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{"sheet":"Limitations and Caveats","index":0,"n_rows":17,"n_cols":4,"rows_kept":17,"merged":[[8,0,8,3],[10,0,10,3],[13,0,13,3],[14,0,14,3]],"flags":["formulas_cached_only"]}
[null,"Washington State Health Care Authority",null,"Illustrative Example Medicaid FFS Allowed Amount"]
[null,"EAPG Calculator Version 1.1",null,"Does Not Represent Actual Claim Payment"]
[null,"Medicaid FFS Rates Effective January 01, 2025",null,"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,"Limitations and Caveats"]
[]
[]
[]
[]
["The purpose of the Oct 2022 Washington EAPG Calculator is to demonstrate an illustrative allowed amount for an example Medicaid fee-for-service (FFS) outpatient claim for in-state acute hospitals reimbursed under the State of Washington Health Care Authority's (HCA's) payment methodology using 3M™ Enhanced Ambulatory Patient Group (EAPG), based on data inputs entered by the user. Users should review its worksheets in their entirety, including the Overview, Contents, and Instructions worksheets, before using the tool. Any user of this tool must possess a certain level of expertise in health care finance that will allow appropriate use of the data and results presented."]
[]
["This Oct 2022 Washington EAPG Calculator represents HCA's payment methodology as reflected in its State Plan Amendment approved by the Centers for Medicare and Medicaid Services (CMS). HCA's final Oct 2022 EAPG base rates are subject to change based on Direct Graduate Medical Education (DGME) and Sole Community Hospital (SCH) updates."]
[]
[" It is important that all users be aware of the limitations of this tool:"]
["- This tool is for illustrative, informational purposes only and should not be relied upon to determine actual claim payment.\n- This tool does not include all of HCA's Medicaid FFS outpatient rate factors, claim payment scenarios, and other claim adjustments included in HCA's Medicaid Management Information System (MMIS). \n- Actual Medicaid FFS claim payments will be determined by the MMIS during the claim adjudication process; in the event of differences between the actual Medicaid FFS claim payment and the results of this tool, the actual claim payment should be considered correct. \n- This tool does not reflect adjustments for patient paid amounts, Third Party Liabilities, or negotiated Managed Care Organization rates."]
["The tool contains information produced, in part, by using 3M Company’s proprietary computer software created, owned and licensed by 3M Company. All copyrights in and to the 3M Software are owned by 3M Company or its affiliates. All rights reserved. 3M has no responsibility for the contents of this tool."]
["AMA Current Procedural Terminology (CPT) / Copyright Statement CPT® codes, descriptions and other data only are copyright 2022 American Medical Association (or such other date of publication of CPT)."]
["CPT is a registered trademark of the American Medical Association."]

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[null,"Washington State Health Care Authority",null,"Illustrative Example Medicaid FFS Allowed Amount"]
[null,"EAPG Calculator Version 1.0 - DRAFT",null,"Does Not Represent Actual Claim Payment"]
[null,"Medicaid FFS Rates Effective January 01, 2025",null,"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,"Overview"]
[]
[]
[]
["The State of Washington Health Care Authority (HCA) is rebasing its outpatient payment methodology that uses the 3M™ Enhanced Ambulatory Patient Group (EAPG) patient classification system, scheduled to be effective for Medicaid Fee-for-Service (FFS) and managed care outpatient reimbursement on July 1, 2022. This dynamic EAPG Calculator (\"July 2022 Washington EAPG Calculator\") is intended to demonstrate HCA's rebased Medicaid FFS outpatient EAPG payment methodology. Note this tool requires the EAPG patient classification as an input, and does not \"group\" the claim (users must obtain the claim line EAPG and discount flag assignments separately using 3M™ software). Also note this tool will not notify the user if the entered Healthcare Common Procedure Coding System (HCPCS) does not align with the entered EAPG."]
