Bernadine Singh
Chief Medical Fee Examiner
N.C. Industrial Commission
E-mail: Bernadine.Singh@ic.nc.gov
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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 23, 2015. |
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CPT Codes and Fees, |
| Surgery |
| Assistant Surgery Guide |
| Radiology |
| Pathology and Laboratory |
| Evaluation & Management, Medicine, Physical Therapy |
|
Commission Assigned Codes |
| N.C. Industrial Commission Assigned Codes |
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NOTE: Click here to view the 2013 CPT Codes and the 2014 CPT Codes. |
The American Medical Association has released its 2015 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, 2015. 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, 2016, for medical treatment in workers’ compensation cases is $0.54 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.
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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 |
| 20604 | $143.81 | $93.81 | 0 | 3 | yes | ||||
| 20606 | $159.22 | $107.16 | 0 | 3 | yes | ||||
| 20611 | $183.11 | $125.58 | 0 | 3 | yes | ||||
| 20983 | $13,467.70 | $807.75 | 0 | 3 | yes | ||||
| 21811 | $1,225.86 | $1,225.86 | 0 | 3 | yes | ||||
| 21812 | $1,469.91 | $1,469.91 | 0 | 3 | yes | ||||
| 21813 | $2,000.40 | $2,000.40 | 0 | 3 | yes | ||||
| 22510 | $3,461.97 | $928.19 | 10 | 3 | yes | ||||
| 22511 | $3,428.11 | $871.05 | 10 | 3 | yes | ||||
| 22512 | $1,922.29 | $432.44 | 0 | 3 | yes | ||||
| 22513 | $14,314.07 | $1,097.90 | 10 | 3 | yes | ||||
| 22514 | $14,236.99 | $1,022.87 | 10 | 3 | yes | ||||
| 22515 | $8,634.37 | $463.13 | 0 | 3 | yes | ||||
| 22858 | $1,008.08 | $1,008.08 | 0 | 3 | yes | ||||
| 27279 | $1,132.36 | $1,132.36 | 90 | 3 | yes | ||||
| 33270 | $1,190.68 | $1,190.68 | 90 | 3 | yes | ||||
| 33271 | $1,001.22 | $1,001.22 | 90 | 3 | no | ||||
| 33272 | $736.37 | $736.37 | 90 | 3 | no | ||||
| 33273 | $811.68 | $811.68 | 90 | 3 | yes | ||||
| 33418 | $3,780.86 | $3,780.86 | 90 | 3 | yes | ||||
| 33419 | $889.49 | $889.49 | 0 | 3 | yes | ||||
| 33946 | $633.26 | $633.26 | 0 | 3 | yes | ||||
| 33947 | $699.45 | $699.45 | 0 | 3 | yes | ||||
| 33948 | $500.70 | $500.70 | 0 | 3 | yes | ||||
| 33951 | $902.26 | $902.26 | 0 | 3 | yes | ||||
| 33952 | $878.45 | $878.45 | 0 | 3 | yes | ||||
| 33953 | $1,006.78 | $1,006.78 | 0 | 3 | yes | ||||
| 33954 | $981.34 | $981.34 | 0 | 3 | yes | ||||
| 33955 | $1,816.76 | $1,816.76 | 0 | 3 | yes | ||||
| 33956 | $1,720.86 | $1,720.86 | 0 | 3 | yes | ||||
| 33957 | $403.43 | $403.43 | 0 | 3 | yes | ||||
| 33958 | $390.41 | $390.41 | 0 | 3 | yes | ||||
| 33959 | $512.49 | $512.49 | 0 | 3 | no | ||||
| 33962 | $481.67 | $481.67 | 0 | 3 | no | ||||
| 33963 | $1,023.82 | $1,023.82 | 0 | 3 | no | ||||
| 33964 | $1,048.68 | $1,048.68 | 0 | 3 | no | ||||
| 33965 | $403.43 | $403.43 | 0 | 3 | no | ||||
| 33966 | $485.13 | $485.13 | 0 | 3 | no | ||||
