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Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
02 UPTAKE,REST INDIRECT 94690 $161.00
17-HYDROXYPREGNENOLONE 84143 $211.00
3D RENDER W/O IMAGE POSTPROCESS 76376 $135.00
3D RENDERING W/ IMAGE POSTPROCESS 76377 $322.00
AB DETECTION NOS IMMUNOFLUORES REF 87299 $76.00
AB ID,PLATELET IMMUNOG.ASSAY 86023 $115.00
AB IGM HERPES SIMPLEX TYPE 1 REF 86695 $122.00
AB IGM HERPES SIMPLEX TYPE 2 REF 86696 $179.00
AB NEISSERIA MENINGITIDIS REF 86741 $446.00
AB,BORRELIA BURGDORFERI CONFRM 86617 $143.00
ABD/LOW EXT A, 1ST ORDER 36245 $1,359.00
ABDOM,B-SCAN &/OR REAL TIME,COMP 76700 $1,125.00
ABDOMEN COMP ACUTE SERIES 74022 $1,125.00
ABDOMEN LIMITED 76705 $1,125.00
ABDOMINAL AORTOGRAM S&I 75625 $26,415.00
ABLATE ARRHYTHMIA ADD ON 93655 $1,996.00
ABO (BLOOD GROUP) 86900 $799.00
ABO BLOOD GROUP BLD 86900 $799.00
ACETONE OR KETONES-SERUM-QUANT 82010 $76.00
ACT PROTEIN C RESISTANCE ASSAY REF 85307 $142.00
ACTH 82024 $358.00
ACTIVATED CLOTTING TIME (ACT) 85347 $39.00
ACUTE GI BLOOD LOSS IMAGING 78278 $3,535.00
ACUTE HEPATITIS PANEL LAB 80074 $441.00
ACYLCARNITINE QUANT 82017 $156.00
ADENOVIRUS BY DFA 87260 $111.00
AEROSOL PENTAMINDINE TREATMENT 94642 $958.00
AEROSOL/VAPOR INHALATIONS 94640 $958.00
AFP L3 FRACTION & TOTAL AFP REF 82107 $596.00
AFTERLOAD BRACHY WWO DOSI >12CH 77772 $7,047.00
AFTERLOAD BRACHY WWO DOSI 1CH 77770 $7,047.00
AFTERLOAD BRACHY WWO DOSI 2-12CH 77771 $7,047.00
AGGLUTININS,FEBRILE,E.ANTIGEN 86000 $65.00
AICD GENERATOR REMOVAL 33241 $17,218.00
AICD LEAD(S) EXTRACTION (S) 33244 $17,218.00
AIR/CONTRAST INJECT INTO ABDOMEN 49400 $530.00
AIRWAY INHALATION TREATMENT 94640 $958.00
ALBUMIN OTHER SOURCE QUAN EA LAB 82042 $58.00
ALBUMIN,SERUM 82040 $46.00
ALCOHOL BIOMARKERS REF G0480 $858.00
ALDOLASE 82085 $90.00
ALDOSTERONE REF 82088 $377.00
Page 1 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
ALERT TEAM TELEMED CVMC ONLY $219.00
ALKALINE PHOSPHATASE 84075 $48.00
ALKALOIDS NOS REF G0480 $858.00
ALLERGEN SPEC IGE QUAL MULTIAL LAB 86005 $74.00
ALLERGEN SPEC IGE QUAN SEMIQUAN LAB 86003 $48.00
ALLERGEN SPEC IGE RECOMB EA REF 86008 $166.00
ALLERGEN SPECIFIC IGG 86001 $59.00
ALPHA FETO PROTEIN 82105 $155.00
ALPHA FETOPROTEIN AM 82106 $155.00
ALPHA I ANTITRYPSIN 82103 $124.00
ALPHA-1-ANTITRYPSIN,PHENOTYPE 82104 $134.00
ALUMINUM 82108 $236.00
AMBULATORY 24HR BP ANALYSIS 93788 $479.00
AMBULATORY 24HR BP RECORDING 93786 $479.00
AMBULATORY PH/24 HR 91034 $2,504.00
AMIKACIN 80150 $140.00
AMINO ACID SINGL QUANT EA SPEC 82131 $172.00
AMINO ACIDS QUANT 82139 $156.00
AMINOLEVULINIC ACID 82135 $152.00
AMMONIA 82140 $135.00
AMNIOCENTESIS,THER AMNIOTIC FLUID REDUCT 59001 $1,502.00
AMNIOCENTESIS-DIAGNOSTIC 59000 $3,069.00
AMYLASE 82150 $60.00
AMYLASE URINE TIMED 82150 $60.00
ANA (ANTI NUCLEAR ANTIBODY) 86038 $112.00
ANAL URINARY MUSCLE STUDY 51785 $1,273.00
ANALYSIS IMP NEUROSTIM ADDL 15 MIN 95984 $204.00
ANALYSIS IMP NEUROSTIM FIRST 15 MIN 95983 $167.00
ANALYSIS,NEUROSTIM W/O PROG 95970 $479.00
ANALYZE CRANIAL NEUROSTIM COMPLEX PRGM 95977 $529.00
ANALYZE CRANIAL NEUROSTIM SIMPLE PRGM 95976 $167.00
ANASCOPY;DIAGNOSTIC 46600 $586.00
ANDROSTENEDIONE 82157 $271.00
ANES TIME/MIN $48.00
ANESTHESIA $48.00
ANES-TIME GENERAL $48.00
ANGIO AORTOBIFEMORAL W CATH 75630 $26,415.00
ANGIO AORTOGRAM ABD SERIAL 75625 $26,415.00
ANGIO AORTOGRAM THOR SERIAL 75605 $43,765.00
ANGIO EA ADDNL SELECTV VESSEL 75774 $674.00
ANGIO EXTERMITY BILAT 75716 $26,415.00
ANGIO EXTREMITY UNILAT 75710 $26,415.00
Page 2 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
ANGIO PELVIS 75736 $43,765.00
ANGIO PULMON BILAT SELECT 75743 $26,415.00
ANGIO PULMON UNILAT SELECT 75741 $26,415.00
ANGIO SPINAL SELECTV 75705 $43,765.00
ANGIO VISCERAL SELECTV/SUBSELEC 75726 $43,765.00
ANGIOGRAM,F/U STUDY,CATH THER/EMBOL 75898 $10,936.00
ANGIOTENSIN I CONV ENZYME 82164 $135.00
ANGIOTENSIN II 82163 $190.00
ANNUAL WELLNESS VISIT INITIAL G0438 $877.00
ANNUAL WELLNESS VISIT SUBSEQ G0439 $595.00
ANTI THY MICROSOMAL 86376 $135.00
ANTI THYROGLOBULIN 86800 $147.00
ANTIBODY CANDIDA REF 86628 $111.00
ANTIBODY CYTOMEGALOVIRUS (CMV) REF 86644 $133.00
ANTIBODY CYTOMEGALOVIRUS IGM REF 86645 $156.00
ANTIBODY ID PLATELET ANTIBODIES LAB 86022 $170.00
ANTIBODY INFLUENZA VIRUS 86710 $125.00
ANTIBODY MUMPS LAB 86735 $121.00
ANTIBODY MUMPS REF 86735 $121.00
ANTIBODY TOXOPLASMA IGM REF 86778 $133.00
ANTIBODY TOXOPLASMA REF 86777 $133.00
ANTIBODY YERSINIA REF 86793 $122.00
ANTIBODY, ASPERGILLUS 86606 $139.00
ANTIBODY, BRUCELLA 86622 $83.00
ANTIBODY, VARICELLA-ZOSTER 86787 $119.00
ANTIBODY,BACTERIUM,NOT SPEC. 86609 $119.00
ANTIBODY,CAMPYLOBACTER 86625 $122.00
ANTIBODY,CHLAMYDIA,IGM 86632 $117.00
ANTIBODY,COCCIDIOIDES 86635 $106.00
ANTIBODY,COXIELLA BRUNETII 86638 $112.00
ANTIBODY,EHRLICHIA 86666 $94.00
ANTIBODY,ENCEPHALITIS,CA. 86651 $122.00
ANTIBODY,ENCEPHALITIS,EAST EQ. 86652 $122.00
ANTIBODY,ENCEPHALITIS,ST.LOUIS 86653 $122.00
ANTIBODY,ENCEPHALITIS,WEST. EQ 86654 $122.00
ANTIBODY,ENTEROVIRUS 86658 $121.00
ANTIBODY,FUNGUS,NOT ELSEWHERE 86671 $113.00
ANTIBODY,HELMINTH,NOT ELSEWHRE 86682 $120.00
ANTIBODY,HEPATITIS,DELTA AGENT 86692 $159.00
ANTIBODY,HERPES SIMPLEX,NSTYPE 86694 $133.00
ANTIBODY,LEGIONELLA 86713 $142.00
ANTIBODY,PARVOVIRUS 86747 $139.00
Page 3 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
ANTIBODY,PROTOZOA,NOT SPECIFED 86753 $115.00
ANTIBODY,RICKETTSIA 86757 $179.00
ANTIBODY,TREPONEMA PALLIDUM 86780 $123.00
ANTIBODY,VIRUS,NOS 86790 $119.00
ANTIDEPRESSANTS NOS REF G0480 $248.00
ANTI-DNASE-B 86215 $123.00
ANTIEPILEPTICS NOS REF G0480 $858.00
ANTINUCLEAR ANTIBODIES,TITER 86039 $103.00
ANTITHROMBIN 3,ANTIGEN ASSAY 85301 $100.00
ANTITHROMBIN III ACTIVITY REF 85300 $110.00
APHERESIS,THERAPEUTIC PLASMA 36514 $6,859.00
APHERESIS,THERAPEUTIC RBC 36512 $6,859.00
APHERESIS,THERAPEUTIC WBC 36511 $6,859.00
APOLIPOPROTEIN A1 REF 82172 $158.00
APOLIPOPROTEIN B 82172 $158.00
APP SKN GRAFT FNHFG<100 1ST25 15275 $8,519.00
APP SKN GRAFT FNHFG<100ADD25 15276 $144.00
APP SKN GRAFT TAL<100CM 1ST25 15271 $8,519.00
APP SKN GRAFT TAL<100CM ADD25 15272 $99.00
APP SKN GRAFT TAL>100 1ST100 15273 $15,214.00
APPL OF HIP SPICA CAST 1LEG 29305 $1,296.00
APPL OF LONG LEG CAST BRACE 29358 $1,296.00
APPLICATION ON-BODY INJECTOR 96377 $189.00
APPLY MULTLAY COMPRS LOWER LEG 29581 $740.00
APPLY MULTLAY COMPRS UPPER ARM,FOREARM, HAND & FINGERS 29584 $740.00
APPLY RIGID LEG CAST 29445 $1,296.00
APPLY UNNA BOOT 29580 $740.00
AQUATIC THERAPY W/THERAPEUT EX 97113 $260.00
ARSENIC REF 82175 $176.00
ARTERIAL CATH INSERTION-CUTDN 36625 $601.00
ARTERIAL CATH INSERTION-PERCT 36620 $253.00
ARTERIAL PUNCTURE-BLOOD DX 36600 $586.00
ARTERIAL STENT OPEN PERQ INITIAL 37236 $53,180.00
ARTHROGRAM OF ANKLE 73615 $3,859.00
ARTHROGRAM OF HIP 73525 $3,859.00
ARTHROGRAM OF SHOULDER 73040 $3,859.00
ARTHROGRAM OF WRIST 73115 $3,859.00
ASCORBIC ACID-VITC 82180 $92.00
ASO TITER STREPTO. 86060 $68.00
ASPERGILLUS AG EIA 87305 $111.00
ASPIRATION AND/OR INJECTION THYROID CYST 60300 $3,186.00
ASPIRATION BLADDER INSERT SUPRAPUBIC CATH 51102 $9,569.00
Page 4 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
ASPIRATION BLADDER TROCAR/INTRACATHETER 51101 $5,020.00
ASPIRATION PUNCTURE 10160 $1,727.00
ASSAY ANTIDEPRESSANT TRICYCLIC REF G0480 $858.00
ASSAY NICKEL REF 83885 $205.00
ASSAY OF ALCOHOL REF G0480 $858.00
ASSAY OF AMPHETAMINES REF G0480 $858.00
ASSAY OF BARBITURATES REF G0480 $858.00
ASSAY OF BENZODIAZEPINES 1 REF G0480 $858.00
ASSAY OF BENZODIAZEPINES 2 REF G0480 $858.00
ASSAY OF CHROMIUM 82495 $188.00
ASSAY OF COCAINE REF G0480 $858.00
ASSAY OF METHADONE REF G0480 $858.00
ASSAY OF OPIATES REF G0480 $858.00
ASSAY OF PHENCYCLIDINE REF G0480 $858.00
ASSAY OF PROTEIN ANY SOURCE 84160 $48.00
ASSAY OF PYRUVATE KINASE 84220 $87.00
ASSAY OF VITAMIN K REF 84597 $127.00
ASSAY SIROLIMUS REF 80195 $127.00
ASSAY UNSPECIFIED DRUG CLASS REF G0480 $858.00
ASSESSMENT OF APHASIA PER HR 96105 $697.00
ATTENDANCE AT DELIVERY 99464 $421.00
AUTO ABSORPTION EA ABSORPTION BLD 86978 $241.00
AUTOMATED DIFF WBC COUNT 85004 $60.00
AV NODE ABLATION 93650 $22,938.00
AVULSION NAIL PLATE SINGLE 11730 $970.00
B CELLS TOTAL COUNT REF 86355 $349.00
B.BURGDORFERI AMP DNA 87476 $325.00
BALLOON DILATION INTRACRANIAL VASOSPASM, INIT 61640 $27,623.00
BARTONELLA ANTIBODY 86611 $94.00
BARTONELLA DNA AMP PROBE 87471 $325.00
BASIC DOSIMETRY 77300 $1,238.00
BASIC METABOLIC PANEL 80048 $78.00
BASIC METABOLIC PAN-ION CALC 80047 $103.00
BASIC VESTIBULAR EVALUATION 92540 $612.00
BCR ABL1 TRANSLOCATION REF 81206 $1,518.00
BCR/ABL1 GENE MINOR BRK-REF 81207 $1,341.00
BEAM SHAP. DEVICE SIMP 77332 $1,238.00
BEAM SHAPING DEV COMP 77334 $3,218.00
BEAM SHAPING DEV INTER 77333 $1,238.00
BEHAVIOR ID ASSESSMENT EA 15 MIN 97151 $167.00
BEHAVIOR ID SUPPORT ASSMT EA 15 MIN 97152 $167.00
BEHAVRAL QUALIT ANALYS VOICE 92524 $591.00
Page 5 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
BENIGN HYPERKERATOTIC 1 LESION 11055 $970.00
BENIGN HYPERKERATOTIC 2-4 LESIONS 11056 $970.00
BENIGN HYPERKERATOTIC 5+ LESIONS 11057 $970.00
BER 92585 $1,135.00
BETA 2 GLYCOPROTEIN I AB,EACH 86146 $236.00
BETA 2 MICROGLOBULIN 82232 $150.00
BIL CATH EX/ CV TO EXT W RAD/GDE 47536 $16,210.00
BIL CATH REMOVAL REQ FLUORO GDE 47537 $4,189.00
BILAT CHEMODENERV MUSC INNERVATED 64615 $1,361.00
BILE ACIDS TOTAL 82239 $159.00
BILIARY EXT CATH CONV INT-EXT RS&I 47535 $16,210.00
BILIRUBIN DIRECT LAB 82248 $46.00
BILIRUBIN TOT.TRANSCUTANEOUS 88720 $46.00
BILIRUBIN,TOTAL 82247 $46.00
BIOPSY OF KIDNEY,PERCUTANEOUS 50200 $7,565.00
BIOPSY OF PROSTATE,NEEDLE/PUNCH 55700 $9,569.00
BIOPSY OF THYROID,PERCUT 60100 $3,186.00
BIOPSY SALIVARY GLAND,NEEDLE 42400 $3,186.00
BIOPSY SOFT TISSUE NECK/CHEST 21550 $7,565.00
BI-VENT NEW 33225 $2,690.00
BI-VENT UPGRADE 33224 $54,336.00
BL COUNT-RETICULOCYTE-AUTO 85045 $37.00
BLADDER IRRIGATION 51700 $1,273.00
BLADDER SCAN PROCEDURE 51798 $307.00
BLADDER TUBE CHANGE 51705 $1,273.00
BLADDER TUBE CHANGE, COMPLICATED 51710 $3,092.00
BLASTOMYCES AB LATE 86612 $119.00
BLOCK $1,410.00
BLOOD COUNT RETICULOCYTES AUTO 1 85046 $52.00
BLOOD COUNT,RBC,AUTOMATED 85041 $28.00
BLOOD COUNT,WBC,AUTOMATED 85048 $23.00
BLOOD COUNT-HEMATOCRIT 85014 $22.00
BLOOD COUNT-PLATELET-AUTOMATED 85049 $41.00
BLOOD CULTURE FOR BACTERIA 87040 $96.00
BLOOD GASES 82803 $196.00
BLOOD GLUCOSE 82947 $36.00
BLOOD GLUCOSE BY REAGENT STRIP 82948 $38.00
BLOOD OCCULT PEROXIDASE SINGLE 82272 $32.00
BLOOD OCCULT-FECES 1 SPECIMEN 82272 $32.00
BLOOD SPLITTING EA UNIT BLD 86985 $1,085.00
BLOOD TYPING AG REAGENT BLD 86902 $2,057.00
BLOOD TYPING RBC ANTIGENS BLD 86905 $2,057.00
Page 6 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
BLOOD TYPING RH (D) BLD 86901 $241.00
BLOOD TYPING RH PHENOTYPE COMP BLD 86906 $241.00
BODY FLUID CHOLESTEROL 84311 $65.00
BONE BIOPSY,TROCAR/NEEDLE DEEP 20225 $7,565.00
BONE BIOPSY,TROCAR/NEEDLE SUPERF 20220 $7,565.00
BONE MARROW ASPIRATION 38220 $7,565.00
BONE/JOINT IMAGING 3 PHASE STUDY 78315 $3,535.00
BONE/JOINT IMAGING LIMITED AREA 78300 $3,535.00
BONE/JOINT IMAGING WHOLE BODY 78306 $3,535.00
BORDETELLA ANTIBODY 86615 $122.00
BOWEL IMAGING 78290 $3,535.00
BRACHYTHERAPY ISODOSE PLAN COMPLEX 77318 $3,218.00
BRACHYTHERAPY ISODOSE PLAN INTERM 77317 $3,218.00
BRAIN CANAL SHUNT PROCEDURE 61070 $3,293.00
BRAIN FLOW IMAGING ONLY 78610 $4,555.00
BRAIN IMAGING MIN 4 STATIC VIEWS 78606 $4,555.00
BRAIN IMAGING PET METABOLIC 78608 $13,755.00
BRCA1 GENE KNOWN FAM VARIANT REF 81215 $2,814.00
BRCA1&2 SEQ FULL DUP DEL REF 81162 $16,897.00
BRONCHOSCOPY - PEDIATRIC $4,497.00
BRONCHOSCOPY PROC-THERAPEUTIC $7,877.00
BRONCHOSCOPY-DIAGNOSTIC $4,497.00
BRONCHOSPASM PROVOCATION EVAL 94070 $1,262.00
BUPRENORPHINE REF G0480 $858.00
BURR HOLE IMPLANT CATH/DEVICE 61210 $4,500.00
BX BREAST 1ST LESION MRI IMAG 19085 $7,565.00
BX BREAST 1ST LESION STRTCTC 19081 $7,565.00
BX BREAST 1ST LESION US IMAG 19083 $7,565.00
BX BREAST ADD LESION MRI IMAG 19086 $525.00
BX BREAST ADD LESION STRTCTC 19082 $483.00
BX BREAST ADD LESION US IMAG 19084 $452.00
C DIFFICELE(C DIFF)TOXIN ASSAY 87230 $183.00
C REACTIVE PROTEIN 86140 $48.00
CA 125 86304 $193.00
CA 15-3 86300 $193.00
CA 27.29 86300 $193.00
CADMIUM 82300 $214.00
CALCITONIN BY RIA 82308 $248.00
CALCIUM 82310 $48.00
CALCIUM IONIZED 82330 $127.00
CALCIUM URINE RANDOM 82340 $56.00
CALCIUM,URINE QUANT,TIMED SPEC 82340 $56.00
Page 7 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
