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 />
74240 $81.58 N<br />
74241 $81.58 N<br />
74245 $131.95 N<br />
74246 $81.58 N<br />
74247 $81.58 N<br />
74249 $131.95 N<br />
74250 $81.58 N<br />
74251 $131.95 N<br />
74260 $81.58 N<br />
74261 Packaged N<br />
74262 Packaged N<br />
74263 By Report N<br />
74270 $81.58 N<br />
74280 $131.95 N<br />
74283 $81.58 N<br />
74290 $81.58 N<br />
74291 $81.58 N<br />
74300 Packaged N<br />
74301 Packaged N<br />
74305 Packaged N<br />
74320 Packaged N<br />
74327 Packaged N<br />
74328 Packaged N<br />
74329 Packaged N<br />
74330 Packaged N<br />
74340 Packaged N<br />
74355 Packaged N<br />
74360 Packaged N<br />
74363 Packaged N<br />
74400 $159.96 N<br />
74410 $159.96 N<br />
74415 $159.96 N<br />
74420 $159.96 N<br />
74425 Packaged N<br />
74430 Packaged N<br />
74440 Packaged N<br />
74445 Packaged N<br />
74450 Packaged N<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
74455 Packaged N<br />
74470 Packaged N<br />
74475 Packaged N<br />
74480 Packaged N<br />
74485 Packaged N<br />
74710 $70.12 N<br />
74740 Packaged N<br />
74742 Packaged N<br />
74775 $159.96 N<br />
75557 $325.80 N<br />
75559 $325.80 N<br />
75561 $499.07 N<br />
75563 $499.07 N<br />
75571 By Report N<br />
75572 By Report N<br />
75573 By Report N<br />
75574 By Report N<br />
75600 Packaged N<br />
75605 Packaged N<br />
75625 Packaged N<br />
75630 Packaged N<br />
75635 Packaged N<br />
75650 Packaged N<br />
75658 Packaged N<br />
75660 Packaged N<br />
75662 Packaged N<br />
75665 Packaged N<br />
75671 Packaged N<br />
75676 Packaged N<br />
75680 Packaged N<br />
75685 Packaged N<br />
75705 Packaged N<br />
75710 Packaged N<br />
75716 Packaged N<br />
75722 Packaged N<br />
75724 Packaged N<br />
75726 Packaged N<br />
75731 Packaged N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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