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
55520 $1,462.92 Y
55530 $1,462.92 Y
55535 $2,008.56 Y
55540 $2,008.56 Y
55550 $2,942.95 Y
55559 $2,390.93 Y
55600 $1,462.92 Y
55680 $1,462.92 Y
55700 $781.06 Y
55705 $781.06 Y
55706 $781.06 Y
55720 $1,603.56 Y
55725 $1,603.56 Y
55860 $1,258.12 Y
55870 $214.16 Y
55873 $7,153.96 Y
55875 $2,274.50 N
55876 $864.39 Y
55899 $68.85 Y
55920 $1,708.06 Y
56405 $95.99 Y
56420 $95.99 Y
56440 $1,259.44 Y
56441 $1,259.44 Y
56442 $1,259.44 Y
56501 $1,336.09 Y
56515 $1,336.09 Y
56605 $214.16 Y
56606 $95.99 Y
56620 $1,259.44 Y
56625 $1,259.44 Y
56700 $1,259.44 Y
56740 $1,259.44 Y
56800 $1,259.44 Y
56805 $1,259.44 Y
56810 $1,259.44 Y
56820 $95.99 Y
56821 $95.99 Y
Procedure
Code
Allowed
Amount
Multiple
Procedure
Discounting
57000 $1,259.44 Y
57010 $1,259.44 Y
57020 $426.92 Y
57022 $793.02 Y
57023 $1,219.29 Y
57061 $1,259.44 Y
57065 $1,259.44 Y
57100 $426.92 Y
57105 $1,259.44 Y
57106 $1,259.44 Y
57107 $2,215.79 Y
57109 $2,215.79 Y
57120 $2,215.79 Y
57130 $1,259.44 Y
57135 $1,259.44 Y
57150 $95.99 Y
57155 $426.92 Y
57160 $95.99 Y
57170 $8.29 Y
57180 $95.99 Y
57200 $1,259.44 Y
57210 $1,259.44 Y
57220 $2,826.68 Y
57230 $2,215.79 Y
57240 $2,215.79 Y
57250 $2,215.79 Y
57260 $2,215.79 Y
57265 $2,826.68 Y
57267 $2,215.79 Y
57268 $2,215.79 Y
57282 $2,826.68 Y
57283 $2,826.68 Y
57284 $2,826.68 Y
57285 $2,826.68 Y
57287 $2,215.79 Y
57288 $2,826.68 Y
57289 $2,215.79 Y
57291 $2,215.79 Y
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply
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