CMS Manual System Department of Health & Human Services (DHHS)

Pub. 100-20 One Time Notification Centers for Medicare & Medicaid Services (CMS)

Transmittal 124 Date: October 29, 2004

CHANGE REQUEST 3551 SUBJECT: Common Working File (CWF) Duplicate Claim Edit for Referred

Clinical Diagnostic and Purchased Diagnostic Services I. SUMMARY OF CHANGES: This instruction implements a new duplicate

claim edit in the Common Working File to identify and reject claims for referred clinical diagnostic laboratory services and purchased diagnostic services when the same services are billed to more than one carrier.

NEW/REVISED MATERIAL - EFFECTIVE DATE*: April 1, 2005 IMPLEMENTATION DATE: April 4, 2005 Disclaimer for manual changes only: The revision date and transmittal number apply to the red italicized material only. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual not updated.) (R = REVISED, N = NEW, D = DELETED) – (Only One Per Row.) R/N/D CHAPTER/SECTION/SUBSECTION/TITLE N/A

III. FUNDING: Medicare contractors shall implement these instructions within their current operating budgets. IV. ATTACHMENTS: Business Requirements Manual Instruction Confidential Requirements X One-Time Notification Recurring Update Notification *Unless otherwise specified, the effective date is the date of service.

Attachment – ONE TIME NOTIFICATION Pub. 100-20 Transmittal: 124 Date: October 29, 2004 Change Request 3551 SUBJECT: Common Working File (CWF) Duplicate Claim Edit for Referred Clinical Diagnostic

and Purchased Diagnostic Services

I. GENERAL INFORMATION

A. Background: Medicare recognizes that a clinical diagnostic laboratory may refer a specimen to another clinical diagnostic laboratory for testing. Generally, Medicare requires that the entity that furnishes the service, in this case the clinical diagnostic laboratory that performs the test, bill for the service. However, §1833(h)(5)(A)(ii) of the Social Security Act permits, under certain conditions, a clinical diagnostic laboratory to bill for a clinical diagnostic laboratory fee schedule service that was performed by another clinical diagnostic laboratory. Prior to July 1, 2004, many carriers were unable to process a claim for a referred clinical diagnostic laboratory test when the test was performed in another jurisdiction because they did not possess the fee schedule of that other jurisdiction. Moreover, CMS has not previously required carriers to adjudicate a claim for a referred clinical diagnostic laboratory service furnished in another jurisdiction. Thus, some carriers previously paid for referred clinical diagnostic services performed outside of their jurisdiction while others did not. In addition, some carriers have permitted reference laboratories located outside of their jurisdiction to enroll by issuing “reference-use-only” Provider Identification Numbers (PINs) for the reference laboratories to use when billing for a referred clinical diagnostic service that was performed within their jurisdiction. Effective for claims with dates of service on or after July 1, 2004, CMS has implemented a national clinical laboratory fee schedule and instructions to make fees for all localities within the United States available to their carriers for processing of diagnostic laboratory claims, including claims for referred clinical diagnostic services performed outside of their jurisdiction. CMS billing guidelines for referred clinical diagnostic services specify that: 1) an independent clinical laboratory may bill only the carrier in which it is enrolled by reason of having a physical presence; 2) an independent clinical laboratory may not enroll with a carrier as a “reference-use-only” laboratory; 3) every carrier must adjudicate a claim for a referred clinical diagnostic service, regardless of where the service was performed, if the claim is submitted by a laboratory located in its jurisdiction; 4) every carrier must pay for a referred clinical diagnostic service on the basis of the fee schedule in effect in the jurisdiction where the test was performed; 5) every carrier must cancel all existing “reference-use-only” enrollments and “reference-use-only” PINs and refrain from making any further “reference-use-only” enrollments; 6) the referring laboratory must identify a referred service as such on the claim and identify the reference laboratory performing such test; and 7) both the referring laboratory and the reference laboratory must be enrolled in Medicare. In addition to allowing clinical diagnostic laboratories to bill for referred clinical diagnostic services, Medicare allows laboratories, physicians, and independent diagnostic testing facilities (IDTFs) to bill for

purchased tests and interpretations, provided that they perform one component of the test. Under the current carrier jurisdictional pricing rules, these physicians/suppliers must bill the purchased test or interpretation to the carrier that has jurisdiction over the geographic location where the test or service was performed (i.e., the carrier that would be billed by the supplier if the test component or interpretation had not been purchased). Since the implementation of carrier jurisdictional pricing edits on April 1, 2004, CMS has received reports that, due to current enrollment restrictions, some physicians/suppliers purchasing diagnostic tests/interpretations are unable to receive reimbursement for these services when the services are performed outside of their local carrier’s jurisdiction. To address this problem, CMS is implementing a national abstract file of the Medicare Physician Fee Schedule (MPFS) containing Healthcare Common Procedural Coding System (HCPCS) codes billable as a purchased diagnostic test/interpretation, for every locality throughout the country. Effective with the implementation of the abstract file in April 2005, carrier jurisdiction rules for purchased diagnostic tests/interpretations will be changed to allow suppliers to bill their local carriers for these services and receive the correct payment amount, regardless of the location where the service was performed. Although CMS has issued billing guidelines for both referred clinical diagnostic laboratory services and purchased diagnostic services specifying that these services must be billed to the local carrier with the implementation of the respective fee schedules, either the physician/supplier performing the service, or the purchasing/referring physician/supplier (as applicable) may bill for the service. To address a potential program vulnerability, CMS is implementing a new Common Working File (CWF) edit for both referred clinical diagnostic laboratory services and purchased diagnostic services to identify as duplicate claims those claims that are submitted for the same service, provided to the same beneficiary, and provided on the same date, when these claims are submitted to more than one carrier. B. Policy: Effective April 1, 2005, the CWF will implement a new edit to check for duplicate claims for referred clinical diagnostic laboratory and purchased diagnostic services submitted by physicians/suppliers to more than one carrier. This new edit will be constructed to identify as duplicates of previously paid claims those claims submitted for referred clinical diagnostic/purchased diagnostic services when all of the data matches on the following claim fields and the claims contain different carrier numbers:

a. Beneficiary Name b. Beneficiary Health Insurance Claim Number (HICN) c. Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System

(HCPCS) Code d. Date of Service e. CPT/HCPCS Code Modifier

NOTE: Referred clinical laboratory services are identified for processing purposes by the presence of a “90” modifier. When performing the data matching, the CWF duplicate claim edit for referred clinical diagnostic/purchased diagnostic services will not include the “90” modifier on referred laboratory claims in the matching criteria, but will perform matching on all other criteria specified above.

The CWF duplicate claim edit will only apply to claims containing a CPT code that is included on the clinical laboratory fee schedule (i.e., CPT codes in the range from 80000 through 89999), or a HCPCS code that is included on the Abstract File for Purchased Diagnostic Tests/Interpretations to be implemented in April 2005. The attached file contains a preliminary list of HCPCS codes to be included in the upcoming release of the national abstract file. In December 2004, CMS will issue a test abstract file for use in planning the 2005 national abstract file implementation. A final list of HCPCS codes will be provided to the CWF maintainer at that time, for use in implementing the business requirements specified in this instruction. Effective with the implementation of this new edit, the CWF will reject a claim for a referred clinical diagnostic/purchased diagnostic service when it identifies the claim as a duplicate of a previously paid claim, using the above matching criteria. The edit will identify as duplicate claims only those claims that match on all of the above data elements when the claims contain different carrier numbers. Claims with matching data elements but the same carrier number will not be subject to this edit. The existing edits for identifying suspected duplicate claims will continue to apply. Carriers should deny the appropriate claim lines when claims are rejected by the CWF duplicate claim edit, and should use the most appropriate duplicate claim messages on the remittance advice notices and Medicare summary notices generated for these claims. When the CWF rejects a claim as a duplicate of a previously paid claim, it will return with a trailer notice containing the carrier number and internal control number of the previously paid claim. The carrier should retain this information for later use in an appeal of the claim denial. If the carrier determines that a referred clinical diagnostic/purchased diagnostic claim rejected by CWF is not a duplicate of another claim submitted for the same service, and that the service is allowable, the carrier should use the CWF override code to allow payment. C. Provider Education: A Medlearn Matters provider education article related to this instruction will be available at www.cms.hhs.gov/medlearn/matters shortly after the CR is released. You will receive notification of the article release via the established "medlearn matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article must be included in your next regularly scheduled bulletin. Contractors are free to supplement Medlearn Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.

II. BUSINESS REQUIREMENTS “Shall" denotes a mandatory requirement "Should" denotes an optional requirement Requirement

Number Requirements Responsibility (place an “X” in the

columns that apply) Shared System

Maintainers

FI

RH

HI

Car

rier

DM

ERC

FISS

MC

S

VM

S

CW

F

Other

Requirement Number

Requirements Responsibility (place an “X” in the columns that apply)

Shared System Maintainers

FI

RH

HI

Car

rier

DM

ERC

FISS

MC

S

VM

S

CW

F

Other

3551.1 Effective for claims with dates of service on or after April 1, 2005, the CWF shall implement a new edit to identify as duplicates of previously paid claims those claims submitted for referred clinical diagnostic/purchased diagnostic services when all of the data matches on the following claim fields and the claims contain different carrier numbers:

a. Beneficiary Name b. Beneficiary HICN c. CPT/HCPCS Code d. Date of Service e. CPT/HCPCS Code Modifier, excluding

modifier “90” for laboratory claims. (NOTE: When performing the data matching, the CWF duplicate claim edit for referred clinical diagnostic/purchased diagnostic services will not include the “90” modifier on referred laboratory claims in the matching criteria, but will perform matching on all other criteria specified above.) The CWF duplicate claim edit shall only apply to claims containing a CPT code that is included on the clinical laboratory fee schedule (i.e., CPT codes in the range from 80000 through 89999), or a HCPCS code that is included on the Abstract File for Purchased Diagnostic Tests/Interpretations to be implemented in April 2005. (NOTE: The attached file contains a preliminary list of HCPCS codes to be included in the upcoming release of the abstract file. In December 2004, CMS will issue a test abstract file for use in planning the 2005 national abstract file implementation. A final list of HCPCS codes will be provided to the CWF maintainer at that time, for use in implementing the business requirements specified in this instruction.) X

Requirement Number

Requirements Responsibility (place an “X” in the columns that apply)

Shared System Maintainers

FI

RH

HI

Car

rier

DM

ERC

FISS

MC

S

VM

S

CW

F

Other

3551.2 When the CWF identifies a claim for a referred clinical diagnostic/purchased diagnostic service as a duplicate of a previously paid claim for the same service, the CWF shall reject the claim. X

3551.3 When a claim for a referred clinical diagnostic/purchased diagnostic service is rejected as a duplicate claim, the CWF shall return the carrier number and internal control number of the previously paid claim in a trailer record. X

3551.4 Carriers shall retain the CWF trailer record information of referred clinical diagnostic/purchased diagnostic service claims that are rejected by the duplicate claim edit, for use in appeals. X

X

X

3551.5 When a claim for a referred clinical diagnostic/purchased diagnostic service is rejected as a duplicate claim, the carrier shall deny the appropriate claim line(s). X

3551.6 Carriers shall use the most appropriate duplicate claim messages on the remittance advice notices and Medicare summary notices that are generated for denied referred clinical diagnostic/purchased diagnostic service claims. X

3551.7 If the carrier determines that a referred clinical diagnostic/purchased diagnostic service claim that has been rejected by CWF is not a duplicate of another claim submitted for the same service, and that the service is allowable, the carrier shall use the CWF override code to allow payment. (NOTE: Beginning on July 1, 2005, carriers must use the new CWF override process.) X

X

X

X

III. SUPPORTING INFORMATION AND POSSIBLE DESIGN CONSIDERATIONS

A. Other Instructions: N/A X-Ref Requirement # Instructions

B. Design Considerations: X-Ref Requirement # Recommendation for Medicare System Requirements 3551.3 The CWF shall modify an existing trailer record to contain the

information specified in this instruction. 3551.7 The CWF shall create a new value for an existing override

code for use prior to July 1, 2005. C. Interfaces: N/A D. Contractor Financial Reporting /Workload Impact: N/A E. Dependencies: N/A F. Testing Considerations: N/A IV. SCHEDULE, CONTACTS, AND FUNDING Effective Date*: April 1, 2005 Implementation Date: April 4, 2005 Pre-Implementation Contact(s): Susan Webster, (410) 786-3384 Post-Implementation Contact(s): Susan Webster, (410) 786-3384

Medicare contractors shall implement these instructions within their current operating budgets.

*Unless otherwise specified, the effective date is the date of service.

