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 2

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
30000	$153.57					0
30020	$155.20					0
30100	$127.58					15
30110	$224.27					15
30115	$552.57					15
30117	$461.56					15
30118	$1,350.56					15
30120	$925.56					15
30124	$340.48					15
30125	$969.44					15
30130	$378.67					15
30140	$494.87					15
30150	$1,289.60					45
30160	$1,604.90					45
30200	$90.21					0
30210	$101.58					0
30220	$234.04					15
30300	$113.77					0
30310	$276.29					15
30320	$677.72					15
30400	$1,510.64					90
30410	$2,118.46					90
30420	$2,601.97					90
30430	$1,002.77					45
30435	$1,673.15					45
30450	$2,285.06					45
30460	$1,412.32					45
30462	$2,827.06					45
30465	$1,591.43					45
30520	$996.26					45
30540	$1,101.09					15
30545	$1,690.23					15
30560	$138.14					0
30580	$992.20					45
30600	$753.28					45
30620	$1,036.88					45
30630	$1,023.08					45
30801	$117.01					0
30802	$229.15					15
30901	$138.95					0
30903	$186.90					0
30905	$293.34					0
30906	$276.29					0
30915	$912.56					15
30920	$1,360.30					15
30930	$150.34					15
30999	BR					0
31000	$120.26					0
31002	$182.02					0
31020	$427.43					45
31030	$999.51					45
31032	$1,111.64					45
31040	$1,314.80					90
31050	$861.37					45
31051	$1,168.54					45
31070	$681.78					45
31075	$1,488.70					90
31080	$1,563.46					90
31081	$1,746.30					90
31084	$2,147.71					90
31085	$2,269.61					90
31086	$1,786.12					90
31087	$1,769.05					90
31090	$1,785.30					90
31200	$726.48					45
31201	$1,166.91					45
31205	$1,381.44					45
31225	$2,713.31					90
31230	$3,349.58					90
31231	$192.59					0
31233	$388.43					15
31235	$393.30					15
31237	$496.50					15
31238	$580.20					15
31239	$1,513.07					15
31240	$464.82					15
31254	$829.67					45
31255	$1,244.92					45
31256	$551.77					45
31267	$843.49					15
31276	$1,105.95					15
31287	$701.29					15
31288	$819.92					15
31290	$2,291.56					45
31291	$2,407.75					45
31292	$1,860.88					45
31293	$2,036.39					45
31294	$2,326.50					45
31295		$4,020.40	$347.01			0
31296		$7,527.32	$414.41			0
31297		$7,456.62	$339.67			0
31299	BR					0
31300	$1,945.38					90
31320	$659.84					45
31360	$2,701.11					90
31365	$3,829.83					90
31367	$2,831.12					90
31368	$3,949.27					90
31370	$2,790.50					90
31375	$2,606.85					90
31380	$2,797.01					90
31382	$2,704.37					90
31390	$3,872.08					90
31395	$4,688.75					90
31400	$1,321.30					90
31420	$1,339.19					90
31500	$238.88					0
31502	$96.70					0
31505	$81.27					0
31510	$194.22					15
31511	$244.60					0
31512	$302.28					0
31513	$383.55					0
31515	$229.98					0
31520	$329.11					0
31525	$377.87					0
31526	$458.31					0
31527	$488.38					15
31528	$393.30					0
31529	$401.43					0
31530	$548.52					0
31531	$667.15					0
31535	$560.69					15
31536	$592.39					15
31540	$737.03					15
31541	$693.15					15
31545	$760.90					0
31546	$1,157.49					0
31560	$815.86					45
31561	$975.12					45
31570	$690.72					15
31571	$667.15					15
31575	$208.02					0
31576	$352.67					15
31577	$440.43					0
31578	$515.19					0
31579	$359.18					0
31580	$1,963.26					90
31582	$2,940.84					90
31584	$2,442.71					90
