CPT Codes and Fees

TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2012

Surgery, Part 1 (10000-29999) (revised May 3, 2012)

Surgery, Part 2 (30000-49999) (revised May 3, 2012)

Surgery, Part 3 (50000-69999) (revised May 3, 2012)

Assistant Surgery Guide (revised August 11, 2011)

Radiology (revised May 3, 2012)

Pathology and Laboratory (revised May 3, 2012)

Evaluation & Management, Medicine, Physical Therapy (revised May 3, 2012)

Commission Assigned Codes

N.C. Industrial Commission Assigned Codes

Surgery, Part 3

Effective January 1, 2012

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)	TC (26)	FUD
50010	$1,537.46					45
50020	$1,509.01					45
50021	$416.20					45
50040	$1,438.29					45
50045	$1,895.82					45
50060	$2,364.69					45
50065	$2,621.47					45
50070	$2,506.09					45
50075	$3,196.79					45
50080	$2,042.08					45
50081	$2,775.87					45
50100	$1,999.83					45
50120	$2,029.90					45
50125	$2,075.41					45
50130	$2,259.06					45
50135	$2,744.19					90
50200	$357.97					0
50205	$1,439.94					45
50220	$2,290.74					90
50225	$2,770.19					90
50230	$3,041.59					90
50234	$2,949.78					90
50236	$3,208.18					90
50240	$2,834.37					90
50250	$2,287.82					90
50280	$1,994.14					90
50290	$1,773.93					90
50300	$1,823.49					0
50320	$2,970.89					90
50323	BR					0
50325	BR					0
50327	$424.25					0
50328	$371.43					0
50329	$354.83					0
50340	$1,843.00					90
50360	$4,080.10					90
50365	$4,964.23					90
50370	$1,758.48					90
50380	$2,104.66					90
50382		$3,047.81	$580.67			0
50384		$2,942.63	$528.66			0
50385		$2,539.05	$468.63			0
50386		$1,641.70	$354.84			0
50387		$1,473.62	$210.26			0
50389		$1,007.28	$115.55			0
50390	$338.00					0
50391		$274.10	$205.50			0
50392	$545.51					0
50393	$678.85					0
50394	$89.86					0
50395	$580.45					0
50396	$178.27					0
50398	$156.02					0
50400	$2,479.27					90
50405	$3,105.78					90
50500	$2,415.89					90
50520	$2,069.72					45
50525	$2,621.47					45
50526	$2,368.75					90
50540	$2,551.60					90
50541	$1,664.27					90
50542	$2,119.80					90
50543	$2,675.05					90
50544	$2,296.12					0
50545	$2,600.11					90
50546	$2,124.77					90
50547	$2,721.10					90
50548	$2,498.62					90
50549	BR					90
50551	$610.28					0
50553	$600.51					0
50555	$876.80					15
50557	$886.56					0
50559	$637.90					15
50561	$993.00					0
50562	$1,124.16					90
50570	$863.80					0
50572	$1,376.55					0
50574	$1,413.12					15
50575	$1,868.19					0
50576	$1,534.21					15
50578	$1,214.04					15
50580	$1,210.79					0
50590	$1,538.26					90
50592		$11,282.46	$763.21			10
50593		$8,956.96	$906.28			10
50600	$1,914.50					45
50605	$1,606.53					45
50610	$2,080.27					45
50620	$2,004.71					45
50630	$2,081.09					45
50650	$2,222.49					90
50660	$2,427.26					90
50684	$97.52					0
50686	$147.89					0
50688	$120.26					0
50690	$116.20					0
50700	$2,083.53					90
50715	$2,268.00					45
50722	$2,019.34					90
50725	$2,298.05					90
50727	$1,010.88					45
50728	$1,487.07					45
50740	$2,375.26					90
50750	$2,509.33					90
50760	$2,393.95					90
50770	$2,606.85					90
50780	$2,416.69					90
50782	$2,504.47					90
50783	$2,578.40					90
50785	$2,709.23					90
