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1 2 3 1 2 3
I
PROFESSIONAL
COMPONENT 10022 0 20 Years 0.00 $0.0000 $14.48 1/1/2015 0.00 $14.48 1/1/2015
I
PROFESSIONAL
COMPONENT 10022 21 999 Years 0.00 $0.0000 $13.78 1/1/2015 0.00 $13.78 1/1/2015
T
TECHNICAL
COMPONENT 10022 0 20 Years 0.00 $0.0000 $80.25 1/1/2015 0.00 $80.25 1/1/2015
T
TECHNICAL
COMPONENT 10022 21 999 Years 0.00 $0.0000 $76.43 1/1/2015 0.00 $76.43 1/1/2015
2 SURGERY 36251 0 20 Years 40.55 $28.0672 $1,138.12 4/1/2016 0.00 $1,138.12 4/1/2016
2 SURGERY 36251 21 999 Years 40.55 $26.7305 $1,083.92 4/1/2016 0.00 $1,083.92 4/1/2016
2 SURGERY 36252 0 20 Years 43.98 $28.0672 $1,234.40 4/1/2016 0.00 $1,234.40 4/1/2016
2 SURGERY 36252 21 999 Years 43.98 $26.7305 $1,175.61 4/1/2016 0.00 $1,175.61 4/1/2016
2 SURGERY 36253 0 20 Years 64.34 $28.0672 $1,805.84 4/1/2016 0.00 $1,805.84 4/1/2016
1st Modifier, if required for pricing determination.
2nd Modifier, if required for pricing determination.
TOS:
TOS Desc:
One-character type-of-service (TOS) code assigned to each procedure code for system administration.
Description of the TOS.
The five-digit code for services and items defined in Current Procedure Terminology or the Healthcare Common Procedure Coding System.
Last Pricing Review
Date:
Adjusted Fee for Report
Date:
Note Codes:
Proc Code:
Mod 1:
Frm:
Client Age
Thru:
Mod 2:
Adjust %:
Total RVUs/Base Units:
Non-facility/Facility
Fee Effect Date:
Medicaid Fee:
Conversion Factor:
MISCELLANEOUS OTHER PROFESSIONALS - PORTABLE X-RAY, RADIOLOGICAL LAB, PHYSIOLOGICAL LAB
Texas Medicaid Fee Schedule Information
This fee schedule is intended to be used by a variety of provider types and provider specialties. Some procedure codes might not apply to every provider type and provider specialty designated to use the fee schedule. For detailed benefits and limitations, providers should refer to the current year’s Texas Medicaid
Provider Procedures Manual and relevant issues of the Texas Medicaid Bulletin.
Field Descriptions
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Client Age Units:
The “from age” is the beginning of an age range, if it is required for determining pricing. Some procedure codes have more than one pricing row. If the first row has a 0-999 age range, and the second row has a 21-999 age range, then the client age range for the first row (0-999) is actually 0-
20 years of age. If the first row has a 0-999 age range and the second row has a 0-20 age range, then the client age range for the first row (0-999) is actually 21-999 years of age. Refer to the Texas Medicaid Provider Procedures Manual (TMPPM) for the exact age limitations.
The “through age” is the end of an age range, if it is required for determining pricing. Some procedure codes have more than one pricing row. If the first row has a 0-999 age range, and the second row has a 21-999 age range, then the client age range for the first row (0-999) is actually 0-20
years of age. If the first row has a 0-999 age range and the second row has a 0-20 age range, then the client age range for the first row (0-999) is actually 21-999 years of age. Refer to the TMPPM for exact age limitations.
Medicaid rates are based on the client’s age in days, months or years.
Non-Facility pricing is for services that are rendered in places of service other than an inpatient hospital or an outpatient hospital. Facility pricing is for services that are rendered in an inpatient hospital (place of service [POS] 3), or an outpatient hospital or ambulatory surgical center (POS 5).
The current relative value units (RVUs) for the procedure code, if the fee is a resource-based fee (RBF). The payable amount for RBFs is calculated by multiplying the total RVUs by the applicable conversion factor. For Anesthesia services only, this column shows the base units instead; and
payment is based on the sum of the base units plus actual face-to-face time units multiplied by the applicable conversion factor.
Note code indicator. Providers should review each note code to identify specific payment explanation or limitation. See Note Codes worksheet for applicable payment explanation or limitation.
Medicaid rates are reviewed every two years or as necessary. This column shows the date on which the most recent review was conducted.
The Texas Medicaid conversion factor that is applicable for determining the amount payable when the rate is calculated by base units for anesthesia services or RVUs for other services.
The Medicaid allowed amount.
The effective date of service for which the fee is payable.
A percentage reduction has been applied to the allowed fee for this service. This column shows the percent by which the fee was adjusted. Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
A percentage reduction has been applied to the allowed fee for this service. This column does not show reductions that may have been applied using other criteria that include but are not limited to place of service, client type program, or provider specialty. Additional information about rate
changes is available on the TMHP website at www.tmhp.com.
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
2 SURGERY 36253 21 999 Years 64.34 $26.7305 $1,719.84 4/1/2016 0.00 $1,719.84 4/1/2016
2 SURGERY 36254 0 20 Years 62.65 $28.0672 $1,758.41 4/1/2016 0.00 $1,758.41 4/1/2016
2 SURGERY 36254 21 999 Years 62.65 $26.7305 $1,674.67 4/1/2016 0.00 $1,674.67 4/1/2016
2 SURGERY 37191 0 20 Years 74.83 $28.0672 $2,100.27 4/1/2016 0.00 $2,100.27 4/1/2016
2 SURGERY 37191 21 999 Years 74.83 $26.7305 $2,000.24 4/1/2016 0.00 $2,000.24 4/1/2016
2 SURGERY 37192 0 20 Years 44.08 $28.0672 $1,237.20 4/1/2016 0.00 $1,237.20 4/1/2016
2 SURGERY 37192 21 999 Years 44.08 $26.7305 $1,178.28 4/1/2016 0.00 $1,178.28 4/1/2016
2 SURGERY 37193 0 20 Years 45.53 $28.0672 $1,277.90 4/1/2016 0.00 $1,277.90 4/1/2016
2 SURGERY 37193 21 999 Years 45.53 $26.7305 $1,217.04 4/1/2016 0.00 $1,217.04 4/1/2016
2 SURGERY 43753 0 20 Years 0.62 $28.0672 $17.40 4/1/2016 0.00 $17.40 0.62 $28.0672 $17.40 4/1/2016 0.00 $17.40 4/1/2016
2 SURGERY 43753 21 999 Years 0.62 $26.7305 $16.57 4/1/2016 0.00 $16.57 0.62 $26.7305 $16.57 4/1/2016 0.00 $16.57 4/1/2016
2 SURGERY 43754 0 20 Years 3.73 $28.0672 $104.69 4/1/2016 0.00 $104.69 1.05 $28.0672 $29.47 4/1/2016 0.00 $29.47 4/1/2016
2 SURGERY 43754 21 999 Years 3.73 $26.7305 $99.70 4/1/2016 0.00 $99.70 1.05 $26.7305 $28.07 4/1/2016 0.00 $28.07 4/1/2016
2 SURGERY 43755 0 20 Years 3.98 $28.0672 $111.71 4/1/2016 0.00 $111.71 1.80 $28.0672 $50.52 4/1/2016 0.00 $50.52 4/1/2016
2 SURGERY 43755 21 999 Years 3.98 $26.7305 $106.39 4/1/2016 0.00 $106.39 1.80 $26.7305 $48.11 4/1/2016 0.00 $48.11 4/1/2016
2 SURGERY 43756 0 20 Years 5.89 $28.0672 $165.32 4/1/2016 0.00 $165.32 1.51 $28.0672 $42.38 4/1/2016 0.00 $42.38 4/1/2016
2 SURGERY 43756 21 999 Years 5.89 $26.7305 $157.44 4/1/2016 0.00 $157.44 1.51 $26.7305 $40.36 4/1/2016 0.00 $40.36 4/1/2016
2 SURGERY 43757 0 20 Years 8.42 $28.0672 $236.33 4/1/2016 0.00 $236.33 2.30 $28.0672 $64.55 4/1/2016 0.00 $64.55 4/1/2016
2 SURGERY 43757 21 999 Years 8.42 $26.7305 $225.07 4/1/2016 0.00 $225.07 2.30 $26.7305 $61.48 4/1/2016 0.00 $61.48 4/1/2016
T
TECHNICAL
COMPONENT 51727 0 20 Years 5.66 $28.0672 $158.86 1/1/2015 0.00 $158.86 1/1/2015
T
TECHNICAL
COMPONENT 51727 21 999 Years 5.66 $26.7305 $151.29 1/1/2015 0.00 $151.29 1/1/2015
T
TECHNICAL
COMPONENT 51728 0 20 Years 5.77 $28.0672 $161.95 1/1/2015 0.00 $161.95 1/1/2015
T
TECHNICAL
COMPONENT 51728 21 999 Years 5.77 $26.7305 $154.23 1/1/2015 0.00 $154.23 1/1/2015
T
TECHNICAL
COMPONENT 51729 0 20 Years 5.88 $28.0672 $165.04 1/1/2015 0.00 $165.04 1/1/2015
T
TECHNICAL
COMPONENT 51729 21 999 Years 5.88 $26.7305 $157.18 1/1/2015 0.00 $157.18 1/1/2015
T
TECHNICAL
COMPONENT 51784 0 20 Years 3.17 $28.0672 $88.97 1/1/2015 0.00 $88.97 1/1/2015
T
TECHNICAL
COMPONENT 51784 21 999 Years 3.17 $26.7305 $84.74 1/1/2015 0.00 $84.74 1/1/2015
T
TECHNICAL
COMPONENT 51785 0 20 Years 4.90 $28.0672 $137.53 1/1/2015 0.00 $137.53 1/1/2015
T
TECHNICAL
COMPONENT 51785 21 999 Years 4.90 $26.7305 $130.98 1/1/2015 0.00 $130.98 1/1/2015
T
TECHNICAL
COMPONENT 62252 0 20 Years 1.09 $28.0672 $30.59 1/1/2015 0.00 $30.59 1/1/2015
T
TECHNICAL
COMPONENT 62252 21 999 Years 1.09 $26.7305 $29.14 1/1/2015 0.00 $29.14 1/1/2015
4 RADIOLOGY 70010 0 20 Years 1.84 $28.0672 $51.64 1/1/2014 0.00 $51.64 9 1/1/2014
4 RADIOLOGY 70010 21 999 Years 1.84 $26.7305 $49.18 1/1/2014 0.00 $49.18 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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MISCELLANEOUS OTHER PROFESSIONALS - PORTABLE X-RAY, RADIOLOGICAL LAB, PHYSIOLOGICAL LAB
1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70010 0 20 Years 0.00 $0.0000 $21.40 1/1/2014 0.00 $21.40 9 1/1/2014
T
TECHNICAL
COMPONENT 70010 21 999 Years 0.00 $0.0000 $20.38 1/1/2014 0.00 $20.38 9 1/1/2014
4 RADIOLOGY 70015 0 20 Years 4.63 $28.0672 $129.95 1/1/2014 0.00 $129.95 9 1/1/2014
4 RADIOLOGY 70015 21 999 Years 4.63 $26.7305 $123.76 1/1/2014 0.00 $123.76 9 1/1/2014
T
TECHNICAL
COMPONENT 70015 0 20 Years 2.92 $28.0672 $81.96 1/1/2014 0.00 $81.96 9 1/1/2014
T
TECHNICAL
COMPONENT 70015 21 999 Years 2.92 $26.7305 $78.05 1/1/2014 0.00 $78.05 9 1/1/2014
4 RADIOLOGY 70030 0 20 Years 0.88 $28.0672 $24.70 1/1/2014 0.00 $24.70 9 1/1/2014
4 RADIOLOGY 70030 21 999 Years 0.88 $26.7305 $23.52 1/1/2014 0.00 $23.52 9 1/1/2014
T
TECHNICAL
COMPONENT 70030 0 20 Years 0.64 $28.0672 $17.96 1/1/2014 0.00 $17.96 9 1/1/2014
T
TECHNICAL
COMPONENT 70030 21 999 Years 0.64 $26.7305 $17.11 1/1/2014 0.00 $17.11 9 1/1/2014
4 RADIOLOGY 70100 0 20 Years 1.05 $28.0672 $29.47 1/1/2014 0.00 $29.47 9 1/1/2014
4 RADIOLOGY 70100 21 999 Years 1.05 $26.7305 $28.07 1/1/2014 0.00 $28.07 9 1/1/2014
T
TECHNICAL
COMPONENT 70100 0 20 Years 0.79 $28.0672 $22.17 1/1/2014 0.00 $22.17 9 1/1/2014
T
TECHNICAL
COMPONENT 70100 21 999 Years 0.79 $26.7305 $21.12 1/1/2014 0.00 $21.12 9 1/1/2014
4 RADIOLOGY 70110 0 20 Years 1.20 $28.0672 $33.68 1/1/2014 0.00 $33.68 9 1/1/2014
4 RADIOLOGY 70110 21 999 Years 1.20 $26.7305 $32.08 1/1/2014 0.00 $32.08 9 1/1/2014
T
TECHNICAL
COMPONENT 70110 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 9 1/1/2014
T
TECHNICAL
COMPONENT 70110 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 9 1/1/2014
4 RADIOLOGY 70120 0 20 Years 1.09 $28.0672 $30.59 1/1/2014 0.00 $30.59 9 1/1/2014
4 RADIOLOGY 70120 21 999 Years 1.09 $26.7305 $29.14 1/1/2014 0.00 $29.14 9 1/1/2014
T
TECHNICAL
COMPONENT 70120 0 20 Years 0.83 $28.0672 $23.30 1/1/2014 0.00 $23.30 9 1/1/2014
T
TECHNICAL
COMPONENT 70120 21 999 Years 0.83 $26.7305 $22.19 1/1/2014 0.00 $22.19 9 1/1/2014
4 RADIOLOGY 70130 0 20 Years 1.78 $28.0672 $49.96 1/1/2014 0.00 $49.96 9 1.78 $28.0672 $49.96 1/1/2014 0.00 $49.96 9 1/1/2014
4 RADIOLOGY 70130 21 999 Years 1.78 $26.7305 $47.58 1/1/2014 0.00 $47.58 9 1.78 $26.7305 $47.58 1/1/2014 0.00 $47.58 9 1/1/2014
I
PROFESSIONAL
COMPONENT 70130 0 20 Years 0.49 $28.0672 $13.75 1/1/2014 0.00 $13.75 9 0.49 $28.0672 $13.75 1/1/2014 0.00 $13.75 9 1/1/2014
I
PROFESSIONAL
COMPONENT 70130 21 999 Years 0.49 $26.7305 $13.10 1/1/2014 0.00 $13.10 9 0.49 $26.7305 $13.10 1/1/2014 0.00 $13.10 9 1/1/2014
T
TECHNICAL
COMPONENT 70130 0 20 Years 1.29 $28.0672 $36.21 1/1/2014 0.00 $36.21 9 1/1/2014
T
TECHNICAL
COMPONENT 70130 21 999 Years 1.29 $26.7305 $34.48 1/1/2014 0.00 $34.48 9 1/1/2014
4 RADIOLOGY 70134 0 20 Years 1.39 $28.0672 $39.01 1/1/2014 0.00 $39.01 9 1/1/2014
4 RADIOLOGY 70134 21 999 Years 1.39 $26.7305 $37.16 1/1/2014 0.00 $37.16 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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MISCELLANEOUS OTHER PROFESSIONALS - PORTABLE X-RAY, RADIOLOGICAL LAB, PHYSIOLOGICAL LAB
1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70134 0 20 Years 0.92 $28.0672 $25.82 1/1/2014 0.00 $25.82 9 1/1/2014
T
TECHNICAL
COMPONENT 70134 21 999 Years 0.92 $26.7305 $24.59 1/1/2014 0.00 $24.59 9 1/1/2014
4 RADIOLOGY 70140 0 20 Years 0.91 $28.0672 $25.54 1/1/2014 0.00 $25.54 9 1/1/2014
4 RADIOLOGY 70140 21 999 Years 0.91 $26.7305 $24.32 1/1/2014 0.00 $24.32 9 1/1/2014
T
TECHNICAL
COMPONENT 70140 0 20 Years 0.62 $28.0672 $17.40 1/1/2014 0.00 $17.40 9 1/1/2014
T
TECHNICAL
COMPONENT 70140 21 999 Years 0.62 $26.7305 $16.57 1/1/2014 0.00 $16.57 9 1/1/2014
4 RADIOLOGY 70150 0 20 Years 1.29 $28.0672 $36.21 1/1/2014 0.00 $36.21 9 1/1/2014
4 RADIOLOGY 70150 21 999 Years 1.29 $26.7305 $34.48 1/1/2014 0.00 $34.48 9 1/1/2014
T
TECHNICAL
COMPONENT 70150 0 20 Years 0.92 $28.0672 $25.82 1/1/2014 0.00 $25.82 9 1/1/2014
T
TECHNICAL
COMPONENT 70150 21 999 Years 0.92 $26.7305 $24.59 1/1/2014 0.00 $24.59 9 1/1/2014
4 RADIOLOGY 70160 0 20 Years 1.02 $28.0672 $28.63 1/1/2014 0.00 $28.63 9 1/1/2014
4 RADIOLOGY 70160 21 999 Years 1.02 $26.7305 $27.27 1/1/2014 0.00 $27.27 9 1/1/2014
T
TECHNICAL
COMPONENT 70160 0 20 Years 0.77 $28.0672 $21.61 1/1/2014 0.00 $21.61 9 1/1/2014
T
TECHNICAL
COMPONENT 70160 21 999 Years 0.77 $26.7305 $20.58 1/1/2014 0.00 $20.58 9 1/1/2014
4 RADIOLOGY 70170 0 20 Years 0.00 $0.0000 $46.15 1/1/2014 0.00 $46.15 9 1/1/2014
4 RADIOLOGY 70170 21 999 Years 0.00 $0.0000 $43.95 1/1/2014 0.00 $43.95 9 1/1/2014
I
PROFESSIONAL
COMPONENT 70170 0 20 Years 0.44 $28.0672 $12.35 1/1/2014 0.00 $12.35 9 0.44 $28.0672 $12.35 1/1/2014 0.00 $12.35 9 1/1/2014
I
PROFESSIONAL
COMPONENT 70170 21 999 Years 0.44 $26.7305 $11.76 1/1/2014 0.00 $11.76 9 0.44 $26.7305 $11.76 1/1/2014 0.00 $11.76 9 1/1/2014
T
TECHNICAL
COMPONENT 70170 0 20 Years 0.00 $0.0000 $33.80 1/1/2014 0.00 $33.80 9 1/1/2014
T
TECHNICAL
COMPONENT 70170 21 999 Years 0.00 $0.0000 $32.19 1/1/2014 0.00 $32.19 9 1/1/2014
4 RADIOLOGY 70190 0 20 Years 1.10 $28.0672 $30.87 1/1/2014 0.00 $30.87 9 1/1/2014
4 RADIOLOGY 70190 21 999 Years 1.10 $26.7305 $29.40 1/1/2014 0.00 $29.40 9 1/1/2014
T
TECHNICAL
COMPONENT 70190 0 20 Years 0.79 $28.0672 $22.17 1/1/2014 0.00 $22.17 9 1/1/2014
T
TECHNICAL
COMPONENT 70190 21 999 Years 0.79 $26.7305 $21.12 1/1/2014 0.00 $21.12 9 1/1/2014
4 RADIOLOGY 70200 0 20 Years 1.32 $28.0672 $37.05 1/1/2014 0.00 $37.05 9 1/1/2014
4 RADIOLOGY 70200 21 999 Years 1.32 $26.7305 $35.28 1/1/2014 0.00 $35.28 9 1/1/2014
T
TECHNICAL
COMPONENT 70200 0 20 Years 0.92 $28.0672 $25.82 1/1/2014 0.00 $25.82 9 1/1/2014
T
TECHNICAL
COMPONENT 70200 21 999 Years 0.92 $26.7305 $24.59 1/1/2014 0.00 $24.59 9 1/1/2014
4 RADIOLOGY 70210 0 20 Years 0.94 $28.0672 $26.38 1/1/2014 0.00 $26.38 9 1/1/2014
4 RADIOLOGY 70210 21 999 Years 0.94 $26.7305 $25.13 1/1/2014 0.00 $25.13 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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MISCELLANEOUS OTHER PROFESSIONALS - PORTABLE X-RAY, RADIOLOGICAL LAB, PHYSIOLOGICAL LAB
1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70210 0 20 Years 0.69 $28.0672 $19.37 1/1/2014 0.00 $19.37 9 1/1/2014
T
TECHNICAL
COMPONENT 70210 21 999 Years 0.69 $26.7305 $18.44 1/1/2014 0.00 $18.44 9 1/1/2014
4 RADIOLOGY 70220 0 20 Years 1.18 $28.0672 $33.12 1/1/2014 0.00 $33.12 9 1/1/2014
4 RADIOLOGY 70220 21 999 Years 1.18 $26.7305 $31.54 1/1/2014 0.00 $31.54 9 1/1/2014
T
TECHNICAL
COMPONENT 70220 0 20 Years 0.82 $28.0672 $23.02 1/1/2014 0.00 $23.02 9 1/1/2014
T
TECHNICAL
COMPONENT 70220 21 999 Years 0.82 $26.7305 $21.92 1/1/2014 0.00 $21.92 9 1/1/2014
4 RADIOLOGY 70240 0 20 Years 0.91 $28.0672 $25.54 1/1/2014 0.00 $25.54 9 1/1/2014
4 RADIOLOGY 70240 21 999 Years 0.91 $26.7305 $24.32 1/1/2014 0.00 $24.32 9 1/1/2014
T
TECHNICAL
COMPONENT 70240 0 20 Years 0.63 $28.0672 $17.68 1/1/2014 0.00 $17.68 9 1/1/2014
T
TECHNICAL
COMPONENT 70240 21 999 Years 0.63 $26.7305 $16.84 1/1/2014 0.00 $16.84 9 1/1/2014
4 RADIOLOGY 70250 0 20 Years 1.13 $28.0672 $31.72 1/1/2014 0.00 $31.72 9 1/1/2014
4 RADIOLOGY 70250 21 999 Years 1.13 $26.7305 $30.21 1/1/2014 0.00 $30.21 9 1/1/2014
T
TECHNICAL
COMPONENT 70250 0 20 Years 0.77 $28.0672 $21.61 1/1/2014 0.00 $21.61 9 1/1/2014
T
TECHNICAL
COMPONENT 70250 21 999 Years 0.77 $26.7305 $20.58 1/1/2014 0.00 $20.58 9 1/1/2014
4 RADIOLOGY 70260 0 20 Years 1.42 $28.0672 $39.86 1/1/2014 0.00 $39.86 9 1/1/2014
4 RADIOLOGY 70260 21 999 Years 1.42 $26.7305 $37.96 1/1/2014 0.00 $37.96 9 1/1/2014
T
TECHNICAL
COMPONENT 70260 0 20 Years 0.93 $28.0672 $26.10 1/1/2014 0.00 $26.10 9 1/1/2014
T
TECHNICAL
COMPONENT 70260 21 999 Years 0.93 $26.7305 $24.86 1/1/2014 0.00 $24.86 9 1/1/2014
4 RADIOLOGY 70300 0 20 Years 0.45 $28.0672 $12.63 1/1/2014 0.00 $12.63 9 1/1/2014
4 RADIOLOGY 70300 21 999 Years 0.45 $26.7305 $12.03 1/1/2014 0.00 $12.03 9 1/1/2014
T
TECHNICAL
COMPONENT 70300 0 20 Years 0.28 $28.0672 $7.86 1/1/2014 0.00 $7.86 9 1/1/2014
T
TECHNICAL
COMPONENT 70300 21 999 Years 0.28 $26.7305 $7.48 1/1/2014 0.00 $7.48 9 1/1/2014
4 RADIOLOGY 70310 0 20 Years 1.17 $28.0672 $32.84 1/1/2014 0.00 $32.84 9 1/1/2014
4 RADIOLOGY 70310 21 999 Years 1.17 $26.7305 $31.27 1/1/2014 0.00 $31.27 9 1/1/2014
T
TECHNICAL
COMPONENT 70310 0 20 Years 0.94 $28.0672 $26.38 1/1/2014 0.00 $26.38 9 1/1/2014
T
TECHNICAL
COMPONENT 70310 21 999 Years 0.94 $26.7305 $25.13 1/1/2014 0.00 $25.13 9 1/1/2014
4 RADIOLOGY 70320 0 20 Years 1.64 $28.0672 $46.03 1/1/2014 0.00 $46.03 9 1/1/2014
4 RADIOLOGY 70320 21 999 Years 1.64 $26.7305 $43.84 1/1/2014 0.00 $43.84 9 1/1/2014
T
TECHNICAL
COMPONENT 70320 0 20 Years 1.30 $28.0672 $36.49 1/1/2014 0.00 $36.49 9 1/1/2014
T
TECHNICAL
COMPONENT 70320 21 999 Years 1.30 $26.7305 $34.75 1/1/2014 0.00 $34.75 9 1/1/2014
4 RADIOLOGY 70328 0 20 Years 0.97 $28.0672 $27.23 1/1/2014 0.00 $27.23 9 1/1/2014
4 RADIOLOGY 70328 21 999 Years 0.97 $26.7305 $25.93 1/1/2014 0.00 $25.93 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70328 0 20 Years 0.70 $28.0672 $19.65 1/1/2014 0.00 $19.65 9 1/1/2014
T
TECHNICAL
COMPONENT 70328 21 999 Years 0.70 $26.7305 $18.71 1/1/2014 0.00 $18.71 9 1/1/2014
4 RADIOLOGY 70330 0 20 Years 1.47 $28.0672 $41.26 1/1/2014 0.00 $41.26 9 1/1/2014
4 RADIOLOGY 70330 21 999 Years 1.47 $26.7305 $39.29 1/1/2014 0.00 $39.29 9 1/1/2014
T
TECHNICAL
COMPONENT 70330 0 20 Years 1.11 $28.0672 $31.15 1/1/2014 0.00 $31.15 9 1/1/2014
T
TECHNICAL
COMPONENT 70330 21 999 Years 1.11 $26.7305 $29.67 1/1/2014 0.00 $29.67 9 1/1/2014
4 RADIOLOGY 70332 0 20 Years 2.14 $28.0672 $60.06 1/1/2014 0.00 $60.06 9 1/1/2014
4 RADIOLOGY 70332 21 999 Years 2.14 $26.7305 $57.20 1/1/2014 0.00 $57.20 9 1/1/2014
T
TECHNICAL
COMPONENT 70332 0 20 Years 1.37 $28.0672 $38.45 1/1/2014 0.00 $38.45 9 1/1/2014
T
TECHNICAL
COMPONENT 70332 21 999 Years 1.37 $26.7305 $36.62 1/1/2014 0.00 $36.62 9 1/1/2014
4 RADIOLOGY 70336 0 20 Years 10.77 $28.0672 $302.28 1/1/2014 0.00 $302.28 10.77 $28.0672 $302.28 1/1/2014 0.00 $302.28 1/1/2014
4 RADIOLOGY 70336 21 999 Years 10.77 $26.7305 $287.89 1/1/2014 0.00 $287.89 10.77 $26.7305 $287.89 1/1/2014 0.00 $287.89 1/1/2014
I
PROFESSIONAL
COMPONENT 70336 0 20 Years 2.08 $28.0672 $58.38 1/1/2014 0.00 $58.38 9 2.08 $28.0672 $58.38 1/1/2014 0.00 $58.38 9 1/1/2014
I
PROFESSIONAL
COMPONENT 70336 21 999 Years 2.08 $26.7305 $55.60 1/1/2014 0.00 $55.60 9 2.08 $26.7305 $55.60 1/1/2014 0.00 $55.60 9 1/1/2014
T
TECHNICAL
COMPONENT 70336 0 20 Years 8.69 $28.0672 $243.90 1/1/2014 0.00 $243.90 9 8.69 $28.0672 $243.90 1/1/2014 0.00 $243.90 9 1/1/2014
T
TECHNICAL
COMPONENT 70336 21 999 Years 8.69 $26.7305 $232.29 1/1/2014 0.00 $232.29 9 8.69 $26.7305 $232.29 1/1/2014 0.00 $232.29 9 1/1/2014
4 RADIOLOGY 70350 0 20 Years 0.65 $28.0672 $18.24 1/1/2014 0.00 $18.24 9 1/1/2014
4 RADIOLOGY 70350 21 999 Years 0.65 $26.7305 $17.37 1/1/2014 0.00 $17.37 9 1/1/2014
T
TECHNICAL
COMPONENT 70350 0 20 Years 0.36 $28.0672 $10.10 1/1/2014 0.00 $10.10 9 1/1/2014
T
TECHNICAL
COMPONENT 70350 21 999 Years 0.36 $26.7305 $9.62 1/1/2014 0.00 $9.62 9 1/1/2014
4 RADIOLOGY 70355 0 20 Years 0.63 $28.0672 $17.68 1/1/2014 0.00 $17.68 9 1/1/2014
4 RADIOLOGY 70355 21 999 Years 0.63 $26.7305 $16.84 1/1/2014 0.00 $16.84 9 1/1/2014
T
TECHNICAL
COMPONENT 70355 0 20 Years 0.31 $28.0672 $8.70 1/1/2014 0.00 $8.70 9 1/1/2014
T
TECHNICAL
COMPONENT 70355 21 999 Years 0.31 $26.7305 $8.29 1/1/2014 0.00 $8.29 9 1/1/2014
4 RADIOLOGY 70360 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 9 1/1/2014
4 RADIOLOGY 70360 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 9 1/1/2014
T
TECHNICAL
COMPONENT 70360 0 20 Years 0.60 $28.0672 $16.84 1/1/2014 0.00 $16.84 9 1/1/2014
T
TECHNICAL
COMPONENT 70360 21 999 Years 0.60 $26.7305 $16.04 1/1/2014 0.00 $16.04 9 1/1/2014
4 RADIOLOGY 70370 0 20 Years 2.46 $28.0672 $69.05 1/1/2014 0.00 $69.05 9 1/1/2014
4 RADIOLOGY 70370 21 999 Years 2.46 $26.7305 $65.76 1/1/2014 0.00 $65.76 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70370 0 20 Years 2.01 $28.0672 $56.42 1/1/2014 0.00 $56.42 9 1/1/2014
T
TECHNICAL
COMPONENT 70370 21 999 Years 2.01 $26.7305 $53.73 1/1/2014 0.00 $53.73 9 1/1/2014
4 RADIOLOGY 70371 0 20 Years 2.75 $28.0672 $77.18 1/1/2014 0.00 $77.18 9 1/1/2014
4 RADIOLOGY 70371 21 999 Years 2.75 $26.7305 $73.51 1/1/2014 0.00 $73.51 9 1/1/2014
4 RADIOLOGY 70380 0 20 Years 1.19 $28.0672 $33.40 1/1/2014 0.00 $33.40 9 1/1/2014
4 RADIOLOGY 70380 21 999 Years 1.19 $26.7305 $31.81 1/1/2014 0.00 $31.81 9 1/1/2014
T
TECHNICAL
COMPONENT 70380 0 20 Years 0.92 $28.0672 $25.82 1/1/2014 0.00 $25.82 9 1/1/2014
T
TECHNICAL
COMPONENT 70380 21 999 Years 0.92 $26.7305 $24.59 1/1/2014 0.00 $24.59 9 1/1/2014
4 RADIOLOGY 70390 0 20 Years 3.07 $28.0672 $86.17 1/1/2014 0.00 $86.17 9 1/1/2014
4 RADIOLOGY 70390 21 999 Years 3.07 $26.7305 $82.06 1/1/2014 0.00 $82.06 9 1/1/2014
T
TECHNICAL
COMPONENT 70390 0 20 Years 2.52 $28.0672 $70.73 1/1/2014 0.00 $70.73 9 1/1/2014
T
TECHNICAL
COMPONENT 70390 21 999 Years 2.52 $26.7305 $67.36 1/1/2014 0.00 $67.36 9 1/1/2014
4 RADIOLOGY 70450 0 20 Years 4.92 $28.0672 $138.09 1/1/2014 0.00 $138.09 4.92 $28.0672 $138.09 1/1/2014 0.00 $138.09 1/1/2014
4 RADIOLOGY 70450 21 999 Years 4.92 $26.7305 $131.51 1/1/2014 0.00 $131.51 4.92 $26.7305 $131.51 1/1/2014 0.00 $131.51 1/1/2014
I
PROFESSIONAL
COMPONENT 70450 0 20 Years 1.20 $28.0672 $33.68 1/1/2014 0.00 $33.68 1.20 $28.0672 $33.68 1/1/2014 0.00 $33.68 1/1/2014
I
PROFESSIONAL
COMPONENT 70450 21 999 Years 1.20 $26.7305 $32.08 1/1/2014 0.00 $32.08 1.20 $26.7305 $32.08 1/1/2014 0.00 $32.08 1/1/2014
T
TECHNICAL
COMPONENT 70450 0 20 Years 3.72 $28.0672 $104.41 1/1/2014 0.00 $104.41 3.72 $28.0672 $104.41 1/1/2014 0.00 $104.41 1/1/2014
T
TECHNICAL
COMPONENT 70450 21 999 Years 3.72 $26.7305 $99.44 1/1/2014 0.00 $99.44 3.72 $26.7305 $99.44 1/1/2014 0.00 $99.44 1/1/2014
4 RADIOLOGY 70460 0 20 Years 6.45 $28.0672 $181.03 1/1/2014 0.00 $181.03 6.45 $28.0672 $181.03 1/1/2014 0.00 $181.03 1/1/2014
4 RADIOLOGY 70460 21 999 Years 6.45 $26.7305 $172.41 1/1/2014 0.00 $172.41 6.45 $26.7305 $172.41 1/1/2014 0.00 $172.41 1/1/2014
I
PROFESSIONAL
COMPONENT 70460 0 20 Years 1.59 $28.0672 $44.63 1/1/2014 0.00 $44.63 1.59 $28.0672 $44.63 1/1/2014 0.00 $44.63 1/1/2014
I
PROFESSIONAL
COMPONENT 70460 21 999 Years 1.59 $26.7305 $42.50 1/1/2014 0.00 $42.50 1.59 $26.7305 $42.50 1/1/2014 0.00 $42.50 1/1/2014
T
TECHNICAL
COMPONENT 70460 0 20 Years 4.86 $28.0672 $136.41 1/1/2014 0.00 $136.41 4.86 $28.0672 $136.41 1/1/2014 0.00 $136.41 1/1/2014
T
TECHNICAL
COMPONENT 70460 21 999 Years 4.86 $26.7305 $129.91 1/1/2014 0.00 $129.91 4.86 $26.7305 $129.91 1/1/2014 0.00 $129.91 1/1/2014
4 RADIOLOGY 70470 0 20 Years 6.52 $28.0672 $183.00 1/1/2014 0.00 $183.00 6.52 $28.0672 $183.00 1/1/2014 0.00 $183.00 1/1/2014
4 RADIOLOGY 70470 21 999 Years 6.52 $26.7305 $174.28 1/1/2014 0.00 $174.28 6.52 $26.7305 $174.28 1/1/2014 0.00 $174.28 1/1/2014
I
PROFESSIONAL
COMPONENT 70470 0 20 Years 1.80 $28.0672 $50.52 1/1/2014 0.00 $50.52 1.80 $28.0672 $50.52 1/1/2014 0.00 $50.52 1/1/2014
I
PROFESSIONAL
COMPONENT 70470 21 999 Years 1.80 $26.7305 $48.11 1/1/2014 0.00 $48.11 1.80 $26.7305 $48.11 1/1/2014 0.00 $48.11 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70470 0 20 Years 4.72 $28.0672 $132.48 1/1/2014 0.00 $132.48 4.72 $28.0672 $132.48 1/1/2014 0.00 $132.48 1/1/2014
T
TECHNICAL
COMPONENT 70470 21 999 Years 4.72 $26.7305 $126.17 1/1/2014 0.00 $126.17 4.72 $26.7305 $126.17 1/1/2014 0.00 $126.17 1/1/2014
4 RADIOLOGY 70480 0 20 Years 8.27 $28.0672 $232.12 1/1/2014 0.00 $232.12 8.27 $28.0672 $232.12 1/1/2014 0.00 $232.12 1/1/2014
4 RADIOLOGY 70480 21 999 Years 8.27 $26.7305 $221.06 1/1/2014 0.00 $221.06 8.27 $26.7305 $221.06 1/1/2014 0.00 $221.06 1/1/2014
I
PROFESSIONAL
COMPONENT 70480 0 20 Years 1.82 $28.0672 $51.08 1/1/2014 0.00 $51.08 1.82 $28.0672 $51.08 1/1/2014 0.00 $51.08 1/1/2014
I
PROFESSIONAL
COMPONENT 70480 21 999 Years 1.82 $26.7305 $48.65 1/1/2014 0.00 $48.65 1.82 $26.7305 $48.65 1/1/2014 0.00 $48.65 1/1/2014
T
TECHNICAL
COMPONENT 70480 0 20 Years 6.45 $28.0672 $181.03 1/1/2014 0.00 $181.03 6.45 $28.0672 $181.03 1/1/2014 0.00 $181.03 1/1/2014
T
TECHNICAL
COMPONENT 70480 21 999 Years 6.45 $26.7305 $172.41 1/1/2014 0.00 $172.41 6.45 $26.7305 $172.41 1/1/2014 0.00 $172.41 1/1/2014
4 RADIOLOGY 70481 0 20 Years 9.58 $28.0672 $268.88 1/1/2014 0.00 $268.88 9.58 $28.0672 $268.88 1/1/2014 0.00 $268.88 1/1/2014
4 RADIOLOGY 70481 21 999 Years 9.58 $26.7305 $256.08 1/1/2014 0.00 $256.08 9.58 $26.7305 $256.08 1/1/2014 0.00 $256.08 1/1/2014
I
PROFESSIONAL
COMPONENT 70481 0 20 Years 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1/1/2014
I
PROFESSIONAL
COMPONENT 70481 21 999 Years 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1/1/2014
T
TECHNICAL
COMPONENT 70481 0 20 Years 7.62 $28.0672 $213.87 1/1/2014 0.00 $213.87 7.62 $28.0672 $213.87 1/1/2014 0.00 $213.87 1/1/2014
T
TECHNICAL
COMPONENT 70481 21 999 Years 7.62 $26.7305 $203.69 1/1/2014 0.00 $203.69 7.62 $26.7305 $203.69 1/1/2014 0.00 $203.69 1/1/2014
4 RADIOLOGY 70482 0 20 Years 10.61 $28.0672 $297.79 1/1/2014 0.00 $297.79 10.61 $28.0672 $297.79 1/1/2014 0.00 $297.79 1/1/2014
4 RADIOLOGY 70482 21 999 Years 10.61 $26.7305 $283.61 1/1/2014 0.00 $283.61 10.61 $26.7305 $283.61 1/1/2014 0.00 $283.61 1/1/2014
I
PROFESSIONAL
COMPONENT 70482 0 20 Years 2.05 $28.0672 $57.54 1/1/2014 0.00 $57.54 2.05 $28.0672 $57.54 1/1/2014 0.00 $57.54 1/1/2014
I
PROFESSIONAL
COMPONENT 70482 21 999 Years 2.05 $26.7305 $54.80 1/1/2014 0.00 $54.80 2.05 $26.7305 $54.80 1/1/2014 0.00 $54.80 1/1/2014
T
TECHNICAL
COMPONENT 70482 0 20 Years 8.56 $28.0672 $240.26 1/1/2014 0.00 $240.26 8.56 $28.0672 $240.26 1/1/2014 0.00 $240.26 1/1/2014
T
TECHNICAL
COMPONENT 70482 21 999 Years 8.56 $26.7305 $228.81 1/1/2014 0.00 $228.81 8.56 $26.7305 $228.81 1/1/2014 0.00 $228.81 1/1/2014
4 RADIOLOGY 70486 0 20 Years 6.80 $28.0672 $190.86 1/1/2014 0.00 $190.86 6.80 $28.0672 $190.86 1/1/2014 0.00 $190.86 1/1/2014
4 RADIOLOGY 70486 21 999 Years 6.80 $26.7305 $181.77 1/1/2014 0.00 $181.77 6.80 $26.7305 $181.77 1/1/2014 0.00 $181.77 1/1/2014
I
PROFESSIONAL
COMPONENT 70486 0 20 Years 1.62 $28.0672 $45.47 1/1/2014 0.00 $45.47 1.62 $28.0672 $45.47 1/1/2014 0.00 $45.47 1/1/2014
I
PROFESSIONAL
COMPONENT 70486 21 999 Years 1.62 $26.7305 $43.30 1/1/2014 0.00 $43.30 1.62 $26.7305 $43.30 1/1/2014 0.00 $43.30 1/1/2014
T
TECHNICAL
COMPONENT 70486 0 20 Years 5.18 $28.0672 $145.39 1/1/2014 0.00 $145.39 5.18 $28.0672 $145.39 1/1/2014 0.00 $145.39 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70486 21 999 Years 5.18 $26.7305 $138.46 1/1/2014 0.00 $138.46 5.18 $26.7305 $138.46 1/1/2014 0.00 $138.46 1/1/2014
4 RADIOLOGY 70487 0 20 Years 8.19 $28.0672 $229.87 1/1/2014 0.00 $229.87 8.19 $28.0672 $229.87 1/1/2014 0.00 $229.87 1/1/2014
4 RADIOLOGY 70487 21 999 Years 8.19 $26.7305 $218.92 1/1/2014 0.00 $218.92 8.19 $26.7305 $218.92 1/1/2014 0.00 $218.92 1/1/2014
I
PROFESSIONAL
COMPONENT 70487 0 20 Years 1.84 $28.0672 $51.64 1/1/2014 0.00 $51.64 1.84 $28.0672 $51.64 1/1/2014 0.00 $51.64 1/1/2014
I
PROFESSIONAL
COMPONENT 70487 21 999 Years 1.84 $26.7305 $49.18 1/1/2014 0.00 $49.18 1.84 $26.7305 $49.18 1/1/2014 0.00 $49.18 1/1/2014
T
TECHNICAL
COMPONENT 70487 0 20 Years 6.35 $28.0672 $178.23 1/1/2014 0.00 $178.23 6.35 $28.0672 $178.23 1/1/2014 0.00 $178.23 1/1/2014
T
TECHNICAL
COMPONENT 70487 21 999 Years 6.35 $26.7305 $169.74 1/1/2014 0.00 $169.74 6.35 $26.7305 $169.74 1/1/2014 0.00 $169.74 1/1/2014
4 RADIOLOGY 70488 0 20 Years 9.86 $28.0672 $276.74 1/1/2014 0.00 $276.74 9.86 $28.0672 $276.74 1/1/2014 0.00 $276.74 1/1/2014
4 RADIOLOGY 70488 21 999 Years 9.86 $26.7305 $263.56 1/1/2014 0.00 $263.56 9.86 $26.7305 $263.56 1/1/2014 0.00 $263.56 1/1/2014
I
PROFESSIONAL
COMPONENT 70488 0 20 Years 2.01 $28.0672 $56.42 1/1/2014 0.00 $56.42 2.01 $28.0672 $56.42 1/1/2014 0.00 $56.42 1/1/2014
I
PROFESSIONAL
COMPONENT 70488 21 999 Years 2.01 $26.7305 $53.73 1/1/2014 0.00 $53.73 2.01 $26.7305 $53.73 1/1/2014 0.00 $53.73 1/1/2014
T
TECHNICAL
COMPONENT 70488 0 20 Years 7.85 $28.0672 $220.33 1/1/2014 0.00 $220.33 7.85 $28.0672 $220.33 1/1/2014 0.00 $220.33 1/1/2014
T
TECHNICAL
COMPONENT 70488 21 999 Years 7.85 $26.7305 $209.83 1/1/2014 0.00 $209.83 7.85 $26.7305 $209.83 1/1/2014 0.00 $209.83 1/1/2014
4 RADIOLOGY 70490 0 20 Years 6.63 $28.0672 $186.09 1/1/2014 0.00 $186.09 6.63 $28.0672 $186.09 1/1/2014 0.00 $186.09 1/1/2014
4 RADIOLOGY 70490 21 999 Years 6.63 $26.7305 $177.22 1/1/2014 0.00 $177.22 6.63 $26.7305 $177.22 1/1/2014 0.00 $177.22 1/1/2014
I
PROFESSIONAL
COMPONENT 70490 0 20 Years 1.82 $28.0672 $51.08 1/1/2014 0.00 $51.08 1.82 $28.0672 $51.08 1/1/2014 0.00 $51.08 1/1/2014
I
PROFESSIONAL
COMPONENT 70490 21 999 Years 1.82 $26.7305 $48.65 1/1/2014 0.00 $48.65 1.82 $26.7305 $48.65 1/1/2014 0.00 $48.65 1/1/2014
T
TECHNICAL
COMPONENT 70490 0 20 Years 4.81 $28.0672 $135.00 1/1/2014 0.00 $135.00 4.81 $28.0672 $135.00 1/1/2014 0.00 $135.00 1/1/2014
T
TECHNICAL
COMPONENT 70490 21 999 Years 4.81 $26.7305 $128.57 1/1/2014 0.00 $128.57 4.81 $26.7305 $128.57 1/1/2014 0.00 $128.57 1/1/2014
4 RADIOLOGY 70491 0 20 Years 7.99 $28.0672 $224.26 1/1/2014 0.00 $224.26 7.99 $28.0672 $224.26 1/1/2014 0.00 $224.26 1/1/2014
4 RADIOLOGY 70491 21 999 Years 7.99 $26.7305 $213.58 1/1/2014 0.00 $213.58 7.99 $26.7305 $213.58 1/1/2014 0.00 $213.58 1/1/2014
I
PROFESSIONAL
COMPONENT 70491 0 20 Years 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1/1/2014
I
PROFESSIONAL
COMPONENT 70491 21 999 Years 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1/1/2014
T
TECHNICAL
COMPONENT 70491 0 20 Years 6.03 $28.0672 $169.25 1/1/2014 0.00 $169.25 6.03 $28.0672 $169.25 1/1/2014 0.00 $169.25 1/1/2014
T
TECHNICAL
COMPONENT 70491 21 999 Years 6.03 $26.7305 $161.18 1/1/2014 0.00 $161.18 6.03 $26.7305 $161.18 1/1/2014 0.00 $161.18 1/1/2014
4 RADIOLOGY 70492 0 20 Years 9.54 $28.0672 $267.76 1/1/2014 0.00 $267.76 9.54 $28.0672 $267.76 1/1/2014 0.00 $267.76 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Note Codes
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Note Codes
Frm Thru Units
Total
RVUs/
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Factor
Medicaid
Fee
Fee Effect
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Adjust
%
Adjusted
Fee for
Report
Date
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RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 70492 21 999 Years 9.54 $26.7305 $255.01 1/1/2014 0.00 $255.01 9.54 $26.7305 $255.01 1/1/2014 0.00 $255.01 1/1/2014
I
PROFESSIONAL
COMPONENT 70492 0 20 Years 2.05 $28.0672 $57.54 1/1/2014 0.00 $57.54 2.05 $28.0672 $57.54 1/1/2014 0.00 $57.54 1/1/2014
I
PROFESSIONAL
COMPONENT 70492 21 999 Years 2.05 $26.7305 $54.80 1/1/2014 0.00 $54.80 2.05 $26.7305 $54.80 1/1/2014 0.00 $54.80 1/1/2014
T
TECHNICAL
COMPONENT 70492 0 20 Years 7.49 $28.0672 $210.22 1/1/2014 0.00 $210.22 7.49 $28.0672 $210.22 1/1/2014 0.00 $210.22 1/1/2014
T
TECHNICAL
COMPONENT 70492 21 999 Years 7.49 $26.7305 $200.21 1/1/2014 0.00 $200.21 7.49 $26.7305 $200.21 1/1/2014 0.00 $200.21 1/1/2014
4 RADIOLOGY 70496 0 20 Years 14.94 $28.0672 $419.32 1/1/2014 0.00 $419.32 14.94 $28.0672 $419.32 1/1/2014 0.00 $419.32 1/1/2014
4 RADIOLOGY 70496 21 999 Years 14.94 $26.7305 $399.35 1/1/2014 0.00 $399.35 14.94 $26.7305 $399.35 1/1/2014 0.00 $399.35 1/1/2014
I
PROFESSIONAL
COMPONENT 70496 0 20 Years 2.48 $28.0672 $69.61 1/1/2014 0.00 $69.61 2.48 $28.0672 $69.61 1/1/2014 0.00 $69.61 1/1/2014
I
PROFESSIONAL
COMPONENT 70496 21 999 Years 2.48 $26.7305 $66.29 1/1/2014 0.00 $66.29 2.48 $26.7305 $66.29 1/1/2014 0.00 $66.29 1/1/2014
T
TECHNICAL
COMPONENT 70496 0 20 Years 12.46 $28.0672 $349.72 1/1/2014 0.00 $349.72 12.46 $28.0672 $349.72 1/1/2014 0.00 $349.72 1/1/2014
T
TECHNICAL
COMPONENT 70496 21 999 Years 12.46 $26.7305 $333.06 1/1/2014 0.00 $333.06 12.46 $26.7305 $333.06 1/1/2014 0.00 $333.06 1/1/2014
4 RADIOLOGY 70498 0 20 Years 15.45 $28.0672 $433.64 1/1/2014 0.00 $433.64 9 15.45 $28.0672 $433.64 1/1/2014 0.00 $433.64 9 1/1/2014
4 RADIOLOGY 70498 21 999 Years 15.45 $26.7305 $412.99 1/1/2014 0.00 $412.99 9 15.45 $26.7305 $412.99 1/1/2014 0.00 $412.99 9 1/1/2014
I
PROFESSIONAL
COMPONENT 70498 0 20 Years 2.48 $28.0672 $69.61 1/1/2014 0.00 $69.61 9 2.48 $28.0672 $69.61 1/1/2014 0.00 $69.61 9 1/1/2014
I
PROFESSIONAL
COMPONENT 70498 21 999 Years 2.48 $26.7305 $66.29 1/1/2014 0.00 $66.29 9 2.48 $26.7305 $66.29 1/1/2014 0.00 $66.29 9 1/1/2014
T
TECHNICAL
COMPONENT 70498 0 20 Years 12.97 $28.0672 $364.03 1/1/2014 0.00 $364.03 9 12.97 $28.0672 $364.03 1/1/2014 0.00 $364.03 9 1/1/2014
T
TECHNICAL
COMPONENT 70498 21 999 Years 12.97 $26.7305 $346.69 1/1/2014 0.00 $346.69 9 12.97 $26.7305 $346.69 1/1/2014 0.00 $346.69 9 1/1/2014
4 RADIOLOGY 70540 0 20 Years 12.17 $28.0672 $341.58 1/1/2014 0.00 $341.58 12.17 $28.0672 $341.58 1/1/2014 0.00 $341.58 1/1/2014
4 RADIOLOGY 70540 21 999 Years 12.17 $26.7305 $325.31 1/1/2014 0.00 $325.31 12.17 $26.7305 $325.31 1/1/2014 0.00 $325.31 1/1/2014
I
PROFESSIONAL
COMPONENT 70540 0 20 Years 1.91 $28.0672 $53.61 1/1/2014 0.00 $53.61 1.91 $28.0672 $53.61 1/1/2014 0.00 $53.61 1/1/2014
I
PROFESSIONAL
COMPONENT 70540 21 999 Years 1.91 $26.7305 $51.06 1/1/2014 0.00 $51.06 1.91 $26.7305 $51.06 1/1/2014 0.00 $51.06 1/1/2014
T
TECHNICAL
COMPONENT 70540 0 20 Years 10.26 $28.0672 $287.97 1/1/2014 0.00 $287.97 10.26 $28.0672 $287.97 1/1/2014 0.00 $287.97 1/1/2014
T
TECHNICAL
COMPONENT 70540 21 999 Years 10.26 $26.7305 $274.25 1/1/2014 0.00 $274.25 10.26 $26.7305 $274.25 1/1/2014 0.00 $274.25 1/1/2014
4 RADIOLOGY 70542 0 20 Years 13.71 $28.0672 $384.80 1/1/2014 0.00 $384.80 13.71 $28.0672 $384.80 1/1/2014 0.00 $384.80 1/1/2014
4 RADIOLOGY 70542 21 999 Years 13.71 $26.7305 $366.48 1/1/2014 0.00 $366.48 13.71 $26.7305 $366.48 1/1/2014 0.00 $366.48 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
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Factor
Medicaid
Fee
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Date
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%
Adjusted
Fee for
Report
Date
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RVUs/
Base
Units
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Factor
Medicaid
Fee
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Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 70542 0 20 Years 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 1/1/2014
I
PROFESSIONAL
COMPONENT 70542 21 999 Years 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 1/1/2014
T
TECHNICAL
COMPONENT 70542 0 20 Years 11.40 $28.0672 $319.97 1/1/2014 0.00 $319.97 11.40 $28.0672 $319.97 1/1/2014 0.00 $319.97 1/1/2014
T
TECHNICAL
COMPONENT 70542 21 999 Years 11.40 $26.7305 $304.73 1/1/2014 0.00 $304.73 11.40 $26.7305 $304.73 1/1/2014 0.00 $304.73 1/1/2014
4 RADIOLOGY 70543 0 20 Years 16.83 $28.0672 $472.37 1/1/2014 0.00 $472.37 16.83 $28.0672 $472.37 1/1/2014 0.00 $472.37 1/1/2014
4 RADIOLOGY 70543 21 999 Years 16.83 $26.7305 $449.87 1/1/2014 0.00 $449.87 16.83 $26.7305 $449.87 1/1/2014 0.00 $449.87 1/1/2014
I
PROFESSIONAL
COMPONENT 70543 0 20 Years 3.04 $28.0672 $85.32 1/1/2014 0.00 $85.32 3.04 $28.0672 $85.32 1/1/2014 0.00 $85.32 1/1/2014
I
PROFESSIONAL
COMPONENT 70543 21 999 Years 3.04 $26.7305 $81.26 1/1/2014 0.00 $81.26 3.04 $26.7305 $81.26 1/1/2014 0.00 $81.26 1/1/2014
T
TECHNICAL
COMPONENT 70543 0 20 Years 13.79 $28.0672 $387.05 1/1/2014 0.00 $387.05 13.79 $28.0672 $387.05 1/1/2014 0.00 $387.05 1/1/2014
T
TECHNICAL
COMPONENT 70543 21 999 Years 13.79 $26.7305 $368.61 1/1/2014 0.00 $368.61 13.79 $26.7305 $368.61 1/1/2014 0.00 $368.61 1/1/2014
4 RADIOLOGY 70544 0 20 Years 13.71 $28.0672 $384.80 1/1/2014 0.00 $384.80 13.71 $28.0672 $384.80 1/1/2014 0.00 $384.80 1/1/2014
4 RADIOLOGY 70544 21 999 Years 13.71 $26.7305 $366.48 1/1/2014 0.00 $366.48 13.71 $26.7305 $366.48 1/1/2014 0.00 $366.48 1/1/2014
I
PROFESSIONAL
COMPONENT 70544 0 20 Years 1.70 $28.0672 $47.71 1/1/2014 0.00 $47.71 1.70 $28.0672 $47.71 1/1/2014 0.00 $47.71 1/1/2014
I
PROFESSIONAL
COMPONENT 70544 21 999 Years 1.70 $26.7305 $45.44 1/1/2014 0.00 $45.44 1.70 $26.7305 $45.44 1/1/2014 0.00 $45.44 1/1/2014
T
TECHNICAL
COMPONENT 70544 0 20 Years 12.01 $28.0672 $337.09 1/1/2014 0.00 $337.09 12.01 $28.0672 $337.09 1/1/2014 0.00 $337.09 1/1/2014
T
TECHNICAL
COMPONENT 70544 21 999 Years 12.01 $26.7305 $321.03 1/1/2014 0.00 $321.03 12.01 $26.7305 $321.03 1/1/2014 0.00 $321.03 1/1/2014
4 RADIOLOGY 70545 0 20 Years 13.49 $28.0672 $378.63 1/1/2014 0.00 $378.63 13.49 $28.0672 $378.63 1/1/2014 0.00 $378.63 1/1/2014
4 RADIOLOGY 70545 21 999 Years 13.49 $26.7305 $360.59 1/1/2014 0.00 $360.59 13.49 $26.7305 $360.59 1/1/2014 0.00 $360.59 1/1/2014
I
PROFESSIONAL
COMPONENT 70545 0 20 Years 1.70 $28.0672 $47.71 1/1/2014 0.00 $47.71 1.70 $28.0672 $47.71 1/1/2014 0.00 $47.71 1/1/2014
I
PROFESSIONAL
COMPONENT 70545 21 999 Years 1.70 $26.7305 $45.44 1/1/2014 0.00 $45.44 1.70 $26.7305 $45.44 1/1/2014 0.00 $45.44 1/1/2014
T
TECHNICAL
COMPONENT 70545 0 20 Years 11.79 $28.0672 $330.91 1/1/2014 0.00 $330.91 11.79 $28.0672 $330.91 1/1/2014 0.00 $330.91 1/1/2014
T
TECHNICAL
COMPONENT 70545 21 999 Years 11.79 $26.7305 $315.15 1/1/2014 0.00 $315.15 11.79 $26.7305 $315.15 1/1/2014 0.00 $315.15 1/1/2014
4 RADIOLOGY 70546 0 20 Years 20.72 $28.0672 $581.55 1/1/2014 0.00 $581.55 20.72 $28.0672 $581.55 1/1/2014 0.00 $581.55 1/1/2014
4 RADIOLOGY 70546 21 999 Years 20.72 $26.7305 $553.86 1/1/2014 0.00 $553.86 20.72 $26.7305 $553.86 1/1/2014 0.00 $553.86 1/1/2014
I
PROFESSIONAL
COMPONENT 70546 0 20 Years 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Mod
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Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 70546 21 999 Years 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 1/1/2014
T
TECHNICAL
COMPONENT 70546 0 20 Years 18.16 $28.0672 $509.70 1/1/2014 0.00 $509.70 9 18.16 $28.0672 $509.70 1/1/2014 0.00 $509.70 9 1/1/2014
T
TECHNICAL
COMPONENT 70546 21 999 Years 18.16 $26.7305 $485.43 1/1/2014 0.00 $485.43 9 18.16 $26.7305 $485.43 1/1/2014 0.00 $485.43 9 1/1/2014
4 RADIOLOGY 70547 0 20 Years 13.73 $28.0672 $385.36 1/1/2014 0.00 $385.36 13.73 $28.0672 $385.36 1/1/2014 0.00 $385.36 1/1/2014
4 RADIOLOGY 70547 21 999 Years 13.73 $26.7305 $367.01 1/1/2014 0.00 $367.01 13.73 $26.7305 $367.01 1/1/2014 0.00 $367.01 1/1/2014
I
PROFESSIONAL
COMPONENT 70547 0 20 Years 1.71 $28.0672 $47.99 1/1/2014 0.00 $47.99 1.71 $28.0672 $47.99 1/1/2014 0.00 $47.99 1/1/2014
I
PROFESSIONAL
COMPONENT 70547 21 999 Years 1.71 $26.7305 $45.71 1/1/2014 0.00 $45.71 1.71 $26.7305 $45.71 1/1/2014 0.00 $45.71 1/1/2014
T
TECHNICAL
COMPONENT 70547 0 20 Years 12.02 $28.0672 $337.37 1/1/2014 0.00 $337.37 12.02 $28.0672 $337.37 1/1/2014 0.00 $337.37 1/1/2014
T
TECHNICAL
COMPONENT 70547 21 999 Years 12.02 $26.7305 $321.30 1/1/2014 0.00 $321.30 12.02 $26.7305 $321.30 1/1/2014 0.00 $321.30 1/1/2014
4 RADIOLOGY 70548 0 20 Years 14.52 $28.0672 $407.54 1/1/2014 0.00 $407.54 14.52 $28.0672 $407.54 1/1/2014 0.00 $407.54 1/1/2014
4 RADIOLOGY 70548 21 999 Years 14.52 $26.7305 $388.13 1/1/2014 0.00 $388.13 14.52 $26.7305 $388.13 1/1/2014 0.00 $388.13 1/1/2014
I
PROFESSIONAL
COMPONENT 70548 0 20 Years 1.71 $28.0672 $47.99 1/1/2014 0.00 $47.99 1.71 $28.0672 $47.99 1/1/2014 0.00 $47.99 1/1/2014
I
PROFESSIONAL
COMPONENT 70548 21 999 Years 1.71 $26.7305 $45.71 1/1/2014 0.00 $45.71 1.71 $26.7305 $45.71 1/1/2014 0.00 $45.71 1/1/2014
T
TECHNICAL
COMPONENT 70548 0 20 Years 12.81 $28.0672 $359.54 1/1/2014 0.00 $359.54 12.81 $28.0672 $359.54 1/1/2014 0.00 $359.54 1/1/2014
T
TECHNICAL
COMPONENT 70548 21 999 Years 12.81 $26.7305 $342.42 1/1/2014 0.00 $342.42 12.81 $26.7305 $342.42 1/1/2014 0.00 $342.42 1/1/2014
4 RADIOLOGY 70549 0 20 Years 20.75 $28.0672 $582.39 1/1/2014 0.00 $582.39 20.75 $28.0672 $582.39 1/1/2014 0.00 $582.39 1/1/2014
4 RADIOLOGY 70549 21 999 Years 20.75 $26.7305 $554.66 1/1/2014 0.00 $554.66 20.75 $26.7305 $554.66 1/1/2014 0.00 $554.66 1/1/2014
I
PROFESSIONAL
COMPONENT 70549 0 20 Years 2.55 $28.0672 $71.57 1/1/2014 0.00 $71.57 2.55 $28.0672 $71.57 1/1/2014 0.00 $71.57 1/1/2014
I
PROFESSIONAL
COMPONENT 70549 21 999 Years 2.55 $26.7305 $68.16 1/1/2014 0.00 $68.16 2.55 $26.7305 $68.16 1/1/2014 0.00 $68.16 1/1/2014
T
TECHNICAL
COMPONENT 70549 0 20 Years 18.20 $28.0672 $510.82 1/1/2014 0.00 $510.82 18.20 $28.0672 $510.82 1/1/2014 0.00 $510.82 1/1/2014
T
TECHNICAL
COMPONENT 70549 21 999 Years 18.20 $26.7305 $486.50 1/1/2014 0.00 $486.50 18.20 $26.7305 $486.50 1/1/2014 0.00 $486.50 1/1/2014
4 RADIOLOGY 70551 0 20 Years 12.85 $28.0672 $360.66 1/1/2014 0.00 $360.66 12.85 $28.0672 $360.66 1/1/2014 0.00 $360.66 1/1/2014
4 RADIOLOGY 70551 21 999 Years 12.85 $26.7305 $343.49 1/1/2014 0.00 $343.49 12.85 $26.7305 $343.49 1/1/2014 0.00 $343.49 1/1/2014
I
PROFESSIONAL
COMPONENT 70551 0 20 Years 2.10 $28.0672 $58.94 1/1/2014 0.00 $58.94 2.10 $28.0672 $58.94 1/1/2014 0.00 $58.94 1/1/2014
I
PROFESSIONAL
COMPONENT 70551 21 999 Years 2.10 $26.7305 $56.13 1/1/2014 0.00 $56.13 2.10 $26.7305 $56.13 1/1/2014 0.00 $56.13 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Mod
1
Mod
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Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 70551 0 20 Years 10.75 $28.0672 $301.72 1/1/2014 0.00 $301.72 10.75 $28.0672 $301.72 1/1/2014 0.00 $301.72 1/1/2014
T
TECHNICAL
COMPONENT 70551 21 999 Years 10.75 $26.7305 $287.35 1/1/2014 0.00 $287.35 10.75 $26.7305 $287.35 1/1/2014 0.00 $287.35 1/1/2014
4 RADIOLOGY 70552 0 20 Years 14.35 $28.0672 $402.76 1/1/2014 0.00 $402.76 14.35 $28.0672 $402.76 1/1/2014 0.00 $402.76 1/1/2014
4 RADIOLOGY 70552 21 999 Years 14.35 $26.7305 $383.58 1/1/2014 0.00 $383.58 14.35 $26.7305 $383.58 1/1/2014 0.00 $383.58 1/1/2014
I
PROFESSIONAL
COMPONENT 70552 0 20 Years 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 1/1/2014
I
PROFESSIONAL
COMPONENT 70552 21 999 Years 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 1/1/2014
T
TECHNICAL
COMPONENT 70552 0 20 Years 11.81 $28.0672 $331.47 1/1/2014 0.00 $331.47 11.81 $28.0672 $331.47 1/1/2014 0.00 $331.47 1/1/2014
T
TECHNICAL
COMPONENT 70552 21 999 Years 11.81 $26.7305 $315.69 1/1/2014 0.00 $315.69 11.81 $26.7305 $315.69 1/1/2014 0.00 $315.69 1/1/2014
4 RADIOLOGY 70553 0 20 Years 16.81 $28.0672 $471.81 1/1/2014 0.00 $471.81 16.81 $28.0672 $471.81 1/1/2014 0.00 $471.81 1/1/2014
4 RADIOLOGY 70553 21 999 Years 16.81 $26.7305 $449.34 1/1/2014 0.00 $449.34 16.81 $26.7305 $449.34 1/1/2014 0.00 $449.34 1/1/2014
I
PROFESSIONAL
COMPONENT 70553 0 20 Years 3.35 $28.0672 $94.03 1/1/2014 0.00 $94.03 3.35 $28.0672 $94.03 1/1/2014 0.00 $94.03 1/1/2014
I
PROFESSIONAL
COMPONENT 70553 21 999 Years 3.35 $26.7305 $89.55 1/1/2014 0.00 $89.55 3.35 $26.7305 $89.55 1/1/2014 0.00 $89.55 1/1/2014
T
TECHNICAL
COMPONENT 70553 0 20 Years 13.46 $28.0672 $377.78 1/1/2014 0.00 $377.78 13.46 $28.0672 $377.78 1/1/2014 0.00 $377.78 1/1/2014
T
TECHNICAL
COMPONENT 70553 21 999 Years 13.46 $26.7305 $359.79 1/1/2014 0.00 $359.79 13.46 $26.7305 $359.79 1/1/2014 0.00 $359.79 1/1/2014
4 RADIOLOGY 70554 0 20 Years 14.62 $28.0672 $410.34 1/1/2014 0.00 $410.34 14.62 $28.0672 $410.34 1/1/2014 0.00 $410.34 1/1/2014
4 RADIOLOGY 70554 21 999 Years 14.62 $26.7305 $390.80 1/1/2014 0.00 $390.80 14.62 $26.7305 $390.80 1/1/2014 0.00 $390.80 1/1/2014
I
PROFESSIONAL
COMPONENT 70554 0 20 Years 3.01 $28.0672 $84.48 1/1/2014 0.00 $84.48 3.01 $28.0672 $84.48 1/1/2014 0.00 $84.48 1/1/2014
I
PROFESSIONAL
COMPONENT 70554 21 999 Years 3.01 $26.7305 $80.46 1/1/2014 0.00 $80.46 3.01 $26.7305 $80.46 1/1/2014 0.00 $80.46 1/1/2014
T
TECHNICAL
COMPONENT 70554 0 20 Years 11.61 $28.0672 $325.86 1/1/2014 0.00 $325.86 11.61 $28.0672 $325.86 1/1/2014 0.00 $325.86 1/1/2014
T
TECHNICAL
COMPONENT 70554 21 999 Years 11.61 $26.7305 $310.34 1/1/2014 0.00 $310.34 11.61 $26.7305 $310.34 1/1/2014 0.00 $310.34 1/1/2014
I
PROFESSIONAL
COMPONENT 70555 0 20 Years 3.71 $28.0672 $104.13 1/1/2014 0.00 $104.13 3.71 $28.0672 $104.13 1/1/2014 0.00 $104.13 1/1/2014
I
PROFESSIONAL
