CPT Codes and Fees: 2013 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 May 20, 2013.


TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2013

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: 2013 CPT Codes

The American Medical Association has released its 2013 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, 2013. 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, 2013, for medical treatment in workers’ compensation cases is $0.565 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 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-92. Starting May 23, 2007, all institutional paper claims must be submitted on the UB-04. The UB-92 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.


2013 CPT Codes

Effective January 1, 2013

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
22586   $2,973.90 $2,973.90     90 3 yes  
23473   $3,184.72 $3,184.72     90 3 yes  
23474   $3,440.30 $3,440.30     90 3 yes  
24370   $3,013.24 $3,013.24     90 3 yes  
24371   $3,472.48 $3,472.48     90 3 yes  
31647   $444.65 $444.65     0 3 no  
31648   $463.27 $463.27     0 3 no  
31649   $147.37 $147.37     0 3 no  
31651   $156.37 $156.37     0 3 no  
31660   $445.52 $445.52     0 3 no  
31661   $470.05 $470.05     0 3 no  
32554   $1,088.32 $178.07     0 3 no  
32555   $1,255.32 $222.27     0 3 no  
32556   $1,148.97 $243.92     0 3 no  
32557   $1,855.77 $321.79     0 3 no  
32701   $429.88 $429.88     0 3 yes  
33361   $2,619.95 $2,619.95     0 3 yes  
33362   $2,866.55 $2,866.55     0 3 yes  
33363   $2,968.05 $2,968.05     0 3 yes  
33364   $3,157.30 $3,157.30     0 3 yes  
33365   $3,454.08 $3,454.08     0 3 yes  
33367   $1,213.32 $1,213.32     0 3 yes  
33368   $1,470.28 $1,470.28     0 3 yes  
33369   $1,941.18 $1,941.18     0 3 yes  
33990   $852.18 $852.18     0 3 yes  
33991   $1,241.75 $1,241.75     0 3 yes  
33992   $405.57 $405.57     0 3 yes  
33993   $356.11 $356.11     0 3 yes  
36221   $2,234.40 $423.00     0 3 no  
36222   $2,769.73 $573.71     0 3 no  
36223   $3,030.07 $620.29     0 3 no  
36224   $3,291.86 $676.13     0 3 no  
36225   $3,008.14 $617.86     0 3 no  
36226   $3,355.53 $677.43     0 3 no  
36227   $486.12 $214.53     0 3 no  
36228   $2,303.68 $437.07     0 3 no  
37197   $3,048.61 $608.96     0 3 no  
37211   $794.73 $794.73     0 3 no  
37212   $701.57 $701.57     0 3 no  
37213   $490.28 $490.28     0 3 no  
37214   $287.53 $287.53     0 3 no  
38243   $231.15 $231.15     0 3 no  
43206 BR           3 no  
43252 BR           3    
44705 BR           3    
52287   $601.60 $328.06     0 3  no  
64615   $274.54 $247.24     0 3 no  
78012 $151.45     $133.99 $17.46   4    
78013 $382.59     $348.80 $33.79   4    
78014 $442.25     $397.02 $45.24   4    
78071 $661.56     $554.03 $107.53   4    
78072         $149.20   4    
81201 BR           5    
81202 BR           5    
81203 BR           5    
81235 BR           5    
81252 BR           5    
81253 BR           5    
81254 BR           5    
81321 BR           5    
81322 BR           5    
81323 BR           5    
81324 BR           5    
81325 BR           5    
81326 BR           5    
81479 BR           5    
81500 BR           5    
81503 BR           5    
81506 BR           5    
81508 BR           5    
81509 BR           5    
81510 BR           5    
81511 BR           5    
81512 BR           5    
81599 BR           5    
82777 BR           5    
86152 BR           5    
86153 BR           5    
86711 BR           5    
86828 BR           5    
86829 BR           5    
86830 BR           5    
86831 BR           5    
86832 BR           5    
86833 BR           5    
86834 BR           5    
86835 BR           5    
87631 BR           5    
87632 BR           5    
87633 BR           5    
87910 BR           5    
87912 BR           5    
88375 BR           5    
90653 BR           1    
90672 BR           1    
90739 BR           1    
90785   $7.28 $7.28       1    
90791   $230.38 $181.04       1    
90792   $192.13 $187.15       1    
90832   $95.97 $76.05       1    
90833   $64.15 $63.64       1    
90834   $124.65 $114.19       1    
90836   $104.20 $104.20       1    
90837   $182.65 $172.19       1    
90838   $168.25 $167.26       1    
90839 BR           1    
90840 BR           1    
90863 BR           1    
91112 $1,745.63     $1,574.56 $171.07   1    
92920   $809.13 $809.13       1    
92921 BR           1    
92924   $961.81 $961.81       1    
92925 BR           1    
92928   $898.45 $898.45       1    
92929 BR           1    
92933   $1,004.71 $1,004.71       1    
92934 BR           1    
92937   $897.42 $897.28       1    
92938 BR           1    
92941   $1,006.65 $1,006.65       1    
92943   $1,006.65 $1,006.65       1    
92944 BR           1    
93653   $1,223.01 $1,223.01       1    
93654   $1,632.19 $1,632.19       1    
93655   $611.57 $611.57       1    
93656   $1,632.77 $1,632.77       1    
93657   $611.95 $611.95       1    
95017   $13.11 $5.62       1    
95018   $32.31 $10.89       1    
95076   $176.69 $110.41       1    
95079   $125.39 $101.47       1    
95782 $1,537.43     $1,341.61 $195.83   1    
95783 $1,640.99     $1,427.07 $213.92   1    
95907 $141.71     $79.30 $62.41   1    
95908 $174.95     $99.59 $75.37   1    
95909 $209.57     $119.01 $90.57   1    
95910 $275.95     $116.86 $159.09   1    
95911 $334.34     $198.80 $135.55   1    
95912 $391.75     $238.39 $153.35   1    
95913 $454.36     $282.82 $171.54   1    
95940   $48.82 $48.82       1    
95941 BR           1    
95924 $221.94     $89.08 $132.86   1    
95943 BR           1    
99485 BR           1    
99486 BR           1    
99487 BR           1    
99488 BR           1    
99489 BR           1    
99495   $246.73 $203.87       1    
99496   $348.33 $299.00       1    

©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/