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
64864 $2,342.33 Y
64865 $2,342.33 Y
64870 $2,342.33 Y
64872 $2,342.33 Y
64874 $2,342.33 Y
64876 $2,342.33 Y
64885 $2,342.33 Y
64886 $2,342.33 Y
64890 $2,342.33 Y
64891 $2,342.33 Y
64892 $2,342.33 Y
64893 $2,342.33 Y
64895 $2,342.33 Y
64896 $2,342.33 Y
64897 $2,342.33 Y
64898 $2,342.33 Y
64901 $2,342.33 Y
64902 $2,342.33 Y
64905 $2,342.33 Y
64907 $2,342.33 Y
64910 $2,342.33 Y
64911 $2,342.33 Y
64999 $160.58 Y
65091 $2,451.08 Y
65093 $2,451.08 Y
65101 $2,451.08 Y
65103 $2,451.08 Y
65105 $2,451.08 Y
65110 $2,451.08 Y
65112 $2,451.08 Y
65114 $2,451.08 Y
65125 $1,686.33 Y
65130 $1,686.33 Y
65135 $1,686.33 Y
65140 $2,451.08 Y
65150 $1,686.33 Y
65155 $2,451.08 Y
65175 $1,140.86 Y
Procedure
Code
Allowed
Amount
Multiple
Procedure
Discounting
65205 $60.02 N
65210 $60.02 N
65220 $60.02 N
65222 $60.02 N
65235 $1,020.89 Y
65260 $367.54 Y
65265 $1,301.49 Y
65270 $1,140.86 Y
65272 $1,533.18 Y
65275 $1,533.18 Y
65280 $1,301.49 Y
65285 $2,510.95 Y
65286 $283.20 Y
65290 $1,474.58 Y
65400 $1,020.89 Y
65410 $1,020.89 Y
65420 $1,020.89 Y
65426 $1,533.18 Y
65430 $60.02 N
65435 $480.15 Y
65436 $1,020.89 Y
65450 $122.99 N
65600 $1,140.86 Y
65710 $2,358.56 Y
65730 $2,358.56 Y
65750 $2,358.56 Y
65755 $2,358.56 Y
65756 $2,358.56 Y
65757 Packaged N
65770 $6,346.82 Y
65772 $1,020.89 Y
65775 $1,020.89 Y
65780 $2,358.56 Y
65781 $2,358.56 Y
65782 $2,358.56 Y
65800 $1,020.89 Y
65805 $1,020.89 Y
65810 $1,533.18 Y
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply
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