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.