CALCULUS SPECTROSCOPY 82365 $119.00
CALPROTECTIN, FECAL 83993 $182.00
CALR GEN EXON 9 MUTATION PCR REF 81219 $1,126.00
CANALITH REPOSITIONING PROC 95992 $251.00
CANDIDA SPECIES DIR PROBE 87480 $186.00
CANNABINOIDS NATURAL REF G0480 $858.00
CAPD 90945 $1,802.00
CAPSULE ENDOSCOPY-ESO TO ILEUM 91110 $3,808.00
CAR. TILT TABLE TEST 93660 $2,049.00
CARBAMAZEPINE TOTAL 80156 $135.00
CARBON DIOXIDE 82374 $45.00
CARBOXYHEMOGLOBIN,QUANT 82375 $114.00
CARCINOEMBRYONIC ANTIGEN 82378 $176.00
CARDIAC DOPPLER EXAM 93320 $163.00
CARDIAC DOPPLER EXAM(2ND) 93320 $163.00
CARDIAC DOPPLER LIMITED 93321 $91.00
CARDIAC FLUORO/FILM 76000 $2,306.00
CARDIAC MRI MORPHOLOGY & FUNCTION 75557 $2,306.00
CARDIAC MRI W/W/O CONTRAST & FURTH 75561 $3,859.00
CARDIAC STRESS TEST-EKG TRACING 93017 $1,135.00
CARDIOLIPIN ANTIBODY-EA IG CLS 86147 $236.00
CARDIOPULM EXERCISE TEST 94621 $1,262.00
CARDIOPULMONARY RESUSCITATION 92950 $1,135.00
CARDIOVASC NUCL EXAM UNLISTED 78499 $3,535.00
CARDIOVASCULAR STRESS TEST 93017 $1,135.00
CARDIOVERSION EXTERNAL ELECTVE 92960 $2,369.00
CARDIOVERSION INTERNAL ELECTIVE 92961 $2,369.00
CARDIOVERSION INTERNAL ICD ELECTIVE 93799 $612.00
CARNITINE(T&F),QUANT,EA SPEC. 82379 $156.00
CAROTENE 82380 $85.00
CAST APPL LONG ARM 29065 $1,296.00
CAST APPL LONG LEG 29345 $1,296.00
CAST APPL SHORT ARM 29075 $1,296.00
CAST APPL SHORT LEG 29405 $1,296.00
CAST APPL SHORT LEG-WALKING 29425 $1,296.00
CAST APPL WALKING HEEL 29440 $740.00
CAST REMOVAL FULL ARM/LEG 29705 $1,296.00
CAST REMOVAL GNTLT/BOOT/BODY 29700 $1,296.00
CAST WINDOWING 29730 $740.00
CAT SCAN OF CHEST COMBO 71270 $2,017.00
CAT SCAN OF CHEST CONTRAST 71260 $2,017.00
CATECHOLAMINES FRACT 82384 $234.00
Page 8 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
CATH 1ST ORD THORA BRACHIOCEPHALIC 36215 $1,217.00
CATH ASPIRATION, NASAL TRACHEAL 31720 $1,054.00
CATH LEFT HEART W/VENTRCL GRAPH 93452 $12,647.00
CATH PCDR,DE SINGLE VSL,RCA C9600 $43,511.00
CATH PCDR,DE,ADDL VSL,CIRC C9601 $27,549.00
CATH PCDR,DE,ADDL VSL,LAD C9601 $27,549.00
CATH PCDR,DE,ADDL VSL,RCA C9601 $27,549.00
CATH PCDR,DE,SINGLE VSL LAD C9600 $43,511.00
CATH PCDR,DE,SINGLE VSL,CIRC C9600 $43,511.00
CATH PLACE REN ART 1ST BILAT 36252 $14,528.00
CATH PLACE REN ART 1ST UNILAT 36251 $14,528.00
CATH PLACE REN ART 2ND+ BIL 36254 $14,528.00
CATH PLACE REN ART 2ND+ UNILAT 36253 $24,071.00
CATH RIGHT HEART 93451 $12,647.00
CATH RT/LT HEART W/ VENTGRAPH 93453 $12,647.00
CATH/INJECT HYSTEROSALPINGOGRAM 58340 $326.00
CAUTERIZATION CHEM TISSUE GRAN 17250 $970.00
CBC, AUTO W/AUTOMATED DIFF 85025 $72.00
CCPD 90945 $1,802.00
CDT (CARB DEF TRANSFERRIN) 82373 $167.00
CELL CT W/DIFF,MISC BODY FLUID 89051 $51.00
CELLULAR FUNCTION ASSAY 86352 $1,258.00
CENTRAL PTA DIALYSIS CIRCUIT S&I 36907 $841.00
CENTRAL STENT DIALYSIS CIRCUIT S&I 36908 $1,189.00
CERCLAGE REMOVAL 59899 $913.00
CEREBRAL PERFUSION ANALYSIS 0042T $2,689.00
CERULOPLASMIN 82390 $99.00
CERVICAL CERCLAGE 59320 $12,987.00
CFTR GENE COMMON VAR REF 81220 $4,175.00
CFTR GENE DUP DELET VARIANT REF 81222 $3,263.00
CFTR GENE FULL SEQUENCE-REF 81223 $3,743.00
CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST 75984 $696.00
CHANGE URETER STENT, PERCUT 50382 $9,569.00
CHEMILUMINESCENT ASSAY REF 82397 $131.00
CHEMO ADMIN INTO CNS 96450 $1,442.00
CHEMO ADMIN INTRA ART PUSH 96420 $1,442.00
CHEMO ADMIN-IV INF-EA ADD HR 96415 $299.00
CHEMO ADMIN-IV-1ST DRUG < 1 HR 96413 $1,442.00
CHEMO ADMIN-IV-DIFF DRUG < 1HR 96417 $299.00
CHEMO ADMIN-IV-PUSH 1ST DRUG 96409 $936.00
CHEMO ADMIN-IV-PUSH ADDL DRUG 96411 $299.00
CHEMO ADMIN-SQ/IM HORMONAL 96402 $299.00
Page 9 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
CHEMO ADMIN-SQ/IM NON HORMONAL 96401 $299.00
CHEMO EXTENDED IV W/PUMP HOME G0498 $1,442.00
CHEMODENERVE- 1ST EXTREMITY 1-4 MUSCLES 64642 $3,293.00
CHEMODENERVE- 1ST EXTREMITY 5+ MUSCLE(S) 64644 $3,293.00
CHEMODENERVE- ADDL EXTREMITY 1-4 MUSCLES 64643 $411.00
CHEMODENERVE- ADDL EXTREMITY 5+ MUSCLE(S) 64645 $473.00
CHEMODENERVE- TRUNK 1-5 MUSCLE(S) 64646 $3,293.00
CHEMODENERVE-MUSC-NECK UNILAT-DYSTONIA 64616 $1,361.00
CHEST PHYSIOTHERAPY-INITIAL 94667 $532.00
CHEST PHYSIOTHERAPY-PEP-SUBQ 94668 $532.00
CHEST PHYSIOTHERAPY-SUBSQ 94668 $532.00
CHEST SURGERY PROCEDURE UNLISTED 32999 $3,410.00
CHEST XRAY 2 VIEWS 71046 $623.00
CHEST XRAY 3 VIEWS 71047 $623.00
CHEST XRAY 4/MORE VIEWS 71048 $1,125.00
CHEST XRAY SINGLE VIEW 71045 $623.00
CHEST,REAL TIME 76604 $1,125.00
CHLAMYDIA AMP 87491 $325.00
CHLAMYDIA GROUP AB 86631 $110.00
CHLAMYDIA PNEUM DNA AMP PROBE MIC 87486 $325.00
CHLAMYDIA PNEUMONIA AMP PROBE REF 87486 $325.00
CHLORIDE SERUM (CL) 82435 $43.00
CHLORIDE URINE 82436 $47.00
CHLORIDE-OTHER SOURCE 82438 $45.00
CHOLECYSTOSTOMY,PERCUT 47490 $16,210.00
CHOLESTEROL DIRECT LDL 83721 $88.00
CHOLESTEROL SERUM WB TOTAL LAB 82465 $40.00
CHOLINESTERASE RBC 82482 $74.00
CHOLINESTERASE,SERUM 82480 $73.00
CHROMO ANAL-ADD KARYOTYPES 88280 $251.00
CHROMO ANALYSIS- 20-25 CELLS 88264 $1,154.00
CHROMO ANYL- 15-20CELLS 2KARY-REF 88262 $1,154.00
CHROMOGRANIN A 86316 $193.00
CIMT STUDY 0126T $177.00
CIQ IMMUNE COMPLEX 86332 $226.00
CIRCUMCISION 54150 $9,569.00
CITRATE 82507 $257.00
CK-MB 82553 $107.00
CLEAR OUTER EAR CANAL 69200 $586.00
CLINICAL PATH CONSULT-LIMITED 80500 $382.00
CLOSTRIDIUM AG IA MIC 87324 $111.00
CLOSTRIDIUM,AMP PROBE 87493 $325.00
Page 10 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
CLOT INHIB PROTEIN C ANTIGEN 85302 $111.00
CLOT INHIB-PROTEIN S,FREE 85306 $142.00
CLOT INHIB-PROTEIN S,TOTAL 85305 $107.00
CLOTTING FACTOR VII 85230 $166.00
CLOTTING FACTOR VIII VW AG REF 85246 $212.00
CLOTTING FACTOR XI (PTA) LAB 85270 $166.00
CLOTTING FACTOR XI (PTA) REF 85270 $166.00
CLOTTING,FACTOR II(FIBRINOGEN) 85210 $120.00
CLOTTING,FACTOR V 85220 $163.00
CLOTTING,FACTOR VIII,ONE STAGE 85240 $166.00
CLOTTING,FACTOR VIII,ONE STAGE 85240 $166.00
CLOTTING,FACTOR VIII,VW,RISTOC 85245 $212.00
CLOTTING,FACTOR X 85260 $166.00
CLOTTING,FACTOR XII (HAGEMAN) 85280 $179.00
CLOTTING,FACTOR XIII,SCRN SOL 85291 $82.00
CMV QUANTIFICATION DNA 87497 $397.00
CMV SCREEN UBS 86644 $133.00
CNS DNA AMP PROBE TYPE 12-25 REF 87483 $3,859.00
CO2 EXPIRED GAS DETERMINATION 94770 $680.00
CO2/MEMBRANE DIFFUSE CAPACITY 94729 $214.00
COAG AND FIB FNC (ADAMTS-13) 85397 $231.00
COGNITIVE INTERVENTION ADDL 15 MIN 97130 $154.00
COGNITIVE INTERVENTION FIRST 15 MIN 97129 $158.00
COL CHROMO/MASS SPECT,QUAL,SNG 82542 $181.00
COLD AGGLUTININS TITER 86157 $75.00
COLLAGEN CROSSLINKS ANY METH REF 82523 $173.00
COLLECT BLOOD FROM CATHETER VENOUS NOS 36592 $586.00
COLLECT BLOOD-ARTERIAL CATH 37799 $3,410.00
COLLECT BLOOD-VENOUS CATH 36592 $586.00
COLLECT BLOOD-VENOUS DVCE 36591 $586.00
COLLECT BLOOD-VENOUS PORT 36591 $586.00
COLON DOUBLE CONTRAST 74280 $2,017.00
COLON SINGLE CONTRAST 74270 $2,017.00
COLOR FLOW MAPPING 93325 $102.00
COMMUNITY WORK REINTEGRATE15MN 97537 $219.00
COMP METABOLIC PANEL 80053 $98.00
COMPATIBILITY TEST-ANTIGLOBULN 86922 $1,085.00
COMPATIBILITY TEST-ELECTRONIC 86923 $1,085.00
COMPATIBILITY TEST-IMMED.SPIN 86920 $1,085.00
COMPLEMENT ANTIGEN EA COMPONENT LAB 86160 $111.00
COMPLEMENT, TOTAL (CH50) 86162 $188.00
COMPLEMENT,FUNCTIONAL ACTIVITY 86161 $111.00
Page 11 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
COMPLEX SIMULATION 77290 $3,218.00
CON SEDATION >5 YR 1ST 15 MIN 99152 $69.00
CON SEDATION EA ADDL 15 MIN 99153 $60.00
CON SEDATION< 5 YR 1ST 15 MIN 99151 $143.00
CONGEN RT/LT RETROGRADE CATH 93531 $12,647.00
CONGEN RT/LT TRANSSEPTAL SEPTUM 93532 $12,647.00
CONGEN RT/LT T-SEPTAL EXIST SEPTAL 93533 $12,647.00
CONGENITAL RT HRT CATH 93530 $12,647.00
CONT PHYSICS SUPPORT 77336 $1,238.00
CONT VENTILATION-FIRST DAY 94002 $2,550.00
CONT VENTILATION-SUBSQ DAY 94003 $2,550.00
CONTRAST BATHS EA 15 MIN 97034 $101.00
CONTRAST EXAM THORACIC AORTA 75600 $26,415.00
CONTRAST INJ CENT VEN CATH, INC FLOURO 36598 $1,029.00
CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE 49424 $218.00
CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE 49465 $1,268.00
CONTRAST XRAY THROAT/CERV ESOPHA 74210 $2,017.00
CONV PERQ NEPH-URET CATH W RAD/GDE 50434 $9,569.00
CONVERT GASTROSTOMY-GASTRO-JEJUNOS* 49446 $8,158.00
COOMBS TEST DIRECT BLD 86880 $241.00
COOMBS TEST INDIRECT TITER BLD 86886 $1,085.00
COPPER SERUM 82525 $115.00
CORONARY ARTERY ANGIO S&I 93454 $12,647.00
CORONARY ARTERY/GRAFT ANGIO 93455 $12,647.00
CORTICOSTERONE 82528 $209.00
CORTISOL 82533 $151.00
CORTISOL FREE REF 82530 $155.00
CPAP INITIATION/MANAGEMENT 94660 $958.00
C-PEPTIDE LEVEL 84681 $193.00
CPK ISOENZYMES 82552 $124.00
CRANIAL HALO 20661 $2,875.00
CRANIAL NERVE EMG BILAT 95868 $612.00
CRANIAL NERVE EMG UNI 95867 $612.00
C-REACTIVE PROTEIN-HIGH SENS. 86141 $120.00
CREATINE 82540 $43.00
CREATINE KINASE(CK)(CPK)-TOTAL 82550 $60.00
CREATININE BLOOD 82565 $47.00
CREATININE BODY FLUID 82570 $48.00
CREATININE CLEARANCE 82575 $88.00
CREATININE,BLOOD 82565 $47.00
CREATININE-OTHER SOURCE 82570 $48.00
CREATION AVF W RADIOFREQUENCY RS&I C9755 $53,180.00
Page 12 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
CREATION AVF W SECONDARY PROCEDURE C9754 $53,180.00
CRITICAL CARE-30 TO 74 MINUTES 99291 $5,920.00
CRITICAL CARE-EA ADDL 30 MIN 99292 $908.00
CRRT 90945 $1,802.00
CRYOABLATE BONE TUMOR(S) PERQ 20983 $31,348.00
CRYOABLATE PULMONARY TUMOR(S) PERQ 32994 $25,277.00
CRYOABLATION RENAL TUMOR UNILATERAL 50593 $42,579.00
CRYOFIBRINOGEN 82585 $106.00
CRYOGLOBULINS 82595 $60.00
CRYPTOCOCCUS ANTIGEN TITER 86406 $98.00
CRYPTOSPORIDIUM AG MIC 87328 $111.00
CRYSTAL ID BY MICROSCOPY 89060 $66.00
C-SECTION DELIVERY SER 59514 $5,174.00
CSF FLUID SCAN CISTERNOGRAPHY 78630 $4,555.00
CSF LEAKAGE DETECTION & LOCALIZATION 78650 $12,294.00
CSF SHUNT REPROGRAM 62252 $1,542.00
CT ANGIO AORTOBIFEMORAL, COMBO 75635 $2,017.00
CT ANGIO HRT CORNRY ART/BYPASS GRFT CONTRAST 3D POST 75574 $2,017.00
CT ANGIO, ABD, COMBO,INCL IMAGE PROC 74175 $2,017.00
CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG PROC 71275 $2,017.00
CT ANGIO, PELVIS, COMBO, INCL IMAGE PROC 72191 $2,017.00
CT ANGIO,LOWER EXTREM,COMBO,IMAGE 73706 $2,017.00
CT ANGIO,UPPER EXTREM,COMBO 73206 $2,017.00
CT CONT EVAL CARD CONGEN HEART DISEASE 75573 $2,017.00
CT GUIDANCE NEEDLE PLACEMENT 77012 $795.00
CT GUIDANCE RAD THPY 77014 $784.00
CT GUIDANCE TISSUE ABLATION 77013 $1,971.00
CT HEAD W/ AND W/OUT 70470 $2,017.00
CT HEAD W/ CONT 70460 $2,017.00
CT HEAD W/O CONT 70450 $1,125.00
CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM 75571 $623.00
CT MAXILLOFAC W/,W/O 70488 $2,017.00
CT MAXILLOFACIAL W/ 70487 $2,017.00
CT MAXILLOFACIAL W/O 70486 $1,125.00
CT NECK W/,W/O 70492 $2,017.00
CT SCAN CERV SP COMBO 72127 $2,017.00
CT SCAN CERV SPINE CONTRAST 72126 $3,859.00
CT SCAN DORSAL SP CONTRAST 72129 $2,017.00
CT SCAN LUMBAR SP CONTRAST 72132 $3,859.00
CT SCAN OF ABDOMEN COMBO 74170 $2,017.00
CT SCAN OF ABDOMEN CONTRAST 74160 $2,017.00
CT SCAN OF ARM COMBO 73202 $2,017.00
Page 13 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
CT SCAN OF ARM CONTRAST 73201 $3,859.00
CT SCAN OF LEG COMBO 73702 $2,017.00
CT SCAN OF LEG CONTRAST 73701 $2,017.00
CT SCAN OF PELVIS COMBO 72194 $2,017.00
CT SCAN OF PELVIS CONTRAST 72193 $2,017.00
CT SCAN,ABD & PELVIS,COMBO 74178 $3,859.00
CT SCAN,ABD & PELVIS,W CONTRAST 74177 $3,859.00
CT SCAN,ABD & PELVIS,W/O CONTRAST 74176 $2,306.00
CT SCAN,ABDOMEN,W/O CONTRAST 74150 $1,125.00
CT SCAN,CERVICAL SPINE,W/O CONTRAST 72125 $1,125.00
CT SCAN,LIMITED/LOCALIZED F/U STUDY 76380 $623.00
CT SCAN,LOWER EXTREMITY,W/O CONTRAST 73700 $1,125.00
CT SCAN,LUMBAR SPINE,W/O CONTRAST 72131 $1,125.00
CT SCAN,PELVIS,W/O CONTRAST 72192 $1,125.00
CT SCAN,THORACIC SPINE,W/O CONTRAST 72128 $1,125.00
CT SCAN,THORAX,W/O CONTRAST 71250 $1,125.00
CT SCAN,UPPER EXTREMITY,W/O CONTRAST 73200 $1,125.00
CT SOFT TISSUE NECK W/ 70491 $2,017.00
CTA ABD/PEL W & W/O 74174 $3,859.00
CTA HEAD W/O,W,POST PROCESS 70496 $2,017.00
CTA NECK W/O,W,POST PROCESS 70498 $2,017.00
CULTURE BACTERI AEROBIC,OTHER 87071 $87.00
CULTURE MYCOPLASMA 87109 $143.00
CULTURE ROUTINE 87070 $80.00
CULTURE,AEROBIC IDENTIFY 87077 $75.00
CULTURE,ANAEROB IDENT EACH 87076 $75.00
CULTURE,BACTERIA,ANAEROBIC 87075 $88.00
CULTURE,FUNGI,DEF ID, MOLD 87107 $96.00
CULTURE,FUNGI,DEF ID, YEAST 87106 $96.00
CULTURE,FUNGI,PRSM ID, BLOOD 87103 $153.00
CULTURE,FUNGI,PRSM ID,OTHR SRC 87102 $78.00
CULTURE,FUNGI,PRSM ID,SK,HR,NL 87101 $71.00
