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U.S. DEPARTMENT OF LABOR, OFFICE OF WORKERS' COMPENSATION PROGRAMSOWCP MEDICAL FEE SCHEDULE -- FECA Program February 27, 2006
000 = endoscopic or minor procedure w/ related preoperative & postoperative relative values on the day of the procedure onlyincluded in the fee schedule payment amount; E&M services on the day of the procedure generally not payable.
010 = minor procedure w/ preoperative relative values on the day of the procedure and postoperative relative values duringa 10-day postoperative period included in the fee schedule amount; E&M services on the day of the procedure andduring the 10-day postoperative period generally not payable.
090 = major surgery w/ a 1-day preoperative period and 90-day postoperative period included in the fee schedule amount.MMM = maternity codes; usual global period does not apply.XXX = the global concept does not apply to the code.YYY = CMS carrier pricing; OWCP treats these as XXXZZZ =
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)00100 C 0.00 0.00 0.00 0.00 XXX 0.0000102 C 0.00 0.00 0.00 0.00 XXX 0.0000103 C 0.00 0.00 0.00 0.00 XXX 0.0000104 C 0.00 0.00 0.00 0.00 XXX 0.0000120 C 0.00 0.00 0.00 0.00 XXX 0.0000124 C 0.00 0.00 0.00 0.00 XXX 0.0000126 C 0.00 0.00 0.00 0.00 XXX 0.0000140 C 0.00 0.00 0.00 0.00 XXX 0.0000142 C 0.00 0.00 0.00 0.00 XXX 0.0000144 C 0.00 0.00 0.00 0.00 XXX 0.0000145 C 0.00 0.00 0.00 0.00 XXX 0.0000147 C 0.00 0.00 0.00 0.00 XXX 0.0000148 C 0.00 0.00 0.00 0.00 XXX 0.0000160 C 0.00 0.00 0.00 0.00 XXX 0.0000162 C 0.00 0.00 0.00 0.00 XXX 0.0000164 C 0.00 0.00 0.00 0.00 XXX 0.0000170 C 0.00 0.00 0.00 0.00 XXX 0.0000172 C 0.00 0.00 0.00 0.00 XXX 0.0000174 C 0.00 0.00 0.00 0.00 XXX 0.0000176 C 0.00 0.00 0.00 0.00 XXX 0.0000190 C 0.00 0.00 0.00 0.00 XXX 0.0000192 C 0.00 0.00 0.00 0.00 XXX 0.0000210 C 0.00 0.00 0.00 0.00 XXX 0.0000212 C 0.00 0.00 0.00 0.00 XXX 0.0000214 C 0.00 0.00 0.00 0.00 XXX 0.0000215 C 0.00 0.00 0.00 0.00 XXX 0.0000216 C 0.00 0.00 0.00 0.00 XXX 0.0000218 C 0.00 0.00 0.00 0.00 XXX 0.0000220 C 0.00 0.00 0.00 0.00 XXX 0.0000222 C 0.00 0.00 0.00 0.00 XXX 0.0000300 C 0.00 0.00 0.00 0.00 XXX 0.0000320 C 0.00 0.00 0.00 0.00 XXX 0.0000322 C 0.00 0.00 0.00 0.00 XXX 0.0000326 D 0.00 0.00 0.00 0.00 XXX 0.0000350 C 0.00 0.00 0.00 0.00 XXX 0.0000352 C 0.00 0.00 0.00 0.00 XXX 0.00
1CPT codes only are copyright 2005 American Medical Association. All rights reserved.2ADA codes and descriptions only are copyright 2005 American Dental Association. All rights reserved.3Pay Status Codes: C = Covered; D = non-covered service; S = Suspend for review4Global Period Codes:
The code is related to another service and is always included in the global period of the other service.
CPT1
ADA2
STATUS3 PERIOD4
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
00400 C 0.00 0.00 0.00 0.00 XXX 0.0000402 C 0.00 0.00 0.00 0.00 XXX 0.0000404 C 0.00 0.00 0.00 0.00 XXX 0.0000406 C 0.00 0.00 0.00 0.00 XXX 0.0000410 C 0.00 0.00 0.00 0.00 XXX 0.0000450 C 0.00 0.00 0.00 0.00 XXX 0.0000452 C 0.00 0.00 0.00 0.00 XXX 0.0000454 C 0.00 0.00 0.00 0.00 XXX 0.0000470 C 0.00 0.00 0.00 0.00 XXX 0.0000472 C 0.00 0.00 0.00 0.00 XXX 0.0000474 C 0.00 0.00 0.00 0.00 XXX 0.0000500 C 0.00 0.00 0.00 0.00 XXX 0.0000520 C 0.00 0.00 0.00 0.00 XXX 0.0000522 C 0.00 0.00 0.00 0.00 XXX 0.0000524 C 0.00 0.00 0.00 0.00 XXX 0.0000528 C 0.00 0.00 0.00 0.00 XXX 0.0000529 C 0.00 0.00 0.00 0.00 XXX 0.0000530 C 0.00 0.00 0.00 0.00 XXX 0.0000532 C 0.00 0.00 0.00 0.00 XXX 0.0000534 C 0.00 0.00 0.00 0.00 XXX 0.0000537 C 0.00 0.00 0.00 0.00 XXX 0.0000539 C 0.00 0.00 0.00 0.00 XXX 0.0000540 C 0.00 0.00 0.00 0.00 XXX 0.0000541 C 0.00 0.00 0.00 0.00 XXX 0.0000542 C 0.00 0.00 0.00 0.00 XXX 0.0000546 C 0.00 0.00 0.00 0.00 XXX 0.0000548 C 0.00 0.00 0.00 0.00 XXX 0.0000550 C 0.00 0.00 0.00 0.00 XXX 0.0000560 D 0.00 0.00 0.00 0.00 XXX 0.0000561 C 0.00 0.00 0.00 0.00 XXX 0.0000562 C 0.00 0.00 0.00 0.00 XXX 0.0000563 C 0.00 0.00 0.00 0.00 XXX 0.0000566 C 0.00 0.00 0.00 0.00 XXX 0.0000580 C 0.00 0.00 0.00 0.00 XXX 0.0000600 C 0.00 0.00 0.00 0.00 XXX 0.0000604 C 0.00 0.00 0.00 0.00 XXX 0.0000620 C 0.00 0.00 0.00 0.00 XXX 0.0000622 C 0.00 0.00 0.00 0.00 XXX 0.0000630 C 0.00 0.00 0.00 0.00 XXX 0.0000632 C 0.00 0.00 0.00 0.00 XXX 0.0000634 C 0.00 0.00 0.00 0.00 XXX 0.0000635 C 0.00 0.00 0.00 0.00 XXX 0.0000640 C 0.00 0.00 0.00 0.00 XXX 0.0000670 C 0.00 0.00 0.00 0.00 XXX 0.0000700 C 0.00 0.00 0.00 0.00 XXX 0.0000702 C 0.00 0.00 0.00 0.00 XXX 0.0000730 C 0.00 0.00 0.00 0.00 XXX 0.0000740 C 0.00 0.00 0.00 0.00 XXX 0.0000750 C 0.00 0.00 0.00 0.00 XXX 0.0000752 C 0.00 0.00 0.00 0.00 XXX 0.0000754 C 0.00 0.00 0.00 0.00 XXX 0.0000756 C 0.00 0.00 0.00 0.00 XXX 0.0000770 C 0.00 0.00 0.00 0.00 XXX 0.0000790 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
00792 C 0.00 0.00 0.00 0.00 XXX 0.0000794 C 0.00 0.00 0.00 0.00 XXX 0.0000796 C 0.00 0.00 0.00 0.00 XXX 0.0000797 C 0.00 0.00 0.00 0.00 XXX 0.0000800 C 0.00 0.00 0.00 0.00 XXX 0.0000802 C 0.00 0.00 0.00 0.00 XXX 0.0000810 C 0.00 0.00 0.00 0.00 XXX 0.0000820 C 0.00 0.00 0.00 0.00 XXX 0.0000830 C 0.00 0.00 0.00 0.00 XXX 0.0000832 C 0.00 0.00 0.00 0.00 XXX 0.0000834 D 0.00 0.00 0.00 0.00 XXX 0.0000836 D 0.00 0.00 0.00 0.00 XXX 0.0000840 C 0.00 0.00 0.00 0.00 XXX 0.0000842 C 0.00 0.00 0.00 0.00 XXX 0.0000844 C 0.00 0.00 0.00 0.00 XXX 0.0000846 C 0.00 0.00 0.00 0.00 XXX 0.0000848 C 0.00 0.00 0.00 0.00 XXX 0.0000851 C 0.00 0.00 0.00 0.00 XXX 0.0000860 C 0.00 0.00 0.00 0.00 XXX 0.0000862 C 0.00 0.00 0.00 0.00 XXX 0.0000864 C 0.00 0.00 0.00 0.00 XXX 0.0000865 C 0.00 0.00 0.00 0.00 XXX 0.0000866 C 0.00 0.00 0.00 0.00 XXX 0.0000868 C 0.00 0.00 0.00 0.00 XXX 0.0000870 C 0.00 0.00 0.00 0.00 XXX 0.0000872 C 0.00 0.00 0.00 0.00 XXX 0.0000873 C 0.00 0.00 0.00 0.00 XXX 0.0000880 C 0.00 0.00 0.00 0.00 XXX 0.0000882 C 0.00 0.00 0.00 0.00 XXX 0.0000902 C 0.00 0.00 0.00 0.00 XXX 0.0000904 C 0.00 0.00 0.00 0.00 XXX 0.0000906 C 0.00 0.00 0.00 0.00 XXX 0.0000908 C 0.00 0.00 0.00 0.00 XXX 0.0000910 C 0.00 0.00 0.00 0.00 XXX 0.0000912 C 0.00 0.00 0.00 0.00 XXX 0.0000914 C 0.00 0.00 0.00 0.00 XXX 0.0000916 C 0.00 0.00 0.00 0.00 XXX 0.0000918 C 0.00 0.00 0.00 0.00 XXX 0.0000920 C 0.00 0.00 0.00 0.00 XXX 0.0000921 C 0.00 0.00 0.00 0.00 XXX 0.0000922 C 0.00 0.00 0.00 0.00 XXX 0.0000924 C 0.00 0.00 0.00 0.00 XXX 0.0000926 C 0.00 0.00 0.00 0.00 XXX 0.0000928 C 0.00 0.00 0.00 0.00 XXX 0.0000930 C 0.00 0.00 0.00 0.00 XXX 0.0000932 C 0.00 0.00 0.00 0.00 XXX 0.0000934 C 0.00 0.00 0.00 0.00 XXX 0.0000936 C 0.00 0.00 0.00 0.00 XXX 0.0000938 C 0.00 0.00 0.00 0.00 XXX 0.0000940 C 0.00 0.00 0.00 0.00 XXX 0.0000942 C 0.00 0.00 0.00 0.00 XXX 0.0000944 C 0.00 0.00 0.00 0.00 XXX 0.0000948 C 0.00 0.00 0.00 0.00 XXX 0.0000950 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
00952 C 0.00 0.00 0.00 0.00 XXX 0.0001112 C 0.00 0.00 0.00 0.00 XXX 0.0001120 C 0.00 0.00 0.00 0.00 XXX 0.0001130 C 0.00 0.00 0.00 0.00 XXX 0.0001140 C 0.00 0.00 0.00 0.00 XXX 0.0001150 C 0.00 0.00 0.00 0.00 XXX 0.0001160 C 0.00 0.00 0.00 0.00 XXX 0.0001170 C 0.00 0.00 0.00 0.00 XXX 0.0001173 C 0.00 0.00 0.00 0.00 XXX 0.0001180 C 0.00 0.00 0.00 0.00 XXX 0.0001190 C 0.00 0.00 0.00 0.00 XXX 0.0001200 C 0.00 0.00 0.00 0.00 XXX 0.0001202 C 0.00 0.00 0.00 0.00 XXX 0.0001210 C 0.00 0.00 0.00 0.00 XXX 0.0001212 C 0.00 0.00 0.00 0.00 XXX 0.0001214 C 0.00 0.00 0.00 0.00 XXX 0.0001215 C 0.00 0.00 0.00 0.00 XXX 0.0001220 C 0.00 0.00 0.00 0.00 XXX 0.0001230 C 0.00 0.00 0.00 0.00 XXX 0.0001232 C 0.00 0.00 0.00 0.00 XXX 0.0001234 C 0.00 0.00 0.00 0.00 XXX 0.0001250 C 0.00 0.00 0.00 0.00 XXX 0.0001260 C 0.00 0.00 0.00 0.00 XXX 0.0001270 C 0.00 0.00 0.00 0.00 XXX 0.0001272 C 0.00 0.00 0.00 0.00 XXX 0.0001274 C 0.00 0.00 0.00 0.00 XXX 0.0001320 C 0.00 0.00 0.00 0.00 XXX 0.0001340 C 0.00 0.00 0.00 0.00 XXX 0.0001360 C 0.00 0.00 0.00 0.00 XXX 0.0001380 C 0.00 0.00 0.00 0.00 XXX 0.0001382 C 0.00 0.00 0.00 0.00 XXX 0.0001390 C 0.00 0.00 0.00 0.00 XXX 0.0001392 C 0.00 0.00 0.00 0.00 XXX 0.0001400 C 0.00 0.00 0.00 0.00 XXX 0.0001402 C 0.00 0.00 0.00 0.00 XXX 0.0001404 C 0.00 0.00 0.00 0.00 XXX 0.0001420 C 0.00 0.00 0.00 0.00 XXX 0.0001430 C 0.00 0.00 0.00 0.00 XXX 0.0001432 C 0.00 0.00 0.00 0.00 XXX 0.0001440 C 0.00 0.00 0.00 0.00 XXX 0.0001442 C 0.00 0.00 0.00 0.00 XXX 0.0001444 C 0.00 0.00 0.00 0.00 XXX 0.0001462 C 0.00 0.00 0.00 0.00 XXX 0.0001464 C 0.00 0.00 0.00 0.00 XXX 0.0001470 C 0.00 0.00 0.00 0.00 XXX 0.0001472 C 0.00 0.00 0.00 0.00 XXX 0.0001474 C 0.00 0.00 0.00 0.00 XXX 0.0001480 C 0.00 0.00 0.00 0.00 XXX 0.0001482 C 0.00 0.00 0.00 0.00 XXX 0.0001484 C 0.00 0.00 0.00 0.00 XXX 0.0001486 C 0.00 0.00 0.00 0.00 XXX 0.0001490 C 0.00 0.00 0.00 0.00 XXX 0.0001500 C 0.00 0.00 0.00 0.00 XXX 0.0001502 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
01520 C 0.00 0.00 0.00 0.00 XXX 0.0001522 C 0.00 0.00 0.00 0.00 XXX 0.0001610 C 0.00 0.00 0.00 0.00 XXX 0.0001620 C 0.00 0.00 0.00 0.00 XXX 0.0001622 C 0.00 0.00 0.00 0.00 XXX 0.0001630 C 0.00 0.00 0.00 0.00 XXX 0.0001632 C 0.00 0.00 0.00 0.00 XXX 0.0001634 C 0.00 0.00 0.00 0.00 XXX 0.0001636 C 0.00 0.00 0.00 0.00 XXX 0.0001638 C 0.00 0.00 0.00 0.00 XXX 0.0001650 C 0.00 0.00 0.00 0.00 XXX 0.0001652 C 0.00 0.00 0.00 0.00 XXX 0.0001654 C 0.00 0.00 0.00 0.00 XXX 0.0001656 C 0.00 0.00 0.00 0.00 XXX 0.0001670 C 0.00 0.00 0.00 0.00 XXX 0.0001680 C 0.00 0.00 0.00 0.00 XXX 0.0001682 C 0.00 0.00 0.00 0.00 XXX 0.0001710 C 0.00 0.00 0.00 0.00 XXX 0.0001712 C 0.00 0.00 0.00 0.00 XXX 0.0001714 C 0.00 0.00 0.00 0.00 XXX 0.0001716 C 0.00 0.00 0.00 0.00 XXX 0.0001730 C 0.00 0.00 0.00 0.00 XXX 0.0001732 C 0.00 0.00 0.00 0.00 XXX 0.0001740 C 0.00 0.00 0.00 0.00 XXX 0.0001742 C 0.00 0.00 0.00 0.00 XXX 0.0001744 C 0.00 0.00 0.00 0.00 XXX 0.0001756 C 0.00 0.00 0.00 0.00 XXX 0.0001758 C 0.00 0.00 0.00 0.00 XXX 0.0001760 C 0.00 0.00 0.00 0.00 XXX 0.0001770 C 0.00 0.00 0.00 0.00 XXX 0.0001772 C 0.00 0.00 0.00 0.00 XXX 0.0001780 C 0.00 0.00 0.00 0.00 XXX 0.0001782 C 0.00 0.00 0.00 0.00 XXX 0.0001810 C 0.00 0.00 0.00 0.00 XXX 0.0001820 C 0.00 0.00 0.00 0.00 XXX 0.0001829 C 0.00 0.00 0.00 0.00 XXX 0.0001830 C 0.00 0.00 0.00 0.00 XXX 0.0001832 C 0.00 0.00 0.00 0.00 XXX 0.0001840 C 0.00 0.00 0.00 0.00 XXX 0.0001842 C 0.00 0.00 0.00 0.00 XXX 0.0001844 C 0.00 0.00 0.00 0.00 XXX 0.0001850 C 0.00 0.00 0.00 0.00 XXX 0.0001852 C 0.00 0.00 0.00 0.00 XXX 0.0001860 C 0.00 0.00 0.00 0.00 XXX 0.0001905 C 0.00 0.00 0.00 0.00 XXX 0.0001916 C 0.00 0.00 0.00 0.00 XXX 0.0001920 C 0.00 0.00 0.00 0.00 XXX 0.0001922 C 0.00 0.00 0.00 0.00 XXX 0.0001924 C 0.00 0.00 0.00 0.00 XXX 0.0001925 C 0.00 0.00 0.00 0.00 XXX 0.0001926 C 0.00 0.00 0.00 0.00 XXX 0.0001930 C 0.00 0.00 0.00 0.00 XXX 0.0001931 C 0.00 0.00 0.00 0.00 XXX 0.0001932 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
01933 C 0.00 0.00 0.00 0.00 XXX 0.0001951 C 0.00 0.00 0.00 0.00 XXX 0.0001952 C 0.00 0.00 0.00 0.00 XXX 0.0001953 C 0.00 0.00 0.00 0.00 XXX 0.0001958 C 0.00 0.00 0.00 0.00 XXX 0.0001960 C 0.00 0.00 0.00 0.00 XXX 0.0001961 C 0.00 0.00 0.00 0.00 XXX 0.0001962 C 0.00 0.00 0.00 0.00 XXX 0.0001963 C 0.00 0.00 0.00 0.00 XXX 0.0001964 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200501965 C 0.00 0.00 0.00 0.00 XXX 0.0001966 D 0.00 0.00 0.00 0.00 XXX 0.0001967 C 0.00 0.00 0.00 0.00 XXX 0.0001968 C 0.00 0.00 0.00 0.00 XXX 0.0001969 C 0.00 0.00 0.00 0.00 XXX 0.0001990 C 0.00 0.00 0.00 0.00 XXX 0.0001991 C 0.00 0.00 0.00 0.00 XXX 0.0001992 C 0.00 0.00 0.00 0.00 XXX 0.0001995 C 0.00 0.00 0.00 0.00 XXX 0.0001996 C 0.00 0.00 0.00 0.00 XXX 0.0001999 C 0.00 0.00 0.00 0.00 XXX 0.0010021 C 1.27 2.16 0.54 0.10 XXX 50.5810021 C TC 0.00 0.47 0.47 0.03 XXX 50.5810021 C 26 1.27 0.55 0.55 0.07 XXX 50.5810022 C 1.27 2.55 0.42 0.08 XXX 50.5810022 C TC 0.00 0.63 0.63 0.03 XXX 50.5810022 C 26 1.27 0.48 0.48 0.05 XXX 50.5810040 C 1.18 1.01 0.79 0.05 010 50.5810060 C 1.17 1.21 0.93 0.12 010 50.5810061 C 2.40 1.83 1.50 0.26 010 50.5810080 C 1.17 3.11 1.11 0.11 010 50.5810081 C 2.45 4.08 1.50 0.24 010 50.5810120 C 1.22 2.18 0.97 0.12 010 50.5810121 C 2.69 3.52 1.79 0.33 010 50.5810140 C 1.53 1.78 1.29 0.19 010 50.5810160 C 1.20 1.60 1.08 0.14 010 50.5810180 C 2.25 2.99 1.99 0.35 010 50.5811000 C 0.60 0.58 0.22 0.07 000 50.5811001 C 0.30 0.23 0.11 0.04 ZZZ 50.5811004 C 10.31 3.91 3.91 0.67 000 50.5811005 C 13.75 5.58 5.58 0.96 000 50.5811006 C 12.61 4.86 4.86 1.28 000 50.5811008 C 5.00 2.03 2.03 0.61 ZZZ 50.5811010 C 4.19 6.89 2.63 0.66 010 50.5811011 C 4.94 8.18 2.35 0.74 000 50.5811012 C 6.87 12.14 3.85 1.16 000 50.5811040 C 0.50 0.52 0.21 0.06 000 50.5811041 C 0.82 0.66 0.33 0.10 000 50.5811042 C 1.12 0.97 0.44 0.13 000 50.5811043 C 2.38 3.39 2.60 0.32 010 50.5811044 C 3.06 4.46 3.76 0.43 010 50.5811055 C 0.43 0.56 0.17 0.05 000 50.5811056 C 0.61 0.64 0.23 0.07 000 50.5811057 C 0.79 0.74 0.30 0.10 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
11100 C 0.81 1.25 0.37 0.03 000 50.5811101 C 0.41 0.33 0.19 0.02 ZZZ 50.5811200 C 0.77 1.04 0.76 0.04 010 50.5811201 C 0.29 0.16 0.12 0.02 ZZZ 50.5811300 C 0.51 0.99 0.21 0.03 000 50.5811301 C 0.85 1.11 0.38 0.04 000 50.5811302 C 1.05 1.30 0.46 0.05 000 50.5811303 C 1.24 1.58 0.52 0.07 000 50.5811305 C 0.67 0.85 0.27 0.07 000 50.5811306 C 0.99 1.10 0.42 0.07 000 50.5811307 C 1.14 1.29 0.49 0.07 000 50.5811308 C 1.41 1.45 0.59 0.13 000 50.5811310 C 0.73 1.11 0.32 0.04 000 50.5811311 C 1.05 1.23 0.49 0.05 000 50.5811312 C 1.20 1.42 0.55 0.06 000 50.5811313 C 1.62 1.81 0.72 0.10 000 50.5811400 C 0.85 2.00 0.88 0.06 010 50.5811401 C 1.23 2.06 1.02 0.10 010 50.5811402 C 1.51 2.23 1.08 0.13 010 50.5811403 C 1.79 2.40 1.32 0.17 010 50.5811404 C 2.06 2.71 1.40 0.21 010 50.5811406 C 2.76 3.07 1.65 0.32 010 50.5811420 C 0.98 1.77 0.93 0.09 010 50.5811421 C 1.42 2.07 1.11 0.13 010 50.5811422 C 1.63 2.26 1.33 0.16 010 50.5811423 C 2.01 2.59 1.45 0.20 010 50.5811424 C 2.43 2.81 1.60 0.25 010 50.5811426 C 3.77 3.49 2.11 0.44 010 50.5811440 C 1.06 2.21 1.31 0.08 010 50.5811441 C 1.48 2.34 1.49 0.13 010 50.5811442 C 1.72 2.55 1.57 0.16 010 50.5811443 C 2.29 2.92 1.82 0.22 010 50.5811444 C 3.14 3.48 2.19 0.30 010 50.5811446 C 4.48 4.05 2.78 0.43 010 50.5811450 C 2.73 5.04 2.03 0.34 090 50.5811451 C 3.94 6.62 2.55 0.53 090 50.5811462 C 2.51 5.12 2.02 0.32 090 50.5811463 C 3.94 6.84 2.69 0.54 090 50.5811470 C 3.25 5.07 2.27 0.40 090 50.5811471 C 4.40 6.72 2.77 0.58 090 50.5811600 C 1.31 2.64 0.97 0.10 010 50.5811601 C 1.80 2.71 1.22 0.12 010 50.5811602 C 1.95 2.83 1.26 0.12 010 50.5811603 C 2.19 3.08 1.33 0.16 010 50.5811604 C 2.40 3.38 1.39 0.20 010 50.5811606 C 3.42 4.07 1.74 0.36 010 50.5811620 C 1.19 2.60 0.95 0.09 010 50.5811621 C 1.76 2.71 1.24 0.12 010 50.5811622 C 2.09 2.97 1.39 0.14 010 50.5811623 C 2.61 3.34 1.58 0.20 010 50.5811624 C 3.06 3.75 1.78 0.27 010 50.5811626 C 4.29 4.64 2.40 0.45 010 50.5811640 C 1.35 2.66 1.11 0.11 010 50.5811641 C 2.16 3.03 1.53 0.16 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
11642 C 2.59 3.41 1.71 0.19 010 50.5811643 C 3.10 3.81 1.97 0.26 010 50.5811644 C 4.02 4.69 2.46 0.37 010 50.5811646 C 5.94 5.77 3.48 0.61 010 50.5811719 C 0.17 0.25 0.07 0.02 000 50.5811720 C 0.32 0.34 0.12 0.04 000 50.5811721 C 0.54 0.44 0.21 0.07 000 50.5811730 C 1.13 1.03 0.43 0.14 000 50.5811732 C 0.57 0.44 0.22 0.07 ZZZ 50.5811740 C 0.37 0.55 0.35 0.04 000 50.5811750 C 1.86 2.17 1.76 0.22 010 50.5811752 C 2.67 3.00 3.00 0.35 010 50.5811755 C 1.31 1.57 0.77 0.14 000 50.5811760 C 1.58 2.63 1.79 0.21 010 50.5811762 C 2.89 2.89 2.35 0.36 010 50.5811765 C 0.69 1.79 0.76 0.08 010 50.5811770 C 2.61 3.49 1.50 0.33 010 50.5811771 C 5.73 5.66 3.32 0.74 090 50.5811772 C 6.97 7.52 5.08 0.89 090 50.5811900 C 0.52 0.65 0.21 0.02 000 50.5811901 C 0.80 0.66 0.35 0.03 000 50.5811920 C 1.61 3.71 1.09 0.24 000 50.5811921 C 1.93 3.97 1.27 0.29 000 50.5811922 C 0.49 1.14 0.25 0.07 ZZZ 50.5811950 C 0.84 1.14 0.39 0.06 000 50.5811951 C 1.19 1.49 0.51 0.11 000 50.5811952 C 1.69 1.86 0.68 0.16 000 50.5811954 C 1.85 2.45 0.90 0.25 000 50.5811960 C 9.07 10.42 10.42 1.31 090 50.5811970 C 7.05 6.15 6.15 1.05 090 50.5811971 C 2.13 9.14 3.80 0.32 090 50.5811975 D 1.48 1.42 0.57 0.17 XXX 50.5811976 D 1.78 1.72 0.68 0.21 000 50.5811977 D 3.30 2.28 1.26 0.37 XXX 50.5811980 D 1.48 1.08 0.54 0.13 000 50.5811981 C 1.48 1.70 0.68 0.12 XXX 50.5811982 C 1.78 1.95 0.83 0.17 XXX 50.5811983 C 3.30 2.29 1.47 0.23 XXX 50.5812001 C 1.70 1.99 0.77 0.15 010 50.5812002 C 1.86 2.05 0.90 0.17 010 50.5812004 C 2.24 2.33 1.01 0.21 010 50.5812005 C 2.86 2.83 1.20 0.27 010 50.5812006 C 3.66 3.40 1.51 0.35 010 50.5812007 C 4.11 3.83 1.82 0.45 010 50.5812011 C 1.76 2.14 0.78 0.16 010 50.5812013 C 1.99 2.28 0.93 0.18 010 50.5812014 C 2.46 2.58 1.06 0.23 010 50.5812015 C 3.19 3.14 1.25 0.29 010 50.5812016 C 3.92 3.56 1.52 0.37 010 50.5812017 C 4.70 1.90 1.90 0.47 010 50.5812018 C 5.52 2.26 2.26 0.64 010 50.5812020 C 2.62 3.83 1.93 0.30 010 50.5812021 C 1.84 1.83 1.41 0.24 010 50.5812031 C 2.15 2.29 0.96 0.17 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
12032 C 2.47 3.85 1.80 0.16 010 50.5812034 C 2.92 3.20 1.45 0.25 010 50.5812035 C 3.42 5.21 2.16 0.39 010 50.5812036 C 4.04 5.57 2.55 0.55 010 50.5812037 C 4.66 6.11 2.97 0.66 010 50.5812041 C 2.37 2.55 1.13 0.19 010 50.5812042 C 2.74 3.27 1.46 0.17 010 50.5812044 C 3.14 3.22 1.60 0.27 010 50.5812045 C 3.63 5.28 2.29 0.41 010 50.5812046 C 4.24 6.52 2.76 0.54 010 50.5812047 C 4.64 6.36 3.09 0.58 010 50.5812051 C 2.47 3.28 1.45 0.20 010 50.5812052 C 2.77 3.23 1.43 0.17 010 50.5812053 C 3.12 3.25 1.53 0.23 010 50.5812054 C 3.45 3.57 1.63 0.30 010 50.5812055 C 4.42 4.49 2.13 0.45 010 50.5812056 C 5.23 6.77 3.06 0.59 010 50.5812057 C 5.95 6.15 3.76 0.56 010 50.5813100 C 3.12 4.06 2.31 0.26 010 50.5813101 C 3.91 4.67 2.69 0.26 010 50.5813102 C 1.24 1.17 0.57 0.13 ZZZ 50.5813120 C 3.30 4.15 2.35 0.26 010 50.5813121 C 4.32 4.86 2.80 0.25 010 50.5813122 C 1.44 1.51 0.63 0.15 ZZZ 50.5813131 C 3.78 4.37 2.69 0.26 010 50.5813132 C 5.94 5.92 4.17 0.32 010 50.5813133 C 2.19 1.66 1.03 0.18 ZZZ 50.5813150 C 3.80 4.88 2.77 0.34 010 50.5813151 C 4.44 4.81 3.15 0.31 010 50.5813152 C 6.32 6.05 4.05 0.40 010 50.5813153 C 2.38 1.94 1.14 0.24 ZZZ 50.5813160 C 10.46 7.18 7.18 1.54 090 50.5814000 C 5.88 7.87 5.48 0.59 090 50.5814001 C 8.46 9.44 7.09 0.82 090 50.5814020 C 6.58 8.63 6.55 0.64 090 50.5814021 C 10.04 10.01 8.30 0.81 090 50.5814040 C 7.86 8.83 7.22 0.62 090 50.5814041 C 11.47 10.62 8.70 0.73 090 50.5814060 C 8.49 8.81 7.45 0.68 090 50.5814061 C 12.27 11.63 9.53 0.76 090 50.5814300 C 11.74 11.16 9.20 1.16 090 50.5814350 C 9.60 7.16 7.16 1.34 090 50.5815000 C 3.99 3.80 2.19 0.54 000 50.5815001 C 1.00 1.35 0.41 0.14 ZZZ 50.5815040 C 2.00 4.57 1.13 0.24 000 50.5815050 C 4.29 6.93 5.12 0.57 090 50.5815100 C 9.04 12.62 7.84 1.28 090 50.5815101 C 1.72 3.74 1.17 0.24 ZZZ 50.5815110 C 9.50 10.70 7.02 1.31 090 50.5815111 C 1.85 1.29 0.79 0.26 ZZZ 50.5815115 C 9.81 9.25 7.37 1.15 090 50.5815116 C 2.50 1.58 1.12 0.33 ZZZ 50.5815120 C 9.82 10.75 7.80 1.16 090 50.5815121 C 2.67 4.51 1.85 0.36 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
15130 C 7.00 9.89 6.36 0.97 090 50.5815131 C 1.50 1.07 0.64 0.21 ZZZ 50.5815135 C 10.50 9.90 8.15 1.23 090 50.5815136 C 1.50 0.89 0.67 0.20 ZZZ 50.5815150 C 8.25 8.48 6.46 1.14 090 50.5815151 C 2.00 1.31 0.85 0.28 ZZZ 50.5815152 C 2.50 1.56 1.06 0.35 ZZZ 50.5815155 C 9.00 7.84 6.98 1.05 090 50.5815156 C 2.75 1.56 1.24 0.36 ZZZ 50.5815157 C 3.00 1.78 1.35 0.39 ZZZ 50.5815170 C 5.00 3.84 2.37 0.55 090 50.5815171 C 1.55 0.68 0.62 0.19 ZZZ 50.5815175 C 7.00 5.44 4.01 0.82 090 50.5815176 C 2.45 1.11 0.99 0.29 ZZZ 50.5815200 C 8.02 9.43 6.22 0.98 090 50.5815201 C 1.32 2.57 0.62 0.19 ZZZ 50.5815220 C 7.86 9.21 6.70 0.84 090 50.5815221 C 1.19 2.33 0.56 0.16 ZZZ 50.5815240 C 9.03 10.23 7.97 0.92 090 50.5815241 C 1.86 2.45 0.91 0.23 ZZZ 50.5815260 C 10.04 10.24 8.60 0.69 090 50.5815261 C 2.23 2.70 1.40 0.21 ZZZ 50.5815300 C 3.99 3.21 2.24 0.49 090 50.5815301 C 1.00 0.47 0.40 0.14 ZZZ 50.5815320 C 4.70 3.63 2.54 0.58 090 50.5815321 C 1.50 0.69 0.59 0.21 ZZZ 50.5815330 C 3.99 3.20 2.23 0.49 090 50.5815331 C 1.00 0.46 0.40 0.14 ZZZ 50.5815335 C 4.50 3.48 2.45 0.55 090 50.5815336 C 1.43 0.69 0.57 0.20 ZZZ 50.5815340 C 3.72 4.01 2.76 0.41 010 50.5815341 C 0.50 0.61 0.20 0.06 ZZZ 50.5815342 C 1.00 1.85 0.55 0.11 010 50.58 12/31/200515343 C 0.25 0.09 0.09 0.03 ZZZ 50.58 12/31/200515350 C 3.99 6.46 3.84 0.49 090 50.58 12/31/200515351 C 1.00 0.36 0.36 0.14 ZZZ 50.58 12/31/200515360 C 3.87 4.48 3.09 0.43 090 50.5815361 C 1.15 0.58 0.46 0.14 ZZZ 50.5815365 C 4.15 4.56 3.20 0.46 090 50.5815366 C 1.45 0.70 0.58 0.17 ZZZ 50.5815400 C 3.99 4.02 4.02 0.47 090 50.5815401 C 1.00 1.90 0.44 0.14 ZZZ 50.5815420 C 4.50 4.79 3.80 0.52 090 50.5815421 C 1.50 1.32 0.62 0.21 ZZZ 50.5815430 C 5.75 6.92 6.63 0.66 090 50.5815431 C 0.00 0.00 0.00 0.00 ZZZ 0.0015570 C 9.20 11.33 6.78 1.34 090 50.5815572 C 9.26 9.52 6.47 1.20 090 50.5815574 C 9.87 10.71 7.81 1.20 090 50.5815576 C 8.68 9.78 6.90 0.87 090 50.5815600 C 1.91 7.62 3.07 0.27 090 50.5815610 C 2.42 4.70 3.43 0.35 090 50.5815620 C 2.94 7.80 3.89 0.35 090 50.5815630 C 3.27 7.06 4.16 0.34 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
15650 C 3.96 7.16 4.22 0.42 090 50.5815732 C 17.81 18.09 12.25 1.99 090 50.5815734 C 17.76 18.16 12.41 2.61 090 50.5815736 C 16.25 18.28 11.25 2.45 090 50.5815738 C 17.89 18.02 11.75 2.65 090 50.5815740 C 10.23 10.16 8.28 0.63 090 50.5815750 C 11.39 9.07 9.07 1.42 090 50.5815756 C 35.18 20.62 20.62 4.61 090 50.5815757 C 35.18 21.65 21.65 3.89 090 50.5815758 C 35.05 21.63 21.63 4.23 090 50.5815760 C 8.73 10.05 7.28 0.85 090 50.5815770 C 7.51 6.70 6.70 1.05 090 50.5815775 C 3.95 4.24 1.30 0.52 000 50.5815776 C 5.53 5.37 2.81 0.72 000 50.5815780 C 7.28 11.55 8.27 0.67 090 50.5815781 C 4.84 6.93 5.38 0.34 090 50.5815782 C 4.31 9.88 6.57 0.34 090 50.5815783 C 4.28 6.89 4.19 0.28 090 50.5815786 C 2.03 3.36 1.32 0.11 010 50.5815787 C 0.33 1.09 0.16 0.04 ZZZ 50.5815788 C 2.09 6.73 3.09 0.11 090 50.5815789 C 4.91 8.11 4.81 0.20 090 50.5815792 C 1.86 7.11 4.46 0.13 090 50.5815793 C 3.73 6.30 4.39 0.19 090 50.5815810 C 4.73 3.89 3.89 0.50 090 50.58 12/31/200515811 C 5.38 5.49 4.77 0.80 090 50.58 12/31/200515819 D 9.37 7.20 7.20 0.97 090 50.5815820 D 5.14 6.99 5.58 0.40 090 50.5815821 D 5.71 7.37 5.73 0.45 090 50.5815822 D 4.44 5.85 4.50 0.37 090 50.5815823 C 7.04 7.87 6.45 0.50 090 50.5815824 D 0.00 0.00 0.00 0.00 000 0.0015825 D 0.00 0.00 0.00 0.00 000 0.0015826 D 0.00 0.00 0.00 0.00 000 0.0015828 D 0.00 0.00 0.00 0.00 000 0.0015829 D 0.00 0.00 0.00 0.00 000 0.0015831 D 12.38 8.18 8.18 1.75 090 50.5815832 D 11.57 8.36 8.36 1.66 090 50.5815833 D 10.62 8.23 8.23 1.49 090 50.5815834 D 10.83 7.71 7.71 1.61 090 50.5815835 D 11.65 7.56 7.56 1.60 090 50.5815836 D 9.33 6.80 6.80 1.34 090 50.5815837 D 8.42 8.57 7.39 1.18 090 50.5815838 D 7.12 6.08 6.08 0.58 090 50.5815839 D 9.37 8.85 6.41 1.22 090 50.5815840 C 13.24 10.00 10.00 1.32 090 50.5815841 C 23.23 15.03 15.03 2.54 090 50.5815842 C 37.90 22.98 22.98 4.93 090 50.5815845 C 12.55 9.33 9.33 0.81 090 50.5815850 C 0.78 1.56 0.30 0.05 XXX 50.5815851 C 0.86 1.68 0.31 0.06 000 50.5815852 C 0.86 1.85 0.33 0.09 000 50.5815860 C 1.95 0.83 0.78 0.27 000 50.5815876 D 0.00 0.00 0.00 0.00 000 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
15877 D 0.00 0.00 0.00 0.00 000 0.0015878 D 0.00 0.00 0.00 0.00 000 0.0015879 D 0.00 0.00 0.00 0.00 000 0.0015920 C 7.94 5.57 5.57 1.04 090 50.5815922 C 9.89 7.23 7.23 1.42 090 50.5815931 C 9.23 5.70 5.70 1.25 090 50.5815933 C 10.83 7.87 7.87 1.52 090 50.5815934 C 12.67 8.06 8.06 1.78 090 50.5815935 C 14.55 10.35 10.35 2.09 090 50.5815936 C 12.36 8.24 8.24 1.76 090 50.5815937 C 14.19 9.85 9.85 2.06 090 50.5815940 C 9.33 6.19 6.19 1.31 090 50.5815941 C 11.41 9.48 9.48 1.66 090 50.5815944 C 11.44 8.62 8.62 1.65 090 50.5815945 C 12.67 9.67 9.67 1.84 090 50.5815946 C 21.54 14.41 14.41 3.16 090 50.5815950 C 7.53 5.43 5.43 1.04 090 50.5815951 C 10.70 7.88 7.88 1.49 090 50.5815952 C 11.37 7.77 7.77 1.60 090 50.5815953 C 12.61 9.02 9.02 1.79 090 50.5815956 C 15.50 10.80 10.80 2.21 090 50.5815958 C 15.46 11.07 11.07 2.25 090 50.5815999 S 0.00 0.00 0.00 0.00 YYY 0.0016000 C 0.89 0.86 0.26 0.08 000 50.5816010 C 0.87 0.66 0.63 0.09 000 50.58 12/31/200516015 C 2.35 1.15 1.15 0.31 000 50.58 12/31/200516020 C 0.80 1.29 0.58 0.08 000 50.5816025 C 1.85 1.77 0.96 0.19 000 50.5816030 C 2.08 2.18 1.12 0.24 000 50.5816035 C 3.74 1.58 1.58 0.46 090 50.5816036 C 1.50 0.60 0.60 0.20 ZZZ 50.5817000 C 0.60 0.97 0.54 0.03 010 50.5817003 C 0.15 0.11 0.07 0.01 ZZZ 50.5817004 C 2.79 2.31 1.59 0.11 010 50.5817106 C 4.58 4.61 3.34 0.35 090 50.5817107 C 9.15 7.22 5.47 0.63 090 50.5817108 C 13.18 9.29 7.68 0.54 090 50.5817110 C 0.65 1.62 0.70 0.05 010 50.5817111 C 0.92 1.67 0.81 0.05 010 50.5817250 C 0.50 1.22 0.34 0.06 000 50.5817260 C 0.91 1.28 0.67 0.04 010 50.5817261 C 1.17 1.61 0.83 0.05 010 50.5817262 C 1.58 1.89 1.02 0.06 010 50.5817263 C 1.79 2.06 1.09 0.07 010 50.5817264 C 1.94 2.23 1.12 0.08 010 50.5817266 C 2.34 2.51 1.22 0.09 010 50.5817270 C 1.32 1.70 0.87 0.05 010 50.5817271 C 1.49 1.78 0.98 0.06 010 50.5817272 C 1.77 2.00 1.11 0.07 010 50.5817273 C 2.05 2.21 1.21 0.08 010 50.5817274 C 2.59 2.57 1.44 0.10 010 50.5817276 C 3.20 2.95 1.68 0.16 010 50.5817280 C 1.17 1.61 0.81 0.05 010 50.5817281 C 1.72 1.91 1.09 0.07 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
17282 C 2.04 2.16 1.24 0.08 010 50.5817283 C 2.64 2.55 1.49 0.11 010 50.5817284 C 3.21 2.93 1.76 0.13 010 50.5817286 C 4.43 3.68 2.45 0.23 010 50.5817304 C 7.59 8.26 3.57 0.30 000 50.5817305 C 2.85 3.90 1.34 0.11 000 50.5817306 C 2.85 3.92 1.35 0.11 000 50.5817307 C 2.85 3.57 1.36 0.11 000 50.5817310 C 0.95 1.62 0.46 0.03 ZZZ 50.5817340 C 0.76 0.37 0.36 0.05 010 50.5817360 C 1.43 1.44 0.87 0.06 010 50.5817380 D 0.00 0.00 0.00 0.00 000 0.0017999 S 0.00 0.00 0.00 0.00 YYY 0.0019000 C 0.84 1.99 0.31 0.08 000 50.5819001 C 0.42 0.25 0.14 0.04 ZZZ 50.5819020 C 3.56 6.35 2.68 0.45 090 50.5819030 C 1.53 2.87 0.50 0.09 000 50.5819100 C 1.27 2.09 0.42 0.16 000 50.5819101 C 3.18 4.51 1.92 0.39 010 50.5819102 C 2.00 3.84 0.66 0.14 000 50.5819103 C 3.69 11.52 1.23 0.30 000 50.5819110 C 4.29 5.81 2.87 0.57 090 50.5819112 C 3.66 6.08 2.69 0.48 090 50.5819120 C 5.55 4.55 3.07 0.73 090 50.5819125 C 6.05 4.79 3.29 0.80 090 50.5819126 C 2.93 1.00 1.00 0.38 ZZZ 50.5819140 C 5.13 7.16 3.40 0.69 090 50.5819160 C 5.98 3.43 3.43 0.79 090 50.5819162 C 13.51 6.35 6.35 1.79 090 50.5819180 C 8.79 5.03 5.03 1.18 090 50.5819182 C 7.72 4.76 4.76 1.04 090 50.5819200 C 15.47 7.98 7.98 1.92 090 50.5819220 C 15.70 8.25 8.25 2.07 090 50.5819240 C 15.98 8.22 8.22 2.12 090 50.5819260 C 15.42 11.18 11.18 2.13 090 50.5819271 C 18.87 18.00 18.00 2.62 090 50.5819272 C 21.52 18.98 18.98 2.99 090 50.5819290 C 1.27 2.86 0.42 0.07 000 50.5819291 C 0.63 1.21 0.21 0.04 ZZZ 50.5819295 C 0.00 2.70 2.70 0.01 ZZZ 50.5819296 C 3.63 125.75 1.53 0.36 000 50.5819297 C 1.72 0.64 0.64 0.17 ZZZ 50.5819298 C 6.00 42.28 2.42 0.43 000 50.5819316 C 10.67 7.53 7.53 1.64 090 50.5819318 C 15.60 11.20 11.20 2.92 090 50.5819324 C 5.84 4.90 4.90 0.84 090 50.5819325 C 8.44 6.54 6.54 1.33 090 50.5819328 C 5.67 5.03 5.03 0.91 090 50.5819330 C 7.58 6.05 6.05 1.26 090 50.5819340 C 6.32 3.12 3.12 1.06 ZZZ 50.5819342 C 11.18 8.95 8.95 1.83 090 50.5819350 C 8.91 13.88 7.19 1.41 090 50.5819355 C 7.56 10.28 4.71 0.92 090 50.5819357 C 18.13 15.66 15.66 2.93 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
19361 C 19.23 12.47 12.47 2.92 090 50.5819364 C 40.94 23.61 23.61 6.22 090 50.5819366 C 21.25 11.61 11.61 3.24 090 50.5819367 C 25.69 16.74 16.74 4.03 090 50.5819368 C 32.37 18.97 18.97 5.52 090 50.5819369 C 29.78 18.45 18.45 4.50 090 50.5819370 C 8.04 6.92 6.92 1.29 090 50.5819371 C 9.34 7.84 7.84 1.62 090 50.5819380 C 9.13 7.72 7.72 1.44 090 50.5819396 C 2.17 1.08 0.99 0.30 000 50.5819499 S 0.00 0.00 0.00 0.00 YYY 0.0020000 C 2.12 2.70 1.74 0.25 010 50.5820005 C 3.41 3.50 2.26 0.46 010 50.5820100 C 10.06 4.47 4.47 1.21 010 50.5820101 C 3.22 5.94 1.62 0.44 010 50.5820102 C 3.93 7.48 1.91 0.49 010 50.5820103 C 5.29 8.60 3.40 0.75 010 50.5820150 C 13.67 7.05 7.05 2.03 090 50.5820200 C 1.46 3.04 0.75 0.23 000 50.5820205 C 2.35 3.90 1.19 0.33 000 50.5820206 C 0.99 6.52 0.63 0.07 000 50.5820220 C 1.27 4.57 0.79 0.08 000 50.5820225 C 1.87 24.52 1.13 0.22 000 50.5820240 C 3.23 2.56 2.56 0.44 010 50.5820245 C 7.77 6.59 6.59 1.31 010 50.5820250 C 5.02 3.51 3.51 1.02 010 50.5820251 C 5.55 4.17 4.17 1.15 010 50.5820500 C 1.23 2.27 1.53 0.12 010 50.5820501 C 0.76 2.92 0.25 0.04 000 50.5820520 C 1.85 2.92 1.77 0.21 010 50.5820525 C 3.49 9.17 2.63 0.51 010 50.5820526 C 0.94 0.97 0.52 0.13 000 50.5820550 C 0.75 0.71 0.23 0.09 000 50.5820551 C 0.75 0.68 0.33 0.08 000 50.5820552 C 0.66 0.72 0.20 0.05 000 50.5820553 C 0.75 0.82 0.22 0.04 000 50.5820600 C 0.66 0.65 0.35 0.08 000 50.5820605 C 0.68 0.76 0.36 0.08 000 50.5820610 C 0.79 0.95 0.42 0.11 000 50.5820612 C 0.70 0.71 0.36 0.10 000 50.5820615 C 2.28 3.52 1.85 0.20 010 50.5820650 C 2.23 2.37 1.55 0.31 010 50.5820660 C 2.51 3.06 1.61 0.59 000 50.5820661 C 4.88 4.92 4.92 1.14 090 50.5820662 C 6.06 5.54 5.54 0.56 090 50.5820663 C 5.42 4.84 4.84 0.94 090 50.5820664 C 8.05 7.06 7.06 1.74 090 50.5820665 C 1.31 2.16 1.35 0.19 010 50.5820670 C 1.74 11.57 2.11 0.28 010 50.5820680 C 3.34 8.81 3.73 0.56 090 50.5820690 C 3.51 2.52 2.52 0.59 090 50.5820692 C 6.40 3.78 3.78 1.05 090 50.5820693 C 5.85 5.46 5.46 0.98 090 50.5820694 C 4.15 7.16 4.05 0.71 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
20802 C 41.09 21.01 21.01 3.81 090 50.5820805 C 49.93 34.41 34.41 4.84 090 50.5820808 C 61.56 42.34 42.34 6.86 090 50.5820816 C 30.89 37.90 37.90 4.52 090 50.5820822 C 25.55 34.69 34.69 4.18 090 50.5820824 C 30.89 36.65 36.65 4.61 090 50.5820827 C 26.37 36.58 36.58 3.66 090 50.5820838 C 41.35 22.34 22.34 1.12 090 50.5820900 C 5.57 8.45 5.69 0.94 090 50.5820902 C 7.54 6.90 6.90 1.30 090 50.5820910 C 5.33 5.20 5.20 0.71 090 50.5820912 C 6.34 5.81 5.81 0.69 090 50.5820920 C 5.30 4.23 4.23 0.66 090 50.5820922 C 6.60 7.56 4.88 0.70 090 50.5820924 C 6.47 5.90 5.90 1.04 090 50.5820926 C 5.52 4.76 4.76 0.87 090 50.5820930 C 0.00 0.00 0.00 0.00 XXX 0.0020931 C 1.81 0.93 0.93 0.43 ZZZ 50.5820936 C 0.00 0.00 0.00 0.00 XXX 0.0020937 C 2.79 1.45 1.45 0.54 ZZZ 50.5820938 C 3.02 1.56 1.56 0.64 ZZZ 50.5820950 C 1.26 6.86 0.99 0.20 000 50.5820955 C 39.15 24.34 24.34 4.89 090 50.5820956 C 39.21 24.81 24.81 7.01 090 50.5820957 C 40.59 18.99 18.99 7.05 090 50.5820962 C 39.21 26.60 26.60 6.55 090 50.5820969 C 43.85 26.71 26.71 4.79 090 50.5820970 C 43.00 25.45 25.45 6.60 090 50.5820972 C 42.93 20.64 20.64 5.30 090 50.5820973 C 45.69 25.23 25.23 5.54 090 50.5820974 C 0.62 0.69 0.54 0.11 000 50.5820975 C 2.60 1.71 1.71 0.51 000 50.5820979 C 0.62 0.80 0.34 0.09 000 50.5820982 C 7.27 109.86 2.98 0.69 000 50.5820999 S 0.00 0.00 0.00 0.00 YYY 0.0021010 C 10.12 7.11 7.11 1.11 090 50.5821015 C 5.28 5.02 5.02 0.70 090 50.5821025 C 10.04 12.28 9.38 1.32 090 50.5821026 C 4.84 7.88 6.34 0.60 090 50.5821029 C 7.70 9.40 7.03 0.94 090 50.5821030 C 4.49 6.35 5.04 0.54 090 50.5821031 C 3.24 5.18 3.63 0.48 090 50.5821032 C 3.24 5.36 3.52 0.47 090 50.5821034 C 16.15 15.97 12.70 1.71 090 50.5821040 C 4.49 6.41 4.73 0.54 090 50.5821044 C 11.84 9.40 9.40 1.12 090 50.5821045 C 16.15 12.39 12.39 1.52 090 50.5821046 C 12.98 11.93 11.93 1.85 090 50.5821047 C 18.72 13.48 13.48 2.12 090 50.5821048 C 13.48 12.17 12.17 1.76 090 50.5821049 C 17.97 13.06 13.06 1.59 090 50.5821050 C 10.75 9.47 9.47 1.47 090 50.5821060 C 10.21 8.63 8.63 1.38 090 50.5821070 C 8.19 7.12 7.12 1.27 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
21076 C 13.40 12.39 10.03 1.99 010 50.5821077 C 33.70 31.42 26.08 4.55 090 50.5821079 C 22.31 21.56 17.20 3.15 090 50.5821080 C 25.06 24.56 19.42 3.74 090 50.5821081 C 22.85 22.36 17.54 3.20 090 50.5821082 C 20.84 19.40 15.78 3.11 090 50.5821083 C 19.27 18.84 14.47 2.88 090 50.5821084 C 22.48 22.50 17.75 2.18 090 50.5821085 C 8.99 8.31 6.80 1.27 010 50.5821086 C 24.88 23.81 19.49 3.71 090 50.5821087 C 24.88 23.35 19.25 3.44 090 50.5821088 C 866.24 0.00 0.00 0.00 090 2.5021089 S 0.00 0.00 0.00 0.00 090 0.0021100 C 4.21 11.56 4.75 0.34 090 50.5821110 C 5.20 9.59 8.38 0.72 090 50.5821116 C 0.81 4.34 0.33 0.06 000 50.5821120 C 4.92 10.61 7.51 0.60 090 50.5821121 C 7.63 9.76 7.84 0.90 090 50.5821122 C 8.51 8.64 8.64 1.07 090 50.5821123 C 11.14 10.83 10.83 1.40 090 50.5821125 C 10.60 55.38 8.34 0.79 090 50.5821127 C 11.10 42.92 9.48 1.52 090 50.5821137 C 9.81 7.75 7.75 1.32 090 50.5821138 C 12.17 9.56 9.56 1.74 090 50.5821139 C 14.59 11.09 11.09 1.18 090 50.5821141 C 18.07 13.69 13.69 2.35 090 50.5821142 C 18.78 12.86 12.86 2.38 090 50.5821143 C 19.55 14.35 14.35 1.66 090 50.5821145 C 19.91 13.94 13.94 2.84 090 50.5821146 C 20.68 15.37 15.37 3.09 090 50.5821147 C 21.74 15.09 15.09 1.84 090 50.5821150 C 25.20 16.81 16.81 2.55 090 50.5821151 C 28.26 23.02 23.02 2.30 090 50.5821154 C 30.47 23.19 23.19 2.48 090 50.5821155 C 34.40 23.96 23.96 6.64 090 50.5821159 C 42.32 29.16 29.16 8.18 090 50.5821160 C 46.37 27.55 27.55 4.13 090 50.5821172 C 27.76 13.79 13.79 3.55 090 50.5821175 C 33.12 17.84 17.84 4.83 090 50.5821179 C 22.22 14.17 14.17 2.80 090 50.5821180 C 25.15 15.42 15.42 3.48 090 50.5821181 C 9.89 7.48 7.48 1.32 090 50.5821182 C 32.14 19.17 19.17 2.80 090 50.5821183 C 35.26 20.89 20.89 4.47 090 50.5821184 C 38.18 22.00 22.00 5.70 090 50.5821188 C 22.43 18.92 18.92 1.69 090 50.5821193 C 17.12 12.69 12.69 2.23 090 50.5821194 C 19.81 13.79 13.79 2.02 090 50.5821195 C 17.21 14.86 14.86 1.64 090 50.5821196 C 18.88 15.74 15.74 2.07 090 50.5821198 C 14.14 12.74 12.74 1.44 090 50.5821199 C 15.98 9.14 9.14 1.39 090 50.5821206 C 14.08 12.67 12.67 1.33 090 50.5821208 C 10.21 22.39 9.61 1.09 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
21209 C 6.71 10.83 8.09 0.90 090 50.5821210 C 10.21 24.94 9.38 1.30 090 50.5821215 C 10.75 42.00 9.39 1.53 090 50.5821230 C 10.75 8.06 8.06 1.29 090 50.5821235 C 6.71 9.87 6.43 0.61 090 50.5821240 C 14.03 12.08 12.08 2.24 090 50.5821242 C 12.93 11.54 11.54 1.78 090 50.5821243 C 20.76 17.48 17.48 3.25 090 50.5821244 C 11.84 12.13 12.13 1.25 090 50.5821245 C 11.84 14.44 9.88 1.19 090 50.5821246 C 12.45 9.07 9.07 1.35 090 50.5821247 C 22.60 17.40 17.40 2.83 090 50.5821248 C 11.46 12.17 9.43 1.55 090 50.5821249 C 17.49 16.77 12.73 2.48 090 50.5821255 C 16.69 16.18 16.18 2.38 090 50.5821256 C 16.17 11.85 11.85 1.50 090 50.5821260 C 16.50 12.80 12.80 0.97 090 50.5821261 C 31.44 24.30 24.30 3.42 090 50.5821263 C 28.38 19.13 19.13 2.62 090 50.5821267 C 18.87 19.83 19.83 1.70 090 50.5821268 C 24.44 20.27 20.27 3.65 090 50.5821270 C 10.21 11.68 7.27 0.72 090 50.5821275 C 11.22 8.18 8.18 1.29 090 50.5821280 C 6.02 5.94 5.94 0.42 090 50.5821282 C 3.48 4.49 4.49 0.26 090 50.5821295 C 1.53 2.54 2.54 0.16 090 50.5821296 C 4.24 4.92 4.92 0.34 090 50.5821299 S 0.00 0.00 0.00 0.00 YYY 0.0021300 C 0.72 2.37 0.26 0.13 000 50.5821310 C 0.58 2.29 0.15 0.05 000 50.5821315 C 1.51 4.24 1.89 0.14 010 50.5821320 C 1.85 3.92 1.62 0.18 010 50.5821325 C 3.76 8.64 8.64 0.31 090 50.5821330 C 5.37 9.73 9.73 0.56 090 50.5821335 C 8.60 9.65 9.65 0.74 090 50.5821336 C 5.71 9.64 9.64 0.55 090 50.5821337 C 2.70 6.14 3.58 0.28 090 50.5821338 C 6.45 14.06 14.06 0.82 090 50.5821339 C 8.08 13.94 13.94 0.96 090 50.5821340 C 10.75 8.42 8.42 1.15 090 50.5821343 C 12.93 15.51 15.51 1.47 090 50.5821344 C 19.69 16.55 16.55 2.43 090 50.5821345 C 8.15 9.87 7.19 0.92 090 50.5821346 C 10.59 12.24 12.24 1.21 090 50.5821347 C 12.67 16.24 16.24 1.47 090 50.5821348 C 16.66 11.14 11.14 2.48 090 50.5821355 C 3.76 6.25 3.49 0.34 010 50.5821356 C 4.14 7.14 4.56 0.46 010 50.5821360 C 6.45 5.95 5.95 0.74 090 50.5821365 C 14.93 10.86 10.86 1.69 090 50.5821366 C 17.74 11.36 11.36 2.49 090 50.5821385 C 9.15 8.30 8.30 0.97 090 50.5821386 C 9.15 7.09 7.09 0.97 090 50.5821387 C 9.69 8.98 8.98 1.08 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
21390 C 10.11 7.82 7.82 0.90 090 50.5821395 C 12.66 9.05 9.05 1.44 090 50.5821400 C 1.40 2.62 1.88 0.15 090 50.5821401 C 3.26 8.01 3.50 0.38 090 50.5821406 C 7.00 6.10 6.10 0.73 090 50.5821407 C 8.60 6.88 6.88 0.94 090 50.5821408 C 12.36 8.91 8.91 1.44 090 50.5821421 C 5.13 9.36 8.33 0.73 090 50.5821422 C 8.31 8.10 8.10 0.99 090 50.5821423 C 10.38 9.35 9.35 1.27 090 50.5821431 C 7.04 9.55 9.55 0.70 090 50.5821432 C 8.60 8.08 8.08 0.81 090 50.5821433 C 25.31 16.45 16.45 2.78 090 50.5821435 C 17.22 12.74 12.74 1.98 090 50.5821436 C 28.00 18.27 18.27 3.09 090 50.5821440 C 2.70 7.12 6.18 0.38 090 50.5821445 C 5.37 9.78 8.39 0.78 090 50.5821450 C 2.97 7.40 6.89 0.33 090 50.5821451 C 4.86 9.38 8.42 0.63 090 50.5821452 C 1.98 13.06 4.62 0.27 090 50.5821453 C 5.53 10.77 10.76 0.74 090 50.5821454 C 6.45 6.28 6.28 0.82 090 50.5821461 C 8.08 24.53 12.70 0.98 090 50.5821462 C 9.78 27.69 12.75 1.27 090 50.5821465 C 11.89 9.84 9.84 1.50 090 50.5821470 C 15.32 12.05 12.05 1.96 090 50.5821480 C 0.61 1.78 0.19 0.06 000 50.5821485 C 3.98 8.24 7.68 0.51 090 50.5821490 C 11.84 9.72 9.72 1.96 090 50.5821493 C 1.27 0.55 0.55 0.12 090 50.58 12/31/200521494 C 6.27 3.54 3.54 0.57 090 50.58 12/31/200521495 C 5.68 8.44 8.44 0.46 090 50.5821497 C 3.85 8.47 7.66 0.50 090 50.5821499 S 0.00 0.00 0.00 0.00 YYY 0.0021501 C 3.80 6.44 3.83 0.43 090 50.5821502 C 7.11 5.65 5.65 0.97 090 50.5821510 C 5.73 5.68 5.68 0.80 090 50.5821550 C 2.06 3.59 1.72 0.16 010 50.5821555 C 4.34 5.53 3.20 0.56 090 50.5821556 C 5.56 4.11 4.11 0.65 090 50.5821557 C 8.87 5.37 5.37 1.08 090 50.5821600 C 6.88 5.75 5.75 0.99 090 50.5821610 C 14.59 8.89 8.89 3.07 090 50.5821615 C 9.86 6.70 6.70 1.45 090 50.5821616 C 12.02 8.04 8.04 1.86 090 50.5821620 C 6.78 5.99 5.99 0.98 090 50.5821627 C 6.80 6.32 6.32 1.02 090 50.5821630 C 17.35 11.87 11.87 2.58 090 50.5821632 C 18.11 11.14 11.14 2.65 090 50.5821685 C 12.98 10.00 10.00 1.06 090 50.5821700 C 6.18 4.45 4.45 0.32 090 50.5821705 C 9.59 5.60 5.60 1.43 090 50.5821720 C 5.67 2.47 2.47 0.91 090 50.5821725 C 6.98 5.46 5.46 1.21 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
21740 C 16.48 8.54 8.54 2.36 090 50.5821742 C 0.00 0.00 0.00 0.00 090 0.0021743 C 0.00 0.00 0.00 0.00 090 0.0021750 C 10.75 6.13 6.13 1.63 090 50.5821800 C 0.96 1.34 1.34 0.09 090 50.5821805 C 2.75 3.21 3.21 0.38 090 50.5821810 C 6.85 4.98 4.98 0.94 090 50.5821820 C 1.28 1.83 1.77 0.16 090 50.5821825 C 7.40 6.41 6.41 1.11 090 50.5821899 S 0.00 0.00 0.00 0.00 YYY 0.0021920 C 2.06 3.29 1.47 0.14 010 50.5821925 C 4.48 5.18 3.25 0.60 090 50.5821930 C 4.99 5.73 3.41 0.66 090 50.5821935 C 17.93 9.65 9.65 2.47 090 50.5822010 C 11.05 8.91 8.91 1.73 090 50.5822015 C 10.94 8.85 8.85 1.71 090 50.5822100 C 9.72 7.55 7.55 2.13 090 50.5822101 C 9.80 7.77 7.77 1.90 090 50.5822102 C 9.80 8.13 8.13 1.87 090 50.5822103 C 2.34 1.21 1.21 0.44 ZZZ 50.5822110 C 12.72 9.19 9.19 2.76 090 50.5822112 C 12.79 9.30 9.30 2.52 090 50.5822114 C 12.79 9.28 9.28 2.63 090 50.5822116 C 2.32 1.17 1.17 0.50 ZZZ 50.5822210 C 23.78 15.45 15.45 5.44 090 50.5822212 C 19.39 13.31 13.31 3.90 090 50.5822214 C 19.42 13.85 13.85 3.91 090 50.5822216 C 6.03 3.14 3.14 1.29 ZZZ 50.5822220 C 21.34 13.66 13.66 5.06 090 50.5822222 C 21.49 11.16 11.16 4.12 090 50.5822224 C 21.49 14.26 14.26 4.18 090 50.5822226 C 6.03 3.10 3.10 1.29 ZZZ 50.5822305 C 2.05 2.32 1.93 0.39 090 50.5822310 C 2.61 2.81 2.36 0.50 090 50.5822315 C 8.83 9.71 7.35 1.85 090 50.5822318 C 21.47 13.42 13.42 5.28 090 50.5822319 C 23.96 14.75 14.75 6.03 090 50.5822325 C 18.27 12.11 12.11 3.87 090 50.5822326 C 19.56 12.74 12.74 4.42 090 50.5822327 C 19.17 12.40 12.40 3.98 090 50.5822328 C 4.60 2.27 2.27 0.94 ZZZ 50.5822505 C 1.87 0.94 0.94 0.36 010 50.5822520 C 8.90 61.84 5.11 1.71 010 50.5822521 C 8.33 56.13 4.96 1.60 010 50.5822522 C 4.30 1.68 1.68 0.82 ZZZ 50.5822523 C 8.94 5.92 5.92 1.43 010 50.5822524 C 8.54 5.71 5.71 1.36 010 50.5822525 C 4.47 2.28 2.28 0.72 ZZZ 50.5822532 C 23.96 14.86 14.86 4.34 090 50.5822533 C 23.09 13.63 13.63 3.15 090 50.5822534 C 5.99 3.04 3.04 1.25 ZZZ 50.5822548 C 25.78 15.85 15.85 5.59 090 50.5822554 C 18.59 12.38 12.38 4.45 090 50.5822556 C 23.42 14.77 14.77 4.34 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
22558 C 22.25 13.33 13.33 3.15 090 50.5822585 C 5.52 2.80 2.80 1.25 ZZZ 50.5822590 C 20.48 13.36 13.36 4.78 090 50.5822595 C 19.36 12.87 12.87 4.40 090 50.5822600 C 16.12 11.22 11.22 3.72 090 50.5822610 C 16.00 11.44 11.44 3.52 090 50.5822612 C 20.97 14.24 14.24 4.46 090 50.5822614 C 6.43 3.36 3.36 1.38 ZZZ 50.5822630 C 20.81 13.64 13.64 4.72 090 50.5822632 C 5.22 2.67 2.67 1.16 ZZZ 50.5822800 C 18.22 12.81 12.81 3.75 090 50.5822802 C 30.83 19.65 19.65 6.15 090 50.5822804 C 36.22 22.76 22.76 6.98 090 50.5822808 C 26.23 16.35 16.35 4.92 090 50.5822810 C 30.22 18.41 18.41 5.13 090 50.5822812 C 32.65 20.12 20.12 5.28 090 50.5822818 C 31.78 18.92 18.92 6.45 090 50.5822819 C 36.39 20.11 20.11 7.65 090 50.5822830 C 10.83 7.98 7.98 2.29 090 50.5822840 C 12.52 6.51 6.51 2.78 ZZZ 50.5822841 C 0.00 0.00 0.00 0.00 XXX 0.0022842 C 12.56 6.52 6.52 2.74 ZZZ 50.5822843 C 13.44 6.62 6.62 2.85 ZZZ 50.5822844 C 16.42 8.78 8.78 3.18 ZZZ 50.5822845 C 11.94 6.09 6.09 2.85 ZZZ 50.5822846 C 12.40 6.35 6.35 2.95 ZZZ 50.5822847 C 13.78 7.04 7.04 2.99 ZZZ 50.5822848 C 5.99 3.19 3.19 1.15 ZZZ 50.5822849 C 18.48 11.76 11.76 3.89 090 50.5822850 C 9.51 7.01 7.01 2.04 090 50.5822851 C 6.70 3.37 3.37 1.49 ZZZ 50.5822852 C 9.00 6.81 6.81 1.89 090 50.5822855 C 15.11 9.69 9.69 3.51 090 50.5822899 S 0.00 0.00 0.00 0.00 YYY 0.0022900 C 5.79 3.23 3.23 0.76 090 50.5822999 S 0.00 0.00 0.00 0.00 YYY 0.0023000 C 4.35 8.55 4.43 0.68 090 50.5823020 C 8.92 7.58 7.58 1.54 090 50.5823030 C 3.42 7.41 2.91 0.57 010 50.5823031 C 2.74 7.88 2.73 0.46 010 50.5823035 C 8.60 8.29 8.29 1.47 090 50.5823040 C 9.19 7.88 7.88 1.60 090 50.5823044 C 7.11 6.45 6.45 1.24 090 50.5823065 C 2.27 2.49 1.62 0.20 010 50.5823066 C 4.15 7.69 3.99 0.63 090 50.5823075 C 2.39 3.67 1.79 0.34 010 50.5823076 C 7.62 5.57 5.57 1.13 090 50.5823077 C 16.07 10.24 10.24 2.33 090 50.5823100 C 6.02 5.67 5.67 1.04 090 50.5823101 C 5.57 5.35 5.35 0.96 090 50.5823105 C 8.22 7.14 7.14 1.42 090 50.5823106 C 5.95 5.72 5.72 0.99 090 50.5823107 C 8.61 7.41 7.41 1.49 090 50.5823120 C 7.10 6.48 6.48 1.23 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
23125 C 9.38 7.58 7.58 1.62 090 50.5823130 C 7.54 7.15 7.15 1.30 090 50.5823140 C 6.88 5.24 5.24 1.08 090 50.5823145 C 9.08 7.46 7.46 1.49 090 50.5823146 C 7.82 7.13 7.13 1.35 090 50.5823150 C 8.47 6.94 6.94 1.32 090 50.5823155 C 10.33 8.35 8.35 1.80 090 50.5823156 C 8.67 7.40 7.40 1.50 090 50.5823170 C 6.85 6.04 6.04 1.12 090 50.5823172 C 6.89 6.30 6.30 1.01 090 50.5823174 C 9.50 8.38 8.38 1.65 090 50.5823180 C 8.52 9.02 9.02 1.47 090 50.5823182 C 8.14 8.57 8.57 1.37 090 50.5823184 C 9.37 9.34 9.34 1.63 090 50.5823190 C 7.23 6.19 6.19 1.17 090 50.5823195 C 9.80 7.75 7.75 1.70 090 50.5823200 C 12.06 8.75 8.75 1.93 090 50.5823210 C 12.47 9.02 9.02 2.02 090 50.5823220 C 14.54 10.85 10.85 2.48 090 50.5823221 C 17.71 11.75 11.75 3.05 090 50.5823222 C 23.88 15.83 15.83 3.94 090 50.5823330 C 1.85 3.69 1.89 0.24 010 50.5823331 C 7.37 6.81 6.81 1.27 090 50.5823332 C 11.60 9.35 9.35 2.02 090 50.5823350 C 1.00 3.47 0.33 0.06 000 50.5823395 C 16.82 12.90 12.90 2.93 090 50.5823397 C 16.11 11.40 11.40 2.73 090 50.5823400 C 13.52 10.10 10.10 2.29 090 50.5823405 C 8.36 6.94 6.94 1.45 090 50.5823406 C 10.77 8.36 8.36 1.87 090 50.5823410 C 12.43 9.43 9.43 2.16 090 50.5823412 C 13.29 9.92 9.92 2.31 090 50.5823415 C 9.96 8.01 8.01 1.73 090 50.5823420 C 13.28 10.87 10.87 2.31 090 50.5823430 C 9.97 8.12 8.12 1.73 090 50.5823440 C 10.46 8.28 8.28 1.82 090 50.5823450 C 13.38 9.87 9.87 2.32 090 50.5823455 C 14.35 10.47 10.47 2.49 090 50.5823460 C 15.35 11.40 11.40 2.66 090 50.5823462 C 15.28 10.78 10.78 2.59 090 50.5823465 C 15.83 11.21 11.21 2.76 090 50.5823466 C 14.20 11.40 11.40 2.46 090 50.5823470 C 17.12 12.29 12.29 2.98 090 50.5823472 C 21.07 14.45 14.45 3.66 090 50.5823480 C 11.16 8.80 8.80 1.94 090 50.5823485 C 13.41 9.92 9.92 2.33 090 50.5823490 C 11.84 8.72 8.72 1.47 090 50.5823491 C 14.19 10.74 10.74 2.46 090 50.5823500 C 2.08 2.88 2.53 0.30 090 50.5823505 C 3.68 4.42 3.85 0.61 090 50.5823515 C 7.40 6.57 6.57 1.28 090 50.5823520 C 2.16 2.86 2.75 0.34 090 50.5823525 C 3.59 4.55 3.95 0.46 090 50.5823530 C 7.30 5.95 5.95 1.20 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
23532 C 8.00 6.99 6.99 1.38 090 50.5823540 C 2.23 2.87 2.37 0.29 090 50.5823545 C 3.25 4.20 3.37 0.35 090 50.5823550 C 7.23 6.39 6.39 1.25 090 50.5823552 C 8.44 7.34 7.34 1.46 090 50.5823570 C 2.23 3.02 2.90 0.36 090 50.5823575 C 4.05 4.89 4.32 0.59 090 50.5823585 C 8.95 7.66 7.66 1.54 090 50.5823600 C 2.93 4.56 3.56 0.48 090 50.5823605 C 4.86 6.17 5.12 0.84 090 50.5823615 C 9.34 8.86 8.86 1.62 090 50.5823616 C 21.24 14.18 14.18 3.69 090 50.5823620 C 2.40 3.62 2.99 0.40 090 50.5823625 C 3.92 4.95 4.29 0.67 090 50.5823630 C 7.34 6.65 6.65 1.27 090 50.5823650 C 3.38 3.78 2.77 0.30 090 50.5823655 C 4.56 4.18 4.18 0.69 090 50.5823660 C 7.48 6.40 6.40 1.29 090 50.5823665 C 4.46 5.35 4.73 0.71 090 50.5823670 C 7.89 6.85 6.85 1.36 090 50.5823675 C 6.04 6.85 5.85 1.01 090 50.5823680 C 10.04 8.13 8.13 1.75 090 50.5823700 C 2.52 2.18 2.18 0.44 010 50.5823800 C 14.14 10.44 10.44 2.35 090 50.5823802 C 16.58 10.20 10.20 2.70 090 50.5823900 C 19.69 11.74 11.74 3.18 090 50.5823920 C 14.59 9.95 9.95 2.46 090 50.5823921 C 5.48 5.09 5.09 0.78 090 50.5823929 C 0.00 0.00 0.00 0.00 YYY 0.0023930 C 2.94 6.34 2.32 0.43 010 50.5823931 C 1.79 5.93 2.18 0.28 010 50.5823935 C 6.08 5.93 5.93 1.05 090 50.5824000 C 5.81 5.43 5.43 0.97 090 50.5824006 C 9.30 7.77 7.77 1.50 090 50.5824065 C 2.08 3.22 1.75 0.17 010 50.5824066 C 5.20 8.96 4.14 0.80 090 50.5824075 C 3.91 7.37 3.41 0.56 090 50.5824076 C 6.29 4.87 4.87 0.95 090 50.5824077 C 11.74 7.76 7.76 1.72 090 50.5824100 C 4.92 4.53 4.53 0.85 090 50.5824101 C 6.12 5.95 5.95 1.03 090 50.5824102 C 8.02 6.88 6.88 1.33 090 50.5824105 C 3.60 4.40 4.40 0.61 090 50.5824110 C 7.38 6.68 6.68 1.28 090 50.5824115 C 9.62 7.23 7.23 1.67 090 50.5824116 C 11.79 9.10 9.10 2.05 090 50.5824120 C 6.64 5.94 5.94 1.10 090 50.5824125 C 7.88 6.18 6.18 1.06 090 50.5824126 C 8.30 7.04 7.04 1.16 090 50.5824130 C 6.24 6.04 6.04 1.04 090 50.5824134 C 9.72 8.88 8.88 1.64 090 50.5824136 C 7.98 7.24 7.24 1.38 090 50.5824138 C 8.04 7.80 7.80 1.34 090 50.5824140 C 9.17 9.13 9.13 1.51 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
24145 C 7.57 8.08 8.08 1.25 090 50.5824147 C 7.53 8.62 8.62 1.30 090 50.5824149 C 14.18 11.65 11.65 2.34 090 50.5824150 C 13.25 10.02 10.02 2.32 090 50.5824151 C 15.56 11.54 11.54 2.59 090 50.5824152 C 10.04 7.75 7.75 1.48 090 50.5824153 C 11.52 5.59 5.59 0.74 090 50.5824155 C 11.71 8.42 8.42 1.92 090 50.5824160 C 7.82 6.91 6.91 1.30 090 50.5824164 C 6.22 5.79 5.79 1.03 090 50.5824200 C 1.76 3.42 1.63 0.20 010 50.5824201 C 4.55 9.84 4.24 0.72 090 50.5824220 C 1.31 3.64 0.44 0.08 000 50.5824300 C 3.74 5.73 5.73 0.65 090 50.5824301 C 10.18 8.20 8.20 1.66 090 50.5824305 C 7.44 6.73 6.73 1.15 090 50.5824310 C 5.97 5.60 5.60 0.96 090 50.5824320 C 10.54 7.55 7.55 1.73 090 50.5824330 C 9.59 7.90 7.90 1.60 090 50.5824331 C 10.63 8.70 8.70 1.77 090 50.5824332 C 7.44 6.79 6.79 1.23 090 50.5824340 C 7.88 7.00 7.00 1.36 090 50.5824341 C 7.89 7.94 7.94 1.36 090 50.5824342 C 10.60 8.54 8.54 1.85 090 50.5824343 C 8.64 8.17 8.17 1.43 090 50.5824344 C 13.98 11.55 11.55 2.36 090 50.5824345 C 8.64 8.04 8.04 1.44 090 50.5824346 C 13.98 11.37 11.37 2.33 090 50.5824350 C 5.24 5.60 5.60 0.87 090 50.5824351 C 5.90 5.94 5.94 1.02 090 50.5824352 C 6.42 6.20 6.20 1.10 090 50.5824354 C 6.47 6.17 6.17 1.07 090 50.5824356 C 6.67 6.33 6.33 1.11 090 50.5824360 C 12.32 9.50 9.50 2.05 090 50.5824361 C 14.06 10.61 10.61 2.18 090 50.5824362 C 14.97 10.07 10.07 2.60 090 50.5824363 C 18.46 13.75 13.75 3.01 090 50.5824365 C 8.38 7.22 7.22 1.41 090 50.5824366 C 9.12 7.56 7.56 1.52 090 50.5824400 C 11.04 8.88 8.88 1.92 090 50.5824410 C 14.80 10.34 10.34 2.57 090 50.5824420 C 13.42 10.57 10.57 2.17 090 50.5824430 C 12.79 9.77 9.77 2.21 090 50.5824435 C 13.15 10.91 10.91 2.27 090 50.5824470 C 8.73 7.74 7.74 1.48 090 50.5824495 C 8.11 8.77 8.77 1.18 090 50.5824498 C 11.90 9.29 9.29 2.06 090 50.5824500 C 3.21 4.86 3.69 0.50 090 50.5824505 C 5.16 6.62 5.41 0.89 090 50.5824515 C 11.63 9.41 9.41 2.02 090 50.5824516 C 11.63 9.14 9.14 2.02 090 50.5824530 C 3.49 5.22 4.05 0.57 090 50.5824535 C 6.86 7.86 6.64 1.18 090 50.5824538 C 9.42 8.73 8.73 1.64 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
24545 C 10.44 8.47 8.47 1.82 090 50.5824546 C 15.67 11.35 11.35 2.73 090 50.5824560 C 2.80 4.49 3.20 0.44 090 50.5824565 C 5.55 6.63 5.54 0.93 090 50.5824566 C 7.78 8.18 8.18 1.30 090 50.5824575 C 10.64 8.42 8.42 1.86 090 50.5824576 C 2.86 4.77 3.72 0.46 090 50.5824577 C 5.78 6.95 5.86 0.95 090 50.5824579 C 11.58 8.86 8.86 2.02 090 50.5824582 C 8.54 9.14 9.14 1.48 090 50.5824586 C 15.19 11.26 11.26 2.64 090 50.5824587 C 15.14 11.05 11.05 2.52 090 50.5824600 C 4.22 4.87 3.51 0.50 090 50.5824605 C 5.41 5.38 5.38 0.89 090 50.5824615 C 9.41 7.84 7.84 1.60 090 50.5824620 C 6.97 6.27 6.27 1.07 090 50.5824635 C 13.17 14.09 14.09 2.28 090 50.5824640 C 1.20 1.85 0.80 0.12 010 50.5824650 C 2.16 3.79 2.76 0.35 090 50.5824655 C 4.39 5.97 4.80 0.70 090 50.5824665 C 8.13 7.53 7.53 1.41 090 50.5824666 C 9.48 8.09 8.09 1.62 090 50.5824670 C 2.54 4.12 3.08 0.41 090 50.5824675 C 4.71 6.02 4.98 0.81 090 50.5824685 C 8.79 7.54 7.54 1.52 090 50.5824800 C 11.18 8.77 8.77 1.63 090 50.5824802 C 13.67 10.41 10.41 2.37 090 50.5824900 C 9.59 7.08 7.08 1.53 090 50.5824920 C 9.53 6.96 6.96 1.61 090 50.5824925 C 7.06 6.10 6.10 1.14 090 50.5824930 C 10.23 7.26 7.26 1.67 090 50.5824931 C 12.70 5.74 5.74 1.89 090 50.5824935 C 15.54 8.04 8.04 2.13 090 50.5824940 C 0.00 0.00 0.00 0.00 090 0.0024999 S 0.00 0.00 0.00 0.00 YYY 0.0025000 C 3.37 6.89 6.89 0.55 090 50.5825001 C 3.37 4.24 4.24 0.55 090 50.5825020 C 5.91 9.59 9.59 0.93 090 50.5825023 C 12.94 14.98 14.98 2.03 090 50.5825024 C 9.49 7.49 7.49 1.36 090 50.5825025 C 16.52 10.00 10.00 1.82 090 50.5825028 C 5.24 8.18 8.18 0.81 090 50.5825031 C 4.13 7.94 7.94 0.63 090 50.5825035 C 7.35 13.63 13.63 1.24 090 50.5825040 C 7.17 7.32 7.32 1.15 090 50.5825065 C 1.99 3.23 1.91 0.15 010 50.5825066 C 4.12 7.08 7.08 0.64 090 50.5825075 C 3.73 5.91 5.91 0.55 090 50.5825076 C 4.91 9.57 9.57 0.74 090 50.5825077 C 9.75 12.12 12.12 1.42 090 50.5825085 C 5.49 7.14 7.14 0.85 090 50.5825100 C 3.89 5.29 5.29 0.59 090 50.5825101 C 4.68 5.91 5.91 0.75 090 50.5825105 C 5.84 7.32 7.32 0.92 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
25107 C 6.42 8.36 8.36 0.99 090 50.5825110 C 3.91 7.07 7.07 0.62 090 50.5825111 C 3.38 4.71 4.71 0.53 090 50.5825112 C 4.52 5.27 5.27 0.70 090 50.5825115 C 8.81 14.07 14.07 1.31 090 50.5825116 C 7.10 13.18 13.18 1.11 090 50.5825118 C 4.36 5.76 5.76 0.68 090 50.5825119 C 6.03 7.62 7.62 0.96 090 50.5825120 C 6.09 12.12 12.12 1.00 090 50.5825125 C 7.47 12.88 12.88 1.06 090 50.5825126 C 7.54 13.05 13.05 1.27 090 50.5825130 C 5.25 6.44 6.44 0.80 090 50.5825135 C 6.88 7.53 7.53 1.02 090 50.5825136 C 5.96 6.61 6.61 1.03 090 50.5825145 C 6.36 12.09 12.09 1.01 090 50.5825150 C 7.08 8.23 8.23 1.14 090 50.5825151 C 7.38 12.76 12.76 1.18 090 50.5825170 C 11.07 15.19 15.19 1.77 090 50.5825210 C 5.94 6.81 6.81 0.88 090 50.5825215 C 7.88 8.78 8.78 1.19 090 50.5825230 C 5.22 6.16 6.16 0.79 090 50.5825240 C 5.16 6.97 6.97 0.81 090 50.5825246 C 1.45 3.45 0.48 0.09 000 50.5825248 C 5.13 8.54 8.54 0.72 090 50.5825250 C 6.59 6.12 6.12 1.01 090 50.5825251 C 9.56 7.94 7.94 1.26 090 50.5825259 C 3.74 5.74 5.74 0.62 090 50.5825260 C 7.79 13.35 13.35 1.19 090 50.5825263 C 7.81 13.30 13.30 1.18 090 50.5825265 C 9.87 14.35 14.35 1.47 090 50.5825270 C 5.99 12.06 12.06 0.95 090 50.5825272 C 7.03 12.83 12.83 1.11 090 50.5825274 C 8.74 13.66 13.66 1.36 090 50.5825275 C 8.49 7.60 7.60 1.31 090 50.5825280 C 7.21 12.67 12.67 1.08 090 50.5825290 C 5.28 15.03 15.03 0.82 090 50.5825295 C 6.54 12.19 12.19 1.00 090 50.5825300 C 8.79 8.47 8.47 1.26 090 50.5825301 C 8.39 8.08 8.08 1.29 090 50.5825310 C 8.13 13.07 13.07 1.21 090 50.5825312 C 9.56 13.98 13.98 1.41 090 50.5825315 C 10.18 14.44 14.44 1.58 090 50.5825316 C 12.31 16.27 16.27 1.74 090 50.5825320 C 10.75 11.42 11.42 1.61 090 50.5825332 C 11.39 9.20 9.20 1.83 090 50.5825335 C 12.86 11.62 11.62 1.92 090 50.5825337 C 10.15 11.11 11.11 1.61 090 50.5825350 C 8.77 14.01 14.01 1.46 090 50.5825355 C 10.15 14.65 14.65 1.73 090 50.5825360 C 8.42 13.91 13.91 1.41 090 50.5825365 C 12.38 15.69 15.69 2.15 090 50.5825370 C 13.34 16.12 16.12 2.28 090 50.5825375 C 13.02 16.47 16.47 2.26 090 50.5825390 C 10.38 14.62 14.62 1.65 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
25391 C 13.63 16.60 16.60 2.21 090 50.5825392 C 13.93 16.01 16.01 2.10 090 50.5825393 C 15.85 17.63 17.63 2.76 090 50.5825394 C 10.38 8.08 8.08 1.59 090 50.5825400 C 10.90 15.23 15.23 1.82 090 50.5825405 C 14.36 17.32 17.32 2.32 090 50.5825415 C 13.33 16.56 16.56 2.17 090 50.5825420 C 16.31 18.32 18.32 2.61 090 50.5825425 C 13.19 21.45 21.45 2.08 090 50.5825426 C 15.80 16.60 16.60 2.54 090 50.5825430 C 9.24 7.36 7.36 1.27 090 50.5825431 C 10.42 8.42 8.42 1.90 090 50.5825440 C 10.42 9.43 9.43 1.63 090 50.5825441 C 12.88 10.03 10.03 2.07 090 50.5825442 C 10.83 8.91 8.91 1.53 090 50.5825443 C 10.37 8.80 8.80 1.37 090 50.5825444 C 11.13 9.06 9.06 1.71 090 50.5825445 C 9.68 8.01 8.01 1.55 090 50.5825446 C 16.53 11.95 11.95 2.47 090 50.5825447 C 10.35 8.68 8.68 1.61 090 50.5825449 C 14.47 10.70 10.70 2.21 090 50.5825450 C 7.86 10.22 10.22 1.36 090 50.5825455 C 9.48 10.89 10.89 0.96 090 50.5825490 C 9.53 13.77 13.77 1.43 090 50.5825491 C 9.95 14.50 14.50 1.60 090 50.5825492 C 12.31 15.34 15.34 2.14 090 50.5825500 C 2.45 3.58 2.72 0.35 090 50.5825505 C 5.20 6.56 5.44 0.90 090 50.5825515 C 9.17 7.48 7.48 1.59 090 50.5825520 C 6.25 6.88 6.08 1.08 090 50.5825525 C 12.22 10.02 10.02 2.12 090 50.5825526 C 12.96 13.54 13.54 2.19 090 50.5825530 C 2.09 3.77 2.87 0.34 090 50.5825535 C 5.13 6.03 5.31 0.89 090 50.5825545 C 8.89 7.68 7.68 1.53 090 50.5825560 C 2.44 3.70 2.61 0.35 090 50.5825565 C 5.62 6.72 5.44 0.93 090 50.5825574 C 7.00 7.22 7.22 1.21 090 50.5825575 C 10.43 9.54 9.54 1.81 090 50.5825600 C 2.63 4.10 2.98 0.42 090 50.5825605 C 5.80 7.25 6.24 1.00 090 50.5825611 C 7.76 8.99 8.99 1.34 090 50.5825620 C 8.54 7.28 7.28 1.42 090 50.5825622 C 2.61 4.28 3.11 0.41 090 50.5825624 C 4.52 6.32 5.08 0.76 090 50.5825628 C 8.42 7.84 7.84 1.37 090 50.5825630 C 2.88 4.19 2.95 0.45 090 50.5825635 C 4.38 5.96 3.91 0.74 090 50.5825645 C 7.24 6.65 6.65 1.20 090 50.5825650 C 3.05 4.32 3.18 0.45 090 50.5825651 C 5.35 5.50 5.50 0.86 090 50.5825652 C 7.59 7.02 7.02 1.21 090 50.5825660 C 4.75 4.72 4.72 0.58 090 50.5825670 C 7.91 7.01 7.01 1.28 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
25671 C 5.99 6.17 6.17 1.00 090 50.5825675 C 4.66 5.67 4.66 0.62 090 50.5825676 C 8.03 7.32 7.32 1.34 090 50.5825680 C 5.98 4.75 4.75 0.78 090 50.5825685 C 9.77 7.82 7.82 1.60 090 50.5825690 C 5.49 5.52 5.52 0.88 090 50.5825695 C 8.33 7.11 7.11 1.32 090 50.5825800 C 9.75 9.12 9.12 1.57 090 50.5825805 C 11.26 10.28 10.28 1.80 090 50.5825810 C 10.55 9.93 9.93 1.67 090 50.5825820 C 7.44 7.87 7.87 1.22 090 50.5825825 C 9.26 9.26 9.26 1.41 090 50.5825830 C 10.04 14.45 14.45 1.55 090 50.5825900 C 9.00 12.60 12.60 1.30 090 50.5825905 C 9.11 12.33 12.33 1.40 090 50.5825907 C 7.79 11.79 11.79 1.10 090 50.5825909 C 8.95 12.31 12.31 1.44 090 50.5825915 C 17.05 18.93 18.93 2.93 090 50.5825920 C 8.67 7.87 7.87 1.35 090 50.5825922 C 7.41 7.07 7.07 1.12 090 50.5825924 C 8.45 8.11 8.11 1.32 090 50.5825927 C 8.79 11.71 11.71 1.27 090 50.5825929 C 7.58 5.89 5.89 1.14 090 50.5825931 C 7.80 11.49 11.49 1.15 090 50.5825999 S 0.00 0.00 0.00 0.00 YYY 0.0026010 C 1.54 5.58 1.63 0.18 010 50.5826011 C 2.19 8.84 2.33 0.33 010 50.5826020 C 4.66 5.37 5.37 0.73 090 50.5826025 C 4.81 5.13 5.13 0.76 090 50.5826030 C 5.92 5.74 5.74 0.92 090 50.5826034 C 6.22 6.37 6.37 1.01 090 50.5826035 C 9.50 7.89 7.89 1.47 090 50.5826037 C 7.24 6.34 6.34 1.13 090 50.5826040 C 3.33 4.06 4.06 0.53 090 50.5826045 C 5.55 5.66 5.66 0.93 090 50.5826055 C 2.69 14.39 3.95 0.43 090 50.5826060 C 2.81 3.52 3.52 0.45 090 50.5826070 C 3.68 3.37 3.37 0.48 090 50.5826075 C 3.78 3.79 3.79 0.53 090 50.5826080 C 4.23 4.86 4.86 0.66 090 50.5826100 C 3.66 4.14 4.14 0.54 090 50.5826105 C 3.70 4.24 4.24 0.59 090 50.5826110 C 3.52 4.05 4.05 0.53 090 50.5826115 C 3.85 13.13 4.78 0.59 090 50.5826116 C 5.52 6.02 6.02 0.84 090 50.5826117 C 8.54 7.08 7.08 1.26 090 50.5826121 C 7.53 6.98 6.98 1.17 090 50.5826123 C 9.28 8.88 8.88 1.43 090 50.5826125 C 4.60 2.45 2.45 0.70 ZZZ 50.5826130 C 5.41 5.36 5.36 0.94 090 50.5826135 C 6.95 6.48 6.48 1.07 090 50.5826140 C 6.16 6.06 6.06 0.92 090 50.5826145 C 6.31 6.07 6.07 0.97 090 50.5826160 C 3.15 12.41 4.13 0.49 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
26170 C 4.76 4.95 4.95 0.69 090 50.5826180 C 5.17 5.43 5.43 0.78 090 50.5826185 C 5.24 6.05 6.05 0.81 090 50.5826200 C 5.50 5.37 5.37 0.88 090 50.5826205 C 7.69 6.91 6.91 1.20 090 50.5826210 C 5.14 5.44 5.44 0.79 090 50.5826215 C 7.09 6.33 6.33 0.98 090 50.5826230 C 6.32 5.93 5.93 1.01 090 50.5826235 C 6.18 5.83 5.83 0.95 090 50.5826236 C 5.31 5.34 5.34 0.81 090 50.5826250 C 7.54 6.45 6.45 1.07 090 50.5826255 C 12.41 9.40 9.40 1.68 090 50.5826260 C 7.02 6.20 6.20 1.01 090 50.5826261 C 9.08 6.19 6.19 1.14 090 50.5826262 C 5.66 5.35 5.35 0.88 090 50.5826320 C 3.97 4.32 4.32 0.59 090 50.5826340 C 2.50 4.89 4.89 0.39 090 50.5826350 C 5.98 14.65 14.65 0.93 090 50.5826352 C 7.67 15.40 15.40 1.13 090 50.5826356 C 8.06 18.42 18.42 1.21 090 50.5826357 C 8.57 15.68 15.68 1.33 090 50.5826358 C 9.13 16.69 16.69 1.38 090 50.5826370 C 7.10 15.15 15.15 1.12 090 50.5826372 C 8.75 16.58 16.58 1.40 090 50.5826373 C 8.15 16.09 16.09 1.23 090 50.5826390 C 9.18 13.32 13.32 1.40 090 50.5826392 C 10.24 16.77 16.77 1.57 090 50.5826410 C 4.62 11.97 11.97 0.73 090 50.5826412 C 6.30 13.31 13.31 0.97 090 50.5826415 C 8.33 11.81 11.81 0.98 090 50.5826416 C 9.36 14.63 14.63 0.79 090 50.5826418 C 4.24 12.36 12.36 0.67 090 50.5826420 C 6.76 13.67 13.67 1.07 090 50.5826426 C 6.14 13.20 13.20 0.95 090 50.5826428 C 7.20 13.90 13.90 1.09 090 50.5826432 C 4.01 10.29 10.29 0.64 090 50.5826433 C 4.55 10.82 10.82 0.72 090 50.5826434 C 6.08 11.57 11.57 0.93 090 50.5826437 C 5.81 11.60 11.60 0.89 090 50.5826440 C 5.01 13.47 13.47 0.75 090 50.5826442 C 8.15 15.99 15.99 1.20 090 50.5826445 C 4.30 13.18 13.18 0.65 090 50.5826449 C 6.99 15.82 15.82 1.06 090 50.5826450 C 3.66 7.35 7.35 0.59 090 50.5826455 C 3.63 7.30 7.30 0.58 090 50.5826460 C 3.45 7.16 7.16 0.55 090 50.5826471 C 5.72 11.27 11.27 0.88 090 50.5826474 C 5.31 11.42 11.42 0.76 090 50.5826476 C 5.17 10.96 10.96 0.79 090 50.5826477 C 5.14 11.09 11.09 0.81 090 50.5826478 C 5.79 11.87 11.87 0.90 090 50.5826479 C 5.73 11.59 11.59 0.92 090 50.5826480 C 6.68 15.08 15.08 1.02 090 50.5826483 C 8.28 15.54 15.54 1.26 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
26485 C 7.69 15.40 15.40 1.15 090 50.5826489 C 9.54 12.09 12.09 1.26 090 50.5826490 C 8.40 12.86 12.86 1.21 090 50.5826492 C 9.61 13.64 13.64 1.40 090 50.5826494 C 8.46 13.01 13.01 1.28 090 50.5826496 C 9.58 13.27 13.27 1.45 090 50.5826497 C 9.56 13.61 13.61 1.41 090 50.5826498 C 13.98 16.21 16.21 2.10 090 50.5826499 C 8.97 13.08 13.08 1.35 090 50.5826500 C 5.95 11.47 11.47 0.90 090 50.5826502 C 7.13 12.05 12.05 1.13 090 50.5826504 C 7.46 12.62 12.62 1.24 090 50.5826508 C 6.00 11.71 11.71 0.98 090 50.5826510 C 5.42 11.37 11.37 0.79 090 50.5826516 C 7.14 12.27 12.27 1.10 090 50.5826517 C 8.82 13.54 13.54 1.41 090 50.5826518 C 9.01 13.43 13.43 1.35 090 50.5826520 C 5.29 13.93 13.93 0.80 090 50.5826525 C 5.32 14.01 14.01 0.81 090 50.5826530 C 6.68 6.16 6.16 1.04 090 50.5826531 C 7.90 7.14 7.14 1.17 090 50.5826535 C 5.23 3.75 3.75 0.71 090 50.5826536 C 6.36 9.68 9.68 0.96 090 50.5826540 C 6.42 11.90 11.90 0.99 090 50.5826541 C 8.61 13.43 13.43 1.28 090 50.5826542 C 6.77 12.06 12.06 1.02 090 50.5826545 C 6.91 12.17 12.17 1.05 090 50.5826546 C 8.91 15.07 15.07 1.44 090 50.5826548 C 8.02 12.89 12.89 1.20 090 50.5826550 C 21.21 17.63 17.63 2.45 090 50.5826551 C 46.51 32.53 32.53 7.96 090 50.5826553 C 46.20 22.75 22.75 2.41 090 50.5826554 C 54.87 37.64 37.64 9.41 090 50.5826555 C 16.61 18.23 18.23 2.48 090 50.5826556 C 47.19 33.42 33.42 2.57 090 50.5826560 C 5.37 9.83 9.83 0.85 090 50.5826561 C 10.90 12.38 12.38 1.45 090 50.5826562 C 14.98 17.19 17.19 2.23 090 50.5826565 C 6.73 12.04 12.04 1.00 090 50.5826567 C 6.81 11.98 11.98 1.04 090 50.5826568 C 9.07 15.47 15.47 1.49 090 50.5826580 C 18.15 13.68 13.68 2.28 090 50.5826587 C 14.03 9.24 9.24 1.53 090 50.5826590 C 17.93 13.98 13.98 2.77 090 50.5826591 C 3.25 9.65 9.65 0.48 090 50.5826593 C 5.30 11.16 11.16 0.78 090 50.5826596 C 8.94 8.85 8.85 1.43 090 50.5826600 C 1.96 3.62 2.66 0.30 090 50.5826605 C 2.85 4.57 3.66 0.49 090 50.5826607 C 5.35 6.29 6.29 0.87 090 50.5826608 C 5.35 6.27 6.27 0.88 090 50.5826615 C 5.32 5.32 5.32 0.86 090 50.5826641 C 3.93 4.58 3.54 0.39 090 50.5826645 C 4.40 5.18 4.20 0.67 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
26650 C 5.71 6.71 6.71 0.94 090 50.5826665 C 7.59 6.63 6.63 0.90 090 50.5826670 C 3.68 4.27 2.95 0.39 090 50.5826675 C 4.63 5.49 4.48 0.77 090 50.5826676 C 5.51 6.71 6.71 0.91 090 50.5826685 C 6.97 6.16 6.16 1.09 090 50.5826686 C 7.93 6.92 6.92 1.24 090 50.5826700 C 3.68 3.77 2.87 0.35 090 50.5826705 C 4.18 5.35 4.31 0.66 090 50.5826706 C 5.11 5.10 5.10 0.81 090 50.5826715 C 5.73 5.53 5.53 0.91 090 50.5826720 C 1.66 2.79 2.06 0.24 090 50.5826725 C 3.33 4.78 3.51 0.53 090 50.5826727 C 5.22 6.25 6.25 0.84 090 50.5826735 C 5.97 5.57 5.57 0.95 090 50.5826740 C 1.94 3.14 2.71 0.31 090 50.5826742 C 3.84 5.00 3.89 0.58 090 50.5826746 C 5.80 5.58 5.58 0.91 090 50.5826750 C 1.70 2.49 2.02 0.22 090 50.5826755 C 3.10 4.43 3.01 0.42 090 50.5826756 C 4.38 5.74 5.74 0.71 090 50.5826765 C 4.16 4.40 4.40 0.66 090 50.5826770 C 3.02 3.44 2.42 0.27 090 50.5826775 C 3.70 5.21 3.82 0.54 090 50.5826776 C 4.79 6.02 6.02 0.77 090 50.5826785 C 4.20 4.54 4.54 0.68 090 50.5826820 C 8.25 13.29 13.29 1.30 090 50.5826841 C 7.12 13.27 13.27 1.18 090 50.5826842 C 8.23 13.41 13.41 1.32 090 50.5826843 C 7.60 12.39 12.39 1.15 090 50.5826844 C 8.72 13.40 13.40 1.33 090 50.5826850 C 6.96 12.24 12.24 1.06 090 50.5826852 C 8.45 12.93 12.93 1.22 090 50.5826860 C 4.68 11.22 11.22 0.73 090 50.5826861 C 1.74 0.93 0.93 0.27 ZZZ 50.5826862 C 7.36 12.38 12.38 1.10 090 50.5826863 C 3.89 2.12 2.12 0.56 ZZZ 50.5826910 C 7.59 11.25 11.25 1.16 090 50.5826951 C 4.58 10.18 10.18 0.71 090 50.5826952 C 6.30 11.69 11.69 0.95 090 50.5826989 S 0.00 0.00 0.00 0.00 YYY 0.0026990 C 7.47 7.23 7.23 1.22 090 50.5826991 C 6.67 11.19 5.45 1.11 090 50.5826992 C 13.00 10.41 10.41 2.16 090 50.5827000 C 5.61 5.30 5.30 0.98 090 50.5827001 C 6.93 6.11 6.11 1.24 090 50.5827003 C 7.33 6.50 6.50 1.12 090 50.5827005 C 9.65 7.84 7.84 1.72 090 50.5827006 C 9.67 8.00 8.00 1.69 090 50.5827025 C 11.14 8.57 8.57 1.84 090 50.5827030 C 12.99 9.67 9.67 2.26 090 50.5827033 C 13.37 9.95 9.95 2.32 090 50.5827035 C 16.66 11.26 11.26 2.15 090 50.5827036 C 12.86 10.03 10.03 2.26 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
27040 C 2.87 5.25 2.02 0.27 010 50.5827041 C 9.88 6.66 6.66 1.35 090 50.5827047 C 7.44 7.13 4.78 1.03 090 50.5827048 C 6.24 4.81 4.81 0.92 090 50.5827049 C 13.64 8.42 8.42 2.06 090 50.5827050 C 4.35 4.43 4.43 0.60 090 50.5827052 C 6.22 5.90 5.90 1.08 090 50.5827054 C 8.53 7.36 7.36 1.47 090 50.5827060 C 5.42 4.38 4.38 0.80 090 50.5827062 C 5.36 5.21 5.21 0.93 090 50.5827065 C 5.89 5.46 5.46 1.01 090 50.5827066 C 10.31 8.46 8.46 1.79 090 50.5827067 C 13.81 10.69 10.69 1.84 090 50.5827070 C 10.70 9.16 9.16 1.74 090 50.5827071 C 11.44 10.15 10.15 1.92 090 50.5827075 C 34.95 19.26 19.26 5.64 090 50.5827076 C 22.09 14.55 14.55 3.70 090 50.5827077 C 39.94 22.73 22.73 6.12 090 50.5827078 C 13.42 9.97 9.97 2.22 090 50.5827079 C 13.73 9.57 9.57 1.94 090 50.5827080 C 6.38 4.84 4.84 0.93 090 50.5827086 C 1.87 4.56 1.83 0.25 010 50.5827087 C 8.53 6.68 6.68 1.35 090 50.5827090 C 11.13 8.81 8.81 1.94 090 50.5827091 C 22.11 14.03 14.03 3.84 090 50.5827093 C 1.30 4.47 0.48 0.13 000 50.5827095 C 1.50 5.74 0.52 0.14 000 50.5827096 C 1.40 4.36 0.33 0.08 000 50.5827097 C 8.79 6.43 6.43 1.57 090 50.5827098 C 8.82 7.04 7.04 0.95 090 50.5827100 C 11.06 8.69 8.69 1.85 090 50.5827105 C 11.75 9.19 9.19 1.72 090 50.5827110 C 13.24 9.14 9.14 2.18 090 50.5827111 C 12.13 9.16 9.16 1.94 090 50.5827120 C 17.98 11.87 11.87 3.08 090 50.5827122 C 14.96 11.07 11.07 2.61 090 50.5827125 C 14.67 10.65 10.65 2.54 090 50.5827130 C 20.09 13.34 13.34 3.50 090 50.5827132 C 23.27 15.68 15.68 4.04 090 50.5827134 C 28.48 17.84 17.84 4.94 090 50.5827137 C 21.14 13.97 13.97 3.67 090 50.5827138 C 22.14 14.43 14.43 3.84 090 50.5827140 C 12.22 9.44 9.44 2.11 090 50.5827146 C 17.40 12.17 12.17 2.96 090 50.5827147 C 20.55 13.29 13.29 3.57 090 50.5827151 C 22.48 7.97 7.97 3.91 090 50.5827156 C 24.59 16.11 16.11 4.21 090 50.5827158 C 19.71 11.00 11.00 3.16 090 50.5827161 C 16.68 12.14 12.14 2.94 090 50.5827165 C 17.88 12.95 12.95 3.10 090 50.5827170 C 16.05 11.33 11.33 2.81 090 50.5827175 C 8.45 6.69 6.69 1.46 090 50.5827176 C 12.03 9.04 9.04 2.22 090 50.5827177 C 15.06 10.92 10.92 2.61 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
27178 C 11.97 8.44 8.44 2.08 090 50.5827179 C 12.96 10.02 10.02 2.25 090 50.5827181 C 14.66 10.23 10.23 1.57 090 50.5827185 C 9.17 7.54 7.54 2.39 090 50.5827187 C 13.52 10.35 10.35 2.37 090 50.5827193 C 5.55 5.10 5.10 0.96 090 50.5827194 C 9.64 7.67 7.67 1.65 090 50.5827200 C 1.84 2.23 2.16 0.28 090 50.5827202 C 7.03 16.91 16.91 1.06 090 50.5827215 C 10.03 7.10 7.10 1.97 090 50.5827216 C 15.17 9.62 9.62 2.63 090 50.5827217 C 14.09 10.17 10.17 2.41 090 50.5827218 C 20.12 11.43 11.43 3.48 090 50.5827220 C 6.17 5.74 5.65 1.07 090 50.5827222 C 12.68 10.00 10.00 2.19 090 50.5827226 C 14.89 7.83 7.83 2.48 090 50.5827227 C 23.41 15.44 15.44 4.05 090 50.5827228 C 27.12 17.67 17.67 4.66 090 50.5827230 C 5.49 5.53 5.11 0.95 090 50.5827232 C 10.66 7.19 7.19 1.85 090 50.5827235 C 12.14 9.48 9.48 2.11 090 50.5827236 C 15.58 11.08 11.08 2.71 090 50.5827238 C 5.51 5.15 5.15 0.89 090 50.5827240 C 12.48 9.50 9.50 2.16 090 50.5827244 C 15.92 11.33 11.33 2.77 090 50.5827245 C 20.28 13.78 13.78 3.52 090 50.5827246 C 4.70 4.47 4.43 0.81 090 50.5827248 C 10.43 8.23 8.23 1.81 090 50.5827250 C 6.94 4.63 4.63 0.62 090 50.5827252 C 10.37 7.45 7.45 1.66 090 50.5827253 C 12.90 9.81 9.81 2.24 090 50.5827254 C 18.23 12.05 12.05 3.17 090 50.5827256 C 4.11 3.53 2.09 0.46 010 50.5827257 C 5.21 2.82 2.82 0.69 010 50.5827258 C 15.41 10.90 10.90 2.64 090 50.5827259 C 21.52 14.16 14.16 3.74 090 50.5827265 C 5.04 4.80 4.80 0.63 090 50.5827266 C 7.48 6.36 6.36 1.29 090 50.5827275 C 2.27 2.11 2.11 0.39 010 50.5827280 C 13.37 10.29 10.29 2.53 090 50.5827282 C 11.32 8.02 8.02 1.86 090 50.5827284 C 23.41 14.80 14.80 3.92 090 50.5827286 C 23.41 15.84 15.84 3.12 090 50.5827290 C 23.25 14.10 14.10 3.43 090 50.5827295 C 18.62 11.34 11.34 2.95 090 50.5827299 C 0.00 0.00 0.00 0.00 YYY 0.0027301 C 6.48 10.10 5.15 1.04 090 50.5827303 C 8.27 7.00 7.00 1.43 090 50.5827305 C 5.91 5.20 5.20 1.01 090 50.5827306 C 4.61 4.73 4.73 0.85 090 50.5827307 C 5.79 5.40 5.40 1.04 090 50.5827310 C 9.26 7.60 7.60 1.61 090 50.5827315 C 6.96 4.96 4.96 1.09 090 50.5827320 C 6.29 5.25 5.25 1.06 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
27323 C 2.28 3.52 1.89 0.24 010 50.5827324 C 4.89 4.19 4.19 0.75 090 50.5827327 C 4.46 6.01 3.73 0.64 090 50.5827328 C 5.56 4.38 4.38 0.84 090 50.5827329 C 14.12 9.05 9.05 2.14 090 50.5827330 C 4.96 4.58 4.58 0.86 090 50.5827331 C 5.87 5.54 5.54 1.02 090 50.5827332 C 8.26 7.14 7.14 1.43 090 50.5827333 C 7.29 6.69 6.69 1.26 090 50.5827334 C 8.69 7.43 7.43 1.51 090 50.5827335 C 9.99 8.24 8.24 1.74 090 50.5827340 C 4.17 4.57 4.57 0.72 090 50.5827345 C 5.91 5.64 5.64 1.00 090 50.5827347 C 5.77 5.44 5.44 0.98 090 50.5827350 C 8.16 7.26 7.26 1.41 090 50.5827355 C 7.64 6.79 6.79 1.32 090 50.5827356 C 9.47 7.87 7.87 1.65 090 50.5827357 C 10.51 8.73 8.73 1.95 090 50.5827358 C 4.73 2.53 2.53 0.82 ZZZ 50.5827360 C 10.48 9.58 9.58 1.83 090 50.5827365 C 16.25 11.71 11.71 2.79 090 50.5827370 C 0.96 3.73 0.32 0.08 000 50.5827372 C 5.06 10.08 4.70 0.84 090 50.5827380 C 7.15 7.30 7.30 1.24 090 50.5827381 C 10.32 9.12 9.12 1.79 090 50.5827385 C 7.75 7.65 7.65 1.36 090 50.5827386 C 10.54 9.54 9.54 1.85 090 50.5827390 C 5.32 5.12 5.12 0.92 090 50.5827391 C 7.19 6.58 6.58 1.23 090 50.5827392 C 9.19 7.61 7.61 1.57 090 50.5827393 C 6.38 5.85 5.85 1.10 090 50.5827394 C 8.49 7.24 7.24 1.47 090 50.5827395 C 11.71 9.35 9.35 2.04 090 50.5827396 C 7.85 7.02 7.02 1.34 090 50.5827397 C 11.26 9.07 9.07 1.82 090 50.5827400 C 9.01 7.27 7.27 1.31 090 50.5827403 C 8.32 7.20 7.20 1.44 090 50.5827405 C 8.64 7.51 7.51 1.51 090 50.5827407 C 10.26 8.34 8.34 1.78 090 50.5827409 C 12.88 9.98 9.98 2.24 090 50.5827412 C 23.23 14.84 14.84 4.35 090 50.5827415 C 18.49 12.59 12.59 4.35 090 50.5827418 C 10.83 8.93 8.93 1.88 090 50.5827420 C 9.82 8.13 8.13 1.71 090 50.5827422 C 9.77 8.14 8.14 1.70 090 50.5827424 C 9.80 8.11 8.11 1.70 090 50.5827425 C 5.21 5.54 5.54 0.90 090 50.5827427 C 9.35 7.82 7.82 1.63 090 50.5827428 C 13.98 11.27 11.27 2.42 090 50.5827429 C 15.50 12.45 12.45 2.70 090 50.5827430 C 9.66 8.02 8.02 1.69 090 50.5827435 C 9.48 8.50 8.50 1.69 090 50.5827437 C 8.45 7.26 7.26 1.49 090 50.5827438 C 11.21 8.56 8.56 1.95 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
27440 C 10.41 6.01 6.01 1.81 090 50.5827441 C 10.80 6.73 6.73 1.88 090 50.5827442 C 11.87 8.94 8.94 2.09 090 50.5827443 C 10.91 8.75 8.75 1.90 090 50.5827445 C 17.65 12.39 12.39 3.08 090 50.5827446 C 15.82 11.30 11.30 2.80 090 50.5827447 C 21.45 14.64 14.64 3.79 090 50.5827448 C 11.04 8.62 8.62 1.94 090 50.5827450 C 13.96 10.61 10.61 2.42 090 50.5827454 C 17.53 12.54 12.54 3.12 090 50.5827455 C 12.80 9.91 9.91 2.24 090 50.5827457 C 13.43 9.95 9.95 2.34 090 50.5827465 C 13.85 10.25 10.25 2.47 090 50.5827466 C 16.31 11.86 11.86 2.77 090 50.5827468 C 18.94 12.39 12.39 3.30 090 50.5827470 C 16.05 11.82 11.82 2.79 090 50.5827472 C 17.69 12.72 12.72 3.07 090 50.5827475 C 8.63 7.23 7.23 1.36 090 50.5827477 C 9.84 7.75 7.75 1.73 090 50.5827479 C 12.78 9.67 9.67 2.78 090 50.5827485 C 8.83 7.42 7.42 1.53 090 50.5827486 C 19.24 13.53 13.53 3.36 090 50.5827487 C 25.23 16.60 16.60 4.39 090 50.5827488 C 15.72 11.73 11.73 2.74 090 50.5827495 C 15.53 11.44 11.44 2.71 090 50.5827496 C 6.10 5.62 5.62 0.99 090 50.5827497 C 7.16 5.45 5.45 1.15 090 50.5827498 C 7.98 5.97 5.97 1.24 090 50.5827499 C 8.99 6.84 6.84 1.47 090 50.5827500 C 5.91 6.14 5.00 1.02 090 50.5827501 C 5.91 5.81 5.40 1.03 090 50.5827502 C 10.56 8.13 8.13 1.78 090 50.5827503 C 10.56 8.31 8.31 1.84 090 50.5827506 C 17.42 12.82 12.82 3.03 090 50.5827507 C 13.97 9.87 9.87 2.42 090 50.5827508 C 5.82 6.48 5.50 0.97 090 50.5827509 C 7.70 7.98 7.98 1.34 090 50.5827510 C 9.12 7.35 7.35 1.53 090 50.5827511 C 13.62 11.23 11.23 2.37 090 50.5827513 C 17.89 13.92 13.92 3.12 090 50.5827514 C 17.27 13.39 13.39 3.00 090 50.5827516 C 5.36 6.37 5.53 0.81 090 50.5827517 C 8.77 7.47 7.47 1.22 090 50.5827519 C 15.00 11.62 11.62 2.55 090 50.5827520 C 2.86 4.55 3.45 0.47 090 50.5827524 C 9.99 8.25 8.25 1.74 090 50.5827530 C 3.77 5.33 4.43 0.65 090 50.5827532 C 7.29 7.38 6.47 1.26 090 50.5827535 C 11.48 10.14 10.14 2.00 090 50.5827536 C 15.63 11.64 11.64 2.73 090 50.5827538 C 4.86 6.15 5.21 0.84 090 50.5827540 C 13.08 9.54 9.54 2.27 090 50.5827550 C 5.75 6.03 4.94 0.76 090 50.5827552 C 7.89 6.97 6.97 1.36 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
27556 C 14.39 11.68 11.68 2.50 090 50.5827557 C 16.74 13.16 13.16 2.97 090 50.5827558 C 17.69 13.08 13.08 3.08 090 50.5827560 C 3.81 4.85 3.19 0.40 090 50.5827562 C 5.78 4.78 4.78 0.94 090 50.5827566 C 12.21 9.35 9.35 2.12 090 50.5827570 C 1.74 1.78 1.78 0.30 010 50.5827580 C 19.34 14.84 14.84 3.37 090 50.5827590 C 12.01 6.69 6.69 1.74 090 50.5827591 C 12.66 8.67 8.67 2.02 090 50.5827592 C 10.00 6.19 6.19 1.45 090 50.5827594 C 6.91 5.18 5.18 1.02 090 50.5827596 C 10.58 6.83 6.83 1.57 090 50.5827598 C 10.51 7.04 7.04 1.65 090 50.5827599 S 0.00 0.00 0.00 0.00 YYY 0.0027600 C 5.64 4.54 4.54 0.86 090 50.5827601 C 5.63 4.86 4.86 0.80 090 50.5827602 C 7.34 5.14 5.14 1.10 090 50.5827603 C 4.93 7.51 4.17 0.74 090 50.5827604 C 4.46 6.10 3.97 0.69 090 50.5827605 C 2.87 7.70 2.33 0.41 010 50.5827606 C 4.13 3.37 3.37 0.69 010 50.5827607 C 7.96 6.19 6.19 1.31 090 50.5827610 C 8.33 7.02 7.02 1.40 090 50.5827612 C 7.32 6.11 6.11 1.13 090 50.5827613 C 2.17 3.24 1.81 0.20 010 50.5827614 C 5.65 7.15 4.45 0.78 090 50.5827615 C 12.54 9.42 9.42 1.83 090 50.5827618 C 5.08 6.03 4.00 0.72 090 50.5827619 C 8.39 9.54 5.97 1.25 090 50.5827620 C 5.97 5.48 5.48 0.97 090 50.5827625 C 8.29 6.48 6.48 1.28 090 50.5827626 C 8.90 6.94 6.94 1.48 090 50.5827630 C 4.79 7.58 4.39 0.74 090 50.5827635 C 7.77 6.76 6.76 1.31 090 50.5827637 C 9.84 8.31 8.31 1.66 090 50.5827638 C 10.55 8.31 8.31 1.84 090 50.5827640 C 11.35 10.34 10.34 1.88 090 50.5827641 C 9.23 8.36 8.36 1.46 090 50.5827645 C 14.15 12.08 12.08 2.41 090 50.5827646 C 12.64 11.06 11.06 2.05 090 50.5827647 C 12.22 7.63 7.63 1.75 090 50.5827648 C 0.96 3.53 0.33 0.08 000 50.5827650 C 9.68 7.53 7.53 1.59 090 50.5827652 C 10.31 8.05 8.05 1.71 090 50.5827654 C 10.00 7.16 7.16 1.58 090 50.5827656 C 4.56 8.55 3.78 0.69 090 50.5827658 C 4.97 4.57 4.57 0.79 090 50.5827659 C 6.80 5.66 5.66 1.09 090 50.5827664 C 4.58 4.56 4.56 0.76 090 50.5827665 C 5.39 4.98 4.98 0.89 090 50.5827675 C 7.17 5.75 5.75 1.11 090 50.5827676 C 8.41 6.77 6.77 1.37 090 50.5827680 C 5.73 5.12 5.12 0.93 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
27681 C 6.81 5.93 5.93 1.15 090 50.5827685 C 6.49 7.31 5.48 0.97 090 50.5827686 C 7.45 6.51 6.51 1.24 090 50.5827687 C 6.23 5.33 5.33 1.00 090 50.5827690 C 8.70 6.37 6.37 1.33 090 50.5827691 C 9.95 7.78 7.78 1.64 090 50.5827692 C 1.87 0.93 0.93 0.32 ZZZ 50.5827695 C 6.50 5.89 5.89 1.05 090 50.5827696 C 8.26 6.45 6.45 1.28 090 50.5827698 C 9.35 6.96 6.96 1.47 090 50.5827700 C 9.28 5.70 5.70 1.30 090 50.5827702 C 13.65 10.49 10.49 2.37 090 50.5827703 C 15.85 11.26 11.26 2.76 090 50.5827704 C 7.61 5.61 5.61 1.27 090 50.5827705 C 10.36 8.19 8.19 1.80 090 50.5827707 C 4.36 4.95 4.95 0.76 090 50.5827709 C 9.94 8.15 8.15 1.73 090 50.5827712 C 14.23 10.77 10.77 2.47 090 50.5827715 C 14.37 10.80 10.80 2.49 090 50.5827720 C 11.77 9.43 9.43 2.04 090 50.5827722 C 11.80 9.16 9.16 2.05 090 50.5827724 C 18.17 12.40 12.40 3.16 090 50.5827725 C 15.57 11.94 11.94 2.71 090 50.5827727 C 13.99 10.37 10.37 2.43 090 50.5827730 C 7.40 6.44 6.44 1.72 090 50.5827732 C 5.31 4.94 4.94 0.77 090 50.5827734 C 8.47 6.30 6.30 1.35 090 50.5827740 C 9.29 8.01 8.01 1.62 090 50.5827742 C 10.28 5.58 5.58 1.79 090 50.5827745 C 10.05 8.19 8.19 1.75 090 50.5827750 C 3.19 4.77 3.86 0.55 090 50.5827752 C 5.83 6.67 5.69 1.01 090 50.5827756 C 6.77 6.48 6.48 1.17 090 50.5827758 C 11.65 9.21 9.21 2.03 090 50.5827759 C 13.74 10.34 10.34 2.38 090 50.5827760 C 3.01 4.69 3.60 0.48 090 50.5827762 C 5.24 6.35 5.29 0.85 090 50.5827766 C 8.35 7.24 7.24 1.44 090 50.5827780 C 2.65 4.19 3.22 0.41 090 50.5827781 C 4.39 5.51 4.65 0.73 090 50.5827784 C 7.10 6.49 6.49 1.23 090 50.5827786 C 2.84 4.47 3.34 0.46 090 50.5827788 C 4.44 5.66 4.66 0.74 090 50.5827792 C 7.65 6.98 6.98 1.32 090 50.5827808 C 2.83 4.81 3.71 0.46 090 50.5827810 C 5.12 6.26 5.16 0.82 090 50.5827814 C 10.66 8.58 8.58 1.85 090 50.5827816 C 2.89 4.39 3.42 0.43 090 50.5827818 C 5.49 6.39 5.18 0.82 090 50.5827822 C 10.98 10.68 10.68 1.91 090 50.5827823 C 12.98 11.50 11.50 2.25 090 50.5827824 C 2.89 4.07 3.57 0.45 090 50.5827825 C 6.18 6.62 5.40 1.02 090 50.5827826 C 8.53 8.85 8.85 1.47 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
27827 C 14.04 12.80 12.80 2.43 090 50.5827828 C 16.21 13.97 13.97 2.81 090 50.5827829 C 5.48 6.80 6.80 0.95 090 50.5827830 C 3.78 4.40 3.86 0.54 090 50.5827831 C 4.55 4.47 4.47 0.73 090 50.5827832 C 6.48 6.19 6.19 1.03 090 50.5827840 C 4.57 3.77 3.77 0.46 090 50.5827842 C 6.20 5.13 5.13 1.00 090 50.5827846 C 9.78 7.95 7.95 1.70 090 50.5827848 C 11.18 9.74 9.74 1.94 090 50.5827860 C 2.34 1.99 1.99 0.39 010 50.5827870 C 13.89 10.55 10.55 2.36 090 50.5827871 C 9.16 7.60 7.60 1.59 090 50.5827880 C 11.83 7.15 7.15 1.75 090 50.5827881 C 12.32 8.87 8.87 1.98 090 50.5827882 C 8.93 6.50 6.50 1.29 090 50.5827884 C 8.20 5.77 5.77 1.22 090 50.5827886 C 9.31 6.53 6.53 1.40 090 50.5827888 C 9.66 7.52 7.52 1.51 090 50.5827889 C 9.97 6.49 6.49 1.46 090 50.5827892 C 7.38 5.61 5.61 1.10 090 50.5827893 C 7.34 5.48 5.48 1.10 090 50.5827894 C 10.47 7.79 7.79 1.65 090 50.5827899 S 0.00 0.00 0.00 0.00 YYY 0.0028001 C 2.73 2.99 1.96 0.33 010 50.5828002 C 4.61 5.00 3.78 0.61 010 50.5828003 C 8.40 6.25 5.24 1.12 090 50.5828005 C 8.67 6.06 6.06 1.16 090 50.5828008 C 4.44 4.56 3.21 0.57 090 50.5828010 C 2.84 2.38 2.38 0.36 090 50.5828011 C 4.13 3.31 3.31 0.59 090 50.5828020 C 5.00 6.03 4.14 0.72 090 50.5828022 C 4.66 5.21 3.86 0.62 090 50.5828024 C 4.37 5.23 3.93 0.58 090 50.5828030 C 6.14 3.66 3.66 0.74 090 50.5828035 C 5.08 5.87 4.10 0.70 090 50.5828043 C 3.53 3.82 3.18 0.46 090 50.5828045 C 4.71 5.39 3.61 0.63 090 50.5828046 C 10.16 8.79 6.49 1.36 090 50.5828050 C 4.24 4.90 3.60 0.60 090 50.5828052 C 3.93 4.92 3.44 0.53 090 50.5828054 C 3.44 4.73 3.24 0.46 090 50.5828060 C 5.22 5.49 3.88 0.70 090 50.5828062 C 6.51 6.53 4.02 0.83 090 50.5828070 C 5.09 5.23 3.82 0.73 090 50.5828072 C 4.57 5.54 4.31 0.68 090 50.5828080 C 3.57 5.12 3.69 0.47 090 50.5828086 C 4.77 8.00 4.69 0.76 090 50.5828088 C 3.85 5.77 3.90 0.61 090 50.5828090 C 4.40 5.15 3.46 0.59 090 50.5828092 C 3.63 5.23 3.53 0.49 090 50.5828100 C 5.65 7.98 4.70 0.82 090 50.5828102 C 7.72 5.96 5.96 1.14 090 50.5828103 C 6.49 4.62 4.62 0.91 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
28104 C 5.11 5.50 3.93 0.70 090 50.5828106 C 7.15 4.44 4.44 0.97 090 50.5828107 C 5.55 6.54 4.21 0.74 090 50.5828108 C 4.15 4.60 3.26 0.53 090 50.5828110 C 4.07 5.23 3.23 0.54 090 50.5828111 C 5.00 6.29 3.66 0.67 090 50.5828112 C 4.48 5.82 3.58 0.61 090 50.5828113 C 4.78 6.07 4.32 0.63 090 50.5828114 C 9.78 11.65 8.39 1.42 090 50.5828116 C 7.74 6.81 5.18 1.03 090 50.5828118 C 5.95 6.26 4.35 0.84 090 50.5828119 C 5.38 5.44 3.73 0.70 090 50.5828120 C 5.39 7.30 4.42 0.77 090 50.5828122 C 7.28 6.85 5.28 0.98 090 50.5828124 C 4.80 5.00 3.66 0.60 090 50.5828126 C 3.51 4.22 3.00 0.45 090 50.5828130 C 8.10 6.73 6.73 1.26 090 50.5828140 C 6.90 7.24 4.77 0.92 090 50.5828150 C 4.08 4.84 3.29 0.53 090 50.5828153 C 3.65 4.32 2.69 0.47 090 50.5828160 C 3.73 4.57 3.34 0.49 090 50.5828171 C 9.59 5.44 5.44 1.33 090 50.5828173 C 8.79 7.61 5.21 1.12 090 50.5828175 C 6.04 5.72 3.71 0.73 090 50.5828190 C 1.96 3.40 1.48 0.22 010 50.5828192 C 4.63 5.49 3.65 0.61 090 50.5828193 C 5.72 5.62 3.93 0.73 090 50.5828200 C 4.59 5.10 3.56 0.61 090 50.5828202 C 6.83 7.23 4.50 0.91 090 50.5828208 C 4.36 4.82 3.31 0.58 090 50.5828210 C 6.34 6.23 4.03 0.81 090 50.5828220 C 4.52 4.68 3.43 0.57 090 50.5828222 C 5.61 5.25 4.13 0.69 090 50.5828225 C 3.65 4.29 2.91 0.46 090 50.5828226 C 4.52 4.80 3.75 0.58 090 50.5828230 C 4.23 4.68 3.68 0.55 090 50.5828232 C 3.38 4.53 3.32 0.44 090 50.5828234 C 3.36 4.68 3.36 0.44 090 50.5828238 C 7.72 7.26 4.94 1.06 090 50.5828240 C 4.35 4.64 3.49 0.58 090 50.5828250 C 5.91 5.64 4.14 0.82 090 50.5828260 C 7.95 6.34 5.00 1.14 090 50.5828261 C 11.71 8.63 7.32 1.57 090 50.5828262 C 15.81 13.59 10.94 2.59 090 50.5828264 C 10.33 7.75 7.30 1.54 090 50.5828270 C 4.75 4.90 3.74 0.62 090 50.5828272 C 3.79 4.19 2.86 0.46 090 50.5828280 C 5.18 6.26 4.49 0.73 090 50.5828285 C 4.58 4.87 3.43 0.59 090 50.5828286 C 4.55 4.80 3.26 0.57 090 50.5828288 C 4.73 5.95 4.89 0.65 090 50.5828289 C 7.03 8.00 5.78 1.02 090 50.5828290 C 5.65 6.27 4.73 0.82 090 50.5828292 C 7.03 7.48 5.55 0.91 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
28293 C 9.14 10.77 6.12 1.13 090 50.5828294 C 8.55 7.45 4.72 1.09 090 50.5828296 C 9.17 8.17 5.43 1.19 090 50.5828297 C 9.17 8.97 6.27 1.32 090 50.5828298 C 7.93 7.23 5.01 1.05 090 50.5828299 C 10.56 8.79 6.08 1.37 090 50.5828300 C 9.53 7.05 7.05 1.54 090 50.5828302 C 9.54 6.90 6.90 1.42 090 50.5828304 C 9.15 7.96 5.75 1.27 090 50.5828305 C 10.48 6.74 6.74 1.27 090 50.5828306 C 5.85 6.85 4.18 0.84 090 50.5828307 C 6.32 11.05 5.30 0.90 090 50.5828308 C 5.28 5.76 3.69 0.70 090 50.5828309 C 12.76 7.97 7.97 2.04 090 50.5828310 C 5.42 5.76 3.56 0.70 090 50.5828312 C 4.54 5.45 3.64 0.63 090 50.5828313 C 5.00 5.29 4.84 0.73 090 50.5828315 C 4.85 4.90 3.34 0.63 090 50.5828320 C 9.17 6.73 6.73 1.43 090 50.5828322 C 8.33 9.20 6.35 1.27 090 50.5828340 C 6.97 6.46 4.25 0.84 090 50.5828341 C 8.40 6.95 4.82 1.01 090 50.5828344 C 4.25 5.76 3.64 0.51 090 50.5828345 C 5.91 6.21 4.69 0.80 090 50.5828360 C 13.32 10.52 10.52 2.28 090 50.5828400 C 2.16 3.64 3.06 0.35 090 50.5828405 C 4.56 4.84 4.63 0.73 090 50.5828406 C 6.30 6.81 6.81 1.11 090 50.5828415 C 15.95 13.32 13.32 2.66 090 50.5828420 C 16.62 12.95 12.95 2.80 090 50.5828430 C 2.09 3.40 2.57 0.31 090 50.5828435 C 3.39 3.89 3.75 0.55 090 50.5828436 C 4.70 5.93 5.93 0.81 090 50.5828445 C 15.60 11.06 11.06 2.58 090 50.5828450 C 1.90 3.12 2.48 0.28 090 50.5828455 C 3.09 3.43 3.43 0.44 090 50.5828456 C 2.68 4.16 4.16 0.44 090 50.5828465 C 7.00 6.33 6.33 1.10 090 50.5828470 C 1.99 3.13 2.45 0.30 090 50.5828475 C 2.97 3.34 3.22 0.44 090 50.5828476 C 3.37 4.99 4.99 0.54 090 50.5828485 C 5.70 5.46 5.46 0.83 090 50.5828490 C 1.09 2.02 1.64 0.14 090 50.5828495 C 1.58 2.18 2.07 0.20 090 50.5828496 C 2.33 8.27 3.20 0.36 090 50.5828505 C 3.80 8.12 3.91 0.56 090 50.5828510 C 1.09 1.53 1.53 0.14 090 50.5828515 C 1.46 1.90 1.90 0.18 090 50.5828525 C 3.32 7.53 3.44 0.49 090 50.5828530 C 1.06 1.44 1.44 0.14 090 50.5828531 C 2.35 7.28 2.07 0.34 090 50.5828540 C 2.04 2.41 2.41 0.26 090 50.5828545 C 2.45 2.35 2.35 0.37 090 50.5828546 C 3.20 6.93 4.39 0.52 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
28555 C 6.29 9.93 5.69 1.04 090 50.5828570 C 1.66 2.43 2.34 0.23 090 50.5828575 C 3.31 3.73 3.73 0.56 090 50.5828576 C 4.16 4.18 4.18 0.69 090 50.5828585 C 7.98 7.34 5.85 1.25 090 50.5828600 C 1.89 2.82 2.69 0.27 090 50.5828605 C 2.71 3.13 3.13 0.40 090 50.5828606 C 4.89 4.70 4.70 0.82 090 50.5828615 C 7.76 8.06 8.06 1.30 090 50.5828630 C 1.70 1.57 1.00 0.20 010 50.5828635 C 1.91 2.03 1.53 0.26 010 50.5828636 C 2.77 3.88 2.63 0.43 010 50.5828645 C 4.21 4.96 3.28 0.57 090 50.5828660 C 1.23 1.26 0.79 0.13 010 50.5828665 C 1.92 1.43 1.43 0.26 010 50.5828666 C 2.66 5.90 2.59 0.43 010 50.5828675 C 2.92 7.16 3.36 0.45 090 50.5828705 C 18.77 12.47 12.47 3.08 090 50.5828715 C 13.08 9.78 9.78 2.16 090 50.5828725 C 11.59 8.26 8.26 1.86 090 50.5828730 C 10.74 8.50 8.50 1.70 090 50.5828735 C 10.83 7.84 7.84 1.68 090 50.5828737 C 9.63 6.82 6.82 1.47 090 50.5828740 C 8.01 10.89 6.48 1.22 090 50.5828750 C 7.29 11.94 6.68 1.13 090 50.5828755 C 4.73 6.12 3.76 0.65 090 50.5828760 C 7.74 7.99 5.53 1.05 090 50.5828800 C 8.20 5.81 5.81 1.15 090 50.5828805 C 8.38 5.66 5.66 1.18 090 50.5828810 C 6.20 4.48 4.48 0.86 090 50.5828820 C 4.40 7.57 3.79 0.61 090 50.5828825 C 3.58 7.01 3.49 0.50 090 50.5828890 C 3.30 5.73 2.09 0.41 090 50.5828899 S 0.00 0.00 0.00 0.00 YYY 0.0029000 C 2.25 2.97 1.74 0.41 000 50.5829010 C 2.06 3.29 1.78 0.45 000 50.5829015 C 2.41 2.98 1.60 0.28 000 50.5829020 C 2.11 3.19 1.41 0.28 000 50.5829025 C 2.40 3.15 1.86 0.44 000 50.5829035 C 1.77 3.62 1.58 0.28 000 50.5829040 C 2.22 2.47 1.51 0.36 000 50.5829044 C 2.12 3.98 1.91 0.35 000 50.5829046 C 2.41 3.24 2.10 0.42 000 50.5829049 C 0.89 1.30 0.53 0.13 000 50.5829055 C 1.78 2.99 1.47 0.30 000 50.5829058 C 1.31 1.56 0.72 0.17 000 50.5829065 C 0.87 1.33 0.75 0.15 000 50.5829075 C 0.77 1.26 0.68 0.13 000 50.5829085 C 0.87 1.28 0.63 0.14 000 50.5829086 C 0.62 0.96 0.49 0.07 000 50.5829105 C 0.87 1.23 0.51 0.12 000 50.5829125 C 0.59 1.02 0.39 0.07 000 50.5829126 C 0.77 1.21 0.46 0.07 000 50.5829130 C 0.50 0.47 0.17 0.06 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
29131 C 0.55 0.74 0.24 0.03 000 50.5829200 C 0.65 0.72 0.34 0.04 000 50.5829220 C 0.64 0.72 0.39 0.04 000 50.5829240 C 0.71 0.85 0.36 0.06 000 50.5829260 C 0.55 0.74 0.32 0.05 000 50.5829280 C 0.51 0.80 0.32 0.03 000 50.5829305 C 2.03 3.35 1.77 0.35 000 50.5829325 C 2.32 3.54 1.96 0.40 000 50.5829345 C 1.40 1.77 1.06 0.24 000 50.5829355 C 1.53 1.71 1.12 0.26 000 50.5829358 C 1.43 2.07 1.09 0.25 000 50.5829365 C 1.18 1.66 0.95 0.20 000 50.5829405 C 0.86 1.22 0.71 0.14 000 50.5829425 C 1.01 1.23 0.74 0.15 000 50.5829435 C 1.18 1.56 0.93 0.20 000 50.5829440 C 0.57 0.69 0.27 0.08 000 50.5829445 C 1.78 1.81 0.96 0.27 000 50.5829450 C 2.08 1.47 1.09 0.27 000 50.5829505 C 0.69 1.18 0.45 0.08 000 50.5829515 C 0.73 0.87 0.46 0.09 000 50.5829520 C 0.54 0.85 0.47 0.03 000 50.5829530 C 0.57 0.79 0.33 0.05 000 50.5829540 C 0.51 0.42 0.31 0.06 000 50.5829550 C 0.47 0.42 0.28 0.06 000 50.5829580 C 0.57 0.65 0.35 0.07 000 50.5829590 C 0.76 0.51 0.29 0.09 000 50.5829700 C 0.57 0.89 0.28 0.08 000 50.5829705 C 0.76 0.82 0.38 0.13 000 50.5829710 C 1.34 1.53 0.70 0.20 000 50.5829715 C 0.94 1.17 0.40 0.09 000 50.5829720 C 0.68 1.16 0.39 0.12 000 50.5829730 C 0.75 0.81 0.35 0.12 000 50.5829740 C 1.12 1.15 0.49 0.18 000 50.5829750 C 1.26 1.06 0.58 0.21 000 50.5829799 S 0.00 0.00 0.00 0.00 YYY 0.0029800 C 6.42 6.99 6.99 0.99 090 50.5829804 C 8.13 7.64 7.64 1.38 090 50.5829805 C 5.88 5.69 5.69 1.02 090 50.5829806 C 14.35 11.19 11.19 2.49 090 50.5829807 C 13.88 11.02 11.02 2.41 090 50.5829819 C 7.61 6.81 6.81 1.32 090 50.5829820 C 7.06 6.24 6.24 1.22 090 50.5829821 C 7.71 6.82 6.82 1.33 090 50.5829822 C 7.42 6.71 6.71 1.28 090 50.5829823 C 8.16 7.24 7.24 1.41 090 50.5829824 C 8.24 7.55 7.55 1.42 090 50.5829825 C 7.61 6.78 6.78 1.32 090 50.5829826 C 8.98 7.55 7.55 1.55 090 50.5829827 C 15.34 11.56 11.56 2.66 090 50.5829830 C 5.75 5.36 5.36 0.99 090 50.5829834 C 6.27 5.85 5.85 1.08 090 50.5829835 C 6.47 5.90 5.90 1.13 090 50.5829836 C 7.54 6.81 6.81 1.22 090 50.5829837 C 6.86 6.15 6.15 1.19 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
29838 C 7.70 6.91 6.91 1.30 090 50.5829840 C 5.53 5.34 5.34 0.84 090 50.5829843 C 6.00 5.64 5.64 0.92 090 50.5829844 C 6.36 5.84 5.84 1.04 090 50.5829845 C 7.51 6.49 6.49 0.99 090 50.5829846 C 6.74 6.07 6.07 1.07 090 50.5829847 C 7.07 6.21 6.21 1.08 090 50.5829848 C 5.43 5.62 5.62 0.86 090 50.5829850 C 8.18 5.05 5.05 1.25 090 50.5829851 C 13.08 9.82 9.82 2.34 090 50.5829855 C 10.60 8.79 8.79 1.84 090 50.5829856 C 14.12 10.70 10.70 2.39 090 50.5829860 C 8.04 6.97 6.97 1.36 090 50.5829861 C 9.14 7.36 7.36 1.59 090 50.5829862 C 9.89 8.58 8.58 1.62 090 50.5829863 C 9.89 8.53 8.53 1.42 090 50.5829866 C 13.88 11.38 11.38 2.39 090 50.5829867 C 17.00 13.26 13.26 2.78 090 50.5829868 C 23.59 16.84 16.84 4.35 090 50.5829870 C 5.06 4.90 4.90 0.85 090 50.5829871 C 6.54 5.89 5.89 1.14 090 50.5829873 C 5.99 6.59 6.59 1.04 090 50.5829874 C 7.04 6.09 6.09 1.11 090 50.5829875 C 6.30 5.87 5.87 1.09 090 50.5829876 C 7.91 7.04 7.04 1.37 090 50.5829877 C 7.34 6.76 6.76 1.28 090 50.5829879 C 8.03 7.14 7.14 1.39 090 50.5829880 C 8.49 7.38 7.38 1.47 090 50.5829881 C 7.75 6.98 6.98 1.34 090 50.5829882 C 8.64 7.26 7.26 1.50 090 50.5829883 C 11.03 9.09 9.09 1.92 090 50.5829884 C 7.32 6.72 6.72 1.27 090 50.5829885 C 9.08 7.99 7.99 1.58 090 50.5829886 C 7.53 6.87 6.87 1.30 090 50.5829887 C 9.03 7.95 7.95 1.57 090 50.5829888 C 13.88 10.23 10.23 2.41 090 50.5829889 C 15.98 12.47 12.47 2.78 090 50.5829891 C 8.39 7.53 7.53 1.39 090 50.5829892 C 8.99 7.76 7.76 1.41 090 50.5829893 C 5.21 6.30 4.00 0.63 090 50.5829894 C 7.20 5.49 5.49 1.15 090 50.5829895 C 6.98 5.49 5.49 1.11 090 50.5829897 C 7.17 5.90 5.90 1.17 090 50.5829898 C 8.31 6.21 6.21 1.28 090 50.5829899 C 13.89 10.57 10.57 2.40 090 50.5829900 C 5.41 5.88 5.88 0.94 090 50.5829901 C 6.12 6.28 6.28 1.06 090 50.5829902 C 6.69 6.56 6.56 1.12 090 50.5829999 S 0.00 0.00 0.00 0.00 YYY 0.0030000 C 1.43 4.08 1.39 0.12 010 50.5830020 C 1.43 3.28 1.47 0.12 010 50.5830100 C 0.94 1.98 0.82 0.07 000 50.5830110 C 1.63 3.25 1.57 0.14 010 50.5830115 C 4.34 5.78 5.78 0.41 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
30117 C 3.16 13.18 4.64 0.26 090 50.5830118 C 9.68 9.22 9.22 0.78 090 50.5830120 C 5.26 6.51 6.02 0.52 090 50.5830124 C 3.10 3.62 3.62 0.25 090 50.5830125 C 7.15 8.34 8.34 0.63 090 50.5830130 C 3.37 5.61 5.61 0.31 090 50.5830140 C 3.42 6.21 6.21 0.35 090 50.5830150 C 9.13 11.04 11.04 0.93 090 50.5830160 C 9.57 10.24 10.24 0.88 090 50.5830200 C 0.78 1.62 0.74 0.06 000 50.5830210 C 1.08 2.11 1.31 0.09 010 50.5830220 C 1.54 4.24 1.53 0.12 010 50.5830300 C 1.04 4.64 1.92 0.08 010 50.5830310 C 1.96 3.11 3.11 0.16 010 50.5830320 C 4.51 7.06 7.06 0.39 090 50.5830400 C 9.82 15.53 15.53 1.04 090 50.5830410 C 12.96 18.42 18.42 1.42 090 50.5830420 C 15.86 17.96 17.96 1.46 090 50.5830430 C 7.20 16.06 16.06 0.77 090 50.5830435 C 11.69 19.41 19.41 1.22 090 50.5830450 C 18.62 21.95 21.95 1.96 090 50.5830460 C 9.95 9.97 9.97 1.03 090 50.5830462 C 19.54 20.30 20.30 2.53 090 50.5830465 C 11.62 12.00 12.00 1.06 090 50.5830520 C 5.69 6.68 6.68 0.46 090 50.5830540 C 7.74 9.30 9.30 0.67 090 50.5830545 C 11.36 11.93 11.93 1.70 090 50.5830560 C 1.26 4.78 2.14 0.10 010 50.5830580 C 6.68 7.79 5.81 0.89 090 50.5830600 C 6.01 7.54 5.03 0.70 090 50.5830620 C 5.96 8.86 8.86 0.57 090 50.5830630 C 7.11 7.97 7.97 0.61 090 50.5830801 C 1.09 4.14 1.93 0.09 010 50.5830802 C 2.03 4.62 2.37 0.16 010 50.5830901 C 1.21 1.36 0.32 0.11 000 50.5830903 C 1.54 2.72 0.50 0.13 000 50.5830905 C 1.97 3.52 0.76 0.17 000 50.5830906 C 2.45 3.90 1.20 0.20 000 50.5830915 C 7.19 6.71 6.71 0.58 090 50.5830920 C 9.82 9.00 9.00 0.80 090 50.5830930 C 1.26 1.62 1.62 0.12 010 50.5830999 S 0.00 0.00 0.00 0.00 YYY 0.0031000 C 1.15 2.85 1.40 0.09 010 50.5831002 C 1.91 3.25 3.25 0.15 010 50.5831020 C 2.94 8.55 5.20 0.29 090 50.5831030 C 5.91 11.53 6.68 0.60 090 50.5831032 C 6.56 7.25 7.25 0.59 090 50.5831040 C 9.41 9.85 9.85 0.87 090 50.5831050 C 5.27 6.37 6.37 0.49 090 50.5831051 C 7.10 8.26 8.26 0.62 090 50.5831070 C 4.27 5.95 5.95 0.38 090 50.5831075 C 9.15 9.76 9.76 0.75 090 50.5831080 C 11.40 13.57 13.57 1.23 090 50.5831081 C 12.73 14.04 14.04 2.46 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
31084 C 13.49 13.54 13.54 1.19 090 50.5831085 C 14.18 14.00 14.00 1.72 090 50.5831086 C 12.84 13.32 13.32 1.07 090 50.5831087 C 13.08 12.57 12.57 1.44 090 50.5831090 C 9.52 12.59 12.59 0.94 090 50.5831200 C 4.96 9.24 9.24 0.29 090 50.5831201 C 8.36 9.20 9.20 0.82 090 50.5831205 C 10.22 11.91 11.91 0.67 090 50.5831225 C 19.20 17.87 17.87 1.59 090 50.5831230 C 21.91 19.42 19.42 1.77 090 50.5831231 C 1.10 3.39 0.88 0.09 000 50.5831233 C 2.18 4.31 1.48 0.20 000 50.5831235 C 2.64 4.92 1.72 0.26 000 50.5831237 C 2.98 5.21 1.89 0.28 000 50.5831238 C 3.26 5.25 2.10 0.27 000 50.5831239 C 8.69 8.02 8.02 0.62 010 50.5831240 C 2.61 1.74 1.74 0.24 000 50.5831254 C 4.64 2.86 2.86 0.45 000 50.5831255 C 6.95 4.12 4.12 0.73 000 50.5831256 C 3.29 2.12 2.12 0.33 000 50.5831267 C 5.45 3.30 3.30 0.55 000 50.5831276 C 8.84 5.13 5.13 0.92 000 50.5831287 C 3.91 2.46 2.46 0.39 000 50.5831288 C 4.57 2.82 2.82 0.46 000 50.5831290 C 17.21 12.08 12.08 1.40 010 50.5831291 C 18.16 12.51 12.51 1.68 010 50.5831292 C 14.74 10.64 10.64 1.21 010 50.5831293 C 16.19 11.41 11.41 1.28 010 50.5831294 C 19.03 12.91 12.91 1.53 010 50.5831299 S 0.00 0.00 0.00 0.00 YYY 0.0031300 C 14.27 15.02 15.02 1.17 090 50.5831320 C 5.25 10.33 10.33 0.46 090 50.5831360 C 17.05 16.77 16.77 1.38 090 50.5831365 C 24.12 20.42 20.42 1.97 090 50.5831367 C 21.83 21.95 21.95 1.78 090 50.5831368 C 27.05 25.56 25.56 2.20 090 50.5831370 C 21.35 22.32 22.32 1.74 090 50.5831375 C 20.18 20.44 20.44 1.63 090 50.5831380 C 20.18 20.66 20.66 1.70 090 50.5831382 C 20.49 21.67 21.67 1.67 090 50.5831390 C 27.49 24.45 24.45 2.23 090 50.5831395 C 31.04 28.38 28.38 2.48 090 50.5831400 C 10.29 13.81 13.81 0.83 090 50.5831420 C 10.20 9.57 9.57 0.83 090 50.5831500 C 2.33 0.55 0.55 0.17 000 50.5831502 C 0.65 0.31 0.28 0.05 000 50.5831505 C 0.61 1.45 0.61 0.05 000 50.5831510 C 1.92 3.31 1.25 0.16 000 50.5831511 C 2.16 3.13 1.06 0.19 000 50.5831512 C 2.07 3.21 1.36 0.18 000 50.5831513 C 2.10 1.46 1.46 0.17 000 50.5831515 C 1.80 3.55 1.06 0.14 000 50.5831520 C 2.56 1.56 1.56 0.20 000 50.5831525 C 2.63 3.65 1.66 0.21 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
31526 C 2.57 1.72 1.72 0.21 000 50.5831527 C 3.27 1.88 1.88 0.26 000 50.5831528 C 2.37 1.46 1.46 0.19 000 50.5831529 C 2.68 1.71 1.71 0.22 000 50.5831530 C 3.38 1.96 1.96 0.29 000 50.5831531 C 3.58 2.28 2.28 0.29 000 50.5831535 C 3.16 2.00 2.00 0.26 000 50.5831536 C 3.55 2.26 2.26 0.29 000 50.5831540 C 4.12 2.55 2.55 0.33 000 50.5831541 C 4.52 2.79 2.79 0.37 000 50.5831545 C 6.30 3.48 3.48 0.37 000 50.5831546 C 9.73 4.98 4.98 0.78 000 50.5831560 C 5.45 3.16 3.16 0.43 000 50.5831561 C 5.99 3.38 3.38 0.49 000 50.5831570 C 3.86 5.69 2.39 0.31 000 50.5831571 C 4.26 2.61 2.61 0.35 000 50.5831575 C 1.10 1.91 0.89 0.09 000 50.5831576 C 1.97 3.67 1.29 0.14 000 50.5831577 C 2.47 3.77 1.53 0.21 000 50.5831578 C 2.84 4.29 1.52 0.23 000 50.5831579 C 2.26 3.79 1.48 0.18 000 50.5831580 C 12.36 15.96 15.96 1.00 090 50.5831582 C 21.59 25.87 25.87 1.75 090 50.5831584 C 19.61 18.20 18.20 1.71 090 50.5831585 C 4.63 6.69 6.69 0.37 090 50.58 12/31/200531586 C 8.02 10.86 10.86 0.66 090 50.58 12/31/200531587 C 11.97 9.29 9.29 0.97 090 50.5831588 C 13.09 13.65 13.65 1.06 090 50.5831590 C 6.96 15.58 15.58 0.84 090 50.5831595 C 8.33 10.58 10.58 0.68 090 50.5831599 S 0.00 0.00 0.00 0.00 YYY 0.0031600 C 7.17 3.20 3.20 0.80 000 50.5831601 C 4.44 2.41 2.41 0.40 000 50.5831603 C 4.14 1.71 1.71 0.44 000 50.5831605 C 3.57 1.19 1.19 0.40 000 50.5831610 C 8.75 8.28 8.28 0.79 090 50.5831611 C 5.63 7.08 7.08 0.46 090 50.5831612 C 0.91 1.10 0.35 0.08 000 50.5831613 C 4.58 6.01 6.01 0.42 090 50.5831614 C 7.11 8.74 8.74 0.58 090 50.5831615 C 2.09 2.60 1.20 0.16 000 50.5831620 C 1.40 5.66 0.55 0.11 ZZZ 50.5831622 C 2.78 5.67 1.06 0.18 000 50.5831623 C 2.88 6.44 1.05 0.13 000 50.5831624 C 2.88 5.79 1.05 0.13 000 50.5831625 C 3.36 5.83 1.21 0.18 000 50.5831628 C 3.80 7.04 1.30 0.18 000 50.5831629 C 4.09 14.29 1.40 0.16 000 50.5831630 C 3.81 1.72 1.72 0.32 000 50.5831631 C 4.36 1.77 1.77 0.34 000 50.5831632 C 1.03 0.81 0.31 0.18 ZZZ 50.5831633 C 1.32 0.92 0.40 0.16 ZZZ 50.5831635 C 3.67 6.13 1.43 0.24 000 50.5831636 C 4.30 1.77 1.77 0.31 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
31637 C 1.58 0.56 0.56 0.13 ZZZ 50.5831638 C 4.88 1.98 1.98 0.22 000 50.5831640 C 4.93 2.08 2.08 0.46 000 50.5831641 C 5.02 1.89 1.89 0.35 000 50.5831643 C 3.49 1.23 1.23 0.20 000 50.5831645 C 3.16 5.15 1.12 0.16 000 50.5831646 C 2.72 4.87 1.00 0.14 000 50.5831656 C 2.17 7.31 0.83 0.15 000 50.5831700 C 1.34 2.16 0.68 0.08 000 50.5831708 C 1.41 2.04 0.46 0.07 000 50.5831710 C 1.30 0.41 0.41 0.12 000 50.5831715 C 1.11 0.34 0.34 0.07 000 50.5831717 C 2.12 8.27 0.79 0.14 000 50.5831720 C 1.06 0.33 0.33 0.07 000 50.5831725 C 1.96 0.65 0.58 0.14 000 50.5831730 C 2.85 2.20 1.00 0.21 000 50.5831750 C 13.00 17.60 17.60 1.05 090 50.5831755 C 15.91 24.59 24.59 1.29 090 50.5831760 C 22.32 10.74 10.74 2.94 090 50.5831766 C 30.38 13.69 13.69 4.52 090 50.5831770 C 22.48 10.27 10.27 2.83 090 50.5831775 C 23.50 11.82 11.82 3.01 090 50.5831780 C 17.69 11.08 11.08 1.65 090 50.5831781 C 23.49 12.16 12.16 2.24 090 50.5831785 C 17.20 10.21 10.21 1.59 090 50.5831786 C 23.94 13.13 13.13 3.29 090 50.5831800 C 7.42 9.27 9.27 0.79 090 50.5831805 C 13.11 7.23 7.23 1.82 090 50.5831820 C 4.48 5.68 3.66 0.38 090 50.5831825 C 6.80 7.68 5.39 0.53 090 50.5831830 C 4.49 5.78 3.99 0.44 090 50.5831899 S 0.00 0.00 0.00 0.00 YYY 0.0032000 C 1.54 3.06 0.48 0.08 000 50.5832002 C 2.19 3.22 1.06 0.12 000 50.5832005 C 2.19 6.47 0.70 0.23 000 50.5832019 C 4.17 20.02 1.65 0.42 000 50.5832020 C 3.97 1.35 1.35 0.43 000 50.5832035 C 8.66 5.87 5.87 1.26 090 50.5832036 C 9.67 6.45 6.45 1.43 090 50.5832095 C 8.35 5.38 5.38 1.22 090 50.5832100 C 15.22 7.84 7.84 2.23 090 50.5832110 C 22.97 10.76 10.76 3.21 090 50.5832120 C 11.52 7.09 7.09 1.63 090 50.5832124 C 12.70 7.23 7.23 1.89 090 50.5832140 C 13.91 7.70 7.70 1.96 090 50.5832141 C 13.98 7.57 7.57 2.00 090 50.5832150 C 14.13 7.62 7.62 2.00 090 50.5832151 C 14.19 8.02 8.02 2.03 090 50.5832160 C 9.29 5.28 5.28 1.31 090 50.5832200 C 15.27 8.63 8.63 2.13 090 50.5832201 C 3.99 20.76 1.30 0.24 000 50.5832215 C 11.31 6.92 6.92 1.68 090 50.5832220 C 23.96 12.99 12.99 3.56 090 50.5832225 C 13.94 7.67 7.67 2.06 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
32310 C 13.42 7.41 7.41 1.99 090 50.5832320 C 23.96 12.19 12.19 3.51 090 50.5832400 C 1.76 2.13 0.55 0.10 000 50.5832402 C 7.55 5.12 5.12 1.07 090 50.5832405 C 1.93 0.67 0.63 0.11 000 50.5832420 C 2.18 0.68 0.68 0.12 000 50.5832440 C 24.96 12.93 12.93 3.68 090 50.5832442 C 26.20 14.80 14.80 3.84 090 50.5832445 C 25.05 14.10 14.10 3.71 090 50.5832480 C 23.71 12.09 12.09 3.49 090 50.5832482 C 24.96 12.95 12.95 3.66 090 50.5832484 C 20.66 11.41 11.41 3.03 090 50.5832486 C 23.88 13.28 13.28 3.51 090 50.5832488 C 25.67 13.82 13.82 3.80 090 50.5832491 C 21.22 12.66 12.66 2.98 090 50.5832500 C 21.97 12.39 12.39 3.25 090 50.5832501 C 4.68 1.54 1.54 0.65 ZZZ 50.5832503 C 30.00 15.11 15.11 4.37 090 50.5832504 C 34.80 16.72 16.72 5.07 090 50.5832520 C 21.65 11.31 11.31 3.04 090 50.58 12/31/200532522 C 24.16 12.12 12.12 3.28 090 50.58 12/31/200532525 C 26.46 12.80 12.80 3.72 090 50.58 12/31/200532540 C 14.62 9.66 9.66 2.07 090 50.5832601 C 5.45 2.36 2.36 0.80 000 50.5832602 C 5.95 2.53 2.53 0.87 000 50.5832603 C 7.80 3.04 3.04 1.14 000 50.5832604 C 8.77 3.46 3.46 1.25 000 50.5832605 C 6.92 2.91 2.91 1.00 000 50.5832606 C 8.39 3.34 3.34 1.22 000 50.5832650 C 10.73 6.78 6.78 1.58 090 50.5832651 C 12.89 7.25 7.25 1.86 090 50.5832652 C 18.63 10.17 10.17 2.72 090 50.5832653 C 12.85 6.99 6.99 1.88 090 50.5832654 C 12.42 7.55 7.55 1.63 090 50.5832655 C 13.08 7.26 7.26 1.89 090 50.5832656 C 12.89 7.96 7.96 1.89 090 50.5832657 C 13.63 7.70 7.70 1.99 090 50.5832658 C 11.61 7.37 7.37 1.69 090 50.5832659 C 11.57 7.47 7.47 1.62 090 50.5832660 C 17.40 9.51 9.51 2.08 090 50.5832661 C 13.23 7.81 7.81 1.92 090 50.5832662 C 16.42 8.85 8.85 2.17 090 50.5832663 C 18.44 10.79 10.79 2.72 090 50.5832664 C 14.18 7.65 7.65 2.32 090 50.5832665 C 15.52 8.15 8.15 2.15 090 50.5832800 C 13.67 7.43 7.43 1.98 090 50.5832810 C 13.03 7.54 7.54 1.93 090 50.5832815 C 23.12 11.00 11.00 3.27 090 50.5832820 C 21.45 12.20 12.20 2.52 090 50.5832850 C 0.00 0.00 0.00 0.00 XXX 0.0032851 C 38.57 27.74 27.74 5.56 090 50.5832852 C 41.74 33.26 33.26 6.00 090 50.5832853 C 47.74 31.84 31.84 7.05 090 50.5832854 C 50.90 34.83 34.83 7.20 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
32855 C 317.73 0.00 0.00 0.00 XXX 1.2532856 C 384.04 0.00 0.00 0.00 XXX 1.2532900 C 20.24 9.91 9.91 2.93 090 50.5832905 C 20.72 10.16 10.16 3.15 090 50.5832906 C 26.73 12.09 12.09 3.97 090 50.5832940 C 19.40 9.50 9.50 2.88 090 50.5832960 C 1.84 1.74 0.56 0.16 000 50.5832997 C 5.99 1.92 1.92 0.55 000 50.5832999 S 0.00 0.00 0.00 0.00 YYY 0.0033010 C 2.24 0.78 0.78 0.14 000 50.5833011 C 2.24 0.81 0.81 0.15 000 50.5833015 C 6.79 4.96 4.96 0.65 090 50.5833020 C 12.59 6.80 6.80 1.79 090 50.5833025 C 12.07 6.37 6.37 1.80 090 50.5833030 C 18.68 9.55 9.55 2.83 090 50.5833031 C 21.76 10.06 10.06 3.13 090 50.5833050 C 14.34 7.86 7.86 2.14 090 50.5833120 C 24.52 11.61 11.61 3.69 090 50.5833130 C 21.36 10.14 10.14 3.00 090 50.5833140 C 19.97 10.91 10.91 2.85 090 50.5833141 C 4.83 1.58 1.58 0.69 ZZZ 50.5833200 C 12.46 6.86 6.86 1.70 090 50.5833201 C 10.16 6.60 6.60 1.36 090 50.5833206 C 6.66 4.47 4.47 0.52 090 50.5833207 C 8.03 4.67 4.67 0.59 090 50.5833208 C 8.12 4.78 4.78 0.56 090 50.5833210 C 3.30 1.25 1.25 0.18 000 50.5833211 C 3.39 1.31 1.31 0.21 000 50.5833212 C 5.51 3.37 3.37 0.43 090 50.5833213 C 6.36 3.73 3.73 0.45 090 50.5833214 C 7.74 4.90 4.90 0.58 090 50.5833215 C 4.75 3.19 3.19 0.37 090 50.5833216 C 5.77 4.21 4.21 0.36 090 50.5833217 C 5.74 4.24 4.24 0.39 090 50.5833218 C 5.43 4.31 4.31 0.37 090 50.5833220 C 5.51 4.28 4.28 0.37 090 50.5833222 C 4.95 4.30 4.30 0.42 090 50.5833223 C 6.45 4.60 4.60 0.45 090 50.5833224 C 9.04 4.01 4.01 0.54 000 50.5833225 C 8.33 3.26 3.26 0.45 ZZZ 50.5833226 C 8.68 3.83 3.83 0.59 000 50.5833233 C 3.29 3.28 3.28 0.22 090 50.5833234 C 7.81 4.92 4.92 0.56 090 50.5833235 C 9.39 6.83 6.83 0.73 090 50.5833236 C 12.58 7.45 7.45 1.68 090 50.5833237 C 13.69 7.80 7.80 1.59 090 50.5833238 C 15.20 8.22 8.22 2.02 090 50.5833240 C 7.59 4.59 4.59 0.41 090 50.5833241 C 3.24 2.97 2.97 0.18 090 50.5833243 C 22.61 11.49 11.49 2.09 090 50.5833244 C 13.74 8.92 8.92 0.99 090 50.5833245 C 14.28 7.92 7.92 2.01 090 50.5833246 C 20.68 10.31 10.31 2.63 090 50.5833249 C 14.21 8.38 8.38 0.77 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
33250 C 21.82 11.05 11.05 3.18 090 50.5833251 C 24.84 11.69 11.69 3.59 090 50.5833253 C 31.01 13.86 13.86 4.52 090 50.5833261 C 24.84 11.80 11.80 3.45 090 50.5833282 C 4.16 4.03 4.03 0.23 090 50.5833284 C 2.50 3.54 3.54 0.14 090 50.5833300 C 17.89 9.26 9.26 2.65 090 50.5833305 C 21.41 10.64 10.64 3.12 090 50.5833310 C 18.48 9.61 9.61 2.58 090 50.5833315 C 22.34 10.91 10.91 3.27 090 50.5833320 C 16.76 8.24 8.24 2.07 090 50.5833321 C 20.17 9.81 9.81 2.90 090 50.5833322 C 20.59 10.39 10.39 2.85 090 50.5833330 C 21.40 10.29 10.29 2.81 090 50.5833332 C 23.92 10.54 10.54 3.02 090 50.5833335 C 29.96 13.37 13.37 4.27 090 50.5833400 C 28.46 15.71 15.71 4.10 090 50.5833401 C 23.87 13.54 13.54 3.56 090 50.5833403 C 24.85 14.34 14.34 3.54 090 50.5833404 C 28.50 14.58 14.58 4.32 090 50.5833405 C 34.95 18.34 18.34 5.31 090 50.5833406 C 37.44 19.18 19.18 5.43 090 50.5833410 C 32.41 16.63 16.63 4.68 090 50.5833411 C 36.20 18.79 18.79 5.46 090 50.5833412 C 41.94 20.46 20.46 6.37 090 50.5833413 C 43.43 20.87 20.87 6.51 090 50.5833414 C 30.30 14.17 14.17 4.56 090 50.5833415 C 27.11 12.05 12.05 4.13 090 50.5833416 C 30.30 13.54 13.54 4.56 090 50.5833417 C 28.49 13.65 13.65 4.09 090 50.5833420 C 22.67 9.59 9.59 1.81 090 50.5833422 C 25.90 13.69 13.69 3.93 090 50.5833425 C 26.96 13.09 13.09 4.06 090 50.5833426 C 32.95 17.18 17.18 5.01 090 50.5833427 C 39.94 19.42 19.42 6.07 090 50.5833430 C 33.45 17.34 17.34 5.08 090 50.5833460 C 23.56 11.33 11.33 3.44 090 50.5833463 C 25.58 12.95 12.95 3.86 090 50.5833464 C 27.29 13.56 13.56 4.14 090 50.5833465 C 28.75 13.00 13.00 4.38 090 50.5833468 C 30.07 13.69 13.69 4.06 090 50.5833470 C 20.78 10.72 10.72 1.03 090 50.5833471 C 22.22 9.78 9.78 3.38 090 50.5833472 C 22.22 11.89 11.89 3.54 090 50.5833474 C 23.01 10.91 10.91 3.21 090 50.5833475 C 32.95 15.41 15.41 4.92 090 50.5833476 C 25.73 11.99 11.99 2.41 090 50.5833478 C 26.70 13.09 13.09 3.88 090 50.5833496 C 27.21 12.78 12.78 4.12 090 50.5833500 C 25.51 11.49 11.49 3.86 090 50.5833501 C 17.75 8.30 8.30 1.90 090 50.5833502 C 21.01 11.10 11.10 2.99 090 50.5833503 C 21.75 9.76 9.76 1.77 090 50.5833504 C 24.62 11.84 11.84 3.35 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
33505 C 26.80 12.94 12.94 2.18 090 50.5833506 C 35.45 14.60 14.60 4.65 090 50.5833507 C 30.00 13.68 13.68 4.05 090 50.5833508 C 0.31 0.10 0.10 0.04 ZZZ 50.5833510 C 28.96 16.38 16.38 4.40 090 50.5833511 C 29.96 17.12 17.12 4.55 090 50.5833512 C 31.75 17.65 17.65 4.66 090 50.5833513 C 31.95 17.83 17.83 4.87 090 50.5833514 C 32.70 18.10 18.10 4.76 090 50.5833516 C 34.95 18.85 18.85 5.11 090 50.5833517 C 2.57 0.84 0.84 0.39 ZZZ 50.5833518 C 4.84 1.58 1.58 0.73 ZZZ 50.5833519 C 7.11 2.33 2.33 1.04 ZZZ 50.5833521 C 9.39 3.08 3.08 1.37 ZZZ 50.5833522 C 11.65 3.82 3.82 1.77 ZZZ 50.5833523 C 13.93 4.54 4.54 2.12 ZZZ 50.5833530 C 5.85 1.92 1.92 0.88 ZZZ 50.5833533 C 29.96 16.51 16.51 4.55 090 50.5833534 C 32.15 17.76 17.76 4.69 090 50.5833535 C 34.45 18.18 18.18 5.01 090 50.5833536 C 37.44 18.34 18.34 5.42 090 50.5833542 C 28.81 13.03 13.03 4.37 090 50.5833545 C 36.72 15.67 15.67 5.19 090 50.5833548 C 37.97 19.35 19.35 5.51 090 50.5833572 C 4.44 1.45 1.45 0.65 ZZZ 50.5833600 C 29.47 12.55 12.55 4.41 090 50.5833602 C 28.50 12.48 12.48 3.81 090 50.5833606 C 30.69 13.71 13.71 4.40 090 50.5833608 C 31.04 14.14 14.14 4.73 090 50.5833610 C 30.56 13.64 13.64 4.55 090 50.5833611 C 33.95 14.17 14.17 4.36 090 50.5833612 C 34.95 15.19 15.19 5.28 090 50.5833615 C 33.95 13.18 13.18 4.31 090 50.5833617 C 36.94 16.04 16.04 5.64 090 50.5833619 C 44.93 20.86 20.86 6.44 090 50.5833641 C 21.36 9.60 9.60 3.22 090 50.5833645 C 24.78 11.80 11.80 3.78 090 50.5833647 C 28.69 13.81 13.81 3.31 090 50.5833660 C 29.96 13.52 13.52 4.48 090 50.5833665 C 28.56 13.87 13.87 3.99 090 50.5833670 C 34.95 13.21 13.21 4.64 090 50.5833681 C 30.56 14.72 14.72 4.44 090 50.5833684 C 29.61 13.66 13.66 3.38 090 50.5833688 C 30.57 10.50 10.50 4.72 090 50.5833690 C 19.52 10.19 10.19 1.96 090 50.5833692 C 30.70 13.96 13.96 4.57 090 50.5833694 C 33.95 14.26 14.26 5.26 090 50.5833697 C 35.95 14.91 14.91 4.08 090 50.5833702 C 26.50 12.60 12.60 3.67 090 50.5833710 C 29.67 14.00 14.00 4.42 090 50.5833720 C 26.52 12.32 12.32 3.83 090 50.5833722 C 28.37 13.89 13.89 1.30 090 50.5833730 C 34.20 14.16 14.16 5.01 090 50.5833732 C 28.12 13.42 13.42 3.67 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
33735 C 21.36 8.98 8.98 1.91 090 50.5833736 C 23.48 11.88 11.88 3.08 090 50.5833737 C 21.73 10.96 10.96 3.24 090 50.5833750 C 21.38 10.24 10.24 1.16 090 50.5833755 C 21.76 8.83 8.83 3.25 090 50.5833762 C 21.76 10.18 10.18 3.13 090 50.5833764 C 21.76 10.25 10.25 3.00 090 50.5833766 C 22.73 11.70 11.70 3.69 090 50.5833767 C 24.46 11.75 11.75 3.81 090 50.5833768 C 8.00 2.67 2.67 1.19 ZZZ 50.5833770 C 36.94 14.72 14.72 5.72 090 50.5833771 C 34.60 12.42 12.42 5.66 090 50.5833774 C 30.93 14.70 14.70 4.80 090 50.5833775 C 32.15 15.03 15.03 4.98 090 50.5833776 C 33.99 15.85 15.85 5.07 090 50.5833777 C 33.41 15.66 15.66 5.47 090 50.5833778 C 39.94 16.94 16.94 6.18 090 50.5833779 C 36.16 15.41 15.41 2.91 090 50.5833780 C 41.69 19.14 19.14 3.67 090 50.5833781 C 36.40 13.37 13.37 5.95 090 50.5833786 C 38.94 16.76 16.76 5.69 090 50.5833788 C 26.58 11.98 11.98 4.02 090 50.5833800 C 16.22 8.13 8.13 2.45 090 50.5833802 C 17.63 9.25 9.25 2.26 090 50.5833803 C 19.57 9.79 9.79 3.19 090 50.5833813 C 20.62 10.94 10.94 3.12 090 50.5833814 C 25.73 12.68 12.68 3.84 090 50.5833820 C 16.27 8.38 8.38 2.34 090 50.5833822 C 17.29 8.98 8.98 2.67 090 50.5833824 C 19.49 10.01 10.01 2.88 090 50.5833840 C 20.60 10.32 10.32 2.15 090 50.5833845 C 22.09 11.38 11.38 3.21 090 50.5833851 C 21.24 10.71 10.71 3.17 090 50.5833852 C 23.67 11.39 11.39 2.15 090 50.5833853 C 31.67 14.86 14.86 4.47 090 50.5833860 C 37.94 16.50 16.50 5.74 090 50.5833861 C 41.94 17.76 17.76 6.35 090 50.5833863 C 44.93 18.74 18.74 6.57 090 50.5833870 C 43.93 18.43 18.43 6.60 090 50.5833875 C 33.01 14.13 14.13 4.88 090 50.5833877 C 42.54 16.36 16.36 5.92 090 50.5833880 C 33.00 13.51 13.51 2.74 090 50.5833881 C 28.00 11.99 11.99 2.32 090 50.5833883 C 20.00 9.21 9.21 2.10 090 50.5833884 C 8.20 2.58 2.58 0.86 ZZZ 50.5833886 C 17.00 8.25 8.25 1.79 090 50.5833889 C 15.92 5.19 5.19 2.17 000 50.5833891 C 20.00 6.98 6.98 2.72 000 50.5833910 C 24.55 11.46 11.46 3.69 090 50.5833915 C 20.99 9.66 9.66 1.44 090 50.5833916 C 25.79 11.37 11.37 3.66 090 50.5833917 C 24.46 12.22 12.22 3.69 090 50.5833918 C 26.41 12.07 12.07 4.12 090 50.58 12/31/200533919 C 39.94 17.51 17.51 5.90 090 50.58 12/31/2005
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
33920 C 31.90 13.86 13.86 4.37 090 50.5833922 C 23.48 10.93 10.93 3.09 090 50.5833924 C 5.49 1.85 1.85 0.82 ZZZ 50.5833925 C 29.50 14.70 14.70 4.60 090 50.5833926 C 42.00 17.73 17.73 6.20 090 50.5833930 C 0.00 0.00 0.00 0.00 XXX 0.0033933 C 439.86 0.00 0.00 0.00 XXX 1.2533935 C 60.87 28.85 28.85 9.03 090 50.5833940 C 0.00 0.00 0.00 0.00 XXX 0.0033944 C 309.72 0.00 0.00 0.00 XXX 1.2533945 C 42.04 21.45 21.45 6.24 090 50.5833960 C 19.33 4.92 4.92 2.66 000 50.5833961 C 10.91 3.62 3.62 0.88 ZZZ 50.5833967 C 4.84 1.85 1.85 0.35 000 50.5833968 C 0.64 0.23 0.23 0.07 000 50.5833970 C 6.74 2.29 2.29 0.82 000 50.5833971 C 9.68 6.02 6.02 1.25 090 50.5833973 C 9.75 3.32 3.32 1.26 000 50.5833974 C 14.39 7.90 7.90 1.73 090 50.5833975 C 20.97 6.30 6.30 3.06 XXX 50.5833976 C 22.97 7.57 7.57 3.25 XXX 50.5833977 C 19.26 11.10 11.10 2.80 090 50.5833978 C 21.70 11.78 11.78 3.30 090 50.5833979 C 45.93 14.96 14.96 6.95 XXX 50.5833980 C 56.17 25.31 25.31 8.56 090 50.5833999 S 0.00 0.00 0.00 0.00 YYY 0.0034001 C 12.89 6.73 6.73 1.84 090 50.5834051 C 15.19 7.80 7.80 2.20 090 50.5834101 C 9.99 5.37 5.37 1.41 090 50.5834111 C 9.99 5.37 5.37 1.40 090 50.5834151 C 24.96 10.43 10.43 3.55 090 50.5834201 C 10.01 5.43 5.43 1.45 090 50.5834203 C 16.48 8.08 8.08 2.35 090 50.5834401 C 24.96 10.69 10.69 3.09 090 50.5834421 C 11.98 6.31 6.31 1.55 090 50.5834451 C 26.96 11.47 11.47 3.83 090 50.5834471 C 10.16 5.32 5.32 1.18 090 50.5834490 C 9.85 5.44 5.44 1.41 090 50.5834501 C 15.98 8.51 8.51 2.34 090 50.5834502 C 26.91 12.33 12.33 3.62 090 50.5834510 C 18.92 9.44 9.44 2.32 090 50.5834520 C 17.92 8.47 8.47 2.28 090 50.5834530 C 16.62 8.63 8.63 1.73 090 50.5834800 C 20.72 9.19 9.19 2.45 090 50.5834802 C 22.97 9.81 9.81 2.32 090 50.5834803 C 24.00 10.24 10.24 2.00 090 50.5834804 C 22.97 9.83 9.83 2.29 090 50.5834805 C 21.85 9.67 9.67 2.00 090 50.5834808 C 4.12 1.37 1.37 0.59 ZZZ 50.5834812 C 6.74 2.24 2.24 1.18 000 50.5834813 C 4.79 1.57 1.57 0.67 ZZZ 50.5834820 C 9.74 3.24 3.24 1.50 000 50.5834825 C 11.98 6.16 6.16 1.28 090 50.5834826 C 4.12 1.37 1.37 0.44 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
34830 C 32.54 13.73 13.73 4.54 090 50.5834831 C 35.29 11.76 11.76 4.88 090 50.5834832 C 35.29 14.66 14.66 4.84 090 50.5834833 C 11.98 4.44 4.44 1.69 000 50.5834834 C 5.34 2.20 2.20 0.76 000 50.5834900 C 16.36 7.60 7.60 1.99 090 50.5835001 C 19.61 9.58 9.58 2.80 090 50.5835002 C 20.97 9.72 9.72 2.99 090 50.5835005 C 18.09 8.87 8.87 1.76 090 50.5835011 C 17.97 8.00 8.00 2.54 090 50.5835013 C 21.97 9.70 9.70 3.09 090 50.5835021 C 19.62 9.44 9.44 2.86 090 50.5835022 C 23.15 9.88 9.88 3.16 090 50.5835045 C 17.54 7.52 7.52 2.44 090 50.5835081 C 27.97 11.49 11.49 4.00 090 50.5835082 C 38.44 15.33 15.33 5.42 090 50.5835091 C 35.35 13.60 13.60 5.12 090 50.5835092 C 44.93 17.68 17.68 6.38 090 50.5835102 C 30.71 12.39 12.39 4.47 090 50.5835103 C 40.44 15.89 15.89 5.74 090 50.5835111 C 24.96 10.49 10.49 3.46 090 50.5835112 C 29.96 11.99 11.99 4.07 090 50.5835121 C 29.96 12.40 12.40 4.29 090 50.5835122 C 34.95 13.84 13.84 4.74 090 50.5835131 C 24.96 10.77 10.77 3.79 090 50.5835132 C 29.96 12.41 12.41 4.29 090 50.5835141 C 19.97 8.94 8.94 2.89 090 50.5835142 C 23.27 10.39 10.39 3.35 090 50.5835151 C 22.61 10.01 10.01 3.23 090 50.5835152 C 25.58 11.40 11.40 3.60 090 50.5835180 C 13.60 6.96 6.96 1.00 090 50.5835182 C 29.96 12.83 12.83 4.35 090 50.5835184 C 17.97 8.31 8.31 2.52 090 50.5835188 C 14.26 7.65 7.65 2.15 090 50.5835189 C 27.96 11.98 11.98 4.00 090 50.5835190 C 12.73 6.49 6.49 1.79 090 50.5835201 C 16.12 8.01 8.01 2.33 090 50.5835206 C 13.23 6.57 6.57 1.86 090 50.5835207 C 10.13 7.37 7.37 1.48 090 50.5835211 C 22.09 10.64 10.64 3.19 090 50.5835216 C 18.72 9.00 9.00 2.64 090 50.5835221 C 24.35 9.96 9.96 3.36 090 50.5835226 C 14.48 7.45 7.45 2.01 090 50.5835231 C 19.97 9.79 9.79 2.88 090 50.5835236 C 17.08 7.90 7.90 2.42 090 50.5835241 C 23.09 11.15 11.15 3.52 090 50.5835246 C 26.41 11.45 11.45 3.85 090 50.5835251 C 30.15 11.82 11.82 4.12 090 50.5835256 C 18.33 8.37 8.37 2.62 090 50.5835261 C 17.77 8.03 8.03 2.60 090 50.5835266 C 14.89 7.02 7.02 2.09 090 50.5835271 C 22.09 10.54 10.54 3.15 090 50.5835276 C 24.21 11.23 11.23 3.48 090 50.5835281 C 27.96 11.73 11.73 3.96 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
35286 C 16.14 8.07 8.07 2.34 090 50.5835301 C 18.67 8.45 8.45 2.67 090 50.5835311 C 26.96 11.77 11.77 3.41 090 50.5835321 C 15.98 7.40 7.40 2.24 090 50.5835331 C 26.16 11.26 11.26 3.82 090 50.5835341 C 25.07 10.89 10.89 3.77 090 50.5835351 C 22.97 9.62 9.62 3.34 090 50.5835355 C 18.47 8.10 8.10 2.66 090 50.5835361 C 28.16 11.73 11.73 4.14 090 50.5835363 C 30.15 12.62 12.62 4.32 090 50.5835371 C 14.70 6.97 6.97 2.13 090 50.5835372 C 17.97 8.06 8.06 2.62 090 50.5835381 C 15.79 7.83 7.83 2.25 090 50.5835390 C 3.19 1.06 1.06 0.46 ZZZ 50.5835400 C 3.00 1.11 1.11 0.43 ZZZ 50.5835450 C 10.05 3.57 3.57 1.25 000 50.5835452 C 6.90 2.61 2.61 0.94 000 50.5835454 C 6.03 2.32 2.32 0.87 000 50.5835456 C 7.34 2.77 2.77 1.04 000 50.5835458 C 9.48 3.48 3.48 1.26 000 50.5835459 C 8.62 3.18 3.18 1.21 000 50.5835460 C 6.03 2.28 2.28 0.83 000 50.5835470 C 8.62 89.12 3.36 0.69 000 50.5835471 C 10.05 100.55 3.96 0.67 000 50.5835472 C 6.90 64.54 2.75 0.58 000 50.5835473 C 6.03 60.01 2.43 0.51 000 50.5835474 C 7.35 87.98 2.90 0.57 000 50.5835475 C 9.48 56.26 3.57 0.62 000 50.5835476 C 6.03 44.86 2.36 0.34 000 50.5835480 C 11.06 4.05 4.05 1.28 000 50.5835481 C 7.60 2.88 2.88 1.13 000 50.5835482 C 6.64 2.57 2.57 0.89 000 50.5835483 C 8.09 3.03 3.03 1.15 000 50.5835484 C 10.42 3.78 3.78 1.27 000 50.5835485 C 9.48 3.54 3.54 1.35 000 50.5835490 C 11.06 4.71 4.71 0.71 000 50.5835491 C 7.60 3.30 3.30 0.74 000 50.5835492 C 6.64 3.20 3.20 0.43 000 50.5835493 C 8.09 3.81 3.81 0.56 000 50.5835494 C 10.42 4.47 4.47 0.59 000 50.5835495 C 9.48 4.40 4.40 0.69 000 50.5835500 C 6.44 2.03 2.03 0.93 ZZZ 50.5835501 C 19.16 8.48 8.48 2.80 090 50.5835506 C 19.64 9.49 9.49 2.86 090 50.5835507 C 19.64 9.45 9.45 2.84 090 50.5835508 C 18.62 9.47 9.47 2.77 090 50.5835509 C 18.04 8.79 8.79 2.61 090 50.5835510 C 22.97 10.20 10.20 2.11 090 50.5835511 C 21.17 9.38 9.38 2.90 090 50.5835512 C 22.47 10.03 10.03 2.11 090 50.5835515 C 18.62 9.31 9.31 2.77 090 50.5835516 C 16.30 6.82 6.82 2.33 090 50.5835518 C 21.17 9.00 9.00 3.02 090 50.5835521 C 22.17 9.86 9.86 3.12 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
35522 C 21.73 9.78 9.78 2.11 090 50.5835525 C 20.60 9.40 9.40 2.11 090 50.5835526 C 29.91 12.54 12.54 3.62 090 50.5835531 C 36.15 14.51 14.51 5.16 090 50.5835533 C 27.96 11.75 11.75 3.84 090 50.5835536 C 31.65 12.98 12.98 4.61 090 50.5835541 C 25.76 11.23 11.23 3.70 090 50.5835546 C 25.50 10.89 10.89 3.69 090 50.5835548 C 21.54 9.45 9.45 2.97 090 50.5835549 C 23.31 10.40 10.40 3.29 090 50.5835551 C 26.63 11.52 11.52 3.74 090 50.5835556 C 21.73 9.75 9.75 3.09 090 50.5835558 C 21.17 9.57 9.57 2.99 090 50.5835560 C 31.95 13.35 13.35 4.74 090 50.5835563 C 24.16 10.55 10.55 3.51 090 50.5835565 C 23.17 10.16 10.16 3.29 090 50.5835566 C 26.88 11.41 11.41 3.82 090 50.5835571 C 24.02 10.87 10.87 3.42 090 50.5835572 C 6.81 2.25 2.25 0.99 ZZZ 50.5835583 C 28.35 12.25 12.25 4.01 090 50.5835585 C 24.71 11.48 11.48 3.51 090 50.5835587 C 4.94 1.62 1.62 0.73 ZZZ 50.5835600 C 17.47 8.64 8.64 2.49 090 50.5835601 C 18.68 9.04 9.04 2.69 090 50.5835606 C 15.74 7.90 7.90 2.08 090 50.5835612 C 15.68 8.12 8.12 2.19 090 50.5835616 C 19.97 8.70 8.70 2.91 090 50.5835621 C 23.96 10.52 10.52 3.45 090 50.5835623 C 27.71 12.00 12.00 4.07 090 50.5835626 C 33.95 13.87 13.87 4.95 090 50.5835631 C 33.95 13.87 13.87 4.95 090 50.5835636 C 29.46 12.33 12.33 4.09 090 50.5835641 C 24.53 11.09 11.09 3.53 090 50.5835642 C 17.95 8.71 8.71 2.27 090 50.5835645 C 17.44 8.29 8.29 2.49 090 50.5835646 C 30.95 13.14 13.14 4.43 090 50.5835647 C 27.96 11.80 11.80 3.98 090 50.5835650 C 18.97 8.38 8.38 2.71 090 50.5835651 C 25.00 10.75 10.75 3.35 090 50.5835654 C 24.96 10.68 10.68 3.52 090 50.5835656 C 19.50 8.62 8.62 2.79 090 50.5835661 C 18.97 8.95 8.95 2.71 090 50.5835663 C 21.97 10.00 10.00 3.10 090 50.5835665 C 20.97 9.47 9.47 3.00 090 50.5835666 C 22.16 10.67 10.67 3.15 090 50.5835671 C 19.30 9.39 9.39 2.77 090 50.5835681 C 1.60 0.53 0.53 0.23 ZZZ 50.5835682 C 7.19 2.39 2.39 1.03 ZZZ 50.5835683 C 8.49 2.83 2.83 1.20 ZZZ 50.5835685 C 4.04 1.35 1.35 0.58 ZZZ 50.5835686 C 3.34 1.13 1.13 0.47 ZZZ 50.5835691 C 18.02 8.42 8.42 2.58 090 50.5835693 C 15.34 7.74 7.74 2.21 090 50.5835694 C 19.13 8.62 8.62 2.69 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
