CPT Codes and Fees: 2014 CPT Codes


Bernadine Singh
Chief Medical Fee Examiner
N.C. Industrial Commission
E-mail: Bernadine.Singh@ic.nc.gov

NOTE 1: To purchase a complete copy of the American Medical Association’s Current Procedural Technology Codes, telephone OptumInsight™ at (800) 464-3649, option 1, or go to http://www.optumcoding.com/ to order a CPT® code book online.

NOTE 2: Please report any problems or errors directly to Bernadine.Singh@ic.nc.gov.

NOTE 3: This page was last revised on June 5, 2014.


TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2014

Surgery
Assistant Surgery Guide
Radiology
Pathology and Laboratory
Evaluation & Management, Medicine, Physical Therapy

Commission Assigned Codes

N.C. Industrial Commission Assigned Codes

NOTE: Click here to view the 2012 CPT Codes and 2013 CPT Codes.

Update to Workers’ Compensation Medical Fee Schedule: 2014 CPT Codes

The American Medical Association has released its 2014 Current Procedural Terminology (CPT Codes). As a result, the North Carolina Industrial Commission is publishing the attached fees for these CPT Codes on our website at http://www.ic.nc.gov/ncic/pages/commcode.htm, effective January 1, 2014. We also have deleted the codes that the American Medical Association no longer recognizes. Effective January 1, 2010, providers may no longer use the deleted codes for billing purposes. Please see our website at http://www.ic.nc.gov/ncic/pages/feesec13.htm for the 2007-08 updates to the Dental Fee Schedule. In addition, the new mileage rate for trips taken on or after January 1, 2014, for medical treatment in workers’ compensation cases is $0.56 a mile, provided the roundtrip is 20 miles or more. You may access the new form by clicking here: http://www.ic.nc.gov/forms/form25t.pdf.

The National Uniform Claim Committee (NUCC) revised the CMS-1500 form in 2012. CMS discontinued acceptance of the CMS-1500 (08-05), effective April 1, 2014, and adopted the new CMS-1500 (02-12). Effective April 1, 2014, the Industrial Commission requires that providers who submit paper medical bills to carriers and third-party administrators use the CMS-1500 (02-12). As outlined in the Federal Regulation, the National Provider Identifier (NPI) is a 10-position numeric identifier, with a check digit in the 10th position, and no intelligence about the health care provider in the number. A health care provider must comply with the implementation specifications in §162.410 for the new NPI no later than May 23, 2007. In addition, The National Uniform Claim Committee (NUCC) released updates to the Health Care Provider Taxonomy Code List that became effective on April 1, 2006. Additional information concerning these mandatory changes can be located by clicking on the following links:

UB-04: http://www.cms.hhs.gov/Transmittals/downloads/R1104CP.pdf

CMS-1500 (02-12): http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02.pdf

NPI: http://www.cms.hhs.gov/NationalProvIdentStand/

Taxonomy: http://www.nucc.org/content/view/26/0/

Thank you in advance for your anticipated cooperation in instituting these mandatory changes.


2014 CPT Codes Added

Effective January 1, 2014

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.


CPT Codes Deleted for 2014

Effective January 1, 2014

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.
 

CPT Code Explanation of Deletion
13150 Code deleted
19102 Code deleted - see 19081-19086
19103 Code deleted - see 19081-19086
19290 Code deleted
19291 Code deleted
19295 Code deleted
23331 Code deleted - see 23330, 23333
23332 Code deleted - see 23330, 23333
32201 Code deleted
37204 Code deleted - see 37241, 37242, 37243, 37244
37205 Code deleted - see 37236-37239
37206 Code deleted - see 37236-37239
37207 Code deleted - see 37236-37239
37208 Code deleted - see 37236-37239
37209 Code deleted
37210 Code deleted - see 36243
42802 Code deleted
43219 Code deleted - see 43212
43228 Code deleted - see 43229
43267 Code deleted - see 43274
43268 Code deleted - see 43274
43269 Code deleted - see 43275, 43276
43271 Code deleted - see 43277
43272 Code deleted - see 43278
43456 Code deleted - see 43213
43458 Code deleted - see 43214, 43233
44901 Code deleted
47011 Code deleted
48511 Code deleted
49021 Code deleted
49041 Code deleted
49061 Code deleted
50021 Code deleted
58823 Code deleted
64613 Code deleted - see 64616
64614 Code deleted - see 64642 - 64647
75960 Code deleted
77031 Code deleted
77032 Code deleted
92506 Code deleted - see 92521 - 92524

©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.


N.C. Industrial Commission ·  Medical Fees Section
4337 Mail Service Center ·  Raleigh, NC 27699-4337
Telephone: (919) 807-2503 ·  Fax: (919) 715-0280
NCIC Home Page: http://www.ic.nc.gov/