|
CPT Codes and Fees, |
| Surgery, Part 1 (10000-29999) (revised May 3, 2011) |
| Surgery, Part 2 (30000-49999) (revised May 3, 2011) |
| Surgery, Part 3 (50000-69999) (revised May 3, 2011) |
| Assistant Surgery Guide (revised August 11, 2011) |
| Radiology (revised May 3, 2011) |
| Pathology and Laboratory (revised May 3, 2011) |
| Evaluation & Management, Medicine, Physical Therapy (revised May 3, 2011) |
|
Commission Assigned Codes |
| N.C. Industrial Commission Assigned Codes |
Effective January 1, 2011ABBREVIATIONS: 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), 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.
|
| CPT Code | Total | TC (27) | PC (26) |
| 70010 | $374.52 | $243.44 | $131.08 |
| 70015 | $194.73 | $126.57 | $68.16 |
| 70030 | $42.06 | $25.24 | $16.82 |
| 70100 | $49.53 | $29.72 | $19.81 |
| 70110 | $61.74 | $37.04 | $24.70 |
| 70120 | $54.96 | $32.98 | $21.98 |
| 70130 | $80.73 | $48.44 | $32.29 |
| 70134 | $77.34 | $46.40 | $30.94 |
| 70140 | $55.64 | $33.38 | $22.26 |
| 70150 | $72.60 | $43.56 | $29.04 |
| 70160 | $48.18 | $28.91 | $19.27 |
| 70170 | $86.16 | $56.00 | $30.16 |
| 70190 | $57.66 | $34.60 | $23.06 |
| 70200 | $74.64 | $44.78 | $29.86 |
| 70210 | $53.61 | $32.17 | $21.44 |
| 70220 | $71.91 | $43.15 | $28.76 |
| 70240 | $44.10 | $26.46 | $17.64 |
| 70250 | $60.39 | $36.23 | $24.16 |
| 70260 | $86.85 | $52.11 | $34.74 |
| 70300 | $25.77 | $15.46 | $10.31 |
| 70310 | $40.71 | $24.43 | $16.28 |
| 70320 | $69.21 | $41.53 | $27.68 |
| 70328 | $47.49 | $28.49 | $19.00 |
| 70330 | $73.95 | $44.37 | $29.58 |
| 70332 | $179.12 | $116.43 | $62.69 |
| 70336 | $768.71 | $614.97 | $153.74 |
| 70350 | $39.36 | $23.62 | $15.74 |
| 70355 | $53.61 | $32.17 | $21.44 |
| 70360 | $42.06 | $25.24 | $16.82 |
| 70370 | $109.92 | $65.95 | $43.97 |
| 70371 | $207.60 | $124.56 | $83.04 |
| 70373 | $149.94 | $97.46 | $52.48 |
| 70380 | $57.00 | $34.20 | $22.80 |
| 70390 | $144.51 | $93.93 | $50.58 |
| 70450 | $367.05 | $256.93 | $110.12 |
| 70460 | $449.82 | $328.37 | $121.45 |
| 70470 | $548.88 | $411.66 | $137.22 |
| 70480 | $407.76 | $285.43 | $122.33 |
| 70481 | $473.58 | $345.71 | $127.87 |
| 70482 | $565.85 | $424.39 | $141.46 |
| 70486 | $394.20 | $275.94 | $118.26 |
| 70487 | $465.44 | $339.77 | $125.67 |
| 70488 | $563.13 | $422.35 | $140.78 |
| 70490 | $407.76 | $285.43 | $122.33 |
| 70491 | $473.58 | $345.71 | $127.87 |
| 70492 | $565.85 | $424.39 | $141.46 |
| 70496 | $685.33 | $506.93 | $178.40 |
| 70498 | $685.33 | $506.93 | $178.40 |
| 70540 | $818.93 | $655.14 | $163.79 |
| 70542 | $1,059.18 | $943.25 | $115.93 |
| 70543 | $1,901.96 | $1,746.30 | $155.66 |
| 70544 | $913.77 | $793.74 | $120.03 |
| 70545 | $913.77 | $793.74 | $120.03 |
| 70546 | $1,744.99 | $1,566.71 | $178.28 |
