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Medi-Cal Rates Information

Medi-Cal Rates as of 05/15/2019 (Codes 94799 thru 99499)

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month


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Proc Type Proc Code Procedure Description Unit Value Basic Rate Child Rate ER Rate Conv Ind ER Ind Cut-back Ind Prof % Rental Rate Non-Physn. Med.Prac. Ind
N 94799 PULMONARY SERVICE/PROCEDURE 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 95004 PERCUT ALLERGY SKIN TESTS 0.19 $1.90 $2.07 $2.36 053 1 1 0.00 $0.00 Y
P 95004 PERCUT ALLERGY SKIN TESTS 0.19 $1.90 $2.07 -- 052 0 1 0.00 $0.00 Y
N 95017 PERQ & ICUT ALLG TEST VENOMS 9.45 $7.75 --- $9.83 007 1 0 0.00 $0.00 Y
N 95018 PERQ&IC ALLG TEST DRUGS/BIOL 23.65 $19.39 --- $24.60 007 1 0 0.00 $0.00 Y
N 95024 ICUT ALLERGY TEST DRUG/BUG 0.28 $2.80 $3.05 $3.48 053 1 1 0.00 $0.00 Y
P 95024 ICUT ALLERGY TEST DRUG/BUG 0.28 $2.80 $3.05 -- 052 0 1 0.00 $0.00 Y
P 95027 ICUT ALLERGY TITRATE-AIRBORN 0.28 $2.80 $3.05 -- 052 0 1 0.00 $0.00 Y
N 95027 ICUT ALLERGY TITRATE-AIRBORN 0.28 $2.80 $3.05 $3.48 053 1 1 0.00 $0.00 Y
N 95028 ICUT ALLERGY TEST-DELAYED 0.42 $4.20 $4.58 $5.22 053 1 1 0.00 $0.00 Y
P 95028 ICUT ALLERGY TEST-DELAYED 0.42 $4.20 $4.58 -- 052 0 1 0.00 $0.00 Y
N 95044 PATCH/APPLIC TEST(S)(SPECIFY # OF TESTS) 0.37 $3.70 $4.04 $4.60 053 1 0 0.00 $0.00 Y
N 95052 PHOTO PATCH TEST(S)(SPECIFY # OF TESTS) 0.46 $4.60 $5.02 $5.71 053 1 0 0.00 $0.00 Y
N 95056 PHOTOSENSITIVITY TESTS 0.32 $3.20 $3.49 $3.97 053 1 1 0.00 $0.00 Y
N 95060 EYE ALLERGY TESTS 0.65 $6.50 $7.09 $8.07 053 1 1 0.00 $0.00 Y
N 95065 NOSE ALLERGY TEST 0.41 $4.10 $4.47 $5.09 053 1 1 0.00 $0.00 Y
N 95070 BRONCHIAL ALLERGY TESTS 4.12 $41.20 $44.95 $51.17 053 1 1 0.00 $0.00 Y
N 95071 BRONCHIAL ALLERGY TESTS 5.27 $52.70 $57.50 $65.45 053 1 1 0.00 $0.00 Y
N 95076 INGEST CHALLENGE INI 120 MIN 124.44 $102.04 --- -- 007 0 0 0.00 $0.00 Y
N 95079 INGEST CHALLENGE ADDL 60 MIN 86.06 $70.57 --- -- 007 0 0 0.00 $0.00 Y
N 95115 IMMUNOTHERAPY ONE INJECTION 0.49 $4.90 $5.35 $6.09 001 1 0 0.00 $0.00 Y
N 95117 PROF SVC,ALLERGEN IMMUNOTHERAPY,2 OR MOR 9.45 $9.45 --- -- 009 0 0 0.00 $0.00 Y
N 95144 ANTIGEN THERAPY SERVICES 11.22 $9.20 --- -- 007 0 0 0.00 $0.00 N
N 95170 ANTIGEN THERAPY SERVICES 10.47 $8.59 --- $10.89 007 1 1 0.00 $0.00 N
N 95180 RAPID DESENSITIZATION 6.10 $61.00 $66.55 $75.76 053 1 1 0.00 $0.00 Y
N 95199 ALLERGY IMMUNOLOGY SERVICES 0.51 $5.10 $5.56 $6.33 053 1 1 0.00 $0.00 Y
N 95782 POLYSOM <6 YRS 4/> PARAMTRS 1154.29 $946.52 --- $1200.46 007 1 0 0.11 $0.00 Y
N 95783 POLYSOM <6 YRS CPAP/BILVL 1231.49 $1009.82 --- $1280.75 007 1 0 0.12 $0.00 Y
N 95805 MULTIPLE SLEEP LATENCY TEST 238.68 $195.72 --- $248.23 007 1 0 0.35 $0.00 Y
N 95807 SLEEP STUDY ATTENDED 257.67 $211.29 --- $267.98 007 1 0 0.39 $0.00 Y
N 95808 POLYSOM ANY AGE 1-3> PARAM 285.18 $233.85 --- $296.59 007 1 0 0.45 $0.00 Y
N 95810 POLYSOM 6/> YRS 4/> PARAM 424.48 $348.07 --- $441.46 007 1 0 0.45 $0.00 Y
N 95811 POLYSOM 6/>YRS CPAP 4/> PARM 436.24 $357.72 --- $453.69 007 1 0 0.47 $0.00 Y
N 95812 EEG 41-60 MINUTES 99.78 $81.82 --- $103.77 007 1 1 0.51 $0.00 Y
N 95813 EEG OVER 1 HOUR 135.78 $111.34 --- $141.21 007 1 1 0.60 $0.00 Y
N 95816 EEG AWAKE AND DROWSY 92.17 $75.58 --- $95.86 007 1 1 0.48 $0.00 Y
N 95819 EEG AWAKE AND ASLEEP 79.28 $65.01 --- $82.45 007 1 1 0.53 $0.00 Y
N 95822 EEG COMA OR SLEEP ONLY 79.28 $65.01 --- $82.45 007 1 1 0.46 $0.00 Y
N 95824 EEG CEREBRAL DEATH ONLY 49.78 $40.82 --- $51.77 007 1 0 0.75 $0.00 Y
N 95827 EEG ALL NIGHT RECORDING 140.44 $115.16 --- $146.06 007 1 0 0.45 $0.00 Y
N 95829 SURGERY ELECTROCORTICOGRAM 271.32 $222.48 --- $282.17 007 1 0 0.97 $0.00 Y
N 95830 INSERT ELECTRODES FOR EEG 96.76 $79.34 --- $100.63 007 1 1 0.00 $0.00 Y
N 95831 LIMB MUSCLE TESTING MANUAL 18.12 $14.86 --- $18.84 007 1 1 0.00 $0.00 Y
P 95831 LIMB MUSCLE TESTING MANUAL 18.12 $14.86 --- -- 019 0 1 0.00 $0.00 Y
N 95832 HAND MUSCLE TESTING MANUAL 18.12 $14.86 --- $18.84 007 1 1 0.00 $0.00 Y
N 95833 BODY MUSCLE TESTING MANUAL 64.00 $52.48 --- $66.56 007 1 1 0.00 $0.00 Y
N 95834 BODY MUSCLE TESTING MANUAL 64.00 $52.48 --- $66.56 007 1 1 0.00 $0.00 Y
N 95836 ECOG IMPLTD BRN NPGT <30 D 113.12 $92.76 --- -- 007 0 0 0.00 $0.00 Y
N 95851 RANGE OF MOTION MEASUREMENTS 18.12 $14.86 --- $18.84 007 1 1 0.00 $0.00 Y
P 95851 RANGE OF MOTION MEASUREMENTS 18.12 $14.86 --- -- 019 0 1 0.00 $0.00 Y
N 95852 RANGE OF MOTION MEASUREMENTS 9.98 $8.18 --- $10.38 007 1 1 0.00 $0.00 Y
N 95857 CHOLINESTERASE CHALLENGE 36.24 $29.72 --- $37.69 007 1 1 0.00 $0.00 Y
