Medi-Cal Rates Information
Medi-Cal Rates as of 03/15/2020 (Codes 94799 thru 99600)
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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 | 95012 | EXHALED NITRIC OXIDE MEAS | 22.87 | $18.75 | --- | -- | 007 | 0 | 0 | 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 | 95700 | EEG CONT REC W/VID EEG TECH | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95705 | EEG W/O VID 2-12 HR UNMNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95706 | EEG WO VID 2-12HR INTMT MNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95707 | EEG W/O VID 2-12HR CONT MNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95708 | EEG WO VID EA 12-26HR UNMNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95709 | EEG W/O VID EA 12-26HR INTMT | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95710 | EEG W/O VID EA 12-26HR CONT | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95711 | VEEG 2-12 HR UNMONITORED | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95712 | VEEG 2-12 HR INTMT MNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95713 | VEEG 2-12 HR CONT MNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95714 | VEEG EA 12-26 HR UNMNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95715 | VEEG EA 12-26HR INTMT MNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95716 | VEEG EA 12-26HR CONT MNTR | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95717 | EEG PHYS/QHP 2-12 HR W/O VID | 109.59 | $89.87 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95718 | EEG PHYS/QHP 2-12 HR W/VEEG | 144.41 | $118.42 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95719 | EEG PHYS/QHP EA INCR W/O VID | 169.57 | $139.05 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95720 | EEG PHY/QHP EA INCR W/VEEG | 223.53 | $183.30 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95721 | EEG PHY/QHP>36<60 HR W/O VID | 225.57 | $184.97 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95722 | EEG PHY/QHP>36<60 HR W/VEEG | 273.51 | $224.28 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95723 | EEG PHY/QHP>60<84 HR W/O VID | 279.46 | $229.16 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95724 | EEG PHY/QHP>60<84 HR W/VEEG | 349.37 | $286.49 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95725 | EEG PHY/QHP>84 HR W/O VID | 319.14 | $261.70 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 95726 | EEG PHY/QHP>84 HR W/VEEG | 441.52 | $362.05 | --- | -- | 007 | 0 | 0 | 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 EXTND MNTR 61-119 MIN | 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 | 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 | 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 | 95955 | EEG DURING SURGERY | 135.56 | $111.16 | --- | $140.98 | 007 | 1 | 0 | 0.50 | $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 | 172.32 | $141.30 | --- | -- | 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 |
| N | 96156 | HLTH BHV ASSMT/REASSESSMENT | 102.80 | $84.30 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96158 | HLTH BHV IVNTJ INDIV 1ST 30 | 70.28 | $57.63 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96159 | HLTH BHV IVNTJ INDIV EA ADDL | 24.52 | $20.11 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96164 | HLTH BHV IVNTJ GRP 1ST 30 | 10.38 | $8.52 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96165 | HLTH BHV IVNTJ GRP EA ADDL | 4.89 | $4.01 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96167 | HLTH BHV IVNTJ FAM 1ST 30 | 75.40 | $61.83 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96168 | HLTH BHV IVNTJ FAM EA ADDL | 26.76 | $21.95 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96170 | HLTH BHV IVNTJ FAM WO PT 1ST | 85.71 | $70.29 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 96171 | HLTH BHV IVNTJ FAM W/O PT EA | 31.15 | $25.55 | --- | -- | 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 | 97129 | THER IVNTJ 1ST 15 MIN | 25.34 | $20.78 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 97130 | THER IVNTJ EA ADDL 15 MIN | 24.19 | $19.84 | --- | -- | 007 | 0 | 0 | 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 | 3.47 | $3.47 | --- | -- | 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 | 11.16 | $11.16 | --- | -- | 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 | 99415 | PROLONG CLINCL STAFF SVC | 8.11 | $8.11 | --- | -- | 009 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99416 | PROLONG CLINCL STAFF SVC ADD | 4.49 | $4.49 | --- | -- | 009 | 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 | 99451 | NTRPROF PH1/NTRNET/EHR 5/> | 31.45 | $31.45 | --- | -- | 009 | 0 | 0 | 0.00 | $0.00 | N |
| 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 | 99468 | NEONATE CRIT CARE INITIAL | 364.64 | $299.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99469 | NEONATE CRIT CARE SUBSQ | 175.02 | $143.52 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99471 | PED CRITICAL CARE INITIAL | 364.64 | $299.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99472 | PED CRITICAL CARE SUBSQ | 175.02 | $143.52 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99475 | PED CRIT CARE AGE 2-5 INIT | 364.64 | $299.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99476 | PED CRIT CARE AGE 2-5 SUBSQ | 175.02 | $143.52 | --- | -- | 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 | 99478 | IC LBW INF < 1500 GM SUBSQ | 148.18 | $121.51 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99479 | IC LBW INF 1500-2500 G SUBSQ | 127.33 | $104.41 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99480 | IC INF PBW 2501-5000 G SUBSQ | 120.28 | $98.63 | --- | -- | 007 | 0 | 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 |
| N | 99501 | HOME VISIT POSTNATAL | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99502 | HOME VISIT NB CARE | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | Y |
| N | 99600 | UNLISTED HOME VISIT SVC | 0.00 | $0.00 | --- | -- | 007 | 0 | 0 | 0.00 | $0.00 | N |