NOTICES
Medical Assistance Program Fee Schedule Revisions
[39 Pa.B. 2860]
[Saturday, June 6, 2009]The Department of Public Welfare (Department) announces that it will revise the fees, or a component of the fee, on the Medical Assistance (MA) Program Fee Schedule for select medical, surgical, laboratory, durable medical equipment and radiological services effective June 15, 2009.
Fee Schedule Revisions
The Pennsylvania Medicaid State Plan (State Plan) specifies that maximum fees for services covered under the MA Program are to be determined on the basis of the following: fees may not exceed the Medicare upper limit when applicable; fees must be consistent with efficiency, economy and quality of care; and fees must be sufficient to assure the availability of services to recipients. The regulations at 55 Pa. Code § 1150.62(a) (relating to payment levels and notice of rate setting changes) also specify that the MA fees may not exceed the Medicare upper limit.
The Department has determined that MA fees for approximately 670 medical, surgical, laboratory, durable medical equipment and radiological procedure codes or combinations of procedure codes and modifiers, are above the Medicare upper limit for the same procedure codes. The Department is adjusting the fees on the MA Program Fee Schedule for these combinations of procedure codes and modifiers to equal the Medicare upper limit. Revision of these fees is necessary to comply with the regulation and State Plan, and to avoid a Federal disallowance. When adjusting the assistant surgeon fee (modifier 80), the Department followed the Medicare guidelines of paying 16% of the maximum allowable payment to a primary surgeon, as MA fees may not exceed the Medicare upper limit.
The Department has also determined that for the following services, the sum of the professional and technical component fees did not equal the total component fees. The Department has made adjustments to the professional, technical and total component fees as follows:
Procedure Code Procedure Code Description Current Fees Revised Fees as of
June 15, 200970350 Cephalogram $19.28 (Total Comp Fee)
$8.38 (26--Prof Comp)
No Change (TC--Tech Comp)
$19.41 (Total Comp Fee)
$8.16 (26--Prof Comp)
No Change (TC--Tech Comp)70355 Orthopantogram $27.00 (Total Comp Fee)
$9.52 (26--Prof Comp)
$17.48 (TC--Tech Comp)
$25.00 (Total Comp Fee)
$9.65 (26--Prof Comp)
$15.35 (TC--Tech Comp)70549 Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences $556.65 (Total Comp Fee)
$90.83 (26--Prof Comp)
No Change (TC--Tech Comp)$557.97 (Total Comp Fee)
$84.65 (26--Prof Comp)
No Change (TC--Tech Comp)73020 Radiologic examination, shoulder; 1 view $22.96 (Total Comp Fee)
$6.94 (26--Prof Comp)
$16.02 (TC--Tech Comp)$22.73 (Total Comp Fee)
$7.05 (26--Prof Comp)
$15.68 (TC--Tech Comp)74485 Dilation of nephrostomy, ureters or urethra, radiological supervision and interpretation $128.39 (Total Comp Fee)
$25.30 (26--Prof Comp)
$103.90 (TC--Tech Comp)$122.90 (Total Comp Fee)
$25.97 (26--Prof Comp)
$96.93 (TC--Tech Comp)76098 Radiological examination, surgical specimen $20.94 (Total Comp Fee)
$7.32 (26--Prof Comp)
$13.62 (TC--Tech Comp)$19.98 (Total Comp Fee)
$7.43 (26--Prof Comp)
$12.55 (TC--Tech Comp)76820 Doppler velocimetry, fetal; umbilical artery $68.82 (Total Comp Fee)
$21.17 (26--Prof Comp)
$47.65 (TC--Tech Comp)$63.19 (Total Comp Fee)
$23.74 (26--Prof Comp)
$39.45 (TC--Tech Comp)76977 Ultrasound bone density measurement and interpretation, peripheral site(s) any method $25.93 (Total Comp Fee)
$2.50 (26--Prof Comp)
$23.43 (TC--Tech Comp)$20.38 (Total Comp Fee)
$2.58 (26--Prof Comp)
$17.80 (TC--Tech Comp)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 $215.87 (Total Comp Fee)
$57.96 (26--Prof Comp)
$157.91 (TC--Tech Comp)$212.33 (Total Comp Fee)
$58.23 (26--Prof Comp)
$154.10 (TC--Tech Comp)78608 Brain imaging, positron emission tomography (PET); metabolic evaluation $669.07 (Total Comp Fee)
$70.82 (26--Prof Comp)
No Change (TC--Tech Comp)$683.09 (Total Comp Fee)
$69.82 (26--Prof Comp)
No Change (TC--Tech Comp)88182 Flow cytometry, cell cycle or DNA analysis $39.49 (Total Comp Fee)
$35.55 (26--Prof Comp)
No Change (TC--Tech Comp)$41.34 (Total Comp Fee)
$34.98 (26--Prof Comp)
No Change (TC--Tech Comp)93278 Signal-averaged electrocardiography (SAECG), with or without ECG $49.26 (Total Comp Fee)
$12.06 (26--Prof Comp)
$36.49 (TC--Tech Comp)$45.04 (Total Comp Fee)
$12.22 (26--Prof Comp)
$32.82 (TC--Tech Comp)93321 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging.); follow-up or limited study (List separately in addition to codes for echocardiographic imaging.) $43.27 (Total Comp Fee)
$7.63 (26--Prof Comp)
$35.64 (TC--Tech Comp)
$39.15 (Total Comp Fee)
$7.75 (26--Prof Comp)
$31.40 (TC--Tech Comp)
