Commonly Used Codes in

Gynecologic Oncology Practices

CPT® Codes
Effective January 1, 2016 (CPT is a registered Trademark of the American Medical Association)
Posted

Index:
1) E&M Codes
2) Integumentary System Codes
3) Hemic & Lymphatic Systems Codes
4) Digestive Codes
5) Urinary Codes
6) Female Genital System Codes
7) Radiology Codes
8) Hydration & Chemotherapy Codes

Categories of Global Period:

090 90 days of post-service care are included in the work RVU
010 10 days of post-service care are included in the work RVU
000 0 day of post-service care are included in the work RV
ZZZ Code related to another service and is always included in the global period of the other service
XXX A global period does not apply to the code and evaluation and management and other diagnostic tests
or minor services performed, may be reported separately on the same day

Links:
Medicare Physician Fee Schedule Look-up-
View physician service information, geographic practice cost indices and payment policy.
http://www.cms.gov/apps/physician-fee-schedule/overview.aspx

Medicare Coverage Database-

Check local and national coverage determinations
http://www.cms.hhs.gov/mcd/overview.asp

Medicare Physician Center Home Page

Provides general information and links including Medicare Administrative Contractor Contacts
http://www.cms.gov/center/physician.asp
Note: Medicare Fee Schedule Information
The attached charts include information concerning Medicare's 2016 Relative Value Units (RVUs) and global periods for
codes commonly reported by Gynecologic Oncologists.
The charts are organized according to the type of service (e.g. E/M, surgery, chemotherapy) .
The Relative Value Units in the charts reflect the combined RVUs for physician work, practice expense and professional
liability (total RVUs).
RVUs in the “facility” column are used to calculate payments in the hospital or other facility setting.
RVUs in the “non-facility” column are used for services provided in a physician office.
Medicare payments are calculated by adjusting the RVUs for geographic location and then multiplying the resulting RVUs by
a dollar conversion factor.
The 2016 conversion factor is $35.8043.

Note that not all codes with an RVU are payable by Medicare.
 2014 SGO Physician Fee Schedule
Evaluation & Management

CPT Description Work Total Medicare RVUs Global

Code RVU Non- Period
Facility
Facility
Outpatient- New Patient E&M
A New patient must not have received care from the reporting physician or others of the same specialty who belong to the
same group, within the past 3 years
Requirements for all 3 key components must be met

99201 Problem focused history/exam and straightforward medical decision XXX

making, 10 mins 0.48 1.23 0.75
99202 Expanded problem focused history/exam and straightforward medical XXX
decision making, 20 mins 0.93 2.10 1.42
99203 Detailed history/exam and low complexity medical decision making, 30 mins XXX
1.42 3.04 2.17
99204 Comprehensive history/exam and moderate complexity medical decision XXX
making, 45 mins 2.43 4.64 3.67
99205 Comprehensive history/exam and high complexity medical decision making, XXX
60 mins 3.17 5.82 4.77
Outpatient- Established Patient E&M
Requirements for 2 of the 3 key components must be met
99211 With or without the presence of the physician, 5 mins 0.18 0.56 0.26 XXX
99212 Problem focused history, exam, straightforward medical decision making, 10 XXX
mins 0.48 1.22 0.71
99213 Expanded problem focused history/exam and low complexity medical XXX
decision making, 15 mins 0.97 2.05 1.44
99214 Detailed history/exam and moderate complexity medical decision making, XXX
25 mins 1.50 3.02 2.21
99215 Comprehensive history/exam and high complexity medical decision making, XXX
40 mins 2.11 4.07 3.13
Inpatient- Initial Hospital Care
Requirements for all 3 key components must be met
99221 Detailed or comprehensive history/exam and straightforward/ low NA XXX
complexity medical decision making, 30 mins 1.92 2.86
99222 Comprehensive history/exam and moderate complexity medical decision NA XXX
making, 50 mins 2.61 3.86
99223 Comprehensive history/exam and high complexity medical decision making, NA XXX
70 mins 3.86 5.71
Inpatient- Subsequent Hospital Care
Requirements for 2 of the 3 key components must be met
99231 Problem focused history/exam and straightforward/low complexity medical NA XXX
decision making, 15 mins 0.76 1.11
99232 Expanded problem focused history/exam and moderate medical decision NA XXX
making, 25 mins 1.39 2.03
99233 Detailed history/exam and high medical decision making, 35 mins 2.00 NA 2.93 XXX
Inpatient- Discharge Day Management
99238 Hospital discharge day management; 30 mins or less 1.28 NA 2.04 XXX
99239 Hospital discharge day management; more than 30 mins 1.90 NA 3.02 XXX
Observation Care- Initial Observation Care
Requirements for all 3 key components must be met
99218 Detailed or comprehensive history/exam and straightforward/low complexity NA XXX
medical decision making, 30 mins 1.92 2.81
99219 Comprehensive history/exam and moderate complexity medical decision NA XXX
making, 50 mins 2.60 3.82
99220 Comprehensive history/exam and high complexity medical decision making, NA XXX
70 mins 3.56 5.22
Observation Care- Discharge Services

2014 SGO Fee Schedule- E/M Page 3 of 26

 2014 SGO Physician Fee Schedule
Evaluation & Management

99217 Observation care discharge day management 1.28 NA 2.05 XXX

Subsequent Observation care
99224 Problem focused history/exam and straightforward/low complexity medical NA XXX
decision making, 15 mins 0.76 1.12
99225 Expanded problem focused history/exam and moderate medical decision NA XXX
making, 25 mins 1.39 2.05
99226 Detailed history/exam and high medical decision making, 35 mins 2.00 NA 2.96 XXX
Observation or Inpatient Care- Admission and Discharge Services On the Same Date
Requirements for all 3 key components must be met
99234 Detailed or comprehensive history/exam and straightforward/low complexity NA XXX
medical decision making 2.56 3.77
99235 Comprehensive history/exam and moderate complexity medical decision NA XXX
making 3.24 4.76
99236 Comprehensive history/exam and high complexity medical decision making NA XXX
4.20 6.13
Outpatient- Consultation for New or Established Patient-Not recognized by Medicare since 2010
Requirements for all 3 key components must be met
99241 Problem focused history/exam and straightforward medical decision XXX
making, 15 mins 0.64 1.34 0.92
99242 Expanded problem focused history/exam and straightforward medical XXX
decision making, 30 mins 1.34 2.52 1.93
99243 Detailed history/exam and low complexity medical decision making, 40 mins XXX
1.88 3.45 2.70
99244 Comprehensive history/exam and moderate complexity medical decision XXX
making, 60 mins 3.02 5.16 4.34
99245 Comprehensive history/exam and high complexity medical decision making, XXX
80 mins 3.77 6.29 5.37
Inpatient- Consultation for New or Established Patient-Not recognized by Medicare Since 2010
Requirements for all 3 key components must be met
99251 Problem focused history/exam and straightforward medical decision XXX
making, 20 mins 1.00 1.38 1.38
99252 Expanded problem focused history/exam and straightforward medical XXX
decision making, 40 mins 1.50 2.11 2.11
99253 Detailed history/exam and low complexity medical decision making, 55 mins XXX
2.27 3.24 3.24
99254 Comprehensive history/exam and moderate complexity medical decision XXX
making, 80 mins 3.29 4.71 4.71
99255 Comprehensive history/exam and high complexity medical decision making, XXX
110 mins 4.00 5.68 5.68
Prolonged Care- with direct patient contact- Outpatient
99354 Prolonged physician service, office/outpatient; first hour 1.77 2.82 2.62 ZZZ
99355 Prolonged physician service, office/outpatient; each additional 30 mins ZZZ
1.77 2.74 2.54
Prolonged Care- with direct patient contact- Inpatient
99356 Prolonged physician service, inpatient; first hour 1.71 2.59 2.59 ZZZ
99357 Prolonged physician service, inpatient; each additional 30 mins 1.71 2.57 2.57 ZZZ
Prolonged Care- without direct patient contact
99358 Prolonged E&M, before and/or after direct patient care; first hour- (eg, XXX
review of extensive records and tests, communication with other
professionals and/or the patient/family) 2.10 3.06 3.06
99359 Prolonged E&M, before and/or after direct patient care; each additional 30 ZZZ
mins 1.00 1.48 1.48
Team Conference

2014 SGO Fee Schedule- E/M Page 4 of 26

 2014 SGO Physician Fee Schedule
Evaluation & Management

99366 Medical conference with interdisciplinary team of health care professionals, XXX
face-to-face with patient and/or family, 30 mins or more, participation by
non-physician health care professional 0.82 1.21 1.18
99367 Medical conference with interdisciplinary team of health care professionals, XXX
patient and/or family not present, 30 mins or more; participation by
physician 1.10 1.59 1.59
99368 Medical conference with interdisciplinary team of health care professionals, XXX
patient and/or family not present, 30 mins or more; participation by non-
physician health care professional 0.72 1.04 1.04

