CPT Codes and Fees


TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2014

Surgery, Part 1 (10000-29999)
Surgery, Part 2 (30000-49999)
Surgery, Part 3 (50000-69999)
Assistant Surgery Guide
Radiology
Pathology and Laboratory
Evaluation & Management, Medicine, Physical Therapy

Commission Assigned Codes

N.C. Industrial Commission Assigned Codes

Evaluation & Management, Medicine, Physical Therapy

Effective January 1, 2014

ABBREVIATIONS: 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

OFF

FAC

TC (27)

PC (26)

Units Required

90281

BR

 

 

 

 

 

90283

BR

 

 

 

 

 

90284

BR

 

 

 

 

 

90287

BR

 

 

 

 

 

90288

BR

 

 

 

 

 

90291

BR

 

 

 

 

 

90296

BR

 

 

 

 

 

90371

BR

 

 

 

 

 

90375

BR

 

 

 

 

 

90376

BR

 

 

 

 

 

90378

BR

 

 

 

 

 

90384

BR

 

 

 

 

 

90385

BR

 

 

 

 

 

90386

BR

 

 

 

 

 

90389

BR

 

 

 

 

 

90393

BR

 

 

 

 

 

90396

BR

 

 

 

 

 

90399

BR

 

 

 

 

 

90460

 

$45.96

 

 

 

 

90461

 

$23.05

 

 

 

 

90471

BR

 

 

 

 

 

90472

BR

 

 

 

 

 

90473

BR

 

 

 

 

 

90474

BR

 

 

 

 

 

90476

BR

 

 

 

 

 

90477

BR

 

 

 

 

 

90581

BR

 

 

 

 

 

90585

BR

 

 

 

 

 

90586

BR

 

 

 

 

 

90632

BR

 

 

 

 

 

90633

BR

 

 

 

 

 

90634

BR

 

 

 

 

 

90636

BR

 

 

 

 

 

90644

BR

 

 

 

 

 

90645

BR

 

 

 

 

 

90646

BR

 

 

 

 

 

90647

BR

 

 

 

 

 

90648

BR

 

 

 

 

 

90649

BR

 

 

 

 

 

90650

BR

 

 

 

 

 

90653

BR

 

 

 

 

 

90654 BR          

90655

BR

 

 

 

 

 

90656

BR

 

 

 

 

 

90657

BR

 

 

 

 

 

90658

BR

 

 

 

 

 

90659

BR

 

 

 

 

 

90660

BR

 

 

 

 

 

90661

BR

 

 

 

 

 

90662

BR

 

 

 

 

 

90664

BR

 

 

 

 

 

90666

BR

 

 

 

 

 

90667

BR

 

 

 

 

 

90668

BR

 

 

 

 

 

90669

BR

 

 

 

 

 

90670

BR

 

 

 

 

 

90672

BR

 

 

 

 

 

90673

BR

 

 

 

 

 

90675

BR

 

 

 

 

 

90676

BR

 

 

 

 

 

90680

BR

 

 

 

 

 

90681

BR

 

 

 

 

 

90685

BR

 

 

 

 

 

90686

BR

 

 

 

 

 

90687

BR

 

 

 

 

 

90688

BR

 

 

 

 

 

90690

BR

 

 

 

 

 

90691

BR

 

 

 

 

 

90692

BR

 

 

 

 

 

90693

BR

 

 

 

 

 

90696

BR

 

 

 

 

 

90698

BR

 

 

 

 

 

90700

$25.15

 

 

 

 

 

90702

$13.67

 

 

 

 

 

90703

$12.58

 

 

 

 

 

90704

$22.97

 

 

 

 

 

90705

$20.78

 

 

 

 

 

90706

$21.88

 

 

 

 

 

90707

$28.44

 

 

 

 

 

90708

$25.15

 

 

 

 

 

90710

$34.46

 

 

 

 

 

90712

$13.67

 

 

 

 

 

90713

$26.26

 

 

 

 

 

90714

$24.19

 

 

 

 

 

90715

BR

 

 

 

 

 

90716

$34.46

 

 

 

 

 

90717

$33.37

 

 

 

 

 

90719

$20.78

 

 

 

 

 

90720

$37.75

 

 

 

 

 

90721

BR

 

 

 

 

 

