|
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 |
| 22586 | $2,973.90 | $2,973.90 | 90 | 3 | yes | ||||
| 23473 | $3,184.72 | $3,184.72 | 90 | 3 | yes | ||||
| 23474 | $3,440.30 | $3,440.30 | 90 | 3 | yes | ||||
| 24370 | $3,013.24 | $3,013.24 | 90 | 3 | yes | ||||
| 24371 | $3,472.48 | $3,472.48 | 90 | 3 | yes | ||||
| 31647 | $444.65 | $444.65 | 0 | 3 | no | ||||
| 31648 | $463.27 | $463.27 | 0 | 3 | no | ||||
| 31649 | $147.37 | $147.37 | 0 | 3 | no | ||||
| 31651 | $156.37 | $156.37 | 0 | 3 | no | ||||
| 31660 | $445.52 | $445.52 | 0 | 3 | no | ||||
| 31661 | $470.05 | $470.05 | 0 | 3 | no | ||||
| 32554 | $1,088.32 | $178.07 | 0 | 3 | no | ||||
| 32555 | $1,255.32 | $222.27 | 0 | 3 | no | ||||
| 32556 | $1,148.97 | $243.92 | 0 | 3 | no | ||||
| 32557 | $1,855.77 | $321.79 | 0 | 3 | no | ||||
| 32701 | $429.88 | $429.88 | 0 | 3 | yes | ||||
| 33361 | $2,619.95 | $2,619.95 | 0 | 3 | yes | ||||
| 33362 | $2,866.55 | $2,866.55 | 0 | 3 | yes | ||||
| 33363 | $2,968.05 | $2,968.05 | 0 | 3 | yes | ||||
| 33364 | $3,157.30 | $3,157.30 | 0 | 3 | yes | ||||
| 33365 | $3,454.08 | $3,454.08 | 0 | 3 | yes | ||||
| 33367 | $1,213.32 | $1,213.32 | 0 | 3 | yes | ||||
| 33368 | $1,470.28 | $1,470.28 | 0 | 3 | yes | ||||
| 33369 | $1,941.18 | $1,941.18 | 0 | 3 | yes | ||||
| 33990 | $852.18 | $852.18 | 0 | 3 | yes | ||||
| 33991 | $1,241.75 | $1,241.75 | 0 | 3 | yes | ||||
| 33992 | $405.57 | $405.57 | 0 | 3 | yes | ||||
| 33993 | $356.11 | $356.11 | 0 | 3 | yes | ||||
| 36221 | $2,234.40 | $423.00 | 0 | 3 | no | ||||
| 36222 | $2,769.73 | $573.71 | 0 | 3 | no | ||||
| 36223 | $3,030.07 | $620.29 | 0 | 3 | no | ||||
| 36224 | $3,291.86 | $676.13 | 0 | 3 | no | ||||
| 36225 | $3,008.14 | $617.86 | 0 | 3 | no | ||||
| 36226 | $3,355.53 | $677.43 | 0 | 3 | no | ||||
| 36227 | $486.12 | $214.53 | 0 | 3 | no | ||||
| 36228 | $2,303.68 | $437.07 | 0 | 3 | no | ||||
| 37197 | $3,048.61 | $608.96 | 0 | 3 | no | ||||
| 37211 | $794.73 | $794.73 | 0 | 3 | no | ||||
| 37212 | $701.57 | $701.57 | 0 | 3 | no | ||||
| 37213 | $490.28 | $490.28 | 0 | 3 | no | ||||
| 37214 | $287.53 | $287.53 | 0 | 3 | no | ||||
| 38243 | $231.15 | $231.15 | 0 | 3 | no | ||||
| 43206 | BR | 3 | no | ||||||
| 43252 | BR | 3 | |||||||
| 44705 | BR | 3 | |||||||
| 52287 | $601.60 | $328.06 | 0 | 3 | no | ||||
| 64615 | $274.54 | $247.24 | 0 | 3 | no | ||||
| 78012 | $151.45 | $133.99 | $17.46 | 4 | |||||
| 78013 | $382.59 | $348.80 | $33.79 | 4 | |||||
| 78014 | $442.25 | $397.02 | $45.24 | 4 | |||||
| 78071 | $661.56 | $554.03 | $107.53 | 4 | |||||
| 78072 | $149.20 | 4 | |||||||
| 81201 | BR | 5 | |||||||
| 81202 | BR | 5 | |||||||
| 81203 | BR | 5 | |||||||
| 81235 | BR | 5 | |||||||
| 81252 | BR | 5 | |||||||
| 81253 | BR | 5 | |||||||
| 81254 | BR | 5 | |||||||
| 81321 | BR | 5 | |||||||
| 81322 | BR | 5 | |||||||
| 81323 | BR | 5 | |||||||
| 81324 | BR | 5 | |||||||
| 81325 | BR | 5 | |||||||
| 81326 | BR | 5 | |||||||
| 81479 | BR | 5 | |||||||
| 81500 | BR | 5 | |||||||
