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COMMONWEALTH OF PENNSYLVANIA

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PA Bulletin, Doc. No. 06-2478a

[36 Pa.B. 7698]
[Saturday, December 16, 2006]

[Continued from previous Web Page]

Procedure Codes with Fees Exceeding 100% Medicare
Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier)
29875 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE) $94.54 N/A N/A $472.71
29894 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY $99.13 N/A N/A $495.66
29895 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL $97.22 N/A N/A $486.10
29897 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED $101.83 N/A N/A $509.15
30150 RHINECTOMY; PARTIAL N/A N/A N/A $751.80
30160 RHINECTOMY; TOTAL $147.92 N/A N/A $739.60
30540 REPAIR CHOANAL ATRESIA; INTRANASAL N/A N/A N/A $631.70
31239 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY $124.48 N/A N/A $622.42
31240 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION $33.14 N/A N/A $165.72
31255 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND POSTERIOR) $85.30 N/A N/A $426.52
31287 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; $48.84 N/A N/A $244.18
31288 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS $56.73 N/A N/A $283.64
31292 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL OR INFERIOR ORBITAL WALL DECOMPRESSION $191.86 N/A N/A $959.28
31512 LARYNGOSCOPY, INDIRECT; WITH REMOVAL OF LESION N/A N/A N/A $130.44
31513 LARYNGOSCOPY, INDIRECT; WITH VOCAL CORD INJECTION N/A N/A N/A $134.69
31528 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL N/A N/A N/A $145.53
31535 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY N/A N/A N/A $196.06
31540 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS N/A N/A N/A $253.39
31560 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY N/A N/A N/A $327.70
31561 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE OR TELESCOPE N/A N/A N/A $357.51
31576 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY N/A N/A N/A $123.03
31578 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF LESION N/A N/A N/A $166.61
31603 TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL N/A N/A N/A $228.79
31605 TRACHEOSTOMY, EMERGENCY PROCEDURE; CRICOTHYROID MEMBRANE N/A N/A N/A $188.19
31630 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE N/A N/A N/A $212.96
31643 BRONCHOSCOPY, (RIGID OR FLEXIBLE); WITH PLACEMENT OF CATHETER(S) FOR INTRACAVITARY RADIOELEMENT APPLICATION N/A N/A N/A $180.42
31710 CATHETERIZATION FOR BRONCHOGRAPHY, WITH OR WITHOUT INSTILLATION OF CONTRAST MATERIAL N/A N/A N/A $66.95
31820 SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR N/A N/A N/A $306.50
32020TUBE THORACOSTOMY WITH OR WITHOUT WATER SEAL (EG, FOR ABSCESS, HEMOTHORAX, EMPYEMA) (SEPARATE PROCEDURE) N/A N/A N/A $209.74
32160THORACOTOMY, MAJOR; WITH CARDIAC MASSAGE $114.51 N/A N/A $572.57
32402BIOPSY, PLEURA; OPEN $98.77 N/A N/A $493.83
32405BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE N/A N/A N/A $98.04
32420PNEUMOCENTESIS, PUNCTURE OF LUNG FOR ASPIRATION N/A N/A N/A $109.53
32501 RESECTION AND REPAIR OF PORTION OF BRONCHUS (BRONCHOPLASTY) WHEN PERFORMED AT TIME OF LOBECTOMY OR SEGMENTECTOMY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $49.97 N/A N/A $249.86
32602THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS AND PLEURAL SPACE, WITH BIOPSY $67.71 N/A N/A $338.55
32651THORACOSCOPY, SURGICAL; WITH PARTIAL PULMONARY DECORTICATION $158.63 N/A N/A $793.14
32653 THORACOSCOPY, SURGICAL; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN DEPOSIT $156.67 N/A N/A $783.35
32654 THORACOSCOPY, SURGICAL; WITH CONTROL OF TRAUMATIC HEMORRHAGE $155.71 N/A N/A $778.56
32655 THORACOSCOPY, SURGICAL; WITH EXCISION-PLICATION OF BULLAE, INCLUDING ANY PLEURAL PROCEDURE $160.32 N/A N/A $801.60
32656 THORACOSCOPY, SURGICAL; WITH PARIETAL PLEURECTOMY $163.67 N/A N/A $818.33
32657 THORACOSCOPY, SURGICAL; WITH WEDGE RESECTION OF LUNG, SINGLE OR MULTIPLE $168.11 N/A N/A $840.54
32658 THORACOSCOPY, SURGICAL; WITH REMOVAL OF CLOT OR FOREIGN BODY FROM PERICARDIAL SAC $148.71 N/A N/A $743.54
32659 THORACOSCOPY, SURGICAL; WITH CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION OF PERICARDIAL SAC FOR DRAINAGE $148.66 N/A N/A $743.31
32662 THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR OR MASS $198.22 N/A N/A $991.08
