Professional/Technical Component Policy, Professional for ...€¦ · This policy describes the reimbursement methodology for Current Procedural Terminology (CPT®) and Healthcare

REIMBURSEMENT POLICY CMS-1500

Policy Number 2019R0012H.LA

Proprietary information of UnitedHealthcare Community Plan. Copyright 2019 United HealthCare Services, Inc. 2019R0012H.LA

Professional/Technical Component Policy, Professional for Louisiana

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 Product. 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.

Table of Contents

Application

Policy Overview Reimbursement

UnitedHealthcare Community Plan Professional/Technical Splits Reimbursement Amounts for Professional/Technical Splits Reimbursement for Professional/Technical Components Based on Place of Service

Services Reported in a CMS Place of Service (POS) 24 (Ambulatory Surgical Center) Duplicate or Repeat Services for Professional/Technical Eligible Codes Professional Component with an Evaluation and Management Service Modifiers

Definitions

Questions and Answers

Attachments




Resources

History

Policy

Overview

This policy describes the reimbursement methodology for Current Procedural Terminology (CPT®) and Healthcare Common Procedural Coding System (HCPCS) codes based on the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File, Professional Component (PC)/Technical Component (TC) Indicators.

NPFS PC/TC Indicator

Description

0 Physician Service Codes

1 Diagnostic Tests

2 Professional Component Only Codes

3 Technical Component Only Codes

4 Global Test Only Codes

5 Incident To Codes

6 Laboratory Physician Interpretation Codes

8 Physician interpretation codes

9 Not Applicable

Relative to these services, this policy also addresses information pertaining to Duplicate or Repeat Services, modifier usage, submissions based on place of service (POS), and the Professional Component with an Evaluation and Management service. Unless otherwise specified, for the purposes of this policy, Same Individual Physician or Other Qualified Health Care Professional is defined as the same individual rendering health care services reporting the same Federal Tax Identification number.

Reimbursement Guidelines

UnitedHealthcare Community Plan Professional/Technical Splits

UnitedHealthcare Community Plan uses the Center for Medicare and Medicaid Services' (CMS) PC/TC indicators as set forth in the "CMS Payment Policies" under the National Physician Fee Schedule Relative Value File to determine whether a CPT or HCPCS procedure code is eligible for separate professional and technical services reimbursement.

CPT or HCPCS codes assigned a CMS PC/TC Indicator 1 are comprised of a Professional Component and a Technical Component which together constitute the Global Service. The Professional Component (PC), (supervision and interpretation) is reported with modifier 26, and the Technical Component (TC) is reported with modifier TC.

The term “professional/technical split” is used to reference a Global Service assigned a PC/TC Indicator 1 that may be “split” into a Professional and Technical Component. CPT or HCPCS codes assigned a PC/TC Indicator 1 are listed in the National Physician Fee Schedule Relative Value File. Each Global Service is listed on a separate row followed immediately by separate rows listing the corresponding Technical Component, and Professional Component.

CPT or HCPCS codes with CMS PC/TC indicators 0, 2, 3, 4, 5, 7, 8, and 9 are not considered eligible for reimbursement when submitted with modifiers 26 and/or TC.

CPT or HCPCS codes with CMS PC/TC indicator 6 are not considered eligible for reimbursement when submitted with modifier TC.

CMS publishes this information in the "Physician Fee Schedule, PFS Relative Value Files" page, accessible through the following website:




Physician Fee Schedule Relative Value Files

UnitedHealthcare Community Plan’s percentage splits are developed on a national level from the CMS Non-Facility Total Resource Based Relative Value Scale (RBRVS) based percentage splits. UnitedHealthcare Community Plan’s splits are updated quarterly and differ no more than 2.5% (for each CPT and HCPCS code) from the CMS Non-Facility Total RBRVS based percentage splits. The current splits are attached to this policy in the next section.

Services assigned a PC/TC Indicator 1 that CMS indicates may be carrier-priced, or those for which CMS does not develop RVUs are considered Gap Codes.

Gap Fill Codes: When data is available for Gap 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.

UnitedHealthcare Community Plan Professional Technical Component Policy Gap Fill Codes

Gap Codes that are eligible for PC/TC per CMS but do not have RVUs established, or data available for gap fill, are included in the "Codes Subject to the CMS PC/TC Concept Without RVU Splits" list below and are allowed at 100% of the Allowable Amount for both the Professional Component and Technical Component.

UnitedHealthcare Community Plan Codes Subject to the Professional Technical Concept without RVU Splits

For additional information refer to the Questions and Answers section, Q&A #1.

Reimbursement Amounts for Professional/Technical Splits

The Professional and Technical Component reimbursement for PC/TC split eligible services is calculated at a percentage of the Global Service Allowable Amount, except when provided otherwise by a physician or other qualified health care professional contract. When a contract applies, payments for PC/TC split eligible services are based on specific professional and technical fees contained within the contract's fee schedules or are paid at the percentage of charge level in the fee schedule.

UnitedHealthcare Community Plan Professional/Technical Component Split Codes (PC/TC Indicator 1 Diagnostic Tests)

When eligible for reimbursement, Professional/Technical Component codes with a CMS PC/TC indicator of 2, 3, 4, 5, 6, or 8 are reimbursed at 100% of the Allowable Amount.

For additional information, refer to the Questions and Answers section, Q&A #2.

Reimbursement for Professional/Technical Component Based on POS

Reimbursement of the Professional Component, the Technical Component, and the Global Service for codes assigned a PC/TC indicator 1, 2, 3, 4, 5, 6, 8 or 9 subject to the PC/TC concept according to the National Physician Fee Schedule Relative Value File are based upon physician and other qualified health care professional specialty and CMS POS code set, as described below. CMS POS Code Set For the purposes of this policy, a facility POS is considered POS 19, 21, 22, 23, 26, 34, 51, 52, 55, 56, 57 and 61. All other POS are considered non-facility. For Services Furnished in a Mobile Unit Services furnished in a mobile unit are often provided to serve an entity for which another POS code exists. When this is the case, the POS for that entity should be reported. For example, a mobile unit may be sent to a physician’s office. Since the mobile unit is serving an entity for which an office POS already exists, the POS code 11 (office) for that location should be reported. However, if the mobile unit is not serving an entity which could be described by an existing POS code, report POS 15 (mobile unit). For PC/TC Indicator 8 Codes Furnished in a POS Other than POS 21 The CMS NPFS guidelines advise that payment should not be recognized for PC/TC Indicator 8 codes, which are defined as physician interpretation codes, furnished to patients in the outpatient or non-hospital setting (POS other than 21).

http://www.cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.htmlhttp://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html




In alignment with CMS, UnitedHealthcare Community Plan will not reimburse PC/TC Indicator 8 (CPT code 85060) when reported by a physician or other qualified health care professional with a CMS POS code other than inpatient hospital (POS 21). For Services Furnished in a Facility (POS 19, 21, 22, 23, 26, 34, 51, 52, 55, 56, 57 or 61) Services that are provided in a facility POS and that are subject to the PC/TC concept or that have both a Professional Component and a Technical Component according to the CMS PC/TC indicators, UnitedHealthcare Community Plan will reimburse the interpreting physician or other qualified health care professional only the Professional Component as the facility is reimbursed for the Technical Component of the service. To be considered for Professional Component reimbursement, a service or procedure must have a:

CMS PC/TC Indicator 1, and must be reported with modifier 26;

CMS PC/TC Indicator 2 (Professional Component Only Codes), and must be reported without modifier 26 or TC; or

CMS PC/TC Indicator 6 (Laboratory Physician Interpretation Codes) and must be reported with modifier 26. UnitedHealthcare Community Plan follows CMS PC/TC indicators to determine which clinical laboratory interpretive services provided in a facility setting qualify for Professional Component reimbursement. To be considered for Professional Component reimbursement, the clinical laboratory interpretive service code must have a:

CMS PC/TC Indicator 1 (Diagnostic Tests), and be reported with modifier 26;

CMS PC/TC Indicator 6 (Laboratory Physician Interpretation Codes), and be reported with modifier 26; or

CMS PC/TC Indicator 8 (Physician Interpretation Codes), and be reported without modifier 26. When a physician or other qualified health care professional provides the equipment to perform the service or procedure in a facility POS only the facility may be reimbursed for the Technical Component of the service or procedure. Based on the CMS PC/TC indicators, UnitedHealthcare Community Plan considers the Technical Component to be a service or procedure that has a:

CMS PC/TC Indicator 1 (Diagnostic Test), and is reported with modifier TC; or

CMS PC/TC Indicator 3 (Technical Component Only Codes), and is reported without modifier TC. For Services Furnished in a Non-Facility POS (POS other than 19, 21, 22, 23, 26, 34, 51, 52, 55, 56, 57 or 61) For services assigned a PC/TC Indicator 1 according to CMS, and provided in a non-facility POS, UnitedHealthcare Community Plan will consider reimbursement of the Professional Component and the Technical Component when eligible. Non-Allowed Services Furnished in a Facility POS Consistent with CMS, UnitedHealthcare Community Plan will not allow reimbursement to physicians and other qualified health care professionals for "Incident To" codes identified with a CMS PC/TC indicator 5 when reported in a facility place of service (POS 19, 21, 22, 23, 26, 34, 51, 52, 56, or 61) regardless of whether a modifier is reported with the code. In addition, CPT coding guidelines for many of the PC/TC Indicator 5 codes specify that these codes are not intended to be reported by a physician in a facility setting. For services with a CMS PC/TC indicator 4 (Stand-alone Global Test Only Codes), UnitedHealthcare Community Plan will not reimburse the physician or other qualified health care professional when rendered in a facility POS. Global Test Only Codes with a PC/TC indicator 4 identify Stand-alone Codes that describe selected diagnostic tests for which there are separate associated codes that depict the Professional Component only (PC/TC indicator 2) and Technical Component only (PC/TC indicator 3). UnitedHealthcare Community Plan utilizes the CMS National Physician Fee Schedule (NPFS) PC/TC Indicators 3 or 9 to identify laboratory services that are not reimbursable to a Reference Laboratory or Non-Reference Laboratory in a facility setting.

CMS PC/TC Indicator 3 (Technical Component Only Codes)

CMS PC/TC Indicator 9 (PC/TC Concept Not Applicable) UnitedHealthcare Community Plan will not reimburse a Professional Component when a diagnostic laboratory service is provided either manually or with automated equipment, as these codes are not subject to the PC/TC concept or are Technical Component only codes. UnitedHealthcare Community Plan follows CMS PC/TC indicators in determining which services do not qualify for Professional Component reimbursement:

CMS PC/TC Indicator 3 (Technical Component Only Codes)

CMS PC/TC Indicator 9 (PC/TC Concept Not Applicable)




UnitedHealthcare Community Plan Laboratory Codes with a (PC/TC Indicator 3 or 9 Diagnostic Tests) Note: UnitedHealthcare Community Plan will make an exception to this policy for reproductive medicine procedures 89250-89398 when the facility laboratory is not equipped to perform these specialized services and refers them to a reproductive laboratory. In the event that both a facility and a Reference Laboratory report the same service on the same day for the same member, only the facility laboratory may be reimbursed.

Services Reported in a CMS POS 24 (Ambulatory Surgical Center)

Consistent with CMS guidelines, UnitedHealthcare Community Plan will not reimburse physicians or other qualified health care professionals for the Technical Component of services included in the Ambulatory Surgery Center Fee Schedule (ASCFS) Addendum BB and reported with a CMS POS 24 as the ambulatory surgical center (ASC) is reimbursed for the Technical Component.

