*

46220

EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS

746.40

010

N

1391.30

*

*

46221

HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS

932.40

010

N

1057.74

*

*

J1

46230

EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS

973.20

010

N

4663.33

*

*

J1

46250

HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP

1612.80

090

N

4663.33

*

*

J1

46255

HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP

1765.20

090

N

4663.33

*

*

J1

46257

HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO

1468.80

090

N

4663.33

*

*

J1

46258

HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY

1627.20

090

N

4663.33

*

*

J1

46260

HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO

1654.80

090

N

4663.33

*

*

J1

46261

HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU

1809.60

090

N

4663.33

*

*

J1

46262

HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY

1921.20

090

N

4663.33

*

*

J1

46270

SURG TX ANAL FISTULA SUBQ

1777.20

090

N

4663.33

*

*

J1

46275

SURG TX ANAL FISTULA INTERSPHINCTERIC

1875.60

090

N

4663.33

*

*

J1

46280

TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON

1638.00

090

N

4663.33

*

*

J1

46285

SURG TX ANAL FISTULA 2ND STAGE

1867.20

090

N

4663.33

*

*

J1

46288

CLSR ANAL FSTL W/RCT ADVMNT FLAP

1903.20

090

N

4663.33

*

*

46320

EXC THROMBOSED HEMORRHOID XTRNL

651.60

010

N

1391.30

*

*

46500

INJECTION SCLEROSING SOLUTION HEMORRHOIDS

987.60

010

N

1057.74

*

*

46505

CHEMODENERVATION INTERNAL ANAL SPHINCTER

1002.00

010

N

1391.30

*

*

46600

ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD

326.40

000

N

151.20

*

*

46601

ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT

476.40

000

N

151.20

*

*

46604

ANOSCOPY W/DILATION

2196.00

000

N

1391.30

*

*

46606

ANOSCOPY W/BX SINGLE/MULTIPLE

826.80

000

N

1391.30

*

*

46607

ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX

670.80

000

N

1391.30

*

*

46608

ANOSCOPY W/RMVL FOREIGN BODY

871.20

000

N

1057.74

*

*

J1

46610

ANOSCOPY W/RMVL LESION CAUTERY

826.80

000

N

4663.33

*

*

46611

ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ

651.60

000

N

1057.74

*

*

J1

46612

ANOSC RMVL MULT TUMORS CAUTERY/SNARE

1005.60

000

N

4663.33

*

*

46614

ANOSCOPY CONTROL BLEEDING

476.40

000

N

1391.30

*

*

J1

46615

ANOSCOPY ABLATION LESION

520.80

000

N

4663.33

*

*

J1

46700

ANOPLASTY PLASTIC OPERATION STRICTURE ADULT

2277.60

090

N

4663.33

*

*

46705

ANOPLASTY PLASTIC OPERATION STRICTURE INFANT

1933.20

090

Y

*

*

J1

46706

REPAIR ANAL FISTULA W/FIBRIN GLUE

612.00

010

N

4663.33

*

*

J1

46707

REPAIR ANORECTAL FISTULA PLUG

1702.80

090

N

4663.33

*

*

46710

RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR

3854.40

090

Y

*

*

46712

RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR

7768.80

090

Y

*

*

46715

RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK

1892.40

090

Y

*

*

46716

RPR LW IMPERFORATE ANUS W/TRPOS FISTULA

4214.40

090

Y

*

*

46730

RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR

6846.00

090

Y

*

*

46735

RPR HI IMPRF ANUS W/O FISTULA CMBN APPR

7900.80

090

Y

*

*

46740

RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR

7482.00

090

Y

*

*

46742

RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL

8667.60

090

Y

*

*

46744

RPR CLOACAL ANOMALY SACROPERINEAL

12150.00

090

Y

*

*

46746

RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL

13568.40

090

Y

*

*

46748

RPR CLOACAL ANOMALY CMBN ABDL & SACROPRNL W/GRF

14727.60

090

Y

*

*

J1

46750

SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT

2592.00

090

Y

4663.33

*

*

46751

SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD

2281.20

090

Y

*

*

J1

46753

GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE

2131.20

090

N

4663.33

*

*

J1

46754

RMVL THIERSCH WIRE/SUTURE ANAL CANAL

1083.60

010

N

4663.33

*

*

J1

46760

SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT

3792.00

090

Y

4663.33

*

*

J1

46761

SPHNCTROP ANAL LEVATOR MUSC IMBRCJ

3171.60

090

Y

4663.33

*

*

46900

DSTRJ LESION ANUS SIMPLE CHEMICAL

811.20

010

N

445.99

*

*

46910

DSTRJ LESION ANUS SMPL ELTRDSICCATION

886.80

010

N

2199.52

*

*

46916

DSTRJ LESION ANUS SIMPLE CRYOSURGERY

819.60

010

N

250.56

*

*

J1

46917

DSTRJ LESION ANUS SIMPLE LASER SURG

1472.40

010

N

4663.33

*

*

J1

46922

DSTRJ LESION ANUS SIMPLE SURG EXCISION

960.00

010

N

4663.33

*

*

J1

46924

DSTRJ LESION ANUS EXTENSIVE

1812.00

010

N

4663.33

*

*

46930

DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY

722.40

090

N

1391.30

*

*

J1

46940

CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST

814.80

010

N

4663.33

*

*

46942

CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ

777.60

010

N

1057.74

*

*

J1

46945

HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP

1089.60

090

N

4663.33

*

*

J1

46946

HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP

1100.40

090

N

4663.33

*

*

J1

46947

HEMORRHOIDOPEXY STAPLING

1330.80

090

N

4663.33

*

*

46999

UNLISTED PROCEDURE ANUS

BR

YYY

N

1057.74

*

*

J1

47000

BIOPSY LIVER NEEDLE PERCUTANEOUS

1046.40

000

N

2734.29

+

*

47001

BX LVR NDL DONE PURPOSE TM OTH MAJOR PX

362.40

ZZZ

N

*

*

47010

HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES

4220.40

090

Y

*

*

47015

LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS

4054.80

090

Y

*

*

47100

BIOPSY LIVER WEDGE

2940.00

090

Y

2639.59

*

*

47120

HEPATECTOMY RESCJ PARTIAL LOBECTOMY

8134.80

090

Y

5041.12

*

*

47122

HEPATECTOMY RESCJ TRISEGMENTECTOMY

11960.40

090

Y

*

*

47125

HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY

10744.80

090

Y

*

*

47130

HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY

11544.00

090

Y

*

*

47133

DONOR HEPATECTOMY CADAVER DONOR

19334.40

XXX

N

*

*

47135

LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE

18756.00

090

Y

*

*

47140

DONOR HEPATECTOMY LIVING DONOR SEG II & III

12439.20

090

Y

*

*

47141

DONOR HEPATECTOMY LIVING DONOR SEG II III & IV

14890.80

090

Y

*

*

47142

DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI

16384.80

090

Y

*

*

47143

BKBENCH PREP CADAVER DONOR

2956.80

XXX

Y

*

*

47144

BKBENCH PREPJ CADAVER WHOLE LIVER GRF I&IV VII

4603.20

090

Y

*

*

47145

BKBENCH PREPJ CADAVER DONOR WHL LVR GRF I&V VI

BR

XXX

Y

*

*

47146

BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA

1131.60

XXX

Y

*

*

47147

BKBENCH RCNSTJ LVR GRF ARTL ANAST EA

1333.20

XXX

Y

*

*

47300

MARSUPIALIZATION CST/ABSC LVR

3936.00

090

Y

*

*

47350

MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ

4764.00

090

Y

*

*

47360

MGMT LVR HEMRRG CPLX SUTR WND/INJ

6537.60

090

Y

*

*

47361

MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR

10560.00

090

Y

*

*

47362

MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING

5054.40

090

Y

*

*

J1

47370

LAPS SURG ABLTJ 1/> LVR TUM RF

4354.80

090

Y

15106.63

*

*

J1

47371

LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG

4256.40

090

Y

15106.63

*

*

J1

47379

UNLIS LAPAROSCOPIC PROCEDURE LIVER

BR

YYY

Y

9076.35

*

*

47380

ABLTJ OPN 1/> LVR TUM RF

5020.80

090

Y

*

*

47381

ABLTJ OPN 1/> LVR TUM CRYOSURG

5096.40

090

Y

*

*

J1

47382

ABLTJ 1/> LVR TUM PRQ RF

15680.40

010

N

9076.35

*

*

J1

47383

ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION

23541.60

010

N

9076.35

*

*

47399

UNLISTED PROCEDURE LIVER

BR

YYY

N

822.66

*

*

47400

HEPATCOTOMY/HEPATCOSTOMY W/EXPL DRG/RMVL ST1

7514.40

090

Y

*

*

47420

CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP

4668.00

090

Y

5823.45

*

*

47425

CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP

4765.20

090

Y

*

*

47460

TRANSDUOL SPHINCTEROT/PLASTY W/WO RMVL CALCULUS

4405.20

090

Y

*

*

47480

CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX

3050.40

090

Y

*

*

J1

47490

CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT

1147.20

010

N

5716.03

*

*

47531

NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS

1186.80

000

N

4185.19

*

*

47532

NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS

2787.60

000

N

4185.19

*

*

J1

47533

PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL

4228.80

000

N

5716.03

*

*

J1

47534

PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT

4927.20

000

N

5716.03

*

*

J1

47535

CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH

3414.00

000

N

5716.03

*

*

J1

47536

EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I

2350.80

000

N

5716.03

*

*

47537

REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I

1381.20

000

N

1081.40

*

*

J1

47538

PLMT BILE DUCT STENT PRQ EXISTING ACCESS

14616.00

000

N

9076.35

*

*

J1

47539

PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH

16210.80

000

N

9076.35

*

*

J1

47540

PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH

16488.00

000

N

9076.35

*

*

J1

47541

PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW

4057.20

000

N

5716.03

+

*

47542

BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT

1670.40

ZZZ

N

+

*

47543

ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT

1605.60

ZZZ

N

+

*

47544

REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I

3513.60

ZZZ

N

+

*

47550

BILIARY NDSC INTRAOPERATIVE

576.00

ZZZ

Y

*

*

J1

47552

BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH

1081.20

000

N

5716.03

*

*

J1

47553

BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE

1069.20

000

N

5716.03

*

*

J1

47554

BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS

1797.60

000

N

9076.35

*

*

J1

47555

BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT

1135.20

000

N

5716.03

*

*

J1

47556

BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT

1286.40

000

N

9076.35

*

*

J1

47562

LAPAROSCOPY SURG CHOLECYSTECTOMY

2288.40

090

Y

9076.35

*

*

J1

47563

LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

2490.00

090

Y

9076.35

*

*

J1

47564

LAPS SURG CHOLECSTC W/EXPL COMMON DUCT

3872.40

090

Y

9076.35

*

*

47570

LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY

2700.00

090

Y

*

*

J1

47579

UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT

BR

YYY

Y

9076.35

*

*

47600

CHOLECYSTECTOMY

3716.40

090

Y

5718.92

*

*

47605

CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

3912.00

090

Y

4907.68

*

*

47610

CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT

4366.80

090

Y

*

*

47612

CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY

4401.60

090

Y

*

*

47620

CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP

4749.60

090

Y

*

*

47700

EXPL CONGENITAL ATRESIA BILE DUCTS

3674.40

090

Y

*

*

47701

PORTOENETEROSTOMY

5947.20

090

N

*

*

47711

EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC

5415.60

090

Y

*

*

47712

EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC

6945.60

090

Y

*

*

47715

EXCISION CHOLEDOCHAL CYST

4615.20

090

Y

*

*

47720

CHOLECYSTOENTEROSTOMY DIRECT

4011.60

090

Y

*

*

47721

CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY

4722.00

090

Y

*

*

47740

CHOLECYSTOENTEROSTOMY ROUX-EN-Y

4531.20

090

Y

*

*

47741

CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM

5132.40

090

Y

*

*

47760

ANAST XTRHEPATC BILIARY DUCTS & GI TRACT

7856.40

090

Y

*

*

47765

ANAST INTRAHEPATC DUCTS & GI TRACT

10556.40

090

Y

*

*

47780

ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI

8626.80

090

Y

*

*

47785

ANAST ROUX-EN-Y INTRAHEPATC BILIARY DUCTS & GI

11331.60

090

Y

*

*

47800

RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST

5466.00

090

Y

*

*

47801

PLACEMENT CHOLEDOCHAL STENT

3879.60

090

Y

*

*

47802

U-TUBE HEPATICOENTEROSTOMY

5322.00

090

Y

*

*

47900

SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY

4770.00

090

Y

*

*

47999

UNLISTED PROCEDURE BILIARY TRACT

BR

YYY

N

1081.40

*

*

48000

PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS

6562.80

090

Y

*

*

48001

PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY

8000.40

090

Y

*

*

48020

REMOVAL PANCREATIC CALCULUS

4102.80

090

Y

*

*

48100

BIOPSY PANCREAS OPEN

3099.60

090

Y

*

*

J1

48102

BIOPSY PANCREA PERCUTANEOUS NEEDLE

1826.40

010

N

2734.29

*

*

48105

RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS

9892.80

090

Y

*

*

48120

EXCISION LESION PANCREAS

3849.60

090

Y

*

*

48140

PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY

5454.00

090

Y

*

*

48145

PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY

5680.80

090

Y

*

*

48146

PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX

6541.20

090

Y

*

*

48148

EXCISION AMPULLA VATER

4341.60

090

Y

*

*

48150

PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY

10872.00

090

Y

*

*

48152

PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY

10065.60

090

Y

*

*

48153

PNCRTECT W/PANCREATOJEJUNOSTOMY

10821.60

090

Y

*

*

48154

PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY

10126.80

090

Y

*

*

48155

PANCREATECTOMY TOTAL

6320.40

090

Y

*

*

48160

PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS

21482.40

XXX

N

+

*

48400

INJECTION INTRAOPERATIVE PANCREATOGRAPHY

368.40

ZZZ

N

*

*

48500

MARSUPIALIZATION PANCREATIC CYST

4010.40

090

Y

*

*

48510

EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN

3814.80

090

Y

*

*

48520

INT ANAST PANCREATIC CYST GI TRACT DIRECT

3789.60

090

Y

*

*

48540

INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y

4543.20

090

Y

*

*

48545

PANCREATORRHAPHY INJURY

4669.20

090

Y

*

*

48547

DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ

6228.00

090

Y

*

*

48548

PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST

5786.40

090

Y

*

*

48550

DONOR PANCREATECTOMY DUODENAL SGM TRANSPLANT

BR

XXX

N

*

*

48551

BKBENCH PREPJ CADAVER DONOR PANCREAS ALLOGRAFT

2762.40

XXX

Y

*

*

48552

BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA

824.40

XXX

Y

*

*

48554

TRANSPLANTATION PANCREATIC ALLOGRAFT

8868.00

090

Y

*

*

48556

RMVL TRANSPLANTED PANCREATIC ALLOGRAFT

4434.00

090

Y

*

*

48999

UNLISTED PROCEDURE PANCREAS

BR

YYY

Y

822.66

*

*

49000

EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX

2678.40

090

Y

3629.56

*

*

49002

REOPENING RECENT LAPAROTOMY

3640.80

090

Y

*

*

49010

EXPL RETROPERITONEUM W/WO BX SPX

3228.00

090

Y

3435.31

*

*

49020

DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN

5535.60

090

Y

2006.96

*

*

49040

DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN

3468.00

090

Y

*

*

49060

DRAINAGE OF RETROPERITONEAL ABSCESS OPEN

3820.80

090

N

*

*

49062

DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN

2566.80

090

Y

*

*

49082

ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE

680.40

000

N

1081.40

*

*

49083

ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE

1012.80

000

N

1081.40

*

*

49084

PERITONEAL LAVAGE W/WO IMAGING GUIDANCE

375.60

000

N

1081.40

*

*

J1

49180

BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE

565.20

000

N

2734.29

*

*

49185

SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID

3633.60

000

N

822.66

*

*

49203

EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<

4164.00

090

Y

3431.95

*

*

49204

EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM

5325.60

090

Y

3348.68

*

*

49205

EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM

6126.00

090

Y

3307.41

*

*

49215

EXC PRESAC/SACROCOCCYGEAL TUMOR

7713.60

090

Y

*

*

49220

STAGING LAPAROTOMY HODGKINS DISEASE/LYMPHOMA

3385.20

090

Y

*

*

J1

49250

UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX

2048.40

090

N

5716.03

*

*

49255

OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX

2751.60

090

Y

2855.68

*

*

J1

49320

LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX

1131.60

010

Y

9076.35

*

*

J1

49321

LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE

1196.40

010

Y

9076.35

*

*

J1

49322

LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE

1284.00

010

Y

9076.35

*

*

J1

49323

LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY

2196.00

090

Y

9076.35

*

*

J1

49324

LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER

1344.00

010

Y

9076.35

*

*

J1

49325

LAPS W/REVISION INTRAPERITONEAL CATHETER

1434.00

010

Y

9076.35

+

*

49326

LAPAROSCOPY W/OMENTOPEXY

656.40

ZZZ

Y

+

*

49327

LAPS W/INSERTION NTRSTL DEV W/IMG GUID 1/MLT

452.40

ZZZ

Y

*

*

J1

49329

UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM

BR

YYY

Y

9076.35

*

*

49400

INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX

471.60

000

N

*

*

J1

49402

REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY

2979.60

090

N

5716.03

*

*

J1

49405

IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ

2871.60

000

N

2734.29

*

*

J1

49406

IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ

2870.40

000

N

2734.29

*

*

J1

49407

IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL

2331.60

000

N

2734.29

*

*

49411

INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT

1650.00

000

N

1692.53

+

*

49412

PLACEMENT INTRSTL DEV OPN W/IMG GUID 1/MLT

289.20

ZZZ

N

*

*

J1

49418

INSJ INTRAPERITONEAL CATHETER W/IMG GUID

4334.40

000

N

5716.03

*

*

J1

49419

INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT

1532.40

090

N

8407.95

*

*

J1

49421

INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN

796.80

000

N

5716.03

*

*

49422

REMOVAL TUNNELED INTRAPERITONEAL CATHETER

775.20

000

N

3750.96

*

*

J1

49423

EXCHNG ABSC/CST DRG CATH RAD GID SPX

1936.80

000

N

2902.55

*

*

49424

CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX

522.00

000

N

*

*

49425

INSERTION PERITONEAL-VENOUS SHUNT

2502.00

090

Y

*

*

J1

49426

REVIS PERITONEAL-VENOUS SHUNT

2143.20

090

N

5716.03

*

*

49427

INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT

158.40

000

N

*

*

49428

LIGATION PERITONEAL-VENOUS SHUNT

1501.20

010

N

*

*

49429

RMVL PERITONEAL-VENOUS SHUNT

1594.80

010

N

3750.96

+

*

49435

INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER

414.00

ZZZ

Y

*

*

J1

49436

DELAYED CREATION EXIT SITE EMBEDDED CATHETER

643.20

010

Y

2902.55

*

*

J1

49440

INSERT GASTROSTOMY TUBE PERCUTANEOUS

3238.80

010

N

2902.55

*

*

J1

49441

INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

3675.60

010

N

2902.55

*

*

49442

INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS

3058.80

010

N

1391.30

*

*

J1

49446

CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ

3114.00

000

N

2902.55

*

*

49450

REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS

2256.00

000

N

1081.40

*

*

49451

REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

2454.00

000

N

1081.40

*

*

49452

REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS

3019.20

000

N

1081.40

*

*

49460

OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE

2452.80

000

N

1081.40

*

*

49465

CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE

537.60

000

N

327.40

*

*

J1

49491

RPR 1ST INGUN HRNA PRETERM INFT RDC

2764.80

090

Y

9076.35

*

*

J1

49492

RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED

3334.80

090

Y

5716.03

*

*

J1

49495

RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC

1423.20

090

Y

5716.03

*

*

J1

49496

RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER

2134.80

090

Y

5716.03

*

*

J1

49500

RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE

1404.00

090

Y

5716.03

*

*

J1

49501

RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED

2106.00

090

Y

5716.03

*

*

J1

49505

RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE

1808.40

090

Y

5716.03

*

*

J1

49507

RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED

2036.40

090

Y

5716.03

*

*

J1

49520

RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE

2197.20

090

Y

5716.03

*

*

J1

49521

RPR RECRT INGUN HERNIA ANY AGE INCARCERATED

2492.40

090

Y

5716.03

*

*

J1

49525

RPR INGUN HERNIA SLIDING ANY AGE

1993.20

090

Y

5716.03

*

*

J1

49540

REPAIR LUMBAR HERNIA

2342.40

090

Y

9076.35

*

*

J1

49550

RPR 1ST FEM HRNA ANY AGE REDUCIBLE

2001.60

090

Y

5716.03

*

*

J1

49553

RPR 1ST FEM HERNIA ANY AGE INCARCERATED

2197.20

090

Y

5716.03

*

*

J1

49555

RPR RECRT FEM HERNIA REDUCIBLE

2079.60

090

Y

5716.03

*

*

J1

49557

RPR RECRT FEM HRNA INCARCERATED

2516.40

090

Y

5716.03

*

*

J1

49560

REPAIR FIRST ABDOMINAL WALL HERNIA

2565.60

090

Y

5716.03

*

*

J1

49561

RPR 1ST INCAL/VNT HERNIA INCARCERATED

3232.80

090

Y

5716.03

*

*

J1

49565

RPR RECRT INCAL/VNT HERNIA REDUCIBLE

2671.20

090

Y

9076.35

*

*

J1

49566

RPR RECRT INCAL/VNT HERNIA INCARCERATED

3261.60

090

Y

9076.35

+

*

49568

IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE

932.40

ZZZ

Y

*

*

J1

49570

RPR EPIGASTRIC HERNIA REDUCIBLE SPX

1448.40

090

Y

5716.03

*

*

J1

49572

RPR EPIGASTRIC HERNIA INCARCERATED

1794.00

090

Y

5716.03

*

*

J1

49580

RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE

1124.40

090

Y

5716.03

*

*

J1

49582

RPR UMBILICAL HERNIA < 5 YRS INCARCERATED

1604.40

090

Y

5716.03

*

*

J1

49585

RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE

1544.40

090

Y

5716.03

*

*

J1

49587

RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED

1651.20

090

Y

5716.03

*

*

J1

49590

RPR SPIGELIAN HERNIA

1989.60

090

Y

5716.03

*

*

J1

49600

RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE

2523.60

090

Y

5716.03

*

*

49605

RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH

17102.40

090

Y

*

*

49606

RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH

3949.20

090

Y

*

*

49610

RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG

2398.80

090

Y

*

*

49611

RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG

2112.00

090

Y

*

*

J1

49650

LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA

1489.20

090

Y

9076.35

*

*

J1

49651

LAPS SURG RPR RECURRENT INGUINAL HERNIA

1938.00

090

Y

9076.35

*

*

J1

49652

LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE

2586.00

090

Y

9076.35

*

*

J1

49653

LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED

3229.20

090

Y

9076.35

*

*

J1

49654

LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE

2938.80

090

Y

15106.63

*

*

J1

49655

LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED

3589.20

090

Y

15106.63

*

*

J1

49656

LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE

3187.20

090

Y

15106.63

*

*

J1

49657

LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED

4588.80

090

Y

15106.63

*

*

J1

49659

UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY

BR

YYY

Y

9076.35

*

*

49900

SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN

2836.80

090

Y

2915.22

*

*

49904

OMENTAL FLAP EXTRA-ABDOMINAL

4915.20

090

N

+

*

49905

OMENTAL FLAP INTRA-ABDOMINAL

1230.00

ZZZ

Y

*

*

49906

FREE OMENTAL FLAP W/MICROVASCULAR ANAST

4119.60

090

N

*

*

49999

UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM

BR

YYY

N

1081.40

*

*

50010

RNL EXPL X NECESSITATING OTH SPEC PX

2546.40

090

Y

*

*

J1

50020

DRAINAGE PERIRENAL/RENAL ABSCESS OPEN

3516.00

090

N

3422.70

*

*

50040

NEPHROSTOMY/NEPHROTOMY W/DRAINAGE

3216.00

090

N

2568.93

*

*

50045

NEPHROTOMY W/EXPLORATION

3236.40

090

Y

*

*

50060

NEPHROLITHOTOMY REMOVAL STAGE 1

3960.00

090

Y

5198.54

*

*

50065

NEPHROLITHOTOMY SECONDARY FOR CALCULUS

4197.60

090

Y

4748.77

*

*

50070

NEPHROLITHOTOMY COMP CGEN KDN ABNORMALITY

4117.20

090

Y

*

*

50075

NEPHROLITHOTOMY RMVL LG STAGHORN STAGE 1

5055.60

090

Y

*

*

J1

50080

PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY </2 CM

3018.00

090

N

13305.84

*

*

J1

50081

PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY > 2 CM

4435.20

090

Y

13305.84

*

*

50100

TRNSXJ/REPOSITIONING ABERRANT RENAL VESSEL SPX

3650.40

090

Y

*

*

50120

PYELOTOMY W/EXPLORATION

3295.20

090

Y

*

*

50125

PYELOTOMY W/DRAINAGE PYELOSTOMY

3411.60

090

Y

*

*

50130

PYELOTOMY W/REMOVAL CALCULUS

3584.40

090

Y

*

*

50135

PYELOTOMY COMPLICATED

3896.40

090

Y

*

*

J1

50200

RENAL BIOPSY PRQ TROCAR/NEEDLE

1833.60

000

N

2734.29

*

*

50205

RENAL BIOPSY SURG EXPOSURE KIDNEY

2623.20

090

Y

*

*

50220

NEPHRECTOMY W/PRTL URETERECTOMY W/OPEN RIB RESCJ

3638.40

090

Y

5492.23

*

*

50225

NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL

4183.20

090

Y

*

*

50230

NEPHRECTOMY W/PRTL URETERECT OPEN RIB RESCJ RAD

4453.20

090

Y

*

*

50234

NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC

4525.20

090

Y

*

*

50236

NEPHRECTOMY TOT URETEREC&BLDR CUFF SEPAR INCISN

5089.20

090

Y

*

*

50240

NEPHRECTOMY PARTIAL

4602.00

090

Y

*

*

50250

OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND

4221.60

090

Y

*

*

50280

EXCISION/UNROOFING CYST KIDNEY

3320.40

090

Y

*

*

50290

EXCISION PERINEPHRIC CYST

3118.80

090

Y

*

*

50300

DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL

BR

XXX

N

*

*

50320

DONOR NEPHRECTOMY OPEN LIVING DONOR

5214.00

090

Y

*

*

50323

BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT

1826.40

XXX

Y

*

*

50325

BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT

1826.40

XXX

Y

*

*

50327

BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA

754.80

XXX

Y

*

*

50328

BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA

661.20

XXX

Y

*

*

50329

BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA

628.80

XXX

Y

*

*

50340

RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE

3296.40

090

Y

*

*

50360

RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY

8408.40

090

Y

*

*

50365

RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY

9961.20

090

Y

*

*

50370

RMVL TRNSPLED RENAL ALLOGRAFT

4185.60

090

Y

*

*

50380

RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY

6942.00

090

Y

*

*

J1

50382

RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ

3762.00

000

N

3422.70

*

*

50384

REMOVAL INDWELLING URETERAL STENT PRQ

3004.80

000

N

2470.45

*

*

J1

50385

REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL

3692.40

000

N

3422.70

*

*

50386

REMOVE INT DWELL URETERAL STENT TRANSURETHRAL

2437.20

000

N

2470.45

*

*

J1

50387

RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH

1759.20

000

N

3422.70

*

*

50389

RMVL NFROS TUBE REQ FLUORO GUIDANCE

1138.80

000

N

798.40

*

*

50390

ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ

333.60

000

N

822.66

*

*

50391

INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB

422.40

000

N

328.62

*

*

50396

MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH

405.60

000

N

798.40

*

*

50400

PYELOPLASTY SIMPLE

4027.20

090

Y

*

*

50405

PYELOPLASTY COMPLICATED

4844.40

090

Y

3161.09

*

*

50430

NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS

1743.60

000

N

798.40

*

*

50431

NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

723.60

000

N

798.40

*

*

J1

50432

PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I

2822.40

000

N

3422.70

*

*

J1

50433

PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I

3750.00

000

N

3422.70

*

*

J1

50434

CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ

2959.20

000

N

3422.70

*

*

J1

50435

EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I

1755.60

000

N

3422.70

*

*

J1

50436

PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG

524.40

000

N

3422.70

*

*

J1

50437

PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS

874.80

000

N

5757.14

*

*

50500

NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY

4478.40

090

Y

*

*

50520

CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA

4032.00

090

Y

*

*

50525

CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR

5116.80

090

Y

*

*

50526

CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR

5485.20

090

Y

*

*

50540

SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI

3972.00

090

Y

*

*

J1

50541

LAPAROSCOPY SURG ABLATION RENAL CYSTS

3190.80

090

Y

9076.35

*

*

J1

50542

LAPS ABLTJ RENAL MASS LESION W/INTRAOP US

4051.20

090

Y

15106.63

*

*

J1

50543

LAPAROSCOPY SURG PARTIAL NEPHRECTOMY

5168.40

090

Y

15106.63

*

*

J1

50544

LAPAROSCOPY SURG PYELOPLASTY

4323.60

090

Y

15106.63

*

*

50545

LAPAROSCOPY RADICAL NEPHRECTOMY

4652.40

090

Y

12149.08

*

*

50546

LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT

4182.00

090

Y

7337.95

*

*

50547

LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR

5578.80

090

Y

*

*

50548

LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY

4678.80

090

Y

*

*

J1

50549

UNLISTED LAPAROSCOPY PROCEDURE RENAL

BR

YYY

Y

9076.35

*

*

J1

50551

RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION

1251.60

000

N

7926.90

*

*

J1

50553

RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA

1336.80

000

N

7926.90

*

*

J1

50555

RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY

1429.20

000

N

7926.90

*

*

J1

50557

RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI

1454.40

000

N

13305.84

*

*

J1

50561

RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS

1646.40

000

N

7926.90

*

*

J1

50562

RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR

2017.20

090

Y

13305.84

*

*

J1

50570

RENAL NDSC NEPHROTOMY W/WO IRRIGATION

1707.60

000

N

5757.14

*

*

50572

RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER

1848.00

000

N

798.40

*

*

J1

50574

RENAL NDSC NEPHROTOMY W/BIOPSY

1965.60

000

N

3422.70

*

*

J1

50575

RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY

2481.60

000

N

7926.90

*

*

J1

50576

RNL NDSC NFROT FULGURATION &/INCISION W/WO BX

1960.80

000

N

7926.90

*

*

J1

50580

RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS

2110.80

000

N

7926.90

*

*

J1

50590

LITHOTRIPSY XTRCORP SHOCK WAVE

2520.00

090

N

5757.14

*

*

J1

50592

ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY

11086.80

010

N

9076.35

*

*

J1

50593

ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY

15058.80

010

Y

15106.63

*

*

50600

URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE

3259.20

090

Y

*

*

50605

URETEROTOMY INSERTION INDWELLING STENT ALL TYPES

3440.40

090

Y

+

*

50606

ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC

2256.00

ZZZ

N

*

*

50610

URTROLITHOTOMY UPPER ONE-THIRD URETER

3272.40

090

Y

*

*

50620

URTROLITHOTOMY MIDDLE ONE-THIRD URETER

3132.00

090

Y

*

*

50630

URTROLITHOTOMY LOWER ONE-THIRD URETER

3099.60

090

Y

*

*

50650

URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE

3603.60

090

Y

*

*

50660

URETERECTOMY TOT ECTOPIC URETER CMBN APPR

3966.00

090

Y

*

*

50684

INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH

372.00

000

N

*

*

50686

MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH

478.80

000

N

193.05

*

*

J1

50688

CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL

270.00

010

N

3422.70

*

*

50690

NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG

344.40

000

N

*

*

J1

50693

PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT

3448.80

000

N

3422.70

*

*

J1

50694

PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH

3804.00

000

N

5757.14

*

*

J1

50695

PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH

4645.20

000

N

5757.14

*

*

50700

URETEROPLASTY PLASTIC OPERATION URETER

3212.40

090

Y

+

*

50705

URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I

6818.40

ZZZ

N

+

*

50706

BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I

3289.20

ZZZ

N

*

*

50715

URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS

4230.00

090

Y

3102.68

*

*

50722

URETEROLYSIS FOR OVARIAN VEIN SYNDROME

3490.80

090

Y

*

*

50725

URTROLSS RETROCAVAL URTR W/REANAST

3828.00

090

Y

*

*

J1

50727

REVJ URINARY-CUTANEOUS ANASTAMOSIS

1765.20

090

Y

5757.14

*

*

50728

REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA

2547.60

090

Y

*

*

50740

EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR

4257.60

090

Y

*

*

50750

URETEROCALYCOSTOMY ANAST URETER RENAL CALYX

4006.80

090

Y

*

*

50760

URETEROURETEROSTOMY

3916.80

090

Y

*

*

50770

TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR

4002.00

090

Y

*

*

50780

URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER

3837.60

090

Y

6235.43

*

*

50782

URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR

3728.40

090

Y

*

*

50783

URETERONEOCYSTOSTOMY W/URETERAL TAILORING

3915.60

090

Y

*

*

50785

URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP

4216.80

090

Y

*

*

50800

URETEROENTEROSTOMY ANAST URETER INTESTINE

3223.20

090

Y

*

*

50810

URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER & COLOSTO

4868.40

090

Y

*

*

50815

URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS

4244.40

090

Y

*

*

50820

URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS

4563.60

090

Y

*

*

50825

CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN

5769.60

090

Y

*

*

50830

URINARY UNIDIVERSION

6258.00

090

Y

*

*

50840

RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST

4267.20

090

Y

*

*

50845

CUTANANEOUS APPENDICO-VESICOSTOMY

4339.20

090

Y

*

*

50860

URETEROSTOMY TRANSPLANTATION URETER SKIN

3279.60

090

Y

*

*

50900

URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE

2922.00

090

Y

*

*

50920

CLOSURE URETEROCUTANEOUS FISTULA

3045.60

090

Y

*

*

50930

CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR

3826.80

090

Y

*

*

50940

DELIGATION URETER

3075.60

090

Y

*

*

J1

50945

LAPAROSCOPY URTROLITHOTOMY

3372.00

090

Y

9076.35

*

*

J1

50947

LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT

4821.60

090

Y

9076.35

*

*

J1

50948

LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT

4423.20

090

Y

15106.63

*

*

J1

50949

UNLISTED LAPAROSCOPY PROCEDURE URETER

BR

YYY

Y

9076.35

*

*

J1

50951

URETERAL ENDOSCOPY VIA URETEROSTOMY

1308.00

000

N

3422.70

*

*

J1

50953

URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER

1383.60

000

N

5757.14

*

*

J1

50955

URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY

1476.00

000

N

7926.90

*

*

J1

50957

URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY

1489.20

000

N

7926.90

*

*

J1

50961

URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE

1342.80

000

N

7926.90

*

*

J1

50970

URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING

1286.40

000

N

3422.70

*

*

J1

50972

NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER

1244.40

000

N

5757.14

*

*

J1

50974

URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX

1642.80

000

N

7926.90

*

*

J1

50976

URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX

1621.20

000

N

7926.90

*

*

J1

50980

NDSC URETEROTOMY RMVL FB/CALCULUS

1237.20

000

N

7926.90

*

*

J1

51020

CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL

1621.20

090

Y

3422.70

*

*

J1

51030

CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES

1633.20

090

N

5757.14

*

*

J1

51040

CYSTOSTOMY CYSTOTOMY W/DRAINAGE

1003.20

090

Y

3422.70

*

*

J1

51045

CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX

1704.00

090

Y

3422.70

*

*

J1

51050

CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS

1639.20

090

Y

7926.90

*

*

J1

51060

TRANSVESICAL URETROLITHOTOMY

2018.40

090

Y

3422.70

*

*

J1

51065

CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO

2011.20

090

N

5757.14

*

*

J1

51080

DRG PRIVESICAL/PREVESICAL SPACE ABSC

1417.20

090

Y

4742.07

*

*

51100

ASPIRATION BLADDER NEEDLE

220.80

000

N

328.62

*

*

51101

ASPIRATION BLADDER TROCAR/INTRACATHETER

454.80

000

N

1296.16

*

*

J1

51102

ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER

792.00

000

N

3422.70

*

*

J1

51500

EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR

2208.00

090

Y

9076.35

*

*

J1

51520

CYSTOTOMY SIMPLE EXCISION VESICAL NECK

2064.00

090

Y

3422.70

*

*

51525

CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE

2980.80

090

Y

*

*

51530

CYSTOTOMY EXCISION BLADDER TUMOR

2670.00

090

Y

*

*

J1

51535

CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE

2704.80

090

Y

5757.14

*

*

51550

CYSTECTOMY PARTIAL SIMPLE

3348.00

090

Y

*

*

51555

CYSTECTOMY PARTIAL COMPLICATED

4402.80

090

Y

*

*

51565

CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST

4506.00

090

Y

*

*

51570

CYSTECTOMY COMPLETE SEPARATE PROCEDURE

5116.80

090

Y

*

*

51575

CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY

6331.20

090

Y

*

*

51580

CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES

6572.40

090

Y

*

*

51585

CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES

7326.00

090

Y

*

*

51590

CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST

6716.40

090

Y

*

*

51595

CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC

7602.00

090

Y

*

*

51596

CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR

8180.40

090

Y

*

*

51597

PELVIC EXENTERATION COMPLETE MALIGNANCY

7963.20

090

Y

*

*

51600

NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY

668.40

000

N

*

*

51605

NJX & PLACEMENT CHAIN CONTRAST&/URETHROCSTOGRAPY

133.20

000

N

*

*

51610

NJX RETROGRADE URETHROCSTOGRAPY

385.20

000

N

*

*

51700

BLDR IRRIGATION SMPL LAVAGE &/INSTLJ

254.40

000

N

328.62

*

*

51701

INSJ NON-NDWELLG BLADDER CATHETER

152.40

000

N

151.20

*

*

51702

INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE

211.20

000

N

