CPT Codes and Fees

TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2015

Surgery, Part 1 (10000-29999)

Surgery, Part 2 (30000-49999)

Surgery, Part 3 (50000-69999)

Assistant Surgery Guide

Radiology

Pathology and Laboratory

Evaluation & Management, Medicine, Physical Therapy

Commission Assigned Codes

N.C. Industrial Commission Assigned Codes

Surgery, Part 1

Effective January 1, 2015

ABBREVIATIONS: BR = by report (i.e., report is needed to establish fee), CPT = Current Procedural Terminology, FAC = services were performed in a facility setting, FUD = follow-up days (i.e., number of days in global period), NA = no allowance, OFF = services were performed in physician office setting, PC (26) = professional component, PER AGM = per agreement, SC = special consideration (see Guides or contact Industrial Commission), TBA = to be assigned, TC (27) = technical component, Total = total fee, and Units = requires time or number of units.

CPT Code	Total	OFF	FAC	TC (27)	PC (26)	FUD
10021	$167.11			$33.95	$133.16	0
10022	$172.48			$45.07	$127.41	0
10030		$1,524.81	$316.87			0
10040	$130.03					0
10060	$121.89					0
10061	$244.60					15
10080	$146.18					0
10081	$276.29					15
10120	$129.20					0
10121	$286.03					15
10140	$153.57					0
10160	$120.26					0
10180	$256.78					15
11000	$102.38					0
11001	$55.25					0
11004	$1,120.00					0
11005	$1,522.91					0
11006	$1,398.63					0
11008	$566.68					0
11010	$642.39					0
11011	$765.76					0
11012	$1,064.30					0
11042	$138.95					0
11043	$289.29					15
11044	$404.69					15
11045		$60.63	$35.08
11046		$105.64	$74.74
11047		$173.49	$129.82
11055	$25.13					0
11056	$35.99					0
11057	$41.65					0
11100	$103.21					15
11101	$54.45					15
11200	$87.76					0
11201	$34.13					0
11300	$81.27					0
11301	$118.64					0
11302	$151.14					0
11303	$203.96					0
11305	$92.64					0
11306	$132.46					0
11307	$162.51					0
11308	$220.21					0
11310	$110.52					0
11311	$147.89					0
11312	$181.22					0
11313	$242.98					0
11400	$108.89					15
11401	$151.97					15
11402	$191.77					15
11403	$238.09					15
11404	$277.09					15
11406	$363.24					15
11420	$119.46					15
11421	$171.45					15
11422	$207.22					15
11423	$268.97					15
11424	$310.42					15
11426	$438.80					15
11440	$139.77					15
11441	$188.53					15
11442	$229.98					15
11443	$304.74					15
11444	$378.67					15
11446	$487.56					15
11450	$416.06					15
11451	$529.01					15
11462	$376.24					15
11463	$458.31					15
11470	$464.82					15
11471	$533.89					15
11600	$194.22					15
11601	$255.15					15
11602	$300.66					15
11603	$354.30					15
11604	$399.80					15
11606	$512.75					15
11620	$204.78					15
11621	$286.03					15
11622	$349.42					15
11623	$425.80					15
11624	$514.38					15
11626	$599.71					15
11640	$243.78					15
11641	$348.61					15
11642	$425.00					15
11643	$503.81					15
11644	$624.90					15
11646	$800.41					15
11719	$11.93					0
11720	$49.93					0
11721	$84.23					0
11730	$123.52					0
11732	$48.76					0
11740	$59.33					0
11750	$292.54					10
11752	$407.12					15
11755	$180.39					15
11760	$192.59					15
11762	$421.74					15
11765	$90.21					15
11770	$413.63					15
11771	$770.36					45
11772	$891.42					45
11900	$60.13					0
11901	$94.27					0
11920	$221.84					0
11921	$264.92					0
11922	$67.44					0
11950	$157.65					0
11951	$185.28					0
11952	$225.10					0
11954	$237.29					0
11960	$1,096.21					90
11970	$1,206.73					90
11971	$376.24					15
11976	$214.63					15
11980	$215.54					0
11981		$222.95	$154.23			15
11982		$254.33	$185.59			15
11983		$412.82	$344.10			15
12001	$152.60					0
12002	$178.27					0
12004	$228.19					0