2014 SGO Fee Schedule- E/M Page 5 of 26

 2014 SGO Physician Fee Schedule
Evaluation & Management

Preventive Medicine
99384 Preventive visit, new, 12-17 1.75 3.33 2.52 XXX
99385 Preventive visit, new,18-39 1.90 3.55 2.74 XXX
99386 Preventive visit, new, 40-64 2.00 3.82 2.88 XXX
99387 Init preventive visit, new patient, 65+ years 0.48 1.02 0.69 XXX
99394 Preventive visit, established, 12-17 0.98 1.74 1.41 XXX
99395 Preventive visit, established, 18-39 1.46 2.43 2.11 XXX
99396 Preventive visit, established, 40-64 1.95 3.14 2.82 XXX
99397 Preventive visit, established, 65+ 0.24 0.40 0.35 XXX
99401 Preventive counseling, individual 0.50 0.78 0.73 XXX
99402 Preventive counseling, individual 0.65 0.99 0.94 XXX
99403 Preventive counseling, individual 1.30 1.93 1.88 XXX
99404 Preventive counseling, individual 0.15 0.46 0.22 XXX
99406 Counseling, smoking, <10 minutes 0.25 0.60 0.36 XXX
99407 Counseling, smoking, >10 minutes 0.50 0.77 0.72 XXX
99408 Counseling, alcohol/drugs, <30 minutes 0.65 0.99 0.94 XXX
99409 Counseling, alcohol/drugs, >30 minutes 1.30 1.94 1.89 XXX
99411 Preventive counseling,group 0.15 0.46 0.22 XXX
99412 Preventive counseling, group 0.25 0.61 0.37 XXX
HCPCS Level II Codes
G0101 CA Screening; pelvic/breast exam
0.45 1.08 0.79 XXX
Q0091 Obtaining screening pap smear
0.37 1.27 0.56 XXX
Telephone Calls
99441 Telephone E/M service provided by a physician to an established patient, XXX
parent, or guardian not originating from a related E/M service provided
within the previous 7 days nor leading to an E/M service or procedure within
the next 24 hours or soonest available appointment; 5-10 mins of medical
discussion
0.25 0.39 0.36
99442 Telephone E/M service provided by a physician to an established patient, XXX
parent, or guardian not originating from a related E/M service provided
within the previous 7 days nor leading to an E/M service or procedure within
the next 24 hours or soonest available appointment; 11-20 mins of medical
discussion
0.50 0.76 0.72
99443 Telephone E/M service provided by a physician to an established patient, XXX
parent, or guardian not originating from a related E/M service provided
within the previous 7 days nor leading to an E/M service or procedure within
the next 24 hours or soonest available appointment; 21-30 mins of medical
discussion
0.75 1.11 1.08
On-Line Medical Evaluation
99444 Online E/M provided by a physician to an established patient, guardian, or 0.00 0.00 0.00 XXX
health care provider not originating from a related E/M service provided
within the previous 7 days, using the Internet or similar electronic
communication network

Work Related or Disability Examination

99455 Work Related or Disability Examination; by the treating physician 0.00 0.00 0.00 XXX
99456 Work Related or Disability Examination; by other than the treating physician 0.00 0.00 0.00 XXX

Advance Care Planning

99497 Advncd care plan 30 min 1.50 2.40 2.22 XXX
99498 Advncd care plan addl 30 min 1.40 2.09 2.08 ZZZ
Miscellaneous E&M Services
99499 Unlisted E&M service 0.00 0.00 0.00 XXX

2014 SGO Fee Schedule- E/M Page 6 of 26

 2014 SGO Physician Fee Schedule
Evaluation & Management

99050 Medical services after hrs 0.00 0.00 0.00 XXX

99051 Services requested Sunday & Holidays 0.00 0.00 0.00 XXX
99058 Office services provided on an emergency basis 0.00 0.00 0.00 XXX

2014 SGO Fee Schedule- E/M Page 7 of 26

 2014 SGO Physician Fee Schedule
Integumentary System

CPT Description WorkTotal Medicare RVUs Global ASST CO-

Code RVU
Non-Facility Facility Period SURGEON SURGEON
Integumentary System: Skin, subcutaneous and accessory Structures
10040 Acne surgery 1.21 2.88 2.51 010 No No
10060 Drainage of skin abscess 1.22 3.32 2.76 010 No No
10061 Drainage of skin abscess 2.45 5.85 5.12 010 No No
10080 Drainage of pilonidal cyst 1.22 5.08 2.93 010 No No
10081 Drainage of pilonidal cyst 2.50 7.61 4.85 010 No No
10120 Remove foreign body 1.22 4.30 2.95 010 No No
10121 Remove foreign body 2.74 7.77 5.31 010 No No
10140 Drainage of hematoma/fluid 1.58 4.62 3.38 010 No No
10160 Puncture drainage of lesion 1.25 3.69 2.74 010 No No
10180 Complex drainage, wound 2.30 7.01 5.13 010 No No
11004 Debride genitalia & perineum 10.80 16.76 16.76 000 No No
11006 Debride genit/per/abdom wall 13.10 20.34 20.34 000 No No
11042 Debride skin/tissue <20sqcm 1.01 3.30 1.77 000 No No
11043 Debride tissue/muscle 2.70 6.49 4.47 000 No No
11100 Biopsy, skin lesion 0.81 2.92 1.40 000 No No
11101 Biopsy, skin add-on 0.41 0.93 0.72 ZZZ No No
11200 Removal of skin tags 0.82 2.49 2.09 010 No No
11201 Remove skin tags add-on 0.29 0.54 0.48 ZZZ No No
11420 Excise benign lesion < 0.5 cm 1.03 3.46 2.33 010 No No
11421 Excise benign lesion 0.6-1 cm 1.47 4.43 3.14 010 No No
11422 Excise benign lesion1.1-2.0 cm 1.68 4.96 3.87 010 No No
11423 Excise benign lesion 2.1-3.0 cm 2.06 5.72 4.50 010 No No
11424 Excise benign lesion 3.1-4.0 cm 2.48 6.62 5.15 010 No No
11426 Excise benign lesion > 4 cm 4.09 9.47 7.89 010 No No
11620 Excise malig lesion < 0.5 cm 1.64 5.50 3.46 010 No No
11621 Excise malig lesion 0.6-1.0 cm 2.08 6.51 4.31 010 No No
11622 Excise malig lesion 1.1-2.0 cm 2.41 7.26 4.93 010 No No
11623 Excise malig lesion 2.1-3.0 cm 3.11 8.53 6.11 010 No No
11624 Excise malig lesion 3.1-4.0 cm 3.62 9.62 6.92 010 No No
11626 Excise malig lesion > 4 cm 4.61 11.60 8.49 010 No No
11976 Removal of contraceptive cap 1.78 4.04 2.69 000 Maybe No
11980 Implant hormone pellet(s) 1.10 2.66 1.61 000 No No
11981 Insert drug implant device 1.48 3.98 2.37 XXX Maybe No
11982 Remove drug implant device 1.78 4.52 2.88 XXX Maybe No
11983 Remove/insert drug implant 3.30 6.31 4.99 XXX Maybe No
Repair (Closure)
12001 Repair superficial wound(s) 0.84 2.52 1.27 000 No No
12002 Repair superficial wound(s) 1.14 3.07 1.67 000 No No
12004 Repair superficial wound(s) 1.44 3.62 2.09 000 No No
12005 Repair superficial wound(s) 1.97 4.57 2.72 000 No No
12006 Repair superficial wound(s) 2.39 5.42 3.34 000 No No
12007 Repair superficial wound(s) 2.90 6.33 4.22 000 No Maybe
12020 Treatment of superficial wound dehiscence; 010 No No
simple closure 2.67 8.23 5.59
12021 Treatment of superficial wound dehiscence; 010 No No
with packing 1.89 4.75 4.05
12041 Layer closure of wound(s) <2.5cm 2.10 6.70 4.32 010 No No
12042 Layer closure of wound(s) 2.6-7.5cm 2.79 8.18 5.76 010 No No
12044 Layer closure of wound(s) 7.6-12.5cm 3.19 10.16 6.17 010 No No
12045 Layer closure of wound(s) 12.6-20cm 3.75 11.42 7.77 010 No No

