[37 Pa.B. 6610]
[Saturday, December 15, 2007]
[Continued from previous Web Page]
Procedure Code Procedure 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) Billing with No Modifier or Pricing Modifiers U6, U7, U8, U9, SU or TH Billing with NU (New) or RR (Rental) Modifiers 71020 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL N/A $10.28 No Change $25.28 N/A 71021 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL LORDOTIC PROCEDURE N/A $12.48 No Change $27.48 N/A 71022 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH OBLIQUE PROJECTIONS N/A $14.34 No Change $29.34 N/A 71030 RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS N/A $14.34 No Change $36.84 N/A 71035 RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY STUDIES) N/A $8.42 No Change $26.80 N/A 71250 COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL N/A $53.59 No Change $133.59 N/A 71260 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S) N/A $57.65 No Change $145.15 N/A 71270 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $63.87 No Change $167.37 N/A 71275 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $89.17 No Change $305.97 N/A 71550 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S) N/A $67.21 No Change $336.21 N/A 71551 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITH CONTRAST MATERIAL(S) N/A $80.37 No Change $392.47 N/A 71552 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $104.60 $472.89 $577.50 N/A 72010 RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL N/A $20.56 No Change $57.26 N/A 72020 RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL N/A $6.94 $14.65 $21.59 N/A 72050 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS N/A $14.34 No Change $40.84 N/A 72052 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR EXTENSION STUDIES N/A $16.84 No Change $49.34 N/A 72069 RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS) N/A $10.62 No Change $27.98 N/A 72070 RADIOLOGIC EXAMINATION, SPINE; THORACIC, TWO VIEWS N/A $10.28 No Change $31.28 N/A 72072 RADIOLOGIC EXAMINATION, SPINE; THORACIC, THREE VIEWS N/A $10.28 No Change $31.78 N/A 72074 RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF FOUR VIEWS N/A $10.28 $21.50 $31.78 N/A 72090 RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT STUDIES N/A $12.86 No Change $33.86 N/A 72100 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; TWO OR THREE VIEWS N/A $10.28 No Change $32.78 N/A 72110 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; MINIMUM OF FOUR VIEWS N/A $14.34 No Change $36.84 N/A 72120 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR VIEWS N/A $10.28 No Change $31.28 N/A 72125 COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL N/A $53.59 No Change $133.59 N/A 72126 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL N/A $56.55 No Change $150.55 N/A 72127 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $59.05 No Change $195.05 N/A 72128 COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL N/A $53.59 No Change $141.09 N/A 72129 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL N/A $56.55 No Change $144.05 N/A 72130 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $59.05 No Change $195.05 N/A 72131 COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL N/A $53.59 No Change $138.59 N/A 72132 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL N/A $56.55 No Change $150.55 N/A 72133 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $59.05 No Change $195.05 N/A 72146 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL N/A $74.15 No Change $261.35 N/A 72148 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL N/A $68.95 No Change $256.15 N/A 72190 RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS N/A $9.90 No Change $30.90 N/A 72191 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, PELVIS, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST-PROCESSING N/A $84.05 No Change $293.85 N/A 72193 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S) N/A $53.59 No Change $140.09 N/A 72194 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $56.55 No Change $159.05 N/A 72195 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S) N/A $67.55 No Change $328.67 N/A 72196 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S) N/A $80.37 No Change $283.77 N/A 72197 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $104.60 $472.26 $576.87 N/A 72200 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS N/A $8.04 No Change $24.54 N/A 72202 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS N/A $8.80 No Change $25.30 N/A 72220 RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS N/A $8.04 No Change $24.54 N/A 73000 RADIOLOGIC EXAMINATION; CLAVICLE, COMPLE N/A $7.32 No Change $18.82 N/A 73020 RADIOLOGIC EXAMINATION, SHOULDER; ONE VI N/A $6.94 $16.02 $22.96 N/A 73030 RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS N/A $8.42 No Change $24.92 N/A 73050 RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT WEIGHTED DISTRACTION N/A $9.52 No Change $28.52 N/A 73070 RADIOLOGIC EXAMINATION, ELBOW; TWO VIEWS N/A $6.94 No Change $18.44 N/A 73090 RADIOLOGIC EXAMINATION; FOREARM, TWO VIEWS N/A $7.32 No Change $18.82 N/A 73092 RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS N/A $7.32 No Change $18.32 N/A 73100 RADIOLOGIC EXAMINATION, WRIST; TWO VIEWS N/A $7.32 No Change $18.82 N/A 73120 RADIOLOGIC EXAMINATION, HAND; TWO VIEWS N/A $7.32 No Change $17.32 N/A 73200 COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL N/A $50.63 No Change $129.63 N/A 73201 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $53.59 No Change $136.09 N/A 73202 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $56.55 No Change $149.05 N/A 73206 