|
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 |
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 |
|
|
|
|
|
|
90379 |
BR |
|
|
|
|
|
|
90384 |
BR |
|
|
|
|
|
|
90385 |
BR |
|
|
|
|
|
|
90386 |
BR |
|
|
|
|
|
|
90389 |
BR |
|
|
|
|
|
|
90393 |
BR |
|
|
|
|
|
|
90396 |
BR |
|
|
|
|
|
|
90399 |
BR |
|
|
|
|
|
|
90460 |
|
$45.96 |
|
|
|
|
|
90461 |
|
$23.05 |
|
|
|
|
|
90470 |
BR |
|
|
|
|
|
|
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 |
|
|
|
|
|
|
90655 |
BR |
|
|
|
|
|
|
90656 |
BR |
|
|
|
|
|
|
90657 |
BR |
|
|
|
|
|
|
90658 |
BR |
|
|
|
|
|
|
90659 |
BR |
|
|
|
|
|
|
90660 |
BR |
|
|
|
|
|
|
90661 |
BR |
|
|
|
|
|
|
90662 |
BR |
|
|
|
|
|
|
90663 |
BR |
|
|
|
|
|
|
90664 |
BR |
|
|
|
|
|
|
90665 |
BR |
|
|
|
|
|
|
90666 |
BR |
|
|
|
|
|
|
90667 |
BR |
|
|
|
|
|
|
90668 |
BR |
|
|
|
|
|
|
90669 |
BR |
|
|
|
|
|
|
90670 |
BR |
|
|
|
|
|
|
90675 |
BR |
|
|
|
|
|
|
90676 |
BR |
|
|
|
|
|
|
90680 |
BR |
|
|
|
|
|
|
90681 |
BR |
|
|
|
|
|
|
90690 |
BR |
|
|
|
|
|
|
90691 |
BR |
|
|
|
|
|
|
90692 |
BR |
|
|
|
|
|
|
90693 |
BR |
|
|
|
|
|
|
90696 |
BR |
|
|
|
|
|
|
90698 |
BR |
|
|
|
|
|
|
90700 |
$25.15 |
|
|
|
|
|
|
90701 |
$20.78 |
|
|
|
|
|
|
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 |
|
|
|
|
|
|
90718 |
$11.49 |
|
|
|
|
|
|
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 |
|
|
|
|
|
|
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 |
|
|
|
|
|
|
90788 |
$5.47 |
|
|
|
|
|
|
90799 |
BR |
|
|
|
|
|
|
90801 |
$151.51 |
|
|
|
|
|
|
90802 |
$176.99 |
|
|
|
|
|
|
90804 |
$77.33 |
|
|
|
|
|
|
90805 |
$95.91 |
|
|
|
|
|
|
90806 |
$120.29 |
|
|
|
|
|
|
90807 |
$134.22 |
|
|
|
|
|
|
90808 |
$202.56 |
|
|
|
|
|
|
90809 |
$222.69 |
|
|
|
|
|
|
90810 |
$95.35 |
|
|
|
|
|
|
90811 |
$115.48 |
|
|
|
|
|
|
90812 |
$129.92 |
|
|
|
|
|
|
90813 |
$144.90 |
|
|
|
|
|
|
90814 |
$187.21 |
|
|
|
|
|
|
90815 |
$208.89 |
|
|
|
|
|
|
90816 |
$84.04 |
|
|
|
|
|
|
90817 |
$105.20 |
|
|
|
|
|
|
90818 |
$131.12 |
|
|
|
|
|
|
90819 |
$146.61 |
|
|
|
|
|
|
90821 |
$219.59 |
|
|
|
|
|
|
90822 |
$242.31 |
|
|
|
|
|
|
90823 |
$102.57 |
|
|
|
|
|
|
90824 |
$125.28 |
|
|
|
|
|
|
90826 |
$141.28 |
|
|
|
|
|
|
90827 |
$158.32 |
|
|
|
|
|
|
90828 |
$205.29 |
|
|
|
|
|
|
90829 |
$230.06 |
|
|
|
|
|
|
90845 |
$115.96 |
|
|
|
|
|
|
90846 |
$129.07 |
|
|
|
|
|
|
90847 |
$146.58 |
|
|
|
|
|
|
90849 |
$44.86 |
|
|
|
|
|
|
90853 |
$36.64 |
|
|
|
|
|
|
90857 |
$30.62 |
|
|
|
|
|
|
90862 |
$70.01 |
|
|
|
|
|
|
90865 |
$175.16 |
|
|
|
|
|
|
90867 |
BR |
|
|
|
|
|
|
90868 |
BR |
|
|
|
|
|
|
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 |
|
|
|
|
|
|
90968 |
$30.32 |
|
|
|
|
|
|
90969 |
$29.58 |
|
|
|
|
|
|
90970 |
$15.68 |
|
|
|
|
|
|
90989 |
$526.69 |
|
|
|
|
|
|
90993 |
$88.05 |
|
|
|
|
|
|
90997 |
$218.23 |
|
|
|
|
|
|
90999 |
BR |
|
|
|
|
|
|
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 |
|
|
|
|
|
|
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 |
|
|
|
|
|
|
92060 |
$56.98 |
|
|
$9.88 |
$47.10 |
|
|
92065 |
$38.60 |
|
|
$8.55 |
$30.05 |
|
|
92070 |
$98.45 |
|
|
|
|
|
|
92081 |
$35.94< |