Medicare Program; Prospective Payment System for Hospital Outpatient Services; Correction
Federal RegisterJun 30, 1999
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SUMMARY: This document corrects technical and typographic errors that
appeared in the proposed rule published in the Federal Register on
September 8, 1998 entitled ``Medicare Program; Prospective Payment
System for Hospital Outpatient Services.
FOR FURTHER INFORMATION CONTACT:
Janet Wellham, (410) 786-4510 (for general information).
Kitty Ahern, (410) 786-4515 (for information related to the
classification of services into ambulatory payment classification (APC)
groups).
Suzanne Letsch (410) 786-4558 (for information related to volume
control measures and updates).
Janet Samen (410) 789-9161 (for information on the application of APCs
to community health centers).
SUPPLEMENTARY INFORMATION:
Background
In FR Doc. 98-23383 of September 8, 1998 (63 FR 47551), we
published a proposed rule that reflected a number of technical errors,
resulting in inconsistencies between the proposed policies and the
associated numerical values. Specifically, the numerical values in the
proposed rule reflected incorrect data and data programming. This
document sets forth corrected numerical values.
The problems in the data and data programming are a direct result
of the frequent modifications to our databases during the initial
development of the model prospective payment system and the changes we
made during the development of the proposed rule to reflect the final
legislative provision enacted on August 5, 1997 in the Balanced Budget
Act of 1997 (BBA 1997), Public Law 105-33. We have corrected our
databases and our data programming, and this document corrects the
numerical values published in the September 8, 1998 proposed rule.
Correcting the data errors does not mean that the proposed policies
themselves need to be revised. Correcting the data changes the impacts
of the proposed policies to a very limited extent, but this document
does not revise any of the policies reflected in the September 8, 1998
proposed rule.
Accordingly, we have recalculated the current payment, total
services (total units) and corrected relative weights, proposed payment
rates, national unadjusted coinsurance, minimum unadjusted coinsurance,
and service-mix index that were published on September 8, 1998.
The service-mix indices previously published in the proposed rule
are significantly different from the service-mix index published in
this correction notice (in Addendum I) because the ambulatory payment
classification (APC) relative weights used to calculate the service mix
published in the proposed rule were scaled using a factor ``for a high-
level clinic visit for cardiovascular services (that is, APC 91356)
rather than a mid-level clinic visit for cardiovascular services,
identified as APC 91336.'' In addition, the service-mix index published
in this correction notice incorporates the discount policy applied to
multiple surgeries. However, the relative differences among hospitals
did not change substantially between the proposed and corrected
service-mix indices.
These data corrections required that we also correct our
simulations of current payment, costs, and total units, leading to
slight differences from the September 8, 1998 published version. Fully
modeling proposed payment after accounting for data corrections, we
calculated a new calendar year (CY) 1996 conversion factor of $46.87,
which is slightly higher than the published CY 1996 conversion factor
of $46.32. In addition to the data corrections mentioned above, we also
made a correction in the computation of the conversion factor to
appropriately account for wage index adjustments in proposed payments.
The adjusted CY 1999 conversion factor is $51.42.
Corrected simulations of costs and total units impacted the results
of the regression analyses that we use in conjunction with payment
simulations to determine whether the payment system should include
adjustments for specific classes of hospitals. However, the results do
not change our conclusion hat no adjustments be proposed at this time.
These corrections require revisions to the impact tables and they
also affect entries contained in Addendum A, Addendum B, Addendum C,
Addendum D, and Addendum G. Addendum J, Addendum K, and Addendum L are
revised to reflect the correct version of the wage index. Because of
the many corrections to these ``materials, we are reprinting portions
of the impact analysis and the entire impact tables and agenda, below,
in this notice.
The September 8, 1998 proposed rule also contained other technical
and typographic errors. Errors related to the incorrect assignment of
status indicators to certain CPT codes listed in Addendum B are
corrected and reflected in the revised Addendum B printed in full
below.
In FR Doc. 98-23383 of September 8, 1998, make the following
corrections to the preamble, regulations text and addenda:
Correction of Errors in the Preamble
1. On pages 47564 through 47565, the table titled ``Packaged
Services by Revenue Center'' is corrected to read as follows:
Packaged Services by Revenue Center
------------------------------------------------------------------------
------------------------------------------------------------------------
SURGERY
------------------------------------------------------------------------
250............................... PHARMACY
251............................... GENERIC
252............................... NONGENERIC
257............................... NONPRESCRIPTION DRUGS
258............................... IV SOLUTIONS
259............................... OTHER PHARMACY
270............................... M&S SUPPLIES
271............................... NONSTERILE SUPPLIES
272............................... STERILE SUPPLIES
276............................... INTRAOCULAR LENS
279............................... OTHER M&S SUPPLIES
370............................... ANESTHESIA
379............................... OTHER ANESTHESIA
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
700............................... CAST ROOM
709............................... OTHER CAST ROOM
710............................... RECOVERY ROOM
719............................... OTHER RECOVERY ROOM
720............................... LABOR ROOM
721............................... LABOR
723............................... CIRCUMCISION
762............................... OBSERVATION ROOM
810............................... ORGAN ACQUISITION
[[Page 35259]]
819............................... OTHER ORGAN ACQUISITION
890............................... OTHER DONOR BANK
891............................... BONE
892............................... ORGAN
893............................... SKIN
899............................... OTHER DONOR BANK, OTHER
------------------------------------------------------------------------
MEDICAL VISIT
------------------------------------------------------------------------
250............................... PHARMACY
251............................... GENERIC
252............................... NONGENERIC
257............................... NONPRESCRIPTION DRUGS
258............................... IV SOLUTIONS
259............................... OTHER PHARMACY
270............................... M&S SUPPLIES
271............................... NONSTERILE SUPPLIES
272............................... STERILE SUPPLIES
279............................... OTHER M&S SUPPLIES
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
700............................... CAST ROOM
709............................... OTHER CAST ROOM
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
OTHER DIAGNOSTIC (BLENDED SERVICES)
------------------------------------------------------------------------
254............................... PHARMACY INCIDENT TO OTHER
DIAGNOSTIC
372............................... ANESTHESIA INCIDENT TO OTHER
DIAGNOSTIC
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
397............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
622............................... SUPPLIES INCIDENT TO OTHER
DIAGNOSTIC
710............................... RECOVERY ROOM
719............................... OTHER RECOVERY ROOM
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
RADIOLOGY
------------------------------------------------------------------------
255............................... PHARMACY INCIDENT TO RADIOLOGY
371............................... ANESTHESIA INCIDENT TO RADIOLOGY
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
621............................... SUPPLIES INCIDENT TO RADIOLOGY
710............................... RECOVERY ROOM
719............................... OTHER RECOVERY ROOM
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
ALL OTHER APC GROUPS
------------------------------------------------------------------------
250............................... PHARMACY
251............................... GENERIC
252............................... NONGENERIC
257............................... NONPRESCRIPTION DRUGS
258............................... IV SOLUTIONS
259............................... OTHER PHARMACY
270............................... M&S SUPPLIES
271............................... NONSTERILE SUPPLIES
272............................... STERILE SUPPLIES
279............................... OTHER M&S SUPPLIES
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
2. On page 47568, column two, line 16, the figure ``$208.25'' is
corrected to read ``$206.71''.
3. On page 47572, column one, last paragraph, the date and Federal
Register citation are corrected to read as follows: August 29, 1997 (62
FR 45984).
4. On page 47573, column three, line nine, ``$46.32'' is corrected
to read ``$46.87''.
5. On page 47573, column three, line 12, ``1.0939'' is corrected to
read ``1.097''.
6. On page 47573, column three, line 24, the text beginning with
the sentence ``In estimating the update factor, HCFA's Office of the
Actuary assumed * * *'' through the phrase ending ``Medicare absorbing
this impact'' in line 44 is removed.
7. On page 47573, column three, line 46, ``$50.67'' is corrected to
read ``$51.42''.
8. On page 47574, column two, in section 2(a)(ii), line four,
``29.2'' is corrected to read ``13.0''.
9. On page 47576, column two, line 26, ``1999'' is corrected to
read ``1998''.
10. On page 47576, column two, line 28, the Federal Register title,
date, and citation are corrected to read as follows: ``Changes to the
Hospital Inpatient Prospective Payment Systems and Fiscal Year 1998
Rates (BPD-878-FC) published in the Federal Register on August 29, 1997
(62 FR 45995)''.
11. On page 47577, column one, paragraph two, line 39, ``1996'' is
corrected to read ``1998''.
12. On page 47577, column two, last paragraph, line nine, ``$105''
is corrected to read ``$120''.
13. On page 47578, column two, second full paragraph, line four,
the following new sentence is added to read as follows: ``The edits
referred to in this section were not used in the development of the
weights or the impact analysis described in this proposed rule.''
14. On page 47580, column one, First line, the words ``level 1''
are added after the words ``hospitals with'' and before the word
``trauma''.
15. On page 47580, column one, line two, the sentence beginning
``These costs were * * *'' is removed and is replaced with the
following: ``These costs were 200 percent or more higher than the
average cost per unit for all hospitals.''
16. On page 47580, column one, last paragraph, line one, ``83'' is
corrected to read ``96''.
17. On page 47580, column one, last paragraph, line three, ``51''
is corrected to read ``46''.
18. On page 47580, column one, last paragraph, line six, ``32'' is
corrected to read ``50''.
19. On page 47580, column two, line five, ``5,419'' is corrected to
read ``5,335''.
20. On page 47580, column two, second full paragraph, line 14, the
words ``level 1'' are added before the words ``trauma unit''.
21. On page 47580, column two, last paragraph, line four, the
sentence beginning ``We also calculated * * *'' is removed and is
replaced with the following: ``This service mix is ``discounted'' to
reflect the reduced weight for additional surgical procedures performed
at the same time, which is consistent with the proposed payment
system.''
22. On page 47580, column two, last paragraph, line 10, the
sentence beginning ``The national average * * *'' is removed and is
replaced with the following: ``The national average service mix
discounted for multiple procedures is 2.05.''
[[Page 35260]]
23. On page 47580, column two, last paragraph, last line, remove
text from the sentence beginning ``The differences between * * *''
through line seven in column three.
24. On page 47580, column three, first full paragraph, line 13,
``0.68'' is corrected to read ``0.76''.
25. On page 47580, column three, first full paragraph, line 17,
``6.8 percent'' is corrected to read ``7.6 percent''.
26. On page 47580, column three, paragraph two, line 25, ``7.5
percent'' is corrected to read ``8.9 percent''.
27. On page 47580, column three, the third full paragraph through
page 47581, column one, line 10, is removed and is replaced with the
following: ``While the regression analysis shows less than a
proportional relationship between the service mix and the cost per
unit, the difference is relatively small. The coefficient of service
mix ranged from 0.76 to 0.92 over the regression models we examined. We
will continue to monitor the method of basing payments on median APC
costs to ascertain whether it is representative of both high-weighted
and low-weighted procedures.''
28. On page 47581, column one, first full paragraph, line nine,
``0.51 to 0.68'' is corrected to read ``0.40 to 0.58.''
29. On page 47581, column one, first full paragraph, lines 10 to
11, ``50 and 70 percent.'' is corrected to read ``40 and 60 percent.''
30. On page 47581, column one, first full paragraph, line 29, the
sentence beginning ``The explanatory regression * * *'' is removed.
31. On page 47581, column two, first full paragraph, line 10, the
word ``not'' is added before ``significant''.
32. On page 47581, column two, first full paragraph, line 13, ``4.5
percent [calculated (eDSHP*0.11-1)*100]'' is corrected read
``1.6 percent [calculated (eDSHP*0.04-1)*100]''.
33. On page 47581, column two, first full paragraph, line 16, the
text beginning with ``Teaching intensity * * *'' through line 21 ending
with ``services.'' is removed and is replaced with the following: ``The
extremely small percentage difference in costs reflects the lack of
significance observed for the disproportionate share variable. In most
regression specifications, the teaching intensity variables were
positive, significant (p0.14-1)*100].''
35. On page 47581, column three, first full paragraph, line eight,
``8 percent'' is corrected to read ``12 percent''.
36. On page 47581, column three, first full paragraph, line nine,
``other'' is added before ``urban''.
37. On page 47581, column three, second full paragraph, line two,
``(long-term care, children's, and psychiatric)'' is corrected to read
``(long-term care and children's)''.
38. On page 47581, column three, second full paragraph, line six,
``Cancer, children's and long-term care'' is removed and is replaced
with ``These''.
39. On pages 47581 through 47582 and continued on page 47585,
through line five of the first full paragraph in column two, the text
in the section titled ``Estimated Payments'' is removed and is replaced
with the following:
The appropriateness of potential payment adjustments must be based
on both cost effects estimated by regression analysis and other factors
including simulated payment impacts. We simulated the impact of the
proposed system on hospitals by calculating the percentage difference
between payments made under current law and payments under the proposed
system (column 3). Section X. contains a more complete table that
considers the impact of proposed payments on additional classes of
hospitals, including TEFRA and cancer hospitals. Although Column 3
represents the net effect of the new PPS on hospitals, we though it was
necessary to show the impacts on hospitals of simply changing the
payment system without including the effects of the overall reduced
payment to hospitals because the PPS system is not budget neutral to
current payment. To reiterate, the conversion factor is set by summing
Medicare payments under the current system and beneficiary copayment
under the new system and dividing by the sum of the relative weights.