| 70547 | $913.77 | $793.74 | $120.03 |
| 70548 | $913.77 | $793.74 | $120.03 |
| 70549 | $1,744.99 | $1,566.71 | $178.28 |
| 70551 | $818.93 | $655.14 | $163.79 |
| 70552 | $983.12 | $786.50 | $196.62 |
| 70553 | $1,731.46 | $1,385.17 | $346.29 |
| 70554 | $1,108.05 | $921.14 | $186.91 |
| 70555 | $223.81 | ||
| 70557 | $282.61 | ||
| 70558 | $312.29 | ||
| 70559 | $313.19 | ||
| 71010 | $45.45 | $27.27 | $18.18 |
| 71015 | $52.23 | $31.34 | $20.89 |
| 71020 | $58.35 | $35.01 | $23.34 |
| 71021 | $70.56 | $42.34 | $28.22 |
| 71022 | $73.95 | $44.37 | $29.58 |
| 71023 | $84.12 | $50.47 | $33.65 |
| 71030 | $77.34 | $46.40 | $30.94 |
| 71034 | $130.95 | $78.57 | $52.38 |
| 71035 | $48.84 | $29.30 | $19.54 |
| 71040 | $144.51 | $93.93 | $50.58 |
| 71060 | $204.90 | $133.18 | $71.72 |
| 71090 | $154.02 | $100.11 | $53.91 |
| 71100 | $55.64 | $33.38 | $22.26 |
| 71101 | $67.17 | $40.30 | $26.87 |
| 71110 | $73.95 | $44.37 | $29.58 |
| 71111 | $84.81 | $50.89 | $33.92 |
| 71120 | $58.35 | $35.01 | $23.34 |
| 71130 | $63.09 | $37.85 | $25.24 |
| 71250 | $467.46 | $327.22 | $140.24 |
| 71260 | $545.49 | $398.21 | $147.28 |
| 71270 | $665.58 | $499.18 | $166.40 |
| 71275 | $746.11 | $623.41 | $122.70 |
| 71550 | $830.45 | $664.36 | $166.09 |
| 71551 | $1,073.47 | $944.89 | $128.58 |
| 71552 | $1,908.79 | $1,740.56 | $168.23 |
| 71555 | $844.70 | $675.76 | $168.94 |
| 72010 | $105.15 | $63.09 | $42.06 |
| 72020 | $40.02 | $24.01 | $16.01 |
| 72040 | $57.00 | $34.20 | $22.80 |
| 72050 | $83.46 | $50.08 | $33.38 |
| 72052 | $103.14 | $61.88 | $41.26 |
| 72069 | $50.88 | $30.53 | $20.35 |
| 72070 | $60.39 | $36.23 | $24.16 |
| 72072 | $65.82 | $39.49 | $26.33 |
| 72074 | $75.99 | $45.59 | $30.40 |
| 72080 | $61.74 | $37.04 | $24.70 |
| 72090 | $67.86 | $40.72 | $27.14 |
| 72100 | $61.74 | $37.04 | $24.70 |
| 72110 | $84.81 | $50.89 | $33.92 |
| 72114 | $106.53 | $63.92 | $42.61 |
| 72120 | $75.30 | $45.18 | $30.12 |
| 72125 | $467.46 | $327.22 | $140.24 |
| 72126 | $543.45 | $396.72 | $146.73 |
| 72127 | $655.40 | $491.55 | $163.85 |
| 72128 | $467.46 | $327.22 | $140.24 |
| 72129 | $543.45 | $396.72 | $146.73 |
| 72130 | $655.40 | $491.55 | $163.85 |
| 72131 | $467.46 | $327.22 | $140.24 |
| 72132 | $543.45 | $396.72 | $146.73 |
| 72133 | $655.40 | $491.55 | $163.85 |
| 72141 | $830.45 | $664.36 | $166.09 |
| 72142 | $995.99 | $796.79 | $199.20 |
| 72146 | $905.09 | $724.07 | $181.02 |
| 72147 | $995.99 | $796.79 | $199.20 |
| 72148 | $893.54 | $714.83 | $178.71 |
| 72149 | $983.12 | $786.50 | $196.62 |
| 72156 | $1,750.46 | $1,400.37 | $350.09 |
| 72157 | $1,750.46 | $1,400.37 | $350.09 |
| 72158 | $1,731.46 | $1,385.17 | $346.29 |
| 72159 | $914.58 | $731.66 | $182.92 |
| 72170 | $47.49 | $28.49 | $19.00 |
| 72190 | $61.05 | $36.63 | $24.42 |
