MEDICAl FEE CPT CODE LIST - 2013 2014 - South Carolina · 65110 exenteration of orbit w/o skin graft rem orbit content ... 67700 blepharotomy, drainage of abscess, eyelid 160.23

SCCB - CPT CODE LIST – 2013- 2014

CPT CODE DESCRIPTION OF SERVICE FEE

EYEBALL – REMOVAL OF EYE

65091 EVISCREATION OF EYE, WITHOUT IMPLANT 389.63

65093 EVISCERATION OF EYE WITH IMPLANT 388.84

65101 ENUCLEATION WITHOUT IMPLANT 448.91

65103 ENUCLEATION W/IMPLANT, MUSCLES NOT ATTACHED 469.19

65105 ENUCLEATION W/IMPLANT, MUSCLES ATTACHED TO IMPLANT

517.99

65110 EXENTERATION OF ORBIT W/O SKIN GRAFT REM ORBIT CONTENT

757.20

65112 EXENTERATION, W/THERAPEUTIC REMOVALOF BONE 890.15

65114 EXENTERATION, WITH MUSCLE OR MYOCULANEOUS FLAP 927.92

SECONDARY IMPLANT(S) PROCEDURES

65125 MODIFICATION, OCULAR IMPLANT (SEPARATE PROCEDURE) 275.36

65130 EVISCREATION, EYE IMPLANTATION IN SCLERAL SHELL 444.63

65135 AFTER ENUCLEATION, MUSCLES NOT ATTAHCED TO IMPLANT

452.88

65140 AFTER ENUCLEATION, MUSCLES ATTACHED TO IMPLANT 493.55

65150 REINSERTION/OCULAR IMPLANT W/WO CONJUNCTIVAL GRAFT

356.78

65155 REINSERTION, IMPLANT W/FOREING MAT F/REIN ATT MUSC 520.71

65175 REMOVAL OCULAR IMPLANT 400.19

REMOVAL OF FOREIGN BODY

65205 REMOVAL FOREING BODY EXTERNAL EYE CONJUNCTIVA 35.39

65210 REMOVAL EMBEDDED CONJENCTIVA/SCLERAL NONPERFORATIIN

43.25


REMOVAL OF FOREIGN BODY

65220 REMOVAL, CORNEAL WITHOUT SLIT SLAMP 36.15

65222 REMOVAL, CORNEAL WITH SLIT LAMP 47.56

65235 REMOVAL, INTRAOCULAR, ANTERIOR CHAMBER OR LENS 429.03

65260 REMOVAL, POSTERIOR SEGMENT MAGNETIC EXTRACTION 588.65

65265 REMOVAL, POSTERIOR SEGMENT NONMAGNETIC EXTRACTION

663.29

REPAIR OF LACERATION

65270 REPAIR LACERATION CONJUNCTIVA W-W/O DIRECT CLOSURE

161.68

65272 REPAIR CONJUNCTIVA MOBILE & REARRANGE W/O HOSPITAL

300.48

65273 REPAIR CONJUNCTIVA MOBILE & RERRANGE W/HOSPITAL 234.23

65275 REPAIR CORNEA NONPERFORATING W-W/O REM FORGN BODY

339.37

65280 REMOVAL OF EPITHELIAL DOWNBROTH, ANTERIOR CHAMBER

411.04

65285 CORNEA/SCLERA, PERFOORATING W/REPOS OR RESEC UVEAL

642.35

65286 APPLICATION, TISSUE GLUE, WOUNDS CORNEA/SCLERA 425.44

65290 REPAIR WOUND, EXTRAOCULAR MUSCLE TENDON - CAPSULE

301.30

CORNEA

65400 EXCISION LESION, CORNEA NON PTERYGIUM 407.34

65410 BIOPSY, CORNEA 88.37

65420 PTERYGIUM EXCISION OR TRANSPOSITION WITHOUT GRAFT 311.02

65426 PTERYGIUM EXCISION WITH GRAFT 393.74

65430 SCRAPING CORNEA, DIAGNOSTIC F/SMAR/CULTURE 72.06

65435 REMOVAL CORNEAL EPITHELIUM W-W/O CHEMOCAUTHERIZATIO

49.58


CORNEA

65436 REMOVAL WITH APPLICATION CHELATING AGENT (EDTA) 236.09

65450 DESTRUCTION LESION CORNEA (CRYTO/PHOTO/THERMO) 194.12

65600 MULTIPLE PUNCTURES OF ANTERIOR CORNEA

KERATOPLASTY (Corneal Transplant)