Beneficiary copayments under the new system will reduce overall
payments to most hospitals because 20 percent of the median group
charges is less than 20 percent of actual charges. Therefore, we
simulated the impacts as though the conversion factor were set as if
the system were to be budget neutral. Column 4 demonstrates the
distributional impacts resulting from implementing the new system after
eliminating the overall reduction in payment most hospitals will
experience due to the effect of the methodology used to set the
conversion factor. We believe the column 4 percentage differences are
what we should examine since any adjustment we would consider should
correct for inequities caused by moving to a PPS (not the legislated
reduction in total payment). Therefore, we based our decision about
adjustments on these percentage differences rather than percentages
combining the PPS and the overall reduction in coinsurance amounts
required by law. We also estimated payment-to-cost ratios associated
with the new payment methods and the percent change in total Medicare
payments. All simulations used a labor share of 60 percent. The table
below shows the results of two simulations. The first contains only the
wage index adjustment to the APC rates. The second also includes the
threshold adjustment for teaching intensity discussed above.
Based on our analyses, we are not proposing to make adjustments to
the outpatient payment rates for disproportionate share patient
percentage and teaching intensity and rural location for the following
reasons.
1. Estimated effects of disproportionate share patient percentage
on costs were small and most often not statistically significant.
2. After removing the copay effect, most teaching hospitals gain
under the proposed system payments relative to current law. Although
teaching hospitals with a large number of residents relative to
outpatient and inpatient utilization demonstrate slightly higher costs,
targeting these hospitals with a small adjustment does not greatly
improve their payment
[[Page 35261]]
impacts. These impacts should also be evaluated in terms of the overall
effect on Medicare payments because on average, outpatient services
account for 10 percent of hospitals' Medicare payments. For example,
the associated reduction of total Medicare payments for major teaching
hospitals would be about 1 percent.
3. With the teaching adjustment we considered, estimated overall
payment reductions for rural hospitals would be 7.9 percent under the
proposed system, rather than 7.4 percent. These hospitals also receive
a greater percent of their Medicare income (14.7 percent) from
providing outpatient services. Similarly, payment reductions for low-
volume rural hospitals would be 17.8 percent of current payments,
rather than 17.4 percent, and these hospitals also earn a greater
percentage of their Medicare income (18.4 percent) from providing
outpatient services. Because of these potential shifts in payments, any
adjustment should be based on stronger analytic results then those
found with the current data.
4. We also believe the issue of payment adjustments should be
reexamined using data from initial years of the implemented system
because current cost calculations and relationships among key factors
and costs probably are affected by variation in coding patterns.
5. HCFA is working towards standardizing payment across all sites
of service. Fewer adjustments to the outpatient PPS would allow HCFA to
move ahead more quickly with this approach.
6. We believe that we should monitor the impact of basing APC
weight calculations on the median rather than the geometric mean
because better correlation between costs and service mix would impact
the size of adjustments.
Although the payment simulations show potentially large percentage
losses and low payment-to-cost ratios for low-volume hospitals, we are
not proposing an adjustment for volume. The low-volume hospitals get a
much greater percent of their Medicare income from the provision of
outpatient services than the average, and total Medicare payments would
drop by 3.2 percent for rural low-volume hospitals and 1.7 percent for
urban low-volume hospitals. Low-volume hospitals have higher than
average standardized unit costs, which may be attributable to economies
of scale, undercoding, or cost allocations to the outpatient
departments that are not volume related. However, an adjustment to the
rates based on volume alone might reward inefficiency and create
adverse incentives such as a reduction in services in order to increase
payment rates.
We are particularly concerned about the potential impact of the
outpatient PPS on low-volume rural hospitals that are sole community
hospitals or Medicare-dependent hospitals.
39a. On page 47585, column two, first full paragraph, line six, the
sentence beginning ``Approximately 60 percent * * * is removed.
39b. On page 47585, the text in column three, first full paragraph,
through the third full paragraph is removed and replaced with the
following:
We also are not proposing adjustments for cancer or TEFRA hospitals
at this time. We believe that claims from cancer and TEFRA hospitals
have been undercoded, due to the lack of payment incentives for proper
coding of these services under the current system. Further analysis
will be conducted to determine if current coding practices explain the
negative impact. If we determine that cancer hospitals would be unduly
harmed because of the new outpatient PPS, we will consider whether an
adjustment or perhaps a transition period is needed to moderate the
impact. By statute, any adjustment would have to be budget neutral.
We do not believe that this action will restrict beneficiary access
because other hospitals provide many of the same services provided at
TEFRA hospitals. In addition, rehabilitation and long-term care
hospitals are less dependent than other hospitals on Medicare
outpatient revenues.
We are not proposing adjustments for any eye and ear hospitals
because payment simulations demonstrated an increase in payments under
the proposed PPS. We also are not proposing an adjustment for trauma
hospitals because these hospitals did not demonstrate significantly
higher costs and only lose a modest percentage of their total Medicare
payments, 0.8 percent, compared to all hospitals. We will assess the
need for additional adjustments and make any appropriate changes as
data become available under the new system.''
40. On pages 47583 through 47584, the table ``Changes for 1999
Outpatient Prospective Payment System'' is retitled ``Changes for
Outpatient Prospective Payment Systems'' and is corrected to read as
follows:
Changes for Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
No teaching adjustment Teaching adjustment
---------------------------------------------------------------------------------------
Percent Percent
change Percent change Percent
Number of Outpatient in Copay Standardized change in Copay Standardized change
hospitals percent Medicare Effect payment to is total Medicare Effect payment to in total
out- removed cost ratio Medicare out- removed cost ratio Medicare
patient payments patient payments
payments payments
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL HOSPITALS............................ 5,335 9.9 -5.7 0.0 1.0000 -0.6 -5.7 0.0 1.0000 -0.6
NON-TEFRA HOSPITALS..................
4,818 10.0 -5.7 0.0 1.0001 -0.6 -5.7 0.0 1.0001 -0.6
NON-TEFRA HOSPITALS
GEOGRAPHIC LOCATION:
URBAN HOSPITALS...................... 2,643 9.3 -5.3 0.4 1.0053 -0.5 -5.2 0.5 1.0065 -0.5
LARGE URBAN AREAS................ 1,492 9.1 -6.6 -0.9 0.9890 -0.6 -6.3 -0.6 0.9928 -0.6
OTHER URBAN AREAS................ 1,151 9.6 -3.5 2.4 1.0287 -0.3 -3.7 2.1 1.0262 -0.4
RURAL HOSPITALS...................... 2,173 14.7 -7.4 -1.8 0.9784 -1.1 -7.9 -2.3 0.9734 -1.2
VOLUME (URBAN):
0-4,999 UNITS........................ 357 12.2 -13.6 -8.3 0.8493 -1.7 -13.9 -8.7 0.8458 -1.7
5,000-10, 999 UNITS.................. 502 9.6 -6.6 -0.9 0.9577 -0.6 -7.0 -1.3 0.9535 -0.7
11,000-20,999 UNITS.................. 597 9.0 -5.7 0.0 0.9839 -0.5 -6.1 -0.4 0.9802 -0.5
21,000-42,999 UNITS.................. 756 8.8 -4.2 1.6 1.0202 -0.4 -4.4 1.4 1.0180 -0.4
43,000 OR MORE UNITS................. 431 9.7 -5.7 0.0 1.0133 -0.6 -5.1 0.7 1.0201 -0.5
[[Page 35262]]
VOLUME (RURAL):
0-4,999 UNITS........................ 1,047 18.4 -17.4 -12.4 0.8216 -3.2 -17.8 -12.8 0.8170 -3.3
5,000-10,999 UNITS................... 601 15.3 -10.1 -4.6 0.9384 -1.5 -10.6 -5.2 0.9332 -1.6
11,000- 20,999 UNITS................. 333 13.7 -6.5 -0.8 0.9962 -0.9 -7.0 -1.4 0.9910 -1.0
21,000- 42,999 UNITS................. 170 13.5 -3.2 2.7 1.0435 -0.4 -3.7 2.2 1.0376 -0.5
43,000 OR MORE UNITS................. 22 13.3 -2.6 +3.3 1.0674 -0.3 -2.6 3.3 1.0677 -0.3
TEACHING STATUS:
NON-TEACHING......................... 3,814 11.2 -5.1 0.7 1.0029 -0.6 -5.6 0.1 0.9973 -0.6
FEWER THAN 100 RESIDENTS............. 758 9.1 -4.4 1.4 1.0256 -0.4 -4.9 0.9 1.0204 -0.4
100 OR MORE RESIDENTS................ 245 9.2 -10.6 -5.2 0.9414 -1.0 -7.9 -2.3 0.9697 -0.7
DISPROPORTIONATE SHARE PATIENT RATIO:
0.................................... 17 20.3 -20.0 -15.1 0.7376 -4.1 -20.0 -15.1 0.7377 -4.1
0.001-0.099.......................... 904 10.3 -6.6 -0.9 0.9860 -0.7 -6.9 -1.2 0.9825 -0.7
0.100-0.159.......................... 1,008 10.9 -3.7 2.2 1.0307 -0.4 -4.1 1.7 1.0261 -0.4
0.160-0.229.......................... 971 10.2 -4.8 1.0 1.0143 -0.5 -4.9 0.9 1.0132 -0.5
0.230-0.349.......................... 956 9.6 -6.2 -0.5 0.9977 -0.6 -6.0 -0.3 1.0001 -0.6
0.350 AND GREATER.................... 962 9.2 -8.4 -2.9 0.9579 -0.8 -7.5 -1.9 0.9675 -0.7
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: Urban and rural breakouts in this table are based on MSA status/location only.
41. On page 47596, in the table titled ``Estimated Annual Burden'',
column one, line two, ``419.42(b) and (d)'' is corrected to read
``419.42(b) and (c)''.
42. On page 47596, in the table titled ``Estimated Annual Burden'',
column one, line three, ``419.42(f)'' is corrected to read
``419.42(e)''.
42a. On page 47597, column one, first full paragraph, line 14,
``$300'' is corrected to read ``$600''.
42b. On page 47597, column two, the table is corrected to read as
follows:
------------------------------------------------------------------------
Impact ($
Fiscal year millions)
------------------------------------------------------------------------
1998.................................................... -940
1999.................................................... -1640
2000.................................................... -1320
2001.................................................... -1070
2002.................................................... -990
2003.................................................... -700
------------------------------------------------------------------------
42c. On page 47597, column two, line five of text, ``6.9'' is
corrected to read ``10.9''.
43. On pages 47597 through 47598, entire section F. is removed and
replaced with the following:
F. Quantitative Impact Analysis of the Proposed Policy Changes Under
the Prospective Payment System for Operating Costs and Capital Costs
Basis and Methodology of Estimates
The data used in developing quantitative analyses presented below
are taken from the CY 1996 cost and charge data and the most current
provider-specific file that is used for payment purposes. Our analysis
has several qualifications. First, we draw upon various sources for the
data used to categorize hospitals in the tables. In some cases, there
is a fair degree of variation in the data from different sources. We
have attempted to construct these variables with the best available
source overall. For individual hospitals, however, some
miscategorizations are possible.
Using CY 1996 cost and charge data, we simulated payments using the
current and proposed payment methodologies. We used both single and
multiple bills to calculate current and proposed Medicare and
beneficiary hospital outpatient payment amounts. Both current and
proposed payment estimates include operating and capital costs. We
excluded Kaiser, New York Health and Hospital Corporation, and all-
inclusive providers because reported charges on their cost reports are
not actual charges. Cost-to-charge ratios for these hospitals are not
comparable to all other hospitals. The exempted Maryland hospitals were
also excluded from the simulations; however, we included the 10 cancer
hospitals that will be paid under the proposed system.
We also trimmed outlier hospitals from the impact analysis because
we had indications that hospitals with extreme unit costs would not
allow us to access the impacts among the various classes of hospitals
accurately. First, we identified all the outlier hospitals by using an
edit of three standard deviations from the mean of the logged unit
costs. Trimming the data in this manner ensures that only the hospitals
with extremely high and low costs are eliminated from the impacts. In
doing this, we removed 96 hospitals of which 50 hospitals had extremely
low unit costs and 46 hospitals had extremely high unit costs. We
conducted a thorough analysis of these hospitals to ensure that we did
not remove any particular type of hospital (for example, teaching
hospitals) that would further harm the integrity of the data. We
speculate many of these hospitals are not coding accurately, and we
will continue to perform further analysis in this area after
implementation of the new APC system.
After removing the 54 exempted Maryland hospitals, the all-
inclusive rate hospitals, the outlier hospitals, and hospitals for
which we could not identify payment variables, we included 5,335
hospitals in our analysis. The impact analysis focuses on this set of
hospitals. The table below demonstrates the results of our analysis.