12005	$293.80					15
12006	$371.52					15
12007	$459.94					15
12011	$168.28					0
12013	$203.24					0
12014	$246.73					15
12015	$326.59					15
12016	$420.71					15
12017	$549.07					15
12018	$828.86					15
12020	$296.60					15
12021	$190.96					15
12031	$221.04					0
12032	$271.41					0
12034	$339.67					15
12035	$416.06					15
12036	$498.93					15
12037	$608.65					15
12041	$217.49					0
12042	$265.27					15
12044	$323.75					15
12045	$392.90					15
12046	$551.77					15
12047	$595.42					15
12051	$268.97					0
12052	$327.48					15
12053	$377.87					15
12054	$469.68					15
12055	$597.28					15
12056	$776.85					15
12057	$893.88					15
13100	$330.73					15
13101	$465.62					15
13102	$143.19					0
13120	$361.61					15
13121	$544.44					15
13122	$166.57					0
13131	$448.57					15
13132	$684.21					15
13133	$246.95					0
13151	$539.58					15
13152	$897.11					15
13153	$271.03					0
13160	$1,016.57					45
14000	$692.35					45
14001	$989.75					45
14020	$858.11					45
14021	$1,228.67					45
14040	$1,088.09					45
14041	$1,462.70					45
14060	$1,241.67					45
14061	$1,717.85					45
14301		$1,971.17	$1,670.00			90
14302		$433.73	$433.73
14350	$1,196.96					45
15002		$576.72	$398.94			0
15003		$127.84	$81.78			0
15004		$695.48	$493.95			0
15005		$215.37	$163.54			0
15040		$496.36	$249.28			0
15050	$449.37					15
15100	$999.51					45
15101	$264.09					0
15110		$1,575.61	$1,311.31			90
15111		$250.06	$214.16			0
15115		$1,487.67	$1,352.66			90
15116		$325.15	$292.11			0
15120	$1,198.59					45
15121	$442.88					0
15130		$1,305.28	$1,051.75			90
15131		$204.46	$173.56			0
15135		$1,592.24	$1,466.53			90
15136		$191.02	$175.22			0
15150		$1,310.10	$1,165.01			90
15151		$264.22	$231.17			0
15152		$324.70	$288.79			0
15155		$1,318.17	$1,256.41			90
15156		$344.72	$321.73			0
15157		$381.53	$350.65			0
15200	$915.81					45
15201	$273.03					0
15220	$971.06					45
15221	$257.60					0
15240	$1,139.28					45
15241	$360.79					0
15260	$1,337.56					45
15261	$442.88					0
15570	$901.19					45
15271		$279.21	$171.31			0
15272		$53.05	$34.20			0
15273		$573.98	$407.57			0
15274		$135.71	$86.97			0
15275		$300.06	$198.67			0
15276		$65.94	$49.03			0
15277		$580.26	$423.62			0
15278		$159.65	$107.66			0
15572	$875.17					45
15574	$871.94					45
15576	$586.71					45
15600	$407.92					45
15610	$436.37					45
15620	$533.07					45
15630	$582.63					45
15650	$656.58					45
15731		$1,927.54	$1,742.55			90
15732	$2,235.49					45
15734	$2,814.87					45
15736	$2,501.21					45
15738	$1,908.01					45
15740	$1,566.71					45
15750	$1,787.73					45
15756	$5,022.98					45
15757	$5,022.98					45
15758	$5,022.98					45
15760	$1,228.67					45
15770	$1,123.03					45
15775	$543.63					15
15776	$760.59					15
15777		$415.01	$415.01			0
15780	$647.64					15
15781	$659.84					45
15782	$422.55					45
15783	$471.31					45
15786	$203.96					0
15787	$43.88					0
15788	$268.17					45
15789	$482.70					45
15792	$174.71					45
15793	$315.28					45
15819	$1,320.48					45
15820	$853.23					45
15821	$954.01					45
15822	$778.47					45
15823	$1,114.09					45
15824	$1,418.00					45
15825	$1,621.16					45
15826	$1,418.00					45
15828	$3,748.56					45
15829	$4,153.25					45
15830	$2,061.34					90
15832	$1,521.21					45
15833	$1,286.37					45
15834	$1,371.69					45
15835	$1,423.69					45
15836	$1,161.22					45
15837	$1,106.78					45
15838	$993.00					45
15839	$898.74					45
15840	$2,190.79					45
15841	$3,035.90					45
15842	$5,069.04					45
15845	$2,130.66					45
15847	BR					0
15850	$89.38					0
15851	$79.87					0
15852	$89.86					0
15860	$261.66					0
15876	BR					45
15877	BR					45