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG1 70336 Magnetic image, jaw joint 1 GLOB TC PC I2D ADVANCED IMAGING2 70450 Ct head/brain w/o dye 1 GLOB TC PC I2A ADVANCED IMAGING3 70460 Ct head/brain w/dye 1 GLOB TC PC I2A ADVANCED IMAGING4 70470 Ct head/brain w/o & w/ dye 1 GLOB TC PC I2A ADVANCED IMAGING5 70480 Ct orbit/ear/fossa w/o dye 1 GLOB TC PC I2A ADVANCED IMAGING6 70481 Ct orbit/ear/fossa w/dye 1 GLOB TC PC I2A ADVANCED IMAGING7 70482 Ct orbit/ear/fossa w/o&w dye 1 GLOB TC PC I2A ADVANCED IMAGING8 70486 Ct maxillofacial w/o dye 1 GLOB TC PC I2A ADVANCED IMAGING9 70487 Ct maxillofacial w/dye 1 GLOB TC PC I2A ADVANCED IMAGING10 70488 Ct maxillofacial w/o & w dye 1 GLOB TC PC I2A ADVANCED IMAGING11 70490 Ct soft tissue neck w/o dye 1 GLOB TC PC I2A ADVANCED IMAGING12 70491 Ct soft tissue neck w/dye 1 GLOB TC PC I2A ADVANCED IMAGING13 70492 Ct sft tsue nck w/o & w/dye 1 GLOB TC PC I2A ADVANCED IMAGING14 70496 Ct angiography, head 1 GLOB TC PC I2A ADVANCED IMAGING15 70498 Ct angiography, neck 1 GLOB TC PC I2A ADVANCED IMAGING16 70540 Mri orbit/face/neck w/o dye 1 GLOB TC PC I2C ADVANCED IMAGING17 70542 Mri orbit/face/neck w/dye 1 GLOB TC PC I2C ADVANCED IMAGING18 70543 Mri orbt/fac/nck w/o & w dye 1 GLOB TC PC I2C ADVANCED IMAGING19 70544 Mr angiography head w/o dye 1 GLOB TC PC I2C ADVANCED IMAGING20 70545 Mr angiography head w/dye 1 GLOB TC PC I2C ADVANCED IMAGING21 70546 Mr angiograph head w/o&w dye 1 GLOB TC PC I2C ADVANCED IMAGING22 70547 Mr angiography neck w/o dye 1 GLOB TC PC I2C ADVANCED IMAGING23 70548 Mr angiography neck w/dye 1 GLOB TC PC I2C ADVANCED IMAGING24 70549 Mr angiograph neck w/o&w dye 1 GLOB TC PC I2C ADVANCED IMAGING25 70551 Mri brain w/o dye 1 GLOB TC PC I2C ADVANCED IMAGING26 70552 Mri brain w/ dye 1 GLOB TC PC I2C ADVANCED IMAGING27 70553 Mri brain w/o & w/ dye 1 GLOB TC PC I2C ADVANCED IMAGING28 70557 Mri brain w/o dye 1 GLOB TC PC I2C ADVANCED IMAGING29 70558 Mri brain w/ dye 1 GLOB TC PC I2C ADVANCED IMAGING30 70559 Mri brain w/o & w/ dye 1 GLOB TC PC I2C ADVANCED IMAGING31 71250 Ct thorax w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING32 71260 Ct thorax w/dye 1 GLOB TC PC I2B ADVANCED IMAGING33 71270 Ct thorax w/o & w/ dye 1 GLOB TC PC I2B ADVANCED IMAGING34 71275 Ct angiography, chest 1 GLOB TC PC I2B ADVANCED IMAGING35 71550 Mri chest w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING36 71551 Mri chest w/dye 1 GLOB TC PC I2D ADVANCED IMAGING37 71552 Mri chest w/o & w/dye 1 GLOB TC PC I2D ADVANCED IMAGING38 71555 Mri angio chest w or w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING39 72125 Ct neck spine w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING40 72126 Ct neck spine w/dye 1 GLOB TC PC I2B ADVANCED IMAGING41 72127 Ct neck spine w/o & w/dye 1 GLOB TC PC I2B ADVANCED IMAGING42 72128 Ct chest spine w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING43 72129 Ct chest spine w/dye 1 GLOB TC PC I2B ADVANCED IMAGING44 72130 Ct chest spine w/o & w/dye 1 GLOB TC PC I2B ADVANCED IMAGING45 72131 Ct lumbar spine w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING46 72132 Ct lumbar spine w/dye 1 GLOB TC PC I2B ADVANCED IMAGING47 72133 Ct lumbar spine w/o & w/dye 1 GLOB TC PC I2B ADVANCED IMAGING48 72141 Mri neck spine w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING49 72142 Mri neck spine w/dye 1 GLOB TC PC I2D ADVANCED IMAGING

1 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG50 72146 Mri chest spine w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING51 72147 Mri chest spine w/dye 1 GLOB TC PC I2D ADVANCED IMAGING52 72148 Mri lumbar spine w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING53 72149 Mri lumbar spine w/dye 1 GLOB TC PC I2D ADVANCED IMAGING54 72156 Mri neck spine w/o & w/dye 1 GLOB TC PC I2D ADVANCED IMAGING55 72157 Mri chest spine w/o & w/dye 1 GLOB TC PC I2D ADVANCED IMAGING56 72158 Mri lumbar spine w/o & w/dye 1 GLOB TC PC I2D ADVANCED IMAGING57 72191 Ct angiograph pelv w/o&w/dye 1 GLOB TC PC I2B ADVANCED IMAGING58 72192 Ct pelvis w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING59 72193 Ct pelvis w/dye 1 GLOB TC PC I2B ADVANCED IMAGING60 72194 Ct pelvis w/o & w/dye 1 GLOB TC PC I2B ADVANCED IMAGING61 72195 Mri pelvis w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING62 72196 Mri pelvis w/dye 1 GLOB TC PC I2D ADVANCED IMAGING63 72197 Mri pelvis w/o & w/dye 1 GLOB TC PC I2D ADVANCED IMAGING64 72198 Mr angio pelvis w/o & w/dye 1 GLOB TC PC I2D ADVANCED IMAGING65 73200 Ct upper extremity w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING66 73201 Ct upper extremity w/dye 1 GLOB TC PC I2B ADVANCED IMAGING67 73202 Ct uppr extremity w/o&w/dye 1 GLOB TC PC I2B ADVANCED IMAGING68 73206 Ct angio upr extrm w/o&w/dye 1 GLOB TC PC I2B ADVANCED IMAGING69 73218 Mri upper extremity w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING70 73219 Mri upper extremity w/dye 1 GLOB TC PC I2D ADVANCED IMAGING71 73220 Mri uppr extremity w/o&w/dye 1 GLOB TC PC I2D ADVANCED IMAGING72 73221 Mri joint upr extrem w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING73 73222 Mri joint upr extrem w/dye 1 GLOB TC PC I2D ADVANCED IMAGING74 73223 Mri joint upr extr w/o&w/dye 1 GLOB TC PC I2D ADVANCED IMAGING75 73700 Ct lower extremity w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING76 73701 Ct lower extremity w/dye 1 GLOB TC PC I2B ADVANCED IMAGING77 73702 Ct lwr extremity w/o&w/dye 1 GLOB TC PC I2B ADVANCED IMAGING78 73706 Ct angio lwr extr w/o&w/dye 1 GLOB TC PC I2B ADVANCED IMAGING79 73718 Mri lower extremity w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING80 73719 Mri lower extremity w/dye 1 GLOB TC PC I2D ADVANCED IMAGING81 73720 Mri lwr extremity w/o&w/dye 1 GLOB TC PC I2D ADVANCED IMAGING82 73721 Mri jnt of lwr extre w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING83 73722 Mri joint of lwr extr w/dye 1 GLOB TC PC I2D ADVANCED IMAGING84 73723 Mri joint lwr extr w/o&w/dye 1 GLOB TC PC I2D ADVANCED IMAGING85 73725 Mr ang lwr ext w or w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING86 74150 Ct abdomen w/o dye 1 GLOB TC PC I2B ADVANCED IMAGING87 74160 Ct abdomen w/dye 1 GLOB TC PC I2B ADVANCED IMAGING88 74170 Ct abdomen w/o &w /dye 1 GLOB TC PC I2B ADVANCED IMAGING89 74175 Ct angio abdom w/o & w/dye 1 GLOB TC PC I2B ADVANCED IMAGING90 74181 Mri abdomen w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING91 74182 Mri abdomen w/dye 1 GLOB TC PC I2D ADVANCED IMAGING92 74183 Mri abdomen w/o & w/dye 1 GLOB TC PC I2D ADVANCED IMAGING93 74185 Mri angio, abdom w orw/o dye 1 GLOB TC PC I2D ADVANCED IMAGING94 75552 Heart mri for morph w/o dye 1 GLOB TC PC I2D ADVANCED IMAGING95 75553 Heart mri for morph w/dye 1 GLOB TC PC I2D ADVANCED IMAGING96 75554 Cardiac MRI/function 1 GLOB TC PC I2D ADVANCED IMAGING97 75555 Cardiac MRI/limited study 1 GLOB TC PC I2D ADVANCED IMAGING98 75635 Ct angio abdominal arteries 1 GLOB TC PC I2B ADVANCED IMAGING

2 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG99 76070 Ct bone density, axial 1 GLOB TC PC I2B ADVANCED IMAGING100 76071 Ct bone density, peripheral 1 GLOB TC PC I2B ADVANCED IMAGING101 76093 Magnetic image, breast 1 GLOB TC PC I2D ADVANCED IMAGING102 76094 Magnetic image, both breasts 1 GLOB TC PC I2D ADVANCED IMAGING103 76355 Ct scan for localization 1 GLOB TC PC I2B ADVANCED IMAGING104 76360 Ct scan for needle biopsy 1 GLOB TC PC I2B ADVANCED IMAGING105 76362 Ct guide for tissue ablation 1 GLOB TC PC I2B ADVANCED IMAGING106 76370 Ct scan for therapy guide 1 GLOB TC PC I2B ADVANCED IMAGING107 76380 CAT scan follow-up study 1 GLOB TC PC I2B ADVANCED IMAGING108 76393 Mr guidance for needle place 1 GLOB TC PC I2D ADVANCED IMAGING109 76394 Mri for tissue ablation 1 GLOB TC PC I2D ADVANCED IMAGING110 76400 Magnetic image, bone marrow 1 GLOB TC PC I2D ADVANCED IMAGING111 76497 Ct procedure 1 GLOB TC PC I2B ADVANCED IMAGING112 76498 Mri procedure 1 GLOB TC PC I2D ADVANCED IMAGING113 G0125 PET image pulmonary nodule 1 GLOB TC PC I2D ADVANCED IMAGING114 G0253 PET image brst dection recur 1 GLOB TC PC I2D ADVANCED IMAGING115 G0288 Recon, CTA for surg plan 3 TC I2B ADVANCED IMAGING119 75945 Intravascular us 1 GLOB TC PC I3F ECHOGRAPHY120 75946 Intravascular us add-on 1 GLOB TC PC I3F ECHOGRAPHY121 76506 Echo exam of head 1 GLOB TC PC I3F ECHOGRAPHY122 76511 Echo exam of eye 1 GLOB TC PC I3A ECHOGRAPHY123 76512 Echo exam of eye 1 GLOB TC PC I3A ECHOGRAPHY124 76513 Echo exam of eye, water bath 1 GLOB TC PC I3A ECHOGRAPHY125 76516 Echo exam of eye 1 GLOB TC PC I3A ECHOGRAPHY126 76519 Echo exam of eye 1 GLOB TC PC I3A ECHOGRAPHY127 76529 Echo exam of eye 1 GLOB TC PC I3A ECHOGRAPHY128 76536 Us exam of head and neck 1 GLOB TC PC I3F ECHOGRAPHY129 76604 Us exam, chest, b-scan 1 GLOB TC PC I3F ECHOGRAPHY130 76645 Us exam, breast(s) 1 GLOB TC PC I3F ECHOGRAPHY131 76700 Us exam, abdom, complete 1 GLOB TC PC I3B ECHOGRAPHY132 76705 Echo exam of abdomen 1 GLOB TC PC I3B ECHOGRAPHY133 76770 Us exam abdo back wall, comp 1 GLOB TC PC I3B ECHOGRAPHY134 76775 Us exam abdo back wall, lim 1 GLOB TC PC I3B ECHOGRAPHY135 76778 Us exam kidney transplant 1 GLOB TC PC I3B ECHOGRAPHY136 76800 Us exam, spinal canal 1 GLOB TC PC I3F ECHOGRAPHY137 76801 Ob us < 14 wks, single fetus 1 GLOB TC PC I3B ECHOGRAPHY138 76802 Ob us < 14 wks, add’l fetus 1 GLOB TC PC I3B ECHOGRAPHY139 76805 Ob us >/= 14 wks, sngl fetus 1 GLOB TC PC I3B ECHOGRAPHY140 76810 Ob us >/= 14 wks, addl fetus 1 GLOB TC PC I3B ECHOGRAPHY141 76811 Ob us, detailed, sngl fetus 1 GLOB TC PC I3B ECHOGRAPHY142 76812 Ob us, detailed, addl fetus 1 GLOB TC PC I3B ECHOGRAPHY143 76815 Ob us, limited, fetus(s) 1 GLOB TC PC I3B ECHOGRAPHY144 76816 Ob us, follow-up, per fetus 1 GLOB TC PC I3B ECHOGRAPHY145 76817 Transvaginal us, obstetric 1 GLOB TC PC I3B ECHOGRAPHY146 76818 Fetal biophys profile w/nst 1 GLOB TC PC I3B ECHOGRAPHY147 76819 Fetal biophys profil w/o nst 1 GLOB TC PC I3B ECHOGRAPHY148 76825 Echo exam of fetal heart 1 GLOB TC PC I3B ECHOGRAPHY149 76826 Echo exam of fetal heart 1 GLOB TC PC I3B ECHOGRAPHY150 76827 Echo exam of fetal heart 1 GLOB TC PC I3B ECHOGRAPHY