The table categorizes hospitals by various geographic and special
payment consideration groups to illustrate the varying impacts on
different types of hospitals. The first column represents the number of
hospitals in each category. The second column is the hospitals'
Medicate outpatient payments as a percentage of the hospitals' total
Medicare payment. The third column shows the percentage change in
Medicare outpatient payments comparing the current and proposed payment
systems. The fourth column shows the change in total Medicare
[[Page 35263]]
payments, resulting from implementing the PPS for outpatient services.
The top row of the table shows the overall impact on the 5,335
hospitals included in the analysis. We included as much of the data as
possible to the extent that we were able to capture all the provider
information necessary to determine payment. Further, our estimates
include the same set of services for both current and proposed APC
payments so that we could determine the impact as accurately as
possible. Since payment under the proposed APC system can only be
determined if bills are accurately coded, the data upon which the
impacts were developed do not reflect all CY 1996 hospital outpatient
services, but only those that were coded using valid HCPCS.
The second row identifies the hospitals in our analysis with the
exception of psychiatric, long-term care, children, and rehabilitation
hospitals, which account for 4,818 hospitals.
The next four rows of the table contain hospitals categorized
according to their geographic location (all urban, which is further
divided into large urban and other urban, or rural). There are 2,643
hospitals located in urban areas (MSAs or NECMAs) included in our
analysis. Among these, there are 1,492 hospitals located in large urban
areas (populations over 1 million), and 1,151 hospitals in other urban
areas (populations of 1 million or fewer). In addition, there are 2,173
hospitals in rural areas. The next two groupings are by bed-size
categories, shown separately for urban and rural hospitals. The next
category includes the volume of outpatient services, also shown
separately for urban and rural hospitals. The final groupings by
geographic location are by census divisions, also shown separately for
urban and rural hospitals.
The next three groupings examine the impacts of the proposed
changes on hospitals grouped by whether or not they have residency
programs (teaching hospitals that receive an indirect medical education
(IME) adjustment), receive disproportionate share hospital (DSH)
payments, or some combination of these two adjustments. There are 3,814
non-teaching hospitals in our analysis, 758 teaching hospitals with
fewer than 100 residents, and 245 teaching hospitals with 100 or more
residents.
In the DSH categories, hospitals are grouped according to their DSH
payment status. The next category groups hospitals considered urban
after geographic reclassification, in terms of whether they receive the
IME adjustment, the DSH adjustment, both, or neither. The next five
rows examine the impacts of the proposed changes on rural hospitals by
special payment groups (rural referral centers (RRCs), sole community
hospitals/essential access community hospitals (SCHs/EACHs), Medicare
dependent hospitals (MDHs), and SCHs and RRCs), as well as rural
hospitals not receiving a special payment designation. The RRCs (168),
SCH/EACHs (626), MDHs (365), and SCH and RRCs (55) shown here were not
reclassified for purposes of the standardized amount.
The next grouping is based on type of ownership. These data are
taken primarily from the FY 1995 Medicare cost report files, if
available (otherwise, FY 1994 data are used).
The next groupings are the specialty hospitals. The first set
includes the categorizations of eye and ear hospitals and trauma
hospitals (hospitals having a level one trauma center) and cancer
hospitals. The final groupings are the TEFRA hospitals, specifically
rehabilitation, psychiatric, long-term care, and children hospitals.
43a. On page 47598, the text in section G. Beginning in column two,
first full paragraph, through page 47599, column three, line 16, is
removed and replaced with the following:
G. Estimated Impact of the New APC System
Column 3 compares our estimate of payments, incorporating statutory
and policy changes reflected in this proposed rule for CY 1996, to our
estimate of payments in CY 1996 under the current payment system.
Percent differences between current and proposed payment reflect the
combined impact of a proportionally equal reduction in payments due to
the calculation of the conversion factor and distributional differences
attributable to variation in cost and charge structures among
hospitals. The methodology described in section 1833(t)(3)(C) of the
Act outlining the calculation of the conversion factor reduces payment
to hospitals overall by 5.7 percent relative to current law. As noted,
section 1833(t)(3)(C) of the Act requires us to set the conversion
factor so that total 1999 payments to hospitals under the proposed PPS
system equal Medicare payment amounts as calculated under the current
payment system plus beneficiary copayments as calculated under the
proposed system (20 percent of the APC median charge or, at minimum, 20
percent of the APC rate). The 5.7 percent loss implies that the
difference between the median and charges higher than the median was
proportionally larger than the difference between the median and
charges lower than the median. Because this reduction is incorporated
into the conversion factor, the 5.7 percent is distributed among
hospitals proportional to their total payments. After removing the
effect of the conversion factor calculation on total payments, the
remaining percent differences demonstrate the redistribution of
payments among hospitals and can be attributed to variation in both
costs and charge structures. Variation in costs among hospitals results
in differences between current and proposed Medicare payments, and
variation in charge structures results in differences between current
and proposed beneficiary copayment.
Redistributions may also occur as a result of current payment
methods. Total Medicare outpatient payments are less than reported
total costs because (in addition to the 5.8 and 10 percent reductions
for operating and capital costs) the blended payment methods applicable
to many surgical and diagnostic services often result in payments that
are less than reported costs. Other services such as medical visits,
chemotherapy services, and non-ASC approved surgeries are paid based on
hospital costs. The new system redistributes the current total Medicare
payments, based in part on cost-based payments and in part on blended
payment amounts, across all services. Hospitals, in the aggregate, will
receive proportionately less for services that are currently paid based
on costs and more for services that had been paid under blended payment
methods.
The impact on TEFRA hospitals is shown separately at the end of the
table; however, these hospitals were not included in determining the
impact on any of the other categories (for example, geographic
location, bed size, volume, etc.). These hospitals demonstrated a very
low service mix, but an average unit cost that approximates the
national average. We believe that billing practices may account for
this phenomenon. Some TEFRA hospitals appear to undercode HCPCS and
units. This may be because correct coding is not required for payment
or because they bill an all-inclusive rate. Undercoding or billing an
all-inclusive rate could account for their low-volume, low-service mix,
and average cost per unit. We expect that once these hospitals begin to
code HCPCS according to the new payment system, new payments will
better reflect current payments.
In general, differences among hospital classifications for short-
term acute care
[[Page 35264]]
hospitals were relatively small. This is, payments under the proposed
outpatient system were within a few percentage points of payments made
under current law. The following discussion highlights some of the
variation in payments among hospital classifications.
Based on comparing current and proposed payment estimates, minor
teaching hospitals lose 4.4 percent, while major teaching hospitals
experience a reduction of 10.6 percent. Non-teaching hospitals
experience a decrease of 5.1 percent. However, major teaching hospitals
gain less of their total Medicare income (9.2 percent) from outpatient
services than the national average (10 percent). This results in a 1
percent loss in their total Medicare income.
Hospitals with a high percentage of low-income patients
(disproportionate share patient percentage greater than or equal to
0.35) appear to experience payment reductions of 8.4 percent relative
to current law. These hospitals have lower than average volume, and
like major teaching hospitals, they receive a smaller than average
percent of their Medicare income from outpatient services.
Rural hospitals would lose about 7.4 percent, large urban hospitals
would lose about 6.6 percent, and other urban hospitals would lose 3.5
under the new system. Rural hospitals get a greater percentage of their
Medicare income (14.7 percent) from outpatient services compared to the
national average of 10 percent.
Low-volume hospitals appear to lose a large percentage of their
payments under the new payment system (17.4 percent for rural and 13.6
percent for urban hospitals with less than 5,000 units of service). We
believe several factors are contributing to this outcome, including
undercoding, lack of economies of scale, and underpayment due to the
reliance on the median instead of the geometric mean in the calculation
of APC weights. The majority of these hospitals (about 75 percent) are
rural. For these small hospitals, some of the higher standardized unit
costs could be attributed to economies of scale. These low-volume rural
hospitals also receive a greater percentage of their Medicare income
(18.4 percent) from outpatient services than the average.
43b. On page 47599, the table titled: Estimated Impact of a
Transition Policy on Medicare Outpatient Payment for Medicare-Dependent
and Sole Community Hospitals,'' is corrected to read as follows:
Estimated Impact of a Transition Policy on Medicare Outpatient Payments
for Medicare-Dependent and Sole Community Hospitals
[In percent]
------------------------------------------------------------------------
Year 1 Year 2 Year 3 Year 4
------------------------------------------------------------------------
MDH......................... -2.8 -5.6 -8.5 -11.3
SCH......................... -3.2 -6.4 -9.7 -12.9
SCH/RRC..................... -1.9 -3.8 -5.8 -7.7
------------------------------------------------------------------------
43c. On page 47599, the text in section G. beginning in column two,
line seven from the bottom through page 47600, is corrected to read as
follows:
As noted above, rural hospitals lose a larger percent of their
payments than urban hospitals. Among the census divisions, rural New
England hospitals experience the largest negative payment impact of
12.2 percent. This could be attributed to higher nonlabor costs in New
England.
Urban census division breakouts reveal that Middle Atlantic urban
hospitals have the largest negative payment impact of 9.7 percent.
Hospitals located in Puerto Rico gain because of the change in the
beneficiary copayment. Previously these hospitals received 20 percent
of their charges from the beneficiary, whereas under the new PPS they
would receive 20 percent of the APC median charge or, at minimum, they
would receive 20 percent of the payment rate. Hospitals in Puerto Rico
gain under the new proposed system because 20 percent of their charges
are lower than 20 percent of the APC median charges or 20 percent of
the rates
Among special categories of rural hospitals, MDHs and SCHs/EACHs
would experience decreases of 11.3 and 12.9 percent, respectively, Some
of this decrease may be attributed to the impact on low-volume rural
hospitals.
Cancer hospitals experience a 32.4 percent loss. Several factors
may contribute to this loss. Undercoding could be a factor contributing
to the percentage loss. In addition, the current requirements for batch
billing of services such as chemotherapy and radiation therapy and the
fact that we used only single procedure bills to calculate group
weights may also have contributed to the impact on these hospitals.
Further analysis will be conducted to determine if current coding
practices explain the negative impact. We will be verifying the
accuracy of the rates for these types of procedures. Specifically, the
APC weights were calculated using single bill procedures. Using single
bill procedures to compute a weight for services that are not typically
billed as a single procedure could result in rates that are not
accurate for these services. We will verify the accuracy of the rates
for these types of procedures by analyzing the costs from the multiple
bills. If further analysis reveals that cancer hospitals would be
unduly harmed because of the new outpatient PPS, we will consider
whether an adjustment or perhaps a transition period is needed to
moderate the impact. By statute, any adjustment would have to be budget
neutral. Until further analysis can be conducted, we are not proposing
an adjustment for cancer hospitals.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
44. On pages 47601 through 47604, the table titled ``Changes for
Outpatient Prospective Payment System'' is re-titled ``Impact of
Outpatient Prospective Payment System'' and corrected to read as
follows:
[[Page 35265]]
Impact of Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
Percent Percent
change in change in
Number of Outpatient Medicare total
hospitals percent outpatient Medicare
payments payments
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS............................................... 5,335 9.9 -5.7 -0.6
NON-TEFRA HOSPITALS.....................................