COMPONENT 70555 21 999 Years 3.71 $26.7305 $99.17 1/1/2014 0.00 $99.17 3.71 $26.7305 $99.17 1/1/2014 0.00 $99.17 1/1/2014
4 RADIOLOGY 71010 0 20 Years 0.70 $28.0672 $19.65 1/1/2014 0.00 $19.65 9 0.70 $28.0672 $19.65 1/1/2014 0.00 $19.65 9 1/1/2014
4 RADIOLOGY 71010 21 999 Years 0.70 $26.7305 $18.71 1/1/2014 0.00 $18.71 9 0.70 $26.7305 $18.71 1/1/2014 0.00 $18.71 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71010 0 20 Years 0.26 $28.0672 $7.30 1/1/2014 0.00 $7.30 9 0.26 $28.0672 $7.30 1/1/2014 0.00 $7.30 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 71010 21 999 Years 0.26 $26.7305 $6.95 1/1/2014 0.00 $6.95 9 0.26 $26.7305 $6.95 1/1/2014 0.00 $6.95 9 1/1/2014
T
TECHNICAL
COMPONENT 71010 0 20 Years 0.44 $28.0672 $12.35 1/1/2014 0.00 $12.35 9 1/1/2014
T
TECHNICAL
COMPONENT 71010 21 999 Years 0.44 $26.7305 $11.76 1/1/2014 0.00 $11.76 9 1/1/2014
4 RADIOLOGY 71015 0 20 Years 0.92 $28.0672 $25.82 1/1/2014 0.00 $25.82 9 0.92 $28.0672 $25.82 1/1/2014 0.00 $25.82 9 1/1/2014
4 RADIOLOGY 71015 21 999 Years 0.92 $26.7305 $24.59 1/1/2014 0.00 $24.59 9 0.92 $26.7305 $24.59 1/1/2014 0.00 $24.59 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71015 0 20 Years 0.30 $28.0672 $8.42 1/1/2014 0.00 $8.42 9 0.30 $28.0672 $8.42 1/1/2014 0.00 $8.42 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71015 21 999 Years 0.30 $26.7305 $8.02 1/1/2014 0.00 $8.02 9 0.30 $26.7305 $8.02 1/1/2014 0.00 $8.02 9 1/1/2014
T
TECHNICAL
COMPONENT 71015 0 20 Years 0.62 $28.0672 $17.40 1/1/2014 0.00 $17.40 9 1/1/2014
T
TECHNICAL
COMPONENT 71015 21 999 Years 0.62 $26.7305 $16.57 1/1/2014 0.00 $16.57 9 1/1/2014
4 RADIOLOGY 71020 0 20 Years 0.91 $28.0672 $25.54 1/1/2014 0.00 $25.54 9 0.91 $28.0672 $25.54 1/1/2014 0.00 $25.54 9 1/1/2014
4 RADIOLOGY 71020 21 999 Years 0.91 $26.7305 $24.32 1/1/2014 0.00 $24.32 9 0.91 $26.7305 $24.32 1/1/2014 0.00 $24.32 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71020 0 20 Years 0.31 $28.0672 $8.70 1/1/2014 0.00 $8.70 9 0.31 $28.0672 $8.70 1/1/2014 0.00 $8.70 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71020 21 999 Years 0.31 $26.7305 $8.29 1/1/2014 0.00 $8.29 9 0.31 $26.7305 $8.29 1/1/2014 0.00 $8.29 9 1/1/2014
T
TECHNICAL
COMPONENT 71020 0 20 Years 0.60 $28.0672 $16.84 1/1/2014 0.00 $16.84 9 1/1/2014
T
TECHNICAL
COMPONENT 71020 21 999 Years 0.60 $26.7305 $16.04 1/1/2014 0.00 $16.04 9 1/1/2014
4 RADIOLOGY 71021 0 20 Years 1.13 $28.0672 $31.72 1/1/2014 0.00 $31.72 9 1.13 $28.0672 $31.72 1/1/2014 0.00 $31.72 9 1/1/2014
4 RADIOLOGY 71021 21 999 Years 1.13 $26.7305 $30.21 1/1/2014 0.00 $30.21 9 1.13 $26.7305 $30.21 1/1/2014 0.00 $30.21 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71021 0 20 Years 0.39 $28.0672 $10.95 1/1/2014 0.00 $10.95 9 0.39 $28.0672 $10.95 1/1/2014 0.00 $10.95 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71021 21 999 Years 0.39 $26.7305 $10.42 1/1/2014 0.00 $10.42 9 0.39 $26.7305 $10.42 1/1/2014 0.00 $10.42 9 1/1/2014
T
TECHNICAL
COMPONENT 71021 0 20 Years 0.74 $28.0672 $20.77 1/1/2014 0.00 $20.77 9 1/1/2014
T
TECHNICAL
COMPONENT 71021 21 999 Years 0.74 $26.7305 $19.78 1/1/2014 0.00 $19.78 9 1/1/2014
4 RADIOLOGY 71022 0 20 Years 1.44 $28.0672 $40.42 1/1/2014 0.00 $40.42 9 1.44 $28.0672 $40.42 1/1/2014 0.00 $40.42 9 1/1/2014
4 RADIOLOGY 71022 21 999 Years 1.44 $26.7305 $38.49 1/1/2014 0.00 $38.49 9 1.44 $26.7305 $38.49 1/1/2014 0.00 $38.49 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71022 0 20 Years 0.45 $28.0672 $12.63 1/1/2014 0.00 $12.63 9 0.45 $28.0672 $12.63 1/1/2014 0.00 $12.63 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71022 21 999 Years 0.45 $26.7305 $12.03 1/1/2014 0.00 $12.03 9 0.45 $26.7305 $12.03 1/1/2014 0.00 $12.03 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 71022 0 20 Years 0.99 $28.0672 $27.79 1/1/2014 0.00 $27.79 9 1/1/2014
T
TECHNICAL
COMPONENT 71022 21 999 Years 0.99 $26.7305 $26.46 1/1/2014 0.00 $26.46 9 1/1/2014
4 RADIOLOGY 71023 0 20 Years 1.98 $28.0672 $55.57 1/1/2014 0.00 $55.57 9 1/1/2014
4 RADIOLOGY 71023 21 999 Years 1.98 $26.7305 $52.93 1/1/2014 0.00 $52.93 9 1/1/2014
T
TECHNICAL
COMPONENT 71023 0 20 Years 1.45 $28.0672 $40.70 1/1/2014 0.00 $40.70 9 1/1/2014
T
TECHNICAL
COMPONENT 71023 21 999 Years 1.45 $26.7305 $38.76 1/1/2014 0.00 $38.76 9 1/1/2014
4 RADIOLOGY 71030 0 20 Years 1.38 $28.0672 $38.73 1/1/2014 0.00 $38.73 9 1/1/2014
4 RADIOLOGY 71030 21 999 Years 1.38 $26.7305 $36.89 1/1/2014 0.00 $36.89 9 1/1/2014
T
TECHNICAL
COMPONENT 71030 0 20 Years 0.95 $28.0672 $26.66 1/1/2014 0.00 $26.66 9 1/1/2014
T
TECHNICAL
COMPONENT 71030 21 999 Years 0.95 $26.7305 $25.39 1/1/2014 0.00 $25.39 9 1/1/2014
4 RADIOLOGY 71034 0 20 Years 2.58 $28.0672 $72.41 1/1/2014 0.00 $72.41 9 1/1/2014
4 RADIOLOGY 71034 21 999 Years 2.58 $26.7305 $68.96 1/1/2014 0.00 $68.96 9 1/1/2014
T
TECHNICAL
COMPONENT 71034 0 20 Years 1.94 $28.0672 $54.45 1/1/2014 0.00 $54.45 9 1/1/2014
T
TECHNICAL
COMPONENT 71034 21 999 Years 1.94 $26.7305 $51.86 1/1/2014 0.00 $51.86 9 1/1/2014
4 RADIOLOGY 71035 0 20 Years 1.08 $28.0672 $30.31 1/1/2014 0.00 $30.31 9 1.08 $28.0672 $30.31 1/1/2014 0.00 $30.31 9 1/1/2014
4 RADIOLOGY 71035 21 999 Years 1.08 $26.7305 $28.87 1/1/2014 0.00 $28.87 9 1.08 $26.7305 $28.87 1/1/2014 0.00 $28.87 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71035 0 20 Years 0.25 $28.0672 $7.02 1/1/2014 0.00 $7.02 9 0.25 $28.0672 $7.02 1/1/2014 0.00 $7.02 9 1/1/2014
I
PROFESSIONAL
COMPONENT 71035 21 999 Years 0.25 $26.7305 $6.68 1/1/2014 0.00 $6.68 9 0.25 $26.7305 $6.68 1/1/2014 0.00 $6.68 9 1/1/2014
T
TECHNICAL
COMPONENT 71035 0 20 Years 0.83 $28.0672 $23.30 1/1/2014 0.00 $23.30 9 1/1/2014
T
TECHNICAL
COMPONENT 71035 21 999 Years 0.83 $26.7305 $22.19 1/1/2014 0.00 $22.19 9 1/1/2014
4 RADIOLOGY 71100 0 20 Years 0.98 $28.0672 $27.51 1/1/2014 0.00 $27.51 9 1/1/2014
4 RADIOLOGY 71100 21 999 Years 0.98 $26.7305 $26.20 1/1/2014 0.00 $26.20 9 1/1/2014
T
TECHNICAL
COMPONENT 71100 0 20 Years 0.66 $28.0672 $18.52 1/1/2014 0.00 $18.52 9 1/1/2014
T
TECHNICAL
COMPONENT 71100 21 999 Years 0.66 $26.7305 $17.64 1/1/2014 0.00 $17.64 9 1/1/2014
4 RADIOLOGY 71101 0 20 Years 1.19 $28.0672 $33.40 1/1/2014 0.00 $33.40 9 1/1/2014
4 RADIOLOGY 71101 21 999 Years 1.19 $26.7305 $31.81 1/1/2014 0.00 $31.81 9 1/1/2014
T
TECHNICAL
COMPONENT 71101 0 20 Years 0.81 $28.0672 $22.73 1/1/2014 0.00 $22.73 9 1/1/2014
T
TECHNICAL
COMPONENT 71101 21 999 Years 0.81 $26.7305 $21.65 1/1/2014 0.00 $21.65 9 1/1/2014
4 RADIOLOGY 71110 0 20 Years 1.23 $28.0672 $34.52 1/1/2014 0.00 $34.52 9 1/1/2014
4 RADIOLOGY 71110 21 999 Years 1.23 $26.7305 $32.88 1/1/2014 0.00 $32.88 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 71110 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 9 1/1/2014
T
TECHNICAL
COMPONENT 71110 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 9 1/1/2014
4 RADIOLOGY 71111 0 20 Years 1.61 $28.0672 $45.19 1/1/2014 0.00 $45.19 9 1/1/2014
4 RADIOLOGY 71111 21 999 Years 1.61 $26.7305 $43.04 1/1/2014 0.00 $43.04 9 1/1/2014
T
TECHNICAL
COMPONENT 71111 0 20 Years 1.15 $28.0672 $32.28 1/1/2014 0.00 $32.28 9 1/1/2014
T
TECHNICAL
COMPONENT 71111 21 999 Years 1.15 $26.7305 $30.74 1/1/2014 0.00 $30.74 9 1/1/2014
4 RADIOLOGY 71120 0 20 Years 0.95 $28.0672 $26.66 1/1/2014 0.00 $26.66 9 1/1/2014
4 RADIOLOGY 71120 21 999 Years 0.95 $26.7305 $25.39 1/1/2014 0.00 $25.39 9 1/1/2014
T
TECHNICAL
COMPONENT 71120 0 20 Years 0.67 $28.0672 $18.81 1/1/2014 0.00 $18.81 9 1/1/2014
T
TECHNICAL
COMPONENT 71120 21 999 Years 0.67 $26.7305 $17.91 1/1/2014 0.00 $17.91 9 1/1/2014
4 RADIOLOGY 71130 0 20 Years 1.13 $28.0672 $31.72 1/1/2014 0.00 $31.72 9 1/1/2014
4 RADIOLOGY 71130 21 999 Years 1.13 $26.7305 $30.21 1/1/2014 0.00 $30.21 9 1/1/2014
T
TECHNICAL
COMPONENT 71130 0 20 Years 0.81 $28.0672 $22.73 1/1/2014 0.00 $22.73 9 1/1/2014
T
TECHNICAL
COMPONENT 71130 21 999 Years 0.81 $26.7305 $21.65 1/1/2014 0.00 $21.65 9 1/1/2014
4 RADIOLOGY 71250 0 20 Years 6.26 $28.0672 $175.70 1/1/2014 0.00 $175.70 6.26 $28.0672 $175.70 1/1/2014 0.00 $175.70 1/1/2014
4 RADIOLOGY 71250 21 999 Years 6.26 $26.7305 $167.33 1/1/2014 0.00 $167.33 6.26 $26.7305 $167.33 1/1/2014 0.00 $167.33 1/1/2014
I
PROFESSIONAL
COMPONENT 71250 0 20 Years 1.44 $28.0672 $40.42 1/1/2014 0.00 $40.42 1.44 $28.0672 $40.42 1/1/2014 0.00 $40.42 1/1/2014
I
PROFESSIONAL
COMPONENT 71250 21 999 Years 1.44 $26.7305 $38.49 1/1/2014 0.00 $38.49 1.44 $26.7305 $38.49 1/1/2014 0.00 $38.49 1/1/2014
T
TECHNICAL
COMPONENT 71250 0 20 Years 4.82 $28.0672 $135.28 1/1/2014 0.00 $135.28 4.82 $28.0672 $135.28 1/1/2014 0.00 $135.28 1/1/2014
T
TECHNICAL
COMPONENT 71250 21 999 Years 4.82 $26.7305 $128.84 1/1/2014 0.00 $128.84 4.82 $26.7305 $128.84 1/1/2014 0.00 $128.84 1/1/2014
4 RADIOLOGY 71260 0 20 Years 7.83 $28.0672 $219.77 1/1/2014 0.00 $219.77 7.83 $28.0672 $219.77 1/1/2014 0.00 $219.77 1/1/2014
4 RADIOLOGY 71260 21 999 Years 7.83 $26.7305 $209.30 1/1/2014 0.00 $209.30 7.83 $26.7305 $209.30 1/1/2014 0.00 $209.30 1/1/2014
I
PROFESSIONAL
COMPONENT 71260 0 20 Years 1.77 $28.0672 $49.68 1/1/2014 0.00 $49.68 1.77 $28.0672 $49.68 1/1/2014 0.00 $49.68 1/1/2014
I
PROFESSIONAL
COMPONENT 71260 21 999 Years 1.77 $26.7305 $47.31 1/1/2014 0.00 $47.31 1.77 $26.7305 $47.31 1/1/2014 0.00 $47.31 1/1/2014
T
TECHNICAL
COMPONENT 71260 0 20 Years 6.06 $28.0672 $170.09 1/1/2014 0.00 $170.09 6.06 $28.0672 $170.09 1/1/2014 0.00 $170.09 1/1/2014
T
TECHNICAL
COMPONENT 71260 21 999 Years 6.06 $26.7305 $161.99 1/1/2014 0.00 $161.99 6.06 $26.7305 $161.99 1/1/2014 0.00 $161.99 1/1/2014
4 RADIOLOGY 71270 0 20 Years 9.49 $28.0672 $266.36 1/1/2014 0.00 $266.36 9.49 $28.0672 $266.36 1/1/2014 0.00 $266.36 1/1/2014
4 RADIOLOGY 71270 21 999 Years 9.49 $26.7305 $253.67 1/1/2014 0.00 $253.67 9.49 $26.7305 $253.67 1/1/2014 0.00 $253.67 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 71270 0 20 Years 1.95 $28.0672 $54.73 1/1/2014 0.00 $54.73 1.95 $28.0672 $54.73 1/1/2014 0.00 $54.73 1/1/2014
I
PROFESSIONAL
COMPONENT 71270 21 999 Years 1.95 $26.7305 $52.12 1/1/2014 0.00 $52.12 1.95 $26.7305 $52.12 1/1/2014 0.00 $52.12 1/1/2014
T
TECHNICAL
COMPONENT 71270 0 20 Years 7.54 $28.0672 $211.63 1/1/2014 0.00 $211.63 7.54 $28.0672 $211.63 1/1/2014 0.00 $211.63 1/1/2014
T
TECHNICAL
COMPONENT 71270 21 999 Years 7.54 $26.7305 $201.55 1/1/2014 0.00 $201.55 7.54 $26.7305 $201.55 1/1/2014 0.00 $201.55 1/1/2014
4 RADIOLOGY 71275 0 20 Years 12.04 $28.0672 $337.93 1/1/2014 0.00 $337.93 12.04 $28.0672 $337.93 1/1/2014 0.00 $337.93 1/1/2014
4 RADIOLOGY 71275 21 999 Years 12.04 $26.7305 $321.84 1/1/2014 0.00 $321.84 12.04 $26.7305 $321.84 1/1/2014 0.00 $321.84 1/1/2014
I
PROFESSIONAL
COMPONENT 71275 0 20 Years 2.72 $28.0672 $76.34 1/1/2014 0.00 $76.34 2.72 $28.0672 $76.34 1/1/2014 0.00 $76.34 1/1/2014
I
PROFESSIONAL
COMPONENT 71275 21 999 Years 2.72 $26.7305 $72.71 1/1/2014 0.00 $72.71 2.72 $26.7305 $72.71 1/1/2014 0.00 $72.71 1/1/2014
T
TECHNICAL
COMPONENT 71275 0 20 Years 9.32 $28.0672 $261.59 1/1/2014 0.00 $261.59 9.32 $28.0672 $261.59 1/1/2014 0.00 $261.59 1/1/2014
T
TECHNICAL
COMPONENT 71275 21 999 Years 9.32 $26.7305 $249.13 1/1/2014 0.00 $249.13 9.32 $26.7305 $249.13 1/1/2014 0.00 $249.13 1/1/2014
4 RADIOLOGY 71550 0 20 Years 14.04 $28.0672 $394.06 1/1/2014 0.00 $394.06 14.04 $28.0672 $394.06 1/1/2014 0.00 $394.06 1/1/2014
4 RADIOLOGY 71550 21 999 Years 14.04 $26.7305 $375.30 1/1/2014 0.00 $375.30 14.04 $26.7305 $375.30 1/1/2014 0.00 $375.30 1/1/2014
I
PROFESSIONAL
COMPONENT 71550 0 20 Years 2.06 $28.0672 $57.82 1/1/2014 0.00 $57.82 2.06 $28.0672 $57.82 1/1/2014 0.00 $57.82 1/1/2014
I
PROFESSIONAL
COMPONENT 71550 21 999 Years 2.06 $26.7305 $55.06 1/1/2014 0.00 $55.06 2.06 $26.7305 $55.06 1/1/2014 0.00 $55.06 1/1/2014
T
TECHNICAL
COMPONENT 71550 0 20 Years 11.98 $28.0672 $336.25 1/1/2014 0.00 $336.25 11.98 $28.0672 $336.25 1/1/2014 0.00 $336.25 1/1/2014
T
TECHNICAL
COMPONENT 71550 21 999 Years 11.98 $26.7305 $320.23 1/1/2014 0.00 $320.23 11.98 $26.7305 $320.23 1/1/2014 0.00 $320.23 1/1/2014
4 RADIOLOGY 71551 0 20 Years 15.60 $28.0672 $437.85 1/1/2014 0.00 $437.85 15.60 $28.0672 $437.85 1/1/2014 0.00 $437.85 1/1/2014
4 RADIOLOGY 71551 21 999 Years 15.60 $26.7305 $417.00 1/1/2014 0.00 $417.00 15.60 $26.7305 $417.00 1/1/2014 0.00 $417.00 1/1/2014
I
PROFESSIONAL
COMPONENT 71551 0 20 Years 2.45 $28.0672 $68.76 1/1/2014 0.00 $68.76 2.45 $28.0672 $68.76 1/1/2014 0.00 $68.76 1/1/2014
I
PROFESSIONAL
COMPONENT 71551 21 999 Years 2.45 $26.7305 $65.49 1/1/2014 0.00 $65.49 2.45 $26.7305 $65.49 1/1/2014 0.00 $65.49 1/1/2014
T
TECHNICAL
COMPONENT 71551 0 20 Years 13.15 $28.0672 $369.08 1/1/2014 0.00 $369.08 13.15 $28.0672 $369.08 1/1/2014 0.00 $369.08 1/1/2014
T
TECHNICAL
COMPONENT 71551 21 999 Years 13.15 $26.7305 $351.51 1/1/2014 0.00 $351.51 13.15 $26.7305 $351.51 1/1/2014 0.00 $351.51 1/1/2014
4 RADIOLOGY 71552 0 20 Years 19.84 $28.0672 $556.85 1/1/2014 0.00 $556.85 19.84 $28.0672 $556.85 1/1/2014 0.00 $556.85 1/1/2014
4 RADIOLOGY 71552 21 999 Years 19.84 $26.7305 $530.33 1/1/2014 0.00 $530.33 19.84 $26.7305 $530.33 1/1/2014 0.00 $530.33 1/1/2014
I
PROFESSIONAL
COMPONENT 71552 0 20 Years 3.19 $28.0672 $89.53 1/1/2014 0.00 $89.53 3.19 $28.0672 $89.53 1/1/2014 0.00 $89.53 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 71552 21 999 Years 3.19 $26.7305 $85.27 1/1/2014 0.00 $85.27 3.19 $26.7305 $85.27 1/1/2014 0.00 $85.27 1/1/2014
T
TECHNICAL
COMPONENT 71552 0 20 Years 16.65 $28.0672 $467.32 1/1/2014 0.00 $467.32 16.65 $28.0672 $467.32 1/1/2014 0.00 $467.32 1/1/2014
T
TECHNICAL
COMPONENT 71552 21 999 Years 16.65 $26.7305 $445.06 1/1/2014 0.00 $445.06 16.65 $26.7305 $445.06 1/1/2014 0.00 $445.06 1/1/2014
4 RADIOLOGY 71555 0 20 Years 13.84 $28.0672 $388.45 1/1/2014 0.00 $388.45 13.84 $28.0672 $388.45 1/1/2014 0.00 $388.45 1/1/2014
4 RADIOLOGY 71555 21 999 Years 13.84 $26.7305 $369.95 1/1/2014 0.00 $369.95 13.84 $26.7305 $369.95 1/1/2014 0.00 $369.95 1/1/2014
I
PROFESSIONAL
COMPONENT 71555 0 20 Years 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 1/1/2014
I
PROFESSIONAL
COMPONENT 71555 21 999 Years 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 1/1/2014
T
TECHNICAL
COMPONENT 71555 0 20 Years 11.28 $28.0672 $316.60 1/1/2014 0.00 $316.60 11.28 $28.0672 $316.60 1/1/2014 0.00 $316.60 1/1/2014
T
TECHNICAL
COMPONENT 71555 0 20 Years 11.28 $28.0672 $316.60 1/1/2014 0.00 $316.60 1/1/2014
T
TECHNICAL
COMPONENT 71555 21 999 Years 11.28 $26.7305 $301.52 1/1/2014 0.00 $301.52 11.28 $26.7305 $301.52 1/1/2014 0.00 $301.52 1/1/2014
T
TECHNICAL
COMPONENT 71555 21 999 Years 11.28 $26.7305 $301.52 1/1/2014 0.00 $301.52 1/1/2014
4 RADIOLOGY 72020 0 20 Years 0.71 $28.0672 $19.93 1/1/2014 0.00 $19.93 9 1/1/2014
4 RADIOLOGY 72020 21 999 Years 0.71 $26.7305 $18.98 1/1/2014 0.00 $18.98 9 1/1/2014
T
TECHNICAL
COMPONENT 72020 0 20 Years 0.49 $28.0672 $13.75 1/1/2014 0.00 $13.75 9 1/1/2014
T
TECHNICAL
COMPONENT 72020 21 999 Years 0.49 $26.7305 $13.10 1/1/2014 0.00 $13.10 9 1/1/2014
4 RADIOLOGY 72040 0 20 Years 1.08 $28.0672 $30.31 1/1/2014 0.00 $30.31 9 1/1/2014
4 RADIOLOGY 72040 21 999 Years 1.08 $26.7305 $28.87 1/1/2014 0.00 $28.87 9 1/1/2014
T
TECHNICAL
COMPONENT 72040 0 20 Years 0.74 $28.0672 $20.77 1/1/2014 0.00 $20.77 9 1/1/2014
T
TECHNICAL
COMPONENT 72040 21 999 Years 0.74 $26.7305 $19.78 1/1/2014 0.00 $19.78 9 1/1/2014
4 RADIOLOGY 72050 0 20 Years 1.46 $28.0672 $40.98 1/1/2014 0.00 $40.98 9 1/1/2014
4 RADIOLOGY 72050 21 999 Years 1.46 $26.7305 $39.03 1/1/2014 0.00 $39.03 9 1/1/2014
T
TECHNICAL
COMPONENT 72050 0 20 Years 1.00 $28.0672 $28.07 1/1/2014 0.00 $28.07 9 1/1/2014
T
TECHNICAL
COMPONENT 72050 21 999 Years 1.00 $26.7305 $26.73 1/1/2014 0.00 $26.73 9 1/1/2014
4 RADIOLOGY 72052 0 20 Years 1.88 $28.0672 $52.77 1/1/2014 0.00 $52.77 9 1/1/2014
4 RADIOLOGY 72052 21 999 Years 1.88 $26.7305 $50.25 1/1/2014 0.00 $50.25 9 1/1/2014
T
TECHNICAL
COMPONENT 72052 0 20 Years 1.35 $28.0672 $37.89 1/1/2014 0.00 $37.89 9 1/1/2014
T
TECHNICAL
COMPONENT 72052 21 999 Years 1.35 $26.7305 $36.09 1/1/2014 0.00 $36.09 9 1/1/2014
4 RADIOLOGY 72070 0 20 Years 1.02 $28.0672 $28.63 1/1/2014 0.00 $28.63 9 1/1/2014
4 RADIOLOGY 72070 21 999 Years 1.02 $26.7305 $27.27 1/1/2014 0.00 $27.27 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 72070 0 20 Years 0.70 $28.0672 $19.65 1/1/2014 0.00 $19.65 9 1/1/2014
T
TECHNICAL
COMPONENT 72070 21 999 Years 0.70 $26.7305 $18.71 1/1/2014 0.00 $18.71 9 1/1/2014
4 RADIOLOGY 72072 0 20 Years 1.12 $28.0672 $31.44 1/1/2014 0.00 $31.44 9 1/1/2014
4 RADIOLOGY 72072 21 999 Years 1.12 $26.7305 $29.94 1/1/2014 0.00 $29.94 9 1/1/2014
T
TECHNICAL
COMPONENT 72072 0 20 Years 0.81 $28.0672 $22.73 1/1/2014 0.00 $22.73 9 1/1/2014
T
TECHNICAL
COMPONENT 72072 21 999 Years 0.81 $26.7305 $21.65 1/1/2014 0.00 $21.65 9 1/1/2014
4 RADIOLOGY 72074 0 20 Years 1.34 $28.0672 $37.61 1/1/2014 0.00 $37.61 9 1/1/2014
4 RADIOLOGY 72074 21 999 Years 1.34 $26.7305 $35.82 1/1/2014 0.00 $35.82 9 1/1/2014
T
TECHNICAL
COMPONENT 72074 0 20 Years 1.03 $28.0672 $28.91 1/1/2014 0.00 $28.91 9 1/1/2014
T
TECHNICAL
COMPONENT 72074 21 999 Years 1.03 $26.7305 $27.53 1/1/2014 0.00 $27.53 9 1/1/2014
4 RADIOLOGY 72080 0 20 Years 1.11 $28.0672 $31.15 1/1/2014 0.00 $31.15 9 1/1/2014
4 RADIOLOGY 72080 21 999 Years 1.11 $26.7305 $29.67 1/1/2014 0.00 $29.67 9 1/1/2014
T
TECHNICAL
COMPONENT 72080 0 20 Years 0.77 $28.0672 $21.61 1/1/2014 0.00 $21.61 9 1/1/2014
T
TECHNICAL
COMPONENT 72080 21 999 Years 0.77 $26.7305 $20.58 1/1/2014 0.00 $20.58 9 1/1/2014
4 RADIOLOGY 72100 0 20 Years 1.09 $28.0672 $30.59 1/1/2014 0.00 $30.59 9 1/1/2014
4 RADIOLOGY 72100 21 999 Years 1.09 $26.7305 $29.14 1/1/2014 0.00 $29.14 9 1/1/2014
T
TECHNICAL
COMPONENT 72100 0 20 Years 0.75 $28.0672 $21.05 1/1/2014 0.00 $21.05 9 1/1/2014
T
TECHNICAL
COMPONENT 72100 21 999 Years 0.75 $26.7305 $20.05 1/1/2014 0.00 $20.05 9 1/1/2014
4 RADIOLOGY 72110 0 20 Years 1.48 $28.0672 $41.54 1/1/2014 0.00 $41.54 9 1/1/2014
4 RADIOLOGY 72110 21 999 Years 1.48 $26.7305 $39.56 1/1/2014 0.00 $39.56 9 1/1/2014
T
TECHNICAL
COMPONENT 72110 0 20 Years 1.02 $28.0672 $28.63 1/1/2014 0.00 $28.63 9 1/1/2014
T
TECHNICAL
COMPONENT 72110 21 999 Years 1.02 $26.7305 $27.27 1/1/2014 0.00 $27.27 9 1/1/2014
4 RADIOLOGY 72114 0 20 Years 1.94 $28.0672 $54.45 1/1/2014 0.00 $54.45 9 1/1/2014
4 RADIOLOGY 72114 21 999 Years 1.94 $26.7305 $51.86 1/1/2014 0.00 $51.86 9 1/1/2014
T
TECHNICAL
COMPONENT 72114 0 20 Years 1.45 $28.0672 $40.70 1/1/2014 0.00 $40.70 9 1/1/2014
T
TECHNICAL
COMPONENT 72114 21 999 Years 1.45 $26.7305 $38.76 1/1/2014 0.00 $38.76 9 1/1/2014
4 RADIOLOGY 72120 0 20 Years 1.29 $28.0672 $36.21 1/1/2014 0.00 $36.21 9 1/1/2014
4 RADIOLOGY 72120 21 999 Years 1.29 $26.7305 $34.48 1/1/2014 0.00 $34.48 9 1/1/2014
T
TECHNICAL
COMPONENT 72120 0 20 Years 0.94 $28.0672 $26.38 1/1/2014 0.00 $26.38 9 1/1/2014
T
TECHNICAL
COMPONENT 72120 21 999 Years 0.94 $26.7305 $25.13 1/1/2014 0.00 $25.13 9 1/1/2014
4 RADIOLOGY 72125 0 20 Years 6.40 $28.0672 $179.63 1/1/2014 0.00 $179.63 6.40 $28.0672 $179.63 1/1/2014 0.00 $179.63 1/1/2014
4 RADIOLOGY 72125 21 999 Years 6.40 $26.7305 $171.08 1/1/2014 0.00 $171.08 6.40 $26.7305 $171.08 1/1/2014 0.00 $171.08 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 72125 0 20 Years 1.51 $28.0672 $42.38 1/1/2014 0.00 $42.38 1.51 $28.0672 $42.38 1/1/2014 0.00 $42.38 1/1/2014
I
PROFESSIONAL
COMPONENT 72125 21 999 Years 1.51 $26.7305 $40.36 1/1/2014 0.00 $40.36 1.51 $26.7305 $40.36 1/1/2014 0.00 $40.36 1/1/2014
T
TECHNICAL
COMPONENT 72125 0 20 Years 4.89 $28.0672 $137.25 1/1/2014 0.00 $137.25 4.89 $28.0672 $137.25 1/1/2014 0.00 $137.25 1/1/2014
T
TECHNICAL
COMPONENT 72125 21 999 Years 4.89 $26.7305 $130.71 1/1/2014 0.00 $130.71 4.89 $26.7305 $130.71 1/1/2014 0.00 $130.71 1/1/2014
4 RADIOLOGY 72126 0 20 Years 7.82 $28.0672 $219.49 1/1/2014 0.00 $219.49 7.82 $28.0672 $219.49 1/1/2014 0.00 $219.49 1/1/2014
4 RADIOLOGY 72126 21 999 Years 7.82 $26.7305 $209.03 1/1/2014 0.00 $209.03 7.82 $26.7305 $209.03 1/1/2014 0.00 $209.03 1/1/2014
I
PROFESSIONAL
COMPONENT 72126 0 20 Years 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1/1/2014
I
PROFESSIONAL
COMPONENT 72126 21 999 Years 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1/1/2014
T
TECHNICAL
COMPONENT 72126 0 20 Years 6.09 $28.0672 $170.93 1/1/2014 0.00 $170.93 6.09 $28.0672 $170.93 1/1/2014 0.00 $170.93 1/1/2014
T
TECHNICAL
COMPONENT 72126 21 999 Years 6.09 $26.7305 $162.79 1/1/2014 0.00 $162.79 6.09 $26.7305 $162.79 1/1/2014 0.00 $162.79 1/1/2014
4 RADIOLOGY 72127 0 20 Years 9.36 $28.0672 $262.71 1/1/2014 0.00 $262.71 9.36 $28.0672 $262.71 1/1/2014 0.00 $262.71 1/1/2014
4 RADIOLOGY 72127 21 999 Years 9.36 $26.7305 $250.20 1/1/2014 0.00 $250.20 9.36 $26.7305 $250.20 1/1/2014 0.00 $250.20 1/1/2014
I
PROFESSIONAL
COMPONENT 72127 0 20 Years 1.80 $28.0672 $50.52 1/1/2014 0.00 $50.52 1.80 $28.0672 $50.52 1/1/2014 0.00 $50.52 1/1/2014
I
PROFESSIONAL
COMPONENT 72127 21 999 Years 1.80 $26.7305 $48.11 1/1/2014 0.00 $48.11 1.80 $26.7305 $48.11 1/1/2014 0.00 $48.11 1/1/2014
T
TECHNICAL
COMPONENT 72127 0 20 Years 7.56 $28.0672 $212.19 1/1/2014 0.00 $212.19 7.56 $28.0672 $212.19 1/1/2014 0.00 $212.19 1/1/2014
T
TECHNICAL
COMPONENT 72127 21 999 Years 7.56 $26.7305 $202.08 1/1/2014 0.00 $202.08 7.56 $26.7305 $202.08 1/1/2014 0.00 $202.08 1/1/2014
4 RADIOLOGY 72128 0 20 Years 6.27 $28.0672 $175.98 1/1/2014 0.00 $175.98 6.27 $28.0672 $175.98 1/1/2014 0.00 $175.98 1/1/2014
4 RADIOLOGY 72128 21 999 Years 6.27 $26.7305 $167.60 1/1/2014 0.00 $167.60 6.27 $26.7305 $167.60 1/1/2014 0.00 $167.60 1/1/2014
I
PROFESSIONAL
COMPONENT 72128 0 20 Years 1.41 $28.0672 $39.57 1/1/2014 0.00 $39.57 1.41 $28.0672 $39.57 1/1/2014 0.00 $39.57 1/1/2014
I
PROFESSIONAL
COMPONENT 72128 21 999 Years 1.41 $26.7305 $37.69 1/1/2014 0.00 $37.69 1.41 $26.7305 $37.69 1/1/2014 0.00 $37.69 1/1/2014
T
TECHNICAL
COMPONENT 72128 0 20 Years 4.86 $28.0672 $136.41 1/1/2014 0.00 $136.41 4.86 $28.0672 $136.41 1/1/2014 0.00 $136.41 1/1/2014
T
TECHNICAL
COMPONENT 72128 21 999 Years 4.86 $26.7305 $129.91 1/1/2014 0.00 $129.91 4.86 $26.7305 $129.91 1/1/2014 0.00 $129.91 1/1/2014
4 RADIOLOGY 72129 0 20 Years 7.85 $28.0672 $220.33 1/1/2014 0.00 $220.33 7.85 $28.0672 $220.33 1/1/2014 0.00 $220.33 1/1/2014
4 RADIOLOGY 72129 21 999 Years 7.85 $26.7305 $209.83 1/1/2014 0.00 $209.83 7.85 $26.7305 $209.83 1/1/2014 0.00 $209.83 1/1/2014
I
PROFESSIONAL
COMPONENT 72129 0 20 Years 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 72129 21 999 Years 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1/1/2014
T
TECHNICAL
COMPONENT 72129 0 20 Years 6.12 $28.0672 $171.77 1/1/2014 0.00 $171.77 6.12 $28.0672 $171.77 1/1/2014 0.00 $171.77 1/1/2014
T
TECHNICAL
COMPONENT 72129 21 999 Years 6.12 $26.7305 $163.59 1/1/2014 0.00 $163.59 6.12 $26.7305 $163.59 1/1/2014 0.00 $163.59 1/1/2014
4 RADIOLOGY 72130 0 20 Years 9.41 $28.0672 $264.11 1/1/2014 0.00 $264.11 9.41 $28.0672 $264.11 1/1/2014 0.00 $264.11 1/1/2014
4 RADIOLOGY 72130 21 999 Years 9.41 $26.7305 $251.53 1/1/2014 0.00 $251.53 9.41 $26.7305 $251.53 1/1/2014 0.00 $251.53 1/1/2014
I
PROFESSIONAL
COMPONENT 72130 0 20 Years 1.80 $28.0672 $50.52 1/1/2014 0.00 $50.52 1.80 $28.0672 $50.52 1/1/2014 0.00 $50.52 1/1/2014
I
PROFESSIONAL
COMPONENT 72130 21 999 Years 1.80 $26.7305 $48.11 1/1/2014 0.00 $48.11 1.80 $26.7305 $48.11 1/1/2014 0.00 $48.11 1/1/2014
T
TECHNICAL
COMPONENT 72130 0 20 Years 7.61 $28.0672 $213.59 1/1/2014 0.00 $213.59 7.61 $28.0672 $213.59 1/1/2014 0.00 $213.59 1/1/2014
T
TECHNICAL
COMPONENT 72130 21 999 Years 7.61 $26.7305 $203.42 1/1/2014 0.00 $203.42 7.61 $26.7305 $203.42 1/1/2014 0.00 $203.42 1/1/2014
4 RADIOLOGY 72131 0 20 Years 6.25 $28.0672 $175.42 1/1/2014 0.00 $175.42 6.25 $28.0672 $175.42 1/1/2014 0.00 $175.42 1/1/2014
4 RADIOLOGY 72131 21 999 Years 6.25 $26.7305 $167.07 1/1/2014 0.00 $167.07 6.25 $26.7305 $167.07 1/1/2014 0.00 $167.07 1/1/2014
I
PROFESSIONAL
COMPONENT 72131 0 20 Years 1.41 $28.0672 $39.57 1/1/2014 0.00 $39.57 1.41 $28.0672 $39.57 1/1/2014 0.00 $39.57 1/1/2014
I
PROFESSIONAL
COMPONENT 72131 21 999 Years 1.41 $26.7305 $37.69 1/1/2014 0.00 $37.69 1.41 $26.7305 $37.69 1/1/2014 0.00 $37.69 1/1/2014
T
TECHNICAL
COMPONENT 72131 0 20 Years 4.84 $28.0672 $135.85 1/1/2014 0.00 $135.85 4.84 $28.0672 $135.85 1/1/2014 0.00 $135.85 1/1/2014
T
TECHNICAL
COMPONENT 72131 21 999 Years 4.84 $26.7305 $129.38 1/1/2014 0.00 $129.38 4.84 $26.7305 $129.38 1/1/2014 0.00 $129.38 1/1/2014
4 RADIOLOGY 72132 0 20 Years 7.83 $28.0672 $219.77 1/1/2014 0.00 $219.77 7.83 $28.0672 $219.77 1/1/2014 0.00 $219.77 1/1/2014
4 RADIOLOGY 72132 21 999 Years 7.83 $26.7305 $209.30 1/1/2014 0.00 $209.30 7.83 $26.7305 $209.30 1/1/2014 0.00 $209.30 1/1/2014
I
PROFESSIONAL
COMPONENT 72132 0 20 Years 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1/1/2014
I
PROFESSIONAL
COMPONENT 72132 21 999 Years 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1/1/2014
T
TECHNICAL
COMPONENT 72132 0 20 Years 6.10 $28.0672 $171.21 1/1/2014 0.00 $171.21 6.10 $28.0672 $171.21 1/1/2014 0.00 $171.21 1/1/2014
T
TECHNICAL
COMPONENT 72132 21 999 Years 6.10 $26.7305 $163.06 1/1/2014 0.00 $163.06 6.10 $26.7305 $163.06 1/1/2014 0.00 $163.06 1/1/2014
4 RADIOLOGY 72133 0 20 Years 9.36 $28.0672 $262.71 1/1/2014 0.00 $262.71 9.36 $28.0672 $262.71 1/1/2014 0.00 $262.71 1/1/2014
4 RADIOLOGY 72133 21 999 Years 9.36 $26.7305 $250.20 1/1/2014 0.00 $250.20 9.36 $26.7305 $250.20 1/1/2014 0.00 $250.20 1/1/2014
I
PROFESSIONAL
COMPONENT 72133 0 20 Years 1.79 $28.0672 $50.24 1/1/2014 0.00 $50.24 1.79 $28.0672 $50.24 1/1/2014 0.00 $50.24 1/1/2014
I
PROFESSIONAL
COMPONENT 72133 21 999 Years 1.79 $26.7305 $47.85 1/1/2014 0.00 $47.85 1.79 $26.7305 $47.85 1/1/2014 0.00 $47.85 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 72133 0 20 Years 7.57 $28.0672 $212.47 1/1/2014 0.00 $212.47 7.57 $28.0672 $212.47 1/1/2014 0.00 $212.47 1/1/2014
T
TECHNICAL
COMPONENT 72133 21 999 Years 7.57 $26.7305 $202.35 1/1/2014 0.00 $202.35 7.57 $26.7305 $202.35 1/1/2014 0.00 $202.35 1/1/2014
4 RADIOLOGY 72141 0 20 Years 11.38 $28.0672 $319.40 1/1/2014 0.00 $319.40 11.38 $28.0672 $319.40 1/1/2014 0.00 $319.40 1/1/2014
4 RADIOLOGY 72141 21 999 Years 11.38 $26.7305 $304.19 1/1/2014 0.00 $304.19 11.38 $26.7305 $304.19 1/1/2014 0.00 $304.19 1/1/2014
I
PROFESSIONAL
COMPONENT 72141 0 20 Years 2.28 $28.0672 $63.99 1/1/2014 0.00 $63.99 2.28 $28.0672 $63.99 1/1/2014 0.00 $63.99 1/1/2014
I
PROFESSIONAL
COMPONENT 72141 21 999 Years 2.28 $26.7305 $60.95 1/1/2014 0.00 $60.95 2.28 $26.7305 $60.95 1/1/2014 0.00 $60.95 1/1/2014
T
TECHNICAL
COMPONENT 72141 0 20 Years 9.10 $28.0672 $255.41 1/1/2014 0.00 $255.41 9.10 $28.0672 $255.41 1/1/2014 0.00 $255.41 1/1/2014
T
TECHNICAL
COMPONENT 72141 21 999 Years 9.10 $26.7305 $243.25 1/1/2014 0.00 $243.25 9.10 $26.7305 $243.25 1/1/2014 0.00 $243.25 1/1/2014
4 RADIOLOGY 72142 0 20 Years 14.64 $28.0672 $410.90 1/1/2014 0.00 $410.90 14.64 $28.0672 $410.90 1/1/2014 0.00 $410.90 1/1/2014
4 RADIOLOGY 72142 21 999 Years 14.64 $26.7305 $391.33 1/1/2014 0.00 $391.33 14.64 $26.7305 $391.33 1/1/2014 0.00 $391.33 1/1/2014
I
PROFESSIONAL
COMPONENT 72142 0 20 Years 2.74 $28.0672 $76.90 1/1/2014 0.00 $76.90 2.74 $28.0672 $76.90 1/1/2014 0.00 $76.90 1/1/2014
I
PROFESSIONAL
COMPONENT 72142 21 999 Years 2.74 $26.7305 $73.24 1/1/2014 0.00 $73.24 2.74 $26.7305 $73.24 1/1/2014 0.00 $73.24 1/1/2014
T
TECHNICAL
COMPONENT 72142 0 20 Years 11.90 $28.0672 $334.00 1/1/2014 0.00 $334.00 11.90 $28.0672 $334.00 1/1/2014 0.00 $334.00 1/1/2014
T
TECHNICAL
COMPONENT 72142 21 999 Years 11.90 $26.7305 $318.09 1/1/2014 0.00 $318.09 11.90 $26.7305 $318.09 1/1/2014 0.00 $318.09 1/1/2014
4 RADIOLOGY 72146 0 20 Years 11.40 $28.0672 $319.97 1/1/2014 0.00 $319.97 11.40 $28.0672 $319.97 1/1/2014 0.00 $319.97 1/1/2014
4 RADIOLOGY 72146 21 999 Years 11.40 $26.7305 $304.73 1/1/2014 0.00 $304.73 11.40 $26.7305 $304.73 1/1/2014 0.00 $304.73 1/1/2014
I
PROFESSIONAL
COMPONENT 72146 0 20 Years 2.28 $28.0672 $63.99 1/1/2014 0.00 $63.99 2.28 $28.0672 $63.99 1/1/2014 0.00 $63.99 1/1/2014
I
PROFESSIONAL
COMPONENT 72146 21 999 Years 2.28 $26.7305 $60.95 1/1/2014 0.00 $60.95 2.28 $26.7305 $60.95 1/1/2014 0.00 $60.95 1/1/2014
T
TECHNICAL
COMPONENT 72146 0 20 Years 9.12 $28.0672 $255.97 1/1/2014 0.00 $255.97 9.12 $28.0672 $255.97 1/1/2014 0.00 $255.97 1/1/2014
T
TECHNICAL
COMPONENT 72146 21 999 Years 9.12 $26.7305 $243.78 1/1/2014 0.00 $243.78 9.12 $26.7305 $243.78 1/1/2014 0.00 $243.78 1/1/2014
4 RADIOLOGY 72147 0 20 Years 12.93 $28.0672 $362.91 1/1/2014 0.00 $362.91 12.93 $28.0672 $362.91 1/1/2014 0.00 $362.91 1/1/2014
4 RADIOLOGY 72147 21 999 Years 12.93 $26.7305 $345.63 1/1/2014 0.00 $345.63 12.93 $26.7305 $345.63 1/1/2014 0.00 $345.63 1/1/2014
I
PROFESSIONAL
COMPONENT 72147 0 20 Years 2.73 $28.0672 $76.62 1/1/2014 0.00 $76.62 2.73 $28.0672 $76.62 1/1/2014 0.00 $76.62 1/1/2014
I
PROFESSIONAL
COMPONENT 72147 21 999 Years 2.73 $26.7305 $72.97 1/1/2014 0.00 $72.97 2.73 $26.7305 $72.97 1/1/2014 0.00 $72.97 1/1/2014
T
TECHNICAL
COMPONENT 72147 0 20 Years 10.20 $28.0672 $286.29 1/1/2014 0.00 $286.29 10.20 $28.0672 $286.29 1/1/2014 0.00 $286.29 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Mod
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Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 72147 21 999 Years 10.20 $26.7305 $272.65 1/1/2014 0.00 $272.65 10.20 $26.7305 $272.65 1/1/2014 0.00 $272.65 1/1/2014
4 RADIOLOGY 72148 0 20 Years 11.23 $28.0672 $315.19 1/1/2014 0.00 $315.19 11.23 $28.0672 $315.19 1/1/2014 0.00 $315.19 1/1/2014
4 RADIOLOGY 72148 21 999 Years 11.23 $26.7305 $300.18 1/1/2014 0.00 $300.18 11.23 $26.7305 $300.18 1/1/2014 0.00 $300.18 1/1/2014
I
PROFESSIONAL
COMPONENT 72148 0 20 Years 2.12 $28.0672 $59.50 1/1/2014 0.00 $59.50 2.12 $28.0672 $59.50 1/1/2014 0.00 $59.50 1/1/2014
I
PROFESSIONAL
COMPONENT 72148 21 999 Years 2.12 $26.7305 $56.67 1/1/2014 0.00 $56.67 2.12 $26.7305 $56.67 1/1/2014 0.00 $56.67 1/1/2014
T
TECHNICAL
COMPONENT 72148 0 20 Years 9.11 $28.0672 $255.69 1/1/2014 0.00 $255.69 9.11 $28.0672 $255.69 1/1/2014 0.00 $255.69 1/1/2014
T
TECHNICAL
COMPONENT 72148 21 999 Years 9.11 $26.7305 $243.51 1/1/2014 0.00 $243.51 9.11 $26.7305 $243.51 1/1/2014 0.00 $243.51 1/1/2014
4 RADIOLOGY 72149 0 20 Years 14.15 $28.0672 $397.15 1/1/2014 0.00 $397.15 14.15 $28.0672 $397.15 1/1/2014 0.00 $397.15 1/1/2014
4 RADIOLOGY 72149 21 999 Years 14.15 $26.7305 $378.24 1/1/2014 0.00 $378.24 14.15 $26.7305 $378.24 1/1/2014 0.00 $378.24 1/1/2014
I
PROFESSIONAL
COMPONENT 72149 0 20 Years 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 1/1/2014
I
PROFESSIONAL
COMPONENT 72149 21 999 Years 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 1/1/2014
T
TECHNICAL
COMPONENT 72149 0 20 Years 11.61 $28.0672 $325.86 1/1/2014 0.00 $325.86 11.61 $28.0672 $325.86 1/1/2014 0.00 $325.86 1/1/2014
T
TECHNICAL
COMPONENT 72149 21 999 Years 11.61 $26.7305 $310.34 1/1/2014 0.00 $310.34 11.61 $26.7305 $310.34 1/1/2014 0.00 $310.34 1/1/2014
4 RADIOLOGY 72156 0 20 Years 16.82 $28.0672 $472.09 1/1/2014 0.00 $472.09 16.82 $28.0672 $472.09 1/1/2014 0.00 $472.09 1/1/2014
4 RADIOLOGY 72156 21 999 Years 16.82 $26.7305 $449.61 1/1/2014 0.00 $449.61 16.82 $26.7305 $449.61 1/1/2014 0.00 $449.61 1/1/2014
I
PROFESSIONAL
COMPONENT 72156 0 20 Years 3.66 $28.0672 $102.73 1/1/2014 0.00 $102.73 3.66 $28.0672 $102.73 1/1/2014 0.00 $102.73 1/1/2014
I
PROFESSIONAL
COMPONENT 72156 21 999 Years 3.66 $26.7305 $97.83 1/1/2014 0.00 $97.83 3.66 $26.7305 $97.83 1/1/2014 0.00 $97.83 1/1/2014
T
TECHNICAL
COMPONENT 72156 0 20 Years 13.16 $28.0672 $369.36 1/1/2014 0.00 $369.36 13.16 $28.0672 $369.36 1/1/2014 0.00 $369.36 1/1/2014
T
TECHNICAL
COMPONENT 72156 21 999 Years 13.16 $26.7305 $351.77 1/1/2014 0.00 $351.77 13.16 $26.7305 $351.77 1/1/2014 0.00 $351.77 1/1/2014
4 RADIOLOGY 72157 0 20 Years 15.63 $28.0672 $438.69 1/1/2014 0.00 $438.69 15.63 $28.0672 $438.69 1/1/2014 0.00 $438.69 1/1/2014
4 RADIOLOGY 72157 21 999 Years 15.63 $26.7305 $417.80 1/1/2014 0.00 $417.80 15.63 $26.7305 $417.80 1/1/2014 0.00 $417.80 1/1/2014
I
PROFESSIONAL
COMPONENT 72157 0 20 Years 3.66 $28.0672 $102.73 1/1/2014 0.00 $102.73 3.66 $28.0672 $102.73 1/1/2014 0.00 $102.73 1/1/2014
I
PROFESSIONAL
COMPONENT 72157 21 999 Years 3.66 $26.7305 $97.83 1/1/2014 0.00 $97.83 3.66 $26.7305 $97.83 1/1/2014 0.00 $97.83 1/1/2014
T
TECHNICAL
COMPONENT 72157 0 20 Years 11.97 $28.0672 $335.96 1/1/2014 0.00 $335.96 11.97 $28.0672 $335.96 1/1/2014 0.00 $335.96 1/1/2014
T
TECHNICAL
COMPONENT 72157 21 999 Years 11.97 $26.7305 $319.96 1/1/2014 0.00 $319.96 11.97 $26.7305 $319.96 1/1/2014 0.00 $319.96 1/1/2014
4 RADIOLOGY 72158 0 20 Years 16.46 $28.0672 $461.99 1/1/2014 0.00 $461.99 16.46 $28.0672 $461.99 1/1/2014 0.00 $461.99 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 72158 21 999 Years 16.46 $26.7305 $439.98 1/1/2014 0.00 $439.98 16.46 $26.7305 $439.98 1/1/2014 0.00 $439.98 1/1/2014
I
PROFESSIONAL
COMPONENT 72158 0 20 Years 3.38 $28.0672 $94.87 1/1/2014 0.00 $94.87 3.38 $28.0672 $94.87 1/1/2014 0.00 $94.87 1/1/2014
I
PROFESSIONAL
COMPONENT 72158 21 999 Years 3.38 $26.7305 $90.35 1/1/2014 0.00 $90.35 3.38 $26.7305 $90.35 1/1/2014 0.00 $90.35 1/1/2014
T
TECHNICAL
COMPONENT 72158 0 20 Years 13.08 $28.0672 $367.12 1/1/2014 0.00 $367.12 13.08 $28.0672 $367.12 1/1/2014 0.00 $367.12 1/1/2014
T
TECHNICAL
COMPONENT 72158 21 999 Years 13.08 $26.7305 $349.63 1/1/2014 0.00 $349.63 13.08 $26.7305 $349.63 1/1/2014 0.00 $349.63 1/1/2014
4 RADIOLOGY 72159 0 20 Years 14.16 $28.0672 $397.43 1/1/2014 0.00 $397.43 14.16 $28.0672 $397.43 1/1/2014 0.00 $397.43 1/1/2014
4 RADIOLOGY 72159 21 999 Years 14.16 $26.7305 $378.50 1/1/2014 0.00 $378.50 14.16 $26.7305 $378.50 1/1/2014 0.00 $378.50 1/1/2014
I
PROFESSIONAL
COMPONENT 72159 0 20 Years 2.52 $28.0672 $70.73 1/1/2014 0.00 $70.73 2.52 $28.0672 $70.73 1/1/2014 0.00 $70.73 1/1/2014
I
PROFESSIONAL
COMPONENT 72159 21 999 Years 2.52 $26.7305 $67.36 1/1/2014 0.00 $67.36 2.52 $26.7305 $67.36 1/1/2014 0.00 $67.36 1/1/2014
T
TECHNICAL
COMPONENT 72159 0 20 Years 11.64 $28.0672 $326.70 1/1/2014 0.00 $326.70 11.64 $28.0672 $326.70 1/1/2014 0.00 $326.70 1/1/2014
T
TECHNICAL
COMPONENT 72159 21 999 Years 11.64 $26.7305 $311.14 1/1/2014 0.00 $311.14 11.64 $26.7305 $311.14 1/1/2014 0.00 $311.14 1/1/2014
4 RADIOLOGY 72170 0 20 Years 0.88 $28.0672 $24.70 1/1/2014 0.00 $24.70 9 1/1/2014
4 RADIOLOGY 72170 21 999 Years 0.88 $26.7305 $23.52 1/1/2014 0.00 $23.52 9 1/1/2014
T
TECHNICAL
COMPONENT 72170 0 20 Years 0.61 $28.0672 $17.12 1/1/2014 0.00 $17.12 9 1/1/2014
T
TECHNICAL
COMPONENT 72170 21 999 Years 0.61 $26.7305 $16.31 1/1/2014 0.00 $16.31 9 1/1/2014
4 RADIOLOGY 72190 0 20 Years 1.32 $28.0672 $37.05 1/1/2014 0.00 $37.05 9 1/1/2014
4 RADIOLOGY 72190 21 999 Years 1.32 $26.7305 $35.28 1/1/2014 0.00 $35.28 9 1/1/2014
T
TECHNICAL
COMPONENT 72190 0 20 Years 0.99 $28.0672 $27.79 1/1/2014 0.00 $27.79 9 1/1/2014
T
TECHNICAL
COMPONENT 72190 21 999 Years 0.99 $26.7305 $26.46 1/1/2014 0.00 $26.46 9 1/1/2014
4 RADIOLOGY 72191 0 20 Years 11.96 $28.0672 $335.68 1/1/2014 0.00 $335.68 11.96 $28.0672 $335.68 1/1/2014 0.00 $335.68 1/1/2014
4 RADIOLOGY 72191 21 999 Years 11.96 $26.7305 $319.70 1/1/2014 0.00 $319.70 11.96 $26.7305 $319.70 1/1/2014 0.00 $319.70 1/1/2014
I
PROFESSIONAL
COMPONENT 72191 0 20 Years 2.57 $28.0672 $72.13 1/1/2014 0.00 $72.13 2.57 $28.0672 $72.13 1/1/2014 0.00 $72.13 1/1/2014
I
PROFESSIONAL
COMPONENT 72191 21 999 Years 2.57 $26.7305 $68.70 1/1/2014 0.00 $68.70 2.57 $26.7305 $68.70 1/1/2014 0.00 $68.70 1/1/2014
T
TECHNICAL
COMPONENT 72191 0 20 Years 9.39 $28.0672 $263.55 1/1/2014 0.00 $263.55 9.39 $28.0672 $263.55 1/1/2014 0.00 $263.55 1/1/2014
T
TECHNICAL
COMPONENT 72191 21 999 Years 9.39 $26.7305 $251.00 1/1/2014 0.00 $251.00 9.39 $26.7305 $251.00 1/1/2014 0.00 $251.00 1/1/2014
4 RADIOLOGY 72192 0 20 Years 5.18 $28.0672 $145.39 1/1/2014 0.00 $145.39 5.18 $28.0672 $145.39 1/1/2014 0.00 $145.39 1/1/2014
4 RADIOLOGY 72192 21 999 Years 5.18 $26.7305 $138.46 1/1/2014 0.00 $138.46 5.18 $26.7305 $138.46 1/1/2014 0.00 $138.46 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 72192 0 20 Years 1.53 $28.0672 $42.94 1/1/2014 0.00 $42.94 1.53 $28.0672 $42.94 1/1/2014 0.00 $42.94 1/1/2014
I
PROFESSIONAL
COMPONENT 72192 21 999 Years 1.53 $26.7305 $40.90 1/1/2014 0.00 $40.90 1.53 $26.7305 $40.90 1/1/2014 0.00 $40.90 1/1/2014
T
TECHNICAL
COMPONENT 72192 0 20 Years 3.65 $28.0672 $102.45 1/1/2014 0.00 $102.45 3.65 $28.0672 $102.45 1/1/2014 0.00 $102.45 1/1/2014
T
TECHNICAL
COMPONENT 72192 21 999 Years 3.65 $26.7305 $97.57 1/1/2014 0.00 $97.57 3.65 $26.7305 $97.57 1/1/2014 0.00 $97.57 1/1/2014
4 RADIOLOGY 72193 0 20 Years 8.17 $28.0672 $229.31 1/1/2014 0.00 $229.31 8.17 $28.0672 $229.31 1/1/2014 0.00 $229.31 1/1/2014
4 RADIOLOGY 72193 21 999 Years 8.17 $26.7305 $218.39 1/1/2014 0.00 $218.39 8.17 $26.7305 $218.39 1/1/2014 0.00 $218.39 1/1/2014
I
PROFESSIONAL
COMPONENT 72193 0 20 Years 1.65 $28.0672 $46.31 1/1/2014 0.00 $46.31 1.65 $28.0672 $46.31 1/1/2014 0.00 $46.31 1/1/2014
I
PROFESSIONAL
COMPONENT 72193 21 999 Years 1.65 $26.7305 $44.11 1/1/2014 0.00 $44.11 1.65 $26.7305 $44.11 1/1/2014 0.00 $44.11 1/1/2014
T
TECHNICAL
COMPONENT 72193 0 20 Years 6.52 $28.0672 $183.00 1/1/2014 0.00 $183.00 6.52 $28.0672 $183.00 1/1/2014 0.00 $183.00 1/1/2014
T
TECHNICAL
COMPONENT 72193 21 999 Years 6.52 $26.7305 $174.28 1/1/2014 0.00 $174.28 6.52 $26.7305 $174.28 1/1/2014 0.00 $174.28 1/1/2014
4 RADIOLOGY 72194 0 20 Years 9.16 $28.0672 $257.10 1/1/2014 0.00 $257.10 9.16 $28.0672 $257.10 1/1/2014 0.00 $257.10 1/1/2014
4 RADIOLOGY 72194 21 999 Years 9.16 $26.7305 $244.85 1/1/2014 0.00 $244.85 9.16 $26.7305 $244.85 1/1/2014 0.00 $244.85 1/1/2014
I
PROFESSIONAL
COMPONENT 72194 0 20 Years 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1/1/2014
I
PROFESSIONAL
COMPONENT 72194 21 999 Years 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1/1/2014
T
TECHNICAL
COMPONENT 72194 0 20 Years 7.43 $28.0672 $208.54 1/1/2014 0.00 $208.54 7.43 $28.0672 $208.54 1/1/2014 0.00 $208.54 1/1/2014
T
TECHNICAL
COMPONENT 72194 21 999 Years 7.43 $26.7305 $198.61 1/1/2014 0.00 $198.61 7.43 $26.7305 $198.61 1/1/2014 0.00 $198.61 1/1/2014
4 RADIOLOGY 72195 0 20 Years 12.70 $28.0672 $356.45 1/1/2014 0.00 $356.45 12.70 $28.0672 $356.45 1/1/2014 0.00 $356.45 1/1/2014
4 RADIOLOGY 72195 21 999 Years 12.70 $26.7305 $339.48 1/1/2014 0.00 $339.48 12.70 $26.7305 $339.48 1/1/2014 0.00 $339.48 1/1/2014
I
PROFESSIONAL
COMPONENT 72195 0 20 Years 2.09 $28.0672 $58.66 1/1/2014 0.00 $58.66 2.09 $28.0672 $58.66 1/1/2014 0.00 $58.66 1/1/2014
I
PROFESSIONAL
COMPONENT 72195 21 999 Years 2.09 $26.7305 $55.87 1/1/2014 0.00 $55.87 2.09 $26.7305 $55.87 1/1/2014 0.00 $55.87 1/1/2014
T
TECHNICAL
COMPONENT 72195 0 20 Years 10.61 $28.0672 $297.79 1/1/2014 0.00 $297.79 10.61 $28.0672 $297.79 1/1/2014 0.00 $297.79 1/1/2014
T
TECHNICAL
COMPONENT 72195 21 999 Years 10.61 $26.7305 $283.61 1/1/2014 0.00 $283.61 10.61 $26.7305 $283.61 1/1/2014 0.00 $283.61 1/1/2014
4 RADIOLOGY 72196 0 20 Years 14.11 $28.0672 $396.03 1/1/2014 0.00 $396.03 14.11 $28.0672 $396.03 1/1/2014 0.00 $396.03 1/1/2014
4 RADIOLOGY 72196 21 999 Years 14.11 $26.7305 $377.17 1/1/2014 0.00 $377.17 14.11 $26.7305 $377.17 1/1/2014 0.00 $377.17 1/1/2014
I
PROFESSIONAL
COMPONENT 72196 0 20 Years 2.46 $28.0672 $69.05 1/1/2014 0.00 $69.05 2.46 $28.0672 $69.05 1/1/2014 0.00 $69.05 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 72196 21 999 Years 2.46 $26.7305 $65.76 1/1/2014 0.00 $65.76 2.46 $26.7305 $65.76 1/1/2014 0.00 $65.76 1/1/2014
T
TECHNICAL
COMPONENT 72196 0 20 Years 11.65 $28.0672 $326.98 1/1/2014 0.00 $326.98 11.65 $28.0672 $326.98 1/1/2014 0.00 $326.98 1/1/2014
T
TECHNICAL
COMPONENT 72196 21 999 Years 11.65 $26.7305 $311.41 1/1/2014 0.00 $311.41 11.65 $26.7305 $311.41 1/1/2014 0.00 $311.41 1/1/2014
4 RADIOLOGY 72197 0 20 Years 17.22 $28.0672 $483.32 1/1/2014 0.00 $483.32 17.22 $28.0672 $483.32 1/1/2014 0.00 $483.32 1/1/2014
4 RADIOLOGY 72197 21 999 Years 17.22 $26.7305 $460.30 1/1/2014 0.00 $460.30 17.22 $26.7305 $460.30 1/1/2014 0.00 $460.30 1/1/2014
I
PROFESSIONAL
COMPONENT 72197 0 20 Years 3.19 $28.0672 $89.53 1/1/2014 0.00 $89.53 3.19 $28.0672 $89.53 1/1/2014 0.00 $89.53 1/1/2014
I
PROFESSIONAL
COMPONENT 72197 21 999 Years 3.19 $26.7305 $85.27 1/1/2014 0.00 $85.27 3.19 $26.7305 $85.27 1/1/2014 0.00 $85.27 1/1/2014
T
TECHNICAL
COMPONENT 72197 0 20 Years 14.03 $28.0672 $393.78 1/1/2014 0.00 $393.78 14.03 $28.0672 $393.78 1/1/2014 0.00 $393.78 1/1/2014
T
TECHNICAL
COMPONENT 72197 21 999 Years 14.03 $26.7305 $375.03 1/1/2014 0.00 $375.03 14.03 $26.7305 $375.03 1/1/2014 0.00 $375.03 1/1/2014
4 RADIOLOGY 72198 0 20 Years 13.96 $28.0672 $391.82 1/1/2014 0.00 $391.82 13.96 $28.0672 $391.82 1/1/2014 0.00 $391.82 1/1/2014
4 RADIOLOGY 72198 21 999 Years 13.96 $26.7305 $373.16 1/1/2014 0.00 $373.16 13.96 $26.7305 $373.16 1/1/2014 0.00 $373.16 1/1/2014
I
PROFESSIONAL
COMPONENT 72198 0 20 Years 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 1/1/2014
I
PROFESSIONAL
COMPONENT 72198 21 999 Years 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 1/1/2014
T
TECHNICAL
COMPONENT 72198 0 20 Years 11.42 $28.0672 $320.53 1/1/2014 0.00 $320.53 11.42 $28.0672 $320.53 1/1/2014 0.00 $320.53 1/1/2014
T
TECHNICAL
COMPONENT 72198 0 20 Years 11.42 $28.0672 $320.53 1/1/2014 0.00 $320.53 1/1/2014
T
TECHNICAL
COMPONENT 72198 21 999 Years 11.42 $26.7305 $305.26 1/1/2014 0.00 $305.26 11.42 $26.7305 $305.26 1/1/2014 0.00 $305.26 1/1/2014
T
TECHNICAL
COMPONENT 72198 21 999 Years 11.42 $26.7305 $305.26 1/1/2014 0.00 $305.26 1/1/2014
4 RADIOLOGY 72200 0 20 Years 0.90 $28.0672 $25.26 1/1/2014 0.00 $25.26 9 1/1/2014
4 RADIOLOGY 72200 21 999 Years 0.90 $26.7305 $24.06 1/1/2014 0.00 $24.06 9 1/1/2014
T
TECHNICAL
COMPONENT 72200 0 20 Years 0.65 $28.0672 $18.24 1/1/2014 0.00 $18.24 9 1/1/2014
T
TECHNICAL
COMPONENT 72200 21 999 Years 0.65 $26.7305 $17.37 1/1/2014 0.00 $17.37 9 1/1/2014
4 RADIOLOGY 72202 0 20 Years 1.05 $28.0672 $29.47 1/1/2014 0.00 $29.47 9 1/1/2014
4 RADIOLOGY 72202 21 999 Years 1.05 $26.7305 $28.07 1/1/2014 0.00 $28.07 9 1/1/2014
T
TECHNICAL
COMPONENT 72202 0 20 Years 0.78 $28.0672 $21.89 1/1/2014 0.00 $21.89 9 1/1/2014
T
TECHNICAL
COMPONENT 72202 21 999 Years 0.78 $26.7305 $20.85 1/1/2014 0.00 $20.85 9 1/1/2014
4 RADIOLOGY 72220 0 20 Years 0.88 $28.0672 $24.70 1/1/2014 0.00 $24.70 9 1/1/2014
4 RADIOLOGY 72220 21 999 Years 0.88 $26.7305 $23.52 1/1/2014 0.00 $23.52 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 72220 0 20 Years 0.63 $28.0672 $17.68 1/1/2014 0.00 $17.68 9 1/1/2014
T
TECHNICAL
COMPONENT 72220 21 999 Years 0.63 $26.7305 $16.84 1/1/2014 0.00 $16.84 9 1/1/2014
4 RADIOLOGY 72240 0 20 Years 3.86 $28.0672 $108.34 1/1/2014 0.00 $108.34 9 1/1/2014
4 RADIOLOGY 72240 21 999 Years 3.86 $26.7305 $103.18 1/1/2014 0.00 $103.18 9 1/1/2014
T
TECHNICAL
COMPONENT 72240 0 20 Years 2.57 $28.0672 $72.13 1/1/2014 0.00 $72.13 9 1/1/2014
T
TECHNICAL
COMPONENT 72240 21 999 Years 2.57 $26.7305 $68.70 1/1/2014 0.00 $68.70 9 1/1/2014
4 RADIOLOGY 72255 0 20 Years 3.68 $28.0672 $103.29 1/1/2014 0.00 $103.29 9 1/1/2014
4 RADIOLOGY 72255 21 999 Years 3.68 $26.7305 $98.37 1/1/2014 0.00 $98.37 9 1/1/2014
T
TECHNICAL
COMPONENT 72255 0 20 Years 2.38 $28.0672 $66.80 1/1/2014 0.00 $66.80 9 1/1/2014
T
TECHNICAL
COMPONENT 72255 21 999 Years 2.38 $26.7305 $63.62 1/1/2014 0.00 $63.62 9 1/1/2014
4 RADIOLOGY 72265 0 20 Years 3.79 $28.0672 $106.37 1/1/2014 0.00 $106.37 9 1/1/2014
4 RADIOLOGY 72265 21 999 Years 3.79 $26.7305 $101.31 1/1/2014 0.00 $101.31 9 1/1/2014
T
TECHNICAL
COMPONENT 72265 0 20 Years 2.61 $28.0672 $73.26 1/1/2014 0.00 $73.26 9 1/1/2014
T
TECHNICAL
COMPONENT 72265 21 999 Years 2.61 $26.7305 $69.77 1/1/2014 0.00 $69.77 9 1/1/2014
4 RADIOLOGY 72270 0 20 Years 5.90 $28.0672 $165.60 1/1/2014 0.00 $165.60 9 1/1/2014
4 RADIOLOGY 72270 21 999 Years 5.90 $26.7305 $157.71 1/1/2014 0.00 $157.71 9 1/1/2014
T
TECHNICAL
COMPONENT 72270 0 20 Years 4.01 $28.0672 $112.55 1/1/2014 0.00 $112.55 9 1/1/2014
T
TECHNICAL
COMPONENT 72270 21 999 Years 4.01 $26.7305 $107.19 1/1/2014 0.00 $107.19 9 1/1/2014
4 RADIOLOGY 72275 0 20 Years 3.62 $28.0672 $101.60 1/1/2014 0.00 $101.60 9 1/1/2014
4 RADIOLOGY 72275 21 999 Years 3.62 $26.7305 $96.76 1/1/2014 0.00 $96.76 9 1/1/2014
T
TECHNICAL
COMPONENT 72275 0 20 Years 2.47 $28.0672 $69.33 1/1/2014 0.00 $69.33 9 1/1/2014
T
TECHNICAL
COMPONENT 72275 21 999 Years 2.47 $26.7305 $66.02 1/1/2014 0.00 $66.02 9 1/1/2014
4 RADIOLOGY 72285 0 20 Years 3.50 $28.0672 $98.24 1/1/2014 0.00 $98.24 9 1/1/2014
4 RADIOLOGY 72285 21 999 Years 3.50 $26.7305 $93.56 1/1/2014 0.00 $93.56 9 1/1/2014
T
TECHNICAL
COMPONENT 72285 0 20 Years 1.75 $28.0672 $49.12 1/1/2014 0.00 $49.12 9 1/1/2014
T
TECHNICAL
COMPONENT 72285 21 999 Years 1.75 $26.7305 $46.78 1/1/2014 0.00 $46.78 9 1/1/2014
