SURGERY GROUND RULES

1.

PACKAGE OR GLOBAL FEE CONCEPT: Listed surgical procedures include the surgery itself, local
anesthesia, metacarpal/digital block, or topical anesthesia when used, and normal, uncomplicated follow-up
care. The Unit Values for all procedures in this section applies to this "package" or "global" service for
surgical procedures. To report a postoperative follow-up for documentation purposes only, use 99024 (see
Special Services and Reports Section). For preoperative visits, see Ground Rules 3 and 4 below; see the
respective Anesthesia Ground Rule pertaining to anesthesia administered by other than an anesthesiologist
or anesthetist.

2.

OPERATIVE REPORT AND BILLING: A bill for an operative procedure shall be deemed properly submitted
only if an operative report or an informative description of the surgery performed is received by the payer. If
surgery was performed in a hospital or an ambulatory surgery center, a copy of the hospital's or ambulatory
surgery center's operative report will suffice. If surgery was performed at some other site and classified as
minor surgery, such as at a physician's office, identify the (geographic) location and submit an informative
description of the surgery performed.

3.

IMMEDIATE PREOPERATIVE VISITS AND OTHER SERVICES BY THE SURGEON: Under most
circumstances, including ordinary referrals, the immediate preoperative visit in the hospital or elsewhere that
is necessary to examine the patient, or to initiate the treatment program, is included in the Unit Value listed
for the surgical procedure.

4.

SEPARATE PREOPERATIVE CHARGES: Charges for separate preoperative procedures are sometimes
warranted and may be billed under the following circumstances:
a)

when the preoperative visit is the initial visit (e.g., an emergency) and prolonged detention or
evaluation is required to prepare the patient, or to establish the need for and type of surgical
procedure.

b)

when the preoperative visit is an initial consultation, as defined in the Medicine Section of this
manual.

c)

when procedures not usually part of the basic surgical procedure (e.g., myelography prior to
laminectomy, bronchoscopy prior to chest surgery) are provided during the immediate
preoperative visit.

5.

FOLLOW-UP CARE FOR DIAGNOSTIC PROCEDURES: Follow-up care for diagnostic procedures (e.g.,
endoscopy, injection procedures for radiography) includes only that care related to recovery from the
diagnostic procedure itself. Care of the condition for which the diagnostic procedure was performed or of
other concomitant conditions is not included and may be billed separately.

6.

MULTIPLE OR BILATERAL PROCEDURES: Multiple related procedures shall not warrant an additional fee
except in those subsections of the listings where separate codes are given. When more than one identifiable
surgical procedure or service is rendered, an additional fee may be warranted. Identify each procedure and
bill at full value for the major procedure and at 50% for the lesser procedure, up to a total maximum of twice
the greater fee (e.g., unsuccessful closed reduction of a fracture followed on a different day by open
reduction).
When multiple procedures, unrelated to the major procedure and adding significant time or complexity are
provided at the same operative session, payment is for the procedure with the highest allowance, plus half of
the lesser procedure up to a total maximum allowance of twice the highest fee.
When bilateral procedures are performed that require preparation of separate operative sites (e.g., bilateral
carpal tunnel), payment for the second (or bilateral) procedure is to be reimbursed at 75% of the primary
procedure.

CPT only copyright 2004 American Medical Association. All Rights Reserved.

11

SURGERY GROUND RULES
MULTIPLE/BILATERAL EXAMPLES:
Related Procedures.
a)

Open reduction of a fracture: the excision of a previous scar, the incision of fascia
and muscle, the identification and retraction of nerves, muscles, and area structures,
and the closure of the wound (irrespective of type of closure) are all related to the
principal procedure of the bone repair and merit no additional fee.

b)

Repair of a tendon: the skin incision and linear closure, as well as the identification,
incision and retraction of adjacent or overlying structures are related to the principal
procedure and merit no additional fee.

Unrelated Procedures.
a) Multiple lacerations of an area such as the face: an additional fee may be warranted
when such lacerations are not continuous.
b)

Closure of an incision or laceration incidental to the repair of deeper structures such
as nerves, tendons, etc., does not merit an additional fee irrespective of the method
of closure.

7.

ADD-ON CODES: Certain codes, by the nature of their description and the unit values assigned, have
already been reduced, as they are not to be billed as primary procedures. For a complete list of the codes
which are considered to be add-on codes, refer to the appropriate appendix found within the most recent
publication of the AMA Current Procedural Terminology (CPT).

8.

CODES THAT ARE NOT CLASSIFIED AS ADD-ON CODES BUT ARE EXEMPT FROM THE MULTIPLE
PROCEDURE RULE / MODIFIER -51: For a complete list of the codes which fall into this category, refer to
the appropriate appendix found within the most recent publication of the AMA Current Procedural
Terminology (CPT).

9.

CODES WHICH INCLUDE CONSCIOUS SEDATION: Certain codes include conscious sedation as an
inherent part of providing the procedure. For a complete list of codes that include conscious sedation, refer
to the appropriate appendix that is found within the most recent publication of the AMA Current Procedural
Terminology (CPT).

10. FOLLOW-UP OR AFTERCARE: Follow-up care for therapeutic surgical procedures includes all normal
postoperative care, that care which is usually a part of the surgical service. Complications, exacerbations,
recurrence of the condition, or the presence of other diseases or injuries requiring additional services
concurrent with the procedure may warrant additional charges. If such separate charges are made, explain
by report with an adequate description. When an additional surgical procedure is performed during any
follow-up care and is related to the previously performed procedure but is not an intrinsic part of the latter,
the additional procedure will be paid at one-half the maximum allowable payment.
The column headed “FUD” reflects the amount of days that would be applicable for the particular type of
surgical procedure and/or service provided. Note that some procedures show the “FUD” as being XXX,
YYY, or ZZZ. The following definitions, which correspond with the Medicare Fee Schedule, are incorporated
within this fee schedule:
XXX = Reflects that the global surgery concept does not apply to these codes.
YYY = Reflects that the global period (FUD’s) are to be set by the carrier.
ZZZ = Reflects that the codes are an add-on service and are to be treated in the global
period (FUD’s) of the other procedures that are billed in conjunction with the ZZZ
code.
CPT only copyright 2004 American Medical Association. All Rights Reserved.

12

SURGERY GROUND RULES
11. SEPARATE PROCEDURE: Some of the procedures or services listed are commonly carried out as an
integral component of a total service or procedure and are identified by the inclusion of the term “separate
procedure.” The codes designated as “separate procedure” should not be reported in addition to the code
for the total procedure or service of which it is considered an integral component.
However, when a procedure or service that is designated as a “separate procedure” is carried out
independently or considered to be unrelated or distinct from other procedures/services provided at that time,
it may be reported by itself, or in addition to other procedures/services by appending modifier -59 to the
specific “separate procedure” code to indicate that the procedure is not considered to be a component of
another procedure, but is a distinct, independent procedure. This may represent a different session or
patient encounter, different procedure or surgery, different site or organ system, separate incision/excision,
separate lesion, or separate injury (or area of injury in extensive injuries).
12. PRIMARY, SECONDARY, OR DELAYED PROCEDURES: A primary procedure is one that is attempted or
performed for the first time, irrespective of the relationship to the date of injury or the onset of the condition
being treated. Secondary refers to a procedure performed when a condition has been previously treated.
For example, where a tendon is lacerated and it is elected to close the laceration without suturing the tendon,
the first direct repair of the tendon would constitute a delayed but primary repair. In this example, if the first
repair is unsuccessful, any subsequent repair of the tendon would be a secondary procedure. Secondary
procedures lie within the content of service. Delayed procedures have the same Maximum Allowable Fee as
the primary procedures.
13. PROCEDURES LISTED WITHOUT SPECIFIED MAXIMUM ALLOWANCE: "BR" in the Unit Value column
indicates that the amount charged for this service is to be determined "by report" because the service is too
unusual or variable to be assigned a Unit Value. Pertinent information should be furnished concerning the
nature, extent, and need for the procedure or service, the skill and equipment necessary, etc., using any of
the following as indicated:
• Diagnosis (postoperative), pertinent history, and physical findings
• Size, location, and number of lesions or procedures where appropriate
• Major surgical procedure accompanied by an additional procedure
• The closest similar procedure by code number and the associated Unit Value, if possible
• Operative time
14. UNLISTED SERVICE OR PROCEDURE: When an unlisted service or procedure is performed, the
procedure should be identified and the amount charged substantiated "by report" (BR). Unlisted service or
procedure codes usually end in "99."
15. CONCURRENT SERVICES BY MORE THAN ONE HEALTH CARE PROVIDER: Charges for concurrent
services of two or more health care providers may be warranted under the following circumstances:
a) Identifiable medical services: Services provided prior to or during the surgical procedure or in the
postoperative period are to be charged by the health care provider rendering the service,
identified by the appropriate code. Payable fees under this category are unrelated to the
surgeon's fee.
b) Assistant surgeon: Identify the surgery performed by using the respective code number along
with the appropriate modifier (-80, -81, or -82) and bill at 25% of the code fee. The code number
must coincide with that of the primary surgeon. Assistant surgeon fees are not payable when the
hospital provides an intern or a resident staff to assist at surgery.
c) Two surgeons: Under certain circumstances, the skills of two surgeons (usually with different
skills) may be required in the management of a specific surgical procedure. Identify the surgery
performed by using the respective code number along with modifier -62. The total allowable fee
may be increased by 25% in lieu of an assistant surgeon’s fee. If the physicians have
agreed upon a payment distribution and that agreement is documented and explained in
conjunction with the bill, payment is to be made in accordance with the percentage agreed upon.
CPT only copyright 2004 American Medical Association. All Rights Reserved.

13

SURGERY GROUND RULES
In the absence of a prior agreement, the total allowable fee will be divided equally between the
two surgeons.
d) Surgical team: Under some circumstances, highly complex procedures (e.g., open heart or
organ transplant surgery) may require the concurrent services of several health care providers,
often of different specializations and using various types of complex equipment. These types of
services vary widely and a single unit value cannot be assigned. The amount charged should be
supported by a narrative report to include itemization of the health care provider, paramedical
personnel, and equipment involved. Modifier -66 should be used in this type of situation.

16. SURGERY AND FOLLOW-UP CARE PROVIDED BY DIFFERENT HEALTH CARE PROVIDERS: When
one health care provider performs the surgical procedure and another provides the follow-up care, the value
may be apportioned between them by agreement. Whether the amount charged is for the procedure, or the
follow-up care should be clearly indicated. The "global fee" is not to be increased, but prorated between the
health care providers.
17. REPEAT PROCEDURE BY ANOTHER HEALTH CARE PROVIDER: A basic procedure performed by one
health care provider may have to be repeated by another. Identify and submit an explanatory note. (See
modifier -77.)
18. PRORATION OF SCHEDULED FEE: When the schedule specifies a unit value for a definite treatment and
the patient is transferred from one health care provider to another, the applicable Unit Value is to be
apportioned between the health care providers. The providers involved shall agree upon the amount of the
proration, and shall render separate bills accordingly with an explanatory note.
19. MATERIALS SUPPLIED BY HEALTH CARE PROVIDER: Supplies and materials provided by the health
care provider (e.g., sterile trays, drugs) over and above those included with the office visit or other services
rendered may be listed separately. The statement of charges will need to reflect any drugs, trays, supplies,
and materials provided. Payment shall not exceed the cost of the item(s) to the health care provider plus
25%, or the cost of the item(s) plus $15.00 per item, whichever is less. Use procedure code 99070.
20. SURGICAL IMPLANTABLES: Reimbursement for any single surgical implantable item (e.g. rods, pins,
screws, plates, prosthetic joint replacements) and which is made of plastic, metallic, or of autogenous/nonautogenous graft material that reflects a charge of $250.00 or more, is to be determined by cost to the
provider plus a 50% markup above the invoice cost. A copy of the invoice (date of purchase within twelve
months of implantation) must be submitted with the bill.
21. SURGICAL ASSISTANT: Non-physician surgical assistants such as physician assistants or registered
nurses, who are either certified or licensed by the Kansas State Board of Healing Arts, the Kansas State
Board of Nursing, or some other comparable State licensing agency, may bill at 10% of the code fee. The
code(s) must coincide with those of the primary surgeon who must be identified as the responsible physician.
Such services are to be identified by adding modifier -NP to the procedure code. (See modifier -NP).
Additionally, bills for any surgical services provided by non-physicians such as physician assistants or
registered nurses must be submitted on the CMS 1500 or an equivalent form containing the same
information. The form must also clearly identify the responsible physician.
22. OTHER FEES: The Unit Values for anesthesia, x-rays, laboratory procedures, consultation and other
medical services, and office and hospital visits are listed in the following sections: Anesthesia, Radiology,
Pathology and Laboratory, Medicine, Physical Medicine and Rehabilitation, and Evaluation and
Management.
23. MEASUREMENTS: When listed with a described procedure, measurements pertain to the original wounds
or defects before any treatment is effected. The allowable charge includes creation of any additional defect.
The necessary preparations for repair do not merit an additional charge. The depth of a wound is not a
factor in the measurements when the described procedure is stated in terms of length or area.
CPT only copyright 2004 American Medical Association. All Rights Reserved.

14

SURGERY GROUND RULES
24. PROFESSIONAL/TECHNICAL COMPONENTS: When the professional and technical components are
furnished by different providers (inclusive of hospitals and ambulatory surgical centers), the professional
component and the technical component shall be identified by adding either modifier -26 or modifier -TC to
the usual procedure number. For surgical procedures, the unit value for the professional component is 60%
of the total unit value, and the unit value for the technical component is 40% of the total unit value for the
procedure code submitted. See Appendix A - Modifiers for the listing of the modifiers.
Additionally, and except for outpatient services, hospitals and ambulatory surgical centers will continue to be
reimbursed at their usual and customary charge less the specified discount as contained within the
Hospital/Ambulatory Surgical Center Section of the fee schedule. However, hospitals and ambulatory
surgical centers need to amend their billing process to specify, by use of modifiers, when only the technical
component or the professional component was provided.
25. MODIFIERS:
Procedure codes for surgery may be modified under certain circumstances.
The
circumstances are to be identified by the addition of a hyphen and the appropriate two-digit modifier code.
Refer to Appendix A - Modifiers for a list of modifiers that may be used.
26. COST CONTAINMENT: Nothing in this section shall preclude an employer (or insurance carrier) from
entering into payment agreements to promote the continuity of care and the reduction of health care costs.
Such payment agreements, if less, will supersede the limitation amounts specified herein. Please refer to
K.S.A. 44-510i(e) for further clarification, if necessary.

CONVERSION FACTOR = $67.95

CPT only copyright 2004 American Medical Association. All Rights Reserved.