151.20

*

*

51703

INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED

453.60

000

N

193.05

*

*

51705

CHANGE CYSTOSTOMY TUBE SIMPLE

320.40

000

N

328.62

*

*

51710

CHANGE CYSTOSTOMY TUBE COMPLICATED

442.80

000

N

798.40

*

*

J1

51715

NDSC NJX IMPLT MATRL URT&/BLDR NCK

1088.40

000

N

5757.14

*

*

51720

BLADDER INSTILLATION ANTICARCINOGENIC AGENT

288.00

000

N

328.62

*

*

51725

SIMPLE CYSTOMETROGRAM

682.80

262.80

420.00

000

N

*

*

51726

BLADDER PRESSURE MEASUREMENT DURING FILLING

952.80

295.20

657.60

000

N

*

*

51727

COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE

1126.80

367.20

759.60

000

N

*

*

51728

COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES

1146.00

361.20

784.80

000

N

*

*

51729

COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL

1225.20

435.60

789.60

000

N

*

*

51736

SIMPLE UROFLOMETRY

48.00

28.80

19.20

XXX

N

*

*

51741

COMPLEX UROFLOMETRY

49.20

28.80

20.40

XXX

N

*

*

51784

EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL

231.60

129.60

102.00

XXX

N

*

*

51785

NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ

1100.40

319.20

781.20

XXX

N

*

*

51792

STIMULUS EVOKED RESPONSE

788.40

190.80

597.60

000

N

+

*

51797

VOID PRESSURE STUDIES INTRAABDOMINAL

474.00

139.20

334.80

ZZZ

N

*

*

51798

MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP

43.20

BR

43.20

XXX

N

*

*

51800

CSTOPLASTY/CSTOURTP PLSTC ANY

3646.80

090

Y

*

*

51820

CSTOURTP W/UNI/BI URTRONEOCSTOST

3764.40

090

Y

*

*

51840

ANT VESICOURETHROPEXY/URETHROPEXY SMPL

2316.00

090

Y

3769.10

*

*

51841

ANT VESICOURETHROPEXY/URETHROPEXY COMP

2696.40

090

Y

*

*

J1

51845

ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL

2019.60

090

Y

7920.98

*

*

J1

51860

CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE

2586.00

090

Y

7926.90

*

*

51865

CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED

3114.00

090

Y

*

*

J1

51880

CLOSURE CYSTOSTOMY SEPARATE PROCEDURE

1621.20

090

Y

5757.14

*

*

51900

CLSR VESICOVAGINAL FISTUL AABDL APPROACH

2858.40

090

Y

*

*

51920

CLOSURE VESICOUTERINE FISTULA

2649.60

090

Y

*

*

51925

CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY

3543.60

090

Y

*

*

51940

CLOSURE EXSTROPHY BLADDER

5702.40

090

Y

*

*

51960

ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS

4806.00

090

Y

*

*

51980

CUTANEOUS VESICOSTOMY

2474.40

090

Y

*

*

J1

51990

LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT

2595.60

090

Y

9076.35

*

*

J1

51992

LAPAROSCOPY SLING OPERATION STRESS INCONT

2882.40

090

Y

9076.35

*

*

J1

51999

UNLISTED LAPAROSCOPY PROCEDURE BLADDER

BR

YYY

N

9076.35

*

*

52000

CYSTOURETHROSCOPY

646.80

000

N

798.40

*

*

J1

52001

CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS

1358.40

000

N

5757.14

*

*

J1

52005

CYSTO BLADDER W/URETERAL CATHETERIZATION

966.00

000

N

3422.70

*

*

J1

52007

CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS

1581.60

000

N

5757.14

*

*

52010

CYSTO W/EJACULATORY DUCT CATHETERIZATION

1317.60

000

N

798.40

*

*

J1

52204

CYSTOURETHROSCOPY WITH BIOPSY

1297.20

000

N

3422.70

*

*

J1

52214

CYSTO W/DESTRUCTION OF LESIONS

2400.00

000

N

3422.70

*

*

J1

52224

CYSTO W/REMOVAL OF LESIONS SMALL

2508.00

000

N

3422.70

*

*

J1

52234

CYSTO W/REMOVAL OF TUMORS SMALL

854.40

000

N

5757.14

*

*

J1

52235

CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM

1000.80

000

N

5757.14

*

*

J1

52240

CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE

1360.80

000

N

7926.90

*

*

J1

52250

CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG

830.40

000

N

5757.14

*

*

J1

52260

CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH

728.40

000

N

3422.70

*

*

J1

52265

CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA

1275.60

000

N

3422.70

*

*

J1

52270

CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE

1309.20

000

N

3422.70

*

*

J1

52275

CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE

1735.20

000

N

3422.70

*

*

J1

52276

CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE

918.00

000

N

3422.70

*

*

J1

52277

CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER

1122.00

000

N

5757.14

*

*

J1

52281

CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS

1023.60

000

N

3422.70

*

*

J1

52282

CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT

1171.20

000

N

5757.14

*

*

J1

52283

CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE

1041.60

000

N

3422.70

*

*

52285

CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME

1039.20

000

N

798.40

*

*

J1

52287

CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER

1158.00

000

N

3422.70

*

*

J1

52290

CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI

848.40

000

N

3422.70

*

*

J1

52300

CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI

970.80

000

N

5757.14

*

*

J1

52301

CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI

1005.60

000

N

5757.14

*

*

J1

52305

CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT

967.20

000

N

7926.90

*

*

J1

52310

CYSTO W/SIMPLE REMOVAL STONE & STENT

921.60

000

N

3422.70

*

*

J1

52315

CYSTO W/COMPLEX REMOVAL STONE & STENT

1514.40

000

N

3422.70

*

*

J1

52317

LITHOLAPAXY SMPL/SM <2.5 CM

2893.20

000

N

5757.14

*

*

J1

52318

LITHOLAPAXY COMP/LG > 2.5 CM

1645.20

000

N

5757.14

*

*

J1

52320

CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS

855.60

000

N

5757.14

*

*

J1

52325

CYSTO FRAGMENTATION URETERAL STONE

1112.40

000

N

7926.90

*

*

J1

52327

CYSTO W/SUBURTRIC NJX IMPLT MATRL

910.80

000

N

7926.90

*

*

J1

52330

CYSTO MANJ W/O RMVL URETERAL STONE

1855.20

000

N

5757.14

*

*

J1

52332

CYSTO W/INSERT URETERAL STENT

1623.60

000

N

5757.14

*

*

J1

52334

CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR

636.00

000

N

5757.14

*

*

J1

52341

CYSTO W/TX URETERAL STRICTURE

985.20

000

N

3422.70

*

*

J1

52342

CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE

1071.60

000

N

5757.14

*

*

J1

52343

CYSTO W/TX INTRA-RENAL STRICTURE

1195.20

000

N

3422.70

*

*

J1

52344

CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE

1282.80

000

N

5757.14

*

*

J1

52345

CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX

1369.20

000

N

5757.14

*

*

J1

52346

CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE

1550.40

000

N

7926.90

*

*

J1

52351

CYSTO W/URTROSCOPY&/PYELOSCOPY DX

1050.00

000

N

3422.70

*

*

J1

52352

CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES

1231.20

000

N

5757.14

*

*

J1

52353

CYSTO W/URETEROSCOPY W/LITHOTRIPSY

1360.80

000

N

7926.90

*

*

J1

52354

CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION

1449.60

000

N

7926.90

*

*

J1

52355

CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR

1623.60

000

N

7926.90

*

*

J1

52356

CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT

1446.00

000

N

7926.90

*

*

J1

52400

CYSTO INC FULG/RESCJ URTL VALVES/FOLDS

1659.60

090

N

5757.14

*

*

J1

52402

CSTO W/TRURL RESCJ/INC EJACULATORY DUXS

927.60

000

N

5757.14

*

*

52441

CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE

4340.40

000

N

+

*

52442

CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL

3255.60

ZZZ

N

*

*

J1

52450

TRANSURETHRAL INCISION PROSTATE

1630.80

090

N

5757.14

*

*

J1

52500

TRANSURETHRAL RESECTION BLADDER NECK

1695.60

090

N

5757.14

*

*

J1

52601

TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE

2530.80

090

N

7926.90

*

*

J1

52630

TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS

1390.80

090

N

7926.90

*

*

J1

52640

TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE

1096.80

090

N

5757.14

*

*

J1

52647

LASER COAGULATION OF PROSTATE FOR URINE FLOW

5554.80

090

N

7926.90

*

*

J1

52648

LASER VAPORIZATION OF PROSTATE FOR URINE FLOW

5728.80

090

N

7926.90

*

*

J1

52649

LASER ENUCLEATION PROSTATE W/MORCELLATION

2860.80

090

N

7926.90

*

*

J1

52700

TRURL DRAINAGE PROSTATIC ABSCESS

1531.20

090

N

5757.14

*

*

J1

53000

URTT/URTS XTRNL SPX PENDULOUS URETHRA

513.60

010

N

3422.70

*

*

J1

53010

URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA

1021.20

090

N

7926.90

*

*

J1

53020

MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT

336.00

000

N

3422.70

*

*

J1

53025

MEATOTOMY CUTTING MEATUS SPX INFANT

236.40

000

N

3422.70

*

*

J1

53040

DRAINAGE DEEP PERIURETHRAL ABSCESS

1362.00

090

N

3422.70

*

*

J1

53060

DRG OF SKENE'S GLAND ABSCESS OR CYST

628.80

010

N

3422.70

*

*

53080

DRG PERINEAL URINARY XTRVASATION UNCOMP SPX

1458.00

090

N

798.40

*

*

J1

53085

DRG PERINEAL URINARY XTRVASATION COMPLIC

2253.60

090

Y

3422.70

*

*

J1

53200

BIOPSY URETHRA

546.00

000

N

3422.70

*

*

J1

53210

URETHRECTOMY TOT W/CYSTOST FEMALE

2671.20

090

Y

5757.14

*

*

J1

53215

URETHRECTOMY TOT W/CYSTOST MALE

3222.00

090

Y

7926.90

*

*

J1

53220

EXC/FULGURATION CARCINOMA URETHRA

1567.20

090

N

5757.14

*

*

J1

53230

EXC URETHRAL DIVERTICULUM SPX FEMALE

2101.20

090

Y

7926.90

*

*

J1

53235

EXC URETHRAL DIVERTICULUM SPX MALE

2194.80

090

Y

7926.90

*

*

J1

53240

MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE

1473.60

090

N

3422.70

*

*

J1

53250

EXCISION OF BULBOURETHRAL GLAND

1372.80

090

N

5757.14

*

*

J1

53260

EXC/FULGURATION URETHRAL POLYP DSTL URETHRA

699.60

010

N

3422.70

*

*

J1

53265

EXC/FULGURATION URETHRAL CARUNCLE

763.20

010

N

3422.70

*

*

J1

53270

EXCISION OR FULGURATION SKENES GLANDS

717.60

010

N

3422.70

*

*

J1

53275

EXCISION/FULGURATION URETHRAL PROLAPSE

909.60

010

N

3422.70

*

*

J1

53400

URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX

2775.60

090

Y

7926.90

*

*

J1

53405

URETHROPLASTY 2ND STAGE W/URINARY DIVERSION

3032.40

090

Y

7926.90

*

*

J1

53410

URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA

3396.00

090

Y

7926.90

*

*

53415

URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT

3924.00

090

Y

7311.55

*

*

J1

53420

URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE

2920.80

090

N

7926.90

*

*

J1

53425

URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE

3252.00

090

Y

7926.90

*

*

J1

53430

URETHROPLASTY RCNSTJ FEMALE URETHRA

3354.00

090

Y

7926.90

*

*

J1

53431

URTP W/TUBULARIZATION POST URT&/LWR BLDR

4005.60

090

Y

7926.90

*

*

J1

53440

SLING OPRATION CORRJ MALE URINARY INCONTINENCE

2613.60

090

Y

13305.84

*

*

J1

53442

RMVL/REVJ SLING MALE URINARY INCONTINENCE

2716.80

090

Y

7926.90

*

*

J1

53444

INSERTION TANDEM CUFF

2751.60

090

Y

26963.98

*

*

J1

53445

INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER

2613.60

090

Y

26963.98

*

*

53446

REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER

2228.40

090

Y

5709.17

*

*

J1

53447

RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC

2804.40

090

Y

26963.98

*

*

53448

RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD

4437.60

090

Y

*

*

J1

53449

RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER

2122.80

090

Y

7926.90

*

*

J1

53450

URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT

1418.40

090

N

3422.70

*

*

J1

53460

URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM

1588.80

090

N

3422.70

*

*

J1

53500

URETHROLSS TRVG SEC OPN W/CSTO

2584.80

090

Y

5757.14

*

*

J1

53502

URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE

1687.20

090

N

5757.14

*

*

J1

53505

URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE

1686.00

090

Y

7926.90

*

*

J1

53510

URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL

2191.20

090

Y

7926.90

*

*

J1

53515

URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS

2762.40

090

Y

7926.90

*

*

J1

53520

CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX

1934.40

090

N

7926.90

*

*

53600

DILAT URETHRAL STRIX DILATOR MALE 1ST

286.80

000

N

328.62

*

*

53601

DILAT URETHRAL STRIX DILATOR MALE SBSQ

274.80

000

N

151.20

*

*

J1

53605

DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES

224.40

000

N

3422.70

*

*

53620

DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST

454.80

000

N

798.40

*

*

53621

DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ

427.20

000

N

328.62

*

*

53660

DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI

238.80

000

N

193.05

*

*

53661

DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ

235.20

000

N

151.20

*

*

J1

53665

DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES

134.40

000

N

3422.70

*

*

J1

53850

TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH

5449.20

090

N

5757.14

*

*

J1

53852

TRURL DSTRJ PRSTATE TISS RF THERMOTH

5276.40

090

N

5757.14

*

*

J1

53854

TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY

6246.00

090

N

3422.70

*

*

J1

53855

INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT

2613.60

000

N

3422.70

*

*

J1

53860

TRURL RF FEMALE BLADDER NECK STRS URIN INCONT

6326.40

090

N

3422.70

*

*

53899

UNLISTED PROCEDURE URINARY SYSTEM

BR

YYY

N

328.62

*

*

J1

54000

SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN

528.00

010

N

3422.70

*

*

J1

54001

SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN

652.80

010

N

3422.70

*

*

J1

54015

I&D PENIS DEEP

1070.40

010

N

2734.29

*

*

54050

DSTRJ LESION PENIS SIMPLE CHEMICAL

456.00

010

N

445.99

*

*

54055

DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION

418.80

010

N

2199.52

*

*

54056

DSTRJ LESION PENIS SIMPLE CRYOSURGERY

483.60

010

N

250.56

*

*

54057

DSTRJ LESION PENIS SIMPLE LASER

476.40

010

N

2199.52

*

*

54060

DSTRJ LESION PENIS SIMPLE SURG EXCISION

634.80

010

N

2199.52

*

*

54065

DSTRJ LESION PENIS EXTENSIVE

757.20

010

N

2199.52

*

*

J1

54100

BIOPSY PENIS SEPARATE PROCEDURE

676.80

000

N

2734.29

*

*

J1

54105

BIOPSY PENIS DEEP STRUCTURES

921.60

010

N

4742.07

*

*

J1

54110

EXCISION OF PENILE PLAQUE

2166.00

090

Y

5757.14

*

*

J1

54111

EXC PENILE PLAQUE GRAFT &/5 CM LENGTH

2773.20

090

Y

7926.90

*

*

J1

54112

EXC PENILE PLAQUE GRAFT > 5 CM LENGTH

3256.80

090

Y

13305.84

*

*

J1

54115

REMOVAL FOREIGN BODY DEEP PENILE TISSUE

1570.80

090

Y

4742.07

*

*

J1

54120

AMPUTATION PENIS PARTIAL

2194.80

090

Y

5757.14

*

*

54125

AMPUTATION PENIS COMPLETE

2828.40

090

Y

*

*

54130

AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE

4144.80

090

Y

*

*

54135

AMPUTATION PENIS RADICAL W/LYMPH NODES

5251.20

090

Y

*

*

J1

54150

CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK

530.40

000

N

3422.70

*

*

54160

CIRCUMCISION NEONATE

758.40

010

N

798.40

*

*

J1

54161

CIRCUMCISION AGE >28 DAYS

684.00

010

N

3422.70

*

*

J1

54162

LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS

890.40

010

N

3422.70

*

*

J1

54163

REPAIR INCOMPLETE CIRCUMCISION

757.20

010

N

3422.70

*

*

J1

54164

FRENULOTOMY PENIS

672.00

010

N

3422.70

*

*

54200

INJECTION PEYRONIE DISEASE

375.60

010

N

328.62

*

*

J1

54205

NJX PEYRONIE W/SURG EXPOS PLAQUE

1848.00

090

Y

7926.90

*

*

54220

IRRIGATION CORPORA CAVERNOSA PRIAPISM

716.40

000

N

328.62

*

*

54230

INJECTION CORPORA CAVERNOSOGRAPY

338.40

000

N

*

*

54231

DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS

489.60

000

N

328.62

*

*

54235

NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT

307.20

000

N

328.62

*

*

54240

PENILE PLETHYSMOGRAPHY

356.40

231.60

124.80

000

N

*

*

54250

NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST

420.00

379.20

40.80

000

N

*

*

J1

54300

PENIS STRAIGHTENING CHORDEE

2238.00

090

Y

5757.14

*

*

J1

54304

PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR

2600.40

090

Y

5757.14

*

*

J1

54308

URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM

2482.80

090

Y

7926.90

*

*

J1

54312

URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM

2841.60

090

Y

5757.14

*

*

J1

54316

URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF

3464.40

090

Y

7926.90

*

*

J1

54318

URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS

2467.20

090

Y

5757.14

*

*

J1

54322

1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT

2712.00

090

Y

5757.14

*

*

J1

54324

1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS

3363.60

090

Y

5757.14

*

*

J1

54326

1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS

3282.00

090

Y

3422.70

*

*

J1

54328

1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ

3260.40

090

Y

5757.14

*

*

J1

54332

1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR

3520.80

090

Y

5757.14

*

*

J1

54336

1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLAP

4131.60

090

Y

5757.14

*

*

J1

54340

RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE

1977.60

090

Y

5757.14

*

*

J1

54344

RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP

3289.20

090

Y

7926.90

*

*

J1

54348

RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF

3520.80

090

Y

7926.90

*

*

J1

54352

RPR HYPOSPADIAS CRIPPLE W/DSJ & EXC & GRFS/FLAP

4921.20

090

Y

7926.90

*

*

J1

54360

PLASTIC RPR PENIS CORRECT ANGULATION

2500.80

090

Y

5757.14

*

*

J1

54380

PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR

2775.60

090

Y

3422.70

*

*

J1

54385

PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT

3225.60

090

Y

3422.70

*

*

54390

PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER

4311.60

090

Y

*

*

J1

54400

INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID

1840.80

090

N

26963.98

*

*

J1

54401

INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED

2277.60

090

N

26963.98

*

*

J1

54405

INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH

2808.00

090

Y

26963.98

*

*

54406

RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH

2535.60

090

Y

4156.14

*

*

J1

54408

RPR COMPONENT INFLATABLE PENILE PROSTHESIS

2744.40

090

Y

7926.90

*

*

J1

54410

RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS

2986.80

090

Y

26963.98

*

*

J1

54411

RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL

3564.00

090

Y

26963.98

*

*

54415

RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT

1836.00

090

Y

4156.14

*

*

J1

54416

RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI

2469.60

090

Y

26963.98

*

*

J1

54417

RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD

3116.40

090

Y

26963.98

*

*

J1

54420

CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI

2443.20

090

Y

3422.70

*

*

54430

CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI

2223.60

090

Y

3414.89

*

*

J1

54435

CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM

1443.60

090

N

3422.70

*

*

J1

54437

REPAIR OF TRAUMATIC CORPOREAL TEAR(S)

