Ambulatory Surgery Center Fee Schedule - Washington Department ...

More documents

Recommendations

Info

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 Multiple Procedure Discounting 94681 $53.37 N 94690 $37.50 N 94720 $53.37 N 94725 $53.37 N 94750 $37.50 N 94760 Packaged N 94761 Packaged N 94770 $37.50 N 94772 $164.79 N 94775 $61.87 N 94776 $61.87 N 94799 $37.50 N 95004 $27.09 N 95010 $27.09 N 95015 $27.09 N 95024 $27.09 N 95027 $27.09 N 95028 $27.09 N 95044 $27.09 N 95052 $27.09 N 95056 $91.72 N 95060 $91.72 N 95065 $27.09 N 95070 $164.79 N 95071 $164.79 N 95075 $256.59 N 95115 $23.93 N 95117 $23.93 N 95144 $34.90 N 95145 $34.90 N 95146 $70.55 N 95147 $70.55 N 95148 $34.90 N 95149 $34.90 N 95165 $23.93 N 95170 $34.90 N 95180 $91.72 N 95199 $27.09 N Procedure Code Allowed Amount Multiple Procedure Discounting 95803 By Report N 95805 $718.24 N 95806 $151.06 N 95807 $718.24 N 95808 $718.24 N 95810 $718.24 N 95811 $718.24 N 95812 $151.06 N 95813 $151.06 N 95816 $151.06 N 95819 $151.06 N 95822 $151.06 N 95824 $168.58 N 95827 $151.06 N 95829 Packaged N 95857 $75.18 N 95860 $75.18 N 95861 $75.18 N 95863 $75.18 N 95864 $75.18 N 95865 $75.18 N 95866 $75.18 N 95867 $75.18 N 95868 $75.18 N 95869 $38.55 N 95870 $38.55 N 95872 $75.18 N 95873 Packaged N 95874 Packaged N 95875 $38.55 N 95900 $38.55 N 95903 $38.55 N 95904 $38.55 N 95905 By Report N 95920 Packaged N 95921 $75.18 N 95922 $38.55 N 95923 $75.18 N CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 74
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 Multiple Procedure Discounting 95925 $168.58 N 95926 $168.58 N 95927 $168.58 N 95928 $75.18 N 95929 $75.18 N 95930 $168.58 N 95933 $38.55 N 95934 $38.55 N 95936 $38.55 N 95937 $75.18 N 95950 $718.24 N 95951 $718.24 N 95953 $718.24 N 95954 $75.18 N 95955 Packaged N 95956 $718.24 N 95957 Packaged N 95958 $151.06 N 95961 $168.58 N 95962 $168.58 N 95965 $3,329.29 N 95966 $897.26 N 95967 $897.26 N 95970 $75.18 N 95971 $100.53 N 95972 $100.53 N 95973 $100.53 N 95974 $100.53 N 95975 $100.53 N 95978 $100.53 N 95979 $100.53 N 95980 Packaged N 95981 $75.18 N 95982 $100.53 N 95990 $118.17 Y 95991 $118.17 Y 95992 $56.10 N 95999 $38.55 N Procedure Code Allowed Amount Multiple Procedure Discounting 96000 $168.58 N 96001 $168.58 N 96002 $75.18 N 96003 $38.55 N 96020 By Report N 96360 $70.55 N 96361 $23.93 N 96365 $118.17 N 96366 $23.93 N 96367 $34.90 N 96368 Packaged N 96369 $118.17 N 96370 $34.90 N 96371 $23.93 N 96372 $23.93 N 96373 $34.90 N 96374 $34.90 N 96375 $34.90 N 96376 Packaged N 96379 $23.93 N 96401 $34.90 N 96402 $34.90 N 96405 $34.90 N 96406 $118.17 N 96409 $118.17 N 96411 $70.55 N 96413 $205.03 N 96415 $34.90 N 96416 $205.03 N 96417 $70.55 N 96420 $70.55 N 96422 $205.03 N 96423 $70.55 N 96425 $205.03 N 96440 $118.17 N 96445 $205.03 N 96450 $205.03 N 96521 $118.17 N CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 75
Page 1 and 2:
Ambulatory Surgery Center Fee Sched
Page 3 and 4:
DOC ASC Fee Schedule Effective Date
Page 5 and 6:
Pain Management Procedures DOC ASC
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24: DOC ASC Fee Schedule Effective Date
Page 73: DOC ASC Fee Schedule Effective Date
show all

Ambulatory Surgery Center Fee Schedule - Washington Department ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?