4 RADIOLOGY 72295 0 20 Years 3.07 $28.0672 $86.17 1/1/2014 0.00 $86.17 9 1/1/2014
4 RADIOLOGY 72295 21 999 Years 3.07 $26.7305 $82.06 1/1/2014 0.00 $82.06 9 1/1/2014
T
TECHNICAL
COMPONENT 72295 0 20 Years 1.81 $28.0672 $50.80 1/1/2014 0.00 $50.80 9 1/1/2014
T
TECHNICAL
COMPONENT 72295 21 999 Years 1.81 $26.7305 $48.38 1/1/2014 0.00 $48.38 9 1/1/2014
4 RADIOLOGY 73000 0 20 Years 0.88 $28.0672 $24.70 1/1/2014 0.00 $24.70 9 1/1/2014
4 RADIOLOGY 73000 21 999 Years 0.88 $26.7305 $23.52 1/1/2014 0.00 $23.52 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 73000 0 20 Years 0.64 $28.0672 $17.96 1/1/2014 0.00 $17.96 9 1/1/2014
T
TECHNICAL
COMPONENT 73000 21 999 Years 0.64 $26.7305 $17.11 1/1/2014 0.00 $17.11 9 1/1/2014
4 RADIOLOGY 73010 0 20 Years 0.98 $28.0672 $27.51 1/1/2014 0.00 $27.51 9 1/1/2014
4 RADIOLOGY 73010 21 999 Years 0.98 $26.7305 $26.20 1/1/2014 0.00 $26.20 9 1/1/2014
T
TECHNICAL
COMPONENT 73010 0 20 Years 0.70 $28.0672 $19.65 1/1/2014 0.00 $19.65 9 1/1/2014
T
TECHNICAL
COMPONENT 73010 21 999 Years 0.70 $26.7305 $18.71 1/1/2014 0.00 $18.71 9 1/1/2014
4 RADIOLOGY 73020 0 20 Years 0.72 $28.0672 $20.21 1/1/2014 0.00 $20.21 9 1/1/2014
4 RADIOLOGY 73020 21 999 Years 0.72 $26.7305 $19.25 1/1/2014 0.00 $19.25 9 1/1/2014
T
TECHNICAL
COMPONENT 73020 0 20 Years 0.50 $28.0672 $14.03 1/1/2014 0.00 $14.03 9 1/1/2014
T
TECHNICAL
COMPONENT 73020 21 999 Years 0.50 $26.7305 $13.37 1/1/2014 0.00 $13.37 9 1/1/2014
4 RADIOLOGY 73030 0 20 Years 0.94 $28.0672 $26.38 1/1/2014 0.00 $26.38 9 1/1/2014
4 RADIOLOGY 73030 21 999 Years 0.94 $26.7305 $25.13 1/1/2014 0.00 $25.13 9 1/1/2014
T
TECHNICAL
COMPONENT 73030 0 20 Years 0.65 $28.0672 $18.24 1/1/2014 0.00 $18.24 9 1/1/2014
T
TECHNICAL
COMPONENT 73030 21 999 Years 0.65 $26.7305 $17.37 1/1/2014 0.00 $17.37 9 1/1/2014
4 RADIOLOGY 73040 0 20 Years 3.21 $28.0672 $90.10 1/1/2014 0.00 $90.10 9 1/1/2014
4 RADIOLOGY 73040 21 999 Years 3.21 $26.7305 $85.80 1/1/2014 0.00 $85.80 9 1/1/2014
T
TECHNICAL
COMPONENT 73040 0 20 Years 2.42 $28.0672 $67.92 1/1/2014 0.00 $67.92 9 1/1/2014
T
TECHNICAL
COMPONENT 73040 21 999 Years 2.42 $26.7305 $64.69 1/1/2014 0.00 $64.69 9 1/1/2014
4 RADIOLOGY 73050 0 20 Years 1.23 $28.0672 $34.52 1/1/2014 0.00 $34.52 9 1/1/2014
4 RADIOLOGY 73050 21 999 Years 1.23 $26.7305 $32.88 1/1/2014 0.00 $32.88 9 1/1/2014
T
TECHNICAL
COMPONENT 73050 0 20 Years 0.91 $28.0672 $25.54 1/1/2014 0.00 $25.54 9 1/1/2014
T
TECHNICAL
COMPONENT 73050 21 999 Years 0.91 $26.7305 $24.32 1/1/2014 0.00 $24.32 9 1/1/2014
4 RADIOLOGY 73060 0 20 Years 0.88 $28.0672 $24.70 1/1/2014 0.00 $24.70 9 1/1/2014
4 RADIOLOGY 73060 21 999 Years 0.88 $26.7305 $23.52 1/1/2014 0.00 $23.52 9 1/1/2014
T
TECHNICAL
COMPONENT 73060 0 20 Years 0.63 $28.0672 $17.68 1/1/2014 0.00 $17.68 9 1/1/2014
T
TECHNICAL
COMPONENT 73060 21 999 Years 0.63 $26.7305 $16.84 1/1/2014 0.00 $16.84 9 1/1/2014
4 RADIOLOGY 73070 0 20 Years 0.87 $28.0672 $24.42 1/1/2014 0.00 $24.42 9 1/1/2014
4 RADIOLOGY 73070 21 999 Years 0.87 $26.7305 $23.26 1/1/2014 0.00 $23.26 9 1/1/2014
T
TECHNICAL
COMPONENT 73070 0 20 Years 0.64 $28.0672 $17.96 1/1/2014 0.00 $17.96 9 1/1/2014
T
TECHNICAL
COMPONENT 73070 21 999 Years 0.64 $26.7305 $17.11 1/1/2014 0.00 $17.11 9 1/1/2014
4 RADIOLOGY 73080 0 20 Years 1.02 $28.0672 $28.63 1/1/2014 0.00 $28.63 9 1/1/2014
4 RADIOLOGY 73080 21 999 Years 1.02 $26.7305 $27.27 1/1/2014 0.00 $27.27 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 73080 0 20 Years 0.77 $28.0672 $21.61 1/1/2014 0.00 $21.61 9 1/1/2014
T
TECHNICAL
COMPONENT 73080 21 999 Years 0.77 $26.7305 $20.58 1/1/2014 0.00 $20.58 9 1/1/2014
4 RADIOLOGY 73085 0 20 Years 3.09 $28.0672 $86.73 1/1/2014 0.00 $86.73 9 1/1/2014
4 RADIOLOGY 73085 21 999 Years 3.09 $26.7305 $82.60 1/1/2014 0.00 $82.60 9 1/1/2014
T
TECHNICAL
COMPONENT 73085 0 20 Years 2.26 $28.0672 $63.43 1/1/2014 0.00 $63.43 9 1/1/2014
T
TECHNICAL
COMPONENT 73085 21 999 Years 2.26 $26.7305 $60.41 1/1/2014 0.00 $60.41 9 1/1/2014
4 RADIOLOGY 73090 0 20 Years 0.85 $28.0672 $23.86 1/1/2014 0.00 $23.86 9 1/1/2014
4 RADIOLOGY 73090 21 999 Years 0.85 $26.7305 $22.72 1/1/2014 0.00 $22.72 9 1/1/2014
T
TECHNICAL
COMPONENT 73090 0 20 Years 0.61 $28.0672 $17.12 1/1/2014 0.00 $17.12 9 1/1/2014
T
TECHNICAL
COMPONENT 73090 21 999 Years 0.61 $26.7305 $16.31 1/1/2014 0.00 $16.31 9 1/1/2014
4 RADIOLOGY 73092 0 365 Days 0.99 $28.0672 $27.79 1/1/2014 0.00 $27.79 9 1/1/2014
T
TECHNICAL
COMPONENT 73092 0 365 Days 0.75 $28.0672 $21.05 1/1/2014 0.00 $21.05 9 1/1/2014
4 RADIOLOGY 73100 0 20 Years 0.98 $28.0672 $27.51 1/1/2014 0.00 $27.51 9 1/1/2014
4 RADIOLOGY 73100 21 999 Years 0.98 $26.7305 $26.20 1/1/2014 0.00 $26.20 9 1/1/2014
T
TECHNICAL
COMPONENT 73100 0 20 Years 0.71 $28.0672 $19.93 1/1/2014 0.00 $19.93 9 1/1/2014
T
TECHNICAL
COMPONENT 73100 21 999 Years 0.71 $26.7305 $18.98 1/1/2014 0.00 $18.98 9 1/1/2014
4 RADIOLOGY 73110 0 20 Years 1.15 $28.0672 $32.28 1/1/2014 0.00 $32.28 9 1/1/2014
4 RADIOLOGY 73110 21 999 Years 1.15 $26.7305 $30.74 1/1/2014 0.00 $30.74 9 1/1/2014
T
TECHNICAL
COMPONENT 73110 0 20 Years 0.90 $28.0672 $25.26 1/1/2014 0.00 $25.26 9 1/1/2014
T
TECHNICAL
COMPONENT 73110 21 999 Years 0.90 $26.7305 $24.06 1/1/2014 0.00 $24.06 9 1/1/2014
4 RADIOLOGY 73115 0 20 Years 3.38 $28.0672 $94.87 1/1/2014 0.00 $94.87 9 1/1/2014
4 RADIOLOGY 73115 21 999 Years 3.38 $26.7305 $90.35 1/1/2014 0.00 $90.35 9 1/1/2014
T
TECHNICAL
COMPONENT 73115 0 20 Years 2.57 $28.0672 $72.13 1/1/2014 0.00 $72.13 9 1/1/2014
T
TECHNICAL
COMPONENT 73115 21 999 Years 2.57 $26.7305 $68.70 1/1/2014 0.00 $68.70 9 1/1/2014
4 RADIOLOGY 73120 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 9 1/1/2014
4 RADIOLOGY 73120 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 9 1/1/2014
T
TECHNICAL
COMPONENT 73120 0 20 Years 0.60 $28.0672 $16.84 1/1/2014 0.00 $16.84 9 1/1/2014
T
TECHNICAL
COMPONENT 73120 21 999 Years 0.60 $26.7305 $16.04 1/1/2014 0.00 $16.04 9 1/1/2014
4 RADIOLOGY 73130 0 20 Years 0.99 $28.0672 $27.79 1/1/2014 0.00 $27.79 9 1/1/2014
4 RADIOLOGY 73130 21 999 Years 0.99 $26.7305 $26.46 1/1/2014 0.00 $26.46 9 1/1/2014
T
TECHNICAL
COMPONENT 73130 0 20 Years 0.74 $28.0672 $20.77 1/1/2014 0.00 $20.77 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 73130 21 999 Years 0.74 $26.7305 $19.78 1/1/2014 0.00 $19.78 9 1/1/2014
4 RADIOLOGY 73140 0 20 Years 1.03 $28.0672 $28.91 1/1/2014 0.00 $28.91 9 1/1/2014
4 RADIOLOGY 73140 21 999 Years 1.03 $26.7305 $27.53 1/1/2014 0.00 $27.53 9 1/1/2014
T
TECHNICAL
COMPONENT 73140 0 20 Years 0.83 $28.0672 $23.30 1/1/2014 0.00 $23.30 9 1/1/2014
T
TECHNICAL
COMPONENT 73140 21 999 Years 0.83 $26.7305 $22.19 1/1/2014 0.00 $22.19 9 1/1/2014
4 RADIOLOGY 73200 0 20 Years 6.23 $28.0672 $174.86 1/1/2014 0.00 $174.86 6.23 $28.0672 $174.86 1/1/2014 0.00 $174.86 1/1/2014
4 RADIOLOGY 73200 21 999 Years 6.23 $26.7305 $166.53 1/1/2014 0.00 $166.53 6.23 $26.7305 $166.53 1/1/2014 0.00 $166.53 1/1/2014
I
PROFESSIONAL
COMPONENT 73200 0 20 Years 1.43 $28.0672 $40.14 1/1/2014 0.00 $40.14 1.43 $28.0672 $40.14 1/1/2014 0.00 $40.14 1/1/2014
I
PROFESSIONAL
COMPONENT 73200 21 999 Years 1.43 $26.7305 $38.22 1/1/2014 0.00 $38.22 1.43 $26.7305 $38.22 1/1/2014 0.00 $38.22 1/1/2014
T
TECHNICAL
COMPONENT 73200 0 20 Years 4.80 $28.0672 $134.72 1/1/2014 0.00 $134.72 4.80 $28.0672 $134.72 1/1/2014 0.00 $134.72 1/1/2014
T
TECHNICAL
COMPONENT 73200 21 999 Years 4.80 $26.7305 $128.31 1/1/2014 0.00 $128.31 4.80 $26.7305 $128.31 1/1/2014 0.00 $128.31 1/1/2014
4 RADIOLOGY 73201 0 20 Years 7.65 $28.0672 $214.71 1/1/2014 0.00 $214.71 7.65 $28.0672 $214.71 1/1/2014 0.00 $214.71 1/1/2014
4 RADIOLOGY 73201 21 999 Years 7.65 $26.7305 $204.49 1/1/2014 0.00 $204.49 7.65 $26.7305 $204.49 1/1/2014 0.00 $204.49 1/1/2014
I
PROFESSIONAL
COMPONENT 73201 0 20 Years 1.65 $28.0672 $46.31 1/1/2014 0.00 $46.31 1.65 $28.0672 $46.31 1/1/2014 0.00 $46.31 1/1/2014
I
PROFESSIONAL
COMPONENT 73201 21 999 Years 1.65 $26.7305 $44.11 1/1/2014 0.00 $44.11 1.65 $26.7305 $44.11 1/1/2014 0.00 $44.11 1/1/2014
T
TECHNICAL
COMPONENT 73201 0 20 Years 6.00 $28.0672 $168.40 1/1/2014 0.00 $168.40 6.00 $28.0672 $168.40 1/1/2014 0.00 $168.40 1/1/2014
T
TECHNICAL
COMPONENT 73201 21 999 Years 6.00 $26.7305 $160.38 1/1/2014 0.00 $160.38 6.00 $26.7305 $160.38 1/1/2014 0.00 $160.38 1/1/2014
4 RADIOLOGY 73202 0 20 Years 9.74 $28.0672 $273.37 1/1/2014 0.00 $273.37 9.74 $28.0672 $273.37 1/1/2014 0.00 $273.37 1/1/2014
4 RADIOLOGY 73202 21 999 Years 9.74 $26.7305 $260.36 1/1/2014 0.00 $260.36 9.74 $26.7305 $260.36 1/1/2014 0.00 $260.36 1/1/2014
I
PROFESSIONAL
COMPONENT 73202 0 20 Years 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1/1/2014
I
PROFESSIONAL
COMPONENT 73202 21 999 Years 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1/1/2014
T
TECHNICAL
COMPONENT 73202 0 20 Years 8.01 $28.0672 $224.82 1/1/2014 0.00 $224.82 8.01 $28.0672 $224.82 1/1/2014 0.00 $224.82 1/1/2014
T
TECHNICAL
COMPONENT 73202 21 999 Years 8.01 $26.7305 $214.11 1/1/2014 0.00 $214.11 8.01 $26.7305 $214.11 1/1/2014 0.00 $214.11 1/1/2014
4 RADIOLOGY 73206 0 20 Years 10.92 $28.0672 $306.49 1/1/2014 0.00 $306.49 10.92 $28.0672 $306.49 1/1/2014 0.00 $306.49 1/1/2014
4 RADIOLOGY 73206 21 999 Years 10.92 $26.7305 $291.90 1/1/2014 0.00 $291.90 10.92 $26.7305 $291.90 1/1/2014 0.00 $291.90 1/1/2014
I
PROFESSIONAL
COMPONENT 73206 0 20 Years 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 73206 21 999 Years 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 1/1/2014
T
TECHNICAL
COMPONENT 73206 0 20 Years 8.38 $28.0672 $235.20 1/1/2014 0.00 $235.20 8.38 $28.0672 $235.20 1/1/2014 0.00 $235.20 1/1/2014
T
TECHNICAL
COMPONENT 73206 21 999 Years 8.38 $26.7305 $224.00 1/1/2014 0.00 $224.00 8.38 $26.7305 $224.00 1/1/2014 0.00 $224.00 1/1/2014
4 RADIOLOGY 73218 0 20 Years 12.49 $28.0672 $350.56 1/1/2014 0.00 $350.56 12.49 $28.0672 $350.56 1/1/2014 0.00 $350.56 1/1/2014
4 RADIOLOGY 73218 21 999 Years 12.49 $26.7305 $333.86 1/1/2014 0.00 $333.86 12.49 $26.7305 $333.86 1/1/2014 0.00 $333.86 1/1/2014
I
PROFESSIONAL
COMPONENT 73218 0 20 Years 1.92 $28.0672 $53.89 1/1/2014 0.00 $53.89 1.92 $28.0672 $53.89 1/1/2014 0.00 $53.89 1/1/2014
I
PROFESSIONAL
COMPONENT 73218 21 999 Years 1.92 $26.7305 $51.32 1/1/2014 0.00 $51.32 1.92 $26.7305 $51.32 1/1/2014 0.00 $51.32 1/1/2014
T
TECHNICAL
COMPONENT 73218 0 20 Years 10.57 $28.0672 $296.67 1/1/2014 0.00 $296.67 10.57 $28.0672 $296.67 1/1/2014 0.00 $296.67 1/1/2014
T
TECHNICAL
COMPONENT 73218 21 999 Years 10.57 $26.7305 $282.54 1/1/2014 0.00 $282.54 10.57 $26.7305 $282.54 1/1/2014 0.00 $282.54 1/1/2014
4 RADIOLOGY 73219 0 20 Years 13.86 $28.0672 $389.01 1/1/2014 0.00 $389.01 13.86 $28.0672 $389.01 1/1/2014 0.00 $389.01 1/1/2014
4 RADIOLOGY 73219 21 999 Years 13.86 $26.7305 $370.48 1/1/2014 0.00 $370.48 13.86 $26.7305 $370.48 1/1/2014 0.00 $370.48 1/1/2014
I
PROFESSIONAL
COMPONENT 73219 0 20 Years 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 1/1/2014
I
PROFESSIONAL
COMPONENT 73219 21 999 Years 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 1/1/2014
T
TECHNICAL
COMPONENT 73219 0 20 Years 11.55 $28.0672 $324.18 1/1/2014 0.00 $324.18 11.55 $28.0672 $324.18 1/1/2014 0.00 $324.18 1/1/2014
T
TECHNICAL
COMPONENT 73219 21 999 Years 11.55 $26.7305 $308.74 1/1/2014 0.00 $308.74 11.55 $26.7305 $308.74 1/1/2014 0.00 $308.74 1/1/2014
4 RADIOLOGY 73220 0 20 Years 17.09 $28.0672 $479.67 1/1/2014 0.00 $479.67 17.09 $28.0672 $479.67 1/1/2014 0.00 $479.67 1/1/2014
4 RADIOLOGY 73220 21 999 Years 17.09 $26.7305 $456.82 1/1/2014 0.00 $456.82 17.09 $26.7305 $456.82 1/1/2014 0.00 $456.82 1/1/2014
I
PROFESSIONAL
COMPONENT 73220 0 20 Years 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 1/1/2014
I
PROFESSIONAL
COMPONENT 73220 21 999 Years 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 1/1/2014
T
TECHNICAL
COMPONENT 73220 0 20 Years 14.04 $28.0672 $394.06 1/1/2014 0.00 $394.06 14.04 $28.0672 $394.06 1/1/2014 0.00 $394.06 1/1/2014
T
TECHNICAL
COMPONENT 73220 21 999 Years 14.04 $26.7305 $375.30 1/1/2014 0.00 $375.30 14.04 $26.7305 $375.30 1/1/2014 0.00 $375.30 1/1/2014
4 RADIOLOGY 73221 0 20 Years 8.29 $28.0672 $232.68 1/1/2014 0.00 $232.68 8.29 $28.0672 $232.68 1/1/2014 0.00 $232.68 1/1/2014
4 RADIOLOGY 73221 21 999 Years 8.29 $26.7305 $221.60 1/1/2014 0.00 $221.60 8.29 $26.7305 $221.60 1/1/2014 0.00 $221.60 1/1/2014
I
PROFESSIONAL
COMPONENT 73221 0 20 Years 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1/1/2014
I
PROFESSIONAL
COMPONENT 73221 21 999 Years 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 73221 0 20 Years 6.33 $28.0672 $177.67 1/1/2014 0.00 $177.67 6.33 $28.0672 $177.67 1/1/2014 0.00 $177.67 1/1/2014
T
TECHNICAL
COMPONENT 73221 21 999 Years 6.33 $26.7305 $169.20 1/1/2014 0.00 $169.20 6.33 $26.7305 $169.20 1/1/2014 0.00 $169.20 1/1/2014
4 RADIOLOGY 73222 0 20 Years 13.01 $28.0672 $365.15 1/1/2014 0.00 $365.15 13.01 $28.0672 $365.15 1/1/2014 0.00 $365.15 1/1/2014
4 RADIOLOGY 73222 21 999 Years 13.01 $26.7305 $347.76 1/1/2014 0.00 $347.76 13.01 $26.7305 $347.76 1/1/2014 0.00 $347.76 1/1/2014
I
PROFESSIONAL
COMPONENT 73222 0 20 Years 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 1/1/2014
I
PROFESSIONAL
COMPONENT 73222 21 999 Years 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 1/1/2014
T
TECHNICAL
COMPONENT 73222 0 20 Years 10.70 $28.0672 $300.32 1/1/2014 0.00 $300.32 10.70 $28.0672 $300.32 1/1/2014 0.00 $300.32 1/1/2014
T
TECHNICAL
COMPONENT 73222 21 999 Years 10.70 $26.7305 $286.02 1/1/2014 0.00 $286.02 10.70 $26.7305 $286.02 1/1/2014 0.00 $286.02 1/1/2014
4 RADIOLOGY 73223 0 20 Years 16.11 $28.0672 $452.16 1/1/2014 0.00 $452.16 16.11 $28.0672 $452.16 1/1/2014 0.00 $452.16 1/1/2014
4 RADIOLOGY 73223 21 999 Years 16.11 $26.7305 $430.63 1/1/2014 0.00 $430.63 16.11 $26.7305 $430.63 1/1/2014 0.00 $430.63 1/1/2014
I
PROFESSIONAL
COMPONENT 73223 0 20 Years 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 1/1/2014
I
PROFESSIONAL
COMPONENT 73223 21 999 Years 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 1/1/2014
T
TECHNICAL
COMPONENT 73223 0 20 Years 13.06 $28.0672 $366.56 1/1/2014 0.00 $366.56 13.06 $28.0672 $366.56 1/1/2014 0.00 $366.56 1/1/2014
T
TECHNICAL
COMPONENT 73223 21 999 Years 13.06 $26.7305 $349.10 1/1/2014 0.00 $349.10 13.06 $26.7305 $349.10 1/1/2014 0.00 $349.10 1/1/2014
4 RADIOLOGY 73225 0 20 Years 14.18 $28.0672 $397.99 1/1/2014 0.00 $397.99 9 14.18 $28.0672 $397.99 1/1/2014 0.00 $397.99 9 1/1/2014
4 RADIOLOGY 73225 21 999 Years 14.18 $26.7305 $379.04 1/1/2014 0.00 $379.04 9 14.18 $26.7305 $379.04 1/1/2014 0.00 $379.04 9 1/1/2014
I
PROFESSIONAL
COMPONENT 73225 0 20 Years 2.41 $28.0672 $67.64 1/1/2014 0.00 $67.64 9 2.41 $28.0672 $67.64 1/1/2014 0.00 $67.64 9 1/1/2014
I
PROFESSIONAL
COMPONENT 73225 21 999 Years 2.41 $26.7305 $64.42 1/1/2014 0.00 $64.42 9 2.41 $26.7305 $64.42 1/1/2014 0.00 $64.42 9 1/1/2014
T
TECHNICAL
COMPONENT 73225 0 20 Years 11.77 $28.0672 $330.35 1/1/2014 0.00 $330.35 9 11.77 $28.0672 $330.35 1/1/2014 0.00 $330.35 9 1/1/2014
T
TECHNICAL
COMPONENT 73225 21 999 Years 11.77 $26.7305 $314.62 1/1/2014 0.00 $314.62 9 11.77 $26.7305 $314.62 1/1/2014 0.00 $314.62 9 1/1/2014
4 RADIOLOGY 73525 0 20 Years 3.20 $28.0672 $89.82 1/1/2014 0.00 $89.82 9 1/1/2014
4 RADIOLOGY 73525 21 999 Years 3.20 $26.7305 $85.54 1/1/2014 0.00 $85.54 9 1/1/2014
T
TECHNICAL
COMPONENT 73525 0 20 Years 2.36 $28.0672 $66.24 1/1/2014 0.00 $66.24 9 1/1/2014
T
TECHNICAL
COMPONENT 73525 21 999 Years 2.36 $26.7305 $63.08 1/1/2014 0.00 $63.08 9 1/1/2014
4 RADIOLOGY 73560 0 20 Years 0.95 $28.0672 $26.66 1/1/2014 0.00 $26.66 9 1/1/2014
4 RADIOLOGY 73560 21 999 Years 0.95 $26.7305 $25.39 1/1/2014 0.00 $25.39 9 1/1/2014
T
TECHNICAL
COMPONENT 73560 0 20 Years 0.67 $28.0672 $18.81 1/1/2014 0.00 $18.81 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 73560 21 999 Years 0.67 $26.7305 $17.91 1/1/2014 0.00 $17.91 9 1/1/2014
4 RADIOLOGY 73562 0 20 Years 1.15 $28.0672 $32.28 1/1/2014 0.00 $32.28 9 1/1/2014
4 RADIOLOGY 73562 21 999 Years 1.15 $26.7305 $30.74 1/1/2014 0.00 $30.74 9 1/1/2014
T
TECHNICAL
COMPONENT 73562 0 20 Years 0.86 $28.0672 $24.14 1/1/2014 0.00 $24.14 9 1/1/2014
T
TECHNICAL
COMPONENT 73562 21 999 Years 0.86 $26.7305 $22.99 1/1/2014 0.00 $22.99 9 1/1/2014
4 RADIOLOGY 73564 0 20 Years 1.34 $28.0672 $37.61 1/1/2014 0.00 $37.61 9 1/1/2014
4 RADIOLOGY 73564 21 999 Years 1.34 $26.7305 $35.82 1/1/2014 0.00 $35.82 9 1/1/2014
T
TECHNICAL
COMPONENT 73564 0 20 Years 0.99 $28.0672 $27.79 1/1/2014 0.00 $27.79 9 1/1/2014
T
TECHNICAL
COMPONENT 73564 21 999 Years 0.99 $26.7305 $26.46 1/1/2014 0.00 $26.46 9 1/1/2014
4 RADIOLOGY 73565 0 20 Years 1.10 $28.0672 $30.87 1/1/2014 0.00 $30.87 9 1/1/2014
4 RADIOLOGY 73565 21 999 Years 1.10 $26.7305 $29.40 1/1/2014 0.00 $29.40 9 1/1/2014
T
TECHNICAL
COMPONENT 73565 0 20 Years 0.81 $28.0672 $22.73 1/1/2014 0.00 $22.73 9 1/1/2014
T
TECHNICAL
COMPONENT 73565 21 999 Years 0.81 $26.7305 $21.65 1/1/2014 0.00 $21.65 9 1/1/2014
4 RADIOLOGY 73580 0 20 Years 3.97 $28.0672 $111.43 1/1/2014 0.00 $111.43 9 1/1/2014
4 RADIOLOGY 73580 21 999 Years 3.97 $26.7305 $106.12 1/1/2014 0.00 $106.12 9 1/1/2014
T
TECHNICAL
COMPONENT 73580 0 20 Years 3.13 $28.0672 $87.85 1/1/2014 0.00 $87.85 9 1/1/2014
T
TECHNICAL
COMPONENT 73580 21 999 Years 3.13 $26.7305 $83.67 1/1/2014 0.00 $83.67 9 1/1/2014
4 RADIOLOGY 73590 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 9 1/1/2014
4 RADIOLOGY 73590 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 9 1/1/2014
T
TECHNICAL
COMPONENT 73590 0 20 Years 0.59 $28.0672 $16.56 1/1/2014 0.00 $16.56 9 1/1/2014
T
TECHNICAL
COMPONENT 73590 21 999 Years 0.59 $26.7305 $15.77 1/1/2014 0.00 $15.77 9 1/1/2014
4 RADIOLOGY 73592 0 365 Days 0.85 $28.0672 $23.86 1/1/2014 0.00 $23.86 1/1/2014
T
TECHNICAL
COMPONENT 73592 0 365 Days 0.62 $28.0672 $17.40 1/1/2014 0.00 $17.40 1/1/2014
4 RADIOLOGY 73600 0 20 Years 0.88 $28.0672 $24.70 1/1/2014 0.00 $24.70 1/1/2014
4 RADIOLOGY 73600 21 999 Years 0.88 $26.7305 $23.52 1/1/2014 0.00 $23.52 1/1/2014
T
TECHNICAL
COMPONENT 73600 0 20 Years 0.64 $28.0672 $17.96 1/1/2014 0.00 $17.96 9 1/1/2014
T
TECHNICAL
COMPONENT 73600 21 999 Years 0.64 $26.7305 $17.11 1/1/2014 0.00 $17.11 9 1/1/2014
4 RADIOLOGY 73610 0 20 Years 1.02 $28.0672 $28.63 1/1/2014 0.00 $28.63 1/1/2014
4 RADIOLOGY 73610 21 999 Years 1.02 $26.7305 $27.27 1/1/2014 0.00 $27.27 1/1/2014
T
TECHNICAL
COMPONENT 73610 0 20 Years 0.77 $28.0672 $21.61 1/1/2014 0.00 $21.61 9 1/1/2014
T
TECHNICAL
COMPONENT 73610 21 999 Years 0.77 $26.7305 $20.58 1/1/2014 0.00 $20.58 9 1/1/2014
4 RADIOLOGY 73615 0 20 Years 3.20 $28.0672 $89.82 1/1/2014 0.00 $89.82 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 73615 21 999 Years 3.20 $26.7305 $85.54 1/1/2014 0.00 $85.54 9 1/1/2014
T
TECHNICAL
COMPONENT 73615 0 20 Years 2.37 $28.0672 $66.52 1/1/2014 0.00 $66.52 9 1/1/2014
T
TECHNICAL
COMPONENT 73615 21 999 Years 2.37 $26.7305 $63.35 1/1/2014 0.00 $63.35 9 1/1/2014
4 RADIOLOGY 73620 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 1/1/2014
4 RADIOLOGY 73620 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 1/1/2014
T
TECHNICAL
COMPONENT 73620 0 20 Years 0.62 $28.0672 $17.40 1/1/2014 0.00 $17.40 9 1/1/2014
T
TECHNICAL
COMPONENT 73620 21 999 Years 0.62 $26.7305 $16.57 1/1/2014 0.00 $16.57 9 1/1/2014
4 RADIOLOGY 73630 0 20 Years 0.96 $28.0672 $26.94 1/1/2014 0.00 $26.94 1/1/2014
4 RADIOLOGY 73630 21 999 Years 0.96 $26.7305 $25.66 1/1/2014 0.00 $25.66 1/1/2014
T
TECHNICAL
COMPONENT 73630 0 20 Years 0.72 $28.0672 $20.21 1/1/2014 0.00 $20.21 9 1/1/2014
T
TECHNICAL
COMPONENT 73630 21 999 Years 0.72 $26.7305 $19.25 1/1/2014 0.00 $19.25 9 1/1/2014
4 RADIOLOGY 73650 0 20 Years 0.87 $28.0672 $24.42 1/1/2014 0.00 $24.42 1/1/2014
4 RADIOLOGY 73650 21 999 Years 0.87 $26.7305 $23.26 1/1/2014 0.00 $23.26 1/1/2014
T
TECHNICAL
COMPONENT 73650 0 20 Years 0.64 $28.0672 $17.96 1/1/2014 0.00 $17.96 9 1/1/2014
T
TECHNICAL
COMPONENT 73650 21 999 Years 0.64 $26.7305 $17.11 1/1/2014 0.00 $17.11 9 1/1/2014
4 RADIOLOGY 73660 0 20 Years 0.93 $28.0672 $26.10 1/1/2014 0.00 $26.10 1/1/2014
4 RADIOLOGY 73660 21 999 Years 0.93 $26.7305 $24.86 1/1/2014 0.00 $24.86 1/1/2014
T
TECHNICAL
COMPONENT 73660 0 20 Years 0.74 $28.0672 $20.77 1/1/2014 0.00 $20.77 9 1/1/2014
T
TECHNICAL
COMPONENT 73660 21 999 Years 0.74 $26.7305 $19.78 1/1/2014 0.00 $19.78 9 1/1/2014
4 RADIOLOGY 73700 0 20 Years 6.25 $28.0672 $175.42 1/1/2014 0.00 $175.42 6.25 $28.0672 $175.42 1/1/2014 0.00 $175.42 1/1/2014
4 RADIOLOGY 73700 21 999 Years 6.25 $26.7305 $167.07 1/1/2014 0.00 $167.07 6.25 $26.7305 $167.07 1/1/2014 0.00 $167.07 1/1/2014
I
PROFESSIONAL
COMPONENT 73700 0 20 Years 1.43 $28.0672 $40.14 1/1/2014 0.00 $40.14 1.43 $28.0672 $40.14 1/1/2014 0.00 $40.14 1/1/2014
I
PROFESSIONAL
COMPONENT 73700 21 999 Years 1.43 $26.7305 $38.22 1/1/2014 0.00 $38.22 1.43 $26.7305 $38.22 1/1/2014 0.00 $38.22 1/1/2014
T
TECHNICAL
COMPONENT 73700 0 20 Years 4.82 $28.0672 $135.28 1/1/2014 0.00 $135.28 4.82 $28.0672 $135.28 1/1/2014 0.00 $135.28 1/1/2014
T
TECHNICAL
COMPONENT 73700 21 999 Years 4.82 $26.7305 $128.84 1/1/2014 0.00 $128.84 4.82 $26.7305 $128.84 1/1/2014 0.00 $128.84 1/1/2014
4 RADIOLOGY 73701 0 20 Years 7.76 $28.0672 $217.80 1/1/2014 0.00 $217.80 7.76 $28.0672 $217.80 1/1/2014 0.00 $217.80 1/1/2014
4 RADIOLOGY 73701 21 999 Years 7.76 $26.7305 $207.43 1/1/2014 0.00 $207.43 7.76 $26.7305 $207.43 1/1/2014 0.00 $207.43 1/1/2014
I
PROFESSIONAL
COMPONENT 73701 0 20 Years 1.65 $28.0672 $46.31 1/1/2014 0.00 $46.31 1.65 $28.0672 $46.31 1/1/2014 0.00 $46.31 1/1/2014
I
PROFESSIONAL
COMPONENT 73701 21 999 Years 1.65 $26.7305 $44.11 1/1/2014 0.00 $44.11 1.65 $26.7305 $44.11 1/1/2014 0.00 $44.11 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 73701 0 20 Years 6.11 $28.0672 $171.49 1/1/2014 0.00 $171.49 6.11 $28.0672 $171.49 1/1/2014 0.00 $171.49 1/1/2014
T
TECHNICAL
COMPONENT 73701 21 999 Years 6.11 $26.7305 $163.32 1/1/2014 0.00 $163.32 6.11 $26.7305 $163.32 1/1/2014 0.00 $163.32 1/1/2014
4 RADIOLOGY 73702 0 20 Years 9.72 $28.0672 $272.81 1/1/2014 0.00 $272.81 9.72 $28.0672 $272.81 1/1/2014 0.00 $272.81 1/1/2014
4 RADIOLOGY 73702 21 999 Years 9.72 $26.7305 $259.82 1/1/2014 0.00 $259.82 9.72 $26.7305 $259.82 1/1/2014 0.00 $259.82 1/1/2014
I
PROFESSIONAL
COMPONENT 73702 0 20 Years 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1.73 $28.0672 $48.56 1/1/2014 0.00 $48.56 1/1/2014
I
PROFESSIONAL
COMPONENT 73702 21 999 Years 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1.73 $26.7305 $46.24 1/1/2014 0.00 $46.24 1/1/2014
T
TECHNICAL
COMPONENT 73702 0 20 Years 7.99 $28.0672 $224.26 1/1/2014 0.00 $224.26 7.99 $28.0672 $224.26 1/1/2014 0.00 $224.26 1/1/2014
T
TECHNICAL
COMPONENT 73702 21 999 Years 7.99 $26.7305 $213.58 1/1/2014 0.00 $213.58 7.99 $26.7305 $213.58 1/1/2014 0.00 $213.58 1/1/2014
4 RADIOLOGY 73706 0 20 Years 12.09 $28.0672 $339.33 1/1/2014 0.00 $339.33 12.09 $28.0672 $339.33 1/1/2014 0.00 $339.33 1/1/2014
4 RADIOLOGY 73706 21 999 Years 12.09 $26.7305 $323.17 1/1/2014 0.00 $323.17 12.09 $26.7305 $323.17 1/1/2014 0.00 $323.17 1/1/2014
I
PROFESSIONAL
COMPONENT 73706 0 20 Years 2.69 $28.0672 $75.50 1/1/2014 0.00 $75.50 2.69 $28.0672 $75.50 1/1/2014 0.00 $75.50 1/1/2014
I
PROFESSIONAL
COMPONENT 73706 21 999 Years 2.69 $26.7305 $71.91 1/1/2014 0.00 $71.91 2.69 $26.7305 $71.91 1/1/2014 0.00 $71.91 1/1/2014
T
TECHNICAL
COMPONENT 73706 0 20 Years 9.40 $28.0672 $263.83 1/1/2014 0.00 $263.83 9.40 $28.0672 $263.83 1/1/2014 0.00 $263.83 1/1/2014
T
TECHNICAL
COMPONENT 73706 21 999 Years 9.40 $26.7305 $251.27 1/1/2014 0.00 $251.27 9.40 $26.7305 $251.27 1/1/2014 0.00 $251.27 1/1/2014
4 RADIOLOGY 73718 0 20 Years 12.41 $28.0672 $348.31 1/1/2014 0.00 $348.31 12.41 $28.0672 $348.31 1/1/2014 0.00 $348.31 1/1/2014
4 RADIOLOGY 73718 21 999 Years 12.41 $26.7305 $331.73 1/1/2014 0.00 $331.73 12.41 $26.7305 $331.73 1/1/2014 0.00 $331.73 1/1/2014
I
PROFESSIONAL
COMPONENT 73718 0 20 Years 1.92 $28.0672 $53.89 1/1/2014 0.00 $53.89 1.92 $28.0672 $53.89 1/1/2014 0.00 $53.89 1/1/2014
I
PROFESSIONAL
COMPONENT 73718 21 999 Years 1.92 $26.7305 $51.32 1/1/2014 0.00 $51.32 1.92 $26.7305 $51.32 1/1/2014 0.00 $51.32 1/1/2014
T
TECHNICAL
COMPONENT 73718 0 20 Years 10.49 $28.0672 $294.42 1/1/2014 0.00 $294.42 10.49 $28.0672 $294.42 1/1/2014 0.00 $294.42 1/1/2014
T
TECHNICAL
COMPONENT 73718 21 999 Years 10.49 $26.7305 $280.40 1/1/2014 0.00 $280.40 10.49 $26.7305 $280.40 1/1/2014 0.00 $280.40 1/1/2014
4 RADIOLOGY 73719 0 20 Years 14.09 $28.0672 $395.47 1/1/2014 0.00 $395.47 14.09 $28.0672 $395.47 1/1/2014 0.00 $395.47 1/1/2014
4 RADIOLOGY 73719 21 999 Years 14.09 $26.7305 $376.63 1/1/2014 0.00 $376.63 14.09 $26.7305 $376.63 1/1/2014 0.00 $376.63 1/1/2014
I
PROFESSIONAL
COMPONENT 73719 0 20 Years 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 2.31 $28.0672 $64.84 1/1/2014 0.00 $64.84 1/1/2014
I
PROFESSIONAL
COMPONENT 73719 21 999 Years 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 2.31 $26.7305 $61.75 1/1/2014 0.00 $61.75 1/1/2014
T
TECHNICAL
COMPONENT 73719 0 20 Years 11.78 $28.0672 $330.63 1/1/2014 0.00 $330.63 11.78 $28.0672 $330.63 1/1/2014 0.00 $330.63 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 73719 21 999 Years 11.78 $26.7305 $314.89 1/1/2014 0.00 $314.89 11.78 $26.7305 $314.89 1/1/2014 0.00 $314.89 1/1/2014
4 RADIOLOGY 73720 0 20 Years 17.20 $28.0672 $482.76 1/1/2014 0.00 $482.76 17.20 $28.0672 $482.76 1/1/2014 0.00 $482.76 1/1/2014
4 RADIOLOGY 73720 21 999 Years 17.20 $26.7305 $459.76 1/1/2014 0.00 $459.76 17.20 $26.7305 $459.76 1/1/2014 0.00 $459.76 1/1/2014
I
PROFESSIONAL
COMPONENT 73720 0 20 Years 3.04 $28.0672 $85.32 1/1/2014 0.00 $85.32 3.04 $28.0672 $85.32 1/1/2014 0.00 $85.32 1/1/2014
I
PROFESSIONAL
COMPONENT 73720 21 999 Years 3.04 $26.7305 $81.26 1/1/2014 0.00 $81.26 3.04 $26.7305 $81.26 1/1/2014 0.00 $81.26 1/1/2014
T
TECHNICAL
COMPONENT 73720 0 20 Years 14.16 $28.0672 $397.43 1/1/2014 0.00 $397.43 14.16 $28.0672 $397.43 1/1/2014 0.00 $397.43 1/1/2014
T
TECHNICAL
COMPONENT 73720 21 999 Years 14.16 $26.7305 $378.50 1/1/2014 0.00 $378.50 14.16 $26.7305 $378.50 1/1/2014 0.00 $378.50 1/1/2014
4 RADIOLOGY 73721 0 20 Years 8.29 $28.0672 $232.68 1/1/2014 0.00 $232.68 8.29 $28.0672 $232.68 1/1/2014 0.00 $232.68 1/1/2014
4 RADIOLOGY 73721 21 999 Years 8.29 $26.7305 $221.60 1/1/2014 0.00 $221.60 8.29 $26.7305 $221.60 1/1/2014 0.00 $221.60 1/1/2014
I
PROFESSIONAL
COMPONENT 73721 0 20 Years 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1.96 $28.0672 $55.01 1/1/2014 0.00 $55.01 1/1/2014
I
PROFESSIONAL
COMPONENT 73721 21 999 Years 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1.96 $26.7305 $52.39 1/1/2014 0.00 $52.39 1/1/2014
T
TECHNICAL
COMPONENT 73721 0 20 Years 6.33 $28.0672 $177.67 1/1/2014 0.00 $177.67 6.33 $28.0672 $177.67 1/1/2014 0.00 $177.67 1/1/2014
T
TECHNICAL
COMPONENT 73721 21 999 Years 6.33 $26.7305 $169.20 1/1/2014 0.00 $169.20 6.33 $26.7305 $169.20 1/1/2014 0.00 $169.20 1/1/2014
4 RADIOLOGY 73722 0 20 Years 13.20 $28.0672 $370.49 1/1/2014 0.00 $370.49 13.20 $28.0672 $370.49 1/1/2014 0.00 $370.49 1/1/2014
4 RADIOLOGY 73722 21 999 Years 13.20 $26.7305 $352.84 1/1/2014 0.00 $352.84 13.20 $26.7305 $352.84 1/1/2014 0.00 $352.84 1/1/2014
I
PROFESSIONAL
COMPONENT 73722 0 20 Years 2.33 $28.0672 $65.40 1/1/2014 0.00 $65.40 2.33 $28.0672 $65.40 1/1/2014 0.00 $65.40 1/1/2014
I
PROFESSIONAL
COMPONENT 73722 21 999 Years 2.33 $26.7305 $62.28 1/1/2014 0.00 $62.28 2.33 $26.7305 $62.28 1/1/2014 0.00 $62.28 1/1/2014
T
TECHNICAL
COMPONENT 73722 0 20 Years 10.87 $28.0672 $305.09 1/1/2014 0.00 $305.09 10.87 $28.0672 $305.09 1/1/2014 0.00 $305.09 1/1/2014
T
TECHNICAL
COMPONENT 73722 21 999 Years 10.87 $26.7305 $290.56 1/1/2014 0.00 $290.56 10.87 $26.7305 $290.56 1/1/2014 0.00 $290.56 1/1/2014
4 RADIOLOGY 73723 0 20 Years 16.10 $28.0672 $451.88 1/1/2014 0.00 $451.88 16.10 $28.0672 $451.88 1/1/2014 0.00 $451.88 1/1/2014
4 RADIOLOGY 73723 21 999 Years 16.10 $26.7305 $430.36 1/1/2014 0.00 $430.36 16.10 $26.7305 $430.36 1/1/2014 0.00 $430.36 1/1/2014
I
PROFESSIONAL
COMPONENT 73723 0 20 Years 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 1/1/2014
I
PROFESSIONAL
COMPONENT 73723 21 999 Years 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 1/1/2014
T
TECHNICAL
COMPONENT 73723 0 20 Years 13.05 $28.0672 $366.28 1/1/2014 0.00 $366.28 13.05 $28.0672 $366.28 1/1/2014 0.00 $366.28 1/1/2014
T
TECHNICAL
COMPONENT 73723 21 999 Years 13.05 $26.7305 $348.83 1/1/2014 0.00 $348.83 13.05 $26.7305 $348.83 1/1/2014 0.00 $348.83 1/1/2014
4 RADIOLOGY 73725 0 20 Years 14.04 $28.0672 $394.06 1/1/2014 0.00 $394.06 14.04 $28.0672 $394.06 1/1/2014 0.00 $394.06 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
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Review Date
Mod
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Mod
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Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 73725 21 999 Years 14.04 $26.7305 $375.30 1/1/2014 0.00 $375.30 14.04 $26.7305 $375.30 1/1/2014 0.00 $375.30 1/1/2014
I
PROFESSIONAL
COMPONENT 73725 0 20 Years 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 1/1/2014
I
PROFESSIONAL
COMPONENT 73725 21 999 Years 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 1/1/2014
T
TECHNICAL
COMPONENT 73725 0 20 Years 11.48 $28.0672 $322.21 1/1/2014 0.00 $322.21 9 11.48 $28.0672 $322.21 1/1/2014 0.00 $322.21 9 1/1/2014
T
TECHNICAL
COMPONENT 73725 21 999 Years 11.48 $26.7305 $306.87 1/1/2014 0.00 $306.87 9 11.48 $26.7305 $306.87 1/1/2014 0.00 $306.87 9 1/1/2014
4 RADIOLOGY 74000 0 20 Years 0.66 $28.0672 $18.52 1/1/2016 0.00 $18.52 1/1/2016
4 RADIOLOGY 74000 21 999 Years 0.66 $26.7305 $17.64 1/1/2016 0.00 $17.64 1/1/2016
T
TECHNICAL
COMPONENT 74000 0 20 Years 0.40 $28.0672 $11.23 1/1/2016 0.00 $11.23 1/1/2016
T
TECHNICAL
COMPONENT 74000 21 999 Years 0.40 $26.7305 $10.69 1/1/2016 0.00 $10.69 1/1/2016
4 RADIOLOGY 74010 0 20 Years 0.98 $28.0672 $27.51 1/1/2016 0.00 $27.51 1/1/2016
4 RADIOLOGY 74010 21 999 Years 0.98 $26.7305 $26.20 1/1/2016 0.00 $26.20 1/1/2016
T
TECHNICAL
COMPONENT 74010 0 20 Years 0.65 $28.0672 $18.24 1/1/2016 0.00 $18.24 1/1/2016
T
TECHNICAL
COMPONENT 74010 21 999 Years 0.65 $26.7305 $17.37 1/1/2016 0.00 $17.37 1/1/2016
4 RADIOLOGY 74020 0 20 Years 1.22 $28.0672 $34.24 1/1/2014 0.00 $34.24 9 1/1/2014
4 RADIOLOGY 74020 21 999 Years 1.22 $26.7305 $32.61 1/1/2014 0.00 $32.61 9 1/1/2014
T
TECHNICAL
COMPONENT 74020 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 9 1/1/2014
T
TECHNICAL
COMPONENT 74020 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 9 1/1/2014
4 RADIOLOGY 74022 0 20 Years 1.47 $28.0672 $41.26 1/1/2014 0.00 $41.26 9 1/1/2014
4 RADIOLOGY 74022 21 999 Years 1.47 $26.7305 $39.29 1/1/2014 0.00 $39.29 9 1/1/2014
T
TECHNICAL
COMPONENT 74022 0 20 Years 1.02 $28.0672 $28.63 1/1/2014 0.00 $28.63 9 1/1/2014
T
TECHNICAL
COMPONENT 74022 21 999 Years 1.02 $26.7305 $27.27 1/1/2014 0.00 $27.27 9 1/1/2014
4 RADIOLOGY 74150 0 20 Years 5.29 $28.0672 $148.48 1/1/2014 0.00 $148.48 5.29 $28.0672 $148.48 1/1/2014 0.00 $148.48 1/1/2014
4 RADIOLOGY 74150 21 999 Years 5.29 $26.7305 $141.40 1/1/2014 0.00 $141.40 5.29 $26.7305 $141.40 1/1/2014 0.00 $141.40 1/1/2014
I
PROFESSIONAL
COMPONENT 74150 0 20 Years 1.69 $28.0672 $47.43 1/1/2014 0.00 $47.43 1.69 $28.0672 $47.43 1/1/2014 0.00 $47.43 1/1/2014
I
PROFESSIONAL
COMPONENT 74150 21 999 Years 1.69 $26.7305 $45.17 1/1/2014 0.00 $45.17 1.69 $26.7305 $45.17 1/1/2014 0.00 $45.17 1/1/2014
T
TECHNICAL
COMPONENT 74150 0 20 Years 3.60 $28.0672 $101.04 1/1/2014 0.00 $101.04 3.60 $28.0672 $101.04 1/1/2014 0.00 $101.04 1/1/2014
T
TECHNICAL
COMPONENT 74150 21 999 Years 3.60 $26.7305 $96.23 1/1/2014 0.00 $96.23 3.60 $26.7305 $96.23 1/1/2014 0.00 $96.23 1/1/2014
4 RADIOLOGY 74160 0 20 Years 8.31 $28.0672 $233.24 1/1/2014 0.00 $233.24 8.31 $28.0672 $233.24 1/1/2014 0.00 $233.24 1/1/2014
4 RADIOLOGY 74160 21 999 Years 8.31 $26.7305 $222.13 1/1/2014 0.00 $222.13 8.31 $26.7305 $222.13 1/1/2014 0.00 $222.13 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
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Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 74160 0 20 Years 1.81 $28.0672 $50.80 1/1/2014 0.00 $50.80 1.81 $28.0672 $50.80 1/1/2014 0.00 $50.80 1/1/2014
I
PROFESSIONAL
COMPONENT 74160 21 999 Years 1.81 $26.7305 $48.38 1/1/2014 0.00 $48.38 1.81 $26.7305 $48.38 1/1/2014 0.00 $48.38 1/1/2014
T
TECHNICAL
COMPONENT 74160 0 20 Years 6.50 $28.0672 $182.44 1/1/2014 0.00 $182.44 6.50 $28.0672 $182.44 1/1/2014 0.00 $182.44 1/1/2014
T
TECHNICAL
COMPONENT 74160 21 999 Years 6.50 $26.7305 $173.75 1/1/2014 0.00 $173.75 6.50 $26.7305 $173.75 1/1/2014 0.00 $173.75 1/1/2014
4 RADIOLOGY 74170 0 20 Years 9.57 $28.0672 $268.60 1/1/2014 0.00 $268.60 9.57 $28.0672 $268.60 1/1/2014 0.00 $268.60 1/1/2014
4 RADIOLOGY 74170 21 999 Years 9.57 $26.7305 $255.81 1/1/2014 0.00 $255.81 9.57 $26.7305 $255.81 1/1/2014 0.00 $255.81 1/1/2014
I
PROFESSIONAL
COMPONENT 74170 0 20 Years 1.99 $28.0672 $55.85 1/1/2014 0.00 $55.85 1.99 $28.0672 $55.85 1/1/2014 0.00 $55.85 1/1/2014
I
PROFESSIONAL
COMPONENT 74170 21 999 Years 1.99 $26.7305 $53.19 1/1/2014 0.00 $53.19 1.99 $26.7305 $53.19 1/1/2014 0.00 $53.19 1/1/2014
T
TECHNICAL
COMPONENT 74170 0 20 Years 7.58 $28.0672 $212.75 1/1/2014 0.00 $212.75 7.58 $28.0672 $212.75 1/1/2014 0.00 $212.75 1/1/2014
T
TECHNICAL
COMPONENT 74170 21 999 Years 7.58 $26.7305 $202.62 1/1/2014 0.00 $202.62 7.58 $26.7305 $202.62 1/1/2014 0.00 $202.62 1/1/2014
4 RADIOLOGY 74174 0 20 Years 14.90 $28.0672 $418.20 1/1/2014 0.00 $418.20 9 1/1/2014
4 RADIOLOGY 74174 21 999 Years 14.90 $26.7305 $398.28 1/1/2014 0.00 $398.28 9 1/1/2014
T
TECHNICAL
COMPONENT 74174 0 20 Years 11.78 $28.0672 $330.63 1/1/2014 0.00 $330.63 9 1/1/2014
T
TECHNICAL
COMPONENT 74174 21 999 Years 11.78 $26.7305 $314.89 1/1/2014 0.00 $314.89 9 1/1/2014
4 RADIOLOGY 74175 0 20 Years 12.11 $28.0672 $339.89 1/1/2014 0.00 $339.89 12.11 $28.0672 $339.89 1/1/2014 0.00 $339.89 1/1/2014
4 RADIOLOGY 74175 21 999 Years 12.11 $26.7305 $323.71 1/1/2014 0.00 $323.71 12.11 $26.7305 $323.71 1/1/2014 0.00 $323.71 1/1/2014
I
PROFESSIONAL
COMPONENT 74175 0 20 Years 2.70 $28.0672 $75.78 1/1/2014 0.00 $75.78 2.70 $28.0672 $75.78 1/1/2014 0.00 $75.78 1/1/2014
I
PROFESSIONAL
COMPONENT 74175 21 999 Years 2.70 $26.7305 $72.17 1/1/2014 0.00 $72.17 2.70 $26.7305 $72.17 1/1/2014 0.00 $72.17 1/1/2014
T
TECHNICAL
COMPONENT 74175 0 20 Years 9.41 $28.0672 $264.11 1/1/2014 0.00 $264.11 9.41 $28.0672 $264.11 1/1/2014 0.00 $264.11 1/1/2014
T
TECHNICAL
COMPONENT 74175 21 999 Years 9.41 $26.7305 $251.53 1/1/2014 0.00 $251.53 9.41 $26.7305 $251.53 1/1/2014 0.00 $251.53 1/1/2014
4 RADIOLOGY 74176 0 20 Years 6.83 $28.0672 $191.70 1/1/2014 0.00 $191.70 6.83 $28.0672 $191.70 1/1/2014 0.00 $191.70 1/1/2014
4 RADIOLOGY 74176 21 999 Years 6.83 $26.7305 $182.57 1/1/2014 0.00 $182.57 6.83 $26.7305 $182.57 1/1/2014 0.00 $182.57 1/1/2014
I
PROFESSIONAL
COMPONENT 74176 0 20 Years 2.47 $28.0672 $69.33 1/1/2014 0.00 $69.33 2.47 $28.0672 $69.33 1/1/2014 0.00 $69.33 1/1/2014
I
PROFESSIONAL
COMPONENT 74176 21 999 Years 2.47 $26.7305 $66.02 1/1/2014 0.00 $66.02 2.47 $26.7305 $66.02 1/1/2014 0.00 $66.02 1/1/2014
T
TECHNICAL
COMPONENT 74176 0 20 Years 4.36 $28.0672 $122.37 1/1/2014 0.00 $122.37 4.36 $28.0672 $122.37 1/1/2014 0.00 $122.37 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 74176 21 999 Years 4.36 $26.7305 $116.54 1/1/2014 0.00 $116.54 4.36 $26.7305 $116.54 1/1/2014 0.00 $116.54 1/1/2014
4 RADIOLOGY 74177 0 20 Years 10.28 $28.0672 $288.53 1/1/2014 0.00 $288.53 10.28 $28.0672 $288.53 1/1/2014 0.00 $288.53 1/1/2014
4 RADIOLOGY 74177 21 999 Years 10.28 $26.7305 $274.79 1/1/2014 0.00 $274.79 10.28 $26.7305 $274.79 1/1/2014 0.00 $274.79 1/1/2014
I
PROFESSIONAL
COMPONENT 74177 0 20 Years 2.58 $28.0672 $72.41 1/1/2014 0.00 $72.41 2.58 $28.0672 $72.41 1/1/2014 0.00 $72.41 1/1/2014
I
PROFESSIONAL
COMPONENT 74177 21 999 Years 2.58 $26.7305 $68.96 1/1/2014 0.00 $68.96 2.58 $26.7305 $68.96 1/1/2014 0.00 $68.96 1/1/2014
T
TECHNICAL
COMPONENT 74177 0 20 Years 7.70 $28.0672 $216.12 1/1/2014 0.00 $216.12 7.70 $28.0672 $216.12 1/1/2014 0.00 $216.12 1/1/2014
T
TECHNICAL
COMPONENT 74177 21 999 Years 7.70 $26.7305 $205.82 1/1/2014 0.00 $205.82 7.70 $26.7305 $205.82 1/1/2014 0.00 $205.82 1/1/2014
4 RADIOLOGY 74178 0 20 Years 12.04 $28.0672 $337.93 1/1/2014 0.00 $337.93 12.04 $28.0672 $337.93 1/1/2014 0.00 $337.93 1/1/2014
4 RADIOLOGY 74178 21 999 Years 12.04 $26.7305 $321.84 1/1/2014 0.00 $321.84 12.04 $26.7305 $321.84 1/1/2014 0.00 $321.84 1/1/2014
I
PROFESSIONAL
COMPONENT 74178 0 20 Years 2.86 $28.0672 $80.27 1/1/2014 0.00 $80.27 2.86 $28.0672 $80.27 1/1/2014 0.00 $80.27 1/1/2014
I
PROFESSIONAL
COMPONENT 74178 21 999 Years 2.86 $26.7305 $76.45 1/1/2014 0.00 $76.45 2.86 $26.7305 $76.45 1/1/2014 0.00 $76.45 1/1/2014
T
TECHNICAL
COMPONENT 74178 0 20 Years 9.18 $28.0672 $257.66 1/1/2014 0.00 $257.66 9.18 $28.0672 $257.66 1/1/2014 0.00 $257.66 1/1/2014
T
TECHNICAL
COMPONENT 74178 21 999 Years 9.18 $26.7305 $245.39 1/1/2014 0.00 $245.39 9.18 $26.7305 $245.39 1/1/2014 0.00 $245.39 1/1/2014
4 RADIOLOGY 74181 0 20 Years 11.24 $28.0672 $315.48 1/1/2014 0.00 $315.48 11.24 $28.0672 $315.48 1/1/2014 0.00 $315.48 1/1/2014
4 RADIOLOGY 74181 21 999 Years 11.24 $26.7305 $300.45 1/1/2014 0.00 $300.45 11.24 $26.7305 $300.45 1/1/2014 0.00 $300.45 1/1/2014
I
PROFESSIONAL
COMPONENT 74181 0 20 Years 2.06 $28.0672 $57.82 1/1/2014 0.00 $57.82 2.06 $28.0672 $57.82 1/1/2014 0.00 $57.82 1/1/2014
I
PROFESSIONAL
COMPONENT 74181 21 999 Years 2.06 $26.7305 $55.06 1/1/2014 0.00 $55.06 2.06 $26.7305 $55.06 1/1/2014 0.00 $55.06 1/1/2014
T
TECHNICAL
COMPONENT 74181 0 20 Years 9.18 $28.0672 $257.66 1/1/2014 0.00 $257.66 9.18 $28.0672 $257.66 1/1/2014 0.00 $257.66 1/1/2014
T
TECHNICAL
COMPONENT 74181 21 999 Years 9.18 $26.7305 $245.39 1/1/2014 0.00 $245.39 9.18 $26.7305 $245.39 1/1/2014 0.00 $245.39 1/1/2014
4 RADIOLOGY 74182 0 20 Years 15.52 $28.0672 $435.60 1/1/2014 0.00 $435.60 15.52 $28.0672 $435.60 1/1/2014 0.00 $435.60 1/1/2014
4 RADIOLOGY 74182 21 999 Years 15.52 $26.7305 $414.86 1/1/2014 0.00 $414.86 15.52 $26.7305 $414.86 1/1/2014 0.00 $414.86 1/1/2014
I
PROFESSIONAL
COMPONENT 74182 0 20 Years 2.45 $28.0672 $68.76 1/1/2014 0.00 $68.76 2.45 $28.0672 $68.76 1/1/2014 0.00 $68.76 1/1/2014
I
PROFESSIONAL
COMPONENT 74182 21 999 Years 2.45 $26.7305 $65.49 1/1/2014 0.00 $65.49 2.45 $26.7305 $65.49 1/1/2014 0.00 $65.49 1/1/2014
T
TECHNICAL
COMPONENT 74182 0 20 Years 13.07 $28.0672 $366.84 1/1/2014 0.00 $366.84 13.07 $28.0672 $366.84 1/1/2014 0.00 $366.84 1/1/2014
T
TECHNICAL
COMPONENT 74182 21 999 Years 13.07 $26.7305 $349.37 1/1/2014 0.00 $349.37 13.07 $26.7305 $349.37 1/1/2014 0.00 $349.37 1/1/2014
4 RADIOLOGY 74183 0 20 Years 17.28 $28.0672 $485.00 1/1/2014 0.00 $485.00 17.28 $28.0672 $485.00 1/1/2014 0.00 $485.00 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 74183 21 999 Years 17.28 $26.7305 $461.90 1/1/2014 0.00 $461.90 17.28 $26.7305 $461.90 1/1/2014 0.00 $461.90 1/1/2014
I
PROFESSIONAL
COMPONENT 74183 0 20 Years 3.19 $28.0672 $89.53 1/1/2014 0.00 $89.53 3.19 $28.0672 $89.53 1/1/2014 0.00 $89.53 1/1/2014
I
PROFESSIONAL
COMPONENT 74183 21 999 Years 3.19 $26.7305 $85.27 1/1/2014 0.00 $85.27 3.19 $26.7305 $85.27 1/1/2014 0.00 $85.27 1/1/2014
T
TECHNICAL
COMPONENT 74183 0 20 Years 14.09 $28.0672 $395.47 1/1/2014 0.00 $395.47 14.09 $28.0672 $395.47 1/1/2014 0.00 $395.47 1/1/2014
T
TECHNICAL
COMPONENT 74183 21 999 Years 14.09 $26.7305 $376.63 1/1/2014 0.00 $376.63 14.09 $26.7305 $376.63 1/1/2014 0.00 $376.63 1/1/2014
4 RADIOLOGY 74185 0 20 Years 13.95 $28.0672 $391.54 1/1/2014 0.00 $391.54 13.95 $28.0672 $391.54 1/1/2014 0.00 $391.54 1/1/2014
4 RADIOLOGY 74185 21 999 Years 13.95 $26.7305 $372.89 1/1/2014 0.00 $372.89 13.95 $26.7305 $372.89 1/1/2014 0.00 $372.89 1/1/2014
I
PROFESSIONAL
COMPONENT 74185 0 20 Years 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 2.54 $28.0672 $71.29 1/1/2014 0.00 $71.29 1/1/2014
I
PROFESSIONAL
COMPONENT 74185 21 999 Years 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 2.54 $26.7305 $67.90 1/1/2014 0.00 $67.90 1/1/2014
T
TECHNICAL
COMPONENT 74185 0 20 Years 11.41 $28.0672 $320.25 1/1/2014 0.00 $320.25 11.41 $28.0672 $320.25 1/1/2014 0.00 $320.25 1/1/2014
T
TECHNICAL
COMPONENT 74185 21 999 Years 11.41 $26.7305 $305.00 1/1/2014 0.00 $305.00 11.41 $26.7305 $305.00 1/1/2014 0.00 $305.00 1/1/2014
4 RADIOLOGY 74190 0 20 Years 0.00 $0.0000 $65.45 1/1/2014 0.00 $65.45 9 1/1/2014
4 RADIOLOGY 74190 21 999 Years 0.00 $0.0000 $62.33 1/1/2014 0.00 $62.33 9 1/1/2014
T
TECHNICAL
COMPONENT 74190 0 20 Years 0.00 $0.0000 $46.08 1/1/2014 0.00 $46.08 9 1/1/2014
T
TECHNICAL
COMPONENT 74190 21 999 Years 0.00 $0.0000 $43.89 1/1/2014 0.00 $43.89 9 1/1/2014
4 RADIOLOGY 74210 0 20 Years 2.36 $28.0672 $66.24 1/1/2014 0.00 $66.24 9 1/1/2014
4 RADIOLOGY 74210 21 999 Years 2.36 $26.7305 $63.08 1/1/2014 0.00 $63.08 9 1/1/2014
T
TECHNICAL
COMPONENT 74210 0 20 Years 1.86 $28.0672 $52.20 1/1/2014 0.00 $52.20 9 1/1/2014
T
TECHNICAL
COMPONENT 74210 21 999 Years 1.86 $26.7305 $49.72 1/1/2014 0.00 $49.72 9 1/1/2014
4 RADIOLOGY 74220 0 20 Years 2.76 $28.0672 $77.47 1/1/2014 0.00 $77.47 9 1/1/2014
4 RADIOLOGY 74220 21 999 Years 2.76 $26.7305 $73.78 1/1/2014 0.00 $73.78 9 1/1/2014
T
TECHNICAL
COMPONENT 74220 0 20 Years 2.10 $28.0672 $58.94 1/1/2014 0.00 $58.94 9 1/1/2014
T
TECHNICAL
COMPONENT 74220 21 999 Years 2.10 $26.7305 $56.13 1/1/2014 0.00 $56.13 9 1/1/2014
4 RADIOLOGY 74230 0 20 Years 2.74 $28.0672 $76.90 1/1/2014 0.00 $76.90 9 1/1/2014
4 RADIOLOGY 74230 21 999 Years 2.74 $26.7305 $73.24 1/1/2014 0.00 $73.24 9 1/1/2014
T
TECHNICAL
COMPONENT 74230 0 20 Years 1.99 $28.0672 $55.85 1/1/2014 0.00 $55.85 9 1/1/2014
T
TECHNICAL
COMPONENT 74230 21 999 Years 1.99 $26.7305 $53.19 1/1/2014 0.00 $53.19 9 1/1/2014
4 RADIOLOGY 74235 0 20 Years 0.00 $0.0000 $129.35 1/1/2014 0.00 $129.35 9 1/1/2014
4 RADIOLOGY 74235 21 999 Years 0.00 $0.0000 $123.19 1/1/2014 0.00 $123.19 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 74235 0 20 Years 0.00 $0.0000 $75.46 1/1/2014 0.00 $75.46 9 1/1/2014
T
TECHNICAL
COMPONENT 74235 21 999 Years 0.00 $0.0000 $71.87 1/1/2014 0.00 $71.87 9 1/1/2014
4 RADIOLOGY 74240 0 20 Years 3.44 $28.0672 $96.55 1/1/2014 0.00 $96.55 9 1/1/2014
4 RADIOLOGY 74240 21 999 Years 3.44 $26.7305 $91.95 1/1/2014 0.00 $91.95 9 1/1/2014
T
TECHNICAL
COMPONENT 74240 0 20 Years 2.45 $28.0672 $68.76 1/1/2014 0.00 $68.76 9 1/1/2014
T
TECHNICAL
COMPONENT 74240 21 999 Years 2.45 $26.7305 $65.49 1/1/2014 0.00 $65.49 9 1/1/2014
4 RADIOLOGY 74241 0 20 Years 3.60 $28.0672 $101.04 1/1/2014 0.00 $101.04 9 1/1/2014
4 RADIOLOGY 74241 21 999 Years 3.60 $26.7305 $96.23 1/1/2014 0.00 $96.23 9 1/1/2014
T
TECHNICAL
COMPONENT 74241 0 20 Years 2.63 $28.0672 $73.82 1/1/2014 0.00 $73.82 9 1/1/2014
T
TECHNICAL
COMPONENT 74241 21 999 Years 2.63 $26.7305 $70.30 1/1/2014 0.00 $70.30 9 1/1/2014
4 RADIOLOGY 74245 0 20 Years 5.37 $28.0672 $150.72 1/1/2014 0.00 $150.72 9 1/1/2014
4 RADIOLOGY 74245 21 999 Years 5.37 $26.7305 $143.54 1/1/2014 0.00 $143.54 9 1/1/2014
T
TECHNICAL
COMPONENT 74245 0 20 Years 4.08 $28.0672 $114.51 1/1/2014 0.00 $114.51 9 1/1/2014
T
TECHNICAL
COMPONENT 74245 21 999 Years 4.08 $26.7305 $109.06 1/1/2014 0.00 $109.06 9 1/1/2014
4 RADIOLOGY 74246 0 20 Years 3.88 $28.0672 $108.90 1/1/2014 0.00 $108.90 9 1/1/2014
4 RADIOLOGY 74246 21 999 Years 3.88 $26.7305 $103.71 1/1/2014 0.00 $103.71 9 1/1/2014
T
TECHNICAL
COMPONENT 74246 0 20 Years 2.90 $28.0672 $81.39 1/1/2014 0.00 $81.39 9 1/1/2014
T
TECHNICAL
COMPONENT 74246 21 999 Years 2.90 $26.7305 $77.52 1/1/2014 0.00 $77.52 9 1/1/2014
4 RADIOLOGY 74247 0 20 Years 4.32 $28.0672 $121.25 1/1/2014 0.00 $121.25 9 1/1/2014
4 RADIOLOGY 74247 21 999 Years 4.32 $26.7305 $115.48 1/1/2014 0.00 $115.48 9 1/1/2014
T
TECHNICAL
COMPONENT 74247 0 20 Years 3.34 $28.0672 $93.74 1/1/2014 0.00 $93.74 9 1/1/2014
T
TECHNICAL
COMPONENT 74247 21 999 Years 3.34 $26.7305 $89.28 1/1/2014 0.00 $89.28 9 1/1/2014
4 RADIOLOGY 74249 0 20 Years 5.80 $28.0672 $162.79 1/1/2014 0.00 $162.79 9 1/1/2014
4 RADIOLOGY 74249 21 999 Years 5.80 $26.7305 $155.04 1/1/2014 0.00 $155.04 9 1/1/2014
T
TECHNICAL
COMPONENT 74249 0 20 Years 4.51 $28.0672 $126.58 1/1/2014 0.00 $126.58 9 1/1/2014
T
TECHNICAL
COMPONENT 74249 21 999 Years 4.51 $26.7305 $120.55 1/1/2014 0.00 $120.55 9 1/1/2014
4 RADIOLOGY 74250 0 20 Years 3.28 $28.0672 $92.06 1/1/2014 0.00 $92.06 9 1/1/2014
4 RADIOLOGY 74250 21 999 Years 3.28 $26.7305 $87.68 1/1/2014 0.00 $87.68 9 1/1/2014
T
TECHNICAL
COMPONENT 74250 0 20 Years 2.61 $28.0672 $73.26 1/1/2014 0.00 $73.26 9 1/1/2014
T
TECHNICAL
COMPONENT 74250 21 999 Years 2.61 $26.7305 $69.77 1/1/2014 0.00 $69.77 9 1/1/2014
4 RADIOLOGY 74251 0 20 Years 12.67 $28.0672 $355.61 1/1/2014 0.00 $355.61 9 1/1/2014