[]
["The purpose of the July 2022 Washington EAPG Calculator is to demonstrate an illustrative allowed amount for an example Medicaid FFS outpatient claim for outpatient hospital services reimbursed under the EAPG methodology, based on data inputs entered by the user. Please note that this tool does not include all Medicaid FFS outpatient rate factors, claim payment scenarios, and other claim adjustments included in HCA's Medicaid Management Information System (MMIS). This tool also does not simulate payments under EAPG carve out services paid under a fee schedule or other payment methodology outside of EAPGs. Actual Medicaid FFS claim payments will be determined by the MMIS during the claim adjudication process; in the event of differences between the actual Medicaid FFS claim payment and the results of this tool, the actual claim payment should be considered correct. This tool does not reflect adjustments for patient paid amounts, Third Party Liabilities, negotiated Managed Care Organization rates, or reduced rates for state-only programs."]
[]
["HCA's rebased Washington Medicaid outpatient EAPG payment methodology is applicable to in-state general acute hospitals, excluding outpatient services paid via non-EAPG payment methodologies. The EAPG payment methodology is not applicable to out-of-state hospitals."]
[]
["For more information on HCA's rebased Washington Medicaid's FFS Outpatient EAPG payment methodology, please refer to the provider billing guides and fee schedule website (https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules)."]
[]
["For questions related to HCA's rebased Washington Medicaid FFS EAPG payment methodology and this tool, please email Abby Cole at HCA at abigail.cole@hca.wa.gov."]
[]
["Washington EAPG Calculator Change History:"]
["Date","Description"]
["2022-05-11","Initial draft version to demonstrate HCA's EAPG payment methodology. EAPG base rates reflect SCH adjustments consistent with SFY 2022 eligibility. DGME and SCH adjustments will be updated prior to July 1, 2022."]
["2022-06-16","DGME and SCH adjsutments have been updates for 7/1/22"]
["2022-11-29","Updated rate for Oct 1 OPPS Rate Sheet"]

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[null,"Washington State Health Care Authority","Illustrative Example Medicaid FFS Allowed Amount"]
[null,"EAPG Calculator Version 1.0","Does Not Represent Actual Claim Payment"]
[null,"Medicaid FFS Rates Effective January 01, 2025","SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,"Contents"]
[]
[]
[]
["The July 2022 Washington EAPG Calculator includes the following worksheets:"]
[]
["Worksheet Name","Worksheet Description"]
["Limitations and Caveats","Limitations and caveats for consideration by users of the July 2022 Washington EAPG Calculator."]
["Overview","Overview and background on the July 2022 Washington EAPG Calculator."]
["Contents","Contents of each worksheet in the July 2022 Washington EAPG Calculator."]
["Instructions","Instructions for users of the July 2022 Washington EAPG Calculator, primarily focused on the \"Allowed Amount Calculation\" worksheet."]
["Allowed Amount Calculation","This worksheet contains the data input section for users to enter the data required for EAPG pricing, and calculates the illustrative Washington Medicaid FFS outpatient allowed amount for services paid under EAPGs based on HCA's rebased payment methodology. Data inputs include key claims data values and claim line EAPG and discount flag classification (note that the July 2022 EAPG calculator does not assign the EAPGs or discount flags). "]
["Table 1 | Hospital Rate Factors","This worksheet contains conversion factors for each hospital reimbursed under EAPG."]
["Table 2 | EAPG Rate Factors","This worksheet includes rebased EAPG-specific rate factors, including the normalized v3.16 EAPG relative weights that include the chemotherapy policy adjustor for the following EAPGs: 0430, 0431, 0432, 0433, 0434, 0441, 0443, 0460, 0461, 0462, 0463, 0464, 0465, 0466."]
["Table 3 | Age Adjustor","This worksheet includes the pediatric policy adjustor for patients below the age of 18 years."]
["Table 4 | Grouper Settings","This worksheet includes the 3M™ EAPG grouper software settings used in the HCA MMIS for EAPG grouping purposes."]
["Table 5a | OPPS Fee Schedule","This worksheet includes the most recent HCA OPPS fee schedule used to identify procedures that are eligible to be paid using EAPG payment methodology."]
["Table 5b | OPPS Fee Schedule Legend","This worksheet includes the corresponding legend for Table 5a HCA OPPS fee schedule."]
["Table 6 | Bundled Revenue Codes","This worksheet includes a list of Bundled Revenue codes that are carved out from the Washington EAPG payment system."]

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[null,"Washington State Health Care Authority","Illustrative Example Medicaid FFS Allowed Amount"]
[null,"EAPG Calculator Version 1.0","Does Not Represent Actual Claim Payment"]
[null,"Medicaid FFS Rates Effective January 01, 2025","SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,"Instructions"]
[]
[]
["Instructions for users for the July 2022 Washington EAPG Calculator are described below."]