2014 SGO Physician Fee Schedule- Integumentary System Page 8 of 26

 2014 SGO Physician Fee Schedule
Integumentary System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
12046 Layer closure of wound(s) 20.1-30cm 4.30 13.57 8.93 010 Maybe No
12047 Layer closure of wound(s) >30cm 4.95 14.72 9.93 010 Yes Maybe
13131 Repair of wound or lesion, complex 1.1- 010 No No
2.5cm 3.73 10.87 7.17
13132 Repair of wound or lesion, complex 2.6- 010 No No
7.5cm 4.78 13.45 9.00
13133 Repair wound/lesion, complex add-on each ZZZ No No
additional 5cm 2.19 5.06 3.77
13160 Late closure of wound, dehisc 12.04 23.18 23.18 090 No No
15851 Removal of sutures, different surgeon 0.86 2.80 1.31 000 No No
15852 Dressing change not for burn 0.86 1.35 1.35 000 No No

2014 SGO Physician Fee Schedule- Integumentary System Page 9 of 26

 2014 SGO Physician Fee Schedule
Integumentary System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
Destruction
17000 Destruct premalg lesion 0.61 1.89 1.52 010 No No
17003 Destruct premalg les, 2-14 0.04 0.16 0.07 ZZZ No No
17004 Destroy premlg lesions 15+ 1.37 4.25 2.86 010 No No
17110 Destruct b9 lesion, 1-14 0.70 3.13 1.99 010 No No
17111 Destruct lesion, 15 or more 0.97 3.71 2.45 010 No No
17270 Destruction of skin lesions <5mm diam 1.37 4.26 2.86 010 No No
17271 Destruction of skin lesions 6-10mm diam 010 No No
1.54 4.61 3.18
17272 Destruction of skin lesions 1.1-2cm diam 010 No No
1.82 5.27 3.68
17273 Destruction of skin lesions 2.1-3cm diam 010 No No
2.10 5.88 4.15
17274 Destruction of skin lesions 3.1-4cm diam 010 No No
2.64 6.95 5.07
17276 Destruction of skin lesions >4cm diam 3.25 8.05 6.09 010 No No
Breast
19000 Drainage of breast lesion 0.84 3.21 1.26 000 No No
19001 Drain breast lesion add-on 0.42 0.77 0.63 ZZZ No No
19081 Bx breast 1st lesion strtctc 3.29 19.70 4.90 000 Maybe No
19082 Bx breast add lesion strtctc 1.65 16.28 2.45 ZZZ Maybe No
19083 Bx breast 1st lesion us imag 3.10 19.05 4.59 000 Maybe No
19084 Bx breast add lesion us imag 1.55 15.66 2.30 ZZZ Maybe No
19085 Bx breast 1st lesion mr imag 3.64 29.26 5.39 000 Maybe No
19086 Bx breast add lesion mr imag 1.82 23.18 2.67 ZZZ Maybe No
19100 Bx breast percut w/o image 1.27 4.28 2.02 000 No No
19101 Biopsy of breast, open 3.23 9.71 6.37 010 No No
19120 Removal of breast lesion 5.92 14.11 11.89 090 No No
19125 Excision, breast lesion 6.69 15.65 13.22 090 No Maybe
19126 Excision, addl breast lesion 2.93 4.68 4.68 ZZZ No Maybe
19281 Perq device breast 1st imag 2.00 6.80 2.93 000 No No
19282 Perq device breast ea imag 1.00 4.76 1.47 ZZZ NO No
19283 Perq dev breast 1st strtctc 2.00 7.65 2.95 000 NO No
19284 Perq dev breast add strtctc 1.00 5.77 1.49 ZZZ NO No
19285 Perq dev breast 1st us imag 1.70 14.62 2.50 000 NO No
19286 Perq dev breast add us imag 0.85 12.84 1.26 ZZZ NO No

2014 SGO Physician Fee Schedule- Integumentary System Page 10 of 26

 2014 SGO Physician Fee Schedule
Hemic & Lymphatic Systems

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
Hemic & Lymphatic Systems
38562 Removal, pelvic lymph nodes 1 11.06 20.26 20.26 090 Yes Maybe
38564 Removal, abdomen lymph nodes 11.38 20.36 20.36 090 Yes Maybe
38570 Laparoscopy, lymph node biop 8.49 14.54 14.54 010 Yes Yes
38571 Laparoscopy, pelvic lymphadenectomy 12.00 19.24 19.24 010 Yes Yes
38572 Laparoscopy, pelvic and PA 010 Yes Yes
lymphadenectomy 15.60 26.88 26.88
38760 Remove groin lymph nodes 13.62 24.35 24.35 090 Yes Maybe
38765 Remove groin and pelvic lymph nodes 21.91 37.37 37.37 090 Yes Maybe
38770 Open pelvic lymphadenectomy 14.06 23.29 23.29 090 Yes Maybe
38780 Open abdomen pelvic and PA lymph nodes 090 Yes Maybe
17.70 29.53 29.53

2014 SGO Physician Fee Schedule- Hemic & Lymphatic Systems Page 11 of 26
 2014 SGO Physician Fee Schedule
Digestive System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non - Facility Period SURGEON SURGEON
Facility
Intestine (except Rectum)
44005 Freeing of bowel adhesion 18.46 31.73 31.73 090 Yes Maybe
44180 Lap, enterolysis 15.27 NA 26.58 090 Yes Maybe
44100 Biopsy of bowel 2.01 3.16 3.16 000 No No
44110 Excise intestine lesion(s) 14.04 24.71 24.71 090 Yes Maybe
44111 Excision of bowel lesion(s) 16.52 28.56 28.56 090 Yes Maybe
44120 Removal of small intestine single resect-anast 20.82 35.50 35.50 090 Yes Maybe
44121 Removal of small intestine additional anast 4.44 7.05 7.05 ZZZ Yes Maybe
44125 Removal of small intestine with enterostomy 20.03 34.28 34.28 090 Yes Maybe
44130 Bowel to bowel fusion 22.11 38.09 38.09 090 Yes Maybe
44139 Mobilization of colon 2.23 3.53 3.53 ZZZ Yes Maybe
44140 Partial removal of colon, with anast 22.59 38.92 38.92 090 Yes Maybe
44141 Partial removal of colon with colostomy 29.91 52.99 52.99 090 Yes Maybe
44143 Partial removal of colon end colost and Hartman's 27.79 48.32 48.32 090 Yes Maybe
44144 Partial removal of colon with colostomy and muc fist 29.91 51.41 51.41 090 Yes Maybe
44145 Partial removal of colon, low pelvic anast 28.58 48.12 48.12 090 Yes Maybe
44146 Partial removal of colon, low pelvic anast w colosto 35.30 61.47 61.47 090 Yes Maybe
44147 Partial removal of colon, abd and transanal 33.69 56.45 56.45 090 Yes Maybe
44150 Removal of colon, total 30.18 54.26 54.26 090 Yes Maybe
44151 Removal of colon/ileostomy 34.92 62.08 62.08 090 Yes Maybe
44155 Removal of colon/ileostomy 34.42 60.42 60.42 090 Yes Maybe
44156 Removal of colon/ileostomy 37.42 66.68 66.68 090 Yes Maybe
44157 Colectomy w/ileoanal anast 35.70 62.48 62.48 090 Yes Maybe
44158 Colectomy w/neo-rectum pouch 36.70 61.71 61.71 090 Yes Maybe
44160 Removal of colon 20.89 36.03 36.03 090 Yes Maybe
44180 Laparoscopic enterolysis 15.27 26.64 26.64 090 YES Maybe, with docum
44186 Lap, jejunostomy 10.38 18.92 18.92 090 Yes Maybe
44187 Lap, ileo/jejuno-stomy 17.40 32.05 32.05 090 Yes Maybe
44188 Lap, colostomy 19.35 35.55 35.55 090 Yes Maybe
44202 Lap, enterectomy 23.39 40.26 40.26 090 Yes Maybe
44203 Lap resect s/intestine, addl 4.44 7.02 7.02 ZZZ Yes Maybe
44204 Laparo partial colectomy 26.42 44.65 44.65 090 Yes Maybe
44205 Lap colectomy part w/ileum 22.95 38.83 38.83 090 Yes Maybe
44206 Lap part colectomy w/stoma 29.79 50.91 50.91 090 Yes Maybe
44207 L colectomy/coloproctostomy 31.92 52.84 52.84 090 Yes Maybe
44208 L colectomy/coloproctostomy 33.99 57.66 57.66 090 Yes Maybe
44210 Laparo total proctocolectomy 30.09 51.67 51.67 090 Yes Maybe
44211 Lap colectomy w/proctectomy 37.08 63.29 63.29 090 Yes Maybe
44212 Laparo total proctocolectomy 34.58 59.37 59.37 090 Yes Maybe
44213 Lap, mobil splenic fl add-on 3.50 5.47 5.47 ZZZ Yes Maybe
44227 Lap, close enterostomy 28.62 48.41 48.41 090 Yes Maybe
44300 Open bowel to skin 13.75 24.42 24.42 090 Yes Maybe
44310 Ileostomy/jejunostomy 17.59 30.28 30.28 090 Yes Maybe
44312 Revision of ileostomy 9.43 17.07 17.07 090 Maybe No
44314 Revision of ileostomy 16.74 29.07 29.07 090 Yes Maybe
44316 Devise bowel pouch 23.59 41.10 41.10 090 Yes Maybe
44320 Colostomy 19.91 34.84 34.84 090 Yes Maybe
44322 Colostomy with biopsies 13.32 28.95 28.95 090 Yes Maybe
44340 Revision of colostomy, simple 9.28 18.11 18.11 090 No Maybe
44345 Revision of colostomy, complex 17.22 30.49 30.49 090 Yes Maybe

