CPT Codes and Fees


TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2014

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, 2014

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

20605

$88.58

 

 

 

 

0

20610

$85.57

 

 

 

 

0

20612

 

$108.48

$73.91

 

 

0

20615

$187.54

 

 

 

 

15

20650

$247.84

 

 

 

 

0

20660

$320.17

 

 

 

 

0

20661

$640.33