CPT Codes and Fees: 2015 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 April 24, 2015.


TABLE OF CONTENTS

CPT Codes and Fees,
Effective January 1, 2015

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 2013 CPT Codes and the 2014 CPT Codes.

Update to Workers’ Compensation Medical Fee Schedule: 2015 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, 2015, for medical treatment in workers’ compensation cases is $0.575 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.


2015 CPT Codes Added

Effective January 1, 2015

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    
80823 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.


CPT Codes Deleted for 2015

Effective January 1, 2015

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.


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/