2010 HCPCS Schedule - DE Medical Assistance Program

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64490 INJ PARAVERT F JNT C/T 1 LEV 2.99 1.00 64491 INJ PARAVERT F JNT C/T 2 LEV 1.7 1.00 64492 INJ PARAVERT F JNT C/T 3 LEV 1.73 1.00 64493 INJ PARAVERT F JNT L/S 1 LEV 2.52 1.00 64494 INJ PARAVERT F JNT L/S 2 LEV 1.45 1.00 64495 INJ PARAVERT F JNT L/S 3 LEV 1.48 1.00 64505 N BLOCK, SPENOPALATINE GANGL 2.18 1.00 64508 N BLOCK, CAROTID SINUS S/P 1.98 1.00 64510 N BLOCK, STELLATE GANGLION 1.82 1.00 64517 N BLOCK INJ, HYPOGAS PLXS 3.2 1.00 64520 N BLOCK, LUMBAR/THORACIC 2.05 1.00 64530 N BLOCK INJ, CELIAC PELUS 2.41 1.00 64550 APPLY NEUROSTIMULATOR 0.24 1.00 64553 IMPLANT NEUROELECTRODES 4.28 1.00 64555 IMPLANT NEUROELECTRODES 4.04 1.00 64560 IMPLANT NEUROELECTRODES 4.08 1.00 64561 IMPLANT NEUROELECTRODES 11.32 1.00 64565 IMPLANT NEUROELECTRODES 3.25 1.00 64573 IMPLANT NEUROELECTRODES 15.68 1.00 64575 IMPLANT NEUROELECTRODES 7.36 1.00 64577 IMPLANT NEUROELECTRODES 9.9 1.00 64580 IMPLANT NEUROELECTRODES 7.99 1.00 64581 IMPLANT NEUROELECTRODES 21.88 1.00 64585 REVISE/REMOVE NEUROELECTRODE 4.14 1.00 64590 INSRT/REDO PN/GASTR STIMUL 4.62 1.00 64595 REVISE/RMV PN/GASTR STIMUL 3.63 1.00 64600 INJECTION TREATMENT OF NERVE 5.76 1.00 64605 INJECTION TREATMENT OF NERVE 8.86 1.00 64610 INJECTION TREATMENT OF NERVE 12.82 1.00 64612 DESTROY NERVE, FACE MUSCLE 3.99 1.00 64613 DESTROY NERVE, NECK MUSCLE 3.73 1.00 64614 DESTROY NERVE, EXTREM MUSC 3.95 1.00 64620 INJECTION TREATMENT OF NERVE 4.48 1.00 64622 DESTR PARAVERTEBRL NERVE L/S 4.77 1.00 64623 DESTR PARAVERTEBRAL N ADD-ON 1.33 1.00 64626 DESTR PARAVERTEBRL NERVE C/T 6.41 1.00 64627 DESTR PARAVERTEBRAL N ADD-ON 1.56 1.00 64630 INJECTION TREATMENT OF NERVE 5.06 1.00 64632 N BLOCK INJ, COMMON DIGIT 1.96 1.00 64640 INJECTION TREATMENT OF NERVE 4.55 1.00 64650 CHEMODENERV ECCRINE GLANDS 1.07 1.00 64653 CHEMODENERV ECCRINE GLANDS 1.41 1.00 64680 INJECTION TREATMENT OF NERVE 4.32 1.00 64681 INJECTION TREATMENT OF NERVE 5.46 1.00 64702 REVISE FINGER/TOE NERVE 12.37 1.00 64704 REVISE HAND/FOOT NERVE 8.59 1.00 64708 REVISE ARM/LEG NERVE 12.53 1.00 64712 REVISION OF SCIATIC NERVE 14.32 1.00 64713 REVISION OF ARM NERVE(S) 20.07 1.00 64714 REVISE LOW BACK NERVE(S) 17.46 1.00 64716 REVISION OF CRANIAL NERVE 13.84 1.00 64718 REVISE ULNAR NERVE AT ELBOW 14.97 1.00 64719 REVISE ULNAR NERVE AT WRIST 10.18 1.00