N 95860 MUSCLE TEST ONE LIMB 80.00 $65.60 --- $83.20 007 1 1 0.81 $0.00 Y
N 95861 MUSCLE TEST 2 LIMBS 120.00 $98.40 --- $124.80 007 1 1 0.78 $0.00 Y
N 95863 MUSCLE TEST 3 LIMBS 135.91 $111.45 --- $141.35 007 1 1 0.77 $0.00 Y
N 95864 MUSCLE TEST 4 LIMBS 200.00 $164.00 --- $208.00 007 1 1 0.67 $0.00 Y
N 95865 MUSCLE TEST LARYNX 121.76 $99.84 --- -- 007 0 0 0.75 $0.00 Y
N 95866 MUSCLE TEST HEMIDIAPHRAGM 81.06 $66.47 --- -- 007 0 0 0.75 $0.00 Y
N 95867 MUSCLE TEST CRAN NERV UNILAT 58.82 $48.23 --- $61.17 007 1 1 0.67 $0.00 Y
N 95868 MUSCLE TEST CRAN NERVE BILAT 99.28 $81.41 --- $103.25 007 1 1 0.79 $0.00 Y
N 95869 MUSCLE TEST THOR PARASPINAL 32.00 $26.24 --- $33.28 007 1 1 0.75 $0.00 Y
N 95870 MUSCLE TEST NONPARASPINAL 24.70 $20.25 --- $25.69 007 1 0 0.76 $0.00 Y
N 95872 MUSCLE TEST ONE FIBER 89.33 $73.25 --- $92.90 007 1 1 0.77 $0.00 Y
N 95873 GUIDE NERV DESTR ELEC STIM 29.87 $24.49 --- -- 007 0 0 0.77 $0.00 Y
N 95874 GUIDE NERV DESTR NEEDLE EMG 30.28 $24.83 --- -- 007 0 0 0.77 $0.00 Y
N 95875 LIMB EXERCISE TEST 62.41 $51.18 --- $64.91 007 1 1 0.77 $0.00 Y
N 95885 MUSC TST DONE W/NERV TST LIM 60.78 $49.84 --- $63.21 007 1 1 0.30 $0.00 Y
N 95886 MUSC TEST DONE W/N TEST COMP 93.71 $76.84 --- $97.46 007 1 1 0.52 $0.00 Y
N 95887 MUSC TST DONE W/N TST NONEXT 83.94 $68.83 --- $87.30 007 1 1 0.46 $0.00 Y
N 95905 MOTOR &/ SENS NRVE CNDJ TEST 86.34 $70.80 --- -- 007 0 1 0.74 $0.00 Y
N 95907 NVR CNDJ TST 1-2 STUDIES 100.99 $82.81 --- -- 007 0 0 0.53 $0.00 Y
N 95908 NRV CNDJ TST 3-4 STUDIES 124.62 $102.19 --- -- 007 0 0 0.54 $0.00 Y
N 95909 NRV CNDJ TST 5-6 STUDIES 149.20 $122.34 --- -- 007 0 0 0.54 $0.00 Y
N 95910 NRV CNDJ TEST 7-8 STUDIES 196.28 $160.95 --- -- 007 0 0 0.55 $0.00 Y
N 95911 NRV CNDJ TEST 9-10 STUDIES 237.26 $194.55 --- -- 007 0 0 0.57 $0.00 Y
N 95912 NRV CNDJ TEST 11-12 STUDIES 277.48 $227.53 --- -- 007 0 0 0.58 $0.00 Y
N 95913 NRV CNDJ TEST 13/> STUDIES 321.28 $263.45 --- -- 007 0 0 0.06 $0.00 Y
N 95924 ANS PARASYMP & SYMP W/TILT 157.10 $128.82 --- -- 007 0 0 0.57 $0.00 Y
N 95925 SHORTLATENCY SOMATOSENSORY, UPPER LIMBS 103.35 $84.75 --- $107.48 007 1 1 0.55 $0.00 Y
N 95926 SHLATENCY SOMATOSENSORY EVOK STUDY LL 123.15 $123.15 --- -- 009 0 1 0.55 $0.00 Y
N 95927 SHLATENCY SOMATOSENORY STUDY TRUNK OR H 123.15 $123.15 --- -- 009 0 1 0.55 $0.00 Y
N 95928 C MOTOR EVOKED UPPR LIMBS 186.77 $153.15 --- $194.24 007 1 1 0.55 $0.00 Y
N 95929 C MOTOR EVOKED LWR LIMBS 194.77 $159.69 --- $202.56 007 1 1 0.55 $0.00 Y
N 95930 VISUAL EVOKED POTENTIAL (VEP) TESTING CE 42.00 $34.44 --- $43.68 007 1 1 0.79 $0.00 Y
N 95937 NEUROMUSCULAR JUNCTION TEST 27.18 $22.29 --- $28.27 007 1 1 0.75 $0.00 Y
N 95938 *12SOMATOSENSORY TESTING 326.42 $267.67 --- $339.48 007 1 1 0.14 $0.00 Y
N 95939 C MOTOR EVOKED UPR&LWR LIMBS 506.75 $415.54 --- $527.02 007 1 1 0.23 $0.00 Y
N 95940 IONM IN OPERATNG ROOM 15 MIN 32.99 $27.05 --- -- 007 0 0 0.00 $0.00 Y
N 95941 IONM REMOTE/>1 PT OR PER HR 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 N
N 95943 PARASYMP&SYMP HRT RATE TEST 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 N
N 95950 AMBULATORY EEG MONITORING 217.18 $178.09 --- $225.87 007 1 1 0.29 $0.00 Y
N 95951 EEG MONITORING/VIDEORECORD 617.50 $506.35 --- $642.20 007 1 1 0.39 $0.00 Y
N 95953 EEG MONITORING/COMPUTER 305.82 $250.77 --- $318.05 007 1 0 0.38 $0.00 Y
N 95955 EEG DURING SURGERY 135.56 $111.16 --- $140.98 007 1 0 0.50 $0.00 Y
N 95956 EEG MONITOR TECHNOL ATTENDED 598.10 $490.44 --- $622.02 007 1 0 0.40 $0.00 Y
N 95957 EEG DIGITAL ANALYSIS 141.89 $116.35 --- $147.57 007 1 1 0.42 $0.00 Y
N 95958 EEG MONITORING/FUNCTION TEST 301.54 $247.26 --- $313.60 007 1 0 0.80 $0.00 Y
N 95970 ANALYZE NEUROSTIM NO PROG 24.13 $19.79 --- $25.10 007 1 0 0.00 $0.00 Y
N 95971 ANALYZE NEUROSTIM SIMPLE 41.12 $33.72 --- $42.76 007 1 0 0.00 $0.00 Y
N 95972 ANALYZE NEUROSTIM COMPLEX 78.94 $64.73 --- $82.10 007 1 0 0.00 $0.00 Y
N 95976 ALYS SMPL CN NPGT PRGRMG 42.71 $35.02 --- -- 007 0 0 0.00 $0.00 Y
N 95977 ALYS CPLX CN NPGT PRGRMG 56.76 $46.54 --- -- 007 0 0 0.00 $0.00 Y
N 95983 ALYS BRN NPGT PRGRMG 15 MIN 53.56 $43.92 --- -- 007 0 0 0.00 $0.00 Y
N 95984 ALYS BRN NPGT PRGRMG ADDL 15 46.70 $38.29 --- -- 007 0 0 0.00 $0.00 Y
N 95990 SPIN/BRAIN PUMP REFIL & MAIN 60.39 $49.52 --- -- 007 0 0 0.00 $0.00 Y
N 95991 SPIN/BRAIN PUMP REFIL & MAIN 88.79 $72.81 --- -- 007 0 0 0.00 $0.00 Y
N 95992 CANALITH REPOSITIONING PROC 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 95999 NEUROLOGICAL PROCEDURE 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 96020 FUNCTIONAL BRAIN MAPPING 17.74 $14.55 --- -- 007 0 0 1.00 $0.00 Y
