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 />
41805 $1,568.46 Y<br />
41806 $1,079.91 Y<br />
41820 $478.74 Y<br />
41821 $478.74 Y<br />
41822 $1,079.91 Y<br />
41823 $1,568.46 Y<br />
41825 $1,079.91 Y<br />
41826 $1,568.46 Y<br />
41827 $1,568.46 Y<br />
41828 $1,079.91 Y<br />
41830 $1,079.91 Y<br />
41850 $1,079.91 Y<br />
41870 $1,568.46 Y<br />
41872 $1,079.91 Y<br />
41874 $1,568.46 Y<br />
41899 $72.39 Y<br />
42000 $215.19 Y<br />
42100 $478.74 Y<br />
42104 $1,079.91 Y<br />
42106 $1,079.91 Y<br />
42107 $1,568.46 Y<br />
42120 $2,700.59 Y<br />
42140 $478.74 Y<br />
42145 $1,568.46 Y<br />
42160 $1,079.91 Y<br />
42180 $215.19 Y<br />
42182 $2,700.59 Y<br />
42200 $2,700.59 Y<br />
42205 $2,700.59 Y<br />
42210 $2,700.59 Y<br />
42215 $2,700.59 Y<br />
42220 $2,700.59 Y<br />
42225 $2,700.59 Y<br />
42226 $2,700.59 Y<br />
42227 $2,700.59 Y<br />
42235 $1,079.91 Y<br />
42260 $1,568.46 Y<br />
42280 $215.19 Y<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
42281 $1,079.91 Y<br />
42299 $72.39 Y<br />
42300 $1,079.91 Y<br />
42305 $1,079.91 Y<br />
42310 $215.19 Y<br />
42320 $215.19 Y<br />
42330 $1,079.91 Y<br />
42335 $1,079.91 Y<br />
42340 $1,079.91 Y<br />
42400 $490.98 Y<br />
42405 $1,568.46 Y<br />
42408 $1,079.91 Y<br />
42409 $1,079.91 Y<br />
42410 $2,700.59 Y<br />
42415 $2,700.59 Y<br />
42420 $2,700.59 Y<br />
42425 $2,700.59 Y<br />
42440 $2,700.59 Y<br />
42450 $1,568.46 Y<br />
42500 $1,568.46 Y<br />
42505 $2,700.59 Y<br />
42507 $2,700.59 Y<br />
42508 $2,700.59 Y<br />
42509 $2,700.59 Y<br />
42510 $2,700.59 Y<br />
42550 Packaged N<br />
42600 $1,079.91 Y<br />
42650 $478.74 Y<br />
42660 $215.19 Y<br />
42665 $1,568.46 Y<br />
42699 $72.39 Y<br />
42700 $215.19 Y<br />
42720 $1,079.91 Y<br />
42725 $2,700.59 Y<br />
42800 $1,079.91 Y<br />
42802 $1,079.91 Y<br />
42804 $1,079.91 Y<br />
42806 $1,568.46 Y<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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