3 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG151 76828 Echo exam of fetal heart 1 GLOB TC PC I3B ECHOGRAPHY152 76830 Transvaginal us, non-ob 1 GLOB TC PC I3B ECHOGRAPHY153 76831 Echo exam, uterus 1 GLOB TC PC I3B ECHOGRAPHY154 76856 Us exam, pelvic, complete 1 GLOB TC PC I3B ECHOGRAPHY155 76857 Us exam, pelvic, limited 1 GLOB TC PC I3B ECHOGRAPHY156 76870 Us exam, scrotum 1 GLOB TC PC I3F ECHOGRAPHY157 76872 Us, transrectal 1 GLOB TC PC I3E ECHOGRAPHY158 76873 Echograp trans r, pros study 1 GLOB TC PC I3E ECHOGRAPHY159 76880 Us exam, extremity 1 GLOB TC PC I3F ECHOGRAPHY160 76885 Us exam infant hips, dynamic 1 GLOB TC PC I3F ECHOGRAPHY161 76886 Us exam infant hips, static 1 GLOB TC PC I3F ECHOGRAPHY162 76930 Echo guide, cardiocentesis 1 GLOB TC PC I3C ECHOGRAPHY163 76932 Echo guide for heart biopsy 1 GLOB TC PC I3C ECHOGRAPHY164 76937 Us guide, vascular access 1 GLOB TC PC I3F ECHOGRAPHY165 76940 Us guide, tissue ablation 1 GLOB TC PC I3F ECHOGRAPHY166 76941 Echo guide for transfusion 1 GLOB TC PC I3B ECHOGRAPHY167 76942 Echo guide for biopsy 1 GLOB TC PC I3F ECHOGRAPHY168 76945 Echo guide, villus sampling 1 GLOB TC PC I3B ECHOGRAPHY169 76946 Echo guide for amniocentesis 1 GLOB TC PC I3B ECHOGRAPHY170 76948 Echo guide, ova aspiration 1 GLOB TC PC I3B ECHOGRAPHY171 76950 Echo guidance radiotherapy 1 GLOB TC PC I3F ECHOGRAPHY172 76965 Echo guidance radiotherapy 1 GLOB TC PC I3F ECHOGRAPHY173 76970 Ultrasound exam follow-up 1 GLOB TC PC I3F ECHOGRAPHY174 76975 GI endoscopic ultrasound 1 GLOB TC PC I3B ECHOGRAPHY175 76977 Us bone density measure 1 GLOB TC PC I3F ECHOGRAPHY176 76986 Ultrasound guide intraoper 1 GLOB TC PC I3F ECHOGRAPHY177 76999 Echo examination procedure 1 GLOB TC PC I3F ECHOGRAPHY178 92136 Ophthalmic biometry 1 GLOB TC PC I3A ECHOGRAPHY179 92978 Intravasc us, heart add-on 1 GLOB TC PC I3C ECHOGRAPHY180 92979 Intravasc us, heart add-on 1 GLOB TC PC I3C ECHOGRAPHY181 93303 Echo transthoracic 1 GLOB TC PC I3C ECHOGRAPHY182 93304 Echo transthoracic 1 GLOB TC PC I3C ECHOGRAPHY183 93307 Echo exam of heart 1 GLOB TC PC I3C ECHOGRAPHY184 93308 Echo exam of heart 1 GLOB TC PC I3C ECHOGRAPHY185 93312 Echo transesophageal 1 GLOB TC PC I3C ECHOGRAPHY186 93314 Echo transesophageal 1 GLOB TC PC I3C ECHOGRAPHY187 93315 Echo transesophageal 1 GLOB TC PC I3C ECHOGRAPHY188 93317 Echo transesophageal 1 GLOB TC PC I3C ECHOGRAPHY189 93318 Echo transesophageal intraop 1 GLOB TC PC I3C ECHOGRAPHY190 93320 Doppler echo exam, heart 1 GLOB TC PC I3C ECHOGRAPHY191 93321 Doppler echo exam, heart 1 GLOB TC PC I3C ECHOGRAPHY192 93325 Doppler color flow add-on 1 GLOB TC PC I3C ECHOGRAPHY193 93571 Heart flow reserve measure 1 GLOB TC PC I3C ECHOGRAPHY194 93572 Heart flow reserve measure 1 GLOB TC PC I3C ECHOGRAPHY195 93880 Extracranial study 1 GLOB TC PC I3D ECHOGRAPHY196 93882 Extracranial study 1 GLOB TC PC I3D ECHOGRAPHY197 93925 Lower extremity study 1 GLOB TC PC I3F ECHOGRAPHY198 93926 Lower extremity study 1 GLOB TC PC I3F ECHOGRAPHY199 93930 Upper extremity study 1 GLOB TC PC I3F ECHOGRAPHY

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April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG200 93931 Upper extremity study 1 GLOB TC PC I3F ECHOGRAPHY201 93970 Extremity study 1 GLOB TC PC I3F ECHOGRAPHY202 93971 Extremity study 1 GLOB TC PC I3F ECHOGRAPHY203 93975 Vascular study 1 GLOB TC PC I3F ECHOGRAPHY204 93976 Vascular study 1 GLOB TC PC I3F ECHOGRAPHY205 93978 Vascular study 1 GLOB TC PC I3F ECHOGRAPHY206 93979 Vascular study 1 GLOB TC PC I3F ECHOGRAPHY207 93980 Penile vascular study 1 GLOB TC PC I3F ECHOGRAPHY208 93981 Penile vascular study 1 GLOB TC PC I3F ECHOGRAPHY213 92611 Motion fluoroscopy/swallow 0 TC I4B IMAGING PROCEDUR214 70010 Contrast x-ray of brain 1 GLOB TC PC I4B IMAGING PROCEDUR215 70015 Contrast x-ray of brain 1 GLOB TC PC I4B IMAGING PROCEDUR216 72240 Contrast x-ray of neck spine 1 GLOB TC PC I4B IMAGING PROCEDUR217 72255 Contrast x-ray, thorax spine 1 GLOB TC PC I4B IMAGING PROCEDUR218 72265 Contrast x-ray, lower spine 1 GLOB TC PC I4B IMAGING PROCEDUR219 72270 Contrast x-ray, spine 1 GLOB TC PC I4B IMAGING PROCEDUR220 72275 Epidurography 1 GLOB TC PC I4B IMAGING PROCEDUR221 72285 X-ray c/t spine disk 1 GLOB TC PC I4B IMAGING PROCEDUR222 72295 X-ray of lower spine disk 1 GLOB TC PC I4B IMAGING PROCEDUR223 73040 Contrast x-ray of shoulder 1 GLOB TC PC I4B IMAGING PROCEDUR224 73085 Contrast x-ray of elbow 1 GLOB TC PC I4B IMAGING PROCEDUR225 73115 Contrast x-ray of wrist 1 GLOB TC PC I4B IMAGING PROCEDUR226 73525 Contrast x-ray of hip 1 GLOB TC PC I4B IMAGING PROCEDUR227 73542 X-ray exam, sacroiliac joint 1 GLOB TC PC I4B IMAGING PROCEDUR228 73580 Contrast x-ray of knee joint 1 GLOB TC PC I4B IMAGING PROCEDUR229 73615 Contrast x-ray of ankle 1 GLOB TC PC I4B IMAGING PROCEDUR230 74190 X-ray exam of peritoneum 1 GLOB TC PC I4B IMAGING PROCEDUR231 74283 Contrast x-ray exam of colon 1 GLOB TC PC I4B IMAGING PROCEDUR232 75600 Contrast x-ray exam of aorta 1 GLOB TC PC I4B IMAGING PROCEDUR233 75605 Contrast x-ray exam of aorta 1 GLOB TC PC I4B IMAGING PROCEDUR234 75625 Contrast x-ray exam of aorta 1 GLOB TC PC I4B IMAGING PROCEDUR235 75630 X-ray aorta, leg arteries 1 GLOB TC PC I4B IMAGING PROCEDUR236 75650 Artery x-rays, head & neck 1 GLOB TC PC I4B IMAGING PROCEDUR237 75658 Artery x-rays, arm 1 GLOB TC PC I4B IMAGING PROCEDUR238 75660 Artery x-rays, head & neck 1 GLOB TC PC I4B IMAGING PROCEDUR239 75662 Artery x-rays, head & neck 1 GLOB TC PC I4B IMAGING PROCEDUR240 75665 Artery x-rays, head & neck 1 GLOB TC PC I4B IMAGING PROCEDUR241 75671 Artery x-rays, head & neck 1 GLOB TC PC I4B IMAGING PROCEDUR242 75676 Artery x-rays, neck 1 GLOB TC PC I4B IMAGING PROCEDUR243 75680 Artery x-rays, neck 1 GLOB TC PC I4B IMAGING PROCEDUR244 75685 Artery x-rays, spine 1 GLOB TC PC I4B IMAGING PROCEDUR245 75705 Artery x-rays, spine 1 GLOB TC PC I4B IMAGING PROCEDUR246 75710 Artery x-rays, arm/leg 1 GLOB TC PC I4B IMAGING PROCEDUR247 75716 Artery x-rays, arms/legs 1 GLOB TC PC I4B IMAGING PROCEDUR248 75722 Artery x-rays, kidney 1 GLOB TC PC I4B IMAGING PROCEDUR249 75724 Artery x-rays, kidneys 1 GLOB TC PC I4B IMAGING PROCEDUR250 75726 Artery x-rays, abdomen 1 GLOB TC PC I4B IMAGING PROCEDUR251 75731 Artery x-rays, adrenal gland 1 GLOB TC PC I4B IMAGING PROCEDUR252 75733 Artery x-rays, adrenals 1 GLOB TC PC I4B IMAGING PROCEDUR

5 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG253 75736 Artery x-rays, pelvis 1 GLOB TC PC I4B IMAGING PROCEDUR254 75741 Artery x-rays, lung 1 GLOB TC PC I4B IMAGING PROCEDUR255 75743 Artery x-rays, lungs 1 GLOB TC PC I4B IMAGING PROCEDUR256 75746 Artery x-rays, lung 1 GLOB TC PC I4B IMAGING PROCEDUR257 75756 Artery x-rays, chest 1 GLOB TC PC I4A IMAGING PROCEDUR258 75774 Artery x-ray, each vessel 1 GLOB TC PC I4B IMAGING PROCEDUR259 75790 Visualize A-V shunt 1 GLOB TC PC I4B IMAGING PROCEDUR260 75801 Lymph vessel x-ray, arm/leg 1 GLOB TC PC I4B IMAGING PROCEDUR261 75803 Lymph vessel x-ray,arms/legs 1 GLOB TC PC I4B IMAGING PROCEDUR262 75805 Lymph vessel x-ray, trunk 1 GLOB TC PC I4B IMAGING PROCEDUR263 75807 Lymph vessel x-ray, trunk 1 GLOB TC PC I4B IMAGING PROCEDUR264 75810 Vein x-ray, spleen/liver 1 GLOB TC PC I4B IMAGING PROCEDUR265 75820 Vein x-ray, arm/leg 1 GLOB TC PC I4B IMAGING PROCEDUR266 75822 Vein x-ray, arms/legs 1 GLOB TC PC I4B IMAGING PROCEDUR267 75825 Vein x-ray, trunk 1 GLOB TC PC I4B IMAGING PROCEDUR268 75827 Vein x-ray, chest 1 GLOB TC PC I4B IMAGING PROCEDUR269 75831 Vein x-ray, kidney 1 GLOB TC PC I4B IMAGING PROCEDUR270 75833 Vein x-ray, kidneys 1 GLOB TC PC I4B IMAGING PROCEDUR271 75840 Vein x-ray, adrenal gland 1 GLOB TC PC I4B IMAGING PROCEDUR272 75842 Vein x-ray, adrenal glands 1 GLOB TC PC I4B IMAGING PROCEDUR273 75860 Vein x-ray, neck 1 GLOB TC PC I4B IMAGING PROCEDUR274 75870 Vein x-ray, skull 1 GLOB TC PC I4B IMAGING PROCEDUR275 75872 Vein x-ray, skull 1 GLOB TC PC I4B IMAGING PROCEDUR276 75880 Vein x-ray, eye socket 1 GLOB TC PC I4B IMAGING PROCEDUR277 75885 Vein x-ray, liver 1 GLOB TC PC I4B IMAGING PROCEDUR278 75887 Vein x-ray, liver 1 GLOB TC PC I4B IMAGING PROCEDUR279 75889 Vein x-ray, liver 1 GLOB TC PC I4B IMAGING PROCEDUR280 75891 Vein x-ray, liver 1 GLOB TC PC I4B IMAGING PROCEDUR281 75893 Venous sampling by catheter 1 GLOB TC PC I4B IMAGING PROCEDUR282 75898 Follow-up angiography 1 GLOB TC PC I4B IMAGING PROCEDUR283 75901 Remove cva device obstruct 1 GLOB TC PC I4B IMAGING PROCEDUR284 75902 Remove cva lumen obstruct 1 GLOB TC PC I4B IMAGING PROCEDUR285 75998 Fluoroguide for vein device 1 GLOB TC PC I4B IMAGING PROCEDUR286 76000 Fluoroscope examination 1 GLOB TC PC I4B IMAGING PROCEDUR287 76001 Fluoroscope exam, extensive 1 GLOB TC PC I4B IMAGING PROCEDUR288 76003 Needle localization by x-ray 1 GLOB TC PC I4B IMAGING PROCEDUR289 76005 Fluoroguide for spine inject 1 GLOB TC PC I4B IMAGING PROCEDUR290 76076 Dexa, peripheral study 1 GLOB TC PC I4B IMAGING PROCEDUR291 76078 Radiographic absorptiometry 1 GLOB TC PC I4B IMAGING PROCEDUR292 76375 3d/holograph reconstr add-on 1 GLOB TC PC I4B IMAGING PROCEDUR293 76496 Fluoroscopic procedure 1 GLOB TC PC I4B IMAGING PROCEDUR294 76499 Radiographic procedure 1 GLOB TC PC I4B IMAGING PROCEDUR295 76936 Echo guide for artery repair 1 GLOB TC PC I4B IMAGING PROCEDUR296 91110 Gi tract capsule endoscopy 1 GLOB TC PC I4B IMAGING PROCEDUR297 93555 Imaging, cardiac cath 1 GLOB TC PC I4A IMAGING PROCEDUR298 93556 Imaging, cardiac cath 1 GLOB TC PC I4A IMAGING PROCEDUR299 G0030 PET imaging prev PET single 1 GLOB TC PC I4A IMAGING PROCEDUR300 G0031 PET imaging prev PET multple 1 GLOB TC PC I4A IMAGING PROCEDUR301 G0032 PET follow SPECT 78464 singl 1 GLOB TC PC I4A IMAGING PROCEDUR