N 96105 ASSESSMENT OF APHASIA (INCLUDES ASSESSME 62.44 $51.20 --- $64.94 007 1 1 0.00 $0.00 Y
Q 96105 ASSESSMENT OF APHASIA (INCLUDES ASSESSME 51.20 $51.20 --- -- 009 0 0 0.00 $0.00 N
Q 96110 DEVELOPMENTAL SCREEN 54.90 $54.90 --- -- 009 0 0 0.00 $0.00 N
E 96110 DEVELOPMENTAL TEST LIM 6.37 $6.37 --- -- 009 0 0 0.00 $0.00 Y
N 96110 DEVELOPMENTAL SCREEN 5.49 $54.90 $59.90 $68.19 001 1 1 0.00 $0.00 Y
N 96112 DEVEL TST PHYS/QHP 1ST HR 142.16 $116.57 --- -- 007 0 0 0.00 $0.00 Y
Q 96112 DEVEL TST PHYS/QHP 1ST HR 142.16 $116.57 --- -- 007 0 0 0.00 $0.00 N
Q 96113 DEVEL TST PHYS/QHP EA ADDL 63.26 $51.87 --- -- 007 0 0 0.00 $0.00 N
N 96113 DEVEL TST PHYS/QHP EA ADDL 63.26 $51.87 --- -- 007 0 0 0.00 $0.00 Y
N 96116 NUBHVL XM PHYS/QHP 1ST HR 5.62 $56.20 $61.31 $69.80 053 1 1 0.00 $0.00 Y
Q 96116 NUBHVL XM PHYS/QHP 1ST HR 56.20 $56.20 --- -- 009 0 0 0.00 $0.00 N
Q 96121 NUBHVL XM PHY/QHP EA ADDL HR 85.57 $70.17 --- -- 007 0 0 0.00 $0.00 N
N 96121 NUBHVL XM PHY/QHP EA ADDL HR 85.57 $70.17 --- -- 007 0 0 0.00 $0.00 Y
N 96127 BRIEF EMOTIONAL/BEHAV ASSMT 5.87 $4.81 --- -- 007 0 0 0.00 $0.00 Y
N 96130 PSYCL TST EVAL PHYS/QHP 1ST 121.46 $99.60 --- -- 007 0 0 0.00 $0.00 Y
Q 96130 PSYCL TST EVAL PHYS/QHP 1ST 121.46 $99.60 --- -- 007 0 0 0.00 $0.00 N
E 96130 PSYCL TST EVAL PHYS/QHP 1ST 257.63 $257.63 --- -- 009 0 0 0.00 $0.00 Y
Q 96131 PSYCL TST EVAL PHYS/QHP EA 92.45 $75.81 --- -- 007 0 0 0.00 $0.00 N
N 96131 PSYCL TST EVAL PHYS/QHP EA 92.45 $75.81 --- -- 007 0 0 0.00 $0.00 Y
N 96132 NRPSYC TST EVAL PHYS/QHP 1ST 138.25 $113.37 --- -- 007 0 0 0.00 $0.00 Y
Q 96132 NRPSYC TST EVAL PHYS/QHP 1ST 138.25 $113.37 --- -- 007 0 0 0.00 $0.00 N
Q 96133 NRPSYC TST EVAL PHYS/QHP EA 105.40 $86.43 --- -- 007 0 0 0.00 $0.00 N
N 96133 NRPSYC TST EVAL PHYS/QHP EA 105.40 $86.43 --- -- 007 0 0 0.00 $0.00 Y
N 96136 PSYCL/NRPSYC TST PHY/QHP 1ST 51.07 $41.88 --- -- 007 0 0 0.00 $0.00 Y
Q 96136 PSYCL/NRPSYC TST PHY/QHP 1ST 51.07 $41.88 --- -- 007 0 0 0.00 $0.00 N
Q 96137 PSYCL/NRPSYC TST PHY/QHP EA 47.57 $39.01 --- -- 007 0 0 0.00 $0.00 N
N 96137 PSYCL/NRPSYC TST PHY/QHP EA 47.57 $39.01 --- -- 007 0 0 0.00 $0.00 Y
N 96138 PSYCL/NRPSYC TECH 1ST 43.52 $35.69 --- -- 007 0 0 0.00 $0.00 Y
Q 96138 PSYCL/NRPSYC TECH 1ST 43.52 $35.69 --- -- 007 0 0 0.00 $0.00 N
Q 96139 PSYCL/NRPSYC TST TECH EA 43.52 $35.69 --- -- 007 0 0 0.00 $0.00 N
N 96139 PSYCL/NRPSYC TST TECH EA 43.52 $35.69 --- -- 007 0 0 0.00 $0.00 N
N 96146 PSYCL/NRPSYC TST AUTO RESULT 2.24 $1.84 --- -- 007 0 0 0.00 $0.00 Y
Q 96146 PSYCL/NRPSYC TST AUTO RESULT 2.24 $1.84 --- -- 007 0 0 0.00 $0.00 N
E 96150 ASSESS HLTH/BEHAVE INIT 10.74 $10.74 --- -- 009 0 0 0.00 $0.00 Y
N 96150 ASSESS HLTH/BEHAVE INIT 21.99 $18.03 --- -- 007 0 0 0.00 $0.00 Y
N 96151 ASSESS HLTH/BEHAVE SUBSEQ 21.27 $17.44 --- -- 007 0 0 0.00 $0.00 Y
E 96151 ASSESS HLTH/BEHAVE SUBSEQ 10.74 $10.74 --- -- 009 0 0 0.00 $0.00 Y
E 96152 INTERVENE HLTH/BEHAVE INDIV 39.53 $39.53 --- -- 009 0 0 0.00 $0.00 Y
N 96152 INTERVENE HLTH/BEHAVE INDIV 20.13 $16.51 --- -- 007 0 0 0.00 $0.00 Y
N 96153 INTERVENE HLTH/BEHAVE GROUP 4.67 $3.83 --- -- 007 0 0 0.00 $0.00 Y
E 96153 INTERVENE HLTH/BEHAVE GROUP 8.71 $8.71 --- -- 009 0 0 0.00 $0.00 Y
N 96154 INTERV HLTH/BEHAV FAM W/PT 19.77 $16.21 --- -- 007 0 0 0.00 $0.00 Y
N 96360 HYDRATION IV INFUSION INIT 5.13 $51.30 $55.97 $63.71 053 1 0 0.00 $0.00 Y
N 96361 HYDRATE IV INFUSION ADD-ON 1.46 $14.60 $15.93 $18.13 053 1 0 0.00 $0.00 Y
N 96365 THER/PROPH/DIAG IV INF INIT 76.34 $62.60 --- $79.39 007 1 0 0.00 $0.00 Y
N 96366 THER/PROPH/DIAG IV INF ADDON 23.50 $19.27 --- $24.44 007 1 0 0.00 $0.00 Y
N 96367 TX/PROPH/DG ADDL SEQ IV INF 37.86 $31.05 --- $39.37 007 1 0 0.00 $0.00 Y
N 96368 THER/DIAG CONCURRENT INF 21.90 $17.96 --- $22.78 007 1 0 0.00 $0.00 Y
N 96369 SC THER INFUSION UP TO 1 HR 168.79 $138.41 --- $175.54 007 1 0 0.00 $0.00 Y
N 96370 SC THER INFUSION ADDL HR 16.50 $13.53 --- $17.16 007 1 0 0.00 $0.00 Y
N 96371 SC THER INFUSION RESET PUMP 82.60 $67.73 --- $85.90 007 1 0 0.00 $0.00 Y
N 96372 THER/PROPH/DIAG INJ SC/IM 22.86 $18.75 --- $23.77 007 1 0 0.00 $0.00 Y
N 96373 THER/PROPH/DIAG INJ IA 19.39 $15.90 --- $20.17 007 1 0 0.00 $0.00 Y
N 96374 THER/PROPH/DIAG INJ IV PUSH 60.75 $49.82 --- $63.18 007 1 0 0.00 $0.00 Y
N 96375 TX/PRO/DX INJ NEW DRUG ADDON 25.96 $21.29 --- $27.00 007 1 0 0.00 $0.00 Y