15

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
10021
10022
10040
10060
10061
10080
10081
10120
10121
10140
10160
10180
11000
11001
11004
11005
11006
11008
11010
11011
11012
11040
11041
11042
11043
11044
11055
11056
11057
11100
11101
11200
11201
11300
11301
11302
11303
11305
11306
11307
11308
11310
11311
11312
11313
11400
11401
11402
11403
11404
11406
11420
11421

FUD
XXX
XXX
10
10
10
10
10
10
10
10
10
10
00
ZZZ
00
00
00
ZZZ
10
00
00
00
00
00
10
10
00
00
00
00
ZZZ
10
ZZZ
00
00
00
00
00
00
00
00
00
00
00
00
10
10
10
10
10
10
10
10

UNIT VALUE
3.52
3.89
2.25
2.50
4.48
4.38
6.77
3.51
6.52
3.49
2.94
5.56
1.25
0.56
14.88
20.27
18.74
7.63
11.66
13.80
20.09
1.08
1.58
2.22
6.05
7.91
1.04
1.32
1.63
2.10
0.76
1.86
0.47
1.53
2.01
2.40
2.89
1.59
2.17
2.51
2.99
1.89
2.34
2.68
3.52
2.91
3.38
3.86
4.35
4.97
6.14
2.84
3.61

CODE
11422
11423
11424
11426
11440
11441
11442
11443
11444
11446
11450
11451
11462
11463
11470
11471
11600
11601
11602
11603
11604
11606
11620
11621
11622
11623
11624
11626
11640
11641
11642
11643
11644
11646
11719
11720
11721
11730
11732
11740
11750
11752
11755
11760
11762
11765
11770
11771
11772
11900
11901
11920
11921

FUD
10
10
10
10
10
10
10
10
10
10
42
42
42
42
42
42
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
00
00
00
00
ZZZ
00
10
10
00
10
10
10
10
42
42
00
00
00
00

UNIT VALUE
4.03
4.79
5.48
7.67
3.34
3.94
4.41
5.41
6.90
8.94
8.10
11.05
7.92
11.27
8.70
11.65
4.04
4.62
4.90
5.42
5.97
7.84
3.88
4.58
5.19
6.14
7.07
9.36
4.10
5.34
6.18
7.15
9.07
12.29
0.44
0.70
1.05
2.30
1.08
0.96
4.24
6.01
3.03
4.40
6.13
2.55
6.40
12.10
15.35
1.20
1.49
5.54
6.17

CPT only copyright 2004 American Medical Association. All Rights Reserved.

16

CODE
11922
11950
11951
11952
11954
11960
11970
11971
11975
11976
11977
11980
11981
11982
11983
12001
12002
12004
12005
12006
12007
12011
12013
12014
12015
12016
12017
12018
12020
12021
12031
12032
12034
12035
12036
12037
12041
12042
12044
12045
12046
12047
12051
12052
12053
12054
12055
12056
12057
13100
13101
13102
13120

FUD
ZZZ
00
00
00
00
42
42
42
XXX
00
XXX
00
XXX
XXX
XXX
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
ZZZ
10

UNIT VALUE
1.70
2.04
2.79
3.70
4.53
20.74
14.21
11.54
3.07
3.71
5.94
2.69
3.30
3.89
5.82
3.84
4.08
4.78
5.96
7.43
8.37
4.06
4.45
5.26
6.62
7.85
7.08
8.38
6.74
3.89
4.61
6.48
6.37
8.99
10.11
11.37
5.11
6.19
6.64
9.29
11.25
11.54
5.94
6.18
6.60
7.31
9.35
12.55
12.62
7.44
8.85
2.54
7.72

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
13121
13122
13131
13132
13133
13150
13151
13152
13153
13160
14000
14001
14020
14021
14040
14041
14060
14061
14300
14350
15000
15001
15050
15100
15101
15120
15121
15200
15201
15220
15221
15240
15241
15260
15261
15342
15343
15350
15351
15400
15401
15570
15572
15574
15576
15600
15610
15620
15630
15650
15732
15734
15736

FUD
10
ZZZ
10
10
ZZZ
10
10
10
ZZZ
42
42
42
42
42
42
42
42
42
42
42
00
ZZZ
42
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
10
ZZZ
42
ZZZ
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
9.46
3.10
8.42
12.19
4.03
9.01
9.56
12.77
4.56
19.11
14.32
18.70
15.83
20.85
17.31
22.82
17.95
24.64
24.03
18.06
8.26
2.49
11.76
22.87
5.69
21.69
7.52
18.39
4.06
17.87
3.67
20.17
4.52
20.96
5.13
2.96
0.37
10.94
1.50
8.46
3.03
21.77
19.93
21.73
19.30
9.77
7.45
11.07
10.64
11.52
37.82
38.41
36.86

CODE
15738
15740
15750
15756
15757
15758
15760
15770
15775
15776
15780
15781
15782
15783
15786
15787
15788
15789
15792
15793
15810
15811
15819
15820
15821
15822
15823
15824
15825
15826
15828
15829
15831
15832
15833
15834
15835
15836
15837
15838
15839
15840
15841
15842
15845
15850
15851
15852
15860
15876
15877
15878
15879

FUD
42
42
42
42
42
42
42
42
00
00
42
42
42
42
10
ZZZ
42
42
42
42
42
42
42
42
42
42
42
00
00
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
XXX
00
00
00
00
00
00
00

UNIT VALUE
38.47
21.04
21.83
60.30
60.68
60.84
19.60
15.22
8.70
11.60
19.47
12.09
14.50
11.43
5.51
1.46
8.93
13.21
9.08
10.22
9.12
11.67
17.52
12.52
13.51
10.63
15.39
20.45
23.38
20.45
54.04
59.88
22.25
21.55
20.25
20.12
20.78
17.43
18.15
13.78
19.37
24.54
40.78
65.70
22.65
2.39
2.60
2.79
3.03
BR
BR
BR
BR

CPT only copyright 2004 American Medical Association. All Rights Reserved.

17

CODE
15920
15922
15931
15933
15934
15935
15936
15937
15940
15941
15944
15945
15946
15950
15951
15952
15953
15956
15958
15999
16000
16010
16015
16020
16025
16030
16035
16036
17000
17003
17004
17106
17107
17108
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
17281
17282
17283

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
00
00
00
00
00
00
42
ZZZ
10
ZZZ
10
42
42
42
10
10
00
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10

UNIT VALUE
14.52
18.50
16.14
20.17
22.47
26.92
22.31
26.03
16.79
22.50
21.67
24.10
39.01
13.95
20.01
20.71
23.38
28.43
28.71
BR
1.83
1.62
3.81
2.17
3.80
4.49
5.77
2.30
1.60
0.27
5.22
9.53
17.01
23.26
2.32
2.64
1.77
2.23
2.83
3.53
3.92
4.24
4.96
3.08
3.32
3.84
4.34
5.27
6.32
2.83
3.69
4.28
5.30

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
17284
17286
17304
17305
17306
17307
17310
17340
17360
17380
17999
19000
19001
19020
19030
19100
19101
19102
19103
19110
19112
19120
19125
19126
19140
19160
19162
19180
19182
19200
19220
19240
19260
19271
19272
19290
19291
19295
19296
19297
19298
19316
19318
19324
19325
19328
19330
19340
19342
19350
19355
19357
19361

FUD
10
10
00
00
00
00
ZZZ
10
10
00
YYY
00
ZZZ
42
00
00
10
00
00
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
00
ZZZ
ZZZ
00
ZZZ
00
42
42
42
42
42
42
ZZZ
42
42
42
42
42

UNIT VALUE
6.28
8.36
16.15
6.86
6.88
6.53
2.60
1.18
2.93
1.99
BR
2.90
0.71
10.33
4.48
3.51
8.06
5.97
15.48
10.64
10.20
10.81
11.62
4.31
12.97
10.19
21.61
14.99
13.51
25.32
25.95
26.28
28.64
39.41
43.42
4.20
1.88
2.70
129.38
2.53
48.59
19.78
29.63
11.57
16.26
11.59
14.82
10.47
21.89
24.14
18.73
36.60
34.52

CODE
19364
19366
19367
19368
19369
19370
19371
19380
19396
19499
20000
20005
20100
20101
20102
20103
20150
20200
20205
20206
20220
20225
20240
20245
20250
20251
20500
20501
20520
20525
20526
20550
20551
20552
20553
20600
20605
20610
20612
20615
20650
20660
20661
20662
20663
20664
20665
20670
20680
20690
20692
20693
20694

FUD
42
42
42
42
42
42
42
42
00
YYY
10
10
10
10
10
10
42
00
00
00
00
00
10
10
10
10
10
00
10
10
00
00
00
00
00
00
00
00
00
10
10
00
42
42
42
42
10
10
42
42
42
42
42

UNIT VALUE
70.61
36.03
46.33
56.77
52.62
16.21
18.75
18.25
3.55
BR
5.05
7.34
15.76
9.56
11.88
14.58
22.71
4.70
6.56
7.56
5.92
26.54
6.20
15.57
9.50
10.81
3.61
3.71
4.97
13.12
2.03
1.54
1.51
1.43
1.62
1.39
1.52
1.84
1.50
5.99
4.90
6.11
10.90
12.14
11.18
16.77
3.64
13.55
12.66
6.60
11.20
12.27
11.98

CPT only copyright 2004 American Medical Association. All Rights Reserved.

18

CODE
20802
20805
20808
20816
20822
20824
20827
20838
20900
20902
20910
20912
20920
20922
20924
20926
20930
20931
20936
20937
20938
20950
20955
20956
20957
20962
20969
20970
20972
20973
20974
20975
20979
20982
20999
21010
21015
21025
21026
21029
21030
21031
21032
21034
21040
21044
21045
21046
21047
21048
21049
21050
21060

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
XXX
ZZZ
XXX
ZZZ
ZZZ
00
42
42
42
42
42
42
42
42
00
00
00
00
YYY
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
65.82
89.04
110.59
73.17
63.69
72.00
66.47
64.74
14.92
15.70
11.14
12.84
10.15
14.85
13.37
11.08
2.60
3.16
2.74
4.78
5.20
8.29
68.23
70.76
66.53
71.89
75.34
74.93
68.82
76.41
1.41
4.81
1.51
117.50
BR
18.26
10.97
23.59
13.30
18.01
11.33
8.88
9.04
33.76
11.41
22.35
30.03
26.71
34.26
27.36
32.56
21.60
20.20

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
21070
21076
21077
21079
21080
21081
21082
21083
21084
21085
21086
21087
21088
21089
21100
21110
21116
21120
21121
21122
21123
21125
21127
21137
21138
21139
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21172
21175
21179
21180
21181
21182
21183
21184
21188
21193
21194
21195
21196
21198
21199

FUD
42
10
42
42
42
42
42
42
42
10
42
42
42
42
42
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
16.55
27.71
69.54
46.86
53.19
48.33
43.26
40.91
47.15
18.49
52.30
51.58
BR
BR
16.09
15.41
5.20
16.10
18.26
18.20
23.34
66.59
55.42
18.86
23.42
26.83
34.05
33.97
35.51
36.62
39.07
38.62
44.49
53.49
56.05
64.90
79.53
77.93
45.02
55.70
39.12
43.98
18.67
54.08
60.53
65.77
42.97
31.97
35.56
33.65
36.63
28.28
26.51

CODE
21206
21208
21209
21210
21215
21230
21235
21240
21242
21243
21244
21245
21246
21247
21248
21249
21255
21256
21260
21261
21263
21267
21268
21270
21275
21280
21282
21295
21296
21299
21300
21310
21315
21320
21325
21330
21335
21336
21337
21338
21339
21340
21343
21344
21345
21346
21347
21348
21355
21356
21360
21365
21366

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
00
00
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
10
42
42
42

UNIT VALUE
28.03
33.63
18.39
36.35
54.15
20.07
17.16
28.31
26.21
41.37
25.20
27.43
22.83
42.75
25.13
36.67
35.19
29.63
30.23
59.06
50.06
40.32
48.27
22.58
20.66
12.36
8.22
4.22
9.49
BR
3.20
2.92
5.88
5.94
12.69
15.65
18.96
15.88
9.10
21.26
22.93
20.29
29.89
38.53
18.91
23.98
30.31
30.24
10.33
11.72
13.10
27.43
31.55

CPT only copyright 2004 American Medical Association. All Rights Reserved.

19

CODE
21385
21386
21387
21390
21395
21400
21401
21406
21407
21408
21421
21422
21423
21431
21432
21433
21435
21436
21440
21445
21450
21451
21452
21453
21454
21461
21462
21465
21470
21480
21485
21490
21493
21494
21495
21497
21499
21501
21502
21510
21550
21555
21556
21557
21600
21610
21615
21616
21620
21627
21630
21632
21685

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
18.39
17.20
19.70
18.83
23.14
4.15
11.63
13.80
16.41
22.67
15.15
17.38
20.94
17.26
17.47
44.46
31.88
49.28
10.17
15.88
10.66
14.81
15.27
17.00
13.52
33.51
38.64
23.19
29.28
2.44
12.70
23.47
1.94
10.38
14.56
12.80
BR
10.66
13.72
12.16
5.81
10.39
10.32
15.30
13.57
26.21
17.98
21.89
13.71
14.09
31.71
31.78
24.01

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
21700
21705
21720
21725
21740
21742
21743
21750
21800
21805
21810
21820
21825
21899
21920
21925
21930
21935
22100
22101
22102
22103
22110
22112
22114
22116
22210
22212
22214
22216
22220
22222
22224
22226
22305
22310
22315
22318
22319
22325
22326
22327
22328
22505
22520
22521
22522
22532
22533
22534
22548
22554
22556

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
10
42
42
42
42
42
42
ZZZ
42
42
42
ZZZ
42
42
42
ZZZ
42
42
42
ZZZ
42
42
42
42
42
42
42
42
ZZZ
10
10
10
ZZZ
42
42
ZZZ
42
42
42

UNIT VALUE
11.07
16.60
9.01
13.62
27.35
24.87
32.74
18.41
2.39
6.33
12.76
3.25
14.86
BR
5.49
10.24
11.34
29.94
19.32
19.24
19.59
3.96
24.58
24.50
24.53
3.96
44.54
36.39
37.05
10.44
39.98
36.05
39.75
10.35
4.71
5.89
20.30
39.99
44.60
34.10
36.51
35.41
7.79
3.11
71.98
65.63
6.67
42.85
39.61
10.20
47.12
35.26
42.22

CODE
22558
22585
22590
22595
22600
22610
22612
22614
22630
22632
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22850
22851
22852
22855
22899
22900
22999
23000
23020
23030
23031
23035
23040
23044
23065
23066
23075
23076
23077
23100
23101
23105
23106
23107

FUD
42
ZZZ
42
42
42
42
42
ZZZ
42
ZZZ
42
42
42
42
42
42
42
42
42
ZZZ
XXX
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
42
42
ZZZ
42
42
YYY
42
YYY
42
42
10
10
42
42
42
10
42
10
42
42
42
42
42
42
42

UNIT VALUE
38.47
9.49
38.43
36.46
30.94
30.84
39.53
11.14
39.00
9.02
34.64
56.50
65.82
47.31
53.35
57.96
56.94
64.03
21.03
21.72
6.41
21.71
22.83
28.30
20.77
21.60
23.76
10.31
34.01
18.50
11.52
17.64
28.17
BR
9.76
BR
13.53
18.00
11.34
11.04
18.31
18.61
14.74
4.95
12.43
6.37
14.27
28.56
12.70
11.84
16.74
12.62
17.47

CPT only copyright 2004 American Medical Association. All Rights Reserved.