93555 Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography $257.90 (Total Comp Fee)
$40.56 (26--Prof Comp)
$220.60 (TC--Tech Comp)
$165.23 (Total Comp Fee)
$40.99 (26--Prof Comp)
$124.24 (TC--Tech Comp)
93556 Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits (whether native or used in bypass) $389.77 (Total Comp Fee)
$41.66 (26--Prof Comp)
$348.11 (TC--Tech Comp)
$240.30 (Total Comp Fee)
$42.10 (26--Prof Comp)
$198.20 (TC--Tech Comp)
93724 Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings) $359.32 (Total Comp Fee)
$242.48 (26--Prof Comp)
$116.84 (TC--Tech Comp)
$336.10 (Total Comp Fee)
$243.28 (26--Prof Comp)
$92.82 (TC--Tech Comp)As set forth as follows, the Department has revised the total fee (billed with no modifier) and, as applicable, the professional component fee (billed with modifier 26), the technical component fee (billed with modifier TC), the assistant surgeon fee (billed with modifier 80), and the fee when billing with pricing modifiers SU, TH, NU or U7 for the following procedure codes; ''N/A'' indicates that the modifier is not on the MA Program Fee Schedule for the procedure code, and ''N/C'' indicates that there is no change in the fee associated with the modifier:
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 U710021 Fine needle aspiration; without imaging guidance N/A N/A N/A $62.24 11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface N/A N/A N/A $29.30 11001 Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure.) N/A N/A N/A $14.81 11011 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, and muscle N/A N/A N/A $268.00 11012 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, muscle, and bone N/A N/A N/A $392.66 11041 Debridement; skin, full thickness N/A N/A N/A $32.81 11056 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); 2 to 4 lesions N/A N/A N/A $29.68 11057 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); more than 4 lesions N/A N/A N/A $38.94 11101 Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary procedure.) N/A N/A N/A $21.04 11720 Debridement of nail(s) by any method(s); 1 to 5 N/A N/A N/A $15.57 11755 Biopsy of nail unit (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) N/A N/A N/A $75.26 11981 Insertion, non-biodegradable drug delivery implant N/A N/A N/A $75.73 11982 Removal, non-biodegradable drug delivery implant N/A N/A N/A $92.33 15101 Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure.) $16.20 N/A N/A $101.25 15121 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure.) $25.12 N/A N/A $157.02 15201 Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure.) N/A N/A N/A $69.77 15221 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure.) N/A N/A N/A $64.16 15241 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure.) N/A N/A N/A $100.62 15261 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids and/or lips; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure.) N/A N/A N/A $126.71 15570 Formation of direct or tubed pedicle, with or without transfer; trunk $97.66 N/A N/A $610.39 15574 Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet $104.62 N/A N/A $653.86 15576 Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips or intraoral N/A N/A N/A $574.35 15600 Delay of flap or sectioning of flap (division and inset); at trunk N/A N/A N/A $176.46 15610 Delay of flap or sectioning of flap (division and inset); at scalp, arms or legs N/A N/A N/A $207.94 15822 Blepharoplasty, upper eyelid N/A N/A N/A $313.77 15936 Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure $123.63 N/A N/A $772.70 15937 Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy $144.58 N/A N/A $903.61 16025 Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (e.g., whole face or whole extremity, or 5% to 10% total body surface area) N/A N/A N/A $100.55 16035 Escharotomy; initial incision N/A N/A N/A $190.48 17003 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (e.g., actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion.) N/A N/A N/A $4.38 17004 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (e.g., actinic keratoses), 15 or more lesions N/A N/A N/A $116.39 19001 Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure.) N/A N/A N/A $20.39 19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) N/A N/A N/A $61.25 19126 Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure.) $22.74 N/A N/A $142.13 19296 Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy N/A N/A N/A $182.08 19298 Placement of radiotherapy afterloading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance N/A N/A N/A $295.14 20100 Exploration of penetrating wound (separate procedure); neck $84.76 N/A N/A $529.76 20103 Exploration of penetrating wound (separate procedure); extremity $50.02 N/A N/A $312.61 20615 Aspiration and injection for