4 RADIOLOGY 74251 21 999 Years 12.67 $26.7305 $338.68 1/1/2014 0.00 $338.68 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 74251 0 20 Years 11.69 $28.0672 $328.11 1/1/2014 0.00 $328.11 9 1/1/2014
T
TECHNICAL
COMPONENT 74251 21 999 Years 11.69 $26.7305 $312.48 1/1/2014 0.00 $312.48 9 1/1/2014
4 RADIOLOGY 74260 0 20 Years 10.44 $28.0672 $293.02 1/1/2014 0.00 $293.02 9 1/1/2014
4 RADIOLOGY 74260 21 999 Years 10.44 $26.7305 $279.07 1/1/2014 0.00 $279.07 9 1/1/2014
T
TECHNICAL
COMPONENT 74260 0 20 Years 9.73 $28.0672 $273.09 1/1/2014 0.00 $273.09 9 1/1/2014
T
TECHNICAL
COMPONENT 74260 21 999 Years 9.73 $26.7305 $260.09 1/1/2014 0.00 $260.09 9 1/1/2014
4 RADIOLOGY 74261 0 20 Years 15.94 $28.0672 $447.39 1/1/2014 0.00 $447.39 1/1/2014
4 RADIOLOGY 74261 21 999 Years 15.94 $26.7305 $426.08 1/1/2014 0.00 $426.08 1/1/2014
T
TECHNICAL
COMPONENT 74261 0 20 Years 12.54 $28.0672 $351.96 1/1/2014 0.00 $351.96 1/1/2014
T
TECHNICAL
COMPONENT 74261 21 999 Years 12.54 $26.7305 $335.20 1/1/2014 0.00 $335.20 1/1/2014
4 RADIOLOGY 74262 0 20 Years 17.58 $28.0672 $493.42 1/1/2014 0.00 $493.42 1/1/2014
4 RADIOLOGY 74262 21 999 Years 17.58 $26.7305 $469.92 1/1/2014 0.00 $469.92 1/1/2014
T
TECHNICAL
COMPONENT 74262 0 20 Years 14.05 $28.0672 $394.34 1/1/2014 0.00 $394.34 1/1/2014
T
TECHNICAL
COMPONENT 74262 21 999 Years 14.05 $26.7305 $375.56 1/1/2014 0.00 $375.56 1/1/2014
4 RADIOLOGY 74263 0 20 Years 23.13 $28.0672 $649.19 1/1/2014 0.00 $649.19 1/1/2014
4 RADIOLOGY 74263 21 999 Years 23.13 $26.7305 $618.28 1/1/2014 0.00 $618.28 1/1/2014
T
TECHNICAL
COMPONENT 74263 0 20 Years 19.81 $28.0672 $556.01 1/1/2014 0.00 $556.01 1/1/2014
T
TECHNICAL
COMPONENT 74263 21 999 Years 19.81 $26.7305 $529.53 1/1/2014 0.00 $529.53 1/1/2014
4 RADIOLOGY 74270 0 20 Years 4.76 $28.0672 $133.60 1/1/2014 0.00 $133.60 9 1/1/2014
4 RADIOLOGY 74270 21 999 Years 4.76 $26.7305 $127.24 1/1/2014 0.00 $127.24 9 1/1/2014
T
TECHNICAL
COMPONENT 74270 0 20 Years 3.78 $28.0672 $106.09 1/1/2014 0.00 $106.09 9 1/1/2014
T
TECHNICAL
COMPONENT 74270 21 999 Years 3.78 $26.7305 $101.04 1/1/2014 0.00 $101.04 9 1/1/2014
4 RADIOLOGY 74280 0 20 Years 6.65 $28.0672 $186.65 1/1/2014 0.00 $186.65 9 1/1/2014
4 RADIOLOGY 74280 21 999 Years 6.65 $26.7305 $177.76 1/1/2014 0.00 $177.76 9 1/1/2014
T
TECHNICAL
COMPONENT 74280 0 20 Years 5.25 $28.0672 $147.35 1/1/2014 0.00 $147.35 9 1/1/2014
T
TECHNICAL
COMPONENT 74280 21 999 Years 5.25 $26.7305 $140.34 1/1/2014 0.00 $140.34 9 1/1/2014
4 RADIOLOGY 74283 0 20 Years 6.01 $28.0672 $168.68 1/1/2014 0.00 $168.68 9 1/1/2014
4 RADIOLOGY 74283 21 999 Years 6.01 $26.7305 $160.65 1/1/2014 0.00 $160.65 9 1/1/2014
T
TECHNICAL
COMPONENT 74283 0 20 Years 3.20 $28.0672 $89.82 1/1/2014 0.00 $89.82 9 1/1/2014
T
TECHNICAL
COMPONENT 74283 21 999 Years 3.20 $26.7305 $85.54 1/1/2014 0.00 $85.54 9 1/1/2014
4 RADIOLOGY 74290 0 20 Years 2.11 $28.0672 $59.22 1/1/2014 0.00 $59.22 9 1/1/2014
4 RADIOLOGY 74290 21 999 Years 2.11 $26.7305 $56.40 1/1/2014 0.00 $56.40 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 74290 0 20 Years 1.66 $28.0672 $46.59 1/1/2014 0.00 $46.59 9 1/1/2014
T
TECHNICAL
COMPONENT 74290 21 999 Years 1.66 $26.7305 $44.37 1/1/2014 0.00 $44.37 9 1/1/2014
4 RADIOLOGY 74300 0 20 Years 0.00 $0.0000 $37.58 1/1/2014 0.00 $37.58 1/1/2014
4 RADIOLOGY 74300 21 999 Years 0.00 $0.0000 $35.79 1/1/2014 0.00 $35.79 1/1/2014
T
TECHNICAL
COMPONENT 74300 0 20 Years 0.00 $0.0000 $22.99 1/1/2014 0.00 $22.99 9 1/1/2014
T
TECHNICAL
COMPONENT 74300 21 999 Years 0.00 $0.0000 $21.89 1/1/2014 0.00 $21.89 9 1/1/2014
4 RADIOLOGY 74301 0 20 Years 0.00 $0.0000 $22.11 1/1/2014 0.00 $22.11 9 1/1/2014
4 RADIOLOGY 74301 21 999 Years 0.00 $0.0000 $21.06 1/1/2014 0.00 $21.06 9 1/1/2014
T
TECHNICAL
COMPONENT 74301 0 20 Years 0.00 $0.0000 $13.41 1/1/2014 0.00 $13.41 9 1/1/2014
T
TECHNICAL
COMPONENT 74301 21 999 Years 0.00 $0.0000 $12.77 1/1/2014 0.00 $12.77 9 1/1/2014
4 RADIOLOGY 74328 0 20 Years 0.00 $0.0000 $140.17 1/1/2014 0.00 $140.17 9 1/1/2014
4 RADIOLOGY 74328 21 999 Years 0.00 $0.0000 $133.49 1/1/2014 0.00 $133.49 9 1/1/2014
T
TECHNICAL
COMPONENT 74328 0 20 Years 0.00 $0.0000 $111.26 1/1/2014 0.00 $111.26 9 1/1/2014
T
TECHNICAL
COMPONENT 74328 21 999 Years 0.00 $0.0000 $105.96 1/1/2014 0.00 $105.96 9 1/1/2014
4 RADIOLOGY 74329 0 20 Years 0.00 $0.0000 $140.17 1/1/2014 0.00 $140.17 9 1/1/2014
4 RADIOLOGY 74329 21 999 Years 0.00 $0.0000 $133.49 1/1/2014 0.00 $133.49 9 1/1/2014
T
TECHNICAL
COMPONENT 74329 0 20 Years 0.00 $0.0000 $110.98 1/1/2014 0.00 $110.98 9 1/1/2014
T
TECHNICAL
COMPONENT 74329 21 999 Years 0.00 $0.0000 $105.69 1/1/2014 0.00 $105.69 9 1/1/2014
4 RADIOLOGY 74330 0 20 Years 0.00 $0.0000 $148.29 1/1/2014 0.00 $148.29 9 1/1/2014
4 RADIOLOGY 74330 21 999 Years 0.00 $0.0000 $141.23 1/1/2014 0.00 $141.23 9 1/1/2014
T
TECHNICAL
COMPONENT 74330 0 20 Years 0.00 $0.0000 $111.24 1/1/2014 0.00 $111.24 9 1/1/2014
T
TECHNICAL
COMPONENT 74330 21 999 Years 0.00 $0.0000 $105.95 1/1/2014 0.00 $105.95 1/1/2014
4 RADIOLOGY 74340 0 20 Years 0.00 $0.0000 $114.40 1/1/2014 0.00 $114.40 9 1/1/2014
4 RADIOLOGY 74340 21 999 Years 0.00 $0.0000 $108.96 1/1/2014 0.00 $108.96 9 1/1/2014
T
TECHNICAL
COMPONENT 74340 0 20 Years 0.00 $0.0000 $92.51 1/1/2014 0.00 $92.51 9 1/1/2014
T
TECHNICAL
COMPONENT 74340 21 999 Years 0.00 $0.0000 $88.11 1/1/2014 0.00 $88.11 9 1/1/2014
4 RADIOLOGY 74360 0 20 Years 0.00 $0.0000 $134.54 1/1/2014 0.00 $134.54 9 1/1/2014
4 RADIOLOGY 74360 21 999 Years 0.00 $0.0000 $128.13 1/1/2014 0.00 $128.13 9 1/1/2014
T
TECHNICAL
COMPONENT 74360 0 20 Years 0.00 $0.0000 $111.24 1/1/2014 0.00 $111.24 9 1/1/2014
T
TECHNICAL
COMPONENT 74360 21 999 Years 0.00 $0.0000 $105.94 1/1/2014 0.00 $105.94 9 1/1/2014
4 RADIOLOGY 74363 0 20 Years 0.00 $0.0000 $90.70 1/1/2014 0.00 $90.70 9 1/1/2014
4 RADIOLOGY 74363 21 999 Years 0.00 $0.0000 $86.38 1/1/2014 0.00 $86.38 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 74363 0 20 Years 0.00 $0.0000 $55.34 1/1/2014 0.00 $55.34 9 1/1/2014
T
TECHNICAL
COMPONENT 74363 21 999 Years 0.00 $0.0000 $52.70 1/1/2014 0.00 $52.70 9 1/1/2014
4 RADIOLOGY 74400 0 20 Years 3.41 $28.0672 $95.71 1/1/2014 0.00 $95.71 9 1/1/2014
4 RADIOLOGY 74400 21 999 Years 3.41 $26.7305 $91.15 1/1/2014 0.00 $91.15 9 1/1/2014
T
TECHNICAL
COMPONENT 74400 0 20 Years 2.71 $28.0672 $76.06 1/1/2014 0.00 $76.06 9 1/1/2014
T
TECHNICAL
COMPONENT 74400 21 999 Years 2.71 $26.7305 $72.44 1/1/2014 0.00 $72.44 9 1/1/2014
4 RADIOLOGY 74410 0 20 Years 3.37 $28.0672 $94.59 1/1/2014 0.00 $94.59 9 1/1/2014
4 RADIOLOGY 74410 21 999 Years 3.37 $26.7305 $90.08 1/1/2014 0.00 $90.08 9 1/1/2014
T
TECHNICAL
COMPONENT 74410 0 20 Years 2.68 $28.0672 $75.22 1/1/2014 0.00 $75.22 9 1/1/2014
T
TECHNICAL
COMPONENT 74410 21 999 Years 2.68 $26.7305 $71.64 1/1/2014 0.00 $71.64 9 1/1/2014
4 RADIOLOGY 74415 0 20 Years 4.18 $28.0672 $117.32 1/1/2014 0.00 $117.32 9 1/1/2014
4 RADIOLOGY 74415 21 999 Years 4.18 $26.7305 $111.73 1/1/2014 0.00 $111.73 9 1/1/2014
T
TECHNICAL
COMPONENT 74415 0 20 Years 3.48 $28.0672 $97.67 1/1/2014 0.00 $97.67 9 1/1/2014
T
TECHNICAL
COMPONENT 74415 21 999 Years 3.48 $26.7305 $93.02 1/1/2014 0.00 $93.02 9 1/1/2014
4 RADIOLOGY 74425 0 20 Years 0.00 $0.0000 $60.39 1/1/2014 0.00 $60.39 9 1/1/2014
4 RADIOLOGY 74425 21 999 Years 0.00 $0.0000 $57.51 1/1/2014 0.00 $57.51 9 1/1/2014
T
TECHNICAL
COMPONENT 74425 0 20 Years 0.00 $0.0000 $46.08 1/1/2014 0.00 $46.08 9 1/1/2014
T
TECHNICAL
COMPONENT 74425 21 999 Years 0.00 $0.0000 $43.88 1/1/2014 0.00 $43.88 9 1/1/2014
4 RADIOLOGY 74430 0 20 Years 1.22 $28.0672 $34.24 1/1/2014 0.00 $34.24 9 1/1/2014
4 RADIOLOGY 74430 21 999 Years 1.22 $26.7305 $32.61 1/1/2014 0.00 $32.61 9 1/1/2014
T
TECHNICAL
COMPONENT 74430 0 20 Years 0.78 $28.0672 $21.89 1/1/2014 0.00 $21.89 9 1/1/2014
T
TECHNICAL
COMPONENT 74430 21 999 Years 0.78 $26.7305 $20.85 1/1/2014 0.00 $20.85 9 1/1/2014
4 RADIOLOGY 74440 0 20 Years 2.53 $28.0672 $71.01 1/1/2014 0.00 $71.01 9 1/1/2014
4 RADIOLOGY 74440 21 999 Years 2.53 $26.7305 $67.63 1/1/2014 0.00 $67.63 9 1/1/2014
T
TECHNICAL
COMPONENT 74440 0 20 Years 1.98 $28.0672 $55.57 1/1/2014 0.00 $55.57 9 1/1/2014
T
TECHNICAL
COMPONENT 74440 21 999 Years 1.98 $26.7305 $52.93 1/1/2014 0.00 $52.93 9 1/1/2014
4 RADIOLOGY 74445 0 20 Years 0.00 $0.0000 $85.76 1/1/2014 0.00 $85.76 9 1/1/2014
4 RADIOLOGY 74445 21 999 Years 0.00 $0.0000 $81.68 1/1/2014 0.00 $81.68 9 1/1/2014
T
TECHNICAL
COMPONENT 74445 0 20 Years 0.00 $0.0000 $39.73 1/1/2014 0.00 $39.73 9 1/1/2014
T
TECHNICAL
COMPONENT 74445 21 999 Years 0.00 $0.0000 $37.84 1/1/2014 0.00 $37.84 9 1/1/2014
4 RADIOLOGY 74450 0 20 Years 0.00 $0.0000 $64.90 1/1/2014 0.00 $64.90 9 1/1/2014
4 RADIOLOGY 74450 21 999 Years 0.00 $0.0000 $61.81 1/1/2014 0.00 $61.81 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 74450 0 20 Years 0.00 $0.0000 $51.43 1/1/2014 0.00 $51.43 9 1/1/2014
T
TECHNICAL
COMPONENT 74450 21 999 Years 0.00 $0.0000 $48.98 1/1/2014 0.00 $48.98 9 1/1/2014
4 RADIOLOGY 74455 0 20 Years 2.55 $28.0672 $71.57 1/1/2014 0.00 $71.57 9 1/1/2014
4 RADIOLOGY 74455 21 999 Years 2.55 $26.7305 $68.16 1/1/2014 0.00 $68.16 9 1/1/2014
T
TECHNICAL
COMPONENT 74455 0 20 Years 2.09 $28.0672 $58.66 1/1/2014 0.00 $58.66 9 1/1/2014
T
TECHNICAL
COMPONENT 74455 21 999 Years 2.09 $26.7305 $55.87 1/1/2014 0.00 $55.87 9 1/1/2014
4 RADIOLOGY 74470 0 20 Years 0.00 $0.0000 $65.76 1/1/2014 0.00 $65.76 9 1/1/2014
4 RADIOLOGY 74470 21 999 Years 0.00 $0.0000 $62.62 1/1/2014 0.00 $62.62 9 1/1/2014
T
TECHNICAL
COMPONENT 74470 0 20 Years 0.00 $0.0000 $44.15 1/1/2014 0.00 $44.15 1/1/2014
T
TECHNICAL
COMPONENT 74470 21 999 Years 0.00 $0.0000 $42.04 1/1/2014 0.00 $42.04 1/1/2014
4 RADIOLOGY 74485 0 20 Years 2.93 $28.0672 $82.24 1/1/2014 0.00 $82.24 9 1/1/2014
4 RADIOLOGY 74485 21 999 Years 2.93 $26.7305 $78.32 1/1/2014 0.00 $78.32 9 1/1/2014
T
TECHNICAL
COMPONENT 74485 0 20 Years 2.17 $28.0672 $60.91 1/1/2014 0.00 $60.91 9 1/1/2014
T
TECHNICAL
COMPONENT 74485 21 999 Years 2.17 $26.7305 $58.01 1/1/2014 0.00 $58.01 9 1/1/2014
4 RADIOLOGY 74710 0 20 Years 0.99 $28.0672 $27.79 1/1/2014 0.00 $27.79 9 1/1/2014
4 RADIOLOGY 74710 21 999 Years 0.99 $26.7305 $26.46 1/1/2014 0.00 $26.46 9 1/1/2014
T
TECHNICAL
COMPONENT 74710 0 20 Years 0.55 $28.0672 $15.44 1/1/2014 0.00 $15.44 9 1/1/2014
T
TECHNICAL
COMPONENT 74710 21 999 Years 0.55 $26.7305 $14.70 1/1/2014 0.00 $14.70 9 1/1/2014
4 RADIOLOGY 74740 0 20 Years 2.11 $28.0672 $59.22 1/1/2016 0.00 $59.22 1/1/2016
4 RADIOLOGY 74740 21 999 Years 2.11 $26.7305 $56.40 1/1/2016 0.00 $56.40 1/1/2016
T
TECHNICAL
COMPONENT 74740 0 20 Years 1.56 $28.0672 $43.78 1/1/2016 0.00 $43.78 1/1/2016
T
TECHNICAL
COMPONENT 74740 21 999 Years 1.56 $26.7305 $41.70 1/1/2016 0.00 $41.70 1/1/2016
T
TECHNICAL
COMPONENT 74775 0 20 Years 0.00 $0.0000 $51.46 1/1/2014 0.00 $51.46 1/1/2014
4 RADIOLOGY 75557 0 20 Years 10.78 $28.0672 $302.56 1/1/2014 0.00 $302.56 10.78 $28.0672 $302.56 1/1/2014 0.00 $302.56 1/1/2014
4 RADIOLOGY 75557 21 999 Years 10.78 $26.7305 $288.15 1/1/2014 0.00 $288.15 10.78 $26.7305 $288.15 1/1/2014 0.00 $288.15 1/1/2014
I
PROFESSIONAL
COMPONENT 75557 0 20 Years 3.31 $28.0672 $92.90 1/1/2014 0.00 $92.90 3.31 $28.0672 $92.90 1/1/2014 0.00 $92.90 1/1/2014
I
PROFESSIONAL
COMPONENT 75557 21 999 Years 3.31 $26.7305 $88.48 1/1/2014 0.00 $88.48 3.31 $26.7305 $88.48 1/1/2014 0.00 $88.48 1/1/2014
T
TECHNICAL
COMPONENT 75557 0 20 Years 7.47 $28.0672 $209.66 1/1/2014 0.00 $209.66 7.47 $28.0672 $209.66 1/1/2014 0.00 $209.66 1/1/2014
T
TECHNICAL
COMPONENT 75557 21 999 Years 7.47 $26.7305 $199.68 1/1/2014 0.00 $199.68 7.47 $26.7305 $199.68 1/1/2014 0.00 $199.68 1/1/2014
4 RADIOLOGY 75559 0 20 Years 14.76 $28.0672 $414.27 1/1/2014 0.00 $414.27 14.76 $28.0672 $414.27 1/1/2014 0.00 $414.27 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 75559 21 999 Years 14.76 $26.7305 $394.54 1/1/2014 0.00 $394.54 14.76 $26.7305 $394.54 1/1/2014 0.00 $394.54 1/1/2014
I
PROFESSIONAL
COMPONENT 75559 0 20 Years 4.14 $28.0672 $116.20 1/1/2014 0.00 $116.20 4.14 $28.0672 $116.20 1/1/2014 0.00 $116.20 1/1/2014
I
PROFESSIONAL
COMPONENT 75559 21 999 Years 4.14 $26.7305 $110.66 1/1/2014 0.00 $110.66 4.14 $26.7305 $110.66 1/1/2014 0.00 $110.66 1/1/2014
T
TECHNICAL
COMPONENT 75559 0 20 Years 10.62 $28.0672 $298.07 1/1/2014 0.00 $298.07 10.62 $28.0672 $298.07 1/1/2014 0.00 $298.07 1/1/2014
T
TECHNICAL
COMPONENT 75559 21 999 Years 10.62 $26.7305 $283.88 1/1/2014 0.00 $283.88 10.62 $26.7305 $283.88 1/1/2014 0.00 $283.88 1/1/2014
4 RADIOLOGY 75561 0 20 Years 14.39 $28.0672 $403.89 1/1/2014 0.00 $403.89 14.39 $28.0672 $403.89 1/1/2014 0.00 $403.89 1/1/2014
4 RADIOLOGY 75561 21 999 Years 14.39 $26.7305 $384.65 1/1/2014 0.00 $384.65 14.39 $26.7305 $384.65 1/1/2014 0.00 $384.65 1/1/2014
I
PROFESSIONAL
COMPONENT 75561 0 20 Years 3.65 $28.0672 $102.45 1/1/2014 0.00 $102.45 3.65 $28.0672 $102.45 1/1/2014 0.00 $102.45 1/1/2014
I
PROFESSIONAL
COMPONENT 75561 21 999 Years 3.65 $26.7305 $97.57 1/1/2014 0.00 $97.57 3.65 $26.7305 $97.57 1/1/2014 0.00 $97.57 1/1/2014
T
TECHNICAL
COMPONENT 75561 0 20 Years 10.74 $28.0672 $301.44 1/1/2014 0.00 $301.44 10.74 $28.0672 $301.44 1/1/2014 0.00 $301.44 1/1/2014
T
TECHNICAL
COMPONENT 75561 21 999 Years 10.74 $26.7305 $287.09 1/1/2014 0.00 $287.09 10.74 $26.7305 $287.09 1/1/2014 0.00 $287.09 1/1/2014
4 RADIOLOGY 75563 0 20 Years 17.00 $28.0672 $477.14 1/1/2014 0.00 $477.14 17.00 $28.0672 $477.14 1/1/2014 0.00 $477.14 1/1/2014
4 RADIOLOGY 75563 21 999 Years 17.00 $26.7305 $454.42 1/1/2014 0.00 $454.42 17.00 $26.7305 $454.42 1/1/2014 0.00 $454.42 1/1/2014
I
PROFESSIONAL
COMPONENT 75563 0 20 Years 4.20 $28.0672 $117.88 1/1/2014 0.00 $117.88 4.20 $28.0672 $117.88 1/1/2014 0.00 $117.88 1/1/2014
I
PROFESSIONAL
COMPONENT 75563 21 999 Years 4.20 $26.7305 $112.27 1/1/2014 0.00 $112.27 4.20 $26.7305 $112.27 1/1/2014 0.00 $112.27 1/1/2014
T
TECHNICAL
COMPONENT 75563 0 20 Years 12.80 $28.0672 $359.26 1/1/2014 0.00 $359.26 12.80 $28.0672 $359.26 1/1/2014 0.00 $359.26 1/1/2014
T
TECHNICAL
COMPONENT 75563 21 999 Years 12.80 $26.7305 $342.15 1/1/2014 0.00 $342.15 12.80 $26.7305 $342.15 1/1/2014 0.00 $342.15 1/1/2014
4 RADIOLOGY 75565 0 20 Years 1.88 $28.0672 $52.77 1/1/2014 0.00 $52.77 1.88 $28.0672 $52.77 1/1/2014 0.00 $52.77 1/1/2014
4 RADIOLOGY 75565 21 999 Years 1.88 $26.7305 $50.25 1/1/2014 0.00 $50.25 1.88 $26.7305 $50.25 1/1/2014 0.00 $50.25 1/1/2014
I
PROFESSIONAL
COMPONENT 75565 0 20 Years 0.35 $28.0672 $9.82 1/1/2014 0.00 $9.82 0.35 $28.0672 $9.82 1/1/2014 0.00 $9.82 1/1/2014
I
PROFESSIONAL
COMPONENT 75565 21 999 Years 0.35 $26.7305 $9.36 1/1/2014 0.00 $9.36 0.35 $26.7305 $9.36 1/1/2014 0.00 $9.36 1/1/2014
T
TECHNICAL
COMPONENT 75565 0 20 Years 1.53 $28.0672 $42.94 1/1/2014 0.00 $42.94 1.53 $28.0672 $42.94 1/1/2014 0.00 $42.94 1/1/2014
T
TECHNICAL
COMPONENT 75565 21 999 Years 1.53 $26.7305 $40.90 1/1/2014 0.00 $40.90 1.53 $26.7305 $40.90 1/1/2014 0.00 $40.90 1/1/2014
4 RADIOLOGY 75571 0 20 Years 3.36 $28.0672 $94.31 1/1/2014 0.00 $94.31 3.36 $28.0672 $94.31 1/1/2014 0.00 $94.31 1/1/2014
4 RADIOLOGY 75571 21 999 Years 3.36 $26.7305 $89.81 1/1/2014 0.00 $89.81 3.36 $26.7305 $89.81 1/1/2014 0.00 $89.81 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 75571 0 20 Years 0.80 $28.0672 $22.45 1/1/2014 0.00 $22.45 0.80 $28.0672 $22.45 1/1/2014 0.00 $22.45 1/1/2014
I
PROFESSIONAL
COMPONENT 75571 21 999 Years 0.80 $26.7305 $21.38 1/1/2014 0.00 $21.38 0.80 $26.7305 $21.38 1/1/2014 0.00 $21.38 1/1/2014
T
TECHNICAL
COMPONENT 75571 0 20 Years 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 2.56 $28.0672 $71.85 1/1/2014 0.00 $71.85 1/1/2014
T
TECHNICAL
COMPONENT 75571 21 999 Years 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 2.56 $26.7305 $68.43 1/1/2014 0.00 $68.43 1/1/2014
4 RADIOLOGY 75572 0 20 Years 9.22 $28.0672 $258.78 1/1/2014 0.00 $258.78 9.22 $28.0672 $258.78 1/1/2014 0.00 $258.78 1/1/2014
4 RADIOLOGY 75572 21 999 Years 9.22 $26.7305 $246.46 1/1/2014 0.00 $246.46 9.22 $26.7305 $246.46 1/1/2014 0.00 $246.46 1/1/2014
I
PROFESSIONAL
COMPONENT 75572 0 20 Years 2.44 $28.0672 $68.48 1/1/2014 0.00 $68.48 2.44 $28.0672 $68.48 1/1/2014 0.00 $68.48 1/1/2014
I
PROFESSIONAL
COMPONENT 75572 21 999 Years 2.44 $26.7305 $65.22 1/1/2014 0.00 $65.22 2.44 $26.7305 $65.22 1/1/2014 0.00 $65.22 1/1/2014
T
TECHNICAL
COMPONENT 75572 0 20 Years 6.78 $28.0672 $190.30 1/1/2014 0.00 $190.30 6.78 $28.0672 $190.30 1/1/2014 0.00 $190.30 1/1/2014
T
TECHNICAL
COMPONENT 75572 21 999 Years 6.78 $26.7305 $181.23 1/1/2014 0.00 $181.23 6.78 $26.7305 $181.23 1/1/2014 0.00 $181.23 1/1/2014
4 RADIOLOGY 75573 0 20 Years 12.59 $28.0672 $353.37 1/1/2014 0.00 $353.37 12.59 $28.0672 $353.37 1/1/2014 0.00 $353.37 1/1/2014
4 RADIOLOGY 75573 21 999 Years 12.59 $26.7305 $336.54 1/1/2014 0.00 $336.54 12.59 $26.7305 $336.54 1/1/2014 0.00 $336.54 1/1/2014
I
PROFESSIONAL
COMPONENT 75573 0 20 Years 3.55 $28.0672 $99.64 1/1/2014 0.00 $99.64 3.55 $28.0672 $99.64 1/1/2014 0.00 $99.64 1/1/2014
I
PROFESSIONAL
COMPONENT 75573 21 999 Years 3.55 $26.7305 $94.89 1/1/2014 0.00 $94.89 3.55 $26.7305 $94.89 1/1/2014 0.00 $94.89 1/1/2014
T
TECHNICAL
COMPONENT 75573 0 20 Years 9.04 $28.0672 $253.73 1/1/2014 0.00 $253.73 9.04 $28.0672 $253.73 1/1/2014 0.00 $253.73 1/1/2014
T
TECHNICAL
COMPONENT 75573 21 999 Years 9.04 $26.7305 $241.64 1/1/2014 0.00 $241.64 9.04 $26.7305 $241.64 1/1/2014 0.00 $241.64 1/1/2014
4 RADIOLOGY 75574 0 20 Years 13.61 $28.0672 $381.99 1/1/2014 0.00 $381.99 13.61 $28.0672 $381.99 1/1/2014 0.00 $381.99 1/1/2014
4 RADIOLOGY 75574 21 999 Years 13.61 $26.7305 $363.80 1/1/2014 0.00 $363.80 13.61 $26.7305 $363.80 1/1/2014 0.00 $363.80 1/1/2014
I
PROFESSIONAL
COMPONENT 75574 0 20 Years 3.35 $28.0672 $94.03 1/1/2014 0.00 $94.03 3.35 $28.0672 $94.03 1/1/2014 0.00 $94.03 1/1/2014
I
PROFESSIONAL
COMPONENT 75574 21 999 Years 3.35 $26.7305 $89.55 1/1/2014 0.00 $89.55 3.35 $26.7305 $89.55 1/1/2014 0.00 $89.55 1/1/2014
T
TECHNICAL
COMPONENT 75574 0 20 Years 10.26 $28.0672 $287.97 1/1/2014 0.00 $287.97 10.26 $28.0672 $287.97 1/1/2014 0.00 $287.97 1/1/2014
T
TECHNICAL
COMPONENT 75574 21 999 Years 10.26 $26.7305 $274.25 1/1/2014 0.00 $274.25 10.26 $26.7305 $274.25 1/1/2014 0.00 $274.25 1/1/2014
4 RADIOLOGY 75600 0 20 Years 6.38 $28.0672 $179.07 1/1/2014 0.00 $179.07 9 1/1/2014
4 RADIOLOGY 75600 21 999 Years 6.38 $26.7305 $170.54 1/1/2014 0.00 $170.54 9 1/1/2014
T
TECHNICAL
COMPONENT 75600 0 20 Years 5.69 $28.0672 $159.70 1/1/2014 0.00 $159.70 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 75600 21 999 Years 5.69 $26.7305 $152.10 1/1/2014 0.00 $152.10 9 1/1/2014
4 RADIOLOGY 75605 0 20 Years 4.61 $28.0672 $129.39 1/1/2014 0.00 $129.39 9 1/1/2014
4 RADIOLOGY 75605 21 999 Years 4.61 $26.7305 $123.23 1/1/2014 0.00 $123.23 9 1/1/2014
T
TECHNICAL
COMPONENT 75605 0 20 Years 3.01 $28.0672 $84.48 1/1/2014 0.00 $84.48 9 1/1/2014
T
TECHNICAL
COMPONENT 75605 21 999 Years 3.01 $26.7305 $80.46 1/1/2014 0.00 $80.46 9 1/1/2014
4 RADIOLOGY 75625 0 20 Years 4.62 $28.0672 $129.67 1/1/2014 0.00 $129.67 9 1/1/2014
4 RADIOLOGY 75625 21 999 Years 4.62 $26.7305 $123.49 1/1/2014 0.00 $123.49 9 1/1/2014
T
TECHNICAL
COMPONENT 75625 0 20 Years 3.02 $28.0672 $84.76 1/1/2014 0.00 $84.76 9 1/1/2014
T
TECHNICAL
COMPONENT 75625 21 999 Years 3.02 $26.7305 $80.73 1/1/2014 0.00 $80.73 9 1/1/2014
4 RADIOLOGY 75630 0 20 Years 5.48 $28.0672 $153.81 1/1/2014 0.00 $153.81 9 1/1/2014
4 RADIOLOGY 75630 21 999 Years 5.48 $26.7305 $146.48 1/1/2014 0.00 $146.48 9 1/1/2014
T
TECHNICAL
COMPONENT 75630 0 20 Years 2.99 $28.0672 $83.92 1/1/2014 0.00 $83.92 9 1/1/2014
T
TECHNICAL
COMPONENT 75630 21 999 Years 2.99 $26.7305 $79.92 1/1/2014 0.00 $79.92 9 1/1/2014
4 RADIOLOGY 75635 0 20 Years 13.39 $28.0672 $375.82 1/1/2014 0.00 $375.82 13.39 $28.0672 $375.82 1/1/2014 0.00 $375.82 1/1/2014
4 RADIOLOGY 75635 21 999 Years 13.39 $26.7305 $357.92 1/1/2014 0.00 $357.92 13.39 $26.7305 $357.92 1/1/2014 0.00 $357.92 1/1/2014
I
PROFESSIONAL
COMPONENT 75635 0 20 Years 3.38 $28.0672 $94.87 1/1/2014 0.00 $94.87 3.38 $28.0672 $94.87 1/1/2014 0.00 $94.87 1/1/2014
I
PROFESSIONAL
COMPONENT 75635 21 999 Years 3.38 $26.7305 $90.35 1/1/2014 0.00 $90.35 3.38 $26.7305 $90.35 1/1/2014 0.00 $90.35 1/1/2014
T
TECHNICAL
COMPONENT 75635 0 20 Years 10.01 $28.0672 $280.95 1/1/2014 0.00 $280.95 10.01 $28.0672 $280.95 1/1/2014 0.00 $280.95 1/1/2014
T
TECHNICAL
COMPONENT 75635 21 999 Years 10.01 $26.7305 $267.57 1/1/2014 0.00 $267.57 10.01 $26.7305 $267.57 1/1/2014 0.00 $267.57 1/1/2014
4 RADIOLOGY 75658 0 20 Years 5.46 $28.0672 $153.25 1/1/2014 0.00 $153.25 9 1/1/2014
4 RADIOLOGY 75658 21 999 Years 5.46 $26.7305 $145.95 1/1/2014 0.00 $145.95 9 1/1/2014
T
TECHNICAL
COMPONENT 75658 0 20 Years 3.66 $28.0672 $102.73 1/1/2014 0.00 $102.73 9 1/1/2014
T
TECHNICAL
COMPONENT 75658 21 999 Years 3.66 $26.7305 $97.83 1/1/2014 0.00 $97.83 9 1/1/2014
4 RADIOLOGY 75705 0 20 Years 7.34 $28.0672 $206.01 1/1/2014 0.00 $206.01 9 1/1/2014
4 RADIOLOGY 75705 21 999 Years 7.34 $26.7305 $196.20 1/1/2014 0.00 $196.20 9 1/1/2014
T
TECHNICAL
COMPONENT 75705 0 20 Years 4.26 $28.0672 $119.57 1/1/2014 0.00 $119.57 9 1/1/2014
T
TECHNICAL
COMPONENT 75705 21 999 Years 4.26 $26.7305 $113.87 1/1/2014 0.00 $113.87 9 1/1/2014
4 RADIOLOGY 75710 0 20 Years 5.36 $28.0672 $150.44 1/1/2014 0.00 $150.44 9 1/1/2014
4 RADIOLOGY 75710 21 999 Years 5.36 $26.7305 $143.28 1/1/2014 0.00 $143.28 9 1/1/2014
T
TECHNICAL
COMPONENT 75710 0 20 Years 3.79 $28.0672 $106.37 1/1/2014 0.00 $106.37 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 75710 21 999 Years 3.79 $26.7305 $101.31 1/1/2014 0.00 $101.31 9 1/1/2014
4 RADIOLOGY 75716 0 20 Years 6.42 $28.0672 $180.19 1/1/2014 0.00 $180.19 9 1/1/2014
4 RADIOLOGY 75716 21 999 Years 6.42 $26.7305 $171.61 1/1/2014 0.00 $171.61 9 1/1/2014
T
TECHNICAL
COMPONENT 75716 0 20 Years 4.58 $28.0672 $128.55 1/1/2014 0.00 $128.55 9 1/1/2014
T
TECHNICAL
COMPONENT 75716 21 999 Years 4.58 $26.7305 $122.43 1/1/2014 0.00 $122.43 9 1/1/2014
4 RADIOLOGY 75726 0 20 Years 5.38 $28.0672 $151.00 1/1/2014 0.00 $151.00 9 1/1/2014
4 RADIOLOGY 75726 21 999 Years 5.38 $26.7305 $143.81 1/1/2014 0.00 $143.81 9 1/1/2014
T
TECHNICAL
COMPONENT 75726 0 20 Years 3.77 $28.0672 $105.81 1/1/2014 0.00 $105.81 9 1/1/2014
T
TECHNICAL
COMPONENT 75726 21 999 Years 3.77 $26.7305 $100.77 1/1/2014 0.00 $100.77 9 1/1/2014
4 RADIOLOGY 75731 0 20 Years 4.98 $28.0672 $139.77 1/1/2014 0.00 $139.77 9 1/1/2014
4 RADIOLOGY 75731 21 999 Years 4.98 $26.7305 $133.12 1/1/2014 0.00 $133.12 9 1/1/2014
T
TECHNICAL
COMPONENT 75731 0 20 Years 3.38 $28.0672 $94.87 1/1/2014 0.00 $94.87 9 1/1/2014
T
TECHNICAL
COMPONENT 75731 21 999 Years 3.38 $26.7305 $90.35 1/1/2014 0.00 $90.35 9 1/1/2014
4 RADIOLOGY 75733 0 20 Years 6.19 $28.0672 $173.74 1/1/2014 0.00 $173.74 9 1/1/2014
4 RADIOLOGY 75733 21 999 Years 6.19 $26.7305 $165.46 1/1/2014 0.00 $165.46 9 1/1/2014
T
TECHNICAL
COMPONENT 75733 0 20 Years 4.36 $28.0672 $122.37 1/1/2014 0.00 $122.37 9 1/1/2014
T
TECHNICAL
COMPONENT 75733 21 999 Years 4.36 $26.7305 $116.54 1/1/2014 0.00 $116.54 9 1/1/2014
4 RADIOLOGY 75736 0 20 Years 5.20 $28.0672 $145.95 1/1/2014 0.00 $145.95 9 1/1/2014
4 RADIOLOGY 75736 21 999 Years 5.20 $26.7305 $139.00 1/1/2014 0.00 $139.00 9 1/1/2014
T
TECHNICAL
COMPONENT 75736 0 20 Years 3.64 $28.0672 $102.16 1/1/2014 0.00 $102.16 9 1/1/2014
T
TECHNICAL
COMPONENT 75736 21 999 Years 3.64 $26.7305 $97.30 1/1/2014 0.00 $97.30 9 1/1/2014
4 RADIOLOGY 75741 0 20 Years 4.84 $28.0672 $135.85 1/1/2014 0.00 $135.85 9 1/1/2014
4 RADIOLOGY 75741 21 999 Years 4.84 $26.7305 $129.38 1/1/2014 0.00 $129.38 9 1/1/2014
T
TECHNICAL
COMPONENT 75741 0 20 Years 3.00 $28.0672 $84.20 1/1/2014 0.00 $84.20 9 1/1/2014
T
TECHNICAL
COMPONENT 75741 21 999 Years 3.00 $26.7305 $80.19 1/1/2014 0.00 $80.19 9 1/1/2014
4 RADIOLOGY 75743 0 20 Years 5.63 $28.0672 $158.02 1/1/2014 0.00 $158.02 9 1/1/2014
4 RADIOLOGY 75743 21 999 Years 5.63 $26.7305 $150.49 1/1/2014 0.00 $150.49 9 1/1/2014
T
TECHNICAL
COMPONENT 75743 0 20 Years 3.31 $28.0672 $92.90 1/1/2014 0.00 $92.90 9 1/1/2014
T
TECHNICAL
COMPONENT 75743 21 999 Years 3.31 $26.7305 $88.48 1/1/2014 0.00 $88.48 9 1/1/2014
4 RADIOLOGY 75746 0 20 Years 5.06 $28.0672 $142.02 1/1/2014 0.00 $142.02 9 1/1/2014
4 RADIOLOGY 75746 21 999 Years 5.06 $26.7305 $135.26 1/1/2014 0.00 $135.26 9 1/1/2014
T
TECHNICAL
COMPONENT 75746 0 20 Years 3.44 $28.0672 $96.55 1/1/2014 0.00 $96.55 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 75746 21 999 Years 3.44 $26.7305 $91.95 1/1/2014 0.00 $91.95 9 1/1/2014
4 RADIOLOGY 75756 0 20 Years 5.69 $28.0672 $159.70 1/1/2014 0.00 $159.70 9 1/1/2014
4 RADIOLOGY 75756 21 999 Years 5.69 $26.7305 $152.10 1/1/2014 0.00 $152.10 9 1/1/2014
T
TECHNICAL
COMPONENT 75756 0 20 Years 3.96 $28.0672 $111.15 1/1/2014 0.00 $111.15 9 1/1/2014
T
TECHNICAL
COMPONENT 75756 21 999 Years 3.96 $26.7305 $105.85 1/1/2014 0.00 $105.85 9 1/1/2014
4 RADIOLOGY 75774 0 20 Years 3.02 $28.0672 $84.76 1/1/2014 0.00 $84.76 9 1/1/2014
4 RADIOLOGY 75774 21 999 Years 3.02 $26.7305 $80.73 1/1/2014 0.00 $80.73 9 1/1/2014
T
TECHNICAL
COMPONENT 75774 0 20 Years 2.51 $28.0672 $70.45 1/1/2014 0.00 $70.45 9 1/1/2014
T
TECHNICAL
COMPONENT 75774 21 999 Years 2.51 $26.7305 $67.09 1/1/2014 0.00 $67.09 9 1/1/2014
4 RADIOLOGY 75791 0 20 Years 10.05 $28.0672 $282.08 1/1/2014 0.00 $282.08 1/1/2014
4 RADIOLOGY 75791 21 999 Years 10.05 $26.7305 $268.64 1/1/2014 0.00 $268.64 1/1/2014
T
TECHNICAL
COMPONENT 75791 0 20 Years 7.68 $28.0672 $215.56 1/1/2014 0.00 $215.56 1/1/2014
T
TECHNICAL
COMPONENT 75791 21 999 Years 7.68 $26.7305 $205.29 1/1/2014 0.00 $205.29 1/1/2014
4 RADIOLOGY 75801 0 20 Years 0.00 $0.0000 $227.24 1/1/2014 0.00 $227.24 1/1/2014
4 RADIOLOGY 75801 21 999 Years 0.00 $0.0000 $216.42 1/1/2014 0.00 $216.42 1/1/2014
T
TECHNICAL
COMPONENT 75801 0 20 Years 0.00 $0.0000 $190.47 1/1/2014 0.00 $190.47 1/1/2014
T
TECHNICAL
COMPONENT 75801 21 999 Years 0.00 $0.0000 $181.40 1/1/2014 0.00 $181.40 1/1/2014
4 RADIOLOGY 75803 0 20 Years 0.00 $0.0000 $238.70 1/1/2014 0.00 $238.70 1/1/2014
4 RADIOLOGY 75803 21 999 Years 0.00 $0.0000 $227.33 1/1/2014 0.00 $227.33 1/1/2014
T
TECHNICAL
COMPONENT 75803 0 20 Years 0.00 $0.0000 $190.99 1/1/2014 0.00 $190.99 1/1/2014
T
TECHNICAL
COMPONENT 75803 21 999 Years 0.00 $0.0000 $181.89 1/1/2014 0.00 $181.89 1/1/2014
4 RADIOLOGY 75805 0 20 Years 0.00 $0.0000 $248.50 1/1/2014 0.00 $248.50 1/1/2014
4 RADIOLOGY 75805 21 999 Years 0.00 $0.0000 $236.66 1/1/2014 0.00 $236.66 1/1/2014
T
TECHNICAL
COMPONENT 75805 0 20 Years 0.00 $0.0000 $215.38 1/1/2014 0.00 $215.38 1/1/2014
T
TECHNICAL
COMPONENT 75805 21 999 Years 0.00 $0.0000 $205.12 1/1/2014 0.00 $205.12 1/1/2014
4 RADIOLOGY 75807 0 20 Years 0.00 $0.0000 $121.06 1/1/2014 0.00 $121.06 1/1/2014
4 RADIOLOGY 75807 21 999 Years 0.00 $0.0000 $115.30 1/1/2014 0.00 $115.30 1/1/2014
T
TECHNICAL
COMPONENT 75807 0 20 Years 0.00 $0.0000 $73.35 1/1/2014 0.00 $73.35 1/1/2014
T
TECHNICAL
COMPONENT 75807 21 999 Years 0.00 $0.0000 $69.86 1/1/2014 0.00 $69.86 1/1/2014
4 RADIOLOGY 75809 0 20 Years 3.12 $28.0672 $87.57 1/1/2014 0.00 $87.57 9 1/1/2014
4 RADIOLOGY 75809 21 999 Years 3.12 $26.7305 $83.40 1/1/2014 0.00 $83.40 9 1/1/2014
T
TECHNICAL
COMPONENT 75809 0 20 Years 2.44 $28.0672 $68.48 1/1/2014 0.00 $68.48 9 2.44 $28.0672 $68.48 1/1/2014 0.00 $68.48 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 75809 21 999 Years 2.44 $26.7305 $65.22 1/1/2014 0.00 $65.22 9 2.44 $26.7305 $65.22 1/1/2014 0.00 $65.22 9 1/1/2014
4 RADIOLOGY 75810 0 20 Years 0.00 $0.0000 $489.79 1/1/2014 0.00 $489.79 1/1/2014
4 RADIOLOGY 75810 21 999 Years 0.00 $0.0000 $466.46 1/1/2014 0.00 $466.46 1/1/2014
T
TECHNICAL
COMPONENT 75810 0 20 Years 0.00 $0.0000 $443.48 1/1/2014 0.00 $443.48 1/1/2014
T
TECHNICAL
COMPONENT 75810 21 999 Years 0.00 $0.0000 $422.35 1/1/2014 0.00 $422.35 1/1/2014
4 RADIOLOGY 75820 0 20 Years 3.78 $28.0672 $106.09 1/1/2014 0.00 $106.09 9 1/1/2014
4 RADIOLOGY 75820 21 999 Years 3.78 $26.7305 $101.04 1/1/2014 0.00 $101.04 9 1/1/2014
T
TECHNICAL
COMPONENT 75820 0 20 Years 2.79 $28.0672 $78.31 1/1/2014 0.00 $78.31 9 1/1/2014
T
TECHNICAL
COMPONENT 75820 21 999 Years 2.79 $26.7305 $74.58 1/1/2014 0.00 $74.58 9 1/1/2014
4 RADIOLOGY 75822 0 20 Years 4.70 $28.0672 $131.92 1/1/2014 0.00 $131.92 9 1/1/2014
4 RADIOLOGY 75822 21 999 Years 4.70 $26.7305 $125.63 1/1/2014 0.00 $125.63 9 1/1/2014
T
TECHNICAL
COMPONENT 75822 0 20 Years 3.21 $28.0672 $90.10 1/1/2014 0.00 $90.10 9 1/1/2014
T
TECHNICAL
COMPONENT 75822 21 999 Years 3.21 $26.7305 $85.80 1/1/2014 0.00 $85.80 9 1/1/2014
4 RADIOLOGY 75825 0 20 Years 4.45 $28.0672 $124.90 1/1/2014 0.00 $124.90 9 1/1/2014
4 RADIOLOGY 75825 21 999 Years 4.45 $26.7305 $118.95 1/1/2014 0.00 $118.95 9 1/1/2014
T
TECHNICAL
COMPONENT 75825 0 20 Years 2.86 $28.0672 $80.27 1/1/2014 0.00 $80.27 9 1/1/2014
T
TECHNICAL
COMPONENT 75825 21 999 Years 2.86 $26.7305 $76.45 1/1/2014 0.00 $76.45 9 1/1/2014
4 RADIOLOGY 75827 0 20 Years 4.55 $28.0672 $127.71 1/1/2014 0.00 $127.71 9 1/1/2014
4 RADIOLOGY 75827 21 999 Years 4.55 $26.7305 $121.62 1/1/2014 0.00 $121.62 9 1/1/2014
T
TECHNICAL
COMPONENT 75827 0 20 Years 2.97 $28.0672 $83.36 1/1/2014 0.00 $83.36 9 1/1/2014
T
TECHNICAL
COMPONENT 75827 21 999 Years 2.97 $26.7305 $79.39 1/1/2014 0.00 $79.39 9 1/1/2014
4 RADIOLOGY 75831 0 20 Years 4.79 $28.0672 $134.44 1/1/2014 0.00 $134.44 9 1/1/2014
4 RADIOLOGY 75831 21 999 Years 4.79 $26.7305 $128.04 1/1/2014 0.00 $128.04 9 1/1/2014
T
TECHNICAL
COMPONENT 75831 0 20 Years 3.03 $28.0672 $85.04 1/1/2014 0.00 $85.04 9 1/1/2014
T
TECHNICAL
COMPONENT 75831 21 999 Years 3.03 $26.7305 $80.99 1/1/2014 0.00 $80.99 9 1/1/2014
4 RADIOLOGY 75833 0 20 Years 5.56 $28.0672 $156.05 1/1/2014 0.00 $156.05 9 1/1/2014
4 RADIOLOGY 75833 21 999 Years 5.56 $26.7305 $148.62 1/1/2014 0.00 $148.62 9 1/1/2014
T
TECHNICAL
COMPONENT 75833 0 20 Years 3.53 $28.0672 $99.08 1/1/2014 0.00 $99.08 9 1/1/2014
T
TECHNICAL
COMPONENT 75833 21 999 Years 3.53 $26.7305 $94.36 1/1/2014 0.00 $94.36 9 1/1/2014
4 RADIOLOGY 75840 0 20 Years 4.80 $28.0672 $134.72 1/1/2014 0.00 $134.72 9 1/1/2014
4 RADIOLOGY 75840 21 999 Years 4.80 $26.7305 $128.31 1/1/2014 0.00 $128.31 9 1/1/2014
T
TECHNICAL
COMPONENT 75840 0 20 Years 3.00 $28.0672 $84.20 1/1/2014 0.00 $84.20 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 75840 21 999 Years 3.00 $26.7305 $80.19 1/1/2014 0.00 $80.19 9 1/1/2014
4 RADIOLOGY 75842 0 20 Years 5.72 $28.0672 $160.54 1/1/2014 0.00 $160.54 9 1/1/2014
4 RADIOLOGY 75842 21 999 Years 5.72 $26.7305 $152.90 1/1/2014 0.00 $152.90 9 1/1/2014
T
TECHNICAL
COMPONENT 75842 0 20 Years 3.60 $28.0672 $101.04 1/1/2014 0.00 $101.04 9 1/1/2014
T
TECHNICAL
COMPONENT 75842 21 999 Years 3.60 $26.7305 $96.23 1/1/2014 0.00 $96.23 9 1/1/2014
4 RADIOLOGY 75860 0 20 Years 4.62 $28.0672 $129.67 1/1/2014 0.00 $129.67 9 1/1/2014
4 RADIOLOGY 75860 21 999 Years 4.62 $26.7305 $123.49 1/1/2014 0.00 $123.49 9 1/1/2014
T
TECHNICAL
COMPONENT 75860 0 20 Years 3.01 $28.0672 $84.48 1/1/2014 0.00 $84.48 9 1/1/2014
T
TECHNICAL
COMPONENT 75860 21 999 Years 3.01 $26.7305 $80.46 1/1/2014 0.00 $80.46 9 1/1/2014
4 RADIOLOGY 75870 0 20 Years 4.61 $28.0672 $129.39 1/1/2014 0.00 $129.39 9 1/1/2014
4 RADIOLOGY 75870 21 999 Years 4.61 $26.7305 $123.23 1/1/2014 0.00 $123.23 9 1/1/2014
T
TECHNICAL
COMPONENT 75870 0 20 Years 2.99 $28.0672 $83.92 1/1/2014 0.00 $83.92 9 1/1/2014
T
TECHNICAL
COMPONENT 75870 21 999 Years 2.99 $26.7305 $79.92 1/1/2014 0.00 $79.92 9 1/1/2014
4 RADIOLOGY 75872 0 20 Years 4.61 $28.0672 $129.39 1/1/2014 0.00 $129.39 9 1/1/2014
4 RADIOLOGY 75872 21 999 Years 4.61 $26.7305 $123.23 1/1/2014 0.00 $123.23 9 1/1/2014
T
TECHNICAL
COMPONENT 75872 0 20 Years 2.99 $28.0672 $83.92 1/1/2014 0.00 $83.92 9 1/1/2014
T
TECHNICAL
COMPONENT 75872 21 999 Years 2.99 $26.7305 $79.92 1/1/2014 0.00 $79.92 9 1/1/2014
4 RADIOLOGY 75880 0 20 Years 7.10 $28.0672 $199.28 1/1/2014 0.00 $199.28 9 1/1/2014
4 RADIOLOGY 75880 21 999 Years 7.10 $26.7305 $189.79 1/1/2014 0.00 $189.79 9 1/1/2014
T
TECHNICAL
COMPONENT 75880 0 20 Years 6.02 $28.0672 $168.96 1/1/2014 0.00 $168.96 9 1/1/2014
T
TECHNICAL
COMPONENT 75880 21 999 Years 6.02 $26.7305 $160.92 1/1/2014 0.00 $160.92 9 1/1/2014
4 RADIOLOGY 75885 0 20 Years 5.05 $28.0672 $141.74 1/1/2014 0.00 $141.74 9 1/1/2014
4 RADIOLOGY 75885 21 999 Years 5.05 $26.7305 $134.99 1/1/2014 0.00 $134.99 9 1/1/2014
T
TECHNICAL
COMPONENT 75885 0 20 Years 3.03 $28.0672 $85.04 1/1/2014 0.00 $85.04 9 1/1/2014
T
TECHNICAL
COMPONENT 75885 21 999 Years 3.03 $26.7305 $80.99 1/1/2014 0.00 $80.99 9 1/1/2014
4 RADIOLOGY 75887 0 20 Years 5.00 $28.0672 $140.34 1/1/2014 0.00 $140.34 9 1/1/2014
4 RADIOLOGY 75887 21 999 Years 5.00 $26.7305 $133.65 1/1/2014 0.00 $133.65 9 1/1/2014
T
TECHNICAL
COMPONENT 75887 0 20 Years 3.01 $28.0672 $84.48 1/1/2014 0.00 $84.48 9 1/1/2014
T
TECHNICAL
COMPONENT 75887 21 999 Years 3.01 $26.7305 $80.46 1/1/2014 0.00 $80.46 9 1/1/2014
4 RADIOLOGY 75889 0 20 Years 4.65 $28.0672 $130.51 1/1/2014 0.00 $130.51 9 1/1/2014
4 RADIOLOGY 75889 21 999 Years 4.65 $26.7305 $124.30 1/1/2014 0.00 $124.30 9 1/1/2014
T
TECHNICAL
COMPONENT 75889 0 20 Years 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 75889 21 999 Years 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 9 1/1/2014
4 RADIOLOGY 75891 0 20 Years 4.65 $28.0672 $130.51 1/1/2014 0.00 $130.51 9 1/1/2014
4 RADIOLOGY 75891 21 999 Years 4.65 $26.7305 $124.30 1/1/2014 0.00 $124.30 9 1/1/2014
T
TECHNICAL
COMPONENT 75891 0 20 Years 3.04 $28.0672 $85.32 1/1/2014 0.00 $85.32 9 1/1/2014
T
TECHNICAL
COMPONENT 75891 21 999 Years 3.04 $26.7305 $81.26 1/1/2014 0.00 $81.26 9 1/1/2014
4 RADIOLOGY 75893 0 20 Years 3.78 $28.0672 $106.09 1/1/2014 0.00 $106.09 9 1/1/2014
4 RADIOLOGY 75893 21 999 Years 3.78 $26.7305 $101.04 1/1/2014 0.00 $101.04 9 1/1/2014
T
TECHNICAL
COMPONENT 75893 0 20 Years 3.04 $28.0672 $85.32 1/1/2014 0.00 $85.32 9 1/1/2014
T
TECHNICAL
COMPONENT 75893 21 999 Years 3.04 $26.7305 $81.26 1/1/2014 0.00 $81.26 9 1/1/2014
4 RADIOLOGY 75894 0 20 Years 0.00 $0.0000 $792.66 1/1/2014 0.00 $792.66 1/1/2014
4 RADIOLOGY 75894 21 999 Years 0.00 $0.0000 $754.91 1/1/2014 0.00 $754.91 1/1/2014
T
TECHNICAL
COMPONENT 75894 0 20 Years 0.00 $0.0000 $738.77 1/1/2014 0.00 $738.77 1/1/2014
T
TECHNICAL
COMPONENT 75894 21 999 Years 0.00 $0.0000 $703.59 1/1/2014 0.00 $703.59 1/1/2014
4 RADIOLOGY 75898 0 20 Years 0.00 $0.0000 $105.35 1/1/2014 0.00 $105.35 1/1/2014
4 RADIOLOGY 75898 21 999 Years 0.00 $0.0000 $100.33 1/1/2014 0.00 $100.33 1/1/2014
T
TECHNICAL
COMPONENT 75898 0 20 Years 0.00 $0.0000 $36.87 1/1/2014 0.00 $36.87 1/1/2014
T
TECHNICAL
COMPONENT 75898 21 999 Years 0.00 $0.0000 $35.11 1/1/2014 0.00 $35.11 1/1/2014
4 RADIOLOGY 75901 0 20 Years 5.25 $28.0672 $147.35 1/1/2014 0.00 $147.35 9 1/1/2014
4 RADIOLOGY 75901 21 999 Years 5.25 $26.7305 $140.34 1/1/2014 0.00 $140.34 9 1/1/2014
T
TECHNICAL
COMPONENT 75901 0 20 Years 4.56 $28.0672 $127.99 1/1/2014 0.00 $127.99 9 1/1/2014
T
TECHNICAL
COMPONENT 75901 21 999 Years 4.56 $26.7305 $121.89 1/1/2014 0.00 $121.89 9 1/1/2014
4 RADIOLOGY 75902 0 20 Years 2.27 $28.0672 $63.71 1/1/2014 0.00 $63.71 9 1/1/2014
4 RADIOLOGY 75902 21 999 Years 2.27 $26.7305 $60.68 1/1/2014 0.00 $60.68 9 1/1/2014
T
TECHNICAL
COMPONENT 75902 0 20 Years 1.71 $28.0672 $47.99 1/1/2014 0.00 $47.99 9 1/1/2014
T
TECHNICAL
COMPONENT 75902 21 999 Years 1.71 $26.7305 $45.71 1/1/2014 0.00 $45.71 9 1/1/2014
I
PROFESSIONAL
COMPONENT 75952 0 20 Years 6.67 $28.0672 $187.21 1/1/2014 0.00 $187.21 9 6.67 $28.0672 $187.21 1/1/2014 0.00 $187.21 9 1/1/2014
I
PROFESSIONAL
COMPONENT 75952 21 999 Years 6.67 $26.7305 $178.29 1/1/2014 0.00 $178.29 9 6.67 $26.7305 $178.29 1/1/2014 0.00 $178.29 9 1/1/2014
I
PROFESSIONAL
COMPONENT 75953 0 20 Years 2.03 $28.0672 $56.98 1/1/2014 0.00 $56.98 9 2.03 $28.0672 $56.98 1/1/2014 0.00 $56.98 9 1/1/2014
I
PROFESSIONAL
COMPONENT 75953 21 999 Years 2.03 $26.7305 $54.26 1/1/2014 0.00 $54.26 9 2.03 $26.7305 $54.26 1/1/2014 0.00 $54.26 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 75962 0 20 Years 4.50 $28.0672 $126.30 1/1/2014 0.00 $126.30 9 1/1/2014
4 RADIOLOGY 75962 21 999 Years 4.50 $26.7305 $120.29 1/1/2014 0.00 $120.29 9 1/1/2014
T
TECHNICAL
COMPONENT 75962 0 20 Years 3.75 $28.0672 $105.25 1/1/2014 0.00 $105.25 9 1/1/2014
T
TECHNICAL
COMPONENT 75962 21 999 Years 3.75 $26.7305 $100.24 1/1/2014 0.00 $100.24 9 1/1/2014
4 RADIOLOGY 75964 0 20 Years 2.91 $28.0672 $81.68 1/1/2014 0.00 $81.68 9 1/1/2014
4 RADIOLOGY 75964 21 999 Years 2.91 $26.7305 $77.79 1/1/2014 0.00 $77.79 9 1/1/2014
T
TECHNICAL
COMPONENT 75964 0 20 Years 2.39 $28.0672 $67.08 1/1/2014 0.00 $67.08 9 1/1/2014
T
TECHNICAL
COMPONENT 75964 21 999 Years 2.39 $26.7305 $63.89 1/1/2014 0.00 $63.89 9 1/1/2014
4 RADIOLOGY 75966 0 20 Years 5.28 $28.0672 $148.19 1/1/2014 0.00 $148.19 9 1/1/2014
4 RADIOLOGY 75966 21 999 Years 5.28 $26.7305 $141.14 1/1/2014 0.00 $141.14 9 1/1/2014
T
TECHNICAL
COMPONENT 75966 0 20 Years 3.47 $28.0672 $97.39 1/1/2014 0.00 $97.39 9 1/1/2014
T
TECHNICAL
COMPONENT 75966 21 999 Years 3.47 $26.7305 $92.75 1/1/2014 0.00 $92.75 9 1/1/2014
4 RADIOLOGY 75968 0 20 Years 2.64 $28.0672 $74.10 1/1/2014 0.00 $74.10 9 1/1/2014
4 RADIOLOGY 75968 21 999 Years 2.64 $26.7305 $70.57 1/1/2014 0.00 $70.57 9 1/1/2014
T
TECHNICAL
COMPONENT 75968 0 20 Years 2.15 $28.0672 $60.34 1/1/2014 0.00 $60.34 9 1/1/2014
T
TECHNICAL
COMPONENT 75968 21 999 Years 2.15 $26.7305 $57.47 1/1/2014 0.00 $57.47 9 1/1/2014
4 RADIOLOGY 75970 0 20 Years 0.00 $0.0000 $439.27 1/1/2014 0.00 $439.27 1/1/2014
4 RADIOLOGY 75970 21 999 Years 0.00 $0.0000 $418.35 1/1/2014 0.00 $418.35 1/1/2014
T
TECHNICAL
COMPONENT 75970 0 20 Years 0.00 $0.0000 $406.15 1/1/2014 0.00 $406.15 1/1/2014
T
TECHNICAL
COMPONENT 75970 21 999 Years 0.00 $0.0000 $386.81 1/1/2014 0.00 $386.81 1/1/2014
4 RADIOLOGY 75978 0 20 Years 4.46 $28.0672 $125.18 1/1/2014 0.00 $125.18 9 1/1/2014
4 RADIOLOGY 75978 21 999 Years 4.46 $26.7305 $119.22 1/1/2014 0.00 $119.22 9 1/1/2014
T
TECHNICAL
COMPONENT 75978 0 20 Years 3.71 $28.0672 $104.13 1/1/2014 0.00 $104.13 9 1/1/2014
T
TECHNICAL
COMPONENT 75978 21 999 Years 3.71 $26.7305 $99.17 1/1/2014 0.00 $99.17 9 1/1/2014
4 RADIOLOGY 75984 0 20 Years 3.34 $28.0672 $93.74 1/1/2014 0.00 $93.74 9 1/1/2014
4 RADIOLOGY 75984 21 999 Years 3.34 $26.7305 $89.28 1/1/2014 0.00 $89.28 9 1/1/2014
T
TECHNICAL
COMPONENT 75984 0 20 Years 2.33 $28.0672 $65.40 1/1/2014 0.00 $65.40 9 1/1/2014
T
TECHNICAL
COMPONENT 75984 21 999 Years 2.33 $26.7305 $62.28 1/1/2014 0.00 $62.28 9 1/1/2014
4 RADIOLOGY 75989 0 20 Years 3.72 $28.0672 $104.41 1/1/2014 0.00 $104.41 9 1/1/2014
4 RADIOLOGY 75989 21 999 Years 3.72 $26.7305 $99.44 1/1/2014 0.00 $99.44 9 1/1/2014
T
TECHNICAL
COMPONENT 75989 0 20 Years 2.06 $28.0672 $57.82 1/1/2014 0.00 $57.82 9 1/1/2014
T
TECHNICAL
COMPONENT 75989 21 999 Years 2.06 $26.7305 $55.06 1/1/2014 0.00 $55.06 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 76000 0 20 Years 1.56 $28.0672 $43.78 1/1/2014 0.00 $43.78 9 1/1/2014
4 RADIOLOGY 76000 21 999 Years 1.56 $26.7305 $41.70 1/1/2014 0.00 $41.70 9 1/1/2014
4 RADIOLOGY 76001 0 20 Years 0.00 $0.0000 $121.31 1/1/2014 0.00 $121.31 1/1/2014
4 RADIOLOGY 76001 21 999 Years 0.00 $0.0000 $115.53 1/1/2014 0.00 $115.53 1/1/2014
T
TECHNICAL
COMPONENT 76001 0 20 Years 0.00 $0.0000 $92.40 1/1/2014 0.00 $92.40 1/1/2014
T
TECHNICAL
COMPONENT 76001 21 999 Years 0.00 $0.0000 $88.00 1/1/2014 0.00 $88.00 1/1/2014
4 RADIOLOGY 76010 0 20 Years 0.81 $28.0672 $22.73 1/1/2014 0.00 $22.73 9 1/1/2014
T
TECHNICAL
COMPONENT 76010 0 20 Years 0.55 $28.0672 $15.44 1/1/2014 0.00 $15.44 9 1/1/2014
4 RADIOLOGY 76080 0 20 Years 1.81 $28.0672 $50.80 1/1/2014 0.00 $50.80 9 1/1/2014
4 RADIOLOGY 76080 21 999 Years 1.81 $26.7305 $48.38 1/1/2014 0.00 $48.38 9 1/1/2014
T
TECHNICAL
COMPONENT 76080 0 20 Years 1.05 $28.0672 $29.47 1/1/2014 0.00 $29.47 9 1/1/2014
T
TECHNICAL
COMPONENT 76080 21 999 Years 1.05 $26.7305 $28.07 1/1/2014 0.00 $28.07 9 1/1/2014
T
TECHNICAL
COMPONENT 76098 0 20 Years 0.33 $28.0672 $9.26 1/1/2014 0.00 $9.26 9 1/1/2014
T
TECHNICAL
COMPONENT 76098 21 999 Years 0.33 $26.7305 $8.82 1/1/2014 0.00 $8.82 9 1/1/2014
4 RADIOLOGY 76100 0 20 Years 3.05 $28.0672 $85.60 1/1/2014 0.00 $85.60 9 1/1/2014
4 RADIOLOGY 76100 21 999 Years 3.05 $26.7305 $81.53 1/1/2014 0.00 $81.53 9 1/1/2014
T
TECHNICAL
COMPONENT 76100 0 20 Years 2.14 $28.0672 $60.06 1/1/2014 0.00 $60.06 9 1/1/2014
T
TECHNICAL
COMPONENT 76100 21 999 Years 2.14 $26.7305 $57.20 1/1/2014 0.00 $57.20 9 1/1/2014
4 RADIOLOGY 76101 0 20 Years 4.60 $28.0672 $129.11 1/1/2014 0.00 $129.11 9 1/1/2014
4 RADIOLOGY 76101 21 999 Years 4.60 $26.7305 $122.96 1/1/2014 0.00 $122.96 9 1/1/2014
T
TECHNICAL
COMPONENT 76101 0 20 Years 3.57 $28.0672 $100.20 1/1/2014 0.00 $100.20 9 1/1/2014
T
TECHNICAL
COMPONENT 76101 21 999 Years 3.57 $26.7305 $95.43 1/1/2014 0.00 $95.43 9 1/1/2014
4 RADIOLOGY 76102 0 20 Years 6.15 $28.0672 $172.61 1/1/2014 0.00 $172.61 9 1/1/2014
4 RADIOLOGY 76102 21 999 Years 6.15 $26.7305 $164.39 1/1/2014 0.00 $164.39 9 1/1/2014
T
TECHNICAL
COMPONENT 76102 0 20 Years 5.10 $28.0672 $143.14 1/1/2014 0.00 $143.14 9 1/1/2014
T
TECHNICAL
COMPONENT 76102 21 999 Years 5.10 $26.7305 $136.33 1/1/2014 0.00 $136.33 9 1/1/2014
4 RADIOLOGY 76120 0 20 Years 2.27 $28.0672 $63.71 1/1/2014 0.00 $63.71 9 1/1/2014
4 RADIOLOGY 76120 21 999 Years 2.27 $26.7305 $60.68 1/1/2014 0.00 $60.68 9 1/1/2014
T
TECHNICAL
COMPONENT 76120 0 20 Years 1.72 $28.0672 $48.28 1/1/2014 0.00 $48.28 9 1/1/2014
T
TECHNICAL
COMPONENT 76120 21 999 Years 1.72 $26.7305 $45.98 1/1/2014 0.00 $45.98 9 1/1/2014
4 RADIOLOGY 76125 0 20 Years 0.00 $0.0000 $39.27 1/1/2014 0.00 $39.27 1/1/2014
4 RADIOLOGY 76125 21 999 Years 0.00 $0.0000 $37.40 1/1/2014 0.00 $37.40 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 76125 0 20 Years 0.00 $0.0000 $27.76 1/1/2014 0.00 $27.76 1/1/2014
T
TECHNICAL
COMPONENT 76125 21 999 Years 0.00 $0.0000 $26.44 1/1/2014 0.00 $26.44 1/1/2014
4 RADIOLOGY 76376 0 20 Years 1.77 $28.0672 $49.68 1/1/2014 0.00 $49.68 1.77 $28.0672 $49.68 1/1/2014 0.00 $49.68 1/1/2014
4 RADIOLOGY 76376 21 999 Years 1.77 $26.7305 $47.31 1/1/2014 0.00 $47.31 1.77 $26.7305 $47.31 1/1/2014 0.00 $47.31 1/1/2014
I
PROFESSIONAL
COMPONENT 76376 0 20 Years 0.28 $28.0672 $7.86 1/1/2014 0.00 $7.86 0.28 $28.0672 $7.86 1/1/2014 0.00 $7.86 1/1/2014
I
PROFESSIONAL
COMPONENT 76376 21 999 Years 0.28 $26.7305 $7.48 1/1/2014 0.00 $7.48 0.28 $26.7305 $7.48 1/1/2014 0.00 $7.48 1/1/2014
T
TECHNICAL
COMPONENT 76376 0 20 Years 1.49 $28.0672 $41.82 1/1/2014 0.00 $41.82 1.49 $28.0672 $41.82 1/1/2014 0.00 $41.82 1/1/2014
T
TECHNICAL
COMPONENT 76376 21 999 Years 1.49 $26.7305 $39.83 1/1/2014 0.00 $39.83 1.49 $26.7305 $39.83 1/1/2014 0.00 $39.83 1/1/2014
4 RADIOLOGY 76377 0 20 Years 2.43 $28.0672 $68.20 1/1/2014 0.00 $68.20 2.43 $28.0672 $68.20 1/1/2014 0.00 $68.20 1/1/2014
4 RADIOLOGY 76377 21 999 Years 2.43 $26.7305 $64.96 1/1/2014 0.00 $64.96 2.43 $26.7305 $64.96 1/1/2014 0.00 $64.96 1/1/2014
I
PROFESSIONAL
COMPONENT 76377 0 20 Years 1.12 $28.0672 $31.44 1/1/2014 0.00 $31.44 1.12 $28.0672 $31.44 1/1/2014 0.00 $31.44 1/1/2014
I
PROFESSIONAL
COMPONENT 76377 21 999 Years 1.12 $26.7305 $29.94 1/1/2014 0.00 $29.94 1.12 $26.7305 $29.94 1/1/2014 0.00 $29.94 1/1/2014
T
TECHNICAL
COMPONENT 76377 0 20 Years 1.31 $28.0672 $36.77 1/1/2014 0.00 $36.77 1.31 $28.0672 $36.77 1/1/2014 0.00 $36.77 1/1/2014
T
TECHNICAL
COMPONENT 76377 21 999 Years 1.31 $26.7305 $35.02 1/1/2014 0.00 $35.02 1.31 $26.7305 $35.02 1/1/2014 0.00 $35.02 1/1/2014
4 RADIOLOGY 76380 0 20 Years 4.93 $28.0672 $138.37 1/1/2014 0.00 $138.37 4.93 $28.0672 $138.37 1/1/2014 0.00 $138.37 1/1/2014
4 RADIOLOGY 76380 21 999 Years 4.93 $26.7305 $131.78 1/1/2014 0.00 $131.78 4.93 $26.7305 $131.78 1/1/2014 0.00 $131.78 1/1/2014
I
PROFESSIONAL
COMPONENT 76380 0 20 Years 1.38 $28.0672 $38.73 1/1/2014 0.00 $38.73 1.38 $28.0672 $38.73 1/1/2014 0.00 $38.73 1/1/2014
I
PROFESSIONAL
COMPONENT 76380 21 999 Years 1.38 $26.7305 $36.89 1/1/2014 0.00 $36.89 1.38 $26.7305 $36.89 1/1/2014 0.00 $36.89 1/1/2014
T
TECHNICAL
COMPONENT 76380 0 20 Years 3.55 $28.0672 $99.64 1/1/2014 0.00 $99.64 3.55 $28.0672 $99.64 1/1/2014 0.00 $99.64 1/1/2014
T
TECHNICAL
COMPONENT 76380 21 999 Years 3.55 $26.7305 $94.89 1/1/2014 0.00 $94.89 3.55 $26.7305 $94.89 1/1/2014 0.00 $94.89 1/1/2014
4 RADIOLOGY 76390 0 20 Years 13.68 $28.0672 $383.96 1/1/2014 0.00 $383.96 13.68 $28.0672 $383.96 1/1/2014 0.00 $383.96 1/1/2014
4 RADIOLOGY 76390 21 999 Years 13.68 $26.7305 $365.67 1/1/2014 0.00 $365.67 13.68 $26.7305 $365.67 1/1/2014 0.00 $365.67 1/1/2014
I
PROFESSIONAL
COMPONENT 76390 0 20 Years 2.02 $28.0672 $56.70 1/1/2014 0.00 $56.70 2.02 $28.0672 $56.70 1/1/2014 0.00 $56.70 1/1/2014
I
PROFESSIONAL
COMPONENT 76390 21 999 Years 2.02 $26.7305 $54.00 1/1/2014 0.00 $54.00 2.02 $26.7305 $54.00 1/1/2014 0.00 $54.00 1/1/2014