6 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG302 G0033 PET follow SPECT 78464 mult 1 GLOB TC PC I4A IMAGING PROCEDUR303 G0034 PET follow SPECT 76865 singl 1 GLOB TC PC I4A IMAGING PROCEDUR304 G0035 PET follow SPECT 78465 mult 1 GLOB TC PC I4A IMAGING PROCEDUR305 G0036 PET follow cornry angio sing 1 GLOB TC PC I4A IMAGING PROCEDUR306 G0037 PET follow cornry angio mult 1 GLOB TC PC I4A IMAGING PROCEDUR307 G0038 PET follow myocard perf sing 1 GLOB TC PC I4A IMAGING PROCEDUR308 G0039 PET follow myocard perf mult 1 GLOB TC PC I4A IMAGING PROCEDUR309 G0040 PET follow stress echo singl 1 GLOB TC PC I4A IMAGING PROCEDUR310 G0041 PET follow stress echo mult 1 GLOB TC PC I4A IMAGING PROCEDUR311 G0042 PET follow ventriculogm sing 1 GLOB TC PC I4A IMAGING PROCEDUR312 G0043 PET follow ventriculogm mult 1 GLOB TC PC I4A IMAGING PROCEDUR313 G0044 PET following rest ECG singl 1 GLOB TC PC I4A IMAGING PROCEDUR314 G0045 PET following rest ECG mult 1 GLOB TC PC I4A IMAGING PROCEDUR315 G0046 PET follow stress ECG singl 1 GLOB TC PC I4A IMAGING PROCEDUR316 G0047 PET follow stress ECG mult 1 GLOB TC PC I4A IMAGING PROCEDUR317 G0130 Single energy x-ray study 1 GLOB TC PC I4B IMAGING PROCEDUR318 G0210 PET img wholebody dxlung 1 GLOB TC PC I4B IMAGING PROCEDUR319 G0211 PET img wholbody init lung 1 GLOB TC PC I4B IMAGING PROCEDUR320 G0212 PET img wholebod restag lung 1 GLOB TC PC I4B IMAGING PROCEDUR321 G0213 PET img wholbody dx 1 GLOB TC PC I4B IMAGING PROCEDUR322 G0214 PET img wholebod init 1 GLOB TC PC I4B IMAGING PROCEDUR323 G0215 PETimg wholebod restag 1 GLOB TC PC I4B IMAGING PROCEDUR324 G0216 PET img wholebod dx melanoma 1 GLOB TC PC I4B IMAGING PROCEDUR325 G0217 PET img wholebod init melan 1 GLOB TC PC I4B IMAGING PROCEDUR326 G0218 PET img wholebod restag mela 1 GLOB TC PC I4B IMAGING PROCEDUR327 G0220 PET img wholebod dx lymphoma 1 GLOB TC PC I4B IMAGING PROCEDUR328 G0221 PET imag wholbod init lympho 1 GLOB TC PC I4B IMAGING PROCEDUR329 G0222 PET imag wholbod resta lymph 1 GLOB TC PC I4B IMAGING PROCEDUR330 G0223 PET imag wholbod reg dx head 1 GLOB TC PC I4B IMAGING PROCEDUR331 G0224 PET imag wholbod reg ini hea 1 GLOB TC PC I4B IMAGING PROCEDUR332 G0225 PET whol restag headneckonly 1 GLOB TC PC I4B IMAGING PROCEDUR333 G0226 PET img wholbody dx esophagl 1 GLOB TC PC I4B IMAGING PROCEDUR334 G0227 PET img wholbod ini esophage 1 GLOB TC PC I4B IMAGING PROCEDUR335 G0228 PET img wholbod restg esopha 1 GLOB TC PC I4B IMAGING PROCEDUR336 G0229 PET img metaboloc brain pres 1 GLOB TC PC I4B IMAGING PROCEDUR337 G0230 PET myocard viability post 1 GLOB TC PC I4B IMAGING PROCEDUR338 G0231 PET WhBD colorec; gamma cam 1 GLOB TC PC I4B IMAGING PROCEDUR339 G0232 PET whbd lymphoma; gamma cam1 GLOB TC PC I4B IMAGING PROCEDUR340 G0233 PET whbd melanoma; gamma cam1 GLOB TC PC I4B IMAGING PROCEDUR341 G0234 PET WhBD pulm nod; gamma cam1 GLOB TC PC I4B IMAGING PROCEDUR342 G0296 PET imge restag thyrod cance 1 GLOB TC PC I4B IMAGING PROCEDUR345 88104 Cytopathology, fluids 1 GLOB TC PC T1G LAB TESTS346 88106 Cytopathology, fluids 1 GLOB TC PC T1G LAB TESTS347 88107 Cytopathology, fluids 1 GLOB TC PC T1G LAB TESTS348 88108 Cytopath, concentrate tech 1 GLOB TC PC T1G LAB TESTS349 88112 Cytopath, cell enhance tech 1 GLOB TC PC T1G LAB TESTS350 88125 Forensic cytopathology 1 GLOB TC PC T1G LAB TESTS351 88160 Cytopath smear, other source 1 GLOB TC PC T1G LAB TESTS352 88161 Cytopath smear, other source 1 GLOB TC PC T1G LAB TESTS

7 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG353 88162 Cytopath smear, other source 1 GLOB TC PC T1G LAB TESTS354 88172 Cytopathology eval of fna 1 GLOB TC PC T1G LAB TESTS355 88173 Cytopath eval, fna, report 1 GLOB TC PC T1G LAB TESTS356 88180 Cell marker study 1 GLOB TC PC T1G LAB TESTS357 88182 Cell marker study 1 GLOB TC PC T1G LAB TESTS358 88199 Cytopathology procedure 1 GLOB TC PC T1G LAB TESTS359 88300 Surgical path, gross 1 GLOB TC PC T1G LAB TESTS360 88302 Tissue exam by pathologist 1 GLOB TC PC T1G LAB TESTS361 88304 Tissue exam by pathologist 1 GLOB TC PC T1G LAB TESTS362 88305 Tissue exam by pathologist 1 GLOB TC PC T1G LAB TESTS363 88307 Tissue exam by pathologist 1 GLOB TC PC T1G LAB TESTS364 88309 Tissue exam by pathologist 1 GLOB TC PC T1G LAB TESTS365 88311 Decalcify tissue 1 GLOB TC PC T1G LAB TESTS366 88312 Special stains 1 GLOB TC PC T1G LAB TESTS367 88313 Special stains 1 GLOB TC PC T1G LAB TESTS368 88314 Histochemical stain 1 GLOB TC PC T1G LAB TESTS369 88318 Chemical histochemistry 1 GLOB TC PC T1G LAB TESTS370 88319 Enzyme histochemistry 1 GLOB TC PC T1G LAB TESTS371 88323 Microslide consultation 1 GLOB TC PC T1G LAB TESTS372 88331 Path consult intraop, 1 bloc 1 GLOB TC PC T1G LAB TESTS373 88332 Path consult intraop, add’l 1 GLOB TC PC T1G LAB TESTS374 88342 Immunohistochemistry 1 GLOB TC PC T1G LAB TESTS375 88346 Immunofluorescent study 1 GLOB TC PC T1G LAB TESTS376 88347 Immunofluorescent study 1 GLOB TC PC T1G LAB TESTS377 88348 Electron microscopy 1 GLOB TC PC T1G LAB TESTS378 88349 Scanning electron microscopy 1 GLOB TC PC T1G LAB TESTS379 88355 Analysis, skeletal muscle 1 GLOB TC PC T1G LAB TESTS380 88356 Analysis, nerve 1 GLOB TC PC T1G LAB TESTS381 88358 Analysis, tumor 1 GLOB TC PC T1G LAB TESTS382 88361 Immunohistochemistry, tumor 1 GLOB TC PC T1G LAB TESTS383 88362 Nerve teasing preparations 1 GLOB TC PC T1G LAB TESTS384 88365 Tissue hybridization 1 GLOB TC PC T1G LAB TESTS385 88380 Microdissection 1 GLOB TC PC T1H LAB TESTS386 88399 Surgical pathology procedure 1 GLOB TC PC T1G LAB TESTS387 88141 Cytopath, c/v, interpret 2 PC T1G LAB TESTS388 88291 Cyto/molecular report 2 PC T1G LAB TESTS389 86485 Skin test, candida 3 TC T1H LAB TESTS390 86490 Coccidioidomycosis skin test 3 TC T1G LAB TESTS391 86510 Histoplasmosis skin test 3 TC T1G LAB TESTS392 86580 TB intradermal test 3 TC T1G LAB TESTS393 86585 TB tine test 3 TC T1G LAB TESTS394 86586 Skin test, unlisted 3 TC T1H LAB TESTS395 89220 Sputum specimen collection 3 TC T1G LAB TESTS396 89230 Collect sweat for test 3 TC T1G LAB TESTS397 95250 Glucose monitoring, cont 3 TC T1E LAB TESTS398 83020 Hemoglobin electrophoresis 6 PC T1H LAB TESTS399 83912 Genetic examination 6 PC T1H LAB TESTS400 84165 Electrophoreisis of proteins 6 PC T1H LAB TESTS401 84181 Western blot test 6 PC T1H LAB TESTS