N 96377 APPLICATON ON-BODY INJECTOR 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 96379 THER/PROP/DIAG INJ/INF PROC 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 96401 CHEMO ANTI-NEOPL SQ/IM 13.00 $10.66 --- $13.52 007 1 0 0.00 $0.00 Y
N 96402 CHEMO HORMON ANTINEOPL SQ/IM 13.00 $10.66 --- $13.52 007 1 0 0.00 $0.00 Y
N 96405 CHEMO INTRALESIONAL UP TO 7 47.94 $39.31 --- $49.86 007 1 0 0.00 $0.00 Y
N 96406 CHEMO INTRALESIONAL OVER 7 63.10 $51.74 --- $65.62 007 1 0 0.00 $0.00 Y
N 96409 CHEMO IV PUSH SNGL DRUG 21.90 $17.96 --- $22.78 007 1 0 0.00 $0.00 Y
N 96411 CHEMO IV PUSH ADDL DRUG 21.90 $17.96 --- $22.78 007 1 0 0.00 $0.00 Y
N 96413 CHEMO IV INFUSION 1 HR 34.87 $28.59 --- $36.26 007 1 0 0.00 $0.00 Y
N 96415 CHEMO IV INFUSION ADDL HR 26.21 $21.49 --- -- 007 0 0 0.00 $0.00 Y
N 96416 CHEMO PROLONG INFUSE W/PUMP 56.33 $46.19 --- $58.58 007 1 0 0.00 $0.00 Y
N 96417 CHEMO IV INFUS EACH ADDL SEQ 34.87 $28.59 --- $36.26 007 1 0 0.00 $0.00 Y
N 96420 CHEMO IA PUSH TECNIQUE 51.43 $42.17 --- $53.49 007 1 0 0.00 $0.00 Y
N 96422 CHEMO IA INFUSION UP TO 1 HR 45.30 $37.15 --- $47.11 007 1 0 0.00 $0.00 Y
N 96423 CHEMO IA INFUSE EACH ADDL HR 20.39 $16.72 --- -- 007 0 0 0.00 $0.00 Y
N 96425 CHEMOTHERAPY INFUSION METHOD 186.63 $153.04 --- $194.10 007 1 0 0.00 $0.00 Y
N 96440 CHEMOTHERAPY INTRACAVITARY 202.90 $166.38 --- $211.02 007 1 0 0.00 $0.00 Y
N 96446 CHEMOTX ADMN PRTL CAVITY 151.54 $124.26 --- $157.60 007 1 0 0.00 $0.00 Y
N 96450 CHEMOTHERAPY INTO CNS 159.32 $130.64 --- $165.69 007 1 0 0.00 $0.00 Y
N 96521 REFILL/MAINT PORTABLE PUMP 20.16 $16.53 --- -- 007 0 1 0.00 $0.00 Y
N 96522 REFILL/MAINT PUMP/RESVR SYST 34.23 $28.07 --- $35.60 007 1 1 0.00 $0.00 Y
N 96523 IRRIG DRUG DELIVERY DEVICE 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 96542 CHEMOTHERAPY INJECTION 104.29 $85.52 --- $108.46 007 1 0 0.00 $0.00 Y
N 96549 CHEMOTHERAPY UNSPECIFIED 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 96567 PHOTODYNAMIC TX SKIN 0.00 $0.00 --- -- 007 0 0 0.00 $0.00 Y
N 96573 PDT DSTR PRMLG LES PHYS/QHP 214.62 $175.99 --- -- 007 0 0 0.00 $0.00 Y
N 96574 DBRDMT PRMLG LES W/PDT 274.79 $225.33 --- -- 007 0 0 0.00 $0.00 Y
N 96900 ULTRAVIOLET LIGHT THERAPY 9.02 $7.40 --- $9.38 007 1 1 0.00 $0.00 Y
N 96910 PHOTOCHEMOTHERAPY WITH UV-B 30.00 $24.60 --- $31.20 007 1 1 0.00 $0.00 Y
N 96912 PHOTOCHEMOTHERAPY WITH UV-A 19.46 $15.96 --- $20.24 007 1 1 0.00 $0.00 Y
N 96913 PHOTOCHEMOTHERAPY UV-A OR B 39.79 $32.63 --- $41.38 007 1 0 0.00 $0.00 Y
N 96920 LASER TX SKIN < 250 SQ CM 151.57 $124.29 --- -- 007 0 0 0.00 $0.00 Y
N 96921 LASER TX SKIN 250-500 SQ CM 162.40 $133.17 --- -- 007 0 0 0.00 $0.00 Y
N 96922 LASER TX SKIN >500 SQ CM 222.13 $182.15 --- -- 007 0 0 0.00 $0.00 Y
N 96999 DERMATOLOGICAL PROCEDURE 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 97010 APPLICATION 12.00 $9.84 --- $12.48 007 1 1 0.00 $0.00 Y
P 97010 APPLICATION 12.00 $9.84 --- -- 019 0 1 0.00 $0.00 Y
P 97012 MECHANICAL TRACTION THERAPY 13.59 $11.14 --- -- 019 0 1 0.00 $0.00 Y
N 97012 MECHANICAL TRACTION THERAPY 13.59 $11.14 --- $14.13 007 1 1 0.00 $0.00 Y
N 97014 ELECTRIC STIMULATION THERAPY 13.59 $11.14 --- $14.13 007 1 1 0.00 $0.00 Y
P 97014 ELECTRIC STIMULATION THERAPY 13.59 $11.14 --- -- 019 0 1 0.00 $0.00 Y
P 97016 VASOPNEUMATIC DEVICE THERAPY 13.59 $11.14 --- -- 019 0 1 0.00 $0.00 Y
N 97016 VASOPNEUMATIC DEVICE THERAPY 13.59 $11.14 --- $14.13 007 1 1 0.00 $0.00 Y
N 97018 PARAFFIN BATH THERAPY 12.00 $9.84 --- $12.48 007 1 1 0.00 $0.00 Y
P 97018 PARAFFIN BATH THERAPY 12.00 $9.84 --- -- 019 0 1 0.00 $0.00 Y
P 97022 WHIRLPOOL THERAPY 13.59 $11.14 --- -- 019 0 1 0.00 $0.00 Y
N 97022 WHIRLPOOL THERAPY 13.59 $11.14 --- $14.13 007 1 1 0.00 $0.00 Y
N 97024 DIATHERMY EG MICROWAVE 12.00 $9.84 --- $12.48 007 1 1 0.00 $0.00 Y
P 97024 DIATHERMY EG MICROWAVE 12.00 $9.84 --- -- 019 0 1 0.00 $0.00 Y
P 97026 INFRARED THERAPY 12.00 $9.84 --- -- 019 0 1 0.00 $0.00 Y
N 97026 INFRARED THERAPY 12.00 $9.84 --- $12.48 007 1 1 0.00 $0.00 Y
N 97028 ULTRAVIOLET THERAPY 12.00 $9.84 --- $12.48 007 1 1 0.00 $0.00 Y
P 97028 ULTRAVIOLET THERAPY 12.00 $9.84 --- -- 019 0 1 0.00 $0.00 Y
P 97032 APPLICATION A MODALITY TO ONE/MORE AREA 10.56 $8.66 --- -- 019 0 1 0.00 $0.00 Y
N 97032 APPLICATION TO ONE OR MORE AREAS 10.56 $8.66 --- $10.98 007 1 1 0.00 $0.00 Y
N 97033 APPLICATION A MODALITY TO ONE/MORE AREA 11.20 $9.18 --- $11.65 007 1 1 0.00 $0.00 Y
P 97033 APPLICATION MODALITY TO ONE/MORE AREA 11.20 $9.18 --- -- 019 0 1 0.00 $0.00 Y
P 97034 APPLICATION MODALITY TO ONE/MORE AREA 9.55 $7.83 --- -- 019 0 1 0.00 $0.00 Y
N 97034 APPLICATION MODALITY TO ONE/MORE AREA 9.55 $7.83 --- $9.93 007 1 1 0.00 $0.00 Y