[]
["Step 1: Review Limitations, Overview, Contents, and Instructions worksheets"]
[]
["Step 2: Collect required outpatient claim line data inputs"]
["Data inputs required for pricing include the following:"]
["- EAPG version 3.16 claim line patient classification, including all 4 digits with applicable leading 0's (this must be obtained separately using 3M™'s EAPG patient classification software)"]
["- Assignments for multiple significant procedure, same significant procedure consolidation, clinical significant procedure consolidation, procedure packaging, repeat ancillary discounting, bilateral adjustment, and terminated procedure discount flags (also must be obtained separately using 3M™'s EAPG patient classification software)"]
["- Hospital national provider identifier (NPI): For out-of-state hospitals that are not critical border hospitals, enter “OOS”."]
["- Patient Age: Enter patient age in years. Enter “0” for patients under 1 year old."]
[]
["Step 3: Enter required data inputs on the \"Allowed Amount Calculation\" worksheet"]
["The fields highlighted in green need to be populated by the user. The calculator populates values associated with the user-defined EAPG code and Hospital NPI, and then it calculates the Medicaid allowed amount for the outpatient hospital visit.\n\nThis calculator is intended to calculate payment for a single outpatient hospital visit on a single service date on claim lines that qualify for EAPG payment methodology only."]
[]
["Step 4: Review Total Illustrative FFS Allowed Amount"]
[]
["Field Reference","Field Name","Description"]
["Section A: Outpatient Claim Input Parameters"]
["A.1","Hospital NPI","OPPS Fee schedule NPI"]
["A.2","Provider Name","The provider name, populated from the \"Table 1 | Hospital Rate Factors\" worksheet based on the Hospital NPI entered in cell F10."]
["A.3","EAPG Conversion Factor","The EAPG conversion factor for the provider, pulled from the \"Table 1 | Hospital Rate Factors\" worksheet."]
["A.4","Patient Age","Patient age in years"]
[]
["Section B: EAPG Information and Payment System Parameters"]
["B.1","HCPCS","5-digit procedure code. AMA CPT / Copyright Statement CPT® codes, descriptions and other data only are copyright 2022 American Medical Association (or such other date of publication of CPT). CPT is a registered trademark of the American Medical Association."]
["B.2","Revenue Code","4-digit number containing the revenue code that is used to identify Bundled Revenue codes that are carved out from the Washington EAPG payment system and paid $0."]
["B.3","EAPG Code","4-digit number containing the EAPG code. Effective 7/1/2022, the EAPG version is 3.16."]
["B.4","EAPG Description","Based on the EAPG code that has been entered in Column E, the EAPG description is pulled from the \"Table 2 | EAPG Rate Factors\" worksheet."]
["B.5","Normalized EAPG v3.16 Weight","Based on the EAPG code that has been entered in Column E, the normalized EAPG relative weight is pulled from the \"Table 2 | EAPG Rate Factors\" worksheet. Includes a 1.15 chemotherapy policy adjuster."]
[]
["Section C: 3M™ EAPG Discount Flag Assignments and EAPG Service Line Payment Adjustments"]
["C.1 - C.7","3M™ EAPG Discount Flag Assignments","The EAPG discount flag assignments, which are generated by 3M™'s EAPG software."]
["C.8","Multiple Significant Procedure Adjustment","If the Multiple Significant Procedure Discounting Flag is \"Yes\" and the Bilateral Adjustment Flag is \"No\" and the Terminated Procedure Discounting Flag is \"No\" then the value of the multiple significant procedure adjustment is 0.5. Otherwise, the value of the multiple significant procedure adjustment is 1.0."]
["C.9","Bundling Adjustment","If the Same Significant Procedure Consolidation Flag, Clinical Significant Procedure Consolidation Flag, or Procedure Packaging Indicator is \"Yes\" then the value of the bundling adjustment is 0 and the allowed amount for the claim line will be $0."]
