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43600 BIOPSY OF STOMACH 2.76 1.00 43605 BIOPSY OF STOMACH 20.54 1.00 43610 EXCISION OF STOMACH LESION 24.29 1.00 43611 EXCISION OF STOMACH LESION 30.14 1.00 43620 REMOVAL OF STOMACH 49.32 1.00 43621 REMOVAL OF STOMACH 55.63 1.00 43622 REMOVAL OF STOMACH 56.75 1.00 43631 REMOVAL OF STOMACH, PARTIAL 36.25 1.00 43632 REMOVAL OF STOMACH, PARTIAL 48.22 1.00 43633 REMOVAL OF STOMACH, PARTIAL 46.11 1.00 43634 REMOVAL OF STOMACH, PARTIAL 50.78 1.00 43635 REMOVAL OF STOMACH, PARTIAL 2.94 1.00 43640 VAGOTOMY & PYLORUS REPAIR 28.99 1.00 43641 VAGOTOMY & PYLORUS REPAIR 29.43 1.00 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 43.06 1.00 43645 LAP GASTR BYPASS INCL SMLL I 46.16 1.00 43651 LAPAROSCOPY, VAGUS NERVE 16.15 1.00 43652 LAPAROSCOPY, VAGUS NERVE 19.17 1.00 43653 LAPAROSCOPY, GASTROSTOMY 13.71 1.00 43752 NASAL/OROGASTRIC W/STENT 1.09 1.00 43760 CHANGE GASTROSTOMY TUBE 1.38 1.00 43761 REPOSITION GASTROSTOMY TUBE 2.82 1.00 43770 LAP PLACE GASTR ADJ DEVICE 27.60 1.00 43771 LAP REVISE GASTR ADJ DEVICE 31.55 1.00 43772 LAP RMVL GASTR ADJ DEVICE 23.76 1.00 43773 LAP REPLACE GASTR ADJ DEVICE 31.55 1.00 43774 LAP RMVL GASTR ADJ ALL PARTS 23.88 1.00 43800 RECONSTRUCTION OF PYLORUS 23.03 1.00 43810 FUSION OF STOMACH AND BOWEL 24.90 1.00 43820 FUSION OF STOMACH AND BOWEL 31.68 1.00 43825 FUSION OF STOMACH AND BOWEL 32.13 1.00 43830 PLACE GASTROSTOMY TUBE 17.01 1.00 43831 PLACE GASTROSTOMY TUBE 14.13 1.00 43832 PLACE GASTROSTOMY TUBE 26.20 1.00 43840 REPAIR OF STOMACH LESION 32.22 1.00 43842 V-BAND GASTROPLASTY 30.62 1.00 43843 GASTROPLASTY W/O V-BAND 31.34 1.00 43845 GASTRIC RESTRICTIVE PROCEDURE 49.01 1.00 43846 GASTRIC BYPASS FOR OBESITY 40.43 1.00 43847 GASTRIC BYPASS INCL SMALL I 44.37 1.00 43848 REVISION GASTROPLASTY 48.01 1.00 43850 REVISE STOMACH-BOWEL FUSION 40.39 1.00 43855 REVISE STOMACH-BOWEL FUSION 42.05 1.00 43860 REVISE STOMACH-BOWEL FUSION 40.80 1.00 43865 REVISE STOMACH-BOWEL FUSION 42.55 1.00 43870 REPAIR STOMACH OPENING 17.36 1.00 43880 REPAIR STOMACH-BOWEL FISTULA 39.91 1.00 43886 REVISE GASTRIC PORT, OPEN 8.08 1.00 43887 REMOVE GASTRIC PORT, OPEN 7.66 1.00 43888 CHANGE GASTRIC PORT, OPEN 10.93 1.00