N 97035 APPLICATION MODALITY TO ONE/MORE AREA 9.06 $7.43 --- $9.42 007 1 1 0.00 $0.00 Y
P 97035 APPLICATION MODALITY TO ONE/MORE AREA 9.06 $7.43 --- -- 019 0 1 0.00 $0.00 Y
P 97036 APPLICATION MODALITY TO 1/MORE AREA 13.59 $11.14 --- -- 019 1 1 0.00 $0.00 Y
N 97036 APPLICATION MODALITY TO ONE/MORE AREA 13.59 $11.14 --- $14.13 007 1 1 0.00 $0.00 Y
N 97039 UNLISTED MODALITY(SPEC TYPE/TIME IF CONS 17.40 $14.27 --- $18.10 007 1 1 0.00 $0.00 Y
P 97039 UNLISTED MODALITY(SPEC TYPE/TIME IF CONS 17.40 $14.27 --- -- 007 0 1 0.00 $0.00 Y
P 97110 THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 13.37 $10.96 --- -- 019 0 1 0.00 $0.00 Y
E 97110 THERAPEUTIC PROC, 1 OR MORE AREAS,EA 15M 6.37 $6.37 --- -- 009 0 0 0.00 $0.00 Y
N 97110 THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 13.37 $10.96 --- $13.90 007 1 1 0.00 $0.00 Y
N 97112 NEUROMUSCULAR REEDUCATION 14.90 $12.22 --- $15.50 007 1 1 0.00 $0.00 Y
P 97112 NEUROMUSCULAR REEDUCATION 14.90 $12.22 --- -- 019 0 1 0.00 $0.00 Y
P 97113 THERAPEUTIC PROC ONE/MORE AREA 15 MIN 16.99 $13.93 --- -- 019 0 1 0.00 $0.00 Y
N 97113 THERAPEUTIC PROC ONE/MORE AREA 15 MIN 16.99 $13.93 --- $17.67 007 1 1 0.00 $0.00 Y
N 97116 THERAPEUTIC PROCEDURE, GAIT TRAINING 13.76 $11.28 --- $14.31 007 1 1 0.00 $0.00 Y
P 97116 THERAPEUTIC PROCEDURE, GAIT TRAINING 13.76 $11.28 --- -- 019 0 1 0.00 $0.00 Y
P 97124 THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 12.55 $10.29 --- -- 019 0 1 0.00 $0.00 Y
N 97124 THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 12.55 $10.29 --- $13.05 007 1 1 0.00 $0.00 Y
N 97139 THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 9.33 $7.65 --- $9.70 007 1 1 0.00 $0.00 Y
P 97139 THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M 9.33 $7.65 --- -- 019 0 1 0.00 $0.00 Y
P 97140 MANUAL THERAPY 1/> REGIONS 27.09 $22.21 --- -- 019 1 0 0.00 $0.00 Y
N 97140 MANUAL THERAPY 1/> REGIONS 27.09 $22.21 --- $28.17 007 1 0 0.00 $0.00 Y
E 97163 PT EVALUATION 135.56 $135.56 --- -- 009 0 0 0.00 $0.00 Y
E 97164 PT RE-EVALUATION 94.14 $94.14 --- -- 009 0 0 0.00 $0.00 Y
E 97167 OT EVALUATION 125.74 $125.74 --- -- 009 0 0 0.00 $0.00 Y
E 97168 OT RE-EVALUATION 87.32 $87.32 --- -- 009 0 0 0.00 $0.00 Y
N 97530 THERAPEUTIC ACTIVITIES 13.59 $11.14 --- $14.13 007 1 1 0.00 $0.00 Y
N 97533 SENSORY INTEGRATION 29.48 $24.17 --- $30.66 007 1 1 0.00 $0.00 Y
N 97597 RMVL DEVITAL TIS 20 CM/< 51.35 $42.11 --- $53.40 007 1 0 0.00 $0.00 Y
P 97597 RMVL DEVITAL TIS 20 CM/< 51.35 $42.11 --- -- 019 1 0 0.00 $0.00 Y
P 97598 RMVL DEVITAL TIS ADDL 20CM/< 65.21 $53.47 --- -- 019 1 0 0.00 $0.00 Y
N 97598 RMVL DEVITAL TIS ADDL 20CM/< 65.21 $53.47 --- $67.82 007 1 0 0.00 $0.00 Y
N 97750 PHYSICAL PERFORMANCE TEST OR MEASUREMENT 14.02 $11.50 --- $14.58 007 1 0 0.00 $0.00 Y
N 97799 UNLISTED PHYS MED/REHAB SERV OR PROC 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y
N 97802 MEDICAL NUTRITION INDIV IN 30.35 $30.35 --- $30.35 009 1 1 0.00 $0.00 Y
T 97802 MED NUTRTN TX;INITIAL ASSMNT PER 15MIN 30.35 $30.35 --- -- 009 0 0 0.00 $0.00 Y
T 97803 MED NUTRTN TX;RE-ASSMNT EACH 15MINS 26.11 $26.11 --- -- 009 0 0 0.00 $0.00 Y
N 97803 MED NUTRITION INDIV SUBSEQ 26.11 $26.11 --- $26.11 009 1 1 0.00 $0.00 Y
N 97804 MEDICAL NUTRITION GROUP 13.91 $13.91 --- $13.91 009 1 1 0.00 $0.00 Y
T 97804 MED NUTRITION TX EACH 30 MIN 13.91 $13.91 --- -- 009 0 0 0.00 $0.00 Y
P 97810 ACUPUNCT W/O STIMUL 15 MIN 7.06 $5.79 --- -- 019 1 1 0.00 $0.00 Y
N 97810 ACUPUNCT W/O STIMUL 15 MIN 7.06 $5.79 --- $7.34 007 1 1 0.00 $0.00 Y
N 97811 ACUPUNCT W/O STIMUL ADDL 15M 7.06 $5.79 --- $7.34 007 1 1 0.00 $0.00 Y
P 97811 ACUPUNCT W/O STIMUL ADDL 15M 7.06 $5.79 --- -- 019 1 1 0.00 $0.00 Y
P 97813 ACUPUNCT W/STIMUL 15 MIN 7.06 $5.79 --- -- 019 1 1 0.00 $0.00 Y
N 97813 ACUPUNCT W/STIMUL 15 MIN 7.06 $5.79 --- $7.34 007 1 1 0.00 $0.00 Y
N 97814 ACUPUNCT W/STIMUL ADDL 15M 7.06 $5.79 --- $7.34 007 1 1 0.00 $0.00 Y
P 97814 ACUPUNCT W/STIMUL ADDL 15M 7.06 $5.79 --- -- 019 1 1 0.00 $0.00 Y
N 98925 OSTEOPATH MANJ 1-2 REGIONS 27.57 $27.57 --- -- 009 0 0 0.00 $0.00 N
N 98926 OSTEOPATH MANJ 3-4 REGIONS 39.54 $39.54 --- -- 009 0 0 0.00 $0.00 N
1 98940 CHIROPRACT MANJ 1-2 REGIONS 16.72 $16.72 --- -- 009 0 0 0.00 $0.00 N
1 98941 CHIROPRACT MANJ 3-4 REGIONS 16.72 $16.72 --- -- 009 0 0 0.00 $0.00 N
1 98942 CHIROPRACTIC MANJ 5 REGIONS 16.72 $16.72 --- -- 009 0 0 0.00 $0.00 N
N 99000 SPECIMEN HANDLING OFFICE-LAB 4.43 $3.63 --- -- 007 0 0 0.00 $0.00 Y
1 99056 OUT OF OFFICE CALL 7.50 $7.50 --- -- 009 0 1 0.00 $0.00 N