15878	BR					45
15879	BR					45
15920	$819.92					45
15922	$1,204.28					45
15931	$875.99					15
15933	$1,318.85					45
15934	$1,500.07					45
15935	$1,934.81					45
15936	$1,718.66					45
15937	$2,107.09					45
15940	$932.07					15
15941	$1,367.61					45
15944	$1,547.20					45
15945	$1,785.30					45
15946	$2,896.96					45
15950	$776.85					15
15951	$1,372.50					45
15952	$1,374.93					45
15953	$1,630.90					45
15956	$2,479.27					45
15958	$2,532.89					45
15999	BR					0
16000	$84.85					0
16020	$78.44					0
16025	$180.39					0
16030	$204.78					0
16035	$507.07					15
16036	$169.17					15
17000	$82.89					0
17003	$14.98					0
17004	$273.09					0
17106	$506.25					15
17107	$1,000.32					15
17108	$1,744.68					15
17110	$73.95					0
17111	$84.54					0
17250	$65.82					0
17260	$154.40					0
17261	$195.02					15
17262	$260.84					15
17263	$310.42					15
17264	$349.42					15
17266	$426.63					15
17270	$203.16					0
17271	$247.84					15
17272	$304.74					15
17273	$356.73					15
17274	$447.74					15
17276	$517.64					15
17280	$215.33					0
17281	$291.72					15
17282	$354.30					15
17283	$436.37					15
17284	$519.26					15
17286	$685.03					15
17311		$1,224.05	$674.88			0
17312		$736.35	$359.18			0
17313		$1,117.36	$604.86			0
17314		$681.98	$332.15			0
17315		$145.15	$94.04			0
17340	$78.82					0
17360	$130.83					0
17380	$60.96					0
17999	BR					0
19000	$96.70					0
19001	$52.82					0
19020	$378.67					15
19030	$139.05					0
19081		$1,311.93	$365.18			0
19082		$1,059.54	$175.86			0
19083		$1,303.03	$342.58			0
19084		$1,044.91	$165.34			0
19085		$1,970.23	$400.30			0
19086		$1,572.42	$183.48			0
19100	$151.97					0
19101	$434.74					15
19105		$3,579.97	$345.92
19110	$525.75					15
19112	$462.37					15
19120	$615.96					15
19125	$695.60					15
19126	$348.61					0
19260	$1,504.13					90
19271	$2,468.70					90
19272	$2,550.77					90
19281		$478.00	$208.58			0
19282		$331.12	$100.78			0
19283		$541.76	$210.64			0
19284		$396.26	$101.48			0
19285		$910.15	$178.66			0
19286		$761.56	$86.97			0
19287		$1,679.50	$285.06			0
19288		$1,338.84	$130.21			0
19296		$9,356.25	$411.85			0
19297	$188.98					0
19298		$3,534.42	$663.93			0
19300		$927.62	$651.23			90
19301	$711.75					90
19302	$1,515.58					90
19303	$1555.36					90
19304	$944.70					90
19305	$1881.54					90
19306	$1954.90					90
19307	$1965.10					90
19316	$1,823.49					45
19318	$2,028.28					45
19324	$702.91					45
19325	$1,105.95					45
19328	$721.60					15
19330	$877.62					45
19340	$1,203.47					0
19342	$1,704.86					45
19350	$1,216.47					15
19355	$970.26					15
19357	$2,294.80					90
19361	$3,021.28					90
19364	$3,526.72					90
19366	$2,881.51					0
19367	$3,565.72					90
19368	$4,071.98					90
19369	$3,876.96					90
19370	$1,093.78					15
19371	$1,332.68					45
19380	$1,331.87					90
19396	$297.42					0
19499	BR					0
20005	$382.75					15
20100	$1,201.15					10
20101	$379.48					10
20102	$464.91					10
20103	$625.73					10
20150	$2,011.71					15
20200	$203.96					15
20205	$334.79					15
20206	$153.57					0
20220	$175.43					15
20225	$292.38					15
20240	$386.81					15
20245	$569.63					15
20250	$764.67					45
20251	$868.68					45
20500	$106.25					0
20501	$72.74					0
20520	$196.65					0
20525	$430.68					15
20526		$119.03	$91.94			0
20527		$147.62	$116.43			0
20550	$85.57					0
20551		$119.03	$91.94			0
20552		$119.03	$91.94			0
20553		$119.03	$91.94			0
20555			$593.47			0
20600	$88.58					0
20604		$143.81	$93.81			0
20605	$88.58					0
20606		$159.22	$107.16			0
20610	$85.57					0
20611		$183.11	$125.58			0
20612		$108.48	$73.91			0
20615	$187.54					15
20650	$247.84					0
20660