50800	$2,167.22					90
50810	$2,417.51					90
50815	$2,981.46					90
50820	$3,073.29					90
50825	$4,432.77					90
50830	$3,931.41					90
50840	$2,459.76					90
50845	$2,608.48					45
50860	$1,948.64					90
50900	$1,767.42					45
50920	$1,778.79					45
50930	$2,352.50					45
50940	$1,825.12					45
50945	$1,760.56					90
50947	$2,801.09					90
50948	$2,561.05					90
50949	BR					90
50951	$589.14					0
50953	$620.02					0
50955	$728.91					15
50957	$728.11					15
50959	$606.20					15
50961	$679.35					0
50970	$962.12					0
50972	$662.27					0
50974	$1,262.80					15
50976	$1,206.73					15
50978	$717.54					15
50980	$780.93					0
51020	$1,006.00					45
51030	$825.61					45
51040	$767.91					45
51045	$859.74					45
51050	$1,025.51					45
51060	$1,435.88					45
51065	$1,181.53					45
51080	$828.04					45
51100		$123.25	$76.18			0
51101		$250.10	$100.20			0
51102		$652.88	$480.52			0
51500	$1,299.37					45
51520	$1,344.05					45
51525	$1,831.63					45
51530	$1,609.79					45
51535	$1,513.07					45
51550	$1,960.83					45
51555	$2,494.70					45
51565	$2,803.50					45
51570	$2,957.89					45
51575	$3,967.15					90
51580	$3,765.62					90
51585	$4,477.47					90
51590	$4,279.20					90
51595	$5,309.59					90
51596	$5,552.54					90
51597	$5,187.70					90
51600	$91.01					0
51605	$112.15					0
51610	$146.26					0
51700	$86.13					0
51701		$112.89	$52.22			0
51702		$177.10	$57.14			0
51703		$246.85	$153.74			0
51705	$107.26					0
51710	$159.28					0
51715	$499.76					0
51720	$189.33					0
51725	$197.47			$29.62	$167.85	0
51726	$234.84			$35.23	$199.61	0
51727	$532.32			$331.48	$102.47	0
51728	$532.08			$333.44	$101.35	0
51729	$573.32			$337.37	$120.38	0
51736	$97.52			$14.63	$82.89	0
51741	$167.40			$25.11	$142.29	0
51784	$201.53			$30.23	$171.30	0
51785	$201.53			$30.23	$171.30	0
51792	$235.66			$35.35	$200.31	0
51797	$200.71			$30.11	$170.60	0
51798	$37.02					0
51800	$2,223.30					90
51820	$1,903.93					90
51840	$1,494.39					45
51841	$1,816.98					45
51845	$1,542.32					45
51860	$1,474.07					45
51865	$1,955.13					45
51880	$952.38					45
51900	$1,827.55					45
51920	$1,412.32					45
51925	$1,933.19					45
51940	$3,445.45					45
51960	$3,324.39					90
51980	$1,398.49					45
51990	$1,361.10					90
51992	$1,485.84					90
51999	BR					0
52000	$261.66					0
52001	$253.67					15
52005	$356.73					0
52007	$455.88					15
52010	$385.18					0
52204	$370.55					15
52214	$508.70					0
52224	$471.31					0
52234	$728.11					15
52235	$971.89					15
52240	$1,587.83					15
52250	$576.14					15
52260	$472.13					15
52265	$336.42					0
52270	$570.46					0
52275	$634.64					0
52276	$663.09					0
52277	$858.11					0
52281	$398.98					0
52282	$765.31					0
52283	$411.18					0
52285	$511.95					0
52290	$542.83					0
52300	$689.91					0
52301	$695.97					0
52305	$689.09					0
52310	$452.62					0
52315	$724.85					0
52317	$1,006.83					15
52318	$1,332.68					15
52320	$745.16					0
52325	$1,026.33					0
52327	$693.97					0
52330	$665.52					0
52332	$471.31					0
52334	$637.90					0
52341	$648.65					45
52342	$702.36					45
52343	$778.04					45
52344	$831.75					45
52345	$886.29					45
52346	$997.14					45
