Multiple Procedure Policy · 2019-06-20 · This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2018 UnitedHealthcare Services, Inc. 2018R0034B

Multiple Procedure Policy

Policy Number 2018R0034B Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT

®*), Centers for Medicare and

Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider

contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. *CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

Application

This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid products. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. Payment Policies for Medicare & Retirement, UnitedHealthcare Community Plan Medicare and Employer & Individual please use this link. Medicare & Retirement and UnitedHealthcare Community Plan Medicare Policies are listed under Medicare Advantage Reimbursement Policies. Employer & Individual are listed under Reimbursement Policies-Commercial.

Table of Contents

Application

Policy Overview

Multiple Procedure Concept

Multiple Procedure Reductions

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____


CMS-1500


Multiple Procedure Ranking Multiple Procedure Reduction Codes with Assigned CMS RVUs Reported with Modifiers 26, 53, TC

Multiple Procedure Reduction Codes with No Assigned CMS RVU Multiple Procedure Reduction Methods Multiple Procedures Reported with Modifier 78

Multiple Procedures for Assistant Surgeon Services Reported with Modifiers 80, 81, 82, AS

Multiple Procedures for Co-Surgeon/Team Surgeon Services Reported with Modifiers 62, 66 Multiple Procedures for Bilateral Surgeries Reported with Modifier 50 Anesthesia Management Services

Definitions

Questions and Answers

Codes

Attachments

Resources

History

Policy

Overview

Many medical and surgical services include pre-procedure and post-procedure work, as well as generic services integral to the standard medical/surgical service. When multiple procedures are performed on the same day, by the Same Group Physician and/or Other Health Care Professional, reduction in reimbursement for secondary and subsequent procedures will occur. Payment at 100% for secondary and subsequent procedures would represent reimbursement for duplicative components of the primary procedure. The Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File identifies procedures that are subject to multiple procedure reductions. Medical and surgical services which have multiple procedure indicators 2 and 3 are subject to the multiple procedure concept and multiple procedure reductions. UnitedHealthcare aligns with CMS in determining which procedures are subject to multiple procedure reductions and the primary or secondary ranking of these procedures based on Relative Value Units. The codes with the following CMS multiple procedure indicators are addressed within this reimbursement policy:

Multiple Procedure Indicator 2 - Standard payment adjustment rules for multiple procedures apply

Multiple Procedure Indicator 3 - Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure).

For endoscopy codes CMS applies special adjustment rules when multiple endoscopic procedures from the same family (same Endoscopic Base Code) are reported on the same day. CMS allows the full Allowable Amount for the highest valued endoscopy code in the family and allows any additional endoscopy codes in the same family at a reduced amount based on the value of the NPFS designated Endoscopic Base Code. To further align with CMS, effective with dates of service 8/1/2016, UnitedHealthcare will apply CMS multiple Endoscopic Adjustment Rules when related endoscopic procedures (within the same family) are performed on the same day. If billed

on the same day as other procedures that are subject to multiple procedure reduction, endoscopy codes may be subject to the both endoscopic and multiple procedure reductions.

The codes with the following CMS multiple procedure indicators are addressed in separate reimbursement policies:

Multiple Procedure Indicator 4 – Refer to the Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy;

Multiple Procedure Indicator 5 – Refer to the Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy;


CMS-1500


Multiple Procedure Indicator 6 and 7 – Refer to the Multiple Procedure Payment Reduction (MPPR) for Diagnostic Cardiovascular and Ophthalmology Procedures Policy.

Multiple Procedure Concept

Multiple procedure reductions apply when:

There are two or more procedure codes subject to reductions (i.e., two or more codes on the Multiple Procedure Reduction Codes list). If two codes are billed but only one is subject to reduction, no reduction will be taken on either procedure;

A single code subject to the multiple procedure concept is submitted with multiple units. For example, CPT code 11300 is submitted with 3 units. Multiple procedure reductions would apply to the second and third unit. The units may also be subject to UnitedHealthcare Community Plan’s other policies, such as the “Maximum Frequency Per Day Policy.”

UnitedHealthcare Community Plan uses the CMS multiple procedure indicators 2 and 3 in the NPFS Relative Value File to determine which procedures are eligible for multiple procedure reductions. The use of modifier 51 appended to a code is not a factor in determining which codes are considered subject to multiple procedure reductions. In addition, UnitedHealthcare Community Plan applies the payment indicators for HCPCS codes G0412-G0415 when adjudicating CPT codes 27215-27218 for the purposes of this policy. The Multiple Procedure Reduction Codes list contains all codes that are subject to the multiple procedure concept as described above.

2016 Multiple Procedure Reduction Codes CMS Physician Fee Schedule Relative Value Files

Endoscopic Procedures for Dates of Service Through 7/31/2016 For dates of service 2/29/2016 and prior, when multiple endoscopic procedures from the Multiple Procedure Reduction Codes list are performed on the same patient by the Same Group Physician and/or Other Health Care Professional on the same day, UnitedHealthcare applies multiple procedure reductions to the endoscopic code(s) with the lower RVU values [i.e., the secondary/subsequent procedure(s)]. Endoscopic Procedures for Dates of Service Beginning 8/1/2016 For dates of service 3/1/2016 and after, when related endoscopic procedures (within the same family) are performed on the same day, the lower ranking endoscopy codes will receive an adjustment under the Endoscopic Adjustment Rule to reduce the Allowed Amount based on the amount of the Endoscopic Base Code. No reimbursement will be made for the Endoscopic Base Code. Multiple endoscopies in the same family performed on the same day as other procedures subject to multiple procedure reduction will be ranked accordingly and may be subject to endoscopic and multiple procedure reduction. A list of Endoscopy codes and Endoscopic Base codes can be found in the Attachments section of the policy. Refer to the Questions and Answers section, Q&A #7 and #8 for examples of how the Endoscopic Adjustment Rule will be applied. If two or more endoscopic procedures are performed on the same day from different families, the multiple procedure reduction will be applied to the endoscopic codes with the lower RVU values. Additional Services Additional reimbursement will not be allowed for the following services which are considered included in the procedure being performed:

Moving a patient from one surgical suite to another surgical suite to perform an additional procedure;

Repositioning a patient;

Re-draping a patient;

Separate incisions or operative sites

Multiple Procedure Reductions

Multiple procedures subject to the multiple procedure concept (as described above) performed by the Same Group

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU16A.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descendinghttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files-Items/RVU16A.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending


CMS-1500


Physician and/or Other Health Care Professional on the same date of service are ranked to determine applicable reductions. There are no modifiers that override the multiple procedure concept other than those services which are appropriately reported with modifier 78. Multiple Procedure Ranking UnitedHealthcare Community Plan uses the CMS Facility Total RVUs to determine the ranking of primary, secondary and subsequent procedures when those services are performed in a facility setting (Place of Service [POS] 19, 21, 22, 23, 24, 26, 31, 34, 41, 42, 51, 52, 53, 56 and 61). Procedures performed in a place of service other than the facility POS setting will be ranked by the CMS Non-Facility RVUs. Examples: Note: RVU values in these examples may not accurately reflect the current NPFS and are intended for illustrative purposes only.

POS 11 (Office)

Code Description Units Non-Facility Total RVUs

Facility Total RVUs

Multiple Procedure Ranking

11012 Debride skin/muscle/bone, fx 1 18.59 11.50 1 - Primary

14301 Adjacent skin tissue rearrangement 1 18.56 16.16 2 - Secondary

POS 22 (Outpatient Hospital)

Code Description Units Non-Facility Total RVUs

Facility Total RVUs


11012 Debride skin/muscle/bone, fx 1 18.59 11.50 2 - Secondary

14301 Adjacent skin tissue rearrangement 1 18.56 16.16 1- Primary

Multiple Procedure Reduction Codes with Assigned RVUs Reported with Modifiers 26, 53, TC For certain codes that are subject to multiple procedure reductions CMS has assigned separate RVU values when reported with modifiers 26, 53, and TC. When these modified services are billed with other services subject to the multiple procedure concept, the CMS RVUs associated with the reported modifier 26, 53, or TC are used in determining which services should be reduced according to the multiple procedure concept. Example: Note: RVU values in this example may not accurately reflect the current NPFS and are intended for illustrative purposes only. 522xx was reported with the professional component for 517xx (Modifier 26) in POS 11(office). The global procedure (517xx) is not applicable in this example.

Code Modifier Non-Facility

RVU Facility

RVU RVU used for

Ranking Multiple Procedure

Ranking

522xx 8.25 5.25 8.25 1 - Primary

517xx 9.00 6.00 Not

applicable Not applicable

517xx 26 3.15 1.45 3.15 2 - Secondary

Note: Multiple procedure reduction codes may be reported with modifier 53 that have not been assigned a separate RVU for modifier 53 by CMS. In these situations the global RVU is used for multiple procedure ranking.


CMS-1500


Refer to the Multiple Procedure Reduction Codes list for all codes subject to multiple procedure reductions that have a separate RVU value associated with the 26, 53, or TC modifier. Multiple Procedure Reduction Codes with No Assigned CMS RVU Services that CMS indicates may be carrier-priced, or those for which CMS does not develop RVUs are considered Gap Fill Codes and are addressed as follow:

Gap Fill Codes: When data is available for Gap Fill Codes, UnitedHealthcare Community Plan uses the relative values published in the first quarter update of the Optum The Essential RBRVS publication for the current calendar year.

2016 Multiple Procedure Reduction Codes Assigned Gap Fill RVUs

0.00 RVU Codes: Some codes cannot be assigned a gap value or remain without an RVU due to the nature of the service (example: unlisted codes). These codes are assigned an RVU value of 0.00 on the Multiple Procedure Reduction Codes list and will be excluded from ranking.

Multiple Procedure Reduction Methods Multiple procedure reductions will be applied using either the Standard or Alternate method as set forth below. The Alternate method is used by Administrative Services Only groups that have not adopted UnitedHealthcare Community Plan's Standard method and by Medicaid programs which require a 100%-50%-25% method of reduction.

Standard Method 100% of the Allowable Amount for the primary/major procedure. 50% of the Allowable Amount for the secondary procedure. 50% of the Allowable Amount for all subsequent procedures.

Alternate Method 100% of the Allowable Amount for the primary/major procedure. 50% of the Allowable Amount for the secondary procedure. 25% of the Allowable Amount for all subsequent procedures.

NOTE: Multiple procedure reductions are applicable to percent of charge or discount contracts. For percent of charge or discount contracts, the Allowable Amount is determined as the billed amount, less the discount.