4,819 10.0 -5.7 -0.6
NON-TEFRA HOSPITALS
GEOGRAPHIC LOCATION:
URBAN HOSPITALS......................................... 2,643 9.3 -5.3 -0.5
LARGE URBAN AREAS................................... 1,492 9.1 -6.6 -0.6
OTHER URBAN AREAS................................... 1,151 9.6 -3.5 -0.3
RURAL HOSPITALS......................................... 2,173 14.7 -7.4 -1.1
BED SIZE (URBAN):
0-99 BEDS............................................... 646 15.4 -7.3 -1.1
100-199 BEDS............................................ 910 10.4 -4.2 -0.4
200-299 BEDS............................................ 531 9.2 -3.8 -0.3
300-499 BEDS............................................ 418 8.6 -4.8 -0.4
500 OR MORE BEDS........................................ 138 8.3 -9.7 -0.8
BED SIZE (RURAL):
0-49 BEDS............................................... 1,138 19.6 -13.8 -2.7
50-99 BEDS.............................................. 641 15.5 -8.4 -1.3
100-149 BEDS............................................ 229 13.5 -6.0 -0.8
150-199 BEDS............................................ 91 13.0 -4.3 -0.6
200 OR MORE BEDS........................................ 74 11.4 -2.9 -0.3
VOLUME (URBAN):
0-4,999 UNITS........................................... 357 12.2 -13.6 -1.7
5,000-10,999 UNITS...................................... 502 9.6 -6.6 -0.6
11,000-20,999 UNITS..................................... 597 9.0 -5.7 -0.5
21,000-42,999 UNITS..................................... 756 8.8 -4.2 -0.4
43,000 OR MORE UNITS.................................... 431 9.7 -5.7 -0.6
VOLUME (RURAL):
0-4,999 UNITS........................................... 1,047 18.4 -17.4 -3.2
5,000-10,999 UNITS...................................... 601 15.3 -10.1 -1.5
11,000-20,999 UNITS..................................... 333 13.7 -6.5 -0.9
21,000-42,999 UNITS..................................... 170 13.5 -3.2 -0.4
43,000 OR MORE UNITS.................................... 22 13.3 -2.6 -0.3
URBAN BY CENSUS DIV.:
NEW ENGLAND............................................. 148 10.8 -3.2 -0.3
MIDDLE ATLANTIC......................................... 391 8.3 -9.7 -0.8
SOUTH ATLANTIC.......................................... 393 8.6 -5.8 -0.5
EAST NORTH CENTRAL...................................... 446 10.6 -4.3 -0.5
EAST SOUTH CENTRAL...................................... 158 7.9 -1.8 -0.1
WEST NORTH CENTRAL...................................... 187 9.5 -6.5 -0.6
WEST SOUTH CENTRAL...................................... 337 9.7 -7.4 -0.7
MOUNTAIN................................................ 120 10.3 -2.2 -0.2
PACIFIC................................................. 428 9.3 -1.8 -0.2
PUERTO RICO............................................. 35 6.6 8.5 0.6
RURAL BY CENSUS DIV.:
NEW ENGLAND............................................. 56 16.9 -12.2 -2.1
MIDDLE ATLANTIC......................................... 81 13.5 0.2 0.0
SOUTH ATLANTIC.......................................... 282 11.8 -7.7 -0.9
EAST NORTH CENTRAL...................................... 287 15.8 -6.1 -1.0
EAST SOUTH CENTRAL...................................... 266 11.2 -6.5 -0.7
WEST NORTH CENTRAL...................................... 516 19.6 -10.9 -2.1
WEST SOUTH CENTRAL...................................... 339 14.2 -10.6 -1.5
MOUNTAIN................................................ 207 16.7 -8.3 -1.4
PACIFIC................................................. 137 16.4 -3.4 -0.6
PUERTO RICO............................................. 2 6.6 28.5 1.9
TEACHING STATUS:
NON-TEACHING............................................ 3,814 11.2 -5.1 -0.6
FEWER THAN 100 RESIDENTS................................ 758 9.1 -4.4 -0.4
100 OR MORE RESIDENTS................................... 245 9.2 -10.6 -1.0
DISPROPORTIONATE SHARE PATIENT RATIO:
0....................................................... 17 20.3 -20.0 -4.1
0.001-0.099............................................. 904 10.3 -6.6 -0.7
0.100-0.159............................................. 1,008 10.9 -3.7 -0.4
0.160-0.229............................................. 971 10.2 -4.8 -0.5
0.230-0.349............................................. 956 9.6 -6.2 -0.6
0.350 AND GREATER....................................... 962 9.2 -8.4 -0.8
[[Page 35266]]
URBAN TEACHING AND DSH:
BOTH TEACHING AND DSH................................... 944 9.0 -6.6 -0.6
TEACHING AND NO DSH..................................... 2 19.8 -31.0 -6.1
NO TEACHING AND DSH..................................... 1,688 9.8 -3.7 -0.4
NO TEACHING AND NO DSH.................................. 9 30.4 7.2 2.2
RURAL HOSPITAL TYPES:
NONSPECIAL STATUS HOSPITALS............................. 944 15.0 -6.8 -1.0
RRC..................................................... 168 12.4 -2.3 -0.3
SCH/EACH................................................ 626 16.4 -12.9 -2.1
MDH..................................................... 365 18.2 -11.3 -2.1
SCHM/EACH AND RRC....................................... 55 13.7 -7.7 -1.1
TYPE OF OWNERSHIP:
VOLUNTARY............................................... 2,839 9.9 -5.6 -0.6
PROPRIETARY............................................. 671 7.9 -4.7 -0.4
GOVERNMENT.............................................. 1,308 12.3 -7.4 -0.9
SPECIALTY HOSPITALS:
EYE AND EAR............................................. 10 31.1 10.4 3.2
TRAUMA.................................................. 157 9.1 -8.4 -0.8
CANCER.................................................. 10 22.0 -32.4 -7.1
TEFRA HOSPITALS:
REHABILITATION.......................................... 138 3.7 -11.1 -0.4
PSYCHIATRIC............................................. 278 10.7 -0.5 -0.1
LONG-TERM CARE.......................................... 63 3.7 -19.6 -0.7
CHILDREN'S.............................................. 38 9.4 -23.9 -2.2
----------------------------------------------------------------------------------------------------------------
Note: Urban and rural breakouts in this table are based on MSA status/location only.
Correction to the Regulations Text
Sec. 419.32 [Corrected]
45. On page 47613, in the regulations text, in column one, in
paragraph (b)(1), in the second line, ``paragraph (c)(2)'' is corrected
to read ``paragraph (b)(2)''; and in paragraph (b)(2), in the fourth
line, ``paragraph (c)(1)'' is corrected to read ``paragraph (b)(1)''.
Corrections to the Addenda
46. On pages 47615 through 47620, Addendum A is corrected to read
as follows:
Addendum A.--List of Proposed Hospital Outpatient Ambulatory Payment Classes with Status Indicators, Relative
Weights, Payment Rates, and Coinsurance Amounts
----------------------------------------------------------------------------------------------------------------
\7\ Minimum
APC Group title Status Relative Payment National unadjusted
indicator weight rate unadjusted coinsurance
----------------------------------------------------------------------------------------coinsurance-------------
\6\ 020 Partial ................... P 4.02 $206.71 $46.78 $41.34
Hospitalizaiton.
031 Dental procedures.. ................... S 1.37 $70.45 $14.09 $14.09
061 Level I ................... X 1.15 $59.13 $37.52 $11.83
Chemotherapeutic
agents.
062 Level II ................... X 1.78 $91.53 $36.61 $18.31
Chemotherapeutic
agents.
063 Level III ................... X 2.94 $151.17 $110.97 $30.24
Chemotherapeutic
agents.
064 Level IV ................... X 4.15 $213.39 $138.99 $42.68
Chemotherapeutic
agents.
089 Neuropsychological ................... X 4.06 $208.77 $46.10 $41.75
Testing.
090 Monitoring ................... X 0.85 $43.71 $12.20 $8.74
psychiatric drugs.
\1\ 091 Brief Individual ................... S 1.09 $56.05 $14.01 $11.21
Psychotherapy.
\2\ 092 Extended Individual ................... S 1.63 $83.81 $21.47 $16.76
Psychotherapy.
093 Family ................... S 1.56 $80.22 $20.11 $16.04
Psychotherapy.
094 Group Psychotherapy ................... S 1.31 $67.36 $19.89 $13.47
121 Level I needle ................... T 0.63 $32.39 $21.02 $6.48
biopsy/aspiration.
122 Level II needle ................... T 4.59 $236.02 $113.00 $47.20
biopsy/aspiration.
131 Level I incision & ................... T 1.93 $99.24 $36.61 $19.85
drainage.
132 Level II incision & ................... T 5.63 $289.49 $132.89 $57.90
drainage.
137 Nail procedures.... ................... T 0.60 $30.85 $9.27 $6.17
141 Level I Destruction ................... T 0.52 $26.74 $9.49 $5.35
of lesion.
142 Level II ................... T 2.94 $151.17 $54.24 $30.24
Destruction of
lesion.
151 Level I debridement/ ................... T 1.63 $83.81 $33.22 $16.76
destruction.
152 Level II ................... T 10.07 $517.80 $251.54 $103.56
debridement/
destruction.
161 Level I excision/ ................... T 3.43 $176.37 $75.71 $35.27
biopsy.
162 Level II excision/ ................... T 5.59 $287.44 $125.66 $57.49
biopsy.
163 Level III excision/ ................... T 10.48 $538.88 $260.80 $107.78
biopsy.
181 Level I skin repair ................... T 2.17 $111.58 $44.07 $22.32
182 Level II skin ................... T 4.11 $211.34 $92.43 $42.27
repair.
183 Level III skin ................... T 11.04 $567.68 $283.18 $113.54
repair.
[[Page 35267]]
184 Level IV skin ................... T 14.85 $763.59 $397.99 $152.72
repair.
197 Incision/excision ................... T 11.94 $613.95 $308.26 $122.79
breast.
198 Breast ................... T 18.63 $957.95 $523.42 $191.59
reconstruction/
mastectomy.
200 Arthrocentesis & ................... T 1.76 $90.50 $39.10 $18.10
Ligament/Tendon
Injection.
207 Closed treatment ................... T 1.70 $87.41 $32.32 $17.48
fracture finger/
toe/trunk.
209 Closed treatment ................... T 1.94 $99.75 $37.74 $19.95
fracture/
dislocation/except
finger/toe/trunk.
210 Bone/joint ................... T 10.06 $517.29 $279.34 $103.46
manipulation under
anesthesia.
216 Open/percutaneous ................... T 20.09 $1,033.03 $524.09 $206.61
treatment fracture
or dislocation.
217 Arthroplasty....... ................... T 20.54 $1,056.17 $530.42 $211.23
218 Arthroplasty with ................... T 27.80 $1,429.48 $720.71 $285.90
prosthesis.
226 Maxillofacial ................... T 1.56 $80.22 $21.92 $16.04
prostheses.
231 Level I skull and ................... T 11.31 $581.56 $286.79 $116.31
facial bone
procedures.
232 Level II skull and ................... T 23.82 $1,224.82 $636.87 $244.96
facial bone
procedures.
251 Level I ................... T 13.88 $713.71 $365.89 $142.74
musculoskeletal
procedures.
252 Level II ................... T 19.24 $989.32 $512.34 $197.86
Musculoskeletal
Procedures.
253 Level III ................... T 25.74 $1,323.55 $684.55 $264.71
Musculoskeletal
Procedures.
254 Level IV ................... T 32.70 $1,681.43 $922.98 $336.29
Musculoskeletal
Procedures.
261 Level I Hand ................... T 10.41 $535.28 $259.00 $107.06
Musculoskeletal
Procedures.
262 Level II Hand ................... T 18.07 $929.16 $475.96 $185.83
Musculoskeletal
Procedures.
271 Level I Foot ................... T 14.12 $726.05 $365.44 $145.21
Musculoskeletal
Procedures.
272 Level II Foot ................... T 16.11 $828.38 $411.09 $165.68
Musculoskeletal
Procedures.
276 Bunion Procedures.. ................... T 19.00 $976.98 $495.39 $195.40
280 Diagnostic ................... T 22.15 $1,138.95 $581.72 $227.79
Arthroscopy.
281 Level I Surgical ................... T 22.37 $1,150.27 $589.18 $230.05
Arthroscopy.
282 Level II Surgical ................... T 23.65 $1,216.08 $609.97 $243.22
Arthroscopy.
286 Arthroscopically- ................... T 27.69 $1,423.82 $791.90 $284.76
Aided Procedures.
311 Level I ENT ................... T 1.41 $72.50 $20.57 $14.50
Procedures.
312 Level II ENT ................... T 7.07 $363.54 $170.86 $72.71
Procedures.
313 Level III ENT ................... T 15.46 $794.95 $407.70 $158.99
Procedures.
314 Level IV ENT ................... T 25.15 $1,293.21 $687.72 $258.64
Procedures.
\5\ 317 Implantation of ................... T ......... ......... ........... ...........
Cochlear Device.
318 Nasal Cauterization/ ................... T 2.07 $106.44 $38.87 $21.29
Packing.
319 Tonsil/Adenoid ................... T 16.20 $833.00 $463.53 $166.60
Procedures.
320 Thoracentesis/ ................... T 3.09 $158.89 $80.91 $31.78
Lavage Procedures.
331 Level I Endoscopy ................... T 0.57 $29.31 $14.01 $5.86
Upper Airway.
332 Level II Endoscopy ................... T 9.67 $497.23 $242.72 $99.45
Upper Airway.
333 Level III Endoscopy ................... T 16.81 $864.37 $461.04 $172.87
Upper Airway.
336 Endoscopy Lower ................... T 7.24 $372.28 $195.49 $74.46
Airway.
339 Injection of ................... T 0.98 $50.39 $19.66 $10.08
Sclerosing
Solution.
341 Level I Needle and ................... T 0.09 $4.63 $2.49 $0.93
Catheter Placement.
342 Level II Needle and ................... T 2.61 $134.21 $68.70 $26.84
Catheter Placement.
343 Level III Needle ................... T 8.76 $450.44 $240.24 $90.09
and Catheter
Placement.
346 Placement ................... T 4.63 $238.07 $121.59 $47.61
Transvenous Caths/
Cutdown.
347 Injection ................... T 2.57 $132.15 $62.38 $26.43
Procedures for
Interventional
Radiology.
360 Removal/Revision, ................... T 6.04 $310.58 $138.54 $62.12
Pacemaker/Vascular
Device.
367 Vascular Ligation.. ................... T 17.02 $875.17 $441.15 $175.03
368 Vascular Repair/ ................... T 22.59 $1,161.58 $647.49 $232.32
Fistula
Construction.
369 Blood and Blood ................... T 6.33 $325.49 $155.49 $65.10
Product Exchange.
396 Lymph Node ................... T 12.98 $667.43 $334.48 $133.49
Excisions.
397 Thyroid/ ................... T 19.12 $983.15 $542.17 $196.63
Lymphadenectomy
Procedures.
406 Esophageal Dilation ................... T 4.17 $214.42 $106.67 $42.88
without Endoscopy.
407 Esophagoscopy...... ................... T 6.89 $354.28 $189.39 $70.86
417 Diagnostic Upper GI ................... T 6.35 $326.52 $179.22 $65.30
Endoscopy.