35695 C 19.13 8.57 8.57 2.73 090 50.5835697 C 3.00 1.02 1.02 0.41 ZZZ 50.5835700 C 3.08 1.02 1.02 0.44 ZZZ 50.5835701 C 8.49 5.16 5.16 1.12 090 50.5835721 C 7.17 4.44 4.44 1.03 090 50.5835741 C 7.99 4.67 4.67 1.12 090 50.5835761 C 5.36 4.02 4.02 0.75 090 50.5835800 C 7.01 4.66 4.66 0.95 090 50.5835820 C 12.86 7.22 7.22 1.94 090 50.5835840 C 9.76 5.30 5.30 1.34 090 50.5835860 C 5.54 4.04 4.04 0.78 090 50.5835870 C 22.14 9.79 9.79 3.00 090 50.5835875 C 10.11 5.20 5.20 1.41 090 50.5835876 C 16.97 7.53 7.53 2.39 090 50.5835879 C 15.98 7.71 7.71 2.27 090 50.5835881 C 17.97 8.69 8.69 2.55 090 50.5835901 C 8.18 5.32 5.32 1.15 090 50.5835903 C 9.38 6.17 6.17 1.30 090 50.5835905 C 31.20 13.22 13.22 4.43 090 50.5835907 C 34.95 14.20 14.20 4.91 090 50.5836000 C 0.18 0.57 0.05 0.01 XXX 50.5836002 C 1.96 2.87 0.97 0.17 000 50.5836005 C 0.95 7.67 0.31 0.05 000 50.5836010 C 2.43 19.36 0.79 0.20 XXX 50.5836011 C 3.14 27.90 1.06 0.27 XXX 50.5836012 C 3.51 19.00 1.19 0.23 XXX 50.5836013 C 2.52 21.42 0.69 0.25 XXX 50.5836014 C 3.02 20.18 1.03 0.19 XXX 50.5836015 C 3.51 23.73 1.19 0.21 XXX 50.5836100 C 3.02 12.11 1.11 0.26 XXX 50.5836120 C 2.01 10.73 0.65 0.14 XXX 50.5836140 C 2.01 12.81 0.64 0.16 XXX 50.5836145 C 2.01 12.59 0.66 0.11 XXX 50.5836160 C 2.52 13.52 0.84 0.26 XXX 50.5836200 C 3.02 16.56 1.01 0.24 XXX 50.5836215 C 4.67 27.11 1.61 0.27 XXX 50.5836216 C 5.27 29.16 1.80 0.31 XXX 50.5836217 C 6.29 55.60 2.18 0.44 XXX 50.5836218 C 1.01 5.10 0.34 0.07 ZZZ 50.5836245 C 4.67 32.18 1.68 0.31 XXX 50.5836246 C 5.27 30.05 1.83 0.38 XXX 50.5836247 C 6.29 49.65 2.15 0.47 XXX 50.5836248 C 1.01 4.05 0.34 0.07 ZZZ 50.5836260 C 9.70 4.89 4.89 1.29 090 50.5836261 C 5.44 3.67 3.67 0.70 090 50.5836262 C 4.01 2.76 2.76 0.54 090 50.5836299 S 0.00 0.00 0.00 0.00 YYY 0.0036400 D 0.38 0.28 0.09 0.03 XXX 50.5836405 D 0.31 0.26 0.08 0.03 XXX 50.5836406 D 0.18 0.28 0.05 0.01 XXX 50.5836410 C 0.18 0.29 0.05 0.01 XXX 50.5836415 C 3.00 0.00 0.00 0.00 XXX 1.7536416 D 0.00 0.00 0.00 0.00 XXX 0.0036420 D 1.01 0.34 0.27 0.07 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
36425 C 0.76 0.22 0.22 0.06 XXX 50.5836430 C 0.00 1.01 1.01 0.06 XXX 50.5836440 D 1.03 0.29 0.29 0.10 XXX 50.5836450 D 2.23 0.71 0.71 0.21 XXX 50.5836455 C 2.43 1.01 1.01 0.15 XXX 50.5836460 D 6.58 2.25 2.25 0.79 XXX 50.5836468 C 0.00 0.00 0.00 0.00 000 0.0036469 C 0.00 0.00 0.00 0.00 000 0.0036470 C 1.09 2.69 0.73 0.12 010 50.5836471 C 1.57 3.08 0.96 0.19 010 50.5836475 C 6.72 51.54 2.54 0.37 000 50.5836476 C 3.38 7.90 1.14 0.18 ZZZ 50.5836478 C 6.72 46.91 2.54 0.37 000 50.5836479 C 3.38 8.01 1.14 0.18 ZZZ 50.5836481 C 6.98 5.75 2.60 0.55 000 50.5836500 C 3.51 1.37 1.37 0.20 000 50.5836510 C 1.09 3.90 0.61 0.10 000 50.5836511 C 1.74 0.73 0.73 0.08 000 50.5836512 C 1.74 0.74 0.74 0.08 000 50.5836513 C 1.74 0.73 0.73 0.17 000 50.5836514 C 1.74 17.02 0.71 0.08 000 50.5836515 C 1.74 66.49 0.66 0.08 000 50.5836516 C 1.22 84.29 0.48 0.08 000 50.5836522 C 1.67 32.46 0.96 0.13 000 50.5836540 D 0.00 0.00 0.00 0.00 XXX 0.0036550 C 0.00 0.39 0.39 0.37 XXX 50.5836555 D 2.68 5.77 0.80 0.11 000 50.5836556 C 2.50 5.64 0.74 0.19 000 50.5836557 D 5.09 21.20 2.66 0.57 010 50.5836558 C 4.79 21.10 2.56 0.57 010 50.5836560 D 6.24 29.76 3.04 0.57 010 50.5836561 C 5.99 29.67 2.96 0.57 010 50.5836563 C 6.19 26.82 2.99 0.84 010 50.5836565 C 5.99 24.77 2.96 0.57 010 50.5836566 C 6.49 25.57 3.12 0.57 010 50.5836568 D 1.92 7.55 0.58 0.11 000 50.5836569 C 1.82 7.36 0.57 0.19 000 50.5836570 D 5.31 33.27 2.73 0.57 010 50.5836571 C 5.29 33.34 2.72 0.57 010 50.5836575 C 0.67 4.06 0.26 0.20 000 50.5836576 C 3.19 6.96 1.85 0.19 010 50.5836578 C 3.49 11.16 2.31 0.19 010 50.5836580 C 1.31 6.96 0.41 0.19 000 50.5836581 C 3.43 19.55 1.93 0.19 010 50.5836582 C 5.19 26.09 2.87 0.19 010 50.5836583 C 5.24 26.11 2.89 0.19 010 50.5836584 C 1.20 6.99 0.55 0.19 000 50.5836585 C 4.79 27.90 2.74 0.19 010 50.5836589 C 2.27 2.25 1.39 0.24 010 50.5836590 C 3.30 3.38 1.72 0.44 010 50.5836595 C 3.59 17.30 1.45 0.21 000 50.5836596 C 0.75 3.70 0.50 0.05 000 50.5836597 C 1.21 2.41 0.44 0.07 000 50.5836598 C 0.74 2.65 2.65 0.05 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
36600 C 0.32 0.49 0.09 0.02 XXX 50.5836620 C 1.15 0.23 0.23 0.07 000 50.5836625 C 2.11 0.53 0.53 0.26 000 50.5836640 C 2.10 1.04 1.04 0.21 000 50.5836660 D 1.40 0.44 0.44 0.14 000 50.5836680 C 1.20 0.49 0.49 0.11 000 50.5836800 C 2.43 1.81 1.81 0.25 000 50.5836810 C 3.96 1.68 1.68 0.45 000 50.5836815 C 2.62 1.17 1.17 0.35 000 50.5836818 C 11.52 6.05 6.05 1.89 090 50.5836819 C 13.98 6.39 6.39 1.95 090 50.5836820 C 13.98 6.40 6.40 1.94 090 50.5836821 C 8.92 4.66 4.66 1.23 090 50.5836822 C 5.41 4.39 4.39 0.79 090 50.5836823 C 20.97 9.40 9.40 2.88 090 50.5836825 C 9.83 5.06 5.06 1.35 090 50.5836830 C 11.98 5.25 5.25 1.66 090 50.5836831 C 7.99 3.95 3.95 1.09 090 50.5836832 C 10.48 4.73 4.73 1.44 090 50.5836833 C 11.93 5.22 5.22 1.65 090 50.5836834 C 9.92 4.80 4.80 1.37 090 50.5836835 C 7.14 4.33 4.33 0.98 090 50.5836838 C 20.60 9.41 9.41 3.01 090 50.5836860 C 2.01 1.78 0.68 0.11 000 50.5836861 C 2.52 1.49 1.49 0.27 000 50.5836870 C 5.15 53.18 3.16 0.29 090 50.5837140 C 23.56 10.51 10.51 2.01 090 50.5837145 C 24.57 10.89 10.89 3.25 090 50.5837160 C 21.57 9.28 9.28 2.81 090 50.5837180 C 24.57 10.32 10.32 3.34 090 50.5837181 C 26.64 11.03 11.03 3.40 090 50.5837182 C 16.97 6.08 6.08 1.00 000 50.5837183 C 7.99 3.02 3.02 0.47 000 50.5837184 C 8.66 71.90 3.36 0.55 000 50.5837185 C 3.28 22.95 1.11 0.21 ZZZ 50.5837186 C 4.92 49.53 1.66 0.32 ZZZ 50.5837187 C 8.03 70.38 3.15 0.51 000 50.5837188 C 5.71 62.15 2.37 0.37 000 50.5837195 C 384.35 0.00 0.00 0.00 XXX 1.2537200 C 4.55 1.50 1.50 0.27 000 50.5837201 C 4.99 2.55 2.55 0.33 000 50.5837202 C 5.67 3.04 3.04 0.43 000 50.5837203 C 5.02 32.97 2.04 0.29 000 50.5837204 C 18.11 5.92 5.92 1.48 000 50.5837205 C 8.27 3.76 3.76 0.60 000 50.5837206 C 4.12 1.43 1.43 0.31 ZZZ 50.5837207 C 8.27 3.17 3.17 1.17 000 50.5837208 C 4.12 1.38 1.38 0.59 ZZZ 50.5837209 C 2.27 0.74 0.74 0.15 000 50.5837215 C 18.71 9.12 9.12 1.09 090 50.5837216 C 17.98 8.84 8.84 1.04 090 50.5837250 C 2.10 0.75 0.75 0.21 ZZZ 50.5837251 C 1.60 0.55 0.55 0.19 ZZZ 50.5837500 C 10.98 6.87 6.87 1.54 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
37501 C 0.00 0.00 0.00 0.00 YYY 0.0037565 C 10.86 5.64 5.64 1.33 090 50.5837600 C 11.23 6.65 6.65 1.41 090 50.5837605 C 13.09 6.92 6.92 1.98 090 50.5837606 C 6.27 4.57 4.57 1.23 090 50.5837607 C 6.15 3.57 3.57 0.85 090 50.5837609 C 3.00 4.51 1.97 0.36 010 50.5837615 C 5.72 4.12 4.12 0.68 090 50.5837616 C 16.47 8.10 8.10 2.32 090 50.5837617 C 22.03 9.20 9.20 2.97 090 50.5837618 C 4.83 3.62 3.62 0.67 090 50.5837620 C 10.54 5.73 5.73 0.91 090 50.5837650 C 7.79 4.69 4.69 1.01 090 50.5837660 C 20.97 9.08 9.08 2.48 090 50.5837700 C 3.72 2.80 2.80 0.53 090 50.5837718 C 6.76 4.07 4.07 0.14 090 50.5837720 C 5.65 3.70 3.70 0.78 090 50.58 12/31/200537722 C 7.79 4.42 4.42 0.86 090 50.5837730 C 7.32 4.26 4.26 1.01 090 50.58 12/31/200537735 C 10.51 5.52 5.52 1.48 090 50.5837760 C 10.45 5.36 5.36 1.44 090 50.5837765 C 7.34 4.63 4.63 0.48 090 50.5837766 C 9.29 5.34 5.34 0.48 090 50.5837780 C 3.83 2.86 2.86 0.53 090 50.5837785 C 3.83 5.21 2.73 0.54 090 50.5837788 C 21.98 9.11 9.11 2.25 090 50.5837790 C 8.33 4.38 4.38 0.59 090 50.5837799 S 0.00 0.00 0.00 0.00 YYY 0.0038100 C 14.48 6.19 6.19 1.91 090 50.5838101 C 15.29 6.54 6.54 2.04 090 50.5838102 C 4.79 1.64 1.64 0.63 ZZZ 50.5838115 C 15.80 6.66 6.66 2.08 090 50.5838120 C 16.97 7.40 7.40 2.24 090 50.5838129 C 0.00 0.00 0.00 0.00 YYY 0.0038200 C 2.64 0.89 0.89 0.14 000 50.5838204 C 0.00 0.00 0.00 0.00 XXX 0.0038205 C 1.50 0.67 0.67 0.07 000 50.5838206 C 1.50 0.67 0.67 0.07 000 50.5838207 C 0.00 0.00 0.00 0.00 XXX 0.0038208 C 0.00 0.00 0.00 0.00 XXX 0.0038209 C 0.00 0.00 0.00 0.00 XXX 0.0038210 C 0.00 0.00 0.00 0.00 XXX 0.0038211 C 0.00 0.00 0.00 0.00 XXX 0.0038212 C 0.00 0.00 0.00 0.00 XXX 0.0038213 C 0.00 0.00 0.00 0.00 XXX 0.0038214 C 0.00 0.00 0.00 0.00 XXX 0.0038215 C 0.00 0.00 0.00 0.00 XXX 0.0038220 C 1.08 3.73 0.52 0.05 XXX 50.5838221 C 1.37 3.94 0.65 0.07 XXX 50.5838230 C 4.53 3.23 3.23 0.48 010 50.5838240 C 2.24 1.03 1.03 0.11 XXX 50.5838241 C 2.24 1.04 1.04 0.11 XXX 50.5838242 C 1.71 0.78 0.78 0.08 000 50.5838300 C 1.99 4.31 2.06 0.25 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
38305 C 5.99 4.45 4.45 0.88 090 50.5838308 C 6.44 3.75 3.75 0.85 090 50.5838380 C 7.45 5.70 5.70 0.74 090 50.5838381 C 12.86 6.90 6.90 1.84 090 50.5838382 C 10.06 5.77 5.77 1.37 090 50.5838500 C 3.74 3.70 2.09 0.49 010 50.5838505 C 1.14 2.06 0.78 0.09 000 50.5838510 C 6.42 5.56 3.49 0.72 010 50.5838520 C 6.66 4.06 4.06 0.84 090 50.5838525 C 6.06 3.30 3.30 0.80 090 50.5838530 C 7.97 4.40 4.40 1.12 090 50.5838542 C 5.90 4.49 4.49 0.60 090 50.5838550 C 6.91 3.92 3.92 0.88 090 50.5838555 C 14.12 8.55 8.55 1.75 090 50.5838562 C 10.47 5.79 5.79 1.20 090 50.5838564 C 10.81 5.26 5.26 1.32 090 50.5838570 C 9.24 3.98 3.98 1.13 010 50.5838571 C 14.66 5.66 5.66 1.15 010 50.5838572 C 16.57 7.09 7.09 1.90 010 50.5838589 S 0.00 0.00 0.00 0.00 YYY 0.0038700 C 8.23 6.25 6.25 0.72 090 50.5838720 C 13.59 9.38 9.38 1.20 090 50.5838724 C 14.52 9.86 9.86 1.28 090 50.5838740 C 10.01 4.95 4.95 1.32 090 50.5838745 C 13.08 6.09 6.09 1.73 090 50.5838746 C 4.88 1.61 1.61 0.72 ZZZ 50.5838747 C 4.88 1.67 1.67 0.64 ZZZ 50.5838760 C 12.93 6.14 6.14 1.71 090 50.5838765 C 19.95 8.83 8.83 2.47 090 50.5838770 C 13.21 5.76 5.76 1.40 090 50.5838780 C 16.57 8.22 8.22 1.88 090 50.5838790 C 1.29 7.37 0.76 0.13 000 50.5838792 C 0.52 0.44 0.44 0.06 000 50.5838794 C 4.44 3.46 3.46 0.32 090 50.5838999 S 0.00 0.00 0.00 0.00 YYY 0.0039000 C 6.09 4.66 4.66 0.89 090 50.5839010 C 11.77 7.56 7.56 1.75 090 50.5839200 C 13.60 7.55 7.55 2.02 090 50.5839220 C 17.39 9.39 9.39 2.45 090 50.5839400 C 5.60 4.86 4.86 0.82 010 50.5839499 S 0.00 0.00 0.00 0.00 YYY 0.0039501 C 13.17 6.47 6.47 1.77 090 50.5839502 C 16.31 7.16 7.16 2.16 090 50.5839503 C 94.86 33.47 33.47 10.95 090 50.5839520 C 16.08 8.06 8.06 2.23 090 50.5839530 C 15.39 7.15 7.15 2.10 090 50.5839531 C 16.40 7.40 7.40 2.21 090 50.5839540 C 13.30 6.24 6.24 1.79 090 50.5839541 C 14.39 6.60 6.60 1.92 090 50.5839545 C 13.35 7.56 7.56 1.83 090 50.5839560 C 11.98 6.30 6.30 1.59 090 50.5839561 C 17.47 9.36 9.36 2.44 090 50.5839599 S 0.00 0.00 0.00 0.00 YYY 0.0040490 C 1.22 1.63 0.61 0.05 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
40500 C 4.27 6.91 4.34 0.38 090 50.5840510 C 4.69 6.63 4.02 0.49 090 50.5840520 C 4.66 7.56 4.12 0.52 090 50.5840525 C 7.54 6.32 6.32 0.85 090 50.5840527 C 9.12 7.37 7.37 0.97 090 50.5840530 C 5.39 7.83 4.59 0.55 090 50.5840650 C 3.63 6.81 3.30 0.38 090 50.5840652 C 4.25 7.76 4.27 0.52 090 50.5840654 C 5.30 8.62 4.94 0.60 090 50.5840700 C 12.77 9.10 9.10 0.95 090 50.5840701 C 15.83 11.36 11.36 1.65 090 50.5840702 C 13.02 8.27 8.27 1.23 090 50.5840720 C 13.53 9.92 9.92 1.79 090 50.5840761 C 14.70 10.30 10.30 1.93 090 50.5840799 S 0.00 0.00 0.00 0.00 YYY 0.0040800 C 1.17 2.97 1.78 0.13 010 50.5840801 C 2.53 4.03 2.75 0.31 010 50.5840804 C 1.24 3.40 1.86 0.11 010 50.5840805 C 2.69 4.49 2.82 0.32 010 50.5840806 C 0.31 1.84 0.50 0.04 000 50.5840808 C 0.96 2.66 1.48 0.10 010 50.5840810 C 1.31 2.89 1.66 0.13 010 50.5840812 C 2.31 3.73 2.41 0.28 010 50.5840814 C 3.41 4.95 3.90 0.41 090 50.5840816 C 3.66 5.18 4.01 0.40 090 50.5840818 C 2.41 5.18 3.98 0.21 090 50.5840819 C 2.41 4.09 3.10 0.29 090 50.5840820 C 1.28 3.94 2.45 0.11 010 50.5840830 C 1.76 3.73 2.10 0.19 010 50.5840831 C 2.46 4.67 3.06 0.30 010 50.5840840 C 8.72 9.81 6.99 1.08 090 50.5840842 C 8.72 10.09 6.80 1.08 090 50.5840843 C 12.08 11.98 7.83 1.39 090 50.5840844 C 15.99 15.81 11.59 1.99 090 50.5840845 C 18.55 17.11 13.25 2.00 090 50.5840899 S 0.00 0.00 0.00 0.00 YYY 0.0041000 C 1.30 2.32 1.41 0.12 010 50.5841005 C 1.26 3.34 1.72 0.12 010 50.5841006 C 3.24 4.80 3.18 0.35 090 50.5841007 C 3.10 5.15 3.03 0.31 090 50.5841008 C 3.36 4.69 3.21 0.42 090 50.5841009 C 3.58 4.98 3.58 0.47 090 50.5841010 C 1.06 3.43 1.60 0.07 010 50.5841015 C 3.95 5.42 4.15 0.46 090 50.5841016 C 4.06 5.63 4.23 0.53 090 50.5841017 C 4.06 5.65 4.31 0.53 090 50.5841018 C 5.09 6.15 4.58 0.68 090 50.5841100 C 1.63 2.43 1.42 0.15 010 50.5841105 C 1.42 2.31 1.32 0.13 010 50.5841108 C 1.05 2.08 1.13 0.10 010 50.5841110 C 1.51 2.99 1.64 0.13 010 50.5841112 C 2.73 4.48 3.23 0.28 090 50.5841113 C 3.19 4.75 3.48 0.34 090 50.5841114 C 8.46 7.21 7.21 0.83 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
41115 C 1.74 3.30 1.86 0.18 010 50.5841116 C 2.44 4.36 2.81 0.23 090 50.5841120 C 9.76 15.35 15.35 0.79 090 50.5841130 C 11.13 16.24 16.24 0.93 090 50.5841135 C 23.06 23.29 23.29 1.88 090 50.5841140 C 25.46 26.75 26.75 2.26 090 50.5841145 C 30.01 30.63 30.63 2.54 090 50.5841150 C 23.01 24.78 24.78 1.94 090 50.5841153 C 23.73 25.09 25.09 2.00 090 50.5841155 C 27.68 26.88 26.88 2.33 090 50.5841250 C 1.91 2.75 1.18 0.18 010 50.5841251 C 2.27 3.28 1.55 0.22 010 50.5841252 C 2.97 3.90 2.26 0.29 010 50.5841500 C 3.70 7.47 7.47 0.30 090 50.5841510 C 3.41 7.95 7.95 0.20 090 50.5841520 C 2.73 4.63 3.63 0.27 090 50.5841599 S 0.00 0.00 0.00 0.00 YYY 0.0041800 C 1.17 2.60 1.28 0.12 010 50.5841805 C 1.24 2.68 2.22 0.13 010 50.5841806 C 2.69 3.59 3.04 0.37 010 50.5841820 C 0.00 0.00 0.00 0.00 000 0.0041821 C 0.00 0.00 0.00 0.00 000 0.0041822 C 2.31 3.90 1.88 0.31 010 50.5841823 C 3.30 5.58 4.02 0.47 090 50.5841825 C 1.31 3.07 2.25 0.15 010 50.5841826 C 2.31 2.44 2.11 0.30 010 50.5841827 C 3.41 5.53 3.67 0.35 090 50.5841828 C 3.09 3.81 2.97 0.44 010 50.5841830 C 3.34 4.97 3.63 0.44 010 50.5841850 C 0.00 0.00 0.00 0.00 000 0.0041870 C 0.00 0.00 0.00 0.00 000 0.0041872 C 2.59 5.03 3.47 0.30 090 50.5841874 C 3.09 4.85 3.18 0.45 090 50.5841899 S 0.00 0.00 0.00 0.00 YYY 0.0042000 C 1.23 2.57 1.25 0.12 010 50.5842100 C 1.31 2.09 1.36 0.13 010 50.5842104 C 1.64 2.55 1.55 0.16 010 50.5842106 C 2.10 3.23 2.45 0.25 010 50.5842107 C 4.43 5.73 3.96 0.44 090 50.5842120 C 6.16 11.80 11.80 0.52 090 50.5842140 C 1.62 3.73 2.10 0.13 090 50.5842145 C 8.04 7.51 7.51 0.65 090 50.5842160 C 1.80 4.26 2.30 0.17 010 50.5842180 C 2.50 3.08 2.11 0.21 010 50.5842182 C 3.82 3.88 3.04 0.40 010 50.5842200 C 11.98 10.24 10.24 1.27 090 50.5842205 C 13.27 10.10 10.10 1.58 090 50.5842210 C 14.48 11.49 11.49 2.16 090 50.5842215 C 8.81 9.10 9.10 1.31 090 50.5842220 C 7.01 6.80 6.80 0.73 090 50.5842225 C 9.53 17.11 17.11 0.86 090 50.5842226 C 9.99 14.74 14.74 1.01 090 50.5842227 C 9.51 15.59 15.59 0.98 090 50.5842235 C 7.86 11.89 11.89 0.72 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
42260 C 9.79 10.22 7.08 1.26 090 50.5842280 C 1.54 1.97 1.14 0.19 010 50.5842281 C 1.93 2.64 1.88 0.17 010 50.5842299 S 0.00 0.00 0.00 0.00 YYY 0.0042300 C 1.93 2.83 1.82 0.16 010 50.5842305 C 6.06 4.73 4.73 0.51 090 50.5842310 C 1.56 2.27 1.54 0.13 010 50.5842320 C 2.35 3.28 2.10 0.21 010 50.5842325 C 2.75 4.61 2.30 0.26 090 50.58 12/31/200542326 C 3.77 5.90 3.15 0.29 090 50.58 12/31/200542330 C 2.21 3.15 1.85 0.19 010 50.5842335 C 3.31 4.91 3.15 0.29 090 50.5842340 C 4.59 6.06 3.94 0.42 090 50.5842400 C 0.78 1.65 0.72 0.06 000 50.5842405 C 3.29 4.01 2.46 0.28 010 50.5842408 C 4.53 5.93 3.62 0.45 090 50.5842409 C 2.81 4.53 2.77 0.27 090 50.5842410 C 9.33 6.24 6.24 0.91 090 50.5842415 C 16.86 10.89 10.89 1.43 090 50.5842420 C 19.56 12.41 12.41 1.65 090 50.5842425 C 13.00 8.63 8.63 1.05 090 50.5842426 C 21.23 13.05 13.05 1.80 090 50.5842440 C 6.96 4.80 4.80 0.59 090 50.5842450 C 4.61 5.92 4.26 0.42 090 50.5842500 C 4.29 5.70 4.19 0.41 090 50.5842505 C 6.17 7.14 5.38 0.55 090 50.5842507 C 6.10 6.55 6.55 0.49 090 50.5842508 C 9.09 8.36 8.36 1.04 090 50.5842509 C 11.52 10.22 10.22 0.93 090 50.5842510 C 8.14 7.81 7.81 0.66 090 50.5842550 C 1.25 3.22 0.41 0.07 000 50.5842600 C 4.81 6.60 4.13 0.43 090 50.5842650 C 0.77 1.10 0.71 0.07 000 50.5842660 C 1.13 1.35 0.85 0.09 000 50.5842665 C 2.53 4.18 2.60 0.23 090 50.5842699 S 0.00 0.00 0.00 0.00 YYY 0.0042700 C 1.62 2.66 1.70 0.13 010 50.5842720 C 5.41 4.84 3.80 0.44 010 50.5842725 C 10.70 8.24 8.24 0.91 090 50.5842800 C 1.39 2.19 1.40 0.11 010 50.5842802 C 1.54 4.77 2.07 0.12 010 50.5842804 C 1.24 3.75 1.74 0.10 010 50.5842806 C 1.58 4.08 1.94 0.13 010 50.5842808 C 2.30 3.10 1.94 0.19 010 50.5842809 C 1.81 2.34 1.33 0.16 010 50.5842810 C 3.25 5.73 3.55 0.29 090 50.5842815 C 7.06 6.43 6.43 0.61 090 50.5842820 D 3.90 3.30 3.30 0.31 090 50.5842821 C 4.28 3.51 3.51 0.35 090 50.5842825 D 3.41 3.18 3.18 0.25 090 50.5842826 C 3.37 3.04 3.04 0.27 090 50.5842830 D 2.57 2.57 2.57 0.20 090 50.5842831 C 2.71 2.85 2.85 0.22 090 50.5842835 D 2.30 2.47 2.47 0.21 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
42836 C 3.18 2.97 2.97 0.26 090 50.5842842 C 8.75 11.02 11.02 0.71 090 50.5842844 C 14.29 16.28 16.28 1.16 090 50.5842845 C 24.25 23.25 23.25 1.98 090 50.5842860 C 2.22 2.41 2.41 0.18 090 50.5842870 C 5.39 8.59 8.59 0.44 090 50.5842890 C 12.92 14.19 14.19 1.05 090 50.5842892 C 15.81 17.22 17.22 1.28 090 50.5842894 C 22.85 22.08 22.08 1.86 090 50.5842900 C 5.24 3.67 3.67 0.50 010 50.5842950 C 8.09 11.90 11.90 0.72 090 50.5842953 C 8.95 17.38 17.38 0.88 090 50.5842955 C 7.38 10.70 10.70 0.80 090 50.5842960 C 2.33 1.97 1.97 0.19 010 50.5842961 C 5.58 4.97 4.97 0.45 090 50.5842962 C 7.13 5.93 5.93 0.58 090 50.5842970 C 5.42 4.19 4.19 0.39 090 50.5842971 C 6.20 5.13 5.13 0.51 090 50.5842972 C 7.19 5.72 5.72 0.62 090 50.5842999 S 0.00 0.00 0.00 0.00 YYY 0.0043020 C 8.08 5.43 5.43 0.87 090 50.5843030 C 7.68 5.51 5.51 0.70 090 50.5843045 C 20.09 10.73 10.73 2.58 090 50.5843100 C 9.18 6.24 6.24 0.93 090 50.5843101 C 16.22 7.90 7.90 2.31 090 50.5843107 C 39.94 18.31 18.31 5.22 090 50.5843108 C 34.14 14.25 14.25 4.07 090 50.5843112 C 43.43 19.42 19.42 5.79 090 50.5843113 C 35.22 15.15 15.15 4.42 090 50.5843116 C 31.17 16.74 16.74 3.05 090 50.5843117 C 39.94 17.32 17.32 5.17 090 50.5843118 C 33.15 13.82 13.82 4.10 090 50.5843121 C 29.15 13.71 13.71 3.90 090 50.5843122 C 39.94 17.44 17.44 5.40 090 50.5843123 C 33.15 14.14 14.14 4.15 090 50.5843124 C 27.28 13.12 13.12 3.73 090 50.5843130 C 11.73 7.58 7.58 1.16 090 50.5843135 C 16.08 8.11 8.11 2.33 090 50.5843200 C 1.59 4.14 1.07 0.13 000 50.5843201 C 2.09 4.64 1.10 0.15 000 50.5843202 C 1.89 5.56 0.94 0.15 000 50.5843204 C 3.76 1.52 1.52 0.30 000 50.5843205 C 3.78 1.52 1.52 0.28 000 50.5843215 C 2.60 1.20 1.20 0.22 000 50.5843216 C 2.40 1.06 1.06 0.20 000 50.5843217 C 2.90 6.97 1.19 0.26 000 50.5843219 C 2.80 1.35 1.35 0.24 000 50.5843220 C 2.10 0.97 0.97 0.17 000 50.5843226 C 2.34 1.03 1.03 0.19 000 50.5843227 C 3.59 1.45 1.45 0.28 000 50.5843228 C 3.76 1.55 1.55 0.34 000 50.5843231 C 3.19 1.31 1.31 0.23 000 50.5843232 C 4.47 1.82 1.82 0.34 000 50.5843234 C 2.01 5.34 0.87 0.17 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
43235 C 2.39 5.18 1.02 0.19 000 50.5843236 C 2.92 6.42 1.22 0.21 000 50.5843237 C 3.98 1.59 1.59 0.43 000 50.5843238 C 5.02 1.97 1.97 0.43 000 50.5843239 C 2.87 5.73 1.19 0.22 000 50.5843240 C 6.85 2.61 2.61 0.56 000 50.5843241 C 2.59 1.10 1.10 0.21 000 50.5843242 C 7.30 2.74 2.74 0.53 000 50.5843243 C 4.56 1.80 1.80 0.33 000 50.5843244 C 5.04 1.97 1.97 0.37 000 50.5843245 C 3.18 1.30 1.30 0.26 000 50.5843246 C 4.32 1.69 1.69 0.34 000 50.5843247 C 3.38 1.37 1.37 0.27 000 50.5843248 C 3.15 1.31 1.31 0.23 000 50.5843249 C 2.90 1.21 1.21 0.22 000 50.5843250 C 3.20 1.31 1.31 0.26 000 50.5843251 C 3.69 1.48 1.48 0.29 000 50.5843255 C 4.81 1.89 1.89 0.35 000 50.5843256 C 4.34 1.71 1.71 0.32 000 50.5843257 C 5.50 2.21 2.21 0.36 000 50.5843258 C 4.54 1.79 1.79 0.33 000 50.5843259 C 5.19 2.00 2.00 0.35 000 50.5843260 C 5.95 2.29 2.29 0.43 000 50.5843261 C 6.26 2.40 2.40 0.46 000 50.5843262 C 7.38 2.79 2.79 0.54 000 50.5843263 C 7.28 2.77 2.77 0.54 000 50.5843264 C 8.89 3.32 3.32 0.65 000 50.5843265 C 10.00 3.70 3.70 0.73 000 50.5843267 C 7.38 2.79 2.79 0.54 000 50.5843268 C 7.38 2.89 2.89 0.54 000 50.5843269 C 8.20 3.08 3.08 0.60 000 50.5843271 C 7.38 2.79 2.79 0.54 000 50.5843272 C 7.38 2.79 2.79 0.54 000 50.5843280 C 17.22 7.29 7.29 2.27 090 50.5843289 C 0.00 0.00 0.00 0.00 YYY 0.0043300 C 9.13 6.39 6.39 1.12 090 50.5843305 C 17.36 10.72 10.72 1.54 090 50.5843310 C 25.35 11.09 11.09 3.60 090 50.5843312 C 28.38 11.92 11.92 4.00 090 50.5843313 C 45.21 18.86 18.86 5.45 090 50.5843314 C 50.19 19.24 19.24 6.63 090 50.5843320 C 19.90 9.23 9.23 2.73 090 50.5843324 C 20.54 8.79 8.79 2.75 090 50.5843325 C 20.03 8.81 8.81 2.59 090 50.5843326 C 19.71 9.32 9.32 2.84 090 50.5843330 C 19.74 8.55 8.55 2.62 090 50.5843331 C 20.10 9.81 9.81 2.93 090 50.5843340 C 19.58 8.99 8.99 2.45 090 50.5843341 C 20.82 10.04 10.04 2.91 090 50.5843350 C 15.76 8.46 8.46 1.42 090 50.5843351 C 18.32 9.82 9.82 2.46 090 50.5843352 C 15.24 8.40 8.40 2.05 090 50.5843360 C 35.65 15.11 15.11 4.96 090 50.5843361 C 40.44 16.93 16.93 4.49 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
43400 C 21.17 9.46 9.46 1.95 090 50.5843401 C 22.06 9.51 9.51 3.04 090 50.5843405 C 19.98 9.61 9.61 2.83 090 50.5843410 C 13.45 7.65 7.65 1.71 090 50.5843415 C 24.96 11.77 11.77 3.52 090 50.5843420 C 14.33 7.42 7.42 1.43 090 50.5843425 C 21.00 10.00 10.00 3.02 090 50.5843450 C 1.38 2.64 0.69 0.11 000 50.5843453 C 1.51 6.08 0.73 0.11 000 50.5843456 C 2.57 13.78 1.10 0.20 000 50.5843458 C 3.06 6.67 1.28 0.24 000 50.5843460 C 3.79 1.49 1.49 0.31 000 50.5843496 C 0.00 0.00 0.00 0.00 090 0.0043499 S 0.00 0.00 0.00 0.00 YYY 0.0043500 C 11.03 4.98 4.98 1.45 090 50.5843501 C 20.01 8.32 8.32 2.64 090 50.5843502 C 23.10 9.48 9.48 3.09 090 50.5843510 C 13.06 6.60 6.60 1.48 090 50.5843520 C 9.98 5.27 5.27 1.36 090 50.5843600 C 1.91 0.66 0.66 0.14 000 50.5843605 C 11.96 5.30 5.30 1.58 090 50.5843610 C 14.58 6.16 6.16 1.93 090 50.5843611 C 17.81 7.58 7.58 2.35 090 50.5843620 C 29.99 11.82 11.82 3.95 090 50.5843621 C 30.68 12.00 12.00 4.03 090 50.5843622 C 32.48 12.62 12.62 4.29 090 50.5843631 C 22.56 9.18 9.18 2.98 090 50.5843632 C 22.56 9.18 9.18 2.98 090 50.5843633 C 23.07 9.35 9.35 3.05 090 50.5843634 C 25.08 10.11 10.11 3.32 090 50.5843635 C 2.06 0.70 0.70 0.27 ZZZ 50.5843638 C 28.96 11.88 11.88 3.75 090 50.58 12/31/200543639 C 29.61 11.68 11.68 3.85 090 50.58 12/31/200543640 C 16.99 7.27 7.27 2.25 090 50.5843641 C 17.24 7.38 7.38 2.24 090 50.5843644 C 27.83 11.24 11.24 3.15 090 50.5843645 C 29.96 12.04 12.04 3.53 090 50.5843651 C 10.13 4.77 4.77 1.33 090 50.5843652 C 12.13 5.77 5.77 1.55 090 50.5843653 C 7.72 4.19 4.19 1.01 090 50.5843659 C 0.00 0.00 0.00 0.00 YYY 0.0043750 C 4.48 2.20 2.20 0.43 010 50.5843752 C 0.81 0.28 0.26 0.02 000 50.5843760 C 1.10 2.09 0.45 0.09 000 50.5843761 C 2.01 1.17 0.66 0.13 000 50.5843770 C 16.71 7.73 7.73 2.18 090 50.5843771 C 19.50 8.61 8.61 2.54 090 50.5843772 C 15.00 6.44 6.44 1.92 090 50.5843773 C 19.50 8.61 8.61 2.55 090 50.5843774 C 15.00 6.58 6.58 1.84 090 50.5843800 C 13.67 5.91 5.91 1.81 090 50.5843810 C 14.63 6.19 6.19 1.93 090 50.5843820 C 15.35 6.42 6.42 2.03 090 50.5843825 C 19.19 8.03 8.03 2.53 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
43830 C 9.52 4.85 4.85 1.25 090 50.5843831 C 7.83 4.52 4.52 1.03 090 50.5843832 C 15.58 6.86 6.86 1.97 090 50.5843840 C 15.54 6.78 6.78 2.05 090 50.5843842 C 18.44 7.81 7.81 2.44 090 50.5843843 C 18.62 7.78 7.78 2.45 090 50.5843845 C 31.00 10.80 10.80 4.05 090 50.5843846 C 24.01 10.05 10.05 3.18 090 50.5843847 C 26.88 10.92 10.92 3.55 090 50.5843848 C 29.35 11.84 11.84 3.87 090 50.5843850 C 24.68 9.84 9.84 3.27 090 50.5843855 C 26.12 10.35 10.35 3.46 090 50.5843860 C 24.96 9.99 9.99 3.30 090 50.5843865 C 26.48 10.53 10.53 3.50 090 50.5843870 C 9.68 4.52 4.52 1.27 090 50.5843880 C 24.61 9.92 9.92 3.26 090 50.5843886 C 4.00 3.14 3.14 0.25 090 50.5843887 C 3.95 2.78 2.78 0.51 090 50.5843888 C 5.80 3.77 3.77 0.70 090 50.5843999 S 0.00 0.00 0.00 0.00 YYY 0.0044005 C 16.21 6.73 6.73 2.14 090 50.5844010 C 12.50 5.46 5.46 1.64 090 50.5844015 C 2.62 0.88 0.88 0.35 ZZZ 50.5844020 C 13.97 5.95 5.95 1.85 090 50.5844021 C 14.06 5.98 5.98 1.86 090 50.5844025 C 14.26 6.04 6.04 1.89 090 50.5844050 C 14.01 5.97 5.97 1.85 090 50.5844055 C 21.97 8.75 8.75 2.90 090 50.5844100 C 2.01 0.71 0.71 0.17 000 50.5844110 C 11.79 5.24 5.24 1.55 090 50.5844111 C 14.27 6.12 6.12 1.86 090 50.5844120 C 16.97 7.09 7.09 2.24 090 50.5844121 C 4.44 1.52 1.52 0.58 ZZZ 50.5844125 C 17.51 7.27 7.27 2.26 090 50.5844126 C 35.45 14.15 14.15 4.68 090 50.5844127 C 40.94 15.76 15.76 5.75 090 50.5844128 C 4.44 1.53 1.53 0.61 ZZZ 50.5844130 C 14.47 6.23 6.23 1.87 090 50.5844132 C 0.00 0.00 0.00 0.00 XXX 0.0044133 C 0.00 0.00 0.00 0.00 XXX 0.0044135 C 0.00 0.00 0.00 0.00 XXX 0.0044136 C 0.00 0.00 0.00 0.00 XXX 0.0044137 C 0.00 0.00 0.00 0.00 XXX 0.0044139 C 2.23 0.76 0.76 0.28 ZZZ 50.5844140 C 20.97 8.67 8.67 2.70 090 50.5844141 C 19.48 10.07 10.07 2.52 090 50.5844143 C 22.96 10.71 10.71 3.04 090 50.5844144 C 21.50 9.64 9.64 2.85 090 50.5844145 C 26.38 10.83 10.83 3.28 090 50.5844146 C 27.50 12.89 12.89 3.40 090 50.5844147 C 20.68 8.71 8.71 2.55 090 50.5844150 C 23.91 12.05 12.05 3.03 090 50.5844151 C 26.84 13.43 13.43 3.48 090 50.5844152 C 27.79 11.62 11.62 3.51 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
44153 C 30.54 14.41 14.41 3.54 090 50.5844155 C 27.82 13.34 13.34 3.27 090 50.5844156 C 30.74 15.07 15.07 3.94 090 50.5844160 C 18.59 7.76 7.76 2.36 090 50.5844180 C 14.42 6.25 6.25 1.85 090 50.5844186 C 9.77 4.80 4.80 1.27 090 50.5844187 C 15.93 8.29 8.29 1.95 090 50.5844188 C 17.61 8.87 8.87 2.23 090 50.5844200 C 14.42 6.19 6.19 1.85 090 50.58 12/31/200544201 C 9.77 4.66 4.66 1.27 090 50.58 12/31/200544202 C 22.01 8.95 8.95 2.84 090 50.5844203 C 4.44 1.50 1.50 0.57 ZZZ 50.5844204 C 25.04 9.98 9.98 3.10 090 50.5844205 C 22.20 8.87 8.87 2.74 090 50.5844206 C 26.96 11.28 11.28 3.45 090 50.5844207 C 29.96 11.51 11.51 3.66 090 50.5844208 C 31.95 13.17 13.17 3.87 090 50.5844210 C 27.96 11.90 11.90 3.41 090 50.5844211 C 34.95 14.71 14.71 4.16 090 50.5844212 C 32.45 13.72 13.72 3.77 090 50.5844213 C 3.50 1.22 1.22 0.44 ZZZ 50.5844227 C 26.50 10.65 10.65 3.37 090 50.5844238 C 0.00 0.00 0.00 0.00 YYY 0.0044239 C 0.00 0.00 0.00 0.00 YYY 0.00 12/31/200544300 C 12.09 5.50 5.50 1.60 090 50.5844310 C 15.93 6.71 6.71 1.98 090 50.5844312 C 8.01 4.00 4.00 0.92 090 50.5844314 C 15.03 6.57 6.57 1.74 090 50.5844316 C 21.06 8.56 8.56 2.37 090 50.5844320 C 17.61 7.67 7.67 2.25 090 50.5844322 C 11.96 8.59 8.59 1.54 090 50.5844340 C 7.71 4.27 4.27 0.99 090 50.5844345 C 15.41 6.90 6.90 1.96 090 50.5844346 C 16.96 7.40 7.40 2.12 090 50.5844360 C 2.59 1.10 1.10 0.19 000 50.5844361 C 2.87 1.20 1.20 0.21 000 50.5844363 C 3.49 1.38 1.38 0.27 000 50.5844364 C 3.73 1.49 1.49 0.27 000 50.5844365 C 3.31 1.36 1.36 0.24 000 50.5844366 C 4.40 1.74 1.74 0.32 000 50.5844369 C 4.51 1.74 1.74 0.33 000 50.5844370 C 4.79 1.98 1.98 0.37 000 50.5844372 C 4.40 1.74 1.74 0.35 000 50.5844373 C 3.49 1.42 1.42 0.27 000 50.5844376 C 5.25 2.03 2.03 0.42 000 50.5844377 C 5.52 2.14 2.14 0.40 000 50.5844378 C 7.12 2.70 2.70 0.52 000 50.5844379 C 7.46 2.92 2.92 0.62 000 50.5844380 C 1.05 0.55 0.55 0.08 000 50.5844382 C 1.27 0.63 0.63 0.12 000 50.5844383 C 2.94 1.27 1.27 0.21 000 50.5844385 C 1.82 3.36 0.75 0.15 000 50.5844386 C 2.12 6.66 0.88 0.20 000 50.5844388 C 2.82 5.09 1.15 0.26 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
44389 C 3.13 6.64 1.27 0.27 000 50.5844390 C 3.82 7.13 1.49 0.32 000 50.5844391 C 4.31 8.75 1.69 0.34 000 50.5844392 C 3.81 6.60 1.49 0.34 000 50.5844393 C 4.83 6.92 1.87 0.42 000 50.5844394 C 4.42 7.83 1.72 0.38 000 50.5844397 C 4.70 1.80 1.80 0.39 000 50.5844500 C 0.49 0.16 0.16 0.03 000 50.5844602 C 16.01 6.41 6.41 2.11 090 50.5844603 C 18.63 7.29 7.29 2.41 090 50.5844604 C 16.01 6.47 6.47 2.11 090 50.5844605 C 19.50 8.41 8.41 2.51 090 50.5844615 C 15.91 6.69 6.69 2.06 090 50.5844620 C 12.18 5.34 5.34 1.51 090 50.5844625 C 15.03 6.32 6.32 1.85 090 50.5844626 C 25.32 9.84 9.84 3.26 090 50.5844640 C 21.62 8.59 8.59 2.77 090 50.5844650 C 22.54 8.91 8.91 2.92 090 50.5844660 C 21.33 8.36 8.36 2.13 090 50.5844661 C 24.77 9.58 9.58 2.80 090 50.5844680 C 15.38 6.46 6.46 1.99 090 50.5844700 C 16.09 6.68 6.68 1.83 090 50.5844701 C 3.10 1.06 1.06 0.37 ZZZ 50.5844715 C 0.00 0.00 0.00 0.00 XXX 0.0044720 C 5.00 1.71 1.71 0.37 XXX 50.5844721 C 7.00 2.40 2.40 0.97 XXX 50.5844799 S 0.00 0.00 0.00 0.00 YYY 0.0044800 C 11.21 5.40 5.40 1.47 090 50.5844820 C 12.07 5.50 5.50 1.59 090 50.5844850 C 10.72 5.01 5.01 1.39 090 50.5844899 S 0.00 0.00 0.00 0.00 YYY 0.0044900 C 10.12 4.70 4.70 1.33 090 50.5844901 C 3.37 27.97 1.11 0.22 000 50.5844950 C 9.99 4.32 4.32 1.31 090 50.5844955 C 1.53 0.54 0.54 0.20 ZZZ 50.5844960 C 12.32 5.35 5.35 1.63 090 50.5844970 C 8.69 4.09 4.09 1.14 090 50.5844979 C 0.00 0.00 0.00 0.00 YYY 0.0045000 C 4.51 2.97 2.97 0.52 090 50.5845005 C 1.99 4.06 1.58 0.25 010 50.5845020 C 4.71 3.28 3.28 0.55 090 50.5845100 C 3.67 2.37 2.37 0.44 090 50.5845108 C 4.75 2.78 2.78 0.59 090 50.5845110 C 27.96 12.43 12.43 3.35 090 50.5845111 C 16.46 7.18 7.18 2.06 090 50.5845112 C 30.49 11.79 11.79 3.42 090 50.5845113 C 30.53 12.63 12.63 3.48 090 50.5845114 C 27.28 10.90 10.90 3.35 090 50.5845116 C 24.54 10.05 10.05 2.87 090 50.5845119 C 30.79 12.49 12.49 3.35 090 50.5845120 C 24.56 10.15 10.15 2.89 090 50.5845121 C 27.00 11.13 11.13 3.24 090 50.5845123 C 16.68 6.87 6.87 1.85 090 50.5845126 C 45.09 19.26 19.26 4.32 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
45130 C 16.42 6.78 6.78 1.79 090 50.5845135 C 19.25 8.43 8.43 2.35 090 50.5845136 C 27.26 12.55 12.55 2.81 090 50.5845150 C 5.66 2.97 2.97 0.61 090 50.5845160 C 15.30 6.66 6.66 1.67 090 50.5845170 C 11.47 5.25 5.25 1.35 090 50.5845190 C 9.73 4.63 4.63 1.13 090 50.5845300 C 0.38 1.53 0.28 0.04 000 50.5845303 C 0.44 18.73 0.33 0.05 000 50.5845305 C 1.01 2.64 0.50 0.11 000 50.5845307 C 0.94 3.04 0.48 0.11 000 50.5845308 C 0.83 2.00 0.44 0.09 000 50.5845309 C 2.01 2.82 0.84 0.22 000 50.5845315 C 1.40 2.87 0.63 0.15 000 50.5845317 C 1.50 2.44 0.66 0.15 000 50.5845320 C 1.58 2.92 0.71 0.16 000 50.5845321 C 1.17 0.56 0.56 0.13 000 50.5845327 C 1.65 0.69 0.69 0.16 000 50.5845330 C 0.96 2.28 0.50 0.08 000 50.5845331 C 1.15 3.08 0.59 0.09 000 50.5845332 C 1.79 5.01 0.80 0.16 000 50.5845333 C 1.79 4.88 0.80 0.15 000 50.5845334 C 2.73 1.14 1.14 0.20 000 50.5845335 C 1.46 3.22 0.69 0.11 000 50.5845337 C 2.36 1.00 1.00 0.21 000 50.5845338 C 2.34 5.23 1.00 0.19 000 50.5845339 C 3.14 3.47 1.28 0.26 000 50.5845340 C 1.89 6.19 0.83 0.15 000 50.5845341 C 2.60 1.07 1.07 0.19 000 50.5845342 C 4.05 1.54 1.54 0.30 000 50.5845345 C 2.92 1.16 1.16 0.23 000 50.5845355 C 3.51 1.38 1.38 0.36 000 50.5845378 C 3.69 6.16 1.47 0.30 000 50.5845378 C 53 0.96 2.28 0.50 0.08 000 50.5845379 C 4.68 7.68 1.82 0.39 000 50.5845380 C 4.43 7.21 1.74 0.35 000 50.5845381 C 4.19 7.13 1.65 0.30 000 50.5845382 C 5.68 9.97 2.19 0.41 000 50.5845383 C 5.86 7.94 2.23 0.48 000 50.5845384 C 4.69 6.82 1.83 0.38 000 50.5845385 C 5.30 7.82 2.04 0.42 000 50.5845386 C 4.57 12.44 1.79 0.39 000 50.5845387 C 5.90 2.34 2.34 0.48 000 50.5845391 C 5.09 1.98 1.98 0.42 000 50.5845392 C 6.54 2.49 2.49 0.42 000 50.5845395 C 30.50 13.71 13.71 3.62 090 50.5845397 C 34.00 14.30 14.30 3.66 090 50.5845400 C 18.06 7.85 7.85 2.02 090 50.5845402 C 25.04 10.01 10.01 2.81 090 50.5845499 C 0.00 0.00 0.00 0.00 YYY 0.0045500 C 7.28 3.54 3.54 0.75 090 50.5845505 C 7.57 3.86 3.86 0.86 090 50.5845520 C 0.55 1.64 0.37 0.05 000 50.5845540 C 16.25 6.81 6.81 1.84 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
45541 C 13.38 5.96 5.96 1.55 090 50.5845550 C 22.97 9.24 9.24 2.61 090 50.5845560 C 10.56 5.06 5.06 1.13 090 50.5845562 C 15.36 7.00 7.00 1.83 090 50.5845563 C 23.43 10.54 10.54 3.10 090 50.5845800 C 17.74 7.44 7.44 1.85 090 50.5845805 C 20.75 9.53 9.53 2.02 090 50.5845820 C 18.45 7.64 7.64 1.58 090 50.5845825 C 21.22 9.84 9.84 2.31 090 50.5845900 C 2.61 1.50 1.50 0.30 010 50.5845905 C 2.30 1.43 1.43 0.27 010 50.5845910 C 2.80 1.66 1.66 0.30 010 50.5845915 C 3.14 4.33 2.10 0.30 010 50.5845990 C 1.80 0.79 0.79 0.17 000 50.5845999 S 0.00 0.00 0.00 0.00 YYY 0.0046020 C 2.90 2.34 1.86 0.31 010 50.5846030 C 1.23 1.35 0.71 0.14 010 50.5846040 C 4.95 5.51 3.59 0.62 090 50.5846045 C 4.31 2.90 2.90 0.54 090 50.5846050 C 1.19 2.55 0.84 0.14 010 50.5846060 C 5.68 3.25 3.25 0.67 090 50.5846070 C 2.71 1.84 1.84 0.36 090 50.5846080 C 2.49 2.37 1.13 0.30 010 50.5846083 C 1.40 2.53 0.92 0.15 010 50.5846200 C 3.41 3.86 2.87 0.39 090 50.5846210 C 2.67 5.12 2.63 0.31 090 50.5846211 C 4.24 5.42 3.51 0.48 090 50.5846220 C 1.56 2.30 0.95 0.17 010 50.5846221 C 2.04 2.65 1.75 0.23 010 50.5846230 C 2.57 3.08 1.29 0.30 010 50.5846250 C 3.88 5.32 2.62 0.48 090 50.5846255 C 4.59 5.85 2.84 0.58 090 50.5846257 C 5.39 2.88 2.88 0.64 090 50.5846258 C 5.72 3.28 3.28 0.68 090 50.5846260 C 6.36 3.19 3.19 0.76 090 50.5846261 C 7.07 3.61 3.61 0.79 090 50.5846262 C 7.49 3.74 3.74 0.83 090 50.5846270 C 3.71 5.00 2.84 0.46 090 50.5846275 C 4.55 4.64 2.98 0.52 090 50.5846280 C 5.97 3.26 3.26 0.66 090 50.5846285 C 4.08 3.77 2.75 0.44 090 50.5846288 C 7.12 3.68 3.68 0.79 090 50.5846320 C 1.61 2.13 0.85 0.18 010 50.5846500 C 1.61 2.12 1.15 0.16 010 50.5846505 C 2.86 3.05 1.97 0.14 010 50.5846600 C 0.50 1.56 0.34 0.05 000 50.5846604 C 1.31 9.15 0.62 0.12 000 50.5846606 C 0.81 3.79 0.43 0.09 000 50.5846608 C 1.51 4.41 0.65 0.16 000 50.5846610 C 1.32 4.04 0.61 0.15 000 50.5846611 C 1.81 3.34 0.78 0.19 000 50.5846612 C 2.34 5.20 0.98 0.28 000 50.5846614 C 2.01 2.33 0.84 0.20 000 50.5846615 C 2.68 2.49 1.07 0.33 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
46700 C 9.12 4.21 4.21 0.94 090 50.5846705 C 6.89 3.69 3.69 0.91 090 50.5846706 C 2.39 1.25 1.25 0.28 010 50.5846710 C 16.00 7.77 7.77 1.38 090 50.5846712 C 34.00 15.08 15.08 3.66 090 50.5846715 C 7.19 3.58 3.58 0.92 090 50.5846716 C 15.05 7.99 7.99 1.58 090 50.5846730 C 26.71 12.05 12.05 2.46 090 50.5846735 C 32.12 13.58 13.58 3.20 090 50.5846740 C 29.96 13.26 13.26 2.41 090 50.5846742 C 35.75 17.43 17.43 3.19 090 50.5846744 C 52.55 21.17 21.17 6.38 090 50.5846746 C 58.13 25.21 25.21 7.68 090 50.5846748 C 64.11 23.70 23.70 3.36 090 50.5846750 C 10.23 5.06 5.06 1.10 090 50.5846751 C 8.76 5.43 5.43 0.94 090 50.5846753 C 8.28 3.85 3.85 0.94 090 50.5846754 C 2.20 3.60 1.67 0.19 010 50.5846760 C 14.41 7.10 7.10 1.59 090 50.5846761 C 13.82 6.02 6.02 1.43 090 50.5846762 C 12.69 5.53 5.53 1.24 090 50.5846900 C 1.91 2.59 1.27 0.17 010 50.5846910 C 1.86 2.91 1.06 0.19 010 50.5846916 C 1.86 3.16 1.39 0.11 010 50.5846917 C 1.86 9.15 1.12 0.21 010 50.5846922 C 1.86 3.28 1.07 0.22 010 50.5846924 C 2.76 8.71 1.35 0.26 010 50.5846934 C 3.50 5.08 2.96 0.32 090 50.5846935 C 2.43 3.47 1.21 0.23 010 50.5846936 C 3.68 4.88 2.50 0.34 090 50.5846937 C 2.69 2.78 1.22 0.14 010 50.5846938 C 4.65 4.00 3.06 0.58 090 50.5846940 C 2.32 2.00 1.09 0.23 010 50.5846942 C 2.04 1.84 1.02 0.19 010 50.5846945 C 1.84 3.27 2.48 0.19 090 50.5846946 C 2.58 3.73 2.40 0.27 090 50.5846947 C 5.20 2.72 2.72 0.75 090 50.5846999 S 0.00 0.00 0.00 0.00 YYY 0.0047000 C 1.90 3.08 0.63 0.12 000 50.5847001 C 1.90 0.65 0.65 0.25 ZZZ 50.5847010 C 15.99 8.41 8.41 1.80 090 50.5847011 C 3.69 1.21 1.21 0.22 000 50.5847015 C 15.09 7.50 7.50 1.83 090 50.5847100 C 11.65 6.05 6.05 1.53 090 50.5847120 C 35.45 15.18 15.18 4.65 090 50.5847122 C 55.05 21.50 21.50 7.19 090 50.5847125 C 49.12 19.56 19.56 6.45 090 50.5847130 C 53.27 21.02 21.02 6.94 090 50.5847133 C 0.00 0.00 0.00 0.00 XXX 0.0047135 C 81.40 31.59 31.59 9.93 090 50.5847136 C 68.50 27.09 27.09 8.41 090 50.5847140 C 54.92 22.33 22.33 5.17 090 50.5847141 C 67.40 26.98 26.98 5.17 090 50.5847142 C 74.89 29.55 29.55 5.17 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
47143 C 540.47 0.00 0.00 0.00 XXX 1.2547144 C 540.47 0.00 0.00 0.00 XXX 1.2547145 C 540.47 0.00 0.00 0.00 XXX 1.2547146 C 6.00 2.06 2.06 0.83 XXX 50.5847147 C 7.00 2.40 2.40 0.97 XXX 50.5847300 C 15.06 7.24 7.24 1.98 090 50.5847350 C 19.53 8.89 8.89 2.58 090 50.5847360 C 26.88 11.60 11.60 3.37 090 50.5847361 C 47.05 18.56 18.56 5.85 090 50.5847362 C 18.48 8.74 8.74 2.50 090 50.5847370 C 19.66 8.15 8.15 2.46 090 50.5847371 C 19.66 8.16 8.16 2.58 090 50.5847379 C 0.00 0.00 0.00 0.00 YYY 0.0047380 C 22.97 9.38 9.38 2.78 090 50.5847381 C 23.24 9.61 9.61 2.81 090 50.5847382 C 15.17 6.09 6.09 0.97 010 50.5847399 S 0.00 0.00 0.00 0.00 YYY 0.0047400 C 32.44 13.47 13.47 3.11 090 50.5847420 C 19.85 8.78 8.78 2.59 090 50.5847425 C 19.80 8.83 8.83 2.57 090 50.5847460 C 18.01 8.38 8.38 2.10 090 50.5847480 C 10.80 5.92 5.92 1.39 090 50.5847490 C 7.22 5.58 5.58 0.44 090 50.5847500 C 1.96 0.64 0.64 0.12 000 50.5847505 C 0.76 0.25 0.25 0.04 000 50.5847510 C 7.82 5.02 5.02 0.46 090 50.5847511 C 10.48 5.09 5.09 0.62 090 50.5847525 C 5.54 15.13 2.81 0.33 010 50.5847530 C 5.84 33.88 3.72 0.37 090 50.5847550 C 3.02 1.02 1.02 0.40 ZZZ 50.5847552 C 6.03 2.38 2.38 0.42 000 50.5847553 C 6.34 2.07 2.07 0.37 000 50.5847554 C 9.05 3.36 3.36 0.96 000 50.5847555 C 7.55 2.47 2.47 0.45 000 50.5847556 C 8.55 2.79 2.79 0.50 000 50.5847560 C 4.88 1.67 1.67 0.65 000 50.5847561 C 5.17 1.92 1.92 0.66 000 50.5847562 C 11.07 4.99 4.99 1.46 090 50.5847563 C 11.92 5.31 5.31 1.58 090 50.5847564 C 14.21 5.96 5.96 1.88 090 50.5847570 C 12.56 5.38 5.38 1.65 090 50.5847579 C 0.00 0.00 0.00 0.00 YYY 0.0047600 C 13.56 6.14 6.14 1.79 090 50.5847605 C 14.67 6.51 6.51 1.94 090 50.5847610 C 18.79 7.94 7.94 2.48 090 50.5847612 C 18.75 7.89 7.89 2.47 090 50.5847620 C 20.61 8.53 8.53 2.73 090 50.5847630 C 9.10 4.89 4.89 0.65 090 50.5847700 C 15.60 7.42 7.42 2.06 090 50.5847701 C 27.77 11.50 11.50 3.67 090 50.5847711 C 23.00 9.94 9.94 3.04 090 50.5847712 C 30.19 12.44 12.44 3.92 090 50.5847715 C 18.77 8.44 8.44 2.48 090 50.5847716 C 16.42 7.83 7.83 2.14 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
47720 C 15.89 7.48 7.48 2.10 090 50.5847721 C 19.09 8.57 8.57 2.52 090 50.5847740 C 18.45 8.38 8.38 2.41 090 50.5847741 C 21.31 9.30 9.30 2.82 090 50.5847760 C 25.81 10.86 10.86 3.41 090 50.5847765 C 24.84 10.81 10.81 3.29 090 50.5847780 C 26.46 11.22 11.22 3.49 090 50.5847785 C 31.13 12.93 12.93 4.09 090 50.5847800 C 23.27 10.07 10.07 3.07 090 50.5847801 C 15.15 8.16 8.16 1.16 090 50.5847802 C 21.52 9.68 9.68 2.85 090 50.5847900 C 19.87 8.88 8.88 2.64 090 50.5847999 S 0.00 0.00 0.00 0.00 YYY 0.0048000 C 28.03 11.52 11.52 3.47 090 50.5848001 C 35.40 13.90 13.90 4.68 090 50.5848005 C 42.11 16.59 16.59 5.54 090 50.5848020 C 15.68 7.31 7.31 2.12 090 50.5848100 C 12.21 5.60 5.60 1.62 090 50.5848102 C 4.67 7.97 1.95 0.28 010 50.5848120 C 15.83 6.86 6.86 2.09 090 50.5848140 C 22.91 9.55 9.55 3.02 090 50.5848145 C 23.98 9.84 9.84 3.17 090 50.5848146 C 26.36 12.00 12.00 3.49 090 50.5848148 C 17.31 7.61 7.61 2.29 090 50.5848150 C 47.93 19.54 19.54 6.30 090 50.5848152 C 43.68 18.23 18.23 5.78 090 50.5848153 C 47.82 19.58 19.58 6.29 090 50.5848154 C 44.03 18.26 18.26 5.82 090 50.5848155 C 24.60 11.68 11.68 3.26 090 50.5848160 C 0.00 0.00 0.00 0.00 XXX 0.0048180 C 24.68 10.17 10.17 3.27 090 50.5848400 C 1.95 0.64 0.64 0.15 ZZZ 50.5848500 C 15.26 7.34 7.34 2.02 090 50.5848510 C 14.29 7.45 7.45 1.82 090 50.5848511 C 3.99 20.95 1.31 0.24 000 50.5848520 C 15.57 6.71 6.71 2.05 090 50.5848540 C 19.69 8.12 8.12 2.60 090 50.5848545 C 18.15 7.99 7.99 2.37 090 50.5848547 C 25.79 10.50 10.50 3.41 090 50.5848550 C 0.00 0.00 0.00 0.00 XXX 0.0048551 C 249.33 0.00 0.00 0.00 XXX 1.2548552 C 4.30 1.46 1.46 0.31 XXX 50.5848554 C 34.12 18.30 18.30 4.18 090 50.5848556 C 15.69 8.08 8.08 2.07 090 50.5848999 S 0.00 0.00 0.00 0.00 YYY 0.0049000 C 11.66 5.39 5.39 1.52 090 50.5849002 C 10.47 5.02 5.02 1.37 090 50.5849010 C 12.26 5.91 5.91 1.51 090 50.5849020 C 22.81 10.21 10.21 2.84 090 50.5849021 C 3.37 21.11 1.11 0.20 000 50.5849040 C 13.50 6.43 6.43 1.69 090 50.5849041 C 3.99 19.57 1.31 0.24 000 50.5849060 C 15.84 7.44 7.44 1.74 090 50.5849061 C 3.69 19.68 1.21 0.22 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
49062 C 11.34 5.44 5.44 1.39 090 50.5849080 C 1.35 3.99 0.46 0.08 000 50.5849081 C 1.26 2.59 0.43 0.09 000 50.5849085 C 12.12 5.51 5.51 1.62 090 50.5849180 C 1.73 3.11 0.57 0.10 000 50.5849200 C 10.23 5.03 5.03 1.24 090 50.5849201 C 14.82 7.04 7.04 1.87 090 50.5849215 C 33.45 14.08 14.08 4.37 090 50.5849220 C 14.86 6.64 6.64 1.88 090 50.5849250 C 8.34 4.27 4.27 1.08 090 50.5849255 C 11.12 5.62 5.62 1.43 090 50.5849320 C 5.09 2.64 2.64 0.65 010 50.5849321 C 5.39 2.65 2.65 0.70 010 50.5849322 C 5.69 3.00 3.00 0.71 010 50.5849323 C 9.47 4.50 4.50 1.20 090 50.5849329 S 0.00 0.00 0.00 0.00 YYY 0.0049400 C 1.88 3.08 0.62 0.15 000 50.5849419 C 6.64 3.57 3.57 0.81 090 50.5849420 C 2.22 1.09 1.09 0.21 000 50.5849421 C 5.53 3.16 3.16 0.74 090 50.5849422 C 6.24 2.90 2.90 0.83 010 50.5849423 C 1.46 14.11 0.52 0.09 000 50.5849424 C 0.76 3.72 0.29 0.04 000 50.5849425 C 11.35 5.61 5.61 1.54 090 50.5849426 C 9.62 4.77 4.77 1.28 090 50.5849427 C 0.89 0.30 0.30 0.07 000 50.5849428 C 6.05 3.93 3.93 0.80 010 50.5849429 C 7.39 3.43 3.43 1.02 010 50.5849491 D 11.11 5.06 5.06 1.40 090 50.5849492 D 14.01 6.12 6.12 1.80 090 50.5849495 D 5.88 2.96 2.96 0.74 090 50.5849496 D 8.78 4.28 4.28 1.07 090 50.5849500 D 5.47 3.12 3.12 0.71 090 50.5849501 D 8.87 4.21 4.21 1.12 090 50.5849505 C 7.59 3.75 3.75 1.03 090 50.5849507 C 9.56 4.46 4.46 1.27 090 50.5849520 C 9.62 4.44 4.44 1.28 090 50.5849521 C 11.95 5.25 5.25 1.59 090 50.5849525 C 8.56 4.08 4.08 1.13 090 50.5849540 C 10.37 4.75 4.75 1.37 090 50.5849550 C 8.62 4.13 4.13 1.14 090 50.5849553 C 9.43 4.42 4.42 1.24 090 50.5849555 C 9.02 4.27 4.27 1.20 090 50.5849557 C 11.13 4.99 4.99 1.47 090 50.5849560 C 11.55 5.15 5.15 1.52 090 50.5849561 C 14.23 6.07 6.07 1.88 090 50.5849565 C 11.55 5.23 5.23 1.52 090 50.5849566 C 14.38 6.14 6.14 1.90 090 50.5849568 C 4.88 1.67 1.67 0.64 ZZZ 50.5849570 C 5.68 3.17 3.17 0.75 090 50.5849572 C 6.72 3.47 3.47 0.88 090 50.5849580 D 4.10 2.60 2.60 0.54 090 50.5849582 D 6.64 3.47 3.47 0.88 090 50.5849585 C 6.22 3.30 3.30 0.82 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
49587 C 7.55 3.74 3.74 0.99 090 50.5849590 C 8.53 4.09 4.09 1.13 090 50.5849600 C 10.94 5.34 5.34 1.32 090 50.5849605 C 75.89 28.58 28.58 9.36 090 50.5849606 C 18.57 7.70 7.70 2.45 090 50.5849610 C 10.48 5.21 5.21 1.07 090 50.5849611 C 8.91 6.99 6.99 0.78 090 50.5849650 C 6.26 3.20 3.20 0.93 090 50.5849651 C 8.23 4.05 4.05 1.14 090 50.5849659 C 0.00 0.00 0.00 0.00 YYY 0.0049900 C 12.26 6.24 6.24 1.62 090 50.5849904 C 19.97 15.25 15.25 2.69 090 50.5849905 C 6.54 2.30 2.30 0.75 ZZZ 50.5849906 C 0.00 0.00 0.00 0.00 090 0.0049999 S 0.00 0.00 0.00 0.00 YYY 0.0050010 C 10.96 5.23 5.23 0.93 090 50.5850020 C 14.64 7.76 7.76 1.34 090 50.5850021 C 3.37 21.71 1.10 0.20 000 50.5850040 C 14.92 6.82 6.82 1.03 090 50.5850045 C 15.44 6.61 6.61 1.24 090 50.5850060 C 19.27 7.84 7.84 1.36 090 50.5850065 C 20.76 6.09 6.09 1.59 090 50.5850070 C 20.29 8.23 8.23 1.44 090 50.5850075 C 25.30 9.92 9.92 1.80 090 50.5850080 C 14.69 6.29 6.29 1.04 090 50.5850081 C 21.77 8.78 8.78 1.54 090 50.5850100 C 16.07 7.80 7.80 2.06 090 50.5850120 C 15.89 6.78 6.78 1.21 090 50.5850125 C 16.50 6.98 6.98 1.43 090 50.5850130 C 17.26 7.18 7.18 1.22 090 50.5850135 C 19.15 7.79 7.79 1.33 090 50.5850200 C 2.63 1.29 1.29 0.16 000 50.5850205 C 11.29 5.02 5.02 1.30 090 50.5850220 C 17.12 7.25 7.25 1.35 090 50.5850225 C 20.20 8.16 8.16 1.50 090 50.5850230 C 22.04 8.59 8.59 1.55 090 50.5850234 C 22.37 8.85 8.85 1.59 090 50.5850236 C 24.82 10.27 10.27 1.76 090 50.5850240 C 21.97 9.03 9.03 1.55 090 50.5850250 C 19.97 9.18 9.18 1.39 090 50.5850280 C 15.65 6.70 6.70 1.19 090 50.5850290 C 14.71 6.47 6.47 1.41 090 50.5850300 C 0.00 0.00 0.00 0.00 XXX 0.0050320 C 22.18 10.68 10.68 2.35 090 50.5850323 C 270.54 0.00 0.00 0.00 XXX 1.2550325 C 159.18 0.00 0.00 0.00 XXX 1.2550327 C 4.00 1.35 1.35 0.29 XXX 50.5850328 C 3.50 1.18 1.18 0.26 XXX 50.5850329 C 3.34 1.13 1.13 0.25 XXX 50.5850340 C 12.13 6.51 6.51 1.65 090 50.5850360 C 31.48 15.51 15.51 3.81 090 50.5850365 C 36.75 18.24 18.24 4.42 090 50.5850370 C 13.70 7.16 7.16 1.67 090 50.5850380 C 20.73 12.05 12.05 2.50 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
50382 C 5.50 36.22 1.87 0.34 000 50.5850384 C 5.00 35.32 1.71 0.31 000 50.5850387 C 2.00 18.26 0.67 0.12 000 50.5850389 C 1.10 12.78 0.37 0.07 000 50.5850390 C 1.96 0.64 0.64 0.12 000 50.5850391 C 1.96 1.58 0.63 0.14 000 50.5850392 C 3.37 1.52 1.52 0.20 000 50.5850393 C 4.15 1.79 1.79 0.25 000 50.5850394 C 0.76 2.69 0.66 0.05 000 50.5850395 C 3.37 1.50 1.50 0.21 000 50.5850396 C 2.09 1.08 1.08 0.13 000 50.5850398 C 1.46 16.36 0.52 0.09 000 50.5850400 C 19.47 7.89 7.89 1.38 090 50.5850405 C 23.89 9.05 9.05 1.78 090 50.5850500 C 19.54 8.40 8.40 2.01 090 50.5850520 C 17.20 7.44 7.44 1.49 090 50.5850525 C 22.24 9.02 9.02 1.83 090 50.5850526 C 23.98 9.88 9.88 1.96 090 50.5850540 C 19.90 8.34 8.34 1.36 090 50.5850541 C 15.98 6.50 6.50 1.13 090 50.5850542 C 19.97 8.15 8.15 1.39 090 50.5850543 C 25.46 10.22 10.22 1.80 090 50.5850544 C 22.37 8.54 8.54 1.58 090 50.5850545 C 23.96 9.21 9.21 1.70 090 50.5850546 C 20.45 8.38 8.38 1.57 090 50.5850547 C 25.46 11.13 11.13 2.76 090 50.5850548 C 24.36 9.20 9.20 1.72 090 50.5850549 C 0.00 0.00 0.00 0.00 YYY 0.0050551 C 5.59 4.15 1.98 0.40 000 50.5850553 C 5.98 4.37 2.18 0.39 000 50.5850555 C 6.52 4.82 2.34 0.45 000 50.5850557 C 6.61 4.59 2.30 0.47 000 50.5850561 C 7.58 5.09 2.65 0.54 000 50.5850562 C 10.90 4.32 4.32 0.73 090 50.5850570 C 9.53 3.22 3.22 0.68 000 50.5850572 C 10.33 3.51 3.51 0.85 000 50.5850574 C 11.00 3.75 3.75 0.77 000 50.5850575 C 13.96 4.64 4.64 0.99 000 50.5850576 C 10.97 3.67 3.67 0.78 000 50.5850580 C 11.84 3.97 3.97 0.83 000 50.5850590 C 9.08 12.43 4.12 0.65 090 50.5850592 C 6.75 149.45 2.99 0.43 010 50.5850600 C 15.82 6.68 6.68 1.13 090 50.5850605 C 15.44 6.75 6.75 1.45 090 50.5850610 C 15.90 6.98 6.98 1.43 090 50.5850620 C 15.14 6.35 6.35 1.07 090 50.5850630 C 14.92 6.29 6.29 1.09 090 50.5850650 C 17.38 7.24 7.24 1.23 090 50.5850660 C 19.52 7.97 7.97 1.38 090 50.5850684 C 0.76 4.98 0.47 0.05 000 50.5850686 C 1.51 3.45 0.82 0.11 000 50.5850688 C 1.17 1.06 1.06 0.07 010 50.5850690 C 1.16 1.83 0.72 0.07 000 50.5850700 C 15.19 7.13 7.13 1.27 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
50715 C 18.87 8.76 8.76 2.13 090 50.5850722 C 16.33 7.82 7.82 1.90 090 50.5850725 C 18.46 8.06 8.06 1.52 090 50.5850727 C 8.17 4.28 4.28 0.61 090 50.5850728 C 12.00 5.57 5.57 1.00 090 50.5850740 C 18.39 7.75 7.75 1.96 090 50.5850750 C 19.48 8.00 8.00 1.38 090 50.5850760 C 18.39 7.69 7.69 1.55 090 50.5850770 C 19.48 7.99 7.99 1.45 090 50.5850780 C 18.33 7.60 7.60 1.51 090 50.5850782 C 19.51 8.79 8.79 1.61 090 50.5850783 C 20.52 8.23 8.23 1.98 090 50.5850785 C 20.49 8.31 8.31 1.45 090 50.5850800 C 14.50 6.48 6.48 1.19 090 50.5850810 C 20.02 9.11 9.11 2.31 090 50.5850815 C 19.90 8.46 8.46 1.54 090 50.5850820 C 21.86 8.66 8.66 1.89 090 50.5850825 C 28.14 11.15 11.15 2.07 090 50.5850830 C 31.23 12.20 12.20 2.37 090 50.5850840 C 19.97 8.44 8.44 1.47 090 50.5850845 C 20.86 8.92 8.92 1.57 090 50.5850860 C 15.34 6.63 6.63 1.29 090 50.5850900 C 13.60 6.15 6.15 1.14 090 50.5850920 C 14.31 6.58 6.58 1.01 090 50.5850930 C 18.69 7.98 7.98 1.28 090 50.5850940 C 14.49 6.41 6.41 1.26 090 50.5850945 C 16.97 7.05 7.05 1.36 090 50.5850947 C 24.46 9.71 9.71 2.16 090 50.5850948 C 22.47 8.71 8.71 1.70 090 50.5850949 C 0.00 0.00 0.00 0.00 YYY 0.0050951 C 5.83 4.30 2.06 0.41 000 50.5850953 C 6.23 4.41 2.37 0.43 000 50.5850955 C 6.74 6.43 2.69 0.48 000 50.5850957 C 6.78 4.57 2.38 0.48 000 50.5850961 C 6.04 4.37 2.19 0.41 000 50.5850970 C 7.13 2.47 2.47 0.52 000 50.5850972 C 6.88 2.47 2.47 0.49 000 50.5850974 C 9.16 3.11 3.11 0.64 000 50.5850976 C 9.03 3.07 3.07 0.66 000 50.5850980 C 6.84 2.38 2.38 0.48 000 50.5851000 C 0.78 1.95 0.24 0.05 000 50.5851005 C 1.02 4.71 0.34 0.10 000 50.5851010 C 3.52 5.62 1.88 0.28 010 50.5851020 C 6.70 3.86 3.86 0.47 090 50.5851030 C 6.76 3.98 3.98 0.58 090 50.5851040 C 4.39 2.77 2.77 0.31 090 50.5851045 C 6.76 3.93 3.93 0.52 090 50.5851050 C 6.91 3.65 3.65 0.49 090 50.5851060 C 8.84 4.51 4.51 0.62 090 50.5851065 C 8.84 4.36 4.36 0.63 090 50.5851080 C 5.95 3.55 3.55 0.43 090 50.5851500 C 10.12 5.01 5.01 1.03 090 50.5851520 C 9.28 4.68 4.68 0.69 090 50.5851525 C 13.95 6.14 6.14 0.99 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
51530 C 12.36 5.76 5.76 1.05 090 50.5851535 C 12.55 6.12 6.12 1.23 090 50.5851550 C 15.64 6.74 6.74 1.31 090 50.5851555 C 21.20 8.68 8.68 1.69 090 50.5851565 C 21.59 8.98 8.98 1.63 090 50.5851570 C 24.20 9.76 9.76 1.71 090 50.5851575 C 30.40 12.05 12.05 2.16 090 50.5851580 C 31.03 12.52 12.52 2.24 090 50.5851585 C 35.18 13.73 13.73 2.48 090 50.5851590 C 32.61 12.64 12.64 2.27 090 50.5851595 C 37.08 14.16 14.16 2.59 090 50.5851596 C 39.46 15.26 15.26 2.77 090 50.5851597 C 38.29 14.86 14.86 2.81 090 50.5851600 C 0.88 5.06 0.29 0.06 000 50.5851605 C 0.64 6.07 0.35 0.04 000 50.5851610 C 1.05 2.29 0.60 0.07 000 50.5851700 C 0.88 1.60 0.28 0.06 000 50.5851701 C 0.50 1.58 0.19 0.04 000 50.5851702 C 0.50 2.09 0.24 0.04 000 50.5851703 C 1.47 2.74 0.56 0.10 000 50.5851705 C 1.02 2.28 0.61 0.07 010 50.5851710 C 1.49 3.34 0.77 0.11 010 50.5851715 C 3.73 3.91 1.35 0.29 000 50.5851720 C 1.96 1.75 0.69 0.14 000 50.5851725 C 1.51 5.60 5.60 0.16 000 50.5851725 C TC 0.00 5.11 5.11 0.04 000 50.5851725 C 26 1.51 0.49 0.49 0.12 000 50.5851726 C 1.71 7.52 7.52 0.18 000 50.5851726 C TC 0.00 6.96 6.96 0.05 000 50.5851726 C 26 1.71 0.56 0.56 0.13 000 50.5851736 C 0.61 0.58 0.58 0.06 000 50.5851736 C TC 0.00 0.38 0.38 0.01 000 50.5851736 C 26 0.61 0.20 0.20 0.05 000 50.5851741 C 1.14 0.79 0.79 0.11 000 50.5851741 C TC 0.00 0.42 0.42 0.02 000 50.5851741 C 26 1.14 0.37 0.37 0.09 000 50.5851772 C 1.61 5.59 5.59 0.19 000 50.5851772 C TC 0.00 5.04 5.04 0.05 000 50.5851772 C 26 1.61 0.55 0.55 0.14 000 50.5851784 C 1.53 3.99 3.99 0.16 000 50.5851784 C TC 0.00 3.49 3.49 0.04 000 50.5851784 C 26 1.53 0.50 0.50 0.12 000 50.5851785 C 1.53 4.45 4.45 0.15 000 50.5851785 C TC 0.00 3.95 3.95 0.04 000 50.5851785 C 26 1.53 0.50 0.50 0.11 000 50.5851792 C 1.10 6.01 6.01 0.20 000 50.5851792 C TC 0.00 5.60 5.60 0.13 000 50.5851792 C 26 1.10 0.41 0.41 0.07 000 50.5851795 C 1.53 7.31 7.31 0.22 000 50.5851795 C TC 0.00 6.81 6.81 0.10 000 50.5851795 C 26 1.53 0.50 0.50 0.12 000 50.5851797 C 1.60 5.80 5.80 0.17 000 50.5851797 C TC 0.00 5.27 5.27 0.05 000 50.5851797 C 26 1.60 0.53 0.53 0.12 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
51798 C 0.00 0.34 0.34 0.08 XXX 50.5851800 C 17.39 7.58 7.58 1.32 090 50.5851820 C 17.86 8.30 8.30 1.74 090 50.5851840 C 10.69 5.58 5.58 1.06 090 50.5851841 C 13.01 6.39 6.39 1.24 090 50.5851845 C 9.72 4.75 4.75 0.79 090 50.5851860 C 12.00 5.77 5.77 1.16 090 50.5851865 C 15.02 6.69 6.69 1.23 090 50.5851880 C 7.65 3.96 3.96 0.72 090 50.5851900 C 12.95 6.08 6.08 1.21 090 50.5851920 C 11.79 5.65 5.65 1.18 090 50.5851925 C 15.56 8.63 8.63 2.03 090 50.5851940 C 28.39 12.11 12.11 2.14 090 50.5851960 C 22.98 9.66 9.66 1.63 090 50.5851980 C 11.34 5.39 5.39 0.86 090 50.5851990 C 12.48 6.16 6.16 1.39 090 50.5851992 C 13.99 6.22 6.22 1.41 090 50.5851999 C 0.00 0.00 0.00 0.00 YYY 0.0052000 C 2.01 3.31 0.76 0.14 000 50.5852001 C 5.44 5.08 1.87 0.39 000 50.5852005 C 2.37 5.58 0.89 0.17 000 50.5852007 C 3.02 16.49 1.15 0.22 000 50.5852010 C 3.02 10.78 1.15 0.21 000 50.5852204 C 2.37 14.55 0.90 0.17 000 50.5852214 C 3.70 38.21 1.33 0.26 000 50.5852224 C 3.14 36.56 1.15 0.22 000 50.5852234 C 4.62 1.66 1.66 0.33 000 50.5852235 C 5.44 1.94 1.94 0.39 000 50.5852240 C 9.71 3.31 3.31 0.69 000 50.5852250 C 4.49 1.65 1.65 0.32 000 50.5852260 C 3.91 1.42 1.42 0.28 000 50.5852265 C 2.94 13.38 1.11 0.22 000 50.5852270 C 3.36 11.06 1.24 0.24 000 50.5852275 C 4.69 15.60 1.66 0.33 000 50.5852276 C 4.99 1.79 1.79 0.35 000 50.5852277 C 6.16 2.23 2.23 0.44 000 50.5852281 C 2.80 7.11 1.08 0.20 000 50.5852282 C 6.39 2.24 2.24 0.45 000 50.5852283 C 3.73 3.95 1.38 0.26 000 50.5852285 C 3.60 4.02 1.33 0.26 000 50.5852290 C 4.58 1.65 1.65 0.32 000 50.5852300 C 5.30 1.91 1.91 0.38 000 50.5852301 C 5.50 1.99 1.99 0.46 000 50.5852305 C 5.30 1.86 1.86 0.38 000 50.5852310 C 2.81 4.70 1.03 0.20 000 50.5852315 C 5.20 8.69 1.84 0.37 000 50.5852317 C 6.71 29.02 2.29 0.48 000 50.5852318 C 9.18 3.10 3.10 0.65 000 50.5852320 C 4.69 1.63 1.63 0.33 000 50.5852325 C 6.15 2.12 2.12 0.44 000 50.5852327 C 5.18 31.90 1.82 0.37 000 50.5852330 C 5.03 38.93 1.76 0.36 000 50.5852332 C 2.83 5.76 1.05 0.21 000 50.5852334 C 4.82 1.74 1.74 0.35 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
52341 C 5.99 2.22 2.22 0.43 000 50.5852342 C 6.49 2.35 2.35 0.46 000 50.5852343 C 7.19 2.59 2.59 0.51 000 50.5852344 C 7.69 2.80 2.80 0.55 000 50.5852345 C 8.19 2.96 2.96 0.58 000 50.5852346 C 9.22 3.29 3.29 0.65 000 50.5852351 C 5.85 2.15 2.15 0.41 000 50.5852352 C 6.87 2.51 2.51 0.49 000 50.5852353 C 7.96 2.86 2.86 0.57 000 50.5852354 C 7.33 2.68 2.68 0.52 000 50.5852355 C 8.81 3.15 3.15 0.63 000 50.5852400 C 9.67 3.74 3.74 0.68 090 50.5852402 C 5.27 1.70 1.70 0.40 000 50.5852450 C 7.63 3.68 3.68 0.54 090 50.5852500 C 8.46 3.93 3.93 0.60 090 50.5852510 C 6.71 3.12 3.12 0.48 090 50.5852601 C 12.35 5.11 5.11 0.87 090 50.5852606 C 8.12 3.56 3.56 0.57 090 50.5852612 C 7.97 3.74 3.74 0.56 090 50.5852614 C 6.83 3.35 3.35 0.48 090 50.5852620 C 6.60 2.99 2.99 0.47 090 50.5852630 C 7.25 3.20 3.20 0.51 090 50.5852640 C 6.61 2.97 2.97 0.47 090 50.5852647 C 10.34 74.15 4.54 0.73 090 50.5852648 C 11.19 74.15 4.80 0.79 090 50.5852700 C 6.79 3.19 3.19 0.48 090 50.5853000 C 2.28 1.54 1.54 0.16 010 50.5853010 C 3.63 2.92 2.92 0.24 090 50.5853020 C 1.77 3.01 0.67 0.13 000 50.5853025 C 1.13 3.74 0.51 0.08 000 50.5853040 C 6.39 3.44 3.44 0.45 090 50.5853060 C 2.63 2.09 1.37 0.28 010 50.5853080 C 6.28 5.97 5.97 0.52 090 50.5853085 C 10.25 7.42 7.42 0.92 090 50.5853200 C 2.59 1.32 0.98 0.20 000 50.5853210 C 12.55 5.85 5.85 0.89 090 50.5853215 C 15.56 6.64 6.64 1.10 090 50.5853220 C 6.99 3.72 3.72 0.49 090 50.5853230 C 9.57 4.72 4.72 0.73 090 50.5853235 C 10.12 4.91 4.91 0.72 090 50.5853240 C 6.44 3.53 3.53 0.52 090 50.5853250 C 5.88 3.30 3.30 0.49 090 50.5853260 C 2.98 2.25 1.42 0.25 010 50.5853265 C 3.12 2.72 1.42 0.24 010 50.5853270 C 3.09 2.21 1.54 0.30 010 50.5853275 C 4.52 2.26 2.26 0.32 010 50.5853400 C 12.75 6.04 6.04 0.98 090 50.5853405 C 14.46 6.33 6.33 1.10 090 50.5853410 C 16.42 7.07 7.07 1.16 090 50.5853415 C 19.38 7.35 7.35 1.37 090 50.5853420 C 14.06 6.30 6.30 0.96 090 50.5853425 C 15.96 6.90 6.90 1.13 090 50.5853430 C 16.32 7.01 7.01 1.15 090 50.5853431 C 19.86 8.07 8.07 1.41 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
53440 C 13.60 5.99 5.99 0.96 090 50.5853442 C 11.55 5.45 5.45 0.82 090 50.5853444 C 13.38 5.89 5.89 0.94 090 50.5853445 C 14.04 7.10 7.10 0.99 090 50.5853446 C 10.21 5.23 5.23 0.72 090 50.5853447 C 13.47 6.44 6.44 0.95 090 50.5853448 C 21.12 9.07 9.07 1.50 090 50.5853449 C 9.69 4.73 4.73 0.68 090 50.5853450 C 6.13 3.30 3.30 0.43 090 50.5853460 C 7.11 3.70 3.70 0.50 090 50.5853500 C 12.19 6.22 6.22 0.90 090 50.5853502 C 7.62 3.99 3.99 0.62 090 50.5853505 C 7.62 3.87 3.87 0.54 090 50.5853510 C 10.09 5.17 5.17 0.74 090 50.5853515 C 13.29 5.94 5.94 1.05 090 50.5853520 C 8.67 4.48 4.48 0.61 090 50.5853600 C 1.21 1.14 0.43 0.09 000 50.5853601 C 0.98 1.27 0.37 0.07 000 50.5853605 C 1.28 0.41 0.41 0.09 000 50.5853620 C 1.62 2.00 0.59 0.11 000 50.5853621 C 1.35 2.08 0.49 0.10 000 50.5853660 C 0.71 1.31 0.31 0.05 000 50.5853661 C 0.72 1.30 0.29 0.05 000 50.5853665 C 0.76 0.25 0.25 0.06 000 50.5853850 C 9.44 94.33 3.95 0.67 090 50.5853852 C 9.87 89.03 4.38 0.70 090 50.5853853 C 5.23 55.50 2.86 0.37 090 50.5853899 S 0.00 0.00 0.00 0.00 YYY 0.0054000 D 1.54 2.92 0.93 0.11 010 50.5854001 C 2.19 3.19 1.11 0.15 010 50.5854015 C 5.31 2.56 2.56 0.38 010 50.5854050 C 1.24 1.66 1.03 0.08 010 50.5854055 C 1.22 1.57 0.80 0.08 010 50.5854056 C 1.24 1.69 1.13 0.06 010 50.5854057 C 1.24 2.22 0.83 0.09 010 50.5854060 C 1.93 3.11 1.06 0.13 010 50.5854065 C 2.42 2.64 1.23 0.13 010 50.5854100 C 1.90 2.81 0.82 0.10 000 50.5854105 C 3.49 4.29 1.94 0.25 010 50.5854110 C 10.11 4.76 4.76 0.72 090 50.5854111 C 13.55 5.78 5.78 0.96 090 50.5854112 C 15.84 6.81 6.81 1.11 090 50.5854115 C 6.14 4.38 3.46 0.43 090 50.5854120 C 9.96 4.68 4.68 0.68 090 50.5854125 C 13.51 5.84 5.84 0.95 090 50.5854130 C 20.11 8.19 8.19 1.52 090 50.5854135 C 26.32 10.19 10.19 1.87 090 50.5854150 D 1.81 4.36 0.70 0.16 000 50.5854152 C 2.31 1.20 1.20 0.19 010 50.5854160 D 2.48 4.15 1.09 0.19 010 50.5854161 C 3.27 1.56 1.56 0.23 010 50.5854162 D 3.00 4.66 1.44 0.21 010 50.5854163 D 3.00 2.01 2.01 0.21 010 50.5854164 C 2.50 1.84 1.84 0.18 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
54200 C 1.06 1.80 0.97 0.08 010 50.5854205 C 7.92 4.69 4.69 0.56 090 50.5854220 C 2.42 3.85 0.95 0.17 000 50.5854230 C 1.34 1.08 0.63 0.09 000 50.5854231 C 2.04 1.37 0.87 0.16 000 50.5854235 C 1.19 0.96 0.58 0.08 000 50.5854240 C 1.31 1.03 1.03 0.16 000 50.5854240 C TC 0.00 0.60 0.60 0.06 000 50.5854240 C 26 1.31 0.43 0.43 0.10 000 50.5854250 C 2.22 0.91 0.91 0.18 000 50.5854250 C TC 0.00 0.20 0.20 0.02 000 50.5854250 C 26 2.22 0.71 0.71 0.16 000 50.5854300 C 10.39 5.58 5.58 0.76 090 50.5854304 C 12.47 6.34 6.34 0.88 090 50.5854308 C 11.81 5.97 5.97 0.84 090 50.5854312 C 13.55 7.00 7.00 1.24 090 50.5854316 C 16.79 7.96 7.96 1.21 090 50.5854318 C 11.23 5.80 5.80 1.39 090 50.5854322 C 12.99 6.47 6.47 0.92 090 50.5854324 C 16.29 7.97 7.97 1.14 090 50.5854326 C 15.70 7.79 7.79 1.11 090 50.5854328 C 15.63 7.26 7.26 0.98 090 50.5854332 C 17.05 7.74 7.74 1.21 090 50.5854336 C 20.01 10.31 10.31 2.20 090 50.5854340 C 8.90 5.04 5.04 0.63 090 50.5854344 C 15.92 7.76 7.76 1.54 090 50.5854348 C 17.12 8.36 8.36 1.23 090 50.5854352 C 24.70 11.20 11.20 2.24 090 50.5854360 C 11.91 6.04 6.04 0.84 090 50.5854380 C 13.16 6.62 6.62 0.93 090 50.5854385 C 15.37 8.27 8.27 0.86 090 50.5854390 C 21.58 9.43 9.43 1.54 090 50.5854400 C 8.98 4.35 4.35 0.64 090 50.5854401 C 10.26 5.74 5.74 0.73 090 50.5854405 C 13.41 5.93 5.93 0.95 090 50.5854406 C 12.08 5.43 5.43 0.86 090 50.5854408 C 12.73 5.74 5.74 0.90 090 50.5854410 C 15.48 6.63 6.63 1.10 090 50.5854411 C 15.98 7.05 7.05 1.13 090 50.5854415 C 8.19 4.20 4.20 0.58 090 50.5854416 C 10.85 5.38 5.38 0.77 090 50.5854417 C 14.17 6.18 6.18 1.00 090 50.5854420 C 11.40 5.58 5.58 0.81 090 50.5854430 C 10.13 5.11 5.11 0.72 090 50.5854435 C 6.11 3.62 3.62 0.43 090 50.5854440 C 639.94 0.00 0.00 0.00 090 2.5054450 C 1.12 0.95 0.44 0.08 000 50.5854500 C 1.31 0.61 0.56 0.10 000 50.5854505 C 3.45 1.92 1.92 0.27 010 50.5854512 C 8.57 4.13 4.13 0.67 090 50.5854520 C 5.22 2.79 2.79 0.50 090 50.5854522 C 9.49 4.87 4.87 0.89 090 50.5854530 C 8.57 4.24 4.24 0.66 090 50.5854535 C 12.14 5.55 5.55 0.95 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
54550 C 7.77 3.81 3.81 0.59 090 50.5854560 C 11.11 5.16 5.16 0.90 090 50.5854600 C 7.00 3.55 3.55 0.51 090 50.5854620 C 4.89 2.44 2.44 0.37 010 50.5854640 C 6.89 3.74 3.74 0.62 090 50.5854650 C 11.43 5.41 5.41 1.16 090 50.5854660 C 5.10 3.00 3.00 0.44 090 50.5854670 C 6.40 3.54 3.54 0.47 090 50.5854680 C 12.63 6.16 6.16 1.16 090 50.5854690 C 10.94 4.94 4.94 1.02 090 50.5854692 C 12.86 5.44 5.44 1.30 090 50.5854699 S 0.00 0.00 0.00 0.00 YYY 0.0054700 C 3.42 1.94 1.94 0.28 010 50.5854800 C 2.33 0.94 0.90 0.23 000 50.5854820 C 5.13 2.94 2.94 0.40 090 50.5854830 C 5.37 3.02 3.02 0.41 090 50.5854840 C 5.19 2.78 2.78 0.37 090 50.5854860 C 6.31 3.31 3.31 0.45 090 50.5854861 C 8.89 4.31 4.31 0.63 090 50.5854900 C 13.18 5.80 5.80 0.93 090 50.5854901 C 17.91 7.53 7.53 1.82 090 50.5855000 C 1.43 2.07 0.65 0.11 000 50.5855040 C 5.35 2.90 2.90 0.43 090 50.5855041 C 7.73 3.97 3.97 0.60 090 50.5855060 C 5.51 3.08 3.08 0.46 090 50.5855100 C 2.13 3.68 1.56 0.17 010 50.5855110 C 5.69 3.13 3.13 0.43 090 50.5855120 C 5.08 2.95 2.95 0.39 090 50.5855150 C 7.21 3.84 3.84 0.56 090 50.5855175 C 5.23 3.01 3.01 0.37 090 50.5855180 C 10.70 5.37 5.37 0.90 090 50.5855200 C 4.23 12.35 2.38 0.33 090 50.5855250 C 3.29 11.50 2.22 0.25 090 50.5855300 C 3.50 1.31 1.31 0.25 000 50.5855400 C 8.48 4.06 4.06 0.64 090 50.5855450 C 4.11 7.01 1.87 0.29 010 50.5855500 C 5.58 3.09 3.09 0.55 090 50.5855520 C 6.02 3.25 3.25 0.75 090 50.5855530 C 5.65 3.01 3.01 0.45 090 50.5855535 C 6.55 3.40 3.40 0.47 090 50.5855540 C 7.66 3.80 3.80 0.94 090 50.5855550 C 6.56 3.30 3.30 0.57 090 50.5855559 C 0.00 0.00 0.00 0.00 YYY 0.0055600 C 6.37 3.33 3.33 0.62 090 50.5855605 C 7.95 4.29 4.29 0.64 090 50.5855650 C 11.78 5.28 5.28 0.92 090 50.5855680 C 5.18 2.97 2.97 0.47 090 50.5855700 C 1.57 4.20 0.64 0.11 000 50.5855705 C 4.56 2.30 2.30 0.32 010 50.5855720 C 7.63 3.82 3.82 0.95 090 50.5855725 C 8.67 4.49 4.49 0.70 090 50.5855801 C 17.77 7.62 7.62 1.34 090 50.5855810 C 22.55 8.95 8.95 1.60 090 50.5855812 C 27.47 10.99 10.99 2.04 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
55815 C 30.41 11.90 11.90 2.16 090 50.5855821 C 14.23 6.21 6.21 1.01 090 50.5855831 C 15.60 6.66 6.66 1.10 090 50.5855840 C 22.66 9.29 9.29 1.61 090 50.5855842 C 24.34 9.85 9.85 1.72 090 50.5855845 C 28.51 10.94 10.94 2.02 090 50.5855859 C 12.50 5.85 5.85 0.89 090 50.5855860 C 14.43 6.41 6.41 1.02 090 50.5855862 C 18.36 7.85 7.85 1.49 090 50.5855865 C 22.84 9.27 9.27 1.63 090 50.5855866 C 30.69 11.73 11.73 2.16 090 50.5855870 C 2.58 1.53 1.08 0.16 000 50.5855873 C 19.44 8.96 8.96 1.38 090 50.5855899 S 0.00 0.00 0.00 0.00 YYY 0.0055970 D 0.00 0.00 0.00 0.00 XXX 0.0055980 D 0.00 0.00 0.00 0.00 XXX 0.0056405 C 1.44 1.33 1.14 0.17 010 50.5856420 C 1.39 2.28 1.04 0.16 010 50.5856440 C 2.84 1.71 1.71 0.34 010 50.5856441 C 1.97 1.82 1.41 0.20 010 50.5856501 C 1.53 1.79 1.24 0.18 010 50.5856515 C 2.76 2.55 1.82 0.33 010 50.5856605 C 1.10 1.07 0.46 0.13 000 50.5856606 C 0.55 0.49 0.22 0.07 ZZZ 50.5856620 C 7.46 4.80 4.80 0.90 090 50.5856625 C 8.39 5.33 5.33 1.02 090 50.5856630 C 12.34 6.85 6.85 1.49 090 50.5856631 C 16.18 8.83 8.83 1.95 090 50.5856632 C 20.26 9.54 9.54 2.38 090 50.5856633 C 16.45 8.61 8.61 1.97 090 50.5856634 C 17.85 9.45 9.45 2.16 090 50.5856637 C 21.94 11.09 11.09 2.60 090 50.5856640 C 22.14 10.64 10.64 2.88 090 50.5856700 D 2.52 1.84 1.84 0.30 010 50.5856720 D 0.68 0.51 0.51 0.08 000 50.5856740 C 4.56 2.57 2.57 0.56 010 50.5856800 C 3.88 2.20 2.20 0.44 010 50.5856805 D 18.83 9.44 9.44 2.14 090 50.5856810 C 4.12 2.30 2.30 0.49 010 50.5856820 C 1.50 1.31 0.65 0.18 000 50.5856821 C 2.05 1.76 0.91 0.25 000 50.5857000 C 2.97 1.72 1.72 0.31 010 50.5857010 C 6.02 3.81 3.81 0.71 090 50.5857020 C 1.50 0.94 0.59 0.18 000 50.5857022 C 2.56 1.49 1.49 0.26 010 50.5857023 C 4.74 2.58 2.58 0.58 010 50.5857061 C 1.25 1.65 1.12 0.15 010 50.5857065 C 2.61 2.30 1.67 0.31 010 50.5857100 C 1.20 1.08 0.48 0.14 000 50.5857105 C 1.69 1.80 1.42 0.20 010 50.5857106 C 6.35 4.19 4.19 0.73 090 50.5857107 C 22.97 10.49 10.49 2.71 090 50.5857109 C 26.96 11.27 11.27 3.21 090 50.5857110 C 14.27 7.29 7.29 1.73 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
57111 C 26.96 12.65 12.65 3.17 090 50.5857112 C 28.96 12.13 12.13 3.07 090 50.5857120 C 7.40 4.61 4.61 0.89 090 50.5857130 C 2.43 2.16 1.54 0.29 010 50.5857135 C 2.67 2.27 1.65 0.31 010 50.5857150 C 0.55 1.10 0.21 0.07 000 50.5857155 C 6.26 4.57 4.57 0.43 090 50.5857160 C 0.89 1.01 0.34 0.10 000 50.5857170 C 0.91 1.48 0.33 0.11 000 50.5857180 C 1.58 2.17 1.26 0.19 010 50.5857200 C 3.93 2.90 2.90 0.46 090 50.5857210 C 5.16 3.44 3.44 0.62 090 50.5857220 C 4.30 3.11 3.11 0.51 090 50.5857230 C 5.63 3.41 3.41 0.54 090 50.5857240 C 6.06 3.82 3.82 0.62 090 50.5857250 C 5.52 3.58 3.58 0.65 090 50.5857260 C 8.26 4.84 4.84 0.97 090 50.5857265 C 11.32 6.05 6.05 1.32 090 50.5857267 C 4.88 1.98 1.98 0.64 ZZZ 50.5857268 C 6.75 4.20 4.20 0.79 090 50.5857270 C 12.09 6.26 6.26 1.42 090 50.5857280 C 15.02 7.38 7.38 1.67 090 50.5857282 C 6.86 4.51 4.51 1.02 090 50.5857283 C 10.84 5.93 5.93 1.02 090 50.5857284 C 12.68 7.16 7.16 1.41 090 50.5857287 C 10.69 5.49 5.49 0.90 090 50.5857288 C 13.00 5.92 5.92 1.12 090 50.5857289 C 11.56 6.05 6.05 1.21 090 50.5857291 C 7.94 4.93 4.93 0.93 090 50.5857292 C 13.07 6.95 6.95 1.58 090 50.5857295 C 7.45 4.44 4.44 0.91 090 50.5857300 C 7.60 4.29 4.29 0.87 090 50.5857305 C 13.75 6.28 6.28 1.72 090 50.5857307 C 15.91 7.01 7.01 2.01 090 50.5857308 C 9.93 5.10 5.10 1.14 090 50.5857310 C 6.77 3.84 3.84 0.54 090 50.5857311 C 7.97 4.12 4.12 0.65 090 50.5857320 C 8.00 4.37 4.37 0.69 090 50.5857330 C 12.33 5.72 5.72 1.06 090 50.5857335 D 18.70 9.05 9.05 1.91 090 50.5857400 C 2.27 1.11 1.11 0.26 000 50.5857410 C 1.75 2.02 0.89 0.18 000 50.5857415 C 2.17 1.42 1.42 0.24 010 50.5857420 C 1.60 1.35 0.67 0.19 000 50.5857421 C 2.20 1.85 0.96 0.27 000 50.5857425 C 15.73 6.65 6.65 1.75 090 50.5857452 C 1.50 1.28 0.76 0.18 000 50.5857454 C 2.33 1.64 1.15 0.28 000 50.5857455 C 1.99 1.72 0.87 0.24 000 50.5857456 C 1.85 1.65 0.82 0.22 000 50.5857460 C 2.83 5.86 1.38 0.34 000 50.5857461 C 3.43 6.12 1.47 0.41 000 50.5857500 C 0.97 2.55 0.63 0.12 000 50.5857505 C 1.14 1.46 1.10 0.14 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
57510 C 1.90 1.56 1.04 0.23 010 50.5857511 C 1.90 1.83 1.37 0.23 010 50.5857513 C 1.90 1.72 1.40 0.23 010 50.5857520 C 4.03 3.94 2.88 0.49 090 50.5857522 C 3.35 3.16 2.46 0.41 090 50.5857530 C 4.78 3.39 3.39 0.58 090 50.5857531 C 27.96 13.20 13.20 3.34 090 50.5857540 C 12.20 6.25 6.25 1.49 090 50.5857545 C 13.01 6.69 6.69 1.52 090 50.5857550 C 5.52 3.83 3.83 0.67 090 50.5857555 C 8.94 5.09 5.09 1.09 090 50.5857556 C 8.36 4.86 4.86 0.92 090 50.5857700 C 3.54 3.11 3.11 0.41 090 50.5857720 C 4.12 3.11 3.11 0.49 090 50.5857800 C 0.77 0.76 0.47 0.09 000 50.5857820 C 1.67 1.47 1.14 0.20 010 50.5858100 C 1.53 1.32 0.72 0.18 000 50.5858110 C 0.77 0.55 0.31 0.09 ZZZ 50.5858120 C 3.27 2.31 1.88 0.39 010 50.5858140 C 14.58 7.12 7.12 1.81 090 50.5858145 C 8.03 4.80 4.80 0.97 090 50.5858146 C 18.97 9.03 9.03 2.32 090 50.5858150 C 15.22 7.50 7.50 1.84 090 50.5858152 C 20.57 9.88 9.88 2.47 090 50.5858180 C 15.27 7.47 7.47 1.64 090 50.5858200 C 21.56 10.02 10.02 2.54 090 50.5858210 C 28.81 13.23 13.23 3.37 090 50.5858240 C 38.33 17.66 17.66 4.22 090 50.5858260 C 12.96 6.71 6.71 1.57 090 50.5858262 C 14.75 7.40 7.40 1.79 090 50.5858263 C 16.04 7.90 7.90 1.94 090 50.5858267 C 17.01 8.39 8.39 2.06 090 50.5858270 C 14.24 7.08 7.08 1.73 090 50.5858275 C 15.74 7.79 7.79 1.91 090 50.5858280 C 16.98 8.27 8.27 2.06 090 50.5858285 C 22.23 9.97 9.97 2.70 090 50.5858290 C 18.97 9.15 9.15 2.29 090 50.5858291 C 20.76 9.90 9.90 2.52 090 50.5858292 C 22.05 10.39 10.39 2.67 090 50.5858293 C 23.03 10.68 10.68 2.78 090 50.5858294 C 20.25 9.58 9.58 2.39 090 50.5858300 D 1.01 1.42 0.38 0.12 XXX 50.5858301 D 1.27 1.32 0.48 0.15 000 50.5858321 D 0.92 1.15 0.37 0.10 000 50.5858322 D 1.10 1.20 0.42 0.13 000 50.5858323 D 0.23 0.53 0.09 0.03 000 50.5858340 C 0.88 3.17 0.65 0.09 000 50.5858345 D 4.65 2.44 2.44 0.41 010 50.5858346 C 6.74 3.93 3.93 0.56 090 50.5858350 D 1.01 1.49 0.92 0.12 010 50.5858353 C 3.55 35.76 2.06 0.43 010 50.5858356 C 6.37 56.84 2.60 0.82 010 50.5858400 C 6.35 3.94 3.94 0.75 090 50.5858410 C 12.71 6.45 6.45 1.45 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
58520 C 11.90 6.05 6.05 1.47 090 50.5858540 C 14.62 6.97 6.97 1.78 090 50.5858545 C 14.58 7.20 7.20 1.77 090 50.5858546 C 18.97 8.94 8.94 2.30 090 50.5858550 C 14.17 7.31 7.31 1.72 090 50.5858552 C 15.98 8.03 8.03 1.72 090 50.5858553 C 18.97 8.94 8.94 2.30 090 50.5858554 C 21.97 10.42 10.42 2.27 090 50.5858555 C 3.33 2.20 1.55 0.40 000 50.5858558 C 4.74 2.18 2.18 0.57 000 50.5858559 C 6.16 2.74 2.74 0.74 000 50.5858560 C 6.99 3.09 3.09 0.84 000 50.5858561 C 9.99 4.29 4.29 1.21 000 50.5858562 C 5.20 2.36 2.36 0.63 000 50.5858563 C 6.16 56.35 2.76 0.74 000 50.5858565 C 7.02 49.70 3.91 1.19 090 50.5858578 C 0.00 0.00 0.00 0.00 YYY 0.0058579 C 0.00 0.00 0.00 0.00 YYY 0.0058600 C 5.59 3.34 3.34 0.66 090 50.5858605 C 4.99 3.12 3.12 0.59 090 50.5858611 C 1.45 0.57 0.57 0.18 ZZZ 50.5858615 C 3.89 2.71 2.71 0.47 010 50.5858660 C 11.27 5.27 5.27 1.40 090 50.5858661 C 11.03 5.13 5.13 1.34 010 50.5858662 C 11.77 5.80 5.80 1.43 090 50.5858670 C 5.59 3.28 3.28 0.67 090 50.5858671 C 5.59 3.28 3.28 0.68 090 50.5858672 C 12.86 6.20 6.20 1.60 090 50.5858673 C 13.72 6.59 6.59 1.69 090 50.5858679 C 0.00 0.00 0.00 0.00 YYY 0.0058700 C 12.03 6.00 6.00 1.51 090 50.5858720 C 11.34 5.79 5.79 1.39 090 50.5858740 C 13.98 7.15 7.15 1.71 090 50.5858750 C 14.82 7.38 7.38 1.84 090 50.5858752 C 14.82 6.96 6.96 1.80 090 50.5858760 C 13.11 6.73 6.73 1.79 090 50.5858770 C 13.95 6.92 6.92 1.73 090 50.5858800 C 4.13 3.65 2.91 0.43 090 50.5858805 C 5.87 3.51 3.51 0.69 090 50.5858820 C 4.21 3.30 3.30 0.52 090 50.5858822 C 10.11 5.23 5.23 1.16 090 50.5858823 C 3.37 21.38 1.12 0.24 000 50.5858825 C 10.96 5.81 5.81 1.32 090 50.5858900 C 5.98 3.58 3.58 0.69 090 50.5858920 C 11.34 5.59 5.59 1.43 090 50.5858925 C 11.34 5.70 5.70 1.41 090 50.5858940 C 7.28 4.11 4.11 0.91 090 50.5858943 C 18.40 8.67 8.67 2.22 090 50.5858950 C 16.90 8.42 8.42 2.04 090 50.5858951 C 22.35 10.47 10.47 2.63 090 50.5858952 C 24.97 11.78 11.78 3.02 090 50.5858953 C 31.95 14.58 14.58 3.83 090 50.5858954 C 34.95 15.75 15.75 4.17 090 50.5858956 C 20.78 10.34 10.34 4.00 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
58960 C 14.63 7.37 7.37 1.79 090 50.5858970 D 3.52 2.32 1.49 0.43 000 50.5858974 D 0.00 0.00 0.00 0.00 000 0.0058976 D 3.82 2.69 1.83 0.47 000 50.5858999 S 0.00 0.00 0.00 0.00 YYY 0.0059000 C 1.30 2.08 0.67 0.31 000 50.5859001 C 3.00 1.41 1.41 0.71 000 50.5859012 C 3.44 1.54 1.54 0.82 000 50.5859015 C 2.20 1.55 1.04 0.52 000 50.5859020 C 0.66 0.78 0.78 0.26 000 50.5859020 C TC 0.00 0.52 0.52 0.10 000 50.5859020 C 26 0.66 0.26 0.26 0.16 000 50.5859025 C 0.53 0.44 0.44 0.14 000 50.5859025 C TC 0.00 0.23 0.23 0.02 000 50.5859025 C 26 0.53 0.21 0.21 0.12 000 50.5859030 C 1.99 0.77 0.77 0.47 000 50.5859050 C 0.89 0.35 0.35 0.21 XXX 50.5859051 C 0.74 0.29 0.29 0.17 XXX 50.5859070 C 5.24 5.16 2.32 0.28 000 50.5859072 C 8.99 3.13 3.13 0.16 000 50.5859074 C 5.24 4.58 2.32 0.28 000 50.5859076 C 8.99 3.13 3.13 0.16 000 50.5859100 C 12.33 6.47 6.47 2.94 090 50.5859120 C 11.47 6.26 6.26 2.72 090 50.5859121 C 11.65 6.34 6.34 2.78 090 50.5859130 C 14.20 4.80 4.80 3.38 090 50.5859135 C 13.86 7.24 7.24 3.30 090 50.5859136 C 13.16 6.62 6.62 3.13 090 50.5859140 C 5.45 2.22 2.22 1.29 090 50.5859150 C 11.65 6.01 6.01 2.78 090 50.5859151 C 11.47 6.07 6.07 2.73 090 50.5859160 C 2.71 3.30 2.14 0.64 010 50.5859200 C 0.79 1.19 0.30 0.19 000 50.5859300 C 2.41 2.18 0.96 0.57 000 50.5859320 C 2.48 1.24 1.24 0.59 000 50.5859325 C 4.06 1.90 1.90 0.88 000 50.5859350 C 4.94 1.88 1.88 1.17 000 50.5859400 C 23.03 15.36 15.36 5.48 MMM 50.5859409 C 13.48 5.32 5.32 3.21 MMM 50.5859410 C 14.76 6.32 6.32 3.51 MMM 50.5859412 C 1.71 0.81 0.81 0.40 MMM 50.5859414 C 1.61 0.64 0.64 0.38 MMM 50.5859425 C 4.80 4.21 1.86 1.14 MMM 50.5859426 C 8.27 7.56 3.23 1.97 MMM 50.5859430 C 2.13 1.23 0.94 0.50 MMM 50.5859510 C 26.18 17.31 17.31 6.23 MMM 50.5859514 C 15.95 6.23 6.23 3.79 MMM 50.5859515 C 17.34 7.85 7.85 4.12 MMM 50.5859525 C 8.53 3.31 3.31 1.94 ZZZ 50.5859610 C 24.58 15.91 15.91 5.85 MMM 50.5859612 C 15.04 6.07 6.07 3.58 MMM 50.5859614 C 16.32 6.95 6.95 3.88 MMM 50.5859618 C 27.74 18.28 18.28 6.59 MMM 50.5859620 C 17.50 6.78 6.78 4.16 MMM 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
59622 C 18.90 8.66 8.66 4.49 MMM 50.5859812 C 4.00 2.55 2.55 0.95 090 50.5859820 C 4.00 4.43 3.57 0.95 090 50.5859821 C 4.46 4.28 3.41 1.06 090 50.5859830 C 6.10 3.99 3.99 1.44 090 50.5859840 C 3.01 2.13 2.13 0.71 010 50.5859841 C 5.23 3.50 2.98 1.24 010 50.5859850 C 5.90 3.26 3.26 1.28 090 50.5859851 C 5.92 3.75 3.75 1.28 090 50.5859852 C 8.23 5.05 5.05 1.80 090 50.5859855 C 6.11 3.55 3.55 1.45 090 50.5859856 C 7.47 4.07 4.07 1.78 090 50.5859857 C 9.28 4.72 4.72 2.01 090 50.5859866 D 3.99 1.90 1.90 0.87 000 50.5859870 C 6.00 4.49 4.49 1.42 090 50.5859871 C 2.13 1.75 1.13 0.50 000 50.5859897 C 0.00 0.00 0.00 0.00 YYY 0.0059898 S 0.00 0.00 0.00 0.00 YYY 0.0059899 S 0.00 0.00 0.00 0.00 YYY 0.0060000 C 1.76 1.93 1.71 0.15 010 50.5860001 C 0.97 1.41 0.33 0.07 000 50.5860100 C 1.56 1.40 0.53 0.10 000 50.5860200 C 9.54 6.00 6.00 1.01 090 50.5860210 C 10.86 5.65 5.65 1.23 090 50.5860212 C 16.01 7.69 7.69 1.94 090 50.5860220 C 11.88 6.16 6.16 1.32 090 50.5860225 C 14.17 7.42 7.42 1.64 090 50.5860240 C 16.04 7.60 7.60 1.85 090 50.5860252 C 20.54 10.12 10.12 2.29 090 50.5860254 C 26.95 14.18 14.18 2.60 090 50.5860260 C 17.44 8.67 8.67 1.93 090 50.5860270 C 20.24 10.48 10.48 2.32 090 50.5860271 C 16.80 8.60 8.60 1.74 090 50.5860280 C 5.86 4.67 4.67 0.54 090 50.5860281 C 8.52 5.85 5.85 0.73 090 50.5860500 C 16.21 7.42 7.42 2.00 090 50.5860502 C 20.32 9.38 9.38 2.53 090 50.5860505 C 21.46 10.95 10.95 2.64 090 50.5860512 C 4.44 1.62 1.62 0.53 ZZZ 50.5860520 C 16.78 8.31 8.31 2.19 090 50.5860521 C 18.84 9.57 9.57 2.81 090 50.5860522 C 23.06 11.29 11.29 3.26 090 50.5860540 C 17.00 7.60 7.60 1.74 090 50.5860545 C 19.85 8.55 8.55 2.07 090 50.5860600 C 17.90 10.99 10.99 2.19 090 50.5860605 C 20.21 12.29 12.29 2.49 090 50.5860650 C 19.97 8.00 8.00 2.28 090 50.5860659 C 0.00 0.00 0.00 0.00 YYY 0.0060699 S 0.00 0.00 0.00 0.00 YYY 0.0061000 C 1.58 0.95 0.95 0.13 000 50.5861001 C 1.49 1.06 1.06 0.16 000 50.5861020 C 1.51 1.34 1.34 0.34 000 50.5861026 C 1.69 1.39 1.39 0.33 000 50.5861050 C 1.51 1.27 1.27 0.11 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
61055 C 2.10 1.42 1.42 0.17 000 50.5861070 C 0.89 1.01 1.01 0.17 000 50.5861105 C 5.13 3.94 3.94 1.32 090 50.5861107 C 4.99 2.54 2.54 1.29 000 50.5861108 C 10.17 7.16 7.16 2.63 090 50.5861120 C 8.75 6.01 6.01 2.09 090 50.5861140 C 15.88 9.91 9.91 4.11 090 50.5861150 C 17.54 10.40 10.40 4.31 090 50.5861151 C 12.40 7.83 7.83 3.00 090 50.5861154 C 14.97 9.51 9.51 4.20 090 50.5861156 C 16.30 9.86 9.86 4.22 090 50.5861210 C 5.83 2.92 2.92 1.50 000 50.5861215 C 4.88 4.01 4.01 1.26 090 50.5861250 C 10.40 6.87 6.87 2.76 090 50.5861253 C 12.34 7.74 7.74 2.61 090 50.5861304 C 21.93 12.87 12.87 5.61 090 50.5861305 C 26.57 15.35 15.35 6.07 090 50.5861312 C 24.53 15.08 15.08 6.34 090 50.5861313 C 24.89 14.84 14.84 6.43 090 50.5861314 C 24.19 13.07 13.07 6.26 090 50.5861315 C 27.64 16.06 16.06 7.14 090 50.5861316 C 1.39 0.60 0.60 0.35 ZZZ 50.5861320 C 25.58 14.79 14.79 6.60 090 50.5861321 C 28.46 16.17 16.17 7.12 090 50.5861322 C 29.46 15.71 15.71 7.61 090 50.5861323 C 30.95 16.13 16.13 8.01 090 50.5861330 C 23.29 13.76 13.76 2.31 090 50.5861332 C 27.24 15.64 15.64 4.82 090 50.5861333 C 27.91 15.62 15.62 3.91 090 50.5861334 C 18.24 10.66 10.66 1.74 090 50.5861340 C 18.63 11.15 11.15 4.83 090 50.5861343 C 29.73 16.85 16.85 7.62 090 50.5861345 C 27.16 15.43 15.43 7.02 090 50.5861440 C 26.59 14.24 14.24 6.88 090 50.5861450 C 25.91 14.32 14.32 5.77 090 50.5861458 C 27.25 15.55 15.55 7.01 090 50.5861460 C 28.35 16.46 16.46 6.02 090 50.5861470 C 26.02 13.89 13.89 5.88 090 50.5861480 C 26.45 15.31 15.31 6.71 090 50.5861490 C 25.62 14.36 14.36 6.90 090 50.5861500 C 17.89 10.83 10.83 4.10 090 50.5861501 C 14.82 9.23 9.23 3.21 090 50.5861510 C 28.41 16.74 16.74 7.33 090 50.5861512 C 35.04 19.73 19.73 9.05 090 50.5861514 C 25.22 14.47 14.47 6.52 090 50.5861516 C 24.57 14.30 14.30 6.33 090 50.5861517 C 1.38 0.64 0.64 0.35 ZZZ 50.5861518 C 37.26 21.15 21.15 9.62 090 50.5861519 C 41.33 22.71 22.71 10.60 090 50.5861520 C 54.76 30.41 30.41 11.18 090 50.5861521 C 44.41 24.28 24.28 11.36 090 50.5861522 C 29.41 16.46 16.46 7.60 090 50.5861524 C 27.82 15.71 15.71 7.14 090 50.5861526 C 52.09 29.57 29.57 7.05 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
61530 C 43.79 25.12 25.12 6.13 090 50.5861531 C 14.61 9.15 9.15 3.78 090 50.5861533 C 19.68 11.56 11.56 5.10 090 50.5861534 C 20.94 12.12 12.12 5.42 090 50.5861535 C 11.61 7.44 7.44 3.01 090 50.5861536 C 35.47 19.84 19.84 9.18 090 50.5861537 C 24.96 14.78 14.78 6.92 090 50.5861538 C 26.77 15.35 15.35 6.92 090 50.5861539 C 32.03 17.81 17.81 8.30 090 50.5861540 C 29.96 17.29 17.29 8.30 090 50.5861541 C 28.81 16.25 16.25 6.58 090 50.5861542 C 30.97 17.87 17.87 8.01 090 50.5861543 C 29.18 16.43 16.43 7.54 090 50.5861544 C 25.46 13.86 13.86 5.95 090 50.5861545 C 43.73 24.28 24.28 10.60 090 50.5861546 C 31.25 17.54 17.54 7.65 090 50.5861548 C 21.50 12.82 12.82 3.42 090 50.5861550 C 14.63 6.95 6.95 0.98 090 50.5861552 C 19.53 9.14 9.14 1.06 090 50.5861556 C 22.23 11.39 11.39 4.64 090 50.5861557 C 22.35 13.66 13.66 5.78 090 50.5861558 C 25.54 14.23 14.23 1.36 090 50.5861559 C 32.74 19.37 19.37 8.48 090 50.5861563 C 26.79 15.28 15.28 5.15 090 50.5861564 C 33.78 18.33 18.33 8.75 090 50.5861566 C 30.95 17.82 17.82 6.92 090 50.5861567 C 35.45 20.73 20.73 6.52 090 50.5861570 C 24.56 13.95 13.95 5.86 090 50.5861571 C 26.35 15.18 15.18 6.77 090 50.5861575 C 34.31 19.69 19.69 5.32 090 50.5861576 C 52.35 34.83 34.83 5.56 090 50.5861580 C 30.30 25.65 25.65 3.36 090 50.5861581 C 34.55 23.51 23.51 3.91 090 50.5861582 C 31.61 27.38 27.38 7.19 090 50.5861583 C 36.16 25.18 25.18 9.18 090 50.5861584 C 34.60 24.59 24.59 8.16 090 50.5861585 C 38.55 26.57 26.57 7.01 090 50.5861586 C 25.06 22.65 22.65 4.36 090 50.5861590 C 41.72 28.70 28.70 5.29 090 50.5861591 C 43.61 29.61 29.61 5.64 090 50.5861592 C 39.58 26.58 26.58 10.04 090 50.5861595 C 29.53 22.41 22.41 3.97 090 50.5861596 C 35.58 24.51 24.51 3.39 090 50.5861597 C 37.90 23.06 23.06 8.81 090 50.5861598 C 33.36 23.30 23.30 5.68 090 50.5861600 C 25.81 19.83 19.83 3.78 090 50.5861601 C 27.85 20.55 20.55 6.61 090 50.5861605 C 29.29 22.02 22.02 2.85 090 50.5861606 C 38.77 25.22 25.22 8.94 090 50.5861607 C 36.22 23.85 23.85 6.88 090 50.5861608 C 42.04 26.66 26.66 10.72 090 50.5861609 C 9.88 4.86 4.86 2.55 ZZZ 50.5861610 C 29.63 13.18 13.18 7.66 ZZZ 50.5861611 C 7.41 3.83 3.83 1.88 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
61612 C 27.84 13.35 13.35 4.30 ZZZ 50.5861613 C 40.80 26.34 26.34 8.42 090 50.5861615 C 32.02 22.79 22.79 4.72 090 50.5861616 C 43.27 28.73 28.73 8.24 090 50.5861618 C 16.96 10.47 10.47 3.71 090 50.5861619 C 20.68 12.28 12.28 3.94 090 50.5861623 C 9.95 4.09 4.09 1.05 000 50.5861624 C 20.12 6.91 6.91 1.95 000 50.5861626 C 16.60 5.53 5.53 1.24 000 50.5861630 C 21.08 12.53 12.53 2.01 090 50.5861635 C 23.08 13.58 13.58 2.20 090 50.5861640 C 0.00 0.00 0.00 0.00 000 0.0061641 C 0.00 0.00 0.00 0.00 ZZZ 0.0061642 C 0.00 0.00 0.00 0.00 ZZZ 0.0061680 C 30.66 17.48 17.48 7.93 090 50.5861682 C 61.48 32.30 32.30 15.85 090 50.5861684 C 39.75 22.06 22.06 10.28 090 50.5861686 C 64.39 34.82 34.82 16.66 090 50.5861690 C 29.27 16.77 16.77 6.92 090 50.5861692 C 51.79 27.55 27.55 13.39 090 50.5861697 C 50.44 28.09 28.09 12.81 090 50.5861698 C 48.34 26.77 26.77 12.50 090 50.5861700 C 50.44 27.88 27.88 12.98 090 50.5861702 C 48.34 26.11 26.11 10.76 090 50.5861703 C 17.44 10.49 10.49 4.05 090 50.5861705 C 36.15 19.31 19.31 8.84 090 50.5861708 C 35.25 15.19 15.19 2.50 090 50.5861710 C 29.63 13.68 13.68 4.51 090 50.5861711 C 36.28 19.86 19.86 9.39 090 50.5861720 C 16.74 10.00 10.00 2.78 090 50.5861735 C 20.40 12.20 12.20 2.72 090 50.5861750 C 18.17 10.64 10.64 4.71 090 50.5861751 C 17.59 10.85 10.85 4.55 090 50.5861760 C 22.24 8.74 8.74 5.40 090 50.5861770 C 21.41 12.29 12.29 3.54 090 50.5861790 C 10.84 5.93 5.93 2.81 090 50.5861791 C 14.59 8.94 8.94 3.39 090 50.5861793 C 17.21 10.15 10.15 4.45 090 50.5861795 C 4.03 2.04 2.04 0.79 ZZZ 50.5861850 C 12.37 7.69 7.69 3.21 090 50.5861860 C 20.84 12.09 12.09 4.94 090 50.5861863 C 18.97 11.80 11.80 5.41 090 50.5861864 C 4.49 2.29 2.29 5.41 ZZZ 50.5861867 C 31.29 18.07 18.07 5.41 090 50.5861868 C 7.91 4.02 4.02 5.41 ZZZ 50.5861870 C 14.92 9.73 9.73 3.86 090 50.5861875 C 15.04 8.59 8.59 2.94 090 50.5861880 C 6.28 4.58 4.58 1.66 090 50.5861885 C 5.84 5.32 5.32 1.59 090 50.5861886 C 7.99 6.37 6.37 1.96 090 50.5861888 C 5.06 3.68 3.68 1.33 010 50.5862000 C 12.51 5.53 5.53 1.06 090 50.5862005 C 16.15 8.82 8.82 3.86 090 50.5862010 C 19.78 11.74 11.74 5.12 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
62100 C 22.00 12.82 12.82 4.83 090 50.5862115 C 21.63 11.67 11.67 5.49 090 50.5862116 C 23.55 13.40 13.40 6.09 090 50.5862117 C 26.56 15.41 15.41 4.52 090 50.5862120 C 23.31 18.53 18.53 2.99 090 50.5862121 C 21.55 15.49 15.49 4.16 090 50.5862140 C 13.49 8.34 8.34 3.46 090 50.5862141 C 14.89 9.07 9.07 3.75 090 50.5862142 C 10.77 7.01 7.01 2.72 090 50.5862143 C 13.03 8.06 8.06 3.36 090 50.5862145 C 18.79 10.92 10.92 4.49 090 50.5862146 C 16.10 9.66 9.66 3.61 090 50.5862147 C 19.31 11.33 11.33 4.31 090 50.5862148 C 2.00 0.86 0.86 0.48 ZZZ 50.5862160 C 3.00 1.53 1.53 0.77 ZZZ 50.5862161 C 19.97 12.13 12.13 5.17 090 50.5862162 C 25.21 14.89 14.89 5.89 090 50.5862163 C 15.48 9.95 9.95 4.00 090 50.5862164 C 27.46 14.99 14.99 5.36 090 50.5862165 C 21.97 13.42 13.42 3.00 090 50.5862180 C 21.03 12.32 12.32 4.97 090 50.5862190 C 11.05 7.10 7.10 2.79 090 50.5862192 C 12.23 7.64 7.64 3.01 090 50.5862194 C 5.02 2.44 2.44 0.92 010 50.5862200 C 18.29 10.87 10.87 4.64 090 50.5862201 C 14.84 9.47 9.47 3.67 090 50.5862220 C 12.98 8.00 8.00 3.34 090 50.5862223 C 12.85 8.26 8.26 3.13 090 50.5862225 C 5.40 4.10 4.10 1.39 090 50.5862230 C 10.52 6.50 6.50 2.70 090 50.5862252 C 0.74 1.47 1.47 0.21 XXX 50.5862252 C TC 0.00 1.10 1.10 0.02 XXX 50.5862252 C 26 0.74 0.37 0.37 0.19 XXX 50.5862256 C 6.59 4.70 4.70 1.71 090 50.5862258 C 14.52 8.74 8.74 3.73 090 50.5862263 C 6.13 12.73 3.20 0.41 010 50.5862264 C 4.42 7.75 1.42 0.27 010 50.5862268 C 4.73 11.56 2.15 0.43 000 50.5862269 C 5.01 14.72 1.98 0.37 000 50.5862270 C 1.13 3.00 0.56 0.08 000 50.5862272 C 1.35 3.62 0.71 0.18 000 50.5862273 C 2.15 2.72 0.71 0.13 000 50.5862280 C 2.63 6.95 1.01 0.30 010 50.5862281 C 2.66 5.67 0.89 0.19 010 50.5862282 C 2.33 8.38 0.92 0.17 010 50.5862284 C 1.54 4.97 0.68 0.13 000 50.5862287 C 8.07 5.57 5.57 0.58 090 50.5862290 C 3.00 7.15 1.38 0.23 000 50.5862291 C 2.91 5.95 1.23 0.26 000 50.5862292 C 7.85 4.48 4.48 0.82 090 50.5862294 C 11.81 5.60 5.60 1.24 090 50.5862310 C 1.91 4.82 0.65 0.12 000 50.5862311 C 1.54 4.93 0.59 0.09 000 50.5862318 C 2.04 5.74 0.65 0.12 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
62319 C 1.87 4.99 0.61 0.11 000 50.5862350 C 6.86 3.95 3.95 1.02 090 50.5862351 C 9.99 7.14 7.14 2.24 090 50.5862355 C 5.44 3.17 3.17 0.71 090 50.5862360 C 2.62 2.69 2.69 0.34 090 50.5862361 C 5.41 3.93 3.93 0.80 090 50.5862362 C 7.03 4.37 4.37 1.18 090 50.5862365 C 5.41 3.59 3.59 0.86 090 50.5862367 C 0.48 0.61 0.10 0.03 XXX 50.5862367 C TC 0.00 0.48 0.00 0.01 XXX 50.5862367 C 26 0.48 0.13 0.10 0.02 XXX 50.5862368 C 0.75 0.69 0.17 0.06 XXX 50.5862368 C TC 0.00 0.50 0.00 0.00 XXX 50.5862368 C 26 0.75 0.19 0.17 0.06 XXX 50.5863001 C 15.80 9.54 9.54 3.76 090 50.5863003 C 15.93 9.89 9.89 3.72 090 50.5863005 C 14.90 10.00 10.00 3.34 090 50.5863011 C 14.50 8.29 8.29 3.37 090 50.5863012 C 15.38 10.15 10.15 3.48 090 50.5863015 C 19.32 11.90 11.90 4.75 090 50.5863016 C 19.17 11.81 11.81 4.58 090 50.5863017 C 15.92 10.42 10.42 3.63 090 50.5863020 C 14.79 9.70 9.70 3.71 090 50.5863030 C 11.98 8.44 8.44 3.00 090 50.5863035 C 3.15 1.59 1.59 0.79 ZZZ 50.5863040 C 18.78 11.53 11.53 4.67 090 50.5863042 C 17.44 11.37 11.37 4.25 090 50.5863043 C 332.45 0.00 0.00 0.00 ZZZ 1.2563044 C 313.27 0.00 0.00 0.00 ZZZ 1.2563045 C 16.48 10.38 10.38 3.98 090 50.5863046 C 15.78 10.21 10.21 3.55 090 50.5863047 C 14.59 9.92 9.92 3.23 090 50.5863048 C 3.26 1.66 1.66 0.72 ZZZ 50.5863050 C 20.75 11.87 11.87 4.66 090 50.5863051 C 24.25 13.51 13.51 4.66 090 50.5863055 C 21.96 13.17 13.17 5.27 090 50.5863056 C 20.33 12.60 12.60 4.75 090 50.5863057 C 5.25 2.64 2.64 1.22 ZZZ 50.5863064 C 24.57 14.46 14.46 5.69 090 50.5863066 C 3.26 1.66 1.66 0.69 ZZZ 50.5863075 C 19.38 12.12 12.12 4.62 090 50.5863076 C 4.04 2.06 2.06 0.96 ZZZ 50.5863077 C 21.41 12.83 12.83 3.98 090 50.5863078 C 3.28 1.64 1.64 0.66 ZZZ 50.5863081 C 23.69 14.36 14.36 5.54 090 50.5863082 C 4.36 2.23 2.23 1.02 ZZZ 50.5863085 C 26.88 15.51 15.51 4.48 090 50.5863086 C 3.19 1.59 1.59 0.59 ZZZ 50.5863087 C 35.52 19.51 19.51 6.20 090 50.5863088 C 4.32 2.18 2.18 0.82 ZZZ 50.5863090 C 28.12 16.08 16.08 4.21 090 50.5863091 C 3.03 1.46 1.46 0.48 ZZZ 50.5863101 C 31.95 19.33 19.33 5.69 090 50.5863102 C 31.95 19.33 19.33 5.69 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
63103 C 4.82 2.51 2.51 0.69 ZZZ 50.5863170 C 19.80 11.89 11.89 4.86 090 50.5863172 C 17.63 10.67 10.67 4.48 090 50.5863173 C 21.96 12.84 12.84 5.68 090 50.5863180 C 18.24 11.01 11.01 3.95 090 50.5863182 C 20.47 10.98 10.98 5.30 090 50.5863185 C 15.02 8.11 8.11 2.79 090 50.5863190 C 17.42 10.16 10.16 3.24 090 50.5863191 C 17.51 10.50 10.50 6.34 090 50.5863194 C 19.16 11.74 11.74 3.26 090 50.5863195 C 18.81 11.07 11.07 4.87 090 50.5863196 C 22.27 13.42 13.42 5.76 090 50.5863197 C 21.08 12.24 12.24 5.36 090 50.5863198 C 25.34 8.45 8.45 6.43 090 50.5863199 C 26.85 15.07 15.07 1.40 090 50.5863200 C 19.15 11.32 11.32 4.96 090 50.5863250 C 40.70 19.98 19.98 9.01 090 50.5863251 C 41.14 22.65 22.65 10.41 090 50.5863252 C 41.13 22.29 22.29 10.64 090 50.5863265 C 21.53 12.80 12.80 5.43 090 50.5863266 C 22.27 13.21 13.21 5.54 090 50.5863267 C 17.92 11.10 11.10 4.37 090 50.5863268 C 18.49 10.39 10.39 3.69 090 50.5863270 C 26.76 15.50 15.50 6.82 090 50.5863271 C 26.88 15.61 15.61 6.90 090 50.5863272 C 25.28 14.72 14.72 6.18 090 50.5863273 C 24.25 14.37 14.37 5.74 090 50.5863275 C 23.64 13.80 13.80 5.80 090 50.5863276 C 23.41 13.71 13.71 5.83 090 50.5863277 C 20.80 12.55 12.55 5.01 090 50.5863278 C 20.53 12.42 12.42 4.55 090 50.5863280 C 28.31 16.35 16.35 7.27 090 50.5863281 C 28.01 16.21 16.21 7.17 090 50.5863282 C 26.35 15.36 15.36 6.76 090 50.5863283 C 24.96 14.69 14.69 6.26 090 50.5863285 C 35.95 19.99 19.99 9.18 090 50.5863286 C 35.58 19.95 19.95 9.21 090 50.5863287 C 36.64 20.47 20.47 9.39 090 50.5863290 C 37.32 20.64 20.64 9.02 090 50.5863295 C 5.25 2.15 2.15 1.03 ZZZ 50.5863300 C 24.39 14.33 14.33 5.97 090 50.5863301 C 27.56 15.59 15.59 5.39 090 50.5863302 C 27.77 15.89 15.89 5.53 090 50.5863303 C 30.45 16.95 16.95 4.68 090 50.5863304 C 30.28 17.31 17.31 6.41 090 50.5863305 C 31.98 18.09 18.09 5.71 090 50.5863306 C 32.17 17.84 17.84 8.33 090 50.5863307 C 31.58 16.85 16.85 4.46 090 50.5863308 C 5.24 2.61 2.61 1.29 ZZZ 50.5863600 C 14.00 5.41 5.41 1.52 090 50.5863610 C 8.72 59.85 2.26 0.86 000 50.5863615 C 16.26 9.29 9.29 2.84 090 50.5863650 C 6.73 3.18 3.18 0.53 090 50.5863655 C 10.27 6.91 6.91 2.43 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
63660 C 6.15 3.62 3.62 0.78 090 50.5863685 C 7.03 4.15 4.15 1.05 090 50.5863688 C 5.38 3.56 3.56 0.89 090 50.5863700 C 16.51 10.33 10.33 3.52 090 50.5863702 C 18.45 11.06 11.06 4.12 090 50.5863704 C 21.15 12.95 12.95 4.57 090 50.5863706 C 24.07 13.61 13.61 6.23 090 50.5863707 C 11.24 7.72 7.72 2.51 090 50.5863709 C 14.30 9.42 9.42 3.09 090 50.5863710 C 14.05 9.06 9.06 3.40 090 50.5863740 C 11.34 7.36 7.36 2.93 090 50.5863741 C 8.24 4.76 4.76 1.66 090 50.5863744 C 8.09 5.27 5.27 1.89 090 50.5863746 C 6.42 3.78 3.78 1.53 090 50.5864400 C 1.11 1.90 0.43 0.07 000 50.5864402 C 1.25 1.61 0.60 0.09 000 50.5864405 C 1.32 1.46 0.46 0.08 000 50.5864408 C 1.41 1.58 0.85 0.10 000 50.5864410 C 1.43 2.51 0.46 0.09 000 50.5864412 C 1.18 2.66 0.43 0.08 000 50.5864413 C 1.40 1.85 0.50 0.08 000 50.5864415 C 1.48 2.81 0.46 0.09 000 50.5864416 C 3.49 0.79 0.79 0.31 010 50.5864417 C 1.44 3.04 0.49 0.11 000 50.5864418 C 1.32 2.63 0.44 0.07 000 50.5864420 C 1.18 3.89 0.42 0.08 000 50.5864421 C 1.68 6.10 0.52 0.11 000 50.5864425 C 1.75 1.65 0.54 0.13 000 50.5864430 C 1.46 2.52 0.55 0.10 000 50.5864435 C 1.45 2.53 0.69 0.16 000 50.5864445 C 1.48 2.68 0.50 0.10 000 50.5864446 C 3.25 1.00 1.00 0.20 010 50.5864447 C 1.50 0.43 0.43 0.09 000 50.5864448 C 3.00 0.81 0.81 0.18 010 50.5864449 C 3.00 0.96 0.96 0.15 010 50.5864450 C 1.27 1.24 0.48 0.13 000 50.5864470 C 1.85 7.25 0.71 0.11 000 50.5864472 C 1.29 2.34 0.34 0.08 ZZZ 50.5864475 C 1.41 6.90 0.63 0.10 000 50.5864476 C 0.98 2.13 0.24 0.07 ZZZ 50.5864479 C 2.20 7.51 0.89 0.12 000 50.5864480 C 1.54 2.85 0.47 0.10 ZZZ 50.5864483 C 1.90 7.91 0.83 0.11 000 50.5864484 C 1.33 3.29 0.37 0.08 ZZZ 50.5864505 C 1.36 1.24 0.66 0.10 000 50.5864508 C 1.12 3.33 0.74 0.07 000 50.5864510 C 1.22 3.46 0.51 0.07 000 50.5864517 C 2.20 2.73 0.87 0.11 000 50.5864520 C 1.35 5.15 0.55 0.08 000 50.5864530 C 1.58 4.46 0.65 0.10 000 50.5864550 C 0.18 0.28 0.05 0.01 000 50.5864553 C 2.31 2.84 1.86 0.18 010 50.5864555 C 2.27 3.11 1.19 0.19 010 50.5864560 C 2.36 2.64 1.28 0.22 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
64561 C 6.73 30.14 2.78 0.51 010 50.5864565 C 1.76 3.29 1.26 0.13 010 50.5864573 C 7.49 5.26 5.26 1.60 090 50.5864575 C 4.34 2.68 2.68 0.61 090 50.5864577 C 4.61 3.29 3.29 1.04 090 50.5864580 C 4.11 3.56 3.56 0.36 090 50.5864581 C 13.48 5.39 5.39 1.05 090 50.5864585 C 2.06 11.31 2.14 0.20 010 50.5864590 C 2.40 7.16 2.29 0.19 010 50.5864595 C 1.73 10.42 1.93 0.19 010 50.5864600 C 3.44 9.38 1.65 0.34 010 50.5864605 C 5.60 9.58 2.19 0.79 010 50.5864610 C 7.15 8.89 3.72 1.58 010 50.5864612 C 1.96 2.49 1.32 0.11 010 50.5864613 C 1.96 2.94 1.22 0.11 010 50.5864614 C 2.20 3.23 1.31 0.10 010 50.5864620 C 2.84 5.07 1.33 0.20 010 50.5864622 C 3.00 7.78 1.37 0.18 010 50.5864623 C 0.99 2.97 0.22 0.06 ZZZ 50.5864626 C 3.28 7.80 1.97 0.20 010 50.5864627 C 1.16 4.54 0.27 0.07 ZZZ 50.5864630 C 3.00 2.74 1.41 0.22 010 50.5864640 C 2.76 4.19 1.85 0.29 010 50.5864650 C 0.70 0.87 0.30 0.06 000 50.5864653 C 0.88 0.92 0.38 0.08 000 50.5864680 C 2.62 6.73 1.43 0.18 010 50.5864681 C 3.54 9.32 2.07 0.28 010 50.5864702 C 4.22 3.87 3.87 0.61 090 50.5864704 C 4.56 3.32 3.32 0.61 090 50.5864708 C 6.11 4.87 4.87 0.96 090 50.5864712 C 7.74 4.97 4.97 0.95 090 50.5864713 C 10.98 5.89 5.89 1.82 090 50.5864714 C 10.31 4.21 4.21 1.19 090 50.5864716 C 6.30 5.99 5.99 0.63 090 50.5864718 C 5.98 6.01 6.01 1.05 090 50.5864719 C 4.84 4.53 4.53 0.77 090 50.5864721 C 4.28 5.38 5.38 0.73 090 50.5864722 C 4.69 3.05 3.05 0.48 090 50.5864726 C 4.17 2.80 2.80 0.54 090 50.5864727 C 3.10 1.50 1.50 0.48 ZZZ 50.5864732 C 4.40 3.51 3.51 0.98 090 50.5864734 C 4.91 4.06 4.06 0.89 090 50.5864736 C 4.59 4.03 4.03 0.52 090 50.5864738 C 5.72 4.62 4.62 1.08 090 50.5864740 C 5.58 5.13 5.13 0.69 090 50.5864742 C 6.21 4.71 4.71 0.73 090 50.5864744 C 5.23 3.78 3.78 1.16 090 50.5864746 C 5.92 4.51 4.51 0.82 090 50.5864752 C 7.05 4.29 4.29 0.93 090 50.5864755 C 13.50 5.65 5.65 1.83 090 50.5864760 C 6.95 3.46 3.46 0.81 090 50.5864761 C 6.40 3.53 3.53 0.53 090 50.5864763 C 6.92 5.21 5.21 0.94 090 50.5864766 C 8.66 5.26 5.26 1.06 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
64771 C 7.34 5.57 5.57 1.23 090 50.5864772 C 7.20 4.93 4.93 1.40 090 50.5864774 C 5.16 3.84 3.84 0.74 090 50.5864776 C 5.11 3.69 3.69 0.76 090 50.5864778 C 3.11 1.50 1.50 0.46 ZZZ 50.5864782 C 6.22 3.78 3.78 0.86 090 50.5864783 C 3.71 1.84 1.84 0.51 ZZZ 50.5864784 C 9.81 6.61 6.61 1.38 090 50.5864786 C 15.44 9.86 9.86 2.60 090 50.5864787 C 4.29 2.13 2.13 0.58 ZZZ 50.5864788 C 4.60 3.47 3.47 0.73 090 50.5864790 C 11.29 7.22 7.22 2.10 090 50.5864792 C 14.90 8.85 8.85 2.48 090 50.5864795 C 3.01 1.56 1.56 0.52 000 50.5864802 C 9.14 5.14 5.14 1.29 090 50.5864804 C 14.62 7.18 7.18 2.14 090 50.5864809 C 13.65 5.78 5.78 1.50 090 50.5864818 C 10.28 5.30 5.30 1.33 090 50.5864820 C 10.35 7.14 7.14 1.49 090 50.5864821 C 8.74 7.36 7.36 1.24 090 50.5864822 C 8.74 7.25 7.25 1.30 090 50.5864823 C 10.35 8.15 8.15 1.57 090 50.5864831 C 9.43 7.09 7.09 1.41 090 50.5864832 C 5.65 2.94 2.94 0.85 ZZZ 50.5864834 C 10.17 7.11 7.11 1.54 090 50.5864835 C 10.92 7.71 7.71 1.73 090 50.5864836 C 10.92 7.68 7.68 1.67 090 50.5864837 C 6.25 3.24 3.24 0.97 ZZZ 50.5864840 C 13.00 8.27 8.27 1.37 090 50.5864856 C 13.78 9.21 9.21 2.12 090 50.5864857 C 14.47 9.66 9.66 2.21 090 50.5864858 C 16.47 10.80 10.80 3.33 090 50.5864859 C 4.25 2.20 2.20 0.67 ZZZ 50.5864861 C 19.21 11.80 11.80 4.08 090 50.5864862 C 19.41 11.96 11.96 4.31 090 50.5864864 C 12.53 8.79 8.79 1.26 090 50.5864865 C 15.22 13.56 13.56 1.50 090 50.5864866 C 15.72 13.20 13.20 2.04 090 50.5864868 C 14.02 11.46 11.46 1.43 090 50.5864870 C 15.97 8.75 8.75 1.30 090 50.5864872 C 1.99 1.08 1.08 0.29 ZZZ 50.5864874 C 2.98 1.53 1.53 0.42 ZZZ 50.5864876 C 3.37 1.75 1.75 0.47 ZZZ 50.5864885 C 17.50 11.63 11.63 1.63 090 50.5864886 C 20.72 13.58 13.58 2.08 090 50.5864890 C 15.13 10.02 10.02 2.29 090 50.5864891 C 16.12 7.60 7.60 1.63 090 50.5864892 C 14.63 8.89 8.89 2.47 090 50.5864893 C 15.58 9.89 9.89 2.61 090 50.5864895 C 19.22 9.68 9.68 2.57 090 50.5864896 C 20.46 11.01 11.01 3.16 090 50.5864897 C 18.21 10.72 10.72 2.54 090 50.5864898 C 19.47 11.82 11.82 2.77 090 50.5864901 C 10.20 5.28 5.28 1.37 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
64902 C 11.81 5.98 5.98 1.55 ZZZ 50.5864905 C 14.00 8.51 8.51 2.00 090 50.5864907 C 18.80 12.56 12.56 3.16 090 50.5864999 S 0.00 0.00 0.00 0.00 YYY 0.0065091 C 6.45 8.37 8.37 0.32 090 50.5865093 C 6.86 8.74 8.74 0.34 090 50.5865101 C 7.02 9.55 9.55 0.35 090 50.5865103 C 7.56 9.76 9.76 0.37 090 50.5865105 C 8.48 10.49 10.49 0.42 090 50.5865110 C 13.93 13.71 13.71 0.81 090 50.5865112 C 16.36 16.18 16.18 1.30 090 50.5865114 C 17.50 16.39 16.39 1.02 090 50.5865125 C 3.12 8.83 3.61 0.19 090 50.5865130 C 7.14 9.19 9.19 0.35 090 50.5865135 C 7.32 9.34 9.34 0.36 090 50.5865140 C 8.01 9.90 9.90 0.40 090 50.5865150 C 6.25 7.99 7.99 0.31 090 50.5865155 C 8.65 10.51 10.51 0.50 090 50.5865175 C 6.27 8.50 8.50 0.31 090 50.5865205 C 0.71 0.64 0.29 0.03 000 50.5865210 C 0.84 0.81 0.38 0.04 000 50.5865220 C 0.71 0.64 0.28 0.05 000 50.5865222 C 0.93 0.89 0.38 0.04 000 50.5865235 C 7.56 6.76 6.76 0.37 090 50.5865260 C 10.94 9.68 9.68 0.57 090 50.5865265 C 12.57 10.65 10.65 0.62 090 50.5865270 C 1.90 5.24 1.39 0.09 010 50.5865272 C 3.81 7.73 3.30 0.19 090 50.5865273 C 4.35 3.59 3.59 0.22 090 50.5865275 C 5.33 6.33 3.95 0.26 090 50.5865280 C 7.65 6.25 6.25 0.38 090 50.5865285 C 12.88 9.24 9.24 0.64 090 50.5865286 C 5.50 11.17 4.63 0.27 090 50.5865290 C 5.40 4.75 4.75 0.31 090 50.5865400 C 6.05 8.35 6.14 0.30 090 50.5865410 C 1.47 2.12 0.97 0.07 000 50.5865420 C 4.16 8.88 4.45 0.21 090 50.5865426 C 5.24 10.20 4.93 0.25 090 50.5865430 C 1.47 1.29 0.98 0.07 000 50.5865435 C 0.92 1.00 0.71 0.04 000 50.5865436 C 4.18 4.10 3.68 0.21 090 50.5865450 C 3.27 4.08 3.95 0.16 090 50.5865600 C 3.39 5.02 3.36 0.17 090 50.5865710 C 12.33 11.23 11.23 0.61 090 50.5865730 C 14.23 12.05 12.05 0.70 090 50.5865750 C 14.98 12.00 12.00 0.74 090 50.5865755 C 14.87 11.92 11.92 0.73 090 50.5865760 C 0.00 0.00 0.00 0.00 XXX 0.0065765 C 0.00 0.00 0.00 0.00 XXX 0.0065767 C 0.00 0.00 0.00 0.00 XXX 0.0065770 C 17.53 13.24 13.24 0.87 090 50.5865771 C 0.00 0.00 0.00 0.00 XXX 0.0065772 C 4.28 5.55 4.14 0.21 090 50.5865775 C 5.78 5.97 5.97 0.28 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
65780 C 10.23 10.32 10.32 0.44 090 50.5865781 C 17.64 13.71 13.71 0.44 090 50.5865782 C 14.98 12.02 12.02 0.44 090 50.5865800 C 1.91 1.80 1.18 0.09 000 50.5865805 C 1.91 2.18 1.19 0.09 000 50.5865810 C 4.86 4.71 4.71 0.24 090 50.5865815 C 5.04 10.03 4.82 0.25 090 50.5865820 C 8.12 9.08 9.08 0.40 090 50.5865850 C 10.50 8.46 8.46 0.52 090 50.5865855 C 3.84 4.32 3.11 0.19 010 50.5865860 C 3.54 4.05 2.51 0.18 090 50.5865865 C 5.59 5.64 5.64 0.28 090 50.5865870 C 6.26 6.43 6.43 0.31 090 50.5865875 C 6.53 6.81 6.81 0.32 090 50.5865880 C 7.08 7.05 7.05 0.35 090 50.5865900 C 10.91 10.28 10.28 0.54 090 50.5865920 C 8.39 8.19 8.19 0.41 090 50.5865930 C 7.43 6.85 6.85 0.37 090 50.5866020 C 1.59 3.13 1.44 0.08 010 50.5866030 C 1.25 2.97 1.28 0.06 010 50.5866130 C 7.68 9.65 5.63 0.38 090 50.5866150 C 8.29 9.43 9.43 0.46 090 50.5866155 C 8.28 9.38 9.38 0.41 090 50.5866160 C 10.15 10.22 10.22 0.50 090 50.5866165 C 8.00 9.27 9.27 0.40 090 50.5866170 C 12.14 12.26 12.26 0.60 090 50.5866172 C 15.02 15.24 15.24 0.74 090 50.5866180 C 14.53 10.79 10.79 0.71 090 50.5866185 C 8.13 7.40 7.40 0.40 090 50.5866220 C 7.76 7.12 7.12 0.40 090 50.5866225 C 11.03 8.76 8.76 0.55 090 50.5866250 C 5.97 11.72 5.50 0.30 090 50.5866500 C 3.70 4.65 4.65 0.18 090 50.5866505 C 4.07 5.00 5.00 0.20 090 50.5866600 C 8.67 8.24 8.24 0.43 090 50.5866605 C 12.77 10.05 10.05 0.77 090 50.5866625 C 5.12 4.74 4.74 0.26 090 50.5866630 C 6.15 5.73 5.73 0.31 090 50.5866635 C 6.24 5.76 5.76 0.31 090 50.5866680 C 5.43 5.29 5.29 0.27 090 50.5866682 C 6.20 6.63 6.63 0.31 090 50.5866700 C 4.77 5.26 3.94 0.24 090 50.5866710 C 4.77 5.18 3.85 0.23 090 50.5866711 C 6.60 6.49 6.49 0.30 090 50.5866720 C 4.77 5.81 4.73 0.26 090 50.5866740 C 4.77 5.10 3.98 0.23 090 50.5866761 C 4.06 5.61 4.32 0.20 090 50.5866762 C 4.57 5.67 4.30 0.23 090 50.5866770 C 5.17 6.10 4.81 0.26 090 50.5866820 C 3.88 5.83 5.83 0.19 090 50.5866821 C 2.35 4.10 3.63 0.11 090 50.5866825 C 8.22 9.09 9.09 0.40 090 50.5866830 C 8.19 6.97 6.97 0.36 090 50.5866840 C 7.90 6.88 6.88 0.39 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
66850 C 9.10 7.66 7.66 0.45 090 50.5866852 C 9.96 8.12 8.12 0.49 090 50.5866920 C 8.85 7.32 7.32 0.44 090 50.5866930 C 10.16 8.16 8.16 0.49 090 50.5866940 C 8.92 7.62 7.62 0.43 090 50.5866982 C 13.48 9.89 9.89 0.63 090 50.5866983 C 8.98 6.13 6.13 0.14 090 50.5866984 C 10.21 7.44 7.44 0.39 090 50.5866985 C 8.38 7.47 7.47 0.36 090 50.5866986 C 12.26 9.20 9.20 0.60 090 50.5866990 C 1.51 0.69 0.69 0.07 ZZZ 50.5866999 S 0.00 0.00 0.00 0.00 YYY 0.0067005 C 5.69 4.87 4.87 0.28 090 50.5867010 C 6.86 5.43 5.43 0.34 090 50.5867015 C 6.91 6.47 6.47 0.34 090 50.5867025 C 6.83 9.25 6.24 0.34 090 50.5867027 C 10.83 8.02 8.02 0.54 090 50.5867028 C 2.52 2.71 1.46 0.12 000 50.5867030 C 4.83 5.87 5.87 0.24 090 50.5867031 C 3.66 4.61 3.65 0.18 090 50.5867036 C 11.87 9.15 9.15 0.58 090 50.5867038 C 21.21 15.53 15.53 1.04 090 50.5867039 C 14.50 12.22 12.22 0.71 090 50.5867040 C 17.20 13.72 13.72 0.85 090 50.5867101 C 7.52 9.15 6.55 0.37 090 50.5867105 C 7.40 8.10 6.17 0.37 090 50.5867107 C 14.82 11.33 11.33 0.73 090 50.5867108 C 20.79 14.46 14.46 1.02 090 50.5867110 C 8.80 10.26 7.41 0.44 090 50.5867112 C 16.83 11.84 11.84 0.83 090 50.5867115 C 4.98 5.09 5.09 0.25 090 50.5867120 C 5.97 8.60 5.55 0.29 090 50.5867121 C 10.65 8.55 8.55 0.53 090 50.5867141 C 5.19 5.87 4.87 0.26 090 50.5867145 C 5.36 5.74 4.94 0.27 090 50.5867208 C 6.69 6.14 5.53 0.33 090 50.5867210 C 8.81 6.59 5.90 0.44 090 50.5867218 C 18.50 12.19 12.19 0.92 090 50.5867220 C 13.11 10.45 9.04 0.65 090 50.5867221 C 4.00 4.34 1.81 0.20 000 50.5867225 C 0.47 0.25 0.21 0.02 ZZZ 50.5867227 C 6.57 6.60 5.54 0.33 090 50.5867228 C 12.72 11.51 8.56 0.63 090 50.5867250 C 8.65 9.20 9.20 0.47 090 50.5867255 C 8.89 9.92 9.92 0.44 090 50.5867299 S 0.00 0.00 0.00 0.00 YYY 0.0067311 C 6.64 6.04 6.04 0.37 090 50.5867312 C 8.53 6.77 6.77 0.43 090 50.5867314 C 7.51 6.57 6.57 0.39 090 50.5867316 C 9.65 7.52 7.52 0.49 090 50.5867318 C 7.84 6.95 6.95 0.41 090 50.5867320 C 4.32 1.96 1.96 0.22 ZZZ 50.5867331 C 4.05 1.84 1.84 0.21 ZZZ 50.5867332 C 4.48 2.03 2.03 0.23 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
67334 C 3.97 1.80 1.80 0.20 ZZZ 50.5867335 C 2.49 1.12 1.12 0.13 ZZZ 50.5867340 C 4.92 2.21 2.21 0.25 ZZZ 50.5867343 C 7.34 6.53 6.53 0.37 090 50.5867345 C 2.96 2.59 2.02 0.17 010 50.5867350 C 2.87 1.88 1.88 0.15 000 50.5867399 S 0.00 0.00 0.00 0.00 YYY 0.0067400 C 9.75 11.29 11.29 0.56 090 50.5867405 C 7.92 9.80 9.80 0.44 090 50.5867412 C 9.49 10.96 10.96 0.48 090 50.5867413 C 9.99 10.80 10.80 0.50 090 50.5867414 C 11.11 12.07 12.07 0.65 090 50.5867415 C 1.76 0.76 0.76 0.09 000 50.5867420 C 20.03 17.44 17.44 1.15 090 50.5867430 C 13.37 14.93 14.93 0.86 090 50.5867440 C 13.07 14.30 14.30 0.70 090 50.5867445 C 14.40 13.95 13.95 0.90 090 50.5867450 C 13.49 14.73 14.73 0.68 090 50.5867500 C 0.79 0.67 0.29 0.05 000 50.5867505 C 0.82 0.69 0.31 0.05 000 50.5867515 C 0.61 0.59 0.38 0.03 000 50.5867550 C 10.17 11.33 11.33 0.72 090 50.5867560 C 10.58 11.40 11.40 0.60 090 50.5867570 C 13.56 13.62 13.62 0.68 090 50.5867599 S 0.00 0.00 0.00 0.00 YYY 0.0067700 C 1.35 6.04 1.27 0.07 010 50.5867710 C 1.02 5.39 1.21 0.05 010 50.5867715 C 1.22 5.39 1.29 0.06 010 50.5867800 C 1.38 1.62 1.04 0.07 010 50.5867801 C 1.88 1.97 1.26 0.09 010 50.5867805 C 2.22 2.53 1.65 0.11 010 50.5867808 C 3.79 3.78 3.78 0.19 090 50.5867810 C 1.48 3.34 0.68 0.06 000 50.5867820 C 0.89 0.60 0.56 0.04 000 50.5867825 C 1.38 1.74 1.41 0.07 010 50.5867830 C 1.70 5.55 1.50 0.08 010 50.5867835 C 5.55 4.63 4.63 0.28 090 50.5867840 C 2.04 5.49 1.65 0.10 010 50.5867850 C 1.69 3.38 1.47 0.07 010 50.5867875 C 1.35 3.31 0.94 0.07 000 50.5867880 C 3.79 6.63 3.81 0.19 090 50.5867882 C 5.06 7.65 4.82 0.25 090 50.5867900 C 6.13 9.09 5.27 0.38 090 50.5867901 C 7.39 5.42 5.42 0.54 090 50.5867902 C 9.35 5.48 5.48 0.60 090 50.5867903 C 6.36 9.59 5.53 0.47 090 50.5867904 C 6.25 9.66 5.25 0.41 090 50.5867906 C 6.78 5.39 5.04 0.46 090 50.5867908 C 5.12 6.65 5.36 0.28 090 50.5867909 C 5.39 8.05 4.96 0.31 090 50.5867911 C 5.26 4.79 4.79 0.31 090 50.5867912 C 5.67 18.98 5.55 0.28 090 50.5867914 C 3.67 6.36 3.06 0.19 090 50.5867915 C 3.18 6.00 2.81 0.16 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
67916 C 5.30 8.07 4.77 0.28 090 50.5867917 C 6.01 8.48 5.08 0.36 090 50.5867921 C 3.39 6.21 2.90 0.17 090 50.5867922 C 3.06 5.93 2.76 0.15 090 50.5867923 C 5.87 8.14 4.98 0.30 090 50.5867924 C 5.78 8.95 4.69 0.30 090 50.5867930 C 3.60 5.73 2.18 0.19 010 50.5867935 C 6.21 8.54 4.42 0.39 090 50.5867938 C 1.33 5.40 1.26 0.06 010 50.5867950 C 5.81 8.66 5.23 0.36 090 50.5867961 C 5.68 8.71 5.04 0.33 090 50.5867966 C 6.56 9.16 5.58 0.37 090 50.5867971 C 9.78 7.30 7.30 0.53 090 50.5867973 C 12.85 9.34 9.34 0.75 090 50.5867974 C 12.82 9.26 9.26 0.75 090 50.5867975 C 9.12 6.97 6.97 0.50 090 50.5867999 S 0.00 0.00 0.00 0.00 YYY 0.0068020 C 1.37 1.41 1.21 0.06 010 50.5868040 C 0.85 0.71 0.43 0.04 000 50.5868100 C 1.35 3.26 0.95 0.07 000 50.5868110 C 1.77 4.11 1.65 0.09 010 50.5868115 C 2.36 5.98 1.92 0.12 010 50.5868130 C 4.92 8.74 4.61 0.24 090 50.5868135 C 1.84 1.82 1.65 0.09 010 50.5868200 C 0.49 0.54 0.33 0.02 000 50.5868320 C 5.36 11.31 5.54 0.27 090 50.5868325 C 7.35 6.56 6.56 0.44 090 50.5868326 C 7.14 6.43 6.43 0.35 090 50.5868328 C 8.17 7.31 7.31 0.54 090 50.5868330 C 4.82 9.44 4.73 0.24 090 50.5868335 C 7.18 6.40 6.40 0.36 090 50.5868340 C 4.16 8.90 4.11 0.21 090 50.5868360 C 4.36 8.06 4.19 0.22 090 50.5868362 C 7.33 6.42 6.42 0.36 090 50.5868371 C 4.89 4.74 4.74 0.44 010 50.5868399 S 0.00 0.00 0.00 0.00 YYY 0.0068400 C 1.69 5.92 1.83 0.08 010 50.5868420 C 2.30 6.21 2.11 0.11 010 50.5868440 C 0.94 2.09 1.27 0.05 010 50.5868500 C 11.00 9.76 9.76 0.55 090 50.5868505 C 10.92 10.68 10.68 0.55 090 50.5868510 C 4.60 7.35 2.10 0.23 000 50.5868520 C 7.50 7.44 7.44 0.37 090 50.5868525 C 4.42 2.03 2.03 0.22 000 50.5868530 C 3.65 8.19 2.65 0.18 010 50.5868540 C 10.58 9.42 9.42 0.52 090 50.5868550 C 13.24 11.38 11.38 0.80 090 50.5868700 C 6.59 6.00 6.00 0.32 090 50.5868705 C 2.06 4.18 1.80 0.10 010 50.5868720 C 8.95 7.88 7.88 0.44 090 50.5868745 C 8.62 7.88 7.88 0.52 090 50.5868750 C 8.65 8.29 8.29 0.43 090 50.5868760 C 1.73 3.55 1.63 0.09 010 50.5868761 C 1.36 2.28 1.32 0.06 010 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
68770 C 7.01 3.19 3.19 0.35 090 50.5868801 C 0.94 1.95 1.48 0.05 010 50.5868810 C 1.90 3.67 2.68 0.10 010 50.5868811 C 2.35 2.42 2.42 0.13 010 50.5868815 C 3.20 8.26 2.82 0.17 010 50.5868840 C 1.25 1.60 1.12 0.06 010 50.5868850 C 0.80 0.88 0.68 0.04 000 50.5868899 S 0.00 0.00 0.00 0.00 YYY 0.0069000 C 1.45 2.89 1.36 0.12 010 50.5869005 C 2.11 2.94 1.84 0.17 010 50.5869020 C 1.48 4.00 2.07 0.12 010 50.5869090 D 0.00 0.00 0.00 0.00 XXX 0.0069100 C 0.81 1.71 0.39 0.03 000 50.5869105 C 0.85 2.35 0.77 0.07 000 50.5869110 C 3.43 6.76 4.48 0.30 090 50.5869120 C 4.04 6.20 6.20 0.38 090 50.5869140 C 7.96 13.32 13.32 0.65 090 50.5869145 C 2.62 5.80 3.31 0.21 090 50.5869150 C 13.41 13.44 13.44 1.22 090 50.5869155 C 20.77 19.60 19.60 1.92 090 50.5869200 C 0.77 2.39 0.55 0.06 000 50.5869205 C 1.20 1.36 1.36 0.10 010 50.5869210 C 0.61 0.63 0.23 0.05 000 50.5869220 C 0.83 2.37 0.73 0.07 000 50.5869222 C 1.40 3.86 2.07 0.12 010 50.5869300 C 6.35 4.23 4.23 0.72 YYY 50.5869310 C 10.77 16.33 16.33 0.85 090 50.5869320 C 16.93 21.90 21.90 1.37 090 50.5869399 S 0.00 0.00 0.00 0.00 YYY 0.0069400 C 0.83 2.17 0.67 0.07 000 50.5869401 C 0.63 1.24 0.65 0.05 000 50.5869405 C 2.63 3.51 2.32 0.21 010 50.5869410 C 0.33 2.10 0.48 0.03 000 50.58 12/31/200569420 C 1.33 3.16 1.59 0.11 010 50.5869421 C 1.73 2.17 2.17 0.15 010 50.5869424 C 0.85 2.19 0.68 0.07 000 50.5869433 C 1.52 3.10 1.64 0.13 010 50.5869436 C 1.96 2.30 2.30 0.19 010 50.5869440 C 7.56 8.80 8.80 0.61 090 50.5869450 C 5.56 7.05 7.05 0.45 090 50.5869501 C 9.06 9.03 9.03 0.73 090 50.5869502 C 12.36 11.62 11.62 1.00 090 50.5869505 C 12.97 17.24 17.24 1.05 090 50.5869511 C 13.50 17.52 17.52 1.09 090 50.5869530 C 19.16 21.69 21.69 1.54 090 50.5869535 C 36.09 32.05 32.05 2.92 090 50.5869540 C 1.20 3.75 1.98 0.10 010 50.5869550 C 10.97 14.90 14.90 0.89 090 50.5869552 C 19.43 20.73 20.73 1.59 090 50.5869554 C 33.11 30.42 30.42 2.91 090 50.5869601 C 13.22 12.71 12.71 1.07 090 50.5869602 C 13.56 13.27 13.27 1.10 090 50.5869603 C 14.00 18.41 18.41 1.14 090 50.5869604 C 14.00 13.73 13.73 1.14 090 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
69605 C 18.46 21.01 21.01 1.50 090 50.5869610 C 4.42 5.57 3.28 0.36 010 50.5869620 C 5.88 11.15 6.31 0.48 090 50.5869631 C 9.85 11.23 11.23 0.80 090 50.5869632 C 12.73 13.51 13.51 1.03 090 50.5869633 C 12.08 13.09 13.09 0.98 090 50.5869635 C 13.31 16.79 16.79 1.08 090 50.5869636 C 15.20 19.36 19.36 1.23 090 50.5869637 C 15.09 19.28 19.28 1.22 090 50.5869641 C 12.69 12.82 12.82 1.03 090 50.5869642 C 16.81 16.33 16.33 1.36 090 50.5869643 C 15.30 14.86 14.86 1.24 090 50.5869644 C 16.94 20.46 20.46 1.37 090 50.5869645 C 16.36 20.08 20.08 1.33 090 50.5869646 C 17.96 20.82 20.82 1.46 090 50.5869650 C 9.65 9.94 9.94 0.78 090 50.5869660 C 11.88 11.21 11.21 0.96 090 50.5869661 C 15.72 14.74 14.74 1.27 090 50.5869662 C 15.42 13.79 13.79 1.25 090 50.5869666 C 9.74 10.00 10.00 0.79 090 50.5869667 C 9.75 10.01 10.01 0.79 090 50.5869670 C 11.49 11.74 11.74 0.93 090 50.5869676 C 9.51 10.78 10.78 0.81 090 50.5869700 C 8.22 9.27 9.27 0.67 090 50.5869710 C 0.00 0.00 0.00 0.00 XXX 0.0069711 C 10.42 10.82 10.82 0.83 090 50.5869714 C 13.98 12.70 12.70 1.13 090 50.5869715 C 18.22 15.07 15.07 1.48 090 50.5869717 C 14.96 14.51 14.51 0.90 090 50.5869718 C 18.47 15.34 15.34 3.21 090 50.5869720 C 14.36 14.56 14.56 1.16 090 50.5869725 C 25.34 20.19 20.19 2.44 090 50.5869740 C 15.94 13.45 13.45 1.27 090 50.5869745 C 16.66 15.01 15.01 1.14 090 50.5869799 S 0.00 0.00 0.00 0.00 YYY 0.0069801 C 8.55 9.49 9.49 0.69 090 50.5869802 C 13.08 12.36 12.36 1.06 090 50.5869805 C 13.80 11.91 11.91 1.12 090 50.5869806 C 12.33 11.07 11.07 1.00 090 50.5869820 C 10.32 11.25 11.25 0.90 090 50.5869840 C 10.24 13.21 13.21 0.79 090 50.5869905 C 11.08 11.38 11.38 0.90 090 50.5869910 C 13.61 11.95 11.95 1.07 090 50.5869915 C 21.20 16.51 16.51 1.69 090 50.5869930 C 16.78 14.79 14.79 1.36 090 50.5869949 S 0.00 0.00 0.00 0.00 YYY 0.0069950 C 25.60 18.95 18.95 2.28 090 50.5869955 C 27.00 21.44 21.44 2.48 090 50.5869960 C 27.00 20.11 20.11 2.17 090 50.5869970 C 29.99 23.34 23.34 2.41 090 50.5869979 S 0.00 0.00 0.00 0.00 YYY 0.0069990 C 3.46 1.80 1.80 0.89 ZZZ 50.5870010 C 1.19 4.73 4.73 0.27 XXX 50.5870010 C TC 0.00 4.34 4.34 0.22 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
70010 C 26 1.19 0.39 0.39 0.05 XXX 50.5870015 C 1.19 1.74 1.74 0.16 XXX 50.5870015 C TC 0.00 1.35 1.35 0.08 XXX 50.5870015 C 26 1.19 0.39 0.39 0.08 XXX 50.5870030 C 0.17 0.48 0.48 0.03 XXX 50.5870030 C TC 0.00 0.42 0.42 0.02 XXX 50.5870030 C 26 0.17 0.06 0.06 0.01 XXX 50.5870100 C 0.18 0.58 0.58 0.03 XXX 50.5870100 C TC 0.00 0.52 0.52 0.02 XXX 50.5870100 C 26 0.18 0.06 0.06 0.01 XXX 50.5870110 C 0.25 0.70 0.70 0.05 XXX 50.5870110 C TC 0.00 0.62 0.62 0.04 XXX 50.5870110 C 26 0.25 0.08 0.08 0.01 XXX 50.5870120 C 0.18 0.68 0.68 0.05 XXX 50.5870120 C TC 0.00 0.62 0.62 0.04 XXX 50.5870120 C 26 0.18 0.06 0.06 0.01 XXX 50.5870130 C 0.34 0.89 0.89 0.07 XXX 50.5870130 C TC 0.00 0.78 0.78 0.05 XXX 50.5870130 C 26 0.34 0.11 0.11 0.02 XXX 50.5870134 C 0.34 0.84 0.84 0.07 XXX 50.5870134 C TC 0.00 0.73 0.73 0.05 XXX 50.5870134 C 26 0.34 0.11 0.11 0.02 XXX 50.5870140 C 0.19 0.68 0.68 0.05 XXX 50.5870140 C TC 0.00 0.62 0.62 0.04 XXX 50.5870140 C 26 0.19 0.06 0.06 0.01 XXX 50.5870150 C 0.26 0.86 0.86 0.06 XXX 50.5870150 C TC 0.00 0.78 0.78 0.05 XXX 50.5870150 C 26 0.26 0.08 0.08 0.01 XXX 50.5870160 C 0.17 0.58 0.58 0.03 XXX 50.5870160 C TC 0.00 0.52 0.52 0.02 XXX 50.5870160 C 26 0.17 0.06 0.06 0.01 XXX 50.5870170 C 0.30 1.05 1.05 0.07 XXX 50.5870170 C TC 0.00 0.95 0.95 0.06 XXX 50.5870170 C 26 0.30 0.10 0.10 0.01 XXX 50.5870190 C 0.21 0.69 0.69 0.05 XXX 50.5870190 C TC 0.00 0.62 0.62 0.04 XXX 50.5870190 C 26 0.21 0.07 0.07 0.01 XXX 50.5870200 C 0.28 0.87 0.87 0.06 XXX 50.5870200 C TC 0.00 0.78 0.78 0.05 XXX 50.5870200 C 26 0.28 0.09 0.09 0.01 XXX 50.5870210 C 0.17 0.68 0.68 0.05 XXX 50.5870210 C TC 0.00 0.62 0.62 0.04 XXX 50.5870210 C 26 0.17 0.06 0.06 0.01 XXX 50.5870220 C 0.25 0.86 0.86 0.06 XXX 50.5870220 C TC 0.00 0.78 0.78 0.05 XXX 50.5870220 C 26 0.25 0.08 0.08 0.01 XXX 50.5870240 C 0.19 0.48 0.48 0.03 XXX 50.5870240 C TC 0.00 0.42 0.42 0.02 XXX 50.5870240 C 26 0.19 0.06 0.06 0.01 XXX 50.5870250 C 0.24 0.70 0.70 0.05 XXX 50.5870250 C TC 0.00 0.62 0.62 0.04 XXX 50.5870250 C 26 0.24 0.08 0.08 0.01 XXX 50.5870260 C 0.34 1.00 1.00 0.08 XXX 50.5870260 C TC 0.00 0.89 0.89 0.06 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
70260 C 26 0.34 0.11 0.11 0.02 XXX 50.5870300 C 0.10 0.31 0.31 0.03 XXX 50.5870300 C TC 0.00 0.26 0.26 0.02 XXX 50.5870300 C 26 0.10 0.05 0.05 0.01 XXX 50.5870310 C 0.16 0.50 0.50 0.03 XXX 50.5870310 C TC 0.00 0.42 0.42 0.02 XXX 50.5870310 C 26 0.16 0.08 0.08 0.01 XXX 50.5870320 C 0.22 0.86 0.86 0.06 XXX 50.5870320 C TC 0.00 0.78 0.78 0.05 XXX 50.5870320 C 26 0.22 0.08 0.08 0.01 XXX 50.5870328 C 0.18 0.55 0.55 0.03 XXX 50.5870328 C TC 0.00 0.49 0.49 0.02 XXX 50.5870328 C 26 0.18 0.06 0.06 0.01 XXX 50.5870330 C 0.24 0.92 0.92 0.06 XXX 50.5870330 C TC 0.00 0.84 0.84 0.05 XXX 50.5870330 C 26 0.24 0.08 0.08 0.01 XXX 50.5870332 C 0.54 2.31 2.31 0.14 XXX 50.5870332 C TC 0.00 2.11 2.11 0.12 XXX 50.5870332 C 26 0.54 0.20 0.20 0.02 XXX 50.5870336 C 1.48 11.72 11.72 0.66 XXX 50.5870336 C TC 0.00 11.23 11.23 0.59 XXX 50.5870336 C 26 1.48 0.49 0.49 0.07 XXX 50.5870350 C 0.17 0.45 0.45 0.03 XXX 50.5870350 C TC 0.00 0.38 0.38 0.02 XXX 50.5870350 C 26 0.17 0.07 0.07 0.01 XXX 50.5870355 C 0.20 0.64 0.64 0.05 XXX 50.5870355 C TC 0.00 0.57 0.57 0.04 XXX 50.5870355 C 26 0.20 0.07 0.07 0.01 XXX 50.5870360 C 0.17 0.48 0.48 0.03 XXX 50.5870360 C TC 0.00 0.42 0.42 0.02 XXX 50.5870360 C 26 0.17 0.06 0.06 0.01 XXX 50.5870370 C 0.32 1.41 1.41 0.08 XXX 50.5870370 C TC 0.00 1.31 1.31 0.07 XXX 50.5870370 C 26 0.32 0.10 0.10 0.01 XXX 50.5870371 C 0.84 2.39 2.39 0.16 XXX 50.5870371 C TC 0.00 2.11 2.11 0.12 XXX 50.5870371 C 26 0.84 0.28 0.28 0.04 XXX 50.5870373 C 0.44 1.93 1.93 0.13 XXX 50.5870373 C TC 0.00 1.79 1.79 0.11 XXX 50.5870373 C 26 0.44 0.14 0.14 0.02 XXX 50.5870380 C 0.17 0.73 0.73 0.05 XXX 50.5870380 C TC 0.00 0.67 0.67 0.04 XXX 50.5870380 C 26 0.17 0.06 0.06 0.01 XXX 50.5870390 C 0.38 1.91 1.91 0.13 XXX 50.5870390 C TC 0.00 1.79 1.79 0.11 XXX 50.5870390 C 26 0.38 0.12 0.12 0.02 XXX 50.5870450 C 0.85 5.01 5.01 0.29 XXX 50.5870450 C TC 0.00 4.73 4.73 0.25 XXX 50.5870450 C 26 0.85 0.28 0.28 0.04 XXX 50.5870460 C 1.13 6.05 6.05 0.35 XXX 50.5870460 C TC 0.00 5.68 5.68 0.30 XXX 50.5870460 C 26 1.13 0.37 0.37 0.05 XXX 50.5870470 C 1.27 7.51 7.51 0.43 XXX 50.5870470 C TC 0.00 7.09 7.09 0.37 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
70470 C 26 1.27 0.42 0.42 0.06 XXX 50.5870480 C 1.28 5.15 5.15 0.31 XXX 50.5870480 C TC 0.00 4.73 4.73 0.25 XXX 50.5870480 C 26 1.28 0.42 0.42 0.06 XXX 50.5870481 C 1.38 6.13 6.13 0.36 XXX 50.5870481 C TC 0.00 5.68 5.68 0.30 XXX 50.5870481 C 26 1.38 0.45 0.45 0.06 XXX 50.5870482 C 1.45 7.57 7.57 0.43 XXX 50.5870482 C TC 0.00 7.09 7.09 0.37 XXX 50.5870482 C 26 1.45 0.48 0.48 0.06 XXX 50.5870486 C 1.14 5.10 5.10 0.30 XXX 50.5870486 C TC 0.00 4.73 4.73 0.25 XXX 50.5870486 C 26 1.14 0.37 0.37 0.05 XXX 50.5870487 C 1.30 6.11 6.11 0.36 XXX 50.5870487 C TC 0.00 5.68 5.68 0.30 XXX 50.5870487 C 26 1.30 0.43 0.43 0.06 XXX 50.5870488 C 1.42 7.55 7.55 0.43 XXX 50.5870488 C TC 0.00 7.09 7.09 0.37 XXX 50.5870488 C 26 1.42 0.46 0.46 0.06 XXX 50.5870490 C 1.28 5.15 5.15 0.31 XXX 50.5870490 C TC 0.00 4.73 4.73 0.25 XXX 50.5870490 C 26 1.28 0.42 0.42 0.06 XXX 50.5870491 C 1.38 6.13 6.13 0.36 XXX 50.5870491 C TC 0.00 5.68 5.68 0.30 XXX 50.5870491 C 26 1.38 0.45 0.45 0.06 XXX 50.5870492 C 1.45 7.56 7.56 0.43 XXX 50.5870492 C TC 0.00 7.09 7.09 0.37 XXX 50.5870492 C 26 1.45 0.47 0.47 0.06 XXX 50.5870496 C 1.75 11.20 11.20 0.66 XXX 50.5870496 C TC 0.00 10.63 10.63 0.58 XXX 50.5870496 C 26 1.75 0.57 0.57 0.08 XXX 50.5870498 C 1.75 11.20 11.20 0.66 XXX 50.5870498 C TC 0.00 10.63 10.63 0.58 XXX 50.5870498 C 26 1.75 0.57 0.57 0.08 XXX 50.5870540 C 1.35 11.67 11.67 0.45 XXX 50.5870540 C TC 0.00 11.23 11.23 0.39 XXX 50.5870540 C 26 1.35 0.44 0.44 0.06 XXX 50.5870542 C 1.62 14.01 14.01 0.54 XXX 50.5870542 C TC 0.00 13.48 13.48 0.47 XXX 50.5870542 C 26 1.62 0.53 0.53 0.07 XXX 50.5870543 C 2.15 25.66 25.66 0.94 XXX 50.5870543 C TC 0.00 24.95 24.95 0.84 XXX 50.5870543 C 26 2.15 0.71 0.71 0.10 XXX 50.5870544 C 1.20 11.63 11.63 0.64 XXX 50.5870544 C TC 0.00 11.23 11.23 0.59 XXX 50.5870544 C 26 1.20 0.40 0.40 0.05 XXX 50.5870545 C 1.20 11.62 11.62 0.64 XXX 50.5870545 C TC 0.00 11.23 11.23 0.59 XXX 50.5870545 C 26 1.20 0.39 0.39 0.05 XXX 50.5870546 C 1.80 23.06 23.06 0.67 XXX 50.5870546 C TC 0.00 22.47 22.47 0.59 XXX 50.5870546 C 26 1.80 0.59 0.59 0.08 XXX 50.5870547 C 1.20 11.62 11.62 0.64 XXX 50.5870547 C TC 0.00 11.23 11.23 0.59 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
70547 C 26 1.20 0.39 0.39 0.05 XXX 50.5870548 C 1.20 11.62 11.62 0.64 XXX 50.5870548 C TC 0.00 11.23 11.23 0.59 XXX 50.5870548 C 26 1.20 0.39 0.39 0.05 XXX 50.5870549 C 1.80 23.06 23.06 0.67 XXX 50.5870549 C TC 0.00 22.47 22.47 0.59 XXX 50.5870549 C 26 1.80 0.59 0.59 0.08 XXX 50.5870551 C 1.48 11.72 11.72 0.66 XXX 50.5870551 C TC 0.00 11.23 11.23 0.59 XXX 50.5870551 C 26 1.48 0.49 0.49 0.07 XXX 50.5870552 C 1.78 14.07 14.07 0.78 XXX 50.5870552 C TC 0.00 13.48 13.48 0.70 XXX 50.5870552 C 26 1.78 0.59 0.59 0.08 XXX 50.5870553 C 2.36 25.73 25.73 1.41 XXX 50.5870553 C TC 0.00 24.95 24.95 1.31 XXX 50.5870553 C 26 2.36 0.78 0.78 0.10 XXX 50.5870557 C 0.00 0.00 0.00 0.00 XXX 0.0070557 C TC 0.00 0.00 0.00 0.00 XXX 0.0070557 C 26 2.90 1.13 1.13 0.08 XXX 50.5870558 C 0.00 0.00 0.00 0.00 XXX 0.0070558 C TC 0.00 0.00 0.00 0.00 XXX 0.0070558 C 26 3.20 1.24 1.24 0.10 XXX 50.5870559 C 0.00 0.00 0.00 0.00 XXX 0.0070559 C TC 0.00 0.00 0.00 0.00 XXX 0.0070559 C 26 3.20 1.24 1.24 0.12 XXX 50.5871010 C 0.18 0.53 0.53 0.03 XXX 50.5871010 C TC 0.00 0.47 0.47 0.02 XXX 50.5871010 C 26 0.18 0.06 0.06 0.01 XXX 50.5871015 C 0.21 0.59 0.59 0.03 XXX 50.5871015 C TC 0.00 0.52 0.52 0.02 XXX 50.5871015 C 26 0.21 0.07 0.07 0.01 XXX 50.5871020 C 0.22 0.69 0.69 0.05 XXX 50.5871020 C TC 0.00 0.62 0.62 0.04 XXX 50.5871020 C 26 0.22 0.07 0.07 0.01 XXX 50.5871021 C 0.27 0.82 0.82 0.06 XXX 50.5871021 C TC 0.00 0.73 0.73 0.05 XXX 50.5871021 C 26 0.27 0.09 0.09 0.01 XXX 50.5871022 C 0.31 0.83 0.83 0.06 XXX 50.5871022 C TC 0.00 0.73 0.73 0.05 XXX 50.5871022 C 26 0.31 0.10 0.10 0.01 XXX 50.5871023 C 0.38 0.91 0.91 0.06 XXX 50.5871023 C TC 0.00 0.78 0.78 0.05 XXX 50.5871023 C 26 0.38 0.13 0.13 0.01 XXX 50.5871030 C 0.31 0.88 0.88 0.06 XXX 50.5871030 C TC 0.00 0.78 0.78 0.05 XXX 50.5871030 C 26 0.31 0.10 0.10 0.01 XXX 50.5871034 C 0.46 1.60 1.60 0.10 XXX 50.5871034 C TC 0.00 1.44 1.44 0.08 XXX 50.5871034 C 26 0.46 0.16 0.16 0.02 XXX 50.5871035 C 0.18 0.58 0.58 0.03 XXX 50.5871035 C TC 0.00 0.52 0.52 0.02 XXX 50.5871035 C 26 0.18 0.06 0.06 0.01 XXX 50.5871040 C 0.58 1.65 1.65 0.11 XXX 50.5871040 C TC 0.00 1.46 1.46 0.08 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
