[39 Pa.B. 2860]
[Saturday, June 6, 2009]
[Continued from previous Web Page]
Procedure Code/
Modifier SU, TH, NU or U7 where indicatedProcedure 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 SU, TH, NU or U766920 Removal of lens material; intracapsular N/A N/A N/A $591.24 66940 Removal of lens material; extracapsular (other than 66840, 66850, 66852) N/A N/A N/A $609.60 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification) N/A N/A N/A $602.53 67005 Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal N/A N/A N/A $367.80 67010 Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with mechanical vitrectomy N/A N/A N/A $426.23 67028 Intravitreal injection of a pharmacologic agent (separate procedure) N/A N/A N/A $135.84 67036 Vitrectomy, mechanical, pars plana approach $121.42 N/A N/A $758.89 67107 Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), with or without implant, with or without cryotherapy, photocoagulation, and drainage of subretinal fluid $152.25 N/A N/A $951.54 67221 Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photodynamic therapy (includes intravenous infusion) N/A N/A N/A $178.28 67225 Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment.) N/A N/A N/A $22.94 67227 Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), 1 or more sessions, cryotherapy, diathermy N/A N/A N/A $445.25 67250 Scleral reinforcement (separate procedure); without graft N/A N/A N/A $627.17 67255 Scleral reinforcement (separate procedure); with graft N/A N/A N/A $669.00 67311 Strabismus surgery, recession or resection procedure; 1 horizontal muscle N/A N/A N/A $468.15 67335 Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (List separately in addition to code for specific strabismus surgery.) N/A N/A N/A $122.87 67345 Chemodenervation of extraocular muscle N/A N/A N/A $170.26 67415 Fine needle aspiration of orbital contents N/A N/A N/A $86.27 67715 Canthotomy (separate procedure) N/A N/A N/A $86.13 67825 Correction of trichiasis; epilation by other than forceps (e.g., by electrosurgery, cryotherapy, laser surgery) N/A N/A N/A $95.65 67830 Correction of trichiasis; incision of lid margin N/A N/A N/A $109.45 67835 Correction of trichiasis; incision of lid margin, with free mucous membrane graft N/A N/A N/A $350.28 67875 Temporary closure of eyelids by suture (e.g., Frost suture) N/A N/A N/A $78.81 67882 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate N/A N/A N/A $367.02 67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material (e.g., banked fascia) N/A N/A N/A $456.15 67903 Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach N/A N/A N/A $403.60 67906 Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) N/A N/A N/A $411.07 67908 Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (e.g., Fasanella-Servat type) N/A N/A N/A $349.07 67912 Correction of lagophthalmos, with implantation of upper eyelid lid load (e.g., gold weight) N/A N/A N/A $398.03 67914 Repair of ectropion; suture N/A N/A N/A $230.51 67916 Repair of ectropion; excision tarsal wedge N/A N/A N/A $345.07 67921 Repair of entropion; suture N/A N/A N/A $215.75 67923 Repair of entropion; excision tarsal wedge N/A N/A N/A $371.79 67924 Repair of entropion; extensive (e.g., tarsal strip or capsulopalpebral fascia repairs operation) N/A N/A N/A $358.61 67935 Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; full thickness N/A N/A N/A $363.42 67950 Canthoplasty (reconstruction of canthus) N/A N/A N/A $377.25 68200 Subconjunctival injection N/A N/A N/A $27.88 68320 Conjunctivoplasty; with conjunctival graft or extensive rearrangement N/A N/A N/A $414.28 68720 Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity) $96.03 N/A N/A $600.21 69100 Biopsy external ear N/A N/A N/A $41.69 69120 Excision external ear; complete amputation N/A N/A N/A $351.17 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure.) N/A N/A N/A $201.22 70130 Radiologic examination, mastoids; complete, minimum of 3 views per side N/A $15.97 N/C $43.47 70134 Radiologic examination, internal auditory meati, complete N/A $15.97 N/C $38.47 70170 Dacryocystography, nasolacrimal duct, radiological supervision and interpretation N/A $13.74 N/C $40.24 70190 Radiologic examination; optic foramina N/A $9.65 N/C $30.65 70210 Radiologic examination, sinuses, paranasal, less than 3 views N/A $7.81 N/C $24.31 70250 Radiologic examination, skull; less than 4 views N/A $10.79 N/C $31.79 70260 Radiologic examination, skull; complete, minimum of 4 views N/A $15.97 N/C $43.47 70320 Radiologic examination, teeth; complete, full mouth N/A $10.38 N/C $34.37 71020 Radiologic examination, chest, 2 views, frontal and lateral N/A $10.03 N/C $25.03 71022 Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections N/A $14.12 N/C $29.12 71030 Radiologic examination, chest, complete, minimum of 4 views N/A $14.12 N/C $36.62 72050 Radiologic examination, spine, cervical; minimum of 4 views N/A $14.12 N/C $40.62 72069 Radiologic examination, spine, thoracolumbar, standing (scoliosis) N/A $10.38 N/C $27.74 72070 Radiologic examination, spine; thoracic, 2 views N/A $10.03 N/C $31.03 72072 Radiologic examination, spine; thoracic, 3 views N/A $10.03 N/C $31.53 72074 Radiologic examination, spine; thoracic, minimum of 4 views N/A $10.03 N/C $31.53 72100 Radiologic examination, spine, lumbosacral; 2 or 3 views N/A $10.03 N/C $32.53 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views N/A $14.12 N/C $36.62 72120 Radiologic examination, spine, lumbosacral, bending views only, minimum of 4 views N/A $10.03 N/C $31.03 72190 Radiologic examination, pelvis; complete, minimum of 3 views N/A $9.65 N/C $30.65 73510 Radiologic examination, hip, unilateral; complete, minimum of 2 views N/A $9.65 N/C $26.15 73525 Radiologic examination, hip, arthrography, radiological supervision and interpretation N/A $25.62 N/C $73.12 73542 Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation N/A $26.10 N/C $82.04 73564 Radiologic examination, knee; complete, 4 or more views N/A $10.03 N/C $32.45 74301 Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and interpretation (List separately in addition to code for primary procedure.) N/A $9.65 N/C $35.15 75809 Shuntogram for investigation of previously placed indwelling nonvascular shunt (e.g., LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation N/A $21.55 N/C $49.74 75900 Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation N/A $23.02 N/C $670.71 75902 Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation N/A $18.19 N/C $65.61 75978 Transluminal balloon angioplasty, venous (e.g., subclavian stenosis), radiological supervision and interpretation N/A $25.26 N/C $294.26 75993 Transluminal atherectomy, each additional peripheral artery, radiological supervision and interpretation (List separately in addition to code for primary procedure.) N/A $17.43 N/C $299.93 75994 Transluminal atherectomy, renal, radiological supervision and interpretation N/A $63.71 N/C $587.40 75995 Transluminal atherectomy, visceral, radiological supervision and interpretation N/A $61.95 N/C $585.64 75996 Transluminal atherectomy, each additional visceral artery, radiological supervision and interpretation (List separately in addition to code for primary procedure.) N/A $17.08 N/C $299.58 76120 Cineradiography/videoradiography, except where specifically included N/A $17.81 N/C $52.81 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 $30.75 N/C $78.25 76516 Ophthalmic biometry by ultrasound echography, A-scan N/A $25.95 $40.79 $66.74 76519 Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation N/A $26.30 $44.27 $70.57 76529 Ophthalmic ultrasonic foreign body localization N/A $27.42 $39.06 $66.48 76800 Ultrasound, spinal canal and contents N/A $50.66 N/C $101.64 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (aaa 14 weeks 0 days), transabdominal approach; single or first gestation N/A $45.70 N/C $84.09 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 $88.40 $120.49 $208.89 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal N/A $34.56 N/C $87.59 76818 Fetal biophysical profile; with non-stress testing N/A $49.01 N/C $107.10 76820 Doppler velocimetry, fetal; umbilical artery N/A $23.74 $39.45 $63.19 76827 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete N/A $26.75 $49.89 $76.64 76828 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study N/A $26.35 N/C $54.75 76941 Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation N/A $62.41 N/C $109.65 76945 Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation N/A $30.85 N/C $78.09 76946 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation N/A $17.46 $35.95 $53.41 76970 Ultrasound study follow-up (specify) N/A $18.22 N/C $55.95 77079 Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) N/A N/C $66.19 $74.41 77261 Therapeutic radiology treatment planning; simple N/A N/A N/A $66.02 77262 Therapeutic radiology treatment planning; intermediate N/A N/A N/A $99.84 77263 Therapeutic radiology treatment planning; complex N/A N/A N/A $148.47 77295 Therapeutic radiology simulation-aided field setting; 3-dimensional N/A $212.85 $642.93 $855.78 77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications N/A $372.58 N/C $1,080.41 77326 Brachytherapy isodose plan; simple (calculation made from single plane, 1 to 4 sources/ribbon application, remote afterloading brachytherapy, 1 to 8 sources) N/A $43.46 N/C $115.96 77333 Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus) N/A