44005 FREEING OF BOWEL ADHESION 27.18 1.00 44010 INCISION OF SMALL BOWEL 21.31 1.00 44015 INSERT NEEDLE CATH BOWEL 3.75 1.00 44020 EXPLORE SMALL INTESTINE 23.97 1.00 44021 DECOMPRESS SMALL BOWEL 24.16 1.00 44025 INCISION OF LARGE BOWEL 24.37 1.00 44050 REDUCE BOWEL OBSTRUCTION 23.19 1.00 44055 CORRECT MALROTATION OF BOWEL 37.05 1.00 44100 BIOPSY OF BOWEL 2.99 1.00 44110 EXCISE INTESTINE LESION(S) 20.88 1.00 44111 EXCISION OF BOWEL LESION(S) 24.41 1.00 44120 REMOVAL OF SMALL INTESTINE 30.10 1.00 44121 REMOVAL OF SMALL INTESTINE 6.34 1.00 44125 REMOVAL OF SMALL INTESTINE 29.34 1.00 44126 ENTERECTOMY W/O TAPER, CONG 60.57 1.00 44127 ENTERECTOMY W/TAPER, CONG 70.55 1.00 44128 ENTERECTOMY CONG, ADD-ON 6.42 1.00 44130 BOWEL TO BOWEL FUSION 30.96 1.00 44133 ENTERECTOMY, LIVE DONOR 6.00 1.00 44136 INTESTINE TRANSPLANT, LIVE 6.00 1.00 44139 MOBILIZATION OF COLON 3.17 1.00 44140 PARTIAL REMOVAL OF COLON 33.53 1.00 44141 PARTIAL REMOVAL OF COLON 43.23 1.00 44143 PARTIAL REMOVAL OF COLON 41.17 1.00 44144 PARTIAL REMOVAL OF COLON 42.73 1.00 44145 PARTIAL REMOVAL OF COLON 41.89 1.00 44146 PARTIAL REMOVAL OF COLON 51.67 1.00 44147 PARTIAL REMOVAL OF COLON 45.86 1.00 44150 REMOVAL OF COLON 45.35 1.00 44151 REMOVAL OF COLON/ILEOSTOMY 51.89 1.00 44155 REMOVAL OF COLON/ILEOSTOMY 50.89 1.00 44156 REMOVAL OF COLON/ILEOSTOMY 55.94 1.00 44157 COLECTOMY W/ILEOANAL ANAST 56.52 1.00 44158 COLECTOMY W/NEO-RECTUM POUCH 57.99 1.00 44160 REMOVAL OF COLON 30.78 1.00 44180 LAP, ENTEROLYSIS 23.07 1.00 44186 LAP, JEJUNOSTOMY 16.26 1.00 44187 LAP, ILEO/JEJUNO-STOMY 27.43 1.00 44188 LAP, COLOSTOMY 30.20 1.00 44202 LAP, ENTERECTOMY 34.73 1.00 44203 LAP RESECT S/INTESTINE, ADDL 6.32 1.00 44204 LAPARO PARTIAL COLECTOMY 38.82 1.00 44205 LAP COLECTOMY PART W/ILEUM 33.94 1.00 44206 LAP PART COLECTOMY W/STOMA 43.96 1.00 44207 L COLECTOMY/COLOPROCTOSTOMY 46.26 1.00 44208 L COLECTOMY/COLOPROCTOSTOMY 50.32 1.00 44210 LAPARO TOTAL PROCTOCOLECTOMY 44.83 1.00 44211 LAP COLECTOMY W/PROCTECTOMY 55.18 1.00 44212 LAPARO TOTAL PROCTOCOLECTOMY 51.52 1.00 44213 LAP, MOBIL SPLENIC FL ADD-ON 4.98 1.00
Page 1 and 2:
Fee Schedule 2009 Procedure Code Pr
Page 3 and 4:
00404 A ANESTH, SURGERY OF BREAST 0
Page 5 and 6:
0079T 9 ENDOVASC VISC EXTNSN REPR 0
Page 7 and 8:
0115T O MED TX MNGMT 15 MIN 0.00 01
Page 9 and 10:
01654 A ANESTH, SHOULDER VESSEL SUR
Page 11 and 12:
01968 A ANES/ANALG CS DELIVER ADD-O
Page 13 and 14:
11008 3 REMOVE MESH FROM ABD WALL 2
Page 15 and 16:
11643 3 EXC FACE-MM MALIG+MARG 2.1-
Page 17 and 18:
14060 3 SKIN TISSUE REARRANGEMENT 6
Page 19 and 20:
15755 O FREE FLAP (MICROVASCULAR TR
Page 21 and 22:
16036 3 ESCHAROTOMY; ADDÏL INCISIO
Page 23 and 24:
19330 3 REMOVAL OF IMPLANT MATERIAL
Page 25 and 26:
20827 3 REPLANTATION THUMB, COMPLET
Page 27 and 28:
21179 3 RECONSTRUCT ENTIRE FOREHEAD
Page 29 and 30:
21465 3 TREAT LOWER JAW FRACTURE 83
Page 31 and 32:
22554 3 NECK SPINE FUSION 1,179.36
Page 33 and 34:
23440 3 REMOVE/TRANSPLANT TENDON 70
Page 35 and 36:
24342 3 REPAIR OF RUPTURED TENDON 7
Page 37 and 38:
25076 3 REMOVAL FOREARM LESION DEEP
Page 39 and 40:
25540 O TREATMENT OF OPEN ULNAR SHA
Page 41 and 42:
26320 3 REMOVAL OF IMPLANT FROM HAN
Page 43 and 44:
26645 3 TREAT THUMB FRACTURE 363.93
Page 45 and 46:
27111 3 TRANSFER OF ILIOPSOAS MUSCL
Page 47 and 48:
27329 3 REMOVE TUMOR, THIGH/KNEE 93
Page 49 and 50:
27524 3 TREAT KNEECAP FRACTURE 698.
Page 51 and 52:
27754 O TREATMENT OF OPEN TIBIAL SH
Page 53 and 54:
28116 3 REVISION OF FOOT 653.00 281
Page 55 and 56:
28520 O TREATMENT OF OPEN FRACTURE,
Page 57 and 58:
29799 5 CASTING/STRAPPING PROCEDURE
Page 59 and 60:
30210 3 NASAL SINUS THERAPY 130.90
Page 61 and 62:
31201 3 REMOVAL OF ETHMOID SINUS 66
Page 63 and 64:
31571 3 LARYNGOSCOP W/VC INJ + SCOP
Page 65 and 66:
3220F 9 HEP C QUANT RNA TSTNG DOCÏ
Page 67 and 68:
32998 3 PERQ RF ABLATE TX, PUL TUMO
Page 69 and 70:
33320 3 REPAIR MAJOR BLOOD VESSEL(S
Page 71 and 72:
33610 3 REPAIR BY ENLARGEMENT 1,728
Page 73 and 74:
33916 3 SURGERY OF GREAT VESSEL 1,5
Page 75 and 76:
35103 3 REPAIR ARTERY RUPTURE, GROI
Page 77 and 78:
35516 3 ARTERY BYPASS GRAFT 1,167.2
Page 79 and 80:
36000 3 PLACE NEEDLE IN VEIN 26.52
Page 81 and 82:
36585 3 REPLACE PICVAD CATH 1,160.3
Page 83 and 84:
38120 3 LAPAROSCOPY, SPLENECTOMY 92
Page 85 and 86:
4041F 9 DOC ORDER CEFAZOLIN/CEFUROX
Page 87 and 88:
4120F 9 ANTIBIOT RXÏD/GIVEN 0.00 4
Page 89 and 90:
42235 3 REPAIR PALATE 726.80 42260
Page 91 and 92:
43020 3 INCISION OF ESOPHAGUS 498.5
Page 93 and 94:
43352 3 SURGICAL OPENING, ESOPHAGUS
Page 95 and 96:
44121 3 REMOVAL OF SMALL INTESTINE
Page 97 and 98:
44650 3 REPAIR BOWEL FISTULA 1,274.