65710 KERATOPLASTY (CORN. TRANS), LAMELLAR 677.77

65730 KERATOPLASTY, PENETRATING (NON-AHAKIA) 754.53

65750 KERATOPLASTY PENETRATING (IN APHAKIA) 765.81

65755 KERATOPLASTY, PENETRATING (IN PSEUDOPHAKIA) 761.32

65756 KERTOPLASTY ENDOTHELIAL 734.32

65757 BACKBENCH PREPARATION OF CORNEAL ENDOTHELIAL ALLOGRAFT PRIOR TO TRANSPLANTATION (USE IN CONJUCTION WITH 65756)

!M

65760 KERATOMILEUSIS 873.97

65765 KERATOPHAKIA 873.97

65767 EPIKERATOPLASTY 873.97

65770 KERATOPROSTHESIS 876.31

65772 CORNEAL RELAXING ENCISION (BR) SURGICALLY IND. AST 272.66

65775 CORNEAL WEDGE RESECTION (BR) SURGICALLY ASTI 336.34

ANTERIOR CHAMBER - INCISION

65800 PARACENTESIS, ANTERIOR CHAMPER W/DIAGNOSTIC ASP 94.11

65810 PARACENTESIS, W-W/O AIR INJECTION 285.11

65815 PARACENTESIS, W/REML BLOOD W-W/O IRRIGATION/AIR 385.37


ANTERIOR CHAMBER

65820 GONIOTOMY 458.06

65850 TRABECULTOMY AB EXTERNO 523.57

65855 LASER TRABECULOPLASTY; ONE OR MORE SESSIONS 208.44

65860 SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER 192.38

65865 SEVERING ADESIONS OF ANTERIOR SEGMENT OF EYE 291.55

65870 POSTERIOR SYNCHEIAE

65875 SEVERING POSTERIOR SYNECHIAE 383.00

65880 SEVERING CORNEOVITREAL ADHESIONS (BR) 403.95

ANTERIOR CHAMBER - REMOVAL

65900 REMOVAL OF EPITHELIAL DOWNBROWTH, ANTERIOR CHAMBER OF EYE

65920 REMOVAL OF IMPLANTED MARTERIAL, ANTERIOR CHAMBER 479.74

65930 REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT 395.23

66020 INJECTION, ANTERIOR CHAMBER, AIR/LIQUID, SEP PROC 113.08

66030 INJECTION, ANTERIOR CHAMBER, MEDICATION 99.69

ANTERIOR SCLERA - EXCISION

66130 EXCISION OFLESION, SCLERA 431.76

66150 FISTUIZATION OF SCLERA F/GLAUCOMA; TREPHINATION 526.38

66155 THERMOCAUTERIZATION WITH IRIDECTOMY 524.96

65160 SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IDECTOMY 598.33

66165 SCLEROTOMY W/PUNC OR SCISSORS, W/IRIDECTOMY 514.16

CPT CODE DESCRIPTION OF SERVICES FEE

ANTERIOR SCLERA - EXCISION

66170 TRABECLECTOMY (SURGICAL FILTERING) 724.53

66172 TRABECULECTOMY (INCLUED INJECTION OF ANTIFIBROTIC AGNT)

910.38

65174 TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITHOUT RETENTION OF DEVICE OR STENT

!570.82

65175 WITH RETENTION OF DEVICE OR STENT 623.72

AQUEOUS SHUNT

66180 AQUEOUS SHUNT TO EXTRAOCULAR RESERVIOR (MOLTENO) 723.63

66185 REVISION OF AQUEOUS SHUNT – EXTRAOCULAR RESERVIOR 455.39

REPAIR OR REVISION

66220 REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT 444.47

66225 REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT 573.60

66250 REVISION, REPAIR OPERATIVE WOUND OF ANTERIOR SEGM 452.81

IRIS, CILIARY BODY

66500 IRIDOTOMY BY STAB INCISION, EXCEPT TRANSFIXION 214.55

66505 IRIDOTOMY WITH TRANSFIXION AS FOR IRIS BOMBE 234.92