71040 C 26 0.58 0.19 0.19 0.03 XXX 50.5871060 C 0.74 2.45 2.45 0.16 XXX 50.5871060 C TC 0.00 2.21 2.21 0.13 XXX 50.5871060 C 26 0.74 0.24 0.24 0.03 XXX 50.5871090 C 0.54 1.89 1.89 0.13 XXX 50.5871090 C TC 0.00 1.68 1.68 0.11 XXX 50.5871090 C 26 0.54 0.21 0.21 0.02 XXX 50.5871100 C 0.22 0.64 0.64 0.05 XXX 50.5871100 C TC 0.00 0.57 0.57 0.04 XXX 50.5871100 C 26 0.22 0.07 0.07 0.01 XXX 50.5871101 C 0.27 0.76 0.76 0.05 XXX 50.5871101 C TC 0.00 0.67 0.67 0.04 XXX 50.5871101 C 26 0.27 0.09 0.09 0.01 XXX 50.5871110 C 0.27 0.87 0.87 0.06 XXX 50.5871110 C TC 0.00 0.78 0.78 0.05 XXX 50.5871110 C 26 0.27 0.09 0.09 0.01 XXX 50.5871111 C 0.32 0.99 0.99 0.07 XXX 50.5871111 C TC 0.00 0.89 0.89 0.06 XXX 50.5871111 C 26 0.32 0.10 0.10 0.01 XXX 50.5871120 C 0.20 0.72 0.72 0.05 XXX 50.5871120 C TC 0.00 0.65 0.65 0.04 XXX 50.5871120 C 26 0.20 0.07 0.07 0.01 XXX 50.5871130 C 0.22 0.78 0.78 0.05 XXX 50.5871130 C TC 0.00 0.71 0.71 0.04 XXX 50.5871130 C 26 0.22 0.07 0.07 0.01 XXX 50.5871250 C 1.16 6.31 6.31 0.36 XXX 50.5871250 C TC 0.00 5.93 5.93 0.31 XXX 50.5871250 C 26 1.16 0.38 0.38 0.05 XXX 50.5871260 C 1.24 7.50 7.50 0.42 XXX 50.5871260 C TC 0.00 7.09 7.09 0.37 XXX 50.5871260 C 26 1.24 0.41 0.41 0.05 XXX 50.5871270 C 1.38 9.33 9.33 0.52 XXX 50.5871270 C TC 0.00 8.88 8.88 0.46 XXX 50.5871270 C 26 1.38 0.45 0.45 0.06 XXX 50.5871275 C 1.92 13.05 13.05 0.48 XXX 50.5871275 C TC 0.00 12.42 12.42 0.39 XXX 50.5871275 C 26 1.92 0.63 0.63 0.09 XXX 50.5871550 C 1.46 11.71 11.71 0.51 XXX 50.5871550 C TC 0.00 11.23 11.23 0.45 XXX 50.5871550 C 26 1.46 0.48 0.48 0.06 XXX 50.5871551 C 1.73 14.05 14.05 0.60 XXX 50.5871551 C TC 0.00 13.48 13.48 0.52 XXX 50.5871551 C 26 1.73 0.57 0.57 0.08 XXX 50.5871552 C 2.26 25.69 25.69 0.78 XXX 50.5871552 C TC 0.00 24.95 24.95 0.68 XXX 50.5871552 C 26 2.26 0.74 0.74 0.10 XXX 50.5871555 C 1.81 11.83 11.83 0.67 XXX 50.5871555 C TC 0.00 11.23 11.23 0.59 XXX 50.5871555 C 26 1.81 0.60 0.60 0.08 XXX 50.5872010 C 0.45 1.17 1.17 0.08 XXX 50.5872010 C TC 0.00 1.02 1.02 0.06 XXX 50.5872010 C 26 0.45 0.15 0.15 0.02 XXX 50.5872020 C 0.15 0.47 0.47 0.03 XXX 50.5872020 C TC 0.00 0.42 0.42 0.02 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
72020 C 26 0.15 0.05 0.05 0.01 XXX 50.5872040 C 0.22 0.67 0.67 0.05 XXX 50.5872040 C TC 0.00 0.60 0.60 0.04 XXX 50.5872040 C 26 0.22 0.07 0.07 0.01 XXX 50.5872050 C 0.31 0.99 0.99 0.07 XXX 50.5872050 C TC 0.00 0.89 0.89 0.06 XXX 50.5872050 C 26 0.31 0.10 0.10 0.01 XXX 50.5872052 C 0.36 1.25 1.25 0.08 XXX 50.5872052 C TC 0.00 1.13 1.13 0.06 XXX 50.5872052 C 26 0.36 0.12 0.12 0.02 XXX 50.5872069 C 0.22 0.57 0.57 0.03 XXX 50.5872069 C TC 0.00 0.49 0.49 0.02 XXX 50.5872069 C 26 0.22 0.08 0.08 0.01 XXX 50.5872070 C 0.22 0.72 0.72 0.05 XXX 50.5872070 C TC 0.00 0.65 0.65 0.04 XXX 50.5872070 C 26 0.22 0.07 0.07 0.01 XXX 50.5872072 C 0.22 0.80 0.80 0.06 XXX 50.5872072 C TC 0.00 0.73 0.73 0.05 XXX 50.5872072 C 26 0.22 0.07 0.07 0.01 XXX 50.5872074 C 0.22 0.98 0.98 0.07 XXX 50.5872074 C TC 0.00 0.91 0.91 0.06 XXX 50.5872074 C 26 0.22 0.07 0.07 0.01 XXX 50.5872080 C 0.22 0.74 0.74 0.05 XXX 50.5872080 C TC 0.00 0.67 0.67 0.04 XXX 50.5872080 C 26 0.22 0.07 0.07 0.01 XXX 50.5872090 C 0.28 0.76 0.76 0.05 XXX 50.5872090 C TC 0.00 0.67 0.67 0.04 XXX 50.5872090 C 26 0.28 0.09 0.09 0.01 XXX 50.5872100 C 0.22 0.74 0.74 0.05 XXX 50.5872100 C TC 0.00 0.67 0.67 0.04 XXX 50.5872100 C 26 0.22 0.07 0.07 0.01 XXX 50.5872110 C 0.31 1.01 1.01 0.07 XXX 50.5872110 C TC 0.00 0.91 0.91 0.06 XXX 50.5872110 C 26 0.31 0.10 0.10 0.01 XXX 50.5872114 C 0.36 1.31 1.31 0.08 XXX 50.5872114 C TC 0.00 1.19 1.19 0.06 XXX 50.5872114 C 26 0.36 0.12 0.12 0.02 XXX 50.5872120 C 0.22 0.96 0.96 0.07 XXX 50.5872120 C TC 0.00 0.89 0.89 0.06 XXX 50.5872120 C 26 0.22 0.07 0.07 0.01 XXX 50.5872125 C 1.16 6.31 6.31 0.36 XXX 50.5872125 C TC 0.00 5.93 5.93 0.31 XXX 50.5872125 C 26 1.16 0.38 0.38 0.05 XXX 50.5872126 C 1.22 7.49 7.49 0.42 XXX 50.5872126 C TC 0.00 7.09 7.09 0.37 XXX 50.5872126 C 26 1.22 0.40 0.40 0.05 XXX 50.5872127 C 1.27 9.30 9.30 0.52 XXX 50.5872127 C TC 0.00 8.88 8.88 0.46 XXX 50.5872127 C 26 1.27 0.42 0.42 0.06 XXX 50.5872128 C 1.16 6.31 6.31 0.36 XXX 50.5872128 C TC 0.00 5.93 5.93 0.31 XXX 50.5872128 C 26 1.16 0.38 0.38 0.05 XXX 50.5872129 C 1.22 7.49 7.49 0.42 XXX 50.5872129 C TC 0.00 7.09 7.09 0.37 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
72129 C 26 1.22 0.40 0.40 0.05 XXX 50.5872130 C 1.27 9.30 9.30 0.52 XXX 50.5872130 C TC 0.00 8.88 8.88 0.46 XXX 50.5872130 C 26 1.27 0.42 0.42 0.06 XXX 50.5872131 C 1.16 6.31 6.31 0.36 XXX 50.5872131 C TC 0.00 5.93 5.93 0.31 XXX 50.5872131 C 26 1.16 0.38 0.38 0.05 XXX 50.5872132 C 1.22 7.49 7.49 0.42 XXX 50.5872132 C TC 0.00 7.09 7.09 0.37 XXX 50.5872132 C 26 1.22 0.40 0.40 0.05 XXX 50.5872133 C 1.27 9.30 9.30 0.52 XXX 50.5872133 C TC 0.00 8.88 8.88 0.46 XXX 50.5872133 C 26 1.27 0.42 0.42 0.06 XXX 50.5872141 C 1.60 11.76 11.76 0.66 XXX 50.5872141 C TC 0.00 11.23 11.23 0.59 XXX 50.5872141 C 26 1.60 0.53 0.53 0.07 XXX 50.5872142 C 1.92 14.12 14.12 0.79 XXX 50.5872142 C TC 0.00 13.48 13.48 0.70 XXX 50.5872142 C 26 1.92 0.64 0.64 0.09 XXX 50.5872146 C 1.60 13.01 13.01 0.71 XXX 50.5872146 C TC 0.00 12.48 12.48 0.64 XXX 50.5872146 C 26 1.60 0.53 0.53 0.07 XXX 50.5872147 C 1.92 14.11 14.11 0.79 XXX 50.5872147 C TC 0.00 13.48 13.48 0.70 XXX 50.5872147 C 26 1.92 0.63 0.63 0.09 XXX 50.5872148 C 1.48 12.97 12.97 0.71 XXX 50.5872148 C TC 0.00 12.48 12.48 0.64 XXX 50.5872148 C 26 1.48 0.49 0.49 0.07 XXX 50.5872149 C 1.78 14.08 14.08 0.78 XXX 50.5872149 C TC 0.00 13.48 13.48 0.70 XXX 50.5872149 C 26 1.78 0.60 0.60 0.08 XXX 50.5872156 C 2.57 25.80 25.80 1.42 XXX 50.5872156 C TC 0.00 24.95 24.95 1.31 XXX 50.5872156 C 26 2.57 0.85 0.85 0.11 XXX 50.5872157 C 2.57 25.79 25.79 1.42 XXX 50.5872157 C TC 0.00 24.95 24.95 1.31 XXX 50.5872157 C 26 2.57 0.84 0.84 0.11 XXX 50.5872158 C 2.36 25.73 25.73 1.41 XXX 50.5872158 C TC 0.00 24.95 24.95 1.31 XXX 50.5872158 C 26 2.36 0.78 0.78 0.10 XXX 50.5872159 C 1.80 12.96 12.96 0.74 XXX 50.5872159 C TC 0.00 12.27 12.27 0.64 XXX 50.5872159 C 26 1.80 0.69 0.69 0.10 XXX 50.5872170 C 0.17 0.58 0.58 0.03 XXX 50.5872170 C TC 0.00 0.52 0.52 0.02 XXX 50.5872170 C 26 0.17 0.06 0.06 0.01 XXX 50.5872190 C 0.21 0.74 0.74 0.05 XXX 50.5872190 C TC 0.00 0.67 0.67 0.04 XXX 50.5872190 C 26 0.21 0.07 0.07 0.01 XXX 50.5872191 C 1.81 12.66 12.66 0.47 XXX 50.5872191 C TC 0.00 12.06 12.06 0.39 XXX 50.5872191 C 26 1.81 0.60 0.60 0.08 XXX 50.5872192 C 1.09 6.29 6.29 0.36 XXX 50.5872192 C TC 0.00 5.93 5.93 0.31 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
72192 C 26 1.09 0.36 0.36 0.05 XXX 50.5872193 C 1.16 7.24 7.24 0.41 XXX 50.5872193 C TC 0.00 6.86 6.86 0.36 XXX 50.5872193 C 26 1.16 0.38 0.38 0.05 XXX 50.5872194 C 1.22 8.91 8.91 0.48 XXX 50.5872194 C TC 0.00 8.51 8.51 0.43 XXX 50.5872194 C 26 1.22 0.40 0.40 0.05 XXX 50.5872195 C 1.46 11.71 11.71 0.51 XXX 50.5872195 C TC 0.00 11.23 11.23 0.45 XXX 50.5872195 C 26 1.46 0.48 0.48 0.06 XXX 50.5872196 C 1.73 14.05 14.05 0.60 XXX 50.5872196 C TC 0.00 13.48 13.48 0.52 XXX 50.5872196 C 26 1.73 0.57 0.57 0.08 XXX 50.5872197 C 2.26 25.69 25.69 1.02 XXX 50.5872197 C TC 0.00 24.95 24.95 0.92 XXX 50.5872197 C 26 2.26 0.74 0.74 0.10 XXX 50.5872198 C 1.80 11.82 11.82 0.67 XXX 50.5872198 C TC 0.00 11.23 11.23 0.59 XXX 50.5872198 C 26 1.80 0.59 0.59 0.08 XXX 50.5872200 C 0.17 0.58 0.58 0.03 XXX 50.5872200 C TC 0.00 0.52 0.52 0.02 XXX 50.5872200 C 26 0.17 0.06 0.06 0.01 XXX 50.5872202 C 0.19 0.68 0.68 0.05 XXX 50.5872202 C TC 0.00 0.62 0.62 0.04 XXX 50.5872202 C 26 0.19 0.06 0.06 0.01 XXX 50.5872220 C 0.17 0.63 0.63 0.05 XXX 50.5872220 C TC 0.00 0.57 0.57 0.04 XXX 50.5872220 C 26 0.17 0.06 0.06 0.01 XXX 50.5872240 C 0.91 5.05 5.05 0.29 XXX 50.5872240 C TC 0.00 4.76 4.76 0.25 XXX 50.5872240 C 26 0.91 0.29 0.29 0.04 XXX 50.5872255 C 0.91 4.61 4.61 0.26 XXX 50.5872255 C TC 0.00 4.34 4.34 0.22 XXX 50.5872255 C 26 0.91 0.27 0.27 0.04 XXX 50.5872265 C 0.83 4.33 4.33 0.26 XXX 50.5872265 C TC 0.00 4.08 4.08 0.22 XXX 50.5872265 C 26 0.83 0.25 0.25 0.04 XXX 50.5872270 C 1.33 6.54 6.54 0.39 XXX 50.5872270 C TC 0.00 6.12 6.12 0.33 XXX 50.5872270 C 26 1.33 0.42 0.42 0.06 XXX 50.5872275 C 0.76 2.31 2.31 0.26 XXX 50.5872275 C TC 0.00 2.11 2.11 0.22 XXX 50.5872275 C 26 0.76 0.20 0.20 0.04 XXX 50.5872285 C 1.16 8.76 8.76 0.50 XXX 50.5872285 C TC 0.00 8.40 8.40 0.43 XXX 50.5872285 C 26 1.16 0.36 0.36 0.07 XXX 50.5872295 C 0.83 8.15 8.15 0.46 XXX 50.5872295 C TC 0.00 7.88 7.88 0.40 XXX 50.5872295 C 26 0.83 0.27 0.27 0.06 XXX 50.5873000 C 0.16 0.57 0.57 0.03 XXX 50.5873000 C TC 0.00 0.52 0.52 0.02 XXX 50.5873000 C 26 0.16 0.05 0.05 0.01 XXX 50.5873010 C 0.17 0.58 0.58 0.03 XXX 50.5873010 C TC 0.00 0.52 0.52 0.02 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
73010 C 26 0.17 0.06 0.06 0.01 XXX 50.5873020 C 0.15 0.52 0.52 0.03 XXX 50.5873020 C TC 0.00 0.47 0.47 0.02 XXX 50.5873020 C 26 0.15 0.05 0.05 0.01 XXX 50.5873030 C 0.18 0.63 0.63 0.05 XXX 50.5873030 C TC 0.00 0.57 0.57 0.04 XXX 50.5873030 C 26 0.18 0.06 0.06 0.01 XXX 50.5873040 C 0.54 2.29 2.29 0.14 XXX 50.5873040 C TC 0.00 2.11 2.11 0.12 XXX 50.5873040 C 26 0.54 0.18 0.18 0.02 XXX 50.5873050 C 0.20 0.74 0.74 0.05 XXX 50.5873050 C TC 0.00 0.67 0.67 0.04 XXX 50.5873050 C 26 0.20 0.07 0.07 0.01 XXX 50.5873060 C 0.17 0.63 0.63 0.05 XXX 50.5873060 C TC 0.00 0.57 0.57 0.04 XXX 50.5873060 C 26 0.17 0.06 0.06 0.01 XXX 50.5873070 C 0.15 0.57 0.57 0.03 XXX 50.5873070 C TC 0.00 0.52 0.52 0.02 XXX 50.5873070 C 26 0.15 0.05 0.05 0.01 XXX 50.5873080 C 0.17 0.63 0.63 0.05 XXX 50.5873080 C TC 0.00 0.57 0.57 0.04 XXX 50.5873080 C 26 0.17 0.06 0.06 0.01 XXX 50.5873085 C 0.54 2.30 2.30 0.14 XXX 50.5873085 C TC 0.00 2.11 2.11 0.12 XXX 50.5873085 C 26 0.54 0.19 0.19 0.02 XXX 50.5873090 C 0.16 0.57 0.57 0.03 XXX 50.5873090 C TC 0.00 0.52 0.52 0.02 XXX 50.5873090 C 26 0.16 0.05 0.05 0.01 XXX 50.5873092 C 0.16 0.54 0.54 0.03 XXX 50.5873092 C TC 0.00 0.49 0.49 0.02 XXX 50.5873092 C 26 0.16 0.05 0.05 0.01 XXX 50.5873100 C 0.16 0.54 0.54 0.03 XXX 50.5873100 C TC 0.00 0.49 0.49 0.02 XXX 50.5873100 C 26 0.16 0.05 0.05 0.01 XXX 50.5873110 C 0.17 0.59 0.59 0.03 XXX 50.5873110 C TC 0.00 0.53 0.53 0.02 XXX 50.5873110 C 26 0.17 0.06 0.06 0.01 XXX 50.5873115 C 0.54 1.76 1.76 0.12 XXX 50.5873115 C TC 0.00 1.58 1.58 0.10 XXX 50.5873115 C 26 0.54 0.18 0.18 0.02 XXX 50.5873120 C 0.16 0.54 0.54 0.03 XXX 50.5873120 C TC 0.00 0.49 0.49 0.02 XXX 50.5873120 C 26 0.16 0.05 0.05 0.01 XXX 50.5873130 C 0.17 0.59 0.59 0.03 XXX 50.5873130 C TC 0.00 0.53 0.53 0.02 XXX 50.5873130 C 26 0.17 0.06 0.06 0.01 XXX 50.5873140 C 0.13 0.46 0.46 0.03 XXX 50.5873140 C TC 0.00 0.42 0.42 0.02 XXX 50.5873140 C 26 0.13 0.04 0.04 0.01 XXX 50.5873200 C 1.09 5.33 5.33 0.30 XXX 50.5873200 C TC 0.00 4.97 4.97 0.25 XXX 50.5873200 C 26 1.09 0.36 0.36 0.05 XXX 50.5873201 C 1.16 6.31 6.31 0.36 XXX 50.5873201 C TC 0.00 5.93 5.93 0.31 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
73201 C 26 1.16 0.38 0.38 0.05 XXX 50.5873202 C 1.22 7.84 7.84 0.44 XXX 50.5873202 C TC 0.00 7.44 7.44 0.39 XXX 50.5873202 C 26 1.22 0.40 0.40 0.05 XXX 50.5873206 C 1.81 11.58 11.58 0.47 XXX 50.5873206 C TC 0.00 10.99 10.99 0.39 XXX 50.5873206 C 26 1.81 0.59 0.59 0.08 XXX 50.5873218 C 1.35 11.67 11.67 0.45 XXX 50.5873218 C TC 0.00 11.23 11.23 0.39 XXX 50.5873218 C 26 1.35 0.44 0.44 0.06 XXX 50.5873219 C 1.62 14.02 14.02 0.54 XXX 50.5873219 C TC 0.00 13.48 13.48 0.47 XXX 50.5873219 C 26 1.62 0.54 0.54 0.07 XXX 50.5873220 C 2.15 25.66 25.66 0.94 XXX 50.5873220 C TC 0.00 24.95 24.95 0.84 XXX 50.5873220 C 26 2.15 0.71 0.71 0.10 XXX 50.5873221 C 1.35 11.67 11.67 0.45 XXX 50.5873221 C TC 0.00 11.23 11.23 0.39 XXX 50.5873221 C 26 1.35 0.44 0.44 0.06 XXX 50.5873222 C 1.62 14.01 14.01 0.54 XXX 50.5873222 C TC 0.00 13.48 13.48 0.47 XXX 50.5873222 C 26 1.62 0.53 0.53 0.07 XXX 50.5873223 C 2.15 25.66 25.66 0.94 XXX 50.5873223 C TC 0.00 24.95 24.95 0.84 XXX 50.5873223 C 26 2.15 0.71 0.71 0.10 XXX 50.5873225 C 1.73 11.71 11.71 0.69 XXX 50.5873225 C TC 0.00 11.04 11.04 0.59 XXX 50.5873225 C 26 1.73 0.67 0.67 0.10 XXX 50.5873500 C 0.17 0.53 0.53 0.03 XXX 50.5873500 C TC 0.00 0.47 0.47 0.02 XXX 50.5873500 C 26 0.17 0.06 0.06 0.01 XXX 50.5873510 C 0.21 0.64 0.64 0.05 XXX 50.5873510 C TC 0.00 0.57 0.57 0.04 XXX 50.5873510 C 26 0.21 0.07 0.07 0.01 XXX 50.5873520 C 0.26 0.76 0.76 0.05 XXX 50.5873520 C TC 0.00 0.67 0.67 0.04 XXX 50.5873520 C 26 0.26 0.09 0.09 0.01 XXX 50.5873525 C 0.54 2.29 2.29 0.15 XXX 50.5873525 C TC 0.00 2.11 2.11 0.12 XXX 50.5873525 C 26 0.54 0.18 0.18 0.03 XXX 50.5873530 C 0.29 0.62 0.62 0.03 XXX 50.5873530 C TC 0.00 0.52 0.52 0.02 XXX 50.5873530 C 26 0.29 0.10 0.10 0.01 XXX 50.5873540 C 0.20 0.64 0.64 0.05 XXX 50.5873540 C TC 0.00 0.57 0.57 0.04 XXX 50.5873540 C 26 0.20 0.07 0.07 0.01 XXX 50.5873542 C 0.59 2.27 2.27 0.15 XXX 50.5873542 C TC 0.00 2.11 2.11 0.12 XXX 50.5873542 C 26 0.59 0.16 0.16 0.03 XXX 50.5873550 C 0.17 0.63 0.63 0.05 XXX 50.5873550 C TC 0.00 0.57 0.57 0.04 XXX 50.5873550 C 26 0.17 0.06 0.06 0.01 XXX 50.5873560 C 0.17 0.58 0.58 0.03 XXX 50.5873560 C TC 0.00 0.52 0.52 0.02 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
73560 C 26 0.17 0.06 0.06 0.01 XXX 50.5873562 C 0.18 0.63 0.63 0.05 XXX 50.5873562 C TC 0.00 0.57 0.57 0.04 XXX 50.5873562 C 26 0.18 0.06 0.06 0.01 XXX 50.5873564 C 0.22 0.69 0.69 0.05 XXX 50.5873564 C TC 0.00 0.62 0.62 0.04 XXX 50.5873564 C 26 0.22 0.07 0.07 0.01 XXX 50.5873565 C 0.17 0.55 0.55 0.03 XXX 50.5873565 C TC 0.00 0.49 0.49 0.02 XXX 50.5873565 C 26 0.17 0.06 0.06 0.01 XXX 50.5873580 C 0.54 2.80 2.80 0.17 XXX 50.5873580 C TC 0.00 2.63 2.63 0.14 XXX 50.5873580 C 26 0.54 0.17 0.17 0.03 XXX 50.5873590 C 0.17 0.58 0.58 0.03 XXX 50.5873590 C TC 0.00 0.52 0.52 0.02 XXX 50.5873590 C 26 0.17 0.06 0.06 0.01 XXX 50.5873592 C 0.16 0.54 0.54 0.03 XXX 50.5873592 C TC 0.00 0.49 0.49 0.02 XXX 50.5873592 C 26 0.16 0.05 0.05 0.01 XXX 50.5873600 C 0.16 0.54 0.54 0.03 XXX 50.5873600 C TC 0.00 0.49 0.49 0.02 XXX 50.5873600 C 26 0.16 0.05 0.05 0.01 XXX 50.5873610 C 0.17 0.59 0.59 0.03 XXX 50.5873610 C TC 0.00 0.53 0.53 0.02 XXX 50.5873610 C 26 0.17 0.06 0.06 0.01 XXX 50.5873615 C 0.54 2.29 2.29 0.15 XXX 50.5873615 C TC 0.00 2.11 2.11 0.12 XXX 50.5873615 C 26 0.54 0.18 0.18 0.03 XXX 50.5873620 C 0.16 0.54 0.54 0.03 XXX 50.5873620 C TC 0.00 0.49 0.49 0.02 XXX 50.5873620 C 26 0.16 0.05 0.05 0.01 XXX 50.5873630 C 0.17 0.59 0.59 0.03 XXX 50.5873630 C TC 0.00 0.53 0.53 0.02 XXX 50.5873630 C 26 0.17 0.06 0.06 0.01 XXX 50.5873650 C 0.16 0.52 0.52 0.03 XXX 50.5873650 C TC 0.00 0.47 0.47 0.02 XXX 50.5873650 C 26 0.16 0.05 0.05 0.01 XXX 50.5873660 C 0.13 0.46 0.46 0.03 XXX 50.5873660 C TC 0.00 0.42 0.42 0.02 XXX 50.5873660 C 26 0.13 0.04 0.04 0.01 XXX 50.5873700 C 1.09 5.33 5.33 0.30 XXX 50.5873700 C TC 0.00 4.97 4.97 0.25 XXX 50.5873700 C 26 1.09 0.36 0.36 0.05 XXX 50.5873701 C 1.16 6.31 6.31 0.36 XXX 50.5873701 C TC 0.00 5.93 5.93 0.31 XXX 50.5873701 C 26 1.16 0.38 0.38 0.05 XXX 50.5873702 C 1.22 7.84 7.84 0.44 XXX 50.5873702 C TC 0.00 7.44 7.44 0.39 XXX 50.5873702 C 26 1.22 0.40 0.40 0.05 XXX 50.5873706 C 1.90 11.61 11.61 0.47 XXX 50.5873706 C TC 0.00 10.99 10.99 0.39 XXX 50.5873706 C 26 1.90 0.62 0.62 0.08 XXX 50.5873718 C 1.35 11.67 11.67 0.45 XXX 50.5873718 C TC 0.00 11.23 11.23 0.39 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
73718 C 26 1.35 0.44 0.44 0.06 XXX 50.5873719 C 1.62 14.01 14.01 0.54 XXX 50.5873719 C TC 0.00 13.48 13.48 0.47 XXX 50.5873719 C 26 1.62 0.53 0.53 0.07 XXX 50.5873720 C 2.15 25.65 25.65 0.94 XXX 50.5873720 C TC 0.00 24.95 24.95 0.84 XXX 50.5873720 C 26 2.15 0.70 0.70 0.10 XXX 50.5873721 C 1.35 11.67 11.67 0.45 XXX 50.5873721 C TC 0.00 11.23 11.23 0.39 XXX 50.5873721 C 26 1.35 0.44 0.44 0.06 XXX 50.5873722 C 1.62 14.01 14.01 0.54 XXX 50.5873722 C TC 0.00 13.48 13.48 0.47 XXX 50.5873722 C 26 1.62 0.53 0.53 0.07 XXX 50.5873723 C 2.15 25.66 25.66 0.94 XXX 50.5873723 C TC 0.00 24.95 24.95 0.84 XXX 50.5873723 C 26 2.15 0.71 0.71 0.10 XXX 50.5873725 C 1.82 11.83 11.83 0.67 XXX 50.5873725 C TC 0.00 11.23 11.23 0.59 XXX 50.5873725 C 26 1.82 0.60 0.60 0.08 XXX 50.5874000 C 0.18 0.58 0.58 0.03 XXX 50.5874000 C TC 0.00 0.52 0.52 0.02 XXX 50.5874000 C 26 0.18 0.06 0.06 0.01 XXX 50.5874010 C 0.23 0.65 0.65 0.05 XXX 50.5874010 C TC 0.00 0.57 0.57 0.04 XXX 50.5874010 C 26 0.23 0.08 0.08 0.01 XXX 50.5874020 C 0.27 0.71 0.71 0.05 XXX 50.5874020 C TC 0.00 0.62 0.62 0.04 XXX 50.5874020 C 26 0.27 0.09 0.09 0.01 XXX 50.5874022 C 0.32 0.83 0.83 0.06 XXX 50.5874022 C TC 0.00 0.73 0.73 0.05 XXX 50.5874022 C 26 0.32 0.10 0.10 0.01 XXX 50.5874150 C 1.19 6.07 6.07 0.35 XXX 50.5874150 C TC 0.00 5.68 5.68 0.30 XXX 50.5874150 C 26 1.19 0.39 0.39 0.05 XXX 50.5874160 C 1.27 7.28 7.28 0.42 XXX 50.5874160 C TC 0.00 6.86 6.86 0.36 XXX 50.5874160 C 26 1.27 0.42 0.42 0.06 XXX 50.5874170 C 1.40 8.97 8.97 0.49 XXX 50.5874170 C TC 0.00 8.51 8.51 0.43 XXX 50.5874170 C 26 1.40 0.46 0.46 0.06 XXX 50.5874175 C 1.90 12.68 12.68 0.47 XXX 50.5874175 C TC 0.00 12.06 12.06 0.39 XXX 50.5874175 C 26 1.90 0.62 0.62 0.08 XXX 50.5874181 C 1.46 11.71 11.71 0.51 XXX 50.5874181 C TC 0.00 11.23 11.23 0.45 XXX 50.5874181 C 26 1.46 0.48 0.48 0.06 XXX 50.5874182 C 1.73 14.05 14.05 0.60 XXX 50.5874182 C TC 0.00 13.48 13.48 0.52 XXX 50.5874182 C 26 1.73 0.57 0.57 0.08 XXX 50.5874183 C 2.26 25.69 25.69 1.02 XXX 50.5874183 C TC 0.00 24.95 24.95 0.92 XXX 50.5874183 C 26 2.26 0.74 0.74 0.10 XXX 50.5874185 C 1.80 11.82 11.82 0.67 XXX 50.5874185 C TC 0.00 11.23 11.23 0.59 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
74185 C 26 1.80 0.59 0.59 0.08 XXX 50.5874190 C 0.48 1.47 1.47 0.09 XXX 50.5874190 C TC 0.00 1.31 1.31 0.07 XXX 50.5874190 C 26 0.48 0.16 0.16 0.02 XXX 50.5874210 C 0.36 1.31 1.31 0.08 XXX 50.5874210 C TC 0.00 1.19 1.19 0.06 XXX 50.5874210 C 26 0.36 0.12 0.12 0.02 XXX 50.5874220 C 0.46 1.34 1.34 0.08 XXX 50.5874220 C TC 0.00 1.19 1.19 0.06 XXX 50.5874220 C 26 0.46 0.15 0.15 0.02 XXX 50.5874230 C 0.53 1.48 1.48 0.09 XXX 50.5874230 C TC 0.00 1.31 1.31 0.07 XXX 50.5874230 C 26 0.53 0.17 0.17 0.02 XXX 50.5874235 C 1.19 3.01 3.01 0.20 XXX 50.5874235 C TC 0.00 2.62 2.62 0.14 XXX 50.5874235 C 26 1.19 0.39 0.39 0.05 XXX 50.5874240 C 0.69 1.69 1.69 0.11 XXX 50.5874240 C TC 0.00 1.46 1.46 0.08 XXX 50.5874240 C 26 0.69 0.23 0.23 0.03 XXX 50.5874241 C 0.69 1.72 1.72 0.11 XXX 50.5874241 C TC 0.00 1.49 1.49 0.08 XXX 50.5874241 C 26 0.69 0.23 0.23 0.03 XXX 50.5874245 C 0.91 2.69 2.69 0.17 XXX 50.5874245 C TC 0.00 2.39 2.39 0.13 XXX 50.5874245 C 26 0.91 0.30 0.30 0.04 XXX 50.5874246 C 0.69 1.87 1.87 0.13 XXX 50.5874246 C TC 0.00 1.64 1.64 0.10 XXX 50.5874246 C 26 0.69 0.23 0.23 0.03 XXX 50.5874247 C 0.69 1.91 1.91 0.14 XXX 50.5874247 C TC 0.00 1.68 1.68 0.11 XXX 50.5874247 C 26 0.69 0.23 0.23 0.03 XXX 50.5874249 C 0.91 2.88 2.88 0.18 XXX 50.5874249 C TC 0.00 2.58 2.58 0.14 XXX 50.5874249 C 26 0.91 0.30 0.30 0.04 XXX 50.5874250 C 0.47 1.46 1.46 0.09 XXX 50.5874250 C TC 0.00 1.31 1.31 0.07 XXX 50.5874250 C 26 0.47 0.15 0.15 0.02 XXX 50.5874251 C 0.69 1.54 1.54 0.10 XXX 50.5874251 C TC 0.00 1.31 1.31 0.07 XXX 50.5874251 C 26 0.69 0.23 0.23 0.03 XXX 50.5874260 C 0.50 1.65 1.65 0.10 XXX 50.5874260 C TC 0.00 1.49 1.49 0.08 XXX 50.5874260 C 26 0.50 0.16 0.16 0.02 XXX 50.5874270 C 0.69 1.93 1.93 0.14 XXX 50.5874270 C TC 0.00 1.70 1.70 0.11 XXX 50.5874270 C 26 0.69 0.23 0.23 0.03 XXX 50.5874280 C 0.99 2.56 2.56 0.17 XXX 50.5874280 C TC 0.00 2.24 2.24 0.13 XXX 50.5874280 C 26 0.99 0.32 0.32 0.04 XXX 50.5874283 C 2.02 3.23 3.23 0.23 XXX 50.5874283 C TC 0.00 2.57 2.57 0.14 XXX 50.5874283 C 26 2.02 0.66 0.66 0.09 XXX 50.5874290 C 0.32 0.83 0.83 0.06 XXX 50.5874290 C TC 0.00 0.73 0.73 0.05 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
74290 C 26 0.32 0.10 0.10 0.01 XXX 50.5874291 C 0.20 0.49 0.49 0.03 XXX 50.5874291 C TC 0.00 0.42 0.42 0.02 XXX 50.5874291 C 26 0.20 0.07 0.07 0.01 XXX 50.5874300 C 0.36 0.85 0.85 0.10 XXX 50.5874300 C TC 0.00 0.73 0.73 0.08 XXX 50.5874300 C 26 0.36 0.12 0.12 0.02 XXX 50.5874301 C 0.36 0.85 0.85 0.10 ZZZ 50.5874301 C TC 0.15 0.78 0.78 0.09 ZZZ 50.5874301 C 26 0.21 0.07 0.07 0.01 ZZZ 50.5874305 C 0.42 0.92 0.92 0.07 XXX 50.5874305 C TC 0.00 0.78 0.78 0.05 XXX 50.5874305 C 26 0.42 0.14 0.14 0.02 XXX 50.5874320 C 0.54 3.34 3.34 0.19 XXX 50.5874320 C TC 0.00 3.16 3.16 0.17 XXX 50.5874320 C 26 0.54 0.18 0.18 0.02 XXX 50.5874327 C 0.70 2.00 2.00 0.14 XXX 50.5874327 C TC 0.00 1.77 1.77 0.11 XXX 50.5874327 C 26 0.70 0.23 0.23 0.03 XXX 50.5874328 C 0.70 3.39 3.39 0.20 XXX 50.5874328 C TC 0.00 3.16 3.16 0.17 XXX 50.5874328 C 26 0.70 0.23 0.23 0.03 XXX 50.5874329 C 0.70 3.38 3.38 0.20 XXX 50.5874329 C TC 0.00 3.15 3.15 0.17 XXX 50.5874329 C 26 0.70 0.23 0.23 0.03 XXX 50.5874330 C 0.90 3.45 3.45 0.21 XXX 50.5874330 C TC 0.00 3.16 3.16 0.17 XXX 50.5874330 C 26 0.90 0.29 0.29 0.04 XXX 50.5874340 C 0.54 2.81 2.81 0.16 XXX 50.5874340 C TC 0.00 2.63 2.63 0.14 XXX 50.5874340 C 26 0.54 0.18 0.18 0.02 XXX 50.5874350 C 0.76 3.41 3.41 0.20 XXX 50.5874350 C TC 0.00 3.16 3.16 0.17 XXX 50.5874350 C 26 0.76 0.25 0.25 0.03 XXX 50.5874355 C 0.76 2.88 2.88 0.17 XXX 50.5874355 C TC 0.00 2.63 2.63 0.14 XXX 50.5874355 C 26 0.76 0.25 0.25 0.03 XXX 50.5874360 C 0.54 3.35 3.35 0.19 XXX 50.5874360 C TC 0.00 3.16 3.16 0.17 XXX 50.5874360 C 26 0.54 0.19 0.19 0.02 XXX 50.5874363 C 0.88 6.39 6.39 0.37 XXX 50.5874363 C TC 0.00 6.10 6.10 0.33 XXX 50.5874363 C 26 0.88 0.29 0.29 0.04 XXX 50.5874400 C 0.49 1.84 1.84 0.13 XXX 50.5874400 C TC 0.00 1.68 1.68 0.11 XXX 50.5874400 C 26 0.49 0.16 0.16 0.02 XXX 50.5874410 C 0.49 2.12 2.12 0.13 XXX 50.5874410 C TC 0.00 1.96 1.96 0.11 XXX 50.5874410 C 26 0.49 0.16 0.16 0.02 XXX 50.5874415 C 0.49 2.29 2.29 0.14 XXX 50.5874415 C TC 0.00 2.13 2.13 0.12 XXX 50.5874415 C 26 0.49 0.16 0.16 0.02 XXX 50.5874420 C 0.36 2.75 2.75 0.16 XXX 50.5874420 C TC 0.00 2.63 2.63 0.14 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
74420 C 26 0.36 0.12 0.12 0.02 XXX 50.5874425 C 0.36 1.43 1.43 0.09 XXX 50.5874425 C TC 0.00 1.31 1.31 0.07 XXX 50.5874425 C 26 0.36 0.12 0.12 0.02 XXX 50.5874430 C 0.32 1.15 1.15 0.08 XXX 50.5874430 C TC 0.00 1.05 1.05 0.06 XXX 50.5874430 C 26 0.32 0.10 0.10 0.02 XXX 50.5874440 C 0.38 1.25 1.25 0.08 XXX 50.5874440 C TC 0.00 1.13 1.13 0.06 XXX 50.5874440 C 26 0.38 0.12 0.12 0.02 XXX 50.5874445 C 1.14 1.50 1.50 0.13 XXX 50.5874445 C TC 0.00 1.13 1.13 0.06 XXX 50.5874445 C 26 1.14 0.37 0.37 0.07 XXX 50.5874450 C 0.33 1.57 1.57 0.10 XXX 50.5874450 C TC 0.00 1.46 1.46 0.08 XXX 50.5874450 C 26 0.33 0.11 0.11 0.02 XXX 50.5874455 C 0.33 1.69 1.69 0.12 XXX 50.5874455 C TC 0.00 1.58 1.58 0.10 XXX 50.5874455 C 26 0.33 0.11 0.11 0.02 XXX 50.5874470 C 0.54 1.43 1.43 0.09 XXX 50.5874470 C TC 0.00 1.25 1.25 0.07 XXX 50.5874470 C 26 0.54 0.18 0.18 0.02 XXX 50.5874475 C 0.54 4.26 4.26 0.24 XXX 50.5874475 C TC 0.00 4.08 4.08 0.22 XXX 50.5874475 C 26 0.54 0.18 0.18 0.02 XXX 50.5874480 C 0.54 4.26 4.26 0.24 XXX 50.5874480 C TC 0.00 4.08 4.08 0.22 XXX 50.5874480 C 26 0.54 0.18 0.18 0.02 XXX 50.5874485 C 0.54 3.33 3.33 0.20 XXX 50.5874485 C TC 0.00 3.16 3.16 0.17 XXX 50.5874485 C 26 0.54 0.17 0.17 0.03 XXX 50.5874710 C 0.34 1.16 1.16 0.08 XXX 50.5874710 C TC 0.00 1.05 1.05 0.06 XXX 50.5874710 C 26 0.34 0.11 0.11 0.02 XXX 50.5874740 C 0.38 1.44 1.44 0.09 XXX 50.5874740 C TC 0.00 1.31 1.31 0.07 XXX 50.5874740 C 26 0.38 0.13 0.13 0.02 XXX 50.5874742 C 0.61 3.35 3.35 0.20 XXX 50.5874742 C TC 0.00 3.15 3.15 0.17 XXX 50.5874742 C 26 0.61 0.20 0.20 0.03 XXX 50.5874775 C 0.62 1.67 1.67 0.11 XXX 50.5874775 C TC 0.00 1.46 1.46 0.08 XXX 50.5874775 C 26 0.62 0.21 0.21 0.03 XXX 50.5875552 C 1.60 11.76 11.76 0.66 XXX 50.5875552 C TC 0.00 11.23 11.23 0.59 XXX 50.5875552 C 26 1.60 0.53 0.53 0.07 XXX 50.5875553 C 2.00 11.88 11.88 0.66 XXX 50.5875553 C TC 0.00 11.23 11.23 0.59 XXX 50.5875553 C 26 2.00 0.65 0.65 0.07 XXX 50.5875554 C 1.83 11.87 11.87 0.66 XXX 50.5875554 C TC 0.00 11.23 11.23 0.59 XXX 50.5875554 C 26 1.83 0.64 0.64 0.07 XXX 50.5875555 C 1.74 11.87 11.87 0.66 XXX 50.5875555 C TC 0.00 11.23 11.23 0.59 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
75555 C 26 1.74 0.64 0.64 0.07 XXX 50.5875556 C 0.00 0.00 0.00 0.00 XXX 0.0075600 C 0.49 12.83 12.83 0.67 XXX 50.5875600 C TC 0.00 12.64 12.64 0.65 XXX 50.5875600 C 26 0.49 0.19 0.19 0.02 XXX 50.5875605 C 1.14 13.04 13.04 0.70 XXX 50.5875605 C TC 0.00 12.64 12.64 0.65 XXX 50.5875605 C 26 1.14 0.40 0.40 0.05 XXX 50.5875625 C 1.14 13.02 13.02 0.71 XXX 50.5875625 C TC 0.00 12.64 12.64 0.65 XXX 50.5875625 C 26 1.14 0.38 0.38 0.06 XXX 50.5875630 C 1.79 13.78 13.78 0.80 XXX 50.5875630 C TC 0.00 13.17 13.17 0.69 XXX 50.5875630 C 26 1.79 0.61 0.61 0.11 XXX 50.5875635 C 2.40 16.75 16.75 0.50 XXX 50.5875635 C TC 0.00 15.96 15.96 0.39 XXX 50.5875635 C 26 2.40 0.79 0.79 0.11 XXX 50.5875650 C 1.49 13.13 13.13 0.72 XXX 50.5875650 C TC 0.00 12.64 12.64 0.65 XXX 50.5875650 C 26 1.49 0.49 0.49 0.07 XXX 50.5875658 C 1.31 13.11 13.11 0.72 XXX 50.5875658 C TC 0.00 12.64 12.64 0.65 XXX 50.5875658 C 26 1.31 0.47 0.47 0.07 XXX 50.5875660 C 1.31 13.08 13.08 0.71 XXX 50.5875660 C TC 0.00 12.64 12.64 0.65 XXX 50.5875660 C 26 1.31 0.44 0.44 0.06 XXX 50.5875662 C 1.66 13.23 13.23 0.71 XXX 50.5875662 C TC 0.00 12.64 12.64 0.65 XXX 50.5875662 C 26 1.66 0.59 0.59 0.06 XXX 50.5875665 C 1.31 13.08 13.08 0.74 XXX 50.5875665 C TC 0.00 12.64 12.64 0.65 XXX 50.5875665 C 26 1.31 0.44 0.44 0.09 XXX 50.5875671 C 1.66 13.19 13.19 0.72 XXX 50.5875671 C TC 0.00 12.64 12.64 0.65 XXX 50.5875671 C 26 1.66 0.55 0.55 0.07 XXX 50.5875676 C 1.31 13.08 13.08 0.72 XXX 50.5875676 C TC 0.00 12.64 12.64 0.65 XXX 50.5875676 C 26 1.31 0.44 0.44 0.07 XXX 50.5875680 C 1.66 13.19 13.19 0.72 XXX 50.5875680 C TC 0.00 12.64 12.64 0.65 XXX 50.5875680 C 26 1.66 0.55 0.55 0.07 XXX 50.5875685 C 1.31 13.07 13.07 0.71 XXX 50.5875685 C TC 0.00 12.64 12.64 0.65 XXX 50.5875685 C 26 1.31 0.43 0.43 0.06 XXX 50.5875705 C 2.18 13.37 13.37 0.78 XXX 50.5875705 C TC 0.00 12.64 12.64 0.65 XXX 50.5875705 C 26 2.18 0.73 0.73 0.13 XXX 50.5875710 C 1.14 13.03 13.03 0.72 XXX 50.5875710 C TC 0.00 12.64 12.64 0.65 XXX 50.5875710 C 26 1.14 0.39 0.39 0.07 XXX 50.5875716 C 1.31 13.07 13.07 0.72 XXX 50.5875716 C TC 0.00 12.64 12.64 0.65 XXX 50.5875716 C 26 1.31 0.43 0.43 0.07 XXX 50.5875722 C 1.14 13.04 13.04 0.70 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
75722 C TC 0.00 12.64 12.64 0.65 XXX 50.5875722 C 26 1.14 0.40 0.40 0.05 XXX 50.5875724 C 1.49 13.20 13.20 0.70 XXX 50.5875724 C TC 0.00 12.64 12.64 0.65 XXX 50.5875724 C 26 1.49 0.56 0.56 0.05 XXX 50.5875726 C 1.14 13.01 13.01 0.70 XXX 50.5875726 C TC 0.00 12.64 12.64 0.65 XXX 50.5875726 C 26 1.14 0.37 0.37 0.05 XXX 50.5875731 C 1.14 13.01 13.01 0.71 XXX 50.5875731 C TC 0.00 12.64 12.64 0.65 XXX 50.5875731 C 26 1.14 0.37 0.37 0.06 XXX 50.5875733 C 1.31 13.08 13.08 0.71 XXX 50.5875733 C TC 0.00 12.64 12.64 0.65 XXX 50.5875733 C 26 1.31 0.44 0.44 0.06 XXX 50.5875736 C 1.14 13.02 13.02 0.71 XXX 50.5875736 C TC 0.00 12.64 12.64 0.65 XXX 50.5875736 C 26 1.14 0.38 0.38 0.06 XXX 50.5875741 C 1.31 13.07 13.07 0.71 XXX 50.5875741 C TC 0.00 12.64 12.64 0.65 XXX 50.5875741 C 26 1.31 0.43 0.43 0.06 XXX 50.5875743 C 1.66 13.18 13.18 0.72 XXX 50.5875743 C TC 0.00 12.64 12.64 0.65 XXX 50.5875743 C 26 1.66 0.54 0.54 0.07 XXX 50.5875746 C 1.14 13.02 13.02 0.70 XXX 50.5875746 C TC 0.00 12.64 12.64 0.65 XXX 50.5875746 C 26 1.14 0.38 0.38 0.05 XXX 50.5875756 C 1.14 13.09 13.09 0.69 XXX 50.5875756 C TC 0.00 12.64 12.64 0.65 XXX 50.5875756 C 26 1.14 0.45 0.45 0.04 XXX 50.5875774 C 0.36 12.76 12.76 0.67 ZZZ 50.5875774 C TC 0.00 12.64 12.64 0.65 ZZZ 50.5875774 C 26 0.36 0.12 0.12 0.02 ZZZ 50.5875790 C 1.84 1.95 1.95 0.17 XXX 50.5875790 C TC 0.00 1.35 1.35 0.08 XXX 50.5875790 C 26 1.84 0.60 0.60 0.09 XXX 50.5875801 C 0.81 5.70 5.70 0.37 XXX 50.5875801 C TC 0.00 5.43 5.43 0.29 XXX 50.5875801 C 26 0.81 0.27 0.27 0.08 XXX 50.5875803 C 1.17 5.81 5.81 0.34 XXX 50.5875803 C TC 0.00 5.43 5.43 0.29 XXX 50.5875803 C 26 1.17 0.38 0.38 0.05 XXX 50.5875805 C 0.81 6.39 6.39 0.38 XXX 50.5875805 C TC 0.00 6.12 6.12 0.33 XXX 50.5875805 C 26 0.81 0.27 0.27 0.05 XXX 50.5875807 C 1.17 6.48 6.48 0.38 XXX 50.5875807 C TC 0.00 6.10 6.10 0.33 XXX 50.5875807 C 26 1.17 0.38 0.38 0.05 XXX 50.5875809 C 0.47 0.93 0.93 0.07 XXX 50.5875809 C TC 0.00 0.78 0.78 0.05 XXX 50.5875809 C 26 0.47 0.15 0.15 0.02 XXX 50.5875810 C 1.14 13.01 13.01 0.70 XXX 50.5875810 C TC 0.00 12.64 12.64 0.65 XXX 50.5875810 C 26 1.14 0.37 0.37 0.05 XXX 50.5875820 C 0.70 1.18 1.18 0.09 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
75820 C TC 0.00 0.95 0.95 0.06 XXX 50.5875820 C 26 0.70 0.23 0.23 0.03 XXX 50.5875822 C 1.06 1.83 1.83 0.13 XXX 50.5875822 C TC 0.00 1.48 1.48 0.08 XXX 50.5875822 C 26 1.06 0.35 0.35 0.05 XXX 50.5875825 C 1.14 13.01 13.01 0.72 XXX 50.5875825 C TC 0.00 12.64 12.64 0.65 XXX 50.5875825 C 26 1.14 0.37 0.37 0.07 XXX 50.5875827 C 1.14 13.01 13.01 0.70 XXX 50.5875827 C TC 0.00 12.64 12.64 0.65 XXX 50.5875827 C 26 1.14 0.37 0.37 0.05 XXX 50.5875831 C 1.14 13.01 13.01 0.71 XXX 50.5875831 C TC 0.00 12.64 12.64 0.65 XXX 50.5875831 C 26 1.14 0.37 0.37 0.06 XXX 50.5875833 C 1.49 13.13 13.13 0.74 XXX 50.5875833 C TC 0.00 12.64 12.64 0.65 XXX 50.5875833 C 26 1.49 0.49 0.49 0.09 XXX 50.5875840 C 1.14 13.02 13.02 0.72 XXX 50.5875840 C TC 0.00 12.64 12.64 0.65 XXX 50.5875840 C 26 1.14 0.38 0.38 0.07 XXX 50.5875842 C 1.49 13.12 13.12 0.72 XXX 50.5875842 C TC 0.00 12.64 12.64 0.65 XXX 50.5875842 C 26 1.49 0.48 0.48 0.07 XXX 50.5875860 C 1.14 13.03 13.03 0.69 XXX 50.5875860 C TC 0.00 12.64 12.64 0.65 XXX 50.5875860 C 26 1.14 0.39 0.39 0.04 XXX 50.5875870 C 1.14 13.03 13.03 0.70 XXX 50.5875870 C TC 0.00 12.64 12.64 0.65 XXX 50.5875870 C 26 1.14 0.39 0.39 0.05 XXX 50.5875872 C 1.14 13.01 13.01 0.79 XXX 50.5875872 C TC 0.00 12.64 12.64 0.65 XXX 50.5875872 C 26 1.14 0.37 0.37 0.14 XXX 50.5875880 C 0.70 1.18 1.18 0.09 XXX 50.5875880 C TC 0.00 0.95 0.95 0.06 XXX 50.5875880 C 26 0.70 0.23 0.23 0.03 XXX 50.5875885 C 1.44 13.11 13.11 0.71 XXX 50.5875885 C TC 0.00 12.64 12.64 0.65 XXX 50.5875885 C 26 1.44 0.47 0.47 0.06 XXX 50.5875887 C 1.44 13.11 13.11 0.71 XXX 50.5875887 C TC 0.00 12.64 12.64 0.65 XXX 50.5875887 C 26 1.44 0.47 0.47 0.06 XXX 50.5875889 C 1.14 13.01 13.01 0.70 XXX 50.5875889 C TC 0.00 12.64 12.64 0.65 XXX 50.5875889 C 26 1.14 0.37 0.37 0.05 XXX 50.5875891 C 1.14 13.01 13.01 0.70 XXX 50.5875891 C TC 0.00 12.64 12.64 0.65 XXX 50.5875891 C 26 1.14 0.37 0.37 0.05 XXX 50.5875893 C 0.54 12.82 12.82 0.67 XXX 50.5875893 C TC 0.00 12.64 12.64 0.65 XXX 50.5875893 C 26 0.54 0.18 0.18 0.02 XXX 50.5875894 C 1.31 24.63 24.63 1.35 XXX 50.5875894 C TC 0.00 24.20 24.20 1.27 XXX 50.5875894 C 26 1.31 0.43 0.43 0.08 XXX 50.5875896 C 1.31 21.50 21.50 1.15 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
75896 C TC 0.00 21.05 21.05 1.10 XXX 50.5875896 C 26 1.31 0.45 0.45 0.05 XXX 50.5875898 C 1.65 1.60 1.60 0.13 XXX 50.5875898 C TC 0.00 1.05 1.05 0.06 XXX 50.5875898 C 26 1.65 0.55 0.55 0.07 XXX 50.5875900 C 0.49 21.13 21.13 1.14 XXX 50.5875900 C TC 0.00 20.97 20.97 1.11 XXX 50.5875900 C 26 0.49 0.16 0.16 0.03 XXX 50.5875901 C 0.49 1.47 1.47 0.85 XXX 50.5875901 C TC 0.00 1.31 1.31 0.83 XXX 50.5875901 C 26 0.49 0.16 0.16 0.02 XXX 50.5875902 C 0.39 1.44 1.44 0.85 XXX 50.5875902 C TC 0.00 1.31 1.31 0.83 XXX 50.5875902 C 26 0.39 0.13 0.13 0.02 XXX 50.5875940 C 0.54 12.82 12.82 0.69 XXX 50.5875940 C TC 0.00 12.64 12.64 0.65 XXX 50.5875940 C 26 0.54 0.18 0.18 0.04 XXX 50.5875945 C 0.40 4.71 4.71 0.28 XXX 50.5875945 C TC 0.00 4.57 4.57 0.24 XXX 50.5875945 C 26 0.40 0.14 0.14 0.04 XXX 50.5875946 C 0.40 2.43 2.43 0.18 ZZZ 50.5875946 C TC 0.00 2.29 2.29 0.13 ZZZ 50.5875946 C 26 0.40 0.14 0.14 0.05 ZZZ 50.5875952 C 0.00 0.00 0.00 0.00 XXX 0.0075952 C TC 0.00 0.00 0.00 0.00 XXX 0.0075952 C 26 4.49 1.49 1.49 0.43 XXX 50.5875953 C 0.00 0.00 0.00 0.00 XXX 0.0075953 C TC 0.00 0.00 0.00 0.00 XXX 0.0075953 C 26 1.36 0.45 0.45 0.13 XXX 50.5875954 C 0.00 0.00 0.00 0.00 XXX 0.0075954 C TC 0.00 0.00 0.00 0.00 XXX 0.0075954 C 26 2.25 0.78 0.78 0.15 XXX 50.5875956 C 0.00 0.00 0.00 0.00 XXX 0.0075956 C TC 0.00 0.00 0.00 0.00 XXX 0.0075956 C 26 7.00 2.71 2.71 0.69 XXX 50.5875957 C 0.00 0.00 0.00 0.00 XXX 0.0075957 C TC 0.00 0.00 0.00 0.00 XXX 0.0075957 C 26 6.00 2.32 2.32 0.59 XXX 50.5875958 C 0.00 0.00 0.00 0.00 XXX 0.0075958 C TC 0.00 0.00 0.00 0.00 XXX 0.0075958 C 26 4.00 1.55 1.55 0.39 XXX 50.5875959 C 0.00 0.00 0.00 0.00 XXX 0.0075959 C TC 0.00 0.00 0.00 0.00 XXX 0.0075959 C 26 3.50 1.36 1.36 0.34 XXX 50.5875960 C 0.82 15.22 15.22 0.82 XXX 50.5875960 C TC 0.00 14.94 14.94 0.77 XXX 50.5875960 C 26 0.82 0.28 0.28 0.05 XXX 50.5875961 C 4.24 11.92 11.92 0.73 XXX 50.5875961 C TC 0.00 10.53 10.53 0.55 XXX 50.5875961 C 26 4.24 1.39 1.39 0.18 XXX 50.5875962 C 0.54 15.97 15.97 0.86 XXX 50.5875962 C TC 0.00 15.79 15.79 0.83 XXX 50.5875962 C 26 0.54 0.18 0.18 0.03 XXX 50.5875964 C 0.36 8.53 8.53 0.46 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
75964 C TC 0.00 8.41 8.41 0.43 ZZZ 50.5875964 C 26 0.36 0.12 0.12 0.03 ZZZ 50.5875966 C 1.31 16.25 16.25 0.89 XXX 50.5875966 C TC 0.00 15.79 15.79 0.83 XXX 50.5875966 C 26 1.31 0.46 0.46 0.06 XXX 50.5875968 C 0.36 8.54 8.54 0.45 ZZZ 50.5875968 C TC 0.00 8.41 8.41 0.43 ZZZ 50.5875968 C 26 0.36 0.13 0.13 0.02 ZZZ 50.5875970 C 0.83 11.85 11.85 0.64 XXX 50.5875970 C TC 0.00 11.57 11.57 0.60 XXX 50.5875970 C 26 0.83 0.28 0.28 0.04 XXX 50.5875978 C 0.54 15.97 15.97 0.85 XXX 50.5875978 C TC 0.00 15.79 15.79 0.83 XXX 50.5875978 C 26 0.54 0.18 0.18 0.02 XXX 50.5875980 C 1.44 5.90 5.90 0.35 XXX 50.5875980 C TC 0.00 5.43 5.43 0.29 XXX 50.5875980 C 26 1.44 0.47 0.47 0.06 XXX 50.5875982 C 1.44 6.57 6.57 0.39 XXX 50.5875982 C TC 0.00 6.10 6.10 0.33 XXX 50.5875982 C 26 1.44 0.47 0.47 0.06 XXX 50.5875984 C 0.72 2.19 2.19 0.14 XXX 50.5875984 C TC 0.00 1.96 1.96 0.11 XXX 50.5875984 C 26 0.72 0.23 0.23 0.03 XXX 50.5875989 C 1.19 3.55 3.55 0.22 XXX 50.5875989 C TC 0.00 3.16 3.16 0.17 XXX 50.5875989 C 26 1.19 0.39 0.39 0.05 XXX 50.5875992 C 0.54 15.98 15.98 0.86 XXX 50.5875992 C TC 0.00 15.79 15.79 0.83 XXX 50.5875992 C 26 0.54 0.19 0.19 0.03 XXX 50.5875993 C 0.36 8.52 8.52 0.45 ZZZ 50.5875993 C TC 0.00 8.39 8.39 0.43 ZZZ 50.5875993 C 26 0.36 0.13 0.13 0.02 ZZZ 50.5875994 C 1.31 16.20 16.20 0.90 XXX 50.5875994 C TC 0.00 15.74 15.74 0.83 XXX 50.5875994 C 26 1.31 0.46 0.46 0.07 XXX 50.5875995 C 1.31 16.21 16.21 0.88 XXX 50.5875995 C TC 0.00 15.74 15.74 0.83 XXX 50.5875995 C 26 1.31 0.47 0.47 0.05 XXX 50.5875996 C 0.36 8.51 8.51 0.45 ZZZ 50.5875996 C TC 0.00 8.39 8.39 0.43 ZZZ 50.5875996 C 26 0.36 0.12 0.12 0.02 ZZZ 50.5875998 C 0.38 1.44 1.44 0.11 ZZZ 50.5875998 C TC 0.00 1.31 1.31 0.10 ZZZ 50.5875998 C 26 0.38 0.13 0.13 0.01 ZZZ 50.5876000 C 0.17 1.36 1.36 0.08 XXX 50.5876000 C TC 0.00 1.31 1.31 0.07 XXX 50.5876000 C 26 0.17 0.05 0.05 0.01 XXX 50.5876001 C 0.67 2.85 2.85 0.19 XXX 50.5876001 C TC 0.00 2.63 2.63 0.14 XXX 50.5876001 C 26 0.67 0.22 0.22 0.05 XXX 50.5876003 C 0.54 1.48 1.48 0.09 XXX 50.5876003 C TC 0.00 1.31 1.31 0.07 XXX 50.5876003 C 26 0.54 0.17 0.17 0.02 XXX 50.5876005 C 0.60 1.46 1.46 0.10 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
76005 C TC 0.00 1.31 1.31 0.07 XXX 50.5876005 C 26 0.60 0.15 0.15 0.03 XXX 50.5876006 C 0.41 0.18 0.18 0.06 XXX 50.5876010 C 0.18 0.58 0.58 0.03 XXX 50.5876010 C TC 0.00 0.52 0.52 0.02 XXX 50.5876010 C 26 0.18 0.06 0.06 0.01 XXX 50.5876012 C 0.00 0.00 0.00 0.00 XXX 0.0076012 C TC 0.00 0.00 0.00 0.00 XXX 0.0076012 C 26 1.31 0.47 0.47 0.10 XXX 50.5876013 C 0.00 0.00 0.00 0.00 XXX 0.0076013 C TC 0.00 0.00 0.00 0.00 XXX 0.0076013 C 26 1.38 0.48 0.48 0.07 XXX 50.5876020 C 0.19 0.58 0.58 0.03 XXX 50.5876020 C TC 0.00 0.52 0.52 0.02 XXX 50.5876020 C 26 0.19 0.06 0.06 0.01 XXX 50.5876040 C 0.27 0.87 0.87 0.06 XXX 50.5876040 C TC 0.00 0.78 0.78 0.05 XXX 50.5876040 C 26 0.27 0.09 0.09 0.01 XXX 50.5876061 C 0.45 1.15 1.15 0.08 XXX 50.5876061 C TC 0.00 1.00 1.00 0.06 XXX 50.5876061 C 26 0.45 0.15 0.15 0.02 XXX 50.5876062 C 0.54 1.62 1.62 0.10 XXX 50.5876062 C TC 0.00 1.44 1.44 0.08 XXX 50.5876062 C 26 0.54 0.18 0.18 0.02 XXX 50.5876065 C 0.70 0.96 0.96 0.08 XXX 50.5876065 C TC 0.00 0.73 0.73 0.05 XXX 50.5876065 C 26 0.70 0.23 0.23 0.03 XXX 50.5876066 C 0.31 1.21 1.21 0.08 XXX 50.5876066 C TC 0.00 1.11 1.11 0.06 XXX 50.5876066 C 26 0.31 0.10 0.10 0.02 XXX 50.5876070 C 0.25 3.04 3.04 0.17 XXX 50.5876070 C TC 0.00 2.96 2.96 0.16 XXX 50.5876070 C 26 0.25 0.08 0.08 0.01 XXX 50.5876071 C 0.22 3.03 3.03 0.06 XXX 50.5876071 C TC 0.00 2.96 2.96 0.05 XXX 50.5876071 C 26 0.22 0.07 0.07 0.01 XXX 50.5876075 C 0.30 3.20 3.20 0.18 XXX 50.5876075 C TC 0.00 3.10 3.10 0.17 XXX 50.5876075 C 26 0.30 0.10 0.10 0.01 XXX 50.5876076 C 0.22 0.83 0.83 0.06 XXX 50.5876076 C TC 0.00 0.75 0.75 0.05 XXX 50.5876076 C 26 0.22 0.08 0.08 0.01 XXX 50.5876077 C 0.17 0.81 0.81 0.06 XXX 50.5876077 C TC 0.00 0.75 0.75 0.05 XXX 50.5876077 C 26 0.17 0.06 0.06 0.01 XXX 50.5876078 C 0.20 0.82 0.82 0.06 XXX 50.5876078 C TC 0.00 0.75 0.75 0.05 XXX 50.5876078 C 26 0.20 0.07 0.07 0.01 XXX 50.5876080 C 0.54 1.23 1.23 0.08 XXX 50.5876080 C TC 0.00 1.05 1.05 0.06 XXX 50.5876080 C 26 0.54 0.18 0.18 0.02 XXX 50.5876082 C 0.06 0.44 0.44 0.02 ZZZ 50.5876082 C TC 0.00 0.42 0.42 0.01 ZZZ 50.5876082 C 26 0.06 0.02 0.02 0.01 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
76083 C 0.06 0.44 0.44 0.02 ZZZ 50.5876083 C TC 0.00 0.42 0.42 0.01 ZZZ 50.5876083 C 26 0.06 0.02 0.02 0.01 ZZZ 50.5876086 C 0.36 2.75 2.75 0.16 XXX 50.5876086 C TC 0.00 2.63 2.63 0.14 XXX 50.5876086 C 26 0.36 0.12 0.12 0.02 XXX 50.5876088 C 0.45 3.82 3.82 0.21 XXX 50.5876088 C TC 0.00 3.67 3.67 0.19 XXX 50.5876088 C 26 0.45 0.15 0.15 0.02 XXX 50.5876090 C 0.70 1.28 1.28 0.09 XXX 50.5876090 C TC 0.00 1.05 1.05 0.06 XXX 50.5876090 C 26 0.70 0.23 0.23 0.03 XXX 50.5876091 C 0.87 1.59 1.59 0.11 XXX 50.5876091 C TC 0.00 1.31 1.31 0.07 XXX 50.5876091 C 26 0.87 0.28 0.28 0.04 XXX 50.5876092 C 0.70 1.46 1.46 0.10 XXX 50.5876092 C TC 0.00 1.23 1.23 0.07 XXX 50.5876092 C 26 0.70 0.23 0.23 0.03 XXX 50.5876093 C 1.63 18.20 18.20 0.99 XXX 50.5876093 C TC 0.00 17.67 17.67 0.92 XXX 50.5876093 C 26 1.63 0.53 0.53 0.07 XXX 50.5876094 C 1.63 24.51 24.51 1.31 XXX 50.5876094 C TC 0.00 23.98 23.98 1.24 XXX 50.5876094 C 26 1.63 0.53 0.53 0.07 XXX 50.5876095 C 1.59 7.70 7.70 0.46 XXX 50.5876095 C TC 0.00 7.18 7.18 0.37 XXX 50.5876095 C 26 1.59 0.52 0.52 0.09 XXX 50.5876096 C 0.56 1.49 1.49 0.09 XXX 50.5876096 C TC 0.00 1.31 1.31 0.07 XXX 50.5876096 C 26 0.56 0.18 0.18 0.02 XXX 50.5876098 C 0.16 0.47 0.47 0.03 XXX 50.5876098 C TC 0.00 0.42 0.42 0.02 XXX 50.5876098 C 26 0.16 0.05 0.05 0.01 XXX 50.5876100 C 0.58 1.44 1.44 0.10 XXX 50.5876100 C TC 0.00 1.25 1.25 0.07 XXX 50.5876100 C 26 0.58 0.19 0.19 0.03 XXX 50.5876101 C 0.58 1.61 1.61 0.11 XXX 50.5876101 C TC 0.00 1.42 1.42 0.08 XXX 50.5876101 C 26 0.58 0.19 0.19 0.03 XXX 50.5876102 C 0.58 1.93 1.93 0.14 XXX 50.5876102 C TC 0.00 1.74 1.74 0.11 XXX 50.5876102 C 26 0.58 0.19 0.19 0.03 XXX 50.5876120 C 0.38 1.18 1.18 0.08 XXX 50.5876120 C TC 0.00 1.05 1.05 0.06 XXX 50.5876120 C 26 0.38 0.13 0.13 0.02 XXX 50.5876125 C 0.27 0.87 0.87 0.06 ZZZ 50.5876125 C TC 0.00 0.78 0.78 0.05 ZZZ 50.5876125 C 26 0.27 0.09 0.09 0.01 ZZZ 50.5876140 C 0.00 0.00 0.00 0.00 XXX 0.0076150 C 0.00 0.42 0.42 0.02 XXX 50.5876350 C 0.00 0.00 0.00 0.00 XXX 0.0076355 C 1.21 8.68 8.68 0.47 XXX 50.5876355 C TC 0.00 8.28 8.28 0.42 XXX 50.5876355 C 26 1.21 0.40 0.40 0.05 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
76360 C 1.16 8.66 8.66 0.47 XXX 50.5876360 C TC 0.00 8.28 8.28 0.42 XXX 50.5876360 C 26 1.16 0.38 0.38 0.05 XXX 50.5876362 C 3.99 9.58 9.58 1.64 XXX 50.5876362 C TC 0.00 8.28 8.28 1.46 XXX 50.5876362 C 26 3.99 1.30 1.30 0.18 XXX 50.5876370 C 0.85 3.24 3.24 0.20 XXX 50.5876370 C TC 0.00 2.96 2.96 0.16 XXX 50.5876370 C 26 0.85 0.28 0.28 0.04 XXX 50.5876375 C 0.16 3.59 3.59 0.19 XXX 50.58 12/31/200576375 C TC 0.00 3.54 3.54 0.18 XXX 50.58 12/31/200576375 C 26 0.16 0.05 0.05 0.01 XXX 50.58 12/31/200576376 C 0.20 3.50 3.50 0.10 XXX 50.5876376 C TC 0.00 3.43 3.43 0.08 XXX 50.5876376 C 26 0.20 0.07 0.07 0.02 XXX 50.5876377 C 0.79 3.70 3.70 0.39 XXX 50.5876377 C TC 0.00 3.43 3.43 0.31 XXX 50.5876377 C 26 0.79 0.27 0.27 0.08 XXX 50.5876380 C 0.98 3.83 3.83 0.22 XXX 50.5876380 C TC 0.00 3.51 3.51 0.18 XXX 50.5876380 C 26 0.98 0.32 0.32 0.04 XXX 50.5876390 C 1.40 11.51 11.51 0.66 XXX 50.5876390 C TC 0.00 11.04 11.04 0.59 XXX 50.5876390 C 26 1.40 0.47 0.47 0.07 XXX 50.5876393 C 1.50 11.73 11.73 0.64 XXX 50.5876393 C TC 0.00 11.23 11.23 0.55 XXX 50.5876393 C 26 1.50 0.50 0.50 0.09 XXX 50.5876394 C 4.24 12.61 12.61 1.81 XXX 50.5876394 C TC 0.00 11.23 11.23 1.57 XXX 50.5876394 C 26 4.24 1.38 1.38 0.24 XXX 50.5876400 C 1.60 11.75 11.75 0.66 XXX 50.5876400 C TC 0.00 11.23 11.23 0.59 XXX 50.5876400 C 26 1.60 0.52 0.52 0.07 XXX 50.5876496 C 0.00 0.00 0.00 0.00 XXX 0.0076496 C TC 0.00 0.00 0.00 0.00 XXX 0.0076496 C 26 0.00 0.00 0.00 0.00 XXX 0.0076497 C 0.00 0.00 0.00 0.00 XXX 0.0076497 C TC 0.00 0.00 0.00 0.00 XXX 0.0076497 C 26 0.00 0.00 0.00 0.00 XXX 0.0076498 C 0.00 0.00 0.00 0.00 XXX 0.0076498 C TC 0.00 0.00 0.00 0.00 XXX 0.0076498 C 26 0.00 0.00 0.00 0.00 XXX 0.0076499 S 0.00 0.00 0.00 0.00 XXX 0.0076499 S TC 0.00 0.00 0.00 0.00 XXX 0.0076499 S 26 0.00 0.00 0.00 0.00 XXX 0.0076506 C 0.63 1.66 1.66 0.14 XXX 50.5876506 C TC 0.00 1.42 1.42 0.08 XXX 50.5876506 C 26 0.63 0.24 0.24 0.06 XXX 50.5876510 C 1.55 2.87 2.87 0.10 XXX 50.5876510 C TC 0.00 2.19 2.19 0.07 XXX 50.5876510 C 26 1.55 0.68 0.68 0.03 XXX 50.5876511 C 0.94 2.44 2.44 0.10 XXX 50.5876511 C TC 0.00 2.04 2.04 0.07 XXX 50.5876511 C 26 0.94 0.40 0.40 0.03 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
76512 C 0.94 2.24 2.24 0.12 XXX 50.5876512 C TC 0.00 1.82 1.82 0.10 XXX 50.5876512 C 26 0.94 0.42 0.42 0.02 XXX 50.5876513 C 0.66 1.81 1.81 0.12 XXX 50.5876513 C TC 0.00 1.52 1.52 0.10 XXX 50.5876513 C 26 0.66 0.29 0.29 0.02 XXX 50.5876514 C 0.17 0.13 0.13 0.02 XXX 50.5876514 C TC 0.00 0.05 0.05 0.01 XXX 50.5876514 C 26 0.17 0.08 0.08 0.01 XXX 50.5876516 C 0.54 1.46 1.46 0.08 XXX 50.5876516 C TC 0.00 1.22 1.22 0.07 XXX 50.5876516 C 26 0.54 0.24 0.24 0.01 XXX 50.5876519 C 0.54 1.55 1.55 0.08 XXX 50.5876519 C TC 0.00 1.31 1.31 0.07 XXX 50.5876519 C 26 0.54 0.24 0.24 0.01 XXX 50.5876529 C 0.57 1.37 1.37 0.10 XXX 50.5876529 C TC 0.00 1.13 1.13 0.08 XXX 50.5876529 C 26 0.57 0.24 0.24 0.02 XXX 50.5876536 C 0.56 1.60 1.60 0.10 XXX 50.5876536 C TC 0.00 1.42 1.42 0.08 XXX 50.5876536 C 26 0.56 0.18 0.18 0.02 XXX 50.5876604 C 0.55 1.49 1.49 0.09 XXX 50.5876604 C TC 0.00 1.31 1.31 0.07 XXX 50.5876604 C 26 0.55 0.18 0.18 0.02 XXX 50.5876645 C 0.54 1.23 1.23 0.08 XXX 50.5876645 C TC 0.00 1.05 1.05 0.06 XXX 50.5876645 C 26 0.54 0.18 0.18 0.02 XXX 50.5876700 C 0.81 2.25 2.25 0.15 XXX 50.5876700 C TC 0.00 1.98 1.98 0.11 XXX 50.5876700 C 26 0.81 0.27 0.27 0.04 XXX 50.5876705 C 0.59 1.61 1.61 0.11 XXX 50.5876705 C TC 0.00 1.42 1.42 0.08 XXX 50.5876705 C 26 0.59 0.19 0.19 0.03 XXX 50.5876770 C 0.74 2.22 2.22 0.14 XXX 50.5876770 C TC 0.00 1.98 1.98 0.11 XXX 50.5876770 C 26 0.74 0.24 0.24 0.03 XXX 50.5876775 C 0.58 1.61 1.61 0.11 XXX 50.5876775 C TC 0.00 1.42 1.42 0.08 XXX 50.5876775 C 26 0.58 0.19 0.19 0.03 XXX 50.5876778 C 0.74 2.22 2.22 0.14 XXX 50.5876778 C TC 0.00 1.98 1.98 0.11 XXX 50.5876778 C 26 0.74 0.24 0.24 0.03 XXX 50.5876800 C 1.13 1.76 1.76 0.13 XXX 50.5876800 C TC 0.00 1.42 1.42 0.08 XXX 50.5876800 C 26 1.13 0.34 0.34 0.05 XXX 50.5876801 C 0.99 2.45 2.45 0.16 XXX 50.5876801 C TC 0.00 2.11 2.11 0.12 XXX 50.5876801 C 26 0.99 0.34 0.34 0.04 XXX 50.5876802 C 0.83 1.34 1.34 0.16 ZZZ 50.5876802 C TC 0.00 1.05 1.05 0.12 ZZZ 50.5876802 C 26 0.83 0.29 0.29 0.04 ZZZ 50.5876805 C 0.99 2.45 2.45 0.16 XXX 50.5876805 C TC 0.00 2.11 2.11 0.12 XXX 50.5876805 C 26 0.99 0.34 0.34 0.04 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
76810 C 0.98 1.39 1.39 0.26 ZZZ 50.5876810 C TC 0.00 1.05 1.05 0.22 ZZZ 50.5876810 C 26 0.98 0.34 0.34 0.04 ZZZ 50.5876811 C 1.90 4.25 4.25 0.52 XXX 50.5876811 C TC 0.00 3.54 3.54 0.43 XXX 50.5876811 C 26 1.90 0.71 0.71 0.09 XXX 50.5876812 C 1.78 1.71 1.71 0.49 ZZZ 50.5876812 C TC 0.00 1.05 1.05 0.41 ZZZ 50.5876812 C 26 1.78 0.66 0.66 0.08 ZZZ 50.5876815 C 0.65 1.65 1.65 0.11 XXX 50.5876815 C TC 0.00 1.42 1.42 0.08 XXX 50.5876815 C 26 0.65 0.23 0.23 0.03 XXX 50.5876816 C 0.85 1.43 1.43 0.10 XXX 50.5876816 C TC 0.00 1.11 1.11 0.06 XXX 50.5876816 C 26 0.85 0.32 0.32 0.04 XXX 50.5876817 C 0.75 1.78 1.78 0.09 XXX 50.5876817 C TC 0.00 1.52 1.52 0.06 XXX 50.5876817 C 26 0.75 0.26 0.26 0.03 XXX 50.5876818 C 1.05 2.00 2.00 0.15 XXX 50.5876818 C TC 0.00 1.61 1.61 0.10 XXX 50.5876818 C 26 1.05 0.39 0.39 0.05 XXX 50.5876819 C 0.77 1.89 1.89 0.13 XXX 50.5876819 C TC 0.00 1.61 1.61 0.10 XXX 50.5876819 C 26 0.77 0.28 0.28 0.03 XXX 50.5876820 C 0.50 1.80 1.80 0.15 XXX 50.5876820 C TC 0.00 1.61 1.61 0.12 XXX 50.5876820 C 26 0.50 0.19 0.19 0.03 XXX 50.5876821 C 0.70 1.88 1.88 0.15 XXX 50.5876821 C TC 0.00 1.61 1.61 0.12 XXX 50.5876821 C 26 0.70 0.27 0.27 0.03 XXX 50.5876825 C 1.67 2.58 2.58 0.18 XXX 50.5876825 C TC 0.00 1.98 1.98 0.11 XXX 50.5876825 C 26 1.67 0.60 0.60 0.07 XXX 50.5876826 C 0.83 1.00 1.00 0.08 XXX 50.5876826 C TC 0.00 0.71 0.71 0.05 XXX 50.5876826 C 26 0.83 0.29 0.29 0.03 XXX 50.5876827 C 0.58 1.93 1.93 0.14 XXX 50.5876827 C TC 0.00 1.72 1.72 0.12 XXX 50.5876827 C 26 0.58 0.21 0.21 0.02 XXX 50.5876828 C 0.56 1.33 1.33 0.11 XXX 50.5876828 C TC 0.00 1.11 1.11 0.08 XXX 50.5876828 C 26 0.56 0.22 0.22 0.03 XXX 50.5876830 C 0.69 1.75 1.75 0.13 XXX 50.5876830 C TC 0.00 1.52 1.52 0.10 XXX 50.5876830 C 26 0.69 0.23 0.23 0.03 XXX 50.5876831 C 0.72 1.77 1.77 0.13 XXX 50.5876831 C TC 0.00 1.52 1.52 0.10 XXX 50.5876831 C 26 0.72 0.25 0.25 0.03 XXX 50.5876856 C 0.69 1.75 1.75 0.13 XXX 50.5876856 C TC 0.00 1.52 1.52 0.10 XXX 50.5876856 C 26 0.69 0.23 0.23 0.03 XXX 50.5876857 C 0.38 1.83 1.83 0.08 XXX 50.5876857 C TC 0.00 1.71 1.71 0.06 XXX 50.5876857 C 26 0.38 0.12 0.12 0.02 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
76870 C 0.64 1.73 1.73 0.13 XXX 50.5876870 C TC 0.00 1.52 1.52 0.10 XXX 50.5876870 C 26 0.64 0.21 0.21 0.03 XXX 50.5876872 C 0.69 2.25 2.25 0.14 XXX 50.5876872 C TC 0.00 2.03 2.03 0.10 XXX 50.5876872 C 26 0.69 0.22 0.22 0.04 XXX 50.5876873 C 1.55 2.61 2.61 0.25 XXX 50.5876873 C TC 0.00 2.11 2.11 0.16 XXX 50.5876873 C 26 1.55 0.50 0.50 0.09 XXX 50.5876880 C 0.59 1.61 1.61 0.11 XXX 50.5876880 C TC 0.00 1.42 1.42 0.08 XXX 50.5876880 C 26 0.59 0.19 0.19 0.03 XXX 50.5876885 C 0.74 1.76 1.76 0.13 XXX 50.5876885 C TC 0.00 1.52 1.52 0.10 XXX 50.5876885 C 26 0.74 0.24 0.24 0.03 XXX 50.5876886 C 0.62 1.62 1.62 0.11 XXX 50.5876886 C TC 0.00 1.42 1.42 0.08 XXX 50.5876886 C 26 0.62 0.20 0.20 0.03 XXX 50.5876930 C 0.67 1.77 1.77 0.12 XXX 50.5876930 C TC 0.00 1.52 1.52 0.10 XXX 50.5876930 C 26 0.67 0.25 0.25 0.02 XXX 50.5876932 C 0.67 1.77 1.77 0.12 XXX 50.5876932 C TC 0.00 1.52 1.52 0.10 XXX 50.5876932 C 26 0.67 0.25 0.25 0.02 XXX 50.5876936 C 1.99 6.97 6.97 0.47 XXX 50.5876936 C TC 0.00 6.31 6.31 0.34 XXX 50.5876936 C 26 1.99 0.66 0.66 0.13 XXX 50.5876937 C 0.30 0.48 0.48 0.13 ZZZ 50.5876937 C TC 0.00 0.38 0.38 0.10 ZZZ 50.5876937 C 26 0.30 0.10 0.10 0.03 ZZZ 50.5876940 C 2.00 2.17 2.17 0.60 XXX 50.5876940 C TC 0.00 1.52 1.52 0.29 XXX 50.5876940 C 26 2.00 0.65 0.65 0.31 XXX 50.5876941 C 1.34 2.00 2.00 0.15 XXX 50.5876941 C TC 0.00 1.53 1.53 0.08 XXX 50.5876941 C 26 1.34 0.47 0.47 0.07 XXX 50.5876942 C 0.67 3.04 3.04 0.13 XXX 50.5876942 C TC 0.00 2.82 2.82 0.10 XXX 50.5876942 C 26 0.67 0.22 0.22 0.03 XXX 50.5876945 C 0.67 1.75 1.75 0.11 XXX 50.5876945 C TC 0.00 1.53 1.53 0.08 XXX 50.5876945 C 26 0.67 0.22 0.22 0.03 XXX 50.5876946 C 0.38 1.66 1.66 0.12 XXX 50.5876946 C TC 0.00 1.52 1.52 0.10 XXX 50.5876946 C 26 0.38 0.14 0.14 0.02 XXX 50.5876948 D 0.38 1.65 1.65 0.12 XXX 50.5876948 D TC 0.00 1.52 1.52 0.10 XXX 50.5876948 D 26 0.38 0.13 0.13 0.02 XXX 50.5876950 C 0.58 1.50 1.50 0.10 XXX 50.5876950 C TC 0.00 1.31 1.31 0.07 XXX 50.5876950 C 26 0.58 0.19 0.19 0.03 XXX 50.5876965 C 1.34 6.02 6.02 0.37 XXX 50.5876965 C TC 0.00 5.59 5.59 0.29 XXX 50.5876965 C 26 1.34 0.43 0.43 0.08 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
76970 C 0.40 1.18 1.18 0.08 XXX 50.5876970 C TC 0.00 1.05 1.05 0.06 XXX 50.5876970 C 26 0.40 0.13 0.13 0.02 XXX 50.5876975 C 0.81 1.80 1.80 0.14 XXX 50.5876975 C TC 0.00 1.52 1.52 0.10 XXX 50.5876975 C 26 0.81 0.28 0.28 0.04 XXX 50.5876977 C 0.05 0.84 0.84 0.06 XXX 50.5876977 C TC 0.00 0.82 0.82 0.05 XXX 50.5876977 C 26 0.05 0.02 0.02 0.01 XXX 50.5876986 C 1.20 3.03 3.03 0.27 XXX 50.5876986 C TC 0.00 2.63 2.63 0.14 XXX 50.5876986 C 26 1.20 0.40 0.40 0.13 XXX 50.5876999 S 0.00 0.00 0.00 0.00 XXX 0.0076999 S TC 0.00 0.00 0.00 0.00 XXX 0.0076999 S 26 0.00 0.00 0.00 0.00 XXX 0.0077261 C 1.39 0.51 0.51 0.07 XXX 50.5877262 C 2.11 0.75 0.75 0.11 XXX 50.5877263 C 3.14 1.11 1.11 0.16 XXX 50.5877280 C 0.70 3.70 3.70 0.22 XXX 50.5877280 C TC 0.00 3.48 3.48 0.18 XXX 50.5877280 C 26 0.70 0.22 0.22 0.04 XXX 50.5877285 C 1.05 5.93 5.93 0.35 XXX 50.5877285 C TC 0.00 5.59 5.59 0.30 XXX 50.5877285 C 26 1.05 0.34 0.34 0.05 XXX 50.5877290 C 1.56 7.03 7.03 0.43 XXX 50.5877290 C TC 0.00 6.53 6.53 0.35 XXX 50.5877290 C 26 1.56 0.50 0.50 0.08 XXX 50.5877295 C 4.56 29.47 29.47 1.71 XXX 50.5877295 C TC 0.00 28.01 28.01 1.48 XXX 50.5877295 C 26 4.56 1.46 1.46 0.23 XXX 50.5877299 S 0.00 0.00 0.00 0.00 XXX 0.0077299 S TC 0.00 0.00 0.00 0.00 XXX 0.0077299 S 26 0.00 0.00 0.00 0.00 XXX 0.0077300 C 0.62 1.54 1.54 0.10 XXX 50.5877300 C TC 0.00 1.34 1.34 0.07 XXX 50.5877300 C 26 0.62 0.20 0.20 0.03 XXX 50.5877301 C 7.99 30.58 30.58 1.88 XXX 50.5877301 C TC 0.00 28.01 28.01 1.48 XXX 50.5877301 C 26 7.99 2.57 2.57 0.40 XXX 50.5877305 C 0.70 2.10 2.10 0.15 XXX 50.5877305 C TC 0.00 1.87 1.87 0.11 XXX 50.5877305 C 26 0.70 0.23 0.23 0.04 XXX 50.5877310 C 1.05 2.68 2.68 0.18 XXX 50.5877310 C TC 0.00 2.34 2.34 0.13 XXX 50.5877310 C 26 1.05 0.34 0.34 0.05 XXX 50.5877315 C 1.56 3.17 3.17 0.22 XXX 50.5877315 C TC 0.00 2.67 2.67 0.14 XXX 50.5877315 C 26 1.56 0.50 0.50 0.08 XXX 50.5877321 C 0.95 4.35 4.35 0.26 XXX 50.5877321 C TC 0.00 4.05 4.05 0.21 XXX 50.5877321 C 26 0.95 0.30 0.30 0.05 XXX 50.5877326 C 0.93 2.67 2.67 0.18 XXX 50.5877326 C TC 0.00 2.37 2.37 0.13 XXX 50.5877326 C 26 0.93 0.30 0.30 0.05 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
77327 C 1.39 3.92 3.92 0.25 XXX 50.5877327 C TC 0.00 3.48 3.48 0.18 XXX 50.5877327 C 26 1.39 0.44 0.44 0.07 XXX 50.5877328 C 2.09 5.64 5.64 0.36 XXX 50.5877328 C TC 0.00 4.97 4.97 0.25 XXX 50.5877328 C 26 2.09 0.67 0.67 0.11 XXX 50.5877331 C 0.87 0.78 0.78 0.06 XXX 50.5877331 C TC 0.00 0.50 0.50 0.02 XXX 50.5877331 C 26 0.87 0.28 0.28 0.04 XXX 50.5877332 C 0.54 1.51 1.51 0.10 XXX 50.5877332 C TC 0.00 1.34 1.34 0.07 XXX 50.5877332 C 26 0.54 0.17 0.17 0.03 XXX 50.5877333 C 0.84 2.17 2.17 0.15 XXX 50.5877333 C TC 0.00 1.90 1.90 0.11 XXX 50.5877333 C 26 0.84 0.27 0.27 0.04 XXX 50.5877334 C 1.24 3.66 3.66 0.23 XXX 50.5877334 C TC 0.00 3.26 3.26 0.17 XXX 50.5877334 C 26 1.24 0.40 0.40 0.06 XXX 50.5877336 C 0.00 2.99 2.99 0.16 XXX 50.5877370 C 0.00 3.50 3.50 0.18 XXX 50.5877399 S 0.00 0.00 0.00 0.00 XXX 0.0077399 S TC 0.00 0.00 0.00 0.00 XXX 0.0077399 S 26 0.00 0.00 0.00 0.00 XXX 0.0077401 C 0.00 1.78 1.78 0.11 XXX 50.5877402 C 0.00 1.78 1.78 0.11 XXX 50.5877403 C 0.00 1.78 1.78 0.11 XXX 50.5877404 C 0.00 1.78 1.78 0.11 XXX 50.5877406 C 0.00 1.78 1.78 0.11 XXX 50.5877407 C 0.00 2.10 2.10 0.12 XXX 50.5877408 C 0.00 2.10 2.10 0.12 XXX 50.5877409 C 0.00 2.10 2.10 0.12 XXX 50.5877411 C 0.00 2.10 2.10 0.12 XXX 50.5877412 C 0.00 2.34 2.34 0.13 XXX 50.5877413 C 0.00 2.34 2.34 0.13 XXX 50.5877414 C 0.00 2.34 2.34 0.13 XXX 50.5877416 C 0.00 2.34 2.34 0.13 XXX 50.5877417 C 0.00 0.59 0.59 0.04 XXX 50.5877418 C 0.00 18.07 18.07 0.13 XXX 50.5877421 C 0.39 3.49 3.49 0.12 XXX 50.5877421 C TC 0.00 3.36 3.36 0.10 XXX 50.5877421 C 26 0.39 0.13 0.13 0.02 XXX 50.5877422 C 0.00 1.71 1.71 0.13 XXX 50.5877423 C 0.00 2.26 2.26 0.13 XXX 50.5877427 C 3.31 1.06 1.06 0.17 XXX 50.5877431 C 1.81 0.68 0.68 0.09 XXX 50.5877432 C 7.92 2.91 2.91 0.41 XXX 50.5877470 C 2.09 11.85 11.85 0.70 XXX 50.5877470 C TC 0.00 11.18 11.18 0.59 XXX 50.5877470 C 26 2.09 0.67 0.67 0.11 XXX 50.5877499 S 0.00 0.00 0.00 0.00 XXX 0.0077499 S TC 0.00 0.00 0.00 0.00 XXX 0.0077499 S 26 0.00 0.00 0.00 0.00 XXX 0.0077520 C 79.01 0.00 0.00 0.00 XXX 1.2577522 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
77523 C 92.69 0.00 0.00 0.00 XXX 1.2577525 C 0.00 0.00 0.00 0.00 XXX 0.0077600 C 1.56 3.56 3.56 0.24 XXX 50.5877600 C TC 0.00 3.06 3.06 0.16 XXX 50.5877600 C 26 1.56 0.50 0.50 0.08 XXX 50.5877605 C 2.09 4.73 4.73 0.38 XXX 50.5877605 C TC 0.00 4.07 4.07 0.22 XXX 50.5877605 C 26 2.09 0.66 0.66 0.16 XXX 50.5877610 C 1.56 3.57 3.57 0.24 XXX 50.5877610 C TC 0.00 3.06 3.06 0.16 XXX 50.5877610 C 26 1.56 0.51 0.51 0.08 XXX 50.5877615 C 2.09 4.73 4.73 0.33 XXX 50.5877615 C TC 0.00 4.07 4.07 0.22 XXX 50.5877615 C 26 2.09 0.66 0.66 0.11 XXX 50.5877620 C 1.56 3.58 3.58 0.36 XXX 50.5877620 C TC 0.00 3.06 3.06 0.16 XXX 50.5877620 C 26 1.56 0.52 0.52 0.20 XXX 50.5877750 C 4.90 2.91 2.91 0.32 090 50.5877750 C TC 0.00 1.33 1.33 0.07 090 50.5877750 C 26 4.90 1.58 1.58 0.25 090 50.5877761 C 3.80 3.60 3.60 0.33 090 50.5877761 C TC 0.00 2.51 2.51 0.14 090 50.5877761 C 26 3.80 1.09 1.09 0.19 090 50.5877762 C 5.71 5.46 5.46 0.48 090 50.5877762 C TC 0.00 3.62 3.62 0.19 090 50.5877762 C 26 5.71 1.84 1.84 0.29 090 50.5877763 C 8.56 7.25 7.25 0.66 090 50.5877763 C TC 0.00 4.50 4.50 0.23 090 50.5877763 C 26 8.56 2.75 2.75 0.43 090 50.5877776 C 4.65 3.14 3.14 0.57 090 50.5877776 C TC 0.00 2.19 2.19 0.13 090 50.5877776 C 26 4.65 0.95 0.95 0.44 090 50.5877777 C 7.47 6.62 6.62 0.61 090 50.5877777 C TC 0.00 4.24 4.24 0.22 090 50.5877777 C 26 7.47 2.38 2.38 0.39 090 50.5877778 C 11.17 8.72 8.72 0.84 090 50.5877778 C TC 0.00 5.14 5.14 0.27 090 50.5877778 C 26 11.17 3.58 3.58 0.57 090 50.5877781 C 1.66 20.89 20.89 1.14 090 50.5877781 C TC 0.00 20.36 20.36 1.06 090 50.5877781 C 26 1.66 0.53 0.53 0.08 090 50.5877782 C 2.49 21.16 21.16 1.19 090 50.5877782 C TC 0.00 20.36 20.36 1.06 090 50.5877782 C 26 2.49 0.80 0.80 0.13 090 50.5877783 C 3.72 21.55 21.55 1.25 090 50.5877783 C TC 0.00 20.36 20.36 1.06 090 50.5877783 C 26 3.72 1.19 1.19 0.19 090 50.5877784 C 5.60 22.16 22.16 1.35 090 50.5877784 C TC 0.00 20.36 20.36 1.06 090 50.5877784 C 26 5.60 1.80 1.80 0.29 090 50.5877789 C 1.12 0.82 0.82 0.08 000 50.5877789 C TC 0.00 0.45 0.45 0.02 000 50.5877789 C 26 1.12 0.37 0.37 0.06 000 50.5877790 C 1.05 0.84 0.84 0.07 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
77790 C TC 0.00 0.50 0.50 0.02 XXX 50.5877790 C 26 1.05 0.34 0.34 0.05 XXX 50.5877799 S 0.00 0.00 0.00 0.00 XXX 0.0077799 S TC 0.00 0.00 0.00 0.00 XXX 0.0077799 S 26 0.00 0.00 0.00 0.00 XXX 0.0078000 C 0.19 1.03 1.03 0.07 XXX 50.5878000 C TC 0.00 0.97 0.97 0.06 XXX 50.5878000 C 26 0.19 0.06 0.06 0.01 XXX 50.5878001 C 0.26 1.40 1.40 0.08 XXX 50.5878001 C TC 0.00 1.31 1.31 0.07 XXX 50.5878001 C 26 0.26 0.09 0.09 0.01 XXX 50.5878003 C 0.33 1.08 1.08 0.07 XXX 50.5878003 C TC 0.00 0.97 0.97 0.06 XXX 50.5878003 C 26 0.33 0.11 0.11 0.01 XXX 50.5878006 C 0.49 2.55 2.55 0.15 XXX 50.5878006 C TC 0.00 2.39 2.39 0.13 XXX 50.5878006 C 26 0.49 0.16 0.16 0.02 XXX 50.5878007 C 0.50 2.75 2.75 0.16 XXX 50.5878007 C TC 0.00 2.58 2.58 0.14 XXX 50.5878007 C 26 0.50 0.17 0.17 0.02 XXX 50.5878010 C 0.39 1.96 1.96 0.13 XXX 50.5878010 C TC 0.00 1.83 1.83 0.11 XXX 50.5878010 C 26 0.39 0.13 0.13 0.02 XXX 50.5878011 C 0.45 2.57 2.57 0.15 XXX 50.5878011 C TC 0.00 2.42 2.42 0.13 XXX 50.5878011 C 26 0.45 0.15 0.15 0.02 XXX 50.5878015 C 0.67 2.81 2.81 0.17 XXX 50.5878015 C TC 0.00 2.58 2.58 0.14 XXX 50.5878015 C 26 0.67 0.23 0.23 0.03 XXX 50.5878016 C 0.82 3.77 3.77 0.21 XXX 50.5878016 C TC 0.00 3.49 3.49 0.18 XXX 50.5878016 C 26 0.82 0.28 0.28 0.03 XXX 50.5878018 C 0.86 5.74 5.74 0.33 XXX 50.5878018 C TC 0.00 5.44 5.44 0.29 XXX 50.5878018 C 26 0.86 0.30 0.30 0.04 XXX 50.5878020 C 0.60 1.52 1.52 0.16 ZZZ 50.5878020 C TC 0.00 1.31 1.31 0.14 ZZZ 50.5878020 C 26 0.60 0.21 0.21 0.02 ZZZ 50.5878070 C 0.82 4.56 4.56 0.15 XXX 50.5878070 C TC 0.00 4.28 4.28 0.11 XXX 50.5878070 C 26 0.82 0.28 0.28 0.04 XXX 50.5878075 C 0.74 5.70 5.70 0.32 XXX 50.5878075 C TC 0.00 5.44 5.44 0.29 XXX 50.5878075 C 26 0.74 0.26 0.26 0.03 XXX 50.5878099 S 0.00 0.00 0.00 0.00 XXX 0.0078099 S TC 0.00 0.00 0.00 0.00 XXX 0.0078099 S 26 0.00 0.00 0.00 0.00 XXX 0.0078102 C 0.55 2.24 2.24 0.14 XXX 50.5878102 C TC 0.00 2.05 2.05 0.12 XXX 50.5878102 C 26 0.55 0.19 0.19 0.02 XXX 50.5878103 C 0.75 3.44 3.44 0.20 XXX 50.5878103 C TC 0.00 3.18 3.18 0.17 XXX 50.5878103 C 26 0.75 0.26 0.26 0.03 XXX 50.5878104 C 0.80 4.35 4.35 0.25 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78104 C TC 0.00 4.08 4.08 0.22 XXX 50.5878104 C 26 0.80 0.27 0.27 0.03 XXX 50.5878110 C 0.19 1.02 1.02 0.07 XXX 50.5878110 C TC 0.00 0.95 0.95 0.06 XXX 50.5878110 C 26 0.19 0.07 0.07 0.01 XXX 50.5878111 C 0.22 2.66 2.66 0.15 XXX 50.5878111 C TC 0.00 2.58 2.58 0.14 XXX 50.5878111 C 26 0.22 0.08 0.08 0.01 XXX 50.5878120 C 0.23 1.82 1.82 0.12 XXX 50.5878120 C TC 0.00 1.74 1.74 0.11 XXX 50.5878120 C 26 0.23 0.08 0.08 0.01 XXX 50.5878121 C 0.32 3.03 3.03 0.15 XXX 50.5878121 C TC 0.00 2.92 2.92 0.14 XXX 50.5878121 C 26 0.32 0.11 0.11 0.01 XXX 50.5878122 C 0.45 4.77 4.77 0.26 XXX 50.5878122 C TC 0.00 4.61 4.61 0.24 XXX 50.5878122 C 26 0.45 0.16 0.16 0.02 XXX 50.5878130 C 0.61 3.07 3.07 0.17 XXX 50.5878130 C TC 0.00 2.86 2.86 0.14 XXX 50.5878130 C 26 0.61 0.21 0.21 0.03 XXX 50.5878135 C 0.64 5.10 5.10 0.28 XXX 50.5878135 C TC 0.00 4.88 4.88 0.25 XXX 50.5878135 C 26 0.64 0.22 0.22 0.03 XXX 50.5878140 C 0.61 4.14 4.14 0.24 XXX 50.5878140 C TC 0.00 3.94 3.94 0.21 XXX 50.5878140 C 26 0.61 0.20 0.20 0.03 XXX 50.5878160 C 0.33 3.78 3.78 0.23 XXX 50.58 12/31/200578160 C TC 0.00 3.66 3.66 0.19 XXX 50.58 12/31/200578160 C 26 0.33 0.12 0.12 0.04 XXX 50.58 12/31/200578162 C 0.45 3.39 3.39 0.19 XXX 50.58 12/31/200578162 C TC 0.00 3.20 3.20 0.17 XXX 50.58 12/31/200578162 C 26 0.45 0.19 0.19 0.02 XXX 50.58 12/31/200578170 C 0.41 5.45 5.45 0.30 XXX 50.58 12/31/200578170 C TC 0.00 5.31 5.31 0.28 XXX 50.58 12/31/200578170 C 26 0.41 0.14 0.14 0.02 XXX 50.58 12/31/200578172 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200578172 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200578172 C 26 0.53 0.17 0.17 0.02 XXX 50.58 12/31/200578185 C 0.40 2.51 2.51 0.15 XXX 50.5878185 C TC 0.00 2.37 2.37 0.13 XXX 50.5878185 C 26 0.40 0.14 0.14 0.02 XXX 50.5878190 C 1.09 6.12 6.12 0.38 XXX 50.5878190 C TC 0.00 5.73 5.73 0.30 XXX 50.5878190 C 26 1.09 0.39 0.39 0.08 XXX 50.5878191 C 0.61 7.56 7.56 0.40 XXX 50.5878191 C TC 0.00 7.36 7.36 0.37 XXX 50.5878191 C 26 0.61 0.20 0.20 0.03 XXX 50.5878195 C 1.20 4.49 4.49 0.28 XXX 50.5878195 C TC 0.00 4.08 4.08 0.22 XXX 50.5878195 C 26 1.20 0.41 0.41 0.06 XXX 50.5878199 S 0.00 0.00 0.00 0.00 XXX 0.0078199 S TC 0.00 0.00 0.00 0.00 XXX 0.0078199 S 26 0.00 0.00 0.00 0.00 XXX 0.0078201 C 0.44 2.52 2.52 0.15 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78201 C TC 0.00 2.37 2.37 0.13 XXX 50.5878201 C 26 0.44 0.15 0.15 0.02 XXX 50.5878202 C 0.51 3.06 3.06 0.16 XXX 50.5878202 C TC 0.00 2.89 2.89 0.14 XXX 50.5878202 C 26 0.51 0.17 0.17 0.02 XXX 50.5878205 C 0.71 6.17 6.17 0.34 XXX 50.5878205 C TC 0.00 5.93 5.93 0.31 XXX 50.5878205 C 26 0.71 0.24 0.24 0.03 XXX 50.5878206 C 0.96 6.26 6.26 0.15 XXX 50.5878206 C TC 0.00 5.93 5.93 0.11 XXX 50.5878206 C 26 0.96 0.33 0.33 0.04 XXX 50.5878215 C 0.49 3.11 3.11 0.16 XXX 50.5878215 C TC 0.00 2.95 2.95 0.14 XXX 50.5878215 C 26 0.49 0.16 0.16 0.02 XXX 50.5878216 C 0.57 3.68 3.68 0.20 XXX 50.5878216 C TC 0.00 3.49 3.49 0.18 XXX 50.5878216 C 26 0.57 0.19 0.19 0.02 XXX 50.5878220 C 0.49 3.89 3.89 0.21 XXX 50.5878220 C TC 0.00 3.73 3.73 0.19 XXX 50.5878220 C 26 0.49 0.16 0.16 0.02 XXX 50.5878223 C 0.84 3.95 3.95 0.23 XXX 50.5878223 C TC 0.00 3.67 3.67 0.19 XXX 50.5878223 C 26 0.84 0.28 0.28 0.04 XXX 50.5878230 C 0.45 2.34 2.34 0.15 XXX 50.5878230 C TC 0.00 2.19 2.19 0.13 XXX 50.5878230 C 26 0.45 0.15 0.15 0.02 XXX 50.5878231 C 0.52 3.36 3.36 0.19 XXX 50.5878231 C TC 0.00 3.18 3.18 0.17 XXX 50.5878231 C 26 0.52 0.18 0.18 0.02 XXX 50.5878232 C 0.47 3.71 3.71 0.20 XXX 50.5878232 C TC 0.00 3.55 3.55 0.18 XXX 50.5878232 C 26 0.47 0.16 0.16 0.02 XXX 50.5878258 C 0.74 3.14 3.14 0.17 XXX 50.5878258 C TC 0.00 2.89 2.89 0.14 XXX 50.5878258 C 26 0.74 0.25 0.25 0.03 XXX 50.5878261 C 0.69 4.35 4.35 0.25 XXX 50.5878261 C TC 0.00 4.11 4.11 0.22 XXX 50.5878261 C 26 0.69 0.24 0.24 0.03 XXX 50.5878262 C 0.68 4.49 4.49 0.25 XXX 50.5878262 C TC 0.00 4.26 4.26 0.22 XXX 50.5878262 C 26 0.68 0.23 0.23 0.03 XXX 50.5878264 C 0.78 4.40 4.40 0.25 XXX 50.5878264 C TC 0.00 4.14 4.14 0.22 XXX 50.5878264 C 26 0.78 0.26 0.26 0.03 XXX 50.5878267 C 10.98 0.00 0.00 0.00 XXX 1.7578268 C 94.11 0.00 0.00 0.00 XXX 1.7578270 C 0.20 1.62 1.62 0.11 XXX 50.5878270 C TC 0.00 1.55 1.55 0.10 XXX 50.5878270 C 26 0.20 0.07 0.07 0.01 XXX 50.5878271 C 0.20 1.71 1.71 0.11 XXX 50.5878271 C TC 0.00 1.64 1.64 0.10 XXX 50.5878271 C 26 0.20 0.07 0.07 0.01 XXX 50.5878272 C 0.27 2.42 2.42 0.14 XXX 50.5878272 C TC 0.00 2.33 2.33 0.13 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78272 C 26 0.27 0.09 0.09 0.01 XXX 50.5878278 C 0.99 5.21 5.21 0.29 XXX 50.5878278 C TC 0.00 4.88 4.88 0.25 XXX 50.5878278 C 26 0.99 0.33 0.33 0.04 XXX 50.5878282 C 0.38 4.71 4.71 0.55 XXX 50.5878282 C TC 0.00 4.58 4.58 0.53 XXX 50.5878282 C 26 0.38 0.13 0.13 0.02 XXX 50.5878290 C 0.68 3.29 3.29 0.19 XXX 50.5878290 C TC 0.00 3.06 3.06 0.16 XXX 50.5878290 C 26 0.68 0.23 0.23 0.03 XXX 50.5878291 C 0.88 3.37 3.37 0.20 XXX 50.5878291 C TC 0.00 3.07 3.07 0.16 XXX 50.5878291 C 26 0.88 0.30 0.30 0.04 XXX 50.5878299 S 0.00 0.00 0.00 0.00 XXX 0.0078299 S TC 0.00 0.00 0.00 0.00 XXX 0.0078299 S 26 0.00 0.00 0.00 0.00 XXX 0.0078300 C 0.62 2.70 2.70 0.17 XXX 50.5878300 C TC 0.00 2.49 2.49 0.14 XXX 50.5878300 C 26 0.62 0.21 0.21 0.03 XXX 50.5878305 C 0.83 3.95 3.95 0.23 XXX 50.5878305 C TC 0.00 3.67 3.67 0.19 XXX 50.5878305 C 26 0.83 0.28 0.28 0.04 XXX 50.5878306 C 0.86 4.57 4.57 0.26 XXX 50.5878306 C TC 0.00 4.28 4.28 0.22 XXX 50.5878306 C 26 0.86 0.29 0.29 0.04 XXX 50.5878315 C 1.02 5.13 5.13 0.29 XXX 50.5878315 C TC 0.00 4.79 4.79 0.25 XXX 50.5878315 C 26 1.02 0.34 0.34 0.04 XXX 50.5878320 C 1.04 6.29 6.29 0.35 XXX 50.5878320 C TC 0.00 5.93 5.93 0.31 XXX 50.5878320 C 26 1.04 0.36 0.36 0.04 XXX 50.5878350 C 0.22 0.82 0.82 0.06 XXX 50.5878350 C TC 0.00 0.75 0.75 0.05 XXX 50.5878350 C 26 0.22 0.07 0.07 0.01 XXX 50.5878351 C 0.30 1.72 0.12 0.01 XXX 50.5878399 S 0.00 0.00 0.00 0.00 XXX 0.0078399 S TC 0.00 0.00 0.00 0.00 XXX 0.0078399 S 26 0.00 0.00 0.00 0.00 XXX 0.0078414 C 0.45 2.75 2.75 0.10 XXX 50.5878414 C TC 0.00 2.59 2.59 0.08 XXX 50.5878414 C 26 0.45 0.16 0.16 0.02 XXX 50.5878428 C 0.78 2.55 2.55 0.16 XXX 50.5878428 C TC 0.00 2.26 2.26 0.13 XXX 50.5878428 C 26 0.78 0.29 0.29 0.03 XXX 50.5878445 C 0.49 2.04 2.04 0.13 XXX 50.5878445 C TC 0.00 1.87 1.87 0.11 XXX 50.5878445 C 26 0.49 0.17 0.17 0.02 XXX 50.5878455 C 0.73 4.23 4.23 0.24 XXX 50.58 12/31/200578455 C TC 0.00 3.98 3.98 0.21 XXX 50.58 12/31/200578455 C 26 0.73 0.25 0.25 0.03 XXX 50.58 12/31/200578456 C 1.00 4.33 4.33 0.33 XXX 50.5878456 C TC 0.00 3.99 3.99 0.29 XXX 50.5878456 C 26 1.00 0.34 0.34 0.04 XXX 50.5878457 C 0.77 2.93 2.93 0.17 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78457 C TC 0.00 2.67 2.67 0.14 XXX 50.5878457 C 26 0.77 0.26 0.26 0.03 XXX 50.5878458 C 0.90 4.35 4.35 0.25 XXX 50.5878458 C TC 0.00 4.03 4.03 0.21 XXX 50.5878458 C 26 0.90 0.32 0.32 0.04 XXX 50.5878459 C 1.50 55.57 55.57 1.51 XXX 50.5878459 C TC 0.00 55.00 55.00 1.46 XXX 50.5878459 C 26 1.50 0.57 0.57 0.05 XXX 50.5878460 C 0.86 2.66 2.66 0.17 XXX 50.5878460 C TC 0.00 2.37 2.37 0.13 XXX 50.5878460 C 26 0.86 0.29 0.29 0.04 XXX 50.5878461 C 1.23 5.16 5.16 0.30 XXX 50.5878461 C TC 0.00 4.73 4.73 0.25 XXX 50.5878461 C 26 1.23 0.43 0.43 0.05 XXX 50.5878464 C 1.09 7.47 7.47 0.41 XXX 50.5878464 C TC 0.00 7.09 7.09 0.37 XXX 50.5878464 C 26 1.09 0.38 0.38 0.04 XXX 50.5878465 C 1.46 12.34 12.34 0.67 XXX 50.5878465 C TC 0.00 11.82 11.82 0.62 XXX 50.5878465 C 26 1.46 0.52 0.52 0.05 XXX 50.5878466 C 0.69 2.87 2.87 0.17 XXX 50.5878466 C TC 0.00 2.63 2.63 0.14 XXX 50.5878466 C 26 0.69 0.24 0.24 0.03 XXX 50.5878468 C 0.80 3.94 3.94 0.22 XXX 50.5878468 C TC 0.00 3.67 3.67 0.19 XXX 50.5878468 C 26 0.80 0.27 0.27 0.03 XXX 50.5878469 C 0.92 5.55 5.55 0.31 XXX 50.5878469 C TC 0.00 5.24 5.24 0.28 XXX 50.5878469 C 26 0.92 0.31 0.31 0.03 XXX 50.5878472 C 0.98 5.87 5.87 0.34 XXX 50.5878472 C TC 0.00 5.53 5.53 0.30 XXX 50.5878472 C 26 0.98 0.34 0.34 0.04 XXX 50.5878473 C 1.47 8.79 8.79 0.48 XXX 50.5878473 C TC 0.00 8.28 8.28 0.42 XXX 50.5878473 C 26 1.47 0.51 0.51 0.06 XXX 50.5878478 C 0.62 1.79 1.79 0.12 XXX 50.5878478 C TC 0.00 1.56 1.56 0.10 XXX 50.5878478 C 26 0.62 0.23 0.23 0.02 XXX 50.5878480 C 0.62 1.78 1.78 0.12 XXX 50.5878480 C TC 0.00 1.56 1.56 0.10 XXX 50.5878480 C 26 0.62 0.22 0.22 0.02 XXX 50.5878481 C 0.98 5.60 5.60 0.31 XXX 50.5878481 C TC 0.00 5.24 5.24 0.28 XXX 50.5878481 C 26 0.98 0.36 0.36 0.03 XXX 50.5878483 C 1.47 8.43 8.43 0.46 XXX 50.5878483 C TC 0.00 7.89 7.89 0.41 XXX 50.5878483 C 26 1.47 0.54 0.54 0.05 XXX 50.5878491 C 1.50 9.23 9.23 1.31 XXX 50.5878491 C TC 0.00 8.64 8.64 1.25 XXX 50.5878491 C 26 1.50 0.59 0.59 0.06 XXX 50.5878492 C 1.87 16.21 16.21 1.56 XXX 50.5878492 C TC 0.00 15.47 15.47 1.49 XXX 50.5878492 C 26 1.87 0.74 0.74 0.07 XXX 50.5878494 C 1.19 7.51 7.51 0.35 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78494 C TC 0.00 7.09 7.09 0.30 XXX 50.5878494 C 26 1.19 0.42 0.42 0.05 XXX 50.5878496 C 0.50 7.27 7.27 0.32 ZZZ 50.5878496 C TC 0.00 7.09 7.09 0.30 ZZZ 50.5878496 C 26 0.50 0.18 0.18 0.02 ZZZ 50.5878499 S 0.00 0.00 0.00 0.00 XXX 0.0078499 S TC 0.00 0.00 0.00 0.00 XXX 0.0078499 S 26 0.00 0.00 0.00 0.00 XXX 0.0078580 C 0.74 3.69 3.69 0.21 XXX 50.5878580 C TC 0.00 3.44 3.44 0.18 XXX 50.5878580 C 26 0.74 0.25 0.25 0.03 XXX 50.5878584 C 0.99 3.54 3.54 0.21 XXX 50.5878584 C TC 0.00 3.21 3.21 0.17 XXX 50.5878584 C 26 0.99 0.33 0.33 0.04 XXX 50.5878585 C 1.09 6.02 6.02 0.35 XXX 50.5878585 C TC 0.00 5.66 5.66 0.30 XXX 50.5878585 C 26 1.09 0.36 0.36 0.05 XXX 50.5878586 C 0.40 2.73 2.73 0.16 XXX 50.5878586 C TC 0.00 2.60 2.60 0.14 XXX 50.5878586 C 26 0.40 0.13 0.13 0.02 XXX 50.5878587 C 0.49 2.98 2.98 0.16 XXX 50.5878587 C TC 0.00 2.81 2.81 0.14 XXX 50.5878587 C 26 0.49 0.17 0.17 0.02 XXX 50.5878588 C 1.09 3.57 3.57 0.23 XXX 50.5878588 C TC 0.00 3.21 3.21 0.18 XXX 50.5878588 C 26 1.09 0.36 0.36 0.05 XXX 50.5878591 C 0.40 2.99 2.99 0.16 XXX 50.5878591 C TC 0.00 2.86 2.86 0.14 XXX 50.5878591 C 26 0.40 0.13 0.13 0.02 XXX 50.5878593 C 0.49 3.62 3.62 0.20 XXX 50.5878593 C TC 0.00 3.46 3.46 0.18 XXX 50.5878593 C 26 0.49 0.16 0.16 0.02 XXX 50.5878594 C 0.53 5.17 5.17 0.27 XXX 50.5878594 C TC 0.00 4.99 4.99 0.25 XXX 50.5878594 C 26 0.53 0.18 0.18 0.02 XXX 50.5878596 C 1.27 7.51 7.51 0.42 XXX 50.5878596 C TC 0.00 7.09 7.09 0.37 XXX 50.5878596 C 26 1.27 0.42 0.42 0.05 XXX 50.5878599 S 0.00 0.00 0.00 0.00 XXX 0.0078599 S TC 0.00 0.00 0.00 0.00 XXX 0.0078599 S 26 0.00 0.00 0.00 0.00 XXX 0.0078600 C 0.44 3.04 3.04 0.16 XXX 50.5878600 C TC 0.00 2.89 2.89 0.14 XXX 50.5878600 C 26 0.44 0.15 0.15 0.02 XXX 50.5878601 C 0.51 3.58 3.58 0.20 XXX 50.5878601 C TC 0.00 3.41 3.41 0.18 XXX 50.5878601 C 26 0.51 0.17 0.17 0.02 XXX 50.5878605 C 0.53 3.59 3.59 0.20 XXX 50.5878605 C TC 0.00 3.41 3.41 0.18 XXX 50.5878605 C 26 0.53 0.18 0.18 0.02 XXX 50.5878606 C 0.64 4.09 4.09 0.24 XXX 50.5878606 C TC 0.00 3.88 3.88 0.21 XXX 50.5878606 C 26 0.64 0.21 0.21 0.03 XXX 50.5878607 C 1.23 7.00 7.00 0.40 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78607 C TC 0.00 6.57 6.57 0.35 XXX 50.5878607 C 26 1.23 0.43 0.43 0.05 XXX 50.5878608 C 1.50 55.57 55.57 1.50 XXX 50.5878608 C TC 0.00 55.06 55.06 1.44 XXX 50.5878608 C 26 1.50 0.51 0.51 0.06 XXX 50.5878609 C 1.50 55.57 55.57 1.50 XXX 50.5878609 C TC 0.00 55.06 55.06 1.44 XXX 50.5878609 C 26 1.50 0.51 0.51 0.06 XXX 50.5878610 C 0.30 1.69 1.69 0.11 XXX 50.5878610 C TC 0.00 1.58 1.58 0.10 XXX 50.5878610 C 26 0.30 0.11 0.11 0.01 XXX 50.5878615 C 0.42 4.01 4.01 0.23 XXX 50.5878615 C TC 0.00 3.86 3.86 0.21 XXX 50.5878615 C 26 0.42 0.15 0.15 0.02 XXX 50.5878630 C 0.68 5.28 5.28 0.30 XXX 50.5878630 C TC 0.00 5.05 5.05 0.27 XXX 50.5878630 C 26 0.68 0.23 0.23 0.03 XXX 50.5878635 C 0.61 2.78 2.78 0.16 XXX 50.5878635 C TC 0.00 2.55 2.55 0.14 XXX 50.5878635 C 26 0.61 0.23 0.23 0.02 XXX 50.5878645 C 0.57 3.63 3.63 0.20 XXX 50.5878645 C TC 0.00 3.44 3.44 0.18 XXX 50.5878645 C 26 0.57 0.19 0.19 0.02 XXX 50.5878647 C 0.90 6.24 6.24 0.35 XXX 50.5878647 C TC 0.00 5.93 5.93 0.31 XXX 50.5878647 C 26 0.90 0.31 0.31 0.04 XXX 50.5878650 C 0.61 4.86 4.86 0.27 XXX 50.5878650 C TC 0.00 4.65 4.65 0.24 XXX 50.5878650 C 26 0.61 0.21 0.21 0.03 XXX 50.5878660 C 0.53 2.31 2.31 0.14 XXX 50.5878660 C TC 0.00 2.13 2.13 0.12 XXX 50.5878660 C 26 0.53 0.18 0.18 0.02 XXX 50.5878699 S 0.00 0.00 0.00 0.00 XXX 0.0078699 S TC 0.00 0.00 0.00 0.00 XXX 0.0078699 S 26 0.00 0.00 0.00 0.00 XXX 0.0078700 C 0.45 3.21 3.21 0.18 XXX 50.5878700 C TC 0.00 3.06 3.06 0.16 XXX 50.5878700 C 26 0.45 0.15 0.15 0.02 XXX 50.5878701 C 0.49 3.73 3.73 0.20 XXX 50.5878701 C TC 0.00 3.57 3.57 0.18 XXX 50.5878701 C 26 0.49 0.16 0.16 0.02 XXX 50.5878704 C 0.74 4.21 4.21 0.24 XXX 50.5878704 C TC 0.00 3.96 3.96 0.21 XXX 50.5878704 C 26 0.74 0.25 0.25 0.03 XXX 50.5878707 C 0.96 4.80 4.80 0.27 XXX 50.5878707 C TC 0.00 4.48 4.48 0.23 XXX 50.5878707 C 26 0.96 0.32 0.32 0.04 XXX 50.5878708 C 1.21 4.89 4.89 0.28 XXX 50.5878708 C TC 0.00 4.48 4.48 0.23 XXX 50.5878708 C 26 1.21 0.41 0.41 0.05 XXX 50.5878709 C 1.41 4.95 4.95 0.29 XXX 50.5878709 C TC 0.00 4.48 4.48 0.23 XXX 50.5878709 C 26 1.41 0.47 0.47 0.06 XXX 50.5878710 C 0.66 6.15 6.15 0.34 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78710 C TC 0.00 5.93 5.93 0.31 XXX 50.5878710 C 26 0.66 0.22 0.22 0.03 XXX 50.5878715 C 0.30 1.69 1.69 0.11 XXX 50.5878715 C TC 0.00 1.58 1.58 0.10 XXX 50.5878715 C 26 0.30 0.11 0.11 0.01 XXX 50.5878725 C 0.38 1.92 1.92 0.13 XXX 50.5878725 C TC 0.00 1.79 1.79 0.11 XXX 50.5878725 C 26 0.38 0.13 0.13 0.02 XXX 50.5878730 C 0.36 1.58 1.58 0.10 XXX 50.5878730 C TC 0.00 1.46 1.46 0.08 XXX 50.5878730 C 26 0.36 0.12 0.12 0.02 XXX 50.5878740 C 0.57 2.32 2.32 0.15 XXX 50.5878740 C TC 0.00 2.13 2.13 0.12 XXX 50.5878740 C 26 0.57 0.19 0.19 0.03 XXX 50.5878760 C 0.66 2.91 2.91 0.17 XXX 50.5878760 C TC 0.00 2.69 2.69 0.14 XXX 50.5878760 C 26 0.66 0.22 0.22 0.03 XXX 50.5878761 C 0.71 3.45 3.45 0.20 XXX 50.5878761 C TC 0.00 3.21 3.21 0.17 XXX 50.5878761 C 26 0.71 0.24 0.24 0.03 XXX 50.5878799 S 0.00 0.00 0.00 0.00 XXX 0.0078799 S TC 0.00 0.00 0.00 0.00 XXX 0.0078799 S 26 0.00 0.00 0.00 0.00 XXX 0.0078800 C 0.66 3.63 3.63 0.22 XXX 50.5878800 C TC 0.00 3.41 3.41 0.18 XXX 50.5878800 C 26 0.66 0.22 0.22 0.04 XXX 50.5878801 C 0.79 4.50 4.50 0.27 XXX 50.5878801 C TC 0.00 4.23 4.23 0.22 XXX 50.5878801 C 26 0.79 0.27 0.27 0.05 XXX 50.5878802 C 0.86 5.84 5.84 0.34 XXX 50.5878802 C TC 0.00 5.55 5.55 0.30 XXX 50.5878802 C 26 0.86 0.29 0.29 0.04 XXX 50.5878803 C 1.09 6.95 6.95 0.40 XXX 50.5878803 C TC 0.00 6.57 6.57 0.35 XXX 50.5878803 C 26 1.09 0.38 0.38 0.05 XXX 50.5878804 C 1.07 11.46 11.46 0.34 XXX 50.5878804 C TC 0.00 11.09 11.09 0.30 XXX 50.5878804 C 26 1.07 0.37 0.37 0.04 XXX 50.5878805 C 0.73 3.66 3.66 0.21 XXX 50.5878805 C TC 0.00 3.41 3.41 0.18 XXX 50.5878805 C 26 0.73 0.25 0.25 0.03 XXX 50.5878806 C 0.86 6.74 6.74 0.39 XXX 50.5878806 C TC 0.00 6.45 6.45 0.35 XXX 50.5878806 C 26 0.86 0.29 0.29 0.04 XXX 50.5878807 C 1.09 6.96 6.96 0.39 XXX 50.5878807 C TC 0.00 6.57 6.57 0.35 XXX 50.5878807 C 26 1.09 0.39 0.39 0.04 XXX 50.5878811 C 3.91 41.83 41.83 1.24 XXX 50.5878811 C TC 3.75 40.11 40.11 1.19 XXX 50.5878811 C 26 1.54 0.53 0.53 0.11 XXX 50.5878812 C 3.95 42.29 42.29 1.25 XXX 50.5878812 C TC 3.77 40.40 40.40 1.20 XXX 50.5878812 C 26 1.93 0.66 0.66 0.11 XXX 50.5878813 C 4.01 42.98 42.98 1.28 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
78813 C TC 3.80 40.68 40.68 1.21 XXX 50.5878813 C 26 2.00 0.69 0.69 0.11 XXX 50.5878814 C 4.14 44.29 44.29 1.31 XXX 50.5878814 C TC 3.93 42.06 42.06 1.25 XXX 50.5878814 C 26 2.20 0.76 0.76 0.11 XXX 50.5878815 C 4.17 44.69 44.69 1.33 XXX 50.5878815 C TC 3.96 42.40 42.40 1.26 XXX 50.5878815 C 26 2.44 0.84 0.84 0.11 XXX 50.5878816 C 4.22 45.15 45.15 1.34 XXX 50.5878816 C TC 3.98 42.63 42.63 1.26 XXX 50.5878816 C 26 2.50 0.86 0.86 0.11 XXX 50.5878890 C 0.05 1.33 1.33 0.07 XXX 49.8478890 C TC 0.00 1.31 1.31 0.06 XXX 49.8478890 C 26 0.05 0.02 0.02 0.01 XXX 49.8478891 C 0.10 2.67 2.67 0.14 XXX 50.5878891 C TC 0.00 2.63 2.63 0.13 XXX 50.5878891 C 26 0.10 0.04 0.04 0.01 XXX 50.5878999 S 0.00 0.00 0.00 0.00 XXX 0.0078999 S TC 0.00 0.00 0.00 0.00 XXX 0.0078999 S 26 0.00 0.00 0.00 0.00 XXX 0.0079005 C 1.80 3.23 3.23 0.22 XXX 50.5879005 C TC 0.00 2.63 2.63 0.14 XXX 50.5879005 C 26 1.80 0.60 0.60 0.08 XXX 50.5879101 C 1.96 3.30 3.30 0.22 XXX 50.5879101 C TC 0.00 2.63 2.63 0.14 XXX 50.5879101 C 26 1.96 0.67 0.67 0.08 XXX 50.5879200 C 1.99 3.32 3.32 0.23 XXX 50.5879200 C TC 0.00 2.63 2.63 0.14 XXX 50.5879200 C 26 1.99 0.69 0.69 0.09 XXX 50.5879300 C 1.60 4.55 4.55 0.34 XXX 50.5879300 C TC 0.00 3.99 3.99 0.21 XXX 50.5879300 C 26 1.60 0.56 0.56 0.13 XXX 50.5879403 C 2.25 5.17 5.17 0.24 XXX 50.5879403 C TC 0.00 4.28 4.28 0.14 XXX 50.5879403 C 26 2.25 0.89 0.89 0.10 XXX 50.5879440 C 1.99 3.35 3.35 0.22 XXX 50.5879440 C TC 0.00 2.63 2.63 0.14 XXX 50.5879440 C 26 1.99 0.72 0.72 0.08 XXX 50.5879445 C 2.40 3.44 3.44 0.28 XXX 50.5879445 C TC 0.00 2.62 2.62 0.16 XXX 50.5879445 C 26 2.40 0.82 0.82 0.12 XXX 50.5879999 S 0.00 0.00 0.00 0.00 XXX 0.0079999 S TC 0.00 0.00 0.00 0.00 XXX 0.0079999 S 26 0.00 0.00 0.00 0.00 XXX 0.0080048 C 11.83 0.00 0.00 0.00 XXX 1.8080050 C 0.00 0.00 0.00 0.00 XXX 0.0080051 C 9.80 0.00 0.00 0.00 XXX 1.8080053 C 15.16 0.00 0.00 0.00 XXX 1.8080055 C 0.00 0.00 0.00 0.00 XXX 0.0080061 C 18.72 0.00 0.00 0.00 XXX 1.8080061 C QW 18.72 0.00 0.00 0.00 XXX 1.8080069 C 12.13 0.00 0.00 0.00 XXX 1.8080074 C 66.54 0.00 0.00 0.00 XXX 1.8080076 C 11.42 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
80100 C 20.32 0.00 0.00 0.00 XXX 1.8080101 C 19.25 0.00 0.00 0.00 XXX 1.8080101 C QW 19.24 0.00 0.00 0.00 XXX 1.8080102 C 18.51 0.00 0.00 0.00 XXX 1.8080103 C 0.00 0.00 0.00 0.00 XXX 0.0080150 C 21.06 0.00 0.00 0.00 XXX 1.8080152 C 25.01 0.00 0.00 0.00 XXX 1.8080154 C 25.84 0.00 0.00 0.00 XXX 1.8080156 C 20.34 0.00 0.00 0.00 XXX 1.8080157 C 18.52 0.00 0.00 0.00 XXX 1.8080158 C 25.23 0.00 0.00 0.00 XXX 1.8080160 C 24.05 0.00 0.00 0.00 XXX 1.8080162 C 18.55 0.00 0.00 0.00 XXX 1.8080164 C 18.93 0.00 0.00 0.00 XXX 1.8080166 C 21.66 0.00 0.00 0.00 XXX 1.8080168 C 22.83 0.00 0.00 0.00 XXX 1.8080170 C 22.90 0.00 0.00 0.00 XXX 1.8080172 C 22.76 0.00 0.00 0.00 XXX 1.8080173 C 20.34 0.00 0.00 0.00 XXX 1.8080174 C 24.05 0.00 0.00 0.00 XXX 1.8080176 C 20.52 0.00 0.00 0.00 XXX 1.8080178 C 9.24 0.00 0.00 0.00 XXX 1.8080182 C 18.93 0.00 0.00 0.00 XXX 1.8080184 C 16.01 0.00 0.00 0.00 XXX 1.8080185 C 18.52 0.00 0.00 0.00 XXX 1.8080186 C 19.23 0.00 0.00 0.00 XXX 1.8080188 C 23.18 0.00 0.00 0.00 XXX 1.8080190 C 23.41 0.00 0.00 0.00 XXX 1.8080192 C 23.41 0.00 0.00 0.00 XXX 1.8080194 C 20.39 0.00 0.00 0.00 XXX 1.8080195 C 19.17 0.00 0.00 0.00 XXX 1.8080196 C 9.92 0.00 0.00 0.00 XXX 1.8080197 C 19.17 0.00 0.00 0.00 XXX 1.8080198 C 19.77 0.00 0.00 0.00 XXX 1.8080200 C 22.52 0.00 0.00 0.00 XXX 1.8080201 C 16.66 0.00 0.00 0.00 XXX 1.8080202 C 18.93 0.00 0.00 0.00 XXX 1.8080299 C 19.13 0.00 0.00 0.00 XXX 1.8080400 C 45.56 0.00 0.00 0.00 XXX 1.8080402 C 121.46 0.00 0.00 0.00 XXX 1.8080406 C 109.34 0.00 0.00 0.00 XXX 1.8080408 C 175.34 0.00 0.00 0.00 XXX 1.8080410 C 112.23 0.00 0.00 0.00 XXX 1.8080412 C 460.50 0.00 0.00 0.00 XXX 1.8080414 C 72.16 0.00 0.00 0.00 XXX 1.8080415 C 78.08 0.00 0.00 0.00 XXX 1.8080416 C 184.38 0.00 0.00 0.00 XXX 1.8080417 C 61.46 0.00 0.00 0.00 XXX 1.8080418 C 809.76 0.00 0.00 0.00 XXX 1.8080420 C 100.64 0.00 0.00 0.00 XXX 1.8080422 C 64.38 0.00 0.00 0.00 XXX 1.8080424 C 70.56 0.00 0.00 0.00 XXX 1.8080426 C 207.40 0.00 0.00 0.00 XXX 1.8080428 C 93.16 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
80430 C 109.60 0.00 0.00 0.00 XXX 1.8080432 C 188.73 0.00 0.00 0.00 XXX 1.8080434 C 141.30 0.00 0.00 0.00 XXX 1.8080435 C 143.85 0.00 0.00 0.00 XXX 1.8080436 C 127.36 0.00 0.00 0.00 XXX 1.8080438 C 70.41 0.00 0.00 0.00 XXX 1.8080439 C 93.88 0.00 0.00 0.00 XXX 1.8080440 C 81.24 0.00 0.00 0.00 XXX 1.8080500 C 0.37 0.21 0.16 0.01 XXX 50.5880502 C 1.33 0.54 0.54 0.04 XXX 50.5881000 C 4.43 0.00 0.00 0.00 XXX 1.8081001 C 4.43 0.00 0.00 0.00 XXX 1.8081002 C 3.57 0.00 0.00 0.00 XXX 1.8081003 C 3.14 0.00 0.00 0.00 XXX 1.8081003 C QW 3.14 0.00 0.00 0.00 XXX 1.8081005 C 3.03 0.00 0.00 0.00 XXX 1.8081007 C 3.59 0.00 0.00 0.00 XXX 1.8081007 C QW 3.59 0.00 0.00 0.00 XXX 1.8081015 C 4.24 0.00 0.00 0.00 XXX 1.8081020 C 5.15 0.00 0.00 0.00 XXX 1.8081025 C 8.84 0.00 0.00 0.00 XXX 1.8081050 C 4.19 0.00 0.00 0.00 XXX 1.8081099 S 0.00 0.00 0.00 0.00 XXX 0.0082000 C 17.31 0.00 0.00 0.00 XXX 1.8082003 C 28.28 0.00 0.00 0.00 XXX 1.8082009 C 6.31 0.00 0.00 0.00 XXX 1.8082010 C 11.42 0.00 0.00 0.00 XXX 1.8082010 C QW 11.42 0.00 0.00 0.00 XXX 1.8082013 C 15.61 0.00 0.00 0.00 XXX 1.8082016 C 19.37 0.00 0.00 0.00 XXX 1.8082017 C 23.57 0.00 0.00 0.00 XXX 1.8082024 C 53.97 0.00 0.00 0.00 XXX 1.8082030 C 36.05 0.00 0.00 0.00 XXX 1.8082040 C 6.92 0.00 0.00 0.00 XXX 1.8082042 C 7.23 0.00 0.00 0.00 XXX 1.8082043 C 8.09 0.00 0.00 0.00 XXX 1.8082044 C 6.39 0.00 0.00 0.00 XXX 1.8082044 C QW 6.39 0.00 0.00 0.00 XXX 1.8082045 C 47.43 0.00 0.00 0.00 XXX 1.8082055 C 15.10 0.00 0.00 0.00 XXX 1.8082055 C QW 15.10 0.00 0.00 0.00 XXX 1.8082075 C 16.84 0.00 0.00 0.00 XXX 1.8082085 C 13.56 0.00 0.00 0.00 XXX 1.8082088 C 56.94 0.00 0.00 0.00 XXX 1.8082101 C 41.94 0.00 0.00 0.00 XXX 1.8082103 C 18.77 0.00 0.00 0.00 XXX 1.8082104 C 20.20 0.00 0.00 0.00 XXX 1.8082105 C 23.44 0.00 0.00 0.00 XXX 1.8082106 C 23.44 0.00 0.00 0.00 XXX 1.8082108 C 35.60 0.00 0.00 0.00 XXX 1.8082120 C 5.25 0.00 0.00 0.00 XXX 1.8082120 C QW 5.25 0.00 0.00 0.00 XXX 1.8082127 C 19.37 0.00 0.00 0.00 XXX 1.8082128 C 19.37 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
82131 C 23.57 0.00 0.00 0.00 XXX 1.8082135 C 23.00 0.00 0.00 0.00 XXX 1.8082136 C 23.57 0.00 0.00 0.00 XXX 1.8082139 C 23.57 0.00 0.00 0.00 XXX 1.8082140 C 20.36 0.00 0.00 0.00 XXX 1.8082143 C 9.61 0.00 0.00 0.00 XXX 1.8082145 C 21.72 0.00 0.00 0.00 XXX 1.8082150 C 9.06 0.00 0.00 0.00 XXX 1.8082154 C 40.29 0.00 0.00 0.00 XXX 1.8082157 C 40.90 0.00 0.00 0.00 XXX 1.8082160 C 34.94 0.00 0.00 0.00 XXX 1.8082163 C 28.68 0.00 0.00 0.00 XXX 1.8082164 C 20.39 0.00 0.00 0.00 XXX 1.8082172 C 21.65 0.00 0.00 0.00 XXX 1.8082175 C 26.51 0.00 0.00 0.00 XXX 1.8082180 C 13.81 0.00 0.00 0.00 XXX 1.8082190 C 20.83 0.00 0.00 0.00 XXX 1.8082205 C 16.01 0.00 0.00 0.00 XXX 1.8082232 C 22.61 0.00 0.00 0.00 XXX 1.8082239 C 23.94 0.00 0.00 0.00 XXX 1.8082240 C 37.13 0.00 0.00 0.00 XXX 1.8082247 C 7.02 0.00 0.00 0.00 XXX 1.8082248 C 7.02 0.00 0.00 0.00 XXX 1.8082252 C 6.35 0.00 0.00 0.00 XXX 1.8082261 C 23.57 0.00 0.00 0.00 XXX 1.8082270 C 4.54 0.00 0.00 0.00 XXX 1.8082271 C 4.54 0.00 0.00 0.00 XXX 1.8082271 C QW 4.54 0.00 0.00 0.00 XXX 1.8082272 C 4.54 0.00 0.00 0.00 XXX 1.8082272 C QW 4.54 0.00 0.00 0.00 XXX 1.8082273 C 0.00 4.66 4.66 0.00 XXX 1.73 12/31/200582273 C QW 0.00 4.66 4.66 0.00 XXX 1.73 12/31/200582274 C 22.22 0.00 0.00 0.00 XXX 1.8082274 C QW 22.22 0.00 0.00 0.00 XXX 1.8082286 C 9.62 0.00 0.00 0.00 XXX 1.8082300 C 32.33 0.00 0.00 0.00 XXX 1.8082306 C 41.36 0.00 0.00 0.00 XXX 1.8082307 C 45.02 0.00 0.00 0.00 XXX 1.8082308 C 37.41 0.00 0.00 0.00 XXX 1.8082310 C 7.20 0.00 0.00 0.00 XXX 1.8082330 C 19.09 0.00 0.00 0.00 XXX 1.8082331 C 7.23 0.00 0.00 0.00 XXX 1.8082340 C 8.43 0.00 0.00 0.00 XXX 1.8082355 C 16.17 0.00 0.00 0.00 XXX 1.8082360 C 17.99 0.00 0.00 0.00 XXX 1.8082365 C 18.01 0.00 0.00 0.00 XXX 1.8082370 C 17.51 0.00 0.00 0.00 XXX 1.8082373 C 25.23 0.00 0.00 0.00 XXX 1.8082374 C 6.83 0.00 0.00 0.00 XXX 1.8082375 C 17.22 0.00 0.00 0.00 XXX 1.8082376 C 8.37 0.00 0.00 0.00 XXX 1.8082378 C 26.51 0.00 0.00 0.00 XXX 1.8082379 C 23.57 0.00 0.00 0.00 XXX 1.8082380 C 12.89 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
82382 C 24.02 0.00 0.00 0.00 XXX 1.8082383 C 35.01 0.00 0.00 0.00 XXX 1.8082384 C 35.28 0.00 0.00 0.00 XXX 1.8082387 C 29.07 0.00 0.00 0.00 XXX 1.8082390 C 15.01 0.00 0.00 0.00 XXX 1.8082397 C 19.74 0.00 0.00 0.00 XXX 1.8082415 C 17.70 0.00 0.00 0.00 XXX 1.8082435 C 6.42 0.00 0.00 0.00 XXX 1.8082436 C 7.02 0.00 0.00 0.00 XXX 1.8082438 C 6.83 0.00 0.00 0.00 XXX 1.8082441 C 8.38 0.00 0.00 0.00 XXX 1.8082465 C 6.08 0.00 0.00 0.00 XXX 1.8082465 C QW 6.08 0.00 0.00 0.00 XXX 1.8082480 C 11.01 0.00 0.00 0.00 XXX 1.8082482 C 10.74 0.00 0.00 0.00 XXX 1.8082485 C 28.85 0.00 0.00 0.00 XXX 1.8082486 C 25.23 0.00 0.00 0.00 XXX 1.8082487 C 22.30 0.00 0.00 0.00 XXX 1.8082488 C 29.85 0.00 0.00 0.00 XXX 1.8082489 C 25.84 0.00 0.00 0.00 XXX 1.8082491 C 25.23 0.00 0.00 0.00 XXX 1.8082492 C 25.23 0.00 0.00 0.00 XXX 1.8082495 C 28.34 0.00 0.00 0.00 XXX 1.8082507 C 38.85 0.00 0.00 0.00 XXX 1.8082520 C 21.17 0.00 0.00 0.00 XXX 1.8082523 C 26.11 0.00 0.00 0.00 XXX 1.8082523 C QW 26.11 0.00 0.00 0.00 XXX 1.8082525 C 17.34 0.00 0.00 0.00 XXX 1.8082528 C 31.45 0.00 0.00 0.00 XXX 1.8082530 C 23.35 0.00 0.00 0.00 XXX 1.8082533 C 22.78 0.00 0.00 0.00 XXX 1.8082540 C 6.48 0.00 0.00 0.00 XXX 1.8082541 C 25.23 0.00 0.00 0.00 XXX 1.8082542 C 25.23 0.00 0.00 0.00 XXX 1.8082543 C 25.23 0.00 0.00 0.00 XXX 1.8082544 C 25.23 0.00 0.00 0.00 XXX 1.8082550 C 9.10 0.00 0.00 0.00 XXX 1.8082552 C 18.71 0.00 0.00 0.00 XXX 1.8082553 C 16.13 0.00 0.00 0.00 XXX 1.8082554 C 16.58 0.00 0.00 0.00 XXX 1.8082565 C 7.16 0.00 0.00 0.00 XXX 1.8082570 C 7.23 0.00 0.00 0.00 XXX 1.8082570 C QW 7.23 0.00 0.00 0.00 XXX 1.8082575 C 13.20 0.00 0.00 0.00 XXX 1.8082585 C 11.98 0.00 0.00 0.00 XXX 1.8082595 C 9.04 0.00 0.00 0.00 XXX 1.8082600 C 27.11 0.00 0.00 0.00 XXX 1.8082607 C 21.06 0.00 0.00 0.00 XXX 1.8082608 C 20.01 0.00 0.00 0.00 XXX 1.8082615 C 11.41 0.00 0.00 0.00 XXX 1.8082626 C 35.31 0.00 0.00 0.00 XXX 1.8082627 C 31.07 0.00 0.00 0.00 XXX 1.8082633 C 43.28 0.00 0.00 0.00 XXX 1.8082634 C 40.90 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
82638 C 17.11 0.00 0.00 0.00 XXX 1.8082646 C 28.85 0.00 0.00 0.00 XXX 1.8082649 C 35.91 0.00 0.00 0.00 XXX 1.8082651 C 36.07 0.00 0.00 0.00 XXX 1.8082652 C 53.78 0.00 0.00 0.00 XXX 1.8082654 C 19.34 0.00 0.00 0.00 XXX 1.8082656 C 16.12 0.00 0.00 0.00 XXX 1.8082657 C 25.23 0.00 0.00 0.00 XXX 1.8082658 C 25.23 0.00 0.00 0.00 XXX 1.8082664 C 48.00 0.00 0.00 0.00 XXX 1.8082666 C 30.01 0.00 0.00 0.00 XXX 1.8082668 C 26.26 0.00 0.00 0.00 XXX 1.8082670 C 39.04 0.00 0.00 0.00 XXX 1.8082671 C 45.13 0.00 0.00 0.00 XXX 1.8082672 C 30.30 0.00 0.00 0.00 XXX 1.8082677 C 33.79 0.00 0.00 0.00 XXX 1.8082679 C 34.88 0.00 0.00 0.00 XXX 1.8082679 C QW 34.88 0.00 0.00 0.00 XXX 1.8082690 C 24.15 0.00 0.00 0.00 XXX 1.8082693 C 20.82 0.00 0.00 0.00 XXX 1.8082696 C 32.95 0.00 0.00 0.00 XXX 1.8082705 C 7.11 0.00 0.00 0.00 XXX 1.8082710 C 23.47 0.00 0.00 0.00 XXX 1.8082715 C 24.05 0.00 0.00 0.00 XXX 1.8082725 C 18.60 0.00 0.00 0.00 XXX 1.8082726 C 25.23 0.00 0.00 0.00 XXX 1.8082728 C 19.03 0.00 0.00 0.00 XXX 1.8082731 C 89.99 0.00 0.00 0.00 XXX 1.8082735 C 25.91 0.00 0.00 0.00 XXX 1.8082742 C 27.66 0.00 0.00 0.00 XXX 1.8082746 C 20.54 0.00 0.00 0.00 XXX 1.8082747 C 24.20 0.00 0.00 0.00 XXX 1.8082757 C 24.24 0.00 0.00 0.00 XXX 1.8082759 C 30.01 0.00 0.00 0.00 XXX 1.8082760 C 15.64 0.00 0.00 0.00 XXX 1.8082775 C 29.43 0.00 0.00 0.00 XXX 1.8082776 C 11.71 0.00 0.00 0.00 XXX 1.8082784 C 12.99 0.00 0.00 0.00 XXX 1.8082785 C 23.01 0.00 0.00 0.00 XXX 1.8082787 C 11.20 0.00 0.00 0.00 XXX 1.8082800 C 11.83 0.00 0.00 0.00 XXX 1.8082803 C 27.04 0.00 0.00 0.00 XXX 1.8082805 C 39.65 0.00 0.00 0.00 XXX 1.8082810 C 12.20 0.00 0.00 0.00 XXX 1.8082820 C 13.96 0.00 0.00 0.00 XXX 1.8082926 C 7.61 0.00 0.00 0.00 XXX 1.8082928 C 9.15 0.00 0.00 0.00 XXX 1.8082938 C 24.72 0.00 0.00 0.00 XXX 1.8082941 C 24.64 0.00 0.00 0.00 XXX 1.8082943 C 19.97 0.00 0.00 0.00 XXX 1.8082945 C 5.48 0.00 0.00 0.00 XXX 1.8082946 C 21.06 0.00 0.00 0.00 XXX 1.8082947 C 5.48 0.00 0.00 0.00 XXX 1.8082947 C QW 5.48 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
82948 C 4.43 0.00 0.00 0.00 XXX 1.8082950 C 6.64 0.00 0.00 0.00 XXX 1.8082950 C QW 6.64 0.00 0.00 0.00 XXX 1.8082951 C 17.99 0.00 0.00 0.00 XXX 1.8082951 C QW 17.99 0.00 0.00 0.00 XXX 1.8082952 C 5.48 0.00 0.00 0.00 XXX 1.8082952 C QW 5.48 0.00 0.00 0.00 XXX 1.8082953 C 21.16 0.00 0.00 0.00 XXX 1.8082955 C 13.55 0.00 0.00 0.00 XXX 1.8082960 C 8.47 0.00 0.00 0.00 XXX 1.8082962 C 3.27 0.00 0.00 0.00 XXX 1.8082963 C 30.01 0.00 0.00 0.00 XXX 1.8082965 C 10.80 0.00 0.00 0.00 XXX 1.8082975 C 22.13 0.00 0.00 0.00 XXX 1.8082977 C 10.06 0.00 0.00 0.00 XXX 1.8082978 C 19.91 0.00 0.00 0.00 XXX 1.8082979 C 9.62 0.00 0.00 0.00 XXX 1.8082980 C 25.60 0.00 0.00 0.00 XXX 1.8082985 C 21.06 0.00 0.00 0.00 XXX 1.8082985 C QW 21.06 0.00 0.00 0.00 XXX 1.8083001 C 25.97 0.00 0.00 0.00 XXX 1.8083001 C QW 25.97 0.00 0.00 0.00 XXX 1.8083002 C 25.88 0.00 0.00 0.00 XXX 1.8083002 C QW 25.88 0.00 0.00 0.00 XXX 1.8083003 C 23.29 0.00 0.00 0.00 XXX 1.8083008 C 23.45 0.00 0.00 0.00 XXX 1.8083009 C 94.11 0.00 0.00 0.00 XXX 1.8083010 C 17.58 0.00 0.00 0.00 XXX 1.8083012 C 24.02 0.00 0.00 0.00 XXX 1.8083013 C 94.11 0.00 0.00 0.00 XXX 1.8083014 C 10.98 0.00 0.00 0.00 XXX 1.8083015 C 26.31 0.00 0.00 0.00 XXX 1.8083018 C 30.68 0.00 0.00 0.00 XXX 1.8083020 C 17.99 0.00 0.00 0.00 XXX 1.8083020 C 26 0.37 0.15 0.15 0.01 XXX 50.5883021 C 25.23 0.00 0.00 0.00 XXX 1.8083026 C 3.30 0.00 0.00 0.00 XXX 1.8083030 C 11.56 0.00 0.00 0.00 XXX 1.8083033 C 8.33 0.00 0.00 0.00 XXX 1.8083036 C 13.56 0.00 0.00 0.00 XXX 1.8083036 C QW 13.56 0.00 0.00 0.00 XXX 1.8083037 C 0.00 0.00 0.00 0.00 XXX 0.0083037 C QW 0.00 0.00 0.00 0.00 XXX 0.0083045 C 6.93 0.00 0.00 0.00 XXX 1.8083050 C 10.23 0.00 0.00 0.00 XXX 1.8083051 C 10.21 0.00 0.00 0.00 XXX 1.8083055 C 6.87 0.00 0.00 0.00 XXX 1.8083060 C 11.56 0.00 0.00 0.00 XXX 1.8083065 C 9.62 0.00 0.00 0.00 XXX 1.8083068 C 11.83 0.00 0.00 0.00 XXX 1.8083069 C 5.51 0.00 0.00 0.00 XXX 1.8083070 C 6.64 0.00 0.00 0.00 XXX 1.8083071 C 9.61 0.00 0.00 0.00 XXX 1.8083080 C 23.57 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
83088 C 41.26 0.00 0.00 0.00 XXX 1.8083090 C 23.57 0.00 0.00 0.00 XXX 1.8083150 C 27.04 0.00 0.00 0.00 XXX 1.8083491 C 24.47 0.00 0.00 0.00 XXX 1.8083497 C 18.01 0.00 0.00 0.00 XXX 1.8083498 C 37.95 0.00 0.00 0.00 XXX 1.8083499 C 35.22 0.00 0.00 0.00 XXX 1.8083500 C 31.65 0.00 0.00 0.00 XXX 1.8083505 C 33.96 0.00 0.00 0.00 XXX 1.8083516 C 16.12 0.00 0.00 0.00 XXX 1.8083518 C 11.85 0.00 0.00 0.00 XXX 1.8083518 C QW 11.85 0.00 0.00 0.00 XXX 1.8083519 C 18.88 0.00 0.00 0.00 XXX 1.8083520 C 18.09 0.00 0.00 0.00 XXX 1.8083525 C 15.98 0.00 0.00 0.00 XXX 1.8083527 C 18.09 0.00 0.00 0.00 XXX 1.8083528 C 22.22 0.00 0.00 0.00 XXX 1.8083540 C 9.05 0.00 0.00 0.00 XXX 1.8083550 C 12.21 0.00 0.00 0.00 XXX 1.8083570 C 12.36 0.00 0.00 0.00 XXX 1.8083582 C 19.80 0.00 0.00 0.00 XXX 1.8083586 C 17.89 0.00 0.00 0.00 XXX 1.8083593 C 36.75 0.00 0.00 0.00 XXX 1.8083605 C 14.92 0.00 0.00 0.00 XXX 1.8083605 C QW 14.92 0.00 0.00 0.00 XXX 1.8083615 C 8.44 0.00 0.00 0.00 XXX 1.8083625 C 17.88 0.00 0.00 0.00 XXX 1.8083630 C 27.42 0.00 0.00 0.00 XXX 1.8083631 C 27.42 0.00 0.00 0.00 XXX 1.8083632 C 28.24 0.00 0.00 0.00 XXX 1.8083633 C 7.69 0.00 0.00 0.00 XXX 1.8083634 C 16.10 0.00 0.00 0.00 XXX 1.8083655 C 16.91 0.00 0.00 0.00 XXX 1.8083661 C 30.71 0.00 0.00 0.00 XXX 1.8083662 C 26.43 0.00 0.00 0.00 XXX 1.8083663 C 26.43 0.00 0.00 0.00 XXX 1.8083664 C 26.43 0.00 0.00 0.00 XXX 1.8083670 C 12.80 0.00 0.00 0.00 XXX 1.8083690 C 9.62 0.00 0.00 0.00 XXX 1.8083695 C 18.09 0.00 0.00 0.00 XXX 1.8083700 C 15.73 0.00 0.00 0.00 XXX 1.8083701 C 34.68 0.00 0.00 0.00 XXX 1.8083704 C 44.08 0.00 0.00 0.00 XXX 1.8083715 C 0.00 16.14 16.14 0.00 XXX 1.73 12/31/200583716 C 0.00 35.58 35.58 0.00 XXX 1.73 12/31/200583718 C 11.44 0.00 0.00 0.00 XXX 1.8083718 C QW 11.44 0.00 0.00 0.00 XXX 1.8083719 C 16.26 0.00 0.00 0.00 XXX 1.8083721 C 13.33 0.00 0.00 0.00 XXX 1.8083721 C QW 13.33 0.00 0.00 0.00 XXX 1.8083727 C 24.02 0.00 0.00 0.00 XXX 1.8083735 C 9.36 0.00 0.00 0.00 XXX 1.8083775 C 10.30 0.00 0.00 0.00 XXX 1.8083785 C 34.36 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
83788 C 25.23 0.00 0.00 0.00 XXX 1.8083789 C 25.23 0.00 0.00 0.00 XXX 1.8083805 C 24.63 0.00 0.00 0.00 XXX 1.8083825 C 22.72 0.00 0.00 0.00 XXX 1.8083835 C 23.67 0.00 0.00 0.00 XXX 1.8083840 C 22.81 0.00 0.00 0.00 XXX 1.8083857 C 15.01 0.00 0.00 0.00 XXX 1.8083858 C 20.71 0.00 0.00 0.00 XXX 1.8083864 C 27.82 0.00 0.00 0.00 XXX 1.8083866 C 13.76 0.00 0.00 0.00 XXX 1.8083872 C 8.19 0.00 0.00 0.00 XXX 1.8083873 C 24.04 0.00 0.00 0.00 XXX 1.8083874 C 18.04 0.00 0.00 0.00 XXX 1.8083880 C 47.43 0.00 0.00 0.00 XXX 1.8083880 C QW 47.43 0.00 0.00 0.00 XXX 1.8083883 C 19.00 0.00 0.00 0.00 XXX 1.8083885 C 34.23 0.00 0.00 0.00 XXX 1.8083887 C 33.09 0.00 0.00 0.00 XXX 1.8083890 C 5.60 0.00 0.00 0.00 XXX 1.8083891 C 5.60 0.00 0.00 0.00 XXX 1.8083892 C 5.60 0.00 0.00 0.00 XXX 1.8083893 C 5.60 0.00 0.00 0.00 XXX 1.8083894 C 5.60 0.00 0.00 0.00 XXX 1.8083896 C 5.60 0.00 0.00 0.00 XXX 1.8083897 C 5.60 0.00 0.00 0.00 XXX 1.8083898 C 23.42 0.00 0.00 0.00 XXX 1.8083900 C 46.84 0.00 0.00 0.00 XXX 1.8083901 C 23.42 0.00 0.00 0.00 XXX 1.8083902 C 19.83 0.00 0.00 0.00 XXX 1.8083903 C 23.42 0.00 0.00 0.00 XXX 1.8083904 C 23.42 0.00 0.00 0.00 XXX 1.8083905 C 23.42 0.00 0.00 0.00 XXX 1.8083906 C 23.42 0.00 0.00 0.00 XXX 1.8083907 C 18.66 0.00 0.00 0.00 XXX 1.8083908 C 23.42 0.00 0.00 0.00 XXX 1.8083909 C 23.42 0.00 0.00 0.00 XXX 1.8083912 C 5.60 0.00 0.00 0.00 XXX 1.8083912 C 26 0.37 0.12 0.12 0.01 XXX 50.5883914 C 23.42 0.00 0.00 0.00 XXX 1.8083915 C 15.58 0.00 0.00 0.00 XXX 1.8083916 C 28.09 0.00 0.00 0.00 XXX 1.8083918 C 23.00 0.00 0.00 0.00 XXX 1.8083919 C 23.00 0.00 0.00 0.00 XXX 1.8083921 C 23.00 0.00 0.00 0.00 XXX 1.8083925 C 27.19 0.00 0.00 0.00 XXX 1.8083930 C 9.24 0.00 0.00 0.00 XXX 1.8083935 C 9.52 0.00 0.00 0.00 XXX 1.8083937 C 41.71 0.00 0.00 0.00 XXX 1.8083945 C 17.99 0.00 0.00 0.00 XXX 1.8083950 C 89.99 0.00 0.00 0.00 XXX 1.8083970 C 57.70 0.00 0.00 0.00 XXX 1.8083986 C 5.00 0.00 0.00 0.00 XXX 1.8083986 C QW 5.00 0.00 0.00 0.00 XXX 1.8083992 C 20.54 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
84022 C 21.76 0.00 0.00 0.00 XXX 1.8084030 C 7.69 0.00 0.00 0.00 XXX 1.8084035 C 5.11 0.00 0.00 0.00 XXX 1.8084060 C 10.32 0.00 0.00 0.00 XXX 1.8084061 C 11.06 0.00 0.00 0.00 XXX 1.8084066 C 13.50 0.00 0.00 0.00 XXX 1.8084075 C 7.23 0.00 0.00 0.00 XXX 1.8084078 C 10.20 0.00 0.00 0.00 XXX 1.8084080 C 20.66 0.00 0.00 0.00 XXX 1.8084081 C 23.09 0.00 0.00 0.00 XXX 1.8084085 C 9.42 0.00 0.00 0.00 XXX 1.8084087 C 14.42 0.00 0.00 0.00 XXX 1.8084100 C 6.63 0.00 0.00 0.00 XXX 1.8084105 C 7.23 0.00 0.00 0.00 XXX 1.8084106 C 5.99 0.00 0.00 0.00 XXX 1.8084110 C 11.80 0.00 0.00 0.00 XXX 1.8084119 C 12.03 0.00 0.00 0.00 XXX 1.8084120 C 20.55 0.00 0.00 0.00 XXX 1.8084126 C 35.59 0.00 0.00 0.00 XXX 1.8084127 C 16.28 0.00 0.00 0.00 XXX 1.8084132 C 6.42 0.00 0.00 0.00 XXX 1.8084133 C 6.01 0.00 0.00 0.00 XXX 1.8084134 C 20.38 0.00 0.00 0.00 XXX 1.8084135 C 26.73 0.00 0.00 0.00 XXX 1.8084138 C 26.46 0.00 0.00 0.00 XXX 1.8084140 C 28.89 0.00 0.00 0.00 XXX 1.8084143 C 31.89 0.00 0.00 0.00 XXX 1.8084144 C 29.15 0.00 0.00 0.00 XXX 1.8084146 C 27.08 0.00 0.00 0.00 XXX 1.8084150 C 34.88 0.00 0.00 0.00 XXX 1.8084152 C 25.70 0.00 0.00 0.00 XXX 1.8084153 C 25.70 0.00 0.00 0.00 XXX 1.8084154 C 25.70 0.00 0.00 0.00 XXX 1.8084155 C 5.12 0.00 0.00 0.00 XXX 1.8084156 C 5.12 0.00 0.00 0.00 XXX 1.8084157 C 5.12 0.00 0.00 0.00 XXX 1.8084160 C 7.23 0.00 0.00 0.00 XXX 1.8084163 C 21.03 0.00 0.00 0.00 XXX 1.8084165 C 15.01 0.00 0.00 0.00 XXX 1.8084165 C 26 0.37 0.14 0.14 0.01 XXX 50.5884166 C 24.92 0.00 0.00 0.00 XXX 1.8084166 C 26 0.37 0.14 0.14 0.01 XXX 50.5884181 C 23.80 0.00 0.00 0.00 XXX 1.8084181 C 26 0.37 0.14 0.14 0.01 XXX 50.5884182 C 25.15 0.00 0.00 0.00 XXX 1.8084182 C 26 0.37 0.16 0.16 0.02 XXX 50.5884202 C 20.05 0.00 0.00 0.00 XXX 1.8084203 C 12.03 0.00 0.00 0.00 XXX 1.8084206 C 24.89 0.00 0.00 0.00 XXX 1.8084207 C 39.25 0.00 0.00 0.00 XXX 1.8084210 C 15.17 0.00 0.00 0.00 XXX 1.8084220 C 13.18 0.00 0.00 0.00 XXX 1.8084228 C 16.26 0.00 0.00 0.00 XXX 1.8084233 C 89.99 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
84234 C 90.64 0.00 0.00 0.00 XXX 1.8084235 C 73.12 0.00 0.00 0.00 XXX 1.8084238 C 51.09 0.00 0.00 0.00 XXX 1.8084244 C 30.73 0.00 0.00 0.00 XXX 1.8084252 C 28.28 0.00 0.00 0.00 XXX 1.8084255 C 35.67 0.00 0.00 0.00 XXX 1.8084260 C 43.28 0.00 0.00 0.00 XXX 1.8084270 C 30.36 0.00 0.00 0.00 XXX 1.8084275 C 18.77 0.00 0.00 0.00 XXX 1.8084285 C 32.90 0.00 0.00 0.00 XXX 1.8084295 C 6.72 0.00 0.00 0.00 XXX 1.8084300 C 6.79 0.00 0.00 0.00 XXX 1.8084302 C 6.79 0.00 0.00 0.00 XXX 1.8084305 C 29.70 0.00 0.00 0.00 XXX 1.8084307 C 25.54 0.00 0.00 0.00 XXX 1.8084311 C 9.77 0.00 0.00 0.00 XXX 1.8084315 C 3.50 0.00 0.00 0.00 XXX 1.8084375 C 27.39 0.00 0.00 0.00 XXX 1.8084376 C 7.69 0.00 0.00 0.00 XXX 1.8084377 C 7.69 0.00 0.00 0.00 XXX 1.8084378 C 16.10 0.00 0.00 0.00 XXX 1.8084379 C 16.10 0.00 0.00 0.00 XXX 1.8084392 C 6.64 0.00 0.00 0.00 XXX 1.8084402 C 35.57 0.00 0.00 0.00 XXX 1.8084403 C 36.08 0.00 0.00 0.00 XXX 1.8084425 C 29.67 0.00 0.00 0.00 XXX 1.8084430 C 16.26 0.00 0.00 0.00 XXX 1.8084432 C 22.44 0.00 0.00 0.00 XXX 1.8084436 C 9.61 0.00 0.00 0.00 XXX 1.8084437 C 9.04 0.00 0.00 0.00 XXX 1.8084439 C 12.60 0.00 0.00 0.00 XXX 1.8084442 C 20.66 0.00 0.00 0.00 XXX 1.8084443 C 23.47 0.00 0.00 0.00 XXX 1.8084445 C 71.05 0.00 0.00 0.00 XXX 1.8084446 C 19.81 0.00 0.00 0.00 XXX 1.8084449 C 25.15 0.00 0.00 0.00 XXX 1.8084450 C 7.22 0.00 0.00 0.00 XXX 1.8084450 C QW 7.22 0.00 0.00 0.00 XXX 1.8084460 C 7.40 0.00 0.00 0.00 XXX 1.8084460 C QW 7.40 0.00 0.00 0.00 XXX 1.8084466 C 17.84 0.00 0.00 0.00 XXX 1.8084478 C 8.04 0.00 0.00 0.00 XXX 1.8084478 C QW 8.04 0.00 0.00 0.00 XXX 1.8084479 C 9.04 0.00 0.00 0.00 XXX 1.8084480 C 19.81 0.00 0.00 0.00 XXX 1.8084481 C 23.67 0.00 0.00 0.00 XXX 1.8084482 C 22.02 0.00 0.00 0.00 XXX 1.8084484 C 13.75 0.00 0.00 0.00 XXX 1.8084485 C 10.49 0.00 0.00 0.00 XXX 1.8084488 C 10.20 0.00 0.00 0.00 XXX 1.8084490 C 10.63 0.00 0.00 0.00 XXX 1.8084510 C 14.53 0.00 0.00 0.00 XXX 1.8084512 C 10.76 0.00 0.00 0.00 XXX 1.8084520 C 5.51 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
84525 C 5.25 0.00 0.00 0.00 XXX 1.8084540 C 6.64 0.00 0.00 0.00 XXX 1.8084545 C 9.23 0.00 0.00 0.00 XXX 1.8084550 C 6.31 0.00 0.00 0.00 XXX 1.8084560 C 6.64 0.00 0.00 0.00 XXX 1.8084577 C 17.43 0.00 0.00 0.00 XXX 1.8084578 C 4.54 0.00 0.00 0.00 XXX 1.8084580 C 9.92 0.00 0.00 0.00 XXX 1.8084583 C 7.02 0.00 0.00 0.00 XXX 1.8084585 C 21.66 0.00 0.00 0.00 XXX 1.8084586 C 49.37 0.00 0.00 0.00 XXX 1.8084588 C 47.43 0.00 0.00 0.00 XXX 1.8084590 C 16.20 0.00 0.00 0.00 XXX 1.8084591 C 16.20 0.00 0.00 0.00 XXX 1.8084597 C 19.15 0.00 0.00 0.00 XXX 1.8084600 C 22.45 0.00 0.00 0.00 XXX 1.8084620 C 16.55 0.00 0.00 0.00 XXX 1.8084630 C 15.91 0.00 0.00 0.00 XXX 1.8084681 C 29.07 0.00 0.00 0.00 XXX 1.8084702 C 21.03 0.00 0.00 0.00 XXX 1.8084703 C 10.49 0.00 0.00 0.00 XXX 1.8084703 C QW 10.49 0.00 0.00 0.00 XXX 1.8084830 C 14.02 0.00 0.00 0.00 XXX 1.8084999 S 0.00 0.00 0.00 0.00 XXX 0.0085002 C 6.29 0.00 0.00 0.00 XXX 1.8085004 C 9.04 0.00 0.00 0.00 XXX 1.8085007 C 4.81 0.00 0.00 0.00 XXX 1.8085008 C 4.81 0.00 0.00 0.00 XXX 1.8085009 C 5.19 0.00 0.00 0.00 XXX 1.8085013 C 3.31 0.00 0.00 0.00 XXX 1.8085014 C 3.31 0.00 0.00 0.00 XXX 1.8085014 C QW 3.31 0.00 0.00 0.00 XXX 1.8085018 C 3.31 0.00 0.00 0.00 XXX 1.8085018 C QW 3.31 0.00 0.00 0.00 XXX 1.8085025 C 10.86 0.00 0.00 0.00 XXX 1.8085027 C 9.04 0.00 0.00 0.00 XXX 1.8085032 C 6.01 0.00 0.00 0.00 XXX 1.8085041 C 4.20 0.00 0.00 0.00 XXX 1.8085044 C 6.01 0.00 0.00 0.00 XXX 1.8085045 C 5.59 0.00 0.00 0.00 XXX 1.8085046 C 7.80 0.00 0.00 0.00 XXX 1.8085048 C 3.55 0.00 0.00 0.00 XXX 1.8085049 C 6.25 0.00 0.00 0.00 XXX 1.8085055 C 37.41 0.00 0.00 0.00 XXX 1.8085060 C 0.45 0.18 0.18 0.02 XXX 50.5885097 C 0.94 1.92 0.41 0.04 XXX 50.5885130 C 16.62 0.00 0.00 0.00 XXX 1.8085170 C 5.05 0.00 0.00 0.00 XXX 1.8085175 C 6.35 0.00 0.00 0.00 XXX 1.8085210 C 18.14 0.00 0.00 0.00 XXX 1.8085220 C 24.66 0.00 0.00 0.00 XXX 1.8085230 C 25.02 0.00 0.00 0.00 XXX 1.8085240 C 25.02 0.00 0.00 0.00 XXX 1.8085244 C 28.53 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
85245 C 32.06 0.00 0.00 0.00 XXX 1.8085246 C 32.06 0.00 0.00 0.00 XXX 1.8085247 C 32.06 0.00 0.00 0.00 XXX 1.8085250 C 26.60 0.00 0.00 0.00 XXX 1.8085260 C 25.02 0.00 0.00 0.00 XXX 1.8085270 C 25.02 0.00 0.00 0.00 XXX 1.8085280 C 27.04 0.00 0.00 0.00 XXX 1.8085290 C 22.83 0.00 0.00 0.00 XXX 1.8085291 C 12.42 0.00 0.00 0.00 XXX 1.8085292 C 26.46 0.00 0.00 0.00 XXX 1.8085293 C 26.46 0.00 0.00 0.00 XXX 1.8085300 C 16.55 0.00 0.00 0.00 XXX 1.8085301 C 15.11 0.00 0.00 0.00 XXX 1.8085302 C 16.80 0.00 0.00 0.00 XXX 1.8085303 C 19.32 0.00 0.00 0.00 XXX 1.8085305 C 16.20 0.00 0.00 0.00 XXX 1.8085306 C 21.41 0.00 0.00 0.00 XXX 1.8085307 C 21.41 0.00 0.00 0.00 XXX 1.8085335 C 17.99 0.00 0.00 0.00 XXX 1.8085337 C 14.56 0.00 0.00 0.00 XXX 1.8085345 C 6.01 0.00 0.00 0.00 XXX 1.8085347 C 5.95 0.00 0.00 0.00 XXX 1.8085348 C 5.20 0.00 0.00 0.00 XXX 1.8085360 C 11.74 0.00 0.00 0.00 XXX 1.8085362 C 9.62 0.00 0.00 0.00 XXX 1.8085366 C 12.03 0.00 0.00 0.00 XXX 1.8085370 C 15.87 0.00 0.00 0.00 XXX 1.8085378 C 9.97 0.00 0.00 0.00 XXX 1.8085379 C 14.22 0.00 0.00 0.00 XXX 1.8085380 C 14.22 0.00 0.00 0.00 XXX 1.8085384 C 11.87 0.00 0.00 0.00 XXX 1.8085385 C 11.87 0.00 0.00 0.00 XXX 1.8085390 C 7.22 0.00 0.00 0.00 XXX 1.8085390 C 26 0.37 0.13 0.13 0.01 XXX 50.5885396 C 0.37 0.16 0.16 0.04 XXX 50.5885400 C 12.36 0.00 0.00 0.00 XXX 1.8085410 C 10.77 0.00 0.00 0.00 XXX 1.8085415 C 24.02 0.00 0.00 0.00 XXX 1.8085420 C 9.13 0.00 0.00 0.00 XXX 1.8085421 C 14.23 0.00 0.00 0.00 XXX 1.8085441 C 5.88 0.00 0.00 0.00 XXX 1.8085445 C 9.52 0.00 0.00 0.00 XXX 1.8085460 C 10.81 0.00 0.00 0.00 XXX 1.8085461 C 9.26 0.00 0.00 0.00 XXX 1.8085475 C 12.40 0.00 0.00 0.00 XXX 1.8085520 C 18.29 0.00 0.00 0.00 XXX 1.8085525 C 16.55 0.00 0.00 0.00 XXX 1.8085530 C 19.81 0.00 0.00 0.00 XXX 1.8085536 C 9.04 0.00 0.00 0.00 XXX 1.8085540 C 12.02 0.00 0.00 0.00 XXX 1.8085547 C 12.02 0.00 0.00 0.00 XXX 1.8085549 C 26.21 0.00 0.00 0.00 XXX 1.8085555 C 9.34 0.00 0.00 0.00 XXX 1.8085557 C 18.66 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
85576 C 30.01 0.00 0.00 0.00 XXX 1.8085576 C 26 0.37 0.16 0.16 0.01 XXX 50.5885576 C QW 30.01 0.00 0.00 0.00 XXX 1.8085597 C 25.12 0.00 0.00 0.00 XXX 1.8085610 C 5.49 0.00 0.00 0.00 XXX 1.8085610 C QW 5.49 0.00 0.00 0.00 XXX 1.8085611 C 5.51 0.00 0.00 0.00 XXX 1.8085612 C 13.37 0.00 0.00 0.00 XXX 1.8085613 C 13.37 0.00 0.00 0.00 XXX 1.8085635 C 13.76 0.00 0.00 0.00 XXX 1.8085651 C 4.96 0.00 0.00 0.00 XXX 1.8085652 C 3.77 0.00 0.00 0.00 XXX 1.8085660 C 7.71 0.00 0.00 0.00 XXX 1.8085670 C 8.07 0.00 0.00 0.00 XXX 1.8085675 C 9.58 0.00 0.00 0.00 XXX 1.8085705 C 13.45 0.00 0.00 0.00 XXX 1.8085730 C 8.38 0.00 0.00 0.00 XXX 1.8085732 C 9.04 0.00 0.00 0.00 XXX 1.8085810 C 16.32 0.00 0.00 0.00 XXX 1.8085999 S 0.00 0.00 0.00 0.00 XXX 0.0086000 C 9.75 0.00 0.00 0.00 XXX 1.8086001 C 7.30 0.00 0.00 0.00 XXX 1.8086003 C 7.30 0.00 0.00 0.00 XXX 1.8086005 C 11.14 0.00 0.00 0.00 XXX 1.8086021 C 21.03 0.00 0.00 0.00 XXX 1.8086022 C 25.66 0.00 0.00 0.00 XXX 1.8086023 C 17.40 0.00 0.00 0.00 XXX 1.8086038 C 16.89 0.00 0.00 0.00 XXX 1.8086039 C 15.60 0.00 0.00 0.00 XXX 1.8086060 C 10.20 0.00 0.00 0.00 XXX 1.8086063 C 8.07 0.00 0.00 0.00 XXX 1.8086064 C 0.00 52.70 52.70 0.00 XXX 1.73 12/31/200586077 C 0.94 0.39 0.39 0.03 XXX 50.5886078 C 0.94 0.46 0.40 0.03 XXX 50.5886079 C 0.94 0.45 0.41 0.03 XXX 50.5886140 C 7.23 0.00 0.00 0.00 XXX 1.8086141 C 18.09 0.00 0.00 0.00 XXX 1.8086146 C 35.54 0.00 0.00 0.00 XXX 1.8086147 C 35.54 0.00 0.00 0.00 XXX 1.8086148 C 22.44 0.00 0.00 0.00 XXX 1.8086155 C 22.33 0.00 0.00 0.00 XXX 1.8086156 C 9.36 0.00 0.00 0.00 XXX 1.8086157 C 11.27 0.00 0.00 0.00 XXX 1.8086160 C 16.78 0.00 0.00 0.00 XXX 1.8086161 C 16.78 0.00 0.00 0.00 XXX 1.8086162 C 28.39 0.00 0.00 0.00 XXX 1.8086171 C 14.00 0.00 0.00 0.00 XXX 1.8086185 C 12.50 0.00 0.00 0.00 XXX 1.8086200 C 18.09 0.00 0.00 0.00 XXX 1.8086215 C 18.51 0.00 0.00 0.00 XXX 1.8086225 C 19.20 0.00 0.00 0.00 XXX 1.8086226 C 16.92 0.00 0.00 0.00 XXX 1.8086235 C 25.06 0.00 0.00 0.00 XXX 1.8086243 C 28.68 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
86255 C 16.84 0.00 0.00 0.00 XXX 1.8086255 C 26 0.37 0.15 0.15 0.01 XXX 50.5886256 C 16.84 0.00 0.00 0.00 XXX 1.8086256 C 26 0.37 0.15 0.15 0.01 XXX 50.5886277 C 21.99 0.00 0.00 0.00 XXX 1.8086280 C 11.44 0.00 0.00 0.00 XXX 1.8086294 C 27.41 0.00 0.00 0.00 XXX 1.8086294 C QW 27.41 0.00 0.00 0.00 XXX 1.8086300 C 29.09 0.00 0.00 0.00 XXX 1.8086301 C 29.07 0.00 0.00 0.00 XXX 1.8086304 C 29.07 0.00 0.00 0.00 XXX 1.8086308 C 7.23 0.00 0.00 0.00 XXX 1.8086308 C QW 7.23 0.00 0.00 0.00 XXX 1.8086309 C 9.04 0.00 0.00 0.00 XXX 1.8086310 C 10.30 0.00 0.00 0.00 XXX 1.8086316 C 29.07 0.00 0.00 0.00 XXX 1.8086317 C 20.95 0.00 0.00 0.00 XXX 1.8086318 C 18.09 0.00 0.00 0.00 XXX 1.8086318 C QW 18.09 0.00 0.00 0.00 XXX 1.8086320 C 31.32 0.00 0.00 0.00 XXX 1.8086320 C 26 0.37 0.15 0.15 0.01 XXX 50.5886325 C 31.24 0.00 0.00 0.00 XXX 1.8086325 C 26 0.37 0.13 0.13 0.01 XXX 50.5886327 C 31.70 0.00 0.00 0.00 XXX 1.8086327 C 26 0.42 0.18 0.18 0.02 XXX 50.5886329 C 19.62 0.00 0.00 0.00 XXX 1.8086331 C 16.75 0.00 0.00 0.00 XXX 1.8086332 C 34.05 0.00 0.00 0.00 XXX 1.8086334 C 31.21 0.00 0.00 0.00 XXX 1.8086334 C 26 0.37 0.15 0.15 0.01 XXX 50.5886335 C 41.00 0.00 0.00 0.00 XXX 1.8086335 C 26 0.37 0.14 0.14 0.01 XXX 50.5886336 C 21.77 0.00 0.00 0.00 XXX 1.8086337 C 29.92 0.00 0.00 0.00 XXX 1.8086340 C 21.06 0.00 0.00 0.00 XXX 1.8086341 C 27.65 0.00 0.00 0.00 XXX 1.8086343 C 17.41 0.00 0.00 0.00 XXX 1.8086344 C 11.16 0.00 0.00 0.00 XXX 1.8086353 C 68.49 0.00 0.00 0.00 XXX 1.8086355 C 52.70 0.00 0.00 0.00 XXX 1.8086357 C 52.70 0.00 0.00 0.00 XXX 1.8086359 C 52.70 0.00 0.00 0.00 XXX 1.8086360 C 65.65 0.00 0.00 0.00 XXX 1.8086361 C 37.41 0.00 0.00 0.00 XXX 1.8086367 C 52.70 0.00 0.00 0.00 XXX 1.8086376 C 20.33 0.00 0.00 0.00 XXX 1.8086378 C 27.51 0.00 0.00 0.00 XXX 1.8086379 C 0.00 52.70 52.70 0.00 XXX 1.73 12/31/200586382 C 23.62 0.00 0.00 0.00 XXX 1.8086384 C 15.91 0.00 0.00 0.00 XXX 1.8086403 C 14.24 0.00 0.00 0.00 XXX 1.8086406 C 14.87 0.00 0.00 0.00 XXX 1.8086430 C 7.93 0.00 0.00 0.00 XXX 1.8086431 C 7.93 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
86480 C 86.59 0.00 0.00 0.00 XXX 1.8086485 C 9.40 0.00 0.00 0.00 XXX 1.8086490 C 0.00 0.29 0.29 0.02 XXX 50.5886510 C 0.00 0.32 0.32 0.02 XXX 50.5886580 C 0.00 0.25 0.25 0.02 XXX 50.5886585 C 0.00 0.20 0.20 0.01 XXX 50.58 12/31/200586585 C TC 0.00 0.20 0.20 0.01 XXX 29.46 12/31/200586585 C 26 0.00 0.20 0.20 0.01 XXX 19.64 12/31/200586586 C 52.70 0.00 0.00 0.00 XXX 1.8086587 C 0.00 52.70 52.70 0.00 XXX 1.73 12/31/200586590 C 15.41 0.00 0.00 0.00 XXX 1.8086592 C 5.96 0.00 0.00 0.00 XXX 1.8086593 C 6.16 0.00 0.00 0.00 XXX 1.8086602 C 14.22 0.00 0.00 0.00 XXX 1.8086603 C 17.98 0.00 0.00 0.00 XXX 1.8086606 C 21.03 0.00 0.00 0.00 XXX 1.8086609 C 18.00 0.00 0.00 0.00 XXX 1.8086611 C 14.22 0.00 0.00 0.00 XXX 1.8086612 C 18.03 0.00 0.00 0.00 XXX 1.8086615 C 18.43 0.00 0.00 0.00 XXX 1.8086617 C 21.64 0.00 0.00 0.00 XXX 1.8086618 C 23.80 0.00 0.00 0.00 XXX 1.8086618 C QW 23.80 0.00 0.00 0.00 XXX 1.8086619 C 18.69 0.00 0.00 0.00 XXX 1.8086622 C 12.48 0.00 0.00 0.00 XXX 1.8086625 C 18.33 0.00 0.00 0.00 XXX 1.8086628 C 16.78 0.00 0.00 0.00 XXX 1.8086631 C 16.52 0.00 0.00 0.00 XXX 1.8086632 C 17.74 0.00 0.00 0.00 XXX 1.8086635 C 16.03 0.00 0.00 0.00 XXX 1.8086638 C 16.94 0.00 0.00 0.00 XXX 1.8086641 C 20.14 0.00 0.00 0.00 XXX 1.8086644 C 20.11 0.00 0.00 0.00 XXX 1.8086645 C 23.54 0.00 0.00 0.00 XXX 1.8086648 C 21.25 0.00 0.00 0.00 XXX 1.8086651 C 18.43 0.00 0.00 0.00 XXX 1.8086652 C 18.43 0.00 0.00 0.00 XXX 1.8086653 C 18.43 0.00 0.00 0.00 XXX 1.8086654 C 18.43 0.00 0.00 0.00 XXX 1.8086658 C 18.20 0.00 0.00 0.00 XXX 1.8086663 C 18.33 0.00 0.00 0.00 XXX 1.8086664 C 21.38 0.00 0.00 0.00 XXX 1.8086665 C 25.35 0.00 0.00 0.00 XXX 1.8086666 C 14.22 0.00 0.00 0.00 XXX 1.8086668 C 14.53 0.00 0.00 0.00 XXX 1.8086671 C 17.13 0.00 0.00 0.00 XXX 1.8086674 C 20.56 0.00 0.00 0.00 XXX 1.8086677 C 20.28 0.00 0.00 0.00 XXX 1.8086682 C 18.17 0.00 0.00 0.00 XXX 1.8086684 C 22.14 0.00 0.00 0.00 XXX 1.8086687 C 11.72 0.00 0.00 0.00 XXX 1.8086688 C 19.57 0.00 0.00 0.00 XXX 1.8086689 C 27.05 0.00 0.00 0.00 XXX 1.8086692 C 23.98 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
86694 C 20.11 0.00 0.00 0.00 XXX 1.8086695 C 18.43 0.00 0.00 0.00 XXX 1.8086696 C 27.05 0.00 0.00 0.00 XXX 1.8086698 C 17.46 0.00 0.00 0.00 XXX 1.8086701 C 12.41 0.00 0.00 0.00 XXX 1.8086701 C QW 12.41 0.00 0.00 0.00 XXX 1.8086702 C 18.88 0.00 0.00 0.00 XXX 1.8086703 C 19.17 0.00 0.00 0.00 XXX 1.8086703 C QW 19.17 0.00 0.00 0.00 XXX 1.8086704 C 16.84 0.00 0.00 0.00 XXX 1.8086705 C 16.44 0.00 0.00 0.00 XXX 1.8086706 C 15.01 0.00 0.00 0.00 XXX 1.8086707 C 16.16 0.00 0.00 0.00 XXX 1.8086708 C 17.31 0.00 0.00 0.00 XXX 1.8086709 C 15.73 0.00 0.00 0.00 XXX 1.8086710 C 18.94 0.00 0.00 0.00 XXX 1.8086713 C 21.39 0.00 0.00 0.00 XXX 1.8086717 C 17.12 0.00 0.00 0.00 XXX 1.8086720 C 18.43 0.00 0.00 0.00 XXX 1.8086723 C 18.43 0.00 0.00 0.00 XXX 1.8086727 C 17.98 0.00 0.00 0.00 XXX 1.8086729 C 16.69 0.00 0.00 0.00 XXX 1.8086732 C 18.43 0.00 0.00 0.00 XXX 1.8086735 C 18.23 0.00 0.00 0.00 XXX 1.8086738 C 18.51 0.00 0.00 0.00 XXX 1.8086741 C 18.43 0.00 0.00 0.00 XXX 1.8086744 C 18.43 0.00 0.00 0.00 XXX 1.8086747 C 21.00 0.00 0.00 0.00 XXX 1.8086750 C 18.43 0.00 0.00 0.00 XXX 1.8086753 C 17.32 0.00 0.00 0.00 XXX 1.8086756 C 18.01 0.00 0.00 0.00 XXX 1.8086757 C 27.05 0.00 0.00 0.00 XXX 1.8086759 C 18.43 0.00 0.00 0.00 XXX 1.8086762 C 20.11 0.00 0.00 0.00 XXX 1.8086765 C 18.00 0.00 0.00 0.00 XXX 1.8086768 C 18.43 0.00 0.00 0.00 XXX 1.8086771 C 18.43 0.00 0.00 0.00 XXX 1.8086774 C 20.68 0.00 0.00 0.00 XXX 1.8086777 C 20.11 0.00 0.00 0.00 XXX 1.8086778 C 20.12 0.00 0.00 0.00 XXX 1.8086781 C 18.50 0.00 0.00 0.00 XXX 1.8086784 C 17.55 0.00 0.00 0.00 XXX 1.8086787 C 18.00 0.00 0.00 0.00 XXX 1.8086790 C 18.00 0.00 0.00 0.00 XXX 1.8086793 C 18.43 0.00 0.00 0.00 XXX 1.8086800 C 22.22 0.00 0.00 0.00 XXX 1.8086803 C 19.94 0.00 0.00 0.00 XXX 1.8086804 C 21.64 0.00 0.00 0.00 XXX 1.8086805 C 73.05 0.00 0.00 0.00 XXX 1.8086806 C 66.49 0.00 0.00 0.00 XXX 1.8086807 C 55.29 0.00 0.00 0.00 XXX 1.8086808 C 41.47 0.00 0.00 0.00 XXX 1.8086812 C 36.06 0.00 0.00 0.00 XXX 1.8086813 C 81.02 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
86816 C 38.92 0.00 0.00 0.00 XXX 1.8086817 C 89.95 0.00 0.00 0.00 XXX 1.8086821 C 78.88 0.00 0.00 0.00 XXX 1.8086822 C 51.07 0.00 0.00 0.00 XXX 1.8086849 C 0.00 0.00 0.00 0.00 XXX 0.0086850 C 0.00 0.00 0.00 0.00 XXX 0.0086860 C 0.00 0.00 0.00 0.00 XXX 0.0086870 C 0.00 0.00 0.00 0.00 XXX 0.0086880 C 7.50 0.00 0.00 0.00 XXX 1.8086885 C 7.99 0.00 0.00 0.00 XXX 1.8086886 C 7.23 0.00 0.00 0.00 XXX 1.8086890 C 0.00 4.28 4.28 0.00 XXX 1.7386891 C 0.00 0.00 0.00 0.00 XXX 0.0086900 C 4.17 0.00 0.00 0.00 XXX 1.8086901 C 0.00 0.00 0.00 0.00 XXX 0.0086903 C 13.19 0.00 0.00 0.00 XXX 1.8086904 C 13.28 0.00 0.00 0.00 XXX 1.8086905 C 5.34 0.00 0.00 0.00 XXX 1.8086906 C 10.83 0.00 0.00 0.00 XXX 1.8086910 D 0.00 0.00 0.00 0.00 XXX 0.0086911 C 0.00 0.00 0.00 0.00 XXX 0.0086920 C 0.00 0.00 0.00 0.00 XXX 0.0086921 C 0.00 0.00 0.00 0.00 XXX 0.0086922 C 0.00 0.00 0.00 0.00 XXX 0.0086923 C 0.00 0.00 0.00 0.00 XXX 0.0086927 C 0.00 0.00 0.00 0.00 XXX 0.0086930 C 0.00 0.00 0.00 0.00 XXX 0.0086931 C 0.00 0.00 0.00 0.00 XXX 0.0086932 C 0.00 0.00 0.00 0.00 XXX 0.0086940 C 11.46 0.00 0.00 0.00 XXX 1.8086941 C 16.92 0.00 0.00 0.00 XXX 1.8086945 C 0.00 0.00 0.00 0.00 XXX 0.0086950 C 0.00 0.00 0.00 0.00 XXX 0.0086960 C 0.00 0.00 0.00 0.00 XXX 0.0086965 C 0.00 0.00 0.00 0.00 XXX 0.0086970 C 0.00 0.00 0.00 0.00 XXX 0.0086971 C 0.00 0.00 0.00 0.00 XXX 0.0086972 C 0.00 0.00 0.00 0.00 XXX 0.0086975 C 0.00 0.00 0.00 0.00 XXX 0.0086976 C 0.00 0.00 0.00 0.00 XXX 0.0086977 C 0.00 0.00 0.00 0.00 XXX 0.0086978 C 0.00 0.00 0.00 0.00 XXX 0.0086985 C 0.00 0.00 0.00 0.00 XXX 0.0086999 S 0.00 0.00 0.00 0.00 XXX 0.0087001 C 18.47 0.00 0.00 0.00 XXX 1.8087003 C 23.52 0.00 0.00 0.00 XXX 1.8087015 C 9.33 0.00 0.00 0.00 XXX 1.8087040 C 14.42 0.00 0.00 0.00 XXX 1.8087045 C 13.18 0.00 0.00 0.00 XXX 1.8087046 C 13.18 0.00 0.00 0.00 XXX 1.8087070 C 12.03 0.00 0.00 0.00 XXX 1.8087071 C 13.18 0.00 0.00 0.00 XXX 1.8087073 C 13.18 0.00 0.00 0.00 XXX 1.8087075 C 13.22 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
87076 C 11.29 0.00 0.00 0.00 XXX 1.8087077 C 11.29 0.00 0.00 0.00 XXX 1.8087077 C QW 11.29 0.00 0.00 0.00 XXX 1.8087081 C 9.26 0.00 0.00 0.00 XXX 1.8087084 C 12.03 0.00 0.00 0.00 XXX 1.8087086 C 11.28 0.00 0.00 0.00 XXX 1.8087088 C 11.31 0.00 0.00 0.00 XXX 1.8087101 C 10.77 0.00 0.00 0.00 XXX 1.8087102 C 11.74 0.00 0.00 0.00 XXX 1.8087103 C 12.60 0.00 0.00 0.00 XXX 1.8087106 C 14.42 0.00 0.00 0.00 XXX 1.8087107 C 14.42 0.00 0.00 0.00 XXX 1.8087109 C 21.50 0.00 0.00 0.00 XXX 1.8087110 C 27.37 0.00 0.00 0.00 XXX 1.8087116 C 15.10 0.00 0.00 0.00 XXX 1.8087118 C 15.29 0.00 0.00 0.00 XXX 1.8087140 C 7.79 0.00 0.00 0.00 XXX 1.8087143 C 17.51 0.00 0.00 0.00 XXX 1.8087147 C 7.23 0.00 0.00 0.00 XXX 1.8087149 C 28.02 0.00 0.00 0.00 XXX 1.8087152 C 7.31 0.00 0.00 0.00 XXX 1.8087158 C 7.31 0.00 0.00 0.00 XXX 1.8087164 C 15.01 0.00 0.00 0.00 XXX 1.8087164 C 26 0.37 0.12 0.12 0.01 XXX 50.5887166 C 15.78 0.00 0.00 0.00 XXX 1.8087168 C 5.96 0.00 0.00 0.00 XXX 1.8087169 C 5.96 0.00 0.00 0.00 XXX 1.8087172 C 5.96 0.00 0.00 0.00 XXX 1.8087176 C 8.22 0.00 0.00 0.00 XXX 1.8087177 C 12.43 0.00 0.00 0.00 XXX 1.8087181 C 6.64 0.00 0.00 0.00 XXX 1.8087184 C 9.63 0.00 0.00 0.00 XXX 1.8087185 C 6.64 0.00 0.00 0.00 XXX 1.8087186 C 12.08 0.00 0.00 0.00 XXX 1.8087187 C 14.48 0.00 0.00 0.00 XXX 1.8087188 C 9.27 0.00 0.00 0.00 XXX 1.8087190 C 7.90 0.00 0.00 0.00 XXX 1.8087197 C 20.99 0.00 0.00 0.00 XXX 1.8087205 C 5.96 0.00 0.00 0.00 XXX 1.8087206 C 7.50 0.00 0.00 0.00 XXX 1.8087207 C 8.37 0.00 0.00 0.00 XXX 1.8087207 C 26 0.37 0.16 0.16 0.01 XXX 50.5887209 C 25.11 0.00 0.00 0.00 XXX 1.8087210 C 5.96 0.00 0.00 0.00 XXX 1.8087210 C QW 5.96 0.00 0.00 0.00 XXX 1.8087220 C 5.96 0.00 0.00 0.00 XXX 1.8087230 C 27.59 0.00 0.00 0.00 XXX 1.8087250 C 27.32 0.00 0.00 0.00 XXX 1.8087252 C 36.42 0.00 0.00 0.00 XXX 1.8087253 C 28.22 0.00 0.00 0.00 XXX 1.8087254 C 27.32 0.00 0.00 0.00 XXX 1.8087255 C 47.31 0.00 0.00 0.00 XXX 1.8087260 C 16.76 0.00 0.00 0.00 XXX 1.8087265 C 16.76 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
87267 C 16.76 0.00 0.00 0.00 XXX 1.8087269 C 16.76 0.00 0.00 0.00 XXX 1.8087270 C 16.76 0.00 0.00 0.00 XXX 1.8087271 C 16.76 0.00 0.00 0.00 XXX 1.8087272 C 16.76 0.00 0.00 0.00 XXX 1.8087273 C 16.76 0.00 0.00 0.00 XXX 1.8087274 C 16.76 0.00 0.00 0.00 XXX 1.8087275 C 16.76 0.00 0.00 0.00 XXX 1.8087276 C 16.76 0.00 0.00 0.00 XXX 1.8087277 C 16.76 0.00 0.00 0.00 XXX 1.8087278 C 16.76 0.00 0.00 0.00 XXX 1.8087279 C 16.76 0.00 0.00 0.00 XXX 1.8087280 C 16.76 0.00 0.00 0.00 XXX 1.8087281 C 16.76 0.00 0.00 0.00 XXX 1.8087283 C 16.76 0.00 0.00 0.00 XXX 1.8087285 C 16.76 0.00 0.00 0.00 XXX 1.8087290 C 16.76 0.00 0.00 0.00 XXX 1.8087299 S 16.76 0.00 0.00 0.00 XXX 1.8087300 C 16.76 0.00 0.00 0.00 XXX 1.8087301 C 16.76 0.00 0.00 0.00 XXX 1.8087320 C 16.76 0.00 0.00 0.00 XXX 1.8087324 C 16.76 0.00 0.00 0.00 XXX 1.8087327 C 16.76 0.00 0.00 0.00 XXX 1.8087328 C 16.76 0.00 0.00 0.00 XXX 1.8087329 C 16.76 0.00 0.00 0.00 XXX 1.8087332 C 16.76 0.00 0.00 0.00 XXX 1.8087335 C 16.76 0.00 0.00 0.00 XXX 1.8087336 C 16.76 0.00 0.00 0.00 XXX 1.8087337 C 16.76 0.00 0.00 0.00 XXX 1.8087338 C 20.10 0.00 0.00 0.00 XXX 1.8087339 C 16.76 0.00 0.00 0.00 XXX 1.8087340 C 14.43 0.00 0.00 0.00 XXX 1.8087341 C 14.43 0.00 0.00 0.00 XXX 1.8087350 C 16.10 0.00 0.00 0.00 XXX 1.8087380 C 22.94 0.00 0.00 0.00 XXX 1.8087385 C 16.76 0.00 0.00 0.00 XXX 1.8087390 C 24.65 0.00 0.00 0.00 XXX 1.8087391 C 24.65 0.00 0.00 0.00 XXX 1.8087400 C 16.76 0.00 0.00 0.00 XXX 1.8087420 C 16.76 0.00 0.00 0.00 XXX 1.8087425 C 16.76 0.00 0.00 0.00 XXX 1.8087427 C 16.76 0.00 0.00 0.00 XXX 1.8087430 C 16.76 0.00 0.00 0.00 XXX 1.8087449 C 16.76 0.00 0.00 0.00 XXX 1.8087449 C QW 16.76 0.00 0.00 0.00 XXX 1.8087450 C 13.39 0.00 0.00 0.00 XXX 1.8087451 C 13.39 0.00 0.00 0.00 XXX 1.8087470 C 28.02 0.00 0.00 0.00 XXX 1.8087471 C 49.04 0.00 0.00 0.00 XXX 1.8087472 C 59.85 0.00 0.00 0.00 XXX 1.8087475 C 28.02 0.00 0.00 0.00 XXX 1.8087476 C 49.04 0.00 0.00 0.00 XXX 1.8087477 C 59.85 0.00 0.00 0.00 XXX 1.8087480 C 28.02 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
87481 C 49.04 0.00 0.00 0.00 XXX 1.8087482 C 58.33 0.00 0.00 0.00 XXX 1.8087485 C 28.02 0.00 0.00 0.00 XXX 1.8087486 C 49.04 0.00 0.00 0.00 XXX 1.8087487 C 59.85 0.00 0.00 0.00 XXX 1.8087490 C 28.02 0.00 0.00 0.00 XXX 1.8087491 C 49.04 0.00 0.00 0.00 XXX 1.8087492 C 48.84 0.00 0.00 0.00 XXX 1.8087495 C 28.02 0.00 0.00 0.00 XXX 1.8087496 C 49.04 0.00 0.00 0.00 XXX 1.8087497 C 59.85 0.00 0.00 0.00 XXX 1.8087510 C 28.02 0.00 0.00 0.00 XXX 1.8087511 C 49.04 0.00 0.00 0.00 XXX 1.8087512 C 58.33 0.00 0.00 0.00 XXX 1.8087515 C 28.02 0.00 0.00 0.00 XXX 1.8087516 C 49.04 0.00 0.00 0.00 XXX 1.8087517 C 59.85 0.00 0.00 0.00 XXX 1.8087520 C 28.02 0.00 0.00 0.00 XXX 1.8087521 C 49.04 0.00 0.00 0.00 XXX 1.8087522 C 59.85 0.00 0.00 0.00 XXX 1.8087525 C 28.02 0.00 0.00 0.00 XXX 1.8087526 C 49.04 0.00 0.00 0.00 XXX 1.8087527 C 58.33 0.00 0.00 0.00 XXX 1.8087528 C 28.02 0.00 0.00 0.00 XXX 1.8087529 C 49.04 0.00 0.00 0.00 XXX 1.8087530 C 59.85 0.00 0.00 0.00 XXX 1.8087531 C 28.02 0.00 0.00 0.00 XXX 1.8087532 C 49.04 0.00 0.00 0.00 XXX 1.8087533 C 58.33 0.00 0.00 0.00 XXX 1.8087534 C 28.02 0.00 0.00 0.00 XXX 1.8087535 C 49.04 0.00 0.00 0.00 XXX 1.8087536 C 118.89 0.00 0.00 0.00 XXX 1.8087537 C 28.02 0.00 0.00 0.00 XXX 1.8087538 C 49.04 0.00 0.00 0.00 XXX 1.8087539 C 59.85 0.00 0.00 0.00 XXX 1.8087540 C 28.02 0.00 0.00 0.00 XXX 1.8087541 C 49.04 0.00 0.00 0.00 XXX 1.8087542 C 58.33 0.00 0.00 0.00 XXX 1.8087550 C 28.02 0.00 0.00 0.00 XXX 1.8087551 C 49.04 0.00 0.00 0.00 XXX 1.8087552 C 59.85 0.00 0.00 0.00 XXX 1.8087555 C 28.02 0.00 0.00 0.00 XXX 1.8087556 C 49.04 0.00 0.00 0.00 XXX 1.8087557 C 59.85 0.00 0.00 0.00 XXX 1.8087560 C 28.02 0.00 0.00 0.00 XXX 1.8087561 C 49.04 0.00 0.00 0.00 XXX 1.8087562 C 59.85 0.00 0.00 0.00 XXX 1.8087580 C 28.02 0.00 0.00 0.00 XXX 1.8087581 C 49.04 0.00 0.00 0.00 XXX 1.8087582 C 58.33 0.00 0.00 0.00 XXX 1.8087590 C 28.02 0.00 0.00 0.00 XXX 1.8087591 C 49.04 0.00 0.00 0.00 XXX 1.8087592 C 59.85 0.00 0.00 0.00 XXX 1.8087620 C 28.02 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
87621 C 49.04 0.00 0.00 0.00 XXX 1.8087622 C 58.33 0.00 0.00 0.00 XXX 1.8087650 C 28.02 0.00 0.00 0.00 XXX 1.8087651 C 49.04 0.00 0.00 0.00 XXX 1.8087652 C 58.33 0.00 0.00 0.00 XXX 1.8087660 C 28.02 0.00 0.00 0.00 XXX 1.8087797 C 28.02 0.00 0.00 0.00 XXX 1.8087798 C 49.04 0.00 0.00 0.00 XXX 1.8087799 C 59.85 0.00 0.00 0.00 XXX 1.8087800 C 56.03 0.00 0.00 0.00 XXX 1.8087801 C 98.07 0.00 0.00 0.00 XXX 1.8087802 C 16.76 0.00 0.00 0.00 XXX 1.8087803 C 16.76 0.00 0.00 0.00 XXX 1.8087804 C 16.76 0.00 0.00 0.00 XXX 1.8087804 C QW 16.76 0.00 0.00 0.00 XXX 1.8087807 C 16.76 0.00 0.00 0.00 XXX 1.8087807 C QW 16.76 0.00 0.00 0.00 XXX 1.8087810 C 16.76 0.00 0.00 0.00 XXX 1.8087850 C 16.76 0.00 0.00 0.00 XXX 1.8087880 C 16.76 0.00 0.00 0.00 XXX 1.8087880 C QW 16.76 0.00 0.00 0.00 XXX 1.8087899 C 16.76 0.00 0.00 0.00 XXX 1.8087899 C QW 16.76 0.00 0.00 0.00 XXX 1.8087900 C 182.11 0.00 0.00 0.00 XXX 1.8087901 C 359.69 0.00 0.00 0.00 XXX 1.8087902 C 359.69 0.00 0.00 0.00 XXX 1.8087903 C 682.72 0.00 0.00 0.00 XXX 1.8087904 C 36.42 0.00 0.00 0.00 XXX 1.8087999 S 0.00 0.00 0.00 0.00 XXX 0.0088000 C 0.00 0.00 0.00 0.00 XXX 0.0088005 C 0.00 0.00 0.00 0.00 XXX 0.0088007 C 0.00 0.00 0.00 0.00 XXX 0.0088012 C 0.00 0.00 0.00 0.00 XXX 0.0088014 C 0.00 0.00 0.00 0.00 XXX 0.0088016 C 0.00 0.00 0.00 0.00 XXX 0.0088020 C 0.00 0.00 0.00 0.00 XXX 0.0088025 C 0.00 0.00 0.00 0.00 XXX 0.0088027 C 0.00 0.00 0.00 0.00 XXX 0.0088028 C 0.00 0.00 0.00 0.00 XXX 0.0088029 C 0.00 0.00 0.00 0.00 XXX 0.0088036 C 0.00 0.00 0.00 0.00 XXX 0.0088037 C 0.00 0.00 0.00 0.00 XXX 0.0088040 C 0.00 0.00 0.00 0.00 XXX 0.0088045 C 0.00 0.00 0.00 0.00 XXX 0.0088099 S 0.00 0.00 0.00 0.00 XXX 0.0088104 C 0.56 0.85 0.85 0.04 XXX 50.5888104 C TC 0.00 0.61 0.61 0.02 XXX 50.5888104 C 26 0.56 0.24 0.24 0.02 XXX 50.5888106 C 0.56 1.35 1.35 0.04 XXX 50.5888106 C TC 0.00 1.11 1.11 0.02 XXX 50.5888106 C 26 0.56 0.24 0.24 0.02 XXX 50.5888107 C 0.76 1.54 1.54 0.05 XXX 50.5888107 C TC 0.00 1.21 1.21 0.02 XXX 50.5888107 C 26 0.76 0.33 0.33 0.03 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