| 33969 | $594.95 | $594.95 | 0 | 3 | no | ||||
| 33984 | $584.53 | $584.53 | 0 | 3 | no | ||||
| 33985 | $1,120.45 | $1,120.45 | 0 | 3 | no | ||||
| 33986 | $1,065.86 | $1,065.86 | 0 | 3 | no | ||||
| 33987 | $427.57 | $427.57 | 0 | 3 | no | ||||
| 33988 | $1,590.20 | $1,590.20 | 0 | 3 | no | ||||
| 33989 | $1,010.97 | $1,010.97 | 0 | 3 | no | ||||
| 34839 | BR | 3 | |||||||
| 37218 | $1,688.19 | $1,688.19 | 90 | 3 | no | ||||
| 43180 | $1,136.25 | $1,136.25 | 90 | 3 | no | ||||
| 44381 | BR | 3 | |||||||
| 44384 | BR | 3 | |||||||
| 44401 | BR | 3 | |||||||
| 44402 | BR | 3 | |||||||
| 44403 | BR | 3 | |||||||
| 44404 | BR | 3 | |||||||
| 44405 | BR | 3 | |||||||
| 44406 | BR | 3 | |||||||
| 44407 | BR | 3 | |||||||
| 44408 | BR | 3 | |||||||
| 45346 | BR | 3 | |||||||
| 45347 | BR | 3 | |||||||
| 45349 | BR | 3 | |||||||
| 45350 | BR | 3 | |||||||
| 45388 | BR | 3 | |||||||
| 45389 | BR | 3 | |||||||
| 45390 | BR | 3 | |||||||
| 45393 | BR | 3 | |||||||
| 45398 | BR | 3 | |||||||
| 45399 | BR | 3 | |||||||
| 46601 | BR | 3 | |||||||
| 46607 | BR | 3 | |||||||
| 47383 | $14,798.28 | $986.18 | 10 | 3 | no | ||||
| 52441 | $2,407.60 | $464.98 | 0 | 3 | yes | ||||
| 52442 | $1,832.74 | $124.38 | 0 | 3 | |||||
| 62302 | $484.66 | $255.87 | 0 | 3 | |||||
| 62303 | $503.16 | $259.29 | 0 | 3 | |||||
| 62304 | $478.29 | $251.55 | 0 | 3 | |||||
| 62305 | $521.84 | $263.60 | 0 | 3 | |||||
| 64486 | $247.16 | $129.35 | 0 | 3 | |||||
| 64487 | $301.54 | $148.79 | 0 | 3 | |||||
| 64488 | $304.10 | $162.31 | 0 | 3 | |||||
| 64489 | $420.55 | $182.17 | 0 | 3 | |||||
| 66179 | $2,147.86 | $2,147.86 | 90 | 3 | |||||
| 66184 | $1,561.03 | $1,561.03 | 90 | 3 | |||||
| 76641 | $202.33 | $130.89 | $71.44 | 4 | |||||
| 76642 | $166.89 | $100.25 | $66.64 | 4 | |||||
| 77061 | BR | 4 | |||||||
| 77063 | $104.80 | $46.80 | $58.00 | 4 | |||||
| 77085 | $104.21 | $74.83 | $29.38 | 4 | |||||
| 77086 | $65.78 | $48.76 | $17.01 | 4 | |||||
| 77306 | $271.34 | $133.50 | $137.85 | 4 | |||||
| 77307 | $531.73 | $244.71 | $287.02 | 4 | |||||
| 77316 | $346.06 | $208.21 | $137.85 | 4 | |||||
| 77317 | $452.64 | $271.32 | $181.32 | 4 | |||||
| 77318 | $655.35 | $368.32 | $287.02 | 4 | |||||
| 77385 | BR | 4 | |||||||
| 77386 | BR | 4 | |||||||
| 77387 | BR | 4 | |||||||
| 80163 | BR | 5 | |||||||
| 80165 | BR | 5 | |||||||
| 80300 | BR | 5 | |||||||
| 80301 | BR | 5 | |||||||
| 80302 | BR | 5 | |||||||
| 80303 | BR | 5 | |||||||
| 80304 | BR | 5 | |||||||
| 80320 | BR | 5 | |||||||
| 80321 | BR | 5 | |||||||
| 80322 | BR | 5 | |||||||
| 80323 | BR | 5 | |||||||
| 80324 | BR | 5 | |||||||
| 80325 | BR | 5 | |||||||
| 80326 | BR | 5 | |||||||
| 80327 | BR | 5 | |||||||
| 80328 | BR | 5 | |||||||
| 80329 | BR | 5 | |||||||
| 80330 | BR | 5 | |||||||
| 80331 | BR | 5 | |||||||
| 80332 | BR | 5 | |||||||
| 80333 | BR | 5 | |||||||
| 80334 | BR | 5 | |||||||
| 80335 | BR | 5 | |||||||
| 80336 | BR | 5 | |||||||
| 80337 | BR | 5 | |||||||
| 80338 | BR | 5 | |||||||
| 80339 | BR | 5 | |||||||
