October 2, 1989

SUBJECT: INSURANCE

Circular Letter No. 14 (1989)

WITHDRAWN

TO: AUTOMOBILE SELF-INSURERS AND INSURERS LICENSED TO WRITE AUTOMOBILE INSURANCE IN NEW YORK STATE

RE: NO-FAULT REIMBURSMENT SCHEDULES FOR HOSPITAL (A) INPATIENT SERVICES RENDERED ON AND AFTER JANUARY 1, 1986; AND (B) INPATIENT SERVICES RENDERED ON AND AFTER JANUARY 1, 1987

Pursuant to Regulation No. 83, 11 NYCRR 68.2; the no-fault rate schedules' for reimbursing hospital services provided under § 5102(a)(1) of the Insurance Law shall be those established, for workers' compensation by the Chair of the Workers' Compensation Board (WCB). These rates have now been established for hospital inpatient services in conformity with Chapter 767 of the Laws of 1977, as amended and § 2807-a of the Public Health Law; as amended.

Attached are two rate schedules duly established by the WCB Chair:

  1. the first revised per diem schedule to. reimburse hospitals for inpatient services rendered during the period January 1, 1986' through December 31, 1986.
  2. the second per diem schedule to reimburse hospitals for inpatient services, rendered during the period January 1, 1987 through December 31, 1987.

Please note that the Health Department has determined that inpatient hospital admissions prior to January 1, 1988 shall be reimbursed on a per diem basis, rather than by the Diagnosis-Related Group (DRG) approach, effective January 1, 1988 for inpatient reimbursement as discussed in Circular Letters Number 11 and 18 (1988).

Very truly yours,

[SIGNATURE]

James P. Corcoran

Superintendent of Insurance

TO: Medical Fee Schedule Users

Subject: Amendments to September 1986 Medical Fee Schedule

Attached are amendments to the September 1986 Workers' Compensation Board Schedule of Medical Fees. The amendments to the Medical Fee. Schedule, which include changes in Dollar Conversion Factors, apply to Medical, Physical Therapy and Occupational Therapy services rendered on or after September 1, 1989.

For services rendered prior to September 1, 1989, please refer to previously issued material.

NOTE: Effective 1-1-89, the fees listed in this schedule are applicable to services rendered under the Volunteer Ambulance Workers' Benefit Law.

Barbara Patton, Chairwoman

Conversion Factors

This schedule is divided into seven sections, each containing a coded listing of procedures pertinent to the section, with unit values assigned on a relativity basis to each section therein. The relativity within any one section is applicable to that particular section only. Familiarize yourself with the instructions preceding each section. In submitting reports and bills, list the 5 digit code(s) that identifies the service(s) performed (it is not necessary to describe the service if the 5 digit code is enumerated).

Billing: The unit values reflect relativity, not fees. To determine the fee for a procedure, it is necessary to multiply the unit value of each procedure by the dollar conversion factor applicable to the particular section in effect on the date the service was rendered.

The Chairman has established four regions within New York State based on the difference in cost of maintaining a medical practice in different localities of the State. The Chairman has defined each such region by use of the U.S. Postal Service Zip Codes for the State of New York, based upon the relative cost factors which are compatible with that region.

The fees payable for medical care and treatment shall be determined by the Region in which the services were rendered.

Regional Conversion Factors - effective September 1, 1986

SECTIONSREGION 1REGION 2REGION 3REGION 4
Medicine$ 4.88$ 5.11$ 5.85$ 6.36
Physical Therapy4.304.515.165.61
Anesthesia16.7417.5220.0521.81
Surgery123.66129.42148.12161.00
Radiology31.3532.8237.5540.82
Pathology.76.80.911.00

Regional Conversion Factors - effective September 1, 1987

SECTIONSREGION 1REGION 2REGION 3REGION 4
Medicine$ 5.10$ 5.35$ 6.12$ 6.65
Physical Therapy4.614.835.536.01
Anesthesia17.5118.3320.9722.81
Surgery129.35135.37154.93168.41
Radiology32.79343339.2842.70
Pathology.79.84.951.05

Regional Conversion Factors - effective September 1, 1988

SECTIONSREGION 1REGION 2REGION 3REGION 4
Medicine$ 5.39$ 5.65$ 6.46$ 7.02
Physical Therapy4.825.055.786.29
Occupational Therapy4.825.055.786.29
Anesthesia18.4919.3622.1424.09
Surgery136.59142.95163.61177.84
Radiology34.6336.2541.4845.09
Pathology.83.891.001.11

Regional Conversion Factors - effective September 1, 1989

SECTIONSREGION 1REGION 2REGION 3
Medicine,$ 5.71$ 5.98$ 6.84
Physical Therapy5.105.356.12
Occupational Therapy5.105.356.12
Anesthesia19.5820.5023.45
Surgery144.65151.38173.26
Radiology36.6738.3943.93
Pathology.88.941.06    

POSTAL ZIP CODES INCLUDED IN EACH REGION

 

Region I

 

 

Region II

 

 

Region IV

 
From,ThruFromThruFromThru
120071209912180121831000110099
121061217712201122571030110314
121841219912301123451040110475
124011249812501125941100111050
127011279212601126141110111111
128011288713201132601120111252
129011299813440 1130111390
130201309413501135031140111460
131011316713901139051150111598
133011336814201142651160111697
134011343914601146921170111798
1344113495  1180111819
1360113698    
1373013797    
1380113865    
  FromThru  
14001140981050110598  
14101141741060110650  
14301143051070110710  
14410144891080110805  
14501145921090110998  
14701147881190111980  
1480114898    
1490114905    

NUMERICAL LIST OF POSTAL ZIP CODES

FromThruRegionFromThruRegion
1000110099IV1260112614II
1030110314IV1270112792I
1040110475IV1280112887I
1050110598III1290112998I
1060110650III1302013094I
1070110710III1310113176I
1080110805III1320113260II
1090110998III1330113368I
1100111050IV1340113439I
1110111111IV13440 II
1120111252IV1344113495I
1130111390IV1350113503II
1140111460IV1360113698I
1150111598IV1373013797I
1160111697IV1380113865I
1170111798IV1390113905II
1180111819IV1400114098I
1190111980III1410114174I
1200712099I1420114265II
1210612177I1430114305I
1218012183II1441014489I
1218412199I1450114592I
1220112257II1460114692II
1230112345II1470114788I
1240112498I1480114898I
1250112594II1490114905I

Medicine

The relative values listed in this section have been determined on an entirely different basis than those in other sections. A conversion factor applicable to this section is not applicable to any other section.

The unit values listed in this section reflect the relativity of charges for procedures within this section only.

The fee for a particular procedure or service in this section is determined by multiplying the listed "unit value" by the current dollar "conversion factor" applicable to this section, subject to the Ground Rules, Instructions and Definitions of the Schedule.