2337.60

090

Y

5757.14

*

*

54438

REPLANTATION PENIS COMP AMPUTATION W/URETH REP

4647.60

090

Y

*

*

J1

54440

PLASTIC OPERATION PENIS INJURY

3268.80

090

Y

5757.14

*

*

54450

FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING

238.80

000

N

328.62

*

*

J1

54500

BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE

258.00

000

N

4742.07

*

*

J1

54505

BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE

728.40

010

N

5757.14

*

*

J1

54512

EXC XTRPARENCHYMAL LESION TESTIS

1873.20

090

N

5757.14

*

*

J1

54520

ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH

1134.00

090

N

3422.70

*

*

J1

54522

ORCHIECTOMY PARTIAL

2046.00

090

Y

3422.70

*

*

J1

54530

ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH

1755.60

090

Y

5716.03

*

*

J1

54535

ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL

2578.80

090

Y

5757.14

*

*

J1

54550

EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA

1707.60

090

Y

5716.03

*

*

J1

54560

EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL

2384.40

090

Y

3422.70

*

*

J1

54600

RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS

1572.00

090

N

3422.70

*

*

J1

54620

FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE

1039.20

010

N

5757.14

*

*

J1

54640

ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR

1660.80

090

N

5716.03

*

*

J1

54650

ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS

2468.40

090

Y

5716.03

*

*

J1

54660

INSJ TESTICULAR PROSTH SEPARATE PROCEDURE

1239.60

090

N

7926.90

*

*

J1

54670

SUTURE/REPAIR TESTICULAR INJURY

1410.00

090

N

3422.70

*

*

J1

54680

TRANSPLANTATION TESTIS TO THIGH

2733.60

090

Y

3422.70

*

*

J1

54690

LAPAROSCOPY SURGICAL ORCHIECTOMY

2278.80

090

Y

9076.35

*

*

J1

54692

LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS

2632.80

090

N

9076.35

*

*

J1

54699

UNLISTED LAPAROSCOPY PROCEDURE TESTIS

BR

YYY

Y

9076.35

*

*

J1

54700

I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE

739.20

010

N

3422.70

*

*

J1

54800

BIOPSY EPIDIDYMIS NEEDLE

436.80

000

N

2734.29

*

*

J1

54830

EXCISION LOCAL LESION EPIDIDYMIS

1293.60

090

N

3422.70

*

*

J1

54840

EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY

1114.80

090

N

3422.70

*

*

J1

54860

EPIDIDYMECTOMY UNILATERAL

1454.40

090

N

3422.70

*

*

J1

54861

EPIDIDYMECTOMY BILATERAL

1966.80

090

N

5757.14

*

*

J1

54865

EXPLORATION EPIDIDYMIS W/WO BIOPSY

1244.40

090

N

3422.70

*

*

J1

54900

EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI

2780.40

090

N

3422.70

*

*

J1

54901

EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI

3670.80

090

N

5757.14

*

*

55000

PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED

400.80

000

N

822.66

*

*

J1

55040

EXCISION HYDROCELE UNILATERAL

1172.40

090

N

5716.03

*

*

J1

55041

EXCISION HYDROCELE BILATERAL

1772.40

090

N

5716.03

*

*

J1

55060

RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE

1321.20

090

N

3422.70

*

*

J1

55100

DRAINAGE SCROTAL WALL ABSCESS

753.60

010

N

2734.29

*

*

J1

55110

SCROTAL EXPLORATION

1344.00

090

N

5757.14

*

*

J1

55120

REMOVAL FOREIGN BODY SCROTUM

1227.60

090

N

3422.70

*

*

J1

55150

RESECTION SCROTUM

1707.60

090

Y

3422.70

*

*

J1

55175

SCROTOPLASTY SIMPLE

1260.00

090

N

5757.14

*

*

J1

55180

SCROTOPLASTY COMPLICATED

2390.40

090

N

7926.90

*

*

J1

55200

VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX

1455.60

090

N

3422.70

*

*

J1

55250

VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

1279.20

090

N

3422.70

*

*

55300

VASOTOMY VASOGRAMS UNI/BI

650.40

000

N

*

*

J1

55400

VASOVASOSTOMY VASOVASORRHAPHY

1726.80

090

Y

5757.14

*

*

J1

55500

EXC HYDROCELE SPRMATIC CORD UNI SPX

1370.40

090

N

3422.70

*

*

J1

55520

EXC LESION SPERMATIC CORD SEPARATE PROCEDURE

1574.40

090

Y

3422.70

*

*

J1

55530

EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX

1220.40

090

N

5757.14

*

*

J1

55535

EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL

1492.80

090

Y

5716.03

*

*

J1

55540

EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR

1920.00

090

N

5716.03

*

*

J1

55550

LAPS LIGATION SPERMATIC VEINS VARICOCELE

1486.80

090

Y

9076.35

*

*

J1

55559

UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD

BR

YYY

Y

9076.35

*

*

J1

55600

VESICULOTOMY

1462.80

090

N

3422.70

*

*

55605

VESICULOTOMY COMPLICATED

1812.00

090

N

*

*

55650

VESICULECTOMY ANY APPROACH

2486.40

090

Y

*

*

J1

55680

EXCISION MULLERIAN DUCT CYST

1190.40

090

N

5757.14

*

*

J1

55700

PROSTATE NEEDLE BIOPSY ANY APPROACH

854.40

000

N

3422.70

*

*

J1

55705

BIOPSY PROSTATE INCISIONAL ANY APPROACH

921.60

010

N

3422.70

*

*

J1

55706

BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID

1293.60

010

Y

3422.70

*

*

J1

55720

PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE

1567.20

090

Y

3422.70

*

*

J1

55725

PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED

2061.60

090

Y

5757.14

*

*

55801

PROSTATECTOMY PERINEAL SUBTOTAL

3796.80

090

Y

*

*

55810

PROSTATECTOMY PERINEAL RADICAL

4562.40

090

Y

*

*

55812

PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX

5589.60

090

Y

*

*

55815

PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC

6104.40

090

Y

*

*

55821

PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES

3033.60

090

Y

*

*

55831

PROSTATECTOMY RETROPUBIC SUBTOTAL

3282.00

090

Y

*

*

55840

PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING

4069.20

090

Y

*

*

55842

PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX

4072.80

090

Y

*

*

55845

PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM

4737.60

090

Y

6090.43

*

*

J1

55860

EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST

3039.60

090

N

7926.90

*

*

55862

EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX

3808.80

090

Y

*

*

55865

EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH

4605.60

090

Y

*

*

J1

55866

LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT

5013.60

090

Y

15106.63

*

*

55870

ELECTROEJACULATION

604.80

000

N

792.42

*

*

J1

55873

CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI

21183.60

090

N

13305.84

*

*

55874

TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX

11836.80

000

N

5709.17

*

*

J1

55875

TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ

2656.80

090

N

7926.90

*

*

55876

PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT

486.00

000

N

1692.53

*

*

55899

UNLISTED PROCEDURE MALE GENITAL SYSTEM

BR

YYY

N

328.62

*

*

J1

55920

PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL

1561.20

000

N

7920.98

*

*

J1

55970

INTERSEX SURG MALE FEMALE

BR

YYY

N

4707.90

*

*

J1

55980

INTERSEX SURG FEMALE MALE

BR

YYY

N

5757.14

*

*

56405

I&D VULVA/PERINEAL ABSCESS

390.00

010

N

387.66

*

*

56420

I&D OF BARTHOLINS GLAND ABSCESS

463.20

010

N

235.62

*

*

J1

56440

MARSUPIALIZATION BARTHOLINS GLAND CYST

618.00

010

N

4707.90

*

*

J1

56441

LYSIS LABIAL ADHESIONS

519.60

010

N

4707.90

*

*

J1

56442

HYMENOTOMY SIMPLE INCISION

160.80

000

N

4707.90

*

*

56501

DESTRUCTION LESIONS VULVA SIMPLE

492.00

010

N

2199.52

*

*

56515

DESTRUCTION LESIONS VULVA EXTENSIVE

806.40

010

N

2199.52

*

*

56605

BIOPSY VULVA/PERINEUM 1 LESION SPX

291.60

000

N

792.42

+

*

56606

BIOPSY VULVA/PERINEUM EACH ADDL LESION

130.80

ZZZ

N

*

*

J1

56620

VULVECTOMY SIMPLE PARTIAL

1860.00

090

Y

4707.90

*

*

J1

56625

VULVECTOMY SIMPLE COMPLETE

2229.60

090

Y

4707.90

*

*

56630

VULVECTOMY RADICAL PARTIAL

3271.20

090

Y

3040.15

*

*

56631

VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADECTOMY

4136.40

090

Y

*

*

56632

VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY

4881.60

090

Y

*

*

56633

VULVECTOMY RADICAL COMPLETE

4243.20

090

Y

*

*

56634

VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADECTOMY

4546.80

090

Y

*

*

56637

VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADECTOMY

5271.60

090

Y

*

*

56640

VULVECTOMY RAD COMPL ILIAC & PELVIC LMPHADECTOMY

5232.00

090

Y

*

*

J1

56700

PRTL HYMENECTOMY/REVJ HYMENAL RING

645.60

010

Y

4707.90

*

*

J1

56740

EXC BARTHOLINS GLAND/CYST

1039.20

010

N

4707.90

*

*

J1

56800

PLASTIC REPAIR INTROITUS

830.40

010

Y

4707.90

*

*

J1

56805

CLITOROPLASTY INTERSEX STATE

3900.00

090

Y

4707.90

*

*

J1

56810

PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX

898.80

010

Y

4707.90

*

*

56820

COLPOSCOPY VULVA

393.60

000

N

235.62

*

*

56821

COLPOSCOPY VULVA W/BIOPSY

523.20

000

N

387.66

*

*

J1

57000

COLPOTOMY W/EXPLORATION

652.80

010

N

4707.90

*

*

J1

57010

COLPOTOMY W/DRAINAGE PELVIC ABSCESS

1491.60

090

N

4707.90

*

*

J1

57020

COLPOCENTESIS SEPARATE PROCEDURE

332.40

000

N

4707.90

*

*

J1

57022

I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM

583.20

010

N

2734.29

*

*

J1

57023

I&D VAGINAL HEMATOMA NON-OBSTETRICAL

1059.60

010

N

4742.07

*

*

J1

57061

DESTRUCTION VAGINAL LESIONS SIMPLE

422.40

010

N

4707.90

*

*

J1

57065

DESTRUCTION VAGINAL LESIONS EXTENSIVE

705.60

010

N

4707.90

*

*

57100

BIOPSY VAGINAL MUCOSA SIMPLE

316.80

000

N

792.42

*

*

J1

57105

BIOPSY VAGINAL MUCOSA EXTENSIVE

502.80

010

N

4707.90

*

*

J1

57106

VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL

1744.80

090

Y

4707.90

*

*

J1

57107

VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T

5031.60

090

Y

4707.90

*

*

J1

57109

VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC

6106.80

090

Y

4707.90

*

*

57110

VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL

3046.80

090

Y

*

*

57111

VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS

6117.60

090

Y

*

*

57112

VAGNC COMPL RMVL VAG WALL TOT PEL LMPHADEC BX

6567.60

090

Y

*

*

J1

57120

COLPOCLEISIS LE FORT TYPE

1752.00

090

Y

7920.98

*

*

J1

57130

EXCISION VAGINAL SEPTUM

638.40

010

Y

4707.90

*

*

J1

57135

EXCISION VAGINAL CYST/TUMOR

696.00

010

N

4707.90

*

*

57150

IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE

165.60

000

N

151.20

*

*

J1

57155

INSERTION UTERINE TANDEM&/VAGINAL OVOIDS

1281.60

000

N

4707.90

*

*

57156

INSERTION VAGINAL RADIATION DEVICE

710.40

000

N

387.66

*

*

57160

FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI

214.80

000

N

235.62

*

*

57170

DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS

222.00

000

N

235.62

*

*

57180

INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX

524.40

010

N

235.62

*

*

J1

57200

COLPORRHAPHY SUTURE INJURY VAGINA

1064.40

090

Y

4707.90

*

*

J1

57210

COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU

1275.60

090

Y

4707.90

*

*

J1

57220

PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH

1108.80

090

Y

7920.98

*

*

J1

57230

PLASTIC REPAIR URETHROCELE

1360.80

090

Y

4707.90

*

*

J1

57240

ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO

2040.00

090

Y

7920.98

*

*

J1

57250

POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY

2044.80

090

Y

7920.98

*

*

J1

57260

CMBND ANTERPOST COLPORRAPHY W/CYSTO

2611.20

090

Y

7920.98

*

*

J1

57265

CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR

2931.60

090

Y

7920.98

+

*

57267

INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE

870.00

ZZZ

Y

*

*

J1

57268

REPAIR ENTEROCELE VAGINAL APPROACH SPX

1672.80

090

Y

4707.90

*

*

57270

REPAIR ENTEROCELE ABDOMINAL APPROACH SPX

2763.60

090

Y

2767.50

*

*

57280

COLPOPEXY ABDOMINAL APPROACH

3272.40

090

Y

3811.53

*

*

J1

57282

COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH

1747.20

090

Y

12024.56

*

*

J1

57283

COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH

2354.40

090

Y

12024.56

*

*

J1

57284

PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR

2800.80

090

Y

7920.98

*

*

J1

57285

PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH

2313.60

090

Y

12024.56

*

*

57287

RMVL/REVJ SLING STRESS INCONTINENCE

2394.00

090

Y

3353.00

*

*

J1

57288

SLING OPERATION STRESS INCONTINENCE

2475.60

090

Y

7920.98

*

*

J1

57289

PEREYRA PX W/ANTERIOR COLPORRHAPHY

2613.60

090

Y

12024.56

*

*

J1

57291

CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT

1810.80

090

Y

4707.90

*

*

J1

57292

CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT

2773.20

090

Y

7920.98

*

*

J1

57295

REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP

1652.40

090

Y

4707.90

*

*

57296

REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR

3228.00

090

Y

*

*

J1

57300

CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR

1977.60

090

Y

4707.90

*

*

57305

CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH

3280.80

090

Y

*

*

57307

CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST

3576.00

090

Y

*

*

57308

CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ

2277.60

090

Y

*

*

J1

57310

CLOSURE URETHROVAGINAL FISTULA

1628.40

090

Y

12024.56

*

*

57311

CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL

1851.60

090

Y

*

*

J1

57320

CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH

1863.60

090

Y

7920.98

*

*

J1

57330

CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR

2594.40

090

Y

12024.56

*

*

J1

57335

VAGINOPLASTY INTERSEX STATE

3937.20

090

Y

4707.90

*

*

J1

57400

DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL

457.20

000

N

4707.90

*

*

J1

57410

PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL

366.00

000

N

4707.90

*

*

J1

57415

REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL

564.00

010

N

4707.90

*

*

57420

COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT

414.00

000

N

387.66

*

*

57421

COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX

554.40

000

N

792.42

*

*

J1

57423

PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH

3134.40

090

Y

15106.63

*

*

J1

57425

LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX

3321.60

090

Y

15106.63

*

*

J1

57426

REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC

2906.40

090

Y

12024.56

*

*

57452

COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA

390.00

000

N

235.62

*

*

57454

COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE

534.00

000

N

387.66

*

*

57455

COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX

504.00

000

N

387.66

*

*

57456

COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE

474.00

000

N

387.66

*

*

J1

57460

COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX

996.00

000

N

4707.90

*

*

J1

57461

COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX

1120.80

000

N

4707.90

*

*

57500

BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX

456.00

000

N

792.42

*

*

57505

ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C

382.80

010

N

792.42

*

*

J1

57510

CAUTERY CERVIX ELECTRO/THERMAL

468.00

010

N

4707.90

*

*

57511

CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT

531.60

010

N

387.66

*

*

J1

57513

CAUTERY CERVIX LASER ABLATION

553.20

010

N

4707.90

*

*

J1

57520

CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER

1099.20

090

N

4707.90

*

*

J1

57522

CONIZATION CERVIX W/WO D&C RPR ELTRD EXC

934.80

090

N

4707.90

*

*

J1

57530

TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX

1206.00

090

Y

4707.90

*

*

57531

RAD TRACHELECTOMY W/BI PEL LMPHADEC

5744.40

090

Y

*

*

57540

EXCISION CERVICAL STUMP ABDOMINAL APPROACH

2637.60

090

Y

*

*

57545

EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR

2796.00

090

Y

*

*

J1

57550

EXCISION CERVICAL STUMP VAGINAL APPROACH

1400.40

090

Y

4707.90

*

*

J1

57555

EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR

2053.20

090

Y

7920.98

*

*

J1

57556

EXC CRV STUMP VAG APPR W/RPR NTRCL

1942.80

090

Y

7920.98

*

*

J1

57558

DILATION & CURETTAGE CERVICAL STUMP

456.00

010

N

4707.90

*

*

J1

57700

CERCLAGE UTERINE CERVIX NONOBSTETRICAL

1095.60

090

N

4707.90

*

*

J1

57720

TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG

1066.80

090

Y

4707.90

*

*

J1

57800

DILATION CERVICAL CANAL INSTRUMENTAL SPX

222.00

000

N

4707.90

*

*

58100

ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX

316.80

000

N

235.62

+

*

58110

ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY

172.80

ZZZ

N

*

*

J1

58120

DILATION & CURETTAGE DX&/THER NONOBSTETRIC

919.20

010

N

4707.90

*

*

58140

MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR

3141.60

090

Y

5464.40

*

*

J1

58145

MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR

1893.60

090

Y

4707.90

*

*

58146

MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA

3906.00

090

Y

5200.25

*

*

58150

TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY

3492.00

090

Y

6383.31

*

*

58152

TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY

4270.80

090

Y

*

*

58180

SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY

3286.80

090

Y

5378.29

*

*

58200

TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM

4765.20

090

Y

*

*

58210

RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY

6410.40

090

Y

8135.99

*

*

58240

PEL EXNTJ GYNECOLOGIC MAL

10178.40

090

Y

*

*

J1

58260

VAGINAL HYSTERECTOMY UTERUS 250 GM/<

2817.60

090

Y

7920.98

*

*

J1

58262

VAG HYST 250 GM/< W/RMVL TUBE&/OVARY

3132.00

090

Y

7920.98

*

*

J1

58263

VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL

3367.20

090

Y

7920.98

*

*

58267

VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY

3582.00

090

Y

2863.66

*

*

J1

58270

VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE

3009.60

090

Y

7920.98

*

*

58275

VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY

3350.40

090

Y

*

*

58280

VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE

3567.60

090

Y

*

*

58285

VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION

5023.20

090

Y

5700.23

*

*

J1

58290

VAGINAL HYSTERECTOMY UTERUS > 250 GM

3909.60

090

Y

12024.56

*

*

J1

58291

VAG HYST > 250 GM RMVL TUBE&/OVARY

4272.00

090

Y

7920.98

*

*

J1

58292

VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE

4441.20

090

Y

12024.56

*

*

58293

VAG HYST >250 GM COLPOURTCSTOPEXY W/WO NDSC CTR

4626.00

090

Y

*

*

J1

58294

VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE

4125.60

090

Y

7920.98

*

*

58300

INSERTION INTRAUTERINE DEVICE IUD

273.60

XXX

N

1318.23

*

*

58301

REMOVAL INTRAUTERINE DEVICE IUD

324.00

000

N

235.62

*

*

58321

ARTIFICIAL INSEMINATION INTRA-CERVICAL

264.00

000

N

387.66

*

*

58322

ARTIFICIAL INSEMINATION INTRA-UTERINE

296.40

000

N

235.62

*

*

58323

SPERM WASHING ARTIFICIAL INSEMINATION

51.60

000

N

235.62

*

*

58340

CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI

536.40

000

N

*

*

J1

58345

TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING

952.80

010

Y

4707.90

*

*

J1

58346

INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY

1591.20

090

N

4707.90

*

*

J1

58350

CHROMOTUBATION OVIDUCT W/MATERIALS

368.40

010

N

7920.98

*

*

J1

58353

ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID

3367.20

010

N

7920.98

*

*

J1

58356

ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR

6256.80

010

Y

7920.98

*

*

58400

UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX

1524.00

090

Y

3101.58

*

*

58410

UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY

2734.80

090

Y

*

*

58520

HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL

2677.20

090

Y

2594.03

*

*

58540

HYSTEROPLASTY RPR UTERINE ANOMALY

3085.20

090

Y

3363.49

*

*

J1

58541

LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<

2442.00

090

Y

9076.35

*

*

J1

58542

LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR

2794.80

090

Y

15106.63

*

*

J1

58543

LAPS SUPRACERVICAL HYSTERECTOMY >250

2820.00

090

Y

15106.63

*

*

J1

58544

LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY

3063.60

090

Y

15106.63

*

*

J1

58545

LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<

3074.40

090

Y

9076.35

*

*

J1

58546

LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS

3794.40

090

Y

15106.63

*

*

58548

LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY

6607.20

090

Y

10075.94

*

*

J1

58550

LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<

2990.40

090

Y

9076.35

*

*

J1

58552

LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES

3366.00

090

Y

15106.63

*

*

J1

58553

LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS

3816.00

090

Y

15106.63

*

*

J1

58554

LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR

4513.20

090

Y

15106.63

*

*

J1

58555

HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE

1008.00

000

N

4707.90

*

*

J1

58558

HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

4664.40

000

N

4707.90

*

*

J1

58559

HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS

984.00

000

N

7920.98

*

*

J1

58560

HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM

1072.80

000

Y

7920.98

*

*

J1

58561

HYSTEROSCOPY REMOVAL LEIOMYOMATA

1231.20

000

N

7920.98

*

*

J1

58562

HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY

1246.80

000

N

4707.90

*

*

J1

58563

HYSTEROSCOPY ENDOMETRIAL ABLATION

6025.20

000

N

7920.98

*

*

J1

58565

HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS

6216.00

090

N

7920.98

*

*

J1

58570

LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<

2690.40

090

Y

15106.63

*

*

J1

58571

LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY

3099.60

090

Y

15106.63

*

*

J1

58572

LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM

3525.60

090

Y

15106.63

*

*

J1

58573

LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR

4200.00

090

Y

15106.63

*

*

58575

LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC

6531.60

090

Y

*

*

J1

58578

UNLISTED LAPAROSCOPY PROCEDURE UTERUS

BR

YYY

Y

