Buck Lattimore, Chairman
Thomas J. Bolch, Commissioner
Laura K. Mavretic, Commissioner
Renée C. Riggsbee, Commissioner
Christopher Scott, Commissioner
Dianne C. Sellers, Commissioner
| Michael F. Easley, Governor Buck Lattimore, Chairman |
|
Bernadine S. Ballance,
Commissioner Thomas J. Bolch, Commissioner Laura K. Mavretic, Commissioner Renée C. Riggsbee, Commissioner Christopher Scott, Commissioner Dianne C. Sellers, Commissioner |
North Carolina
Industrial Commission
MEMORANDUM
| TO: | All Workers’ Compensation Payors, Medical Bill
Processors, and Medical Providers |
| FROM: | Jennifer
Gudac, Chief Medical Fee Examiner |
| DATE: | June 27, 2002 |
| SUBJECT: | New Fee Assignments |
The North Carolina Industrial Commission has been asked to review medical fees assigned to the CPT codes that were new in 1997. When these fifty-four codes were released by the American Medical Association, the Industrial Commission assigned fees based on Medicare plus an additional factor. However, the factors used were incorrect. The following fees are being reassigned to these codes and will become effective for services rendered on or after August 1, 2002. There will be no retroactive reconsiderations.
| CPT CODE | PROCEDURE | FACTOR | MCR TC (27) | MCR PC (26) | MCR TOTAL | TC (27) | PC (26) | TOTAL |
| 11010 | DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL | 2.06 | $311.84 | $642.39 | ||||
| 11011 | DEBRIDEMENT OF MUSCULOSKELETAL | 2.06 | $371.73 | $765.76 | ||||
| 11012 | DEBRIDEMENT OF MUSCULOSKELETAL | 2.06 | $516.65 | $1,064.30 | ||||
| 11720 | DEBRIDEMENT OF NAIL | 2.06 | $24.24 | $49.93 | ||||
| 11721 | DEBRIDEMENT OF NAIL | 2.06 | $40.89 | $84.23 | ||||
| 15756 | MICROVASCULAR FREE MUSCLE FLAP | 2.06 | $2,438.34 | $5,022.98 | ||||
| 15757 | MICROVASCULAR FREE SKIN FLAP | 2.06 | $2,438.34 | $5,022.98 | ||||
| 15758 | MICROVASCULAR FREE FASCIAL FLAP | 2.06 | $2,438.34 | $5,022.98 | ||||
| 20150 | EXCISION OF EPIPHYSEAL BAR | 2.06 | $976.56 | $2,011.71 | ||||
| 20956 | MICROVASCULAR ILIAC CREST BONE GRAFT | 2.06 | $2,454.64 | $5,056.56 | ||||
| 20957 | MICROVASCULAR METATARSAL BONE GRAFT | 2.06 | $2,543.01 | $5,238.60 | ||||
| 24149 | RADICAL RESECTION AND RELEASE OF ELBOW JOINT | 2.06 | $995.41 | $2,050.54 | ||||
| 24341 | MUSCLE OR TENDON REPAIR | 2.06 | $550.48 | $1,133.99 | ||||
| 26185 | SESAMOIDECTOMY OF THUMB OR FINGER | 2.06 | $349.09 | $719.13 | ||||
| 26546 | REPAIR OF METACARPAL OF PHALANX NON-UNION | 2.06 | $638.65 | $1,315.62 | ||||
| 26551 | MICROVASCULAR TOE-TO-HAND | 2.06 | $3,328.01 | $6,855.70 | ||||
| 26553 | MICROVASCULAR TOE-TO-HAND TRANSFER | 2.06 | $3,304.91 | $6,808.11 | ||||
| 26554 | MICROVASCULAR TOE-TO-HAND TRANSFER | 2.06 | $3,943.18 | $8,122.95 | ||||
| 26556 | MICROVASCULAR TOE JOINT TRANSFER | 2.06 | $3,361.10 | $6,923.87 | ||||
| 27036 | RELEASE OF HIP FLEXION CONTRACTURE | 2.06 | $901.14 | $1,856.35 | ||||
| 32491 | EXCISION OF EMPHTSEMATOUS LUNG | 2.06 | by report | by report | ||||
| 37250 | INTRAVASCULAR ULTRASOUND, NON-CORONARY | 2.06 | $82.84 | $170.65 | ||||