90723

BR

 

 

 

 

 

90725

$14.77

 

 

 

 

 

90727

$20.78

 

 

 

 

 

90732

$18.04

 

 

 

 

 

90733

$39.93

 

 

 

 

 

90734

BR

 

 

 

 

 

90735

$16.40

 

 

 

 

 

90736

BR

 

 

 

 

 

90738

BR

 

 

 

 

 

90739

BR

 

 

 

 

 

90740

BR

 

 

 

 

 

90743

BR

 

 

 

 

 

90744

BR

 

 

 

 

 

90746

BR

 

 

 

 

 

90747

BR

 

 

 

 

 

90748

BR

 

 

 

 

 

90749

BR

 

 

 

 

 

90780

$54.70

 

 

 

 

 

90781

$27.35

 

 

 

 

 

90782

$5.47

 

 

 

 

 

90783

$20.24

 

 

 

 

 

90784

$23.51

 

 

 

 

 

90785

 

$7.28 $7.28

 

 

 

90788

$5.47

 

 

 

 

 

90791

 

$230.38 $181.04

 

 

 

90792

 

$192.13 $187.15

 

 

 

90799

BR

 

 

 

 

 

90832

  $95.97 $76.05      
90833   $64.15 $63.64      
90834   $124.65 $114.19      
90836 $104.20 $104.20
90837   $182.65 $172.19      
90838   $168.25 $167.26
90839 BR          
90840 BR          

90845

$115.96

 

 

 

 

 

90846

$129.07

 

 

 

 

 

90847

$146.58

 

 

 

 

 

90849

$44.86

 

 

 

 

 

90853

$36.64

 

 

 

 

 

90863

BR

 

 

 

 

 

90865

$175.16

 

 

 

 

 

90867

BR

 

 

 

 

 

90868

BR

 

 

 

 

 

90869   $899.83 $234.24      

90870

$129.07

 

 

 

 

 

90871

$188.70

 

 

 

 

 

90875

$71.19

 

 

 

 

YES

90876

$110.74

 

 

 

 

YES

90880

$149.86

 

 

 

 

 

90882

$98.45

 

 

 

 

 

90885

BR

 

 

 

 

 

90887

$95.72

 

 

 

 

 

90889

$80.41

 

 

 

 

 

90899

BR

 

 

 

 

 

90901

$78.00

 

 

 

 

 

90911

$124.00

 

 

 

 

 

90935

$141.11

 

 

 

 

 

90937

$247.76

 

 

 

 

 

90939

BR

 

 

 

 

 

90940

BR

 

 

 

 

 

90945

$132.91

 

 

 

 

 

90947

$221.50

 

 

 

 

 

90951

$1,922.58

 

 

 

 

 

90952

BR

 

 

 

 

 

90953

BR

 

 

 

 

 

90954

$1,578.58

 

 

 

 

 

90955

$893.77

 

 

 

 

 

90956

$605.43

 

 

 

 

 

90957

$1,267.02

 

 

 

 

 

90958

$854.82

 

 

 

 

 

90959

$560.96

 

 

 

 

 

90960

$561.93

 

 

 

 

 

90961

$453.67

 

 

 

 

 

90962

$328.10

 

 

 

 

 

90963

$1,086.05

 

 

 

 

 

90964

$906.30

 

 

 

 

 

90965

$862.05

 

 

 

 

 

90966

$448.87

 

 

 

 

 

90967 $38.85          

90968

$30.32

 

 

 

 

 

90969

$29.58

 

 

 

 

 

90970

$15.68

 

 

 

 

 

90989

$526.69

 

 

 

 

 

90993

$88.05

 

 

 

 

 

90997

$218.23

 

 

 

 

 

90999

PA

 

 

 

 

 

91010

$204.55

 

 

$40.91

$163.64

 

91013

$45.77

 

 

$26.00

$19.78

 

91020

$228.61

 

 

$45.72

$182.89

 

91022

$334.14

 

 

$217.14

$117.00

 

91030

$92.43

 

 

$9.24

$83.19

 

91034

$352.90

 

 

$273.70

$79.20

 

91035

$697.98

 

 

$569.46

$128.51

 

91037

$224.96

 

 

$145.75

$79.20

 

91038

$193.42

 

 

$103.66

$89.75

 