For additional examples of multiple procedure ranking on claims reported by a surgeon, refer to the Questions and Answers section, Q&A #1.

Multiple Procedures Reported with Modifier 78

Per CPT, it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first, and requires the use of an operating/procedure room, it should be reported by adding modifier 78 to the related procedure. In accordance with CMS guidelines, procedures reported with a modifier 78 that have a 10 or 90 day global period are not subject to the multiple procedure concept.

Refer to UnitedHealthcare Community Plan’s “Global Days Policy” for details regarding modifier 78 reductions.

For additional information, refer to the Questions and Answers section, Q&A #6.

Multiple Procedures for Assistant Surgeon Services Reported with Modifiers 80, 81, 82, AS

When services are reported by more than one assistant surgeon using modifiers 80, 81, 82 or AS those services will be ranked collectively if reported by the Same Group Physician and/or Other Health Care Professional. Assistant surgeon services will be ranked separately from the services reported by the primary surgeon.

Refer to UnitedHealthcare Community Plan "Assistant Surgeon Policy" for information on when assistant surgeon services are reimbursable. Refer to the Questions and Answers section, Q&A #3 for an example of multiple procedure ranking on an assistant


CMS-1500


surgeon claim.

Multiple Procedures for Co-Surgeon/Team Surgeon Services Reported with Modifiers 62, 66

Multiple procedures performed by a co-surgeon (modifier 62) or team surgeon (modifier 66) are subject to the multiple procedure concept as defined above when performed by the Same Individual Physician or Other Health Care Professional on the same date of service. Co-surgeon and team surgeon services are ranked separately and independently of any other co-surgeon or team surgeon services. Refer to UnitedHealthcare Community Plan's "Co-Surgeon/Team Surgeon Policy" for information on when co-surgeon and team surgeon services are reimbursable.

Refer to the Questions and Answers section, Q&A #5 for an example of multiple procedure ranking on a co-surgeon claim.

Multiple Procedures for Bilateral Surgeries Reported with Modifier 50

Selected bilateral eligible services may also be subject to multiple procedure reductions when billed alone or with other multiple procedure reduction codes.

Refer to UnitedHealthcare Community Plan's "Bilateral Procedures Policy" for information on when bilateral procedures are a reimbursable service. Refer to the Questions and Answers section, Q&A #4 for an example of multiple procedure ranking on a bilateral procedure.

Anesthesia Management Services

Multiple procedure reductions do not apply to time-based anesthesia management services, as identified in UnitedHealthcare Community Plan’s "Anesthesia Policy."

State Exceptions

Florida Uses the Alternate Reduction Method

100% of the Allowable Amount for the primary/major procedure. 50% of the Allowable Amount for the secondary procedure. 25% of the Allowable Amount for all subsequent procedures.

Kansas Uses the Alternate Reduction Method


Louisiana Multiple Procedure Reduction will not apply to code 11981 when billed with OB delivery codes 59400 – 59414 and 59430 – 59622.

Missouri Uses the Alternate Reduction Method 100% of the Allowable Amount for the primary/major procedure. 50% of the Allowable Amount for the secondary procedure. 25% of the Allowable Amount for all subsequent procedures. If billed a cesarean section on a subsequent delivery after a child has been delivered vaginally, reimbursement is 100% for both deliveries

New Mexico Uses the Alternate Reduction Method



CMS-1500


Ohio Uses the Alternate Reduction Method


Tennessee Tennessee is excluded from the 8/1/2016 update to endoscopy multiple procedure reduction process.

Washington Washington state regulations allow a specified reimbursement amount for nurse midwives billing 59409 appended with the SU modifier. This code is not subject to a multiple procedure reduction.

Wisconsin Uses the Alternate Reduction Method

100% of the Allowable Amount for the primary/major procedure. 50% of the Allowable Amount for the secondary procedure. 25% of the Allowable Amount for the tertiary procedure. 13% of the Allowable Amount for all subsequent procedures.

Definitions

Allowable Amount Defined as the dollar amount eligible for reimbursement to the physician or health care professional on the claim. Contracted rate, reasonable charge, or billed charges are examples of Allowable Amounts. For percent of charge or discount contracts, the Allowable Amount is determined as the billed amount, less the discount.

Endoscopic Adjustment Rule

Allows the full Allowable Amount for the highest valued endoscopy code and allows any additional endoscopy codes (within the same family) at a reduced amount based on the value of the NPFS designated Endoscopic Base Code.

Endoscopic Base Code The most basic, least complex form of the endoscopic procedure being done.

Gap Fill Codes Codes for which CMS does not develop RVUs. Relative values are therefore assigned based on the first quarter update of Optum The Essential RBRVS publication for the current calendar year. Note: Under the Multiple Procedure policy a Gap Fill Code would also be subject to reduction per the CMS NPFS multiple procedure indicator of 2 or 3.

Relative Value Units (RVU) The assigned unit value of a particular CPT or HCPCS code. The associated RVU is either from the CMS NPFS Non-Facility Total value or Facility Total value.

Same Individual Physician or Other Health Care Professional

The same individual rendering health care services reporting the same Federal Tax Identification number.

Same Group Physician and/or Other Health Care Professional

All physicians and/or other health care professionals of the same group reporting the same Federal Tax Identification number.

Questions and Answers

1

Q: Which procedure would be primary when CPT code 58150 (total abdominal hysterectomy) and CPT code 57270 (repair of enterocele) are performed in a facility and reported by two different specialty physicians within the same group practice?

A: Multiple procedure ranking is based on the facility RVUs. CPT code 58150 is the primary procedure with the higher CMS RVU value of 29.55 and CPT code 57270 is the secondary procedure with the lower CMS RVU of


CMS-1500


23.74. CPT code 58150 would be reimbursed at 100% of the Allowable Amount, and CPT code 57270 would be reimbursed at 50% of the Allowable Amount. Example: Note: RVU values in this Q&A may not accurately reflect the current NPFS and are intended for illustrative purposes only.

Two Different Specialty

Physicians/Same Group

Code Non-Facility RVU

Facility RVU RVU used for ranking


Dr. A 57270 29.22 23.74 23.74 – facility 2 - Secondary

Dr. B 58150 34.01 29.55 29.55 – facility 1 - Primary

2

Q: Are multiple procedure reductions applied when the same individual surgeon reports multiple procedure reduction codes while acting as both surgeon and assistant surgeon during the same operative session?

A: Yes, however the surgeon is acting in two different capacities, as surgeon and assistant surgeon. This means all multiple procedure reduction codes reported by the surgeon (with no assistant surgeon modifier) are ranked as one group and all multiple procedure reduction codes reported with an assistant surgeon modifier are ranked as a second group, independent of each other.

3

Q: Are multiple procedure reductions applied when two different physicians within the same group practice each report assistant surgeon services, Dr. A reports 19307-80 and the Dr. B reports 19367-81?

A: Yes. A multiple procedure reduction would be applied to CPT code 19307-80 (the secondary code). In addition, both 19307-80 and 19367-81 would be subject to reduction based on the assistant surgeon modifiers (e.g. 80, 81).

Example:

Note: RVU values in this Q&A may not accurately reflect the current NPFS and are intended for illustrative purposes only.

Two Different Physicians/Same

Group

Code Non-Facility

RVU

Facility RVU

RVU used for

ranking


Applicable Reductions

Dr. A 19307-80

34.16 34.16 34.16 2 - Secondary

50% of the Allowable Amount

for multiple procedure subject

to modifier 80 assistant surgeon

reduction.

Dr. B 19367-81

53.54 53.54 53.54 1 - Primary 100% of the Allowable Amount

for multiple procedure subject

to modifier 81 assistant surgeon

reduction.

4

Q: How is multiple procedure ranking applied to a bilateral eligible procedure reported with a modifier 50?

A: When the bilateral code is split for processing, each side is considered separately for ranking when a multiple procedure reduction applies. Side 1 will be ranked primary and side 2 will be ranked secondary.

Example: Note: RVU values in this example may not accurately reflect the current NPFS and are intended for illustrative purposes only.


CMS-1500


Line Bilateral Code

Charge Multiple Procedure Ranking


1 19361-50 $2000.00 1 - Primary 100% of the Allowable Amount

2 19361 $2000.00 2 - Secondary 50% of the Allowable Amount

5

Q: How is multiple procedure ranking applied when two different physicians in the same group practice each report multiple co-surgeon services eligible for multiple procedure reductions on the same day?

A: Each co-surgeon’s services are ranked separately and independently of the other regardless of whether they are in the same group practice. In addition, each co-surgeon’s services are subject to reduction based on the co-surgeon modifier (62) reported.

Example: Note: RVU values in this example may not accurately reflect the current NPFS and are intended for illustrative purposes only.

Services reported by Dr. A - CPT 19361-62, RVU = 29, CPT 19340-62, RVU = 20 Services reported by Dr. B - CPT 19361-62, RVU = 29, CPT 19340-62, RVU = 20

Dr. A

Code



1 19361-62 $4000.00 1 – Primary 100% of the Allowable Amount for multiple procedure subject to modifier

62 co-surgeon reduction

2 19340-62 $1600.00 2 – Secondary 50% of the Allowable Amount for multiple procedure subject to modifier


Dr. B

Code



1 19361-62 $4000.00 1 – Primary 100% of the Allowable Amount for multiple procedure subject to modifier


2 19340-62 $1600.00 2 – Secondary 50% of the Allowable Amount for multiple procedure subject to modifier


6

Q: Are there any modifiers that will override the multiple procedure policy?

A: No, other than those services which are appropriately reported with modifier 78 as described in UnitedHealthcare Community Plan’s “Global Days Policy”.

7

Q: How will the Endoscopic Adjustment Rule be applied to multiple endoscopy codes within the same family (same Endoscopic Base Code) billed on the same day by the Same Group Physician and/or Other Health Care Professional on or after 3/1/2016 date of service?

A: Below is an example of how the Endoscopic Adjustment Rule will be applied:

In the course of performing a fiber optic colonoscopy (CPT code 45378), a physician performs a biopsy on a lesion

(code 45380) and removes a polyp (code 45385) from a different part of the colon. The physician bills for codes

45380 and 45385. The value of codes 45380 and 45385 have the value of the diagnostic colonoscopy (45378) built


CMS-1500


in. Rather than paying 100 percent for the highest valued procedure (45385) and 50 percent for the next (45380),

the Endoscopic Adjustment Rule will pay the full value of the higher valued endoscopy (45385), plus the difference

between the next highest endoscopy (45380) and the Endoscopic Base Code (45378) or Adjusted Allowable for

(45380).