EXCISION

66600 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION

500.01

66605 IRIDECTOMY; WITH CYCLECTOMY 651.48

66625 IRIDECTOMY; PERIPHERAL FOR GLAUCOMA 262.69

66630 IRIDECTOMY; SECTOR FOR GLAUCOMA 346.36

66635 IRIDECTOMY; “OPTICAL” 349.91

REPAIR

66680 REPAIR OF IRIS, CILIARY BODY (IRIDODIALYSIS) 312.74

66682 SUTURE OF IRIS CILIARY BODY (SEPERATE PROCEDURE) 379.84


DESTRUCTION

66700 CILIARY BODY DESTRUCTION; DIATHERMY 273.30

66710 CYCLOPHOTOCOAGULATION; TRANSSCLERAL 268.85

66711 CYCOLPHOTOCOAGULATION, ENDOSCOPIC 386.56

66720 CILIARY BODY DESTRUCTION; CRYOTHERAPY 280.93

66740 CILIARY BODY DESTRUCTION; CYCLODIALYSIS 267.03

66761 IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (FOR GLAUCOMA PER SESSION)

273.58

66762 IRIDOPLASTY, PHOTOCOAGULATION (1 OR MORE SESSIONS) 286.94

66770 DESTRUCTION OF CYST ORLESION IRIS OR CILIARY BODY 319.07

LENS – INCISION

66820 DISCUSSION – SECONDARY MEMBRANOUS CATARACT (KNIFE) 240.38

66821 LASER SURGRY (YAG LASER) (1 OR MORE STAGES) 195.71

66825 REPOSITIONING OF INTRAOCULAR LENS PROTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE)

464.44

LENS - REMOVAL

66830 REMOVAL SECONDARY MEMBRANOUS CATARACT 437.09

66840 REMOVAL OF LENS; ASPIRATION (ONE OR MORE SESSIONS) 425.74

66850 REMOVALOF LENS; PHACOFRAGMENTATION, W/ASPIRATION 486.10

66852 REMOVAL OF LENS; PARS PLANA W-W/P VITRECTOMY 520.49

66920 REMOVAL OF LENS; INTRACAPSULAR 464.30

66930 REMOVAL OF LENS; INTRACAPSULAR F/DISLOCATED LENS 527.90

66940 REMOVAL OF LENS; EXTRACAPSULAR 479.01


INTRAOCULAR LEN PROCEDURES

66982 EXTRACAPULAR CATARACT EXTRACTION W/IOL 661.11

66983 INTRACAPSULAR CATARACT EXTRACTION W/IOL 457.17

66984 EXTRACAPSULAR CATARACT EXTRACTION W/IOL 473.73

66985 INSERTION OF I.O.L. , (SECONDARY IMPLANT) NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL

467.61

66986 EXCHANGE OF INTRAOCULAR LENS 572.38

66990 USE OF OPHTHALMIC ENDOSCOPE (LIST SEPARETLY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

!59.16

VITREOUS

67005 REMOVAL – VITREOUS, ANTERIO APPROCAH (SKY/LIMBAL) 287.66

67010 REMOVAL – VITREOUS, SUBTOTAL/MECHANICAL VITRECTOMY

333.57

67015 ASPIRATION OR RELEASE OF VITREOUS PARS PLANA 355.13

67025 INJECTION, VITREOUS SUBSTITUTE, PARS PLANA/LIMBAL 440.12

67027 IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM INCLUDES CONCOMITANT REMOVAL OF VITREOUS

!527.12

67028 INTRAVITREALM INJECTION OF PHARMACOLOGIC AGENT 132.30

67030 DISCUSSION, VITREOUS STRANDS W/O REML PARS PLANA 316.84

67031 SEVERING OF VITREOUS STRANDS 234.20

67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH 595.99

67039 VITRECTOMY, WITH FOCAL ENDOLASER PHOTOCOAGULATION

762.59