T
TECHNICAL
COMPONENT 76390 0 20 Years 11.66 $28.0672 $327.26 1/1/2014 0.00 $327.26 11.66 $28.0672 $327.26 1/1/2014 0.00 $327.26 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 76390 21 999 Years 11.66 $26.7305 $311.68 1/1/2014 0.00 $311.68 11.66 $26.7305 $311.68 1/1/2014 0.00 $311.68 1/1/2014
4 RADIOLOGY 76496 0 999 Years 0.00 $0.0000 $0.00 1/1/2010 -2.00 $0.00 5 1/1/2014
4 RADIOLOGY 76497 0 999 Years 0.00 $0.0000 $0.00 1/1/2010 -2.00 $0.00 5 1/1/2014
T
TECHNICAL
COMPONENT 76497 0 999 Years 0.00 $0.0000 $0.00 10/1/2012 -2.00 $0.00 5 1/1/2014
4 RADIOLOGY 76498 0 999 Years 0.00 $0.0000 $0.00 1/1/2010 -2.00 $0.00 5 1/1/2014
T
TECHNICAL
COMPONENT 76498 0 999 Years 0.00 $0.0000 $0.00 10/1/2012 -2.00 $0.00 5 1/1/2014
4 RADIOLOGY 76499 0 20 Years 0.00 $0.0000 $0.00 1/1/2010 -2.00 $0.00 1/1/2014
4 RADIOLOGY 76499 21 999 Years 0.00 $0.0000 $0.00 1/1/2010 -2.00 $0.00 1/1/2014
4 RADIOLOGY 76506 0 20 Years 3.77 $28.0672 $105.81 1/1/2014 0.00 $105.81 1/1/2014
4 RADIOLOGY 76506 21 999 Years 3.77 $26.7305 $100.77 1/1/2014 0.00 $100.77 1/1/2014
T
TECHNICAL
COMPONENT 76506 0 20 Years 2.86 $28.0672 $80.27 1/1/2014 0.00 $80.27 1/1/2014
T
TECHNICAL
COMPONENT 76506 21 999 Years 2.86 $26.7305 $76.45 1/1/2014 0.00 $76.45 1/1/2014
4 RADIOLOGY 76510 0 20 Years 5.36 $28.0672 $150.44 1/1/2014 0.00 $150.44 9 1/1/2014
4 RADIOLOGY 76510 21 999 Years 5.36 $26.7305 $143.28 1/1/2014 0.00 $143.28 9 1/1/2014
T
TECHNICAL
COMPONENT 76510 0 20 Years 2.53 $28.0672 $71.01 1/1/2014 0.00 $71.01 9 1/1/2014
T
TECHNICAL
COMPONENT 76510 21 999 Years 2.53 $26.7305 $67.63 1/1/2014 0.00 $67.63 9 1/1/2014
4 RADIOLOGY 76511 0 20 Years 3.04 $28.0672 $85.32 1/1/2014 0.00 $85.32 9 1/1/2014
4 RADIOLOGY 76511 21 999 Years 3.04 $26.7305 $81.26 1/1/2014 0.00 $81.26 9 1/1/2014
T
TECHNICAL
COMPONENT 76511 0 20 Years 1.50 $28.0672 $42.10 1/1/2014 0.00 $42.10 9 1/1/2014
T
TECHNICAL
COMPONENT 76511 21 999 Years 1.50 $26.7305 $40.10 1/1/2014 0.00 $40.10 9 1/1/2014
4 RADIOLOGY 76512 0 20 Years 2.82 $28.0672 $79.15 1/1/2014 0.00 $79.15 9 1/1/2014
4 RADIOLOGY 76512 21 999 Years 2.82 $26.7305 $75.38 1/1/2014 0.00 $75.38 9 1/1/2014
T
TECHNICAL
COMPONENT 76512 0 20 Years 1.24 $28.0672 $34.80 1/1/2014 0.00 $34.80 9 1/1/2014
T
TECHNICAL
COMPONENT 76512 21 999 Years 1.24 $26.7305 $33.15 1/1/2014 0.00 $33.15 9 1/1/2014
4 RADIOLOGY 76513 0 20 Years 2.93 $28.0672 $82.24 1/1/2014 0.00 $82.24 9 1/1/2014
4 RADIOLOGY 76513 21 999 Years 2.93 $26.7305 $78.32 1/1/2014 0.00 $78.32 9 1/1/2014
T
TECHNICAL
COMPONENT 76513 0 20 Years 1.88 $28.0672 $52.77 1/1/2014 0.00 $52.77 9 1/1/2014
T
TECHNICAL
COMPONENT 76513 21 999 Years 1.88 $26.7305 $50.25 1/1/2014 0.00 $50.25 9 1/1/2014
4 RADIOLOGY 76514 0 20 Years 0.45 $28.0672 $12.63 1/1/2014 0.00 $12.63 9 1/1/2014
4 RADIOLOGY 76514 21 999 Years 0.45 $26.7305 $12.03 1/1/2014 0.00 $12.03 9 1/1/2014
T
TECHNICAL
COMPONENT 76514 0 20 Years 0.17 $28.0672 $4.77 1/1/2014 0.00 $4.77 9 1/1/2014
T
TECHNICAL
COMPONENT 76514 21 999 Years 0.17 $26.7305 $4.54 1/1/2014 0.00 $4.54 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 76516 0 20 Years 2.38 $28.0672 $66.80 1/1/2014 0.00 $66.80 9 1/1/2014
4 RADIOLOGY 76516 21 999 Years 2.38 $26.7305 $63.62 1/1/2014 0.00 $63.62 9 1/1/2014
T
TECHNICAL
COMPONENT 76516 0 20 Years 1.48 $28.0672 $41.54 1/1/2014 0.00 $41.54 9 1/1/2014
T
TECHNICAL
COMPONENT 76516 21 999 Years 1.48 $26.7305 $39.56 1/1/2014 0.00 $39.56 9 1/1/2014
4 RADIOLOGY 76519 0 20 Years 2.58 $28.0672 $72.41 1/1/2014 0.00 $72.41 9 1/1/2014
4 RADIOLOGY 76519 21 999 Years 2.58 $26.7305 $68.96 1/1/2014 0.00 $68.96 9 1/1/2014
T
TECHNICAL
COMPONENT 76519 0 20 Years 1.65 $28.0672 $46.31 1/1/2014 0.00 $46.31 9 1/1/2014
T
TECHNICAL
COMPONENT 76519 21 999 Years 1.65 $26.7305 $44.11 1/1/2014 0.00 $44.11 9 1/1/2014
4 RADIOLOGY 76529 0 20 Years 2.42 $28.0672 $67.92 1/1/2014 0.00 $67.92 9 1/1/2014
4 RADIOLOGY 76529 21 999 Years 2.42 $26.7305 $64.69 1/1/2014 0.00 $64.69 9 1/1/2014
T
TECHNICAL
COMPONENT 76529 0 20 Years 1.45 $28.0672 $40.70 1/1/2014 0.00 $40.70 9 1/1/2014
T
TECHNICAL
COMPONENT 76529 21 999 Years 1.45 $26.7305 $38.76 1/1/2014 0.00 $38.76 9 1/1/2014
4 RADIOLOGY 76536 0 20 Years 3.67 $28.0672 $103.01 1/1/2014 0.00 $103.01 1/1/2014
4 RADIOLOGY 76536 21 999 Years 3.67 $26.7305 $98.10 1/1/2014 0.00 $98.10 1/1/2014
T
TECHNICAL
COMPONENT 76536 0 20 Years 2.87 $28.0672 $80.55 1/1/2014 0.00 $80.55 1/1/2014
T
TECHNICAL
COMPONENT 76536 21 999 Years 2.87 $26.7305 $76.72 1/1/2014 0.00 $76.72 1/1/2014
4 RADIOLOGY 76604 0 20 Years 2.64 $28.0672 $74.10 1/1/2014 0.00 $74.10 1/1/2014
4 RADIOLOGY 76604 21 999 Years 2.64 $26.7305 $70.57 1/1/2014 0.00 $70.57 1/1/2014
T
TECHNICAL
COMPONENT 76604 0 20 Years 1.86 $28.0672 $52.20 1/1/2014 0.00 $52.20 1/1/2014
T
TECHNICAL
COMPONENT 76604 21 999 Years 1.86 $26.7305 $49.72 1/1/2014 0.00 $49.72 1/1/2014
T
TECHNICAL
COMPONENT 76641 0 20 Years 2.01 $28.0672 $56.42 1/1/2015 0.00 $56.42 9 7/1/2015
T
TECHNICAL
COMPONENT 76641 21 999 Years 2.01 $26.7305 $53.73 1/1/2015 0.00 $53.73 9 7/1/2015
T
TECHNICAL
COMPONENT 76642 0 20 Years 1.54 $28.0672 $43.22 1/1/2015 0.00 $43.22 9 7/1/2015
T
TECHNICAL
COMPONENT 76642 21 999 Years 1.54 $26.7305 $41.16 1/1/2015 0.00 $41.16 9 7/1/2015
4 RADIOLOGY 76700 0 20 Years 4.21 $28.0672 $118.16 1/1/2014 0.00 $118.16 1/1/2014
4 RADIOLOGY 76700 21 999 Years 4.21 $26.7305 $112.54 1/1/2014 0.00 $112.54 1/1/2014
T
TECHNICAL
COMPONENT 76700 0 20 Years 3.06 $28.0672 $85.89 1/1/2014 0.00 $85.89 1/1/2014
T
TECHNICAL
COMPONENT 76700 21 999 Years 3.06 $26.7305 $81.80 1/1/2014 0.00 $81.80 1/1/2014
4 RADIOLOGY 76705 0 20 Years 3.24 $28.0672 $90.94 1/1/2014 0.00 $90.94 1/1/2014
4 RADIOLOGY 76705 21 999 Years 3.24 $26.7305 $86.61 1/1/2014 0.00 $86.61 1/1/2014
T
TECHNICAL
COMPONENT 76705 0 20 Years 2.41 $28.0672 $67.64 1/1/2014 0.00 $67.64 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 76705 21 999 Years 2.41 $26.7305 $64.42 1/1/2014 0.00 $64.42 1/1/2014
4 RADIOLOGY 76770 0 20 Years 3.97 $28.0672 $111.43 1/1/2014 0.00 $111.43 1/1/2014
4 RADIOLOGY 76770 21 999 Years 3.97 $26.7305 $106.12 1/1/2014 0.00 $106.12 1/1/2014
T
TECHNICAL
COMPONENT 76770 0 20 Years 2.92 $28.0672 $81.96 1/1/2014 0.00 $81.96 1/1/2014
T
TECHNICAL
COMPONENT 76770 21 999 Years 2.92 $26.7305 $78.05 1/1/2014 0.00 $78.05 1/1/2014
4 RADIOLOGY 76775 0 20 Years 3.26 $28.0672 $91.50 1/1/2014 0.00 $91.50 1/1/2014
4 RADIOLOGY 76775 21 999 Years 3.26 $26.7305 $87.14 1/1/2014 0.00 $87.14 1/1/2014
T
TECHNICAL
COMPONENT 76775 0 20 Years 2.44 $28.0672 $68.48 1/1/2014 0.00 $68.48 1/1/2014
T
TECHNICAL
COMPONENT 76775 21 999 Years 2.44 $26.7305 $65.22 1/1/2014 0.00 $65.22 1/1/2014
4 RADIOLOGY 76776 0 20 Years 4.60 $28.0672 $129.11 1/1/2014 0.00 $129.11 1/1/2014
4 RADIOLOGY 76776 21 999 Years 4.60 $26.7305 $122.96 1/1/2014 0.00 $122.96 1/1/2014
T
TECHNICAL
COMPONENT 76776 0 20 Years 3.53 $28.0672 $99.08 1/1/2014 0.00 $99.08 1/1/2014
T
TECHNICAL
COMPONENT 76776 21 999 Years 3.53 $26.7305 $94.36 1/1/2014 0.00 $94.36 1/1/2014
4 RADIOLOGY 76800 0 20 Years 3.92 $28.0672 $110.02 1/1/2014 0.00 $110.02 1/1/2014
4 RADIOLOGY 76800 21 999 Years 3.92 $26.7305 $104.78 1/1/2014 0.00 $104.78 1/1/2014
T
TECHNICAL
COMPONENT 76800 0 20 Years 2.32 $28.0672 $65.12 1/1/2014 0.00 $65.12 1/1/2014
T
TECHNICAL
COMPONENT 76800 21 999 Years 2.32 $26.7305 $62.01 1/1/2014 0.00 $62.01 1/1/2014
4 RADIOLOGY 76801 10 20 Years 3.79 $28.0672 $106.37 1/1/2014 0.00 $106.37 9 1/1/2014
4 RADIOLOGY 76801 21 55 Years 3.79 $26.7305 $101.31 1/1/2014 0.00 $101.31 9 1/1/2014
T
TECHNICAL
COMPONENT 76801 10 20 Years 2.38 $28.0672 $66.80 1/1/2014 0.00 $66.80 9 1/1/2014
T
TECHNICAL
COMPONENT 76801 21 55 Years 2.38 $26.7305 $63.62 1/1/2014 0.00 $63.62 9 1/1/2014
4 RADIOLOGY 76802 10 20 Years 1.97 $28.0672 $55.29 1/1/2014 0.00 $55.29 9 1/1/2014
4 RADIOLOGY 76802 21 55 Years 1.97 $26.7305 $52.66 1/1/2014 0.00 $52.66 9 1/1/2014
T
TECHNICAL
COMPONENT 76802 10 20 Years 0.78 $28.0672 $21.89 1/1/2014 0.00 $21.89 9 1/1/2014
T
TECHNICAL
COMPONENT 76802 21 55 Years 0.78 $26.7305 $20.85 1/1/2014 0.00 $20.85 9 1/1/2014
4 RADIOLOGY 76805 10 20 Years 4.43 $28.0672 $124.34 1/1/2014 0.00 $124.34 9 1/1/2014
4 RADIOLOGY 76805 21 55 Years 4.43 $26.7305 $118.42 1/1/2014 0.00 $118.42 9 1/1/2014
T
TECHNICAL
COMPONENT 76805 10 20 Years 3.01 $28.0672 $84.48 1/1/2014 0.00 $84.48 9 1/1/2014
T
TECHNICAL
COMPONENT 76805 21 55 Years 3.01 $26.7305 $80.46 1/1/2014 0.00 $80.46 9 1/1/2014
4 RADIOLOGY 76810 10 20 Years 2.89 $28.0672 $81.11 1/1/2014 0.00 $81.11 9 1/1/2014
4 RADIOLOGY 76810 21 55 Years 2.89 $26.7305 $77.25 1/1/2014 0.00 $77.25 9 1/1/2014
T
TECHNICAL
COMPONENT 76810 10 20 Years 1.49 $28.0672 $41.82 1/1/2014 0.00 $41.82 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 76810 21 55 Years 1.49 $26.7305 $39.83 1/1/2014 0.00 $39.83 9 1/1/2014
4 RADIOLOGY 76811 10 20 Years 5.57 $28.0672 $156.33 1/1/2014 0.00 $156.33 9 1/1/2014
4 RADIOLOGY 76811 21 55 Years 5.57 $26.7305 $148.89 1/1/2014 0.00 $148.89 9 1/1/2014
T
TECHNICAL
COMPONENT 76811 10 20 Years 2.82 $28.0672 $79.15 1/1/2014 0.00 $79.15 9 1/1/2014
T
TECHNICAL
COMPONENT 76811 21 55 Years 2.82 $26.7305 $75.38 1/1/2014 0.00 $75.38 9 1/1/2014
4 RADIOLOGY 76812 10 20 Years 6.36 $28.0672 $178.51 1/1/2014 0.00 $178.51 9 1/1/2014
4 RADIOLOGY 76812 21 55 Years 6.36 $26.7305 $170.01 1/1/2014 0.00 $170.01 9 1/1/2014
T
TECHNICAL
COMPONENT 76812 10 20 Years 3.77 $28.0672 $105.81 1/1/2014 0.00 $105.81 9 1/1/2014
T
TECHNICAL
COMPONENT 76812 21 55 Years 3.77 $26.7305 $100.77 1/1/2014 0.00 $100.77 9 1/1/2014
4 RADIOLOGY 76813 10 20 Years 3.65 $28.0672 $102.45 1/1/2014 0.00 $102.45 9 1/1/2014
4 RADIOLOGY 76813 21 55 Years 3.65 $26.7305 $97.57 1/1/2014 0.00 $97.57 9 1/1/2014
T
TECHNICAL
COMPONENT 76813 10 20 Years 1.94 $28.0672 $54.45 1/1/2014 0.00 $54.45 1/1/2014
T
TECHNICAL
COMPONENT 76813 21 55 Years 1.94 $26.7305 $51.86 1/1/2014 0.00 $51.86 1/1/2014
4 RADIOLOGY 76814 10 20 Years 2.37 $28.0672 $66.52 1/1/2014 0.00 $66.52 9 1/1/2014
4 RADIOLOGY 76814 21 55 Years 2.37 $26.7305 $63.35 1/1/2014 0.00 $63.35 9 1/1/2014
T
TECHNICAL
COMPONENT 76814 10 20 Years 0.93 $28.0672 $26.10 1/1/2014 0.00 $26.10 1/1/2014
T
TECHNICAL
COMPONENT 76814 21 55 Years 0.93 $26.7305 $24.86 1/1/2014 0.00 $24.86 1/1/2014
4 RADIOLOGY 76815 10 20 Years 2.70 $28.0672 $75.78 1/1/2014 0.00 $75.78 9 1/1/2014
4 RADIOLOGY 76815 21 55 Years 2.70 $26.7305 $72.17 1/1/2014 0.00 $72.17 9 1/1/2014
T
TECHNICAL
COMPONENT 76815 10 20 Years 1.79 $28.0672 $50.24 1/1/2014 0.00 $50.24 9 1/1/2014
T
TECHNICAL
COMPONENT 76815 21 55 Years 1.79 $26.7305 $47.85 1/1/2014 0.00 $47.85 9 1/1/2014
4 RADIOLOGY 76816 10 20 Years 3.55 $28.0672 $99.64 1/1/2014 0.00 $99.64 9 1/1/2014
4 RADIOLOGY 76816 21 55 Years 3.55 $26.7305 $94.89 1/1/2014 0.00 $94.89 9 1/1/2014
T
TECHNICAL
COMPONENT 76816 10 20 Years 2.32 $28.0672 $65.12 1/1/2014 0.00 $65.12 9 1/1/2014
T
TECHNICAL
COMPONENT 76816 21 55 Years 2.32 $26.7305 $62.01 1/1/2014 0.00 $62.01 9 1/1/2014
4 RADIOLOGY 76817 10 20 Years 3.06 $28.0672 $85.89 1/1/2014 0.00 $85.89 9 1/1/2014
4 RADIOLOGY 76817 21 55 Years 3.06 $26.7305 $81.80 1/1/2014 0.00 $81.80 9 1/1/2014
T
TECHNICAL
COMPONENT 76817 10 20 Years 1.98 $28.0672 $55.57 1/1/2014 0.00 $55.57 9 1/1/2014
T
TECHNICAL
COMPONENT 76817 21 55 Years 1.98 $26.7305 $52.93 1/1/2014 0.00 $52.93 9 1/1/2014
4 RADIOLOGY 76818 10 20 Years 3.70 $28.0672 $103.85 1/1/2014 0.00 $103.85 9 1/1/2014
4 RADIOLOGY 76818 21 55 Years 3.70 $26.7305 $98.90 1/1/2014 0.00 $98.90 9 1/1/2014
T
TECHNICAL
COMPONENT 76818 10 20 Years 2.18 $28.0672 $61.19 1/1/2014 0.00 $61.19 9 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 76818 21 55 Years 2.18 $26.7305 $58.27 1/1/2014 0.00 $58.27 9 1/1/2014
4 RADIOLOGY 76819 10 20 Years 2.69 $28.0672 $75.50 1/1/2014 0.00 $75.50 9 1/1/2014
4 RADIOLOGY 76819 21 55 Years 2.69 $26.7305 $71.91 1/1/2014 0.00 $71.91 9 1/1/2014
T
TECHNICAL
COMPONENT 76819 10 20 Years 1.58 $28.0672 $44.35 1/1/2014 0.00 $44.35 9 1/1/2014
T
TECHNICAL
COMPONENT 76819 21 55 Years 1.58 $26.7305 $42.23 1/1/2014 0.00 $42.23 9 1/1/2014
4 RADIOLOGY 76820 10 20 Years 1.20 $28.0672 $33.68 1/1/2014 0.00 $33.68 9 1/1/2014
4 RADIOLOGY 76820 21 55 Years 1.20 $26.7305 $32.08 1/1/2014 0.00 $32.08 9 1/1/2014
T
TECHNICAL
COMPONENT 76820 10 20 Years 0.48 $28.0672 $13.47 1/1/2014 0.00 $13.47 9 1/1/2014
T
TECHNICAL
COMPONENT 76820 21 55 Years 0.48 $26.7305 $12.83 1/1/2014 0.00 $12.83 9 1/1/2014
4 RADIOLOGY 76821 10 20 Years 2.85 $28.0672 $79.99 1/1/2014 0.00 $79.99 9 1/1/2014
4 RADIOLOGY 76821 21 55 Years 2.85 $26.7305 $76.18 1/1/2014 0.00 $76.18 9 1/1/2014
T
TECHNICAL
COMPONENT 76821 10 20 Years 1.83 $28.0672 $51.36 1/1/2014 0.00 $51.36 9 1/1/2014
T
TECHNICAL
COMPONENT 76821 21 55 Years 1.83 $26.7305 $48.92 1/1/2014 0.00 $48.92 9 1/1/2014
4 RADIOLOGY 76825 10 20 Years 6.52 $28.0672 $183.00 1/1/2014 0.00 $183.00 9 1/1/2014
4 RADIOLOGY 76825 21 55 Years 6.52 $26.7305 $174.28 1/1/2014 0.00 $174.28 9 1/1/2014
T
TECHNICAL
COMPONENT 76825 10 20 Years 4.14 $28.0672 $116.20 1/1/2014 0.00 $116.20 9 1/1/2014
T
TECHNICAL
COMPONENT 76825 21 55 Years 4.14 $26.7305 $110.66 1/1/2014 0.00 $110.66 9 1/1/2014
4 RADIOLOGY 76826 10 20 Years 3.93 $28.0672 $110.30 1/1/2014 0.00 $110.30 9 1/1/2014
4 RADIOLOGY 76826 21 55 Years 3.93 $26.7305 $105.05 1/1/2014 0.00 $105.05 9 1/1/2014
T
TECHNICAL
COMPONENT 76826 10 20 Years 2.74 $28.0672 $76.90 1/1/2014 0.00 $76.90 9 1/1/2014
T
TECHNICAL
COMPONENT 76826 21 55 Years 2.74 $26.7305 $73.24 1/1/2014 0.00 $73.24 9 1/1/2014
4 RADIOLOGY 76827 10 20 Years 1.78 $28.0672 $49.96 1/1/2014 0.00 $49.96 9 1/1/2014
4 RADIOLOGY 76827 21 55 Years 1.78 $26.7305 $47.58 1/1/2014 0.00 $47.58 9 1/1/2014
T
TECHNICAL
COMPONENT 76827 10 20 Years 0.96 $28.0672 $26.94 1/1/2014 0.00 $26.94 9 1/1/2014
T
TECHNICAL
COMPONENT 76827 21 55 Years 0.96 $26.7305 $25.66 1/1/2014 0.00 $25.66 9 1/1/2014
4 RADIOLOGY 76828 10 20 Years 1.32 $28.0672 $37.05 1/1/2014 0.00 $37.05 9 1/1/2014
4 RADIOLOGY 76828 21 55 Years 1.32 $26.7305 $35.28 1/1/2014 0.00 $35.28 9 1/1/2014
T
TECHNICAL
COMPONENT 76828 10 20 Years 0.52 $28.0672 $14.59 1/1/2014 0.00 $14.59 9 1/1/2014
T
TECHNICAL
COMPONENT 76828 21 55 Years 0.52 $26.7305 $13.90 1/1/2014 0.00 $13.90 9 1/1/2014
4 RADIOLOGY 76830 0 20 Years 3.46 $28.0672 $97.11 1/1/2016 0.00 $97.11 9 3.46 $28.0672 $97.11 1/1/2016 0.00 $97.11 9 1/1/2016
4 RADIOLOGY 76830 21 999 Years 3.46 $26.7305 $92.49 1/1/2016 0.00 $92.49 9 3.46 $26.7305 $92.49 1/1/2016 0.00 $92.49 9 1/1/2016
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 76830 0 20 Years 1.00 $28.0672 $28.07 1/1/2016 0.00 $28.07 1.00 $28.0672 $28.07 1/1/2016 0.00 $28.07 1/1/2016
I
PROFESSIONAL
COMPONENT 76830 21 999 Years 1.00 $26.7305 $26.73 1/1/2016 0.00 $26.73 1.00 $26.7305 $26.73 1/1/2016 0.00 $26.73 1/1/2016
T
TECHNICAL
COMPONENT 76830 0 20 Years 2.46 $28.0672 $69.05 1/1/2016 0.00 $69.05 1/1/2016
T
TECHNICAL
COMPONENT 76830 21 999 Years 2.46 $26.7305 $65.76 1/1/2016 0.00 $65.76 1/1/2016
4 RADIOLOGY 76831 0 20 Years 3.79 $28.0672 $106.37 1/1/2014 0.00 $106.37 3.79 $28.0672 $106.37 1/1/2014 0.00 $106.37 1/1/2014
4 RADIOLOGY 76831 21 999 Years 3.79 $26.7305 $101.31 1/1/2014 0.00 $101.31 3.79 $26.7305 $101.31 1/1/2014 0.00 $101.31 1/1/2014
T
TECHNICAL
COMPONENT 76831 0 20 Years 2.74 $28.0672 $76.90 1/1/2014 0.00 $76.90 1/1/2014
T
TECHNICAL
COMPONENT 76831 21 999 Years 2.74 $26.7305 $73.24 1/1/2014 0.00 $73.24 1/1/2014
4 RADIOLOGY 76856 0 20 Years 3.10 $28.0672 $87.01 1/1/2016 0.00 $87.01 1/1/2016
4 RADIOLOGY 76856 21 999 Years 3.10 $26.7305 $82.86 1/1/2016 0.00 $82.86 1/1/2016
T
TECHNICAL
COMPONENT 76856 0 20 Years 2.13 $28.0672 $59.78 1/1/2016 0.00 $59.78 1/1/2016
T
TECHNICAL
COMPONENT 76856 21 999 Years 2.13 $26.7305 $56.94 1/1/2016 0.00 $56.94 1/1/2016
4 RADIOLOGY 76857 0 20 Years 1.33 $28.0672 $37.33 1/1/2016 0.00 $37.33 1/1/2016
4 RADIOLOGY 76857 21 999 Years 1.33 $26.7305 $35.55 1/1/2016 0.00 $35.55 1/1/2016
T
TECHNICAL
COMPONENT 76857 0 20 Years 0.64 $28.0672 $17.96 1/1/2016 0.00 $17.96 1/1/2016
T
TECHNICAL
COMPONENT 76857 21 999 Years 0.64 $26.7305 $17.11 1/1/2016 0.00 $17.11 1/1/2016
4 RADIOLOGY 76870 0 20 Years 3.73 $28.0672 $104.69 1/1/2014 0.00 $104.69 1/1/2014
4 RADIOLOGY 76870 21 999 Years 3.73 $26.7305 $99.70 1/1/2014 0.00 $99.70 1/1/2014
T
TECHNICAL
COMPONENT 76870 0 20 Years 2.82 $28.0672 $79.15 1/1/2014 0.00 $79.15 1/1/2014
T
TECHNICAL
COMPONENT 76870 21 999 Years 2.82 $26.7305 $75.38 1/1/2014 0.00 $75.38 1/1/2014
4 RADIOLOGY 76872 0 20 Years 2.16 $28.0672 $60.63 1/1/2014 0.00 $60.63 1/1/2014
4 RADIOLOGY 76872 21 999 Years 2.16 $26.7305 $57.74 1/1/2014 0.00 $57.74 1/1/2014
T
TECHNICAL
COMPONENT 76872 0 20 Years 1.19 $28.0672 $33.40 1/1/2014 0.00 $33.40 1/1/2014
T
TECHNICAL
COMPONENT 76872 21 999 Years 1.19 $26.7305 $31.81 1/1/2014 0.00 $31.81 1/1/2014
4 RADIOLOGY 76873 0 20 Years 5.09 $28.0672 $142.86 1/1/2014 0.00 $142.86 1/1/2014
4 RADIOLOGY 76873 21 999 Years 5.09 $26.7305 $136.06 1/1/2014 0.00 $136.06 1/1/2014
T
TECHNICAL
COMPONENT 76873 0 20 Years 2.86 $28.0672 $80.27 1/1/2014 0.00 $80.27 1/1/2014
T
TECHNICAL
COMPONENT 76873 21 999 Years 2.86 $26.7305 $76.45 1/1/2014 0.00 $76.45 1/1/2014
4 RADIOLOGY 76881 0 20 Years 3.29 $28.0672 $92.34 1/1/2016 0.00 $92.34 1/1/2016
4 RADIOLOGY 76881 21 999 Years 3.29 $26.7305 $87.94 1/1/2016 0.00 $87.94 1/1/2016
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 76881 0 20 Years 2.39 $28.0672 $67.08 1/1/2016 0.00 $67.08 1/1/2016
T
TECHNICAL
COMPONENT 76881 21 999 Years 2.39 $26.7305 $63.89 1/1/2016 0.00 $63.89 1/1/2016
4 RADIOLOGY 76882 0 20 Years 1.02 $28.0672 $28.63 1/1/2016 0.00 $28.63 1/1/2016
4 RADIOLOGY 76882 21 999 Years 1.02 $26.7305 $27.27 1/1/2016 0.00 $27.27 1/1/2016
T
TECHNICAL
COMPONENT 76882 0 20 Years 0.32 $28.0672 $8.98 1/1/2016 0.00 $8.98 10/1/2014
T
TECHNICAL
COMPONENT 76882 21 999 Years 0.32 $26.7305 $8.55 1/1/2016 0.00 $8.55 10/1/2014
4 RADIOLOGY 76885 0 365 Days 4.47 $28.0672 $125.46 1/1/2014 0.00 $125.46 1/1/2014
T
TECHNICAL
COMPONENT 76885 0 365 Days 3.42 $28.0672 $95.99 1/1/2014 0.00 $95.99 1/1/2014
4 RADIOLOGY 76886 0 365 Days 3.16 $28.0672 $88.69 1/1/2014 0.00 $88.69 1/1/2014
T
TECHNICAL
COMPONENT 76886 0 365 Days 2.30 $28.0672 $64.55 1/1/2014 0.00 $64.55 1/1/2014
4 RADIOLOGY 76930 0 20 Years 2.52 $28.0672 $70.73 1/1/2014 0.00 $70.73 9 1/1/2014
4 RADIOLOGY 76930 21 999 Years 2.52 $26.7305 $67.36 1/1/2014 0.00 $67.36 9 1/1/2014
T
TECHNICAL
COMPONENT 76930 0 20 Years 1.60 $28.0672 $44.91 1/1/2014 0.00 $44.91 9 1/1/2014
T
TECHNICAL
COMPONENT 76930 21 999 Years 1.60 $26.7305 $42.77 1/1/2014 0.00 $42.77 9 1/1/2014
4 RADIOLOGY 76932 0 20 Years 0.00 $0.0000 $81.02 1/1/2014 0.00 $81.02 1/1/2014
4 RADIOLOGY 76932 21 999 Years 0.00 $0.0000 $77.16 1/1/2014 0.00 $77.16 1/1/2014
T
TECHNICAL
COMPONENT 76932 0 20 Years 0.00 $0.0000 $54.36 1/1/2014 0.00 $54.36 1/1/2014
T
TECHNICAL
COMPONENT 76932 21 999 Years 0.00 $0.0000 $51.77 1/1/2014 0.00 $51.77 1/1/2014
4 RADIOLOGY 76936 0 20 Years 8.43 $28.0672 $236.61 1/1/2014 0.00 $236.61 1/1/2014
4 RADIOLOGY 76936 21 999 Years 8.43 $26.7305 $225.34 1/1/2014 0.00 $225.34 1/1/2014
T
TECHNICAL
COMPONENT 76936 0 20 Years 5.59 $28.0672 $156.90 1/1/2014 0.00 $156.90 1/1/2014
T
TECHNICAL
COMPONENT 76936 21 999 Years 5.59 $26.7305 $149.42 1/1/2014 0.00 $149.42 1/1/2014
4 RADIOLOGY 76937 0 20 Years 1.07 $28.0672 $30.03 1/1/2014 0.00 $30.03 1/1/2014
4 RADIOLOGY 76937 21 999 Years 1.07 $26.7305 $28.60 1/1/2014 0.00 $28.60 1/1/2014
T
TECHNICAL
COMPONENT 76937 0 20 Years 0.64 $28.0672 $17.96 1/1/2014 0.00 $17.96 1/1/2014
T
TECHNICAL
COMPONENT 76937 21 999 Years 0.64 $26.7305 $17.11 1/1/2014 0.00 $17.11 1/1/2014
4 RADIOLOGY 76940 0 20 Years 0.00 $0.0000 $146.51 1/1/2014 0.00 $146.51 1/1/2014
4 RADIOLOGY 76940 21 999 Years 0.00 $0.0000 $139.53 1/1/2014 0.00 $139.53 1/1/2014
T
TECHNICAL
COMPONENT 76940 0 20 Years 0.00 $0.0000 $61.75 1/1/2014 0.00 $61.75 1/1/2014
T
TECHNICAL
COMPONENT 76940 21 999 Years 0.00 $0.0000 $58.80 1/1/2014 0.00 $58.80 1/1/2014
4 RADIOLOGY 76941 10 20 Years 0.00 $0.0000 $110.53 1/1/2014 0.00 $110.53 1/1/2014
4 RADIOLOGY 76941 21 55 Years 0.00 $0.0000 $105.26 1/1/2014 0.00 $105.26 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 76941 10 20 Years 0.00 $0.0000 $53.83 1/1/2014 0.00 $53.83 9 1/1/2014
T
TECHNICAL
COMPONENT 76941 21 55 Years 0.00 $0.0000 $51.26 1/1/2014 0.00 $51.26 9 1/1/2014
4 RADIOLOGY 76942 0 20 Years 6.13 $28.0672 $172.05 1/1/2014 0.00 $172.05 9 1/1/2014
4 RADIOLOGY 76942 21 999 Years 6.13 $26.7305 $163.86 1/1/2014 0.00 $163.86 9 1/1/2014
T
TECHNICAL
COMPONENT 76942 0 20 Years 5.17 $28.0672 $145.11 1/1/2014 0.00 $145.11 1/1/2014
T
TECHNICAL
COMPONENT 76942 21 999 Years 5.17 $26.7305 $138.20 1/1/2014 0.00 $138.20 1/1/2014
T
TECHNICAL
COMPONENT 76945 10 20 Years 0.00 $0.0000 $53.85 1/1/2014 0.00 $53.85 1/1/2014
T
TECHNICAL
COMPONENT 76945 21 55 Years 0.00 $0.0000 $51.29 1/1/2014 0.00 $51.29 1/1/2014
4 RADIOLOGY 76946 10 20 Years 0.96 $28.0672 $26.94 1/1/2014 0.00 $26.94 1/1/2014
4 RADIOLOGY 76946 21 55 Years 0.96 $26.7305 $25.66 1/1/2014 0.00 $25.66 1/1/2014
T
TECHNICAL
COMPONENT 76946 10 20 Years 0.41 $28.0672 $11.51 1/1/2014 0.00 $11.51 9 1/1/2014
T
TECHNICAL
COMPONENT 76946 21 55 Years 0.41 $26.7305 $10.96 1/1/2014 0.00 $10.96 9 1/1/2014
4 RADIOLOGY 76965 0 20 Years 2.64 $28.0672 $74.10 1/1/2014 0.00 $74.10 1/1/2014
4 RADIOLOGY 76965 21 999 Years 2.64 $26.7305 $70.57 1/1/2014 0.00 $70.57 1/1/2014
T
TECHNICAL
COMPONENT 76965 0 20 Years 0.72 $28.0672 $20.21 1/1/2014 0.00 $20.21 1/1/2014
T
TECHNICAL
COMPONENT 76965 21 999 Years 0.72 $26.7305 $19.25 1/1/2014 0.00 $19.25 1/1/2014
4 RADIOLOGY 76970 0 20 Years 3.02 $28.0672 $84.76 1/1/2014 0.00 $84.76 1/1/2014
4 RADIOLOGY 76970 21 999 Years 3.02 $26.7305 $80.73 1/1/2014 0.00 $80.73 1/1/2014
T
TECHNICAL
COMPONENT 76970 0 20 Years 2.43 $28.0672 $68.20 1/1/2014 0.00 $68.20 1/1/2014
T
TECHNICAL
COMPONENT 76970 21 999 Years 2.43 $26.7305 $64.96 1/1/2014 0.00 $64.96 1/1/2014
4 RADIOLOGY 76975 0 20 Years 0.00 $0.0000 $89.92 1/1/2014 0.00 $89.92 1/1/2014
4 RADIOLOGY 76975 21 999 Years 0.00 $0.0000 $85.64 1/1/2014 0.00 $85.64 1/1/2014
T
TECHNICAL
COMPONENT 76975 0 20 Years 0.00 $0.0000 $54.27 1/1/2014 0.00 $54.27 1/1/2014
T
TECHNICAL
COMPONENT 76975 21 999 Years 0.00 $0.0000 $51.69 1/1/2014 0.00 $51.69 1/1/2014
4 RADIOLOGY 76977 0 20 Years 0.21 $28.0672 $5.89 1/1/2014 0.00 $5.89 1/1/2014
4 RADIOLOGY 76977 21 999 Years 0.21 $26.7305 $5.61 1/1/2014 0.00 $5.61 1/1/2014
T
TECHNICAL
COMPONENT 76977 0 20 Years 0.13 $28.0672 $3.65 1/1/2014 0.00 $3.65 1/1/2014
T
TECHNICAL
COMPONENT 76977 21 999 Years 0.13 $26.7305 $3.47 1/1/2014 0.00 $3.47 1/1/2014
T
TECHNICAL
COMPONENT 76998 0 20 Years 0.00 $0.0000 $91.76 1/1/2014 0.00 $91.76 9 1/1/2014
T
TECHNICAL
COMPONENT 76998 21 999 Years 0.00 $0.0000 $87.40 1/1/2014 0.00 $87.40 9 1/1/2014
4 RADIOLOGY 76999 0 20 Years 0.00 $0.0000 $0.00 4/1/1992 -2.00 $0.00 9 5 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 76999 21 999 Years 0.00 $0.0000 $0.00 4/1/1992 -2.00 $0.00 9 5 1/1/2014
T
TECHNICAL
COMPONENT 76999 0 20 Years 0.00 $0.0000 $0.00 1/1/2010 -2.00 $0.00 9 5 1/1/2014
T
TECHNICAL
COMPONENT 76999 21 999 Years 0.00 $0.0000 $0.00 1/1/2010 -2.00 $0.00 9 5 1/1/2014
4 RADIOLOGY 77001 0 20 Years 1.97 $28.0672 $55.29 11/1/2015 0.00 $55.29 11/1/2015
4 RADIOLOGY 77001 21 999 Years 1.97 $26.7305 $52.66 11/1/2015 0.00 $52.66 11/1/2015
T
TECHNICAL
COMPONENT 77001 0 20 Years 1.44 $28.0672 $40.42 11/1/2015 0.00 $40.42 11/1/2015
T
TECHNICAL
COMPONENT 77001 21 999 Years 1.44 $26.7305 $38.49 11/1/2015 0.00 $38.49 11/1/2015
4 RADIOLOGY 77002 0 20 Years 2.59 $28.0672 $72.69 11/1/2015 0.00 $72.69 11/1/2015
4 RADIOLOGY 77002 21 999 Years 2.59 $26.7305 $69.23 11/1/2015 0.00 $69.23 11/1/2015
T
TECHNICAL
COMPONENT 77002 0 20 Years 1.80 $28.0672 $50.52 11/1/2015 0.00 $50.52 11/1/2015
T
TECHNICAL
COMPONENT 77002 21 999 Years 1.80 $26.7305 $48.11 11/1/2015 0.00 $48.11 11/1/2015
4 RADIOLOGY 77003 0 20 Years 2.40 $28.0672 $67.36 11/1/2015 0.00 $67.36 11/1/2015
4 RADIOLOGY 77003 21 999 Years 2.40 $26.7305 $64.15 11/1/2015 0.00 $64.15 11/1/2015
T
TECHNICAL
COMPONENT 77003 0 20 Years 1.54 $28.0672 $43.22 11/1/2015 0.00 $43.22 11/1/2015
T
TECHNICAL
COMPONENT 77003 21 999 Years 1.54 $26.7305 $41.16 11/1/2015 0.00 $41.16 11/1/2015
4 RADIOLOGY 77011 0 20 Years 6.17 $28.0672 $173.17 11/1/2015 0.00 $173.17 6.17 $28.0672 $173.17 11/1/2015 0.00 $173.17 11/1/2015
4 RADIOLOGY 77011 21 999 Years 6.17 $26.7305 $164.93 11/1/2015 0.00 $164.93 6.17 $26.7305 $164.93 11/1/2015 0.00 $164.93 11/1/2015
I
PROFESSIONAL
COMPONENT 77011 0 20 Years 1.75 $28.0672 $49.12 11/1/2015 0.00 $49.12 1.75 $28.0672 $49.12 11/1/2015 0.00 $49.12 11/1/2015
I
PROFESSIONAL
COMPONENT 77011 21 999 Years 1.75 $26.7305 $46.78 11/1/2015 0.00 $46.78 1.75 $26.7305 $46.78 11/1/2015 0.00 $46.78 11/1/2015
T
TECHNICAL
COMPONENT 77011 0 20 Years 4.42 $28.0672 $124.06 11/1/2015 0.00 $124.06 4.42 $28.0672 $124.06 11/1/2015 0.00 $124.06 11/1/2015
T
TECHNICAL
COMPONENT 77011 21 999 Years 4.42 $26.7305 $118.15 11/1/2015 0.00 $118.15 4.42 $26.7305 $118.15 11/1/2015 0.00 $118.15 11/1/2015
4 RADIOLOGY 77012 0 20 Years 3.50 $28.0672 $98.24 11/1/2015 0.00 $98.24 11/1/2015
4 RADIOLOGY 77012 21 999 Years 3.50 $26.7305 $93.56 11/1/2015 0.00 $93.56 11/1/2015
T
TECHNICAL
COMPONENT 77012 0 20 Years 1.87 $28.0672 $52.49 11/1/2015 0.00 $52.49 11/1/2015
T
TECHNICAL
COMPONENT 77012 21 999 Years 1.87 $26.7305 $49.99 11/1/2015 0.00 $49.99 11/1/2015
4 RADIOLOGY 77014 0 20 Years 3.28 $28.0672 $92.06 11/1/2015 0.00 $92.06 11/1/2015
4 RADIOLOGY 77014 21 999 Years 3.28 $26.7305 $87.68 11/1/2015 0.00 $87.68 11/1/2015
T
TECHNICAL
COMPONENT 77014 0 20 Years 2.05 $28.0672 $57.54 11/1/2015 0.00 $57.54 9 11/1/2015
T
TECHNICAL
COMPONENT 77014 21 999 Years 2.05 $26.7305 $54.80 11/1/2015 0.00 $54.80 9 11/1/2015
4 RADIOLOGY 77021 0 20 Years 11.55 $28.0672 $324.18 11/1/2015 0.00 $324.18 11/1/2015
4 RADIOLOGY 77021 21 999 Years 11.55 $26.7305 $308.74 11/1/2015 0.00 $308.74 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 77021 0 20 Years 9.40 $28.0672 $263.83 11/1/2015 0.00 $263.83 11/1/2015
T
TECHNICAL
COMPONENT 77021 21 999 Years 9.40 $26.7305 $251.27 11/1/2015 0.00 $251.27 11/1/2015
T
TECHNICAL
COMPONENT 77051 0 20 Years 0.16 $28.0672 $4.49 11/1/2015 0.00 $4.49 11/1/2015
T
TECHNICAL
COMPONENT 77051 21 999 Years 0.16 $26.7305 $4.28 11/1/2015 0.00 $4.28 11/1/2015
T
TECHNICAL
COMPONENT 77052 0 20 Years 0.16 $28.0672 $4.49 11/1/2015 0.00 $4.49 11/1/2015
T
TECHNICAL
COMPONENT 77052 21 999 Years 0.16 $26.7305 $4.28 11/1/2015 0.00 $4.28 11/1/2015
T
TECHNICAL
COMPONENT 77053 0 20 Years 1.26 $28.0672 $35.36 1/1/2014 0.00 $35.36 9 1/1/2014
T
TECHNICAL
COMPONENT 77053 21 999 Years 1.26 $26.7305 $33.68 1/1/2014 0.00 $33.68 9 1/1/2014
T
TECHNICAL
COMPONENT 77054 0 20 Years 1.73 $28.0672 $48.56 4/1/2014 0.00 $48.56 9 4/1/2014
T
TECHNICAL
COMPONENT 77054 21 999 Years 1.73 $26.7305 $46.24 4/1/2014 0.00 $46.24 9 4/1/2014
T
TECHNICAL
COMPONENT 77055 0 20 Years 1.52 $28.0672 $42.66 11/1/2015 0.00 $42.66 9 11/1/2015
T
TECHNICAL
COMPONENT 77055 21 999 Years 1.52 $26.7305 $40.63 11/1/2015 0.00 $40.63 9 11/1/2015
T
TECHNICAL
COMPONENT 77056 0 20 Years 2.00 $28.0672 $56.13 11/1/2015 0.00 $56.13 9 11/1/2015
T
TECHNICAL
COMPONENT 77056 21 999 Years 2.00 $26.7305 $53.46 11/1/2015 0.00 $53.46 9 11/1/2015
T
TECHNICAL
COMPONENT 77057 0 20 Years 1.31 $28.0672 $36.77 11/1/2015 0.00 $36.77 9 11/1/2015
T
TECHNICAL
COMPONENT 77057 21 999 Years 1.31 $26.7305 $35.02 11/1/2015 0.00 $35.02 9 11/1/2015
4 RADIOLOGY 77058 0 20 Years 15.18 $28.0672 $426.06 11/1/2015 0.00 $426.06 15.18 $28.0672 $426.06 11/1/2015 0.00 $426.06 11/1/2015
4 RADIOLOGY 77058 21 999 Years 15.18 $26.7305 $405.77 11/1/2015 0.00 $405.77 15.18 $26.7305 $405.77 11/1/2015 0.00 $405.77 11/1/2015
I
PROFESSIONAL
COMPONENT 77058 0 20 Years 2.33 $28.0672 $65.40 11/1/2015 0.00 $65.40 2.33 $28.0672 $65.40 11/1/2015 0.00 $65.40 11/1/2015
I
PROFESSIONAL
COMPONENT 77058 21 999 Years 2.33 $26.7305 $62.28 11/1/2015 0.00 $62.28 2.33 $26.7305 $62.28 11/1/2015 0.00 $62.28 11/1/2015
T
TECHNICAL
COMPONENT 77058 0 20 Years 12.85 $28.0672 $360.66 11/1/2015 0.00 $360.66 12.85 $28.0672 $360.66 11/1/2015 0.00 $360.66 11/1/2015
T
TECHNICAL
COMPONENT 77058 21 999 Years 12.85 $26.7305 $343.49 11/1/2015 0.00 $343.49 12.85 $26.7305 $343.49 11/1/2015 0.00 $343.49 11/1/2015
4 RADIOLOGY 77059 0 20 Years 15.02 $28.0672 $421.57 11/1/2015 0.00 $421.57 15.02 $28.0672 $421.57 11/1/2015 0.00 $421.57 11/1/2015
4 RADIOLOGY 77059 21 999 Years 15.02 $26.7305 $401.49 11/1/2015 0.00 $401.49 15.02 $26.7305 $401.49 11/1/2015 0.00 $401.49 11/1/2015
I
PROFESSIONAL
COMPONENT 77059 0 20 Years 2.33 $28.0672 $65.40 11/1/2015 0.00 $65.40 2.33 $28.0672 $65.40 11/1/2015 0.00 $65.40 11/1/2015
I
PROFESSIONAL
COMPONENT 77059 21 999 Years 2.33 $26.7305 $62.28 11/1/2015 0.00 $62.28 2.33 $26.7305 $62.28 11/1/2015 0.00 $62.28 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
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Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 77059 0 20 Years 12.69 $28.0672 $356.17 11/1/2015 0.00 $356.17 12.69 $28.0672 $356.17 11/1/2015 0.00 $356.17 11/1/2015
T
TECHNICAL
COMPONENT 77059 21 999 Years 12.69 $26.7305 $339.21 11/1/2015 0.00 $339.21 12.69 $26.7305 $339.21 11/1/2015 0.00 $339.21 11/1/2015
4 RADIOLOGY 77071 0 20 Years 1.54 $28.0672 $43.22 1/1/2014 0.00 $43.22 1/1/2014
4 RADIOLOGY 77071 21 999 Years 1.54 $26.7305 $41.16 1/1/2014 0.00 $41.16 1/1/2014
4 RADIOLOGY 77072 0 20 Years 0.70 $28.0672 $19.65 1/1/2014 0.00 $19.65 1/1/2014
4 RADIOLOGY 77072 21 999 Years 0.70 $26.7305 $18.71 1/1/2014 0.00 $18.71 1/1/2014
T
TECHNICAL
COMPONENT 77072 0 20 Years 0.43 $28.0672 $12.07 1/1/2014 0.00 $12.07 1/1/2014
T
TECHNICAL
COMPONENT 77072 21 999 Years 0.43 $26.7305 $11.49 1/1/2014 0.00 $11.49 1/1/2014
4 RADIOLOGY 77073 0 20 Years 1.16 $28.0672 $32.56 1/1/2014 0.00 $32.56 1/1/2014
4 RADIOLOGY 77073 21 999 Years 1.16 $26.7305 $31.01 1/1/2014 0.00 $31.01 1/1/2014
T
TECHNICAL
COMPONENT 77073 0 20 Years 0.73 $28.0672 $20.49 1/1/2014 0.00 $20.49 1/1/2014
T
TECHNICAL
COMPONENT 77073 21 999 Years 0.73 $26.7305 $19.51 1/1/2014 0.00 $19.51 1/1/2014
4 RADIOLOGY 77074 0 20 Years 2.10 $28.0672 $58.94 1/1/2014 0.00 $58.94 1/1/2014
4 RADIOLOGY 77074 21 999 Years 2.10 $26.7305 $56.13 1/1/2014 0.00 $56.13 1/1/2014
T
TECHNICAL
COMPONENT 77074 0 20 Years 1.46 $28.0672 $40.98 1/1/2014 0.00 $40.98 1/1/2014
T
TECHNICAL
COMPONENT 77074 21 999 Years 1.46 $26.7305 $39.03 1/1/2014 0.00 $39.03 1/1/2014
4 RADIOLOGY 77075 0 20 Years 3.18 $28.0672 $89.25 1/1/2014 0.00 $89.25 1/1/2014
4 RADIOLOGY 77075 21 999 Years 3.18 $26.7305 $85.00 1/1/2014 0.00 $85.00 1/1/2014
T
TECHNICAL
COMPONENT 77075 0 20 Years 2.41 $28.0672 $67.64 1/1/2014 0.00 $67.64 1/1/2014
T
TECHNICAL
COMPONENT 77075 21 999 Years 2.41 $26.7305 $64.42 1/1/2014 0.00 $64.42 1/1/2014
4 RADIOLOGY 77076 0 365 Days 3.18 $28.0672 $89.25 1/1/2014 0.00 $89.25 1/1/2014
T
TECHNICAL
COMPONENT 77076 0 365 Days 2.19 $28.0672 $61.47 1/1/2014 0.00 $61.47 1/1/2014
4 RADIOLOGY 77077 0 20 Years 1.22 $28.0672 $34.24 1/1/2014 0.00 $34.24 1/1/2014
4 RADIOLOGY 77077 21 999 Years 1.22 $26.7305 $32.61 1/1/2014 0.00 $32.61 1/1/2014
T
TECHNICAL
COMPONENT 77077 0 20 Years 0.73 $28.0672 $20.49 1/1/2014 0.00 $20.49 1/1/2014
T
TECHNICAL
COMPONENT 77077 21 999 Years 0.73 $26.7305 $19.51 1/1/2014 0.00 $19.51 1/1/2014
4 RADIOLOGY 77078 0 20 Years 3.93 $28.0672 $110.30 1/1/2014 0.00 $110.30 1/1/2014
4 RADIOLOGY 77078 21 999 Years 3.93 $26.7305 $105.05 1/1/2014 0.00 $105.05 1/1/2014
T
TECHNICAL
COMPONENT 77078 0 20 Years 3.58 $28.0672 $100.48 1/1/2014 0.00 $100.48 1/1/2014
T
TECHNICAL
COMPONENT 77078 21 999 Years 3.58 $26.7305 $95.70 1/1/2014 0.00 $95.70 1/1/2014
4 RADIOLOGY 77080 0 20 Years 1.48 $28.0672 $41.54 1/1/2014 0.00 $41.54 1/1/2014
4 RADIOLOGY 77080 21 999 Years 1.48 $26.7305 $39.56 1/1/2014 0.00 $39.56 1/1/2014
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 77080 0 20 Years 1.19 $28.0672 $33.40 1/1/2014 0.00 $33.40 1/1/2014
T
TECHNICAL
COMPONENT 77080 21 999 Years 1.19 $26.7305 $31.81 1/1/2014 0.00 $31.81 1/1/2014
4 RADIOLOGY 77081 0 20 Years 0.84 $28.0672 $23.58 1/1/2014 0.00 $23.58 1/1/2014
4 RADIOLOGY 77081 21 999 Years 0.84 $26.7305 $22.45 1/1/2014 0.00 $22.45 1/1/2014
T
TECHNICAL
COMPONENT 77081 0 20 Years 0.52 $28.0672 $14.59 1/1/2014 0.00 $14.59 1/1/2014
T
TECHNICAL
COMPONENT 77081 21 999 Years 0.52 $26.7305 $13.90 1/1/2014 0.00 $13.90 1/1/2014
4 RADIOLOGY 77084 0 20 Years 13.13 $28.0672 $368.52 1/1/2014 0.00 $368.52 13.13 $28.0672 $368.52 1/1/2014 0.00 $368.52 1/1/2014
4 RADIOLOGY 77084 21 999 Years 13.13 $26.7305 $350.97 1/1/2014 0.00 $350.97 13.13 $26.7305 $350.97 1/1/2014 0.00 $350.97 1/1/2014
I
PROFESSIONAL
COMPONENT 77084 0 20 Years 2.28 $28.0672 $63.99 1/1/2014 0.00 $63.99 2.28 $28.0672 $63.99 1/1/2014 0.00 $63.99 1/1/2014
I
PROFESSIONAL
COMPONENT 77084 21 999 Years 2.28 $26.7305 $60.95 1/1/2014 0.00 $60.95 2.28 $26.7305 $60.95 1/1/2014 0.00 $60.95 1/1/2014
T
TECHNICAL
COMPONENT 77084 0 20 Years 10.85 $28.0672 $304.53 1/1/2014 0.00 $304.53 10.85 $28.0672 $304.53 1/1/2014 0.00 $304.53 1/1/2014
T
TECHNICAL
COMPONENT 77084 21 999 Years 10.85 $26.7305 $290.03 1/1/2014 0.00 $290.03 10.85 $26.7305 $290.03 1/1/2014 0.00 $290.03 1/1/2014
4 RADIOLOGY 78012 0 20 Years 2.44 $28.0672 $68.48 1/1/2014 0.00 $68.48 1/1/2014
4 RADIOLOGY 78012 21 999 Years 2.44 $26.7305 $65.22 1/1/2014 0.00 $65.22 1/1/2014
T
TECHNICAL
COMPONENT 78012 0 20 Years 2.17 $28.0672 $60.91 1/1/2014 0.00 $60.91 1/1/2014
T
TECHNICAL
COMPONENT 78012 21 999 Years 2.17 $26.7305 $58.01 1/1/2014 0.00 $58.01 1/1/2014
4 RADIOLOGY 78013 0 20 Years 6.17 $28.0672 $173.17 1/1/2014 0.00 $173.17 1/1/2014
4 RADIOLOGY 78013 21 999 Years 6.17 $26.7305 $164.93 1/1/2014 0.00 $164.93 1/1/2014
T
TECHNICAL
COMPONENT 78013 0 20 Years 5.65 $28.0672 $158.58 1/1/2014 0.00 $158.58 1/1/2014
T
TECHNICAL
COMPONENT 78013 21 999 Years 5.65 $26.7305 $151.03 1/1/2014 0.00 $151.03 1/1/2014
4 RADIOLOGY 78014 0 20 Years 7.13 $28.0672 $200.12 1/1/2014 0.00 $200.12 1/1/2014
4 RADIOLOGY 78014 21 999 Years 7.13 $26.7305 $190.59 1/1/2014 0.00 $190.59 1/1/2014
T
TECHNICAL
COMPONENT 78014 0 20 Years 6.43 $28.0672 $180.47 1/1/2014 0.00 $180.47 1/1/2014
T
TECHNICAL
COMPONENT 78014 21 999 Years 6.43 $26.7305 $171.88 1/1/2014 0.00 $171.88 1/1/2014
4 RADIOLOGY 78015 0 20 Years 6.39 $28.0672 $179.35 11/1/2015 0.00 $179.35 11/1/2015
4 RADIOLOGY 78015 21 999 Years 6.39 $26.7305 $170.81 11/1/2015 0.00 $170.81 11/1/2015
T
TECHNICAL
COMPONENT 78015 0 20 Years 5.47 $28.0672 $153.53 11/1/2015 0.00 $153.53 11/1/2015
T
TECHNICAL
COMPONENT 78015 21 999 Years 5.47 $26.7305 $146.22 11/1/2015 0.00 $146.22 11/1/2015
4 RADIOLOGY 78016 0 20 Years 8.21 $28.0672 $230.43 11/1/2015 0.00 $230.43 11/1/2015
4 RADIOLOGY 78016 21 999 Years 8.21 $26.7305 $219.46 11/1/2015 0.00 $219.46 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 78016 0 20 Years 7.23 $28.0672 $202.93 11/1/2015 0.00 $202.93 11/1/2015
T
TECHNICAL
COMPONENT 78016 21 999 Years 7.23 $26.7305 $193.26 11/1/2015 0.00 $193.26 11/1/2015
4 RADIOLOGY 78018 0 20 Years 9.04 $28.0672 $253.73 11/1/2015 0.00 $253.73 11/1/2015
4 RADIOLOGY 78018 21 999 Years 9.04 $26.7305 $241.64 11/1/2015 0.00 $241.64 11/1/2015
T
TECHNICAL
COMPONENT 78018 0 20 Years 7.87 $28.0672 $220.89 11/1/2015 0.00 $220.89 11/1/2015
T
TECHNICAL
COMPONENT 78018 21 999 Years 7.87 $26.7305 $210.37 11/1/2015 0.00 $210.37 11/1/2015
4 RADIOLOGY 78020 0 20 Years 2.42 $28.0672 $67.92 11/1/2015 0.00 $67.92 11/1/2015
4 RADIOLOGY 78020 21 999 Years 2.42 $26.7305 $64.69 11/1/2015 0.00 $64.69 11/1/2015
T
TECHNICAL
COMPONENT 78020 0 20 Years 1.63 $28.0672 $45.75 11/1/2015 0.00 $45.75 11/1/2015
T
TECHNICAL
COMPONENT 78020 21 999 Years 1.63 $26.7305 $43.57 11/1/2015 0.00 $43.57 11/1/2015
4 RADIOLOGY 78070 0 20 Years 8.72 $28.0672 $244.75 11/1/2015 0.00 $244.75 11/1/2015
4 RADIOLOGY 78070 21 999 Years 8.72 $26.7305 $233.09 11/1/2015 0.00 $233.09 11/1/2015
T
TECHNICAL
COMPONENT 78070 0 20 Years 7.60 $28.0672 $213.31 11/1/2015 0.00 $213.31 11/1/2015
T
TECHNICAL
COMPONENT 78070 21 999 Years 7.60 $26.7305 $203.15 11/1/2015 0.00 $203.15 11/1/2015
4 RADIOLOGY 78071 0 20 Years 10.39 $28.0672 $291.62 11/1/2015 0.00 $291.62 11/1/2015
4 RADIOLOGY 78071 21 999 Years 10.39 $26.7305 $277.73 11/1/2015 0.00 $277.73 11/1/2015
T
TECHNICAL
COMPONENT 78071 0 20 Years 8.72 $28.0672 $244.75 11/1/2015 0.00 $244.75 11/1/2015
T
TECHNICAL
COMPONENT 78071 21 999 Years 8.72 $26.7305 $233.09 11/1/2015 0.00 $233.09 11/1/2015
4 RADIOLOGY 78075 0 20 Years 13.13 $28.0672 $368.52 11/1/2015 0.00 $368.52 11/1/2015
4 RADIOLOGY 78075 21 999 Years 13.13 $26.7305 $350.97 11/1/2015 0.00 $350.97 11/1/2015
T
TECHNICAL
COMPONENT 78075 0 20 Years 12.07 $28.0672 $338.77 11/1/2015 0.00 $338.77 11/1/2015
T
TECHNICAL
COMPONENT 78075 21 999 Years 12.07 $26.7305 $322.64 11/1/2015 0.00 $322.64 11/1/2015
4 RADIOLOGY 78099 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78102 0 20 Years 4.92 $28.0672 $138.09 11/1/2015 0.00 $138.09 11/1/2015
4 RADIOLOGY 78102 21 999 Years 4.92 $26.7305 $131.51 11/1/2015 0.00 $131.51 11/1/2015
T
TECHNICAL
COMPONENT 78102 0 20 Years 4.16 $28.0672 $116.76 11/1/2015 0.00 $116.76 11/1/2015
T
TECHNICAL
COMPONENT 78102 21 999 Years 4.16 $26.7305 $111.20 11/1/2015 0.00 $111.20 11/1/2015
4 RADIOLOGY 78103 0 20 Years 6.40 $28.0672 $179.63 11/1/2015 0.00 $179.63 11/1/2015
4 RADIOLOGY 78103 21 999 Years 6.40 $26.7305 $171.08 11/1/2015 0.00 $171.08 11/1/2015
T
TECHNICAL
COMPONENT 78103 0 20 Years 5.40 $28.0672 $151.56 11/1/2015 0.00 $151.56 11/1/2015
T
TECHNICAL
COMPONENT 78103 21 999 Years 5.40 $26.7305 $144.34 11/1/2015 0.00 $144.34 11/1/2015
4 RADIOLOGY 78104 0 20 Years 7.10 $28.0672 $199.28 11/1/2015 0.00 $199.28 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78104 21 999 Years 7.10 $26.7305 $189.79 11/1/2015 0.00 $189.79 11/1/2015
T
TECHNICAL
COMPONENT 78104 0 20 Years 6.03 $28.0672 $169.25 11/1/2015 0.00 $169.25 11/1/2015
T
TECHNICAL
COMPONENT 78104 21 999 Years 6.03 $26.7305 $161.18 11/1/2015 0.00 $161.18 11/1/2015
4 RADIOLOGY 78110 0 20 Years 2.98 $28.0672 $83.64 11/1/2015 0.00 $83.64 11/1/2015
4 RADIOLOGY 78110 21 999 Years 2.98 $26.7305 $79.66 11/1/2015 0.00 $79.66 11/1/2015
T
TECHNICAL
COMPONENT 78110 0 20 Years 2.70 $28.0672 $75.78 11/1/2015 0.00 $75.78 11/1/2015
T
TECHNICAL
COMPONENT 78110 21 999 Years 2.70 $26.7305 $72.17 11/1/2015 0.00 $72.17 11/1/2015
4 RADIOLOGY 78111 0 20 Years 2.79 $28.0672 $78.31 11/1/2015 0.00 $78.31 11/1/2015
4 RADIOLOGY 78111 21 999 Years 2.79 $26.7305 $74.58 11/1/2015 0.00 $74.58 11/1/2015
T
TECHNICAL
COMPONENT 78111 0 20 Years 2.48 $28.0672 $69.61 11/1/2015 0.00 $69.61 11/1/2015
T
TECHNICAL
COMPONENT 78111 21 999 Years 2.48 $26.7305 $66.29 11/1/2015 0.00 $66.29 11/1/2015
4 RADIOLOGY 78120 0 20 Years 2.72 $28.0672 $76.34 11/1/2015 0.00 $76.34 11/1/2015
4 RADIOLOGY 78120 21 999 Years 2.72 $26.7305 $72.71 11/1/2015 0.00 $72.71 11/1/2015
T
TECHNICAL
COMPONENT 78120 0 20 Years 2.39 $28.0672 $67.08 11/1/2015 0.00 $67.08 11/1/2015
T
TECHNICAL
COMPONENT 78120 21 999 Years 2.39 $26.7305 $63.89 11/1/2015 0.00 $63.89 11/1/2015
4 RADIOLOGY 78121 0 20 Years 3.05 $28.0672 $85.60 11/1/2015 0.00 $85.60 11/1/2015
4 RADIOLOGY 78121 21 999 Years 3.05 $26.7305 $81.53 11/1/2015 0.00 $81.53 11/1/2015
T
TECHNICAL
COMPONENT 78121 0 20 Years 2.60 $28.0672 $72.97 11/1/2015 0.00 $72.97 11/1/2015
T
TECHNICAL
COMPONENT 78121 21 999 Years 2.60 $26.7305 $69.50 11/1/2015 0.00 $69.50 11/1/2015
4 RADIOLOGY 78122 0 20 Years 2.78 $28.0672 $78.03 11/1/2015 0.00 $78.03 11/1/2015
4 RADIOLOGY 78122 21 999 Years 2.78 $26.7305 $74.31 11/1/2015 0.00 $74.31 11/1/2015
T
TECHNICAL
COMPONENT 78122 0 20 Years 2.19 $28.0672 $61.47 11/1/2015 0.00 $61.47 11/1/2015
T
TECHNICAL
COMPONENT 78122 21 999 Years 2.19 $26.7305 $58.54 11/1/2015 0.00 $58.54 11/1/2015
4 RADIOLOGY 78130 0 20 Years 4.56 $28.0672 $127.99 11/1/2015 0.00 $127.99 11/1/2015
4 RADIOLOGY 78130 21 999 Years 4.56 $26.7305 $121.89 11/1/2015 0.00 $121.89 11/1/2015
T
TECHNICAL
COMPONENT 78130 0 20 Years 3.74 $28.0672 $104.97 11/1/2015 0.00 $104.97 11/1/2015
T
TECHNICAL
COMPONENT 78130 21 999 Years 3.74 $26.7305 $99.97 11/1/2015 0.00 $99.97 11/1/2015
4 RADIOLOGY 78135 0 20 Years 10.18 $28.0672 $285.72 11/1/2015 0.00 $285.72 11/1/2015
4 RADIOLOGY 78135 21 999 Years 10.18 $26.7305 $272.12 11/1/2015 0.00 $272.12 11/1/2015
T
TECHNICAL
COMPONENT 78135 0 20 Years 9.26 $28.0672 $259.90 11/1/2015 0.00 $259.90 11/1/2015
T
TECHNICAL
COMPONENT 78135 21 999 Years 9.26 $26.7305 $247.52 11/1/2015 0.00 $247.52 11/1/2015
4 RADIOLOGY 78140 0 20 Years 3.93 $28.0672 $110.30 11/1/2015 0.00 $110.30 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78140 21 999 Years 3.93 $26.7305 $105.05 11/1/2015 0.00 $105.05 11/1/2015
T
TECHNICAL
COMPONENT 78140 0 20 Years 3.08 $28.0672 $86.45 11/1/2015 0.00 $86.45 11/1/2015
T
TECHNICAL
COMPONENT 78140 21 999 Years 3.08 $26.7305 $82.33 11/1/2015 0.00 $82.33 11/1/2015
4 RADIOLOGY 78185 0 20 Years 6.15 $28.0672 $172.61 11/1/2015 0.00 $172.61 11/1/2015
4 RADIOLOGY 78185 21 999 Years 6.15 $26.7305 $164.39 11/1/2015 0.00 $164.39 11/1/2015
T
TECHNICAL
COMPONENT 78185 0 20 Years 5.58 $28.0672 $156.61 11/1/2015 0.00 $156.61 11/1/2015
T
TECHNICAL
COMPONENT 78185 21 999 Years 5.58 $26.7305 $149.16 11/1/2015 0.00 $149.16 11/1/2015
4 RADIOLOGY 78190 0 20 Years 11.40 $28.0672 $319.97 11/1/2015 0.00 $319.97 11/1/2015
4 RADIOLOGY 78190 21 999 Years 11.40 $26.7305 $304.73 11/1/2015 0.00 $304.73 11/1/2015
T
TECHNICAL
COMPONENT 78190 0 20 Years 9.85 $28.0672 $276.46 11/1/2015 0.00 $276.46 11/1/2015
T
TECHNICAL
COMPONENT 78190 21 999 Years 9.85 $26.7305 $263.30 11/1/2015 0.00 $263.30 11/1/2015
4 RADIOLOGY 78191 0 20 Years 4.83 $28.0672 $135.56 11/1/2015 0.00 $135.56 11/1/2015
4 RADIOLOGY 78191 21 999 Years 4.83 $26.7305 $129.11 11/1/2015 0.00 $129.11 11/1/2015
T
TECHNICAL
COMPONENT 78191 0 20 Years 3.95 $28.0672 $110.87 11/1/2015 0.00 $110.87 11/1/2015
T
TECHNICAL
COMPONENT 78191 21 999 Years 3.95 $26.7305 $105.59 11/1/2015 0.00 $105.59 11/1/2015
4 RADIOLOGY 78195 0 20 Years 10.33 $28.0672 $289.93 11/1/2015 0.00 $289.93 11/1/2015
4 RADIOLOGY 78195 21 999 Years 10.33 $26.7305 $276.13 11/1/2015 0.00 $276.13 11/1/2015
T
TECHNICAL
COMPONENT 78195 0 20 Years 8.66 $28.0672 $243.06 11/1/2015 0.00 $243.06 11/1/2015
T
TECHNICAL
COMPONENT 78195 21 999 Years 8.66 $26.7305 $231.49 11/1/2015 0.00 $231.49 11/1/2015
4 RADIOLOGY 78199 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78201 0 20 Years 5.46 $28.0672 $153.25 11/1/2015 0.00 $153.25 11/1/2015
4 RADIOLOGY 78201 21 999 Years 5.46 $26.7305 $145.95 11/1/2015 0.00 $145.95 11/1/2015
T
TECHNICAL
COMPONENT 78201 0 20 Years 4.85 $28.0672 $136.13 11/1/2015 0.00 $136.13 11/1/2015
T
TECHNICAL
COMPONENT 78201 21 999 Years 4.85 $26.7305 $129.64 11/1/2015 0.00 $129.64 11/1/2015
4 RADIOLOGY 78202 0 20 Years 5.82 $28.0672 $163.35 11/1/2015 0.00 $163.35 11/1/2015
4 RADIOLOGY 78202 21 999 Years 5.82 $26.7305 $155.57 11/1/2015 0.00 $155.57 11/1/2015
T
TECHNICAL
COMPONENT 78202 0 20 Years 5.15 $28.0672 $144.55 11/1/2015 0.00 $144.55 11/1/2015
T
TECHNICAL
COMPONENT 78202 21 999 Years 5.15 $26.7305 $137.66 11/1/2015 0.00 $137.66 11/1/2015
4 RADIOLOGY 78205 0 20 Years 6.10 $28.0672 $171.21 11/1/2015 0.00 $171.21 11/1/2015
4 RADIOLOGY 78205 21 999 Years 6.10 $26.7305 $163.06 11/1/2015 0.00 $163.06 11/1/2015
T
TECHNICAL
COMPONENT 78205 0 20 Years 5.14 $28.0672 $144.27 11/1/2015 0.00 $144.27 11/1/2015
T
TECHNICAL
COMPONENT 78205 21 999 Years 5.14 $26.7305 $137.39 11/1/2015 0.00 $137.39 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78206 0 20 Years 9.97 $28.0672 $279.83 11/1/2015 0.00 $279.83 11/1/2015
4 RADIOLOGY 78206 21 999 Years 9.97 $26.7305 $266.50 11/1/2015 0.00 $266.50 11/1/2015
T
TECHNICAL
COMPONENT 78206 0 20 Years 8.63 $28.0672 $242.22 11/1/2015 0.00 $242.22 11/1/2015
T
TECHNICAL
COMPONENT 78206 21 999 Years 8.63 $26.7305 $230.68 11/1/2015 0.00 $230.68 11/1/2015
4 RADIOLOGY 78215 0 20 Years 5.63 $28.0672 $158.02 11/1/2015 0.00 $158.02 11/1/2015
4 RADIOLOGY 78215 21 999 Years 5.63 $26.7305 $150.49 11/1/2015 0.00 $150.49 11/1/2015
T
TECHNICAL
COMPONENT 78215 0 20 Years 4.95 $28.0672 $138.93 11/1/2015 0.00 $138.93 11/1/2015
T
TECHNICAL
COMPONENT 78215 21 999 Years 4.95 $26.7305 $132.32 11/1/2015 0.00 $132.32 11/1/2015
4 RADIOLOGY 78216 0 20 Years 3.64 $28.0672 $102.16 11/1/2015 0.00 $102.16 11/1/2015
4 RADIOLOGY 78216 21 999 Years 3.64 $26.7305 $97.30 11/1/2015 0.00 $97.30 11/1/2015
T
TECHNICAL
COMPONENT 78216 0 20 Years 2.85 $28.0672 $79.99 11/1/2015 0.00 $79.99 11/1/2015
T
TECHNICAL
COMPONENT 78216 21 999 Years 2.85 $26.7305 $76.18 11/1/2015 0.00 $76.18 11/1/2015
4 RADIOLOGY 78226 0 20 Years 9.62 $28.0672 $270.01 11/1/2015 0.00 $270.01 11/1/2015