9076.35

*

*

58579

UNLISTED HYSTEROSCOPY PROCEDURE UTERUS

BR

YYY

Y

235.62

*

*

J1

58600

LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI

1239.60

090

Y

4707.90

*

*

58605

LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX

1122.00

090

Y

+

*

58611

LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG

260.40

ZZZ

Y

1208.07

*

*

J1

58615

OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR

834.00

010

Y

4707.90

*

*

J1

58660

LAPAROSCOPY W/LYSIS OF ADHESIONS

2305.20

090

Y

9076.35

*

*

J1

58661

LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES

2226.00

010

Y

9076.35

*

*

J1

58662

LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE

2426.40

090

Y

9076.35

*

*

J1

58670

LAPAROSCOPY FULGURATION OVIDUCTS

1239.60

090

N

9076.35

*

*

J1

58671

LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS

1240.80

090

N

9076.35

*

*

J1

58672

LAPAROSCOPY FIMBRIOPLASTY

2484.00

090

Y

9076.35

*

*

J1

58673

LAPAROSCOPY SALPINGOSTOMY

2692.80

090

Y

9076.35

*

*

J1

58674

LAPS ABLTJ UTERINE FIBROIDS W/INTRAOP US GDN

2761.20

090

Y

15106.63

*

*

J1

58679

UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT/OVARY

BR

YYY

Y

9076.35

*

*

58700

SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX

2684.40

090

Y

3661.40

*

*

58720

SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX

2558.40

090

Y

4047.95

*

*

58740

LYSIS OF ADHESIONS SALPINX/OVARY

3064.80

090

Y

2052.31

*

*

58750

TUBOTUBAL ANASTATOMOSIS

3060.00

090

Y

6199.72

*

*

58752

TUBOUTERINE IMPLANTATION

3051.60

090

Y

*

*

58760

FIMBRIOPLASTY

2752.80

090

Y

*

*

J1

58770

SALPINGOSTOMY

2896.80

090

Y

4707.90

*

*

J1

58800

DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR

1120.80

090

N

4707.90

*

*

J1

58805

DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL

1393.20

090

Y

4707.90

*

*

J1

58820

DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN

1082.40

090

Y

4707.90

*

*

58822

DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH

2377.20

090

Y

*

*

58825

TRANSPOSITION OVARY

2360.40

090

Y

4473.34

*

*

J1

58900

BIOPSY OVARY UNI/BI SEPARATE PROCEDURE

1419.60

090

Y

4707.90

*

*

J1

58920

WEDGE RESCJ/BISCTJ OVARY UNI/BI

2383.20

090

Y

12024.56

*

*

J1

58925

OVARIAN CYSTECTOMY UNI/BI

2575.20

090

Y

7920.98

*

*

58940

OOPHORECTOMY PARTIAL/TOTAL UNI/BI

1837.20

090

Y

4080.76

*

*

58943

OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY

4102.80

090

Y

*

*

58950

RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO

3956.40

090

Y

*

*

58951

RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD

5058.00

090

Y

*

*

58952

RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING

5738.40

090

Y

*

*

58953

BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION

7070.40

090

Y

*

*

58954

BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY

7677.60

090

Y

*

*

58956

BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC

4797.60

090

Y

*

*

58957

RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY

5554.80

090

Y

*

*

58958

RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC

6148.80

090

Y

*

*

58960

LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK

3391.20

090

Y

*

*

58970

FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD

771.60

000

N

792.42

*

*

58974

EMBRYO TRANSFER INTRAUTERINE

1534.80

000

Y

792.42

*

*

58976

GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH

846.00

000

Y

387.66

*

*

58999

UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL

BR

YYY

N

235.62

*

*

59000

AMNIOCENTESIS DIAGNOSIC

423.60

000

N

792.42

*

*

59001

AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID

618.00

000

N

387.66

*

*

59012

CORDOCENTESIS INTRAUTERINE

698.40

000

N

387.66

*

*

59015

CHORIONIC VILLUS SAMPLING

536.40

000

N

792.42

*

*

59020

FETAL CONTRACTION STRESS TEST

238.80

127.20

111.60

000

N

*

*

59025

FETAL NONSTRESS TEST

164.40

102.00

62.40

000

N

*

*

59030

FETAL SCALP BLOOD SAMPLING

390.00

000

N

387.66

*

*

59050

FETAL MONITORING LABOR PHYS WRITTEN REPORT

175.20

XXX

N

*

*

59051

FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY

145.20

XXX

N

*

*

59070

TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE

1383.60

000

Y

387.66

*

*

59072

FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE

1807.20

000

N

387.66

*

*

59074

FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE

1333.20

000

Y

387.66

*

*

59076

FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE

1807.20

000

Y

387.66

*

*

J1

59100

HYSTEROTOMY ABDOMINAL

2902.80

090

Y

4707.90

*

*

59120

TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR

2764.80

090

Y

4014.66

*

*

59121

TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY

2768.40

090

Y

3447.52

*

*

59130

TX ECTOPIC PREGNANCY ABDL PREGNANCY

3226.80

090

N

*

*

59135

TX ECTOPIC PREGNANCY NTRSTL REQ TOT HYST

3187.20

090

N

*

*

59136

TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER

3056.40

090

Y

*

*

59140

TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION

1398.00

090

Y

*

*

J1

59150

LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY

2679.60

090

Y

9076.35

*

*

J1

59151

LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY

2606.40

090

Y

9076.35

*

*

J1

59160

CURETTAGE POSTPARTUM

745.20

010

N

4707.90

*

*

59200

INSERTION CERVICAL DILATOR SEPARATE PROCEDURE

267.60

000

N

387.66

*

*

J1

59300

EPISIOTOMY/VAG RPR OTH/THN ATTENDING

692.40

000

N

4707.90

*

*

J1

59320

CERCLAGE CERVIX PREGNANCY VAGINAL

524.40

000

N

4707.90

*

*

59325

CERCLAGE CERVIX PREGNANCY ABDOMINAL

835.20

000

N

5193.61

*

*

59350

HYSTERORRHAPHY RUPTURED UTERUS

969.60

000

Y

*

*

59400

OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM

7251.60

MMM

N

*

*

J1

59409

VAGINAL DELIVERY ONLY

2804.40

MMM

N

4707.90

*

*

59410

VAGINAL DELIVERY ONLY W/POSTPARTUM CARE

3592.80

MMM

N

*

*

J1

59412

EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS

354.00

MMM

N

4707.90

*

*

J1

59414

DELIVERY PLACENTA SEPARATE PROCEDURE

318.00

MMM

N

4707.90

*

*

59425

ANTEPARTUM CARE ONLY 4-6 VISITS

1581.60

MMM

N

*

*

59426

ANTEPARTUM CARE ONLY 7/> VISITS

2822.40

MMM

N

*

*

59430

POSTPARTUM CARE ONLY SEPARATE PROCEDURE

668.40

MMM

N

*

*

59510

OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM

8040.00

MMM

N

*

*

59514

CESAREAN DELIVERY ONLY

3159.60

MMM

Y

2410.81

*

*

59515

CESAREAN DELIVERY ONLY W/POSTPARTUM CARE

4368.00

MMM

N

+

*

59525

STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY

1675.20

ZZZ

Y

*

*

59610

ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB

7609.20

MMM

N

*

*

J1

59612

VAGINAL DELIVERY AFTER CESAREAN DELIVERY

3160.80

MMM

N

4707.90

*

*

59614

VAGINAL DELIVERY & POSTPARTUM CARE VBAC

3919.20

MMM

N

*

*

59618

ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC

8145.60

MMM

N

*

*

59620

CESAREAN DELIVERY ATTEMPTED VBAC

3247.20

MMM

Y

*

*

59622

CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA

4498.80

MMM

N

*

*

J1

59812

TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL

1124.40

090

N

4707.90

*

*

J1

59820

TX MISSED ABORTION FIRST TRIMESTER SURGICAL

1348.80

090

N

4707.90

*

*

J1

59821

TX MISSED ABORTION SECOND TRIMESTER SURGICAL

1350.00

090

N

4707.90

*

*

59830

TX SEPTIC ABORTION SURGICAL

1531.20

090

N

*

*

J1

59840

INDUCED ABORTION DILATION AND CURETTAGE

780.00

010

N

4707.90

*

*

J1

59841

INDUCED ABORTION DILATION & EVACUATION

1348.80

010

N

4707.90

*

*

59850

INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ

1222.80

090

N

*

*

59851

INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C

1317.60

090

N

*

*

59852

INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM

1803.60

090

N

*

*

59855

INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS

1440.00

090

N

1676.03

*

*

59856

INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC

1692.00

090

N

*

*

59857

INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT

1807.20

090

N

*

*

59866

MULTIFETAL PREGNANCY REDUCTION

746.40

000

Y

387.66

*

*

J1

59870

UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE

1686.00

090

Y

4707.90

*

*

59871

REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA

458.40

000

N

3353.00

*

*

59897

UNLISTED FETAL INVASIVE PX W/ULTRASOUND

BR

YYY

N

235.62

*

*

J1

59898

UNLISTED LAPAROSCOPY PX MATERNITY CARE&DELIVERY

BR

YYY

Y

9076.35

*

*

59899

UNLISTED PROCEDURE MATERNITY CARE & DELIVERY

BR

YYY

Y

235.62

*

*

J1

60000

I&D THYROGLOSSAL DUCT CYST INFECTED

584.40

010

N

2543.11

*

*

60100

BIOPSY THYROID PERCUTANEOUS CORE NEEDLE

384.00

000

N

822.66

*

*

J1

60200

EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS

2284.80

090

Y

9076.35

*

*

J1

60210

PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

2444.40

090

Y

9076.35

*

*

J1

60212

PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC

3488.40

090

Y

9076.35

*

*

J1

60220

TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

2438.40

090

Y

9076.35

*

*

J1

60225

TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC

3212.40

090

Y

9076.35

*

*

J1

60240

THYROIDECTOMY TOTAL/COMPLETE

3176.40

090

Y

9076.35

*

*

J1

60252

THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT

4562.40

090

Y

8765.29

*

*

60254

THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT

5776.80

090

Y

8266.16

*

*

J1

60260

THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL

3775.20

090

Y

8765.29

*

*

60270

THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC

4732.80

090

Y

5962.10

*

*

J1

60271

THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH

3654.00

090

Y

8765.29

*

*

J1

60280

EXCISION THYROGLOSSAL DUCT CYST/SINUS

1522.80

090

Y

9076.35

*

*

J1

60281

EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT

2018.40

090

Y

9076.35

*

*

60300

ASPIRATION AND/OR INJECTION THYROID CYST

392.40

000

N

822.66

*

*

J1

60500

PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS

3344.40

090

Y

8765.29

*

*

J1

60502

PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR

4474.80

090

Y

8765.29

*

*

60505

PARATHYRDEC/EXPL PARATHYR MEDSTNL STERNAL/TTHRC

4819.20

090

Y

6469.55

+

*

60512

PARATHYROID AUTOTRANSPLANTATION ADD-ON

843.60

ZZZ

Y

*

*

J1

60520

THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX

3624.00

090

Y

8765.29

*

*

60521

THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX

3889.20

090

Y

*

*

60522

THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX

4741.20

090

Y

*

*

60540

ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX

3705.60

090

Y

*

*

60545

ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR

4242.00

090

Y

*

*

60600

EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY

4755.60

090

Y

*

*

60605

EXC CAROTID BODY TUMOR W EXC CAROTID ARTERY

5755.20

090

Y

*

*

60650

LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL

4141.20

090

Y

8777.94

*

*

J1

60659

UNLISTED LAPAROSCOPY PROCEDURE ENDOCRINE SYSTEM

BR

YYY

Y

9076.35

*

*

J1

60699

UNLISTED PROCEDURE ENDOCRINE SYSTEM

BR

YYY

Y

9076.35

*

*

61000

SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT

382.80

000

N

850.31

*

*

61001

SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ

379.20

000

N

850.31

*

*

61020

VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX

344.40

000

N

1086.07

*

*

61026

VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ

366.00

000

N

850.31

*

*

61050

CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX

294.00

000

N

351.42

*

*

61055

CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION

434.40

000

N

351.42

*

*

61070

PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX

196.80

000

N

850.31

*

*

61105

TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE

1621.20

090

N

*

Ø

61107

TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE

1104.00

000

N

*

*

61108

TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA

3123.60

090

N

*

*

61120

BURR HOLE VENTRICULAR PUNCTURE

2611.20

090

N

*

*

61140

BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION

4432.80

090

Y

*

*

61150

BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST

4776.00

090

N

*

*

61151

BURR HOLE/TREPHINE W/SBSQ TAPPING ICRA ABSC/CST

3501.60

090

N

*

*

61154

BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL

4456.80

090

Y

*

*

61156

BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL

4382.40

090

Y

*

*

61210

BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE

1303.20

000

N

5491.97

*

*

J1

61215

INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH

1785.60

090

N

8627.34

*

*

61250

BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG

3031.20

090

Y

*

*

61253

BURR HOLE/TREPHINE INFRATENTORIAL UNI/BI

3465.60

090

Y

*

*

61304

CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL

5778.00

090

Y

*

*

61305

CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL

7039.20

090

Y

*

*

61312

CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL

7306.80

090

Y

*

*

61313

CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL

6964.80

090

Y

*

*

61314

CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL

6392.40

090

Y

*

*

61315

CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL

7251.60

090

Y

+

*

61316

INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF

312.00

ZZZ

N

*

*

61320

CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL

6667.20

090

Y

*

*

61321

CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL

7404.00

090

Y

*

*

61322

CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY

8370.00

090

Y

*

*

61323

CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY

8378.40

090

Y

*

*

J1

61330

DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH

6270.00

090

Y

4449.71

*

*

61333

EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION

7156.80

090

Y

*

*

61340

SUBTEMPORAL CRANIAL DECOMPRESSION

4970.40

090

Y

*

*

61343

CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD

7688.40

090

Y

*

*

61345

OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA

7159.20

090

Y

*

*

61450

CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION

6720.00

090

Y

*

*

61458

CRNEC SOPL EXPL/DCMPRN CRNL NRV

7065.60

090

Y

*

*

61460

CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NR

7405.20

090

Y

*

*

61500

CRANIECTOMY W/EXCISION TUMOR/LESION SKULL

4585.20

090

Y

*

*

61501

CRANIECTOMY OSTEOMYELITIS

3980.40

090

Y

*

*

61510

CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR

7690.80

090

Y

*

*

61512

CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR

8977.20

090

Y

*

*

61514

CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR

6715.20

090

Y

*

*

61516

CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR

6535.20

090

Y

+

*

61517

IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT

310.80

ZZZ

N

*

*

61518

CRNEC EXC BRAIN TUMOR INFRATENTORIAL/POST FOSSA

9724.80

090

Y

*

*

61519

CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA

10410.00

090

Y

*

*

61520

CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM

13240.80

090

Y

*

*

61521

CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL

11247.60

090

Y

*

*

61522

CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS

7554.00

090

Y

*

*

61524

CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST

7304.40

090

Y

*

*

61526

CRNEC TRANSTEMPOR EXC CEREBELLOPONTINE ANGLE TUM

11752.80

090

N

*

*

61530

CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA

10929.60

090

N

*

*

61531

SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING

4232.40

090

Y

*

*

61533

CRANIOT SUBDURAL IMPLT ELCTRD SEIZURE MONITORING

5335.20

090

Y

*

*

61534

CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY

5692.80

090

Y

*

*

61535

CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX

3498.00

090

Y

*

*

61536

CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY

9027.60

090

Y

*

*

61537

CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY

8695.20

090

Y

*

*

61538

CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY

9394.80

090

Y

*

*

61539

CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG

8356.80

090

Y

*

*

61540

CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG

7568.40

090

Y

*

*

61541

CRANIOTOMY TRANSECTION CORPUS CALLOSUM

7525.20

090

Y

*

*

61543

CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY

7406.40

090

Y

*

*

61544

CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS

6720.00

090

Y

*

*

61545

CRANIOTOMY EXCISION CRANIOPHARYNGIOMA

11162.40

090

Y

*

*

61546

CRANIOT HYPOPHYSEC/EXC PITUITARY TUMOR ICRL APPR

8094.00

090

Y

*

*

61548

HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL

5502.00

090

Y

*

*

61550

CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE

3855.60

090

Y

*

*

61552

CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES

5222.40

090

Y

*

*

61556

CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP

6020.40

090

Y

*

*

61557

CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP

5930.40

090

Y

*

*

61558

XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS

6633.60

090

Y

*

*

61559

XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT

7982.40

090

Y

*

*

61563

EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN

6903.60

090

Y

*

*

61564

EXC BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN

8514.00

090

Y

*

*

61566

CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY

7784.40

090

Y

*

*

61567

CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG

8752.80

090

Y

*

*

61570

CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN

6541.20

090

Y

*

*

61571

CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN

6879.60

090

Y

*

*

61575

TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES

8834.40

090

Y

*

*

61576

TRNSRL SKUL BSE/BR STM/CORD BX/DCMP/ SPLT TONGUE

14538.00

090

Y

*

*

61580

CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ

8446.80

090

N

*

*

61581

CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ

9139.20

090

N

*

*

61582

CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT

10629.60

090

Y

*

*

61583

CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE

10108.80

090

Y

*

*

61584

ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ

10046.40

090

Y

*

*

61585

ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ

11422.80

090

Y

*

*

61586

BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT

8464.80

090

Y

*

*

61590

INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN

10581.60

090

Y

*

*

61591

INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI

10696.80

090

Y

*

*

61592

ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE

11108.40

090

Y

*

*

61595

TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV

8176.80

090

N

*

*

61596

TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART

8412.00

090

Y

*

*

61597

TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL

10261.20

090

Y

*

*

61598

TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM

9948.00

090

Y

*

*

61600

RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL

7389.60

090

Y

*

*

61601

RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF

8412.00

090

Y

*

*

61605

RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL

7458.00

090

Y

*

*

61606

RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR

10284.00

090

Y

*

*

61607

RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL

9339.60

090

Y

*

*

61608

RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL

11484.00

090

Y

+

*

61611

TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR

1665.60

ZZZ

Y

*

*

61613

OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ

11637.60

090

Y

*

*

61615

RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL

9830.40

090

Y

*

*

61616

RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL

11676.00

090

Y

*

*

61618

SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT

4507.20

090

Y

*

*

61619

SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP

4966.80

090

Y

*

*

J1

61623

EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK

1993.20

000

N

17440.05

*

*

61624

TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS

4045.20

000

N

3796.76

*

*

J1

61626

TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS

3068.40

000

N

17440.05

*

*

61630

BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS

4876.80

XXX

Y

*

*

61635

TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD

5113.20

XXX

Y

*

*

61640

BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL

1681.20

000

N

+

*

61641

PERQ BALO DILA IC VSPSM EA VSL SM VASC TER

590.40

ZZZ

N

+

*

61642

PERQ BALO DILA IC VSPSM EA VSL DIFF VASC TER

1180.80

ZZZ

N

*

*

61645

PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL

2919.60

000

N

*

*

61650

EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST

1932.00

000

N

+

*

61651

EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL

841.20

ZZZ

N

*

*

61680

INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL

7932.00

090

Y

*

*

61682

INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL

14820.00

090

Y

*

*

61684

INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL

9978.00

090

Y

*

*

61686

INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL

16371.60

090

Y

*

*

61690

INTRACRANIAL ARVEN MALFRMJ DURAL SMPL

7640.40

090

Y

*

*

61692

INTRACRANIAL ARVEN MALFRMJ DURAL CMPL

13057.20

090

Y

*

*

61697

COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION

15056.40

090

Y

*

*

61698

CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

16801.20

090

Y

*

*

61700

SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION

12090.00

090

Y

*

*

61702

SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

14194.80

090

Y

*

*

61703

ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART

4682.40

090

Y

*

*

61705

ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART

8832.00

090

Y

*

*

61708

ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS

9021.60

090

Y

*

*

61710

ARYSM VASC MALFRMJ IA EMBOLIZATION

7606.80

090

N

*

*

61711

ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES

9096.00

090

Y

*

*

J1

61720

CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS

4479.60

090

N

8627.34

*

*

61735

CRTJ LES STRTCTC BURR SUBCORTICAL STRUX OTH/THN

5616.00

090

N

*

*

61750

STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES

4970.40

090

N

*

*

61751

STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR

4857.60

090

N

6944.14

*

*

61760

STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING

5526.00

090

N

*

*

J1

61770

STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC

5733.60

090

N

8627.34

+

*

61781

STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL

832.80

ZZZ

N

+

*

61782

STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL

602.40

ZZZ

N

+

*

61783

STEREOTACTIC COMPUTER ASSISTED PX SPINAL

816.00

ZZZ

N

*

*

J1

61790

CREATE LESION STRTCTC PRQ NEUROLYTIC GASSERIAN

3093.60

090

N

3259.45

*

*

J1

61791

CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC

3963.60

090

N

3259.45

*

*

61796

STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES

3568.80

090

Y

+

*

61797

STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE

777.60

ZZZ

Y

*

*

61798

STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES

4867.20

090

Y

+

*

61799

STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX

1077.60

ZZZ

Y

+

*

61800

APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY

542.40

ZZZ

Y

*

*

61850

TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL

3381.60

090

Y

*

*

61860

CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL

5493.60

090

Y

*

*

61863

STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY

5277.60

090

Y

+

*

61864

STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY

1003.20

ZZZ

Y

*

*

61867

STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY

8025.60

090

Y

+

*

61868

STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY

1767.60

ZZZ

Y

*

*

61870

CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL

4174.80

090

Y

*

*

61880

REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS

2001.60

090

Y

4089.32

*

*

J1

61885

INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR

1796.40

090

N

29514.29

*

*

J1

61886

INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS

2972.40

090

N

43809.69

*

*

J1

61888

REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR

1388.40

010

N

10355.35

*

*

J1

62000

ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL

3630.00

090

N

4449.71

*

*

62005

ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL

4396.80

090

Y

*

*

62010

ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN

5367.60

090

Y

*

*

62100

CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA

5570.40

090

Y

3919.72

*

*

62115

RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY

5905.20

090

Y

*

*

62117

RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT

6940.80

090

Y

*

*

62120

RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY

7434.00

090

Y

*

*

62121

CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE

5487.60

090

Y

*

*

62140

CRANIOPLASTY SKULL DEFECT </5 CM DIAMETER

3594.00

090

Y

3847.29

*

*

62141

CRANIOPLASTY SKULL DEFECT >5 CM DIAMETER

3982.80

090

Y

*

*

62142

RMVL BONE FLAP/PROSTHETIC PLATE SKULL

3096.00

090

Y

4092.77

*

*

62143

RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL

3645.60

090

Y

*

*

62145

CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG

4923.60

090

Y

*

*

62146

CRANIOPLASTY W/AUTOGRAFT </ 5 CM DIAMETER

4112.40

090

Y

*

*

62147

CRANIOPLASTY W/AUTOGRAFT > 5 CM DIAMETER

5036.40

090

Y

+

*

62148

INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT

447.60

ZZZ

N

+

*

62160

NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS

673.20

ZZZ

N

*

*

62161

NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS

5296.80

090

Y

*

*

62162

NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG

6642.00

090

Y

*

*

62163

NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY

4130.40

090

Y

*

*

62164

NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY

7328.40

090

Y

*

*

62165

NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID

5353.20

090

N

*

*

62180

VENTRICULOCISTERNOSTOMY

5648.40

090

Y

*

*

62190

CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR

3255.60

090

N

*

*

62192

CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH

3430.80

090

Y

*

*

J1

62194

RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER

1700.40

010

N

3259.45

*

*

62200

VENTRICULOCISTERNOSTOMY 3RD VENTRICLE

4834.80

090

Y

*

*

62201

VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC

4246.80

090

N

*

*

62220

CRTJ SHUNT VENTRICULO-ATR-JUG-AUR

3513.60

090

Y

*

*

62223

CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS

3643.20

090

Y

5410.04

*

*

J1

62225

RPLCMT/IRRIGATION VENTRICULAR CATHETER

1845.60

090

N

8627.34

*

*

J1

62230

RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS

2946.00

090

Y

8627.34

*

*

62252

REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT

280.80

162.00

118.80

XXX

N

*

*

62256

RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT

2104.80

090

Y

*

*

62258

RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT

3907.20

090

Y

*

*

62263

PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS

2054.40

010

N

1086.07

*

*

62264

PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY

1466.40

010

N

1086.07

*

*

62267

PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS

880.80

000

N

822.66

*

*

62268

PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX

888.00

000

N

1086.07

*

*

J1

62269

BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE

919.20

000

N

2734.29

*

*

62270

SPINAL PUNCTURE LUMBAR DIAGNOSTIC

506.40

000

N

850.31

*

*

62272

SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID

668.40

000

N

850.31

*

*

62273

INJECTION EPIDURAL BLOOD/CLOT PATCH

591.60

000

N

850.31

*

*

62280

INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID

1134.00

010

N

1086.07

*

*

62281

INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC

832.80

010

N

1086.07

*

*

62282

INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL

1035.60

010

N

1086.07

*

*

62284

INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR

673.20

000

N

*

*

J1

62287

DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR

2007.60

090

N

8627.34

*

*

62290

INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR

1154.40

000

N

*

*

62291

INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC

1113.60

000

N

*

*

J1

62292

INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR

1975.20

090

N

3259.45

*

*

62294

NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL

3342.00

090

N

1086.07

*

*

62302

MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL

855.60

000

N

982.29

*

*

62303

MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC

874.80

000

N

982.29

*

*

62304

MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL

844.80

000

N

982.29

*

*

62305

MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS

918.00

000

N

982.29

*

*

62320

NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN

561.60

000

N

850.31

*

*

62321

NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN

862.80

000

N

850.31

*

*

62322

NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN

523.20

000

N

850.31

*

*

62323

NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

853.20

000

N

850.31

*

*

62324

NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN

494.40

000

N

1086.07

*

*

62325

NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN

800.40

000

N

1086.07

*

*

62326

NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN

513.60

000

N

1086.07

*

*

62327

NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

802.80

000

N

1086.07

*

*

J1

62350

IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM

1380.00

010

N

8627.34

*

*

J1

62351

IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM

2986.80

090

Y

10775.65

*

*

62355

RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH

927.60

010

N

2316.70

*

*

J1

62360

IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR

1095.60

010

N

26058.10

*

*

J1

62361

IMPLTJ/RPLCMT FS NON-PRGRBL PUMP

1495.20

010

N

26058.10

*

*

J1

62362

IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP

1324.80

010

N

26058.10

*

*

62365

RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS

1022.40

010

N

6483.81

*

*

62367

ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL

136.80

XXX

N

398.18

*

*

62368

ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG

188.40

XXX

N

398.18

*

*

62369

ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL

400.80

XXX

N

398.18

*

*

62370

ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP

416.40

XXX

N

398.18

*

*

J1

62380

NDSC DCMPRN SPINAL CORD 1 W/LAMOT NTRSPC LUMBAR

10444.80

090

Y

10775.65

*

*

J1

63001

LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV

4329.60

090

Y

10775.65

*

*

J1

63003

LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC

4322.40

090

Y

10775.65

*

*

J1

63005

LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR

4135.20

090

Y

10775.65

*

*

J1

63011

LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL

3799.20

090

Y

10775.65

*

*

J1

63012

LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR

4159.20

090

Y

10775.65

*

*

J1

63015

LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL

5184.00

090

Y

10775.65

*

*

J1

63016

LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC

5326.80

090

Y

10775.65

*

*

J1

63017

LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR

4404.00

090

Y

10775.65

*

*

J1

63020

LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC

4042.80

090

Y

10775.65

*

*

J1

63030

LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR

3384.00

090

Y

10775.65

+

*

63035

LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR

669.60

ZZZ

Y

*

*

J1

63040

LAMOT PRTL FFD EXC DISC REEX PL 1 NTRSPC CERVICAL

4857.60

090

Y

10775.65

*

*

J1

63042

LAMOT PRTL FFD EXC DISC REEX PL 1 NTRSPC LUMBAR

4515.60

090

Y

10775.65

+

*

63043

LAMOT PRTL FFD EXC DISC REEX PL 1 NTRSPC EA CRV

3068.40

ZZZ

Y

+

*

63044

LAMOT W/PRTL FFD HRNA8 REEX PL 1 NTRSPC EA LMBR

2677.20

ZZZ

Y

*

*

J1

63045

LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL

4486.80

090

Y

19120.53

*

*

J1

63046

LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT THORACIC

4276.80

090

Y

19120.53

*

*

J1

63047

LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR

3836.40

090

Y

19120.53

+

*

63048

LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR

740.40

ZZZ

Y

*

*

63050

LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG

5220.00

090

Y

*

*

63051

LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ

5965.20

090

Y

*

*

J1

63055

TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC

5698.80

090

Y

10775.65

*

*

J1

63056

TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR

5194.80

090

Y

10775.65

+

*

63057

TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR

1118.40

ZZZ

Y

*

*

J1

63064

COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG

6228.00

090

Y

10775.65

+

*

63066

COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG

723.60

ZZZ

Y

*

*

J1

63075

DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC

4713.60

090

Y

10775.65

+

*

63076

DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC

864.00

ZZZ

Y

*

*

63077

DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC

5308.80

090

Y

+

*

63078

DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC

727.20

ZZZ

Y

*

*

63081

VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG

6136.80

090

Y

2049.98

+

*

63082

VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG

932.40

ZZZ

Y

1354.52

*

*

63085

VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG

6718.80

090

Y

+

*

63086

VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG

669.60

ZZZ

Y

*

*

63087

VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG

8438.40

090

Y

+

*

63088

VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG

903.60

ZZZ

Y

*

*

63090

VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG

6837.60

090

Y

+

*

63091

VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG

621.60

ZZZ

Y

*

*

63101

VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG

8138.40

090

Y

*

*

63102

VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG

7928.40

090

Y

+

*

63103

VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG

1032.00

ZZZ

Y

*

*

63170

LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR

5571.60

090

Y

*

*

63172

LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID

4855.20

090

Y

*

*

63173

LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL

6013.20

090

Y

*

*

63180

LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV 1/2 SEG

4998.00

090

Y

*

*

63182

LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV >2 SEG

5283.60

090

Y

*

*

63185

LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS

3988.80

090

Y

*

*

63190

LAMINECTOMY W/RHIZOTOMY > 2 SEGMENTS

4318.80

090

Y

*

*

63191

LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE

4862.40

090

Y

*

*

63194

LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT CERVICAL

5634.00

090

Y

*

*

63195

LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT THORACIC

5418.00

090

Y

*

*

63196

LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACTS CRV

6290.40

090

Y

*

*

63197

LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACT THRC

5539.20

090

Y

*

*

63198

LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES CERVICAL

7389.60

090

Y

*

*

63199

LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES THORACIC

7743.60

090

Y

*

*

63200

LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR

5365.20

090

Y

*

*

63250

LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL

10275.60

090

Y

*

*

63251

LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC

10732.80

090

Y

*

*

63252

LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR

10670.40

090

Y

*

*

63265

LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL

5838.00

090

Y

*

*

63266

LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC

6032.40

090

Y

*

*

63267

LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR

4779.60

090

Y

5908.86

*

*

63268

LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL

4944.00

090

Y

*

*

63270

LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL

7251.60

090

Y

*

*

63271

LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC

7251.60

090

Y

*

*

63272

LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR

6621.60

090

Y

9804.37

*

*

63273

LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL

6535.20

090

Y

*

*

63275

LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL

6313.20

090

Y

*

*

63276

LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC

6272.40

090

Y

*

*

63277

LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR

5443.20

090

Y

*

*

63278

LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL

5554.80

090

Y

*

*

63280

LAM BX/EXC ISPI NEO IDRL XMED CERVICAL

7434.00

090

Y

*

*

63281

LAM BX/EXC ISPI NEO IDRL XMED THORACIC

7347.60

090

Y

*

*

63282

LAM BX/EXC ISPI NEO IDRL XMED LUMBAR

6924.00

090

Y

7305.40

*

*

63283

LAM BX/EXC ISPI NEO IDRL SACRAL

6639.60

090

Y

*

*

63285

LAM BX/EXC ISPI NEO IDRL IMED CERVICAL

9218.40

090

Y

*

*

63286

LAM BX/EXC ISPI NEO IDRL IMED THORACIC

9079.20

090

Y

*

*

63287

LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR

9615.60

090

Y

*

*

63290

LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL

9760.80

090

Y

+

*

63295

OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX

1171.20

ZZZ

Y

*

*

63300

VCRPEC LES 1 SGM XDRL CERVICAL

6434.40

090

Y

*

*

63301

VCRPEC LES 1 SGM XDRL THORACIC TTHRC

7700.40

090

Y

*

*

63302

VCRPEC LES 1 SEG XDRL THRC THORACOLMBR

7597.20

090

Y

*

*

63303

VCRPEC LES 1 SEG XDRL LMBR/SAC TRANSPRTL/RPR

7582.80

090

Y

*

*

63304

VERTEBRAL CORPECTOMY EXC LES 1 SEG IDRL CERVICAL

8102.40

090

Y

*

*

63305

VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC

8854.80

090

Y

*

*

63306

VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR

8430.00

090

Y

*

*

63307

VCRPEC LES 1 SEG IDRL LMBR/SAC TRANSPRTL/RPR

8520.00

090

Y

+

*

63308

VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG

1135.20

ZZZ

Y

*

*

J1

63600

CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ

3848.40

090

N

3259.45

*

*

J1

63610

STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG

2058.00

000

N

3259.45

*

*

63620

STEREOTACTIC RADIOSURGERY 1 SPINAL LESION

3946.80

090

Y

+

*

63621

STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION

897.60

ZZZ

Y

*

*

J1

63650

PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL

1077.15

010

N

10355.35

*

*

J1

63655

LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL

2892.00

090

Y

29514.29

*

*

63661

RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR

2101.20

010

Y

2316.70

*

*

63662

RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR

2928.00

090

Y

4089.32

*

*

J1

63663

REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR

2812.80

010

Y

10355.35

*

*

J1

63664

REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR

3034.80

090

Y

29514.29

*

*

J1

63685

INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING

1248.00

010

Y

43809.69

*

*

63688

REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR

1287.60

010

N

4089.32

*

*

63700

REPAIR MENINGOCELE < 5 CM DIAMETER

4557.60

090

Y

*

*

63702

REPAIR MENINGOCELE > 5 CM DIAMETER

5019.60

090

Y

*

*

63704

REPAIR MYELOMENINGOCELE < 5 CM DIAMETER

5594.40

090

Y

*

*

63706

REPAIR MYELOMENINGOCELE > 5 CM DIAMETER

6202.80

090

Y

*

*

63707

RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM

3237.60

090

Y

4537.54

*

*

63709

RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM

3846.00

090

Y

4472.23

*

*

63710

DURAL GRAFT SPINAL

3792.00

090

Y

2819.14

*

*

63740

CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM

3406.80

090

Y

*

*

J1

63741

CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM

2364.00

090

Y

8627.34

*

*

J1

63744

RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT

2342.40

090

Y

8627.34

*

*

63746

RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT

2085.60

090

N

2316.70

*

*

64400

NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH

465.60

000

N

351.42

*

*

64402

INJECTION ANESTHETIC AGENT FACIAL NERVE

514.80

000

N

151.20

*

*

64405

INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV

284.40

000

N

351.42

*

*

64408

INJECTION ANESTHETIC AGENT VAGUS NERVE

402.00

000

N

351.42

*

*

64410

INJECTION ANESTHETIC AGENT PHRENIC NERVE

531.60

000

N

1086.07

*

*

64413

INJECTION ANESTHETIC AGENT CERVICAL PLEXUS

432.00

000

N

850.31

*

*

64415

SINGLE NERVE BLOCK INJECTION ARM NERVE

405.60

000

N

1086.07

*

*

64416

INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH

273.60

000

N

1086.07

*

*

64417

INJECTION ANESTHETIC AGENT AXILLARY NERVE

451.20

000

N

1086.07

*

*

64418

INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE

325.20

000

N

850.31

*

*

64420

INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE

378.00

000

N

850.31

*

*

64421

MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES

535.20

000

N

1086.07

*

*

64425

INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS

471.60

000

N

850.31

*

*

64430

INJECTION ANESTHETIC AGENT PUDENDAL NERVE

496.80

000

N

1086.07

*

*

64435

INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE

480.00

000

N

850.31

*

*

64445

INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE

466.80

000

N

850.31

*

*

64446

INJECTION ANES SCIATIC NERVE CONT INFUSION CATH

273.60

000

N

1086.07

*

*

64447

INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE

415.20

000

N

850.31

*

*

64448

INJECTION ANES FEMORAL NERVE CONT INFUSION CATH

246.00

000

N

1086.07

*

*

64449

INJECTION ANES LUMBAR PLEXUS POST CONT NFS CATH

292.80

000

N

1086.07

*

*

64450

INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH

262.80

000

N

850.31

*

*

64455

NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE

163.20

000

N

351.42

*

*

64461

PVB THORACIC SINGLE INJECTION SITE W/IMG GID

475.20

000

N

850.31

+

*

64462

PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID

264.00

ZZZ

N

*

*

64463

PVB THORACIC CONT CATHETER INFUSION W/IMG GID

615.60

000

N

850.31

*

*

64479

NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL

834.00

000

N

1086.07

+

*

64480

NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV

410.40

ZZZ

N

*

*

64483

NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL

772.80

000

N

1086.07

+

*

64484

NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV

334.80

ZZZ

N

*

*

64486

TAP BLOCK UNILATERAL BY INJECTION(S)

374.40

000

N

*

*

64487

TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S)

538.80

000

N

*

*

64488

TAP BLOCK BILATERAL BY INJECTION(S)

459.60

000

N

*

*

64489

TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S)

