[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) 73206 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, UPPER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $91.21 No Change $279.78 73218 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $324.90 73219 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) N/A $81.99 No Change $389.74 73221 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $337.04 73222 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40 73223 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $108.80 No Change $662.69 73510 RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS N/A $10.66 No Change $27.16 73525 RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.53 No Change $75.03 73530 RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE N/A $14.71 $18.39 $33.10 73542 RADIOLOGICAL EXAMINATION, SACROILIAC JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $28.75 No Change $84.69 73550 RADIOLOGIC EXAMINATION, FEMUR, TWO VIEWS N/A $8.80 No Change $25.30 73560 RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS N/A $8.80 No Change $25.30 73562 RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS N/A $9.18 No Change $25.68 73565 RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR N/A $8.80 $17.36 $26.16 73590 RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, TWO VIEWS N/A $8.80 No Change $25.30 73592 RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS N/A $8.08 No Change $24.58 73702 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $61.44 No Change $153.94 73706 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LOWER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST-PROCESSING N/A $95.64 No Change $284.21 73718 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $324.90 73719 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40 73721 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL N/A $68.04 No Change $337.04 73722 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40 73723 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $108.80 No Change $662.69 74022 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/OR DECUBITUS VIEWS, SINGLE VIEW CHEST N/A $15.85 No Change $39.85 74170 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $70.61 No Change $182.11 74175 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $95.64 No Change $305.44 74249 RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH SMALL INTESTINE FOLLOW THROUGH N/A $45.96 No Change $121.96 74291 CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE DAY EXAMINATION N/A $10.28 $14.97 $25.25 74301 CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; ADDITIONAL SET INTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $10.66 No Change $36.16 74350 PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $38.26 $113.21 $151.48 74355 PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $38.26 $94.18 $132.44 74360 INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.57 No Change $109.94 74363 PERCUTANEOUS TRANSHEPATIC DILATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT PLACEMENT OF STENT, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $44.48 No Change $179.48 74475 INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $107.23 74480 INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $63.23 74485 DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.19 $113.21 $140.40 74742 TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $30.87 No Change $77.87 75630 AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $92.05 No Change $278.05 75635 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND BILATERAL ILIOFEMORAL LOWER EXTREMITY RUNOFF, RADIOLOGICAL SUPERVISION AND INTERPRETATION, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST PROCESSING N/A $121.32 No Change $349.68 75790 ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $92.99 $48.59 $141.58 75809 SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT, INDWELLING INFUSION PUMP), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $23.55 $28.19 $51.74 75885 PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $72.47 No Change $198.97 75889 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $57.38 No Change $188.88 75891 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $57.38 No Change $178.88 75893 VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUT ANGIOGRAPHY (EG, FOR PARATHYROID