8 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG402 84182 Protein, western blot test 6 PC T1H LAB TESTS403 85390 Fibrinolysins screen 6 PC T1H LAB TESTS404 85576 Blood platelet aggregation 6 PC T1H LAB TESTS405 86255 Fluorescent antibody, screen 6 PC T1H LAB TESTS406 86256 Fluorescent antibody, titer 6 PC T1H LAB TESTS407 86320 Serum immunoelectrophoresis 6 PC T1H LAB TESTS408 86325 Other immunoelectrophoresis 6 PC T1H LAB TESTS409 86327 Immunoelectrophoresis assay 6 PC T1H LAB TESTS410 86334 Immunofixation procedure 6 PC T1H LAB TESTS411 87164 Dark field examination 6 PC T1H LAB TESTS412 87207 Smear, special stain 6 PC T1H LAB TESTS413 88371 Protein, western blot tissue 6 PC T1H LAB TESTS414 88372 Protein analysis w/probe 6 PC T1H LAB TESTS415 89060 Exam,synovial fluid crystals 6 PC T1H LAB TESTS416 85060 Blood smear interpretation 8 PC T1G LAB TESTS420 93505 Biopsy of heart lining 1 GLOB TC PC P2F MAJOR PROCEDURE607 92601 Cochlear implt f/up exam < 7 0 TC T2D OTHER TESTS608 92602 Reprogram cochlear implt < 7 0 TC T2D OTHER TESTS609 92603 Cochlear implt f/up exam 7 > 0 TC T2D OTHER TESTS610 92604 Reprogram cochlear implt 7 > 0 TC T2D OTHER TESTS611 92610 Evaluate swallowing function 0 TC T2D OTHER TESTS612 54240 Penis study 1 GLOB TC PC T2D OTHER TESTS613 91010 Esophagus motility study 1 GLOB TC PC T2D OTHER TESTS614 91011 Esophagus motility study 1 GLOB TC PC T2D OTHER TESTS615 91012 Esophagus motility study 1 GLOB TC PC T2D OTHER TESTS616 91020 Gastric motility 1 GLOB TC PC T2D OTHER TESTS617 91030 Acid perfusion of esophagus 1 GLOB TC PC T2D OTHER TESTS618 91032 Esophagus, acid reflux test 1 GLOB TC PC T2D OTHER TESTS619 91033 Prolonged acid reflux test 1 GLOB TC PC T2D OTHER TESTS620 91052 Gastric analysis test 1 GLOB TC PC T2D OTHER TESTS621 91065 Breath hydrogen test 1 GLOB TC PC T2D OTHER TESTS622 91122 Anal pressure record 1 GLOB TC PC T2D OTHER TESTS623 91299 Gastroenterology procedure 1 GLOB TC PC T2D OTHER TESTS624 92499 Eye service or procedure 1 GLOB TC PC T2D OTHER TESTS625 92541 Spontaneous nystagmus test 1 GLOB TC PC T2D OTHER TESTS626 92542 Positional nystagmus test 1 GLOB TC PC T2D OTHER TESTS627 92543 Caloric vestibular test 1 GLOB TC PC T2D OTHER TESTS628 92544 Optokinetic nystagmus test 1 GLOB TC PC T2D OTHER TESTS629 92545 Oscillating tracking test 1 GLOB TC PC T2D OTHER TESTS630 92546 Sinusoidal rotational test 1 GLOB TC PC T2D OTHER TESTS631 92548 Posturography 1 GLOB TC PC T2D OTHER TESTS632 92585 Auditor evoke potent, compre 1 GLOB TC PC T2D OTHER TESTS633 92587 Evoked auditory test 1 GLOB TC PC T2D OTHER TESTS634 92588 Evoked auditory test 1 GLOB TC PC T2D OTHER TESTS635 93024 Cardiac drug stress test 1 GLOB TC PC T2D OTHER TESTS636 93025 Microvolt t-wave assess 1 GLOB TC PC T2D OTHER TESTS637 93278 ECG/signal-averaged 1 GLOB TC PC T2C OTHER TESTS638 93350 Echo transthoracic 1 GLOB TC PC T2B OTHER TESTS639 93640 Evaluation heart device 1 GLOB TC PC T2D OTHER TESTS

9 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG640 93641 Electrophysiology evaluation 1 GLOB TC PC T2D OTHER TESTS641 93642 Electrophysiology evaluation 1 GLOB TC PC T2D OTHER TESTS642 93701 Bioimpedance, thoracic 1 GLOB TC PC T2D OTHER TESTS643 93724 Analyze pacemaker system 1 GLOB TC PC T2D OTHER TESTS644 93731 Analyze pacemaker system 1 GLOB TC PC T2D OTHER TESTS645 93732 Analyze pacemaker system 1 GLOB TC PC T2D OTHER TESTS646 93733 Telephone analy, pacemaker 1 GLOB TC PC T2D OTHER TESTS647 93734 Analyze pacemaker system 1 GLOB TC PC T2D OTHER TESTS648 93735 Analyze pacemaker system 1 GLOB TC PC T2D OTHER TESTS649 93736 Telephonic analy, pacemaker 1 GLOB TC PC T2D OTHER TESTS650 93741 Analyze ht pace device sngl 1 GLOB TC PC T2B OTHER TESTS651 93742 Analyze ht pace device sngl 1 GLOB TC PC T2B OTHER TESTS652 93743 Analyze ht pace device dual 1 GLOB TC PC T2B OTHER TESTS653 93744 Analyze ht pace device dual 1 GLOB TC PC T2B OTHER TESTS654 93799 Cardiovascular procedure 1 GLOB TC PC T2D OTHER TESTS655 93875 Extracranial study 1 GLOB TC PC T2D OTHER TESTS656 93886 Intracranial study 1 GLOB TC PC T2D OTHER TESTS657 93888 Intracranial study 1 GLOB TC PC T2D OTHER TESTS658 93922 Extremity study 1 GLOB TC PC T2D OTHER TESTS659 93923 Extremity study 1 GLOB TC PC T2D OTHER TESTS660 93924 Extremity study 1 GLOB TC PC T2D OTHER TESTS661 93965 Extremity study 1 GLOB TC PC T2D OTHER TESTS662 94010 Breathing capacity test 1 GLOB TC PC T2D OTHER TESTS663 94060 Evaluation of wheezing 1 GLOB TC PC T2D OTHER TESTS664 94070 Evaluation of wheezing 1 GLOB TC PC T2D OTHER TESTS665 94200 Lung function test (MBC/MVV) 1 GLOB TC PC T2D OTHER TESTS666 94240 Residual lung capacity 1 GLOB TC PC T2D OTHER TESTS667 94250 Expired gas collection 1 GLOB TC PC T2D OTHER TESTS668 94260 Thoracic gas volume 1 GLOB TC PC T2D OTHER TESTS669 94350 Lung nitrogen washout curve 1 GLOB TC PC T2D OTHER TESTS670 94360 Measure airflow resistance 1 GLOB TC PC T2D OTHER TESTS671 94370 Breath airway closing volume 1 GLOB TC PC T2D OTHER TESTS672 94375 Respiratory flow volume loop 1 GLOB TC PC T2D OTHER TESTS673 94400 CO2 breathing response curve 1 GLOB TC PC T2D OTHER TESTS674 94450 Hypoxia response curve 1 GLOB TC PC T2D OTHER TESTS675 94620 Pulmonary stress test/simple 1 GLOB TC PC T2D OTHER TESTS676 94621 Pulm stress test/complex 1 GLOB TC PC T2D OTHER TESTS677 94680 Exhaled air analysis, o2 1 GLOB TC PC T2D OTHER TESTS678 94681 Exhaled air analysis, o2/co2 1 GLOB TC PC T2D OTHER TESTS679 94690 Exhaled air analysis 1 GLOB TC PC T2D OTHER TESTS680 94720 Monoxide diffusing capacity 1 GLOB TC PC T2D OTHER TESTS681 94725 Membrane diffusion capacity 1 GLOB TC PC T2D OTHER TESTS682 94750 Pulmonary compliance study 1 GLOB TC PC T2D OTHER TESTS683 94770 Exhaled carbon dioxide test 1 GLOB TC PC T2D OTHER TESTS684 94772 Breath recording, infant 1 GLOB TC PC T2D OTHER TESTS685 94799 Pulmonary service/procedure 1 GLOB TC PC T2D OTHER TESTS686 95805 Multiple sleep latency test 1 GLOB TC PC T2D OTHER TESTS687 95806 Sleep study, unattended 1 GLOB TC PC T2D OTHER TESTS688 95807 Sleep study, attended 1 GLOB TC PC T2D OTHER TESTS

10 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG689 95808 Polysomnography, 1-3 1 GLOB TC PC T2D OTHER TESTS690 95810 Polysomnography, 4 or more 1 GLOB TC PC T2D OTHER TESTS691 95811 Polysomnography w/cpap 1 GLOB TC PC T2D OTHER TESTS692 95812 Eeg, 41-60 minutes 1 GLOB TC PC T2D OTHER TESTS693 95813 Eeg, over 1 hour 1 GLOB TC PC T2D OTHER TESTS694 95816 Eeg, awake and drowsy 1 GLOB TC PC T2D OTHER TESTS695 95819 Eeg, awake and asleep 1 GLOB TC PC T2D OTHER TESTS696 95822 Eeg, coma or sleep only 1 GLOB TC PC T2D OTHER TESTS697 95824 Eeg, cerebral death only 1 GLOB TC PC T2D OTHER TESTS698 95827 Eeg, all night recording 1 GLOB TC PC T2D OTHER TESTS699 95858 Tensilon test & myogram 1 GLOB TC PC T2D OTHER TESTS700 95900 Motor nerve conduction test 1 GLOB TC PC T2D OTHER TESTS701 95903 Motor nerve conduction test 1 GLOB TC PC T2D OTHER TESTS702 95904 Sense nerve conduction test 1 GLOB TC PC T2D OTHER TESTS703 95921 Autonomic nerv function test 1 GLOB TC PC T2D OTHER TESTS704 95922 Autonomic nerv function test 1 GLOB TC PC T2D OTHER TESTS705 95923 Autonomic nerv function test 1 GLOB TC PC T2D OTHER TESTS706 95925 Somatosensory testing 1 GLOB TC PC T2D OTHER TESTS707 95926 Somatosensory testing 1 GLOB TC PC T2D OTHER TESTS708 95927 Somatosensory testing 1 GLOB TC PC T2D OTHER TESTS709 95930 Visual evoked potential test 1 GLOB TC PC T2D OTHER TESTS710 95933 Blink reflex test 1 GLOB TC PC T2D OTHER TESTS711 95934 H-reflex test 1 GLOB TC PC T2D OTHER TESTS712 95936 H-reflex test 1 GLOB TC PC T2D OTHER TESTS713 95937 Neuromuscular junction test 1 GLOB TC PC T2D OTHER TESTS714 95950 Ambulatory eeg monitoring 1 GLOB TC PC T2D OTHER TESTS715 95951 EEG monitoring/videorecord 1 GLOB TC PC T2D OTHER TESTS716 95957 EEG digital analysis 1 GLOB TC PC T2D OTHER TESTS717 95965 Meg, spontaneous 1 GLOB TC PC T2D OTHER TESTS718 95966 Meg, evoked, single 1 GLOB TC PC T2D OTHER TESTS719 95967 Meg, evoked, each add’l 1 GLOB TC PC T2D OTHER TESTS720 Q0035 Cardiokymography 1 GLOB TC PC T2D OTHER TESTS721 93010 Electrocardiogram report 2 PC T2A OTHER TESTS722 93014 Report on transmitted ecg 2 PC T2C OTHER TESTS723 93016 Cardiovascular stress test 2 PC T2B OTHER TESTS724 93018 Cardiovascular stress test 2 PC T2B OTHER TESTS725 93042 Rhythm ECG, report 2 PC T2A OTHER TESTS726 93227 ECG monitor/review, 24 hrs 2 PC T2C OTHER TESTS727 93233 ECG monitor/review, 24 hrs 2 PC T2C OTHER TESTS728 93237 ECG monitor/review, 24 hrs 2 PC T2C OTHER TESTS729 93272 Ecg/review, interpret only 2 PC T2C OTHER TESTS730 93722 Plethysmography report 2 PC T2D OTHER TESTS731 93727 Analyze ilr system 2 PC T2C OTHER TESTS732 93790 Review/report BP recording 2 PC T2D OTHER TESTS733 94016 Review patient spirometry 2 PC T2D OTHER TESTS734 96004 Phys review of motion tests 2 PC T2D OTHER TESTS735 92547 Supplemental electrical test 3 TC T2D OTHER TESTS736 92552 Pure tone audiometry, air 3 TC T2D OTHER TESTS737 92553 Audiometry, air & bone 3 TC T2D OTHER TESTS