The Technical Component of services reported on a CM-1500 claim form with an SG modifier (Ambulatory surgical center [ASC] facility service) is not reimbursed as a professional claim. Claim lines reported with modifier SG indicate a facility charge and are reimbursed as a facility claim.

PC/TC Indicator 1 Codes For codes included in the ASCFS Addendum BB PC/TC Indicator 1 Codes list, only the Professional Component (PC, modifier 26) will be reimbursed.

When reported globally (no modifier), the Technical Component of the code will not be reimbursed. When reported with modifier TC, the code will not be reimbursed.

PC/TC Indicator 3 Codes Codes included in the ASCFS Addendum BB PC/TC Indicator 3 Codes list will not be reimbursed as they represent Technical Component services only.

UnitedHealthcare Community Plan ASCFS Addendum BB PC/TC Indicator 1 Codes UnitedHealthcare Community Plan ASCFS Addendum BB PC/TC Indicator 3 Codes Drug Administration Codes According to the CMS National Correct Coding Initiative (NCCI) Policy Manual, drug administration codes CPT 96360-96379, 96401-96425, and 96521-96523 are considered included in the facility payment when reported in POS 24. In alignment with CMS, UnitedHealthcare Community Plan will not reimburse drug administration codes 96360-96379, 96401-96425, and 96521-96523 reported by a physician or other qualified health care professional in POS 24.

Duplicate or Repeat Services for Professional/Technical Eligible Codes

This section of the policy applies to when Duplicate or Repeat Services are reported by the same or different physician or other qualified health care professional. When services are eligible for reimbursement under this policy, only one physician or other qualified health care professional will be reimbursed when Duplicate or Repeat Services are reported. Duplicate or Repeat Services are defined as identical CPT or HCPCS codes assigned a PC/TC indicator 1, 2, 3, 4, 6 or 8 submitted for the same patient on the same date of service on separate claim lines or on different claims regardless of the assigned Maximum Frequency per Day (MFD) value.

For services that have both a Professional and Technical Component (i.e., PC/TC Indicator 1, Diagnostic Tests) UnitedHealthcare Community Plan will also review the submission of modifier 26 and TC appended to the code to identify whether a Duplicate or Repeat Services has been reported.

Should the Same Individual Physician or Other Qualified Health Care Professional report the Professional Component (modifier 26) and the Technical Component (modifier TC) for the same PC/TC Indicator 1 service separately, UnitedHealthcare Community Plan will consider both services eligible for reimbursement unless subject to other portions of this policy.

Modifiers offer specific information and should be used appropriately. Separate consideration will be given to duplicate or repeat multiple submissions of the same code when the appropriate modifier is appended to the Duplicate or Repeat Service with one of the following modifiers:




Modifier 59 - Same or different physicians or other qualified health care professionals*

Modifier 76 - Same physicians or other qualified health care professionals

Modifier 77 - Different physicians or other qualified health care professionals

Modifier 91 - Same or different physicians or other qualified health care professionals for repeat laboratory services

Modifier RT or LT - when reporting bilateral procedures

Modifier XE - Separate encounter

Modifier XP - Separate practitioner

Modifier XS - Separate structure

Modifier XU - Unusual non-overlapping service Additional anatomic modifiers - refer to Modifiers, Anatomic Modifier section.

*Note: CPT instructions state that modifier 59 should not be used when a more descriptive modifier is available. CMS guidelines cite that the –X {EPSU} modifiers are more selective versions of modifier 59 so it would be incorrect to include both modifiers on the same line. Please refer to the “Modifiers” section for a complete listing of modifiers and their descriptions.

For additional information, refer to the Questions and Answers section, Q&A #3.

UnitedHealthcare Community Plan follows a "first in, first out" claim payment methodology in determining which claim will be considered for reimbursement when claims for Duplicate or Repeat Services are received.

When the Same Individual Physician or Other Qualified Health Care Professional reports the global PC/TC Indicator 1 service (no modifier) or a Stand-alone service (PC/TC Indicator 2, 3, or 4) more than once and on separate lines, separate consideration will only be given to those services reported with the appropriate modifier. Otherwise, the second and subsequent services received will not be separately reimbursed.

When the same PC/TC Indicator 6 or 8 service is reported more than once and on separate lines by the same or different physician or qualified health care professional, separate consideration will only be given to those services reported with modifier 59, XE, XP, XS, XU or 91. Otherwise the second and subsequent services reported will not be separately reimbursed.

When the Same Individual Physician or Other Qualified Health Care Professional reports the global PC/TC Indicator 1 service (no modifier) and a modifier 26 or TC for the same service for the same member on the same date of service, separate consideration will only be given to those services reported with the appropriate modifier. Otherwise, the second and subsequent services will not be separately reimbursed.

When the same PC/TC Indicator 1 service is reported globally (no modifier) by different physicians or other qualified health care professionals on the same date or service for the same member, UnitedHealthcare Community Plan will only consider separate reimbursement for the second claim when reported with an appropriate modifier. Otherwise, the second and subsequent services received will not be separately reimbursed.

When the same PC/TC Indicator 1 service is reported globally (no modifier) by one physician or other qualified health care professional, and a different physician or other qualified health care professional reports modifier 26 or TC for the same service for the same member on the same date of service, UnitedHealthcare Community Plan will consider separate reimbursement for the second claim when reported with an appropriate modifier. Otherwise, the second and subsequent services will not be separately reimbursed.

For example:

If the claim for the physician reporting the Global Service is received first and allowed, the subsequent claim received by a different physician for a single component (i.e., Professional or Technical Component) will be denied as duplicate.

If the claim for the physician reporting the Professional Component (modifier 26) service is received first and allowed, the subsequent claim received by a different physician for the Global Service will be reimbursed only for the Technical Component.

If the claim for the physician reporting the Technical Component (modifier TC) service is received first and allowed, the subsequent claim received by a different physician for the Global Service will be reimbursed only for the Professional Component.

Refer to the UnitedHealthcare Community Plan "Laboratory Services Policy" for additional information on duplicate charges for laboratory services. Refer to the UnitedHealthcare Community Plan “Maximum Frequency per Day Policy” for additional information on assigned MFD values.




Professional Component with an Evaluation and Management Service

With the exception of radiologic codes that describe fluoroscopic or ultrasonic guidance for placement of a needle, catheter, or tube, UnitedHealthcare Community Plan considers the interpretation (modifier 26) of a radiology service assigned a PC/TC Indicator 1 to be included in the Evaluation and Management (E/M) service when performed by the Same Individual Physician or Other Qualified Health Care Professional on the same date of service for the same patient as these services usually are not distinct from the E/M service when both are provided on the same day.

American College of Radiology (ACR) guidelines suggest that physicians and other qualified health care professionals who believe the Professional Component (modifier 26) for a PC/TC Indicator 1 radiology code is reimbursable in addition to the E/M service on the same day include the following information in the medical record:

Procedures and materials The report or record should include a description of the studies and/or procedures performed and any contrast

media and/or radio-pharmaceuticals (including specific administered activities, concentration, volume, and route of administration when applicable), medications, catheters, or devices used, if not recorded elsewhere.

Findings The report or record should use appropriate anatomic, pathologic, and radiologic terminology to describe the

findings.

Impression Conclusion or diagnosis

Modifiers

Modifier Description

TC

Technical Component Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the technical component is reported separately, the service may be identified by adding the modifier ‘TC’ to the usual procedure number.

26

Professional Component Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.

59

Distinct Procedural Service Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

76

Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service. Note: This modifier should not be appended to an E/M service.

77

Repeat Procedure by Another Physician or Other Qualified Health Care Professional It may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 77 to the repeated procedure or service. Note: This modifier should not be appended to an E/M service.

91 Repeat Clinical Diagnostic Laboratory Test In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the




same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. Note: This modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (eg., glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.

XE Separate Encounter A Service That Is Distinct Because It Occurred During A Separate Encounter

XP Separate Practitioner A Service That Is Distinct Because It Was Performed By A Different Practitioner

XS Separate Structure A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure

XU Unusual Non-Overlapping Service The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

Anatomic Modifier

Description Anatomic Modifier

Description

E1 Upper left, eyelid LM Left main coronary artery

E2 Lower left, eyelid LT Left side

E3 Upper right, eyelid RC Right coronary artery

E4 Lower right, eyelid RI Ramus intermedius

F1 Left hand, second digit RT Right side

F2 Left hand, third digit T1 Left foot, second digit

F3 Left hand, fourth digit T2 Left foot, third digit

F4 Left hand, fifth digit T3 Left foot, fourth digit

F5 Right hand, thumb T4 Left foot, fifth digit

F6 Right hand, second digit T5 Right foot, great toe

F7 Right hand, third digit T6 Right foot, second digit

F8 Right hand, fourth digit T7 Right foot, third digit

F9 Right hand, fifth digit T8 Right foot, fourth digit

FA Left hand, thumb T9 Right foot, fifth digit

LC Left circumflex coronary artery TA Left foot, great toe

LD Left anterior descending coronary artery

State Exceptions

All Medicaid Lines of Business Codes 90471 and 90472 are allowed in a facility place of service.

California Medicaid allows the PC/TC Modifiers on HCPC codes Q0111, Q0112 and Q0113.

Louisiana Pay 26 modifier at 40%, TC not covered




Mississippi Per state regulation, MSCAN and MSCHIP allow reimbursement for codes 96160 and 96161 when submitted with Modifier EP in a facility place of service

Ohio OH Medicaid and MMP products allows professional providers to be reimbursed for 96372 in a place of service 57

Washington Per state regulation, WA allows H0003 in a facility Place of service

Wisconsin Per state regulation, WI considers place of service 19 as a non-facility and allows code H0049

Definitions

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

Duplicate or Repeat Services

Identical CPT or HCPCS codes assigned a PC/TC indicator 1, 2, 3, 4, 6 or 8 submitted for the same patient on the same date of service on separate claim lines or on different claims regardless of the assigned Maximum Frequency per Day (MFD) value.

Gap Code A CPT or HCPCS code for which CMS does not develop RVUs. Note: Under the Professional/Technical Component Policy a Gap Code has a CMS PC/TC indicator 1 assignment.

Gap Fill Code 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.

Global Service A Global Service includes both a Professional Component and a Technical Component. When a physician or other qualified health care professional bills a Global Service, he or she is submitting for both the Professional Component and the Technical Component of that code. Submission of a Global Service asserts that the Same Individual Physician or Other Qualified Health Care Professional provided the supervision, interpretation and report of the professional services as well as the technician, equipment, and the facility needed to perform the procedure. In appropriate circumstances, the Global Service is identified by reporting the appropriate PC/TC split eligible procedure code with no modifier attached or by reporting a Stand-alone code for global test only services.

Independent Laboratory

An Independent Laboratory is one that is independent both of an attending or consulting physician’s office and of a hospital that meets at least the requirements to qualify as an emergency hospital. An independent laboratory must meet Federal and State requirements for certification and proficiency testing under the Clinical Laboratories Improvement Act (CLIA).

Non-Reference Laboratory

A physician or a Pathologist reporting laboratory procedures performed in their office

Pathologist A Pathologist is a physician who specializes in diagnosing diseases by examining tissue, blood, and body fluids using advanced laboratory techniques.

