Buck Lattimore, Chairman
Thomas J. Bolch, Commissioner
Laura K. Mavretic, Commissioner
Christopher Scott, Commissioner
Dianne C. Sellers, Commissioner
Pamela T. Young, Commissioner
| Michael F. Easley, Governor Buck Lattimore, Chairman |
|
Bernadine S.
Ballance,
Commissioner Thomas J. Bolch, Commissioner Laura K. Mavretic, Commissioner Christopher Scott, Commissioner Dianne C. Sellers, Commissioner Pamela T. Young, Commissioner |
North Carolina
Industrial Commission
MEMORANDUM
| TO: | All North Carolina Workers’ Compensation Medical Bill Processors and Professional Medical Service Providers |
| FROM: | Medical Fees Section |
| DATE: | February 2004 |
| SUBJECT: | 2004 CPT Codes/Update to the Workers’ Compensation Medical Fee Schedule |
The American Medical Association has released its 2004 Current Procedural Terminology (CPT Codes). As a result, the North Carolina Industrial Commission is releasing the following fees for these CPT codes. We have also deleted the codes that the American Medical Association no longer recognizes.
These codes and their associated fees become effective March 1, 2004. Effective that date, providers should no longer use the deleted codes for billing purposes.
Thank you very much for your cooperation in instituting these changes.
| NOTE: | Click the hypertext links at right to see the N.C. Industrial
Commission's complete Medical
Fee Schedule and the rest of the pertinent American Medical
Association CPT
Codes. |
2004 Updates to North Carolina Workers' Compensation Medical Fees*
|
||
|
ABBREVIATIONS: Asst Surg = assistant surgeon allowed, 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), Mod 51 Exempt =
Modifier 51 cannot be used with this code, 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 | Group | Units | Asst Surg | Mod 51 Exempt |
| 20982 | $8,135.87 | $806.08 | 0 | 3 | no | |||||
| 21685 | $1,793.13 | 90 | 3 | no | ||||||
| 22532 | $3,120.86 | 90 | 3 | no | ||||||
| 22533 | $2,923.78 | 90 | 3 | no | ||||||
| 22534 | $734.49 | 0 | 3 | no | no mod 51 | |||||
| 31632 | $141.73 | $110.21 | 0 | 3 | no | no mod 51 | ||||
| 31633 | $174.77 | $138.25 | 0 | 3 | no | no mod 51 | ||||
| 34805 | $2,452.59 | 90 | 3 | no | ||||||
| 35510 | $2,594.82 | 90 | 3 | no | ||||||
| 35512 | $2,544.18 | 90 | 3 | no | ||||||
| 35522 | $2,468.64 | 90 | 3 | no | ||||||
| 35525 | $2,353.80 | 90 | 3 | no | ||||||
| 35697 | $324.00 | 0 | 3 | no | no mod 51 | |||||
| 36555 | $645.77 | $274.82 | 0 | 3 | no | |||||
| 36556 | $615.94 | $250.02 | 0 | 3 | no | |||||
| 36557 | $1,384.36 | $604.30 | 10 | 3 | no | |||||
| 36558 | $1,359.60 | $573.34 | 10 | 3 | no | |||||
| 36560 | $2,598.24 | $719.95 | 10 | 3 | no | |||||
| 36561 | $2,573.27 | $694.28 | 10 | 3 | no | |||||
| 36563 | $3,235.97 | $721.82 | 10 | 3 | no | |||||
| 36565 | $2,074.87 | $694.28 | 10 | 3 | no | |||||
| 36566 | $2,170.62 | $744.92 | 10 | 3 | no | |||||
| 36568 | $744.13 | $199.90 | 0 | 3 | no | |||||
| 36569 | $676.77 | $188.41 | 0 | 3 | no | |||||
| 36570 | $3,320.12 | $625.50 | 10 | 3 | no | |||||
| 36571 | $2,987.04 | $623.25 | 10 | 3 | no | |||||
| 36575 | $319.46 | $98.20 | 0 | 3 | no | |||||
| 36576 | $825.50 | $399.43 | 10 | 3 | no | |||||
| 36578 | $1,051.22 | $454.02 | 10 | 3 | no | |||||
| 36580 | $592.44 | $137.73 | 0 | 3 | no | |||||
| 36581 | $1,242.10 | $423.62 | 10 | 3 | no | |||||
| 36582 | $2,334.14 | $624.88 | 10 | 3 | no | |||||
| 36583 | $1,371.30 | $629.43 | 10 | 3 | no | |||||
| 36584 | $617.63 | $138.58 | 0 | 3 | no | |||||
| 36585 | $2,935.69 | $584.07 | 10 | 3 | no | |||||
| 36589 | $344.02 | $287.45 | 10 | 3 | no | |||||