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, UPPER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST-PROCESSING N/A $84.05 No Change $272.62 N/A 73218 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) N/A $62.39 No Change $319.25 N/A 73219 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) N/A $75.25 No Change $383.00 N/A 73221 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S) N/A $62.39 No Change $331.39 N/A 73222 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $75.25 No Change $383.00 N/A 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 $99.79 $472.43 $572.90 N/A 73510 RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS N/A $9.90 No Change $26.40 N/A 73525 RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.64 No Change $73.14 N/A 73530 RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE N/A $13.58 No Change $31.97 N/A 73540 RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT OR CHILD, MINIMUM OF TWO VIEWS N/A $9.52 No Change $26.02 N/A 73542 RADIOLOGICAL EXAMINATION, SACROILIAC JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $26.47 No Change $82.41 N/A 73550 RADIOLOGIC EXAMINATION, FEMUR, TWO VIEWS N/A $8.04 No Change $24.54 N/A 73560 RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS N/A $8.04 No Change $24.54 N/A 73562 RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS N/A $8.42 No Change $24.92 N/A 73564 RADIOLOGIC EXAMINATION, KNEE; COMPLETE, FOUR OR MORE VIEWS N/A $10.28 No Change $32.69 N/A 73565 RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR N/A $8.04 No Change $25.40 N/A 73590 RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, TWO VIEWS N/A $8.04 No Change $24.54 N/A 73592 RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS N/A $7.32 No Change $23.82 N/A 73600 RADIOLOGIC EXAMINATION, ANKLE; TWO VIEWS N/A $7.32 No Change $18.82 N/A 73610 RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREE VIEWS N/A $8.04 No Change $26.77 N/A 73620 RADIOLOGIC EXAMINATION, FOOT; TWO VIEWS N/A $7.32 No Change $17.32 N/A 73650 RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS N/A $7.32 No Change $18.82 N/A 73700 COMPUTED TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL N/A $50.63 No Change $129.63 N/A 73701 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $53.59 No Change $136.09 N/A 73702 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $56.55 No Change $149.05 N/A 73706 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LOWER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST-PROCESSING N/A $88.45 No Change $277.02 N/A 73718 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) N/A $62.39 No Change $319.25 N/A 73719 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) N/A $74.91 No Change $382.66 N/A 73721 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL N/A $62.39 No Change $331.39 N/A 73722 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $75.25 No Change $383.00 N/A 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 $99.79 $472.43 $572.22 N/A 74022 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/OR DECUBITUS VIEWS, SINGLE VIEW CHEST N/A $14.72 No Change $38.72 N/A 74160 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S) N/A $59.05 No Change $149.05 N/A 74170 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.97 No Change $176.47 N/A 74175 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST-PROCESSING N/A $88.11 No Change $297.91 N/A 74181 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S) N/A $67.21 No Change $336.21 N/A 74182 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITH CONTRAST MATERIAL(S) N/A $80.37 No Change $392.57 N/A 74183 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY WITH CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $104.60 $472.26 $576.86 N/A 74235 REMOVAL OF FOREIGN BODY(S), ESOPHAGEAL, WITH USE OF BALLOON CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $55.41 No Change $144.41 N/A 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 $42.21 No Change $118.21 N/A 74290 CHOLECYSTOGRAPHY, ORAL CONTRAST N/A $14.72 No Change $37.22 N/A 74291 CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE DAY EXAMINATION N/A $9.52 No Change $24.49 N/A 74300 CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; INTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $16.84 No Change $42.34 N/A 74301 CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; ADDITIONAL SET INTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $9.90 No Change $35.40 N/A 74350 PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $34.89 $98.34 $133.23 N/A 74355 PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $34.89 No Change $129.07 N/A 74360 INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $26.02 No Change $108.39 N/A 74363 PERCUTANEOUS TRANSHEPATIC DILATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT PLACEMENT OF STENT, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $40.73 No Change $175.73 N/A 74475 INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.34 No Change $105.34 N/A 74480 INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.34 No Change $61.34 N/A 74485 DILATION OF NEPHROSTOMY, URETERS OR URETHRA, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.30 $103.09 $128.39 N/A 74742 TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $28.25 No Change $75.25 N/A 75554 CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY; COMPLETE STUDY N/A No Change $330.42 $417.63 N/A 75555 CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY; LIMITED STUDY N/A $84.86 $330.42 $415.28 N/A 75630 AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $86.25 No Change $272.25 N/A 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 $111.89 No Change $340.25 N/A 75790 ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $85.11 No Change $133.70 N/A 75809 SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT, INDWELLING INFUSION PUMP), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $21.66 No Change $49.85 N/A 75885 PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $66.83 No Change $193.33 N/A 75887 PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $67.17 No Change $174.67 N/A 75889 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $52.87 No Change $184.37 N/A 75891 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $52.87 No Change $174.37 N/A 75893 VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUT ANGIOGRAPHY (EG, FOR PARATHYROID HORMONE, RENIN), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.34 No Change $126.34 N/A 75894 TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $61.51 No Change $162.51 N/A 75896 TRANSCATHETER THERAPY, INFUSION, ANY METHOD (EG, THROMBOLYSIS OTHER THAN CORONARY), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $61.98 No Change $162.98 N/A 75900 EXCHANGE OF A PREVIOUSLY PLACED INTRAVASCULAR CATHETER DURING THROMBOLYTIC THERAPY WITH CONTRAST MONITORING, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $23.06 No Change $670.75 N/A 75901 MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG, FIBRIN SHEATH) FROM CENTRAL VENOUS DEVICE VIA SEPARATE VENOUS ACCESS, RADIOLOGIC SUPERVISION AND INTERPRETATION N/A $22.76 No Change $69.17 N/A 75902 MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) OBSTRUCTIVE MATERIAL FROM CENTRAL VENOUS DEVICE THROUGH DEVICE LUMEN, RADIOLOGIC SUPERVISION AND INTERPRETATION N/A $18.32 No Change $65.74 N/A 75940 PERCUTANEOUS PLACEMENT OF IVC FILTER, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.94 No Change $261.94 N/A 75962 TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.64 No Change $323.24 N/A 75964 TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $17.14 No Change $206.14 N/A 75966 TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $63.31 No Change $360.91 N/A 75968 TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $17.52 No Change $206.52 N/A 75978 TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG, SUBCLAVIAN STENOSIS), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $25.34 No Change $294.34 N/A 75992 TRANSLUMINAL ATHERECTOMY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $26.32 No Change $555.62 N/A 75993 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $17.52 No Change $300.02 N/A 75994 TRANSLUMINAL ATHERECTOMY, RENAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $63.95 No Change $587.64 N/A 75995 TRANSLUMINAL ATHERECTOMY, VISCERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $62.67 No Change $586.36 N/A 75996 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $17.18 No Change $299.68 N/A 76098 RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN N/A $7.32 $13.62 $20.94 N/A 76120 CINERADIOGRAPHY/VIDEORADIO- GRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED N/A $17.94 No Change $52.94 N/A 76376 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION N/A No Change $35.50 $43.94 N/A 76377 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY; REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION N/A No Change $89.01 $122.27 N/A 76380 COMPUTED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY N/A $45.17 No Change $124.37 N/A 76506 ECHOENCEPHALOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (GRAY SCALE) (FOR DETERMINATION OF VENTRICULAR SIZE, DELINEATION OF CEREBRAL CONTENTS AND DETECTION OF FLUID MASSES OR OTHER INTRACRANIAL ABNORMALITIES), INCLUDING A-MODE ENCEPHALOGRAPHY AS SECONDARY COMPONENT WHERE INDICATED N/A $31.28 No Change $78.78 N/A 76516 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN N/A $26.75 $41.84 $68.59 N/A 76519 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS POWER CALCULATION N/A $26.75 $45.27 $72.02 N/A 76529 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION N/A $27.81 $39.75 $67.56 N/A 76536 ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), REAL TIME WITH IMAGE DOCUMENTATION N/A $25.37 No Change $76.35 N/A 76604 ULTRASOUND, CHEST (INCLUDES MEDIASTINUM), REAL TIME WITH IMAGE DOCUMENTATION N/A $24.99 No Change $74.03 N/A 76645 ULTRASOUND, BREAST(S) (UNILATERAL OR BILATERAL), REAL TIME WITH IMAGE DOCUMENTATION N/A $24.99 No Change $62.72 N/A 76700 ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE N/A $37.77 No Change $95.27 N/A 76775 ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED N/A $27.12 No Change $76.12 N/A 76800 ULTRASOUND, SPINAL CANAL AND CONTENTS N/A $51.46 No Change $102.45 N/A 76801 ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, FIRST TRIMESTER (14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION N/A $46.24 No Change $84.63 N/A 76811 ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION PLUS DETAILED FETAL ANATOMIC EXAMINATION, TRANSABDOMINAL APPROACH; SINGLE OR FIRST GESTATION N/A $90.46 $124.61 $215.07 N/A 76817 ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, TRANSVAGINAL N/A $34.86 No Change $87.89 N/A 76818 FETAL BIOPHYSICAL PROFILE; WITH NON-STRESS TESTING N/A $49.80 No Change $110.02 N/A 76827 DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; COMPLETE N/A $27.16 No Change $77.06 N/A 76828 DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE SPECTRAL DISPLAY; FOLLOW UP OR REPEAT STUDY N/A $27.04 No Change $55.44 N/A 76872 ULTRASOUND, TRANSRECTAL N/A $32.58 No Change $86.73 N/A 76880 ULTRASOUND, EXTREMITY, NONVASCULAR, REAL TIME WITH IMAGE DOCUMENTATION N/A $27.15 No Change $74.65 N/A
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