CPT Codes and Fees


TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2013

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, 2013

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

 

32201

$492.40

 

 

 

 

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

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

 

33332

$2,966.83

 

 

 

 

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

 

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