91040

$679.14

 

 

$599.92

$79.20

 

91065

$66.19

 

 

$13.24

$52.95

 

91110

$1,378.53

 

 

 

 

 

91111 $1,085.40     $1,004.97 $80.42  
91112 $1,745.63     $1,574.56 $171.07  

91117

 

$280.51

$298.66

 

 

 

91120

$670.44

 

 

$590.85

$79.60

 

91122

$210.66

 

 

$42.13

$168.53

 

91132

BR

 

 

 

 

 

91133

BR

 

 

 

 

 

91299

BR

 

 

 

 

 

92002

$82.21

 

 

 

 

 

92004

$120.14

 

 

 

 

 

92012

$65.63

 

 

 

 

 

92014

$83.68

 

 

 

 

 

92015

$36.64

 

 

 

 

 

92018

$103.92

 

 

 

 

 

92019

$93.52

 

 

 

 

 

92020

$34.46

 

 

 

 

 

92025

$43.61

 

 

$18.04

$25.56

 

92060

$56.98

 

 

$9.88

$47.10

 

92065

$38.60

 

 

$8.55

$30.05

 

92071   $74.14 $66.33      
92072   $236.45 $190.94      

92081

$35.94

 

 

$8.01

$27.93

 

92082

$49.40

 

 

$10.41

$38.99

 

92083

$71.20

 

 

$15.22

$55.98

 

92100

$61.26

 

 

 

 

 

92132

$72.06

 

 

$30.03

$42.02

 

92133

$88.60

 

 

$30.03

$58.57

 

92134

$88.60

 

 

$30.03

$58.57

 

92136

$113.27

 

 

$71.26

$42.01

 

92140

$41.57

 

 

 

 

 

92225

$53.59

 

 

 

 

 

92226

$47.04

 

 

 

 

 

92227

 

$22.64

 

 

 

 

92228

$59.55

 

 

$24.66

$34.90

 

92230

$67.28

 

 

 

 

 

92235

$128.60

 

 

$54.48

$74.12

 

92240

$132.02

 

 

$49.99

$82.03

 

92250

$45.67

 

 

$9.35

$36.32

 

92260

$54.15

 

 

 

 

 

92265

$57.84

 

 

$12.29

$45.55

 

92270

$78.92

 

 

$16.56

$62.36

 

92275

$101.53

 

 

$21.36

$80.17

 

92283

$24.52

 

 

$6.40

$18.12

 

92284

$36.95

 

 

$9.35

$27.60

 

92285

$26.09

 

 

$5.88

$20.21

 

92286

$101.09

 

 

$21.36

$79.73

 

92287

$120.33

 

 

 

 

 

92310

$127.98

 

 

 

 

 

92311

$102.83

 

 

 

 

 

92312

$125.25

 

 

 

 

 

92313

$93.52

 

 

 

 

 

92314

$75.48

 

 

 

 

 

92315

$57.43

 

 

 

 

 

92316

$84.23

 

 

 

 

 

92317

$43.75

 

 

 

 

 

92325

$19.15

 

 

 

 

 

92326

$78.76

 

 

 

 

 

92341

$51.41

 

 

 

 

 

92342

$57.97

 

 

 

 

 

92352

$35.00

 

 

 

 

 

92353

$46.48

 

 

 

 

 

92354

$422.24

 

 

 

 

 

92355

$205.65

 

 

 

 

 

92358

$47.04

 

 

 

 

 

92370

$35.00

 

 

 

 

 

92371

$30.08

 

 

 

 

 

92499

BR

 

 

 

 

 

92502

$138.38

 

 

 

 

 

92504

$22.97

 

 

 

 

 

92507

$44.86

 

 

 

 

 

92508

$22.97

 

 

 

 

 

92511

$100.96

 

 

 

 

 

92512

$53.59

 

 

 

 

 

92516

$43.21

 

 

 

 

 

92520

$67.81

 

 

 

 

 

92521

 

$174.32

$174.32

 

 

 

92522

 

$141.88

$141.88

 

 

 

92523

 

$294.16

$294.16

 

 

 

92524

 

$147.10

$147.10

 

 

 

92526

$52.43

 

 

 

 

 

92531

$25.15

 

 

 

 

 

92532

$36.64

 

 

 

 

