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 />
96522 $118.17 N<br />
96542 $70.55 N<br />
96549 $23.93 N<br />
96567 $175.81 N<br />
96570 $96.83 N<br />
96571 $96.83 N<br />
96900 $33.31 N<br />
96902 Packaged N<br />
96904 Packaged N<br />
96910 $33.31 N<br />
96912 $33.31 N<br />
96913 $168.32 N<br />
96920 $96.83 Y<br />
96921 $96.83 Y<br />
96922 $96.83 Y<br />
96999 $27.87 N<br />
99143 Packaged N<br />
99144 Packaged N<br />
99145 Packaged N<br />
99148 By Report N<br />
99149 By Report N<br />
99150 By Report N<br />
99170 $8.29 Y<br />
99174 By Report N<br />
99175 Packaged N<br />
99195 $38.53 N<br />
0016T $367.54 Y<br />
0017T $367.54 Y<br />
0042T Packaged N<br />
0071T $3,329.29 N<br />
0072T $3,329.29 N<br />
0073T $392.62 N<br />
0085T Packaged N<br />
0123T $1,533.18 Y<br />
0124T $283.20 Y<br />
0159T Packaged N<br />
0173T By Report N<br />
0174T By Report N<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
0175T By Report N<br />
0183T By Report N<br />
0185T By Report N<br />
0186T By Report N<br />
0187T By Report N<br />
0190T By Report N<br />
0191T By Report N<br />
0192T By Report N<br />
0193T By Report N<br />
0197T By Report N<br />
0198T By Report N<br />
0199T By Report N<br />
0200T By Report N<br />
0201T By Report N<br />
0203T By Report N<br />
0204T By Report N<br />
0205T By Report N<br />
0206T By Report N<br />
0207T By Report N<br />
0208T By Report N<br />
0209T By Report N<br />
0210T By Report N<br />
0211T By Report N<br />
0212T By Report N<br />
0213T By Report N<br />
0214T By Report N<br />
0215T By Report N<br />
0216T By Report N<br />
0217T By Report N<br />
0218T By Report N<br />
0221T By Report N<br />
0222T By Report N<br />
A4218 Packaged N<br />
A4220 Packaged N<br />
A4230 Packaged N<br />
A4231 Packaged N<br />
A4248 Packaged N<br />
A4252 Packaged N<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
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