64721 CARPAL TUNNEL SURGERY 10.81 1.00 64722 RELIEVE PRESSURE ON NERVE(S) 8.91 1.00 64726 RELEASE FOOT/TOE NERVE 7.39 1.00 64727 INTERNAL NERVE REVISION 4.95 1.00 64732 INCISION OF BROW NERVE 10.61 1.00 64734 INCISION OF CHEEK NERVE 10.8 1.00 64736 INCISION OF CHIN NERVE 11.3 1.00 64738 INCISION OF JAW NERVE 13.05 1.00 64740 INCISION OF TONGUE NERVE 11.97 1.00 64742 INCISION OF FACIAL NERVE 12.39 1.00 64744 INCISE NERVE, BACK OF HEAD 11.59 1.00 64746 INCISE DIAPHRAGM NERVE 12.1 1.00 64752 INCISION OF VAGUS NERVE 13.42 1.00 64760 INCISION OF VAGUS NERVE 12.95 1.00 64761 INCISION OF PELVIS NERVE 11.91 1.00 64763 INCISE HIP/THIGH NERVE 14.18 1.00 64766 INCISE HIP/THIGH NERVE 15.9 1.00 64771 SEVER CRANIAL NERVE 14.94 1.00 64772 INCISION OF SPINAL NERVE 14.92 1.00 64774 REMOVE SKIN NERVE LESION 10.79 1.00 64776 REMOVE DIGIT NERVE LESION 10.18 1.00 64778 DIGIT NERVE SURGERY ADD-ON 4.95 1.00 64782 REMOVE LIMB NERVE LESION 11.96 1.00 64783 LIMB NERVE SURGERY ADD-ON 5.79 1.00 64784 REMOVE NERVE LESION 19.04 1.00 64786 REMOVE SCIATIC NERVE LESION 28.23 1.00 64787 IMPLANT NERVE END 6.66 1.00 64788 REMOVE SKIN NERVE LESION 10.2 1.00 64790 REMOVAL OF NERVE LESION 21.68 1.00 64792 REMOVAL OF NERVE LESION 30.01 1.00 64795 BIOPSY OF NERVE 5.21 1.00 64802 REMOVE SYMPATHETIC NERVES 15.84 1.00 64804 REMOVE SYMPATHETIC NERVES 22.25 1.00 64809 REMOVE SYMPATHETIC NERVES 21.05 1.00 64818 REMOVE SYMPATHETIC NERVES 17.74 1.00 64820 REMOVE SYMPATHETIC NERVES 19.71 1.00 64821 REMOVE SYMPATHETIC NERVES 17.95 1.00 64822 REMOVE SYMPATHETIC NERVES 17.76 1.00 64823 REMOVE SYMPATHETIC NERVES 20.16 1.00 64831 REPAIR OF DIGIT NERVE 17.62 1.00 64832 REPAIR NERVE ADD-ON 9.11 1.00 64834 REPAIR OF HAND OR FOOT NERVE 19.39 1.00 64835 REPAIR OF HAND OR FOOT NERVE 21.21 1.00 64836 REPAIR OF HAND OR FOOT NERVE 21.23 1.00 64837 REPAIR NERVE ADD-ON 9.89 1.00 64840 REPAIR OF LEG NERVE 22.39 1.00 64856 REPAIR/TRANSPOSE NERVE 26.67 1.00 64857 REPAIR ARM/LEG NERVE 27.84 1.00 64858 REPAIR SCIATIC NERVE 31.43 1.00 64859 NERVE SURGERY 6.85 1.00 64861 REPAIR OF ARM NERVES 35.66 1.00 64862 REPAIR OF LOW BACK NERVES 37.74 1.00 64864 REPAIR OF FACIAL NERVE 22.92 1.00
Page 1 and 2:
Procedure Pricing Action Maximum Co
Page 3 and 4:
00402 ANESTH, SURGERY OF BREAST A $
Page 5 and 6:
00794 ANESTH, PANCREAS REMOVAL A $0
Page 7 and 8:
0111T RBC MEMBRANES FATTY ACIDS 9 $
Page 9 and 10:
01634 ANESTH, SHOULDER JOINT AMPUT
Page 11 and 12:
0195T ARTHROD PRESAC INTERBODY 9 $0
Page 13 and 14:
10141 INCISION AND DRAINAGE OF HEMA
Page 15 and 16:
11422 EXC H-F-NK-SP B9+MARG 1.1-2 3
Page 17 and 18:
12021 CLOSURE OF SPLIT WOUND 3 $148
Page 19 and 20:
15343 CULTURE SKN GRAFT ADDL 25 CM
Page 21 and 22:
15876 SUCTION ASSISTED LIPECTOMY 5
Page 23 and 24:
17313 MOHS, 1 STAGE, T/A/L 3 $587.8
Page 25 and 26:
20251 OPEN BONE BIOPSY 3 $389.97 20
Page 27 and 28:
21015 RESECT FACE TUM < 2 CM 3 $602
Page 29 and 30:
21260 REVISE EYE SOCKETS 3 $1,215.7
Page 31 and 32:
21742 REPAIR STERN/NUSS W/O SCOPE 5
Page 33 and 34:
22842 INSERT SPINE FIXATION DEVICE
Page 35 and 36:
23515 TREAT CLAVICLE FRACTURE 3 $67
Page 37 and 38:
24358 REPAIR ELBOW W/DEB, OPEN 3 $4
Page 39 and 40:
25107 REMOVE WRIST JOINT CARTILAGE
Page 41 and 42:
25570 TREATMENT OF OPEN RADIAL AND
Page 43 and 44:
26262 RESECT DISTAL FINGER TUMOR 3
Page 45 and 46:
26610 TREATMENT OF OPEN METACARPAL
Page 47 and 48:
27093 INJECTION FOR HIP X-RAY 3 $18
Page 49 and 50:
27307 INCISION OF THIGH TENDONS 3 $
Page 51 and 52:
27506 TREATMENT OF THIGH FRACTURE 3
Page 53 and 54:
27704 REMOVAL OF ANKLE IMPLANT 3 $5
Page 55 and 56:
28050 BIOPSY OF FOOT JOINT LINING 3
Page 57 and 58:
28406 TREATMENT OF HEEL FRACTURE 3
Page 59 and 60:
29280 STRAPPING OF HAND OR FINGER 3
Page 61 and 62:
29901 MCP JOINT ARTHROSCOPY, SURG 3
Page 63 and 64:
30901 CONTROL OF NOSEBLEED 3 $98.42
Page 65 and 66:
31368 PARTIAL REMOVAL OF LARYNX 3 $
Page 67 and 68:
31725 CLEARANCE OF AIRWAYS 3 $93.80
Page 69 and 70:
32655 THORACOSCOPY, SURGICAL 3 $943
Page 71 and 72:
33214 UPGRADE OF PACEMAKER SYSTEM 3
Page 73 and 74:
33471 VALVOTOMY, PULMONARY VALVE 3
Page 75 and 76:
3374F AJCC BRST CNCR STAGE 1+DOCD 9
Page 77 and 78:
34101 REMOVAL OF ARTERY CLOT 3 $626
Page 79 and 80:
35226 REPAIR BLOOD VESSEL LESION 3
Page 81 and 82:
35570 ARTERY BYPASS GRAFT 3 $1,528.
Page 83 and 84:
36261 REVISION OF INFUSION PUMP 3 $
Page 85 and 86:
36821 AV FUSION DIRECT ANY SITE 3 $
Page 87 and 88:
38240 BONE MARROW/STEM TRANSPLANT 3
Page 89 and 90:
40527 RECONSTRUCT LIP WITH FLAP 3 $
Page 91 and 92:
4149F HEP B VAC INJXN ADMIN/RECVD 9
Page 93 and 94:
42326 CREATE SALIVARY CYST DRAIN O
Page 95 and 96:
43100 EXCISION OF ESOPHAGUS LESION
Page 97 and 98:
43360 GASTROINTESTINAL REPAIR 3 $2,
Page 99 and 100:
44110 EXCISE INTESTINE LESION(S) 3
Page 101 and 102:
44615 INTESTINAL STRICTUROPLASTY 3
Page 103 and 104:
45505 REPAIR OF RECTUM 3 $533.70 45
Page 105 and 106:
46947 HEMORRHOIDOPEXY BY STAPLING 3
Page 107 and 108:
48140 PARTIAL REMOVAL OF PANCREAS 3
Page 109 and 110:
49507 PRP I/HERN INIT BLOCK >5 YR 3
Page 111 and 112:
50392 INSERT KIDNEY DRAIN 3 $187.72
