|
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 |
| 20696 | $1,968.60 | 90 | yes | ||||||
| 20697 | $2,273.89 | 90 | yes | yes | |||||
| 22856 | $2,977.15 | 90 | yes | ||||||
| 22861 | $3,656.54 | 90 | yes | ||||||
| 22864 | $3,344.64 | 90 | yes | ||||||
| 27027 | $1,567.70 | 90 | no | ||||||
| 27057 | $1,759.30 | 90 | no | ||||||
| 35535 | $4,002.93 | 90 | yes | ||||||
| 35570 | $3,091.34 | 90 | yes | ||||||
| 35633 | $4,103.89 | 90 | yes | ||||||
| 35634 | $3,719.06 | 90 | yes | ||||||
| 41512 | $1,104.12 | 90 | no | ||||||
| 41530 | $5,365.19 | $722.81 | 10 | no | |||||
| 43273 | $248.19 | $248.19 | no | ||||||
| 43279 | $2,312.56 | 90 | yes | ||||||
| 46930 | $366.72 | $267.08 | 90 | no | |||||
| 49652 | $1,401.44 | 90 | yes | ||||||
| 49653 | $1,751.06 | 90 | yes | ||||||
| 49654 | $1,610.67 | 90 | yes | ||||||
| 49655 | $1,938.81 | 90 | yes | ||||||
| 49656 | $1,616.48 | 90 | yes | ||||||
| 49657 | $2,334.93 | 90 | yes | ||||||
| 55706 | $776.99 | 10 | yes | ||||||
| 61796 | $1,396.78 | 90 | yes | ||||||
| 61797 | $384.56 | $384.56 | yes | ||||||
| 61798 | $1,396.78 | 90 | yes | ||||||
| 61799 | $531.62 | $531.62 | yes | ||||||
| 61800 | $270.29 | yes | |||||||
| 62267 | $466.01 | $312.75 | 0 | no | |||||
| 63620 | $1,396.78 | 90 | yes | ||||||
| 63621 | $442.12 | $442.12 | yes | ||||||
| 64455 | $95.71 | $76.45 | 0 | no | |||||
| 64632 | $156.81 | $134.81 | 10 | no | |||||
| 65756 | $1,965.05 | 90 | yes | ||||||
| 65757 | BR | BR | no | ||||||
| 77785 | $340.82 | $205.27 | $135.55 | ||||||
| 77786 | $1,019.34 | $713.97 | $305.37 | ||||||
| 77787 | $1,515.02 | $1,046.33 | $468.69 | ||||||
| 78808 | $84.67 | ||||||||
| 83876 | BR | ||||||||
| 83951 | BR | ||||||||
| 85397 | BR | ||||||||
| 87905 | BR | ||||||||
| 88720 | BR | ||||||||
| 88740 | BR | ||||||||
| 88741 | BR | ||||||||
| 90650 | BR | ||||||||
| 90681 | BR | ||||||||
| 90696 | BR | ||||||||
| 90738 | BR | ||||||||
| 90951 | $1,922.58 | ||||||||
| 90952 | BR | ||||||||
| 90953 | BR | ||||||||
| 90954 | $1,578.58 | ||||||||
| 90955 | $893.77 | ||||||||
| 90956 | $605.43 | ||||||||
| 90957 | $1,267.02 | ||||||||
| 90958 | $854.82 | ||||||||
| 90959 | $560.96 | ||||||||
| 90960 | $561.93 | ||||||||
| 90961 | $453.67 | ||||||||
| 90962 | $328.10 | ||||||||
| 90963 | $1,086.05 | ||||||||
| 90964 | $906.30 | ||||||||
| 90965 | $862.05 | ||||||||
| 90966 | $448.87 | ||||||||
| 90967 | $38.85 | ||||||||
| 90968 | $30.32 | ||||||||
| 90969 | $29.58 | ||||||||
| 90970 | $15.68 | ||||||||
| 93228 | $51.25 | ||||||||
| 93229 | BR | ||||||||
| 93279 | $108.85 | $36.94 | $71.91 | ||||||
| 93280 | $128.98 | $42.64 | $86.33 | ||||||
| 93281 | $150.79 | $50.00 | $100.80 | ||||||
| 93282 | $139.30 | $45.18 | $94.12 | ||||||
| 93283 | $169.76 | $51.38 | $118.39 | ||||||
| 93284 | $199.04 | $58.24 | $140.80 | ||||||
| 93285 | $93.69 | $34.88 | $58.81 | ||||||
| 93286 | $53.02 | $22.93 | $30.10 | ||||||
| 93287 | $70.14 | $25.94 | $44.21 | ||||||
| 93288 | $83.78 | $35.56 | $48.22 | ||||||
| 93289 | $129.72 | $42.64 | $87.08 | ||||||
| 93290 | $62.27 | $19.76 | $42.52 | ||||||
| 93291 | $80.36 | $31.66 | $48.70 | ||||||
| 93292 | $72.78 | $24.56 | $48.22 | ||||||
| 93293 | $113.07 | $79.41 | $33.66 | ||||||
| 93294 | $73.07 | ||||||||
| 93295 | $132.11 | ||||||||
| 93296 | $69.20 | ||||||||
| 93297 | $51.25 | ||||||||
| 93298 | $58.81 | ||||||||
| 93299 | BR | ||||||||
| 93306 | $509.19 | $366.04 | $143.15 | ||||||
| 93307 | $336.93 | $237.62 | $99.31 | ||||||
| 93351 | $530.43 | ||||||||
| 93352 | $73.73 | ||||||||
| 95803 | BR | ||||||||
| 95992 | BR | ||||||||
| 96360 | $107.33 | ||||||||
| 96361 | $31.25 | ||||||||
| 96365 | $130.91 | ||||||||
| 96366 | $42.07 | ||||||||
| 96367 | $66.17 | ||||||||
| 96368 | $39.26 | ||||||||
| 96369 | $285.08 | ||||||||
| 96370 | $30.39 | ||||||||
| 96371 | $137.92 | ||||||||
| 96372 | $40.58 | ||||||||
| 96374 | $103.91 | ||||||||
| 96375 | $45.05 | ||||||||
| 96376 | BR | ||||||||
| 96379 | BR | ||||||||
| 99460 | $112.64 | ||||||||
| 99461 | $166.32 | ||||||||
| 99462 | $60.07 | ||||||||
| 99463 | $150.69 | ||||||||
| 99464 | $141.77 | ||||||||
| 99465 | $290.01 | ||||||||
| 99466 | $463.40 | ||||||||
| 99467 | $231.38 | ||||||||
| 99468 | $1,736.81 | ||||||||
| 99469 | $760.59 | ||||||||
| 99471 | $1,547.22 | ||||||||
| 99472 | $766.71 | ||||||||
| 99475 | $1,067.55 | ||||||||
| 99476 | $636.23 | ||||||||
| 99479 | $242.07 | ||||||||
| 99480 | $232.80 |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.