 

92533

$57.43

 

 

 

 

 

92534

$28.44

 

 

 

 

 

92540

$185.21

 

 

$31.42

$153.80

 

92541

$56.33

 

 

$11.27

$45.06

 

92542

$49.22

 

 

$9.84

$39.38

 

92543

$62.90

 

 

$12.58

$50.32

 

92544

$38.28

 

 

$7.66

$30.62

 

92545

$32.82

 

 

$6.56

$26.26

 

92546

$42.66

 

 

$8.53

$34.13

 

92547

$27.89

 

 

$5.58

$22.31

 

92548

$119.05

 

 

$71.98

$47.07

 

92551

$16.40

 

 

 

 

 

92552

$21.88

 

 

 

 

 

92553

$32.82

 

 

 

 

 

92555

$18.60

 

 

 

 

 

92556

$28.44

 

 

 

 

 

92557

$59.08

 

 

 

 

 

92558 BR          

92559

$48.13

 

 

 

 

 

92560

$28.44

 

 

 

 

 

92561

$35.55

 

 

 

 

 

92562

$20.24

 

 

 

 

 

92563

$18.60

 

 

 

 

 

92564

$23.51

 

 

 

 

 

92565

$19.69

 

 

 

 

 

92567

$26.26

 

 

 

 

 

92568

$18.60

 

 

 

 

 

92570

$61.31

$57.87

 

 

 

 

92571

$19.15

 

 

 

 

 

92572

$4.38

 

 

 

 

 

92575

$15.31

 

 

 

 

 

92576

$21.88

 

 

 

 

 

92577

$35.55

 

 

 

 

 

92579

$36.33

 

 

 

 

 

92582

$36.10

 

 

 

 

 

92583

$44.30

 

 

 

 

 

92584

$123.07

 

 

 

 

 

92585

$195.26

 

 

$97.63

$97.63

 

92586

$107.06

 

 

 

 

 

92587

$82.29

 

 

$69.44

$12.85

 

92588

$113.67

 

 

$78.53

$35.14

 

92589

$26.80

 

 

 

 

 

92590

$74.39

 

 

 

 

 

92591

$97.36

 

 

 

 

 

92592

$27.35

 

 

 

 

 

92593

$51.41

 

 

 

 

 

92594

$27.35

 

 

 

 

 

92595

$51.41

 

 

 

 

 

92596

$28.99

 

 

 

 

 

92597

$112.33

 

 

 

 

 

92601

$191.46

 

 

 

 

 

92602

$134.11

 

 

 

 

 

92603

$128.69

 

 

 

 

 

92604

$87.56

 

 

 

 

 

92605

BR

 

 

 

 

 

92606

BR

 

 

 

 

 

92607

$159.93

 

 

 

 

 

92608

$31.14

 

 

 

 

 

92609

$86.54

 

 

 

 

 

92610

$60.86

 

 

 

 

 

92611

$66.27

 

 

 

 

 

92612

 

$255.83

$101.07

 

 

YES

92613

BR

 

 

 

 

 

92614

 

$197.93

$101.07

 

 

YES

92615

BR

 

 

 

 

 

92616

 

$271.82

$147.90

 

 

YES

92617

BR

 

 

 

 

 

92618 BR          

92620

$65.44

 

 

 

 

 

92621

$16.14

 

 

 

 

 

92625

$64.33

 

 

 

 

 

92626

$123.49

 

 

 

 

 

92627

$31.06

 

 

 

 

 

92630

BR

 

 

 

 

 

92633

BR

 

 

 

 

 

92640 $77.67          

92700

BR

 

 

 

 

 

92920

 

$809.13 $809.13

 

 

 

92921

BR

 

 

 

 

 

92924

 

$961.81 $961.81

 

 

 

92925

BR

 

 

 

 

 

92928

 

$898.45 $898.45

 

 

 

92929

BR

 

 

 

 

 

92933

 

$1,004.71 $1,004.71

 

 

 

92934

BR

 

 

 

 

 

92937

 

$897.42 $897.42

 

 

 

92938

BR

 

 

 

 

 

92941

 

$1,006.65 $1,006.65

 

 

 

92943

 

$1,006.65 $1,006.65

 

 

 

92944

BR

 

 

 

 

 

92950

$318.32

 

