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 />
77071 $41.85 N<br />
77072 $41.85 N<br />
77073 $41.85 N<br />
77074 $70.12 N<br />
77075 $70.12 N<br />
77076 $70.12 N<br />
77077 $41.85 N<br />
77078 $67.57 N<br />
77079 $102.36 N<br />
77080 $67.57 N<br />
77081 $27.13 N<br />
77082 $41.85 N<br />
77083 $70.12 N<br />
77084 $325.80 N<br />
77280 $95.95 N<br />
77285 $248.24 N<br />
77290 $248.24 N<br />
77295 $864.39 N<br />
77299 $95.95 N<br />
77300 $95.95 N<br />
77301 $864.39 N<br />
77305 $95.95 N<br />
77310 $95.95 N<br />
77315 $248.24 N<br />
77321 $248.24 N<br />
77326 $95.95 N<br />
77327 $248.24 N<br />
77328 $248.24 N<br />
77331 $95.95 N<br />
77332 $177.68 N<br />
77333 $177.68 N<br />
77334 $177.68 N<br />
77336 $95.95 N<br />
77338 $177.68 N<br />
77370 $95.95 N<br />
77371 $6,845.67 N<br />
77399 $95.95 N<br />
77401 $86.48 N<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
77402 $86.48 N<br />
77403 $86.48 N<br />
77404 $86.48 N<br />
77406 $144.70 N<br />
77407 $86.48 N<br />
77408 $86.48 N<br />
77409 $86.48 N<br />
77411 $144.70 N<br />
77412 $144.70 N<br />
77413 $144.70 N<br />
77414 $144.70 N<br />
77416 $144.70 N<br />
77417 Packaged N<br />
77418 $392.62 N<br />
77421 Packaged N<br />
77422 $144.70 N<br />
77423 $144.70 N<br />
77435 Packaged N<br />
77470 $354.74 N<br />
77520 $878.34 N<br />
77522 $878.34 N<br />
77523 $1,148.99 N<br />
77525 $1,148.99 N<br />
77600 $354.74 N<br />
77605 $354.74 N<br />
77610 $354.74 N<br />
77615 $354.74 N<br />
77620 $354.74 N<br />
77750 $144.70 N<br />
77761 $281.77 N<br />
77762 $281.77 N<br />
77763 $281.77 N<br />
77776 $281.77 N<br />
77777 $281.77 N<br />
77778 $832.84 N<br />
77785 $724.76 N<br />
77786 $724.76 N<br />
77787 $724.76 N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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