CULTURE,OTHER/COLONY COUNT 87084 $203.00
CULTURE-FECES,BACTERIA 87045 $87.00
CULTURE-PRESUMPTIVE-SCREEN 87081 $61.00
CULTURE-STOOL,BACTERIA,EACH 87046 $87.00
CVC, NON TUNNELED < AGE 5 36555 $6,015.00
CVC, NON TUNNELED >AGE 5 36556 $6,015.00
CVC,PORT PLACEMENT > AGE 5 36561 $14,528.00
CVP/DEEP LINE INSERT $2,195.00
CYANIDE LEVEL QUANT REF 82600 $180.00
CYANOCOBALAMIN 82607 $140.00
Page 14 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
CYCLIC AMP 82030 $239.00
CYCLIC CITRULLINATED PEPTIDE AB REF 86200 $120.00
CYCLOSPORIN (CYCLO) 80158 $167.00
CYSTATIN C REF 82610 $92.00
CYTO/MOLECULAR REPORT-REF 88291 $256.00
CYTOGEN M ARRAY COPY NO&SNP-REF 81229 $8,700.00
CYTOLOGY CELLULAR ENHANCEMENT 88112 $382.00
CYTOLOGY I 88104 $241.00
CYTOMEGALOVIRUS DFA 87271 $111.00
CYTOPATH C/V AUTO FLUID REDO 88175 $245.00
CYTOPATH C/V THIN LAYER REF 88142 $188.00
CYTOPATH FNA EVAL-ADDL 88177 $55.00
CYTOPATH SMEAR >5 SLIDES PAT 88162 $382.00
CYTOPATH TBS C/V MANUAL 88164 $110.00
CYTOPATH-EVALUATION OF FNA-IMM 88172 $1,085.00
CYTOPATH-FNA EVAL INTERPRET. 88173 $382.00
CYTOPATHOLOGY-CONCENTRATION 88108 $241.00
CYTOPATH-PREPARATION 88161 $241.00
CYTOPATH-SMEARS-OTHER SOURCE 88160 $129.00
D/C OR D/E 59160 $12,987.00
D-DIMER QUANTITATIVE 85379 $94.00
DEBRIDE BONE ADD 20 SQ CM 11047 $562.00
DEBRIDE MUSC/FASCIA ADD 20 SQ CM 11046 $318.00
DEBRIDE MUSC/FASCIA FIRST 20 SQ CM 11043 $2,656.00
DEBRIDE NAIL,ANY METHOD 1 TO 5 11720 $307.00
DEBRIDE NAIL,ANY METHOD 6/MORE 11721 $307.00
DEBRIDE SUBQ TISSUE 20SQCM< 11042 $1,727.00
DEBRIDE SUBQ TISSUE ADD 20 SQ CM 11045 $150.00
DEBRIDEMENT NON-SELECTIVE 97602 $1,147.00
DEBRIDE-SELECTIVE ADDL 20 CM 97598 $75.00
DEBRIDE-SELECTIVE FIRST 20 CM 97597 $1,147.00
DECALCIFICATION PROCEDURE 88311 $68.00
DECLOTTING OF VASCULAR DEVICE 36593 $1,586.00
DEHYDROEPIANDROSTERONE 82626 $234.00
DELIVERY PLACENTA (SEP PROC) 59414 $12,987.00
DELIVERY SERVICES-VAGINAL 59409 $12,987.00
DEOXYCORTISOL,11 82634 $271.00
DES-GAMMA-CARBOXY PROTHROMBIN 83951 $596.00
DESOXYCORTICOSTERONE 11- 82633 $287.00
DEST BENIGN LESION 1ST LESION 17000 $970.00
DEST BENIGN LESIONS (2-14)EACH 17003 $14.00
DEST FLAT WARTS <15 LESIONS 17110 $970.00
Page 15 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
DETECT AGNT MULT DNA AMP PROBE 87801 $650.00
DEVELOPMENTAL TEST ADMIN ADD 30MIN 96113 $298.00
DEVELOPMENTAL TEST ADMIN FIRST HOUR 96112 $680.00
DEXA,BONE DENSITY,AXIAL SKELETON 77080 $1,125.00
DHEA-S 82627 $206.00
DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILAT OR BILAT 77063 $257.00
DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILAT OR BILAT G0279 $257.00
DIGOXIN 80162 $123.00
DILANTIN (PHENYTOIN) 80185 $123.00
DILAT EXISTING URINARY TRACT RS&I 50436 $9,569.00
DILAT URINARY TRACT NEW ACCESS RS&I 50437 $16,098.00
DILATION URETER(S) URETHRA RS&I 74485 $17,398.00
DILUTED RUSSELL VIP VEN TIME 85613 $89.00
DISCO,EA LEVEL,S&I-LUMBAR 72295 $16,315.00
DISKO INJ,EA LEVEL-LUMBAR 62290 $955.00
DISLOC ACROMIOCLAVICULAR CLSD 23540 $1,238.00
DISLOC SHOULDER W/MANIP CLSD 23650 $1,238.00
DISLOC STERNOCLAVICULAR CLSD 23520 $7,223.00
DISLOC TX ANKLE WO ANESTH CLSD 27840 $1,238.00
DISLOC TX CARPAL W/MANIP CLSD 25660 $1,238.00
DISLOC TX ELBOW W/O ANES CLSD 24600 $1,238.00
DISLOC TX FINGER W/O ANES CLSD 26770 $1,238.00
DISLOC TX KNEE W/O ANES CLSD 27550 $1,238.00
DISLOC TX RADIUS/ULNA CLSD 25605 $7,223.00
DNA AB SINGLE STRAND 86226 $112.00
DNA ANTIBODY 86225 $127.00
DNA RNA AMPLIFIED PROBE MIC 87150 $325.00
DOPPLER PRESSURE-ADDL. VESSEL 93572 $293.00
DOPPLER PRESSURE-INIT. VESSEL 93571 $361.00
DRAIN APPENDICEAL ABSCESS, OPEN 44900 $4,418.00
DRAIN SKIN ABSCESS SIMPLE 10060 $970.00
DRAINAGE CATHETER EXCHANGE 49423 $8,158.00
DRAINAGE OF HEMATOMA/FLUID 10140 $7,565.00
DRESS/DEBRIDE-LARGE 16030 $1,727.00
DRESS/DEBRIDE-MEDIUM 16025 $970.00
DRESS/DEBRIDE-SMALL 16020 $970.00
DRUG ADMIN & HEMODYNAMIC MEASURE 93463 $458.00
DRUG ASSAY EVEROLIMUS REF 80169 $127.00
DRUG QUANTITATION-NOT SPECIFED 80299 $140.00
DRUG SCREEN CAFFEINE QUANT 80155 $289.00
DRUG SCREEN GABAPENTIN QUANT 80171 $163.00
DRUG SCREEN LAMOTRIGINE QUANT 80175 $123.00
Page 16 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
DRUG SCREEN LEVETIRACETAM QUANT 80177 $123.00
DRUG SCREEN MYCOPHENOLATE QUANT REF 80180 $167.00
DRUG SCREEN OXCARBAZEPINE QUANT 80183 $123.00
DRUG SCREEN PHENYTOIN TOTAL LAB 80185 $123.00
DRUG SCREEN PHENYTOIN TOTAL REF 80186 $127.00
DRUG TEST PRSMV CHEM ANLYZR LAB 80307 $539.00
DRUG TEST PRSMV DIR OPT OBS LAB 80305 $101.00
DUPLEX ABD/PEL VASC STUDY,COMPLETE 93975 $1,038.00
DUPLEX ABD/PEL VASC STUDY,LIMITD 93976 $506.00
DUPLEX EXTREM VENOUS,BILAT 93970 $1,038.00
DUPLEX EXTREM VENOUS,UNI OR LTD 93971 $506.00
DUPLEX HEMODIALYSIS ACCESS 93990 $506.00
DUPLEX LARGE VESSEL(S),COMPLETE 93978 $1,038.00
DUPLEX LARGE VESSEL(S),LIMITED 93979 $506.00
DUPLEX LO EXTREM ART BILAT 93925 $1,038.00
DUPLEX LO EXTREM ART UNILAT/LTD 93926 $506.00
DUPLEX SCAN EXTRACRANIAL,BILAT 93880 $1,038.00
DUPLEX SCAN EXTRACRANIAL,LIMITED 93882 $506.00
DUPLEX UP EXTREM ART BILAT 93930 $1,038.00
DUPLEX UP EXTREM ART UNILAT/LTD 93931 $506.00
DX BONE MARROW BIOPSIES 38221 $7,565.00
DX BONE MARROW BX & ASPIR 38222 $7,565.00
DX MAMMO BILAT W/WO CAD 77066 $1,224.00
DX MAMMO UNILATERAL W/WO CAD 77065 $956.00
DX SPINE L/S BENDING ONLY 2-3 VIEWS 72120 $1,125.00
E STIM ATTENDED 15 MIN 97032 $99.00
E STIM-UNATTENDED-NON WND CARE 97014 $224.00
EAR/PULSE OXIMETRY-OVERNIGHT MONITOR 94762 $680.00
EAR/PULSE OXIMETRY-SINGLE DETM 94760 $13.00
ECHO COMP W/ CONTRAST 93306 $2,239.00
ECHO COMP W/O CONT W/O CF 93307 $1,038.00
ECHO COMP W/O CONTRAST 93306 $2,239.00
ECHO REST/STRESS W/ CONT 93350 $2,239.00
ECHO REST/STRESS W/O CONTRAST 93350 $2,239.00
ECHO TEE TAVR TMVR LAAC W WO CONT 93355 $1,067.00
ECHO,SCROTUM & CONTENTS 76870 $1,125.00
ECHOCARDIOGRAM LTD W/O CONT 93308 $1,038.00
ECHO-CNGNTL COMP W/ CONT 93303 $2,239.00
ECHO-CNGNTL LTD W/ CONT 93304 $2,239.00
ECHO-CONGENITAL COMP W/O CONT 93303 $2,239.00
ECHO-CONGENITAL LTD W/O CONT 93304 $2,239.00
ECHOCRDGRM LTD W/ CONT 93308 $1,038.00
Page 17 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
ECHOGRAPHY,TRANSVAGINAL 76830 $1,125.00
EEG 95819 $1,135.00
EEG AWAKE 95816 $1,135.00
EEG CEREBRAL DEATH EVAL 95824 $2,049.00
EEG DURING CAROTID SURGERY 95955 $726.00
EEG EXTENDED MONITORING 41-60 MIN 95812 $1,135.00
EEG SETUP/EDUCATION BY EEG TECH 95700 $1,157.00
EEG SLEEP 95822 $1,135.00
EEG W VIDEO 2-12 HR CONTINUOUS 95713 $2,220.00
EEG W VIDEO 2-12 HR CONTINUOUS 95716 $4,156.00
EEG W VIDEO 2-12 HR INTERMITTENT 95712 $1,157.00
EEG W VIDEO 2-12 HR INTERMITTENT 95715 $2,220.00
EEG W VIDEO 2-12 HR UNMONITORED 95711 $1,157.00
EEG W VIDEO 2-12 HR UNMONITORED 95714 $2,220.00
EEG W/O VIDEO 2-12 HR CONTINUOUS 95707 $1,157.00
EEG W/O VIDEO 2-12 HR CONTINUOUS 95710 $2,220.00
EEG W/O VIDEO 2-12 HR INTERMITTENT 95706 $1,157.00
EEG W/O VIDEO 2-12 HR INTERMITTENT 95709 $2,220.00
EEG W/O VIDEO 2-12 HR UNMONITORED 95705 $1,157.00
EEG W/O VIDEO 2-12 HR UNMONITORED 95708 $2,220.00
EHEC (SHIGA TOXIN) DETECTION 87899 $121.00
EIA TUMOR AG CA 19-9 LAB 86301 $193.00
EIA TUMOR AG CA 19-9 REF 86301 $193.00
ELEC STIM ATTENDED 15 MIN 97032 $99.00
ELECTRIC STIMULATION THERAPY 97014 $224.00
ELECTROCARDIOGRAM 93005 $252.00
ELECTRODE STIM BRAIN 1ST HR 95961 $4,108.00
ELECTROLYTES, SERUM 80051 $65.00
ELECTRON MICROSCOPY DIAG - PAT 88348 $4,186.00
ELECTROPHORETIC TECHNIQUE 82664 $461.00
ELECTROPHYSIOLOGY EVALUATION 93622 $809.00
ELUTION RBC AB EACH ELUTION BLD 86860 $1,085.00
EMBO OCCLUSION DIALYSIS CIRCUIT S&I 36909 $1,152.00
EMG EXTREMITY W/NCD COMPLETE 95886 $224.00
EMG EXTREMITY W/NCD LIMITED 95885 $196.00
EMG FOUR EXTR 95864 $612.00
EMG NON-EXTREMITY W/NCD 95887 $206.00
EMG ONE EXTR 95860 $479.00
EMG PARASPINAL MUSCLES 95869 $612.00
EMG SINGLE MUSCLE 95870 $252.00
EMG THREE EXTR 95863 $612.00
EMG TWO EXTR 95861 $479.00
Page 18 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
ENDO ADDL MIN LVL 1 $59.00
ENDO ADDL MIN LVL 2 $63.00
ENDO ADDL MIN LVL 3 $67.00
ENDO ADDL MIN LVL 4 $71.00
ENDO ADDL MIN LVL 5 $77.00
ENDO MIN 1ST 30 MIN LVL 1 $3,313.00
ENDO MIN 1ST 30 MIN LVL 2 $3,939.00
ENDO MIN 1ST 30 MIN LVL 3 $4,507.00
ENDO MIN 1ST 30 MIN LVL 4 $5,122.00
ENDO MIN 1ST 30 MIN LVL 5 $5,610.00
ENDOLUMINAL BX PELVIS W RAD/GDE 50606 $878.00
ENDOLUML BX(S) BIL TREE W RAD/GDE 47543 $832.00
ENDOMYOCARDIAL BIOPSY 93505 $11,887.00
ENDOTRACHEAL INTUBATION 31500 $1,134.00
ENDOVAS INTRACRANIAL RX ADMIN ADDL 61651 $1,376.00
ENDOVAS INTRACRANIAL RX ADMIN INIT 61650 $3,163.00
ENDOVASC TEMP BALLOON OCCLUS,HEAD/NCK 61623 $53,180.00
ENTAMOEBA HIST AG 87337 $111.00
ENTEROVIRUS AMP PROBE REF 87498 $325.00
ENZYME CELL ACTIVITY 82657 $167.00
EP & ABLATE SUPRAVENT ARRHYT 93653 $86,462.00
EP & ABLATE VENTRIC TACHY 93654 $86,462.00
EP EVAL CARDIO/DEFIB LEADS 93640 $838.00
EP EVAL CARDIO/DEFIB SNG/DUAL 93642 $4,137.00
EP EVAL CARDIO/DIFIB GENERATOR 93641 $1,467.00
EP STUDY-LT ATR PACE W/INDUCT 93621 $547.00
EP STUDY-RT A/V PACE W/INDUCT 93620 $22,938.00
EPIDERM AUTOGRFT TAL 1ST 100 SQCM 15110 $8,519.00
EPIDURAL ANESTHESIA FOR LABOR $1,046.00
EPIDUROGRAPHY,SUPERV/INTERPRET 72275 $868.00
EPISIOTOMY OR VAGINAL REPAIR,BY OTHER THAN ATTENDING PHY 59300 $12,987.00
EPISTAXIS CONTROL $754.00
EPSTEIN BARR VIRUS EARLY AG REF 86663 $122.00
EPSTEIN BARR VIRUS NUCLEAR AG REF 86664 $142.00
EPSTEIN BARR VIRUS-CAPSID AG 86665 $168.00
ERYTHROPOIETIN 82668 $174.00
ESOPH MOTILITY/MANOMETRY 91010 $2,504.00
ESOPHAGRAM DOUBLE CONTRAST STUDY 74221 $1,852.00
ESOPHAGRAM SINGLE CONTRAST STUDY 74220 $2,017.00
ESTRADIOL (E2) 82670 $259.00
ESTRIOL SERUM REF 82677 $224.00
ESTROGENS FRACTIONATED 82671 $299.00
Page 19 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
ESTRONE REF 82679 $231.00
ETHOSUXIMIDE 80168 $151.00
ETHYLENE GLYCOL 82693 $138.00
EUGLOBULIN LYSIS 85360 $78.00
EVAL PHYS PERFORMANCE 15 MIN 97750 $234.00
EVALUATE SPEECH PRODUCTION 92522 $612.00
EVALUATION OF SPEECH FLUENCY 92521 $757.00
EVOKED AUDITORY SCREEN 92558 $32.00
EXCHANGE PERQ NEPH CATH W RAD/GDE 50435 $9,569.00
EXCISION,BENIGN LESION,>4.0 CM 11426 $13,081.00
EXCISION-NAIL & MATRIX 11750 $1,727.00
EXERCISE TEST BRONCOSPASM 94617 $532.00
EXPLORATION ARTERY LOWER EXTREMITY 35703 $2,448.00
EXPLORATION ARTERY UPPER EXTREMITY 35702 $2,408.00
EXPOSURE BEHAVIOR TX EA 15 MIN 0373T $167.00
EXTERNAL CEPHALIC VERSION 59412 $12,987.00
EXTRACTABLE NUCLEAR ANTIGEN,AB 86235 $166.00
EYE B-SCAN 76512 $1,125.00
F2 GENE ANALYSIS A VARIANT REF 81240 $493.00
F5 GENE LEIDEN VAR 81241 $566.00
FACTOR INHIBITOR TEST 85335 $119.00
FACTOR IX 85250 $176.00
FACTOR VIII RELATED ANTIGEN 85244 $189.00
FACTOR VIII VW MULTIMERIC 85247 $212.00
FAT QUAL STOOL URINE RESP SEC 89125 $44.00
FATS OR LIPIDS FECES QUAL REF 82705 $47.00
FATTY ACIDS,NONESTERIFIED 82725 $141.00
FENTANYL REF G0480 $858.00
FERRITIN 82728 $126.00
FETAL BIOPHYSICAL PROFILE WO NST 76819 $1,125.00
FETAL CHRMOML MICRODELTJ REF 81422 $5,693.00
FETAL CHROMOSOMAL ANEUPLOIDY REF 81420 $5,693.00
FETAL CONGEN ABNOR ASSAY 2 ANAL REF 81508 $407.00
FETAL CONGENITAL ABNOR ASSAY 4 ANAL 81511 $1,151.00
FETAL CONTRACTION STRESS TEST 59020 $913.00
FETAL FIBRONECTIN 82731 $596.00
FETAL HEMOGLOBIN 83030 $81.00
FETAL HEMOGLOBIN ASSAY QUAL REF 83033 $60.00
FETAL NON-STRESS TEST 59025 $913.00
FIBRIN DEGRAD PRODUCT 85362 $64.00
FIBRINOGEN QUANT 85384 $79.00
FIBRINOLYTIC F/I,PLASMINOGEN 85420 $60.00
Page 20 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
FISH NON QUANT 1ST STAIN PAT 88365 $1,085.00
FISH NON QUANT EA ADDL STAIN PAT 88364 $1,024.00
FLOW CYTO 16+ MARKERS REF 88189 $664.00
FLOW CYTO CELL CYCLE OR DNA-REF 88182 $382.00
FLOW CYTOMETRY EA ADDL MARKER 88185 $190.00
FLOW CYTOMETRY FIRST MARKER 88184 $2,057.00
FLOW CYTOMETRY READ 2-8 MARKERS REF 88187 $293.00
FLUORESCENT ANTIBODY TITER REF 86256 $112.00
FLUORESCENT N.INF AGENT-SCREEN 86255 $112.00
FLUORO GUIDE NEEDLE PLACEMENT 77002 $758.00
FLUORO GUIDE SPINE INJECTION 77003 $700.00
FLUORO GUIDE VENOUS ACCESS DEVICE 77001 $740.00
FLUOROSCOPE EXAMINATION 76000 $2,306.00
FMR1 GENE ALLELE CHARACTERIZATION REF 81244 $337.00
FMR1 GENE DETECTION (FRAGILE X) - REF 81243 $428.00
FNA BIOPSY W CT GUIDE 1ST LESION 10009 $3,186.00
FNA BIOPSY W CT GUIDE EA ADD LESION 10010 $473.00
FNA BIOPSY W FLUORO 1ST LESION 10007 $3,186.00
FNA BIOPSY W FLUORO EA ADD LESION 10008 $349.00
FNA BIOPSY W MRI 1ST LESION 10011 $3,186.00