["C.10","Repeat Ancillary Procedure Adjustment","If the Repeat Ancillary Discounting Flag is \"Yes\" and the Multiple Significant Procedure Discounting Flag is \"No\" and the Bilateral Adjustment Flag is \"No\" and the Terminated Procedure Discounting Flag is \"No\" then the value of the repeat ancillary procedure adjustment is 0.5. Otherwise, the value of the repeat ancillary procedure adjustment is 1.0."]
["C.11","Bilateral Adjustment","If the Bilateral Adjustment Flag is \"Yes\" and Repeat Ancillary Discounting Flag is \"No\" and the Multiple Significant Procedure Discounting Flag is \"No\" and the Terminated Procedure Discounting Flag is \"No\" then the value of the bilateral adjustment is 1.5. Otherwise, the value of the bilateral adjustment is 1.0."]
["C.12","Terminated Procedure Adjustment","If the Terminated Procedure Discounting Flag is \"Yes\" then the value of the terminated procedure adjustment is 0.5. Otherwise, the value of the terminated procedure adjustment is 1.0."]
["C.13","Multiple Significant and Bilateral Procedure Adjustment","If the Multiple Significant Procedure Discounting Flag is \"Yes\" and the Bilateral Adjustment Flag is \"Yes\" and the Terminated Procedure Discounting Flag is \"No\" then the value of the multiple significant and bilateral procedure adjustment is (0.5 * 1.5). Otherwise, the value of the multiple significant procedure adjustment is 1.0."]
["C.14","Repeat Ancillary and Bilateral Procedure Adjustment","If the Bilateral Adjustment Flag is \"Yes\" and Repeat Ancillary Discounting Flag is \"Yes\" and the Multiple Significant Procedure Discounting Flag is \"No\" and the Terminated Procedure Discounting Flag is \"No\" then the value of the repeat ancillary and bilateral procedure adjustment is (0.5 * 1.5). Otherwise, the value of the repeat ancillary and bilateral procedure adjustment is 1.0."]
["C.15","Maximum EAPG Weight on Multiple Significant Procedure Lines","If the Multiple Significant Procedure Discounting Flag is \"Yes\" and the claim line has the highest EAPG weight across all claim lines for the same visit, then the value of the adjustment is 1.0. Otherwise the adjustment is 0."]
[]
["Section D: FFS EAPG Allowed Amount Calculation"]
["D.1","Final EAPG Discount Factor","If the Multiple Significant Procedure Discounting Flag is \"Yes\" and the claim line has the highest EAPG weight across all claim lines for the same visit, then the value of the adjustment is 1.0. Otherwise the value of the adjustment is the product of C.8 through C.14"]
["D.2","HCA OPPS Fee Schedule Methodology","OPPS pricing methodology from the HCA OPPS Fee Schedule for each procedure code. If the OPPS pricing methodology indicator is not \"E\", then the procedure is not paid using EAPG pricing methodology in Washington's outpatient payment system. The EAPG payment amount in this calculator will be displayed as \"n/a.\""]
["D.3","Bundled Revenue Code","Indicator for whether the revenue code is a Bundled Revenue Code that is carved-out from Washington's EAPG payment system and paid $0, based on ProviderOne documentation. If the revenue code is a Bundled Revenue Code, the EAPG payment amount in this calculator will be displayed as $0."]
["D.4","EAPG Age Adjustor","For patients age 17 or younger, a policy Adjustor of 1.35 will be applied in the calculation of the EAPG allowed amount."]
["D.5","EAPG \nAllowed Amount","The EAPG allowed amount. This is calculated as (EAPG Weight) x (EAPG Conversion Factor) x (EAPG Policy Adjustor). If the procedure code is not paid using EAPG pricing methodology in Washington's OPPS payment system, then the EAPG allowed amount for that claim line will be displayed as \"n/a.\" If the revenue code is a Bundled Revenue Code that is carved-out from Washington's EAPG pricing methodology, then the EAPG allowed amount for that claim line will be displayed as $0."]