52347	$545.14					15
52351	$661.94					45
52352	$818.48					45
52353	$948.22					45
52354	$830.08					45
52355	$974.87					45
52400	$1,158.79					45
52402	$554.18					0
52450	$941.01					45
52500	$1,190.47					90
52601	$1,823.49					90
52630	$1,219.73					90
52640	$971.89					90
52647	$1,500.90					45
52648	$1,597.59					45
52649			$1,915.49			90
52700	$752.48					45
53000	$294.17					15
53010	$510.32					45
53020	$203.16					0
53025	$151.14					15
53040	$616.76					45
53060	$243.78					15
53080	$771.99					0
53085	$1,284.74					15
53200	$289.29					15
53210	$1,435.88					45
53215	$1,921.01					45
53220	$887.37					45
53230	$1,325.36					45
53235	$1,004.02					45
53240	$810.18					15
53250	$761.42					15
53260	$319.36					15
53265	$388.43					15
53270	$299.03					15
53275	$528.20					15
53400	$1,506.58					45
53405	$1,887.68					45
53410	$1,889.31					45
53415	$2,373.64					45
53420	$1,886.05					45
53425	$1,909.62					90
53430	$1,779.61					90
53431	$2,045.39					90
53440	$1,923.44					90
53442	$1,058.82					45
53444	$1,466.68					45
53445	$2,347.62					90
53446	$1,354.37					90
53447	$1,682.09					45
53448	$2,443.59					90
53449	$1,370.87					45
53450	$662.27					45
53460	$716.72					45
53500	$1,423.15					90
53502	$954.01					45
53505	$967.81					45
53510	$1,292.05					45
53515	$1,698.35					45
53520	$1,101.09					45
53600	$121.09					0
53601	$99.95					0
53605	$136.52					0
53620	$164.14					0
53621	$135.71					0
53660	$78.01					0
53661	$76.38					0
53665	$87.76					0
53850	$1,126.22					45
53852	$1,177.08					45
53855		$1,245.15	$160.80			0
53860		$2,884.25	$459.30			90
53899	BR					0
54000	$166.59					0
54001	$234.04					0
54015	$471.31					15
54050	$122.69					0
54055	$140.57					0
54056	$134.09					0
54057	$219.41					0
54060	$238.90					15
54065	$377.87					15
54100	$199.90					15
54105	$350.24					15
54110	$1,227.84					45
54111	$1,738.17					45
54112	$2,032.33					45
54115	$771.16					45
54120	$1,227.04					45
54125	$1,902.31					90
54130	$2,619.04					90
54135	$3,341.44					90
54150	$182.02					15
54160	$320.99					15
54161	$421.74					15
54162	$427.02					15
54163	$401.33					15
54164	$352.03					15
54200	$104.01					0
54205	$962.12					15
54220	$312.85					0
54230	$208.84					0
54231	$272.23					0
54235	$126.77					0
54240	$180.39			$27.06	$153.33	15
54250	$236.47			$35.47	$201.00	0
54300	$1,329.42					45
54304	$1,626.02					45
54308	$1,369.24					45
54312	$1,760.11					45
54316	$2,134.72					45
54318	$1,418.80					45
54322	$1,560.20					45
54324	$2,066.47					45
54326	$1,978.69					45
54328	$1,999.83					90
54332	$2,237.92					90
54336	$2,929.44					90
54340	$1,142.52					45
54344	$2,464.65					90
54348	$2,187.53					90
54352	$3,124.48					90
54360	$1,440.76					45
54380	$1,713.80					45
54385	$1,965.69					45
54390	$2,708.43					45
54400	$1,530.95					45
54401	$1,836.49					45
54405	$2,328.93					45
54406	$1,333.52					45
54408	$1,406.24					45
54410	$1,667.63					45
54411	$1,816.26					45
54415	$988.96					45
54416	$1,292.49					45
54417	$1,598.58					45
54420	$1,448.08					45
54430	$1,292.05					45
54435	$763.85					45
54440	$1,114.09					45
54450	$140.57					15