418 Therapeutic Upper ................... T 7.44 $382.56 $213.57 $76.51
GI Endoscopy.
419 Small Intestine ................... T 6.83 $351.20 $164.08 $70.24
Endoscopy.
426 Diagnostic Lower GI ................... T 6.74 $346.57 $185.32 $69.31
Endoscopy.
427 Therapeutic Lower ................... T 8.09 $415.99 $222.84 $83.20
GI Endoscopy.
437 Therapeutic ................... T 6.54 $336.29 $173.79 $67.26
Anoscopy.
446 Diagnostic ................... T 2.54 $130.61 $64.86 $26.12
Sigmoidoscopy.
447 Therapeutic ................... T 7.06 $363.03 $191.87 $72.61
Proctosigmoidoscop
y.
448 Therapeutic ................... T 5.28 $271.50 $139.22 $54.30
Flexible
Sigmoidoscopy.
449 Complex GI ................... T 7.63 $392.33 $213.57 $78.47
Endoscopy.
451 Level I Anal/Rectal ................... T 2.42 $124.44 $53.56 $24.89
Procedures.
452 Level II Anal/ ................... T 4.52 $232.42 $103.06 $46.48
Rectal Procedures.
453 Level III Anal/ ................... T 16.26 $836.09 $440.47 $167.22
Rectal Procedures.
456 Endoscopic ................... T 9.61 $494.15 $249.05 $98.83
Retrograde
Cholangio-
Pancreatography
(ERCP).
458 Percutaneous ................... T 6.81 $350.17 $181.70 $70.03
Biliary Endoscopic
Procedures.
459 Peritoneal and ................... T 17.85 $917.85 $497.88 $183.57
Abdominal
Procedures.
466 Hernia/Hydrocele ................... T 20.67 $1,062.85 $556.64 $212.57
Procedures.
470 Tube Procedures.... ................... T 2.19 $112.61 $54.92 $22.52
521 Level I ................... T 4.89 $251.44 $110.06 $50.29
Cystourethroscopy
and other
Genitourinary
Procedures.
[[Page 35268]]
522 Level II ................... T 10.15 $521.91 $259.45 $104.38
Cystourethroscopy
and other
Genitourinary
Procedures.
523 Level III ................... T 16.35 $840.72 $438.89 $168.14
Cystourethroscopy
and other
Genitourinary
Procedures.
524 Level IV ................... T 27.20 $1,398.62 $824.90 $279.72
Cystourethroscopy
and other
Genitourinary
Procedures.
527 Lithotripsy........ ................... T 43.48 $2,235.74 $1,372.95 $447.15
529 Simple Urinary ................... T 2.33 $119.81 $59.66 $23.96
Studies and
Procedures.
530 Genitourinary ................... T 2.46 $126.49 $53.34 $25.30
Procedures.
531 Level I Urethral ................... T 18.59 $955.90 $531.55 $191.18
Procedures.
532 Level II Urethral ................... T 23.02 $1,183.69 $588.50 $236.74
Procedures.
536 Circumcision....... ................... T 12.89 $662.80 $321.60 $132.56
537 Penile Procedures.. ................... T 28.65 $1,473.18 $872.36 $294.64
538 Insertion of Penile ................... T 48.41 $2,489.24 $1,563.47 $497.85
Prosthesis.
546 Testes/Epididymis ................... T 16.54 $850.49 $449.51 $170.10
Procedures.
547 Prostate Biopsy.... ................... T 4.39 $225.73 $125.20 $45.15
550 Surgical ................... T 16.46 $846.37 $445.22 $169.27
Hysteroscopy.
551 Level I Laparoscopy ................... T 24.61 $1,265.45 $701.73 $253.09
552 Level II ................... T 37.09 $1,907.17 $1,053.84 $381.43
Laparoscopy.
561 Level I Female ................... T 1.46 $75.07 $24.41 $15.01
Reproductive
Procedures.
562 Level II Female ................... T 12.30 $632.47 $325.44 $126.49
Reproductive
Procedures.
563 Level III Female ................... T 16.50 $848.43 $461.72 $169.69
Reproductive
Procedures.
567 D & C.............. ................... T 13.18 $677.72 $360.70 $135.54
568 Infertility ................... T 2.79 $143.46 $55.60 $28.69
Procedures.
578 Pregnancy and ................... T 1.17 $60.16 $32.77 $12.03
Neonatal Care
Procedures.
580 Vaginal Delivery... ................... T 4.31 $221.62 $44.32 $44.32
586 Therapeutic ................... T 11.98 $616.01 $409.29 $123.20
Abortion.
587 Spontaneous ................... T 12.96 $666.40 $347.14 $133.28
Abortion.
600 Spinal Tap......... ................... T 2.41 $123.92 $61.47 $24.78
601 Level I Nervous ................... T 3.00 $154.26 $74.13 $30.85
System Injections.
602 Level II Nervous ................... T 3.19 $164.03 $87.01 $32.81
System Injections.
616 Implantation of ................... T 11.85 $609.33 $329.06 $121.87
Neurostimulator
Electrodes.
617 Revision/Removal ................... T 11.31 $581.56 $280.01 $116.31
Neurological
Device.
618 Implantation of ................... T 24.78 $1,274.19 $808.18 $254.84
Neurological
Device.
631 Level I Nerve ................... T 12.70 $653.03 $329.06 $130.61
Procedures.
632 Level II Nerve ................... T 16.48 $847.40 $453.58 $169.48
Procedures.
648 Laser Retinal ................... T 3.76 $193.34 $93.56 $38.67
Procedures.
649 Laser Eye ................... T 4.37 $224.71 $111.64 $44.94
Procedures except
Retinal.
651 Level I Anterior ................... T 6.85 $352.23 $171.99 $70.45
Segment Eye
Procedures.
652 Level II Anterior ................... T 16.35 $840.72 $433.92 $168.14
Segment Eye
Procedures.
667 Cataract Procedures ................... T 20.35 $1,046.40 $538.11 $209.28
668 Cataract Procedures ................... T 22.02 $1,132.27 $617.21 $226.45
with IOL Insert.
670 Corneal Transplant. ................... T 30.78 $1,582.71 $885.92 $316.54
676 Posterior Segment ................... T 5.87 $301.84 $138.54 $60.37
Eye Procedures.
677 Strabismus/Muscle ................... T 16.11 $828.38 $428.95 $165.68
Procedures.
681 Level I Eye ................... T 1.65 $84.84 $30.51 $16.97
Procedures.
682 Level II Eye ................... T 3.41 $175.34 $80.68 $35.07
Procedures.
683 Level III Eye ................... T 9.56 $491.58 $252.44 $98.32
Procedures.
684 Level IV Eye ................... T 13.26 $681.83 $341.94 $136.37
Procedures.
690 Vitrectomy......... ................... T 30.39 $1,562.65 $845.69 $312.53
700 Plain Film......... ................... X 0.80 $41.14 $22.37 $8.23
706 Miscellaneous ................... X 1.43 $73.53 $39.10 $14.71
Radiological
Procedures.
710 Computerized Axial ................... S 4.98 $256.07 $173.12 $51.21
Tomography.
716 Fluoroscopy........ ................... X 1.39 $71.47 $40.00 $14.29
720 Magnetic Resonance ................... S 6.37 $327.55 $204.98 $65.51
Angiography.
726 Magnetic Resonance ................... S 7.91 $406.73 $256.06 $81.35
Imaging.
728 Myelography........ ................... S 3.50 $179.97 $91.98 $35.99
730 Arthography........ ................... S 2.30 $118.27 $65.77 $23.65
736 Digestive Radiology ................... S 1.85 $95.13 $53.79 $19.03
737 Diagnostic ................... S 2.69 $138.32 $81.81 $27.66
Urography.
738 Therapeutic ................... S 3.74 $192.31 $104.86 $38.46
Radiologic
Procedures.
739 Diagnostic ................... S 5.33 $274.07 $150.74 $54.81
Angiography and
Venography.
746 Mammography........ ................... S 0.69 $35.48 $19.44 $7.10
747 Diagnostic ................... S 1.65 $84.84 $54.47 $16.97
Ultrasound Except
Vascular.
749 Guidance under ................... X 2.22 $114.15 $70.06 $22.83
Ultrasound.
750 Therapeutic ................... X 0.96 $49.36 $25.99 $9.87
Radiation
Treatment Planning.
751 Level I Therapeutic ................... X 1.15 $59.13 $33.22 $11.83
Radiation
Treatment
Preparation.
752 Level II ................... X 3.48 $178.94 $86.56 $35.79
Therapeutic
Radiation
Treatment
Preparation.
757 Radiation Therapy.. ................... S 2.26 $116.21 $52.43 $23.24
758 Hyperthermic ................... S 5.08 $261.21 $137.18 $52.24
Therapies.
759 Brachytherapy and ................... S 7.98 $410.33 $157.97 $82.07
Complex
Radioelement
Applications.
760 PET Scans.......... ................... S 14.89 $765.64 $419.46 $153.13
761 Standard Non- ................... S 1.80 $92.56 $54.01 $18.51
Imaging Nuclear
Medicine.
762 Complex Non-Imaging ................... S 2.02 $103.87 $55.82 $20.77
Nuclear Medicine.
771 Standard Planar ................... S 3.81 $195.91 $117.29 $39.18
Nuclear Medicine.
[[Page 35269]]
772 Complex Planar ................... S 4.26 $219.05 $128.37 $43.81
Nuclear Medicine.
781 Standard SPECT ................... S 5.43 $279.21 $155.04 $55.84
Nuclear Medicine.
782 Complex SPECT ................... S 9.00 $462.78 $267.13 $92.56
Nuclear Medicine.
791 Standard ................... S 14.74 $757.93 $539.91 $151.59
Therapeutic
Nuclear Medicine.
792 Complex Therapeutic ................... S 4.81 $247.33 $143.06 $49.47
Nuclear Medicine.
861 Immunology Tests... ................... X 0.13 $6.68 $3.62 $1.34
881 Level I Pathology.. ................... X 0.22 $11.31 $6.78 $2.26
882 Level II Pathology. ................... X 0.39 $20.05 $11.75 $4.01
883 Level III Pathology ................... X 0.69 $35.48 $20.34 $7.10
900 Critical Care...... ................... S 7.54 $387.71 $145.09 $77.54
901 Level I ................... X 0.07 $3.60 $2.49 $0.72
Immunization.
902 Level II ................... X 1.31 $67.36 $38.19 $13.47
Immunization.
903 Level III ................... X 1.00 $51.42 $24.86 $10.28
Immunization.
906 Infusion Therapy ................... X 1.93 $99.24 $57.18 $19.85
except
Chemotherapy.
907 Intramuscular ................... X 0.74 $38.05 $11.53 $7.61
Injections.
\3\ 911 Low Level Clinic Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
91118 Low Level Clinic Skin and breast V 0.83 $42.68 $9.27 $8.54
Visits. diseases.
91124 Low Level Clinic Musculoskeletal V 0.87 $44.74 $9.49 $8.95
Visits. diseases.
91131 Low Level Clinic Ear, nose, mouth V 0.81 $41.65 $9.04 $8.33
Visits. and throat
diseases.
91133 Low Level Clinic Respiratory system V 0.83 $42.68 $8.59 $8.54
Visits. diseases.
91136 Low Level Clinic Cardiovascular V 0.87 $44.74 $8.95 $8.95
Visits. system diseases.
91141 Low Level Clinic Digestive system V 0.96 $49.36 $10.40 $9.87
Visits. diseases.
91153 Low Level Clinic Kidney, urinary V 0.91 $46.79 $9.49 $9.36
Visits. tract and male
genital diseases.
91156 Low Level Clinic Female genital V 0.93 $47.82 $9.56 $9.56
Visits. system diseases.
91157 Low Level Clinic Pregnancy and V 1.37 $70.45 $17.85 $14.09
Visits. neonatal care.
91163 Low Level Clinic Nervous system V 0.98 $50.39 $10.17 $10.08
Visits. diseases.
91168 Low Level Clinic Eye diseases....... V 0.96 $49.36 $10.40 $9.87
Visits.
91172 Low Level Clinic Trauma and V 1.06 $54.51 $14.24 $10.90
Visits. poisoning.
91178 Low Level Clinic Major signs, V 1.52 $78.16 $21.47 $15.63
Visits. symptoms and
findings.
91182 Low Level Clinic Endocrine, V 0.87 $44.74 $9.04 $8.95
Visits. nutritional and
metabolic diseases.
91186 Low Level Clinic Immunologic and V 1.07 $55.02 $11.53 $11.00
Visits. hematologic
diseases.
91188 Low Level Clinic Malignancy......... V 0.72 $37.02 $8.14 $7.40
Visits.
\1\ 911 Low Level Clinic Psychiatric V 1.09 $56.05 $14.01 $11.21
91 Visits. disorders.
91197 Low Level Clinic Infectious disease. V 1.02 $52.45 $11.53 $10.49
Visits.
\4\ 911 Low Level Clinic Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
\3\ 913 Mid Level Clinic Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
91318 Mid Level Clinic Skin and breast V 0.98 $50.39 $10.08 $10.08
Visits. diseases.
