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
21013 $515.38 Y
21014 $515.38 Y
21015 $1,099.36 Y
21016 $1,469.46 Y
21025 $2,700.59 Y
21026 $2,700.59 Y
21029 $2,700.59 Y
21030 $1,568.46 Y
21031 $1,568.46 Y
21032 $1,568.46 Y
21034 $2,700.59 Y
21040 $1,568.46 Y
21044 $2,700.59 Y
21046 $2,700.59 Y
21047 $2,700.59 Y
21048 $2,700.59 Y
21049 $2,700.59 Y
21050 $2,700.59 Y
21060 $2,700.59 Y
21070 $2,700.59 Y
21073 By Report N
21076 $1,568.46 Y
21077 $2,700.59 Y
21079 $2,700.59 Y
21080 $2,700.59 Y
21081 $2,700.59 Y
21082 $2,700.59 Y
21083 $2,700.59 Y
21084 $2,700.59 Y
21085 $1,079.91 Y
21086 $2,700.59 Y
21087 $2,700.59 Y
21088 $2,700.59 Y
21089 $72.39 Y
21100 $2,700.59 Y
21110 $478.74 Y
21116 Packaged N
21120 $1,568.46 Y
Procedure
Code
Allowed
Amount
Multiple
Procedure
Discounting
21121 $1,568.46 Y
21122 $1,568.46 Y
21123 $1,568.46 Y
21125 $1,568.46 Y
21127 $2,700.59 Y
21137 $1,568.46 Y
21138 $2,700.59 Y
21139 $2,700.59 Y
21150 $2,700.59 Y
21175 $2,700.59 Y
21181 $1,568.46 Y
21195 $2,700.59 Y
21198 $2,700.59 Y
21199 $2,700.59 Y
21206 $2,700.59 Y
21208 $2,700.59 Y
21209 $2,700.59 Y
21210 $2,700.59 Y
21215 $2,700.59 Y
21230 $2,700.59 Y
21235 $1,568.46 Y
21240 $2,700.59 Y
21242 $2,700.59 Y
21243 $2,700.59 Y
21244 $2,700.59 Y
21245 $2,700.59 Y
21246 $2,700.59 Y
21248 $2,700.59 Y
21249 $2,700.59 Y
21260 $2,700.59 Y
21261 $2,700.59 Y
21263 $2,700.59 Y
21267 $2,700.59 Y
21270 $2,700.59 Y
21275 $2,700.59 Y
21280 $2,700.59 Y
21282 $1,079.91 Y
21295 $478.74 Y
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply
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