31587	$1,188.04					90
31588	$1,760.93					90
31590	$947.50					90
31595	$1,127.89					90
31599	BR					0
31600	$605.39					15
31601	$744.34					15
31603	$661.47					15
31605	$608.65					15
31610	$1,144.14					15
31611	$965.38					15
31612	$162.51					0
31613	$507.07					45
31614	$1,004.37					45
31615	$316.11					0
31620		$522.08	$154.50			0
31622	$434.99					0
31623	$442.80					0
31624	$446.90					0
31625	$492.03					15
31626		$814.94	$411.32			0
31627		$2,224.84	$199.88
31628	$591.16					15
31629	$522.70					15
31630	$592.39					15
31631	$571.90					15
31632		$141.73	$110.21			0
31633		$174.77	$138.25			0
31634		$3,571.57	$412.89			0
31635	$642.78					0
31636	$478.29					0
31637	$170.27					0
31638	$534.21					0
31640	$782.53					15
31641	$793.68					15
31643	$380.75					0
31645	$462.08					0
31646	$394.35					0
31647		$444.65	$444.65			0
31648		$463.27	$463.27			0
31649		$147.37	$147.37			0
31651		$156.37	$156.37			0
31660		$445.52	$445.52			0
31661		$470.05	$470.05			0
31717	$196.09					0
31720	$124.07					0
31725	$231.75					0
31730	$364.39					0
31750	$1,405.81					45
31755	$2,189.16					45
31760	$2,538.58					45
31766	$3,668.92					45
31770	$2,849.82					45
31775	$3,019.65					45
31780	$2,622.28					45
31781	$3,062.73					45
31785	$1,970.58					45
31786	$2,834.37					45
31800	$920.68					15
31805	$1,764.99					15
31820	$602.96					15
31825	$886.56					15
31830	$620.02					15
31899	BR					0
32035	$1,057.21					45
32036	$1,166.91					45
32096			$1,594.21			90
32097			$1,594.21			90
32098			$1,498.44			90
32100	$1,694.29					90
32110	$1,844.63					90
32120	$1,513.89					90
32124	$1,743.05					90
32140	$1,951.89					90
32141	$2,033.14					90
32150	$1,809.67					90
32151	$1,700.80					90
32160	$1,287.17					90
32200	$1,572.40					45
32215	$1,399.32					45
32220	$2,657.24					45
32225	$1,904.76					45
32310	$1,879.56					90
32320	$2,960.32					90
32400	$221.06					0
32405	$275.96					0
32440	$2,999.34					90
32442	$3,387.77					90
32445	$3,482.84					90
32480	$2,701.92					90
32482	$2,836.00					90
32484	$2,913.19					90
32486	$3,122.86					90
32488	$3,350.38					90
32491	BR					0
32501	$740.86					0
32503	$3,645.66					90
32504	$4,171.01					90
32505			$1,839.91			0
32506			$310.61			0
32507			$310.61			0
32540	$1,979.52					90
32550		$1,573.90	$423.19			0
32551			$332.85			0
32552		$344.25	$305.04			10
32553		$1,107.15	$393.42			0
32554		$1,088.32	$178.07			0
32555		$1,255.32	$222.27			0
32556		$1,148.97	$243.92			0
32557		$1,855.77	$321.79			0
32560		$579.95	$209.17			0
32561		$180.41	$138.47			0
32562		$160.39	$123.95			0
32601	$706.15					0
32604	$999.51					15
32606	$969.44					15
32607			$611.16			0
32608			$750.62			0
32609			$518.23			0
32650	$1,399.32					15
32651	$1,904.76					15
32652	$2,657.24					15
32653	$1,809.67					15
32654	$1,844.63					15
32655	$2,055.08					15
32656	$2,019.34					15
32658	$1,937.27					15
32659	$1,978.69					15
32661	$1,733.28					15
32662	$2,408.57					15
32663	$2,748.25					15
32664	$1,923.44					15
32665	$2,307.80					15
32666			$1,719.44			90
32667			$310.61			0
32668			$312.23			0
32669			$2,650.75			90
32670			$3,164.74			90
32671			$3,511.02			90