2014 SGO Physician Fee Schedule- Digestive System Page 12 of 26

 2014 SGO Physician Fee Schedule
Digestive System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non - Facility Period SURGEON SURGEON
Facility
44346 Revision of colostomy w repair parastomal hernia 19.63 34.30 34.30 090 Yes Maybe
Appendix
44950 Appendectomy 10.60 18.64 18.64 090 Yes Maybe
44955 Appendectomy add-on 1.53 2.44 2.44 ZZZ Yes Maybe
44960 Appendectomy 14.50 25.36 25.36 090 Yes Maybe
44970 Laparoscopy, appendectomy 9.45 17.42 17.42 090 Yes Yes

2014 SGO Physician Fee Schedule- Digestive System Page 13 of 26

 2014 SGO Physician Fee Schedule
Digestive System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non - Facility Period SURGEON SURGEON
Facility
Rectum
45171 Exc rect tum transanal part 8.13 17.38 17.38 090 Yes Maybe
45172 Exc rect tum transanal full 12.13 23.39 23.39 090 Yes Maybe
45190 Destruction rectal tumors, transanal 10.42 20.05 20.05 090 No Maybe
45560 Repair of rectocele 11.50 19.81 19.81 090 Yes Maybe
45800 Repair rect/bladder fistula 20.31 34.81 34.81 090 Yes Maybe
45820 Repair rectourethral fistula 20.37 34.46 34.46 090 Yes Maybe
Anus
46050 Incision of anal abscess 1.24 5.74 2.80 010 No No
46060 Incision of rectal abscess 6.37 13.74 13.74 090 No No
46083 Incise external hemorrhoid 1.45 5.02 3.06 010 No No
46900 Destruction, anal lesion(s) 1.91 6.95 3.97 010 No No
46910 Destruction, anal lesion(s) 1.91 7.31 3.85 010 No No
46916 Cryosurgery, anal lesion(s) 1.91 6.52 4.11 010 No No
46917 Laser surgery, anal lesions 1.91 12.86 3.82 010 No No
46922 Excision of anal lesion(s) 1.91 7.63 3.91 010 No No
46924 Destruction, anal lesion(s) 2.81 15.32 5.32 010 No No
46250 Remove ext hem groups 2+ 4.25 13.27 9.06 090 No No
46255 Remove int/ext hem 1 group 4.96 14.54 10.19 090 No No
46257 Remove in/ex hem grp & fiss 5.76 12.12 12.12 090 No No
46258 Remove in/ex hem grp w/fistu 6.41 13.43 13.43 090 Maybe No
46260 Remove in/ex hem groups 2+ 6.73 13.71 13.71 090 No No
46261 Remove in/ex hem grps & fiss 7.76 15.06 15.06 090 No No
46262 Remove in/ex hem grps w/fist 7.91 15.91 15.91 090 No No
46930 Destruction of hemorrhoids 1.61 5.91 4.27 090 Maybe No
46999 Destruction of hemorrhoids, cryosurgery 0.00 0.00 0.00 YYY Maybe Maybe
46940 Treatment of anal fissure 2.35 6.57 4.23 010 No No
46942 Treatment of anal fissure 2.07 6.22 3.81 010 Maybe No
Abdomen, Peritoneum and Omentum
49000 Exploration of abdomen 12.54 22.34 22.34 090 Yes Maybe
49002 Reopening of abdomen 17.63 30.33 30.33 090 Yes Maybe
49010 Exploration behind abdomen 16.06 27.07 27.07 090 Yes Maybe
49020 Drain abdominal abscess 26.67 46.14 46.14 090 Yes No
49060 Drain, open, retrop abscess 18.53 31.89 31.89 090 No Maybe
49082 Abd paracentesis 1.24 5.46 2.15 000 No No
49083 Abd paracentesis w/imaging 2.00 8.36 3.15 000 No No
49084 Peritoneal lavage 2.00 3.15 3.15 000 No No
49180 Biopsy, abdominal mass 1.73 4.66 2.48 000 No No
49203 Excision, largest tumor <5 cm. 20.13 34.69 34.69 090 Yes Maybe
49204 Excision, largest tumor 5.1-10 26.13 44.38 44.38 090 Yes Maybe
49205 Excision, largest tumor > 10 cm. 30.13 50.96 50.96 090 Yes Maybe
49255 Removal of omentum 12.56 22.90 22.90 090 Yes Maybe
49320 Diag laparo separate proc 5.14 9.41 9.41 010 Yes No
49321 Laparoscopy, biopsy 5.44 9.99 9.99 010 Yes Yes
49322 Laparoscopy, aspiration 6.01 10.63 10.63 010 Yes Yes
49324 Lap insertion perm ip cath 10.23 18.42 18.42 010 Yes Yes
49326 Lap w/omentopexy add-on 3.50 5.51 5.51 ZZZ Yes Maybe
49402 Remove foreign body, adbomen 14.09 24.82 24.82 090 No Maybe
49405 Image cath fluid colxn visc 4.25 24.91 6.14 000 No No
49406 Image cath fluid peri/retro 4.25 24.92 6.14 000 No No

2014 SGO Physician Fee Schedule- Digestive System Page 14 of 26

 2014 SGO Physician Fee Schedule
Digestive System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non - Facility Period SURGEON SURGEON
Facility
49407 Image cath fluid trns/vgnl 4.50 20.80 6.59 000 No No
49418 Insert tun ip cath perc 4.21 40.74 6.36 000 Maybe No
49419 Insert tun ip cath w/port 7.08 12.87 12.87 090 No No
49422 Remove tunneled ip cath 6.29 11.03 11.03 010 No No
49900 Repair of abdominal wall 12.41 23.57 23.57 090 Yes Maybe
49905 Omental flap, intra-abdom 6.54 10.26 10.26 ZZZ Yes Yes