The calculation of the Adjusted Allowable for the lesser valued endoscopy code(s) in the same family is as follows: a. Determine the Adjusted RVU: Lesser valued endoscopy code(s) RVU minus the Endoscopic Base

Code RVU b. Determine the Percentage to Allow: Adjusted RVU (Step 1a) divided by the lesser valued RVU = ratio

(percentage to allow for the lesser valued endoscopy code). c. Determine the Adjusted Allowable for the lesser code(s): Lesser valued code fee schedule x ratio (Step

1b) = endoscopic adjusted allowable for the lesser valued code. Based on the following RVUs for these codes if the procedures were performed in a facility: 45378 (6.48), 45380 (7.73) and 45385 (9.17), UHC would reimburse the full value of 45385 ($374.56), plus the Adjusted Allowable for 45380 ($45.76). The Endoscopic Base Code (45378) is not reimbursed. Note: RVU values and dollar amounts in this example may not accurately reflect the current NPFS and are intended for illustrative purposes only.

Code Description

Facility RVU

Adjusted RVU

Percentage to Allow Adjusted Allowable

45378

Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

6.48 Endoscopic Base Code

= not allowed

N/A N/A

45380 Colonoscopy, flexible; with biopsy, single or multiple

7.73 7.73 – 6.48 = 1.25

1.25/7.73 = 16%

285.98 x 16% = $45.76

45385

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

9.17 Highest RVU – no

adjustment

100% $374.56 – no adjustment

8

Q: How will the Endoscopic Adjustment Rule be applied to multiple endoscopy codes within the same family and another procedure that is not related?

A: Below is an example of how the Endoscopic Adjustment Rule and multiple procedure reduction will be applied when the physician bills for codes 45380 and 45381 (same endoscopic family) and 45562 (unrelated procedure).

a. First determine the Total Adjusted RVU for each endoscopic family. Each “family” of endoscopic codes is considered as a single procedure (RVUs combined) for ranking.

b. Rank the Family Adjusted RVUs against other reducible procedures RVUs from highest to lowest. c. Apply the Multiple Procedure Reduction (Example: Standard reduction of 100-50-50).

Based on the following RVUs for these codes if the procedures were performed in a facility: 45378 (6.48), 45380

(7.73), 45381 (7.34) and 45562 (33.19), first calculate the Total Adjusted RVUs based on the Endoscopic

Adjustment Rule by subtracting the difference between the Endoscopic Base Code and the lower valued

endoscopy code (.86) and then adding that calculation to the higher valued endoscopy code (7.73), which equals

(8.56). Compare the Family Adjusted RVUs (8.56) to the RVUs of the unrelated procedure (33.19) to determine

Multiple Procedure Ranking.

Note: RVU values and dollar amounts in this example may not accurately reflect the current NPFS and are intended for illustrative purposes only.

Code Description Facility Total Family Multiple Multiple


CMS-1500


RVU Adjusted RVU

Adjusted RVU

Procedure Ranking

Procedure Reduction

45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

6.48 Endoscopic Base Code = not allowed

N/A N/A N/A

45380 Colonoscopy, flexible; with biopsy, single or multiple

7.73 Highest RVU – no adjustment 7.73 + .86

= 8.56

2 50%

45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance

7.34 7.34 – 6.48 = .86

45562 Exploration, repair, and presacral drainage for rectal injury

33.19 Unrelated Procedure

N/A 1

100%

Codes

Modifier Descriptions

26 Professional Component

50 Bilateral Procedure

51 Multiple Procedures

53 Discontinued Procedure

62 Two Surgeons

66 Surgical Team

78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

80 Assistant Surgeon

81 Minimum Assistant Surgeon

82 Assistant Surgeon (when qualified resident surgeon not available)

AS PA, nurse practitioner, or clinical nurse specialist services for assistant at surgery

TC Technical component

Attachments: Please right-click on the icon to open the file

UnitedHealthcare Community Plan Multiple Procedure Reduction Codes

Assigned Gap-Fill RVU

The list identifies codes on the Multiple Procedure Reduction Codes list

that have been assigned gap fill RVUs.

2018 Multiple Procedure Codes Assigned Gap Filled RVUs

Code Modifier NFRVU FacRVU

15824 31.77 31.77

15825 35.74 35.74

15826 25.81 25.81

15828 67.51 67.51

15829 75.45 75.45

17380 2.15 2.15

21742 34.63 34.63

21743 45.56 45.56

24940 30.17 30.17

41820 7.01 7.01

41821 1.58 1.58

41850 3.50 3.50

41870 8.76 8.76

54440 16.28 16.28

58974 4.18 4.18

92992 30.98 30.98

92993 24.51 24.51

93530 23.12 23.12

93531 49.72 49.72

93532 61.92 61.92

93533 51.70 51.70

93619 19.93 19.93

93620 24.36 24.36

93624 9.01 9.01

93640 13.03 13.03

93641 17.15 17.15

ctracy5File Attachment2018 Multiple Procedure Codes Assigned Gap Filled RVUs.pdf


CMS-1500


UnitedHealthcare Community Plan Multiple Procedure Reduction Codes

The list identifies codes that are subject to multiple procedure reductions and their associated CMS NPFS Non-Facility RVU value and Facility Total RVU value.

Endoscopy Code Policy Table

The list identifies Endoscopy codes and Endoscopic Base codes that are subject to the Endoscopic Adjustment Rule.

Resources

Individual state Medicaid regulations, manuals & fee schedules

American Medical Association, Current Procedural Terminology (CPT®) and associated publications and services

Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and services

Centers for Medicare and Medicaid Services, Physician Fee Schedule (PFS) Relative Value Files

Optum, “The Essential RBRVS” 1st Quarter Update

History

4/11/2018 State Exceptions Updated: updated Ohio

4/6/2018 State Exceptions Updated: Corrected entry error for Louisiana 59430 (No new version)

3/22/2018 State Exceptions Updated: Corrected entry error for Washington 59409 (No new version)

1/1/2018 Annual Policy Version Change Policy List Change: Updated Multiple Procedure Reduction Codes, Multiple Procedure Codes Assigned Gap Fill RVUs, and Endoscopy Codes Policy Table History Section: Entries prior to 1/1/2016 archived

9/25/2017 State Exceptions Updated: Added exception for Louisiana

7/2/2017 Application Section: Removed UnitedHealthcare Community Plan Medicare products as applying to this policy. Added location for UnitedHealthcare Community Plan Medicare reimbursement policies. Attachments: Update Endoscopy Code Policy Table.

4/12/2017 State Exceptions Section Updated: Added exception for Missouri

3/16/2017 State Exceptions Section Updated: Removed exception for Iowa

2/12/2017 State Exceptions Section Updated: Added information for Florida and Missouri

1/1/2016 Annual Policy Version Change Policy List Change: Updated Multiple Procedure Reduction Codes, Multiple Procedure Codes Assigned Gap Fill RVUs, and Endoscopy lists History Section: Entries prior to 1/1/2015 archived

10/2/2016 Attachments: Updated the Endoscopy Code Policy Table to include Reduction Percent and Facility Reduction Percent columns and updated the description of the table.