 

 

 

 

92953

$70.55

 

 

 

 

 

92960

$216.59

 

 

 

 

 

92961

$349.35

 

 

 

 

 

92970

$368.63

 

 

 

 

 

92971

$150.95

 

 

 

 

 

92973

$260.70

 

 

 

 

 

92974

$273.69

 

 

 

 

 

92975

$678.20

 

 

 

 

 

92977

$394.34

 

 

 

 

 

92978

$359.67

 

 

$220.06

$139.61

 

92979

$221.96

 

 

$110.27

$111.69

 

92986

$1,698.23

 

 

 

 

 

92987

$1,733.64

 

 

 

 

 

92990

$1,353.67

 

 

 

 

 

92992

$3,429.18

 

 

 

 

 

92993

$2,402.67

 

 

 

 

 

92997

$1,357.01

 

 

 

 

 

92998

$524.43

 

 

 

 

 

93000

$39.37

 

 

$23.62

$15.75

 

93005

$21.88

 

 

 

 

 

93010

$16.95

 

 

$0.00

$16.95

 

93015

$161.89

 

 

$80.94

$80.95

 

93016

$43.75

 

 

 

 

 

93017

$82.03

 

 

 

 

 

93018

$35.55

 

 

 

 

 

93024

$194.70

 

 

$77.88

$116.82

 

93025

$387.21

 

 

 

 

 

93040

$21.88

 

 

$7.66

$14.22

 

93041

$7.11

 

 

 

 

 

93042

$14.77

 

 

 

 

 

93224

$230.81

 

 

$138.49

$92.32

 

93225

$60.70

 

 

$60.70

$0.00

 

93226

$107.20

 

 

 

 

 

93227

$63.44

 

 

 

 

 

93228

$51.25

 

 

 

 

 

93229

BR

 

 

 

 

 

93268

$226.43

 

 

$135.86

$90.57

 

93270

$60.70

 

 

 

 

 

93271

$117.05

 

 

 

 

 

93272

$48.68

 

 

$0.00

$48.68

 

93278

$104.47

 

 

$62.68

$41.79

 

93279

$108.85

 

 

$36.94

$71.91

 

93280

$128.98

 

 

$42.64

$86.33

 

93281

$150.79

 

 

$50.00

$100.80

 

93282

$139.30

 

 

$45.18

$94.12

 

93283

$169.76

 

 

$51.38

$118.39

 

93284

$199.04

 

 

$58.24

$140.80

 

93285

$93.69

 

 

$34.88

$58.81

 

93286

$53.02

 

 

$22.93

$30.10

 

93287

$70.14

 

 

$25.94

$44.21

 

93288

$83.78

 

 

$35.56

$48.22

 

93289

$129.72

 

 

$42.64

$87.08

 

93290

$62.27

 

 

$19.76

$42.52

 

93291

$80.36

 

 

$31.66

$48.70

 

93292

$72.78

 

 

$24.56

$48.22

 

93293

$113.07

 

 

$79.41

$33.66

 

93294

$73.07

 

 

 

 

 

93295

$132.11

 

 

 

 

 

93296

$69.20

 

 

 

 

 

93297

$51.25

 

 

 

 

 

93298

$58.81

 

 

 

 

 

93299

BR

 

 

 

 

 

93303

$300.01

 

 

$186.93

$113.08

 

93304

$164.33

 

 

$94.07

$70.26

 

93306

$509.19

 

 

$366.04

$143.15

 

93307

$336.93

 

 

$237.62

$99.31

 

93308

$162.22

 

 

$102.54

$59.68

 

93312

$339.65

 

 

$186.81

$152.84

 

93313

$85.32

 

 

$0.00

$85.32

 

93314

$271.82

 

 

$163.09

$108.73

 

93315

$385.83

 

 

$184.40

$201.43

 

93316

$79.52

 

 

 

 

 

93317

$305.82

 

 

$184.40

$121.42

 

93318

BR

 

 

 

 

 

93320

$131.80

 

 

$79.08

$52.72

 

93321

$73.83

 

 

$44.30

$29.53

 

93325

$148.77

 

 

$89.26

$59.51

 

93350

$227.52

 

 

$136.51

$91.01

 

93351

$530.43

 

 

 

 

 

93352

$73.73