Medicine Ground Rules

General information and Instructions

  1. GENERAL: Visits, examinations, consultations and similar services as listed in this section reflect the wide variations in time and skills required in the diagnosis and treatment of illness or injury. The listed relativities apply only when these services are performed by or under the responsible and direct supervision of a physician unless otherwise stated.
  2. Specialists rendering services outside their field of specialization as designated by Workers' Compensation Board Coding may charge only general practitioner fees. A specialist shall be paid a specialist's fee only if the injuries sustained or the services rendered are within the scope of his specialty and the services of specialists are indicated or required. (See page 6 for specialist coding and scope restrictions.)
  3. Fees indicated for examinations or visits by specialists are payable only to specialists with "C" ratings. Physicians with specialty ratings such as "IM,S" etc., (without the "C" prefix) shall be paid three-quarters of the fee indicated as payable to a specialist with a "C" rating for an office, home or hospital call, but in no event shall the fee for a physician with such a specialty rating be less than the fee payable to a general practitioner for the same service. (See also comprehensive level of service, page 4.)
  4. If a patient is referred by a physician to a specialist for an opinion on diagnosis, prognosis, necessity and type of treatment, and such written opinion is sent to the referring physician, the insurance carrier, and the Workers' Compensation Board, a fee shall be payable for such opinion and examination in accordance with the level of service (see definitions), regardless of whether or not the specialist subsequently operates upon or treats the patient. See Ground Rule 20 below.
  5. If a patient consults a specialist directly (non-referred case) and a complete examination is necessary for diagnosis, prognosis, necessity and type of treatment, and the specialist submits a report thereon to the Workers' Compensation Board and to the insurance carrier, in addition to or on the regular C-4/C-48 form, a specialist's fee is payable in accordance with the level of service (see definitions), regardless of whether or not the specialist subsequently operates upon or treats the patient.
  6. A fee is payable to a specialist, in accordance with the level of service, for the examination of a patient who seeks the care of a physician either directly or by referral from another physician, in instances of elective surgery or when it is incumbent upon the specialist to examine the patient in order to make a proper diagnosis, prognosis and to decide on the necessity and type of treatment to be rendered. This fee is in addition to the unit fee prescribed for the operation or treatment subsequently rendered by the specialist except that where the therapeutic procedure or treatment is of a minor character and the fee for the procedure or treatment is in excess of the fee for the office visit, the greater fee (not both fees) is payable. Similarly, if the fee for the minor procedure or treatment is less than the fee for the office visit, the fee for the office visit alone is payable.
  7. Where a physician renders treatment in the EMERGENCY ROOM of a hospital as an individual or as a member of a group under contract with the hospital, including those physicians who are hospital salaried or employed, all such services shall be paid at the general practice rates.

Where a physician enters into an agreement to cover the emergency room of a hospital on a fee-for-service basis, and is not under contract or salaried by the hospital, such physician shall be paid the fees of a general practitioner for the services rendered under the appropriate office visit category.

The above applies to all physicians regardless of specialty coding except for those physicians coded C-EM (Board Certified in Emergency Medicine) or EM (Board-eligible). C-EM's or EM's practicing under a fee-for-service agreement with a hospital shall be paid fees as set forth in the Specialist Fees section, office visits (see page 17). However, C-EM or EM remuneration shall not be at a level of reimbursement above the intermediate level with the exception of treatment of a substantiated life or limb threatening situation when the comprehensive level of service may be applicable. Consultation fees do not apply to C-EMs.

  Unit Value
90620A comprehensive consultation involves an in-depth evaluation of a patient with a problem requiring the development and documentation of medical data (the chief complaints, present illness, family history, past medical history, personal history, system review and physical examination, review of all diagnostic tests and procedures that have previously been done), the establishment or verification of a plan for further investigative and/or therapeutic management and the preparation of a report. For example: A young person with fever, arthritis, and anemia; or a comprehensive psychiatric consultation that may include a detailed present illness history, past history, a mental status examination, exchange of information with primary physician or nursing personnel or family members and other informants, and preparation of a report with recommendations; or a neurological evaluation for possible intracranial pathology; or the in-depth evaluation for spinal cord pathology or a chronic back disorder22.0

SUBSEQUENT CONSULTATIONS

  Unit Value
90640Brief consultative follow-up visit3.5
90641Limited consultative follow-up visit6.0
90642Intermediate consultative follow-up visit and evaluation8.5

Immunization and Therapeutic Injections

(For allergy testing, see 95000) (For skin testing of bacterial, viral, fungal extracts see 86400-86585)

These injections are usually given in conjunction with a medical service. The unit value for the appropriate medical service will be added to the unit values for the type of injection administered. The cost of the medication or material injected is also additional in accordance with Ground Rule 13; specify material.

  Unit
Value
90745Injection, subcutaneous. No additional other than the cost of the specified injectant.0.0
90746Intramuscular or deep structures0.83
90747Intravenous3.42
90798Intravenous therapy for severe or intractable allergic disease in physician's office or institution (eg. theophyllines, corticosteroids, antihistamines) 
90799Unlisted therapeutic injectionBR

Psychiatric Services

Medical services may be described as coded and listed in other segments in the Medicine Section as appropriate. For initial office or hospital visit see 90010-90020; for subsequent office or hospital visit see 90040-90060; for consultations see 90600-90642. For diagnostic services performed in hospital emergency rooms, Hospital care by the attending physician in treating a psychiatric inpatient may be initial or subsequent in nature, and may include exchanges with nursing and ancillary personnel. Hospital care services involve a variety of responsibilities unique to the medical management of inpatients, such as physician hospital orders, interpretation of laboratory or other medical diagnostic studies and observations, review of activity therapy reports, supervision of nursing and ancillary personnel, and the programming of all hospital resources for diagnosis and treatment. Some patients receive hospital care services only and others receive hospital care services and other procedures. If other procedures such as electroconvulsive therapy or medical psychotherapy are rendered, these should be listed separately.

  Unit
Value
Basic
Anes
90803Psychotherapy, adult or child (verbal and/or play therapy, with or without drug management), 45-50 minutes, office16.0 
90805home17.5 
9080625 minutes, office9.7 
90808home10.0 
9081115 minutes, office6.4 
90813home7.3 
90815Group therapy (maximum 8 persons per group), per person; per session, 45-50 minutes, office

 

6.4

 
9081790 minutes, office

 

3.2

 
90821Group therapy (maximum 16 persons per group), per person, per session, 45-50 minutes, office

 

4.8

 
9082390 minutes, office  
90835Narcosynthesis for psychiatric diagnostic and therapeutic purposes, e.g. sodium amobarbital (Amytal) interview

 

20.5

 
90836Convulsive therapy, in-patient14.03.0
90838out-patient14.03.0
90840Psychologic testing, psychometric and/ or projective tests, with written report, given by or under supervision of physician, per hour (identify test(s) used)

 

18.5

 
90860Marathon therapyBR 
90870Crisis interventionBR 
90875Hypnotherapy, 45-50 minutes16.0 
9087625 minutes9.7 
9087715 minutes6.4 
90880Sleep therapy, drug inducedBR 
90885electrically inducedBR 
90899Unlisted psychiatric procedureBR 

Biofeedback

Administration of biofeedback treatment is limited to qualified physicians. Those wishing to administer such treatments to patients covered by the provisions of the Workers' Compensation Law for the conditions listed below should submit evidence of their training and experience to the insurance carrier to expedite processing. Biofeedback treatments may be administered only for the following conditions:

(a) Idiopathic Raynaud's disease

(b) Temporomandibular Joint Dysfunction

(c) Myofascial Pain Dysfunction Syndrome (MPD)

(d) Tension headaches

(e) Migraine headaches

(f) Tinnitus

(g) Torticollis

(h) Neuromuscular re-education as result of neurological damage in CVA or spinal cord injury

(i) Inflammatory and/or musculoskeletal disorders usually related to the accepted condition.