FNA BIOPSY W MRI EA ADD LESION 10012 $823.00
FNA BIOPSY W US GUIDE 1ST LESION 10005 $3,186.00
FNA BIOPSY W US GUIDE EA ADD LESION 10006 $283.00
FNA BIOPSY WO IMAGING EA ADD LESION 10004 $247.00
FOLIC ACID RBC REF 82747 $160.00
FOLIC ACID,SERUM 82746 $136.00
FOLLOW UP EPS 93624 $22,938.00
FREE T3 TRIIODOTHYRONINE 84481 $157.00
FRUCTOSAMINE 82985 $140.00
FSH SERUM 83001 $172.00
FUNCTIONAL TRNG SELF CARE 15M 97535 $229.00
GAIT TRAINING 97116 $203.00
GAMMA GT 82977 $67.00
GARDNERELLA VAG DIRECT PROBE 87510 $186.00
GASES,BLOOD,O2,SATURATION ONLY 82810 $81.00
GASTRIC EMPTYING STUDY 78264 $3,535.00
GASTRIC INTUBATION TREATMENT 43753 $1,388.00
GASTRIN SERUM 82941 $163.00
GATED HEART, PLANAR SINGLE 78472 $3,535.00
GC NUCLEIC AMP 87591 $325.00
GENOTYPE DNA HEPATITIS B-REF 87912 $2,384.00
GENTAMICIN 80170 $152.00
Page 21 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
GIARDIA ANTIGEN 87329 $111.00
GLUCAGON 82943 $132.00
GLUCOSE 1HR GESTATIONAL LOAD 82950 $44.00
GLUCOSE BLOOD TEST 82962 $25.00
GLUCOSE TOLERANCE 3 SPECIMENS 82951 $119.00
GLUCOSE TOLERANCE EA ADDL SPEC 82952 $36.00
GLUCOSE,BODY FLUID,NOT BLOOD 82945 $36.00
GLUCOSE,QUANT,BLOOD 82947 $36.00
GLUCOSE-6-PHOSPHATE DEHYDROG 82955 $90.00
GLYCOHEMOGLOBIN A1C 83036 $90.00
GONADOTROPIN,CHORIONIC-QUAL. 84703 $70.00
GONADOTROPIN,CHORIONIC-QUANT. 84702 $139.00
GREEN TRAUMA ACT PRE-NOTIFY NO CC $11,562.00
GREEN TRAUMA ACTIVATE PRE-NOTIFY G0390 $11,562.00
GREEN TRAUMA TEAM SERVICES $11,562.00
GROUP ACTIVITIES 97150 $123.00
GUIDANCE FOR RT DELIVERY 77387 $1,851.00
H.PYLORI,UREA BREATH TEST 83013 $624.00
HAPTOGLOBIN REF 83010 $116.00
HBA1 HBA2 FULL GENE SEQUENCE REF 81259 $1,200.00
HBA1 HBA2 GENE DUP DEL VRNTS REF 81269 $881.00
HBA1/HBA2 GENE-REF 81257 $767.00
HBB FULL GENE SEQUENCE REF 81364 $979.00
HBB GENE COM VARIANTS REF 81361 $455.00
HBB GENE DUP DEL VRNTS REF 81363 $1,055.00
HBSAG NEUTRALIZATION 87341 $96.00
HCV SCRN DOB 1945-1965 1X LIFE LAB G0472 $348.00
HEAD, REAL TIME 76506 $1,125.00
HEAD/NECK TISSUES,REAL TIME 76536 $1,125.00
HEAVY METALS-QUANT,EACH 83018 $203.00
HELICOBACTER AB SERUM 86677 $134.00
HEMODIALYSIS 90935 $3,059.00
HEMODIALYSIS ACCESS CREATION BILAT 93985 $1,049.00
HEMODIALYSIS ACCESS CREATION UNILAT 93986 $504.00
HEMOGLOBIN 85018 $22.00
HEMOGLOBIN ELECTROPHORESIS-REF 83020 $119.00
HEMOGLOBIN FRACT/QUANT,CHROMO-REF 83021 $167.00
HEMOGRAM + PLTS 85027 $60.00
HEMOSIDERIN 83070 $44.00
HEP B ANTIGEN 87340 $96.00
HEP B CORE IGM (HBCAB) 86705 $109.00
HEP B E ANTIBODY (HBEAB) 86707 $107.00
Page 22 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
HEP B E ANTIGEN (HBEAG) 87350 $107.00
HEP B S ANTIBODY (HBSAB) 86706 $99.00
HEPARIN ASSAY 85520 $121.00
HEPATIC FUNCTION PANEL 80076 $76.00
HEPATITIS A ANTIBODY,TOTAL 86708 $115.00
HEPATITIS A IGM AB 86709 $104.00
HEPATITIS B CORE AB LAB 86704 $112.00
HEPATITIS C AB 86803 $132.00
HEPATITIS C DETECT PROBE TECH REF 87522 $397.00
HEPATOBILIARY IMAGING 78226 $3,535.00
HEPATOBILIARY WITH CCK 78227 $4,555.00
HETEROPHILE SCREEN 86308 $48.00
HEXAGONAL PHOSPHOLIPID REF 85598 $166.00
HFE GENE ANALYSIS REF 81256 $605.00
HHV 6 DNA QUANT REF 87533 $375.00
HIGH DENSITY LIPOPROTEIN (HDL) 83718 $76.00
HISTAMINE 83088 $273.00
HISTOPLASMA ANTIGEN EIA 87385 $111.00
HISTOPLASMOSIS AB 86698 $116.00
HIV AG AB COMB ASSAY SCREENING LAB G0475 $223.00
HIV VIRAL LOAD RNA QT 87536 $788.00
HIV1 AG W HIV1-2 AB DIAGNOSTIC LAB 87389 $223.00
HIV-1 AMPLIFIED PROBE 87535 $325.00
HIV-1/HIV-2 SINGLE RESULT 86703 $127.00
HIV-2 AMPLIFIED PROBE 87538 $325.00
HIV-2 ANTIBODY 86702 $125.00
HIV-WESTERN BLOT CONFIRM 86689 $179.00
HLA I TYPING 1 ALLELE HR REF 81381 $1,274.00
HLA I TYPING 1 ANTIGEN LR-REF 81374 $674.00
HLA I TYPING 1 LOCUS HR-REF 81380 $1,641.00
HLA I TYPING COMPLETE HR REF 81379 $3,105.00
HLA II TYPING 1 ALLELE HR - REF 81383 $1,010.00
HLA II TYPING 1 LOC HR-REF 81382 $1,145.00
HLA II TYPING 1 LOCUS LR - REF 81376 $1,132.00
HLA-B27 REF 86812 $239.00
HOMOCYSTEINE, SERUM 83090 $156.00
HOMOVANILLIC ACID 83150 $179.00
HOT OR COLD PACKS THERAPY 97010 $130.00
HPV HIGH-RISK TYPES MIC 87624 $325.00
HPV TYPES 16 & 18 ONLY REF 87625 $325.00
HSV,AMPLIFIED PROBE TECHNIQUE 87529 $325.00
HTLV III (HIV) 86701 $82.00
Page 23 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
HUMAN GROWTH HORMONE 83003 $154.00
HYDROXYCORTICOSTEROIDS, 17 83491 $162.00
HYDROXYINDOLACETIC ACID URINE 83497 $119.00
HYDROXYPROGESTERONE, 17-D 83498 $252.00
HYPERBARIC 02 CHAMBER EA 30MIN G0277 $572.00
HYSTERECTOMY SERVICES $10,658.00
I & D $2,932.00
I&D ABSCESS, SIMPLE OR SINGLE 10060 $970.00
I&D DEEP ABSC/HEMATOMA NECK/CHEST 21501 $13,081.00
I&D PERIANAL ABSCESS,SUPERFICIAL 46050 $4,097.00
I&D PERIRECTAL ABSCESS 46040 $5,389.00
I131 IODINE THERAPUTIC PER MCI A9530 $84.00
IAB INSERTION 33967 $1,486.00
ICD INSERT ONLY W EXISTING SGL LEAD 33240 $120,981.00
ICD INSERT ONLY(DUAL LD EXIST) 33230 $120,981.00
ICD INSERT ONLY(MULT LD EXIST) 33231 $168,610.00
ICD INSERT W/LD(S)1/2 CHAMBER 33249 $168,610.00
ICD REMVL W/ICD INSERT DUAL LD 33263 $120,981.00
ICD REMVL W/ICD INSERT MULT LD 33264 $168,610.00
ICD REMVL W/ICD INSERT SNGL LD 33262 $120,981.00
ICD SUBQ INSERT OR REPLACEMT W LEAD 33270 $168,610.00
ICP MONITOR INSERTION 61107 $1,798.00
IGG SUBCLASSES 1,2,3 OR 4 EACH REF 82787 $74.00
IGH VARI REGIONAL MUTATION REF 81263 $2,727.00
IKBKAP GENE 81260 $295.00
ILIAC CONTRALATERAL WITH CATH G0278 $79.00
IMAGE CATH FLUID COLXN VISC 49405 $7,565.00
IMAGE CATH FLUID PERI/RETRO 49406 $7,565.00
IMAGE-GUIDED CATH FLUID DRAINAGE 10030 $3,186.00
IMMUNIZATION ADMINISTRATION 90471 $299.00
IMMUNOASSAY,ANALYTE-NONSP.TECH 83520 $130.00
IMMUNOASSAY,INF AGENT,QUANT 86317 $139.00
IMMUNOASSAY,QUAL/SEMIQUAN-MULT 83516 $107.00
IMMUNOASSAY-TUMOR,OTHER,QUANT. 86316 $193.00
IMMUNOCYTOCHEMISTRY,EACH AB 88342 $1,085.00
IMMUNODIFFUSION,GEL,QUAL,EACH 86331 $111.00
IMMUNOFIX ELP URINE/CSF 86335 $272.00
IMMUNOFIXATION ELECTROPHORESIS REF 86334 $207.00
IMMUNOFLUOR AB PER SPEC INIT 88346 $2,057.00
IMMUNOGLOBULIN A 82784 $86.00
IMMUNOGLOBULIN G (IGG) 82784 $86.00
IMMUNOGLOBULIN IGE 82785 $152.00
Page 24 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
IMMUNOGLOBULIN M (IGM) 82784 $86.00
IMMUNOHISTO ANTIBODY 1ST SLIDE 88342 $1,085.00
IMMUNOHISTO ANTIBODY ADD SLIDE PAT 88341 $492.00
IMMUNOSSAY ANAL RIA NONANTIBODY REF 83519 $138.00
IMPLANT NEUROSTIM EPI ARRAY 63650 $32,887.00
IMPLANT TRANSCATH PULM ARTERY RHC 33289 $161,374.00
IMRT DELIVERY COMPLEX 77386 $5,199.00
IMRT DELIVERY SIMPLE 77385 $5,199.00
IMRT PLAN 77301 $11,919.00
INCISION HEMORRHOID EXTERNAL 46083 $1,273.00
INCISION/REM FB SUBQ SIMPLE 10120 $1,727.00
INCISIONAL BX OF SKIN EACH ADD LESION 11107 $184.00
INCISIONAL BX OF SKIN SINGLE LESION 11106 $1,727.00
INF AG DETECT NOS IA MULT REF 87449 $111.00
INF AGENT BY NUC HEP C AMP PRB REF 87521 $325.00
INF AGENT GENOTYPE ANAL HEP C REF 87902 $2,384.00
INF AGENT HPYLORI STOOL EIA MIC 87338 $133.00
INF AGENT NUC NOT SPECFD PRBE 87798 $325.00
INF THERAPY-HYDRATION 31-60MIN 96360 $936.00
INF THERAPY-HYDRATION EA ADDHR 96361 $189.00
INF THERAPY-TH/DIAG ADDHR 96366 $189.00
INF THERAPY-TH/DIAG-CONC < 1HR 96368 $107.00
INF THERAPY-TH/DIAG-INIT < 1HR 96365 $936.00
INF THERAPY-TH/DIAG-SEQ < 1HR 96367 $299.00
INF.AGENT BY NUC-CYTOMEGA-APT 87496 $325.00
INF.AGENT GENOTYPE ANAL-HIV-1 87901 $2,384.00
INF.AGENT-BY NUC-HEP B-QUANT. 87517 $397.00
INF.AGENT-IMMUNOASSAY-NOT SPFD 87899 $121.00
INF.AGENT-IMMUNO-HEPATITIS-DLT 87380 $152.00
INFECTIOUS AGENT DNA QUANT NOS 87799 $397.00
INFLUENZA A,AG,IF 87276 $121.00
INFLUENZA ADMINISTRATION 90471 $299.00
INFLUENZA B,AG,IF 87275 $111.00
INFLUENZA DNA AMP PROBE 87502 $788.00
INFLUENZA DNA AMP PROBE ADDL 87503 $219.00
INHIBIN A 86336 $144.00
INIT PROSTHETIC TRAINING EA 15 MIN 97761 $274.00
INITIAL ORTHOTIC TRAINING EA 15 MIN 97760 $319.00
INJ ANES CELIAC PLEXUS 64530 $4,207.00
INJ CONGENITAL CARD CATH 93563 $273.00
INJ CONGENITAL HRT ART/GRAPH 93564 $288.00
INJ FOR SACROILIAC JT ANESTH G0260 $3,293.00
Page 25 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
INJ LT ATRIAL/VENTRIC ANGIO 93565 $211.00
INJ PARA FACET C/T 1 LVL W/IG 64490 $4,207.00
INJ PARA FACET C/T 2D LVL W/IG 64491 $341.00
INJ PARA FACET C/T 3D LVL W/IG 64492 $345.00
INJ PARA FACET L/S 1 LVL W/IG 64493 $4,207.00
INJ PARA FACET L/S 2D LVL W/IG 64494 $295.00
INJ PARA FACET L/S 3D LVL W/IG 64495 $299.00
INJ PERQ CHOLANGIO EXIST W RAD/GDE 47531 $16,210.00
INJ PERQ CHOLANGIO NEW W RAD/GDE 47532 $16,210.00
INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI 23350 $291.00
INJ PULMONARY ANGIO 93568 $222.00
INJ RT ATRIAL/VENTRIC ANGIO 93566 $217.00
INJ SUPRAVALVULAR AORTOGRAPHY 93567 $246.00
INJ THRU KIDNEY TUBE EXIST W RGDE 50431 $3,092.00
INJ THRU KIDNEY TUBE NEW W RGDE 50430 $3,092.00
INJ(S) ANES BRACHIAL PLEXUS NERVE 64415 $4,207.00
INJ(S) ANES GREATER OCCIPITAL NERVE 64405 $1,361.00
INJ(S) ANES ILIO-ING/HYPOGI NERVE 64425 $3,293.00
INJ(S) ANES INTERCOSTAL NERVE ADD LVL 64421 $4,207.00
INJ(S) ANES OTHER PERIPHERAL NERVE 64450 $3,293.00
INJ(S) ANES PUDENDAL NERVE 64430 $4,207.00
INJ(S) ANES SUPRASCAPULAR NERVE 64418 $3,293.00
INJ(S) ANES TRIGEMINAL NERVE 64400 $1,361.00
INJ(S) SINGLE TENDON ORIGIN/INSRT 20551 $1,361.00
INJ(S) SNGL TENDON SHEATH/LIGAMNT 20550 $1,361.00
INJ(S) TRIGGER PT(S) 1/2 MUSCLE 20552 $1,361.00
INJ(S) TRIGGER PT(S) 3/MORE MS 20553 $1,361.00
INJ,EPI CERV/THOR SINGLE W IG 62321 $3,293.00
INJ,EPI CERV/THOR SINGLE W/O IG 62320 $3,293.00
INJ,EPI LUMB/SAC SINGLE W IG 62323 $3,293.00
INJ,EPI LUMB/SAC SINGLE W/O IG 62322 $3,293.00
INJ,FORAMEN,L/S,1 LEVEL 64483 $4,207.00
INJ,FORAMEN,L/S,ADDL LEVELS 64484 $296.00
INJ,LUMB EPIDUR,BLOOD/CLOT PATCH 62273 $3,293.00
INJ/ASPIR-INT JT/BURSA WITH US GUIDE 20606 $3,293.00
INJ/ASPIR-INTERMED JT/BURSA W/O US GUIDE 20605 $1,361.00
INJ/ASPIR-LARGE JT/BURSA W/O US GUIDE 20610 $1,361.00
INJ/ASPIR-LARGE JT/BURSA WITH US GUIDE 20611 $1,361.00
INJ/ASPIR-SMALL JT/BURSA W/O US GUIDE 20600 $1,361.00
INJ/ASPIR-SMALL JT/BURSA WITH US GUIDE 20604 $1,361.00
INJECT CORPORA CAVERN,PHARM AGNT 54235 $1,273.00
INJECT FOR RETROGRADE URETHOCYSTO 51610 $368.00
Page 26 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
INJECT FOR SACROILIAC JOINT 27096 $473.00
INJECT NERV BLOCK CELIAC PLEXUS 64530 $4,207.00
INJECT RETROGRADE/CONDUIT X-RAY 50690 $401.00
INJECT SINUS TRACT FOR DX W XRAY 20501 $216.00
INJECT,MYELOGRAPHY &/OR CT SCAN,SPINAL 62284 $503.00
INJECTION FOR ANKLE ARTHROGRAM 27648 $301.00
INJECTION FOR BLADDER X-RAY 51600 $255.00
INJECTION FOR ELBOW ARTHROGRAM 24220 $387.00
INJECTION FOR SALIVARY X-RAY 42550 $365.00
INJECTION FOR WRIST ARTHROGRAM 25246 $428.00
INJECTION HIP ARTHROGRAM 27093 $398.00
INJECTION KNEE CONTRAST 27369 $232.00
INJECTION PROC,EXTREMITY,VENOGRAPHY 36005 $276.00
INJECTION RX EXTREMITY PSEUDOANEURYSM 36002 $3,410.00
INJECTION,THERAPEUTIC CARPAL T 20526 $1,361.00
INJECTION-DIAG/THERAP-SQ/IM 96372 $299.00
INJECTION-SACROILIAC-ANES/STER G0260 $3,293.00
INJ-FORAMEN EPI CER/THOR ADDL 64480 $357.00
INJ-FORAMEN EPI CERV/THOR SNGL 64479 $4,207.00
INJ-FORAMEN EPI LUM/SAC ADDL 64484 $296.00
INJ-FORAMEN EPI LUM/SAC SNGL 64483 $4,207.00
INSERT CATH PLEURA W/IG 32557 $6,015.00
INSERT CATH UMB ART 36660 $393.00
INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERC 49441 $8,158.00
INSERT GASTROSTOMY TUBE PERCUTANEOUS 49440 $8,158.00
INSERT IVC FILTER WITH IG & SI 37191 $24,071.00
INSERT NEEDLE BONE CAVITY FOR INTRAOSSEOUS INFUSION 36680 $660.00
INSERT NON-TUNNEL CV CATH 36556 $6,015.00
INSERT NON-TUNNEL CV CATH < 5 Y/O 36555 $6,015.00
INSERT PICC CV CATH W/SUBQ PORT 36571 $14,528.00
INSERT SUBQ CRM W PROGRAMMING 33285 $40,723.00
INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT 37182 $4,714.00
INSERT TUN IP CATH PERC W/IMAGING 49418 $16,210.00
INSERT TUNNELED CV CATH 36563 $24,071.00
INSERT TUNNELED CV CATH SUB Q 36561 $14,528.00
INSERT TUNNELED CV CATH W/O PORT OR PUMP 36558 $14,528.00
INSERT UTERINE TNDM/VAG OVOID 57155 $12,987.00
INSERT VAD ARTERY & VEIN ACCESS 33991 $3,576.00
INSERT VAD ARTERY ACCESS 33990 $2,437.00
INSERT VAG RAD AFTLOAD DEVICE 57156 $1,502.00
INSERTION CATH MINI 51701 $586.00
INSERTION CATHETER FOLEY 51702 $586.00
Page 27 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
INSERTION INDWELLING TUNNELED PLEURAL CATHETER 32550 $16,210.00
INSERTION OF CATHETER UMB VEIN 36510 $306.00
INSERTION,PPM/AICD ONE LEAD 33216 $40,723.00