32665 THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYOTOMY (HELLER TYPE) $186.49 N/A N/A $932.44
33010PERICARDIOCENTESIS; INITIAL N/A N/A N/A $115.83
33011 PERICARDIOCENTESIS; SUBSEQUENT N/A N/A N/A $117.16
33206 INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL $84.22 N/A N/A $421.08
33207 INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); VENTRICULAR N/A N/A N/A $481.98
33208 INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VENTRICULAR N/A N/A N/A $488.23
33210 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC ELECTRODE OR PACEMAKER CATHETER (SEPARATE PROCEDURE) N/A N/A N/A $173.29
33211 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES (SEPARATE PROCEDURE) $35.93 N/A N/A $179.67
33213 INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; DUAL CHAMBER $76.46 N/A N/A $382.28
33216 INSERTION OF A TRANSVENOUS ELECTRODE; SINGLE CHAMBER (ONE ELECTRODE) PERMANENT PACEMAKER OR SINGLE CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR N/A N/A N/A $373.58
33218 REPAIR OF SINGLE TRANSVENOUS ELECTRODE FOR A SINGLE CHAMBER, PERMANENT PACEMAKER OR SINGLE CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR N/A N/A N/A $364.42
33222 REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER N/A N/A N/A $347.41
33223 REVISION OF SKIN POCKET FOR SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR $83.09 N/A N/A $415.43
33233 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR $48.70 N/A N/A $243.52
33249 INSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR AND INSERTION OF PULSE GENERATOR N/A N/A N/A $848.50
33282 IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RECORDER $60.49 N/A N/A $302.44
33284 REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER $44.01 N/A N/A $220.03
33517 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SINGLE VEIN GRAFT (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $27.60 N/A N/A $138.02
33518 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); TWO VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $51.95 N/A N/A $259.73
33519 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); THREE VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $76.17 N/A N/A $380.87
33521 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FOUR VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $100.60 N/A N/A $502.99
33522 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FIVE VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $125.23 N/A N/A $626.15
33530REOPERATION, CORONARY ARTERY BYPASS PROCEDURE OR VALVE PROCEDURE, MORE THAN ONE MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $62.84 N/A N/A $314.21
33572 CORONARY ENDARTERECTOMY, OPEN, ANY METHOD, OF LEFT ANTERIOR DESCENDING, CIRCUMFLEX, OR RIGHT CORONARY ARTERY PERFORMED IN CONJUNCTION WITH CORONARY ARTERY BYPASS GRAFT PROCEDURE, EACH VESSEL (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $47.54 N/A N/A $237.69
33924 LIGATION AND TAKEDOWN OF A SYSTEMIC-TO-PULMONARY ARTERY SHUNT, PERFORMED IN CONJUNCTION WITH A CONGENITAL HEART PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $59.27 N/A N/A $296.34
33961PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; EACH ADDITIONAL 24 HOURS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $112.82 N/A N/A $564.09
33968 REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS N/A N/A N/A $34.25
33970 INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE FEMORAL ARTERY, OPEN APPROACH N/A N/A N/A $358.76
33973 INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE ASCENDING AORTA $104.30 N/A N/A $521.48
34051EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; INNOMINATE, SUBCLAVIAN ARTERY, BY THORACIC INCISION $181.90 N/A N/A $909.49
34201 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; FEMOROPOPLITEAL, AORTOILIAC ARTERY, BY LEG INCISION $121.85 N/A N/A $609.26
35180 REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; HEAD AND NECK $156.77 N/A N/A $783.87
35188 REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; HEAD AND NECK $173.52 N/A N/A $867.60
35190 REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; EXTREMITIES $151.79 N/A N/A $758.96
35207 REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER $136.21 N/A N/A $681.04
35390 REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE THAN ONE MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $34.24 N/A N/A $171.18