Up to twelve Biofeedback treatments in a ninety day period may be allowed for the above conditions when the following is presented and authorization granted:

(a) An evaluation report documenting:

(i) The basis for the claimant's condition;

(ii) The condition's relationship to the industrial injury or illness;

(iii) An evaluation of the claimant's current functional measurable modalities (i.e., range of motion, up time, walking tolerance, medication intake, etc.);

(iv) An outline of the proposed treatment program;

(v) An outline of the expected restoration goals.

(b) No further Biofeedback treatments will be authorized or paid for without substantiation of evidence of improvement in measurable, functional modalities (i.e., range of motion, up time, walking tolerance, medication intake, etc.). The need for additional treatments will be determined on a case by case review in accordance with Workers' Compensation Board practices. The fees include interpretations and reports of the treatments.

When more than one of the treatments are performed on the same day, the maximum payment will be limited to 8.0 units.

  Unit
Value
90900Biofeedback training by electromyogram application - separate procedure (one-half hour)5.0
90901Biofeedback training, by electromyogram application, including office visit (one-hour)8.0
90902In conduction disorder-separate procedure (one-half hour)5.0
90903In conduction disorder, including office visit (one hour)8.0
90904Regulation of blood pressure-separate procedure (one-half hour)5.0
90905Regulation of blood pressure, including office visit (one hour)8.0
90906Regulation of skin temperature or peripheral blood flow-separate procedure (one-half hour)5.0
90907Regulation of skin temperature or peripheral blood flow, including office visit (one hour)8.0
90908By electroencephalogram application - separate procedure (one-half hour)5.0
90909By electroencephalogram application, including office visit (one hour)8.0
90910By electro-oculogram application - separate procedure (one-half. hour)5.0
90911By electro-oculogram application, including office visit (one hour)8.0

MONITORING SERVICES

(For fetal monitoring during labor, see 59050)

The following values are for physician's services only and do not include charges for use of equipment or supplies where such charges are justified. The values apply only when the physician is engaged solely and is continuously present in the monitoring process.

  Unit
Value
90919Assembly and operation of pump with oxygenator or heat exchanger (with or without ECG and/or pressure monitoring), per hour19.0
90920Monitoring ECG, pressures, etc., in intrathoracic or other critical surgery, per hour (independent procedure)16.0

Dialysis

The following descriptors apply only when these services are under the direct supervision of a physician and reflect only the professional component. Supplies, materials, and services of other personnel should be identified separately. If hemodialysis for acute renal failure exceeds six weeks, a further report is required. Detention time may be allowed in addition for highly complicated or unusual or extended hemodialysis if substantiated by report. If other significant, identifiable services are provided in addition to the appropriate hemodialysis procedure, list the appropriate visit for that service.

Peritoneal Dialysis

  Unit
Value
90962Acute renal failure and/or intoxication, including cannula insertion and institution of treatment program, per dialysis80.0
90963excluding cannula and/or catheter insertion, per dialysis

 

30.0

90964Chronic renal failure, cannula and/or catheter insertion, per dialysis80.0
90965excluding cannula and/or catheter insertions with dialysis through a permanent indwelling peritoneal catheter, per dialysis30.0
Hemodialysis
 

(Each of the following code numbers (90970- 90981) is for a single therapeutic hemodialysis treatment.)

 

Unit
Value
90970Acute renal failure and/or intoxication, initial hemodialysis130.0
90971second hemodialysis80.0
90972third hemodialysis80.0
90973fourth hemodialysis through end of second week, per treatment40.0
90974third through end of sixth week, per treatment.  (For cannula declotting, see 36860-36861)20.0
90980Chronic renal failure, initial stabilization through sixth treatment, per treatment80.0
90981seventh stabilization through end of first month of chronic hemodialysis therapy, per treatment30.0
90982Hemodialysis service for a hospitalized chronic renal failure patient who is hospitalized because of an inter-current illness or for a problem related or unrelated to chronic renal failure30.0
90983Hemodialysis treatment per month, two treatments per week120.0
90984three treatments per week180.0

PHYSICAL THERAPY

The procedure codes listed in this section apply only to services rendered by a self-employed duly licensed and registered physical therapist (PT) unless otherwise stated. Physicians rendering physical therapy should utilize the appropriate codes in the Medicine Section.

The relative values listed in this section have been determined on an entirely different basis than those in other sections. A conversion factor applicable to this Section is not applicable to any other section.

The unit values listed in this section reflect the relativity for procedures within this section only.

The fee for a particular procedure or service in this section is determined by multiplying the listed "unit value" by the current dollar "conversion factor" applicable to this section, subject to the Ground Rules, Instructions and Definitions of the Schedule.

Physical Therapists are advised to familiarize themselves with the appropriate Ground Rules listed in the Medicine and Surgery Sections of this Schedule.

PHYSICAL THERAPY

The fees for physical therapy services listed below are payable only when the services are rendered by a self-employed duly licensed and registered physical therapist (PT) unless otherwise stated.

Referral of patients by a physician for the treatment by a PT must be made by means of a referral which may be directive, indicating treatment plan and duration of such treatment. The Physical Therapist shall be responsible for obtaining initial authorization and reauthorization from the carrier after the twelfth physical therapy treatment or after 45 days, whichever comes first, unless previous authorization was for a longer period of time or number of treatments.

The physical therapist shall submit PT-4 reports as required by regulation.

PT's employed by physicians (i.e. not self-employed) may not bill separately from the physician-employer although the latter's billing must indicate the manner of service as delineated above.

When physical therapy is rendered in a hospital department, the hospital shall be entitled to the listed values whether or not the head of the department is C-PMR or PMR coded.

When physical therapists who are self-employed render physical therapy during the after care periods for fractures, dislocations or other post-operative procedures, fees for such treatments shall be in addition to those payable to the referring physician or physician for the after care period, notwithstanding that one or more physicians are also treating the same patient during said after-care period. The referring physician or the physical therapist must inform the employer or carrier of the need for such additional therapy and obtain authorization for such from the employer or carrier. If such authorization is refused, a determination by the Workers' Compensation Board shall be requested. The refusal of such requested authorization shall be appealable in accordance with the Workers' Compensation Law.