INSERTION-CERVICAL DIALATOR 59200 $1,502.00
INSULIN 83525 $106.00
INSULIN ANTIBODIES 86337 $198.00
INTERMED SIMULATION 77285 $3,218.00
INTEROPERATIVE PTH INTACT 83970 $382.00
INTERROGATION DEVICE EVAL ICD 93289 $167.00
INTERSTI.RADIO.AP:10+ 77778 $7,047.00
INTERSTITIAL FIDUCIAL MARKER PLACE 49411 $6,556.00
INTERSTITIAL PLACEMENT PERQ 49411 $6,556.00
INTRACARDIAC ECHOCARDIOGRAPHY 93662 $663.00
INTRACARDIAC EP 3D MAPPING 93613 $1,389.00
INTRACRANIAL BALLOON ANGIOPLASTY 61630 $7,981.00
INTRACRANIAL BALLOON ANGIOPLSTY W/STENT 61635 $8,379.00
INTRAOP CYTO PATH CONSULT 1 88333 $4,186.00
INTRAOP CYTO PATH CONSULT 2 88334 $129.00
INTRAOP NEURO IN OR 1:1 PER 15 MIN 95940 $151.00
INTRAVAS US PROCEDURE INIT VSL 92978 $449.00
INTRINSIC FACTOR ANTIBODIES 86340 $140.00
INTRO ANGIO DIALYSIS CIRCUIT S&I 36901 $6,015.00
INTRO NEEDLE CATH UE/LE ARTERY 36140 $515.00
INTRO PTA DIALYSIS CIRCUIT IMG S&I 36902 $25,732.00
INTRO STENT DIALYSIS CIRCUIT S&I 36903 $53,180.00
INTRODUCTION OF CATHETER,AORTA 36200 $796.00
IONTOPHORESIS EA 15 MIN 97033 $139.00
IOP DIAGNOSTIC INTERVIEW 90791 $638.00
IOP DIAGNOSTIC INTERVIEW CD 90791 $638.00
IOP FAMILY THERAPY W/ PT 90847 $638.00
IOP FAMILY THERAPY W/O PT 90846 $638.00
IOP GROUP THERAPY-CD 90853 $382.00
IOP GROUP THERAPY-PSYCH 90853 $382.00
IRON 83540 $60.00
IRON BINDING CAPACITY 83550 $81.00
IRRIGATE IMPLANTED VNS PRT 96523 $307.00
ISLET CELL ANTIBODY 86341 $183.00
IV START 36000 $755.00
IVUS ADDL VESSEL LAD 92979 $358.00
JAK2 V617F MUTATION DETECT 81270 $849.00
JOINT SURVEY, SINGLE VIEW 77077 $1,125.00
KETOSTEROIDS, 17- TOTAL 83586 $119.00
Page 28 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
KLEIHAUER BETKE STAIN FETAL RBC LAB 85460 $72.00
KOH WET MOUNT-HAIR,SKIN,NAILS Q0112 $44.00
L HRT CATH TRNSPTL PUNCTURE 93462 $984.00
LAB SPECIMEN HANDLING REF 99001 $87.00
LACTIC ACID 83605 $99.00
LACTOFERRIN FECAL QUAL LAB 83630 $182.00
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC 31575 $902.00
LARYNGOSCOPY,DIAGNOSTIC 31575 $902.00
LARYNGOSCOPY,FLEXIBLE FIBEROPTIC; W/REMOVAL OF FOREIGN BODY 31577 $2,126.00
LC APP SKN GRAFT FNHFG<100 1ST25 C5275 $2,656.00
LC APP SKN GRAFT FNHFG<100ADD25 C5276 $683.00
LC APP SKN GRAFT TAL<100CM 1ST25 C5271 $2,656.00
LC APP SKN GRAFT TAL<100CM ADD25 C5272 $683.00
LDH 83615 $56.00
LDH ISOENZYMES-SEP. & QUANT. 83625 $119.00
LEAD BLOOD REF 83655 $112.00
LEPTOSPIRA ANTIBODY 86720 $122.00
LEUKOCYTE ALK P 85540 $80.00
LEUKOCYTES STOOL LAB 89055 $40.00
LEVEL I BRIEF 99281 $558.00
LEVEL I NEW PATIENT 99201 $137.00
LEVEL I NEW PATIENT-ET 99201 $137.00
LEVEL I SURG PATH GROSS ONLY 88300 $129.00
LEVEL I VISIT ESTABLISHED PT 99211 $47.00
LEVEL I VISIT ESTABLISHED-ET 99211 $47.00
LEVEL II LIMITED 99282 $1,024.00
LEVEL II NEW PATIENT 99202 $258.00
LEVEL II S.PATH GROSS&MICRO 88302 $241.00
LEVEL II VISIT ESTABLISHED PT 99212 $130.00
LEVEL II VISIT ESTABLISHED-ET 99212 $130.00
LEVEL III INTERMEDIATE 99283 $1,784.00
LEVEL III NEW PATIENT 99203 $387.00
LEVEL III NEW PATIENT-ET 99203 $387.00
LEVEL III S.PATH GROSS&MICRO 88304 $382.00
LEVEL III VISIT ESTABLISHED 99213 $260.00
LEVEL III VISIT ESTABLISHED-ET 99213 $260.00
LEVEL IV EXTENDED 99284 $2,883.00
LEVEL IV NEW PATIENT 99204 $656.00
LEVEL IV S.PATH GROSS&MICRO 88305 $382.00
LEVEL IV VISIT ESTABLISHED PT 99214 $401.00
LEVEL V COMPREHENSIVE 99285 $4,202.00
LEVEL V S.PATH GROSS&MICRO 88307 $2,057.00
Page 29 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
LEVEL VI S.PATH GROSS&MICRO 88309 $4,186.00
LIDOCAINE (XYLOCAINE) 80176 $136.00
LIGATION OF A-V FISTULA 37607 $14,528.00
LINAC SRS FRACT PER SESSION M5 FRACT 77373 $16,906.00
LIPASE 83690 $64.00
LIPID PANEL 80061 $124.00
LIPIDS FECES QUANT 82710 $156.00
LIPO-ASSOC PHOS A2 (LP-PLA2) 83698 $347.00
LIPOPROTEIN FRACTIONS REF 83701 $254.00
LIPOPROTEIN QT BLOOD BY NMR 83704 $292.00
LIPOPROTEINS A*R 83695 $120.00
LITHIUM 80178 $61.00
LIVER & SPLEEN IMAGE VASCULAR FLOW 78216 $3,535.00
LIVER AND SPLEEN IMAGING 78215 $3,535.00
LOCAL $888.00
LOW DOSE CT LUNG CA SCREEN G0297 $623.00
LT ATRIAL APPENDAGE CLOSURE 33340 $4,528.00
LT HRT ART/VENTRICLE ANGIO 93458 $12,647.00
LT HRT ARTERY/GRAFT ANGIO 93459 $12,647.00
LUMBAR PUNCTURE-DIAGNOSTIC 62270 $3,293.00
LUMBAR PUNCTURE-THERAPEUTIC 62272 $3,293.00
LUMBAR SYMP BLOCK 64520 $4,207.00
LUNG PERFUSION IMAGING 78580 $3,535.00
LUNG VENT/PERF IMAGING 78582 $4,555.00
LUTEINIZING HORMONE 83002 $171.00
LYME DISEASE ANTIBODY 86618 $158.00
LYMPHATICS & LYMPH GLANDS IMAGING 78195 $4,555.00
LYMPHATICS INJ-SUBQUE/MUSCLE 38792 $1,944.00
LYMPHOCYTE TRANSFORMATION 86353 $454.00
MACROSCOPIC EXAM PARASITE MIC 87169 $40.00
MAGNESIUM 83735 $62.00
MAMMARY DUCTOGRAM, SINGLE 77053 $2,306.00
MANGANESE 83785 $228.00
MANUAL DIFF WBC COUNT 85007 $32.00
MANUAL THERAPY JOINT MOBILIZAT 97140 $186.00
MANUAL THERAPY TECHNIQUE 15MIN 97140 $186.00
MASS SPECTOMETRY-QN CARNITINE 83789 $181.00
MASSAGE 97124 $191.00
MEASURE KIDNEY PRESSURE THRU TUBE 50396 $3,092.00
MEAT FIBERS FECES LAB 89160 $36.00
MECH CHEST WALL OSCIL PER/SESSION 94669 $958.00
MECH RMV TUNNELED CV CATH SEP ACC 36595 $14,528.00
Page 30 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
MECHANICAL TRACTION 97012 $99.00
MEP LOWER LIMBS 95929 $2,049.00
MEP UPPER AND LOWER 95939 $4,108.00
MEP UPPER LIMBS 95928 $4,108.00
MERCURY LEVEL QUANT REF 83825 $151.00
METANEPHRINES TOTAL 83835 $157.00
METHEMOGLOBIN 83050 $68.00
METHOTREXATE 80299 $140.00
METHYLENEDIOXYAMPHETAMINES REF G0480 $248.00
MICROALBUMIN URINE QT 82043 $54.00
MICROBE SUSCEPTIBLE,DIFFUSE 87181 $44.00
MICROBE SUSCEPTIBLE,DISK 87184 $64.00
MICROSOMAL ANTIBODIES-EACH 86376 $135.00
MIDLINE NON-ROUTINE BL DRAW > AGE 3 36410 $2,188.00
MLC DEVICE DESIGN FOR IMRT 77338 $3,218.00
MOLE CYTO-CHROMO SITU 10-30CLS 88273 $297.00
MOLE CYTO-INTER SITU-100-300 C 88275 $384.00
MOLECULAR CYTOGENETICS-DNA PRB 88271 $198.00
MONONUCLEAR CELL AG NOS 86356 $248.00
MOPATH LEVEL 2 APOE 2 Mutat-REF 81401 $1,028.00
MOPATH PROCEDURE LEVEL 1 REF 81400 $480.00
MOPATH PROCEDURE LEVEL 3 REF 81402 $1,127.00
MOPATH PROCEDURE LEVEL 4 REF 81403 $1,389.00
MOPATH PROCEDURE LEVEL 5 REF 81404 $2,061.00
MOPATH PROCEDURE LEVEL 6 REF 81405 $2,260.00
MOPATH PROCEDURE LEVEL 7 REF 81406 $2,300.00
MOPATH PROCEDURE LEVEL 9 REF 81408 $15,000.00
MORPH ANAL TUMOR IMMUNO 88360 $1,085.00
MORPHOMETRIC QUANT 1ST STAIN PAT 88368 $860.00
MORPHOMETRIC QUANT EA ADDL PAT 88369 $2,057.00
MR ANGIO UPPER EXTREMITY W/ W/O CONT 73225 $3,859.00
MR ANGIO UPPER EXTREMITY W/CONT 73225 $3,859.00
MR ANGIO, HEAD 70544 $2,306.00
MR ANGIO, HEAD W/CONTRAST 70545 $3,859.00
MR ANGIO, HEAD, COMBO 70546 $3,859.00
MR ANGIO, NECK 70547 $2,306.00
MR ANGIO, NECK W/CONTRAST 70548 $3,859.00
MR ANGIO, NECK, W&WO CONTRAST 70549 $3,859.00
MRA W/O CONT, ABD C8901 $2,306.00
MRA W/O CONT, CHEST C8910 $2,306.00
MRA W/O CONT, LWR EXT C8913 $2,306.00
MRA W/O CONT, PELVIS C8919 $2,306.00
Page 31 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
MRA W/O FOL W/CONT, ABD C8902 $3,859.00
MRA W/O FOL W/CONT, CHEST C8911 $3,859.00
MRA W/O FOL W/CONT, LWR EXT C8914 $3,859.00
MRA W/O FOL W/CONT, PELVIS C8920 $3,859.00
MRI BRAIN 70551 $2,306.00
MRI BRAIN COMBO 70553 $3,859.00
MRI BRAIN CONTRAST 70552 $3,859.00
MRI BREAST W CONTRAST UNILATERAL C8903 $2,017.00
MRI BREAST WO CONTRAST BILATERAL 77047 $2,306.00
MRI BREAST WO CONTRAST UNILATERAL 77046 $2,306.00
MRI LOWER EXTREM JT, W/O CONTRAST 73721 $2,306.00
MRI SPECTROSCOPY 76390 $3,096.00
MRI UPPER EXTR, W/CONTRAST 73220 $3,859.00
MRI W/O FOL W/CONT, BREAST, C8908 $3,859.00
MRI, ABDOMEN (MRI) 74181 $2,306.00
MRI, ABDOMEN, COMBO 74183 $3,859.00
MRI, CERV SPINE 72141 $2,306.00
MRI, CERV SPINE COMBO 72156 $3,859.00
MRI, CERV SPINE CONTRAST 72142 $3,859.00
MRI, CHEST 71550 $2,306.00
MRI, CHEST, COMBO 71552 $3,859.00
MRI, DORSAL SPINE 72146 $2,306.00
MRI, DORSAL SPINE COMBO 72157 $3,859.00
MRI, DORSAL SPINE CONTRAST 72147 $3,859.00
MRI, FACE, NECK 70540 $2,306.00
MRI, FACE, NECK W/CONTRAST 70542 $3,859.00
MRI, FACE, NECK, COMBO 70543 $3,859.00
MRI, JOINT OF LEG W/CONTRAST 73722 $6,918.00
MRI, JOINT OF LEG. COMBO 73723 $3,859.00
MRI, JOINT UPPER EXTREM 73221 $2,306.00
MRI, JOINT UPPER EXTREM COMBO 73223 $3,859.00
MRI, JOINT UPPER EXTREM W/CONTRAST 73222 $6,918.00
MRI, LOWER EXTR, W/O CONTRAST F/U 73720 $3,859.00
MRI, LOWER EXTREM 73718 $2,306.00
MRI, LOWER EXTREM W/CONTRAST 73719 $3,859.00
MRI, LUMBAR SPINE 72148 $2,306.00
MRI, LUMBAR SPINE COMBO 72158 $3,859.00
MRI, LUMBAR SPINE CONTRAST 72149 $3,859.00
MRI, PELVIS W/CONTRAST 72196 $3,859.00
MRI, PELVIS, COMBO 72197 $3,859.00
MRI, PELVIS, W/O CONTRAST 72195 $2,306.00
MRI, TMJ 70336 $2,306.00
Page 32 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
MRI, UPPER EXTREM 73218 $2,306.00
MRSA BY PCR (AMP) 87641 $325.00
MTHFR GENE COMMON VARIANT REF 81291 $490.00
MUCOPOLYSACCHARIDES REF 83864 $590.00
MURAMIDASE 85549 $174.00
MUSCLE TEST LARYNX 95865 $479.00
MYCOBACTERIA CULTURE 87116 $100.00
MYCOBACTERIA TB AMP PROBE DNA 87556 $325.00
MYCOPLASMA ANTIBODY 86738 $123.00
MYCOPLASMA PNEUM DNA AMP PROBE MIC 87581 $325.00
MYCOPLASMA PNEUM DNA AMP PROBE REF 87581 $325.00
MYELIN BASIC PROTEIN 83873 $159.00
MYELOGRAPHY LUMBAR SPINE 72265 $6,918.00
MYELOGRAPHY VIA LUMBAR IN 2+ REGIONS 62305 $3,805.00
MYELOGRAPHY VIA LUMBAR IN LUMBOSACRAL 62304 $3,805.00
MYOCARDIAL SPECT MULTIPLE STUDIES 78452 $12,294.00
MYOCARDIAL STRAIN IMAGING STE 93356 $56.00
MYOGLOBIN 83874 $120.00
N BLOCK INJ(S) AXILLARY 64417 $4,538.00
N BLOCK INJ(S) BRACHIAL PLEXUS 64415 $4,207.00
N BLOCK INJ(S) FEM SINGLE 64447 $3,493.00
N BLOCK INJ(S) GREATER OCCIPITAL 64405 $1,361.00
N BLOCK INJ(S) ILIO-ING/HYPOGI 64425 $3,293.00
N BLOCK INJ(S) INTERCOST MLT 64421 $4,207.00
N BLOCK INJ(S) INTERCOST SNG 64420 $3,493.00
N BLOCK INJ(S) LUMBAR PLEXUS 64449 $4,538.00
N BLOCK INJ(S) OTHER PERIPHERAL 64450 $3,493.00
N BLOCK INJ(S) PUDENDAL 64430 $4,207.00
N BLOCK INJ(S) SCIATIC SNG 64445 $3,493.00
N BLOCK INJ(S) SUPRASCAPULAR 64418 $3,293.00
N BLOCK INJ(S) TRIGEMINAL EA BRANCH 64400 $1,361.00
N BLOCK INJ(S) VAGUS 64408 $1,463.00
NASO GASTRIC TUBE PLACEMENT 43752 $1,915.00
NATRIURETIC PEPTIDE 83880 $314.00
NATRIURETIC PEPTIDE (BNP) 83880 $314.00
NB SCREEN STATE S3620 $130.00
NEEDLE BIOPSY LIVER 47000 $7,565.00
NEEDLE BIOPSY OF PANCREAS 48102 $7,565.00
NEEDLE BIOPSY PLEURA 32400 $7,565.00
NEEDLE BIOPSY, LYMPH NODE(S) 38505 $7,565.00
NEEDLE BIOPSY,MUSCLE 20206 $7,565.00
NEG PRESS WND THERAPY <50CM DME 97605 $1,147.00
Page 33 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
NEG PRESS WND THERAPY >50CM DME 97606 $2,042.00
NEOPLASTIC-CULTURE-B.MARROW 88237 $1,169.00
NEPHELOMETRY EA NOT SPEC REF 83883 $126.00
NEURO CSF PRION PROTEIN QUAL REF 0035U $202.00
NEURO DEST FACET C/T W/IG ADDL 64634 $387.00
NEURO DEST FACET C/T W/IG SNGL 64633 $8,973.00
NEURO DEST FACET L/S W/IG ADDL 64636 $339.00
NEURO DEST FACET L/S W/IG SNGL 64635 $8,973.00
NEUROBEHAVIOR STATUS EXAM EA ADD HR 96121 $399.00
NEUROBEHAVIOR STATUS EXAM FIRST HR 96116 $1,262.00
NEUROLYTIC DEST GENICULAR NERVE 64624 $9,609.00
NEUROLYTIC DEST-CELIAC PLEXUS 64680 $4,207.00
NEUROLYTIC DEST-OTHER NERVE 64640 $4,207.00
NEUROMS REED,BALANCE,COOR,POST 97112 $234.00
NEUROMUSCULAR REED. EA 15 MIN 97112 $234.00
NEUROMUSCULAR RE-EDUCATION 97112 $234.00
NEUROPSYCH TEST EVAL ADD HOUR 96133 $420.00
NEUROPSYCH TEST EVAL FIRST HOUR 96132 $680.00
NEWBORN RESUSCITATION 99465 $2,896.00
NK CELL TOTAL COUNT REF 86357 $314.00
NONINVASV EXT EXAM,1LEVEL,UNILAT 93922 $479.00
NONINVASV EXTREM EXAM,1LEVEL,BILAT 93922 $479.00
NONINVASV EXTREM EXAM,MULT,BILAT 93923 $612.00
NON-NEOPLASTIC-CULTURE-SKIN/TS 88233 $1,303.00
NPPB OP TREATMENT 94640 $958.00
NPPB TREATMENT 94640 $958.00
NRV BLOCK SPENO GANG 64999 $489.00
NRV CONDUCT STUDIES 11-12 95912 $2,049.00
NRV CONDUCT STUDIES 1-2 95907 $612.00
NRV CONDUCT STUDIES 13+ 95913 $2,049.00
NRV CONDUCT STUDIES 3-4 95908 $1,135.00
NRV CONDUCT STUDIES 5-6 95909 $1,135.00
NRV CONDUCT STUDIES 7-8 95910 $1,135.00
NRV CONDUCT STUDIES 9-10 95911 $2,049.00
NUC THERAPY INTRA-ARTERIAL 79101 $2,309.00
NUC THERAPY INTRACAVITARY RAD 79005 $2,309.00
NUCLEOTIDASE, 5- 83915 $103.00
NUDT15 GENE COMMON VARIANTS REF 81306 $2,185.00
OB < 14 WKS, ADD'L FETUS 76802 $224.00
OB < 14 WKS, SINGLE FETUS 76801 $1,125.00
OB >/= 14 WKS, ADDL FETUS 76810 $440.00
OB >/= 14 WKS, SNGL FETUS 76805 $1,125.00
Page 34 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