Page 99 and 100:
45805 3 REPAIR FISTULA W/COLOSTOMY
Page 101 and 102:
47133 9 REMOVAL OF DONOR LIVER 0.00
Page 103 and 104:
48510 3 DRAIN PANCREATIC PSEUDOCYST
Page 105 and 106:
49566 3 REREPAIR VENTRL HERN, BLOCK
Page 107 and 108:
50546 3 LAPAROSCOPIC NEPHRECTOMY 1,
Page 109 and 110:
51570 3 REMOVAL OF BLADDER 1,434.15
Page 111 and 112:
52354 3 CYSTOURETERO W/BIOPSY 388.0
Page 113 and 114:
54152 O CIRCUMCISION 0.00 54160 3 C
Page 115 and 116:
55530 3 REVISE SPERMATIC CORD VEINS
Page 117 and 118:
56631 3 EXTENSIVE VULVA SURGERY 1,0
Page 119 and 120:
57545 3 REMOVE CERVIX/REPAIR PELVIS
Page 121 and 122:
58800 3 DRAINAGE OF OVARIAN CYST(S)
Page 123 and 124:
59898 5 LAPARO PROC, OB CARE/DELIVE
Page 125 and 126:
61522 3 REMOVAL OF BRAIN ABSCESS 1,
Page 127 and 128:
61795 3 BRAIN SURGERY USING COMPUTE
Page 129 and 130:
63011 3 REMOVAL OF SPINAL LAMINA 97
Page 131 and 132:
63690 O ANALYSIS OF NEURORECEIVER 0
Page 133 and 134:
64727 3 INTERNAL NERVE REVISION 172
Page 135 and 136:
65265 3 REMOVE FOREIGN BODY FROM EY
Page 137 and 138:
66940 3 EXTRACTION OF LENS 643.79 6
Page 139 and 140:
67900 3 REPAIR BROW DEFECT 561.45 6
Page 141 and 142:
69399 5 OUTER EAR SURGERY PROCEDURE
Page 143 and 144:
70250 3 X-RAY EXAM OF SKULL 36.71 7
Page 145 and 146:
72126 3 CT NECK SPINE W/DYE 341.82
Page 147 and 148:
73630 3 X-RAY EXAM OF FOOT 31.45 73
Page 149 and 150:
75520 O CARDIAC RADIOGRAPHY, SELECT
Page 151 and 152:
75764 O ANGIOGRAPHY, CORONARY BYPAS
Page 153 and 154:
76000 3 FLUOROSCOPE EXAMINATION 89.
Page 155 and 156:
76825 3 ECHO EXAM OF FETAL HEART 17
Page 157 and 158:
77336 3 RADIATION PHYSICS CONSULT 8
Page 159 and 160:
78191 3 PLATELET SURVIVAL 250.20 78
Page 161 and 162:
78601 3 BRAIN IMAGE W/FLOW < 4 VIEW
Page 163 and 164:
80057 9 MALE INFERTILITY AND/OR GYN
Page 165 and 166:
81007 3 URINE SCREEN FOR BACTERIA 3
Page 167 and 168:
82250 O ASSAY BILIRUBIN 0.00 82251
Page 169 and 170:
82554 3 CREATINE, ISOFORMS 16.58 82
Page 171 and 172:
82812 O GASES, BLOOD PO2 BY MANOMET
Page 173 and 174:
83524 O INDICAN, URINE 0.00 83525 3
Page 175 and 176:
83865 O MUCOPOLYSACCHARIDES, ACID,
Page 177 and 178:
84132 3 ASSAY OF SERUM POTASSIUM 6.