Professional Component

The Professional Component represents the physician or other qualified health care professional work portion (physician work/practice overhead/malpractice expense) of the procedure. The Professional Component is the physician or other qualified health care professional supervision and interpretation of a procedure that is personally furnished to an individual patient, results in a written narrative report to be included in the patient's medical record, and directly contributes to the patient's diagnosis and/or treatment. In appropriate circumstances, it is identified by appending modifier 26 to the designated procedure code or by reporting a Stand-alone code that describes the Professional Component only of a selected diagnostic test.

Reference Laboratory A Reference Laboratory that receives a Specimen from another, Referring Laboratory for testing




and that actually performs the test is often referred to as an Independent Laboratory. Services billed by a Reference Laboratory should use modifier 90 to identify the Reference Laboratory services.

Relative Value Unit (RVU)

The assigned unit value of a particular CPT or HCPCS code. The associated RVU is from CMS NPFS Non-Facility Total value.

Resource-Based Relative Value Scale (RBRVS)

Payment schedule based on the relative values of services provided. The current RBRVS system ranks services according to the relative costs required to provide them. These costs are defined in terms of units, with more complex, more time consuming services having higher unit values than less complex, less time-consuming services. Furthermore, each service is compared to all other physician services so that each service is given a value that reflects its cost or value when compared to all other physician services.

Same Individual Physician or Other Qualified Health Care Professional

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

Specimen Tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathological diagnosis. Two or more such Specimens from the same patient (eg, separately identifiable endoscopic biopsies, skin lesions) are each appropriately assigned an individual code reflective of its proper level of service.

Stand-alone Code A Stand-alone Code describes a specific component of a selected diagnostic test. There is an associated code that describes the Professional Component only of the diagnostic test, an associated code that describes the Technical Component only, and another associated code that describes the global test only. An example is the series of codes used to describe electrocardiograms with at least 12 leads. CPT code 93010 describes the Professional Component only, 93005 describes the Technical Component only, and 93000 describes the global test only. Modifiers TC or 26 are not used to report these services as they are inherent within the code descriptions.

Technical Component The Technical Component is the performance (technician/equipment/facility) of the procedure. In appropriate circumstances, it is identified by appending modifier TC to the designated procedure code or by reporting a Stand-alone Code that describes the Technical Component only of a selected diagnostic test.

Questions and Answers

1

Q: Are the CMS Geographic Practice Cost Indices by Medicare Carrier and Locality considered when developing UnitedHealthcare Community Plan percentage splits?

A: No. The UnitedHealthcare Community Plan percentage splits are developed on a national level from the CMS Resource Based Relative Value Scale (RBRVS) percentage splits.

2

Q: If a physician or other qualified health care professional is contracted with specific rates for the Professional Component and the Technical Component, will their contracted rates be updated quarterly to reflect changes in CMS professional and technical rates?

A: No. As their fees for the Professional Component and the Technical Component are determined by their contract, the physician or other qualified health care professional will not be impacted by UnitedHealthcare Community Plan's quarterly updates to the percentage calculation methodology for Professional Component and Technical Component reimbursement.

3

Q: When does UnitedHealthcare Community Plan give consideration for repeat procedures by the same individual physician, another physician or other qualified health care professional when reported with modifiers 76 or 77?

A: Repeat procedures must be identified with modifiers 76 or 77 as appropriate to indicate that subsequent procedures were performed at different episodes on the same day. Modifiers 76 or 77 should not be used to report multiple interpretations by the same or different physicians or other qualified health care professionals for the same




EKG or x-ray procedure for quality control purposes. However, when subsequent interpretations of the same procedure show a different finding that alters/contributes to the diagnosis and treatment of the patient, use of modifier 76 or 77 is appropriate. Note: It is inappropriate to use modifier 76 or 77 to indicate repeat laboratory services. Modifiers 59, XE, XP, XS or XU or 91 should be used to indicate repeat or distinct laboratory services, as appropriate according to the AMA and CMS. Separate consideration for reimbursement will not be given to laboratory codes reported with modifier 76 or 77.

Attachments

Professional/Technical Component Codes (PC/TC

Indicator 1 Diagnostic Tests)

A list of codes with a CMS PC/TC Indicator 1 with their percentage splits. These codes have both a Professional Component and a Technical Component. Modifiers 26 and TC can be used with these codes.

Codes Subject to the PC/TC Concept Without RVU Splits

A list of PC/TC Indicator 1 Diagnostic Test codes subject to the CMS PC/TC component concept without RVUs for one or more components. These codes are allowed at 100% for both the Professional Component and the Technical Component.

Gap Fill Codes

A list of PC/TC Indicator 1 Diagnostic Test codes subject to the CMS PC/TC component concept, for which CMS does not develop RVUs or which CMS states may be carrier-based. These are assigned gap fill RVUs from data published by CMS Carriers or are otherwise assigned RVUs by UnitedHealthcare Community Plan.

Stand-alone Professional Component Only Codes

(PC/TC Indicator 2)

A list of codes with a CMS PC/TC Indicator 2. Modifiers 26 and TC cannot be used with these codes. These codes are allowed at 100% if modifier 26 or TC is not used.

Stand-alone Technical Component Only Codes

(PC/TC Indicator 3)

A list of codes with a CMS PC/TC Indicator 3. This indicator identifies Stand-alone Codes that describe the Technical Component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the Professional Component of the diagnostic test only. Modifiers 26 and TC cannot be used with these codes. These codes are allowed at 100% if no modifier 26 or TC is used, and they are not reported in a facility POS.

Stand-alone Global Test Only Codes (PC/TC

Indicator 4)

A list of codes with a CMS PC/TC Indicator 4. Modifiers 26 and TC cannot be used with these codes. These codes are allowed at 100% if modifier 26 or TC is not used, and they are not reported in a facility POS.

Stand-alone Incident To Codes (PC/TC Indicator 5)

A list of codes with a CMS PC/TC Indicator 5. Modifiers 26 and TC cannot be used with these codes. These codes are allowed at 100% if modifier 26 or TC is not used, and they are not reported in a facility POS.

Professional Component Codes (PC/TC Indicator 6 or

8)

A list of codes with a CMS PC/TC Indicator 6 or 8. Indicator 6 codes identify clinical laboratory codes for which A list of codes with a CMS PC/TC Indicator 6 or 8. Indicator 6 codes identify clinical laboratory codes for which separate payment for interpretations by laboratory physicians may be made. These codes may also be reported with no modifier by the laboratory actually performing the test. Indicator 6 codes are