P 99070 SPECIAL SUPPLIES PHYS/QHP 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
N 99070 SPECIAL SUPPLIES PHYS/QHP 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 Y
N 99082 TRAVEL TIME / MEDICAL PER HOUR 50.40 $50.40 --- -- 009 0 0 0.00 $0.00 N
N 99151 MOD SED SAME PHYS/QHP <5 YRS 4.97 $69.63 --- -- 002 0 0 0.00 $0.00 Y
N 99152 MOD SED SAME PHYS/QHP 5/>YRS 3.33 $46.65 --- -- 002 0 0 0.00 $0.00 Y
N 99153 MOD SED SAME PHYS/QHP EA 0.72 $10.09 --- -- 002 0 0 0.00 $0.00 Y
N 99155 MOD SED OTH PHYS/QHP <5 YRS 5.59 $78.32 --- -- 002 0 0 0.00 $0.00 Y
N 99156 MOD SED OTH PHYS/QHP 5/>YRS 4.54 $63.61 --- -- 002 0 0 0.00 $0.00 Y
N 99157 MOD SED OTHER PHYS/QHP EA 3.44 $48.19 --- -- 002 0 0 0.00 $0.00 Y
N 99170 ANOGENITAL EXAM CHILD 10.88 $108.80 $118.70 $135.13 001 1 0 0.00 $0.00 Y
E 99173 VISUAL ACUITY SCREEN 3.44 $3.44 --- -- 009 0 0 0.00 $0.00 Y
N 99183 HYPERBARIC OXYGEN THERAPY 113.29 $92.90 --- $117.82 007 1 0 0.00 $0.00 Y
N 99184 HYPOTHERMIA ILL NEONATE 242.80 $199.10 --- -- 007 0 0 0.00 $0.00 Y
N 99188 APP TOPICAL FLUORIDE VARNISH 18.00 $18.00 --- -- 009 0 0 0.00 $0.00 Y
N 99195 PHLEBOTOMY 20.00 $16.40 --- $20.80 007 1 0 0.00 $0.00 Y
N 99199 SPECIAL SERVICE/PROC/REPORT 0.00 $0.00 --- -- 007 1 0 0.00 $0.00 Y
N 99201 OFFICE/OUTPATIENT VISIT NEW 2.29 $22.90 $24.98 $28.44 001 1 1 0.00 $0.00 Y
P 99201 OFFICE/OUTPATIENT VISIT NEW 2.29 $22.90 $24.98 -- 052 0 1 0.00 $0.00 Y
1 99201 OFFICE/OUTPATIENT VISIT NEW 11.41 $11.41 --- $11.41 009 1 0 0.00 $0.00 Y
1 99202 OFFICE/OUTPATIENT VISIT NEW 34.30 $34.30 --- $34.30 009 1 0 0.00 $0.00 Y
P 99202 OFFICE/OUTPATIENT VISIT NEW 3.43 $34.30 $37.42 -- 052 0 1 0.00 $0.00 Y
N 99202 OFFICE/OUTPATIENT VISIT NEW 3.43 $34.30 $37.42 $42.60 001 1 1 0.00 $0.00 Y
N 99203 OFFICE/OUTPATIENT VISIT NEW 5.72 $57.20 $62.41 $71.04 001 1 1 0.00 $0.00 Y
P 99203 OFFICE/OUTPATIENT VISIT NEW 5.72 $57.20 $62.41 -- 052 0 1 0.00 $0.00 Y
1 99203 OFFICE/OUTPATIENT VISIT NEW 57.20 $57.20 --- $57.20 009 1 0 0.00 $0.00 Y
1 99204 OFFICE/OUTPATIENT VISIT NEW 68.90 $68.90 --- $68.90 009 1 0 0.00 $0.00 Y
N 99204 OFFICE/OUTPATIENT VISIT NEW 6.89 $68.90 $75.17 $85.57 001 1 1 0.00 $0.00 Y
N 99205 OFFICE/OUTPATIENT VISIT NEW 8.27 $82.70 $90.23 $102.71 001 1 1 0.00 $0.00 Y
1 99205 OFFICE/OUTPATIENT VISIT NEW 82.70 $82.70 --- $82.70 009 1 0 0.00 $0.00 Y
1 99211 OFFICE/OUTPATIENT VISIT EST 12.00 $12.00 --- $12.00 009 1 0 0.00 $0.00 Y
P 99211 OFFICE/OUTPATIENT VISIT EST 1.20 $12.00 $13.09 -- 052 0 1 0.00 $0.00 Y
N 99211 OFFICE/OUTPATIENT VISIT EST 1.20 $12.00 $13.09 $14.90 001 1 1 0.00 $0.00 Y
N 99212 OFFICE/OUTPATIENT VISIT EST 1.81 $18.10 $19.75 $22.48 001 1 1 0.00 $0.00 Y
P 99212 OFFICE/OUTPATIENT VISIT EST 1.81 $18.10 $19.75 -- 052 0 1 0.00 $0.00 Y
1 99212 OFFICE/OUTPATIENT VISIT EST 11.41 $11.41 --- $11.41 009 1 0 0.00 $0.00 Y
1 99213 OFFICE/OUTPATIENT VISIT EST 24.00 $24.00 --- $24.00 009 1 0 0.00 $0.00 Y
P 99213 OFFICE/OUTPATIENT VISIT EST 2.40 $24.00 $26.18 -- 052 0 1 0.00 $0.00 Y
N 99213 OFFICE/OUTPATIENT VISIT EST 2.40 $24.00 $26.18 $29.81 001 1 1 0.00 $0.00 Y
N 99214 OFFICE/OUTPATIENT VISIT EST 3.75 $37.50 $40.91 $46.58 001 1 1 0.00 $0.00 Y
1 99214 OFFICE/OUTPATIENT VISIT EST 37.50 $37.50 --- $37.50 009 1 0 0.00 $0.00 Y
1 99215 OFFICE/OUTPATIENT VISIT EST 57.20 $57.20 --- $57.20 009 1 0 0.00 $0.00 Y
N 99215 OFFICE/OUTPATIENT VISIT EST 5.72 $57.20 $62.41 $71.04 001 1 1 0.00 $0.00 Y
N 99221 INITIAL HOSPITAL CARE 3.43 $34.30 $37.42 $42.60 001 1 0 0.00 $0.00 Y
P 99221 INITIAL HOSPITAL CARE 3.43 $34.30 $37.42 -- 052 0 0 0.00 $0.00 Y
P 99222 INITIAL HOSPITAL CARE 7.32 $73.20 $79.86 -- 052 0 0 0.00 $0.00 Y
N 99222 INITIAL HOSPITAL CARE 7.32 $73.20 $79.86 $90.91 001 1 0 0.00 $0.00 Y
N 99223 INITIAL HOSPITAL CARE 8.01 $80.10 $87.39 $99.48 001 1 0 0.00 $0.00 Y
P 99223 INITIAL HOSPITAL CARE 8.01 $80.10 $87.39 -- 052 0 0 0.00 $0.00 Y
P 99231 SUBSEQUENT HOSPITAL CARE 2.75 $27.50 $30.00 -- 052 0 0 0.00 $0.00 Y
N 99231 SUBSEQUENT HOSPITAL CARE 2.75 $27.50 $30.00 $34.16 001 1 0 0.00 $0.00 Y
N 99232 SUBSEQUENT HOSPITAL CARE 3.78 $37.80 $41.24 $46.95 001 1 0 0.00 $0.00 Y
P 99232 SUBSEQUENT HOSPITAL CARE 3.78 $37.80 $41.24 -- 052 0 0 0.00 $0.00 Y
N 99233 SUBSEQUENT HOSPITAL CARE 4.58 $45.80 $49.97 $56.88 001 1 0 0.00 $0.00 Y
N 99234 OBSERV/HOSP SAME DATE 7.47 $74.70 $81.50 $92.78 001 1 0 0.00 $0.00 Y
N 99235 OBSERV/HOSP SAME DATE 10.35 $103.50 $112.92 $128.55 001 1 0 0.00 $0.00 Y
N 99236 OBSERV/HOSP SAME DATE 12.46 $124.60 $135.94 $154.75 001 1 0 0.00 $0.00 Y
N 99238 HOSP DISCHARGE DAY MGMT;30 MIN OR LESS 3.76 $37.60 $41.02 $46.70 001 1 0 0.00 $0.00 Y
