|
ABBREVIATIONS: Asst Surg = assistant surgeon allowed, BM
= bilateral modifier, 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. |
| CODE | TOTAL | OFF | FAC | TC (27) | PC (26) | FUD | Bilateral Mod (50) | Asst Surg (80,81or 82) | Mod -51 Exempt |
| 15002 | $576.72 | $398.94 | 0 | Yes | |||||
| 15003 | $127.84 | $81.78 | 0 | Yes | |||||
| 15004 | $695.48 | $493.95 | 0 | Yes | |||||
| 15005 | $215.37 | $163.54 | 0 | Yes | |||||
| 15731 | $1,927.54 | $1,742.55 | 90 | Yes | |||||
| 15830 | $2,061.34 | 90 | Yes | ||||||
| 15847 | BR | 0 | Yes | ||||||
| 17311 | $1,224.05 | $674.88 | 0 | ||||||
| 17312 | $736.35 | $359.18 | 0 | ||||||
| 17313 | $1,117.36 | $604.86 | 0 | ||||||
| 17314 | $681.98 | $332.15 | 0 | ||||||
| 17315 | $145.15 | $94.04 | 0 | ||||||
| 19105 | $3,579.97 | $345.92 | 0 | Yes | |||||
| 19300 | $927.62 | $651.23 | 90 | Yes | |||||
| 19301 | $711.75 | 90 | Yes | Yes | |||||
| 19302 | $1,515.58 | 90 | Yes | Yes | |||||
| 19303 | $1,555.36 | 90 | Yes | Yes | |||||
| 19304 | $944.70 | 90 | Yes | Yes | |||||
| 19305 | $1,881.54 | 90 | Yes | Yes | |||||
| 19306 | $1,954.90 | 90 | Yes | Yes | |||||
| 19307 | $1,965.10 | 90 | Yes | Yes | |||||
| 22526 | $ 3,831.06 | $ 633.02 | 10 | ||||||
| 22527 | $ 3,112.91 | $ 292.05 | 0 | ||||||
| 22857 | $ 2,699.34 | 90 | Yes | ||||||
| 22862 | $ 3,265.72 | 90 | Yes | ||||||
| 22865 | $3,180.80 | 90 | Yes | ||||||
| 25109 | $907.92 | 90 | Yes | ||||||
| 25606 | $1,236.43 | 90 | Yes | ||||||
| 25607 | $1,246.01 | 90 | Yes | Yes | |||||
| 25608 | $1,420.43 | 90 | Yes | Yes | |||||
| 25609 | $1,811.77 | 90 | Yes | Yes | |||||
| 27325 | $917.34 | 90 | Yes | Yes | |||||
| 27326 | $867.22 | 90 | Yes | Yes | |||||
| 28055 | $732.58 | 90 | Yes | ||||||
| 32998 | $5,357.32 | $544.05 | 0 | Yes | |||||
| 33202 | $1,455.37 | 90 | |||||||
| 33203 | $1,498.55 | 90 | |||||||
| 33254 | $2,536.09 | 90 | Yes | ||||||
| 33255 | $3,056.38 | 90 | Yes | ||||||
| 33256 | $3,647.04 | 90 | Yes | ||||||
| 33265 | $2,536.09 | 90 | Yes | ||||||
| 33266 | $3,468.26 | 90 | Yes | ||||||
| 33675 | $4,044.62 | 90 | Yes | ||||||
| 33676 | $4,164.19 | 90 | Yes | ||||||
| 33677 | $4,328.16 | 90 | Yes | ||||||
| 33724 | $2,891.37 | 90 | Yes | ||||||
| 33726 | $3,816.71 | 90 | Yes | ||||||
| 35302 | $2,153.96 | 90 | Yes | Yes | |||||
| 35303 | $2,367.17 | 90 | Yes | Yes | |||||
| 35304 | $2,462.81 | 90 | Yes | Yes | |||||
| 35305 | $2,367.17 | 90 | Yes | ||||||
| 35306 | $886.75 | 0 | Yes | ||||||
| 35537 | $4,164.39 | 90 | Yes | ||||||
| 35538 | $4,652.65 | 90 | Yes | ||||||
| 35539 | $4,372.76 | 90 | Yes | Yes | |||||
| 35540 | $4,873.92 | 90 | Yes | ||||||
| 35637 | $3,316.00 | 90 | Yes | ||||||
| 35638 | $3,368.26 | 90 | Yes | ||||||
| 35883 | $2,421.76 | 90 | Yes | Yes | |||||
| 35884 | $2,571.81 | 90 | Yes | Yes | |||||
| 37210 | $998.81 | 0 | |||||||
| 43647 | BR | 0 | Yes | ||||||
| 43648 | BR | 0 | Yes | ||||||
| 43881 | BR | 0 | Yes | ||||||
| 43882 | BR | 0 | Yes | ||||||
| 44157 | $3,813.16 | 90 | Yes | ||||||
| 44158 | $3,911.43 | 90 | Yes | ||||||
| 47719 | $2,009.67 | 90 | Yes | ||||||
| 48105 | $4,899.03 | 90 | Yes | ||||||
| 48548 | $2,851.02 | 90 | Yes | ||||||
| 49324 | $677.76 | 10 | Yes | ||||||
| 49325 | $728.64 | 10 | Yes | ||||||
| 49326 | $333.78 | 0 | Yes | ||||||
| 49402 | $1,459.94 | 90 | Yes | ||||||
| 49435 | $214.65 | 0 | Yes | ||||||
| 49436 | $320.02 | 10 | Yes | ||||||
| 54865 | $654.63 | 90 | Yes | ||||||
| 55875 | $1,437.49 | 90 | Yes | ||||||