798.00

000

N

*

*

64490

NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL

646.80

000

Y

1086.07

+

*

64491

NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL

321.60

ZZZ

Y

+

*

64492

NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL

324.00

ZZZ

Y

*

*

64493

NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL

589.20

000

Y

1086.07

+

*

64494

NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL

298.80

ZZZ

Y

+

*

64495

NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL

298.80

ZZZ

Y

*

*

64505

INJECTION ANES AGENT SPHENOPALATINE GANGLION

403.20

000

N

351.42

*

*

64510

NJX ANES STELLATE GANGLION CRV SYMPATHETIC

453.60

000

N

1086.07

*

*

64517

INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS

651.60

000

N

1086.07

*

*

64520

INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC

690.00

000

N

1086.07

*

*

64530

INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG

687.60

000

N

1086.07

*

*

J1

64553

PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE

5857.20

010

N

10355.35

*

*

J1

64555

PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV

5317.20

010

N

10355.35

*

*

J1

64561

PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING

2510.40

010

N

10355.35

*

*

64566

POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE

434.40

000

N

351.42

*

*

J1

64568

INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER

2211.60

090

N

43809.69

*

*

J1

64569

REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV

2653.20

090

N

10355.35

*

*

64570

REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO

2554.80

090

N

6483.81

*

*

J1

64575

INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD

1152.00

090

N

29514.29

*

*

J1

64580

INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR

1063.20

090

Y

29514.29

*

*

J1

64581

INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE

2290.80

090

N

10355.35

*

*

64585

REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE

843.60

010

N

4089.32

*

*

J1

64590

INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR

912.00

010

N

29514.29

*

*

64595

REVISION/RMVL PERIPHERAL/GASTRIC NPGR

826.80

010

N

4089.32

*

*

64600

DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH

1482.00

010

N

1086.07

*

*

J1

64605

DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH

2026.80

010

N

3259.45

*

*

J1

64610

DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR

2650.80

010

N

3259.45

*

*

64611

CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS

414.00

010

N

351.42

*

*

64612

CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL

459.60

010

N

351.42

*

*

64615

CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE

512.40

010

N

351.42

*

*

64616

CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA

456.00

010

N

351.42

*

*

64617

CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG

554.40

010

N

351.42

*

*

64620

DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE

709.20

010

N

1086.07

*

*

64630

DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE

812.40

010

N

1086.07

*

*

64632

DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE

294.00

010

N

351.42

*

*

J1

64633

DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA

1426.80

010

N

3259.45

+

*

64634

DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA

640.80

ZZZ

N

*

*

J1

64635

DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL

1411.20

010

N

3259.45

+

*

64636

DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL

582.00

ZZZ

N

*

*

64640

DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE

463.20

010

N

1086.07

*

*

64642

CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE

498.00

000

N

850.31

+

*

64643

CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE

318.00

ZZZ

N

*

*

64644

CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES

578.40

000

N

850.31

+

*

64645

CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES

399.60

ZZZ

N

*

*

64646

CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES

522.00

000

N

850.31

*

*

64647

CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES

614.40

000

N

850.31

*

*

64650

CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE

270.00

000

N

351.42

*

*

64653

CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY

331.20

000

N

351.42

*

*

64680

DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS

1088.40

010

N

1086.07

*

*

64681

DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS

1971.60

010

N

1086.07

*

*

J1

64702

NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT

1736.40

090

N

3259.45

*

*

J1

64704

NEUROPLASTY NERVE HAND/FOOT

1107.60

090

Y

3259.45

*

*

J1

64708

NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC

1730.40

090

Y

3259.45

*

*

J1

64712

NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV

2014.80

090

Y

3259.45

*

*

J1

64713

NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS

2697.60

090

Y

3259.45

*

*

J1

64714

NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS

2497.20

090

Y

3259.45

*

*

J1

64716

NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE

1800.00

090

Y

3259.45

*

*

J1

64718

NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW

2044.80

090

N

3259.45

*

*

J1

64719

NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST

1387.20

090

N

3259.45

*

*

J1

64721

NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE

1494.00

090

N

3259.45

*

*

J1

64722

DECOMPRESSION UNSPECIFIED NERVE

1230.00

090

Y

3259.45

*

*

J1

64726

DECOMPRESSION PLANTAR DIGITAL NERVE

936.00

090

N

3259.45

+

*

64727

INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE

637.20

ZZZ

N

*

*

J1

64732

TRANSECTION/AVULSION SUPRAORBITAL NERVE

1546.80

090

Y

3259.45

*

*

J1

64734

TRANSECTION/AVULSION INFRAORBITAL NERVE

1748.40

090

N

3259.45

*

*

J1

64736

TRANSECTION/AVULSION MENTAL NERVE

1287.60

090

Y

3259.45

*

*

J1

64738

TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO

1604.40

090

Y

3259.45

*

*

J1

64740

TRANSECTION/AVULSION LINGUAL NERVE

1681.20

090

Y

3259.45

*

*

J1

64742

TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL

1693.20

090

Y

3259.45

*

*

J1

64744

TRANSECTION/AVULSION GREATER OCCIPITAL NERVE

1714.80

090

N

3259.45

*

*

J1

64746

TRANSECTION/AVULSION PHRENIC NERVE

1490.40

090

Y

3259.45

*

*

64755

TRANSECTION/AVULSION VAGUS NERVES

3157.20

090

Y

*

*

64760

TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL

1773.60

090

Y

*

*

J1

64763

TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY

1771.20

090

Y

3259.45

*

*

J1

64766

TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY

2145.60

090

Y

8627.34

*

*

J1

64771

TRANSECTION/AVULSION OTH CRANIAL NRV XDRL

2050.80

090

Y

3259.45

*

*

J1

64772

TRANSECTION/AVULSION OTH SPINAL NRV XDRL

1950.00

090

Y

3259.45

*

*

J1

64774

EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE

1405.20

090

N

3259.45

*

*

J1

64776

EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT

1341.60

090

N

3259.45

+

*

64778

EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT

636.00

ZZZ

N

*

*

J1

64782

EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE

1586.40

090

N

3259.45

+

*

64783

EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT

759.60

ZZZ

N

*

*

J1

64784

EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC

2510.40

090

N

3259.45

*

*

J1

64786

EXCISION NEUROMA SCIATIC NERVE

3477.60

090

Y

8627.34

+

*

64787

IMPLANTATION NERVE END BONE/MUSCLE

835.20

ZZZ

N

*

*

J1

64788

EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV

1386.00

090

N

3259.45

*

*

J1

64790

EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV

2902.80

090

N

3259.45

*

*

J1

64792

EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV

3776.40

090

Y

8627.34

*

*

J1

64795

BIOPSY NERVE

676.80

000

N

3259.45

*

*

J1

64802

SYMPATHECTOMY CERVICAL

2920.80

090

Y

3259.45

*

*

J1

64804

SYMPATHECTOMY CERVICOTHORACIC

4102.80

090

Y

3259.45

*

*

64809

SYMPATHECTOMY THORACOLUMBAR

3723.60

090

Y

*

*

64818

SYMPATHECTOMY LUMBAR

2706.00

090

Y

*

*

J1

64820

SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT

2469.60

090

N

3259.45

*

*

J1

64821

SYMPATHECTOMY RADIAL ARTERY

2401.20

090

N

5184.51

*

*

J1

64822

SYMPATHECTOMY ULNAR ARTERY

2401.20

090

N

5184.51

*

*

J1

64823

SYMPATHECTOMY SUPERFICIAL PALMAR ARCH

2731.20

090

N

5184.51

*

*

J1

64831

SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE

2374.80

090

N

8627.34

+

*

64832

SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV

1167.60

ZZZ

N

*

*

J1

64834

SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE

2566.80

090

N

8627.34

*

*

J1

64835

SUTURE 1 NERVE MEDIAN MOTOR THENAR

2816.40

090

Y

8627.34

*

*

J1

64836

SUTURE 1 NERVE ULNAR MOTOR

2818.80

090

Y

8627.34

+

*

64837

SUTURE EACH ADDITIONAL NERVE HAND/FOOT

1278.00

ZZZ

Y

*

*

J1

64840

SUTURE POSTERIOR TIBIAL NERVE

3338.40

090

Y

8627.34

*

*

J1

64856

SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS

3507.60

090

N

8627.34

*

*

J1

64857

SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS

3652.80

090

Y

8627.34

*

*

J1

64858

SUTURE SCIATIC NERVE

4088.40

090

Y

8627.34

+

*

64859

SUTURE EACH ADDITIONAL PERIPHERAL NERVE

862.80

ZZZ

Y

*

*

J1

64861

SUTURE BRACHIAL PLEXUS

5342.40

090

Y

8627.34

*

*

J1

64862

SUTURE LUMBAR PLEXUS

4717.20

090

Y

8627.34

*

*

J1

64864

SUTURE FACIAL NERVE EXTRACRANIAL

2989.20

090

Y

8627.34

*

*

J1

64865

SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT

3768.00

090

Y

8627.34

*

*

64866

ANASTOMOSIS FACIAL-SPINAL ACCESSORY

4414.80

090

Y

*

*

64868

ANASTOMOSIS FACIAL HYPOGLOSSAL

3462.00

090

Y

+

*

64872

SUTURE NERVE REQ SECONDARY/DELAYED SUTURE

406.80

ZZZ

Y

+

*

64874

SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE

607.20

ZZZ

Y

+

*

64876

SUTURE NERVE REQ SHORTENING BONE EXTREMITY

690.00

ZZZ

Y

*

*

J1

64885

NERVE GRAFT HEAD/NECK </ 4 CM

3856.80

090

Y

8627.34

*

*

J1

64886

NERVE GRAFT HEAD/NECK >4 CM

4473.60

090

Y

8627.34

*

*

J1

64890

NERVE GRAFT 1 STRAND HAND/FOOT </4 CM

3745.20

090

Y

8627.34

*

*

J1

64891

NRV GRF 1 STRAND HAND/FOOT >4 CM

3973.20

090

Y

8627.34

*

*

J1

64892

NERVE GRAFT 1 STRAND ARM/LEG <4 CM

3615.60

090

Y

8627.34

*

*

J1

64893

NERVE GRAFT 1 STRAND ARM/LEG >4 CM

3894.00

090

Y

8627.34

*

*

J1

64895

NERVE GRAFT MLT STRANDS HAND/FOOT </4 CM

4593.60

090

Y

8627.34

*

*

J1

64896

NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM

4976.40

090

Y

8627.34

*

*

J1

64897

NERVE GRAFT MLT STRANDS ARM/LEG </4 CM

4378.80

090

Y

8627.34

*

*

J1

64898

NERVE GRAFT MLT STRANDS ARM/LEG >4 CM

4756.80

090

Y

8627.34

+

*

64901

NERVE GRAFT EACH NERVE 1 STRAND

2089.20

ZZZ

Y

+

*

64902

NERVE GRAFT EACH NERVE MULTIPLE STRANDS

2418.00

ZZZ

Y

*

*

J1

64905

NERVE PEDICLE TRANSFER FIRST STAGE

3536.40

090

Y

8627.34

*

*

J1

64907

NERVE PEDICAL TRANSFER SECOND STAGE

4526.40

090

Y

8627.34

*

*

J1

64910

NERVE REPAIR W/CONDUIT EACH NERVE

2746.80

090

Y

8627.34

*

*

J1

64911

NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE

3544.80

090

Y

8627.34

*

*

J1

64912

NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND

2678.40

090

Y

8627.34

+

*

64913

NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND

540.00

ZZZ

Y

*

*

64999

UNLISTED PROCEDURE NERVOUS SYSTEM

BR

YYY

N

351.42

*

*

J1

65091

EVISCERATION OCULAR CONTENTS W/O IMPLANT

2208.00

090

N

5848.19

*

*

J1

65093

EVISCERATION OCULAR CONTENTS W/IMPLANT

2185.20

090

N

5848.19

*

*

J1

65101

ENUCLEATION OF EYE W/O IMPLANT

2564.40

090

N

5848.19

*

*

J1

65103

ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT

2670.00

090

N

5848.19

*

*

J1

65105

ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT

2938.80

090

Y

5848.19

*

*

J1

65110

EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY

4206.00

090

Y

5848.19

*

*

J1

65112

EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE

4869.60

090

Y

5848.19

*

*

J1

65114

EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP

5102.40

090

Y

5848.19

*

*

J1

65125

MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX

1563.60

090

N

3609.14

*

*

J1

65130

INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL

2540.40

090

N

5848.19

*

*

J1

65135

INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED

2576.40

090

N

5848.19

*

*

J1

65140

INSJ OC IMPLT AFTER ENCL MUSC ATTACHED

2798.40

090

N

5848.19

*

*

J1

65150

REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT

2016.00

090

N

5848.19

*

*

J1

65155

REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE

2928.00

090

N

5848.19

*

*

J1

65175

REMOVAL OCULAR IMPLANT

2286.00

090

N

5848.19

*

*

65205

REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL

157.20

000

N

151.20

*

*

65210

RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR

192.00

000

N

494.39

*

*

65220

RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP

201.60

000

N

494.39

*

*

65222

RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP

231.60

000

N

151.20

*

*

J1

65235

RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS

2431.20

090

N

3707.69

*

*

J1

65260

RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE

3289.20

090

Y

3707.69

*

*

J1

65265

RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ

3694.80

090

Y

3707.69

*

*

J1

65270

RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR

934.80

010

N

3609.14

*

*

J1

65272

RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION

1747.20

090

N

3609.14

*

*

65273

RPR LAC CJNC MOBLJ & REARGMT W/HOSPIZATION

1302.00

090

N

*

*

J1

65275

RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY

1986.00

090

N

5848.19

*

*

J1

65280

RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS

2292.00

090

N

7014.24

*

*

J1

65285

RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T

3788.40

090

N

7014.24

*

*

J1

65286

RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA

2408.40

090

N

3707.69

*

*

J1

65290

RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU

1675.20

090

N

5848.19

*

*

65400

EXCISION LESION CORNEA XCP PTERYGIUM

2332.80

090

N

1146.35

*

*

J1

65410

BIOPSY CORNEA

493.20

000

N

3609.14

*

*

J1

65420

EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT

1791.60

090

N

3609.14

*

*

J1

65426

EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG

2251.20

090

N

3609.14

*

*

65430

CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE

397.20

000

N

494.39

*

*

65435

RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION

278.40

000

N

1146.35

*

*

J1

65436

RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT

1326.00

090

N

3609.14

*

*

65450

DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION

1116.00

090

N

402.60

*

*

J1

65600

MULTIPLE PUNCTURES ANTERIOR CORNEA

1365.60

090

N

3609.14

*

*

J1

65710

KERATOPLASTY ANTERIOR LAMELLAR

3811.20

090

Y

7014.24

*

*

J1

65730

KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA

4218.00

090

Y

7014.24

*

*

J1

65750

KERATOPLASTY PENETRAING APHAKIA

4238.40

090

Y

7014.24

*

*

J1

65755

KERATOPLASTY PENETRATING PSEUDOPHAKIA

4216.80

090

Y

7014.24

*

*

J1

65756

KERATOPLASTY ENDOTHELIAL

4038.00

090

Y

7014.24

+

*

65757

BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT

871.20

ZZZ

N

*

*

65760

KERATOMILEUSIS

4296.00

XXX

N

*

*

65765

KERATOPHAKIA

4036.13

XXX

N

*

*

65767

EPIKERATOPLASTY

3757.93

XXX

N

*

*

J1

65770

KERATOPROSTHESIS

4755.60

090

Y

17339.92

*

*

65771

RADIAL KERATOTOMY

690.00

XXX

N

1221.00

*

*

65772

CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM

1545.60

090

N

1146.35

*

*

J1

65775

CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM

1898.40

090

N

3609.14

*

*

65778

PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES

4809.60

000

N

1146.35

*

*

65779

PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED

4141.20

000

N

4224.88

*

*

J1

65780

OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE

2274.00

090

N

5848.19

*

*

J1

65781

OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT

4549.20

090

Y

7014.24

*

*

J1

65782

OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT

3921.60

090

N

5848.19

*

*

J1

65785

IMPLANTATION INTRASTROMAL CORNEAL RING SEGMENTS

8347.20

090

N

7014.24

*

*

J1

65800

PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX

410.40

000

N

3707.69

*

*

J1

65810

PARACENTSIS ANT CHAM RMVL VITREOUS W/WO AIR INJX

1587.60

090

N

3707.69

*

*

J1

65815

PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR IN

2191.20

090

N

3707.69

*

*

J1

65820

GONIOTOMY

2584.80

090

N

7014.24

*

*

J1

65850

TRABECULOTOMY AB EXTERNO

2864.40

090

N

3707.69

*

*

65855

TRABECULOPLASTY BY LASER SURGERY

841.20

010

N

704.58

*

*

65860

SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX

1057.20

090

N

704.58

*

*

J1

65865

SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE

1615.20

090

N

3707.69

*

*

J1

65870

SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE

2013.60

090

N

3707.69

*

*

J1

65875

SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE

2150.40

090

N

3707.69

*

*

J1

65880

SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL

2263.20

090

N

7014.24

*

*

J1

65900

RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE

3315.60

090

Y

3707.69

*

*

J1

65920

RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE

2689.20

090

N

3707.69

*

*

J1

65930

RMVL BLOOD CLOT ANTERIOR SEGMENT EYE

2170.80

090

N

3707.69

*

*

J1

66020

INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX

651.60

010

N

3707.69

*

*

J1

66030

INJX ANTERIOR CHAMBER EYE MEDICATION SPX

584.40

010

N

3707.69

*

*

J1

66130

EXCISION LESION SCLERA

2394.00

090

N

3609.14

*

*

J1

66150

FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY

2992.80

090

N

7014.24

*

*

J1

66155

FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC

2990.40

090

N

7014.24

*

*

J1

66160

FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT

3372.00

090

N

3707.69

*

*

J1

66170

FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO

3734.40

090

Y

3707.69

*

*

J1

66172

FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING

4068.00

090

Y

3707.69

*

*

J1

66174

TRLUML DILAT AQUEOUS CANAL W/O DEVICE/STENT

3232.80

090

Y

7014.24

*

*

J1

66175

TRLUML DILAT AQUEOUS CANAL W/DEVICE/STENT

3386.40

090

Y

7014.24

*

*

J1

66179

AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT

3679.20

090

Y

7014.24

*

*

J1

66180

AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT

3882.00

090

Y

7014.24

*

*

J1

66183

INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR

3514.80

090

Y

7014.24

*

*

J1

66184

REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT

2680.80

090

Y

3707.69

*

*

J1

66185

REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT

2886.00

090

Y

3707.69

*

*

J1

66225

REPAIR SCLERAL STAPHYLOMA W/GRAFT

3177.60

090

N

7014.24

*

*

J1

66250

REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT

2569.20

090

N

3609.14

*

*

J1

66500

IRIDOTOMY STAB INC SPX XCP TRANSFIXION

1224.00

090

N

3707.69

*

*

J1

66505

IRIDOTOMY STAB INC SPX TRANSFIXION

1340.40

090

N

3707.69

*

*

J1

66600

IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES

2872.80

090

N

7014.24

*

*

J1

66605

IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY

3640.80

090

N

3707.69

*

*

J1

66625

IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX

1464.00

090

N

3707.69

*

*

J1

66630

IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX

1940.40

090

N

3707.69

*

*

J1

66635

IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX

1959.60

090

N

3707.69

*

*

J1

66680

REPAIR IRIS CILIARY BODY

1765.20

090

N

3707.69

*

*

J1

66682

SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE

2206.80

090

N

3707.69

*

*

J1

66700

CILIARY BODY DESTRUCTION DIATHERMY

1543.20

090

N

3707.69

*

*

J1

66710

CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL

1512.00

090

N

3609.14

*

*

J1

66711

CILIARY BODY DSTRJ CYCLOPHOTOCOAG ENDOSCOPIC

2193.60

090

N

3707.69

*

*

J1

66720

CILIARY BODY DESTRUCTION CRYOTHERAPY

1579.20

090

N

3609.14

*

*

J1

66740

CILIARY BODY DESTRUCTION CYCLODIALYSIS

1500.00

090

N

3609.14

*

*

66761

IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION

1020.00

010

N

704.58

*

*

66762

IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS

1628.40

090

N

704.58

*

*

66770

DSTRJ CYST/LESION IRIS/CILIARY BODY

1808.40

090

N

704.58

*

*

J1

66820

DISCISSION SECONDARY MEMBRANOUS CATARACT

1375.20

090

N

3707.69

*

*

66821

POST-CATARACT LASER SURGERY

1130.40

090

N

704.58

*

*

J1

66825

REPOSITIONING IO LENS PROSTHESIS REQ INC SPX

2622.00

090

N

3707.69

*

*

J1

66830

RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ

2418.00

090

N

3707.69

*

*

J1

66840

RMVL LENS MATERIAL ASPIR TQ 1/> STAGES

2374.80

090

N

3707.69

*

*

J1

66850

RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR

2702.40

090

N

3707.69

*

*

J1

66852

RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY

2878.80

090

N

7014.24

*

*

J1

66920

RMVL LENS MATERIAL INTRACAPSULAR

2569.20

090

N

3707.69

*

*

J1

66930

REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS

2919.60

090

N

7014.24

*

*

J1

66940

REMOVAL LENS MATERIAL EXTRACAPSULAR

2667.60

090

N

3707.69

*

*

J1

66982

XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG

2707.20

090

N

3707.69

*

*

J1

66983

ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG

2530.80

090

N

3707.69

*

*

J1

66984

CATARACT REMOVAL INSERTION OF LENS

2179.20

090

N

3707.69

*

*

J1

66985

INSJ IO LENS PROSTHESIS NOT W/CONCURRENT RMVL

2623.20

090

N

3707.69

*

*

J1

66986

EXCHANGE INTRAOCULAR LENS

3099.60

090

N

3707.69

+

*

66990

USE OPHTHALMIC ENDOSCOPE

307.20

ZZZ

N

*

*

J1

66999

UNLISTED PROCEDURE ANTERIOR SEGMENT EYE

BR

YYY

N

3707.69

*

*

J1

67005

RMVL VITREOUS ANT APPR PARTIAL REMOVAL

1611.60

090

N

3707.69

*

*

J1

67010

RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT

1850.40

090

N

3707.69

*

*

J1

67015

ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL

1989.60

090

N

3707.69

*

*

J1

67025

INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX

2502.00

090

N

3707.69

*

*

J1

67027

IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS

2906.40

090

Y

32207.07

*

*

67028

INTRAVITREAL NJX PHARMACOLOGIC AGT SPX

346.80

000

N

409.50

*

*

J1

67030

DISCISSION VITREOUS STRANS PARS PLANA APPROACH

1825.20

090

N

3707.69

*

*

67031

SEVERING VITREOUS STRANS LASER 1/> STAGES

1333.20

090

N

704.58

*

*

J1

67036

VITRECTOMY MECHANICAL PARS PLANA

3073.20

090

Y

7014.24

*

*

J1

67039

VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC

3291.60

090

Y

7014.24

*

*

J1

67040

VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC

3556.80

090

Y

7014.24

*

*

J1

67041

VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE

3930.00

090

Y

7014.24

*

*

J1

67042

VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA

3930.00

090

Y

7014.24

*

*

J1

67043

VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE

4146.00

090

Y

7014.24

*

*

J1

67101

RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX

1128.00

010

N

3707.69

*

*

67105

RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC

1014.00

010

N

704.58

*

*

J1

67107

REPAIR RETINAL DETACHMENT SCLERAL BUCKLING

3862.80

090

Y

7014.24

*

*

J1

67108

RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH

4092.00

090

Y

7014.24

*

*

J1

67110

RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS

3010.80

090

N

3707.69

*

*

J1

67113

RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL

4567.20

090

Y

7014.24

*

*

J1

67115

RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT

1702.80

090

N

7014.24

*

*

J1

67120

RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR

2263.20

090

N

3707.69

*

*

J1

67121

RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR

3097.20

090

Y

3707.69

*

*

67141

PROPH RTA DTCHMNT W/O DRG 1/> SESS CRTX DTHRM

1790.40

090

N

402.60

*

*

67145

PROPH RTA DTCHMNT W/O DRG 1/> SESS

1802.40

090

N

704.58

*

*

67208

DSTRJ LOCLZD LESION RETINA 1/> SESS CRTX DTHRM

2048.40

090

N

402.60

*

*

67210

DSTRJ LOCLZD LESION RETINA 1/> SESS PC

1766.40

090

N

704.58

*

*

J1

67218

DSTRJ LESION RETINA 1/> SESS RADJ IMPLTJ

4725.60

090

N

5848.19

*

*

67220

DSTRJ LESION CHOROID PC 1/> SESS

1821.60

090

N

704.58

*

*

67221

DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY

968.40

000

N

704.58

+

*

67225

DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION

100.80

ZZZ

N

*

*

J1

67227

DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY

1000.80

010

N

5848.19

*

*

67228

TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION

1167.60

010

N

704.58

*

*

67229

EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT

3976.80

090

N

704.58

*

*

J1

67250

SCLERAL REINFORCEMENT SPX W/O GRAFT

2713.20

090

N

3609.14

*

*

J1

67255

SCLERAL REINFORCEMENT SPX W/GRAFT

2330.40

090

Y

3707.69

*

*

J1

67299

UNLISTED PROCEDURE POSTERIOR SEGMENT

BR

YYY

N

3707.69

*

*

J1

67311

STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC

2035.20

090

N

3609.14

*

*

J1

67312

STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC

2427.60

090

N

5848.19

*

*

J1

67314

STRABISMUS RECESSION/RESCJ 1 VER MUSC

2292.00

090

N

3609.14

*

*

J1

67316

STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC

2728.80

090

N

3609.14

*

*

J1

67318

STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE

2395.20

090

N

3609.14

+

*

67320

TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC

1100.40

ZZZ

N

+

*

67331

STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC

1044.00

ZZZ

N

+

*

67332

STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY

1132.80

ZZZ

N

+

*

67334

STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION

1030.80

ZZZ

N

+

*

67335

PLACEMENT ADJUSTABLE SUTURE STRABISMUS

505.20

ZZZ

N

+

*

67340

STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC

1222.80

ZZZ

Y

*

*

J1

67343

RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX

2224.80

090

N

3609.14

*

*

67345

CHEMODENERVATION EXTRAOCULAR MUSCLE

835.20

010

N

402.60

*

*

J1

67346

BIOPSY EXTRAOCULAR MUSCLE

660.00

000

N

5848.19

*

*

67399

UNLISTED PROCEDURE EXTRAOCULAR MUSCLE

BR

YYY

Y

402.60

*

*

J1

67400

ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY

3214.80

090

N

5848.19

*

*

J1

67405

ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY

2743.20

090

N

3609.14

*

*

J1

67412

ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION

2961.60

090

N

3609.14

*

*

J1

67413

ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY

2964.00

090

Y

3609.14

*

*

J1

67414

ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN

4574.40

090

Y

5848.19

*

*

J1

67415

FINE NEEDLE ASPIRATION ORBITAL CONTENTS

356.40

000

N

3609.14

*

*

J1

67420

ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION

5553.60

090

Y

5848.19

*

*

J1

67430

ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB

4312.80

090

Y

5848.19

*

*

J1

67440

ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG

4173.60

090

Y

5848.19

*

*

J1

67445

ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN

4838.40

090

Y

5848.19

*

*

J1

67450

ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX

4338.00

090

Y

5848.19

*

*

67500

RETROBULBAR INJECTION MEDICATION SPX

242.40

000

N

402.60

*

*

67505

RETROBULBAR INJECTION ALCOHOL

285.60

000

N

402.60

*

*

67515

INJECTION MEDICATION/OTHER SUBST TENON CAPSULE

268.80

000

N

402.60

*

*

J1

67550

ORBITAL IMPLANT INSERTION

3338.40

090

N

5848.19

*

*

J1

67560

ORBITAL IMPLANT REMOVAL/REVISION

3421.20

090

N

5848.19

*

*

J1

67570

OPTIC NERVE DECOMPRESSION

4074.00

090

Y

5848.19

*

*

67599

UNLISTED PROCEDURE ORBIT

BR

YYY

Y

402.60

*

*

67700

BLEPHAROTOMY DRAINAGE ABSCESS EYELID

938.40

010

N

402.60

*

*

67710

SEVERING TARSORRHAPHY

787.20

010

N

1146.35

*

*

J1

67715

CANTHOTOMY SEPARATE PROCEDURE

848.40

010

N

3609.14

*

*

67800

EXCISION CHALAZION SINGLE

436.80

010

N

402.60

*

*

67801

EXCISION CHALAZION MULTIPLE SAME LID

556.80

010

N

1146.35

*

*

67805

EXCISION CHALAZION MULTIPLE DIFFERENT LIDS

691.20

010

N

402.60

*

*

J1

67808

EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT

1254.00

090

N

3609.14

*

*

67810

INCISIONAL BIOPSY EYELID SKIN & LID MARGIN

598.80

000

N

402.60

*

*

67820

CORRECTION TRICHIASIS EPILATION FORCEPS ONLY

111.60

000

N

151.20

*

*

67825

CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS

445.20

010

N

402.60

*

*

67830

CORRECTION TRICHIASIS INCCISION LID MARGIN

916.80

010

N

1146.35

*

*

J1

67835

CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF

1496.40

090

N

3609.14

*

*

67840

EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE

949.20

010

N

1146.35

*

*

67850

DESTRUCTION LESION LID MARGIN </ 1 CM

735.60

010

N

1146.35

*

*

67875

TEMPORARY CLOSURE EYELIDS SUTURE

595.20

000

N

1146.35

*

*

J1

67880

CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY

1574.40

090

N

3609.14

*

*

J1

67882

CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS

1932.00

090

N

3609.14

*

*

J1

67900

REPAIR BROW PTOSIS

2193.60

090

N

3609.14

*

*

J1

67901

RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL

2630.40

090

N

3609.14

*

*

J1

67902

RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING

2464.80

090

N

5848.19

*

*

J1

67903

RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL

2037.60

090

N

3609.14

*

*

J1

67904

RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL

2512.80

090

N

3609.14

*

*

J1

67906

RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING

1732.80

090

N

5848.19

*

*

J1

67908

RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ

1700.40

090

N

3609.14

*

*

J1

67909

REDUCTION OVERCORRECTION PTOSIS

1843.20

090

N

3609.14

*

*

J1

67911

CORRECTION LID RETRACTION

1916.40

090

N

3609.14

*

*

J1

67912

CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD

3050.40

090

N

3609.14

*

*

J1

67914

REPAIR ECTROPION SUTURE

1623.60

090

N

3609.14

*

*

J1

67915

REPAIR ECTROPION THERMOCAUTERIZATION

1022.40

090

N

3609.14

*

*

J1

67916

REPAIR ECTROPION EXCISION TARSAL WEDGE

2046.00

090

N

3609.14

*

*

J1

67917

REPAIR ECTROPION EXTENSIVE

2083.20

090

N

3609.14

*

*

J1

67921

REPAIR ENTROPION SUTURE

1593.60

090

N

3609.14

*

*

J1

67922

REPAIR ENTROPION THERMOCAUTERIZATION

1004.40

090

N

3609.14

*

*

J1

67923

REPAIR ENTROPION EXCISION TARSAL WEDGE

2046.00

090

N

3609.14

*

*

J1

67924

REPAIR ENTROPION EXTENSIVE

2179.20

090

N

3609.14

*

*

J1

67930

SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK

1251.60

010

N

3609.14

*

*

J1

67935

SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK

2035.20

090

N

3609.14

*

*

67938

REMOVAL EMBEDDED FOREIGN BODY EYELID

862.80

010

N

402.60

*

*

J1

67950

CANTHOPLASTY

1966.80

090

N

3609.14

*

*

J1

67961

EXCISION & REPAIR EYELID < ONE-FOURTH LID MARGIN

1976.40

090

N

3609.14

*

*

J1

67966

EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN

2635.20

090

N

3609.14

*

*

J1

67971

RCNSTJ EYELID FULL THICKNESS 1 STG

2469.60

090

N

3609.14

*

*

J1

67973

RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG

3176.40

090

Y

3609.14

*

*

J1

67974

RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG

3169.20

090

Y

5848.19

*

*

J1

67975

RCNSTJ EYELID FULL THICKNESS SECOND STAGE

2336.40

090

N

3609.14

*

*

67999

UNLISTED PROCEDURE EYELIDS

BR

YYY

N

402.60

*

*

68020

INCISION CONJUNCTIVA DRAINAGE OF CYST

412.80

010

N

1146.35

*

*

68040

EXPRESSION CONJUNCTIVAL FOLLICLES

213.60

000

N

402.60

*

*

J1

68100

BIOPSY CONJUNCTIVA

596.40

000

N

3609.14

*

*

J1

68110

EXCISION LESION CONJUNCTIVA </1 CM

787.20

010

N

3609.14

*

*

J1

68115

EXCISION LESION CONJUNCTIVA > 1 CM

1088.40

010

N

3609.14

*

*

J1

68130

EXCISION LESION CONJUNCTIVA ADJACENT SCLERA

1857.60

090

N

3609.14

*

*

J1

68135

DESTRUCTION LESION CONJUNCTIVA

538.80

010

N

3609.14

*

*

68200

SUBCONJUNCTIVAL INJECTION

141.60

000

N

151.20

*

*

J1

68320

CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT

2498.40

090

N

3609.14

*

*

J1

68325

CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT

2242.80

090

N

5848.19

*

*

J1

68326

CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT

2202.00

090

N

5848.19

*

*

J1

68328

CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT

2414.40

090

N

3609.14

*

*

J1

68330

RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT

2086.80

090

N

3707.69

*

*

J1

68335

RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB

2210.40

090

N

5848.19

*

*

J1

68340

RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE

1923.60

090

N

3609.14

*

*

J1

68360

CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX

1836.00

090

N

5848.19

*

*

J1

68362

CONJUNCTIVAL FLAP TOTAL

2240.40

090

N

3609.14

*

*

J1

68371

HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR

1408.80

010

N

3609.14

*

*

68399

UNLISTED PROCEDURE CONJUNCTIVA

BR

YYY

N

402.60

*

*

68400

INCISION DRAINAGE LACRIMAL GLAND

988.80

010

N

1146.35

*

*

J1

68420

INCISION DRAINAGE LACRIMAL SAC

1113.60

010

N

3609.14

*

*

68440

SNIP INCISION LACRIMAL PUNCTUM

350.40

010

N

402.60

*

*

J1

68500

EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL

3344.40

090

N

5848.19

*

*

J1

68505

EXCISION LACRIMAL GLAND XCPT TUMOR PRTL

3328.80

090

N

5848.19

*

*

J1

68510

BIOPSY LACRIMAL GLAND

1540.80

000

N

3609.14

*

*

J1

68520

EXCISION LACRIMAL SAC

2352.00

090

N

5848.19

*

*

J1

68525

BIOPSY LACRIMAL SAC

902.40

000

N

3609.14

*

*

68530

RMVL FB/DACRYOLITH LACRIMAL PASSAGES

1471.20

010

N

402.60

*

*

J1

68540

EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH

3181.20

090

N

3609.14

*

*

J1

68550

EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY

3903.60

090

N

5848.19

*

*

J1

68700

PLASTIC REPAIR CANALICULI

2060.40

090

N

3609.14

*

*

68705

CORRECTION EVERTED PUNCTUM CAUTERY

838.80

010

N

402.60

*

*

J1

68720

DACRYOCSTORHINOSTOMY

2592.00

090

Y

5848.19

*

*

J1

68745

CONJUNCTIVORHINOSTOMY W/O TUBE

2602.80

090

Y

5848.19

*

*

J1

68750

CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT

2698.80

090

Y

5848.19

*

*

68760

CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER

710.40

010

N

402.60

*

*

68761

CLSR LACRIMAL PUNCTUM PLUG EACH

506.40

010

N

402.60

*

*

J1

68770

CLOSURE LACRIMAL FISTULA SPX

2145.60

090

N

3609.14

*

*

68801

DILATION LACRIMAL PUNCTUM W/WO IRRGATION

308.40

010

N

494.39

*

*

68810

PROBE NASOLACRIMAL DUCT W/WO IRRIGATION

536.40

010

N

402.60

*

*

J1

68811

PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES

464.40

010

N

3609.14

*

*

J1

68815

PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT

1345.20

010

N

3609.14

*

*

J1

68816

PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION

2460.00

010

N

3609.14

*

*

68840

PROBE LACRIMAL CANALICULI W/WO IRRIGATION

440.40

010

N

402.60

*

*

68850

INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY

214.80

000

N

*

*

68899

UNLISTED PROCEDURE LACRIMAL SYSTEM

BR

YYY

N

402.60

*

*

69000

DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE

634.80

010

N

822.66

*

*

J1

69005

DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX

735.60

010

N

2734.29

*

*

69020

DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS

788.40

010

N

822.66

*

*

69090

EAR PIERCING

92.40

XXX

N

*

*

69100

BIOPSY EXTERNAL EAR

334.80

000

N

292.72

*

*

J1

69105

BIOPSY EXTERNAL AUDITORY CANAL

478.80

000

N

2543.11

*

*

J1

69110

EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR

1560.00

090

N

4742.07

*

*

J1

69120

EXCISION EXTERNAL EAR COMPLETE AMPUTATION

1365.60

090

N

8765.29

*

*

J1

69140

EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL

3002.40

090

N

8765.29

*

*

J1

69145

EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL

1336.80

090

N

4742.07

*

*

J1

69150

RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ

3540.00

090

N

8765.29

*

*

69155

RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ

5643.60

090

Y

*

*

69200

RMVL FB XTRNL AUDITORY CANAL W/O ANES

278.40

000

N

151.20

*

*

J1

69205

RMVL FB XTRNL AUDITORY CANAL ANES

338.40

010

N

2734.29

*

*

69209

REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT

48.00

000

N

79.38

*

*

69210

REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT

160.80

000

N

79.38

*

*

69220

DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE

274.80

000

N

250.56

*

*

69222

DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX

734.40

010

N

691.72

*

*

J1

69300

OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ

2181.60

YYY

N

4449.71

*

*

J1

69310

RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX

3724.80

090

N

8765.29

*

*

J1

69320

RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG

5226.00

090

Y

8765.29

*

*

69399

UNLISTED PROCEDURE EXTERNAL EAR

BR

YYY

N

292.72

*

*

69420

MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ

643.20

010

N

292.72

*

*

J1

69421

MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES

506.40

010

N

4449.71

*

*

69424

VENTILATING TUBE RMVL REQUIRING GENERAL ANES

435.60

000

N

3168.40

*

*

69433

TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA

680.40

010

N

691.72

*

*

J1

69436

TYMPANOSTOMY GENERAL ANESTHESIA

541.20

010

N

2543.11

*

*

J1

69440

MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC

2346.00

090

N

4449.71

*

*

J1

69450

TYMPANOLYSIS TRANSCANAL

1856.40

090

N

4449.71

*

*

J1

69501

TRANSMASTOID ANTROTOMY

2474.40

090

N

8765.29

*

*

J1

69502

MASTOIDECTOMY COMPLETE

3283.20

090

N

8765.29

*

*

J1

69505

MASTOIDECTOMY MODIFIED RADICAL

4113.60

090

N

8765.29

*

*

J1

69511

MASTOIDECTOMY RADICAL

4215.60

090

N

8765.29

*

*

J1

69530

PETROUS APICECTOMY RADICAL MASTOIDECTOMY

5655.60

090

Y

8765.29

*

*

69535

RESCJ TEMPORAL BONE EXTERNAL APPROACH

9205.20

090

N

*

*

J1

69540

EXCISION AURAL POLYP

704.40

010

N

2543.11

*

*

J1

69550

EXCISION AURAL GLOMUS TUMOR TRANSCANAL

3558.00

090

Y

8765.29

*

*

J1

69552

EXCISION AURAL GLOMUS TUMOR TRANSMASTOID

5370.00

090

Y

8765.29

*

*

69554

EXCISION AURAL GLOMUS TUMOR EXTENDED

8622.00

090

Y

*

*

J1

69601

REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY

3540.00

090

N

8765.29

*

*

J1

69602

REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC

3714.00

090

N

8765.29

*

*

J1

69603

REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY

4311.60

090

N

8765.29

*

*

J1

69604

REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY

3799.20

090

N

8765.29

*

*

J1

69605

REVJ MASTOIDECTOMY W/APICECTOMY

5336.40

090

Y

8765.29

*

*

J1

69610

TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH

1299.60

010

N

4449.71

*

*

J1

69620

MYRINGOPLASTY

2378.40

090

N

4449.71

*

*

J1

69631

TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ

3015.60

090

N

8765.29

*

*

J1

69632

TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ

3678.00

090

N

8765.29

*

*

J1

69633

TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP

3565.20

090

N

8765.29

*

*

J1

69635

TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ

4246.80

090

N

8765.29

*

*

J1

69636

TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ

4720.80

090

N

8765.29

*

*

J1

69637

TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP

4788.00

090

N

8765.29

*

*

J1

69641

TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ

3554.40

090

N

8765.29

*

*

J1

69642

TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ

4569.60

090

N

8765.29

*

*

J1

69643

TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR

4174.80

090

N

8765.29

*

*

J1

69644

TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR

5061.60

090

N

8765.29

*

*

J1

69645

TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR

4972.80

090

N

8765.29

*

*

J1

69646

TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR

5292.00

090

N

8765.29

*

*

J1

69650

STAPES MOBILIZATION

2739.60

090

N

4449.71

*

*

J1

69660

STAPEDECTOMY/STAPEDOTOMY

3163.20

090

N

8765.29

*

*

J1

69661

STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT

4122.00

090

N

8765.29

*

*

J1

69662

REVISION STAPEDECTOMY/STAPEDOTOMY

3954.00

090

N

8765.29

*

*

J1

69666

REPAIR OVAL WINDOW FISTULA

2755.20

090

N

4449.71

*

*

J1

69667

REPAIR ROUND WINDOW FISTULA

2766.00

090

N

4449.71

*

*

J1

69670

MASTOID OBLITERATION SEPARATE PROCEDURE

3218.40

090

Y

8765.29

*

*

J1

69676

TYMPANIC NEURECTOMY

2832.00

090

N

4449.71

*

*

J1

69700

CLOSURE POSTAURICULAR FISTULA MASTOID SPX

2316.00

090

N

2543.11

*

*

69710

IMPLTJ/RPLCMT EMGNT BONE CNDJ DEV TEMPORAL BONE

3990.00

XXX

N

3728.20

*

*

J1

69711

RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE

2914.80

090

Y

4449.71

*

*

J1

69714

IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID

3656.40

090

N

19120.53

*

*

J1

69715

IMPLJ OSSEOINTEGRATED TEMPORAL BONE W/O MASTOID

4515.60

090

N

26078.68

*

*

J1

69717

RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY

3831.60

090

N

10775.65

*

*

J1

69718

RPLMCT OSSEOINTEGRATE IMPLNT W/MASTOIDECTOMY

4561.20

090

N

19120.53

*

*

J1

69720

DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION

4099.20

090

N

8765.29

*

*

J1

69725

DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE

6427.20

090

Y

8765.29

*

*

J1

69740

SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE

3986.40

090

Y

8765.29

*

*

J1

69745

SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE

4242.00

090

Y

8765.29

*

*

69799

UNLISTED PROCEDURE MIDDLE EAR

BR

YYY

N

292.72

*

*

J1

69801

LABYRINTHOTOMY TRANSCANAL

699.60

000

N

2543.11

*

*

J1

69805

ENDOLYMPHATIC SAC W/O SHUNT

3578.40

090

Y

8765.29

*

*

J1

69806

ENDOLYMPHATIC SAC SHUNT

3194.40

090

N

8765.29

*

*

J1

69905

LABYRINTHECTOMY TRANSCANAL

3127.20

090

N

8765.29

*

*

J1

69910

LABYRINTHECTOMY W/MASTOIDECTOMY

3444.00

090

N

8765.29

*

*

J1

69915

VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR

5233.20

090

Y

4449.71

*

*

J1

69930

COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY

4183.20

090

N

50908.68

*

*

69949

UNLISTED PROCEDURE INNER EAR

BR

YYY

N

292.72

*

*

69950

VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH

6073.20

090

Y

*

*

J1

69955

TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR

6747.60

090

Y

8765.29

*

*

J1

69960

DECOMPRESSION INTERNAL AUDITORY CANAL

6555.60

090

Y

8765.29

*

*

J1

69970

REMOVAL TUMOR TEMPORAL BONE

7326.00

090

Y

8765.29

*

*

69979

UNLISTED PROCEDURE TEMPORAL BONE MIDDLE FOSSA

BR

YYY

N

292.72

+

*

69990

MICROSURG TQS REQ USE OPERATING MICROSCOPE

768.00

ZZZ

Y

20 Miss. Code. R. § 2-VI

Amended 6/14/2017
Amended 6/15/2019