Page 179 and 180:
84446 3 ASSAY OF VITAMIN E 19.81 84
Page 181 and 182:
85109 O BONE MARROW BIOPSY, NEEDLE
Page 183 and 184:
85610 3 PROTHROMBIN TIME 5.49 85611
Page 185 and 186:
86255 3 FLUORESCENT ANTIBODY, SCREE
Page 187 and 188:
86586 O SKIN TEST, UNLISTED 0.00 86
Page 189 and 190:
86800 3 THYROGLOBULIN ANTIBODY 22.2
Page 191 and 192:
87172 3 PINWORM EXAM 5.96 87174 O E
Page 193 and 194:
87500 3 VANOMYCIN, DNA, AMP PROBE 4
Page 195 and 196:
88142 3 CYTOPATH, C/V, THIN LAYER 2
Page 197 and 198:
88371 3 PROTEIN, WESTERN BLOT TISSU
Page 199 and 200:
90240 O SUBSEQUENT HOSPITAL CARE, E
Page 201 and 202:
90665 3 LYME DISEASE VACCINE, IM 53
Page 203 and 204:
90808 3 PSYTX, OFFICE, 75-80 MIN 13
Page 205 and 206:
90999 5 DIALYSIS PROCEDURE 0.00 910
Page 207 and 208:
92510 O REHAB FOR EAR IMPLANT 0.00
Page 209 and 210:
92977 3 DISSOLVE CLOT, HEART VESSEL
Page 211 and 212:
93505 3 BIOPSY OF HEART LINING 645.
Page 213 and 214:
93882 3 EXTRACRANIAL STUDY 171.47 9
Page 215 and 216:
95011 O PERCUTANEOUS TESTS (SCRATCH
Page 217 and 218:
95868 3 MUSCLE TEST CRAN NERVE BILA
Page 219 and 220:
96400 O CHEMOTHERAPY, SC/IM 0.00 96
Page 221 and 222:
97541 O TRAINING IN ACTIVITIES OF D
Page 223 and 224:
99173 3 VISUAL ACUITY SCREEN 2.66 9
Page 225 and 226:
99332 O REST HOME VISIT, EST PAT 0.
Page 227 and 228:
99479 6 IC LBW INF 1500-2500 G SUBS
Page 229 and 230:
A0396 9 ALS ESOPHAGEAL INTUB SUPPLS
Page 231 and 232:
A4324 O MALE EXT CATH W/ADH COATING
Page 233 and 234:
A4433 3 URINE OST PCH BAR W LOCK FL
Page 235 and 236:
A4645 O CONTRAST 200-299 MGS IODINE
Page 237 and 238:
A5093 3 OSTOMY ACCESSORY CONVEX INS
Page 239 and 240:
A6261 5 WOUND FILLER GEL/PASTE /OZ
Page 241 and 242:
A7028 6 REPL ORAL CUSHION COMBO MAS
Page 243 and 244:
A9536 9 TC99M DEPREOTIDE 0.00 A9537
Page 245 and 246:
B4197 9 PARENTERAL SOL 74-100 GM PR
Page 247 and 248:
C1096 9 TC 99M EXAMETAZIME, PER DOS
Page 249 and 250:
C1319 9 WALLSTENT: ENTERAL--60MM 0.
Page 251 and 252:
C1769 9 GUIDE WIRE 0.00 C1770 9 IMA
Page 253 and 254:
C1931 9 TALON DIL CATH 0.00 C1932 9
Page 255 and 256:
C2676 9 RSPONSE CV CATHETER 0.00 C2
Page 257 and 258:
C5030 9 STENT, CORONARY, S660 9/12M
Page 259 and 260:
C8102 9 SURGIVISION ESOPH COIL 0.00
Page 261 and 262:
C9001 9 LINEZOLID INJ, 200MG 0.00 C
Page 263 and 264:
C9419 O INJ CLADRIBINE, BRAND 0.00
Page 265 and 266:
D0474 1 MICRO W EXAM OF SURG MARGIN
Page 267 and 268:
D2799 1 PROVISIONAL CROWN 0.00 D281
Page 269 and 270:
D5130 1 DENTURES IMMEDIAT MAXILLARY
Page 271 and 272:
D6010 9 ODONTICS ENDOSTEAL IMPLANT
Page 273 and 274:
D6930 1 DENTAL RECEMENT BRIDGE 0.00
Page 275 and 276:
D7840 9 REMOVAL OF TMJ CONDYLE 0.00
Page 277 and 278:
D9410 9 DENTAL HOUSE CALL 0.00 D942
Page 279 and 280:
E0203 5 THERAPEUTIC LIGHTBOX TABLET
Page 281 and 282:
E0460 O NEG PRESS VENT PORTABL/STAT
Page 283 and 284:
E0748 3 ELEC OSTEOGEN STIM SPINAL 3
Page 285 and 286:
E0997 O WHEELCHAIR CASTER W/ A FORK
Page 287 and 288:
E1297 3 WHEELCHAIR SPECIAL SEAT DEP
Page 289 and 290:
E2207 6 CRUTCH AND CANE HOLDER 0.00
Page 291 and 292:
E2603 6 SKIN PROTECT WC CUS WD =22I
Page 293 and 294:
G0078 9 INDIVIDUAL PSYCHOTHERAPY, I
Page 295 and 296:
G0201 9 MODIFORTRAININGINUSEVOICEPR
Page 297 and 298:
G0313 O ESRD RELATED SVS 1 MON 2-11
Page 299 and 300:
G8012 9 PNEUM PT RECV ANTIBIOTIC 4
Page 301 and 302:
G8192 O ANTIB GIVEN PRIOR SURG INCI
Page 303 and 304:
G8294 O COPD PT INELIG SPIR RESULTS
Page 305 and 306:
G8416 9 PT INELIG FOOTWEAR EVALUATI
Page 307 and 308:
G8517 9 SCRN FALL RSK;
Page 309 and 310:
G9082 O ONC DX PROSTATE CASTRATE ME
Page 311 and 312:
H0042 9 FOS C CHLD NON-THER PER MON
Page 313 and 314:
HI100 O MCO SPECIFIC CODE: HOME INF
Page 315 and 316:
J0695 O CEFONOCID SODIUM INJECTION
Page 317 and 318:
J1452 5 INTRAOCULAR FOMIVIRSEN NA 0
Page 319 and 320:
J2050 O INJECTION, LIVER, UP TO 20
Page 321 and 322:
J2850 5 INJ SECRETIN SYNTHETIC HUMA
Page 323 and 324:
J7070 5 D5W INFUSION 0.00 J7080 O I
Page 325 and 326:
J7632 9 CROMOLYN SODIUM COMP UNIT 0
Page 327 and 328:
J9170 6 DOCETAXEL INJECTION 0.00 J9
Page 329 and 330:
K0041 3 LARGE SIZE FOOTPLATE EACH 5
Page 331 and 332:
K0141 9 ALBUTEROL SULFATE, COMPOUND
Page 333 and 334:
K0257 9 TRANSPARENT FILM, 16 SQ. IN
Page 335 and 336:
K0513 9 DEXAMETHASONE INH SOL U D 0
Page 337 and 338:
K0651 O GEN W/C CUSHION WIDTH GREAT
Page 339 and 340:
L0120 3 CERV FLEXIBLE NON-ADJUSTABL
Page 341 and 342:
L0930 O PENDULOUS ABDOMEN SUPP CUST
Page 343 and 344:
L1950 3 AFO SPIRAL MOLDED TO PT PLA
Page 345 and 346:
L2670 3 THORAC CONT PARASPINAL UPRI
Page 347 and 348:
L3570 5 O SHOE ADD INSTEP EXTENSION
Page 349 and 350:
L3964 3 SEO MOBILE ARM SUP ATT TO W
Page 351 and 352:
L5611 3 AK 4 BAR LINK W/FRIC SWING
Page 353 and 354:
L5814 3 ENDO KNEE-SHIN HYDRAL SWG P
Page 355 and 356:
L6632 3 LATEX SUSPENSION SLEEVE EAC
Page 357 and 358:
L6915 3 HAND RESTORATION REPLACMNT
Page 359 and 360:
L8330 3 TRUSS ADD TO STD PAD SCROTA
Page 361 and 362:
M0580 9 TRANSTELEPHONIC ELECTROENCE
Page 363 and 364:
Q0047 9 ANESTHESIA FOR BLEPHAROPLAS
Page 365 and 366:
Q0513 9 DISP FEE INHAL DRUGS/30 DAY
Page 367 and 368:
Q4048 9 CAST SUP SHT LEG SPLNT PED
Page 369 and 370:
S0016 O INJECTION, AMIKACIN SULFATE
Page 371 and 372:
S0201 9 PARTIAL HOSPITALIZATION SER
Page 373 and 374:
S2112 9 KNEE ARTHROSCP HARV 0.00 S2
Page 375 and 376:
S3847 9 GENE TEST TAY-SACHS 0.00 S3
Page 377 and 378:
S5181 9 HH RESIRATORY THRPY NOS DAY
Page 379 and 380:
S9015 9 AUTOMATED EEG MONITORING 0.