| 81503 | BR | 5 | |||||||
| 81506 | BR | 5 | |||||||
| 81508 | BR | 5 | |||||||
| 81509 | BR | 5 | |||||||
| 81510 | BR | 5 | |||||||
| 81511 | BR | 5 | |||||||
| 81512 | BR | 5 | |||||||
| 81599 | BR | 5 | |||||||
| 82777 | BR | 5 | |||||||
| 86152 | BR | 5 | |||||||
| 86153 | BR | 5 | |||||||
| 86711 | BR | 5 | |||||||
| 86828 | BR | 5 | |||||||
| 86829 | BR | 5 | |||||||
| 86830 | BR | 5 | |||||||
| 86831 | BR | 5 | |||||||
| 86832 | BR | 5 | |||||||
| 86833 | BR | 5 | |||||||
| 86834 | BR | 5 | |||||||
| 86835 | BR | 5 | |||||||
| 87631 | BR | 5 | |||||||
| 87632 | BR | 5 | |||||||
| 87633 | BR | 5 | |||||||
| 87910 | BR | 5 | |||||||
| 87912 | BR | 5 | |||||||
| 88375 | BR | 5 | |||||||
| 90653 | BR | 1 | |||||||
| 90672 | BR | 1 | |||||||
| 90739 | BR | 1 | |||||||
| 90785 | $7.28 | $7.28 | 1 | ||||||
| 90791 | $230.38 | $181.04 | 1 | ||||||
| 90792 | $192.13 | $187.15 | 1 | ||||||
| 90832 | $95.97 | $76.05 | 1 | ||||||
| 90833 | $64.15 | $63.64 | 1 | ||||||
| 90834 | $124.65 | $114.19 | 1 | ||||||
| 90836 | $104.20 | $104.20 | 1 | ||||||
| 90837 | $182.65 | $172.19 | 1 | ||||||
| 90838 | $168.25 | $167.26 | 1 | ||||||
| 90839 | BR | 1 | |||||||
| 90840 | BR | 1 | |||||||
| 90863 | BR | 1 | |||||||
| 91112 | $1,745.63 | $1,574.56 | $171.07 | 1 | |||||
| 92920 | $809.13 | $809.13 | 1 | ||||||
| 92921 | BR | 1 | |||||||
| 92924 | $961.81 | $961.81 | 1 | ||||||
| 92925 | BR | 1 | |||||||
| 92928 | $898.45 | $898.45 | 1 | ||||||
| 92929 | BR | 1 | |||||||
| 92933 | $1,004.71 | $1,004.71 | 1 | ||||||
| 92934 | BR | 1 | |||||||
| 92937 | $897.42 | $897.28 | 1 | ||||||
| 92938 | BR | 1 | |||||||
| 92941 | $1,006.65 | $1,006.65 | 1 | ||||||
| 92943 | $1,006.65 | $1,006.65 | 1 | ||||||
| 92944 | BR | 1 | |||||||
| 93653 | $1,223.01 | $1,223.01 | 1 | ||||||
| 93654 | $1,632.19 | $1,632.19 | 1 | ||||||
| 93655 | $611.57 | $611.57 | 1 | ||||||
| 93656 | $1,632.77 | $1,632.77 | 1 | ||||||
| 93657 | $611.95 | $611.95 | 1 | ||||||
| 95017 | $13.11 | $5.62 | 1 | ||||||
| 95018 | $32.31 | $10.89 | 1 | ||||||
| 95076 | $176.69 | $110.41 | 1 | ||||||
| 95079 | $125.39 | $101.47 | 1 | ||||||
| 95782 | $1,537.43 | $1,341.61 | $195.83 | 1 | |||||
| 95783 | $1,640.99 | $1,427.07 | $213.92 | 1 | |||||
| 95907 | $141.71 | $79.30 | $62.41 | 1 | |||||
| 95908 | $174.95 | $99.59 | $75.37 | 1 | |||||
| 95909 | $209.57 | $119.01 | $90.57 | 1 | |||||
| 95910 | $275.95 | $116.86 | $159.09 | 1 | |||||
| 95911 | $334.34 | $198.80 | $135.55 | 1 | |||||
| 95912 | $391.75 | $238.39 | $153.35 | 1 | |||||
| 95913 | $454.36 | $282.82 | $171.54 | 1 | |||||
| 95940 | $48.82 | $48.82 | 1 | ||||||
| 95941 | BR | 1 | |||||||
| 95924 | $221.94 | $89.08 | $132.86 | 1 | |||||
| 95943 | BR | 1 | |||||||
| 99485 | BR | 1 | |||||||
| 99486 | BR | 1 | |||||||
| 99487 | BR | 1 | |||||||
| 99488 | BR | 1 | |||||||
| 99489 | BR | 1 | |||||||
| 99495 | $246.73 | $203.87 | 1 | ||||||
| 99496 | $348.33 | $299.00 | 1 |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.