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[{"$nulls":3},"Washington State Health Care Authority",{"$nulls":22},"Illustrative Example Medicaid FFS Allowed Amount"]
[{"$nulls":3},"EAPG Calculator Version 1.0",{"$nulls":22},"Does Not Represent Actual Claim Payment"]
[{"$nulls":3},"Medicaid FFS Rates Effective January 01, 2025",{"$nulls":22},"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[{"$nulls":3},"Outpatient Claim EAPG Allowed Amount Calculation"]
[]
[null,"Indicates a value to be input by the user"]
[]
[null,"Section A: Outpatient Claim Input Parameters"]
[null,"A.1","Hospital NPI",null,null,"1801851258"]
[null,"A.2","Provider Name",null,null,{"$error":"#N/A"}]
[null,"A.3","EAPG Conversion Factor",null,null,{"$error":"#N/A"}]
[null,"A.4","Patient Age",null,null,35]
[]
[null,"Washington Medicaid FFS EAPG Allowed Amount Calculation (For Illustration for a Single Visit Only, Does Not Include EAPG Carve Out Fee Schedule Payments)"]
[null,"Section B: EAPG Information and Payment System Parameters",{"$nulls":5},"Section C: 3M™ EAPG Discount Flag Assignments and EAPG Service Line Payment Adjustments",{"$nulls":14},"Section D: FFS EAPG Allowed Amount Calculation"]
[null,null,"B.1","B.2","B.3","B.4","B.5","C.1","C.2","C.3","C.4","C.5","C.6","C.7","C.8 = If [ C.1 = \"Yes\" and C.6 = \"No\" and C.7 = \"No\" ] then 0.5, Else 1.0","C.9 = If [ C.2 = \"Yes\" or C.3 = \"Yes\" or C.4 = \"Yes\" ] then 0, Else 1.0","C.10 = If [ C.1 = \"No\" and C.5 = \"Yes\" and C.6 = \"No\" and C.7 = \"No\" ] then 0.5, Else 1.0","C.11 = If [ C.1 = \"No\" and C.5 = \"No\" and C.6 = \"Yes\" and C.7 = \"No\" ] then 1.5, Else 1.0","C.12 = If C.7 = \"Yes\" then 0.5, Else 1.0","C.13 = If [ C.1 = \"Yes\" and C.6 = \"Yes\" and C.7 = \"No\" ] then (0.5 * 1.5), Else 1.0","C.14 = If [ C.1 = \"No\" and C.5 = \"Yes\" and C.6 = \"Yes\" and C.7 = \"No\" ] then (0.5 * 1.5), Else 1.0","C.15 = If [ C.1 = \"Yes\" and B.5x = B.5max ] then 1.0, Else 0","D.1 = If C.15 = 1.0, then 1.0, Else Product(C.8:C.14)","D.2","D.3","D.4","D.5 = [ If D.3 = \"Yes\" then $0, If D.2 not equal to 'E' then 'n/a', Else Product(A.3,B.5,D.1,D.4)"]
[null,"Line Number","HCPCS\n(5 Digits)","Revenue Code\n(4 Digits)","EAPG Code\n(4 Digits)","EAPG Description","Normalized EAPG v3.16 Weight","Multiple Significant Procedure Discounting Flag","Same Significant Procedure Consolidation Flag","Clinical Significant Procedure Consolidation Flag","Procedure Packaging Indicator","Repeat Ancillary Discounting Flag","Bilateral Adjustment Flag","Terminated Procedure Discounting Flag","Multiple Significant Procedure Adjustment","Bundling Adjustment","Repeat Ancillary Procedure Adjustment","Bilateral Adjustment","Terminated Procedure Adjustment","Multiple Significant and Bilateral Procedure Adjustment","Repeat Ancillary and Bilateral Procedure Adjustment","Maximum EAPG Weight on Multiple Significant Procedure Lines","Final EAPG Discount Factor","HCA OPPS Fee Schedule Methodology","Bundled Revenue Code","EAPG Age Adjustor","EAPG \nAllowed Amount"]
[{"$nulls":25},"Total does not include EAPG carve out fee schedule payments",{"$error":"#N/A"}]
[]
[null,1,"80307","0301","0384","LEVEL III CHEMISTRY TESTS",0.180524,"No","No","No","No","No","No","No",{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.00"},{"v":1,"d":"1.00"},{"v":0,"d":"0.0"},{"v":1,"d":"1.00"},"E","No",{"v":1,"d":"1.00"},{"$error":"#N/A"}]
[null,2,"G0480","0301","0401","LEVEL II CHEMISTRY TESTS",0.052607,"No","No","No","Yes","No","No","No",{"v":1,"d":"1.0"},{"v":0,"d":"0.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":0,"d":"0.0"},{"v":0,"d":"0.00"},"E","No",{"v":1,"d":"1.00"},{"$error":"#N/A"}]
[null,3,"99285","0450","0491","MEDICAL VISIT INDICATOR",{"v":0,"d":"0.000000"},"No","No","No","Yes","No","No","No",{"v":1,"d":"1.0"},{"v":0,"d":"0.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":0,"d":"0.0"},{"v":0,"d":"0.00"},"E","No",{"v":1,"d":"1.00"},{"$error":"#N/A"}]
[null,4,"85027","0305","0408","LEVEL I HEMATOLOGY TESTS",0.009288,"No","No","No","Yes","No","No","No",{"v":1,"d":"1.0"},{"v":0,"d":"0.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":1,"d":"1.0"},{"v":0,"d":"0.0"},{"v":0,"d":"0.00"},"E","No",{"v":1,"d":"1.00"},{"$error":"#N/A"}]
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[null,"CALCULATOR VALUES ARE FOR PURPOSES OF ILLUSTRATION ONLY."]