2019 Professional/Technical Component Codes (PCTC 1 Diagnostic Tests)

Code Modifier RVU RBRVS Split RBRVS % Split RBRVSVariance

0509T 2.24 1.000 100.00% 0.00%

0509T TC 1.62 0.723 70.00% -2.30%

0509T 26 0.62 0.277 30.00% 2.30%

51725 5.69 1.000 100.00% 0.00%

51725 TC 3.50 0.615 60.00% -1.50%

51725 26 2.19 0.385 40.00% 1.50%

51726 7.94 1.000 100.00% 0.00%

51726 TC 5.48 0.690 70.00% 1.00%

51726 26 2.46 0.310 30.00% -1.00%

51727 9.38 1.000 100.00% 0.00%

51727 TC 6.32 0.674 65.00% -2.40%

51727 26 3.06 0.326 35.00% 2.40%

51728 9.55 1.000 100.00% 0.00%

51728 TC 6.54 0.685 70.00% 1.50%

51728 26 3.01 0.315 30.00% -1.50%

51729 10.21 1.000 100.00% 0.00%

51729 TC 6.58 0.644 65.00% 0.60%

51729 26 3.63 0.356 35.00% -0.60%

51736 0.40 1.000 100.00% 0.00%

51736 TC 0.16 0.400 40.00% 0.00%

51736 26 0.24 0.600 60.00% 0.00%

51741 0.41 1.000 100.00% 0.00%

51741 TC 0.17 0.415 40.00% -1.50%

51741 26 0.24 0.585 60.00% 1.50%

51784 1.93 1.000 100.00% 0.00%

51784 TC 0.85 0.440 45.00% 1.00%

51784 26 1.08 0.560 55.00% -1.00%

51785 9.17 1.000 100.00% 0.00%

51785 TC 6.51 0.710 70.00% -1.00%

51785 26 2.66 0.290 30.00% 1.00%

51792 6.57 1.000 100.00% 0.00%

51792 TC 4.98 0.758 75.00% -0.80%

51792 26 1.59 0.242 25.00% 0.80%

51797 3.95 1.000 100.00% 0.00%

51797 TC 2.79 0.706 70.00% -0.60%

51797 26 1.16 0.294 30.00% 0.60%

54240 2.97 1.000 100.00% 0.00%

54240 TC 1.04 0.350 35.00% 0.00%

54240 26 1.93 0.650 65.00% 0.00%

54250 3.50 1.000 100.00% 0.00%

54250 TC 0.34 0.097 10.00% 0.30%

54250 26 3.16 0.903 90.00% -0.30%

59020 1.99 1.000 100.00% 0.00%

59020 TC 0.93 0.467 45.00% -1.70%


59020 26 1.06 0.533 55.00% 1.70%

59025 1.37 1.000 100.00% 0.00%

59025 TC 0.52 0.380 40.00% 2.00%

59025 26 0.85 0.620 60.00% -2.00%

62252 2.34 1.000 100.00% 0.00%

62252 TC 0.99 0.423 40.00% -2.30%

62252 26 1.35 0.577 60.00% 2.30%

70015 4.35 1.000 100.00% 0.00%

70015 TC 2.65 0.609 60.00% -0.90%

70015 26 1.70 0.391 40.00% 0.90%

70030 0.83 1.000 100.00% 0.00%

70030 TC 0.59 0.711 70.00% -1.10%

70030 26 0.24 0.289 30.00% 1.10%

70100 0.97 1.000 100.00% 0.00%

70100 TC 0.71 0.732 75.00% 1.80%

70100 26 0.26 0.268 25.00% -1.80%

70110 1.13 1.000 100.00% 0.00%

70110 TC 0.77 0.681 70.00% 1.90%

70110 26 0.36 0.319 30.00% -1.90%

70120 0.97 1.000 100.00% 0.00%

70120 TC 0.71 0.732 75.00% 1.80%

70120 26 0.26 0.268 25.00% -1.80%

70130 1.61 1.000 100.00% 0.00%

70130 TC 1.12 0.696 70.00% 0.40%

70130 26 0.49 0.304 30.00% -0.40%

70134 1.51 1.000 100.00% 0.00%

70134 TC 1.01 0.669 65.00% -1.90%

70134 26 0.50 0.331 35.00% 1.90%

70140 0.86 1.000 100.00% 0.00%

70140 TC 0.57 0.663 65.00% -1.30%

70140 26 0.29 0.337 35.00% 1.30%

70150 1.23 1.000 100.00% 0.00%

70150 TC 0.85 0.691 70.00% 0.90%

70150 26 0.38 0.309 30.00% -0.90%

70160 0.97 1.000 100.00% 0.00%

70160 TC 0.72 0.742 75.00% 0.80%

70160 26 0.25 0.258 25.00% -0.80%

70170 1.48 1.000 100.00% 0.00%

70170 TC 1.05 0.709 70.00% -0.90%

70170 26 0.43 0.291 30.00% 0.90%

70190 1.03 1.000 100.00% 0.00%

70190 TC 0.72 0.699 70.00% 0.10%

70190 26 0.31 0.301 30.00% -0.10%

70200 1.24 1.000 100.00% 0.00%

70200 TC 0.84 0.677 70.00% 2.30%

70200 26 0.40 0.323 30.00% -2.30%


70210 0.89 1.000 100.00% 0.00%

70210 TC 0.64 0.719 70.00% -1.90%

70210 26 0.25 0.281 30.00% 1.90%

70220 1.10 1.000 100.00% 0.00%

70220 TC 0.74 0.673 65.00% -2.30%

70220 26 0.36 0.327 35.00% 2.30%

70240 0.89 1.000 100.00% 0.00%

70240 TC 0.61 0.685 70.00% 1.50%

70240 26 0.28 0.315 30.00% -1.50%

70250 1.07 1.000 100.00% 0.00%

70250 TC 0.71 0.664 65.00% -1.40%

70250 26 0.36 0.336 35.00% 1.40%

70260 1.34 1.000 100.00% 0.00%

70260 TC 0.84 0.627 65.00% 2.30%

70260 26 0.50 0.373 35.00% -2.30%

70300 0.40 1.000 100.00% 0.00%

70300 TC 0.24 0.600 60.00% 0.00%

70300 26 0.16 0.400 40.00% 0.00%

70310 1.06 1.000 100.00% 0.00%

70310 TC 0.84 0.792 80.00% 0.80%

70310 26 0.22 0.208 20.00% -0.80%

70320 1.53 1.000 100.00% 0.00%

70320 TC 1.18 0.771 75.00% -2.10%

70320 26 0.35 0.229 25.00% 2.10%

70328 0.89 1.000 100.00% 0.00%

70328 TC 0.63 0.708 70.00% -0.80%

70328 26 0.26 0.292 30.00% 0.80%

70330 1.39 1.000 100.00% 0.00%

70330 TC 1.04 0.748 75.00% 0.20%

70330 26 0.35 0.252 25.00% -0.20%

70332 2.15 1.000 100.00% 0.00%

70332 TC 1.38 0.642 65.00% 0.80%

70332 26 0.77 0.358 35.00% -0.80%

70336 8.86 1.000 100.00% 0.00%

70336 TC 6.77 0.764 75.00% -1.40%

70336 26 2.09 0.236 25.00% 1.40%

70350 0.53 1.000 100.00% 0.00%

70350 TC 0.25 0.472 45.00% -2.20%

70350 26 0.28 0.528 55.00% 2.20%

70355 0.56 1.000 100.00% 0.00%

70355 TC 0.25 0.446 45.00% 0.40%

70355 26 0.31 0.554 55.00% -0.40%

70360 0.85 1.000 100.00% 0.00%

70360 TC 0.61 0.718 70.00% -1.80%

70360 26 0.24 0.282 30.00% 1.80%

70370 2.27 1.000 100.00% 0.00%


70370 TC 1.85 0.815 80.00% -1.50%

70370 26 0.42 0.185 20.00% 1.50%

70371 2.77 1.000 100.00% 0.00%

70371 TC 1.56 0.563 55.00% -1.30%

70371 26 1.21 0.437 45.00% 1.30%

70380 0.95 1.000 100.00% 0.00%

70380 TC 0.71 0.747 75.00% 0.30%

70380 26 0.24 0.253 25.00% -0.30%

70390 2.90 1.000 100.00% 0.00%

70390 TC 2.36 0.814 80.00% -1.40%

70390 26 0.54 0.186 20.00% 1.40%

70450 3.26 1.000 100.00% 0.00%

70450 TC 2.05 0.629 65.00% 2.10%

70450 26 1.21 0.371 35.00% -2.10%

70460 4.61 1.000 100.00% 0.00%

70460 TC 2.99 0.649 65.00% 0.10%

70460 26 1.62 0.351 35.00% -0.10%

70470 5.39 1.000 100.00% 0.00%

70470 TC 3.58 0.664 65.00% -1.40%

70470 26 1.81 0.336 35.00% 1.40%

70480 6.55 1.000 100.00% 0.00%

70480 TC 4.73 0.722 70.00% -2.20%

70480 26 1.82 0.278 30.00% 2.20%

70481 7.76 1.000 100.00% 0.00%

70481 TC 5.79 0.746 75.00% 0.40%

70481 26 1.97 0.254 25.00% -0.40%

70482 8.45 1.000 100.00% 0.00%

70482 TC 6.39 0.756 75.00% -0.60%

70482 26 2.06 0.244 25.00% 0.60%

70486 3.92 1.000 100.00% 0.00%

70486 TC 2.70 0.689 70.00% 1.10%

70486 26 1.22 0.311 30.00% -1.10%

70487 4.71 1.000 100.00% 0.00%

70487 TC 3.11 0.660 65.00% -1.00%

70487 26 1.60 0.340 35.00% 1.00%

70488 5.74 1.000 100.00% 0.00%

70488 TC 3.93 0.685 70.00% 1.50%

70488 26 1.81 0.315 30.00% -1.50%

70490 4.63 1.000 100.00% 0.00%

70490 TC 2.81 0.607 60.00% -0.70%

70490 26 1.82 0.393 40.00% 0.70%

70491 5.71 1.000 100.00% 0.00%

70491 TC 3.74 0.655 65.00% -0.50%

70491 26 1.97 0.345 35.00% 0.50%

70492 6.88 1.000 100.00% 0.00%

70492 TC 4.58 0.666 65.00% -1.60%


70492 26 2.30 0.334 35.00% 1.60%

70496 8.31 1.000 100.00% 0.00%

70496 TC 5.82 0.700 70.00% 0.00%

70496 26 2.49 0.300 30.00% 0.00%

70498 8.29 1.000 100.00% 0.00%

70498 TC 5.80 0.700 70.00% 0.00%

70498 26 2.49 0.300 30.00% 0.00%

70540 7.48 1.000 100.00% 0.00%

70540 TC 5.56 0.743 75.00% 0.70%

70540 26 1.92 0.257 25.00% -0.70%

70542 8.89 1.000 100.00% 0.00%

70542 TC 6.58 0.740 75.00% 1.00%

70542 26 2.31 0.260 25.00% -1.00%

70543 11.17 1.000 100.00% 0.00%

70543 TC 8.13 0.728 75.00% 2.20%

70543 26 3.04 0.272 25.00% -2.20%

70544 7.84 1.000 100.00% 0.00%

70544 TC 6.13 0.782 80.00% 1.80%

70544 26 1.71 0.218 20.00% -1.80%

70545 7.78 1.000 100.00% 0.00%

70545 TC 6.07 0.780 80.00% 2.00%

70545 26 1.71 0.220 20.00% -2.00%

70546 11.50 1.000 100.00% 0.00%

70546 TC 9.40 0.817 80.00% -1.70%

70546 26 2.10 0.183 20.00% 1.70%

70547 7.87 1.000 100.00% 0.00%

70547 TC 6.16 0.783 80.00% 1.70%

70547 26 1.71 0.217 20.00% -1.70%

70548 8.66 1.000 100.00% 0.00%

70548 TC 6.52 0.753 75.00% -0.30%

70548 26 2.14 0.247 25.00% 0.30%

70549 12.02 1.000 100.00% 0.00%

70549 TC 9.46 0.787 80.00% 1.30%

70549 26 2.56 0.213 20.00% -1.30%

70551 6.38 1.000 100.00% 0.00%

70551 TC 4.27 0.669 65.00% -1.90%

70551 26 2.11 0.331 35.00% 1.90%

70552 8.86 1.000 100.00% 0.00%

