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 | Group | Asst Surg | Mod 51 exempt |
11045 | 60.63 | $35.08 | 3 | yes | |||||
11046 | $105.64 | $74.74 | 3 | yes | |||||
11047 | $173.49 | $129.82 | 3 | yes | |||||
22551 | $3,349.35 | 90 | 3 | yes | |||||
22552 | $782.24 | 3 | yes | ||||||
29914 | $2,018.04 | 90 | 3 | yes | |||||
29915 | $2,056.44 | 90 | 3 | yes | |||||
29916 | $2,056.44 | 90 | 3 | yes | |||||
31295 | $4,020.40 | $347.01 | 0 | 3 | yes | ||||
31296 | $7,527.32 | $414.41 | 0 | 3 | yes | ||||
31297 | $7,456.62 | $339.67 | 0 | 3 | yes | ||||
31634 | $3,571.57 | $412.89 | 0 | 3 | yes | ||||
33620 | $3,348.67 | 90 | 3 | yes | |||||
33621 | $1,803.76 | 90 | 3 | yes | |||||
33622 | $7,070.44 | 90 | 3 | yes | |||||
37220 | $6,260.57 | $850.97 | 0 | 3 | yes | ||||
37221 | $9,256.59 | $1,038.38 | 0 | 3 | no | ||||
37222 | $1,803.49 | $386.44 | 0 | 3 | yes | ||||
37223 | $5,098.38 | $439.30 | 0 | 3 | yes | ||||
37224 | $7,523.24 | $937.79 | 0 | 3 | yes | ||||
37225 | $21,254.96 | $1,261.40 | 0 | 3 | yes | ||||
37226 | $17,809.13 | $1,056.88 | 0 | 3 | yes | ||||
37227 | $28,737.47 | $1,523.49 | 0 | 3 | yes | ||||
37228 | $10,710.46 | $1,145.05 | 0 | 3 | yes | ||||
37229 | $21,069.76 | $1,476.65 | 0 | 3 | yes | ||||
37230 | $16,556.06 | $1,430.53 | 0 | 3 | yes | ||||
37231 | $26,572.27 | $1,554.76 | 0 | 3 | yes | ||||
37232 | $2,403.71 | $414.16 | 0 | 3 | yes | ||||
37233 | $2,934.82 | $679.88 | 0 | 3 | yes | ||||
37234 | $7,664.09 | $567.98 | 0 | 3 | yes | ||||
37235 | $8,185.78 | $806.10 | 0 | 3 | yes | ||||
38900 | $267.47 | $267.47 | 0 | 3 | yes | ||||
43283 | $320.37 | 0 | 3 | yes | |||||
43327 | $1,611.97 | 90 | 3 | yes | |||||
43328 | $2,351.98 | 90 | 3 | yes | |||||
43332 | $2,307.94 | 90 | 3 | yes | |||||
43333 | $2,506.34 | 90 | 3 | yes | |||||
43334 | $2,532.42 | 90 | 3 | yes | |||||
43335 | $2,728.82 | 90 | 3 | yes | |||||
43336 | $2,982.76 | 90 | 3 | yes | |||||
43337 | $3,256.70 | 90 | 3 | yes | |||||
43338 | $265.27 | 0 | 3 | yes | |||||
43753 | $41.63 | 0 | 3 | yes | |||||
43754 | $156.31 | $62.91 | 0 | 3 | yes | ||||
43755 | $238.84 | $115.20 | 0 | 3 | yes | ||||
43757 | $556.88 | $150.36 | 0 | 3 | yes | ||||
49327 | $258.10 | 0 | 3 | yes | |||||
49412 | $161.26 | 0 | 3 | yes | |||||
49418 | $3,002.88 | $463.03 | 0 | 3 | yes | ||||
53860 | $2,884.25 | $459.30 | 90 | 3 | yes | ||||
57156 | $298.23 | $204.85 | 0 | 3 | yes | ||||
61781 | $463.69 | 0 | 3 | yes | |||||
61782 | $383.94 | 0 | 3 | yes | |||||
61783 | $463.69 | 0 | 3 | yes | |||||
64566 | $255.98 | $59.78 | 0 | 3 | yes | ||||