88108 C 0.56 1.21 1.21 0.04 XXX 50.5888108 C TC 0.00 0.97 0.97 0.02 XXX 50.5888108 C 26 0.56 0.24 0.24 0.02 XXX 50.5888112 C 1.18 1.97 1.97 0.04 XXX 50.5888112 C TC 0.00 1.46 1.46 0.02 XXX 50.5888112 C 26 1.18 0.51 0.51 0.02 XXX 50.5888125 C 0.26 0.27 0.27 0.02 XXX 50.5888125 C TC 0.00 0.16 0.16 0.01 XXX 50.5888125 C 26 0.26 0.11 0.11 0.01 XXX 50.5888130 C 21.02 0.00 0.00 0.00 XXX 1.8088140 C 11.17 0.00 0.00 0.00 XXX 1.8088141 C 0.42 0.15 0.15 0.02 XXX 50.5888142 C 28.31 0.00 0.00 0.00 XXX 1.8088143 C 28.31 0.00 0.00 0.00 XXX 1.8088147 C 15.90 0.00 0.00 0.00 XXX 1.8088148 C 21.23 0.00 0.00 0.00 XXX 1.8088150 C 14.76 0.00 0.00 0.00 XXX 1.8088152 C 14.76 0.00 0.00 0.00 XXX 1.8088153 C 14.76 0.00 0.00 0.00 XXX 1.8088154 C 14.76 0.00 0.00 0.00 XXX 1.8088155 C 8.37 0.00 0.00 0.00 XXX 1.8088160 C 0.50 0.83 0.83 0.04 XXX 50.5888160 C TC 0.00 0.62 0.62 0.02 XXX 50.5888160 C 26 0.50 0.21 0.21 0.02 XXX 50.5888161 C 0.50 0.94 0.94 0.04 XXX 50.5888161 C TC 0.00 0.73 0.73 0.02 XXX 50.5888161 C 26 0.50 0.21 0.21 0.02 XXX 50.5888162 C 0.76 1.02 1.02 0.05 XXX 50.5888162 C TC 0.00 0.69 0.69 0.02 XXX 50.5888162 C 26 0.76 0.33 0.33 0.03 XXX 50.5888164 C 14.76 0.00 0.00 0.00 XXX 1.8088165 C 14.76 0.00 0.00 0.00 XXX 1.8088166 C 14.76 0.00 0.00 0.00 XXX 1.8088167 C 14.76 0.00 0.00 0.00 XXX 1.8088172 C 0.60 0.73 0.73 0.04 XXX 50.5888172 C TC 0.00 0.47 0.47 0.02 XXX 50.5888172 C 26 0.60 0.26 0.26 0.02 XXX 50.5888173 C 1.39 2.14 2.14 0.07 XXX 50.5888173 C TC 0.00 1.55 1.55 0.02 XXX 50.5888173 C 26 1.39 0.59 0.59 0.05 XXX 50.5888174 C 29.85 0.00 0.00 0.00 XXX 1.8088175 C 37.01 0.00 0.00 0.00 XXX 1.8088182 C 0.77 1.98 1.98 0.07 XXX 50.5888182 C TC 0.00 1.65 1.65 0.04 XXX 50.5888182 C 26 0.77 0.33 0.33 0.03 XXX 50.5888184 C 0.00 1.32 1.32 0.02 XXX 50.5888185 C 0.00 0.64 0.64 0.02 XXX 50.5888187 C 1.36 0.45 0.45 0.01 XXX 50.5888188 C 1.69 0.57 0.57 0.01 XXX 50.5888189 C 2.23 0.75 0.75 0.01 XXX 50.5888199 S 0.00 0.00 0.00 0.00 XXX 0.0088199 S TC 0.00 0.00 0.00 0.00 XXX 0.0088199 S 26 0.00 0.00 0.00 0.00 XXX 0.0088230 C 162.77 0.00 0.00 0.00 XXX 1.80
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
88233 C 196.63 0.00 0.00 0.00 XXX 1.8088235 C 205.74 0.00 0.00 0.00 XXX 1.8088237 C 176.47 0.00 0.00 0.00 XXX 1.8088239 C 206.12 0.00 0.00 0.00 XXX 1.8088240 C 14.11 0.00 0.00 0.00 XXX 1.8088241 C 14.11 0.00 0.00 0.00 XXX 1.8088245 C 207.98 0.00 0.00 0.00 XXX 1.8088248 C 241.96 0.00 0.00 0.00 XXX 1.8088249 C 241.96 0.00 0.00 0.00 XXX 1.8088261 C 246.93 0.00 0.00 0.00 XXX 1.8088262 C 174.14 0.00 0.00 0.00 XXX 1.8088263 C 209.97 0.00 0.00 0.00 XXX 1.8088264 C 174.14 0.00 0.00 0.00 XXX 1.8088267 C 251.17 0.00 0.00 0.00 XXX 1.8088269 C 232.38 0.00 0.00 0.00 XXX 1.8088271 C 29.93 0.00 0.00 0.00 XXX 1.8088272 C 37.41 0.00 0.00 0.00 XXX 1.8088273 C 44.89 0.00 0.00 0.00 XXX 1.8088274 C 48.63 0.00 0.00 0.00 XXX 1.8088275 C 56.11 0.00 0.00 0.00 XXX 1.8088280 C 35.07 0.00 0.00 0.00 XXX 1.8088283 C 95.84 0.00 0.00 0.00 XXX 1.8088285 C 26.54 0.00 0.00 0.00 XXX 1.8088289 C 48.11 0.00 0.00 0.00 XXX 1.8088291 C 0.52 0.17 0.17 0.02 XXX 50.5888299 S 0.00 0.00 0.00 0.00 XXX 0.0088300 C 0.08 0.45 0.45 0.02 XXX 50.5888300 C TC 0.00 0.42 0.42 0.01 XXX 50.5888300 C 26 0.08 0.03 0.03 0.01 XXX 50.5888302 C 0.13 1.03 1.03 0.03 XXX 50.5888302 C TC 0.00 0.97 0.97 0.02 XXX 50.5888302 C 26 0.13 0.06 0.06 0.01 XXX 50.5888304 C 0.22 1.32 1.32 0.03 XXX 50.5888304 C TC 0.00 1.23 1.23 0.02 XXX 50.5888304 C 26 0.22 0.09 0.09 0.01 XXX 50.5888305 C 0.75 1.91 1.91 0.07 XXX 50.5888305 C TC 0.00 1.58 1.58 0.04 XXX 50.5888305 C 26 0.75 0.33 0.33 0.03 XXX 50.5888307 C 1.59 3.16 3.16 0.12 XXX 50.5888307 C TC 0.00 2.48 2.48 0.06 XXX 50.5888307 C 26 1.59 0.68 0.68 0.06 XXX 50.5888309 C 2.28 4.40 4.40 0.14 XXX 50.5888309 C TC 0.00 3.43 3.43 0.06 XXX 50.5888309 C 26 2.28 0.97 0.97 0.08 XXX 50.5888311 C 0.24 0.23 0.23 0.02 XXX 50.5888311 C TC 0.00 0.13 0.13 0.01 XXX 50.5888311 C 26 0.24 0.10 0.10 0.01 XXX 50.5888312 C 0.54 1.52 1.52 0.03 XXX 50.5888312 C TC 0.00 1.29 1.29 0.01 XXX 50.5888312 C 26 0.54 0.23 0.23 0.02 XXX 50.5888313 C 0.24 1.25 1.25 0.02 XXX 50.5888313 C TC 0.00 1.15 1.15 0.01 XXX 50.5888313 C 26 0.24 0.10 0.10 0.01 XXX 50.5888314 C 0.45 2.07 2.07 0.04 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
88314 C TC 0.00 1.88 1.88 0.02 XXX 50.5888314 C 26 0.45 0.19 0.19 0.02 XXX 50.5888318 C 0.42 1.65 1.65 0.03 XXX 50.5888318 C TC 0.00 1.47 1.47 0.01 XXX 50.5888318 C 26 0.42 0.18 0.18 0.02 XXX 50.5888319 C 0.53 3.42 3.42 0.04 XXX 50.5888319 C TC 0.00 3.20 3.20 0.02 XXX 50.5888319 C 26 0.53 0.22 0.22 0.02 XXX 50.5888321 C 1.30 0.79 0.56 0.05 XXX 50.5888323 C 1.35 1.78 1.78 0.07 XXX 50.5888323 C TC 0.00 1.21 1.21 0.02 XXX 50.5888323 C 26 1.35 0.57 0.57 0.05 XXX 50.5888325 C 2.22 2.94 0.95 0.07 XXX 50.5888329 C 0.67 0.65 0.29 0.20 XXX 50.5888331 C 1.19 1.10 1.10 0.08 XXX 50.5888331 C TC 0.00 0.59 0.59 0.04 XXX 50.5888331 C 26 1.19 0.51 0.51 0.04 XXX 50.5888332 C 0.59 0.46 0.46 0.04 XXX 50.5888332 C TC 0.00 0.21 0.21 0.02 XXX 50.5888332 C 26 0.59 0.25 0.25 0.02 XXX 50.5888333 C 1.20 1.08 1.08 0.08 XXX 50.5888333 C TC 0.00 0.55 0.55 0.04 XXX 50.5888333 C 26 1.20 0.53 0.53 0.04 XXX 50.5888334 C 0.59 0.60 0.60 0.04 XXX 50.5888334 C TC 0.00 0.34 0.34 0.02 XXX 50.5888334 C 26 0.59 0.26 0.26 0.02 XXX 50.5888342 C 0.85 1.46 1.46 0.05 XXX 50.5888342 C TC 0.00 1.10 1.10 0.02 XXX 50.5888342 C 26 0.85 0.36 0.36 0.03 XXX 50.5888346 C 0.86 1.57 1.57 0.05 XXX 50.5888346 C TC 0.00 1.21 1.21 0.02 XXX 50.5888346 C 26 0.86 0.36 0.36 0.03 XXX 50.5888347 C 0.86 1.26 1.26 0.05 XXX 50.5888347 C TC 0.00 0.91 0.91 0.02 XXX 50.5888347 C 26 0.86 0.35 0.35 0.03 XXX 50.5888348 C 1.51 9.38 9.38 0.13 XXX 50.5888348 C TC 0.00 8.74 8.74 0.07 XXX 50.5888348 C 26 1.51 0.64 0.64 0.06 XXX 50.5888349 C 0.76 3.57 3.57 0.09 XXX 50.5888349 C TC 0.00 3.24 3.24 0.06 XXX 50.5888349 C 26 0.76 0.33 0.33 0.03 XXX 50.5888355 C 1.85 8.79 8.79 0.13 XXX 50.5888355 C TC 0.00 8.00 8.00 0.06 XXX 50.5888355 C 26 1.85 0.79 0.79 0.07 XXX 50.5888356 C 3.02 4.19 4.19 0.19 XXX 50.5888356 C TC 0.00 2.93 2.93 0.07 XXX 50.5888356 C 26 3.02 1.26 1.26 0.12 XXX 50.5888358 C 0.95 0.84 0.84 0.17 XXX 50.5888358 C TC 0.00 0.44 0.44 0.07 XXX 50.5888358 C 26 0.95 0.40 0.40 0.10 XXX 50.5888360 C 1.10 1.73 1.73 0.08 XXX 50.5888360 C TC 0.00 1.26 1.26 0.02 XXX 50.5888360 C 26 1.10 0.47 0.47 0.06 XXX 50.5888361 C 1.18 3.03 3.03 0.17 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
88361 C TC 0.00 2.54 2.54 0.07 XXX 50.5888361 C 26 1.18 0.49 0.49 0.10 XXX 50.5888362 C 2.17 4.70 4.70 0.15 XXX 50.5888362 C TC 0.00 3.78 3.78 0.06 XXX 50.5888362 C 26 2.17 0.92 0.92 0.09 XXX 50.5888365 C 1.20 2.13 2.13 0.05 XXX 50.5888365 C TC 0.00 1.62 1.62 0.02 XXX 50.5888365 C 26 1.20 0.51 0.51 0.03 XXX 50.5888367 C 1.30 4.04 4.04 0.12 XXX 50.5888367 C TC 0.00 3.50 3.50 0.06 XXX 50.5888367 C 26 1.30 0.54 0.54 0.06 XXX 50.5888368 C 1.40 2.40 2.40 0.12 XXX 50.5888368 C TC 0.00 1.80 1.80 0.06 XXX 50.5888368 C 26 1.40 0.60 0.60 0.06 XXX 50.5888371 C 31.05 0.00 0.00 0.00 XXX 1.8088371 C 26 0.37 0.13 0.13 0.01 XXX 50.5888372 C 31.79 0.00 0.00 0.00 XXX 1.8088372 C 26 0.37 0.16 0.16 0.01 XXX 50.5888380 C 0.00 0.00 0.00 0.00 XXX 0.0088380 C TC 0.00 0.00 0.00 0.00 XXX 0.0088380 C 26 0.00 0.00 0.00 0.00 XXX 0.0088384 C 0.00 0.00 0.00 0.00 XXX 0.0088384 C TC 0.00 0.00 0.00 0.00 XXX 0.0088384 C 26 0.00 0.00 0.00 0.00 XXX 0.0088385 C 1.50 7.10 7.10 0.12 XXX 50.5888385 C TC 0.00 6.45 6.45 0.06 XXX 50.5888385 C 26 1.50 0.65 0.65 0.06 XXX 50.5888386 C 1.88 7.05 7.05 0.16 XXX 50.5888386 C TC 0.00 6.23 6.23 0.08 XXX 50.5888386 C 26 1.88 0.82 0.82 0.08 XXX 50.5888399 S 0.00 0.00 0.00 0.00 XXX 0.0088399 S TC 0.00 0.00 0.00 0.00 XXX 0.0088399 S 26 0.00 0.00 0.00 0.00 XXX 0.0088400 C 7.02 0.00 0.00 0.00 XXX 1.8089049 C 1.40 3.56 0.27 0.06 XXX 50.5889050 C 6.61 0.00 0.00 0.00 XXX 1.8089051 C 7.70 0.00 0.00 0.00 XXX 1.8089055 C 5.96 0.00 0.00 0.00 XXX 1.8089060 C 9.99 0.00 0.00 0.00 XXX 1.8089060 C 26 0.37 0.16 0.16 0.01 XXX 50.5889100 C 0.60 1.84 0.21 0.03 XXX 50.5889105 C 0.50 2.23 0.17 0.02 XXX 50.5889125 C 6.03 0.00 0.00 0.00 XXX 1.8089130 C 0.45 1.75 0.13 0.02 XXX 50.5889132 C 0.19 1.55 0.06 0.01 XXX 50.5889135 C 0.79 1.90 0.25 0.04 XXX 50.5889136 C 0.21 1.74 0.09 0.01 XXX 50.5889140 C 0.94 2.09 0.27 0.04 XXX 50.5889141 C 0.85 2.79 0.33 0.03 XXX 50.5889160 C 5.15 0.00 0.00 0.00 XXX 1.8089190 C 6.64 0.00 0.00 0.00 XXX 1.8089220 C 0.00 0.43 0.43 0.02 XXX 1.7389225 C 7.69 0.00 0.00 0.00 XXX 1.8089230 C 0.00 0.11 0.11 0.02 XXX 1.73
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
89235 C 7.69 0.00 0.00 0.00 XXX 1.8089240 C 0.00 0.00 0.00 0.00 XXX 0.0089250 D 0.00 0.00 0.00 0.00 XXX 0.0089251 D 0.00 0.00 0.00 0.00 XXX 0.0089253 D 0.00 0.00 0.00 0.00 XXX 0.0089254 D 0.00 0.00 0.00 0.00 XXX 0.0089255 D 0.00 0.00 0.00 0.00 XXX 0.0089257 C 0.00 0.00 0.00 0.00 XXX 0.0089258 D 0.00 0.00 0.00 0.00 XXX 0.0089259 D 0.00 0.00 0.00 0.00 XXX 0.0089260 C 0.00 0.00 0.00 0.00 XXX 0.0089261 C 0.00 0.00 0.00 0.00 XXX 0.0089264 C 0.00 0.00 0.00 0.00 XXX 0.0089268 D 0.00 0.00 0.00 0.00 XXX 0.0089272 D 0.00 0.00 0.00 0.00 XXX 0.0089280 D 0.00 0.00 0.00 0.00 XXX 0.0089281 D 0.00 0.00 0.00 0.00 XXX 0.0089290 D 0.00 0.00 0.00 0.00 XXX 0.0089291 D 0.00 0.00 0.00 0.00 XXX 0.0089300 C 12.45 0.00 0.00 0.00 XXX 1.8089300 C QW 12.45 0.00 0.00 0.00 XXX 1.8089310 C 12.03 0.00 0.00 0.00 XXX 1.8089320 C 16.84 0.00 0.00 0.00 XXX 1.8089321 C 16.84 0.00 0.00 0.00 XXX 1.8089325 C 14.91 0.00 0.00 0.00 XXX 1.8089329 D 29.30 0.00 0.00 0.00 XXX 1.8089330 C 13.83 0.00 0.00 0.00 XXX 1.8089335 D 0.00 0.00 0.00 0.00 XXX 0.0089342 D 0.00 0.00 0.00 0.00 XXX 0.0089343 D 0.00 0.00 0.00 0.00 XXX 0.0089344 D 0.00 0.00 0.00 0.00 XXX 0.0089346 D 0.00 0.00 0.00 0.00 XXX 0.0089352 D 0.00 0.00 0.00 0.00 XXX 0.0089353 D 0.00 0.00 0.00 0.00 XXX 0.0089354 D 0.00 0.00 0.00 0.00 XXX 0.0089356 D 0.00 7.89 7.89 0.00 XXX 1.7390281 C 0.00 0.00 0.00 0.00 XXX 0.0090283 C 0.00 0.00 0.00 0.00 XXX 0.0090287 C 0.00 0.00 0.00 0.00 XXX 0.0090288 C 0.00 0.00 0.00 0.00 XXX 0.0090291 C 0.00 0.00 0.00 0.00 XXX 0.0090296 C 0.00 0.00 0.00 0.00 XXX 0.0090371 C 118.24 0.00 0.00 0.00 XXX 1.2590375 C 64.91 0.00 0.00 0.00 XXX 1.2590376 C 68.92 0.00 0.00 0.00 XXX 1.2590378 C 0.00 0.00 0.00 0.00 XXX 0.0090379 C 0.00 0.00 0.00 0.00 XXX 0.0090384 C 0.00 0.00 0.00 0.00 XXX 0.0090385 C 6.62 0.00 0.00 0.00 XXX 1.2590386 C 0.00 0.00 0.00 0.00 XXX 0.0090389 C 0.00 0.00 0.00 0.00 XXX 0.0090393 C 0.00 0.00 0.00 0.00 XXX 0.0090396 C 110.42 0.00 0.00 0.00 XXX 1.2590399 S 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
90465 D 0.17 0.31 0.31 0.01 XXX 50.5890466 D 0.15 0.13 0.13 0.01 ZZZ 50.5890467 D 0.17 0.17 0.09 0.01 XXX 50.5890468 D 0.15 0.11 0.06 0.01 XXX 50.5890471 C 0.17 0.31 0.31 0.01 XXX 50.5890472 C 0.15 0.13 0.13 0.01 XXX 50.5890473 C 0.17 0.19 0.07 0.01 XXX 50.5890474 C 0.15 0.10 0.06 0.01 XXX 50.5890476 C 0.00 0.00 0.01 0.00 XXX 0.0090477 C 0.00 0.00 0.00 0.00 XXX 0.0090581 C 0.00 0.00 0.00 0.00 XXX 0.0090585 C 118.16 0.00 0.00 0.00 XXX 1.2590586 C 115.09 0.00 0.00 0.00 XXX 1.2590632 C 42.18 0.00 0.00 0.00 XXX 1.2590633 D 22.64 0.00 0.00 0.00 XXX 1.2590634 D 22.65 0.00 0.00 0.00 XXX 1.2590636 C 0.00 0.00 0.00 0.00 XXX 0.0090645 C 21.52 0.00 0.00 0.00 XXX 1.2590646 C 0.00 0.00 0.00 0.00 XXX 0.0090647 C 21.52 0.00 0.00 0.00 XXX 1.2590648 C 21.78 0.00 0.00 0.00 XXX 1.2590649 D 0.00 0.00 0.00 0.00 XXX 0.0090655 D 14.68 0.00 0.00 0.00 XXX 1.2590656 C 15.82 0.00 0.00 0.00 XXX 1.2590657 D 6.03 0.00 0.00 0.00 XXX 1.2590658 C 12.06 0.00 0.00 0.00 XXX 1.2590659 C 9.95 0.00 0.00 0.00 XXX 1.25 12/31/200390660 C 0.00 0.00 0.00 0.00 XXX 0.0090665 C 0.00 0.00 0.00 0.00 XXX 0.0090669 D 0.00 0.00 0.00 0.00 XXX 0.0090675 C 147.20 0.00 0.00 0.00 XXX 1.2590676 C 0.00 0.00 0.00 0.00 XXX 0.0090680 C 0.00 0.00 0.00 0.00 XXX 0.0090690 C 0.00 0.00 0.00 0.00 XXX 0.0090691 C 37.52 0.00 0.00 0.00 XXX 1.2590692 C 0.00 0.00 0.00 0.00 XXX 0.0090693 C 0.00 0.00 0.00 0.00 XXX 0.0090698 C 0.00 0.00 0.00 0.00 XXX 0.0090700 C 22.64 0.00 0.00 0.00 XXX 1.2590701 C 0.00 0.00 0.00 0.00 XXX 0.0090702 D 17.50 0.00 0.00 0.00 XXX 1.2590703 C 21.42 0.00 0.00 0.00 XXX 1.2590704 C 19.15 0.00 0.00 0.00 XXX 1.2590705 C 14.49 0.00 0.00 0.00 XXX 1.2590706 C 16.17 0.00 0.00 0.00 XXX 1.2590707 C 38.51 0.00 0.00 0.00 XXX 1.2590708 C 0.00 0.00 0.00 0.00 XXX 0.0090710 C 0.00 0.00 0.00 0.00 XXX 0.0090712 C 0.00 0.00 0.00 0.00 XXX 0.0090713 C 25.01 0.00 0.00 0.00 XXX 1.2590714 C 0.00 0.00 0.00 0.00 XXX 0.0090715 C 0.00 0.00 0.00 0.00 XXX 0.0090716 C 67.34 0.00 0.00 0.00 XXX 1.2590717 C 59.46 0.00 0.00 0.00 XXX 1.25
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
90718 C 16.27 0.00 0.00 0.00 XXX 1.2590719 C 0.00 0.00 0.00 0.00 XXX 0.0090720 C 28.34 0.00 0.00 0.00 XXX 1.2590721 C 41.72 0.00 0.00 0.00 XXX 1.2590723 C 0.00 0.00 0.00 0.00 XXX 0.0090725 C 0.00 0.00 0.00 0.00 XXX 0.0090727 C 0.00 0.00 0.00 0.00 XXX 0.0090732 C 24.57 0.00 0.00 0.00 XXX 1.2590733 C 86.10 0.00 0.00 0.00 XXX 1.2590734 C 0.00 0.00 0.00 0.00 XXX 0.0090735 C 88.13 0.00 0.00 0.00 XXX 1.2590736 C 0.00 0.00 0.00 0.00 XXX 0.0090740 C 113.91 0.00 0.00 0.00 XXX 1.2590743 D 67.93 0.00 0.00 0.00 XXX 1.2590744 D 68.38 0.00 0.00 0.00 XXX 1.2590746 C 56.96 0.00 0.00 0.00 XXX 1.2590747 C 113.91 0.00 0.00 0.00 XXX 1.2590748 C 0.00 0.00 0.00 0.00 XXX 0.0090749 C 0.00 0.00 0.00 0.00 XXX 0.0090760 C 0.17 1.43 1.43 0.07 XXX 50.5890761 C 0.09 0.40 0.40 0.04 ZZZ 50.5890765 C 0.21 1.76 1.76 0.07 XXX 50.5890766 C 0.18 0.46 0.46 0.04 ZZZ 50.5890767 C 0.19 0.89 0.89 0.04 ZZZ 50.5890768 C 0.17 0.44 0.44 0.04 ZZZ 50.5890772 C 0.17 0.31 0.31 0.01 XXX 50.5890773 C 0.17 0.31 0.31 0.02 XXX 50.5890774 C 0.18 1.30 1.30 0.04 XXX 50.5890775 C 0.10 0.57 0.57 0.04 ZZZ 50.5890779 C 0.00 0.00 0.00 0.00 XXX 0.0090780 C 0.22 2.15 2.15 0.07 XXX 50.58 12/31/200590781 C 0.22 0.46 0.46 0.04 ZZZ 50.58 12/31/200590782 C 0.22 0.32 0.32 0.01 XXX 50.58 12/31/200590783 C 0.22 0.31 0.31 0.02 XXX 50.58 12/31/200590784 C 0.22 0.80 0.80 0.04 XXX 50.58 12/31/200590788 C 0.22 0.26 0.26 0.01 XXX 50.58 12/31/200590799 S 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200590801 C 2.80 1.17 0.93 0.06 XXX 50.5890802 C 3.01 1.20 0.98 0.07 XXX 50.5890804 C 1.21 0.49 0.38 0.03 XXX 50.5890805 C 1.37 0.50 0.42 0.03 XXX 50.5890806 C 1.86 0.70 0.60 0.04 XXX 50.5890807 C 2.02 0.70 0.63 0.05 XXX 50.5890808 C 2.79 1.03 0.90 0.06 XXX 50.5890809 C 2.95 1.00 0.92 0.07 XXX 50.5890810 C 1.32 0.51 0.42 0.04 XXX 50.5890811 C 1.48 0.57 0.46 0.04 XXX 50.5890812 C 1.97 0.79 0.64 0.04 XXX 50.5890813 C 2.13 0.77 0.67 0.05 XXX 50.5890814 C 2.90 1.10 0.98 0.06 XXX 50.5890815 C 3.06 1.05 0.95 0.07 XXX 50.5890816 C 1.25 0.46 0.46 0.03 XXX 50.5890817 C 1.41 0.46 0.46 0.03 XXX 50.5890818 C 1.89 0.69 0.69 0.04 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
90819 C 2.05 0.65 0.65 0.05 XXX 50.5890821 C 2.83 1.01 1.01 0.06 XXX 50.5890822 C 2.99 0.95 0.95 0.08 XXX 50.5890823 C 1.36 0.48 0.48 0.03 XXX 50.5890824 C 1.52 0.49 0.49 0.04 XXX 50.5890826 C 2.01 0.72 0.72 0.05 XXX 50.5890827 C 2.16 0.68 0.68 0.05 XXX 50.5890828 C 2.94 1.06 1.06 0.06 XXX 50.5890829 C 3.10 0.98 0.98 0.07 XXX 50.5890845 C 1.79 0.58 0.55 0.04 XXX 50.5890846 C 1.83 0.65 0.65 0.04 XXX 50.5890847 C 2.21 0.82 0.76 0.05 XXX 50.5890849 C 0.59 0.27 0.24 0.02 XXX 50.5890853 C 0.59 0.25 0.23 0.01 XXX 50.5890857 C 0.63 0.29 0.25 0.01 XXX 50.5890862 C 0.95 0.40 0.32 0.02 XXX 50.5890865 C 2.84 1.36 0.91 0.12 XXX 50.5890870 C 1.88 1.94 0.59 0.04 000 50.5890871 C 2.72 1.07 1.07 0.07 000 50.58 12/31/200590875 C 1.20 0.90 0.46 0.04 XXX 50.5890876 C 1.90 1.16 0.73 0.05 XXX 50.5890880 C 2.19 1.04 0.69 0.05 XXX 50.5890882 C 0.00 0.00 0.00 0.00 XXX 0.0090885 C 0.97 0.37 0.37 0.02 XXX 50.5890887 C 1.48 0.82 0.56 0.04 XXX 50.5890889 C 3.87 1.83 1.83 0.13 XXX 50.5890899 S 0.00 0.00 0.00 0.00 XXX 0.0090901 C 0.41 0.65 0.14 0.02 XXX 50.5890911 C 0.89 1.56 0.31 0.06 XXX 50.5890918 D 11.16 6.13 6.13 0.36 XXX 50.5890919 D 8.53 4.01 4.01 0.29 XXX 50.5890920 D 7.26 3.76 3.76 0.23 XXX 50.5890921 C 4.46 2.45 2.45 0.14 XXX 50.5890922 D 0.37 0.21 0.21 0.01 XXX 50.5890923 D 0.28 0.13 0.13 0.01 XXX 50.5890924 D 0.24 0.12 0.12 0.01 XXX 50.5890925 C 0.15 0.08 0.08 0.01 XXX 50.5890935 C 1.22 0.67 0.67 0.04 XXX 50.5890937 C 2.11 0.97 0.97 0.07 XXX 50.5890939 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200590940 C 0.00 0.00 0.00 0.00 XXX 0.0090945 C 1.28 0.69 0.69 0.04 000 50.5890947 C 2.16 0.99 0.99 0.07 000 50.5890989 C 0.00 0.00 0.00 0.00 XXX 0.0090993 C 0.00 0.00 0.00 0.00 XXX 0.0090997 C 1.84 0.66 0.66 0.06 000 50.5890999 S 0.00 0.00 0.00 0.00 XXX 0.0091000 C 0.73 0.33 0.33 0.04 000 50.5891000 C TC 0.00 0.08 0.08 0.01 000 50.5891000 C 26 0.73 0.25 0.25 0.03 000 50.5891010 C 1.25 4.42 4.42 0.12 000 50.5891010 C TC 0.00 3.98 3.98 0.06 000 50.5891010 C 26 1.25 0.44 0.44 0.06 000 50.5891011 C 1.50 5.24 5.24 0.13 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
91011 C TC 0.00 4.71 4.71 0.06 000 50.5891011 C 26 1.50 0.53 0.53 0.07 000 50.5891012 C 1.46 5.77 5.77 0.13 000 50.5891012 C TC 0.00 5.26 5.26 0.07 000 50.5891012 C 26 1.46 0.51 0.51 0.06 000 50.5891020 C 1.44 4.53 4.53 0.13 000 50.5891020 C TC 0.00 4.04 4.04 0.06 000 50.5891020 C 26 1.44 0.49 0.49 0.07 000 50.5891022 C 1.44 4.41 4.41 0.13 000 50.5891022 C TC 0.00 3.90 3.90 0.06 000 50.5891022 C 26 1.44 0.51 0.51 0.07 000 50.5891030 C 0.91 2.44 2.44 0.06 000 50.5891030 C TC 0.00 2.12 2.12 0.02 000 50.5891030 C 26 0.91 0.32 0.32 0.04 000 50.5891034 C 0.97 5.25 5.25 0.12 000 50.5891034 C TC 0.00 4.91 4.91 0.06 000 50.5891034 C 26 0.97 0.34 0.34 0.06 000 50.5891035 C 1.59 10.83 10.83 0.12 000 50.5891035 C TC 0.00 10.27 10.27 0.06 000 50.5891035 C 26 1.59 0.56 0.56 0.06 000 50.5891037 C 0.97 2.94 2.94 0.12 000 50.5891037 C TC 0.00 2.60 2.60 0.06 000 50.5891037 C 26 0.97 0.34 0.34 0.06 000 50.5891038 C 1.10 2.23 2.23 0.12 000 50.5891038 C TC 0.00 1.84 1.84 0.06 000 50.5891038 C 26 1.10 0.39 0.39 0.06 000 50.5891040 C 0.97 11.16 11.16 0.12 000 50.5891040 C TC 0.00 10.82 10.82 0.06 000 50.5891040 C 26 0.97 0.34 0.34 0.06 000 50.5891052 C 0.79 2.46 2.46 0.05 000 50.5891052 C TC 0.00 2.18 2.18 0.02 000 50.5891052 C 26 0.79 0.28 0.28 0.03 000 50.5891055 C 0.94 2.95 2.95 0.07 000 50.5891055 C TC 0.00 2.68 2.68 0.02 000 50.5891055 C 26 0.94 0.27 0.27 0.05 000 50.5891060 C 0.45 1.97 1.97 0.05 000 50.5891060 C TC 0.00 1.83 1.83 0.02 000 50.5891060 C 26 0.45 0.14 0.14 0.03 000 50.5891065 C 0.20 1.46 1.46 0.03 000 50.5891065 C TC 0.00 1.39 1.39 0.02 000 50.5891065 C 26 0.20 0.07 0.07 0.01 000 50.5891100 C 1.08 2.80 2.80 0.07 000 50.5891105 C 0.37 2.11 0.09 0.03 000 50.5891110 C 3.64 22.24 22.24 0.16 XXX 50.5891110 C TC 0.00 20.96 20.96 0.07 XXX 50.5891110 C 26 3.64 1.28 1.28 0.09 XXX 50.5891120 C 0.97 11.01 11.01 0.11 XXX 50.5891120 C TC 0.00 10.67 10.67 0.04 XXX 50.5891120 C 26 0.97 0.34 0.34 0.07 XXX 50.5891122 C 1.77 5.11 5.11 0.21 000 50.5891122 C TC 0.00 4.51 4.51 0.08 000 50.5891122 C 26 1.77 0.60 0.60 0.13 000 50.5891123 C 0.00 0.00 0.00 0.00 XXX 0.0091132 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
91132 C TC 0.00 0.00 0.00 0.00 XXX 0.0091132 C 26 0.52 0.18 0.18 0.02 XXX 50.5891133 C 0.00 0.00 0.00 0.00 XXX 0.0091133 C TC 0.00 0.00 0.00 0.00 XXX 0.0091133 C 26 0.66 0.23 0.23 0.03 XXX 50.5891299 S 0.00 0.00 0.00 0.00 XXX 0.0091299 S TC 0.00 0.00 0.00 0.00 XXX 0.0091299 S 26 0.00 0.00 0.00 0.00 XXX 0.0092002 C 0.88 0.97 0.34 0.02 XXX 50.5892004 C 1.67 1.70 0.68 0.04 XXX 50.5892012 C 0.67 1.03 0.29 0.02 XXX 50.5892014 C 1.10 1.41 0.47 0.03 XXX 50.5892015 C 0.38 1.49 0.15 0.01 XXX 50.5892018 C 2.50 1.07 1.07 0.07 XXX 50.5892019 C 1.31 0.56 0.56 0.03 XXX 50.5892020 C 0.37 0.34 0.16 0.01 XXX 50.5892060 C 0.69 0.73 0.73 0.03 XXX 50.5892060 C TC 0.00 0.44 0.44 0.01 XXX 50.5892060 C 26 0.69 0.29 0.29 0.02 XXX 50.5892065 C 0.37 0.53 0.53 0.02 XXX 50.5892065 C TC 0.00 0.38 0.38 0.01 XXX 50.5892065 C 26 0.37 0.15 0.15 0.01 XXX 50.5892070 C 0.70 1.07 0.32 0.02 XXX 50.5892081 C 0.36 0.94 0.94 0.02 XXX 50.5892081 C TC 0.00 0.79 0.79 0.01 XXX 50.5892081 C 26 0.36 0.15 0.15 0.01 XXX 50.5892082 C 0.44 1.23 1.23 0.02 XXX 50.5892082 C TC 0.00 1.04 1.04 0.01 XXX 50.5892082 C 26 0.44 0.19 0.19 0.01 XXX 50.5892083 C 0.50 1.43 1.43 0.02 XXX 50.5892083 C TC 0.00 1.21 1.21 0.01 XXX 50.5892083 C 26 0.50 0.22 0.22 0.01 XXX 50.5892100 C 0.92 1.35 0.36 0.02 XXX 50.5892120 C 0.81 1.07 0.32 0.02 XXX 50.5892130 C 0.81 1.28 0.37 0.02 XXX 50.5892135 C 0.35 0.79 0.79 0.02 XXX 50.5892135 C TC 0.00 0.64 0.64 0.01 XXX 50.5892135 C 26 0.35 0.15 0.15 0.01 XXX 50.5892136 C 0.54 1.65 1.65 0.08 XXX 50.5892136 C TC 0.00 1.41 1.41 0.07 XXX 50.5892136 C 26 0.54 0.24 0.24 0.01 XXX 50.5892140 C 0.50 0.99 0.21 0.01 XXX 50.5892225 C 0.38 0.22 0.16 0.01 XXX 50.5892226 C 0.33 0.21 0.14 0.01 XXX 50.5892230 C 0.60 1.53 0.20 0.02 XXX 50.5892235 C 0.81 2.62 2.62 0.08 XXX 50.5892235 C TC 0.00 2.25 2.25 0.06 XXX 50.5892235 C 26 0.81 0.37 0.37 0.02 XXX 50.5892240 C 1.10 6.12 6.12 0.09 XXX 50.5892240 C TC 0.00 5.62 5.62 0.06 XXX 50.5892240 C 26 1.10 0.50 0.50 0.03 XXX 50.5892250 C 0.44 1.53 1.53 0.02 XXX 50.5892250 C TC 0.00 1.34 1.34 0.01 XXX 50.5892250 C 26 0.44 0.19 0.19 0.01 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
92260 C 0.20 0.26 0.09 0.01 XXX 50.5892265 C 0.81 1.49 1.49 0.06 XXX 50.5892265 C TC 0.00 1.21 1.21 0.02 XXX 50.5892265 C 26 0.81 0.28 0.28 0.04 XXX 50.5892270 C 0.81 1.53 1.53 0.05 XXX 50.5892270 C TC 0.00 1.20 1.20 0.02 XXX 50.5892270 C 26 0.81 0.33 0.33 0.03 XXX 50.5892275 C 1.01 1.94 1.94 0.05 XXX 50.5892275 C TC 0.00 1.51 1.51 0.02 XXX 50.5892275 C 26 1.01 0.43 0.43 0.03 XXX 50.5892283 C 0.17 0.84 0.84 0.02 XXX 50.5892283 C TC 0.00 0.77 0.77 0.01 XXX 50.5892283 C 26 0.17 0.07 0.07 0.01 XXX 50.5892284 C 0.24 1.89 1.89 0.02 XXX 50.5892284 C TC 0.00 1.81 1.81 0.01 XXX 50.5892284 C 26 0.24 0.08 0.08 0.01 XXX 50.5892285 C 0.20 0.99 0.99 0.02 XXX 50.5892285 C TC 0.00 0.90 0.90 0.01 XXX 50.5892285 C 26 0.20 0.09 0.09 0.01 XXX 50.5892286 C 0.66 3.06 3.06 0.04 XXX 50.5892286 C TC 0.00 2.77 2.77 0.02 XXX 50.5892286 C 26 0.66 0.29 0.29 0.02 XXX 50.5892287 C 0.81 2.39 2.39 0.02 XXX 50.5892310 C 1.17 1.12 0.45 0.04 XXX 50.5892311 C 1.08 1.09 0.35 0.03 XXX 50.5892312 C 1.26 1.08 0.50 0.03 XXX 50.5892313 C 0.92 1.06 0.29 0.02 XXX 50.5892314 C 0.69 0.94 0.27 0.01 XXX 50.5892315 C 0.45 0.85 0.16 0.01 XXX 50.5892316 C 0.68 0.91 0.29 0.02 XXX 50.5892317 C 0.45 0.94 0.15 0.01 XXX 50.5892325 C 0.00 0.40 0.40 0.01 XXX 50.5892326 C 0.00 1.63 1.63 0.06 XXX 50.5892330 C 1.08 0.99 0.32 0.03 XXX 50.58 12/31/200592335 C 0.45 0.90 0.16 0.01 XXX 50.58 12/31/200592340 C 0.37 0.70 0.14 0.01 XXX 50.5892341 C 0.47 0.74 0.18 0.01 XXX 50.5892342 C 0.53 0.76 0.21 0.01 XXX 50.5892352 C 0.37 0.68 0.14 0.01 XXX 50.5892353 C 0.50 0.73 0.19 0.02 XXX 50.5892354 C 0.00 8.89 8.89 0.10 XXX 50.5892355 C 0.00 4.34 4.34 0.01 XXX 50.5892358 C 0.00 0.97 0.97 0.05 XXX 50.5892370 C 0.32 0.55 0.13 0.02 XXX 50.5892371 C 0.00 0.62 0.62 0.02 XXX 50.5892390 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200592391 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200592392 C 0.00 3.79 3.79 0.02 XXX 50.58 12/31/200592393 C 0.00 11.76 11.76 0.57 XXX 50.58 12/31/200592395 C 0.00 1.28 1.28 0.10 XXX 50.58 12/31/200592396 C 0.00 2.16 2.16 0.07 XXX 50.58 12/31/200592499 S 0.00 0.00 0.00 0.00 XXX 0.0092499 S TC 0.00 0.00 0.00 0.00 XXX 0.0092499 S 26 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
92502 C 1.51 1.11 1.11 0.05 XXX 50.5892504 C 0.18 0.50 0.09 0.01 XXX 50.5892506 C 0.86 2.60 0.40 0.03 XXX 50.5892507 C 0.52 1.11 0.23 0.02 XXX 50.5892508 C 0.26 0.51 0.12 0.01 XXX 50.5892510 C 1.50 2.08 0.82 0.07 XXX 50.58 12/31/200592511 C 0.84 3.32 0.78 0.03 000 50.5892512 C 0.55 1.14 0.18 0.02 XXX 50.5892516 C 0.43 1.20 0.22 0.01 XXX 50.5892520 C 0.75 0.51 0.39 0.03 XXX 50.5892526 C 0.55 1.64 0.20 0.02 XXX 50.5892531 C 0.00 0.00 0.00 0.00 XXX 0.0092532 C 0.00 0.00 0.00 0.00 XXX 0.0092533 C 0.00 0.00 0.00 0.00 XXX 0.0092534 C 0.00 0.00 0.00 0.00 XXX 0.0092541 C 0.40 1.03 1.03 0.04 XXX 50.5892541 C TC 0.00 0.84 0.84 0.02 XXX 50.5892541 C 26 0.40 0.19 0.19 0.02 XXX 50.5892542 C 0.33 1.14 1.14 0.03 XXX 50.5892542 C TC 0.00 0.98 0.98 0.02 XXX 50.5892542 C 26 0.33 0.16 0.16 0.01 XXX 50.5892543 C 0.10 0.57 0.57 0.02 XXX 50.5892543 C TC 0.00 0.52 0.52 0.01 XXX 50.5892543 C 26 0.10 0.05 0.05 0.01 XXX 50.5892544 C 0.26 0.90 0.90 0.03 XXX 50.5892544 C TC 0.00 0.78 0.78 0.02 XXX 50.5892544 C 26 0.26 0.12 0.12 0.01 XXX 50.5892545 C 0.23 0.80 0.80 0.03 XXX 50.5892545 C TC 0.00 0.69 0.69 0.02 XXX 50.5892545 C 26 0.23 0.11 0.11 0.01 XXX 50.5892546 C 0.29 1.99 1.99 0.03 XXX 50.5892546 C TC 0.00 1.86 1.86 0.02 XXX 50.5892546 C 26 0.29 0.13 0.13 0.01 XXX 50.5892547 C 0.00 0.08 0.08 0.06 ZZZ 50.5892548 C 0.50 2.26 2.26 0.15 XXX 50.5892548 C TC 0.00 2.00 2.00 0.13 XXX 50.5892548 C 26 0.50 0.26 0.26 0.02 XXX 50.5892551 C 0.00 0.00 0.00 0.00 XXX 0.0092552 C 0.00 0.44 0.44 0.04 XXX 50.5892553 C 0.00 0.66 0.66 0.06 XXX 50.5892555 C 0.00 0.38 0.38 0.04 XXX 50.5892556 C 0.00 0.57 0.57 0.06 XXX 50.5892557 C 0.00 1.19 1.19 0.12 XXX 50.5892559 C 0.00 0.00 0.00 0.00 XXX 0.0092560 C 0.00 0.00 0.00 0.00 XXX 0.0092561 C 0.00 0.72 0.72 0.06 XXX 50.5892562 C 0.00 0.41 0.41 0.04 XXX 50.5892563 C 0.00 0.38 0.38 0.04 XXX 50.5892564 C 0.00 0.47 0.47 0.05 XXX 50.5892565 C 0.00 0.40 0.40 0.04 XXX 50.5892567 C 0.00 0.52 0.52 0.06 XXX 50.5892568 C 0.00 0.38 0.38 0.04 XXX 50.5892569 C 0.00 0.41 0.41 0.04 XXX 50.5892571 C 0.00 0.39 0.39 0.04 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
92572 C 0.00 0.09 0.09 0.01 XXX 50.5892573 C 0.00 0.35 0.35 0.04 XXX 50.5892575 C 0.00 0.30 0.30 0.02 XXX 50.5892576 C 0.00 0.44 0.44 0.05 XXX 50.5892577 C 0.00 0.72 0.72 0.07 XXX 50.5892579 C 0.00 0.73 0.73 0.06 XXX 50.5892582 C 0.00 0.73 0.73 0.06 XXX 50.5892583 C 0.00 0.89 0.89 0.08 XXX 50.5892584 C 0.00 2.48 2.48 0.21 XXX 50.5892585 C 0.50 2.07 2.07 0.17 XXX 50.5892585 C TC 0.00 1.86 1.86 0.14 XXX 50.5892585 C 26 0.50 0.21 0.21 0.03 XXX 50.5892586 C 0.00 1.86 1.86 0.14 XXX 50.5892586 C TC 0.00 1.75 1.75 0.12 XXX 50.5892586 C 26 0.50 0.23 0.23 0.02 XXX 50.5892587 C 0.13 1.37 1.37 0.12 XXX 50.5892587 C TC 0.00 1.31 1.31 0.11 XXX 50.5892587 C 26 0.13 0.06 0.06 0.01 XXX 50.5892588 C 0.36 1.63 1.63 0.14 XXX 50.5892588 C TC 0.00 1.47 1.47 0.13 XXX 50.5892588 C 26 0.36 0.16 0.16 0.01 XXX 50.5892590 C 0.00 0.00 0.00 0.00 XXX 0.0092591 C 0.00 0.00 0.00 0.00 XXX 0.0092592 C 0.00 0.00 0.00 0.00 XXX 0.0092593 C 0.00 0.00 0.00 0.00 XXX 0.0092594 C 0.00 0.00 0.00 0.00 XXX 0.0092595 C 0.00 0.00 0.00 0.00 XXX 0.0092596 C 0.00 0.59 0.59 0.06 XXX 50.5892597 C 0.86 1.69 0.45 0.03 XXX 50.5892601 D 0.00 3.51 3.51 0.07 XXX 50.5892602 D 0.00 2.39 2.39 0.07 XXX 50.5892603 C 0.00 2.15 2.15 0.07 XXX 50.5892604 C 0.00 1.35 1.35 0.07 XXX 50.5892605 C 0.00 0.00 0.00 0.00 XXX 0.0092606 C 0.00 0.00 0.00 0.00 XXX 0.0092607 C 0.00 3.09 3.09 0.05 XXX 50.5892608 C 0.00 0.55 0.55 0.05 XXX 50.5892609 C 0.00 1.59 1.59 0.04 XXX 50.5892610 C 0.00 3.44 3.44 0.08 XXX 50.5892611 C 0.00 3.44 3.44 0.08 XXX 50.5892612 C 1.27 2.75 0.66 0.04 XXX 50.5892613 C 0.71 0.40 0.39 0.05 XXX 50.5892614 C 1.27 2.51 0.66 0.04 XXX 50.5892615 C 0.63 0.35 0.35 0.05 XXX 50.5892616 C 1.88 3.40 0.99 0.06 XXX 50.5892617 C 0.79 0.44 0.44 0.05 XXX 50.5892620 C 0.00 1.14 1.14 0.06 XXX 50.5892621 C 0.00 0.25 0.25 0.06 ZZZ 50.5892625 C 0.00 1.12 1.12 0.06 XXX 50.5892626 C 0.00 2.20 2.20 0.06 XXX 50.5892627 C 0.00 0.55 0.55 0.02 ZZZ 50.5892630 C 0.00 0.00 0.00 0.00 XXX 0.0092633 C 0.00 0.00 0.00 0.00 XXX 0.0092700 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
92950 C 3.79 4.21 0.97 0.28 000 50.5892953 C 0.23 0.07 0.07 0.02 000 50.5892960 C 2.25 6.33 1.17 0.07 000 50.5892961 C 4.59 2.09 2.09 0.29 000 50.5892970 C 3.51 1.06 1.06 0.16 000 50.5892971 C 1.77 0.85 0.85 0.06 000 50.5892973 C 3.28 1.29 1.29 0.23 ZZZ 50.5892974 C 3.00 1.18 1.18 0.21 ZZZ 50.5892975 C 7.24 2.82 2.82 0.50 000 50.5892977 C 0.00 8.07 8.07 0.46 XXX 50.5892978 C 1.80 5.28 5.28 0.30 ZZZ 50.5892978 C TC 0.00 4.57 4.57 0.24 ZZZ 50.5892978 C 26 1.80 0.71 0.71 0.06 ZZZ 50.5892979 C 1.44 2.86 2.86 0.19 ZZZ 50.5892979 C TC 0.00 2.30 2.30 0.13 ZZZ 50.5892979 C 26 1.44 0.56 0.56 0.06 ZZZ 50.5892980 C 14.82 6.07 6.07 1.03 000 50.5892981 C 4.16 1.63 1.63 0.29 ZZZ 50.5892982 C 10.96 4.54 4.54 0.76 000 50.5892984 C 2.97 1.16 1.16 0.21 ZZZ 50.5892986 C 21.77 11.86 11.86 1.51 090 50.5892987 C 22.67 12.25 12.25 1.59 090 50.5892990 C 17.31 9.82 9.82 1.20 090 50.5892992 C 21.13 11.51 11.51 0.70 090 50.5892993 C 21.13 11.51 11.51 0.70 090 50.5892995 C 12.07 4.97 4.97 0.84 000 50.5892996 C 3.26 1.27 1.27 0.10 ZZZ 50.5892997 C 11.98 4.83 4.83 0.40 000 50.5892998 C 5.99 2.21 2.21 0.28 ZZZ 50.5893000 C 0.17 0.51 0.51 0.03 XXX 50.5893005 C 0.00 0.45 0.45 0.02 XXX 50.5893010 C 0.17 0.06 0.06 0.01 XXX 50.5893012 C 0.00 6.03 6.03 0.18 XXX 50.5893014 C 0.52 0.19 0.19 0.02 XXX 50.5893015 C 0.75 1.96 1.96 0.14 XXX 50.5893016 C 0.45 0.17 0.17 0.02 XXX 50.5893017 C 0.00 1.68 1.68 0.11 XXX 50.5893018 C 0.30 0.11 0.11 0.01 XXX 50.5893024 C 1.17 1.57 1.57 0.12 XXX 50.5893024 C TC 0.00 1.12 1.12 0.08 XXX 50.5893024 C 26 1.17 0.45 0.45 0.04 XXX 50.5893025 C 0.75 7.61 7.61 0.14 XXX 50.5893025 C TC 0.00 7.32 7.32 0.11 XXX 50.5893025 C 26 0.75 0.29 0.29 0.03 XXX 50.5893040 C 0.16 0.20 0.20 0.02 XXX 50.5893041 C 0.00 0.15 0.15 0.01 XXX 50.5893042 C 0.16 0.05 0.05 0.01 XXX 50.5893224 C 0.52 3.62 3.62 0.24 XXX 50.5893225 C 0.00 1.24 1.24 0.08 XXX 50.5893226 C 0.00 2.19 2.19 0.14 XXX 50.5893227 C 0.52 0.19 0.19 0.02 XXX 50.5893230 C 0.52 3.90 3.90 0.26 XXX 50.5893231 C 0.00 1.52 1.52 0.11 XXX 50.5893232 C 0.00 2.19 2.19 0.13 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
93233 C 0.52 0.19 0.19 0.02 XXX 50.5893235 C 0.45 2.79 2.79 0.16 XXX 50.5893236 C 0.00 2.63 2.63 0.14 XXX 50.5893237 C 0.45 0.16 0.16 0.02 XXX 50.5893268 C 0.52 7.46 7.46 0.28 XXX 50.5893270 C 0.00 1.24 1.24 0.08 XXX 50.5893271 C 0.00 6.03 6.03 0.18 XXX 50.5893272 C 0.52 0.19 0.19 0.02 XXX 50.5893278 C 0.25 1.25 1.25 0.12 XXX 50.5893278 C TC 0.00 1.15 1.15 0.11 XXX 50.5893278 C 26 0.25 0.10 0.10 0.01 XXX 50.5893303 C 1.30 4.35 4.35 0.27 XXX 50.5893303 C TC 0.00 3.87 3.87 0.23 XXX 50.5893303 C 26 1.30 0.48 0.48 0.04 XXX 50.5893304 C 0.75 2.23 2.23 0.15 XXX 50.5893304 C TC 0.00 1.95 1.95 0.13 XXX 50.5893304 C 26 0.75 0.28 0.28 0.02 XXX 50.5893307 C 0.92 4.22 4.22 0.26 XXX 50.5893307 C TC 0.00 3.87 3.87 0.23 XXX 50.5893307 C 26 0.92 0.35 0.35 0.03 XXX 50.5893308 C 0.53 2.15 2.15 0.15 XXX 50.5893308 C TC 0.00 1.95 1.95 0.13 XXX 50.5893308 C 26 0.53 0.20 0.20 0.02 XXX 50.5893312 C 2.20 4.58 4.58 0.37 XXX 50.5893312 C TC 0.00 3.79 3.79 0.29 XXX 50.5893312 C 26 2.20 0.79 0.79 0.08 XXX 50.5893313 C 0.95 0.21 0.21 0.06 XXX 50.5893314 C 1.25 4.26 4.26 0.33 XXX 50.5893314 C TC 0.00 3.79 3.79 0.29 XXX 50.5893314 C 26 1.25 0.47 0.47 0.04 XXX 50.5893315 C 2.78 4.81 4.81 0.23 XXX 50.5893315 C TC 0.00 3.80 3.80 0.12 XXX 50.5893315 C 26 2.78 1.01 1.01 0.09 XXX 50.5893316 C 0.95 0.24 0.24 0.05 XXX 50.5893317 C 0.00 0.00 0.00 0.00 XXX 0.0093317 C TC 0.00 0.00 0.00 0.00 XXX 0.0093317 C 26 1.83 0.67 0.67 0.08 XXX 50.5893318 C 0.00 0.00 0.00 0.00 XXX 0.0093318 C TC 0.00 0.00 0.00 0.00 XXX 0.0093318 C 26 2.20 0.48 0.48 0.14 XXX 50.5893320 C 0.38 1.86 1.86 0.13 ZZZ 50.5893320 C TC 0.00 1.71 1.71 0.12 ZZZ 50.5893320 C 26 0.38 0.15 0.15 0.01 ZZZ 50.5893321 C 0.15 1.17 1.17 0.09 ZZZ 50.5893321 C TC 0.00 1.11 1.11 0.08 ZZZ 50.5893321 C 26 0.15 0.06 0.06 0.01 ZZZ 50.5893325 C 0.07 2.94 2.94 0.22 ZZZ 50.5893325 C TC 0.00 2.91 2.91 0.21 ZZZ 50.5893325 C 26 0.07 0.03 0.03 0.01 ZZZ 50.5893350 C 1.48 2.34 2.34 0.18 XXX 50.5893350 C TC 0.00 1.77 1.77 0.13 XXX 50.5893350 C 26 1.48 0.57 0.57 0.05 XXX 50.5893501 C 3.02 18.10 18.10 1.26 000 50.5893501 C TC 0.00 16.95 16.95 1.05 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
93501 C 26 3.02 1.15 1.15 0.21 000 50.5893503 C 2.91 0.68 0.68 0.20 000 50.5893505 C 4.37 3.67 3.67 0.46 000 50.5893505 C TC 0.00 1.99 1.99 0.16 000 50.5893505 C 26 4.37 1.68 1.68 0.30 000 50.5893508 C 4.09 14.73 14.73 0.93 000 50.5893508 C TC 0.00 12.64 12.64 0.65 000 50.5893508 C 26 4.09 2.09 2.09 0.28 000 50.5893510 C 4.32 39.24 39.24 2.61 000 50.5893510 C TC 0.00 37.06 37.06 2.31 000 50.5893510 C 26 4.32 2.18 2.18 0.30 000 50.5893511 C 5.02 38.52 38.52 2.59 000 50.5893511 C TC 0.00 36.07 36.07 2.24 000 50.5893511 C 26 5.02 2.45 2.45 0.35 000 50.5893514 C 7.04 39.09 39.09 2.74 000 50.5893514 C TC 0.00 35.96 35.96 2.23 000 50.5893514 C 26 7.04 3.13 3.13 0.49 000 50.5893524 C 6.94 50.32 50.32 3.43 000 50.5893524 C TC 0.00 47.14 47.14 2.95 000 50.5893524 C 26 6.94 3.18 3.18 0.48 000 50.5893526 C 5.98 51.25 51.25 3.46 000 50.5893526 C TC 0.00 48.43 48.43 3.04 000 50.5893526 C 26 5.98 2.82 2.82 0.42 000 50.5893527 C 7.27 50.46 50.46 3.46 000 50.5893527 C TC 0.00 47.14 47.14 2.95 000 50.5893527 C 26 7.27 3.32 3.32 0.51 000 50.5893528 C 8.99 51.18 51.18 3.57 000 50.5893528 C TC 0.00 47.14 47.14 2.95 000 50.5893528 C 26 8.99 4.04 4.04 0.62 000 50.5893529 C 4.79 49.42 49.42 3.28 000 50.5893529 C TC 0.00 47.14 47.14 2.95 000 50.5893529 C 26 4.79 2.28 2.28 0.33 000 50.5893530 C 4.22 18.89 18.89 1.34 000 50.5893530 C TC 0.00 16.95 16.95 1.05 000 50.5893530 C 26 4.22 1.94 1.94 0.29 000 50.5893531 C 8.34 52.02 52.02 3.62 000 50.5893531 C TC 0.00 48.43 48.43 3.04 000 50.5893531 C 26 8.34 3.59 3.59 0.58 000 50.5893532 C 9.99 51.26 51.26 3.62 000 50.5893532 C TC 0.00 47.00 47.00 2.93 000 50.5893532 C 26 9.99 4.26 4.26 0.69 000 50.5893533 C 6.69 49.80 49.80 3.40 000 50.5893533 C TC 0.00 47.00 47.00 2.93 000 50.5893533 C 26 6.69 2.80 2.80 0.47 000 50.5893539 C 0.40 0.16 0.16 0.01 000 50.5893540 C 0.43 0.17 0.17 0.01 000 50.5893541 C 0.29 0.11 0.11 0.01 000 50.5893542 C 0.29 0.11 0.11 0.01 000 50.5893543 C 0.29 0.11 0.11 0.01 000 50.5893544 C 0.25 0.10 0.10 0.01 000 50.5893545 C 0.40 0.16 0.16 0.01 000 50.5893555 C 0.81 6.61 6.61 0.37 XXX 50.5893555 C TC 0.00 6.29 6.29 0.34 XXX 50.5893555 C 26 0.81 0.32 0.32 0.03 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
93556 C 0.83 10.24 10.24 0.54 XXX 50.5893556 C TC 0.00 9.92 9.92 0.51 XXX 50.5893556 C 26 0.83 0.32 0.32 0.03 XXX 50.5893561 C 0.50 0.68 0.68 0.08 000 50.5893561 C TC 0.00 0.52 0.52 0.06 000 50.5893561 C 26 0.50 0.16 0.16 0.02 000 50.5893562 C 0.16 0.37 0.37 0.05 000 50.5893562 C TC 0.00 0.32 0.32 0.04 000 50.5893562 C 26 0.16 0.05 0.05 0.01 000 50.5893571 C 1.80 5.25 5.25 0.30 ZZZ 50.5893571 C TC 0.00 4.57 4.57 0.24 ZZZ 50.5893571 C 26 1.80 0.68 0.68 0.06 ZZZ 50.5893572 C 1.44 2.79 2.79 0.17 ZZZ 50.5893572 C TC 0.00 2.29 2.29 0.13 ZZZ 50.5893572 C 26 1.44 0.50 0.50 0.04 ZZZ 50.5893580 C 17.97 7.40 7.40 1.25 000 50.5893581 C 24.39 9.42 9.42 1.71 000 50.5893600 C 2.12 2.79 2.79 0.29 000 50.5893600 C TC 0.00 1.96 1.96 0.13 000 50.5893600 C 26 2.12 0.83 0.83 0.16 000 50.5893602 C 2.12 1.93 1.93 0.24 000 50.5893602 C TC 0.00 1.11 1.11 0.07 000 50.5893602 C 26 2.12 0.82 0.82 0.17 000 50.5893603 C 2.12 2.49 2.49 0.29 000 50.5893603 C TC 0.00 1.68 1.68 0.11 000 50.5893603 C 26 2.12 0.81 0.81 0.18 000 50.5893609 C 4.99 4.69 4.69 0.52 ZZZ 50.5893609 C TC 0.00 2.73 2.73 0.17 ZZZ 50.5893609 C 26 4.99 1.96 1.96 0.35 ZZZ 50.5893610 C 3.02 2.51 2.51 0.34 000 50.5893610 C TC 0.00 1.35 1.35 0.10 000 50.5893610 C 26 3.02 1.16 1.16 0.24 000 50.5893612 C 3.02 2.77 2.77 0.36 000 50.5893612 C TC 0.00 1.61 1.61 0.11 000 50.5893612 C 26 3.02 1.16 1.16 0.25 000 50.5893613 C 6.99 2.77 2.77 0.49 ZZZ 50.5893613 C TC 0.00 0.00 0.00 0.00 ZZZ 0.0093613 C 26 7.00 2.79 2.79 0.52 ZZZ 50.5893615 C 0.99 0.59 0.59 0.05 000 50.5893615 C TC 0.00 0.32 0.32 0.02 000 50.5893615 C 26 0.99 0.27 0.27 0.03 000 50.5893616 C 1.49 0.75 0.75 0.11 000 50.5893616 C TC 0.00 0.32 0.32 0.02 000 50.5893616 C 26 1.49 0.43 0.43 0.09 000 50.5893618 C 4.25 5.64 5.64 0.54 000 50.5893618 C TC 0.00 3.97 3.97 0.24 000 50.5893618 C 26 4.25 1.67 1.67 0.30 000 50.5893619 C 7.31 10.91 10.91 0.98 000 50.5893619 C TC 0.00 7.72 7.72 0.47 000 50.5893619 C 26 7.31 3.19 3.19 0.51 000 50.5893620 C 11.57 16.59 16.59 1.54 ZZZ 50.5893620 C TC 0.00 11.78 11.78 0.74 ZZZ 50.5893620 C 26 11.57 4.85 4.85 0.80 ZZZ 50.5893621 C 2.10 2.80 2.80 0.29 ZZZ 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
93621 C TC 0.00 1.98 1.98 0.14 ZZZ 50.5893621 C 26 2.10 0.82 0.82 0.15 ZZZ 50.5893622 C 3.10 4.13 4.13 0.43 ZZZ 50.5893622 C TC 0.00 2.92 2.92 0.21 ZZZ 50.5893622 C 26 3.10 1.21 1.21 0.22 ZZZ 50.5893623 C 2.85 3.79 3.79 0.39 ZZZ 50.5893623 C TC 0.00 2.68 2.68 0.19 ZZZ 50.5893623 C 26 2.85 1.11 1.11 0.20 ZZZ 50.5893624 C 4.80 4.19 4.19 0.46 000 50.5893624 C TC 0.00 1.99 1.99 0.13 000 50.5893624 C 26 4.80 2.20 2.20 0.33 000 50.5893631 C 7.59 8.93 8.93 1.59 000 50.5893631 C TC 0.00 6.15 6.15 0.62 000 50.5893631 C 26 7.59 2.78 2.78 0.97 000 50.5893640 C 3.51 8.55 8.55 0.66 000 50.5893640 C TC 0.00 7.19 7.19 0.42 000 50.5893640 C 26 3.51 1.36 1.36 0.24 000 50.5893641 C 5.92 9.51 9.51 0.83 000 50.5893641 C TC 0.00 7.19 7.19 0.42 000 50.5893641 C 26 5.92 2.32 2.32 0.41 000 50.5893642 C 4.88 9.41 9.41 0.57 000 50.5893642 C TC 0.00 7.19 7.19 0.42 000 50.5893642 C 26 4.88 2.22 2.22 0.15 000 50.5893650 C 10.49 4.44 4.44 0.73 000 50.5893651 C 16.23 6.34 6.34 1.13 000 50.5893652 C 17.65 6.90 6.90 1.23 000 50.5893660 C 1.89 2.42 2.42 0.08 000 50.5893660 C TC 0.00 1.68 1.68 0.02 000 50.5893660 C 26 1.89 0.74 0.74 0.06 000 50.5893662 C 2.80 4.71 4.71 0.34 ZZZ 50.5893662 C TC 0.00 3.60 3.60 0.25 ZZZ 50.5893662 C 26 2.80 1.11 1.11 0.09 ZZZ 50.5893668 C 0.00 0.00 0.00 0.00 XXX 0.0093701 C 0.17 0.98 0.98 0.02 XXX 50.5893701 C TC 0.00 0.91 0.91 0.01 XXX 50.5893701 C 26 0.17 0.07 0.07 0.01 XXX 50.5893720 C 0.17 0.76 0.76 0.07 XXX 50.5893721 C 0.00 0.71 0.71 0.06 XXX 50.5893722 C 0.17 0.05 0.05 0.01 XXX 50.5893724 C 4.88 5.89 5.89 0.39 000 50.5893724 C TC 0.00 3.97 3.97 0.24 000 50.5893724 C 26 4.88 1.92 1.92 0.15 000 50.5893727 C 0.52 0.20 0.20 0.02 XXX 50.5893731 C 0.45 0.66 0.66 0.05 XXX 50.5893731 C TC 0.00 0.49 0.49 0.04 XXX 50.5893731 C 26 0.45 0.17 0.17 0.01 XXX 50.5893732 C 0.92 0.86 0.86 0.07 XXX 50.5893732 C TC 0.00 0.51 0.51 0.04 XXX 50.5893732 C 26 0.92 0.35 0.35 0.03 XXX 50.5893733 C 0.17 0.80 0.80 0.07 XXX 50.5893733 C TC 0.00 0.73 0.73 0.06 XXX 50.5893733 C 26 0.17 0.07 0.07 0.01 XXX 50.5893734 C 0.38 0.50 0.50 0.03 XXX 50.5893734 C TC 0.00 0.35 0.35 0.02 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
93734 C 26 0.38 0.15 0.15 0.01 XXX 50.5893735 C 0.74 0.72 0.72 0.06 XXX 50.5893735 C TC 0.00 0.44 0.44 0.04 XXX 50.5893735 C 26 0.74 0.28 0.28 0.02 XXX 50.5893736 C 0.15 0.69 0.69 0.07 XXX 50.5893736 C TC 0.00 0.63 0.63 0.06 XXX 50.5893736 C 26 0.15 0.06 0.06 0.01 XXX 50.5893740 C 0.16 0.19 0.19 0.02 XXX 50.5893740 C TC 0.00 0.15 0.15 0.01 XXX 50.5893740 C 26 0.16 0.04 0.04 0.01 XXX 50.5893741 C 0.80 0.98 0.98 0.07 XXX 50.5893741 C TC 0.00 0.67 0.67 0.04 XXX 50.5893741 C 26 0.80 0.31 0.31 0.03 XXX 50.5893742 C 0.91 1.03 1.03 0.07 XXX 50.5893742 C TC 0.00 0.67 0.67 0.04 XXX 50.5893742 C 26 0.91 0.36 0.36 0.03 XXX 50.5893743 C 1.03 1.13 1.13 0.07 XXX 50.5893743 C TC 0.00 0.73 0.73 0.04 XXX 50.5893743 C 26 1.03 0.40 0.40 0.03 XXX 50.5893744 C 1.18 1.13 1.13 0.08 XXX 50.5893744 C TC 0.00 0.67 0.67 0.04 XXX 50.5893744 C 26 1.18 0.46 0.46 0.04 XXX 50.5893745 C 0.00 0.00 0.00 0.00 XXX 0.0093745 C TC 0.00 0.00 0.00 0.00 XXX 0.0093745 C 26 0.00 0.00 0.00 0.00 XXX 0.0093760 C 0.00 0.00 0.00 0.00 XXX 0.0093762 C 0.00 0.00 0.00 0.00 XXX 0.0093770 C 0.16 0.08 0.08 0.02 XXX 50.5893770 C TC 0.00 0.03 0.03 0.01 XXX 50.5893770 C 26 0.16 0.05 0.05 0.01 XXX 50.5893784 C 0.38 1.55 1.55 0.03 XXX 50.5893786 C 0.00 0.91 0.91 0.01 XXX 50.5893788 C 0.00 0.51 0.51 0.01 XXX 50.5893790 C 0.38 0.13 0.13 0.01 XXX 50.5893797 C 0.18 0.30 0.07 0.01 000 50.5893798 C 0.28 0.46 0.11 0.01 000 50.5893799 S 0.00 0.00 0.00 0.00 XXX 0.0093799 S TC 0.00 0.00 0.00 0.00 XXX 0.0093799 S 26 0.00 0.00 0.00 0.00 XXX 0.0093875 C 0.22 2.34 2.34 0.12 XXX 50.5893875 C TC 0.00 2.26 2.26 0.11 XXX 50.5893875 C 26 0.22 0.08 0.08 0.01 XXX 50.5893880 C 0.60 5.57 5.57 0.39 XXX 50.5893880 C TC 0.00 5.37 5.37 0.35 XXX 50.5893880 C 26 0.60 0.20 0.20 0.04 XXX 50.5893882 C 0.40 3.51 3.51 0.26 XXX 50.5893882 C TC 0.00 3.37 3.37 0.22 XXX 50.5893882 C 26 0.40 0.14 0.14 0.04 XXX 50.5893886 C 0.94 6.76 6.76 0.45 XXX 50.5893886 C TC 0.00 6.39 6.39 0.39 XXX 50.5893886 C 26 0.94 0.37 0.37 0.06 XXX 50.5893888 C 0.62 4.25 4.25 0.32 XXX 50.5893888 C TC 0.00 4.02 4.02 0.27 XXX 50.5893888 C 26 0.62 0.23 0.23 0.05 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
93890 C 1.00 4.91 4.91 0.45 XXX 50.5893890 C TC 0.00 4.51 4.51 0.39 XXX 50.5893890 C 26 1.00 0.40 0.40 0.06 XXX 50.5893892 C 1.15 5.17 5.17 0.45 XXX 50.5893892 C TC 0.00 4.71 4.71 0.39 XXX 50.5893892 C 26 1.15 0.46 0.46 0.06 XXX 50.5893893 C 1.15 5.04 5.04 0.45 XXX 50.5893893 C TC 0.00 4.58 4.58 0.39 XXX 50.5893893 C 26 1.15 0.46 0.46 0.06 XXX 50.5893922 C 0.25 2.69 2.69 0.15 XXX 50.5893922 C TC 0.00 2.61 2.61 0.13 XXX 50.5893922 C 26 0.25 0.08 0.08 0.02 XXX 50.5893923 C 0.45 4.04 4.04 0.26 XXX 50.5893923 C TC 0.00 3.89 3.89 0.22 XXX 50.5893923 C 26 0.45 0.15 0.15 0.04 XXX 50.5893924 C 0.50 4.80 4.80 0.30 XXX 50.5893924 C TC 0.00 4.63 4.63 0.25 XXX 50.5893924 C 26 0.50 0.17 0.17 0.05 XXX 50.5893925 C 0.58 6.80 6.80 0.39 XXX 50.5893925 C TC 0.00 6.60 6.60 0.35 XXX 50.5893925 C 26 0.58 0.20 0.20 0.04 XXX 50.5893926 C 0.39 4.06 4.06 0.27 XXX 50.5893926 C TC 0.00 3.93 3.93 0.23 XXX 50.5893926 C 26 0.39 0.13 0.13 0.04 XXX 50.5893930 C 0.46 5.37 5.37 0.41 XXX 50.5893930 C TC 0.00 5.21 5.21 0.37 XXX 50.5893930 C 26 0.46 0.16 0.16 0.04 XXX 50.5893931 C 0.31 3.49 3.49 0.27 XXX 50.5893931 C TC 0.00 3.39 3.39 0.24 XXX 50.5893931 C 26 0.31 0.10 0.10 0.03 XXX 50.5893965 C 0.35 2.80 2.80 0.14 XXX 50.5893965 C TC 0.00 2.68 2.68 0.12 XXX 50.5893965 C 26 0.35 0.12 0.12 0.02 XXX 50.5893970 C 0.68 5.26 5.26 0.46 XXX 50.5893970 C TC 0.00 5.03 5.03 0.40 XXX 50.5893970 C 26 0.68 0.23 0.23 0.06 XXX 50.5893971 C 0.45 3.60 3.60 0.30 XXX 50.5893971 C TC 0.00 3.45 3.45 0.27 XXX 50.5893971 C 26 0.45 0.15 0.15 0.03 XXX 50.5893975 C 1.80 7.65 7.65 0.56 XXX 50.5893975 C TC 0.00 7.05 7.05 0.43 XXX 50.5893975 C 26 1.80 0.60 0.60 0.13 XXX 50.5893976 C 1.21 4.34 4.34 0.35 XXX 50.5893976 C TC 0.00 3.94 3.94 0.30 XXX 50.5893976 C 26 1.21 0.40 0.40 0.05 XXX 50.5893978 C 0.65 4.52 4.52 0.43 XXX 50.5893978 C TC 0.00 4.30 4.30 0.37 XXX 50.5893978 C 26 0.65 0.22 0.22 0.06 XXX 50.5893979 C 0.44 3.22 3.22 0.27 XXX 50.5893979 C TC 0.00 3.07 3.07 0.24 XXX 50.5893979 C 26 0.44 0.15 0.15 0.03 XXX 50.5893980 C 1.25 2.86 2.86 0.42 XXX 50.5893980 C TC 0.00 2.45 2.45 0.34 XXX 50.5893980 C 26 1.25 0.41 0.41 0.08 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
93981 C 0.44 2.88 2.88 0.33 XXX 50.5893981 C TC 0.00 2.74 2.74 0.31 XXX 50.5893981 C 26 0.44 0.14 0.14 0.02 XXX 50.5893990 C 0.25 4.00 4.00 0.26 XXX 50.5893990 C TC 0.00 3.91 3.91 0.23 XXX 50.5893990 C 26 0.25 0.09 0.09 0.03 XXX 50.5894010 C 0.17 0.67 0.67 0.03 XXX 50.5894010 C TC 0.00 0.62 0.62 0.02 XXX 50.5894010 C 26 0.17 0.05 0.05 0.01 XXX 50.5894014 C 0.52 0.76 0.76 0.03 XXX 50.5894015 C 0.00 0.59 0.59 0.01 XXX 50.5894016 C 0.52 0.17 0.17 0.02 XXX 50.5894060 C 0.31 1.07 1.07 0.07 XXX 50.5894060 C TC 0.00 0.98 0.98 0.06 XXX 50.5894060 C 26 0.31 0.09 0.09 0.01 XXX 50.5894070 C 0.60 0.82 0.82 0.13 XXX 50.5894070 C TC 0.00 0.64 0.64 0.10 XXX 50.5894070 C 26 0.60 0.18 0.18 0.03 XXX 50.5894150 C 0.07 0.47 0.47 0.02 XXX 50.5894150 C TC 0.00 0.44 0.44 0.01 XXX 50.5894150 C 26 0.07 0.03 0.03 0.01 XXX 50.5894200 C 0.11 0.44 0.44 0.03 XXX 50.5894200 C TC 0.00 0.41 0.41 0.02 XXX 50.5894200 C 26 0.11 0.03 0.03 0.01 XXX 50.5894240 C 0.26 0.66 0.66 0.06 XXX 50.5894240 C TC 0.00 0.58 0.58 0.05 XXX 50.5894240 C 26 0.26 0.08 0.08 0.01 XXX 50.5894250 C 0.11 0.64 0.64 0.02 XXX 50.5894250 C TC 0.00 0.61 0.61 0.01 XXX 50.5894250 C 26 0.11 0.03 0.03 0.01 XXX 50.5894260 C 0.13 0.58 0.58 0.05 XXX 50.5894260 C TC 0.00 0.54 0.54 0.04 XXX 50.5894260 C 26 0.13 0.04 0.04 0.01 XXX 50.5894350 C 0.26 0.76 0.76 0.05 XXX 50.5894350 C TC 0.00 0.68 0.68 0.04 XXX 50.5894350 C 26 0.26 0.08 0.08 0.01 XXX 50.5894360 C 0.26 0.70 0.70 0.07 XXX 50.5894360 C TC 0.00 0.62 0.62 0.06 XXX 50.5894360 C 26 0.26 0.08 0.08 0.01 XXX 50.5894370 C 0.26 0.72 0.72 0.03 XXX 50.5894370 C TC 0.00 0.64 0.64 0.02 XXX 50.5894370 C 26 0.26 0.08 0.08 0.01 XXX 50.5894375 C 0.31 0.60 0.60 0.03 XXX 50.5894375 C TC 0.00 0.51 0.51 0.02 XXX 50.5894375 C 26 0.31 0.09 0.09 0.01 XXX 50.5894400 C 0.40 0.84 0.84 0.09 XXX 50.5894400 C TC 0.00 0.72 0.72 0.06 XXX 50.5894400 C 26 0.40 0.12 0.12 0.03 XXX 50.5894450 C 0.40 0.85 0.85 0.04 XXX 50.5894450 C TC 0.00 0.73 0.73 0.02 XXX 50.5894450 C 26 0.40 0.12 0.12 0.02 XXX 50.5894452 C 0.31 1.02 1.02 0.04 XXX 50.5894452 C TC 0.00 0.93 0.93 0.02 XXX 50.5894452 C 26 0.31 0.09 0.09 0.02 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
94453 C 0.40 1.51 1.51 0.04 XXX 50.5894453 C TC 0.00 1.39 1.39 0.02 XXX 50.5894453 C 26 0.40 0.12 0.12 0.02 XXX 50.5894620 C 0.64 2.50 2.50 0.13 XXX 50.5894620 C TC 0.00 2.30 2.30 0.10 XXX 50.5894620 C 26 0.64 0.20 0.20 0.03 XXX 50.5894621 C 1.42 2.21 2.21 0.16 XXX 50.5894621 C TC 0.00 1.77 1.77 0.10 XXX 50.5894621 C 26 1.42 0.44 0.44 0.06 XXX 50.5894640 C 0.00 0.30 0.30 0.02 XXX 50.5894642 C 0.00 0.67 0.67 0.05 XXX 50.5894656 C 1.22 1.16 0.32 0.06 XXX 50.5894657 C 0.83 0.98 0.25 0.04 XXX 50.5894660 C 0.76 0.65 0.23 0.04 XXX 50.5894662 C 0.76 0.23 0.23 0.03 XXX 50.5894664 C 0.00 0.31 0.31 0.04 XXX 50.5894667 C 0.00 0.52 0.52 0.05 XXX 50.5894668 C 0.00 0.45 0.45 0.02 XXX 50.5894680 C 0.26 1.87 1.87 0.07 XXX 50.5894680 C TC 0.00 1.79 1.79 0.06 XXX 50.5894680 C 26 0.26 0.08 0.08 0.01 XXX 50.5894681 C 0.20 2.53 2.53 0.13 XXX 50.5894681 C TC 0.00 2.47 2.47 0.12 XXX 50.5894681 C 26 0.20 0.06 0.06 0.01 XXX 50.5894690 C 0.07 2.00 2.00 0.05 XXX 50.5894690 C TC 0.00 1.98 1.98 0.04 XXX 50.5894690 C 26 0.07 0.02 0.02 0.01 XXX 50.5894720 C 0.26 1.00 1.00 0.07 XXX 50.5894720 C TC 0.00 0.92 0.92 0.06 XXX 50.5894720 C 26 0.26 0.08 0.08 0.01 XXX 50.5894725 C 0.26 2.92 2.92 0.13 XXX 50.5894725 C TC 0.00 2.84 2.84 0.12 XXX 50.5894725 C 26 0.26 0.08 0.08 0.01 XXX 50.5894750 C 0.23 1.34 1.34 0.05 XXX 50.5894750 C TC 0.00 1.27 1.27 0.04 XXX 50.5894750 C 26 0.23 0.07 0.07 0.01 XXX 50.5894760 C 0.00 0.04 0.04 0.02 XXX 50.5894761 C 0.00 0.07 0.07 0.06 XXX 50.5894762 C 0.00 0.47 0.47 0.10 XXX 50.5894770 C 0.15 0.75 0.75 0.08 XXX 50.5894770 C TC 0.00 0.71 0.71 0.07 XXX 50.5894770 C 26 0.15 0.04 0.04 0.01 XXX 50.5894772 C 0.00 0.00 0.00 0.00 XXX 0.0094772 C TC 0.00 0.00 0.00 0.00 XXX 0.0094772 C 26 0.00 0.00 0.00 0.00 XXX 0.0094799 S 0.00 0.00 0.00 0.00 XXX 0.0094799 S TC 0.00 0.00 0.00 0.00 XXX 0.0094799 S 26 0.00 0.00 0.00 0.00 XXX 0.0095004 C 0.00 0.10 0.10 0.01 XXX 50.5895010 C 0.15 0.32 0.06 0.01 XXX 50.5895015 C 0.15 0.14 0.06 0.01 XXX 50.5895024 C 0.00 0.15 0.15 0.01 XXX 50.5895027 C 0.00 0.15 0.15 0.01 XXX 50.5895028 C 0.00 0.23 0.23 0.01 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
95044 C 0.00 0.20 0.20 0.01 XXX 50.5895052 C 0.00 0.25 0.25 0.01 XXX 50.5895056 C 0.00 0.17 0.17 0.01 XXX 50.5895060 C 0.00 0.35 0.35 0.02 XXX 50.5895065 C 0.00 0.20 0.20 0.01 XXX 50.5895070 C 0.00 2.29 2.29 0.02 XXX 50.5895071 C 0.00 2.93 2.93 0.02 XXX 50.5895075 C 0.95 0.82 0.38 0.03 XXX 50.5895078 C 0.00 0.25 0.25 0.02 XXX 50.5895115 C 0.00 0.39 0.39 0.02 XXX 50.5895117 C 0.00 0.50 0.50 0.02 XXX 50.5895120 C 0.00 0.00 0.00 0.00 XXX 0.0095125 C 0.00 0.00 0.00 0.00 XXX 0.0095130 C 0.00 0.00 0.00 0.00 XXX 0.0095131 C 0.00 0.00 0.00 0.00 XXX 0.0095132 C 0.00 0.00 0.00 0.00 XXX 0.0095133 C 0.00 0.00 0.00 0.00 XXX 0.0095134 C 0.00 0.00 0.00 0.00 XXX 0.0095144 C 0.06 0.19 0.02 0.01 XXX 50.5895145 C 0.06 0.32 0.02 0.01 XXX 50.5895146 C 0.06 0.44 0.03 0.01 XXX 50.5895147 C 0.06 0.42 0.02 0.01 XXX 50.5895148 C 0.06 0.58 0.03 0.01 XXX 50.5895149 C 0.06 0.80 0.03 0.01 XXX 50.5895165 C 0.06 0.19 0.02 0.01 XXX 50.5895170 C 0.06 0.13 0.03 0.01 XXX 50.5895180 C 2.01 2.04 0.93 0.04 XXX 50.5895199 S 0.00 0.00 0.00 0.00 XXX 0.0095250 C 0.00 4.11 4.11 0.01 XXX 50.5895251 C 0.52 0.19 0.19 0.02 XXX 50.5895805 C 1.88 17.31 17.31 0.43 XXX 50.5895805 C TC 0.00 16.65 16.65 0.34 XXX 50.5895805 C 26 1.88 0.66 0.66 0.09 XXX 50.5895806 C 1.66 3.34 3.34 0.39 XXX 50.5895806 C TC 0.00 2.80 2.80 0.31 XXX 50.5895806 C 26 1.66 0.54 0.54 0.08 XXX 50.5895807 C 1.66 11.88 11.88 0.50 XXX 50.5895807 C TC 0.00 11.35 11.35 0.42 XXX 50.5895807 C 26 1.66 0.53 0.53 0.08 XXX 50.5895808 C 2.65 13.23 13.23 0.55 XXX 50.5895808 C TC 0.00 12.31 12.31 0.42 XXX 50.5895808 C 26 2.65 0.92 0.92 0.13 XXX 50.5895810 C 3.52 17.54 17.54 0.59 XXX 50.5895810 C TC 0.00 16.36 16.36 0.42 XXX 50.5895810 C 26 3.52 1.18 1.18 0.17 XXX 50.5895811 C 3.79 19.24 19.24 0.61 XXX 50.5895811 C TC 0.00 17.97 17.97 0.43 XXX 50.5895811 C 26 3.79 1.27 1.27 0.18 XXX 50.5895812 C 1.08 4.04 4.04 0.17 XXX 50.5895812 C TC 0.00 3.59 3.59 0.11 XXX 50.5895812 C 26 1.08 0.45 0.45 0.06 XXX 50.5895813 C 1.73 5.03 5.03 0.20 XXX 50.5895813 C TC 0.00 4.33 4.33 0.11 XXX 50.5895813 C 26 1.73 0.70 0.70 0.09 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
95816 C 1.08 3.72 3.72 0.16 XXX 50.5895816 C TC 0.00 3.26 3.26 0.10 XXX 50.5895816 C 26 1.08 0.46 0.46 0.06 XXX 50.5895819 C 1.08 2.99 2.99 0.16 XXX 50.5895819 C TC 0.00 2.53 2.53 0.10 XXX 50.5895819 C 26 1.08 0.46 0.46 0.06 XXX 50.5895822 C 1.08 4.61 4.61 0.19 XXX 50.5895822 C TC 0.00 4.15 4.15 0.13 XXX 50.5895822 C 26 1.08 0.46 0.46 0.06 XXX 50.5895824 C 0.74 2.51 2.51 0.11 XXX 50.5895824 C TC 0.00 2.20 2.20 0.07 XXX 50.5895824 C 26 0.74 0.31 0.31 0.04 XXX 50.5895827 C 1.08 2.71 2.71 0.19 XXX 50.5895827 C TC 0.00 2.30 2.30 0.14 XXX 50.5895827 C 26 1.08 0.41 0.41 0.05 XXX 50.5895829 C 6.20 31.09 31.09 0.50 XXX 50.5895829 C TC 0.00 28.77 28.77 0.02 XXX 50.5895829 C 26 6.20 2.32 2.32 0.48 XXX 50.5895830 C 1.70 3.30 0.73 0.11 XXX 50.5895831 C 0.28 0.46 0.13 0.01 XXX 50.5895832 C 0.29 0.33 0.12 0.02 XXX 50.5895833 C 0.47 0.58 0.23 0.02 XXX 50.5895834 C 0.60 0.63 0.28 0.03 XXX 50.5895851 C 0.16 0.36 0.08 0.01 XXX 50.5895852 C 0.11 0.26 0.05 0.01 XXX 50.5895857 C 0.53 0.60 0.23 0.02 XXX 50.5895858 C 1.56 1.07 1.07 0.12 XXX 50.58 12/31/200595858 C TC 0.00 0.40 0.40 0.04 XXX 50.58 12/31/200595858 C 26 1.56 0.67 0.67 0.08 XXX 50.58 12/31/200595860 C 0.96 1.42 1.42 0.07 XXX 50.5895860 C TC 0.00 1.00 1.00 0.02 XXX 50.5895860 C 26 0.96 0.42 0.42 0.05 XXX 50.5895861 C 1.54 1.41 1.41 0.13 XXX 50.5895861 C TC 0.00 0.73 0.73 0.06 XXX 50.5895861 C 26 1.54 0.68 0.68 0.07 XXX 50.5895863 C 1.87 1.74 1.74 0.15 XXX 50.5895863 C TC 0.00 0.94 0.94 0.06 XXX 50.5895863 C 26 1.87 0.80 0.80 0.09 XXX 50.5895864 C 1.99 2.66 2.66 0.21 XXX 50.5895864 C TC 0.00 1.79 1.79 0.12 XXX 50.5895864 C 26 1.99 0.87 0.87 0.09 XXX 50.5895865 C 1.57 1.45 1.45 0.11 XXX 50.5895865 C TC 0.00 0.68 0.68 0.03 XXX 50.5895865 C 26 1.57 0.77 0.77 0.08 XXX 50.5895866 C 1.25 0.76 0.76 0.10 XXX 50.5895866 C TC 0.00 0.20 0.20 0.03 XXX 50.5895866 C 26 1.25 0.56 0.56 0.07 XXX 50.5895867 C 0.79 0.93 0.93 0.07 XXX 50.5895867 C TC 0.00 0.58 0.58 0.04 XXX 50.5895867 C 26 0.79 0.35 0.35 0.03 XXX 50.5895868 C 1.18 1.21 1.21 0.10 XXX 50.5895868 C TC 0.00 0.70 0.70 0.05 XXX 50.5895868 C 26 1.18 0.51 0.51 0.05 XXX 50.5895869 C 0.37 0.37 0.37 0.04 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
95869 C TC 0.00 0.21 0.21 0.02 XXX 50.5895869 C 26 0.37 0.16 0.16 0.02 XXX 50.5895870 C 0.37 0.37 0.37 0.04 XXX 50.5895870 C TC 0.00 0.21 0.21 0.02 XXX 50.5895870 C 26 0.37 0.16 0.16 0.02 XXX 50.5895872 C 1.50 1.23 1.23 0.13 XXX 50.5895872 C TC 0.00 0.60 0.60 0.05 XXX 50.5895872 C 26 1.50 0.63 0.63 0.08 XXX 50.5895873 C 0.37 0.36 0.36 0.04 ZZZ 50.5895873 C TC 0.00 0.20 0.20 0.02 ZZZ 50.5895873 C 26 0.37 0.16 0.16 0.02 ZZZ 50.5895874 C 0.37 0.37 0.37 0.04 ZZZ 50.5895874 C TC 0.00 0.20 0.20 0.02 ZZZ 50.5895874 C 26 0.37 0.17 0.17 0.02 ZZZ 50.5895875 C 1.10 1.45 1.45 0.11 XXX 50.5895875 C TC 0.00 0.98 0.98 0.06 XXX 50.5895875 C 26 1.10 0.47 0.47 0.05 XXX 50.5895900 C 0.42 1.26 1.26 0.04 XXX 50.5895900 C TC 0.00 1.08 1.08 0.02 XXX 50.5895900 C 26 0.42 0.18 0.18 0.02 XXX 50.5895903 C 0.60 1.19 1.19 0.05 XXX 50.5895903 C TC 0.00 0.93 0.93 0.02 XXX 50.5895903 C 26 0.60 0.26 0.26 0.03 XXX 50.5895904 C 0.34 1.09 1.09 0.04 XXX 50.5895904 C TC 0.00 0.94 0.94 0.02 XXX 50.5895904 C 26 0.34 0.15 0.15 0.02 XXX 50.5895920 C 2.11 2.24 2.24 0.23 ZZZ 50.5895920 C TC 0.00 1.31 1.31 0.07 ZZZ 50.5895920 C 26 2.11 0.93 0.93 0.16 ZZZ 50.5895921 C 0.90 0.71 0.71 0.06 XXX 50.5895921 C TC 0.00 0.38 0.38 0.02 XXX 50.5895921 C 26 0.90 0.33 0.33 0.04 XXX 50.5895922 C 0.96 0.78 0.78 0.07 XXX 50.5895922 C TC 0.00 0.38 0.38 0.02 XXX 50.5895922 C 26 0.96 0.40 0.40 0.05 XXX 50.5895923 C 0.90 1.94 1.94 0.07 XXX 50.5895923 C TC 0.00 1.56 1.56 0.02 XXX 50.5895923 C 26 0.90 0.38 0.38 0.05 XXX 50.5895925 C 0.54 1.13 1.13 0.10 XXX 50.5895925 C TC 0.00 0.91 0.91 0.06 XXX 50.5895925 C 26 0.54 0.22 0.22 0.04 XXX 50.5895926 C 0.54 1.14 1.14 0.09 XXX 50.5895926 C TC 0.00 0.91 0.91 0.06 XXX 50.5895926 C 26 0.54 0.23 0.23 0.03 XXX 50.5895927 C 0.54 1.16 1.16 0.10 XXX 50.5895927 C TC 0.00 0.91 0.91 0.06 XXX 50.5895927 C 26 0.54 0.25 0.25 0.04 XXX 50.5895928 C 1.50 3.03 3.03 0.09 XXX 50.5895928 C TC 0.00 2.38 2.38 0.03 XXX 50.5895928 C 26 1.50 0.65 0.65 0.06 XXX 50.5895929 C 1.50 3.22 3.22 0.09 XXX 50.5895929 C TC 0.00 2.57 2.57 0.03 XXX 50.5895929 C 26 1.50 0.65 0.65 0.06 XXX 50.5895930 C 0.35 2.25 2.25 0.03 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
95930 C TC 0.00 2.10 2.10 0.01 XXX 50.5895930 C 26 0.35 0.15 0.15 0.02 XXX 50.5895933 C 0.59 1.02 1.02 0.10 XXX 50.5895933 C TC 0.00 0.78 0.78 0.06 XXX 50.5895933 C 26 0.59 0.24 0.24 0.04 XXX 50.5895934 C 0.51 0.43 0.43 0.04 XXX 50.5895934 C TC 0.00 0.21 0.21 0.02 XXX 50.5895934 C 26 0.51 0.22 0.22 0.02 XXX 50.5895936 C 0.55 0.45 0.45 0.05 XXX 50.5895936 C TC 0.00 0.21 0.21 0.02 XXX 50.5895936 C 26 0.55 0.24 0.24 0.03 XXX 50.5895937 C 0.65 0.61 0.61 0.10 XXX 50.5895937 C TC 0.00 0.34 0.34 0.02 XXX 50.5895937 C 26 0.65 0.27 0.27 0.08 XXX 50.5895950 C 1.51 3.94 3.94 0.51 XXX 50.5895950 C TC 0.00 3.30 3.30 0.43 XXX 50.5895950 C 26 1.51 0.64 0.64 0.08 XXX 50.5895951 C 5.99 15.12 15.12 1.13 XXX 50.5895951 C TC 0.00 12.56 12.56 0.81 XXX 50.5895951 C 26 5.99 2.56 2.56 0.32 XXX 50.5895953 C 3.08 7.64 7.64 0.60 XXX 50.5895953 C TC 0.00 6.35 6.35 0.43 XXX 50.5895953 C 26 3.08 1.29 1.29 0.17 XXX 50.5895954 C 2.45 4.23 4.23 0.19 XXX 50.5895954 C TC 0.00 3.19 3.19 0.06 XXX 50.5895954 C 26 2.45 1.04 1.04 0.13 XXX 50.5895955 C 1.01 2.33 2.33 0.22 XXX 50.5895955 C TC 0.00 1.97 1.97 0.17 XXX 50.5895955 C 26 1.01 0.36 0.36 0.05 XXX 50.5895956 C 3.08 15.45 15.45 0.59 XXX 50.5895956 C TC 0.00 14.15 14.15 0.43 XXX 50.5895956 C 26 3.08 1.30 1.30 0.16 XXX 50.5895957 C 1.98 2.55 2.55 0.23 XXX 50.5895957 C TC 0.00 1.70 1.70 0.12 XXX 50.5895957 C 26 1.98 0.85 0.85 0.11 XXX 50.5895958 C 4.24 3.50 3.50 0.34 XXX 50.5895958 C TC 0.00 1.75 1.75 0.13 XXX 50.5895958 C 26 4.24 1.75 1.75 0.21 XXX 50.5895961 C 2.97 2.63 2.63 0.55 XXX 50.5895961 C TC 0.00 1.31 1.31 0.07 XXX 50.5895961 C 26 2.97 1.32 1.32 0.48 XXX 50.5895962 C 3.21 2.70 2.70 0.39 ZZZ 50.5895962 C TC 0.00 1.31 1.31 0.07 ZZZ 50.5895962 C 26 3.21 1.39 1.39 0.32 ZZZ 50.5895965 C 7.99 6.86 6.86 0.74 XXX 50.5895965 C TC 0.00 3.43 3.43 0.28 XXX 50.5895965 C 26 7.99 3.43 3.43 0.46 XXX 50.5895966 C 3.99 3.42 3.42 0.31 XXX 50.5895966 C TC 0.00 1.71 1.71 0.12 XXX 50.5895966 C 26 3.99 1.71 1.71 0.19 XXX 50.5895967 C 3.49 3.36 3.36 0.24 ZZZ 50.5895967 C TC 0.00 1.18 1.18 0.08 ZZZ 50.5895967 C 26 3.49 1.18 1.18 0.16 ZZZ 50.5895970 C 0.45 0.85 0.14 0.03 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
95971 C 0.78 0.68 0.22 0.07 XXX 50.5895972 C 1.50 1.21 0.49 0.14 XXX 50.5895973 C 0.92 0.62 0.34 0.07 ZZZ 50.5895974 C 3.00 1.70 1.30 0.16 XXX 50.5895975 C 1.70 0.89 0.73 0.12 ZZZ 50.5895978 C 3.50 1.93 1.30 0.18 XXX 50.5895979 C 1.64 0.87 0.69 0.08 ZZZ 50.5895990 C 0.00 1.50 1.50 0.06 XXX 50.5895991 C 0.77 1.46 0.17 0.06 XXX 50.5895999 S 0.00 0.00 0.00 0.00 XXX 0.0096000 C 1.80 0.53 0.53 0.11 XXX 50.5896001 C 2.15 0.66 0.66 0.10 XXX 50.5896002 C 0.41 0.15 0.15 0.02 XXX 50.5896003 C 0.37 0.12 0.12 0.02 XXX 50.5896004 C 2.14 0.94 0.94 0.11 XXX 50.5896100 C 0.00 1.76 1.76 0.18 XXX 50.58 12/31/200596101 C 1.86 0.65 0.63 0.05 XXX 50.5896102 C 0.50 0.66 0.17 0.01 XXX 50.5896103 C 0.51 0.21 0.17 0.02 XXX 50.5896105 C 0.00 1.77 1.77 0.18 XXX 50.5896110 C 0.00 0.18 0.18 0.18 XXX 50.5896111 C 2.60 1.05 1.05 0.18 XXX 50.5896115 C 0.00 1.76 1.76 0.18 XXX 50.58 12/31/200596116 C 1.86 0.83 0.64 0.18 XXX 50.5896117 C 0.00 1.76 1.76 0.18 XXX 50.58 12/31/200596118 C 1.86 1.39 0.63 0.18 XXX 50.5896119 C 0.55 1.02 0.19 0.18 XXX 50.5896120 C 0.51 0.74 0.17 0.02 XXX 50.5896150 C 0.50 0.18 0.18 0.01 XXX 50.5896151 C 0.48 0.18 0.17 0.01 XXX 50.5896152 C 0.46 0.17 0.16 0.01 XXX 50.5896153 C 0.10 0.04 0.03 0.01 XXX 50.5896154 C 0.45 0.17 0.16 0.01 XXX 50.5896155 C 0.44 0.18 0.17 0.02 XXX 50.5896400 C 0.22 1.12 1.12 0.01 XXX 50.58 12/31/200596401 C 0.21 1.17 1.17 0.01 XXX 50.5896402 C 0.19 1.01 1.01 0.01 XXX 50.5896405 C 0.52 2.44 0.24 0.03 000 50.5896406 C 0.80 3.02 0.29 0.03 000 50.5896408 C 0.22 2.91 2.91 0.06 XXX 50.58 12/31/200596409 C 0.24 2.93 2.93 0.06 XXX 50.5896410 C 0.22 4.16 4.16 0.08 XXX 50.58 12/31/200596411 C 0.20 1.61 1.61 0.06 ZZZ 50.5896412 C 0.17 0.74 0.74 0.07 ZZZ 50.58 12/31/200596413 C 0.28 4.20 4.20 0.08 XXX 50.5896414 C 0.22 5.22 5.22 0.08 XXX 50.58 12/31/200596415 C 0.19 0.77 0.77 0.07 ZZZ 50.5896416 C 0.21 4.61 4.61 0.08 XXX 50.5896417 C 0.21 1.95 1.95 0.07 ZZZ 50.5896420 C 0.17 2.67 2.67 0.08 XXX 50.5896422 C 0.17 4.84 4.84 0.08 XXX 50.5896423 C 0.17 1.89 1.89 0.02 ZZZ 50.5896425 C 0.17 4.48 4.48 0.08 XXX 50.5896440 C 2.37 8.15 1.23 0.17 000 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
96445 C 2.20 8.05 1.18 0.14 000 50.5896450 C 1.53 6.97 1.29 0.09 000 50.5896520 C 0.22 3.76 3.76 0.06 XXX 50.58 12/31/200596521 C 0.21 3.77 3.77 0.06 XXX 50.5896522 C 0.21 2.65 2.65 0.06 XXX 50.5896523 C 0.04 0.69 0.69 0.01 XXX 50.5896530 C 0.22 2.64 2.64 0.06 XXX 50.58 12/31/200596542 C 0.75 4.26 0.66 0.07 XXX 50.5896545 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200596549 C 0.00 0.00 0.00 0.00 XXX 0.0096567 C 0.00 1.96 0.00 0.04 XXX 50.5896570 C 1.10 0.37 0.37 0.11 ZZZ 50.5896571 C 0.55 0.19 0.19 0.03 ZZZ 50.5896900 C 0.00 0.44 0.44 0.02 XXX 50.5896902 C 0.41 0.18 0.16 0.01 XXX 50.5896910 C 0.00 0.99 0.99 0.04 XXX 50.5896912 C 0.00 1.26 1.26 0.05 XXX 50.5896913 C 0.00 1.68 1.68 0.10 XXX 50.5896920 C 1.15 2.54 0.56 0.02 000 50.5896921 C 1.17 2.61 0.57 0.03 000 50.5896922 C 2.10 3.49 0.62 0.04 000 50.5896999 S 0.00 0.00 0.00 0.00 XXX 0.0097001 C 1.20 0.75 0.45 0.05 XXX 50.5897002 C 0.60 0.44 0.23 0.02 XXX 50.5897003 C 1.20 0.88 0.40 0.06 XXX 50.5897004 C 0.60 0.67 0.19 0.02 XXX 50.5897005 D 0.00 0.00 0.00 0.00 XXX 0.0097006 D 0.00 0.00 0.00 0.00 XXX 0.0097010 D 0.06 0.05 0.05 0.01 XXX 50.5897012 C 0.25 0.13 0.13 0.01 XXX 50.5897014 C 0.18 0.19 0.19 0.01 XXX 50.5897016 C 0.18 0.18 0.18 0.01 XXX 50.5897018 C 0.06 0.10 0.10 0.01 XXX 50.5897020 C 0.06 0.06 0.06 0.01 XXX 50.58 12/31/200597022 C 0.17 0.21 0.21 0.01 XXX 50.5897024 C 0.06 0.07 0.07 0.01 XXX 50.5897026 C 0.06 0.06 0.06 0.01 XXX 50.5897028 C 0.08 0.07 0.07 0.01 XXX 50.5897032 C 0.25 0.16 0.16 0.01 XXX 50.5897033 C 0.26 0.27 0.27 0.01 XXX 50.5897034 C 0.21 0.15 0.15 0.01 XXX 50.5897035 C 0.21 0.10 0.10 0.01 XXX 50.5897036 C 0.28 0.32 0.32 0.01 XXX 50.5897039 C 0.20 0.10 0.10 0.01 XXX 50.5897110 C 0.45 0.27 0.27 0.02 XXX 50.5897112 C 0.45 0.31 0.31 0.01 XXX 50.5897113 C 0.44 0.39 0.39 0.01 XXX 50.5897116 C 0.40 0.24 0.24 0.01 XXX 50.5897124 C 0.35 0.23 0.23 0.01 XXX 50.5897139 C 0.21 0.20 0.20 0.01 XXX 50.5897140 C 0.43 0.25 0.25 0.01 XXX 50.5897150 C 0.27 0.18 0.18 0.01 XXX 50.5897504 C 0.45 0.33 0.33 0.03 XXX 50.58 12/31/200597520 C 0.45 0.27 0.27 0.02 XXX 50.58 12/31/2005
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
97530 C 0.44 0.32 0.32 0.01 XXX 50.5897532 C 0.44 0.20 0.20 0.01 XXX 50.5897533 C 0.44 0.24 0.24 0.01 XXX 50.5897535 C 0.45 0.33 0.33 0.01 XXX 50.5897537 C 0.45 0.26 0.26 0.01 XXX 50.5897542 C 0.45 0.28 0.28 0.01 XXX 50.5897545 C 0.00 0.00 0.00 0.00 XXX 0.0097546 C 0.00 0.00 0.00 0.00 ZZZ 0.0097597 C 0.58 0.66 0.66 0.05 XXX 50.5897598 C 0.80 0.79 0.79 0.05 XXX 50.5897602 C 0.00 0.00 0.00 0.00 XXX 0.0097605 C 0.55 0.34 0.22 0.02 XXX 50.5897606 C 0.60 0.35 0.24 0.03 XXX 50.5897703 C 0.25 0.41 0.41 0.02 XXX 50.58 12/31/200597750 C 0.45 0.32 0.32 0.02 XXX 50.5897755 C 0.62 0.28 0.28 0.02 XXX 50.5897760 C 0.45 0.34 0.20 0.03 XXX 50.5897761 C 0.45 0.28 0.19 0.02 XXX 50.5897762 C 0.25 0.42 0.19 0.02 XXX 50.5897799 C 0.00 0.00 0.00 0.00 XXX 0.0097802 C 0.00 0.47 0.47 0.01 XXX 50.5897803 C 0.00 0.47 0.47 0.01 XXX 50.5897804 C 0.00 0.18 0.18 0.01 XXX 50.5897810 C 0.60 0.38 0.23 0.03 XXX 50.5897811 C 0.50 0.25 0.19 0.03 ZZZ 50.5897813 C 0.65 0.40 0.25 0.03 XXX 50.5897814 C 0.55 0.30 0.21 0.03 ZZZ 50.5898925 C 0.45 0.32 0.14 0.02 000 50.5898926 C 0.65 0.41 0.25 0.03 000 50.5898927 C 0.87 0.50 0.29 0.03 000 50.5898928 C 1.03 0.59 0.34 0.04 000 50.5898929 C 1.19 0.67 0.37 0.05 000 50.5898940 C 0.45 0.23 0.12 0.01 000 50.5898941 C 0.65 0.30 0.17 0.02 000 50.5898942 C 0.87 0.36 0.23 0.02 000 50.5898943 D 0.40 0.24 0.16 0.01 XXX 50.5898960 C 0.00 0.00 0.00 0.00 XXX 0.0098961 C 0.00 0.00 0.00 0.00 XXX 0.0098962 C 0.00 0.00 0.00 0.00 XXX 0.0099000 C 0.00 0.00 0.00 0.00 XXX 0.0099001 C 0.00 0.00 0.00 0.00 XXX 0.0099002 C 0.00 0.00 0.00 0.00 XXX 0.0099024 C 0.00 0.00 0.00 0.00 XXX 0.0099026 C 0.00 0.00 0.00 0.00 XXX 0.0099027 C 0.00 0.00 0.00 0.00 XXX 0.0099050 C 0.00 0.00 0.00 0.00 XXX 0.0099051 C 0.00 0.00 0.00 0.00 XXX 0.0099052 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200599053 C 0.00 0.00 0.00 0.00 XXX 0.0099054 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/200599056 C 0.00 0.00 0.00 0.00 XXX 0.0099058 C 0.00 0.00 0.00 0.00 XXX 0.0099060 C 0.00 0.00 0.00 0.00 XXX 0.0099070 C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
99071 C 0.00 0.00 0.00 0.00 XXX 0.0099075 C 0.00 0.00 0.00 0.00 XXX 0.0099078 C 0.00 0.00 0.00 0.00 XXX 0.0099080 C 3.87 1.83 1.83 0.13 XXX 50.5899082 C 0.00 0.00 0.00 0.00 XXX 0.0099090 C 0.00 0.00 0.00 0.00 XXX 0.0099091 C 0.00 0.00 0.00 0.00 XXX 0.0099100 C 0.00 0.00 0.00 0.00 ZZZ 0.0099116 C 0.00 0.00 0.00 0.00 ZZZ 0.0099135 C 0.00 0.00 0.00 0.00 ZZZ 0.0099140 C 0.00 0.00 0.00 0.00 ZZZ 0.0099141 C 0.80 1.87 0.38 0.05 XXX 50.58 12/31/200599142 C 0.60 0.95 0.30 0.04 XXX 50.58 12/31/200599143 D 0.00 0.00 0.00 0.00 XXX 0.0099144 C 0.00 0.00 0.00 0.00 XXX 0.0099145 C 0.00 0.00 0.00 0.00 ZZZ 0.0099148 D 0.00 0.00 0.00 0.00 XXX 0.0099149 C 0.00 0.00 0.00 0.00 XXX 0.0099150 C 0.00 0.00 0.00 0.00 ZZZ 0.0099170 D 1.75 1.77 0.55 0.08 000 50.5899172 C 0.00 0.00 0.00 0.00 XXX 0.0099173 C 0.00 0.00 0.00 0.00 XXX 0.0099175 C 0.00 1.39 1.39 0.10 XXX 50.5899183 C 2.34 3.25 0.72 0.16 XXX 50.5899185 C 0.00 0.64 0.64 0.04 XXX 50.5899186 C 0.00 1.79 1.79 0.45 XXX 50.5899190 C 0.00 0.00 0.00 0.00 XXX 0.0099191 C 0.00 0.00 0.00 0.00 XXX 0.0099192 C 0.00 0.00 0.00 0.00 XXX 0.0099195 C 0.00 0.44 0.44 0.02 XXX 50.5899199 S 0.00 0.00 0.00 0.00 XXX 0.0099201 C 0.45 0.49 0.15 0.03 XXX 50.5899202 C 0.88 0.79 0.31 0.05 XXX 50.5899203 C 1.34 1.13 0.48 0.09 XXX 50.5899204 C 2.00 1.50 0.71 0.12 XXX 50.5899205 C 2.67 1.78 0.95 0.15 XXX 50.5899211 C 0.17 0.39 0.06 0.01 XXX 50.5899212 C 0.45 0.54 0.16 0.03 XXX 50.5899213 C 0.67 0.69 0.24 0.03 XXX 50.5899214 C 1.10 1.03 0.41 0.05 XXX 50.5899215 C 1.77 1.32 0.65 0.08 XXX 50.5899217 C 1.28 0.53 0.53 0.06 XXX 50.5899218 C 1.28 0.44 0.44 0.06 XXX 50.5899219 C 2.14 0.72 0.72 0.10 XXX 50.5899220 C 2.99 1.03 1.03 0.14 XXX 50.5899221 C 1.28 0.45 0.45 0.07 XXX 50.5899222 C 2.14 0.74 0.74 0.10 XXX 50.5899223 C 2.99 1.03 1.03 0.13 XXX 50.5899231 C 0.64 0.23 0.23 0.03 XXX 50.5899232 C 1.06 0.37 0.37 0.04 XXX 50.5899233 C 1.51 0.52 0.52 0.06 XXX 50.5899234 C 2.56 0.89 0.89 0.13 XXX 50.5899235 C 3.41 1.15 1.15 0.16 XXX 50.5899236 C 4.26 1.44 1.44 0.19 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
99238 C 1.28 0.54 0.54 0.05 XXX 50.5899239 C 1.75 0.73 0.73 0.07 XXX 50.5899241 C 0.64 0.64 0.22 0.05 XXX 50.5899242 C 1.29 1.04 0.46 0.10 XXX 50.5899243 C 1.72 1.39 0.63 0.13 XXX 50.5899244 C 2.58 1.83 0.92 0.16 XXX 50.5899245 C 3.42 2.28 1.24 0.21 XXX 50.5899251 C 0.66 0.24 0.24 0.05 XXX 50.5899252 C 1.32 0.50 0.50 0.09 XXX 50.5899253 C 1.82 0.68 0.68 0.11 XXX 50.5899254 C 2.64 0.98 0.98 0.13 XXX 50.5899255 C 3.64 1.35 1.35 0.18 XXX 50.5899261 C 0.42 0.15 0.15 0.02 XXX 50.58 12/31/200599262 C 0.85 0.31 0.31 0.04 XXX 50.58 12/31/200599263 C 1.27 0.45 0.45 0.06 XXX 50.58 12/31/200599271 C 0.45 0.55 0.16 0.03 XXX 50.58 12/31/200599272 C 0.84 0.83 0.31 0.06 XXX 50.58 12/31/200599273 C 1.19 1.11 0.45 0.10 XXX 50.58 12/31/200599274 C 1.73 1.37 0.64 0.12 XXX 50.58 12/31/200599275 C 2.31 1.65 0.84 0.14 XXX 50.58 12/31/200599281 C 0.33 0.09 0.09 0.02 XXX 50.5899282 C 0.55 0.14 0.14 0.04 XXX 50.5899283 C 1.24 0.31 0.31 0.09 XXX 50.5899284 C 1.95 0.47 0.47 0.14 XXX 50.5899285 C 3.06 0.72 0.72 0.23 XXX 50.5899288 C 0.00 0.00 0.00 0.00 XXX 0.0099289 D 4.79 1.45 1.45 0.24 XXX 50.5899290 D 2.40 0.81 0.81 0.12 ZZZ 50.5899291 C 3.99 2.58 1.28 0.21 XXX 50.5899292 C 2.00 0.90 0.64 0.11 ZZZ 50.5899293 D 15.98 4.76 4.76 1.12 XXX 50.5899294 D 7.99 2.41 2.41 0.45 XXX 50.5899295 D 18.46 5.39 5.39 1.16 XXX 50.5899296 D 7.99 2.55 2.55 0.32 XXX 50.5899298 D 2.75 0.93 0.93 0.17 XXX 50.5899299 D 2.50 0.86 0.86 0.16 XXX 50.5899300 D 2.40 0.84 0.84 0.15 XXX 50.5899301 C 1.20 0.50 0.50 0.05 XXX 50.58 12/31/200599302 C 1.61 0.64 0.64 0.07 XXX 50.58 12/31/200599303 C 2.01 0.76 0.76 0.09 XXX 50.58 12/31/200599304 C 1.20 0.49 0.49 0.05 XXX 50.5899305 C 1.61 0.63 0.63 0.07 XXX 50.5899306 C 2.01 0.75 0.75 0.09 XXX 50.5899307 C 0.60 0.27 0.27 0.03 XXX 50.5899308 C 1.00 0.45 0.45 0.04 XXX 50.5899309 C 1.42 0.62 0.62 0.06 XXX 50.5899310 C 1.77 0.78 0.78 0.08 XXX 50.5899311 C 0.60 0.27 0.27 0.03 XXX 50.58 12/31/200599312 C 1.00 0.45 0.45 0.04 XXX 50.58 12/31/200599313 C 1.42 0.62 0.62 0.06 XXX 50.58 12/31/200599315 C 1.13 0.45 0.45 0.05 XXX 50.5899316 C 1.50 0.59 0.59 0.06 XXX 50.5899318 C 1.20 0.49 0.49 0.05 XXX 50.5899321 C 0.71 0.34 0.34 0.03 XXX 50.58 12/31/2005
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
99322 C 1.01 0.46 0.46 0.05 XXX 50.58 12/31/200599323 C 1.28 0.55 0.55 0.05 XXX 50.58 12/31/200599324 C 1.01 0.49 0.49 0.05 XXX 50.5899325 C 1.52 0.68 0.68 0.07 XXX 50.5899326 C 2.27 0.92 0.92 0.10 XXX 50.5899327 C 3.03 1.17 1.17 0.13 XXX 50.5899328 C 3.78 1.42 1.42 0.16 XXX 50.5899331 C 0.60 0.32 0.32 0.03 XXX 50.58 12/31/200599332 C 0.80 0.38 0.38 0.03 XXX 50.58 12/31/200599333 C 1.00 0.46 0.46 0.04 XXX 50.58 12/31/200599334 C 0.76 0.40 0.40 0.04 XXX 50.5899335 C 1.26 0.58 0.58 0.06 XXX 50.5899336 C 2.02 0.82 0.82 0.09 XXX 50.5899337 C 3.03 1.15 1.15 0.13 XXX 50.5899339 C 0.00 0.00 0.00 0.00 XXX 0.0099340 C 0.00 0.00 0.00 0.00 XXX 0.0099341 C 1.01 0.48 0.48 0.05 XXX 50.5899342 C 1.52 0.68 0.68 0.07 XXX 50.5899343 C 2.27 0.94 0.94 0.10 XXX 50.5899344 C 3.03 1.18 1.18 0.13 XXX 50.5899345 C 3.78 1.43 1.43 0.16 XXX 50.5899347 C 0.76 0.40 0.40 0.04 XXX 50.5899348 C 1.26 0.58 0.58 0.06 XXX 50.5899349 C 2.02 0.83 0.83 0.09 XXX 50.5899350 C 3.03 1.18 1.18 0.13 XXX 50.5899354 C 1.77 0.77 0.66 0.08 ZZZ 50.5899355 C 1.77 0.75 0.62 0.07 ZZZ 50.5899356 C 1.71 0.62 0.62 0.07 ZZZ 50.5899357 C 1.71 0.63 0.63 0.08 ZZZ 50.5899358 C 1.77 1.46 1.46 0.06 ZZZ 50.5899359 C 1.77 1.24 1.24 0.06 ZZZ 50.5899360 C 0.00 0.00 0.00 0.00 XXX 0.0099361 C 0.00 0.00 0.00 0.00 XXX 0.0099362 C 0.00 0.00 0.00 0.00 XXX 0.0099371 C 0.00 0.00 0.00 0.00 XXX 0.0099372 C 0.00 0.00 0.00 0.00 XXX 0.0099373 C 0.00 0.00 0.00 0.00 XXX 0.0099374 C 1.10 0.70 0.42 0.05 XXX 50.5899375 C 1.73 1.55 1.55 0.07 XXX 50.5899377 C 1.10 0.70 0.42 0.05 XXX 50.5899378 C 1.73 1.95 1.95 0.07 XXX 50.5899379 C 1.10 0.70 0.42 0.04 XXX 50.5899380 C 1.73 0.99 0.66 0.06 XXX 50.5899381 D 1.19 1.50 0.45 0.05 XXX 50.5899382 D 1.36 1.54 0.52 0.05 XXX 50.5899383 D 1.36 1.48 0.52 0.05 XXX 50.5899384 D 1.53 1.55 0.59 0.06 XXX 50.5899385 D 1.53 1.55 0.59 0.06 XXX 50.5899386 D 1.88 1.75 0.72 0.07 XXX 50.5899387 D 2.06 1.88 0.79 0.07 XXX 50.5899391 D 1.02 1.02 0.39 0.04 XXX 50.5899392 D 1.19 1.09 0.45 0.05 XXX 50.5899393 D 1.19 1.06 0.45 0.05 XXX 50.5899394 D 1.36 1.13 0.52 0.05 XXX 50.58
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
99395 D 1.36 1.16 0.52 0.05 XXX 50.5899396 D 1.53 1.25 0.59 0.06 XXX 50.5899397 D 1.71 1.36 0.66 0.06 XXX 50.5899401 D 0.48 0.62 0.19 0.01 XXX 50.5899402 D 0.98 0.87 0.37 0.02 XXX 50.5899403 D 1.46 1.09 0.56 0.04 XXX 50.5899404 D 1.95 1.32 0.75 0.05 XXX 50.5899411 D 0.15 0.18 0.06 0.01 XXX 50.5899412 D 0.25 0.25 0.10 0.01 XXX 50.5899420 D 0.00 0.00 0.00 0.00 XXX 0.0099429 D 0.00 0.00 0.00 0.00 XXX 0.0099431 D 1.17 0.38 0.38 0.05 XXX 50.5899432 D 1.26 0.93 0.40 0.07 XXX 50.5899433 D 0.62 0.20 0.20 0.02 XXX 50.5899435 D 1.50 0.59 0.59 0.06 XXX 50.5899436 D 1.50 0.47 0.47 0.06 XXX 50.5899440 D 2.93 0.93 0.93 0.12 XXX 50.5899450 D 0.00 0.00 0.00 0.00 XXX 0.0099455 C 5.16 1.67 1.67 0.13 XXX 50.5899456 C 6.86 2.14 2.14 0.16 XXX 50.5899499 S 0.00 0.00 0.00 0.00 XXX 0.0099500 C 0.00 0.00 0.00 0.00 XXX 0.0099501 C 0.00 0.00 0.00 0.00 XXX 0.0099502 D 0.00 0.00 0.00 0.00 XXX 0.0099503 C 1.72 1.56 1.56 0.07 XXX 50.5899504 C 1.72 1.56 1.56 0.07 XXX 50.5899505 C 1.72 1.56 1.56 0.07 XXX 50.5899506 C 1.72 1.56 1.56 0.07 XXX 50.5899507 C 1.72 1.56 1.56 0.07 XXX 50.5899509 C 1.72 1.56 1.56 0.07 XXX 50.5899510 C 1.72 1.56 1.56 0.07 XXX 50.5899511 C 1.72 1.56 1.56 0.07 XXX 50.5899512 C 1.72 1.56 1.56 0.07 XXX 50.5899600 C 1.09 0.70 0.43 0.05 XXX 50.5899601 C 0.00 2.75 2.75 0.18 XXX 50.5899602 C 0.00 0.70 0.70 0.05 XXX 50.580001F C 0.00 0.00 0.00 0.00 XXX 0.000003T C 0.00 0.00 0.00 0.00 XXX 0.000005F C 0.00 0.00 0.00 0.00 XXX 0.000008T C 341.10 0.00 0.00 0.00 XXX 1.250010T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050016T C 0.00 0.00 0.00 0.00 XXX 0.000017T C 0.00 0.00 0.00 0.00 XXX 0.000018T C 0.00 0.00 0.00 0.00 XXX 0.000019T C 0.00 0.00 0.00 0.00 XXX 0.000020T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050021T C 0.00 0.00 0.00 0.00 XXX 0.000023T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050024T C 0.00 0.00 0.00 0.00 XXX 0.000026T C 0.00 0.00 0.00 0.00 XXX 0.000027T C 0.00 0.00 0.00 0.00 XXX 0.000028T C 0.00 0.00 0.00 0.00 XXX 0.000029T C 58.08 0.00 0.00 0.00 XXX 1.250030T C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
0031T C 0.00 0.00 0.00 0.00 XXX 0.000032T C 0.00 0.00 0.00 0.00 XXX 0.000033T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050034T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050035T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050036T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050037T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050038T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050039T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050040T C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/20050041T C 0.00 0.00 0.00 0.00 XXX 0.000042T C 0.00 0.00 0.00 0.00 XXX 0.000043T C 0.00 0.00 0.00 0.00 XXX 0.000044T C 0.00 0.00 0.00 0.00 XXX 0.000045T C 0.00 0.00 0.00 0.00 XXX 0.000046T C 145.20 0.00 0.00 0.00 XXX 1.250047T C 72.61 0.00 0.00 0.00 XXX 1.250048T C 0.00 0.00 0.00 0.00 XXX 0.000049T C 0.00 0.00 0.00 0.00 XXX 0.000050T C 0.00 0.00 0.00 0.00 XXX 0.000051T C 0.00 0.00 0.00 0.00 XXX 0.000052T C 0.00 0.00 0.00 0.00 XXX 0.000053T C 0.00 0.00 0.00 0.00 XXX 0.000054T C 0.00 0.00 0.00 0.00 XXX 0.000055T C 0.00 0.00 0.00 0.00 XXX 0.000056T C 0.00 0.00 0.00 0.00 XXX 0.000058T D 0.00 0.00 0.00 0.00 XXX 0.000059T D 0.00 0.00 0.00 0.00 XXX 0.000060T C 0.00 0.00 0.00 0.00 XXX 0.000061T C 0.00 0.00 0.00 0.00 XXX 0.000062T C 0.00 0.00 0.00 0.00 XXX 0.000063T C 0.00 0.00 0.00 0.00 XXX 0.000064T C 0.00 0.00 0.00 0.00 XXX 0.000065T C 0.00 0.00 0.00 0.00 XXX 0.000066T C 0.00 0.00 0.00 0.00 XXX 0.000066T C TC 0.00 0.00 0.00 0.00 XXX 0.000066T C 26 0.00 0.00 0.00 0.00 XXX 0.000067T C 797.20 0.00 0.00 0.00 XXX 1.250067T C TC 681.63 0.00 0.00 0.00 XXX 1.250067T C 26 115.55 0.00 0.00 0.00 XXX 1.250068T C 0.00 0.00 0.00 0.00 XXX 0.000069T C 0.00 0.00 0.00 0.00 XXX 0.000070T C 0.00 0.00 0.00 0.00 XXX 0.000071T C 0.00 0.00 0.00 0.00 XXX 0.000072T C 0.00 0.00 0.00 0.00 XXX 0.000073T C 0.00 18.07 18.07 0.13 XXX 50.580074T C 0.00 0.00 0.00 0.00 XXX 0.000075T C 732.70 0.00 0.00 0.00 XXX 2.500075T C TC 826.69 0.00 0.00 0.00 XXX 1.250075T C 26 638.70 0.00 0.00 0.00 XXX 1.250076T C 574.65 0.00 0.00 0.00 XXX 2.500076T C TC 826.69 0.00 0.00 0.00 XXX 1.250076T C 26 322.62 0.00 0.00 0.00 XXX 1.250077T C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
0078T C 0.00 0.00 0.00 0.00 XXX 0.000079T C 0.00 0.00 0.00 0.00 XXX 0.000080T C 0.00 0.00 0.00 0.00 XXX 0.000081T C 0.00 0.00 0.00 0.00 XXX 0.000082T C 0.00 0.00 0.00 0.00 XXX 0.000083T C 0.00 0.00 0.00 0.00 XXX 0.000084T C 0.00 0.00 0.00 0.00 XXX 0.000085T C 0.00 0.00 0.00 0.00 XXX 0.000086T C 0.00 0.00 0.00 0.00 XXX 0.000087T D 0.00 0.00 0.00 0.00 XXX 0.000088T C 0.00 0.00 0.00 0.00 XXX 0.000089T C 0.00 0.00 0.00 0.00 XXX 0.000090T C 28.04 16.98 16.98 6.48 XXX 50.580091T C 28.19 17.58 17.58 5.50 XXX 50.580092T C 12.73 6.45 6.45 2.69 XXX 50.580093T C 19.68 12.08 12.08 4.49 XXX 50.580094T C 21.41 12.79 12.79 3.70 XXX 50.580095T C 4.04 2.05 2.05 0.93 XXX 50.580096T C 28.04 16.98 16.98 6.48 XXX 50.580097T C 28.19 17.58 17.58 5.50 XXX 50.580098T C 12.73 6.45 6.45 2.69 XXX 50.580099T C 0.00 0.00 0.00 0.00 XXX 0.000100T C 0.00 0.00 0.00 0.00 XXX 0.000101T C 0.00 0.00 0.00 0.00 XXX 0.000102T C 0.00 0.00 0.00 0.00 XXX 0.000103T C 0.00 0.00 0.00 0.00 XXX 0.000104T C 0.00 0.00 0.00 0.00 XXX 0.000105T C 0.00 0.00 0.00 0.00 XXX 0.000106T C 0.00 0.00 0.00 0.00 XXX 0.000107T C 0.00 0.00 0.00 0.00 XXX 0.000108T C 0.00 0.00 0.00 0.00 XXX 0.000109T C 0.00 0.00 0.00 0.00 XXX 0.000110T C 0.00 0.00 0.00 0.00 XXX 0.000111T C 0.00 0.00 0.00 0.00 XXX 0.000115T D 0.00 0.00 0.00 0.00 XXX 0.000116T D 0.00 0.00 0.00 0.00 XXX 0.000117T D 0.00 0.00 0.00 0.00 XXX 0.000120T C 0.00 0.00 0.00 0.00 XXX 0.000123T C 0.00 0.00 0.00 0.00 XXX 0.000124T C 0.00 0.00 0.00 0.00 XXX 0.000126T C 0.00 0.00 0.00 0.00 XXX 0.000130T D 0.00 0.00 0.00 0.00 XXX 0.000133T C 0.00 0.00 0.00 0.00 XXX 0.000135T C 0.00 0.00 0.00 0.00 XXX 0.000137T C 0.00 0.00 0.00 0.00 XXX 0.000140T C 0.00 0.00 0.00 0.00 XXX 0.000141T C 0.00 0.00 0.00 0.00 XXX 0.000142T C 0.00 0.00 0.00 0.00 XXX 0.000143T C 0.00 0.00 0.00 0.00 XXX 0.000144T C 0.00 0.00 0.00 0.00 XXX 0.000145T C 0.00 0.00 0.00 0.00 XXX 0.000146T C 0.00 0.00 0.00 0.00 XXX 0.000147T C 0.00 0.00 0.00 0.00 XXX 0.000148T C 0.00 0.00 0.00 0.00 XXX 0.00
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
0149T C 0.00 0.00 0.00 0.00 XXX 0.000150T C 0.00 0.00 0.00 0.00 XXX 0.000151T C 0.00 0.00 0.00 0.00 XXX 0.000152T C 0.00 0.00 0.00 0.00 XXX 0.000153T C 0.00 0.00 0.00 0.00 XXX 0.000154T C 0.00 0.00 0.00 0.00 XXX 0.000500F C 0.00 0.00 0.00 0.00 XXX 0.000501F C 0.00 0.00 0.00 0.00 XXX 0.000502F C 0.00 0.00 0.00 0.00 XXX 0.000503F C 0.00 0.00 0.00 0.00 XXX 0.001000F C 0.00 0.00 0.00 0.00 XXX 0.001001F C 0.00 0.00 0.00 0.00 XXX 0.001002F C 0.00 0.00 0.00 0.00 XXX 0.001003F D 0.00 0.00 0.00 0.00 XXX 0.001004F D 0.00 0.00 0.00 0.00 XXX 0.001005F D 0.00 0.00 0.00 0.00 XXX 0.001006F D 0.00 0.00 0.00 0.00 XXX 0.001007F D 0.00 0.00 0.00 0.00 XXX 0.001008F D 0.00 0.00 0.00 0.00 XXX 0.002000F C 0.00 0.00 0.00 0.00 XXX 0.002001F D 0.00 0.00 0.00 0.00 XXX 0.002002F D 0.00 0.00 0.00 0.00 XXX 0.002003F D 0.00 0.00 0.00 0.00 XXX 0.002004F D 0.00 0.00 0.00 0.00 XXX 0.003000F D 0.00 0.00 0.00 0.00 XXX 0.003002F D 0.00 0.00 0.00 0.00 XXX 0.004000F C 0.00 0.00 0.00 0.00 XXX 0.004001F C 0.00 0.00 0.00 0.00 XXX 0.004002F C 0.00 0.00 0.00 0.00 XXX 0.004003F D 0.00 0.00 0.00 0.00 XXX 0.004006F C 0.00 0.00 0.00 0.00 XXX 0.004009F C 0.00 0.00 0.00 0.00 XXX 0.004011F C 0.00 0.00 0.00 0.00 XXX 0.004012F D 0.00 0.00 0.00 0.00 XXX 0.004014F D 0.00 0.00 0.00 0.00 XXX 0.004015F D 0.00 0.00 0.00 0.00 XXX 0.004016F D 0.00 0.00 0.00 0.00 XXX 0.004017F D 0.00 0.00 0.00 0.00 XXX 0.004018F D 0.00 0.00 0.00 0.00 XXX 0.00A0021 C 0.00 0.00 0.00 0.00 XXX 0.00 Outside state ambulance serv, Medicaid onlyA0080 C 0.00 0.00 0.00 0.00 XXX 0.00 Noninterest escort in non erA0090 C 0.00 0.00 0.00 0.00 XXX 0.00 Interest escort in non erA0100 C 0.00 0.00 0.00 0.00 XXX 0.00 Nonemergency transport taxiA0110 C 0.00 0.00 0.00 0.00 XXX 0.00 Nonemergency transport busA0120 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport mini-busA0130 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport wheelch vanA0140 C 0.00 0.00 0.00 0.00 XXX 0.00 Nonemergency transport airA0160 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport case workerA0170 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport parking feesA0180 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport lodgng recipA0190 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport meals recipA0200 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport lodgng escrtA0210 C 0.00 0.00 0.00 0.00 XXX 0.00 Noner transport meals escortA0225 D 0.00 0.00 0.00 0.00 XXX 0.00 Neonatal emergency transport
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A0380 C 0.00 0.00 0.00 0.00 XXX 0.00 BLS mileage, per mileA0382 C 0.00 0.00 0.00 0.00 XXX 0.00 Basic support routine supplsA0384 C 0.00 0.00 0.00 0.00 XXX 0.00 Bls defibrillation suppliesA0390 C 0.00 0.00 0.00 0.00 XXX 0.00 ALS mileage, per mileA0392 C 0.00 0.00 0.00 0.00 XXX 0.00 Als defibrillation suppliesA0394 C 0.00 0.00 0.00 0.00 XXX 0.00 Als IV drug therapy suppliesA0396 C 0.00 0.00 0.00 0.00 XXX 0.00 Als esophageal intub supplsA0398 C 0.00 0.00 0.00 0.00 XXX 0.00 Als routine disposble supplsA0420 C 0.00 0.00 0.00 0.00 XXX 0.00 Ambulance waiting 1/2 hrA0422 C 0.00 0.00 0.00 0.00 XXX 0.00 Ambulance 02 life sustainingA0424 C 0.00 0.00 0.00 0.00 XXX 0.00 Extra ambulance attendantA0425 C 0.00 0.00 0.00 0.00 XXX 0.00 Ground mileageA0426 C 0.00 0.00 0.00 0.00 XXX 0.00 Als 1A0427 C 0.00 0.00 0.00 0.00 XXX 0.00 ALS1-emergencyA0428 C 0.00 0.00 0.00 0.00 XXX 0.00 blsA0429 C 0.00 0.00 0.00 0.00 XXX 0.00 BLS-emergencyA0430 C 0.00 0.00 0.00 0.00 XXX 0.00 Fixed wing air transportA0431 C 0.00 0.00 0.00 0.00 XXX 0.00 Rotary wing air transportA0432 C 0.00 0.00 0.00 0.00 XXX 0.00 PI volunteer ambulance coA0433 C 0.00 0.00 0.00 0.00 XXX 0.00 ALS 2A0434 C 0.00 0.00 0.00 0.00 XXX 0.00 Specialty care transportA0435 C 0.00 0.00 0.00 0.00 XXX 0.00 Fixed wing air mileageA0436 C 0.00 0.00 0.00 0.00 XXX 0.00 Rotary wing air mileageA0800 C 0.00 0.00 0.00 0.00 XXX 0.00 Amb trans 7pm-7amA0888 C 0.00 0.00 0.00 0.00 XXX 0.00 Noncovered ambulance mileageA0998 D 0.00 0.00 0.00 0.00 XXX 0.00 Ambulance response/treatmentA0999 S 0.00 0.00 0.00 0.00 XXX 0.00 Unlisted ambulance serviceA4206 C 0.00 0.00 0.00 0.00 XXX 0.00 1 CC sterile syringe&needleA4207 C 0.00 0.00 0.00 0.00 XXX 0.00 2 CC sterile syringe&needleA4208 C 0.00 0.00 0.00 0.00 XXX 0.00 3 CC sterile syringe&needleA4209 C 0.00 0.00 0.00 0.00 XXX 0.00 5+ CC sterile syringe&needleA4210 C 0.00 0.00 0.00 0.00 XXX 0.00 Nonneedle injection deviceA4211 C 0.00 0.00 0.00 0.00 XXX 0.00 Supp for self-adm injectionsA4212 C 0.00 0.00 0.00 0.00 XXX 0.00 Non coring needle or styletA4213 C 0.00 0.00 0.00 0.00 XXX 0.00 20+ CC syringe onlyA4215 C 0.00 0.00 0.00 0.00 XXX 0.00 Sterile needleA4216 C 0.86 0.00 0.00 0.00 XXX 1.25 Sterile water/saline, 10 mlA4217 C 4.30 0.00 0.00 0.00 XXX 1.25 Sterile water/saline, 500 mlA4217 C AU 4.30 0.00 0.00 0.00 XXX 1.25 Sterile water/saline, 500 mlA4218 C 0.00 0.00 0.00 0.00 XXX 0.00 Sterile saline or water, metered dose dispenser, 10 mlA4220 C 0.00 0.00 0.00 0.00 XXX 0.00 Infusion pump refill kitA4221 C 33.98 0.00 0.00 0.00 XXX 1.25 Maint drug infus cath per wkA4222 C 67.39 0.00 0.00 0.00 XXX 1.25 Infusion supplies, ext pump, per unitA4223 C 0.00 0.00 0.00 0.00 XXX 0.00 Infusion supplies w/o pumpA4230 C 0.00 0.00 0.00 0.00 XXX 0.00 Infus insulin pump non needlA4231 C 0.00 0.00 0.00 0.00 XXX 0.00 Infusion insulin pump needleA4232 C 2.74 0.00 0.00 0.00 XXX 1.25 Syringe w/needle insulin 3ccA4233 C 1.19 0.00 0.00 0.00 XXX 1.25 Alkalin batt for glucose monA4233 C NU 1.19 0.00 0.00 0.00 XXX 1.25 Alkalin batt for glucose monA4234 C 5.45 0.00 0.00 0.00 XXX 1.25 J-cell batt for glucose monA4234 C NU 5.45 0.00 0.00 0.00 XXX 1.25 J-cell batt for glucose monA4235 C 3.50 0.00 0.00 0.00 XXX 1.25 Lithium batt for glucose monA4235 C NU 3.50 0.00 0.00 0.00 XXX 1.25 Lithium batt for glucose monA4236 C 2.50 0.00 0.00 0.00 XXX 1.25 Silvr oxide batt glucose mon
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A4236 C NU 2.50 0.00 0.00 0.00 XXX 1.25 Silvr oxide batt glucose monA4244 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol or peroxide per pintA4245 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol wipes per boxA4246 C 0.00 0.00 0.00 0.00 XXX 0.00 Betadine/phisohex solutionA4247 C 0.00 0.00 0.00 0.00 XXX 0.00 Betadine/iodine swabs/wipesA4248 C 0.00 0.00 0.00 0.00 XXX 0.00 Chlorhexidine antiseptA4250 C 0.00 0.00 0.00 0.00 XXX 0.00 Urine reagent strips/tabletsA4253 C 46.19 0.00 0.00 0.00 XXX 1.25 Blood glucose/reagent stripsA4253 C NU 46.19 0.00 0.00 0.00 XXX 1.25 Blood glucose/reagent stripsA4254 C 0.99 0.00 0.00 0.00 XXX 1.25 12/31/2005 Battery for glucose monitorA4254 C NU 9.85 0.00 0.00 0.00 XXX 1.25 12/31/2005 Battery for glucose monitorA4254 C RR 0.99 0.00 0.00 0.00 XXX 1.25 12/31/2005 Battery for glucose monitorA4254 C UE 7.40 0.00 0.00 0.00 XXX 1.25 12/31/2005 Battery for glucose monitorA4255 C 5.65 0.00 0.00 0.00 XXX 1.25 Glucose monitor platformsA4256 C 14.30 0.00 0.00 0.00 XXX 1.25 Calibrator solution/chipsA4257 C 19.13 0.00 0.00 0.00 XXX 1.25 Replace Lensshield CartridgeA4258 C 27.09 0.00 0.00 0.00 XXX 1.25 Lancet device eachA4259 C 15.09 0.00 0.00 0.00 XXX 1.25 Lancets per boxA4260 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Levonorgestrel implantA4261 C 0.00 0.00 0.00 0.00 XXX 0.00 Cervical cap contraceptiveA4262 C 0.00 0.00 0.00 0.00 XXX 0.00 Temporary tear duct plugA4263 C 0.00 0.00 0.00 0.00 XXX 0.00 Permanent tear duct plugA4265 C 5.06 0.00 0.00 0.00 XXX 1.25 ParaffinA4266 D 0.00 0.00 0.00 0.00 XXX 0.00 DiaphragmA4267 D 0.00 0.00 0.00 0.00 XXX 0.00 Male condomA4268 D 0.00 0.00 0.00 0.00 XXX 0.00 Female condomA4269 D 0.00 0.00 0.00 0.00 XXX 0.00 SpermicideA4270 C 0.00 0.00 0.00 0.00 XXX 0.00 Disposable endoscope sheathA4280 C 6.66 0.00 0.00 0.00 XXX 1.25 Brst prsths adhsv attchmntA4281 D 0.00 0.00 0.00 0.00 XXX 0.00 Replacement breastpump tubeA4282 D 0.00 0.00 0.00 0.00 XXX 0.00 Replacement breastpump adptA4283 D 0.00 0.00 0.00 0.00 XXX 0.00 Replacement breastpump capA4284 D 0.00 0.00 0.00 0.00 XXX 0.00 Replcmnt breast pump shieldA4285 D 0.00 0.00 0.00 0.00 XXX 0.00 Replcmnt breast pump bottleA4286 D 0.00 0.00 0.00 0.00 XXX 0.00 Replcmnt breastpump lok ringA4290 C 147.75 0.00 0.00 0.00 XXX 1.25 Sacral nerve stim test leadA4300 C 0.27 0.00 0.00 0.00 XXX 1.25 Cath impl vasc access portalA4301 C 0.00 0.00 0.00 0.00 XXX 0.00 Implantable access syst percA4305 C 0.00 0.00 0.00 0.00 XXX 0.00 Drug delivery system >=50 MLA4306 C 0.00 0.00 0.00 0.00 XXX 0.00 Drug delivery system <=5 MLA4310 C 22.13 0.00 0.00 0.00 XXX 1.25 Insert tray w/o bag/cathA4311 C 24.57 0.00 0.00 0.00 XXX 1.25 Catheter w/o bag 2-way latexA4312 C 32.10 0.00 0.00 0.00 XXX 1.25 Cath w/o bag 2-way siliconeA4313 C 35.51 0.00 0.00 0.00 XXX 1.25 Catheter w/bag 3-wayA4314 C 36.62 0.00 0.00 0.00 XXX 1.25 Cath w/drainage 2-way latexA4315 C 42.42 0.00 0.00 0.00 XXX 1.25 Cath w/drainage 2-way silcneA4316 C 42.42 0.00 0.00 0.00 XXX 1.25 Cath w/drainage 3-wayA4320 C 7.40 0.00 0.00 0.00 XXX 1.25 Irrigation trayA4321 C 0.00 0.00 0.00 0.00 XXX 0.00 Cath therapeutic irrig agentA4322 C 4.89 0.00 0.00 0.00 XXX 1.25 Irrigation syringeA4326 C 14.24 0.00 0.00 0.00 XXX 1.25 Male external catheterA4327 C 69.23 0.00 0.00 0.00 XXX 1.25 Fem urinary collect dev cupA4328 C 14.54 0.00 0.00 0.00 XXX 1.25 Fem urinary collect pouchA4330 C 9.29 0.00 0.00 0.00 XXX 1.25 Stool collection pouch
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A4331 C 4.79 0.00 0.00 0.00 XXX 1.25 Extension drainage tubingA4332 C 0.21 0.00 0.00 0.00 XXX 1.25 Lubricant, ind sterile pkt, eachA4333 C 3.85 0.00 0.00 0.00 XXX 1.25 Urinary cath anchor deviceA4334 C 6.78 0.00 0.00 0.00 XXX 1.25 Urinary cath leg strapA4335 C 0.00 0.00 0.00 0.00 XXX 0.00 Incontinence supplyA4338 C 16.91 0.00 0.00 0.00 XXX 1.25 Indwelling catheter latexA4340 C 43.65 0.00 0.00 0.00 XXX 1.25 Indwelling catheter specialA4344 C 34.02 0.00 0.00 0.00 XXX 1.25 Cath indw foley 2 way silicnA4346 C 25.63 0.00 0.00 0.00 XXX 1.25 Cath indw foley 3 wayA4348 C 41.79 0.00 0.00 0.00 XXX 1.25 Male ext cath extended wearA4349 C 2.81 0.00 0.00 0.00 XXX 1.25 Male external cat, disposableA4351 C 2.26 0.00 0.00 0.00 XXX 1.25 Straight tip urine catheterA4352 C 13.39 0.00 0.00 0.00 XXX 1.25 Coude tip urinary catheterA4353 C 9.61 0.00 0.00 0.00 XXX 1.25 Intermittent urinary cathA4354 C 23.96 0.00 0.00 0.00 XXX 1.25 Cath insertion tray w/bagA4355 C 29.56 0.00 0.00 0.00 XXX 1.25 Bladder irrigation tubingA4356 C 69.75 0.00 0.00 0.00 XXX 1.25 Ext ureth clmp or compr dvcA4357 C 13.51 0.00 0.00 0.00 XXX 1.25 Bedside drainage bagA4358 C 8.80 0.00 0.00 0.00 XXX 1.25 Urinary leg or abdomen bagA4359 C 50.23 0.00 0.00 0.00 XXX 1.25 Urinary suspensory w/o leg bA4361 C 36.10 0.00 0.00 0.00 XXX 1.25 Ostomy face plateA4362 C 4.56 0.00 0.00 0.00 XXX 1.25 Solid skin barrierA4363 C 2.95 0.00 0.00 0.00 XXX 1.25 Ostomy clamp, replacementA4364 C 8.21 0.00 0.00 0.00 XXX 1.25 AdhesiveA4365 C 15.58 0.00 0.00 0.00 XXX 1.25 Adhesive remover wipesA4366 C 1.94 0.00 0.00 0.00 XXX 1.25 Ostomy ventA4367 C 9.40 0.00 0.00 0.00 XXX 1.25 Ostomy beltA4368 C 0.35 0.00 0.00 0.00 XXX 1.25 Ostomy filterA4369 C 3.52 0.00 0.00 0.00 XXX 1.25 Skin barrier liquid per ozA4371 C 5.35 0.00 0.00 0.00 XXX 1.25 Skin barrier powder per ozA4372 C 5.74 0.00 0.00 0.00 XXX 1.25 Skin barrier solid 4x4 equivA4373 C 8.64 0.00 0.00 0.00 XXX 1.25 Skin barrier with flangeA4375 C 23.60 0.00 0.00 0.00 XXX 1.25 Drainable plastic pch w fcplA4376 C 65.41 0.00 0.00 0.00 XXX 1.25 Drainable rubber pch w fcpltA4377 C 5.89 0.00 0.00 0.00 XXX 1.25 Drainable plstic pch w/o fpA4378 C 42.26 0.00 0.00 0.00 XXX 1.25 Drainable rubber pch w/o fpA4379 C 20.65 0.00 0.00 0.00 XXX 1.25 Urinary plastic pouch w fcplA4380 C 51.31 0.00 0.00 0.00 XXX 1.25 Urinary rubber pouch w fcpltA4381 C 6.35 0.00 0.00 0.00 XXX 1.25 Urinary plastic pouch w/o fpA4382 C 33.80 0.00 0.00 0.00 XXX 1.25 Urinary hvy plstc pch w/o fpA4383 C 38.80 0.00 0.00 0.00 XXX 1.25 Urinary rubber pouch w/o fpA4384 C 13.22 0.00 0.00 0.00 XXX 1.25 Ostomy faceplt/silicone ringA4385 C 7.00 0.00 0.00 0.00 XXX 1.25 Ost skn barrier sld ext wearA4387 C 0.00 0.00 0.00 0.00 XXX 0.00 Ost clsd pouch w att st barrA4388 C 6.00 0.00 0.00 0.00 XXX 1.25 Drainable pch w ex wear barrA4389 C 8.53 0.00 0.00 0.00 XXX 1.25 Drainable pch w st wear barrA4390 C 13.20 0.00 0.00 0.00 XXX 1.25 Drainable pch ex wear convexA4391 C 9.70 0.00 0.00 0.00 XXX 1.25 Urinary pouch w ex wear barrA4392 C 12.30 0.00 0.00 0.00 XXX 1.25 Urinary pouch w st wear barrA4393 C 13.56 0.00 0.00 0.00 XXX 1.25 Urine pch w ex wear bar convA4394 C 3.51 0.00 0.00 0.00 XXX 1.25 Ostomy pouch liq deodorantA4395 C 0.07 0.00 0.00 0.00 XXX 1.25 Ostomy pouch solid deodorantA4396 C 60.70 0.00 0.00 0.00 XXX 1.25 Peristomal hernia supprt bltA4397 C 9.65 0.00 0.00 0.00 XXX 1.25 Irrigation supply sleeve
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A4398 C 19.46 0.00 0.00 0.00 XXX 1.25 Ostomy irrigation bagA4399 C 17.78 0.00 0.00 0.00 XXX 1.25 Ostomy irrig cone/cath w brsA4400 C 79.80 0.00 0.00 0.00 XXX 1.25 Ostomy irrigation setA4402 C 5.00 0.00 0.00 0.00 XXX 1.25 Lubricant per ounceA4404 C 2.29 0.00 0.00 0.00 XXX 1.25 Ostomy ring eachA4405 C 5.07 0.00 0.00 0.00 XXX 1.25 Nonpectin based ostomy pasteA4406 C 8.60 0.00 0.00 0.00 XXX 1.25 Pectin based ostomy pasteA4407 C 13.13 0.00 0.00 0.00 XXX 1.25 Ext wear ost skn barr <=4sq"A4408 C 14.80 0.00 0.00 0.00 XXX 1.25 Ext wear ost skn barr >4sq"A4409 C 9.30 0.00 0.00 0.00 XXX 1.25 Ost skn barr w flng <=4 sq"A4410 C 13.56 0.00 0.00 0.00 XXX 1.25 Ost skn barr w flng >4sq"A4411 C 7.65 0.00 0.00 0.00 XXX 1.25 Ost skn barr extnd =4sqA4412 C 4.01 0.00 0.00 0.00 XXX 1.25 Ost pouch drain high outputA4413 C 8.27 0.00 0.00 0.00 XXX 1.25 2 pc drainable ost pouchA4414 C 7.38 0.00 0.00 0.00 XXX 1.25 Ostomy sknbarr w flng <=4sq"A4415 C 8.97 0.00 0.00 0.00 XXX 1.25 Ostomy skn barr w flng >4sq"A4416 C 3.80 0.00 0.00 0.00 XXX 1.25 Ost pch clsd w barrier/filtrA4417 C 5.09 0.00 0.00 0.00 XXX 1.25 Ost pch w bar/bltinconv/fltrA4418 C 2.48 0.00 0.00 0.00 XXX 1.25 Ost pch clsd w/o bar w filtrA4419 C 2.39 0.00 0.00 0.00 XXX 1.25 Ost pch for bar w flange/fltA4420 C 0.00 0.00 0.00 0.00 XXX 0.00 Ost pch clsd for bar w lk flA4421 C 0.00 0.00 0.00 0.00 XXX 0.00 Ostomy supply miscA4422 C 0.21 0.00 0.00 0.00 XXX 1.25 Ost pouch absorbent materialA4423 C 2.80 0.00 0.00 0.00 XXX 1.25 Ost pch for bar w lk fl/fltrA4424 C 6.52 0.00 0.00 0.00 XXX 1.25 Ost pch drain w bar & filterA4425 C 4.93 0.00 0.00 0.00 XXX 1.25 Ost pch drain for barrier flA4426 C 4.09 0.00 0.00 0.00 XXX 1.25 Ost pch drain 2 piece systemA4427 C 4.20 0.00 0.00 0.00 XXX 1.25 Ost pch drain/barr lk flng/fA4428 C 8.92 0.00 0.00 0.00 XXX 1.25 Urine ost pouch w faucet/tapA4429 C 12.39 0.00 0.00 0.00 XXX 1.25 Urine ost pouch w bltinconvA4430 C 11.73 0.00 0.00 0.00 XXX 1.25 Ost urine pch w b/bltin convA4431 C 9.30 0.00 0.00 0.00 XXX 1.25 Ost pch urine w barrier/tapvA4432 C 4.94 0.00 0.00 0.00 XXX 1.25 Os pch urine w bar/fange/tapA4433 C 4.56 0.00 0.00 0.00 XXX 1.25 Urine ost pch bar w lock flnA4434 C 5.19 0.00 0.00 0.00 XXX 1.25 Ost pch urine w lock flng/ftA4450 C 0.14 0.00 0.00 0.00 XXX 1.25 Non-waterproof tapeA4450 C AU 0.14 0.00 0.00 0.00 XXX 1.25 Non-waterproof tapeA4450 C AV 0.14 0.00 0.00 0.00 XXX 1.25 Non-waterproof tapeA4450 C AW 0.16 0.00 0.00 0.00 XXX 1.25 Non-waterproof tapeA4452 C 0.49 0.00 0.00 0.00 XXX 1.25 Waterproof tapeA4452 C AU 0.54 0.00 0.00 0.00 XXX 1.25 Waterproof tapeA4452 C AV 0.49 0.00 0.00 0.00 XXX 1.25 Waterproof tapeA4452 C AW 0.60 0.00 0.00 0.00 XXX 1.25 Waterproof tapeA4455 C 2.13 0.00 0.00 0.00 XXX 1.25 Adhesive remover per ounceA4458 C 0.00 0.00 0.00 0.00 XXX 0.00 Reusable enema bagA4462 C 4.93 0.00 0.00 0.00 XXX 1.25 Abdmnl drssng holder/binderA4465 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-elastic extremity binderA4470 C 0.00 0.00 0.00 0.00 XXX 0.00 Gravlee jet washerA4480 C 0.00 0.00 0.00 0.00 XXX 0.00 Vabra aspiratorA4481 C 0.66 0.00 0.00 0.00 XXX 1.25 Tracheostoma filterA4483 C 0.00 0.00 0.00 0.00 XXX 0.00 Moisture exchangerA4490 C 0.00 0.00 0.00 0.00 XXX 0.00 Above knee surgical stockingA4495 C 0.00 0.00 0.00 0.00 XXX 0.00 Thigh length surg stockingA4500 C 0.00 0.00 0.00 0.00 XXX 0.00 Below knee surgical stocking
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A4510 C 0.00 0.00 0.00 0.00 XXX 0.00 Full length surg stockingA4520 C 0.00 0.00 0.00 0.00 XXX 0.00 Incontinence garment anytypeA4550 C 21.78 0.00 0.00 0.00 XXX 1.25 Surgical traysA4554 C 0.00 0.00 0.00 0.00 XXX 0.00 Disposable underpadsA4556 C 15.18 0.00 0.00 0.00 XXX 1.25 ElectrodesA4557 C 26.38 0.00 0.00 0.00 XXX 1.25 Lead wiresA4558 C 8.86 0.00 0.00 0.00 XXX 1.25 Conductive paste or gelA4561 C 24.12 0.00 0.00 0.00 XXX 1.25 Pessary rubberA4562 C 60.05 0.00 0.00 0.00 XXX 1.25 PessaryA4565 C 6.71 0.00 0.00 0.00 XXX 1.25 SlingsA4570 C 0.00 0.00 0.00 0.00 XXX 0.00 SplintA4575 C 0.00 0.00 0.00 0.00 XXX 0.00 Hyperbaric o2 chamber dispsA4580 C 0.00 0.00 0.00 0.00 XXX 0.00 Cast supplies (plaster)A4590 C 0.00 0.00 0.00 0.00 XXX 0.00 Special casting materialA4595 C 43.20 0.00 0.00 0.00 XXX 1.25 TENS suppl 2 lead per monthA4604 C 100.20 0.00 0.00 0.00 XXX 1.25 Tubing with heating elementA4604 C NU 100.20 0.00 0.00 0.00 XXX 1.25 Tubing with heating elementA4605 C 24.56 0.00 0.00 0.00 XXX 1.25 Trach suction cath close sysA4605 C NU 24.56 0.00 0.00 0.00 XXX 1.25 Trach suction cath close sysA4606 C 0.00 0.00 0.00 0.00 XXX 0.00 Oxygen probe used w oximeterA4608 C 87.24 0.00 0.00 0.00 XXX 1.25 Transtracheal oxygen cathA4611 C 41.42 0.00 0.00 0.00 XXX 1.25 Heavy duty batteryA4611 C NU 331.35 0.00 0.00 0.00 XXX 1.25 Heavy duty batteryA4611 C RR 41.42 0.00 0.00 0.00 XXX 1.25 Heavy duty batteryA4611 C UE 248.53 0.00 0.00 0.00 XXX 1.25 Heavy duty batteryA4612 C 11.75 0.00 0.00 0.00 XXX 1.25 Battery cablesA4612 C NU 117.55 0.00 0.00 0.00 XXX 1.25 Battery cablesA4612 C RR 11.75 0.00 0.00 0.00 XXX 1.25 Battery cablesA4612 C UE 88.16 0.00 0.00 0.00 XXX 1.25 Battery cablesA4613 C 18.04 0.00 0.00 0.00 XXX 1.25 Battery chargerA4613 C NU 180.26 0.00 0.00 0.00 XXX 1.25 Battery chargerA4613 C RR 18.04 0.00 0.00 0.00 XXX 1.25 Battery chargerA4613 C UE 130.36 0.00 0.00 0.00 XXX 1.25 Battery chargerA4614 C 35.66 0.00 0.00 0.00 XXX 1.25 Hand-held PEFR meterA4615 C 0.00 0.00 0.00 0.00 XXX 0.00 Cannula nasalA4616 C 0.00 0.00 0.00 0.00 XXX 0.00 Tubing (oxygen) per footA4617 C 0.00 0.00 0.00 0.00 XXX 0.00 Mouth pieceA4618 C 2.71 0.00 0.00 0.00 XXX 1.25 Breathing circuitsA4618 C NU 27.24 0.00 0.00 0.00 XXX 1.25 Breathing circuitsA4618 C RR 2.71 0.00 0.00 0.00 XXX 1.25 Breathing circuitsA4618 C UE 20.43 0.00 0.00 0.00 XXX 1.25 Breathing circuitsA4619 C 1.83 0.00 0.00 0.00 XXX 1.25 Face tentA4620 C 0.00 0.00 0.00 0.00 XXX 0.00 Variable concentration maskA4623 C 8.19 0.00 0.00 0.00 XXX 1.25 Tracheostomy inner cannulaA4624 C 3.68 0.00 0.00 0.00 XXX 1.25 Tracheal suction tubeA4624 C NU 3.68 0.00 0.00 0.00 XXX 1.25 Tracheal suction tubeA4625 C 55.35 0.00 0.00 0.00 XXX 1.25 Trach care kit for new trachA4626 C 3.99 0.00 0.00 0.00 XXX 1.25 Tracheostomy cleaning brushA4627 C 0.00 0.00 0.00 0.00 XXX 0.00 Spacer bag/reservoirA4628 C 5.51 0.00 0.00 0.00 XXX 1.25 Oropharyngeal suction cathA4628 C NU 5.51 0.00 0.00 0.00 XXX 1.25 Oropharyngeal suction cathA4629 C 6.76 0.00 0.00 0.00 XXX 1.25 Tracheostomy care kitA4630 C 7.81 0.00 0.00 0.00 XXX 1.25 Repl bat t.e.n.s. own by ptA4630 C NU 7.81 0.00 0.00 0.00 XXX 1.25 Repl bat t.e.n.s. own by pt
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A4632 C 0.00 0.00 0.00 0.00 XXX 0.00 Infus pump rplcemnt batteryA4632 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Infus pump rplcemnt batteryA4632 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Infus pump rplcemnt batteryA4632 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Infus pump rplcemnt batteryA4633 C 61.55 0.00 0.00 0.00 XXX 1.25 Uvl replacement bulbA4633 C NU 61.55 0.00 0.00 0.00 XXX 1.25 Uvl replacement bulbA4634 C 0.00 0.00 0.00 0.00 XXX 0.00 Replacement bulb th lightboxA4635 C 1.29 0.00 0.00 0.00 XXX 1.25 Underarm crutch padA4635 C NU 13.47 0.00 0.00 0.00 XXX 1.25 Underarm crutch padA4635 C RR 1.29 0.00 0.00 0.00 XXX 1.25 Underarm crutch padA4635 C UE 10.11 0.00 0.00 0.00 XXX 1.25 Underarm crutch padA4636 C 0.55 0.00 0.00 0.00 XXX 1.25 Handgrip for cane etcA4636 C NU 6.18 0.00 0.00 0.00 XXX 1.25 Handgrip for cane etcA4636 C RR 0.55 0.00 0.00 0.00 XXX 1.25 Handgrip for cane etcA4636 C UE 4.61 0.00 0.00 0.00 XXX 1.25 Handgrip for cane etcA4637 C 0.45 0.00 0.00 0.00 XXX 1.25 Repl tip cane/crutch/walkerA4637 C NU 4.23 0.00 0.00 0.00 XXX 1.25 Repl tip cane/crutch/walkerA4637 C RR 0.45 0.00 0.00 0.00 XXX 1.25 Repl tip cane/crutch/walkerA4637 C UE 3.15 0.00 0.00 0.00 XXX 1.25 Repl tip cane/crutch/walkerA4638 C 0.00 0.00 0.00 0.00 XXX 0.00 Repl batt pulse gen sysA4638 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Repl batt pulse gen sysA4638 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Repl batt pulse gen sysA4638 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Repl batt pulse gen sysA4639 C 430.80 0.00 0.00 0.00 XXX 1.25 Infrared ht sys replcmnt padA4639 C NU 430.80 0.00 0.00 0.00 XXX 1.25 Infrared ht sys replcmnt padA4640 C 11.90 0.00 0.00 0.00 XXX 1.25 Alternating pressure padA4640 C NU 95.15 0.00 0.00 0.00 XXX 1.25 Alternating pressure padA4640 C RR 11.90 0.00 0.00 0.00 XXX 1.25 Alternating pressure padA4640 C UE 71.34 0.00 0.00 0.00 XXX 1.25 Alternating pressure padA4641 C 0.00 0.00 0.00 0.00 XXX 0.00 Diagnostic imaging agentA4642 C 0.00 0.00 0.00 0.00 XXX 0.00 Satumomab pendetide per doseA4643 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 High dose contrast MRIA4644 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Contrast 100-199 MGs iodineA4645 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Contrast 200-299 MGs iodineA4646 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Contrast 300-399 MGs iodineA4647 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Supply, paramagnetic contr matA4649 C 0.00 0.00 0.00 0.00 XXX 0.00 Surgical suppliesA4651 C 0.00 0.00 0.00 0.00 XXX 0.00 Calibrated microcap tubeA4652 C 0.00 0.00 0.00 0.00 XXX 0.00 Microcapillary tube sealantA4653 C 0.00 0.00 0.00 0.00 XXX 0.00 PD catheter anchor beltA4656 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Needle any sizeA4657 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialysis syringe w/wo needleA4660 C 0.00 0.00 0.00 0.00 XXX 0.00 Esrd blood pressure deviceA4663 C 0.00 0.00 0.00 0.00 XXX 0.00 Esrd blood pressure cuffA4670 C 0.00 0.00 0.00 0.00 XXX 0.00 Auto blood pressure monitorA4671 C 0.00 0.00 0.00 0.00 XXX 0.00 Disposable cycler setA4672 C 0.00 0.00 0.00 0.00 XXX 0.00 Drainage ext line, dialysisA4673 C 0.00 0.00 0.00 0.00 XXX 0.00 Ext line w easy lock connectA4674 C 0.00 0.00 0.00 0.00 XXX 0.00 Chem/antisept solution, 8ozA4680 C 0.00 0.00 0.00 0.00 XXX 0.00 Activated carbon filter, eaA4690 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialyzers, eaA4706 C 0.00 0.00 0.00 0.00 XXX 0.00 Bicarbonate conc sol per galA4707 C 0.00 0.00 0.00 0.00 XXX 0.00 Bicarbonate conc pow per pacA4708 C 0.00 0.00 0.00 0.00 XXX 0.00 Acetate conc sol per gallon
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A4709 C 0.00 0.00 0.00 0.00 XXX 0.00 Acid conc sol per gallonA4714 C 0.00 0.00 0.00 0.00 XXX 0.00 Treated water for dialysisA4719 C 0.00 0.00 0.00 0.00 XXX 0.00 ”Y set” tubingA4720 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialysat sol fld vol > 249ccA4721 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialysat sol fld vol > 999ccA4722 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialys sol fld vol > 1999ccA4723 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialys sol fld vol > 2999ccA4724 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialys sol fld vol > 3999ccA4725 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialys sol fld vol > 4999ccA4726 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialys sol fld vol > 5999ccA4728 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialysate solution, non-dexA4730 C 0.00 0.00 0.00 0.00 XXX 0.00 Fistula cannulation set dialA4736 C 0.00 0.00 0.00 0.00 XXX 0.00 Topical anesthetic, per gramA4737 C 0.00 0.00 0.00 0.00 XXX 0.00 Inj anesthetic per 10 mlA4740 C 0.00 0.00 0.00 0.00 XXX 0.00 Esrd shunt accessoryA4750 C 0.00 0.00 0.00 0.00 XXX 0.00 Arterial or venous tubingA4755 C 0.00 0.00 0.00 0.00 XXX 0.00 Arterial and venous tubingA4760 C 0.00 0.00 0.00 0.00 XXX 0.00 Standard testing solutionA4765 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialysate concentrateA4766 C 0.00 0.00 0.00 0.00 XXX 0.00 Dialysate conc sol add 10 mlA4770 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood testing suppliesA4771 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood clotting time tubeA4772 C 0.00 0.00 0.00 0.00 XXX 0.00 Dextrostick/glucose stripsA4773 C 0.00 0.00 0.00 0.00 XXX 0.00 HemostixA4774 C 0.00 0.00 0.00 0.00 XXX 0.00 Ammonia test paperA4802 C 0.00 0.00 0.00 0.00 XXX 0.00 Protamine sulfate per 50 mgA4860 C 0.00 0.00 0.00 0.00 XXX 0.00 Disposable catheter capsA4870 C 0.00 0.00 0.00 0.00 XXX 0.00 Plumbing/electrical workA4890 C 0.00 0.00 0.00 0.00 XXX 0.00 Contracts/repair/maintenanceA4911 C 0.00 0.00 0.00 0.00 XXX 0.00 Drain bag/bottleA4913 C 0.00 0.00 0.00 0.00 XXX 0.00 Esrd supplyA4918 C 0.00 0.00 0.00 0.00 XXX 0.00 Venous pressure clampA4927 C 0.00 0.00 0.00 0.00 XXX 0.00 GlovesA4928 C 0.00 0.00 0.00 0.00 XXX 0.00 Surgical maskA4929 C 0.00 0.00 0.00 0.00 XXX 0.00 Tourniquet for dialysis, eaA4930 C 0.00 0.00 0.00 0.00 XXX 0.00 Sterile, gloves per pairA4931 C 0.00 0.00 0.00 0.00 XXX 0.00 Reusable oral thermometerA4932 C 0.00 0.00 0.00 0.00 XXX 0.00 Reusable rectal thermometerA5051 C 3.10 0.00 0.00 0.00 XXX 1.25 Pouch clsd w barr attachedA5052 C 2.25 0.00 0.00 0.00 XXX 1.25 Clsd ostomy pouch w/o barrA5053 C 2.68 0.00 0.00 0.00 XXX 1.25 Clsd ostomy pouch faceplateA5054 C 2.66 0.00 0.00 0.00 XXX 1.25 Clsd ostomy pouch w/flangeA5055 C 1.92 0.00 0.00 0.00 XXX 1.25 Stoma capA5061 C 5.27 0.00 0.00 0.00 XXX 1.25 Pouch drainable w barrier atA5062 C 2.90 0.00 0.00 0.00 XXX 1.25 Drnble ostomy pouch w/o barrA5063 C 4.01 0.00 0.00 0.00 XXX 1.25 Drain ostomy pouch w/flangeA5071 C 9.06 0.00 0.00 0.00 XXX 1.25 Urinary pouch w/barrierA5072 C 5.30 0.00 0.00 0.00 XXX 1.25 Urinary pouch w/o barrierA5073 C 4.44 0.00 0.00 0.00 XXX 1.25 Urinary pouch on barr w/flngA5081 C 4.86 0.00 0.00 0.00 XXX 1.25 Continent stoma plugA5082 C 14.86 0.00 0.00 0.00 XXX 1.25 Continent stoma catheterA5093 C 2.61 0.00 0.00 0.00 XXX 1.25 Ostomy accessory convex inseA5102 C 30.84 0.00 0.00 0.00 XXX 1.25 Bedside drain btl w/wo tubeA5105 C 79.92 0.00 0.00 0.00 XXX 1.25 Urinary suspensory
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A5112 C 54.15 0.00 0.00 0.00 XXX 1.25 Urinary leg bagA5113 C 7.84 0.00 0.00 0.00 XXX 1.25 Latex leg strapA5114 C 23.52 0.00 0.00 0.00 XXX 1.25 Foam/fabric leg strapA5119 C 15.70 0.00 0.00 0.00 XXX 1.25 12/31/2005 Skin barrier wipes box pr 50A5120 C 0.32 0.00 0.00 0.00 XXX 1.25 Skin barrier, wipe or swabA5120 C AU 0.34 0.00 0.00 0.00 XXX 1.25 Skin barrier, wipe or swabA5120 C AV 0.32 0.00 0.00 0.00 XXX 1.25 Skin barrier, wipe or swabA5121 C 11.39 0.00 0.00 0.00 XXX 1.25 Solid skin barrier 6x6A5122 C 19.03 0.00 0.00 0.00 XXX 1.25 Solid skin barrier 8x8A5126 C 2.24 0.00 0.00 0.00 XXX 1.25 Disk/foam pad +or- adhesiveA5131 C 63.26 0.00 0.00 0.00 XXX 1.25 Appliance cleanerA5200 C 16.96 0.00 0.00 0.00 XXX 1.25 Percutaneous catheter anchorA5500 C 74.20 0.00 0.00 0.00 XXX 1.25 Diab shoe for density insertA5501 C 222.55 0.00 0.00 0.00 XXX 1.25 Diabetic custom molded shoeA5503 C 33.00 0.00 0.00 0.00 XXX 1.25 Diabetic shoe w/roller/rockrA5504 C 33.00 0.00 0.00 0.00 XXX 1.25 Diabetic shoe with wedgeA5505 C 33.00 0.00 0.00 0.00 XXX 1.25 Diab shoe w/metatarsal barA5506 C 33.00 0.00 0.00 0.00 XXX 1.25 Diabetic shoe w/off set heelA5507 C 33.00 0.00 0.00 0.00 XXX 1.25 Modification diabetic shoeA5508 C 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic deluxe shoeA5509 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Direct heat form shoe insertA5510 C 0.00 0.00 0.00 0.00 XXX 0.00 Compression form shoe insertA5511 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Custom fab molded shoe inserA5512 C 30.27 0.00 0.00 0.00 XXX 1.25 Multi den insert direct formA5513 C 45.17 0.00 0.00 0.00 XXX 1.25 Multi den insert custom moldA6000 C 0.00 0.00 0.00 0.00 XXX 0.00 Wound warming wound coverA6010 C 46.45 0.00 0.00 0.00 XXX 1.25 Collagen based wound fillerA6011 C 3.43 0.00 0.00 0.00 XXX 1.25 Collagen gel/paste wound filA6021 C 31.52 0.00 0.00 0.00 XXX 1.25 Collagen dressing <=16 sq inA6022 C 31.52 0.00 0.00 0.00 XXX 1.25 Collagen drsg>6<=48 sq inA6023 C 285.46 0.00 0.00 0.00 XXX 1.25 Collagen dressing >48 sq inA6024 C 9.25 0.00 0.00 0.00 XXX 1.25 Collagen dsg wound fillerA6025 C 0.00 0.00 0.00 0.00 XXX 0.00 Silicone gel sheet, eachA6154 C 19.69 0.00 0.00 0.00 XXX 1.25 Wound pouch eachA6196 C 11.04 0.00 0.00 0.00 XXX 1.25 Alginate dressing <=16 sq inA6197 C 24.66 0.00 0.00 0.00 XXX 1.25 Alginate drsg >16 <=48 sq inA6198 C 0.00 0.00 0.00 0.00 XXX 0.00 Alginate dressing > 48 sq inA6199 C 7.89 0.00 0.00 0.00 XXX 1.25 Alginate drsg wound fillerA6200 C 14.24 0.00 0.00 0.00 XXX 1.25 Compos drsg <=16 no borderA6201 C 31.20 0.00 0.00 0.00 XXX 1.25 Compos drsg >16<=48 no bdrA6202 C 52.33 0.00 0.00 0.00 XXX 1.25 Compos drsg >48 no borderA6203 C 5.00 0.00 0.00 0.00 XXX 1.25 Composite drsg <= 16 sq inA6204 C 9.33 0.00 0.00 0.00 XXX 1.25 Composite drsg >16<=48 sq inA6205 C 0.00 0.00 0.00 0.00 XXX 0.00 Composite drsg > 48 sq inA6206 C 0.00 0.00 0.00 0.00 XXX 0.00 Contact layer <= 16 sq inA6207 C 11.01 0.00 0.00 0.00 XXX 1.25 Contact layer >16<= 48 sq inA6208 C 0.00 0.00 0.00 0.00 XXX 0.00 Contact layer > 48 sq inA6209 C 11.25 0.00 0.00 0.00 XXX 1.25 Foam drsg <=16 sq in w/o bdrA6210 C 29.87 0.00 0.00 0.00 XXX 1.25 Foam drg >16<=48 sq in w/o bA6211 C 44.04 0.00 0.00 0.00 XXX 1.25 Foam drg > 48 sq in w/o brdrA6212 C 14.57 0.00 0.00 0.00 XXX 1.25 Foam drg <=16 sq in w/borderA6213 C 0.00 0.00 0.00 0.00 XXX 0.00 Foam drg >16<=48 sq in w/bdrA6214 C 15.44 0.00 0.00 0.00 XXX 1.25 Foam drg > 48 sq in w/borderA6215 C 0.00 0.00 0.00 0.00 XXX 0.00 Foam dressing wound filler
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A6216 C 0.10 0.00 0.00 0.00 XXX 1.25 Non-sterile gauze<=16 sq inA6217 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-sterile gauze>16<=48 sqA6218 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-sterile gauze > 48 sq inA6219 C 1.45 0.00 0.00 0.00 XXX 1.25 Gauze <= 16 sq in w/borderA6220 C 3.84 0.00 0.00 0.00 XXX 1.25 Gauze >16 <=48 sq in w/bordrA6221 C 0.00 0.00 0.00 0.00 XXX 0.00 Gauze > 48 sq in w/borderA6222 C 3.21 0.00 0.00 0.00 XXX 1.25 Gauze <=16 in no w/sal w/o bA6223 C 3.61 0.00 0.00 0.00 XXX 1.25 Gauze >16<=48 no w/sal w/o bA6224 C 5.43 0.00 0.00 0.00 XXX 1.25 Gauze > 48 in no w/sal w/o bA6228 C 0.00 0.00 0.00 0.00 XXX 0.00 Gauze <= 16 sq in water/salA6229 C 5.43 0.00 0.00 0.00 XXX 1.25 Gauze >16<=48 sq in watr/salA6230 C 0.00 0.00 0.00 0.00 XXX 0.00 Gauze > 48 sq in water/salneA6231 C 6.99 0.00 0.00 0.00 XXX 1.25 Hydrogel dsg<=16 sq inA6232 C 10.30 0.00 0.00 0.00 XXX 1.25 Hydrogel dsg>16<=48 sq inA6233 C 28.79 0.00 0.00 0.00 XXX 1.25 Hydrogel dressing >48 sq inA6234 C 9.80 0.00 0.00 0.00 XXX 1.25 Hydrocolld drg <=16 w/o bdrA6235 C 25.26 0.00 0.00 0.00 XXX 1.25 Hydrocolld drg >16<=48 w/o bA6236 C 40.86 0.00 0.00 0.00 XXX 1.25 Hydrocolld drg > 48 in w/o bA6237 C 11.88 0.00 0.00 0.00 XXX 1.25 Hydrocolld drg <=16 in w/bdrA6238 C 34.20 0.00 0.00 0.00 XXX 1.25 Hydrocolld drg >16<=48 w/bdrA6239 C 0.00 0.00 0.00 0.00 XXX 0.00 Hydrocolld drg > 48 in w/bdrA6240 C 18.39 0.00 0.00 0.00 XXX 1.25 Hydrocolld drg filler pasteA6241 C 3.82 0.00 0.00 0.00 XXX 1.25 Hydrocolloid drg filler dryA6242 C 9.11 0.00 0.00 0.00 XXX 1.25 Hydrogel drg <=16 in w/o bdrA6243 C 18.46 0.00 0.00 0.00 XXX 1.25 Hydrogel drg >16<=48 w/o bdrA6244 C 58.90 0.00 0.00 0.00 XXX 1.25 Hydrogel drg >48 in w/o bdrA6245 C 10.86 0.00 0.00 0.00 XXX 1.25 Hydrogel drg <= 16 in w/bdrA6246 C 14.87 0.00 0.00 0.00 XXX 1.25 Hydrogel drg >16<=48 in w/bA6247 C 35.68 0.00 0.00 0.00 XXX 1.25 Hydrogel drg > 48 sq in w/bA6248 C 24.36 0.00 0.00 0.00 XXX 1.25 Hydrogel drsg gel fillerA6250 C 0.00 0.00 0.00 0.00 XXX 0.00 Skin seal protect moisturizrA6251 C 2.99 0.00 0.00 0.00 XXX 1.25 Absorpt drg <=16 sq in w/o bA6252 C 5.09 0.00 0.00 0.00 XXX 1.25 Absorpt drg >16 <=48 w/o bdrA6253 C 9.99 0.00 0.00 0.00 XXX 1.25 Absorpt drg > 48 sq in w/o bA6254 C 1.84 0.00 0.00 0.00 XXX 1.25 Absorpt drg <=16 sq in w/bdrA6255 C 4.52 0.00 0.00 0.00 XXX 1.25 Absorpt drg >16<=48 in w/bdrA6256 C 0.00 0.00 0.00 0.00 XXX 0.00 Absorpt drg > 48 sq in w/bdrA6257 C 2.31 0.00 0.00 0.00 XXX 1.25 Transparent film <= 16 sq inA6258 C 6.44 0.00 0.00 0.00 XXX 1.25 Transparent film >16<=48 inA6259 C 16.40 0.00 0.00 0.00 XXX 1.25 Transparent film > 48 sq inA6260 C 0.00 0.00 0.00 0.00 XXX 0.00 Wound cleanser any type/sizeA6261 C 0.00 0.00 0.00 0.00 XXX 0.00 Wound filler gel/paste /ozA6262 C 0.00 0.00 0.00 0.00 XXX 0.00 Wound filler dry form / gramA6266 C 2.89 0.00 0.00 0.00 XXX 1.25 Impreg gauze no h20/sal/yardA6402 C 0.19 0.00 0.00 0.00 XXX 1.25 Sterile gauze <= 16 sq inA6403 C 0.64 0.00 0.00 0.00 XXX 1.25 Sterile gauze>16 <= 48 sq inA6404 C 0.00 0.00 0.00 0.00 XXX 0.00 Sterile gauze > 48 sq inA6407 C 2.81 0.00 0.00 0.00 XXX 1.25 Packing stripsA6410 C 0.60 0.00 0.00 0.00 XXX 1.25 Sterile eye padA6411 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-sterile eye padA6412 C 0.00 0.00 0.00 0.00 XXX 0.00 Occlusive eye patchA6441 C 1.00 0.00 0.00 0.00 XXX 1.25 Pad band 3"<= w <=5", /ydA6442 C 0.31 0.00 0.00 0.00 XXX 1.25 Conform band n/s w<3"/ydA6443 C 0.43 0.00 0.00 0.00 XXX 1.25 Conform band n/s 3" <= w <= 5", /yd
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A6444 C 0.86 0.00 0.00 0.00 XXX 1.25 Conform band n/s w>=5", /ydA6445 C 0.46 0.00 0.00 0.00 XXX 1.25 Conform band s w <3", /ydA6446 C 0.63 0.00 0.00 0.00 XXX 1.25 Conform band s 3" <= w <=5", /ydA6447 C 1.00 0.00 0.00 0.00 XXX 1.25 Conform band s w >=5", /ydA6448 C 1.76 0.00 0.00 0.00 XXX 1.25 Lt compres band <3", /ydA6449 C 2.61 0.00 0.00 0.00 XXX 1.25 Lt compres band 3" <= w <= 5", /ydA6450 C 0.00 0.00 0.00 0.00 XXX 0.00 Lt compres band >=5", /ydA6451 C 0.00 0.00 0.00 0.00 XXX 0.00 Mod compres band 3" <= w <= 5", /ydA6452 C 8.87 0.00 0.00 0.00 XXX 1.25 High compres band 3" <= w <= 5", /ydA6453 C 0.91 0.00 0.00 0.00 XXX 1.25 Self-adher band w <3"/ydA6454 C 1.12 0.00 0.00 0.00 XXX 1.25 Self-adher band 3" <= w <= 5", /ydA6455 C 2.05 0.00 0.00 0.00 XXX 1.25 Self-adher band >=5", /ydA6456 C 1.92 0.00 0.00 0.00 XXX 1.25 Zinc paste band 3" <= w <= 5", /ydA6457 C 1.74 0.00 0.00 0.00 XXX 1.25 Tubular dressingA6501 C 0.00 0.00 0.00 0.00 XXX 0.00 Compres burngarment bodysuitA6502 C 0.00 0.00 0.00 0.00 XXX 0.00 Compres burngarment chinstrpA6503 C 0.00 0.00 0.00 0.00 XXX 0.00 Compres burngarment facehoodA6504 C 0.00 0.00 0.00 0.00 XXX 0.00 Cmprsburngarment glove-wristA6505 C 0.00 0.00 0.00 0.00 XXX 0.00 Cmprsburngarment glove-elbowA6506 C 0.00 0.00 0.00 0.00 XXX 0.00 Cmprsburngrmnt glove-axillaA6507 C 0.00 0.00 0.00 0.00 XXX 0.00 Cmprs burngarment foot-kneeA6508 C 0.00 0.00 0.00 0.00 XXX 0.00 Cmprs burngarment foot-thighA6509 C 0.00 0.00 0.00 0.00 XXX 0.00 Compres burn garment jacketA6510 C 0.00 0.00 0.00 0.00 XXX 0.00 Compres burn garment leotardA6511 C 0.00 0.00 0.00 0.00 XXX 0.00 Compres burn garment pantyA6512 C 0.00 0.00 0.00 0.00 XXX 0.00 Compres burn garment, nocA6513 C 0.00 0.00 0.00 0.00 XXX 0.00 Compress burn mask face/neckA6530 C 0.00 0.00 0.00 0.00 XXX 0.00 Compression stocking BK18-30A6531 C 64.89 0.00 0.00 0.00 XXX 1.25 Compression stocking BK30-40A6532 C 91.46 0.00 0.00 0.00 XXX 1.25 Compression stocking BK40-50A6533 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking thighlngth 18-30A6534 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking thighlngth 30-40A6535 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking thighlngth 40-50A6536 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking full lngth 18-30A6537 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking full lngth 30-40A6538 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking full lngth 40-50A6539 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking waistlngth 18-30A6540 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking waistlngth 30-40A6541 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking waistlngth 40-50A6542 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking custom madeA6543 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking lymphedemaA6544 C 0.00 0.00 0.00 0.00 XXX 0.00 Gc stocking garter beltA6549 C 0.00 0.00 0.00 0.00 XXX 0.00 G compression stockingA6550 C 41.13 0.00 0.00 0.00 XXX 1.25 Neg pres wound ther drsg setA6551 C 36.78 0.00 0.00 0.00 XXX 1.25 12/31/2005 Neg press wound ther canistrA7000 C 13.62 0.00 0.00 0.00 XXX 1.25 Disposable canister for pumpA7000 C NU 13.62 0.00 0.00 0.00 XXX 1.25 Disposable canister for pumpA7001 C 41.75 0.00 0.00 0.00 XXX 1.25 Nondisposable pump canisterA7001 C NU 41.75 0.00 0.00 0.00 XXX 1.25 Nondisposable pump canisterA7002 C 4.79 0.00 0.00 0.00 XXX 1.25 Tubing used w suction pumpA7002 C NU 4.79 0.00 0.00 0.00 XXX 1.25 Tubing used w suction pumpA7003 C 3.87 0.00 0.00 0.00 XXX 1.25 Nebulizer administration setA7003 C NU 3.87 0.00 0.00 0.00 XXX 1.25 Nebulizer administration setA7004 C 2.25 0.00 0.00 0.00 XXX 1.25 Disposable nebulizer sml vol
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A7004 C NU 2.25 0.00 0.00 0.00 XXX 1.25 Disposable nebulizer sml volA7005 C 38.54 0.00 0.00 0.00 XXX 1.25 Nondisposable nebulizer setA7005 C NU 38.54 0.00 0.00 0.00 XXX 1.25 Nondisposable nebulizer setA7006 C 17.50 0.00 0.00 0.00 XXX 1.25 Filtered nebulizer admin setA7006 C NU 17.50 0.00 0.00 0.00 XXX 1.25 Filtered nebulizer admin setA7007 C 6.46 0.00 0.00 0.00 XXX 1.25 Lg vol nebulizer disposableA7007 C NU 6.46 0.00 0.00 0.00 XXX 1.25 Lg vol nebulizer disposableA7008 C 15.86 0.00 0.00 0.00 XXX 1.25 Disposable nebulizer prefillA7008 C NU 15.86 0.00 0.00 0.00 XXX 1.25 Disposable nebulizer prefillA7009 C 58.58 0.00 0.00 0.00 XXX 1.25 Nebulizer reservoir bottleA7009 C NU 58.58 0.00 0.00 0.00 XXX 1.25 Nebulizer reservoir bottleA7010 C 29.49 0.00 0.00 0.00 XXX 1.25 Disposable corrugated tubingA7010 C NU 29.49 0.00 0.00 0.00 XXX 1.25 Disposable corrugated tubingA7011 C 0.00 0.00 0.00 0.00 XXX 0.00 Nondispos corrugated tubingA7012 C 5.41 0.00 0.00 0.00 XXX 1.25 Nebulizer water collec devicA7012 C NU 5.41 0.00 0.00 0.00 XXX 1.25 Nebulizer water collec devicA7013 C 1.04 0.00 0.00 0.00 XXX 1.25 Disposable compressor filterA7013 C NU 1.04 0.00 0.00 0.00 XXX 1.25 Disposable compressor filterA7014 C 6.49 0.00 0.00 0.00 XXX 1.25 Compressor nondispos filterA7014 C NU 6.49 0.00 0.00 0.00 XXX 1.25 Compressor nondispos filterA7015 C 2.86 0.00 0.00 0.00 XXX 1.25 Aerosol mask used w nebulizeA7015 C NU 2.86 0.00 0.00 0.00 XXX 1.25 Aerosol mask used w nebulizeA7016 C 15.58 0.00 0.00 0.00 XXX 1.25 Nebulizer dome & mouthpieceA7016 C NU 15.58 0.00 0.00 0.00 XXX 1.25 Nebulizer dome & mouthpieceA7017 C 201.06 0.00 0.00 0.00 XXX 1.25 Nebulizer not used w oxygenA7017 C NU 201.06 0.00 0.00 0.00 XXX 1.25 Nebulizer not used w oxygenA7017 C RR 20.11 0.00 0.00 0.00 XXX 1.25 Nebulizer not used w oxygenA7017 C UE 150.76 0.00 0.00 0.00 XXX 1.25 Nebulizer not used w oxygenA7018 C 0.64 0.00 0.00 0.00 XXX 1.25 Water distilled w/nebulizerA7025 C 652.43 0.00 0.00 0.00 XXX 1.25 Replace chest compress vestA7025 C NU 652.43 0.00 0.00 0.00 XXX 1.25 Replace chest compress vestA7026 C 43.11 0.00 0.00 0.00 XXX 1.25 Replace chst cmprss sys hoseA7026 C NU 43.11 0.00 0.00 0.00 XXX 1.25 Replace chst cmprss sys hoseA7030 C 282.96 0.00 0.00 0.00 XXX 1.25 CPAP full face maskA7030 C NU 282.96 0.00 0.00 0.00 XXX 1.25 CPAP full face maskA7031 C 104.62 0.00 0.00 0.00 XXX 1.25 Replacement facemask interfaA7031 C NU 104.62 0.00 0.00 0.00 XXX 1.25 Replacement facemask interfaA7032 C 60.80 0.00 0.00 0.00 XXX 1.25 Replacement nasal cushionA7032 C NU 60.80 0.00 0.00 0.00 XXX 1.25 Replacement nasal cushionA7033 C 42.60 0.00 0.00 0.00 XXX 1.25 Replacement nasal pillowsA7033 C NU 42.60 0.00 0.00 0.00 XXX 1.25 Replacement nasal pillowsA7034 C 176.47 0.00 0.00 0.00 XXX 1.25 Nasal application deviceA7034 C NU 176.47 0.00 0.00 0.00 XXX 1.25 Nasal application deviceA7035 C 52.04 0.00 0.00 0.00 XXX 1.25 Pos airway press headgearA7035 C NU 52.04 0.00 0.00 0.00 XXX 1.25 Pos airway press headgearA7036 C 22.75 0.00 0.00 0.00 XXX 1.25 Pos airway press chinstrapA7036 C NU 22.75 0.00 0.00 0.00 XXX 1.25 Pos airway press chinstrapA7037 C 57.50 0.00 0.00 0.00 XXX 1.25 Pos airway pressure tubingA7037 C NU 57.50 0.00 0.00 0.00 XXX 1.25 Pos airway pressure tubingA7038 C 7.71 0.00 0.00 0.00 XXX 1.25 Pos airway pressure filterA7038 C NU 7.71 0.00 0.00 0.00 XXX 1.25 Pos airway pressure filterA7039 C 19.16 0.00 0.00 0.00 XXX 1.25 Filter, non disposable w papA7039 C NU 19.16 0.00 0.00 0.00 XXX 1.25 FilterA7040 C 47.82 0.00 0.00 0.00 XXX 1.25 One way chest drain valve