2018 Multiple Procedure Reduction Codes


0308T 0.00 0.00

0479T 0.00 0.00

0483T 0.00 0.00

0484T 0.00 0.00

0494T 0.00 0.00

0499T 0.00 0.00

10030 16.04 3.98

10035 14.71 2.49

10040 3.13 2.05

10060 3.38 2.79

10061 5.87 5.14

10080 5.12 2.94

10081 7.68 4.87

10120 4.38 2.97

10121 7.83 5.31

10140 4.69 3.40

10160 3.71 2.73

10180 7.06 5.13

11000 1.56 0.82

11004 16.69 16.69

11006 20.44 20.44

11010 14.43 8.20

11011 15.48 8.68

11012 20.25 12.28

11042 3.35 1.78

11043 6.53 4.47

11044 8.94 6.63

11055 1.37 0.46

11056 1.67 0.65

11057 1.89 0.86

11100 3.00 1.41

11200 2.55 2.11

11300 2.79 1.02

11301 3.42 1.54

11302 4.03 1.82

11303 4.45 2.14

11305 2.82 1.12

11306 3.48 1.50

11307 4.13 1.93

11308 4.31 2.13

11310 3.25 1.37

11311 3.18 1.89

11312 4.58 2.25

11313 5.31 2.90


11400 3.58 2.32

11401 4.27 2.98

11402 4.76 3.29

11403 5.50 4.24

11404 6.23 4.66

11406 8.99 7.11

11420 3.50 2.33

11421 4.48 3.15

11422 5.04 3.92

11423 5.74 4.49

11424 6.67 5.16

11426 9.56 7.93

11440 3.87 2.96

11441 4.80 3.77

11442 5.37 4.16

11443 6.38 5.10

11444 8.02 6.51

11446 11.14 9.34

11450 10.98 7.30

11451 13.90 9.34

11462 10.72 6.97

11463 14.05 9.39

11470 11.82 8.09

11471 14.62 10.07

11600 5.52 3.44

11601 6.53 4.28

11602 7.08 4.71

11603 8.11 5.65

11604 8.99 6.21

11606 12.86 9.24

11620 5.56 3.48

11621 6.56 4.31

11622 7.32 4.93

11623 8.59 6.12

11624 9.68 6.93

11626 11.63 8.47

11640 5.73 3.60

11641 6.78 4.49

11642 7.74 5.29

11643 9.12 6.63

11644 11.26 8.22

11646 14.66 11.38

11719 0.41 0.22

11730 3.01 1.59

11740 1.43 0.94

11750 4.37 2.91


11755 3.75 2.21

11760 5.35 3.26

11762 7.97 5.25

11765 4.77 2.68

11770 7.89 5.31

11771 16.49 12.54

11772 19.86 16.55

11900 1.60 0.90

11901 2.01 1.40

11920 4.91 3.28

11921 5.63 3.84

11950 2.00 1.36

11951 2.88 2.06

11952 3.72 2.78

11954 4.45 3.25

11960 27.35 27.35

11970 17.50 17.50

11971 13.42 9.13

11976 4.10 2.69

11980 2.71 1.62

11981 4.05 2.40

11982 4.53 2.87

11983 6.54 5.11

12001 2.59 1.27

12002 3.15 1.68

12004 3.68 2.09

12005 4.63 2.72

12006 5.50 3.34

12007 6.35 4.20

12011 3.16 1.58

12013 3.31 1.66

12014 3.86 2.14

12015 4.65 2.69

12016 5.86 3.66

12017 4.39 4.39

12018 4.97 4.97

12020 8.00 5.41

12021 4.67 3.97

12031 6.78 4.41

12032 8.61 5.61

12034 8.92 5.99

12035 10.85 6.92

12036 12.06 8.08

12037 13.72 9.46

12041 6.77 4.33

12042 8.24 5.77


12044 10.26 6.20

12045 11.40 7.75

12046 13.70 8.97

12047 15.09 10.02

12051 7.36 4.94

12052 8.39 5.88

12053 9.85 6.29

12054 10.27 6.41

12055 13.27 8.76

12056 15.86 11.07

12057 16.83 12.42

13100 9.54 5.94

13101 11.27 7.30

13120 9.98 6.82

13121 12.16 7.71

13131 10.98 7.22

13132 13.56 9.08

13151 12.01 8.28

13152 14.42 10.04

13160 22.98 22.98

14000 17.73 14.42

14001 22.90 18.88

14020 19.83 16.31

14021 24.81 20.66

14040 21.70 18.17

14041 26.88 22.39

14060 22.14 19.36

14061 28.92 23.95

14301 30.69 25.35

14350 19.67 19.67

15050 15.97 12.74

15100 24.45 20.53

15110 22.69 19.82

15115 22.45 19.63

15120 24.21 20.01

15130 18.80 15.91

15135 24.19 21.29

15150 19.92 18.25

15155 22.86 21.12

15200 23.74 19.35

15220 21.98 17.69

15240 26.60 23.04

15260 28.88 24.73

15271 4.03 2.43

15273 8.59 5.88

15275 4.26 2.75


15277 9.40 6.63

15570 26.08 21.15

15572 25.38 21.46

15574 25.93 21.92

15576 22.95 19.25

15600 9.22 5.93

15610 10.14 6.92

15620 12.42 9.28

15630 13.04 9.91

15650 14.34 10.96

15730 44.24 26.42

15731 31.96 28.77

15733 30.17 30.17

15734 43.56 43.56

15736 35.42 35.42

15738 38.08 38.08

15740 28.95 24.42

15750 26.28 26.28

15756 66.23 66.23

15757 65.12 65.12

15758 65.77 65.77

15760 24.25 20.30

15770 19.05 19.05

15775 8.64 6.44

15776 13.80 10.22

15780 26.75 20.48

15781 15.85 12.43

15782 17.25 12.42

15783 13.86 10.78

15786 7.11 3.96

15788 13.19 7.07

15789 15.91 11.97

15792 12.49 7.37

15793 14.08 10.55

15819 22.73 22.73

15820 15.93 14.31

15821 17.37 15.56

15822 12.74 11.15

15823 17.37 15.54

15824 31.77 31.77

15825 35.74 35.74

15826 25.81 25.81

15828 67.51 67.51

15829 75.45 75.45

15830 33.79 33.79

15832 26.19 26.19


15833 25.02 25.02

15834 25.49 25.49

15835 26.92 26.92

15836 22.66 22.66

15837 24.71 20.69

15838 18.30 18.30

15839 25.16 21.13

15840 28.66 28.66

15841 51.23 51.23

15842 78.10 78.10

15845 28.72 28.72

15851 2.83 1.32

15852 1.34 1.34

15860 3.12 3.12

15876 0.00 0.00

15877 0.00 0.00

15878 0.00 0.00

15879 0.00 0.00

15920 17.40 17.40

15922 22.42 22.42

15931 19.79 19.79

15933 24.28 24.28

15934 26.88 26.88

15935 31.33 31.33

15936 25.55 25.55

15937 29.66 29.66

15940 20.02 20.02

15941 25.86 25.86

15944 25.47 25.47

15945 28.25 28.25

15946 46.91 46.91

15950 17.05 17.05

15951 25.20 25.20

15952 25.94 25.94

15953 28.54 28.54

15956 33.07 33.07

15958 33.81 33.81

15999 0.00 0.00

16000 1.96 1.33

16020 2.35 1.57

16025 4.22 3.21

16030 5.34 3.88

16035 5.61 5.61

17000 1.88 1.51

17106 9.81 7.95

17107 12.52 10.04


17108 18.42 15.22

17110 3.18 2.00

17111 3.76 2.46

17250 2.29 1.07

17260 2.72 2.01

17261 4.11 2.63

17262 5.00 3.34

17263 5.45 3.70

17264 5.85 3.97

17266 6.61 4.63

17270 4.31 2.87

17271 4.66 3.18

17272 5.32 3.67

17273 5.91 4.15

17274 6.99 5.08

17276 8.09 6.08

17280 4.03 2.61

17281 5.08 3.59

17282 5.82 4.13

17283 6.97 5.17

17284 7.98 6.04

17286 10.18 8.07

17311 18.82 10.89

17313 17.60 9.78

17340 1.50 1.40

17360 3.65 2.81

17380 2.15 2.15

17999 0.00 0.00

19000 3.20 1.26

19020 13.56 8.83

19030 4.68 2.24

19081 19.63 4.85

19083 19.09 4.56

19085 28.52 5.29

19100 4.29 2.02

19101 9.74 6.37

19105 84.20 6.13

19110 13.93 9.87

19112 13.16 8.98

19120 14.16 11.90

19125 15.68 13.20

19260 34.67 34.67

19271 46.77 46.77

19272 51.05 51.05

19281 6.83 2.91

19283 7.72 2.93


19285 14.73 2.50

19287 24.43 3.71

19296 113.16 6.09

19298 28.47 9.13

19300 15.05 11.92

19301 18.77 18.77

19302 25.88 25.88

19303 27.63 27.63

19304 16.60 16.60

19305 32.53 32.53

19306 34.57 34.57

19307 34.46 34.46

19316 22.12 22.12

19318 31.66 31.66

19324 15.23 15.23

19325 18.44 18.44

19328 14.24 14.24

19330 18.22 18.22

19340 28.81 28.81

19342 26.51 26.51

19350 23.57 19.33

19355 21.55 17.85

19357 43.27 43.27

19361 45.32 45.32

19364 79.39 79.39

19366 40.66 40.66

19367 51.60 51.60

19368 63.37 63.37

19369 58.81 58.81

19370 19.72 19.72

19371 22.52 22.52

19380 22.23 22.23

19396 8.33 4.20

19499 0.00 0.00

20005 8.99 6.78

20100 17.46 17.46

20101 12.91 6.04

20102 14.00 7.38

20103 16.72 10.04

20150 29.12 29.12

20200 5.89 2.74

20205 8.27 4.51

20206 6.70 1.70

20220 4.77 2.07

20225 14.77 3.09

20240 4.38 4.38


20245 10.17 10.17

20250 11.20 11.20

20251 12.27 12.27

20500 3.00 2.42

20501 3.35 1.09

20520 5.85 4.22

20525 13.69 7.12

20526 2.21 1.66

20527 2.41 1.91

20550 1.51 1.13

20551 1.73 1.23

20552 1.57 1.09

20553 1.81 1.24

20555 9.39 9.39

20600 1.37 1.02

20604 2.05 1.33

20605 1.44 1.08

20606 2.28 1.53

20610 1.72 1.33

20611 2.58 1.76

20612 1.72 1.21

20615 6.87 4.63

20650 6.05 4.56

20660 7.12 7.12

20661 14.49 14.49

20662 14.72 14.72

20663 13.50 13.50

20664 25.26 25.26

20665 3.07 2.62

20670 10.81 4.21

20680 17.68 12.17

20690 17.15 17.15

20692 32.18 32.18

20693 12.75 12.75

20694 12.19 9.74

20696 34.68 34.68

20802 79.67 79.67

20805 94.88 94.88

20808 114.69 114.69

20816 59.71 59.71

20822 51.29 51.29

20824 59.81 59.81

20827 52.66 52.66

20838 73.11 73.11

20900 11.89 5.44

20902 8.24 8.24


20910 13.44 13.44

20912 13.52 13.52

20920 11.35 11.35

20922 16.92 14.06

20924 14.58 14.58

20926 12.13 12.13

20950 7.12 2.61

20955 71.40 71.40

20956 76.62 76.62