Page 113 and 114:
5100F RSK FX REF W/N 24 HRS X-RAY 9
Page 115 and 116:
52305 CYSTOSCOPY AND TREATMENT 3 $2
Page 117 and 118:
53661 DILATION OF URETHRA 3 $74.40
Page 119 and 120:
54670 REPAIR TESTIS INJURY 3 $421.1
Page 121 and 122:
56342 LAPAROSCOPIC CHOLECYSTECTOMY
Page 123 and 124:
57295 REVISE VAG GRAFT VIA VAGINA 3
Page 125 and 126:
58548 LAP RADICAL HYST 3 $1,730.60
Page 127 and 128:
59160 D & C AFTER DELIVERY 3 $202.4
Page 129 and 130:
61150 PIERCE SKULL FOR DRAINAGE 3 $
Page 131 and 132:
61606 RESECT/EXCISE CRANIAL LESION
Page 133 and 134:
62225 REPLACE/IRRIGATE CATHETER 3 $
Page 135 and 136:
63198 INCISE SPINAL COLUMN & CORD 3
Page 137 and 138:
64475 INJ PARAVERTEBRAL L/S O $0.00
Page 139 and 140:
64823 REMOVE SYMPATHETIC NERVES 3 $
Page 141 and 142:
65782 OCULAR RECONST, TRANSPLANT 3
Page 143 and 144:
67120 REMOVE EYE IMPLANT MATERIAL 3
Page 145 and 146:
68020 INCISE/DRAIN EYELID LINING 3
Page 147 and 148:
69620 REPAIR OF EARDRUM 3 $661.13 6
Page 149 and 150:
70482 CT ORBIT/EAR/FOSSA W/O&W/DYE
Page 151 and 152:
72195 MRI PELVIS W/O DYE 3 $432.90
Page 153 and 154:
74181 MRI ABDOMEN W/O DYE 3 $432.28
Page 155 and 156:
75564 HT MRI W/FLO/VEL/STRS & DYE O
Page 157 and 158:
75804 LYMPHANGIOGRAPHY, EXTREMITY O
Page 159 and 160:
76013 PERCUT VERTEBROPLASTY, CT O $
Page 161 and 162:
76831 ECHO EXAM, UTERUS 3 $121.16 7
Page 163 and 164:
77371 SRS, MULTISOURCE 3 $1,188.49
Page 165 and 166:
78191 PLATELET SURVIVAL 3 $181.37 7
Page 167 and 168:
78591 VENT IMAGE, 1 BREATH, 1 PROJ
Page 169 and 170:
80049 METABOLIC PANEL, BASIC 9 $0.0
Page 171 and 172:
80439 TRH STIMULATION PANEL 3 $94.3
Page 173 and 174:
82210 BARBITURATES QUANTITATIVE AND
Page 175 and 176:
82536 CORTISOL AFTER ADRENOCORTICOT
Page 177 and 178:
82784 ASSAY, IGA/IGD/IGG/IGM EACH 3
Page 179 and 180:
83486 HYDROXYBUTYRIC DEHYDROGENASE,
Page 181 and 182:
83785 ASSAY OF MANGANESE 3 $15.28 8
Page 183 and 184:
84061 PHOSPHATASE, FORENSIC EXAM 3
Page 185 and 186:
84377 SUGARS, MULTIPLE, QUAL 3 $7.7
Page 187 and 188:
85012 BLOOD COUNT EOSINOPHIL COUNT,
Page 189 and 190:
85420 FIBRINOLYTIC PLASMINOGEN 3 $9
Page 191 and 192:
86085 BLOOD TYPING ANTIGEN SCREENIN
Page 193 and 194:
86360 T CELL, ABSOLUTE COUNT/RATIO
Page 195 and 196:
86704 HEP B CORE ANTIBODY, TOTAL 3
Page 197 and 198:
87040 BLOOD CULTURE FOR BACTERIA 3
Page 199 and 200:
87301 ADENOVIRUS AG, EIA 3 $15.45 8
Page 201 and 202:
87652 STREP A, DNA, QUANT 3 $39.83
Page 203 and 204:
88261 CHROMOSOME ANALYSIS, 5 3 $248
Page 205 and 206:
89259 CRYOPRESERVATION, SPERM 9 $0.
Page 207 and 208:
90460 REST HOME (EG, BOARDING HOME)
Page 209 and 210:
90723 DTAP-HEP B-IPV VACCINE, IM 5
Page 211 and 212:
90857 INTAC GROUP PSYTX 3 $35.98 90
Page 213 and 214:
92014 EYE EXAM & TREATMENT 3 $111.0
Page 215 and 216:
92562 LOUDNESS BALANCE TEST 3 $25.9
Page 217 and 218:
93024 CARDIAC DRUG STRESS TEST 3 $1
Page 219 and 220:
93547 COMBINED LEFT HEART CATHETERI
Page 221 and 222:
93971 EXTREMITY STUDY 3 $122.87 939
Page 223 and 224:
95031 INTRACUTANEOUS (INTRADERMAL)
Page 225 and 226:
95904 SENSE NERVE CONDUCTION TEST 3
Page 227 and 228:
96413 CHEMO, IV INFUSION, 1 HR 3 $1
Page 229 and 230:
97605 NEG PRESS WOUND TX, < 50 CM 3
Page 231 and 232:
99183 HYPERBARIC OXYGEN THERAPY 3 $
Page 233 and 234:
99336 DOMICIL/R-HOME VISIT EST PAT
Page 235 and 236:
99499 UNLISTED E&M SERVICE 5 $0.00
Page 237 and 238:
A0396 ALS ESOPHAGEAL INTUB SUPPLS 9
Page 239 and 240:
A4321 CATH THERAPEUTIC IRRIG AGENT
Page 241 and 242:
A4427 OST PCH DRAIN/BARR LK FLNG/F
Page 243 and 244:
A4635 UNDERARM CRUTCH PAD 3 $4.16 A
Page 245 and 246:
A5062 DRNBLE OSTOMY POUCH W/O BARR
Page 247 and 248:
A6246 HYDROGEL DRG >16 48 SQ IN W/B
Page 249 and 250:
A7008 DISPOSABLE NEBULIZER PREFILL
Page 251 and 252:
A9518 I-131 SODIUM IODIDE SOLUTION
Page 253 and 254:
B4150 EF COMPLET W/INTACT NUTRIENT
Page 255 and 256:
C1068 PULSAR DDD PMKR 9 $0.00 C1069
Page 257 and 258:
C1178 BUSULFAN IV, 6 MG O $0.00 C11
Page 259 and 260:
C1721 AICD, DUAL CHAMBER 9 $0.00 C1
Page 261 and 262:
C1869 GORE THYROPLASTY DEVICE 9 $0.
Page 263 and 264:
C2607 SPINECATH INTRADISCAL CATH 9
Page 265 and 266:
C4602 TENDRIL SDX, 1488K PMKR LEAD
Page 267 and 268:
C6036 BARD EPTFE: 50/75SQCM-1,2MM 9
Page 269 and 270:
C8830 GIANTURCO-ROUBIN COR SNT 9 $0
Page 271 and 272:
C9224 INJECTION, GALSULFASE O $0.00
Page 273 and 274:
C9700 WATER INDUCED THERMO 9 $0.00
Page 275 and 276:
D1320 TOBACCO COUNSELING 1 $0.00 D1
Page 277 and 278:
D2975 COPING 9 $0.00 D2980 CROWN RE
Page 279 and 280:
D5640 REPLACE PART DENTURE TEETH 1
Page 281 and 282:
D6067 IMPLANT SUPPORTED MTL CROWN 9
Page 283 and 284:
D7140 EXTRACTION ERUPTED TOOTH/EXR
Page 285 and 286:
D7877 TMJ ARTHROSCOPY DEBRIDEMENT 9
Page 287 and 288:
D9941 FABRICATION ATHLETIC GUARD 9
Page 289 and 290:
E0232 WARMING CARD FOR NWT 5 $0.00
Page 291 and 292:
E0480 PERCUSSOR ELECT/PNEUM HOME M
Page 293 and 294:
E0754 PULSEGENERATOR PT PROGRAMMER
Page 295 and 296:
E1001 WHEELCHAIR WHEEL O $0.00 E100
Page 297 and 298:
E1298 WHEELCHAIR SPEC SEAT DEPTH/W