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A7041 C 89.85 0.00 0.00 0.00 XXX 1.25 Water seal drain containerA7042 C 236.94 0.00 0.00 0.00 XXX 1.25 Implanted pleural catheterA7043 C 36.52 0.00 0.00 0.00 XXX 1.25 Vacuum drainagebottle/tubingA7044 C 181.35 0.00 0.00 0.00 XXX 1.25 PAP oral interfaceA7044 C NU 181.35 0.00 0.00 0.00 XXX 1.25 PAP oral interfaceA7045 C 2.92 0.00 0.00 0.00 XXX 1.25 Repl exhalation port for PAPA7045 C NU 29.20 0.00 0.00 0.00 XXX 1.25 Repl exhalation port for PAPA7045 C RR 2.92 0.00 0.00 0.00 XXX 1.25 Repl exhalation port for PAPA7045 C UE 21.93 0.00 0.00 0.00 XXX 1.25 Repl exhalation port for PAPA7046 C 29.24 0.00 0.00 0.00 XXX 1.25 Repl water chamber, PAP devA7046 C NU 29.24 0.00 0.00 0.00 XXX 1.25 Repl water chamberA7501 C 157.55 0.00 0.00 0.00 XXX 1.25 Tracheostoma valve w diaphraA7502 C 74.88 0.00 0.00 0.00 XXX 1.25 Replacement diaphragm/fplateA7503 C 17.02 0.00 0.00 0.00 XXX 1.25 HMES filter holder or capA7504 C 0.99 0.00 0.00 0.00 XXX 1.25 Tracheostoma HMES filterA7505 C 7.01 0.00 0.00 0.00 XXX 1.25 HMES or trach valve housingA7506 C 0.47 0.00 0.00 0.00 XXX 1.25 HMES/trachvalve adhesivediskA7507 C 3.79 0.00 0.00 0.00 XXX 1.25 Integrated filter & holderA7508 C 4.33 0.00 0.00 0.00 XXX 1.25 Housing & Integrated AdhesivA7509 C 2.09 0.00 0.00 0.00 XXX 1.25 Heat & moisture exchange sysA7520 C 71.21 0.00 0.00 0.00 XXX 1.25 Trach/laryn tube non-cuffedA7521 C 70.60 0.00 0.00 0.00 XXX 1.25 Trach/laryn tube cuffedA7522 C 67.74 0.00 0.00 0.00 XXX 1.25 Trach/laryn tube stainlessA7523 C 0.00 0.00 0.00 0.00 XXX 0.00 Tracheostomy shower protectA7524 C 116.09 0.00 0.00 0.00 XXX 1.25 Tracheostoma stent/stud/bttnA7525 C 3.10 0.00 0.00 0.00 XXX 1.25 Tracheostomy maskA7526 C 5.01 0.00 0.00 0.00 XXX 1.25 Tracheostomy tube collarA7527 C 5.36 0.00 0.00 0.00 XXX 1.25 Trach/laryn tube plug/stopA9150 C 0.00 0.00 0.00 0.00 XXX 0.00 Misc/exper non-prescript druA9152 C 0.00 0.00 0.00 0.00 XXX 0.00 Single vitamin nosA9153 C 0.00 0.00 0.00 0.00 XXX 0.00 Multi-vitamin nosA9180 C 0.00 0.00 0.00 0.00 XXX 0.00 Lice treatment, topicalA9270 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-covered item or serviceA9275 C 0.00 0.00 0.00 0.00 XXX 0.00 Disp home glucose monitorA9280 C 0.00 0.00 0.00 0.00 XXX 0.00 Alert device, nocA9281 C 0.00 0.00 0.00 0.00 XXX 0.00 Reaching/grabbing deviceA9282 C 0.00 0.00 0.00 0.00 XXX 0.00 Wig any typeA9300 C 0.00 0.00 0.00 0.00 XXX 0.00 Exercise equipmentA9500 C 121.70 0.00 0.00 0.00 XXX 1.25 Technetium TC 99m sestamibi, per unitA9502 C 125.69 0.00 0.00 0.00 XXX 1.25 Technetium TC99M tetrofosmin, per unitA9503 C 33.25 0.00 0.00 0.00 XXX 1.25 Technetium TC 99m medronate, up to 30mciA9504 C 475.00 0.00 0.00 0.00 XXX 1.25 Technetium tc 99m apcitideA9505 C 33.23 0.00 0.00 0.00 XXX 1.25 Thallous chloride TL 201/mciA9507 C 548.03 0.00 0.00 0.00 XXX 5.00 Indium/111 capromab pendetid, per doseA9508 C 495.65 0.00 0.00 0.00 XXX 1.25 Iobenguane sulfate I-131, 0.5mciA9510 C 95.10 0.00 0.00 0.00 XXX 1.25 Technetium TC99m Disofenin, per vialA9511 C 760.00 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium TC 99m depreotide, per vialA9512 C 0.00 0.00 0.00 0.00 XXX 0.00 Technetiumtc99mpertechnetateA9513 C 51.44 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium tc-99m mebrofeninA9514 C 25.54 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetiumtc99mpyrophosphateA9515 C 28.12 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium tc-99m pentetateA9516 C 65.03 0.00 0.00 0.00 XXX 1.25 I-123 sodium iodide capsule, eaA9517 C 164.81 0.00 0.00 0.00 XXX 1.25 I-131 sodium iodide capsule, eaA9519 C 20.52 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetiumtc-99mmacroag albu, 1mci
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A9520 C 76.00 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetiumtc-99m sulfur clldA9521 C 890.63 0.00 0.00 0.00 XXX 1.25 Technetiumtc-99m exametazineA9522 C 692.41 0.00 0.00 0.00 XXX 1.25 12/31/2005 Indium111ibritumomabtiuxetanA9523 C 922.19 0.00 0.00 0.00 XXX 32.50 12/31/2005 Yttrium90ibritumomabtiuxetanA9524 C 53.39 0.00 0.00 0.00 XXX 1.25 Iodinated I-131 serumalbumin, 5microcuriesA9525 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Low/iso-osmolar contrast matA9526 C 0.00 0.00 0.00 0.00 XXX 0.00 Ammonia N-13, per doseA9528 C 27.47 0.00 0.00 0.00 XXX 1.25 Dx I131 so iodide cap, 1millicurieA9529 C 0.00 0.00 0.00 0.00 XXX 0.00 Dx I131 so iodide sol millicA9530 C 0.00 0.00 0.00 0.00 XXX 0.00 Th I131 so iodide sol millicA9531 C 0.00 0.00 0.00 0.00 XXX 0.00 Dx I131 so iodide microcurieA9532 C 0.00 0.00 0.00 0.00 XXX 0.00 I-125 serum albumin microA9533 C 341.25 0.00 0.00 0.00 XXX 5.00 12/31/2005 I-131 tositumomab diagnosticA9534 C 926.25 0.00 0.00 0.00 XXX 30.00 12/31/2005 I-131 tositumomab therapeutA9535 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, methylene blueA9536 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m depreotideA9537 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m mebrofeninA9538 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m pyrophosphateA9539 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m pentetateA9540 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m MAAA9541 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m sulfur colloidA9542 C 0.00 0.00 0.00 0.00 XXX 0.00 In111 ibritumomab, dxA9543 C 0.00 0.00 0.00 0.00 XXX 0.00 Y90 ibritumomab, rxA9544 C 0.00 0.00 0.00 0.00 XXX 0.00 I131 tositumomab, dxA9545 C 0.00 0.00 0.00 0.00 XXX 0.00 I131 tositumomab, rxA9546 C 0.00 0.00 0.00 0.00 XXX 0.00 Co57/58A9547 C 0.00 0.00 0.00 0.00 XXX 0.00 In111 oxyquinolineA9548 C 0.00 0.00 0.00 0.00 XXX 0.00 In111 pentetateA9549 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m arcitumomabA9550 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m gluceptateA9551 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m succimerA9552 C 0.00 0.00 0.00 0.00 XXX 0.00 F18 fdgA9553 C 0.00 0.00 0.00 0.00 XXX 0.00 Cr51 chromateA9554 C 0.00 0.00 0.00 0.00 XXX 0.00 I125 iothalamate, dxA9555 C 0.00 0.00 0.00 0.00 XXX 0.00 Rb82 rubidiumA9556 C 0.00 0.00 0.00 0.00 XXX 0.00 Ga67 galliumA9557 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m bicisateA9558 C 0.00 0.00 0.00 0.00 XXX 0.00 Xe133 xenon 10mciA9559 C 0.00 0.00 0.00 0.00 XXX 0.00 Co57 cyanoA9560 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m labeled rbcA9561 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m oxidronateA9562 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m mertiatideA9563 C 0.00 0.00 0.00 0.00 XXX 0.00 P32 Na phosphateA9564 C 0.00 0.00 0.00 0.00 XXX 0.00 P32 chromic phosphateA9565 C 0.00 0.00 0.00 0.00 XXX 0.00 In111 pentetreotideA9566 C 0.00 0.00 0.00 0.00 XXX 0.00 Tc99m fanolesomabA9567 C 0.00 0.00 0.00 0.00 XXX 0.00 Technetium TC-99m aerosolA9600 C 963.42 0.00 0.00 0.00 XXX 1.25 Strontium-89 chloride, 1mciA9605 C 510.00 0.00 0.00 0.00 XXX 2.50 Samarium sm153 lexidronamm, 50mciA9698 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-rad contrast materialNOCA9699 C 0.00 0.00 0.00 0.00 XXX 0.00 Noc therapeutic radiopharmA9700 C 153.90 0.00 0.00 0.00 XXX 1.25 Echocardiography Contrast, per studyA9900 C 0.00 0.00 0.00 0.00 XXX 0.00 Supply/accessory/serviceA9901 C 0.00 0.00 0.00 0.00 XXX 0.00 Delivery/set up/dispensing
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
A9999 S 0.00 0.00 0.00 0.00 XXX 0.00 DME supply or accessory, nosASSTR C 0.00 0.00 0.00 0.00 XXX 0.00 Assisted ReemploymentATP02 C 0.00 10.10 10.10 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 1-2 TestsATP03 C 0.00 12.88 12.88 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 3 TestsATP04 C 0.00 13.58 13.58 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 4 TestsATP05 C 0.00 15.15 15.15 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 5 TestsATP06 C 0.00 15.19 15.19 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 6 TestsATP07 C 0.00 15.83 15.83 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 7 TestsATP08 C 0.00 16.40 16.40 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 8 TestsATP09 C 0.00 16.82 16.82 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 9 TestsATP10 C 0.00 16.82 16.82 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 10 TestsATP11 C 0.00 17.11 17.11 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 11 TestsATP12 C 0.00 17.49 17.49 0.00 XXX 1.73 12/31/2005 Auto.Test Pane Pricing Code, 12 TestsATP16 C 0.00 20.48 20.48 0.00 XXX 1.73 12/31/2005 Auto Test Panel Pricing Code 13-16 TestATP18 C 0.00 20.62 20.62 0.00 XXX 1.73 12/31/2005 Auto Test Panel Pricing Code, 17-18 TestATP19 C 0.00 21.42 21.42 0.00 XXX 1.73 12/31/2005 Auto Test Panel Pricing Code, 19 TestsATP20 C 0.00 22.11 22.11 0.00 XXX 1.73 12/31/2005 Auto Test Panel Pricing Code, 20 TestsATP21 C 0.00 22.81 22.81 0.00 XXX 1.73 12/31/2005 Auto Test Panel Pricing Code, 21 TestsATP22 C 0.00 23.51 23.51 0.00 XXX 1.73 12/31/2005 Auto.Test Panel Pricing Code, 22+ TestsATTMD C 3.87 1.83 1.83 0.13 XXX 50.58 Attending physician medical report requestB4034 C 7.46 0.00 0.00 0.00 XXX 1.25 Enter feed supkit syr by dayB4035 C 14.58 0.00 0.00 0.00 XXX 1.25 Enteral feed supp pump per dB4036 C 10.00 0.00 0.00 0.00 XXX 1.25 Enteral feed sup kit grav byB4081 C 27.03 0.00 0.00 0.00 XXX 1.25 Enteral ng tubing w/ styletB4082 C 20.11 0.00 0.00 0.00 XXX 1.25 Enteral ng tubing w/o styletB4083 C 3.08 0.00 0.00 0.00 XXX 1.25 Enteral stomach tube levineB4086 C 44.61 0.00 0.00 0.00 XXX 1.25 Gastrostomy/jejunostomy tube, eachB4100 C 0.00 0.00 0.00 0.00 XXX 0.00 Food thickener oralB4102 C 0.00 0.00 0.00 0.00 XXX 0.00 EF adult fluids and electroB4103 D 0.00 0.00 0.00 0.00 XXX 0.00 EF ped fluids and electroB4104 C 0.00 0.00 0.00 0.00 XXX 0.00 Additive for enteral formula (fiber)B4149 C 1.96 0.00 0.00 0.00 XXX 1.25 EF blenderized foodsB4150 C 0.84 0.00 0.00 0.00 XXX 1.25 Enteral formulae category iB4152 C 0.70 0.00 0.00 0.00 XXX 1.25 Enteral formulae category iiB4153 C 2.39 0.00 0.00 0.00 XXX 1.25 Enteral formulae category iiB4154 C 1.53 0.00 0.00 0.00 XXX 1.25 Enteral formulae category ivB4155 C 1.19 0.00 0.00 0.00 XXX 1.25 Enteral formulae category vB4157 C 0.00 0.00 0.00 0.00 XXX 0.00 EF special metabolic inheritB4158 D 0.00 0.00 0.00 0.00 XXX 0.00 EF, pediatricsB4159 D 0.00 0.00 0.00 0.00 XXX 0.00 EF, pediatrics, soy basedB4160 D 0.00 0.00 0.00 0.00 XXX 0.00 EF, pediatricsB4161 D 0.00 0.00 0.00 0.00 XXX 0.00 EF, pediatricsB4162 D 0.00 0.00 0.00 0.00 XXX 0.00 EF, pediatricsB4164 C 20.60 0.00 0.00 0.00 XXX 1.25 Parenteral 50% dextrose soluB4168 C 30.01 0.00 0.00 0.00 XXX 1.25 Parenteral sol amino acid 3.B4172 C 0.00 0.00 0.00 0.00 XXX 0.00 Parenteral sol amino acid 5.B4176 C 58.08 0.00 0.00 0.00 XXX 1.25 Parenteral sol amino acid 7-B4178 C 69.73 0.00 0.00 0.00 XXX 1.25 Parenteral sol amino acid >B4180 C 29.54 0.00 0.00 0.00 XXX 1.25 Parenteral sol carb > 50%B4184 C 94.44 0.00 0.00 0.00 XXX 1.25 12/31/2005 Parenteral sol lipids 10%B4185 C 0.00 0.00 0.00 0.00 XXX 0.00 Parenteral sol 10 gm lipidsB4186 C 125.94 0.00 0.00 0.00 XXX 1.25 12/31/2005 Parenteral sol lipids 20%B4189 C 215.39 0.00 0.00 0.00 XXX 1.25 Parenteral sol amino acid &B4193 C 278.34 0.00 0.00 0.00 XXX 1.25 Parenteral sol 52-73 gm prot
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
B4197 C 338.85 0.00 0.00 0.00 XXX 1.25 Parenteral sol 74-100 gm proB4199 C 387.21 0.00 0.00 0.00 XXX 1.25 Parenteral sol > 100gm proteB4216 C 9.36 0.00 0.00 0.00 XXX 1.25 Parenteral nutrition additivB4220 C 9.70 0.00 0.00 0.00 XXX 1.25 Parenteral supply kit premixB4222 C 11.96 0.00 0.00 0.00 XXX 1.25 Parenteral supply kit homemiB4224 C 30.31 0.00 0.00 0.00 XXX 1.25 Parenteral administration kiB5000 C 14.40 0.00 0.00 0.00 XXX 1.25 Parenteral sol renal-amirosyB5100 C 5.64 0.00 0.00 0.00 XXX 1.25 Parenteral sol hepatic-freamB5200 C 0.00 0.00 0.00 0.00 XXX 0.00 Parenteral sol stres-brnch cB9000 C 140.85 0.00 0.00 0.00 XXX 1.25 Enter infusion pump w/o alrmB9000 C NU 766.42 0.00 0.00 0.00 XXX 2.50 Enter infusion pump w/o alrmB9000 C RR 140.85 0.00 0.00 0.00 XXX 1.25 Enter infusion pump w/o alrmB9000 C UE 574.81 0.00 0.00 0.00 XXX 2.50 Enter infusion pump w/o alrmB9002 C 148.46 0.00 0.00 0.00 XXX 1.25 Enteral infusion pump w/ alaB9002 C NU 766.42 0.00 0.00 0.00 XXX 2.50 Enteral infusion pump w/ alaB9002 C RR 148.46 0.00 0.00 0.00 XXX 1.25 Enteral infusion pump w/ alaB9002 C UE 574.81 0.00 0.00 0.00 XXX 2.50 Enteral infusion pump w/ alaB9004 C 484.04 0.00 0.00 0.00 XXX 1.25 Parenteral infus pump portabB9004 C NU 764.39 0.00 0.00 0.00 XXX 5.00 Parenteral infus pump portabB9004 C RR 484.04 0.00 0.00 0.00 XXX 1.25 Parenteral infus pump portabB9004 C UE 573.29 0.00 0.00 0.00 XXX 5.00 Parenteral infus pump portabB9006 C 484.04 0.00 0.00 0.00 XXX 1.25 Parenteral infus pump statioB9006 C NU 764.39 0.00 0.00 0.00 XXX 5.00 Parenteral infus pump statioB9006 C RR 484.04 0.00 0.00 0.00 XXX 1.25 Parenteral infus pump statioB9006 C UE 573.29 0.00 0.00 0.00 XXX 5.00 Parenteral infus pump statioB9998 S 0.00 0.00 0.00 0.00 XXX 0.00 Enteral supply, n.o.c.B9999 S 0.00 0.00 0.00 0.00 XXX 0.00 Parenteral supply, n.o.c.C1079 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 CO 57/58 0.5 MciC1080 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 I-131 tositumomab, dxC1081 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 I-131 tositumomab, txC1082 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 In-111 ibritumomab tiuxetanC1083 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Yttrium 90 ibritumomab tiuxeC1091 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 INI111 OXYQUINOLINE,PER 5mciC1092 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 IN 111 PENETATE, PER 1.5 mciC1093 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 TC99M fanolesomab, per dose (10-20 mci)C1122 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Tc 99M ARCITUMOMAB PER VIALC1178 D 0.00 0.00 0.00 0.00 XXX 0.00 BUSULFAN IV, 6 MgC1200 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 TC 99M Sodium GlucoheptonatC1201 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 TC 99M SUCCIMER, PER VialC1300 D 0.00 0.00 0.00 0.00 XXX 0.00 HYPERBARIC OxygenC1305 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Apligraf, Grafskin, per 44 cmC1713 D 0.00 0.00 0.00 0.00 XXX 0.00 Anchor screw, implantableC1714 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, transluminal atherectomy, direct'lC1715 D 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy needleC1716 C 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy seed, gold 198C1717 D 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy seed, hi dose iridium 192C1718 C 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy seed, iodine 125C1719 C 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy seed, non-hi dose iridium 192C1720 C 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy seed, palladium 103C1721 D 0.00 0.00 0.00 0.00 XXX 0.00 Cardioverter-defrib, dual chamber, implantC1722 D 0.00 0.00 0.00 0.00 XXX 0.00 Cardioverter-defrib, single chamber, implantC1724 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, transluminal atherectomy, rotat'lC1725 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, transluminal angioplasty, non-laserC1726 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, balloon dilatation, non-vascular
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
C1727 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, balloon tissue dissector, non-vascC1728 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, brachytherapy seed adminC1729 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, drainageC1730 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, electrophysiology, diag, < 20 electC1731 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, electrophysiology, diag, > 19 electC1732 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, electrophysiology, diag/ablation, 3D mapC1733 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, electrophysiology, diag/ablationC1750 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, hemodialysis, long-termC1751 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, infusionC1752 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, hemodialysis, short-termC1753 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, intravascular ultrasoundC1754 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, intradiscalC1755 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, intraspinalC1756 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, pacing, tranesophagealC1757 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, thrombectomy/embolectomyC1758 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, ureteralC1759 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, intracardiac echocardiographyC1760 D 0.00 0.00 0.00 0.00 XXX 0.00 Closure device, vascularC1762 D 0.00 0.00 0.00 0.00 XXX 0.00 Connective tissue, humanC1763 D 0.00 0.00 0.00 0.00 XXX 0.00 Connective tissue, non-humanC1764 D 0.00 0.00 0.00 0.00 XXX 0.00 Event recorder, cardiac, implantableC1765 D 0.00 0.00 0.00 0.00 XXX 0.00 Adhesion barrierC1766 D 0.00 0.00 0.00 0.00 XXX 0.00 Intro cheath, guiding, intracardiacC1767 D 0.00 0.00 0.00 0.00 XXX 0.00 Generator, neurostimulatorC1768 D 0.00 0.00 0.00 0.00 XXX 0.00 Graft, vascularC1769 D 0.00 0.00 0.00 0.00 XXX 0.00 Guide wireC1770 D 0.00 0.00 0.00 0.00 XXX 0.00 Imaging coil, m.r.C1771 D 0.00 0.00 0.00 0.00 XXX 0.00 Repair device, urinary, incont.C1772 D 0.00 0.00 0.00 0.00 XXX 0.00 Infusion pump, programmableC1773 D 0.00 0.00 0.00 0.00 XXX 0.00 Retrieval device, insertableC1775 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 FDG, per dose (4-40 mCi/ml)C1776 D 0.00 0.00 0.00 0.00 XXX 0.00 Joint deviceC1777 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, cardioverter-defibrillatorC1778 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, neurostimulatorC1779 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, pacemaker, transvenous VDDC1780 D 0.00 0.00 0.00 0.00 XXX 0.00 Lens, intraocularC1781 D 0.00 0.00 0.00 0.00 XXX 0.00 Mesh, implantableC1782 D 0.00 0.00 0.00 0.00 XXX 0.00 MorcellatorC1783 D 0.00 0.00 0.00 0.00 XXX 0.00 Ocular imp, aqueous drain deC1784 D 0.00 0.00 0.00 0.00 XXX 0.00 Ocular device, intraoperative, detach retinaC1785 D 0.00 0.00 0.00 0.00 XXX 0.00 Pacemaker, dual chamber, rate responsC1786 D 0.00 0.00 0.00 0.00 XXX 0.00 Pacemaker, single chamber, rate responsC1787 D 0.00 0.00 0.00 0.00 XXX 0.00 Patient programmer, neurostimulatorC1788 D 0.00 0.00 0.00 0.00 XXX 0.00 Port, indwellingC1789 D 0.00 0.00 0.00 0.00 XXX 0.00 Prosthesis, breast, implantableC1813 D 0.00 0.00 0.00 0.00 XXX 0.00 Prosthesis, penile, inflatableC1814 D 0.00 0.00 0.00 0.00 XXX 0.00 Retinal temponade device, silicone oilC1815 D 0.00 0.00 0.00 0.00 XXX 0.00 Prosthesis, urinary sphincterC1816 D 0.00 0.00 0.00 0.00 XXX 0.00 Receiver/transmitter, neurostimulatorC1817 D 0.00 0.00 0.00 0.00 XXX 0.00 Septal defect implant system, intracardiacC1818 D 0.00 0.00 0.00 0.00 XXX 0.00 Integrated keratoprosthesisC1819 C 0.00 0.00 0.00 0.00 XXX 0.00 Tissue localization-excision deviceC1874 D 0.00 0.00 0.00 0.00 XXX 0.00 Stent, coated/covered, w/deliv sysC1875 D 0.00 0.00 0.00 0.00 XXX 0.00 Stent, coated/covered, w/out deliv sys
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
C1876 D 0.00 0.00 0.00 0.00 XXX 0.00 Stent, non-coat/cov, w/deliv sysC1877 D 0.00 0.00 0.00 0.00 XXX 0.00 Stent, non-coat/cov, w/out deliv sysC1878 D 0.00 0.00 0.00 0.00 XXX 0.00 Material for vocal cord medializ, synthC1879 D 0.00 0.00 0.00 0.00 XXX 0.00 Tissue marker, implantableC1880 D 0.00 0.00 0.00 0.00 XXX 0.00 Vena cava filterC1881 D 0.00 0.00 0.00 0.00 XXX 0.00 Dialysis access systemC1882 D 0.00 0.00 0.00 0.00 XXX 0.00 Cardioverter-defrib, not single/dual chamberC1883 D 0.00 0.00 0.00 0.00 XXX 0.00 Adaptor/extension, pacing leadC1884 D 0.00 0.00 0.00 0.00 XXX 0.00 Embolization protective systemC1885 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, transluminal angioplasty, laserC1887 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, guidingC1888 D 0.00 0.00 0.00 0.00 XXX 0.00 Endovas non-cardiac abl cathC1891 D 0.00 0.00 0.00 0.00 XXX 0.00 Infusion pump, non-program, permanentC1892 D 0.00 0.00 0.00 0.00 XXX 0.00 Introducer/sheath, guiding, intracardiac elecC1893 D 0.00 0.00 0.00 0.00 XXX 0.00 Introducer/sheath, guiding, intracardiac elecC1894 D 0.00 0.00 0.00 0.00 XXX 0.00 Introducer/sheath, not guiding, intracardiac elecC1895 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, cardiovert-defibr, endocard dual coilC1896 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, cardiovert-defibr, not endocard dual coilC1897 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, neurostimulator test kitC1898 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, pacemaker, not transvenous VDDC1899 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, pacemaker/cardiovert-defibr combiC1900 D 0.00 0.00 0.00 0.00 XXX 0.00 Lead, coronary venousC2614 D 0.00 0.00 0.00 0.00 XXX 0.00 Probe, perc lumb discC2615 D 0.00 0.00 0.00 0.00 XXX 0.00 Sealant, pulmonary, liquidC2616 C 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy seed, Yttrium-90C2617 D 0.00 0.00 0.00 0.00 XXX 0.00 Stent, non-coronary, temp, w/out deliv sysC2618 D 0.00 0.00 0.00 0.00 XXX 0.00 Probe, cryoablationC2619 D 0.00 0.00 0.00 0.00 XXX 0.00 Pacemaker, dual chamber, non rate-respC2620 D 0.00 0.00 0.00 0.00 XXX 0.00 Pacemaker, single chamber, non rate-respC2621 D 0.00 0.00 0.00 0.00 XXX 0.00 Pacemaker, not single/dual chamberC2622 D 0.00 0.00 0.00 0.00 XXX 0.00 Prosthesis, penile, non-inflatableC2625 D 0.00 0.00 0.00 0.00 XXX 0.00 Stent, non-coronary, temp, w/deliv sysC2626 D 0.00 0.00 0.00 0.00 XXX 0.00 Infusion pump, non-program, tempC2627 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, suprapubic/cystoscopicC2628 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, occlusionC2629 D 0.00 0.00 0.00 0.00 XXX 0.00 Introducer/sheath, not guiding, intracardiac elecC2630 D 0.00 0.00 0.00 0.00 XXX 0.00 Catheter, elect, diag/ablation not 3D mapC2631 D 0.00 0.00 0.00 0.00 XXX 0.00 Repair device, urinary, incontC2632 D 0.00 0.00 0.00 0.00 XXX 0.00 Brachytx sol, I-125, per mCiC2633 C 0.00 0.00 0.00 0.00 XXX 0.00 Brachytx source, Cesium-131C2634 D 0.00 0.00 0.00 0.00 XXX 0.00 Brachytx source, HA, I-125C2635 D 0.00 0.00 0.00 0.00 XXX 0.00 Brachytx source, HA, P-103C2636 D 0.00 0.00 0.00 0.00 XXX 0.00 Brachytx linear source, P-103C2637 D 0.00 0.00 0.00 0.00 XXX 0.00 Brachytx, Ytterbium-169C8900 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/contrast, abdomenC8901 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out contrast, abdomenC8902 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out + w/contrast, abdomenC8903 D 0.00 0.00 0.00 0.00 XXX 0.00 MRI w/contrast, breast, unilC8904 D 0.00 0.00 0.00 0.00 XXX 0.00 MRI w/out contrast, breast, unilC8905 D 0.00 0.00 0.00 0.00 XXX 0.00 MRI w/out + w/contrast, breast, unilC8906 D 0.00 0.00 0.00 0.00 XXX 0.00 MRI w/contrast, breast, bilC8907 D 0.00 0.00 0.00 0.00 XXX 0.00 MRI w/out contrast, breast, bilC8908 D 0.00 0.00 0.00 0.00 XXX 0.00 MRI w/out + w/contrast, breast, bilC8909 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/contrast, chest
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
C8910 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out contrast, chestC8911 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out + w/contrast, chestC8912 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/contrast, lower extC8913 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out contrast, lower extC8914 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out + w/contrast, lower extC8918 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/ contrast, pelvisC8919 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out contrast, pelvisC8920 D 0.00 0.00 0.00 0.00 XXX 0.00 MRA w/out & w/contrast, pelvisC8950 C 0.00 0.00 0.00 0.00 XXX 0.00 IV inf, tx/dx, up to 1 hrC8951 C 0.00 0.00 0.00 0.00 XXX 0.00 IV inf, tx/dx, each addl hrC8952 C 0.00 0.00 0.00 0.00 XXX 0.00 Tx, prophy, dx IV pushC8953 C 0.00 0.00 0.00 0.00 XXX 0.00 Chemotx adm, IV pushC8954 C 0.00 0.00 0.00 0.00 XXX 0.00 Chemotx adm, IV inf up to 1hrC8955 C 0.00 0.00 0.00 0.00 XXX 0.00 Chemotx adm, IV inf, addl hrC8957 C 0.00 0.00 0.00 0.00 XXX 0.00 Prolonged IV inf, req pumpC9000 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Na chromateCr51, per 0.25mCiC9003 D 0.00 0.00 0.00 0.00 XXX 0.00 Palivizumab, per 50 mgC9007 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Baclofen Intrathecal kit-1amC9008 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Baclofen Refill Kit-500mcgC9009 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Baclofen Refill Kit-2000mcgC9013 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 CO 57 cobaltous chloride, imag agentC9102 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 51 Na Chromate, 50mCiC9103 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Na Iothalamate I-125, 10 uCiC9105 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Hep B imm glob, per 1 mlC9112 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, Perflutren lipid microsphere, per 2 ml vialC9113 D 0.00 0.00 0.00 0.00 XXX 0.00 Injection, Pantoprazole sodium, per vialC9121 D 0.00 0.00 0.00 0.00 XXX 0.00 Injection, argatrobanC9123 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Transcyte, per 247 sq cmC9200 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Orcel, per 36 sq cmC9201 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Dermagraft, per 37.5 sq cmC9202 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, human ser alb w/ octafluoropropaneC9203 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, perflexane lipid microspheresC9205 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, oxaliplatin, per 5 mgC9206 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Integra, per sq cmC9211 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj. alefacept, IVC9212 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj. Alefacept, IMC9218 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj. Azacitidine, per 1 mgC9220 D 0.00 0.00 0.00 0.00 XXX 0.00 Sodium hyaluronate, per 30 mgC9221 D 0.00 0.00 0.00 0.00 XXX 0.00 Graftjacket Reg MatrixC9222 D 0.00 0.00 0.00 0.00 XXX 0.00 Graftjacket SftTisC9224 D 0.00 0.00 0.00 0.00 XXX 0.00 Injection, galsulfaseC9225 D 0.00 0.00 0.00 0.00 XXX 0.00 Fluocinolone acetonideC9399 D 0.00 0.00 0.00 0.00 XXX 0.00 Unclassified drugs/biologicalsC9400 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Radiopharm dx imag agent, thallous chloride TL-201, per mciC9401 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Radiopharm tx agent, strontium 89 chloride, per mciC9402 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Radiopharm tx agent, I-131 socium iodide cap, per mciC9403 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Radiopharm dx agent, I-131 sodium iodide cap, per mciC9404 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Radiopharm dx agent, I-131 sodium iodide soln, per mciC9405 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Radiopharm tx agent, I-131 socium iodide soln, per mciC9410 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj. dexrazoxane hcl, per 250 mgC9411 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj. pamidronate disodium, per 30 mgC9413 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Sodium hyaluronate, per 20-25 mg, inj., intra-articularC9414 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Etoposide, oral, 50 mgC9415 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Doxurubicin HCL, 10 mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
C9417 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Bleomycin sulfate, 15 unitsC9418 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Cisplatin, powder/soln, per 10 mgC9419 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj. cladribine, per 1 mgC9420 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Cyclophosphamide, 100 mgC9421 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Cyclophosphamide, lyophilized, 100 mgC9422 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Cytarabine, 100 mgC9423 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Dacarbazine, 100 mgC9424 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Daunorubicin, 10 mgC9425 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Etoposide, 10 mgC9426 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Floxuridine, 500 mgC9427 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Ifosfamide, 1 gmC9428 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Mesna, 200 mgC9429 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Idarubicin hcl, 5 mgC9430 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Leuprolide acetate, per 1 mgC9431 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Paclitaxel, 30 mgC9432 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Mitomycin, 5mgC9433 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Thiotepa, 15 mgC9435 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gonadorelin hydroch, brandC9436 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Azathioprine parenteral, bmdC9437 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Carmus bischl nitro injC9438 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Cyclosporine, oral, 100 mgC9439 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Diethylstilbestrol injectionC9704 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj. Inert subs upper GIC9713 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Non-contact laser vaporiz prostateC9716 C 0.00 0.00 0.00 0.00 XXX 0.00 Creation thermal anal lesions, radiofrequency energyC9718 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Kyphoplasty, first vertebraC9719 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Kyphoplasty, each add'lC9720 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 HE ESW tx, tennis elbowC9721 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 HE ESW tx. plantar fasciitisC9722 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 KV imaging w/IR trackingC9723 D 0.00 0.00 0.00 0.00 XXX 0.00 Dyn IR Perf ImgC9724 D 0.00 0.00 0.00 0.00 XXX 0.00 EPS gast cardia plicC9725 D 0.00 0.00 0.00 0.00 XXX 0.00 Place endorectal appCANCL C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP-requested examination; claimant failed to show upCHILD C 0.00 0.00 0.00 0.00 XXX 0.00 Child care, per dayCLMMT C 0.00 0.00 0.00 0.00 XXX 0.00 Claimant MaintenanceCLMOD S 0.00 0.00 0.00 0.00 XXX 0.00 Clothing ModificationCNSLT C 0.00 0.00 0.00 0.00 XXX 0.00 Case file review by DMO or office consultantCOPAY C 0.00 0.00 0.00 0.00 XXX 0.00 Reimburse claimant copaymentsCOPTN C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention during COP - telephonicD0120 C 0.00 0.00 0.00 0.00 XXX 0.00 Periodic oral evaluationD0140 C 0.00 0.00 0.00 0.00 XXX 0.00 Limit oral eval problm focusD0150 C 0.00 0.00 0.00 0.00 YYY 0.00 Comprehensve oral evaluationD0160 C 0.00 0.00 0.00 0.00 XXX 0.00 Extensv oral eval prob focusD0170 C 0.00 0.00 0.00 0.00 XXX 0.00 Re-eval,est pt,problem focusD0180 C 0.00 0.00 0.00 0.00 XXX 0.00 Comp periodontal evaluationD0210 C 0.00 0.00 0.00 0.00 XXX 0.00 Intraor complete film seriesD0220 C 0.00 0.00 0.00 0.00 XXX 0.00 Intraoral periapical first fD0230 C 0.00 0.00 0.00 0.00 XXX 0.00 Intraoral periapical ea addD0240 C 0.00 0.00 0.00 0.00 YYY 0.00 Intraoral occlusal filmD0250 C 0.00 0.00 0.00 0.00 YYY 0.00 Extraoral first filmD0260 C 0.00 0.00 0.00 0.00 YYY 0.00 Extraoral ea additional filmD0270 C 0.00 0.00 0.00 0.00 YYY 0.00 Dental bitewing single filmD0272 C 0.00 0.00 0.00 0.00 YYY 0.00 Dental bitewings two films
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D0274 C 0.00 0.00 0.00 0.00 YYY 0.00 Dental bitewings four filmsD0277 C 0.00 0.00 0.00 0.00 XXX 0.00 Vert bitewings-sev to eightD0290 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental film skull/facial bonD0310 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental saliographyD0320 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental tmj arthrogram incl iD0321 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental other tmj filmsD0322 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental tomographic surveyD0330 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental panoramic filmD0340 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental cephalometric filmD0350 C 0.00 0.00 0.00 0.00 XXX 0.00 Oral/facial imagesD0415 C 0.00 0.00 0.00 0.00 XXX 0.00 Bacteriologic studyD0416 C 0.00 0.00 0.00 0.00 XXX 0.00 Viral cultureD0421 C 0.00 0.00 0.00 0.00 XXX 0.00 Gen tst suscept oral diseaseD0425 C 0.00 0.00 0.00 0.00 XXX 0.00 Caries susceptibility testD0431 C 0.00 0.00 0.00 0.00 XXX 0.00 Diag tst detect mucos abnormD0460 C 0.00 0.00 0.00 0.00 YYY 0.00 Pulp vitality testD0470 C 0.00 0.00 0.00 0.00 XXX 0.00 Diagnostic castsD0471 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Diagnostic photographsD0472 C 0.00 0.00 0.00 0.00 XXX 0.00 Gross exam, prep & reportD0473 C 0.00 0.00 0.00 0.00 XXX 0.00 Micro exam, prep & reportD0474 C 0.00 0.00 0.00 0.00 XXX 0.00 Micro w exam of surg marginsD0475 C 0.00 0.00 0.00 0.00 XXX 0.00 Decalcification procedureD0476 C 0.00 0.00 0.00 0.00 XXX 0.00 Spec stains for microorganisD0477 C 0.00 0.00 0.00 0.00 XXX 0.00 Spec stains not for microorgD0478 C 0.00 0.00 0.00 0.00 XXX 0.00 Immunohistochemical stainsD0479 C 0.00 0.00 0.00 0.00 XXX 0.00 Tissue in-situ hybridizationD0480 C 0.00 0.00 0.00 0.00 XXX 0.00 Cytopath smear prep & reportD0481 C 0.00 0.00 0.00 0.00 XXX 0.00 Electron microscopy diagnostD0482 C 0.00 0.00 0.00 0.00 XXX 0.00 Direct immunofluorescenceD0483 C 0.00 0.00 0.00 0.00 XXX 0.00 Indirect immunofluorescenceD0484 C 0.00 0.00 0.00 0.00 XXX 0.00 Consult slides prep elsewherD0485 C 0.00 0.00 0.00 0.00 XXX 0.00 Consult inc prep of slidesD0502 C 0.00 0.00 0.00 0.00 YYY 0.00 Other oral pathology proceduD0999 S 0.00 0.00 0.00 0.00 YYY 0.00 Unspecified diagnostic proceD1110 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental prophylaxis adultD1120 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental prophylaxis childD1201 C 0.00 0.00 0.00 0.00 XXX 0.00 Topical fluor w prophy childD1203 C 0.00 0.00 0.00 0.00 XXX 0.00 Topical fluor w/o prophy chiD1204 C 0.00 0.00 0.00 0.00 XXX 0.00 Topical fluor w/o prophy aduD1205 C 0.00 0.00 0.00 0.00 XXX 0.00 Topical fluoride w/ prophy aD1310 C 0.00 0.00 0.00 0.00 XXX 0.00 Nutri counsel-control cariesD1320 C 0.00 0.00 0.00 0.00 XXX 0.00 Tobacco counselingD1330 C 0.00 0.00 0.00 0.00 XXX 0.00 Oral hygiene instructionD1351 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental sealant per toothD1510 C 0.00 0.00 0.00 0.00 YYY 0.00 Space maintainer fxd unilatD1515 C 0.00 0.00 0.00 0.00 YYY 0.00 Fixed bilat space maintainerD1520 C 0.00 0.00 0.00 0.00 YYY 0.00 Remove unilat space maintainD1525 C 0.00 0.00 0.00 0.00 YYY 0.00 Remove bilat space maintainD1550 C 0.00 0.00 0.00 0.00 YYY 0.00 Recement space maintainerD2140 C 0.00 0.00 0.00 0.00 XXX 0.00 Amalgam one surface permanenD2150 C 0.00 0.00 0.00 0.00 XXX 0.00 Amalgam two surfaces permaneD2160 C 0.00 0.00 0.00 0.00 XXX 0.00 Amalgam three surfaces permaD2161 C 0.00 0.00 0.00 0.00 XXX 0.00 Amalgam 4 or > surfaces permD2330 C 0.00 0.00 0.00 0.00 XXX 0.00 Resin one surface-anterior
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D2331 C 0.00 0.00 0.00 0.00 XXX 0.00 Resin two surfaces-anteriorD2332 C 0.00 0.00 0.00 0.00 XXX 0.00 Resin three surfaces-anterioD2335 C 0.00 0.00 0.00 0.00 XXX 0.00 Resin 4/> surf or w incis anD2390 C 0.00 0.00 0.00 0.00 XXX 0.00 Ant resin-based cmpst crownD2391 C 0.00 0.00 0.00 0.00 XXX 0.00 Post 1 srfc resinbased cmpstD2392 C 0.00 0.00 0.00 0.00 XXX 0.00 Post 2 srfc resinbased cmpstD2393 C 0.00 0.00 0.00 0.00 XXX 0.00 Post 3 srfc resinbased cmpstD2394 C 0.00 0.00 0.00 0.00 XXX 0.00 Post >=4srfc resinbase cmpstD2410 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental gold foil one surfaceD2420 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental gold foil two surfaceD2430 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental gold foil three surfaD2510 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental inlay metalic 1 surfD2520 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental inlay metallic 2 surfD2530 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental inlay metl 3/more surD2542 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay metallic 2 surfD2543 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay metallic 3 surfD2544 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay metl 4/more surD2610 C 0.00 0.00 0.00 0.00 XXX 0.00 Inlay porcelain/ceramic 1 suD2620 C 0.00 0.00 0.00 0.00 XXX 0.00 Inlay porcelain/ceramic 2 suD2630 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay porc 3/more surD2642 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay porcelin 2 surfD2643 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay porcelin 3 surfD2644 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay porc 4/more surD2650 C 0.00 0.00 0.00 0.00 XXX 0.00 Inlay composite/resin one suD2651 C 0.00 0.00 0.00 0.00 XXX 0.00 Inlay composite/resin two suD2652 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental inlay resin 3/mre surD2662 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay resin 2 surfaceD2663 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay resin 3 surfaceD2664 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental onlay resin 4/mre surD2710 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown resin laboratoryD2712 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 resin-based composD2720 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown resin w/ high noble meD2721 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown resin w/ base metalD2722 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown resin w/ noble metalD2740 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain/ceramic subsD2750 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain w/ h noble mD2751 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain fused base mD2752 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain w/ noble metD2780 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 cast hi noble metD2781 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 cast base metalD2782 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 cast noble metalD2783 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 porcelain/ceramicD2790 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown full cast high noble mD2791 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown full cast base metalD2792 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown full cast noble metalD2794 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown-titaniumD2799 C 0.00 0.00 0.00 0.00 XXX 0.00 Provisional crownD2910 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental recement inlayD2915 C 0.00 0.00 0.00 0.00 XXX 0.00 Recement cast or prefab postD2920 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental recement crownD2930 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefab stnlss steel crwn priD2931 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefab stnlss steel crown peD2932 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefabricated resin crownD2933 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefab stainless steel crown
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D2934 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefab steel crown primaryD2940 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental sedative fillingD2950 C 0.00 0.00 0.00 0.00 XXX 0.00 Core build-up incl any pinsD2951 C 0.00 0.00 0.00 0.00 XXX 0.00 Tooth pin retentionD2952 C 0.00 0.00 0.00 0.00 XXX 0.00 Post and core cast + crownD2953 C 0.00 0.00 0.00 0.00 XXX 0.00 Each addtnl cast postD2954 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefab post/core + crownD2955 C 0.00 0.00 0.00 0.00 XXX 0.00 Post removalD2957 C 0.00 0.00 0.00 0.00 XXX 0.00 Each addtnl prefab postD2960 C 0.00 0.00 0.00 0.00 XXX 0.00 Laminate labial veneerD2961 C 0.00 0.00 0.00 0.00 XXX 0.00 Lab labial veneer resinD2962 C 0.00 0.00 0.00 0.00 XXX 0.00 Lab labial veneer porcelainD2971 C 0.00 0.00 0.00 0.00 XXX 0.00 Add proc construct new crownD2975 C 0.00 0.00 0.00 0.00 XXX 0.00 CopingD2980 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown repairD2999 S 0.00 0.00 0.00 0.00 YYY 0.00 Dental unspec restorative prD3110 C 0.00 0.00 0.00 0.00 XXX 0.00 Pulp cap directD3120 C 0.00 0.00 0.00 0.00 XXX 0.00 Pulp cap indirectD3220 C 0.00 0.00 0.00 0.00 XXX 0.00 Therapeutic pulpotomyD3221 C 0.00 0.00 0.00 0.00 XXX 0.00 Gross pulpal debridementD3230 C 0.00 0.00 0.00 0.00 XXX 0.00 Pulpal therapy anterior primD3240 C 0.00 0.00 0.00 0.00 XXX 0.00 Pulpal therapy posterior priD3310 C 0.00 0.00 0.00 0.00 XXX 0.00 AnteriorD3320 C 0.00 0.00 0.00 0.00 XXX 0.00 Root canal therapy 2 canalsD3330 C 0.00 0.00 0.00 0.00 XXX 0.00 Root canal therapy 3 canalsD3331 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-surg tx root canal obsD3332 C 0.00 0.00 0.00 0.00 XXX 0.00 Incomplete endodontic txD3333 C 0.00 0.00 0.00 0.00 XXX 0.00 Internal root repairD3346 C 0.00 0.00 0.00 0.00 XXX 0.00 Retreat root canal anteriorD3347 C 0.00 0.00 0.00 0.00 XXX 0.00 Retreat root canal bicuspidD3348 C 0.00 0.00 0.00 0.00 XXX 0.00 Retreat root canal molarD3351 C 0.00 0.00 0.00 0.00 XXX 0.00 Apexification/recalc initialD3352 C 0.00 0.00 0.00 0.00 XXX 0.00 Apexification/recalc interimD3353 C 0.00 0.00 0.00 0.00 XXX 0.00 Apexification/recalc finalD3410 C 0.00 0.00 0.00 0.00 XXX 0.00 Apicoect/perirad surg anterD3421 C 0.00 0.00 0.00 0.00 XXX 0.00 Root surgery bicuspidD3425 C 0.00 0.00 0.00 0.00 XXX 0.00 Root surgery molarD3426 C 0.00 0.00 0.00 0.00 XXX 0.00 Root surgery ea add rootD3430 C 0.00 0.00 0.00 0.00 XXX 0.00 Retrograde fillingD3450 C 0.00 0.00 0.00 0.00 XXX 0.00 Root amputationD3460 C 0.00 0.00 0.00 0.00 YYY 0.00 Endodontic endosseous implanD3470 C 0.00 0.00 0.00 0.00 XXX 0.00 Intentional replantationD3910 C 0.00 0.00 0.00 0.00 XXX 0.00 Isolation- tooth w rubb damD3920 C 0.00 0.00 0.00 0.00 XXX 0.00 Tooth splittingD3950 C 0.00 0.00 0.00 0.00 XXX 0.00 Canal prep/fitting of dowelD3999 S 0.00 0.00 0.00 0.00 YYY 0.00 Endodontic procedure, nosD4210 C 0.00 0.00 0.00 0.00 XXX 0.00 Gingivectomy/plasty per quadD4211 C 0.00 0.00 0.00 0.00 XXX 0.00 Gingivectomy/plasty per tootD4240 C 0.00 0.00 0.00 0.00 XXX 0.00 Gingival flap proc w/ planinD4241 C 0.00 0.00 0.00 0.00 XXX 0.00 Gngvl flap w rootplan 1-3 thD4245 C 0.00 0.00 0.00 0.00 XXX 0.00 Apically positioned flapD4249 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown lengthen hard tissueD4260 C 0.00 0.00 0.00 0.00 YYY 0.00 Osseous surgery per quadrantD4261 C 0.00 0.00 0.00 0.00 XXX 0.00 Osseous surgl-3teethperquad
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D4263 C 0.00 0.00 0.00 0.00 YYY 0.00 Bone replce graft first siteD4264 C 0.00 0.00 0.00 0.00 YYY 0.00 Bone replce graft each addD4265 C 0.00 0.00 0.00 0.00 XXX 0.00 Bio mtrls to aid soft/os regD4266 C 0.00 0.00 0.00 0.00 XXX 0.00 Guided tiss regen resorbleD4267 C 0.00 0.00 0.00 0.00 XXX 0.00 Guided tiss regen nonresorbD4268 C 0.00 0.00 0.00 0.00 XXX 0.00 Surgical revision procedureD4270 C 0.00 0.00 0.00 0.00 YYY 0.00 Pedicle soft tissue graft prD4271 C 0.00 0.00 0.00 0.00 YYY 0.00 Free soft tissue graft procD4273 C 0.00 0.00 0.00 0.00 YYY 0.00 Subepithelial tissue graftD4274 C 0.00 0.00 0.00 0.00 XXX 0.00 Distal/proximal wedge procD4275 C 0.00 0.00 0.00 0.00 XXX 0.00 Soft tissue allograftD4276 C 0.00 0.00 0.00 0.00 XXX 0.00 Con tissue w dble ped graftD4320 C 0.00 0.00 0.00 0.00 XXX 0.00 Provision splnt intracoronalD4321 C 0.00 0.00 0.00 0.00 XXX 0.00 Provisional splint extracoroD4341 C 0.00 0.00 0.00 0.00 XXX 0.00 Periodontal scaling & rootD4342 C 0.00 0.00 0.00 0.00 XXX 0.00 Periodontal scaling 1-3teethD4355 C 0.00 0.00 0.00 0.00 YYY 0.00 Full mouth debridementD4381 C 0.00 0.00 0.00 0.00 YYY 0.00 Localized chemo deliveryD4910 C 0.00 0.00 0.00 0.00 XXX 0.00 Periodontal maint proceduresD4920 C 0.00 0.00 0.00 0.00 XXX 0.00 Unscheduled dressing changeD4999 S 0.00 0.00 0.00 0.00 XXX 0.00 Unspecified periodontal procD5110 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures complete maxillaryD5120 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures complete mandibleD5130 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures immediat maxillaryD5140 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures immediat mandibleD5211 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures maxill part resinD5212 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures mand part resinD5213 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures maxill part metalD5214 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures mandibl part metalD5225 C 0.00 0.00 0.00 0.00 XXX 0.00 Maxillary part denture flexD5226 C 0.00 0.00 0.00 0.00 XXX 0.00 Mandibular part denture flexD5281 C 0.00 0.00 0.00 0.00 XXX 0.00 Removable partial dentureD5410 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures adjust cmplt maxilD5411 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures adjust cmplt mandD5421 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures adjust part maxillD5422 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures adjust part mandblD5510 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentur repr broken compl basD5520 C 0.00 0.00 0.00 0.00 XXX 0.00 Replace denture teeth compltD5610 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures repair resin baseD5620 C 0.00 0.00 0.00 0.00 XXX 0.00 Rep part denture cast frameD5630 C 0.00 0.00 0.00 0.00 XXX 0.00 Rep partial denture claspD5640 C 0.00 0.00 0.00 0.00 XXX 0.00 Replace part denture teethD5650 C 0.00 0.00 0.00 0.00 XXX 0.00 Add tooth to partial dentureD5660 C 0.00 0.00 0.00 0.00 XXX 0.00 Add clasp to partial dentureD5670 C 0.00 0.00 0.00 0.00 XXX 0.00 Replc tth&acrlc on mtl frmwkD5671 C 0.00 0.00 0.00 0.00 XXX 0.00 Replc tth&acrlc mandibularD5710 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures rebase cmplt maxilD5711 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures rebase cmplt mandD5720 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures rebase part maxillD5721 C 0.00 0.00 0.00 0.00 XXX 0.00 Dentures rebase part mandblD5730 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln cmplt maxil chD5731 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln cmplt mand chrD5740 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln part maxil chrD5741 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln part mand chr
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D5750 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln cmplt max labD5751 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln cmplt mand labD5760 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln part maxil labD5761 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture reln part mand labD5810 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture interm cmplt maxillD5811 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture interm cmplt mandblD5820 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture interm part maxillD5821 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture interm part mandblD5850 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture tiss conditn maxillD5851 C 0.00 0.00 0.00 0.00 XXX 0.00 Denture tiss condtin mandblD5860 C 0.00 0.00 0.00 0.00 XXX 0.00 Overdenture completeD5861 C 0.00 0.00 0.00 0.00 XXX 0.00 Overdenture partialD5862 C 0.00 0.00 0.00 0.00 XXX 0.00 Precision attachmentD5867 C 0.00 0.00 0.00 0.00 XXX 0.00 Replacement of precision attD5875 C 0.00 0.00 0.00 0.00 XXX 0.00 Prosthesis modificationD5899 C 0.00 0.00 0.00 0.00 XXX 0.00 Removable prosthodontic procD5911 C 0.00 0.00 0.00 0.00 YYY 0.00 Facial moulage sectionalD5912 C 0.00 0.00 0.00 0.00 YYY 0.00 Facial moulage completeD5913 C 0.00 0.00 0.00 0.00 XXX 0.00 Nasal prosthesisD5914 C 0.00 0.00 0.00 0.00 XXX 0.00 Auricular prosthesisD5915 C 0.00 0.00 0.00 0.00 XXX 0.00 Orbital prosthesisD5916 C 0.00 0.00 0.00 0.00 XXX 0.00 Ocular prosthesisD5919 C 0.00 0.00 0.00 0.00 XXX 0.00 Facial prosthesisD5922 C 0.00 0.00 0.00 0.00 XXX 0.00 Nasal septal prosthesisD5923 C 0.00 0.00 0.00 0.00 XXX 0.00 Ocular prosthesis interimD5924 C 0.00 0.00 0.00 0.00 XXX 0.00 Cranial prosthesisD5925 C 0.00 0.00 0.00 0.00 XXX 0.00 Facial augmentation implantD5926 C 0.00 0.00 0.00 0.00 XXX 0.00 Replacement nasal prosthesisD5927 C 0.00 0.00 0.00 0.00 XXX 0.00 Auricular replacementD5928 C 0.00 0.00 0.00 0.00 XXX 0.00 Orbital replacementD5929 C 0.00 0.00 0.00 0.00 XXX 0.00 Facial replacementD5931 C 0.00 0.00 0.00 0.00 XXX 0.00 Surgical obturatorD5932 C 0.00 0.00 0.00 0.00 XXX 0.00 Postsurgical obturatorD5933 C 0.00 0.00 0.00 0.00 XXX 0.00 Refitting of obturatorD5934 C 0.00 0.00 0.00 0.00 XXX 0.00 Mandibular flange prosthesisD5935 C 0.00 0.00 0.00 0.00 XXX 0.00 Mandibular denture prosthD5936 C 0.00 0.00 0.00 0.00 XXX 0.00 Temp obturator prosthesisD5937 C 0.00 0.00 0.00 0.00 XXX 0.00 Trismus applianceD5951 C 0.00 0.00 0.00 0.00 YYY 0.00 Feeding aidD5952 C 0.00 0.00 0.00 0.00 XXX 0.00 Pediatric speech aidD5953 C 0.00 0.00 0.00 0.00 XXX 0.00 Adult speech aidD5954 C 0.00 0.00 0.00 0.00 XXX 0.00 Superimposed prosthesisD5955 C 0.00 0.00 0.00 0.00 XXX 0.00 Palatal lift prosthesisD5958 C 0.00 0.00 0.00 0.00 XXX 0.00 Intraoral con def inter pltD5959 C 0.00 0.00 0.00 0.00 XXX 0.00 Intraoral con def mod palatD5960 C 0.00 0.00 0.00 0.00 XXX 0.00 Modify speech aid prosthesisD5982 C 0.00 0.00 0.00 0.00 XXX 0.00 Surgical stentD5983 C 0.00 0.00 0.00 0.00 YYY 0.00 Radiation applicatorD5984 C 0.00 0.00 0.00 0.00 YYY 0.00 Radiation shieldD5985 C 0.00 0.00 0.00 0.00 YYY 0.00 Radiation cone locatorD5986 C 0.00 0.00 0.00 0.00 XXX 0.00 Fluoride applicatorD5987 C 0.00 0.00 0.00 0.00 YYY 0.00 Commissure splintD5988 C 0.00 0.00 0.00 0.00 XXX 0.00 Surgical splintD5999 C 0.00 0.00 0.00 0.00 XXX 0.00 Maxillofacial prosthesis
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D6010 C 0.00 0.00 0.00 0.00 XXX 0.00 Odontics endosteal implantD6040 C 0.00 0.00 0.00 0.00 XXX 0.00 Odontics eposteal implantD6050 C 0.00 0.00 0.00 0.00 XXX 0.00 Odontics transosteal implntD6053 C 0.00 0.00 0.00 0.00 XXX 0.00 Implnt/abtmnt spprt remv dntD6054 C 0.00 0.00 0.00 0.00 XXX 0.00 Implnt/abtmnt spprt remvprtlD6055 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant connecting barD6056 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefabricated abutmentD6057 C 0.00 0.00 0.00 0.00 XXX 0.00 Custom abutmentD6058 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported crownD6059 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported mtl crownD6060 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported mtl crownD6061 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported mtl crownD6062 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported mtl crownD6063 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported mtl crownD6064 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported mtl crownD6065 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant supported crownD6066 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant supported mtl crownD6067 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant supported mtl crownD6068 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported retainerD6069 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported retainerD6070 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported retainerD6071 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported retainerD6072 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported retainerD6073 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported retainerD6074 C 0.00 0.00 0.00 0.00 XXX 0.00 Abutment supported retainerD6075 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant supported retainerD6076 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant supported retainerD6077 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant supported retainerD6078 C 0.00 0.00 0.00 0.00 XXX 0.00 Implnt/abut suprtd fixd dentD6079 C 0.00 0.00 0.00 0.00 XXX 0.00 Implnt/abut suprtd fixd dentD6080 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant maintenanceD6090 C 0.00 0.00 0.00 0.00 XXX 0.00 Repair implantD6094 C 0.00 0.00 0.00 0.00 XXX 0.00 Abut support crown titaniumD6095 C 0.00 0.00 0.00 0.00 XXX 0.00 Odontics repr abutmentD6100 C 0.00 0.00 0.00 0.00 XXX 0.00 Removal of implantD6190 C 0.00 0.00 0.00 0.00 XXX 0.00 Radio/surgical implant indexD6194 C 0.00 0.00 0.00 0.00 XXX 0.00 Abut support retainer titaniD6199 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant procedureD6205 C 0.00 0.00 0.00 0.00 XXX 0.00 Pontic-indirect resin basedD6210 C 0.00 0.00 0.00 0.00 XXX 0.00 Prosthodont high noble metalD6211 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge base metal castD6212 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge noble metal castD6214 C 0.00 0.00 0.00 0.00 XXX 0.00 Pontic titaniumD6240 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge porcelain high nobleD6241 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge porcelain base metalD6242 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge porcelain nobel metalD6245 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge porcelain/ceramicD6250 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge resin w/high nobleD6251 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge resin base metalD6252 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge resin w/noble metalD6253 C 0.00 0.00 0.00 0.00 XXX 0.00 Provisional ponticD6545 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental retainr cast metlD6548 C 0.00 0.00 0.00 0.00 XXX 0.00 Porcelain/ceramic retainerD6600 C 0.00 0.00 0.00 0.00 XXX 0.00 Porcelain/ceramic inlay 2srf
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D6601 C 0.00 0.00 0.00 0.00 XXX 0.00 Porc/ceram inlay >= 3 surfacD6602 C 0.00 0.00 0.00 0.00 XXX 0.00 Cst hgh nble mtl inlay 2 srfD6603 C 0.00 0.00 0.00 0.00 XXX 0.00 Cst hgh nble mtl inlay >=3srD6604 C 0.00 0.00 0.00 0.00 XXX 0.00 Cst bse mtl inlay 2 surfacesD6605 C 0.00 0.00 0.00 0.00 XXX 0.00 Cst bse mtl inlay >= 3 surfaD6606 C 0.00 0.00 0.00 0.00 XXX 0.00 Cast noble metal inlay 2 surD6607 C 0.00 0.00 0.00 0.00 XXX 0.00 Cst noble mtl inlay >=3 surfD6608 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay porc/crmc 2 surfacesD6609 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay porc/crmc >=3 surfacesD6610 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay cst hgh nbl mtl 2 srfcD6611 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay cst hgh nbl mtl >=3srfD6612 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay cst base mtl 2 surfaceD6613 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay cst base mtl >=3 surfaD6614 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay cst nbl mtl 2 surfacesD6615 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay cst nbl mtl >=3 surfacD6624 C 0.00 0.00 0.00 0.00 XXX 0.00 Inlay titaniumD6634 C 0.00 0.00 0.00 0.00 XXX 0.00 Onlay titaniumD6710 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown-indirect resin basedD6720 C 0.00 0.00 0.00 0.00 XXX 0.00 Retain crown resin w hi nbleD6721 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown resin w/base metalD6722 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown resin w/noble metalD6740 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain/ceramicD6750 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain high nobleD6751 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain base metalD6752 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown porcelain noble metalD6780 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 high noble metalD6781 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 cast based metalD6782 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 cast noble metalD6783 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown 3/4 porcelain/ceramicD6790 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown full high noble metalD6791 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown full base metal castD6792 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown full noble metal castD6793 C 0.00 0.00 0.00 0.00 XXX 0.00 Provisional retainer crownD6794 C 0.00 0.00 0.00 0.00 XXX 0.00 Crown titaniumD6920 C 0.00 0.00 0.00 0.00 YYY 0.00 Dental connector barD6930 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental recement bridgeD6940 C 0.00 0.00 0.00 0.00 XXX 0.00 Stress breakerD6950 C 0.00 0.00 0.00 0.00 XXX 0.00 Precision attachmentD6970 C 0.00 0.00 0.00 0.00 XXX 0.00 Post & core plus retainerD6971 C 0.00 0.00 0.00 0.00 XXX 0.00 Cast post bridge retainerD6972 C 0.00 0.00 0.00 0.00 XXX 0.00 Prefab post & core plus retaD6973 C 0.00 0.00 0.00 0.00 XXX 0.00 Core build up for retainerD6975 C 0.00 0.00 0.00 0.00 XXX 0.00 Coping metalD6976 C 0.00 0.00 0.00 0.00 XXX 0.00 Each addtnl cast postD6977 C 0.00 0.00 0.00 0.00 XXX 0.00 Each addtl prefab postD6980 C 0.00 0.00 0.00 0.00 XXX 0.00 Bridge repairD6985 D 0.00 0.00 0.00 0.00 XXX 0.00 Pediatric partial denture fxD6999 C 0.00 0.00 0.00 0.00 XXX 0.00 Fixed prosthodontic procD7111 C 0.00 0.00 0.00 0.00 XXX 0.00 Coronal remnants deciduous tD7140 C 0.00 0.00 0.00 0.00 XXX 0.00 Extraction erupted tooth/exrD7210 C 0.00 0.00 0.00 0.00 YYY 0.00 Rem imp tooth w mucoper flpD7220 C 0.00 0.00 0.00 0.00 YYY 0.00 Impact tooth remov soft tissD7230 C 0.00 0.00 0.00 0.00 YYY 0.00 Impact tooth remov part bonyD7240 C 0.00 0.00 0.00 0.00 YYY 0.00 Impact tooth remov comp bony
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D7241 C 0.00 0.00 0.00 0.00 YYY 0.00 Impact tooth rem bony w/compD7250 C 0.00 0.00 0.00 0.00 YYY 0.00 Tooth root removalD7260 C 0.00 0.00 0.00 0.00 YYY 0.00 Oral antral fistula closureD7261 C 0.00 0.00 0.00 0.00 XXX 0.00 Primary closure sinus perfD7270 C 0.00 0.00 0.00 0.00 XXX 0.00 Tooth reimplantationD7272 C 0.00 0.00 0.00 0.00 XXX 0.00 Tooth transplantationD7280 C 0.00 0.00 0.00 0.00 XXX 0.00 Exposure impact tooth orthodD7282 C 0.00 0.00 0.00 0.00 XXX 0.00 Mobilize erupted/malpos tootD7283 C 0.00 0.00 0.00 0.00 XXX 0.00 Place device impacted toothD7285 C 0.00 0.00 0.00 0.00 XXX 0.00 Biopsy of oral tissue hardD7286 C 0.00 0.00 0.00 0.00 XXX 0.00 Biopsy of oral tissue softD7287 C 0.00 0.00 0.00 0.00 XXX 0.00 Cytology sample collectionD7288 C 0.00 0.00 0.00 0.00 XXX 0.00 Brush biopsyD7290 C 0.00 0.00 0.00 0.00 XXX 0.00 Repositioning of teethD7291 C 0.00 0.00 0.00 0.00 YYY 0.00 Transseptal fiberotomyD7310 C 0.00 0.00 0.00 0.00 XXX 0.00 Alveoplasty w/ extractionD7311 C 0.00 0.00 0.00 0.00 XXX 0.00 Alveoloplasty w/extract 1-3D7320 C 0.00 0.00 0.00 0.00 XXX 0.00 Alveoplasty w/o extractionD7321 C 0.00 0.00 0.00 0.00 XXX 0.00 Alveoloplasty not w/extractsD7340 C 0.00 0.00 0.00 0.00 XXX 0.00 Vestibuloplasty ridge extensD7350 C 0.00 0.00 0.00 0.00 XXX 0.00 Vestibuloplasty exten graftD7410 C 0.00 0.00 0.00 0.00 XXX 0.00 Rad exc lesion up to 1.25 cmD7411 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision benign lesion>1.25cD7412 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision benign lesion complD7413 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision malig lesion<=1.25cD7414 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision malig lesion>1.25cmD7415 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision malig les complicatD7440 C 0.00 0.00 0.00 0.00 XXX 0.00 Malig tumor exc to 1.25 cmD7441 C 0.00 0.00 0.00 0.00 XXX 0.00 Malig tumor > 1.25 cmD7450 C 0.00 0.00 0.00 0.00 XXX 0.00 Rem odontogen cyst to 1.25cmD7451 C 0.00 0.00 0.00 0.00 XXX 0.00 Rem odontogen cyst > 1.25 cmD7460 C 0.00 0.00 0.00 0.00 XXX 0.00 Rem nonodonto cyst to 1.25cmD7461 C 0.00 0.00 0.00 0.00 XXX 0.00 Rem nonodonto cyst > 1.25 cmD7465 C 0.00 0.00 0.00 0.00 XXX 0.00 Lesion destructionD7471 C 0.00 0.00 0.00 0.00 XXX 0.00 Rem exostosis any siteD7472 C 0.00 0.00 0.00 0.00 XXX 0.00 Removal of torus palatinusD7473 C 0.00 0.00 0.00 0.00 XXX 0.00 Remove torus mandibularisD7485 C 0.00 0.00 0.00 0.00 XXX 0.00 Surg reduct osseoustuberositD7490 C 0.00 0.00 0.00 0.00 XXX 0.00 Mandible resectionD7510 C 0.00 0.00 0.00 0.00 XXX 0.00 I&d absc intraoral soft tissD7511 C 0.00 0.00 0.00 0.00 XXX 0.00 Incision/drain abscess intraD7520 C 0.00 0.00 0.00 0.00 XXX 0.00 I&d abscess extraoralD7521 C 0.00 0.00 0.00 0.00 XXX 0.00 Incision/drain abscess extraD7530 C 0.00 0.00 0.00 0.00 XXX 0.00 Removal fb skin/areolar tissD7540 C 0.00 0.00 0.00 0.00 XXX 0.00 Removal of fb reactionD7550 C 0.00 0.00 0.00 0.00 XXX 0.00 Removal of sloughed off boneD7560 C 0.00 0.00 0.00 0.00 XXX 0.00 Maxillary sinusotomyD7610 C 0.00 0.00 0.00 0.00 XXX 0.00 Maxilla open reduct simpleD7620 C 0.00 0.00 0.00 0.00 XXX 0.00 Clsd reduct simpl maxilla fxD7630 C 0.00 0.00 0.00 0.00 XXX 0.00 Open red simpl mandible fxD7640 C 0.00 0.00 0.00 0.00 XXX 0.00 Clsd red simpl mandible fxD7650 C 0.00 0.00 0.00 0.00 XXX 0.00 Open red simp malar/zygom fxD7660 C 0.00 0.00 0.00 0.00 XXX 0.00 Clsd red simp malar/zygom fxD7670 C 0.00 0.00 0.00 0.00 XXX 0.00 Closd rductn splint alveolus
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D7671 C 0.00 0.00 0.00 0.00 XXX 0.00 Alveolus open reductionD7680 C 0.00 0.00 0.00 0.00 XXX 0.00 Reduct simple facial bone fxD7710 C 0.00 0.00 0.00 0.00 XXX 0.00 Maxilla open reduct compoundD7720 C 0.00 0.00 0.00 0.00 XXX 0.00 Clsd reduct compd maxilla fxD7730 C 0.00 0.00 0.00 0.00 XXX 0.00 Open reduct compd mandble fxD7740 C 0.00 0.00 0.00 0.00 XXX 0.00 Clsd reduct compd mandble fxD7750 C 0.00 0.00 0.00 0.00 XXX 0.00 Open red comp malar/zygma fxD7760 C 0.00 0.00 0.00 0.00 XXX 0.00 Clsd red comp malar/zygma fxD7770 C 0.00 0.00 0.00 0.00 XXX 0.00 Open reduc compd alveolus fxD7771 C 0.00 0.00 0.00 0.00 XXX 0.00 Alveolus clsd reduc stblz teD7780 C 0.00 0.00 0.00 0.00 XXX 0.00 Reduct compnd facial bone fxD7810 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj open reduct-dislocationD7820 C 0.00 0.00 0.00 0.00 XXX 0.00 Closed tmp manipulationD7830 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj manipulation under anestD7840 C 0.00 0.00 0.00 0.00 XXX 0.00 Removal of tmj condyleD7850 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj meniscectomyD7852 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj repair of joint discD7854 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj excisn of joint membraneD7856 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj cutting of a muscleD7858 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj reconstructionD7860 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj cutting into jointD7865 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj reshaping componentsD7870 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj aspiration joint fluidD7871 C 0.00 0.00 0.00 0.00 XXX 0.00 Lysis + lavage w cathetersD7872 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj diagnostic arthroscopyD7873 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj arthroscopy lysis adhesnD7874 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj arthroscopy disc repositD7875 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj arthroscopy synovectomyD7876 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj arthroscopy discectomyD7877 C 0.00 0.00 0.00 0.00 XXX 0.00 Tmj arthroscopy debridementD7880 C 0.00 0.00 0.00 0.00 XXX 0.00 Occlusal orthotic applianceD7899 S 0.00 0.00 0.00 0.00 XXX 0.00 Tmj unspecified therapyD7910 C 0.00 0.00 0.00 0.00 XXX 0.00 Dent sutur recent wnd to 5cmD7911 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental suture wound to 5 cmD7912 C 0.00 0.00 0.00 0.00 XXX 0.00 Suture complicate wnd > 5 cmD7920 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental skin graftD7940 C 0.00 0.00 0.00 0.00 YYY 0.00 Reshaping bone orthognathicD7941 C 0.00 0.00 0.00 0.00 XXX 0.00 Bone cutting ramus closedD7943 C 0.00 0.00 0.00 0.00 XXX 0.00 Cutting ramus open w/graftD7944 C 0.00 0.00 0.00 0.00 XXX 0.00 Bone cutting segmentedD7945 C 0.00 0.00 0.00 0.00 XXX 0.00 Bone cutting body mandibleD7946 C 0.00 0.00 0.00 0.00 XXX 0.00 Reconstruction maxilla totalD7947 C 0.00 0.00 0.00 0.00 XXX 0.00 Reconstruct maxilla segmentD7948 C 0.00 0.00 0.00 0.00 XXX 0.00 Reconstruct midface no graftD7949 C 0.00 0.00 0.00 0.00 XXX 0.00 Reconstruct midface w/graftD7950 C 0.00 0.00 0.00 0.00 XXX 0.00 Mandible graftD7953 C 0.00 0.00 0.00 0.00 XXX 0.00 Bone replacement graftD7955 C 0.00 0.00 0.00 0.00 XXX 0.00 Repair maxillofacial defectsD7960 C 0.00 0.00 0.00 0.00 XXX 0.00 Frenulectomy/frenulotomyD7963 C 0.00 0.00 0.00 0.00 XXX 0.00 FrenuloplastyD7970 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision hyperplastic tissueD7971 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision pericoronal gingivaD7972 C 0.00 0.00 0.00 0.00 XXX 0.00 Surg redct fibrous tuberositD7980 C 0.00 0.00 0.00 0.00 XXX 0.00 Sialolithotomy
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D7981 C 0.00 0.00 0.00 0.00 XXX 0.00 Excision of salivary glandD7982 C 0.00 0.00 0.00 0.00 XXX 0.00 SialodochoplastyD7983 C 0.00 0.00 0.00 0.00 XXX 0.00 Closure of salivary fistulaD7990 C 0.00 0.00 0.00 0.00 XXX 0.00 Emergency tracheotomyD7991 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental coronoidectomyD7995 C 0.00 0.00 0.00 0.00 XXX 0.00 Synthetic graft facial bonesD7996 C 0.00 0.00 0.00 0.00 XXX 0.00 Implant mandible for augmentD7997 C 0.00 0.00 0.00 0.00 XXX 0.00 Appliance removalD7999 S 0.00 0.00 0.00 0.00 XXX 0.00 Oral surgery procedure, nosD8010 C 0.00 0.00 0.00 0.00 XXX 0.00 Limited dental tx primaryD8020 C 0.00 0.00 0.00 0.00 XXX 0.00 Limited dental tx transitionD8030 C 0.00 0.00 0.00 0.00 XXX 0.00 Limited dental tx adolescentD8040 C 0.00 0.00 0.00 0.00 XXX 0.00 Limited dental tx adultD8050 C 0.00 0.00 0.00 0.00 XXX 0.00 Intercep dental tx primaryD8060 C 0.00 0.00 0.00 0.00 XXX 0.00 Intercep dental tx transitnD8070 C 0.00 0.00 0.00 0.00 XXX 0.00 Compre dental tx transitionD8080 C 0.00 0.00 0.00 0.00 XXX 0.00 Compre dental tx adolescentD8090 C 0.00 0.00 0.00 0.00 XXX 0.00 Compre dental tx adultD8210 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthodontic rem appliance txD8220 C 0.00 0.00 0.00 0.00 XXX 0.00 Fixed appliance therapy habtD8660 C 0.00 0.00 0.00 0.00 XXX 0.00 Preorthodontic tx visitD8670 C 0.00 0.00 0.00 0.00 XXX 0.00 Periodic orthodontc tx visitD8680 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthodontic retentionD8690 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthodontic treatmentD8691 C 0.00 0.00 0.00 0.00 XXX 0.00 Repair ortho applianceD8692 C 0.00 0.00 0.00 0.00 XXX 0.00 Replacement retainerD8999 S 0.00 0.00 0.00 0.00 XXX 0.00 Orthodontic procedure, nosD9110 C 0.00 0.00 0.00 0.00 YYY 0.00 Tx dental pain minor procD9210 C 0.00 0.00 0.00 0.00 XXX 0.00 Dent anesthesia w/o surgeryD9211 C 0.00 0.00 0.00 0.00 XXX 0.00 Regional block anesthesiaD9212 C 0.00 0.00 0.00 0.00 XXX 0.00 Trigeminal block anesthesiaD9215 C 0.00 0.00 0.00 0.00 XXX 0.00 Local anesthesiaD9220 C 0.00 0.00 0.00 0.00 XXX 0.00 General anesthesiaD9221 C 0.00 0.00 0.00 0.00 XXX 0.00 General anesthesia ea ad 15mD9230 C 0.00 0.00 0.00 0.00 YYY 0.00 AnalgesiaD9241 C 0.00 0.00 0.00 0.00 XXX 0.00 Intravenous sedationD9242 C 0.00 0.00 0.00 0.00 XXX 0.00 IV sedation ea ad 30 mD9248 C 0.00 0.00 0.00 0.00 XXX 0.00 Sedation (non-iv)D9310 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental consultationD9410 C 0.00 0.00 0.00 0.00 XXX 0.00 Dental house callD9420 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospital callD9430 C 0.00 0.00 0.00 0.00 XXX 0.00 Office visit during hoursD9440 C 0.00 0.00 0.00 0.00 XXX 0.00 Office visit after hoursD9450 C 0.00 0.00 0.00 0.00 XXX 0.00 Case presentation tx planD9610 C 0.00 0.00 0.00 0.00 XXX 0.00 Dent therapeutic drug injectD9630 C 0.00 0.00 0.00 0.00 YYY 0.00 Other drugs/medicamentsD9910 C 0.00 0.00 0.00 0.00 XXX 0.00 Dent appl desensitizing medD9911 C 0.00 0.00 0.00 0.00 XXX 0.00 Appl desensitizing resinD9920 C 0.00 0.00 0.00 0.00 XXX 0.00 Behavior managementD9930 C 0.00 0.00 0.00 0.00 YYY 0.00 Treatment of complicationsD9940 C 0.00 0.00 0.00 0.00 YYY 0.00 Dental occlusal guardD9941 C 0.00 0.00 0.00 0.00 XXX 0.00 Fabrication athletic guardD9942 C 0.00 0.00 0.00 0.00 XXX 0.00 Repair/reline occlusal guardD9950 C 0.00 0.00 0.00 0.00 YYY 0.00 Occlusion analysis
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
D9951 C 0.00 0.00 0.00 0.00 YYY 0.00 Limited occlusal adjustmentD9952 C 0.00 0.00 0.00 0.00 YYY 0.00 Complete occlusal adjustmentD9970 C 0.00 0.00 0.00 0.00 XXX 0.00 Enamel microabrasionD9971 C 0.00 0.00 0.00 0.00 XXX 0.00 Odontoplasty 1-2 teethD9972 C 0.00 0.00 0.00 0.00 XXX 0.00 Extrnl bleaching per archD9973 C 0.00 0.00 0.00 0.00 XXX 0.00 Extrnl bleaching per toothD9974 C 0.00 0.00 0.00 0.00 XXX 0.00 Intrnl bleaching per toothD9999 S 0.00 0.00 0.00 0.00 XXX 0.00 Adjunctive procedure, nosE0100 C 17.86 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed with tipE0100 C NU 42.87 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed with tipE0100 C RR 17.86 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed with tipE0100 C UE 32.17 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed with tipE0105 C 22.37 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed quad/3 proE0105 C NU 75.90 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed quad/3 proE0105 C RR 22.37 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed quad/3 proE0105 C UE 56.94 0.00 0.00 0.00 XXX 1.25 Cane adjust/fixed quad/3 proE0110 C 41.48 0.00 0.00 0.00 XXX 1.25 Crutch forearm pairE0110 C NU 124.20 0.00 0.00 0.00 XXX 1.25 Crutch forearm pairE0110 C RR 41.48 0.00 0.00 0.00 XXX 1.25 Crutch forearm pairE0110 C UE 93.15 0.00 0.00 0.00 XXX 1.25 Crutch forearm pairE0111 C 14.90 0.00 0.00 0.00 XXX 1.25 Crutch forearm eachE0111 C NU 70.60 0.00 0.00 0.00 XXX 1.25 Crutch forearm eachE0111 C RR 14.90 0.00 0.00 0.00 XXX 1.25 Crutch forearm eachE0111 C UE 52.93 0.00 0.00 0.00 XXX 1.25 Crutch forearm eachE0112 C 25.39 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair woodE0112 C NU 56.08 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair woodE0112 C RR 25.39 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair woodE0112 C UE 42.05 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair woodE0113 C 16.04 0.00 0.00 0.00 XXX 1.25 Crutch underarm each woodE0113 C NU 48.91 0.00 0.00 0.00 XXX 1.25 Crutch underarm each woodE0113 C RR 16.04 0.00 0.00 0.00 XXX 1.25 Crutch underarm each woodE0113 C UE 36.36 0.00 0.00 0.00 XXX 1.25 Crutch underarm each woodE0114 C 13.10 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair no woodE0114 C NU 77.84 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair no woodE0114 C RR 13.10 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair no woodE0114 C UE 58.39 0.00 0.00 0.00 XXX 1.25 Crutch underarm pair no woodE0116 C 6.75 0.00 0.00 0.00 XXX 1.25 Crutch underarm each no woodE0116 C NU 38.92 0.00 0.00 0.00 XXX 1.25 Crutch underarm each no woodE0116 C RR 6.75 0.00 0.00 0.00 XXX 1.25 Crutch underarm each no woodE0116 C UE 29.18 0.00 0.00 0.00 XXX 1.25 Crutch underarm each no woodE0117 C 28.90 0.00 0.00 0.00 XXX 1.25 Underarm springassist crutchE0117 C NU 289.06 0.00 0.00 0.00 XXX 1.25 Underarm springassist crutchE0117 C RR 28.90 0.00 0.00 0.00 XXX 1.25 Underarm springassist crutchE0117 C UE 216.81 0.00 0.00 0.00 XXX 1.25 Underarm springassist crutchE0118 C 0.00 0.00 0.00 0.00 XXX 0.00 Cruth substitute, lwr leg platformE0118 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Cruth substitute, lwr leg platformE0130 C 32.65 0.00 0.00 0.00 XXX 1.25 Walker rigid adjust/fixed htE0130 C NU 113.65 0.00 0.00 0.00 XXX 1.25 Walker rigid adjust/fixed htE0130 C RR 32.65 0.00 0.00 0.00 XXX 1.25 Walker rigid adjust/fixed htE0130 C UE 98.56 0.00 0.00 0.00 XXX 1.25 Walker rigid adjust/fixed htE0135 C 39.00 0.00 0.00 0.00 XXX 1.25 Walker folding adjust/fixedE0135 C NU 151.30 0.00 0.00 0.00 XXX 1.25 Walker folding adjust/fixedE0135 C RR 39.00 0.00 0.00 0.00 XXX 1.25 Walker folding adjust/fixedE0135 C UE 85.11 0.00 0.00 0.00 XXX 1.25 Walker folding adjust/fixed
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0140 C 54.10 0.00 0.00 0.00 XXX 1.25 Walker w trunk supportE0140 C NU 541.10 0.00 0.00 0.00 XXX 1.25 Walker w trunk supportE0140 C RR 54.10 0.00 0.00 0.00 XXX 1.25 Walker w trunk supportE0140 C UE 405.80 0.00 0.00 0.00 XXX 1.25 Walker w trunk supportE0141 C 46.76 0.00 0.00 0.00 XXX 1.25 Rigid walker wheeled wo seatE0141 C NU 182.36 0.00 0.00 0.00 XXX 1.25 Rigid wheeled walker adj/fixE0141 C RR 46.76 0.00 0.00 0.00 XXX 1.25 Rigid wheeled walker adj/fixE0141 C UE 136.77 0.00 0.00 0.00 XXX 1.25 Rigid wheeled walker adj/fixE0143 C 46.45 0.00 0.00 0.00 XXX 1.25 Walker folding wheeled w/o sE0143 C NU 190.31 0.00 0.00 0.00 XXX 1.25 Walker folding wheeled w/o sE0143 C RR 46.45 0.00 0.00 0.00 XXX 1.25 Walker folding wheeled w/o sE0143 C UE 142.73 0.00 0.00 0.00 XXX 1.25 Walker folding wheeled w/o sE0144 C 47.78 0.00 0.00 0.00 XXX 1.25 Enclosed walker w rear seatE0144 C NU 477.69 0.00 0.00 0.00 XXX 1.25 Enclosed walker w rear seatE0144 C RR 47.78 0.00 0.00 0.00 XXX 1.25 Enclosed walker w rear seatE0144 C UE 358.27 0.00 0.00 0.00 XXX 1.25 Enclosed walker w rear seatE0147 C 86.23 0.00 0.00 0.00 XXX 1.25 Walker variable wheel resistE0147 C NU 862.25 0.00 0.00 0.00 XXX 1.25 Walker variable wheel resistE0147 C RR 86.23 0.00 0.00 0.00 XXX 1.25 Walker variable wheel resistE0147 C UE 646.69 0.00 0.00 0.00 XXX 1.25 Walker variable wheel resistE0148 C 19.08 0.00 0.00 0.00 XXX 1.25 Heavyduty walker no wheelsE0148 C NU 190.59 0.00 0.00 0.00 XXX 1.25 Heavyduty walker no wheelsE0148 C RR 19.08 0.00 0.00 0.00 XXX 1.25 Heavyduty walker no wheelsE0148 C UE 142.95 0.00 0.00 0.00 XXX 1.25 Heavyduty walker no wheelsE0149 C 33.50 0.00 0.00 0.00 XXX 1.25 Heavy duty wheeled walkerE0149 C NU 334.79 0.00 0.00 0.00 XXX 1.25 Heavy duty wheeled walkerE0149 C RR 33.50 0.00 0.00 0.00 XXX 1.25 Heavy duty wheeled walkerE0149 C UE 251.10 0.00 0.00 0.00 XXX 1.25 Heavy duty wheeled walkerE0153 C 21.65 0.00 0.00 0.00 XXX 1.25 Forearm crutch platform attaE0153 C NU 111.60 0.00 0.00 0.00 XXX 1.25 Forearm crutch platform attaE0153 C RR 21.65 0.00 0.00 0.00 XXX 1.25 Forearm crutch platform attaE0153 C UE 83.70 0.00 0.00 0.00 XXX 1.25 Forearm crutch platform attaE0154 C 25.63 0.00 0.00 0.00 XXX 1.25 Walker platform attachmentE0154 C NU 129.83 0.00 0.00 0.00 XXX 1.25 Walker platform attachmentE0154 C RR 25.63 0.00 0.00 0.00 XXX 1.25 Walker platform attachmentE0154 C UE 97.35 0.00 0.00 0.00 XXX 1.25 Walker platform attachmentE0155 C 13.13 0.00 0.00 0.00 XXX 1.25 Walker wheel attachmentE0155 C NU 56.17 0.00 0.00 0.00 XXX 1.25 Walker wheel attachmentE0155 C RR 13.13 0.00 0.00 0.00 XXX 1.25 Walker wheel attachmentE0155 C UE 42.14 0.00 0.00 0.00 XXX 1.25 Walker wheel attachmentE0156 C 19.51 0.00 0.00 0.00 XXX 1.25 Walker seat attachmentE0156 C NU 156.13 0.00 0.00 0.00 XXX 1.25 Walker seat attachmentE0156 C RR 19.51 0.00 0.00 0.00 XXX 1.25 Walker seat attachmentE0156 C UE 117.10 0.00 0.00 0.00 XXX 1.25 Walker seat attachmentE0157 C 11.89 0.00 0.00 0.00 XXX 1.25 Walker crutch attachmentE0157 C NU 102.40 0.00 0.00 0.00 XXX 1.25 Walker crutch attachmentE0157 C RR 11.89 0.00 0.00 0.00 XXX 1.25 Walker crutch attachmentE0157 C UE 76.81 0.00 0.00 0.00 XXX 1.25 Walker crutch attachmentE0158 C 6.25 0.00 0.00 0.00 XXX 1.25 Walker leg extenders set of4E0158 C NU 49.95 0.00 0.00 0.00 XXX 1.25 Walker leg extenders set of4E0158 C RR 6.25 0.00 0.00 0.00 XXX 1.25 Walker leg extenders set of4E0158 C UE 37.46 0.00 0.00 0.00 XXX 1.25 Walker leg extenders set of4E0159 C 2.46 0.00 0.00 0.00 XXX 1.25 Brake for wheeled walkerE0159 C NU 24.56 0.00 0.00 0.00 XXX 1.25 Brake for wheeled walker
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0159 C RR 2.46 0.00 0.00 0.00 XXX 1.25 Brake for wheeled walkerE0159 C UE 18.44 0.00 0.00 0.00 XXX 1.25 Brake for wheeled walkerE0160 C 22.03 0.00 0.00 0.00 XXX 1.25 Sitz type bath or equipmentE0160 C NU 220.00 0.00 0.00 0.00 XXX 1.25 Sitz type bath or equipmentE0160 C RR 22.03 0.00 0.00 0.00 XXX 1.25 Sitz type bath or equipmentE0160 C UE 165.00 0.00 0.00 0.00 XXX 1.25 Sitz type bath or equipmentE0161 C 4.65 0.00 0.00 0.00 XXX 1.25 Sitz bath/equipment w/faucetE0161 C NU 37.10 0.00 0.00 0.00 XXX 1.25 Sitz bath/equipment w/faucetE0161 C RR 4.65 0.00 0.00 0.00 XXX 1.25 Sitz bath/equipment w/faucetE0161 C UE 27.83 0.00 0.00 0.00 XXX 1.25 Sitz bath/equipment w/faucetE0162 C 39.84 0.00 0.00 0.00 XXX 1.25 Sitz bath chairE0162 C NU 318.55 0.00 0.00 0.00 XXX 1.25 Sitz bath chairE0162 C RR 39.84 0.00 0.00 0.00 XXX 1.25 Sitz bath chairE0162 C UE 238.88 0.00 0.00 0.00 XXX 1.25 Sitz bath chairE0163 C 22.70 0.00 0.00 0.00 XXX 1.25 Commode chair stationry fxdE0163 C NU 181.66 0.00 0.00 0.00 XXX 1.25 Commode chair stationry fxdE0163 C RR 22.70 0.00 0.00 0.00 XXX 1.25 Commode chair stationry fxdE0163 C UE 136.25 0.00 0.00 0.00 XXX 1.25 Commode chair stationry fxdE0164 C 38.86 0.00 0.00 0.00 XXX 1.25 Commode chair mobile fixed aE0164 C NU 310.85 0.00 0.00 0.00 XXX 1.25 Commode chair mobile fixed aE0164 C RR 38.86 0.00 0.00 0.00 XXX 1.25 Commode chair mobile fixed aE0164 C UE 233.15 0.00 0.00 0.00 XXX 1.25 Commode chair mobile fixed aE0165 C 29.18 0.00 0.00 0.00 XXX 1.25 Commode chair stationry detE0165 C NU 291.80 0.00 0.00 0.00 XXX 1.25 Commode chair stationry detE0165 C RR 29.18 0.00 0.00 0.00 XXX 1.25 Commode chair stationry detE0165 C UE 218.85 0.00 0.00 0.00 XXX 1.25 Commode chair stationry detE0166 C 55.20 0.00 0.00 0.00 XXX 1.25 Commode chair mobile detachE0166 C NU 552.00 0.00 0.00 0.00 XXX 1.25 Commode chair mobile detachE0166 C RR 55.20 0.00 0.00 0.00 XXX 1.25 Commode chair mobile detachE0166 C UE 414.00 0.00 0.00 0.00 XXX 1.25 Commode chair mobile detachE0167 C 2.18 0.00 0.00 0.00 XXX 1.25 Commode chair pail or panE0167 C NU 17.45 0.00 0.00 0.00 XXX 1.25 Commode chair pail or panE0167 C RR 2.18 0.00 0.00 0.00 XXX 1.25 Commode chair pail or panE0167 C UE 13.08 0.00 0.00 0.00 XXX 1.25 Commode chair pail or panE0168 C 22.63 0.00 0.00 0.00 XXX 1.25 Heavyduty/wide commode chairE0168 C NU 226.39 0.00 0.00 0.00 XXX 1.25 Heavyduty/wide commode chairE0168 C RR 22.63 0.00 0.00 0.00 XXX 1.25 Heavyduty/wide commode chairE0168 C UE 169.78 0.00 0.00 0.00 XXX 1.25 Heavyduty/wide commode chairE0169 C 74.32 0.00 0.00 0.00 XXX 1.25 12/31/2005 Commode chair w/seat lift mechE0169 C NU 743.20 0.00 0.00 0.00 XXX 1.25 12/31/2005 Commode chair w/seat lift mechE0169 C RR 74.32 0.00 0.00 0.00 XXX 1.25 12/31/2005 Seatlift incorp commodechairE0169 C UE 557.40 0.00 0.00 0.00 XXX 1.25 12/31/2005 Commode chair w/seat lift mechE0170 C 241.10 0.00 0.00 0.00 XXX 1.25 Commode chair electricE0170 C NU 602.75 0.00 0.00 0.00 XXX 5.00 Commode chair electricE0170 C RR 241.10 0.00 0.00 0.00 XXX 1.25 Commode chair electricE0170 C UE 904.12 0.00 0.00 0.00 XXX 2.50 Commode chair electricE0171 C 43.41 0.00 0.00 0.00 XXX 1.25 Commode chair non-electricE0171 C NU 434.10 0.00 0.00 0.00 XXX 1.25 Commode chair non-electricE0171 C RR 43.41 0.00 0.00 0.00 XXX 1.25 Commode chair non-electricE0171 C UE 325.58 0.00 0.00 0.00 XXX 1.25 Commode chair non-electricE0172 C 0.00 0.00 0.00 0.00 XXX 0.00 Seat lift mechanism toiletE0175 C 10.90 0.00 0.00 0.00 XXX 1.25 Commode chair foot restE0175 C NU 87.22 0.00 0.00 0.00 XXX 1.25 Commode chair foot restE0175 C RR 10.90 0.00 0.00 0.00 XXX 1.25 Commode chair foot rest
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0175 C UE 65.43 0.00 0.00 0.00 XXX 1.25 Commode chair foot restE0180 C 38.38 0.00 0.00 0.00 XXX 1.25 Press pad alternating w pumpE0180 C NU 383.80 0.00 0.00 0.00 XXX 1.25 Press pad alternating w pumpE0180 C RR 38.38 0.00 0.00 0.00 XXX 1.25 Press pad alternating w pumpE0180 C UE 287.85 0.00 0.00 0.00 XXX 1.25 Press pad alternating w pumpE0181 C 43.34 0.00 0.00 0.00 XXX 1.25 Press pad alternating w/ pumE0181 C NU 433.40 0.00 0.00 0.00 XXX 1.25 Press pad alternating w/ pumE0181 C RR 43.34 0.00 0.00 0.00 XXX 1.25 Press pad alternating w/ pumE0181 C UE 325.05 0.00 0.00 0.00 XXX 1.25 Press pad alternating w/ pumE0182 C 41.33 0.00 0.00 0.00 XXX 1.25 Pressure pad alternating pumE0182 C NU 413.30 0.00 0.00 0.00 XXX 1.25 Pressure pad alternating pumE0182 C RR 41.33 0.00 0.00 0.00 XXX 1.25 Pressure pad alternating pumE0182 C UE 309.98 0.00 0.00 0.00 XXX 1.25 Pressure pad alternating pumE0184 C 36.12 0.00 0.00 0.00 XXX 1.25 Dry pressure mattressE0184 C NU 288.99 0.00 0.00 0.00 XXX 1.25 Dry pressure mattressE0184 C RR 36.12 0.00 0.00 0.00 XXX 1.25 Dry pressure mattressE0184 C UE 216.74 0.00 0.00 0.00 XXX 1.25 Dry pressure mattressE0185 C 76.92 0.00 0.00 0.00 XXX 1.25 Gel pressure mattress padE0185 C NU 615.35 0.00 0.00 0.00 XXX 1.25 Gel pressure mattress padE0185 C RR 76.92 0.00 0.00 0.00 XXX 1.25 Gel pressure mattress padE0185 C UE 461.51 0.00 0.00 0.00 XXX 1.25 Gel pressure mattress padE0186 C 60.52 0.00 0.00 0.00 XXX 1.25 Air pressure mattressE0186 C NU 605.20 0.00 0.00 0.00 XXX 1.25 Air pressure mattressE0186 C RR 60.52 0.00 0.00 0.00 XXX 1.25 Air pressure mattressE0186 C UE 453.90 0.00 0.00 0.00 XXX 1.25 Air pressure mattressE0187 C 60.52 0.00 0.00 0.00 XXX 1.25 Water pressure mattressE0187 C NU 605.20 0.00 0.00 0.00 XXX 1.25 Water pressure mattressE0187 C RR 60.52 0.00 0.00 0.00 XXX 1.25 Water pressure mattressE0187 C UE 453.90 0.00 0.00 0.00 XXX 1.25 Water pressure mattressE0188 C 5.82 0.00 0.00 0.00 XXX 1.25 Synthetic sheepskin padE0188 C NU 58.24 0.00 0.00 0.00 XXX 1.25 Synthetic sheepskin padE0188 C RR 5.82 0.00 0.00 0.00 XXX 1.25 Synthetic sheepskin padE0188 C UE 43.66 0.00 0.00 0.00 XXX 1.25 Synthetic sheepskin padE0189 C 13.98 0.00 0.00 0.00 XXX 1.25 Lambswool sheepskin pad, any sizeE0189 C NU 139.69 0.00 0.00 0.00 XXX 1.25 Lambswool sheepskin padE0189 C RR 13.98 0.00 0.00 0.00 XXX 1.25 Lambswool sheepskin padE0189 C UE 104.77 0.00 0.00 0.00 XXX 1.25 Lambswool sheepskin padE0190 C 0.00 0.00 0.00 0.00 XXX 0.00 Positioning cushionE0190 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Positioning cushionE0191 C 1.96 0.00 0.00 0.00 XXX 1.25 Protector heel or elbowE0191 C NU 15.85 0.00 0.00 0.00 XXX 1.25 Protector heel or elbowE0191 C RR 1.96 0.00 0.00 0.00 XXX 1.25 Protector heel or elbowE0191 C UE 11.89 0.00 0.00 0.00 XXX 1.25 Protector heel or elbowE0193 C 689.20 0.00 0.00 0.00 XXX 2.50 Powered air flotation bedE0193 C NU 861.49 0.00 0.00 0.00 XXX 20.00 Powered air flotation bedE0193 C RR 689.20 0.00 0.00 0.00 XXX 2.50 Powered air flotation bedE0193 C UE 861.49 0.00 0.00 0.00 XXX 15.00 Powered air flotation bedE0194 C 714.02 0.00 0.00 0.00 XXX 7.50 Air fluidized bedE0194 C NU 973.66 0.00 0.00 0.00 XXX 55.00 Air fluidized bedE0194 C RR 714.02 0.00 0.00 0.00 XXX 7.50 Air fluidized bedE0194 C UE 803.27 0.00 0.00 0.00 XXX 50.00 Air fluidized bedE0196 C 60.52 0.00 0.00 0.00 XXX 1.25 Gel pressure mattressE0196 C NU 605.20 0.00 0.00 0.00 XXX 1.25 Gel pressure mattressE0196 C RR 60.52 0.00 0.00 0.00 XXX 1.25 Gel pressure mattress
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0196 C UE 453.90 0.00 0.00 0.00 XXX 1.25 Gel pressure mattressE0197 C 61.53 0.00 0.00 0.00 XXX 1.25 Air pressure pad for mattresE0197 C NU 615.35 0.00 0.00 0.00 XXX 1.25 Air pressure pad for mattresE0197 C RR 61.53 0.00 0.00 0.00 XXX 1.25 Air pressure pad for mattresE0197 C UE 461.51 0.00 0.00 0.00 XXX 1.25 Air pressure pad for mattresE0198 C 72.79 0.00 0.00 0.00 XXX 1.25 Water pressure pad for mattrE0198 C NU 727.89 0.00 0.00 0.00 XXX 1.25 Water pressure pad for mattrE0198 C RR 72.79 0.00 0.00 0.00 XXX 1.25 Water pressure pad for mattrE0198 C UE 545.91 0.00 0.00 0.00 XXX 1.25 Water pressure pad for mattrE0199 C 26.43 0.00 0.00 0.00 XXX 1.25 Dry pressure pad for mattresE0199 C NU 264.34 0.00 0.00 0.00 XXX 1.25 Dry pressure pad for mattresE0199 C RR 26.43 0.00 0.00 0.00 XXX 1.25 Dry pressure pad for mattresE0199 C UE 198.23 0.00 0.00 0.00 XXX 1.25 Dry pressure pad for mattresE0200 C 20.82 0.00 0.00 0.00 XXX 1.25 Heat lamp without standE0200 C NU 208.14 0.00 0.00 0.00 XXX 1.25 Heat lamp without standE0200 C RR 20.82 0.00 0.00 0.00 XXX 1.25 Heat lamp without standE0200 C UE 156.09 0.00 0.00 0.00 XXX 1.25 Heat lamp without standE0202 C 281.20 0.00 0.00 0.00 XXX 1.25 Phototherapy light w/ photomE0202 C NU 703.00 0.00 0.00 0.00 XXX 5.00 Phototherapy light w/ photomE0202 C RR 281.20 0.00 0.00 0.00 XXX 1.25 Phototherapy light w/ photomE0202 C UE 527.25 0.00 0.00 0.00 XXX 5.00 Phototherapy light w/ photomE0203 C 0.00 0.00 0.00 0.00 XXX 0.00 Therapeutic lightbox tabletpE0203 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Therapeutic lightbox tabletpE0203 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Therapeutic lightbox tabletpE0203 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Therapeutic lightbox tabletpE0205 C 32.51 0.00 0.00 0.00 XXX 1.25 Heat lamp with standE0205 C NU 325.10 0.00 0.00 0.00 XXX 1.25 Heat lamp with standE0205 C RR 32.51 0.00 0.00 0.00 XXX 1.25 Heat lamp with standE0205 C UE 243.80 0.00 0.00 0.00 XXX 1.25 Heat lamp with standE0210 C 11.21 0.00 0.00 0.00 XXX 1.25 Electric heat pad standardE0210 C NU 112.05 0.00 0.00 0.00 XXX 1.25 Electric heat pad standardE0210 C RR 11.21 0.00 0.00 0.00 XXX 1.25 Electric heat pad standardE0210 C UE 81.44 0.00 0.00 0.00 XXX 1.25 Electric heat pad standardE0215 C 13.63 0.00 0.00 0.00 XXX 1.25 Electric heat pad moistE0215 C NU 136.27 0.00 0.00 0.00 XXX 1.25 Electric heat pad moistE0215 C RR 13.63 0.00 0.00 0.00 XXX 1.25 Electric heat pad moistE0215 C UE 102.20 0.00 0.00 0.00 XXX 1.25 Electric heat pad moistE0217 C 88.92 0.00 0.00 0.00 XXX 1.25 Water circ heat pad w pumpE0217 C NU 809.78 0.00 0.00 0.00 XXX 1.25 Water circ heat pad w pumpE0217 C RR 88.92 0.00 0.00 0.00 XXX 1.25 Water circ heat pad w pumpE0217 C UE 607.36 0.00 0.00 0.00 XXX 1.25 Water circ heat pad w pumpE0218 C 0.00 0.00 0.00 0.00 XXX 0.00 H20 circulating cold pad w/pumpE0220 C 1.42 0.00 0.00 0.00 XXX 1.25 Hot water bottleE0220 C NU 11.41 0.00 0.00 0.00 XXX 1.25 Hot water bottleE0220 C RR 1.42 0.00 0.00 0.00 XXX 1.25 Hot water bottleE0220 C UE 8.56 0.00 0.00 0.00 XXX 1.25 Hot water bottleE0221 C 223.33 0.00 0.00 0.00 XXX 1.25 Infrared heating pad sysE0221 C NU 558.34 0.00 0.00 0.00 XXX 5.00 Infrared heating pad systemE0221 C RR 223.33 0.00 0.00 0.00 XXX 1.25 Infrared heating pad systemE0221 C UE 837.52 0.00 0.00 0.00 XXX 2.50 Infrared heating pad systemE0225 C 74.88 0.00 0.00 0.00 XXX 1.25 Hydrocollator unitE0225 C NU 598.97 0.00 0.00 0.00 XXX 1.25 Hydrocollator unitE0225 C RR 74.88 0.00 0.00 0.00 XXX 1.25 Hydrocollator unitE0225 C UE 449.24 0.00 0.00 0.00 XXX 1.25 Hydrocollator unit
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0230 C 2.16 0.00 0.00 0.00 XXX 1.25 Ice cap or collarE0230 C NU 17.27 0.00 0.00 0.00 XXX 1.25 Ice cap or collarE0230 C RR 2.16 0.00 0.00 0.00 XXX 1.25 Ice cap or collarE0230 C UE 12.99 0.00 0.00 0.00 XXX 1.25 Ice cap or collarE0231 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-contact wound warm deviceE0231 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Non-contact wound warm deviceE0231 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Non-contact wound warm deviceE0231 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Non-contact wound warm deviceE0232 C 0.00 0.00 0.00 0.00 XXX 0.00 Warming card for use w/E0231E0232 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Warming card for use w/E0231E0232 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Warming card for use w/E0231E0232 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Warming card for use w/E0231E0235 C 43.96 0.00 0.00 0.00 XXX 1.25 Paraffin bath unit portableE0235 C NU 439.60 0.00 0.00 0.00 XXX 1.25 Paraffin bath unit portableE0235 C RR 43.96 0.00 0.00 0.00 XXX 1.25 Paraffin bath unit portableE0235 C UE 329.70 0.00 0.00 0.00 XXX 1.25 Paraffin bath unit portableE0236 C 77.19 0.00 0.00 0.00 XXX 1.25 Pump for water circulating pE0236 C NU 771.90 0.00 0.00 0.00 XXX 1.25 Pump for water circulating pE0236 C RR 77.19 0.00 0.00 0.00 XXX 1.25 Pump for water circulating pE0236 C UE 578.93 0.00 0.00 0.00 XXX 1.25 Pump for water circulating pE0238 C 9.80 0.00 0.00 0.00 XXX 1.25 Heat pad non-electric moistE0238 C NU 98.14 0.00 0.00 0.00 XXX 1.25 Heat pad non-electric moistE0238 C RR 9.80 0.00 0.00 0.00 XXX 1.25 Heat pad non-electric moistE0238 C UE 73.60 0.00 0.00 0.00 XXX 1.25 Heat pad non-electric moistE0239 C 211.56 0.00 0.00 0.00 XXX 1.25 Hydrocollator unit portableE0239 C NU 528.93 0.00 0.00 0.00 XXX 5.00 Hydrocollator unit portableE0239 C RR 211.56 0.00 0.00 0.00 XXX 1.25 Hydrocollator unit portableE0239 C UE 793.38 0.00 0.00 0.00 XXX 2.50 Hydrocollator unit portableE0240 C 0.00 0.00 0.00 0.00 XXX 0.00 Bath/shower chairE0240 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Bath/shower chairE0240 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Bath/shower chairE0240 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Bath/shower chairE0241 C 0.00 0.00 0.00 0.00 XXX 0.00 Bathtub wall rail, eachE0242 C 0.00 0.00 0.00 0.00 XXX 0.00 Bathtub rail, floor baseE0243 C 0.00 0.00 0.00 0.00 XXX 0.00 Toilet rail, eachE0244 C 0.00 0.00 0.00 0.00 XXX 0.00 Raised toilet seatE0245 C 0.00 0.00 0.00 0.00 XXX 0.00 Tub stool or benchE0246 C 0.00 0.00 0.00 0.00 XXX 0.00 Transfer tub rail attachmentE0247 C 0.00 0.00 0.00 0.00 XXX 0.00 Trans bench w/wo comm openE0247 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Trans bench w/wo comm openE0247 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Trans bench w/wo comm openE0247 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Trans bench w/wo comm openE0248 C 0.00 0.00 0.00 0.00 XXX 0.00 HDtrans bench w/wo comm openE0248 C NU 0.00 0.00 0.00 0.00 XXX 0.00 HDtrans bench w/wo comm openE0248 C RR 0.00 0.00 0.00 0.00 XXX 0.00 HDtrans bench w/wo comm openE0248 C UE 0.00 0.00 0.00 0.00 XXX 0.00 HDtrans bench w/wo comm openE0249 C 19.84 0.00 0.00 0.00 XXX 1.25 Pad water circulating heat uE0249 C NU 192.06 0.00 0.00 0.00 XXX 1.25 Pad water circulating heat uE0249 C RR 19.84 0.00 0.00 0.00 XXX 1.25 Pad water circulating heat uE0249 C UE 144.04 0.00 0.00 0.00 XXX 1.25 Pad water circulating heat uE0250 C 164.70 0.00 0.00 0.00 XXX 1.25 Hosp bed fixed ht w/ mattresE0250 C NU 823.50 0.00 0.00 0.00 XXX 2.50 Hosp bed fixed ht w/ mattresE0250 C RR 164.70 0.00 0.00 0.00 XXX 1.25 Hosp bed fixed ht w/ mattresE0250 C UE 617.63 0.00 0.00 0.00 XXX 2.50 Hosp bed fixed ht w/ mattres
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0251 C 125.02 0.00 0.00 0.00 XXX 1.25 Hosp bed fixd ht w/o mattresE0251 C NU 625.10 0.00 0.00 0.00 XXX 2.50 Hosp bed fixd ht w/o mattresE0251 C RR 125.02 0.00 0.00 0.00 XXX 1.25 Hosp bed fixd ht w/o mattresE0251 C UE 937.65 0.00 0.00 0.00 XXX 1.25 Hosp bed fixd ht w/o mattresE0255 C 209.61 0.00 0.00 0.00 XXX 1.25 Hospital bed var ht w/ mattrE0255 C NU 524.03 0.00 0.00 0.00 XXX 5.00 Hospital bed var ht w/ mattrE0255 C RR 209.61 0.00 0.00 0.00 XXX 1.25 Hospital bed var ht w/ mattrE0255 C UE 786.04 0.00 0.00 0.00 XXX 2.50 Hospital bed var ht w/ mattrE0256 C 156.25 0.00 0.00 0.00 XXX 1.25 Hospital bed var ht w/o mattE0256 C NU 781.25 0.00 0.00 0.00 XXX 2.50 Hospital bed var ht w/o mattE0256 C RR 156.25 0.00 0.00 0.00 XXX 1.25 Hospital bed var ht w/o mattE0256 C UE 585.94 0.00 0.00 0.00 XXX 2.50 Hospital bed var ht w/o mattE0260 C 243.02 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-electr w/ mattE0260 C NU 607.55 0.00 0.00 0.00 XXX 5.00 Hosp bed semi-electr w/ mattE0260 C RR 243.02 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-electr w/ mattE0260 C UE 455.66 0.00 0.00 0.00 XXX 5.00 Hosp bed semi-electr w/ mattE0261 C 175.59 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-electr w/o matE0261 C NU 877.95 0.00 0.00 0.00 XXX 2.50 Hosp bed semi-electr w/o matE0261 C RR 175.59 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-electr w/o matE0261 C UE 658.46 0.00 0.00 0.00 XXX 2.50 Hosp bed semi-electr w/o matE0265 C 356.95 0.00 0.00 0.00 XXX 1.25 Hosp bed total electr w/ matE0265 C NU 892.38 0.00 0.00 0.00 XXX 5.00 Hosp bed total electr w/ matE0265 C RR 356.95 0.00 0.00 0.00 XXX 1.25 Hosp bed total electr w/ matE0265 C UE 669.28 0.00 0.00 0.00 XXX 5.00 Hosp bed total electr w/ matE0266 C 317.04 0.00 0.00 0.00 XXX 1.25 Hosp bed total elec w/o mattE0266 C NU 792.60 0.00 0.00 0.00 XXX 5.00 Hosp bed total elec w/o mattE0266 C RR 317.04 0.00 0.00 0.00 XXX 1.25 Hosp bed total elec w/o mattE0266 C UE 594.45 0.00 0.00 0.00 XXX 5.00 Hosp bed total elec w/o mattE0270 C 0.00 0.00 0.00 0.00 XXX 0.00 Hosp bed institu type w/matE0271 C 43.21 0.00 0.00 0.00 XXX 1.25 Mattress innerspringE0271 C NU 432.13 0.00 0.00 0.00 XXX 1.25 Mattress innerspringE0271 C RR 43.21 0.00 0.00 0.00 XXX 1.25 Mattress innerspringE0271 C UE 324.11 0.00 0.00 0.00 XXX 1.25 Mattress innerspringE0272 C 36.68 0.00 0.00 0.00 XXX 1.25 Mattress foam rubberE0272 C NU 293.36 0.00 0.00 0.00 XXX 1.25 Mattress foam rubberE0272 C RR 36.68 0.00 0.00 0.00 XXX 1.25 Mattress foam rubberE0272 C UE 220.05 0.00 0.00 0.00 XXX 1.25 Mattress foam rubberE0273 C 0.00 0.00 0.00 0.00 XXX 0.00 Bed boardE0273 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Bed boardE0273 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Bed boardE0273 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Bed boardE0274 C 0.00 0.00 0.00 0.00 XXX 0.00 Over-bed tableE0274 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Over-bed tableE0274 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Over-bed tableE0274 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Over-bed tableE0275 C 2.43 0.00 0.00 0.00 XXX 1.25 Bed pan standardE0275 C NU 23.26 0.00 0.00 0.00 XXX 1.25 Bed pan standardE0275 C RR 2.43 0.00 0.00 0.00 XXX 1.25 Bed pan standardE0275 C UE 17.46 0.00 0.00 0.00 XXX 1.25 Bed pan standardE0276 C 3.05 0.00 0.00 0.00 XXX 1.25 Bed pan fractureE0276 C NU 24.39 0.00 0.00 0.00 XXX 1.25 Bed pan fractureE0276 C RR 3.05 0.00 0.00 0.00 XXX 1.25 Bed pan fractureE0276 C UE 18.29 0.00 0.00 0.00 XXX 1.25 Bed pan fractureE0277 C 879.40 0.00 0.00 0.00 XXX 1.25 Powered pres-redu air mattrs
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0277 C NU 879.40 0.00 0.00 0.00 XXX 12.50 Powered pres-redu air mattrsE0277 C RR 879.40 0.00 0.00 0.00 XXX 1.25 Powered pres-redu air mattrsE0277 C UE 824.44 0.00 0.00 0.00 XXX 10.00 Powered pres-redu air mattrsE0280 C 9.85 0.00 0.00 0.00 XXX 1.25 Bed cradleE0280 C NU 79.01 0.00 0.00 0.00 XXX 1.25 Bed cradleE0280 C RR 9.85 0.00 0.00 0.00 XXX 1.25 Bed cradleE0280 C UE 59.25 0.00 0.00 0.00 XXX 1.25 Bed cradleE0290 C 124.74 0.00 0.00 0.00 XXX 1.25 Hosp bed fx ht w/o rails w/mE0290 C NU 623.70 0.00 0.00 0.00 XXX 2.50 Hosp bed fx ht w/o rails w/mE0290 C RR 124.74 0.00 0.00 0.00 XXX 1.25 Hosp bed fx ht w/o rails w/mE0290 C UE 935.55 0.00 0.00 0.00 XXX 1.25 Hosp bed fx ht w/o rails w/mE0291 C 90.10 0.00 0.00 0.00 XXX 1.25 Hosp bed fx ht w/o rail w/oE0291 C NU 901.00 0.00 0.00 0.00 XXX 1.25 Hosp bed fx ht w/o rail w/oE0291 C RR 90.10 0.00 0.00 0.00 XXX 1.25 Hosp bed fx ht w/o rail w/oE0291 C UE 675.75 0.00 0.00 0.00 XXX 1.25 Hosp bed fx ht w/o rail w/oE0292 C 163.90 0.00 0.00 0.00 XXX 1.25 Hosp bed var ht w/o rail w/oE0292 C NU 819.50 0.00 0.00 0.00 XXX 2.50 Hosp bed var ht w/o rail w/oE0292 C RR 163.90 0.00 0.00 0.00 XXX 1.25 Hosp bed var ht w/o rail w/oE0292 C UE 614.63 0.00 0.00 0.00 XXX 2.50 Hosp bed var ht w/o rail w/oE0293 C 137.43 0.00 0.00 0.00 XXX 1.25 Hosp bed var ht w/o rail w/E0293 C NU 687.15 0.00 0.00 0.00 XXX 2.50 Hosp bed var ht w/o rail w/E0293 C RR 137.43 0.00 0.00 0.00 XXX 1.25 Hosp bed var ht w/o rail w/E0293 C UE 515.37 0.00 0.00 0.00 XXX 2.50 Hosp bed var ht w/o rail w/E0294 C 250.64 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-elect w/ mattrE0294 C NU 626.60 0.00 0.00 0.00 XXX 5.00 Hosp bed semi-elect w/ mattrE0294 C RR 250.64 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-elect w/ mattrE0294 C UE 939.90 0.00 0.00 0.00 XXX 2.50 Hosp bed semi-elect w/ mattrE0295 C 172.69 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-elect w/o mattE0295 C NU 863.45 0.00 0.00 0.00 XXX 2.50 Hosp bed semi-elect w/o mattE0295 C RR 172.69 0.00 0.00 0.00 XXX 1.25 Hosp bed semi-elect w/o mattE0295 C UE 647.59 0.00 0.00 0.00 XXX 2.50 Hosp bed semi-elect w/o mattE0296 C 273.45 0.00 0.00 0.00 XXX 1.25 Hosp bed total elect w/ mattE0296 C NU 683.63 0.00 0.00 0.00 XXX 5.00 Hosp bed total elect w/ mattE0296 C RR 273.45 0.00 0.00 0.00 XXX 1.25 Hosp bed total elect w/ mattE0296 C UE 512.72 0.00 0.00 0.00 XXX 5.00 Hosp bed total elect w/ mattE0297 C 238.71 0.00 0.00 0.00 XXX 1.25 Hosp bed total elect w/o matE0297 C NU 596.78 0.00 0.00 0.00 XXX 5.00 Hosp bed total elect w/o matE0297 C RR 238.71 0.00 0.00 0.00 XXX 1.25 Hosp bed total elect w/o matE0297 C UE 895.16 0.00 0.00 0.00 XXX 2.50 Hosp bed total elect w/o matE0300 D 425.80 0.00 0.00 0.00 XXX 1.25 Enclosed ped crib hosp gradeE0300 D NU 709.65 0.00 0.00 0.00 XXX 7.50 Enclosed ped crib hosp gradeE0300 D RR 425.80 0.00 0.00 0.00 XXX 1.25 Enclosed ped crib hosp gradeE0300 D UE 798.36 0.00 0.00 0.00 XXX 5.00 Enclosed ped crib hosp gradeE0301 C 404.94 0.00 0.00 0.00 XXX 1.25 HD hosp bedE0301 C NU 674.90 0.00 0.00 0.00 XXX 7.50 HD hosp bedE0301 C RR 404.94 0.00 0.00 0.00 XXX 1.25 HD hosp bedE0301 C UE 759.26 0.00 0.00 0.00 XXX 5.00 HD hosp bedE0302 C 543.49 0.00 0.00 0.00 XXX 2.50 Ex hd hosp bed > 600 lbsE0302 C NU 905.82 0.00 0.00 0.00 XXX 15.00 Ex hd hosp bed > 600 lbsE0302 C RR 543.49 0.00 0.00 0.00 XXX 2.50 Ex hd hosp bed > 600 lbsE0302 C UE 815.24 0.00 0.00 0.00 XXX 12.50 Ex hd hosp bed > 600 lbsE0303 C 446.51 0.00 0.00 0.00 XXX 1.25 Hosp bed hvy dty xtra wideE0303 C NU 744.18 0.00 0.00 0.00 XXX 7.50 Hosp bed hvy dty xtra wideE0303 C RR 446.51 0.00 0.00 0.00 XXX 1.25 Hosp bed hvy dty xtra wide
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0303 C UE 837.21 0.00 0.00 0.00 XXX 5.00 Hosp bed hvy dty xtra wideE0304 C 578.00 0.00 0.00 0.00 XXX 2.50 Hosp bed xtra hvy dty x wideE0304 C NU 963.33 0.00 0.00 0.00 XXX 15.00 Hosp bed xtra hvy dty x wideE0304 C RR 578.00 0.00 0.00 0.00 XXX 2.50 Hosp bed xtra hvy dty x wideE0304 C UE 867.00 0.00 0.00 0.00 XXX 12.50 Hosp bed xtra hvy dty x wideE0305 C 26.20 0.00 0.00 0.00 XXX 1.25 Rails bed side half lengthE0305 C NU 262.00 0.00 0.00 0.00 XXX 1.25 Rails bed side half lengthE0305 C RR 26.20 0.00 0.00 0.00 XXX 1.25 Rails bed side half lengthE0305 C UE 196.50 0.00 0.00 0.00 XXX 1.25 Rails bed side half lengthE0310 C 25.71 0.00 0.00 0.00 XXX 1.25 Rails bed side full lengthE0310 C NU 257.12 0.00 0.00 0.00 XXX 1.25 Rails bed side full lengthE0310 C RR 25.71 0.00 0.00 0.00 XXX 1.25 Rails bed side full lengthE0310 C UE 206.73 0.00 0.00 0.00 XXX 1.25 Rails bed side full lengthE0315 C 0.00 0.00 0.00 0.00 XXX 0.00 Bed accessory; board/table/supportE0316 C 301.08 0.00 0.00 0.00 XXX 1.25 Safety enclos frame/canopy for hosp bedE0316 C NU 752.70 0.00 0.00 0.00 XXX 5.00 Safety enclos frame/canopy for hosp bedE0316 C RR 301.08 0.00 0.00 0.00 XXX 1.25 Bed safety enclosureE0316 C UE 564.53 0.00 0.00 0.00 XXX 5.00 Safety enclos frame/canopy for hosp bedE0325 C 1.41 0.00 0.00 0.00 XXX 1.25 Urinal male jug-typeE0325 C NU 14.03 0.00 0.00 0.00 XXX 1.25 Urinal male jug-typeE0325 C RR 1.41 0.00 0.00 0.00 XXX 1.25 Urinal male jug-typeE0325 C UE 10.54 0.00 0.00 0.00 XXX 1.25 Urinal male jug-typeE0326 C 2.18 0.00 0.00 0.00 XXX 1.25 Urinal female jug-typeE0326 C NU 21.75 0.00 0.00 0.00 XXX 1.25 Urinal female jug-typeE0326 C RR 2.18 0.00 0.00 0.00 XXX 1.25 Urinal female jug-typeE0326 C UE 16.59 0.00 0.00 0.00 XXX 1.25 Urinal female jug-typeE0350 C 0.00 0.00 0.00 0.00 XXX 0.00 Cont unit, electronic bowel irrigaE0352 C 0.00 0.00 0.00 0.00 XXX 0.00 Dispos pack, use w/electronic irrigaE0370 C 0.00 0.00 0.00 0.00 XXX 0.00 Air elevator for heelE0370 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Air elevator for heelE0370 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Air elevator for heelE0370 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Air elevator for heelE0371 C 651.55 0.00 0.00 0.00 XXX 1.25 Nonpower mattress overlayE0371 C NU 814.44 0.00 0.00 0.00 XXX 10.00 Nonpower mattress overlayE0371 C RR 651.55 0.00 0.00 0.00 XXX 1.25 Nonpower mattress overlayE0371 C UE 814.44 0.00 0.00 0.00 XXX 7.50 Nonpower mattress overlayE0372 C 790.63 0.00 0.00 0.00 XXX 1.25 Powered air mattress overlayE0372 C NU 988.29 0.00 0.00 0.00 XXX 10.00 Powered air mattress overlayE0372 C RR 790.63 0.00 0.00 0.00 XXX 1.25 Powered air mattress overlayE0372 C UE 988.29 0.00 0.00 0.00 XXX 7.50 Powered air mattress overlayE0373 C 905.66 0.00 0.00 0.00 XXX 1.25 Nonpowered pressure mattressE0373 C NU 905.66 0.00 0.00 0.00 XXX 12.50 Nonpowered pressure mattressE0373 C RR 905.66 0.00 0.00 0.00 XXX 1.25 Nonpowered pressure mattressE0373 C UE 849.06 0.00 0.00 0.00 XXX 10.00 Nonpowered pressure mattressE0424 C 250.51 0.00 0.00 0.00 XXX 1.25 Stationary compressed gas 02, rentalE0424 C RR 250.51 0.00 0.00 0.00 XXX 1.25 Stationary compressed gas 02, rentalE0425 C 0.00 0.00 0.00 0.00 XXX 0.00 Stationary compressed gas 02, purchaseE0425 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Stationary compressed gas 02, purchaseE0425 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Stationary compressed gas 02, purchaseE0430 C 139.61 0.00 0.00 0.00 XXX 1.25 Portable gaseous 02, purchaseE0430 C NU 186.14 0.00 0.00 0.00 XXX 1.25 Portable gaseous 02, purchaseE0430 C UE 139.61 0.00 0.00 0.00 XXX 1.25 Portable gaseous 02, purchaseE0431 C 40.10 0.00 0.00 0.00 XXX 1.25 Portable gaseous 02, rentalE0431 C RR 40.10 0.00 0.00 0.00 XXX 1.25 Portable gaseous 02, rental
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0434 C 40.10 0.00 0.00 0.00 XXX 1.25 Portable liquid 02, rentalE0434 C RR 40.10 0.00 0.00 0.00 XXX 1.25 Portable liquid 02, rentalE0435 C 139.61 0.00 0.00 0.00 XXX 1.25 Portable liquid 02, purchaseE0435 C NU 186.14 0.00 0.00 0.00 XXX 1.25 Portable liquid 02, purchaseE0435 C UE 139.61 0.00 0.00 0.00 XXX 1.25 Portable liquid 02, purchaseE0439 C 250.51 0.00 0.00 0.00 XXX 1.25 Stationary liquid 02, rentalE0439 C RR 250.51 0.00 0.00 0.00 XXX 1.25 Stationary liquid 02, rentalE0440 C 888.03 0.00 0.00 0.00 XXX 1.25 Stationary liquid 02, purchaseE0440 C NU 592.02 0.00 0.00 0.00 XXX 2.50 Stationary liquid 02, purchaseE0440 C UE 888.03 0.00 0.00 0.00 XXX 1.25 Stationary liquid 02, purchaseE0441 C 247.65 0.00 0.00 0.00 XXX 1.25 Oxygen contentsE0442 C 247.65 0.00 0.00 0.00 XXX 1.25 Oxygen contentsE0443 C 55.45 0.00 0.00 0.00 XXX 1.25 Portable 02 contentsE0444 C 55.45 0.00 0.00 0.00 XXX 1.25 Portable 02 contentsE0445 C 0.00 0.00 0.00 0.00 XXX 0.00 Oximeter non-invasiveE0445 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Oximeter non-invasiveE0445 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Oximeter non-invasiveE0445 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Oximeter non-invasiveE0450 C 991.89 0.00 0.00 0.00 XXX 2.50 Volume vent stationary/portaE0450 C NU 991.89 0.00 0.00 0.00 XXX 25.00 Volume vent stationary/portaE0450 C RR 991.89 0.00 0.00 0.00 XXX 2.50 Volume vent stationary/portaE0450 C UE 929.90 0.00 0.00 0.00 XXX 20.00 Volume vent stationary/portaE0455 C 0.00 0.00 0.00 0.00 XXX 0.00 O2 tent, excl croup/pediatric tentsE0457 C 92.17 0.00 0.00 0.00 XXX 1.25 Chest shellE0457 C NU 921.74 0.00 0.00 0.00 XXX 1.25 Chest shellE0457 C RR 92.17 0.00 0.00 0.00 XXX 1.25 Chest shellE0457 C UE 691.32 0.00 0.00 0.00 XXX 1.25 Chest shellE0459 C 117.10 0.00 0.00 0.00 XXX 1.25 Chest wrapE0459 C NU 585.50 0.00 0.00 0.00 XXX 2.50 Chest wrapE0459 C RR 117.10 0.00 0.00 0.00 XXX 1.25 Chest wrapE0459 C UE 878.25 0.00 0.00 0.00 XXX 1.25 Chest wrapE0460 C 503.79 0.00 0.00 0.00 XXX 2.50 Neg press vent portabl/statnE0460 C NU 839.64 0.00 0.00 0.00 XXX 15.00 Neg press vent portabl/statnE0460 C RR 503.79 0.00 0.00 0.00 XXX 2.50 Neg press vent portabl/statnE0460 C UE 944.60 0.00 0.00 0.00 XXX 10.00 Neg press vent portabl/statnE0461 C 751.55 0.00 0.00 0.00 XXX 2.50 Vol vent noninvasive interfaE0461 C NU 939.44 0.00 0.00 0.00 XXX 20.00 Vol vent noninvasive interfaE0461 C RR 751.55 0.00 0.00 0.00 XXX 2.50 Vol vent noninvasive interfaE0461 C UE 939.44 0.00 0.00 0.00 XXX 15.00 Vol vent noninvasive interfaE0462 C 501.18 0.00 0.00 0.00 XXX 1.25 Rocking bed w/ or w/o side rE0462 C NU 835.30 0.00 0.00 0.00 XXX 7.50 Rocking bed w/ or w/o side rE0462 C RR 501.18 0.00 0.00 0.00 XXX 1.25 Rocking bed w/ or w/o side rE0462 C UE 939.71 0.00 0.00 0.00 XXX 5.00 Rocking bed w/ or w/o side rE0463 C 527.39 0.00 0.00 0.00 XXX 5.00 Press supp vent invasive intE0463 C RR 527.39 0.00 0.00 0.00 XXX 5.00 Press supp vent invasive intE0464 C 527.39 0.00 0.00 0.00 XXX 5.00 Press supp vent invasive intE0464 C RR 527.39 0.00 0.00 0.00 XXX 5.00 Press supp vent invasive intE0470 C 332.56 0.00 0.00 0.00 XXX 1.25 RAD w/o backup non-inv intfcE0470 C NU 831.40 0.00 0.00 0.00 XXX 5.00 RAD w/o backup non-inv intfcE0470 C RR 332.56 0.00 0.00 0.00 XXX 1.25 RAD w/o backup non-inv intfcE0470 C UE 623.55 0.00 0.00 0.00 XXX 5.00 RAD w/o backup non-inv intfcE0471 C 932.86 0.00 0.00 0.00 XXX 1.25 RAD w/backup non inv intrfcE0471 C NU 932.86 0.00 0.00 0.00 XXX 12.50 RAD w/backup non inv intrfcE0471 C RR 932.86 0.00 0.00 0.00 XXX 1.25 RAD w/backup non inv intrfc
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0471 C UE 874.56 0.00 0.00 0.00 XXX 10.00 RAD w/backup non inv intrfcE0472 C 932.86 0.00 0.00 0.00 XXX 1.25 RAD w backup invasive intrfcE0472 C NU 932.86 0.00 0.00 0.00 XXX 12.50 RAD w backup invasive intrfcE0472 C RR 932.86 0.00 0.00 0.00 XXX 1.25 RAD w backup invasive intrfcE0472 C UE 874.56 0.00 0.00 0.00 XXX 10.00 RAD w backup invasive intrfcE0480 C 58.30 0.00 0.00 0.00 XXX 1.25 Percussor elect/pneum home mE0480 C NU 583.00 0.00 0.00 0.00 XXX 1.25 Percussor elect/pneum home mE0480 C RR 58.30 0.00 0.00 0.00 XXX 1.25 Percussor elect/pneum home mE0480 C UE 437.25 0.00 0.00 0.00 XXX 1.25 Percussor elect/pneum home mE0481 C 0.00 0.00 0.00 0.00 XXX 0.00 Intrapulmonary perc vent sys + accessE0481 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Intrapulmonary perc vent sys + accessE0481 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Intrapulmonary perc vent sys + accessE0481 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Intrapulmonary perc vent sys + accessE0482 C 630.39 0.00 0.00 0.00 XXX 1.25 Cough stimulat device, alt +/- air pressE0482 C NU 787.99 0.00 0.00 0.00 XXX 10.00 Cough stimulat device, alt +/- air pressE0482 C RR 630.39 0.00 0.00 0.00 XXX 1.25 Cough stimulating deviceE0482 C UE 787.99 0.00 0.00 0.00 XXX 7.50 Cough stimulat device, alt +/- air pressE0483 C 797.35 0.00 0.00 0.00 XXX 2.50 Chest compression gen systemE0483 C NU 996.69 0.00 0.00 0.00 XXX 20.00 Chest compression gen systemE0483 C RR 797.35 0.00 0.00 0.00 XXX 2.50 Chest compression gen systemE0483 C UE 996.69 0.00 0.00 0.00 XXX 15.00 Chest compression gen systemE0484 C 5.55 0.00 0.00 0.00 XXX 1.25 Non-elec oscillatory pep dvcE0484 C NU 55.36 0.00 0.00 0.00 XXX 1.25 Non-elec oscillatory pep dvcE0484 C RR 5.55 0.00 0.00 0.00 XXX 1.25 Non-elec oscillatory pep dvcE0484 C UE 41.53 0.00 0.00 0.00 XXX 1.25 Non-elec oscillatory pep dvcE0485 C 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance prefabE0485 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance prefabE0485 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance prefabE0485 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance prefabE0486 C 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance cusfabE0486 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance cusfabE0486 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance cusfabE0486 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Oral device/appliance cusfabE0500 C 148.18 0.00 0.00 0.00 XXX 1.25 Ippb all typesE0500 C NU 740.90 0.00 0.00 0.00 XXX 2.50 Ippb all typesE0500 C RR 148.18 0.00 0.00 0.00 XXX 1.25 Ippb all typesE0500 C UE 555.68 0.00 0.00 0.00 XXX 2.50 Ippb all typesE0550 C 103.55 0.00 0.00 0.00 XXX 1.25 Humidif extens supple w ippbE0550 C NU 517.75 0.00 0.00 0.00 XXX 2.50 Humidif extens supple w ippbE0550 C RR 103.55 0.00 0.00 0.00 XXX 1.25 Humidif extens supple w ippbE0550 C UE 776.63 0.00 0.00 0.00 XXX 1.25 Humidif extens supple w ippbE0555 C 0.00 0.00 0.00 0.00 XXX 0.00 Humidifier for use w/ regulaE0555 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Humidifier for use w/ regulaE0555 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Humidifier for use w/ regulaE0555 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Humidifier for use w/ regulaE0560 C 22.92 0.00 0.00 0.00 XXX 1.25 Humidifier supplemental w/ iE0560 C NU 229.25 0.00 0.00 0.00 XXX 1.25 Humidifier supplemental w/ iE0560 C RR 22.92 0.00 0.00 0.00 XXX 1.25 Humidifier supplemental w/ iE0560 C UE 171.95 0.00 0.00 0.00 XXX 1.25 Humidifier supplemental w/ iE0561 C 16.05 0.00 0.00 0.00 XXX 1.25 Humidifier nonheated w PAPE0561 C NU 160.50 0.00 0.00 0.00 XXX 1.25 Humidifier nonheated w PAPE0561 C RR 16.05 0.00 0.00 0.00 XXX 1.25 Humidifier nonheated w PAPE0561 C UE 120.36 0.00 0.00 0.00 XXX 1.25 Humidifier nonheated w PAPE0562 C 45.20 0.00 0.00 0.00 XXX 1.25 Humidifier heated used w PAP
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0562 C NU 451.80 0.00 0.00 0.00 XXX 1.25 Humidifier heated used w PAPE0562 C RR 45.20 0.00 0.00 0.00 XXX 1.25 Humidifier heated used w PAPE0562 C UE 338.86 0.00 0.00 0.00 XXX 1.25 Humidifier heated used w PAPE0565 C 94.88 0.00 0.00 0.00 XXX 1.25 Compressor air power sourceE0565 C NU 948.80 0.00 0.00 0.00 XXX 1.25 Compressor air power sourceE0565 C RR 94.88 0.00 0.00 0.00 XXX 1.25 Compressor air power sourceE0565 C UE 711.60 0.00 0.00 0.00 XXX 1.25 Compressor air power sourceE0570 C 20.14 0.00 0.00 0.00 XXX 1.25 Nebulizer with compressionE0570 C NU 201.40 0.00 0.00 0.00 XXX 1.25 Nebulizer with compressionE0570 C RR 20.14 0.00 0.00 0.00 XXX 1.25 Nebulizer with compressionE0570 C UE 151.05 0.00 0.00 0.00 XXX 1.25 Nebulizer with compressionE0571 C 44.16 0.00 0.00 0.00 XXX 1.25 Aerosol compressor for svnebE0571 C NU 441.60 0.00 0.00 0.00 XXX 1.25 Aerosol compressor for svnebE0571 C RR 44.16 0.00 0.00 0.00 XXX 1.25 Aerosol compressor for svnebE0571 C UE 331.20 0.00 0.00 0.00 XXX 1.25 Aerosol compressor for svnebE0572 C 56.16 0.00 0.00 0.00 XXX 1.25 Aerosol compressor adjust prE0572 C NU 561.60 0.00 0.00 0.00 XXX 1.25 Aerosol compressor adjust prE0572 C RR 56.16 0.00 0.00 0.00 XXX 1.25 Aerosol compressor adjust prE0572 C UE 421.20 0.00 0.00 0.00 XXX 1.25 Aerosol compressor adjust prE0574 C 59.32 0.00 0.00 0.00 XXX 1.25 Ultrasonic generator w svnebE0574 C NU 593.20 0.00 0.00 0.00 XXX 1.25 Ultrasonic generator w svnebE0574 C RR 59.32 0.00 0.00 0.00 XXX 1.25 Ultrasonic generator w svnebE0574 C UE 444.90 0.00 0.00 0.00 XXX 1.25 Ultrasonic generator w svnebE0575 C 139.88 0.00 0.00 0.00 XXX 1.25 Nebulizer ultrasonicE0575 C NU 699.40 0.00 0.00 0.00 XXX 2.50 Nebulizer ultrasonicE0575 C RR 139.88 0.00 0.00 0.00 XXX 1.25 Nebulizer ultrasonicE0575 C UE 524.55 0.00 0.00 0.00 XXX 2.50 Nebulizer ultrasonicE0580 C 20.11 0.00 0.00 0.00 XXX 1.25 Nebulizer for use w/ regulatE0580 C NU 201.06 0.00 0.00 0.00 XXX 1.25 Nebulizer for use w/ regulatE0580 C RR 20.11 0.00 0.00 0.00 XXX 1.25 Nebulizer for use w/ regulatE0580 C UE 150.76 0.00 0.00 0.00 XXX 1.25 Nebulizer for use w/ regulatE0585 C 72.45 0.00 0.00 0.00 XXX 1.25 Nebulizer w/ compressor & heE0585 C NU 724.50 0.00 0.00 0.00 XXX 1.25 Nebulizer w/ compressor & heE0585 C RR 72.45 0.00 0.00 0.00 XXX 1.25 Nebulizer w/ compressor & heE0585 C UE 543.38 0.00 0.00 0.00 XXX 1.25 Nebulizer w/ compressor & heE0590 C 3.31 0.00 0.00 0.00 XXX 1.25 12/31/2005 Dispensing fee; DME neb drugE0600 C 84.96 0.00 0.00 0.00 XXX 1.25 Suction pump portab hom modlE0600 C NU 849.60 0.00 0.00 0.00 XXX 1.25 Suction pump portab hom modlE0600 C RR 84.96 0.00 0.00 0.00 XXX 1.25 Suction pump portab hom modlE0600 C UE 637.20 0.00 0.00 0.00 XXX 1.25 Suction pump portab hom modlE0601 C 146.70 0.00 0.00 0.00 XXX 1.25 Cont airway pressure deviceE0601 C NU 733.50 0.00 0.00 0.00 XXX 2.50 Cont airway pressure deviceE0601 C RR 146.70 0.00 0.00 0.00 XXX 1.25 Cont airway pressure deviceE0601 C UE 550.13 0.00 0.00 0.00 XXX 2.50 Cont airway pressure deviceE0602 C 4.41 0.00 0.00 0.00 XXX 1.25 Breast pump, all typesE0602 C NU 44.29 0.00 0.00 0.00 XXX 1.25 Manual breast pumpE0602 C RR 4.41 0.00 0.00 0.00 XXX 1.25 Manual breast pumpE0602 C UE 33.20 0.00 0.00 0.00 XXX 1.25 Manual breast pumpE0603 C 0.00 0.00 0.00 0.00 XXX 0.00 Breast pump, electric, any typeE0604 C 0.00 0.00 0.00 0.00 XXX 0.00 Breast pump, HD hosp gradeE0605 C 9.45 0.00 0.00 0.00 XXX 1.25 Vaporizer room typeE0605 C NU 94.45 0.00 0.00 0.00 XXX 1.25 Vaporizer room typeE0605 C RR 9.45 0.00 0.00 0.00 XXX 1.25 Vaporizer room typeE0605 C UE 70.84 0.00 0.00 0.00 XXX 1.25 Vaporizer room type
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0606 C 29.32 0.00 0.00 0.00 XXX 1.25 Drainage board posturalE0606 C NU 293.20 0.00 0.00 0.00 XXX 1.25 Drainage board posturalE0606 C RR 29.32 0.00 0.00 0.00 XXX 1.25 Drainage board posturalE0606 C UE 219.90 0.00 0.00 0.00 XXX 1.25 Drainage board posturalE0607 C 9.54 0.00 0.00 0.00 XXX 1.25 Blood glucose monitor homeE0607 C NU 95.23 0.00 0.00 0.00 XXX 1.25 Blood glucose monitor homeE0607 C RR 9.54 0.00 0.00 0.00 XXX 1.25 Blood glucose monitor homeE0607 C UE 71.40 0.00 0.00 0.00 XXX 1.25 Blood glucose monitor homeE0610 C 79.04 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr audible/visE0610 C NU 632.30 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr audible/visE0610 C RR 79.04 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr audible/visE0610 C UE 474.25 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr audible/visE0615 C 79.04 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr digital/visE0615 C NU 632.30 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr digital/visE0615 C RR 79.04 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr digital/visE0615 C UE 474.24 0.00 0.00 0.00 XXX 1.25 Pacemaker monitr digital/visE0616 C 0.00 0.00 0.00 0.00 XXX 0.00 Cardiac event recorderE0617 C 493.04 0.00 0.00 0.00 XXX 1.25 Ext defrib w/ integ EKG analysisE0617 C NU 821.73 0.00 0.00 0.00 XXX 7.50 Ext defrib w/ integ EKG analysisE0617 C RR 493.04 0.00 0.00 0.00 XXX 1.25 Automatic ext defibrillatorE0617 C UE 616.30 0.00 0.00 0.00 XXX 7.50 Ext defrib w/ integ EKG analysisE0618 C 433.77 0.00 0.00 0.00 XXX 1.25 Apnea monitorE0618 C NU 722.95 0.00 0.00 0.00 XXX 7.50 Apnea monitorE0618 C RR 433.77 0.00 0.00 0.00 XXX 1.25 Apnea monitorE0618 C UE 542.21 0.00 0.00 0.00 XXX 7.50 Apnea monitorE0619 C 0.00 0.00 0.00 0.00 XXX 0.00 Apnea monitor w recorderE0619 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Apnea monitor w recorderE0619 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Apnea monitor w recorderE0619 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Apnea monitor w recorderE0620 C 131.18 0.00 0.00 0.00 XXX 1.25 Skin piercing dev, laserE0620 C NU 655.80 0.00 0.00 0.00 XXX 2.50 Cap bld skin piercing laserE0620 C RR 131.18 0.00 0.00 0.00 XXX 1.25 Cap bld skin piercing laserE0620 C UE 983.70 0.00 0.00 0.00 XXX 1.25 Cap bld skin piercing laserE0621 C 14.62 0.00 0.00 0.00 XXX 1.25 Patient lift sling or seatE0621 C NU 121.25 0.00 0.00 0.00 XXX 1.25 Patient lift sling or seatE0621 C RR 14.62 0.00 0.00 0.00 XXX 1.25 Patient lift sling or seatE0621 C UE 90.96 0.00 0.00 0.00 XXX 1.25 Patient lift sling or seatE0625 C 0.00 0.00 0.00 0.00 XXX 0.00 Patient lift; kartop/bath/toilet, NOSE0627 C 62.00 0.00 0.00 0.00 XXX 1.25 Seat lift incorp lift-chairE0627 C NU 496.04 0.00 0.00 0.00 XXX 1.25 Seat lift incorp lift-chairE0627 C RR 62.00 0.00 0.00 0.00 XXX 1.25 Seat lift incorp lift-chairE0627 C UE 372.02 0.00 0.00 0.00 XXX 1.25 Seat lift incorp lift-chairE0628 C 62.00 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-electrE0628 C NU 496.04 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-electrE0628 C RR 62.00 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-electrE0628 C UE 372.02 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-electrE0629 C 62.00 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-non-elE0629 C NU 496.04 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-non-elE0629 C RR 62.00 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-non-elE0629 C UE 372.02 0.00 0.00 0.00 XXX 1.25 Seat lift for pt furn-non-elE0630 C 127.36 0.00 0.00 0.00 XXX 1.25 Patient lift hydraulicE0630 C NU 636.80 0.00 0.00 0.00 XXX 2.50 Patient lift hydraulicE0630 C RR 127.36 0.00 0.00 0.00 XXX 1.25 Patient lift hydraulicE0630 C UE 955.20 0.00 0.00 0.00 XXX 1.25 Patient lift hydraulic
