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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Pain Management Procedures<br />
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 />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
62263 $694.57 63030 $4,748.59 64430 $694.57 64622 $1,277.58<br />
62264 $1,277.58 63035 $4,748.59 64435 $359.06 64623 $694.57<br />
62268 $694.57 63040 $4,748.59 64445 $694.57 64626 $694.57<br />
62269 $932.50 63042 $4,748.59 64446 $694.57 64627 $246.55<br />
62270 $359.06 63045 $4,748.59 64447 $359.06 64630 $694.57<br />
62272 $359.06 63046 $4,748.59 64448 $694.57 64640 $694.57<br />
62273 $359.06 63047 $4,748.59 64449 $694.57 64680 $694.57<br />
62280 $694.57 63048 $4,748.59 64450 $359.06 64681 $1,277.58<br />
62281 $694.57 63055 $4,748.59 64479 $694.57 62267 $443.66<br />
62282 $694.57 63056 $4,748.59 64480 $359.06 63620 $0.00<br />
62284 $0.00 63057 $4,748.59 64483 $694.57 63621 $0.00<br />
62287 $3,596.31 63064 $4,748.59 64484 $359.06 63661 $1,894.41<br />
62290 $0.00 63066 $4,748.59 64505 $246.55 63662 $1,894.41<br />
62291 $0.00 63075 $4,748.59 64508 $246.55 63663 $1,894.41<br />
62292 $694.57 63600 $1,805.84 64510 $694.57 63664 $1,894.41<br />
62294 $694.57 63610 $1,805.84 64517 $694.57 64455 $246.55<br />
62310 $694.57 63615 $1,805.84 64520 $694.57 64490 $694.57<br />
62311 $694.57 63650 $6,338.73 64530 $694.57 64491 $246.55<br />
62318 $694.57 63655 $8,345.95 64553 $6,338.73 64492 $246.55<br />
62319 $694.57 63685 $19,881.73 64555 $6,338.73 64493 $694.57<br />
62350 $3,957.88 63688 $2,765.06 64560 $6,338.73 64494 $246.55<br />
62351 $4,748.59 63741 $3,957.88 64561 $6,338.73 64495 $246.55<br />
62355 $1,277.58 63744 $3,957.88 64565 $6,338.73 64632 $246.55<br />
62360 $3,957.88 63746 $1,277.58 64573 $15,235.73<br />
62361 $19,163.65 64400 $246.55 64575 $8,345.95<br />
62362 $19,163.65 64402 $246.55 64577 $8,345.95<br />
62365 $3,596.31 64405 $359.06 64580 $8,345.95<br />
62367 $245.08 64408 $694.57 64581 $8,345.95<br />
62368 $245.08 64410 $694.57 64585 $1,894.41<br />
63001 $4,748.59 64412 $694.57 64590 $19,881.73<br />
63003 $4,748.59 64413 $359.06 64595 $2,765.06<br />
63005 $4,748.59 64415 $359.06 64600 $1,277.58<br />
63011 $4,748.59 64416 $694.57 64605 $1,805.84<br />
63012 $4,748.59 64417 $359.06 64610 $1,805.84<br />
63015 $4,748.59 64418 $359.06 64612 $246.55<br />
63016 $4,748.59 64420 $359.06 64613 $359.06<br />
63017 $4,748.59 64421 $694.57 64614 $359.06<br />
63020 $4,748.59 64425 $359.06 64620 $694.57<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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