35450 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; RENAL OR OTHER VISCERAL ARTERY $108.22 N/A N/A $541.09
35454 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; ILIAC $66.88 N/A N/A $334.40
35456 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; FEMORAL-POPLITEAL N/A N/A N/A $404.62
35458 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VESSEL $103.34 N/A N/A $516.71
35459 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; TIBIOPERONEAL TRUNK AND BRANCHES $94.47 N/A N/A $472.34
35480 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; RENAL OR OTHER VISCERAL ARTERY $119.34 N/A N/A $596.69
35481 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; AORTIC $84.20 N/A N/A $420.99
35482 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; ILIAC $73.34 N/A N/A $366.68
35483 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; FEMORAL-POPLITEAL $89.06 N/A N/A $445.29
35484 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VESSEL $112.58 N/A N/A $562.90
35492 TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; ILIAC $74.83 N/A N/A $374.16
35493 TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; FEMORAL-POPLITEAL $90.79 N/A N/A $453.94
35681 BYPASS GRAFT; COMPOSITE, PROSTHETIC AND VEIN (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $17.16 N/A N/A $85.78
35682 BYPASS GRAFT; AUTOGENOUS COMPOSITE, TWO SEGMENTS OF VEINS FROM TWO LOCATIONS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $77.13 N/A N/A $385.64
35683 BYPASS GRAFT; AUTOGENOUS COMPOSITE, THREE OR MORE SEGMENTS OF VEIN FROM TWO OR MORE LOCATIONS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $91.03 N/A N/A $455.14
35700 REOPERATION, FEMORAL-POPLITEAL OR FEMORAL (POPLITEAL)-ANTERIOR TIBIAL, POSTERIOR TIBIAL, PERONEAL ARTERY OR OTHER DISTAL VESSELS, MORE THAN 1 MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $33.01 N/A N/A $165.03
35860 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; EXTREMITY $74.38 N/A N/A $371.88
35875 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR FISTULA) $120.79 N/A N/A $603.97
36000 INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN N/A N/A N/A $8.84
36450 EXCHANGE TRANSFUSION, BLOOD; NEWBORN N/A N/A N/A $115.20
36455 EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN N/A N/A N/A $131.20
36550 DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER N/A N/A N/A $24.63
36590 REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION N/A N/A N/A $197.30
36620 ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS N/A N/A N/A $53.58
36800 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE N/A N/A N/A $161.60
36810 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL (SCRIBNER TYPE) N/A N/A N/A $221.25
36815 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE N/A N/A N/A $149.98
36821 ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE) N/A N/A N/A $534.91
36825 CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT N/A N/A N/A $586.74
36830 CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT) N/A N/A N/A $684.18
36832 REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE) $120.57 N/A N/A $602.84
36834 PLASTIC REPAIR OF ARTERIOVENOUS ANEURYSM (SEPARATE PROCEDURE) $116.37 N/A N/A $581.87
36835 INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE) $89.71 N/A N/A $448.54
36860EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER N/A N/A N/A $102.78
36861 EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER N/A N/A N/A $154.68
37207TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NONCORONARY VESSEL), OPEN; INITIAL VESSEL N/A N/A N/A $457.51
37208 TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL), OPEN; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $221.33
37618 LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY $65.45 N/A N/A $327.25
37700 LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS $50.58 N/A N/A $252.88
38102 SPLENECTOMY; TOTAL, EN BLOC FOR EXTENSIVE DISEASE, IN CONJUNCTION WITH OTHER PROCEDURE (LIST IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $51.37 N/A N/A $256.83
38230 BONE MARROW HARVESTING FOR TRANSPLANTATION N/A N/A N/A $296.75
38240 BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENIC N/A N/A N/A $123.46
38241 BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; AUTOLOGOUS $24.76 N/A N/A $123.80
38382 SUTURE AND/OR LIGATION OF THORACIC DUCT; ABDOMINAL APPROACH $124.07 N/A N/A $620.34
38505 BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY) N/A N/A N/A $72.62