| 72191 | $721.79 | $599.09 | $122.70 |
| 72192 | $460.68 | $322.48 | $138.20 |
| 72193 | $523.79 | $382.37 | $141.42 |
| 72194 | $628.26 | $471.19 | $157.07 |
| 72195 | $897.58 | $788.82 | $108.76 |
| 72196 | $830.45 | $664.36 | $166.09 |
| 72197 | $1,917.80 | $1,748.75 | $169.05 |
| 72198 | $844.02 | $675.22 | $168.80 |
| 72200 | $48.18 | $28.91 | $19.27 |
| 72202 | $55.64 | $33.38 | $22.26 |
| 72220 | $50.88 | $30.53 | $20.35 |
| 72240 | $373.83 | $242.99 | $130.84 |
| 72255 | $348.74 | $226.68 | $122.06 |
| 72265 | $326.34 | $212.12 | $114.22 |
| 72270 | $495.29 | $321.94 | $173.35 |
| 72275 | $195.35 | $146.70 | $48.65 |
| 72285 | $586.88 | $381.47 | $205.41 |
| 72291 | $123.83 | ||
| 72292 | $126.89 | ||
| 72295 | $554.99 | $360.74 | $194.25 |
| 73000 | $46.82 | $28.09 | $18.73 |
| 73010 | $48.18 | $28.91 | $19.27 |
| 73020 | $42.75 | $25.65 | $17.10 |
| 73030 | $51.57 | $30.94 | $20.63 |
| 73040 | $179.12 | $116.43 | $62.69 |
| 73050 | $59.70 | $35.82 | $23.88 |
| 73060 | $50.88 | $30.53 | $20.35 |
| 73070 | $46.14 | $27.68 | $18.46 |
| 73080 | $50.88 | $30.53 | $20.35 |
| 73085 | $179.12 | $116.43 | $62.69 |
| 73090 | $46.82 | $28.09 | $18.73 |
| 73092 | $44.79 | $26.87 | $17.92 |
| 73100 | $44.79 | $26.87 | $17.92 |
| 73110 | $48.84 | $29.30 | $19.54 |
| 73115 | $147.24 | $95.71 | $51.53 |
| 73120 | $44.79 | $26.87 | $17.92 |
| 73130 | $48.84 | $29.30 | $19.54 |
| 73140 | $37.98 | $22.79 | $15.19 |
| 73200 | $403.70 | $282.59 | $121.11 |
| 73201 | $467.46 | $341.25 | $126.21 |
| 73202 | $564.50 | $423.37 | $141.13 |
| 73206 | $648.09 | $525.39 | $122.70 |
| 73218 | $884.02 | $786.76 | $97.26 |
| 73219 | $1,059.18 | $943.25 | $115.93 |
| 73220 | $818.93 | $655.14 | $163.79 |
| 73221 | $768.71 | $614.97 | $153.74 |
| 73222 | $1,059.18 | $943.25 | $115.93 |
| 73223 | $1,901.96 | $1,697.64 | $155.66 |
| 73225 | $835.20 | $668.16 | $167.04 |
| 73500 | $44.79 | $26.87 | $17.92 |
| 73510 | $54.96 | $32.98 | $21.98 |
| 73520 | $65.82 | $39.49 | $26.33 |
| 73525 | $179.12 | $116.43 | $62.69 |
| 73530 | $59.04 | $35.42 | $23.62 |
| 73540 | $54.27 | $32.56 | $21.71 |
| 73542 | $192.43 | $143.47 | $48.96 |
| 73550 | $50.88 | $30.53 | $20.35 |
| 73560 | $47.49 | $28.49 | $19.00 |
| 73562 | $52.23 | $31.34 | $20.89 |
| 73564 | $59.04 | $35.42 | $23.62 |
| 73565 | $45.45 | $27.27 | $18.18 |
| 73580 | $211.01 | $137.16 | $73.85 |
| 73590 | $47.49 | $28.49 | $19.00 |
| 73592 | $44.79 | $26.87 | $17.92 |
| 73600 | $44.79 | $26.87 | $17.92 |
| 73610 | $48.84 | $29.30 | $19.54 |
| 73615 | $179.12 | $116.43 | $62.69 |
| 73620 | $44.79 | $26.87 | $17.92 |
| 73630 | $48.84 | $29.30 | $19.54 |
| 73650 | $43.41 | $26.05 | $17.36 |
| 73660 | $37.98 | $22.79 | $15.19 |
| 73700 | $403.70 | $282.59 | $121.11 |
| 73701 | $467.46 | $341.25 | $126.21 |