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0635 C 259.48 0.00 0.00 0.00 XXX 1.25 Patient lift electricE0635 C NU 648.70 0.00 0.00 0.00 XXX 5.00 Patient lift electricE0635 C RR 259.48 0.00 0.00 0.00 XXX 1.25 Patient lift electricE0635 C UE 973.05 0.00 0.00 0.00 XXX 2.50 Patient lift electricE0636 C 790.92 0.00 0.00 0.00 XXX 2.50 PT support & positioning sysE0636 C NU 988.65 0.00 0.00 0.00 XXX 20.00 PT support & positioning sysE0636 C RR 790.92 0.00 0.00 0.00 XXX 2.50 PT support & positioning sysE0636 C UE 988.65 0.00 0.00 0.00 XXX 15.00 PT support & positioning sysE0637 C 315.75 0.00 0.00 0.00 XXX 1.25 Sit-stand w seatliftE0637 C NU 789.36 0.00 0.00 0.00 XXX 5.00 Sit-stand w seatliftE0637 C RR 315.75 0.00 0.00 0.00 XXX 1.25 Sit-stand w seatliftE0637 C UE 592.02 0.00 0.00 0.00 XXX 5.00 Sit-stand w seatliftE0638 C 88.35 0.00 0.00 0.00 XXX 1.25 Standing frame sysE0638 C NU 883.44 0.00 0.00 0.00 XXX 1.25 Standing frame sysE0638 C RR 88.35 0.00 0.00 0.00 XXX 1.25 Standing frame sysE0638 C UE 662.59 0.00 0.00 0.00 XXX 1.25 Standing frame sysE0639 D 0.00 0.00 0.00 0.00 XXX 0.00 Patient lift, moveableE0640 D 0.00 0.00 0.00 0.00 XXX 0.00 Patient lift, fixedE0641 C 0.00 0.00 0.00 0.00 XXX 0.00 Multi-position stnd fram sysE0642 C 0.00 0.00 0.00 0.00 XXX 0.00 Dynamic standing frameE0650 C 134.44 0.00 0.00 0.00 XXX 1.25 Pneuma compresor non-segmentE0650 C NU 532.98 0.00 0.00 0.00 XXX 2.50 Pneuma compresor non-segmentE0650 C RR 134.44 0.00 0.00 0.00 XXX 1.25 Pneuma compresor non-segmentE0650 C UE 799.45 0.00 0.00 0.00 XXX 1.25 Pneuma compresor non-segmentE0651 C 147.43 0.00 0.00 0.00 XXX 1.25 Pneum compressor segmentalE0651 C NU 589.71 0.00 0.00 0.00 XXX 2.50 Pneum compressor segmentalE0651 C RR 147.43 0.00 0.00 0.00 XXX 1.25 Pneum compressor segmentalE0651 C UE 884.56 0.00 0.00 0.00 XXX 1.25 Pneum compressor segmentalE0652 C 989.18 0.00 0.00 0.00 XXX 1.25 Pneum compres w/cal pressureE0652 C NU 825.07 0.00 0.00 0.00 XXX 12.50 Pneum compres w/cal pressureE0652 C RR 989.18 0.00 0.00 0.00 XXX 1.25 Pneum compres w/cal pressureE0652 C UE 618.82 0.00 0.00 0.00 XXX 12.50 Pneum compres w/cal pressureE0655 C 15.85 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half armE0655 C NU 146.08 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half armE0655 C RR 15.85 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half armE0655 C UE 126.37 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half armE0660 C 27.26 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full legE0660 C NU 218.05 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full legE0660 C RR 27.26 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full legE0660 C UE 163.54 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full legE0665 C 21.06 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full armE0665 C NU 171.24 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full armE0665 C RR 21.06 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full armE0665 C UE 128.60 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance full armE0666 C 19.56 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half legE0666 C NU 172.60 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half legE0666 C RR 19.56 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half legE0666 C UE 129.49 0.00 0.00 0.00 XXX 1.25 Pneumatic appliance half legE0667 C 92.46 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full legE0667 C NU 924.70 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full legE0667 C RR 92.46 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full legE0667 C UE 693.51 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full legE0668 C 85.65 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full armE0668 C NU 856.24 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full arm
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0668 C RR 85.65 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full armE0668 C UE 642.21 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appl full armE0669 C 26.11 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appli half legE0669 C NU 261.11 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appli half legE0669 C RR 26.11 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appli half legE0669 C UE 195.83 0.00 0.00 0.00 XXX 1.25 Seg pneumatic appli half legE0671 C 62.33 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full legE0671 C NU 622.90 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full legE0671 C RR 62.33 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full legE0671 C UE 467.26 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full legE0672 C 48.41 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full armE0672 C NU 484.12 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full armE0672 C RR 48.41 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full armE0672 C UE 363.09 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl full armE0673 C 40.25 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl half legE0673 C NU 402.26 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl half legE0673 C RR 40.25 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl half legE0673 C UE 301.69 0.00 0.00 0.00 XXX 1.25 Pressure pneum appl half legE0675 C 480.69 0.00 0.00 0.00 XXX 1.25 Pneumatic compression deviceE0675 C NU 801.15 0.00 0.00 0.00 XXX 7.50 Pneumatic compression deviceE0675 C RR 480.69 0.00 0.00 0.00 XXX 1.25 Pneumatic compression deviceE0675 C UE 600.86 0.00 0.00 0.00 XXX 7.50 Pneumatic compression deviceE0691 C 145.70 0.00 0.00 0.00 XXX 1.25 Uvl pnl 2 sq ft or lessE0691 C NU 728.58 0.00 0.00 0.00 XXX 2.50 Uvl pnl 2 sq ft or lessE0691 C RR 145.70 0.00 0.00 0.00 XXX 1.25 Uvl pnl 2 sq ft or lessE0691 C UE 546.43 0.00 0.00 0.00 XXX 2.50 Uvl pnl 2 sq ft or lessE0692 C 182.99 0.00 0.00 0.00 XXX 1.25 Uvl sys panel 4 ftE0692 C NU 914.89 0.00 0.00 0.00 XXX 2.50 Uvl sys panel 4 ftE0692 C RR 182.99 0.00 0.00 0.00 XXX 1.25 Uvl sys panel 4 ftE0692 C UE 686.17 0.00 0.00 0.00 XXX 2.50 Uvl sys panel 4 ftE0693 C 225.56 0.00 0.00 0.00 XXX 1.25 Uvl sys panel 6 ftE0693 C NU 563.90 0.00 0.00 0.00 XXX 5.00 Uvl sys panel 6 ftE0693 C RR 225.56 0.00 0.00 0.00 XXX 1.25 Uvl sys panel 6 ftE0693 C UE 422.93 0.00 0.00 0.00 XXX 5.00 Uvl sys panel 6 ftE0694 C 717.95 0.00 0.00 0.00 XXX 1.25 Uvl md cabinet sys 6 ftE0694 C NU 897.42 0.00 0.00 0.00 XXX 10.00 Uvl md cabinet sys 6 ftE0694 C RR 717.95 0.00 0.00 0.00 XXX 1.25 Uvl md cabinet sys 6 ftE0694 C UE 673.06 0.00 0.00 0.00 XXX 10.00 Uvl md cabinet sys 6 ftE0700 C 0.00 0.00 0.00 0.00 XXX 0.00 Safety eqip.-belt/harness/vestE0701 C 22.99 0.00 0.00 0.00 XXX 1.25 Helmet w face guard prefabE0701 C NU 230.00 0.00 0.00 0.00 XXX 1.25 Helmet w face guard prefabE0701 C RR 22.99 0.00 0.00 0.00 XXX 1.25 Helmet w face guard prefabE0701 C UE 172.53 0.00 0.00 0.00 XXX 1.25 Helmet w face guard prefabE0705 C 0.00 0.00 0.00 0.00 XXX 0.00 Transfer board or deviceE0710 C 0.00 0.00 0.00 0.00 XXX 0.00 Restraint, any type-body/chest/wrist/ankleE0720 C 60.97 0.00 0.00 0.00 XXX 1.25 Tens two leadE0720 C NU 609.72 0.00 0.00 0.00 XXX 1.25 Tens two leadE0720 C RR 60.97 0.00 0.00 0.00 XXX 1.25 Tens two leadE0720 C UE 457.29 0.00 0.00 0.00 XXX 1.25 Tens two leadE0730 C 66.60 0.00 0.00 0.00 XXX 1.25 Tens four leadE0730 C NU 666.03 0.00 0.00 0.00 XXX 1.25 Tens four leadE0730 C RR 66.60 0.00 0.00 0.00 XXX 1.25 Tens four leadE0730 C UE 499.52 0.00 0.00 0.00 XXX 1.25 Tens four leadE0731 C 74.34 0.00 0.00 0.00 XXX 1.25 Conductive garment for tens/
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0731 C NU 743.36 0.00 0.00 0.00 XXX 1.25 Conductive garment for tens/E0731 C RR 74.34 0.00 0.00 0.00 XXX 1.25 Conductive garment for tens/E0731 C UE 557.52 0.00 0.00 0.00 XXX 1.25 Conductive garment for tens/E0740 C 78.44 0.00 0.00 0.00 XXX 1.25 Incontinence treatment systemE0740 C NU 784.34 0.00 0.00 0.00 XXX 1.25 Incontinence treatment systmE0740 C RR 78.44 0.00 0.00 0.00 XXX 1.25 Incontinence treatment systmE0740 C UE 588.26 0.00 0.00 0.00 XXX 1.25 Incontinence treatment systmE0744 C 167.60 0.00 0.00 0.00 XXX 1.25 Neuromuscular stim for scoliE0744 C NU 838.00 0.00 0.00 0.00 XXX 2.50 Neuromuscular stim for scoliE0744 C RR 167.60 0.00 0.00 0.00 XXX 1.25 Neuromuscular stim for scoliE0744 C UE 628.50 0.00 0.00 0.00 XXX 2.50 Neuromuscular stim for scoliE0745 C 114.13 0.00 0.00 0.00 XXX 1.25 Neuromuscular stim for shockE0745 C NU 570.65 0.00 0.00 0.00 XXX 2.50 Neuromuscular stim for shockE0745 C RR 114.13 0.00 0.00 0.00 XXX 1.25 Neuromuscular stim for shockE0745 C UE 855.98 0.00 0.00 0.00 XXX 1.25 Neuromuscular stim for shockE0746 C 0.00 0.00 0.00 0.00 XXX 0.00 EMG biofeedback deviceE0747 C 685.24 0.00 0.00 0.00 XXX 1.25 Elec osteogen stim not spineE0747 C NU 852.39 0.00 0.00 0.00 XXX 7.50 Elec osteogen stim not spineE0747 C RR 685.24 0.00 0.00 0.00 XXX 1.25 Elec osteogen stim not spineE0747 C UE 639.29 0.00 0.00 0.00 XXX 7.50 Elec osteogen stim not spineE0748 C 568.25 0.00 0.00 0.00 XXX 1.25 Elec osteogen stim spinalE0748 C NU 947.10 0.00 0.00 0.00 XXX 7.50 Elec osteogen stim spinalE0748 C RR 568.25 0.00 0.00 0.00 XXX 1.25 Elec osteogen stim spinalE0748 C UE 710.33 0.00 0.00 0.00 XXX 7.50 Elec osteogen stim spinalE0749 C 346.11 0.00 0.00 0.00 XXX 1.25 Elec osteogen stim implantedE0749 C NU 865.28 0.00 0.00 0.00 XXX 5.00 Elec osteogen stim implantedE0749 C RR 346.11 0.00 0.00 0.00 XXX 1.25 Elec osteogen stim implantedE0749 C UE 648.96 0.00 0.00 0.00 XXX 5.00 Elec osteogen stim implantedE0752 C 475.63 0.00 0.00 0.00 XXX 1.25 12/31/2005 Neurostimulator electrodeE0754 C 720.96 0.00 0.00 0.00 XXX 2.50 12/31/2005 Pulsegenerator pt programmerE0755 C 0.00 0.00 0.00 0.00 XXX 0.00 Electronic salivary reflex stimulatorE0756 C 863.96 0.00 0.00 0.00 XXX 12.50 12/31/2005 Implantable pulse generatorE0757 C 771.60 0.00 0.00 0.00 XXX 10.00 12/31/2005 Implantable RF receiverE0758 C 905.58 0.00 0.00 0.00 XXX 7.50 12/31/2005 External RF transmitterE0759 C 852.60 0.00 0.00 0.00 XXX 1.25 12/31/2005 Replace rdfrquncy transmittrE0760 C 472.21 0.00 0.00 0.00 XXX 1.25 Osteogen ultrasound stimltorE0760 C NU 787.03 0.00 0.00 0.00 XXX 7.50 Osteogen ultrasound stimltorE0760 C RR 472.21 0.00 0.00 0.00 XXX 1.25 Osteogen ultrasound stimltorE0760 C UE 590.27 0.00 0.00 0.00 XXX 7.50 Osteogen ultrasound stimltorE0761 C 0.00 0.00 0.00 0.00 XXX 0.00 Nontherm electromgntc deviceE0762 C 0.00 0.00 0.00 0.00 XXX 0.00 Trans elec jt stim dev sysE0764 C 808.19 0.00 0.00 0.00 XXX 2.50 Functional neuromuscularstimE0764 C NU 808.19 0.00 0.00 0.00 XXX 25.00 Functional neuromuscularstimE0764 C RR 808.19 0.00 0.00 0.00 XXX 2.50 Functional neuromuscularstimE0764 C UE 606.14 0.00 0.00 0.00 XXX 25.00 Functional neuromuscularstimE0765 C 12.61 0.00 0.00 0.00 XXX 1.25 Nerve stimulator for tx n&vE0765 C NU 126.18 0.00 0.00 0.00 XXX 1.25 Nerve stimulator for tx n&vE0765 C RR 12.61 0.00 0.00 0.00 XXX 1.25 Nerve stimulator for tx n&vE0765 C UE 94.65 0.00 0.00 0.00 XXX 1.25 Nerve stimulator for tx n&vE0769 C 0.00 0.00 0.00 0.00 XXX 0.00 Elect/electromag wound tx device NOSE0776 C 43.86 0.00 0.00 0.00 XXX 1.25 Iv poleE0776 C NU 180.38 0.00 0.00 0.00 XXX 1.25 Iv poleE0776 C RR 43.86 0.00 0.00 0.00 XXX 1.25 Iv poleE0776 C UE 135.31 0.00 0.00 0.00 XXX 1.25 Iv pole
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0779 C 27.95 0.00 0.00 0.00 XXX 1.25 Amb infusion pump mechanicalE0779 C NU 279.50 0.00 0.00 0.00 XXX 1.25 Amb infusion pump mechanicalE0779 C RR 27.95 0.00 0.00 0.00 XXX 1.25 Amb infusion pump mechanicalE0779 C UE 209.63 0.00 0.00 0.00 XXX 1.25 Amb infusion pump mechanicalE0780 C 1.55 0.00 0.00 0.00 XXX 1.25 Mech amb infusion pump <8hrsE0780 C NU 15.54 0.00 0.00 0.00 XXX 1.25 Mech amb infusion pump <8hrsE0780 C RR 1.55 0.00 0.00 0.00 XXX 1.25 Mech amb infusion pump <8hrsE0780 C UE 11.66 0.00 0.00 0.00 XXX 1.25 Mech amb infusion pump <8hrsE0781 C 424.00 0.00 0.00 0.00 XXX 1.25 External ambulatory infus puE0781 C NU 706.67 0.00 0.00 0.00 XXX 7.50 External ambulatory infus puE0781 C RR 424.00 0.00 0.00 0.00 XXX 1.25 External ambulatory infus puE0781 C UE 530.00 0.00 0.00 0.00 XXX 7.50 External ambulatory infus puE0782 C 522.59 0.00 0.00 0.00 XXX 1.25 Non-programble infusion pumpE0782 C NU 870.95 0.00 0.00 0.00 XXX 7.50 Non-programble infusion pumpE0782 C RR 522.59 0.00 0.00 0.00 XXX 1.25 Non-programble infusion pumpE0782 C UE 653.21 0.00 0.00 0.00 XXX 7.50 Non-programble infusion pumpE0783 C 996.47 0.00 0.00 0.00 XXX 1.25 Programmable infusion pumpE0783 C NU 996.46 0.00 0.00 0.00 XXX 12.50 Programmable infusion pumpE0783 C RR 996.47 0.00 0.00 0.00 XXX 1.25 Programmable infusion pumpE0783 C UE 747.35 0.00 0.00 0.00 XXX 12.50 Programmable infusion pumpE0784 C 626.31 0.00 0.00 0.00 XXX 1.25 Ext amb infusn pump insulinE0784 C NU 782.89 0.00 0.00 0.00 XXX 10.00 Ext amb infusn pump insulinE0784 C RR 626.31 0.00 0.00 0.00 XXX 1.25 Ext amb infusn pump insulinE0784 C UE 587.17 0.00 0.00 0.00 XXX 10.00 Ext amb infusn pump insulinE0785 C 575.10 0.00 0.00 0.00 XXX 1.25 Replacement impl pump cathetE0785 C KF 575.10 0.00 0.00 0.00 XXX 1.25 Replacement impl pump cathetE0785 C NU 575.10 0.00 0.00 0.00 XXX 1.25 Replacement impl pump cathetE0786 C 971.98 0.00 0.00 0.00 XXX 1.25 Implantable pump replacementE0786 C NU 971.99 0.00 0.00 0.00 XXX 12.50 Implantable pump replacementE0786 C RR 971.98 0.00 0.00 0.00 XXX 1.25 Implantable pump replacementE0786 C UE 728.99 0.00 0.00 0.00 XXX 12.50 Implantable pump replacementE0791 C 426.86 0.00 0.00 0.00 XXX 1.25 Parenteral infusion pump staE0791 C NU 711.43 0.00 0.00 0.00 XXX 7.50 Parenteral infusion pump staE0791 C RR 426.86 0.00 0.00 0.00 XXX 1.25 Parenteral infusion pump staE0791 C UE 533.57 0.00 0.00 0.00 XXX 7.50 Parenteral infusion pump staE0830 C 0.00 0.00 0.00 0.00 XXX 0.00 Ambulatory traction deviceE0840 C 14.62 0.00 0.00 0.00 XXX 1.25 Tract frame attach headboardE0840 C NU 146.18 0.00 0.00 0.00 XXX 1.25 Tract frame attach headboardE0840 C RR 14.62 0.00 0.00 0.00 XXX 1.25 Tract frame attach headboardE0840 C UE 109.65 0.00 0.00 0.00 XXX 1.25 Tract frame attach headboardE0849 C 77.29 0.00 0.00 0.00 XXX 1.25 Cervical pneum trac equipE0849 C NU 772.94 0.00 0.00 0.00 XXX 1.25 Cervical pneum trac equipE0849 C RR 77.29 0.00 0.00 0.00 XXX 1.25 Cervical pneum trac equipE0849 C UE 579.72 0.00 0.00 0.00 XXX 1.25 Cervical pneum trac equipE0850 C 14.35 0.00 0.00 0.00 XXX 1.25 Traction stand free standingE0850 C NU 143.51 0.00 0.00 0.00 XXX 1.25 Traction stand free standingE0850 C RR 14.35 0.00 0.00 0.00 XXX 1.25 Traction stand free standingE0850 C UE 125.16 0.00 0.00 0.00 XXX 1.25 Traction stand free standingE0855 C 74.14 0.00 0.00 0.00 XXX 1.25 Cervical traction equipmentE0855 C NU 741.34 0.00 0.00 0.00 XXX 1.25 Cervical traction equipmentE0855 C RR 74.14 0.00 0.00 0.00 XXX 1.25 Cervical traction equipmentE0855 C UE 556.00 0.00 0.00 0.00 XXX 1.25 Cervical traction equipmentE0860 C 5.86 0.00 0.00 0.00 XXX 1.25 Tract equip cervical tractE0860 C NU 58.65 0.00 0.00 0.00 XXX 1.25 Tract equip cervical tract
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0860 C RR 5.86 0.00 0.00 0.00 XXX 1.25 Tract equip cervical tractE0860 C UE 44.00 0.00 0.00 0.00 XXX 1.25 Tract equip cervical tractE0870 C 18.96 0.00 0.00 0.00 XXX 1.25 Tract frame attach footboardE0870 C NU 189.61 0.00 0.00 0.00 XXX 1.25 Tract frame attach footboardE0870 C RR 18.96 0.00 0.00 0.00 XXX 1.25 Tract frame attach footboardE0870 C UE 142.22 0.00 0.00 0.00 XXX 1.25 Tract frame attach footboardE0880 C 17.50 0.00 0.00 0.00 XXX 1.25 Trac stand free stand extremE0880 C NU 174.86 0.00 0.00 0.00 XXX 1.25 Trac stand free stand extremE0880 C RR 17.50 0.00 0.00 0.00 XXX 1.25 Trac stand free stand extremE0880 C UE 131.18 0.00 0.00 0.00 XXX 1.25 Trac stand free stand extremE0890 C 15.05 0.00 0.00 0.00 XXX 1.25 Traction frame attach pelvicE0890 C NU 150.51 0.00 0.00 0.00 XXX 1.25 Traction frame attach pelvicE0890 C RR 15.05 0.00 0.00 0.00 XXX 1.25 Traction frame attach pelvicE0890 C UE 121.24 0.00 0.00 0.00 XXX 1.25 Traction frame attach pelvicE0900 C 20.52 0.00 0.00 0.00 XXX 1.25 Trac stand free stand pelvicE0900 C NU 205.20 0.00 0.00 0.00 XXX 1.25 Trac stand free stand pelvicE0900 C RR 20.52 0.00 0.00 0.00 XXX 1.25 Trac stand free stand pelvicE0900 C UE 153.94 0.00 0.00 0.00 XXX 1.25 Trac stand free stand pelvicE0910 C 25.00 0.00 0.00 0.00 XXX 1.25 Trapeze bar attached to bedE0910 C NU 250.00 0.00 0.00 0.00 XXX 1.25 Trapeze bar attached to bedE0910 C RR 25.00 0.00 0.00 0.00 XXX 1.25 Trapeze bar attached to bedE0910 C UE 187.50 0.00 0.00 0.00 XXX 1.25 Trapeze bar attached to bedE0911 C 74.74 0.00 0.00 0.00 XXX 1.25 HD trapeze bar attach to bedE0911 C NU 747.40 0.00 0.00 0.00 XXX 1.25 HD trapeze bar attach to bedE0911 C RR 74.74 0.00 0.00 0.00 XXX 1.25 HD trapeze bar attach to bedE0911 C UE 560.55 0.00 0.00 0.00 XXX 1.25 HD trapeze bar attach to bedE0912 C 171.70 0.00 0.00 0.00 XXX 1.25 HD trapeze bar free standingE0912 C NU 858.50 0.00 0.00 0.00 XXX 2.50 HD trapeze bar free standingE0912 C RR 171.70 0.00 0.00 0.00 XXX 1.25 HD trapeze bar free standingE0912 C UE 673.88 0.00 0.00 0.00 XXX 2.50 HD trapeze bar free standingE0920 C 79.72 0.00 0.00 0.00 XXX 1.25 Fracture frame attached to bedE0920 C NU 797.20 0.00 0.00 0.00 XXX 1.25 Fracture frame attached to bedE0920 C RR 79.72 0.00 0.00 0.00 XXX 1.25 Fracture frame attached to bE0920 C UE 597.90 0.00 0.00 0.00 XXX 1.25 Fracture frame attached to bedE0930 C 59.00 0.00 0.00 0.00 XXX 1.25 Fracture frame free standingE0930 C NU 590.00 0.00 0.00 0.00 XXX 1.25 Fracture frame free standingE0930 C RR 59.00 0.00 0.00 0.00 XXX 1.25 Fracture frame free standingE0930 C UE 442.50 0.00 0.00 0.00 XXX 1.25 Fracture frame free standingE0935 C 30.23 0.00 0.00 0.00 XXX 1.25 Exercise device passive motiE0935 C NU 302.30 0.00 0.00 0.00 XXX 1.25 Exercise device passive motiE0935 C RR 30.23 0.00 0.00 0.00 XXX 1.25 Exercise device passive motiE0935 C UE 226.73 0.00 0.00 0.00 XXX 1.25 Exercise device passive motiE0940 C 46.74 0.00 0.00 0.00 XXX 1.25 Trapeze bar free standingE0940 C NU 467.40 0.00 0.00 0.00 XXX 1.25 Trapeze bar free standingE0940 C RR 46.74 0.00 0.00 0.00 XXX 1.25 Trapeze bar free standingE0940 C UE 350.55 0.00 0.00 0.00 XXX 1.25 Trapeze bar free standingE0941 C 82.86 0.00 0.00 0.00 XXX 1.25 Gravity assisted traction deE0941 C NU 828.60 0.00 0.00 0.00 XXX 1.25 Gravity assisted traction deE0941 C RR 82.86 0.00 0.00 0.00 XXX 1.25 Gravity assisted traction deE0941 C UE 621.45 0.00 0.00 0.00 XXX 1.25 Gravity assisted traction deE0942 C 3.44 0.00 0.00 0.00 XXX 1.25 Cervical head harness/halterE0942 C NU 34.39 0.00 0.00 0.00 XXX 1.25 Cervical head harness/halterE0942 C RR 3.44 0.00 0.00 0.00 XXX 1.25 Cervical head harness/halterE0942 C UE 25.82 0.00 0.00 0.00 XXX 1.25 Cervical head harness/halter
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0944 C 8.68 0.00 0.00 0.00 XXX 1.25 Pelvic belt/harness/bootE0944 C NU 69.36 0.00 0.00 0.00 XXX 1.25 Pelvic belt/harness/bootE0944 C RR 8.68 0.00 0.00 0.00 XXX 1.25 Pelvic belt/harness/bootE0944 C UE 52.04 0.00 0.00 0.00 XXX 1.25 Pelvic belt/harness/bootE0945 C 7.20 0.00 0.00 0.00 XXX 1.25 Belt/harness extremityE0945 C NU 59.84 0.00 0.00 0.00 XXX 1.25 Belt/harness extremityE0945 C RR 7.20 0.00 0.00 0.00 XXX 1.25 Belt/harness extremityE0945 C UE 44.89 0.00 0.00 0.00 XXX 1.25 Belt/harness extremityE0946 C 82.33 0.00 0.00 0.00 XXX 1.25 Fracture frame dual w crossE0946 C NU 823.30 0.00 0.00 0.00 XXX 1.25 Fracture frame dual w crossE0946 C RR 82.33 0.00 0.00 0.00 XXX 1.25 Fracture frame dual w crossE0946 C UE 617.48 0.00 0.00 0.00 XXX 1.25 Fracture frame dual w crossE0947 C 122.44 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts peE0947 C NU 979.46 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts peE0947 C RR 122.44 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts peE0947 C UE 734.57 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts peE0948 C 122.03 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts ceE0948 C NU 976.24 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts ceE0948 C RR 122.03 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts ceE0948 C UE 732.17 0.00 0.00 0.00 XXX 1.25 Fracture frame attachmnts ceE0950 C 22.97 0.00 0.00 0.00 XXX 1.25 Tray, wheelchair accessoryE0950 C NU 229.80 0.00 0.00 0.00 XXX 1.25 Tray, wheelchair accessoryE0950 C RR 22.97 0.00 0.00 0.00 XXX 1.25 Tray, wheelchair accessoryE0950 C UE 172.36 0.00 0.00 0.00 XXX 1.25 Tray, wheelchair accessoryE0951 C 6.84 0.00 0.00 0.00 XXX 1.25 Loop heelE0951 C NU 68.40 0.00 0.00 0.00 XXX 1.25 Loop heelE0951 C RR 6.84 0.00 0.00 0.00 XXX 1.25 Loop heelE0951 C UE 51.31 0.00 0.00 0.00 XXX 1.25 Loop heelE0952 C 5.16 0.00 0.00 0.00 XXX 1.25 Toe loop/holder, eachE0952 C NU 51.44 0.00 0.00 0.00 XXX 1.25 Toe loop/holder, eachE0952 C RR 5.16 0.00 0.00 0.00 XXX 1.25 Toe loop/holder, eachE0952 C UE 38.58 0.00 0.00 0.00 XXX 1.25 Toe loop/holder, eachE0953 C 5.12 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tireE0953 C NU 52.24 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tireE0953 C RR 5.12 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tireE0953 C UE 37.41 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tireE0954 C 6.03 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair semi-pneumatic caE0954 C NU 53.44 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair semi-pneumatic caE0954 C RR 6.03 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair semi-pneumatic caE0954 C UE 40.09 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair semi-pneumatic caE0955 C 30.33 0.00 0.00 0.00 XXX 1.25 Cushioned headrestE0955 C NU 303.25 0.00 0.00 0.00 XXX 1.25 Cushioned headrestE0955 C RR 30.33 0.00 0.00 0.00 XXX 1.25 Cushioned headrestE0955 C UE 227.45 0.00 0.00 0.00 XXX 1.25 Cushioned headrestE0956 C 14.80 0.00 0.00 0.00 XXX 1.25 W/c lateral trunk/hip supporE0956 C NU 147.86 0.00 0.00 0.00 XXX 1.25 W/c lateral trunk/hip supporE0956 C RR 14.80 0.00 0.00 0.00 XXX 1.25 W/c lateral trunk/hip supporE0956 C UE 110.92 0.00 0.00 0.00 XXX 1.25 W/c lateral trunk/hip supporE0957 C 20.68 0.00 0.00 0.00 XXX 1.25 W/c medial thigh supportE0957 C NU 206.90 0.00 0.00 0.00 XXX 1.25 W/c medial thigh supportE0957 C RR 20.68 0.00 0.00 0.00 XXX 1.25 W/c medial thigh supportE0957 C UE 155.15 0.00 0.00 0.00 XXX 1.25 W/c medial thigh supportE0958 C 67.26 0.00 0.00 0.00 XXX 1.25 Whlchr att- conv 1 arm driveE0958 C NU 672.60 0.00 0.00 0.00 XXX 1.25 Whlchr att- conv 1 arm drive
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0958 C RR 67.26 0.00 0.00 0.00 XXX 1.25 Whlchr att- conv 1 arm driveE0958 C UE 504.45 0.00 0.00 0.00 XXX 1.25 Whlchr att- conv 1 arm driveE0959 C 9.40 0.00 0.00 0.00 XXX 1.25 Amputee adapterE0959 C NU 93.95 0.00 0.00 0.00 XXX 1.25 Amputee adapterE0959 C RR 9.40 0.00 0.00 0.00 XXX 1.25 Amputee adapterE0959 C UE 70.48 0.00 0.00 0.00 XXX 1.25 Amputee adapterE0960 C 13.62 0.00 0.00 0.00 XXX 1.25 W/c shoulder harness/strapsE0960 C NU 136.46 0.00 0.00 0.00 XXX 1.25 W/c shoulder harness/strapsE0960 C RR 13.62 0.00 0.00 0.00 XXX 1.25 W/c shoulder harness/strapsE0960 C UE 102.36 0.00 0.00 0.00 XXX 1.25 W/c shoulder harness/strapsE0961 C 3.87 0.00 0.00 0.00 XXX 1.25 Wheelchair brake extensionE0961 C NU 37.17 0.00 0.00 0.00 XXX 1.25 Wheelchair brake extensionE0961 C RR 3.87 0.00 0.00 0.00 XXX 1.25 Wheelchair brake extensionE0961 C UE 20.00 0.00 0.00 0.00 XXX 1.25 Wheelchair brake extensionE0966 C 15.04 0.00 0.00 0.00 XXX 1.25 Wheelchair head rest extensiE0966 C NU 150.31 0.00 0.00 0.00 XXX 1.25 Wheelchair head rest extensiE0966 C RR 15.04 0.00 0.00 0.00 XXX 1.25 Wheelchair head rest extensiE0966 C UE 112.74 0.00 0.00 0.00 XXX 1.25 Wheelchair head rest extensiE0967 C 9.81 0.00 0.00 0.00 XXX 1.25 Wheelchair hand rimsE0967 C NU 98.51 0.00 0.00 0.00 XXX 1.25 Wheelchair hand rimsE0967 C RR 9.81 0.00 0.00 0.00 XXX 1.25 Wheelchair hand rimsE0967 C UE 73.90 0.00 0.00 0.00 XXX 1.25 Wheelchair hand rimsE0968 C 27.54 0.00 0.00 0.00 XXX 1.25 Wheelchair commode seatE0968 C NU 275.40 0.00 0.00 0.00 XXX 1.25 Wheelchair commode seatE0968 C RR 27.54 0.00 0.00 0.00 XXX 1.25 Wheelchair commode seatE0968 C UE 206.55 0.00 0.00 0.00 XXX 1.25 Wheelchair commode seatE0969 C 31.61 0.00 0.00 0.00 XXX 1.25 Wheelchair narrowing deviceE0969 C NU 252.74 0.00 0.00 0.00 XXX 1.25 Wheelchair narrowing deviceE0969 C RR 31.61 0.00 0.00 0.00 XXX 1.25 Wheelchair narrowing deviceE0969 C UE 189.55 0.00 0.00 0.00 XXX 1.25 Wheelchair narrowing deviceE0970 C 5.49 0.00 0.00 0.00 XXX 1.25 Wheelchair no. 2 footplatesE0970 C NU 61.50 0.00 0.00 0.00 XXX 1.25 Wheelchair no. 2 footplatesE0970 C RR 5.49 0.00 0.00 0.00 XXX 1.25 Wheelchair no. 2 footplatesE0970 C UE 46.14 0.00 0.00 0.00 XXX 1.25 Wheelchair no. 2 footplatesE0971 C 6.49 0.00 0.00 0.00 XXX 1.25 Wheelchair anti-tipping deviE0971 C NU 65.10 0.00 0.00 0.00 XXX 1.25 Wheelchair anti-tipping deviE0971 C RR 6.49 0.00 0.00 0.00 XXX 1.25 Wheelchair anti-tipping deviE0971 C UE 48.81 0.00 0.00 0.00 XXX 1.25 Wheelchair anti-tipping deviE0972 C 11.83 0.00 0.00 0.00 XXX 1.25 12/31/2005 Transfer board or deviceE0972 C NU 118.21 0.00 0.00 0.00 XXX 1.25 12/31/2005 Transfer board or deviceE0972 C RR 11.83 0.00 0.00 0.00 XXX 1.25 12/31/2005 Transfer board or deviceE0972 C UE 88.65 0.00 0.00 0.00 XXX 1.25 12/31/2005 Transfer board or deviceE0973 C 69.01 0.00 0.00 0.00 XXX 1.25 Wheelchair adjustabl heightE0973 C NU 690.36 0.00 0.00 0.00 XXX 1.25 W/Ch access det adj armrestE0973 C RR 69.01 0.00 0.00 0.00 XXX 1.25 W/Ch access det adj armrestE0973 C UE 517.75 0.00 0.00 0.00 XXX 1.25 W/Ch access det adj armrestE0974 C 10.39 0.00 0.00 0.00 XXX 1.25 Wheelchair grade-aidE0974 C NU 98.01 0.00 0.00 0.00 XXX 1.25 W/Ch access anti-rollbackE0974 C RR 10.39 0.00 0.00 0.00 XXX 1.25 W/Ch access anti-rollbackE0974 C UE 74.06 0.00 0.00 0.00 XXX 1.25 W/Ch access anti-rollbackE0977 C 8.50 0.00 0.00 0.00 XXX 1.25 Wheelchair wedge cushionE0977 C NU 81.76 0.00 0.00 0.00 XXX 1.25 Wheelchair wedge cushionE0977 C RR 8.50 0.00 0.00 0.00 XXX 1.25 Wheelchair wedge cushionE0977 C UE 61.35 0.00 0.00 0.00 XXX 1.25 Wheelchair wedge cushion
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0978 C 8.66 0.00 0.00 0.00 XXX 1.25 W/C acc,saf belt pelv strapE0978 C NU 69.59 0.00 0.00 0.00 XXX 1.25 W/C acc,saf belt pelv strapE0978 C RR 8.66 0.00 0.00 0.00 XXX 1.25 W/C acc,saf belt pelv strapE0978 C UE 52.18 0.00 0.00 0.00 XXX 1.25 W/C acc,saf belt pelv strapE0980 C 5.34 0.00 0.00 0.00 XXX 1.25 Wheelchair safety vestE0980 C NU 42.61 0.00 0.00 0.00 XXX 1.25 Wheelchair safety vestE0980 C RR 5.34 0.00 0.00 0.00 XXX 1.25 Wheelchair safety vestE0980 C UE 31.96 0.00 0.00 0.00 XXX 1.25 Wheelchair safety vestE0981 C 11.56 0.00 0.00 0.00 XXX 1.25 Seat upholsteryE0981 C NU 115.55 0.00 0.00 0.00 XXX 1.25 Seat upholsteryE0981 C RR 11.56 0.00 0.00 0.00 XXX 1.25 Seat upholsteryE0981 C UE 86.65 0.00 0.00 0.00 XXX 1.25 Seat upholsteryE0982 C 10.85 0.00 0.00 0.00 XXX 1.25 Back upholsteryE0982 C NU 108.58 0.00 0.00 0.00 XXX 1.25 Back upholsteryE0982 C RR 10.85 0.00 0.00 0.00 XXX 1.25 Back upholsteryE0982 C UE 81.41 0.00 0.00 0.00 XXX 1.25 Back upholsteryE0983 C 367.15 0.00 0.00 0.00 XXX 1.25 Add pwr joystickE0983 C NU 917.88 0.00 0.00 0.00 XXX 5.00 Add pwr joystickE0983 C RR 367.15 0.00 0.00 0.00 XXX 1.25 Add pwr joystickE0983 C UE 688.41 0.00 0.00 0.00 XXX 5.00 Add pwr joystickE0984 C 372.54 0.00 0.00 0.00 XXX 1.25 Add pwr tillerE0984 C NU 886.60 0.00 0.00 0.00 XXX 5.00 Add pwr tillerE0984 C RR 372.54 0.00 0.00 0.00 XXX 1.25 Add pwr tillerE0984 C UE 664.94 0.00 0.00 0.00 XXX 5.00 Add pwr tillerE0985 C 30.40 0.00 0.00 0.00 XXX 1.25 W/c seat lift mechanismE0985 C NU 304.26 0.00 0.00 0.00 XXX 1.25 W/c seat lift mechanismE0985 C RR 30.40 0.00 0.00 0.00 XXX 1.25 W/c seat lift mechanismE0985 C UE 228.19 0.00 0.00 0.00 XXX 1.25 W/c seat lift mechanismE0986 C 729.64 0.00 0.00 0.00 XXX 1.25 Man w/c push-rim pow assistE0986 C NU 912.05 0.00 0.00 0.00 XXX 10.00 Man w/c push-rim pow assistE0986 C RR 729.64 0.00 0.00 0.00 XXX 1.25 Man w/c push-rim pow assistE0986 C UE 684.04 0.00 0.00 0.00 XXX 10.00 Man w/c push-rim pow assistE0990 C 28.41 0.00 0.00 0.00 XXX 1.25 Whellchair elevating leg resE0990 C NU 227.39 0.00 0.00 0.00 XXX 1.25 Whellchair elevating leg resE0990 C RR 28.41 0.00 0.00 0.00 XXX 1.25 Whellchair elevating leg resE0990 C UE 170.50 0.00 0.00 0.00 XXX 1.25 Whellchair elevating leg resE0992 C 38.29 0.00 0.00 0.00 XXX 1.25 Wheelchair solid seat insertE0992 C NU 306.46 0.00 0.00 0.00 XXX 1.25 Wheelchair solid seat insertE0992 C RR 38.29 0.00 0.00 0.00 XXX 1.25 Wheelchair solid seat insertE0992 C UE 229.85 0.00 0.00 0.00 XXX 1.25 Wheelchair solid seat insertE0994 C 4.12 0.00 0.00 0.00 XXX 1.25 Wheelchair arm restE0994 C NU 41.29 0.00 0.00 0.00 XXX 1.25 Wheelchair arm restE0994 C RR 4.12 0.00 0.00 0.00 XXX 1.25 Wheelchair arm restE0994 C UE 30.95 0.00 0.00 0.00 XXX 1.25 Wheelchair arm restE0995 C 13.03 0.00 0.00 0.00 XXX 1.25 Wheelchair calf restE0995 C NU 130.11 0.00 0.00 0.00 XXX 1.25 Wheelchair calf restE0995 C RR 13.03 0.00 0.00 0.00 XXX 1.25 Wheelchair calf restE0995 C UE 97.62 0.00 0.00 0.00 XXX 1.25 Wheelchair calf restE0996 C 3.51 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire solidE0996 C NU 36.40 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire solidE0996 C RR 3.51 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire solidE0996 C UE 27.84 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire solidE0997 C 21.16 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/ a forkE0997 C NU 211.64 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/ a fork
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E0997 C RR 21.16 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/ a forkE0997 C UE 158.74 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/ a forkE0998 C 16.97 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/o a forkE0998 C NU 169.72 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/o a forkE0998 C RR 16.97 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/o a forkE0998 C UE 127.29 0.00 0.00 0.00 XXX 1.25 Wheelchair caster w/o a forkE0999 C 19.71 0.00 0.00 0.00 XXX 1.25 Wheelchr pneumatic tire w/whE0999 C NU 157.59 0.00 0.00 0.00 XXX 1.25 Wheelchr pneumatic tire w/whE0999 C RR 19.71 0.00 0.00 0.00 XXX 1.25 Wheelchr pneumatic tire w/whE0999 C UE 118.21 0.00 0.00 0.00 XXX 1.25 Wheelchr pneumatic tire w/whE1000 C 5.05 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire pneumatic caE1000 C NU 45.95 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire pneumatic caE1000 C RR 5.05 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire pneumatic caE1000 C UE 34.45 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair tire pneumatic caE1001 C 19.24 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair wheelE1001 C NU 154.03 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair wheelE1001 C RR 19.24 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair wheelE1001 C UE 115.52 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair wheelE1002 C 616.94 0.00 0.00 0.00 XXX 1.25 Pwr seat tiltE1002 C NU 771.19 0.00 0.00 0.00 XXX 10.00 Pwr seat tiltE1002 C RR 616.94 0.00 0.00 0.00 XXX 1.25 Pwr seat tiltE1002 C UE 578.39 0.00 0.00 0.00 XXX 10.00 Pwr seat tiltE1003 C 658.69 0.00 0.00 0.00 XXX 1.25 Pwr seat reclineE1003 C NU 823.37 0.00 0.00 0.00 XXX 10.00 Pwr seat reclineE1003 C RR 658.69 0.00 0.00 0.00 XXX 1.25 Pwr seat reclineE1003 C UE 617.53 0.00 0.00 0.00 XXX 10.00 Pwr seat reclineE1004 C 730.36 0.00 0.00 0.00 XXX 1.25 Pwr seat recline mechE1004 C NU 912.94 0.00 0.00 0.00 XXX 10.00 Pwr seat recline mechE1004 C RR 730.36 0.00 0.00 0.00 XXX 1.25 Pwr seat recline mechE1004 C UE 684.71 0.00 0.00 0.00 XXX 10.00 Pwr seat recline mechE1005 C 790.58 0.00 0.00 0.00 XXX 1.25 Pwr seat recline pwrE1005 C NU 988.20 0.00 0.00 0.00 XXX 10.00 Pwr seat recline pwrE1005 C RR 790.58 0.00 0.00 0.00 XXX 1.25 Pwr seat recline pwrE1005 C UE 741.15 0.00 0.00 0.00 XXX 10.00 Pwr seat recline pwrE1006 C 968.39 0.00 0.00 0.00 XXX 1.25 Pwr seat combo w/o shearE1006 C NU 968.36 0.00 0.00 0.00 XXX 12.50 Pwr seat combo w/o shearE1006 C RR 968.39 0.00 0.00 0.00 XXX 1.25 Pwr seat combo w/o shearE1006 C UE 726.27 0.00 0.00 0.00 XXX 12.50 Pwr seat combo w/o shearE1007 C 655.59 0.00 0.00 0.00 XXX 2.50 Pwr seat combo w/shearE1007 C NU 819.49 0.00 0.00 0.00 XXX 20.00 Pwr seat combo w/shearE1007 C RR 655.59 0.00 0.00 0.00 XXX 2.50 Pwr seat combo w/shearE1007 C UE 614.62 0.00 0.00 0.00 XXX 20.00 Pwr seat combo w/shearE1008 C 655.65 0.00 0.00 0.00 XXX 2.50 Pwr seat combo pwr shearE1008 C NU 819.57 0.00 0.00 0.00 XXX 20.00 Pwr seat combo pwr shearE1008 C RR 655.64 0.00 0.00 0.00 XXX 2.50 Pwr seat combo pwr shearE1008 C UE 614.68 0.00 0.00 0.00 XXX 20.00 Pwr seat combo pwr shearE1009 C 0.00 0.00 0.00 0.00 XXX 0.00 Add mech leg elevationE1009 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Add mech leg elevationE1009 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Add mech leg elevationE1009 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Add mech leg elevationE1010 C 171.57 0.00 0.00 0.00 XXX 1.25 Add pwr leg elevationE1010 C NU 857.84 0.00 0.00 0.00 XXX 2.50 Add pwr leg elevationE1010 C RR 171.57 0.00 0.00 0.00 XXX 1.25 Add pwr leg elevationE1010 C UE 643.39 0.00 0.00 0.00 XXX 2.50 Add pwr leg elevation
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1011 D 0.00 0.00 0.00 0.00 XXX 0.00 Ped wc modify width adjustmE1011 D NU 0.00 0.00 0.00 0.00 XXX 0.00 Ped wc modify width adjustmE1011 D RR 0.00 0.00 0.00 0.00 XXX 0.00 Ped wc modify width adjustmE1011 D UE 0.00 0.00 0.00 0.00 XXX 0.00 Ped wc modify width adjustmE1014 C 54.76 0.00 0.00 0.00 XXX 1.25 Reclining back add ped w/cE1014 C NU 547.70 0.00 0.00 0.00 XXX 1.25 Reclining back add ped w/cE1014 C RR 54.76 0.00 0.00 0.00 XXX 1.25 Reclining back add ped w/cE1014 C UE 410.77 0.00 0.00 0.00 XXX 1.25 Reclining back add ped w/cE1015 C 17.21 0.00 0.00 0.00 XXX 1.25 Shock absorber for man w/cE1015 C NU 172.02 0.00 0.00 0.00 XXX 1.25 Shock absorber for man w/cE1015 C RR 17.21 0.00 0.00 0.00 XXX 1.25 Shock absorber for man w/cE1015 C UE 129.03 0.00 0.00 0.00 XXX 1.25 Shock absorber for man w/cE1016 C 19.71 0.00 0.00 0.00 XXX 1.25 Shock absorber for power w/cE1016 C NU 196.94 0.00 0.00 0.00 XXX 1.25 Shock absorber for power w/cE1016 C RR 19.71 0.00 0.00 0.00 XXX 1.25 Shock absorber for power w/cE1016 C UE 147.74 0.00 0.00 0.00 XXX 1.25 Shock absorber for power w/cE1017 C 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrbr for hd man wcE1017 C NU 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrbr for hd man wcE1017 C RR 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrbr for hd man wcE1017 C UE 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrbr for hd man wcE1018 C 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrber for hd powwcE1018 C NU 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrber for hd powwcE1018 C RR 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrber for hd powwcE1018 C UE 0.00 0.00 0.00 0.00 XXX 0.00 HD shck absrber for hd powwcE1019 C 55.90 0.00 0.00 0.00 XXX 1.25 12/31/2005 HD feature power seatE1019 C NU 559.08 0.00 0.00 0.00 XXX 1.25 12/31/2005 HD feature power seatE1019 C RR 55.90 0.00 0.00 0.00 XXX 1.25 12/31/2005 HD feature power seatE1019 C UE 419.30 0.00 0.00 0.00 XXX 1.25 12/31/2005 HD feature power seatE1020 C 36.51 0.00 0.00 0.00 XXX 1.25 Residual limb support systemE1020 C NU 365.14 0.00 0.00 0.00 XXX 1.25 Residual limb support systemE1020 C RR 36.51 0.00 0.00 0.00 XXX 1.25 Residual limb support systemE1020 C UE 273.84 0.00 0.00 0.00 XXX 1.25 Residual limb support systemE1021 C 40.51 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ex hd feature power seatE1021 C NU 405.20 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ex hd feature power seatE1021 C RR 40.51 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ex hd feature power seatE1021 C UE 303.90 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ex hd feature power seatE1025 C 16.01 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc lat/thor sup nocontourE1025 C NU 159.98 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc lat/thor sup nocontourE1025 C RR 16.01 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc lat/thor sup nocontourE1025 C UE 119.99 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc lat/thor sup nocontourE1026 C 24.63 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc contoured lat/thor supE1026 C NU 246.19 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc contoured lat/thor supE1026 C RR 24.63 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc contoured lat/thor supE1026 C UE 184.64 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pedwc contoured lat/thor supE1027 C 35.09 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ped wc lat/ant supportE1027 C NU 351.05 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ped wc lat/ant supportE1027 C RR 35.09 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ped wc lat/ant supportE1027 C UE 263.26 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ped wc lat/ant supportE1028 C 30.96 0.00 0.00 0.00 XXX 1.25 W/c manual swingawayE1028 C NU 309.81 0.00 0.00 0.00 XXX 1.25 W/c manual swingawayE1028 C RR 30.96 0.00 0.00 0.00 XXX 1.25 W/c manual swingawayE1028 C UE 232.34 0.00 0.00 0.00 XXX 1.25 W/c manual swingawayE1029 C 55.44 0.00 0.00 0.00 XXX 1.25 W/c vent tray fixedE1029 C NU 554.30 0.00 0.00 0.00 XXX 1.25 W/c vent tray fixed
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1029 C RR 55.44 0.00 0.00 0.00 XXX 1.25 W/c vent tray fixedE1029 C UE 415.74 0.00 0.00 0.00 XXX 1.25 W/c vent tray fixedE1030 C 174.80 0.00 0.00 0.00 XXX 1.25 W/c vent tray gimbaledE1030 C NU 873.96 0.00 0.00 0.00 XXX 2.50 W/c vent tray gimbaledE1030 C RR 174.80 0.00 0.00 0.00 XXX 1.25 W/c vent tray gimbaledE1030 C UE 655.47 0.00 0.00 0.00 XXX 2.50 W/c vent tray gimbaledE1031 C 68.01 0.00 0.00 0.00 XXX 1.25 Rollabout chair with castersE1031 C NU 680.10 0.00 0.00 0.00 XXX 1.25 Rollabout chair with castersE1031 C RR 68.01 0.00 0.00 0.00 XXX 1.25 Rollabout chair with castersE1031 C UE 510.08 0.00 0.00 0.00 XXX 1.25 Rollabout chair with castersE1035 C 919.82 0.00 0.00 0.00 XXX 1.25 Patient transfer systemE1035 C NU 919.82 0.00 0.00 0.00 XXX 12.50 Patient transfer systemE1035 C RR 919.82 0.00 0.00 0.00 XXX 1.25 Patient transfer systemE1035 C UE 689.87 0.00 0.00 0.00 XXX 12.50 Patient transfer systemE1037 D 162.74 0.00 0.00 0.00 XXX 1.25 Transport chairE1037 D NU 813.70 0.00 0.00 0.00 XXX 2.50 Transport chair, ped sizeE1037 D RR 162.74 0.00 0.00 0.00 XXX 1.25 Transport chair, ped sizeE1037 D UE 610.28 0.00 0.00 0.00 XXX 2.50 Transport chair, ped sizeE1038 C 27.03 0.00 0.00 0.00 XXX 1.25 Transport chair, adult sizeE1038 C NU 270.30 0.00 0.00 0.00 XXX 1.25 Transport chair, adult sizeE1038 C RR 27.03 0.00 0.00 0.00 XXX 1.25 Transport chair, adult sizeE1038 C UE 202.73 0.00 0.00 0.00 XXX 1.25 Transport chair, adult sizeE1039 C 51.30 0.00 0.00 0.00 XXX 1.25 Transport chair pt wt>=250lbE1039 C NU 513.00 0.00 0.00 0.00 XXX 1.25 Transport chair pt wt>=250lbE1039 C RR 51.30 0.00 0.00 0.00 XXX 1.25 Transport chair pt wt>=250lbE1039 C UE 384.75 0.00 0.00 0.00 XXX 1.25 Transport chair pt wt>=250lbE1050 C 228.69 0.00 0.00 0.00 XXX 1.25 Whelchr fxd full length armsE1050 C NU 571.73 0.00 0.00 0.00 XXX 5.00 Whelchr fxd full length armsE1050 C RR 228.69 0.00 0.00 0.00 XXX 1.25 Whelchr fxd full length armsE1050 C UE 428.80 0.00 0.00 0.00 XXX 5.00 Whelchr fxd full length armsE1060 C 168.00 0.00 0.00 0.00 XXX 1.25 Wheelchair detachable armsE1060 C NU 840.00 0.00 0.00 0.00 XXX 2.50 Wheelchair detachable armsE1060 C RR 168.00 0.00 0.00 0.00 XXX 1.25 Wheelchair detachable armsE1060 C UE 630.00 0.00 0.00 0.00 XXX 2.50 Wheelchair detachable armsE1070 C 199.19 0.00 0.00 0.00 XXX 1.25 Wheelchair detachable foot rE1070 C NU 995.95 0.00 0.00 0.00 XXX 2.50 Wheelchair detachable foot rE1070 C RR 199.19 0.00 0.00 0.00 XXX 1.25 Wheelchair detachable foot rE1070 C UE 746.97 0.00 0.00 0.00 XXX 2.50 Wheelchair detachable foot rE1083 C 102.66 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair fixed armsE1083 C NU 513.30 0.00 0.00 0.00 XXX 2.50 Hemi-wheelchair fixed armsE1083 C RR 102.66 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair fixed armsE1083 C UE 769.96 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair fixed armsE1084 C 130.10 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair detachable aE1084 C NU 650.50 0.00 0.00 0.00 XXX 2.50 Hemi-wheelchair detachable aE1084 C RR 130.10 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair detachable aE1084 C UE 975.75 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair detachable aE1085 C 104.44 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair fixed armsE1085 C NU 522.19 0.00 0.00 0.00 XXX 2.50 Hemi-wheelchair fixed armsE1085 C RR 104.44 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair fixed armsE1085 C UE 783.13 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair fixed armsE1086 C 104.44 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair detachable aE1086 C NU 522.19 0.00 0.00 0.00 XXX 2.50 Hemi-wheelchair detachable aE1086 C RR 104.44 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair detachable aE1086 C UE 783.13 0.00 0.00 0.00 XXX 1.25 Hemi-wheelchair detachable a
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1087 C 216.35 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1087 C NU 540.88 0.00 0.00 0.00 XXX 5.00 Wheelchair lightwt fixed armE1087 C RR 216.35 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1087 C UE 405.66 0.00 0.00 0.00 XXX 5.00 Wheelchair lightwt fixed armE1088 C 260.30 0.00 0.00 0.00 XXX 1.25 Wheelchair lightweight det aE1088 C NU 650.75 0.00 0.00 0.00 XXX 5.00 Wheelchair lightweight det aE1088 C RR 260.30 0.00 0.00 0.00 XXX 1.25 Wheelchair lightweight det aE1088 C UE 488.06 0.00 0.00 0.00 XXX 5.00 Wheelchair lightweight det aE1089 C 170.56 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1089 C NU 852.82 0.00 0.00 0.00 XXX 2.50 Wheelchair lightwt fixed armE1089 C RR 170.56 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1089 C UE 639.53 0.00 0.00 0.00 XXX 2.50 Wheelchair lightwt fixed armE1090 C 170.56 0.00 0.00 0.00 XXX 1.25 Wheelchair lightweight det aE1090 C NU 852.82 0.00 0.00 0.00 XXX 2.50 Wheelchair lightweight det aE1090 C RR 170.56 0.00 0.00 0.00 XXX 1.25 Wheelchair lightweight det aE1090 C UE 639.53 0.00 0.00 0.00 XXX 2.50 Wheelchair lightweight det aE1092 C 213.30 0.00 0.00 0.00 XXX 1.25 Wheelchair wide w/ leg restsE1092 C NU 533.25 0.00 0.00 0.00 XXX 5.00 Wheelchair wide w/ leg restsE1092 C RR 213.30 0.00 0.00 0.00 XXX 1.25 Wheelchair wide w/ leg restsE1092 C UE 399.94 0.00 0.00 0.00 XXX 5.00 Wheelchair wide w/ leg restsE1093 C 195.74 0.00 0.00 0.00 XXX 1.25 Wheelchair wide w/ foot restE1093 C NU 978.70 0.00 0.00 0.00 XXX 2.50 Wheelchair wide w/ foot restE1093 C RR 195.74 0.00 0.00 0.00 XXX 1.25 Wheelchair wide w/ foot restE1093 C UE 734.03 0.00 0.00 0.00 XXX 2.50 Wheelchair wide w/ foot restE1100 C 160.32 0.00 0.00 0.00 XXX 1.25 Whchr s-recl fxd arm leg resE1100 C NU 801.60 0.00 0.00 0.00 XXX 2.50 Whchr s-recl fxd arm leg resE1100 C RR 160.32 0.00 0.00 0.00 XXX 1.25 Whchr s-recl fxd arm leg resE1100 C UE 601.20 0.00 0.00 0.00 XXX 2.50 Whchr s-recl fxd arm leg resE1110 C 133.46 0.00 0.00 0.00 XXX 1.25 Wheelchair semi-recl detachE1110 C NU 667.30 0.00 0.00 0.00 XXX 2.50 Wheelchair semi-recl detachE1110 C RR 133.46 0.00 0.00 0.00 XXX 1.25 Wheelchair semi-recl detachE1110 C UE 500.48 0.00 0.00 0.00 XXX 2.50 Wheelchair semi-recl detachE1130 C 69.71 0.00 0.00 0.00 XXX 1.25 Whlchr std. fxd arm ft restE1130 C NU 697.13 0.00 0.00 0.00 XXX 1.25 Whlchr std. fxd arm ft restE1130 C RR 69.71 0.00 0.00 0.00 XXX 1.25 Whlchr std. fxd arm ft restE1130 C UE 522.81 0.00 0.00 0.00 XXX 1.25 Whlchr std. fxd arm ft restE1140 C 69.71 0.00 0.00 0.00 XXX 1.25 Wheelchair standard detach aE1140 C NU 697.13 0.00 0.00 0.00 XXX 1.25 Wheelchair standard detach aE1140 C RR 69.71 0.00 0.00 0.00 XXX 1.25 Wheelchair standard detach aE1140 C UE 522.81 0.00 0.00 0.00 XXX 1.25 Wheelchair standard detach aE1150 C 128.07 0.00 0.00 0.00 XXX 1.25 Wheelchair standard w/ leg rE1150 C NU 640.35 0.00 0.00 0.00 XXX 2.50 Wheelchair standard w/ leg rE1150 C RR 128.07 0.00 0.00 0.00 XXX 1.25 Wheelchair standard w/ leg rE1150 C UE 480.26 0.00 0.00 0.00 XXX 2.50 Wheelchair standard w/ leg rE1160 C 98.77 0.00 0.00 0.00 XXX 1.25 Wheelchair fixed armsE1160 C NU 987.70 0.00 0.00 0.00 XXX 1.25 Wheelchair fixed armsE1160 C RR 98.77 0.00 0.00 0.00 XXX 1.25 Wheelchair fixed armsE1160 C UE 740.78 0.00 0.00 0.00 XXX 1.25 Wheelchair fixed armsE1161 C 354.90 0.00 0.00 0.00 XXX 1.25 Manual adult wc w tiltinspacE1161 C NU 887.28 0.00 0.00 0.00 XXX 5.00 Manual adult wc w tiltinspacE1161 C RR 354.90 0.00 0.00 0.00 XXX 1.25 Manual adult wc w tiltinspacE1161 C UE 665.47 0.00 0.00 0.00 XXX 5.00 Manual adult wc w tiltinspacE1170 C 184.86 0.00 0.00 0.00 XXX 1.25 Whlchr ampu fxd arm leg restE1170 C NU 924.30 0.00 0.00 0.00 XXX 2.50 Whlchr ampu fxd arm leg rest
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1170 C RR 184.86 0.00 0.00 0.00 XXX 1.25 Whlchr ampu fxd arm leg restE1170 C UE 693.23 0.00 0.00 0.00 XXX 2.50 Whlchr ampu fxd arm leg restE1171 C 147.57 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee w/o leg rE1171 C NU 737.85 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee w/o leg rE1171 C RR 147.57 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee w/o leg rE1171 C UE 553.39 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee w/o leg rE1172 C 158.47 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee detach arE1172 C NU 792.35 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee detach arE1172 C RR 158.47 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee detach arE1172 C UE 594.27 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee detach arE1180 C 152.43 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee w/ foot rE1180 C NU 762.15 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee w/ foot rE1180 C RR 152.43 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee w/ foot rE1180 C UE 571.62 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee w/ foot rE1190 C 190.71 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee w/ leg reE1190 C NU 953.55 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee w/ leg reE1190 C RR 190.71 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee w/ leg reE1190 C UE 715.17 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee w/ leg reE1195 C 184.72 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee heavy dutE1195 C NU 923.60 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee heavy dutE1195 C RR 184.72 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee heavy dutE1195 C UE 692.70 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee heavy dutE1200 C 157.52 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee fixed armE1200 C NU 787.60 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee fixed armE1200 C RR 157.52 0.00 0.00 0.00 XXX 1.25 Wheelchair amputee fixed armE1200 C UE 590.70 0.00 0.00 0.00 XXX 2.50 Wheelchair amputee fixed armE1210 C 683.17 0.00 0.00 0.00 XXX 1.25 12/31/2005 Whlchr moto ful arm leg restE1210 C NU 853.96 0.00 0.00 0.00 XXX 10.00 12/31/2005 Whlchr moto ful arm leg restE1210 C RR 683.17 0.00 0.00 0.00 XXX 1.25 12/31/2005 Whlchr moto ful arm leg restE1210 C UE 853.96 0.00 0.00 0.00 XXX 7.50 12/31/2005 Whlchr moto ful arm leg restE1211 C 720.24 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair motorized w/ detE1211 C NU 900.30 0.00 0.00 0.00 XXX 10.00 12/31/2005 Wheelchair motorized w/ detE1211 C RR 720.24 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair motorized w/ detE1211 C UE 900.30 0.00 0.00 0.00 XXX 7.50 12/31/2005 Wheelchair motorized w/ detE1212 C 543.68 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair motorized w fullE1212 C NU 906.13 0.00 0.00 0.00 XXX 7.50 12/31/2005 Wheelchair motorized w fullE1212 C RR 543.68 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair motorized w fullE1212 C UE 679.58 0.00 0.00 0.00 XXX 7.50 12/31/2005 Wheelchair motorized w fullE1213 C 543.68 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair motorized w/ detE1213 C NU 906.13 0.00 0.00 0.00 XXX 7.50 12/31/2005 Wheelchair motorized w/ detE1213 C RR 543.68 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair motorized w/ detE1213 C UE 679.58 0.00 0.00 0.00 XXX 7.50 12/31/2005 Wheelchair motorized w/ detE1220 C 0.00 0.00 0.00 0.00 XXX 0.00 Wheelchair; specially sized/constrE1221 C 76.95 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w footE1221 C NU 769.50 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w footE1221 C RR 76.95 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w footE1221 C UE 577.13 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w footE1222 C 113.81 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w/ legE1222 C NU 569.05 0.00 0.00 0.00 XXX 2.50 Wheelchair spec size w/ legE1222 C RR 113.81 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w/ legE1222 C UE 426.79 0.00 0.00 0.00 XXX 2.50 Wheelchair spec size w/ legE1223 C 107.51 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w footE1223 C NU 537.55 0.00 0.00 0.00 XXX 2.50 Wheelchair spec size w footE1223 C RR 107.51 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w foot
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1223 C UE 403.16 0.00 0.00 0.00 XXX 2.50 Wheelchair spec size w footE1224 C 121.91 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w/ legE1224 C NU 609.55 0.00 0.00 0.00 XXX 2.50 Wheelchair spec size w/ legE1224 C RR 121.91 0.00 0.00 0.00 XXX 1.25 Wheelchair spec size w/ legE1224 C UE 457.16 0.00 0.00 0.00 XXX 2.50 Wheelchair spec size w/ legE1225 C 61.93 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz semi-reclE1225 C NU 619.30 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz semi-reclE1225 C RR 61.93 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz semi-reclE1225 C UE 464.48 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz semi-reclE1226 C 135.05 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz full-reclE1226 C NU 675.22 0.00 0.00 0.00 XXX 2.50 W/C access fully reclinebackE1226 C RR 135.05 0.00 0.00 0.00 XXX 1.25 W/C access fully reclinebackE1226 C UE 506.30 0.00 0.00 0.00 XXX 2.50 W/C access fully reclinebackE1227 C 52.04 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht aE1227 C NU 416.24 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht aE1227 C RR 52.04 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht aE1227 C UE 320.33 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht aE1228 C 36.39 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht bE1228 C NU 363.90 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht bE1228 C RR 36.39 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht bE1228 C UE 272.93 0.00 0.00 0.00 XXX 1.25 Wheelchair spec sz spec ht bE1229 D 0.00 0.00 0.00 0.00 XXX 0.00 Wheelchair, pediatricE1230 C 419.99 0.00 0.00 0.00 XXX 1.25 Power operated vehicleE1230 C NU 839.97 0.00 0.00 0.00 XXX 5.00 Power operated vehicleE1230 C RR 419.99 0.00 0.00 0.00 XXX 1.25 Power operated vehicleE1230 C UE 629.97 0.00 0.00 0.00 XXX 5.00 Power operated vehicleE1231 D 0.00 0.00 0.00 0.00 XXX 0.00 Rigid ped w/c tilt-in-spaceE1231 D NU 0.00 0.00 0.00 0.00 XXX 0.00 Rigid ped w/c tilt-in-spaceE1231 D RR 0.00 0.00 0.00 0.00 XXX 0.00 Rigid ped w/c tilt-in-spaceE1231 D UE 0.00 0.00 0.00 0.00 XXX 0.00 Rigid ped w/c tilt-in-spaceE1232 D 320.76 0.00 0.00 0.00 XXX 1.25 Folding ped wc tilt-in-spaceE1232 D NU 801.90 0.00 0.00 0.00 XXX 5.00 Folding ped wc tilt-in-spaceE1232 D RR 320.76 0.00 0.00 0.00 XXX 1.25 Folding ped wc tilt-in-spaceE1232 D UE 601.43 0.00 0.00 0.00 XXX 5.00 Folding ped wc tilt-in-spaceE1233 D 332.35 0.00 0.00 0.00 XXX 1.25 Rig ped wc tltnspc w/o seatE1233 D NU 830.90 0.00 0.00 0.00 XXX 5.00 Rig ped wc tltnspc w/o seatE1233 D RR 332.35 0.00 0.00 0.00 XXX 1.25 Rig ped wc tltnspc w/o seatE1233 D UE 623.17 0.00 0.00 0.00 XXX 5.00 Rig ped wc tltnspc w/o seatE1234 D 289.36 0.00 0.00 0.00 XXX 1.25 Fld ped wc tltnspc w/o seatE1234 D NU 723.35 0.00 0.00 0.00 XXX 5.00 Fld ped wc tltnspc w/o seatE1234 D RR 289.36 0.00 0.00 0.00 XXX 1.25 Fld ped wc tltnspc w/o seatE1234 D UE 542.52 0.00 0.00 0.00 XXX 5.00 Fld ped wc tltnspc w/o seatE1235 D 278.64 0.00 0.00 0.00 XXX 1.25 Rigid ped wc adjustableE1235 D NU 696.53 0.00 0.00 0.00 XXX 5.00 Rigid ped wc adjustableE1235 D RR 278.64 0.00 0.00 0.00 XXX 1.25 Rigid ped wc adjustableE1235 D UE 522.40 0.00 0.00 0.00 XXX 5.00 Rigid ped wc adjustableE1236 D 245.81 0.00 0.00 0.00 XXX 1.25 Folding ped wc adjustableE1236 D NU 614.53 0.00 0.00 0.00 XXX 5.00 Folding ped wc adjustableE1236 D RR 245.81 0.00 0.00 0.00 XXX 1.25 Folding ped wc adjustableE1236 D UE 460.90 0.00 0.00 0.00 XXX 5.00 Folding ped wc adjustableE1237 D 247.96 0.00 0.00 0.00 XXX 1.25 Rgd ped wc adjstabl w/o seatE1237 D NU 619.89 0.00 0.00 0.00 XXX 5.00 Rgd ped wc adjstabl w/o seatE1237 D RR 247.96 0.00 0.00 0.00 XXX 1.25 Rgd ped wc adjstabl w/o seatE1237 D UE 464.92 0.00 0.00 0.00 XXX 5.00 Rgd ped wc adjstabl w/o seat
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1238 D 245.81 0.00 0.00 0.00 XXX 1.25 Fld ped wc adjstabl w/o seatE1238 D NU 614.53 0.00 0.00 0.00 XXX 5.00 Fld ped wc adjstabl w/o seatE1238 D RR 245.81 0.00 0.00 0.00 XXX 1.25 Fld ped wc adjstabl w/o seatE1238 D UE 921.79 0.00 0.00 0.00 XXX 2.50 Fld ped wc adjstabl w/o seatE1239 D 0.00 0.00 0.00 0.00 XXX 0.00 Pwr ped wc, NOSE1240 C 138.11 0.00 0.00 0.00 XXX 1.25 Whchr litwt det arm leg restE1240 C NU 690.55 0.00 0.00 0.00 XXX 2.50 Whchr litwt det arm leg restE1240 C RR 138.11 0.00 0.00 0.00 XXX 1.25 Whchr litwt det arm leg restE1240 C UE 517.92 0.00 0.00 0.00 XXX 2.50 Whchr litwt det arm leg restE1250 C 94.67 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1250 C NU 946.71 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1250 C RR 94.67 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1250 C UE 710.01 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt fixed armE1260 C 94.67 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt foot restE1260 C NU 946.71 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt foot restE1260 C RR 94.67 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt foot restE1260 C UE 710.01 0.00 0.00 0.00 XXX 1.25 Wheelchair lightwt foot restE1270 C 108.84 0.00 0.00 0.00 XXX 1.25 Wheelchair lightweight leg rE1270 C NU 544.20 0.00 0.00 0.00 XXX 2.50 Wheelchair lightweight leg rE1270 C RR 108.84 0.00 0.00 0.00 XXX 1.25 Wheelchair lightweight leg rE1270 C UE 816.30 0.00 0.00 0.00 XXX 1.25 Wheelchair lightweight leg rE1280 C 259.48 0.00 0.00 0.00 XXX 1.25 Whchr h-duty det arm leg resE1280 C NU 648.70 0.00 0.00 0.00 XXX 5.00 Whchr h-duty det arm leg resE1280 C RR 259.48 0.00 0.00 0.00 XXX 1.25 Whchr h-duty det arm leg resE1280 C UE 486.53 0.00 0.00 0.00 XXX 5.00 Whchr h-duty det arm leg resE1285 C 132.52 0.00 0.00 0.00 XXX 1.25 Wheelchair heavy duty fixedE1285 C NU 662.61 0.00 0.00 0.00 XXX 2.50 Wheelchair heavy duty fixedE1285 C RR 132.52 0.00 0.00 0.00 XXX 1.25 Wheelchair heavy duty fixedE1285 C UE 993.91 0.00 0.00 0.00 XXX 1.25 Wheelchair heavy duty fixedE1290 C 132.52 0.00 0.00 0.00 XXX 1.25 Wheelchair hvy duty detach aE1290 C NU 662.61 0.00 0.00 0.00 XXX 2.50 Wheelchair hvy duty detach aE1290 C RR 132.52 0.00 0.00 0.00 XXX 1.25 Wheelchair hvy duty detach aE1290 C UE 993.91 0.00 0.00 0.00 XXX 1.25 Wheelchair hvy duty detach aE1295 C 215.51 0.00 0.00 0.00 XXX 1.25 Wheelchair heavy duty fixedE1295 C NU 538.78 0.00 0.00 0.00 XXX 5.00 Wheelchair heavy duty fixedE1295 C RR 215.51 0.00 0.00 0.00 XXX 1.25 Wheelchair heavy duty fixedE1295 C UE 404.09 0.00 0.00 0.00 XXX 5.00 Wheelchair heavy duty fixedE1296 C 80.51 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat heigE1296 C NU 644.23 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat heigE1296 C RR 80.51 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat heigE1296 C UE 483.16 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat heigE1297 C 18.26 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat deptE1297 C NU 146.04 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat deptE1297 C RR 18.26 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat deptE1297 C UE 109.53 0.00 0.00 0.00 XXX 1.25 Wheelchair special seat deptE1298 C 61.95 0.00 0.00 0.00 XXX 1.25 Wheelchair spec seat depth/wE1298 C NU 542.06 0.00 0.00 0.00 XXX 1.25 Wheelchair spec seat depth/wE1298 C RR 61.95 0.00 0.00 0.00 XXX 1.25 Wheelchair spec seat depth/wE1298 C UE 406.53 0.00 0.00 0.00 XXX 1.25 Wheelchair spec seat depth/wE1300 C 0.00 0.00 0.00 0.00 XXX 0.00 Whirlpool, portable (overtub)E1310 C 397.65 0.00 0.00 0.00 XXX 1.25 Whirlpool non-portableE1310 C NU 795.33 0.00 0.00 0.00 XXX 5.00 Whirlpool non-portableE1310 C RR 397.65 0.00 0.00 0.00 XXX 1.25 Whirlpool non-portableE1310 C UE 596.50 0.00 0.00 0.00 XXX 5.00 Whirlpool non-portable
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1340 C 0.00 0.00 0.00 0.00 XXX 1.25 Repair/service for DME per 15 minE1353 C 0.00 0.00 0.00 0.00 XXX 0.00 RegulatorE1355 C 0.00 0.00 0.00 0.00 XXX 0.00 Stand/rackE1372 C 62.45 0.00 0.00 0.00 XXX 1.25 Oxy suppl heater for nebulizE1372 C NU 218.30 0.00 0.00 0.00 XXX 1.25 Oxy suppl heater for nebulizE1372 C RR 62.45 0.00 0.00 0.00 XXX 1.25 Oxy suppl heater for nebulizE1372 C UE 163.72 0.00 0.00 0.00 XXX 1.25 Oxy suppl heater for nebulizE1390 C 250.51 0.00 0.00 0.00 XXX 1.25 Oxygen concentratorE1390 C NU 626.28 0.00 0.00 0.00 XXX 5.00 Oxygen concentratorE1390 C RR 250.51 0.00 0.00 0.00 XXX 1.25 Oxygen concentratorE1390 C UE 469.71 0.00 0.00 0.00 XXX 5.00 Oxygen concentratorE1391 C 250.51 0.00 0.00 0.00 XXX 1.25 Oxygen concentratorE1391 C NU 626.28 0.00 0.00 0.00 XXX 5.00 Oxygen concentratorE1391 C RR 250.51 0.00 0.00 0.00 XXX 1.25 Oxygen concentratorE1391 C UE 469.71 0.00 0.00 0.00 XXX 5.00 Oxygen concentratorE1392 C 40.10 0.00 0.00 0.00 XXX 1.25 Portable oxygen concentratorE1392 C RR 40.10 0.00 0.00 0.00 XXX 1.25 Portable oxygen concentratorE1399 S 0.00 0.00 0.00 0.00 XXX 0.00 Durable medical equip. miscE1405 C 322.94 0.00 0.00 0.00 XXX 1.25 O2/water vapor enrich w/heatE1405 C NU 807.35 0.00 0.00 0.00 XXX 5.00 O2/water vapor enrich w/heatE1405 C RR 322.94 0.00 0.00 0.00 XXX 1.25 O2/water vapor enrich w/heatE1405 C UE 605.51 0.00 0.00 0.00 XXX 5.00 O2/water vapor enrich w/heatE1406 C 270.65 0.00 0.00 0.00 XXX 1.25 O2/water vapor enrich w/o heE1406 C NU 676.63 0.00 0.00 0.00 XXX 5.00 O2/water vapor enrich w/o heE1406 C RR 270.65 0.00 0.00 0.00 XXX 1.25 O2/water vapor enrich w/o heE1406 C UE 507.47 0.00 0.00 0.00 XXX 5.00 O2/water vapor enrich w/o heE1500 C 0.00 0.00 0.00 0.00 XXX 0.00 Centrifuge, for dialysisE1510 C 0.00 0.00 0.00 0.00 XXX 0.00 Kidney dialysate del sys kidney machineE1520 C 0.00 0.00 0.00 0.00 XXX 0.00 Heparin infus pump-dialysisE1530 C 0.00 0.00 0.00 0.00 XXX 0.00 Air bubble detector for dialysisE1540 C 0.00 0.00 0.00 0.00 XXX 0.00 Pressure alarm for dialysisE1550 C 0.00 0.00 0.00 0.00 XXX 0.00 Bath conductivity meter for dialysisE1560 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood leak detector for dialysisE1570 C 0.00 0.00 0.00 0.00 XXX 0.00 Adjust chair for ESRD patientsE1575 C 0.00 0.00 0.00 0.00 XXX 0.00 Transducer protector/fluid barrier any sizE1580 C 0.00 0.00 0.00 0.00 XXX 0.00 Unipuncture control sys for dialysisE1590 C 0.00 0.00 0.00 0.00 XXX 0.00 Hemodialysis machineE1592 C 0.00 0.00 0.00 0.00 XXX 0.00 Automatic intermittent periotneal dialysisE1594 C 0.00 0.00 0.00 0.00 XXX 0.00 Cycler dialysis mach for peritoneal dialysE1600 C 0.00 0.00 0.00 0.00 XXX 0.00 Deliv &/or installa chgs-renal dialysis eqE1610 C 0.00 0.00 0.00 0.00 XXX 0.00 Reverse osmosis H20 purification sysE1615 C 0.00 0.00 0.00 0.00 XXX 0.00 Deionizer water purification sysE1620 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood pump for dialysisE1625 C 0.00 0.00 0.00 0.00 XXX 0.00 Water softening systemE1630 C 0.00 0.00 0.00 0.00 XXX 0.00 Reciprocating peritoneal dialysis sysE1632 C 0.00 0.00 0.00 0.00 XXX 0.00 Wearable artifical kidneyE1634 C 0.00 0.00 0.00 0.00 XXX 0.00 Peritoneal dialysis clamp, eachE1635 C 0.00 0.00 0.00 0.00 XXX 0.00 Compact travel hemodialyzer sysE1636 C 0.00 0.00 0.00 0.00 XXX 0.00 Sorbent cartridges, per caseE1637 C 0.00 0.00 0.00 0.00 XXX 0.00 Hemostats for dialysis, eachE1639 C 0.00 0.00 0.00 0.00 XXX 0.00 Scale, for dialysis, eachE1699 S 0.00 0.00 0.00 0.00 XXX 0.00 Dialysis equip, unspecified by rptE1700 C 68.32 0.00 0.00 0.00 XXX 1.25 Jaw motion rehab systemE1700 C NU 546.69 0.00 0.00 0.00 XXX 1.25 Jaw motion rehab system
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1700 C RR 68.32 0.00 0.00 0.00 XXX 1.25 Jaw motion rehab systemE1700 C UE 410.05 0.00 0.00 0.00 XXX 1.25 Jaw motion rehab systemE1701 C 14.31 0.00 0.00 0.00 XXX 1.25 Repl cushions for jaw motionE1702 C 35.80 0.00 0.00 0.00 XXX 1.25 Repl measr scales jaw motionE1800 C 195.21 0.00 0.00 0.00 XXX 1.25 Adjust elbow ext/flex deviceE1800 C NU 976.05 0.00 0.00 0.00 XXX 2.50 Adjust elbow ext/flex deviceE1800 C RR 195.21 0.00 0.00 0.00 XXX 1.25 Adjust elbow ext/flex deviceE1800 C UE 732.04 0.00 0.00 0.00 XXX 2.50 Adjust elbow ext/flex deviceE1801 C 189.13 0.00 0.00 0.00 XXX 1.25 Bi-direct static prog stretch elbow deviceE1801 C NU 945.65 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch elbow deviceE1801 C RR 189.13 0.00 0.00 0.00 XXX 1.25 SPS elbow deviceE1801 C UE 709.24 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch elbow deviceE1802 C 490.21 0.00 0.00 0.00 XXX 1.25 Adjst forearm pro/sup deviceE1802 C NU 817.02 0.00 0.00 0.00 XXX 7.50 Adjst forearm pro/sup deviceE1802 C RR 490.21 0.00 0.00 0.00 XXX 1.25 Adjst forearm pro/sup deviceE1802 C UE 612.76 0.00 0.00 0.00 XXX 7.50 Adjst forearm pro/sup deviceE1805 C 195.21 0.00 0.00 0.00 XXX 1.25 Adjust wrist ext/flex deviceE1805 C NU 976.05 0.00 0.00 0.00 XXX 2.50 Adjust wrist ext/flex deviceE1805 C RR 195.21 0.00 0.00 0.00 XXX 1.25 Adjust wrist ext/flex deviceE1805 C UE 732.04 0.00 0.00 0.00 XXX 2.50 Adjust wrist ext/flex deviceE1806 C 155.26 0.00 0.00 0.00 XXX 1.25 Bi-direct static prog stretch wrist deviceE1806 C NU 776.30 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch wrist deviceE1806 C RR 155.26 0.00 0.00 0.00 XXX 1.25 SPS wrist deviceE1806 C UE 582.23 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch wrist deviceE1810 C 195.21 0.00 0.00 0.00 XXX 1.25 Adjust knee ext/flex deviceE1810 C NU 976.05 0.00 0.00 0.00 XXX 2.50 Adjust knee ext/flex deviceE1810 C RR 195.21 0.00 0.00 0.00 XXX 1.25 Adjust knee ext/flex deviceE1810 C UE 732.04 0.00 0.00 0.00 XXX 2.50 Adjust knee ext/flex deviceE1811 C 196.64 0.00 0.00 0.00 XXX 1.25 Bi-direct static prog stretch knee deviceE1811 C NU 983.20 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch knee deviceE1811 C RR 196.64 0.00 0.00 0.00 XXX 1.25 SPS knee deviceE1811 C UE 737.40 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch knee deviceE1812 C 0.00 0.00 0.00 0.00 XXX 0.00 Knee ext/flex w act res ctrlE1812 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Knee ext/flex w act res ctrlE1812 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Knee ext/flex w act res ctrlE1812 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Knee ext/flex w act res ctrlE1815 C 195.21 0.00 0.00 0.00 XXX 1.25 Adjust ankle ext/flex deviceE1815 C NU 976.05 0.00 0.00 0.00 XXX 2.50 Adjust ankle ext/flex deviceE1815 C RR 195.21 0.00 0.00 0.00 XXX 1.25 Adjust ankle ext/flex deviceE1815 C UE 732.04 0.00 0.00 0.00 XXX 2.50 Adjust ankle ext/flex deviceE1816 C 199.72 0.00 0.00 0.00 XXX 1.25 Bi-direct static prog stretch ankle deviceE1816 C NU 998.60 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch ankle deviceE1816 C RR 199.72 0.00 0.00 0.00 XXX 1.25 SPS ankle deviceE1816 C UE 748.95 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch ankle deviceE1818 C 203.89 0.00 0.00 0.00 XXX 1.25 Bi-direct static prog stretch forarm deviceE1818 C NU 509.73 0.00 0.00 0.00 XXX 5.00 Bi-direct static prog stretch forarm deviceE1818 C RR 203.89 0.00 0.00 0.00 XXX 1.25 SPS forearm deviceE1818 C UE 764.59 0.00 0.00 0.00 XXX 2.50 Bi-direct static prog stretch forarm deviceE1820 C 12.66 0.00 0.00 0.00 XXX 1.25 Soft interface materialE1820 C NU 126.66 0.00 0.00 0.00 XXX 1.25 Soft interface materialE1820 C RR 12.66 0.00 0.00 0.00 XXX 1.25 Soft interface materialE1820 C UE 94.99 0.00 0.00 0.00 XXX 1.25 Soft interface materialE1821 C 15.79 0.00 0.00 0.00 XXX 1.25 Replacement, soft interface materialE1821 C NU 157.89 0.00 0.00 0.00 XXX 1.25 Replacement interface SPSD
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E1821 C RR 15.79 0.00 0.00 0.00 XXX 1.25 Replacement interface SPSDE1821 C UE 118.42 0.00 0.00 0.00 XXX 1.25 Replacement interface SPSDE1825 C 195.21 0.00 0.00 0.00 XXX 1.25 Adjust finger ext/flex devcE1825 C NU 976.05 0.00 0.00 0.00 XXX 2.50 Adjust finger ext/flex devcE1825 C RR 195.21 0.00 0.00 0.00 XXX 1.25 Adjust finger ext/flex devcE1825 C UE 732.04 0.00 0.00 0.00 XXX 2.50 Adjust finger ext/flex devcE1830 C 195.21 0.00 0.00 0.00 XXX 1.25 Adjust toe ext/flex deviceE1830 C NU 976.05 0.00 0.00 0.00 XXX 2.50 Adjust toe ext/flex deviceE1830 C RR 195.21 0.00 0.00 0.00 XXX 1.25 Adjust toe ext/flex deviceE1830 C UE 732.04 0.00 0.00 0.00 XXX 2.50 Adjust toe ext/flex deviceE1840 C 560.88 0.00 0.00 0.00 XXX 1.25 Dynamic adj shouldter flex/abduct/rot deviceE1840 C NU 934.80 0.00 0.00 0.00 XXX 7.50 Dynamic adj shouldter flex/abduct/rot deviceE1840 C RR 560.88 0.00 0.00 0.00 XXX 1.25 Adj shoulder ext/flex deviceE1840 C UE 701.10 0.00 0.00 0.00 XXX 7.50 Dynamic adj shouldter flex/abduct/rot deviceE1841 C 679.46 0.00 0.00 0.00 XXX 1.25 Static str shldr dev rom adjE1841 C NU 849.33 0.00 0.00 0.00 XXX 10.00 Static str shldr dev rom adjE1841 C RR 679.46 0.00 0.00 0.00 XXX 1.25 Static str shldr dev rom adjE1841 C UE 636.99 0.00 0.00 0.00 XXX 10.00 Static str shldr dev rom adjE1902 C 0.00 0.00 0.00 0.00 XXX 0.00 Commun board, non-electE2000 C 75.96 0.00 0.00 0.00 XXX 1.25 Gastric suction pump, home modelE2000 C NU 759.60 0.00 0.00 0.00 XXX 1.25 Gastric suction pump, home modelE2000 C RR 75.96 0.00 0.00 0.00 XXX 1.25 Gastric suction pump hme mdlE2000 C UE 569.70 0.00 0.00 0.00 XXX 1.25 Gastric suction pump, home modelE2100 C 118.94 0.00 0.00 0.00 XXX 1.25 Blood glucose monitor w/int voice synthE2100 C NU 951.44 0.00 0.00 0.00 XXX 1.25 Bld glucose monitor w voiceE2100 C RR 118.94 0.00 0.00 0.00 XXX 1.25 Bld glucose monitor w voiceE2100 C UE 713.60 0.00 0.00 0.00 XXX 1.25 Bld glucose monitor w voiceE2101 C 28.29 0.00 0.00 0.00 XXX 1.25 Blood glucose monitor w/int lancingE2101 C NU 282.80 0.00 0.00 0.00 XXX 1.25 Bld glucose monitor w lanceE2101 C RR 28.29 0.00 0.00 0.00 XXX 1.25 Bld glucose monitor w lanceE2101 C UE 212.12 0.00 0.00 0.00 XXX 1.25 Bld glucose monitor w lanceE2120 C 425.31 0.00 0.00 0.00 XXX 1.25 Pulse gen sys tx endolymp flE2120 C NU 708.85 0.00 0.00 0.00 XXX 7.50 Pulse gen sys tx endolymp flE2120 C RR 425.31 0.00 0.00 0.00 XXX 1.25 Pulse gen sys tx endolymp flE2120 C UE 531.64 0.00 0.00 0.00 XXX 7.50 Pulse gen sys tx endolymp flE2201 C 55.95 0.00 0.00 0.00 XXX 1.25 Man w/ch acc seat w>=20ö<24öE2201 C NU 559.66 0.00 0.00 0.00 XXX 1.25 Man w/ch acc seat w>=20ö<24öE2201 C RR 55.95 0.00 0.00 0.00 XXX 1.25 Man w/ch acc seat w>=20ö<24öE2201 C UE 419.76 0.00 0.00 0.00 XXX 1.25 Man w/ch acc seat w>=20ö<24öE2202 C 71.13 0.00 0.00 0.00 XXX 1.25 Seat width 24-27 inE2202 C NU 710.98 0.00 0.00 0.00 XXX 1.25 Seat width 24-27 inE2202 C RR 71.13 0.00 0.00 0.00 XXX 1.25 Seat width 24-27 inE2202 C UE 533.22 0.00 0.00 0.00 XXX 1.25 Seat width 24-27 inE2203 C 71.85 0.00 0.00 0.00 XXX 1.25 Frame depth less than 22 inE2203 C NU 718.53 0.00 0.00 0.00 XXX 1.25 Frame depth less than 22 inE2203 C RR 71.85 0.00 0.00 0.00 XXX 1.25 Frame depth less than 22 inE2203 C UE 538.93 0.00 0.00 0.00 XXX 1.25 Frame depth less than 22 inE2204 C 122.00 0.00 0.00 0.00 XXX 1.25 Frame depth 22 to 25 inE2204 C NU 610.06 0.00 0.00 0.00 XXX 2.50 Frame depth 22 to 25 inE2204 C RR 122.00 0.00 0.00 0.00 XXX 1.25 Frame depth 22 to 25 inE2204 C UE 915.09 0.00 0.00 0.00 XXX 1.25 Frame depth 22 to 25 inE2205 C 4.91 0.00 0.00 0.00 XXX 1.25 Manual wc accessory, handrimE2205 C NU 49.00 0.00 0.00 0.00 XXX 1.25 Manual wc accessory, handrimE2205 C RR 4.91 0.00 0.00 0.00 XXX 1.25 Manual wc accessory, handrim
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E2205 C UE 36.75 0.00 0.00 0.00 XXX 1.25 Manual wc accessory, handrimE2206 C 6.11 0.00 0.00 0.00 XXX 1.25 Complete wheel lock assemblyE2206 C NU 61.04 0.00 0.00 0.00 XXX 1.25 Complete wheel lock assemblyE2206 C RR 6.11 0.00 0.00 0.00 XXX 1.25 Complete wheel lock assemblyE2206 C UE 45.77 0.00 0.00 0.00 XXX 1.25 Complete wheel lock assemblyE2207 C 6.47 0.00 0.00 0.00 XXX 1.25 Crutch and cane holderE2207 C NU 65.04 0.00 0.00 0.00 XXX 1.25 Crutch and cane holderE2207 C RR 6.47 0.00 0.00 0.00 XXX 1.25 Crutch and cane holderE2207 C UE 48.75 0.00 0.00 0.00 XXX 1.25 Crutch and cane holderE2208 C 17.79 0.00 0.00 0.00 XXX 1.25 Cylinder tank carrierE2208 C NU 178.15 0.00 0.00 0.00 XXX 1.25 Cylinder tank carrierE2208 C RR 17.79 0.00 0.00 0.00 XXX 1.25 Cylinder tank carrierE2208 C UE 133.63 0.00 0.00 0.00 XXX 1.25 Cylinder tank carrierE2209 C 16.07 0.00 0.00 0.00 XXX 1.25 Arm trough eachE2209 C NU 160.76 0.00 0.00 0.00 XXX 1.25 Arm trough eachE2209 C RR 16.07 0.00 0.00 0.00 XXX 1.25 Arm trough eachE2209 C UE 120.57 0.00 0.00 0.00 XXX 1.25 Arm trough eachE2210 C 0.91 0.00 0.00 0.00 XXX 1.25 Wheelchair bearingsE2210 C NU 8.97 0.00 0.00 0.00 XXX 1.25 Wheelchair bearingsE2210 C RR 0.91 0.00 0.00 0.00 XXX 1.25 Wheelchair bearingsE2210 C UE 6.76 0.00 0.00 0.00 XXX 1.25 Wheelchair bearingsE2211 C 15.70 0.00 0.00 0.00 XXX 1.25 Pneumatic propulsion tireE2211 C NU 156.91 0.00 0.00 0.00 XXX 1.25 Pneumatic propulsion tireE2211 C RR 15.70 0.00 0.00 0.00 XXX 1.25 Pneumatic propulsion tireE2211 C UE 117.69 0.00 0.00 0.00 XXX 1.25 Pneumatic propulsion tireE2212 C 0.90 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire tubeE2212 C NU 8.82 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire tubeE2212 C RR 0.90 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire tubeE2212 C UE 6.63 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire tubeE2213 C 4.56 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire insertE2213 C NU 45.60 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire insertE2213 C RR 4.56 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire insertE2213 C UE 34.20 0.00 0.00 0.00 XXX 1.25 Pneumatic prop tire insertE2214 C 6.20 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire eachE2214 C NU 61.93 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire eachE2214 C RR 6.20 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire eachE2214 C UE 46.44 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire eachE2215 C 1.45 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire tubeE2215 C NU 14.40 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire tubeE2215 C RR 1.45 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire tubeE2215 C UE 10.76 0.00 0.00 0.00 XXX 1.25 Pneumatic caster tire tubeE2216 C 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled propulsion tireE2216 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled propulsion tireE2216 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled propulsion tireE2216 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled propulsion tireE2217 C 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled caster tire eachE2217 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled caster tire eachE2217 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled caster tire eachE2217 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Foam filled caster tire eachE2218 C 0.00 0.00 0.00 0.00 XXX 0.00 Foam propulsion tire eachE2218 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Foam propulsion tire eachE2218 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Foam propulsion tire eachE2218 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Foam propulsion tire eachE2219 C 12.32 0.00 0.00 0.00 XXX 1.25 Foam caster tire any size ea
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E2219 C NU 123.04 0.00 0.00 0.00 XXX 1.25 Foam caster tire any size eaE2219 C RR 12.32 0.00 0.00 0.00 XXX 1.25 Foam caster tire any size eaE2219 C UE 92.25 0.00 0.00 0.00 XXX 1.25 Foam caster tire any size eaE2220 C 5.56 0.00 0.00 0.00 XXX 1.25 Solid propulsion tire eachE2220 C NU 45.12 0.00 0.00 0.00 XXX 1.25 Solid propulsion tire eachE2220 C RR 5.56 0.00 0.00 0.00 XXX 1.25 Solid propulsion tire eachE2220 C UE 33.84 0.00 0.00 0.00 XXX 1.25 Solid propulsion tire eachE2221 C 3.84 0.00 0.00 0.00 XXX 1.25 Solid caster tire eachE2221 C NU 38.34 0.00 0.00 0.00 XXX 1.25 Solid caster tire eachE2221 C RR 3.84 0.00 0.00 0.00 XXX 1.25 Solid caster tire eachE2221 C UE 28.75 0.00 0.00 0.00 XXX 1.25 Solid caster tire eachE2222 C 3.15 0.00 0.00 0.00 XXX 1.25 Solid caster integrated whlE2222 C NU 31.61 0.00 0.00 0.00 XXX 1.25 Solid caster integrated whlE2222 C RR 3.15 0.00 0.00 0.00 XXX 1.25 Solid caster integrated whlE2222 C UE 23.71 0.00 0.00 0.00 XXX 1.25 Solid caster integrated whlE2223 C 0.86 0.00 0.00 0.00 XXX 1.25 Valve replacement only eachE2223 C NU 8.40 0.00 0.00 0.00 XXX 1.25 Valve replacement only eachE2223 C RR 0.86 0.00 0.00 0.00 XXX 1.25 Valve replacement only eachE2223 C UE 6.32 0.00 0.00 0.00 XXX 1.25 Valve replacement only eachE2224 C 19.24 0.00 0.00 0.00 XXX 1.25 Propulsion whl excludes tireE2224 C NU 154.03 0.00 0.00 0.00 XXX 1.25 Propulsion whl excludes tireE2224 C RR 19.24 0.00 0.00 0.00 XXX 1.25 Propulsion whl excludes tireE2224 C UE 115.52 0.00 0.00 0.00 XXX 1.25 Propulsion whl excludes tireE2225 C 2.60 0.00 0.00 0.00 XXX 1.25 Caster wheel excludes tireE2225 C NU 26.10 0.00 0.00 0.00 XXX 1.25 Caster wheel excludes tireE2225 C RR 2.60 0.00 0.00 0.00 XXX 1.25 Caster wheel excludes tireE2225 C UE 19.56 0.00 0.00 0.00 XXX 1.25 Caster wheel excludes tireE2226 C 5.69 0.00 0.00 0.00 XXX 1.25 Caster fork replacement onlyE2226 C NU 56.93 0.00 0.00 0.00 XXX 1.25 Caster fork replacement onlyE2226 C RR 5.69 0.00 0.00 0.00 XXX 1.25 Caster fork replacement onlyE2226 C UE 42.69 0.00 0.00 0.00 XXX 1.25 Caster fork replacement onlyE2291 D 0.00 0.00 0.00 0.00 XXX 0.00 Back, planar, ped wcE2292 D 0.00 0.00 0.00 0.00 XXX 0.00 Seat, planar, ped wcE2293 D 0.00 0.00 0.00 0.00 XXX 0.00 Back, contoured, ped wcE2294 D 0.00 0.00 0.00 0.00 XXX 0.00 Seat, contoured, ped wcE2300 C 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr seat elev systemE2300 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr seat elev systemE2300 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr seat elev systemE2300 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr seat elev systemE2301 C 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr standing systemE2301 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr standing systemE2301 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr standing systemE2301 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access., pwr standing systemE2310 C 175.55 0.00 0.00 0.00 XXX 1.25 Electro connect btw controlE2310 C NU 877.68 0.00 0.00 0.00 XXX 2.50 Electro connect btw controlE2310 C RR 175.55 0.00 0.00 0.00 XXX 1.25 Electro connect btw controlE2310 C UE 658.26 0.00 0.00 0.00 XXX 2.50 Electro connect btw controlE2311 C 355.39 0.00 0.00 0.00 XXX 1.25 Electro connect btw 2 sysE2311 C NU 888.46 0.00 0.00 0.00 XXX 5.00 Electro connect btw 2 sysE2311 C RR 355.39 0.00 0.00 0.00 XXX 1.25 Electro connect btw 2 sysE2311 C UE 666.34 0.00 0.00 0.00 XXX 5.00 Electro connect btw 2 sysE2320 C 208.60 0.00 0.00 0.00 XXX 1.25 Hand chin controlE2320 C NU 521.46 0.00 0.00 0.00 XXX 5.00 Hand chin controlE2320 C RR 208.60 0.00 0.00 0.00 XXX 1.25 Hand chin control
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E2320 C UE 782.21 0.00 0.00 0.00 XXX 2.50 Hand chin controlE2321 C 334.66 0.00 0.00 0.00 XXX 1.25 Hand interface joystickE2321 C NU 836.62 0.00 0.00 0.00 XXX 5.00 Hand interface joystickE2321 C RR 334.66 0.00 0.00 0.00 XXX 1.25 Hand interface joystickE2321 C UE 627.46 0.00 0.00 0.00 XXX 5.00 Hand interface joystickE2322 C 354.38 0.00 0.00 0.00 XXX 1.25 Mult mech switchesE2322 C NU 885.98 0.00 0.00 0.00 XXX 5.00 Mult mech switchesE2322 C RR 354.38 0.00 0.00 0.00 XXX 1.25 Mult mech switchesE2322 C UE 664.48 0.00 0.00 0.00 XXX 5.00 Mult mech switchesE2323 C 10.35 0.00 0.00 0.00 XXX 1.25 Special joystick handleE2323 C NU 103.74 0.00 0.00 0.00 XXX 1.25 Special joystick handleE2323 C RR 10.35 0.00 0.00 0.00 XXX 1.25 Special joystick handleE2323 C UE 77.81 0.00 0.00 0.00 XXX 1.25 Special joystick handleE2324 C 6.58 0.00 0.00 0.00 XXX 1.25 Chin cup interfaceE2324 C NU 65.76 0.00 0.00 0.00 XXX 1.25 Chin cup interfaceE2324 C RR 6.58 0.00 0.00 0.00 XXX 1.25 Chin cup interfaceE2324 C UE 49.30 0.00 0.00 0.00 XXX 1.25 Chin cup interfaceE2325 C 202.02 0.00 0.00 0.00 XXX 1.25 Sip and puff interfaceE2325 C NU 505.06 0.00 0.00 0.00 XXX 5.00 Sip and puff interfaceE2325 C RR 202.02 0.00 0.00 0.00 XXX 1.25 Sip and puff interfaceE2325 C UE 757.60 0.00 0.00 0.00 XXX 2.50 Sip and puff interfaceE2326 C 52.09 0.00 0.00 0.00 XXX 1.25 Breath tube kitE2326 C NU 520.69 0.00 0.00 0.00 XXX 1.25 Breath tube kitE2326 C RR 52.09 0.00 0.00 0.00 XXX 1.25 Breath tube kitE2326 C UE 390.54 0.00 0.00 0.00 XXX 1.25 Breath tube kitE2327 C 513.11 0.00 0.00 0.00 XXX 1.25 Head control interface mechE2327 C NU 855.19 0.00 0.00 0.00 XXX 7.50 Head control interface mechE2327 C RR 513.11 0.00 0.00 0.00 XXX 1.25 Head control interface mechE2327 C UE 962.09 0.00 0.00 0.00 XXX 5.00 Head control interface mechE2328 C 743.31 0.00 0.00 0.00 XXX 1.25 Head/extremity control interE2328 C NU 929.13 0.00 0.00 0.00 XXX 10.00 Head/extremity control interE2328 C RR 743.31 0.00 0.00 0.00 XXX 1.25 Head/extremity control interE2328 C UE 929.12 0.00 0.00 0.00 XXX 7.50 Head/extremity control interE2329 C 264.93 0.00 0.00 0.00 XXX 1.25 Head control nonproportionalE2329 C NU 662.30 0.00 0.00 0.00 XXX 5.00 Head control nonproportionalE2329 C RR 264.93 0.00 0.00 0.00 XXX 1.25 Head control nonproportionalE2329 C UE 993.46 0.00 0.00 0.00 XXX 2.50 Head control nonproportionalE2330 C 513.31 0.00 0.00 0.00 XXX 1.25 Head control proximity switcE2330 C NU 855.52 0.00 0.00 0.00 XXX 7.50 Head control proximity switcE2330 C RR 513.31 0.00 0.00 0.00 XXX 1.25 Head control proximity switcE2330 C UE 962.46 0.00 0.00 0.00 XXX 5.00 Head control proximity switcE2331 C 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access, attendant controlE2331 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access, attendant controlE2331 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access, attendant controlE2331 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access, attendant controlE2340 C 53.75 0.00 0.00 0.00 XXX 1.25 W/c wdth 20-23 in seat frameE2340 C NU 537.57 0.00 0.00 0.00 XXX 1.25 W/c wdth 20-23 in seat frameE2340 C RR 53.75 0.00 0.00 0.00 XXX 1.25 W/c wdth 20-23 in seat frameE2340 C UE 403.18 0.00 0.00 0.00 XXX 1.25 W/c wdth 20-23 in seat frameE2341 C 80.63 0.00 0.00 0.00 XXX 1.25 W/c wdth 24-27 in seat frameE2341 C NU 806.36 0.00 0.00 0.00 XXX 1.25 W/c wdth 24-27 in seat frameE2341 C RR 80.63 0.00 0.00 0.00 XXX 1.25 W/c wdth 24-27 in seat frameE2341 C UE 604.79 0.00 0.00 0.00 XXX 1.25 W/c wdth 24-27 in seat frameE2342 C 67.22 0.00 0.00 0.00 XXX 1.25 W/c dpth 20-21 in seat frame
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E2342 C NU 671.96 0.00 0.00 0.00 XXX 1.25 W/c dpth 20-21 in seat frameE2342 C RR 67.22 0.00 0.00 0.00 XXX 1.25 W/c dpth 20-21 in seat frameE2342 C UE 503.97 0.00 0.00 0.00 XXX 1.25 W/c dpth 20-21 in seat frameE2343 C 107.51 0.00 0.00 0.00 XXX 1.25 W/c dpth 22-25 in seat frameE2343 C NU 537.58 0.00 0.00 0.00 XXX 2.50 W/c dpth 22-25 in seat frameE2343 C RR 107.51 0.00 0.00 0.00 XXX 1.25 W/c dpth 22-25 in seat frameE2343 C UE 806.36 0.00 0.00 0.00 XXX 1.25 W/c dpth 22-25 in seat frameE2351 C 104.81 0.00 0.00 0.00 XXX 1.25 Electronic SGD interfaceE2351 C NU 523.98 0.00 0.00 0.00 XXX 2.50 Electronic SGD interfaceE2351 C RR 104.81 0.00 0.00 0.00 XXX 1.25 Electronic SGD interfaceE2351 C UE 785.98 0.00 0.00 0.00 XXX 1.25 Electronic SGD interfaceE2360 C 16.97 0.00 0.00 0.00 XXX 1.25 22nf nonsealed leadacidE2360 C NU 169.50 0.00 0.00 0.00 XXX 1.25 22nf nonsealed leadacidE2360 C RR 16.97 0.00 0.00 0.00 XXX 1.25 22nf nonsealed leadacidE2360 C UE 127.12 0.00 0.00 0.00 XXX 1.25 22nf nonsealed leadacidE2361 C 20.91 0.00 0.00 0.00 XXX 1.25 22nf sealed leadacid batteryE2361 C NU 209.21 0.00 0.00 0.00 XXX 1.25 22nf sealed leadacid batteryE2361 C RR 20.91 0.00 0.00 0.00 XXX 1.25 22nf sealed leadacid batteryE2361 C UE 156.91 0.00 0.00 0.00 XXX 1.25 22nf sealed leadacid batteryE2362 C 13.79 0.00 0.00 0.00 XXX 1.25 Gr24 nonsealed leadacidE2362 C NU 137.97 0.00 0.00 0.00 XXX 1.25 Gr24 nonsealed leadacidE2362 C RR 13.79 0.00 0.00 0.00 XXX 1.25 Gr24 nonsealed leadacidE2362 C UE 103.49 0.00 0.00 0.00 XXX 1.25 Gr24 nonsealed leadacidE2363 C 27.90 0.00 0.00 0.00 XXX 1.25 Gr24 sealed leadacid batteryE2363 C NU 279.00 0.00 0.00 0.00 XXX 1.25 Gr24 sealed leadacid batteryE2363 C RR 27.90 0.00 0.00 0.00 XXX 1.25 Gr24 sealed leadacid batteryE2363 C UE 208.89 0.00 0.00 0.00 XXX 1.25 Gr24 sealed leadacid batteryE2364 C 16.97 0.00 0.00 0.00 XXX 1.25 U1nonsealed leadacid batteryE2364 C NU 169.50 0.00 0.00 0.00 XXX 1.25 U1nonsealed leadacid batteryE2364 C RR 16.97 0.00 0.00 0.00 XXX 1.25 U1nonsealed leadacid batteryE2364 C UE 127.12 0.00 0.00 0.00 XXX 1.25 U1nonsealed leadacid batteryE2365 C 16.84 0.00 0.00 0.00 XXX 1.25 U1 sealed leadacid batteryE2365 C NU 168.29 0.00 0.00 0.00 XXX 1.25 U1 sealed leadacid batteryE2365 C RR 16.84 0.00 0.00 0.00 XXX 1.25 U1 sealed leadacid batteryE2365 C UE 127.12 0.00 0.00 0.00 XXX 1.25 U1 sealed leadacid batteryE2366 C 63.10 0.00 0.00 0.00 XXX 1.25 Battery chargerE2366 C NU 504.86 0.00 0.00 0.00 XXX 1.25 Battery chargerE2366 C RR 63.10 0.00 0.00 0.00 XXX 1.25 Battery chargerE2366 C UE 378.68 0.00 0.00 0.00 XXX 1.25 Battery chargerE2367 C 62.85 0.00 0.00 0.00 XXX 1.25 Battery chargerE2367 C NU 628.60 0.00 0.00 0.00 XXX 1.25 Battery chargerE2367 C RR 62.85 0.00 0.00 0.00 XXX 1.25 Battery chargerE2367 C UE 471.46 0.00 0.00 0.00 XXX 1.25 Battery chargerE2368 C 77.50 0.00 0.00 0.00 XXX 1.25 Power wc motor replacementE2368 C NU 774.85 0.00 0.00 0.00 XXX 1.25 Power wc motor replacementE2368 C RR 77.50 0.00 0.00 0.00 XXX 1.25 Power wc motor replacementE2368 C UE 581.16 0.00 0.00 0.00 XXX 1.25 Power wc motor replacementE2369 C 67.51 0.00 0.00 0.00 XXX 1.25 Pwr wc gear box replacementE2369 C NU 674.86 0.00 0.00 0.00 XXX 1.25 Pwr wc gear box replacementE2369 C RR 67.51 0.00 0.00 0.00 XXX 1.25 Pwr wc gear box replacementE2369 C UE 506.19 0.00 0.00 0.00 XXX 1.25 Pwr wc gear box replacementE2370 C 120.42 0.00 0.00 0.00 XXX 1.25 Pwr wc motor/gear box comboE2370 C NU 602.13 0.00 0.00 0.00 XXX 2.50 Pwr wc motor/gear box comboE2370 C RR 120.42 0.00 0.00 0.00 XXX 1.25 Pwr wc motor/gear box combo
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E2370 C UE 903.20 0.00 0.00 0.00 XXX 1.25 Pwr wc motor/gear box comboE2371 C 22.61 0.00 0.00 0.00 XXX 1.25 Gr27 sealed leadacid batteryE2371 C NU 226.10 0.00 0.00 0.00 XXX 1.25 Gr27 sealed leadacid batteryE2371 C RR 22.61 0.00 0.00 0.00 XXX 1.25 Gr27 sealed leadacid batteryE2371 C UE 169.59 0.00 0.00 0.00 XXX 1.25 Gr27 sealed leadacid batteryE2372 C 0.00 0.00 0.00 0.00 XXX 0.00 Gr27 non-sealed leadacidE2372 C NU 0.00 0.00 0.00 0.00 XXX 0.00 Gr27 non-sealed leadacidE2372 C RR 0.00 0.00 0.00 0.00 XXX 0.00 Gr27 non-sealed leadacidE2372 C UE 0.00 0.00 0.00 0.00 XXX 0.00 Gr27 non-sealed leadacidE2399 C 0.00 0.00 0.00 0.00 XXX 0.00 Pwr whl chr access, n.o.c.E2402 C 643.66 0.00 0.00 0.00 XXX 5.00 Neg press wound therapy pumpE2402 C NU 919.51 0.00 0.00 0.00 XXX 35.00 Neg press wound therapy pumpE2402 C RR 643.66 0.00 0.00 0.00 XXX 5.00 Neg press wound therapy pumpE2402 C UE 965.49 0.00 0.00 0.00 XXX 25.00 Neg press wound therapy pumpE2500 C 58.67 0.00 0.00 0.00 XXX 1.25 SGD digitized pre-rec <=8minE2500 C NU 586.59 0.00 0.00 0.00 XXX 1.25 SGD digitized pre-rec <=8minE2500 C RR 58.67 0.00 0.00 0.00 XXX 1.25 SGD digitized pre-rec <=8minE2500 C UE 439.93 0.00 0.00 0.00 XXX 1.25 SGD digitized pre-rec <=8minE2502 C 179.38 0.00 0.00 0.00 XXX 1.25 SGD prerec msg >8min <=20minE2502 C NU 896.84 0.00 0.00 0.00 XXX 2.50 SGD prerec msg >8min <=20minE2502 C RR 179.38 0.00 0.00 0.00 XXX 1.25 SGD prerec msg >8min <=20minE2502 C UE 672.64 0.00 0.00 0.00 XXX 2.50 SGD prerec msg >8min <=20minE2504 C 236.64 0.00 0.00 0.00 XXX 1.25 SGD prerec msg>20min <=40minE2504 C NU 591.53 0.00 0.00 0.00 XXX 5.00 SGD prerec msg>20min <=40minE2504 C RR 236.64 0.00 0.00 0.00 XXX 1.25 SGD prerec msg>20min <=40minE2504 C UE 887.30 0.00 0.00 0.00 XXX 2.50 SGD prerec msg>20min <=40minE2506 C 346.94 0.00 0.00 0.00 XXX 1.25 SGD prerec msg > 40 minE2506 C NU 867.36 0.00 0.00 0.00 XXX 5.00 SGD prerec msg > 40 minE2506 C RR 346.94 0.00 0.00 0.00 XXX 1.25 SGD prerec msg > 40 minE2506 C UE 650.52 0.00 0.00 0.00 XXX 5.00 SGD prerec msg > 40 minE2508 C 536.50 0.00 0.00 0.00 XXX 1.25 SGD spelling phys contactE2508 C NU 894.16 0.00 0.00 0.00 XXX 7.50 SGD spelling phys contactE2508 C RR 536.50 0.00 0.00 0.00 XXX 1.25 SGD spelling phys contactE2508 C UE 670.61 0.00 0.00 0.00 XXX 7.50 SGD spelling phys contactE2510 C 507.63 0.00 0.00 0.00 XXX 2.50 SGD w multi methods msg/accsE2510 C NU 846.03 0.00 0.00 0.00 XXX 15.00 SGD w multi methods msg/accsE2510 C RR 507.63 0.00 0.00 0.00 XXX 2.50 SGD w multi methods msg/accsE2510 C UE 951.79 0.00 0.00 0.00 XXX 10.00 SGD w multi methods msg/accsE2511 C 0.00 0.00 0.00 0.00 XXX 0.00 SGD sftwre prgrm for PC/PDAE2511 C NU 0.00 0.00 0.00 0.00 XXX 0.00 SGD sftwre prgrm for PC/PDAE2511 C RR 0.00 0.00 0.00 0.00 XXX 0.00 SGD sftwre prgrm for PC/PDAE2511 C UE 0.00 0.00 0.00 0.00 XXX 0.00 SGD sftwre prgrm for PC/PDAE2512 C 0.00 0.00 0.00 0.00 XXX 0.00 SGD accessoryE2512 C NU 0.00 0.00 0.00 0.00 XXX 0.00 SGD accessoryE2512 C RR 0.00 0.00 0.00 0.00 XXX 0.00 SGD accessoryE2512 C UE 0.00 0.00 0.00 0.00 XXX 0.00 SGD accessoryE2599 C 0.00 0.00 0.00 0.00 XXX 0.00 SGD accessory, n.o.c.E2601 C 13.27 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth < 22 inE2601 C NU 132.99 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth < 22 inE2601 C RR 13.27 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth < 22 inE2601 C UE 99.74 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth < 22 inE2602 C 24.29 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth >=22 inE2602 C NU 242.84 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth >=22 inE2602 C RR 24.29 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth >=22 in
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E2602 C UE 182.14 0.00 0.00 0.00 XXX 1.25 Gen w/c cushion wdth >=22 inE2603 C 33.46 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd <22inE2603 C NU 334.55 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd <22inE2603 C RR 33.46 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd <22inE2603 C UE 250.95 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd <22inE2604 C 47.35 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd>=22inE2604 C NU 473.65 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd>=22inE2604 C RR 47.35 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd>=22inE2604 C UE 355.22 0.00 0.00 0.00 XXX 1.25 Skin protect wc cus wd>=22inE2605 C 48.25 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth <22 inE2605 C NU 482.54 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth <22 inE2605 C RR 48.25 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth <22 inE2605 C UE 361.91 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth <22 inE2606 C 65.41 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth>=22 inE2606 C NU 654.12 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth>=22 inE2606 C RR 65.41 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth>=22 inE2606 C UE 490.60 0.00 0.00 0.00 XXX 1.25 Position wc cush wdth>=22 inE2607 C 44.35 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd <22inE2607 C NU 443.40 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd <22inE2607 C RR 44.35 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd <22inE2607 C UE 332.56 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd <22inE2608 C 53.09 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd>=22inE2608 C NU 531.00 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd>=22inE2608 C RR 53.09 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd>=22inE2608 C UE 398.26 0.00 0.00 0.00 XXX 1.25 Skin pro/pos wc cus wd>=22inE2609 C 0.00 0.00 0.00 0.00 XXX 0.00 Cus fabricated wc seat cush, any sizeE2610 C 0.00 0.00 0.00 0.00 XXX 0.00 Wc seat cush, poweredE2611 C 46.85 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth <22inE2611 C NU 468.57 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth <22inE2611 C RR 46.85 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth <22inE2611 C UE 351.43 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth <22inE2612 C 63.38 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth>=22inE2612 C NU 633.80 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth>=22inE2612 C RR 63.38 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth>=22inE2612 C UE 475.37 0.00 0.00 0.00 XXX 1.25 Gen use back cush wdth>=22inE2613 C 58.95 0.00 0.00 0.00 XXX 1.25 Position back cush wd <22inE2613 C NU 589.56 0.00 0.00 0.00 XXX 1.25 Position back cush wd <22inE2613 C RR 58.95 0.00 0.00 0.00 XXX 1.25 Position back cush wd <22inE2613 C UE 442.16 0.00 0.00 0.00 XXX 1.25 Position back cush wd <22inE2614 C 81.58 0.00 0.00 0.00 XXX 1.25 Position back cush wd>=22inE2614 C NU 815.91 0.00 0.00 0.00 XXX 1.25 Position back cush wd>=22inE2614 C RR 81.58 0.00 0.00 0.00 XXX 1.25 Position back cush wd>=22inE2614 C UE 611.95 0.00 0.00 0.00 XXX 1.25 Position back cush wd>=22inE2615 C 67.85 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth <22inE2615 C NU 678.51 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth <22inE2615 C RR 67.85 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth <22inE2615 C UE 508.86 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth <22inE2616 C 91.29 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth>=22inE2616 C NU 912.87 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth>=22inE2616 C RR 91.29 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth>=22inE2616 C UE 684.64 0.00 0.00 0.00 XXX 1.25 Pos back post/lat wdth>=22inE2617 C 0.00 0.00 0.00 0.00 XXX 0.00 Cus fabricated wc back cush, any sizeE2618 C 23.07 0.00 0.00 0.00 XXX 1.25 Wc acc solid seat supp baseE2618 C NU 230.54 0.00 0.00 0.00 XXX 1.25 Wc acc solid seat supp base
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
E2618 C RR 23.07 0.00 0.00 0.00 XXX 1.25 Wc acc solid seat supp baseE2618 C UE 172.89 0.00 0.00 0.00 XXX 1.25 Wc acc solid seat supp baseE2619 C 7.72 0.00 0.00 0.00 XXX 1.25 Replace cover w/c seat cushE2619 C NU 76.96 0.00 0.00 0.00 XXX 1.25 Replace cover w/c seat cushE2619 C RR 7.72 0.00 0.00 0.00 XXX 1.25 Replace cover w/c seat cushE2619 C UE 57.70 0.00 0.00 0.00 XXX 1.25 Replace cover w/c seat cushE2620 C 86.21 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd <22inE2620 C NU 862.16 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd <22inE2620 C RR 86.21 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd <22inE2620 C UE 646.64 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd <22inE2621 C 82.16 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd>=22inE2621 C NU 821.52 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd>=22inE2621 C RR 82.16 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd>=22inE2621 C UE 616.19 0.00 0.00 0.00 XXX 1.25 WC planar back cush wd>=22inE8000 D 0.00 0.00 0.00 0.00 XXX 0.00 Gait trainer, ped, post supportE8001 D 0.00 0.00 0.00 0.00 XXX 0.00 Gait trainer, ped, upright supportE8002 D 0.00 0.00 0.00 0.00 XXX 0.00 Gait trainer, ped, ant support
EDCAN C 0.00 0.00 0.00 0.00 XXX 0.00 FECA Dep Dir AuthEXTRA C 0.00 0.00 0.00 0.00 XXX 0.00 Court costs/collection agency fees/etc-payable on delin billsFOLUP C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP-requested follow-up report with additional med/other evidenceFORGN C 0.00 0.00 0.00 0.00 XXX 0.00 Foreign Dummy Procedure CodeG0008 C 0.00 0.20 0.20 0.01 XXX 50.58 Admin influenza virus vacG0009 C 0.00 0.20 0.20 0.01 XXX 50.58 Admin pneumococcal vaccineG0010 C 0.00 0.20 0.20 0.01 XXX 50.58 Admin hepatitis b vaccineG0027 C 9.09 0.00 0.00 0.00 XXX 1.80 Semen analysisG0030 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imaging prev PET singleG0030 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imaging prev PET singleG0030 C 26 1.50 0.58 0.58 0.06 XXX 50.58 12/31/2005 PET imaging prev PET singleG0031 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imaging prev PET multpleG0031 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imaging prev PET multpleG0031 C 26 1.87 0.72 0.72 0.07 XXX 50.58 12/31/2005 PET imaging prev PET multpleG0032 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 78464 singlG0032 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 78464 singlG0032 C 26 1.50 0.54 0.54 0.06 XXX 50.58 12/31/2005 PET follow SPECT 78464 singlG0033 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 78464 multG0033 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 78464 multG0033 C 26 1.87 0.74 0.74 0.07 XXX 50.58 12/31/2005 PET follow SPECT 78464 multG0034 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 76865 singlG0034 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 76865 singlG0034 C 26 1.50 0.57 0.57 0.05 XXX 50.58 12/31/2005 PET follow SPECT 76865 singlG0035 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 78465 multG0035 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow SPECT 78465 multG0035 C 26 1.87 0.73 0.73 0.06 XXX 50.58 12/31/2005 PET follow SPECT 78465 multG0036 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow cornry angio singG0036 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow cornry angio singG0036 C 26 1.50 0.56 0.56 0.05 XXX 50.58 12/31/2005 PET follow cornry angio singG0037 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow cornry angio multG0037 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow cornry angio multG0037 C 26 1.87 0.71 0.71 0.06 XXX 50.58 12/31/2005 PET follow cornry angio multG0038 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow myocard perf singG0038 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow myocard perf singG0038 C 26 1.50 0.52 0.52 0.07 XXX 50.58 12/31/2005 PET follow myocard perf singG0039 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow myocard perf multG0039 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow myocard perf mult
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G0039 C 26 1.87 0.71 0.71 0.07 XXX 50.58 12/31/2005 PET follow myocard perf multG0040 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress echo singlG0040 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress echo singlG0040 C 26 1.50 0.59 0.59 0.06 XXX 50.58 12/31/2005 PET follow stress echo singlG0041 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress echo multG0041 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress echo multG0041 C 26 1.87 0.73 0.73 0.06 XXX 50.58 12/31/2005 PET follow stress echo multG0042 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow ventriculogm singG0042 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow ventriculogm singG0042 C 26 1.50 0.61 0.61 0.05 XXX 50.58 12/31/2005 PET follow ventriculogm singG0043 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow ventriculogm multG0043 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow ventriculogm multG0043 C 26 1.87 0.75 0.75 0.07 XXX 50.58 12/31/2005 PET follow ventriculogm multG0044 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET following rest ECG singlG0044 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET following rest ECG singlG0044 C 26 1.50 0.59 0.59 0.05 XXX 50.58 12/31/2005 PET following rest ECG singlG0045 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET following rest ECG multG0045 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET following rest ECG multG0045 C 26 1.87 0.72 0.72 0.06 XXX 50.58 12/31/2005 PET following rest ECG multG0046 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress ECG singlG0046 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress ECG singlG0046 C 26 1.50 0.59 0.59 0.05 XXX 50.58 12/31/2005 PET follow stress ECG singlG0047 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress ECG multG0047 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET follow stress ECG multG0047 C 26 1.87 0.73 0.73 0.06 XXX 50.58 12/31/2005 PET follow stress ECG multG0101 C 0.45 0.52 0.17 0.02 XXX 50.58 CA screen;pelvic/breast examG0102 C 0.17 0.39 0.06 0.01 XXX 50.58 Prostate ca screening; dreG0103 C 25.70 0.00 0.00 0.00 XXX 1.80 Psa, total screeningG0104 C 0.96 2.28 0.50 0.08 000 50.58 CA screen;flexi sigmoidscopeG0105 C 3.69 6.16 1.47 0.30 000 50.58 Colorectal scrn; hi risk indG0105 C 53 0.96 2.28 0.50 0.08 000 50.58 Colorectal scrn; hi risk indG0106 C 0.99 2.56 2.56 0.17 XXX 50.58 Colon CA screen;barium enemaG0106 C TC 0.00 2.24 2.24 0.13 XXX 50.58 Colon CA screen;barium enemaG0106 C 26 0.99 0.32 0.32 0.04 XXX 50.58 Colon CA screen;barium enemaG0107 C 4.54 0.00 0.00 0.00 XXX 1.80 CA screen; fecal blood testG0108 C 0.00 0.83 0.83 0.01 XXX 50.58 Diab manage trn per indivG0109 C 0.00 0.48 0.48 0.01 XXX 50.58 Diab manage trn ind/groupG0110 D 0.90 0.68 0.29 0.04 XXX 50.58 12/31/2005 NETT pulm-rehab educ; indG0111 D 0.27 0.29 0.13 0.01 XXX 50.58 12/31/2005 NETT pulm-rehab educ; groupG0112 D 1.72 1.21 0.65 0.05 XXX 50.58 12/31/2005 NETT;nutrition guid, initialG0113 D 1.29 0.81 0.41 0.05 XXX 50.58 12/31/2005 NETT;nutrition guid,subseqntG0114 D 1.20 0.49 0.37 0.05 XXX 50.58 12/31/2005 NETT; psychosocial consultG0115 D 1.20 0.82 0.37 0.03 XXX 50.58 12/31/2005 NETT; psychological testingG0116 D 1.11 0.95 0.33 0.05 XXX 50.58 12/31/2005 NETT; psychosocial counselG0117 D 0.45 0.72 0.19 0.01 XXX 50.58 Glaucoma scrn hgh risk direcG0118 D 0.17 0.53 0.06 0.01 XXX 50.58 Glaucoma scrn hgh risk direcG0120 C 0.99 2.56 2.56 0.17 XXX 50.58 Colon ca scrn; barium enemaG0120 C TC 0.00 2.24 2.24 0.13 XXX 50.58 Colon ca scrn; barium enemaG0120 C 26 0.99 0.32 0.32 0.04 XXX 50.58 Colon ca scrn; barium enemaG0121 C 3.69 6.16 1.47 0.30 000 50.58 Colon ca scrn not hi rsk indG0121 C 53 0.96 2.28 0.50 0.08 000 50.58 Colon ca scrn not hi rsk indG0122 C 0.99 2.58 2.58 0.18 XXX 50.58 Colon ca scrn; barium enemaG0122 C TC 0.00 2.20 2.20 0.13 XXX 50.58 Colon ca scrn; barium enemaG0122 C 26 0.99 0.38 0.38 0.05 XXX 50.58 Colon ca scrn; barium enema
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G0123 C 28.31 0.00 0.00 0.00 XXX 1.80 Screen cerv/vag thin layerG0124 C 0.42 0.15 0.15 0.02 XXX 50.58 Screen c/v thin layer by MDG0125 C 1.50 55.83 55.83 2.00 XXX 50.58 12/31/2005 Lung image (PET)G0125 C TC 0.00 55.31 55.31 1.95 XXX 50.58 12/31/2005 Lung image (PET)G0125 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 Lung image (PET)G0127 C 0.17 0.25 0.07 0.01 000 50.58 Trim nail(s)G0128 C 0.08 0.03 0.03 0.01 XXX 50.58 CORF skilled nursing service / 10 min.G0129 C 3.36 1.26 1.26 0.42 XXX 50.58 O.T. component of partial hosp serv/dayG0130 C 0.22 0.87 0.87 0.06 XXX 50.58 Single energy x-ray studyG0130 C TC 0.00 0.80 0.80 0.05 XXX 50.58 Single energy x-ray studyG0130 C 26 0.22 0.07 0.07 0.01 XXX 50.58 Single energy x-ray studyG0141 C 0.42 0.15 0.15 0.02 XXX 50.58 Scr c/v cyto,autosys and mdG0143 C 28.31 0.00 0.00 0.00 XXX 1.80 Scr c/v cyto,thinlayer,rescrG0144 C 29.85 0.00 0.00 0.00 XXX 1.80 Scr c/v cyto,thinlayer,rescrG0145 C 37.01 0.00 0.00 0.00 XXX 1.80 Scr c/v cyto,thinlayer,rescrG0147 C 15.90 0.00 0.00 0.00 XXX 1.80 Scr c/v cyto, automated sysG0148 C 21.23 0.00 0.00 0.00 XXX 1.80 Scr c/v cyto, autosys, rescrG0151 C 28.89 0.00 0.00 0.00 XXX 1.80 HHCP-serv of pt,ea 15 minG0152 C 28.99 0.00 0.00 0.00 XXX 1.80 HHCP-serv of ot,ea 15 minG0153 C 29.27 0.00 0.00 0.00 XXX 1.80 HHCP-svs of s/l path,ea 15mnG0154 C 25.20 0.00 0.00 0.00 XXX 1.80 HHCP-svs of rn,ea 15 minG0155 C 35.35 0.00 0.00 0.00 XXX 1.80 HHCP-svs of csw,ea 15 minG0156 C 3.87 0.00 0.00 0.00 XXX 1.80 HHCP-svs of aide,ea 15 minG0166 C 0.07 3.58 0.03 0.01 XXX 50.58 Extrnl counterpulse, per txG0168 C 0.45 1.94 0.22 0.03 000 50.58 Wound closure by adhesiveG0173 C 0.00 0.00 0.00 0.00 XXX 0.00 Stereo radoisurgery,completeG0175 C 0.00 0.00 0.00 0.00 XXX 0.00 OPPS Service,sched team confG0176 C 0.00 0.00 0.00 0.00 XXX 0.00 OPPS/PHP;activity therapyG0177 C 0.00 0.00 0.00 0.00 XXX 0.00 OPPS/PHP; train & educ servG0179 D 0.45 1.03 1.03 0.02 XXX 50.58 MD recertification HHA PTG0180 D 0.67 1.26 1.26 0.03 XXX 50.58 MD certification HHA patientG0181 D 1.73 1.48 1.48 0.07 XXX 50.58 Home health care supervision, 30+ min.G0182 C 1.73 1.66 1.66 0.07 XXX 50.58 Hospice care supervisionG0186 C 0.00 0.00 0.00 0.00 YYY 0.00 Dstry eye lesn,fdr vssl techG0202 C 0.70 2.78 2.78 0.10 XXX 50.58 Screening mammographyG0202 C TC 0.00 2.55 2.55 0.07 XXX 50.58 Screening mammographyG0202 C 26 0.70 0.23 0.23 0.03 XXX 50.58 Screening mammographyG0204 C 0.87 2.79 2.79 0.11 XXX 50.58 Diagnostic mammography, bilateralG0204 C TC 0.00 2.51 2.51 0.07 XXX 50.58 Diagnostic mammography, bilateralG0204 C 26 0.87 0.28 0.28 0.04 XXX 50.58 Diagnostic mammography, bilateralG0206 C 0.70 2.26 2.26 0.09 XXX 50.58 Diagnostic mammography, unilateralG0206 C TC 0.00 2.03 2.03 0.06 XXX 50.58 Diagnostic mammography, unilateralG0206 C 26 0.70 0.23 0.23 0.03 XXX 50.58 Diagnostic mammography, unilateralG0210 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebody dxlungG0210 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebody dxlungG0210 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholebody dxlungG0211 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbody init lungG0211 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbody init lungG0211 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholbody init lungG0212 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod restag lungG0212 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod restag lungG0212 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholebod restag lungG0213 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbody dxG0213 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbody dx
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G0213 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholbody dxG0214 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod initG0214 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod initG0214 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholebod initG0215 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PETimg wholebod restagG0215 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PETimg wholebod restagG0215 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PETimg wholebod restagG0216 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod dx melanomaG0216 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod dx melanomaG0216 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholebod dx melanomaG0217 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod init melanG0217 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod init melanG0217 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholebod init melanG0218 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod restag melaG0218 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod restag melaG0218 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET img wholebod restag melaG0219 C 0.00 0.00 0.00 0.00 XXX 0.00 PET img wholbod melano noncoG0219 C TC 0.00 0.00 0.00 0.00 XXX 0.00 PET img wholbod melano noncoG0219 C 26 0.00 0.00 0.00 0.00 XXX 0.00 PET img wholbod melano noncoG0220 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod dx lymphomaG0220 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholebod dx lymphomaG0220 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholebod dx lymphomaG0221 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod init lymphoG0221 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod init lymphoG0221 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET imag wholbod init lymphoG0222 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod resta lymphG0222 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod resta lymphG0222 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET imag wholbod resta lymphG0223 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod reg dx headG0223 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod reg dx headG0223 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET imag wholbod reg dx headG0224 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod reg ini heaG0224 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imag wholbod reg ini heaG0224 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET imag wholbod reg ini heaG0225 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET whol restag headneckonlyG0225 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET whol restag headneckonlyG0225 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET whol restag headneckonlyG0226 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbody dx esophaglG0226 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbody dx esophaglG0226 C 26 1.50 0.53 0.53 0.06 XXX 50.58 12/31/2005 PET img wholbody dx esophaglG0227 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbod ini esophageG0227 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbod ini esophageG0227 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET img wholbod ini esophageG0228 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbod restg esophaG0228 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img wholbod restg esophaG0228 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET img wholbod restg esophaG0229 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img metaboloc brain presG0229 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET img metaboloc brain presG0229 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET img metaboloc brain presG0230 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET myocard viability postG0230 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET myocard viability postG0230 C 26 1.50 0.53 0.53 0.06 XXX 50.58 12/31/2005 PET myocard viability postG0231 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET WhBD colorec; gamma camG0231 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET WhBD colorec; gamma cam
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G0231 C 26 1.50 0.51 0.51 0.06 XXX 50.58 12/31/2005 PET WhBD colorec; gamma camG0232 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET whbd lymphoma; gamma camG0232 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET whbd lymphoma; gamma camG0232 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET whbd lymphoma; gamma camG0233 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET whbd melanoma; gamma camG0233 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET whbd melanoma; gamma camG0233 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET whbd melanoma; gamma camG0234 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET WhBD pulm nod; gamma camG0234 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET WhBD pulm nod; gamma camG0234 C 26 1.50 0.52 0.52 0.06 XXX 50.58 12/31/2005 PET WhBD pulm nod; gamma camG0235 D 0.00 0.00 0.00 0.00 XXX 0.00 PET not otherwise specifiedG0235 D TC 0.00 0.00 0.00 0.00 XXX 0.00 PET not otherwise specifiedG0235 D 26 0.00 0.00 0.00 0.00 XXX 0.00 PET not otherwise specifiedG0237 C 0.00 0.47 0.47 0.02 XXX 50.58 Therapeutic procedures, c 15 minG0238 C 0.00 0.49 0.49 0.02 XXX 50.58 Therapeutic procedures, not G0237, c 15 minG0239 C 0.00 0.33 0.33 0.02 XXX 50.58 Therapeutic proced, not G0236, 2 or moreG0242 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Multi-sourc photon stereotacti radiosurgery, planG0243 C 0.00 0.00 0.00 0.00 XXX 0.00 Multi-sourc photon stereo radiosurg, deliveryG0244 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Observation care, 8-48 hoursG0245 C 0.88 0.79 0.31 0.04 XXX 50.58 Initial foot exam pt lopsG0246 C 0.45 0.54 0.16 0.02 XXX 50.58 Followup eval of foot pt lopG0247 C 0.50 0.52 0.21 0.02 ZZZ 50.58 Routine footcare pt w lopsG0248 D 0.00 6.63 6.63 0.01 XXX 50.58 Demonstrate use home inr monG0249 D 0.00 3.97 3.97 0.01 XXX 50.58 Provide test material,equipmG0250 D 0.18 0.06 0.06 0.01 XXX 50.58 MD review interpret of testG0251 C 0.00 0.00 0.00 0.00 XXX 0.00 Linear acc based stero radioG0252 C 0.00 0.00 0.00 0.00 XXX 0.00 PET imaging initial dxG0252 C TC 0.00 0.00 0.00 0.00 XXX 0.00 PET imaging initial dxG0252 C 26 1.50 0.60 0.60 0.04 XXX 50.58 PET imaging initial dxG0253 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET image brst dection recurG0253 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET image brst dection recurG0253 C 26 1.87 0.63 0.63 0.08 XXX 50.58 12/31/2005 PET image brst dection recurG0254 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET image brst eval to txG0254 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET image brst eval to txG0254 C 26 1.87 0.65 0.65 0.08 XXX 50.58 12/31/2005 PET image brst eval to txG0255 C 1.50 0.59 0.59 0.04 XXX 50.58 Current percep threshold tstG0255 C TC 0.00 0.00 0.00 0.00 XXX 0.00 Current percep threshold tstG0255 C 26 1.50 0.59 0.59 0.04 XXX 50.58 Current percep threshold tstG0257 D 0.00 0.00 0.00 0.00 XXX 0.00 Unsched dialysis ESRD pt hosG0258 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 IV infusion during obs stayG0259 D 0.00 0.00 0.00 0.00 XXX 0.00 Inject for sacroiliac jointG0260 C 1.40 9.35 0.33 0.10 XXX 50.58 Inj for sacroiliac jt anesthG0263 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Adm with CHF, CP, asthmaG0264 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Assmt otr CHF, CP, asthmaG0265 C 14.11 0.00 0.00 0.00 XXX 1.80 Cryopresevation Freeze+storaG0266 C 14.11 0.00 0.00 0.00 XXX 1.80 Thawing + expansion froz celG0267 D 0.00 0.00 0.00 0.00 XXX 0.00 Bone marrow or psc harvestG0268 C 0.61 0.63 0.24 0.02 000 50.58 Removal of impacted wax mdG0269 D 0.00 0.00 0.00 0.00 XXX 0.00 Occlusive device in vein artG0270 C 0.00 0.47 0.47 0.01 XXX 50.58 MNT subs tx for change dxG0271 C 0.00 0.18 0.18 0.01 XXX 50.58 Group MNT 2 or more 30 minsG0275 C 0.25 0.10 0.10 0.01 ZZZ 50.58 Renal angio, cardiac cathG0278 C 0.25 0.10 0.10 0.01 ZZZ 50.58 Iliac art angio,cardiac cathG0279 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Excorp shock tx, elbow epi
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G0280 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Excorp shock tx other thanG0281 C 0.18 0.11 0.11 0.01 XXX 50.58 Elec stim unattend for pressG0282 D 0.00 0.00 0.00 0.00 XXX 0.00 Elect stim wound care not pdG0283 C 0.18 0.11 0.11 0.01 XXX 50.58 Elec stim other than woundG0288 C 0.00 10.64 10.64 0.18 XXX 50.58 Recon, CTA for surg planG0289 C 1.48 0.80 0.80 0.26 ZZZ 50.58 Arthro, loose body + chondroG0290 D 0.00 0.00 0.00 0.00 XXX 0.00 Drug-eluting stents, singleG0291 D 0.00 0.00 0.00 0.00 XXX 0.00 Drug-eluting stents,each addG0293 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-cov surg proc,clin trialG0294 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-cov proc, clinical trialG0295 D 0.00 0.00 0.00 0.00 XXX 0.00 Electromagnetic therapy oncG0296 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imge restag thyrod canceG0296 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imge restag thyrod canceG0296 C 26 1.87 0.71 0.71 0.08 XXX 50.58 12/31/2005 PET imge restag thyrod canceG0297 C 0.00 0.00 0.00 0.00 XXX 0.00 Insert single chamber/cdG0298 C 0.00 0.00 0.00 0.00 XXX 0.00 Insert dual chamber/cdG0299 C 0.00 0.00 0.00 0.00 XXX 0.00 Inser/repos single icd+leadsG0300 C 0.00 0.00 0.00 0.00 XXX 0.00 Insert reposit lead dual+genG0302 C 0.00 0.00 0.00 0.00 XXX 0.00 Pre-op service LVRS completeG0303 C 0.00 0.00 0.00 0.00 XXX 0.00 Pre-op service LVRS 10-15dosG0304 C 0.00 0.00 0.00 0.00 XXX 0.00 Pre-op service LVRS 1-9 dosG0305 C 0.00 0.00 0.00 0.00 XXX 0.00 Post op service LVRS min 6G0306 C 10.86 0.00 0.00 0.00 XXX 1.80 CBC/diffwbc w/o plateletG0307 C 9.04 0.00 0.00 0.00 XXX 1.80 CBC without plateletG0308 D 12.74 8.56 8.56 0.42 XXX 50.58 ESRD related svc 4+mo<2yrsG0309 D 10.61 7.12 7.12 0.36 XXX 50.58 ESRD related svc 2-3mo<2yrsG0310 D 8.49 5.70 5.70 0.28 XXX 50.58 ESRD related svc 1 visit<2yrG0311 D 9.73 4.73 4.73 0.34 XXX 50.58 ESRD related svs 4+mo 2-11yrG0312 D 8.11 3.93 3.93 0.29 XXX 50.58 ESRD relate svs 2-3 mo 2-11yG0313 D 6.49 3.15 3.15 0.22 XXX 50.58 ESRD related svs 1 mon 2-11yG0314 D 8.28 4.43 4.43 0.27 XXX 50.58 ESRD related svs 4+ mo 12-19G0315 D 6.90 3.68 3.68 0.23 XXX 50.58 ESRD related svs 2-3mo 12-19G0316 D 5.52 2.95 2.95 0.17 XXX 50.58 ESRD relate svs 1 vist 12-19G0317 C 5.09 2.87 2.87 0.17 XXX 50.58 ESRD related svs 4+mo 20+yrsG0318 C 4.24 2.39 2.39 0.14 XXX 50.58 ESRD related svs 2-3 mo 20+yG0319 C 3.39 1.91 1.91 0.11 XXX 50.58 ESRD related svs 1 visit 20+G0320 D 10.61 7.12 7.12 0.36 XXX 50.58 ESRD related svs home under2G0321 D 8.11 3.93 3.93 0.29 XXX 50.58 ESRD related svs home mo<2ysG0322 D 6.90 3.68 3.68 0.23 XXX 50.58 ESRD relate svs home mo12-19G0323 C 4.24 2.39 2.39 0.14 XXX 50.58 ESRD related svs home mo 20+G0324 D 0.35 0.24 0.24 0.01 XXX 50.58 ESRD related svs home/dy<2yG0325 D 0.23 0.12 0.12 0.01 XXX 50.58 ESRD relate home/dy 2-11 yrG0326 D 0.27 0.13 0.13 0.01 XXX 50.58 ESRD relate home/dy 12-19yG0327 C 0.14 0.08 0.08 0.01 XXX 50.58 ESRD relate home/dy 20+yrsG0328 C 22.22 0.00 0.00 0.00 XXX 1.80 Fecal blood scrn immunoassayG0328 C QW 22.22 0.00 0.00 0.00 XXX 1.80 Fecal blood scrn immunoassayG0329 C 0.06 0.14 0.02 0.01 XXX 50.58 Electromagnetic tx for ulcersG0330 C 0.00 0.00 0.00 0.00 XXX 0.00 PET imaging, init dx, cervicalG0331 C 0.00 0.00 0.00 0.00 XXX 0.00 PET imaging, restaging, ovarianG0332 C 0.00 1.91 1.91 0.00 XXX 1.25 Preadmin IV immunoglobulinG0333 C 3.31 0.00 0.00 0.00 XXX 1.25 Dispense fee initial 30 dayG0336 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imaging brain AlzheimersG0336 C TC 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 PET imaging brain AlzheimersG0336 C 26 1.50 0.49 0.49 0.05 XXX 50.58 12/31/2005 PET imaging brain Alzheimers
