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 Ingenix, Inc. at (800) INGENIX (464-3649), option 1, or go to http://www.shopingenix.com/modules/catalog/catalog_category.asp 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 May 7, 2009. |
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CPT Codes
and Fees, |
| Surgery (revised May 7, 2009) |
| Assistant Surgery Guide (revised February 20, 2009) |
| Radiology (revised February 20, 2009) |
| Pathology and Laboratory (revised February 20, 2009) |
| Evaluation & Management, Medicine, Physical Therapy (revised February 20, 2009) |
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Commission Assigned Codes |
| N.C. Industrial Commission Assigned Codes |
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NOTE: Click here to view the 2008 CPT Codes. |
The American Medical Association has released its 2009 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, 2009. We also have deleted the codes that the American Medical Association no longer recognizes. Effective January 1, 2009, 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, 2009, for medical treatment in workers’ compensation cases is $0.55 a mile, provided the roundtrip is 20 miles or more. You may access the new form by clicking here: http://www.ic.nc.gov/ncic/pages/form25t.pdf
The Commission requires all healthcare providers which include individuals, such as physicians, dentists, and pharmacists, and organizations, such as hospitals, nursing homes, home health agencies, pharmacies, and group practices to submit medical bills using the new UB-04 and CMS 1500 forms along with the newly implemented National Provider Identifier (NPI) and Taxonomy code sets. The National Uniform Billing Committee (NUBC) approved the UB-04 as the replacement for the UB-04. Starting May 23, 2007, all institutional paper claims must be submitted on the UB-04. The UB-04 will no longer be acceptable, even as an adjusted claims, after May 22, 2007. The National Uniform Claim Committee (NUCC) revised the CMS-1500 in 2006; the new version, CMS-1500 (08-05), will replace the current CMS-1500 (12-90) version effective April 1, 2007. CMS will discontinue acceptance of 12-90 version of the CMS-1500 form on April 1, 2007 as will the Commission. These new forms will incorporate the new NPI and taxonomy code sets. 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: http://www.nucc.org/images/stories/PDF/claim_form_manual_v2-0_1-07.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 | Bilateral Mod (50) | Asst Surg (80,81, or 82) | Mod 51 exempt |
| 20696 | $1,968.60 | 90 | yes | ||||||
| 20697 | $2,273.89 | 90 | yes | yes | |||||
| 22856 | $2,977.15 | 90 | yes | ||||||
| 22861 | $3,656.54 | 90 | yes | ||||||
| 22864 | $3,344.64 | 90 | yes | ||||||
| 27027 | $1,567.70 | 90 | no | ||||||
| 27057 | $1,759.30 | 90 | no | ||||||
| 35535 | $4,002.93 | 90 | yes | ||||||
| 35570 | $3,091.34 | 90 | yes | ||||||
| 35633 | $4,103.89 | 90 | yes | ||||||
| 35634 | $3,719.06 | 90 | yes | ||||||
| 41512 | $1,104.12 | 90 | no | ||||||
| 41530 | $5,365.19 | $722.81 | 10 | no | |||||
| 43273 | $248.19 | $248.19 | no | ||||||
| 43279 | $2,312.56 | 90 | yes | ||||||
| 46930 | $366.72 | $267.08 | 90 | no | |||||
| 49652 | $1,401.44 | 90 | yes | ||||||
| 49653 | $1,751.06 | 90 | yes | ||||||
| 49654 | $1,610.67 | 90 | yes | ||||||
| 49655 | $1,938.81 | 90 | yes | ||||||
| 49656 | $1,616.48 | 90 | yes | ||||||
| 49657 | $2,334.93 | 90 | yes | ||||||
| 55706 | $776.99 | 10 | yes | ||||||
| 61796 | $1,396.78 | 90 | yes | ||||||
| 61797 | $384.56 | $384.56 | yes | ||||||
| 61798 | $1,396.78 | 90 | yes | ||||||
| 61799 | $531.62 | $531.62 | yes | ||||||
| 61800 | $270.29 | yes | |||||||
| 62267 | $466.01 | $312.75 | 0 | no | |||||
| 63620 | $1,396.78 | 90 | yes | ||||||
| 63621 | $442.12 | $442.12 | yes | ||||||
| 64455 | $95.71 | $76.45 | 0 | no | |||||
| 64632 | $156.81 | $134.81 | 10 | no | |||||
| 65756 | $1,965.05 | 90 | yes | ||||||
| 65757 | BR | BR | no | ||||||
| 77785 | $340.82 | $205.27 | $135.55 | ||||||
| 77786 | $1,019.34 | $713.97 | $305.37 | ||||||
| 77787 | $1,515.02 | $1,046.33 | $468.69 | ||||||
| 78808 | $84.67 | ||||||||
| 83876 | BR | ||||||||
| 83951 | BR | ||||||||
| 85397 | BR | ||||||||
| 87905 | BR | ||||||||
| 88720 | BR | ||||||||
| 88740 | BR | ||||||||
| 88741 | BR | ||||||||
| 90650 | BR | ||||||||
| 90681 | BR | ||||||||
| 90696 | BR | ||||||||
| 90738 | BR | ||||||||
| 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 | ||||||||
| 93228 | $51.25 | ||||||||
| 93229 | BR | ||||||||
| 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 | ||||||||
| 93306 | $509.19 | $366.04 | $143.15 | ||||||
| 93307 | $336.93 | $237.62 | $99.31 | ||||||
| 93351 | $530.43 | ||||||||
| 93352 | $73.73 | ||||||||
| 95803 | BR | ||||||||
| 95992 | BR | ||||||||
| 96360 | $107.33 | ||||||||
| 96361 | $31.25 | ||||||||
| 96365 | $130.91 | ||||||||
| 96366 | $42.07 | ||||||||
| 96367 | $66.17 | ||||||||
| 96368 | $39.26 | ||||||||
| 96369 | $285.08 | ||||||||
| 96370 | $30.39 | ||||||||
| 96371 | $137.92 | ||||||||
| 96372 | $40.58 | ||||||||
| 96374 | $103.91 | ||||||||
| 96375 | $45.05 | ||||||||
| 96376 | BR | ||||||||
| 96379 | BR | ||||||||
| 99460 | $112.64 | ||||||||
| 99461 | $166.32 | ||||||||
| 99462 | $60.07 | ||||||||
| 99463 | $150.69 | ||||||||
| 99464 | $141.77 |