N 99239 HOSP DISCHARGE DAY MAN MORE THAN 30 MIN 5.34 $53.40 $58.26 $66.32 001 1 0 0.00 $0.00 Y
N 99241 OFFICE CONSULTATION 3.06 $30.60 $33.38 $38.01 053 1 1 0.00 $0.00 Y
P 99241 OFFICE CONSULTATION 3.06 $30.60 $33.38 -- 052 0 1 0.00 $0.00 Y
1 99241 OFFICE CONSULTATION 30.60 $30.60 --- $30.60 009 1 0 0.00 $0.00 Y
1 99242 OFFICE CONSULTATION 47.20 $47.20 --- $47.20 009 1 0 0.00 $0.00 Y
P 99242 OFFICE CONSULTATION 4.72 $47.20 $51.50 -- 052 0 1 0.00 $0.00 Y
N 99242 OFFICE CONSULTATION 4.72 $47.20 $51.50 $58.62 053 1 1 0.00 $0.00 Y
N 99243 OFFICE CONSULTATION 5.95 $59.50 $64.91 $73.90 053 1 1 0.00 $0.00 Y
P 99243 OFFICE CONSULTATION 5.95 $59.50 $64.91 -- 052 0 1 0.00 $0.00 Y
1 99243 OFFICE CONSULTATION 59.50 $59.50 --- $59.50 009 1 0 0.00 $0.00 Y
N 99244 OFFICE CONSULTATION 8.14 $81.40 $88.81 $101.10 053 1 1 0.00 $0.00 Y
N 99245 OFFICE CONSULTATION 10.22 $102.20 $111.50 $126.93 053 1 1 0.00 $0.00 Y
N 99251 INPATIENT CONSULTATION 33.98 $27.86 --- -- 007 0 1 0.00 $0.00 Y
P 99251 INPATIENT CONSULTATION 33.98 $27.86 --- -- 019 0 1 0.00 $0.00 Y
P 99252 INPATIENT CONSULTATION 39.59 $32.46 --- -- 019 0 1 0.00 $0.00 Y
N 99252 INPATIENT CONSULTATION 39.59 $32.46 --- -- 007 0 1 0.00 $0.00 Y
N 99253 INPATIENT CONSULTATION 56.63 $46.44 --- -- 007 0 1 0.00 $0.00 Y
P 99253 INPATIENT CONSULTATION 56.63 $46.44 --- -- 019 0 1 0.00 $0.00 Y
N 99254 INPATIENT CONSULTATION 79.28 $65.01 --- -- 007 0 1 0.00 $0.00 Y
N 99255 INPATIENT CONSULTATION 105.18 $86.25 --- -- 007 0 1 0.00 $0.00 Y
N 99281 EMERGENCY DEPT VISIT 14.60 $15.18 --- $15.18 017 1 0 0.00 $0.00 Y
P 99281 EMERGENCY DEPT VISIT 12.61 $10.34 --- -- 019 0 0 0.00 $0.00 Y
P 99282 EMERGENCY DEPT VISIT 23.42 $19.20 --- -- 019 0 0 0.00 $0.00 Y
N 99282 EMERGENCY DEPT VISIT 23.44 $24.38 --- $24.38 017 1 0 0.00 $0.00 Y
N 99283 EMERGENCY DEPT VISIT 42.88 $44.60 --- $44.60 017 1 0 0.00 $0.00 Y
P 99283 EMERGENCY DEPT VISIT 42.83 $35.12 --- -- 019 0 0 0.00 $0.00 Y
P 99284 EMERGENCY DEPT VISIT 65.65 $53.83 --- -- 019 0 0 0.00 $0.00 Y
N 99284 EMERGENCY DEPT VISIT 65.72 $68.35 --- $68.35 017 1 0 0.00 $0.00 Y
N 99285 EMERGENCY DEPT VISIT 103.92 $108.08 --- $108.08 017 1 0 0.00 $0.00 Y
N 99291 CRITICAL CARE FIRST HOUR 12.16 $121.60 $132.67 $151.03 001 1 0 0.00 $0.00 Y
N 99292 CRITICAL CARE ADDL 30 MIN 5.89 $58.90 $64.26 $73.15 001 1 0 0.00 $0.00 Y
N 99304 NURSING FACILITY CARE INIT 3.78 $37.80 $41.24 -- 001 0 0 0.00 $0.00 Y
P 99304 NURSING FACILITY CARE INIT 3.78 $37.80 $41.24 -- 052 0 0 0.00 $0.00 Y
N 99305 NURSING FACILITY CARE INIT 4.69 $46.90 $51.17 -- 001 0 0 0.00 $0.00 Y
N 99306 NURSING FACILITY CARE INIT 7.21 $72.10 $78.66 -- 001 0 0 0.00 $0.00 Y
N 99307 NURSING FAC CARE SUBSEQ 1.37 $13.70 $14.95 -- 001 0 0 0.00 $0.00 Y
P 99307 NURSING FAC CARE SUBSEQ 1.37 $13.70 $14.95 -- 052 0 0 0.00 $0.00 Y
P 99308 NURSING FAC CARE SUBSEQ 2.75 $27.50 $30.00 -- 052 0 0 0.00 $0.00 Y
N 99308 NURSING FAC CARE SUBSEQ 2.75 $27.50 $30.00 -- 001 0 0 0.00 $0.00 Y
N 99309 NURSING FAC CARE SUBSEQ 4.00 $40.00 $43.64 -- 001 0 0 0.00 $0.00 Y
P 99309 NURSING FAC CARE SUBSEQ 4.00 $40.00 $43.64 -- 052 0 0 0.00 $0.00 Y
N 99310 NURSING FAC CARE SUBSEQ 5.20 $52.00 $56.73 -- 001 0 0 0.00 $0.00 Y
N 99315 NURSING FAC DISCHARGE DAY 3.84 $38.40 $41.89 $47.69 001 1 0 0.00 $0.00 Y
N 99316 NURSING FAC DISCHARGE DAY 4.66 $46.60 $50.84 $57.88 001 1 0 0.00 $0.00 Y
N 99324 DOMICIL/R-HOME VISIT NEW PAT 3.74 $37.40 $40.80 -- 001 0 0 0.00 $0.00 Y
P 99324 DOMICIL/RHOME VISIT NEW PAT 3.74 $37.40 $40.80 -- 052 0 0 0.00 $0.00 Y
P 99325 DOMICIL/RHOME VISIT NEW PAT 5.15 $51.50 $56.19 -- 052 0 0 0.00 $0.00 Y
N 99325 DOMICIL/R-HOME VISIT NEW PAT 5.15 $51.50 $56.19 -- 001 0 0 0.00 $0.00 Y
N 99326 DOMICIL/R-HOME VISIT NEW PAT 6.88 $68.80 $75.06 -- 001 0 0 0.00 $0.00 Y
P 99326 DOMICIL/RHOME VISIT NEW PAT 6.88 $68.80 $75.06 -- 052 0 0 0.00 $0.00 Y
N 99327 DOMICIL/R-HOME VISIT NEW PAT 8.00 $80.00 $87.28 -- 001 0 0 0.00 $0.00 Y
N 99328 DOMICIL/R-HOME VISIT NEW PAT 8.00 $80.00 $87.28 -- 001 0 0 0.00 $0.00 Y
N 99334 DOMICIL/R-HOME VISIT EST PAT 1.95 $19.50 $21.27 -- 001 0 0 0.00 $0.00 Y
P 99334 DOMICIL/RHOME VISIT EST PAT 1.95 $19.50 $21.27 -- 052 0 0 0.00 $0.00 Y
P 99335 DOMICIL/RHOME VISIT EST PAT 3.55 $35.50 $38.73 -- 052 0 0 0.00 $0.00 Y
N 99335 DOMICIL/R-HOME VISIT EST PAT 3.55 $35.50 $38.73 -- 001 0 0 0.00 $0.00 Y
N 99336 DOMICIL/R-HOME VISIT EST PAT 4.23 $42.30 $46.15 -- 001 0 0 0.00 $0.00 Y
P 99336 DOMICIL/RHOME VISIT EST PAT 4.23 $42.30 $46.15 -- 052 0 0 0.00 $0.00 Y
N 99337 DOMICIL/R-HOME VISIT EST PAT 4.23 $42.30 $46.15 -- 001 0 0 0.00 $0.00 Y