Page 381 and 382:
S9434 6 MOD SOLID FOOD SUPPL 0.00 S
Page 383 and 384:
T1016 9 CASE MANAGEMENT 0.00 T1017
Page 385 and 386:
TI420 O MCO SPECIFIC CODE: INTERPER
Page 387 and 388:
V2531 3 CONTACT LENS GAS PERMEABLE
Page 389 and 390:
V5258 5 HEARING AID, DIGIT, BIN, CI
Page 391 and 392:
WW508 O VISION PROGRAM UNDER EPSDT-
Page 393 and 394:
WW831 O PICC INSERTION TRAY 0.00 WW
Page 395 and 396:
YY301 O FAMILY AND CHILDREN'S SERVI
Page 397 and 398:
YY635 O HOME AND COMMUNITY-BASED SE
Page 399 and 400: ZH004 O MCO SPECIFIC CODE: HOME INF
Page 401 and 402: Procedure Code Description Pricing
Page 403 and 404: D3320 END THXPY, BICUSPID TOOTH 85.
Page 405 and 406: D5926 REPLACEMENT NASAL PROSTHESIS
Page 407 and 408: D9120 FIX PARTIAL DENTURE SECTION 8
Page 409 and 410: 00474 ANESTH, SURGERY OF RIB(S) 13.
Page 411 and 412: 01120 ANESTH, PELVIS SURGERY 6.00 1
Page 413 and 414: 01925 ANES, THER INTERVEN RAD, CAR
Page 415 and 416: 11624 EXC H-F-NK-SP MLG+MARG 3.1-4
Page 417 and 418: 15002 WOUND PREP, TRK/ARM/LEG 5.83
Page 419 and 420: 15842 FLAP FOR FACE NERVE PALSY 67.
Page 421 and 422: 19342 DELAYED BREAST PROSTHESIS 23.
Page 423 and 424: 23630 TREAT HUMERUS FRACTURE 18.66
Page 425 and 426: 24582 TREAT HUMERUS FRACTURE 20.02
Page 427 and 428: 25393 LENGTHEN RADIUS & ULNA 32.77
Page 429 and 430: 26123 RELEASE PALM CONTRACTURE 20.6
Page 431 and 432: 26568 LENGTHEN METACARPAL/FINGER 23
Page 433 and 434: 33255 ABLATE ATRIA W/O BYPASS, EXT
Page 435 and 436: 33676 CLOSE MULT VSD W/RESECTION 58
Page 437 and 438: 34451 REMOVAL OF VEIN CLOT 42.67 1.
Page 439 and 440: 35470 REPAIR ARTERIAL BLOCKAGE 12.7
Page 441 and 442: 35870 REPAIR VESSEL GRAFT DEFECT 36
Page 443 and 444: 36800 INSERTION OF CANNULA 4.35 1.0
Page 445 and 446: 40819 EXCISE LIP OR CHEEK FOLD 5.84
Page 447 and 448: 42508 PAROTID DUCT DIVERSION 18.47
Page 449: 43259 ENDOSCOPIC ULTRASOUND EXAM 7.
