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 />
69905 $2,700.59 Y<br />
69910 $2,700.59 Y<br />
69915 $2,700.59 Y<br />
69930 $26,943.70 Y<br />
69949 $72.39 Y<br />
69955 $2,700.59 Y<br />
69960 $2,700.59 Y<br />
69970 $2,700.59 Y<br />
69979 $72.39 Y<br />
69990 Packaged N<br />
70010 Packaged N<br />
70015 Packaged N<br />
70030 $41.85 N<br />
70100 $41.85 N<br />
70110 $41.85 N<br />
70120 $41.85 N<br />
70130 $41.85 N<br />
70134 $70.12 N<br />
70140 $41.85 N<br />
70150 $41.85 N<br />
70160 $41.85 N<br />
70170 Packaged N<br />
70190 $41.85 N<br />
70200 $41.85 N<br />
70210 $41.85 N<br />
70220 $41.85 N<br />
70240 $41.85 N<br />
70250 $41.85 N<br />
70260 $70.12 N<br />
70300 $28.08 N<br />
70310 $28.08 N<br />
70320 $28.08 N<br />
70328 $41.85 N<br />
70330 $41.85 N<br />
70332 Packaged N<br />
70336 $325.80 N<br />
70350 $41.85 N<br />
70355 $41.85 N<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
70360 $41.85 N<br />
70370 $79.75 N<br />
70371 $79.75 N<br />
70373 Packaged N<br />
70380 $41.85 N<br />
70390 Packaged N<br />
70450 $181.83 N<br />
70460 $276.87 N<br />
70470 $310.88 N<br />
70480 $181.83 N<br />
70481 $276.87 N<br />
70482 $310.88 N<br />
70486 $181.83 N<br />
70487 $276.87 N<br />
70488 $310.88 N<br />
70490 $181.83 N<br />
70491 $276.87 N<br />
70492 $310.88 N<br />
70496 $317.36 N<br />
70498 $317.36 N<br />
70540 $325.80 N<br />
70542 $395.21 N<br />
70543 $499.07 N<br />
70544 $325.80 N<br />
70545 $395.21 N<br />
70546 $499.07 N<br />
70547 $325.80 N<br />
70548 $395.21 N<br />
70549 $499.07 N<br />
70551 $325.80 N<br />
70552 $395.21 N<br />
70553 $499.07 N<br />
70557 $325.80 N<br />
70558 $395.21 N<br />
70559 $499.07 N<br />
71010 $41.85 N<br />
71015 $41.85 N<br />
71020 $41.85 N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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