| 37251 | INTRAVASCULAR ULTRASOUND, NON-CORONARY | 2.06 | $63.16 | $130.11 | ||||
| 43496 | MICROVASCULAR FREE JEJUNUM TRANSFER | 2.06 | by report | by report | ||||
| 49021 | PRECUTANEOUS DRAINAGE OF PERITONEAL ABSCESS | 2.06 | $436.19 | $898.55 | ||||
| 49906 | MICROVASCULAR FREE OMENTAL FLAP | 2.06 | by report | by report | ||||
| 52301 | CYSTOURETHROSCORY FOR RESECTION OF ECTOPIC URETEROCELE | 2.06 | $337.85 | $695.97 | ||||
| 59866 | MULTIFETAL PREGNANCY REDUCTION | 2.06 | $265.19 | $546.29 | ||||
| 61586 | RESECTION OF NASOPHARYNX | 2.06 | $1,705.98 | $3,514.32 | ||||
| 68801 | DILATION OF LACRIMAL PUNCTUM | 2.06 | $48.61 | $100.14 | ||||
| 68810 | PROBING OF NASOLACRIMAL DUCT | 2.06 | $67.53 | $139.11 | ||||
| 68811 | PROBING OF NASOLACRIMAL DUCT | 2.06 | $139.69 | $287.76 | ||||
| 68815 | PROBING OF NASOLACRIMAL DUCT | 2.06 | $183.77 | $378.57 | ||||
| 75945 | INTRAVASCULAR ULTRASOUND, NON-CORONARY | 1.96 | $139.28 | $16.02 | $155.29 | $272.99 | $31.40 | $304.39 |
| 75946 | INTRAVASCULAR ULTRASOUND, NON-CORONARY | 1.96 | $69.79 | $16.02 | $85.81 | $136.79 | $31.40 | $168.19 |
| 80197 | TACROLIMUS DRUG ASSAY | 1.58 | by report | by report | ||||
| 82523 | N TELOPEPTIDE TESTING | 1.58 | by report | by report | ||||
| 83902 | MOLECULAR DIAGNOSTICS | 1.58 | by report | by report | ||||
| 84484 | TROPONIN ANALYTE CHEMISTRY | 1.58 | by report | by report | ||||
| 90875 | PSYCHOPHYSIOLOGICAL THERAPY WITH BIOFEEDBACK 20-30 MIN. | 1.58 | $45.06 | $71.19 | ||||
| 90876 | PSYCHOPHYSIOLOGICAL THERAPY WITH BIOFEEDBACK 45-50 MIN. | 1.58 | $70.09 | $110.74 | ||||
| 92240 | INDOCYANIN-GREEN ANGIOGRAPHY WITH INTERP/REPORT | 1.58 | $31.64 | $51.92 | $83.57 | $49.99 | $82.03 | $132.02 |
| 92548 | COMPUTERIZED DYNAMIC POSTUROGRAPHY | 1.58 | $45.56 | $29.79 | $75.35 | $71.98 | $47.07 | $119.05 |
| 92978 | INTRAVASCULAR ULTRASOUND CORONARY | 1.58 | $139.28 | $88.36 | $227.63 | $220.06 | $139.61 | $359.67 |
| 92979 | INTRAVASCULAR ULTRASOUND CORONARY | 1.58 | $69.79 | $70.69 | $140.48 | $110.27 | $111.69 | $221.96 |
| 93303 | TRANSTHORACIC ECHOCARDIOGRAPHY, CONGENITAL | 1.58 | $118.31 | $71.57 | $189.89 | $186.93 | $113.08 | $300.01 |
| 93304 | TRANSTHORACIC ECHOCARDIOGRAPHY, CONGENITAL | 1.58 | $59.54 | $44.47 | $104.01 | $94.07 | $70.26 | $164.33 |
| 93315 | TRANSEOPHAGEAL ECHOCARDIOGRAPHY, CONGENITAL | 1.58 | $116.71 | $127.49 | $244.20 | $184.40 | $201.43 | $385.83 |
| 93316 | TRANSEOPHAGEAL ECHOCARDIOGRAPHY, CONGENITAL | 1.58 | $50.33 | $79.52 | ||||
| 93317 | TRANSEOPHAGEAL ECHOCARDIOGRAPHY | 1.58 | $116.71 | $76.85 | $193.56 | $184.40 | $121.42 | $305.82 |
| 95921 | AUTONOMIC NERVOUS SYSTEM | 1.58 | $11.63 | $23.80 | $35.43 | $18.38 | $37.60 | $55.98 |
| 95922 | AUTONOMIC NERVOUS SYSTEM | 1.58 | $11.63 | $25.47 | $37.10 | $18.38 | $40.24 | $58.62 |
| 95923 | AUTONOMIC NERVOUS SYSTEM | 1.58 | $11.63 | $23.80 | $35.43 | $18.38 | $37.60 | $55.98 |
| 97504 | ORTHOTICS FITTING AND TRAINING EACH 15 MINUTES | 1.3 | $18.21 | $23.67 |