54500	$137.34					0
54505	$413.63					15
54512	$1,032.93					15
54520	$789.79					15
54522	$1,173.79					15
54530	$1,200.22					45
54535	$1,565.89					45
54550	$988.14					45
54560	$1,385.49					45
54600	$876.80					45
54620	$625.70					45
54640	$1,124.66					45
54650	$1,470.02					45
54660	$641.15					45
54670	$810.18					45
54680	$1,540.72					45
54690	$1,323.22					90
54692	$1,362.42					90
54699	BR					90
54700	$336.42					15
54800	$335.62					0
54830	$672.03					15
54840	$768.73					45
54860	$872.74					45
54861	$1,236.78					45
54900	$1,684.54					90
54901	$2,311.88					90
55000	$143.83					0
55040	$784.98					45
55041	$1,161.22					45
55060	$732.97					45
55100	$208.84					0
55110	$685.84					15
55120	$516.01					15
55150	$943.44					15
55175	$736.22					15
55180	$1,326.19					15
55200	$478.62					15
55250	$456.68					45
55300	$485.93					15
55400	$1,155.54					45
55450	$511.95					15
55500	$752.48					45
55520	$698.03					15
55530	$833.74					45
55535	$832.92					45
55540	$936.93					45
55550	$778.99					90
55559	BR					90
55600	$815.04					45
55605	$1,032.82					45
55650	$1,446.45					45
55680	$719.97					45
55700	$239.72					0
55705	$607.82					15
55706			$776.99			10
55720	$866.25					15
55725	$1,040.14					45
55801	$2,272.06					90
55810	$3,052.16					90
55812	$3,393.46					90
55815	$4,187.36					90
55821	$2,074.58					90
55831	$2,251.74					90
55840	$2,952.21					90
55842	$3,268.31					90
55845	$4,043.53					90
55860	$1,600.85					45
55862	$2,250.92					90
55865	$3,598.22					90
55866	$3,153.10					90
55870	$302.35					0
55873	$2,146.50					45
55899	BR					0
55920			$830.47			0
55970	BR					90
55980	BR					90
56405	$170.65					0
56420	$169.02					0
56440	$431.49					15
56441	$283.60					15
56501	$160.08					15
56515	$349.42					15
56605	$122.69					0
56606	$62.56					0
56620	$1,050.70					45
56625	$1,358.67					45
56630	$1,929.13					90
56631	$2,679.98					90
56632	$3,195.99					90
56633	$2,246.86					90
56634	$2,997.71					90
56637	$3,335.76					90
56640	$3,202.50					90
56700	$337.24					15
56740	$514.38					15
56800	$529.01					15
56805	$2,134.72					90
56810	$523.32					15
56820		$230.47	$160.62			0
56821		$299.05	$221.45			0
57000	$391.67					15
57010	$639.53					15
57020	$170.65					0
57022	$318.62					45
57023	$318.62					15
57061	$160.91					15
57065	$468.88					15
57100	$126.77					0
57105	$255.98					15
57106	$633.94					15
57107	$2,202.61					45
57109	$2,600.34					45
57110	$1,703.23					45
57111	$2,604.97					45
57112	$2,781.45					45
57120	$1,097.01					45
57130	$401.43					15
57135	$363.24					15
57150	$89.38					0
57155	$736.26					45
57156		$298.23	$204.85			0
57160	$90.21					0
57170	$97.52					0
57180	$164.96					15
57200	$510.32					15
57210	$636.27					15
57220	$659.84					15
57230	$704.54					15
57240	$988.14					45
57250	$919.87					45
57260	$1,300.17					45
57265	$1,346.50					45
57267	$555.21					0
57268	$1,052.33					45
57270	$1,132.77					45
57280	$1,349.73					45
57282	$1,342.42					45
57283	$1,324.00					90
57284	$1,680.92					90
57285			$1,200.49			90
57287	$1,359.17					15
57288	$1,810.49					45
57289	$1,147.40					45
