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 J1785 $4.12 N J1790 Packaged N J1800 Packaged N J1815 Packaged N J1817 $3.37 N J1830 $175.51 N J1835 Packaged N J1840 Packaged N J1850 Packaged N J1885 Packaged N J1890 Packaged N J1930 $26.62 N J1931 $25.08 N J1940 Packaged N J1945 $226.90 N J1950 $483.41 N J1953 $0.46 N J1956 Packaged N J1960 Packaged N J1980 Packaged N J1990 Packaged N J2001 Packaged N J2010 Packaged N J2020 $30.94 N J2060 Packaged N J2150 Packaged N J2170 Packaged N J2175 Packaged N J2180 Packaged N J2185 Packaged N J2210 Packaged N J2248 $1.11 N J2250 Packaged N J2260 Packaged N J2270 Packaged N J2271 Packaged N J2275 Packaged N J2278 $6.38 N Procedure Code Allowed Amount Multiple Procedure Discounting J2280 Packaged N J2300 Packaged N J2310 Packaged N J2315 $2.10 N J2320 $7.00 N J2321 $7.00 N J2322 $14.73 N J2323 $8.08 N J2325 $37.25 N J2353 $106.19 N J2354 Packaged N J2355 $241.17 N J2357 $18.86 N J2360 Packaged N J2370 Packaged N J2400 Packaged N J2405 Packaged N J2410 Packaged N J2425 $11.11 N J2430 $19.98 N J2440 Packaged N J2460 Packaged N J2469 $17.18 N J2501 Packaged N J2503 $1,014.11 N J2504 $242.67 N J2505 $2,320.08 N J2510 Packaged N J2513 $158.77 N J2515 Packaged N J2540 Packaged N J2543 Packaged N J2550 Packaged N J2560 Packaged N J2562 $268.72 N J2590 Packaged N J2597 Packaged N J2650 Packaged N CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 86
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 J2670 Packaged N J2675 Packaged N J2680 Packaged N J2690 Packaged N J2700 Packaged N J2710 Packaged N J2720 Packaged N J2724 $11.96 N J2725 Packaged N J2730 $89.08 N J2760 Packaged N J2765 Packaged N J2770 $144.34 N J2778 $397.01 N J2780 Packaged N J2783 $169.23 N J2785 $50.85 N J2788 $25.47 N J2790 $84.51 N J2791 $5.12 N J2792 $18.22 N J2793 $23.64 N J2794 $4.94 N J2795 Packaged N J2796 $43.60 N J2800 Packaged N J2805 Packaged N J2810 Packaged N J2820 $23.81 N J2850 $19.93 N J2910 Packaged N J2916 Packaged N J2920 Packaged N J2930 Packaged N J2940 $4.89 N J2941 $54.38 N J2950 Packaged N J2993 $1,258.72 N Procedure Code Allowed Amount Multiple Procedure Discounting J2995 $78.00 N J2997 $36.23 N J3000 Packaged N J3010 Packaged N J3030 $42.72 N J3070 Packaged N J3101 $41.84 N J3105 Packaged N J3120 Packaged N J3130 Packaged N J3140 Packaged N J3150 Packaged N J3230 Packaged N J3240 $1,043.80 N J3243 $1.15 N J3246 $7.74 N J3250 Packaged N J3260 Packaged N J3265 Packaged N J3280 Packaged N J3285 $54.83 N J3300 $3.16 N J3301 Packaged N J3302 Packaged N J3303 Packaged N J3305 $146.89 N J3310 Packaged N J3315 $153.42 N J3320 Packaged N J3350 Packaged N J3355 $57.43 N J3360 Packaged N J3364 Packaged N J3365 $449.09 N J3370 Packaged N J3396 $9.31 N J3400 Packaged N J3410 Packaged N CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply Page | 87
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