[null,null,"","",""]

{"sheet":"Table 1 | Hospital Rate Factors","index":5,"n_rows":65,"n_cols":4,"rows_kept":65,"flags":["formulas_cached_only"]}
[null,"Washington State Health Care Authority",null,"Illustrative Example Medicaid FFS Allowed Amount"]
[null,"EAPG Calculator Version 1.0 - DRAFT",null,"Does Not Represent Actual Claim Payment"]
[null,"Medicaid FFS Rates Effective January 01, 2025",null,"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,"Table 1: Hospital Rate Factors"]
[]
[]
["Hospital \nNPI","Medicare \nID","Provider Name","EAPG Conversion Factor"]
[1255327201,"500015","Auburn Regional Med Ctr - Auburn",{"v":421.7,"d":"$ 421.70"}]
[1841258639,"500139","Capital Med Ctr- Olympia",{"v":420.2,"d":"$ 420.20"}]
[1073566246,"500060","Cascade Valley Hosp - Arlington",{"v":423.49,"d":"$ 423.49"}]
[1306883228,"500016","Central Washington Hosp-Wenatchee",{"v":421.7,"d":"$ 421.70"}]
[1245756410,"503026","CHI Franciscan Rehabilitation Hospital",{"v":429.47,"d":"$ 429.47"}]
[1326564071,"500154","Covington Medical Center",{"v":421.7,"d":"$ 421.70"}]
[1356528269,"500044","Deaconess Med Ctr  - Spokane",{"v":407.08,"d":"$ 407.08"}]
[1033174933,"500124","Evergreen Hosp Med Ctr-Kirkland",{"v":421.7,"d":"$ 421.70"}]
[1013074061,"500084","EvergreenHealth Monroe (Valley General Hosp)",{"v":423.49,"d":"$ 423.49"}]
[1841231461,"500079","Good Samaritan - Puyallup",{"v":431.45,"d":"$ 431.45"}]
[1154378859,"500031","Grays Harbor Community Hosp-Aberdeen",{"v":505.24,"d":"$ 505.24"}]
[1861522088,"500052","Group Health Central Hospital",{"v":421.7,"d":"$ 421.70"}]
[1053359729,"500064","Harborview Medical Center-Seattle",{"v":465.38,"d":"$ 465.38"}]
[1518912609,"500039","Harrison Memorial Hosp-Bremerton",{"v":448.9,"d":"$ 448.90"}]
[1558333682,"500011","Highline Medical Center - Burien",{"v":421.7,"d":"$ 421.70"}]
[1225289895,"500077","Holy Family Hospital - Spokane",{"v":404.19,"d":"$ 404.19"}]
[1710913140,"500007","Island Hospital - Anacortes",{"v":404.19,"d":"$ 404.19"}]
[1972507580,"500058","Kadlec Medical Center ",{"v":407.96,"d":"$ 407.96"}]
[1700809829,"500150","Legacy Salmon Creek - Salmon Creek",{"v":413.42,"d":"$ 413.42"}]
[1306952726,"503301","Mary Bridge Children's Hosp & Health Ctr -Tacoma",{"v":429.47,"d":"$ 429.47"}]
[1306845557,"500072","Olympic Medical Center - Pt. Angeles",{"v":505.49,"d":"$ 505.49"}]
[1861432726,"500051","Overlake Hospital Med Ctr-Bellevue",{"v":421.7,"d":"$ 421.70"}]
[1376624981,"500019","Providence Centralia Hospital - Centralia",{"v":424.24,"d":"$ 424.24"}]
[1700037801,"500014","Providence Regional Medical Center - Everett",{"v":431.39,"d":"$ 431.39"}]