20957 79.66 79.66

20962 77.10 77.10

20969 78.93 78.93

20970 82.87 82.87

20972 82.72 82.72

20973 87.32 87.32

20982 111.35 10.56

20983 170.65 10.38

20999 0.00 0.00

21010 21.95 21.95

21011 9.91 7.43

21012 9.76 9.76

21013 14.84 11.53

21014 15.03 15.03

21015 20.35 20.35

21016 29.16 29.16

21025 25.43 21.54

21026 17.61 14.31

21029 22.08 18.38

21030 14.86 11.98

21031 11.40 8.51

21032 11.49 8.37

21034 37.33 32.96

21040 14.96 12.00

21044 24.96 24.96

21045 35.06 35.06

21046 32.07 32.07

21047 37.67 37.67

21048 32.69 32.69

21049 34.33 34.33

21050 25.94 25.94

21060 23.58 23.58

21070 18.49 18.49

21073 11.03 7.27

21076 28.26 23.72

21077 71.13 60.01

21079 48.00 40.05


21080 54.05 44.67

21081 49.71 40.93

21082 46.82 38.26

21083 44.62 35.55

21084 51.19 41.13

21085 21.50 16.16

21086 52.77 44.28

21087 52.85 44.00

21100 20.66 11.75

21110 22.84 19.14

21116 4.68 1.38

21120 19.68 15.63

21121 22.02 18.82

21122 22.85 22.85

21123 26.45 26.45

21125 84.42 22.18

21127 107.99 25.56

21137 21.66 21.66

21138 26.47 26.47

21139 32.44 32.44

21141 39.21 39.21

21142 40.31 40.31

21143 42.30 42.30

21145 46.02 46.02

21146 47.98 47.98

21147 50.58 50.58

21150 47.56 47.56

21151 50.95 50.95

21154 56.27 56.27

21155 62.41 62.41

21159 74.78 74.78

21160 81.09 81.09

21172 60.13 60.13

21175 63.73 63.73

21179 43.76 43.76

21180 49.03 49.03

21181 21.31 21.31

21182 61.29 61.29

21183 66.79 66.79

21184 71.93 71.93

21188 48.59 48.59

21193 36.82 36.82

21194 42.17 42.17

21195 41.33 41.33

21196 42.59 42.59

21198 33.61 33.61


21199 31.08 31.08

21206 34.52 34.52

21208 50.63 23.96

21209 25.38 19.23

21210 63.80 24.58

21215 111.22 25.65

21230 21.28 21.28

21235 20.63 16.16

21240 32.24 32.24

21242 29.91 29.91

21243 49.27 49.27

21244 30.34 30.34

21245 34.57 27.48

21246 25.39 25.39

21247 47.23 47.23

21248 31.63 25.88

21249 44.62 36.70

21255 41.00 41.00

21256 35.87 35.87

21260 40.59 40.59

21261 71.77 71.77

21263 66.39 66.39

21267 47.52 47.52

21268 59.43 59.43

21270 29.21 21.72

21275 24.11 24.11

21280 16.33 16.33

21282 10.93 10.93

21295 5.31 5.31

21296 11.80 11.80

21299 0.00 0.00

21310 3.87 0.78

21315 7.78 4.30

21320 7.20 3.82

21325 13.38 13.38

21330 16.14 16.14

21335 20.53 20.53

21336 18.31 18.31

21337 11.47 8.39

21338 18.77 18.77

21339 21.32 21.32

21340 21.12 21.12

21343 30.61 30.61

21344 39.29 39.29

21345 21.95 17.74

21346 25.49 25.49


21347 28.67 28.67

21348 30.66 30.66

21355 12.03 9.05

21356 14.30 10.81

21360 15.40 15.40

21365 31.94 31.94

21366 36.74 36.74

21385 21.98 21.98

21386 20.06 20.06

21387 22.92 22.92

21390 22.84 22.84

21395 29.06 29.06

21400 5.51 4.50

21401 14.85 9.24

21406 16.51 16.51

21407 18.45 18.45

21408 25.93 25.93

21421 21.15 17.87

21422 19.31 19.31

21423 22.63 22.63

21431 20.65 20.65

21432 20.69 20.69

21433 50.18 50.18

21435 40.48 40.48

21436 58.90 58.90

21440 16.60 13.47

21445 22.21 17.98

21450 16.17 13.27

21451 21.48 18.05

21452 18.30 10.71

21453 26.13 22.39

21454 16.23 16.23

21461 61.10 26.90

21462 65.16 30.08

21465 26.77 26.77

21470 34.62 34.62

21480 2.82 0.92

21485 22.25 18.27

21490 26.42 26.42

21497 19.23 16.23

21499 0.00 0.00

21501 12.94 9.22

21502 14.50 14.50

21510 12.71 12.71

21550 7.47 4.52

21552 12.87 12.87


21554 21.05 21.05

21555 11.88 8.78

21556 15.13 15.13

21557 27.41 27.41

21558 38.67 38.67

21600 15.90 15.90

21610 35.05 35.05

21615 17.76 17.76

21616 20.66 20.66

21620 14.52 14.52

21627 15.51 15.51

21630 35.37 35.37

21632 34.81 34.81

21685 28.10 28.10

21700 10.39 10.39

21705 15.53 15.53

21720 15.17 15.17

21725 15.58 15.58

21740 29.84 29.84

21742 34.63 34.63

21743 45.56 45.56

21750 19.71 19.71

21811 17.27 17.27

21812 21.03 21.03

21813 28.66 28.66

21820 4.07 4.13

21825 15.51 15.51

21899 0.00 0.00

21920 7.34 4.59

21925 12.87 10.23

21930 13.58 10.51

21931 13.56 13.56

21932 19.08 19.08

21933 21.28 21.28

21935 29.61 29.61

21936 40.90 40.90

22010 27.54 27.54

22015 27.32 27.32

22100 26.25 26.25

22101 26.06 26.06

22102 22.93 22.93

22110 30.20 30.20

22112 32.64 32.64

22114 32.64 32.64

22206 70.90 70.90

22207 69.79 69.79


22210 52.02 52.02

22212 43.10 43.10

22214 43.21 43.21

22220 46.50 46.50

22222 50.90 50.90

22224 45.92 45.92

22310 8.88 8.16

22315 25.43 22.22

22318 47.61 47.61

22319 53.44 53.44

22325 41.78 41.78

22326 43.41 43.41

22327 43.61 43.61

22505 3.81 3.81

22510 47.99 12.59

22511 47.38 11.77

22513 203.56 15.04

22514 202.60 14.00

22532 52.09 52.09

22533 48.14 48.14

22548 57.39 57.39

22551 49.71 49.71

22554 36.40 36.40

22556 48.47 48.47

22558 44.54 44.54

22586 58.29 58.29

22590 45.92 45.92

22595 43.83 43.83

22600 37.45 37.45

22610 36.71 36.71

22612 46.10 46.10

22630 45.76 45.76

22633 53.87 53.87

22800 39.19 39.19

22802 61.14 61.14

22804 70.48 70.48

22808 53.95 53.95

22810 57.25 57.25

22812 64.08 64.08

22818 62.96 62.96

22819 72.37 72.37

22830 23.60 23.60

22849 37.73 37.73

22850 20.96 20.96

22852 20.12 20.12

22855 32.16 32.16


22856 47.57 47.57

22857 49.11 49.11

22861 68.15 68.15

22862 67.83 67.83

22864 60.79 60.79

22865 59.09 59.09

22867 27.01 27.01

22869 15.33 15.33

22899 0.00 0.00

22900 16.28 16.28

22901 19.22 19.22

22902 12.57 9.52

22903 12.67 12.67

22904 30.33 30.33

22905 38.50 38.50

22999 0.00 0.00

23000 16.63 10.62

23020 19.84 19.84

23030 12.80 7.41

23031 11.96 6.22

23035 19.55 19.55

23040 20.63 20.63

23044 16.29 16.29

23065 6.23 4.82

23066 16.01 10.29

23071 12.11 12.11

23073 20.02 20.02

23075 13.52 9.43

23076 15.55 15.55

23077 32.89 32.89

23078 41.50 41.50

23100 14.42 14.42

23101 13.13 13.13

23105 18.37 18.37

23106 14.29 14.29

23107 19.03 19.03

23120 16.80 16.80

23125 20.43 20.43

23130 17.54 17.54

23140 15.37 15.37

23145 20.01 20.01

23146 17.88 17.88

23150 19.09 19.09

23155 22.85 22.85

23156 19.51 19.51

23170 16.14 16.14


23172 16.30 16.30

23174 21.83 21.83

23180 18.83 18.83

23182 18.86 18.86

23184 21.00 21.00

23190 16.46 16.46

23195 21.77 21.77

23200 43.82 43.82

23210 51.50 51.50

23220 56.57 56.57

23330 7.83 4.79

23333 13.39 13.39

23334 31.02 31.02

23335 36.93 36.93

23350 3.70 1.47

23395 36.94 36.94

23397 32.76 32.76

23400 28.00 28.00

23405 17.81 17.81

23406 22.16 22.16

23410 23.64 23.64

23412 24.53 24.53

23415 20.05 20.05

23420 27.92 27.92

23430 21.40 21.40

23440 21.69 21.69

23450 27.36 27.36

23455 28.72 28.72

23460 31.45 31.45

23462 30.70 30.70

23465 32.27 32.27

23466 32.44 32.44

23470 34.58 34.58

23472 42.01 42.01

23473 46.89 46.89

23474 50.64 50.64

23480 23.67 23.67

23485 27.40 27.40

23490 24.86 24.86

23491 29.26 29.26

23500 6.27 6.34

23505 10.10 9.49

23515 20.70 20.70

23520 6.66 6.73

23525 11.06 10.21

23530 16.47 16.47


23532 17.97 17.97

23540 6.45 6.52

23545 9.80 8.87

23550 16.16 16.16

23552 18.81 18.81

23570 6.67 6.84

23575 11.53 10.78

23585 28.22 28.22

23600 9.36 8.79

23605 13.27 12.12

23615 25.47 25.47

23616 35.75 35.75

23620 7.72 7.32

23625 10.83 10.03

23630 22.43 22.43

23650 9.02 8.24

23655 11.52 11.52

23660 16.76 16.76

23665 12.18 11.31

23670 25.17 25.17

23675 15.71 14.27

23680 26.76 26.76

23700 5.65 5.65

23800 29.58 29.58

23802 37.07 37.07

23900 40.10 40.10

23920 32.55 32.55

23921 13.46 13.46

23929 0.00 0.00

23930 10.27 6.25

23931 8.28 4.59

23935 14.51 14.51

24000 13.70 13.70

24006 20.43 20.43

24065 7.35 4.81

24066 17.78 11.90

24071 11.72 11.72

24073 19.99 19.99

24075 14.08 9.51

24076 15.67 15.67

24077 29.89 29.89

24079 38.35 38.35

24100 12.01 12.01

24101 14.34 14.34

