|
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 |
| 10030 | $1,524.81 | $316.87 | 0 | 3 | yes | ||||
| 19081 | $1,311.93 | $365.18 | 0 | 3 | yes | ||||
| 19082 | $1,059.54 | $175.86 | 0 | 3 | yes | ||||
| 19083 | $1,303.03 | $342.58 | 0 | 3 | yes | ||||
| 19084 | $1,044.91 | $165.34 | 0 | 3 | yes | ||||
| 19085 | $1,970.23 | $400.30 | 0 | 3 | yes | ||||
| 19086 | $1,572.42 | $183.48 | 0 | 3 | yes | ||||
| 19281 | $478.00 | $208.58 | 0 | 3 | yes | ||||
| 19282 | $331.12 | $100.78 | 0 | 3 | yes | ||||
| 19283 | $541.76 | $210.64 | 0 | 3 | yes | ||||
| 19284 | $396.26 | $101.48 | 0 | 3 | yes | ||||
| 19285 | $910.15 | $178.66 | 0 | 3 | yes | ||||
| 19286 | $761.56 | $86.97 | 0 | 3 | yes | ||||
| 19287 | $1,679.50 | $285.06 | 0 | 3 | yes | ||||
| 19288 | $1,338.84 | $130.21 | 0 | 3 | yes | ||||
| 23333 | $907.06 | $907.06 | 90 | 3 | yes | ||||
| 23334 | $2,144.40 | $2,144.40 | 90 | 3 | no | ||||
| 23335 | $2,558.44 | $2,558.44 | 90 | 3 | no | ||||
| 33366 | $3,886.50 | $3,886.50 | 0 | 3 | yes | ||||
| 34841 | BR | 0 | 3 | yes | |||||
| 34842 | BR | 0 | 3 | yes | |||||
| 34843 | BR | 0 | 3 | yes | |||||
| 34844 | BR | 0 | 3 | yes | |||||
| 34845 | BR | 0 | 3 | yes | |||||
| 34846 | BR | 0 | 3 | yes | |||||
| 34847 | BR | 0 | 3 | yes | |||||
| 34848 | BR | 0 | 3 | yes | |||||
| 37217 | $2,274.51 | $2,274.51 | 90 | 3 | yes | ||||
| 37236 | $5,501.87 | $946.36 | 0 | 3 | yes | ||||
| 37237 | $2,390.20 | $441.85 | 0 | 3 | yes | ||||
| 37238 | $8,027.24 | $663.01 | 0 | 3 | yes | ||||
| 37239 | $3,989.13 | $308.38 | 0 | 3 | yes | ||||
| 37241 | $8,900.23 | $919.69 | 0 | 3 | no | ||||
| 37242 | $14,973.07 | $1,026.81 | 0 | 3 | no | ||||
| 37243 | $18,899.20 | $1,224.22 | 0 | 3 | no | ||||
| 37244 | $13,252.62 | $1,428.16 | 0 | 3 | no | ||||
| 43191 | $256.96 | $256.96 | 0 | 3 | no | ||||
| 43192 | $306.59 | $306.59 | 0 | 3 | no | ||||
| 43193 | $365.51 | $365.51 | 0 | 3 | no | ||||
| 43194 | $332.59 | $332.59 | 0 | 3 | no | ||||
| 43195 | $366.19 | $366.19 | 0 | 3 | no | ||||
| 43196 | $400.59 | $400.59 | 0 | 3 | no | ||||
| 43197 | $364.81 | $163.93 | 0 | 3 | no | ||||
| 43198 | $407.76 | $195.25 | 0 | 3 | no | ||||
| 43211 | $497.78 | $497.78 | 0 | 3 | no | ||||
| 43212 | $391.56 | $391.56 | 0 | 3 | no | ||||
| 43213 | $2,412.42 | $553.21 | 0 | 3 | no | ||||
| 43214 | $400.13 | $400.13 | 0 | 3 | no | ||||
| 43229 | $1,424.30 | $422.03 | 0 | 3 | no | ||||
| 43233 | $474.99 | $474.99 | 0 | 3 | no | ||||
| 43253 | $551.03 | $551.03 | 0 | 3 | no | ||||
| 43254 | $571.92 | $571.92 | 0 | 3 | no | ||||
| 43266 | $473.18 | $473.18 | 0 | 3 | no | ||||
| 43270 | $1,422.84 | $497.35 | 0 | 3 | no | ||||
| 43274 | $980.60 | $980.60 | 0 | 3 | no | ||||
| 43275 | $808.41 | $808.41 | 0 | 3 | no | ||||
| 43276 | $1,020.30 | $1,020.30 | 0 | 3 | no | ||||
| 43277 | $813.41 | $813.41 | 0 | 3 | no | ||||
| 43278 | $924.88 | $924.88 | 0 | 3 | no | ||||
| 49405 | $1,712.95 | $438.51 | 0 | 3 | no | ||||
| 49406 | $1,712.27 | $439.19 | 0 | 3 | no | ||||
| 49407 | $1,450.57 | $467.50 | 0 | 3 | no | ||||
| 52356 | $842.17 | $842.17 | 0 | 3 | no | ||||
| 64616 | $240.34 | $212.22 | 10 | 3 | no | ||||
| 64617 | $376.82 | $230.10 | 10 | 3 | no | ||||
| 64642 | $274.93 | $213.91 | 0 | 3 | no | ||||
| 64643 | $181.44 | $143.73 | 0 | 3 | no | ||||
| 64644 | $313.92 | $233.71 | 0 | 3 | no | ||||
| 64645 | $221.51 | $164.61 | 0 | 3 | no | ||||
| 64646 | $296.00 | $231.54 | 0 | 3 | no | ||||
| 64647 | $342.83 | $267.41 | 0 | 3 | no | ||||
| 66183 | $2,122.50 | $2,122.50 | 10 | 3 | yes | ||||
| 77293 | $845.31 | $647.56 | $197.74 | 4 | |||||
| 80155 | BR | 5 | |||||||
| 80159 | BR | 5 | |||||||
| 80169 | BR | 5 | |||||||
| 80171 | BR | 5 | |||||||
| 80175 | BR | 5 | |||||||
| 80177 | BR | 5 | |||||||
| 80180 | BR | 5 | |||||||
| 80183 | BR | 5 | |||||||
| 80199 | BR | 5 | |||||||
| 80203 | BR | 5 | |||||||
| 81287 | BR | 5 | |||||||
| 81504 | BR | 5 | |||||||
| 81507 | BR | 5 | |||||||
| 87661 | BR | 5 | |||||||
| 88343 | BR | 5 | |||||||
| 90673 | BR | 1 | |||||||
| 90685 | BR | 1 | |||||||
| 90686 | BR | 1 | |||||||
| 90687 | BR | 1 | |||||||
| 90688 | BR | 1 | |||||||
| 92521 | $174.32 | $174.32 | 1 | ||||||
| 92522 | $141.88 | $141.88 | 1 | ||||||
| 92523 | $294.16 | $294.16 | 1 | ||||||
| 92524 | $147.10 | $147.10 | 1 | ||||||
| 93582 | $1,045.03 | $1,045.03 | 1 | ||||||
| 93583 | $1,163.15 | $1,163.15 | 1 | ||||||
| 94669 | $51.95 | $51.95 | 1 | ||||||
| 97610 | BR | 1 | |||||||
| 99446 | BR | 1 | |||||||
| 99447 | BR | 1 | |||||||
| 99448 | BR | 1 | |||||||
| 99449 | BR | 1 | |||||||
| 99481 | BR | 1 | |||||||
| 99482 | BR | 1 |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.