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 />
90647 Packaged N<br />
90648 Packaged N<br />
90650 By Report N<br />
90655 Packaged N<br />
90656 Packaged N<br />
90657 Packaged N<br />
90658 Packaged N<br />
90660 Packaged N<br />
90661 By Report N<br />
90662 By Report N<br />
90663 Bundled N<br />
90665 $0.93 N<br />
90669 Packaged N<br />
90670 By Report N<br />
90675 $173.25 N<br />
90676 $96.27 N<br />
90680 $72.37 N<br />
90681 $106.60 N<br />
90690 By Report N<br />
90691 By Report N<br />
90692 By Report N<br />
90696 Packaged N<br />
90698 Packaged N<br />
90700 Packaged N<br />
90701 Packaged N<br />
90702 Packaged N<br />
90703 Packaged N<br />
90704 Packaged N<br />
90705 Packaged N<br />
90706 Packaged N<br />
90707 Packaged N<br />
90708 Packaged N<br />
90710 Packaged N<br />
90712 Packaged N<br />
90713 Packaged N<br />
90714 Packaged N<br />
90715 Packaged N<br />
90717 By Report N<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
90718 Packaged N<br />
90719 Packaged N<br />
90720 Packaged N<br />
90721 Packaged N<br />
90725 By Report N<br />
90727 By Report N<br />
90732 Packaged N<br />
90733 $98.54 N<br />
90734 $102.46 N<br />
90735 $100.15 N<br />
90738 By Report N<br />
90740 Packaged N<br />
90743 Packaged N<br />
90744 Packaged N<br />
90746 Packaged N<br />
90747 Packaged N<br />
90749 Packaged N<br />
91000 $256.59 N<br />
91010 $256.59 N<br />
91011 $256.59 N<br />
91012 $256.59 N<br />
91020 $256.59 N<br />
91022 $256.59 N<br />
91030 $256.59 N<br />
91034 $256.59 N<br />
91035 $256.59 N<br />
91037 $256.59 N<br />
91038 $256.59 N<br />
91040 $95.52 N<br />
91052 $256.59 N<br />
91055 $95.52 N<br />
91065 $95.52 N<br />
91105 $95.52 N<br />
91110 $618.89 Y<br />
91120 $68.85 Y<br />
91122 $189.83 Y<br />
91123 Packaged N<br />
91132 $95.52 N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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