4 RADIOLOGY 78226 21 999 Years 9.62 $26.7305 $257.15 11/1/2015 0.00 $257.15 11/1/2015
T
TECHNICAL
COMPONENT 78226 0 20 Years 8.58 $28.0672 $240.82 11/1/2015 0.00 $240.82 11/1/2015
T
TECHNICAL
COMPONENT 78226 21 999 Years 8.58 $26.7305 $229.35 11/1/2015 0.00 $229.35 11/1/2015
4 RADIOLOGY 78227 0 20 Years 13.04 $28.0672 $366.00 11/1/2015 0.00 $366.00 11/1/2015
4 RADIOLOGY 78227 21 999 Years 13.04 $26.7305 $348.57 11/1/2015 0.00 $348.57 11/1/2015
T
TECHNICAL
COMPONENT 78227 0 20 Years 11.78 $28.0672 $330.63 11/1/2015 0.00 $330.63 11/1/2015
T
TECHNICAL
COMPONENT 78227 21 999 Years 11.78 $26.7305 $314.89 11/1/2015 0.00 $314.89 11/1/2015
4 RADIOLOGY 78230 0 20 Years 5.01 $28.0672 $140.62 11/1/2015 0.00 $140.62 11/1/2015
4 RADIOLOGY 78230 21 999 Years 5.01 $26.7305 $133.92 11/1/2015 0.00 $133.92 11/1/2015
T
TECHNICAL
COMPONENT 78230 0 20 Years 4.38 $28.0672 $122.93 11/1/2015 0.00 $122.93 11/1/2015
T
TECHNICAL
COMPONENT 78230 21 999 Years 4.38 $26.7305 $117.08 11/1/2015 0.00 $117.08 11/1/2015
4 RADIOLOGY 78231 0 20 Years 3.75 $28.0672 $105.25 11/1/2015 0.00 $105.25 11/1/2015
4 RADIOLOGY 78231 21 999 Years 3.75 $26.7305 $100.24 11/1/2015 0.00 $100.24 11/1/2015
T
TECHNICAL
COMPONENT 78231 0 20 Years 3.02 $28.0672 $84.76 11/1/2015 0.00 $84.76 11/1/2015
T
TECHNICAL
COMPONENT 78231 21 999 Years 3.02 $26.7305 $80.73 11/1/2015 0.00 $80.73 11/1/2015
4 RADIOLOGY 78232 0 20 Years 2.86 $28.0672 $80.27 11/1/2015 0.00 $80.27 11/1/2015
4 RADIOLOGY 78232 21 999 Years 2.86 $26.7305 $76.45 11/1/2015 0.00 $76.45 11/1/2015
T
TECHNICAL
COMPONENT 78232 0 20 Years 2.28 $28.0672 $63.99 11/1/2015 0.00 $63.99 11/1/2015
T
TECHNICAL
COMPONENT 78232 21 999 Years 2.28 $26.7305 $60.95 11/1/2015 0.00 $60.95 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78258 0 20 Years 6.38 $28.0672 $179.07 11/1/2015 0.00 $179.07 11/1/2015
4 RADIOLOGY 78258 21 999 Years 6.38 $26.7305 $170.54 11/1/2015 0.00 $170.54 11/1/2015
T
TECHNICAL
COMPONENT 78258 0 20 Years 5.36 $28.0672 $150.44 11/1/2015 0.00 $150.44 11/1/2015
T
TECHNICAL
COMPONENT 78258 21 999 Years 5.36 $26.7305 $143.28 11/1/2015 0.00 $143.28 11/1/2015
4 RADIOLOGY 78261 0 20 Years 7.34 $28.0672 $206.01 11/1/2015 0.00 $206.01 11/1/2015
4 RADIOLOGY 78261 21 999 Years 7.34 $26.7305 $196.20 11/1/2015 0.00 $196.20 11/1/2015
T
TECHNICAL
COMPONENT 78261 0 20 Years 6.35 $28.0672 $178.23 11/1/2015 0.00 $178.23 11/1/2015
T
TECHNICAL
COMPONENT 78261 21 999 Years 6.35 $26.7305 $169.74 11/1/2015 0.00 $169.74 11/1/2015
4 RADIOLOGY 78262 0 20 Years 7.07 $28.0672 $198.44 11/1/2015 0.00 $198.44 9 11/1/2015
4 RADIOLOGY 78262 21 999 Years 7.07 $26.7305 $188.98 11/1/2015 0.00 $188.98 9 11/1/2015
T
TECHNICAL
COMPONENT 78262 0 20 Years 6.13 $28.0672 $172.05 11/1/2015 0.00 $172.05 9 11/1/2015
T
TECHNICAL
COMPONENT 78262 21 999 Years 6.13 $26.7305 $163.86 11/1/2015 0.00 $163.86 9 11/1/2015
4 RADIOLOGY 78264 0 20 Years 8.40 $28.0672 $235.76 11/1/2015 0.00 $235.76 11/1/2015
4 RADIOLOGY 78264 21 999 Years 8.40 $26.7305 $224.54 11/1/2015 0.00 $224.54 11/1/2015
T
TECHNICAL
COMPONENT 78264 0 20 Years 7.28 $28.0672 $204.33 11/1/2015 0.00 $204.33 11/1/2015
T
TECHNICAL
COMPONENT 78264 21 999 Years 7.28 $26.7305 $194.60 11/1/2015 0.00 $194.60 11/1/2015
4 RADIOLOGY 78270 0 20 Years 2.94 $28.0672 $82.52 11/1/2015 0.00 $82.52 11/1/2015
4 RADIOLOGY 78270 21 999 Years 2.94 $26.7305 $78.59 11/1/2015 0.00 $78.59 11/1/2015
T
TECHNICAL
COMPONENT 78270 0 20 Years 2.64 $28.0672 $74.10 11/1/2015 0.00 $74.10 11/1/2015
T
TECHNICAL
COMPONENT 78270 21 999 Years 2.64 $26.7305 $70.57 11/1/2015 0.00 $70.57 11/1/2015
4 RADIOLOGY 78271 0 20 Years 2.62 $28.0672 $73.54 11/1/2015 0.00 $73.54 11/1/2015
4 RADIOLOGY 78271 21 999 Years 2.62 $26.7305 $70.03 11/1/2015 0.00 $70.03 11/1/2015
T
TECHNICAL
COMPONENT 78271 0 20 Years 2.33 $28.0672 $65.40 11/1/2015 0.00 $65.40 11/1/2015
T
TECHNICAL
COMPONENT 78271 21 999 Years 2.33 $26.7305 $62.28 11/1/2015 0.00 $62.28 11/1/2015
4 RADIOLOGY 78272 0 20 Years 2.81 $28.0672 $78.87 11/1/2015 0.00 $78.87 11/1/2015
4 RADIOLOGY 78272 21 999 Years 2.81 $26.7305 $75.11 11/1/2015 0.00 $75.11 11/1/2015
T
TECHNICAL
COMPONENT 78272 0 20 Years 2.43 $28.0672 $68.20 11/1/2015 0.00 $68.20 11/1/2015
T
TECHNICAL
COMPONENT 78272 21 999 Years 2.43 $26.7305 $64.96 11/1/2015 0.00 $64.96 11/1/2015
4 RADIOLOGY 78278 0 20 Years 10.14 $28.0672 $284.60 11/1/2015 0.00 $284.60 11/1/2015
4 RADIOLOGY 78278 21 999 Years 10.14 $26.7305 $271.05 11/1/2015 0.00 $271.05 11/1/2015
T
TECHNICAL
COMPONENT 78278 0 20 Years 8.74 $28.0672 $245.31 11/1/2015 0.00 $245.31 11/1/2015
T
TECHNICAL
COMPONENT 78278 21 999 Years 8.74 $26.7305 $233.62 11/1/2015 0.00 $233.62 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78282 0 20 Years 0.00 $0.0000 $38.37 11/1/2015 0.00 $38.37 9 11/1/2015
4 RADIOLOGY 78282 21 999 Years 0.00 $0.0000 $36.54 11/1/2015 0.00 $36.54 9 11/1/2015
T
TECHNICAL
COMPONENT 78282 0 20 Years 0.00 $0.0000 $22.93 11/1/2015 0.00 $22.93 9 11/1/2015
T
TECHNICAL
COMPONENT 78282 21 999 Years 0.00 $0.0000 $21.84 11/1/2015 0.00 $21.84 9 11/1/2015
4 RADIOLOGY 78290 0 20 Years 9.66 $28.0672 $271.13 11/1/2015 0.00 $271.13 11/1/2015
4 RADIOLOGY 78290 21 999 Years 9.66 $26.7305 $258.22 11/1/2015 0.00 $258.22 11/1/2015
T
TECHNICAL
COMPONENT 78290 0 20 Years 8.70 $28.0672 $244.18 11/1/2015 0.00 $244.18 11/1/2015
T
TECHNICAL
COMPONENT 78290 21 999 Years 8.70 $26.7305 $232.56 11/1/2015 0.00 $232.56 11/1/2015
4 RADIOLOGY 78291 0 20 Years 7.22 $28.0672 $202.65 11/1/2015 0.00 $202.65 11/1/2015
4 RADIOLOGY 78291 21 999 Years 7.22 $26.7305 $192.99 11/1/2015 0.00 $192.99 11/1/2015
T
TECHNICAL
COMPONENT 78291 0 20 Years 6.02 $28.0672 $168.96 11/1/2015 0.00 $168.96 11/1/2015
T
TECHNICAL
COMPONENT 78291 21 999 Years 6.02 $26.7305 $160.92 11/1/2015 0.00 $160.92 11/1/2015
4 RADIOLOGY 78299 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78300 0 20 Years 5.23 $28.0672 $146.79 11/1/2015 0.00 $146.79 9 5.23 $28.0672 $146.79 11/1/2015 0.00 $146.79 9 11/1/2015
4 RADIOLOGY 78300 21 999 Years 5.23 $26.7305 $139.80 11/1/2015 0.00 $139.80 9 5.23 $26.7305 $139.80 11/1/2015 0.00 $139.80 9 11/1/2015
I
PROFESSIONAL
COMPONENT 78300 0 20 Years 0.89 $28.0672 $24.98 11/1/2015 0.00 $24.98 0.89 $28.0672 $24.98 11/1/2015 0.00 $24.98 11/1/2015
I
PROFESSIONAL
COMPONENT 78300 21 999 Years 0.89 $26.7305 $23.79 11/1/2015 0.00 $23.79 0.89 $26.7305 $23.79 11/1/2015 0.00 $23.79 11/1/2015
T
TECHNICAL
COMPONENT 78300 0 20 Years 4.34 $28.0672 $121.81 11/1/2015 0.00 $121.81 9 11/1/2015
T
TECHNICAL
COMPONENT 78300 21 999 Years 4.34 $26.7305 $116.01 11/1/2015 0.00 $116.01 9 11/1/2015
4 RADIOLOGY 78305 0 20 Years 6.69 $28.0672 $187.77 11/1/2015 0.00 $187.77 9 6.69 $28.0672 $187.77 11/1/2015 0.00 $187.77 9 11/1/2015
4 RADIOLOGY 78305 21 999 Years 6.69 $26.7305 $178.83 11/1/2015 0.00 $178.83 9 6.69 $26.7305 $178.83 11/1/2015 0.00 $178.83 9 11/1/2015
I
PROFESSIONAL
COMPONENT 78305 0 20 Years 1.16 $28.0672 $32.56 4/1/2014 0.00 $32.56 1.16 $28.0672 $32.56 4/1/2014 0.00 $32.56 11/1/2015
I
PROFESSIONAL
COMPONENT 78305 21 999 Years 1.16 $26.7305 $31.01 4/1/2014 0.00 $31.01 1.16 $26.7305 $31.01 4/1/2014 0.00 $31.01 11/1/2015
T
TECHNICAL
COMPONENT 78305 0 20 Years 5.53 $28.0672 $155.21 11/1/2015 0.00 $155.21 9 11/1/2015
T
TECHNICAL
COMPONENT 78305 21 999 Years 5.53 $26.7305 $147.82 11/1/2015 0.00 $147.82 9 11/1/2015
4 RADIOLOGY 78306 0 20 Years 7.31 $28.0672 $205.17 11/1/2015 0.00 $205.17 9 7.31 $28.0672 $205.17 11/1/2015 0.00 $205.17 9 11/1/2015
4 RADIOLOGY 78306 21 999 Years 7.31 $26.7305 $195.40 11/1/2015 0.00 $195.40 9 7.31 $26.7305 $195.40 11/1/2015 0.00 $195.40 9 11/1/2015
I
PROFESSIONAL
COMPONENT 78306 0 20 Years 1.20 $28.0672 $33.68 11/1/2015 0.00 $33.68 1.20 $28.0672 $33.68 11/1/2015 0.00 $33.68 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 78306 21 999 Years 1.20 $26.7305 $32.08 11/1/2015 0.00 $32.08 1.20 $26.7305 $32.08 11/1/2015 0.00 $32.08 11/1/2015
T
TECHNICAL
COMPONENT 78306 0 20 Years 6.11 $28.0672 $171.49 11/1/2015 0.00 $171.49 9 11/1/2015
T
TECHNICAL
COMPONENT 78306 21 999 Years 6.11 $26.7305 $163.32 11/1/2015 0.00 $163.32 9 11/1/2015
4 RADIOLOGY 78315 0 20 Years 10.08 $28.0672 $282.92 11/1/2015 0.00 $282.92 11/1/2015
4 RADIOLOGY 78315 21 999 Years 10.08 $26.7305 $269.44 11/1/2015 0.00 $269.44 11/1/2015
T
TECHNICAL
COMPONENT 78315 0 20 Years 8.65 $28.0672 $242.78 11/1/2015 0.00 $242.78 11/1/2015
T
TECHNICAL
COMPONENT 78315 21 999 Years 8.65 $26.7305 $231.22 11/1/2015 0.00 $231.22 11/1/2015
4 RADIOLOGY 78320 0 20 Years 6.61 $28.0672 $185.52 11/1/2015 0.00 $185.52 11/1/2015
4 RADIOLOGY 78320 21 999 Years 6.61 $26.7305 $176.69 11/1/2015 0.00 $176.69 11/1/2015
T
TECHNICAL
COMPONENT 78320 0 20 Years 5.18 $28.0672 $145.39 11/1/2015 0.00 $145.39 11/1/2015
T
TECHNICAL
COMPONENT 78320 21 999 Years 5.18 $26.7305 $138.46 11/1/2015 0.00 $138.46 11/1/2015
4 RADIOLOGY 78350 0 20 Years 0.93 $28.0672 $26.10 11/1/2015 0.00 $26.10 9 11/1/2015
4 RADIOLOGY 78350 21 999 Years 0.93 $26.7305 $24.86 11/1/2015 0.00 $24.86 9 11/1/2015
T
TECHNICAL
COMPONENT 78350 0 20 Years 0.62 $28.0672 $17.40 11/1/2015 0.00 $17.40 11/1/2015
T
TECHNICAL
COMPONENT 78350 21 999 Years 0.62 $26.7305 $16.57 11/1/2015 0.00 $16.57 11/1/2015
4 RADIOLOGY 78399 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78414 0 20 Years 0.00 $0.0000 $93.49 11/1/2015 0.00 $93.49 9 11/1/2015
4 RADIOLOGY 78414 21 999 Years 0.00 $0.0000 $89.07 11/1/2015 0.00 $89.07 9 11/1/2015
T
TECHNICAL
COMPONENT 78414 0 20 Years 0.00 $0.0000 $75.53 11/1/2015 0.00 $75.53 11/1/2015
T
TECHNICAL
COMPONENT 78414 21 999 Years 0.00 $0.0000 $71.96 11/1/2015 0.00 $71.96 11/1/2015
4 RADIOLOGY 78428 0 20 Years 5.24 $28.0672 $147.07 11/1/2015 0.00 $147.07 11/1/2015
4 RADIOLOGY 78428 21 999 Years 5.24 $26.7305 $140.07 11/1/2015 0.00 $140.07 11/1/2015
T
TECHNICAL
COMPONENT 78428 0 20 Years 4.17 $28.0672 $117.04 11/1/2015 0.00 $117.04 11/1/2015
T
TECHNICAL
COMPONENT 78428 21 999 Years 4.17 $26.7305 $111.47 11/1/2015 0.00 $111.47 11/1/2015
4 RADIOLOGY 78445 0 20 Years 5.21 $28.0672 $146.23 11/1/2015 0.00 $146.23 11/1/2015
4 RADIOLOGY 78445 21 999 Years 5.21 $26.7305 $139.27 11/1/2015 0.00 $139.27 11/1/2015
T
TECHNICAL
COMPONENT 78445 0 20 Years 4.54 $28.0672 $127.43 11/1/2015 0.00 $127.43 11/1/2015
T
TECHNICAL
COMPONENT 78445 21 999 Years 4.54 $26.7305 $121.36 11/1/2015 0.00 $121.36 11/1/2015
4 RADIOLOGY 78451 0 20 Years 9.90 $28.0672 $277.87 11/1/2015 0.00 $277.87 11/1/2015
4 RADIOLOGY 78451 21 999 Years 9.90 $26.7305 $264.63 11/1/2015 0.00 $264.63 11/1/2015
T
TECHNICAL
COMPONENT 78451 0 20 Years 8.00 $28.0672 $224.54 11/1/2015 0.00 $224.54 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 78451 21 999 Years 8.00 $26.7305 $213.84 11/1/2015 0.00 $213.84 11/1/2015
4 RADIOLOGY 78452 0 20 Years 13.71 $28.0672 $384.80 11/1/2015 0.00 $384.80 11/1/2015
4 RADIOLOGY 78452 21 999 Years 13.71 $26.7305 $366.48 11/1/2015 0.00 $366.48 11/1/2015
T
TECHNICAL
COMPONENT 78452 0 20 Years 11.47 $28.0672 $321.93 11/1/2015 0.00 $321.93 11/1/2015
T
TECHNICAL
COMPONENT 78452 21 999 Years 11.47 $26.7305 $306.60 11/1/2015 0.00 $306.60 11/1/2015
4 RADIOLOGY 78453 0 20 Years 8.83 $28.0672 $247.83 11/1/2015 0.00 $247.83 11/1/2015
4 RADIOLOGY 78453 21 999 Years 8.83 $26.7305 $236.03 11/1/2015 0.00 $236.03 11/1/2015
T
TECHNICAL
COMPONENT 78453 0 20 Years 7.44 $28.0672 $208.82 11/1/2015 0.00 $208.82 11/1/2015
T
TECHNICAL
COMPONENT 78453 21 999 Years 7.44 $26.7305 $198.87 11/1/2015 0.00 $198.87 11/1/2015
4 RADIOLOGY 78454 0 20 Years 12.64 $28.0672 $354.77 11/1/2015 0.00 $354.77 11/1/2015
4 RADIOLOGY 78454 21 999 Years 12.64 $26.7305 $337.87 11/1/2015 0.00 $337.87 11/1/2015
T
TECHNICAL
COMPONENT 78454 0 20 Years 10.76 $28.0672 $302.00 11/1/2015 0.00 $302.00 11/1/2015
T
TECHNICAL
COMPONENT 78454 21 999 Years 10.76 $26.7305 $287.62 11/1/2015 0.00 $287.62 11/1/2015
4 RADIOLOGY 78456 0 20 Years 9.30 $28.0672 $261.02 11/1/2015 0.00 $261.02 11/1/2015
4 RADIOLOGY 78456 21 999 Years 9.30 $26.7305 $248.59 11/1/2015 0.00 $248.59 11/1/2015
T
TECHNICAL
COMPONENT 78456 0 20 Years 7.92 $28.0672 $222.29 11/1/2015 0.00 $222.29 11/1/2015
T
TECHNICAL
COMPONENT 78456 21 999 Years 7.92 $26.7305 $211.71 11/1/2015 0.00 $211.71 11/1/2015
4 RADIOLOGY 78457 0 20 Years 5.08 $28.0672 $142.58 11/1/2015 0.00 $142.58 11/1/2015
4 RADIOLOGY 78457 21 999 Years 5.08 $26.7305 $135.79 11/1/2015 0.00 $135.79 11/1/2015
T
TECHNICAL
COMPONENT 78457 0 20 Years 4.02 $28.0672 $112.83 11/1/2015 0.00 $112.83 11/1/2015
T
TECHNICAL
COMPONENT 78457 21 999 Years 4.02 $26.7305 $107.46 11/1/2015 0.00 $107.46 11/1/2015
4 RADIOLOGY 78458 0 20 Years 5.95 $28.0672 $167.00 11/1/2015 0.00 $167.00 11/1/2015
4 RADIOLOGY 78458 21 999 Years 5.95 $26.7305 $159.05 11/1/2015 0.00 $159.05 11/1/2015
T
TECHNICAL
COMPONENT 78458 0 20 Years 4.68 $28.0672 $131.35 11/1/2015 0.00 $131.35 11/1/2015
T
TECHNICAL
COMPONENT 78458 21 999 Years 4.68 $26.7305 $125.10 11/1/2015 0.00 $125.10 11/1/2015
4 RADIOLOGY 78466 0 20 Years 5.65 $28.0672 $158.58 11/1/2015 0.00 $158.58 11/1/2015
4 RADIOLOGY 78466 21 999 Years 5.65 $26.7305 $151.03 11/1/2015 0.00 $151.03 11/1/2015
T
TECHNICAL
COMPONENT 78466 0 20 Years 4.66 $28.0672 $130.79 11/1/2015 0.00 $130.79 11/1/2015
T
TECHNICAL
COMPONENT 78466 21 999 Years 4.66 $26.7305 $124.56 11/1/2015 0.00 $124.56 11/1/2015
4 RADIOLOGY 78468 0 20 Years 5.60 $28.0672 $157.18 11/1/2015 0.00 $157.18 11/1/2015
4 RADIOLOGY 78468 21 999 Years 5.60 $26.7305 $149.69 11/1/2015 0.00 $149.69 11/1/2015
T
TECHNICAL
COMPONENT 78468 0 20 Years 4.50 $28.0672 $126.30 11/1/2015 0.00 $126.30 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 78468 21 999 Years 4.50 $26.7305 $120.29 11/1/2015 0.00 $120.29 11/1/2015
4 RADIOLOGY 78472 0 20 Years 6.67 $28.0672 $187.21 11/1/2015 0.00 $187.21 11/1/2015
4 RADIOLOGY 78472 21 999 Years 6.67 $26.7305 $178.29 11/1/2015 0.00 $178.29 11/1/2015
T
TECHNICAL
COMPONENT 78472 0 20 Years 5.31 $28.0672 $149.04 11/1/2015 0.00 $149.04 11/1/2015
T
TECHNICAL
COMPONENT 78472 21 999 Years 5.31 $26.7305 $141.94 11/1/2015 0.00 $141.94 11/1/2015
4 RADIOLOGY 78473 0 20 Years 8.37 $28.0672 $234.92 11/1/2015 0.00 $234.92 11/1/2015
4 RADIOLOGY 78473 21 999 Years 8.37 $26.7305 $223.73 11/1/2015 0.00 $223.73 11/1/2015
T
TECHNICAL
COMPONENT 78473 0 20 Years 6.36 $28.0672 $178.51 11/1/2015 0.00 $178.51 11/1/2015
T
TECHNICAL
COMPONENT 78473 21 999 Years 6.36 $26.7305 $170.01 11/1/2015 0.00 $170.01 11/1/2015
4 RADIOLOGY 78481 0 20 Years 5.06 $28.0672 $142.02 11/1/2015 0.00 $142.02 11/1/2015
4 RADIOLOGY 78481 21 999 Years 5.06 $26.7305 $135.26 11/1/2015 0.00 $135.26 11/1/2015
T
TECHNICAL
COMPONENT 78481 0 20 Years 3.71 $28.0672 $104.13 11/1/2015 0.00 $104.13 11/1/2015
T
TECHNICAL
COMPONENT 78481 21 999 Years 3.71 $26.7305 $99.17 11/1/2015 0.00 $99.17 11/1/2015
4 RADIOLOGY 78483 0 20 Years 6.89 $28.0672 $193.38 11/1/2015 0.00 $193.38 11/1/2015
4 RADIOLOGY 78483 21 999 Years 6.89 $26.7305 $184.17 11/1/2015 0.00 $184.17 11/1/2015
T
TECHNICAL
COMPONENT 78483 0 20 Years 4.87 $28.0672 $136.69 11/1/2015 0.00 $136.69 11/1/2015
T
TECHNICAL
COMPONENT 78483 21 999 Years 4.87 $26.7305 $130.18 11/1/2015 0.00 $130.18 11/1/2015
4 RADIOLOGY 78494 0 20 Years 6.49 $28.0672 $182.16 11/1/2015 0.00 $182.16 11/1/2015
4 RADIOLOGY 78494 21 999 Years 6.49 $26.7305 $173.48 11/1/2015 0.00 $173.48 11/1/2015
T
TECHNICAL
COMPONENT 78494 0 20 Years 4.85 $28.0672 $136.13 11/1/2015 0.00 $136.13 11/1/2015
T
TECHNICAL
COMPONENT 78494 21 999 Years 4.85 $26.7305 $129.64 11/1/2015 0.00 $129.64 11/1/2015
4 RADIOLOGY 78496 0 20 Years 1.28 $28.0672 $35.93 11/1/2015 0.00 $35.93 11/1/2015
4 RADIOLOGY 78496 21 999 Years 1.28 $26.7305 $34.22 11/1/2015 0.00 $34.22 11/1/2015
T
TECHNICAL
COMPONENT 78496 0 20 Years 0.59 $28.0672 $16.56 11/1/2015 0.00 $16.56 11/1/2015
T
TECHNICAL
COMPONENT 78496 21 999 Years 0.59 $26.7305 $15.77 11/1/2015 0.00 $15.77 11/1/2015
4 RADIOLOGY 78499 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78579 0 20 Years 5.35 $28.0672 $150.16 11/1/2015 0.00 $150.16 11/1/2015
4 RADIOLOGY 78579 21 999 Years 5.35 $26.7305 $143.01 11/1/2015 0.00 $143.01 11/1/2015
T
TECHNICAL
COMPONENT 78579 0 20 Years 4.69 $28.0672 $131.64 11/1/2015 0.00 $131.64 11/1/2015
T
TECHNICAL
COMPONENT 78579 21 999 Years 4.69 $26.7305 $125.37 11/1/2015 0.00 $125.37 11/1/2015
4 RADIOLOGY 78580 0 20 Years 6.92 $28.0672 $194.23 11/1/2015 0.00 $194.23 11/1/2015
4 RADIOLOGY 78580 21 999 Years 6.92 $26.7305 $184.98 11/1/2015 0.00 $184.98 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 78580 0 20 Years 5.89 $28.0672 $165.32 11/1/2015 0.00 $165.32 11/1/2015
T
TECHNICAL
COMPONENT 78580 21 999 Years 5.89 $26.7305 $157.44 11/1/2015 0.00 $157.44 11/1/2015
4 RADIOLOGY 78582 0 20 Years 9.72 $28.0672 $272.81 11/1/2015 0.00 $272.81 11/1/2015
4 RADIOLOGY 78582 21 999 Years 9.72 $26.7305 $259.82 11/1/2015 0.00 $259.82 11/1/2015
T
TECHNICAL
COMPONENT 78582 0 20 Years 8.22 $28.0672 $230.71 11/1/2015 0.00 $230.71 11/1/2015
T
TECHNICAL
COMPONENT 78582 21 999 Years 8.22 $26.7305 $219.72 11/1/2015 0.00 $219.72 11/1/2015
4 RADIOLOGY 78597 0 20 Years 5.86 $28.0672 $164.47 11/1/2015 0.00 $164.47 11/1/2015
4 RADIOLOGY 78597 21 999 Years 5.86 $26.7305 $156.64 11/1/2015 0.00 $156.64 11/1/2015
T
TECHNICAL
COMPONENT 78597 0 20 Years 4.84 $28.0672 $135.85 11/1/2015 0.00 $135.85 11/1/2015
T
TECHNICAL
COMPONENT 78597 21 999 Years 4.84 $26.7305 $129.38 11/1/2015 0.00 $129.38 11/1/2015
4 RADIOLOGY 78598 0 20 Years 8.89 $28.0672 $249.52 11/1/2015 0.00 $249.52 11/1/2015
4 RADIOLOGY 78598 21 999 Years 8.89 $26.7305 $237.63 11/1/2015 0.00 $237.63 11/1/2015
T
TECHNICAL
COMPONENT 78598 0 20 Years 7.71 $28.0672 $216.40 11/1/2015 0.00 $216.40 11/1/2015
T
TECHNICAL
COMPONENT 78598 21 999 Years 7.71 $26.7305 $206.09 11/1/2015 0.00 $206.09 11/1/2015
4 RADIOLOGY 78599 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78600 0 20 Years 5.34 $28.0672 $149.88 11/1/2015 0.00 $149.88 11/1/2015
4 RADIOLOGY 78600 21 999 Years 5.34 $26.7305 $142.74 11/1/2015 0.00 $142.74 11/1/2015
T
TECHNICAL
COMPONENT 78600 0 20 Years 4.72 $28.0672 $132.48 11/1/2015 0.00 $132.48 11/1/2015
T
TECHNICAL
COMPONENT 78600 21 999 Years 4.72 $26.7305 $126.17 11/1/2015 0.00 $126.17 11/1/2015
4 RADIOLOGY 78601 0 20 Years 6.23 $28.0672 $174.86 11/1/2015 0.00 $174.86 11/1/2015
4 RADIOLOGY 78601 21 999 Years 6.23 $26.7305 $166.53 11/1/2015 0.00 $166.53 11/1/2015
T
TECHNICAL
COMPONENT 78601 0 20 Years 5.52 $28.0672 $154.93 11/1/2015 0.00 $154.93 11/1/2015
T
TECHNICAL
COMPONENT 78601 21 999 Years 5.52 $26.7305 $147.55 11/1/2015 0.00 $147.55 11/1/2015
4 RADIOLOGY 78605 0 20 Years 5.76 $28.0672 $161.67 11/1/2015 0.00 $161.67 11/1/2015
4 RADIOLOGY 78605 21 999 Years 5.76 $26.7305 $153.97 11/1/2015 0.00 $153.97 11/1/2015
T
TECHNICAL
COMPONENT 78605 0 20 Years 5.01 $28.0672 $140.62 11/1/2015 0.00 $140.62 11/1/2015
T
TECHNICAL
COMPONENT 78605 21 999 Years 5.01 $26.7305 $133.92 11/1/2015 0.00 $133.92 11/1/2015
4 RADIOLOGY 78606 0 20 Years 9.66 $28.0672 $271.13 11/1/2015 0.00 $271.13 11/1/2015
4 RADIOLOGY 78606 21 999 Years 9.66 $26.7305 $258.22 11/1/2015 0.00 $258.22 11/1/2015
T
TECHNICAL
COMPONENT 78606 0 20 Years 8.77 $28.0672 $246.15 11/1/2015 0.00 $246.15 11/1/2015
T
TECHNICAL
COMPONENT 78606 21 999 Years 8.77 $26.7305 $234.43 11/1/2015 0.00 $234.43 11/1/2015
4 RADIOLOGY 78607 0 20 Years 10.23 $28.0672 $287.13 11/1/2015 0.00 $287.13 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78607 21 999 Years 10.23 $26.7305 $273.45 11/1/2015 0.00 $273.45 11/1/2015
T
TECHNICAL
COMPONENT 78607 0 20 Years 8.55 $28.0672 $239.97 11/1/2015 0.00 $239.97 11/1/2015
T
TECHNICAL
COMPONENT 78607 21 999 Years 8.55 $26.7305 $228.55 11/1/2015 0.00 $228.55 11/1/2015
I
PROFESSIONAL
COMPONENT 78608 0 20 Years 2.04 $28.0672 $57.26 7/1/2016 0.00 $57.26 2.04 $28.0672 $57.26 7/1/2016 0.00 $57.26 7/1/2016
I
PROFESSIONAL
COMPONENT 78608 21 999 Years 2.04 $26.7305 $54.53 7/1/2016 0.00 $54.53 2.04 $26.7305 $54.53 7/1/2016 0.00 $54.53 7/1/2016
4 RADIOLOGY 78610 0 20 Years 5.05 $28.0672 $141.74 11/1/2015 0.00 $141.74 11/1/2015
4 RADIOLOGY 78610 21 999 Years 5.05 $26.7305 $134.99 11/1/2015 0.00 $134.99 11/1/2015
T
TECHNICAL
COMPONENT 78610 0 20 Years 4.63 $28.0672 $129.95 11/1/2015 0.00 $129.95 11/1/2015
T
TECHNICAL
COMPONENT 78610 21 999 Years 4.63 $26.7305 $123.76 11/1/2015 0.00 $123.76 11/1/2015
4 RADIOLOGY 78630 0 20 Years 9.86 $28.0672 $276.74 11/1/2015 0.00 $276.74 11/1/2015
4 RADIOLOGY 78630 21 999 Years 9.86 $26.7305 $263.56 11/1/2015 0.00 $263.56 11/1/2015
T
TECHNICAL
COMPONENT 78630 0 20 Years 8.90 $28.0672 $249.80 11/1/2015 0.00 $249.80 11/1/2015
T
TECHNICAL
COMPONENT 78630 21 999 Years 8.90 $26.7305 $237.90 11/1/2015 0.00 $237.90 11/1/2015
4 RADIOLOGY 78635 0 20 Years 9.89 $28.0672 $277.58 11/1/2015 0.00 $277.58 11/1/2015
4 RADIOLOGY 78635 21 999 Years 9.89 $26.7305 $264.36 11/1/2015 0.00 $264.36 11/1/2015
T
TECHNICAL
COMPONENT 78635 0 20 Years 9.01 $28.0672 $252.89 11/1/2015 0.00 $252.89 11/1/2015
T
TECHNICAL
COMPONENT 78635 21 999 Years 9.01 $26.7305 $240.84 11/1/2015 0.00 $240.84 11/1/2015
4 RADIOLOGY 78645 0 20 Years 9.40 $28.0672 $263.83 11/1/2015 0.00 $263.83 11/1/2015
4 RADIOLOGY 78645 21 999 Years 9.40 $26.7305 $251.27 11/1/2015 0.00 $251.27 11/1/2015
T
TECHNICAL
COMPONENT 78645 0 20 Years 8.61 $28.0672 $241.66 11/1/2015 0.00 $241.66 11/1/2015
T
TECHNICAL
COMPONENT 78645 21 999 Years 8.61 $26.7305 $230.15 11/1/2015 0.00 $230.15 11/1/2015
4 RADIOLOGY 78647 0 20 Years 10.19 $28.0672 $286.00 11/1/2015 0.00 $286.00 11/1/2015
4 RADIOLOGY 78647 21 999 Years 10.19 $26.7305 $272.38 11/1/2015 0.00 $272.38 11/1/2015
T
TECHNICAL
COMPONENT 78647 0 20 Years 8.94 $28.0672 $250.92 11/1/2015 0.00 $250.92 11/1/2015
T
TECHNICAL
COMPONENT 78647 21 999 Years 8.94 $26.7305 $238.97 11/1/2015 0.00 $238.97 11/1/2015
4 RADIOLOGY 78650 0 20 Years 9.70 $28.0672 $272.25 11/1/2015 0.00 $272.25 11/1/2015
4 RADIOLOGY 78650 21 999 Years 9.70 $26.7305 $259.29 11/1/2015 0.00 $259.29 11/1/2015
T
TECHNICAL
COMPONENT 78650 0 20 Years 8.84 $28.0672 $248.11 11/1/2015 0.00 $248.11 11/1/2015
T
TECHNICAL
COMPONENT 78650 21 999 Years 8.84 $26.7305 $236.30 11/1/2015 0.00 $236.30 11/1/2015
4 RADIOLOGY 78660 0 20 Years 5.11 $28.0672 $143.42 11/1/2015 0.00 $143.42 11/1/2015
4 RADIOLOGY 78660 21 999 Years 5.11 $26.7305 $136.59 11/1/2015 0.00 $136.59 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 78660 0 20 Years 4.38 $28.0672 $122.93 11/1/2015 0.00 $122.93 11/1/2015
T
TECHNICAL
COMPONENT 78660 21 999 Years 4.38 $26.7305 $117.08 11/1/2015 0.00 $117.08 11/1/2015
4 RADIOLOGY 78699 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78700 0 20 Years 4.97 $28.0672 $139.49 11/1/2015 0.00 $139.49 11/1/2015
4 RADIOLOGY 78700 21 999 Years 4.97 $26.7305 $132.85 11/1/2015 0.00 $132.85 11/1/2015
T
TECHNICAL
COMPONENT 78700 0 20 Years 4.35 $28.0672 $122.09 11/1/2015 0.00 $122.09 11/1/2015
T
TECHNICAL
COMPONENT 78700 21 999 Years 4.35 $26.7305 $116.28 11/1/2015 0.00 $116.28 11/1/2015
4 RADIOLOGY 78701 0 20 Years 6.10 $28.0672 $171.21 11/1/2015 0.00 $171.21 11/1/2015
4 RADIOLOGY 78701 21 999 Years 6.10 $26.7305 $163.06 11/1/2015 0.00 $163.06 11/1/2015
T
TECHNICAL
COMPONENT 78701 0 20 Years 5.43 $28.0672 $152.40 11/1/2015 0.00 $152.40 11/1/2015
T
TECHNICAL
COMPONENT 78701 21 999 Years 5.43 $26.7305 $145.15 11/1/2015 0.00 $145.15 11/1/2015
4 RADIOLOGY 78707 0 20 Years 6.73 $28.0672 $188.89 11/1/2015 0.00 $188.89 11/1/2015
4 RADIOLOGY 78707 21 999 Years 6.73 $26.7305 $179.90 11/1/2015 0.00 $179.90 11/1/2015
T
TECHNICAL
COMPONENT 78707 0 20 Years 5.41 $28.0672 $151.84 11/1/2015 0.00 $151.84 11/1/2015
T
TECHNICAL
COMPONENT 78707 21 999 Years 5.41 $26.7305 $144.61 11/1/2015 0.00 $144.61 11/1/2015
4 RADIOLOGY 78708 0 20 Years 5.03 $28.0672 $141.18 11/1/2015 0.00 $141.18 11/1/2015
4 RADIOLOGY 78708 21 999 Years 5.03 $26.7305 $134.45 11/1/2015 0.00 $134.45 11/1/2015
T
TECHNICAL
COMPONENT 78708 0 20 Years 3.34 $28.0672 $93.74 11/1/2015 0.00 $93.74 11/1/2015
T
TECHNICAL
COMPONENT 78708 21 999 Years 3.34 $26.7305 $89.28 11/1/2015 0.00 $89.28 11/1/2015
4 RADIOLOGY 78709 0 20 Years 10.48 $28.0672 $294.14 11/1/2015 0.00 $294.14 11/1/2015
4 RADIOLOGY 78709 21 999 Years 10.48 $26.7305 $280.14 11/1/2015 0.00 $280.14 11/1/2015
T
TECHNICAL
COMPONENT 78709 0 20 Years 8.56 $28.0672 $240.26 11/1/2015 0.00 $240.26 11/1/2015
T
TECHNICAL
COMPONENT 78709 21 999 Years 8.56 $26.7305 $228.81 11/1/2015 0.00 $228.81 11/1/2015
4 RADIOLOGY 78710 0 20 Years 5.73 $28.0672 $160.83 11/1/2015 0.00 $160.83 11/1/2015
4 RADIOLOGY 78710 21 999 Years 5.73 $26.7305 $153.17 11/1/2015 0.00 $153.17 11/1/2015
T
TECHNICAL
COMPONENT 78710 0 20 Years 4.89 $28.0672 $137.25 11/1/2015 0.00 $137.25 11/1/2015
T
TECHNICAL
COMPONENT 78710 21 999 Years 4.89 $26.7305 $130.71 11/1/2015 0.00 $130.71 11/1/2015
4 RADIOLOGY 78725 0 20 Years 3.13 $28.0672 $87.85 11/1/2015 0.00 $87.85 11/1/2015
4 RADIOLOGY 78725 21 999 Years 3.13 $26.7305 $83.67 11/1/2015 0.00 $83.67 11/1/2015
T
TECHNICAL
COMPONENT 78725 0 20 Years 2.62 $28.0672 $73.54 11/1/2015 0.00 $73.54 11/1/2015
T
TECHNICAL
COMPONENT 78725 21 999 Years 2.62 $26.7305 $70.03 11/1/2015 0.00 $70.03 11/1/2015
4 RADIOLOGY 78730 0 20 Years 2.22 $28.0672 $62.31 11/1/2015 0.00 $62.31 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78730 21 999 Years 2.22 $26.7305 $59.34 11/1/2015 0.00 $59.34 11/1/2015
T
TECHNICAL
COMPONENT 78730 0 20 Years 2.00 $28.0672 $56.13 11/1/2015 0.00 $56.13 11/1/2015
T
TECHNICAL
COMPONENT 78730 21 999 Years 2.00 $26.7305 $53.46 11/1/2015 0.00 $53.46 11/1/2015
4 RADIOLOGY 78740 0 20 Years 6.34 $28.0672 $177.95 11/1/2015 0.00 $177.95 11/1/2015
4 RADIOLOGY 78740 21 999 Years 6.34 $26.7305 $169.47 11/1/2015 0.00 $169.47 11/1/2015
T
TECHNICAL
COMPONENT 78740 0 20 Years 5.55 $28.0672 $155.77 11/1/2015 0.00 $155.77 11/1/2015
T
TECHNICAL
COMPONENT 78740 21 999 Years 5.55 $26.7305 $148.35 11/1/2015 0.00 $148.35 11/1/2015
4 RADIOLOGY 78761 0 20 Years 6.11 $28.0672 $171.49 11/1/2015 0.00 $171.49 11/1/2015
4 RADIOLOGY 78761 21 999 Years 6.11 $26.7305 $163.32 11/1/2015 0.00 $163.32 11/1/2015
T
TECHNICAL
COMPONENT 78761 0 20 Years 5.09 $28.0672 $142.86 11/1/2015 0.00 $142.86 11/1/2015
T
TECHNICAL
COMPONENT 78761 21 999 Years 5.09 $26.7305 $136.06 11/1/2015 0.00 $136.06 11/1/2015
4 RADIOLOGY 78799 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 78800 0 20 Years 5.52 $28.0672 $154.93 11/1/2015 0.00 $154.93 11/1/2015
4 RADIOLOGY 78800 21 999 Years 5.52 $26.7305 $147.55 11/1/2015 0.00 $147.55 11/1/2015
T
TECHNICAL
COMPONENT 78800 0 20 Years 4.58 $28.0672 $128.55 11/1/2015 0.00 $128.55 11/1/2015
T
TECHNICAL
COMPONENT 78800 21 999 Years 4.58 $26.7305 $122.43 11/1/2015 0.00 $122.43 11/1/2015
4 RADIOLOGY 78801 0 20 Years 7.55 $28.0672 $211.91 11/1/2015 0.00 $211.91 11/1/2015
4 RADIOLOGY 78801 21 999 Years 7.55 $26.7305 $201.82 11/1/2015 0.00 $201.82 11/1/2015
T
TECHNICAL
COMPONENT 78801 0 20 Years 6.42 $28.0672 $180.19 11/1/2015 0.00 $180.19 11/1/2015
T
TECHNICAL
COMPONENT 78801 21 999 Years 6.42 $26.7305 $171.61 11/1/2015 0.00 $171.61 11/1/2015
4 RADIOLOGY 78802 0 20 Years 9.42 $28.0672 $264.39 11/1/2015 0.00 $264.39 11/1/2015
4 RADIOLOGY 78802 21 999 Years 9.42 $26.7305 $251.80 11/1/2015 0.00 $251.80 11/1/2015
T
TECHNICAL
COMPONENT 78802 0 20 Years 8.22 $28.0672 $230.71 11/1/2015 0.00 $230.71 11/1/2015
T
TECHNICAL
COMPONENT 78802 21 999 Years 8.22 $26.7305 $219.72 11/1/2015 0.00 $219.72 11/1/2015
4 RADIOLOGY 78803 0 20 Years 9.89 $28.0672 $277.58 11/1/2015 0.00 $277.58 11/1/2015
4 RADIOLOGY 78803 21 999 Years 9.89 $26.7305 $264.36 11/1/2015 0.00 $264.36 11/1/2015
T
TECHNICAL
COMPONENT 78803 0 20 Years 8.41 $28.0672 $236.05 11/1/2015 0.00 $236.05 11/1/2015
T
TECHNICAL
COMPONENT 78803 21 999 Years 8.41 $26.7305 $224.80 11/1/2015 0.00 $224.80 11/1/2015
4 RADIOLOGY 78804 0 20 Years 16.55 $28.0672 $464.51 11/1/2015 0.00 $464.51 16.55 $28.0672 $464.51 11/1/2015 0.00 $464.51 11/1/2015
4 RADIOLOGY 78804 21 999 Years 16.55 $26.7305 $442.39 11/1/2015 0.00 $442.39 16.55 $26.7305 $442.39 11/1/2015 0.00 $442.39 11/1/2015
T
TECHNICAL
COMPONENT 78804 0 20 Years 15.07 $28.0672 $422.97 11/1/2015 0.00 $422.97 11/1/2015
T
TECHNICAL
COMPONENT 78804 21 999 Years 15.07 $26.7305 $402.83 11/1/2015 0.00 $402.83 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 78805 0 20 Years 5.27 $28.0672 $147.91 11/1/2015 0.00 $147.91 11/1/2015
4 RADIOLOGY 78805 21 999 Years 5.27 $26.7305 $140.87 11/1/2015 0.00 $140.87 11/1/2015
T
TECHNICAL
COMPONENT 78805 0 20 Years 4.25 $28.0672 $119.29 11/1/2015 0.00 $119.29 11/1/2015
T
TECHNICAL
COMPONENT 78805 21 999 Years 4.25 $26.7305 $113.60 11/1/2015 0.00 $113.60 11/1/2015
4 RADIOLOGY 78806 0 20 Years 9.68 $28.0672 $271.69 11/1/2015 0.00 $271.69 11/1/2015
4 RADIOLOGY 78806 21 999 Years 9.68 $26.7305 $258.75 11/1/2015 0.00 $258.75 11/1/2015
T
TECHNICAL
COMPONENT 78806 0 20 Years 8.49 $28.0672 $238.29 11/1/2015 0.00 $238.29 11/1/2015
T
TECHNICAL
COMPONENT 78806 21 999 Years 8.49 $26.7305 $226.94 11/1/2015 0.00 $226.94 11/1/2015
4 RADIOLOGY 78807 0 20 Years 9.90 $28.0672 $277.87 11/1/2015 0.00 $277.87 11/1/2015
4 RADIOLOGY 78807 21 999 Years 9.90 $26.7305 $264.63 11/1/2015 0.00 $264.63 11/1/2015
T
TECHNICAL
COMPONENT 78807 0 20 Years 8.44 $28.0672 $236.89 11/1/2015 0.00 $236.89 11/1/2015
T
TECHNICAL
COMPONENT 78807 21 999 Years 8.44 $26.7305 $225.61 11/1/2015 0.00 $225.61 11/1/2015
4 RADIOLOGY 78811 0 20 Years 0.00 $0.0000 $1,081.49 11/1/2015 0.00 $1,081.49 0.00 $0.0000 $1,081.49 11/1/2015 0.00 $1,081.49 11/1/2015
4 RADIOLOGY 78811 21 999 Years 0.00 $0.0000 $1,029.99 11/1/2015 0.00 $1,029.99 0.00 $0.0000 $1,029.99 11/1/2015 0.00 $1,029.99 11/1/2015
I
PROFESSIONAL
COMPONENT 78811 0 20 Years 2.24 $28.0672 $62.87 11/1/2015 0.00 $62.87 2.24 $28.0672 $62.87 11/1/2015 0.00 $62.87 11/1/2015
I
PROFESSIONAL
COMPONENT 78811 21 999 Years 2.24 $26.7305 $59.88 11/1/2015 0.00 $59.88 2.24 $26.7305 $59.88 11/1/2015 0.00 $59.88 11/1/2015
T
TECHNICAL
COMPONENT 78811 0 20 Years 0.00 $0.0000 $1,018.62 11/1/2015 0.00 $1,018.62 11/1/2015
T
TECHNICAL
COMPONENT 78811 21 999 Years 0.00 $0.0000 $970.11 11/1/2015 0.00 $970.11 11/1/2015
4 RADIOLOGY 78812 0 20 Years 0.00 $0.0000 $1,095.83 11/1/2015 0.00 $1,095.83 9 0.00 $0.0000 $1,095.83 11/1/2015 0.00 $1,095.83 9 11/1/2015
4 RADIOLOGY 78812 21 999 Years 0.00 $0.0000 $1,043.65 11/1/2015 0.00 $1,043.65 9 0.00 $0.0000 $1,043.65 11/1/2015 0.00 $1,043.65 9 11/1/2015
I
PROFESSIONAL
COMPONENT 78812 0 20 Years 2.75 $28.0672 $77.18 11/1/2015 0.00 $77.18 2.75 $28.0672 $77.18 11/1/2015 0.00 $77.18 11/1/2015
I
PROFESSIONAL
COMPONENT 78812 21 999 Years 2.75 $26.7305 $73.51 11/1/2015 0.00 $73.51 2.75 $26.7305 $73.51 11/1/2015 0.00 $73.51 11/1/2015
T
TECHNICAL
COMPONENT 78812 0 20 Years 0.00 $0.0000 $1,018.65 11/1/2015 0.00 $1,018.65 11/1/2015
T
TECHNICAL
COMPONENT 78812 21 999 Years 0.00 $0.0000 $970.14 11/1/2015 0.00 $970.14 11/1/2015
4 RADIOLOGY 78813 0 20 Years 0.00 $0.0000 $1,099.18 11/1/2015 0.00 $1,099.18 0.00 $0.0000 $1,099.18 11/1/2015 0.00 $1,099.18 11/1/2015
4 RADIOLOGY 78813 21 999 Years 0.00 $0.0000 $1,046.83 11/1/2015 0.00 $1,046.83 0.00 $0.0000 $1,046.83 11/1/2015 0.00 $1,046.83 11/1/2015
I
PROFESSIONAL
COMPONENT 78813 0 20 Years 2.87 $28.0672 $80.55 11/1/2015 0.00 $80.55 2.87 $28.0672 $80.55 11/1/2015 0.00 $80.55 11/1/2015
I
PROFESSIONAL
COMPONENT 78813 21 999 Years 2.87 $26.7305 $76.72 11/1/2015 0.00 $76.72 2.87 $26.7305 $76.72 11/1/2015 0.00 $76.72 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 78813 0 20 Years 0.00 $0.0000 $1,018.63 11/1/2015 0.00 $1,018.63 11/1/2015
T
TECHNICAL
COMPONENT 78813 21 999 Years 0.00 $0.0000 $970.11 11/1/2015 0.00 $970.11 11/1/2015
4 RADIOLOGY 78814 0 20 Years 0.00 $0.0000 $1,108.10 11/1/2015 0.00 $1,108.10 0.00 $0.0000 $1,108.10 11/1/2015 0.00 $1,108.10 11/1/2015
4 RADIOLOGY 78814 21 999 Years 0.00 $0.0000 $1,055.32 11/1/2015 0.00 $1,055.32 0.00 $0.0000 $1,055.32 11/1/2015 0.00 $1,055.32 11/1/2015
I
PROFESSIONAL
COMPONENT 78814 0 20 Years 3.19 $28.0672 $89.53 11/1/2015 0.00 $89.53 3.19 $28.0672 $89.53 11/1/2015 0.00 $89.53 11/1/2015
I
PROFESSIONAL
COMPONENT 78814 21 999 Years 3.19 $26.7305 $85.27 11/1/2015 0.00 $85.27 3.19 $26.7305 $85.27 11/1/2015 0.00 $85.27 11/1/2015
T
TECHNICAL
COMPONENT 78814 0 20 Years 0.00 $0.0000 $1,018.57 11/1/2015 0.00 $1,018.57 11/1/2015
T
TECHNICAL
COMPONENT 78814 21 999 Years 0.00 $0.0000 $970.05 11/1/2015 0.00 $970.05 11/1/2015
4 RADIOLOGY 78815 0 20 Years 0.00 $0.0000 $1,116.87 11/1/2015 0.00 $1,116.87 0.00 $0.0000 $1,116.87 11/1/2015 0.00 $1,116.87 11/1/2015
4 RADIOLOGY 78815 21 999 Years 0.00 $0.0000 $1,063.68 11/1/2015 0.00 $1,063.68 0.00 $0.0000 $1,063.68 11/1/2015 0.00 $1,063.68 11/1/2015
I
PROFESSIONAL
COMPONENT 78815 0 20 Years 3.50 $28.0672 $98.24 11/1/2015 0.00 $98.24 3.50 $28.0672 $98.24 11/1/2015 0.00 $98.24 11/1/2015
I
PROFESSIONAL
COMPONENT 78815 21 999 Years 3.50 $26.7305 $93.56 11/1/2015 0.00 $93.56 3.50 $26.7305 $93.56 11/1/2015 0.00 $93.56 11/1/2015
T
TECHNICAL
COMPONENT 78815 0 20 Years 0.00 $0.0000 $1,018.63 11/1/2015 0.00 $1,018.63 11/1/2015
T
TECHNICAL
COMPONENT 78815 21 999 Years 0.00 $0.0000 $970.12 11/1/2015 0.00 $970.12 11/1/2015
4 RADIOLOGY 78816 0 20 Years 0.00 $0.0000 $1,117.52 11/1/2015 0.00 $1,117.52 0.00 $0.0000 $1,117.52 11/1/2015 0.00 $1,117.52 11/1/2015
4 RADIOLOGY 78816 21 999 Years 0.00 $0.0000 $1,064.29 11/1/2015 0.00 $1,064.29 0.00 $0.0000 $1,064.29 11/1/2015 0.00 $1,064.29 11/1/2015
I
PROFESSIONAL
COMPONENT 78816 0 20 Years 3.52 $28.0672 $98.80 11/1/2015 0.00 $98.80 3.52 $28.0672 $98.80 11/1/2015 0.00 $98.80 11/1/2015
I
PROFESSIONAL
COMPONENT 78816 21 999 Years 3.52 $26.7305 $94.09 11/1/2015 0.00 $94.09 3.52 $26.7305 $94.09 11/1/2015 0.00 $94.09 11/1/2015
T
TECHNICAL
COMPONENT 78816 0 20 Years 0.00 $0.0000 $1,018.72 11/1/2015 0.00 $1,018.72 11/1/2015
T
TECHNICAL
COMPONENT 78816 21 999 Years 0.00 $0.0000 $970.20 11/1/2015 0.00 $970.20 11/1/2015
4 RADIOLOGY 78999 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
4 RADIOLOGY 79005 0 20 Years 3.86 $28.0672 $108.34 11/1/2015 0.00 $108.34 3.86 $28.0672 $108.34 11/1/2015 0.00 $108.34 11/1/2015
4 RADIOLOGY 79005 21 999 Years 3.86 $26.7305 $103.18 11/1/2015 0.00 $103.18 3.86 $26.7305 $103.18 11/1/2015 0.00 $103.18 11/1/2015
4 RADIOLOGY 79200 0 20 Years 3.84 $28.0672 $107.78 11/1/2015 0.00 $107.78 11/1/2015
4 RADIOLOGY 79200 21 999 Years 3.84 $26.7305 $102.65 11/1/2015 0.00 $102.65 11/1/2015
I
PROFESSIONAL
COMPONENT 79300 0 20 Years 2.05 $28.0672 $57.54 11/1/2015 0.00 $57.54 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 79300 21 999 Years 2.05 $26.7305 $54.80 11/1/2015 0.00 $54.80 11/1/2015
4 RADIOLOGY 79440 0 20 Years 3.64 $28.0672 $102.16 11/1/2015 0.00 $102.16 11/1/2015
4 RADIOLOGY 79440 21 999 Years 3.64 $26.7305 $97.30 11/1/2015 0.00 $97.30 11/1/2015
T
TECHNICAL
COMPONENT 79440 0 20 Years 1.13 $28.0672 $31.72 11/1/2015 0.00 $31.72 11/1/2015
T
TECHNICAL
COMPONENT 79440 21 999 Years 1.13 $26.7305 $30.21 11/1/2015 0.00 $30.21 11/1/2015
4 RADIOLOGY 79999 0 999 Years 0.00 $0.0000 $0.00 4/1/2014 -2.00 $0.00 5 11/1/2015
T
TECHNICAL
COMPONENT 88104 0 20 Years 1.27 $28.0672 $35.65 4/1/2015 0.00 $35.65 4/1/2015
T
TECHNICAL
COMPONENT 88104 21 999 Years 1.27 $26.7305 $33.95 4/1/2015 0.00 $33.95 4/1/2015
T
TECHNICAL
COMPONENT 88106 0 20 Years 1.89 $28.0672 $53.05 4/1/2015 0.00 $53.05 4/1/2015
T
TECHNICAL
COMPONENT 88106 21 999 Years 1.89 $26.7305 $50.52 4/1/2015 0.00 $50.52 4/1/2015
T
TECHNICAL
COMPONENT 88108 0 20 Years 1.71 $28.0672 $47.99 4/1/2015 0.00 $47.99 4/1/2015
T
TECHNICAL
COMPONENT 88108 21 999 Years 1.71 $26.7305 $45.71 4/1/2015 0.00 $45.71 4/1/2015
T
TECHNICAL
COMPONENT 88112 0 20 Years 1.01 $28.0672 $28.35 4/1/2015 0.00 $28.35 4/1/2015
T
TECHNICAL
COMPONENT 88112 21 999 Years 1.01 $26.7305 $27.00 4/1/2015 0.00 $27.00 4/1/2015
T
TECHNICAL
COMPONENT 88172 0 20 Years 0.55 $28.0672 $15.44 4/1/2015 0.00 $15.44 4/1/2015
T
TECHNICAL
COMPONENT 88172 21 999 Years 0.55 $26.7305 $14.70 4/1/2015 0.00 $14.70 4/1/2015
T
TECHNICAL
COMPONENT 88173 0 20 Years 2.22 $28.0672 $62.31 4/1/2015 0.00 $62.31 4/1/2015
T
TECHNICAL
COMPONENT 88173 21 999 Years 2.22 $26.7305 $59.34 4/1/2015 0.00 $59.34 4/1/2015
T
TECHNICAL
COMPONENT 88182 0 20 Years 2.02 $28.0672 $56.70 4/1/2015 0.00 $56.70 4/1/2015
T
TECHNICAL
COMPONENT 88182 21 999 Years 2.02 $26.7305 $54.00 4/1/2015 0.00 $54.00 4/1/2015
T
TECHNICAL
COMPONENT 88184 0 20 Years 2.62 $28.0672 $73.54 4/1/2015 0.00 $73.54 4/1/2015
T
TECHNICAL
COMPONENT 88184 21 999 Years 2.62 $26.7305 $70.03 4/1/2015 0.00 $70.03 4/1/2015
T
TECHNICAL
COMPONENT 88185 0 20 Years 1.59 $28.0672 $44.63 4/1/2013 0.00 $44.63 4/1/2015
T
TECHNICAL
COMPONENT 88185 21 999 Years 1.59 $26.7305 $42.50 4/1/2013 0.00 $42.50 4/1/2015
T
TECHNICAL
COMPONENT 88300 0 20 Years 0.30 $28.0672 $8.42 4/1/2013 0.00 $8.42 4/1/2015
T
TECHNICAL
COMPONENT 88300 21 999 Years 0.30 $26.7305 $8.02 4/1/2013 0.00 $8.02 4/1/2015
T
TECHNICAL
COMPONENT 88302 0 20 Years 0.70 $28.0672 $19.65 4/1/2015 0.00 $19.65 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 88302 21 999 Years 0.70 $26.7305 $18.71 4/1/2015 0.00 $18.71 4/1/2015
T
TECHNICAL
COMPONENT 88304 0 20 Years 0.95 $28.0672 $26.66 4/1/2015 0.00 $26.66 4/1/2015
T
TECHNICAL
COMPONENT 88304 21 999 Years 0.95 $26.7305 $25.39 4/1/2015 0.00 $25.39 4/1/2015
5 LABORATORY 88305 0 20 Years 2.04 $28.0672 $57.26 4/1/2015 0.00 $57.26 2.04 $28.0672 $57.26 4/1/2015 0.00 $57.26 4/1/2015
5 LABORATORY 88305 21 999 Years 2.04 $26.7305 $54.53 4/1/2015 0.00 $54.53 2.04 $26.7305 $54.53 4/1/2015 0.00 $54.53 4/1/2015
I
PROFESSIONAL
COMPONENT 88305 0 20 Years 1.09 $28.0672 $30.59 4/1/2015 0.00 $30.59 1.09 $28.0672 $30.59 4/1/2015 0.00 $30.59 4/1/2015
I
PROFESSIONAL
COMPONENT 88305 21 999 Years 1.09 $26.7305 $29.14 4/1/2015 0.00 $29.14 1.09 $26.7305 $29.14 4/1/2015 0.00 $29.14 4/1/2015
T
TECHNICAL
COMPONENT 88305 0 20 Years 0.95 $28.0672 $26.66 4/1/2015 0.00 $26.66 4/1/2015
T
TECHNICAL
COMPONENT 88305 21 999 Years 0.95 $26.7305 $25.39 4/1/2015 0.00 $25.39 4/1/2015
T
TECHNICAL
COMPONENT 88307 0 20 Years 6.17 $28.0672 $173.17 4/1/2015 0.00 $173.17 4/1/2015
T
TECHNICAL
COMPONENT 88307 21 999 Years 6.17 $26.7305 $164.93 4/1/2015 0.00 $164.93 4/1/2015
T
TECHNICAL
COMPONENT 88309 0 20 Years 8.75 $28.0672 $245.59 4/1/2015 0.00 $245.59 4/1/2015
T
TECHNICAL
COMPONENT 88309 21 999 Years 8.75 $26.7305 $233.89 4/1/2015 0.00 $233.89 4/1/2015
T
TECHNICAL
COMPONENT 88311 0 20 Years 0.23 $28.0672 $6.46 4/1/2015 0.00 $6.46 4/1/2015
T
TECHNICAL
COMPONENT 88311 21 999 Years 0.23 $26.7305 $6.15 4/1/2015 0.00 $6.15 4/1/2015
T
TECHNICAL
COMPONENT 88312 0 20 Years 1.95 $28.0672 $54.73 4/1/2015 0.00 $54.73 4/1/2015
T
TECHNICAL
COMPONENT 88312 21 999 Years 1.95 $26.7305 $52.12 4/1/2015 0.00 $52.12 4/1/2015
T
TECHNICAL
COMPONENT 88313 0 20 Years 1.55 $28.0672 $43.50 4/1/2015 0.00 $43.50 4/1/2015
T
TECHNICAL
COMPONENT 88313 21 999 Years 1.55 $26.7305 $41.43 4/1/2015 0.00 $41.43 4/1/2015
T
TECHNICAL
COMPONENT 88314 0 20 Years 1.45 $28.0672 $40.70 4/1/2015 0.00 $40.70 4/1/2015
T
TECHNICAL
COMPONENT 88314 21 999 Years 1.45 $26.7305 $38.76 4/1/2015 0.00 $38.76 4/1/2015
T
TECHNICAL
COMPONENT 88319 0 20 Years 1.69 $28.0672 $47.43 4/1/2015 0.00 $47.43 4/1/2015
T
TECHNICAL
COMPONENT 88319 21 999 Years 1.69 $26.7305 $45.17 4/1/2015 0.00 $45.17 4/1/2015
I
PROFESSIONAL
COMPONENT 88331 0 20 Years 1.80 $28.0672 $50.52 4/1/2015 0.00 $50.52 9 4/1/2015
I
PROFESSIONAL
COMPONENT 88331 21 999 Years 1.80 $26.7305 $48.11 4/1/2015 0.00 $48.11 9 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 88331 0 20 Years 1.08 $28.0672 $30.31 4/1/2015 0.00 $30.31 4/1/2015
T
TECHNICAL
COMPONENT 88331 21 999 Years 1.08 $26.7305 $28.87 4/1/2015 0.00 $28.87 4/1/2015
I
PROFESSIONAL
COMPONENT 88332 0 20 Years 0.89 $28.0672 $24.98 4/1/2013 0.00 $24.98 9 4/1/2015
I
PROFESSIONAL
COMPONENT 88332 21 999 Years 0.89 $26.7305 $23.79 4/1/2013 0.00 $23.79 9 4/1/2015
T
TECHNICAL
COMPONENT 88332 0 20 Years 0.38 $28.0672 $10.67 4/1/2015 0.00 $10.67 4/1/2015
T
TECHNICAL
COMPONENT 88332 21 999 Years 0.38 $26.7305 $10.16 4/1/2015 0.00 $10.16 4/1/2015
T
TECHNICAL
COMPONENT 88346 0 20 Years 1.86 $28.0672 $52.20 4/1/2015 0.00 $52.20 4/1/2015
T
TECHNICAL
COMPONENT 88346 21 999 Years 1.86 $26.7305 $49.72 4/1/2015 0.00 $49.72 4/1/2015
T
TECHNICAL
COMPONENT 88348 0 20 Years 3.70 $28.0672 $103.85 4/1/2015 0.00 $103.85 4/1/2015
T
TECHNICAL
COMPONENT 88348 21 999 Years 3.70 $26.7305 $98.90 4/1/2015 0.00 $98.90 4/1/2015
T
TECHNICAL
COMPONENT 88350 0 20 Years 1.22 $28.0672 $34.24 1/1/2016 0.00 $34.24 1/1/2016
T
TECHNICAL
COMPONENT 88350 21 999 Years 1.22 $26.7305 $32.61 1/1/2016 0.00 $32.61 1/1/2016
T
TECHNICAL
COMPONENT 88355 0 20 Years 2.56 $28.0672 $71.85 4/1/2015 0.00 $71.85 4/1/2015
T
TECHNICAL
COMPONENT 88355 21 999 Years 2.56 $26.7305 $68.43 4/1/2015 0.00 $68.43 4/1/2015
T
TECHNICAL
COMPONENT 88356 0 20 Years 2.33 $28.0672 $65.40 4/1/2015 0.00 $65.40 4/1/2015
T
TECHNICAL
COMPONENT 88356 21 999 Years 2.33 $26.7305 $62.28 4/1/2015 0.00 $62.28 4/1/2015
T
TECHNICAL
COMPONENT 88360 0 20 Years 2.25 $28.0672 $63.15 4/1/2015 0.00 $63.15 4/1/2015
T
TECHNICAL
COMPONENT 88360 21 999 Years 2.25 $26.7305 $60.14 4/1/2015 0.00 $60.14 4/1/2015
T
TECHNICAL
COMPONENT 88361 0 20 Years 3.05 $28.0672 $85.60 4/1/2015 0.00 $85.60 4/1/2015
T
TECHNICAL
COMPONENT 88361 21 999 Years 3.05 $26.7305 $81.53 4/1/2015 0.00 $81.53 4/1/2015
T
TECHNICAL
COMPONENT 88364 0 20 Years 1.96 $28.0672 $55.01 1/1/2015 0.00 $55.01 1/1/2015
T
TECHNICAL
COMPONENT 88364 21 999 Years 1.96 $26.7305 $52.39 1/1/2015 0.00 $52.39 1/1/2015
T
TECHNICAL
COMPONENT 88365 0 20 Years 3.27 $28.0672 $91.78 1/1/2015 0.00 $91.78 1/1/2015
T
TECHNICAL
COMPONENT 88365 21 999 Years 3.27 $26.7305 $87.41 1/1/2015 0.00 $87.41 1/1/2015
T
TECHNICAL
COMPONENT 88366 0 20 Years 2.42 $28.0672 $67.92 1/1/2015 0.00 $67.92 1/1/2015
T
TECHNICAL
COMPONENT 88366 21 999 Years 2.42 $26.7305 $64.69 1/1/2015 0.00 $64.69 1/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 88367 0 20 Years 5.39 $28.0672 $151.28 1/1/2015 0.00 $151.28 1/1/2015
T
TECHNICAL
COMPONENT 88367 21 999 Years 5.39 $26.7305 $144.08 1/1/2015 0.00 $144.08 1/1/2015
T
TECHNICAL
COMPONENT 88368 0 20 Years 4.68 $28.0672 $131.35 1/1/2015 0.00 $131.35 1/1/2015
T
TECHNICAL
COMPONENT 88368 21 999 Years 4.68 $26.7305 $125.10 1/1/2015 0.00 $125.10 1/1/2015
T
TECHNICAL
COMPONENT 88369 0 20 Years 1.36 $28.0672 $38.17 1/1/2015 0.00 $38.17 1/1/2015
T
TECHNICAL
COMPONENT 88369 21 999 Years 1.36 $26.7305 $36.35 1/1/2015 0.00 $36.35 1/1/2015
T
TECHNICAL
COMPONENT 88373 0 20 Years 1.10 $28.0672 $30.87 1/1/2015 0.00 $30.87 1/1/2015
T
TECHNICAL
COMPONENT 88373 21 999 Years 1.10 $26.7305 $29.40 1/1/2015 0.00 $29.40 1/1/2015
T
TECHNICAL
COMPONENT 88374 0 20 Years 4.46 $28.0672 $125.18 1/1/2015 0.00 $125.18 1/1/2015
T
TECHNICAL
COMPONENT 88374 21 999 Years 4.46 $26.7305 $119.22 1/1/2015 0.00 $119.22 1/1/2015
T
TECHNICAL
COMPONENT 88377 0 20 Years 4.15 $28.0672 $116.48 1/1/2015 0.00 $116.48 1/1/2015
T
TECHNICAL
COMPONENT 88377 21 999 Years 4.15 $26.7305 $110.93 1/1/2015 0.00 $110.93 1/1/2015
T
TECHNICAL
COMPONENT 88387 0 20 Years 0.28 $28.0672 $7.86 4/1/2015 0.00 $7.86 4/1/2015
T
TECHNICAL
COMPONENT 88387 21 999 Years 0.28 $26.7305 $7.48 4/1/2015 0.00 $7.48 4/1/2015
T
TECHNICAL
COMPONENT 88388 0 20 Years 0.27 $28.0672 $7.58 4/1/2015 0.00 $7.58 4/1/2015
T
TECHNICAL
COMPONENT 88388 21 999 Years 0.27 $26.7305 $7.22 4/1/2015 0.00 $7.22 4/1/2015
2 SURGERY 91010 0 20 Years 5.03 $28.0672 $141.18 7/1/2015 0.00 $141.18 7/1/2015
2 SURGERY 91010 21 999 Years 5.03 $26.7305 $134.45 7/1/2015 0.00 $134.45 7/1/2015
T
TECHNICAL
COMPONENT 91010 0 20 Years 3.09 $28.0672 $86.73 7/1/2015 0.00 $86.73 7/1/2015
T
TECHNICAL
COMPONENT 91010 21 999 Years 3.09 $26.7305 $82.60 7/1/2015 0.00 $82.60 7/1/2015
2 SURGERY 91013 0 20 Years 0.68 $28.0672 $19.09 7/1/2015 0.00 $19.09 7/1/2015
2 SURGERY 91013 21 999 Years 0.68 $26.7305 $18.18 7/1/2015 0.00 $18.18 7/1/2015
T
TECHNICAL
COMPONENT 91013 0 20 Years 0.41 $28.0672 $11.51 7/1/2015 0.00 $11.51 7/1/2015
T
TECHNICAL
COMPONENT 91013 21 999 Years 0.41 $26.7305 $10.96 7/1/2015 0.00 $10.96 7/1/2015
2 SURGERY 91020 0 20 Years 6.63 $28.0672 $186.09 7/1/2015 0.00 $186.09 7/1/2015
2 SURGERY 91020 21 999 Years 6.63 $26.7305 $177.22 7/1/2015 0.00 $177.22 7/1/2015
T
TECHNICAL
COMPONENT 91020 0 20 Years 4.49 $28.0672 $126.02 7/1/2015 0.00 $126.02 7/1/2015
T
TECHNICAL
COMPONENT 91020 21 999 Years 4.49 $26.7305 $120.02 7/1/2015 0.00 $120.02 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 91022 0 20 Years 2.67 $28.0672 $74.94 7/1/2015 0.00 $74.94 2.67 $28.0672 $74.94 7/1/2015 0.00 $74.94 7/1/2015
2 SURGERY 91030 0 20 Years 3.88 $28.0672 $108.90 1/1/2015 0.00 $108.90 1/1/2015
2 SURGERY 91030 21 999 Years 3.88 $26.7305 $103.71 1/1/2015 0.00 $103.71 1/1/2015
T
TECHNICAL
COMPONENT 91030 0 20 Years 2.51 $28.0672 $70.45 1/1/2015 0.00 $70.45 1/1/2015