24102 17.70 17.70

24105 10.07 10.07


24110 16.87 16.87

24115 21.24 21.24

24116 24.85 24.85

24120 15.24 15.24

24125 17.86 17.86

24126 18.69 18.69

24130 14.61 14.61

24134 21.53 21.53

24136 18.16 18.16

24138 19.42 19.42

24140 20.21 20.21

24145 17.04 17.04

24147 17.91 17.91

24149 33.84 33.84

24150 44.99 44.99

24152 39.06 39.06

24155 24.61 24.61

24160 36.42 36.42

24164 21.00 21.00

24200 5.94 4.00

24201 15.80 10.45

24220 4.47 1.97

24300 11.93 11.93

24301 21.60 21.60

24305 16.58 16.58

24310 13.46 13.46

24320 22.50 22.50

24330 20.68 20.68

24331 22.66 22.66

24332 17.63 17.63

24340 17.62 17.62

24341 21.42 21.42

24342 22.31 22.31

24343 20.31 20.31

24344 31.72 31.72

24345 20.20 20.20

24346 31.67 31.67

24357 12.05 12.05

24358 15.03 15.03

24359 18.98 18.98

24360 25.93 25.93

24361 29.02 29.02

24362 30.58 30.58

24363 42.02 42.02

24365 18.41 18.41

24366 19.56 19.56


24370 44.55 44.55

24371 51.96 51.96

24400 23.59 23.59

24410 30.48 30.48

24420 28.67 28.67

24430 30.41 30.41

24435 30.97 30.97

24470 19.32 19.32

24495 21.22 21.22

24498 24.94 24.94

24500 10.28 9.33

24505 14.22 12.82

24515 25.22 25.22

24516 24.75 24.75

24530 10.91 9.86

24535 17.70 16.31

24538 21.40 21.40

24545 26.78 26.78

24546 29.94 29.94

24560 9.21 8.22

24565 15.32 14.04

24566 20.63 20.63

24575 21.12 21.12

24576 9.76 8.73

24577 15.79 14.44

24579 24.05 24.05

24582 23.27 23.27

24586 31.24 31.24

24587 31.52 31.52

24600 10.46 9.54

24605 13.50 13.50

24615 20.51 20.51

24620 15.82 15.82

24635 19.38 19.38

24640 2.84 2.22

24650 7.51 6.86

24655 12.55 11.39

24665 18.79 18.79

24666 21.08 21.08

24670 8.34 7.50

24675 13.02 11.84

24685 18.81 18.81

24800 23.91 23.91

24802 28.88 28.88

24900 21.31 21.31

24920 21.10 21.10


24925 16.12 16.12

24930 22.31 22.31

24931 26.91 26.91

24935 33.23 33.23

24940 30.17 30.17

24999 0.00 0.00

25000 9.67 9.67

25001 9.87 9.87

25020 16.47 16.47

25023 31.88 31.88

25024 22.30 22.30

25025 34.98 34.98

25028 15.10 15.10

25031 10.12 10.12

25035 16.81 16.81

25040 16.17 16.17

25065 7.26 4.67

25066 10.30 10.30

25071 12.25 12.25

25073 15.35 15.35

25075 13.71 9.11

25076 14.91 14.91

25077 25.50 25.50

25078 33.63 33.63

25085 12.91 12.91

25100 9.93 9.93

25101 11.58 11.58

25105 13.84 13.84

25107 17.73 17.73

25109 15.47 15.47

25110 9.78 9.78

25111 9.20 9.20

25112 11.11 11.11

25115 21.84 21.84

25116 17.26 17.26

25118 10.95 10.95

25119 14.35 14.35

25120 14.27 14.27

25125 17.05 17.05

25126 17.17 17.17

25130 12.83 12.83

25135 16.07 16.07

25136 14.18 14.18

25145 14.87 14.87

25150 16.32 16.32

25151 16.75 16.75


25170 42.73 42.73

25210 14.00 14.00

25215 17.76 17.76

25230 12.44 12.44

25240 12.31 12.31

25246 4.59 2.16

25248 11.84 11.84

25250 15.25 15.25

25251 20.72 20.72

25259 11.94 11.94

25260 18.10 18.10

25263 18.04 18.04

25265 21.77 21.77

25270 14.08 14.08

25272 16.02 16.02

25274 19.36 19.36

25275 19.30 19.30

25280 16.20 16.20

25290 12.54 12.54

25295 15.08 15.08

25300 19.84 19.84

25301 18.50 18.50

25310 17.82 17.82

25312 20.64 20.64

25315 22.19 22.19

25316 26.32 26.32

25320 28.39 28.39

25332 24.23 24.23

25335 27.17 27.17

25337 25.69 25.69

25350 19.40 19.40

25355 22.06 22.06

25360 18.80 18.80

25365 26.35 26.35

25370 28.98 28.98

25375 27.45 27.45

25390 22.14 22.14

25391 28.69 28.69

25392 29.21 29.21

25393 32.60 32.60

25394 22.58 22.58

25400 23.13 23.13

25405 29.84 29.84

25415 27.87 27.87

25420 33.68 33.68

25425 27.73 27.73


25426 32.41 32.41

25430 21.05 21.05

25431 22.73 22.73

25440 22.14 22.14

25441 26.98 26.98

25442 23.18 23.18

25443 22.49 22.49

25444 23.80 23.80

25445 20.77 20.77

25446 33.78 33.78

25447 23.83 23.83

25449 29.71 29.71

25450 17.72 17.72

25455 20.87 20.87

25490 20.70 20.70

25491 21.29 21.29

25492 26.05 26.05

25500 7.84 7.16

25505 14.24 13.00

25515 19.24 19.24

25520 16.32 15.46

25525 22.57 22.57

25526 27.51 27.51

25530 7.54 6.79

25535 13.92 12.89

25545 17.87 17.87

25560 7.98 7.19

25565 14.80 13.33

25574 19.36 19.36

25575 25.91 25.91

25600 9.42 8.88

25605 15.54 14.58

25606 19.06 19.06

25607 21.12 21.12

25608 23.71 23.71

25609 30.14 30.14

25622 8.76 7.96

25624 13.74 12.49

25628 20.69 20.69

25630 8.77 8.03

25635 13.09 11.92

25645 16.37 16.37

25650 9.16 8.56

25651 13.92 13.92

25652 17.91 17.91

25660 11.87 11.87


25670 17.35 17.35

25671 15.27 15.27

25675 12.41 11.26

25676 18.10 18.10

25680 14.96 14.96

25685 21.18 21.18

25690 13.81 13.81

25695 18.22 18.22

25800 21.07 21.07

25805 24.33 24.33

25810 24.97 24.97

25820 17.71 17.71

25825 21.81 21.81

25830 27.38 27.38

25900 20.31 20.31

25905 20.18 20.18

25907 17.63 17.63

25909 19.70 19.70

25915 33.80 33.80

25920 20.03 20.03

25922 17.58 17.58

25924 19.57 19.57

25927 23.30 23.30

25929 17.16 17.16

25931 21.41 21.41

25999 0.00 0.00

26010 7.58 3.94

26011 11.18 5.31

26020 12.44 12.44

26025 12.11 12.11

26030 14.17 14.17

26034 15.57 15.57

26035 24.70 24.70

26037 16.28 16.28

26040 8.95 8.95

26045 13.42 13.42

26055 15.97 8.90

26060 7.47 7.47

26070 9.16 9.16

26075 9.55 9.55

26080 11.21 11.21

26100 9.63 9.63

26105 9.69 9.69

26110 9.23 9.23

26111 12.03 12.03

26113 15.79 15.79


26115 14.43 9.57

26116 15.17 15.17

26117 21.46 21.46

26118 30.33 30.33

26121 17.19 17.19

26123 23.99 23.99

26130 13.22 13.22

26135 15.84 15.84

26140 14.47 14.47

26145 14.72 14.72

26160 16.44 9.59

26170 11.68 11.68

26180 12.74 12.74

26185 15.84 15.84

26200 12.91 12.91

26205 17.31 17.31

26210 12.70 12.70

26215 16.20 16.20

26230 14.37 14.37

26235 14.16 14.16

26236 12.67 12.67

26250 30.89 30.89

26260 23.16 23.16

26262 18.26 18.26

26320 9.95 9.95

26340 9.55 9.55

26341 2.84 2.15

26350 20.17 20.17

26352 23.20 23.20

26356 22.79 22.79

26357 25.52 25.52

26358 28.26 28.26

26370 21.46 21.46

26372 25.14 25.14

26373 24.12 24.12

26390 23.77 23.77

26392 27.70 27.70

26410 16.01 16.01

26412 19.42 19.42

26415 23.12 23.12

26416 25.16 25.16

26418 16.34 16.34

26420 20.29 20.29

26426 14.38 14.38

26428 21.48 21.48

26432 14.12 14.12


26433 15.02 15.02

26434 18.38 18.38

26437 17.65 17.65

26440 17.55 17.55

26442 27.37 27.37

26445 16.33 16.33

26449 19.77 19.77

26450 11.54 11.54

26455 11.44 11.44

26460 11.18 11.18

26471 17.47 17.47

26474 17.05 17.05

26476 16.81 16.81

26477 16.45 16.45

26478 17.51 17.51

26479 17.77 17.77

26480 21.32 21.32

26483 23.89 23.89

26485 22.84 22.84

26489 26.60 26.60

26490 22.62 22.62

26492 25.09 25.09

26494 22.73 22.73

26496 24.67 24.67

26497 24.61 24.61

26498 32.55 32.55

26499 23.58 23.58

26500 17.66 17.66

26502 20.16 20.16

26508 17.86 17.86

26510 16.86 16.86

26516 19.85 19.85

26517 23.43 23.43

26518 23.76 23.76

26520 18.39 18.39

26525 18.45 18.45

26530 15.46 15.46

26531 17.94 17.94

26535 12.23 12.23

26536 20.14 20.14

26540 18.62 18.62

26541 22.72 22.72

26542 19.20 19.20

26545 19.85 19.85

26546 28.20 28.20

26548 21.58 21.58


26550 46.99 46.99

26551 94.73 94.73

26553 94.09 94.09

26554 109.78 109.78

26555 39.12 39.12

26556 97.75 97.75

26560 16.76 16.76

26561 26.90 26.90

26562 38.29 38.29

26565 19.37 19.37

26567 19.29 19.29

26568 25.58 25.58

26580 43.20 43.20

26587 29.92 29.92

26590 40.20 40.20

26591 12.37 12.37

26593 17.00 17.00

26596 21.72 21.72

26600 8.43 7.91

26605 9.21 8.37

26607 13.16 13.16

26608 13.64 13.64

26615 16.55 16.55

26641 10.97 9.96

26645 12.28 11.26

26650 13.66 13.66

26665 18.00 18.00

26670 9.79 8.83

26675 13.05 11.98

26676 14.37 14.37

26685 16.56 16.56

26686 17.93 17.93

26700 9.26 8.66

26705 11.84 10.84