91324 Mid Level Clinic Musculoskeletal V 0.96 $49.36 $9.87 $9.87
Visits. diseases.
91331 Mid Level Clinic Ear, nose, mouth V 0.94 $48.33 $9.67 $9.67
Visits. and throat
diseases.
91333 Mid Level Clinic Respiratory system V 0.93 $47.82 $9.56 $9.56
Visits. diseases.
91336 Mid Level Clinic Cardiovascular V 1.00 $51.42 $10.28 $10.28
Visits. system diseases.
91341 Mid Level Clinic Digestive system V 1.00 $51.42 $10.28 $10.28
Visits. diseases.
91353 Mid Level Clinic Kidney, urinary V 1.00 $51.42 $10.28 $10.28
Visits. tract and male
genital diseases.
91356 Mid Level Clinic Female genital V 1.04 $53.48 $10.70 $10.70
Visits. system diseases.
91357 Mid Level Clinic Pregnancy and V 1.33 $68.39 $13.68 $13.68
Visits. neonatal care.
91363 Mid Level Clinic Nervous system V 1.04 $53.48 $10.70 $10.70
Visits. diseases.
91368 Mid Level Clinic Eye diseases....... V 0.85 $43.71 $8.74 $8.74
Visits.
91372 Mid Level Clinic Trauma and V 1.06 $54.51 $10.90 $10.90
Visits. poisoning.
91378 Mid Level Clinic Major signs, V 1.13 $58.10 $11.62 $11.62
Visits. symptoms and
findings.
91382 Mid Level Clinic Endocrine, V 1.00 $51.42 $10.28 $10.28
Visits. nutritional and
metabolic diseases.
91386 Mid Level Clinic Immunologic and V 1.04 $53.48 $10.70 $10.70
Visits. hematologic
diseases.
91388 Mid Level Clinic Malignancy......... V 0.83 $42.68 $8.54 $8.54
Visits.
\1\ 913 Mid Level Clinic Psychiatric V 1.09 $56.05 $14.01 $11.21
91 Visits. disorders.
91397 Mid Level Clinic Infectious disease. V 1.04 $53.48 $10.70 $10.70
Visits.
\4\ 913 Mid Level Clinic Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
\3\ 915 High Level Clinic Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
91518 High Level Clinic Skin and breast V 1.72 $88.44 $19.21 $17.69
Visits. diseases.
91524 High Level Clinic Musculoskeletal V 1.46 $75.07 $15.37 $15.01
Visits. diseases.
91531 High Level Clinic Ear, nose, mouth V 1.35 $69.42 $14.24 $13.88
Visits. and throat
diseases.
91533 High Level Clinic Respiratory system V 1.44 $74.04 $14.81 $14.81
Visits. diseases.
91536 High Level Clinic Cardiovascular V 1.46 $75.07 $15.37 $15.01
Visits. system diseases.
91541 High Level Clinic Digestive system V 1.54 $79.19 $15.84 $15.84
Visits. diseases.
91553 High Level Clinic Kidney, urinary V 1.44 $74.04 $14.81 $14.81
Visits. tract and male
genital diseases.
91556 High Level Clinic Female genital V 1.44 $74.04 $15.14 $14.81
Visits. system diseases.
91557 High Level Clinic Pregnancy and V 1.76 $90.50 $22.83 $18.10
Visits. neonatal care.
91563 High Level Clinic Nervous system V 1.50 $77.13 $16.05 $15.43
Visits. diseases.
91568 High Level Clinic Eye diseases....... V 1.33 $68.39 $13.79 $13.68
Visits.
91572 High Level Clinic Trauma and V 1.72 $88.44 $22.15 $17.69
Visits. poisoning.
91578 High Level Clinic Major signs, V 1.89 $97.18 $29.15 $19.44
Visits. symptoms and
findings.
91582 High Level Clinic Endocrine, V 1.46 $75.07 $15.14 $15.01
Visits. nutritional and
metabolic diseases.
91586 High Level Clinic Immunologic and V 1.76 $90.50 $19.21 $18.10
Visits. hematologic
diseases.
91588 High Level Clinic Malignancy......... V 1.19 $61.19 $12.88 $12.24
Visits.
[[Page 35270]]
\2\ 915 High Level Clinic Psychiatric V 1.63 $83.81 $21.47 $16.76
91 Visits. disorders.
91597 High Level Clinic Infectious disease. V 1.76 $90.50 $19.66 $18.10
Visits.
\4\ 915 High Level Clinic Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
919 Electroconvulsive ................... S 3.09 $158.89 $80.00 $31.78
Therapy.
920 Biofeedback and ................... S 1.17 $60.16 $29.61 $12.03
other Training.
\5\ 921 Diabetes Education. ................... S ......... ......... ........... ...........
926 Dialysis for other ................... S 4.22 $216.99 $69.83 $43.40
than ESRD patients.
928 Alimentary Tests... ................... X 2.91 $149.63 $79.78 $29.93
930 Minor Eye ................... X 1.04 $53.48 $22.83 $10.70
Examinations.
931 Level I Eye Tests.. ................... X 0.74 $38.05 $21.47 $7.61
932 Level II Eye Tests. ................... X 2.41 $123.92 $63.73 $24.78
936 Fitting of Vision ................... X 0.48 $24.68 $9.49 $4.94
Aids.
940 Otorhinolaryngologi ................... X 3.13 $160.94 $52.21 $32.19
c Function Tests.
941 Level I Audiometry. ................... X 0.74 $38.05 $13.33 $7.61
942 Level II Audiometry ................... X 1.46 $75.07 $22.15 $15.01
947 Resuscitation and ................... S 4.11 $211.34 $106.22 $42.27
Cardioversion.
948 Cardiac ................... X 0.81 $41.65 $16.95 $8.33
Rehabilitation.
949 Cardiovascular ................... X 1.43 $73.53 $61.92 $14.71
Stress Test.
950 Electrocardiogram ................... X 0.35 $18.00 $15.82 $3.60
(ECG).
\3\ 951 Low Level ER Visits Well care and V 1.24 $63.76 $15.14 $12.75
11 administrative.
95118 Low Level ER Visits Skin and breast V 1.17 $60.16 $19.21 $12.03
diseases.
95124 Low Level ER Visits Musculoskeletal V 1.17 $60.16 $20.11 $12.03
diseases.
95131 Low Level ER Visits Ear, nose, mouth V 1.11 $57.08 $17.63 $11.42
and throat
diseases.
95133 Low Level ER Visits Respiratory system V 1.15 $59.13 $18.53 $11.83
diseases.
95136 Low Level ER Visits Cardiovascular V 1.26 $64.79 $19.89 $12.96
system diseases.
95141 Low Level ER Visits Digestive system V 1.30 $66.85 $21.02 $13.37
diseases.
95153 Low Level ER Visits Kidney, urinary V 1.43 $73.53 $24.86 $14.71
tract and male
genital diseases.
95156 Low Level ER Visits Female genital V 1.41 $72.50 $23.96 $14.50
system diseases.
95157 Low Level ER Visits Pregnancy and V 1.46 $75.07 $24.63 $15.01
neonatal care.
95163 Low Level ER Visits Nervous system V 1.30 $66.85 $22.60 $13.37
diseases.
95168 Low Level ER Visits Eye diseases....... V 1.20 $61.70 $20.79 $12.34
95172 Low Level ER Visits Trauma and V 1.28 $65.82 $22.15 $13.16
poisoning.
95178 Low Level ER Visits Major signs, V 1.94 $99.75 $36.39 $19.95
symptoms and
findings.
95182 Low Level ER Visits Endocrine, V 1.50 $77.13 $24.63 $15.43
nutritional and
metabolic diseases.
95186 Low Level ER Visits Immunologic and V 1.46 $75.07 $26.89 $15.01
hematologic
diseases.
95188 Low Level ER Visits Malignancy......... V 1.57 $80.73 $27.35 $16.15
\1\ 951 Low Level ER Visits Psychiatric V 1.09 $56.05 $14.01 $11.21
91 Disorders.
95197 Low Level ER Visits Infectious disease. V 1.24 $63.76 $20.57 $12.75
\4\ 951 Low Level ER Visits Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 mortality.
\3\ 953 Mid Level ER Visits Well care and V 1.24 $63.76 $15.14 $12.75
11 administrative.
95318 Mid Level ER Visits Skin and breast V 1.89 $97.18 $34.80 $19.44
diseases.
95324 Mid Level ER Visits Musculoskeletal V 1.78 $91.53 $32.32 $18.31
diseases.
95331 Mid Level ER Visits Ear, nose, mouth V 1.80 $92.56 $31.64 $18.51
and throat
diseases.
95333 Mid Level ER Visits Respiratory system V 1.91 $98.21 $33.67 $19.64
diseases.
95336 Mid Level ER Visits Cardiovascular V 2.02 $103.87 $36.16 $20.77
system diseases.
95341 Mid Level ER Visits Digestive system V 2.02 $103.87 $36.61 $20.77
diseases.
95353 Mid Level ER Visits Kidney, urinary V 2.06 $105.93 $38.65 $21.19
tract and male
genital diseases.
95356 Mid Level ER Visits Female genital V 2.06 $105.93 $36.84 $21.19
system diseases.
95357 Mid Level ER Visits Pregnancy and V 2.10 $107.98 $40.68 $21.60
neonatal care.
95363 Mid Level ER Visits Nervous system V 1.89 $97.18 $35.03 $19.44
diseases.
95368 Mid Level ER Visits Eye diseases....... V 1.67 $85.87 $33.00 $17.17
95372 Mid Level ER Visits Trauma and V 2.02 $103.87 $39.10 $20.77
poisoning.
95378 Mid Level ER Visits Major signs, V 3.07 $157.86 $58.76 $31.57
symptoms and
findings.
95382 Mid Level ER Visits Endocrine, V 2.30 $118.27 $43.84 $23.65
nutritional and
metabolic diseases.
95386 Mid Level ER Visits Immunologic and V 2.48 $127.52 $49.27 $25.50
hematologic
diseases.
95388 Mid Level ER Visits Malignancy......... V 2.17 $111.58 $42.26 $22.32
95391 Mid Level ER Visits Psychiatric V 2.02 $103.87 $35.93 $20.77
Disorders.
95397 Mid Level ER Visits Infectious disease. V 1.99 $102.33 $36.61 $20.47
\4\ 953 Mid Level ER Visits Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 mortality.
\3\ 955 High Level ER Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
95518 High Level ER Skin and breast V 2.59 $133.18 $46.78 $26.64
Visits. diseases.
95524 High Level ER Musculoskeletal V 2.46 $126.49 $41.36 $25.30
Visits. diseases.
95531 High Level ER Ear, nose, mouth V 2.57 $132.15 $44.07 $26.43
Visits. and throat
diseases.
95533 High Level ER Respiratory system V 3.13 $160.94 $54.69 $32.19
Visits. diseases.
95536 High Level ER Cardiovascular V 3.13 $160.94 $54.69 $32.19
Visits. system diseases.
95541 High Level ER Digestive system V 2.89 $148.60 $54.69 $29.72
Visits. diseases.
95553 High Level ER Kidney, urinary V 2.87 $147.58 $54.69 $29.52
Visits. tract and male
genital diseases.
95556 High Level ER Female genital V 2.70 $138.83 $51.08 $27.77
Visits. system diseases.
95557 High Level ER Pregnancy and V 2.89 $148.60 $54.92 $29.72
Visits. neonatal care.
95563 High Level ER Nervous system V 2.74 $140.89 $52.43 $28.18
Visits. diseases.
95568 High Level ER Eye diseases....... V 2.33 $119.81 $40.23 $23.96
Visits.
95572 High Level ER Trauma and V 2.72 $139.86 $50.17 $27.97
Visits. poisoning.
95578 High Level ER Major signs, V 6.83 $351.20 $148.48 $70.24
Visits. symptoms and
findings.
[[Page 35271]]
95582 High Level ER Endocrine, V 3.26 $167.63 $64.86 $33.53
Visits. nutritional and
metabolic diseases.
95586 High Level ER Immunologic and V 3.89 $200.02 $81.81 $40.00
Visits. hematologic
diseases.
95588 High Level ER Malignancy......... V 3.63 $186.65 $68.48 $37.33
Visits.
95591 High Level ER Psychiatric V 3.48 $178.94 $62.60 $35.79
Visits. Disorders.
95597 High Level ER Infectious disease. V 2.78 $142.95 $53.11 $28.59
Visits.
\4\ 955 High Level ER Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
956 Continuous ECG and ................... X 1.09 $56.05 $54.47 $11.21
Blood Pressure
Monitoring.
957 Echocardiography... ................... S 4.04 $207.74 $114.13 $41.55
958 Diagnostic Cardiac ................... S 23.74 $1,220.71 $705.57 $244.14
Catheterization.
960 Cardiac ................... S 4.80 $246.82 $143.74 $49.36
Electrophysiologic
Tests/Procedures.
966 Electronic Analysis ................... X 0.39 $20.05 $12.43 $4.01
of Pacemakers/
other Devices.
967 Non-Invasive ................... X 1.70 $87.41 $57.40 $17.48
Vascular Studies.