67040 VITRECTOMY; WITH ENDOLASER, PANRETINAL PHOTOCOAGULATI

880.43

67041 VITRECTOMY; WITH REMOVAL OF PRERETINAL CELLULAR MEMB

825.40


VITREOUS

67042 VITRECTOMY; WITH REMOVAL OF INTERNAL LIMITING MEMBR

946.31

67043 VITRECTOMY; WITH REMOVAL OF SUBRETINAL MEMBRANE 992.28

RETINA OR CHOROID - REPAIR

67101 REPAIR RETINAL DETACHMENT (ONE OR MORE SESSIONS) 471.63

67105 PHOTOCOAGULATION W-W/O DRAINAGE SUBRETINAL 437.33

67107 REPAIR OF RETINA DETACHMENT, SCLERAL BUCKLING 749.22

67108 REPAIR, SCLERAL BUDKLING W/VITRECTOMY 999.00

67110 BY INJECTION AIR/OTHER GAS (PNEUMORETINOPEXY) 529.03

67112 REPAIR BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT HAVING HAD PREVIOUS DETACHMENT REPAIR

824.09

67113 REPAIR OF COMPLEX RETINAL DETACHMENT 1,086.28

67115 RELEASE ENCIRCLING MATERIAL (POSTERIOR SEGMENT; EXTRAOCULAR)

!300.20

67120 REMOVAL OF IMPLANTED MATERIAL, EXTRAOCULAR 397.11

67121 REMOVAL OF IMPLANTED MATERIAL, INTRAOCULAR 558.07

PROPHYLAXIS

67141 PROPHYLAXIS RETINAL DETACHMENT DIATHERMY/CRYOTHERAP

316.06

67145 PROPHYSAXIS PHOTOCOAGULATION LASER 318.93

DESTRUCTION

67208 DESTRUCTION OF LOCALIZED LESION OF RETINA – 1 SESSION

366.53

67210 PHOTOCOAGULATION, LASER OR SENON ARC – FOCAL LASER

429.38

67218 RADIATION BY IMPLANTATIONOF SOURCE (INC. REMOVAL) 873.99

67220 DESTRUCTION OF LOCALIZED LESION OF CHOROID 658.91


DESTRUCTION

67221 PHOTODYNAMIC THERAPY (INCLUDES INTRAVENOUS INFUSION)

184.95

!!67225

PHTODYNAMIC THERAPY, (SECOND EYE) LIST SEPERATELY IN ADDITION TO PRIMARY CODE (USE IN CONJUNCTION WITH 67221)

!!19.34

67227 DESTRUCTION, EXTENSIVE/PROGRESSIVE RETINOPATHY 372.58

67228 PHOTOCOAGULATION – PAN RETINAL (SAME EYE – 6 MONTHS)

732.72

POSTERIOR SCLERA - REPAIR

67250 SCLERAL REINFORCEMENT; WITHOUT GRAFT 482.55

67255 SCLERAL REINFORCEMENT; WITH GRAFT 515.89

ORBIT – EXPLORATION, EXCISION, DECOMPRESSION

!!67400

ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNTIVAL APPROACH); FOR EXPLORATION, WITH OR WITHOUT BIOPSY

!!632.12

67405 ORBITOTOMY WITH DRAINAGE ONLY 487.33

67412 ORBITOTOMY WITH REMOVAL OF LESION 530.95

67413 ORBITOTOMY W/REMOVAL OF FOREIGN BODY 530.99

67414 ORBITOTOMY WITH REMOVAL OF BONE FOR DECOMPRESSION

819.03

67415 FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS 68.23

67420 ORBITOTOMY W/BONE FLAP/WINDOW LATERIAL APP W/LESION

1,018.21

67430 OBITOTOMY WITH REMOVALOF FOREIGN BODY 770.71

67440 ORBITOTOMY WITH DRAINAGE 748.86

67445 ORBITOTOMY WITH REMOVALOF BONE FOR DECOMPRESSION

877.80

67450 ORBITOTOMY FOR EXPLORATION, WITH OR WITHOUT BIOPSY

772.08

67500 RETROBULBAR INJECTIONS; MEDICATION 57.20


ORBIT – OTHER PROCEDURES

!67500

RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION)