When it is necessary to render physical therapy in a patient's home, add 50% to the listed unit value. An explanation justifying the need for home therapy rather than in an office or out-patient hospital setting shall be submitted along with the bill.

When multiple services or procedures (different code numbers) are rendered or performed on one day, the payments will be limited to the greatest allowable fee plus one-half of the lesser fee(s) up to a maximum of twice the highest fee.

ELECTROMYOGRAPHY:

  Unit
Value
 (See codes 95860-95869 and addendum
thereto).
 
T95860Electromyography, one extremity and related 
 paraspinal areas12.0
T95861two extremities and related paraspinal areas21.6
T95863three extremities and related paraspinal areas26.4
195864four extremities and related paraspinal areas31.2
T95867cranial nerve supplied muscles, unilateral15.6
T95868bilateral23.4
T95869Limited study of specific muscles, e.g., external
anal sphincter, thoracic spinal muscles, etc
12.0

MODALITIES

Codes 97000 through 97201 apply whether treatment is rendered

to one or more areas on any one day. List Modalities used.

  Unit
Value
T97000Office visit with one or more of the following 
 modalities initial 30 minutes3.0
   
 a. Hot or cold packs 
 b. Traction, mechanical 
 c. Electrical stimulation 
 d. Vasopneumatic devices 
 e. Paraffin bath 
 f. Microwave 
 g. Whirlpool 
 h. Diathermy 
 i. Infrared 
 j. Ultraviolet 
 k. Other (identify) 
   
T97001maximum additional 1.1 

PHYSICAL THERAPY

(T97100-T97799)

PROCEDURES

Physical therapist is required to be in constant attendance

  Unit Value
   
T97100Office visit with one or more of the following 
 procedures, initial 30 minutes3.8
   
 a. Therapeutic exercises 
 b. Neuromuscular re-education 
 c. Functional activities 
 d. Gait training 
 e. Electrical stimulation (manual) 
 f. lontophoresis 
 g. Traction, manual 
 h. Massage 
 i. Contrast baths 
 j. Isokinetic or Isometric exercises (eg. Cybex) 
 k. Ultrasound 
 l. Laser 
 m. Other (identify) 
   
T97101maximum additional1.8
T97200Office visit including combination of any 
 modality (ies) and procedures(s) initial 30 
 minutes4.7
T97201maximum additional1.7
T97220Hubbard tank, initial 30 minutes5.4
T97221each additional 15 minutes (maximum 
 allowance, one hour)1.1
197240Pool therapy or Hubbard tank with therapeutic 
 exercises initial 30 minutes6.6
T97241each additional 15 minutes (maximum 
 allowance, one hour)1.4
   
T97500Orthotics training 
 (dynamic bracing, splinting4.5
 etc) initial 30 minutes 
T97501each additional 
 15 minutes (maximum 
 allowance, one hour)0.9
197520Prosthetic training, initial 30 minutes4.5
 allowance, one hour) 
T97521each additional 15 minutes (maximum 
 allowance, one hour)1.7
197540Activities of daily 
 with adequate report to be submitted (initial and 
 separate procedure)4.5
T97541each additional 15 minutes (maximum 
 allowance, one hour)1.3
 (For subsequent ADL training, use code 
 T97100) 
 (For muscle testing, manual or electrical, joint 
 range of motion, electromyography or nerve 
 velocity determination, use 95842 et seq) 
T97700Office visit, including one of the following tests 
 or measurements, with adequate report 
 a. Orthotic "check-out" 
 b. Prosthetic "check-out" 
 c. Activities of daily living "check-out" 
 initial 30 minutes6.8
T97101each additional 15 minutes1.9
197702maximum allowance9.8
 machine) initial testing7.3
T97752Muscle testing, torque curves during isometric 
 and isokinetic exercise (eg. by use of Cybex 
T97753subsequent retesting5.3
 (applicable only after suitable period of therapy 
T97799Unlisted physical therapy service or procedure.BR

OCCUPATIONAL THERAPY

The procedure codes listed in this section apply only to services rendered by a self-employed duly licensed and registered Occupational Therapist (OT). Physicians rendering occupational therapy should utilize the appropriate codes in the Medicine Section.

The relative values listed in this section have been determined on an entirely different basis than those in other sections. A conversion factor applicable to this Section is not applicable to any other section.

The fee for a particular procedure or service in this section is determined by multiplying the listed "unit value" by the current dollar "conversion factor" applicable to this section, subject to the Ground Rules, Instructions and Definitions of the Schedule.

Occupational Therapists are advised to familiarize themselves with the appropriate Ground Rules listed in the Medicine and Surgery Sections of this Schedule.

AUDITORY SYSTEM

EXTERNAL EAR

(For diagnostic services, such as

audiometric, vestibular and

speech tests, see 92551 et seq)

  Unit
Value
Follow-up
Days
Basic
Anes:
*69000Drainage, external ear, abscess   
 or hematoma*0.2504
*69020Drainage, external auditory   
 canal, abscess*0.2504
69350Otoscopy, under general   
     
EXCISION
69100Biopsy, external ear0.4504
69105Biopsy, external auditory canal0.4504
69110Excision, external ear,1.9304
 partial   
69120complete amputation5.1904
 (For reconstructive of ear, see   
 15100 et seq., bone and cartilage   
 grafts)   
69140Excision, exostosis(es), external   
 auditory canal7.7904
69145Excision, soft tissue lesion,   
 external auditory canal0.35304
69150Radical excision, external   
 auditory canal lesion, without   
 neck dissection14.4904
69155with neck dissection19.2906
     
 (for resection of temporal bone,   
 see 69535)   
 (For skin grafts and flaps, see   
 15000 et seq.)   
     
REMOVAL, FOREIGN BODY
*69200Removal, foreign body from   
 external auditory canal, without   
 general anesthesia*0.250 
69205with general anesthesia1.374
 one or both ears (separate   
 procedure)0.2504
     
REPAIR
 (For suture of wound or injury of   
 external ear, see 12011-14062)   
 Unit Follow-up Basic   
 Value Days Anes:   
69300Otoplasty for protruding ear,   
 with or without size reduction,   
 unilateral5.8904
69301bilateral8.3904
69320Reconstruction, external auditory   
 canal for congenital atresia,   
 single stageBR 4
 (For combination with middle   
 ear reconstruction, see 69631 or   
 69641)   
 (For other reconstructive   
 procedures with grafts [skin,   
 cartilage, bone], see 13150-   
 15730, 21230-21235)   
OTHER PROCEDURES
     
69350Otoscopy, under general   
 anesthesia1.374
69399Unlisted Procedure on external   
 earBR 4
MIDDLE EAR
INTRODUCTION
69400Eustachian tube inflation,   
 transnasal, with catheterization0.204
69401without catheterization0.204
INCISION
*69420Myringotomy, including   
 aspiration and/or eustachian   
 tube inflation*0.3504
*69424Ventilating tube removal when   
 originally inserted by another   
 physician, unlateral*0.3504
*69425bilateral*0.4504
*69433Tympanostomy (requiring   
 insertion of ventilating tube)   
 local or topical, anesthesia,   
 unilateral*0.6504
*69434bilateral*0.904
69436general anesthesia, unilateral2.3154
69437bilateral3.2154
69440Middle ear exploration through   
 post auricular or ear canal   
 incision6.4305
 (For atticotomy, see 69601 et   
 seq)   
EXCISION
69501Transmastoid antrotomy6.4905
69502Mastoidectomy, complete10.0905
69505modified radical13.0905
69511radical13.0906
 (For skin graft, see 15100 et seq.)   
69530Petrous apicectomy including   
 radical mastoidectomy20.8905

An error occurred in the processing of a table at this point in the document. Please refer to the table in the online document.