968 Vascular Ultrasound ................... X 2.39 $122.89 $79.55 $24.58
969 Hyperbaric Oxygen.. ................... S 2.65 $136.26 $141.70 $27.25
971 Level I Pulmonary ................... X 0.98 $50.39 $26.44 $10.08
Tests.
972 Level II Pulmonary ................... X 1.00 $51.42 $29.38 $10.28
Tests.
973 Level III Pulmonary ................... S 1.81 $93.07 $55.82 $18.61
Tests.
976 Pulmonary Therapy.. ................... S 0.44 $22.62 $14.69 $4.53
977 Allergy Tests...... ................... X 0.56 $28.80 $11.30 $5.76
978 Allergy Injections. ................... X 0.30 $15.43 $3.39 $3.09
979 Extended EEG ................... S 10.15 $521.91 $287.25 $104.38
Studies and Sleep
Studies.
980 Electroencephalogra ................... S 2.15 $110.55 $57.86 $22.11
m.
981 Level I Nerve and ................... X 1.22 $62.73 $34.35 $12.55
Muscle Tests.
982 Level II Nerve and ................... X 1.37 $70.45 $38.42 $14.09
Muscle Tests.
987 Subcutaneous or ................... S 2.09 $107.47 $65.09 $21.49
Intramuscular
Chemotherapy.
988 Chemotherapy except ................... S 4.02 $206.71 $110.29 $41.34
by Extended
Infusion.
989 Chemotherapy by ................... S 1.91 $98.21 $44.52 $19.64
Extended Infusion.
990 Photochemotherapy.. ................... S 0.43 $22.11 $8.14 $4.42
997 Manipulation ................... S 0.69 $35.48 $7.46 $7.10
Therapy.
999 Therapeutic ................... X 0.43 $22.11 $11.07 $4.42
Phlebotomy.
----------------------------------------------------------------------------------------------------------------
Notes:
\1\ Median costs APCs 091, 91191, 91391, 95191 computed together because there is no differences in facility
resources.
\2\ Median costs APCs 092 and 91591 computed together because there is no differences in facility resources.
\3\ Median costs for all claims in combined visit levels for MDC 11; one rate is paid for multiple levels.
\4\ Median costs for all claims in combined visit levels for MDC 99; one rate is paid for multiple levels.
\5\ APCs 317 and 921 have anomalous weights. Refer to preamble for discussion.
\6\ This APC reflects the per-diem payment for patients recieving services under a partial hospitalization
program.
\7\ The national unadjusted coinsurance amount is subtracted from the proposed payment rate to determine the
amount Medicare pays.
47. On pages 47621 through 47761, Addendum B is corrected to read
as follows:
CPT codes and descriptions only are
copyright 1997 American Medical Association. All rights reserved.
Applicable FARS/DFARS apply.
Copyright 1994 American Dental Association. All rights reserved.
[[Page 35271]]
Addendum B.--Proposed Hospital Outpatient Department (HOPD) Payment Status by HCPCS Code and Related Information
----------------------------------------------------------------------------------------------------------------
Proposed National Minimum
CPT/ HOPD status Description Proposed Relative payment unadjusted unadjusted
HCPCS indicator APC weight rate coinsurance coinsurance
----------------------------------------------------------------------------------------------------------------
00100 N Anesth, skin surgery... ......... ......... ......... ........... ...........
00102 N Anesth, repair of cleft ......... ......... ......... ........... ...........
lip.
00103 N Anesth, blepharoplasty. ......... ......... ......... ........... ...........
00104 N Anesth for electroshock ......... ......... ......... ........... ...........
00120 N Anesthesia for ear ......... ......... ......... ........... ...........
surgery.
00124 N Anesthesia for ear exam ......... ......... ......... ........... ...........
00126 N Anesth, tympanotomy.... ......... ......... ......... ........... ...........
00140 N Anesth, procedures on ......... ......... ......... ........... ...........
eye.
00142 N Anesthesia for lens ......... ......... ......... ........... ...........
surgery.
00144 N Anesth, corneal ......... ......... ......... ........... ...........
transplant.
00145 N Anesth, vitrectomy..... ......... ......... ......... ........... ...........
00147 N Anesth, iridectomy..... ......... ......... ......... ........... ...........
00148 N Anesthesia for eye exam ......... ......... ......... ........... ...........
00160 N Anesth, nose, sinus ......... ......... ......... ........... ...........
surgery.
00162 N Anesth, nose, sinus ......... ......... ......... ........... ...........
surgery.
00164 N Anesth, biopsy of nose. ......... ......... ......... ........... ...........
00170 N Anesth, procedure on ......... ......... ......... ........... ...........
mouth.
00172 N Anesth, cleft palate ......... ......... ......... ........... ...........
repair.
00174 C Anesth, pharyngeal ......... ......... ......... ........... ...........
surgery.
00176 C Anesth, pharyngeal ......... ......... ......... ........... ...........
surgery.
[[Page 35272]]
00190 N Anesth, facial bone ......... ......... ......... ........... ...........
surgery.
00192 C Anesth, facial bone ......... ......... ......... ........... ...........
surgery.
00210 N Anesth, open head ......... ......... ......... ........... ...........
surgery.
00212 N Anesth, skull drainage. ......... ......... ......... ........... ...........
00214 C Anesth, skull drainage. ......... ......... ......... ........... ...........
00215 C Anesth, skull fracture. ......... ......... ......... ........... ...........
00216 N Anesth, head vessel ......... ......... ......... ........... ...........
surgery.
00218 N Anesth, special head ......... ......... ......... ........... ...........
surgery.
00220 N Anesth, spinal fluid ......... ......... ......... ........... ...........
shunt.
00222 N Anesth, head nerve ......... ......... ......... ........... ...........
surgery.
00300 N Anesth, skin surgery, ......... ......... ......... ........... ...........
neck.
00320 N Anesth, neck organ ......... ......... ......... ........... ...........
surgery.
00322 N Anesth, biopsy of ......... ......... ......... ........... ...........
thyroid.
00350 N Anesth, neck vessel ......... ......... ......... ........... ...........
surgery.
00352 N Anesth, neck vessel ......... ......... ......... ........... ...........
surgery.
00400 N Anesth, chest skin ......... ......... ......... ........... ...........
surgery.
00402 N Anesth, surgery of ......... ......... ......... ........... ...........
breast.
00404 C Anesth, surgery of ......... ......... ......... ........... ...........
breast.
00406 C Anesth, surgery of ......... ......... ......... ........... ...........
breast.
00410 N Anesth, correct heart ......... ......... ......... ........... ...........
rhythm.
00420 N Anesth, skin surgery, ......... ......... ......... ........... ...........
back.
00450 N Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
00452 C Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
00454 N Anesth, collar bone ......... ......... ......... ........... ...........
biopsy.
00470 N Anesth, removal of rib. ......... ......... ......... ........... ...........
00472 N Anesth, chest wall ......... ......... ......... ........... ...........
repair.
00474 C Anesth, surgery of ......... ......... ......... ........... ...........
rib(s).
00500 N Anesth, esophageal ......... ......... ......... ........... ...........
surgery.
00520 N Anesth, chest procedure ......... ......... ......... ........... ...........
00522 N Anesth, chest lining ......... ......... ......... ........... ...........
biopsy.
00524 C Anesth, chest drainage. ......... ......... ......... ........... ...........
00528 N Anesth, chest partition ......... ......... ......... ........... ...........
view.
00530 C Anesth, pacemaker ......... ......... ......... ........... ...........
insertion.
00532 N Anesth, vascular access ......... ......... ......... ........... ...........
00534 N Anesth, cardioverter/ ......... ......... ......... ........... ...........
defib.
00540 C Anesth, chest surgery.. ......... ......... ......... ........... ...........
00542 C Anesth, release of lung ......... ......... ......... ........... ...........
00544 C Anesth, chest lining ......... ......... ......... ........... ...........
removal.
00546 C Anesth, lung,chest wall ......... ......... ......... ........... ...........
surg.
00548 N Anesth, trachea,bronchi ......... ......... ......... ........... ...........
surg.
00560 C Anesth, open heart ......... ......... ......... ........... ...........
surgery.
00562 C Anesth, open heart ......... ......... ......... ........... ...........
surgery.
00580 C Anesth,heart/lung ......... ......... ......... ........... ...........
transplant.
00600 N Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00604 C Anesth, surgery of ......... ......... ......... ........... ...........
vertebra.
00620 N Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00622 C Anesth, removal of ......... ......... ......... ........... ...........
nerves.
00630 N Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00632 C Anesth, removal of ......... ......... ......... ........... ...........
nerves.
00634 C Anesth for ......... ......... ......... ........... ...........
chemonucleolysis.
00670 C Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00700 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00702 N Anesth, for liver ......... ......... ......... ........... ...........
biopsy.
00730 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00740 N Anesth, gi ......... ......... ......... ........... ...........
visualization.
00750 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00752 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00754 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00756 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00770 N Anesth, blood vessel ......... ......... ......... ........... ...........
repair.
00790 N Anesth, surg upper ......... ......... ......... ........... ...........
abdomen.
00792 C Anesth, part liver ......... ......... ......... ........... ...........
removal.
00794 C Anesth, pancreas ......... ......... ......... ........... ...........
removal.
00796 C Anesth, for liver ......... ......... ......... ........... ...........
transplant.
00800 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00802 C Anesth, fat layer ......... ......... ......... ........... ...........
removal.
00810 N Anesth, intestine ......... ......... ......... ........... ...........
endoscopy.
00820 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00830 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00832 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00840 N Anesth, surg lower ......... ......... ......... ........... ...........
abdomen.
00842 N Anesth, amniocentesis.. ......... ......... ......... ........... ...........
00844 C Anesth, pelvis surgery. ......... ......... ......... ........... ...........
00846 C Anesth, hysterectomy... ......... ......... ......... ........... ...........
00848 C Anesth, pelvic organ ......... ......... ......... ........... ...........
surg.
[[Page 35273]]
00850 C Anesth, cesarean ......... ......... ......... ........... ...........
section.
00855 C Anesth, hysterectomy... ......... ......... ......... ........... ...........
00857 C Analgesia, labor & c- ......... ......... ......... ........... ...........
section.
00860 N Anesth, surgery of ......... ......... ......... ........... ...........
abdomen.
00862 N Anesth, kidney, ureter ......... ......... ......... ........... ...........
surg.
00864 C Anesth, removal of ......... ......... ......... ........... ...........
bladder.
00865 C Anesth, removal of ......... ......... ......... ........... ...........
prostate.
00866 C Anesth, removal of ......... ......... ......... ........... ...........
adrenal.
00868 C Anesth, kidney ......... ......... ......... ........... ...........
transplant.
00870 N Anesth, bladder stone ......... ......... ......... ........... ...........
surg.
00872 N Anesth,kidney stone ......... ......... ......... ........... ...........
destruct.
00873 N Anesth,kidney stone ......... ......... ......... ........... ...........
destruct.
00880 N Anesth, abdomen vessel ......... ......... ......... ........... ...........
surg.
00882 C Anesth, major vein ......... ......... ......... ........... ...........
ligation.
00884 C Anesth, major vein ......... ......... ......... ........... ...........
revision.
00900 N Anesth, perineal ......... ......... ......... ........... ...........
procedure.
00902 N Anesth, anorectal ......... ......... ......... ........... ...........
surgery.
00904 C Anesth, perineal ......... ......... ......... ........... ...........
surgery.
00906 N Anesth, removal of ......... ......... ......... ........... ...........
vulva.
00908 C Anesth, removal of ......... ......... ......... ........... ...........
prostate.
00910 N Anesth, bladder surgery ......... ......... ......... ........... ...........
00912 N Anesth, bladder tumor ......... ......... ......... ........... ...........
surg.
00914 N Anesth, removal of ......... ......... ......... ........... ...........
prostate.
00916 N Anesth, bleeding ......... ......... ......... ........... ...........
control.
00918 N Anesth, stone removal.. ......... ......... ......... ........... ...........
00920 N Anesth, genitalia ......... ......... ......... ........... ...........
surgery.
00922 N Anesth, sperm duct ......... ......... ......... ........... ...........
surgery.
00924 N Anesth, testis ......... ......... ......... ........... ...........
exploration.
00926 N Anesth, removal of ......... ......... ......... ........... ...........
testis.
00928 C Anesth, removal of ......... ......... ......... ........... ...........
testis.
00930 N Anesth, testis ......... ......... ......... ........... ...........
suspension.
00932 C Anesth, amputation of ......... ......... ......... ........... ...........
penis.
00934 C Anesth, penis, nodes ......... ......... ......... ........... ...........
removal.
00936 C Anesth, penis, nodes ......... ......... ......... ........... ...........
removal.
00938 N Anesth, insert penis ......... ......... ......... ........... ...........
device.
00940 N Anesth, vaginal ......... ......... ......... ........... ...........
procedures.
00942 N Anesth, surgery on ......... ......... ......... ........... ...........
vagina.
00944 C Anesth, vaginal ......... ......... ......... ........... ...........
hysterectomy.
00946 N Anesth, vaginal ......... ......... ......... ........... ...........
delivery.
00948 N Anesth, repair of ......... ......... ......... ........... ...........
cervix.
00950 N Anesth, vaginal ......... ......... ......... ........... ...........
endoscopy.