!57.20

67505 RETROBUBAR INJECTIONS; ALCOHOL 55.47

67515 INJECTION OF THERAPEUTIC ANGENT INTO TENON CAPSULE

59.13

67550 ORBITAL IMPLANT (OUTSIDE MUSCLE CONE); INSERTION 597.17

67560 REMOVAL OF REVISION 908.98

67570 OPTIC NERVE DECOMPRESSION (INCISION/FENESTRATION 716.17

EYELIDS – EXCISION, DESTRUCTION

67800 EXCISION OF CHALAZION; SINGLE 77.70

67801 EXCISION OF CHALAZION; MULTIPLE, SAME LID 99.92

67805 EXCISION OF CHALAZION; MULTIPLE, DIFFERENCE LIDS 123.53

67808 EXCISION, GEN ANESTHESIA, REQD HOSP SINGLE/MULTI 223.20


67700 BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID 160.23

67710 SEVERING OF TARSORRHPHY 134.89

67715 CANTHOTOMY (SEPARATE PROCEDURE) 142.43

67810 BIOPSY EYELID 134.47

67820 CORRECTION OF TRICHIASIS; EPILATION BY FORCEPS 32.96

67825 EPILATION, BY ELECTROSURGERY OR CRYOTHERPHY 78.75

67830 INCISION OF LID MARGIN FOR TRICHIASIS 161.28

67835 INCISION OF LID MARGIN, WITH MUCOUS MEMBRANE GRAFT 271.70



67840 EXCISION OF LESION EYELID (EXCEPT CHALZAION) 169.31

67850 DESTRUCTION OF LESIONOFLID MARGIN (UP TO 1 CM) 136.41

TARSORRHAPHY

67875 TEMPORARY CLOSURE OF EYELIDS BY SUTURE (FROST) 105.89

67880 CONSTRUCTION, INTERMARGINAL ADHESIONS, MEDIAN 276.21

67882 WITH TRANSPOSITION OF TRASAL PLATE 341.59

REPAIR (BROW PTOSIS, BLEPHAROPTOSIS, LID RETRACTION, ECTROPION, ENTROPION)

