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
25360 $2,926.52 Y
25365 $2,926.52 Y
25370 $2,926.52 Y
25375 $2,926.52 Y
25390 $2,926.52 Y
25391 $2,926.52 Y
25392 $1,996.21 Y
25393 $2,926.52 Y
25394 $2,926.52 Y
25400 $2,926.52 Y
25405 $5,569.99 Y
25415 $5,569.99 Y
25420 $5,569.99 Y
25425 $2,926.52 Y
25426 $2,926.52 Y
25430 $2,926.52 Y
25431 $2,926.52 Y
25440 $5,569.99 Y
25441 $7,462.11 Y
25442 $7,462.11 Y
25443 $3,649.39 Y
25444 $3,649.39 Y
25445 $3,649.39 Y
25446 $7,462.11 Y
25447 $2,506.14 Y
25449 $2,506.14 Y
25450 $2,926.52 Y
25455 $2,926.52 Y
25490 $2,926.52 Y
25491 $2,926.52 Y
25492 $2,926.52 Y
25500 $104.15 Y
25505 $301.24 Y
25515 $2,856.73 Y
25520 $301.24 Y
25525 $2,856.73 Y
25526 $2,856.73 Y
25530 $104.15 Y
Procedure
Code
Allowed
Amount
Multiple
Procedure
Discounting
25535 $104.15 Y
25545 $2,856.73 Y
25560 $104.15 Y
25565 $301.24 Y
25574 $4,113.79 Y
25575 $4,113.79 Y
25600 $104.15 Y
25605 $301.24 Y
25606 $1,623.81 Y
25607 $4,113.79 Y
25608 $4,113.79 Y
25609 $4,113.79 Y
25622 $104.15 Y
25624 $301.24 Y
25628 $2,856.73 Y
25630 $104.15 Y
25635 $301.24 Y
25645 $2,856.73 Y
25650 $104.15 Y
25651 $1,623.81 Y
25652 $2,856.73 Y
25660 $104.15 Y
25670 $1,623.81 Y
25671 $1,623.81 Y
25675 $104.15 Y
25676 $1,623.81 Y
25680 $104.15 Y
25685 $1,623.81 Y
25690 $1,155.83 Y
25695 $1,623.81 Y
25800 $5,569.99 Y
25805 $2,926.52 Y
25810 $5,569.99 Y
25820 $2,926.52 Y
25825 $5,569.99 Y
25830 $5,569.99 Y
25907 $1,383.19 Y
25922 $1,383.19 Y
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply
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