HORMONE, RENIN), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $128.23 75894 TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $66.79 No Change $167.79 75896 TRANSCATHETER THERAPY, INFUSION, ANY METHOD (EG, THROMBOLYSIS OTHER THAN CORONARY), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $66.56 No Change $167.56 75898 ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER THERAPY, EMBOLIZATION OR INFUSION N/A No Change $37.73 $107.73 75940 PERCUTANEOUS PLACEMENT OF IVC FILTER, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.84 No Change $263.84 75962 TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.53 No Change $325.13 75964 TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.66 No Change $207.66 75966 TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $67.20 No Change $364.80 75968 TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.70 No Change $207.70 75978 TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG, SUBCLAVIAN STENOSIS), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $296.23 75992 TRANSLUMINAL ATHERECTOMY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.88 No Change $557.18 75993 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.70 No Change $301.20 75994 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $67.51 No Change $591.20 75995 TRANSLUMINAL ATHERECTOMY, VISCERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $67.24 No Change $590.93 75996 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.36 No Change $300.86 76020 BONE AGE STUDIES N/A $9.56 $18.39 $27.94 76040 BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM) N/A $13.61 No Change $41.11 76061 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES) N/A $22.79 $36.02 $58.81 76062 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETON) N/A $27.23 No Change $72.23 76066 JOINT SURVEY, SINGLE VIEW, TWO OR MORE JOINTS (SPECIFY) N/A $15.78 No Change $49.38 76098 RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN N/A $8.08 $14.97 $23.05 76120 CINERADIOGRAPHY/VIDEORADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED N/A $19.46 No Change $54.46 76150 XERORADIOGRAPHY N/A N/A N/A $14.97 76370 COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS N/A $43.01 $106.07 $149.08 76380 COMPUTED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY N/A $49.30 No Change $128.50 76393 MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT (EG, FOR BIOPSY, NEEDLE ASPIRATION, INJECTION, OR PLACEMENT OF LOCALIZATION DEVICE) RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $76.69 No Change $350.69 76516 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; N/A $28.97 $43.84 $72.82 76519 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS POWER CALCULATION N/A $28.97 $46.92 $75.89 76529 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION N/A $30.42 $41.07 $71.49 76536 ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $27.99 $50.98 $78.97 76604 ULTRASOUND, CHEST, B-SCAN (INCLUDES MEDIASTINUM) AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $27.61 $46.92 $74.53 76645 ULTRASOUND, BREAST(S) (UNILATERAL OR BILATERAL), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $27.23 $37.73 $64.95 76775 ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED N/A $29.39 No Change $78.39 76800 ULTRASOUND, SPINAL CANAL AND CONTENTS N/A $55.97 $50.98 $106.96 76810 ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, AFTER FIRST TRIMESTER (> OR = 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A No Change $42.61 $74.11 76816 ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG, RE-EVALUATION OF FETAL SIZE BY MEASURING STANDARD GROWTH PARAMETERS AND AMNIOTIC FLUID VOLUME, RE-EVALUATION OF ORGAN SYSTEM(S) SUSPECTED OR CONFIRMED TO BE ABNORMAL ON A PREVIOUS SCAN),TRANSABDOMINAL APPROACH, PER FETUS N/A No Change $39.78 $72.28 76818 FETAL BIOPHYSICAL PROFILE; WITH NONSTRESS TESTING N/A $54.65 $58.09 $112.74 76826 ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY N/A No Change $25.80 $44.80 76827 DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; COMPLETE N/A $29.77 No Change $79.67 76828 DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY N/A $29.66 No Change $58.06 76872 ULTRASOUND, TRANSRECTAL N/A $34.89 No Change $89.04 76880 ULTRASOUND, EXTREMITY, NONVASCULAR, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $29.77 No Change $77.27 76945 ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING, IMAGING SUPERVISION AND INTERPRETATION N/A $33.83 No Change $81.07 