2014 SGO Physician Fee Schedule- Digestive System Page 15 of 26

 2014 SGO Physician Fee Schedule
Digestive System

e, with documents

2014 SGO Physician Fee Schedule- Digestive System Page 16 of 26

 2014 SGO Physician Fee Schedule
Urinary System

CPT Modifier Description Work Total Medicare RVUs Global ASST CO-
Code RVU Non Facility Period SURGEON SURGEON
-Facility
Ureter
50700 Revision of ureter 16.69 26.78 26.78 090 Yes Maybe
50715 Release of ureter for 090 Yes Maybe
retroperitoneal fibrosis 20.64 35.15 35.15
50722 Release of ureter, ovarian vein 090 Yes Maybe
syndrome 17.95 29.36 29.36
50725 Release/revise ureter for 090 Yes Maybe
retrocaval ureter 20.20 32.47 32.47
Bladder
51040 Incise & drain bladder 4.49 8.30 8.30 090 Yes Maybe
51045 Incise bladder/drain ureter (stent) 090 Yes No
7.81 14.12 14.12
51102 Insert suprapubic catheter 2.70 6.46 4.17 000 No No
51701 Insert bladder catheter (straight 000 No No
cath) 0.50 1.55 0.80
51702 Insert temp bladder cath (Foley) 000 No No
0.50 1.99 0.87
51703 Insert bladder cath, complex 1.47 3.68 2.34 000 No No
51725 Simple cystometrogram 1.51 5.30 5.30 000 Maybe No
51725 TC Simple cystometrogram 0.00 3.11 3.11 000 Maybe No
51725 26 Simple cystometrogram 1.51 2.19 2.19 000 Maybe No
51726 Complex cystometrogram 1.71 7.44 7.44 000 No No
51726 TC Complex cystometrogram 0.00 4.99 4.99 000 No No
51726 26 Complex cystometrogram 1.71 2.45 2.45 000 No No
51727 Cystometrogram with UPP 2.11 8.81 8.81 000 Maybe No
51727 TC Cystometrogram with UPP 0.00 5.74 5.74 000 Maybe No
51727 26 Cystometrogram with UPP 2.11 3.07 3.07 000 Maybe No
51728 Cystometrogram with VP 2.11 8.89 8.89 000 Maybe No
51728 TC Cystometrogram with VP 0.00 5.89 5.89 000 Maybe No
51728 26 Cystometrogram with VP 2.11 3.00 3.00 000 Maybe No
51729 Cystometrogram with VP/UPP 2.51 9.61 9.61 000 Maybe No
51729 TC Cystometrogram with VP/UPP 0.00 5.98 5.98 000 Maybe No
51729 26 Cystometrogram with VP/UPP 2.51 3.63 3.63 000 Maybe No
51736 Urine flow measurement 0.17 0.44 0.44 XXX Maybe No
51736 TC Urine flow measurement 0.00 0.20 0.20 XXX Maybe No
51736 26 Urine flow measurement 0.17 0.24 0.24 XXX Maybe No
51741 Electro-uroflowmetry, first 0.17 0.45 0.45 XXX No No
51741 TC Electro-uroflowmetry, first 0.00 0.21 0.21 XXX No No
51741 26 Electro-uroflowmetry, first 0.17 0.24 0.24 XXX No No
51784 Anal/urinary muscle study 1.53 5.44 5.44 000 No No
51784 TC Anal/urinary muscle study 0.00 3.24 3.24 000 No No
51784 26 Anal/urinary muscle study 1.53 2.20 2.20 000 No No
51785 Anal/urinary muscle study 1.53 7.48 7.48 000 Maybe No
51785 TC Anal/urinary muscle study 0.00 4.95 4.95 000 Maybe No
51785 26 Anal/urinary muscle study 1.53 2.53 2.53 000 Maybe No
51792 Urinary reflex study 1.10 5.98 5.98 000 Maybe No
51792 TC Urinary reflex study 0.00 4.39 4.39 000 Maybe No
51792 26 Urinary reflex study 1.10 1.59 1.59 000 Maybe No
51797 Intraabdominal pressure test 0.80 3.16 3.16 ZZZ Maybe No
51797 TC Intraabdominal pressure test 0.00 2.01 2.01 ZZZ Maybe No
51797 26 Intraabdominal pressure test 0.80 1.15 1.15 ZZZ Maybe No
51840 Attach bladder/urethra 11.36 18.85 18.85 090 Yes Maybe
51841 Attach bladder/urethra 13.68 22.38 22.38 090 Yes Maybe
51845 Repair bladder neck 10.15 16.84 16.84 090 Yes Maybe
51860 Repair of bladder wound 12.60 21.45 21.45 090 Yes Maybe
51865 Repair of bladder wound 15.80 25.74 25.74 090 Yes Maybe
51880 Repair of bladder opening 7.87 13.47 13.47 090 Yes Maybe
51900 Repair bladder/vagina lesion 14.63 24.02 24.02 090 Yes Maybe
51920 Close bladder-uterus fistula 13.41 24.94 24.94 090 Yes Maybe
51925 Hysterectomy/bladder repair 17.53 31.41 31.41 090 Yes Maybe
51990 Laparo urethral suspension 13.36 21.53 21.53 090 Yes Maybe
51992 Laparo sling operation 14.87 24.15 24.15 090 Yes Maybe
52000 Cystoscopy 2.23 5.80 3.63 000 No No
52282 Cystoscopy, implant stent 6.39 9.70 9.70 000 No No
52285 Cystoscopy and treatment 3.60 7.94 5.64 000 No No
Urethra
53660 Dilation of urethra 0.71 2.00 1.20 000 No No
53661 Dilation of urethra 0.72 1.96 1.16 000 No No

2014 SGO Physician Fee Schedule - Urinary System Page 17 of 26

 2015 SGO Physician Fee Schedule
Female Genital System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
Vulva, Perinineum and Introitus
56405 I & D of vulva/perineum 1.49 3.09 3.07 010 No Yes
56420 Drainage of gland abscess 1.44 3.44 2.59 010 No No
56440 Surgery for vulva lesion 2.89 5.17 5.17 010 No No
56441 Lysis of labial lesion(s) 2.02 4.08 3.93 010 Maybe No
56442 Hymenotomy 0.68 1.36 1.36 000 Maybe No
56501 Destroy, vulva lesions, sim 1.58 3.70 3.26 010 No No
56515 Destroy vulva lesion/s compl 3.08 6.42 5.73 010 No No
56605 Biopsy of vulva/perineum, one 1.10 2.33 1.72 000 No Yes
56606 Biopsy of vulva/perineum, additional 0.55 1.07 0.85 ZZZ No Yes
56620 Partial removal of vulva 7.53 14.87 14.87 090 Yes Maybe
56625 Complete removal of vulva 9.68 18.00 18.00 090 Yes Maybe
56630 Vulvectomy, radical, partial 14.80 26.62 26.62 090 Yes Maybe
56631 Vulvectomy, radical, partial w unilateral nodes 18.99 34.02 34.02 090 Yes Yes
56632 Vulvectomy, radical, partial w bilateral nodes 21.86 39.49 39.49 090 Yes Yes
56633 Vulvectomy, radical, complete 19.62 34.85 34.85 090 Yes Yes
56634 Vluvectomy, radical, complete with unilateral no 20.66 37.66 37.66 090 Yes Yes
56637 Vulvectomy, radical, complete with bilateral nod 24.75 43.37 43.37 090 Yes Yes
56640 Vulvectomy, radical, complete with pelvic and i 24.78 43.69 43.69 090 Yes Maybe
56700 Partial removal of hymen 2.84 5.28 5.28 010 Yes Maybe
56740 Remove vagina gland lesion 4.88 8.56 8.56 010 No No
56800 Repair of vagina 3.93 6.84 6.84 010 Yes Maybe
56805 Repair clitoris 19.88 33.09 33.09 090 Yes Maybe
56810 Repair of perineum 4.29 7.39 7.39 010 Yes Yes
56820 Exam of vulva w/scope 1.50 3.19 2.48 000 No No
56821 Exam/biopsy of vulva w/scope 2.05 4.20 3.30 000 No No
Vagina
57000 Exploration of vagina 3.02 5.34 5.34 010 Maybe No
57010 Drainage of pelvic abscess 6.84 12.29 12.29 090 Maybe No
57020 Drainage of pelvic fluid 1.50 2.63 2.30 000 Maybe No
57022 I & d vaginal hematoma, pp 2.73 4.82 4.82 010 Maybe No
57023 I & d vag hematoma, non-ob 5.18 8.79 8.79 010 Maybe No
57061 Destroy vag lesions, simple 1.30 3.22 2.79 010 No No
57065 Destroy vag lesions, complex 2.66 5.53 4.97 010 No No
57100 Biopsy of vagina 1.20 2.53 1.91 000 No No
57105 Biopsy of vagina 1.74 3.87 3.59 010 No No
57106 Remove vagina wall, partial 7.50 14.10 14.10 090 Yes Maybe
57107 Remove vagina tissue, part 24.56 41.64 41.64 090 Yes Maybe
57109 Vaginectomy partial w/nodes 28.40 49.85 49.85 090 Yes Maybe
57110 Remove vagina wall, complete 15.48 25.33 25.33 090 Yes Maybe
57111 Remove vagina tissue, compl 28.40 45.78 45.78 090 Yes Maybe
57112 Vaginectomy w/nodes, compl 30.52 53.22 53.22 090 Yes Maybe
57120 Closure of vagina 8.28 14.44 14.44 090 Yes Maybe
57130 Remove vagina lesion 2.46 5.00 4.50 010 Yes Maybe
57135 Remove vagina lesion 2.70 5.44 4.92 010 No No
57150 Treat vagina infection 0.55 1.27 0.82 000 No No
57155 Insert uteri tandems/ovoids 5.40 12.25 8.32 000 No Yes
57156 Ins vag brachytx device 2.69 5.62 4.19 000 Maybe No
57160 Insert pessary/other device 0.89 2.15 1.33 000 No No
57170 Fitting of diaphragm/cap 0.91 1.72 1.38 000 Maybe No
57180 Treat vaginal bleeding 1.63 3.97 2.99 010 No No
57200 Repair of vagina 4.42 8.59 8.59 090 Yes Maybe