38700 SUPRAHYOID LYMPHADENECTOMY $109.51 N/A N/A $547.54
38747 ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, GASTRIC, PORTAL, PERIPANCREATIC, WITH OR WITHOUT PARA-AORTIC AND VENA CAVAL NODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $52.32 N/A N/A $261.58
38770 PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES (SEPARATE PROCEDURE) $148.06 N/A N/A $740.29
39000MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY; CERVICAL APPROACH $83.46 N/A N/A $417.28
39540REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; ACUTE $154.40 N/A N/A $772.02
39541REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; CHRONIC $165.92 N/A N/A $829.60
39545IMBRICATION OF DIAPHRAGM FOR EVENTRATION, TRANSTHORACIC OR TRANSABDOMINAL, PARALYTIC OR NONPARALYTIC $164.05 N/A N/A $820.26
40525EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER OR FAN) N/A N/A N/A $527.75
40527 EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP (ABBE-ESTLANDER) N/A N/A N/A $627.19
40650 REPAIR LIP, FULL THICKNESS; VERMILION ONLY N/A N/A N/A $261.98
40818 EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT N/A N/A N/A $233.80
41112 EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS N/A N/A N/A $222.43
41113 EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD N/A N/A N/A $250.24
42106 EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE N/A N/A N/A $170.97
42107 EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE N/A N/A N/A $316.69
42120 RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION $130.54 N/A N/A $652.70
42145 PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY) N/A N/A N/A $581.27
42220 PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENING PROCEDURE $104.08 N/A N/A $520.41
42280 MAXILLARY IMPRESSION FOR PALATAL PROSTHESIS N/A N/A N/A $103.14
42408 EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA) N/A N/A N/A $309.17
42450 EXCISION OF SUBLINGUAL GLAND N/A N/A N/A $333.16
42507 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE) N/A N/A N/A $470.04
42508 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF ONE SUBMANDIBULAR GLAND $132.41 N/A N/A $662.03
42509 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF BOTH SUBMANDIBULAR GLANDS N/A N/A N/A $814.34
42510 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH LIGATION OF BOTH SUBMANDIBULAR (WHARTONOS) DUCTS $119.12 N/A N/A $595.62
43020 ESOPHAGOTOMY, CERVICAL APPROACH, WITH REMOVAL OF FOREIGN BODY $103.68 N/A N/A $518.40
43100 EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; CERVICAL APPROACH $117.92 N/A N/A $589.61
43204ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL VARICES N/A N/A $203.62
43215 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGN BODY $29.25 N/A N/A $146.27
43216 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY $26.66 N/A N/A $133.30
43220ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER) N/A N/A N/A $117.94
43226 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OVER GUIDE WIRE N/A N/A N/A $129.69
43227 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR) N/A N/A N/A $194.17
43231 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION N/A N/A N/A $172.70
43241 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC INTRALUMINAL TUBE OR CATHETER PLACEMENT N/A N/A N/A $142.17
43243 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL AND/OR GASTRIC VARICES N/A N/A N/A $244.42
43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR OBSTRUCTION (EG, BALLOON, GUIDE WIRE, BOUGIE) N/A N/A N/A $172.89
43246 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE $46.37 N/A N/A $231.87
43247 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF FOREIGN BODY N/A N/A N/A $183.17
43249 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER) $31.60 N/A N/A $157.98
43250 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY $34.80 N/A N/A $173.99
43251 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE N/A N/A N/A $199.29
43260 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) N/A N/A N/A $316.90
43261 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE $66.67 N/A N/A $333.33
43262 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY N/A N/A N/A $391.55
43267 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF NASOBILIARY OR NASOPANCREATIC DRAINAGE TUBE N/A N/A N/A $391.55

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