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G0337 C 1.34 0.51 0.51 0.09 XXX 50.58 Hospice evaluation preelectiG0338 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Linear accelerator stero planG0339 C 0.00 0.00 0.00 0.00 XXX 0.00 Robot lin-radsurg com, first sessionG0340 C 0.00 0.00 0.00 0.00 XXX 0.00 Robot linear steroradio max5G0341 C 6.98 5.75 2.60 0.48 000 50.58 Percutaneous islet cell transplantG0342 C 11.92 5.31 5.31 1.46 090 50.58 Laparoscopy islet cell transplantG0343 C 19.85 8.78 8.78 2.06 090 50.58 Laparotomy islet cell transplantG0344 C 1.34 1.13 0.48 0.10 XXX 50.58 Initial preventive examG0345 C 0.17 1.42 1.42 0.07 XXX 50.58 12/31/2005 IV infuse hydration, initialG0346 C 0.09 0.40 0.40 0.04 ZZZ 50.58 12/31/2005 Each additional infuse hourG0347 C 0.21 1.75 1.75 0.07 XXX 50.58 12/31/2005 IV infusion therapy/diagnostG0348 C 0.18 0.46 0.46 0.04 ZZZ 50.58 12/31/2005 Each additional hr up to 8hrG0349 C 0.19 0.89 0.89 0.04 ZZZ 50.58 12/31/2005 Additional sequential infuseG0350 C 0.17 0.44 0.44 0.04 ZZZ 50.58 12/31/2005 Concurrent infusionG0351 C 0.17 0.31 0.31 0.01 XXX 50.58 12/31/2005 Therapeutic/diagnostic injecG0353 C 0.18 1.29 1.29 0.04 XXX 50.58 12/31/2005 IV push,single orinitial druG0354 C 0.10 0.57 0.57 0.04 ZZZ 50.58 12/31/2005 Each addition sequential IVG0355 C 0.21 1.14 1.14 0.01 XXX 50.58 12/31/2005 Chemo adminisrate subcut/IMG0356 C 0.19 0.74 0.74 0.01 XXX 50.58 12/31/2005 Hormonal anti-neoplasticG0357 C 0.24 2.92 2.92 0.06 XXX 50.58 12/31/2005 IV push single/initial substG0358 C 0.20 1.61 1.61 0.06 ZZZ 50.58 12/31/2005 IV push each additional drugG0359 C 0.28 4.19 4.19 0.08 XXX 50.58 12/31/2005 Chemotherapy IV one hr initiG0360 C 0.19 0.77 0.77 0.07 ZZZ 50.58 12/31/2005 Each additional hr 1-8 hrsG0361 C 0.21 4.60 4.60 0.08 XXX 50.58 12/31/2005 Prolong chemo infuse>8hrs puG0362 C 0.21 1.94 1.94 0.07 ZZZ 50.58 12/31/2005 Each add sequential infusionG0363 C 0.04 0.69 0.69 0.01 XXX 50.58 12/31/2005 Irrigate implanted venous deG0364 C 0.16 0.14 0.06 0.04 ZZZ 50.58 Bone marrow aspirate &biopsyG0365 C 0.25 4.00 4.00 0.25 XXX 50.58 Vessel mapping hemo accessG0365 C TC 0.00 3.91 3.91 0.23 XXX 50.58 Vessel mapping hemo accessG0365 C 26 0.25 0.09 0.09 0.02 XXX 50.58 Vessel mapping hemo accessG0366 C 0.17 0.51 0.51 0.03 XXX 50.58 EKG for initial prevent examG0367 C 0.00 0.45 0.45 0.02 XXX 50.58 EKG tracing for initial prevG0368 C 0.17 0.06 0.06 0.01 XXX 50.58 EKG interpret & report preveG0369 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Pharm supply fee 1st month transplaG0370 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Pharmacy supply fee oral cancer etc.G0371 C 3.31 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pharm dispense inhalation 30G0372 C 0.17 0.39 0.06 0.01 XXX 50.58 MD service required for PMDG0374 C 3.31 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pharm dispense inhalation 90G0375 C 0.24 0.09 0.09 0.01 XXX 50.58 Smoke/Tobacco counseling 3-10G0376 C 0.48 0.18 0.17 0.01 XXX 50.58 Smoke/Tobacco counseling >10G0378 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospital observation per hrG0379 C 0.00 0.00 0.00 0.00 XXX 0.00 Direct admit hospital observG3001 C 661.47 0.00 0.00 0.00 XXX 5.00 Admin + supply, tositumomab, 450mgG8006 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI pt recd aspirin at arrivG8007 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI pt did not receiv aspirinG8008 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI pt ineligible for aspirinG8009 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI pt recd Bblock at arrivG8010 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI pt did not rec BblockG8011 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI pt inelig Bbloc at arrivG8012 D 0.00 0.00 0.00 0.00 XXX 0.00 Pneum pt recv antibiotic 4 hG8013 D 0.00 0.00 0.00 0.00 XXX 0.00 Pneum pt w/o antibiotic 4 hrG8014 D 0.00 0.00 0.00 0.00 XXX 0.00 Pneum pt not elig antibioticG8015 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic pt w/ HBA1c>9%G8016 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic pt w/ HBA1c<or=9%
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G8017 D 0.00 0.00 0.00 0.00 XXX 0.00 DM pt inelig for HBA1c measuG8018 D 0.00 0.00 0.00 0.00 XXX 0.00 Care not provided for HbA1cG8019 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic pt w/LDL>= 100mg/dlG8020 D 0.00 0.00 0.00 0.00 XXX 0.00 Diab pt w/LDL< 100mg/dlG8021 D 0.00 0.00 0.00 0.00 XXX 0.00 Diab pt inelig for LDL measG8022 D 0.00 0.00 0.00 0.00 XXX 0.00 Care not provided for LDLG8023 D 0.00 0.00 0.00 0.00 XXX 0.00 DM pt w BP>=140/80G8024 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic pt wBP<140/80G8025 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic pt inelig for BP meG8026 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabet pt w no care re BP meG8027 D 0.00 0.00 0.00 0.00 XXX 0.00 HF p w/LVSD on ACE-I/ARBG8028 D 0.00 0.00 0.00 0.00 XXX 0.00 HF pt w/LVSD not on ACE-I/ARG8029 D 0.00 0.00 0.00 0.00 XXX 0.00 HF pt not elig for ACE-I/ARBG8030 D 0.00 0.00 0.00 0.00 XXX 0.00 HF pt w/LVSD on BblockerG8031 D 0.00 0.00 0.00 0.00 XXX 0.00 HF pt w/LVSD not on BblockerG8032 D 0.00 0.00 0.00 0.00 XXX 0.00 HF pt not elig for BblockerG8033 D 0.00 0.00 0.00 0.00 XXX 0.00 PMI-CAD pt on BblockerG8034 D 0.00 0.00 0.00 0.00 XXX 0.00 PMI-CAD pt not on BblockerG8035 D 0.00 0.00 0.00 0.00 XXX 0.00 PMI-CAD pt inelig BblockerG8036 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI-CAD pt doc on antiplatelG8037 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI-CAD pt not docu on antipG8038 D 0.00 0.00 0.00 0.00 XXX 0.00 AMI-CAD inelig antiplate meaG8039 D 0.00 0.00 0.00 0.00 XXX 0.00 CAD pt w/LDL>100mg/dlG8040 D 0.00 0.00 0.00 0.00 XXX 0.00 CAD pt w/LDL<or=100mg/dlG8041 D 0.00 0.00 0.00 0.00 XXX 0.00 CAD pt not eligible for LDLG8051 D 0.00 0.00 0.00 0.00 XXX 0.00 Osteoporosis assessG8052 D 0.00 0.00 0.00 0.00 XXX 0.00 Osteopor pt not assessG8053 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt inelig for osteopor measG8054 D 0.00 0.00 0.00 0.00 XXX 0.00 Falls assess not docum 12 moG8055 D 0.00 0.00 0.00 0.00 XXX 0.00 Falls assess w/ 12 monG8056 D 0.00 0.00 0.00 0.00 XXX 0.00 Not elig for falls assessmenG8057 D 0.00 0.00 0.00 0.00 XXX 0.00 Hearing assess receiveG8058 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt w/o hearing assessG8059 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt inelig for hearing assessG8060 D 0.00 0.00 0.00 0.00 XXX 0.00 Urinary incont pt assessG8061 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt not assess for urinary inG8062 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt not elig for urinary incoG8075 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt w/ dialy of URR>=65%G8076 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt w/ dialy of URR<65%G8077 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt not elig for URR/KtVG8078 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt w/Hct>or=33G8079 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt w/Hct<33G8080 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt inelig for HCT/HgbG8081 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt w/ auto AV fistulaG8082 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD pt w other fistulaG8093 D 0.00 0.00 0.00 0.00 XXX 0.00 COPD pt rec smoking cessatG8094 D 0.00 0.00 0.00 0.00 XXX 0.00 COPD pt w/o smoke cessat intG8099 D 0.00 0.00 0.00 0.00 XXX 0.00 Osteopo pt given Ca+VitD supG8100 D 0.00 0.00 0.00 0.00 XXX 0.00 Osteop pt inelig for Ca+VitDG8103 D 0.00 0.00 0.00 0.00 XXX 0.00 New dx osteo pt w/antiresorpG8104 D 0.00 0.00 0.00 0.00 XXX 0.00 Osteo pt inelig for antiresoG8106 D 0.00 0.00 0.00 0.00 XXX 0.00 Bone dens meas test perfG8107 D 0.00 0.00 0.00 0.00 XXX 0.00 Bone dens meas test ineligG8108 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt receiv influenza vacc
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G8109 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt w/o influenza vaccG8110 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt inelig for influenza vaccG8111 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt receiv mammogramG8112 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt not doc mammogramG8113 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt ineligible mammographyG8114 D 0.00 0.00 0.00 0.00 XXX 0.00 Care not provided for mamogrG8115 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt receiv pneumo vaccG8116 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt did not rec pneumo vaccG8117 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt was inelig for pneumo vacG8126 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt treat w/antidepress12wksG8127 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt not treat w/antidepres12wG8128 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt inelig for antidepres medG8129 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt treat w/antidepres for 6mG8130 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt not treat w/antidepres 6mG8131 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt inelig for antidepres medG8152 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt w/AB 1 hr prior to incisiG8153 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt not doc for AB 1 hr priorG8154 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt ineligi for AB therapyG8155 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt recd thromboemb prophylaxG8156 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt did not rec thromboemboG8157 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt ineligi for thrombolismG8158 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt recd CABG w/ IMAG8159 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt w/CABG w/o IMAG8160 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt inelig for CABG w/IMAG8161 D 0.00 0.00 0.00 0.00 XXX 0.00 Iso CABG pt rec preop bblockG8162 D 0.00 0.00 0.00 0.00 XXX 0.00 Iso CABG pt w/o preop BblockG8163 D 0.00 0.00 0.00 0.00 XXX 0.00 Iso CABG pt inelig for preoG8164 D 0.00 0.00 0.00 0.00 XXX 0.00 Iso CABG pt w/prolng intubG8165 D 0.00 0.00 0.00 0.00 XXX 0.00 Iso CABG pt w/o prolng intubG8166 D 0.00 0.00 0.00 0.00 XXX 0.00 Iso CABG req surg rexpoG8167 D 0.00 0.00 0.00 0.00 XXX 0.00 Iso CABG w/o surg exploG8170 D 0.00 0.00 0.00 0.00 XXX 0.00 CEA/ext bypass pt on aspirinG8171 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt w/carot endarct/ext bypasG8172 D 0.00 0.00 0.00 0.00 XXX 0.00 CEA/ext bypass pt not on aspG8182 D 0.00 0.00 0.00 0.00 XXX 0.00 CAD pt care not prov LDLG8183 D 0.00 0.00 0.00 0.00 XXX 0.00 HF/atrial fib pt on warfarinG8184 D 0.00 0.00 0.00 0.00 XXX 0.00 HF/atrial fib pt inelig warfG8185 D 0.00 0.00 0.00 0.00 XXX 0.00 Osteoarth pt w/ assess painG8186 D 0.00 0.00 0.00 0.00 XXX 0.00 Osteoarth pt inelig assessG9001 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, initialG9002 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, maintenanceG9003 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, risk adj hi, initialG9004 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, risk adj low, initialG9005 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, risk adj maintG9006 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, home monitorG9007 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, schedule team confG9008 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, phys coor care oversiteG9009 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, risk adj maint, level 3G9010 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, risk adj maint, level 4G9011 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, risk adj maint, level 5G9012 D 0.00 0.00 0.00 0.00 XXX 0.00 Coordinated care fee, risk adj maint, otherG9013 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD demo bundle level IG9014 D 0.00 0.00 0.00 0.00 XXX 0.00 ESRD demo bundle-level IIG9016 D 0.00 0.00 0.00 0.00 XXX 0.00 Smoking cessation counseling, individual
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G9017 C 0.00 0.00 0.00 0.00 XXX 0.00 Amantadine HCL, oralG9018 C 0.00 0.00 0.00 0.00 XXX 0.00 Zanamivir, inh pwdrG9019 C 0.00 0.00 0.00 0.00 XXX 0.00 Oseltamivir phospG9020 C 0.00 0.00 0.00 0.00 XXX 0.00 Rimantadine HCLG9021 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess nausea vomit, L-1G9022 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess nausea vomit, L-2G9023 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess nausea vomit, L-3G9024 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess nausea vomit, L-4G9025 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assessment pain level 1G9026 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assessment pain level 2G9027 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assessment pain level 3G9028 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assessment pain level 4G9029 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess for fatigue, level 1G9030 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess for fatigue, level 2G9031 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess for fatigue, level 3G9032 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Chemo assess for fatigue, level 4G9033 C 0.00 0.00 0.00 0.00 XXX 0.00 Amantadine HCL oral brandG9034 D 0.00 0.00 0.00 0.00 XXX 0.00 Services provided by O.T. (demo)G9035 D 0.00 0.00 0.00 0.00 XXX 0.00 Services by orientation&mobility spec (demo)G9036 D 0.00 0.00 0.00 0.00 XXX 0.00 Services by low-vision ther (demo)G9037 D 0.00 0.00 0.00 0.00 XXX 0.00 Services by rehab teacher (demo)G9050 D 0.00 0.00 0.00 0.00 XXX 0.00 Oncology work-up evaluation (demo)G9051 D 0.00 0.00 0.00 0.00 XXX 0.00 Oncology treatment decision (demo)G9052 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc surveillance for disease (demo)G9053 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc expectant management pt (demo)G9054 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc supervision palliative (demo)G9055 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc visit unspecified NOS (demo)G9056 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc prac mgmt adheres guide (demo)G9057 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc pract mgmt differs guide (demo)G9058 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc prac mgmt disagree w/gui (demo)G9059 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc prac mgmt pt opt alterna (demo)G9060 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc prac mgmt dif pt comorb (demo)G9061 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc prac cond noadd by guide (demo)G9062 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc prac guide differs nos (demo)G9063 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx nsclc stgI no dx prog (demo)G9064 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx nsclc stg2 no dx prog (demo)G9065 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx nsclc stg3A nodx prog (demo)G9066 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx nsclc stg3B-4 metasta (demo)G9067 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx nsclc dx unknown nos (demo)G9068 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx nsclc/sclc limited (demo)G9069 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx sclc/nsclc ext at dx (demo)G9070 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx sclc/nsclc ext unknwn (demo)G9071 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx brst stg1 2B no dx pr (demo)G9072 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx brst stg1-2 noprogres (demo)G9073 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx brst stg3-w/progres (demo)G9074 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx brst stg3-noprogress (demo)G9075 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx brst metastic/ recur (demo)G9076 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx brst unknown NOS (demo)G9077 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx prostate T1no progres (demo)G9078 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx prostate T2no progres (demo)G9079 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx prostate T3b-T4noprog (demo)G9080 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx prostate w/rise PSA (demo)G9081 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx prostate mets no cast (demo)G9082 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx prostate castrate met (demo)
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
G9083 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx prostate unknown NOS (demo)G9084 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx colon t1-3,n1-2,no pr (demo)G9085 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx colon T4, N0 w/o prog (demo)G9086 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx colon T1-4 no dx prog (demo)G9087 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx colon radiolg evid dx (demo)G9088 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx colon m1/mets w/o rad (demo)G9089 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx colon extent unknown (demo)G9090 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx rectal T1-2 no progr (demo)G9091 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx rectal T3 N0 no prog (demo)G9092 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx rectal T1-3,N1-2noprg (demo)G9093 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx rectal T4,N,M0 no prg (demo)G9094 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx rectal M1 w/mets prog (demo)G9095 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx rectal extent unknwn (demo)G9096 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx esophag T1-T3 noprog (demo)G9097 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx esophageal T4 no prog (demo)G9098 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx esophageal mets recur (demo)G9099 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx esophageal unknown (demo)G9100 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx gastric no recurrence (demo)G9101 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx gastric p R1-R2noprog (demo)G9102 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx gastric unresectable (demo)G9103 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx gastric recurrent (demo)G9104 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx gastric unknown NOS (demo)G9105 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx pancreatc p R0 res no (demo)G9106 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx pancreatc p R1/R2 no (demo)G9107 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx pancreatic unresectab (demo)G9108 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx pancreatic unknwn NOS (demo)G9109 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx head/neck T1-T2no prg (demo)G9110 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx head/neck T3-4 noprog (demo)G9111 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx head/neck M1 mets rec (demo)G9112 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx head/neck ext unknown (demo)G9113 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx ovarian stg1A-B no pr (demo)G9114 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx ovarian stg1A-B or 2 (demo)G9115 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx ovarian stg3/4 noprog (demo)G9116 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx ovarian recurrence (demo)G9117 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx ovarian unknown NOS (demo)G9118 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx NHL stg 1-2 not relap (demo)G9119 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx NHL stg 3-4 not relap (demo)G9120 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx NHL trans to lg Bcell (demo)G9121 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc NHLstg 1-2 no relap no (demo)G9122 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx NHL stg 3/4no relap (demo)G9123 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx NHL lge Bcell relap (demo)G9124 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx NHL relapse/refractor (demo)G9125 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx NHL stg unknown (demo)G9126 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx ovarian stg IA/B (demo)G9127 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx multi myeloma stage I (demo)G9128 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx mult myeloma stg2 hig (demo)G9129 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx mult myeloma unkwn op (demo)G9130 D 0.00 0.00 0.00 0.00 XXX 0.00 Onc dx multi myeloma unknown (demo)
GYMEQ S 0.00 0.00 0.00 0.00 XXX 0.00 Gym equipt for home use, purchaseGYMME S 0.00 0.00 0.00 0.00 XXX 0.00 Gym membershipH0001 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug assessmentH0002 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug screening, eligibilityH0003 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug screening, lab analysisH0004 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug services, ind counsel
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
H0005 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug services, group counselH0006 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug services, case mgmtH0007 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug services, crisis intervH0008 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, sub-acute dtox, ipH0009 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, acute dtox, ipH0010 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, sub-acute dtoxH0011 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, acute dtoxH0012 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, sub-acute dtox, opH0013 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, acute dtox, opH0014 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, ambulatory dtoxH0015 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, intensive opH0016 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, medical somaticH0017 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, residential, hospH0018 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, s/t residentialH0019 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, l/t residentialH0020 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug serv, methadone svcH0021 D 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug training servH0022 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug intervenH0023 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug outreachH0024 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug preventiH0025 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug preventiH0026 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug preventiH0027 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug preventiH0028 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug preventiH0029 C 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug preventiH0030 D 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol and/or drug hotlineH0031 D 0.00 0.00 0.00 0.00 XXX 0.00 MH health assess by non-mdH0032 D 0.00 0.00 0.00 0.00 XXX 0.00 MH svc plan dev by non-mdH0033 D 0.00 0.00 0.00 0.00 XXX 0.00 Oral med adm direct observeH0034 D 0.00 0.00 0.00 0.00 XXX 0.00 Med trng & support per 15minH0035 C 0.00 0.00 0.00 0.00 XXX 0.00 MH partial hosp tx under 24hH0036 C 0.00 0.00 0.00 0.00 XXX 0.00 Comm psy face-face per 15minH0037 D 0.00 0.00 0.00 0.00 XXX 0.00 Comm psy sup tx pgm per diemH0038 D 0.00 0.00 0.00 0.00 XXX 0.00 Self-help/peer svc per 15minH0039 D 0.00 0.00 0.00 0.00 XXX 0.00 Asser com tx face-face/15minH0040 D 0.00 0.00 0.00 0.00 XXX 0.00 Assert comm tx pgm per diemH0041 D 0.00 0.00 0.00 0.00 XXX 0.00 Fos c chld non-ther per diemH0042 D 0.00 0.00 0.00 0.00 XXX 0.00 Fos c chld non-ther per monH0043 C 0.00 0.00 0.00 0.00 XXX 0.00 Supported housing, per diemH0044 C 0.00 0.00 0.00 0.00 XXX 0.00 Supported housing, per monthH0045 D 0.00 0.00 0.00 0.00 XXX 0.00 Respite not-in-home per diemH0046 D 0.00 0.00 0.00 0.00 XXX 0.00 Mental health service, nosH0047 D 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol/drug abuse svc nosH0048 D 0.00 0.00 0.00 0.00 XXX 0.00 Spec coll non-blood:a/d testH1000 D 0.00 0.00 0.00 0.00 XXX 0.00 Pre-natal care atrisk assessmH1001 D 0.00 0.00 0.00 0.00 XXX 0.00 Antepartum managementH1002 D 0.00 0.00 0.00 0.00 XXX 0.00 Care coordination prenatalH1003 D 0.00 0.00 0.00 0.00 XXX 0.00 Prenatal at risk educationH1004 D 0.00 0.00 0.00 0.00 XXX 0.00 Follow up home visit/prenatalH1005 D 0.00 0.00 0.00 0.00 XXX 0.00 Pre-natal care enhanced srv pkH1010 D 0.00 0.00 0.00 0.00 XXX 0.00 Nonmed family planning edH1011 D 0.00 0.00 0.00 0.00 XXX 0.00 Family assessmentH2000 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp multidisipln evaluationH2001 D 0.00 0.00 0.00 0.00 XXX 0.00 Rehabilitation program 1/2 day
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
H2010 D 0.00 0.00 0.00 0.00 XXX 0.00 Comprehensive med svc 15 minH2011 D 0.00 0.00 0.00 0.00 XXX 0.00 Crisis interven svc, 15 minH2012 D 0.00 0.00 0.00 0.00 XXX 0.00 Behav hlth day treat, per hrH2013 D 0.00 0.00 0.00 0.00 XXX 0.00 Psych hlth fac svc, per diemH2014 D 0.00 0.00 0.00 0.00 XXX 0.00 Skills train and dev, 15 minH2015 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp comm supp svc, 15 minH2016 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp comm supp svc, per diemH2017 D 0.00 0.00 0.00 0.00 XXX 0.00 Psysoc rehab svc, per 15 minH2018 D 0.00 0.00 0.00 0.00 XXX 0.00 Psysoc rehab svc, per diemH2019 D 0.00 0.00 0.00 0.00 XXX 0.00 Ther behav svc, per 15 minH2020 D 0.00 0.00 0.00 0.00 XXX 0.00 Ther behav svc, per diemH2021 D 0.00 0.00 0.00 0.00 XXX 0.00 Com wrap-around sv, 15 minH2022 D 0.00 0.00 0.00 0.00 XXX 0.00 Com wrap-around sv, per diemH2023 D 0.00 0.00 0.00 0.00 XXX 0.00 Supported employ, per 15 minH2024 D 0.00 0.00 0.00 0.00 XXX 0.00 Supported employ, per diemH2025 D 0.00 0.00 0.00 0.00 XXX 0.00 Supp maint employ, 15 minH2026 D 0.00 0.00 0.00 0.00 XXX 0.00 Supp maint employ, per diemH2027 D 0.00 0.00 0.00 0.00 XXX 0.00 Psychoed svc, per 15 minH2028 D 0.00 0.00 0.00 0.00 XXX 0.00 Sex offend tx svc, 15 minH2029 D 0.00 0.00 0.00 0.00 XXX 0.00 Sex offend tx svc, per diemH2030 D 0.00 0.00 0.00 0.00 XXX 0.00 MH clubhouse svc, per 15 minH2031 D 0.00 0.00 0.00 0.00 XXX 0.00 MH clubhouse svc, per diemH2032 D 0.00 0.00 0.00 0.00 XXX 0.00 Activity therapy, per 15 minH2033 D 0.00 0.00 0.00 0.00 XXX 0.00 Multisys ther/juvenile 15minH2034 D 0.00 0.00 0.00 0.00 XXX 0.00 A/D halfway house, per diemH2035 D 0.00 0.00 0.00 0.00 XXX 0.00 A/D tx program, per hourH2036 D 0.00 0.00 0.00 0.00 XXX 0.00 A/D tx program, per diemH2037 D 0.00 0.00 0.00 0.00 XXX 0.00 Dev delay prev dp ch, 15 minHRENT S 0.00 0.00 0.00 0.00 XXX 0.00 Home/apt/garage rental, monthlyHSMDF S 0.00 0.00 0.00 0.00 XXX 0.00 Home modifications per serviceHSPUM S 0.00 0.00 0.00 0.00 XXX 0.00 Home purchase and modificationHSPUR S 0.00 0.00 0.00 0.00 XXX 0.00 Home purchaseIMPAR C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP-requested clinical examination to resolve conflict J0120 C 40.14 0.00 0.00 0.00 XXX 1.25 Tetracyclin inj, 250mgJ0128 C 67.39 0.00 0.00 0.00 XXX 1.25 Abarelix, inj, 10mgJ0130 C 525.99 0.00 0.00 0.00 XXX 1.25 Abciximab inj, 10mgJ0132 C 1.73 0.00 0.00 0.00 XXX 1.25 Acetylcysteine injection, 100 mgJ0133 C 0.25 0.00 0.00 0.00 XXX 1.25 Acyclovir injection, 5 mgJ0135 C 301.77 0.00 0.00 0.00 XXX 1.25 Adalimumab inj, 20mgJ0150 C 32.57 0.00 0.00 0.00 XXX 1.25 Injection adenosine tx 6mgJ0151 C 229.26 0.00 0.00 0.00 XXX 1.25 12/31/2005 Adenosine injectionJ0152 C 70.30 0.00 0.00 0.00 XXX 1.25 Adenosine inj dx 30mgJ0170 C 0.60 0.00 0.00 0.00 XXX 1.25 Adrenalin epinephrin inj, 1mlJ0180 C 127.20 0.00 0.00 0.00 XXX 1.25 Agalsidase beta inj, 1mgJ0190 C 0.00 0.00 0.00 0.00 XXX 0.00 Inj biperiden lactate/5 mgJ0200 C 19.04 0.00 0.00 0.00 XXX 1.25 Alatrofloxacin mesylateJ0205 C 39.22 0.00 0.00 0.00 XXX 1.25 Alglucerase inj, 10unitsJ0207 C 442.33 0.00 0.00 0.00 XXX 1.25 Amifostine inj 500mgJ0210 C 9.99 0.00 0.00 0.00 XXX 1.25 Methyldopate hcl inj, 250mgJ0215 C 26.51 0.00 0.00 0.00 XXX 1.25 Alefacept inj 0.5mgJ0256 C 3.23 0.00 0.00 0.00 XXX 1.25 Alpha 1 proteinase inhibitor, 10mgJ0270 C 1.82 0.00 0.00 0.00 XXX 1.25 Alprostadil for inj, 1.25mcgJ0275 C 21.66 0.00 0.00 0.00 XXX 1.25 Alprostadil urethral suppos, 125mcgJ0278 C 1.30 0.00 0.00 0.00 XXX 1.25 Amikacin sulfate injection, 50mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J0280 C 0.40 0.00 0.00 0.00 XXX 1.25 Aminophyllin 250 MG injJ0282 C 0.33 0.00 0.00 0.00 XXX 1.25 Amiodarone HCl, 30mgJ0285 C 10.28 0.00 0.00 0.00 XXX 1.25 Amphotericin B, 50mgJ0287 C 21.85 0.00 0.00 0.00 XXX 1.25 Amphotericin b lipid complex, 10mgJ0288 C 15.20 0.00 0.00 0.00 XXX 1.25 Ampho b cholesteryl sulfate, 10mgJ0289 C 35.80 0.00 0.00 0.00 XXX 1.25 Amphotericin b liposome inj, 10mgJ0290 C 2.46 0.00 0.00 0.00 XXX 1.25 Ampicillin 500 MG injJ0295 C 6.50 0.00 0.00 0.00 XXX 1.25 Ampicillin sodium per 1.5 gmJ0300 C 2.43 0.00 0.00 0.00 XXX 1.25 Amobarbital 125 MG injJ0330 C 0.14 0.00 0.00 0.00 XXX 1.25 Succinycholine chloride inj, 20mgJ0350 C 567.12 0.00 0.00 0.00 XXX 5.00 Injection anistreplase 30 uJ0360 C 6.09 0.00 0.00 0.00 XXX 1.25 Hydralazine hcl inj, 20mgJ0365 C 2.33 0.00 0.00 0.00 XXX 1.25 Aprotonin, 10,000 kiuJ0380 C 1.15 0.00 0.00 0.00 XXX 1.25 Inj metaraminol bitartrate, 10mgJ0390 C 19.68 0.00 0.00 0.00 XXX 1.25 Chloroquine injJ0395 C 182.40 0.00 0.00 0.00 XXX 1.25 Arbutamine HCl injJ0456 C 24.89 0.00 0.00 0.00 XXX 1.25 Azithromycin, 500mgJ0460 C 0.40 0.00 0.00 0.00 XXX 1.25 Atropine sulfate inj, 0.3mgJ0470 C 21.80 0.00 0.00 0.00 XXX 1.25 Dimecaprol inj, 100mgJ0475 C 215.18 0.00 0.00 0.00 XXX 1.25 Baclofen 10 MG injJ0476 C 79.80 0.00 0.00 0.00 XXX 1.25 Baclofen intrathecal trial, 50mcgJ0480 C 705.45 0.00 0.00 0.00 XXX 2.50 Basiliximab, 20mgJ0500 C 15.96 0.00 0.00 0.00 XXX 1.25 Dicyclomine inj, 20mgJ0515 C 3.87 0.00 0.00 0.00 XXX 1.25 Inj benztropine mesylate, 1mgJ0520 C 5.34 0.00 0.00 0.00 XXX 1.25 Bethanechol chloride injectJ0530 C 13.19 0.00 0.00 0.00 XXX 1.25 Penicillin g benzathine inj, 600000uJ0540 C 25.58 0.00 0.00 0.00 XXX 1.25 Penicillin g benzathine inj, 1200000uJ0550 C 33.48 0.00 0.00 0.00 XXX 1.25 Penicillin g benzathine inj, 2400000uJ0560 C 19.55 0.00 0.00 0.00 XXX 1.25 Penicillin g benzathine inj, 600000uJ0570 C 33.84 0.00 0.00 0.00 XXX 1.25 Penicillin g benzathine inj, 1200000uJ0580 C 65.72 0.00 0.00 0.00 XXX 1.25 Penicillin g benzathine inj, 2400000uJ0583 C 0.16 0.00 0.00 0.00 XXX 1.25 Bivalirudin, 1mgJ0585 C 4.91 0.00 0.00 0.00 XXX 1.25 Botulinum toxin type A per unitJ0587 C 7.82 0.00 0.00 0.00 XXX 1.25 Botulinum toxin type B per 100uJ0592 C 0.75 0.00 0.00 0.00 XXX 1.25 Buprenorphine hydrochloride, 0.1mgJ0595 C 0.77 0.00 0.00 0.00 XXX 1.25 Butorphanol tartrate 1 mgJ0600 C 39.93 0.00 0.00 0.00 XXX 1.25 Edetate calcium disodium inj, 1mlJ0610 C 0.40 0.00 0.00 0.00 XXX 1.25 Calcium gluconate inj, 10mlJ0620 C 8.96 0.00 0.00 0.00 XXX 1.25 Calcium glycer & lact/10 MLJ0630 C 37.81 0.00 0.00 0.00 XXX 1.25 Calcitonin salmon inj, 400uJ0636 C 0.71 0.00 0.00 0.00 XXX 1.25 Inj calcitriol per 0.1 mcgJ0637 C 32.46 0.00 0.00 0.00 XXX 1.25 Caspofungin acetate 5mgJ0640 C 1.28 0.00 0.00 0.00 XXX 1.25 Leucovorin calcium inj/50mgJ0670 C 1.31 0.00 0.00 0.00 XXX 1.25 Inj mepivacaine HCL/10 mlJ0690 C 1.38 0.00 0.00 0.00 XXX 1.25 Cefazolin sodium inj 500mgJ0692 C 7.55 0.00 0.00 0.00 XXX 1.25 Cefepime HCl for inj 500mgJ0694 C 7.14 0.00 0.00 0.00 XXX 1.25 Cefoxitin sodium inj, 1gmJ0696 C 5.43 0.00 0.00 0.00 XXX 1.25 Ceftriaxone sodium inj 250mgJ0697 C 4.12 0.00 0.00 0.00 XXX 1.25 Sterile cefuroxime inj, 750mgJ0698 C 4.35 0.00 0.00 0.00 XXX 1.25 Cefotaxime sodium inj, 1gmJ0702 C 4.98 0.00 0.00 0.00 XXX 1.25 Betamethasone acet&sod phosp, 3mgJ0704 C 0.91 0.00 0.00 0.00 XXX 1.25 Betamethasone sod phosp/4mgJ0706 C 3.37 0.00 0.00 0.00 XXX 1.25 Caffeine citrate inj, 5mgJ0710 C 1.39 0.00 0.00 0.00 XXX 1.25 Cephapirin sodium inj, 1gm
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J0713 C 3.97 0.00 0.00 0.00 XXX 1.25 Inj ceftazidime per 500mgJ0715 C 3.57 0.00 0.00 0.00 XXX 1.25 Ceftizoxime sodium / 500mgJ0720 C 10.18 0.00 0.00 0.00 XXX 1.25 Chloramphenicol sodium injec, 1gmJ0725 C 3.72 0.00 0.00 0.00 XXX 1.25 Chorionic gonadotropin/1000uJ0735 C 63.34 0.00 0.00 0.00 XXX 1.25 Clonidine hydrochloride, 1mgJ0740 C 740.00 0.00 0.00 0.00 XXX 1.25 Cidofovir inj, 375mgJ0743 C 12.63 0.00 0.00 0.00 XXX 1.25 Cilastatin sodium inj, 250mgJ0744 C 8.44 0.00 0.00 0.00 XXX 1.25 Ciprofloxacin iv,200mgJ0745 C 0.72 0.00 0.00 0.00 XXX 1.25 Inj codeine phosphate /30 MGJ0760 C 4.45 0.00 0.00 0.00 XXX 1.25 Colchicine inj, 1mgJ0770 C 24.20 0.00 0.00 0.00 XXX 1.25 Colistimethate sodium inj, 150mgJ0780 C 3.25 0.00 0.00 0.00 XXX 1.25 Prochlorperazine inj, 10mgJ0795 C 4.06 0.00 0.00 0.00 XXX 1.25 Corticorelin ovine triflutal, 1 eaJ0800 C 107.76 0.00 0.00 0.00 XXX 1.25 Corticotropin inj, 40 unitsJ0835 C 65.94 0.00 0.00 0.00 XXX 1.25 Inj cosyntropin per 0.25mgJ0850 C 721.42 0.00 0.00 0.00 XXX 1.25 Cytomegalovirus imm IV /vial, 1mlJ0878 C 0.29 0.00 0.00 0.00 XXX 1.25 Daptomycin inj, 1mgJ0880 C 15.06 0.00 0.00 0.00 XXX 1.25 12/31/2005 Cytomegalovirus imm IV /vialJ0881 C 2.99 0.00 0.00 0.00 XXX 1.25 Darbepoetin alfa, non-esrd, 1mcgJ0882 C 2.99 0.00 0.00 0.00 XXX 1.25 Darbepoetin alfa, esrd use, 1mcgJ0885 C 9.03 0.00 0.00 0.00 XXX 1.25 Epoetin alfa, non-esrd, 1000uJ0886 C 9.57 0.00 0.00 0.00 XXX 1.25 Epoetin alfa, esrd, 1000uJ0895 C 15.63 0.00 0.00 0.00 XXX 1.25 Deferoxamine mesylate inj 500mgJ0900 C 1.38 0.00 0.00 0.00 XXX 1.25 Testosterone enanthate inj, 1ccJ0945 C 0.73 0.00 0.00 0.00 XXX 1.25 Brompheniramine maleate inj, 10mgJ0970 C 30.98 0.00 0.00 0.00 XXX 1.25 Estradiol valerate inj, 40mgJ1000 C 5.29 0.00 0.00 0.00 XXX 1.25 Depo-estradiol cypionate inj 5mgJ1020 C 2.81 0.00 0.00 0.00 XXX 1.25 Methylprednisolone 20mg injJ1030 C 5.27 0.00 0.00 0.00 XXX 1.25 Methylprednisolone 40mg injJ1040 C 9.28 0.00 0.00 0.00 XXX 1.25 Methylprednisolone 80mg injJ1051 C 5.15 0.00 0.00 0.00 XXX 1.25 Medroxyprogesterone inj, 50mgJ1055 C 0.00 0.00 0.00 0.00 XXX 0.00 Medrxyprogester acetate injJ1056 C 22.89 0.00 0.00 0.00 XXX 1.25 MA/EC contraceptive inj, 5mgJ1060 C 4.14 0.00 0.00 0.00 XXX 1.25 Testosterone cypionate 1 MLJ1070 C 5.16 0.00 0.00 0.00 XXX 1.25 Testosterone cypionat 100mgJ1080 C 12.31 0.00 0.00 0.00 XXX 1.25 Testosterone cypionat 200mgJ1094 C 0.75 0.00 0.00 0.00 XXX 1.25 Inj dexamethasone acetate, 1 mgJ1100 C 0.12 0.00 0.00 0.00 XXX 1.25 Dexamethasone sodium phos 1 mgJ1110 C 25.34 0.00 0.00 0.00 XXX 1.25 Inj dihydroergotamine mesylt, 1mgJ1120 C 14.91 0.00 0.00 0.00 XXX 1.25 Acetazolamid sodium inj, 500mgJ1160 C 3.97 0.00 0.00 0.00 XXX 1.25 Digoxin inj, 0.5mgJ1162 C 540.91 0.00 0.00 0.00 XXX 1.25 Digoxin immune fab (ovine), per vialJ1165 C 0.66 0.00 0.00 0.00 XXX 1.25 Phenytoin sodium inj, 50mgJ1170 C 1.61 0.00 0.00 0.00 XXX 1.25 Hydromorphone inj, 4mgJ1180 C 8.05 0.00 0.00 0.00 XXX 1.25 Dyphylline inj, 500mgJ1190 C 186.72 0.00 0.00 0.00 XXX 1.25 Dexrazoxane HCl inj /250mgJ1200 C 0.76 0.00 0.00 0.00 XXX 1.25 Diphenhydramine hcl inj 50mgJ1205 C 10.20 0.00 0.00 0.00 XXX 1.25 Chlorothiazide sodium inj, 500mgJ1212 C 42.37 0.00 0.00 0.00 XXX 1.25 Dimethyl sulfoxide 50%, 50 MLJ1230 C 3.25 0.00 0.00 0.00 XXX 1.25 Methadone inj, 10mgJ1240 C 3.83 0.00 0.00 0.00 XXX 1.25 Dimenhydrinate inj, 50mgJ1245 C 1.68 0.00 0.00 0.00 XXX 1.25 Dipyridamole inj /10mgJ1250 C 5.02 0.00 0.00 0.00 XXX 1.25 Inj dobutamine HCL/250mgJ1260 C 6.37 0.00 0.00 0.00 XXX 1.25 Dolasetron mesylate 10mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J1265 C 0.71 0.00 0.00 0.00 XXX 1.25 Dopamine inj, 40mgJ1270 C 2.69 0.00 0.00 0.00 XXX 1.25 Injection, doxercalciferol, 1mcgJ1320 C 2.24 0.00 0.00 0.00 XXX 1.25 Amitriptyline inj, 20mgJ1325 C 13.27 0.00 0.00 0.00 XXX 1.25 Epoprostenol inj, 0.5mgJ1327 C 13.14 0.00 0.00 0.00 XXX 1.25 Eptifibatide inj, 5mgJ1330 C 4.03 0.00 0.00 0.00 XXX 1.25 Ergonovine maleate inj, 0.2mgJ1335 C 22.25 0.00 0.00 0.00 XXX 1.25 Ertapenem inj, 500mgJ1364 C 5.13 0.00 0.00 0.00 XXX 1.25 Erythro lactobionate /500mgJ1380 C 11.93 0.00 0.00 0.00 XXX 1.25 Estradiol valerate 10mg injJ1390 C 15.49 0.00 0.00 0.00 XXX 1.25 Estradiol valerate 20mg injJ1410 C 56.67 0.00 0.00 0.00 XXX 1.25 Inj estrogen conjugate 25mgJ1430 C 83.14 0.00 0.00 0.00 XXX 1.25 Ethanolamine oleate 100mgJ1435 C 0.14 0.00 0.00 0.00 XXX 1.25 Injection estrone per 1 mgJ1436 C 71.41 0.00 0.00 0.00 XXX 1.25 Etidronate disodium inj, 300mgJ1438 C 154.23 0.00 0.00 0.00 XXX 1.25 Etanercept inj, 25mgJ1440 C 176.96 0.00 0.00 0.00 XXX 1.25 Filgrastim 300 mcg injecitonJ1441 C 279.35 0.00 0.00 0.00 XXX 1.25 Filgrastim 480 mcg injectionJ1450 C 14.04 0.00 0.00 0.00 XXX 1.25 Fluconazole, 200mgJ1451 C 11.89 0.00 0.00 0.00 XXX 1.25 Fomepizole, 15 mgJ1452 C 212.00 0.00 0.00 0.00 XXX 1.25 Intraocular Fomivirsen na, 1.65mgJ1455 C 9.94 0.00 0.00 0.00 XXX 1.25 Foscarnet sodium inj, 1000mgJ1457 C 1.25 0.00 0.00 0.00 XXX 1.25 Gallium nitrate inj, 1mgJ1460 C 11.63 0.00 0.00 0.00 XXX 1.25 Gamma globulin 1CC injJ1470 C 23.27 0.00 0.00 0.00 XXX 1.25 Gamma globulin 2 CC injJ1480 C 34.88 0.00 0.00 0.00 XXX 1.25 Gamma globulin 3 CC injJ1490 C 46.53 0.00 0.00 0.00 XXX 1.25 Gamma globulin 4 CC injJ1500 C 58.16 0.00 0.00 0.00 XXX 1.25 Gamma globulin 5 CC injJ1510 C 69.86 0.00 0.00 0.00 XXX 1.25 Gamma globulin 6 CC injJ1520 C 81.35 0.00 0.00 0.00 XXX 1.25 Gamma globulin 7 CC injJ1530 C 93.06 0.00 0.00 0.00 XXX 1.25 Gamma globulin 8 CC injJ1540 C 104.98 0.00 0.00 0.00 XXX 1.25 Gamma globulin 9 CC injJ1550 C 116.33 0.00 0.00 0.00 XXX 1.25 Gamma globulin 10 CC injJ1560 C 116.25 0.00 0.00 0.00 XXX 1.25 Gamma globulin > 10 CC inj /10mlJ1563 C 78.38 0.00 0.00 0.00 XXX 1.25 12/31/2005 IV immune globulinJ1564 C 0.86 0.00 0.00 0.00 XXX 1.25 12/31/2005 Immune globulin, im, 10 mgJ1565 C 16.18 0.00 0.00 0.00 XXX 1.25 RSV-ivig, 50mgJ1566 C 22.22 0.00 0.00 0.00 XXX 1.25 Immune globulin, powder, 500mgJ1567 C 28.36 0.00 0.00 0.00 XXX 1.25 Immune globulin, liquid, 500mgJ1570 C 35.97 0.00 0.00 0.00 XXX 1.25 Ganciclovir sodium inj, 500mgJ1580 C 0.98 0.00 0.00 0.00 XXX 1.25 Garamycin gentamicin inj 80mgJ1590 C 0.40 0.00 0.00 0.00 XXX 1.25 Gatifloxacin inj, 10mgJ1595 C 42.15 0.00 0.00 0.00 XXX 1.25 Inj glatiramer acetate, 20mgJ1600 C 4.47 0.00 0.00 0.00 XXX 1.25 Gold sodium thiomaleate inj 50mgJ1610 C 65.96 0.00 0.00 0.00 XXX 1.25 Glucagon hydrochloride/1 MGJ1620 C 180.30 0.00 0.00 0.00 XXX 1.25 Gonadorelin hydroch/ 100 mcgJ1626 C 6.98 0.00 0.00 0.00 XXX 1.25 Granisetron HCl injection 100mcgJ1630 C 2.86 0.00 0.00 0.00 XXX 1.25 Haloperidol inj, 5mgJ1631 C 6.22 0.00 0.00 0.00 XXX 1.25 Haloperidol decanoate inj /50mgJ1640 C 6.63 0.00 0.00 0.00 XXX 1.25 Hemin, 1 mgJ1642 C 0.05 0.00 0.00 0.00 XXX 1.25 Inj heparin sodium per 10 uJ1644 C 0.21 0.00 0.00 0.00 XXX 1.25 Inj heparin sodium per 1000 uJ1645 C 10.01 0.00 0.00 0.00 XXX 1.25 Dalteparin sodium per 2500 iuJ1650 C 5.44 0.00 0.00 0.00 XXX 1.25 Inj enoxaparin sodium, 10mgJ1652 C 5.51 0.00 0.00 0.00 XXX 1.25 Fondaparinux sodium, 0.5mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J1655 C 2.41 0.00 0.00 0.00 XXX 1.25 Tinzaparin sodium injection 1000 iuJ1670 C 90.80 0.00 0.00 0.00 XXX 1.25 Tetanus immune globulin inj, 250uJ1675 C 0.00 0.00 0.00 0.00 XXX 0.00 Histrelin acetateJ1700 C 0.34 0.00 0.00 0.00 XXX 1.25 Hydrocortisone acetate injJ1710 C 5.57 0.00 0.00 0.00 XXX 1.25 Hydrocortisone sodium ph injJ1720 C 1.90 0.00 0.00 0.00 XXX 1.25 Hydrocortisone sodium succ inj 100mgJ1730 C 111.30 0.00 0.00 0.00 XXX 1.25 Diazoxide inj, 300mgJ1742 C 252.58 0.00 0.00 0.00 XXX 1.25 Ibutilide fumarate inj, 1mgJ1745 C 53.24 0.00 0.00 0.00 XXX 1.25 Infliximab inj, 10mgJ1750 C 11.34 0.00 0.00 0.00 XXX 1.25 12/31/2005 Iron dextran, 50mgJ1751 C 12.25 0.00 0.00 0.00 XXX 1.25 Iron dextran 165 injection, 50mgJ1752 C 10.24 0.00 0.00 0.00 XXX 1.25 Iron dextran 267 injection, 50mgJ1756 C 0.36 0.00 0.00 0.00 XXX 1.25 Iron sucrose inj, 1mgJ1785 C 3.91 0.00 0.00 0.00 XXX 1.25 Inj imiglucerase, 1unitJ1790 C 0.20 0.00 0.00 0.00 XXX 1.25 Droperidol inj, 1mgJ1800 C 4.55 0.00 0.00 0.00 XXX 1.25 Propranolol inj, 1mgJ1810 C 5.58 0.00 0.00 0.00 XXX 1.25 Droperidol/fentanyl inj, 2mlJ1815 C 0.24 0.00 0.00 0.00 XXX 1.25 Insulin injection, / 5 unitsJ1817 C 2.80 0.00 0.00 0.00 XXX 1.25 Insulin for insulin pump use, 50uJ1825 C 0.00 0.00 0.00 0.00 XXX 0.00 Interferon beta-1aJ1830 C 87.38 0.00 0.00 0.00 XXX 1.25 Interferon beta-1b, 0.25mgJ1835 C 36.26 0.00 0.00 0.00 XXX 1.25 Intraconazole inj, 50mgJ1840 C 3.62 0.00 0.00 0.00 XXX 1.25 Kanamycin sulfate 500mg injJ1850 C 0.55 0.00 0.00 0.00 XXX 1.25 Kanamycin sulfate 75mg injJ1885 C 0.47 0.00 0.00 0.00 XXX 1.25 Ketorolac tromethamine inj 15mgJ1890 C 8.64 0.00 0.00 0.00 XXX 1.25 Cephalothin sodium inj, 1 gramJ1910 C 16.14 0.00 0.00 0.00 XXX 1.25 Kutapressin injectionJ1931 C 23.87 0.00 0.00 0.00 XXX 1.25 Laronidase injection, 0.1mgJ1940 C 0.38 0.00 0.00 0.00 XXX 1.25 Furosemide injection 20mgJ1945 C 146.23 0.00 0.00 0.00 XXX 1.25 Lepirudin, 50mgJ1950 C 440.60 0.00 0.00 0.00 XXX 1.25 Leuprolide acetate, 3.75 MGJ1955 C 10.18 0.00 0.00 0.00 XXX 1.25 Inj levocarnitine per 1 gmJ1956 C 7.68 0.00 0.00 0.00 XXX 1.25 Levofloxacin inj, 250mgJ1960 C 3.76 0.00 0.00 0.00 XXX 1.25 Levorphanol tartrate injJ1980 C 7.41 0.00 0.00 0.00 XXX 1.25 Hyoscyamine sulfate inj, 0.25mgJ1990 C 21.05 0.00 0.00 0.00 XXX 1.25 Chlordiazepoxide inj, 100mgJ2000 C 3.99 0.00 0.00 0.00 XXX 1.25 Lidocaine injectionJ2001 C 0.02 0.00 0.00 0.00 XXX 1.25 Lidocaine inj, 10mgJ2010 C 3.63 0.00 0.00 0.00 XXX 1.25 Lincomycin inj, 300mgJ2020 C 23.80 0.00 0.00 0.00 XXX 1.25 Linezolid inj, 200mgJ2060 C 1.00 0.00 0.00 0.00 XXX 1.25 Lorazepam inj, 2mgJ2150 C 0.87 0.00 0.00 0.00 XXX 1.25 Mannitol injection 25%, 50mlJ2175 C 1.63 0.00 0.00 0.00 XXX 1.25 Meperidine hydrochl, 100mgJ2180 C 3.79 0.00 0.00 0.00 XXX 1.25 Meperidine/promethazine inj, 50mgJ2185 C 3.88 0.00 0.00 0.00 XXX 1.25 Meropenem, 100mgJ2210 C 4.30 0.00 0.00 0.00 XXX 1.25 Methylergonovin maleate inj, 0.2mgJ2250 C 0.26 0.00 0.00 0.00 XXX 1.25 Inj midazolam hydrochloride, 1mgJ2260 C 3.07 0.00 0.00 0.00 XXX 1.25 Inj milrinone lactate / 5mgJ2270 C 1.01 0.00 0.00 0.00 XXX 1.25 Morphine sulfate inj, 10mgJ2271 C 4.67 0.00 0.00 0.00 XXX 1.25 Morphine so4 inj, 100mgJ2275 C 6.07 0.00 0.00 0.00 XXX 1.25 Morphine sulfate inj, 10mgJ2278 C 6.17 0.00 0.00 0.00 XXX 1.25 Ziconotide injection, 1mcgJ2280 C 3.79 0.00 0.00 0.00 XXX 1.25 Inj, moxifloxacin 100 mgJ2300 C 1.31 0.00 0.00 0.00 XXX 1.25 Inj nalbuphine hydrochloride, 10mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J2310 C 5.00 0.00 0.00 0.00 XXX 1.25 Inj naloxone hydrochloride, 1mgJ2320 C 3.29 0.00 0.00 0.00 XXX 1.25 Nandrolone decanoate 50mgJ2321 C 6.61 0.00 0.00 0.00 XXX 1.25 Nandrolone decanoate 100mgJ2322 C 13.15 0.00 0.00 0.00 XXX 1.25 Nandrolone decanoate 200mgJ2324 C 74.74 0.00 0.00 0.00 XXX 1.25 12/31/2005 Nesiritide, inject, 0.25mgJ2325 C 30.09 0.00 0.00 0.00 XXX 1.25 Nesiritide injection 0.1 mgJ2352 C 181.88 0.00 0.00 0.00 XXX 1.25 Octreotide acetate inject, 1mgJ2353 C 89.64 0.00 0.00 0.00 XXX 1.25 Octreotide injection, depot 1mgJ2354 C 6.23 0.00 0.00 0.00 XXX 1.25 Octreotide inj, non-depot 25mcgJ2355 C 247.16 0.00 0.00 0.00 XXX 1.25 Oprelvekin inj, 5mgJ2357 C 16.28 0.00 0.00 0.00 XXX 1.25 Omalizumab injection, 5mgJ2360 C 12.67 0.00 0.00 0.00 XXX 1.25 Orphenadrine inj, 60mgJ2370 C 0.69 0.00 0.00 0.00 XXX 1.25 Phenylephrine hcl inj, 1mlJ2400 C 13.56 0.00 0.00 0.00 XXX 1.25 Chloroprocaine hcl inj, 30mlJ2405 C 3.72 0.00 0.00 0.00 XXX 1.25 Ondansetron hcl inj, 1 mgJ2410 C 2.24 0.00 0.00 0.00 XXX 1.25 Oxymorphone hcl inj, 1mgJ2425 C 11.47 0.00 0.00 0.00 XXX 1.25 Palifermin injection, 50mcgJ2430 C 36.22 0.00 0.00 0.00 XXX 1.25 Pamidronate disodium, 30mgJ2440 C 0.59 0.00 0.00 0.00 XXX 1.25 Papaverin hcl inj, 60mgJ2460 C 0.94 0.00 0.00 0.00 XXX 1.25 Oxytetracycline inj, 50mgJ2469 C 17.99 0.00 0.00 0.00 XXX 1.25 Palonosetron HCl, 25mcgJ2501 C 3.81 0.00 0.00 0.00 XXX 1.25 Paricalcitol 1mcgJ2503 C 527.35 0.00 0.00 0.00 XXX 2.50 Pegaptanib sodium injection, 0.3mgJ2504 C 166.07 0.00 0.00 0.00 XXX 1.25 Pegademase bovine, 25 iuJ2505 C 523.36 0.00 0.00 0.00 XXX 5.00 Inj, pegfilgrastim, 6mgJ2510 C 8.42 0.00 0.00 0.00 XXX 1.25 Penicillin g procaine inj, 600000uJ2513 C 12.72 0.00 0.00 0.00 XXX 1.25 Pentastarch 10% solution, 100mlJ2515 C 5.21 0.00 0.00 0.00 XXX 1.25 Pentobarbital sodium inj, 50mgJ2540 C 0.98 0.00 0.00 0.00 XXX 1.25 Penicillin g potassium inj, 600000uJ2543 C 4.74 0.00 0.00 0.00 XXX 1.25 Piperacillin/tazobactam, 1.125gJ2545 C 43.57 0.00 0.00 0.00 XXX 1.25 Pentamidine isethionte/300mgJ2550 C 2.05 0.00 0.00 0.00 XXX 1.25 Promethazine hcl inj, 50mgJ2560 C 3.20 0.00 0.00 0.00 XXX 1.25 Phenobarbital sodium inj, 120mgJ2590 C 1.35 0.00 0.00 0.00 XXX 1.25 Oxytocin inj, 10uJ2597 C 2.58 0.00 0.00 0.00 XXX 1.25 Inj desmopressin acetate, 1mcgJ2650 C 0.40 0.00 0.00 0.00 XXX 1.25 Prednisolone acetate inj, 1mlJ2670 C 3.92 0.00 0.00 0.00 XXX 1.25 Totazoline hcl injectionJ2675 C 1.71 0.00 0.00 0.00 XXX 1.25 Inj progesterone per 50mgJ2680 C 1.22 0.00 0.00 0.00 XXX 1.25 Fluphenazine decanoate 25mgJ2690 C 1.53 0.00 0.00 0.00 XXX 1.25 Procainamide hcl inj, 1gJ2700 C 1.52 0.00 0.00 0.00 XXX 1.25 Oxacillin sodium inj, 250mgJ2710 C 0.08 0.00 0.00 0.00 XXX 1.25 Neostigmine methylslfte inj, 0.5mgJ2720 C 0.40 0.00 0.00 0.00 XXX 1.25 Inj protamine sulfate/10 MGJ2725 C 21.78 0.00 0.00 0.00 XXX 1.25 Inj protirelin per 250 mcgJ2730 C 91.90 0.00 0.00 0.00 XXX 1.25 Pralidoxime chloride inj, 1gJ2760 C 23.49 0.00 0.00 0.00 XXX 1.25 Phentolaine mesylate inj, 5mgJ2765 C 0.48 0.00 0.00 0.00 XXX 1.25 Metoclopramide hcl inj, 10mgJ2770 C 107.42 0.00 0.00 0.00 XXX 1.25 Quinupristin/dalfopristin, 500mgJ2780 C 0.71 0.00 0.00 0.00 XXX 1.25 Ranitidine hydrochloride inj 25mgJ2783 C 111.34 0.00 0.00 0.00 XXX 1.25 Rasburicase 0.5mgJ2788 C 23.51 0.00 0.00 0.00 XXX 1.25 Rho d immune globulin 50 mcgJ2790 C 88.40 0.00 0.00 0.00 XXX 1.25 Rho d immune globulin inj, 300mcgJ2792 C 13.66 0.00 0.00 0.00 XXX 1.25 Rho(D) immune globulin h, sd, 100iuJ2794 C 4.69 0.00 0.00 0.00 XXX 1.25 Risperidone, long acting, 0.5mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J2795 C 0.08 0.00 0.00 0.00 XXX 1.25 Ropivacaine HCl inj, 1mgJ2800 C 8.49 0.00 0.00 0.00 XXX 1.25 Methocarbamol inj, 10mlJ2805 C 44.48 0.00 0.00 0.00 XXX 1.25 Sincalide injection, 5mcgJ2810 C 0.20 0.00 0.00 0.00 XXX 1.25 Inj theophylline per 40mgJ2820 C 23.67 0.00 0.00 0.00 XXX 1.25 Sargramostim injection 50mcgJ2850 C 20.31 0.00 0.00 0.00 XXX 1.25 Inj secretin synthetic human, 1mcgJ2910 C 24.50 0.00 0.00 0.00 XXX 1.25 Aurothioglucose inj, 50mgJ2912 C 0.12 0.00 0.00 0.00 XXX 1.25 Sodium chloride injection 0.9%, 2mlJ2916 C 4.90 0.00 0.00 0.00 XXX 1.25 NA Ferric Gluconate Complex 12.5 mgJ2920 C 1.92 0.00 0.00 0.00 XXX 1.25 Methylprednisolone injection 40mgJ2930 C 2.50 0.00 0.00 0.00 XXX 1.25 Methylprednisolone injection 125mgJ2940 C 45.56 0.00 0.00 0.00 XXX 1.25 Somatrem injectionJ2941 C 44.06 0.00 0.00 0.00 XXX 1.25 Somatropin inj, 1mgJ2950 C 0.38 0.00 0.00 0.00 XXX 1.25 Promazine hcl inj, 25mgJ2993 C 608.97 0.00 0.00 0.00 XXX 2.50 Reteplase inj, 18.1mgJ2995 C 79.50 0.00 0.00 0.00 XXX 1.25 Inj streptokinase /250000 IUJ2997 C 31.41 0.00 0.00 0.00 XXX 1.25 Alteplase recombinant, 1 mgJ3000 C 5.60 0.00 0.00 0.00 XXX 1.25 Streptomycin inj, 1gJ3010 C 0.30 0.00 0.00 0.00 XXX 1.25 Fentanyl citrate inj, 0.1mgJ3030 C 50.96 0.00 0.00 0.00 XXX 1.25 Sumatriptan succinate / 6 MGJ3070 C 4.51 0.00 0.00 0.00 XXX 1.25 Pentazocine hcl inj, 30mgJ3100 C 522.51 0.00 0.00 0.00 XXX 5.00 Tenecteplase inj, 50mgJ3105 C 5.92 0.00 0.00 0.00 XXX 1.25 Terbutaline sulfate inj, 1mgJ3110 C 7.55 0.00 0.00 0.00 XXX 1.25 Teriparatide injection, 10mcgJ3120 C 7.27 0.00 0.00 0.00 XXX 1.25 Testosterone enanthate inj, 100mgJ3130 C 14.55 0.00 0.00 0.00 XXX 1.25 Testosterone enanthate inj, 200mgJ3140 C 0.56 0.00 0.00 0.00 XXX 1.25 Testosterone suspension inj, 50mgJ3150 C 0.79 0.00 0.00 0.00 XXX 1.25 Testosteron propionate inj, 100mgJ3230 C 3.17 0.00 0.00 0.00 XXX 1.25 Chlorpromazine hcl inj, 50mgJ3240 C 699.28 0.00 0.00 0.00 XXX 1.25 Thyrotropin inj, 0.9mgJ3245 C 471.39 0.00 0.00 0.00 XXX 1.25 12/31/2005 Tirofiban hydrochloride, 12.5mgJ3246 C 7.59 0.00 0.00 0.00 XXX 1.25 Tirofiban hydrochloride, 0.25mgJ3250 C 4.81 0.00 0.00 0.00 XXX 1.25 Trimethobenzamide hcl inj, 200mgJ3260 C 2.02 0.00 0.00 0.00 XXX 1.25 Tobramycin sulfate injection 80mgJ3265 C 2.43 0.00 0.00 0.00 XXX 1.25 Injection torsemide 10 mg/mlJ3280 C 4.76 0.00 0.00 0.00 XXX 1.25 Thiethylperazine maleate inj, 10mgJ3285 C 54.02 0.00 0.00 0.00 XXX 1.25 Treprostinil injection, 1mgJ3301 C 1.39 0.00 0.00 0.00 XXX 1.25 Triamcinolone acetonide inj 10mgJ3302 C 0.77 0.00 0.00 0.00 XXX 1.25 Triamcinolone diacetate inj 5mgJ3303 C 1.68 0.00 0.00 0.00 XXX 1.25 Triamcinolone hexacetonl inj 5mgJ3305 C 146.66 0.00 0.00 0.00 XXX 1.25 Inj trimetrexate glucoronate, 25mgJ3310 C 6.39 0.00 0.00 0.00 XXX 1.25 Perphenazine injeciton, 5mgJ3315 C 305.93 0.00 0.00 0.00 XXX 1.25 Triptorelin pamoate 3.75mgJ3320 C 29.48 0.00 0.00 0.00 XXX 1.25 Spectinomycn di-hcl inj, 2gJ3350 C 75.36 0.00 0.00 0.00 XXX 1.25 Urea injection, 40mgJ3355 C 50.36 0.00 0.00 0.00 XXX 1.25 Urofollitropin, 75 iuJ3360 C 0.80 0.00 0.00 0.00 XXX 1.25 Diazepam inj, 5mgJ3364 C 9.16 0.00 0.00 0.00 XXX 1.25 Urokinase 5000 IU injectionJ3365 C 457.73 0.00 0.00 0.00 XXX 1.25 Urokinase 250,000 IU injJ3370 C 3.12 0.00 0.00 0.00 XXX 1.25 Vancomycin hcl injeciton 500mgJ3395 C 801.56 0.00 0.00 0.00 XXX 2.50 12/31/2005 Verteporfin injection, 15mgJ3396 C 8.94 0.00 0.00 0.00 XXX 1.25 Verteporfin injection, 0.1mgJ3400 C 10.61 0.00 0.00 0.00 XXX 1.25 Triflupromazine hcl inj, 20mgJ3410 C 0.20 0.00 0.00 0.00 XXX 1.25 Hydroxyzine hcl injeciton 25mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J3411 C 1.44 0.00 0.00 0.00 XXX 1.25 Thiamine hcl 100 mgJ3415 C 3.06 0.00 0.00 0.00 XXX 1.25 Pyridoxine hcl 100 mgJ3420 C 0.31 0.00 0.00 0.00 XXX 1.25 Vitamin B-12 inj, 1000mcgJ3430 C 1.86 0.00 0.00 0.00 XXX 1.25 Vitamin K phytonadione inj, 1mgJ3465 C 4.60 0.00 0.00 0.00 XXX 1.25 Injection, voriconazole, 10mgJ3470 C 17.58 0.00 0.00 0.00 XXX 1.25 Hyaluronidase inj, 150uJ3471 C 0.41 0.00 0.00 0.00 XXX 1.25 Ovine, up to 999 USP units, per unitJ3472 C 135.04 0.00 0.00 0.00 XXX 1.25 Ovine, 1000 USP unitsJ3475 C 0.12 0.00 0.00 0.00 XXX 1.25 Inj magnesium sulfate 500mgJ3480 C 0.02 0.00 0.00 0.00 XXX 1.25 Inj potassium chloride /2meqJ3485 C 1.01 0.00 0.00 0.00 XXX 1.25 Zidovudine, 10mgJ3486 C 19.78 0.00 0.00 0.00 XXX 1.25 Ziprasidone mesylate, 10mgJ3487 C 200.45 0.00 0.00 0.00 XXX 1.25 Zoledronic acid, 1 mgJ3490 S 0.00 0.00 0.00 0.00 XXX 0.00 Drugs unclassified injectionJ3520 C 0.00 0.00 0.00 0.00 XXX 0.00 Edetate disodium per 150 mgJ3530 C 0.00 0.00 0.00 0.00 XXX 0.00 Nasal vaccine inhalationJ3535 C 0.00 0.00 0.00 0.00 XXX 0.00 Metered dose inhaler drugJ3570 C 0.00 0.00 0.00 0.00 XXX 0.00 Laetrile amygdalin vit B17J3590 C 0.00 0.00 0.00 0.00 XXX 0.00 Unclassified biologicsJ7030 C 0.90 0.00 0.00 0.00 XXX 1.25 Normal saline solution infus 1000ccJ7040 C 0.46 0.00 0.00 0.00 XXX 1.25 Normal saline solution infus 500ml=1unitJ7042 C 0.36 0.00 0.00 0.00 XXX 1.25 5% dextrose/normal saline, 500mlJ7050 C 0.23 0.00 0.00 0.00 XXX 1.25 Normal saline solution infus, 250ccJ7051 C 0.04 0.00 0.00 0.00 XXX 1.25 12/31/2005 Sterile saline/waterJ7060 C 1.27 0.00 0.00 0.00 XXX 1.25 5% dextrose/water, 500mlJ7070 C 2.31 0.00 0.00 0.00 XXX 1.25 D5w infusion, 1000ccJ7100 C 14.43 0.00 0.00 0.00 XXX 1.25 Dextran 40 infusion, 500mlJ7110 C 8.43 0.00 0.00 0.00 XXX 1.25 Dextran 75 infusion, 500mlJ7120 C 0.88 0.00 0.00 0.00 XXX 1.25 Ringers lactate infusion, 1000ccJ7130 C 1.35 0.00 0.00 0.00 XXX 1.25 Hypertonic saline solution, 20ccJ7188 C 0.87 0.00 0.00 0.00 XXX 1.25 Inj Vonwillebrand factor, 1iuJ7189 C 1.04 0.00 0.00 0.00 XXX 1.25 Factor viia, 1mcgJ7190 C 0.66 0.00 0.00 0.00 XXX 1.25 Factor VIII, 1iuJ7191 C 1.86 0.00 0.00 0.00 XXX 1.25 Factor VIII (porcine), 1iuJ7192 C 1.06 0.00 0.00 0.00 XXX 1.25 Factor VIII recombinant, 1iuJ7193 C 0.89 0.00 0.00 0.00 XXX 1.25 Factor IX non-recombinant, 1iuJ7194 C 0.68 0.00 0.00 0.00 XXX 1.25 Factor IX complex, 1iuJ7195 C 0.99 0.00 0.00 0.00 XXX 1.25 Factor IX recombinant, 1iuJ7197 C 1.66 0.00 0.00 0.00 XXX 1.25 Antithrombin III injection, 1iuJ7198 C 1.30 0.00 0.00 0.00 XXX 1.25 Anti-inhibitor, 1iuJ7199 S 0.00 0.00 0.00 0.00 XXX 0.00 Hemophilia clot factor nocJ7300 D 0.00 0.00 0.00 0.00 XXX 0.00 Intraut copper contraceptiveJ7302 D 0.00 0.00 0.00 0.00 XXX 0.00 Levonorgestrel iu contraceptJ7303 D 0.00 0.00 0.00 0.00 XXX 0.00 Contraceptive vaginal ringJ7304 C 0.00 0.00 0.00 0.00 XXX 0.00 Contraceptive hormone patchJ7306 C 0.00 0.00 0.00 0.00 XXX 0.00 Levonorgestrel implant sysJ7308 C 101.83 0.00 0.00 0.00 XXX 1.25 Aminolevulinic acid hcl top, 354mgJ7310 C 706.67 0.00 0.00 0.00 XXX 7.50 Ganciclovir long act implant, 4.5mgJ7317 C 111.44 0.00 0.00 0.00 XXX 1.25 Sodium hyaluronate injection, 20-25 mgJ7320 C 199.26 0.00 0.00 0.00 XXX 1.25 Hylan G-F 20 injection, 16mgJ7330 C 859.12 0.00 0.00 0.00 XXX 25.00 Cultured chondrocytes implnt, ea.J7340 C 27.39 0.00 0.00 0.00 XXX 1.25 Metabolic active D/E tissue, 1 sq cmJ7341 C 0.06 0.00 0.00 0.00 XXX 1.25 Non-human, metabolic tissue, 1 sq cmJ7342 C 15.38 0.00 0.00 0.00 XXX 1.25 Metabolically active tissue, 1 sq cm
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J7343 C 14.64 0.00 0.00 0.00 XXX 1.25 Nonmetabolic act d/e tissue, 1 sq cmJ7344 C 62.86 0.00 0.00 0.00 XXX 1.25 Nonmetabolic active tissue, 1 sq cmJ7350 C 4.11 0.00 0.00 0.00 XXX 1.25 Injectable human tissue, 10mgJ7500 C 0.13 0.00 0.00 0.00 XXX 1.25 Azathioprine oral, 50mgJ7501 C 49.31 0.00 0.00 0.00 XXX 1.25 Azathioprine parenteral, 100mgJ7502 C 3.48 0.00 0.00 0.00 XXX 1.25 Cyclosporine oral, 100 mgJ7504 C 299.24 0.00 0.00 0.00 XXX 1.25 Lymphocyte immune globulin, 250mgJ7505 C 863.21 0.00 0.00 0.00 XXX 1.25 Monoclonal antibodies, 5mgJ7506 C 0.22 0.00 0.00 0.00 XXX 1.25 Prednisone oral, 5mgJ7507 C 3.45 0.00 0.00 0.00 XXX 1.25 Tacrolimus oral per 1 MGJ7509 C 0.09 0.00 0.00 0.00 XXX 1.25 Methylprednisolone oral, 4mgJ7510 C 0.07 0.00 0.00 0.00 XXX 1.25 Prednisolone oral per 5 mgJ7511 C 301.89 0.00 0.00 0.00 XXX 1.25 Antithymocyte globuln rabbit, 25mgJ7513 C 357.78 0.00 0.00 0.00 XXX 1.25 Daclizumab, parenteral, 25mgJ7515 C 0.94 0.00 0.00 0.00 XXX 1.25 Cyclosporine oral 25 mgJ7516 C 19.17 0.00 0.00 0.00 XXX 1.25 Cyclosporin parenteral 250mgJ7517 C 2.53 0.00 0.00 0.00 XXX 1.25 Mycophenolate mofetil oral, 250mgJ7518 C 2.17 0.00 0.00 0.00 XXX 1.25 Mycophenolic acid, oral, 180mgJ7520 C 6.92 0.00 0.00 0.00 XXX 1.25 Sirolimus, oral, 1mgJ7525 C 136.92 0.00 0.00 0.00 XXX 1.25 Tacrolimus injection, 5mgJ7599 S 0.00 0.00 0.00 0.00 XXX 0.00 Immunosuppressive drug nocJ7608 C 2.60 0.00 0.00 0.00 XXX 1.25 Acetylcysteine inh sol u d, 1gJ7611 C 0.08 0.00 0.00 0.00 XXX 1.25 Albuterol concentrated form, 1mgJ7612 C 0.99 0.00 0.00 0.00 XXX 1.25 Levalbuterol concentrated, 0.5mgJ7613 C 0.06 0.00 0.00 0.00 XXX 1.25 Albuterol unit dose, 1mgJ7614 C 1.34 0.00 0.00 0.00 XXX 1.25 Levalbuterol unit dose, 0.5mgJ7616 C 2.31 0.00 0.00 0.00 XXX 1.25 12/31/2005 Albuterol compound solution, 1uJ7617 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Levalbuterol compounded solJ7618 C 0.12 0.00 0.00 0.00 XXX 1.25 12/31/2005 Albuterol inh sol conJ7619 C 0.41 0.00 0.00 0.00 XXX 1.25 12/31/2005 Albuterol inh sol u dJ7620 C 2.05 0.00 0.00 0.00 XXX 1.25 Albuterol non-compounded, 1unitJ7621 C 3.40 0.00 0.00 0.00 XXX 1.25 12/31/2005 (Levo)albuterol/Ipra-bromideJ7622 C 0.04 0.00 0.00 0.00 XXX 1.25 Beclomethasone inhalatn sol, 1mgJ7624 C 1.21 0.00 0.00 0.00 XXX 1.25 Betamethasone inhalation sol, 1mgJ7626 C 4.41 0.00 0.00 0.00 XXX 1.25 Budesonide inhalation sol, 0.5mgJ7627 C 0.00 0.00 0.00 0.00 XXX 0.00 Budesonide, compoundedJ7628 C 0.00 0.00 0.00 0.00 XXX 0.00 Bitolterol mes inhal sol conJ7629 C 0.00 0.00 0.00 0.00 XXX 0.00 Bitolterol mes inh sol u dJ7631 C 0.06 0.00 0.00 0.00 XXX 1.25 Cromolyn sodium inh sol u d, 10mgJ7633 C 0.02 0.00 0.00 0.00 XXX 1.25 Budesonide concentrated sol, 0.25mgJ7635 C 0.12 0.00 0.00 0.00 XXX 1.25 Atropine inhal sol con, 1mgJ7636 C 0.12 0.00 0.00 0.00 XXX 1.25 Atropine inhal sol unit dose, 1mgJ7637 C 0.10 0.00 0.00 0.00 XXX 1.25 Dexamethasone inhal sol con, 1mgJ7638 C 0.12 0.00 0.00 0.00 XXX 1.25 Dexamethasone inhal sol u d, 1mgJ7639 C 18.65 0.00 0.00 0.00 XXX 1.25 Dornase alpha inhal sol u d, 1mgJ7640 C 0.00 0.00 0.00 0.00 XXX 0.00 Formoterol injection, 12mcgJ7641 C 0.21 0.00 0.00 0.00 XXX 1.25 Flunisolide, inhalation sol, 1mgJ7642 C 1.19 0.00 0.00 0.00 XXX 1.25 Glycopyrrolate inhal sol con, 1mgJ7643 C 1.19 0.00 0.00 0.00 XXX 1.25 Glycopyrrolate inhal sol u d, 1mgJ7644 C 0.23 0.00 0.00 0.00 XXX 1.25 Ipratropium brom inh sol u d, 1mgJ7648 C 0.00 0.00 0.00 0.00 XXX 0.00 Isoetharine hcl inh sol conJ7649 C 0.16 0.00 0.00 0.00 XXX 1.25 Isoetharine hcl inh sol u d, 1mgJ7658 C 6.51 0.00 0.00 0.00 XXX 1.25 Isoproterenolhcl inh sol conJ7659 C 6.56 0.00 0.00 0.00 XXX 1.25 Isoproterenol hcl inh sol ud
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J7668 C 1.07 0.00 0.00 0.00 XXX 1.25 Metaproterenol inh sol con, 10mgJ7669 C 0.23 0.00 0.00 0.00 XXX 1.25 Metaproterenol inh sol u d, 10mgJ7674 C 0.39 0.00 0.00 0.00 XXX 1.25 Methacholine chloride, neb, 1mgJ7680 C 26.30 0.00 0.00 0.00 XXX 1.25 Terbutaline so4 inh sol con, 1mgJ7681 C 0.01 0.00 0.00 0.00 XXX 1.25 Terbutaline so4 inh sol u d, 1mgJ7682 C 52.46 0.00 0.00 0.00 XXX 1.25 Tobramycin inhalation sol, 300mgJ7683 C 0.10 0.00 0.00 0.00 XXX 1.25 Triamcinolone inh sol conJ7684 C 0.17 0.00 0.00 0.00 XXX 1.25 Triamcinolone inh sol u dJ7699 C 0.00 0.00 0.00 0.00 XXX 0.00 Inhalation solution for DMEJ7799 C 0.00 0.00 0.00 0.00 XXX 0.00 Non-inhalation drug for DMEJ8498 C 0.00 0.00 0.00 0.00 XXX 0.00 Antiemetic rectal/supp NOSJ8499 S 0.00 0.00 0.00 0.00 XXX 0.00 Oral prescrip drug non chemoJ8501 C 4.64 0.00 0.00 0.00 XXX 1.25 Aprepitant, oral, 5mgJ8510 C 1.97 0.00 0.00 0.00 XXX 1.25 Oral busulfan, 2mgJ8515 C 15.97 0.00 0.00 0.00 XXX 1.25 Cabergoline, oral 0.25mgJ8520 C 3.64 0.00 0.00 0.00 XXX 1.25 Capecitabine, oral, 150 mgJ8521 C 12.08 0.00 0.00 0.00 XXX 1.25 Capecitabine, oral, 500 mgJ8530 C 0.95 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide oral 25mgJ8540 C 0.07 0.00 0.00 0.00 XXX 1.25 Oral dexamethasone, 0.25mgJ8560 C 32.17 0.00 0.00 0.00 XXX 1.25 Etoposide oral 50 MGJ8565 C 0.00 0.00 0.00 0.00 XXX 0.00 Gefitinib, oral, 250mgJ8597 C 0.00 0.00 0.00 0.00 XXX 0.00 Antiemetic drug oral NOSJ8600 C 2.32 0.00 0.00 0.00 XXX 1.25 Melphalan oral 2 MGJ8610 C 0.28 0.00 0.00 0.00 XXX 1.25 Methotrexate oral 2.5 MGJ8700 C 7.23 0.00 0.00 0.00 XXX 1.25 Temozolmide, 2.5mgJ8999 C 0.00 0.00 0.00 0.00 XXX 0.00 Oral prescription drug chemoJ9000 C 5.93 0.00 0.00 0.00 XXX 1.25 Doxorubic hcl 10 MG vl chemoJ9001 C 370.09 0.00 0.00 0.00 XXX 1.25 Doxorubicin hcl liposome inj 10mgJ9010 C 518.58 0.00 0.00 0.00 XXX 1.25 Alemtuzumab injection 10 mgJ9015 C 731.38 0.00 0.00 0.00 XXX 1.25 Aldesleukin/single use vial, eaJ9017 C 32.96 0.00 0.00 0.00 XXX 1.25 Arsenic trioxide, 1mgJ9020 C 54.18 0.00 0.00 0.00 XXX 1.25 Asparaginase inj, 10000uJ9025 C 4.06 0.00 0.00 0.00 XXX 1.25 Azacitidine injection, 1mgJ9027 C 116.71 0.00 0.00 0.00 XXX 1.25 Clofarabine injection, 1mgJ9031 C 115.09 0.00 0.00 0.00 XXX 1.25 Bcg live intravesical vac, eaJ9035 C 56.98 0.00 0.00 0.00 XXX 1.25 Bevacizumab injection, 10mgJ9040 C 44.94 0.00 0.00 0.00 XXX 1.25 Bleomycin sulfate injection 15uJ9041 C 30.12 0.00 0.00 0.00 XXX 1.25 Bortezomib injection, 0.1mgJ9045 C 17.09 0.00 0.00 0.00 XXX 1.25 Carboplatin injection 50mgJ9050 C 140.11 0.00 0.00 0.00 XXX 1.25 Carmus bischl nitro inj 100mgJ9055 C 49.86 0.00 0.00 0.00 XXX 1.25 Cetuximab injection, 10mgJ9060 C 1.63 0.00 0.00 0.00 XXX 1.25 Cisplatin 10mg injectionJ9062 C 11.01 0.00 0.00 0.00 XXX 1.25 Cisplatin 50mg injectionJ9065 C 38.14 0.00 0.00 0.00 XXX 1.25 Inj cladribine per 1 MGJ9070 C 2.02 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide 100mg injJ9080 C 4.05 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide 200mg injJ9090 C 15.41 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide 500mg injJ9091 C 20.22 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide 1.0 grm injJ9092 C 40.46 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide 2.0 grm injJ9093 C 0.36 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide lyophilized 100mgJ9094 C 0.73 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide lyophilized 200mgJ9095 C 1.82 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide lyophilized 500mgJ9096 C 3.63 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide lyophilized 1 gJ9097 C 7.27 0.00 0.00 0.00 XXX 1.25 Cyclophosphamide lyophilized 2 g
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J9098 C 378.81 0.00 0.00 0.00 XXX 1.25 Cytarabine liposome 10mgJ9100 C 1.55 0.00 0.00 0.00 XXX 1.25 Cytarabine hcl 100mg injJ9110 C 7.76 0.00 0.00 0.00 XXX 1.25 Cytarabine hcl 500mg injJ9120 C 12.63 0.00 0.00 0.00 XXX 1.25 Dactinomycin actinomycin d, 0.5mgJ9130 C 5.16 0.00 0.00 0.00 XXX 1.25 Dacarbazine 100mg injJ9140 C 10.33 0.00 0.00 0.00 XXX 1.25 Dacarbazine 200mg injJ9150 C 24.05 0.00 0.00 0.00 XXX 1.25 Daunorubicin 10mgJ9151 C 56.25 0.00 0.00 0.00 XXX 1.25 Daunorubicin citrate liposom, 10mgJ9160 C 705.20 0.00 0.00 0.00 XXX 2.50 Denileukin diftitox, 300 mcgJ9165 C 14.41 0.00 0.00 0.00 XXX 1.25 Diethylstilbestrol injectionJ9170 C 294.95 0.00 0.00 0.00 XXX 1.25 Docetaxel 20mgJ9175 C 3.73 0.00 0.00 0.00 XXX 1.25 Elliotts b solution, 1mlJ9178 C 24.65 0.00 0.00 0.00 XXX 1.25 Inj, epirubicin hcl, 2 mgJ9180 C 711.71 0.00 0.00 0.00 XXX 1.25 12/31/2005 Epirubicin HCl inj, 50mgJ9181 C 0.50 0.00 0.00 0.00 XXX 1.25 Etoposide 10mg injJ9182 C 4.98 0.00 0.00 0.00 XXX 1.25 Etoposide 100mg injJ9185 C 253.51 0.00 0.00 0.00 XXX 1.25 Fludarabine phosphate inj 50mgJ9190 C 1.51 0.00 0.00 0.00 XXX 1.25 Fluorouracil inj, 500mgJ9200 C 60.81 0.00 0.00 0.00 XXX 1.25 Floxuridine inj, 500mgJ9201 C 117.29 0.00 0.00 0.00 XXX 1.25 Gemcitabine HCl 200mgJ9202 C 196.69 0.00 0.00 0.00 XXX 1.25 Goserelin acetate implant 3.6mgJ9206 C 126.43 0.00 0.00 0.00 XXX 1.25 Irinotecan inj, 20mgJ9208 C 33.56 0.00 0.00 0.00 XXX 1.25 Ifosfomide inj, 1 gmJ9209 C 9.49 0.00 0.00 0.00 XXX 1.25 Mesna inj, 200mgJ9211 C 312.23 0.00 0.00 0.00 XXX 1.25 Idarubicin hcl inj, 5mgJ9212 C 3.92 0.00 0.00 0.00 XXX 1.25 Interferon alfacon-1, 1mcgJ9213 C 33.38 0.00 0.00 0.00 XXX 1.25 Interferon alfa-2a inj, 3mil uJ9214 C 13.47 0.00 0.00 0.00 XXX 1.25 Interferon alfa-2b inj, 1mil uJ9215 C 8.60 0.00 0.00 0.00 XXX 1.25 Interferon alfa-n3 inj, 250000 IUJ9216 C 289.87 0.00 0.00 0.00 XXX 1.25 Interferon gamma 1-b inj, 3mil uJ9217 C 236.13 0.00 0.00 0.00 XXX 1.25 Leuprolide acetate suspnsion, 7.5mgJ9218 C 9.86 0.00 0.00 0.00 XXX 1.25 Leuprolide acetate inj, 1mgJ9219 C 561.70 0.00 0.00 0.00 XXX 5.00 Leuprolide acetate implant 65mgJ9225 C 631.05 0.00 0.00 0.00 XXX 5.00 Histrelin implant, 50mgJ9230 C 11.21 0.00 0.00 0.00 XXX 1.25 Mechlorethamine hcl inj, 10mgJ9245 C 540.55 0.00 0.00 0.00 XXX 2.50 Inj melphalan hydrochl, 50mgJ9250 C 0.18 0.00 0.00 0.00 XXX 1.25 Methotrexate sodium inj, 5mgJ9260 C 1.85 0.00 0.00 0.00 XXX 1.25 Methotrexate sodium inj, 50mgJ9263 C 8.52 0.00 0.00 0.00 XXX 1.25 Oxaliplatin, 0.5 mgJ9264 C 8.34 0.00 0.00 0.00 XXX 1.25 Paclitaxel injection, 1mgJ9265 C 15.10 0.00 0.00 0.00 XXX 1.25 Paclitaxel inj, 30mgJ9266 C 805.60 0.00 0.00 0.00 XXX 2.50 Pegaspargase/singl dose vial, eaJ9268 C 973.29 0.00 0.00 0.00 XXX 2.50 Pentostatin inj, 10mgJ9270 C 93.80 0.00 0.00 0.00 XXX 1.25 Plicamycin (mithramycin) injJ9280 C 19.69 0.00 0.00 0.00 XXX 1.25 Mitomycin 5mg injJ9290 C 78.75 0.00 0.00 0.00 XXX 1.25 Mitomycin 20mg injJ9291 C 157.49 0.00 0.00 0.00 XXX 1.25 Mitomycin 40mg injJ9293 C 338.69 0.00 0.00 0.00 XXX 1.25 Mitoxantrone hydrochl / 5mgJ9300 C 573.16 0.00 0.00 0.00 XXX 5.00 Gemtuzumab ozogamicin, 5mgJ9305 C 41.30 0.00 0.00 0.00 XXX 1.25 Pemetrexed inj, 10mgJ9310 C 462.90 0.00 0.00 0.00 XXX 1.25 Rituximab cancer treatment, 100mgJ9320 C 152.39 0.00 0.00 0.00 XXX 1.25 Streptozocin inj, 1 gmJ9340 C 45.10 0.00 0.00 0.00 XXX 1.25 Thiotepa inj, 15mgJ9350 C 775.11 0.00 0.00 0.00 XXX 1.25 Topotecan, 4 mg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
J9355 C 55.18 0.00 0.00 0.00 XXX 1.25 Trastuzumab, 10mgJ9357 C 369.60 0.00 0.00 0.00 XXX 1.25 Valrubicin, 200 mgJ9360 C 0.79 0.00 0.00 0.00 XXX 1.25 Vinblastine sulfate inj, 1 mgJ9370 C 4.43 0.00 0.00 0.00 XXX 1.25 Vincristine sulfate 1 mg injJ9375 C 8.85 0.00 0.00 0.00 XXX 1.25 Vincristine sulfate 2 mg injJ9380 C 22.13 0.00 0.00 0.00 XXX 1.25 Vincristine sulfate 5 mg injJ9390 C 38.35 0.00 0.00 0.00 XXX 1.25 Vinorelbine tartrate/10 mgJ9395 C 81.42 0.00 0.00 0.00 XXX 1.25 Injection, Fulvestrant, 25mgJ9600 C 613.28 0.00 0.00 0.00 XXX 5.00 Porfimer sodium, 75mgJ9999 S 0.00 0.00 0.00 0.00 XXX 0.00 Chemotherapy drugK0001 C 66.59 0.00 0.00 0.00 XXX 1.25 Standard wheelchairK0001 C NU 665.90 0.00 0.00 0.00 XXX 1.25 Standard wheelchairK0001 C RR 66.59 0.00 0.00 0.00 XXX 1.25 Standard wheelchairK0001 C UE 499.43 0.00 0.00 0.00 XXX 1.25 Standard wheelchairK0002 C 129.80 0.00 0.00 0.00 XXX 1.25 Stnd hemi (low seat) whlchrK0002 C NU 649.00 0.00 0.00 0.00 XXX 2.50 Stnd hemi (low seat) whlchrK0002 C RR 129.80 0.00 0.00 0.00 XXX 1.25 Stnd hemi (low seat) whlchrK0002 C UE 973.50 0.00 0.00 0.00 XXX 1.25 Stnd hemi (low seat) whlchrK0003 C 161.00 0.00 0.00 0.00 XXX 1.25 Lightweight wheelchairK0003 C NU 805.00 0.00 0.00 0.00 XXX 2.50 Lightweight wheelchairK0003 C RR 161.00 0.00 0.00 0.00 XXX 1.25 Lightweight wheelchairK0003 C UE 603.75 0.00 0.00 0.00 XXX 2.50 Lightweight wheelchairK0004 C 236.74 0.00 0.00 0.00 XXX 1.25 High strength ltwt whlchrK0004 C NU 591.85 0.00 0.00 0.00 XXX 5.00 High strength ltwt whlchrK0004 C RR 236.74 0.00 0.00 0.00 XXX 1.25 High strength ltwt whlchrK0004 C UE 887.78 0.00 0.00 0.00 XXX 2.50 High strength ltwt whlchrK0005 C 231.94 0.00 0.00 0.00 XXX 1.25 Ultralightweight wheelchairK0005 C NU 613.52 0.00 0.00 0.00 XXX 5.00 Ultralightweight wheelchairK0005 C RR 231.94 0.00 0.00 0.00 XXX 1.25 Ultralightweight wheelchairK0005 C UE 920.28 0.00 0.00 0.00 XXX 2.50 Ultralightweight wheelchairK0006 C 221.10 0.00 0.00 0.00 XXX 1.25 Heavy duty wheelchairK0006 C NU 552.75 0.00 0.00 0.00 XXX 5.00 Heavy duty wheelchairK0006 C RR 221.10 0.00 0.00 0.00 XXX 1.25 Heavy duty wheelchairK0006 C UE 829.13 0.00 0.00 0.00 XXX 2.50 Heavy duty wheelchairK0007 C 265.25 0.00 0.00 0.00 XXX 1.25 Extra heavy duty wheelchairK0007 C NU 663.13 0.00 0.00 0.00 XXX 5.00 Extra heavy duty wheelchairK0007 C RR 265.25 0.00 0.00 0.00 XXX 1.25 Extra heavy duty wheelchairK0007 C UE 994.69 0.00 0.00 0.00 XXX 2.50 Extra heavy duty wheelchairK0009 C 0.00 0.00 0.00 0.00 XXX 0.00 Other manual wheelchair/baseK0010 C 501.90 0.00 0.00 0.00 XXX 2.50 Stnd wt frame power whlchrK0010 C NU 836.49 0.00 0.00 0.00 XXX 15.00 Stnd wt frame power whlchrK0010 C RR 501.90 0.00 0.00 0.00 XXX 2.50 Stnd wt frame power whlchrK0010 C UE 941.05 0.00 0.00 0.00 XXX 10.00 Stnd wt frame power whlchrK0011 C 692.28 0.00 0.00 0.00 XXX 1.25 Stnd wt pwr whlchr w controlK0011 C NU 865.35 0.00 0.00 0.00 XXX 10.00 Stnd wt pwr whlchr w controlK0011 C RR 692.28 0.00 0.00 0.00 XXX 1.25 Stnd wt pwr whlchr w controlK0011 C UE 649.01 0.00 0.00 0.00 XXX 10.00 Stnd wt pwr whlchr w controlK0012 C 476.30 0.00 0.00 0.00 XXX 1.25 Ltwt portbl power whlchrK0012 C NU 793.83 0.00 0.00 0.00 XXX 7.50 Ltwt portbl power whlchrK0012 C RR 476.30 0.00 0.00 0.00 XXX 1.25 Ltwt portbl power whlchrK0012 C UE 893.06 0.00 0.00 0.00 XXX 5.00 Ltwt portbl power whlchrK0014 C 0.00 0.00 0.00 0.00 XXX 0.00 Other power whlchr baseK0015 C 27.26 0.00 0.00 0.00 XXX 1.25 Detach non-adjus hght armrstK0015 C NU 272.54 0.00 0.00 0.00 XXX 1.25 Detach non-adjus hght armrst
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
K0015 C RR 27.26 0.00 0.00 0.00 XXX 1.25 Detach non-adjus hght armrstK0015 C UE 204.42 0.00 0.00 0.00 XXX 1.25 Detach non-adjus hght armrstK0017 C 7.67 0.00 0.00 0.00 XXX 1.25 Detach adjust armrest baseK0017 C NU 76.65 0.00 0.00 0.00 XXX 1.25 Detach adjust armrest baseK0017 C RR 7.67 0.00 0.00 0.00 XXX 1.25 Detach adjust armrest baseK0017 C UE 57.47 0.00 0.00 0.00 XXX 1.25 Detach adjust armrest baseK0018 C 4.30 0.00 0.00 0.00 XXX 1.25 Detach adjust armrst upperK0018 C NU 42.84 0.00 0.00 0.00 XXX 1.25 Detach adjust armrst upperK0018 C RR 4.30 0.00 0.00 0.00 XXX 1.25 Detach adjust armrst upperK0018 C UE 32.13 0.00 0.00 0.00 XXX 1.25 Detach adjust armrst upperK0019 C 3.22 0.00 0.00 0.00 XXX 1.25 Arm pad eachK0019 C NU 32.00 0.00 0.00 0.00 XXX 1.25 Arm pad eachK0019 C RR 3.22 0.00 0.00 0.00 XXX 1.25 Arm pad eachK0019 C UE 24.00 0.00 0.00 0.00 XXX 1.25 Arm pad eachK0020 C 6.95 0.00 0.00 0.00 XXX 1.25 Fixed adjust armrest pairK0020 C NU 69.69 0.00 0.00 0.00 XXX 1.25 Fixed adjust armrest pairK0020 C RR 6.95 0.00 0.00 0.00 XXX 1.25 Fixed adjust armrest pairK0020 C UE 52.30 0.00 0.00 0.00 XXX 1.25 Fixed adjust armrest pairK0037 C 26.25 0.00 0.00 0.00 XXX 1.25 High mount flip-up footrestK0037 C NU 262.34 0.00 0.00 0.00 XXX 1.25 High mount flip-up footrestK0037 C RR 26.25 0.00 0.00 0.00 XXX 1.25 High mount flip-up footrestK0037 C UE 196.76 0.00 0.00 0.00 XXX 1.25 High mount flip-up footrestK0038 C 3.63 0.00 0.00 0.00 XXX 1.25 Leg strap eachK0038 C NU 36.42 0.00 0.00 0.00 XXX 1.25 Leg strap eachK0038 C RR 3.63 0.00 0.00 0.00 XXX 1.25 Leg strap eachK0038 C UE 27.30 0.00 0.00 0.00 XXX 1.25 Leg strap eachK0039 C 8.09 0.00 0.00 0.00 XXX 1.25 Leg strap h style eachK0039 C NU 80.84 0.00 0.00 0.00 XXX 1.25 Leg strap h style eachK0039 C RR 8.09 0.00 0.00 0.00 XXX 1.25 Leg strap h style eachK0039 C UE 60.64 0.00 0.00 0.00 XXX 1.25 Leg strap h style eachK0040 C 11.21 0.00 0.00 0.00 XXX 1.25 Adjustable angle footplateK0040 C NU 111.99 0.00 0.00 0.00 XXX 1.25 Adjustable angle footplateK0040 C RR 11.21 0.00 0.00 0.00 XXX 1.25 Adjustable angle footplateK0040 C UE 84.00 0.00 0.00 0.00 XXX 1.25 Adjustable angle footplateK0041 C 7.93 0.00 0.00 0.00 XXX 1.25 Large size footplate eachK0041 C NU 79.40 0.00 0.00 0.00 XXX 1.25 Large size footplate eachK0041 C RR 7.93 0.00 0.00 0.00 XXX 1.25 Large size footplate eachK0041 C UE 59.56 0.00 0.00 0.00 XXX 1.25 Large size footplate eachK0042 C 10.76 0.00 0.00 0.00 XXX 1.25 Standard size footplate eachK0042 C NU 86.23 0.00 0.00 0.00 XXX 1.25 Standard size footplate eachK0042 C RR 10.76 0.00 0.00 0.00 XXX 1.25 Standard size footplate eachK0042 C UE 64.68 0.00 0.00 0.00 XXX 1.25 Standard size footplate eachK0043 C 2.92 0.00 0.00 0.00 XXX 1.25 Ftrst lower extension tubeK0043 C NU 29.28 0.00 0.00 0.00 XXX 1.25 Ftrst lower extension tubeK0043 C RR 2.92 0.00 0.00 0.00 XXX 1.25 Ftrst lower extension tubeK0043 C UE 21.96 0.00 0.00 0.00 XXX 1.25 Ftrst lower extension tubeK0044 C 2.49 0.00 0.00 0.00 XXX 1.25 Ftrst upper hanger bracketK0044 C NU 24.95 0.00 0.00 0.00 XXX 1.25 Ftrst upper hanger bracketK0044 C RR 2.49 0.00 0.00 0.00 XXX 1.25 Ftrst upper hanger bracketK0044 C UE 18.70 0.00 0.00 0.00 XXX 1.25 Ftrst upper hanger bracketK0045 C 26.25 0.00 0.00 0.00 XXX 1.25 Footrest complete assemblyK0045 C NU 262.34 0.00 0.00 0.00 XXX 1.25 Footrest complete assemblyK0045 C RR 26.25 0.00 0.00 0.00 XXX 1.25 Footrest complete assemblyK0045 C UE 197.25 0.00 0.00 0.00 XXX 1.25 Footrest complete assembly
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
K0046 C 2.92 0.00 0.00 0.00 XXX 1.25 Elevat legrst low extensionK0046 C NU 29.28 0.00 0.00 0.00 XXX 1.25 Elevat legrst low extensionK0046 C RR 2.92 0.00 0.00 0.00 XXX 1.25 Elevat legrst low extensionK0046 C UE 21.96 0.00 0.00 0.00 XXX 1.25 Elevat legrst low extensionK0047 C 11.46 0.00 0.00 0.00 XXX 1.25 Elevat legrst up hangr brackK0047 C NU 114.71 0.00 0.00 0.00 XXX 1.25 Elevat legrst up hangr brackK0047 C RR 11.46 0.00 0.00 0.00 XXX 1.25 Elevat legrst up hangr brackK0047 C UE 86.04 0.00 0.00 0.00 XXX 1.25 Elevat legrst up hangr brackK0050 C 4.89 0.00 0.00 0.00 XXX 1.25 Ratchet assemblyK0050 C NU 48.75 0.00 0.00 0.00 XXX 1.25 Ratchet assemblyK0050 C RR 4.89 0.00 0.00 0.00 XXX 1.25 Ratchet assemblyK0050 C UE 36.58 0.00 0.00 0.00 XXX 1.25 Ratchet assemblyK0051 C 7.89 0.00 0.00 0.00 XXX 1.25 Cam relese assem ftrst/lgrstK0051 C NU 78.91 0.00 0.00 0.00 XXX 1.25 Cam relese assem ftrst/lgrstK0051 C RR 7.89 0.00 0.00 0.00 XXX 1.25 Cam relese assem ftrst/lgrstK0051 C UE 59.18 0.00 0.00 0.00 XXX 1.25 Cam relese assem ftrst/lgrstK0052 C 13.86 0.00 0.00 0.00 XXX 1.25 Swingaway detach footrestK0052 C NU 138.66 0.00 0.00 0.00 XXX 1.25 Swingaway detach footrestK0052 C RR 13.86 0.00 0.00 0.00 XXX 1.25 Swingaway detach footrestK0052 C UE 104.01 0.00 0.00 0.00 XXX 1.25 Swingaway detach footrestK0053 C 15.29 0.00 0.00 0.00 XXX 1.25 Elevate footrest articulateK0053 C NU 153.01 0.00 0.00 0.00 XXX 1.25 Elevate footrest articulateK0053 C RR 15.29 0.00 0.00 0.00 XXX 1.25 Elevate footrest articulateK0053 C UE 114.77 0.00 0.00 0.00 XXX 1.25 Elevate footrest articulateK0056 C 14.25 0.00 0.00 0.00 XXX 1.25 Seat ht <17 or >=21 ltwt wcK0056 C NU 142.65 0.00 0.00 0.00 XXX 1.25 Seat ht <17 or >=21 ltwt wcK0056 C RR 14.25 0.00 0.00 0.00 XXX 1.25 Seat ht <17 or >=21 ltwt wcK0056 C UE 106.98 0.00 0.00 0.00 XXX 1.25 Seat ht <17 or >=21 ltwt wcK0064 C 4.56 0.00 0.00 0.00 XXX 1.25 12/31/2005 Zero pressure tube flat freeK0064 C NU 45.60 0.00 0.00 0.00 XXX 1.25 12/31/2005 Zero pressure tube flat freeK0064 C RR 4.56 0.00 0.00 0.00 XXX 1.25 12/31/2005 Zero pressure tube flat freeK0064 C UE 34.20 0.00 0.00 0.00 XXX 1.25 12/31/2005 Zero pressure tube flat freeK0065 C 6.69 0.00 0.00 0.00 XXX 1.25 Spoke protectorsK0065 C NU 66.69 0.00 0.00 0.00 XXX 1.25 Spoke protectorsK0065 C RR 6.69 0.00 0.00 0.00 XXX 1.25 Spoke protectorsK0065 C UE 50.01 0.00 0.00 0.00 XXX 1.25 Spoke protectorsK0066 C 5.56 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid tire any size eachK0066 C NU 45.12 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid tire any size eachK0066 C RR 5.56 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid tire any size eachK0066 C UE 61.11 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid tire any size eachK0067 C 8.22 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire any size eachK0067 C NU 82.33 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire any size eachK0067 C RR 8.22 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire any size eachK0067 C UE 61.75 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire any size eachK0068 C 0.90 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire tube eachK0068 C NU 8.82 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire tube eachK0068 C RR 0.90 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire tube eachK0068 C UE 6.63 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic tire tube eachK0069 C 14.97 0.00 0.00 0.00 XXX 1.25 Rear whl complete solid tireK0069 C NU 149.84 0.00 0.00 0.00 XXX 1.25 Rear whl complete solid tireK0069 C RR 14.97 0.00 0.00 0.00 XXX 1.25 Rear whl complete solid tireK0069 C UE 112.41 0.00 0.00 0.00 XXX 1.25 Rear whl complete solid tireK0070 C 27.47 0.00 0.00 0.00 XXX 1.25 Rear whl compl pneum tireK0070 C NU 274.75 0.00 0.00 0.00 XXX 1.25 Rear whl compl pneum tire
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
K0070 C RR 27.47 0.00 0.00 0.00 XXX 1.25 Rear whl compl pneum tireK0070 C UE 206.04 0.00 0.00 0.00 XXX 1.25 Rear whl compl pneum tireK0071 C 16.39 0.00 0.00 0.00 XXX 1.25 Front castr compl pneum tireK0071 C NU 163.88 0.00 0.00 0.00 XXX 1.25 Front castr compl pneum tireK0071 C RR 16.39 0.00 0.00 0.00 XXX 1.25 Front castr compl pneum tireK0071 C UE 122.89 0.00 0.00 0.00 XXX 1.25 Front castr compl pneum tireK0072 C 9.85 0.00 0.00 0.00 XXX 1.25 Frnt cstr cmpl sem-pneum tirK0072 C NU 98.63 0.00 0.00 0.00 XXX 1.25 Frnt cstr cmpl sem-pneum tirK0072 C RR 9.85 0.00 0.00 0.00 XXX 1.25 Frnt cstr cmpl sem-pneum tirK0072 C UE 74.00 0.00 0.00 0.00 XXX 1.25 Frnt cstr cmpl sem-pneum tirK0073 C 5.01 0.00 0.00 0.00 XXX 1.25 Caster pin lock eachK0073 C NU 50.21 0.00 0.00 0.00 XXX 1.25 Caster pin lock eachK0073 C RR 5.01 0.00 0.00 0.00 XXX 1.25 Caster pin lock eachK0073 C UE 37.64 0.00 0.00 0.00 XXX 1.25 Caster pin lock eachK0074 C 6.20 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire eachK0074 C NU 61.93 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire eachK0074 C RR 6.20 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire eachK0074 C UE 46.44 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire eachK0075 C 12.32 0.00 0.00 0.00 XXX 1.25 12/31/2005 Semi-pneumatic caster tireK0075 C NU 123.04 0.00 0.00 0.00 XXX 1.25 12/31/2005 Semi-pneumatic caster tireK0075 C RR 12.32 0.00 0.00 0.00 XXX 1.25 12/31/2005 Semi-pneumatic caster tireK0075 C UE 92.25 0.00 0.00 0.00 XXX 1.25 12/31/2005 Semi-pneumatic caster tireK0076 C 3.84 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid caster tire eachK0076 C NU 38.34 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid caster tire eachK0076 C RR 3.84 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid caster tire eachK0076 C UE 28.75 0.00 0.00 0.00 XXX 1.25 12/31/2005 Solid caster tire eachK0077 C 8.82 0.00 0.00 0.00 XXX 1.25 Front caster assem completeK0077 C NU 88.25 0.00 0.00 0.00 XXX 1.25 Front caster assem completeK0077 C RR 8.82 0.00 0.00 0.00 XXX 1.25 Front caster assem completeK0077 C UE 66.20 0.00 0.00 0.00 XXX 1.25 Front caster assem completeK0078 C 1.45 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire tubeK0078 C NU 14.40 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire tubeK0078 C RR 1.45 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire tubeK0078 C UE 10.76 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pneumatic caster tire tubeK0090 C 11.44 0.00 0.00 0.00 XXX 1.25 Rear tire power wheelchairK0090 C NU 114.29 0.00 0.00 0.00 XXX 1.25 Rear tire power wheelchairK0090 C RR 11.44 0.00 0.00 0.00 XXX 1.25 Rear tire power wheelchairK0090 C UE 85.74 0.00 0.00 0.00 XXX 1.25 Rear tire power wheelchairK0091 C 3.11 0.00 0.00 0.00 XXX 1.25 Rear tire tube power whlchrK0091 C NU 31.15 0.00 0.00 0.00 XXX 1.25 Rear tire tube power whlchrK0091 C RR 3.11 0.00 0.00 0.00 XXX 1.25 Rear tire tube power whlchrK0091 C UE 23.38 0.00 0.00 0.00 XXX 1.25 Rear tire tube power whlchrK0092 C 36.48 0.00 0.00 0.00 XXX 1.25 Rear assem cmplt powr whlchrK0092 C NU 364.70 0.00 0.00 0.00 XXX 1.25 Rear assem cmplt powr whlchrK0092 C RR 36.48 0.00 0.00 0.00 XXX 1.25 Rear assem cmplt powr whlchrK0092 C UE 273.51 0.00 0.00 0.00 XXX 1.25 Rear assem cmplt powr whlchrK0093 C 22.79 0.00 0.00 0.00 XXX 1.25 Rear zero pressure tire tubeK0093 C NU 227.84 0.00 0.00 0.00 XXX 1.25 Rear zero pressure tire tubeK0093 C RR 22.79 0.00 0.00 0.00 XXX 1.25 Rear zero pressure tire tubeK0093 C UE 170.86 0.00 0.00 0.00 XXX 1.25 Rear zero pressure tire tubeK0094 C 7.41 0.00 0.00 0.00 XXX 1.25 Wheel tire for power baseK0094 C NU 74.20 0.00 0.00 0.00 XXX 1.25 Wheel tire for power baseK0094 C RR 7.41 0.00 0.00 0.00 XXX 1.25 Wheel tire for power baseK0094 C UE 55.68 0.00 0.00 0.00 XXX 1.25 Wheel tire for power base
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
K0095 C 7.41 0.00 0.00 0.00 XXX 1.25 Wheel tire tube each baseK0095 C NU 74.20 0.00 0.00 0.00 XXX 1.25 Wheel tire tube each baseK0095 C RR 7.41 0.00 0.00 0.00 XXX 1.25 Wheel tire tube each baseK0095 C UE 55.68 0.00 0.00 0.00 XXX 1.25 Wheel tire tube each baseK0096 C 41.13 0.00 0.00 0.00 XXX 1.25 Wheel assem powr base compltK0096 C NU 411.45 0.00 0.00 0.00 XXX 1.25 Wheel assem powr base compltK0096 C RR 41.13 0.00 0.00 0.00 XXX 1.25 Wheel assem powr base compltK0096 C UE 308.56 0.00 0.00 0.00 XXX 1.25 Wheel assem powr base compltK0097 C 9.11 0.00 0.00 0.00 XXX 1.25 Wheel zero presure tire tubeK0097 C NU 90.99 0.00 0.00 0.00 XXX 1.25 Wheel zero presure tire tubeK0097 C RR 9.11 0.00 0.00 0.00 XXX 1.25 Wheel zero presure tire tubeK0097 C UE 68.25 0.00 0.00 0.00 XXX 1.25 Wheel zero presure tire tubeK0098 C 3.96 0.00 0.00 0.00 XXX 1.25 Drive belt power wheelchairK0098 C NU 39.60 0.00 0.00 0.00 XXX 1.25 Drive belt power wheelchairK0098 C RR 3.96 0.00 0.00 0.00 XXX 1.25 Drive belt power wheelchairK0098 C UE 29.71 0.00 0.00 0.00 XXX 1.25 Drive belt power wheelchairK0099 C 12.12 0.00 0.00 0.00 XXX 1.25 Pwr wheelchair front casterK0099 C NU 121.34 0.00 0.00 0.00 XXX 1.25 Pwr wheelchair front casterK0099 C RR 12.12 0.00 0.00 0.00 XXX 1.25 Pwr wheelchair front casterK0099 C UE 91.00 0.00 0.00 0.00 XXX 1.25 Pwr wheelchair front casterK0102 C 6.47 0.00 0.00 0.00 XXX 1.25 12/31/2005 Crutch and cane holderK0102 C NU 65.04 0.00 0.00 0.00 XXX 1.25 12/31/2005 Crutch and cane holderK0102 C RR 6.47 0.00 0.00 0.00 XXX 1.25 12/31/2005 Crutch and cane holderK0102 C UE 48.76 0.00 0.00 0.00 XXX 1.25 12/31/2005 Crutch and cane holderK0104 C 17.79 0.00 0.00 0.00 XXX 1.25 12/31/2005 Cylinder tank carrierK0104 C NU 178.15 0.00 0.00 0.00 XXX 1.25 12/31/2005 Cylinder tank carrierK0104 C RR 17.79 0.00 0.00 0.00 XXX 1.25 12/31/2005 Cylinder tank carrierK0104 C UE 133.63 0.00 0.00 0.00 XXX 1.25 12/31/2005 Cylinder tank carrierK0105 C 14.91 0.00 0.00 0.00 XXX 1.25 Iv hangerK0105 C NU 149.13 0.00 0.00 0.00 XXX 1.25 Iv hangerK0105 C RR 14.91 0.00 0.00 0.00 XXX 1.25 Iv hangerK0105 C UE 111.88 0.00 0.00 0.00 XXX 1.25 Iv hangerK0106 C 16.07 0.00 0.00 0.00 XXX 1.25 12/31/2005 Arm trough eachK0106 C NU 160.76 0.00 0.00 0.00 XXX 1.25 12/31/2005 Arm trough eachK0106 C RR 16.07 0.00 0.00 0.00 XXX 1.25 12/31/2005 Arm trough eachK0106 C UE 120.57 0.00 0.00 0.00 XXX 1.25 12/31/2005 Arm trough eachK0108 C 0.00 0.00 0.00 0.00 XXX 0.00 W/c component-accessory NOSK0195 C 31.61 0.00 0.00 0.00 XXX 1.25 Elevating whlchair leg restsK0195 C NU 316.10 0.00 0.00 0.00 XXX 1.25 Elevating whlchair leg restsK0195 C RR 31.61 0.00 0.00 0.00 XXX 1.25 Elevating whlchair leg restsK0195 C UE 237.08 0.00 0.00 0.00 XXX 1.25 Elevating whlchair leg restsK0415 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 RX antiemetic drg, oral per 1 mg. NOSK0416 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Rx antiemetic drg,rectal per 1 mg. NOSK0452 C 0.91 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair bearingsK0452 C NU 8.97 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair bearingsK0452 C RR 0.91 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair bearingsK0452 C UE 6.76 0.00 0.00 0.00 XXX 1.25 12/31/2005 Wheelchair bearingsK0455 C 424.00 0.00 0.00 0.00 XXX 1.25 Pump uninterrupted infusionK0455 C NU 706.67 0.00 0.00 0.00 XXX 7.50 Pump uninterrupted infusionK0455 C RR 424.00 0.00 0.00 0.00 XXX 1.25 Pump uninterrupted infusionK0455 C UE 795.00 0.00 0.00 0.00 XXX 5.00 Pump uninterrupted infusionK0462 C 0.00 0.00 0.00 0.00 XXX 0.00 Temporary replacement eqpmntK0552 C 3.89 0.00 0.00 0.00 XXX 1.25 Supply/ext inf pump syr typeK0600 C 788.48 0.00 0.00 0.00 XXX 2.50 12/31/2005 Functional neuromuscularstim
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
K0600 C NU 985.60 0.00 0.00 0.00 XXX 20.00 12/31/2005 Functional neuromuscularstimK0600 C RR 788.48 0.00 0.00 0.00 XXX 2.50 12/31/2005 Functional neuromuscularstimK0600 C UE 985.60 0.00 0.00 0.00 XXX 15.00 12/31/2005 Functional neuromuscularstimK0601 C 1.65 0.00 0.00 0.00 XXX 1.25 Repl batt silver oxide 1.5 vK0601 C NU 1.65 0.00 0.00 0.00 XXX 1.25 Repl batt silver oxide 1.5 vK0602 C 9.57 0.00 0.00 0.00 XXX 1.25 Repl batt silver oxide 3 vK0602 C NU 9.57 0.00 0.00 0.00 XXX 1.25 Repl batt silver oxide 3 vK0603 C 0.87 0.00 0.00 0.00 XXX 1.25 Repl batt alkaline 1.5 vK0603 C NU 0.87 0.00 0.00 0.00 XXX 1.25 Repl batt alkaline 1.5 vK0604 C 9.16 0.00 0.00 0.00 XXX 1.25 Repl batt lithium 3.6 vK0604 C NU 9.16 0.00 0.00 0.00 XXX 1.25 Repl batt lithium 3.6 vK0605 C 21.93 0.00 0.00 0.00 XXX 1.25 Repl batt lithium 4.5 vK0605 C NU 21.93 0.00 0.00 0.00 XXX 1.25 Repl batt lithium 4.5 vK0606 C 0.00 0.00 0.00 0.00 XXX 0.00 AED garment w elec analysisK0606 C NU 0.00 0.00 0.00 0.00 XXX 0.00 AED garment w elec analysisK0606 C RR 0.00 0.00 0.00 0.00 XXX 0.00 AED garment w elec analysisK0606 C UE 0.00 0.00 0.00 0.00 XXX 0.00 AED garment w elec analysisK0607 C 31.50 0.00 0.00 0.00 XXX 1.25 Repl batt for AEDK0607 C NU 315.00 0.00 0.00 0.00 XXX 1.25 Repl batt for AEDK0607 C RR 31.50 0.00 0.00 0.00 XXX 1.25 Repl batt for AEDK0607 C UE 236.20 0.00 0.00 0.00 XXX 1.25 Repl batt for AEDK0608 C 19.65 0.00 0.00 0.00 XXX 1.25 Repl garment for AEDK0608 C NU 196.53 0.00 0.00 0.00 XXX 1.25 Repl garment for AEDK0608 C RR 19.65 0.00 0.00 0.00 XXX 1.25 Repl garment for AEDK0608 C UE 147.43 0.00 0.00 0.00 XXX 1.25 Repl garment for AEDK0609 C 653.59 0.00 0.00 0.00 XXX 2.50 Repl electrode for AEDK0609 C KF 653.59 0.00 0.00 0.00 XXX 2.50 Repl electrode for AEDK0618 C 829.78 0.00 0.00 0.00 XXX 1.25 12/31/2005 TLSO 2 piece rigid shellK0619 C 530.48 0.00 0.00 0.00 XXX 1.25 12/31/2005 TLSO 3 piece rigid shellK0620 C 1.74 0.00 0.00 0.00 XXX 1.25 12/31/2005 Tubular elastic dressingK0628 C 30.27 0.00 0.00 0.00 XXX 1.25 12/31/2005 Multi den insert direct formK0629 C 45.17 0.00 0.00 0.00 XXX 1.25 12/31/2005 Multi den insert custom moldK0630 C 121.04 0.00 0.00 0.00 XXX 1.25 12/31/2005 Sacroiliac orth, flexible, prefabK0631 C 402.31 0.00 0.00 0.00 XXX 1.25 12/31/2005 Sacroiliac orth, flexible, customK0632 C 69.83 0.00 0.00 0.00 XXX 1.25 12/31/2005 Sacroiliac orth, prefabricatedK0633 C 0.00 0.00 0.00 0.00 XXX 1.25 12/31/2005 Sacroiliac orth, customK0634 C 59.52 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar orth, flexible, prefabK0635 C 84.20 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar orth, rigid, prefabK0636 C 444.11 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar orth, rigid, prefabK0637 C 90.63 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar-sacral orth, flex, prefabK0638 C 0.00 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar-sacral orth, flex, customK0639 C 174.97 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar-sacral orth, rigid, prefabK0640 C 554.55 0.00 0.00 0.00 XXX 2.50 12/31/2005 Lumbar-sacral orth, rigid, prefabK0641 C 0.00 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar-sacral orth, rigid, customK0642 C 309.81 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar-sacral orth, rigid, prefabK0643 C 0.00 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lumbar-sacral orth, rigid, customK0644 C 879.36 0.00 0.00 0.00 XXX 2.50 12/31/2005 Lumbar-sacral orth, rigid, prefabK0645 C 557.33 0.00 0.00 0.00 XXX 5.00 12/31/2005 Lumbar-sacral orth, rigid, customK0646 C 688.70 0.00 0.00 0.00 XXX 2.50 12/31/2005 Lumbar-sacral orth, rigid, prefabK0647 C 712.49 0.00 0.00 0.00 XXX 2.50 12/31/2005 Lumbar-sacral orth, rigid, customK0648 C 688.70 0.00 0.00 0.00 XXX 2.50 12/31/2005 Lumbar-sacral orth, rigid, prefabK0649 C 565.27 0.00 0.00 0.00 XXX 2.50 12/31/2005 Lumbar-sacral orth, rigid, customK0669 C 0.00 0.00 0.00 0.00 XXX 1.25 Seat/back cus no sadmerc verK0730 C 0.00 0.00 0.00 0.00 XXX 0.00 Ctrl dose inh drug deliv sys
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L0100 C 703.10 0.00 0.00 0.00 XXX 1.25 Cranial orthosis/helmet moldL0110 C 180.24 0.00 0.00 0.00 XXX 1.25 Cranial orthosis/helmet nonmL0112 C 756.09 0.00 0.00 0.00 XXX 2.50 Cranial cervical orthosisL0120 C 49.39 0.00 0.00 0.00 XXX 1.25 Cerv flexible non-adjustableL0130 C 600.88 0.00 0.00 0.00 XXX 1.25 Flex thermoplastic collar moL0140 C 116.91 0.00 0.00 0.00 XXX 1.25 Cervical semi-rigid adjustabL0150 C 141.50 0.00 0.00 0.00 XXX 1.25 Cerv semi-rig adj molded chnL0160 C 196.49 0.00 0.00 0.00 XXX 1.25 Cerv semi-rig wire occ/mandL0170 C 860.20 0.00 0.00 0.00 XXX 1.25 Cervical collar molded to ptL0172 C 163.29 0.00 0.00 0.00 XXX 1.25 Cerv col thermplas foam 2 piL0174 C 439.96 0.00 0.00 0.00 XXX 1.25 Cerv col foam 2 piece w thorL0180 C 481.04 0.00 0.00 0.00 XXX 1.25 Cer post col occ/man sup adjL0190 C 721.11 0.00 0.00 0.00 XXX 1.25 Cerv collar supp adj cerv baL0200 C 840.43 0.00 0.00 0.00 XXX 1.25 Cerv col supp adj bar & thorL0210 C 55.55 0.00 0.00 0.00 XXX 1.25 Thoracic rib beltL0220 C 153.65 0.00 0.00 0.00 XXX 1.25 Thor rib belt custom fabricaL0430 C 829.16 0.00 0.00 0.00 XXX 2.50 Dewall posture protectorL0450 C 247.39 0.00 0.00 0.00 XXX 1.25 TLSO flex prefab thoracicL0452 C 0.00 0.00 0.00 0.00 XXX 0.00 TLSO flex custom fab thoraciL0454 C 374.74 0.00 0.00 0.00 XXX 1.25 TLSO flex prefab sacrococ-T9L0456 C 537.29 0.00 0.00 0.00 XXX 2.50 TLSO flex prefabL0458 C 963.57 0.00 0.00 0.00 XXX 1.25 TLSO 2Mod symphis-xipho preL0460 C 542.27 0.00 0.00 0.00 XXX 2.50 TLSO2Mod symphysis-stern preL0462 C 674.50 0.00 0.00 0.00 XXX 2.50 TLSO 3Mod sacro-scap preL0464 C 802.99 0.00 0.00 0.00 XXX 2.50 TLSO 4Mod sacro-scap preL0466 C 511.29 0.00 0.00 0.00 XXX 1.25 TLSO rigid frame pre soft apL0468 C 537.76 0.00 0.00 0.00 XXX 2.50 TLSO rigid frame prefab pelvL0470 C 550.09 0.00 0.00 0.00 XXX 2.50 TLSO rigid frame pre subclavL0472 C 506.58 0.00 0.00 0.00 XXX 2.50 TLSO rigid frame hyperex preL0480 C 867.63 0.00 0.00 0.00 XXX 2.50 TLSO rigid plastic custom faL0482 C 974.18 0.00 0.00 0.00 XXX 2.50 TLSO rigid lined custom fabL0484 C 557.39 0.00 0.00 0.00 XXX 5.00 TLSO rigid plastic cust fabL0486 C 759.87 0.00 0.00 0.00 XXX 5.00 TLSO rigidlined cust fab twoL0488 C 542.27 0.00 0.00 0.00 XXX 2.50 TLSO rigid lined pre one pieL0490 C 333.38 0.00 0.00 0.00 XXX 1.25 TLSO rigid plastic pre oneL0491 C 829.78 0.00 0.00 0.00 XXX 1.25 TLSO 2 piece rigid shellL0492 C 530.48 0.00 0.00 0.00 XXX 1.25 TLSO 3 piece rigid shellL0621 C 121.04 0.00 0.00 0.00 XXX 1.25 SIO flex pelvisacral prefabL0622 C 402.31 0.00 0.00 0.00 XXX 1.25 SIO flex pelvisacral customL0623 C 0.00 0.00 0.00 0.00 XXX 1.25 SIO panel prefabL0624 C 0.00 0.00 0.00 0.00 XXX 1.25 SIO panel customL0625 C 59.52 0.00 0.00 0.00 XXX 1.25 LO flexibl L1-below L5 preL0626 C 84.20 0.00 0.00 0.00 XXX 1.25 LO sag stays/panels pre-fabL0627 C 444.11 0.00 0.00 0.00 XXX 1.25 LO sagitt rigid panel prefabL0628 C 90.63 0.00 0.00 0.00 XXX 1.25 LO flex w/o rigid stays preL0629 C 0.00 0.00 0.00 0.00 XXX 1.25 LSO flex w/rigid stays custL0630 C 174.97 0.00 0.00 0.00 XXX 1.25 LSO post rigid panel preL0631 C 554.55 0.00 0.00 0.00 XXX 2.50 LSO sag-coro rigid frame preL0632 C 0.00 0.00 0.00 0.00 XXX 1.25 LSO sag rigid frame custL0633 C 309.81 0.00 0.00 0.00 XXX 1.25 LSO flexion control prefabL0634 C 0.00 0.00 0.00 0.00 XXX 1.25 LSO flexion control customL0635 C 879.36 0.00 0.00 0.00 XXX 2.50 LSO sagit rigid panel prefabL0636 C 557.33 0.00 0.00 0.00 XXX 5.00 LSO sagittal rigid panel cusL0637 C 688.70 0.00 0.00 0.00 XXX 2.50 LSO sag-coronal panel prefab
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L0638 C 712.49 0.00 0.00 0.00 XXX 2.50 LSO sag-coronal panel customL0639 C 688.70 0.00 0.00 0.00 XXX 2.50 LSO s/c shell/panel prefabL0640 C 565.27 0.00 0.00 0.00 XXX 2.50 LSO s/c shell/panel customL0700 C 699.87 0.00 0.00 0.00 XXX 5.00 Ctlso a-p-l control moldedL0710 C 716.03 0.00 0.00 0.00 XXX 5.00 Ctlso a-p-l control w/ interL0810 C 963.46 0.00 0.00 0.00 XXX 5.00 Halo cervical into jckt vestL0820 C 677.51 0.00 0.00 0.00 XXX 5.00 Halo cervical into body jackL0830 C 950.46 0.00 0.00 0.00 XXX 7.50 Halo cerv into milwaukee typL0859 C 764.20 0.00 0.00 0.00 XXX 2.50 MRI compatible systemL0860 C 764.19 0.00 0.00 0.00 XXX 2.50 12/31/2005 Magnetic resonanc image compL0861 C 232.86 0.00 0.00 0.00 XXX 1.25 Halo repl liner/interfaceL0960 C 86.66 0.00 0.00 0.00 XXX 1.25 Post surgical support padsL0970 C 181.35 0.00 0.00 0.00 XXX 1.25 Tlso corset frontL0972 C 162.28 0.00 0.00 0.00 XXX 1.25 Lso corset frontL0974 C 233.85 0.00 0.00 0.00 XXX 1.25 Tlso full corsetL0976 C 200.60 0.00 0.00 0.00 XXX 1.25 Lso full corsetL0978 C 567.29 0.00 0.00 0.00 XXX 1.25 Axillary crutch extensionL0980 C 21.91 0.00 0.00 0.00 XXX 1.25 Peroneal straps pairL0982 C 20.43 0.00 0.00 0.00 XXX 1.25 Stocking supp grips set of fL0984 C 73.94 0.00 0.00 0.00 XXX 1.25 Protective body sock eachL0999 C 0.00 0.00 0.00 0.00 XXX 0.00 Add'n to spinal orthosis, NOSL1000 C 831.64 0.00 0.00 0.00 XXX 5.00 Ctlso milwauke initial modelL1005 C 864.51 0.00 0.00 0.00 XXX 5.00 Tension based scoliosis orthL1010 C 84.20 0.00 0.00 0.00 XXX 1.25 Ctlso axilla slingL1020 C 151.16 0.00 0.00 0.00 XXX 1.25 Kyphosis padL1025 C 264.99 0.00 0.00 0.00 XXX 1.25 Kyphosis pad floatingL1030 C 79.81 0.00 0.00 0.00 XXX 1.25 Lumbar bolster padL1040 C 135.94 0.00 0.00 0.00 XXX 1.25 Lumbar or lumbar rib padL1050 C 116.18 0.00 0.00 0.00 XXX 1.25 Sternal padL1060 C 139.98 0.00 0.00 0.00 XXX 1.25 Thoracic padL1070 C 118.73 0.00 0.00 0.00 XXX 1.25 Trapezius slingL1080 C 67.58 0.00 0.00 0.00 XXX 1.25 OutriggerL1085 C 247.49 0.00 0.00 0.00 XXX 1.25 Outrigger bil w/ vert extensL1090 C 137.39 0.00 0.00 0.00 XXX 1.25 Lumbar slingL1100 C 219.04 0.00 0.00 0.00 XXX 1.25 Ring flange plastic/leatherL1110 C 428.99 0.00 0.00 0.00 XXX 1.25 Ring flange plas/leather molL1120 C 93.76 0.00 0.00 0.00 XXX 1.25 Covers for upright eachL1200 C 701.84 0.00 0.00 0.00 XXX 5.00 Furnsh initial orthosis onlyL1210 C 508.93 0.00 0.00 0.00 XXX 1.25 Lateral thoracic extensionL1220 C 524.99 0.00 0.00 0.00 XXX 1.25 Anterior thoracic extensionL1230 C 937.24 0.00 0.00 0.00 XXX 1.25 Milwaukee type superstructurL1240 C 121.21 0.00 0.00 0.00 XXX 1.25 Lumbar derotation padL1250 C 91.55 0.00 0.00 0.00 XXX 1.25 Anterior asis padL1260 C 100.94 0.00 0.00 0.00 XXX 1.25 Anterior thoracic derotationL1270 C 136.19 0.00 0.00 0.00 XXX 1.25 Abdominal padL1280 C 136.80 0.00 0.00 0.00 XXX 1.25 Rib gusset (elastic) eachL1290 C 191.64 0.00 0.00 0.00 XXX 1.25 Lateral trochanteric padL1300 C 616.99 0.00 0.00 0.00 XXX 5.00 Body jacket mold to patientL1310 C 538.77 0.00 0.00 0.00 XXX 5.00 Post-operative body jacketL1499 S 0.00 0.00 0.00 0.00 XXX 0.00 Spinal orthosis, NOSL1500 C 737.64 0.00 0.00 0.00 XXX 5.00 Thkao mobility frameL1510 C 623.48 0.00 0.00 0.00 XXX 5.00 Thkao standing frameL1520 C 990.07 0.00 0.00 0.00 XXX 5.00 Thkao swivel walkerL1600 C 270.13 0.00 0.00 0.00 XXX 1.25 Abduct hip flex frejka w cvr
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L1610 C 61.77 0.00 0.00 0.00 XXX 1.25 Abduct hip flex frejka covrL1620 C 168.35 0.00 0.00 0.00 XXX 1.25 Abduct hip flex pavlik harneL1630 C 212.60 0.00 0.00 0.00 XXX 1.25 Abduct control hip semi-flexL1640 C 935.22 0.00 0.00 0.00 XXX 1.25 Pelv band/spread bar thigh cL1650 C 288.17 0.00 0.00 0.00 XXX 1.25 HO abduction hip adjustableL1652 C 385.13 0.00 0.00 0.00 XXX 1.25 HO bi thighcuffs w sprdr barL1660 C 214.70 0.00 0.00 0.00 XXX 1.25 HO abduction static plasticL1680 C 658.23 0.00 0.00 0.00 XXX 5.00 Pelvic & hip control thigh cL1685 C 561.01 0.00 0.00 0.00 XXX 5.00 Post-op hip abduct custom faL1686 C 708.64 0.00 0.00 0.00 XXX 2.50 HO post-op hip abductionL1690 C 569.80 0.00 0.00 0.00 XXX 5.00 Combination bilateral HOL1700 C 686.15 0.00 0.00 0.00 XXX 5.00 Leg perthes orth toronto typL1710 C 759.78 0.00 0.00 0.00 XXX 5.00 Legg perthes orth newingtonL1720 C 668.88 0.00 0.00 0.00 XXX 5.00 Legg perthes orthosis trilatL1730 C 986.79 0.00 0.00 0.00 XXX 2.50 Legg perthes orth scottish rL1750 C 246.84 0.00 0.00 0.00 XXX 1.25 12/31/2005 Legg perthes slingL1755 C 536.17 0.00 0.00 0.00 XXX 5.00 Legg perthes patten bottom tL1800 C 98.29 0.00 0.00 0.00 XXX 1.25 Knee orthoses elas w staysL1810 C 136.51 0.00 0.00 0.00 XXX 1.25 Ko elastic with jointsL1815 C 121.54 0.00 0.00 0.00 XXX 1.25 Elastic with condylar padsL1820 C 159.05 0.00 0.00 0.00 XXX 1.25 Ko elas w/ condyle pads & joL1825 C 68.99 0.00 0.00 0.00 XXX 1.25 Ko elastic knee capL1830 C 182.31 0.00 0.00 0.00 XXX 1.25 Ko immobilizer canvas longitL1831 C 318.00 0.00 0.00 0.00 XXX 1.25 Knee orth pos locking jointL1832 C 662.45 0.00 0.00 0.00 XXX 2.50 KO adj jnt pos rigid supportL1834 C 740.37 0.00 0.00 0.00 XXX 2.50 Ko w/0 joint rigid molded toL1836 C 144.17 0.00 0.00 0.00 XXX 1.25 Rigid KO wo jointsL1840 C 657.59 0.00 0.00 0.00 XXX 2.50 Ko derot ant cruciate customL1843 C 969.44 0.00 0.00 0.00 XXX 1.25 KO single upright custom fitL1844 C 997.44 0.00 0.00 0.00 XXX 2.50 Ko w/adj jt rot cntrl moldedL1845 C 966.65 0.00 0.00 0.00 XXX 1.25 Ko w/ adj flex/ext rotat cusL1846 C 775.02 0.00 0.00 0.00 XXX 2.50 Ko w adj flex/ext rotat moldL1847 C 677.91 0.00 0.00 0.00 XXX 1.25 KO adjustable w air chambersL1850 C 463.11 0.00 0.00 0.00 XXX 1.25 Ko swedish typeL1855 C 721.90 0.00 0.00 0.00 XXX 2.50 Ko plas doub upright jnt molL1858 C 865.91 0.00 0.00 0.00 XXX 2.50 Ko polycentric pneumatic padL1860 C 813.09 0.00 0.00 0.00 XXX 2.50 Ko supracondylar socket moldL1870 C 525.87 0.00 0.00 0.00 XXX 5.00 Ko doub upright lacers moldeL1880 C 515.20 0.00 0.00 0.00 XXX 2.50 Ko doub upright cuffs/lacersL1900 C 325.99 0.00 0.00 0.00 XXX 1.25 Afo sprng wir drsflx calf bdL1901 C 19.13 0.00 0.00 0.00 XXX 1.25 Prefab ankle orthosisL1902 C 100.15 0.00 0.00 0.00 XXX 1.25 Afo ankle gauntletL1904 C 811.24 0.00 0.00 0.00 XXX 1.25 Afo molded ankle gauntletL1906 C 260.76 0.00 0.00 0.00 XXX 1.25 Afo multiligamentus ankle suL1907 C 607.94 0.00 0.00 0.00 XXX 1.25 AFO supramalleolar customL1910 C 483.20 0.00 0.00 0.00 XXX 1.25 Afo sing bar clasp attach shL1920 C 623.46 0.00 0.00 0.00 XXX 1.25 Afo sing upright w/ adjust sL1930 C 376.54 0.00 0.00 0.00 XXX 1.25 Afo plasticL1932 C 964.10 0.00 0.00 0.00 XXX 1.25 Afo rig ant tib prefab TCF/=L1940 C 623.49 0.00 0.00 0.00 XXX 2.50 Afo molded to patient plastiL1945 C 650.78 0.00 0.00 0.00 XXX 2.50 Afo molded plas rig ant tibL1950 C 543.82 0.00 0.00 0.00 XXX 2.50 Afo spiral molded to pt plasL1951 C 907.35 0.00 0.00 0.00 XXX 1.25 AFO spiral prefabricatedL1960 C 623.49 0.00 0.00 0.00 XXX 2.50 Afo pos solid ank plastic mo
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L1970 C 528.05 0.00 0.00 0.00 XXX 2.50 Afo plastic molded w/ankle jL1971 C 506.43 0.00 0.00 0.00 XXX 1.25 AFO w/ankle jointL1980 C 651.19 0.00 0.00 0.00 XXX 1.25 Afo sing solid stirrup calfL1990 C 506.58 0.00 0.00 0.00 XXX 2.50 Afo doub solid stirrup calfL2000 C 526.62 0.00 0.00 0.00 XXX 5.00 Kafo sing fre stirr thi/calfL2005 C 737.88 0.00 0.00 0.00 XXX 7.50 KAFO sng/dbl mechanical actL2010 C 920.34 0.00 0.00 0.00 XXX 2.50 Kafo sng solid stirrup w/o jL2020 C 657.48 0.00 0.00 0.00 XXX 5.00 Kafo dbl solid stirrup band/L2030 C 795.96 0.00 0.00 0.00 XXX 2.50 Kafo dbl solid stirrup w/o jL2034 C 0.00 0.00 0.00 0.00 XXX 0.00 KAFO pla sin up w/wo k/a cusL2035 C 204.19 0.00 0.00 0.00 XXX 1.25 KAFO plastic pediatric sizeL2036 C 837.80 0.00 0.00 0.00 XXX 5.00 Kafo plas doub free knee molL2037 C 605.74 0.00 0.00 0.00 XXX 5.00 Kafo plas sing free knee molL2038 C 896.87 0.00 0.00 0.00 XXX 2.50 Kafo w/o joint multi-axis anL2039 C 600.28 0.00 0.00 0.00 XXX 5.00 12/31/2005 KAFOL2040 C 217.09 0.00 0.00 0.00 XXX 1.25 Hkafo torsion bil rot strapsL2050 C 839.39 0.00 0.00 0.00 XXX 1.25 Hkafo torsion cable hip pelvL2060 C 514.36 0.00 0.00 0.00 XXX 2.50 Hkafo torsion ball bearing jL2070 C 168.72 0.00 0.00 0.00 XXX 1.25 Hkafo torsion unilat rot strL2080 C 542.28 0.00 0.00 0.00 XXX 1.25 Hkafo unilat torsion cableL2090 C 728.61 0.00 0.00 0.00 XXX 1.25 Hkafo unilat torsion ball brL2106 C 601.06 0.00 0.00 0.00 XXX 2.50 Afo tib fx cast plaster moldL2108 C 679.63 0.00 0.00 0.00 XXX 2.50 Afo tib fx cast molded to ptL2112 C 580.05 0.00 0.00 0.00 XXX 1.25 Afo tibial fracture softL2114 C 921.83 0.00 0.00 0.00 XXX 1.25 Afo tib fx semi-rigidL2116 C 574.23 0.00 0.00 0.00 XXX 2.50 Afo tibial fracture rigidL2126 C 751.16 0.00 0.00 0.00 XXX 2.50 Kafo fem fx cast thermoplasL2128 C 570.37 0.00 0.00 0.00 XXX 5.00 Kafo fem fx cast molded to pL2132 C 584.51 0.00 0.00 0.00 XXX 2.50 Kafo femoral fx cast softL2134 C 701.41 0.00 0.00 0.00 XXX 2.50 Kafo fem fx cast semi-rigidL2136 C 584.52 0.00 0.00 0.00 XXX 5.00 Kafo femoral fx cast rigidL2180 C 180.64 0.00 0.00 0.00 XXX 1.25 Plas shoe insert w ank jointL2182 C 114.99 0.00 0.00 0.00 XXX 1.25 Drop lock kneeL2184 C 155.41 0.00 0.00 0.00 XXX 1.25 Limited motion knee jointL2186 C 177.33 0.00 0.00 0.00 XXX 1.25 Adj motion knee jnt lerman tL2188 C 375.74 0.00 0.00 0.00 XXX 1.25 Quadrilateral brimL2190 C 109.56 0.00 0.00 0.00 XXX 1.25 Waist beltL2192 C 601.65 0.00 0.00 0.00 XXX 1.25 Pelvic band & belt thigh flaL2200 C 108.71 0.00 0.00 0.00 XXX 1.25 Limited ankle motion ea jntL2210 C 134.55 0.00 0.00 0.00 XXX 1.25 Dorsiflexion assist each joiL2220 C 161.24 0.00 0.00 0.00 XXX 1.25 Dorsi & plantar flex ass/resL2230 C 180.93 0.00 0.00 0.00 XXX 1.25 Split flat caliper stirr & pL2232 C 0.00 0.00 0.00 0.00 XXX 0.00 Rocker bottom, contact AFOL2240 C 179.71 0.00 0.00 0.00 XXX 1.25 Round caliper and plate attaL2250 C 796.03 0.00 0.00 0.00 XXX 1.25 Foot plate molded stirrup atL2260 C 687.21 0.00 0.00 0.00 XXX 1.25 Reinforced solid stirrupL2265 C 288.46 0.00 0.00 0.00 XXX 1.25 Long tongue stirrupL2270 C 132.49 0.00 0.00 0.00 XXX 1.25 Varus/valgus strap padded/liL2275 C 173.81 0.00 0.00 0.00 XXX 1.25 Plastic mod low ext pad/lineL2280 C 709.11 0.00 0.00 0.00 XXX 1.25 Molded inner bootL2300 C 526.43 0.00 0.00 0.00 XXX 1.25 Abduction bar jointed adjustL2310 C 279.11 0.00 0.00 0.00 XXX 1.25 Abduction bar-straightL2320 C 266.89 0.00 0.00 0.00 XXX 1.25 Non-molded lacerL2330 C 740.35 0.00 0.00 0.00 XXX 1.25 Lacer molded to patient mode
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L2335 C 379.46 0.00 0.00 0.00 XXX 1.25 Anterior swing bandL2340 C 628.24 0.00 0.00 0.00 XXX 1.25 Pre-tibial shell molded to pL2350 C 518.25 0.00 0.00 0.00 XXX 5.00 Prosthetic type socket moldeL2360 C 79.26 0.00 0.00 0.00 XXX 1.25 Extended steel shankL2370 C 589.20 0.00 0.00 0.00 XXX 1.25 Patten bottomL2375 C 168.78 0.00 0.00 0.00 XXX 1.25 Torsion ank & half solid stiL2380 C 199.29 0.00 0.00 0.00 XXX 1.25 Torsion straight knee jointL2385 C 185.01 0.00 0.00 0.00 XXX 1.25 Straight knee joint heavy duL2387 C 0.00 0.00 0.00 0.00 XXX 0.00 Add LE poly knee custom KAFOL2390 C 186.65 0.00 0.00 0.00 XXX 1.25 Offset knee joint eachL2395 C 205.70 0.00 0.00 0.00 XXX 1.25 Offset knee joint heavy dutyL2397 C 135.91 0.00 0.00 0.00 XXX 1.25 Suspension sleeve lower extL2405 C 94.19 0.00 0.00 0.00 XXX 1.25 Knee joint drop lock ea jntL2415 C 131.25 0.00 0.00 0.00 XXX 1.25 Knee joint cam lock each joiL2425 C 154.88 0.00 0.00 0.00 XXX 1.25 Knee disc/dial lock/adj flexL2430 C 154.88 0.00 0.00 0.00 XXX 1.25 Knee jnt ratchet lock ea jntL2492 C 127.81 0.00 0.00 0.00 XXX 1.25 Knee lift loop drop lock rinL2500 C 461.55 0.00 0.00 0.00 XXX 1.25 Thi/glut/ischia wgt bearingL2510 C 586.07 0.00 0.00 0.00 XXX 2.50 Th/wght bear quad-lat brim mL2520 C 701.43 0.00 0.00 0.00 XXX 1.25 Th/wght bear quad-lat brim cL2525 C 773.58 0.00 0.00 0.00 XXX 2.50 Th/wght bear nar m-l brim moL2526 C 935.22 0.00 0.00 0.00 XXX 2.50 Th/wght bear nar m-l brim cuL2530 C 450.65 0.00 0.00 0.00 XXX 1.25 Thigh/wght bear lacer non-moL2540 C 738.51 0.00 0.00 0.00 XXX 1.25 Thigh/wght bear lacer moldedL2550 C 498.26 0.00 0.00 0.00 XXX 1.25 Thigh/wght bear high roll cuL2570 C 988.75 0.00 0.00 0.00 XXX 1.25 Hip clevis type 2 posit jntL2580 C 742.16 0.00 0.00 0.00 XXX 1.25 Pelvic control pelvic slingL2600 C 433.13 0.00 0.00 0.00 XXX 1.25 Hip clevis/thrust bearing frL2610 C 480.88 0.00 0.00 0.00 XXX 1.25 Hip clevis/thrust bearing loL2620 C 457.13 0.00 0.00 0.00 XXX 1.25 Pelvic control hip heavy dutL2622 C 573.00 0.00 0.00 0.00 XXX 1.25 Hip joint adjustable flexionL2624 C 717.56 0.00 0.00 0.00 XXX 1.25 Hip adj flex ext abduct contL2627 C 537.68 0.00 0.00 0.00 XXX 5.00 Plastic mold recipro hip & cL2628 C 525.48 0.00 0.00 0.00 XXX 5.00 Metal frame recipro hip & caL2630 C 662.46 0.00 0.00 0.00 XXX 1.25 Pelvic control band & belt uL2640 C 785.22 0.00 0.00 0.00 XXX 1.25 Pelvic control band & belt bL2650 C 150.56 0.00 0.00 0.00 XXX 1.25 Pelv & thor control glutealL2660 C 251.56 0.00 0.00 0.00 XXX 1.25 Thoracic control thoracic baL2670 C 214.40 0.00 0.00 0.00 XXX 1.25 Thorac cont paraspinal uprigL2680 C 196.32 0.00 0.00 0.00 XXX 1.25 Thorac cont lat support upriL2750 C 104.86 0.00 0.00 0.00 XXX 1.25 Plating chrome/nickel pr barL2755 C 141.20 0.00 0.00 0.00 XXX 1.25 Carbon graphite laminationL2760 C 129.76 0.00 0.00 0.00 XXX 1.25 Extension per extension perL2768 C 140.73 0.00 0.00 0.00 XXX 1.25 Ortho sidebar disconnectL2770 C 97.83 0.00 0.00 0.00 XXX 1.25 Low ext orthosis per bar/jntL2780 C 101.54 0.00 0.00 0.00 XXX 1.25 Non-corrosive finishL2785 C 59.75 0.00 0.00 0.00 XXX 1.25 Drop lock retainer eachL2795 C 143.58 0.00 0.00 0.00 XXX 1.25 Knee control full kneecapL2800 C 176.59 0.00 0.00 0.00 XXX 1.25 Knee cap medial or lateral pL2810 C 142.25 0.00 0.00 0.00 XXX 1.25 Knee control condylar padL2820 C 327.32 0.00 0.00 0.00 XXX 1.25 Soft interface below knee seL2830 C 327.32 0.00 0.00 0.00 XXX 1.25 Soft interface above knee seL2840 C 54.81 0.00 0.00 0.00 XXX 1.25 Tibial length sock fx or equL2850 C 77.69 0.00 0.00 0.00 XXX 1.25 Femoral lgth sock fx or equa
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L2860 C 0.00 0.00 0.00 0.00 XXX 0.00 Torsion mechanism knee/ankleL2999 S 0.00 0.00 0.00 0.00 XXX 0.00 Lower extremity orthosis NOSL3000 C 339.39 0.00 0.00 0.00 XXX 1.25 Ft insert ucb berkeley shellL3001 C 142.90 0.00 0.00 0.00 XXX 1.25 Foot insert remov molded speL3002 C 174.52 0.00 0.00 0.00 XXX 1.25 Foot insert plastazote or eqL3003 C 188.24 0.00 0.00 0.00 XXX 1.25 Foot insert silicone gel eacL3010 C 188.24 0.00 0.00 0.00 XXX 1.25 Foot longitudinal arch suppoL3020 C 214.34 0.00 0.00 0.00 XXX 1.25 Foot longitud/metatarsal supL3030 C 82.45 0.00 0.00 0.00 XXX 1.25 Foot arch support remov premL3031 C 0.00 0.00 0.00 0.00 XXX 0.00 Foot, insert/plate, removableL3040 C 50.85 0.00 0.00 0.00 XXX 1.25 Ft arch suprt premold longitL3050 C 50.85 0.00 0.00 0.00 XXX 1.25 Foot arch supp premold metatL3060 C 79.68 0.00 0.00 0.00 XXX 1.25 Foot arch supp longitud/metaL3070 C 34.36 0.00 0.00 0.00 XXX 1.25 Arch suprt att to sho longitL3080 C 34.36 0.00 0.00 0.00 XXX 1.25 Arch supp att to shoe metataL3090 C 43.98 0.00 0.00 0.00 XXX 1.25 Arch supp att to shoe long/mL3100 C 46.73 0.00 0.00 0.00 XXX 1.25 Hallus-valgus nght dynamic sL3140 C 96.19 0.00 0.00 0.00 XXX 1.25 Abduction rotation bar shoeL3150 C 87.95 0.00 0.00 0.00 XXX 1.25 Abduct rotation bar w/o shoeL3160 C 0.00 0.00 0.00 0.00 XXX 0.00 Shoe styled positioning devL3170 C 54.96 0.00 0.00 0.00 XXX 1.25 Foot plastic heel stabilizerL3201 D 0.00 0.00 0.00 0.00 XXX 0.00 Oxford w supinat/pronat infL3202 D 0.00 0.00 0.00 0.00 XXX 0.00 Oxford w/ supinat/pronator cL3203 D 0.00 0.00 0.00 0.00 XXX 0.00 Oxford w/ supinator/pronatorL3204 D 0.00 0.00 0.00 0.00 XXX 0.00 Hightop w/ supp/pronator infL3206 D 0.00 0.00 0.00 0.00 XXX 0.00 Hightop w/ supp/pronator chiL3207 D 0.00 0.00 0.00 0.00 XXX 0.00 Hightop w/ supp/pronator junL3208 D 0.00 0.00 0.00 0.00 XXX 0.00 Surgical boot each infantL3209 D 0.00 0.00 0.00 0.00 XXX 0.00 Surgical boot each childL3211 D 0.00 0.00 0.00 0.00 XXX 0.00 Surgical boot each juniorL3212 D 0.00 0.00 0.00 0.00 XXX 0.00 Benesch boot pair infantL3213 D 0.00 0.00 0.00 0.00 XXX 0.00 Benesch boot pair childL3214 D 0.00 0.00 0.00 0.00 XXX 0.00 Benesch boot pair juniorL3215 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthopedic ftwear ladies oxfL3216 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthoped ladies shoes dpth iL3217 C 0.00 0.00 0.00 0.00 XXX 0.00 Ladies shoes hightop depth iL3219 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthopedic mens shoes oxfordL3221 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthopedic mens shoes dpth iL3222 C 0.00 0.00 0.00 0.00 XXX 0.00 Mens shoes hightop depth inlL3224 C 124.70 0.00 0.00 0.00 XXX 1.25 Woman's shoe oxford braceL3225 C 115.29 0.00 0.00 0.00 XXX 1.25 Man's shoe oxford braceL3230 C 0.00 0.00 0.00 0.00 XXX 0.00 Ortho footwear, custom shoes, depth inlayL3250 C 0.00 0.00 0.00 0.00 XXX 0.00 Ortho footwear, custom molded shoeL3251 C 0.00 0.00 0.00 0.00 XXX 0.00 Foot, shoe molded to pat model/silicone eaL3252 C 0.00 0.00 0.00 0.00 XXX 0.00 Foot, shoe molded to pat model/plastazoteL3253 C 0.00 0.00 0.00 0.00 XXX 0.00 Foot, molded shoe Plasttazote eaL3254 C 0.00 0.00 0.00 0.00 XXX 0.00 Footwear, nonstandard size or widthL3255 C 0.00 0.00 0.00 0.00 XXX 0.00 Orth foot non-standard size/L3257 C 0.00 0.00 0.00 0.00 XXX 0.00 Orth foot add charge split sL3260 C 0.00 0.00 0.00 0.00 XXX 0.00 Ambulatory surgical boot eacL3265 C 0.00 0.00 0.00 0.00 XXX 0.00 Plastazote sandal eachL3300 C 56.35 0.00 0.00 0.00 XXX 1.25 Sho lift taper to metatarsalL3310 C 87.95 0.00 0.00 0.00 XXX 1.25 Shoe lift elev heel/sole neoL3320 C 0.00 0.00 0.00 0.00 XXX 0.00 Shoe lift elev heel/sole cor
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L3330 C 611.43 0.00 0.00 0.00 XXX 1.25 Lifts elevation metal extensL3332 C 79.68 0.00 0.00 0.00 XXX 1.25 Shoe lifts tapered to one-haL3334 C 41.22 0.00 0.00 0.00 XXX 1.25 Shoe lifts elevation heel /iL3340 C 92.08 0.00 0.00 0.00 XXX 1.25 Shoe wedge sachL3350 C 24.69 0.00 0.00 0.00 XXX 1.25 Shoe heel wedgeL3360 C 38.46 0.00 0.00 0.00 XXX 1.25 Shoe sole wedge outside soleL3370 C 53.60 0.00 0.00 0.00 XXX 1.25 Shoe sole wedge between soleL3380 C 53.60 0.00 0.00 0.00 XXX 1.25 Shoe clubfoot wedgeL3390 C 53.60 0.00 0.00 0.00 XXX 1.25 Shoe outflare wedgeL3400 C 43.98 0.00 0.00 0.00 XXX 1.25 Shoe metatarsal bar wedge roL3410 C 100.29 0.00 0.00 0.00 XXX 1.25 Shoe metatarsal bar betweenL3420 C 59.06 0.00 0.00 0.00 XXX 1.25 Full sole/heel wedge btweenL3430 C 173.16 0.00 0.00 0.00 XXX 1.25 Sho heel count plast reinforL3440 C 82.45 0.00 0.00 0.00 XXX 1.25 Heel leather reinforcedL3450 C 114.03 0.00 0.00 0.00 XXX 1.25 Shoe heel sach cushion typeL3455 C 43.98 0.00 0.00 0.00 XXX 1.25 Shoe heel new leather standaL3460 C 37.10 0.00 0.00 0.00 XXX 1.25 Shoe heel new rubber standarL3465 C 63.21 0.00 0.00 0.00 XXX 1.25 Shoe heel thomas with wedgeL3470 C 67.31 0.00 0.00 0.00 XXX 1.25 Shoe heel thomas extend to bL3480 C 67.31 0.00 0.00 0.00 XXX 1.25 Shoe heel pad & depress forL3485 C 0.00 0.00 0.00 0.00 XXX 0.00 Shoe heel pad removable forL3500 C 31.60 0.00 0.00 0.00 XXX 1.25 Ortho shoe add leather insolL3510 C 31.60 0.00 0.00 0.00 XXX 1.25 Orthopedic shoe add rub inslL3520 C 34.36 0.00 0.00 0.00 XXX 1.25 O shoe add felt w leath inslL3530 C 34.36 0.00 0.00 0.00 XXX 1.25 Ortho shoe add half soleL3540 C 54.96 0.00 0.00 0.00 XXX 1.25 Ortho shoe add full soleL3550 C 9.62 0.00 0.00 0.00 XXX 1.25 O shoe add standard toe tapL3560 C 24.69 0.00 0.00 0.00 XXX 1.25 O shoe add horseshoe toe tapL3570 C 92.08 0.00 0.00 0.00 XXX 1.25 O shoe add instep extensionL3580 C 70.08 0.00 0.00 0.00 XXX 1.25 O shoe add instep velcro cloL3590 C 57.70 0.00 0.00 0.00 XXX 1.25 O shoe convert to sof counteL3595 C 45.35 0.00 0.00 0.00 XXX 1.25 Ortho shoe add march barL3600 C 82.45 0.00 0.00 0.00 XXX 1.25 Trans shoe calip plate existL3610 C 108.54 0.00 0.00 0.00 XXX 1.25 Trans shoe caliper plate newL3620 C 82.45 0.00 0.00 0.00 XXX 1.25 Trans shoe solid stirrup exiL3630 C 108.54 0.00 0.00 0.00 XXX 1.25 Trans shoe solid stirrup newL3640 C 46.73 0.00 0.00 0.00 XXX 1.25 Shoe dennis browne splint boL3649 C 0.00 0.00 0.00 0.00 XXX 0.00 Orthopedic shoe modifica NOSL3650 C 86.53 0.00 0.00 0.00 XXX 1.25 Shlder fig 8 abduct restrainL3651 C 64.74 0.00 0.00 0.00 XXX 1.25 Prefab shoulder orthosisL3652 C 195.11 0.00 0.00 0.00 XXX 1.25 Prefab dbl shoulder orthosisL3660 C 126.19 0.00 0.00 0.00 XXX 1.25 Abduct restrainer canvas&webL3670 C 176.46 0.00 0.00 0.00 XXX 1.25 Acromio/clavicular canvas&weL3671 C 0.00 0.00 0.00 0.00 XXX 0.00 SO cap design w/o jnts CFL3672 C 0.00 0.00 0.00 0.00 XXX 0.00 SO airplane w/o jnts CFL3673 C 0.00 0.00 0.00 0.00 XXX 0.00 SO airplane w/joint CFL3675 C 188.24 0.00 0.00 0.00 XXX 1.25 Canvas vest SOL3677 C 0.00 0.00 0.00 0.00 XXX 0.00 Shoulder ortho hard plasticL3700 C 95.35 0.00 0.00 0.00 XXX 1.25 Elbow orthoses elas w staysL3701 C 20.04 0.00 0.00 0.00 XXX 1.25 Prefab elbow orthosisL3702 C 0.00 0.00 0.00 0.00 XXX 0.00 EO w/o joints CFL3710 C 143.89 0.00 0.00 0.00 XXX 1.25 Elbow elastic with metal joiL3720 C 624.63 0.00 0.00 0.00 XXX 2.50 Forearm/arm cuffs free motioL3730 C 673.68 0.00 0.00 0.00 XXX 2.50 Forearm/arm cuffs ext/flex a
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L3740 C 506.39 0.00 0.00 0.00 XXX 5.00 Cuffs adj lock w/ active conL3760 C 536.41 0.00 0.00 0.00 XXX 1.25 EO withjointL3762 C 105.74 0.00 0.00 0.00 XXX 1.25 Rigid EO wo jointsL3763 C 0.00 0.00 0.00 0.00 XXX 0.00 EWHO rigid w/o jnts CFL3764 C 0.00 0.00 0.00 0.00 XXX 0.00 EWHO w/joint(s) CFL3765 C 0.00 0.00 0.00 0.00 XXX 0.00 EWHFO rigid w/o jnts CFL3766 C 0.00 0.00 0.00 0.00 XXX 0.00 EWHFO w/joint(s) CFL3800 C 327.98 0.00 0.00 0.00 XXX 1.25 Whfo short opponen no attachL3805 C 411.06 0.00 0.00 0.00 XXX 1.25 Whfo long opponens no attachL3807 C 268.24 0.00 0.00 0.00 XXX 1.25 WHFOL3810 C 84.30 0.00 0.00 0.00 XXX 1.25 Whfo thumb abduction barL3815 C 73.86 0.00 0.00 0.00 XXX 1.25 Whfo second m.p. abduction aL3820 C 127.16 0.00 0.00 0.00 XXX 1.25 Whfo ip ext asst w/ mp ext sL3825 C 79.56 0.00 0.00 0.00 XXX 1.25 Whfo m.p. extension stopL3830 C 105.31 0.00 0.00 0.00 XXX 1.25 Whfo m.p. extension assistL3835 C 112.67 0.00 0.00 0.00 XXX 1.25 Whfo m.p. spring extension aL3840 C 77.18 0.00 0.00 0.00 XXX 1.25 Whfo spring swivel thumbL3845 C 111.06 0.00 0.00 0.00 XXX 1.25 Whfo thumb ip ext ass w/ mpL3850 C 142.36 0.00 0.00 0.00 XXX 1.25 Action wrist w/ dorsiflex asL3855 C 172.45 0.00 0.00 0.00 XXX 1.25 Whfo adj m.p. flexion controL3860 C 196.42 0.00 0.00 0.00 XXX 1.25 Whfo adj m.p. flex ctrl & i.L3890 C 0.00 0.00 0.00 0.00 XXX 0.00 Torsion mechanism wrist/elboL3900 C 794.79 0.00 0.00 0.00 XXX 2.50 Hinge extension/flex wrist/fL3901 C 980.46 0.00 0.00 0.00 XXX 2.50 Hinge ext/flex wrist fingerL3902 C 619.03 0.00 0.00 0.00 XXX 5.00 Whfo ext power compress gasL3904 C 871.15 0.00 0.00 0.00 XXX 7.50 Whfo electric custom fittedL3905 C 0.00 0.00 0.00 0.00 XXX 0.00 WHO w/nontorsion jnt(s) CFL3906 C 532.57 0.00 0.00 0.00 XXX 1.25 Wrist gauntlet molded to ptL3907 C 896.49 0.00 0.00 0.00 XXX 1.25 Whfo wrst gauntlt thmb spicaL3908 C 103.05 0.00 0.00 0.00 XXX 1.25 Wrist cock-up non-moldedL3909 C 13.90 0.00 0.00 0.00 XXX 1.25 Prefab wrist orthosisL3910 C 480.26 0.00 0.00 0.00 XXX 1.25 Whfo swanson designL3911 C 24.36 0.00 0.00 0.00 XXX 1.25 Prefab hand finger orthosisL3912 C 141.20 0.00 0.00 0.00 XXX 1.25 Flex glove w/elastic fingerL3913 C 0.00 0.00 0.00 0.00 XXX 0.00 HFO w/o joints CFL3914 C 106.08 0.00 0.00 0.00 XXX 1.25 WHO wrist extension cock-upL3916 C 159.54 0.00 0.00 0.00 XXX 1.25 Whfo wrist extens w/ outriggL3917 C 103.84 0.00 0.00 0.00 XXX 1.25 Prefab metacarpl fx orthosisL3918 C 132.25 0.00 0.00 0.00 XXX 1.25 HFO knuckle benderL3919 C 0.00 0.00 0.00 0.00 XXX 0.00 HO w/o joints CFL3920 C 132.64 0.00 0.00 0.00 XXX 1.25 Knuckle bender with outriggeL3921 C 0.00 0.00 0.00 0.00 XXX 0.00 HFO w/joint(s) CFL3922 C 137.08 0.00 0.00 0.00 XXX 1.25 Knuckle bend 2 seg to flex jL3923 C 41.75 0.00 0.00 0.00 XXX 1.25 HFOL3924 C 130.91 0.00 0.00 0.00 XXX 1.25 OppenheimerL3926 C 110.63 0.00 0.00 0.00 XXX 1.25 Thomas suspensionL3928 C 75.51 0.00 0.00 0.00 XXX 1.25 Finger extension w/ clock spL3930 C 73.56 0.00 0.00 0.00 XXX 1.25 Finger extension with wristL3932 C 57.70 0.00 0.00 0.00 XXX 1.25 Safety pin spring wireL3933 C 0.00 0.00 0.00 0.00 XXX 0.00 FO w/o joints CFL3934 C 66.59 0.00 0.00 0.00 XXX 1.25 Safety pin modifiedL3935 C 0.00 0.00 0.00 0.00 XXX 0.00 FO nontorsion joint CFL3936 C 109.36 0.00 0.00 0.00 XXX 1.25 PalmerL3938 C 114.49 0.00 0.00 0.00 XXX 1.25 Dorsal wrist
