Ambulatory Surgery Center Fee Schedule - Washington Department ...

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Gastrointestinal Procedures DOC ASC Fee Schedule Effective Dates of Service 7/1/2012 thru 8/31/2012 Refer to the 2012 CPT® and HCPCS coding books for complete code descriptions Procedure Code Allowed Amount Procedure Code Allowed Amount Procedure Code Allowed Amount 43200 $843.71 44388 $878.33 46040 $2,312.32 43202 $843.71 44389 $878.33 46060 $2,312.32 43235 $843.71 45171 $1,361.52 46080 $2,312.32 43239 $843.71 45172 $2,312.32 46200 $2,312.32 43243 $843.71 45331 $557.06 46220 $1,361.52 43245 $843.71 45333 $891.83 46230 $2,312.32 43247 $843.71 45338 $891.83 46250 $2,312.32 43248 $843.71 45339 $891.83 46260 $2,312.32 43249 $843.71 45355 $878.33 46270 $2,312.32 43250 $843.71 45378 $878.33 46280 $2,312.32 43251 $843.71 45380 $878.33 46615 $2,201.43 43255 $843.71 45381 $878.33 46707 $3,104.39 43273 $2,181.20 45382 $878.33 46924 $2,051.38 43450 $575.15 45383 $878.33 46930 $517.54 44360 $950.22 45384 $878.33 46947 $3,104.39 44361 $950.22 45385 $878.33 44377 $950.22 45560 $3,104.39 44386 $878.33 45990 $2,312.32 CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 6
DOC ASC Fee Schedule Effective Dates of Service 7/1/2012 thru 8/31/2012 Refer to the 2012 CPT® and HCPCS coding books for complete code descriptions 2011 ASC Fee Schedule Procedure Code Allowed Amount Multiple Procedure Discounting 10021 $94.94 Y 10022 $288.96 Y 10040 $55.22 Y 10060 $91.46 Y 10061 $91.46 Y 10080 $91.46 Y 10081 $793.02 Y 10120 $175.81 Y 10121 $1,099.36 Y 10140 $793.02 Y 10160 $91.46 Y 10180 $1,219.29 Y 11000 $96.83 Y 11001 $55.22 Y 11010 $274.10 Y 11011 $274.10 Y 11012 $274.10 Y 11040 $96.83 Y 11041 $96.83 Y 11042 $175.81 Y 11043 $175.81 Y 11044 $515.38 Y 11055 $55.22 Y 11056 $55.22 Y 11057 $55.22 Y 11100 $96.83 Y 11101 $55.22 Y 11200 $55.22 Y 11201 $55.22 Y 11300 $55.22 Y 11301 $55.22 Y 11302 $55.22 Y 11303 $96.83 Y 11305 $55.22 Y 11306 $55.22 Y 11307 $55.22 Y 11308 $55.22 Y Procedure Code Allowed Amount Multiple Procedure Discounting 11310 $55.22 Y 11311 $55.22 Y 11312 $55.22 Y 11313 $55.22 Y 11400 $274.10 Y 11401 $274.10 Y 11402 $274.10 Y 11403 $515.38 Y 11404 $1,099.36 Y 11406 $1,099.36 Y 11420 $515.38 Y 11421 $515.38 Y 11422 $515.38 Y 11423 $1,099.36 Y 11424 $1,099.36 Y 11426 $1,469.46 Y 11440 $274.10 Y 11441 $274.10 Y 11442 $515.38 Y 11443 $515.38 Y 11444 $515.38 Y 11446 $1,469.46 Y 11450 $1,469.46 Y 11451 $1,469.46 Y 11462 $1,469.46 Y 11463 $1,469.46 Y 11470 $1,469.46 Y 11471 $1,469.46 Y 11600 $515.38 Y 11601 $274.10 Y 11602 $274.10 Y 11603 $515.38 Y 11604 $515.38 Y 11606 $1,099.36 Y 11620 $515.38 Y 11621 $274.10 Y 11622 $515.38 Y CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 7
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