20

CODE
23120
23125
23130
23140
23145
23146
23150
23155
23156
23170
23172
23174
23180
23182
23184
23190
23195
23200
23210
23220
23221
23222
23330
23331
23332
23350
23395
23397
23400
23405
23406
23410
23412
23415
23420
23430
23440
23450
23455
23460
23462
23465
23466
23470
23472
23480
23485
23490
23491
23500
23505
23515
23520

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
14.77
18.53
15.96
13.14
18.01
16.28
16.66
20.44
17.54
13.92
14.18
19.49
18.95
18.00
20.27
14.57
19.21
22.56
23.43
27.79
32.46
43.57
5.76
15.40
22.89
4.52
32.48
30.13
25.86
16.70
20.93
23.94
25.44
19.65
26.39
19.77
20.51
25.51
27.24
29.35
28.60
29.72
27.99
32.29
39.07
21.85
25.60
21.99
27.35
5.24
8.68
15.22
5.33

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
23525
23530
23532
23540
23545
23550
23552
23570
23575
23585
23600
23605
23615
23616
23620
23625
23630
23650
23655
23660
23665
23670
23675
23680
23700
23800
23802
23900
23920
23921
23929
23930
23931
23935
24000
24006
24065
24066
24075
24076
24077
24100
24101
24102
24105
24110
24115
24116
24120
24125
24126
24130
24134

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
42
42
YYY
10
10
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
8.57
14.43
16.35
5.36
7.78
14.82
17.21
5.59
9.49
18.12
7.94
11.81
19.77
39.01
6.39
9.48
15.22
7.45
9.38
15.13
10.48
16.06
13.83
19.85
5.12
26.79
29.43
34.51
26.86
11.33
BR
9.67
7.96
13.01
12.17
18.53
5.46
14.89
11.80
12.07
21.13
10.22
13.08
16.16
8.59
15.28
18.49
22.89
13.65
15.10
16.48
13.29
20.19

CODE
24136
24138
24140
24145
24147
24149
24150
24151
24152
24153
24155
24160
24164
24200
24201
24220
24300
24301
24305
24310
24320
24330
24331
24332
24340
24341
24342
24343
24344
24345
24346
24350
24351
24352
24354
24356
24360
24361
24362
24363
24365
24366
24400
24410
24420
24430
24435
24470
24495
24498
24500
24505
24515

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
16.58
17.14
19.77
16.86
17.40
28.10
25.49
29.65
19.25
17.83
22.01
15.98
13.01
5.36
15.02
5.03
10.07
19.94
15.28
12.49
19.79
19.05
21.06
15.44
16.19
17.14
20.90
18.19
27.83
18.05
27.63
11.68
12.82
13.70
13.69
14.07
23.80
26.80
27.59
35.13
16.99
18.17
21.75
27.66
26.11
24.70
26.25
17.93
18.01
23.18
8.54
12.61
22.99

CPT only copyright 2004 American Medical Association. All Rights Reserved.

21

CODE
24516
24530
24535
24538
24545
24546
24560
24565
24566
24575
24576
24577
24579
24582
24586
24587
24600
24605
24615
24620
24635
24640
24650
24655
24665
24666
24670
24675
24685
24800
24802
24900
24920
24925
24930
24931
24935
24940
24999
25000
25001
25020
25023
25024
25025
25028
25031
25035
25040
25065
25066
25075
25076

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
42
42
42
42
42
42
42
42
42
42
10
42
42
42

UNIT VALUE
22.73
9.24
15.85
19.69
20.68
29.66
7.69
13.06
17.23
20.86
8.06
13.65
22.39
19.12
29.00
28.66
9.55
11.64
18.81
14.25
29.47
3.16
6.27
11.02
17.02
19.14
7.04
11.48
17.81
21.54
26.31
18.14
18.05
14.28
19.09
20.30
25.68
27.92
BR
10.77
8.12
16.40
29.84
18.27
28.21
14.17
12.65
22.14
15.60
5.37
11.80
10.13
15.18

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
25077
25085
25100
25101
25105
25107
25110
25111
25112
25115
25116
25118
25119
25120
25125
25126
25130
25135
25136
25145
25150
25151
25170
25210
25215
25230
25240
25246
25248
25250
25251
25259
25260
25263
25265
25270
25272
25274
25275
25280
25290
25295
25300
25301
25310
25312
25315
25316
25320
25332
25335
25337
25350

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
23.19
13.44
9.74
11.32
14.05
15.74
11.57
8.60
10.47
24.14
21.34
10.78
14.56
19.15
21.37
21.82
12.47
15.38
13.58
19.42
16.44
21.28
27.91
13.60
17.82
12.14
12.91
4.98
14.34
13.67
18.73
10.06
22.27
22.21
25.65
18.95
20.91
23.70
17.38
20.90
21.08
19.69
18.50
17.72
22.37
24.91
26.14
30.26
23.72
22.37
26.35
22.81
24.17

CODE
25355
25360
25365
25370
25375
25390
25391
25392
25393
25394
25400
25405
25415
25420
25425
25426
25430
25431
25440
25441
25442
25443
25444
25445
25446
25447
25449
25450
25455
25490
25491
25492
25500
25505
25515
25520
25525
25526
25530
25535
25545
25560
25565
25574
25575
25600
25605
25611
25620
25622
25624
25628
25630

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
26.48
23.69
30.15
31.68
31.68
26.59
32.38
31.98
36.16
20.02
27.88
33.91
31.98
37.17
36.38
34.87
17.84
20.71
21.42
24.89
21.24
20.50
21.85
19.21
30.90
20.59
27.31
19.40
21.29
24.69
25.99
29.73
6.35
12.55
18.18
14.13
24.21
28.59
6.17
11.98
18.04
6.46
13.21
15.40
21.70
7.12
13.98
18.04
17.21
7.27
11.55
17.60
7.49

CPT only copyright 2004 American Medical Association. All Rights Reserved.

22

CODE
25635
25645
25650
25651
25652
25660
25670
25671
25675
25676
25680
25685
25690
25695
25800
25805
25810
25820
25825
25830
25900
25905
25907
25909
25915
25920
25922
25924
25927
25929
25931
25999
26010
26011
26020
26025
26030
26034
26035
26037
26040
26045
26055
26060
26070
26075
26080
26100
26105
26110
26115
26116
26117

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
11.03
15.06
7.79
11.65
15.79
10.03
16.16
13.12
10.89
16.66
11.46
19.13
11.85
16.74
20.38
23.29
22.09
16.50
19.89
25.99
22.84
22.78
20.65
22.60
38.84
17.86
15.58
17.86
21.73
14.59
20.41
BR
7.27
11.32
10.73
10.68
12.55
13.54
18.79
14.68
7.91
12.11
17.47
6.76
7.50
8.07
9.72
8.29
8.51
8.09
17.52
12.35
16.84

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
26121
26123
26125
26130
26135
26140
26145
26160
26170
26180
26185
26200
26205
26210
26215
26230
26235
26236
26250
26255
26260
26261
26262
26320
26340
26350
26352
26356
26357
26358
26370
26372
26373
26390
26392
26410
26412
26415
26416
26418
26420
26426
26428
26432
26433
26434
26437
26440
26442
26445
26449
26450
26455

FUD
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
15.65
19.55
7.74
11.69
14.47
13.11
13.32
16.00
10.40
11.36
12.06
11.70
15.77
11.33
14.37
13.22
12.93
11.42
15.04
23.44
14.18
16.38
11.87
8.86
7.76
21.50
24.15
27.63
25.52
27.14
23.31
26.67
25.42
23.85
28.48
17.27
20.53
21.08
24.74
17.20
21.45
20.23
22.14
14.89
16.05
18.55
18.27
19.18
25.27
18.08
23.81
11.57
11.48

CODE
26460
26471
26474
26476
26477
26478
26479
26480
26483
26485
26489
26490
26492
26494
26496
26497
26498
26499
26500
26502
26504
26508
26510
26516
26517
26518
26520
26525
26530
26531
26535
26536
26540
26541
26542
26545
26546
26548
26550
26551
26553
26554
26555
26556
26560
26561
26562
26565
26567
26568
26580
26587
26590

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
11.13
17.83
17.45
16.87
17.00
18.52
18.20
22.73
25.04
24.18
22.79
22.42
24.61
22.71
24.25
24.52
32.23
23.35
18.28
20.27
21.28
18.64
17.55
20.45
23.72
23.71
19.97
20.09
13.85
16.19
9.68
16.95
19.27
23.27
19.82
20.08
25.37
22.05
41.22
86.87
71.28
101.76
37.25
83.06
16.01
24.69
34.34
19.73
19.79
25.99
34.06
24.76
34.61

CPT only copyright 2004 American Medical Association. All Rights Reserved.

23

CODE
26591
26593
26596
26600
26605
26607
26608
26615
26641
26645
26650
26665
26670
26675
26676
26685
26686
26700
26705
26706
26715
26720
26725
26727
26735
26740
26742
26746
26750
26755
26756
26765
26770
26775
26776
26785
26820
26841
26842
26843
26844
26850
26852
26860
26861
26862
26863
26910
26951
26952
26989
26990
26991

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
ZZZ
42
42
42
YYY
42
42

UNIT VALUE
13.34
17.21
19.14
5.86
7.86
12.47
12.47
11.47
8.90
10.20
13.33
15.08
8.32
10.85
13.08
14.18
16.06
7.79
10.12
10.98
12.15
4.66
8.59
12.28
12.45
5.36
9.39
12.26
4.39
7.92
10.80
9.18
6.73
9.41
11.55
9.38
22.76
21.52
22.92
21.10
23.40
20.21
22.55
16.59
2.93
20.79
6.56
19.96
15.43
18.89
BR
15.85
18.91

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
26992
27000
27001
27003
27005
27006
27025
27030
27033
27035
27036
27040
27041
27047
27048
27049
27050
27052
27054
27060
27062
27065
27066
27067
27070
27071
27075
27076
27077
27078
27079
27080
27086
27087
27090
27091
27093
27095
27096
27097
27098
27100
27105
27110
27111
27120
27122
27125
27130
27132
27134
27137
27138

FUD
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
25.51
11.85
14.24
14.91
19.13
19.32
21.48
24.85
25.58
29.99
25.07
8.37
17.82
15.55
11.94
24.05
9.37
13.15
17.33
10.58
11.47
12.28
20.48
26.29
21.54
23.45
59.65
40.19
68.67
25.56
25.16
12.13
6.65
16.49
21.82
39.88
5.88
7.36
5.85
16.75
16.79
21.50
22.61
24.43
23.18
32.79
28.56
27.79
36.84
42.89
51.15
38.70
40.32

CODE
27140
27146
27147
27151
27156
27158
27161
27165
27170
27175
27176
27177
27178
27179
27181
27185
27187
27193
27194
27200
27202
27215
27216
27217
27218
27220
27222
27226
27227
27228
27230
27232
27235
27236
27238
27240
27244
27245
27246
27248
27250
27252
27253
27254
27256
27257
27258
27259
27265
27266
27275
27280
27282

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
10
42
42
42
42
10
42
42

UNIT VALUE
23.68
32.48
37.34
34.31
44.76
33.81
31.65
33.86
30.11
16.58
23.24
28.55
22.45
25.18
26.42
19.06
26.18
11.57
18.91
4.32
24.95
19.04
27.42
26.58
34.97
12.93
24.75
25.15
42.79
49.35
11.90
19.51
23.67
29.29
11.52
24.01
29.94
37.49
9.96
20.42
12.17
19.40
24.88
33.34
8.07
8.70
28.87
39.35
10.44
15.09
4.75
26.01
21.17

CPT only copyright 2004 American Medical Association. All Rights Reserved.

24

CODE
27284
27286
27290
27295
27299
27301
27303
27305
27306
27307
27310
27315
27320
27323
27324
27327
27328
27329
27330
27331
27332
27333
27334
27335
27340
27345
27347
27350
27355
27356
27357
27358
27360
27365
27370
27372
27380
27381
27385
27386
27390
27391
27392
27393
27394
27395
27396
27397
27400
27403
27405
27407
27409

FUD
42
42
42
42
YYY
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
42.06
42.29
40.63
32.81
BR
17.55
16.65
12.07
10.16
12.20
18.42
13.00
12.57
6.03
9.80
11.07
10.76
25.23
10.35
12.39
16.80
15.22
17.59
19.93
9.44
12.52
12.16
16.80
15.72
18.92
21.13
8.07
21.78
30.66
4.76
15.90
15.66
21.17
16.72
21.86
11.34
14.95
18.34
13.27
17.16
23.05
16.17
22.11
17.57
16.93
17.62
20.29
25.05

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
27412
27415
27418
27420
27422
27424
27425
27427
27428
27429
27430
27435
27437
27438
27440
27441
27442
27443
27445
27446
27447
27448
27450
27454
27455
27457
27465
27466
27468
27470
27472
27475
27477
27479
27485
27486
27487
27488
27495
27496
27497
27498
27499
27500
27501
27502
27503
27506
27507
27508
27509
27510
27511

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
42.36
35.37
21.60
19.60
19.57
19.57
11.63
18.73
27.60
30.58
19.32
19.63
17.17
21.68
18.20
19.35
22.85
21.50
33.05
29.85
39.79
21.54
26.92
33.08
24.90
25.67
26.52
30.88
34.56
30.58
33.39
17.20
19.28
25.17
17.75
36.05
46.11
30.12
29.60
12.67
13.73
15.17
17.27
12.99
12.71
20.39
20.65
33.15
26.17
13.23
16.99
17.94
27.15

CODE
27513
27514
27516
27517
27519
27520
27524
27530
27532
27535
27536
27538
27540
27550
27552
27556
27557
27558
27560
27562
27566
27570
27580
27590
27591
27592
27594
27596
27598
27599
27600
27601
27602
27603
27604
27605
27606
27607
27610
27612
27613
27614
27615
27618
27619
27620
27625
27626
27630
27635
27637
27638
27640

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
YYY
42
42
42
42
42
10
10
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
34.84
33.57
12.49
17.43
29.12
7.85
19.93
9.70
15.89
23.56
29.92
11.80
24.81
12.48
16.17
28.50
32.75
33.78
9.05
11.47
23.63
3.81
37.41
20.40
23.25
17.61
13.09
18.94
19.14
BR
11.01
11.28
13.55
13.13
11.22
10.96
8.17
15.42
16.70
14.53
5.61
13.55
23.70
11.78
19.13
12.38
16.03
17.29
13.08
15.80
19.77
20.63
23.50

CPT only copyright 2004 American Medical Association. All Rights Reserved.