N/C $41.18 $70.18 77432 Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of 1 session) N/A N/A N/A $375.85 77610 Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators N/A $70.01 N/C $179.50 77615 Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators N/A $96.64 N/C $242.49 77620 Hyperthermia generated by intracavitary probe(s) N/A $75.34 N/C $184.83 77781 Remote afterloading high intensity brachytherapy; 1--4 source postions or catheters N/A $59.62 N/C $179.62 77782 Remote afterloading high intensity brachytherapy; 5--8 source positions or catheters N/A $98.61 N/C $278.61 77784 Remote afterloading high intensity brachytherapy; over 12 source postions or catheters N/A $243.85 N/C $633.85 77789 Surface application of radiation source N/A $53.46 N/C $66.81 78006 Thyroid imaging, with uptake; single determination N/A $22.66 N/C $60.16 78111 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings N/A $10.38 N/C $34.38 78120 Red cell volume determination (separate procedure); single sampling N/A $10.76 N/C $29.76 78121 Red cell volume determination (separate procedure); multiple samplings N/A $14.85 N/C $42.35 78135 Red cell survival study; differential organ/tissue kinetics (e.g., splenic and/or hepatic sequestration) N/A $30.06 N/C $195.06 78201 Liver imaging; static only N/A $20.44 N/C $66.94 78220 Liver function study with hepatobiliary agents, with serial images N/A $22.66 N/C $66.66 78271 Vitamin B-12 absorption study (e.g., Schilling test); with intrinsic factor N/A $9.30 N/C $28.30 78456 Acute venous thrombosis imaging, peptide N/A $47.48 N/C $154.14 78480 Myocardial perfusion study with ejection fraction (List separately in addition to code for primary procedure.) N/A $16.88 N/C $56.48 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 $24.44 N/C $72.87 78586 Pulmonary ventilation imaging, aerosol; single projection N/A $18.57 N/C $61.07 78593 Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; single projection N/A $22.66 N/C $66.66 78606 Brain imaging, minimum 4 static views; with vascular flow N/A $29.71 N/C $88.71 78607 Brain imaging, tomographic (SPECT) N/A $57.54 N/C $279.73 78660 Radiopharmaceutical dacryocystography N/A $24.88 N/C $82.38 78725 Kidney function study, non-imaging radioisotopic study N/A $17.81 N/C $82.36 78730 Urinary bladder residual study (List separately in addition to code for primary procedure.) N/A $8.80 N/C $44.22 79005 Radiopharmaceutical therapy, by oral administration N/A N/C $72.88 $146.07 79101 Radiopharmaceutical therapy, by intravenous administration N/A N/C $75.67 $155.65 79200 Radiopharmaceutical therapy, by intracavitary administration N/A N/C $78.11 $143.11 79300 Radiopharmaceutical therapy, by interstitial radioactive colloid administration N/A $77.49 N/C $184.99 79403 Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion N/A N/C $117.09 $211.63 80410 Calcitonin stimulation panel (e.g., calcium, pentagastrin) This panel must include the following: Calcitonin (82308 x 3) N/A N/A N/A $62.79 81020 Urinalysis; 2 or 3 glass test N/A N/A N/A $4.30 82308 Calcitonin N/A N/A N/A $20.93 82330 Calcium; ionized N/A N/A N/A $8.85 82565 Creatinine; blood N/A N/A N/A $6.41 82672 Estrogens; total N/A N/A N/A $13.92 82710 Fat or lipids, feces; quantitative N/A N/A N/A $4.02 82977 Glutamyltransferase, gamma (GGT) N/A N/A N/A $9.36 84060 Phosphatase, acid; total N/A N/A N/A $8.06 84075 Phosphatase, alkaline N/A N/A N/A $6.37 84155 Protein, total, except by refractometry; serum, plasma or whole blood N/A N/A N/A $4.67 84295 Sodium; serum, plasma or whole blood N/A N/A N/A $6.50 85041 Blood count; red blood cell (RBC), automated N/A N/A N/A $4.02 85475 Hemolysin, acid N/A N/A N/A $10.91 86309 Heterophile antibodies; titer N/A N/A N/A $8.58 86631 Antibody; Chlamydia N/A N/A N/A $9.88 86729 Antibody; lymphogranuloma venereum N/A N/A N/A $9.88 87340 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) N/A N/A N/A $14.17 87517 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification N/A N/A N/A $39.65 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification N/A N/A N/A $39.65 88302 Level II--Surgical pathology, gross and microscopic examination Appendix, incidental Fallopian tube, sterilization Fingers/toes, amputation, traumatic Foreskin, newborn Hernia sac, any location Hydrocele sac Nerve Skin, plastic repair Sympathetic ganglion Testis, castration Vaginal mucosa, incidental Vas deferens, sterilization N/A $6.29 N/C $11.29 88304 Level III--Surgical pathology, gross and microscopic examination Abortion, induced Abscess Aneurysm--arterial/ventricular Anus, tag Appendix, other than incidental Artery, atheromatous plaque Bartholin's gland cyst Bone fragment(s), other than pathologic fracture Bursa/synovial