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
69110 $1,099.36 Y
69120 $1,568.46 Y
69140 $1,568.46 Y
69145 $1,099.36 Y
69150 $478.74 Y
69200 $42.05 N
69205 $1,469.46 Y
69210 $42.05 N
69220 $55.22 Y
69222 $1,079.91 Y
69300 $1,568.46 Y
69310 $2,700.59 Y
69320 $2,700.59 Y
69399 $72.39 Y
69400 $215.19 Y
69401 $215.19 Y
69405 $478.74 Y
69420 $215.19 Y
69421 $1,079.91 Y
69424 $1,079.91 Y
69433 $478.74 Y
69436 $1,079.91 Y
69440 $1,568.46 Y
69450 $2,700.59 Y
69501 $2,700.59 Y
69502 $1,568.46 Y
69505 $2,700.59 Y
69511 $2,700.59 Y
69530 $2,700.59 Y
69540 $1,079.91 Y
69550 $2,700.59 Y
69552 $2,700.59 Y
69601 $2,700.59 Y
69602 $2,700.59 Y
69603 $2,700.59 Y
69604 $2,700.59 Y
69605 $2,700.59 Y
69610 $1,568.46 Y
Procedure
Code
Allowed
Amount
Multiple
Procedure
Discounting
69620 $1,568.46 Y
69631 $2,700.59 Y
69632 $2,700.59 Y
69633 $2,700.59 Y
69635 $2,700.59 Y
69636 $2,700.59 Y
69637 $2,700.59 Y
69641 $2,700.59 Y
69642 $2,700.59 Y
69643 $2,700.59 Y
69644 $2,700.59 Y
69645 $2,700.59 Y
69646 $2,700.59 Y
69650 $1,568.46 Y
69660 $2,700.59 Y
69661 $2,700.59 Y
69662 $2,700.59 Y
69666 $2,700.59 Y
69667 $2,700.59 Y
69670 $2,700.59 Y
69676 $2,700.59 Y
69700 $2,700.59 Y
69711 $2,700.59 Y
69714 $7,462.11 Y
69715 $7,462.11 Y
69717 $7,462.11 Y
69718 $7,462.11 Y
69720 $2,700.59 Y
69725 $2,700.59 Y
69740 $2,700.59 Y
69745 $2,700.59 Y
69799 $72.39 Y
69801 $1,568.46 Y
69802 $1,568.46 Y
69805 $2,700.59 Y
69806 $2,700.59 Y
69820 $2,700.59 Y
69840 $2,700.59 Y
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply
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