11 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG738 92555 Speech threshold audiometry 3 TC T2D OTHER TESTS739 92556 Speech audiometry, complete 3 TC T2D OTHER TESTS740 92557 Comprehensive hearing test 3 TC T2D OTHER TESTS741 92561 Bekesy audiometry, diagnosis 3 TC T2D OTHER TESTS742 92562 Loudness balance test 3 TC T2D OTHER TESTS743 92563 Tone decay hearing test 3 TC T2D OTHER TESTS744 92564 Sisi hearing test 3 TC T2D OTHER TESTS745 92565 Stenger test, pure tone 3 TC T2D OTHER TESTS746 92567 Tympanometry 3 TC T2D OTHER TESTS747 92568 Acoustic reflex testing 3 TC T2D OTHER TESTS748 92569 Acoustic reflex decay test 3 TC T2D OTHER TESTS749 92571 Filtered speech hearing test 3 TC T2D OTHER TESTS750 92572 Staggered spondaic word test 3 TC T2D OTHER TESTS751 92573 Lombard test 3 TC T2D OTHER TESTS752 92575 Sensorineural acuity test 3 TC T2D OTHER TESTS753 92576 Synthetic sentence test 3 TC T2D OTHER TESTS754 92577 Stenger test, speech 3 TC T2D OTHER TESTS755 92579 Visual audiometry (vra) 3 TC T2D OTHER TESTS756 92582 Conditioning play audiometry 3 TC T2D OTHER TESTS757 92583 Select picture audiometry 3 TC T2D OTHER TESTS758 92584 Electrocochleography 3 TC T2D OTHER TESTS759 92586 Auditor evoke potent, limit 3 TC T2D OTHER TESTS760 92589 Auditory function test(s) 3 TC T2D OTHER TESTS761 92596 Ear protector evaluation 3 TC T2D OTHER TESTS762 93005 Electrocardiogram, tracing 3 TC T2A OTHER TESTS763 93012 Transmission of ecg 3 TC T2C OTHER TESTS764 93017 Cardiovascular stress test 3 TC T2B OTHER TESTS765 93041 Rhythm ECG, tracing 3 TC T2A OTHER TESTS766 93225 ECG monitor/record, 24 hrs 3 TC T2C OTHER TESTS767 93226 ECG monitor/report, 24 hrs 3 TC T2C OTHER TESTS768 93231 Ecg monitor/record, 24 hrs 3 TC T2C OTHER TESTS769 93232 ECG monitor/report, 24 hrs 3 TC T2C OTHER TESTS770 93236 ECG monitor/report, 24 hrs 3 TC T2C OTHER TESTS771 93270 ECG recording 3 TC T2C OTHER TESTS772 93271 Ecg/monitoring and analysis 3 TC T2C OTHER TESTS773 93721 Plethysmography tracing 3 TC T2D OTHER TESTS774 93786 Ambulatory BP recording 3 TC T2D OTHER TESTS775 93788 Ambulatory BP analysis 3 TC T2D OTHER TESTS776 94015 Patient recorded spirometry 3 TC T2D OTHER TESTS777 94760 Measure blood oxygen level 3 TC T2D OTHER TESTS778 94761 Measure blood oxygen level 3 TC T2D OTHER TESTS779 94762 Measure blood oxygen level 3 TC T2D OTHER TESTS780 95027 Id allergy titrate-airborne 3 TC T2D OTHER TESTS781 95028 Id allergy test-delayed type 3 TC T2D OTHER TESTS782 95060 Eye allergy tests 3 TC T2D OTHER TESTS783 95065 Nose allergy test 3 TC T2D OTHER TESTS784 95070 Bronchial allergy tests 3 TC T2D OTHER TESTS785 95071 Bronchial allergy tests 3 TC T2D OTHER TESTS786 95078 Provocative testing 3 TC T2D OTHER TESTS

12 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG787 93000 Electrocardiogram, complete 4 GLOB T2A OTHER TESTS788 93015 Cardiovascular stress test 4 GLOB T2B OTHER TESTS789 93040 Rhythm ECG with report 4 GLOB T2A OTHER TESTS790 93224 ECG monitor/report, 24 hrs 4 GLOB T2C OTHER TESTS791 93230 ECG monitor/report, 24 hrs 4 GLOB T2C OTHER TESTS792 93235 ECG monitor/report, 24 hrs 4 GLOB T2C OTHER TESTS793 93268 ECG record/review 4 GLOB T2C OTHER TESTS794 93720 Total body plethysmography 4 GLOB T2D OTHER TESTS795 93784 Ambulatory BP monitoring 4 GLOB T2D OTHER TESTS796 94014 Patient recorded spirometry 4 GLOB T2D OTHER TESTS797 95004 Percut allergy skin tests 5 TC T2D OTHER TESTS798 95024 Id allergy test, drug/bug 5 TC T2D OTHER TESTS799 95044 Allergy patch tests 5 TC T2D OTHER TESTS800 95052 Photo patch test 5 TC T2D OTHER TESTS801 95056 Photosensitivity tests 5 TC T2D OTHER TESTS829 70030 X-ray eye for foreign body 1 GLOB TC PC I1F STANDARD IMAGING830 70100 X-ray exam of jaw 1 GLOB TC PC I1B STANDARD IMAGING831 70110 X-ray exam of jaw 1 GLOB TC PC I1B STANDARD IMAGING832 70120 X-ray exam of mastoids 1 GLOB TC PC I1B STANDARD IMAGING833 70130 X-ray exam of mastoids 1 GLOB TC PC I1B STANDARD IMAGING834 70134 X-ray exam of middle ear 1 GLOB TC PC I1B STANDARD IMAGING835 70140 X-ray exam of facial bones 1 GLOB TC PC I1B STANDARD IMAGING836 70150 X-ray exam of facial bones 1 GLOB TC PC I1B STANDARD IMAGING837 70160 X-ray exam of nasal bones 1 GLOB TC PC I1B STANDARD IMAGING838 70170 X-ray exam of tear duct 1 GLOB TC PC I1F STANDARD IMAGING839 70190 X-ray exam of eye sockets 1 GLOB TC PC I1B STANDARD IMAGING840 70200 X-ray exam of eye sockets 1 GLOB TC PC I1B STANDARD IMAGING841 70210 X-ray exam of sinuses 1 GLOB TC PC I1B STANDARD IMAGING842 70220 X-ray exam of sinuses 1 GLOB TC PC I1B STANDARD IMAGING843 70240 X-ray exam, pituitary saddle 1 GLOB TC PC I1B STANDARD IMAGING844 70250 X-ray exam of skull 1 GLOB TC PC I1B STANDARD IMAGING845 70260 X-ray exam of skull 1 GLOB TC PC I1B STANDARD IMAGING846 70300 X-ray exam of teeth 1 GLOB TC PC I1B STANDARD IMAGING847 70310 X-ray exam of teeth 1 GLOB TC PC I1B STANDARD IMAGING848 70320 Full mouth x-ray of teeth 1 GLOB TC PC I1B STANDARD IMAGING849 70328 X-ray exam of jaw joint 1 GLOB TC PC I1B STANDARD IMAGING850 70330 X-ray exam of jaw joints 1 GLOB TC PC I1B STANDARD IMAGING851 70332 X-ray exam of jaw joint 1 GLOB TC PC I1B STANDARD IMAGING852 70350 X-ray head for orthodontia 1 GLOB TC PC I1B STANDARD IMAGING853 70355 Panoramic x-ray of jaws 1 GLOB TC PC I1B STANDARD IMAGING854 70360 X-ray exam of neck 1 GLOB TC PC I1F STANDARD IMAGING855 70370 Throat x-ray & fluoroscopy 1 GLOB TC PC I1F STANDARD IMAGING856 70371 Speech evaluation, complex 1 GLOB TC PC I1F STANDARD IMAGING857 70373 Contrast x-ray of larynx 1 GLOB TC PC I1D STANDARD IMAGING858 70380 X-ray exam of salivary gland 1 GLOB TC PC I1F STANDARD IMAGING859 70390 X-ray exam of salivary duct 1 GLOB TC PC I1F STANDARD IMAGING860 71010 Chest x-ray 1 GLOB TC PC I1A STANDARD IMAGING861 71015 Chest x-ray 1 GLOB TC PC I1A STANDARD IMAGING862 71020 Chest x-ray 1 GLOB TC PC I1A STANDARD IMAGING

13 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG863 71021 Chest x-ray 1 GLOB TC PC I1A STANDARD IMAGING864 71022 Chest x-ray 1 GLOB TC PC I1A STANDARD IMAGING865 71023 Chest x-ray and fluoroscopy 1 GLOB TC PC I1A STANDARD IMAGING866 71030 Chest x-ray 1 GLOB TC PC I1A STANDARD IMAGING867 71034 Chest x-ray and fluoroscopy 1 GLOB TC PC I1A STANDARD IMAGING868 71035 Chest x-ray 1 GLOB TC PC I1A STANDARD IMAGING869 71040 Contrast x-ray of bronchi 1 GLOB TC PC I1F STANDARD IMAGING870 71060 Contrast x-ray of bronchi 1 GLOB TC PC I1F STANDARD IMAGING871 71090 X-ray & pacemaker insertion 1 GLOB TC PC I1F STANDARD IMAGING872 71100 X-ray exam of ribs 1 GLOB TC PC I1B STANDARD IMAGING873 71101 X-ray exam of ribs/chest 1 GLOB TC PC I1B STANDARD IMAGING874 71110 X-ray exam of ribs 1 GLOB TC PC I1B STANDARD IMAGING875 71111 X-ray exam of ribs/ chest 1 GLOB TC PC I1B STANDARD IMAGING876 71120 X-ray exam of breastbone 1 GLOB TC PC I1B STANDARD IMAGING877 71130 X-ray exam of breastbone 1 GLOB TC PC I1B STANDARD IMAGING878 72010 X-ray exam of spine 1 GLOB TC PC I1B STANDARD IMAGING879 72020 X-ray exam of spine 1 GLOB TC PC I1B STANDARD IMAGING880 72040 X-ray exam of neck spine 1 GLOB TC PC I1B STANDARD IMAGING881 72050 X-ray exam of neck spine 1 GLOB TC PC I1B STANDARD IMAGING882 72052 X-ray exam of neck spine 1 GLOB TC PC I1B STANDARD IMAGING883 72069 X-ray exam of trunk spine 1 GLOB TC PC I1B STANDARD IMAGING884 72070 X-ray exam of thoracic spine 1 GLOB TC PC I1B STANDARD IMAGING885 72072 X-ray exam of thoracic spine 1 GLOB TC PC I1B STANDARD IMAGING886 72074 X-ray exam of thoracic spine 1 GLOB TC PC I1B STANDARD IMAGING887 72080 X-ray exam of trunk spine 1 GLOB TC PC I1B STANDARD IMAGING888 72090 X-ray exam of trunk spine 1 GLOB TC PC I1B STANDARD IMAGING889 72100 X-ray exam of lower spine 1 GLOB TC PC I1B STANDARD IMAGING890 72110 X-ray exam of lower spine 1 GLOB TC PC I1B STANDARD IMAGING891 72114 X-ray exam of lower spine 1 GLOB TC PC I1B STANDARD IMAGING892 72120 X-ray exam of lower spine 1 GLOB TC PC I1B STANDARD IMAGING893 72170 X-ray exam of pelvis 1 GLOB TC PC I1B STANDARD IMAGING894 72190 X-ray exam of pelvis 1 GLOB TC PC I1B STANDARD IMAGING895 72200 X-ray exam sacroiliac joints 1 GLOB TC PC I1B STANDARD IMAGING896 72202 X-ray exam sacroiliac joints 1 GLOB TC PC I1B STANDARD IMAGING897 72220 X-ray exam of tailbone 1 GLOB TC PC I1B STANDARD IMAGING898 73000 X-ray exam of collar bone 1 GLOB TC PC I1B STANDARD IMAGING899 73010 X-ray exam of shoulder blade 1 GLOB TC PC I1B STANDARD IMAGING900 73020 X-ray exam of shoulder 1 GLOB TC PC I1B STANDARD IMAGING901 73030 X-ray exam of shoulder 1 GLOB TC PC I1B STANDARD IMAGING902 73050 X-ray exam of shoulders 1 GLOB TC PC I1B STANDARD IMAGING903 73060 X-ray exam of humerus 1 GLOB TC PC I1B STANDARD IMAGING904 73070 X-ray exam of elbow 1 GLOB TC PC I1B STANDARD IMAGING905 73080 X-ray exam of elbow 1 GLOB TC PC I1B STANDARD IMAGING906 73090 X-ray exam of forearm 1 GLOB TC PC I1B STANDARD IMAGING907 73092 X-ray exam of arm, infant 1 GLOB TC PC I1B STANDARD IMAGING908 73100 X-ray exam of wrist 1 GLOB TC PC I1B STANDARD IMAGING909 73110 X-ray exam of wrist 1 GLOB TC PC I1B STANDARD IMAGING910 73120 X-ray exam of hand 1 GLOB TC PC I1B STANDARD IMAGING911 73130 X-ray exam of hand 1 GLOB TC PC I1B STANDARD IMAGING