70552 TC 6.32 0.713 70.00% -1.30%

70552 26 2.54 0.287 30.00% 1.30%

70553 10.45 1.000 100.00% 0.00%

70553 TC 7.20 0.689 70.00% 1.10%

70553 26 3.25 0.311 30.00% -1.10%

70554 12.40 1.000 100.00% 0.00%

70554 TC 9.40 0.758 75.00% -0.80%

70554 26 3.00 0.242 25.00% 0.80%


70555 20.94 1.000 100.00% 0.00%

70555 TC 17.38 0.830 85.00% 2.00%

70555 26 3.56 0.170 15.00% -2.00%

70557 40.55 1.000 100.00% 0.00%

70557 TC 36.09 0.890 90.00% 1.00%

70557 26 4.46 0.110 10.00% -1.00%

70558 44.64 1.000 100.00% 0.00%

70558 TC 39.73 0.890 90.00% 1.00%

70558 26 4.91 0.110 10.00% -1.00%

70559 42.09 1.000 100.00% 0.00%

70559 TC 37.46 0.890 90.00% 1.00%

70559 26 4.63 0.110 10.00% -1.00%

71045 0.70 1.000 100.00% 0.00%

71045 TC 0.44 0.629 65.00% 2.10%

71045 26 0.26 0.371 35.00% -2.10%

71046 0.89 1.000 100.00% 0.00%

71046 TC 0.58 0.652 65.00% -0.20%

71046 26 0.31 0.348 35.00% 0.20%

71047 1.12 1.000 100.00% 0.00%

71047 TC 0.72 0.643 65.00% 0.70%

71047 26 0.40 0.357 35.00% -0.70%

71048 1.21 1.000 100.00% 0.00%

71048 TC 0.75 0.620 60.00% -2.00%

71048 26 0.46 0.380 40.00% 2.00%

71100 0.97 1.000 100.00% 0.00%

71100 TC 0.65 0.670 65.00% -2.00%

71100 26 0.32 0.330 35.00% 2.00%

71101 1.11 1.000 100.00% 0.00%

71101 TC 0.72 0.649 65.00% 0.10%

71101 26 0.39 0.351 35.00% -0.10%

71110 1.16 1.000 100.00% 0.00%

71110 TC 0.74 0.638 65.00% 1.20%

71110 26 0.42 0.362 35.00% -1.20%

71111 1.38 1.000 100.00% 0.00%

71111 TC 0.91 0.659 65.00% -0.90%

71111 26 0.47 0.341 35.00% 0.90%

71120 0.88 1.000 100.00% 0.00%

71120 TC 0.59 0.670 65.00% -2.00%

71120 26 0.29 0.330 35.00% 2.00%

71130 1.05 1.000 100.00% 0.00%

71130 TC 0.74 0.705 70.00% -0.50%

71130 26 0.31 0.295 30.00% 0.50%

71250 4.47 1.000 100.00% 0.00%

71250 TC 2.81 0.629 65.00% 2.10%

71250 26 1.66 0.371 35.00% -2.10%

71260 5.53 1.000 100.00% 0.00%


71260 TC 3.76 0.680 70.00% 2.00%

71260 26 1.77 0.320 30.00% -2.00%

71270 6.56 1.000 100.00% 0.00%

71270 TC 4.59 0.700 70.00% 0.00%

71270 26 1.97 0.300 30.00% 0.00%

71275 8.50 1.000 100.00% 0.00%

71275 TC 5.91 0.695 70.00% 0.50%

71275 26 2.59 0.305 30.00% -0.50%

71550 11.41 1.000 100.00% 0.00%

71550 TC 9.34 0.819 80.00% -1.90%

71550 26 2.07 0.181 20.00% 1.90%

71551 12.63 1.000 100.00% 0.00%

71551 TC 10.17 0.805 80.00% -0.50%

71551 26 2.46 0.195 20.00% 0.50%

71552 15.95 1.000 100.00% 0.00%

71552 TC 12.74 0.799 80.00% 0.10%

71552 26 3.21 0.201 20.00% -0.10%

71555 11.03 1.000 100.00% 0.00%

71555 TC 8.49 0.770 75.00% -2.00%

71555 26 2.54 0.230 25.00% 2.00%

72020 0.65 1.000 100.00% 0.00%

72020 TC 0.43 0.662 65.00% -1.20%

72020 26 0.22 0.338 35.00% 1.20%

72040 1.03 1.000 100.00% 0.00%

72040 TC 0.71 0.689 70.00% 1.10%

72040 26 0.32 0.311 30.00% -1.10%

72050 1.42 1.000 100.00% 0.00%

72050 TC 0.97 0.683 70.00% 1.70%

72050 26 0.45 0.317 30.00% -1.70%

72052 1.69 1.000 100.00% 0.00%

72052 TC 1.17 0.692 70.00% 0.80%

72052 26 0.52 0.308 30.00% -0.80%

72070 0.96 1.000 100.00% 0.00%

72070 TC 0.64 0.667 65.00% -1.70%

72070 26 0.32 0.333 35.00% 1.70%

72072 1.02 1.000 100.00% 0.00%

72072 TC 0.71 0.696 70.00% 0.40%

72072 26 0.31 0.304 30.00% -0.40%

72074 1.12 1.000 100.00% 0.00%

72074 TC 0.81 0.723 70.00% -2.30%

72074 26 0.31 0.277 30.00% 2.30%

72080 0.95 1.000 100.00% 0.00%

72080 TC 0.63 0.663 65.00% -1.30%

72080 26 0.32 0.337 35.00% 1.30%

72081 1.14 1.000 100.00% 0.00%

72081 TC 0.75 0.658 65.00% -0.80%


72081 26 0.39 0.342 35.00% 0.80%

72082 1.83 1.000 100.00% 0.00%

72082 TC 1.37 0.749 75.00% 0.10%

72082 26 0.46 0.251 25.00% -0.10%

72083 2.16 1.000 100.00% 0.00%

72083 TC 1.64 0.759 75.00% -0.90%

72083 26 0.52 0.241 25.00% 0.90%

72084 2.52 1.000 100.00% 0.00%

72084 TC 1.92 0.762 75.00% -1.20%

72084 26 0.60 0.238 25.00% 1.20%

72100 1.03 1.000 100.00% 0.00%

72100 TC 0.71 0.689 70.00% 1.10%

72100 26 0.32 0.311 30.00% -1.10%

72110 1.44 1.000 100.00% 0.00%

72110 TC 0.99 0.688 70.00% 1.20%

72110 26 0.45 0.312 30.00% -1.20%

72114 1.64 1.000 100.00% 0.00%

72114 TC 1.17 0.713 70.00% -1.30%

72114 26 0.47 0.287 30.00% 1.30%

72120 1.21 1.000 100.00% 0.00%

72120 TC 0.89 0.736 75.00% 1.40%

72120 26 0.32 0.264 25.00% -1.40%

72125 5.18 1.000 100.00% 0.00%

72125 TC 3.66 0.707 70.00% -0.70%

72125 26 1.52 0.293 30.00% 0.70%

72126 6.40 1.000 100.00% 0.00%

72126 TC 4.66 0.728 75.00% 2.20%

72126 26 1.74 0.272 25.00% -2.20%

72127 7.58 1.000 100.00% 0.00%

72127 TC 5.78 0.763 75.00% -1.30%

72127 26 1.80 0.237 25.00% 1.30%

72128 5.08 1.000 100.00% 0.00%

72128 TC 3.65 0.719 70.00% -1.90%

72128 26 1.43 0.281 30.00% 1.90%

72129 6.44 1.000 100.00% 0.00%

72129 TC 4.70 0.730 75.00% 2.00%

72129 26 1.74 0.270 25.00% -2.00%

72130 7.59 1.000 100.00% 0.00%

72130 TC 5.79 0.763 75.00% -1.30%

72130 26 1.80 0.237 25.00% 1.30%

72131 5.06 1.000 100.00% 0.00%

72131 TC 3.63 0.717 70.00% -1.70%

72131 26 1.43 0.283 30.00% 1.70%

72132 6.41 1.000 100.00% 0.00%

72132 TC 4.67 0.729 75.00% 2.10%

72132 26 1.74 0.271 25.00% -2.10%


72133 7.56 1.000 100.00% 0.00%

72133 TC 5.75 0.761 75.00% -1.10%

72133 26 1.81 0.239 25.00% 1.10%

72141 6.22 1.000 100.00% 0.00%

72141 TC 4.10 0.659 65.00% -0.90%

72141 26 2.12 0.341 35.00% 0.90%

72142 9.03 1.000 100.00% 0.00%

72142 TC 6.48 0.718 70.00% -1.80%

72142 26 2.55 0.282 30.00% 1.80%

72146 6.23 1.000 100.00% 0.00%

72146 TC 4.11 0.660 65.00% -1.00%

72146 26 2.12 0.340 35.00% 1.00%

72147 8.98 1.000 100.00% 0.00%

72147 TC 6.44 0.717 70.00% -1.70%

72147 26 2.54 0.283 30.00% 1.70%

72148 6.23 1.000 100.00% 0.00%

72148 TC 4.11 0.660 65.00% -1.00%

72148 26 2.12 0.340 35.00% 1.00%

72149 8.92 1.000 100.00% 0.00%

72149 TC 6.37 0.714 70.00% -1.40%

72149 26 2.55 0.286 30.00% 1.40%

72156 10.52 1.000 100.00% 0.00%

72156 TC 7.27 0.691 70.00% 0.90%

72156 26 3.25 0.309 30.00% -0.90%

72157 10.55 1.000 100.00% 0.00%

72157 TC 7.30 0.692 70.00% 0.80%

72157 26 3.25 0.308 30.00% -0.80%

72158 10.50 1.000 100.00% 0.00%

72158 TC 7.25 0.690 70.00% 1.00%

72158 26 3.25 0.310 30.00% -1.00%

72159 11.43 1.000 100.00% 0.00%

72159 TC 8.87 0.776 80.00% 2.40%

72159 26 2.56 0.224 20.00% -2.40%

72170 0.93 1.000 100.00% 0.00%

72170 TC 0.68 0.731 75.00% 1.90%

72170 26 0.25 0.269 25.00% -1.90%

72190 1.12 1.000 100.00% 0.00%

72190 TC 0.81 0.723 70.00% -2.30%

72190 26 0.31 0.277 30.00% 2.30%

72191 8.85 1.000 100.00% 0.00%

72191 TC 6.29 0.711 70.00% -1.10%

72191 26 2.56 0.289 30.00% 1.10%

72192 4.10 1.000 100.00% 0.00%

72192 TC 2.55 0.622 60.00% -2.20%

72192 26 1.55 0.378 40.00% 2.20%

72193 6.59 1.000 100.00% 0.00%


72193 TC 4.93 0.748 75.00% 0.20%

72193 26 1.66 0.252 25.00% -0.20%

72194 7.48 1.000 100.00% 0.00%

72194 TC 5.75 0.769 75.00% -1.90%

72194 26 1.73 0.231 25.00% 1.90%

72195 7.62 1.000 100.00% 0.00%

72195 TC 5.54 0.727 75.00% 2.30%

72195 26 2.08 0.273 25.00% -2.30%

72196 8.90 1.000 100.00% 0.00%

72196 TC 6.43 0.722 70.00% -2.20%

72196 26 2.47 0.278 30.00% 2.20%

72197 11.24 1.000 100.00% 0.00%

72197 TC 8.11 0.722 70.00% -2.20%

72197 26 3.13 0.278 30.00% 2.20%

72198 11.09 1.000 100.00% 0.00%

72198 TC 8.56 0.772 75.00% -2.20%

72198 26 2.53 0.228 25.00% 2.20%

72200 0.87 1.000 100.00% 0.00%

72200 TC 0.62 0.713 70.00% -1.30%

72200 26 0.25 0.287 30.00% 1.30%

72202 0.98 1.000 100.00% 0.00%

72202 TC 0.71 0.724 70.00% -2.40%

72202 26 0.27 0.276 30.00% 2.40%

72220 0.86 1.000 100.00% 0.00%

72220 TC 0.61 0.709 70.00% -0.90%

72220 26 0.25 0.291 30.00% 0.90%

72240 2.94 1.000 100.00% 0.00%

72240 TC 1.65 0.561 55.00% -1.10%

72240 26 1.29 0.439 45.00% 1.10%

72255 2.99 1.000 100.00% 0.00%

72255 TC 1.64 0.548 55.00% 0.20%

72255 26 1.35 0.452 45.00% -0.20%