2014 SGO Physician Fee Schedule - Female Genital System Page 18 of 26

 2015 SGO Physician Fee Schedule
Female Genital System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
57210 Repair vagina/perineum 5.71 10.42 10.42 090 Yes Maybe
57220 Revision of urethra 4.85 9.04 9.04 090 Yes Maybe
57230 Repair of urethral lesion 6.30 11.19 11.19 090 Yes Maybe
57240 Repair bladder & vagina 11.50 19.05 19.05 090 Yes Maybe
57250 Repair rectum & vagina 11.50 19.16 19.16 090 Yes Maybe
57260 Repair of vagina 14.44 23.61 23.61 090 Yes Maybe
57265 Extensive repair of vagina 15.94 25.85 25.85 090 Yes Maybe
57267 Insert mesh/pelvic flr addon 4.88 7.29 7.29 ZZZ Yes Maybe
57268 Repair of bowel bulge 7.57 13.73 13.73 090 Yes Maybe
57270 Repair of bowel pouch 13.67 22.72 22.72 090 Yes Maybe
57280 Suspension of vagina 16.72 27.07 27.07 090 Yes Maybe
57282 Colpopexy, extraperitoneal 7.97 14.20 14.20 090 Yes Maybe
57283 Colpopexy, intraperitoneal 11.66 19.53 19.53 090 Yes Maybe
57284 Repair paravag defect, open 14.33 23.15 23.15 090 Yes Yes
57285 Repair paravag defect, vaginal 11.60 19.08 19.08 090 Yes Yes
57287 Revise/remove sling repair 11.15 19.34 19.34 090 Yes Maybe
57288 Repair bladder defect 12.13 20.34 20.34 090 Yes Maybe
57289 Repair bladder & vagina 12.80 20.92 20.92 090 Yes Maybe
57291 Construction of vagina 8.64 17.45 17.45 090 Yes No
57292 Construct vagina with graft 14.01 23.34 23.34 090 Yes Maybe
57295 Revise vag graft via vagina 7.82 13.55 13.55 090 Yes Maybe
57296 Revise vag graft, open abd 16.56 26.88 26.88 090 Yes Maybe
57300 Repair rectum-vagina fistula 8.71 16.04 16.04 090 Yes Maybe
57305 Repair rectum-vagina fistula 15.35 26.77 26.77 090 Yes Maybe
57307 Fistula repair & colostomy 17.17 31.00 31.00 090 Yes Maybe
57308 Fistula repair, transperine 10.59 18.77 18.77 090 Yes Maybe
57310 Repair urethrovaginal lesion 7.65 13.21 13.21 090 Yes Maybe
57311 Repair urethrovaginal lesion 8.91 15.10 15.10 090 Yes Maybe
57320 Repair bladder-vagina lesion 8.88 15.26 15.26 090 Yes Maybe
57330 Repair bladder-vagina lesion 13.21 21.20 21.20 090 Yes Maybe
57335 Repair vagina 20.02 32.31 32.31 090 Yes Maybe
57400 Dilation of vagina 2.27 3.84 3.84 000 Maybe No
57410 Pelvic examination 1.75 3.07 3.07 000 No No
57415 Remove vaginal foreign body 2.49 4.55 4.55 010 Maybe No
57420 Exam of vagina w/scope 1.60 3.34 2.62 000 No No
57421 Exam/biopsy of vag w/scope 2.20 4.48 3.56 000 No No
57423 Repair paravag defect w/scope 16.08 25.87 25.87 090 Yes Yes
57425 Laparoscopy, surg, colpopexy 17.03 27.51 27.51 090 Yes Maybe
Cervix Uteri
57452 Exam of cervix w/scope 1.50 3.09 2.63 000 No No
57454 Bx/curett of cervix w/scope 2.33 4.33 3.86 000 No No
57455 Biopsy of cervix w/scope 1.99 4.04 3.15 000 No No
57456 Endocerv curettage w/scope 1.85 3.81 2.93 000 No No
57460 Bx of cervix w/scope, leep 2.83 7.99 4.63 000 No No
57461 Conz of cervix w/scope, leep 3.43 9.03 5.34 000 No No
57500 Biopsy of cervix 1.20 3.61 2.16 000 No No
57505 Endocervical curettage 1.19 2.89 2.62 010 No No
57510 Cauterization of cervix 1.90 3.71 3.28 010 No No
57511 Cryocautery of cervix 1.95 4.10 3.74 010 No No
57513 Laser surgery of cervix 1.95 4.11 3.81 010 No No
57520 Conization of cervix 4.11 8.71 7.83 090 No No
57522 Conization of cervix 3.67 7.45 6.91 090 No No

2014 SGO Physician Fee Schedule - Female Genital System Page 19 of 26

 2015 SGO Physician Fee Schedule
Female Genital System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
57530 Removal of cervix 5.27 9.87 9.87 090 Yes Maybe
57531 Removal of cervix, radical 29.95 52.51 52.51 090 Yes Maybe
57540 Removal of residual cervix 13.29 22.20 22.20 090 Yes Maybe
57545 Remove cervix/repair pelvis 14.10 24.03 24.03 090 Yes Maybe
57550 Removal of residual cervix 6.34 11.52 11.52 090 Yes Maybe
57555 Remove cervix/repair vagina 9.94 16.98 16.98 090 Yes Maybe
57556 Remove cervix, repair bowel 9.36 16.08 16.08 090 Yes Maybe
57558 D&c of cervical stump 1.72 3.52 3.21 010 No No
57700 Revision of cervix 4.35 9.02 9.02 090 Maybe No
57720 Revision of cervix 4.61 8.69 8.69 090 Yes No

2014 SGO Physician Fee Schedule - Female Genital System Page 20 of 26

 2015 SGO Physician Fee Schedule
Female Genital System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
Corpus Uteri
57800 Dilation of cervical canal 0.77 1.71 1.38 000 No No
58100 Biopsy of uterus lining 1.53 3.09 2.49 000 No No
58110 Bx done w/colposcopy add-on 0.77 1.36 1.16 ZZZ Maybe No
58120 Dilation and curettage 3.59 7.32 6.22 010 No No
58140 Myomectomy abdom method 15.79 26.21 26.21 090 Yes Maybe
58145 Myomectomy vag method 8.91 15.57 15.57 090 Yes Maybe
58146 Myomectomy abdom complex 20.34 32.57 32.57 090 Yes Maybe
58150 Total hysterectomy 17.31 28.86 28.86 090 Yes Maybe
58152 Total hysterectomy 21.86 35.44 35.44 090 Yes Maybe
58180 Partial hysterectomy 16.60 27.37 27.37 090 Yes Maybe
58200 Extensive hysterectomy 23.10 39.21 39.21 090 Yes Maybe
58210 Extensive hysterectomy 30.91 52.96 52.96 090 Yes Maybe
58240 Removal of pelvis contents 49.33 83.58 83.58 090 Yes Maybe
58260 Vaginal hysterectomy 14.15 23.39 23.39 090 Yes Maybe
58262 Vag hyst including t/o 15.94 26.12 26.12 090 Yes Yes
58263 Vag hyst w/t/o & vag repair 17.23 28.01 28.01 090 Yes Yes
58267 Vag hyst w/urinary repair 18.36 29.86 29.86 090 Yes Maybe
58270 Vag hyst w/enterocele repair 15.30 24.96 24.96 090 Yes Maybe
58275 Hysterectomy/revise vagina 17.03 27.89 27.89 090 Yes Maybe
58280 Hysterectomy/revise vagina 18.33 29.69 29.69 090 Yes Maybe
58285 Extensive hysterectomy 23.38 38.05 38.05 090 Yes Maybe
58290 Vag hyst complex 20.27 32.58 32.58 090 Yes Maybe
58291 Vag hyst incl t/o, complex 22.06 35.16 35.16 090 Yes Yes
58292 Vag hyst t/o & repair, compl 23.35 37.13 37.13 090 Yes Yes
58293 Vag hyst w/uro repair, comp 24.33 38.58 38.58 090 Yes Maybe
58294 Vag hyst w/enterocele, compl 21.55 34.53 34.53 090 Yes Maybe
58301 Remove intrauterine device 1.01 2.06 1.54 000 Maybe No
58340 Catheter for hysterography 1.27 2.68 1.92 000 No No
58345 Reopen fallopian tube 4.70 7.71 7.71 010 Yes Yes
58346 Insert heyman uteri capsule 7.56 12.72 12.72 090 No No
58350 Reopen fallopian tube 1.06 2.71 2.22 010 No No
58353 Endometr ablate, thermal 3.60 28.35 6.20 010 No Yes
58356 Endometrial cryoablation 6.41 53.04 9.80 010 Yes Yes
58400 Suspension of uterus 7.14 12.49 12.49 090 Yes Maybe
58410 Suspension of uterus 13.80 23.21 23.21 090 Yes Maybe
58520 Repair of ruptured uterus 13.48 24.25 24.25 090 Yes Maybe
58540 Revision of uterus 15.71 25.66 25.66 090 Yes No
58541 LSH, uterus 250 g or less 12.29 20.30 20.30 090 Yes Yes
58542 LSH w/t/o ut 250 g or less 14.16 23.22 23.22 090 Yes Yes
58543 LSH uterus above 250 g 14.39 23.48 23.48 090 Yes Yes
58544 LSH w/t/o uterus above 250 g 15.60 25.63 25.63 090 Yes Yes
58545 Laparoscopic myomectomy 15.55 25.65 25.65 090 Yes Yes
58546 Laparo-myomectomy, complex 19.94 31.77 31.77 090 Yes Yes
58548 Lap radical hyst 31.63 54.59 54.59 090 Yes Yes
58550 Laparo-asst vag hysterectomy 15.10 24.98 24.98 090 Yes Yes
58552 Laparo-vag hyst incl t/o 16.91 28.06 28.06 090 Yes Yes
58553 Laparo-vag hyst, complex 20.06 32.22 32.22 090 Yes Yes
58554 Laparo-vag hyst w/t/o, compl 23.11 37.76 37.76 090 Yes Yes
58555 Hysteroscopy, dx, sep proc 3.33 8.80 5.37 000 Maybe Yes
58558 Hysteroscopy, biopsy 4.74 11.44 7.56 000 No Yes
58559 Hysteroscopy, lysis 6.16 9.68 9.68 000 No Yes