| 36590 | $732.31 | $390.74 | 10 | 3 | no | |||||
| 36595 | $1,700.82 | $393.98 | 0 | 3 | no | |||||
| 36596 | $374.43 | $95.15 | 0 | 3 | no | |||||
| 36597 | $324.10 | $127.18 | 0 | 3 | no | |||||
| 36838 | $2,396.83 | 90 | 3 | no | ||||||
| 37765 | $913.20 | 90 | 3 | no | ||||||
| 37766 | $1,114.01 | 90 | 3 | no | ||||||
| 43237 | $434.25 | 0 | 3 | no | ||||||
| 43238 | $540.01 | 0 | 3 | no | ||||||
| 47140 | $6,080.71 | 90 | 3 | no | ||||||
| 47141 | $7,373.58 | 90 | 3 | no | ||||||
| 47142 | $8,134.43 | 90 | 3 | no | ||||||
| 53500 | $1,423.15 | 90 | 3 | no | ||||||
| 57425 | $1,771.64 | 90 | 3 | no | ||||||
| 59070 | $782.99 | 0 | 3 | no | ||||||
| 59072 | $947.93 | 0 | 3 | no | ||||||
| 59074 | $746.46 | $588.91 | 0 | 3 | no | |||||
| 59076 | $947.93 | 0 | 3 | no | ||||||
| 59897 | BR | 0 | 3 | no | ||||||
| 61537 | $3,263.02 | 90 | 3 | no | ||||||
| 61540 | $3,935.40 | 90 | 3 | no | ||||||
| 61566 | $3,936.41 | 90 | 3 | no | ||||||
| 61567 | $4,519.56 | 90 | 3 | no | ||||||
| 61863 | $2,346.28 | 90 | 3 | no | ||||||
| 61864 | $563.04 | 0 | 3 | no | no mod 51 | |||||
| 61867 | $3,623.27 | 90 | 3 | no | ||||||
| 61868 | $954.50 | 0 | 3 | no | no mod 51 | |||||
| 63101 | $4,112.79 | 90 | 3 | no | ||||||
| 63102 | $4,112.79 | 90 | 3 | no | ||||||
| 63103 | $479.26 | 0 | 3 | no | no mod 51 | |||||
| 64449 | $304.96 | 10 | 3 | no | ||||||
| 64517 | $368.74 | $237.68 | 0 | 3 | no | |||||
| 64681 | $904.55 | $431.22 | 10 | 3 | no | |||||
| 65780 | $1,515.25 | 90 | 3 | no | ||||||
| 65781 | $2,326.52 | 90 | 3 | no | ||||||
| 65782 | $2,003.76 | 90 | 3 | no | ||||||
| 67912 | $1,908.80 | $826.80 | 90 | 3 | no | |||||
| 68371 | $716.92 | 10 | 3 | no | ||||||
| 70557 | $282.61 | $0.00 | $282.61 | 4 | ||||||
| 70558 | $312.29 | $0.00 | $312.29 | 4 | ||||||
| 70559 | $313.19 | $0.00 | $313.19 | 4 | ||||||
| 75998 | $132.69 | $93.77 | $38.93 | 4 | no mod 51 | |||||
| 76082 | $34.59 | $28.38 | $6.21 | 4 | no mod 51 | |||||
| 76083 | $34.59 | $28.38 | $6.21 | 4 | no mod 51 | |||||
| 76514 | $22.89 | $4.55 | $18.35 | 4 | ||||||
| 76937 | $60.76 | $29.73 | $31.03 | 4 | no mod 51 | |||||
| 76940 | $313.21 | $116.68 | $196.53 | 4 | ||||||
| 78804 | $411.19 | $305.86 | $105.33 | 4 | ||||||
| 79403 | $529.12 | $298.63 | $230.50 | 4 | ||||||
| 84156 | $8.09 | 5 | ||||||||
| 84157 | $8.09 | 5 | ||||||||
| 85055 | $59.11 | 5 | ||||||||
| 85396 | $32.63 | 5 | ||||||||
| 87269 | $25.30 | 5 | ||||||||
| 87329 | $25.30 | 5 | ||||||||
| 87660 | $44.27 | 5 | ||||||||
| 88112 | $181.27 | $81.46 | $99.81 | 5 | ||||||
| 88361 | $204.63 | $122.28 | $82.35 | 5 | ||||||
| 89220 | BR | 5 | ||||||||
| 89225 | $7.38 | 5 | ||||||||
| 89230 | BR | 5 | ||||||||
| 89235 | $12.15 | 5 | ||||||||
| 89240 | BR | 5 | ||||||||
| 89268 | BR | 5 | ||||||||
| 89272 | BR | 5 | ||||||||
| 89280 | BR | 5 | ||||||||
| 89281 | BR | 5 | ||||||||
| 89290 | BR | 5 | ||||||||
| 89291 | BR | 5 | ||||||||
| 89335 | BR | 5 | ||||||||
| 89342 | BR | 5 | ||||||||
| 89343 | BR | 5 | ||||||||
| 89344 | BR | 5 | ||||||||
| 89346 | BR | 5 | ||||||||
| 89352 | BR | 5 | ||||||||
| 89353 | BR | 5 | ||||||||
| 89354 | BR | 5 | ||||||||
| 89356 | BR | 5 | ||||||||
| 90655 | BR | 1 | no mod 51 | |||||||
| 90698 | BR | 1 | ||||||||
| 90715 | BR | 1 | ||||||||
| 90734 | BR | 1 | ||||||||
| 91110 | $1,378.53 | $1,091.67 | $286.86 | 1 | ||||||
| 95991 | $126.15 | $58.05 | 1 | |||||||
| 97755 | $43.80 | 2 | U | |||||||
| 99601 | In Full | 1 | ||||||||
| 99602 | In Full | 1 | no mod 51 |
*Effective for service dates March 1, 2004 and after.
© CPT Codes are property of American Medical Association. All Rights Reserved.