76946 ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION N/A $19.80 No Change $66.30 76970 ULTRASOUND STUDY FOLLOW-UP (SPECIFY) N/A $20.21 $37.73 $57.94 76977 ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S), ANY METHOD N/A $2.88 No Change $31.57 77261 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE N/A N/A N/A $72.25 77262 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE N/A N/A N/A $108.96 77263 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX N/A N/A N/A $161.83 77326 BRACHYTHERAPY ISODOSE PLAN; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO FOUR SOURCES/RIBBON APPLICATION, REMOTE AFTERLOADING BRACHYTHERAPY, ONE TO EIGHT SOURCES) N/A $47.03 No Change $119.53 77331 SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY THE TREATING PHYSICIAN N/A $43.76 $17.70 $61.47 77610 HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); FIVE OR FEWER INTERSTITIAL APPLICATORS N/A $79.00 $109.49 $188.49 77615 HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN FIVE INTERSTITIAL APPLICATORS N/A $105.13 $145.85 $250.97 77620 HYPERTHERMIA GENERATED BY INTRACAVITARY PROBE(S) N/A $83.00 $109.49 $192.49 77750 INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION (INCLUDES THREE MONTHS FOLLOW-UP CARE) N/A No Change $47.60 $96.60 77761 INTRACAVITARY RADIATION SOURCE APPLICATION; SIMPLE N/A No Change $90.08 $211.08 77762 INTRACAVITARY RADIATION SOURCE APPLICATION; INTERMEDIATE N/A No Change $129.55 $250.55 77763 INTRACAVITARY RADIATION SOURCE APPLICATION; COMPLEX N/A No Change $160.85 $281.85 77776 INTERSTITIAL RADIATION SOURCE APPLICATION; SIMPLE N/A No Change $78.83 $223.83 77777 INTERSTITIAL RADIATION SOURCE APPLICATION; INTERMEDIATE N/A No Change $151.66 $296.66 77778 INTERSTITIAL RADIATION SOURCE APPLICATION; COMPLEX N/A No Change $183.95 $328.95 77781 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 1-4 SOURCE POSITIONS OR CATHETERS N/A $83.47 No Change $203.47 77782 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 5-8 SOURCE POSITIONS OR CATHETERS N/A $125.68 No Change $305.68 77784 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; OVER 12 SOURCE POSITIONS OR CATHETERS N/A $282.61 No Change $672.61 77790 SUPERVISION, HANDLING, LOADING OF RADIATION SOURCE N/A No Change $17.70 $54.20 78000 THYROID UPTAKE; SINGLE DETERMINATION N/A $9.56 No Change $29.56 78006 THYROID IMAGING, WITH UPTAKE; SINGLE DETERMINATION N/A $24.65 No Change $62.15 78011 THYROID IMAGING; WITH VASCULAR FLOW N/A $22.79 No Change $67.79 78103 BONE MARROW IMAGING; MULTIPLE AREAS N/A $38.23 No Change $109.73 78110 PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); SINGLE SAMPLING N/A $9.90 No Change $29.90 78111 PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS N/A $11.38 No Change $35.38 78120 RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); SINGLE SAMPLING N/A $11.76 No Change $30.76 78121 RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS N/A $16.19 No Change $43.69 78122 WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATE MEASUREMENT OF PLASMA VOLUME AND RED CELL VOLUME (RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE) N/A $23.13 No Change $91.13 78130 RED CELL SURVIVAL STUDY N/A $31.21 No Change $77.71 78135 RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE KINETICS, (EG, SPLENIC AND/OR HEPATIC SEQUESTRATION) N/A $32.69 No Change $197.69 78185 SPLEEN IMAGING ONLY, WITH OR WITHOUT VASCULAR FLOW N/A $20.56 No Change $59.56 78201 LIVER IMAGING; STATIC ONLY N/A $22.41 No Change $68.91 78202 LIVER IMAGING; WITH VASCULAR FLOW N/A $25.75 No Change $75.75 78205 LIVER IMAGING (SPECT) N/A $36.03 No Change $171.03 78206 LIVER IMAGING (SPECT); WITH VASCULAR FLOW N/A $48.88 No Change $187.76 78215 LIVER AND SPLEEN IMAGING; STATIC ONLY N/A $24.65 No Change $71.15 78216 LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW N/A $28.71 No Change $90.21 78220 LIVER FUNCTION STUDY WITH HEPATOBILIARY AGENTS, WITH SERIAL IMAGES N/A $24.65 No Change $68.65 78223 HEPATOBILIARY DUCTAL SYSTEM IMAGING, INCLUDING GALLBLADDER, WITH OR WITHOUT PHARMACOLOGIC INTERVENTION, WITH OR WITHOUT QUANTITATIVE MEASUREMENT OF GALLBLADDER FUNCTION N/A $42.63 No Change $115.63 78230 SALIVARY GLAND IMAGING N/A $22.79 No Change $61.79 78232 SALIVARY GLAND FUNCTION STUDY N/A $23.89 No Change $62.89 78258 ESOPHAGEAL MOTILITY N/A $37.51 No Change $101.51 78264 GASTRIC EMPTYING STUDY N/A $39.36 No Change $138.36 78270 VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITHOUT INTRINSIC FACTOR N/A $10.28 No Change $30.28 78271 VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITH INTRINSIC FACTOR N/A $10.28 No Change $29.28 78282 GASTROINTESTINAL PROTEIN LOSS N/A $19.46 No Change $58.46 78291 PERITONEAL-VENOUS SHUNT PATENCY TEST (EG, FOR LEVEEN, DENVER SHUNT) N/A $44.83 $109.83 $154.66 78315 BONE AND/OR JOINT IMAGING; THREE PHASE STUDY N/A $51.50 No Change $170.50 78414 DETERMINATION OF CENTRAL C-V HEMODYNAMICS (NONIMAGING) (EG, EJECTION FRACTION WITH PROBE TECHNIQUE) WITH OR WITHOUT PHARMACOLOGIC INTERVENTION OR EXERCISE, SINGLE OR MULTIPLE DETERMINATIONS N/A $23.13 No Change $84.13 78428 CARDIAC SHUNT DETECTION N/A $40.39 No Change $115.39 78456 ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE N/A $50.74 No Change $157.40 78457 VENOUS THROMBOSIS IMAGING, VENOGRAM; UNILATERAL N/A $38.99 No Change $103.99 78460 MYOCARDIAL PERFUSION IMAGING; (PLANAR) SINGLE STUDY, AT REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION N/A $43.73 $84.99 $128.71 78461 MYOCARDIAL PERFUSION IMAGING; MULTIPLE STUDIES, (PLANAR) AT REST AND/OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), AND REDISTRIBUTION AND/OR REST INJECTION, WITH OR WITHOUT QUANTIFICATION N/A $62.84 $169.32 $232.16 78464 MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), SINGLE STUDY (INCLUDING ATTENUATION CORRECTION WHEN PERFORMED), AT REST OR STRESS (EXERCISE AND/ OR PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION N/A $55.52 No Change $268.52 78466 MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE N/A $35.27 No Change $91.27 78473 CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; MULTIPLE STUDIES, WALL MOTION STUDY PLUS EJECTION FRACTION, AT REST AND STRESS (EXERCISE AND/OR PHARMACOLOGIC), WITH OR WITHOUT ADDITIONAL QUANTIFICATION N/A $74.98 No Change $301.98 78494 CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SPECT, AT REST, WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR WITHOUT QUANTITATIVE PROCESSING N/A $60.98 No Change $231.73 78496 CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SINGLE STUDY, AT REST, WITH RIGHT VENTRICULAR EJECTION FRACTION BY FIRST PASS TECHNIQUE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $25.71 No Change $74.14 78586 PULMONARY VENTILATION IMAGING, AEROSOL; SINGLE PROJECTION N/A $20.21 No Change $62.71 78587 PULMONARY VENTILATION IMAGING, AEROSOL; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL VIEWS) N/A $24.99 No Change $73.99 78588 PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION IMAGING, AEROSOL, ONE OR MULTIPLE PROJECTIONS N/A $55.14 $115.23 $170.37 78591 PULMONARY VENTILATION IMAGING, GASEOUS, SINGLE BREATH, SINGLE PROJECTION N/A $20.21 No Change $84.21 78593 PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE BREATH; SINGLE PROJECTION N/A $24.65 No Change $68.65 78594 PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE BREATH; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL VIEWS) N/A $26.85 No Change $84.35 78600 BRAIN IMAGING, LIMITED PROCEDURE; STATIC N/A $22.41 No Change $79.91 78601 BRAIN IMAGING, LIMITED PROCEDURE; WITH VASCULAR FLOW N/A $25.75 No Change $95.75 78605 BRAIN IMAGING, COMPLETE STUDY; STATIC N/A $26.85 No Change $80.85 78606 BRAIN IMAGING, COMPLETE STUDY; WITH VASCULAR FLOW N/A $32.35 No Change $91.35 78610 BRAIN IMAGING, VASCULAR FLOW ONLY N/A $15.43 No Change $49.43 78615 CEREBRAL VASCULAR FLOW N/A $21.66 No Change $55.66 78630 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); CISTERNOGRAPHY N/A $34.55 No Change $116.05 78645 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); SHUNT EVALUATION N/A $28.71 No Change $138.71 78650 CEREBROSPINAL FLUID LEAKAGE DETECTION AND LOCALIZATION N/A $31.21 No Change $85.21 78700 KIDNEY IMAGING; STATIC ONLY N/A $22.79 No Change $64.29 78701 KIDNEY IMAGING; WITH VASCULAR FLOW N/A $24.65 No Change $79.65 78704 KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM) N/A $37.51 No Change $102.51 78710 KIDNEY IMAGING, TOMOGRAPHIC (SPECT) N/A $33.45 No Change $233.42 78715 KIDNEY VASCULAR FLOW ONLY N/A $15.43 No Change $44.43 78725 KIDNEY FUNCTION STUDY, NONIMAGING RADIOISOTOPIC STUDY N/A $19.46 $64.55 $84.00 78730 URINARY BLADDER RESIDUAL STUDY N/A $18.36 $52.35 $70.71 78740 URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM) N/A $29.01 No Change $79.01 78761 TESTICULAR IMAGING; WITH VASCULAR FLOW N/A $36.03 No Change $131.03
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