| 80340 | BR | 5 | |||||||
| 80341 | BR | 5 | |||||||
| 80342 | BR | 5 | |||||||
| 80343 | BR | 5 | |||||||
| 80344 | BR | 5 | |||||||
| 80345 | BR | 5 | |||||||
| 80346 | BR | 5 | |||||||
| 80347 | BR | 5 | |||||||
| 80348 | BR | 5 | |||||||
| 80349 | BR | 5 | |||||||
| 80350 | BR | 5 | |||||||
| 80351 | BR | 5 | |||||||
| 80352 | BR | 5 | |||||||
| 80353 | BR | 5 | |||||||
| 80354 | BR | 5 | |||||||
| 80355 | BR | 5 | |||||||
| 80356 | BR | 5 | |||||||
| 80357 | BR | 5 | |||||||
| 80358 | BR | 5 | |||||||
| 80359 | BR | 5 | |||||||
| 80360 | BR | 5 | |||||||
| 80361 | BR | 5 | |||||||
| 80362 | BR | 5 | |||||||
| 80363 | BR | 5 | |||||||
| 80364 | BR | 5 | |||||||
| 80365 | BR | 5 | |||||||
| 80366 | BR | 5 | |||||||
| 80367 | BR | 5 | |||||||
| 80368 | BR | 5 | |||||||
| 80369 | BR | 5 | |||||||
| 80370 | BR | 5 | |||||||
| 80371 | BR | 5 | |||||||
| 80372 | BR | 5 | |||||||
| 80373 | BR | 5 | |||||||
| 80374 | BR | 5 | |||||||
| 80375 | BR | 5 | |||||||
| 80376 | BR | 5 | |||||||
| 80377 | BR | 5 | |||||||
| 81246 | BR | 5 | |||||||
| 81288 | BR | 5 | |||||||
| 81313 | BR | 5 | |||||||
| 81410 | BR | 5 | |||||||
| 81411 | BR | 5 | |||||||
| 81415 | BR | 5 | |||||||
| 81416 | BR | 5 | |||||||
| 81417 | BR | 5 | |||||||
| 81420 | BR | 5 | |||||||
| 81425 | BR | 5 | |||||||
| 81426 | BR | 5 | |||||||
| 81427 | BR | 5 | |||||||
| 81430 | BR | 5 | |||||||
| 81431 | BR | 5 | |||||||
| 81435 | BR | 5 | |||||||
| 81436 | BR | 5 | |||||||
| 81440 | BR | 5 | |||||||
| 81445 | BR | 5 | |||||||
| 81450 | BR | 5 | |||||||
| 81455 | BR | 5 | |||||||
| 81460 | BR | 5 | |||||||
| 81465 | BR | 5 | |||||||
| 81470 | BR | 5 | |||||||
| 81471 | BR | 5 | |||||||
| 81519 | BR | 5 | |||||||
| 83006 | BR | 5 | |||||||
| 87505 | BR | 5 | |||||||
| 87506 | BR | 5 | |||||||
| 87507 | BR | 5 | |||||||
| 87623 | BR | 5 | |||||||
| 87624 | BR | 5 | |||||||
| 87625 | BR | 5 | |||||||
| 87806 | BR | 5 | |||||||
| 88341 | $125.01 | $83.30 | $41.71 | 5 | |||||
| 88344 | $216.66 | $140.00 | $76.66 | 5 | |||||
| 88364 | $179.65 | $127.64 | $52.02 | 5 | |||||
| 88366 | $278.28 | $157.60 | $120.68 | 5 | |||||
| 88369 | $136.61 | $88.51 | $48.10 | 5 | |||||
| 88373 | $112.03 | $71.58 | $40.45 | 5 | |||||
| 88374 | $377.14 | $290.57 | $86.57 | 5 | |||||
| 88377 | $396.39 | $270.36 | $126.03 | 5 | |||||
| 89337 | BR | 5 | |||||||
| 90630 | BR | 1 | |||||||
| 90651 | BR | 1 | |||||||
| 91200 | $67.07 | $38.98 | $28.09 | 1 | |||||
| 92145 | $29.28 | $12.27 | $17.01 | 1 | |||||
| 93260 | $126.89 | $40.94 | $85.95 | 1 | |||||
| 93261 | $115.93 | $40.94 | $74.99 | 1 | |||||
| 93355 | $223.62 | $223.62 | 1 | ||||||
| 93644 | $560.87 | $194.65 | $366.23 | 1 | |||||
| 93702 | $106.35 | $106.35 | 1 | ||||||
| 93895 | BR | 1 | |||||||
| 96127 | $7.79 | $7.79 | 1 | ||||||
| 97606 | $78.07 | $46.55 | 1 | ||||||
| 97607 | BR | 1 | |||||||
| 97608 | BR | 1 | |||||||
| 99184 | $361.93 | $361.93 | 1 | ||||||
| 99188 | BR | 1 |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.