treatment of bone cyst N/A N/A N/A $141.20 20910 Cartilage graft; costochondral N/A N/A N/A $376.54 20912 Cartilage graft; nasal septum N/A N/A N/A $426.78 20924 Tendon graft, from a distance (e.g., palmaris, toe extensor, plantaris) $71.53 N/A N/A $447.09 20974 Electrical stimulation to aid bone healing; noninvasive (nonoperative) N/A N/A N/A $42.63 21120 Genioplasty; augmentation (autograft, allograft, prosthetic material) $69.56 N/A N/A N/C 21123 Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) $117.89 N/A N/A N/C 21125 Augmentation, mandibular body or angle; prosthetic material $102.90 N/A N/A $643.15 21127 Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) $121.61 N/A N/A $760.08 21138 Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) $126.55 N/A N/A $790.94 21139 Reduction forehead; contouring and setback of anterior frontal sinus wall $136.99 N/A N/A $856.21 21199 Osteotomy, mandible, segmental; with genioglossus advancement $143.67 N/A N/A $897.93 21206 Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard) $155.61 N/A N/A $972.56 21208 Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) N/A N/A N/A $719.30 21209 Osteoplasty, facial bones; reduction $88.85 N/A N/A $555.29 21210 Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) $115.96 N/A N/A $724.73 21215 Graft, bone; mandible (includes obtaining graft) $121.08 N/A N/A $756.77 21242 Arthroplasty, temporomandibular joint, with allograft $144.28 N/A N/A $901.74 21275 Secondary revision of orbitocraniofacial reconstruction $112.56 N/A N/A $703.51 21295 Reduction of masseter muscle and bone (e.g., for treatment of benign masseteric hypertrophy); extraoral approach $23.92 N/A N/A $149.51 21310 Closed treatment of nasal bone fracture without manipulation N/A N/A N/A $25.74 21320 Closed treatment of nasal bone fracture; with stabilization N/A N/A N/A $120.76 21386 Open treatment of orbital floor blowout fracture; periorbital approach $92.73 N/A N/A $579.59 21387 Open treatment of orbital floor blowout fracture; combined approach N/A N/A N/A $659.93 21390 Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant $105.83 N/A N/A $661.45 21401 Closed treatment of fracture of orbit, except blowout; with manipulation N/A N/A N/A $247.00 21406 Open treatment of fracture of orbit, except blowout; without implant N/A N/A N/A $469.44 21407 Open treatment of fracture of orbit, except blowout; with implant $88.80 N/A N/A $555.01 21423 Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches $111.34 N/A N/A $695.90 21454 Open treatment of mandibular fracture with external fixation N/A N/A N/A $478.49 21480 Closed treatment of temporomandibular dislocation; initial or subsequent N/A N/A N/A $28.98 21557 Radical resection of tumor (e.g., malignant neoplasm), soft tissue of neck or thorax $81.53 N/A N/A $509.54 22103 Partial excision of posterior vertebral component (e.g., spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to code for primary procedure.) $20.92 N/A N/A $130.73 22116 Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure.) $21.03 N/A N/A $131.42 22216 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure.) $54.94 N/A N/A $343.36 22226 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure.) $54.72 N/A N/A $341.97 22328 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment (List separately in addition to code for primary procedure.) $41.25 N/A N/A $257.81 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure.) $50.30 N/A N/A $314.35 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure.) $58.53 N/A N/A $365.83 22632 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure.) $47.64 N/A N/A $297.75 22840 Posterior nonsegmental instrumentation (e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure.) $114.58 N/A N/A $716.11 22842 Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure.) $114.59 N/A N/A $716.17 22843 Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure.) $121.25 N/A N/A $757.82 22844 Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure.) $148.57 N/A N/A $928.57 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure.) $109.80 N/A N/A $686.27 22847 Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure.) $125.10 N/A N/A $781.87 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure.) $54.06 N/A N/A $337.88 23105 Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsy N/A N/A N/A $561.15 23106 Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy N/A N/A N/A $419.99 23107 Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign body $93.54 N/A N/A $584.64 23210 Radical resection for tumor; scapula $129.08 N/A N/A $806.72 24100 Arthrotomy, elbow; with synovial biopsy only N/A N/A N/A $347.61 24152 Radical resection for tumor, radial head or neck $102.14 N/A N/A $638.36 24153 Radical resection