Page 299 and 300:
E2206 COMPLETE WHEEL LOCK ASSEMBLY
Page 301 and 302:
E2599 SGD ACCESSORY NOC 6 $0.00 E26
Page 303 and 304:
G0073 INDIVIDUAL PSYCHOTHERAPY, INS
Page 305 and 306:
G0194 SENSORYTESTINGENDOSCOPICSTUD
Page 307 and 308:
G0304 PRE-OP SERVICE LVRS 1-9 DOS 9
Page 309 and 310:
G0415 OPEN TX POST PELVIC FXCTURE 9
Page 311 and 312:
G8153 PT NOT DOC FOR AB 1 HR PRIOR
Page 313 and 314:
G8268 PT NOT DOC REC CARE URIN INC
Page 315 and 316:
G8366 PT DOC TO HAVE EMPIRIC AB 9 $
Page 317 and 318:
G8473 ACE/ARB THXPY RX'D 9 $0.00 G8
Page 319 and 320:
G8573 STK/CVA CABG 9 $0.00 G8574 NO
Page 321 and 322:
G9052 ONC SURVEILLANCE FOR DISEASE
Page 323 and 324:
H0007 ALCOHOL AND/OR DRUG SERVICES
Page 325 and 326:
H5200 NURSING CARE, OTHER 9 $0.00 H
Page 327 and 328:
J0390 CHLOROQUINE INJECTION 5 $0.00
Page 329 and 330:
J1070 TESTOSTERONE CYPIONAT 100 MG
Page 331 and 332:
J1675 HISTRELIN ACETATE 6 $0.00 J16
Page 333 and 334:
J2469 PALONOSETRON HCL 3 $17.51 J24
Page 335 and 336:
J3265 INJECTION TORSEMIDE 10 MG/ML
Page 337 and 338:
J7321 HYALGAN/SUPARTZ INJ PER DOSE
Page 339 and 340:
J7672 METAPROTERENOL SULFATE .6% O
Page 341 and 342:
J9240 MEDROXYPROGESTERONE ACETATE,
Page 343 and 344:
K0064 ZERO PRESSURE TUBE FLAT FREE
Page 345 and 346:
K0169 DISPOSABLE NEBULIZER SMALL 9
Page 347 and 348:
K0276 OSTOMY FACEPLATE; CONVEX; CUS
Page 349 and 350:
K0531 HEATED HUMIDIFIER USED W PAP
Page 351 and 352:
K0663 POSITION BACK CUSH WDTH GREAT
Page 353 and 354:
L0180 CER POST COL OCC/MAN SUP ADJ
Page 355 and 356:
L0974 TLSO FULL CORSET 3 $128.76 L0
Page 357 and 358:
L1971 AFO W/ANKLE JOINT, PREFAB 6 $
Page 359 and 360:
L2750 PLATING CHROME/NICKEL PR BAR
Page 361 and 362:
L3560 O SHOE ADD HORSESHOE TOE TAP
Page 363 and 364:
L3960 SEWHO AIRPLAN DESIG ABDU POS
Page 365 and 366:
L5580 PREP AK ISCHIAL THERMO MOLD 3
Page 367 and 368:
L5781 LOWER LIMB PROS VACUUM PUMP 5
Page 369 and 370:
L6611 ADDITIONAL SWITCH, EXT POWER
Page 371 and 372:
L6873 HAND MECH INF STEEPER OR EQU
Page 373 and 374:
L8120 COMPRESSION STOCKING BK40-50
Page 375 and 376:
M0023 ROUTINE NEWBORN CARE, INHOSPI
Page 377 and 378:
P9052 PLATELETS, HLA-M, L/R, UNIT 9
Page 379 and 380:
Q0185 METABOLIC ACTIVE D/E TISSUE 9
Page 381 and 382:
Q4011 CAST SUP SHT ARM PED PLASTER
Page 383 and 384:
Q9924 EPOETIN WITH HCT = 24 O $0.00
Page 385 and 386:
S0128 INJ FOLLITROPIN BETA 75 IU 9
Page 387 and 388:
S0518 SUNGLASS FRAMES 9 $0.00 S0580
Page 389 and 390:
S2340 CHEMODENERVATION OF ABDUCTOR
Page 391 and 392:
S4028 MICROSURG EPI SPERM ASP 9 $0.