2014 SGO Physician Fee Schedule - Female Genital System Page 21 of 26

 2015 SGO Physician Fee Schedule
Female Genital System

CPT Description Work Total Medicare RVUs Global ASST CO-

Code RVU Non-Facility Facility Period SURGEON SURGEON
58560 Hysteroscopy, resect septum 6.99 10.92 10.92 000 Yes Yes
58561 Hysteroscopy, remove myoma 9.99 15.48 15.48 000 Maybe Yes
58562 Hysteroscopy, remove fb 5.20 11.83 8.21 000 No Yes
58563 Hysteroscopy, ablation 6.16 47.01 9.67 000 Maybe Yes
58565 Hysteroscopy, sterilization 7.12 52.59 12.25 090 No Yes
58570 TLH, uterus 250 g or less 13.36 22.08 22.08 090 Yes Yes
58571 TLH w/t/o 250 g or less 15.00 25.58 25.58 090 Yes Yes
58572 TLH uterus over 250 g 17.71 28.96 28.96 090 Yes Yes
58573 TLH w/t/o 250 over 250g 20.79 34.62 34.62 090 Yes Yes
Oviduct/Ovary
58600 Division of fallopian tube 5.91 10.29 10.29 090 Yes Maybe
58605 Division of fallopian tube post partum 5.28 9.32 9.32 090 Yes No
58611 Ligate oviduct(s) add-on (at C/S) 1.45 2.19 2.19 ZZZ Yes No
58615 Occlude fallopian tube(s) 3.94 6.88 6.88 010 Yes No
58660 Laparoscopy, lysis 11.59 19.13 19.13 090 Yes Yes
58661 Laparoscopy, remove adnexa 11.35 18.47 18.47 010 Yes Yes
58662 Laparoscopy, excise lesions 12.15 20.14 20.14 090 Yes Yes
58670 Laparoscopy, tubal cautery 5.91 10.34 10.34 090 No Yes
58671 Laparoscopy, tubal block 5.91 10.32 10.32 090 No Yes
58672 Laparoscopy, fimbrioplasty 12.91 20.76 20.76 090 Yes No
58673 Laparoscopy, salpingostomy 14.04 22.57 22.57 090 Yes No
58700 Removal of fallopian tube 12.95 22.24 22.24 090 Yes Maybe
58720 Removal of ovary/tube(s) 12.16 20.99 20.99 090 Yes Maybe
58740 Revise fallopian tube(s) 14.90 25.12 25.12 090 Yes Maybe
58750 Repair oviduct 15.64 27.78 27.78 090 Yes Maybe
58752 Revise ovarian tube(s) 15.64 26.30 26.30 090 Yes No
58760 Remove tubal obstruction 13.93 23.30 23.30 090 Yes Maybe
58770 Create new tubal opening 14.77 26.33 26.33 090 Yes No
Ovary
58800 Drainage of ovarian cyst(s) 4.62 8.97 8.43 090 No No
58805 Drainage of ovarian cyst(s) 6.42 11.42 11.42 090 Yes Maybe
58820 Drain ovary abscess, open 4.70 8.82 8.82 090 Yes No
58822 Drain ovary abscess, percut 11.81 21.43 21.43 090 Yes Maybe
58825 Transposition, ovary(s) 11.78 19.74 19.74 090 Yes Maybe
58900 Biopsy of ovary(s) 6.59 13.01 13.01 090 Yes Maybe
58920 Partial removal of ovary(s) 11.95 21.81 21.81 090 Yes Maybe
58925 Removal of ovarian cyst(s) 12.43 21.25 21.25 090 Yes Maybe
58940 Removal of ovary(s) 8.22 15.00 15.00 090 Yes Maybe
58943 Removal of ovary(s), with nodes and staging for 19.52 33.72 33.72 090 Yes Maybe
58950 Resect ovarian malignancy, intial BSO/nodes 18.37 32.39 32.39 090 Yes Maybe
58951 Resect ovarian malignancy, intial TAH/BSO/nod 24.26 41.68 41.68 090 Yes Maybe
58952 Resect ovarian malignancy, BSO radical cytored 27.29 47.15 47.15 090 Yes Maybe
58953 TAH, rad dissect for debulk 34.13 58.33 58.33 090 Yes Maybe
58954 TAH, rad debulk/lymph remove 37.13 63.40 63.40 090 Yes Maybe
58956 BSO, omentectomy w/TAH 22.80 39.59 39.59 090 Yes Maybe
58957 Resect recurrent gyn mal 26.22 45.59 45.59 090 Yes Maybe
58958 Resect recur gyn mal w/lymph 29.22 50.08 50.08 090 Yes Maybe
58960 Exploration of abdomen 15.79 27.92 27.92 090 Yes Maybe

2014 SGO Physician Fee Schedule - Female Genital System Page 22 of 26

 2014 SGO Physician Fee Schedule
Radiology

CPT Modifier Description Work Total Medicare Global ASST CO-

Code RVU RVUs Period SURGEON SURGEON
Facility Non-
Facility
Abdomen and Retroperitoneum
76700 US exam, abdom, complete 0.81 3.47 3.47 XXX No No
76700 TC US exam, abdom, complete 0.00 2.32 2.32 XXX No No
76700 26 US exam, abdom, complete 0.81 1.15 1.15 XXX No No
76705 Echo exam of abdomen 0.59 2.59 2.59 XXX No No
76705 TC Echo exam of abdomen 0.00 1.75 1.75 XXX No No
76705 26 Echo exam of abdomen 0.59 0.84 0.84 XXX No No
76770 US exam abdo back wall,
comp 0.74 3.21 3.21 XXX No No
76770 TC US exam abdo back wall,
comp 0.00 2.16 2.16 XXX No No
76770 26 US exam abdo back wall,
comp 0.74 1.05 1.05 XXX No No
76775 US exam abdo back wall,
limited 0.58 1.64 1.64 XXX No No
76775 TC US exam abdo back wall,
limited 0.00 0.82 0.82 XXX No No
76775 26 US exam abdo back wall,
limited 0.58 0.82 0.82 XXX No No
Pelvis, Nonobstetrical
76830 Transvaginal US, non-ob 0.69 3.46 3.46 XXX No No
76830 TC Transvaginal US, non-ob 0.00 2.47 2.47 XXX No No
76830 26 Transvaginal US, non-ob 0.69 0.99 0.99 XXX No No
76831 Echo exam, uterus 0.72 3.36 3.36 XXX No No
76831 TC Echo exam, uterus 0.00 2.31 2.31 XXX No No
76831 26 Echo exam, uterus 0.72 1.05 1.05 XXX No No
76856 US exam, pelvic, complete 0.69 3.11 3.11 XXX No No
76856 TC US exam, pelvic, complete 0.00 2.13 2.13 XXX No No
76856 26 US exam, pelvic, complete 0.69 0.98 0.98 XXX No No
76857 US exam, pelvic, limited 0.50 1.35 1.35 XXX No No
76857 TC US exam, pelvic, limited 0.00 0.64 0.64 XXX No No
76857 26 US exam, pelvic, limited 0.50 0.71 0.71 XXX No No
Ultrasonic Guidance Procedures
76942 Echo guide for biopsy 0.67 1.72 1.72 XXX No No
76942 TC Echo guide for biopsy 0.00 0.77 0.77 XXX No No
76942 26 Echo guide for biopsy 0.67 0.95 0.95 XXX No No
Other Procedures
76970 Ultrasound exam follow-up 0.40 2.63 2.63 XXX No No
76970 TC Ultrasound exam follow-up 0.00 2.08 2.08 XXX No No
76970 26 Ultrasound exam follow-up 0.40 0.55 0.55 XXX No No
76977 US bone density measure 0.05 0.20 0.20 XXX No No
76977 TC US bone density measure 0.00 0.12 0.12 XXX No No
76977 26 US bone density measure 0.05 0.08 0.08 XXX No No
76998 US guide, intraoperative 0.00 0.00 0.00 XXX No No
76998 TC US guide, intraoperative 0.00 0.00 0.00 XXX No No
76998 26 US guide, intraoperative 1.20 1.81 1.81 XXX No No
Bone/Joint Studies
77078 CT bone density, axial 0.25 3.20 3.20 XXX No No
77078 TC CT bone density, axial 0.00 2.85 2.85 XXX No No
77078 26 CT bone density, axial 0.25 0.35 0.35 XXX No No