 Basic
Anes:
  
695355
695404
695504
695525
695545
  
REPAIR 
696015
696035
696045
696055
*696104
696204
696315
696325
696355
696365
696375
696415
696425
696435
696445
696455
696465
696505
696665
696675
696705
696755
  
OTHER PROCEDURE 
697004
697209
697405
697455
697995
  
INNER EAR INCISION 
698015

RADIOLOGY

Including Nuclear. Medicine and Diagnostic Ultrasound

GROUND RULES

1. GENERAL: Listed values for radiology procedures apply only when these services are performed by or under the supervision of a physician, with CR ratings. The listed values for Nuclear Medicine also apply to those physicians with C-NUM ratings.

Fees for physicians with R ratings shall be three-fourths of fees indicated. Fees payable to qualified specialists (C-rated but other than C-R) for items listed in this section, and within the scope of their specialty, shall be two-thirds of the indicated fees, except that full fees are payable to those physicians who are certified by the American. Board of Neurological Surgery or the American Board of Psychiatry and Neurology as Neurologists, who perform and interpret CT scans for neurological diagnoses. Fees for all other physicians, including those for items outside the scope of their coding, shall be one-half of the indicated values.

Consultations and referrals for diagnostic and therapeutic radiology are to be done only by specialists, with CR & R ratings.

Physicians qualified as general practitioners with the GP ratings, treating patients under their general medical care are permitted to take x-rays, but radiology requiring the use of ingestion or injection of foreign substance, shall be limited to qualified specialists within their specialty and physicians with the R ratings.

2. DUPLICATION OF X-RAYS: Every attempt should be made to minimize the number of x-rays taken. The attending doctor or any other person or institution having possession of x-rays which pertain to the patient that are deemed to be needed for diagnostic or treatment purposes should make these x-rays available upon request.

No payments shall be made for additional x-rays when recent x-rays are available except when supported by adequate information regarding the need to re-x-ray.

The use of photographic media and/or imaging is not reported separately but is considered to be a component of the basic procedure, and shall not merit any additional payment.

3. MULTIPLE DIAGNOSTIC X-RAY PROCEDURES: The following adjustments apply:

a. For two contiguous parts, the charge shall be the greater fee plus 50% of the lesser fee.

b. For two remote parts, the charge shall be the greater fee plus 75% of the lesser fee.

c. For three or more parts, whether contiguous or remote, the charge shall be the greatest fee plus 75% of the total of the lesser fees.

d. Where more than one part is included in a single line item, it shall be charged for as a single line item. Any additional item examined shall be considered under paragraph a, b, or c above, whichever pertains.

e. No charge shall be made for comparative x-rays except when such x-rays are specifically authorized by the carrier or the chairman. Comparative x-rays specifically authorized shall be subject to fees for contiguous and remote parts as provided in this formula (3a-3d).

f. X-Rays of different areas taken on different but proximate dates and related to the injury or problem necessitating the first x-ray studies, and which could have reasonably been performed at one time, shall be subject to rules a through e above.

4. XERORADIOGRAPHY: Imaging performed by this process shall have the identical values listed for conventional x-ray procedures of the same area and views.

5. MULTIPLE SERVICES OTHER THAN DIAGNOSTIC RADIOLOGY: When multiple or bilateral procedures or services are provided at the same session, the highest fee procedure will be reported as listed. The other procedure (s) will be billed for in accordance with Surgery ground rule 5.

6. UNIT VALUES: The total unit value includes professional services plus expenses of personnel, materials, including usual contrast media and drugs, space, equipment and other facilities. Values for injection procedures include all usual pre and post-injection car specifically related to the injection procedure, necessary local anesthesia, placement of needle or catheter, and injection of contrast media. Supplies and materials provided by the physician (e.g. sterile trays, radioisotopes, etc.) over and above those usually included with or necessitated by the services rendered may be charged for separately; in these instances, list items individually on bill. See Medicine ground rule 13.

The total unit value includes the professional component (see PC unit value below) plus the technical component (TC). This value is applicable in any situation in which a single charge is made to include both professional, services and the technical cost of providing that service. Identification of a procedure by its 5-digit code without modifier -26 or -27 indicates that the charge includes both the "professional" and "technical" components.

The PC unit value (professional component unit value) represents the value of the professional radiological services of the physician. This includes examination of the patient, when indicated, performance and/or supervision of the procedure, interpretation and written report of the examination including images, and consultation with the referring physician. This component is applicable in any situation in which the physician submits a charge for these professional services only. It does not include the cost of personnel, materials, space, equipment or other facilities. To identify a charge for professional component, use the 5-digit procedure code followed by modifier -26. (See modifier -26 and rule 15 for use of modifiers.)

When this section of the Schedule is used in connection with a "conversion factor" to establish fees, it must be emphasized that the conversion factor cannot be applied to both the TOTAL UNIT VALUE and the PROFESSIONAL COMPONENT UNIT VALUE. Physicians who determine their fees by application of conversion factors to the unit values in this section must determine a separate factor for TOTAL UNIT VALUE and for PC UNIT VALUE.

The technical component includes the charges for personnel, materials, including usual contrast media and drugs, film or xerograph, space, equipment and other facilities but excludes the cost of radioisotopes. No unit values are listed for the technical component of radiology procedures, since these are institutional charges not billed separately by physicians. To identify a charge for the technical component, use the 5-digit procedure code followed by modifier -27. (See modifier -27 and Rule 15 for use of modifiers). The total cost of a procedure(s) (PC plus TC) cannot exceed the total unit value cost of the procedure(s).

Fees are for a competent diagnosis by image, expert interpretation and opinion. Size and number of films are not relevant except as indicated by minimum number listed for respective procedures.

7. NECESSITY OF SERVICES OR PROCEDURES: When a patient is referred to radiologists or other specialists for services covered in the Radiology Section, they shall evaluate the patient's problem and determine the service(s) or procedure(s) medically necessary. Such evaluations and necessary consultation with the referring physician(s) is an integral part of the professional component unit value and does not merit any additional charges.

8. REPORTS AND CUSTODY OF X-RAYS AND OTHER RECORDED IMAGES: C48 and C4 reports are not acceptable. A written report of the findings must be submitted in quadruplicate; mail one to the district office of the Workers' Compensation Board, one to the attending physician and retain one for your records; the fourth to accompany bill to insurance carrier, if known, or to the employer.