OBSTETRIC PANEL 80055 $443.00
OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE 49460 $4,189.00
OCCLUSIVE DEVICE IN VEIN ART G0269 $2,430.00
OCCLUSIVE DEVICE PLACEMENT G0269 $2,430.00
OCCULT BLOOD FECES IMMUNOASSAY 82274 $147.00
OCCULT BLOOD STOOL 3 SPECIMENS 82270 $33.00
OCCULT BLOOD,OTHER SOURCES 82271 $40.00
OFFICE VISIT-EST-LEVEL 1 99211 $47.00
OFFICE VISIT-EST-LEVEL 2 99212 $130.00
OFFICE VISIT-EST-LEVEL 3 99213 $260.00
OFFICE VISIT-EST-LEVEL 4 99214 $401.00
OFFICE VISIT-EST-LEVEL 5 99215 $565.00
OFFICE VISIT-EST-LEVEL1-PSUBSP 99211 $47.00
OFFICE VISIT-EST-LEVEL2-PSUBSP 99212 $130.00
OFFICE VISIT-EST-LEVEL3-PSUBSP 99213 $260.00
OFFICE VISIT-EST-LEVEL4-PSUBSP 99214 $401.00
OFFICE VISIT-EST-LEVEL5-PSUBSP 99215 $565.00
OFFICE VISIT-NEW-LEVEL 1 99201 $137.00
OFFICE VISIT-NEW-LEVEL 2 99202 $258.00
OFFICE VISIT-NEW-LEVEL 3 99203 $387.00
OFFICE VISIT-NEW-LEVEL 4 99204 $656.00
OFFICE VISIT-NEW-LEVEL 5 99205 $857.00
OFFICE VISIT-NEW-LEVEL1-PSUBSP 99201 $137.00
OFFICE VISIT-NEW-LEVEL2-PSUBSP 99202 $258.00
OFFICE VISIT-NEW-LEVEL3-PSUBSP 99203 $387.00
OLIGOCLONAL IMMUNE BANDS REF 83916 $205.00
ONCOLOGY PROSTATE PROB SCORE REF 81539 $5,700.00
OP DIAG INTERVIEW ER/C&L 90791 $638.00
OP DIAG INTERVIEW-ER 90791 $638.00
OP DIAGNOSTIC INTERVIEW 90791 $638.00
OPEN PERQ PLACE STENT EA ADDL 37237 $1,216.00
ORAL PHARYNGEAL EVALUATION 92610 $485.00
ORGANIC ACID SINGLE QUANT REF 83921 $159.00
ORGANIC ACIDS TOTAL QT EA SPEC 83918 $177.00
OSMOLALITY BLOOD 83930 $61.00
OSMOLALITY URINE 83935 $63.00
OSTEOCALCIN REF 83937 $276.00
OT EVAL HIGH COMPLX 60 MIN 97167 $609.00
OT EVAL LOW COMPLX 30 MIN 97165 $609.00
OT EVAL MOD COMPLX 45 MIN 97166 $609.00
OT RE-EVAL EST PLAN CARE 97168 $418.00
OVA & PARASITES SMEARS MIC 87177 $82.00
Page 35 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
OXYLATES URINE QUANT 83945 $119.00
PACU - EA ADDL 30 MINS PHASE II $1,004.00
PACU - 1ST 60 MINS PHASE I $2,120.00
PACU - 1ST 60 MINS PHASE II $2,120.00
PACU - EA ADDL 30 MINS PHASE I $1,004.00
PAMG-1 RAPID ASSAY,ROM AMNISUR 84112 $736.00
PANORAMIC X-RAY OF JAWS 70355 $623.00
PAP SMEAR OBTAIN/PREP Q0091 $94.00
PAPP-A (PREG ASSC PLASMA PROT) 84163 $139.00
PARACENTESIS, ABD W/O IMAGING 49082 $4,189.00
PARACENTESIS,ABD W/IMAGING 49083 $4,189.00
PARAFFIN BATH 97018 $47.00
PARAFFIN TREATMENT 97018 $47.00
PARAINFLUENZA,AG,IF 87279 $123.00
PARATHORMONE LAB 83970 $382.00
PARATHYROID NUCLEAR IMAGING 78070 $3,535.00
PARTIAL THROMBO TIME 85730 $56.00
PARTICLE AGGLUTINATION TEST 86403 $94.00
PATENT DUCTUS ARTERIOSUS CLOSURE 93582 $69,095.00
PATH CONSULT-1ST TISSUE BLOCK 88331 $1,085.00
PATH CONSULT-EA ADD TISSUE BLK 88332 $167.00
PCA3/KLK3 ANTIGEN - REF 81313 $1,913.00
PERC ATHERECTOMY DES ADDL LC C9603 $20,301.00
PERC ATHERECTOMY DES ADDL LD C9603 $20,301.00
PERC ATHERECTOMY DES ADDL RC C9603 $20,301.00
PERC ATHERECTOMY DES SINGLE LC C9602 $69,095.00
PERC ATHERECTOMY DES SINGLE LD C9602 $69,095.00
PERC ATHERECTOMY DES SINGLE RC C9602 $69,095.00
PERC REVAS CABG DES ADDL LC C9605 $31,441.00
PERC REVAS CABG DES ADDL LD C9605 $31,441.00
PERC REVAS CABG DES ADDL RC C9605 $31,441.00
PERC REVAS CABG DES SINGLE LC C9604 $43,511.00
PERC REVAS CABG DES SINGLE LD C9604 $43,511.00
PERC REVAS CABG DES SINGLE RC C9604 $43,511.00
PERC REVAS CHRO DES ADDL LC C9608 $28,584.00
PERC REVAS CHRO DES ADDL LD C9608 $28,584.00
PERC REVAS CHRO DES ADDL RC C9608 $28,584.00
PERC REVAS CHRO DES SINGLE LC C9607 $69,095.00
PERC REVAS CHRO DES SINGLE LD C9607 $69,095.00
PERC REVAS CHRO DES SINGLE RC C9607 $69,095.00
PERC REVAS TOT AMI DES SINGLE LC C9606 $42,641.00
PERC REVAS TOT AMI DES SINGLE LD C9606 $42,641.00
Page 36 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
PERC REVAS TOT AMI DES SINGLE RC C9606 $42,641.00
PERCUT ASPIR VERTEBRAL DISC 62267 $3,186.00
PERCUT BIOPSY, ABDOMINAL MASS 49180 $7,565.00
PERCUT BX, LUNG/MEDIASTINUM 32405 $7,565.00
PERCUT CATH OCCLUSN NON CNS LESN 61626 $53,180.00
PERCUT DRAIN/INJECT RENAL CYST 50390 $3,186.00
PERCUT MECH THROMB, VENOUS 37187 $25,732.00
PERCUT PORTAL VEIN CATH 36481 $1,915.00
PERCUT XHEPATIC PORTO+DYNAMIC 75885 $26,415.00
PERCUT XHEPATIC PORTOGRAM 75887 $10,936.00
PERCUTANEOUS CORO THROMBECTOMY 92973 $828.00
PERFUSION $18,316.00
PERICARDIAL DRAIN W/CATH <5YR OLD RS&I 33018 $1,634.00
PERICARDIAL DRAIN W/CATH >6YR OLD RS&I 33017 $1,436.00
PERIOCARDIOCENTESIS W/IMAGING GUIDE 33016 $8,970.00
PERM OCCLUSION/EMBOLIZATION,PERCUT,CNS 61624 $6,615.00
PERQ ART M-THROMBECT NFS 61645 $4,782.00
PERQ BIL CATH PLACE EXT W RAD/GDE 47533 $16,210.00
PERQ BIL CATH PLACE INT-EXT W R/GDE 47534 $16,210.00
PERQ BIL STENT PLACE EXIST W R/GDE 47538 $25,277.00
PERQ CERIVICOTHORACIC INJECT 22510 $14,428.00
PERQ DEV BREAST 1ST MRI IMAG 19287 $3,186.00
PERQ DEV BREAST 1ST STRTCTC 19283 $3,186.00
PERQ DEV BREAST 1ST US IMAG 19285 $3,186.00
PERQ DEV BREAST ADD MRI IMAG 19288 $371.00
PERQ DEV BREAST ADD US IMAG 19286 $248.00
PERQ DEVICE BREAST 1ST IMAG 19281 $3,186.00
PERQ DEVICE BREAST EA IMAG 19282 $289.00
PERQ DILATION BIL DUCT W RAD/GDE 47542 $780.00
PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGE 32556 $8,158.00
PERQ LUMBOSACRAL INJECTION 22511 $14,428.00
PERQ NEPH CATH NEW ACCESS W RAD/GDE 50432 $9,569.00
PERQ STENT CHEST/VERT ART, 1ST VESSEL 0075T $14,324.00
PERQ URET CATH NEW ACCESS W RAD/GDE 50433 $9,569.00
PERQ URTRL STENT EXIST W RAD/GDE 50693 $9,569.00
PERQ URTRL STENT NEW W CATH W RGDE 50695 $16,098.00
PERQ URTRL STENT NEW WO CATH W RGDE 50694 $16,098.00
PERQ VERTEBRAL AUG EACH ADDL 22515 $1,273.00
PERQ VERTEBRAL AUGMENT LUMBAR 22514 $31,348.00
PERQ VERTEBRAL AUGMENT THORACIC 22513 $31,348.00
PET IMAGING CT ATTENUATION SKULL 78815 $13,755.00
PET IMAGING FOR CT ATTENUATION WHOLE 78816 $13,755.00
Page 37 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
PET MYOCARDIAL PERF MULTIPLE 78492 $13,755.00
PH BLOOD 82800 $83.00
PH,BODY FLUID,NOT SPECIFIED 83986 $33.00
PHENOBARBITAL 80184 $115.00
PHENOTYPE ANAL-HIV-1- 1-10 DRG 87903 $4,525.00
PHENYLALANINE (PKU),BLOOD 84030 $51.00
PHLEBOTOMY,THERAPEUTIC 99195 $799.00
PHOSPHATASE ACID TOTAL REF 84060 $68.00
PHOSPHATES ALK-ISOENZYMES REF 84080 $137.00
PHOSPHOLIPID ANTIBODY 86148 $149.00
PHOSPHORUS 84100 $44.00
PHOSPHORUS URINE LAB 84105 $48.00
PHP ACTIVITY THERAPY PER DAY G0176 $530.00
PHP DIAG INTERVIEW 90791 $638.00
PHP EDUCATION TRAINING/DAY G0177 $532.00
PHP FAMILY THERAPY W/ PATIENT 90847 $638.00
PHP GROUP PSYCHOTHERAPY 45-50 MIN G0410 $314.00
PHP INTERACTIVE GRP THRPY 45-50 MIN G0411 $601.00
PICC LINE PLACE W GUIDANCE < AGE 5 36572 $3,410.00
PICC LINE PLACE W GUIDANCE > AGE 5 36573 $6,015.00
PICC LINE PLACE WO GUIDANCE < AGE 5 36568 $3,410.00
PICC LINE PLACE WO GUIDANCE > AGE 5 36569 $6,015.00
PINWORM STUDY Q0113 $40.00
PLACE CATH ADDN SUBSEL ART,ABD/PEL 36248 $281.00
PLACE CATH ADDN SUBSELEC ART,NECK 36218 $298.00
PLACE CATH AORTA 36200 $796.00
PLACE CATH CAROTD ART ANGIO 36224 $24,071.00
PLACE CATH CAROTID/INOM ART-IPS INT ANGIO 36223 $24,071.00
PLACE CATH CAROTID/INOM ARTS-IPS EXT ANGIO 36222 $14,528.00
PLACE CATH IN LT/RT PULM ART 36014 $865.00
PLACE CATH IN SUBSEGMT PULM ART 36015 $985.00
PLACE CATH IN VEIN,SELECT 36011 $896.00
PLACE CATH IN VEIN,SUBSELECT 36012 $992.00
PLACE CATH IN VEIN,SVC,IVC 36010 $629.00
PLACE CATH INTRACRANIAL ART ANGIO 36228 $1,380.00
PLACE CATH SELECT ART,ABD/PEL 36245 $1,359.00
PLACE CATH SUBCLAVIAN ART ANGIO 36225 $14,528.00
PLACE CATH SUBSELECT ART,ABD/PEL 36246 $1,454.00
PLACE CATH SUBSELECT ART,NECK 36216 $1,562.00
PLACE CATH SUBSUBSELECT ART,ABD/PEL 36247 $1,730.00
PLACE CATH SUBSUBSELECT ART,NECK 36217 $1,872.00
PLACE CATH THORACIC AORTA ANGIO 36221 $14,528.00
Page 38 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
PLACE CATH VERTEBRAL ART ANGIO 36226 $24,071.00
PLACE CATH XTRNL CAROTID ANGIO 36227 $670.00
PLACE RAD THERAPY CATH,BREAST 19296 $40,969.00
PLACE RADIOTHER DEVICE/MARKER PROSTATE 55876 $6,556.00
PLACE RADIOTHER NDL/CATH PROSTATE 55875 $22,113.00
PLACEMENT NG/OG TUBE BY PHYSICIAN 43752 $1,915.00
PLASMA HEMOGLOBIN 83051 $68.00
PLASMINOGEN ACTIVATOR 85415 $159.00
PLETHYSMOGRAPHY LUNG VOLUMES 94726 $1,262.00
PML RARALPHA COM BREAKPOINTS REF 81315 $679.00
PMS2 GENE KNOWN FAM VARIANT REF 81318 $2,483.00
PNEUMOCOCCAL ADMINISTRATION 90471 $299.00
PNEUMOCYSTIS CARINII AG IF MIC 87281 $111.00
POC GLUCOSE BLOOD TEST BY DEVICE 82962 $25.00
POC INFLUENZA ASSAY W/ OPTIC 87804 $124.00
POC RSV 87807 $111.00
PORPHOBILINOGEN URINE QUANT 84110 $78.00
PORPHYRINS QUANT 84120 $136.00
POST DRUG INFUSION EPS 93623 $743.00
POST-FOSSA/EAR W/CONTRAST CT 70481 $2,017.00
POSTFOSSA/EAR W/O CONTRAST CT 70480 $1,125.00
POSTFOSSA-EAR W,W/O CONTRST CT 70482 $2,017.00
POTASSIUM RANDOM URINE 84133 $40.00
POTASSIUM,SERUM-PLASMA OR WB 84132 $43.00
POTASSIUM-FLUID 84999 $125.00
PPD-TB SKIN TEST 86580 $129.00
PPM GENERATOR REMOVAL 33233 $40,723.00
PPM INSERT DUAL CH W/LEADS (S) 33208 $54,336.00
PPM INSERT ONLY W EXIST DUAL LEADS 33213 $54,336.00
PPM INSERT ONLY(MULT LD EXIST) 33221 $97,235.00
PPM INSERT SINGLE VENT LEADLESS 33274 $84,450.00
PPM INSERT-SNGL-ATRIAL- W/LEAD 33206 $54,336.00
PPM INSERT-SNGL-VENT W/LEAD(S) 33207 $54,336.00
PPM LEAD REMOVAL-DUAL LEAD SYS 33235 $17,218.00
PPM LEAD REMOVAL-SNGL LEAD SYS 33234 $17,218.00
PPM REMOVAL LEADLESS W/IMAGING GUIDE 33275 $14,528.00
PPM REMVL W/PPM INSERT DUAL LD 33228 $54,336.00
PPM REMVL W/PPM INSERT MULT LD 33229 $97,235.00
PPM REMVL W/PPM INSERT SNGL LD 33227 $40,723.00
PPM/AICD LEAD REVISION 33215 $14,528.00
PRE&POST SPIROMETRY 94060 $1,262.00
PREALBUMIN 84134 $135.00
Page 39 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
PREGNENOLONE 84140 $191.00
PRETREATMENT RBC AB ID BLD 86970 $241.00
PRIM PERC MECH THROMB, ARTER INIT 37184 $25,732.00
PRIM PERC MECH THROMB, ARTER SUB 37185 $954.00
PRIMIDONE 80188 $154.00
PROCALCITONIN (PCT) LAB 84145 $248.00
PROGESTERONE 84144 $193.00
PROINSULIN 84206 $200.00
PROLACTIN 84146 $179.00
PROLONGED SERV OFFICE 1ST HR 99354 $620.00
PROLONGED SERV OFFICE ADDL 30MIN 99355 $469.00
PROPOXYPHENE REF G0480 $248.00
PROSTAGLANDIN REF 84150 $313.00
PROSTATE BIOPSY ANY METHOD PAT G0416 $2,057.00
PROSTATE SPECIFIC AG FREE REF 84154 $170.00
PROTEIN C ACTIVITY 85303 $128.00
PROTEIN ELECTROPHORESIS 84165 $99.00
PROTEIN ELP (URINE, CSF) REF 84166 $165.00
PROTEIN TOTAL SERUM PLASMA LAB 84155 $34.00
PROTEIN,TOTAL,OTHER SOURCE 84157 $34.00
PROTEIN,TOTAL,URINE 84156 $34.00
PROTHROMBIN TIME 85610 $36.00
PROTHROMBIN TIME (PT) 85610 $36.00
PROTHROMBIN TIME (PT) 85610 $36.00
PROTHROMBIN TIME-SUB PLASMA FR 85611 $37.00
PRQ CARD ANGIO/ATHRECT 1 ART 92924 $43,511.00
PRQ CARD ANGIO/ATHRECT ADDL 92925 $28,709.00
PRQ CARD REVASC CHRONIC 1VSL 92943 $43,511.00
PRQ CARD REVASC CHRONIC ADDL 92944 $20,661.00
PRQ CARD REVASC MI 1 VSL 92941 $3,118.00
PRQ CARD STENT W/ANGIO 1 VSL 92928 $43,511.00
PRQ CARD STENT W/ANGIO ADDL 92929 $23,895.00
PRQ CARD STENT/ATH/ANGIO 92933 $69,095.00
PRQ CARD STENT/ATH/ANGIO ADDL 92934 $21,721.00
PRQ CARDIAC ANGIOPLAST 1 ART 92920 $21,053.00
PRQ CARDIAC ANGIOPLAST ADDL 92921 $15,751.00
PRQ POST TIBIAL NV STIM SINGLE 64566 $1,361.00
PRQ REVASC BYP GRAFT 1 VSL 92937 $43,511.00
PRQ REVASC BYP GRAFT ADDL 92938 $20,661.00
PSA DIAGNOSTIC TOTAL LAB 84153 $170.00
PSA SCREENING TOTAL LAB 84153 $170.00
PSEUDO-ANEURYSM COMPRESSION 76936 $2,523.00
Page 40 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
PSYCH NEUR TEST AUTOMATED 96146 $86.00
PSYCH NEUR TEST PHYS 1ST 30M 96136 $86.00
PSYCH NEUR TEST PHYS ADD 30 MIN 96137 $99.00
PSYCH NEUR TEST TECH ADD 30 MIN 96139 $198.00
PSYCH NEURTEST TECH 1ST 30M 96138 $86.00
PSYCH TEST EVAL ADD HOUR 96131 $426.00
PSYCH TEST EVAL FIRST HOUR 96130 $680.00
PSYCHOTHERAPY FOR CRISIS 60 MIN 90839 $638.00
PSYCHOTHERAPY FOR CRISIS ADDL 30 MIN 90840 $318.00
PSYCHOTHERAPY PT &/ FAMILY 30 MIN 90832 $638.00
PSYCHOTHERAPY PT &/ FAMILY 45 MIN 90834 $638.00
PSYCHOTHERAPY PT &/ FAMILY 45 MIN IOP 90834 $638.00
PSYCHOTHERAPY PT &/ FAMILY 45 MIN IOP CD 90834 $638.00
PSYCHOTHERAPY PT &/ FAMILY 60 MIN CD 90837 $638.00
PSYCHOTHERAPY PT &/ FAMILY 60 MIN IOP 90837 $638.00
PT EVAL HIGH COMPLEX 45 MIN 97163 $566.00
PT EVAL LOW COMPLEX 20 MIN 97161 $566.00
PT EVAL MOD COMPLEX 30 MIN 97162 $566.00
PT GAIT TRAINING-15 MIN 97116 $203.00
PT RE-EVAL EST PLAN CARE 97164 $385.00
PTA 1ST ART IMG S&I 37246 $25,732.00
PTA 1ST VEIN IMG S&I 37248 $25,732.00
PTA EA ADDL ART IMG S&I 37247 $980.00