32672			$3,003.23			90
32673			$2,374.11			90
32674			$426.01			90
32701		$429.88	$429.88			0
32800	$1,617.90					45
32810	$1,433.45					45
32815	$2,895.33					45
32820	$3,071.67					45
32850	BR					90
32851	$4,823.63					90
32852	$5,231.58					90
32853	$6,030.36					90
32854	$6,438.30					90
32855	BR					0
32856	BR					0
32900	$2,110.35					90
32905	$2,536.97					90
32906	$3,220.36					90
32940	$2,328.13					90
32960	$191.11					0
32997	$619.61					0
32998		$5,357.32	$544.05			0
32999	BR					0
33010	$258.86					0
33011	$230.33					0
33015	$780.10					15
33020	$1,937.27					90
33025	$1,978.69					90
33030	$2,993.65					90
33031	$2,610.10					90
33050	$1,733.28					90
33120	$4,085.80					90
33130	$2,610.91					90
33140	$2,475.65					90
33141	$539.74					0
33202	$1,455.37					90
33203	$1,498.55					90
33206	$1,092.15					45
33207	$1,283.92					45
33208	$1,164.48					45
33210	$449.97					15
33211	$457.09					15
33212	$837.80					15
33213	$800.08					15
33214	$894.93					15
33215	$588.36					90
33216	$692.41					15
33217	$717.37					15
33218	$755.73					15
33220	$668.88					15
33221			$692.49			90
33222	$816.67					15
33223	$938.56					15
33224	$958.00					0
33225	$848.68					0
33226	$922.37					0
33227			$660.72			90
33228			$689.09			90
33229			$717.44			90
33230			$745.21			90
33231			$773.55			90
33233	$377.93					15
33234	$1,048.27					15
33235	$1,041.10					15
33236	$1,237.61					45
33237	$1,747.11					45
33238	$1,942.95					45
33240	$994.63					15
33241			$441.44			90
33243	$2,410.20					45
33244	$1,374.93					45
33249	$2,359.81					45
33250	$2,423.20					45
33251	$3,098.47					90
33254	$2,536.09					90
33255	$3,056.38					90
33256	$3,647.04					90
33257			$1,105.58
33258			$1,248.09
33259			$1,629.93
33261	$2,901.02					90
33262			$718.20			90
33263			$746.54			90
33264			$774.91			0
33265	$2,536.09					90
33266	$3,468.26					90
33270		$1,190.68				90
33271		$1,001.22	$1,001.22			90
33272		$736.37	$736.37			90
33273		$811.68	$811.68			90
33282	$742.40					90
33284	$575.79					90
33300	$2,424.00					90
33305	$2,902.64					90
33310	$2,246.86					90
33315	$2,744.19					90
33320	$2,341.13					90
33321	$3,204.93					90
33322	$3,178.11					90
33330	$2,510.15					90
33335	$3,373.13					90
33361		$2,619.95	$2,619.95			0
33362		$2,866.55	$2,866.55			0
33363		$2,968.05	$2,968.05			0
33364		$3,157.30	$3,157.30			0
33365		$3,454.08	$3,454.08			0
33366		$3,886.50	$3,886.50			0
33367		$1,213.32	$1,213.32			0
33368		$1,470.28	$1,470.28			0
33369		$1,941.18	$1,941.18			0
33400	$3,857.45					90
33401	$3,801.38					90
33403	$3,878.59					90
33404	$4,593.68					90
33405	$4,674.12					90
33406	$5,565.56					90
33410	$4,154.36					90
33411	$5,498.10					90
33412	$5,646.81					90
33413	$5,970.23					90
33414	$5,411.97					90
33415	$4,401.89					90
33416	$4,468.53					90
33417	$4,925.21					90
33418		$3,780.86	$3,780.86			90
33419		$889.49	$889.49			90
33420	$3,177.30					90
33422	$4,327.13					90
33425	$4,506.72					90
33426	$4,609.93					90
33427	$5,302.28					90
33430	$5,097.49					90
33460	$3,786.75					90
33463	$4,516.47					90
33464	$4,651.38					90
33465	$4,706.63					90
33468	$4,997