57291	$1,023.08					90
57292	$1,502.52					90
57295	$945.97					90
57300	$1,176.65					45
57305	$1,294.48					45
57307	$1,286.37					90
57308	$1,221.81					90
57310	$815.86					45
57311	$996.26					90
57320	$1,315.62					45
57330	$1,559.40					45
57335	$1,255.49					90
57400	$91.83					0
57410	$74.76					0
57415	$99.95					15
57420		$240.65	$170.79			15
57421		$314.31	$236.71			0
57423			$1,659.47			90
57425	$1,771.64					90
57426			$1,637.06			90
57452	$130.83					0
57454	$198.28					0
57455		$289.00	$214.92			0
57456		$273.07	$201.10			0
57460	$387.61					0
57461		$640.80	$371.32			0
57500	$122.69					0
57505	$136.52					0
57510	$186.90					15
57511	$214.53					0
57513	$350.24					0
57520	$591.57					15
57522	$536.32					15
57530	$641.15					45
57531	$2,856.33					45
57540	$1,022.25					45
57545	$895.50					45
57550	$901.99					45
57555	$1,460.25					45
57556	$1,357.05					45
57700	$447.74					45
57720	$525.75					45
57800	$99.15					0
58100	$109.70					0
58110		$104.11	$86.87			0
58120	$411.18					15
58140	$1,272.54					45
58145	$1,240.04					45
58146	$2,107.96					90
58150	$1,800.75					45
58152	$2,083.53					45
58180	$1,505.76					45
58200	$2,655.61					90
58210	$3,330.88					90
58240	$4,596.93					90
58260	$1,660.15					45
58262	$1,791.81					45
58263	$1,960.83					45
58267	$2,032.33					45
58270	$1,829.18					45
58275	$1,994.14					45
58280	$1,983.57					45
58285	$2,322.44					90
58290	$2,113.11					90
58291	$2,321.68					90
58292	$2,458.34					90
58293	$2,556.79					90
58294	$2,265.01					90
58300	$140.57					0
58301	$93.44					0
58321	$130.03					0
58322	$143.83					0
58323	$30.88					0
58340	$113.77					0
58345	$634.64					15
58346	$785.00					15
58350	$131.63					0
58353	$438.14					15
58356		$1,031.42	$728.84			10
58400	$901.19					45
58410	$971.06					45
58520	$846.74					45
58540	$1,176.65					45
58545	$1,686.01					90
58546	$2,135.73					90
58550	$1,657.52					10
58552	$1,641.33					90
58553	$2,127.22					90
58554	$2,105.34					90
58555	$416.45					0
58558	$543.61					0
58559	$695.89					0
58560	$770.03					0
58561	$1,082.45					0
58562	$541.82					0
58563	$718.20					0
58565		$4,186.41	$889.13			90
58570			$1,646.29			90
58571			$1,806.04			90
58572			$2,044.24			90
58573			$2,310.83			90
58578	BR					10
58579	BR					10
58600	$737.03					45
58605	$603.77					45
58611	$87.76					0
58615	$529.81					45
58660	$1,261.52					90
58661	$1,284.29					10
58662	$1,288.08					90
58670	$717.83					90
58671	$738.74					90
58672	$1,389.86					90
58673	$1,480.71					90
58679	BR					90
58700	$977.57					45
58720	$1,097.01					45
58740	$991.38					45
58750	$1,209.98					45
58752	$1,154.71					45
58760	$981.63					45
58770	$975.95					45
58800	$512.75					15
58805	$945.07					45
58820	$532.26					15
58822	$776.04					45
58823	$416.20					45
58825	$772.79					45
58900	$851.60					45
58920	$1,042.59					45
58925	$1,035.25					45
58940	$1,039.33					45
58943	$2,360.64					45
58950	$2,020.96					90
58951	$3,088.72					90
58952	$3,151.29					90
58953	$3,538.98					90
58954	$3,847.05					90
58956	$2,565.64					90
58960	$1,856.80					90
58970	$424.30					0
58974	$284.53					0