PTA EA ADDL VEIN IMG S&I 37249 $833.00
PTC W/IMPLANT ATRIAL 93580 $69,095.00
PUCT/ASPIR BREAST CYST,EACH ADDN 19001 $123.00
PULM REHAB,ONE HOUR SESSION G0424 $280.00
PULMONARY STRESS TEST 94618 $532.00
PUNC/ASPIR BREAST CYST 19000 $3,186.00
PUNCH BIOPSY OF SKIN EACH ADD LESION 11105 $155.00
PUNCH BIOPSY OF SKIN SINGLE LESION 11104 $970.00
PUNCTURE DRAINAGE OF LESION 10160 $1,727.00
PYRUVIC ACID 84210 $109.00
QUANT DIFF LUNG PERF/VENT 78598 $4,555.00
R.T.PORT FILM 77417 $117.00
RA QUANT TITER 86431 $53.00
RA223 RADIUM DICHLORIDE PER UCI A9606 $822.00
RAD GUIDED,PERCUT DRAINAGE,W/CATH 75989 $648.00
RADIANT ANESTHESIA MINUTES $48.00
RADIOACTIVE THERAPY INTRA ART ADMIN 79445 $2,309.00
RADIOELEMENT HANDLING 77790 $157.00
RADIOFREQUENCY ABLATION SAC JT NV 64625 $9,609.00
Page 41 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
RAPID INFLUENZA A AND B (EIA) 87400 $111.00
RAPID PLATELET FUNC ASSAY - BLD 85576 $199.00
RAPID PLATLET FUNC ASSAY 85576 $199.00
RAPID STREP SCREEN 87880 $124.00
RBC OSMOTIC FRAGILITY REF 85555 $62.00
RBC-FETOMATERNAL HEMOR-ROSETTE 85461 $70.00
RECEPTOR ASSAY,NON-ENDOCRINE 84238 $339.00
RECOVERY ROOM TIME 1HR $3,051.00
RECOVERY SERVICES $3,051.00
RECOVERY SVSC TIME ADDL 1/2 HR $626.00
RED TRAUMA ACT PRE-NOTIFY NO CC $29,145.00
RED TRAUMA ACTIVATE PRE-NOTIFY G0390 $29,145.00
RED TRAUMA TEAM SERVICES $29,145.00
REM IMPACTED CERUMEN IRR/LVG UNILAT 69209 $307.00
REM PERC VAD DIFFERENT SESSION 33992 $1,140.00
REMOVAL FB EYE 65205 $586.00
REMOVAL IMPACTED CERUMEN INSTR UNILAT 69210 $307.00
REMOVAL PLEURAL W CUFF 32552 $3,410.00
REMOVAL SUBQ CRM W PROGRAMMING 33286 $3,186.00
REMOVE FOREIGN BODY FROM EYE 65210 $1,915.00
REMOVE FOREIGN BODY FROM EYE 65220 $1,915.00
REMOVE FOREIGN BODY FROM EYE 65222 $586.00
REMOVE NASAL FOREIGN BODY 30300 $586.00
REMOVE PERM CANNULA/CATHETER 49422 $14,528.00
REMOVE RENAL TUBE W/FLUORO 50389 $3,092.00
REMOVE URETER STENT, PERCUT 50384 $9,569.00
REMOVE,OBST MATL,CVA DEV VIA SEP 75901 $1,814.00
RENAL IMAG, MORPH W/ FLO/FUNC, RX SGL 78708 $4,555.00
RENAL IMAGING, MORPH W/ FLOW/FUNC 78707 $4,555.00
RENAL PANEL 80069 $80.00
RENIN 84244 $204.00
REP NERVE CONDUCTION 95937 $612.00
REPAIR TUNNELED CV CATH W/O PORT 36575 $3,410.00
REPAIR-COMPLEX-LVL 1, ADD 5 CM $623.00
REPAIR-COMPLEX-LVL 1,1.1-7.5CM $3,376.00
REPAIR-COMPLEX-NEEL < 1.0 CM $4,051.00
REPAIR-COMPLEX-NEEL 1.0-2.5 CM $393.00
REPAIR-COMPLEX-NEEL 2.6-7.5 CM $787.00
REPAIR-COMPLEX-NEEL ADDL 5 CM $393.00
REPAIR-SIMPLE/INTERMED LEVEL 1 $1,014.00
REPAIR-SIMPLE/INTERMED LEVEL 2 $1,928.00
REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERC 49451 $4,189.00
Page 42 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS 49450 $4,189.00
REPLACE GTUBE REV TRACT WO IMAGE ENDO 43763 $1,273.00
REPLACE GTUBE WO IMAGE ENDO OR TRACT REV 43762 $1,273.00
REPLACE NONTUNNELED CVC WO SUBQ PORT 36580 $6,015.00
REPLACE PICC W SUBQ PORT 36585 $14,528.00
REPLACE PICC WO SUBQ PORT W IMAGING 36584 $6,015.00
REPLACE TUNNELED CVC W SUBQ PORT 36582 $14,528.00
REPLACE TUNNELED CVC WO SUBQ PORT 36581 $14,528.00
REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERC 49452 $4,189.00
REPOS. LT. VENTRICULAR LEAD 33226 $14,528.00
REPOSITION GASTRIC FEEDING TUBE THRU DUODENUM 43761 $1,273.00
REPOSITION VENOUS CATHETER 36597 $6,015.00
REPOSITION,NASO/GASTRIC TUBE 43761 $1,273.00
REPOSITIONING,VENA CAVA FILTER 37192 $14,528.00
RESET DISLOCATED JAW CLOSED TX INITIAL OR SUBSEQUENT 21480 $1,238.00
RESP CARE ASSESSMENT 94664 $958.00
RESP SYNCYTIAL AG,EIA 87420 $111.00
RESP VIRUS 12-25 TARGETS MIC 87633 $3,859.00
RESP VIRUS 3-5 TARGETS MIC 87631 $1,188.00
RESP VIRUS 6-11 TARGETS REF 87632 $1,779.00
RESPIRATORY MOTION MGMT SIMULATION 77293 $3,690.00
RESPIRATORY SYNCYTIAL VIRUS 87280 $111.00
RETICULATED PLATELET ASSAY 85055 $268.00
RETRIEVAL/REMVL VENA CAVA FLTR 37193 $14,528.00
RETROPERITNL ABD, LTD 76775 $1,125.00
REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY 37224 $25,732.00
REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY/ATHERECTOMY 37225 $53,180.00
REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY/STENT 37226 $53,180.00
REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY/STENT/ATHERECT 37227 $84,450.00
REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY EA ADD 37232 $1,150.00
REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY INITIAL 37228 $53,180.00
REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY/ATHERECTOMY 37229 $84,450.00
REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY/STENT INITIAL 37230 $84,450.00
REVISION OF POCKET FOR AICD 33223 $8,519.00
REVISION OF POCKET FOR PPM 33222 $8,519.00
REVSC ILIAC ART EA ADDL VSL 37222 $1,064.00
REVSC ILIAC ART INIT VESSEL 37220 $25,732.00
REVSC ILIAC ART W/STENT 37221 $53,180.00
REVSC ILIAC W/STENT EA ADDL 37223 $1,218.00
RF ABLATE BONE TUMOR(S) PERQ 20982 $31,348.00
RF ABLATE LIVER TUMOR(S) PERQ 47382 $25,277.00
RF ABLATE RENAL TUMOR(S) PERQ 50592 $25,277.00
Page 43 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
RHEUMATOID FACTOR QUANTITATIVE LAB 86431 $53.00
RHYTHM STRIP 93041 $252.00
RIBOFLAVIN ASSAY VITAMIN B-2 REF 84252 $187.00
RMVL TNLD CV CATH W/ PORT,PUMP 36590 $3,410.00
RMVL TNLD CV CATH W/O PORT,PUMP 36589 $3,410.00
ROBOTIC SURGERY SERVICES $40.00
ROOM/CARE - ICU $4,926.00
ROOM/CARE - INTERMEDIATE ICU $4,249.00
ROOM/CARE - ISOLATION $2,970.00
ROOM/CARE - MED/SURG/GYN PRIVATE $2,701.00
ROOM/CARE - MED/SURG/GYN SEMI PRIV $2,701.00
ROOM/CARE - NEGATIVE PRESSURE ISOLATION $4,249.00
ROOM/CARE - NEWBORN LEVEL 1 $1,532.00
ROOM/CARE - NEWBORN LEVEL 2 $2,875.00
ROOM/CARE - NEWBORN LEVEL 3 $4,737.00
ROOM/CARE - NEWBORN LEVEL 4 $5,229.00
ROOM/CARE - OB PRIVATE $2,701.00
ROOM/CARE - OB SEMI PRIVATE $2,701.00
ROOM/CARE - OBSERVATION HOUR CHARGE G0378 $180.00
ROOM/CARE - ONCOLOGY PRIVATE $2,875.00
ROOM/CARE - ONCOLOGY SEMI PRIVATE $2,875.00
ROOM/CARE - PACU ICU OVERFLOW $4,926.00
ROOM/CARE - PEDIATRIC ICU $5,229.00
ROOM/CARE - PEDIATRIC PRIVATE $2,701.00
ROOM/CARE - PEDIATRIC SEMI PRIVATE $2,701.00
ROOM/CARE - PICU SEMI PRIVATE $2,701.00
ROOM/CARE - REHAB PRIVATE $2,701.00
ROOM/CARE - REHAB SEMI PRIVATE $2,701.00
ROOM/CARE - TELEMETRY $4,249.00
ROTAVIRUS 87425 $111.00
ROUTINE VENIPUNCTURE LAB 36415 $23.00
RT DELIVERY >=1 MEV COMPLEX 77412 $2,245.00
RT DELIVERY >=1 MEV INTERMED 77407 $2,245.00
RT DELIVERY >=1 MEV SIMPLE 77402 $1,170.00
RT HRT ARTERY/GRAFT ANGIO 93457 $12,647.00
RT HRT CORONARY ARTERY ANGIO 93456 $12,647.00
RT IMPROVE FUNCTION-IND-15 MIN G0238 $161.00
RT IMPROVE MUSCLE/FUNCTION-GRP G0239 $161.00
RT MUSCLE STRENGTH/END-IND-15M G0237 $161.00
RT/LT HRT ART/VENT ANGIO BYP 93461 $12,647.00
RT/LT HRT ART/VENTRICLE ANGIO 93460 $12,647.00
RUBELLA IMMUNITY SC 86762 $133.00
Page 44 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
RUBEOLA IMMUNITY SC 86765 $119.00
SCLERODERMA (SCL 70) AB 86235 $166.00
SCLEROTX FLUID COLLECTION 49185 $3,186.00
SCREENING MAMMO BILAT W/WO CAD 77067 $1,011.00
SEC PERC MECH THROMBECT, ARTERIAL,W OTHER PROC 37186 $1,396.00
SED RATE,ERYTHROCYTE,AUTOMATED 85652 $25.00
SEDATIVE HYPNOTICS REF G0480 $858.00
SELENIUM 84255 $236.00
SELF CARE ADL TRAINING 15 MIN 97535 $229.00
SELF CARE/ADLS 15 MIN 97535 $229.00
SEMEN ANALYSIS,POSTVASECTOMY 89321 $112.00
SENSORY INT TCHNQS 15 MIN 97533 $286.00
SEP TRUNK AND SCALP 95927 $612.00
SEROTONIN BLOOD 84260 $287.00
SERUM RBC AB EACH PANEL BLD 86870 $2,057.00
SERUM RBC ANTIBODY SCREEN 86850 $382.00
SEX HORMONE BINDING GLOBULIN REF 84270 $201.00
SICKLE CELL PREP 85660 $51.00
SICKLING OF RBC,REDUCTION-REF 85660 $51.00
SIM-AIDED FIELD SETTING;3-D 77295 $11,919.00
SIMPLE SIMULATION 77280 $1,238.00
SKELETAL MUSCLE RELAXANTS REF G0480 $858.00
SLIDE CONSULT REQUIRE PREP 88323 $382.00
SMALL INTESTINE FOLLOW-THROUGH 74248 $480.00
SMALL INTESTINE SINGLE CONTRAST 74250 $1,125.00
SMEAR ACID FAST STAIN MIC 87206 $50.00
SMEAR COMPLEX STAIN MIC 87209 $166.00
SMEAR FOR EOSINOPHILS 89190 $44.00
SMEAR,GRAM STAIN 87205 $40.00
SMEAR,SPECIAL STAIN 87207 $56.00
SMEAR,WET MOUNT,SALINE/INK Q0111 $110.00
SMOKING CESSATION GROUP S9453 $128.00
SMOKING COUNSELING VISIT > 10 MIN 99407 $167.00
SMOKING COUNSELING VISIT 3-10 MIN 99406 $167.00
SNRPN/UBE3A GENE-REF 81331 $383.00
SODIUM RANDOM URINE 84300 $45.00
SODIUM,OTHER SOURCE 84302 $45.00
SODIUM,SERUM-PLASMA OR WB 84295 $45.00
SODIUM,URINE 84300 $45.00
SOFT TISSUE NECK W/O 70490 $1,125.00
SOMATOMEDIN-C IGF-1 (245) REF 84305 $197.00
SOMATOSTATIN 84307 $169.00
Page 45 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
SPEC MED PHYS CONSULT 77370 $1,238.00
SPECIAL DOSIMETRY 77331 $1,238.00
SPECIAL STAINS,GROUP 1,EACH 88312 $382.00
SPECIAL STAINS,GROUP 2,EACH 88313 $241.00
SPECIAL TELE.PORT.PLAN 77321 $3,218.00
SPECIAL TREATMENT PROCEDURE 77470 $5,199.00
SPECIFIC GRAVITY NON-URINE 84315 $25.00
SPECIMEN CONCENTRATION 87015 $62.00
SPECTROPHOTOMETRY,ANALYTE NS 84311 $65.00
SPEECH GEN DEVICE TREATMENT 92609 $727.00
SPEECH LANG TX-INDIVIDUAL 92507 $525.00
SPEECH LANGUAGE TX-GROUP 92508 $158.00
SPEECH SOUND LANG COMPREHEN 92523 $1,307.00
SPINAL $1,340.00
SPINAL BLOOD PATCH INJECTION 62273 $3,293.00
SPINAL CANAL & CONTENTS 76800 $1,125.00
SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC 62270 $3,293.00
SPINE L/S COMPLETE W BEND 6+ 72114 $1,125.00
SPIROMETRY W/ BRONCHODILATION 94060 $1,262.00
SPIROMETRY W/ GRAPHIC RCD (NO PROFEE) 94010 $680.00
SPLINT APPL FINGER DYNAMIC 29131 $307.00
SPLINT APPL SHORT ARM DYNAMIC 29126 $586.00
SPLINT APPLICATION FINGER 29130 $307.00
SPLINT APPLICATION LONG ARM 29105 $740.00
SPLINT APPLICATION LONG LEG 29505 $740.00
SPLINT APPLICATION SHORT ARM 29125 $586.00
SPLINT APPLICATION SHORT LEG 29515 $740.00
SRS TX 1 SESSION CRANIAL LINEAR 77372 $76,442.00
SSEP LOWER EXTREMITY 95926 $1,135.00
SSEP UPPER & LOWER EXTREMITY 95938 $2,049.00
SSEP UPPER EXTREMITIES 95925 $1,135.00
STAPH AUREUS DNA AMP PROBE 87640 $325.00
STELLATE GANGLION INJECTION 64510 $4,207.00
STREP A DNA AMP PROBE 87651 $78.00
STREP GROUP B AMPLIFIED PROBE 87653 $325.00
STREP, PYOGENES, AB SCREEN 86403 $94.00
SUBCUTANEOUS INFUSION EACH ADDL HR 96370 $189.00
SUBSQ PROS/ORTHO TRAINING EA 15 MIN 97763 $338.00
SUBUNGUAL HEMATOMA EVAC 11740 $586.00
SUGARS SINGLE QUAL REF 84376 $51.00
SUGARS,MONO,DI,OLIGO,QUANT 84378 $107.00
SULFATE URINE 84392 $44.00
Page 46 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
SURFACTANT ADMIN THRU TUBE 94610 $958.00
SURGERY MINUTES - 1ST 30 MINS LEVEL 1 $3,313.00
SURGERY MINUTES - 1ST 30 MINS LEVEL 2 $3,939.00
SURGERY MINUTES - 1ST 30 MINS LEVEL 3 $4,507.00
SURGERY MINUTES - 1ST 30 MINS LEVEL 4 $5,122.00
SURGERY MINUTES - 1ST 30 MINS LEVEL 5 $5,610.00
SURGERY MINUTES - EA ADDL 1 MIN LEVEL 1 $59.00
SURGERY MINUTES - EA ADDL 1 MIN LEVEL 2 $63.00
SURGERY MINUTES - EA ADDL 1 MIN LEVEL 3 $67.00
SURGERY MINUTES - EA ADDL 1 MIN LEVEL 4 $71.00
SURGERY MINUTES - EA ADDL 1 MIN LEVEL 5 $77.00
SURGICAL SERVICES 1/4 HOUR $1,474.00
SUSCEPTIBILITY (MIC) 87186 $80.00
SUTURE REMOVAL 99281 $558.00
SWALLOWING DYSFUNCTION TREATMT 92526 $575.00
SWALLOWING FCN,W/CINE &/OR VIDEO 74230 $1,125.00
SWAN GANZ INSERTION 93503 $4,921.00
SWEAT COLLECTION 89230 $382.00
SYPHILIS TEST NON TREP QUAL LAB 86592 $40.00
SYPHILIS TEST,NON-TREP,QUANT 86593 $41.00
T CELL ABSOLUTE COUNT CD4 86361 $248.00
T CELLS ABSOLUTE CD4/CD8 COUNT REF 86360 $435.00
T CELLS TOTAL COUNT REF 86359 $349.00
T3 (TRIIODOTHYRONINE) 84480 $131.00
T4 (THYROXINE) 84436 $64.00
TACHYCARDIA SITE MAPPING 93609 $1,306.00
TACROLIMUS REF 80197 $127.00
TANGENTIAL SKIN BX EACH ADD LESION 11103 $131.00
TANGENTIAL SKIN BX SINGLE LESION 11102 $970.00
TAP BLOCK UNIL BY INJECTION 64486 $325.00
TAPENTADOL REF G0480 $858.00
TB TEST CELL IMM MEASURE AG BLD 86480 $574.00
TEE-CONGENITAL W/ CONT 93315 $2,239.00
TEE-CONGENITAL W/O CONTRAST 93315 $2,239.00
TELEHEALTH ORIGINATING SITE FACILITY FEE Q3014 $77.00
TELETHERAPY ISODOSE PLAN COMPLEX 77307 $3,218.00
TELETHERAPY ISODOSE PLAN SIMPLE 77306 $3,218.00
TENOTOMY PERC TOE MULTIPLE TENDONS 28011 $7,223.00
TENOTOMY PERC TOE SINGLE TENDON 28010 $7,223.00
TENSILON TEST 95857 $1,388.00
TESTOSTERONE BLOOD 84403 $239.00
TESTOSTERONE FREE REF 84402 $236.00
Page 47 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
THEOPHYLLINE (AMINOPHYLLINE) 80198 $131.00
THERA PROPH DX INJ INTRA ARTERIAL 96373 $936.00
THERAPEUTIC ACTIVITIES 15 MIN 97530 $267.00
THERAPEUTIC EXERCISE EA 15 MIN 97110 $205.00