N 99341 HOME VISIT NEW PATIENT 4.12 $41.20 $44.95 $51.17 001 1 0 0.00 $0.00 Y
P 99341 HOME VISIT NEW PATIENT 3.67 $36.70 $40.04 -- 052 0 0 0.00 $0.00 Y
P 99342 HOME VISIT NEW PATIENT 4.38 $43.80 $47.79 -- 052 0 0 0.00 $0.00 Y
N 99342 HOME VISIT NEW PATIENT 4.92 $49.20 $53.68 $61.11 001 1 0 0.00 $0.00 Y
N 99343 HOME VISIT NEW PATIENT 6.29 $62.90 $68.62 $78.12 001 1 0 0.00 $0.00 Y
P 99343 HOME VISIT NEW PATIENT 5.61 $56.10 $61.21 -- 052 0 0 0.00 $0.00 Y
P 99344 HOME VISIT NEW PATIENT 6.86 $68.60 $74.84 -- 052 0 0 0.00 $0.00 Y
N 99344 HOME VISIT NEW PATIENT 7.70 $77.00 $84.01 $95.63 001 1 0 0.00 $0.00 Y
N 99345 HOME VISIT NEW PATIENT 9.43 $94.30 $102.88 $117.12 001 1 0 0.00 $0.00 Y
P 99345 HOME VISIT NEW PATIENT 8.40 $84.00 $91.64 -- 052 0 0 0.00 $0.00 Y
P 99347 HOME VISIT EST PATIENT 2.24 $22.40 $24.44 -- 052 0 0 0.00 $0.00 Y
N 99347 HOME VISIT EST PATIENT 2.52 $25.20 $27.49 $31.30 001 1 0 0.00 $0.00 Y
N 99348 HOME VISIT EST PATIENT 3.43 $34.30 $37.42 $42.60 001 1 0 0.00 $0.00 Y
P 99348 HOME VISIT EST PATIENT 3.06 $30.60 $33.38 -- 052 0 0 0.00 $0.00 Y
P 99349 HOME VISIT EST PATIENT 4.60 $46.00 $50.19 -- 052 0 0 0.00 $0.00 Y
N 99349 HOME VISIT EST PATIENT 5.16 $51.60 $56.30 $64.09 001 1 0 0.00 $0.00 Y
N 99350 HOME VISIT EST PATIENT 8.01 $80.10 $87.39 $99.48 001 1 0 0.00 $0.00 Y
P 99350 HOME VISIT EST PATIENT 7.14 $71.40 $77.90 -- 052 0 0 0.00 $0.00 Y
N 99354 PROLONG E&M/PSYCTX SERV O/P 5.23 $52.30 $57.06 $64.96 053 1 0 0.00 $0.00 Y
N 99355 PROLONG E&M/PSYCTX SERV O/P 4.99 $49.90 $54.44 $61.98 053 1 0 0.00 $0.00 Y
N 99356 PROLONGED SERVICE INPATIENT 4.22 $42.20 $46.04 $52.41 053 1 0 0.00 $0.00 Y
N 99357 PROLONGED SERVICE INPATIENT 3.94 $39.40 $42.99 $48.93 053 1 0 0.00 $0.00 Y
1 99358 PROLONG SERVICE W/O CONTA 42.20 $42.20 --- -- 009 0 0 0.00 $0.00 Y
1 99359 PROLONG SERVICE W/O CONTA 21.10 $21.10 --- -- 009 0 0 0.00 $0.00 Y
N 99360 PHYSICIAN STANDBY SERV, REQ PROL ATTENDA 2.55 $25.50 $27.82 $31.67 053 1 0 0.00 $0.00 Y
N 99366 TEAM CONF W/PAT BY HC PRO 37.24 $30.54 --- -- 007 0 0 0.00 $0.00 Y
Q 99366 TEAM CONF W/PAT BY HC PRO 18.98 $18.98 --- -- 009 0 0 0.00 $0.00 N
Q 99368 TEAM CONF W/O PAT BY HC PRO 18.98 $18.98 --- -- 009 0 0 0.00 $0.00 N
N 99368 TEAM CONF W/O PAT BY HC PRO 34.54 $28.32 --- -- 007 0 0 0.00 $0.00 Y
N 99381 INIT PM E/M NEW PAT INFANT 37.46 $45.33 $45.33 -- 031 0 0 0.00 $0.00 Y
N 99382 INIT PM E/M NEW PAT 1-4 YRS 38.95 $47.13 $47.13 -- 031 0 0 0.00 $0.00 Y
N 99383 PREV VISIT NEW AGE 5-11 45.31 $54.83 $54.83 -- 031 0 0 0.00 $0.00 Y
N 99384 PREV VISIT NEW AGE 12-17 54.36 $65.78 $65.78 -- 031 0 0 0.00 $0.00 Y
N 99385 PREV VISIT NEW AGE 18-39 11.41 $114.10 $124.48 -- 001 0 0 0.00 $0.00 Y
N 99391 PER PM REEVAL EST PAT INFANT 28.67 $34.69 $34.69 -- 031 0 0 0.00 $0.00 Y
N 99392 PREV VISIT EST AGE 1-4 30.90 $37.39 $37.39 -- 031 0 0 0.00 $0.00 Y
N 99393 PREV VISIT EST AGE 5-11 36.24 $43.85 $43.85 -- 031 0 0 0.00 $0.00 Y
N 99394 PREV VISIT EST AGE 12-17 45.31 $54.83 $54.83 -- 031 0 0 0.00 $0.00 Y
N 99395 PREV VISIT EST AGE 18-39 10.29 $102.90 $112.26 -- 001 0 0 0.00 $0.00 Y
E 99401 PREVENTIVE COUNSELING INDIV 10.74 $10.74 --- -- 009 0 0 0.00 $0.00 N
N 99406 BEHAV CHNG SMOKING 310 MIN 12.70 $10.41 --- -- 007 0 0 0.00 $0.00 Y
N 99407 BEHAV CHNG SMOKING > 10 MIN 24.30 $19.93 --- -- 007 0 0 0.00 $0.00 Y
N 99429 UNLISTED PREVENTIVE MED. 0.00 $0.00 --- -- 001 0 1 0.00 $0.00 Y
N 99460 INIT NB EM PER DAY HOSP 4.72 $47.20 $51.50 -- 001 0 0 0.00 $0.00 Y
N 99461 INIT NB EM PER DAY NON-FAC 7.28 $72.80 $79.42 -- 001 0 0 0.00 $0.00 Y
N 99462 SBSQ NB EM PER DAY HOSP 2.52 $25.20 $27.49 -- 001 0 0 0.00 $0.00 Y
N 99464 ATTENDANCE AT DELIVERY 5.92 $59.20 $64.59 $73.53 001 1 0 0.00 $0.00 Y
N 99465 NB RESUSCITATION 12.20 $122.00 $133.10 -- 001 0 0 0.00 $0.00 Y
N 99466 PED CRIT CARE TRANSPORT 236.54 $193.96 --- -- 007 0 0 0.00 $0.00 Y
N 99467 PED CRIT CARE TRANSPORT ADDL 118.04 $96.79 --- -- 007 0 0 0.00 $0.00 Y
N 99477 INIT DAY HOSP NEONATE CARE 323.76 $265.48 --- $336.71 007 1 0 0.00 $0.00 Y
N 99485 SUPRV INTERFACILTY TRANSPORT 76.31 $62.57 --- -- 007 0 0 0.00 $0.00 Y
N 99486 SUPRV INTERFAC TRNSPORT ADDL 66.40 $54.44 --- -- 007 0 0 0.00 $0.00 Y
N 99490 CHRON CARE MGMT SRVC 20 MIN 45.11 $36.99 --- -- 009 0 0 0.00 $0.00 Y
N 99491 CHRNC CARE MGMT SVC 30 MIN 71.19 $71.19 --- -- 009 0 0 0.00 $0.00 Y
N 99497 ADVNCD CARE PLAN 30 MIN 69.59 $69.59 --- -- 009 0 0 0.00 $0.00 Y
N 99498 ADVNCD CARE PLAN ADDL 30 MIN 62.64 $62.64 --- -- 009 0 0 0.00 $0.00 Y
N 99499 UNLISTED E & M SERVICE 0.00 $0.00 --- -- 007 1 1 0.00 $0.00 Y