67900 REPAIR OF BROW PTOSIS 394.32

67901 REPAIR OF BLEPHAROPTOSIS; FRONTAL MUSCLE TECHNIQUE 425.92

67902 REPAIR; FRONTAL MUSCLE TECHNIQUE W/FASCIAL SLING 442.46

!67904

(TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROCAH

!589.37

CONJUNCTIVA – INCISION AND DRAINAGE

68020 INCISION OF CONJUNCTIVA, DRAINAGE OF CYST 73.24

68040 EXPRESSION CONJUNCTIVAL FOLLICLES F/TRACHOMA 40.98

EXCISION AND/OR DESTRUCTION

68100 BIOPSY OF CONJUNCTIVA 105.12

68110 EXISION OF LESION OF CONJUNCTIVA UP TO 1 CM 136.87

68115 EXCISION OF LESIONOF CONJUNCTIVA OVER 1 CM 189.78

68130 EXCISION OF LESION/CONJUNCTIVA W/ ADJACENT SCLERA 328.43

68135 DESTRUCTION OF LESION, CONJUNCTIVA 96.28

INJECTION

68200 SUBCONJUCTIVAL INJECTIONS 13.14


CONJUNCTIVOPLASTY

68320 CONJUNCTIVOPLASTY W/GRAFT OR REARRANGEMENT 434.59

68325 CONJUNCTIVOPLASTY W/BUCCAL MUCOUS MEMBRANE GRAFT

404.77

68326 CONJUNCTIVOPLASTY/ RECONSTRUCTION CUL-DE-SAC W/G-R

394.42

68330 REPAIR SYMBLEMPHARON, CONJUNCTIOPLASTY, NO GRAFT 365.55

68335 REPAIR SYBLEPHARON; W/FREE GRAFT CONJ/BUCCAL MUCO

395.67

!68340

DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OF CONTACT LENS

!328.68

OTHER PROCEDURES

68360 CONJUNCTIAL FLAP; BRIDGE OR PARTIAL 321.17

68362 CONJUNCTIVAL FLAP; TOTAL 401.17

LACRIMAL SYSTEM - INCISION

68400 INCISION DRAINAGE LACRIMAL GLAND 169.95

68420 INCISION, DRAINAGE LACRIMAL SAC 195.59

68440 SNIP INCLSION OF LACRIMAL PUNCTUM 65.10

68500 EXCISION, LACRIMAL BLAND; TOTAL EXCEPT FOR TUMOR 597.60

68505 EXCISION, LACRIMAL GLAND; PARTICAL EXCEPT FOR TUMOR 600.95

68510 BIOPSY OF LACRIMAL GLAND 280.63

68520 EXCISION OF LACRIMAL SAC 422.64

68525 BIOPSY OF LACRIMAL SAC 172.72

68530 REMOVAL FOREIGN BOYD OF DACRYOLITH, LACRIMAL PATH 266.07

68540 EXCISION OF LACRIMAL GLAND TUMOR, FRONTAL APPROCAH

571.53

68550 EXCISION OF LACRIMAL GLAND TUMOR, W/OSTEOTOMY 702.33


LACRIMAL SYSTEM -REPAIR

68700 PLASTIC REPAIR OF CANALICULI 368.89

68705 CORRECTION OF EVERTED PUNCTUM CAUTERY 145.15

68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION LACRIMAL SAC) 268.24

68745 CONJUNCTIVORHINOSTOMY (FIST CONJUNCTIVAL) W/O TUBE

469.54

68750 CONJUNCTIVORHINOSTOMY (FIST CONJUNCTIVA) W/TUBE 482.88

68760 CLOSURE OF LACRIMAL PUNCTUM 123.00

68761 CLOSURE OF LACRIMAL PUNCTUM BY PLUG 89.79

68770 CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE) 365.79

68840 PROVING CANALICULUS W-W/O IRRIGATION 75.99

68850 INJECTION CONTAST MEDIUM F/DARCRYOCYSTOPRAPHY 42.88

DIAGNOSTIC ULTRASOUND - SCANS

76510 !!26

OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND QUANTITATIVE A-SCAN PERFGORMED DURING THE SAME PATIENT ENCOUNTER INTREPRETATION

106.80 !!60.04

76511 26

QUANTITATIVE A-SCAN ONLY INTREPRETATION

69.24 36.25

76512 26

B-SCAN (W-W/O SIMUTANEOUD A-SCAN) INTREPRETATION

64.90 36.38

76513 !26

ANTERIOR SEGMENT ULTRASOUND, B-SCAN OR HIGHER RESOLUTION INTREPRETATION

59.33 !24.94

76514 26

CORNEAL PACHYMETRY, UNILATERIAL OR BILATERAL INTREPRETATION

9.11 6.69


DIAGNOSTIC ULTRASOUND - SCANS

76516 26

OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN

INTREPRETATION

47.57 20.67

76519 26

OPTHALMIC BIOMETRY ULTRASD E’GRAPHY A-SCAN W/ LENS INTREPRETATION

50.86 20.93

OPHTHALMOLOGY – NEW PATIENT

92002 INTERMEDIATE EYE EXAM – NEW PATIENT 49.48

92004 COMPREHENSIVE EYE EXAM – NEW PATIENT 93.50

LOW VISION EXAM

92005 LOW VISION EXAMINATION (SCCB CLINIC) 95.00

ESTABLISHED PATIENT

92012 INTERMEDIATE/RE-EXAM ESTABLISHED PATIENT 52.13

92014 DILATED/INTERMEDIATE EXAM ESTABLISHED PATIENT 76.26

SPECIAL OPHTHALMOLOGICAL SERVICES

92015 DETERMINATION OF REFRACTIVE STATE 24.65

92020 GONIOSCOPY, NOT PART OF COMPLETE EYE EXAM 17.67

92025 !26

COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, INTERPRETATION AND REPORT

22.59 !13.28

92081 26

VISUAL FIELDS EXAMINATION, UNILATERAL OR BILATERIAL INTREPRETATION

34.59 13.56

92082 26

HUMPHREY VISUAL FIELDS EXAMINATION, INTERMEDIATE INTREPRETATION

45.76 16.58

92083 26

GOLDMANN VISUAL FIELDS EXTENDED EXAM INTREPRETATION

52.29 19.03

!92100

SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH MULTIPLE MEASUREMENTS OF INTRAOCULAR PRESSURE

!59.01

92132 26

SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING INTERPRETATION

21.47 12.45


SPECIAL OPHTHALMOLOGICAL SERVICES

92133 26

SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC (OCT) INTREPRETATION

26.41 17.38

92134 26

SCANNING COMPUTERIZED OPHTHALMIC (OCT) INTREPRETATION

26.41 17.38

92136 !26

OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH IOL POWER CALCULATION INTREPRETATION