72265 2.75 1.000 100.00% 0.00%

72265 TC 1.59 0.578 60.00% 2.20%

72265 26 1.16 0.422 40.00% -2.20%

72270 3.82 1.000 100.00% 0.00%

72270 TC 1.90 0.497 50.00% 0.30%

72270 26 1.92 0.503 50.00% -0.30%

72275 3.48 1.000 100.00% 0.00%

72275 TC 2.37 0.681 70.00% 1.90%

72275 26 1.11 0.319 30.00% -1.90%

72285 3.32 1.000 100.00% 0.00%

72285 TC 1.63 0.491 50.00% 0.90%

72285 26 1.69 0.509 50.00% -0.90%

72295 2.90 1.000 100.00% 0.00%

72295 TC 1.67 0.576 60.00% 2.40%


72295 26 1.23 0.424 40.00% -2.40%

73000 0.82 1.000 100.00% 0.00%

73000 TC 0.58 0.707 70.00% -0.70%

73000 26 0.24 0.293 30.00% 0.70%

73010 0.90 1.000 100.00% 0.00%

73010 TC 0.64 0.711 70.00% -1.10%

73010 26 0.26 0.289 30.00% 1.10%

73020 0.67 1.000 100.00% 0.00%

73020 TC 0.44 0.657 65.00% -0.70%

73020 26 0.23 0.343 35.00% 0.70%

73030 0.85 1.000 100.00% 0.00%

73030 TC 0.58 0.682 70.00% 1.80%

73030 26 0.27 0.318 30.00% -1.80%

73040 3.12 1.000 100.00% 0.00%

73040 TC 2.34 0.750 75.00% 0.00%

73040 26 0.78 0.250 25.00% 0.00%

73050 1.05 1.000 100.00% 0.00%

73050 TC 0.75 0.714 70.00% -1.40%

73050 26 0.30 0.286 30.00% 1.40%

73060 0.85 1.000 100.00% 0.00%

73060 TC 0.61 0.718 70.00% -1.80%

73060 26 0.24 0.282 30.00% 1.80%

73070 0.76 1.000 100.00% 0.00%

73070 TC 0.53 0.697 70.00% 0.30%

73070 26 0.23 0.303 30.00% -0.30%

73080 0.84 1.000 100.00% 0.00%

73080 TC 0.59 0.702 70.00% -0.20%

73080 26 0.25 0.298 30.00% 0.20%

73085 2.99 1.000 100.00% 0.00%

73085 TC 2.17 0.726 75.00% 2.40%

73085 26 0.82 0.274 25.00% -2.40%

73090 0.79 1.000 100.00% 0.00%

73090 TC 0.55 0.696 70.00% 0.40%

73090 26 0.24 0.304 30.00% -0.40%

73092 0.81 1.000 100.00% 0.00%

73092 TC 0.58 0.716 70.00% -1.60%

73092 26 0.23 0.284 30.00% 1.60%

73100 0.90 1.000 100.00% 0.00%

73100 TC 0.66 0.733 75.00% 1.70%

73100 26 0.24 0.267 25.00% -1.70%

73110 1.03 1.000 100.00% 0.00%

73110 TC 0.78 0.757 75.00% -0.70%

73110 26 0.25 0.243 25.00% 0.70%

73115 3.33 1.000 100.00% 0.00%

73115 TC 2.52 0.757 75.00% -0.70%

73115 26 0.81 0.243 25.00% 0.70%


73120 0.82 1.000 100.00% 0.00%

73120 TC 0.58 0.707 70.00% -0.70%

73120 26 0.24 0.293 30.00% 0.70%

73130 0.94 1.000 100.00% 0.00%

73130 TC 0.69 0.734 75.00% 1.60%

73130 26 0.25 0.266 25.00% -1.60%

73140 0.95 1.000 100.00% 0.00%

73140 TC 0.75 0.789 80.00% 1.10%

73140 26 0.20 0.211 20.00% -1.10%

73200 5.05 1.000 100.00% 0.00%

73200 TC 3.62 0.717 70.00% -1.70%

73200 26 1.43 0.283 30.00% 1.70%

73201 6.28 1.000 100.00% 0.00%

73201 TC 4.62 0.736 75.00% 1.40%

73201 26 1.66 0.264 25.00% -1.40%

73202 7.82 1.000 100.00% 0.00%

73202 TC 6.08 0.777 80.00% 2.30%

73202 26 1.74 0.223 20.00% -2.30%

73206 9.24 1.000 100.00% 0.00%

73206 TC 6.69 0.724 70.00% -2.40%

73206 26 2.55 0.276 30.00% 2.40%

73218 10.12 1.000 100.00% 0.00%

73218 TC 8.19 0.809 80.00% -0.90%

73218 26 1.93 0.191 20.00% 0.90%

73219 11.11 1.000 100.00% 0.00%

73219 TC 8.80 0.792 80.00% 0.80%

73219 26 2.31 0.208 20.00% -0.80%

73220 13.75 1.000 100.00% 0.00%

73220 TC 10.70 0.778 80.00% 2.20%

73220 26 3.05 0.222 20.00% -2.20%

73221 6.57 1.000 100.00% 0.00%

73221 TC 4.63 0.705 70.00% -0.50%

73221 26 1.94 0.295 30.00% 0.50%

73222 10.47 1.000 100.00% 0.00%

73222 TC 8.15 0.778 80.00% 2.20%

73222 26 2.32 0.222 20.00% -2.20%

73223 12.99 1.000 100.00% 0.00%

73223 TC 9.93 0.764 75.00% -1.40%

73223 26 3.06 0.236 25.00% 1.40%

73225 10.95 1.000 100.00% 0.00%

73225 TC 8.54 0.780 80.00% 2.00%

73225 26 2.41 0.220 20.00% -2.00%

73501 0.87 1.000 100.00% 0.00%

73501 TC 0.60 0.690 70.00% 1.00%

73501 26 0.27 0.310 30.00% -1.00%

73502 1.21 1.000 100.00% 0.00%


73502 TC 0.89 0.736 75.00% 1.40%

73502 26 0.32 0.264 25.00% -1.40%

73503 1.51 1.000 100.00% 0.00%

73503 TC 1.11 0.735 75.00% 1.50%

73503 26 0.40 0.265 25.00% -1.50%

73521 1.08 1.000 100.00% 0.00%

73521 TC 0.76 0.704 70.00% -0.40%

73521 26 0.32 0.296 30.00% 0.40%

73522 1.41 1.000 100.00% 0.00%

73522 TC 0.98 0.695 70.00% 0.50%

73522 26 0.43 0.305 30.00% -0.50%

73523 1.65 1.000 100.00% 0.00%

73523 TC 1.19 0.721 70.00% -2.10%

73523 26 0.46 0.279 30.00% 2.10%

73525 3.18 1.000 100.00% 0.00%

73525 TC 2.35 0.739 75.00% 1.10%

73525 26 0.83 0.261 25.00% -1.10%

73551 0.80 1.000 100.00% 0.00%

73551 TC 0.56 0.700 70.00% 0.00%

73551 26 0.24 0.300 30.00% 0.00%

73552 0.94 1.000 100.00% 0.00%

73552 TC 0.68 0.723 70.00% -2.30%

73552 26 0.26 0.277 30.00% 2.30%

73560 0.91 1.000 100.00% 0.00%

73560 TC 0.67 0.736 75.00% 1.40%

73560 26 0.24 0.264 25.00% -1.40%

73562 1.05 1.000 100.00% 0.00%

73562 TC 0.78 0.743 75.00% 0.70%

73562 26 0.27 0.257 25.00% -0.70%

73564 1.17 1.000 100.00% 0.00%

73564 TC 0.85 0.726 75.00% 2.40%

73564 26 0.32 0.274 25.00% -2.40%

73565 1.05 1.000 100.00% 0.00%

73565 TC 0.80 0.762 75.00% -1.20%

73565 26 0.25 0.238 25.00% 1.20%

73580 3.59 1.000 100.00% 0.00%

73580 TC 2.77 0.772 75.00% -2.20%

73580 26 0.82 0.228 25.00% 2.20%

73590 0.83 1.000 100.00% 0.00%

73590 TC 0.60 0.723 70.00% -2.30%

73590 26 0.23 0.277 30.00% 2.30%

73592 0.81 1.000 100.00% 0.00%

73592 TC 0.58 0.716 70.00% -1.60%

73592 26 0.23 0.284 30.00% 1.60%

73600 0.87 1.000 100.00% 0.00%

73600 TC 0.63 0.724 70.00% -2.40%


73600 26 0.24 0.276 30.00% 2.40%

73610 0.94 1.000 100.00% 0.00%

73610 TC 0.69 0.734 75.00% 1.60%

73610 26 0.25 0.266 25.00% -1.60%

73615 3.34 1.000 100.00% 0.00%

73615 TC 2.51 0.751 75.00% -0.10%

73615 26 0.83 0.249 25.00% 0.10%

73620 0.76 1.000 100.00% 0.00%

73620 TC 0.54 0.711 70.00% -1.10%

73620 26 0.22 0.289 30.00% 1.10%

73630 0.88 1.000 100.00% 0.00%

73630 TC 0.64 0.727 75.00% 2.30%

73630 26 0.24 0.273 25.00% -2.30%

73650 0.76 1.000 100.00% 0.00%

73650 TC 0.53 0.697 70.00% 0.30%

73650 26 0.23 0.303 30.00% -0.30%

73660 0.81 1.000 100.00% 0.00%

73660 TC 0.62 0.765 75.00% -1.50%

73660 26 0.19 0.235 25.00% 1.50%

73700 5.06 1.000 100.00% 0.00%

73700 TC 3.63 0.717 70.00% -1.70%

73700 26 1.43 0.283 30.00% 1.70%

73701 6.36 1.000 100.00% 0.00%

73701 TC 4.70 0.739 75.00% 1.10%

73701 26 1.66 0.261 25.00% -1.10%

73702 7.70 1.000 100.00% 0.00%

73702 TC 5.97 0.775 80.00% 2.50%

73702 26 1.73 0.225 20.00% -2.50%

73706 10.01 1.000 100.00% 0.00%

73706 TC 7.33 0.732 75.00% 1.80%

73706 26 2.68 0.268 25.00% -1.80%

73718 7.39 1.000 100.00% 0.00%

73718 TC 5.47 0.740 75.00% 1.00%

73718 26 1.92 0.260 25.00% -1.00%

73719 8.74 1.000 100.00% 0.00%

73719 TC 6.43 0.736 75.00% 1.40%

73719 26 2.31 0.264 25.00% -1.40%

73720 11.21 1.000 100.00% 0.00%

73720 TC 8.16 0.728 75.00% 2.20%

73720 26 3.05 0.272 25.00% -2.20%

73721 6.57 1.000 100.00% 0.00%

73721 TC 4.63 0.705 70.00% -0.50%

73721 26 1.94 0.295 30.00% 0.50%

73722 10.52 1.000 100.00% 0.00%

73722 TC 8.20 0.779 80.00% 2.10%

73722 26 2.32 0.221 20.00% -2.10%


73723 12.96 1.000 100.00% 0.00%

73723 TC 9.91 0.765 75.00% -1.50%

73723 26 3.05 0.235 25.00% 1.50%

73725 11.10 1.000 100.00% 0.00%

73725 TC 8.55 0.770 75.00% -2.00%

73725 26 2.55 0.230 25.00% 2.00%

74018 0.80 1.000 100.00% 0.00%

74018 TC 0.54 0.675 70.00% 2.50%

74018 26 0.26 0.325 30.00% -2.50%

74019 0.98 1.000 100.00% 0.00%

74019 TC 0.65 0.663 65.00% -1.30%

74019 26 0.33 0.337 35.00% 1.30%

74021 1.13 1.000 100.00% 0.00%

74021 TC 0.74 0.655 65.00% -0.50%

74021 26 0.39 0.345 35.00% 0.50%

74022 1.31 1.000 100.00% 0.00%

74022 TC 0.85 0.649 65.00% 0.10%

74022 26 0.46 0.351 35.00% -0.10%

74150 4.22 1.000 100.00% 0.00%

74150 TC 2.52 0.597 60.00% 0.30%

74150 26 1.70 0.403 40.00% -0.30%

74160 6.72 1.000 100.00% 0.00%

74160 TC 4.91 0.731 75.00% 1.90%

74160 26 1.81 0.269 25.00% -1.90%

74170 7.62 1.000 100.00% 0.00%

74170 TC 5.63 0.739 75.00% 1.10%