14 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG912 73140 X-ray exam of finger(s) 1 GLOB TC PC I1B STANDARD IMAGING913 73500 X-ray exam of hip 1 GLOB TC PC I1B STANDARD IMAGING914 73510 X-ray exam of hip 1 GLOB TC PC I1B STANDARD IMAGING915 73520 X-ray exam of hips 1 GLOB TC PC I1B STANDARD IMAGING916 73530 X-ray exam of hip 1 GLOB TC PC I1B STANDARD IMAGING917 73540 X-ray exam of pelvis & hips 1 GLOB TC PC I1B STANDARD IMAGING918 73550 X-ray exam of thigh 1 GLOB TC PC I1B STANDARD IMAGING919 73560 X-ray exam of knee, 1 or 2 1 GLOB TC PC I1B STANDARD IMAGING920 73562 X-ray exam of knee, 3 1 GLOB TC PC I1B STANDARD IMAGING921 73564 X-ray exam, knee, 4 or more 1 GLOB TC PC I1B STANDARD IMAGING922 73565 X-ray exam of knees 1 GLOB TC PC I1B STANDARD IMAGING923 73590 X-ray exam of lower leg 1 GLOB TC PC I1B STANDARD IMAGING924 73592 X-ray exam of leg, infant 1 GLOB TC PC I1B STANDARD IMAGING925 73600 X-ray exam of ankle 1 GLOB TC PC I1B STANDARD IMAGING926 73610 X-ray exam of ankle 1 GLOB TC PC I1B STANDARD IMAGING927 73620 X-ray exam of foot 1 GLOB TC PC I1B STANDARD IMAGING928 73630 X-ray exam of foot 1 GLOB TC PC I1B STANDARD IMAGING929 73650 X-ray exam of heel 1 GLOB TC PC I1B STANDARD IMAGING930 73660 X-ray exam of toe(s) 1 GLOB TC PC I1B STANDARD IMAGING931 74000 X-ray exam of abdomen 1 GLOB TC PC I1F STANDARD IMAGING932 74010 X-ray exam of abdomen 1 GLOB TC PC I1F STANDARD IMAGING933 74020 X-ray exam of abdomen 1 GLOB TC PC I1F STANDARD IMAGING934 74022 X-ray exam series, abdomen 1 GLOB TC PC I1F STANDARD IMAGING935 74210 Contrst x-ray exam of throat 1 GLOB TC PC I1D STANDARD IMAGING936 74220 Contrast x-ray, esophagus 1 GLOB TC PC I1D STANDARD IMAGING937 74230 Cine/vid x-ray, throat/esoph 1 GLOB TC PC I1D STANDARD IMAGING938 74235 Remove esophagus obstruction 1 GLOB TC PC I1F STANDARD IMAGING939 74240 X-ray exam, upper gi tract 1 GLOB TC PC I1D STANDARD IMAGING940 74241 X-ray exam, upper gi tract 1 GLOB TC PC I1D STANDARD IMAGING941 74245 X-ray exam, upper gi tract 1 GLOB TC PC I1D STANDARD IMAGING942 74246 Contrst x-ray uppr gi tract 1 GLOB TC PC I1D STANDARD IMAGING943 74247 Contrst x-ray uppr gi tract 1 GLOB TC PC I1D STANDARD IMAGING944 74249 Contrst x-ray uppr gi tract 1 GLOB TC PC I1D STANDARD IMAGING945 74250 X-ray exam of small bowel 1 GLOB TC PC I1D STANDARD IMAGING946 74251 X-ray exam of small bowel 1 GLOB TC PC I1D STANDARD IMAGING947 74260 X-ray exam of small bowel 1 GLOB TC PC I1D STANDARD IMAGING948 74270 Contrast x-ray exam of colon 1 GLOB TC PC I1D STANDARD IMAGING949 74280 Contrast x-ray exam of colon 1 GLOB TC PC I1D STANDARD IMAGING950 74290 Contrast x-ray, gallbladder 1 GLOB TC PC I1D STANDARD IMAGING951 74291 Contrast x-rays, gallbladder 1 GLOB TC PC I1D STANDARD IMAGING952 74300 X-ray bile ducts/pancreas 1 GLOB TC PC I1D STANDARD IMAGING953 74301 X-rays at surgery add-on 1 GLOB TC PC I1D STANDARD IMAGING954 74305 X-ray bile ducts/pancreas 1 GLOB TC PC I1D STANDARD IMAGING955 74320 Contrast x-ray of bile ducts 1 GLOB TC PC I1D STANDARD IMAGING956 74327 X-ray bile stone removal 1 GLOB TC PC I1D STANDARD IMAGING957 74328 X-ray bile duct endoscopy 1 GLOB TC PC I1D STANDARD IMAGING958 74329 X-ray for pancreas endoscopy 1 GLOB TC PC I1D STANDARD IMAGING959 74330 X-ray bile/panc endoscopy 1 GLOB TC PC I1D STANDARD IMAGING960 74340 X-ray guide for GI tube 1 GLOB TC PC I1D STANDARD IMAGING

15 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG961 74350 X-ray guide, stomach tube 1 GLOB TC PC I1D STANDARD IMAGING962 74355 X-ray guide, intestinal tube 1 GLOB TC PC I1D STANDARD IMAGING963 74360 X-ray guide, GI dilation 1 GLOB TC PC I1D STANDARD IMAGING964 74363 X-ray, bile duct dilation 1 GLOB TC PC I1D STANDARD IMAGING965 74400 Contrst x-ray, urinary tract 1 GLOB TC PC I1F STANDARD IMAGING966 74410 Contrst x-ray, urinary tract 1 GLOB TC PC I1F STANDARD IMAGING967 74415 Contrst x-ray, urinary tract 1 GLOB TC PC I1F STANDARD IMAGING968 74420 Contrst x-ray, urinary tract 1 GLOB TC PC I1F STANDARD IMAGING969 74425 Contrst x-ray, urinary tract 1 GLOB TC PC I1F STANDARD IMAGING970 74430 Contrast x-ray, bladder 1 GLOB TC PC I1F STANDARD IMAGING971 74440 X-ray, male genital tract 1 GLOB TC PC I1F STANDARD IMAGING972 74445 X-ray exam of penis 1 GLOB TC PC I1F STANDARD IMAGING973 74450 X-ray, urethra/bladder 1 GLOB TC PC I1F STANDARD IMAGING974 74455 X-ray, urethra/bladder 1 GLOB TC PC I1F STANDARD IMAGING975 74470 X-ray exam of kidney lesion 1 GLOB TC PC I1F STANDARD IMAGING976 74475 X-ray control, cath insert 1 GLOB TC PC I1F STANDARD IMAGING977 74480 X-ray control, cath insert 1 GLOB TC PC I1F STANDARD IMAGING978 74485 X-ray guide, GU dilation 1 GLOB TC PC I1F STANDARD IMAGING979 74710 X-ray measurement of pelvis 1 GLOB TC PC I1F STANDARD IMAGING980 74740 X-ray, female genital tract 1 GLOB TC PC I1F STANDARD IMAGING981 74742 X-ray, fallopian tube 1 GLOB TC PC I1F STANDARD IMAGING982 74775 X-ray exam of perineum 1 GLOB TC PC I1F STANDARD IMAGING983 75809 Nonvascular shunt, x-ray 1 GLOB TC PC I1F STANDARD IMAGING984 75894 X-rays, transcath therapy 1 GLOB TC PC I1F STANDARD IMAGING985 75896 X-rays, transcath therapy 1 GLOB TC PC I1F STANDARD IMAGING986 75900 Arterial catheter exchange 1 GLOB TC PC I1F STANDARD IMAGING987 75940 X-ray placement, vein filter 1 GLOB TC PC I1F STANDARD IMAGING988 75952 Endovasc repair abdom aorta 1 GLOB TC PC I1F STANDARD IMAGING989 75953 Abdom aneurysm endovas rpr 1 GLOB TC PC I1F STANDARD IMAGING990 75954 Iliac aneurysm endovas rpr 1 GLOB TC PC I1F STANDARD IMAGING991 75960 Transcatheter intro, stent 1 GLOB TC PC I1F STANDARD IMAGING992 75961 Retrieval, broken catheter 1 GLOB TC PC I1F STANDARD IMAGING993 75962 Repair arterial blockage 1 GLOB TC PC I1F STANDARD IMAGING994 75964 Repair artery blockage, each 1 GLOB TC PC I1F STANDARD IMAGING995 75966 Repair arterial blockage 1 GLOB TC PC I1F STANDARD IMAGING996 75968 Repair artery blockage, each 1 GLOB TC PC I1F STANDARD IMAGING997 75970 Vascular biopsy 1 GLOB TC PC I1F STANDARD IMAGING998 75978 Repair venous blockage 1 GLOB TC PC I1F STANDARD IMAGING999 75980 Contrast xray exam bile duct 1 GLOB TC PC I1F STANDARD IMAGING1000 75982 Contrast xray exam bile duct 1 GLOB TC PC I1F STANDARD IMAGING1001 75984 Xray control catheter change 1 GLOB TC PC I1F STANDARD IMAGING1002 75989 Abscess drainage under x-ray 1 GLOB TC PC I1F STANDARD IMAGING1003 75992 Atherectomy, x-ray exam 1 GLOB TC PC I1F STANDARD IMAGING1004 75993 Atherectomy, x-ray exam 1 GLOB TC PC I1F STANDARD IMAGING1005 75994 Atherectomy, x-ray exam 1 GLOB TC PC I1F STANDARD IMAGING1006 75995 Atherectomy, x-ray exam 1 GLOB TC PC I1F STANDARD IMAGING1007 75996 Atherectomy, x-ray exam 1 GLOB TC PC I1F STANDARD IMAGING1008 76010 X-ray, nose to rectum 1 GLOB TC PC I1F STANDARD IMAGING1009 76012 Percut vertebroplasty fluor 1 GLOB TC PC I1F STANDARD IMAGING

16 of 20

April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG1010 76013 Percut vertebroplasty, ct 1 GLOB TC PC I1F STANDARD IMAGING1011 76020 X-rays for bone age 1 GLOB TC PC I1B STANDARD IMAGING1012 76040 X-rays, bone evaluation 1 GLOB TC PC I1B STANDARD IMAGING1013 76061 X-rays, bone survey 1 GLOB TC PC I1B STANDARD IMAGING1014 76062 X-rays, bone survey 1 GLOB TC PC I1B STANDARD IMAGING1015 76065 X-rays, bone evaluation 1 GLOB TC PC I1B STANDARD IMAGING1016 76066 Joint survey, single view 1 GLOB TC PC I1B STANDARD IMAGING1017 76075 Dexa, axial skeleton study 1 GLOB TC PC I1B STANDARD IMAGING1018 76080 X-ray exam of fistula 1 GLOB TC PC I1F STANDARD IMAGING1019 76082 Computer mammogram add-on 1 GLOB TC PC I1C STANDARD IMAGING1020 76083 Computer mammogram add-on 1 GLOB TC PC I1C STANDARD IMAGING1021 76086 X-ray of mammary duct 1 GLOB TC PC I1C STANDARD IMAGING1022 76088 X-ray of mammary ducts 1 GLOB TC PC I1C STANDARD IMAGING1023 76090 Mammogram, one breast 1 GLOB TC PC I1C STANDARD IMAGING1024 76091 Mammogram, both breasts 1 GLOB TC PC I1C STANDARD IMAGING1025 76092 Mammogram, screening 1 GLOB TC PC I1C STANDARD IMAGING1026 76095 Stereotactic breast biopsy 1 GLOB TC PC I1C STANDARD IMAGING1027 76096 X-ray of needle wire, breast 1 GLOB TC PC I1C STANDARD IMAGING1028 76098 X-ray exam, breast specimen 1 GLOB TC PC I1C STANDARD IMAGING1029 76100 X-ray exam of body section 1 GLOB TC PC I1F STANDARD IMAGING1030 76101 Complex body section x-ray 1 GLOB TC PC I1F STANDARD IMAGING1031 76102 Complex body section x-rays 1 GLOB TC PC I1F STANDARD IMAGING1032 76120 Cine/video x-rays 1 GLOB TC PC I1F STANDARD IMAGING1033 76125 Cine/video x-rays add-on 1 GLOB TC PC I1F STANDARD IMAGING1034 78000 Thyroid, single uptake 1 GLOB TC PC I1E STANDARD IMAGING1035 78001 Thyroid, multiple uptakes 1 GLOB TC PC I1E STANDARD IMAGING1036 78003 Thyroid suppress/stimul 1 GLOB TC PC I1E STANDARD IMAGING1037 78006 Thyroid imaging with uptake 1 GLOB TC PC I1E STANDARD IMAGING1038 78007 Thyroid image, mult uptakes 1 GLOB TC PC I1E STANDARD IMAGING1039 78010 Thyroid imaging 1 GLOB TC PC I1E STANDARD IMAGING1040 78011 Thyroid imaging with flow 1 GLOB TC PC I1E STANDARD IMAGING1041 78015 Thyroid met imaging 1 GLOB TC PC I1E STANDARD IMAGING1042 78016 Thyroid met imaging/studies 1 GLOB TC PC I1E STANDARD IMAGING1043 78018 Thyroid met imaging, body 1 GLOB TC PC I1E STANDARD IMAGING1044 78020 Thyroid met uptake 1 GLOB TC PC I1E STANDARD IMAGING1045 78070 Parathyroid nuclear imaging 1 GLOB TC PC I1E STANDARD IMAGING1046 78075 Adrenal nuclear imaging 1 GLOB TC PC I1E STANDARD IMAGING1047 78099 Endocrine nuclear procedure 1 GLOB TC PC I1E STANDARD IMAGING1048 78102 Bone marrow imaging, ltd 1 GLOB TC PC I1E STANDARD IMAGING1049 78103 Bone marrow imaging, mult 1 GLOB TC PC I1E STANDARD IMAGING1050 78104 Bone marrow imaging, body 1 GLOB TC PC I1E STANDARD IMAGING1051 78110 Plasma volume, single 1 GLOB TC PC I1E STANDARD IMAGING1052 78111 Plasma volume, multiple 1 GLOB TC PC I1E STANDARD IMAGING1053 78120 Red cell mass, single 1 GLOB TC PC I1E STANDARD IMAGING1054 78121 Red cell mass, multiple 1 GLOB TC PC I1E STANDARD IMAGING1055 78122 Blood volume 1 GLOB TC PC I1E STANDARD IMAGING1056 78130 Red cell survival study 1 GLOB TC PC I1E STANDARD IMAGING1057 78135 Red cell survival kinetics 1 GLOB TC PC I1E STANDARD IMAGING1058 78140 Red cell sequestration 1 GLOB TC PC I1E STANDARD IMAGING