cyst Carpal tunnel tissue Cartilage, shavings Cholesteatoma Colon, colostomy stoma Conjunctiva--biopsy/pterygium Cornea Diverticulum--esophagus/small intestine Dupuytren's contracture tissue Femoral head, other than fracture Fissure/fistula Foreskin, other than newborn Gallbladder Ganglion cyst Hematoma Hemorrhoids Hydatid of Morgagni Intervertebral disc Joint, loose body Meniscus Mucocele, salivary Neuroma--Morton's/traumatic Pilonidal cyst/sinus Polyps, inflammatory--nasal/sinusoidal Skin--cyst/tag/debridement Soft tissue, debridement Soft tissue, lipoma Spermatocele Tendon/tendon sheath Testicular appendage Thrombus or embolus Tonsil and/or adenoids Varicocele Vas deferens, other than sterilization Vein, varicosity N/A $10.03 N/C $16.53 88311 Decalcification procedure (List separately in addition to code for surgical pathology examination.) N/A N/A N/A $16.72 88314 Decalcification procedure (List separately in addition to code for surgical pathology examination.) N/A $21.52 N/C $30.11 88318 Determinative histochemistry to identify chemical components (e.g., copper, zinc) N/A $20.03 N/C $23.57 88332 Pathology consultation during surgery; each additional tissue block with frozen section(s) N/A $28.18 N/C $35.97 88349 Electron microscopy; scanning N/A $36.34 N/C $60.94 88355 Morphometric analysis; skeletal muscle N/A $84.77 N/C $116.27 88358 Morphometric analysis; tumor (e.g., DNA ploidy) N/A $45.31 N/C $62.49 89230 Sweat collection by iontophoresis N/A N/A N/A $3.85 92270 Electro-oculography with interpretation and report N/A $37.86 $40.40 $78.26 92283 Color vision examination, extended, e.g., anomaloscope or equivalent N/A $8.16 N/C $11.70 92284 Dark adaptation examination with interpretation and report N/A $10.79 N/C $52.79 92285 External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography) N/A $10.00 N/C $13.25 92516 Facial nerve function studies (e.g., electroneuronography) N/A N/A N/A $21.10 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording N/A $19.27 N/C $27.21 92542 Positional nystagmus test, minimum of 4 positions, with recording N/A $15.93 N/C $25.31 92543 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording N/A $5.18 N/C $20.11 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording N/A $12.60 N/C $19.91 92545 Oscillating tracking test, with recording N/A $11.11 N/C $18.42 92546 Sinusoidal vertical axis rotational testing N/A $13.74 N/C $22.00 92565 Stenger test, pure tone N/A N/A N/A $12.92 92577 Stenger test, speech N/A N/A N/A $19.56 92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited N/A $24.84 $37.25 $62.09 92587 Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products) N/A $6.29 $37.35 $43.64 92588 Evoked otoacoustic emissions; comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies) N/A $17.42 N/C $64.25 92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording N/A N/A N/A $62.88 92613 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; physician interpretation and report only N/A N/A N/A $36.57 92614 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording N/A N/A N/A $62.88 92615 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; physician interpretation and report only N/A N/A N/A $32.48 92616 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording N/A N/A N/A $93.22 92617 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; physician interpretation and report only N/A N/A N/A $40.63 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report N/A N/A N/A $21.41 93224 Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation N/A N/A N/A $129.48 93270 Wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; recording (includes connection, recording, and disconnection) N/A N/A N/A $29.31 93272 Wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; physician review and interpretation N/A N/A N/A $25.20 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete N/A $62.25 N/C $157.25 93313 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only N/A N/A N/A $40.05 93503 Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes N/A N/A N/A $104.65 93875 Noninvasive physiologic studies of extracranial arteries, complete bilateral study (e.g., periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis) N/A $10.03 N/C $46.03 93886 Transcranial Doppler study of the intracranial arteries; complete study N/A $44.90 N/C $164.24 93888 Transcranial Doppler study of the intracranial arteries; limited study N/A $30.04 N/C $82.84 93890 Transcranial Doppler study of the intracranial arteries; vasoreactivity study N/A N/C $87.88 $130.78 93892 Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection N/A N/C $87.87 $136.97 93893 Transcranial Doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection N/A N/C $87.87 $136.97 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study N/A $27.47 N/C $146.81 93926 Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study N/A $18.56 N/C $97.16 93931 Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study N/A $14.84 N/C $93.44 93965 Noninvasive physiologic studies of extremity veins, complete bilateral study (e.g., Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography) N/A $16.35 N/C $52.35 93979 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study N/A $21.15 N/C $99.75 93981 Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study N/A $20.79 N/C $77.79 94240 Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method N/A $11.55 N/C $29.55 94260 Thoracic gas volume N/A $5.59 N/C $19.99 94375 Respiratory flow volume loop N/A $13.43 N/C $31.47 94400 Breathing response to CO2 (CO2 response curve) N/A $18.23 N/C $30.65 94450 Breathing response to hypoxia (hypoxia response curve) N/A $17.53 N/C $43.09 94660 Continuous positive airway pressure ventilation (CPAP), initiation and management N/A N/A N/A $34.26 94662 Continuous negative pressure ventilation (CNP), initiation and management N/A N/A N/A $33.90 94681 Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted N/A $8.95 N/C $31.45 95027 Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report by a physician, specify number of tests N/A N/A N/A $4.92 95075 Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance such as metabisulfite) N/A N/A N/A $44.20 95812 Electroencephalogram (EEG) extended monitoring; 41--60 minutes N/A $51.55 N/C $90.48 95830 Insertion by physician of sphenoidal electrodes for electroencephalographic (EEG) recording N/A N/A N/A $80.90 95831 Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk N/A N/A N/A $13.71 95832 Muscle testing, manual (separate procedure) with report; hand, with or without comparison with normal side N/A N/A N/A $14.45 95833 Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding hands N/A N/A N/A $22.60 95834 Muscle testing, manual (separate procedure) with report; total evaluation of body, including hands N/A N/A N/A $29.26 95851 Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine) N/A N/A N/A $7.78 95852 Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side N/A N/A N/A $5.56 95903 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study N/A $28.92 N/C $37.90 95926 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs N/A $25.97 N/C $58.43 95927 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head N/A $27.02 N/C $59.48 95955 Electroencephalogram (EEG) during nonintracranial surgery (e.g., carotid surgery) N/A $46.82 N/C $119.35 95991 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); administered by physician N/A N/A N/A $33.96 96153 Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients) N/A N/A N/A $4.48 96920 Laser treatment for inflammatory skin disease (psoriasis); total area less than 250 sq cm N/A N/A N/A $58.68 96921 Laser treatment for inflammatory skin disease (psoriasis); 250 sq cm to 500 sq cm N/A N/A N/A $59.10 97597 Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters N/A N/A N/A $34.79 97598 Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters N/A N/A N/A $45.16 97605 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters N/A N/A N/A $24.91 99183 Physician attendance and supervision of hyperbaric oxygen therapy, per session N/A N/A N/A $106.80 A4615 Cannula, nasal N/A N/A N/A $0.83 A4620 Variable concentration mask N/A N/A N/A $0.69 E2373-NU Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware N/A N/A N/A $675.92 G0108 Diabetes outpatient self-management training services, individual, per 30 minutes N/A N/A N/A $25.07 G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes N/A N/A N/A $14.28 L3764 Elbow-wrist-hand orthotic (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment N/A N/A N/A $701.82 Q0035 Cardiokymography N/A $7.81 $11.85 $19.67 Fiscal Impact
It is anticipated that these revisions will result in savings of $0.485 million ($0.190 million in State funds) in the MA Outpatient Program in Fiscal Year (FY) 2009-2010 and annualized savings of $0.529 million ($0.233 million in State funds) in FY 2010-2011. These State fund estimates are based on the increased Federal Medical Assistance Percentages as determined under the American Recovery and Reinvestment Act of 2009.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revisions of the MA Program Fee Schedule.
Persons with a disability who require auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-601. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 09-1034. Filed for public inspection June 5, 2009, 9:00 a.m.]
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