for tumor, radial head or neck; with autograft (includes obtaining graft) N/A N/A N/A $601.59 24155 Resection of elbow joint (arthrectomy) $119.32 N/A N/A $745.75 24361 Arthroplasty, elbow; with distal humeral prosthetic replacement $142.98 N/A N/A $893.62 24365 Arthroplasty, radial head $90.41 N/A N/A $565.05 24366 Arthroplasty, radial head; with implant $96.95 N/A N/A $605.96 24931 Amputation, arm through humerus; with implant $112.42 N/A N/A $702.62 25335 Centralization of wrist on ulna (e.g., radial club hand) N/A N/A N/A $859.80 25820 Arthrodesis, wrist; limited, without bone graft (e.g., intercarpal or radiocarpal) $87.03 N/A N/A $543.93 26030 Drainage of palmar bursa; multiple bursa N/A N/A N/A $425.89 26125 Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft); each additional digit (List separately in addition to code for primary procedure.) $40.71 N/A N/A $254.45 26510 Cross intrinsic transfer, each tendon $86.81 N/A N/A $542.54 26531 Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint $86.63 N/A N/A $541.43 26591 Repair, intrinsic muscles of hand, each muscle N/A N/A N/A $403.69 26861 Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (List separately in addition to code for primary procedure.) N/A N/A N/A $96.46 26863 Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft), each additional joint (List separately in addition to code for primary procedure.) N/A N/A N/A $215.05 27054 Arthrotomy with synovectomy, hip joint N/A N/A N/A $598.11 27071 Partial excision (craterization, saucerization) (e.g., osteomyelitis or bone abscess); deep (subfascial or intramuscular) $128.64 N/A N/A $804.00 27096 Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid N/A N/A N/A $61.19 27256 Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulation N/A N/A N/A $219.80 27334 Arthrotomy, with synovectomy, knee; anterior or posterior N/A N/A N/A $599.16 27335 Arthrotomy, with synovectomy, knee; anterior and posterior including popliteal area N/A N/A N/A $677.42 27358 Excision or curettage of bone cyst or benign tumor of femur; with internal fixation (List in addition to code for primary procedure.) $42.19 N/A N/A $263.66 27396 Transplant or transfer (with muscle redirection or rerouting), thigh (e.g., extensor to flexor); single tendon $86.56 N/A N/A $541.02 27425 Lateral retinacular release, open $62.00 N/A N/A $387.49 27427 Ligamentous reconstruction (augmentation), knee; extra-articular $101.62 N/A N/A $635.12 27438 Arthroplasty, patella; with prosthesis $119.01 N/A N/A $743.79 27450 Osteotomy, femur, shaft or supracondylar; with fixation $145.61 N/A N/A $910.06 27605 Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesia N/A N/A N/A $182.06 27692 Transfer or transplant of single tendon (with muscle redirection or rerouting); each additional tendon (List separately in addition to code for primary procedure.) $16.45 N/A N/A $102.82 27740 Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula $100.87 N/A N/A $630.41 27742 Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; and distal femur $94.89 N/A N/A $593.07 27756 Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (e.g., pins or screws) $80.03 N/A N/A $500.16 27871 Arthrodesis, tibiofibular joint, proximal or distal $98.99 N/A N/A $618.70 28088 N/A N/A N/A $275.66 28160 Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each N/A N/A N/A $253.68 28344 Reconstruction, toe(s); polydactyly $44.34 N/A N/A $277.13 28345 Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web N/A N/A N/A $376.55 28530 Closed treatment of sesamoid fracture N/A N/A N/A $89.57 28725 Arthrodesis; subtalar $116.86 N/A N/A $730.37 29000 Application of halo type body cast (see 20661--20663 for insertion) N/A N/A N/A $148.89 29055 Application, cast; shoulder spica N/A N/A N/A $117.51 29131 Application of finger splint; dynamic N/A N/A N/A $27.71 29325 Application of hip spica cast; 1 and 1/2 spica or both legs N/A N/A N/A $153.60 29445 Application of rigid total contact leg cast N/A N/A N/A $101.47 29520 Strapping; hip N/A N/A N/A $33.97 29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body $83.33 N/A N/A $520.81 29820 Arthroscopy, shoulder, surgical; synovectomy, partial $76.93 N/A N/A $480.82 29821 Arthroscopy, shoulder, surgical; synovectomy, complete $84.05 N/A N/A $525.29 29822 Arthroscopy, shoulder, surgical; debridement, limited $81.74 N/A N/A $510.85 29825 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation $83.27 N/A N/A $520.46 29834 Arthroscopy, elbow, surgical; with removal of loose body or foreign body $69.92 N/A N/A $436.97 29835 Arthroscopy, elbow, surgical; synovectomy, partial $71.74 N/A N/A $448.40 29836 Arthroscopy, elbow, surgical; synovectomy, complete $82.17 N/A N/A $513.56 29837 Arthroscopy, elbow, surgical; debridement, limited $75.11 N/A N/A $469.41 29838 Arthroscopy, elbow, surgical; debridement, extensive $84.09 N/A N/A $525.57 29843 Arthroscopy, wrist, surgical; for infection, lavage and drainage $66.88 N/A N/A $417.97 29844 Arthroscopy, wrist, surgical; synovectomy, partial $70.17 N/A N/A $438.59 29846 Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement $73.75 N/A N/A $460.96 29850 Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy) $78.20 N/A N/A $488.76 29871 Arthroscopy, knee, surgical; for infection, lavage and drainage N/A N/A N/A $452.43 29873 Arthroscopy, knee, surgical; with lateral release N/A N/A N/A $453.30 29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation) $75.51 N/A N/A $471.95 29875 Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection) (separate procedure) $70.27 N/A N/A $439.17 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) $86.49 N/A N/A $540.59 29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure) $86.15 N/A N/A $538.43 29894 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body $73.92 N/A N/A $462.00 29895 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial $71.98 N/A N/A $449.85 29897 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited $75.30 N/A N/A $470.65 29898 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive $84.15 N/A N/A $525.93 30150 Rhinectomy; partial N/A N/A N/A $698.89 30160 Rhinectomy; total $111.24 N/A N/A $695.25 30580 Repair fistula; oromaxillary (combine with 31030 if antrotomy is included) N/A N/A N/A $440.83 31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture) $20.08 N/A N/A $125.53 31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium) $23.92 N/A N/A $149.52 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy $93.25 N/A N/A $582.79 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection $23.74 N/A N/A $148.39 31255 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) $60.40 N/A N/A $377.53 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy $29.58 N/A N/A $184.90 31276 Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus $76.12 N/A N/A $475.74 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy $34.72 N/A N/A $217.01 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus $40.27 N/A N/A $251.70 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital wall decompression $143.64 N/A N/A $897.78 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and inferior orbital wall decompression $156.41 N/A N/A $977.59 31512 Laryngoscopy, indirect; with removal of lesion N/A N/A N/A $117.87 31513 Laryngoscopy, indirect; with vocal cord injection N/A N/A N/A $120.74 31520 Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn N/A N/A N/A $140.88 31528 Laryngoscopy direct, with or without tracheoscopy; with dilation, initial N/A N/A N/A $130.60 31529 Laryngoscopy direct, with or without tracheoscopy; with dilation, subsequent N/A N/A N/A $149.27 31535 Laryngoscopy, direct, operative, with biopsy N/A N/A N/A $175.05 31535-SU Laryngoscopy, direct, operative, with biopsy N/A N/A N/A $175.05 31536 Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope 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 $224.89 31541 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope N/A N/A N/A $246.26 31560 Laryngoscopy, direct, operative, with arytenoidectomy N/A N/A N/A $290.43 31561 Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescope N/A N/A N/A $317.44 31576 Laryngoscopy, flexible fiberoptic; with biopsy N/A N/A N/A $111.62 31577 Laryngoscopy, flexible fiberoptic; with removal of foreign body N/A N/A N/A $137.53 31601 Tracheostomy, planned (separate procedure); younger than 2 years $37.64 N/A N/A $235.27 31603 Tracheostomy, emergency procedure; transtracheal N/A N/A N/A $205.21 31605 Tracheostomy, emergency procedure; cricothyroid membrane N/A N/A N/A $168.69 31615 Tracheobronchoscopy through established tracheostomy incision N/A N/A N/A $114.79 31620 Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) (List separately in addition to code for primary procedure[s].) N/A N/A N/A $66.09 31622 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure) N/A N/A N/A $133.86 31623 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with brushing or protected brushings N/A N/A N/A $135.15 31624 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial alveolar lavage N/A N/A N/A $135.15 31625 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with bronchial or endobronchial biopsy(s), single or multiple sites N/A N/A N/A $157.81 31628 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy(s), single lobe N/A N/A N/A $175.80 31629 Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) N/A N/A N/A $187.39 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 $191.27
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