Films or other recorded images shall be preserved for at least six years (but in no case shall they be destroyed without a report of the findings of such images being filed, as a permanent record). They (or satisfactory reproductions) shall be made available to the attending physician, insurance carrier or self-insured employer. When requested, carriers and self-insured employers shall return original films to the physician within 20 days of their receipt.

When a carrier or self-insured employer requests x-rays and satisfactory reproductions are furnished in lieu of the original films, a fee of four dollars ($ 4.00) may be charged for the first sheet of duplicating film and two dollars ($ 2.00) for each additional sheet of film. These reproductions are not returnable to the physician. Copies of images produced by copiers (e.g. Xerox) shall not merit any additional payment and shall not be returnable to the physician; such copies should accompany the bill submitted for the particular, imaging procedure. (The use of photographic media and/or imaging is not reported separately but is considered to be a component of the basic procedure.)

In cases where the patient transfers from one physician to another the former treating physician will promptly forward all images or copies of such to the new attending physician.

9. MATERIALS SUPPLIED BY PHYSICIAN: Supplies and materials provided by the physician (e.g., sterile trays, drugs, etc.) over and above those usually included with the office visit or other services rendered may be charged for separately. (List drugs, trays, materials or supplies provided.) Radiopharmaceutical or other radionuclide material cost: Listed values in this section do not include these costs. List the name and dosage of radiopharmaceutical material and cost (See Medicine ground rule 13.)

10. INJECTION PROCEDURES: Values for injection procedures include all usual pre-and post-injection care specifically related to the injection procedure, necessary local anesthesia, placement of needle or catheter and injection of contrast media.

Vascular injection procedures are listed in the cardiovascular section, under procedure codes 36000-36299. Other injection procedures are listed in appropriate sections.

11. "BR" (BY REPORT) ITEMS: "BR" in the value column (s) indicates that the value of that service is to be determined by report because the service is too unusual, variable or new to be assigned a unit value (s).

Submit a special report describing medical appropriateness of the service. Pertinent information-should include an adequate definition or description of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service. Additional items which may be helpful might include:

Complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, and follow-up care.

12. UNLISTED SERVICE OR PROCEDURE: A service or procedure may be provided that is not listed in this Fee Schedule. When reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service, identifying it by report ("BR"). See 11. above.

13. SUBSECTION INFORMATION: Several of the subheadings or subsections have special needs or instructions unique to that section. Where these are indicated, e.g. "Therapeutic Radiology," special "NOTES" will be presented preceding those procedural terminology listings, referring to that subsection specifically. If there is an "Unlisted Procedure" code number (see item 12) for the individual subsection it will be shown. Those subsections with "NOTES" are as follows.

SubsectionCode Numbers
Diagnostic Ultrasound76500-76999
Therapeutic Radiology77261-77999
Nuclear Medicine78000-79999

14. MISCELLANEOUS:

a.) Emergency services rendered between 10 p.m. and 8 a.m. in response to requests received during those hours or on Sundays or legal holidays, provided such services are not otherwise reimbursed, may warrant an additional payment of one-third of the applicable fee. Submit report (See 11 above and Medicine ground rules 7 & 8).

b.) Values for office, home and hospital visits, consultation and other medical services, anesthesia, surgical and laboratory procedures are listed in the sections entitled "Medicine," "Anesthesia," "Surgery," and "Pathology."

15. UNIT VALUE MODIFIERS:

-26 Professional Component: When the professional component unit value only is applicable, identify by adding this modifier (-26) to the usual procedure number(s). Charges shall be in accordance with the "PC Unit Value" for that procedure(s).

-27 Technical Component: When the professional component is charged for separately from the total unit value, the technical component will also be charged for separately. The technical component unit value will be the total value, less the professional component value. Identify by adding this modifier (-27) to the usual procedure(s) code number(s).

See item 6 above for correct conversion factor applicable to -26 and -27.

16. CT SCAN RECONSTRUCTION: (effective September 1, 1989)

An additional fee up to a maximum of $ 100 may be permitted for CT scan reconstruction. This additional fee shall be payable only when the reconstruction is requested by the primary care physician. The request must follow a review of the regular CT scan film and only if there is a specifically stated need for clarification via reconstruction.

The fee for reconstruction must be submitted on a separate bill with a separate report and a copy of the primary care physician's request.

17. MAGNETIC RESONANCE IMAGING: (effective September 1, 1989)

The fees for Magnetic Resonance Imaging shall be as follows: Professional component: 4 Radiology units for an MRI of any one part of the body Technical component: see chart below

 Region IRegion IIRegion IIIRegion IV
Technical component$ 611$ 635$ 654$ 670

The fees payable for an MRI study include both standard and axial views.

The provisions of Radiology Ground Rules 1 and 3 apply to Magnetic Resonance Imaging.