|
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 |
| 21800 | Code deleted |
| 21810 | Code deleted - see 21899 |
| 22520 | Code deleted - see 22510-22515 |
| 22521 | Code deleted - see 22510-22515 |
| 22522 | Code deleted - see 22510-22515 |
| 22523 | Code deleted - see 22510-22515 |
| 22524 | Code deleted - see 22510-22515 |
| 22525 | Code deleted - see 22510-22515 |
| 29020 | Code deleted |
| 29025 | Code deleted |
| 29715 | Code deleted |
| 33332 | Code deleted |
| 33472 | Code deleted |
| 33960 | Code deleted - see 33946-33949 |
| 33961 | Code deleted - see 33948, 33949 |
| 36469 | Code deleted |
| 36822 | Code deleted - see 33951-33956 |
| 42508 | Code deleted |
| 43350 | Code deleted |
| 44383 | Code deleted - see 44384 |
| 44393 | Code deleted - see 44401 |
| 44397 | Code deleted - see 44402 |
| 45339 | Code deleted - see 45346 |
| 45345 | Code deleted - see 44547 |
| 45355 | Code deleted - see 45399 |
| 45383 | Code deleted - see 45388 |
| 45387 | Code deleted - see 45389 |
| 61334 | Code deleted |
| 61440 | Code deleted |
| 61470 | Code deleted |
| 61490 | Code deleted |
| 61542 | Code deleted |
| 61609 | Code deleted |
| 61875 | Code deleted |
| 62116 | Code deleted |
| 64752 | Code deleted |
| 64761 | Code deleted |
| 64870 | Code deleted |
| 66165 | Code deleted |
| 69400 | Code deleted - see 69799 |
| 69401 | Code deleted |
| 69405 | Code deleted - see 69799 |
| 72291 | Code deleted |
| 72292 | Code deleted |
| 74291 | Code deleted |
| 76645 | Code deleted - see 76641, 76642 |
| 76950 | Code deleted - see 77387 |
| 77082 | Code deleted - see 77086 |
| 77305 | Code deleted - see 77306 |
| 77310 | Code deleted - see 77306, 77307 |
| 77315 | Code deleted - see 77307 |
| 77326 | Code deleted - see 77316 |
| 77327 | Code deleted - see 77317 |
| 77328 | Code deleted - see 77318 |
| 77403 | Code deleted - see 77402 |
| 77404 | Code deleted - see 77402 |
| 77406 | Code deleted - see 77402 |
| 77408 | Code deleted - see 77407 |
| 77409 | Code deleted - see 77407 |
| 77411 | Code deleted - see 77407 |
| 77413 | Code deleted - see 77412 |
| 77414 | Code deleted - see 77412 |
| 77416 | Code deleted - see 77412 |
| 77418 | Code deleted |
| 77421 | Code deleted - see 77387 |
| 80100 | Code deleted - see 80300-80304 |
| 80101 | Code deleted - see 80300-80304 |
| 80102 | Code deleted - see 80300-80304 |
| 80103 | Code deleted - see 80300-80304 |
| 80104 | Code deleted - see 80300-80304 |
| 80152 | Code deleted |
| 80154 | Code deleted |
| 80160 | Code deleted |
| 80166 | Code deleted |
| 80172 | Code deleted |
| 80174 | Code deleted |
| 80182 | Code deleted |
| 80196 | Code deleted |
| 80440 | Code deleted - see 84146 |
| 82000 | Code deleted |
| 82003 | Code deleted - see 80329-80331 |
| 82055 | Code deleted |
| 82101 | Code deleted - see 80323 |
| 82145 | Code deleted - see 80324-80326 |
| 82205 | Code deleted |
| 82520 | Code deleted |
| 82646 | Code deleted - see 80361 |
| 82649 | Code deleted - see 80361 |
| 82651 | Code deleted - see 80327, 80328 |
| 82654 | Code deleted - see 80339-80341 |
| 82666 | Code deleted - see 80327, 80328 |
| 82690 | Code deleted - see 80320 |
| 82742 | Code deleted - see 80346, 80347 |
| 82953 | Code deleted |
| 82975 | Code deleted - see 882127, 82128, 82131 |
| 82980 | Code deleted |
| 83008 | Code deleted |
| 83055 | Code deleted |
| 83071 | Code deleted |
| 83634 | Code deleted |
| 83805 | Code deleted - see 80369, 80370 |
| 83840 | Code deleted - see 80358 |
| 83858 | Code deleted - see 80339-80341 |
| 83866 | Code deleted |
| 83887 | Code deleted - see 80323 |
| 83925 | Code deleted |
| 84022 | Code deleted - see 80342-80344 |
| 84127 | Code deleted |
| 87001 | Code deleted |
| 87620 | Code deleted - see 87623-87625 |
| 87621 | Code deleted - see 87623-87625 |
| 87622 | Code deleted - see 87623-87625 |
| 88343 | Code deleted |
| 88349 | Code deleted - see 88348 |
| 99481 | Code deleted - see 99184 |
| 99482 | Code deleted - see 99184 |
| 99488 | Code deleted |
©Current Procedural Terminology (CPT) Codes and Descriptors
Are Copyrighted by the American Medical Association.