Ambulatory Surgery Center Fee Schedule - Washington Department ...

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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 J0585 $5.40 N J0586 $7.93 N J0587 $10.38 N J0592 Packaged N J0594 $14.18 N J0595 Packaged N J0598 $41.40 N J0600 $78.86 N J0610 Packaged N J0620 Packaged N J0630 $48.34 N J0636 Packaged N J0637 $11.54 N J0640 Packaged N J0641 $1.36 N J0670 Packaged N J0690 Packaged N J0692 Packaged N J0694 Packaged N J0696 Packaged N J0697 Packaged N J0698 Packaged N J0702 Packaged N J0704 Packaged N J0706 Packaged N J0710 Packaged N J0713 Packaged N J0715 Packaged N J0718 $3.72 N J0720 Packaged N J0725 Packaged N J0735 $110.46 N J0740 $746.87 N J0743 Packaged N J0744 Packaged N J0745 Packaged N J0760 Packaged N J0770 Packaged N Procedure Code Allowed Amount Multiple Procedure Discounting J0780 Packaged N J0795 $4.22 N J0800 $2,394.31 N J0833 $64.19 N J0834 $89.48 N J0850 $862.24 N J0878 $0.42 N J0881 $2.78 N J0885 $9.36 N J0894 $28.68 N J0895 Packaged N J0900 Packaged N J0945 $9.24 N J0970 Packaged N J1000 Packaged N J1020 Packaged N J1030 Packaged N J1040 Packaged N J1051 Packaged N J1060 Packaged N J1070 Packaged N J1080 Packaged N J1094 Packaged N J1100 Packaged N J1110 Packaged N J1120 Packaged N J1160 Packaged N J1162 $467.59 N J1165 Packaged N J1170 Packaged N J1180 Packaged N J1190 $367.10 N J1200 Packaged N J1205 $304.91 N J1212 $68.40 N J1230 Packaged N J1240 Packaged N J1245 Packaged N CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 84
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 J1250 Packaged N J1260 Packaged N J1265 Packaged N J1267 $0.55 N J1270 Packaged N J1300 $177.56 N J1320 Packaged N J1324 $0.48 N J1325 Packaged N J1327 $18.50 N J1330 Packaged N J1335 Packaged N J1364 Packaged N J1380 Packaged N J1390 Packaged N J1410 $87.05 N J1430 $147.14 N J1435 Packaged N J1436 $25.02 N J1438 $188.41 N J1440 $215.57 N J1441 $336.26 N J1450 Packaged N J1451 $7.56 N J1452 Packaged N J1453 $1.57 N J1455 Packaged N J1458 $334.14 N J1459 $35.14 N J1460 $15.85 N J1470 $31.70 N J1480 $47.53 N J1490 $63.39 N J1500 $79.24 N J1510 $95.12 N J1520 $110.86 N J1530 $126.78 N J1540 $158.48 N Procedure Code Allowed Amount Multiple Procedure Discounting J1550 $158.48 N J1560 $158.48 N J1561 $36.91 N J1562 $7.04 N J1566 $29.90 N J1568 $37.00 N J1569 $37.81 N J1570 Packaged N J1571 $50.22 N J1572 $36.42 N J1573 $50.22 N J1580 Packaged N J1590 Packaged N J1595 $81.34 N J1600 Packaged N J1610 $82.64 N J1620 $32.12 N J1626 Packaged N J1630 Packaged N J1631 Packaged N J1640 $7.98 N J1642 Packaged N J1644 Packaged N J1645 Packaged N J1650 Packaged N J1652 $6.04 N J1655 Packaged N J1670 $207.82 N J1680 $0.24 N J1700 Packaged N J1710 Packaged N J1720 Packaged N J1730 $112.16 N J1740 $138.94 N J1742 $395.62 N J1743 $446.44 N J1745 $57.56 N J1756 $0.37 N CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 85
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