Page 393 and 394:
S8042 MRI LOW FIELD 5 $0.00 S8048 I
Page 395 and 396:
S9129 OCCUPATIONAL THERAPY, IN THE
Page 397 and 398:
S9476 VESTIBULAR REHAB PER DIEM 9 $
Page 399 and 400:
T2004 N-ET; COMMERC CARRIER PASS 9
Page 401 and 402: V2105 SPHEROCYLINDER 4.00D/4.25-6D
Page 403 and 404: V2710 GLASS/PLASTIC SLAB OFF PRISM
Page 405 and 406: V5298 HEARING AID NOC 5 $0.00 V5299
Page 407 and 408: WW524 VISION PROGRAM UNDER EPSDT-UN
Page 409 and 410: WW851 OXYGEN CONTENT, GASEOUS, PER
Page 411 and 412: YY409 DPH TUBERCULOSIS CLINIC VISIT
Page 413 and 414: YY645 HOME & COMMUNITY-BASED WAIVER
Page 415 and 416: ZR002 MCO SPECIFIC CODE: HOME INFUS
Page 417 and 418: Procedure Code Description Pricing
Page 419 and 420: D3348 RETREAT ROOT CANAL MOLAR 80 D
Page 421 and 422: D5952 PEDIATRIC SPEECH AID 80 D5953
Page 423 and 424: Procedure Description RVU RVU Coeff
Page 425 and 426: 00842 ANESTH, AMNIOCENTESIS 4 20.93
Page 427 and 428: 01656 ANESTH, ARM-LEG VESSEL SURG 1
Page 429 and 430: 33254 ABLATE ATRIA, LMTD 38.69 1.00
Page 431 and 432: 33690 REINFORCE PULMONARY ARTERY 33
Page 433 and 434: 34802 ENDOVAS AAA REPR W/2-P PART 3
Page 435 and 436: 35492 ATHERECTOMY, PERCUTANEOUS 10.
Page 437 and 438: 36012 PLACE CATHETER IN VEIN 5.16 1
Page 439 and 440: 37145 REVISION OF CIRCULATION 41.57
Page 441 and 442: 52317 REMOVE BLADDER STONE 9.47 1.0
Page 443 and 444: 57530 REMOVAL OF CERVIX 9.27 1.00 5
Page 445 and 446: 61001 REMOVE CRANIAL CAVITY FLUID 3
Page 447 and 448: 61606 RESECT/EXCISE CRANIAL LESION
Page 449 and 450: 62281 TREAT SPINAL CORD LESION 3.99
Page 451: 63307 REMOVAL OF VERTEBRAL BODY 61.
Page 455 and 456: 65400 REMOVAL OF EYE LESION 14.91 1
Page 457 and 458: 67121 REMOVE EYE IMPLANT MATERIAL 2
Page 459 and 460: 68362 REVISE EYELID LINING 16.73 1.
Page 461 and 462: 71260 CT THORAX W/DYE 8.38 1.00 712
Page 463 and 464: 73615 CONTRAST X-RAY OF ANKLE 2.66
Page 465 and 466: 75840 VEIN X-RAY, ADRENAL GLAND 6.1
Page 467 and 468: 77750 INFUSE RADIOACTIVE MATERIALS
Page 469 and 470: 78645 CSF SHUNT EVALUATION 7.94 1.0
Page 471 and 472: 93306 TTE W/DOPPLER, COMPLETE 6.58
Page 473 and 474: 88300 26 3 4.89 E0113 RR 3 4.92 K00
Page 475 and 476: 73030 26 3 9.71 73562 26 3 9.71 782
Page 477 and 478: 94375 26 3 14.59 94452 26 3 14.59 K
Page 479 and 480: 73000 TC 3 19.14 73090 TC 3 19.14 7
Page 481 and 482: 93971 26 3 23.23 E0158 UE 3 23.24 7
Page 483 and 484: 95926 26 3 27.4 78605 26 3 27.41 72
Page 485 and 486: 74022 TC 3 31.24 95873 TC 3 31.24 7
Page 487 and 488: 78761 26 3 36.51 76932 26 3 36.55 E
Page 489 and 490: 95861 TC 3 43.71 E0600 RR 3 43.8 78
Page 491 and 492: 95863 TC 3 52.41 88365 26 3 52.43 7
Page 493 and 494: 92240 26 3 59.96 74445 26 3 59.99 7
Page 495 and 496: 75685 26 3 68.23 88368 TC 3 68.23 7
Page 497 and 498: 76826 TC 3 78.11 E0900 UE 3 78.17 7
Page 499 and 500: 74283 TC 3 89.44 51726 26 3 89.49 7
Page 501 and 502: 76940 26 3 104.29 E0660 UE 3 104.3
Page 503 and 504:
K0070 UE 3 136.7 78300 TC 3 136.94
Page 505 and 506:
75605 TC 3 177.14 75650 TC 3 177.14
Page 507 and 508:
E0667 UE 3 232.3 75952 26 3 233.14
Page 509 and 510:
73202 TC 3 322.28 E0239 UE 3 322.78
Page 511 and 512:
E1086 UE 3 540.83 E1110 UE 3 541.05
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