00952 N Anesth, uterine ......... ......... ......... ........... ...........
endoscopy.
00955 C Analgesia, vaginal ......... ......... ......... ........... ...........
delivery.
01000 N Anesth, skin surgery, ......... ......... ......... ........... ...........
pelvis.
01110 N Anesth, skin surgery, ......... ......... ......... ........... ...........
pelvis.
01120 N Anesth, pelvis surgery. ......... ......... ......... ........... ...........
01130 N Anesth, body cast ......... ......... ......... ........... ...........
procedure.
01140 C Anesth, amputation at ......... ......... ......... ........... ...........
pelvis.
01150 C Anesth, pelvic tumor ......... ......... ......... ........... ...........
surgery.
01160 N Anesth, pelvis ......... ......... ......... ........... ...........
procedure.
01170 N Anesth, pelvis surgery. ......... ......... ......... ........... ...........
01180 N Anesth, pelvis nerve ......... ......... ......... ........... ...........
removal.
01190 C Anesth, pelvis nerve ......... ......... ......... ........... ...........
removal.
01200 N Anesth, hip joint ......... ......... ......... ........... ...........
procedure.
01202 N Anesth, arthroscopy of ......... ......... ......... ........... ...........
hip.
01210 N Anesth, hip joint ......... ......... ......... ........... ...........
surgery.
01212 C Anesth, hip ......... ......... ......... ........... ...........
disarticulation.
01214 C Anesth, replacement of ......... ......... ......... ........... ...........
hip.
01220 N Anesth, procedure on ......... ......... ......... ........... ...........
femur.
01230 N Anesth, surgery of ......... ......... ......... ........... ...........
femur.
01232 C Anesth, amputation of ......... ......... ......... ........... ...........
femur.
01234 C Anesth, radical femur ......... ......... ......... ........... ...........
surg.
01240 N Anesth, upper leg skin ......... ......... ......... ........... ...........
surg.
01250 N Anesth, upper leg ......... ......... ......... ........... ...........
surgery.
01260 N Anesth, upper leg veins ......... ......... ......... ........... ...........
surg.
01270 N Anesth, thigh arteries ......... ......... ......... ........... ...........
surg.
01272 C Anesth, femoral artery ......... ......... ......... ........... ...........
surg.
01274 C Anesth, femoral ......... ......... ......... ........... ...........
embolectomy.
01300 N Anesth, skin surgery, ......... ......... ......... ........... ...........
knee.
01320 N Anesth, knee area ......... ......... ......... ........... ...........
surgery.
01340 N Anesth, knee area ......... ......... ......... ........... ...........
procedure.
01360 N Anesth, knee area ......... ......... ......... ........... ...........
surgery.
01380 N Anesth, knee joint ......... ......... ......... ........... ...........
procedure.
01382 N Anesth, knee ......... ......... ......... ........... ...........
arthroscopy.
01390 N Anesth, knee area ......... ......... ......... ........... ...........
procedure.
[[Page 35274]]
01392 N Anesth, knee area ......... ......... ......... ........... ...........
surgery.
01400 N Anesth, knee joint ......... ......... ......... ........... ...........
surgery.
01402 C Anesth, replacement of ......... ......... ......... ........... ...........
knee.
01404 C Anesth, amputation at ......... ......... ......... ........... ...........
knee.
01420 N Anesth, knee joint ......... ......... ......... ........... ...........
casting.
01430 N Anesth, knee veins ......... ......... ......... ........... ...........
surgery.
01432 N Anesth, knee vessel ......... ......... ......... ........... ...........
surg.
01440 N Anesth, knee arteries ......... ......... ......... ........... ...........
surg.
01442 C Anesth, knee artery ......... ......... ......... ........... ...........
surg.
01444 C Anesth, knee artery ......... ......... ......... ........... ...........
repair.
01460 N Anesth, lower leg skin ......... ......... ......... ........... ...........
surg.
01462 N Anesth, lower leg ......... ......... ......... ........... ...........
procedure.
01464 N Anesth, ankle ......... ......... ......... ........... ...........
arthroscopy.
01470 N Anesth, lower leg ......... ......... ......... ........... ...........
surgery.
01472 N Anesth, achilles tendon ......... ......... ......... ........... ...........
surg.
01474 N Anesth, lower leg ......... ......... ......... ........... ...........
surgery.
01480 N Anesth, lower leg bone ......... ......... ......... ........... ...........
surg.
01482 N Anesth, radical leg ......... ......... ......... ........... ...........
surgery.
01484 N Anesth, lower leg ......... ......... ......... ........... ...........
revision.
01486 C Anesth, ankle ......... ......... ......... ........... ...........
replacement.
01490 N Anesth, lower leg ......... ......... ......... ........... ...........
casting.
01500 N Anesth, leg arteries ......... ......... ......... ........... ...........
surg.
01502 C Anesth, lowerleg ......... ......... ......... ........... ...........
embolectomy.
01520 N Anesth, lower leg vein ......... ......... ......... ........... ...........
surg.
01522 N Anesth, lower leg vein ......... ......... ......... ........... ...........
surg.
01600 N Anesth, shoulder skin ......... ......... ......... ........... ...........
surg.
01610 N Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
01620 N Anesth, shoulder ......... ......... ......... ........... ...........
procedure.
01622 N Anesth, shoulder ......... ......... ......... ........... ...........
arthroscopy.
01630 N Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
01632 C Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
01634 C Anesth, shoulder joint ......... ......... ......... ........... ...........
amput.
01636 C Anesth, forequarter ......... ......... ......... ........... ...........
amput.
01638 C Anesth, shoulder ......... ......... ......... ........... ...........
replacement.
01650 N Anesth, shoulder artery ......... ......... ......... ........... ...........
surg.
01652 C Anesth, shoulder vessel ......... ......... ......... ........... ...........
surg.
01654 C Anesth, shoulder vessel ......... ......... ......... ........... ...........
surg.
01656 C Anesth, arm-leg vessel ......... ......... ......... ........... ...........
surg.
01670 N Anesth, shoulder vein ......... ......... ......... ........... ...........
surg.
01680 N Anesth, shoulder ......... ......... ......... ........... ...........
casting.
01682 N Anesth, airplane cast.. ......... ......... ......... ........... ...........
01700 N Anesth, elbow area skin ......... ......... ......... ........... ...........
surg.
01710 N Anesth, elbow area ......... ......... ......... ........... ...........
surgery.
01712 N Anesth, upperarm tendon ......... ......... ......... ........... ...........
surg.
01714 N Anesth, upperarm tendon ......... ......... ......... ........... ...........
surg.
01716 N Anesth, biceps tendon ......... ......... ......... ........... ...........
repair.
01730 N Anesth, upperarm ......... ......... ......... ........... ...........
procedure.
01732 N Anesth, elbow ......... ......... ......... ........... ...........
arthroscopy.
01740 N Anesth, upper arm ......... ......... ......... ........... ...........
surgery.
01742 N Anesth, humerus surgery ......... ......... ......... ........... ...........
01744 N Anesth, humerus repair. ......... ......... ......... ........... ...........
01756 C Anesth, radical humerus ......... ......... ......... ........... ...........
surg.
01758 N Anesth, humeral lesion ......... ......... ......... ........... ...........
surg.
01760 N Anesth, elbow ......... ......... ......... ........... ...........
replacement.
01770 N Anesth, upperarm artery ......... ......... ......... ........... ...........
surg.
01772 C Anesth, upperarm ......... ......... ......... ........... ...........
embolectomy.
01780 N Anesth, upper arm vein ......... ......... ......... ........... ...........
surg.
01782 C Anesth, upperarm vein ......... ......... ......... ........... ...........
repair.
01784 N Anesth, av fistula ......... ......... ......... ........... ...........
repair.
01800 N Anesth, lower arm skin ......... ......... ......... ........... ...........
surg.
01810 N Anesth, lower arm ......... ......... ......... ........... ...........
surgery.
01820 N Anesth, lower arm ......... ......... ......... ........... ...........
procedure.
01830 N Anesth, lower arm ......... ......... ......... ........... ...........
surgery.
01832 N Anesth, wrist ......... ......... ......... ........... ...........
replacement.
01840 N Anesth, lowerarm artery ......... ......... ......... ........... ...........
surg.
01842 C Anesth, lowerarm ......... ......... ......... ........... ...........
embolectomy.
01844 N Anesth, vascular shunt ......... ......... ......... ........... ...........
surg.
01850 N Anesth, lower arm vein ......... ......... ......... ........... ...........
surg.
01852 C Anesth, lowerarm vein ......... ......... ......... ........... ...........
repair.
01860 N Anesth, lower arm ......... ......... ......... ........... ...........
casting.
01900 N Anesth, uterus/tube ......... ......... ......... ........... ...........
inject.
01902 C Anesth, burr holes, ......... ......... ......... ........... ...........
skull.
01904 C Anesth, skull x-ray ......... ......... ......... ........... ...........
inject.
01906 N Anesth, lumbar ......... ......... ......... ........... ...........
myelography.
01908 N Anesth, cervical ......... ......... ......... ........... ...........
myelography.
[[Page 35275]]
01910 N Anesth, skull ......... ......... ......... ........... ...........
myelography.
01912 N Anesth, lumbar ......... ......... ......... ........... ...........
discography.
01914 N Anesth, cervical ......... ......... ......... ........... ...........
discography.
01916 C Anesth, head ......... ......... ......... ........... ...........
arteriogram.
01918 C Anesth, limb ......... ......... ......... ........... ...........
arteriogram.
01920 N Anesth, catheterize ......... ......... ......... ........... ...........
heart.
01921 C Anesth, vessel surgery. ......... ......... ......... ........... ...........
01922 N Anesth, cat or MRI scan ......... ......... ......... ........... ...........
01990 C Support for organ donor ......... ......... ......... ........... ...........
01995 N Regional anesthesia, ......... ......... ......... ........... ...........
limb.
01996 N Manage daily drug ......... ......... ......... ........... ...........
therapy.
01999 N Unlisted anesth ......... ......... ......... ........... ...........
procedure.
10040 T Acne surgery of skin 131 1.93 $99.24 $36.61 $19.85
abscess.
10060 T Drainage of skin 131 1.93 $99.24 $36.61 $19.85
abscess.
10061 T Drainage of skin 131 1.93 $99.24 $36.61 $19.85
abscess.
10080 T Drainage of pilonidal 131 1.93 $99.24 $36.61 $19.85
cyst.
10081 T Drainage of pilonidal 131 1.93 $99.24 $36.61 $19.85
cyst.
10120 T Remove foreign body.... 131 1.93 $99.24 $36.61 $19.85
10121 T Remove foreign body.... 163 10.48 $538.88 $260.80 $107.78
10140 T Drainage of hematoma/ 131 1.93 $99.24 $36.61 $19.85
fluid.
10160 T Puncture drainage of 131 1.93 $99.24 $36.61 $19.85
lesion.
10180 T Complex drainage, wound 131 1.93 $99.24 $36.61 $19.85
11000 T Debride infected skin.. 151 1.63 $83.81 $33.22 $16.76
11001 T Debride infect skin add- 151 1.63 $83.81 $33.22 $16.76
on.
11010 T Debride skin, fx....... 163 10.48 $538.88 $260.80 $107.78
11011 T Debride skin/muscle, fx 163 10.48 $538.88 $260.80 $107.78
11012 T Debride skin/muscle/ 163 10.48 $538.88 $260.80 $107.78
bone, fx.
11040 T Debride skin partial... 151 1.63 $83.81 $33.22 $16.76
11041 T Debride skin full...... 151 1.63 $83.81 $33.22 $16.76
11042 T Debride skin/tissue.... 151 1.63 $83.81 $33.22 $16.76
11043 T Debride tissue/muscle.. 162 5.59 $287.44 $125.66 $57.49
11044 T Debride tissue/muscle/ 162 5.59 $287.44 $125.66 $57.49
bone.
\2\ 1105 T Trim skin lesion....... 151 1.63 $83.81 $33.22 $16.76
0
\2\ 1105 T Trim 2 to 4 skin 151 1.63 $83.81 $33.22 $16.76
1 lesions.
\2\ 1105 T Trim over 4 skin 151 1.63 $83.81 $33.22 $16.76
2 lesions.
11055 T Trim skin lesion....... 151 1.63 $83.81 $33.22 $16.76
11056 T Trim 2 to 4 skin 151 1.63 $83.81 $33.22 $16.76
lesions.
11057 T Trim over 4 skin 151 1.63 $83.81 $33.22 $16.76
lesions.
11100 T Biopsy of skin lesion.. 161 3.43 $176.37 $75.71 $35.27
11101 T Biopsy, skin add-on.... 161 3.43 $176.37 $75.71 $35.27
11200 T Removal of skin tags... 151 1.63 $83.81 $33.22 $16.76
11201 T Remove skin tags add-on 151 1.63 $83.81 $33.22 $16.76
11300 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11301 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11302 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11303 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11305 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11306 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11307 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11308 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11310 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11311 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11312 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11313 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11400 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11401 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11402 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11403 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11404 T Removal of skin lesion. 162 5.59 $287.44 $125.66 $57.49
11406 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11420 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11421 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11422 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11423 T Removal of skin lesion.
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