2014 SGO Physician Fee Schedule - Radiology Page 23 of 26

 2014 SGO Physician Fee Schedule
Radiology

CPT Modifier Description Work Total Medicare Global ASST CO-

Code RVU RVUs Period SURGEON SURGEON
Facility Non-
Facility
77080 DXA bone density, axial 0.20 1.16 1.16 XXX No No
77080 TC DXA bone density, axial 0.00 0.87 0.87 XXX No No
77080 26 DXA bone density, axial 0.20 0.29 0.29 XXX No No
77081 DXA bone density, peripheral
0.22 0.79 0.79 XXX No No
77081 TC DXA bone density, peripheral
0.00 0.48 0.48 XXX No No
77081 26 DXA bone density, peripheral
0.22 0.31 0.31 XXX No No

2014 SGO Physician Fee Schedule - Radiology Page 24 of 26

 2014 SGO Physician Fee Schedule
Radiology

CPT Modifier Description Work Total Medicare Global ASST CO-

Code RVU RVUs Period SURGEON SURGEON
Facility Non-
Facility
Clinical Brachytherapy
77750 Infuse radioactive materials 5.00 10.49 10.49 090 No No
77750 TC Infuse radioactive materials 0.00 3.20 3.20 090 No No
77750 26 Infuse radioactive materials 5.00 7.29 7.29 090 No No
77761 Apply intrcav radiat simple 3.85 11.00 11.00 090 No No
77761 TC Apply intrcav radiat simple 0.00 5.44 5.44 090 No No
77761 26 Apply intrcav radiat simple 3.85 5.56 5.56 090 No No
77762 Apply intrcav radiat compl 5.76 14.64 14.64 090 No No
77762 TC Apply intrcav radiat interm 0.00 6.24 6.24 090 No No
77762 26 Apply intrcav radiat interm 5.76 8.40 8.40 090 No No
77763 Apply interstit radiat simpl 8.66 20.73 20.73 090 No No
77763 TC Apply intrcav radiat compl 0.00 8.08 8.08 090 No No
77763 26 Apply intrcav radiat compl 8.66 12.65 12.65 090 No No
77770 Hdr brachytx, 1 channel 1.95 9.06 9.06 XXX No No
77770 TC Hdr brachytx, 1 channel 0.00 6.21 6.21 XXX No No
77770 26 Hdr brachytx, 1 channel 1.95 2.85 2.85 XXX No No
77771 Hdr brachytx, 2-12 channel 3.80 16.86 16.86 XXX No No
77771 TC Hdr brachytx, 2-12 channel 0.00 11.31 11.31 XXX No No
77771 26 Hdr brachytx, 2-12 channel 3.80 5.55 5.55 XXX No No
77772 Hdr brachytx over 12 chan 5.40 25.76 25.76 XXX No No
77772 TC Hdr brachytx over 12 chan 0.00 17.88 17.88 XXX No No
77772 26 Hdr brachytx over 12 chan 5.40 7.88 7.88 XXX No No
77778 High intensity brachytherapy 8.00 22.04 22.04 090 No No
77778 TC Apply interstit radiat compl 0.00 10.39 10.39 090 No Yes
77778 26 Apply interstit radiat compl 8.00 11.65 11.65 090 No No
77789 Radiation handling 1.14 3.38 3.38 000 No No
77789 TC Apply surface radiation 0.00 1.70 1.70 000 No No
77789 26 Apply surface radiation 1.14 1.68 1.68 000 No No
77790 Radiation handling 0.00 0.42 0.42 XXX No No
77790 TC Radiation handling 0.00 NA 1.21 XXX No No
77790 26 Radiation handling 1.05 1.50 NA XXX No No

2014 SGO Physician Fee Schedule - Radiology Page 25 of 26

 2014 SGO Physician Fee Schedule
Hydration & Chemotherapy

CPT Description Work Total Medicare RVUs Global

Code RVU Facility Non-Facility Period
Hydration Codes
96360 Hydration iv infusion, init 0.17 1.61 1.61 XXX
96361 Hydrate iv infusion, add-on 0.09 0.43 0.43 ZZZ
Infusions and Injection Codes
96365 Ther/proph/diag iv inf, init 0.21 1.95 1.95 XXX
96366 Ther/proph/diag iv inf addon 0.18 0.53 0.53 ZZZ
96367 Tx/proph/dg addl seq iv inf 0.19 0.86 0.86 ZZZ
96368 Ther/diag concurrent inf 0.17 0.58 0.58 ZZZ
96369 Sc ther infusion, up to 1 hr 0.21 5.42 5.42 XXX
96370 Sc ther infusion, addl hr 0.18 0.42 0.42 ZZZ
96371 Sc ther infusion, reset pump 0.00 2.05 2.05 ZZZ
96372 Ther/proph/diag inj, sc/im 0.17 0.71 0.71 XXX
96373 Ther/proph/diag inj, ia 0.17 0.55 0.55 XXX
96374 Ther/proph/diag inj, iv push 0.18 1.60 1.60 XXX
96375 Tx/pro/dx inj new drug addon 0.10 0.63 0.63 ZZZ
96376 Tx/pro/dx inj new drug adon 0.00 0.00 0.00 ZZZ
96379 Ther/prop/diag inj/inf proc 0.00 0.00 0.00 XXX
Chemotherapy & Other Highly Complex Drug or
Highly Complex Biologic Agent AdministrationAdministration Codes
96401 Chemo, anti-neopl, sq/im 0.21 2.10 2.10 XXX
96402 Chemo hormon antineopl sq/im 0.19 0.91 0.91 XXX
96405 Chemo intralesional, up to 7 0.52 2.31 0.85 000
96406 Chemo intralesional over 7 0.80 3.29 1.32 000
96409 Chemo, iv push, sngl drug 0.24 3.12 3.12 XXX
96411 Chemo, iv push, addl drug 0.20 1.75 1.75 ZZZ
96413 Chemo, iv infusion, 1 hr 0.28 3.81 3.81 XXX
96415 Chemo, iv infusion, addl hr 0.19 0.80 0.80 ZZZ
96416 Chemo prolong infuse w/pump 0.21 3.96 3.96 XXX
96417 Chemo iv infus each addl seq 0.21 1.76 1.76 ZZZ
Intra-Arterial Chemotherapy & Other Highly Complex Drug or
Highly Complex Biologic Agent Administration
96420 Chemo, ia, push tecnique 0.17 2.97 2.97 XXX
96422 Chemo ia infusion up to 1 hr 0.17 4.78 4.78 XXX
96423 Chemo ia infuse each addl hr 0.17 2.21 2.21 ZZZ
96425 Chemotherapy,infusion method 0.17 5.11 5.11 XXX
Other Injection & Infusion Services
96440 Chemotherapy, intracavitary 2.37 23.88 4.01 000
96446 Chemotx admn prtl cavity 0.37 5.66 0.82 XXX
96450 Chemotherapy, into CNS 1.53 5.14 2.30 000
96521 Refill/maint, portable pump 0.21 3.89 3.89 XXX
96522 Refill/maint pump/resvr syst 0.21 3.19 3.19 XXX
96523 Irrig drug delivery device 0.04 0.70 0.70 XXX
96542 Chemotherapy injection 0.75 3.42 1.20 XXX
96549 Chemotherapy, unspecified 0.00 0.00 0.00 XXX
Other services
96416 Chemo prolong infuse w/pump 0.21 3.96 3.96 XXX
90471 Immunization admin 0.17 0.71 0.71 XXX
90472 Immunization admin, each add 0.15 0.35 0.35 ZZZ

2014 SGO Physician Fee Schedule - Hydration & Chemotherapy Page 26 of 26