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L3940 C 131.98 0.00 0.00 0.00 XXX 1.25 Dorsal wrist w/ outrigger atL3942 C 109.06 0.00 0.00 0.00 XXX 1.25 Reverse knuckle benderL3944 C 137.76 0.00 0.00 0.00 XXX 1.25 Reverse knuckle bend w/ outrL3946 C 116.91 0.00 0.00 0.00 XXX 1.25 HFO composite elasticL3948 C 67.65 0.00 0.00 0.00 XXX 1.25 Finger knuckle benderL3950 C 201.28 0.00 0.00 0.00 XXX 1.25 Oppenheimer w/ knuckle bendL3952 C 204.33 0.00 0.00 0.00 XXX 1.25 Oppenheimer w/ rev knuckle 2L3954 C 135.57 0.00 0.00 0.00 XXX 1.25 Spreading handL3956 C 0.00 0.00 0.00 0.00 XXX 0.00 Add joint upper ext orthosisL3960 C 524.23 0.00 0.00 0.00 XXX 2.50 Sewho airplan desig abdu posL3961 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHO cap design w/o jnts CFL3962 C 954.40 0.00 0.00 0.00 XXX 1.25 Sewho erbs palsey design abdL3963 C 512.04 0.00 0.00 0.00 XXX 5.00 12/31/2005 Molded w/ articulating elbowL3964 C 134.01 0.00 0.00 0.00 XXX 1.25 Seo mobile arm sup att to wcL3964 C NU 669.99 0.00 0.00 0.00 XXX 2.50 Seo mobile arm sup att to wcL3964 C RR 134.01 0.00 0.00 0.00 XXX 1.25 Seo mobile arm sup att to wcL3964 C UE 502.49 0.00 0.00 0.00 XXX 2.50 Seo mobile arm sup att to wcL3965 C 223.76 0.00 0.00 0.00 XXX 1.25 Arm supp att to wc rancho tyL3965 C NU 559.41 0.00 0.00 0.00 XXX 5.00 Arm supp att to wc rancho tyL3965 C RR 223.76 0.00 0.00 0.00 XXX 1.25 Arm supp att to wc rancho tyL3965 C UE 839.11 0.00 0.00 0.00 XXX 2.50 Arm supp att to wc rancho tyL3966 C 118.59 0.00 0.00 0.00 XXX 1.25 Mobile arm supports reclininL3966 C NU 593.12 0.00 0.00 0.00 XXX 2.50 Mobile arm supports reclininL3966 C RR 118.59 0.00 0.00 0.00 XXX 1.25 Mobile arm supports reclininL3966 C UE 889.67 0.00 0.00 0.00 XXX 1.25 Mobile arm supports reclininL3967 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHO airplane w/o jnts CFL3968 C 147.81 0.00 0.00 0.00 XXX 1.25 Friction dampening arm suppL3968 C NU 739.04 0.00 0.00 0.00 XXX 2.50 Friction dampening arm suppL3968 C RR 147.81 0.00 0.00 0.00 XXX 1.25 Friction dampening arm suppL3968 C UE 554.27 0.00 0.00 0.00 XXX 2.50 Friction dampening arm suppL3969 C 117.12 0.00 0.00 0.00 XXX 1.25 Monosuspension arm/hand suppL3969 C NU 585.63 0.00 0.00 0.00 XXX 2.50 Monosuspension arm/hand suppL3969 C RR 117.12 0.00 0.00 0.00 XXX 1.25 Monosuspension arm/hand suppL3969 C UE 878.44 0.00 0.00 0.00 XXX 1.25 Monosuspension arm/hand suppL3970 C 51.17 0.00 0.00 0.00 XXX 1.25 Elevat proximal arm supportL3970 C NU 511.64 0.00 0.00 0.00 XXX 1.25 Elevat proximal arm supportL3970 C RR 51.17 0.00 0.00 0.00 XXX 1.25 Elevat proximal arm supportL3970 C UE 383.73 0.00 0.00 0.00 XXX 1.25 Elevat proximal arm supportL3971 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHO cap design w/jnt(s) CFL3972 C 35.44 0.00 0.00 0.00 XXX 1.25 Offset/lat rocker arm w/ elaL3972 C NU 354.10 0.00 0.00 0.00 XXX 1.25 Offset/lat rocker arm w/ elaL3972 C RR 35.44 0.00 0.00 0.00 XXX 1.25 Offset/lat rocker arm w/ elaL3972 C UE 265.58 0.00 0.00 0.00 XXX 1.25 Offset/lat rocker arm w/ elaL3973 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHO airplane w/jnt(s) CFL3974 C 35.44 0.00 0.00 0.00 XXX 1.25 Mobile arm support supinatorL3974 C NU 354.10 0.00 0.00 0.00 XXX 1.25 Mobile arm support supinatorL3974 C RR 35.44 0.00 0.00 0.00 XXX 1.25 Mobile arm support supinatorL3974 C UE 265.58 0.00 0.00 0.00 XXX 1.25 Mobile arm support supinatorL3975 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHFO cap design w/o jnt CFL3976 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHFO airplane w/o jnts CFL3977 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHFO cap desgn w/jnt(s) CFL3978 C 0.00 0.00 0.00 0.00 XXX 0.00 SEWHFO airplane w/jnt(s) CFL3980 C 526.06 0.00 0.00 0.00 XXX 2.50 Upp ext fx orthosis humeralL3982 C 526.06 0.00 0.00 0.00 XXX 2.50 Upper ext fx orthosis rad/ul
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L3984 C 479.84 0.00 0.00 0.00 XXX 1.25 Upper ext fx orthosis wristL3985 C 809.12 0.00 0.00 0.00 XXX 1.25 Forearm hand fx orth w/ wr hL3986 C 724.49 0.00 0.00 0.00 XXX 1.25 Humeral rad/ulna wrist fx orL3995 C 46.76 0.00 0.00 0.00 XXX 1.25 Sock fracture or equal eachL3999 S 0.00 0.00 0.00 0.00 XXX 0.00 Upper limb orthosis, NOSL4000 C 901.84 0.00 0.00 0.00 XXX 2.50 Repl girdle milwaukee orthL4002 C 0.00 0.00 0.00 0.00 XXX 0.00 Replace strap, any orthosisL4010 C 528.18 0.00 0.00 0.00 XXX 2.50 Replace trilateral socket brL4020 C 586.84 0.00 0.00 0.00 XXX 2.50 Replace quadlat socket brimL4030 C 935.22 0.00 0.00 0.00 XXX 1.25 Replace socket brim cust fitL4040 C 561.12 0.00 0.00 0.00 XXX 2.50 Replace molded thigh lacerL4045 C 604.34 0.00 0.00 0.00 XXX 1.25 Replace non-molded thigh lacL4050 C 935.22 0.00 0.00 0.00 XXX 1.25 Replace molded calf lacerL4055 C 561.89 0.00 0.00 0.00 XXX 1.25 Replace non-molded calf laceL4060 C 564.87 0.00 0.00 0.00 XXX 1.25 Replace high roll cuffL4070 C 777.25 0.00 0.00 0.00 XXX 1.25 Replace prox & dist uprightL4080 C 126.90 0.00 0.00 0.00 XXX 1.25 Repl met band kafo-afo proxL4090 C 116.91 0.00 0.00 0.00 XXX 1.25 Repl met band kafo-afo calf/L4100 C 140.28 0.00 0.00 0.00 XXX 1.25 Repl leath cuff kafo prox thL4110 C 140.28 0.00 0.00 0.00 XXX 1.25 Repl leath cuff kafo-afo calL4130 C 668.10 0.00 0.00 0.00 XXX 1.25 Replace pretibial shellL4205 C 21.25 0.00 0.00 0.00 XXX 1.25 Ortho dvc repair, per 15 minL4210 C 0.00 0.00 0.00 0.00 XXX 0.00 Orth dev, repair/repl minor partsL4350 C 169.81 0.00 0.00 0.00 XXX 1.25 Ankle control orthosi prefabL4360 C 347.37 0.00 0.00 0.00 XXX 1.25 Pneumati walking boot prefabL4370 C 236.85 0.00 0.00 0.00 XXX 1.25 Pneumatic full leg splintL4380 C 134.76 0.00 0.00 0.00 XXX 1.25 Pneumatic knee splintL4386 C 171.31 0.00 0.00 0.00 XXX 1.25 Non-pneum walk boot prefabL4392 C 27.74 0.00 0.00 0.00 XXX 1.25 Replace AFO soft interfaceL4394 C 20.25 0.00 0.00 0.00 XXX 1.25 Replace foot drop spintL4396 C 197.79 0.00 0.00 0.00 XXX 1.25 Static AFOL4398 C 91.05 0.00 0.00 0.00 XXX 1.25 Foot drop splint recumbentL5000 C 818.30 0.00 0.00 0.00 XXX 1.25 Sho insert w arch toe fillerL5010 C 807.30 0.00 0.00 0.00 XXX 2.50 Mold socket ank hgt w/ toe fL5020 C 743.39 0.00 0.00 0.00 XXX 5.00 Tibial tubercle hgt w/ toe fL5050 C 779.34 0.00 0.00 0.00 XXX 5.00 Ank symes mold sckt sach ftL5060 C 972.03 0.00 0.00 0.00 XXX 5.00 Symes met fr leath socket arL5100 C 779.34 0.00 0.00 0.00 XXX 5.00 Molded socket shin sach footL5105 C 919.59 0.00 0.00 0.00 XXX 7.50 Plast socket jts/thgh lacerL5150 C 909.24 0.00 0.00 0.00 XXX 7.50 Mold sckt ext knee shin sachL5160 C 765.24 0.00 0.00 0.00 XXX 10.00 Mold socket bent knee shin sL5200 C 805.33 0.00 0.00 0.00 XXX 7.50 Kne sing axis fric shin sachL5210 C 753.37 0.00 0.00 0.00 XXX 7.50 No knee/ankle joints w/ ft bL5220 C 763.36 0.00 0.00 0.00 XXX 7.50 No knee joint with artic aliL5230 C 966.37 0.00 0.00 0.00 XXX 7.50 Fem focal defic constant friL5250 C 844.29 0.00 0.00 0.00 XXX 15.00 Hip canad sing axi cons fricL5270 C 948.25 0.00 0.00 0.00 XXX 12.50 Tilt table locking hip singL5280 C 882.49 0.00 0.00 0.00 XXX 15.00 Hemipelvect canad sing axisL5301 C 886.57 0.00 0.00 0.00 XXX 5.00 BK mold socket SACH ft endoL5311 C 734.80 0.00 0.00 0.00 XXX 7.50 Knee disartL5321 C 915.71 0.00 0.00 0.00 XXX 7.50 AK open end SACHL5331 C 769.50 0.00 0.00 0.00 XXX 10.00 Hip disart canadian SACH ftL5341 C 882.35 0.00 0.00 0.00 XXX 15.00 Hemipelvectomy canadian SACHL5400 C 879.50 0.00 0.00 0.00 XXX 2.50 Postop dress & 1 cast chg bk
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L5410 C 558.46 0.00 0.00 0.00 XXX 1.25 Postop dsg bk ea add cast chL5420 C 550.50 0.00 0.00 0.00 XXX 5.00 Postop dsg & 1 cast chg ak/dL5430 C 745.06 0.00 0.00 0.00 XXX 1.25 Postop dsg ak ea add cast chL5450 C 544.55 0.00 0.00 0.00 XXX 1.25 Postop app non-wgt bear dsgL5460 C 728.82 0.00 0.00 0.00 XXX 1.25 Postop app non-wgt bear dsgL5500 C 935.22 0.00 0.00 0.00 XXX 2.50 Init bk ptb plaster directL5505 C 818.31 0.00 0.00 0.00 XXX 5.00 Init ak ischal plstr directL5510 C 623.48 0.00 0.00 0.00 XXX 5.00 Prep BK ptb plaster moldedL5520 C 623.48 0.00 0.00 0.00 XXX 5.00 Perp BK ptb thermopls directL5530 C 664.42 0.00 0.00 0.00 XXX 5.00 Prep BK ptb thermopls moldedL5535 C 727.47 0.00 0.00 0.00 XXX 5.00 Prep BK ptb open end socketL5540 C 642.96 0.00 0.00 0.00 XXX 5.00 Prep BK ptb laminated socketL5560 C 935.22 0.00 0.00 0.00 XXX 5.00 Prep AK ischial plast moldedL5570 C 701.88 0.00 0.00 0.00 XXX 5.00 Prep AK ischial direct formL5580 C 848.02 0.00 0.00 0.00 XXX 5.00 Prep AK ischial thermo moldL5585 C 935.22 0.00 0.00 0.00 XXX 5.00 Prep AK ischial open endL5590 C 935.22 0.00 0.00 0.00 XXX 5.00 Prep AK ischial laminatedL5595 C 916.77 0.00 0.00 0.00 XXX 12.50 Hip disartic sach thermoplsL5600 C 824.86 0.00 0.00 0.00 XXX 12.50 Hip disart sach laminat moldL5610 C 779.34 0.00 0.00 0.00 XXX 5.00 Above knee hydracadenceL5611 C 562.37 0.00 0.00 0.00 XXX 5.00 Ak 4 bar link w/fric swingL5613 C 933.74 0.00 0.00 0.00 XXX 5.00 Ak 4 bar ling w/hydraul swigL5614 C 913.35 0.00 0.00 0.00 XXX 2.50 4-bar link above knee w/swngL5616 C 907.67 0.00 0.00 0.00 XXX 2.50 Ak univ multiplex sys frictL5617 C 605.69 0.00 0.00 0.00 XXX 1.25 AK/BK self-aligning unit eaL5618 C 375.90 0.00 0.00 0.00 XXX 1.25 Test socket symesL5620 C 396.30 0.00 0.00 0.00 XXX 1.25 Test socket below kneeL5622 C 506.58 0.00 0.00 0.00 XXX 2.50 Test socket knee disarticulaL5624 C 554.76 0.00 0.00 0.00 XXX 1.25 Test socket above kneeL5626 C 623.49 0.00 0.00 0.00 XXX 2.50 Test socket hip disarticulatL5628 C 529.96 0.00 0.00 0.00 XXX 2.50 Test socket hemipelvectomyL5629 C 467.61 0.00 0.00 0.00 XXX 1.25 Below knee acrylic socketL5630 C 603.64 0.00 0.00 0.00 XXX 1.25 Syme typ expandabl wall scktL5631 C 701.43 0.00 0.00 0.00 XXX 1.25 Ak/knee disartic acrylic socL5632 C 296.79 0.00 0.00 0.00 XXX 1.25 Symes type ptb brim design sL5634 C 547.89 0.00 0.00 0.00 XXX 1.25 Symes type poster opening soL5636 C 340.57 0.00 0.00 0.00 XXX 1.25 Symes type medial opening soL5637 C 506.58 0.00 0.00 0.00 XXX 2.50 Below knee total contactL5638 C 768.54 0.00 0.00 0.00 XXX 1.25 Below knee leather socketL5639 C 740.38 0.00 0.00 0.00 XXX 5.00 Below knee wood socketL5640 C 855.65 0.00 0.00 0.00 XXX 1.25 Knee disarticulat leather soL5642 C 828.13 0.00 0.00 0.00 XXX 1.25 Above knee leather socketL5643 C 520.09 0.00 0.00 0.00 XXX 5.00 Hip flex inner socket ext frL5644 C 789.46 0.00 0.00 0.00 XXX 1.25 Above knee wood socketL5645 C 533.24 0.00 0.00 0.00 XXX 2.50 Bk flex inner socket ext fraL5646 C 732.35 0.00 0.00 0.00 XXX 1.25 Below knee cushion socketL5647 C 650.64 0.00 0.00 0.00 XXX 2.50 Below knee suction socketL5648 C 879.99 0.00 0.00 0.00 XXX 1.25 Above knee cushion socketL5649 C 617.84 0.00 0.00 0.00 XXX 5.00 Isch containmt/narrow m-l soL5650 C 545.54 0.00 0.00 0.00 XXX 2.50 Tot contact ak/knee disart sL5651 C 802.58 0.00 0.00 0.00 XXX 2.50 Ak flex inner socket ext fraL5652 C 584.51 0.00 0.00 0.00 XXX 2.50 Suction susp ak/knee disartL5653 C 779.34 0.00 0.00 0.00 XXX 2.50 Knee disart expand wall sockL5654 C 443.27 0.00 0.00 0.00 XXX 1.25 Socket insert symes
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L5655 C 857.28 0.00 0.00 0.00 XXX 1.25 Socket insert below kneeL5656 C 546.21 0.00 0.00 0.00 XXX 1.25 Socket insert knee articulatL5658 C 857.28 0.00 0.00 0.00 XXX 1.25 Socket insert above kneeL5661 C 829.48 0.00 0.00 0.00 XXX 1.25 Multi-durometer symesL5665 C 859.09 0.00 0.00 0.00 XXX 1.25 Multi-durometer below kneeL5666 C 108.54 0.00 0.00 0.00 XXX 1.25 Below knee cuff suspensionL5668 C 152.62 0.00 0.00 0.00 XXX 1.25 Socket insert w/o lock lowerL5670 C 406.73 0.00 0.00 0.00 XXX 1.25 Bk molded supracondylar suspL5671 C 942.47 0.00 0.00 0.00 XXX 1.25 BK/AK locking mechanismL5672 C 398.56 0.00 0.00 0.00 XXX 1.25 Bk removable medial brim susL5673 C 979.86 0.00 0.00 0.00 XXX 1.25 Socket insert w lock mechL5676 C 740.39 0.00 0.00 0.00 XXX 1.25 Bk knee joints single axis pL5677 C 888.74 0.00 0.00 0.00 XXX 1.25 Bk knee joints polycentric pL5678 C 87.95 0.00 0.00 0.00 XXX 1.25 Bk joint covers pairL5679 C 816.55 0.00 0.00 0.00 XXX 1.25 Socket insert w/o lock mechL5680 C 390.74 0.00 0.00 0.00 XXX 1.25 Bk thigh lacer non-moldedL5681 C 711.97 0.00 0.00 0.00 XXX 2.50 Intl custm cong/latyp insertL5682 C 510.58 0.00 0.00 0.00 XXX 2.50 Bk thigh lacer glut/ischia mL5683 C 711.97 0.00 0.00 0.00 XXX 2.50 Initial custom socket insertL5684 C 114.88 0.00 0.00 0.00 XXX 1.25 Bk fork strapL5685 C 138.69 0.00 0.00 0.00 XXX 1.25 Below knee sus/seal sleeveL5686 C 68.27 0.00 0.00 0.00 XXX 1.25 Bk back checkL5688 C 117.14 0.00 0.00 0.00 XXX 1.25 Bk waist belt webbingL5690 C 143.02 0.00 0.00 0.00 XXX 1.25 Bk waist belt padded and linL5692 C 240.34 0.00 0.00 0.00 XXX 1.25 Ak pelvic control belt lightL5694 C 307.86 0.00 0.00 0.00 XXX 1.25 Ak pelvic control belt pad/lL5695 C 227.25 0.00 0.00 0.00 XXX 1.25 Ak sleeve susp neoprene/equaL5696 C 298.69 0.00 0.00 0.00 XXX 1.25 Ak/knee disartic pelvic joinL5697 C 129.77 0.00 0.00 0.00 XXX 1.25 Ak/knee disartic pelvic bandL5698 C 163.15 0.00 0.00 0.00 XXX 1.25 Ak/knee disartic silesian baL5699 C 347.91 0.00 0.00 0.00 XXX 1.25 Shoulder harnessL5700 C 915.09 0.00 0.00 0.00 XXX 5.00 Replace socket below kneeL5701 C 757.44 0.00 0.00 0.00 XXX 7.50 Replace socket above kneeL5702 C 817.35 0.00 0.00 0.00 XXX 10.00 Replace socket hipL5703 C 0.00 0.00 0.00 0.00 XXX 0.00 Symes ankle w/o (SACH) footL5704 C 662.20 0.00 0.00 0.00 XXX 1.25 Custom shape cover BKL5705 C 591.61 0.00 0.00 0.00 XXX 2.50 Custom shape cover AKL5706 C 579.95 0.00 0.00 0.00 XXX 2.50 Custom shape cvr knee disartL5707 C 764.57 0.00 0.00 0.00 XXX 2.50 Custom shape cvr hip disartL5710 C 686.21 0.00 0.00 0.00 XXX 1.25 Kne-shin exo sng axi mnl locL5711 C 806.32 0.00 0.00 0.00 XXX 1.25 Knee-shin exo mnl lock ultraL5712 C 797.28 0.00 0.00 0.00 XXX 1.25 Knee-shin exo frict swg & stL5714 C 512.63 0.00 0.00 0.00 XXX 1.25 Knee-shin exo variable frictL5716 C 625.35 0.00 0.00 0.00 XXX 2.50 Knee-shin exo mech stance phL5718 C 674.02 0.00 0.00 0.00 XXX 2.50 Knee-shin exo frct swg & staL5722 C 584.14 0.00 0.00 0.00 XXX 2.50 Knee-shin pneum swg frct exoL5724 C 517.88 0.00 0.00 0.00 XXX 5.00 Knee-shin exo fluid swing phL5726 C 581.28 0.00 0.00 0.00 XXX 5.00 Knee-shin ext jnts fld swg eL5728 C 961.22 0.00 0.00 0.00 XXX 5.00 Knee-shin fluid swg & stanceL5780 C 959.27 0.00 0.00 0.00 XXX 2.50 Knee-shin pneum/hydra pneumL5781 C 721.90 0.00 0.00 0.00 XXX 7.50 Lower limb pros vacuum pumpL5782 C 761.04 0.00 0.00 0.00 XXX 7.50 HD low limb pros vacuum pumpL5785 C 694.44 0.00 0.00 0.00 XXX 1.25 Exoskeletal bk ultralt materL5790 C 961.06 0.00 0.00 0.00 XXX 1.25 Exoskeletal ak ultra-light m
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L5795 C 717.56 0.00 0.00 0.00 XXX 2.50 Exoskel hip ultra-light mateL5810 C 924.75 0.00 0.00 0.00 XXX 1.25 Endoskel knee-shin mnl lockL5811 C 676.23 0.00 0.00 0.00 XXX 2.50 Endo knee-shin mnl lck ultraL5812 C 516.97 0.00 0.00 0.00 XXX 2.50 Endo knee-shin frct swg & stL5814 C 670.06 0.00 0.00 0.00 XXX 7.50 Endo knee-shin hydral swg phL5816 C 828.42 0.00 0.00 0.00 XXX 2.50 Endo knee-shin polyc mch staL5818 C 834.70 0.00 0.00 0.00 XXX 2.50 Endo knee-shin frct swg & stL5822 C 569.03 0.00 0.00 0.00 XXX 5.00 Endo knee-shin pneum swg frcL5824 C 721.45 0.00 0.00 0.00 XXX 5.00 Endo knee-shin fluid swing pL5826 C 921.98 0.00 0.00 0.00 XXX 5.00 Miniature knee jointL5828 C 676.47 0.00 0.00 0.00 XXX 7.50 Endo knee-shin fluid swg/staL5830 C 860.91 0.00 0.00 0.00 XXX 5.00 Endo knee-shin pneum/swg phaL5840 C 722.42 0.00 0.00 0.00 XXX 7.50 Multi-axial knee/shin systemL5845 C 529.17 0.00 0.00 0.00 XXX 5.00 Knee-shin sys stance flexionL5848 C 582.02 0.00 0.00 0.00 XXX 2.50 Knee-shin sys hydraul stanceL5850 C 170.99 0.00 0.00 0.00 XXX 1.25 Endo ak/hip knee extens assiL5855 C 424.67 0.00 0.00 0.00 XXX 1.25 Mech hip extension assistL5856 C 928.11 0.00 0.00 0.00 XXX 35.00 Elec knee-shin swing/stanceL5857 C 922.11 0.00 0.00 0.00 XXX 12.50 Elec knee-shin swing onlyL5858 C 838.29 0.00 0.00 0.00 XXX 30.00 Stance phase onlyL5910 C 701.43 0.00 0.00 0.00 XXX 1.25 Endo below knee alignable syL5920 C 701.41 0.00 0.00 0.00 XXX 2.50 Endo ak/hip alignable systemL5925 C 608.10 0.00 0.00 0.00 XXX 1.25 Above knee manual lockL5930 C 910.92 0.00 0.00 0.00 XXX 5.00 High activity knee frameL5940 C 935.22 0.00 0.00 0.00 XXX 1.25 Endo bk ultra-light materialL5950 C 519.95 0.00 0.00 0.00 XXX 2.50 Endo ak ultra-light materialL5960 C 954.71 0.00 0.00 0.00 XXX 2.50 Endo hip ultra-light materiaL5962 C 785.65 0.00 0.00 0.00 XXX 1.25 Below knee flex cover systemL5964 C 576.55 0.00 0.00 0.00 XXX 2.50 Above knee flex cover systemL5966 C 747.47 0.00 0.00 0.00 XXX 2.50 Hip flexible cover systemL5968 C 715.24 0.00 0.00 0.00 XXX 7.50 Multiaxial ankle w dorsiflexL5970 C 285.42 0.00 0.00 0.00 XXX 1.25 Foot external keel sach footL5971 C 0.00 0.00 0.00 0.00 XXX 0.00 SACH foot, replacementL5972 C 600.99 0.00 0.00 0.00 XXX 1.25 Flexible keel footL5974 C 433.97 0.00 0.00 0.00 XXX 1.25 Foot single axis ankle/footL5975 C 547.46 0.00 0.00 0.00 XXX 1.25 Combo ankle/foot prosthesisL5976 C 984.33 0.00 0.00 0.00 XXX 1.25 Energy storing footL5978 C 534.09 0.00 0.00 0.00 XXX 1.25 Ft prosth multiaxial ankl/ftL5979 C 762.46 0.00 0.00 0.00 XXX 5.00 Multi-axial ankle/ft prosthL5980 C 945.61 0.00 0.00 0.00 XXX 7.50 Flex foot systemL5981 C 925.12 0.00 0.00 0.00 XXX 5.00 Flex-walk sys low ext prosthL5982 C 879.48 0.00 0.00 0.00 XXX 1.25 Exoskeletal axial rotation uL5984 C 961.14 0.00 0.00 0.00 XXX 1.25 Endoskeletal axial rotationL5985 C 305.70 0.00 0.00 0.00 XXX 1.25 Lwr ext dynamic prosth pylonL5986 C 563.05 0.00 0.00 0.00 XXX 2.50 Multi-axial rotation unitL5987 C 973.43 0.00 0.00 0.00 XXX 10.00 Shank ft w vert load pylonL5988 C 589.79 0.00 0.00 0.00 XXX 5.00 Vertical shock reducing pyloL5990 C 981.95 0.00 0.00 0.00 XXX 2.50 User adjustable heel heightL5995 C 0.00 0.00 0.00 0.00 XXX 0.00 Lower ext pros heavyduty feaL5999 S 0.00 0.00 0.00 0.00 XXX 0.00 Lowr extremity prosthes, NOSL6000 C 602.10 0.00 0.00 0.00 XXX 5.00 Par hand robin-aids thum remL6010 C 681.47 0.00 0.00 0.00 XXX 5.00 Hand robin-aids little/ringL6020 C 624.03 0.00 0.00 0.00 XXX 5.00 Part hand robin-aids no fingL6025 C 866.28 0.00 0.00 0.00 XXX 12.50 Part hand disart myoelectric
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L6050 C 698.92 0.00 0.00 0.00 XXX 5.00 Wrst MLd sck flx hng tri padL6055 C 894.63 0.00 0.00 0.00 XXX 5.00 Wrst mold sock w/exp interfaL6100 C 643.12 0.00 0.00 0.00 XXX 5.00 Elb mold sock flex hinge padL6110 C 761.89 0.00 0.00 0.00 XXX 5.00 Elbow mold sock suspension tL6120 C 856.01 0.00 0.00 0.00 XXX 5.00 Elbow mold doub splt soc steL6130 C 761.78 0.00 0.00 0.00 XXX 7.50 Elbow stump activated lock hL6200 C 677.11 0.00 0.00 0.00 XXX 7.50 Elbow mold outsid lock hingeL6205 C 825.93 0.00 0.00 0.00 XXX 7.50 Elbow molded w/ expand interL6250 C 721.26 0.00 0.00 0.00 XXX 7.50 Elbow inter loc elbow forarmL6300 C 941.61 0.00 0.00 0.00 XXX 7.50 Shlder disart int lock elbowL6310 C 759.27 0.00 0.00 0.00 XXX 7.50 Shoulder passive restor compL6320 C 730.77 0.00 0.00 0.00 XXX 5.00 Shoulder passive restor capL6350 C 946.63 0.00 0.00 0.00 XXX 7.50 Thoracic intern lock elbowL6360 C 763.81 0.00 0.00 0.00 XXX 10.00 Thoracic passive restor compL6370 C 800.82 0.00 0.00 0.00 XXX 5.00 Thoracic passive restor capL6380 C 857.28 0.00 0.00 0.00 XXX 2.50 Postop dsg cast chg wrst/elbL6382 C 701.41 0.00 0.00 0.00 XXX 5.00 Postop dsg cast chg elb dis/L6384 C 818.31 0.00 0.00 0.00 XXX 5.00 Postop dsg cast chg shlder/tL6386 C 584.51 0.00 0.00 0.00 XXX 2.50 Postop ea cast chg & realignL6388 C 587.60 0.00 0.00 0.00 XXX 1.25 Postop applicat rigid dsg onL6400 C 867.62 0.00 0.00 0.00 XXX 5.00 Below elbow prosth tiss shapL6450 C 686.82 0.00 0.00 0.00 XXX 7.50 Elb disart prosth tiss shapL6500 C 675.40 0.00 0.00 0.00 XXX 7.50 Above elbow prosth tiss shapL6550 C 762.79 0.00 0.00 0.00 XXX 10.00 Shldr disar prosth tiss shapL6570 C 883.78 0.00 0.00 0.00 XXX 10.00 Scap thorac prosth tiss shapL6580 C 508.91 0.00 0.00 0.00 XXX 5.00 Wrist/elbow bowden cable molL6582 C 545.54 0.00 0.00 0.00 XXX 5.00 Wrist/elbow bowden cbl dir fL6584 C 701.41 0.00 0.00 0.00 XXX 5.00 Elbow fair lead cable moldedL6586 C 623.48 0.00 0.00 0.00 XXX 5.00 Elbow fair lead cable dir foL6588 C 898.17 0.00 0.00 0.00 XXX 5.00 Shdr fair lead cable moldedL6590 C 812.75 0.00 0.00 0.00 XXX 5.00 Shdr fair lead cable directL6600 C 335.19 0.00 0.00 0.00 XXX 1.25 Polycentric hinge pairL6605 C 348.09 0.00 0.00 0.00 XXX 1.25 Single pivot hinge pairL6610 C 290.86 0.00 0.00 0.00 XXX 1.25 Flexible metal hinge pairL6615 C 216.00 0.00 0.00 0.00 XXX 1.25 Disconnect locking wrist uniL6616 C 86.69 0.00 0.00 0.00 XXX 1.25 Disconnect insert locking wrL6620 C 420.76 0.00 0.00 0.00 XXX 1.25 Flexion/extension wrist unitL6621 C 0.00 0.00 0.00 0.00 XXX 0.00 Flex/ext wrist w/wo frictionL6623 C 857.39 0.00 0.00 0.00 XXX 1.25 Spring-ass rot wrst w/ latchL6625 C 972.68 0.00 0.00 0.00 XXX 1.25 Rotation wrst w/ cable lockL6628 C 640.30 0.00 0.00 0.00 XXX 1.25 Quick disconn hook adapter oL6629 C 195.55 0.00 0.00 0.00 XXX 1.25 Lamination collar w/ couplinL6630 C 288.06 0.00 0.00 0.00 XXX 1.25 Stainless steel any wristL6632 C 86.84 0.00 0.00 0.00 XXX 1.25 Latex suspension sleeve eachL6635 C 268.75 0.00 0.00 0.00 XXX 1.25 Lift assist for elbowL6637 C 490.79 0.00 0.00 0.00 XXX 1.25 Nudge control elbow lockL6638 C 676.77 0.00 0.00 0.00 XXX 5.00 Elec lock on manual pw elbowL6640 C 374.40 0.00 0.00 0.00 XXX 1.25 Shoulder abduction joint paiL6641 C 275.86 0.00 0.00 0.00 XXX 1.25 Excursion amplifier pulley tL6642 C 545.54 0.00 0.00 0.00 XXX 1.25 Excursion amplifier lever tyL6645 C 487.92 0.00 0.00 0.00 XXX 1.25 Shoulder flexion-abduction jL6646 C 853.57 0.00 0.00 0.00 XXX 5.00 Multipo locking shoulder jntL6647 C 562.06 0.00 0.00 0.00 XXX 1.25 Shoulder lock actuatorL6648 C 880.33 0.00 0.00 0.00 XXX 5.00 Ext pwrd shlder lock/unlock
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L6650 C 509.35 0.00 0.00 0.00 XXX 1.25 Shoulder universal jointL6655 C 127.90 0.00 0.00 0.00 XXX 1.25 Standard control cable extraL6660 C 171.22 0.00 0.00 0.00 XXX 1.25 Heavy duty control cableL6665 C 61.56 0.00 0.00 0.00 XXX 1.25 Teflon or equal cable liningL6670 C 97.65 0.00 0.00 0.00 XXX 1.25 Hook to hand cable adapterL6672 C 467.61 0.00 0.00 0.00 XXX 1.25 Harness chest/shlder saddleL6675 C 166.38 0.00 0.00 0.00 XXX 1.25 Harness figure of 8 sing conL6676 C 202.45 0.00 0.00 0.00 XXX 1.25 Harness figure of 8 dual conL6677 C 0.00 0.00 0.00 0.00 XXX 0.00 UE triple control harnessL6680 C 639.06 0.00 0.00 0.00 XXX 1.25 Test sock wrist disart/bel eL6682 C 794.95 0.00 0.00 0.00 XXX 1.25 Test sock elbw disart/aboveL6684 C 628.24 0.00 0.00 0.00 XXX 1.25 Test socket shldr disart/thoL6686 C 557.23 0.00 0.00 0.00 XXX 2.50 Suction socketL6687 C 623.49 0.00 0.00 0.00 XXX 2.50 Frame typ socket bel elbow/wL6688 C 619.59 0.00 0.00 0.00 XXX 2.50 Frame typ sock above elb/disL6689 C 720.91 0.00 0.00 0.00 XXX 2.50 Frame typ socket shoulder diL6690 C 759.87 0.00 0.00 0.00 XXX 2.50 Frame typ sock interscap-thoL6691 C 662.46 0.00 0.00 0.00 XXX 1.25 Removable insert eachL6692 C 935.22 0.00 0.00 0.00 XXX 1.25 Silicone gel insert or equalL6693 C 838.17 0.00 0.00 0.00 XXX 5.00 Lockingelbow forearm cntrbalL6694 C 0.00 0.00 0.00 0.00 XXX 0.00 Elbow socket ins use w/lockL6695 C 0.00 0.00 0.00 0.00 XXX 0.00 Elbow socket ins use w/o lckL6696 C 0.00 0.00 0.00 0.00 XXX 0.00 Cus elbo skt in for con/atypL6697 C 0.00 0.00 0.00 0.00 XXX 0.00 Cus elbo skt in not con/atypL6698 C 0.00 0.00 0.00 0.00 XXX 0.00 Below/above elbow lock mechL6700 C 765.88 0.00 0.00 0.00 XXX 1.25 Terminal device model #3L6705 C 469.08 0.00 0.00 0.00 XXX 1.25 Terminal device model #5L6710 C 451.31 0.00 0.00 0.00 XXX 1.25 Terminal device model #5xL6715 C 462.65 0.00 0.00 0.00 XXX 1.25 Terminal device model #5xaL6720 C 628.25 0.00 0.00 0.00 XXX 2.50 Terminal device model #6L6725 C 576.06 0.00 0.00 0.00 XXX 1.25 Terminal device model #7L6730 C 506.74 0.00 0.00 0.00 XXX 2.50 Terminal device model #7loL6735 C 412.10 0.00 0.00 0.00 XXX 1.25 Terminal device model #8L6740 C 623.19 0.00 0.00 0.00 XXX 1.25 Terminal device model #8xL6745 C 517.89 0.00 0.00 0.00 XXX 1.25 Terminal device model #88xL6750 C 546.43 0.00 0.00 0.00 XXX 1.25 Terminal device model #10pL6755 C 543.56 0.00 0.00 0.00 XXX 1.25 Terminal device model #10xL6765 C 485.72 0.00 0.00 0.00 XXX 1.25 Terminal device model #12pL6770 C 472.92 0.00 0.00 0.00 XXX 1.25 Terminal device model #99xL6775 C 535.63 0.00 0.00 0.00 XXX 1.25 Terminal device model#555L6780 C 676.92 0.00 0.00 0.00 XXX 1.25 Terminal device model #ss555L6790 C 603.97 0.00 0.00 0.00 XXX 1.25 Hooks-accu hook or equalL6795 C 501.31 0.00 0.00 0.00 XXX 5.00 Hooks-2 load or equalL6800 C 929.63 0.00 0.00 0.00 XXX 2.50 Hooks-aprl vc or equalL6805 C 454.24 0.00 0.00 0.00 XXX 1.25 Modifier wrist flexion unitL6806 C 875.40 0.00 0.00 0.00 XXX 2.50 Trs grip vc or equalL6807 C 545.54 0.00 0.00 0.00 XXX 5.00 Term device grip1/2 or equalL6808 C 935.22 0.00 0.00 0.00 XXX 2.50 Term device infant or childL6809 C 573.60 0.00 0.00 0.00 XXX 2.50 Trs super sport passiveL6810 C 249.33 0.00 0.00 0.00 XXX 1.25 Pincher tool otto bock or eqL6825 C 759.87 0.00 0.00 0.00 XXX 2.50 Hands dorrance voL6830 C 577.98 0.00 0.00 0.00 XXX 5.00 Hand aprl vcL6835 C 508.81 0.00 0.00 0.00 XXX 5.00 Hand sierra voL6840 C 779.34 0.00 0.00 0.00 XXX 2.50 Hand becker imperial
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L6845 C 779.34 0.00 0.00 0.00 XXX 2.50 Hand becker lock gripL6850 C 642.96 0.00 0.00 0.00 XXX 2.50 Term dvc-hand becker plyliteL6855 C 857.28 0.00 0.00 0.00 XXX 2.50 Hand robin-aids voL6860 C 949.85 0.00 0.00 0.00 XXX 1.25 Hand robin-aids vo softL6865 C 435.24 0.00 0.00 0.00 XXX 1.25 Hand passive handL6867 C 666.34 0.00 0.00 0.00 XXX 5.00 Hand detroit infant handL6868 C 332.91 0.00 0.00 0.00 XXX 1.25 Passive inf hand steeper/hosL6870 C 311.20 0.00 0.00 0.00 XXX 1.25 Hand child mittL6872 C 584.86 0.00 0.00 0.00 XXX 2.50 Hand nyu child handL6873 C 625.26 0.00 0.00 0.00 XXX 1.25 Hand mech inf steeper or equL6875 C 518.72 0.00 0.00 0.00 XXX 2.50 Hand bock vcL6880 C 954.54 0.00 0.00 0.00 XXX 1.25 Hand bock voL6881 C 737.60 0.00 0.00 0.00 XXX 7.50 Autograsp feature ul term dvL6882 C 839.27 0.00 0.00 0.00 XXX 5.00 Microprocessor control uplmbL6883 C 0.00 0.00 0.00 0.00 XXX 0.00 Replc sockt below e/w disaL6884 C 0.00 0.00 0.00 0.00 XXX 0.00 Replc sockt above elbow disaL6885 C 0.00 0.00 0.00 0.00 XXX 0.00 Replc sockt shldr dis/intercL6890 C 701.43 0.00 0.00 0.00 XXX 1.25 Production gloveL6895 C 746.35 0.00 0.00 0.00 XXX 1.25 Custom gloveL6900 C 548.84 0.00 0.00 0.00 XXX 5.00 Hand restorat thumb/1 fingerL6905 C 589.76 0.00 0.00 0.00 XXX 5.00 Hand restoration multiple fiL6910 C 818.25 0.00 0.00 0.00 XXX 5.00 Hand restoration no fingersL6915 C 894.80 0.00 0.00 0.00 XXX 1.25 Hand restoration replacmnt gL6920 C 857.28 0.00 0.00 0.00 XXX 12.50 Wrist disarticul switch ctrlL6925 C 921.21 0.00 0.00 0.00 XXX 12.50 Wrist disart myoelectronic cL6930 C 854.47 0.00 0.00 0.00 XXX 12.50 Below elbow switch controlL6935 C 917.37 0.00 0.00 0.00 XXX 12.50 Below elbow myoelectronic ctL6940 C 977.26 0.00 0.00 0.00 XXX 15.00 Elbow disarticulation switchL6945 C 901.12 0.00 0.00 0.00 XXX 20.00 Elbow disart myoelectronic cL6950 C 901.12 0.00 0.00 0.00 XXX 20.00 Above elbow switch controlL6955 C 997.74 0.00 0.00 0.00 XXX 20.00 Above elbow myoelectronic ctL6960 C 805.04 0.00 0.00 0.00 XXX 25.00 Shldr disartic switch controL6965 C 947.17 0.00 0.00 0.00 XXX 25.00 Shldr disartic myoelectronicL6970 C 962.73 0.00 0.00 0.00 XXX 25.00 Interscapular-thor switch ctL6975 C 998.43 0.00 0.00 0.00 XXX 25.00 Interscap-thor myoelectronicL7010 C 813.63 0.00 0.00 0.00 XXX 7.50 Hand otto back steeper/eq swL7015 C 969.69 0.00 0.00 0.00 XXX 10.00 Hand sys teknik village switL7020 C 758.06 0.00 0.00 0.00 XXX 7.50 Electronic greifer switch ctL7025 C 765.00 0.00 0.00 0.00 XXX 7.50 Electron hand myoelectronicL7030 C 828.09 0.00 0.00 0.00 XXX 10.00 Hand sys teknik vill myoelecL7035 C 783.45 0.00 0.00 0.00 XXX 7.50 Electron greifer myoelectroL7040 C 942.04 0.00 0.00 0.00 XXX 5.00 Prehensile actuator hosmer sL7045 C 540.10 0.00 0.00 0.00 XXX 5.00 Electron hook child michiganL7170 C 979.66 0.00 0.00 0.00 XXX 10.00 Electronic elbow hosmer switL7180 C 930.63 0.00 0.00 0.00 XXX 55.00 Electronic elbow utah myoeleL7181 C 985.79 0.00 0.00 0.00 XXX 55.00 Electronic elbo simultaneousL7185 C 992.03 0.00 0.00 0.00 XXX 10.00 Electron elbow adolescent swL7186 C 966.39 0.00 0.00 0.00 XXX 15.00 Electron elbow child switchL7190 C 914.91 0.00 0.00 0.00 XXX 15.00 Elbow adolescent myoelectronL7191 C 760.95 0.00 0.00 0.00 XXX 20.00 Elbow child myoelectronic ctL7260 C 818.31 0.00 0.00 0.00 XXX 5.00 Electron wrist rotator ottoL7261 C 825.34 0.00 0.00 0.00 XXX 7.50 Electron wrist rotator utahL7266 C 661.68 0.00 0.00 0.00 XXX 2.50 Servo control steeper or equL7272 C 740.38 0.00 0.00 0.00 XXX 5.00 Analogue control unb or equa
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L7274 C 830.01 0.00 0.00 0.00 XXX 12.50 Proportional ctl 12 volt utaL7360 C 397.48 0.00 0.00 0.00 XXX 1.25 Six volt bat otto bock/eq eaL7362 C 768.81 0.00 0.00 0.00 XXX 1.25 Battery chrgr six volt ottoL7364 C 768.81 0.00 0.00 0.00 XXX 1.25 Twelve volt battery utah/equL7366 C 848.08 0.00 0.00 0.00 XXX 1.25 Battery chrgr 12 volt utah/eL7367 C 421.46 0.00 0.00 0.00 XXX 1.25 Replacemnt lithium ionbatterL7368 C 546.36 0.00 0.00 0.00 XXX 1.25 Lithium ion battery chargerL7400 C 0.00 0.00 0.00 0.00 XXX 0.00 Add UE prost be/wd, ultliteL7401 C 0.00 0.00 0.00 0.00 XXX 0.00 Add UE prost a/e ultlite matL7402 C 0.00 0.00 0.00 0.00 XXX 0.00 Add UE prost s/d ultlite matL7403 C 0.00 0.00 0.00 0.00 XXX 0.00 Add UE prost b/e acrylicL7404 C 0.00 0.00 0.00 0.00 XXX 0.00 Add UE prost a/e acrylicL7405 C 0.00 0.00 0.00 0.00 XXX 0.00 Add UE prost s/d acrylicL7499 S 0.00 0.00 0.00 0.00 XXX 0.00 Upper extremity prosthes, NOSL7500 C 0.00 0.00 0.00 0.00 XXX 0.00 Repair prosthetic dvc, per hourL7510 C 0.00 0.00 0.00 0.00 XXX 0.00 Repair prosth dvc, rep/repl minor partsL7520 C 26.21 0.00 0.00 0.00 XXX 1.25 Repair prosthetic dvc, per 15 minL7600 C 0.00 0.00 0.00 0.00 XXX 0.00 Prosthetic donning sleeveL7900 C 639.15 0.00 0.00 0.00 XXX 1.25 Male vacuum erection systemL8000 C 64.00 0.00 0.00 0.00 XXX 1.25 Mastectomy braL8001 C 135.79 0.00 0.00 0.00 XXX 1.25 Breast prosthesis bra & formL8002 C 178.61 0.00 0.00 0.00 XXX 1.25 Brst prsth bra & bilat formL8010 C 67.45 0.00 0.00 0.00 XXX 1.25 Mastectomy sleeveL8015 C 70.76 0.00 0.00 0.00 XXX 1.25 Ext breastprosthesis garmentL8020 C 299.87 0.00 0.00 0.00 XXX 1.25 Mastectomy formL8030 C 421.67 0.00 0.00 0.00 XXX 1.25 Breast prosthesis silicone/eL8035 C 721.08 0.00 0.00 0.00 XXX 7.50 Custom breast prosthesisL8039 C 0.00 0.00 0.00 0.00 XXX 0.00 Breast prosthesis, NOSL8040 C 732.32 0.00 0.00 0.00 XXX 5.00 Nasal prosthesisL8040 C KM 695.70 0.00 0.00 0.00 XXX 5.00 Nasal prosthesisL8040 C KN 585.85 0.00 0.00 0.00 XXX 2.50 Nasal prosthesisL8041 C 882.68 0.00 0.00 0.00 XXX 5.00 Midfacial prosthesisL8041 C KM 838.55 0.00 0.00 0.00 XXX 5.00 Midfacial prosthesisL8041 C KN 706.14 0.00 0.00 0.00 XXX 2.50 Midfacial prosthesisL8042 C 991.78 0.00 0.00 0.00 XXX 5.00 Orbital prosthesisL8042 C KM 942.19 0.00 0.00 0.00 XXX 5.00 Orbital prosthesisL8042 C KN 793.42 0.00 0.00 0.00 XXX 2.50 Orbital prosthesisL8043 C 740.53 0.00 0.00 0.00 XXX 7.50 Upper facial prosthesisL8043 C KM 703.50 0.00 0.00 0.00 XXX 7.50 Upper facial prosthesisL8043 C KN 888.63 0.00 0.00 0.00 XXX 2.50 Upper facial prosthesisL8044 C 819.87 0.00 0.00 0.00 XXX 7.50 Hemi-facial prosthesisL8044 C KM 778.88 0.00 0.00 0.00 XXX 7.50 Hemi-facial prosthesisL8044 C KN 983.84 0.00 0.00 0.00 XXX 2.50 Hemi-facial prosthesisL8045 C 821.72 0.00 0.00 0.00 XXX 5.00 Auricular prosthesisL8045 C KM 780.63 0.00 0.00 0.00 XXX 5.00 Auricular prosthesisL8045 C KN 657.38 0.00 0.00 0.00 XXX 2.50 Auricular prosthesisL8046 C 793.42 0.00 0.00 0.00 XXX 5.00 Partial facial prosthesisL8046 C KM 753.75 0.00 0.00 0.00 XXX 5.00 Partial facial prosthesisL8046 C KN 634.74 0.00 0.00 0.00 XXX 2.50 Partial facial prosthesisL8047 C 813.26 0.00 0.00 0.00 XXX 2.50 Nasal septal prosthesisL8047 C KM 772.59 0.00 0.00 0.00 XXX 2.50 Nasal septal prosthesisL8047 C KN 650.61 0.00 0.00 0.00 XXX 1.25 Nasal septal prosthesisL8048 C 0.00 0.00 0.00 0.00 XXX 0.00 Unspec maxillofacial prosthL8049 C 22.85 0.00 0.00 0.00 XXX 1.25 Repair maxillofacial prosth
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L8100 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Compression stocking BK18-30L8110 C 64.89 0.00 0.00 0.00 XXX 1.25 12/31/2005 Compression stocking BK30-40L8110 C AW 64.89 0.00 0.00 0.00 XXX 1.25 12/31/2005 Compression stocking BK30-40L8120 C 91.46 0.00 0.00 0.00 XXX 1.25 12/31/2005 Compression stocking BK40-50L8120 C AW 91.46 0.00 0.00 0.00 XXX 1.25 12/31/2005 Compression stocking BK40-50L8130 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking thighlngth 18-30L8140 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking thighlngth 30-40L8150 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking thighlngth 40-50L8160 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking full lngth 18-30L8170 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking full lngth 30-40L8180 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking full lngth 40-50L8190 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking waistlngth 18-30L8195 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking waistlngth 30-40L8200 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking waistlngth 40-50L8210 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking custom madeL8220 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking lymphedemaL8230 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Gc stocking garter beltL8239 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 G compression stocking NOSL8300 C 213.64 0.00 0.00 0.00 XXX 1.25 Truss single w/ standard padL8310 C 229.72 0.00 0.00 0.00 XXX 1.25 Truss double w/ standard padL8320 C 86.64 0.00 0.00 0.00 XXX 1.25 Truss addition to std pad waL8330 C 80.99 0.00 0.00 0.00 XXX 1.25 Truss add to std pad scrotalL8400 C 25.66 0.00 0.00 0.00 XXX 1.25 Sheath below kneeL8410 C 29.56 0.00 0.00 0.00 XXX 1.25 Sheath above kneeL8415 C 28.65 0.00 0.00 0.00 XXX 1.25 Sheath upper limbL8417 C 81.42 0.00 0.00 0.00 XXX 1.25 Pros sheath/sock w gel cushnL8420 C 38.99 0.00 0.00 0.00 XXX 1.25 Prosthetic sock multi ply BKL8430 C 38.99 0.00 0.00 0.00 XXX 1.25 Prosthetic sock multi ply AKL8435 C 28.85 0.00 0.00 0.00 XXX 1.25 Pros sock multi ply upper lmL8440 C 80.99 0.00 0.00 0.00 XXX 1.25 Shrinker below kneeL8460 C 151.15 0.00 0.00 0.00 XXX 1.25 Shrinker above kneeL8465 C 65.20 0.00 0.00 0.00 XXX 1.25 Shrinker upper limbL8470 C 9.86 0.00 0.00 0.00 XXX 1.25 Pros sock single ply BKL8480 C 12.30 0.00 0.00 0.00 XXX 1.25 Pros sock single ply AKL8485 C 14.70 0.00 0.00 0.00 XXX 1.25 Pros sock single ply upper lL8499 S 0.00 0.00 0.00 0.00 XXX 0.00 Unlisted misc prosthetic serL8500 C 882.11 0.00 0.00 0.00 XXX 1.25 Artificial larynxL8501 C 161.46 0.00 0.00 0.00 XXX 1.25 Tracheostomy speaking valveL8505 C 0.00 0.00 0.00 0.00 XXX 0.00 Battery/access, art larynxL8507 C 45.36 0.00 0.00 0.00 XXX 1.25 Trach-esoph voice pros pt inL8509 C 118.23 0.00 0.00 0.00 XXX 1.25 Trach-esoph voice pros md inL8510 C 273.55 0.00 0.00 0.00 XXX 1.25 Voice amplifierL8511 C 85.89 0.00 0.00 0.00 XXX 1.25 Indwelling trach insertL8512 C 2.54 0.00 0.00 0.00 XXX 1.25 Gel cap for trach voice prosL8513 C 6.11 0.00 0.00 0.00 XXX 1.25 Trach pros cleaning deviceL8514 C 111.35 0.00 0.00 0.00 XXX 1.25 Repl trach puncture dilatorL8515 C 68.32 0.00 0.00 0.00 XXX 1.25 Gel cap app device for trachL8600 C 834.65 0.00 0.00 0.00 XXX 1.25 Implant breast silicone/eqL8603 C 441.58 0.00 0.00 0.00 XXX 1.25 Collagen imp urinary 2.5 mlL8606 C 230.77 0.00 0.00 0.00 XXX 1.25 Synthetic implnt urinary 1mlL8609 C 831.84 0.00 0.00 0.00 XXX 10.00 Artificial corneaL8610 C 782.34 0.00 0.00 0.00 XXX 1.25 Ocular implantL8612 C 798.02 0.00 0.00 0.00 XXX 1.25 Aqueous shunt prosthesisL8613 C 342.65 0.00 0.00 0.00 XXX 1.25 Ossicular implant
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
L8614 C 988.71 0.00 0.00 0.00 XXX 25.00 Cochlear device/systemL8615 C 460.66 0.00 0.00 0.00 XXX 1.25 Coch implant headset replaceL8616 C 107.26 0.00 0.00 0.00 XXX 1.25 Coch implant microphone replL8617 C 93.70 0.00 0.00 0.00 XXX 1.25 Coch implant trans coil replL8618 C 26.78 0.00 0.00 0.00 XXX 1.25 Coch implant tran cable replL8619 C 848.89 0.00 0.00 0.00 XXX 12.50 Replace cochlear processorL8620 C 66.08 0.00 0.00 0.00 XXX 1.25 12/31/2005 Repl lithium ion batteryL8621 C 0.65 0.00 0.00 0.00 XXX 1.25 Repl zinc air batteryL8622 C 0.34 0.00 0.00 0.00 XXX 1.25 Repl alkaline batteryL8623 C 66.08 0.00 0.00 0.00 XXX 1.25 Lith ion batt CID,non-earlvlL8624 C 164.69 0.00 0.00 0.00 XXX 1.25 Lith ion batt CID, ear levelL8630 C 450.31 0.00 0.00 0.00 XXX 1.25 Metacarpophalangeal implantL8631 C 566.64 0.00 0.00 0.00 XXX 5.00 MCP joint repl 2 pc or moreL8641 C 467.87 0.00 0.00 0.00 XXX 1.25 Metatarsal joint implantL8642 C 379.50 0.00 0.00 0.00 XXX 1.25 Hallux implantL8658 C 407.94 0.00 0.00 0.00 XXX 1.25 Interphalangeal joint spacerL8659 C 985.48 0.00 0.00 0.00 XXX 2.50 Interphalangeal joint replL8670 C 558.01 0.00 0.00 0.00 XXX 1.25 Vascular graftL8680 C 475.63 0.00 0.00 0.00 XXX 1.25 Implt neurostim elctr eachL8681 C 720.97 0.00 0.00 0.00 XXX 2.50 Pt prgrm for implt neurostimL8682 C 771.60 0.00 0.00 0.00 XXX 10.00 Implt neurostim radiofq recL8683 C 679.19 0.00 0.00 0.00 XXX 10.00 Radiofq trsmtr for implt neuL8684 C 852.60 0.00 0.00 0.00 XXX 1.25 Radiof trsmtr implt scrl neuL8685 C 846.25 0.00 0.00 0.00 XXX 20.00 Implt nrostm pls gen sng recL8686 C 863.96 0.00 0.00 0.00 XXX 12.50 Implt nrostm pls gen sng nonL8687 C 881.05 0.00 0.00 0.00 XXX 25.00 Implt nrostm pls gen dua recL8688 C 936.97 0.00 0.00 0.00 XXX 15.00 Implt nrostm pls gen dua nonL8689 C 72.47 0.00 0.00 0.00 XXX 1.25 External recharging systemL8699 S 0.00 0.00 0.00 0.00 XXX 0.00 Prosthetic implant, NOSL9900 S 0.00 0.00 0.00 0.00 XXX 0.00 O&P supply/accessory/service, otherM0064 C 0.37 0.34 0.12 0.01 XXX 50.58 Visit for drug monitoringM0075 C 0.00 0.00 0.00 0.00 XXX 0.00 Cellular therapyM0076 C 0.00 0.00 0.00 0.00 XXX 0.00 ProlotherapyM0100 C 0.00 0.00 0.00 0.00 XXX 0.00 Intragastric hypothermiaM0300 C 0.00 0.00 0.00 0.00 XXX 0.00 IV chelationtherapyM0301 C 0.00 0.00 0.00 0.00 XXX 0.00 Fabric wrapping of aneurysm
MSAGE C 0.35 0.23 0.23 0.01 XXX 50.58 Massage therapyMUINS C 94.59 0.00 0.00 0.00 XXX 1.25 Muscle interferential stimulatorMUINS C NU 945.89 0.00 0.00 0.00 XXX 1.25 Muscle interferential stimulatorMUINS C RR 94.59 0.00 0.00 0.00 XXX 1.25 Muscle interferential stimulatorMUINS C UE 709.23 0.00 0.00 0.00 XXX 1.25 Muscle interferential stimulatorNCA00 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention; telephonic, administrative; 1 min = 1 unitNCA01 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention; telephonic, administrative; 1 hr = I unitNCP00 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention, telephonic, prof serv; 1 min = 1 unitNCP01 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention, telephonic, prof serv; 1 hr = 1 unitNCPTC C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention, telephonic, long distance call phone chargeNIA00 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention; admin. services, 1 min = I unitNIA01 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention; admin. services; 1 hr = 1 unitNIP00 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention, prof services; 1 min = 1 unitNIP01 C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention, prof services; 1 hr = I unitNIPTC C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention, long distance phone call; actual cost of callNITRA C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention; travel, POV mileage rate.
NOSHO C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP-requested examination; claimant failed to show upNPART C 0.00 0.00 0.00 0.00 XXX 0.00 Nurse intervention; travel, tolls, bridges, parking.
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
P2028 C 0.00 0.00 0.00 0.00 XXX 0.00 Cephalin floculation testP2029 C 0.00 0.00 0.00 0.00 XXX 0.00 Congo red blood testP2031 C 0.00 0.00 0.00 0.00 XXX 0.00 Hair analysisP2033 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood thymol turbidityP2038 C 7.02 0.00 0.00 0.00 XXX 1.80 Blood mucoproteinP3000 C 14.76 0.00 0.00 0.00 XXX 1.80 Screen pap by tech w md supvP3001 C 0.42 0.15 0.15 0.02 XXX 50.58 Screening pap smear by physP7001 C 0.00 0.00 0.00 0.00 XXX 0.00 Culture bacterial urineP9010 C 0.00 0.00 0.00 0.00 XXX 0.00 Whole blood for transfusionP9011 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood split unitP9012 C 0.00 0.00 0.00 0.00 XXX 0.00 Cryoprecipitate each unitP9016 C 0.00 0.00 0.00 0.00 XXX 0.00 RBC leukocytes reducedP9017 C 0.00 0.00 0.00 0.00 XXX 0.00 One donor fresh frozn plasmaP9019 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelets, each unitP9020 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelet rich plasma unitP9021 C 0.00 0.00 0.00 0.00 XXX 0.00 Red blood cells unitP9022 C 0.00 0.00 0.00 0.00 XXX 0.00 Washed red blood cells unitP9023 C 0.00 0.00 0.00 0.00 XXX 0.00 Frozen plasma, pooled, sdP9031 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelets leukocytes reducedP9032 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelets, irradiatedP9033 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelets leukoreduced irradP9034 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelets, pheresisP9035 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelet pheres leukoreducedP9036 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelet pheresis irradiatedP9037 C 0.00 0.00 0.00 0.00 XXX 0.00 Plate pheres leukoredu irradP9038 C 0.00 0.00 0.00 0.00 XXX 0.00 RBC irradiatedP9039 C 0.00 0.00 0.00 0.00 XXX 0.00 RBC deglycerolizedP9040 C 0.00 0.00 0.00 0.00 XXX 0.00 RBC leukoreduced irradiatedP9041 C 11.02 0.00 0.00 0.00 XXX 1.25 Albumin(human), 5%, 50mlP9043 C 14.55 0.00 0.00 0.00 XXX 1.25 Plasma protein fraction, 5%, 50mlP9044 C 0.00 0.00 0.00 0.00 XXX 0.00 CryoprecipitatereducedplasmaP9045 C 78.08 0.00 0.00 0.00 XXX 1.25 Albumin (human), 5%, 250 mlP9046 C 22.04 0.00 0.00 0.00 XXX 1.25 Albumin (human), 25%, 20 mlP9047 C 55.10 0.00 0.00 0.00 XXX 1.25 Albumin (human), 25%, 50mlP9048 C 29.10 0.00 0.00 0.00 XXX 1.25 Plasmaprotein fract,5%,250mlP9050 C 0.00 0.00 0.00 0.00 XXX 0.00 Granulocytes, pheresis unitP9051 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood, l/r, cmv-negP9052 C 0.00 0.00 0.00 0.00 XXX 0.00 Platelets, hla-m, l/r, unitP9053 C 0.00 0.00 0.00 0.00 XXX 0.00 Plt, pher, l/r cmv-neg, irrP9054 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood, l/r, froz/degly/washP9055 C 0.00 0.00 0.00 0.00 XXX 0.00 Plt, aph/pher, l/r, cmv-negP9056 C 0.00 0.00 0.00 0.00 XXX 0.00 Blood, l/r, irradiatedP9057 C 0.00 0.00 0.00 0.00 XXX 0.00 RBC, frz/deg/wsh, l/r, irradP9058 C 0.00 0.00 0.00 0.00 XXX 0.00 RBC, l/r, cmv-neg, irradP9059 C 0.00 0.00 0.00 0.00 XXX 0.00 Plasma, frz between 8-24hourP9060 C 0.00 0.00 0.00 0.00 XXX 0.00 Fr frz plasma donor retestedP9603 C 0.00 0.00 0.00 0.00 XXX 0.00 One-way allow prorated milesP9604 C 0.00 0.00 0.00 0.00 XXX 0.00 One-way allow prorated tripP9612 C 3.00 0.00 0.00 0.00 XXX 1.80 Catheterize for urine specP9615 C 3.00 0.00 0.00 0.00 XXX 1.80 Urine specimen collect multQ0035 C 0.17 0.45 0.45 0.03 XXX 50.58 CardiokymographyQ0035 C TC 0.00 0.39 0.39 0.02 XXX 50.58 CardiokymographyQ0035 C 26 0.17 0.06 0.06 0.01 XXX 50.58 CardiokymographyQ0081 C 0.00 0.00 0.00 0.00 XXX 0.00 Infusion therapy oth than chemo drugs / visit
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
Q0083 C 0.00 0.00 0.00 0.00 XXX 0.00 Chemo therapy oth than infusionQ0084 C 0.00 0.00 0.00 0.00 XXX 0.00 Chemo therapy by infusion techQ0085 C 0.00 0.00 0.00 0.00 XXX 0.00 Chemo therapy-both infusion & othQ0091 C 0.37 0.67 0.14 0.02 XXX 50.58 Obtaining screen pap smearQ0092 C 0.00 0.32 0.32 0.01 XXX 50.58 Set up port xray equipmentQ0111 C 5.96 0.00 0.00 0.00 XXX 1.80 Wet mounts/ w preparationsQ0112 C 5.96 0.00 0.00 0.00 XXX 1.80 Potassium hydroxide prepsQ0113 C 7.56 0.00 0.00 0.00 XXX 1.80 Pinworm examinationsQ0114 C 9.99 0.00 0.00 0.00 XXX 1.80 Fern testQ0115 C 13.83 0.00 0.00 0.00 XXX 1.80 Post-coital mucous examQ0136 C 9.22 0.00 0.00 0.00 XXX 1.25 12/31/2005 Non esrd epoetin alpha inj, 1000uQ0137 C 3.01 0.00 0.00 0.00 XXX 1.25 12/31/2005 Darbepoetin alfa, non-esrd, 1mcgQ0144 C 0.00 0.00 0.00 0.00 XXX 0.00 Azithromycin dihydrate, oralQ0163 C 0.04 0.00 0.00 0.00 XXX 1.25 Diphenhydramine HCl 50mgQ0164 C 0.03 0.00 0.00 0.00 XXX 1.25 Prochlorperazine maleate 5mgQ0165 C 0.09 0.00 0.00 0.00 XXX 1.25 Prochlorperazine maleate10mgQ0166 C 37.19 0.00 0.00 0.00 XXX 1.25 Granisetron HCl 1 mg oralQ0167 C 4.56 0.00 0.00 0.00 XXX 1.25 Dronabinol 2.5mg oralQ0168 C 9.39 0.00 0.00 0.00 XXX 1.25 Dronabinol 5mg oralQ0169 C 0.30 0.00 0.00 0.00 XXX 1.25 Promethazine HCl 12.5mg oralQ0170 C 0.50 0.00 0.00 0.00 XXX 1.25 Promethazine HCl 25 mg oralQ0171 C 0.02 0.00 0.00 0.00 XXX 1.25 Chlorpromazine HCl 10mg oralQ0172 C 0.05 0.00 0.00 0.00 XXX 1.25 Chlorpromazine HCl 25mg oralQ0173 C 0.67 0.00 0.00 0.00 XXX 1.25 Trimethobenzamide HCl 250mgQ0174 C 0.63 0.00 0.00 0.00 XXX 1.25 Thiethylperazine maleate10mgQ0175 C 0.20 0.00 0.00 0.00 XXX 1.25 Perphenazine 4mg oralQ0176 C 0.20 0.00 0.00 0.00 XXX 1.25 Perphenazine 8mg oralQ0177 C 0.07 0.00 0.00 0.00 XXX 1.25 Hydroxyzine pamoate 25mgQ0178 C 0.07 0.00 0.00 0.00 XXX 1.25 Hydroxyzine pamoate 50mgQ0179 C 32.77 0.00 0.00 0.00 XXX 1.25 Ondansetron HCl 8mg oralQ0180 C 48.24 0.00 0.00 0.00 XXX 1.25 Dolasetron mesylate oral, 100mgQ0181 C 0.00 0.00 0.00 0.00 XXX 0.00 Unspecified oral anti-emeticQ0187 C 613.76 0.00 0.00 0.00 XXX 2.50 12/31/2005 Factor viia recombinant, 1.2mgQ0480 C 974.97 0.00 0.00 0.00 XXX 125.00 Driver pneumatic vad, repQ0481 C 983.13 0.00 0.00 0.00 XXX 20.00 Microprcsr cu elec vad, repQ0482 C 821.16 0.00 0.00 0.00 XXX 7.50 Microprcsr cu combo vad, repQ0483 C 922.58 0.00 0.00 0.00 XXX 27.50 Monitor elec vad, repQ0484 C 985.39 0.00 0.00 0.00 XXX 5.00 Monitor elec or comb vad, repQ0485 C 380.57 0.00 0.00 0.00 XXX 1.25 Monitor cable elec vad, repQ0486 C 316.74 0.00 0.00 0.00 XXX 1.25 Mon cable elec/pneum vad, repQ0487 C 369.52 0.00 0.00 0.00 XXX 1.25 Leads any type vad, rep onlyQ0488 C 0.00 0.00 0.00 0.00 XXX 0.00 Pwr pack base elec vad, repQ0489 C 879.81 0.00 0.00 0.00 XXX 25.00 Pwr pack base combo vad, repQ0490 C 761.11 0.00 0.00 0.00 XXX 1.25 Emr pwr source elec vad, repQ0491 C 598.28 0.00 0.00 0.00 XXX 2.50 Emr pwr source combo vad, repQ0492 C 96.42 0.00 0.00 0.00 XXX 1.25 Emr pwr cbl elec vad, repQ0493 C 274.49 0.00 0.00 0.00 XXX 1.25 Emr pwr cbl combo vad, repQ0494 C 232.28 0.00 0.00 0.00 XXX 1.25 Emr hd pmp elec/combo, repQ0495 C 753.63 0.00 0.00 0.00 XXX 7.50 Charger elec/combo vad, repQ0496 C 811.48 0.00 0.00 0.00 XXX 2.50 Battery elec/combo vad, repQ0497 C 506.78 0.00 0.00 0.00 XXX 1.25 Bat clps elec/comb vad, repQ0498 C 556.05 0.00 0.00 0.00 XXX 1.25 Holster elec/combo vad, repQ0499 C 180.66 0.00 0.00 0.00 XXX 1.25 Belt/vest elec/combo vad repQ0500 C 33.06 0.00 0.00 0.00 XXX 1.25 Filters elec/combo vad, rep
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
Q0501 C 552.83 0.00 0.00 0.00 XXX 1.25 Shwr cov elec/combo vad, repQ0502 C 703.82 0.00 0.00 0.00 XXX 1.25 Mobility cart pneum vad, repQ0503 C 703.85 0.00 0.00 0.00 XXX 2.50 Battery pneum vad, replQ0504 C 742.83 0.00 0.00 0.00 XXX 1.25 Pwr adpt pneum vad, rep vehQ0505 C 0.00 0.00 0.00 0.00 XXX 0.00 Miscl supply/accessory vadQ0510 C 0.00 0.00 0.00 0.00 XXX 0.00 Dispens fee immunosupressiveQ0511 C 0.00 0.00 0.00 0.00 XXX 0.00 Sup fee antiem,antica,immunoQ0512 C 0.00 0.00 0.00 0.00 XXX 0.00 Px sup fee anti-can sub presQ0513 C 0.00 0.00 0.00 0.00 XXX 0.00 Disp fee inhal drugs/30 daysQ0514 C 0.00 0.00 0.00 0.00 XXX 0.00 Disp fee inhal drugs/90 daysQ0515 C 0.00 0.00 0.00 0.00 XXX 0.00 Sermorelin acetate injectionQ1001 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Ntiol category 1Q1002 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Ntiol category 2Q1003 C 0.00 0.00 0.00 0.00 XXX 0.00 Ntiol category 3Q1004 C 0.00 0.00 0.00 0.00 XXX 0.00 Ntiol category 4Q1005 C 0.00 0.00 0.00 0.00 XXX 0.00 Ntiol category 5Q2001 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Oral cabergoline 0.5 mgQ2002 C 3.46 0.00 0.00 0.00 XXX 1.25 12/31/2005 Elliotts b solution per mlQ2003 C 2.31 0.00 0.00 0.00 XXX 1.25 12/31/2005 Aprotinin, 10,000 kiuQ2004 C 24.01 0.00 0.00 0.00 XXX 1.25 Bladder calculi irrig sol, 500mlQ2005 C 375.99 0.00 0.00 0.00 XXX 1.25 12/31/2005 Corticorelin ovine triflutat, eaQ2006 C 546.93 0.00 0.00 0.00 XXX 1.25 12/31/2005 Digoxin immune fab (ovine), eaQ2007 C 79.35 0.00 0.00 0.00 XXX 1.25 12/31/2005 Ethanolamine oleate 100 mgQ2008 C 11.88 0.00 0.00 0.00 XXX 1.25 12/31/2005 Fomepizole, 15 mgQ2009 C 5.32 0.00 0.00 0.00 XXX 1.25 Fosphenytoin, 50 mgQ2011 C 6.62 0.00 0.00 0.00 XXX 1.25 12/31/2005 Hemin, per 1 mgQ2012 C 166.07 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pegademase bovine, 25 iuQ2013 C 12.72 0.00 0.00 0.00 XXX 1.25 12/31/2005 Pentastarch 10% solution, 100mlQ2014 C 8.81 0.00 0.00 0.00 XXX 1.25 12/31/2005 Sermorelin acetate, 0.5 mgQ2017 C 264.05 0.00 0.00 0.00 XXX 1.25 Teniposide, 50 mgQ2018 C 48.45 0.00 0.00 0.00 XXX 1.25 12/31/2005 Urofollitropin, 75 iuQ2019 C 710.38 0.00 0.00 0.00 XXX 2.50 12/31/2005 Basiliximab, 20mgQ2020 C 666.83 0.00 0.00 0.00 XXX 7.50 12/31/2005 Histrelin acetateQ2021 C 146.92 0.00 0.00 0.00 XXX 1.25 12/31/2005 Lepirudin, 50mgQ2022 C 0.87 0.00 0.00 0.00 XXX 1.25 12/31/2005 VonWillebrandFactrCmplx, 1 IUQ3000 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Rubidium RB-82Q3001 C 0.00 0.00 0.00 0.00 XXX 0.00 Brachytherapy RadioelementsQ3002 C 64.08 0.00 0.00 0.00 XXX 1.25 12/31/2005 Gallium ga 67, 1mciQ3003 C 424.18 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium tc99m bicisate, per unitQ3004 C 38.96 0.00 0.00 0.00 XXX 1.25 12/31/2005 Xenon xe 133, 10mciQ3005 C 355.68 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium tc99m mertiatide, 1mciQ3006 C 22.61 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium tc99m glucepatate, 5mciQ3007 C 117.52 0.00 0.00 0.00 XXX 1.25 12/31/2005 Sodium phosphate p32, 1mciQ3008 C 708.51 0.00 0.00 0.00 XXX 2.50 12/31/2005 Indium 111-in pentetreotide, 3mciQ3009 C 20.52 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium tc99m oxidronate, 1mciQ3010 C 59.96 0.00 0.00 0.00 XXX 1.25 12/31/2005 Technetium tc99mlabeledrbcs, 1mciQ3011 C 209.46 0.00 0.00 0.00 XXX 1.25 12/31/2005 Chromic phosphate p32, 1mciQ3012 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Cyanocobalamin cobalt co57Q3014 C 0.00 0.00 0.00 0.00 XXX 0.00 Telehealth facility feeQ3019 C 0.00 0.00 0.00 0.00 XXX 0.00 ALS vehicle, emerg trnspt, no ALS serviceQ3020 C 0.00 0.00 0.00 0.00 XXX 0.00 ALS vehicle, non-emerg trnspt, no ALS serviceQ3025 C 93.07 0.00 0.00 0.00 XXX 1.25 IM Inj, interferon beta-1A, 11mcgQ3026 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, interferon beta-1A, subcutaneousQ3031 C 0.00 0.00 0.00 0.00 XXX 0.00 Collagen skin test
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
Q4001 C 38.27 0.00 0.00 0.00 XXX 1.25 Cast sup body cast plasterQ4002 C 144.64 0.00 0.00 0.00 XXX 1.25 Cast sup body cast fiberglasQ4003 C 27.49 0.00 0.00 0.00 XXX 1.25 Cast sup shoulder cast plstrQ4004 C 95.17 0.00 0.00 0.00 XXX 1.25 Cast sup shoulder cast fbrglQ4005 C 10.13 0.00 0.00 0.00 XXX 1.25 Cast sup long arm adult plstQ4006 C 22.84 0.00 0.00 0.00 XXX 1.25 Cast sup long arm adult fbrgQ4007 C 5.07 0.00 0.00 0.00 XXX 1.25 Cast sup long arm ped plsterQ4008 C 11.42 0.00 0.00 0.00 XXX 1.25 Cast sup long arm ped fbrglsQ4009 C 6.76 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm adult plstrQ4010 C 15.23 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm adult fbrglQ4011 C 3.38 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm ped plasterQ4012 C 7.61 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm ped fbrglasQ4013 C 12.30 0.00 0.00 0.00 XXX 1.25 Cast sup gauntlet plasterQ4014 C 20.77 0.00 0.00 0.00 XXX 1.25 Cast sup gauntlet fiberglassQ4015 C 6.16 0.00 0.00 0.00 XXX 1.25 Cast sup gauntlet ped plsterQ4016 C 10.38 0.00 0.00 0.00 XXX 1.25 Cast sup gauntlet ped fbrglsQ4017 C 7.13 0.00 0.00 0.00 XXX 1.25 Cast sup lng arm splint plstQ4018 C 11.35 0.00 0.00 0.00 XXX 1.25 Cast sup lng arm splint fbrgQ4019 C 3.56 0.00 0.00 0.00 XXX 1.25 Cast sup lng arm splnt ped pQ4020 C 5.68 0.00 0.00 0.00 XXX 1.25 Cast sup lng arm splnt ped fQ4021 C 5.27 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm splint plstQ4022 C 9.51 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm splint fbrgQ4023 C 2.64 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm splnt ped pQ4024 C 4.75 0.00 0.00 0.00 XXX 1.25 Cast sup sht arm splnt ped fQ4025 C 29.55 0.00 0.00 0.00 XXX 1.25 Cast sup hip spica plasterQ4026 C 92.27 0.00 0.00 0.00 XXX 1.25 Cast sup hip spica fiberglasQ4027 C 14.78 0.00 0.00 0.00 XXX 1.25 Cast sup hip spica ped plstrQ4028 C 46.13 0.00 0.00 0.00 XXX 1.25 Cast sup hip spica ped fbrglQ4029 C 22.59 0.00 0.00 0.00 XXX 1.25 Cast sup long leg plasterQ4030 C 59.48 0.00 0.00 0.00 XXX 1.25 Cast sup long leg fiberglassQ4031 C 11.30 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg ped plasterQ4032 C 29.74 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg ped fbrglsQ4033 C 21.07 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg cylinder plQ4034 C 52.42 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg cylinder fbQ4035 C 10.55 0.00 0.00 0.00 XXX 1.25 Cast sup lngleg cylndr ped pQ4036 C 26.22 0.00 0.00 0.00 XXX 1.25 Cast sup lngleg cylndr ped fQ4037 C 12.86 0.00 0.00 0.00 XXX 1.25 Cast sup shrt leg plasterQ4038 C 32.21 0.00 0.00 0.00 XXX 1.25 Cast sup shrt leg fiberglassQ4039 C 6.44 0.00 0.00 0.00 XXX 1.25 Cast sup shrt leg ped plsterQ4040 C 16.11 0.00 0.00 0.00 XXX 1.25 Cast sup shrt leg ped fbrglsQ4041 C 15.63 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg splnt plstrQ4042 C 26.69 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg splnt fbrglQ4043 C 7.82 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg splnt ped pQ4044 C 13.35 0.00 0.00 0.00 XXX 1.25 Cast sup lng leg splnt ped fQ4045 C 9.07 0.00 0.00 0.00 XXX 1.25 Cast sup sht leg splnt plstrQ4046 C 14.60 0.00 0.00 0.00 XXX 1.25 Cast sup sht leg splnt fbrglQ4047 C 4.53 0.00 0.00 0.00 XXX 1.25 Cast sup sht leg splnt ped pQ4048 C 7.30 0.00 0.00 0.00 XXX 1.25 Cast sup sht leg splnt ped fQ4049 C 1.65 0.00 0.00 0.00 XXX 1.25 Finger splint, staticQ4050 C 0.00 0.00 0.00 0.00 XXX 0.00 Cast supplies unlistedQ4051 C 0.00 0.00 0.00 0.00 XXX 0.00 Splint supplies miscQ4052 C 83.03 0.00 0.00 0.00 XXX 1.25 Octreotide injection, depotQ4053 C 467.09 0.00 0.00 0.00 XXX 1.25 Pegfilgrastim, 1 mgQ4054 C 3.01 0.00 0.00 0.00 XXX 1.25 12/31/2005 Darbepoetin alfa, esrd use, 1mcg
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
Q4055 C 9.31 0.00 0.00 0.00 XXX 1.25 12/31/2005 Epoetin alfa, esrd use, 1000uQ4075 C 0.03 0.00 0.00 0.00 XXX 1.25 12/31/2005 Acyclovir, 5 mgQ4076 C 0.90 0.00 0.00 0.00 XXX 1.25 12/31/2005 Dopamine hcl, 40 mgQ4077 C 54.02 0.00 0.00 0.00 XXX 1.25 12/31/2005 Treprostinil, 1 mgQ4079 C 0.00 0.00 0.00 0.00 XXX 0.00 Natalizumab injectionQ4080 C 31.11 0.00 0.00 0.00 XXX 1.25 Iloprost inhalation solution, 20 mcgQ9920 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct <= 20Q9921 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 21Q9922 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 22Q9923 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 23Q9924 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 24Q9925 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 25Q9926 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 26Q9927 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 27Q9928 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 28Q9929 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 29Q9930 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 30Q9931 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 31Q9932 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 32Q9933 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 33Q9934 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 34Q9935 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 35Q9936 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 36Q9937 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 37Q9938 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 38Q9939 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct = 39Q9940 C 11.62 0.00 0.00 0.00 XXX 1.25 Epoetin with hct >= 40Q9941 C 42.57 0.00 0.00 0.00 XXX 1.25 12/31/2005 IVIG lyophil, 1GQ9942 C 0.43 0.00 0.00 0.00 XXX 1.25 12/31/2005 IVIG lyophil, 10 mgQ9943 C 56.30 0.00 0.00 0.00 XXX 1.25 12/31/2005 IVIG non-lyophil, 1GQ9944 C 0.56 0.00 0.00 0.00 XXX 1.25 12/31/2005 IVIG non-lyophil, 10 mgQ9945 C 0.24 0.00 0.00 0.00 XXX 1.25 LOCM <=149 mg/ml iodine, 1mlQ9946 C 1.79 0.00 0.00 0.00 XXX 1.25 LOCM 150-199mg/ml iodine,1mlQ9947 C 1.30 0.00 0.00 0.00 XXX 1.25 LOCM 200-249mg/ml iodine,1mlQ9948 C 0.30 0.00 0.00 0.00 XXX 1.25 LOCM 250-299mg/ml iodine,1mlQ9949 C 0.34 0.00 0.00 0.00 XXX 1.25 LOCM 300-349mg/ml iodine,1mlQ9950 C 0.23 0.00 0.00 0.00 XXX 1.25 LOCM 350-399mg/ml iodine,1mlQ9951 C 0.00 0.00 0.00 0.00 XXX 0.00 LOCM >= 400 mg/ml iodine,1mlQ9952 C 2.93 0.00 0.00 0.00 XXX 1.25 Inj Gad-base MR contrast, 1mlQ9953 C 30.41 0.00 0.00 0.00 XXX 1.25 Inj Fe-based MR contrast,1mlQ9954 C 8.97 0.00 0.00 0.00 XXX 1.25 Oral MR contrast, 100 mlQ9955 C 13.25 0.00 0.00 0.00 XXX 1.25 Inj perflexane lip micros, 1ml Q9956 C 41.43 0.00 0.00 0.00 XXX 1.25 Inj octafluoropropane mic, 1mlQ9957 C 61.88 0.00 0.00 0.00 XXX 1.25 Inj perflutren lip micros, 1ml Q9958 C 0.00 0.00 0.00 0.00 XXX 0.00 HOCM <= 149 mg/ml iodine, 1mlQ9959 C 0.00 0.00 0.00 0.00 XXX 0.00 HOCM 150-199 mg/ml iodine, 1mlQ9960 C 0.00 0.00 0.00 0.00 XXX 0.00 HOCM 200-249 mg/ml iodine, 1mlQ9961 C 0.00 0.00 0.00 0.00 XXX 0.00 HOCM 250-299 mg/ml iodine, 1mlQ9962 C 0.00 0.00 0.00 0.00 XXX 0.00 HOCM 300-349 mg/ml iodine, 1mlQ9963 C 0.00 0.00 0.00 0.00 XXX 0.00 HOCM 350-399 mg/ml iodine, 1mlQ9964 C 0.00 0.00 0.00 0.00 XXX 0.00 HOCM >= 400 mg/ml iodine, 1mlR0070 C 119.66 0.00 0.00 0.00 XXX 1.25 Transport portable x-rayR0075 C 119.66 0.00 0.00 0.00 XXX 1.25 Transport port x-ray multiplR0076 C 119.66 0.00 0.00 0.00 XXX 1.25 Transport portable EKG
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
RE100 S 46.73 41.68 41.68 5.04 XXX 1.25 FCE; OWCP Prior-Approved, General Purpose/PM, Per HourRE200 S 46.73 41.68 41.68 5.04 XXX 1.25 FCE for enrollment in an ORP/PM return to work program, per hourRE300 S 46.73 41.68 41.68 5.04 XXX 1.25 FCE for enrollment in an ORP work readiness/PM program, per hourRP100 C 0.00 0.00 0.00 0.00 XXX 0.00 Pain Management; all inclusive per diem rateRP120 C 2.02 0.79 0.79 0.05 XXX 50.58 Pain Management; professional psych services NOS, per hourRP130 C 1.84 0.80 0.80 0.08 XXX 50.58 Pain Management; professional services NOS; one-on-one, per hourRP200 C 0.56 0.56 0.56 0.02 XXX 50.58 Pain Management; professional services NOS for a group of 2 or more, per hourS0012 C 0.00 0.00 0.00 0.00 XXX 0.00 Butorphanol tartrate, nasalS0014 C 0.00 0.00 0.00 0.00 XXX 0.00 Tacrine hydrochloride, 10 mgS0016 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, amikacin sulfate, 500 mg (Amikin)S0017 C 0.04 0.00 0.00 0.00 XXX 1.25 Injection, aminocaproic acid, 250 mgS0020 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, bupivicaine hydroS0021 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, cefoperazone sodS0023 C 0.51 0.00 0.00 0.00 XXX 1.25 Injection, cimetidine hydroc, 150mgS0028 C 0.54 0.00 0.00 0.00 XXX 1.25 Injection, famotidine, 20 mgS0030 C 1.43 0.00 0.00 0.00 XXX 1.25 Injection, metronidazole, 500mgS0032 C 2.48 0.00 0.00 0.00 XXX 1.25 Injection, nafcillin sodium, 1gmS0034 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, ofloxacin, 400 mgS0039 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, sulfamethoxazoleS0040 C 10.80 0.00 0.00 0.00 XXX 1.25 Injection, ticarcillin disod, 0.1-3gmS0071 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, acyclovir sodium, 50 mg (Zovirax)S0072 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, amikacin sulfateS0073 C 10.89 0.00 0.00 0.00 XXX 1.25 Injection, aztreonam, 500 mgS0074 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, cefotetan disodium, 500 mgS0077 C 3.17 0.00 0.00 0.00 XXX 1.25 Injection, clindamycin phosp, 150mgS0078 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, fosphenytoin sodiS0080 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, pentamidine isethS0081 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, piperacillin sodiS0088 C 0.00 0.00 0.00 0.00 XXX 0.00 Imatinib 100 mgS0090 C 0.00 0.00 0.00 0.00 XXX 0.00 Sildenafil citrate, 25 mgS0091 C 0.00 0.00 0.00 0.00 XXX 0.00 Granisetron 1mgS0092 C 0.00 0.00 0.00 0.00 XXX 0.00 Hydromorphone 250 mgS0093 C 0.00 0.00 0.00 0.00 XXX 0.00 Morphine 500 mgS0104 C 0.00 0.00 0.00 0.00 XXX 0.00 Zidovudine, oral, 100 mgS0106 C 0.00 0.00 0.00 0.00 XXX 0.00 Bupropion HCl, 150 mg, per 60 tabletsS0107 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj, omalizumab 25 mgS0108 C 0.00 0.00 0.00 0.00 XXX 0.00 Mercaptopurine, oral, 50 mgS0109 D 0.00 0.00 0.00 0.00 XXX 0.00 Methadone oral, 5mgS0114 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection, traprostinil sodium, 0.5 mgS0116 C 0.00 0.00 0.00 0.00 XXX 0.00 Bevacizumab 100 mgS0117 C 0.00 0.00 0.00 0.00 XXX 0.00 Tretinoin topical 5 gS0122 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, menotropins, 75 luS0126 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, follitropin alfa, 75 luS0128 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, follitropin beta, 75 luS0132 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection, ganirelix acetate, 250 mcg.S0133 C 0.00 0.00 0.00 0.00 XXX 0.00 Histrelin implantS0136 C 0.00 0.00 0.00 0.00 XXX 0.00 Clozapine, 25 mgS0137 C 0.00 0.00 0.00 0.00 XXX 0.00 Didanosine, 25 mgS0138 C 0.00 0.00 0.00 0.00 XXX 0.00 Finasteride, 5 mgS0139 C 0.00 0.00 0.00 0.00 XXX 0.00 Minoxidil, 10 mgS0140 C 0.00 0.00 0.00 0.00 XXX 0.00 Saquinavir, 200 mgS0141 C 0.00 0.00 0.00 0.00 XXX 0.00 Zalcitabine, 0.375 mgS0142 C 0.00 0.00 0.00 0.00 XXX 0.00 Colistimethate inh sol mgS0143 C 0.00 0.00 0.00 0.00 XXX 0.00 Aztreonam, inh sol gram
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S0145 C 0.00 0.00 0.00 0.00 XXX 0.00 Peg interferon alfa-2A/180S0146 C 0.00 0.00 0.00 0.00 XXX 0.00 Peg interferon alfa-2b/10S0155 C 0.00 0.00 0.00 0.00 XXX 0.00 Epoprostenol dilutantS0156 C 0.00 0.00 0.00 0.00 XXX 0.00 Exemestane, 25 mgS0157 C 0.00 0.00 0.00 0.00 XXX 0.00 Becaplermin gel 1%, 0.5 gmS0158 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection laronidase, 0.58 mgS0159 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Injection agalsidase, 34 mgS0160 C 0.00 0.00 0.00 0.00 XXX 0.00 Dextroamphetamine sulfate, 5 mgS0161 C 0.00 0.00 0.00 0.00 XXX 0.00 Calcitrol, 0.25mgS0162 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection efalizumab, 125 mgS0164 C 0.00 0.00 0.00 0.00 XXX 0.00 Injection pantroprazole sodium, 40mgS0166 C 0.00 0.00 0.00 0.00 XXX 0.00 Inj olanzapine, 2.5mgS0167 C 2.60 0.00 0.00 0.00 XXX 1.25 Inj apomorphine HCl, 1mgS0168 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Inj azacitidine, 100mgS0170 C 0.00 0.00 0.00 0.00 XXX 0.00 Anastrozole 1 mgS0171 C 0.49 0.00 0.00 0.00 XXX 1.25 Bumetanide 0.5 mgS0172 C 0.00 0.00 0.00 0.00 XXX 0.00 Chlorambucil 2 mgS0173 C 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Dexamethasone 4 mgS0174 C 0.00 0.00 0.00 0.00 XXX 0.00 Dolasetron 50 mgS0175 C 0.00 0.00 0.00 0.00 XXX 0.00 Flutamide 125 mgS0176 C 0.00 0.00 0.00 0.00 XXX 0.00 Hydroxyurea 500 mgS0177 C 0.00 0.00 0.00 0.00 XXX 0.00 Levamisole 50 mgS0178 C 0.00 0.00 0.00 0.00 XXX 0.00 Lomustine 10 mgS0179 C 0.00 0.00 0.00 0.00 XXX 0.00 Megestrol 20 mgS0181 C 0.00 0.00 0.00 0.00 XXX 0.00 Ondansetron 4 mgS0182 C 0.00 0.00 0.00 0.00 XXX 0.00 Procarbazine 5 mgS0183 C 0.00 0.00 0.00 0.00 XXX 0.00 Prochlorperazine 5 mgS0187 C 0.00 0.00 0.00 0.00 XXX 0.00 Tamoxifen 10 mgS0189 C 0.00 0.00 0.00 0.00 XXX 0.00 Testosterone pellet 75 mgS0190 C 0.00 0.00 0.00 0.00 XXX 0.00 Mifepristone, oral, 200 mgS0191 C 0.00 0.00 0.00 0.00 XXX 0.00 Misoprostol, oral, 200 mcgS0194 C 0.00 0.00 0.00 0.00 XXX 0.00 Vitamin suppl 100 capsS0195 C 0.00 0.00 0.00 0.00 XXX 0.00 Pneumococcal conjugate vaccineS0196 C 0.00 0.00 0.00 0.00 XXX 0.00 Poly-l-lactic acid 1ml faceS0197 C 0.00 0.00 0.00 0.00 XXX 0.00 Prenatal vitamins 30 dayS0198 C 0.00 0.00 0.00 0.00 XXX 0.00 Inj pegaptanib 0.3 mgS0199 D 0.00 0.00 0.00 0.00 XXX 0.00 Med abortion inc all ex drugS0201 D 0.00 0.00 0.00 0.00 XXX 0.00 Partial hospitalization serv, lt 24 hrsS0207 D 0.00 0.00 0.00 0.00 XXX 0.00 Paramedicintercep nonhospalsS0208 D 0.00 0.00 0.00 0.00 XXX 0.00 Paramed intrcept nonvolS0209 D 0.00 0.00 0.00 0.00 XXX 0.00 WC van mileage per miS0215 D 0.00 0.00 0.00 0.00 XXX 0.00 Nonemerg transp mileageS0220 D 0.00 0.00 0.00 0.00 XXX 0.00 Medical conference by physicS0221 D 0.00 0.00 0.00 0.00 XXX 0.00 Medical conference, 60 minS0250 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp geriatr assmt teamS0255 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospice refer visit non-MDS0257 D 0.00 0.00 0.00 0.00 XXX 0.00 End of life counselingS0260 D 0.00 0.00 0.00 0.00 XXX 0.00 H&P for surgeryS0265 C 0.00 0.00 0.00 0.00 XXX 0.00 Genetic counsel 15 minsS0302 D 0.00 0.00 0.00 0.00 XXX 0.00 Completed EPSDTS0310 D 0.00 0.00 0.00 0.00 XXX 0.00 Hospitalist visitS0315 D 0.00 0.00 0.00 0.00 XXX 0.00 Disease management programS0316 D 0.00 0.00 0.00 0.00 XXX 0.00 Follow-up/reassessmentS0317 D 0.00 0.00 0.00 0.00 XXX 0.00 Disease mgmt per diem
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S0320 D 0.00 0.00 0.00 0.00 XXX 0.00 RN telephone calls to DMPS0340 D 0.00 0.00 0.00 0.00 XXX 0.00 Lifestyle mod 1st stageS0341 D 0.00 0.00 0.00 0.00 XXX 0.00 Lifestyle mod 2 or 3 stageS0342 D 0.00 0.00 0.00 0.00 XXX 0.00 Lifestyle mod 4th stageS0390 D 0.00 0.00 0.00 0.00 XXX 0.00 Routine foot careS0395 D 0.00 0.00 0.00 0.00 XXX 0.00 Impression casting ftS0400 D 0.00 0.00 0.00 0.00 XXX 0.00 Global eswl kidneyS0500 D 0.00 0.00 0.00 0.00 XXX 0.00 Dispos cont lensS0504 D 0.00 0.00 0.00 0.00 XXX 0.00 Singl prscrp lensS0506 D 0.00 0.00 0.00 0.00 XXX 0.00 Bifoc prscp lensS0508 D 0.00 0.00 0.00 0.00 XXX 0.00 Trifoc prscrp lensS0510 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-prscrp lensS0512 D 0.00 0.00 0.00 0.00 XXX 0.00 Daily cont lensS0514 D 0.00 0.00 0.00 0.00 XXX 0.00 Color cont lensS0515 D 0.00 0.00 0.00 0.00 XXX 0.00 Scieral lens liquid bandageS0516 D 0.00 0.00 0.00 0.00 XXX 0.00 Safety framesS0518 D 0.00 0.00 0.00 0.00 XXX 0.00 Sunglass framesS0580 D 0.00 0.00 0.00 0.00 XXX 0.00 Polycarb lensS0581 D 0.00 0.00 0.00 0.00 XXX 0.00 Nonstnd lensS0590 D 0.00 0.00 0.00 0.00 XXX 0.00 Misc integral lens servS0592 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp cont lens evalS0595 C 0.00 0.00 0.00 0.00 XXX 0.00 New lenses in pts old frameS0601 D 0.00 0.00 0.00 0.00 XXX 0.00 Screening proctoscopyS0605 D 0.00 0.00 0.00 0.00 XXX 0.00 Digital rectal examination,S0610 D 0.00 0.00 0.00 0.00 XXX 0.00 Annual gynecological examinaS0612 D 0.00 0.00 0.00 0.00 XXX 0.00 Annual gynecological examinaS0613 D 0.00 0.00 0.00 0.00 XXX 0.00 Ann breast examS0618 D 0.00 0.00 0.00 0.00 XXX 0.00 Audiometry for hearing aidS0620 D 0.00 0.00 0.00 0.00 XXX 0.00 Routine ophthalmological exaS0621 D 0.00 0.00 0.00 0.00 XXX 0.00 Routine ophthalmological exaS0622 D 0.00 0.00 0.00 0.00 XXX 0.00 Phys exam for collegeS0625 C 0.00 0.00 0.00 0.00 XXX 0.00 Digital screening retinaS0630 D 0.00 0.00 0.00 0.00 XXX 0.00 Removal of suturesS0800 D 0.00 0.00 0.00 0.00 XXX 0.00 Laser in situ keratomileusisS0810 D 0.00 0.00 0.00 0.00 XXX 0.00 Photorefractive keratectomyS0812 D 0.00 0.00 0.00 0.00 XXX 0.00 Phototherap keratectS0820 D 0.00 0.00 0.00 0.00 XXX 0.00 Computerized corneal topograS0830 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Ultrasound pachymetryS1001 D 0.00 0.00 0.00 0.00 XXX 0.00 Deluxe itemS1002 D 0.00 0.00 0.00 0.00 XXX 0.00 Custom itemS1015 D 0.00 0.00 0.00 0.00 XXX 0.00 IV tubing extension setS1016 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-pvc intravenous administS1025 D 0.00 0.00 0.00 0.00 XXX 0.00 Inhal nitric oxide neonateS1030 D 0.00 0.00 0.00 0.00 XXX 0.00 Gluc monitor purchaseS1031 D 0.00 0.00 0.00 0.00 XXX 0.00 Gluc monitor rentalS1040 D 0.00 0.00 0.00 0.00 XXX 0.00 Cranial remolding orthosisS2053 D 0.00 0.00 0.00 0.00 XXX 0.00 Transplantation of small intS2054 D 0.00 0.00 0.00 0.00 XXX 0.00 Transplantation of multiviscS2055 D 0.00 0.00 0.00 0.00 XXX 0.00 Harvesting of donor multivisS2060 D 0.00 0.00 0.00 0.00 XXX 0.00 Lobar lung transplantationS2061 D 0.00 0.00 0.00 0.00 XXX 0.00 Donor lobectomy (lung)S2065 D 0.00 0.00 0.00 0.00 XXX 0.00 Simult panc kidn transS2068 C 0.00 0.00 0.00 0.00 XXX 0.00 Breast DIEP flap reconstructS2070 D 0.00 0.00 0.00 0.00 XXX 0.00 Cysto laser tx ureteral calc
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S2075 C 0.00 0.00 0.00 0.00 XXX 0.00 Lap inc/vent hernia repairS2076 C 0.00 0.00 0.00 0.00 XXX 0.00 Lap umbilical hernia repairS2077 C 0.00 0.00 0.00 0.00 XXX 0.00 Lap mesh implant hern repS2078 C 0.00 0.00 0.00 0.00 XXX 0.00 Lap supracerv hysterectomyS2079 C 0.00 0.00 0.00 0.00 XXX 0.00 Lap esophagomyotomyS2080 D 0.00 0.00 0.00 0.00 XXX 0.00 LaupS2082 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Lap adjustable gastric bandS2083 D 0.00 0.00 0.00 0.00 XXX 0.00 Adjustment gastric bandS2090 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Open cryosurg renalS2091 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Perc cryosurg renalS2095 D 0.00 0.00 0.00 0.00 XXX 0.00 Transcath emboliz microspherS2102 D 0.00 0.00 0.00 0.00 XXX 0.00 Islet cell tissue transplantS2103 D 0.00 0.00 0.00 0.00 XXX 0.00 Adrenal tissue transplantS2107 D 0.00 0.00 0.00 0.00 XXX 0.00 Adoptive immunotherapyS2112 D 0.00 0.00 0.00 0.00 XXX 0.00 Knee arthroscp harvS2114 C 0.00 0.00 0.00 0.00 XXX 0.00 Arthrosc sh tenodesis bicepsS2115 D 0.00 0.00 0.00 0.00 XXX 0.00 Periacetabular osteotomyS2117 C 0.00 0.00 0.00 0.00 XXX 0.00 Arthroereisis, subtalarS2120 D 0.00 0.00 0.00 0.00 XXX 0.00 Low density lipoprotein(LDL)S2135 D 0.00 0.00 0.00 0.00 XXX 0.00 Neurolysis interspace footS2140 D 0.00 0.00 0.00 0.00 XXX 0.00 Cord blood harvestingS2142 D 0.00 0.00 0.00 0.00 XXX 0.00 Cord blood-derived stem-cellS2150 D 0.00 0.00 0.00 0.00 XXX 0.00 BMT harv/transpl 28d pkgS2152 D 0.00 0.00 0.00 0.00 XXX 0.00 Solid organ transpl pkgS2202 D 0.00 0.00 0.00 0.00 XXX 0.00 EchosclerotherapyS2205 D 0.00 0.00 0.00 0.00 XXX 0.00 Minimally invasive direct coS2206 D 0.00 0.00 0.00 0.00 XXX 0.00 Minimally invasive direct coS2207 D 0.00 0.00 0.00 0.00 XXX 0.00 Minimally invasive direct coS2208 D 0.00 0.00 0.00 0.00 XXX 0.00 Minimally invasive direct coS2209 D 0.00 0.00 0.00 0.00 XXX 0.00 Minimally invasive direct coS2213 D 0.00 0.00 0.00 0.00 XXX 0.00 Implant gastric stimS2215 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 UGI endoscopy inj implantS2225 D 0.00 0.00 0.00 0.00 XXX 0.00 Myringotomy laser-assistS2230 D 0.00 0.00 0.00 0.00 XXX 0.00 Implant semi-imp hearS2235 D 0.00 0.00 0.00 0.00 XXX 0.00 Implant auditory brain impS2250 D 0.00 0.00 0.00 0.00 XXX 0.00 Uterine artery embolizS2260 D 0.00 0.00 0.00 0.00 XXX 0.00 Induced abortion 17-24 weeksS2262 D 0.00 0.00 0.00 0.00 XXX 0.00 Abortion maternal indic >=25wS2265 D 0.00 0.00 0.00 0.00 XXX 0.00 Abortion 25-28wks fetal indiS2266 D 0.00 0.00 0.00 0.00 XXX 0.00 Abortion 29-31 wks fetal indiS2267 D 0.00 0.00 0.00 0.00 XXX 0.00 Abortion >=32wks fetal indicaS2300 D 0.00 0.00 0.00 0.00 XXX 0.00 Arthroscopy, shoulder, surgiS2340 D 0.00 0.00 0.00 0.00 XXX 0.00 Chemodenervation of abductorS2341 D 0.00 0.00 0.00 0.00 XXX 0.00 Chemodenerv adduct vocalS2342 D 0.00 0.00 0.00 0.00 XXX 0.00 Nasal endoscop po debridS2348 D 0.00 0.00 0.00 0.00 XXX 0.00 Decompress disc RF lumbarS2350 D 0.00 0.00 0.00 0.00 XXX 0.00 Diskectomy, anterior, with dS2351 D 0.00 0.00 0.00 0.00 XXX 0.00 Diskectomy, anterior, with dS2360 D 0.00 0.00 0.00 0.00 XXX 0.00 Vertebroplast cerv 1stS2361 D 0.00 0.00 0.00 0.00 XXX 0.00 Vertebroplast cerv addlS2362 C 11.13 6.38 6.38 1.78 XXX 50.58 Kyphoplasty, first vertebraS2363 C 4.30 1.68 1.68 0.69 XXX 50.58 Kyphoplasty, each addlS2370 C 8.07 5.52 5.52 0.80 XXX 49.84 12/31/2005 Intradiscal electrothermalS2371 C 4.30 1.69 1.69 0.40 XXX 49.84 12/31/2005 Each additional interspace
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S2400 D 0.00 0.00 0.00 0.00 XXX 0.00 Fetal surg congen herniaS2401 D 0.00 0.00 0.00 0.00 XXX 0.00 Fetal surg urin trac obstrS2402 D 0.00 0.00 0.00 0.00 XXX 0.00 Fetal surg cong cyst malfS2403 D 0.00 0.00 0.00 0.00 XXX 0.00 Fetal surg pulmon sequestS2404 D 0.00 0.00 0.00 0.00 XXX 0.00 Fetal surg myelomeningoS2405 D 0.00 0.00 0.00 0.00 XXX 0.00 Repair sacrococcygeal teratoma, fetusS2409 D 0.00 0.00 0.00 0.00 XXX 0.00 Fetal surg nocS2411 D 0.00 0.00 0.00 0.00 XXX 0.00 Fetoscop laser ther TTTSS2900 C 0.00 0.00 0.00 0.00 XXX 0.00 Robotic surgical systemS3000 D 0.00 0.00 0.00 0.00 XXX 0.00 Bilat dil retinal examS3005 D 0.00 0.00 0.00 0.00 XXX 0.00 Eval self-assess depressionS3600 D 0.00 0.00 0.00 0.00 XXX 0.00 Stat labS3601 D 0.00 0.00 0.00 0.00 XXX 0.00 Stat lab home/nfS3620 D 0.00 0.00 0.00 0.00 XXX 0.00 Newborn metabolic screeningS3625 D 0.00 0.00 0.00 0.00 XXX 0.00 Maternal triple screen testS3626 D 0.00 0.00 0.00 0.00 XXX 0.00 Maternal serum quad screenS3630 D 0.00 0.00 0.00 0.00 XXX 0.00 Eosinophil blood countS3645 D 0.00 0.00 0.00 0.00 XXX 0.00 HIV-1 antibody testing of orS3650 D 0.00 0.00 0.00 0.00 XXX 0.00 Saliva test, hormone level;S3652 D 0.00 0.00 0.00 0.00 XXX 0.00 Saliva test, hormone level;S3655 D 0.00 0.00 0.00 0.00 XXX 0.00 Antisperm antibodies testS3701 D 0.00 0.00 0.00 0.00 XXX 0.00 NMP-22 assayS3708 D 0.00 0.00 0.00 0.00 XXX 0.00 Gastrointestinal fat absorptS3818 D 0.00 0.00 0.00 0.00 XXX 0.00 BRCA1 gene analS3819 D 0.00 0.00 0.00 0.00 XXX 0.00 BRCA2 gene analS3820 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp BRCA1/BRCA2S3822 D 0.00 0.00 0.00 0.00 XXX 0.00 Sing mutation brst/ovarS3823 D 0.00 0.00 0.00 0.00 XXX 0.00 3 mutation brst/ovarS3828 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp MLH1 geneS3829 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp MLH2 geneS3830 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test HNPCC compS3831 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test HNPCC singleS3833 D 0.00 0.00 0.00 0.00 XXX 0.00 Comp APC sequenceS3834 D 0.00 0.00 0.00 0.00 XXX 0.00 Sing mutation APCS3835 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test cystic fibrosisS3837 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test hemochromatoS3840 D 0.00 0.00 0.00 0.00 XXX 0.00 DNA analysis RET-oncogeneS3841 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test retinoblastomaS3842 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test Hippel-LindauS3843 D 0.00 0.00 0.00 0.00 XXX 0.00 DNA analysis factor vS3844 D 0.00 0.00 0.00 0.00 XXX 0.00 DNA analysis deafnessS3845 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test alpha-thalassemiaS3846 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test beta-thalassemiaS3847 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test Tay-SachsS3848 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test GaucherS3849 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test Niemann-PickS3850 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test sickle cellS3851 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test canavanS3852 D 0.00 0.00 0.00 0.00 XXX 0.00 DNA analysis APOE alzheimerS3853 D 0.00 0.00 0.00 0.00 XXX 0.00 Gene test myo musclr dystS3854 C 0.00 0.00 0.00 0.00 XXX 0.00 Gene profile panel breastS3890 D 0.00 0.00 0.00 0.00 XXX 0.00 Fecal DNA analysisS3900 D 0.00 0.00 0.00 0.00 XXX 0.00 Surface EMGS3902 D 0.00 0.00 0.00 0.00 XXX 0.00 Ballistocardiogram
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S3904 D 0.00 0.00 0.00 0.00 XXX 0.00 Masters two stepS4005 D 0.00 0.00 0.00 0.00 XXX 0.00 Interim labor facilityS4011 D 0.00 0.00 0.00 0.00 XXX 0.00 IVF packageS4013 D 0.00 0.00 0.00 0.00 XXX 0.00 Complete cycle, GIFTS4014 D 0.00 0.00 0.00 0.00 XXX 0.00 Complete cycle, ZIFTS4015 D 0.00 0.00 0.00 0.00 XXX 0.00 Complete IVF case rateS4016 D 0.00 0.00 0.00 0.00 XXX 0.00 Frozen IVF case rateS4017 D 0.00 0.00 0.00 0.00 XXX 0.00 Incomplete cycle, treatmnt cancelS4018 D 0.00 0.00 0.00 0.00 XXX 0.00 F EMB trns canc case rateS4020 D 0.00 0.00 0.00 0.00 XXX 0.00 IVF canc a aspir case rateS4021 D 0.00 0.00 0.00 0.00 XXX 0.00 IVF canc p aspir case rateS4022 D 0.00 0.00 0.00 0.00 XXX 0.00 Asst oocyte fert case rateS4023 D 0.00 0.00 0.00 0.00 XXX 0.00 Donor egg cycle, incompleteS4025 D 0.00 0.00 0.00 0.00 XXX 0.00 Donor serv IVF case rateS4026 D 0.00 0.00 0.00 0.00 XXX 0.00 Procure donor spermS4027 D 0.00 0.00 0.00 0.00 XXX 0.00 Store prev froz embryosS4028 D 0.00 0.00 0.00 0.00 XXX 0.00 Microsurg epi sperm aspS4030 D 0.00 0.00 0.00 0.00 XXX 0.00 Sperm procure init visitS4031 D 0.00 0.00 0.00 0.00 XXX 0.00 Sperm procure subs visitS4035 D 0.00 0.00 0.00 0.00 XXX 0.00 Stimulated IUI, case rateS4036 D 0.00 0.00 0.00 0.00 XXX 0.00 IVC, case rateS4037 D 0.00 0.00 0.00 0.00 XXX 0.00 Cryopreserved emb transfS4040 D 0.00 0.00 0.00 0.00 XXX 0.00 Monitor, store embryo/30 daysS4042 D 0.00 0.00 0.00 0.00 XXX 0.00 Ovulation mgmt per cycleS4981 D 0.00 0.00 0.00 0.00 XXX 0.00 Insert levonorgestrel iusS4989 D 0.00 0.00 0.00 0.00 XXX 0.00 Contracept IUDS4990 D 0.00 0.00 0.00 0.00 XXX 0.00 Nicotine patch legendS4991 D 0.00 0.00 0.00 0.00 XXX 0.00 Nicotine patch nonlegendS4993 D 0.00 0.00 0.00 0.00 XXX 0.00 Birth control pillsS4995 D 0.00 0.00 0.00 0.00 XXX 0.00 Smoking cessation gumS5000 D 0.00 0.00 0.00 0.00 XXX 0.00 Prescription drug, genericS5001 D 0.00 0.00 0.00 0.00 XXX 0.00 Prescription drug,brand nameS5010 C 0.00 0.00 0.00 0.00 XXX 0.00 5% dextrose and 45% salineS5011 C 0.00 0.00 0.00 0.00 XXX 0.00 5% dextrose in lactated ringS5012 C 0.00 0.00 0.00 0.00 XXX 0.00 5% dextrose with potassiumS5013 C 0.00 0.00 0.00 0.00 XXX 0.00 5% dextrose/45%saline,1000mlS5014 C 0.00 0.00 0.00 0.00 XXX 0.00 5% dextrose/45%saline,1500mlS5035 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT routine device maintS5036 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT device repairS5100 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult daycare services, 15 minS5101 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult daycare per half dayS5102 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult day care per diemS5105 D 0.00 0.00 0.00 0.00 XXX 0.00 Centerbaseddaycare per diemS5108 D 0.00 0.00 0.00 0.00 XXX 0.00 Homecare train pt 15 minS5109 D 0.00 0.00 0.00 0.00 XXX 0.00 Homecare train pt sessionS5110 D 0.00 0.00 0.00 0.00 XXX 0.00 Family homecare training, 15minS5111 D 0.00 0.00 0.00 0.00 XXX 0.00 Family homecare training/sessionS5115 D 0.00 0.00 0.00 0.00 XXX 0.00 Nonfamily homecaretrain/15minS5116 D 0.00 0.00 0.00 0.00 XXX 0.00 Nonfamily homecare train/sessionS5120 C 0.07 0.00 0.00 0.00 XXX 50.58 Chore services per 15 minS5121 C 1.68 0.00 0.00 0.00 XXX 50.58 Chore services per diemS5125 C 0.09 0.00 0.00 0.00 XXX 50.58 Attendant care service/15 minS5126 C 2.10 0.00 0.00 0.00 XXX 50.58 Attendant care service/diemS5130 C 0.07 0.00 0.00 0.00 XXX 50.58 Homemaker service NOS/15 min
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S5131 C 1.68 0.00 0.00 0.00 XXX 50.58 Homemaker service NOS/diemS5135 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult companion care/15 minS5136 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult companion care/diemS5140 D 0.00 0.00 0.00 0.00 XXX 0.00 Foster care, adult per diemS5141 D 0.00 0.00 0.00 0.00 XXX 0.00 Foster care, adult per monthS5145 D 0.00 0.00 0.00 0.00 XXX 0.00 Foster care, therapeutic, child/diemS5146 D 0.00 0.00 0.00 0.00 XXX 0.00 Foster care, therapeutic, child/moS5150 D 0.00 0.00 0.00 0.00 XXX 0.00 Unskilled respite care/15 minS5151 D 0.00 0.00 0.00 0.00 XXX 0.00 Unskilled respite care, not hospice/diemS5160 D 0.00 0.00 0.00 0.00 XXX 0.00 Emer response sys install&tstS5161 D 0.00 0.00 0.00 0.00 XXX 0.00 Emer rspns sys serv per monthS5162 D 0.00 0.00 0.00 0.00 XXX 0.00 Emer rspns system purchaseS5165 D 0.00 0.00 0.00 0.00 XXX 0.00 Home modifications per serviceS5170 D 0.00 0.00 0.00 0.00 XXX 0.00 Home delivered prepared mealS5175 D 0.00 0.00 0.00 0.00 XXX 0.00 Laundry serv, ext, prof per orderS5180 D 0.00 0.00 0.00 0.00 XXX 0.00 HH respiratory thrpy in evalS5181 D 0.00 0.00 0.00 0.00 XXX 0.00 HH respiratory thrpy NOS/dayS5185 D 0.00 0.00 0.00 0.00 XXX 0.00 Med reminder serv per monthS5190 D 0.00 0.00 0.00 0.00 XXX 0.00 Wellness assessment by nonphS5199 D 0.00 0.00 0.00 0.00 XXX 0.00 Personal care item NOS eachS5497 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT cath care nocS5498 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT simple cath careS5501 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT complex cath careS5502 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT interim cath careS5517 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT declotting kitS5518 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT cath repair kitS5520 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT picc insert kitS5521 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT midline cath insert kitS5522 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT picc insert no suppS5523 D 0.00 0.00 0.00 0.00 XXX 0.00 HIP midline cath insert kitS5550 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin rapid 5 uS5551 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin most rapid 5 uS5552 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin intermed 5 uS5553 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin long acting 5 uS5560 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin reuse pen 1.5 mlS5561 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin reuse pen 3 mlS5565 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin cartridge 150 uS5566 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin cartridge 300 uS5570 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin dispos pen 1.5 mlS5571 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin dispos pen 3 mlS8004 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Wholebody radiopharm trgcellS8030 D 0.00 0.00 0.00 0.00 XXX 0.00 Tantalum ring applicationS8035 D 0.00 0.00 0.00 0.00 XXX 0.00 Magnetic source imagingS8037 D 0.00 0.00 0.00 0.00 XXX 0.00 MRCPS8040 D 0.00 0.00 0.00 0.00 XXX 0.00 Topographic brain mappingS8042 D 0.00 0.00 0.00 0.00 XXX 0.00 MRI, low fieldS8049 D 0.00 0.00 0.00 0.00 XXX 0.00 Intraoperative radiation theS8055 D 0.00 0.00 0.00 0.00 XXX 0.00 Us guidance fetal reductS8075 D 0.00 0.00 0.00 0.00 XXX 0.00 CAD of digital mammogrS8080 D 0.00 0.00 0.00 0.00 XXX 0.00 ScintimammographyS8085 D 0.00 0.00 0.00 0.00 XXX 0.00 Fluorine-18 fluorodeoxyglucoS8092 D 0.00 0.00 0.00 0.00 XXX 0.00 Electron beam computed tomogS8093 D 0.00 0.00 0.00 0.00 XXX 0.00 CT angiography coronaryS8095 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Wig (for medically-induced h
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S8096 D 0.00 0.00 0.00 0.00 XXX 0.00 Portable peak flow meterS8097 D 0.00 0.00 0.00 0.00 XXX 0.00 Asthma kitS8100 D 0.00 0.00 0.00 0.00 XXX 0.00 Spacer without maskS8101 D 0.00 0.00 0.00 0.00 XXX 0.00 Spacer with maskS8110 D 0.00 0.00 0.00 0.00 XXX 0.00 Peak expiratory flow rate (pS8120 D 0.00 0.00 0.00 0.00 XXX 0.00 O2 contents gas cubic ftS8121 D 0.00 0.00 0.00 0.00 XXX 0.00 O2 contents liquid lbS8185 D 0.00 0.00 0.00 0.00 XXX 0.00 Flutter deviceS8186 D 0.00 0.00 0.00 0.00 XXX 0.00 Swivel adaptorS8189 D 0.00 0.00 0.00 0.00 XXX 0.00 Trach supply nocS8190 D 0.00 0.00 0.00 0.00 XXX 0.00 Electronic spirometerS8210 C 0.00 0.00 0.00 0.00 XXX 0.00 Mucus trapS8260 C 0.00 0.00 0.00 0.00 XXX 0.00 Oral orthotic for treatmentS8262 C 0.00 0.00 0.00 0.00 XXX 0.00 Mandib ortho repos device, eaS8265 D 0.00 0.00 0.00 0.00 XXX 0.00 Haberman feeder, cleft lip/palateS8270 C 0.00 0.00 0.00 0.00 XXX 0.00 Enuresis alarmS8301 D 0.00 0.00 0.00 0.00 XXX 0.00 Infect control supplies NOSS8415 D 0.00 0.00 0.00 0.00 XXX 0.00 Supplies for home deliveryS8420 D 0.00 0.00 0.00 0.00 XXX 0.00 Custom gradient sleev/glovS8421 D 0.00 0.00 0.00 0.00 XXX 0.00 Ready gradient sleev/glovS8422 D 0.00 0.00 0.00 0.00 XXX 0.00 Custom grad sleeve medS8423 D 0.00 0.00 0.00 0.00 XXX 0.00 Custom grad sleeve heavyS8424 D 0.00 0.00 0.00 0.00 XXX 0.00 Ready gradient sleeveS8425 D 0.00 0.00 0.00 0.00 XXX 0.00 Custom grad glove medS8426 D 0.00 0.00 0.00 0.00 XXX 0.00 Custom grad glove heavyS8427 D 0.00 0.00 0.00 0.00 XXX 0.00 Ready gradient gloveS8428 D 0.00 0.00 0.00 0.00 XXX 0.00 Ready gradient gauntletS8429 D 0.00 0.00 0.00 0.00 XXX 0.00 Gradient pressure wrapS8430 D 0.00 0.00 0.00 0.00 XXX 0.00 Padding for comprssn bdgS8431 D 0.00 0.00 0.00 0.00 XXX 0.00 Compression bandageS8450 D 0.00 0.00 0.00 0.00 XXX 0.00 Splint digitS8451 D 0.00 0.00 0.00 0.00 XXX 0.00 Splint wrist or ankleS8452 D 0.00 0.00 0.00 0.00 XXX 0.00 Splint elbowS8460 D 0.00 0.00 0.00 0.00 XXX 0.00 Camisole post-mastS8490 D 0.00 0.00 0.00 0.00 XXX 0.00 100 insulin syringesS8940 C 0.00 0.00 0.00 0.00 XXX 0.00 Hippotherapy per sessionS8948 D 0.00 0.00 0.00 0.00 XXX 0.00 Low-level laser trmt 15 minS8950 D 0.00 0.00 0.00 0.00 XXX 0.00 Complex lymphedema therapy,S8990 D 0.00 0.00 0.00 0.00 XXX 0.00 Pt or manip for maintS8999 D 0.00 0.00 0.00 0.00 XXX 0.00 Resuscitation bagS9001 D 0.00 0.00 0.00 0.00 XXX 0.00 Home uterine monitor with orS9007 D 0.00 0.00 0.00 0.00 XXX 0.00 Ultrafiltration monitorS9015 D 0.00 0.00 0.00 0.00 XXX 0.00 Automated EEG monitoringS9022 D 0.00 0.00 0.00 0.00 XXX 0.00 Digital subtraction angiograS9024 D 0.00 0.00 0.00 0.00 XXX 0.00 Paranasal sinus ultrasoundS9025 D 0.00 0.00 0.00 0.00 XXX 0.00 Omnicardiogram/cardiointegraS9034 D 0.00 0.00 0.00 0.00 XXX 0.00 Extracorp shockwv lithotrip, gall stoneS9055 D 0.00 0.00 0.00 0.00 XXX 0.00 Procuren or other growth facS9056 D 0.00 0.00 0.00 0.00 XXX 0.00 Coma stimulation per diemS9061 D 0.00 0.00 0.00 0.00 XXX 0.00 Medical supplies and equipmeS9075 D 0.00 0.00 0.00 0.00 XXX 0.00 Smoking cessation treatmentS9083 D 0.00 0.00 0.00 0.00 XXX 0.00 Urgent care center globalS9088 D 0.00 0.00 0.00 0.00 XXX 0.00 Services provided in urgentS9090 D 0.00 0.00 0.00 0.00 XXX 0.00 Vertebral axial decompressio
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S9092 D 0.00 0.00 0.00 0.00 XXX 0.00 Canolith repos, per visitS9097 D 0.00 0.00 0.00 0.00 XXX 0.00 Home visit, wound careS9098 D 0.00 0.00 0.00 0.00 XXX 0.00 Home phototherapy visitS9109 D 0.00 0.00 0.00 0.00 XXX 0.00 CHF telemonitoring monthS9117 D 0.00 0.00 0.00 0.00 XXX 0.00 Back school visitS9122 C 0.35 0.00 0.00 0.00 XXX 50.58 Home health aide/cert'd nrs asst; per hrS9123 C 2.27 0.00 0.00 0.00 XXX 50.58 Nursing care, in the home, RN; per hrS9124 C 1.82 0.00 0.00 0.00 XXX 50.58 Nursing care, in the home, LPN; per hrS9125 C 0.00 0.00 0.00 0.00 XXX 0.00 Respite care, in the home; per diemS9126 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospice care, in the home; per diemS9127 C 15.30 0.00 0.00 0.00 XXX 50.58 Social work visit, in the home; per diemS9128 C 12.67 0.00 0.00 0.00 XXX 50.58 Speech therapy, in the home; per diemS9129 C 12.55 0.00 0.00 0.00 XXX 50.58 Occup. therapy, in the home; per diemS9131 C 12.50 0.00 0.00 0.00 XXX 50.58 PT in the home per diemS9140 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic Management Program,S9141 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic Management Program,S9145 D 0.00 0.00 0.00 0.00 XXX 0.00 Insulin pump init, instructionS9150 D 0.00 0.00 0.00 0.00 XXX 0.00 Eval by oculistS9208 D 0.00 0.00 0.00 0.00 XXX 0.00 Home mgmt preterm laborS9209 D 0.00 0.00 0.00 0.00 XXX 0.00 Home mgmt PPROMS9211 D 0.00 0.00 0.00 0.00 XXX 0.00 Home mgmt gest hypertensionS9212 D 0.00 0.00 0.00 0.00 XXX 0.00 Hm postpar hyper per diemS9213 D 0.00 0.00 0.00 0.00 XXX 0.00 Hm preeclamp per diemS9214 D 0.00 0.00 0.00 0.00 XXX 0.00 Hm gest dm per diemS9325 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT pain mgmt per diemS9326 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT cont pain per diemS9327 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT int pain per diemS9328 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT pain imp pump diemS9329 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT chemo per diemS9330 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT cont chem diemS9331 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT intermit chemo diemS9335 D 0.00 0.00 0.00 0.00 XXX 0.00 HT hemodialysis diemS9336 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT cont anticoag diemS9338 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT immunotherapy diemS9339 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT periton dialysis diemS9340 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT enteral per diemS9341 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT enteral grav diemS9342 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT enteral pump diemS9343 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT enteral bolus nursS9345 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT anti-hemophil diemS9346 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT alpha-1-proteinas diemS9347 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT longterm infusion diemS9348 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT sympathomim diemS9349 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT tocolysis diemS9351 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT cont antiemetic diemS9353 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT cont insulin diemS9355 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT chelation diemS9357 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT enzyme replace diemS9359 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT anti-tnf per diemS9361 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT diuretic infus diemS9363 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT anti-spasmotic diemS9364 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT tpn total diemS9365 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT tpn 1 liter diemS9366 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT tpn 2 liter diem
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S9367 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT tpn 3 liter diemS9368 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT tpn over 3l diemS9370 D 0.00 0.00 0.00 0.00 XXX 0.00 HT inj antiemetic diemS9372 D 0.00 0.00 0.00 0.00 XXX 0.00 HT inj anticoag diemS9373 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT hydra total diemS9374 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT hydra 1 liter diemS9375 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT hydra 2 liter diemS9376 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT hydra 3 liter diemS9377 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT hydra over 3l diemS9379 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT noc per diemS9381 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT high risk/escortS9401 D 0.00 0.00 0.00 0.00 XXX 0.00 Anticoag clinic, per sessionS9430 D 0.00 0.00 0.00 0.00 XXX 0.00 Rx compound, dispens serviceS9434 D 0.00 0.00 0.00 0.00 XXX 0.00 Mod solid food supplS9435 D 0.00 0.00 0.00 0.00 XXX 0.00 Medical foods for inborn errS9436 D 0.00 0.00 0.00 0.00 XXX 0.00 Childbirth preparation/class, non-MD per sessS9437 D 0.00 0.00 0.00 0.00 XXX 0.00 Childbirth refresher class, non-MD per sessS9438 D 0.00 0.00 0.00 0.00 XXX 0.00 Cesarean birth class, non-MD per sessS9439 D 0.00 0.00 0.00 0.00 XXX 0.00 VBAC class, non-MD per sessS9441 D 0.00 0.00 0.00 0.00 XXX 0.00 Asthma educationS9442 D 0.00 0.00 0.00 0.00 XXX 0.00 Birthing classS9443 D 0.00 0.00 0.00 0.00 XXX 0.00 Lactation classS9444 D 0.00 0.00 0.00 0.00 XXX 0.00 Parenting class; non-MDS9445 D 0.00 0.00 0.00 0.00 XXX 0.00 PT education noc individS9446 D 0.00 0.00 0.00 0.00 XXX 0.00 PT education noc groupS9447 D 0.00 0.00 0.00 0.00 XXX 0.00 Infant safety; non-MDS9449 D 0.00 0.00 0.00 0.00 XXX 0.00 Weight mgmt; non-MDS9451 D 0.00 0.00 0.00 0.00 XXX 0.00 Exercise class; non-MDS9452 D 0.00 0.00 0.00 0.00 XXX 0.00 Nutrition class; non-MDS9453 D 0.00 0.00 0.00 0.00 XXX 0.00 Smoking cessation class; non-MDS9454 D 0.00 0.00 0.00 0.00 XXX 0.00 Stress mgmt class; non-MDS9455 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic Management Program,S9460 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic Management Program,S9465 D 0.00 0.00 0.00 0.00 XXX 0.00 Diabetic Management Program,S9470 D 0.00 0.00 0.00 0.00 XXX 0.00 Nutritional counseling, dietS9472 D 0.00 0.00 0.00 0.00 XXX 0.00 Cardiac rehabilitation progrS9473 D 0.00 0.00 0.00 0.00 XXX 0.00 Pulmonary rehabilitation proS9474 D 0.00 0.00 0.00 0.00 XXX 0.00 Enterostomal therapy by a reS9475 C 0.00 0.00 0.00 0.00 XXX 0.00 Ambulatory setting substance, per diemS9476 D 0.00 0.00 0.00 0.00 XXX 0.00 Vestibular rehab per diemS9480 C 0.00 0.00 0.00 0.00 XXX 0.00 Intensive outpatient psychiaS9482 C 0.00 0.00 0.00 0.00 XXX 0.00 Family stabilization 15 minS9484 D 0.00 0.00 0.00 0.00 XXX 0.00 Crisis intervention per hourS9485 C 0.00 0.00 0.00 0.00 XXX 0.00 Crisis intervention mental hS9490 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT corticosteroid/diemS9494 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT antibiotic total diemS9497 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT antibiotic q3h diemS9500 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT antibiotic q24h diemS9501 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT antibiotic q12h diemS9502 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT antibiotic q8h diemS9503 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT antibiotic q6h diemS9504 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT antibiotic q4h diemS9529 D 0.00 0.00 0.00 0.00 XXX 0.00 Venipuncture home/snfS9537 D 0.00 0.00 0.00 0.00 XXX 0.00 HT hem horm inj diem
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
S9538 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT blood products diemS9542 D 0.00 0.00 0.00 0.00 XXX 0.00 HT inj noc per diemS9558 D 0.00 0.00 0.00 0.00 XXX 0.00 HT inj growth horm diemS9559 D 0.00 0.00 0.00 0.00 XXX 0.00 HIT inj interferon diemS9560 D 0.00 0.00 0.00 0.00 XXX 0.00 HT inj hormone diemS9562 D 0.00 0.00 0.00 0.00 XXX 0.00 HT inj, palivizumab, per diemS9590 D 0.00 0.00 0.00 0.00 XXX 0.00 HT irrig therapy, per diemS9810 D 0.00 0.00 0.00 0.00 XXX 0.00 HT pharm per hourS9900 D 0.00 0.00 0.00 0.00 XXX 0.00 Christian Sci Pract visitS9970 D 0.00 0.00 0.00 0.00 XXX 0.00 Health club membership, annualS9975 D 0.00 0.00 0.00 0.00 XXX 0.00 Transplant related lodging, meals, transport; per diemS9976 D 0.00 0.00 0.00 0.00 XXX 0.00 Lodging per diemS9977 D 0.00 0.00 0.00 0.00 XXX 0.00 Meals per diemS9981 D 0.00 0.00 0.00 0.00 XXX 0.00 Med record copy adminS9982 D 0.00 0.00 0.00 0.00 XXX 0.00 Med record copy per pageS9986 D 0.00 0.00 0.00 0.00 XXX 0.00 Not medically necessary svcS9988 D 0.00 0.00 0.00 0.00 XXX 0.00 Serv part of phase I trialS9989 D 0.00 0.00 0.00 0.00 XXX 0.00 Services outside USS9990 D 0.00 0.00 0.00 0.00 XXX 0.00 Services provided as part ofS9991 D 0.00 0.00 0.00 0.00 XXX 0.00 Services provided as part ofS9992 D 0.00 0.00 0.00 0.00 XXX 0.00 Transportation costs to andS9994 D 0.00 0.00 0.00 0.00 XXX 0.00 Lodging costs (e.g. hotel chS9996 D 0.00 0.00 0.00 0.00 XXX 0.00 Meals for clinical trial parS9999 S 0.00 0.00 0.00 0.00 XXX 0.00 Sales tax
SECOP C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP-requested second opinion medical evaluationSUPPL C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP-requested supplemental report for clarification; no new med evidenceSURB1 C 0.00 0.00 0.00 0.00 XXX 0.00 Case file review by DMA or office consultation, back surgerySURB2 C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP-requested second opinion clin exam, back surgerySURC1 C 0.00 0.00 0.00 0.00 XXX 0.00 Case file review by DMA or office consultation, carpal tunnel surgerySURC2 C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP requested second opinion clin exam, carpal tunnel surgerySURG3 C 0.00 0.00 0.00 0.00 XXX 0.00 OWCP requested second opinion clin exam, other surgeryT1000 C 0.57 0.00 0.00 0.00 XXX 50.58 Private duty/independent nsg up to 15 minT1001 C 1.72 1.56 1.56 0.07 XXX 50.58 Nursing assessment/evaluatnT1002 C 0.57 0.00 0.00 0.00 XXX 50.58 RN services up to 15 minutesT1003 C 0.45 0.00 0.00 0.00 XXX 50.58 LPN/LVN services up to 15minT1004 C 0.09 0.00 0.00 0.00 XXX 50.58 Nsg aide service up to 15minT1005 D 0.00 0.00 0.00 0.00 XXX 0.00 Respite care service 15 minT1006 D 0.00 0.00 0.00 0.00 XXX 0.00 Alco/subst Abuse Family/Couple CounselingT1007 D 0.00 0.00 0.00 0.00 XXX 0.00 Alco/Subst Abuse Treatment Plan DevelopmentT1009 D 0.00 0.00 0.00 0.00 XXX 0.00 Child Sitting ServicesT1010 D 0.00 0.00 0.00 0.00 XXX 0.00 Meals when Receive ServicesT1012 D 0.00 0.00 0.00 0.00 XXX 0.00 Alcohol/Substance Abuse SkilT1013 C 0.57 0.00 0.00 0.00 XXX 50.58 Sign Lang/Oral InterpreterT1014 D 0.00 0.00 0.00 0.00 XXX 0.00 Telehealth transmit, per minT1015 D 0.00 0.00 0.00 0.00 XXX 0.00 Clinic serviceT1016 D 0.00 0.00 0.00 0.00 XXX 0.00 Case mgmt; per 15 minT1017 D 0.00 0.00 0.00 0.00 XXX 0.00 Targeted case mgmt; per 15 minT1018 D 0.00 0.00 0.00 0.00 XXX 0.00 School-based IEP serv; bundledT1019 D 0.00 0.00 0.00 0.00 XXX 0.00 Personal care serv; per 15 minT1020 D 0.00 0.00 0.00 0.00 XXX 0.00 Personal care serv; per diemT1021 C 0.35 0.00 0.00 0.00 XXX 50.58 HH Aide or cn aide per visitT1022 D 0.00 0.00 0.00 0.00 XXX 0.00 Contracted HH agency serv; per diemT1023 D 0.00 0.00 0.00 0.00 XXX 0.00 Screening; per encounterT1024 D 0.00 0.00 0.00 0.00 XXX 0.00 Eval & treatmt, child; per encounter
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
T1025 D 0.00 0.00 0.00 0.00 XXX 0.00 Multidiscipline svc, child; per diemT1026 D 0.00 0.00 0.00 0.00 XXX 0.00 Multidiscipline svc, child; per hrT1027 D 0.00 0.00 0.00 0.00 XXX 0.00 Family Training, Counseling; per 15 minT1028 D 0.00 0.00 0.00 0.00 XXX 0.00 Assessment, home environmentT1029 D 0.00 0.00 0.00 0.00 XXX 0.00 Comprehensive Pb investigation, per dwellingT1030 C 13.63 0.00 0.00 0.00 XXX 50.58 Home nursing care, RN; per diemT1031 C 10.91 0.00 0.00 0.00 XXX 50.58 Home nursing care, LPN; per diemT1502 D 0.00 0.00 0.00 0.00 XXX 0.00 Admin, oral, im or subcut med; per visitT1999 D 0.00 0.00 0.00 0.00 XXX 0.00 Misc items, suppliesT2001 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-emerg transp; attendant/escortT2002 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-emerg transp; per diemT2003 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-emerg transp; per encounter/tripT2004 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-emerg transp; comm carrierT2005 D 0.00 0.00 0.00 0.00 XXX 0.00 Non-emerg transp; stretcher vanT2006 D 0.00 0.00 0.00 0.00 XXX 0.00 12/31/2005 Ambulance response/treatmt; no transpT2007 D 0.00 0.00 0.00 0.00 XXX 0.00 Transp waiting time; per 1/2 hr.T2010 D 0.00 0.00 0.00 0.00 XXX 0.00 PASRR Level IT2011 D 0.00 0.00 0.00 0.00 XXX 0.00 PASRR Level IIT2012 D 0.00 0.00 0.00 0.00 XXX 0.00 Habil ed waiver, per diemT2013 D 0.00 0.00 0.00 0.00 XXX 0.00 Habil ed waiver per hourT2014 D 0.00 0.00 0.00 0.00 XXX 0.00 Habil prevoc waiver, per dT2015 D 0.00 0.00 0.00 0.00 XXX 0.00 Habil prevoc waiver per hrT2016 C 0.00 0.00 0.00 0.00 XXX 0.00 Habil res waiver per diemT2017 D 0.00 0.00 0.00 0.00 XXX 0.00 Habil res waiver 15 minT2018 D 0.00 0.00 0.00 0.00 XXX 0.00 Habil sup empl waiver/diemT2019 D 0.00 0.00 0.00 0.00 XXX 0.00 Habil sup empl waiver 15minT2020 D 0.00 0.00 0.00 0.00 XXX 0.00 Day habil waiver per diemT2021 D 0.00 0.00 0.00 0.00 XXX 0.00 Day habil waiver per 15 minT2022 D 0.00 0.00 0.00 0.00 XXX 0.00 Case management, per monthT2023 D 0.00 0.00 0.00 0.00 XXX 0.00 Targeted case mgmt per monthT2024 D 0.00 0.00 0.00 0.00 XXX 0.00 Serv asmnt/care plan waiverT2025 D 0.00 0.00 0.00 0.00 XXX 0.00 Waiver service, nosT2026 D 0.00 0.00 0.00 0.00 XXX 0.00 Special childcare waiver/dT2027 D 0.00 0.00 0.00 0.00 XXX 0.00 Spec childcare waiver 15 minT2028 D 0.00 0.00 0.00 0.00 XXX 0.00 Special supply, nos waiverT2029 D 0.00 0.00 0.00 0.00 XXX 0.00 Special med equip, noswaiverT2030 C 0.00 0.00 0.00 0.00 XXX 0.00 Assist living waiver/monthT2031 C 0.00 0.00 0.00 0.00 XXX 0.00 Assist living waiver/diemT2032 C 0.00 0.00 0.00 0.00 XXX 0.00 Res care, nos waiver/monthT2033 C 0.00 0.00 0.00 0.00 XXX 0.00 Res, nos waiver per diemT2034 D 0.00 0.00 0.00 0.00 XXX 0.00 Crisis interven waiver/diemT2035 D 0.00 0.00 0.00 0.00 XXX 0.00 Utility services waiverT2036 D 0.00 0.00 0.00 0.00 XXX 0.00 Camp overnite waiver/sessionT2037 D 0.00 0.00 0.00 0.00 XXX 0.00 Camp day waiver/sessionT2038 D 0.00 0.00 0.00 0.00 XXX 0.00 Comm trans waiver/serviceT2039 D 0.00 0.00 0.00 0.00 XXX 0.00 Vehicle mod waiver/serviceT2040 D 0.00 0.00 0.00 0.00 XXX 0.00 Financial mgt waiver/15minT2041 D 0.00 0.00 0.00 0.00 XXX 0.00 Support broker waiver/15 minT2042 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospice routine home careT2043 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospice continuous home careT2044 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospice respite careT2045 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospice general careT2046 C 0.00 0.00 0.00 0.00 XXX 0.00 Hospice long term care, r&bT2048 D 0.00 0.00 0.00 0.00 XXX 0.00 Bh ltc res r&b, per diem
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
T2049 D 0.00 0.00 0.00 0.00 XXX 0.00 N-ET; stretcher van, mileageT2101 D 0.00 0.00 0.00 0.00 XXX 0.00 Breast milk proc/store/distT4521 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size brief/diaper smT4522 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size brief/diaper medT4523 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size brief/diaper lgT4524 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size brief/diaper xlT4525 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size pull-on smT4526 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size pull-on medT4527 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size pull-on lgT4528 D 0.00 0.00 0.00 0.00 XXX 0.00 Adult size pull-on xlT4529 D 0.00 0.00 0.00 0.00 XXX 0.00 Ped size brief/diaper sm/medT4530 D 0.00 0.00 0.00 0.00 XXX 0.00 Ped size brief/diaper lgT4531 D 0.00 0.00 0.00 0.00 XXX 0.00 Ped size pull-on sm/medT4532 D 0.00 0.00 0.00 0.00 XXX 0.00 Ped size pull-on lgT4533 D 0.00 0.00 0.00 0.00 XXX 0.00 Youth size brief/diaperT4534 D 0.00 0.00 0.00 0.00 XXX 0.00 Youth size pull-onT4535 D 0.00 0.00 0.00 0.00 XXX 0.00 Disposable liner/shield/padT4536 D 0.00 0.00 0.00 0.00 XXX 0.00 Reusable pull-on any sizeT4537 D 0.00 0.00 0.00 0.00 XXX 0.00 Reusable underpad bed sizeT4538 D 0.00 0.00 0.00 0.00 XXX 0.00 Diaper serv reusable diaperT4539 D 0.00 0.00 0.00 0.00 XXX 0.00 Reuse diaper/brief any sizeT4540 D 0.00 0.00 0.00 0.00 XXX 0.00 Reusable underpad chair sizeT4541 D 0.00 0.00 0.00 0.00 XXX 0.00 Large disposable underpadT4542 D 0.00 0.00 0.00 0.00 XXX 0.00 Small disposable underpadT5001 D 0.00 0.00 0.00 0.00 XXX 0.00 Special position seat/vehiclT5999 S 0.00 0.00 0.00 0.00 XXX 0.00 Supply, nosTAXES S 0.00 0.00 0.00 0.00 XXX 0.00 For payment of local or state sales taxes TRANS S 0.00 0.00 0.00 0.00 XXX 0.00 Transportation, otherV2020 C 98.98 0.00 0.00 0.00 XXX 1.25 Vision svcs frames purchasesV2025 D 0.00 0.00 0.00 0.00 XXX 0.00 Eyeglasses delux framesV2100 C 52.35 0.00 0.00 0.00 XXX 1.25 Lens spher single plano 4.00V2101 C 59.65 0.00 0.00 0.00 XXX 1.25 Single visn sphere 4.12-7.00V2102 C 77.61 0.00 0.00 0.00 XXX 1.25 Singl visn sphere 7.12-20.00V2103 C 47.55 0.00 0.00 0.00 XXX 1.25 Spherocylindr 4.00d/12-2.00dV2104 C 50.35 0.00 0.00 0.00 XXX 1.25 Spherocylindr 4.00d/2.12-4dV2105 C 54.81 0.00 0.00 0.00 XXX 1.25 Spherocylinder 4.00d/4.25-6dV2106 C 60.82 0.00 0.00 0.00 XXX 1.25 Spherocylinder 4.00d/>6.00dV2107 C 63.63 0.00 0.00 0.00 XXX 1.25 Spherocylinder 4.25d/12-2dV2108 C 59.97 0.00 0.00 0.00 XXX 1.25 Spherocylinder 4.25d/2.12-4dV2109 C 69.18 0.00 0.00 0.00 XXX 1.25 Spherocylinder 4.25d/4.25-6dV2110 C 65.40 0.00 0.00 0.00 XXX 1.25 Spherocylinder 4.25d/over 6dV2111 C 69.19 0.00 0.00 0.00 XXX 1.25 Spherocylindr 7.25d/.25-2.25V2112 C 74.41 0.00 0.00 0.00 XXX 1.25 Spherocylindr 7.25d/2.25-4dV2113 C 81.79 0.00 0.00 0.00 XXX 1.25 Spherocylindr 7.25d/4.25-6dV2114 C 90.85 0.00 0.00 0.00 XXX 1.25 Spherocylinder over 12.00dV2115 C 111.46 0.00 0.00 0.00 XXX 1.25 Lens lenticular bifocalV2118 C 113.61 0.00 0.00 0.00 XXX 1.25 Lens aniseikonic singleV2121 C 144.40 0.00 0.00 0.00 XXX 1.25 Lenticular lensV2199 S 0.00 0.00 0.00 0.00 XXX 0.00 Lens single vision not oth cV2200 C 68.52 0.00 0.00 0.00 XXX 1.25 Lens spher bifoc plano 4.00dV2201 C 79.84 0.00 0.00 0.00 XXX 1.25 Lens sphere bifocal 4.12-7.0V2202 C 87.89 0.00 0.00 0.00 XXX 1.25 Lens sphere bifocal 7.12-20.V2203 C 69.99 0.00 0.00 0.00 XXX 1.25 Lens sphcyl bifocal 4.00d/.1V2204 C 72.27 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifocal 4.00d/2.1
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
V2205 C 78.15 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifocal 4.00d/4.2V2206 C 83.95 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifocal 4.00d/oveV2207 C 77.00 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifocal 4.25-7d/.V2208 C 85.66 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifocal 4.25-7/2.V2209 C 85.12 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifocal 4.25-7/4.V2210 C 95.19 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifocal 4.25-7/ovV2211 C 107.76 0.00 0.00 0.00 XXX 1.25 Lens sphcy bifo 7.25-12/.25-V2212 C 101.93 0.00 0.00 0.00 XXX 1.25 Lens sphcyl bifo 7.25-12/2.2V2213 C 102.96 0.00 0.00 0.00 XXX 1.25 Lens sphcyl bifo 7.25-12/4.2V2214 C 111.93 0.00 0.00 0.00 XXX 1.25 Lens sphcyl bifocal over 12.V2215 C 161.42 0.00 0.00 0.00 XXX 1.25 Lens lenticular bifocalV2218 C 135.20 0.00 0.00 0.00 XXX 1.25 Lens aniseikonic bifocalV2219 C 59.51 0.00 0.00 0.00 XXX 1.25 Lens bifocal seg width overV2220 C 79.26 0.00 0.00 0.00 XXX 1.25 Lens bifocal add over 3.25dV2221 C 184.68 0.00 0.00 0.00 XXX 1.25 Lenticular lensV2299 S 0.00 0.00 0.00 0.00 XXX 0.00 Lens bifocal specialityV2300 C 84.54 0.00 0.00 0.00 XXX 1.25 Lens sphere trifocal 4.00dV2301 C 101.51 0.00 0.00 0.00 XXX 1.25 Lens sphere trifocal 4.12-7.V2302 C 109.61 0.00 0.00 0.00 XXX 1.25 Lens sphere trifocal 7.12-20V2303 C 86.64 0.00 0.00 0.00 XXX 1.25 Lens sphcy trifocal 4.0/.12-V2304 C 90.36 0.00 0.00 0.00 XXX 1.25 Lens sphcy trifocal 4.0/2.25V2305 C 98.50 0.00 0.00 0.00 XXX 1.25 Lens sphcy trifocal 4.0/4.25V2306 C 107.15 0.00 0.00 0.00 XXX 1.25 Lens sphcyl trifocal 4.00/>6V2307 C 98.50 0.00 0.00 0.00 XXX 1.25 Lens sphcy trifocal 4.25-7/.V2308 C 101.45 0.00 0.00 0.00 XXX 1.25 Lens sphc trifocal 4.25-7/2.V2309 C 118.70 0.00 0.00 0.00 XXX 1.25 Lens sphc trifocal 4.25-7/4.V2310 C 114.45 0.00 0.00 0.00 XXX 1.25 Lens sphc trifocal 4.25-7/>6V2311 C 125.06 0.00 0.00 0.00 XXX 1.25 Lens sphc trifo 7.25-12/.25-V2312 C 159.34 0.00 0.00 0.00 XXX 1.25 Lens sphc trifo 7.25-12/2.25V2313 C 174.74 0.00 0.00 0.00 XXX 1.25 Lens sphc trifo 7.25-12/4.25V2314 C 144.09 0.00 0.00 0.00 XXX 1.25 Lens sphcyl trifocal over 12V2315 C 182.41 0.00 0.00 0.00 XXX 1.25 Lens lenticular trifocalV2318 C 364.21 0.00 0.00 0.00 XXX 1.25 Lens aniseikonic trifocalV2319 C 66.37 0.00 0.00 0.00 XXX 1.25 Lens trifocal seg width > 28V2320 C 95.12 0.00 0.00 0.00 XXX 1.25 Lens trifocal add over 3.25dV2321 C 173.09 0.00 0.00 0.00 XXX 1.25 Lenticular lensV2399 S 0.00 0.00 0.00 0.00 XXX 0.00 Lens trifocal specialityV2410 C 141.25 0.00 0.00 0.00 XXX 1.25 Lens variab asphericity singV2430 C 206.30 0.00 0.00 0.00 XXX 1.25 Lens variable asphericity biV2499 S 0.00 0.00 0.00 0.00 XXX 0.00 Variable asphericity lensV2500 C 317.02 0.00 0.00 0.00 XXX 1.25 Contact lens pmma sphericalV2501 C 356.67 0.00 0.00 0.00 XXX 1.25 Cntct lens pmma-toric/prismV2502 C 355.42 0.00 0.00 0.00 XXX 1.25 Contact lens pmma bifocalV2503 C 197.91 0.00 0.00 0.00 XXX 1.25 Cntct lens pmma color visionV2510 C 317.02 0.00 0.00 0.00 XXX 1.25 Cntct gas permeable sphericlV2511 C 355.42 0.00 0.00 0.00 XXX 1.25 Cntct toric prism ballastV2512 C 355.42 0.00 0.00 0.00 XXX 1.25 Cntct lens gas permbl bifoclV2513 C 317.02 0.00 0.00 0.00 XXX 1.25 Contact lens extended wearV2520 C 317.02 0.00 0.00 0.00 XXX 1.25 Contact lens hydrophilicV2521 C 356.67 0.00 0.00 0.00 XXX 1.25 Cntct lens hydrophilic toricV2522 C 356.67 0.00 0.00 0.00 XXX 1.25 Cntct lens hydrophil bifoclV2523 C 318.44 0.00 0.00 0.00 XXX 1.25 Cntct lens hydrophil extendV2530 C 298.11 0.00 0.00 0.00 XXX 1.25 Contact lens gas impermeableV2531 C 586.15 0.00 0.00 0.00 XXX 1.25 Contact lens gas permeable
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
V2599 S 0.00 0.00 0.00 0.00 XXX 0.00 Contact lens/es other typeV2600 C 0.00 0.00 0.00 0.00 XXX 0.00 Hand held low vision aidsV2610 C 0.00 0.00 0.00 0.00 XXX 0.00 Single lens spectacle mountV2615 C 0.00 0.00 0.00 0.00 XXX 0.00 Telescop/othr compound lensV2623 C 812.36 0.00 0.00 0.00 XXX 2.50 Plastic eye prosth customV2624 C 81.36 0.00 0.00 0.00 XXX 1.25 Polishing artifical eyeV2625 C 494.71 0.00 0.00 0.00 XXX 1.25 Enlargemnt of eye prosthesisV2626 C 292.79 0.00 0.00 0.00 XXX 1.25 Reduction of eye prosthesisV2627 C 861.14 0.00 0.00 0.00 XXX 2.50 Scleral cover shellV2628 C 788.24 0.00 0.00 0.00 XXX 1.25 Fabrication & fittingV2629 C 0.00 0.00 0.00 0.00 XXX 0.00 Prosthetic eye other typeV2630 C 0.00 0.00 0.00 0.00 XXX 0.00 Anter chamber intraocul lensV2631 C 0.00 0.00 0.00 0.00 XXX 0.00 Iris support intraoclr lensV2632 C 0.00 0.00 0.00 0.00 XXX 0.00 Post chmbr intraocular lensV2700 C 81.53 0.00 0.00 0.00 XXX 1.25 Balance lensV2702 C 0.00 0.00 0.00 0.00 XXX 0.00 Deluxe lens featureV2710 C 126.79 0.00 0.00 0.00 XXX 1.25 Glass/plastic slab off prismV2715 C 80.06 0.00 0.00 0.00 XXX 1.25 Prism lens/esV2718 C 79.21 0.00 0.00 0.00 XXX 1.25 Fresnell prism press-on lensV2730 C 30.60 0.00 0.00 0.00 XXX 1.25 Special base curveV2744 C 21.93 0.00 0.00 0.00 XXX 1.25 Tint photochromatic lens/esV2745 C 13.72 0.00 0.00 0.00 XXX 1.25 TintV2750 C 39.35 0.00 0.00 0.00 XXX 1.25 Anti-reflective coatingV2755 C 22.20 0.00 0.00 0.00 XXX 1.25 UV lens/esV2756 C 0.00 0.00 0.00 0.00 XXX 0.00 Eye glass caseV2760 C 29.95 0.00 0.00 0.00 XXX 1.25 Scratch resistant coatingV2761 C 0.00 0.00 0.00 0.00 XXX 0.00 Mirror coatingV2762 C 64.51 0.00 0.00 0.00 XXX 1.25 PolarizationV2770 C 42.79 0.00 0.00 0.00 XXX 1.25 Occluder lens/esV2780 C 31.71 0.00 0.00 0.00 XXX 1.25 Oversize lens/esV2781 C 0.00 0.00 0.00 0.00 XXX 0.00 Progressive lens per lensV2782 C 69.69 0.00 0.00 0.00 XXX 1.25 LensV2783 C 78.59 0.00 0.00 0.00 XXX 1.25 LensV2784 C 51.08 0.00 0.00 0.00 XXX 1.25 Lens polycarb or equalV2785 C 0.00 0.00 0.00 0.00 XXX 0.00 Corneal tissue processingV2786 C 0.00 0.00 0.00 0.00 XXX 0.00 Occupational multifocal lensV2788 C 0.00 0.00 0.00 0.00 XXX 0.00 Presbyopia-correct functionV2790 C 0.00 0.00 0.00 0.00 XXX 0.00 Amniotic membraneV2797 C 0.00 0.00 0.00 0.00 XXX 0.00 Vis item/svc in other codeV2799 S 0.00 0.00 0.00 0.00 XXX 0.00 Miscellaneous vision serviceV5008 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing screeningV5010 C 0.00 0.00 0.00 0.00 XXX 0.00 Assessment for hearing aidV5011 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid fitting/checkingV5014 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid repair/modifyingV5020 C 0.00 0.00 0.00 0.00 XXX 0.00 Conformity evaluationV5030 C 0.00 0.00 0.00 0.00 XXX 0.00 Body-worn hearing aid airV5040 C 0.00 0.00 0.00 0.00 XXX 0.00 Body-worn hearing aid boneV5050 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid monaural in earV5060 C 0.00 0.00 0.00 0.00 XXX 0.00 Behind ear hearing aidV5070 C 0.00 0.00 0.00 0.00 XXX 0.00 Glasses air conductionV5080 C 0.00 0.00 0.00 0.00 XXX 0.00 Glasses bone conductionV5090 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid dispensing feeV5095 C 0.00 0.00 0.00 0.00 XXX 0.00 Semi-implant mid ear prosthesisV5100 C 0.00 0.00 0.00 0.00 XXX 0.00 Body-worn bilat hearing aid
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
V5110 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid dispensing feeV5120 C 0.00 0.00 0.00 0.00 XXX 0.00 Body-worn binaur hearing aidV5130 C 0.00 0.00 0.00 0.00 XXX 0.00 In ear binaural hearing aidV5140 C 0.00 0.00 0.00 0.00 XXX 0.00 Behind ear binaur hearing aiV5150 C 0.00 0.00 0.00 0.00 XXX 0.00 Glasses binaural hearing aidV5160 C 0.00 0.00 0.00 0.00 XXX 0.00 Dispensing fee binauralV5170 C 0.00 0.00 0.00 0.00 XXX 0.00 Within ear cros hearing aidV5180 C 0.00 0.00 0.00 0.00 XXX 0.00 Behind ear cros hearing aidV5190 C 0.00 0.00 0.00 0.00 XXX 0.00 Glasses cros hearing aidV5200 C 0.00 0.00 0.00 0.00 XXX 0.00 Cros hearing aid dispens feeV5210 C 0.00 0.00 0.00 0.00 XXX 0.00 In ear bicros hearing aidV5220 C 0.00 0.00 0.00 0.00 XXX 0.00 Behind ear bicros hearing aiV5230 C 0.00 0.00 0.00 0.00 XXX 0.00 Glasses bicros hearing aidV5240 C 0.00 0.00 0.00 0.00 XXX 0.00 Dispensing fee bicrosV5241 C 0.00 0.00 0.00 0.00 XXX 0.00 Dispensing fee, monauralV5242 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, monaural, cicV5243 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, monaural, itcV5244 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, mon, cicV5245 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, mon, itcV5246 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, mon, iteV5247 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, mon, bteV5248 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, binaural, cicV5249 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, binaural, itcV5250 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, bin, cicV5251 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, bin, itcV5252 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, bin, iteV5253 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, prog, bin, bteV5254 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing id, digit, mon, cicV5255 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, digit, mon, itcV5256 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, digit, mon, iteV5257 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, digit, mon, bteV5258 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, digit, bin, cicV5259 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, digit, bin, itcV5260 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, digit, bin, iteV5261 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, digit, bin, bteV5262 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, disp, monauralV5263 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, disp, binauralV5264 C 0.00 0.00 0.00 0.00 XXX 0.00 Ear mold/insertV5265 C 0.00 0.00 0.00 0.00 XXX 0.00 Ear mold/insert, dispV5266 C 0.00 0.00 0.00 0.00 XXX 0.00 Battery for hearing deviceV5267 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid supply/accessoryV5268 C 0.00 0.00 0.00 0.00 XXX 0.00 ALD Telephone AmplifierV5269 C 0.00 0.00 0.00 0.00 XXX 0.00 Alerting device, any typeV5270 C 0.00 0.00 0.00 0.00 XXX 0.00 ALD, TV amplifier, any typeV5271 C 0.00 0.00 0.00 0.00 XXX 0.00 ALD, TV caption decoderV5272 C 0.00 0.00 0.00 0.00 XXX 0.00 TddV5273 C 0.00 0.00 0.00 0.00 XXX 0.00 ALD for cochlear implantV5274 C 0.00 0.00 0.00 0.00 XXX 0.00 ALD unspecifiedV5275 C 0.00 0.00 0.00 0.00 XXX 0.00 Ear impressionV5298 C 0.00 0.00 0.00 0.00 XXX 0.00 Hearing aid, nosV5299 S 0.00 0.00 0.00 0.00 XXX 0.00 Hearing serviceV5336 C 0.00 0.00 0.00 0.00 XXX 0.00 Repair communication deviceV5362 C 0.86 1.72 1.72 0.04 XXX 50.58 Speech screeningV5363 C 0.86 1.72 1.72 0.04 XXX 50.58 Language screening
NON-FACILITY FACILITYPAY WORK PE PE MPE GLOBAL CONVERSION END
HCPCS MODIFIER RVU RVU RVU RVU FACTOR DATE SHORT DESCRIPTION (Refer to ADA, HCPCS)
CPT1
ADA2
STATUS3 PERIOD4
V5364 C 1.50 1.69 1.69 0.07 XXX 50.58 Dysphagia screeningVHMDF S 0.00 0.00 0.00 0.00 XXX 0.00 Vehicle modificationVHPUM S 0.00 0.00 0.00 0.00 XXX 0.00 Vehicle purchase and modificationVHPUR S 0.00 0.00 0.00 0.00 XXX 0.00 Vehicle purchaseVR001 C 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; Professional ServicesVR002 C 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; Non-professional ServicesVR003 C 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; Reimburse RC for outside testingVR004 C 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; Counselor MileageVR018 C 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; Counselor Phone, Parking, Tolls, other itemized NOSVREDU S 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; TrainingVRLOC S 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; Relocation ExpensesVRSCR C 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; ScreeningVRSUP S 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; Books & SuppliesVRTST C 0.00 0.00 0.00 0.00 XXX 0.00 Vocational Rehab; TestingWRKH1 C 0.00 0.00 0.00 0.00 XXX 0.00 Work hardening 1WRKH2 C 0.00 0.00 0.00 0.00 XXX 0.00 Work hardening 2