25

CODE
27641
27645
27646
27647
27648
27650
27652
27654
27656
27658
27659
27664
27665
27675
27676
27680
27681
27685
27686
27687
27690
27691
27692
27695
27696
27698
27700
27702
27703
27704
27705
27707
27709
27712
27715
27720
27722
27724
27725
27727
27730
27732
27734
27740
27742
27745
27750
27752
27756
27758
27759
27760
27762

FUD
42
42
42
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
19.02
28.55
25.68
21.57
4.56
18.76
20.02
18.70
13.73
10.31
13.52
9.88
11.24
14.01
16.53
11.77
13.86
14.75
15.18
12.54
16.37
19.34
3.12
13.41
15.97
17.76
16.27
26.46
29.80
14.46
20.27
10.04
19.76
27.42
27.58
23.18
22.93
33.65
30.10
26.74
15.52
11.01
16.10
18.88
17.61
19.92
8.46
13.46
14.38
22.83
26.40
8.14
12.38

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
27766
27780
27781
27784
27786
27788
27792
27808
27810
27814
27816
27818
27822
27823
27824
27825
27826
27827
27828
27829
27830
27831
27832
27840
27842
27846
27848
27860
27870
27871
27880
27881
27882
27884
27886
27888
27889
27892
27893
27894
27899
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28030
28035

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
YYY
10
10
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
16.99
7.23
10.59
14.78
7.73
10.79
15.91
8.08
12.16
21.04
7.68
12.65
23.50
26.66
7.38
13.78
18.81
29.19
32.90
13.20
8.69
9.74
13.62
8.78
12.29
19.34
22.77
4.70
26.75
18.30
20.69
23.11
16.69
15.15
17.20
18.66
17.88
14.05
13.89
19.85
BR
6.05
10.22
15.76
15.88
9.57
5.58
8.02
11.73
10.48
10.15
10.55
11.63

CODE
28043
28045
28046
28050
28052
28054
28060
28062
28070
28072
28080
28086
28088
28090
28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
28150
28153
28160
28171
28173
28175
28190
28192
28193
28200
28202
28208
28210
28220
28222
28225
28226

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
7.80
10.71
20.27
9.73
9.37
8.62
11.39
13.86
11.03
10.76
9.15
13.50
10.20
10.13
9.33
14.41
14.81
12.01
11.29
12.55
12.81
9.27
9.82
11.95
10.90
11.46
22.83
15.57
13.03
11.50
13.44
15.09
10.39
8.17
16.06
15.04
9.44
8.43
8.78
16.34
17.51
12.48
5.57
10.69
12.04
10.29
14.95
9.75
13.37
9.76
11.54
8.40
9.89

CPT only copyright 2004 American Medical Association. All Rights Reserved.

26

CODE
28230
28232
28234
28238
28240
28250
28260
28261
28262
28264
28270
28272
28280
28285
28286
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28309
28310
28312
28313
28315
28320
28322
28340
28341
28344
28345
28360
28400
28405
28406
28415
28420
28430
28435
28436
28445

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
9.46
8.35
8.47
16.02
9.56
12.36
15.41
21.89
31.93
19.60
10.26
8.44
12.15
10.04
9.92
11.31
16.03
12.72
15.41
21.02
17.08
18.52
19.43
16.19
20.70
18.09
17.84
18.36
18.47
13.52
18.25
11.72
22.73
11.86
10.60
11.00
10.37
17.30
18.76
14.26
16.38
10.51
12.91
26.08
6.12
10.11
14.18
31.86
32.28
5.78
7.80
11.39
29.18

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
28450
28455
28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
28510
28515
28525
28530
28531
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28800
28805
28810
28820
28825
28899

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
10
10
42
10
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY

UNIT VALUE
5.29
6.94
7.27
14.39
5.40
6.73
8.89
11.97
3.24
3.95
10.94
12.45
2.75
3.53
11.30
2.64
9.95
4.69
5.16
10.63
17.23
4.30
7.59
9.02
16.53
4.97
6.23
10.40
17.09
3.46
4.19
7.07
9.74
2.62
3.60
8.97
10.51
34.25
24.97
21.68
20.90
20.32
17.89
20.09
20.31
11.48
16.77
15.14
15.19
11.53
12.56
11.07
BR

CODE
29000
29010
29015
29020
29025
29035
29040
29044
29046
29049
29055
29058
29065
29075
29085
29086
29105
29125
29126
29130
29131
29200
29220
29240
29260
29280
29305
29325
29345
29355
29358
29365
29405
29425
29435
29440
29445
29450
29505
29515
29520
29530
29540
29550
29580
29590
29700
29705
29710
29715
29720
29730
29740

FUD
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00

UNIT VALUE
5.61
5.79
5.67
5.57
5.98
5.66
5.04
6.44
6.05
2.31
5.04
3.03
2.34
2.15
2.28
1.65
2.22
1.68
2.04
1.03
1.33
1.41
1.40
1.61
1.34
1.34
5.70
6.23
3.39
3.48
3.73
3.04
2.22
2.39
2.94
1.34
3.84
3.82
1.94
1.69
1.42
1.40
0.99
0.95
1.29
1.36
1.53
1.70
3.06
2.21
1.95
1.68
2.44

CPT only copyright 2004 American Medical Association. All Rights Reserved.

27

CODE
29750
29799
29800
29804
29805
29806
29807
29819
29820
29821
29822
29823
29824
29825
29826
29827
29830
29834
29835
29836
29837
29838
29840
29843
29844
29845
29846
29847
29848
29850
29851
29855
29856
29860
29861
29862
29863
29866
29867
29868
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884

FUD
00
YYY
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
2.52
BR
14.37
17.13
12.55
27.96
27.23
15.69
14.48
15.81
15.38
16.77
17.18
15.66
18.05
29.50
12.05
13.16
13.46
15.54
14.17
15.86
11.68
12.54
13.22
14.97
13.85
14.34
11.90
14.39
25.19
21.18
27.17
16.34
18.03
20.06
19.82
27.61
32.98
44.71
10.78
13.53
13.59
14.18
13.23
16.29
15.34
16.53
17.31
16.04
17.36
21.98
15.28

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
29885
29886
29887
29888
29889
29891
29892
29893
29894
29895
29897
29898
29899
29900
29901
29902
29999
30000
30020
30100
30110
30115
30117
30118
30120
30124
30125
30130
30140
30150
30160
30200
30210
30220
30300
30310
30320
30400
30410
30420
30430
30435
30450
30460
30462
30465
30520
30540
30545
30560
30580
30600
30620

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
10
10
00
10
42
42
42
42
42
42
42
42
42
42
42
10
10
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42

UNIT VALUE
18.61
15.67
18.51
26.46
31.14
17.28
18.14
12.14
13.81
13.55
14.22
15.77
26.79
12.20
13.44
14.35
BR
5.62
4.82
2.98
5.01
10.51
16.56
19.69
12.27
6.96
16.12
9.28
9.97
21.04
20.69
2.46
3.27
5.90
5.75
5.23
11.94
26.34
32.74
35.23
23.98
32.23
42.44
20.92
42.29
24.64
12.82
17.69
24.94
6.13
15.34
14.21
15.36

CODE
30630
30801
30802
30901
30903
30905
30906
30915
30920
30930
30999
31000
31002
31020
31030
31032
31040
31050
31051
31070
31075
31080
31081
31084
31085
31086
31087
31090
31200
31201
31205
31225
31230
31231
31233
31235
31237
31238
31239
31240
31254
31255
31256
31267
31276
31287
31288
31290
31291
31292
31293
31294
31299

FUD
42
10
10
00
00
00
00
42
42
10
YYY
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
00
00
00
10
00
00
00
00
00
00
00
00
10
10
10
10
10
YYY

UNIT VALUE
15.67
5.31
6.81
2.68
4.38
5.65
6.54
14.47
19.59
3.00
BR
4.08
5.31
11.76
17.99
14.39
20.08
12.15
15.98
10.60
19.68
26.08
29.17
28.24
29.82
27.21
27.10
23.00
14.47
18.35
22.78
38.71
43.08
4.57
6.68
7.81
8.45
8.76
17.31
4.58
7.94
11.79
5.74
9.29
14.87
6.75
7.84
30.75
32.30
26.56
28.88
33.42
BR

CPT only copyright 2004 American Medical Association. All Rights Reserved.

28

CODE
31300
31320
31360
31365
31367
31368
31370
31375
31380
31382
31390
31395
31400
31420
31500
31502
31505
31510
31511
31512
31513
31515
31520
31525
31526
31527
31528
31529
31530
31531
31535
31536
31540
31541
31545
31546
31560
31561
31570
31571
31575
31576
31577
31578
31579
31580
31582
31584
31585
31586
31587
31588
31590

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
42
42
42
42
42
42
42
42

UNIT VALUE
30.43
16.01
35.17
46.50
45.53
54.77
45.42
42.17
42.47
43.81
54.22
61.86
24.91
20.58
3.07
1.01
2.11
5.38
5.47
5.45
3.73
5.48
4.32
6.48
4.50
5.40
4.03
4.61
5.62
6.14
5.41
6.09
7.00
7.67
10.14
15.48
9.03
9.84
9.84
7.20
3.09
5.78
6.44
7.35
6.23
29.29
49.13
39.46
11.69
19.54
22.26
27.76
23.29

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
31595
31599
31600
31601
31603
31605
31610
31611
31612
31613
31614
31615
31620
31622
31623
31624
31625
31628
31629
31630
31631
31632
31633
31635
31636
31637
31638
31640
31641
31643
31645
31646
31656
31700
31708
31710
31715
31717
31720
31725
31730
31750
31755
31760
31766
31770
31775
31780
31781
31785
31786
31800
31805

FUD
42
YYY
00
00
00
00
42
42
00
42
42
00
ZZZ
00
00
00
00
00
00
00
00
ZZZ
ZZZ
00
00
ZZZ
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
19.57
BR
11.16
7.24
6.29
5.14
17.81
13.16
2.09
11.01
16.44
4.85
7.15
8.63
9.46
8.81
9.37
11.01
18.51
5.87
6.48
2.03
2.41
10.04
6.37
2.27
7.07
7.46
7.28
4.92
8.49
7.74
9.62
3.59
3.51
1.84
1.52
10.51
1.46
2.76
5.27
31.67
41.74
35.81
48.52
35.52
38.27
30.39
37.82
28.97
40.29
17.44
22.13

CODE
31820
31825
31830
31899
32000
32002
32005
32019
32020
32035
32036
32095
32100
32110
32120
32124
32140
32141
32150
32151
32160
32200
32201
32215
32220
32225
32310
32320
32400
32402
32405
32420
32440
32442
32445
32480
32482
32484
32486
32488
32491
32500
32501
32520
32522
32525
32540
32601
32602
32603
32604
32605
32606

FUD
42
42
42
YYY
00
00
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
00
42
42
42
42
42
00
42
00
00
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
00
00
00
00
00
00

UNIT VALUE
10.53
15.02
10.69
BR
4.68
5.54
8.86
24.55
5.74
15.73
17.48
14.88
25.20
36.83
20.20
21.76
23.54
23.51
23.69
24.11
15.80
25.81
24.93
19.77
40.32
23.56
22.73
39.50
3.98
13.70
2.71
3.00
41.41
44.77
42.73
39.15
41.40
34.98
40.60
43.11
36.78
37.46
6.87
36.00
39.56
42.98
26.29
8.58
9.31
11.94
13.45
10.79
12.92

CPT only copyright 2004 American Medical Association. All Rights Reserved.

29

CODE
32650
32651
32652
32653
32654
32655
32656
32657
32658
32659
32660
32661
32662
32663
32664
32665
32800
32810
32815
32820
32850
32851
32852
32853
32854
32855
32856
32900
32905
32906
32940
32960
32997
32999
33010
33011
33015
33020
33025
33030
33031
33050
33120
33130
33140
33141
33200
33201
33206
33207
33208
33210
33211

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
XXX
42
42
42
42
XXX
XXX
42
42
42
42
00
00
YYY
00
00
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
00
00

UNIT VALUE
18.99
21.94
31.37
21.61
21.57
22.14
22.65
23.25
20.58
20.63
28.94
22.84
27.40
31.86
24.14
25.78
22.94
22.42
37.32
36.12
BR
71.58
80.86
86.34
92.79
BR
BR
33.01
33.88
42.61
31.62
3.73
8.44
BR
3.17
3.22
12.38
21.11
20.14
30.93
34.89
24.26
39.67
34.34
33.66
7.10
20.97
18.08
11.64
13.30
13.48
4.74
4.93

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
33212
33213
33214
33215
33216
33217
33218
33220
33222
33223
33224
33225
33226
33233
33234
33235
33236
33237
33238
33240
33241
33243
33244
33245
33246
33249
33250
33251
33253
33261
33282
33284
33300
33305
33310
33315
33320
33321
33322
33330
33332
33335
33400
33401
33403
33404
33405
33406
33410
33411
33412
33413
33414

FUD
42
42
42
42
42
42
42
42
42
42
00
ZZZ
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
9.33
10.56
13.21
8.30
10.37
10.38
10.12
10.17
9.66
11.49
13.61
12.06
13.11
6.79
13.30
16.95
21.67
23.03
25.35
12.65
6.41
36.17
23.63
24.16
33.55
23.40
35.90
39.99
49.28
39.99
8.43
6.18
29.68
35.09
30.62
36.45
27.01
32.82
33.75
34.39
37.42
47.48
48.16
40.90
42.66
47.33
58.33
61.94
53.60
60.23
68.63
70.70
48.88

CODE
33415
33416
33417
33420
33422
33425
33426
33427
33430
33460
33463
33464
33465
33468
33470
33471
33472
33474
33475
33476
33478
33496
33500
33501
33502
33503
33504
33505
33506
33508
33510
33511
33512
33513
33514
33516
33517
33518
33519
33521
33522
33523
33530
33533
33534
33535
33536
33542
33545
33572
33600
33602
33606

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
42
42
42
42
42
42
ZZZ
42
42
42

UNIT VALUE
42.93
48.26
46.15
34.05
43.31
43.92
54.85
65.12
55.59
38.25
42.20
44.77
45.89
47.75
32.50
35.32
37.60
37.07
53.08
40.08
43.60
43.96
40.63
27.87
35.04
33.34
39.75
41.87
54.63
0.45
49.48
51.39
53.94
54.36
55.43
58.77
3.78
7.12
10.46
13.81
17.15
20.52
8.61
50.75
54.39
57.52
61.00
45.98
57.47
6.53
46.36
44.72
48.73

CPT only copyright 2004 American Medical Association. All Rights Reserved.