| 73702 | $564.50 | $423.37 | $141.13 |
| 73706 | $648.09 | $525.39 | $122.70 |
| 73718 | $884.02 | $786.76 | $97.26 |
| 73719 | $1,059.18 | $943.25 | $115.93 |
| 73720 | $818.93 | $655.14 | $163.79 |
| 73721 | $768.71 | $614.97 | $153.74 |
| 73722 | $1,059.18 | $943.25 | $115.93 |
| 73723 | $1,901.96 | $1,746.30 | $155.66 |
| 73725 | $841.31 | $673.05 | $168.26 |
| 74000 | $48.84 | $29.30 | $19.54 |
| 74010 | $57.00 | $34.20 | $22.80 |
| 74020 | $63.78 | $38.27 | $25.51 |
| 74022 | $75.30 | $45.18 | $30.12 |
| 74150 | $455.25 | $318.67 | $136.58 |
| 74160 | $534.63 | $390.28 | $144.35 |
| 74170 | $646.58 | $484.93 | $161.65 |
| 74175 | $721.79 | $599.09 | $122.70 |
| 74176 | $409.70 | $247.84 | $161.86 |
| 74177 | $642.63 | $472.89 | $169.74 |
| 74178 | $812.79 | $625.04 | $187.75 |
| 74181 | $830.45 | $664.36 | $166.09 |
| 74182 | $1,073.47 | $918.72 | $128.58 |
| 74183 | $1,917.80 | $1,748.75 | $169.05 |
| 74185 | $844.02 | $675.22 | $168.80 |
| 74190 | $118.74 | $77.18 | $41.56 |
| 74210 | $105.84 | $63.50 | $42.34 |
| 74220 | $116.01 | $69.61 | $46.40 |
| 74230 | $130.26 | $78.16 | $52.10 |
| 74235 | $271.38 | $176.40 | $94.98 |
| 74240 | $154.68 | $92.81 | $61.87 |
| 74241 | $156.72 | $94.03 | $62.69 |
| 74245 | $231.36 | $138.82 | $92.54 |
| 74246 | $166.23 | $99.74 | $66.49 |
| 74247 | $168.27 | $100.96 | $67.31 |
| 74249 | $242.22 | $145.33 | $96.89 |
| 74250 | $123.48 | $74.09 | $49.39 |
| 74251 | $137.73 | $82.64 | $55.09 |
| 74260 | $138.42 | $83.05 | $55.37 |
| 74261 | $747.19 | $540.82 | $206.37 |
| 74262 | $839.31 | $612.79 | $226.52 |
| 74263 | BR | BR | BR |
| 74270 | $169.62 | $101.77 | $67.85 |
| 74280 | $230.01 | $138.01 | $92.00 |
| 74283 | $347.37 | $208.42 | $138.95 |
| 74290 | $75.30 | $45.18 | $30.12 |
| 74291 | $44.79 | $26.87 | $17.92 |
| 74300 | $99.06 | $64.39 | $34.67 |
| 74301 | $56.31 | $36.60 | $19.71 |
| 74305 | $88.20 | $57.33 | $30.87 |
| 74320 | $242.22 | $157.44 | $84.78 |
| 74327 | $173.70 | $112.90 | $60.80 |
| 74328 | $257.82 | $167.58 | $90.24 |
| 74329 | $257.82 | $167.58 | $90.24 |
| 74330 | $257.82 | $167.58 | $90.24 |
| 74340 | $211.01 | $137.16 | $73.85 |
| 74355 | $232.04 | $150.83 | $81.21 |
| 74360 | $242.22 | $157.44 | $84.78 |
| 74363 | $453.21 | $294.59 | $158.62 |
| 74400 | $148.59 | $89.15 | $59.44 |
| 74410 | $164.88 | $98.93 | $65.95 |
| 74415 | $175.05 | $105.03 | $70.02 |
| 74420 | $193.37 | $116.02 | $77.35 |
| 74425 | $112.62 | $73.20 | $39.42 |
| 74430 | $94.32 | $61.31 | $33.01 |
| 74440 | $105.15 | $68.35 | $36.80 |
| 74445 | $176.40 | $114.66 | $61.74 |
| 74450 | $120.09 | $78.06 | $42.03 |
| 74455 | $126.87 | $82.47 | $44.40 |
| 74470 | $127.56 | $82.91 | $44.65 |
| 74475 | $298.53 | $194.04 | $104.49 |
| 74480 | $298.53 | $194.04 | $104.49 |
| 74485 | $242.22 | $157.44 |