Medi-Cal Rates Information
Medi-Cal Rates as of 08/15/2019 (Codes 94799 thru 99600)
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
CPT codes, descriptions and other data are copyright 2002
American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable
FARS/DFARS Apply.
Note: Should you have landed here as a result of a search engine or other
link, be advised that these files contain material that is copyrighted by the American Medical Association. You are
forbidden to download the materials unless you read, agree to and abide by the provisions of the copyright statement.
Read the copyright statement now (you will be linked back to here).
| 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 | 11.16 | $11.16 | --- | -- | 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 | 11.16 | $11.16 | --- | -- | 009 | 0 | 0 | 0.00 | $0.00 | Y |
| E | 96152 | INTERVENE HLTH/BEHAVE INDIV | 40.93 | $40.93 | --- | -- | 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 | 9.05 | $9.05 | --- | -- | 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 | 3.47 | $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 | 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 | 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 |