T
TECHNICAL
COMPONENT 91030 21 999 Years 2.51 $26.7305 $67.09 1/1/2015 0.00 $67.09 1/1/2015
2 SURGERY 91034 0 20 Years 5.32 $28.0672 $149.32 7/1/2015 0.00 $149.32 7/1/2015
2 SURGERY 91034 21 999 Years 5.32 $26.7305 $142.21 7/1/2015 0.00 $142.21 7/1/2015
T
TECHNICAL
COMPONENT 91034 0 20 Years 3.89 $28.0672 $109.18 7/1/2015 0.00 $109.18 7/1/2013
T
TECHNICAL
COMPONENT 91034 21 999 Years 3.89 $26.7305 $103.98 7/1/2015 0.00 $103.98 7/1/2013
2 SURGERY 91035 0 20 Years 13.70 $28.0672 $384.52 7/1/2015 0.00 $384.52 7/1/2015
2 SURGERY 91035 21 999 Years 13.70 $26.7305 $366.21 7/1/2015 0.00 $366.21 7/1/2015
T
TECHNICAL
COMPONENT 91035 0 20 Years 11.32 $28.0672 $317.72 7/1/2015 0.00 $317.72 7/1/2015
T
TECHNICAL
COMPONENT 91035 21 999 Years 11.32 $26.7305 $302.59 7/1/2015 0.00 $302.59 7/1/2015
2 SURGERY 91037 0 20 Years 4.58 $28.0672 $128.55 7/1/2015 0.00 $128.55 7/1/2015
2 SURGERY 91037 21 999 Years 4.58 $26.7305 $122.43 7/1/2015 0.00 $122.43 7/1/2015
T
TECHNICAL
COMPONENT 91037 0 20 Years 3.12 $28.0672 $87.57 7/1/2015 0.00 $87.57 7/1/2015
T
TECHNICAL
COMPONENT 91037 21 999 Years 3.12 $26.7305 $83.40 7/1/2015 0.00 $83.40 7/1/2015
2 SURGERY 91038 0 20 Years 12.89 $28.0672 $361.79 7/1/2015 0.00 $361.79 7/1/2015
2 SURGERY 91038 21 999 Years 12.89 $26.7305 $344.56 7/1/2015 0.00 $344.56 7/1/2015
T
TECHNICAL
COMPONENT 91038 0 20 Years 11.21 $28.0672 $314.63 7/1/2015 0.00 $314.63 7/1/2015
T
TECHNICAL
COMPONENT 91038 21 999 Years 11.21 $26.7305 $299.65 7/1/2015 0.00 $299.65 7/1/2015
2 SURGERY 91040 0 20 Years 12.45 $28.0672 $349.44 7/1/2015 0.00 $349.44 7/1/2015
2 SURGERY 91040 21 999 Years 12.45 $26.7305 $332.79 7/1/2015 0.00 $332.79 7/1/2015
T
TECHNICAL
COMPONENT 91040 0 20 Years 11.01 $28.0672 $309.02 7/1/2015 0.00 $309.02 7/1/2015
T
TECHNICAL
COMPONENT 91040 21 999 Years 11.01 $26.7305 $294.30 7/1/2015 0.00 $294.30 7/1/2015
2 SURGERY 91065 0 20 Years 2.32 $28.0672 $65.12 1/1/2015 0.00 $65.12 1/1/2015
2 SURGERY 91065 21 999 Years 2.32 $26.7305 $62.01 1/1/2015 0.00 $62.01 1/1/2015
T
TECHNICAL
COMPONENT 91065 0 20 Years 2.02 $28.0672 $56.70 1/1/2015 0.00 $56.70 1/1/2015
T
TECHNICAL
COMPONENT 91065 21 999 Years 2.02 $26.7305 $54.00 1/1/2015 0.00 $54.00 1/1/2015
4 RADIOLOGY 91110 0 20 Years 25.31 $28.0672 $710.38 7/1/2015 0.00 $710.38 7/1/2015
4 RADIOLOGY 91110 21 999 Years 25.31 $26.7305 $676.55 7/1/2015 0.00 $676.55 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 91110 0 20 Years 5.46 $28.0672 $153.25 7/1/2015 0.00 $153.25 5.46 $28.0672 $153.25 7/1/2015 0.00 $153.25 7/1/2015
I
PROFESSIONAL
COMPONENT 91110 21 999 Years 5.46 $26.7305 $145.95 7/1/2015 0.00 $145.95 5.46 $26.7305 $145.95 7/1/2015 0.00 $145.95 7/1/2015
T
TECHNICAL
COMPONENT 91110 0 20 Years 19.85 $28.0672 $557.13 7/1/2015 0.00 $557.13 7/1/2015
T
TECHNICAL
COMPONENT 91110 21 999 Years 19.85 $26.7305 $530.60 7/1/2015 0.00 $530.60 7/1/2015
4 RADIOLOGY 91111 0 20 Years 20.76 $28.0672 $582.68 7/1/2015 0.00 $582.68 7/1/2015
4 RADIOLOGY 91111 21 999 Years 20.76 $26.7305 $554.93 7/1/2015 0.00 $554.93 7/1/2015
T
TECHNICAL
COMPONENT 91111 0 20 Years 19.27 $28.0672 $540.85 7/1/2015 0.00 $540.85 7/1/2015
T
TECHNICAL
COMPONENT 91111 21 999 Years 19.27 $26.7305 $515.10 7/1/2015 0.00 $515.10 7/1/2015
4 RADIOLOGY 91112 0 20 Years 30.79 $28.0672 $864.19 7/1/2015 0.00 $864.19 7/1/2015
4 RADIOLOGY 91112 21 999 Years 30.79 $26.7305 $823.03 7/1/2015 0.00 $823.03 7/1/2015
T
TECHNICAL
COMPONENT 91112 0 20 Years 27.64 $28.0672 $775.78 7/1/2015 0.00 $775.78 1/1/2015
T
TECHNICAL
COMPONENT 91112 21 999 Years 27.64 $26.7305 $738.83 7/1/2015 0.00 $738.83 1/1/2015
1
MEDICAL
SERVICES 91117 0 20 Years 4.02 $28.0672 $112.83 7/1/2015 0.00 $112.83 7/1/2015
2 SURGERY 91120 0 20 Years 12.20 $28.0672 $342.42 7/1/2015 0.00 $342.42 7/1/2015
2 SURGERY 91120 21 999 Years 12.20 $26.7305 $326.11 7/1/2015 0.00 $326.11 7/1/2015
2 SURGERY 91122 0 20 Years 6.38 $28.0672 $179.07 7/1/2015 0.00 $179.07 7/1/2015
2 SURGERY 91122 21 999 Years 6.38 $26.7305 $170.54 7/1/2015 0.00 $170.54 7/1/2015
T
TECHNICAL
COMPONENT 92132 21 999 Years 0.00 $0.0000 $13.10 5/1/2016 0.00 $13.10 5/1/2016
T
TECHNICAL
COMPONENT 92133 21 999 Years 0.00 $0.0000 $13.37 5/1/2016 0.00 $13.37 5/1/2016
T
TECHNICAL
COMPONENT 92134 21 999 Years 0.00 $0.0000 $13.63 5/1/2016 0.00 $13.63 5/1/2016
T
TECHNICAL
COMPONENT 92228 21 999 Years 0.00 $0.0000 $11.49 5/1/2016 0.00 $11.49 5/1/2016
1
MEDICAL
SERVICES 92285 0 20 Years 0.00 $0.0000 $17.68 4/1/2016 0.00 $17.68 0.00 $0.0000 $17.68 4/1/2016 0.00 $17.68 5/1/2016
1
MEDICAL
SERVICES 92285 21 999 Years 0.00 $0.0000 $16.84 5/1/2016 0.00 $16.84 0.00 $0.0000 $16.84 5/1/2016 0.00 $16.84 5/1/2016
T
TECHNICAL
COMPONENT 92537 0 20 Years 0.24 $28.0672 $6.74 1/1/2016 0.00 $6.74 1/1/2016
T
TECHNICAL
COMPONENT 92537 21 999 Years 0.24 $26.7305 $6.42 1/1/2016 0.00 $6.42 1/1/2016
T
TECHNICAL
COMPONENT 92538 0 20 Years 0.13 $28.0672 $3.65 1/1/2016 0.00 $3.65 1/1/2016
T
TECHNICAL
COMPONENT 92538 21 999 Years 0.13 $26.7305 $3.47 1/1/2016 0.00 $3.47 1/1/2016
1
MEDICAL
SERVICES 92540 0 20 Years 2.86 $28.0672 $80.27 1/1/2015 0.00 $80.27 1/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
1
MEDICAL
SERVICES 92540 21 999 Years 2.86 $26.7305 $76.45 1/1/2015 0.00 $76.45 1/1/2015
T
TECHNICAL
COMPONENT 92540 0 20 Years 0.61 $28.0672 $17.12 1/1/2015 0.00 $17.12 1/1/2015
T
TECHNICAL
COMPONENT 92540 21 999 Years 0.61 $26.7305 $16.31 1/1/2015 0.00 $16.31 1/1/2015
1
MEDICAL
SERVICES 92541 0 20 Years 0.86 $28.0672 $24.14 1/1/2015 0.00 $24.14 1/1/2015
1
MEDICAL
SERVICES 92541 21 999 Years 0.86 $26.7305 $22.99 1/1/2015 0.00 $22.99 1/1/2015
T
TECHNICAL
COMPONENT 92541 0 20 Years 0.27 $28.0672 $7.58 1/1/2013 0.00 $7.58 1/1/2015
T
TECHNICAL
COMPONENT 92541 21 999 Years 0.27 $26.7305 $7.22 1/1/2013 0.00 $7.22 1/1/2015
1
MEDICAL
SERVICES 92542 0 20 Years 0.74 $28.0672 $20.77 1/1/2015 0.00 $20.77 1/1/2015
1
MEDICAL
SERVICES 92542 21 999 Years 0.74 $26.7305 $19.78 1/1/2015 0.00 $19.78 1/1/2015
T
TECHNICAL
COMPONENT 92542 0 20 Years 0.25 $28.0672 $7.02 1/1/2015 0.00 $7.02 1/1/2015
T
TECHNICAL
COMPONENT 92542 21 999 Years 0.25 $26.7305 $6.68 1/1/2015 0.00 $6.68 1/1/2015
1
MEDICAL
SERVICES 92544 0 20 Years 0.67 $28.0672 $18.81 1/1/2013 0.00 $18.81 1/1/2015
1
MEDICAL
SERVICES 92544 21 999 Years 0.67 $26.7305 $17.91 1/1/2013 0.00 $17.91 1/1/2015
T
TECHNICAL
COMPONENT 92544 0 20 Years 0.28 $28.0672 $7.86 1/1/2015 0.00 $7.86 1/1/2015
T
TECHNICAL
COMPONENT 92544 21 999 Years 0.28 $26.7305 $7.48 1/1/2015 0.00 $7.48 1/1/2015
1
MEDICAL
SERVICES 92545 0 20 Years 0.58 $28.0672 $16.28 1/1/2015 0.00 $16.28 1/1/2015
1
MEDICAL
SERVICES 92545 21 999 Years 0.58 $26.7305 $15.50 1/1/2015 0.00 $15.50 1/1/2015
T
TECHNICAL
COMPONENT 92545 0 20 Years 0.24 $28.0672 $6.74 1/1/2015 0.00 $6.74 1/1/2015
T
TECHNICAL
COMPONENT 92545 21 999 Years 0.24 $26.7305 $6.42 1/1/2015 0.00 $6.42 1/1/2015
1
MEDICAL
SERVICES 92546 0 20 Years 2.89 $28.0672 $81.11 1/1/2015 0.00 $81.11 1/1/2015
1
MEDICAL
SERVICES 92546 21 999 Years 2.89 $26.7305 $77.25 1/1/2015 0.00 $77.25 1/1/2015
T
TECHNICAL
COMPONENT 92546 0 20 Years 2.46 $28.0672 $69.05 1/1/2015 0.00 $69.05 1/1/2015
T
TECHNICAL
COMPONENT 92546 21 999 Years 2.46 $26.7305 $65.76 1/1/2015 0.00 $65.76 1/1/2015
5 LABORATORY 92550 0 20 Years 0.59 $28.0672 $16.56 4/1/2015 0.00 $16.56 4/1/2015
5 LABORATORY 92550 21 999 Years 0.59 $26.7305 $15.77 4/1/2015 0.00 $15.77 4/1/2015
5 LABORATORY 92551 0 20 Years 0.34 $28.0672 $9.54 4/1/2015 0.00 $9.54 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
5 LABORATORY 92551 21 999 Years 0.34 $26.7305 $9.09 4/1/2015 0.00 $9.09 4/1/2015
5 LABORATORY 92553 0 20 Years 1.04 $26.7305 $27.80 4/1/2015 0.00 $27.80 4/1/2015
5 LABORATORY 92553 21 999 Years 1.04 $26.7305 $27.80 4/1/2015 0.00 $27.80 4/1/2015
5 LABORATORY 92555 0 20 Years 0.65 $26.7305 $17.37 4/1/2015 0.00 $17.37 4/1/2015
5 LABORATORY 92555 21 999 Years 0.65 $26.7305 $17.37 4/1/2015 0.00 $17.37 4/1/2015
5 LABORATORY 92556 0 20 Years 1.05 $26.7305 $28.07 4/1/2015 0.00 $28.07 4/1/2015
5 LABORATORY 92556 21 999 Years 1.05 $26.7305 $28.07 4/1/2015 0.00 $28.07 4/1/2015
5 LABORATORY 92557 0 20 Years 1.05 $28.0672 $29.47 4/1/2015 0.00 $29.47 4/1/2015
5 LABORATORY 92557 21 999 Years 1.05 $26.7305 $28.07 4/1/2015 0.00 $28.07 4/1/2015
I
PROFESSIONAL
COMPONENT 92562 0 20 Years 1.29 $28.0672 $36.21 4/1/2015 0.00 $36.21 4/1/2015
I
PROFESSIONAL
COMPONENT 92562 21 999 Years 1.29 $26.7305 $34.48 4/1/2015 0.00 $34.48 4/1/2015
5 LABORATORY 92563 21 999 Years 0.87 $26.7305 $23.26 4/1/2015 0.00 $23.26 4/1/2015
5 LABORATORY 92564 0 20 Years 0.80 $28.0672 $22.45 4/1/2015 0.00 $22.45 4/1/2015
5 LABORATORY 92564 21 999 Years 0.80 $26.7305 $21.38 4/1/2015 0.00 $21.38 4/1/2015
5 LABORATORY 92565 0 20 Years 0.44 $26.7305 $11.76 4/1/2015 0.00 $11.76 4/1/2015
5 LABORATORY 92565 21 999 Years 0.44 $26.7305 $11.76 4/1/2015 0.00 $11.76 4/1/2015
5 LABORATORY 92567 0 20 Years 0.41 $28.0672 $11.51 4/1/2015 0.00 $11.51 4/1/2015
5 LABORATORY 92567 21 999 Years 0.41 $26.7305 $10.96 4/1/2015 0.00 $10.96 4/1/2015
5 LABORATORY 92568 21 999 Years 0.43 $26.7305 $11.49 4/1/2015 0.00 $11.49 4/1/2015
5 LABORATORY 92571 0 20 Years 0.76 $28.0672 $21.33 4/1/2015 0.00 $21.33 4/1/2015
5 LABORATORY 92571 21 999 Years 0.76 $26.7305 $20.32 4/1/2015 0.00 $20.32 4/1/2015
5 LABORATORY 92572 0 20 Years 0.87 $28.0672 $24.42 4/1/2015 0.00 $24.42 4/1/2015
5 LABORATORY 92572 21 999 Years 0.87 $26.7305 $23.26 4/1/2015 0.00 $23.26 4/1/2015
5 LABORATORY 92575 0 20 Years 1.99 $28.0672 $55.85 4/1/2015 0.00 $55.85 4/1/2015
5 LABORATORY 92575 21 999 Years 1.99 $26.7305 $53.19 4/1/2015 0.00 $53.19 4/1/2015
5 LABORATORY 92576 0 20 Years 0.99 $28.0672 $27.79 4/1/2015 0.00 $27.79 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
5 LABORATORY 92576 21 999 Years 0.99 $26.7305 $26.46 4/1/2015 0.00 $26.46 4/1/2015
5 LABORATORY 92577 0 20 Years 0.44 $26.7305 $11.76 4/1/2015 0.00 $11.76 4/1/2015
5 LABORATORY 92577 21 999 Years 0.44 $26.7305 $11.76 4/1/2015 0.00 $11.76 4/1/2015
5 LABORATORY 92579 0 20 Years 1.27 $28.0672 $35.65 4/1/2015 0.00 $35.65 4/1/2015
5 LABORATORY 92579 21 999 Years 1.27 $26.7305 $33.95 4/1/2015 0.00 $33.95 4/1/2015
5 LABORATORY 92582 0 20 Years 2.01 $28.0672 $56.42 4/1/2015 0.00 $56.42 4/1/2015
5 LABORATORY 92582 21 999 Years 2.01 $26.7305 $53.73 4/1/2015 0.00 $53.73 4/1/2015
5 LABORATORY 92584 21 999 Years 2.08 $26.7305 $55.60 4/1/2015 0.00 $55.60 4/1/2015
5 LABORATORY 92585 0 20 Years 3.81 $26.7305 $101.84 4/1/2015 0.00 $101.84 4/1/2015
5 LABORATORY 92585 21 999 Years 3.81 $26.7305 $101.84 4/1/2015 0.00 $101.84 4/1/2015
T
TECHNICAL
COMPONENT 92585 0 20 Years 3.06 $28.0672 $85.89 4/1/2015 0.00 $85.89 4/1/2015
T
TECHNICAL
COMPONENT 92585 21 999 Years 3.06 $26.7305 $81.80 4/1/2015 0.00 $81.80 4/1/2015
5 LABORATORY 92586 0 20 Years 2.35 $26.7305 $62.82 4/1/2015 0.00 $62.82 4/1/2015
5 LABORATORY 92586 21 999 Years 2.35 $26.7305 $62.82 4/1/2015 0.00 $62.82 4/1/2015
5 LABORATORY 92587 21 999 Years 0.60 $26.7305 $16.04 4/1/2015 0.00 $16.04 4/1/2015
T
TECHNICAL
COMPONENT 92587 0 20 Years 0.08 $28.0672 $2.25 4/1/2015 0.00 $2.25 4/1/2015
T
TECHNICAL
COMPONENT 92587 21 999 Years 0.08 $26.7305 $2.14 4/1/2015 0.00 $2.14 4/1/2015
5 LABORATORY 92588 21 999 Years 0.93 $26.7305 $24.86 4/1/2015 0.00 $24.86 4/1/2015
T
TECHNICAL
COMPONENT 92588 0 20 Years 0.11 $28.0672 $3.09 4/1/2015 0.00 $3.09 4/1/2015
T
TECHNICAL
COMPONENT 92588 21 999 Years 0.11 $26.7305 $2.94 4/1/2015 0.00 $2.94 4/1/2015
1
MEDICAL
SERVICES 92597 0 20 Years 2.03 $28.0672 $56.98 11/1/2015 0.00 $56.98 11/1/2015
1
MEDICAL
SERVICES 92620 0 20 Years 2.65 $28.0672 $74.38 11/1/2015 0.00 $74.38 11/1/2015
1
MEDICAL
SERVICES 92620 21 999 Years 2.65 $26.7305 $70.84 11/1/2015 0.00 $70.84 11/1/2015
1
MEDICAL
SERVICES 92621 0 20 Years 0.63 $28.0672 $17.68 11/1/2015 0.00 $17.68 11/1/2015
1
MEDICAL
SERVICES 92621 21 999 Years 0.63 $26.7305 $16.84 11/1/2015 0.00 $16.84 11/1/2015
1
MEDICAL
SERVICES 92625 0 20 Years 1.97 $28.0672 $55.29 11/1/2015 0.00 $55.29 11/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
1
MEDICAL
SERVICES 92625 21 999 Years 1.97 $26.7305 $52.66 11/1/2015 0.00 $52.66 11/1/2015
T
TECHNICAL
COMPONENT 92978 0 20 Years 0.00 $0.0000 $159.32 1/1/2015 0.00 $159.32 1/1/2015
T
TECHNICAL
COMPONENT 92978 21 999 Years 0.00 $0.0000 $151.73 1/1/2015 0.00 $151.73 1/1/2015
5 LABORATORY 93000 0 20 Years 0.48 $28.0672 $13.47 4/1/2015 0.00 $13.47 0.48 $28.0672 $13.47 4/1/2015 0.00 $13.47 4/1/2015
5 LABORATORY 93000 21 999 Years 0.48 $26.7305 $12.83 4/1/2015 0.00 $12.83 0.48 $26.7305 $12.83 4/1/2015 0.00 $12.83 4/1/2015
T
TECHNICAL
COMPONENT 93005 0 20 Years 0.24 $28.0672 $6.74 4/1/2015 0.00 $6.74 4/1/2015
T
TECHNICAL
COMPONENT 93005 21 999 Years 0.24 $26.7305 $6.42 4/1/2015 0.00 $6.42 4/1/2015
I
PROFESSIONAL
COMPONENT 93010 0 20 Years 0.24 $28.0672 $6.74 4/1/2013 0.00 $6.74 0.24 $28.0672 $6.74 4/1/2013 0.00 $6.74 4/1/2015
I
PROFESSIONAL
COMPONENT 93010 21 999 Years 0.24 $26.7305 $6.42 4/1/2013 0.00 $6.42 0.24 $26.7305 $6.42 4/1/2013 0.00 $6.42 4/1/2015
5 LABORATORY 93015 0 20 Years 2.15 $28.0672 $60.34 7/1/2015 0.00 $60.34 7/1/2015
5 LABORATORY 93015 21 999 Years 2.15 $26.7305 $57.47 7/1/2015 0.00 $57.47 7/1/2015
T
TECHNICAL
COMPONENT 93017 0 20 Years 1.11 $28.0672 $31.15 7/1/2015 0.00 $31.15 7/1/2015
T
TECHNICAL
COMPONENT 93017 21 999 Years 1.11 $26.7305 $29.67 7/1/2015 0.00 $29.67 7/1/2015
T
TECHNICAL
COMPONENT 93024 0 20 Years 1.55 $28.0672 $43.50 7/1/2015 0.00 $43.50 7/1/2015
T
TECHNICAL
COMPONENT 93025 0 20 Years 3.56 $28.0672 $99.92 7/1/2015 0.00 $99.92 7/1/2015
T
TECHNICAL
COMPONENT 93025 21 999 Years 3.56 $26.7305 $95.16 7/1/2015 0.00 $95.16 7/1/2015
5 LABORATORY 93040 0 20 Years 0.36 $28.0672 $10.10 7/1/2015 0.00 $10.10 0.36 $28.0672 $10.10 7/1/2015 0.00 $10.10 7/1/2015
5 LABORATORY 93040 21 999 Years 0.36 $26.7305 $9.62 7/1/2015 0.00 $9.62 0.36 $26.7305 $9.62 7/1/2015 0.00 $9.62 7/1/2015
T
TECHNICAL
COMPONENT 93041 0 20 Years 0.16 $28.0672 $4.49 7/1/2015 0.00 $4.49 7/1/2015
T
TECHNICAL
COMPONENT 93041 21 999 Years 0.16 $26.7305 $4.28 7/1/2015 0.00 $4.28 7/1/2015
I
PROFESSIONAL
COMPONENT 93042 0 20 Years 0.20 $28.0672 $5.61 7/1/2015 0.00 $5.61 0.20 $28.0672 $5.61 7/1/2015 0.00 $5.61 7/1/2015
I
PROFESSIONAL
COMPONENT 93042 21 999 Years 0.20 $26.7305 $5.35 7/1/2015 0.00 $5.35 0.20 $26.7305 $5.35 7/1/2015 0.00 $5.35 7/1/2015
5 LABORATORY 93224 0 20 Years 2.59 $28.0672 $72.69 7/1/2015 0.00 $72.69 7/1/2015
5 LABORATORY 93224 21 999 Years 2.59 $26.7305 $69.23 7/1/2015 0.00 $69.23 7/1/2015
T
TECHNICAL
COMPONENT 93225 0 20 Years 0.76 $28.0672 $21.33 7/1/2015 0.00 $21.33 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93225 21 999 Years 0.76 $26.7305 $20.32 7/1/2015 0.00 $20.32 7/1/2015
T
TECHNICAL
COMPONENT 93226 0 20 Years 1.07 $28.0672 $30.03 7/1/2015 0.00 $30.03 7/1/2015
T
TECHNICAL
COMPONENT 93226 21 999 Years 1.07 $26.7305 $28.60 7/1/2015 0.00 $28.60 7/1/2015
T
TECHNICAL
COMPONENT 93260 0 20 Years 0.59 $28.0672 $16.56 1/1/2015 0.00 $16.56 1/1/2015
T
TECHNICAL
COMPONENT 93260 21 999 Years 0.59 $26.7305 $15.77 1/1/2015 0.00 $15.77 1/1/2015
T
TECHNICAL
COMPONENT 93261 0 20 Years 0.59 $28.0672 $16.56 1/1/2015 0.00 $16.56 1/1/2015
T
TECHNICAL
COMPONENT 93261 21 999 Years 0.59 $26.7305 $15.77 1/1/2015 0.00 $15.77 1/1/2015
5 LABORATORY 93268 0 20 Years 5.78 $28.0672 $162.23 7/1/2015 0.00 $162.23 7/1/2015
5 LABORATORY 93268 21 999 Years 5.78 $26.7305 $154.50 7/1/2015 0.00 $154.50 7/1/2015
5 LABORATORY 93270 0 20 Years 0.26 $28.0672 $7.30 7/1/2015 0.00 $7.30 7/1/2015
5 LABORATORY 93270 21 999 Years 0.26 $26.7305 $6.95 7/1/2015 0.00 $6.95 7/1/2015
5 LABORATORY 93271 0 20 Years 4.80 $28.0672 $134.72 7/1/2015 0.00 $134.72 4.80 $28.0672 $134.72 7/1/2015 0.00 $134.72 7/1/2015
5 LABORATORY 93271 21 999 Years 4.80 $26.7305 $128.31 7/1/2015 0.00 $128.31 4.80 $26.7305 $128.31 7/1/2015 0.00 $128.31 7/1/2015
I
PROFESSIONAL
COMPONENT 93278 0 20 Years 0.35 $28.0672 $9.82 7/1/2015 0.00 $9.82 0.35 $28.0672 $9.82 7/1/2015 0.00 $9.82 7/1/2015
I
PROFESSIONAL
COMPONENT 93278 21 999 Years 0.35 $26.7305 $9.36 7/1/2015 0.00 $9.36 0.35 $26.7305 $9.36 7/1/2015 0.00 $9.36 7/1/2015
T
TECHNICAL
COMPONENT 93278 0 20 Years 0.51 $28.0672 $14.31 7/1/2015 0.00 $14.31 0.51 $28.0672 $14.31 7/1/2015 0.00 $14.31 7/1/2015
T
TECHNICAL
COMPONENT 93278 21 999 Years 0.51 $26.7305 $13.63 7/1/2015 0.00 $13.63 0.51 $26.7305 $13.63 7/1/2015 0.00 $13.63 7/1/2015
I
PROFESSIONAL
COMPONENT 93288 0 20 Years 0.61 $28.0672 $17.12 7/1/2015 0.00 $17.12 7/1/2015
I
PROFESSIONAL
COMPONENT 93288 21 999 Years 0.61 $26.7305 $16.31 7/1/2015 0.00 $16.31 7/1/2015
T
TECHNICAL
COMPONENT 93288 0 20 Years 0.45 $28.0672 $12.63 7/1/2015 0.00 $12.63 7/1/2015
T
TECHNICAL
COMPONENT 93288 21 999 Years 0.45 $26.7305 $12.03 7/1/2015 0.00 $12.03 7/1/2015
T
TECHNICAL
COMPONENT 93292 0 20 Years 0.31 $28.0672 $8.70 7/1/2015 0.00 $8.70 7/1/2015
T
TECHNICAL
COMPONENT 93292 21 999 Years 0.31 $26.7305 $8.29 7/1/2015 0.00 $8.29 7/1/2015
4 RADIOLOGY 93303 0 20 Years 0.00 $0.0000 $174.30 1/1/2016 0.00 $174.30 1/1/2016
4 RADIOLOGY 93303 21 999 Years 6.69 $26.7305 $178.83 7/1/2015 0.00 $178.83 1/1/2016
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93303 0 20 Years 0.00 $0.0000 $119.40 1/1/2016 0.00 $119.40 1/1/2016
T
TECHNICAL
COMPONENT 93303 21 999 Years 4.89 $26.7305 $130.71 7/1/2015 0.00 $130.71 1/1/2016
4 RADIOLOGY 93304 0 20 Years 4.36 $28.0672 $122.37 7/1/2015 0.00 $122.37 7/1/2015
4 RADIOLOGY 93304 21 999 Years 4.36 $26.7305 $116.54 7/1/2015 0.00 $116.54 7/1/2015
T
TECHNICAL
COMPONENT 93304 0 20 Years 3.33 $28.0672 $93.46 7/1/2015 0.00 $93.46 7/1/2015
T
TECHNICAL
COMPONENT 93304 21 999 Years 3.33 $26.7305 $89.01 7/1/2015 0.00 $89.01 7/1/2015
T
TECHNICAL
COMPONENT 93306 0 20 Years 4.61 $28.0672 $129.39 7/1/2015 0.00 $129.39 7/1/2015
T
TECHNICAL
COMPONENT 93306 21 999 Years 4.61 $26.7305 $123.23 7/1/2015 0.00 $123.23 7/1/2015
4 RADIOLOGY 93307 0 20 Years 0.00 $0.0000 $100.80 1/1/2016 0.00 $100.80 1/1/2016
4 RADIOLOGY 93307 21 999 Years 3.67 $26.7305 $98.10 7/1/2015 0.00 $98.10 1/1/2016
T
TECHNICAL
COMPONENT 93307 0 20 Years 0.00 $0.0000 $61.80 1/1/2016 0.00 $61.80 1/1/2016
T
TECHNICAL
COMPONENT 93307 21 999 Years 2.39 $26.7305 $63.89 7/1/2015 0.00 $63.89 1/1/2016
4 RADIOLOGY 93308 0 20 Years 3.51 $28.0672 $98.52 7/1/2015 0.00 $98.52 7/1/2015
4 RADIOLOGY 93308 21 999 Years 3.51 $26.7305 $93.82 7/1/2015 0.00 $93.82 7/1/2015
T
TECHNICAL
COMPONENT 93308 0 20 Years 2.78 $28.0672 $78.03 7/1/2015 0.00 $78.03 7/1/2015
T
TECHNICAL
COMPONENT 93308 21 999 Years 2.78 $26.7305 $74.31 7/1/2015 0.00 $74.31 7/1/2015
I
PROFESSIONAL
COMPONENT 93312 0 20 Years 3.44 $28.0672 $96.55 7/1/2015 0.00 $96.55 3.44 $28.0672 $96.55 7/1/2015 0.00 $96.55 7/1/2015
I
PROFESSIONAL
COMPONENT 93312 21 999 Years 3.44 $26.7305 $91.95 7/1/2015 0.00 $91.95 3.44 $26.7305 $91.95 7/1/2015 0.00 $91.95 7/1/2015
T
TECHNICAL
COMPONENT 93312 0 20 Years 5.18 $28.0672 $145.39 7/1/2015 0.00 $145.39 7/1/2015
T
TECHNICAL
COMPONENT 93312 21 999 Years 5.18 $26.7305 $138.46 7/1/2015 0.00 $138.46 7/1/2015
I
PROFESSIONAL
COMPONENT 93314 0 20 Years 2.80 $28.0672 $78.59 7/1/2015 0.00 $78.59 2.80 $28.0672 $78.59 7/1/2015 0.00 $78.59 7/1/2015
I
PROFESSIONAL
COMPONENT 93314 21 999 Years 2.80 $26.7305 $74.85 7/1/2015 0.00 $74.85 2.80 $26.7305 $74.85 7/1/2015 0.00 $74.85 7/1/2015
T
TECHNICAL
COMPONENT 93314 0 20 Years 5.48 $28.0672 $153.81 7/1/2015 0.00 $153.81 7/1/2015
T
TECHNICAL
COMPONENT 93314 21 999 Years 5.48 $26.7305 $146.48 7/1/2015 0.00 $146.48 7/1/2015
I
PROFESSIONAL
COMPONENT 93315 0 20 Years 4.13 $28.0672 $115.92 7/1/2015 0.00 $115.92 4.13 $28.0672 $115.92 7/1/2015 0.00 $115.92 7/1/2015
I
PROFESSIONAL
COMPONENT 93315 21 999 Years 4.13 $26.7305 $110.40 7/1/2015 0.00 $110.40 4.13 $26.7305 $110.40 7/1/2015 0.00 $110.40 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93315 0 20 Years 0.00 $0.0000 $176.61 7/1/2015 0.00 $176.61 7/1/2015
T
TECHNICAL
COMPONENT 93315 21 999 Years 0.00 $0.0000 $168.20 7/1/2015 0.00 $168.20 7/1/2015
I
PROFESSIONAL
COMPONENT 93317 0 20 Years 3.09 $28.0672 $86.73 7/1/2015 0.00 $86.73 3.09 $28.0672 $86.73 7/1/2015 0.00 $86.73 7/1/2015
I
PROFESSIONAL
COMPONENT 93317 21 999 Years 3.09 $26.7305 $82.60 7/1/2015 0.00 $82.60 3.09 $26.7305 $82.60 7/1/2015 0.00 $82.60 7/1/2015
T
TECHNICAL
COMPONENT 93317 0 20 Years 0.00 $0.0000 $163.93 7/1/2015 0.00 $163.93 7/1/2015
T
TECHNICAL
COMPONENT 93317 21 999 Years 0.00 $0.0000 $156.13 7/1/2015 0.00 $156.13 7/1/2015
T
TECHNICAL
COMPONENT 93318 0 20 Years 0.00 $0.0000 $146.23 7/1/2015 0.00 $146.23 7/1/2015
T
TECHNICAL
COMPONENT 93318 21 999 Years 0.00 $0.0000 $139.27 7/1/2015 0.00 $139.27 7/1/2015
4 RADIOLOGY 93320 0 20 Years 1.54 $28.0672 $43.22 7/1/2015 0.00 $43.22 7/1/2015
4 RADIOLOGY 93320 21 999 Years 1.54 $26.7305 $41.16 7/1/2015 0.00 $41.16 7/1/2015
T
TECHNICAL
COMPONENT 93320 0 20 Years 1.02 $28.0672 $28.63 7/1/2015 0.00 $28.63 7/1/2015
T
TECHNICAL
COMPONENT 93320 21 999 Years 1.02 $26.7305 $27.27 7/1/2015 0.00 $27.27 7/1/2015
4 RADIOLOGY 93321 0 20 Years 0.78 $28.0672 $21.89 7/1/2015 0.00 $21.89 7/1/2015
4 RADIOLOGY 93321 21 999 Years 0.78 $26.7305 $20.85 7/1/2015 0.00 $20.85 7/1/2015
T
TECHNICAL
COMPONENT 93321 0 20 Years 0.57 $28.0672 $16.00 7/1/2015 0.00 $16.00 7/1/2015
T
TECHNICAL
COMPONENT 93321 21 999 Years 0.57 $26.7305 $15.24 7/1/2015 0.00 $15.24 7/1/2015
4 RADIOLOGY 93325 0 20 Years 0.74 $28.0672 $20.77 7/1/2015 0.00 $20.77 7/1/2015
4 RADIOLOGY 93325 21 999 Years 0.74 $26.7305 $19.78 7/1/2015 0.00 $19.78 7/1/2015
T
TECHNICAL
COMPONENT 93325 0 20 Years 0.64 $28.0672 $17.96 7/1/2015 0.00 $17.96 7/1/2015
T
TECHNICAL
COMPONENT 93325 21 999 Years 0.64 $26.7305 $17.11 7/1/2015 0.00 $17.11 7/1/2015
I
PROFESSIONAL
COMPONENT 93350 0 20 Years 2.02 $28.0672 $56.70 7/1/2015 0.00 $56.70 2.02 $28.0672 $56.70 7/1/2015 0.00 $56.70 7/1/2015
I
PROFESSIONAL
COMPONENT 93350 21 999 Years 2.02 $26.7305 $54.00 7/1/2015 0.00 $54.00 2.02 $26.7305 $54.00 7/1/2015 0.00 $54.00 7/1/2015
T
TECHNICAL
COMPONENT 93350 0 20 Years 4.76 $28.0672 $133.60 7/1/2015 0.00 $133.60 7/1/2015
T
TECHNICAL
COMPONENT 93350 21 999 Years 4.76 $26.7305 $127.24 7/1/2015 0.00 $127.24 7/1/2015
2 SURGERY 93451 0 20 Years 22.21 $28.0672 $623.37 7/1/2015 0.00 $623.37 7/1/2015
2 SURGERY 93451 21 999 Years 22.21 $26.7305 $593.68 7/1/2015 0.00 $593.68 7/1/2015
T
TECHNICAL
COMPONENT 93451 0 20 Years 18.03 $28.0672 $506.05 7/1/2015 0.00 $506.05 7/1/2015
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93451 21 999 Years 18.03 $26.7305 $481.95 7/1/2015 0.00 $481.95 7/1/2015
2 SURGERY 93452 0 20 Years 25.11 $28.0672 $704.77 7/1/2015 0.00 $704.77 7/1/2015
2 SURGERY 93452 21 999 Years 25.11 $26.7305 $671.20 7/1/2015 0.00 $671.20 7/1/2015
T
TECHNICAL
COMPONENT 93452 0 20 Years 17.76 $28.0672 $498.47 7/1/2015 0.00 $498.47 7/1/2015
T
TECHNICAL
COMPONENT 93452 21 999 Years 17.76 $26.7305 $474.73 7/1/2015 0.00 $474.73 7/1/2015
2 SURGERY 93453 0 20 Years 32.33 $28.0672 $907.41 7/1/2015 0.00 $907.41 7/1/2015
2 SURGERY 93453 21 999 Years 32.33 $26.7305 $864.20 7/1/2015 0.00 $864.20 7/1/2015
T
TECHNICAL
COMPONENT 93453 0 20 Years 22.66 $28.0672 $636.00 7/1/2015 0.00 $636.00 7/1/2015
T
TECHNICAL
COMPONENT 93453 21 999 Years 22.66 $26.7305 $605.71 7/1/2015 0.00 $605.71 7/1/2015
2 SURGERY 93454 0 20 Years 25.41 $28.0672 $713.19 7/1/2015 0.00 $713.19 7/1/2015
2 SURGERY 93454 21 999 Years 25.41 $26.7305 $679.22 7/1/2015 0.00 $679.22 7/1/2015
T
TECHNICAL
COMPONENT 93454 0 20 Years 18.01 $28.0672 $505.49 7/1/2015 0.00 $505.49 7/1/2015
T
TECHNICAL
COMPONENT 93454 21 999 Years 18.01 $26.7305 $481.42 7/1/2015 0.00 $481.42 7/1/2015
2 SURGERY 93455 0 20 Years 29.59 $28.0672 $830.51 7/1/2015 0.00 $830.51 7/1/2015
2 SURGERY 93455 21 999 Years 29.59 $26.7305 $790.96 7/1/2015 0.00 $790.96 7/1/2015
T
TECHNICAL
COMPONENT 93455 0 20 Years 21.02 $28.0672 $589.97 7/1/2015 0.00 $589.97 7/1/2015
T
TECHNICAL
COMPONENT 93455 21 999 Years 21.02 $26.7305 $561.88 7/1/2015 0.00 $561.88 7/1/2015
2 SURGERY 93456 0 20 Years 31.81 $28.0672 $892.82 7/1/2015 0.00 $892.82 7/1/2015
2 SURGERY 93456 21 999 Years 31.81 $26.7305 $850.30 7/1/2015 0.00 $850.30 7/1/2015
T
TECHNICAL
COMPONENT 93456 0 20 Years 22.29 $28.0672 $625.62 7/1/2015 0.00 $625.62 7/1/2015
T
TECHNICAL
COMPONENT 93456 21 999 Years 22.29 $26.7305 $595.82 7/1/2015 0.00 $595.82 7/1/2015
2 SURGERY 93457 0 20 Years 35.91 $28.0672 $1,007.89 7/1/2015 0.00 $1,007.89 7/1/2015
2 SURGERY 93457 21 999 Years 35.91 $26.7305 $959.89 7/1/2015 0.00 $959.89 7/1/2015
T
TECHNICAL
COMPONENT 93457 0 20 Years 25.27 $28.0672 $709.26 7/1/2015 0.00 $709.26 7/1/2015
T
TECHNICAL
COMPONENT 93457 21 999 Years 25.27 $26.7305 $675.48 7/1/2015 0.00 $675.48 7/1/2015
2 SURGERY 93458 0 20 Years 30.45 $28.0672 $854.65 7/1/2015 0.00 $854.65 7/1/2015
2 SURGERY 93458 21 999 Years 30.45 $26.7305 $813.94 7/1/2015 0.00 $813.94 7/1/2015
T
TECHNICAL
COMPONENT 93458 0 20 Years 21.44 $28.0672 $601.76 7/1/2015 0.00 $601.76 7/1/2015
T
TECHNICAL
COMPONENT 93458 21 999 Years 21.44 $26.7305 $573.10 7/1/2015 0.00 $573.10 7/1/2015
2 SURGERY 93459 0 20 Years 33.64 $28.0672 $944.18 7/1/2015 0.00 $944.18 7/1/2015
2 SURGERY 93459 21 999 Years 33.64 $26.7305 $899.21 7/1/2015 0.00 $899.21 7/1/2015
T
TECHNICAL
COMPONENT 93459 0 20 Years 23.48 $28.0672 $659.02 7/1/2015 0.00 $659.02 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93459 21 999 Years 23.48 $26.7305 $627.63 7/1/2015 0.00 $627.63 7/1/2015
2 SURGERY 93460 0 20 Years 36.12 $28.0672 $1,013.79 7/1/2015 0.00 $1,013.79 7/1/2015
2 SURGERY 93460 21 999 Years 36.12 $26.7305 $965.51 7/1/2015 0.00 $965.51 7/1/2015
T
TECHNICAL
COMPONENT 93460 0 20 Years 24.78 $28.0672 $695.51 7/1/2015 0.00 $695.51 7/1/2015
T
TECHNICAL
COMPONENT 93460 21 999 Years 24.78 $26.7305 $662.38 7/1/2015 0.00 $662.38 7/1/2015
2 SURGERY 93461 0 20 Years 41.30 $28.0672 $1,159.18 7/1/2015 0.00 $1,159.18 7/1/2015
2 SURGERY 93461 21 999 Years 41.30 $26.7305 $1,103.97 7/1/2015 0.00 $1,103.97 7/1/2015
T
TECHNICAL
COMPONENT 93461 0 20 Years 28.78 $28.0672 $807.77 7/1/2015 0.00 $807.77 7/1/2015
T
TECHNICAL
COMPONENT 93461 21 999 Years 28.78 $26.7305 $769.30 7/1/2015 0.00 $769.30 7/1/2015
2 SURGERY 93462 0 20 Years 6.03 $28.0672 $169.25 7/1/2015 0.00 $169.25 7/1/2015
2 SURGERY 93462 21 999 Years 6.03 $26.7305 $161.18 7/1/2015 0.00 $161.18 7/1/2015
2 SURGERY 93503 0 20 Years 3.70 $28.0672 $103.85 7/1/2015 0.00 $103.85 12 7/1/2015
2 SURGERY 93503 21 999 Years 3.70 $26.7305 $98.90 7/1/2015 0.00 $98.90 12 7/1/2015
2 SURGERY 93505 0 20 Years 21.34 $28.0672 $598.95 1/1/2015 0.00 $598.95 1/1/2015
2 SURGERY 93505 21 999 Years 21.34 $26.7305 $570.43 1/1/2015 0.00 $570.43 1/1/2015
T
TECHNICAL
COMPONENT 93505 0 20 Years 14.67 $28.0672 $411.75 1/1/2015 0.00 $411.75 1/1/2015
T
TECHNICAL
COMPONENT 93505 21 999 Years 14.67 $26.7305 $392.14 1/1/2015 0.00 $392.14 1/1/2015
2 SURGERY 93530 0 20 Years 0.00 $0.0000 $756.29 1/1/2015 0.00 $756.29 1/1/2015
2 SURGERY 93530 21 999 Years 0.00 $0.0000 $720.28 1/1/2015 0.00 $720.28 1/1/2015
T
TECHNICAL
COMPONENT 93530 0 20 Years 0.00 $0.0000 $572.17 1/1/2015 0.00 $572.17 1/1/2015
T
TECHNICAL
COMPONENT 93530 21 999 Years 0.00 $0.0000 $544.93 1/1/2015 0.00 $544.93 1/1/2015
2 SURGERY 93531 0 20 Years 0.00 $0.0000 $2,001.51 1/1/2015 0.00 $2,001.51 1/1/2015
2 SURGERY 93531 21 999 Years 0.00 $0.0000 $1,906.23 1/1/2015 0.00 $1,906.23 1/1/2015
T
TECHNICAL
COMPONENT 93531 0 20 Years 0.00 $0.0000 $1,638.60 1/1/2015 0.00 $1,638.60 1/1/2015
T
TECHNICAL
COMPONENT 93531 21 999 Years 0.00 $0.0000 $1,560.60 1/1/2015 0.00 $1,560.60 1/1/2015
2 SURGERY 93532 0 20 Years 0.00 $0.0000 $1,438.32 1/1/2015 0.00 $1,438.32 1/1/2015
2 SURGERY 93532 21 999 Years 0.00 $0.0000 $1,369.82 1/1/2015 0.00 $1,369.82 1/1/2015
T
TECHNICAL
COMPONENT 93532 0 20 Years 0.00 $0.0000 $1,003.28 1/1/2015 0.00 $1,003.28 1/1/2015
T
TECHNICAL
COMPONENT 93532 21 999 Years 0.00 $0.0000 $955.50 1/1/2015 0.00 $955.50 1/1/2015
2 SURGERY 93533 0 20 Years 0.00 $0.0000 $964.15 1/1/2015 0.00 $964.15 1/1/2015
2 SURGERY 93533 21 999 Years 0.00 $0.0000 $918.23 1/1/2015 0.00 $918.23 1/1/2015
T
TECHNICAL
COMPONENT 93533 0 20 Years 0.00 $0.0000 $672.53 1/1/2015 0.00 $672.53 1/1/2015
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93533 21 999 Years 0.00 $0.0000 $640.50 1/1/2015 0.00 $640.50 1/1/2015
T
TECHNICAL
COMPONENT 93561 0 20 Years 0.00 $0.0000 $21.55 4/1/2015 0.00 $21.55 4/1/2015
T
TECHNICAL
COMPONENT 93561 21 999 Years 0.00 $0.0000 $22.49 4/1/2015 0.00 $22.49 4/1/2015
T
TECHNICAL
COMPONENT 93562 0 20 Years 0.00 $0.0000 $12.33 4/1/2015 0.00 $12.33 4/1/2015
T
TECHNICAL
COMPONENT 93562 21 999 Years 0.00 $0.0000 $12.64 4/1/2015 0.00 $12.64 4/1/2015
2 SURGERY 93563 0 20 Years 1.71 $28.0672 $47.99 7/1/2015 0.00 $47.99 7/1/2015
2 SURGERY 93563 21 999 Years 1.71 $26.7305 $45.71 7/1/2015 0.00 $45.71 7/1/2015
2 SURGERY 93564 0 20 Years 1.79 $28.0672 $50.24 7/1/2015 0.00 $50.24 7/1/2015
2 SURGERY 93564 21 999 Years 1.79 $26.7305 $47.85 7/1/2015 0.00 $47.85 7/1/2015
2 SURGERY 93565 0 20 Years 1.34 $28.0672 $37.61 7/1/2015 0.00 $37.61 7/1/2015
2 SURGERY 93565 21 999 Years 1.34 $26.7305 $35.82 7/1/2015 0.00 $35.82 7/1/2015
2 SURGERY 93566 0 20 Years 4.85 $28.0672 $136.13 7/1/2015 0.00 $136.13 7/1/2015
2 SURGERY 93566 21 999 Years 4.85 $26.7305 $129.64 7/1/2015 0.00 $129.64 7/1/2015
2 SURGERY 93567 0 20 Years 4.02 $28.0672 $112.83 7/1/2015 0.00 $112.83 7/1/2015
2 SURGERY 93567 21 999 Years 4.02 $26.7305 $107.46 7/1/2015 0.00 $107.46 7/1/2015
2 SURGERY 93568 0 20 Years 4.36 $28.0672 $122.37 7/1/2015 0.00 $122.37 7/1/2015
2 SURGERY 93568 21 999 Years 4.36 $26.7305 $116.54 7/1/2015 0.00 $116.54 7/1/2015
T
TECHNICAL
COMPONENT 93571 0 20 Years 0.00 $0.0000 $153.56 1/1/2015 0.00 $153.56 1/1/2015
T
TECHNICAL
COMPONENT 93571 21 999 Years 0.00 $0.0000 $146.25 1/1/2015 0.00 $146.25 1/1/2015
T
TECHNICAL
COMPONENT 93572 0 20 Years 0.00 $0.0000 $90.75 1/1/2015 0.00 $90.75 1/1/2015
T
TECHNICAL
COMPONENT 93572 21 999 Years 0.00 $0.0000 $86.43 1/1/2015 0.00 $86.43 1/1/2015
T
TECHNICAL
COMPONENT 93600 0 20 Years 0.00 $0.0000 $65.58 1/1/2015 0.00 $65.58 1/1/2015
T
TECHNICAL
COMPONENT 93600 21 999 Years 0.00 $0.0000 $62.46 1/1/2015 0.00 $62.46 1/1/2015
T
TECHNICAL
COMPONENT 93602 0 20 Years 0.00 $0.0000 $36.45 1/1/2015 0.00 $36.45 1/1/2015
T
TECHNICAL
COMPONENT 93602 21 999 Years 0.00 $0.0000 $34.72 1/1/2015 0.00 $34.72 1/1/2015
T
TECHNICAL
COMPONENT 93603 0 20 Years 0.00 $0.0000 $55.95 1/1/2015 0.00 $55.95 1/1/2015
T
TECHNICAL
COMPONENT 93603 21 999 Years 0.00 $0.0000 $53.30 1/1/2015 0.00 $53.30 1/1/2015
T
TECHNICAL
COMPONENT 93609 0 20 Years 0.00 $0.0000 $89.53 1/1/2015 0.00 $89.53 1/1/2015
T
TECHNICAL
COMPONENT 93609 21 999 Years 0.00 $0.0000 $85.28 1/1/2015 0.00 $85.28 1/1/2015
T
TECHNICAL
COMPONENT 93610 0 20 Years 0.00 $0.0000 $44.61 1/1/2015 0.00 $44.61 1/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93610 21 999 Years 0.00 $0.0000 $42.49 1/1/2015 0.00 $42.49 1/1/2015
T
TECHNICAL
COMPONENT 93612 0 20 Years 0.00 $0.0000 $53.17 1/1/2015 0.00 $53.17 1/1/2015
T
TECHNICAL
COMPONENT 93612 21 999 Years 0.00 $0.0000 $50.64 1/1/2015 0.00 $50.64 1/1/2015
T
TECHNICAL
COMPONENT 93615 0 20 Years 0.00 $0.0000 $11.15 1/1/2015 0.00 $11.15 1/1/2015
T
TECHNICAL
COMPONENT 93615 21 999 Years 0.00 $0.0000 $10.61 1/1/2015 0.00 $10.61 1/1/2015
T
TECHNICAL
COMPONENT 93616 0 20 Years 0.00 $0.0000 $13.82 1/1/2015 0.00 $13.82 1/1/2015
T
TECHNICAL
COMPONENT 93616 21 999 Years 0.00 $0.0000 $13.16 1/1/2015 0.00 $13.16 1/1/2015
2 SURGERY 93618 0 20 Years 0.00 $0.0000 $324.42 1/1/2015 0.00 $324.42 0.00 $0.0000 $324.42 1/1/2015 0.00 $324.42 1/1/2015
2 SURGERY 93618 21 999 Years 0.00 $0.0000 $308.98 1/1/2015 0.00 $308.98 0.00 $0.0000 $308.98 1/1/2015 0.00 $308.98 1/1/2015
I
PROFESSIONAL
COMPONENT 93618 0 20 Years 6.86 $28.0672 $192.54 1/1/2015 0.00 $192.54 1/1/2015
I
PROFESSIONAL
COMPONENT 93618 21 999 Years 6.86 $26.7305 $183.37 1/1/2015 0.00 $183.37 1/1/2015
T
TECHNICAL
COMPONENT 93618 0 20 Years 0.00 $0.0000 $131.88 1/1/2015 0.00 $131.88 1/1/2015
T
TECHNICAL
COMPONENT 93618 21 999 Years 0.00 $0.0000 $125.61 1/1/2015 0.00 $125.61 1/1/2015
2 SURGERY 93619 0 20 Years 0.00 $0.0000 $585.37 1/1/2015 0.00 $585.37 1/1/2015
2 SURGERY 93619 21 999 Years 0.00 $0.0000 $557.50 1/1/2015 0.00 $557.50 1/1/2015
I
PROFESSIONAL
COMPONENT 93619 0 20 Years 11.70 $28.0672 $328.39 1/1/2015 0.00 $328.39 1/1/2015
I
PROFESSIONAL
COMPONENT 93619 21 999 Years 11.70 $26.7305 $312.75 1/1/2015 0.00 $312.75 1/1/2015
T
TECHNICAL
COMPONENT 93619 0 20 Years 0.00 $0.0000 $256.98 1/1/2015 0.00 $256.98 1/1/2015
T
TECHNICAL
COMPONENT 93619 21 999 Years 0.00 $0.0000 $244.75 1/1/2015 0.00 $244.75 1/1/2015
2 SURGERY 93620 0 20 Years 0.00 $0.0000 $900.12 1/1/2015 0.00 $900.12 0.00 $0.0000 $900.12 1/1/2015 0.00 $900.12 1/1/2015
2 SURGERY 93620 21 999 Years 0.00 $0.0000 $857.26 1/1/2015 0.00 $857.26 0.00 $0.0000 $857.26 1/1/2015 0.00 $857.26 1/1/2015
I
PROFESSIONAL
COMPONENT 93620 0 20 Years 18.60 $28.0672 $522.05 1/1/2015 0.00 $522.05 1/1/2015
I
PROFESSIONAL
COMPONENT 93620 21 999 Years 18.60 $26.7305 $497.19 1/1/2015 0.00 $497.19 1/1/2015
T
TECHNICAL
COMPONENT 93620 0 20 Years 0.00 $0.0000 $378.07 1/1/2015 0.00 $378.07 1/1/2015
T
TECHNICAL
COMPONENT 93620 21 999 Years 0.00 $0.0000 $360.07 1/1/2015 0.00 $360.07 1/1/2015
2 SURGERY 93621 0 20 Years 0.00 $0.0000 $227.59 1/1/2015 0.00 $227.59 0.00 $0.0000 $227.59 1/1/2015 0.00 $227.59 1/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
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Review Date
Mod
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Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
2 SURGERY 93621 21 999 Years 0.00 $0.0000 $216.75 1/1/2015 0.00 $216.75 0.00 $0.0000 $216.75 1/1/2015 0.00 $216.75 1/1/2015
I
PROFESSIONAL
COMPONENT 93621 0 20 Years 3.37 $28.0672 $94.59 1/1/2015 0.00 $94.59 1/1/2015
I
PROFESSIONAL
COMPONENT 93621 21 999 Years 3.37 $26.7305 $90.08 1/1/2015 0.00 $90.08 1/1/2015
T
TECHNICAL
COMPONENT 93621 0 20 Years 0.00 $0.0000 $133.00 1/1/2015 0.00 $133.00 1/1/2015
T
TECHNICAL
COMPONENT 93621 21 999 Years 0.00 $0.0000 $126.67 1/1/2015 0.00 $126.67 1/1/2015
2 SURGERY 93622 0 20 Years 0.00 $0.0000 $253.93 1/1/2015 0.00 $253.93 0.00 $0.0000 $253.93 1/1/2015 0.00 $253.93 1/1/2015
2 SURGERY 93622 21 999 Years 0.00 $0.0000 $241.84 1/1/2015 0.00 $241.84 0.00 $0.0000 $241.84 1/1/2015 0.00 $241.84 1/1/2015
I
PROFESSIONAL
COMPONENT 93622 0 20 Years 4.95 $28.0672 $138.93 1/1/2015 0.00 $138.93 1/1/2015
I
PROFESSIONAL
COMPONENT 93622 21 999 Years 4.95 $26.7305 $132.32 1/1/2015 0.00 $132.32 1/1/2015
T
TECHNICAL
COMPONENT 93622 0 20 Years 0.00 $0.0000 $115.00 1/1/2015 0.00 $115.00 1/1/2015
T
TECHNICAL
COMPONENT 93622 21 999 Years 0.00 $0.0000 $109.52 1/1/2015 0.00 $109.52 1/1/2015
T
TECHNICAL
COMPONENT 93623 0 20 Years 0.00 $0.0000 $39.40 1/1/2015 0.00 $39.40 1/1/2015
T
TECHNICAL
COMPONENT 93623 21 999 Years 0.00 $0.0000 $37.53 1/1/2015 0.00 $37.53 1/1/2015
2 SURGERY 93624 0 20 Years 0.00 $0.0000 $276.36 1/1/2015 0.00 $276.36 0.00 $0.0000 $276.36 1/1/2015 0.00 $276.36 1/1/2015
2 SURGERY 93624 21 999 Years 0.00 $0.0000 $263.21 1/1/2015 0.00 $263.21 0.00 $0.0000 $263.21 1/1/2015 0.00 $263.21 1/1/2015
I
PROFESSIONAL
COMPONENT 93624 0 20 Years 7.54 $28.0672 $211.63 1/1/2015 0.00 $211.63 1/1/2015
I
PROFESSIONAL
COMPONENT 93624 21 999 Years 7.54 $26.7305 $201.55 1/1/2015 0.00 $201.55 1/1/2015
T
TECHNICAL
COMPONENT 93624 0 20 Years 0.00 $0.0000 $64.73 1/1/2015 0.00 $64.73 1/1/2015
T
TECHNICAL
COMPONENT 93624 21 999 Years 0.00 $0.0000 $61.66 1/1/2015 0.00 $61.66 1/1/2015
2 SURGERY 93631 0 20 Years 0.00 $0.0000 $503.67 1/1/2015 0.00 $503.67 0.00 $0.0000 $503.67 1/1/2015 0.00 $503.67 1/1/2015
2 SURGERY 93631 21 999 Years 0.00 $0.0000 $479.68 1/1/2015 0.00 $479.68 0.00 $0.0000 $479.68 1/1/2015 0.00 $479.68 1/1/2015
I
PROFESSIONAL
COMPONENT 93631 0 20 Years 11.70 $28.0672 $328.39 1/1/2015 0.00 $328.39 1/1/2015
I
PROFESSIONAL
COMPONENT 93631 21 999 Years 11.70 $26.7305 $312.75 1/1/2015 0.00 $312.75 1/1/2015
T
TECHNICAL
COMPONENT 93631 0 20 Years 0.00 $0.0000 $175.28 1/1/2015 0.00 $175.28 1/1/2015
T
TECHNICAL
COMPONENT 93631 21 999 Years 0.00 $0.0000 $166.93 1/1/2015 0.00 $166.93 1/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
2 SURGERY 93640 0 20 Years 0.00 $0.0000 $396.10 1/1/2015 0.00 $396.10 0.00 $0.0000 $396.10 1/1/2015 0.00 $396.10 1/1/2015
2 SURGERY 93640 21 999 Years 0.00 $0.0000 $377.24 1/1/2015 0.00 $377.24 0.00 $0.0000 $377.24 1/1/2015 0.00 $377.24 1/1/2015
I
PROFESSIONAL
COMPONENT 93640 0 20 Years 5.54 $28.0672 $155.49 1/1/2015 0.00 $155.49 1/1/2015
I
PROFESSIONAL
COMPONENT 93640 21 999 Years 5.54 $26.7305 $148.09 1/1/2015 0.00 $148.09 1/1/2015
T
TECHNICAL
COMPONENT 93640 0 20 Years 0.00 $0.0000 $240.61 1/1/2015 0.00 $240.61 1/1/2015
T
TECHNICAL
COMPONENT 93640 21 999 Years 0.00 $0.0000 $229.15 1/1/2015 0.00 $229.15 1/1/2015
2 SURGERY 93641 0 20 Years 0.00 $0.0000 $424.46 1/1/2015 0.00 $424.46 1/1/2015
2 SURGERY 93641 21 999 Years 0.00 $0.0000 $404.23 1/1/2015 0.00 $404.23 1/1/2015
I
PROFESSIONAL
COMPONENT 93641 0 20 Years 9.45 $28.0672 $265.24 1/1/2015 0.00 $265.24 1/1/2015
I
PROFESSIONAL
COMPONENT 93641 21 999 Years 9.45 $26.7305 $252.60 1/1/2015 0.00 $252.60 1/1/2015
T
TECHNICAL
COMPONENT 93641 0 20 Years 0.00 $0.0000 $159.22 1/1/2015 0.00 $159.22 1/1/2015
T
TECHNICAL
COMPONENT 93641 21 999 Years 0.00 $0.0000 $151.63 1/1/2015 0.00 $151.63 1/1/2015
2 SURGERY 93642 0 20 Years 11.17 $28.0672 $313.51 1/1/2015 0.00 $313.51 11.17 $28.0672 $313.51 1/1/2015 0.00 $313.51 4/1/2011
2 SURGERY 93642 21 999 Years 11.17 $26.7305 $298.58 1/1/2015 0.00 $298.58 11.17 $26.7305 $298.58 1/1/2015 0.00 $298.58 4/1/2011
I
PROFESSIONAL
COMPONENT 93642 0 20 Years 6.98 $28.0672 $195.91 1/1/2015 0.00 $195.91 6.98 $28.0672 $195.91 1/1/2015 0.00 $195.91 4/1/2011
I
PROFESSIONAL
COMPONENT 93642 21 999 Years 6.98 $26.7305 $186.58 1/1/2015 0.00 $186.58 6.98 $26.7305 $186.58 1/1/2015 0.00 $186.58 4/1/2011
T
TECHNICAL
COMPONENT 93642 0 20 Years 4.19 $28.0672 $117.60 1/1/2015 0.00 $117.60 4/1/2011
T
TECHNICAL
COMPONENT 93642 21 999 Years 4.19 $26.7305 $112.00 1/1/2015 0.00 $112.00 4/1/2011
T
TECHNICAL
COMPONENT 93644 0 20 Years 2.95 $28.0672 $82.80 1/1/2015 0.00 $82.80 1/1/2015
T
TECHNICAL
COMPONENT 93644 21 999 Years 2.95 $26.7305 $78.85 1/1/2015 0.00 $78.85 1/1/2015
2 SURGERY 93650 0 20 Years 17.47 $28.0672 $490.33 7/1/2015 0.00 $490.33 7/1/2015
2 SURGERY 93650 21 999 Years 17.47 $26.7305 $466.98 7/1/2015 0.00 $466.98 7/1/2015
T
TECHNICAL
COMPONENT 93660 0 20 Years 1.74 $28.0672 $48.84 1/1/2013 0.00 $48.84 1/1/2015
T
TECHNICAL
COMPONENT 93660 21 999 Years 1.74 $26.7305 $46.51 1/1/2013 0.00 $46.51 1/1/2015
T
TECHNICAL
COMPONENT 93662 0 20 Years 0.00 $0.0000 $69.25 1/1/2015 0.00 $69.25 1/1/2015
T
TECHNICAL
COMPONENT 93662 21 999 Years 0.00 $0.0000 $65.95 1/1/2015 0.00 $65.95 1/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93724 0 20 Years 0.80 $28.0672 $22.45 4/1/2015 0.00 $22.45 4/1/2015
T
TECHNICAL
COMPONENT 93724 21 999 Years 0.80 $26.7305 $21.38 4/1/2015 0.00 $21.38 4/1/2015
T
TECHNICAL
COMPONENT 93740 0 20 Years 0.00 $0.0000 $1.31 4/1/2015 0.00 $1.31 4/1/2015
T
TECHNICAL
COMPONENT 93740 21 999 Years 0.00 $0.0000 $1.31 4/1/2015 0.00 $1.31 4/1/2015
T
TECHNICAL
COMPONENT 93770 0 20 Years 0.00 $0.0000 $0.47 4/1/2015 0.00 $0.47 4/1/2015
T
TECHNICAL
COMPONENT 93770 21 999 Years 0.00 $0.0000 $0.47 4/1/2015 0.00 $0.47 4/1/2015
T
TECHNICAL
COMPONENT 93799 0 999 Years 0.00 $0.0000 $0.00 10/13/2000 -2.00 $0.00 5 4/1/2015
4 RADIOLOGY 93880 0 20 Years 5.71 $28.0672 $160.26 7/1/2015 0.00 $160.26 7/1/2015
4 RADIOLOGY 93880 21 999 Years 5.71 $26.7305 $152.63 7/1/2015 0.00 $152.63 7/1/2015
T
TECHNICAL
COMPONENT 93880 0 20 Years 4.59 $28.0672 $128.83 7/1/2015 0.00 $128.83 7/1/2015
T
TECHNICAL
COMPONENT 93880 21 999 Years 4.59 $26.7305 $122.69 7/1/2015 0.00 $122.69 7/1/2015
4 RADIOLOGY 93882 0 20 Years 3.64 $28.0672 $102.16 7/1/2015 0.00 $102.16 9 7/1/2015
4 RADIOLOGY 93882 21 999 Years 3.64 $26.7305 $97.30 7/1/2015 0.00 $97.30 9 7/1/2015
T
TECHNICAL
COMPONENT 93882 0 20 Years 2.94 $28.0672 $82.52 7/1/2015 0.00 $82.52 9 7/1/2015
T
TECHNICAL
COMPONENT 93882 21 999 Years 2.94 $26.7305 $78.59 7/1/2015 0.00 $78.59 9 7/1/2015
4 RADIOLOGY 93886 0 20 Years 8.12 $28.0672 $227.91 7/1/2015 0.00 $227.91 7/1/2015
4 RADIOLOGY 93886 21 999 Years 8.12 $26.7305 $217.05 7/1/2015 0.00 $217.05 7/1/2015
T
TECHNICAL
COMPONENT 93886 0 20 Years 6.80 $28.0672 $190.86 7/1/2015 0.00 $190.86 7/1/2015
T
TECHNICAL
COMPONENT 93886 21 999 Years 6.80 $26.7305 $181.77 7/1/2015 0.00 $181.77 7/1/2015
4 RADIOLOGY 93888 0 20 Years 4.22 $28.0672 $118.44 7/1/2015 0.00 $118.44 9 7/1/2015
4 RADIOLOGY 93888 21 999 Years 4.22 $26.7305 $112.80 7/1/2015 0.00 $112.80 9 7/1/2015
T
TECHNICAL
COMPONENT 93888 0 20 Years 3.50 $28.0672 $98.24 7/1/2015 0.00 $98.24 9 7/1/2015
T
TECHNICAL
COMPONENT 93888 21 999 Years 3.50 $26.7305 $93.56 7/1/2015 0.00 $93.56 9 7/1/2015
4 RADIOLOGY 93890 0 20 Years 8.22 $28.0672 $230.71 7/1/2015 0.00 $230.71 7/1/2015
4 RADIOLOGY 93890 21 999 Years 8.22 $26.7305 $219.72 7/1/2015 0.00 $219.72 7/1/2015
T
TECHNICAL
COMPONENT 93890 0 20 Years 6.78 $28.0672 $190.30 7/1/2015 0.00 $190.30 7/1/2015
T
TECHNICAL
COMPONENT 93890 21 999 Years 6.78 $26.7305 $181.23 7/1/2015 0.00 $181.23 7/1/2015
4 RADIOLOGY 93892 0 20 Years 9.53 $28.0672 $267.48 7/1/2015 0.00 $267.48 7/1/2015
4 RADIOLOGY 93892 21 999 Years 9.53 $26.7305 $254.74 7/1/2015 0.00 $254.74 7/1/2015
T
TECHNICAL
COMPONENT 93892 0 20 Years 7.86 $28.0672 $220.61 7/1/2015 0.00 $220.61 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93892 21 999 Years 7.86 $26.7305 $210.10 7/1/2015 0.00 $210.10 7/1/2015
4 RADIOLOGY 93893 0 20 Years 9.78 $28.0672 $274.50 7/1/2015 0.00 $274.50 7/1/2015
4 RADIOLOGY 93893 21 999 Years 9.78 $26.7305 $261.42 7/1/2015 0.00 $261.42 7/1/2015
T
TECHNICAL
COMPONENT 93893 0 20 Years 8.11 $28.0672 $227.62 7/1/2015 0.00 $227.62 7/1/2015
T
TECHNICAL
COMPONENT 93893 21 999 Years 8.11 $26.7305 $216.78 7/1/2015 0.00 $216.78 7/1/2015
5 LABORATORY 93922 0 20 Years 2.53 $28.0672 $71.01 7/1/2015 0.00 $71.01 7/1/2015
5 LABORATORY 93922 21 999 Years 2.53 $26.7305 $67.63 7/1/2015 0.00 $67.63 7/1/2015
T
TECHNICAL
COMPONENT 93922 0 20 Years 2.18 $28.0672 $61.19 7/1/2015 0.00 $61.19 7/1/2015
T
TECHNICAL
COMPONENT 93922 21 999 Years 2.18 $26.7305 $58.27 7/1/2015 0.00 $58.27 7/1/2015
4 RADIOLOGY 93923 0 20 Years 3.92 $28.0672 $110.02 7/1/2015 0.00 $110.02 7/1/2015
4 RADIOLOGY 93923 21 999 Years 3.92 $26.7305 $104.78 7/1/2015 0.00 $104.78 7/1/2015
T
TECHNICAL
COMPONENT 93923 0 20 Years 3.29 $28.0672 $92.34 7/1/2015 0.00 $92.34 7/1/2015
T
TECHNICAL
COMPONENT 93923 21 999 Years 3.29 $26.7305 $87.94 7/1/2015 0.00 $87.94 7/1/2015
4 RADIOLOGY 93924 0 20 Years 4.89 $28.0672 $137.25 7/1/2015 0.00 $137.25 7/1/2015
4 RADIOLOGY 93924 21 999 Years 4.89 $26.7305 $130.71 7/1/2015 0.00 $130.71 7/1/2015
T
TECHNICAL
COMPONENT 93924 0 20 Years 4.19 $28.0672 $117.60 7/1/2015 0.00 $117.60 7/1/2015
T
TECHNICAL
COMPONENT 93924 21 999 Years 4.19 $26.7305 $112.00 7/1/2015 0.00 $112.00 7/1/2015
4 RADIOLOGY 93925 0 20 Years 7.37 $28.0672 $206.86 7/1/2015 0.00 $206.86 7/1/2015
4 RADIOLOGY 93925 21 999 Years 7.37 $26.7305 $197.00 7/1/2015 0.00 $197.00 7/1/2015
T
TECHNICAL
COMPONENT 93925 0 20 Years 6.25 $28.0672 $175.42 7/1/2015 0.00 $175.42 7/1/2015
T
TECHNICAL
COMPONENT 93925 21 999 Years 6.25 $26.7305 $167.07 7/1/2015 0.00 $167.07 7/1/2015
4 RADIOLOGY 93926 0 20 Years 4.34 $28.0672 $121.81 7/1/2013 0.00 $121.81 9 7/1/2015
4 RADIOLOGY 93926 21 999 Years 4.34 $26.7305 $116.01 7/1/2013 0.00 $116.01 9 7/1/2015
T
TECHNICAL
COMPONENT 93926 0 20 Years 3.63 $28.0672 $101.88 7/1/2015 0.00 $101.88 9 7/1/2015
T
TECHNICAL
COMPONENT 93926 21 999 Years 3.63 $26.7305 $97.03 7/1/2015 0.00 $97.03 9 7/1/2015
4 RADIOLOGY 93930 0 20 Years 5.92 $28.0672 $166.16 7/1/2015 0.00 $166.16 7/1/2015
4 RADIOLOGY 93930 21 999 Years 5.92 $26.7305 $158.24 7/1/2015 0.00 $158.24 7/1/2015
T
TECHNICAL
COMPONENT 93930 0 20 Years 4.80 $28.0672 $134.72 7/1/2015 0.00 $134.72 7/1/2015
T
TECHNICAL
COMPONENT 93930 21 999 Years 4.80 $26.7305 $128.31 7/1/2015 0.00 $128.31 7/1/2015
4 RADIOLOGY 93931 0 20 Years 3.68 $28.0672 $103.29 7/1/2015 0.00 $103.29 9 7/1/2015
4 RADIOLOGY 93931 21 999 Years 3.68 $26.7305 $98.37 7/1/2015 0.00 $98.37 9 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 93931 0 20 Years 2.97 $28.0672 $83.36 7/1/2015 0.00 $83.36 9 7/1/2015
T
TECHNICAL
COMPONENT 93931 21 999 Years 2.97 $26.7305 $79.39 7/1/2015 0.00 $79.39 9 7/1/2015
4 RADIOLOGY 93965 0 20 Years 3.41 $28.0672 $95.71 7/1/2015 0.00 $95.71 7/1/2015
4 RADIOLOGY 93965 21 999 Years 3.41 $26.7305 $91.15 7/1/2015 0.00 $91.15 7/1/2015
T
TECHNICAL
COMPONENT 93965 0 20 Years 2.92 $28.0672 $81.96 7/1/2015 0.00 $81.96 7/1/2015
T
TECHNICAL