| 55876 | $282.41 | $209.69 | 0 | ||||||
| 56442 | $88.27 | 0 | Yes | ||||||
| 57296 | $1,723.91 | 90 | Yes | ||||||
| 57558 | $232.16 | $209.11 | 10 | Yes | |||||
| 58541 | $1,547.29 | 90 | Yes | ||||||
| 58542 | $1,716.35 | 90 | Yes | ||||||
| 58543 | $1,745.23 | 90 | Yes | ||||||
| 58544 | $1,889.43 | 90 | Yes | ||||||
| 58548 | $3,298.72 | 90 | Yes | ||||||
| 58957 | $2,668.19 | 90 | Yes | ||||||
| 58958 | $2,954.00 | 90 | Yes | ||||||
| 64910 | $1,247.54 | 90 | Yes | ||||||
| 64911 | $1,521.37 | 90 | Yes | ||||||
| 67346 | $340.52 | 0 | Yes | Yes | |||||
| 70554 | $1,108.05 | $921.14 | $186.91 | ||||||
| 70555 | $223.81 | ||||||||
| 72291 | $129.95 | $6.12 | $123.83 | ||||||
| 72292 | $126.89 | ||||||||
| 76776 | $224.85 | $157.19 | $67.66 | ||||||
| 76813 | $228.71 | $125.03 | $103.68 | ||||||
| 76814 | $151.02 | $64.07 | $86.95 | ||||||
| 76998 | $113.01 | ||||||||
| 77001 | $148.88 | $114.25 | $34.63 | ||||||
| 77002 | $136.49 | $88.20 | $48.29 | ||||||
| 77003 | $132.46 | $80.67 | $54.43 | ||||||
| 77011 | $882.31 | $772.30 | $54.43 | ||||||
| 77012 | $580.00 | $475.08 | $104.94 | ||||||
| 77013 | $362.07 | ||||||||
| 77014 | $307.56 | $230.06 | $77.50 | ||||||
| 77021 | $889.04 | $750.99 | $138.04 | ||||||
| 77022 | $386.00 | ||||||||
| 77031 | $551.66 | $406.99 | $144.67 | ||||||
| 77032 | $127.64 | $77.24 | $50.41 | ||||||
| 77051 | $30.67 | $25.13 | $5.55 | ||||||
| 77052 | $30.67 | $25.13 | $5.55 | ||||||
| 77053 | $182.61 | $149.69 | $32.93 | ||||||
| 77054 | $262.11 | $221.19 | $40.92 | ||||||
| 77055 | $142.79 | $79.52 | $63.27 | ||||||
| 77056 | $178.14 | $99.84 | $78.30 | ||||||
| 77057 | $149.41 | $86.14 | $63.27 | ||||||
| 77058 | $1,440.31 | $1,292.91 | $147.39 | ||||||
| 77059 | $1,777.15 | $1,629.76 | $147.39 | ||||||
| 77071 | $52.90 | ||||||||
| 77072 | $40.75 | $24.23 | $16.52 | ||||||
| 77073 | $76.11 | $51.65 | $24.46 | ||||||
| 77074 | $115.64 | $74.72 | $40.92 | ||||||
| 77075 | $161.60 | $111.96 | $49.67 | ||||||
| 77076 | $132.73 | $69.46 | $63.27 | ||||||
| 77077 | $97.82 | $69.25 | $28.58 | ||||||
| 77078 | $257.84 | $235.55 | $22.29 | ||||||
| 77079 | $185.46 | $165.33 | $20.11 | ||||||
| 77080 | $199.18 | $179.16 | $20.01 | ||||||
| 77081 | $72.46 | $51.65 | $20.80 | ||||||
| 77082 | $62.58 | $46.86 | $15.72 | ||||||
| 77083 | $64.80 | $46.18 | $18.64 | ||||||
| 77084 | $976.10 | $830.94 | $145.16 | ||||||
| 77371 | $2,077.76 | ||||||||
| 77372 | $1,576.45 | ||||||||
| 77373 | $2,942.06 | ||||||||
| 77435 | $1,216.77 | ||||||||
| 82107 | BR | ||||||||
| 83698 | BR | ||||||||
| 83913 | BR | ||||||||
| 86788 | BR | ||||||||
| 86789 | BR | ||||||||
| 87305 | BR | ||||||||
| 87498 | BR | ||||||||
| 87640 | BR | ||||||||
| 87641 | BR | ||||||||
| 87653 | BR | ||||||||
| 87808 | BR | ||||||||
| 91111 | $1,085.40 | $1,004.97 | $80.42 | 0 | |||||
| 92025 | $43.61 | $18.04 | $25.56 | 0 | |||||
| 92640 | $77.67 | 0 | |||||||
| 94002 | $129.35 | 0 | |||||||
| 94003 | $94.14 | 0 | |||||||
| 94004 | $68.65 | 0 | |||||||
| 94005 | BR | 0 | |||||||
| 94610 | $91.40 | 0 | Yes | ||||||
| 94644 | $51.54 | 0 | |||||||
| 94645 | $19.53 | 0 | |||||||
| 94774 | BR | 0 | |||||||
| 94775 | BR | 0 | |||||||
| 94776 | BR | 0 | |||||||
| 94777 | BR | 0 | |||||||
| 95012 | $26.88 | 0 | |||||||
| 96020 | $250.95 | 0 | |||||||
| 96040 | BR | 0 | |||||||
| 96904 | $101.96 | 0 | |||||||
| 99363 | BR | ||||||||
| 99364 | BR |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.