74170 26 1.99 0.261 25.00% -1.10%

74174 11.16 1.000 100.00% 0.00%

74174 TC 8.06 0.722 70.00% -2.20%

74174 26 3.10 0.278 30.00% 2.20%

74175 8.87 1.000 100.00% 0.00%

74175 TC 6.30 0.710 70.00% -1.00%

74175 26 2.57 0.290 30.00% 1.00%

74176 5.65 1.000 100.00% 0.00%

74176 TC 3.17 0.561 55.00% -1.10%

74176 26 2.48 0.439 45.00% 1.10%

74177 8.99 1.000 100.00% 0.00%

74177 TC 6.39 0.711 70.00% -1.10%

74177 26 2.60 0.289 30.00% 1.10%

74178 10.15 1.000 100.00% 0.00%

74178 TC 7.30 0.719 70.00% -1.90%

74178 26 2.85 0.281 30.00% 1.90%

74181 6.88 1.000 100.00% 0.00%

74181 TC 4.80 0.698 70.00% 0.20%

74181 26 2.08 0.302 30.00% -0.20%

74182 10.11 1.000 100.00% 0.00%


74182 TC 7.64 0.756 75.00% -0.60%

74182 26 2.47 0.244 25.00% 0.60%

74183 11.25 1.000 100.00% 0.00%

74183 TC 8.12 0.722 70.00% -2.20%

74183 26 3.13 0.278 30.00% 2.20%

74185 11.13 1.000 100.00% 0.00%

74185 TC 8.59 0.772 75.00% -2.20%

74185 26 2.54 0.228 25.00% 2.20%

74190 1.68 1.000 100.00% 0.00%

74190 TC 1.01 0.601 60.00% -0.10%

74190 26 0.67 0.399 40.00% 0.10%

74210 2.49 1.000 100.00% 0.00%

74210 TC 1.65 0.663 65.00% -1.30%

74210 26 0.84 0.337 35.00% 1.30%

74220 2.73 1.000 100.00% 0.00%

74220 TC 1.77 0.648 65.00% 0.20%

74220 26 0.96 0.352 35.00% -0.20%

74230 3.59 1.000 100.00% 0.00%

74230 TC 2.83 0.788 80.00% 1.20%

74230 26 0.76 0.212 20.00% -1.20%

74235 5.03 1.000 100.00% 0.00%

74235 TC 3.27 0.650 65.00% 0.00%

74235 26 1.76 0.350 35.00% 0.00%

74240 3.45 1.000 100.00% 0.00%

74240 TC 2.46 0.713 70.00% -1.30%

74240 26 0.99 0.287 30.00% 1.30%

74241 3.59 1.000 100.00% 0.00%

74241 TC 2.61 0.727 75.00% 2.30%

74241 26 0.98 0.273 25.00% -2.30%

74245 5.24 1.000 100.00% 0.00%

74245 TC 3.95 0.754 75.00% -0.40%

74245 26 1.29 0.246 25.00% 0.40%

74246 3.84 1.000 100.00% 0.00%

74246 TC 2.86 0.745 75.00% 0.50%

74246 26 0.98 0.255 25.00% -0.50%

74247 4.32 1.000 100.00% 0.00%

74247 TC 3.34 0.773 75.00% -2.30%

74247 26 0.98 0.227 25.00% 2.30%

74249 5.62 1.000 100.00% 0.00%

74249 TC 4.33 0.770 75.00% -2.00%

74249 26 1.29 0.230 25.00% 2.00%

74250 3.18 1.000 100.00% 0.00%

74250 TC 2.51 0.789 80.00% 1.10%

74250 26 0.67 0.211 20.00% -1.10%

74251 12.16 1.000 100.00% 0.00%

74251 TC 11.18 0.919 90.00% -1.90%


74251 26 0.98 0.081 10.00% 1.90%

74260 9.92 1.000 100.00% 0.00%

74260 TC 9.20 0.927 95.00% 2.30%

74260 26 0.72 0.073 5.00% -2.30%

74261 13.58 1.000 100.00% 0.00%

74261 TC 10.16 0.748 75.00% 0.20%

74261 26 3.42 0.252 25.00% -0.20%

74262 15.25 1.000 100.00% 0.00%

74262 TC 11.69 0.767 75.00% -1.70%

74262 26 3.56 0.233 25.00% 1.70%

74263 21.30 1.000 100.00% 0.00%

74263 TC 18.08 0.849 85.00% 0.10%

74263 26 3.22 0.151 15.00% -0.10%

74270 4.54 1.000 100.00% 0.00%

74270 TC 3.56 0.784 80.00% 1.60%

74270 26 0.98 0.216 20.00% -1.60%

74280 6.41 1.000 100.00% 0.00%

74280 TC 5.00 0.780 80.00% 2.00%

74280 26 1.41 0.220 20.00% -2.00%

74283 6.61 1.000 100.00% 0.00%

74283 TC 3.67 0.555 55.00% -0.50%

74283 26 2.94 0.445 45.00% 0.50%

74290 2.15 1.000 100.00% 0.00%

74290 TC 1.69 0.786 80.00% 1.40%

74290 26 0.46 0.214 20.00% -1.40%

74300 1.49 1.000 100.00% 0.00%

74300 TC 0.97 0.651 65.00% -0.10%

74300 26 0.52 0.349 35.00% 0.10%

74301 0.86 1.000 100.00% 0.00%

74301 TC 0.56 0.651 65.00% -0.10%

74301 26 0.30 0.349 35.00% 0.10%

74328 3.37 1.000 100.00% 0.00%

74328 TC 2.36 0.700 70.00% 0.00%

74328 26 1.01 0.300 30.00% 0.00%

74329 2.91 1.000 100.00% 0.00%

74329 TC 1.89 0.649 65.00% 0.10%

74329 26 1.02 0.351 35.00% -0.10%

74330 4.81 1.000 100.00% 0.00%

74330 TC 3.51 0.730 75.00% 2.00%

74330 26 1.30 0.270 25.00% -2.00%

74340 3.08 1.000 100.00% 0.00%

74340 TC 2.31 0.750 75.00% 0.00%

74340 26 0.77 0.250 25.00% 0.00%

74355 4.15 1.000 100.00% 0.00%

74355 TC 3.03 0.730 75.00% 2.00%

74355 26 1.12 0.270 25.00% -2.00%


74360 3.33 1.000 100.00% 0.00%

74360 TC 2.53 0.760 75.00% -1.00%

74360 26 0.80 0.240 25.00% 1.00%

74363 3.46 1.000 100.00% 0.00%

74363 TC 2.25 0.650 65.00% 0.00%

74363 26 1.21 0.350 35.00% 0.00%

74400 3.36 1.000 100.00% 0.00%

74400 TC 2.66 0.792 80.00% 0.80%

74400 26 0.70 0.208 20.00% -0.80%

74410 3.41 1.000 100.00% 0.00%

74410 TC 2.72 0.798 80.00% 0.20%

74410 26 0.69 0.202 20.00% -0.20%

74415 4.07 1.000 100.00% 0.00%

74415 TC 3.37 0.828 85.00% 2.20%

74415 26 0.70 0.172 15.00% -2.20%

74420 2.02 1.000 100.00% 0.00%

74420 TC 1.29 0.639 65.00% 1.10%

74420 26 0.73 0.361 35.00% -1.10%

74425 1.85 1.000 100.00% 0.00%

74425 TC 1.35 0.730 75.00% 2.00%

74425 26 0.50 0.270 25.00% -2.00%

74430 1.11 1.000 100.00% 0.00%

74430 TC 0.65 0.586 60.00% 1.40%

74430 26 0.46 0.414 40.00% -1.40%

74440 2.44 1.000 100.00% 0.00%

74440 TC 1.92 0.787 80.00% 1.30%

74440 26 0.52 0.213 20.00% -1.30%

74445 2.79 1.000 100.00% 0.00%

74445 TC 1.20 0.430 45.00% 2.00%

74445 26 1.59 0.570 55.00% -2.00%

74450 2.04 1.000 100.00% 0.00%

74450 TC 1.57 0.770 75.00% -2.00%

74450 26 0.47 0.230 25.00% 2.00%

74455 2.55 1.000 100.00% 0.00%

74455 TC 2.08 0.816 80.00% -1.60%

74455 26 0.47 0.184 20.00% 1.60%

74470 2.08 1.000 100.00% 0.00%

74470 TC 1.33 0.639 65.00% 1.10%

74470 26 0.75 0.361 35.00% -1.10%

74485 3.02 1.000 100.00% 0.00%

74485 TC 1.88 0.623 60.00% -2.30%

74485 26 1.14 0.377 40.00% 2.30%

74710 1.08 1.000 100.00% 0.00%

74710 TC 0.59 0.546 55.00% 0.40%

74710 26 0.49 0.454 45.00% -0.40%

74712 13.56 1.000 100.00% 0.00%


74712 TC 9.29 0.685 70.00% 1.50%

74712 26 4.27 0.315 30.00% -1.50%

74713 6.60 1.000 100.00% 0.00%

74713 TC 3.95 0.598 60.00% 0.20%

74713 26 2.65 0.402 40.00% -0.20%

74740 2.32 1.000 100.00% 0.00%

74740 TC 1.78 0.767 75.00% -1.70%

74740 26 0.54 0.233 25.00% 1.70%

74742 2.51 1.000 100.00% 0.00%

74742 TC 1.63 0.649 65.00% 0.10%

74742 26 0.88 0.351 35.00% -0.10%

74775 2.47 1.000 100.00% 0.00%

74775 TC 1.58 0.640 65.00% 1.00%

74775 26 0.89 0.360 35.00% -1.00%

75557 9.16 1.000 100.00% 0.00%

75557 TC 5.87 0.641 65.00% 0.90%

75557 26 3.29 0.359 35.00% -0.90%

75559 12.77 1.000 100.00% 0.00%

75559 TC 8.72 0.683 70.00% 1.70%

75559 26 4.05 0.317 30.00% -1.70%

75561 12.03 1.000 100.00% 0.00%

75561 TC 8.40 0.698 70.00% 0.20%

75561 26 3.63 0.302 30.00% -0.20%

75563 14.26 1.000 100.00% 0.00%

75563 TC 10.10 0.708 70.00% -0.80%

75563 26 4.16 0.292 30.00% 0.80%

75565 1.51 1.000 100.00% 0.00%

75565 TC 1.16 0.768 75.00% -1.80%

75565 26 0.35 0.232 25.00% 1.80%

75571 2.92 1.000 100.00% 0.00%

75571 TC 2.10 0.719 70.00% -1.90%

75571 26 0.82 0.281 30.00% 1.90%

75572 7.52 1.000 100.00% 0.00%

75572 TC 5.05 0.672 65.00% -2.20%

75572 26 2.47 0.328 35.00% 2.20%

75573 10.18 1.000 100.00% 0.00%

75573 TC 6.59 0.647 65.00% 0.30%

75573 26 3.59 0.353 35.00% -0.30%

75574 11.04 1.000 100.00% 0.00%

75574 TC 7.68 0.696 70.00% 0.40%

75574 26 3.36 0.304 30.00% -0.40%

75600 5.63 1.000 100.00% 0.00%

75600 TC 4.94 0.877 90.00% 2.30%

75600 26 0.69 0.123 10.00% -2.30%

75605 3.78 1.000 100.00% 0.00%

75605 TC 2.20 0.582 60.00% 1.80%


75605 26 1.58 0.418 40.00% -1.80%

75625 3.73 1.000 100.00% 0.00%

75625 TC 2.15 0.576 60.00% 2.40%

75625 26 1.58 0.424 40.00% -2.40%

75630 4.68 1.000 100.00% 0.00%

75630 TC 2.19 0.468 45.00% -1.80%

75630 26 2.49 0.532 55.00% 1.80%

75635 12.45 1.000 100.00% 0.00%

75635 TC 9.08 0.729 75.00% 2.10%

75635 26 3.37 0.271 25.00% -2.10%

75705 7.13 1.000 100.00% 0.00%

75705 TC 3.81 0.534 55.00% 1.60%

75705 26 3.32 0.466 45.00% -1.60%

75710 4.73 1.000 100.00% 0.00%

75710 TC 2.28 0.482 50.00% 1.80%

75710 26 2.45 0.518 50.00% -1.80%

75716 5.04 1.000 100.00% 0.00%

75716 TC 2.31 0.458 45.00% -0.80%

75716 26 2.73 0.542 55.00% 0.80%

