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 />
63047 $4,748.59 Y<br />
63048 $4,748.59 Y<br />
63055 $4,748.59 Y<br />
63056 $4,748.59 Y<br />
63057 $4,748.59 Y<br />
63064 $4,748.59 Y<br />
63066 $4,748.59 Y<br />
63075 $4,748.59 Y<br />
63076 $3,092.83 Y<br />
63081 $3,092.83 Y<br />
63082 $3,092.83 Y<br />
63600 $1,805.84 Y<br />
63610 $1,805.84 Y<br />
63615 $1,805.84 Y<br />
63620 Packaged N<br />
63621 Packaged N<br />
63650 $6,338.73 N<br />
63655 $8,345.95 N<br />
63661 $1,894.41 Y<br />
63662 $1,894.41 Y<br />
63663 $1,894.41 Y<br />
63664 $1,894.41 Y<br />
63685 $19,881.73 N<br />
63688 $2,765.06 Y<br />
63741 $3,957.88 Y<br />
63744 $3,957.88 Y<br />
63746 $1,277.58 Y<br />
64400 $246.55 Y<br />
64402 $246.55 Y<br />
64405 $359.06 Y<br />
64408 $694.57 Y<br />
64410 $694.57 Y<br />
64412 $694.57 Y<br />
64413 $359.06 Y<br />
64415 $359.06 Y<br />
64416 $694.57 Y<br />
64417 $359.06 Y<br />
64418 $359.06 Y<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
64420 $359.06 Y<br />
64421 $694.57 Y<br />
64425 $359.06 Y<br />
64430 $694.57 Y<br />
64435 $359.06 Y<br />
64445 $694.57 Y<br />
64446 $694.57 Y<br />
64447 $359.06 Y<br />
64448 $694.57 Y<br />
64449 $694.57 Y<br />
64450 $359.06 Y<br />
64455 $246.55 Y<br />
64479 $694.57 Y<br />
64480 $359.06 Y<br />
64483 $694.57 Y<br />
64484 $359.06 Y<br />
64490 $694.57 Y<br />
64491 $246.55 Y<br />
64492 $246.55 Y<br />
64493 $694.57 Y<br />
64494 $246.55 Y<br />
64495 $246.55 Y<br />
64505 $246.55 Y<br />
64508 $246.55 Y<br />
64510 $694.57 Y<br />
64517 $694.57 Y<br />
64520 $694.57 Y<br />
64530 $694.57 Y<br />
64553 $6,338.73 N<br />
64555 $6,338.73 N<br />
64560 $6,338.73 N<br />
64561 $6,338.73 N<br />
64565 $6,338.73 N<br />
64573 $15,235.73 N<br />
64575 $8,345.95 N<br />
64577 $8,345.95 N<br />
64580 $8,345.95 N<br />
64581 $8,345.95 N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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