64568 | $1,268.55 | 90 | 3 | yes | |||||
64569 | $1,218.45 | 90 | 3 | yes | |||||
64570 | $1,061.02 | 90 | 3 | yes | |||||
64611 | $195.08 | $176.27 | 10 | 3 | yes | ||||
65778 | $2,481.00 | $148.09 | 10 | 3 | yes | ||||
65779 | $2,244.25 | $573.85 | 10 | 3 | yes | ||||
66174 | $1,931.46 | 90 | 3 | yes | |||||
66175 | $2,139.72 | 0 | 3 | yes | |||||
74176 | $409.70 | $247.84 | $161.86 | 4 | |||||
74177 | $642.63 | $472.89 | $169.74 | 4 | |||||
74178 | $812.79 | $625.04 | $187.75 | 4 | |||||
76881 | $217.31 | $162.19 | $55.12 | 4 | |||||
76882 | $57.19 | $18.97 | $38.22 | 4 | |||||
80104 | 5 | ||||||||
82930 | 5 | ||||||||
83861 | 5 | ||||||||
84112 | 5 | ||||||||
85598 | 5 | ||||||||
86481 | 5 | ||||||||
86902 | 5 | ||||||||
87501 | 5 | ||||||||
87502 | 5 | ||||||||
87503 | 5 | ||||||||
87906 | 5 | ||||||||
88120 | $693.75 | $612.28 | $81.46 | 5 | |||||
88121 | $585.91 | $513.64 | $72.27 | 5 | |||||
88177 | $42.85 | $9.64 | $33.21 | 5 | |||||
88363 | $58.03 | $26.09 | 5 | ||||||
88749 | 5 | ||||||||
90460 | $45.96 | 1 | |||||||
90461 | $23.05 | 1 | |||||||
90470 | 1 | ||||||||
90644 | 1 | ||||||||
90664 | 1 | ||||||||
90666 | 1 | ||||||||
90667 | 1 | ||||||||
90668 | 1 | ||||||||
90867 | 1 | ||||||||
90868 | 1 | ||||||||
91013 | $45.77 | $26.00 | $19.78 | 1 | |||||
91117 | $280.51 | $298.66 | 1 | ||||||
92132 | $72.06 | $30.03 | $42.02 | 1 | |||||
92133 | $88.60 | $30.03 | $58.57 | 1 | |||||
92134 | $88.60 | $30.03 | $58.57 | 1 | |||||
92227 | $22.64 | 1 | |||||||
92228 | $59.55 | $24.66 | $34.90 | 1 | |||||
93451 | $1,504.56 | $1,215.54 | $289.02 | 1 | |||||
93452 | $1,667.14 | $1,161.12 | $506.02 | 1 | |||||
93453 | $2,182.08 | $1,518.38 | $663.69 | 1 | |||||
93454 | $1,719.69 | $1,209.51 | $510.18 | 1 | |||||
93455 | $2,006.71 | $1,417.59 | $589.12 | 1 | |||||
93456 | $2,152.41 | $1,498.90 | $653.51 | 1 | |||||
93457 | $2,439.20 | $1,706.50 | $732.70 | 1 | |||||
93458 | $2,075.12 | $1,452.53 | $622.59 | 1 | |||||
93459 | $2,292.02 | $1,590.94 | $701.08 | 1 | |||||
93460 | $2,452.74 | $1,671.57 | $781.17 | 1 | |||||
93461 | $2,810.38 | $1,948.86 | $861.51 | 1 | |||||
93462 | $397.02 | $397.02 | 1 | ||||||
93463 | $211.19 | $211.19 | 1 | ||||||
93464 | $496.13 | $310.22 | $185.92 | 1 | |||||
93565 | $86.09 | $86.09 | 1 | ||||||
93566 | $335.37 | $86.09 | 1 | ||||||
93567 | $277.21 | $97.15 | 1 | ||||||
93568 | $303.17 | $88.15 | 1 | ||||||
95800 | $408.42 | $291.41 | $117.01 | 1 | |||||
95801 | $193.27 | $89.84 | $103.43 | 1 | |||||
96446 | $349.66 | $41.92 | 1 |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.