Ambulatory Surgery Center Fee Schedule - Washington Department ...
Ambulatory Surgery Center Fee Schedule - Washington Department ...
Ambulatory Surgery Center Fee Schedule - Washington Department ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
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 />
13101 $278.88 Y<br />
13102 $278.88 Y<br />
13120 $197.96 Y<br />
13121 $197.96 Y<br />
13122 $85.08 Y<br />
13131 $197.96 Y<br />
13132 $278.88 Y<br />
13133 $197.96 Y<br />
13150 $278.88 Y<br />
13151 $278.88 Y<br />
13152 $278.88 Y<br />
13153 $197.96 Y<br />
13160 $1,503.62 Y<br />
14000 $1,008.68 Y<br />
14001 $1,008.68 Y<br />
14020 $1,008.68 Y<br />
14021 $1,008.68 Y<br />
14040 $1,008.68 Y<br />
14041 $1,008.68 Y<br />
14060 $1,008.68 Y<br />
14061 $1,008.68 Y<br />
14301 $1,503.62 Y<br />
14302 $1,503.62 Y<br />
14350 $1,503.62 Y<br />
15002 $278.88 Y<br />
15003 $278.88 Y<br />
15004 $278.88 Y<br />
15005 $278.88 Y<br />
15040 $197.96 Y<br />
15050 $278.88 Y<br />
15100 $1,503.62 Y<br />
15101 $1,503.62 Y<br />
15110 $278.88 Y<br />
15111 $278.88 Y<br />
15115 $278.88 Y<br />
15116 $278.88 Y<br />
15120 $1,503.62 Y<br />
15121 $1,503.62 Y<br />
Procedure<br />
Code<br />
Allowed<br />
Amount<br />
Multiple<br />
Procedure<br />
Discounting<br />
15130 $1,008.68 Y<br />
15131 $1,008.68 Y<br />
15135 $1,008.68 Y<br />
15136 $1,008.68 Y<br />
15150 $278.88 Y<br />
15151 $278.88 Y<br />
15152 $278.88 Y<br />
15155 $278.88 Y<br />
15156 $278.88 Y<br />
15157 $278.88 Y<br />
15170 $278.88 Y<br />
15171 $197.96 Y<br />
15175 $278.88 Y<br />
15176 $278.88 Y<br />
15200 $1,008.68 Y<br />
15201 $1,008.68 Y<br />
15220 $1,008.68 Y<br />
15221 $278.88 Y<br />
15240 $1,008.68 Y<br />
15241 $278.88 Y<br />
15260 $1,008.68 Y<br />
15261 $1,008.68 Y<br />
15300 $278.88 Y<br />
15301 $278.88 Y<br />
15320 $278.88 Y<br />
15321 $278.88 Y<br />
15330 $278.88 Y<br />
15331 $278.88 Y<br />
15335 $278.88 Y<br />
15336 $278.88 Y<br />
15340 $197.96 Y<br />
15341 $197.96 Y<br />
15360 $197.96 Y<br />
15361 $197.96 Y<br />
15365 $197.96 Y<br />
15366 $197.96 Y<br />
15400 $278.88 Y<br />
15401 $278.88 Y<br />
CPT® codes only are copyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply<br />
Page | 9