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 />
77789 $86.48 N<br />
77790 Packaged N<br />
77799 $281.77 N<br />
78000 $104.89 N<br />
78001 $104.89 N<br />
78003 $104.89 N<br />
78006 $206.67 N<br />
78007 $206.67 N<br />
78010 $135.68 N<br />
78011 $135.68 N<br />
78015 $270.38 N<br />
78016 $270.38 N<br />
78018 $270.38 N<br />
78020 Packaged N<br />
78070 $206.67 N<br />
78075 $897.67 N<br />
78099 $135.68 N<br />
78102 $240.90 N<br />
78103 $240.90 N<br />
78104 $240.90 N<br />
78110 $363.61 N<br />
78111 $363.61 N<br />
78120 $363.61 N<br />
78121 $363.61 N<br />
78122 $363.61 N<br />
78130 $363.61 N<br />
78135 $363.61 N<br />
78140 $363.61 N<br />
78185 $240.90 N<br />
78190 $168.49 N<br />
78191 $168.49 N<br />
78195 $240.90 N<br />
78199 $240.90 N<br />
78201 $271.04 N<br />
78202 $271.04 N<br />
78205 $271.04 N<br />
78206 $271.04 N<br />
78215 $271.04 N<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
78216 $271.04 N<br />
78220 $271.04 N<br />
78223 $271.04 N<br />
78230 $230.60 N<br />
78231 $230.60 N<br />
78232 $230.60 N<br />
78258 $230.60 N<br />
78261 $230.60 N<br />
78262 $230.60 N<br />
78264 $230.60 N<br />
78270 $168.49 N<br />
78271 $168.49 N<br />
78272 $168.49 N<br />
78278 $230.60 N<br />
78282 $230.60 N<br />
78290 $230.60 N<br />
78291 $230.60 N<br />
78299 $230.60 N<br />
78300 $230.63 N<br />
78305 $230.63 N<br />
78306 $230.63 N<br />
78315 $230.63 N<br />
78320 $230.63 N<br />
78399 $230.63 N<br />
78414 $285.03 N<br />
78428 $285.03 N<br />
78445 $186.47 N<br />
78451 $722.47 N<br />
78452 $722.47 N<br />
78453 $722.47 N<br />
78454 $722.47 N<br />
78456 $186.47 N<br />
78457 $186.47 N<br />
78458 $186.47 N<br />
78459 $1,335.59 N<br />
78466 $285.03 N<br />
78468 $285.03 N<br />
78469 $285.03 N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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