53.91 !20.93

92140 PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTREPRETATION AND REPORT, WITHOUT TONOGRAPHY

!37.89

OPHTHALMOSCOPY

92225 OPHTHALMOSCOPY, EXTENDED W/RETINAL DRAWING 16.93

92226 OPHTHALMOSCOPY - SUBSEQUENT 15.70

92227 REMOTE IMAGING FOR DETECTION OF RETINAL DISEASE 6.79

!92228

REMOTE IMAGING FOR MONITORING AND MANAGEMENT OF ACTIVE RETINAL DISEASE

!17.79

92230 FLRORESCEIN ANGIOSCOPY W/INTERPRETATION AND REPORT

40.07

92235 26

FLUROESCEIN ANGIOGRAPHY INTREPRETATION

83.69 31.45

92250 26

FUNDUS PHTOTS WITH INTERPRETATION AND REPORT INTREPRETATION

47.03 16.58

92285 26

EXTERNAL OCULAR PHOTOGRAPHY INTERPRETATION

27.28 7.79

92286 26

ANTERIOR SEGMENT IMAGING INTERPRETATION

78.20 25.19

CONTACT LENS FITTING

!92071

FITTING OF CONTACT LENS FOR TREATMENT OF OCULAR SURFACE DISEASE

!19.80


CONTACT LENS FITTING

!92072

INITIAL FITTING OF CONTACT LENS – FOR MANAGEMENT OF KERATOCONUS; INITIAL FITTING

!87.00

!92310

PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS

!69.27

92311 CORNEAL LENS FOR APHAKIA, 1 EYE 62.62

92312 CORNEAL LENS FOR APHAKIA, BOTH EYES 72.25

92313 CORNEOSCLERAL LENS 60.03

FITTING FOR GLASSES

92340 FITTING, SPECTACLES EXCEPT FOR APHAKIA, MONOFOCAL 26.53

CONTACT LENS SERVICES

(for treatment of eye disease only)LENS SOFT – ONE EYE 125.00

LENS HARD – ONE EYE 150.00

OFFICE VISIT - MEDICAL

99201 INITIAL OFFICE VISIT – EXAM 26.80

99202 INITIAL OFFICE VISIT - EXAM 46.53

99203 INITIAL OFFICE VISIT - EXAM 67.37

99204 LEVEL IV MEDICAL EXAM; NEW PATIENT 104.69

99205 GENERAL MEDICAL – HEMOGLOBIN & URINALYSIS 132.41

OFFICE VISIT – ESTABLISHED PATIENT

99211 LEVEL I FOLLOW UP; ESTABLISHED PATIENT 13.52

99212 LEVEL II FOLLOWUP; ESTABLSHED PATIENT 27.05


99213 LEVEL III FOLLOWUP; ESTABLISHED PATIENT 45.37

99214 LEVEL V FOLLOWUP; ESTABLSIHED PATIENT 68.36

99215 LEVEL V FOLLOWUP; ESTABLISHED PATIENT 92.44

INITIAL CONSULTANTION

99241 INITIAL OFFICE CONSULTATION 35.45





AUDIOLOGICAL EVALUATION

92550 TYMPANOMETRY AND RELFEX THRESHOLD MEASUREMENTS 12.70

92551 SCREENING TEST, PURE TONE, AIR ONLY 7.77

92552 PURE TONE AUDIOMETRY (THRESHOLD) AIR ONLY 14.52

92553 AIR AND BONE 19.69

92555 SPEECH AUDIOMETRY THRESHOLD 10.69

92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION 31.89

92592 HEARING AID CHECK, MONAURAL 17.91

HEARING AIDS – CONSULT JERRY FRANCIS

ANESTHESIA

ANESTHEISA – ESTIMATION ONLY (once invoice has been received actual amount will be calculated)

!150.00

CORNEA TISSUE

V2785 CORNEA TISSUE 2,880.00


INJECTION

J9035 AVASTIN USE IN CONJUNCTION WITH 67028 90.36

PSYCHIATRIC SERVICES 115.38

90791 PSYCHIATRIC DIAGNOSTIC EVALUATION

90792 PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES

115.38

!90832

PSYCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER

!33.87

!!!90833

PSYSCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE OF PRIMARY PROCEDURE)

!!!22.60

!90834

PSYCHOTHERAPHY, 45 MINTUES WITH PATIENT AND/OR FAMILY MEMBER

!43.95

!!!90836

PSYCHOTHERAPHY, 45 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT OF SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE)

!!!36.73

!90837

PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER

!64.37

!!!90838

PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE)

!!!59.13

Documents

MEDICAl FEE CPT CODE LIST - 2013 2014 - South Carolina · 65110 exenteration of orbit w/o skin graft rem orbit content ... 67700 blepharotomy, drainage of abscess, eyelid 160.23