THORACENTESIS WITH IMAGING GUIDANCE 32555 $3,410.00
THORACENTESIS WITHOUT IMAGING GUIDANCE 32554 $3,410.00
THORACOTOMY 32110 $8,358.00
THROMB INF ANGIO DIALYSIS CIRCUIT 36904 $25,732.00
THROMB INF PTA DIALYSIS CIRCUIT 36905 $53,180.00
THROMB INF STENT DIALYSIS CIRCUIT 36906 $84,450.00
THROMBIN TIME (TT) LAB 85670 $53.00
THROMBOLYSIS CEREBRAL BY INTRAVENOUS INFUSION 37195 $1,586.00
THROMBOLYTIC THERAPY(CORONARY) 92977 $1,586.00
THROMBOPLASTIN TIME PARTIAL 85730 $56.00
THROMBOPLASTIN TIME-SUB PLASMA 85732 $60.00
THYROGLOBULIN 84432 $149.00
THYROID BINDING GLOBULIN 84442 $137.00
THYROID HORMONE UPTAKE 84479 $60.00
THYROID IMAGING W/BLOOD FLOW 78013 $3,535.00
THYROID IMAGING W/BLOOD FLOW W/UPTAKE 78014 $3,535.00
THYROID MET IMAGING BODY 78018 $4,555.00
THYROID STIM IMMUNE GLOBULINS 84445 $471.00
THYROID UPTAKE MEASUREMENT 78012 $3,535.00
THYROXINE FREE 84439 $83.00
THYROXINE,TOTAL 84436 $64.00
TIPS REVISION W IMAGING 37183 $25,732.00
TISSUE BIOPSY CONS 88325 $382.00
TISSUE CULT-NON-NEOPL-LYMPHCYT-REF 88230 $1,079.00
TOBRAMYCIN 80200 $149.00
TOOTH EXCTRACTION 41899 $1,138.00
TOPIRAMATE 80201 $110.00
TPMT GENE ANAL COMMON VARIANTS REF 81335 $1,311.00
TRACH PLANNED 31600 $12,272.00
TRACHEOTOMY TUBE CHANGE 31502 $1,134.00
TRAMADOL REF G0480 $858.00
TRANS THPY ART CORO/INTRAC DAY 1 37211 $24,071.00
TRANSCATH RETRVL,PERCUT W/IMAGING 37197 $14,528.00
TRANSCATH STENT, CCA W/EPS 37215 $5,744.00
TRANSCATH STENT, CCA W/O EPS 37216 $16,526.00
TRANSCATH THERAPY CESSATION 37214 $6,015.00
TRANSCATH THERAPY,ART-VEN, SUBQ DY 37213 $6,015.00
TRANSCATH THERAPY,VEN, INIT DAY 37212 $14,528.00
Page 48 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
TRANSCATHETER BIOPSY 37200 $24,071.00
TRANSCATHETER RX EMBOLIZATN 75894 $739.00
TRANSCRAN DOPPLER INTRACRAN ART 93886 $1,038.00
TRANSCRAN DOPPLER INTRACRAN,LIMITED 93888 $506.00
TRANSESOPHAGEAL ECHO W/O CONT 93312 $2,239.00
TRANSESPHGL ECHO W/ CONT 93312 $2,239.00
TRANSFERASE ALANINE AMINO SGPT 84460 $49.00
TRANSFERASE ASPART AMINO SGOT 84450 $48.00
TRANSFERRIN 84466 $118.00
TRANSVENOUS TEMP PACER DUAL CH 33211 $40,723.00
TRANSVENOUS TEMP PACER SNGL CH 33210 $40,723.00
TREAT FX RADIUS/ULNA W/MANIPULATION 25565 $7,223.00
TREAT FX RADIUS/ULNA W/O MANIPULATION 25560 $1,238.00
TREAT FX W/O MANIPULATION 25600 $1,238.00
TREAT HIP DISL W/O ANES CLOSED 27250 $1,238.00
TREAT HIP DISL W/O ANES POST ARTH 27265 $1,238.00
TREAT HIP DISLOCATION 27256 $1,238.00
TREAT METACARPAL FX W/MANIPULATION 26605 $1,238.00
TREATMENT,MISSED AB,ANY TRI. 59812 $12,987.00
TRG GENE REARRANGEMENT ANALYSIS REF 81342 $1,866.00
TRICHAMONAS VAG DIRECT PROBE 87660 $186.00
TRICHOMONAS VAGINALIS AMPLIF REF 87661 $325.00
TRIGLYCERIDES 84478 $53.00
TRIIODOTHYRONINE T3,FREE 84481 $157.00
TRIIODOTHYRONINE T3,REVERSE 84482 $146.00
TRIM NONDYSTROPHIC NAILS,ANY NUM 11719 $307.00
TROPONIN,QUANTITIVE 84484 $94.00
TSH 84443 $156.00
TUBE THORACOSTOMY INCLUDES WATER SEAL 32551 $6,015.00
TUMOR IMMUNOHISTOCHEM-MANUAL 88360 $1,085.00
TUMOR LOCALIZATION 1 AREA 1 DAY 78800 $3,535.00
TUMOR LOCALIZATION WHOLE BODY 1 DAY 78802 $12,294.00
TUMOR LOCALIZATION WHOLE BODY 2+DAY 78804 $12,294.00
TUMOR SPECT 2+AREA 1D /1 AREA 2+DAY 78831 $12,721.00
TX ATRIAL FIB ADD ON 93657 $1,993.00
TX ATRIAL FIB PULM VEIN ISOL 93656 $86,462.00
TX BURN 1ST DEGREE INITIAL 16000 $970.00
TX ELBOW CHILD W/MANIP CLSD 24640 $1,238.00
TX FINGER FX-W MANIPULATION 26725 $1,238.00
TX-PRO-DX IV PUSH NEW DRUG 96375 $189.00
TX-PRO-DX IV PUSH SAME DRUG 96376 $208.00
TX-PRO-DX IV PUSH SNGL/INITIAL 96374 $936.00
Page 49 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
UGI TRACT DOUBLE CONTRAST STUDY 74246 $1,852.00
UGI TRACT SINGLE CONTRAST STUDY 74240 $2,017.00
ULTRASOUND BREAST COMPLETE 76641 $1,125.00
ULTRASOUND BREAST LIMITED 76642 $623.00
ULTRASOUND ELASTOGRAPHY PARENCHYMA 76981 $1,125.00
ULTRASOUND EXAM FOLLOW-UP 76970 $1,125.00
ULTRASOUND OF PREG UTERUS LMTD 76815 $1,125.00
ULTRASOUND PER 15 MIN 97035 $92.00
UNLISTED CHEMISTRY PROCEDURE 84999 $125.00
UNLISTED CT PROCEDURE 76497 $623.00
UNLISTED DX RADIOGRAPHIC PROCEDURE 76499 $623.00
UNLISTED FLUOROSCOPIC PROCEDURE 76496 $623.00
UNLISTED MOLECULAR PATHOLOGY REF 81479 $1,213.00
UNLISTED NERVOUS SYSTEM SURGERY 64999 $489.00
UNLISTED TRANSFUSION PROCEDURE BLD 86999 $129.00
UNSPECIFIED DRUG CLASS 8-14 REF G0481 $1,174.00
UPGRADE OF PACEMAKER SYSTEM 33214 $54,336.00
UREA NITROGEN URINE LAB 84540 $44.00
UREA NITROGEN,QUANTITIVE 84520 $37.00
URETERAL REFLUX STUDY 78740 $3,535.00
URIC ACID 84550 $42.00
URIC ACID-OTHER SOURCE 84560 $44.00
URINALYSIS (DIPSTICK) W/O MIC 81002 $26.00
URINALYSIS COMPLETE (UA) 81001 $29.00
URINALYSIS MICRO 81015 $28.00
URINALYSIS,AUTO W/O MICRO 81003 $21.00
URINALYSIS,NON-AUTO,W/O MICRO 81002 $26.00
URINE CULTURE/COLONY COUNT 87086 $75.00
URINE PREGNANCY TEST-COLORCOMP 81025 $65.00
URINE VOL.MEASURE,TIMED COLL. 81050 $28.00
US COMPL JOINT RT W/IMAGE DOC 76881 $1,125.00
US DOPPLER FETAL UMBILICAL ARTERY 76820 $1,125.00
US GUID,COMP REPAIR,PSEUDO-ANEUR 76936 $2,523.00
US GUIDANCE FOR NEEDLE PLACEMENT 76942 $256.00
US GUIDANCE FOR RADIOELEMENT APPL 76965 $256.00
US GUIDANCE FOR VASCULAR ACCESS 76937 $202.00
US GUIDANCE INTRAOPERATIVE 76998 $648.00
US GUIDE AMNIOCENTESIS 76946 $135.00
US IV EACH ADD VESSEL ADD-ON 37253 $418.00
US IV FIRST VESSEL ADD-ON 37252 $521.00
US LTD JOINT RT W/IMAGE DOC 76882 $1,125.00
US,INFANT HIPS,DYNAMIC 76885 $623.00
Page 50 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
US,INFANT HIPS,LIMITED/STATIC 76886 $623.00
US,PELVIC (NONOB),REAL TIME LIMIT 76857 $1,125.00
US,PELVIC (NONOB),REAL TIME,COMP 76856 $1,125.00
US,PREG UT,FET & MAT,DETL FET EXM 76811 $2,306.00
US,PREGNANT UTERUS,F/U,TRANSABD APP 76816 $1,125.00
US,PREGNANT UTERUS,LIMITED, 1/> FETUS 76815 $1,125.00
US,PREGNANT UTERUS,TRANSVAGINAL 76817 $1,125.00
US,RETROPERIT,REAL TIME,COMPLETE 76770 $1,125.00
US,TRANSPLANTED KIDNEY, REAL TIME/DOPPLER 76776 $1,125.00
VALPROIC ACID (DEPAKANE) 80164 $125.00
VALVULOPLASTY PULMONARY VALVE 92990 $43,511.00
VALVULOPLASTY-AORTIC VALVE 92986 $21,053.00
VALVULOPLASTY-MITRAL VALVE 92987 $43,511.00
VANCOMYCIN DNA AMP PROBE 87500 $325.00
VANCOMYCIN LEVEL 80202 $125.00
VANILLYLMANDELIC ACID URINE REF 84585 $143.00
VARICELLA ZOSTER BY DFA 87290 $111.00
VASC EMBOLIZE/OCCLUDE ARTERY 37242 $53,180.00
VASC EMBOLIZE/OCCLUDE BLEED 37244 $53,180.00
VASC EMBOLIZE/OCCLUDE ORGAN 37243 $53,180.00
VASC EMBOLIZE/OCCLUDE VENOUS 37241 $53,180.00
VASCULAR BIOPSY 75970 $408.00
VASOACTIVE INTESTINAL PEPTIDE 84586 $327.00
VASOPNEUMATIC PUMP THERAPY 97016 $85.00
VASOPRESSIN (ADH) 84588 $314.00
VENIPUNCTURE,<AGE3,SCALP VEIN 36405 $119.00
VENOGRAM ADRENAL BILAT 75842 $43,765.00
VENOGRAM ADRENAL UNILAT 75840 $26,415.00
VENOGRAM EXTREM BILAT 75822 $10,936.00
VENOGRAM EXTREM UNILAT 75820 $6,200.00
VENOGRAM HEPATIC W HEMODYNAMICS 75889 $26,415.00
VENOGRAM INFER VENA CAVA 75825 $26,415.00
VENOGRAM RENAL UNILAT 75831 $26,415.00
VENOGRAM SINUS/JUGULAR 75860 $26,415.00
VENOGRAM SUPER VENA CAVA 75827 $6,200.00
VENOUS SAMPLING BY CATHETER 75893 $43,765.00
VENOUS SELECT SAMPLING W CATH 36500 $1,045.00
VENOUS STENT OPEN PERQ EA ADDL 37239 $869.00
VENOUS STENT OPEN PERQ INITIAL 37238 $53,180.00
VENT. INLINE MEDS 94640 $958.00
VENTILATION(BIPAP)-FIRST DAY 94002 $2,550.00
VENTILATION(BIPAP)-SUBSQ DAY 94003 $2,550.00
Page 51 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
VENTRICULAR SEPTAL DEFECT CLOSURE 93581 $69,095.00
VEP TEST EXCEPT GLAUCOMA 95930 $612.00
VERTEBROPLASTY ADDL INJECT 22512 $1,184.00
VERY LONG CHAIN FATTY ACIDS 82726 $167.00
VIDEO FLEX FIBERENDO EVAL 92612 $456.00
VIDEOFLUOROSCOPIC EVALUATION 92611 $601.00
VIRUS INOCULATION,SHELL VIA 87254 $181.00
VIRUS ISOL CULT/ADDL DEFIN ID 87253 $187.00
VISCOSITY 85810 $108.00
VIT B-12 BINDING CAP 82608 $133.00
VITAL CAPACITY 94150 $680.00
VITAMIN A 84590 $107.00
VITAMIN B1 THIAMINE REF 84425 $197.00
VITAMIN B3 NIACIN 84591 $128.00
VITAMIN B6 84207 $260.00
VITAMIN D 1 25-DIHYDROXY REF 82652 $356.00
VITAMIN D,25 HYDROXY 82306 $274.00
VITAMIN E 84446 $131.00
VOLATILES 84600 $149.00
WEDGE EXCISION SKIN NAIL FOLD 11765 $629.00
WELLNESS ASSESSMENT-NON PHYS S5190 $294.00
WEST NILE VIRUS AB IGM REF 86788 $156.00
WEST NILE VIRUS ANTIBODY 86789 $133.00
WESTERN BLOT FOR BAND ID 84182 $219.00
WHEELCHAIR MAN/PROP TRNG 15MIN 97542 $222.00
XR SPINE ENTIRE L/T ONE VW 72081 $623.00
XRAY ABDOMEN 1 VIEW 74018 $623.00
XRAY ABDOMEN 2 VIEWS 74019 $1,125.00
XRAY ABDOMEN 3/MORE VIEWS 74021 $1,125.00
X-RAY AC JTS 73050 $623.00
X-RAY ANKLE 2 VW 73600 $623.00
X-RAY ANKLE 3+ VW 73610 $623.00
X-RAY ANTEGRADE PYELOGRAM TUBE 74425 $3,859.00
X-RAY ARM, INFANT 73092 $1,125.00
X-RAY B.E. REDUCTN INTUSS 74283 $2,017.00
X-RAY BILE/PANCREAS ENDOSCOPY 74330 $466.00
X-RAY CERV SPINE 2 VW 72040 $623.00
X-RAY CERV SPINE 4 VW 72050 $1,125.00
X-RAY CERV SPINE 7 VW 72052 $1,125.00
X-RAY CLAVICLE 73000 $623.00
X-RAY CYSTOGRAM, MIN 3 VIEW 74430 $3,859.00
X-RAY ELBOW 2 VW 73070 $623.00
Page 52 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
X-RAY ELBOW 3+ VW 73080 $623.00
X-RAY EXAM OF FINGER(S) 73140 $623.00
X-RAY EXAM, BREAST SPECIMEN 76098 $4,975.00
X-RAY FACIAL BONES <3 VW 70140 $623.00
X-RAY FACIAL BONES 3+ VW 70150 $1,125.00
XRAY FEMUR 1 VW 73551 $623.00
XRAY FEMUR 2+ VW 73552 $623.00
X-RAY FISTULA,ABSCESS,SINUS TRACT 76080 $4,975.00
X-RAY FOOT 2 VW 73620 $623.00
X-RAY FOOT 3+ VW 73630 $623.00
X-RAY FOR BILE DUCT ENDOSCOPY 74328 $365.00
X-RAY FOR PANCREAS ENDOSCOPY 74329 $365.00
X-RAY FOREARM 2 VW 73090 $623.00
X-RAY HAND 2 VW 73120 $1,125.00
X-RAY HAND 3+ VW 73130 $623.00
X-RAY HEEL 73650 $623.00
XRAY HIP BIL W/WO PELVIS 2 VW 73521 $1,125.00
XRAY HIP BIL W/WO PELVIS 3-4 VW 73522 $1,125.00
XRAY HIP BIL W/WO PELVIS 5+ VW 73523 $1,125.00
XRAY HIP UNI W/WO PELVIS 1 VW 73501 $623.00
XRAY HIP UNI W/WO PELVIS 2-3 VW 73502 $623.00
X-RAY HUMERUS 73060 $623.00
X-RAY HYSTEROSALPINGOGRAM 74740 $2,306.00
X-RAY IV PYELOGRAM (IVP) 74400 $2,017.00
X-RAY JAW <4 VW 70100 $623.00
X-RAY JAW 4+ VW 70110 $1,125.00
X-RAY KNEE 1 OR 2 VIEW 73560 $623.00
X-RAY KNEE 3 VIEW 73562 $623.00
X-RAY KNEE 4+ VIEW 73564 $1,125.00
X-RAY KNEE BILAT STANDING 73565 $623.00
X-RAY LEG, INFANT 73592 $623.00
X-RAY LUMBAR SPINE 2/3 VW 72100 $1,125.00
X-RAY LUMBAR SPINE 4 VW 72110 $1,125.00
X-RAY NASAL BONES 70160 $623.00
X-RAY NECK SOFT TISSUE 70360 $623.00
X-RAY NOSE-RECTUM CHILD F.B. 76010 $623.00
X-RAY OPER CHOLANGIO ADDNL SET 74301 $108.00
X-RAY OPER CHOLANGIOGRAM 74300 $188.00
X-RAY ORBITS 70200 $1,125.00
X-RAY PELVIS 1/2 VW 72170 $1,125.00
X-RAY PELVIS 3+ VW 72190 $1,125.00
X-RAY PERITONEUM 74190 $4,975.00
Page 53 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
X-RAY RETROGRADE PYELOGRAM 74420 $3,859.00
X-RAY RIBS 2 VW UNILAT 71100 $623.00
X-RAY RIBS, CHEST 3+ VW 71101 $1,125.00
X-RAY RIBS, CHEST 4+ VW 71111 $1,125.00
X-RAY SACROILIAC JTS <3 VW 72200 $1,125.00
X-RAY SACROILIAC JTS 3+ VW 72202 $1,125.00
X-RAY SACRUM/COCCYX 2+ VW 72220 $623.00
X-RAY SCAPULA 73010 $1,125.00
X-RAY SHOULDER 1 VW 73020 $623.00
X-RAY SHOULDER 2+ VW 73030 $623.00
X-RAY SIALOGRAM 70390 $2,306.00
X-RAY SINUSES <3 VW 70210 $623.00
X-RAY SINUSES 3+ VW 70220 $623.00
X-RAY SKULL <4 VW 70250 $1,125.00
X-RAY SKULL 4+ VW 70260 $1,125.00
X-RAY SPINE ONE VIEW 72020 $623.00
X-RAY STERNO-CLAVICLUAR JT 71130 $623.00
X-RAY STERNUM 2+ VW 71120 $623.00
X-RAY THORACIC SPINE 2 VW 72070 $1,125.00
X-RAY THORACIC SPINE 4 VW 72074 $1,125.00
X-RAY THORACIC SPINE+SWIM 3 VW 72072 $1,125.00
X-RAY THOR-LUMB SP 2 VW 72080 $623.00
X-RAY TIB + FIB, 2VW 73590 $623.00
X-RAY TMJ BILAT 70330 $623.00
X-RAY TOE(S) 73660 $623.00
X-RAY URETHROCYSTOGRAM 74450 $2,306.00
X-RAY URETHROCYSTOGRAM+VOIDING S&I 74455 $2,306.00
X-RAY WRIST 2 VW 73100 $623.00
X-RAY WRIST 3+ VW 73110 $623.00
X-RAYS FOR BONE AGE 77072 $1,125.00
X-RAYS, BONE LENGTH STUDIES 77073 $1,125.00
X-RAYS, BONE SURVEY COMPLETE 77075 $1,125.00
X-RAYS, BONE SURVEY, INFANT 77076 $1,125.00
X-RAYS, BONE SURVEY, LIMITED 77074 $1,125.00
YELLOW TRAUMA ACT PRE-NOTIFY NO CC $20,451.00
YELLOW TRAUMA ACTIVATE PRE-NOTIFY G0390 $20,451.00
YELLOW TRAUMA TEAM SERVICES $20,451.00
ZIKA VIRUS DNA RNA AMP PROBE REF 87662 $475.00
ZIKA VIRUS IGM ANTIBODY REF 86794 $156.00
ZINC PROTOPORPHYRINS 84202 $133.00
ZINC SERUM 84630 $105.00
ZONISAMIDE QUANT 80203 $123.00
Page 54 of 55
Description
CPT(R)/HCPCS Billing
Code
Charge Effective
01/01/2020
Page 55 of 55