COMPONENT 93965 21 999 Years 2.92 $26.7305 $78.05 7/1/2015 0.00 $78.05 7/1/2015
T
TECHNICAL
COMPONENT 93970 0 20 Years 4.59 $28.0672 $128.83 7/1/2015 0.00 $128.83 7/1/2015
T
TECHNICAL
COMPONENT 93970 21 999 Years 4.59 $26.7305 $122.69 7/1/2015 0.00 $122.69 7/1/2015
T
TECHNICAL
COMPONENT 93971 0 20 Years 2.79 $28.0672 $78.31 7/1/2015 0.00 $78.31 9 7/1/2015
T
TECHNICAL
COMPONENT 93971 21 999 Years 2.79 $26.7305 $74.58 7/1/2015 0.00 $74.58 9 7/1/2015
4 RADIOLOGY 93975 0 20 Years 7.97 $28.0672 $223.70 7/1/2015 0.00 $223.70 7/1/2015
4 RADIOLOGY 93975 21 999 Years 7.97 $26.7305 $213.04 7/1/2015 0.00 $213.04 7/1/2015
T
TECHNICAL
COMPONENT 93975 0 20 Years 6.35 $28.0672 $178.23 7/1/2015 0.00 $178.23 7/1/2015
T
TECHNICAL
COMPONENT 93975 21 999 Years 6.35 $26.7305 $169.74 7/1/2015 0.00 $169.74 7/1/2015
4 RADIOLOGY 93976 0 20 Years 4.62 $28.0672 $129.67 7/1/2015 0.00 $129.67 9 7/1/2015
4 RADIOLOGY 93976 21 999 Years 4.62 $26.7305 $123.49 7/1/2015 0.00 $123.49 9 7/1/2015
T
TECHNICAL
COMPONENT 93976 0 20 Years 3.48 $28.0672 $97.67 7/1/2015 0.00 $97.67 9 7/1/2015
T
TECHNICAL
COMPONENT 93976 21 999 Years 3.48 $26.7305 $93.02 7/1/2015 0.00 $93.02 9 7/1/2015
4 RADIOLOGY 93978 0 20 Years 5.40 $28.0672 $151.56 7/1/2015 0.00 $151.56 7/1/2015
4 RADIOLOGY 93978 21 999 Years 5.40 $26.7305 $144.34 7/1/2015 0.00 $144.34 7/1/2015
T
TECHNICAL
COMPONENT 93978 0 20 Years 4.29 $28.0672 $120.41 7/1/2015 0.00 $120.41 7/1/2015
T
TECHNICAL
COMPONENT 93978 21 999 Years 4.29 $26.7305 $114.67 7/1/2015 0.00 $114.67 7/1/2015
4 RADIOLOGY 93979 0 20 Years 3.41 $28.0672 $95.71 7/1/2015 0.00 $95.71 9 7/1/2015
4 RADIOLOGY 93979 21 999 Years 3.41 $26.7305 $91.15 7/1/2015 0.00 $91.15 9 7/1/2015
T
TECHNICAL
COMPONENT 93979 0 20 Years 2.71 $28.0672 $76.06 7/1/2015 0.00 $76.06 9 7/1/2015
T
TECHNICAL
COMPONENT 93979 21 999 Years 2.71 $26.7305 $72.44 7/1/2015 0.00 $72.44 9 7/1/2015
4 RADIOLOGY 93980 0 20 Years 3.38 $28.0672 $94.87 7/1/2015 0.00 $94.87 7/1/2015
4 RADIOLOGY 93980 21 999 Years 3.38 $26.7305 $90.35 7/1/2015 0.00 $90.35 7/1/2015
T
TECHNICAL
COMPONENT 93980 0 20 Years 1.66 $28.0672 $46.59 7/1/2015 0.00 $46.59 7/1/2015
T
TECHNICAL
COMPONENT 93980 21 999 Years 1.66 $26.7305 $44.37 7/1/2015 0.00 $44.37 7/1/2015
4 RADIOLOGY 93981 0 20 Years 2.03 $28.0672 $56.98 7/1/2015 0.00 $56.98 7/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
4 RADIOLOGY 93981 21 999 Years 2.03 $26.7305 $54.26 7/1/2015 0.00 $54.26 7/1/2015
T
TECHNICAL
COMPONENT 93981 0 20 Years 1.43 $28.0672 $40.14 7/1/2015 0.00 $40.14 7/1/2015
T
TECHNICAL
COMPONENT 93981 21 999 Years 1.43 $26.7305 $38.22 7/1/2015 0.00 $38.22 7/1/2015
4 RADIOLOGY 93982 0 20 Years 1.23 $28.0672 $34.52 7/1/2015 0.00 $34.52 7/1/2015
4 RADIOLOGY 93982 21 999 Years 1.23 $26.7305 $32.88 7/1/2015 0.00 $32.88 7/1/2015
T
TECHNICAL
COMPONENT 93990 0 20 Years 3.84 $28.0672 $107.78 7/1/2015 0.00 $107.78 7/1/2015
5 LABORATORY 94010 0 20 Years 1.02 $28.0672 $28.63 4/1/2015 0.00 $28.63 4/1/2015
5 LABORATORY 94010 21 999 Years 1.02 $26.7305 $27.27 4/1/2015 0.00 $27.27 4/1/2015
T
TECHNICAL
COMPONENT 94010 0 20 Years 0.78 $28.0672 $21.89 4/1/2015 0.00 $21.89 4/1/2015
T
TECHNICAL
COMPONENT 94010 21 999 Years 0.78 $26.7305 $20.85 4/1/2015 0.00 $20.85 4/1/2015
5 LABORATORY 94060 0 20 Years 1.72 $26.7305 $45.98 4/1/2015 0.00 $45.98 4/1/2015
5 LABORATORY 94060 21 999 Years 1.72 $26.7305 $45.98 4/1/2015 0.00 $45.98 4/1/2015
T
TECHNICAL
COMPONENT 94060 0 20 Years 1.35 $28.0672 $37.89 4/1/2015 0.00 $37.89 4/1/2015
T
TECHNICAL
COMPONENT 94060 21 999 Years 1.35 $26.7305 $36.09 4/1/2015 0.00 $36.09 4/1/2015
5 LABORATORY 94070 0 20 Years 1.67 $28.0672 $46.87 4/1/2015 0.00 $46.87 4/1/2015
5 LABORATORY 94070 21 999 Years 1.67 $26.7305 $44.64 4/1/2015 0.00 $44.64 4/1/2015
T
TECHNICAL
COMPONENT 94070 0 20 Years 0.86 $28.0672 $24.14 4/1/2015 0.00 $24.14 4/1/2015
T
TECHNICAL
COMPONENT 94070 21 999 Years 0.86 $26.7305 $22.99 4/1/2015 0.00 $22.99 4/1/2015
5 LABORATORY 94150 0 20 Years 0.71 $28.0672 $19.93 4/1/2015 0.00 $19.93 4/1/2015
5 LABORATORY 94150 21 999 Years 0.71 $26.7305 $18.98 4/1/2015 0.00 $18.98 4/1/2015
T
TECHNICAL
COMPONENT 94150 0 20 Years 0.60 $28.0672 $16.84 4/1/2015 0.00 $16.84 4/1/2015
T
TECHNICAL
COMPONENT 94150 21 999 Years 0.60 $26.7305 $16.04 4/1/2015 0.00 $16.04 4/1/2015
5 LABORATORY 94200 0 20 Years 0.72 $28.0672 $20.21 4/1/2015 0.00 $20.21 4/1/2015
5 LABORATORY 94200 21 999 Years 0.72 $26.7305 $19.25 4/1/2015 0.00 $19.25 4/1/2015
T
TECHNICAL
COMPONENT 94200 0 20 Years 0.56 $28.0672 $15.72 4/1/2015 0.00 $15.72 4/1/2015
T
TECHNICAL
COMPONENT 94200 21 999 Years 0.56 $26.7305 $14.97 4/1/2015 0.00 $14.97 4/1/2015
5 LABORATORY 94250 0 20 Years 0.74 $28.0672 $20.77 4/1/2015 0.00 $20.77 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
5 LABORATORY 94250 21 999 Years 0.74 $26.7305 $19.78 4/1/2015 0.00 $19.78 4/1/2015
T
TECHNICAL
COMPONENT 94250 0 20 Years 0.59 $28.0672 $16.56 4/1/2015 0.00 $16.56 4/1/2015
T
TECHNICAL
COMPONENT 94250 21 999 Years 0.59 $26.7305 $15.77 4/1/2015 0.00 $15.77 4/1/2015
5 LABORATORY 94375 0 20 Years 1.11 $28.0672 $31.15 4/1/2015 0.00 $31.15 4/1/2015
5 LABORATORY 94375 21 999 Years 1.11 $26.7305 $29.67 4/1/2015 0.00 $29.67 4/1/2015
T
TECHNICAL
COMPONENT 94375 0 20 Years 0.69 $28.0672 $19.37 4/1/2015 0.00 $19.37 4/1/2015
T
TECHNICAL
COMPONENT 94375 21 999 Years 0.69 $26.7305 $18.44 4/1/2015 0.00 $18.44 4/1/2015
5 LABORATORY 94400 0 20 Years 1.60 $28.0672 $44.91 4/1/2015 0.00 $44.91 4/1/2015
5 LABORATORY 94400 21 999 Years 1.60 $26.7305 $42.77 4/1/2015 0.00 $42.77 4/1/2015
T
TECHNICAL
COMPONENT 94400 0 20 Years 1.05 $28.0672 $29.47 4/1/2015 0.00 $29.47 4/1/2015
T
TECHNICAL
COMPONENT 94400 21 999 Years 1.05 $26.7305 $28.07 4/1/2015 0.00 $28.07 4/1/2015
5 LABORATORY 94450 0 20 Years 1.88 $28.0672 $52.77 4/1/2015 0.00 $52.77 4/1/2015
5 LABORATORY 94450 21 999 Years 1.88 $26.7305 $50.25 4/1/2015 0.00 $50.25 4/1/2015
T
TECHNICAL
COMPONENT 94450 0 20 Years 1.33 $28.0672 $37.33 4/1/2015 0.00 $37.33 4/1/2015
T
TECHNICAL
COMPONENT 94450 21 999 Years 1.33 $26.7305 $35.55 4/1/2015 0.00 $35.55 4/1/2015
5 LABORATORY 94452 1 20 Years 1.62 $28.0672 $45.47 4/1/2015 0.00 $45.47 4/1/2015
5 LABORATORY 94452 21 999 Years 1.62 $26.7305 $43.30 4/1/2015 0.00 $43.30 4/1/2015
T
TECHNICAL
COMPONENT 94452 1 20 Years 1.21 $28.0672 $33.96 4/1/2015 0.00 $33.96 4/1/2015
T
TECHNICAL
COMPONENT 94452 21 999 Years 1.21 $26.7305 $32.34 4/1/2015 0.00 $32.34 4/1/2015
5 LABORATORY 94453 1 20 Years 2.25 $28.0672 $63.15 4/1/2015 0.00 $63.15 4/1/2015
5 LABORATORY 94453 21 999 Years 2.25 $26.7305 $60.14 4/1/2015 0.00 $60.14 4/1/2015
T
TECHNICAL
COMPONENT 94453 1 20 Years 1.71 $28.0672 $47.99 4/1/2015 0.00 $47.99 4/1/2015
T
TECHNICAL
COMPONENT 94453 21 999 Years 1.71 $26.7305 $45.71 4/1/2015 0.00 $45.71 4/1/2015
5 LABORATORY 94620 0 20 Years 1.58 $28.0672 $44.35 4/1/2015 0.00 $44.35 4/1/2015
5 LABORATORY 94620 21 999 Years 1.58 $26.7305 $42.23 4/1/2015 0.00 $42.23 4/1/2015
T
TECHNICAL
COMPONENT 94620 0 20 Years 0.72 $28.0672 $20.21 4/1/2015 0.00 $20.21 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 94620 21 999 Years 0.72 $26.7305 $19.25 4/1/2015 0.00 $19.25 4/1/2015
T
TECHNICAL
COMPONENT 94621 0 20 Years 2.67 $28.0672 $74.94 4/1/2015 0.00 $74.94 4/1/2015
T
TECHNICAL
COMPONENT 94621 21 999 Years 2.67 $26.7305 $71.37 4/1/2015 0.00 $71.37 4/1/2015
1
MEDICAL
SERVICES 94640 0 20 Years 0.52 $28.0672 $14.59 7/1/2015 0.00 $14.59 7/1/2015
1
MEDICAL
SERVICES 94640 21 999 Years 0.52 $26.7305 $13.90 7/1/2015 0.00 $13.90 7/1/2015
1
MEDICAL
SERVICES 94642 0 20 Years 0.00 $0.0000 $14.65 7/1/2015 0.00 $14.65 7/1/2015
1
MEDICAL
SERVICES 94642 21 999 Years 0.00 $0.0000 $13.69 7/1/2015 0.00 $13.69 7/1/2015
1
MEDICAL
SERVICES 94644 0 20 Years 1.23 $28.0672 $34.52 7/1/2015 0.00 $34.52 7/1/2015
1
MEDICAL
SERVICES 94644 21 999 Years 1.23 $26.7305 $32.88 7/1/2015 0.00 $32.88 7/1/2015
5 LABORATORY 94680 0 20 Years 1.61 $28.0672 $45.19 4/1/2015 0.00 $45.19 4/1/2015
5 LABORATORY 94680 21 999 Years 1.61 $26.7305 $43.04 4/1/2015 0.00 $43.04 4/1/2015
T
TECHNICAL
COMPONENT 94680 0 20 Years 1.25 $28.0672 $35.08 4/1/2015 0.00 $35.08 4/1/2015
T
TECHNICAL
COMPONENT 94680 21 999 Years 1.25 $26.7305 $33.41 4/1/2015 0.00 $33.41 4/1/2015
5 LABORATORY 94681 0 20 Years 1.50 $28.0672 $42.10 4/1/2015 0.00 $42.10 4/1/2015
5 LABORATORY 94681 21 999 Years 1.50 $26.7305 $40.10 4/1/2015 0.00 $40.10 4/1/2015
T
TECHNICAL
COMPONENT 94681 0 20 Years 1.22 $28.0672 $34.24 4/1/2015 0.00 $34.24 4/1/2015
T
TECHNICAL
COMPONENT 94681 21 999 Years 1.22 $26.7305 $32.61 4/1/2015 0.00 $32.61 4/1/2015
5 LABORATORY 94690 0 20 Years 1.40 $28.0672 $39.29 4/1/2015 0.00 $39.29 4/1/2015
5 LABORATORY 94690 21 999 Years 1.40 $26.7305 $37.42 4/1/2015 0.00 $37.42 4/1/2015
T
TECHNICAL
COMPONENT 94690 0 20 Years 1.29 $28.0672 $36.21 4/1/2015 0.00 $36.21 4/1/2015
T
TECHNICAL
COMPONENT 94690 21 999 Years 1.29 $26.7305 $34.48 4/1/2015 0.00 $34.48 4/1/2015
5 LABORATORY 94726 0 20 Years 1.49 $28.0672 $41.82 4/1/2015 0.00 $41.82 4/1/2015
5 LABORATORY 94726 21 999 Years 1.49 $26.7305 $39.83 4/1/2015 0.00 $39.83 4/1/2015
I
PROFESSIONAL
COMPONENT 94726 0 20 Years 0.35 $28.0672 $9.82 4/1/2015 0.00 $9.82 4/1/2015
I
PROFESSIONAL
COMPONENT 94726 21 999 Years 0.35 $26.7305 $9.36 4/1/2015 0.00 $9.36 4/1/2015
T
TECHNICAL
COMPONENT 94726 0 20 Years 1.14 $28.0672 $32.00 4/1/2015 0.00 $32.00 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 94726 21 999 Years 1.14 $26.7305 $30.47 4/1/2015 0.00 $30.47 4/1/2015
5 LABORATORY 94727 0 20 Years 1.19 $28.0672 $33.40 4/1/2015 0.00 $33.40 4/1/2015
5 LABORATORY 94727 21 999 Years 1.19 $26.7305 $31.81 4/1/2015 0.00 $31.81 4/1/2015
T
TECHNICAL
COMPONENT 94727 0 20 Years 0.84 $28.0672 $23.58 4/1/2015 0.00 $23.58 4/1/2015
T
TECHNICAL
COMPONENT 94727 21 999 Years 0.84 $26.7305 $22.45 4/1/2015 0.00 $22.45 4/1/2015
5 LABORATORY 94728 0 20 Years 1.11 $28.0672 $31.15 4/1/2015 0.00 $31.15 4/1/2015
5 LABORATORY 94728 21 999 Years 1.11 $26.7305 $29.67 4/1/2015 0.00 $29.67 4/1/2015
T
TECHNICAL
COMPONENT 94728 0 20 Years 0.76 $28.0672 $21.33 4/1/2015 0.00 $21.33 4/1/2015
T
TECHNICAL
COMPONENT 94728 21 999 Years 0.76 $26.7305 $20.32 4/1/2015 0.00 $20.32 4/1/2015
5 LABORATORY 94729 0 20 Years 1.54 $28.0672 $43.22 4/1/2015 0.00 $43.22 4/1/2015
5 LABORATORY 94729 21 999 Years 1.54 $26.7305 $41.16 4/1/2015 0.00 $41.16 4/1/2015
T
TECHNICAL
COMPONENT 94729 0 20 Years 1.28 $28.0672 $35.93 4/1/2015 0.00 $35.93 4/1/2015
T
TECHNICAL
COMPONENT 94729 21 999 Years 1.28 $26.7305 $34.22 4/1/2015 0.00 $34.22 4/1/2015
5 LABORATORY 94750 0 20 Years 2.28 $28.0672 $63.99 4/1/2015 0.00 $63.99 4/1/2015
5 LABORATORY 94750 21 999 Years 2.28 $26.7305 $60.95 4/1/2015 0.00 $60.95 4/1/2015
T
TECHNICAL
COMPONENT 94750 0 20 Years 1.96 $28.0672 $55.01 4/1/2015 0.00 $55.01 4/1/2015
T
TECHNICAL
COMPONENT 94750 21 999 Years 1.96 $26.7305 $52.39 4/1/2015 0.00 $52.39 4/1/2015
5 LABORATORY 94760 0 20 Years 0.09 $28.0672 $2.53 4/1/2015 0.00 $2.53 4/1/2015
5 LABORATORY 94760 21 999 Years 0.09 $26.7305 $2.41 4/1/2015 0.00 $2.41 4/1/2015
5 LABORATORY 94761 0 20 Years 0.14 $28.0672 $3.93 4/1/2015 0.00 $3.93 4/1/2015
5 LABORATORY 94761 21 999 Years 0.14 $26.7305 $3.74 4/1/2015 0.00 $3.74 4/1/2015
5 LABORATORY 94770 0 20 Years 0.21 $28.0672 $5.89 4/1/2015 0.00 $5.89 4/1/2015
5 LABORATORY 94770 21 999 Years 0.21 $26.7305 $5.61 4/1/2015 0.00 $5.61 4/1/2015
T
TECHNICAL
COMPONENT 94770 0 20 Years 0.00 $0.0000 $4.56 4/1/2015 0.00 $4.56 4/1/2015
T
TECHNICAL
COMPONENT 94770 21 999 Years 0.00 $0.0000 $4.34 4/1/2015 0.00 $4.34 4/1/2015
5 LABORATORY 94772 0 11 Months 0.00 $0.0000 $97.83 4/1/2015 0.00 $97.83 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 94772 0 11 Months 0.00 $0.0000 $71.08 4/1/2015 0.00 $71.08 4/1/2015
5 LABORATORY 95782 0 5 Years 25.76 $28.0672 $723.01 4/1/2015 0.00 $723.01 4/1/2015
T
TECHNICAL
COMPONENT 95782 0 5 Years 22.31 $28.0672 $626.18 4/1/2015 0.00 $626.18 4/1/2015
5 LABORATORY 95783 0 5 Years 35.10 $28.0672 $985.16 4/1/2015 0.00 $985.16 4/1/2015
T
TECHNICAL
COMPONENT 95783 0 5 Years 30.93 $28.0672 $868.12 4/1/2015 0.00 $868.12 4/1/2015
T
TECHNICAL
COMPONENT 95803 0 20 Years 2.76 $28.0672 $77.47 4/1/2015 0.00 $77.47 4/1/2015
T
TECHNICAL
COMPONENT 95803 21 999 Years 2.76 $26.7305 $73.78 4/1/2015 0.00 $73.78 4/1/2015
5 LABORATORY 95805 0 20 Years 11.84 $28.0672 $332.32 4/1/2015 0.00 $332.32 4/1/2015
5 LABORATORY 95805 21 999 Years 11.84 $26.7305 $316.49 4/1/2015 0.00 $316.49 4/1/2015
T
TECHNICAL
COMPONENT 95805 0 20 Years 10.17 $28.0672 $285.44 4/1/2015 0.00 $285.44 4/1/2015
T
TECHNICAL
COMPONENT 95805 21 999 Years 10.17 $26.7305 $271.85 4/1/2015 0.00 $271.85 4/1/2015
5 LABORATORY 95808 0 20 Years 16.99 $28.0672 $476.86 4/1/2015 0.00 $476.86 4/1/2015
5 LABORATORY 95808 21 999 Years 16.99 $26.7305 $454.15 4/1/2015 0.00 $454.15 4/1/2015
T
TECHNICAL
COMPONENT 95808 0 20 Years 14.54 $28.0672 $408.10 4/1/2015 0.00 $408.10 4/1/2015
T
TECHNICAL
COMPONENT 95808 21 999 Years 14.54 $26.7305 $388.66 4/1/2015 0.00 $388.66 4/1/2015
5 LABORATORY 95810 6 20 Years 17.51 $28.0672 $491.46 4/1/2015 0.00 $491.46 4/1/2015
5 LABORATORY 95810 21 999 Years 17.51 $26.7305 $468.05 4/1/2015 0.00 $468.05 4/1/2015
T
TECHNICAL
COMPONENT 95810 6 20 Years 14.08 $28.0672 $395.19 4/1/2015 0.00 $395.19 4/1/2015
T
TECHNICAL
COMPONENT 95810 21 999 Years 14.08 $26.7305 $376.37 4/1/2015 0.00 $376.37 4/1/2015
5 LABORATORY 95811 6 20 Years 18.39 $28.0672 $516.16 4/1/2015 0.00 $516.16 4/1/2015
5 LABORATORY 95811 21 999 Years 18.39 $26.7305 $491.57 4/1/2015 0.00 $491.57 4/1/2015
T
TECHNICAL
COMPONENT 95811 6 20 Years 14.82 $28.0672 $415.96 4/1/2015 0.00 $415.96 4/1/2015
T
TECHNICAL
COMPONENT 95811 21 999 Years 14.82 $26.7305 $396.15 4/1/2015 0.00 $396.15 4/1/2015
5 LABORATORY 95812 0 20 Years 11.80 $28.0672 $331.19 4/1/2015 0.00 $331.19 4/1/2015
5 LABORATORY 95812 21 999 Years 11.80 $26.7305 $315.42 4/1/2015 0.00 $315.42 4/1/2015
T
TECHNICAL
COMPONENT 95812 0 20 Years 10.17 $28.0672 $285.44 4/1/2015 0.00 $285.44 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 95812 21 999 Years 10.17 $26.7305 $271.85 4/1/2015 0.00 $271.85 4/1/2015
5 LABORATORY 95813 0 20 Years 14.11 $28.0672 $396.03 4/1/2015 0.00 $396.03 4/1/2015
5 LABORATORY 95813 21 999 Years 14.11 $26.7305 $377.17 4/1/2015 0.00 $377.17 4/1/2015
T
TECHNICAL
COMPONENT 95813 0 20 Years 11.50 $28.0672 $322.77 4/1/2015 0.00 $322.77 4/1/2015
T
TECHNICAL
COMPONENT 95813 21 999 Years 11.50 $26.7305 $307.40 4/1/2015 0.00 $307.40 4/1/2015
5 LABORATORY 95816 0 20 Years 10.12 $28.0672 $284.04 4/1/2015 0.00 $284.04 4/1/2015
5 LABORATORY 95816 21 999 Years 10.12 $26.7305 $270.51 4/1/2015 0.00 $270.51 4/1/2015
T
TECHNICAL
COMPONENT 95816 0 20 Years 8.49 $28.0672 $238.29 4/1/2015 0.00 $238.29 4/1/2015
T
TECHNICAL
COMPONENT 95816 21 999 Years 8.49 $26.7305 $226.94 4/1/2015 0.00 $226.94 4/1/2015
5 LABORATORY 95819 0 20 Years 11.54 $28.0672 $323.90 4/1/2015 0.00 $323.90 4/1/2015
5 LABORATORY 95819 21 999 Years 11.54 $26.7305 $308.47 4/1/2015 0.00 $308.47 4/1/2015
T
TECHNICAL
COMPONENT 95819 0 20 Years 9.91 $28.0672 $278.15 4/1/2015 0.00 $278.15 4/1/2015
T
TECHNICAL
COMPONENT 95819 21 999 Years 9.91 $26.7305 $264.90 4/1/2015 0.00 $264.90 4/1/2015
5 LABORATORY 95822 0 20 Years 10.43 $28.0672 $292.74 4/1/2015 0.00 $292.74 4/1/2015
5 LABORATORY 95822 21 999 Years 10.43 $26.7305 $278.80 4/1/2015 0.00 $278.80 4/1/2015
T
TECHNICAL
COMPONENT 95822 0 20 Years 8.80 $28.0672 $246.99 4/1/2015 0.00 $246.99 4/1/2015
T
TECHNICAL
COMPONENT 95822 21 999 Years 8.80 $26.7305 $235.23 4/1/2015 0.00 $235.23 4/1/2015
5 LABORATORY 95827 0 20 Years 22.12 $28.0672 $620.85 4/1/2015 0.00 $620.85 4/1/2015
5 LABORATORY 95827 21 999 Years 22.12 $26.7305 $591.28 4/1/2015 0.00 $591.28 4/1/2015
T
TECHNICAL
COMPONENT 95827 0 20 Years 20.50 $28.0672 $575.38 4/1/2015 0.00 $575.38 4/1/2015
T
TECHNICAL
COMPONENT 95827 21 999 Years 20.50 $26.7305 $547.98 4/1/2015 0.00 $547.98 4/1/2015
I
PROFESSIONAL
COMPONENT 95829 0 20 Years 9.37 $28.0672 $262.99 4/1/2015 0.00 $262.99 4/1/2015
I
PROFESSIONAL
COMPONENT 95829 21 999 Years 9.37 $26.7305 $250.46 4/1/2015 0.00 $250.46 4/1/2015
T
TECHNICAL
COMPONENT 95829 0 20 Years 43.77 $28.0672 $1,228.50 4/1/2015 0.00 $1,228.50 4/1/2015
T
TECHNICAL
COMPONENT 95829 21 999 Years 43.77 $26.7305 $1,169.99 4/1/2015 0.00 $1,169.99 4/1/2015
5 LABORATORY 95831 0 20 Years 0.85 $28.0672 $23.86 4/1/2013 0.00 $23.86 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Review Date
Mod
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Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
5 LABORATORY 95831 21 999 Years 0.85 $26.7305 $22.72 4/1/2013 0.00 $22.72 4/1/2015
I
PROFESSIONAL
COMPONENT 95831 0 20 Years 0.43 $28.0672 $12.07 4/1/2015 0.00 $12.07 4/1/2015
I
PROFESSIONAL
COMPONENT 95831 21 999 Years 0.43 $26.7305 $11.49 4/1/2015 0.00 $11.49 4/1/2015
5 LABORATORY 95832 0 20 Years 0.86 $28.0672 $24.14 4/1/2015 0.00 $24.14 4/1/2015
5 LABORATORY 95832 21 999 Years 0.86 $26.7305 $22.99 4/1/2015 0.00 $22.99 4/1/2015
I
PROFESSIONAL
COMPONENT 95832 0 20 Years 0.46 $28.0672 $12.91 4/1/2015 0.00 $12.91 4/1/2015
I
PROFESSIONAL
COMPONENT 95832 21 999 Years 0.46 $26.7305 $12.30 4/1/2015 0.00 $12.30 4/1/2015
5 LABORATORY 95833 0 20 Years 1.06 $28.0672 $29.75 4/1/2015 0.00 $29.75 4/1/2015
5 LABORATORY 95833 21 999 Years 1.06 $26.7305 $28.33 4/1/2015 0.00 $28.33 4/1/2015
I
PROFESSIONAL
COMPONENT 95833 0 20 Years 0.61 $28.0672 $17.12 4/1/2015 0.00 $17.12 4/1/2015
I
PROFESSIONAL
COMPONENT 95833 21 999 Years 0.61 $26.7305 $16.31 4/1/2015 0.00 $16.31 4/1/2015
5 LABORATORY 95834 0 20 Years 1.43 $28.0672 $40.14 4/1/2015 0.00 $40.14 4/1/2015
5 LABORATORY 95834 21 999 Years 1.43 $26.7305 $38.22 4/1/2015 0.00 $38.22 4/1/2015
I
PROFESSIONAL
COMPONENT 95834 0 20 Years 0.89 $28.0672 $24.98 4/1/2015 0.00 $24.98 4/1/2015
I
PROFESSIONAL
COMPONENT 95834 21 999 Years 0.89 $26.7305 $23.79 4/1/2015 0.00 $23.79 4/1/2015
5 LABORATORY 95851 0 20 Years 0.52 $28.0672 $14.59 4/1/2015 0.00 $14.59 4/1/2015
5 LABORATORY 95851 21 999 Years 0.52 $26.7305 $13.90 4/1/2015 0.00 $13.90 4/1/2015
I
PROFESSIONAL
COMPONENT 95851 0 20 Years 0.22 $28.0672 $6.17 4/1/2015 0.00 $6.17 4/1/2015
I
PROFESSIONAL
COMPONENT 95851 21 999 Years 0.22 $26.7305 $5.88 4/1/2015 0.00 $5.88 4/1/2015
5 LABORATORY 95852 0 20 Years 0.46 $28.0672 $12.91 4/1/2015 0.00 $12.91 4/1/2015
5 LABORATORY 95852 21 999 Years 0.46 $26.7305 $12.30 4/1/2015 0.00 $12.30 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 95852 0 20 Years 0.17 $28.0672 $4.77 4/1/2015 0.00 $4.77 4/1/2015
I
PROFESSIONAL
COMPONENT 95852 21 999 Years 0.17 $26.7305 $4.54 4/1/2015 0.00 $4.54 4/1/2015
5 LABORATORY 95857 0 20 Years 1.51 $28.0672 $42.38 4/1/2015 0.00 $42.38 4/1/2015
5 LABORATORY 95857 21 999 Years 1.51 $26.7305 $40.36 4/1/2015 0.00 $40.36 4/1/2015
5 LABORATORY 95860 0 20 Years 3.46 $28.0672 $97.11 4/1/2015 0.00 $97.11 3.46 $28.0672 $97.11 4/1/2015 0.00 $97.11 4/1/2015
5 LABORATORY 95860 21 999 Years 3.46 $26.7305 $92.49 4/1/2015 0.00 $92.49 3.46 $26.7305 $92.49 4/1/2015 0.00 $92.49 4/1/2015
T
TECHNICAL
COMPONENT 95860 0 20 Years 1.99 $28.0672 $55.85 4/1/2015 0.00 $55.85 4/1/2015
T
TECHNICAL
COMPONENT 95860 21 999 Years 1.99 $26.7305 $53.19 4/1/2015 0.00 $53.19 4/1/2015
5 LABORATORY 95861 0 20 Years 4.86 $28.0672 $136.41 4/1/2015 0.00 $136.41 4.86 $28.0672 $136.41 4/1/2015 0.00 $136.41 4/1/2015
5 LABORATORY 95861 21 999 Years 4.86 $26.7305 $129.91 4/1/2015 0.00 $129.91 4.86 $26.7305 $129.91 4/1/2015 0.00 $129.91 4/1/2015
T
TECHNICAL
COMPONENT 95861 0 20 Years 2.53 $28.0672 $71.01 4/1/2015 0.00 $71.01 4/1/2015
T
TECHNICAL
COMPONENT 95861 21 999 Years 2.53 $26.7305 $67.63 4/1/2015 0.00 $67.63 4/1/2015
5 LABORATORY 95863 0 20 Years 6.01 $28.0672 $168.68 4/1/2015 0.00 $168.68 6.01 $28.0672 $168.68 4/1/2015 0.00 $168.68 4/1/2015
5 LABORATORY 95863 21 999 Years 6.01 $26.7305 $160.65 4/1/2015 0.00 $160.65 6.01 $26.7305 $160.65 4/1/2015 0.00 $160.65 4/1/2015
T
TECHNICAL
COMPONENT 95863 0 20 Years 3.16 $28.0672 $88.69 4/1/2015 0.00 $88.69 4/1/2015
T
TECHNICAL
COMPONENT 95863 21 999 Years 3.16 $26.7305 $84.47 4/1/2015 0.00 $84.47 4/1/2015
5 LABORATORY 95864 0 20 Years 6.84 $28.0672 $191.98 4/1/2015 0.00 $191.98 6.84 $28.0672 $191.98 4/1/2015 0.00 $191.98 4/1/2015
5 LABORATORY 95864 21 999 Years 6.84 $26.7305 $182.84 4/1/2015 0.00 $182.84 6.84 $26.7305 $182.84 4/1/2015 0.00 $182.84 4/1/2015
T
TECHNICAL
COMPONENT 95864 0 20 Years 3.81 $28.0672 $106.94 4/1/2015 0.00 $106.94 4/1/2015
T
TECHNICAL
COMPONENT 95864 21 999 Years 3.81 $26.7305 $101.84 4/1/2015 0.00 $101.84 4/1/2015
5 LABORATORY 95865 0 20 Years 4.05 $28.0672 $113.67 4/1/2015 0.00 $113.67 4.05 $28.0672 $113.67 4/1/2015 0.00 $113.67 4/1/2015
5 LABORATORY 95865 21 999 Years 4.05 $26.7305 $108.26 4/1/2015 0.00 $108.26 4.05 $26.7305 $108.26 4/1/2015 0.00 $108.26 4/1/2015
I
PROFESSIONAL
COMPONENT 95865 0 20 Years 2.37 $28.0672 $66.52 4/1/2015 0.00 $66.52 4/1/2015
I
PROFESSIONAL
COMPONENT 95865 21 999 Years 2.37 $26.7305 $63.35 4/1/2015 0.00 $63.35 4/1/2015
T
TECHNICAL
COMPONENT 95865 0 20 Years 1.68 $28.0672 $47.15 4/1/2015 0.00 $47.15 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 95865 21 999 Years 1.68 $26.7305 $44.91 4/1/2015 0.00 $44.91 4/1/2015
5 LABORATORY 95866 0 20 Years 3.75 $28.0672 $105.25 4/1/2015 0.00 $105.25 3.75 $28.0672 $105.25 4/1/2015 0.00 $105.25 4/1/2015
5 LABORATORY 95866 21 999 Years 3.75 $26.7305 $100.24 4/1/2015 0.00 $100.24 3.75 $26.7305 $100.24 4/1/2015 0.00 $100.24 4/1/2015
I
PROFESSIONAL
COMPONENT 95866 0 20 Years 1.92 $28.0672 $53.89 4/1/2015 0.00 $53.89 4/1/2015
I
PROFESSIONAL
COMPONENT 95866 21 999 Years 1.92 $26.7305 $51.32 4/1/2015 0.00 $51.32 4/1/2015
T
TECHNICAL
COMPONENT 95866 0 20 Years 1.83 $28.0672 $51.36 4/1/2015 0.00 $51.36 4/1/2015
T
TECHNICAL
COMPONENT 95866 21 999 Years 1.83 $26.7305 $48.92 4/1/2015 0.00 $48.92 4/1/2015
5 LABORATORY 95867 0 20 Years 2.64 $28.0672 $74.10 4/1/2015 0.00 $74.10 2.64 $28.0672 $74.10 4/1/2015 0.00 $74.10 4/1/2015
5 LABORATORY 95867 21 999 Years 2.64 $26.7305 $70.57 4/1/2015 0.00 $70.57 2.64 $26.7305 $70.57 4/1/2015 0.00 $70.57 4/1/2015
I
PROFESSIONAL
COMPONENT 95867 0 20 Years 1.19 $28.0672 $33.40 4/1/2015 0.00 $33.40 4/1/2015
I
PROFESSIONAL
COMPONENT 95867 21 999 Years 1.19 $26.7305 $31.81 4/1/2015 0.00 $31.81 4/1/2015
T
TECHNICAL
COMPONENT 95867 0 20 Years 1.45 $28.0672 $40.70 4/1/2015 0.00 $40.70 4/1/2015
T
TECHNICAL
COMPONENT 95867 21 999 Years 1.45 $26.7305 $38.76 4/1/2015 0.00 $38.76 4/1/2015
5 LABORATORY 95868 0 20 Years 3.72 $28.0672 $104.41 4/1/2015 0.00 $104.41 3.72 $28.0672 $104.41 4/1/2015 0.00 $104.41 4/1/2015
5 LABORATORY 95868 21 999 Years 3.72 $26.7305 $99.44 4/1/2015 0.00 $99.44 3.72 $26.7305 $99.44 4/1/2015 0.00 $99.44 4/1/2015
I
PROFESSIONAL
COMPONENT 95868 0 20 Years 1.79 $28.0672 $50.24 4/1/2015 0.00 $50.24 4/1/2015
I
PROFESSIONAL
COMPONENT 95868 21 999 Years 1.79 $26.7305 $47.85 4/1/2015 0.00 $47.85 4/1/2015
T
TECHNICAL
COMPONENT 95868 0 20 Years 1.93 $28.0672 $54.17 4/1/2015 0.00 $54.17 4/1/2015
T
TECHNICAL
COMPONENT 95868 21 999 Years 1.93 $26.7305 $51.59 4/1/2015 0.00 $51.59 4/1/2015
5 LABORATORY 95869 0 20 Years 2.30 $28.0672 $64.55 4/1/2015 0.00 $64.55 2.30 $28.0672 $64.55 4/1/2015 0.00 $64.55 4/1/2015
5 LABORATORY 95869 21 999 Years 2.30 $26.7305 $61.48 4/1/2015 0.00 $61.48 2.30 $26.7305 $61.48 4/1/2015 0.00 $61.48 4/1/2015
I
PROFESSIONAL
COMPONENT 95869 0 20 Years 0.56 $28.0672 $15.72 4/1/2013 0.00 $15.72 4/1/2015
I
PROFESSIONAL
COMPONENT 95869 21 999 Years 0.56 $26.7305 $14.97 4/1/2013 0.00 $14.97 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 95869 0 20 Years 1.74 $28.0672 $48.84 4/1/2015 0.00 $48.84 4/1/2015
T
TECHNICAL
COMPONENT 95869 21 999 Years 1.74 $26.7305 $46.51 4/1/2015 0.00 $46.51 4/1/2015
5 LABORATORY 95870 0 20 Years 2.48 $28.0672 $69.61 4/1/2015 0.00 $69.61 2.48 $28.0672 $69.61 4/1/2015 0.00 $69.61 4/1/2015
5 LABORATORY 95870 21 999 Years 2.48 $26.7305 $66.29 4/1/2015 0.00 $66.29 2.48 $26.7305 $66.29 4/1/2015 0.00 $66.29 4/1/2015
I
PROFESSIONAL
COMPONENT 95870 0 20 Years 0.55 $28.0672 $15.44 4/1/2015 0.00 $15.44 4/1/2015
I
PROFESSIONAL
COMPONENT 95870 21 999 Years 0.55 $26.7305 $14.70 4/1/2015 0.00 $14.70 4/1/2015
T
TECHNICAL
COMPONENT 95870 0 20 Years 1.93 $28.0672 $54.17 4/1/2015 0.00 $54.17 4/1/2015
T
TECHNICAL
COMPONENT 95870 21 999 Years 1.93 $26.7305 $51.59 4/1/2015 0.00 $51.59 4/1/2015
5 LABORATORY 95872 0 20 Years 5.57 $28.0672 $156.33 4/1/2015 0.00 $156.33 5.57 $28.0672 $156.33 4/1/2015 0.00 $156.33 4/1/2015
5 LABORATORY 95872 21 999 Years 5.57 $26.7305 $148.89 4/1/2015 0.00 $148.89 5.57 $26.7305 $148.89 4/1/2015 0.00 $148.89 4/1/2015
I
PROFESSIONAL
COMPONENT 95872 0 20 Years 4.35 $28.0672 $122.09 4/1/2015 0.00 $122.09 4/1/2015
I
PROFESSIONAL
COMPONENT 95872 21 999 Years 4.35 $26.7305 $116.28 4/1/2015 0.00 $116.28 4/1/2015
T
TECHNICAL
COMPONENT 95872 0 20 Years 1.22 $28.0672 $34.24 4/1/2015 0.00 $34.24 4/1/2015
T
TECHNICAL
COMPONENT 95872 21 999 Years 1.22 $26.7305 $32.61 4/1/2015 0.00 $32.61 4/1/2015
5 LABORATORY 95873 0 20 Years 2.09 $28.0672 $58.66 4/1/2015 0.00 $58.66 4/1/2015
5 LABORATORY 95873 21 999 Years 2.09 $26.7305 $55.87 4/1/2015 0.00 $55.87 4/1/2015
T
TECHNICAL
COMPONENT 95873 0 20 Years 1.52 $28.0672 $42.66 4/1/2015 0.00 $42.66 4/1/2015
T
TECHNICAL
COMPONENT 95873 21 999 Years 1.52 $26.7305 $40.63 4/1/2015 0.00 $40.63 4/1/2015
5 LABORATORY 95874 0 20 Years 2.03 $28.0672 $56.98 4/1/2015 0.00 $56.98 4/1/2015
5 LABORATORY 95874 21 999 Years 2.03 $26.7305 $54.26 4/1/2015 0.00 $54.26 4/1/2015
T
TECHNICAL
COMPONENT 95874 0 20 Years 1.47 $28.0672 $41.26 4/1/2015 0.00 $41.26 4/1/2015
T
TECHNICAL
COMPONENT 95874 21 999 Years 1.47 $26.7305 $39.29 4/1/2015 0.00 $39.29 4/1/2015
5 LABORATORY 95875 0 20 Years 3.40 $28.0672 $95.43 4/1/2015 0.00 $95.43 3.40 $28.0672 $95.43 4/1/2015 0.00 $95.43 4/1/2015
5 LABORATORY 95875 21 999 Years 3.40 $26.7305 $90.88 4/1/2015 0.00 $90.88 3.40 $26.7305 $90.88 4/1/2015 0.00 $90.88 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
I
PROFESSIONAL
COMPONENT 95875 0 20 Years 1.65 $28.0672 $46.31 4/1/2015 0.00 $46.31 4/1/2015
I
PROFESSIONAL
COMPONENT 95875 21 999 Years 1.65 $26.7305 $44.11 4/1/2015 0.00 $44.11 4/1/2015
T
TECHNICAL
COMPONENT 95875 0 20 Years 1.75 $28.0672 $49.12 4/1/2015 0.00 $49.12 4/1/2015
T
TECHNICAL
COMPONENT 95875 21 999 Years 1.75 $26.7305 $46.78 4/1/2015 0.00 $46.78 4/1/2015
5 LABORATORY 95885 0 20 Years 1.65 $28.0672 $46.31 4/1/2015 0.00 $46.31 4/1/2015
5 LABORATORY 95885 21 999 Years 1.65 $26.7305 $44.11 4/1/2015 0.00 $44.11 4/1/2015
T
TECHNICAL
COMPONENT 95885 0 20 Years 1.12 $28.0672 $31.44 4/1/2015 0.00 $31.44 4/1/2015
T
TECHNICAL
COMPONENT 95885 21 999 Years 1.12 $26.7305 $29.94 4/1/2015 0.00 $29.94 4/1/2015
5 LABORATORY 95886 0 20 Years 2.56 $28.0672 $71.85 4/1/2015 0.00 $71.85 4/1/2015
5 LABORATORY 95886 21 999 Years 2.56 $26.7305 $68.43 4/1/2015 0.00 $68.43 4/1/2015
T
TECHNICAL
COMPONENT 95886 0 20 Years 1.26 $28.0672 $35.36 4/1/2015 0.00 $35.36 4/1/2015
T
TECHNICAL
COMPONENT 95886 21 999 Years 1.26 $26.7305 $33.68 4/1/2015 0.00 $33.68 4/1/2015
5 LABORATORY 95887 0 20 Years 2.30 $28.0672 $64.55 4/1/2015 0.00 $64.55 4/1/2015
5 LABORATORY 95887 21 999 Years 2.30 $26.7305 $61.48 4/1/2015 0.00 $61.48 4/1/2015
T
TECHNICAL
COMPONENT 95887 0 20 Years 1.22 $28.0672 $34.24 4/1/2015 0.00 $34.24 4/1/2015
T
TECHNICAL
COMPONENT 95887 21 999 Years 1.22 $26.7305 $32.61 4/1/2015 0.00 $32.61 4/1/2015
5 LABORATORY 95905 0 20 Years 2.02 $28.0672 $56.70 4/1/2015 0.00 $56.70 4/1/2015
5 LABORATORY 95905 21 999 Years 2.02 $26.7305 $54.00 4/1/2015 0.00 $54.00 4/1/2015
T
TECHNICAL
COMPONENT 95905 0 20 Years 1.94 $28.0672 $54.45 4/1/2015 0.00 $54.45 4/1/2015
T
TECHNICAL
COMPONENT 95905 21 999 Years 1.94 $26.7305 $51.86 4/1/2015 0.00 $51.86 4/1/2015
T
TECHNICAL
COMPONENT 95907 0 20 Years 1.23 $28.0672 $34.52 4/1/2015 0.00 $34.52 4/1/2015
T
TECHNICAL
COMPONENT 95907 21 999 Years 1.23 $26.7305 $32.88 4/1/2015 0.00 $32.88 4/1/2015
T
TECHNICAL
COMPONENT 95908 0 20 Years 1.61 $28.0672 $45.19 4/1/2015 0.00 $45.19 4/1/2015
T
TECHNICAL
COMPONENT 95908 21 999 Years 1.61 $26.7305 $43.04 4/1/2015 0.00 $43.04 4/1/2015
T
TECHNICAL
COMPONENT 95909 0 20 Years 1.89 $28.0672 $53.05 4/1/2015 0.00 $53.05 4/1/2015
T
TECHNICAL
COMPONENT 95909 21 999 Years 1.89 $26.7305 $50.52 4/1/2015 0.00 $50.52 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 95910 0 20 Years 2.48 $28.0672 $69.61 4/1/2015 0.00 $69.61 4/1/2015
T
TECHNICAL
COMPONENT 95910 21 999 Years 2.48 $26.7305 $66.29 4/1/2015 0.00 $66.29 4/1/2015
T
TECHNICAL
COMPONENT 95911 0 20 Years 2.79 $28.0672 $78.31 4/1/2015 0.00 $78.31 4/1/2015
T
TECHNICAL
COMPONENT 95911 21 999 Years 2.79 $26.7305 $74.58 4/1/2015 0.00 $74.58 4/1/2015
T
TECHNICAL
COMPONENT 95912 0 20 Years 2.83 $28.0672 $79.43 4/1/2015 0.00 $79.43 4/1/2015
T
TECHNICAL
COMPONENT 95912 21 999 Years 2.83 $26.7305 $75.65 4/1/2015 0.00 $75.65 4/1/2015
T
TECHNICAL
COMPONENT 95913 0 20 Years 3.01 $28.0672 $84.48 4/1/2015 0.00 $84.48 4/1/2015
T
TECHNICAL
COMPONENT 95913 21 999 Years 3.01 $26.7305 $80.46 4/1/2015 0.00 $80.46 4/1/2015
5 LABORATORY 95921 0 20 Years 2.46 $28.0672 $69.05 4/1/2015 0.00 $69.05 4/1/2015
5 LABORATORY 95921 21 999 Years 2.46 $26.7305 $65.76 4/1/2015 0.00 $65.76 4/1/2015
T
TECHNICAL
COMPONENT 95921 0 20 Years 1.17 $28.0672 $32.84 4/1/2015 0.00 $32.84 4/1/2015
T
TECHNICAL
COMPONENT 95921 21 999 Years 1.17 $26.7305 $31.27 4/1/2015 0.00 $31.27 4/1/2015
5 LABORATORY 95922 0 20 Years 2.83 $28.0672 $79.43 4/1/2015 0.00 $79.43 4/1/2015
5 LABORATORY 95922 21 999 Years 2.83 $26.7305 $75.65 4/1/2015 0.00 $75.65 4/1/2015
T
TECHNICAL
COMPONENT 95922 0 20 Years 1.46 $28.0672 $40.98 4/1/2015 0.00 $40.98 4/1/2015
T
TECHNICAL
COMPONENT 95922 21 999 Years 1.46 $26.7305 $39.03 4/1/2015 0.00 $39.03 4/1/2015
5 LABORATORY 95923 0 20 Years 5.41 $28.0672 $151.84 4/1/2015 0.00 $151.84 4/1/2015
5 LABORATORY 95923 21 999 Years 5.41 $26.7305 $144.61 4/1/2015 0.00 $144.61 4/1/2015
T
TECHNICAL
COMPONENT 95923 0 20 Years 4.11 $28.0672 $115.36 4/1/2015 0.00 $115.36 4/1/2015
T
TECHNICAL
COMPONENT 95923 21 999 Years 4.11 $26.7305 $109.86 4/1/2015 0.00 $109.86 4/1/2015
5 LABORATORY 95924 0 20 Years 4.31 $28.0672 $120.97 4/1/2015 0.00 $120.97 4.31 $28.0672 $120.97 4/1/2015 0.00 $120.97 4/1/2015
5 LABORATORY 95924 21 999 Years 4.31 $26.7305 $115.21 4/1/2015 0.00 $115.21 4.31 $26.7305 $115.21 4/1/2015 0.00 $115.21 4/1/2015
T
TECHNICAL
COMPONENT 95924 0 20 Years 1.80 $28.0672 $50.52 4/1/2015 0.00 $50.52 4/1/2015
T
TECHNICAL
COMPONENT 95924 21 999 Years 1.80 $26.7305 $48.11 4/1/2015 0.00 $48.11 4/1/2015
5 LABORATORY 95925 0 20 Years 5.79 $28.0672 $162.51 4/1/2015 0.00 $162.51 4/1/2015
5 LABORATORY 95925 21 999 Years 5.79 $26.7305 $154.77 4/1/2015 0.00 $154.77 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 95925 0 20 Years 4.98 $28.0672 $139.77 4/1/2015 0.00 $139.77 4.98 $28.0672 $139.77 4/1/2015 0.00 $139.77 4/1/2015
T
TECHNICAL
COMPONENT 95925 21 999 Years 4.98 $26.7305 $133.12 4/1/2015 0.00 $133.12 4.98 $26.7305 $133.12 4/1/2015 0.00 $133.12 4/1/2015
5 LABORATORY 95926 0 20 Years 4.06 $28.0672 $113.95 4/1/2015 0.00 $113.95 4/1/2015
5 LABORATORY 95926 21 999 Years 4.06 $26.7305 $108.53 4/1/2015 0.00 $108.53 4/1/2015
T
TECHNICAL
COMPONENT 95926 0 20 Years 3.29 $28.0672 $92.34 4/1/2015 0.00 $92.34 4/1/2015
T
TECHNICAL
COMPONENT 95926 21 999 Years 3.29 $26.7305 $87.94 4/1/2015 0.00 $87.94 4/1/2015
5 LABORATORY 95927 0 20 Years 4.30 $28.0672 $120.69 4/1/2015 0.00 $120.69 4/1/2015
5 LABORATORY 95927 21 999 Years 4.30 $26.7305 $114.94 4/1/2015 0.00 $114.94 4/1/2015
T
TECHNICAL
COMPONENT 95927 0 20 Years 3.52 $28.0672 $98.80 4/1/2015 0.00 $98.80 4/1/2015
T
TECHNICAL
COMPONENT 95927 21 999 Years 3.52 $26.7305 $94.09 4/1/2015 0.00 $94.09 4/1/2015
5 LABORATORY 95928 0 20 Years 7.31 $28.0672 $205.17 4/1/2015 0.00 $205.17 4/1/2015
5 LABORATORY 95928 21 999 Years 7.31 $26.7305 $195.40 4/1/2015 0.00 $195.40 4/1/2015
T
TECHNICAL
COMPONENT 95928 0 20 Years 5.04 $28.0672 $141.46 4/1/2015 0.00 $141.46 4/1/2015
T
TECHNICAL
COMPONENT 95928 21 999 Years 5.04 $26.7305 $134.72 4/1/2015 0.00 $134.72 4/1/2015
5 LABORATORY 95929 0 20 Years 7.30 $28.0672 $204.89 4/1/2015 0.00 $204.89 4/1/2015
5 LABORATORY 95929 21 999 Years 7.30 $26.7305 $195.13 4/1/2015 0.00 $195.13 4/1/2015
T
TECHNICAL
COMPONENT 95929 0 20 Years 5.08 $28.0672 $142.58 4/1/2015 0.00 $142.58 4/1/2015
T
TECHNICAL
COMPONENT 95929 21 999 Years 5.08 $26.7305 $135.79 4/1/2015 0.00 $135.79 4/1/2015
5 LABORATORY 95930 0 20 Years 3.61 $28.0672 $101.32 4/1/2015 0.00 $101.32 3.61 $28.0672 $101.32 4/1/2015 0.00 $101.32 4/1/2015
5 LABORATORY 95930 21 999 Years 3.61 $26.7305 $96.50 4/1/2015 0.00 $96.50 3.61 $26.7305 $96.50 4/1/2015 0.00 $96.50 4/1/2015
T
TECHNICAL
COMPONENT 95930 0 20 Years 3.09 $28.0672 $86.73 4/1/2015 0.00 $86.73 3.09 $28.0672 $86.73 4/1/2015 0.00 $86.73 4/1/2015
T
TECHNICAL
COMPONENT 95930 21 999 Years 3.09 $26.7305 $82.60 4/1/2015 0.00 $82.60 3.09 $26.7305 $82.60 4/1/2015 0.00 $82.60 4/1/2015
5 LABORATORY 95933 0 20 Years 2.37 $28.0672 $66.52 4/1/2015 0.00 $66.52 4/1/2015
5 LABORATORY 95933 21 999 Years 2.37 $26.7305 $63.35 4/1/2015 0.00 $63.35 4/1/2015
T
TECHNICAL
COMPONENT 95933 0 20 Years 1.48 $28.0672 $41.54 4/1/2015 0.00 $41.54 4/1/2015
T
TECHNICAL
COMPONENT 95933 21 999 Years 1.48 $26.7305 $39.56 4/1/2015 0.00 $39.56 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
5 LABORATORY 95937 0 20 Years 2.33 $28.0672 $65.40 4/1/2013 0.00 $65.40 4/1/2015
5 LABORATORY 95937 21 999 Years 2.33 $26.7305 $62.28 4/1/2013 0.00 $62.28 4/1/2015
T
TECHNICAL
COMPONENT 95937 0 20 Years 1.35 $28.0672 $37.89 4/1/2015 0.00 $37.89 4/1/2015
T
TECHNICAL
COMPONENT 95937 21 999 Years 1.35 $26.7305 $36.09 4/1/2015 0.00 $36.09 4/1/2015
5 LABORATORY 95938 0 20 Years 9.62 $28.0672 $270.01 4/1/2015 0.00 $270.01 4/1/2015
5 LABORATORY 95938 21 999 Years 9.62 $26.7305 $257.15 4/1/2015 0.00 $257.15 4/1/2015
T
TECHNICAL
COMPONENT 95938 0 20 Years 8.33 $28.0672 $233.80 4/1/2015 0.00 $233.80 4/1/2015
T
TECHNICAL
COMPONENT 95938 21 999 Years 8.33 $26.7305 $222.67 4/1/2015 0.00 $222.67 4/1/2015
5 LABORATORY 95939 0 20 Years 14.19 $28.0672 $398.27 4/1/2015 0.00 $398.27 4/1/2015
5 LABORATORY 95939 21 999 Years 14.19 $26.7305 $379.31 4/1/2015 0.00 $379.31 4/1/2015
T
TECHNICAL
COMPONENT 95939 0 20 Years 10.75 $28.0672 $301.72 4/1/2015 0.00 $301.72 4/1/2015
T
TECHNICAL
COMPONENT 95939 21 999 Years 10.75 $26.7305 $287.35 4/1/2015 0.00 $287.35 4/1/2015
5 LABORATORY 95943 0 999 Years 0.00 $0.0000 $87.40 4/1/2015 0.00 $87.40 0.00 $0.0000 $87.40 4/1/2015 0.00 $87.40 4/1/2015
T
TECHNICAL
COMPONENT 95943 0 999 Years 0.00 $0.0000 $41.99 4/1/2015 0.00 $41.99 4/1/2015
T
TECHNICAL
COMPONENT 95950 0 20 Years 7.01 $28.0672 $196.75 4/1/2015 0.00 $196.75 4/1/2015
T
TECHNICAL
COMPONENT 95950 21 999 Years 7.01 $26.7305 $187.38 4/1/2015 0.00 $187.38 4/1/2015
T
TECHNICAL
COMPONENT 95951 0 20 Years 0.00 $0.0000 $1,361.80 4/1/2015 0.00 $1,361.80 4/1/2015
T
TECHNICAL
COMPONENT 95951 21 999 Years 0.00 $0.0000 $1,374.18 4/1/2015 0.00 $1,374.18 4/1/2015
T
TECHNICAL
COMPONENT 95953 0 20 Years 7.15 $28.0672 $200.68 4/1/2015 0.00 $200.68 4/1/2015
T
TECHNICAL
COMPONENT 95953 21 999 Years 7.15 $26.7305 $191.12 4/1/2015 0.00 $191.12 4/1/2015
5 LABORATORY 95954 0 20 Years 12.95 $28.0672 $363.47 4/1/2015 0.00 $363.47 4/1/2015
5 LABORATORY 95954 21 999 Years 12.95 $26.7305 $346.16 4/1/2015 0.00 $346.16 4/1/2015
T
TECHNICAL
COMPONENT 95954 0 20 Years 9.42 $28.0672 $264.39 4/1/2015 0.00 $264.39 4/1/2015
T
TECHNICAL
COMPONENT 95954 21 999 Years 9.42 $26.7305 $251.80 4/1/2015 0.00 $251.80 4/1/2015
T
TECHNICAL
COMPONENT 95956 0 20 Years 41.64 $28.0672 $1,168.72 4/1/2015 0.00 $1,168.72 4/1/2015
T
TECHNICAL
COMPONENT 95956 21 999 Years 41.64 $26.7305 $1,113.06 4/1/2015 0.00 $1,113.06 4/1/2015
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT 95957 0 20 Years 5.94 $28.0672 $166.72 4/1/2015 0.00 $166.72 4/1/2015
5 LABORATORY 95958 0 20 Years 16.39 $28.0672 $460.02 4/1/2015 0.00 $460.02 4/1/2015
5 LABORATORY 95958 21 999 Years 16.39 $26.7305 $438.11 4/1/2015 0.00 $438.11 4/1/2015
T
TECHNICAL
COMPONENT 95958 0 20 Years 10.03 $28.0672 $281.51 4/1/2015 0.00 $281.51 4/1/2015
T
TECHNICAL
COMPONENT 95958 21 999 Years 10.03 $26.7305 $268.11 4/1/2015 0.00 $268.11 4/1/2015
5 LABORATORY 95999 0 999 Years 0.00 $0.0000 $0.00 4/1/2013 $0.00 5 4/1/2015
4 RADIOLOGY 96000 3 20 Years 2.69 $28.0672 $75.50 4/1/2015 0.00 $75.50 4/1/2015
4 RADIOLOGY 96001 3 20 Years 2.87 $28.0672 $80.55 4/1/2013 0.00 $80.55 4/1/2015
4 RADIOLOGY 96002 3 20 Years 0.62 $28.0672 $17.40 4/1/2013 0.00 $17.40 4/1/2015
4 RADIOLOGY 96003 3 20 Years 0.54 $28.0672 $15.16 4/1/2015 0.00 $15.16 4/1/2015
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9500 0 999 Years 0.00 $0.0000 $106.71 1/1/2014 0.00 $106.71 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9502 0 999 Years 0.00 $0.0000 $99.41 1/1/2016 0.00 $99.41 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9503 0 999 Years 0.00 $0.0000 $21.87 1/1/2016 0.00 $21.87 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9504 0 999 Years 0.00 $0.0000 $372.77 1/1/2014 0.00 $372.77 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9505 0 999 Years 0.00 $0.0000 $25.26 1/1/2014 0.00 $25.26 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9507 0 999 Years 0.00 $0.0000 $3,634.48 1/1/2016 0.00 $3,634.48 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9508 0 999 Years 0.00 $0.0000 $200.74 1/1/2016 0.00 $200.74 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9510 0 999 Years 0.00 $0.0000 $44.76 1/1/2016 0.00 $44.76 1/1/2016
9
OTHER
MEDICAL
ITEMS OR
SERVICES A9700 0 999 Years 0.00 $0.0000 $238.68 1/1/2014 0.00 $238.68 1/1/2016
2 SURGERY G0104 0 20 Years 4.74 $28.0672 $133.04 4/1/2016 0.00 $133.04 4/1/2016
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
2 SURGERY G0104 21 999 Years 4.74 $26.7305 $126.70 4/1/2016 0.00 $126.70 4/1/2016
2 SURGERY G0105 0 20 Years 10.77 $28.0672 $302.28 4/1/2016 0.00 $302.28 4/1/2016
2 SURGERY G0105 21 999 Years 10.77 $26.7305 $287.89 4/1/2016 0.00 $287.89 4/1/2016
4 RADIOLOGY G0106 0 20 Years 5.96 $28.0672 $167.28 4/1/2016 0.00 $167.28 4/1/2016
4 RADIOLOGY G0106 21 999 Years 5.96 $26.7305 $159.31 4/1/2016 0.00 $159.31 4/1/2016
I
PROFESSIONAL
COMPONENT G0106 0 20 Years 1.41 $28.0672 $39.57 4/1/2016 0.00 $39.57 4/1/2016
I
PROFESSIONAL
COMPONENT G0106 21 999 Years 1.41 $26.7305 $37.69 4/1/2016 0.00 $37.69 4/1/2016
T
TECHNICAL
COMPONENT G0106 0 20 Years 4.55 $28.0672 $127.71 4/1/2016 0.00 $127.71 4/1/2016
T
TECHNICAL
COMPONENT G0106 21 999 Years 4.55 $26.7305 $121.62 4/1/2016 0.00 $121.62 4/1/2016
4 RADIOLOGY G0120 0 20 Years 6.01 $28.0672 $168.68 4/1/2016 0.00 $168.68 4/1/2016
4 RADIOLOGY G0120 21 999 Years 6.01 $26.7305 $160.65 4/1/2016 0.00 $160.65 4/1/2016
T
TECHNICAL
COMPONENT G0120 0 20 Years 4.55 $28.0672 $127.71 4/1/2016 0.00 $127.71 4/1/2016
T
TECHNICAL
COMPONENT G0120 21 999 Years 4.55 $26.7305 $121.62 4/1/2016 0.00 $121.62 4/1/2016
T
TECHNICAL
COMPONENT G0122 50 999 Years 6.16 $26.7305 $164.66 4/1/2016 0.00 $164.66 4/1/2016
4 RADIOLOGY G0130 0 20 Years 0.96 $28.0672 $26.94 4/1/2014 0.00 $26.94 4/1/2016
4 RADIOLOGY G0130 21 999 Years 0.96 $26.7305 $25.66 4/1/2014 0.00 $25.66 4/1/2016
T
TECHNICAL
COMPONENT G0130 0 20 Years 0.64 $28.0672 $17.96 4/1/2014 0.00 $17.96 4/1/2016
T
TECHNICAL
COMPONENT G0130 21 999 Years 0.64 $26.7305 $17.11 4/1/2014 0.00 $17.11 4/1/2016
4 RADIOLOGY G0202 0 20 Years 3.77 $28.0672 $105.81 4/1/2014 0.00 $105.81 4/1/2016
4 RADIOLOGY G0202 21 999 Years 3.77 $26.7305 $100.77 4/1/2014 0.00 $100.77 4/1/2016
T
TECHNICAL
COMPONENT G0202 0 20 Years 2.78 $28.0672 $78.03 4/1/2014 0.00 $78.03 4/1/2016
T
TECHNICAL
COMPONENT G0202 21 999 Years 2.78 $26.7305 $74.31 4/1/2014 0.00 $74.31 4/1/2016
4 RADIOLOGY G0204 0 20 Years 4.60 $28.0672 $129.11 4/1/2014 0.00 $129.11 4/1/2016
4 RADIOLOGY G0204 21 999 Years 4.60 $26.7305 $122.96 4/1/2014 0.00 $122.96 4/1/2016
T
TECHNICAL
COMPONENT G0204 0 20 Years 3.36 $28.0672 $94.31 4/1/2014 0.00 $94.31 4/1/2016
T
TECHNICAL
COMPONENT G0204 21 999 Years 3.36 $26.7305 $89.81 4/1/2014 0.00 $89.81 4/1/2016
4 RADIOLOGY G0206 0 20 Years 3.62 $28.0672 $101.60 4/1/2014 0.00 $101.60 4/1/2016
4 RADIOLOGY G0206 21 999 Years 3.62 $26.7305 $96.76 4/1/2014 0.00 $96.76 4/1/2016
T
TECHNICAL
COMPONENT G0206 0 20 Years 2.63 $28.0672 $73.82 4/1/2014 0.00 $73.82 4/1/2016
T
TECHNICAL
COMPONENT G0206 21 999 Years 2.63 $26.7305 $70.30 4/1/2014 0.00 $70.30 4/1/2016
T
TECHNICAL
COMPONENT G0365 0 20 Years 5.29 $28.0672 $148.48 4/1/2016 0.00 $148.48 4/1/2016
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
T
TECHNICAL
COMPONENT G0365 52 0 20 Years 0.00 $0.0000 $74.24 4/1/2016 0.00 $74.24 9 6 4/1/2016
T
TECHNICAL
COMPONENT G0389 65 75 Years 2.44 $26.7305 $65.22 4/1/2016 0.00 $65.22 4/1/2016
5 LABORATORY G0398 18 20 Years 0.00 $0.0000 $122.63 4/1/2016 0.00 $122.63 4/1/2016
5 LABORATORY G0398 21 999 Years 0.00 $0.0000 $116.79 4/1/2016 0.00 $116.79 4/1/2016
T
TECHNICAL
COMPONENT G0398 18 20 Years 0.00 $0.0000 $40.88 4/1/2016 0.00 $40.88 4/1/2016
T
TECHNICAL
COMPONENT G0398 21 999 Years 0.00 $0.0000 $38.93 4/1/2016 0.00 $38.93 4/1/2016
5 LABORATORY G0399 18 20 Years 0.00 $0.0000 $102.20 4/1/2016 0.00 $102.20 4/1/2016
5 LABORATORY G0399 21 999 Years 0.00 $0.0000 $97.33 4/1/2016 0.00 $97.33 4/1/2016
T
TECHNICAL
COMPONENT G0399 18 20 Years 0.00 $0.0000 $32.71 4/1/2016 0.00 $32.71 4/1/2016
T
TECHNICAL
COMPONENT G0399 21 999 Years 0.00 $0.0000 $31.15 4/1/2016 0.00 $31.15 4/1/2016
5 LABORATORY G0400 18 20 Years 0.00 $0.0000 $80.67 4/1/2016 0.00 $80.67 4/1/2016
5 LABORATORY G0400 21 999 Years 0.00 $0.0000 $76.83 4/1/2016 0.00 $76.83 4/1/2016
T
TECHNICAL
COMPONENT G0400 18 20 Years 0.00 $0.0000 $36.89 4/1/2016 0.00 $36.89 4/1/2016
T
TECHNICAL
COMPONENT G0400 21 999 Years 0.00 $0.0000 $35.13 4/1/2016 0.00 $35.13 4/1/2016
T
TECHNICAL
COMPONENT G6001 0 20 Years 0.62 $28.0672 $17.40 4/1/2016 0.00 $17.40 4/1/2016
T
TECHNICAL
COMPONENT G6001 21 999 Years 0.62 $26.7305 $16.57 4/1/2016 0.00 $16.57 4/1/2016
T
TECHNICAL
COMPONENT G6002 0 20 Years 1.55 $28.0672 $43.50 4/1/2016 0.00 $43.50 4/1/2016
T
TECHNICAL
COMPONENT G6002 21 999 Years 1.55 $26.7305 $41.43 4/1/2016 0.00 $41.43 4/1/2016
1
MEDICAL
SERVICES J7605 0 999 Years 0.00 $0.0000 $6.58 10/1/2016 0.00 $6.58 4/1/2016
1
MEDICAL
SERVICES J7608 0 999 Years 0.00 $0.0000 $4.02 4/1/2016 0.00 $4.02 4/1/2016
1
MEDICAL
SERVICES J7622 0 999 Years 0.00 $0.0000 $0.02 10/1/2016 0.00 $0.02 4/1/2016
1
MEDICAL
SERVICES J7626 0 999 Years 0.00 $0.0000 $4.21 4/1/2014 0.00 $4.21 4/1/2016
1
MEDICAL
SERVICES J7631 0 999 Years 0.00 $0.0000 $0.60 11/1/2015 0.00 $0.60 4/1/2016
1
MEDICAL
SERVICES J7633 0 999 Years 0.00 $0.0000 $8.00 4/1/2014 0.00 $8.00 4/1/2016
1
MEDICAL
SERVICES J7639 0 999 Years 0.00 $0.0000 $31.72 10/1/2016 0.00 $31.72 4/1/2016
1
MEDICAL
SERVICES J7644 0 999 Years 0.00 $0.0000 $0.21 4/1/2016 0.00 $0.21 4/1/2016
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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MISCELLANEOUS OTHER PROFESSIONALS - PORTABLE X-RAY, RADIOLOGICAL LAB, PHYSIOLOGICAL LAB
1 2 3 1 2 3
TOS TOS DescProc
Code
Last Pricing
Review Date
Mod
1
Mod
2
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
1
MEDICAL
SERVICES J7682 0 999 Years 0.00 $0.0000 $51.38 10/1/2016 0.00 $51.38 4/1/2016
T
TECHNICAL
COMPONENT Q0035 0 20 Years 0.34 $28.0672 $9.54 1/1/2016 0.00 $9.54 1/1/2016
4 RADIOLOGY R0070 0 999 Years 0.00 $0.0000 $131.02 1/1/2016 0.00 $131.02 0.00 $0.0000 $131.02 1/1/2016 0.00 $131.02 1/1/2016
4 RADIOLOGY R0075 UN 0 999 Years 0.00 $0.0000 $65.51 1/1/2016 0.00 $65.51 0.00 $0.0000 $65.51 1/1/2016 0.00 $65.51 1/1/2016
4 RADIOLOGY R0075 UP 0 999 Years 0.00 $0.0000 $43.67 1/1/2016 0.00 $43.67 0.00 $0.0000 $43.67 1/1/2016 0.00 $43.67 1/1/2016
4 RADIOLOGY R0075 UQ 0 999 Years 0.00 $0.0000 $32.76 1/1/2016 0.00 $32.76 0.00 $0.0000 $32.76 1/1/2016 0.00 $32.76 1/1/2016
4 RADIOLOGY R0075 UR 0 999 Years 0.00 $0.0000 $26.20 1/1/2016 0.00 $26.20 0.00 $0.0000 $26.20 1/1/2016 0.00 $26.20 1/1/2016
4 RADIOLOGY R0075 US 0 999 Years 0.00 $0.0000 $21.84 1/1/2016 0.00 $21.84 0.00 $0.0000 $21.84 1/1/2016 0.00 $21.84 1/1/2016
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
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MISCELLANEOUS OTHER PROFESSIONALS - PORTABLE X-RAY, RADIOLOGICAL LAB, PHYSIOLOGICAL LAB
Note Code(s): 12 - CRNA/AA providers are reimbursed at 92 percent of the fee applicable to a physician for the same service.
5 - This procedure is manually reviewed to determine pricing.
6 - This procedure is payable only through the CCP program.
9 - The NP/CNS/PA/CNM Provider Fee Schedule reflects 100 percent of the fee applicable to a physician.
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
