Ambulatory Surgery Center Fee Schedule - Washington Department ...
Ambulatory Surgery Center Fee Schedule - Washington Department ...
Ambulatory Surgery Center Fee Schedule - Washington Department ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
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 />
93291 $22.03 N<br />
93292 $35.69 N<br />
93293 $22.03 N<br />
93294 $22.03 N<br />
93295 $35.69 N<br />
93296 $35.69 N<br />
93297 $35.69 N<br />
93298 $22.03 N<br />
93299 $22.03 N<br />
93303 $555.57 N<br />
93304 $420.35 N<br />
93306 $420.35 N<br />
93307 $246.44 N<br />
93308 $246.44 N<br />
93312 $555.57 N<br />
93313 $420.35 N<br />
93314 Packaged N<br />
93315 $555.57 N<br />
93316 $555.57 N<br />
93317 Packaged N<br />
93318 $555.57 N<br />
93320 Packaged N<br />
93321 Packaged N<br />
93325 Packaged N<br />
93350 $420.35 N<br />
93351 $555.57 N<br />
93352 $58.30 N<br />
93501 $2,501.25 Y<br />
93503 $1,121.11 Y<br />
93505 $1,121.11 Y<br />
93508 $2,501.25 Y<br />
93510 $2,501.25 Y<br />
93511 $2,501.25 Y<br />
93514 $2,501.25 Y<br />
93524 $2,501.25 Y<br />
93526 $2,501.25 Y<br />
93527 $2,501.25 Y<br />
93528 $2,501.25 Y<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
93529 $2,501.25 Y<br />
93530 $2,501.25 Y<br />
93531 $2,501.25 Y<br />
93532 $2,501.25 Y<br />
93533 $2,501.25 Y<br />
93539 Packaged N<br />
93540 Packaged N<br />
93541 Packaged N<br />
93542 Packaged N<br />
93543 Packaged N<br />
93544 Packaged N<br />
93545 Packaged N<br />
93555 Packaged N<br />
93556 Packaged N<br />
93561 Packaged N<br />
93562 Packaged N<br />
93571 Packaged N<br />
93572 Packaged N<br />
93580 $9,259.40 Y<br />
93581 $9,259.40 Y<br />
93600 $679.25 N<br />
93602 $679.25 N<br />
93603 $679.25 N<br />
93609 Packaged N<br />
93610 $679.25 N<br />
93612 $679.25 N<br />
93613 Packaged N<br />
93615 $679.25 N<br />
93616 $679.25 N<br />
93618 $679.25 N<br />
93621 Packaged N<br />
93622 Packaged N<br />
93623 Packaged N<br />
93624 $3,291.54 Y<br />
93631 Packaged N<br />
93640 Packaged N<br />
93641 Packaged N<br />
93642 $679.25 N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
Page | 72