DIAGNOSTIC RADIOLOGY

HEAD AND NECK

  PC Unit
Value
Total Unit
Value
70002Pneumoencephalography, supervision and interpretation only3.39.0
70003complete procedure (For injection procedure for pneumoencephalography, see 61053, 62286)9.015.0
70010Myelography, posterior fossa, supervision and interpretation only3.07.5
70011complete procedure (For injection procedure only for myelography, see 61052)5.510.0
70015Cisternography, positive contrast supervision and interpretation only3.07.5
70016complete procedure (For injection procedure only for cisternography, see 61053)5.510.0
70020Ventriculography, air contrast, supervision and interpretation only3.07.5
70021positive contrast, supervision and interpretation only (For injection procedure only for ventriculography, see 61025, 61120)3.07.5
70022Stereotactic localization, head4.09.0
70030Eye, for foreign body detection0.82.0
70040for localization of foreign body (70030 not included)1.53.0
70050combined 70030 and 700402.04.0
70100Mandible, partial, less than four views0.61.5
70110complete, minimum of four views0.82.0
70120Mastoids, less than three views per side0.71.7
70130complete, minimum of three views per side1.02.5
70131Internal auditory complete1.02.5
70140Facial bones, less than three views0.61.5
70150complete, minimum of three views0.82.0
70160Nasal bones, complete, minimum of three views0.61.5
70170Dacryocystography, (nasolacrimal duct), supervision and interpretation only0.82.0
70171complete procedure (For injection procedure only for dacryocystography, see 68850)2.33.5
70190Optic foramina0.61.5
70200Orbits, complete, minimum of four views0.82.0
70210Sinuses, paranasal, less than three views0.61.5
70220complete, minimum of three views, without contrast studies0.82.0
70230with contrast studies, in addition to 70220, supervision and interpretation only0.92.5
70231 with contrast studies, in addition to 70220, complete procedure4.86.0
70240Sella turcica0.71.7
70250Skull, less than four views, with or without stereo0.61.5
70260complete, minimum of four views, with or without stereo1.23.0
70300Teeth, single view0.20.5
70310partial examination, less than full mouth0.41.0
70320complete full mouth0.82.0
70328Temporomandibular joint, open and closed mouth, unilateral0.61.5
70330bilateral1.02.5
70332Temporomandibular joint arthrotomography (includes a contrast arthrogram and appropriate laminographic studies); supervision and interpretation only2.04.5
70333complete procedure (For injection procedure only for arthrotomography, see 21116)4.06.5
70350Cephalogram, orthodontic0.41.0
70355Orthopantogram0.41.0
70360Neck, soft tissue0.41.0
70370pharynx or larynx, including fluoroscopy and/or magnification technique1.02.5
70373Laryngography, contrast, supervision and interpretation only1.23.0
70374complete procedure (For injection procedure only for laryngography, see 31708)3.04.5
70380Radiologic examination, salivary gland for calculus0.61.5
70390Sialography, supervision and interpretation only0.82.0
70391complete procedure2.33.5
 (For injection procedure only for sialography, see 42550)  
70400Orbitography, all or positive contrast, supervision and interpretation only1.84.5
 (For injection procedure only for orbitography, see 67510)  
70401complete procedure5.79.0
70450Computerized axial tomography, head, without contrast material4.08.5
70460with contrast material(s)4.010.5
70470without intravenous contrast material, followed by contrast material(s) and further sections5.012.0
70480Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear, without contrast material4.08.5
  PC Unit
Value
Total Unit
Value
75718by serialography, complete procedure.10.516.5
75722Angiography, renal, unilateral, selective, supervision and interpretation only3.012.0
75723complete procedure9.618.0
75724Angiography, renal, bilateral, selective (including flush aortogram), supervision and interpretation only4.513.5
75725complete procedure13.221.0
75726Angiography, visceral, selective or subselective, supervision and interpretation only3.913.5
75727selective (including flush aortogram), complete procedure11.121.0
75728subselective, complete procedure13.222.5
 (For selective angiography, additional visceral vessels, studied after basic examination, see 75772, 75773)  
75731Angiography, adrenal, unilateral, selective, supervision and interpretation only3.312.0
75732complete procedure11.119.5
75733Angiography, adrenal, bilateral selective, supervision and interpretation only4.813.5
75734complete procedure15.022.5
75736Angiography, pelvic, selective or supraselective, supervision and interpretation only3.09.0
75737selective; complete procedure7.513.5
75738supraselective, complete procedure9.615.0
75741Angiography, pulmonary, unilateral, selective, supervision and interpretation only3.09.0
75742complete procedure9.615.0
75743Angiography, pulmonary, bilateral, selective, supervision and interpretation only4.510.5
75744complete procedure11.118.0
75746Angiography, pulmonary, by nonselective catheter or venous injection, supervision and interpretation only3.09.0
75747catheter, nonselective, complete procedure9.015.0
75748venous injection, complete procedure5.712.0
75750Angiography, coronary, root injection, supervision and interpretation only3.912.0
75751complete procedure9.616.5
75752Angiography, coronary, unilateral selective injection, including left ventricular and supravalvular angiogram and pressure recording, supervision and interpretation only3.915.0
75753complete procedure15.027.0
75754Angiography, coronary, bilateral selective injection, including left ventricular and supravalvular angiogram and pressure recording, supervision and interpretation only5.721.0
75755complete procedure18.934.5
75756Angiography, internal mammary, supervision and interpretation only1.89.0
75757complete procedure9.616.5
75762Angiography, coronary bypass, unilateral selective injection, supervision and interpretation only3.915.0
75764complete procedure15.027.0
75766Angiography, coronary bypass, multiple selective injection, supervision and interpretation only5.721.0
75767complete procedure18.934.5
75772Angiography, visceral, selective, additional vessels studied after basic examination, supervision and interpretation only3.510.5
75773complete procedure8.510.5

VEINS AND LYMPHATICS

For injection procedure only for venous system, see 36400-36510) For injection procedure only for lymphatic system, see 38790-38794)

  PC Unit
Value
Total Unit
Value
75801Lymphangiography, extremity only, unilateral, supervision and interpretation only1.87.5
75802complete procedure7.513.5
75803Lymphangiography, extremity only, bilateral, supervision and interpretation only3.09.0
75804complete procedure9.615.0
75805Lymphangiography, pelvic/abdominal, unilateral, supervision and interpretation only2.47.5
75806complete procedure7.513.5
75807Lymphangiography, pelvic/abdominal, bilateral, supervision and interpretation only3.39.0
75808complete procedure10.215.0
75810Splenoportography, supervision and interpretation only1.87.5
75811complete procedure7.513.5
75820Venography, extremity, unilateral, supervision and interpretation only1.54.5
75821complete procedure3.96.5
75822Venography, extremity, bilateral, supervision and interpretation only1.26.0
75823complete procedure5.79.0
75825Venography, caval, inferior with serialography, supervision and interpretation only1.86.0
75826complete procedure5.79.0
75827Venography, caval, superior, with serialography, supervision and interpretation only1.86.0
75828complete procedure5.79.0
75831Venography, renal, unilateral, selective, supervision and interpretation only2.76.5
75832complete procedure6.310.5
75833Venography, renal, bilateral, selective,  supervision and interpretation only4.27.5
75834complete procedure9.613.5
75840Venography, adrenal, unilateral, selective, supervision and interpretation only2.76.5
75841complete procedure7.512.0
75842bilateral, selective, supervision and interpretation only4.27.5
75843complete procedure13.218.0
75845Venography, azygos, selective or nonselective, supervision and interpretation only2.46.0
  PC Unit ValueTotal Unit Value
75846selective, complete procedure7.512.0
75847non-selective, complete procedure6.310.5
75850Venography, intraosseous, supervision and interpretation only2.46.0
75851complete procedure5.79.0
75860Venography, sinus or jugular, catheter, supervision and interpretation only3.99.0
75861complete procedure9.614.5
75870Venography, superior sagittal sinus, supervision and interpretation only3.07.5
75871direct puncture, complete procedure7.512.0
75880Venography, orbital, supervision and interpretation only1.86.0
75881complete procedure5.710.0
75885Percutaneous transhepatic photography with hemodynamic evaluation, supervision and interpretation only3.08.5
75886complete procedure10.515.0
75887Percutaneous transhepatic portography without hemodynamic evaluation, supervision and interpretation only2.98.4
75888complete procedure10.014.5
75889Hepatic venography, wedged or free, with hemodynamic evaluation, supervision and interpretation only3.510.4
75890complete procedure8.510.5
75891Hepatic venograph, wedged or free without hemodynamic evaluation, supervision and interpretation only3.410.3
75892complete procedure8.410.4
75893Venous sampling through catheter without angiography (eg. for parathyroid hormone, renin)10.015.0

