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.

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 $0.555 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:

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