|
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 (80,81, or 82) | Mod- 51 exempt |
| 20555 | $593.47 | 0 | |||||||
| 20985 | $268.11 | ||||||||
| 20986 | BR | ||||||||
| 20987 | BR | ||||||||
| 21073 | $649.50 | 90 | |||||||
| 22206 | $4,149.09 | 90 | Yes | ||||||
| 22207 | $4,097.94 | 90 | Yes | ||||||
| 22208 | $1,040.44 | Yes | |||||||
| 24357 | $783.27 | 90 | |||||||
| 24358 | $919.93 | 90 | |||||||
| 24359 | $1,130.90 | 90 | |||||||
| 27267 | $734.66 | 90 | Yes | ||||||
| 27268 | $904.36 | 90 | Yes | ||||||
| 27269 | $2,156.86 | 90 | Yes | ||||||
| 27416 | $1,690.02 | 90 | |||||||
| 27726 | $1,607.81 | 90 | |||||||
| 27767 | $449.64 | $451.82 | 90 | ||||||
| 27768 | $695.79 | 90 | |||||||
| 27769 | $1,203.43 | 90 | |||||||
| 28446 | $2,080.79 | 90 | Yes | ||||||
| 29828 | $1,598.33 | 90 | Yes | ||||||
| 29904 | $1,076.19 | 90 | Yes | ||||||
| 29905 | $1,159.80 | 90 | Yes | ||||||
| 29906 | $1,221.52 | 90 | Yes | ||||||
| 29907 | $1,493.46 | 90 | Yes | ||||||
| 32421 | $308.38 | $144.72 | 0 | ||||||
| 32422 | $378.26 | $233.42 | 0 | ||||||
| 32550 | $1,573.90 | $423.19 | 0 | ||||||
| 32551 | $332.85 | 0 | |||||||
| 32560 | $579.95 | $209.17 | 0 | ||||||
| 33257 | $1,105.58 | Yes | |||||||
| 33258 | $1,248.09 | Yes | |||||||
| 33259 | $1,629.93 | Yes | |||||||
| 33864 | $5,935.83 | 90 | Yes | ||||||
| 34806 | $193.83 | Yes | |||||||
| 35523 | $2,431.64 | 90 | Yes | ||||||
| 36591 | $39.59 | ||||||||
| 36592 | $49.01 | ||||||||
| 36593 | $61.80 | ||||||||
| 41019 | $877.19 | 0 | |||||||
| 49203 | $2,048.96 | 90 | Yes | ||||||
| 49204 | $2,613.81 | 90 | Yes | ||||||
| 49205 | $2,991.02 | 90 | Yes | ||||||
| 49440 | $2,127.82 | $444.09 | 90 | ||||||
| 49441 | $2,525.87 | $489.48 | 90 | ||||||
| 49442 | $2,059.42 | $406.11 | 10 | ||||||
| 49446 | $2,104.17 | $320.52 | 0 | ||||||
| 49450 | $1,471.89 | $129.99 | 0 | ||||||
| 49451 | $1,559.91 | $178.91 | 0 | ||||||
| 49452 | $1,909.19 | $279.07 | 0 | ||||||
| 49460 | $1,560.24 | $91.63 | 0 | ||||||
| 49465 | $326.35 | $60.56 | 0 | ||||||
| 50385 | $2,539.05 | $468.63 | 0 | ||||||
| 50386 | $1,641.70 | $354.84 | 0 | ||||||
| 50593 | $8,956.96 | $906.28 | 10 | Yes | Yes | ||||
| 51100 | $123.25 | $76.18 | 0 | ||||||
| 51101 | $250.10 | $100.20 | 0 | ||||||
| 51102 | $652.88 | $480.52 | 0 | ||||||
| 52649 | $1,915.49 | 90 | |||||||
| 55920 | $830.47 | 0 | |||||||
| 57285 | $1,200.49 | 90 | Yes | ||||||
| 57423 | $1,659.47 | 90 | Yes | ||||||
| 58570 | $1,646.29 | 90 | Yes | ||||||
| 58571 | $1,806.04 | 90 | Yes | ||||||
| 58572 | $2,044.24 | 90 | Yes | ||||||
| 58573 | $2,310.83 | 90 | Yes | ||||||
| 60300 | $191.11 | $93.34 | 90 | ||||||
| 67041 | $2,106.25 | 90 | |||||||
| 67042 | $2,410.84 | 90 | |||||||
| 67043 | $2,530.81 | 90 | |||||||
| 67113 | $2,779.46 | 90 | |||||||
| 67229 | $1,830.12 | 90 | |||||||
| 68816 | $1,138.40 | $396.84 | 90 | Yes | |||||
| 75557 | $976.82 | $752.82 | $224.01 | ||||||
| 75558 | BR | ||||||||
| 75559 | $1,429.11 | $1,142.80 | $286.32 | ||||||
| 75560 | BR | ||||||||
| 75561 | $1,322.49 | $1,074.69 | $247.80 | ||||||
| 75562 | BR | ||||||||
| 75563 | $1,641.25 | $1,343.89 | $297.35 | ||||||
| 75564 | BR | ||||||||
| 80047 | BR | ||||||||
| 82610 | BR | ||||||||
| 83993 | BR | ||||||||
| 84704 | BR | ||||||||
| 86356 | BR | ||||||||
| 86486 | $7.98 | ||||||||
| 87500 | BR | ||||||||
| 87809 | BR | ||||||||
| 88381 | $313.90 | $231.26 | $82.63 | ||||||
| 89322 | BR | ||||||||
| 89331 | BR | ||||||||
| 90284 | BR | ||||||||
| 90661 | BR | ||||||||
| 90662 | BR | ||||||||
| 90663 | BR | ||||||||
| 90769 | $301.71 | ||||||||
| 90770 | $30.47 | ||||||||
| 90771 | $135.20 | ||||||||
| 90776 | BR | ||||||||
| 93982 | $78.84 | ||||||||
| 95980 | $76.49 | ||||||||
| 95981 | $53.25 | $30.08 | |||||||
| 95982 | $81.25 | $60.23 | |||||||
| 96125 | $180.66 | $152.42 | |||||||
| 98966 | BR | ||||||||
| 98967 | BR | ||||||||
| 98968 | BR | ||||||||
| 98969 | BR | ||||||||
| 99174 | BR | ||||||||
| 99366 | BR | ||||||||
| 99367 | BR | ||||||||
| 99368 | BR | ||||||||
| 99406 | $24.21 | $22.76 | |||||||
| 99407 | $48.06 | $45.88 | |||||||
| 99408 | BR | ||||||||
| 99409 | BR | ||||||||
| 99441 | BR | ||||||||
| 99442 | BR | ||||||||
| 99443 | BR | ||||||||
| 99444 | BR | ||||||||
| 99477 | $642.56 | ||||||||
| 99605 | BR | ||||||||
| 99606 | BR | ||||||||
| 99607 | BR |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.