Transcatheter Therapy and Biopsy

  PC Unit
Value
Total Unit
Value
75894Transcatheter therapy, embolization, including angiography, supervision and interpretation only3.518.4
75895complete procedure10.515.0
75896Transcatheter therapy, infusion, including angiography, supervision and interpretation only3.510.4
75897complete procedure10.515.0
75898Angiogram through existing catheter for follow-up study for transcatheter therapy, embolization or infusion3.510.5
75950Transcatheter, intravascular occlusion, temporary; supervision and interpretation only3.510.4
75951complete procedure10.515.0
75955Transcatheter intravascular occlusion, permanent, supervision and interpretation only3.510.5
75956complete procedure10.515.0
75961Transcatheter retrieval, percutaneous, of fractured venous or arterial catheter10.012.0
75970Transcatheter biopsy, supervision and interpretation only3.07.5
75971complete procedure (For transcatheter renal and ureteral biopsy, see 52007, 52107) (For percutaneous needle biopsy of pancreas, see 48102; of retroperitoneal lymph node or mass, see 49180)9.512.5
75972Percutaneous transluminal angioplasty, unilateral, supervision and interpretation only6.513.5
75973complete procedure30.037.0
75974Percutaneous transluminal angioplasty, bilateral, single catheter, supervision and interpretation only8.515.0
75975complete procedure35.038.0
75976Percutaneous transluminal angioplasty, bilateral, dual catheters, supervision and interpretation only8.515.0
75977complete procedure35.038.0
75980Percutaneous transhepatic biliary drainage with contrast monitoring, supervision and interpretation only3.07.5
75981complete procedure30.037.5
75982Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, supervision and interpretation only4.59.5
75983complete procedure30.037.5
75985Change of percutaneous drainage catheter with contrast monitoring (ie. biliary tract, urinary tract) complete procedure (For injection procedure only for percutaneous biliary drainage, see 47510)3.07.5
75990Drainage of abscess, percutaneous, with radiologic guidance (ie. fluoroscopy, ultrasound or computerized tomography) with or without placement of indwelling catheter8.515.0
 (75990 is neither organ nor area specific. For drainage of abscess performed without radiology or fluoroscopy, see under specific anatomic site.)  

Miscellaneous

(For arthrography of shoulder, see 73040, 73041; elbow, see 73085, 73086; wrist, see 73115, 73116; hip, see 73525, 73526, knee, see 73580, 73581; ankle, see 73615, 73616)

  PC Unit
Value
Total Unit
Value
76000Fluoroscopy, (separate procedure) other than 710341.30
76020Bone age studies0.61.5
76040Bone length studies (orthoroentgenogram, scanogram)1.02.5
76061Radiologic examination, osseous survey, limited (eg. for metastases)2.04.5
76062complete (axial and appendicular skeleton)BRBR
76065infant0.82.0
76080Radiologic examination, fistula or sinus tract study, supervision and interpretation only1.02.5
76081complete procedure2.54.0
  PC Unit
Value
Total Unit
Value
76086Mammary ductogram or galactogram, unilateral, supervision and interpretation only1.02.5
76087complete procedure1.53.5
76088Mammary ductogram or galactogram, bilateral, supervision and interpretation only1.02.5
76089complete procedure (For injection procedure only for mammary ductogram or galactogram, see 19030)1.53.5
76090Mammography, unilateral1.02.5
76091bilateral1.53.5
76094Radiologic examination, localization of breast nodule or calcification before operation, with marker and confirmation of its position with appropriate imaging2.44.0
76100Radiologic examination, single plane body section (eg. tomography, planigraphy, body section radiography) (Separate procedure)2.02.8
76120Cineradiography, except where specifically included1.12.8
76125Cineradiography, to complement routine examination0.61.5
76400Magnetic Resonance: bone marrow blood supply See page 159  
76499Unlisted diagnostic, radiologic procedureBRBR

Diagnostic Ultrasound

NOTES: A-mode implies a one-dimensional ultrasonic measurement procedure. M-mode implies a one-dimensional ultrasonic measurement procedure with movement of the trace to record amplitude and velocity of moving echo-producing structures. B-scan implies a two-dimensional ultrasonic scanning procedure with a two-dimensional display. Real-time scan implies a two-dimensional ultrasonic scanning procedure with display of both two-dimensional structure and motion with time.

Head and Neck

  PC Unit
Value
Total Unit
Value
76500Echoencephalography, A-mode, diencephalic midline1.02.0
76505complete (diencephalic midline and ventricular size)1.53.0

76506

 

Echoencephalography, B-mode, (gray scale) complete (for determination of ventricular size, delineation of cerebral contents and detection of fluid, masses or other intracranial abnormalities), including A-mode encephalography as secondary component where indicatedBRBR
76511Echography, ophthalmic, spectral analysis with amplitude quantitation, A-mode1.93.8
76512contract B-scan1.93.8
76515tomography with or without A or M-mode2.85.6
76516Echography, ophthalmic, ultrasonic biometry, A-mode1.32.6
76517B-scan2.85.6
76529Ophthalmic ultrasonic, foreign body localizationBRBR
76530Echography, thyroid, A-mode1.02.0
76535B-scan1.53.0
76550Carotid imaging1.53.0
 (For Doppler, see 76900)  

CHEST

  PC Unit
Value
Total Unit
Value
76601Echography, chest, A-mode1.22.5
76604B-scan (includes mediastinum)1.53.0
76620Echocardiography, M-mode complete1.54.0
76625limited (eg. follow-up or limited studies)1.02.0
76627Echocardiography, real-time scan, complete (includes 76620)4.05.6
76628limited3.24.5
 (For echocardiography as a cardiovascular procedure, see 76620- 76625)  
76640Echography, breast, A-mode1.22.5
76645B-scan2.55.0

ABDOMEN AND RETROPERITONEUM

  PC Unit
Value
Total Unit
Value
76700Echography, abdominal, B-scan, complete3.06.0
76705limited (eg. follow-up or limited studies)2.04.0
76770Echography, retroperitoneal (eg. renal, aorta, nodes), B-scan, complete2.55.0
76775limited1.83.5

PELVIS

  PC Unit
Value
Total Unit
Value
76805Echography, pelvic, B-scan (eg. real- time) in obstetrics, gynecology or transplants, complete2.04.0
76815limited (fetal growth rate, heart beat, anomalies, placental location)1.53.0

GENITALIA

  PC Unit
Value
Total Unit
Value
76870Echography, scrotum and contents2.04.0

EXTREMITIES

  PC Unit
Value
Total Unit
Value
76880Echography, extremity, B-scan1.53.0

VASCULAR STUDIES

  PC Unit
Value
Total Unit
Value
76900Peripheral flow study (Doppler), arterial
only
1.53.0
76910venous only1.53.0
76920arterial and venous2.34.5
76925Peripheral imaging, B-scan, Doppler or
real-time scan
1.53.0

 

Magnetic Resonance Imaging 
abdomen74181
bone marrow blood supply76400
brain, including brain stem70551
chest71550
lower extremity73720
myocardium75552
orbit, face and neck70540
pelvis72196
spinal canal and contents; cervical72141
spinal canal and contents; lumbar72144
spinal canal and contents; thoracic72143
upper extremity73220