26706 12.60 12.60

26715 16.46 16.46

26720 5.68 5.26

26725 9.63 8.66

26727 13.46 13.46

26735 17.13 17.13

26740 6.61 6.17

26742 10.60 9.58

26746 21.34 21.34

26750 5.28 5.26

26755 9.00 7.79

26756 11.93 11.93


26765 14.37 14.37

26770 7.90 7.27

26775 10.92 9.87

26776 12.71 12.71

26785 15.71 15.71

26820 22.37 22.37

26841 20.55 20.55

26842 22.17 22.17

26843 20.96 20.96

26844 23.27 23.27

26850 19.59 19.59

26852 22.56 22.56

26860 16.00 16.00

26862 20.59 20.59

26910 20.52 20.52

26951 18.48 18.48

26952 18.26 18.26

26989 0.00 0.00

26990 18.04 18.04

26991 20.32 15.09

26992 27.58 27.58

27000 11.80 11.80

27001 15.49 15.49

27003 17.15 17.15

27005 20.80 20.80

27006 21.00 21.00

27025 26.48 26.48

27027 25.34 25.34

27030 26.97 26.97

27033 27.95 27.95

27035 32.91 32.91

27036 29.13 29.13

27040 9.87 5.73

27041 19.99 19.99

27043 13.54 13.54

27045 21.50 21.50

27047 13.34 10.40

27048 17.58 17.58

27049 38.75 38.75

27050 11.56 11.56

27052 16.68 16.68

27054 19.69 19.69

27057 29.27 29.27

27059 52.65 52.65

27060 13.39 13.39

27062 13.10 13.10


27065 14.94 14.94

27066 23.21 23.21

27067 29.82 29.82

27070 24.32 24.32

27071 26.39 26.39

27075 60.79 60.79

27076 73.62 73.62

27077 82.12 82.12

27078 59.94 59.94

27080 14.76 14.76

27086 8.51 4.83

27087 17.58 17.58

27090 23.89 23.89

27091 46.09 46.09

27093 5.33 2.02

27095 7.00 2.40

27096 4.53 2.40

27097 19.62 19.62

27098 19.97 19.97

27100 23.80 23.80

27105 24.98 24.98

27110 27.94 27.94

27111 25.93 25.93

27120 37.55 37.55

27122 31.71 31.71

27125 32.71 32.71

27130 39.16 39.16

27132 48.36 48.36

27134 55.36 55.36

27137 42.53 42.53

27138 44.20 44.20

27140 25.75 25.75

27146 36.99 36.99

27147 42.50 42.50

27151 46.03 46.03

27156 49.63 49.63

27158 40.52 40.52

27161 34.99 34.99

27165 39.53 39.53

27170 33.92 33.92

27175 19.21 19.21

27176 26.47 26.47

27177 32.17 32.17

27178 26.47 26.47

27179 28.16 28.16

27181 32.44 32.44


27185 20.68 20.68

27187 28.57 28.57

27197 3.45 3.45

27198 8.64 8.64

27200 5.23 5.41

27202 15.35 15.35

27215 18.03 18.03

27216 26.70 26.70

27217 25.06 25.06

27218 34.60 34.60

27220 15.28 15.11

27222 28.02 28.02

27226 30.36 30.36

27227 47.95 47.95

27228 54.44 54.44

27230 13.67 13.54

27232 21.44 21.44

27235 26.21 26.21

27236 34.50 34.50

27238 13.22 13.22

27240 27.63 27.63

27244 35.52 35.52

27245 35.52 35.52

27246 11.07 11.09

27248 21.41 21.41

27250 5.18 5.18

27252 21.79 21.79

27253 27.05 27.05

27254 36.64 36.64

27256 8.70 6.75

27257 10.50 10.50

27258 32.05 32.05

27259 44.89 44.89

27265 11.45 11.45

27266 16.71 16.71

27267 12.42 12.42

27268 15.51 15.51

27269 35.89 35.89

27275 5.26 5.26

27279 20.00 20.00

27280 39.23 39.23

27282 24.66 24.66

27284 46.84 46.84

27286 47.81 47.81

27290 46.97 46.97

27295 36.55 36.55


27299 0.00 0.00

27301 19.34 14.49

27303 18.37 18.37

27305 13.75 13.75

27306 9.98 9.98

27307 12.26 12.26

27310 21.03 21.03

27323 7.80 5.14

27324 11.53 11.53

27325 16.04 16.04

27326 14.79 14.79

27327 13.15 9.03

27328 17.93 17.93

27329 29.93 29.93

27330 11.94 11.94

27331 13.62 13.62

27332 18.52 18.52

27333 16.85 16.85

27334 19.67 19.67

27335 21.94 21.94

27337 12.07 12.07

27339 21.71 21.71

27340 10.67 10.67

27345 13.80 13.80

27347 15.20 15.20

27350 18.74 18.74

27355 17.35 17.35

27356 21.29 21.29

27357 23.46 23.46

27360 24.50 24.50

27364 45.22 45.22

27365 59.70 59.70

27370 4.41 1.45

27372 17.04 11.44

27380 17.04 17.04

27381 22.95 22.95

27385 16.50 16.50

27386 23.85 23.85

27390 12.91 12.91

27391 16.48 16.48

27392 20.52 20.52

27393 14.64 14.64

27394 18.47 18.47

27395 25.31 25.31

27396 17.72 17.72

27397 26.43 26.43


27400 19.99 19.99

27403 18.37 18.37

27405 19.40 19.40

27407 22.83 22.83

27409 27.83 27.83

27412 47.82 47.82

27415 39.34 39.34

27416 28.29 28.29

27418 23.73 23.73

27420 21.37 21.37

27422 21.36 21.36

27424 21.55 21.55

27425 12.88 12.88

27427 20.41 20.41

27428 32.21 32.21

27429 35.82 35.82

27430 21.27 21.27

27435 23.23 23.23

27437 19.03 19.03

27438 24.15 24.15

27440 23.01 23.01

27441 23.77 23.77

27442 25.02 25.02

27443 23.42 23.42

27445 36.13 36.13

27446 33.45 33.45

27447 39.12 39.12

27448 22.36 22.36

27450 28.93 28.93

27454 37.55 37.55

27455 27.16 27.16

27457 27.41 27.41

27465 34.84 34.84

27466 34.18 34.18

27468 38.79 38.79

27470 33.91 33.91

27472 36.41 36.41

27475 19.05 19.05

27477 21.12 21.12

27479 26.54 26.54

27485 19.30 19.30

27486 40.60 40.60

27487 50.78 50.78

27488 34.65 34.65

27495 32.45 32.45

27496 15.66 15.66


27497 16.78 16.78

27498 18.87 18.87

27499 20.17 20.17

27500 14.91 13.78

27501 14.50 14.34

27502 21.83 21.83

27503 23.08 23.08

27506 38.60 38.60

27507 28.04 28.04

27508 15.07 14.15

27509 18.47 18.47

27510 19.64 19.64

27511 28.75 28.75

27513 35.80 35.80

27514 27.88 27.88

27516 14.59 13.72

27517 19.73 19.73

27519 25.74 25.74

27520 9.27 8.43

27524 21.64 21.64

27530 8.68 8.03

27532 17.68 16.57

27535 25.86 25.86

27536 34.31 34.31

27538 13.61 12.71

27540 23.25 23.25

27550 14.70 13.61

27552 17.92 17.92

27556 25.31 25.31

27557 30.28 30.28

27558 34.54 34.54

27560 10.43 9.59

27562 13.91 13.91

27566 25.80 25.80

27570 4.33 4.33

27580 41.44 41.44

27590 23.06 23.06

27591 27.89 27.89

27592 19.65 19.65

27594 14.54 14.54

27596 20.79 20.79

27598 20.65 20.65

27599 0.00 0.00

27600 11.65 11.65

27601 12.88 12.88

27602 14.03 14.03


27603 15.16 11.15

27604 13.72 9.66

27605 9.92 5.35

27606 8.06 8.06

27607 17.46 17.46

27610 18.69 18.69

27612 16.15 16.15

27613 7.27 4.68

27614 16.68 11.72

27615 29.58 29.58

27616 36.71 36.71

27618 12.93 8.89

27619 13.37 13.37

27620 12.89 12.89

27625 16.69 16.69

27626 17.38 17.38

27630 16.06 10.48

27632 11.94 11.94

27634 19.64 19.64

27635 16.85 16.85

27637 22.03 22.03

27638 22.28 22.28

27640 23.97 23.97

27641 19.17 19.17

27645 51.50 51.50

27646 44.67 44.67

27647 29.39 29.39

27648 4.78 1.52

27650 18.92 18.92

27652 19.49 19.49

27654 20.38 20.38

27656 18.27 11.42

27658 10.67 10.67

27659 13.64 13.64

27664 10.40 10.40

27665 11.87 11.87

27675 14.08 14.08

27676 17.43 17.43

27680 12.26 12.26

27681 15.75 15.75

27685 19.10 13.35

27686 15.86 15.86

27687 13.02 13.02

27690 18.27 18.27

27691 21.47 21.47

27695 13.70 13.70


27696 16.08 16.08

27698 18.45 18.45

27700 18.18 18.18

27702 27.67 27.67

27703 31.90 31.90

27704 16.41 16.41

27705 21.99 21.99

27707 11.45 11.45

27709 33.69 33.69

27712 31.92 31.92

27715 30.91 30.91

27720 25.13 25.13

27722 25.68 25.68

27724 36.50 36.50

27725 35.23 35.23

27726 27.70 27.70

27727 29.92 29.92

27730 16.88 16.88

27732 12.88 12.88

27734 18.90 18.90

27740 20.39 20.39

27742 22.43 22.43

27745 21.76 21.76

27750 9.94 9.09

27752 15.36 14.15

27756 16.67 16.67

27758 25.67 25.67

27759 28.79 28.79

27760 9.56 8.69

27762 13.47 12.24

27766 17.47 17.47

27767 8.05 8.10

27768 12.66 12.66

27769 21.06 21.06

27780 8.79 7.97

27781 12.27 11.35

27784 20.48 20.48

27786 9.04 8.16

27788 12.06 10.98

27792 18.70 18.70

27808 9.58 8.57

27810 13.35 12.08

27814 22.18 22.18

27816 9.23 8.25

27818 13.87 12.40

27822 24.69 24.69


27823 27.97 27.97

27824 9.01 8.73

27825 15.70 14.23

27826 24.30 24.30

27827 31.63 31.63

27828 37.81 37.81

27829 20.00 20.00

27830 10.98 10.19

27831 11.51 11.51

27832 21.80 21.80

27840 10.62 10.62

27842 14.18 14.18

27846 20.69 20.69

27848 23.02 23.02

27860 5.02 5.02

27870 29.64 29.64

27871 19.69 19.69

27880 26.45 26.45

27881 24.98 24.98

27882 17.32 17.32

27884 16.51 16.51

27886 18.98 18.98

27888 19.49 19.49

27889 18.76 18.76

