Ambulatory Surgery Center Fee Schedule - Washington Department ...

DOC ASC Fee Schedule
Effective Dates of Service 7/1/2012 thru 8/31/2012
Refer to the 2012 CPT® and HCPCS coding books for complete code descriptions
Procedure
Code
Allowed
Amount
Multiple
Procedure
Discounting
15952 $1,008.68 Y
15953 $1,008.68 Y
15956 $1,008.68 Y
15958 $1,008.68 Y
15999 $274.10 Y
16000 $55.22 Y
16020 $96.83 Y
16025 $96.83 Y
16030 $96.83 Y
16035 $96.83 Y
17000 $55.22 Y
17003 $27.87 Y
17004 $175.81 Y
17106 $175.81 Y
17107 $175.81 Y
17108 $175.81 Y
17110 $55.22 Y
17111 $96.83 Y
17250 $96.83 Y
17260 $96.83 Y
17261 $96.83 Y
17262 $96.83 Y
17263 $96.83 Y
17264 $96.83 Y
17266 $175.81 Y
17270 $96.83 Y
17271 $96.83 Y
17272 $96.83 Y
17273 $175.81 Y
17274 $175.81 Y
17276 $175.81 Y
17280 $96.83 Y
17281 $175.81 Y
17282 $175.81 Y
17283 $175.81 Y
17284 $175.81 Y
17286 $175.81 Y
17311 $309.98 Y
Procedure
Code
Allowed
Amount
Multiple
Procedure
Discounting
17312 $309.98 Y
17313 $309.98 Y
17314 $309.98 Y
17315 $309.98 Y
17340 $55.22 Y
17360 $55.22 Y
17999 $27.87 Y
19000 $288.96 Y
19001 $94.94 Y
19020 $1,219.29 Y
19030 Packaged N
19100 $288.96 Y
19101 $1,555.14 Y
19102 $490.98 Y
19103 $973.88 Y
19110 $1,555.14 Y
19112 $1,555.14 Y
19120 $1,555.14 Y
19125 $1,555.14 Y
19126 $1,555.14 Y
19260 $1,099.36 Y
19290 Packaged N
19291 Packaged N
19295 Packaged N
19296 $3,658.44 Y
19297 $3,658.44 Y
19298 $3,658.44 Y
19301 $1,555.14 Y
19302 $2,638.83 Y
19303 $2,146.61 Y
19304 $2,146.61 Y
19307 $2,638.83 Y
19316 $2,146.61 Y
19318 $2,638.83 Y
19324 $2,638.83 Y
19325 $3,658.44 Y
19328 $2,146.61 Y
19330 $2,146.61 Y
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply
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