Ambulatory Surgery Center Fee Schedule - Washington Department ...
Ambulatory Surgery Center Fee Schedule - Washington Department ...
Ambulatory Surgery Center Fee Schedule - Washington Department ...
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DOC ASC <strong>Fee</strong> <strong>Schedule</strong><br />
Effective Dates of Service 7/1/2012 thru 8/31/2012<br />
Refer to the 2012 CPT® and HCPCS coding books for complete code descriptions<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
28296 $1,982.49 Y<br />
28297 $1,982.49 Y<br />
28298 $1,982.49 Y<br />
28299 $1,982.49 Y<br />
28300 $3,300.19 Y<br />
28302 $1,372.45 Y<br />
28304 $3,300.19 Y<br />
28305 $3,300.19 Y<br />
28306 $1,372.45 Y<br />
28307 $1,372.45 Y<br />
28308 $1,372.45 Y<br />
28309 $3,300.19 Y<br />
28310 $1,372.45 Y<br />
28312 $1,372.45 Y<br />
28313 $1,372.45 Y<br />
28315 $1,372.45 Y<br />
28320 $3,300.19 Y<br />
28322 $3,300.19 Y<br />
28340 $1,372.45 Y<br />
28341 $1,372.45 Y<br />
28344 $1,372.45 Y<br />
28345 $1,372.45 Y<br />
28360 $3,300.19 Y<br />
28400 $104.15 Y<br />
28405 $1,155.83 Y<br />
28406 $1,623.81 Y<br />
28415 $4,113.79 Y<br />
28420 $2,856.73 Y<br />
28430 $104.15 Y<br />
28435 $104.15 Y<br />
28436 $1,623.81 Y<br />
28445 $2,856.73 Y<br />
28446 $3,300.19 Y<br />
28450 $104.15 Y<br />
28455 $104.15 Y<br />
28456 $1,623.81 Y<br />
28465 $2,856.73 Y<br />
28470 $104.15 Y<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
28475 $104.15 Y<br />
28476 $1,623.81 Y<br />
28485 $2,856.73 Y<br />
28490 $104.15 Y<br />
28495 $104.15 Y<br />
28496 $1,623.81 Y<br />
28505 $1,623.81 Y<br />
28510 $104.15 Y<br />
28515 $104.15 Y<br />
28525 $1,623.81 Y<br />
28530 $104.15 Y<br />
28531 $1,623.81 Y<br />
28540 $104.15 Y<br />
28545 $1,623.81 Y<br />
28546 $1,623.81 Y<br />
28555 $2,856.73 Y<br />
28570 $301.24 Y<br />
28575 $1,155.83 Y<br />
28576 $1,623.81 Y<br />
28585 $1,623.81 Y<br />
28600 $104.15 Y<br />
28605 $104.15 Y<br />
28606 $1,623.81 Y<br />
28615 $2,856.73 Y<br />
28630 $104.15 Y<br />
28635 $960.81 Y<br />
28636 $1,623.81 Y<br />
28645 $1,623.81 Y<br />
28660 $104.15 Y<br />
28665 $960.81 Y<br />
28666 $1,623.81 Y<br />
28675 $1,623.81 Y<br />
28705 $3,300.19 Y<br />
28715 $5,569.99 Y<br />
28725 $3,300.19 Y<br />
28730 $3,300.19 Y<br />
28735 $3,300.19 Y<br />
28737 $3,300.19 Y<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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