27892 16.11 16.11

27893 17.56 17.56

27894 24.20 24.20

27899 0.00 0.00

28001 7.95 4.84

28002 12.69 9.10

28003 20.14 16.07

28005 16.54 16.54

28008 12.49 8.44

28010 6.66 5.99

28011 9.19 8.21

28020 15.65 10.44

28022 14.00 9.29

28024 13.27 8.74

28035 15.28 10.24

28039 14.59 9.99

28041 13.13 13.13

28043 11.59 7.57

28045 14.36 10.03

28046 21.03 21.03

28047 30.31 30.31

28050 12.25 8.04


28052 13.05 8.30

28054 10.85 6.77

28055 10.93 10.93

28060 15.00 10.27

28062 16.93 11.71

28070 15.63 10.39

28072 14.58 9.49

28080 15.17 10.56

28086 15.78 10.36

28088 12.98 8.17

28090 13.61 8.86

28092 12.27 7.74

28100 17.72 11.97

28102 17.47 17.47

28103 11.25 11.25

28104 15.30 10.19

28106 12.31 12.31

28107 14.90 10.01

28108 12.74 8.30

28110 13.44 8.34

28111 14.21 9.35

28112 14.14 9.00

28113 17.06 12.20

28114 31.01 24.09

28116 22.33 16.74

28118 17.25 11.93

28119 15.16 10.35

28120 19.56 14.31

28122 17.32 12.67

28124 13.81 9.50

28126 11.46 7.16

28130 21.01 21.01

28140 17.25 12.66

28150 12.27 8.04

28153 11.95 7.62

28160 12.08 7.71

28171 32.25 32.25

28173 21.69 21.69

28175 13.72 13.72

28190 7.47 3.86

28192 13.54 9.00

28193 15.35 10.60

28200 14.28 9.31

28202 17.34 12.31

28208 13.89 9.07

28210 17.07 12.07


28220 13.03 8.68

28222 14.76 10.11

28225 11.97 7.53

28226 17.70 11.35

28230 12.58 8.15

28232 11.19 6.98

28234 11.77 7.55

28238 19.38 14.00

28240 13.33 8.67

28250 16.83 11.67

28260 19.85 14.68

28261 29.41 23.11

28262 42.66 34.24

28264 29.21 22.18

28270 14.28 9.64

28272 11.37 7.28

28280 14.96 10.05

28285 15.49 10.88

28286 13.06 8.60

28288 17.50 12.38

28289 21.53 13.33

28291 21.01 13.66

28292 21.75 14.01

28295 27.20 15.46

28296 26.35 14.82

28297 30.23 17.29

28298 24.68 14.30

28299 29.12 16.73

28300 18.73 18.73

28302 20.63 20.63

28304 23.92 17.49

28305 19.24 19.24

28306 17.80 11.65

28307 19.27 12.90

28308 16.42 10.88

28309 25.74 25.74

28310 15.82 10.29

28312 14.65 9.13

28313 15.11 10.21

28315 13.98 9.39

28320 17.55 17.55

28322 22.81 16.63

28340 16.72 11.88

28341 19.38 14.13

28344 13.05 8.31

28345 15.09 10.48


28360 31.30 31.30

28400 7.16 6.52

28405 11.22 10.16

28406 14.95 14.95

28415 32.22 32.22

28420 36.51 36.51

28430 6.77 5.99

28435 10.41 9.27

28436 12.95 12.95

28445 30.40 30.40

28446 35.36 35.36

28450 6.18 5.48

28455 8.27 7.41

28456 9.20 9.20

28465 18.20 18.20

28470 6.30 5.85

28475 7.32 6.48

28476 10.07 10.07

28485 15.60 15.60

28490 4.21 3.59

28495 5.12 4.28

28496 13.25 7.00

28505 19.28 14.38

28510 3.57 3.44

28515 4.66 4.08

28525 16.44 11.49

28530 3.35 2.97

28531 9.91 5.24

28540 5.52 4.99

28545 8.57 7.56

28546 16.73 9.80

28555 25.12 19.02

28570 6.51 5.50

28575 10.55 9.51

28576 11.41 11.41

28585 24.93 19.47

28600 6.26 5.35

28605 9.47 8.48

28606 11.55 11.55

28615 23.17 23.17

28630 4.52 3.14

28635 5.11 3.82

28636 9.41 6.07

28645 18.87 13.89

28660 3.34 2.54

28665 4.48 3.79


28666 5.16 5.16

28675 16.66 11.69

28705 35.98 35.98

28715 27.05 27.05

28725 22.43 22.43

28730 21.19 21.19

28735 22.53 22.53

28737 20.03 20.03

28740 24.45 17.93

28750 23.34 16.90

28755 14.76 9.54

28760 23.00 16.73

28800 15.45 15.45

28805 21.00 21.00

28810 12.39 12.39

28820 16.28 11.37

28825 15.57 10.67

28890 9.44 6.43

28899 0.00 0.00

29000 10.05 5.74

29010 7.88 4.67

29015 8.47 5.27

29035 7.37 4.17

29040 8.45 5.04

29044 8.28 4.87

29046 9.08 5.47

29049 2.85 2.02

29055 6.41 4.01

29058 3.57 2.73

29065 2.76 1.96

29075 2.49 1.79

29085 2.74 1.94

29086 2.29 1.49

29105 2.52 1.70

29125 1.86 1.14

29126 2.21 1.40

29130 1.19 0.83

29131 1.50 0.98

29200 0.89 0.54

29240 0.86 0.54

29260 0.85 0.56

29280 0.86 0.58

29305 7.12 4.60

29325 7.89 5.17

29345 3.90 2.90

29355 4.02 3.05


29358 4.62 3.01

29365 3.53 2.53

29405 2.33 1.72

29425 2.24 1.62

29435 3.39 2.41

29440 1.25 0.83

29445 3.74 2.96

29450 4.18 3.27

29505 2.44 1.45

29515 2.06 1.43

29520 0.94 0.55

29530 0.85 0.54

29540 0.75 0.52

29550 0.54 0.33

29580 1.75 0.83

29581 2.42 0.80

29584 2.25 0.47

29700 1.86 0.97

29705 1.90 1.35

29710 3.56 2.41

29720 2.45 1.28

29730 1.81 1.27

29740 2.86 2.04

29750 3.10 2.27

29799 0.00 0.00

29800 15.22 15.22

29804 18.47 18.47

29805 13.59 13.59

29806 30.59 30.59

29807 29.88 29.88

29819 16.83 16.83

29820 15.37 15.37

29821 16.84 16.84

29822 16.34 16.34

29823 17.80 17.80

29824 19.19 19.19

29825 16.59 16.59

29827 30.37 30.37

29828 26.20 26.20

29830 13.15 13.15

29834 14.00 14.00

29835 14.65 14.65

29836 16.78 16.78

29837 15.08 15.08

29838 16.94 16.94

29840 13.02 13.02


29843 13.97 13.97

29844 14.30 14.30

29845 16.59 16.59

29846 15.00 15.00

29847 15.68 15.68

29848 14.74 14.74

29850 18.00 18.00

29851 26.92 26.92

29855 22.56 22.56

29856 28.78 28.78

29860 19.25 19.25

29861 20.80 20.80

29862 23.21 23.21

29863 23.18 23.18

29866 30.31 30.31

29867 36.97 36.97

29868 48.43 48.43

29870 16.58 11.77

29871 14.84 14.84

29873 15.13 15.13

29874 15.45 15.45

29875 14.28 14.28

29876 18.95 18.95

29877 17.90 17.90

29879 19.09 19.09

29880 16.21 16.21

29881 15.60 15.60

29882 20.16 20.16

29883 24.32 24.32

29884 17.68 17.68

29885 21.75 21.75

29886 18.39 18.39

29887 21.65 21.65

29888 28.38 28.38

29889 35.35 35.35

29891 19.33 19.33

29892 19.66 19.66

29893 17.65 12.28

29894 14.13 14.13

29895 13.52 13.52

29897 14.46 14.46

29898 16.20 16.20

29899 29.78 29.78

29900 14.28 14.28

29901 15.39 15.39

29902 16.35 16.35


29904 18.42 18.42

29905 15.83 15.83

29906 20.04 20.04

29907 25.31 25.31

29914 28.29 28.29

29915 29.00 29.00

29916 29.18 29.18

29999 0.00 0.00

30000 6.45 3.34

30020 6.51 3.34

30100 3.93 1.93

30110 6.44 3.67

30115 12.09 12.09

30117 24.51 9.55

30118 21.69 21.69

30120 14.77 12.47

30124 7.98 7.98

30125 16.99 16.99

30130 10.68 10.68

30140 7.81 5.12

30150 21.61 21.61

30160 21.65 21.65

30200 3.15 1.66

30210 4.21 2.79

30220 8.45 3.52

30300 5.02 3.00

30310 5.68 5.68

30320 12.63 12.63

30400 29.87 29.87

30410 35.20 35.20

30420 38.41 38.41

30430 26.21 26.21

30435 32.91 32.91

30450 43.68 43.68

30460 23.31 23.31

30462 44.72 44.72

30465 27.48 27.48

30520 17.43 17.43

30540 19.23 19.23

30545 26.33 26.33

30560 7.48 3.84

30580 18.46 14.52

30600 16.62 12.95

30620 17.43 17.43

30630 17.42 17.42

30801 6.41 3.83


30802 8.10 5.31

30901 3.87 1.62

30903 5.95 2.25

30905 9.20 3.01

30906 9.55 3.88

30915 16.11 16.11

30920 23.38 23.38

30930 3.46 3.46

30999 0.00 0.00

31000 5.15 2.99

31002 5.29 5.29

31020 13.63 10.09

31030 19.37 14.87

31032 16.13 16.13

31040 21.45 21.45

31050 13.55 13.55

31051 18.02 18.02

31070 12.26 12.26

31075 21.85 21.85

31080 28.79 28.79

31081 34.44 34.44

31084 32.24 32.24

31085 36.76 36.76

31086 31.31 31.31

31087 30.25 30.25

31090 28.77 28.77

31200 16.30 16.30

31201 20.94 20.94

31205 25.66 25.66

31225 52.88 52.88

31230 58.25 58.25

31231 5.96 1.85

31233 7.32 3.85

31235 8.38 4.57

31237 7.43 4.56

31238 7.41 4.77

31239 17.56 17.56

31240 4.54 4.54

31241 12.83 12.83

31253 14.38 14.38

31254 11.54 6.99

31255 9.29 9.29

31256 5.17 5.17

31257 12.80 12.80

31259 13.57 13.57

31267 7.62 7.62


31276 10.85 10.85

31287 5.78 5.78

31288 6.72 6.72

31290 32.70 32.70

31291 35.01 35.01

31292 28.14 28.14

31293 30.53 30.53

31294 34.97 34.97

31295 57.07 4.52

31296 57.80 5.16

31297 56.67 4.11

31298 109.84 7.33

31299 0.00 0.00

31300 36.75 36.75

31360 59.70 59.70

31365 73.57 73.57

31367 63.16 63.16

31368 70.21 70.21

31370 59.40

Documents

Multiple Procedure Policy · 2019-06-20 · This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care