30

CODE
33608
33610
33611
33612
33615
33617
33619
33641
33645
33647
33660
33665
33670
33681
33684
33688
33690
33692
33694
33697
33702
33710
33720
33722
33730
33732
33735
33736
33737
33750
33755
33762
33764
33766
33767
33770
33771
33774
33775
33776
33777
33778
33779
33780
33781
33786
33788
33800
33802
33803
33813
33814
33820

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
49.83
48.68
52.41
55.33
51.35
58.52
72.12
34.03
40.18
45.68
47.89
46.35
52.73
49.63
46.69
45.73
31.62
49.17
53.38
54.87
42.70
48.01
42.56
43.52
53.28
45.14
32.20
38.38
35.87
32.75
33.78
35.01
34.95
38.07
39.97
57.29
52.61
50.34
52.08
54.81
54.46
62.96
54.42
64.41
55.65
61.31
42.53
26.76
29.09
32.50
34.62
42.17
27.01

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
33822
33824
33840
33845
33851
33852
33853
33860
33861
33863
33870
33875
33877
33910
33915
33916
33917
33918
33919
33920
33922
33924
33930
33933
33935
33940
33944
33945
33960
33961
33967
33968
33970
33971
33973
33974
33975
33976
33977
33978
33979
33980
33999
34001
34051
34101
34111
34151
34201
34203
34401
34421
34451

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
XXX
XXX
42
XXX
XXX
42
00
ZZZ
00
00
00
42
00
42
XXX
XXX
42
42
XXX
42
YYY
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
28.90
32.33
33.03
36.62
35.06
37.16
50.91
59.92
65.72
70.09
68.59
51.83
64.62
39.60
32.28
40.77
40.30
42.60
63.35
50.07
37.44
8.15
BR
BR
98.59
BR
BR
69.51
26.84
15.42
7.03
0.94
9.84
16.89
14.28
23.95
30.24
33.72
33.10
36.65
67.65
89.76
BR
21.37
25.15
16.72
16.69
38.83
16.84
26.85
38.56
19.81
42.10

CODE
34471
34490
34501
34502
34510
34520
34530
34800
34802
34803
34804
34805
34808
34812
34813
34820
34825
34826
34830
34831
34832
34833
34834
34900
35001
35002
35005
35011
35013
35021
35022
35045
35081
35082
35091
35092
35102
35103
35111
35112
35121
35122
35131
35132
35141
35142
35151
35152
35180
35182
35184
35188
35189

FUD
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
00
ZZZ
00
42
ZZZ
42
42
42
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
16.60
16.60
26.66
42.77
30.60
28.55
26.94
32.18
35.00
36.20
35.00
33.48
6.02
10.12
7.00
14.38
19.38
5.92
50.75
51.61
54.60
18.04
8.28
25.84
31.89
33.66
28.68
28.43
34.68
31.79
36.13
27.45
43.34
59.05
53.95
68.78
47.45
61.97
38.78
45.96
46.53
53.44
39.40
46.60
31.70
36.91
35.77
40.50
21.54
47.06
28.75
24.02
43.83

CPT only copyright 2004 American Medical Association. All Rights Reserved.

31

CODE
35190
35201
35206
35207
35211
35216
35221
35226
35231
35236
35241
35246
35251
35256
35261
35266
35271
35276
35281
35286
35301
35311
35321
35331
35341
35351
35355
35361
35363
35371
35372
35381
35390
35400
35450
35452
35454
35456
35458
35459
35460
35470
35471
35472
35473
35474
35475
35476
35480
35481
35482
35483
35484

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
ZZZ
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00

UNIT VALUE
20.96
26.37
21.62
18.92
35.85
30.30
37.55
23.89
32.51
27.36
37.67
41.52
45.99
29.27
28.32
23.94
35.72
38.77
43.55
26.49
29.78
42.08
25.58
41.11
39.64
35.86
29.18
43.82
47.00
23.73
28.60
25.78
4.70
4.53
14.85
10.40
9.18
11.11
14.18
12.96
9.12
98.20
111.02
71.85
66.39
95.67
66.23
51.15
16.38
11.57
10.09
12.22
15.47

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
35485
35490
35491
35492
35493
35494
35495
35500
35501
35506
35507
35508
35509
35510
35511
35512
35515
35516
35518
35521
35522
35525
35526
35531
35533
35536
35541
35546
35548
35549
35551
35556
35558
35560
35563
35565
35566
35571
35572
35583
35585
35587
35600
35601
35606
35612
35616
35621
35623
35626
35631
35636
35641

FUD
00
00
00
00
00
00
00
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
14.32
16.52
11.63
10.31
12.47
15.60
14.58
9.36
30.33
31.88
31.89
30.89
29.41
35.24
33.32
34.57
30.64
25.42
33.09
35.03
33.58
32.07
46.00
55.64
43.38
49.04
40.57
39.97
33.90
36.94
41.66
34.49
33.63
49.92
38.08
36.54
42.04
38.25
10.03
35.62
44.53
39.62
7.28
28.61
30.32
25.65
25.91
31.50
37.88
43.62
52.64
45.81
39.04

CODE
35642
35645
35646
35647
35650
35651
35654
35656
35661
35663
35665
35666
35671
35681
35682
35683
35685
35686
35691
35693
35694
35695
35697
35700
35701
35721
35741
35761
35800
35820
35840
35860
35870
35875
35876
35879
35881
35901
35903
35905
35907
36000
36002
36005
36010
36011
36012
36013
36014
36015
36100
36120
36140

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
42
42
42
42
ZZZ
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
XXX
00
00
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX

UNIT VALUE
28.88
28.18
48.40
43.64
29.99
38.94
39.09
30.83
30.55
35.00
33.37
35.91
31.38
2.35
10.59
12.51
5.97
4.94
29.02
25.26
30.40
30.39
4.43
4.53
14.75
12.62
13.74
10.11
12.61
21.92
16.35
10.34
34.82
16.67
26.84
25.93
29.16
14.62
16.82
48.75
53.95
0.76
4.99
8.66
21.92
31.24
22.70
24.11
23.33
27.39
15.36
12.86
14.94

CPT only copyright 2004 American Medical Association. All Rights Reserved.

32

CODE
36145
36160
36200
36215
36216
36217
36218
36245
36246
36247
36248
36260
36261
36262
36299
36400
36405
36406
36410
36415
36416
36420
36425
36430
36440
36450
36455
36460
36468
36469
36470
36471
36475
36476
36478
36479
36481
36500
36510
36511
36512
36513
36514
36515
36516
36522
36540
36550
36555
36556
36557
36558
36560

FUD
XXX
XXX
XXX
XXX
XXX
XXX
ZZZ
XXX
XXX
XXX
ZZZ
42
42
42
YYY
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
00
00
10
10
00
ZZZ
00
ZZZ
00
00
00
00
00
00
00
00
00
00
XXX
XXX
00
00
10
10
10

UNIT VALUE
14.69
16.25
19.78
32.02
34.72
62.19
6.18
37.09
35.62
56.28
5.13
15.86
9.80
7.28
BR
0.69
0.60
0.47
0.48
0.08
0.10
1.42
1.04
1.07
1.42
3.15
3.60
9.61
BR
BR
3.89
4.83
58.48
11.44
53.86
11.55
13.25
5.11
5.08
2.55
2.56
2.64
18.79
68.12
85.35
34.17
0.75
0.76
8.55
8.31
26.80
26.40
36.48

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
36561
36563
36565
36566
36568
36569
36570
36571
36575
36576
36578
36580
36581
36582
36583
36584
36585
36589
36590
36595
36596
36597
36600
36620
36625
36640
36660
36680
36800
36810
36815
36818
36819
36820
36821
36822
36823
36825
36830
36831
36832
36833
36834
36835
36838
36860
36861
36870
37140
37145
37160
37180
37181

FUD
10
10
10
10
00
00
10
10
00
10
10
00
10
10
10
00
10
10
10
00
00
00
XXX
00
00
00
00
00
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
42
42
42
42
42
42

UNIT VALUE
36.14
33.76
31.26
32.56
9.57
9.35
39.05
39.10
4.93
10.33
14.82
8.44
23.12
31.40
31.47
8.36
32.81
4.75
7.10
21.08
4.49
3.69
0.83
1.46
2.89
3.35
1.98
1.80
4.47
6.08
4.13
19.43
22.27
22.28
14.78
10.53
33.16
16.21
18.85
13.01
16.63
18.77
16.07
12.44
32.97
3.92
4.27
58.51
36.03
38.65
33.60
38.17
41.01

CODE
37182
37183
37195
37200
37201
37202
37203
37204
37205
37206
37207
37208
37209
37215
37216
37250
37251
37500
37501
37565
37600
37605
37606
37607
37609
37615
37616
37617
37618
37620
37650
37660
37700
37720
37730
37735
37760
37765
37766
37780
37785
37788
37790
37799
38100
38101
38102
38115
38120
38129
38200
38204
38205

FUD
00
00
XXX
00
00
00
00
00
00
ZZZ
00
ZZZ
00
42
42
ZZZ
ZZZ
42
YYY
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
42
42
ZZZ
42
42
YYY
00
XXX
00

UNIT VALUE
24.03
11.48
6.99
6.32
7.89
9.16
38.24
25.52
12.63
5.87
12.56
6.07
3.17
28.89
27.83
3.06
2.34
19.36
BR
17.81
19.27
21.93
12.06
10.54
7.87
10.53
26.84
34.13
9.10
17.18
13.45
32.48
7.03
10.13
12.59
17.49
17.18
12.44
15.09
7.21
9.53
33.29
13.29
BR
22.53
23.77
7.05
24.44
26.56
BR
3.70
BR
2.24

CPT only copyright 2004 American Medical Association. All Rights Reserved.

33

CODE
38206
38207
38208
38209
38210
38211
38212
38213
38214
38215
38220
38221
38230
38240
38241
38242
38300
38305
38308
38380
38381
38382
38500
38505
38510
38520
38525
38530
38542
38550
38555
38562
38564
38570
38571
38572
38589
38700
38720
38724
38740
38745
38746
38747
38760
38765
38770
38780
38790
38792
38794
38999
39000

FUD
00
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10
XXX
XXX
00
10
42
42
42
42
42
10
00
10
42
42
42
42
42
42
42
42
10
10
10
YYY
42
42
42
42
42
ZZZ
ZZZ
42
42
42
42
00
00
42
YYY
42

UNIT VALUE
2.24
1.65
1.80
1.58
1.72
1.72
1.72
1.72
1.44
1.72
4.86
5.37
8.22
3.39
3.42
2.59
6.53
11.28
11.03
13.93
21.57
17.18
7.91
3.28
12.70
11.55
10.15
13.46
11.00
11.69
24.43
17.45
17.37
14.34
21.46
25.53
BR
15.22
24.19
25.66
16.26
20.86
7.19
7.18
20.73
31.21
20.36
26.64
8.77
1.02
8.20
BR
11.59

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
39010
39200
39220
39400
39499
39501
39502
39503
39520
39530
39531
39540
39541
39545
39560
39561
39599
40490
40500
40510
40520
40525
40527
40530
40650
40652
40654
40700
40701
40702
40720
40761
40799
40800
40801
40804
40805
40806
40808
40810
40812
40814
40816
40818
40819
40820
40830
40831
40840
40842
40843
40844
40845

FUD
42
42
42
10
YYY
42
42
42
42
42
42
42
42
42
42
42
YYY
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
10
10
10
10
00
10
10
10
42
42
42
42
10
10
10
42
42
42
42
42

UNIT VALUE
20.98
23.04
29.13
11.25
BR
21.35
25.59
139.10
26.32
24.60
25.97
21.27
22.87
22.70
19.81
29.16
BR
2.91
11.55
11.78
12.72
14.69
17.46
13.75
10.80
12.49
14.50
22.79
28.80
22.51
25.20
26.88
BR
4.25
6.86
4.74
7.48
2.18
3.71
4.32
6.31
8.76
9.24
7.79
6.76
5.32
5.67
7.41
19.55
19.86
25.41
33.72
37.60

CODE
40899
41000
41005
41006
41007
41008
41009
41010
41015
41016
41017
41018
41100
41105
41108
41110
41112
41113
41114
41115
41116
41120
41130
41135
41140
41145
41150
41153
41155
41250
41251
41252
41500
41510
41520
41599
41800
41805
41806
41820
41821
41822
41823
41825
41826
41827
41828
41830
41850
41870
41872
41874
41899

FUD
YYY
10
10
42
42
42
42
10
42
42
42
42
10
10
10
10
42
42
42
10
42
42
42
42
42
42
42
42
42
10
10
10
42
42
42
YYY
10
10
10
00
00
10
42
10
10
42
10
10
00
00
42
42
YYY

UNIT VALUE
BR
3.73
4.71
8.38
8.55
8.46
9.01
4.56
9.81
10.19
10.22
11.88
4.20
3.85
3.22
4.62
7.49
8.27
16.48
5.21
7.02
25.90
28.29
48.25
54.37
63.13
49.73
50.82
56.90
4.84
5.76
7.15
11.45
11.54
7.62
BR
3.88
4.04
6.63
5.92
1.34
6.51
9.32
4.52
5.04
9.27
7.33
8.74
2.96
7.40
7.91
8.37
BR

CPT only copyright 2004 American Medical Association. All Rights Reserved.

34

CODE
42000
42100
42104
42106
42107
42120
42140
42145
42160
42180
42182
42200
42205
42210
42215
42220
42225
42226
42227
42235
42260
42280
42281
42299
42300
42305
42310
42320
42325
42326
42330
42335
42340
42400
42405
42408
42409
42410
42415
42420
42425
42426
42440
42450
42500
42505
42507
42508
42509
42510
42550
42600
42650

FUD
10
10
10
10
42
42
42
42
10
10
10
42
42
42
42
42
42
42
42
42
42
10
10
YYY
10
42
10
10
42
42
10
42
42
00
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00

UNIT VALUE
3.91
3.52
4.34
5.57
10.59
18.47
5.47
16.18
6.22
5.78
8.09
23.46
24.90
28.08
19.18
14.51
27.48
25.70
26.03
20.44
21.23
3.69
4.73
BR
4.91
11.31
3.95
5.83
7.62
9.96
5.54
8.51
11.06
2.49
7.57
10.89
7.60
16.46
29.18
33.60
22.74
36.09
12.35
10.93
10.38
13.85
13.12
18.47
22.64
16.59
4.53
11.82
1.94

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
42660
42665
42699
42700
42720
42725
42800
42802
42804
42806
42808
42809
42810
42815
42820
42821
42825
42826
42830
42831
42835
42836
42842
42844
42845
42860
42870
42890
42892
42894
42900
42950
42953
42955
42960
42961
42962
42970
42971
42972
42999
43020
43030
43045
43100
43101
43107
43108
43112
43113
43116
43117
43118

FUD
00
42
YYY
10
10
42
10
10
10
10
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
10
42
42
42
42
42
YYY
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
2.57
6.93
BR
4.40
10.71
19.88
3.68
6.43
5.08
5.78
5.58
4.30
9.26
14.09
7.50
8.13
6.83
6.68
5.33
5.77
4.97
6.40
20.46
31.71
49.49
4.80
14.40
28.16
34.33
46.78
9.43
20.68
27.18
18.85
4.49
11.00
13.63
9.99
11.83
13.51
BR
14.37
13.87
33.35
16.32
26.33
63.22
52.29
68.45
54.71
50.88
62.28
51.00

CODE
43121
43122
43123
43124
43130
43135
43200
43201
43202
43204
43205
43215
43216
43217
43219
43220
43226
43227
43228
43231
43232
43234
43235
43236
43237
43238
43239
43240
43241
43242
43243
43244
43245
43246
43247
43248
43249
43250
43251
43255
43256
43257
43258
43259
43260
43261
43262
43263
43264
43265
43267
43268
43269

FUD
42
42
42
42
42
42
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00

UNIT VALUE
46.68
62.58
51.41
44.03
20.47
26.44
5.85
6.88
7.59
5.58
5.58
4.03
3.66
10.11
4.39
3.24
3.56
5.32
5.65
4.74
6.62
7.51
7.75
9.54
6.01
7.42
8.80
10.01
3.90
10.56
6.70
7.37
4.74
6.35
5.02
4.70
4.33
4.77
5.46
7.05
6.39
8.06
6.66
7.54
8.67
9.11
10.70
10.58
12.85
14.42
10.71
10.80
11.88

CPT only copyright 2004 American Medical Association. All Rights Reserved.