58976	$460.66					0
58999	BR					0
59000	$180.39					0
59001	$322.31					0
59012	$476.19					15
59015	$265.72					15
59020	$161.71			$24.26	$137.45	0
59025	$91.01			$13.65	$77.36	0
59030	$280.35					0
59050	$134.89					0
59051	$108.40					0
59070	$782.99					0
59072	$947.93					0
59074		$746.46	$588.91			0
59076	$947.93					0
59100	$807.73					45
59120	$1,191.28					45
59121	$984.06					45
59130	$1,084.84					45
59135	$1,790.98					45
59136	$1,192.10					45
59140	$755.73					45
59150	$869.48					45
59151	$1,228.67					45
59160	$443.68					15
59200	$105.64					0
59300	$266.54					0
59320	$340.48					0
59325	$544.44					15
59350	$679.35					45
59400	$2,877.45					45
59409	$1,820.24					0
59410	$1,979.52					45
59412	$234.84					0
59414	$221.04					0
59425	$553.38					0
59426	$947.50					0
59430	$188.53					45
59510	$3,244.75					45
59514	$2,109.52					45
59515	$2,268.80					45
59525	$984.06					0
59610	BR					0
59612	BR					0
59614	BR					0
59618	BR					0
59620	BR					0
59622	BR					0
59812	$536.32					15
59820	$596.45					15
59821	$557.46					15
59830	$821.55					15
59840	$490.01					15
59841	$557.46					15
59850	$754.10					45
59851	$788.24					45
59852	$1,056.39					45
59855	$650.90					45
59856	$981.63					45
59857	$1,193.73					45
59866	$546.29					0
59870	$559.08					15
59871	$281.66					15
59897	BR
59898	BR					90
59899	BR					0
60000	$159.73					0
60100	$139.05					0
60200	$1,175.85					15
60210	$1,524.46					45
60212	$1,946.21					45
60220	$1,461.88					45
60225	$1,757.67					45
60240	$2,081.09					45
60252	$2,306.99					45
60254	$2,836.81					90
60260	$1,385.49					45
60270	$2,412.63					45
60271	$2,088.41					45
60280	$999.51					45
60281	$1,034.45					45
60300		$191.11	$93.34			90
60500	$2,129.85					45
60502	$2,436.20					45
60505	$2,627.16					45
60512	$540.38					45
60520	$2,329.76					45
60521	$2,485.76					45
60522	$2,797.81					45
60540	$2,198.93					45
60545	$2,591.40					45
60600	$2,181.05					45
60605	$2,299.68					45
60650	BR					90
60659	BR					90
60699	BR					0
61000	$209.65					0
61001	$188.53					0
61020	$218.59					0
61026	$255.30					0
61050	$188.26					0
61055	$272.39					0
61070	$94.12					0
61105	$1,196.16					0
61107	$804.49					0
61108	$1,815.38					15
61120	$1,209.16					15
61140	$2,298.88					45
61150	$2,460.59					45
61151	$1,068.58					15
61154	$2,479.27					90
61156	$2,497.96					90
61210	$906.05					0
61215	$1,511.44					0
61250	$1,510.64					90
61253	$1,791.81					90
61304	$3,708.74					90
61305	$4,271.88					90
61312	$3,550.29					90
61313	$3,541.35					90
61314	$3,844.45					90
61315	$3,994.77					90
61316	$161.77					0
61320	$3,378.83					90
61321	$3,684.37					90
61322	$3,372.61					90
61323	$3,496.97					90
61330	$2,233.04					90
61332	$3,678.69					90
61333	$3,729.05					90
61334	$2,489.02					90
61340	$2,089.21					90
61343	$4,592.85					90
61345	$3,530.78					90
61440	$3,587.68					90
61450	$3,538.92					90
61458	$4,224.75					90
61460	$4,092.29					90
61470	$2,747.42					90
61480	$2,494.70					90
61490	$2,169.65					90
61500	$2,936.76					90
61501	$2,467.90					90
61510	$4,004.54					90
61512	$4,232.06					90
61514	$3,894.82					90
61516