75726 4.08 1.000 100.00% 0.00%

75726 TC 2.52 0.618 60.00% -1.80%

75726 26 1.56 0.382 40.00% 1.80%

75731 4.73 1.000 100.00% 0.00%

75731 TC 3.10 0.655 65.00% -0.50%

75731 26 1.63 0.345 35.00% 0.50%

75733 5.09 1.000 100.00% 0.00%

75733 TC 3.28 0.644 65.00% 0.60%

75733 26 1.81 0.356 35.00% -0.60%

75736 4.38 1.000 100.00% 0.00%

75736 TC 2.82 0.644 65.00% 0.60%

75736 26 1.56 0.356 35.00% -0.60%

75741 4.13 1.000 100.00% 0.00%

75741 TC 2.33 0.564 55.00% -1.40%

75741 26 1.80 0.436 45.00% 1.40%

75743 4.64 1.000 100.00% 0.00%

75743 TC 2.36 0.509 50.00% -0.90%

75743 26 2.28 0.491 50.00% 0.90%

75746 4.16 1.000 100.00% 0.00%

75746 TC 2.58 0.620 60.00% -2.00%

75746 26 1.58 0.380 40.00% 2.00%

75756 4.79 1.000 100.00% 0.00%

75756 TC 3.17 0.662 65.00% -1.20%

75756 26 1.62 0.338 35.00% 1.20%

75774 2.33 1.000 100.00% 0.00%

75774 TC 1.84 0.790 80.00% 1.00%

75774 26 0.49 0.210 20.00% -1.00%


75801 7.47 1.000 100.00% 0.00%

75801 TC 6.20 0.830 85.00% 2.00%

75801 26 1.27 0.170 15.00% -2.00%

75803 7.77 1.000 100.00% 0.00%

75803 TC 6.06 0.780 80.00% 2.00%

75803 26 1.71 0.220 20.00% -2.00%

75805 7.47 1.000 100.00% 0.00%

75805 TC 6.35 0.850 85.00% 0.00%

75805 26 1.12 0.150 15.00% 0.00%

75807 8.05 1.000 100.00% 0.00%

75807 TC 6.44 0.800 80.00% 0.00%

75807 26 1.61 0.200 20.00% 0.00%

75809 2.69 1.000 100.00% 0.00%

75809 TC 2.01 0.747 75.00% 0.30%

75809 26 0.68 0.253 25.00% -0.30%

75810 14.09 1.000 100.00% 0.00%

75810 TC 12.54 0.890 90.00% 1.00%

75810 26 1.55 0.110 10.00% -1.00%

75820 3.15 1.000 100.00% 0.00%

75820 TC 2.16 0.686 70.00% 1.40%

75820 26 0.99 0.314 30.00% -1.40%

75822 3.68 1.000 100.00% 0.00%

75822 TC 2.21 0.601 60.00% -0.10%

75822 26 1.47 0.399 40.00% 0.10%

75825 3.68 1.000 100.00% 0.00%

75825 TC 2.10 0.571 55.00% -2.10%

75825 26 1.58 0.429 45.00% 2.10%

75827 3.82 1.000 100.00% 0.00%

75827 TC 2.22 0.581 60.00% 1.90%

75827 26 1.60 0.419 40.00% -1.90%

75831 3.84 1.000 100.00% 0.00%

75831 TC 2.28 0.594 60.00% 0.60%

75831 26 1.56 0.406 40.00% -0.60%

75833 4.55 1.000 100.00% 0.00%

75833 TC 2.48 0.545 55.00% 0.50%

75833 26 2.07 0.455 45.00% -0.50%

75840 4.08 1.000 100.00% 0.00%

75840 TC 2.45 0.600 60.00% 0.00%

75840 26 1.63 0.400 40.00% 0.00%

75842 4.95 1.000 100.00% 0.00%

75842 TC 2.82 0.570 55.00% -2.00%

75842 26 2.13 0.430 45.00% 2.00%

75860 3.99 1.000 100.00% 0.00%

75860 TC 2.39 0.599 60.00% 0.10%

75860 26 1.60 0.401 40.00% -0.10%

75870 5.30 1.000 100.00% 0.00%


75870 TC 3.47 0.655 65.00% -0.50%

75870 26 1.83 0.345 35.00% 0.50%

75872 4.08 1.000 100.00% 0.00%

75872 TC 2.45 0.600 60.00% 0.00%

75872 26 1.63 0.400 40.00% 0.00%

75880 3.44 1.000 100.00% 0.00%

75880 TC 2.44 0.709 70.00% -0.90%

75880 26 1.00 0.291 30.00% 0.90%

75885 4.29 1.000 100.00% 0.00%

75885 TC 2.37 0.552 55.00% -0.20%

75885 26 1.92 0.448 45.00% 0.20%

75887 4.31 1.000 100.00% 0.00%

75887 TC 2.38 0.552 55.00% -0.20%

75887 26 1.93 0.448 45.00% 0.20%

75889 3.93 1.000 100.00% 0.00%

75889 TC 2.38 0.606 60.00% -0.60%

75889 26 1.55 0.394 40.00% 0.60%

75891 3.98 1.000 100.00% 0.00%

75891 TC 2.41 0.606 60.00% -0.60%

75891 26 1.57 0.394 40.00% 0.60%

75893 3.32 1.000 100.00% 0.00%

75893 TC 2.55 0.768 75.00% -1.80%

75893 26 0.77 0.232 25.00% 1.80%

75894 29.29 1.000 100.00% 0.00%

75894 TC 27.24 0.930 95.00% 2.00%

75894 26 2.05 0.070 5.00% -2.00%

75898 3.82 1.000 100.00% 0.00%

75898 TC 1.26 0.330 35.00% 2.00%

75898 26 2.56 0.670 65.00% -2.00%

75901 5.62 1.000 100.00% 0.00%

75901 TC 4.95 0.881 90.00% 1.90%

75901 26 0.67 0.119 10.00% -1.90%

75902 2.22 1.000 100.00% 0.00%

75902 TC 1.68 0.757 75.00% -0.70%

75902 26 0.54 0.243 25.00% 0.70%

75970 12.56 1.000 100.00% 0.00%

75970 TC 11.43 0.910 90.00% -1.00%

75970 26 1.13 0.090 10.00% 1.00%

75984 2.89 1.000 100.00% 0.00%

75984 TC 1.90 0.657 65.00% -0.70%

75984 26 0.99 0.343 35.00% 0.70%

75989 3.42 1.000 100.00% 0.00%

75989 TC 1.77 0.518 50.00% -1.80%

75989 26 1.65 0.482 50.00% 1.80%

76000 1.33 1.000 100.00% 0.00%

76000 TC 0.89 0.669 65.00% -1.90%


76000 26 0.44 0.331 35.00% 1.90%

76010 0.77 1.000 100.00% 0.00%

76010 TC 0.51 0.662 65.00% -1.20%

76010 26 0.26 0.338 35.00% 1.20%

76080 1.61 1.000 100.00% 0.00%

76080 TC 0.87 0.540 55.00% 1.00%

76080 26 0.74 0.460 45.00% -1.00%

76098 0.47 1.000 100.00% 0.00%

76098 TC 0.24 0.511 50.00% -1.10%

76098 26 0.23 0.489 50.00% 1.10%

76100 2.67 1.000 100.00% 0.00%

76100 TC 1.78 0.667 65.00% -1.70%

76100 26 0.89 0.333 35.00% 1.70%

76101 2.65 1.000 100.00% 0.00%

76101 TC 1.85 0.698 70.00% 0.20%

76101 26 0.80 0.302 30.00% -0.20%

76102 4.88 1.000 100.00% 0.00%

76102 TC 3.92 0.803 80.00% -0.30%

76102 26 0.96 0.197 20.00% 0.30%

76120 2.87 1.000 100.00% 0.00%

76120 TC 2.35 0.819 80.00% -1.90%

76120 26 0.52 0.181 20.00% 1.90%

76125 1.29 1.000 100.00% 0.00%

76125 TC 0.89 0.690 70.00% 1.00%

76125 26 0.40 0.310 30.00% -1.00%

76376 0.65 1.000 100.00% 0.00%

76376 TC 0.37 0.569 55.00% -1.90%

76376 26 0.28 0.431 45.00% 1.90%

76377 2.01 1.000 100.00% 0.00%

76377 TC 0.88 0.438 45.00% 1.20%

76377 26 1.13 0.562 55.00% -1.20%

76380 4.07 1.000 100.00% 0.00%

76380 TC 2.69 0.661 65.00% -1.10%

76380 26 1.38 0.339 35.00% 1.10%

76390 12.31 1.000 100.00% 0.00%

76390 TC 10.33 0.839 85.00% 1.10%

76390 26 1.98 0.161 15.00% -1.10%

76391 6.66 1.000 100.00% 0.00%

76391 TC 5.08 0.763 75.00% -1.30%

76391 26 1.58 0.237 25.00% 1.30%

76506 3.26 1.000 100.00% 0.00%

76506 TC 2.35 0.721 70.00% -2.10%

76506 26 0.91 0.279 30.00% 2.10%

76510 3.15 1.000 100.00% 0.00%

76510 TC 1.50 0.476 50.00% 2.40%

76510 26 1.65 0.524 50.00% -2.40%


76511 1.93 1.000 100.00% 0.00%

76511 TC 0.90 0.466 45.00% -1.60%

76511 26 1.03 0.534 55.00% 1.60%

76512 1.73 1.000 100.00% 0.00%

76512 TC 0.74 0.428 45.00% 2.20%

76512 26 0.99 0.572 55.00% -2.20%

76513 2.78 1.000 100.00% 0.00%

76513 TC 1.76 0.633 65.00% 1.70%

76513 26 1.02 0.367 35.00% -1.70%

76514 0.36 1.000 100.00% 0.00%

76514 TC 0.13 0.361 35.00% -1.10%

76514 26 0.23 0.639 65.00% 1.10%

76516 1.53 1.000 100.00% 0.00%

76516 TC 0.88 0.575 60.00% 2.50%

76516 26 0.65 0.425 40.00% -2.50%

76519 1.87 1.000 100.00% 0.00%

76519 TC 0.98 0.524 50.00% -2.40%

76519 26 0.89 0.476 50.00% 2.40%

76529 2.33 1.000 100.00% 0.00%

76529 TC 1.39 0.597 60.00% 0.30%

76529 26 0.94 0.403 40.00% -0.30%

76536 3.25 1.000 100.00% 0.00%

76536 TC 2.45 0.754 75.00% -0.40%

76536 26 0.80 0.246 25.00% 0.40%

76604 2.51 1.000 100.00% 0.00%

76604 TC 1.74 0.693 70.00% 0.70%

76604 26 0.77 0.307 30.00% -0.70%

76641 3.02 1.000 100.00% 0.00%

76641 TC 1.98 0.656 65.00% -0.60%

76641 26 1.04 0.344 35.00% 0.60%

76642 2.47 1.000 100.00% 0.00%

76642 TC 1.50 0.607 60.00% -0.70%

76642 26 0.97 0.393 40.00% 0.70%

76700 3.43 1.000 100.00% 0.00%

76700 TC 2.28 0.665 65.00% -1.50%

76700 26 1.15 0.335 35.00% 1.50%

76705 2.56 1.000 100.00% 0.00%

76705 TC 1.73 0.676 70.00% 2.40%

76705 26 0.83 0.324 30.00% -2.40%

76706 3.20 1.000 100.00% 0.00%

76706 TC 2.42 0.756 75.00% -0.60%

76706 26 0.78 0.244 25.00% 0.60%

76770 3.18 1.000 100.00% 0.00%

76770 TC 2.13 0.670 65.00% -2.00%

76770 26 1.05 0.330 35.00% 2.00%

76775 1.65 1.000 100.00% 0.00%


76775 TC 0.83 0.503 50.00% -0.30%

76775 26 0.82 0.497 50.00% 0.30%

76776 4.38 1.000 100.00% 0.00%

76776 TC 3.30 0.753 75.00% -0.30%

76776 26 1.08 0.247 25.00% 0.30%

76800 4.04 1.000 100.00% 0.00%

76800 TC 2.36 0.584 60.00% 1.60%

76800 26 1.68 0.416 40.00% -1.60

Documents

Professional/Technical Component Policy, Professional for ...€¦ · This policy describes the reimbursement methodology for Current Procedural Terminology (CPT®) and Healthcare