35

CODE
43271
43272
43280
43289
43300
43305
43310
43312
43313
43314
43320
43324
43325
43326
43330
43331
43340
43341
43350
43351
43352
43360
43361
43400
43401
43405
43410
43415
43420
43425
43450
43453
43456
43458
43460
43496
43499
43500
43501
43502
43510
43520
43600
43605
43610
43611
43620
43621
43622
43631
43632
43633
43634

FUD
00
00
42
YYY
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
00
00
00
42
YYY
42
42
42
42
42
00
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
10.70
10.71
26.74
BR
16.57
29.63
39.80
44.23
69.42
75.95
31.63
32.02
31.40
31.78
30.85
32.71
30.99
33.71
25.61
30.55
25.59
55.55
61.75
32.51
34.55
32.32
22.83
40.09
23.17
33.89
4.12
7.68
16.51
9.95
5.60
BR
BR
17.41
30.93
35.61
21.10
16.55
2.71
18.81
22.62
27.69
45.69
46.65
49.31
34.65
34.65
35.41
38.46

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
43635
43638
43639
43640
43641
43644
43645
43651
43652
43653
43659
43750
43752
43760
43761
43800
43810
43820
43825
43830
43831
43832
43840
43842
43843
43845
43846
43847
43848
43850
43855
43860
43865
43870
43880
43999
44005
44010
44015
44020
44021
44025
44050
44055
44100
44110
44111
44120
44121
44125
44126
44127
44128

FUD
ZZZ
42
42
42
42
42
42
42
42
42
YYY
10
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
42
42
ZZZ
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
ZZZ

UNIT VALUE
3.03
44.59
45.14
26.46
26.78
42.17
45.48
16.22
19.42
12.90
BR
7.10
1.11
3.27
3.32
21.34
22.71
23.75
29.72
15.56
13.33
24.35
24.32
28.65
28.81
49.41
37.16
41.28
44.99
37.67
39.87
38.17
40.42
15.42
37.68
BR
25.00
19.54
3.84
21.69
21.81
22.07
21.77
33.50
2.89
18.52
22.20
26.23
6.53
26.99
54.22
62.35
6.58

CODE
44130
44132
44133
44135
44136
44137
44139
44140
44141
44143
44144
44145
44146
44147
44150
44151
44152
44153
44155
44156
44160
44200
44201
44202
44203
44204
44205
44206
44207
44208
44210
44211
44212
44238
44239
44300
44310
44312
44314
44316
44320
44322
44340
44345
44346
44360
44361
44363
44364
44365
44366
44369
44370

FUD
42
XXX
XXX
XXX
XXX
XXX
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
YYY
YYY
42
42
42
42
42
42
42
42
42
42
00
00
00
00
00
00
00
00

UNIT VALUE
22.52
BR
BR
BR
BR
BR
3.27
32.28
32.01
36.59
33.88
40.42
43.72
31.87
38.93
43.67
42.85
48.43
44.36
49.71
28.66
22.46
15.70
33.74
6.51
38.06
33.75
41.62
45.07
48.92
43.22
53.76
49.79
BR
BR
19.13
24.57
12.93
23.31
31.96
27.49
22.06
12.95
24.23
26.43
3.88
4.28
5.14
5.49
4.91
6.45
6.57
7.13

CPT only copyright 2004 American Medical Association. All Rights Reserved.

36

CODE
44372
44373
44376
44377
44378
44379
44380
44382
44383
44385
44386
44388
44389
44390
44391
44392
44393
44394
44397
44500
44602
44603
44604
44605
44615
44620
44625
44626
44640
44650
44660
44661
44680
44700
44701
44715
44720
44721
44799
44800
44820
44850
44899
44900
44901
44950
44955
44960
44970
44979
45000
45005
45020

FUD
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
XXX
XXX
XXX
YYY
42
42
42
YYY
42
00
42
ZZZ
42
42
YYY
42
10
42

UNIT VALUE
6.48
5.18
7.70
8.05
10.34
10.99
1.68
2.02
4.43
5.32
8.95
8.16
10.02
11.25
13.37
10.73
12.15
12.61
6.88
0.68
24.45
28.28
24.50
30.37
24.59
19.01
23.16
38.35
32.91
34.26
31.79
37.11
23.71
24.55
4.53
BR
7.08
10.36
BR
18.01
19.08
17.09
BR
16.10
31.49
15.60
2.26
19.26
13.90
BR
7.98
6.28
8.52

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
45100
45108
45110
45111
45112
45113
45114
45116
45119
45120
45121
45123
45126
45130
45135
45136
45150
45160
45170
45190
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45339
45340
45341
45342
45345
45355
45378
45379
45380
45381
45382
45383
45384
45385

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00

UNIT VALUE
6.45
8.10
43.67
25.66
45.63
46.49
41.46
37.47
46.55
37.54
41.31
25.36
68.56
24.94
30.00
42.48
9.21
23.60
18.04
15.44
1.95
19.17
3.75
4.08
2.91
5.04
4.41
4.08
4.65
1.86
2.50
3.31
4.31
6.95
6.81
4.08
4.78
3.57
7.74
6.86
8.21
3.87
5.89
4.31
5.24
10.13
12.73
11.97
11.62
16.05
14.26
11.87
13.52

CODE
45386
45387
45391
45392
45500
45505
45520
45540
45541
45550
45560
45562
45563
45800
45805
45820
45825
45900
45905
45910
45915
45999
46020
46030
46040
46045
46050
46060
46070
46080
46083
46200
46210
46211
46220
46221
46230
46250
46255
46257
46258
46260
46261
46262
46270
46275
46280
46285
46288
46320
46500
46600
46604

FUD
00
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
10
10
10
10
YYY
10
10
42
42
10
42
42
10
10
42
42
42
10
10
10
42
42
42
42
42
42
42
42
42
42
42
42
10
10
00
00

UNIT VALUE
17.36
8.71
7.48
9.44
11.54
12.27
2.24
24.86
20.87
34.76
16.74
24.15
36.98
26.99
32.31
27.66
33.32
4.41
4.00
4.75
7.76
BR
5.54
2.71
11.04
7.73
3.86
9.58
4.89
5.15
4.07
7.64
8.09
10.11
4.02
4.90
5.93
9.65
10.98
8.89
9.67
10.29
11.46
12.04
9.16
9.70
9.88
8.27
11.58
3.91
3.88
2.11
10.55

CPT only copyright 2004 American Medical Association. All Rights Reserved.

37

CODE
46606
46608
46610
46611
46612
46614
46615
46700
46705
46706
46715
46716
46730
46735
46740
46742
46744
46746
46748
46750
46751
46753
46754
46760
46761
46762
46900
46910
46916
46917
46922
46924
46934
46935
46936
46937
46938
46940
46942
46945
46946
46947
46999
47000
47001
47010
47011
47015
47100
47120
47122
47125
47130

FUD
00
00
00
00
00
00
00
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
10
42
42
42
10
10
10
10
10
10
42
10
42
10
42
10
10
42
42
42
YYY
00
ZZZ
42
42
42
42
42
42
42
42

UNIT VALUE
4.68
6.07
5.50
5.33
7.79
4.53
5.48
14.25
11.47
3.91
11.68
24.59
41.18
48.84
45.58
56.30
79.99
90.89
91.08
16.37
15.11
13.06
5.98
23.05
21.23
19.43
4.66
4.94
5.12
11.19
5.34
11.70
8.88
6.12
8.89
5.60
9.22
4.53
4.06
5.29
6.56
8.66
BR
5.09
2.79
26.15
5.12
24.36
19.18
55.13
83.59
74.79
80.99

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
47133
47135
47136
47140
47141
47142
47143
47144
47145
47146
47147
47300
47350
47360
47361
47362
47370
47371
47379
47380
47381
47382
47399
47400
47420
47425
47460
47480
47490
47500
47505
47510
47511
47525
47530
47550
47552
47553
47554
47555
47556
47560
47561
47562
47563
47564
47570
47579
47600
47605
47610
47612
47620

FUD
XXX
42
42
42
42
42
XXX
42
42
XXX
XXX
42
42
42
42
42
42
42
YYY
42
42
10
YYY
42
42
42
42
42
42
00
00
42
42
10
42
ZZZ
00
00
00
00
00
00
00
42
42
42
42
YYY
42
42
42
42
42

UNIT VALUE
BR
122.55
103.87
82.32
99.43
109.48
BR
BR
BR
8.88
10.36
24.20
30.90
41.76
71.35
29.58
30.25
30.38
BR
35.10
35.63
22.21
BR
48.98
31.19
31.17
28.47
18.09
13.22
2.72
1.06
13.31
16.19
20.96
39.99
4.43
8.83
8.80
13.35
10.46
11.84
7.19
7.72
17.49
18.77
22.01
19.55
BR
21.45
23.08
29.16
29.08
31.82

CODE
47630
47700
47701
47711
47712
47715
47716
47720
47721
47740
47741
47760
47765
47780
47785
47800
47801
47802
47900
47999
48000
48001
48005
48020
48100
48102
48120
48140
48145
48146
48148
48150
48152
48153
48154
48155
48160
48180
48400
48500
48510
48511
48520
48540
48545
48547
48550
48551
48552
48554
48556
48999
49000

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
XXX
42
ZZZ
42
42
00
42
42
42
42
XXX
XXX
XXX
42
42
YYY
42

UNIT VALUE
14.63
25.02
42.88
35.92
46.46
29.64
26.35
25.43
30.12
29.16
33.39
40.01
38.86
41.08
48.01
36.29
24.45
33.99
31.35
BR
42.89
53.86
64.10
25.07
19.35
12.91
24.73
35.40
36.94
41.78
27.12
73.64
67.63
73.60
68.01
39.45
68.87
38.04
2.74
24.58
23.50
25.12
24.28
30.32
28.44
39.59
BR
BR
6.07
56.50
25.75
BR
18.51

CPT only copyright 2004 American Medical Association. All Rights Reserved.

38

CODE
49002
49010
49020
49021
49040
49041
49060
49061
49062
49080
49081
49085
49180
49200
49201
49215
49220
49250
49255
49320
49321
49322
49323
49329
49400
49419
49420
49421
49422
49423
49424
49425
49426
49427
49428
49429
49491
49492
49495
49496
49500
49501
49505
49507
49520
49521
49525
49540
49550
49553
49555
49557
49560

FUD
42
42
42
00
42
00
42
00
42
00
00
42
00
42
42
42
42
42
42
10
10
10
42
YYY
00
42
00
42
10
00
00
42
42
00
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
16.82
19.66
35.74
24.62
21.56
23.74
25.01
23.53
18.16
5.42
3.93
19.16
4.94
16.45
23.61
51.73
23.36
13.67
18.12
8.35
8.72
9.39
15.14
BR
5.10
11.00
3.52
9.38
9.92
15.62
4.52
18.44
15.63
1.26
10.77
11.81
17.56
21.89
9.56
14.12
9.29
14.15
12.34
15.26
15.32
18.74
13.74
16.47
13.87
15.07
14.46
17.57
18.19

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
49561
49565
49566
49568
49570
49572
49580
49582
49585
49587
49590
49600
49605
49606
49610
49611
49650
49651
49659
49900
49904
49905
49906
49999
50010
50020
50021
50040
50045
50060
50065
50070
50075
50080
50081
50100
50120
50125
50130
50135
50200
50205
50220
50225
50230
50234
50236
50240
50280
50290
50300
50320
50323

FUD
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
42
42
ZZZ
42
YYY
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
XXX
42
XXX

UNIT VALUE
22.13
18.27
22.37
7.19
9.58
11.06
7.19
10.98
10.32
12.26
13.72
17.58
113.68
28.67
16.74
16.66
10.37
13.40
BR
20.03
37.81
9.60
BR
BR
17.11
23.66
25.22
22.79
23.29
28.45
28.41
29.93
36.99
22.00
32.06
25.87
23.87
24.89
25.64
28.29
4.08
17.60
25.73
29.84
32.20
32.80
36.81
32.56
23.52
22.55
BR
35.19
BR

CODE
50325
50327
50328
50329
50340
50360
50365
50370
50380
50390
50391
50392
50393
50394
50395
50396
50398
50400
50405
50500
50520
50525
50526
50540
50541
50542
50543
50544
50545
50546
50547
50548
50549
50551
50553
50555
50557
50561
50562
50570
50572
50574
50575
50576
50580
50590
50600
50605
50610
50620
50630
50650
50660

FUD
XXX
XXX
XXX
XXX
42
42
42
42
42
00
00
00
00
00
00
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
00
00
00
00
00
42
00
00
00
00
00
00
42
42
42
42
42
42
42
42

UNIT VALUE
BR
5.64
4.94
4.72
20.26
50.73
59.33
22.49
35.16
2.72
3.68
5.10
6.18
3.49
5.08
3.30
17.86
28.74
34.67
29.92
26.11
33.05
35.78
29.57
23.61
29.49
37.49
32.46
34.88
30.37
39.30
35.27
BR
10.14
10.73
11.79
11.66
13.20
15.97
13.42
14.67
15.53
19.59
15.41
16.68
22.12
23.69
23.63
24.24
22.56
22.30
25.86
28.90

CPT only copyright 2004 American Medical Association. All Rights Reserved.

39

CODE
50684
50686
50688
50690
50700
50715
50722
50725
50727
50728
50740
50750
50760
50770
50780
50782
50783
50785
50800
50810
50815
50820
50825
50830
50840
50845
50860
50900
50920
50930
50940
50945
50947
50948
50949
50951
50953
50955
50957
50961
50970
50972
50974
50976
50980
51000
51005
51010
51020
51030
51040
51045
51050

FUD
00
00
10
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
YYY
00
00
00
00
00
00
00
00
00
00
00
00
10
42
42
42
42
42

UNIT VALUE
5.78
5.06
2.30
3.05
23.58
29.71
26.01
28.01
13.06
18.56
28.08
28.84
27.64
28.93
27.44
29.85
30.70
30.34
22.16
31.40
29.94
32.37
41.34
45.73
29.90
31.28
23.25
20.90
21.88
27.93
22.14
25.36
36.28
32.84
BR
10.54
11.07
13.63
11.83
10.81
10.11
9.84
12.90
12.74
9.71
2.78
5.82
9.40
11.04
11.31
7.47
11.23
11.04

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
51060
51065
51080
51500
51520
51525
51530
51535
51550
51555
51565
51570
51575
51580
51585
51590
51595
51596
51597
51600
51605
51610
51700
51701
51702
51703
51705
51710
51715
51720
51725
51726
51736
51741
51772
51784
51785
51792
51795
51797
51798
51800
51820
51840
51841
51845
51860
51865
51880
51900
51920
51925
51940

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
00
00
00
00
00
10
10
00
00
00
00
00
00
00
00
00
00
00
00
XXX
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
13.95
13.83
9.93
16.15
14.64
21.08
19.16
19.86
23.70
31.57
32.20
35.77
44.58
45.73
51.35
47.53
53.82
57.46
55.94
5.99
6.73
3.40
2.55
2.12
2.62
4.31
3.36
4.93
7.92
3.84
7.26
9.39
1.25
2.04
7.38
5.67
6.12
7.29
9.04
7.55
0.42
26.30
27.87
17.32
20.64
15.26
18.91
22.95
12.32
20.22
18.60
26.19
42.58

CODE
51960
51980
51990
51992
52000
52001
52005
52007
52010
52204
52214
52224
52234
52235
52240
52250
52260
52265
52270
52275
52276
52277
52281
52282
52283
52285
52290
52300
52301
52305
52310
52315
52317
52318
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52351
52352
52353
52354
52355
52400
52402

FUD
42
42
42
42
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
42
00

UNIT VALUE
34.26
17.57
20.02
21.59
5.45
10.90
8.10
19.68
13.99
17.05
42.06
39.81
6.61
7.76
13.70
6.46
5.61
16.50
14.63
20.57
7.12
8.82
10.09
9.09
7.93
7.87
6.55
7.58
7.94
7.53
7.70
14.23
36.13
12.92
6.66
8.70
37.37
44.21
8.78
6.89
8.63
9.29
10.29
11.03
11.72
13.17
8.41
9.86
11.38
10.52
12.58
14.09
7.37

CPT only copyright 2004 American Medical Association. All Rights Reserved.