Page 453 and 454: 44680 SURGICAL REVISION, INTESTINE
Page 455 and 456: 46070 INCISION OF ANAL SEPTUM 5.19
Page 457 and 458: 47530 REVISE/REINSERT BILE TUBE 9.9
Page 459 and 460: 49428 LIGATION OF SHUNT 11.05 1.00
Page 461 and 462: 50405 REVISION OF KIDNEY/URETER 38.
Page 463 and 464: 51575 REMOVAL OF BLADDER & NODES 50
Page 465 and 466: 52648 LASER SURGERY OF PROSTATE 18.
Page 467 and 468: 61458 INCISE SKULL FOR BRAIN WOUND
Page 469 and 470: 61710 REVISE CIRCULATION TO HEAD 49
Page 471 and 472: 63042 LAMINOTOMY, SINGLE LUMBAR 33.
Page 473 and 474: 64413 N BLOCK INJ, CERVICAL PLEXUS
Page 475 and 476: 64795 BIOPSY OF NERVE 5.02 1.00 648
Page 477 and 478: 65815 DRAINAGE OF EYE 10.79 1.00 65
Page 479 and 480: 67320 REVISE EYE MUSCLE(S) ADD-ON 7
Page 481 and 482: 68700 REPAIR TEAR DUCTS 13.76 1.00
Page 483 and 484: 71555 MRI ANGIO CHEST W OR W/O DYE
Page 485 and 486: 73610 X-RAY EXAM OF ANKLE 0.83 1.00
Page 487 and 488: 75736 ARTERY X-RAYS, PELVIS 10.29 1
Page 489 and 490: 77417 RADIOLOGY PORT FILM(S) 0.52 1
Page 491 and 492: 78585 LUNG V/Q IMAGING 8.76 1.00 78
Page 493 and 494: 91037 ESOPH IMPED FUNCTION TEST 4.2
Page 495 and 496: 93270 ECG RECORDING 0.84 1.00 93271
Page 497 and 498: 94450 HYPOXIA RESPONSE CURVE 1.36 1
Page 499 and 500: 97018 PARAFFIN BATH THERAPY 0.20 1.
Page 501 and 502:
Fee Schedule Modifiers Procedure Co
Page 503 and 504:
70380 TC 3 29.51 70390 26 3 18.41 7
Page 505 and 506:
71250 26 3 56.10 71250 TC 3 195.86
Page 507 and 508:
72197 26 3 109.49 72197 TC 3 537.09
Page 509 and 510:
73560 26 3 8.43 73560 TC 3 21.05 73
Page 511 and 512:
74260 26 3 24.22 74260 TC 3 90.89 7
Page 513 and 514:
75716 26 3 64.45 75716 TC 3 354.45
Page 515 and 516:
75962 TC 3 399.51 75964 26 3 17.93
Page 517 and 518:
76813 TC 3 75.36 76814 26 3 46.39 7
Page 519 and 520:
77052 TC 3 12.10 77280 26 3 34.11 7
Page 521 and 522:
78130 26 3 29.94 78130 TC 3 124.93
Page 523 and 524:
78478 26 3 26.98 78478 TC 3 44.66 7
Page 525 and 526:
78811 26 3 76.48 78811 TC 3 1,383.9
Page 527 and 528:
88346 TC 3 41.95 88347 26 3 47.83 8
Page 529 and 530:
92284 26 3 11.14 92284 TC 3 56.56 9
Page 531 and 532:
93624 26 3 267.07 93631 26 3 394.51
Page 533 and 534:
94621 TC 3 91.48 94680 26 3 11.91 9
Page 535 and 536:
95950 26 3 74.43 95950 TC 3 166.17
Page 537 and 538:
E0189 UE 3 23.31 E0191 RR 3 0.97 E0
Page 539 and 540:
E0565 RR 3 49.61 E0565 UE 3 318.83
Page 541 and 542:
E0946 RR 3 56.60 E0946 UE 3 408.08
Page 543 and 544:
E1200 RR 3 73.20 E1200 UE 3 447.97
Page 545:
K0056 UE 3 70.98 K0065 RR 3 4.43 K0
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fee schedule 2009 new - DE Medical Assistance Program

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