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April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG1059 78160 Plasma iron turnover 1 GLOB TC PC I1E STANDARD IMAGING1060 78162 Radioiron absorption exam 1 GLOB TC PC I1E STANDARD IMAGING1061 78170 Red cell iron utilization 1 GLOB TC PC I1E STANDARD IMAGING1062 78172 Total body iron estimation 1 GLOB TC PC I1E STANDARD IMAGING1063 78185 Spleen imaging 1 GLOB TC PC I1E STANDARD IMAGING1064 78190 Platelet survival, kinetics 1 GLOB TC PC I1E STANDARD IMAGING1065 78191 Platelet survival 1 GLOB TC PC I1E STANDARD IMAGING1066 78195 Lymph system imaging 1 GLOB TC PC I1E STANDARD IMAGING1067 78199 Blood/lymph nuclear exam 1 GLOB TC PC I1E STANDARD IMAGING1068 78201 Liver imaging 1 GLOB TC PC I1E STANDARD IMAGING1069 78202 Liver imaging with flow 1 GLOB TC PC I1E STANDARD IMAGING1070 78205 Liver imaging (3D) 1 GLOB TC PC I1E STANDARD IMAGING1071 78206 Liver image (3d) with flow 1 GLOB TC PC I1E STANDARD IMAGING1072 78215 Liver and spleen imaging 1 GLOB TC PC I1E STANDARD IMAGING1073 78216 Liver & spleen image/flow 1 GLOB TC PC I1E STANDARD IMAGING1074 78220 Liver function study 1 GLOB TC PC I1E STANDARD IMAGING1075 78223 Hepatobiliary imaging 1 GLOB TC PC I1E STANDARD IMAGING1076 78230 Salivary gland imaging 1 GLOB TC PC I1E STANDARD IMAGING1077 78231 Serial salivary imaging 1 GLOB TC PC I1E STANDARD IMAGING1078 78232 Salivary gland function exam 1 GLOB TC PC I1E STANDARD IMAGING1079 78258 Esophageal motility study 1 GLOB TC PC I1E STANDARD IMAGING1080 78261 Gastric mucosa imaging 1 GLOB TC PC I1E STANDARD IMAGING1081 78262 Gastroesophageal reflux exam 1 GLOB TC PC I1E STANDARD IMAGING1082 78264 Gastric emptying study 1 GLOB TC PC I1E STANDARD IMAGING1083 78270 Vit B-12 absorption exam 1 GLOB TC PC I1E STANDARD IMAGING1084 78271 Vit b-12 absrp exam, int fac 1 GLOB TC PC I1E STANDARD IMAGING1085 78272 Vit B-12 absorp, combined 1 GLOB TC PC I1E STANDARD IMAGING1086 78278 Acute GI blood loss imaging 1 GLOB TC PC I1E STANDARD IMAGING1087 78282 GI protein loss exam 1 GLOB TC PC I1E STANDARD IMAGING1088 78290 Meckel’s divert exam 1 GLOB TC PC I1E STANDARD IMAGING1089 78291 Leveen/shunt patency exam 1 GLOB TC PC I1E STANDARD IMAGING1090 78299 GI nuclear procedure 1 GLOB TC PC I1E STANDARD IMAGING1091 78300 Bone imaging, limited area 1 GLOB TC PC I1E STANDARD IMAGING1092 78305 Bone imaging, multiple areas 1 GLOB TC PC I1E STANDARD IMAGING1093 78306 Bone imaging, whole body 1 GLOB TC PC I1E STANDARD IMAGING1094 78315 Bone imaging, 3 phase 1 GLOB TC PC I1E STANDARD IMAGING1095 78320 Bone imaging (3D) 1 GLOB TC PC I1E STANDARD IMAGING1096 78350 Bone mineral, single photon 1 GLOB TC PC I1E STANDARD IMAGING1097 78399 Musculoskeletal nuclear exam 1 GLOB TC PC I1E STANDARD IMAGING1098 78414 Non-imaging heart function 1 GLOB TC PC I1E STANDARD IMAGING1099 78428 Cardiac shunt imaging 1 GLOB TC PC I1E STANDARD IMAGING1100 78445 Vascular flow imaging 1 GLOB TC PC I1E STANDARD IMAGING1101 78455 Venous thrombosis study 1 GLOB TC PC I1E STANDARD IMAGING1102 78456 Acute venous thrombus image 1 GLOB TC PC I1E STANDARD IMAGING1103 78457 Venous thrombosis imaging 1 GLOB TC PC I1E STANDARD IMAGING1104 78458 Ven thrombosis images, bilat 1 GLOB TC PC I1E STANDARD IMAGING1105 78459 Heart muscle imaging (PET) 1 GLOB TC PC I1E STANDARD IMAGING1106 78460 Heart muscle blood, single 1 GLOB TC PC I1E STANDARD IMAGING1107 78461 Heart muscle blood, multiple 1 GLOB TC PC I1E STANDARD IMAGING

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April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG1108 78464 Heart image (3d), single 1 GLOB TC PC I1E STANDARD IMAGING1109 78465 Heart image (3d), multiple 1 GLOB TC PC I1E STANDARD IMAGING1110 78466 Heart infarct image 1 GLOB TC PC I1E STANDARD IMAGING1111 78468 Heart infarct image (ef) 1 GLOB TC PC I1E STANDARD IMAGING1112 78469 Heart infarct image (3D) 1 GLOB TC PC I1E STANDARD IMAGING1113 78472 Gated heart, planar, single 1 GLOB TC PC I1E STANDARD IMAGING1114 78473 Gated heart, multiple 1 GLOB TC PC I1E STANDARD IMAGING1115 78478 Heart wall motion add-on 1 GLOB TC PC I1E STANDARD IMAGING1116 78480 Heart function add-on 1 GLOB TC PC I1E STANDARD IMAGING1117 78481 Heart first pass, single 1 GLOB TC PC I1E STANDARD IMAGING1118 78483 Heart first pass, multiple 1 GLOB TC PC I1E STANDARD IMAGING1119 78494 Heart image, spect 1 GLOB TC PC I1E STANDARD IMAGING1120 78496 Heart first pass add-on 1 GLOB TC PC I1E STANDARD IMAGING1121 78499 Cardiovascular nuclear exam 1 GLOB TC PC I1E STANDARD IMAGING1122 78580 Lung perfusion imaging 1 GLOB TC PC I1E STANDARD IMAGING1123 78584 Lung V/Q image single breath 1 GLOB TC PC I1E STANDARD IMAGING1124 78585 Lung V/Q imaging 1 GLOB TC PC I1E STANDARD IMAGING1125 78586 Aerosol lung image, single 1 GLOB TC PC I1E STANDARD IMAGING1126 78587 Aerosol lung image, multiple 1 GLOB TC PC I1E STANDARD IMAGING1127 78588 Perfusion lung image 1 GLOB TC PC I1E STANDARD IMAGING1128 78591 Vent image, 1 breath, 1 proj 1 GLOB TC PC I1E STANDARD IMAGING1129 78593 Vent image, 1 proj, gas 1 GLOB TC PC I1E STANDARD IMAGING1130 78594 Vent image, mult proj, gas 1 GLOB TC PC I1E STANDARD IMAGING1131 78596 Lung differential function 1 GLOB TC PC I1E STANDARD IMAGING1132 78599 Respiratory nuclear exam 1 GLOB TC PC I1E STANDARD IMAGING1133 78600 Brain imaging, ltd static 1 GLOB TC PC I1E STANDARD IMAGING1134 78601 Brain imaging, ltd w/flow 1 GLOB TC PC I1E STANDARD IMAGING1135 78605 Brain imaging, complete 1 GLOB TC PC I1E STANDARD IMAGING1136 78606 Brain imaging, compl w/flow 1 GLOB TC PC I1E STANDARD IMAGING1137 78607 Brain imaging (3D) 1 GLOB TC PC I1E STANDARD IMAGING1138 78610 Brain flow imaging only 1 GLOB TC PC I1E STANDARD IMAGING1139 78615 Cerebral vascular flow image 1 GLOB TC PC I1E STANDARD IMAGING1140 78630 Cerebrospinal fluid scan 1 GLOB TC PC I1E STANDARD IMAGING1141 78635 CSF ventriculography 1 GLOB TC PC I1E STANDARD IMAGING1142 78645 CSF shunt evaluation 1 GLOB TC PC I1E STANDARD IMAGING1143 78647 Cerebrospinal fluid scan 1 GLOB TC PC I1E STANDARD IMAGING1144 78650 CSF leakage imaging 1 GLOB TC PC I1E STANDARD IMAGING1145 78660 Nuclear exam of tear flow 1 GLOB TC PC I1E STANDARD IMAGING1146 78699 Nervous system nuclear exam 1 GLOB TC PC I1E STANDARD IMAGING1147 78700 Kidney imaging, static 1 GLOB TC PC I1E STANDARD IMAGING1148 78701 Kidney imaging with flow 1 GLOB TC PC I1E STANDARD IMAGING1149 78704 Imaging renogram 1 GLOB TC PC I1E STANDARD IMAGING1150 78707 Kidney flow/function image 1 GLOB TC PC I1E STANDARD IMAGING1151 78708 Kidney flow/function image 1 GLOB TC PC I1E STANDARD IMAGING1152 78709 Kidney flow/function image 1 GLOB TC PC I1E STANDARD IMAGING1153 78710 Kidney imaging (3D) 1 GLOB TC PC I1E STANDARD IMAGING1154 78715 Renal vascular flow exam 1 GLOB TC PC I1E STANDARD IMAGING1155 78725 Kidney function study 1 GLOB TC PC I1E STANDARD IMAGING1156 78730 Urinary bladder retention 1 GLOB TC PC I1E STANDARD IMAGING

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April 2005 Abstract of Medicare Physician Fee Schedule for Purchased Diagnostic Services

(sorted by BTOSCATG, PCTC, and HCPCS)

OBS HCPCS SHRTDESC PCTC GLOB TC PC BETOS BTOSCATG1157 78740 Ureteral reflux study 1 GLOB TC PC I1E STANDARD IMAGING1158 78760 Testicular imaging 1 GLOB TC PC I1E STANDARD IMAGING1159 78761 Testicular imaging/flow 1 GLOB TC PC I1E STANDARD IMAGING1160 78799 Genitourinary nuclear exam 1 GLOB TC PC I1E STANDARD IMAGING1161 78800 Tumor imaging, limited area 1 GLOB TC PC I1E STANDARD IMAGING1162 78801 Tumor imaging, mult areas 1 GLOB TC PC I1E STANDARD IMAGING1163 78802 Tumor imaging, whole body 1 GLOB TC PC I1E STANDARD IMAGING1164 78803 Tumor imaging (3D) 1 GLOB TC PC I1E STANDARD IMAGING1165 78804 Tumor imaging, whole body 1 GLOB TC PC I1E STANDARD IMAGING1166 78805 Abscess imaging, ltd area 1 GLOB TC PC I1E STANDARD IMAGING1167 78806 Abscess imaging, whole body 1 GLOB TC PC I1E STANDARD IMAGING1168 78807 Nuclear localization/abscess 1 GLOB TC PC I1E STANDARD IMAGING1169 78999 Nuclear diagnostic exam 1 GLOB TC PC I1E STANDARD IMAGING1170 79403 Hematopoetic nuclear therapy 1 GLOB TC PC I1E STANDARD IMAGING1171 G0106 Colon CA screen;barium enema 1 GLOB TC PC I1D STANDARD IMAGING1172 G0120 Colon ca scrn; barium enema 1 GLOB TC PC I1D STANDARD IMAGING1173 G0202 Screeningmammographydigital 1 GLOB TC PC I1C STANDARD IMAGING1174 G0204 Diagnosticmammographydigital 1 GLOB TC PC I1C STANDARD IMAGING1175 G0206 Diagnosticmammographydigital 1 GLOB TC PC I1C STANDARD IMAGING1176 G0254 PET image brst eval to tx 1 GLOB TC PC I1C STANDARD IMAGING1177 76006 X-ray stress view 2 PC I1B STANDARD IMAGING1178 76150 X-ray exam, dry process 3 TC I1F STANDARD IMAGING1179 76350 Special x-ray contrast study 3 TC I1F STANDARD IMAGING1180 79900 Provide ther radiopharm(s) 3 TC I1E STANDARD IMAGING1181 Q0092 Set up port xray equipment 3 TC I1F STANDARD IMAGING1182 R0070 Transport portable x-ray 3 TC I1F STANDARD IMAGING1183 R0075 Transport port x-ray multipl 3 TC I1F STANDARD IMAGING1184 92607 Ex for speech device rx, 1hr 0 TC O1F VISION1185 92608 Ex for speech device rx addl 0 TC O1F VISION1186 92609 Use of speech device service 0 TC O1F VISION

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