40

CODE
52450
52500
52510
52601
52606
52612
52614
52620
52630
52640
52647
52648
52700
53000
53010
53020
53025
53040
53060
53080
53085
53200
53210
53215
53220
53230
53235
53240
53250
53260
53265
53270
53275
53400
53405
53410
53415
53420
53425
53430
53431
53440
53442
53444
53445
53446
53447
53448
53449
53450
53460
53500
53502

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
00
00
42
10
42
42
00
42
42
42
42
42
42
42
10
10
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
11.84
12.98
10.30
18.32
12.25
12.27
10.65
10.05
10.95
10.04
85.01
16.77
10.45
3.98
6.79
4.90
4.94
10.29
4.98
12.75
18.56
4.12
19.31
23.29
11.23
15.01
15.75
10.49
9.66
5.48
6.07
5.59
7.10
19.77
21.86
24.66
28.09
21.35
23.97
24.51
29.36
20.54
17.81
20.19
22.12
16.15
20.84
31.68
15.10
9.85
11.32
19.30
12.23

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
53505
53510
53515
53520
53600
53601
53605
53620
53621
53660
53661
53665
53850
53852
53853
53899
54000
54001
54015
54050
54055
54056
54057
54060
54065
54100
54105
54110
54111
54112
54115
54120
54125
54130
54135
54150
54152
54160
54161
54162
54163
54164
54200
54205
54220
54230
54231
54235
54240
54250
54300
54304
54308

FUD
42
42
42
42
00
00
00
00
00
00
00
00
42
42
42
YYY
10
10
10
10
10
10
10
10
10
00
10
42
42
42
42
42
42
42
42
10
10
10
10
10
10
10
10
42
00
00
00
00
00
00
42
42
42

UNIT VALUE
12.02
16.02
20.26
13.77
2.44
2.32
1.78
3.73
3.52
2.07
2.07
1.07
104.17
99.34
60.94
BR
4.56
5.53
8.24
2.98
2.87
2.99
3.54
5.17
5.19
4.81
8.02
15.60
20.28
23.75
10.96
15.31
20.31
29.79
38.34
6.32
3.70
6.81
5.07
7.87
5.22
4.52
2.93
13.16
6.44
2.51
3.57
2.24
2.50
3.31
16.71
19.66
18.60

CODE
54312
54316
54318
54322
54324
54326
54328
54332
54336
54340
54344
54348
54352
54360
54380
54385
54390
54400
54401
54405
54406
54408
54410
54411
54415
54416
54417
54420
54430
54435
54440
54450
54500
54505
54512
54520
54522
54530
54535
54550
54560
54600
54620
54640
54650
54660
54670
54680
54690
54692
54699
54700
54800

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
10
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
YYY
10
00

UNIT VALUE
21.76
25.94
18.40
20.36
25.37
24.58
23.84
25.97
32.48
14.56
25.19
26.69
38.09
18.78
20.69
24.48
32.52
13.96
16.71
20.27
18.35
19.36
23.19
24.13
12.96
16.98
21.33
17.76
15.95
10.16
15.25
2.15
2.01
5.63
13.37
8.50
15.24
13.46
18.65
12.16
17.16
11.06
7.69
11.25
17.97
8.53
10.39
19.93
16.88
19.58
BR
5.63
3.50

CPT only copyright 2004 American Medical Association. All Rights Reserved.

41

CODE
54820
54830
54840
54860
54861
54900
54901
55000
55040
55041
55060
55100
55110
55120
55150
55175
55180
55200
55250
55300
55400
55450
55500
55520
55530
55535
55540
55550
55559
55600
55605
55650
55680
55700
55705
55720
55725
55801
55810
55812
55815
55821
55831
55840
55842
55845
55859
55860
55862
55865
55866
55870
55873

FUD
42
42
42
42
42
42
42
00
42
42
42
10
42
42
42
42
42
42
42
00
42
10
42
42
42
42
42
42
YYY
42
42
42
42
00
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
42

UNIT VALUE
8.46
8.79
8.34
10.06
13.82
19.89
27.23
3.60
8.67
12.29
9.04
5.97
9.24
8.41
11.61
8.62
16.95
16.86
15.02
5.06
13.17
11.39
9.22
10.00
9.10
10.43
12.39
10.42
BR
10.32
12.87
18.00
8.61
5.87
7.18
12.38
13.85
26.71
33.06
40.46
44.44
21.43
23.35
33.53
35.86
41.44
19.20
21.84
27.67
33.69
44.54
4.27
29.74

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
55899
55970
55980
56405
56420
56440
56441
56501
56515
56605
56606
56620
56625
56630
56631
56632
56633
56634
56637
56640
56700
56720
56740
56800
56805
56810
56820
56821
57000
57010
57020
57022
57023
57061
57065
57100
57105
57106
57107
57109
57110
57111
57112
57120
57130
57135
57150
57155
57160
57170
57180
57200
57210

FUD
YYY
XXX
XXX
10
10
10
10
10
10
00
ZZZ
42
42
42
42
42
42
42
42
42
10
00
10
10
42
10
00
00
10
42
00
10
10
10
10
00
10
42
42
42
42
42
42
42
10
10
00
42
00
00
10
42
42

UNIT VALUE
BR
BR
BR
2.94
3.82
4.89
3.98
3.48
5.62
2.30
1.11
13.14
14.70
20.64
26.90
32.10
26.97
29.41
35.54
35.55
4.65
1.27
7.66
6.51
30.37
6.89
2.99
4.04
5.00
10.50
2.61
4.31
7.86
3.05
5.21
2.42
3.68
11.26
36.08
41.34
23.23
42.73
44.09
12.87
4.87
5.24
1.71
11.25
2.00
2.50
3.92
7.27
9.20

CODE
57220
57230
57240
57250
57260
57265
57267
57268
57270
57280
57282
57283
57284
57287
57288
57289
57291
57292
57300
57305
57307
57308
57310
57311
57320
57330
57335
57400
57410
57415
57420
57421
57425
57452
57454
57455
57456
57460
57461
57500
57505
57510
57511
57513
57520
57522
57530
57531
57540
57545
57550
57555
57556

FUD
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
10
00
00
42
00
00
00
00
00
00
00
10
10
10
10
42
42
42
42
42
42
42
42
42

UNIT VALUE
7.90
9.58
10.49
9.74
14.06
18.67
7.49
11.72
19.74
24.04
12.38
17.77
21.23
17.07
20.02
18.80
13.79
21.56
12.74
21.70
24.82
16.15
11.14
12.73
13.04
19.09
29.61
3.63
3.93
3.83
3.13
4.30
24.10
2.95
4.25
3.95
3.72
9.01
9.94
3.62
2.73
3.68
3.94
3.85
8.44
6.90
8.74
44.43
19.91
21.19
10.00
15.09
14.14

CPT only copyright 2004 American Medical Association. All Rights Reserved.

42

CODE
57700
57720
57800
57820
58100
58120
58140
58145
58146
58150
58152
58180
58200
58210
58240
58260
58262
58263
58267
58270
58275
58280
58285
58290
58291
58292
58293
58294
58300
58301
58321
58322
58323
58340
58345
58346
58350
58353
58356
58400
58410
58520
58540
58545
58546
58550
58552
58553
58554
58555
58558
58559
58560

FUD
42
42
00
10
00
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
XXX
00
00
00
00
00
10
42
10
10
10
42
42
42
42
42
42
42
42
42
42
00
00
00
00

UNIT VALUE
7.05
7.70
1.62
3.34
3.03
5.96
23.46
13.78
30.24
24.51
32.83
24.36
34.04
45.30
60.09
21.20
23.90
25.84
27.42
23.00
25.37
27.22
34.85
30.37
33.11
35.08
36.43
32.12
2.55
2.74
2.17
2.43
0.79
4.13
7.49
11.24
2.62
39.63
14.02
11.02
20.59
19.40
23.33
23.52
30.16
23.16
25.69
30.17
34.60
5.92
7.48
9.62
10.90

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
58561
58562
58563
58565
58578
58579
58600
58605
58611
58615
58660
58661
58662
58670
58671
58672
58673
58679
58700
58720
58740
58750
58752
58760
58770
58800
58805
58820
58822
58823
58825
58900
58920
58925
58940
58943
58950
58951
58952
58953
58954
58956
58960
58970
58974
58976
58999
59000
59001
59012
59015
59020
59025

FUD
00
00
00
42
YYY
YYY
42
42
ZZZ
10
42
10
42
42
42
42
42
YYY
42
42
42
42
42
42
42
42
42
42
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
00
YYY
00
00
00
00
00
00

UNIT VALUE
15.46
8.17
63.09
57.77
BR
BR
9.57
8.69
2.19
7.06
17.90
17.48
18.97
9.53
9.53
20.62
21.95
BR
19.51
18.48
22.78
24.01
23.54
21.60
22.57
8.19
10.03
8.02
16.47
24.94
18.07
10.23
18.32
18.41
12.27
29.24
27.31
35.38
39.68
50.24
54.76
35.07
23.74
6.25
3.75
6.97
BR
3.68
5.12
5.79
4.27
1.70
1.11

CODE
59030
59050
59051
59070
59072
59074
59076
59100
59120
59121
59130
59135
59136
59140
59150
59151
59160
59200
59300
59320
59325
59350
59400
59409
59410
59412
59414
59425
59426
59430
59510
59514
59515
59525
59610
59612
59614
59618
59620
59622
59812
59820
59821
59830
59840
59841
59850
59851
59852
59855
59856
59857
59866

FUD
00
XXX
XXX
00
00
00
00
42
42
42
42
42
42
42
42
42
10
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
ZZZ
00
00
00
00
00
00
42
42
42
42
10
10
42
42
42
42
42
42
00

UNIT VALUE
3.23
1.45
1.20
10.67
12.27
10.09
12.27
21.69
20.37
20.72
22.34
24.35
22.87
8.95
20.39
20.23
6.64
2.17
5.15
4.30
6.83
7.98
43.78
21.96
24.54
2.92
2.63
10.13
17.76
3.86
49.62
25.92
29.26
13.76
46.24
24.64
27.10
52.51
28.39
31.99
7.48
9.36
9.78
11.52
5.84
9.95
10.43
10.94
15.06
11.09
13.29
15.99
6.75

CPT only copyright 2004 American Medical Association. All Rights Reserved.

43

CODE
59870
59871
59897
59898
59899
60000
60001
60100
60200
60210
60212
60220
60225
60240
60252
60254
60260
60270
60271
60280
60281
60500
60502
60505
60512
60520
60521
60522
60540
60545
60600
60605
60650
60659
60699
61000
61001
61020
61026
61050
61055
61070
61105
61107
61108
61120
61140
61150
61151
61154
61156
61210
61215

FUD
42
42
YYY
YYY
YYY
10
00
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
YYY
YYY
00
00
00
00
00
00
00
42
00
42
42
42
42
42
42
42
00
42

UNIT VALUE
11.90
4.37
BR
BR
BR
3.82
2.45
3.06
16.53
17.72
25.60
19.35
23.20
25.47
32.94
43.72
28.02
32.97
27.17
11.06
15.08
25.61
32.18
35.00
6.60
27.22
31.13
37.54
26.34
30.47
31.05
34.92
30.22
BR
BR
2.66
2.71
3.14
3.36
2.89
3.68
2.05
10.34
8.75
19.84
16.65
29.79
32.19
23.18
28.52
30.18
10.19
10.08

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
61250
61253
61304
61305
61312
61313
61314
61315
61316
61320
61321
61322
61323
61330
61332
61333
61334
61340
61343
61345
61440
61450
61458
61460
61470
61480
61490
61500
61501
61510
61512
61514
61516
61517
61518
61519
61520
61521
61522
61524
61526
61530
61531
61533
61534
61535
61536
61537
61538
61539
61540
61541
61542

FUD
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
19.98
22.65
39.95
47.66
45.71
45.95
43.34
50.56
2.33
46.57
51.50
52.38
54.84
39.35
47.44
47.29
30.60
34.34
53.93
49.23
47.62
45.92
49.48
50.64
45.70
48.40
46.79
32.62
27.03
52.19
63.47
45.91
45.02
2.36
67.65
74.07
95.80
79.14
53.25
50.14
88.39
74.84
27.44
36.13
38.35
21.95
63.93
46.45
48.83
58.01
55.42
51.54
56.74

CODE
61543
61544
61545
61546
61548
61550
61552
61556
61557
61558
61559
61563
61564
61566
61567
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61609
61610
61611
61612
61613
61615
61616
61618
61619
61623
61624
61626
61680
61682

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
ZZZ
ZZZ
ZZZ
42
42
42
42
42
00
00
00
42
42

UNIT VALUE
53.05
45.20
77.86
56.21
37.62
22.54
29.70
38.19
41.71
41.08
60.45
47.14
60.73
55.47
62.61
43.79
48.21
59.04
92.59
59.21
61.86
65.82
69.59
66.81
72.00
51.96
75.52
78.61
75.39
55.74
63.38
69.20
62.12
49.20
54.68
54.06
72.49
66.69
78.55
17.26
50.37
13.10
45.43
75.40
59.39
79.81
31.02
36.81
15.08
28.93
23.35
55.69
109.19

CPT only copyright 2004 American Medical Association. All Rights Reserved.

44

CODE
61684
61686
61690
61692
61697
61698
61700
61702
61703
61705
61708
61710
61711
61720
61735
61750
61751
61760
61770
61790
61791
61793
61795
61850
61860
61863
61864
61867
61868
61870
61875
61880
61885
61886
61888
62000
62005
62010
62100
62115
62116
62117
62120
62121
62140
62141
62142
62143
62145
62146
62147
62148
62160

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
ZZZ
42
ZZZ
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
ZZZ

UNIT VALUE
71.95
115.26
52.86
92.55
90.89
87.11
90.83
84.69
31.84
64.16
52.89
47.74
65.24
29.43
35.25
33.28
32.80
36.02
37.17
19.43
26.57
31.57
6.83
23.22
37.80
35.95
11.98
54.52
17.13
28.45
26.53
12.43
12.56
16.26
9.96
19.06
28.68
36.29
39.49
38.73
42.96
46.41
44.75
41.08
25.03
27.42
20.31
24.25
33.98
29.25
34.81
3.33
5.28

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
62161
62162
62163
62164
62165
62180
62190
62192
62194
62200
62201
62220
62223
62225
62230
62252
62256
62258
62263
62264
62268
62269
62270
62272
62273
62280
62281
62282
62284
62287
62290
62291
62292
62294
62310
62311
62318
62319
62350
62351
62355
62360
62361
62362
62365
62367
62368
63001
63003
63005
63011
63012
63015

FUD
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
XXX
42
42
10
10
00
00
00
00
00
10
10
10
00
42
00
00
42
42
00
00
00
00
42
42
42
42
42
42
42
XXX
XXX
42
42
42
42
42
42

UNIT VALUE
37.08
45.91
29.37
47.72
38.30
38.08
20.89
22.78
8.34
33.62
27.69
24.02
24.11
10.82
19.54
2.41
12.93
26.79
19.24
12.42
16.69
20.08
4.20
5.13
5.00
9.87
8.49
10.88
6.63
14.26
10.38
9.10
13.13
18.62
6.84
6.56
7.89
6.97
11.78
19.28
9.34
5.66
10.10
12.54
9.82
0.64
1.00
28.96
29.42
28.14
26.08
28.91
35.83

CODE
63016
63017
63020
63030
63035
63040
63042
63043
63044
63045
63046
63047
63048
63050
63051
63055
63056
63057
63064
63066
63075
63076
63077
63078
63081
63082
63085
63086
63087
63088
63090
63091
63101
63102
63103
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
63199
63200
63250
63251
63252

FUD
42
42
42
42
ZZZ
42
42
ZZZ
ZZZ
42
42
42
ZZZ
42
42
42
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
42
ZZZ
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
35.40
29.87
28.06
23.31
5.51
34.77
32.86
14.41
13.69
30.72
29.43
27.63
5.63
37.23
42.36
40.22
37.46
9.06
44.44
5.59
35.95
7.02
37.90
5.55
43.37
7.58
46.53
5.33
60.62
7.27
48.21
4.96
56.67
56.67
7.99
36.47
32.64
40.40
33.14
36.67
25.77
30.76
34.27
34.10
34.68
41.37
38.61
40.17
43.28
35.17
69.55
73.64
73.43

CPT only copyright 2004 American Medical Association. All Rights Reserved.

45

CODE
63265
63266
63267
63268
63270
63271
63272
63273
63275
63276
63277
63278
63280
63281
63282
63283
63285
63286
63287
63290
63295
63300
63301
63302
63303
63304
63305
63306
63307
63308
63600
63610
63615
63650
63655
63660
63685
63688
63700
63702
63704
63706
63707
63709
63710
63740
63741
63744
63746
64400
64402
64405
64408

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
ZZZ
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
00
00
00
00

UNIT VALUE
39.57
40.81
33.25
32.46
48.78
48.91
46.00
44.27
43.01
42.68
38.17
37.31
51.62
51.07
48.07
45.83
64.86
64.34
65.86
66.64
8.42
44.24
48.01
48.83
51.84
53.90
55.68
58.22
52.81
9.10
20.88
69.26
28.16
10.44
19.49
10.55
12.19
9.78
30.23
33.57
38.60
43.82
21.35
26.71
26.42
21.36
14.58
15.10
11.68
3.09
2.95
2.86
3.09

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
64410
64412
64413
64415
64416
64417
64418
64420
64421
64425
64430
64435
64445
64446
64447
64448
64449
64450
64470
64472
64475
64476
64479
64480
64483
64484
64505
64508
64510
64517
64520
64530
64550
64553
64555
64560
64561
64565
64573
64575
64577
64580
64581
64585
64590
64595
64600
64605
64610
64612
64613
64614
64620

FUD
00
00
00
00
10
00
00
00
00
00
00
00
00
10
00
10
10
00
00
ZZZ
00
ZZZ
00
ZZZ
00
ZZZ
00
00
00
00
00
00
00
10
10
10
10
10
42
42
42
42
42
10
10
10
10
10
10
10
10
10
10

UNIT VALUE
4.03
3.91
3.33
4.38
4.59
4.58
4.02
5.15
7.88
3.54
4.08
4.12
4.25
4.49
2.03
4.02
4.12
2.64
9.21
3.71
8.40
3.17
9.84
4.50
9.91
4.70
2.70
4.51
4.74
5.03
6.57
6.13
0.47
5.33
5.57
5.20
37.29
5.17
14.26
7.60
8.93
8.02
19.90
13.54
9.75
12.31
13.12
15.92
17.49
4.56
5.00
5.53
8.10

CODE
64622
64623
64626
64627
64630
64640
64680
64681
64702
64704
64708
64712
64713
64714
64716
64718
64719
64721
64722
64726
64727
64732
64734
64736
64738
64740
64742
64744
64746
64752
64755
64760
64761
64763
64766
64771
64772
64774
64776
64778
64782
64783
64784
64786
64787
64788
64790
64792
64795
64802
64804
64809
64818

FUD
10
ZZZ
10
ZZZ
10
10
10
10
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
ZZZ
42
42
ZZZ
42
42
42
42
42
42
42
42

UNIT VALUE
10.97
4.02
11.28
5.77
5.96
7.22
9.51
13.11
8.69
8.48
11.91
13.69
18.59
15.70
12.92
13.01
10.13
10.36
8.25
7.51
5.07
8.84
9.84
9.13
11.40
11.39
11.64
10.09
11.24
12.25
20.94
11.18
10.45
13.05
14.96
14.11
13.41
9.74
9.52
5.06
10.86
6.05
17.82
27.80
6.99
8.74
20.48
26.08
5.07
15.55
23.87
20.91
16.88

CPT only copyright 2004 American Medical Association. All Rights Reserved.

46

CODE
64820
64821
64822
64823
64831
64832
64834
64835
64836
64837
64840
64856
64857
64858
64859
64861
64862
64864
64865
64866
64868
64870
64872
64874
64876
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898
64901
64902
64905
64907
64999
65091
65093
65101
65103
65105
65110
65112
65114
65125
65130
65135
65140
65150

FUD
42
42
42
42
42
ZZZ
42
42
42
ZZZ
42
42
42
42
ZZZ
42
42
42
42
42
42
42
ZZZ
ZZZ
ZZZ
42
42
42
42
42
42
42
42
42
42
ZZZ
ZZZ
42
42
YYY
42
42
42
42
42
42
42
42
42
42
42
42
42

UNIT VALUE
18.95
17.32
17.24
20.03
17.89
9.42
18.78
20.28
20.24
10.44
22.61
25.04
26.32
30.54
7.11
35.03
35.62
22.59
30.29
30.91
26.88
25.99
3.36
4.93
5.58
30.77
36.36
27.40
25.32
25.94
28.04
31.42
34.57
31.42
34.00
16.83
19.31
24.47
34.45
BR
15.12
15.93
16.91
17.67
19.37
28.44
33.87
34.86
12.10
16.65
17.01
18.31
14.55

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
65155
65175
65205
65210
65220
65222
65235
65260
65265
65270
65272
65273
65275
65280
65285
65286
65290
65400
65410
65420
65426
65430
65435
65436
65450
65600
65710
65730
65750
65755
65760
65765
65767
65770
65771
65772
65775
65780
65781
65782
65800
65805
65810
65815
65820
65850
65855
65860
65865
65870
65875
65880
65900

FUD
42
42
00
00
00
00
42
42
42
10
42
42
42
42
42
42
42
42
00
42
42
00
00
42
42
42
42
42
42
42
XXX
XXX
XXX
42
XXX
42
42
42
42
42
00
00
42
42
42
42
10
42
42
42
42
42
42

UNIT VALUE
19.63
15.09
1.39
1.69
1.40
1.87
14.69
21.16
23.82
7.22
11.72
8.15
11.93
14.26
22.73
16.91
10.46
14.68
3.65
13.22
15.67
2.83
1.97
8.48
7.50
8.57
24.13
26.95
27.69
27.49
32.51
37.70
35.11
31.59
19.11
10.02
12.01
20.96
31.75
27.41
3.79
4.17
9.80
15.29
17.57
19.46
8.34
7.76
11.49
12.98
13.64
14.46
21.73

CODE
65920
65930
66020
66030
66130
66150
66155
66160
66165
66170
66172
66180
66185
66220
66225
66250
66500
66505
66600
66605
66625
66630
66635
66680
66682
66700
66710
66711
66720
66740
66761
66762
66770
66820
66821
66825
66830
66840
66850
66852
66920
66930
66940
66982
66983
66984
66985
66986
66990
66999
67005
67010
67015

FUD
42
42
10
10
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
YYY
42
42
42

UNIT VALUE
16.97
14.63
4.79
4.27
17.68
18.15
18.04
20.84
17.64
24.95
30.96
26.00
15.91
15.28
20.30
17.96
8.52
9.26
17.33
23.56
10.10
12.16
12.29
10.97
13.12
10.25
10.17
13.37
10.82
10.09
9.85
10.45
11.51
9.88
6.55
17.68
15.52
15.14
17.18
18.55
16.59
18.78
16.95
23.95
15.31
18.05
16.21
22.02
2.28
BR
10.83
12.61
13.70

CPT only copyright 2004 American Medical Association. All Rights Reserved.

47

CODE
67025
67027
67028
67030
67031
67036
67038
67039
67040
67101
67105
67107
67108
67110
67112
67115
67120
67121
67141
67145
67208
67210
67218
67220
67221
67225
67227
67228
67250
67255
67299
67311
67312
67314
67316
67318
67320
67331
67332
67334
67335
67340
67343
67345
67350
67399
67400
67405
67412
67413
67414
67415
67420

FUD
42
42
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
ZZZ
42
42
42
42
YYY
42
42
42
42
42
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
ZZZ
42
10
00
YYY
42
42
42
42
42
42
42

UNIT VALUE
16.39
19.37
5.34
10.92
8.44
21.57
37.74
27.39
31.73
17.01
15.85
26.85
36.23
19.47
29.47
10.31
14.85
19.71
11.30
11.35
13.14
15.82
31.57
24.18
8.53
0.74
13.48
24.83
18.29
19.22
BR
13.03
15.71
14.45
17.64
15.18
6.50
6.09
6.74
5.96
3.74
7.37
14.22
5.71
4.90
BR
21.58
18.15
20.95
21.30
23.81
2.62
38.64

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
67430
67440
67445
67450
67500
67505
67515
67550
67560
67570
67599
67700
67710
67715
67800
67801
67805
67808
67810
67820
67825
67830
67835
67840
67850
67875
67880
67882
67900
67901
67902
67903
67904
67906
67908
67909
67911
67912
67914
67915
67916
67917
67921
67922
67923
67924
67930
67935
67938
67950
67961
67966
67971

FUD
42
42
42
42
00
00
00
42
42
42
YYY
10
10
10
10
10
10
42
00
00
10
10
42
10
10
00
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
42
10
42
10
42
42
42
42

UNIT VALUE
29.17
28.10
29.24
28.91
1.52
1.56
1.23
22.20
22.54
27.93
BR
7.44
6.44
6.65
3.07
3.93
4.85
7.77
4.88
1.53
3.18
7.32
10.46
7.61
5.14
4.73
10.60
12.96
15.57
12.87
12.93
16.39
16.29
12.61
12.04
13.73
10.35
24.88
10.22
9.33
13.65
14.83
9.76
9.12
14.31
15.02
9.52
15.12
6.78
14.80
14.69
16.06
17.59

CODE
67973
67974
67975
67999
68020
68040
68100
68110
68115
68130
68135
68200
68320
68325
68326
68328
68330
68335
68340
68360
68362
68371
68399
68400
68420
68440
68500
68505
68510
68520
68525
68530
68540
68550
68700
68705
68720
68745
68750
68760
68761
68770
68801
68810
68811
68815
68840
68850
68899
69000
69005
69020
69090

FUD
42
42
42
YYY
10
00
00
10
10
42
10
00
42
42
42
42
42
42
42
42
42
10
YYY
10
10
10
42
42
00
42
00
10
42
42
42
10
42
42
42
10
10
42
10
10
10
10
10
00
YYY
10
10
10
XXX

UNIT VALUE
22.91
22.80
16.57
BR
2.85
1.60
4.67
5.96
8.44
13.88
3.74
1.05
16.92
14.33
13.93
16.00
14.48
13.92
13.24
12.62
14.09
10.06
BR
7.68
8.61
3.07
21.28
22.14
12.17
15.33
6.67
12.02
20.58
25.38
12.92
6.33
17.30
16.99
17.39
5.36
3.70
10.54
2.93
5.67
4.90
11.62
2.91
1.72
BR
4.45
5.22
5.59
0.77

CPT only copyright 2004 American Medical Association. All Rights Reserved.

48

CODE
69100
69105
69110
69120
69140
69145
69150
69155
69200
69205
69210
69220
69222
69300
69310
69320
69399
69400
69401
69405
69410
69420
69421
69424
69433
69436
69440
69450
69501
69502
69505
69511
69530
69535
69540
69550
69552
69554
69601
69602
69603
69604
69605
69610
69620
69631
69632
69633
69635
69636
69637
69641
69642

FUD
00
00
42
42
42
42
42
42
00
10
00
00
10
YYY
42
42
YYY
00
00
10
00
10
10
00
10
10
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
10
42
42
42
42
42
42
42
42
42

UNIT VALUE
2.56
3.26
10.47
10.60
21.91
8.62
28.06
42.29
3.21
2.66
1.29
3.26
5.37
11.29
27.91
40.17
BR
3.06
1.92
6.35
2.46
4.59
4.04
3.10
4.74
4.44
16.94
13.04
18.83
24.95
31.24
32.06
42.31
70.91
5.04
26.73
41.67
66.33
26.94
27.89
33.51
28.81
40.90
10.33
17.47
21.85
27.24
26.11
31.14
35.74
35.54
26.51
34.46

SURGERY
(CONVERSION FACTOR = $67.95)
CODE
69643
69644
69645
69646
69650
69660
69661
69662
69666
69667
69670
69676
69700
69710
69711
69714
69715
69717
69718
69720
69725
69740
69745
69799
69801
69802
69805
69806
69820
69840
69905
69910
69915
69930
69949
69950
69955
69960
69970
69979
69990

FUD
42
42
42
42
42
42
42
42
42
42
42
42
42
XXX
42
42
42
42
42
42
42
42
42
YYY
42
42
42
42
42
42
42
42
42
42
YYY
42
42
42
42
YYY
ZZZ

UNIT VALUE
31.36
38.71
37.71
40.18
20.34
24.02
31.69
30.42
20.50
20.52
24.12
21.06
18.13
BR
22.04
27.77
34.72
30.33
36.95
30.06
47.89
30.62
32.77
BR
18.70
26.46
26.80
24.38
22.44
24.20
23.45
26.59
39.33
32.89
BR
46.76
50.84
49.20
55.85
BR
6.08

CPT only copyright 2004 American Medical Association. All Rights Reserved.

49