[1144471715,"500054","Providence Sacred Heart Med Ctr  - Spokane",{"v":416.57,"d":"$ 416.57"}]
[1346250594,"500024","Providence St Peter Hospital - Olympia",{"v":426.37,"d":"$ 426.37"}]
[1497752091,"503025","Saint Luke's Rehabilation Institute",{"v":430.84,"d":"$ 430.84"}]
[1902818883,"500033","Samaritan Hospital - Moses Lk",{"v":404.19,"d":"$ 404.19"}]
[1164493847,"500138","Seattle Cancer Care Alliance",{"v":422.78,"d":"$ 422.78"}]
[1467536276,"503300","Seattle Children's Hosp & Regional Med Ctr-Seattle",{"v":434.56,"d":"$ 434.56"}]
[1992848857,"503302","Shriner's Hospital for Children - Spokane",{"v":404.19,"d":"$ 404.19"}]
[1053357244,"500003","Skagit Valley Hospital",{"v":409.91,"d":"$ 409.91"}]
[1134178999,"500050","Southwest Washington Medical Center",{"v":416.2,"d":"$ 416.20"}]
[1447406699,"500151","St Anthony",{"v":429.43,"d":"$ 429.43"}]
[1689672693,"500021","St Clare Hospital - Tacoma",{"v":429.43,"d":"$ 429.43"}]
[1093713091,"500141","St Francis Hosp-Federal Way",{"v":423.79,"d":"$ 423.79"}]
[1073510277,"500041","St John Medical Ctr - Longview",{"v":406.19,"d":"$ 406.19"}]
[1487904546,"500030","St Joseph Hosp - Bellingham",{"v":404.19,"d":"$ 404.19"}]
[1952309098,"500108","St Joseph Med Ctr - Tacoma",{"v":430.75,"d":"$ 430.75"}]
[1386895886,"500002","St Mary Medical Ctr - Walla Walla",{"v":404.19,"d":"$ 404.19"}]
[1851686059,"500152","Swedish Issaquah Campus",{"v":421.7,"d":"$ 421.70"}]
[1306992151,"500027","Swedish Med Ctr 1st Hill Campus & Ballard - Seattle",{"v":429.42,"d":"$ 429.42"}]
[1356496582,"500025","Swedish Med Ctr Cherry Hill Campus - Seattle",{"v":434.58,"d":"$ 434.58"}]
[1033107214,"500026","Swedish Memorial Hospital Edmonds Campus - Edmonds",{"v":423.49,"d":"$ 423.49"}]
[1366556227,"500129","Tacoma General Allenmore Hospital - Tacoma",{"v":431.62,"d":"$ 431.62"}]
[1851817308,"500037","Toppenish Community Hospital - Toppenish",{"v":404.19,"d":"$ 404.19"}]
[1578058137,"500053","Trios Health",{"v":404.19,"d":"$ 404.19"}]
[1326002049,"500008","U of W Medical Ctr - Seattle",{"v":450.01,"d":"$ 450.01"}]
[1538345251,"500119","Valley Hosp Med Ctr - Spokane",{"v":404.19,"d":"$ 404.19"}]
[1649209230,"500088","Valley Medical Ctr - Renton",{"v":424.27,"d":"$ 424.27"}]
[1801851258,"500005","Virginia Mason - Seattle",{"v":432.82,"d":"$ 432.82"}]
[1306183314,"500148","Wenatchee Valley Hospital - Wenatchee",{"$error":"#N/A"}]
[1053373480,"500036","Yakima Valley Memorial  Hosp - Yakima",{"v":404.36,"d":"$ 404.36"}]
["OOS","n/a","OUT-OF-STATE",{"$error":"#N/A"}]
[]
["Source:"]
["EAPG Conversion Factor is based on modeled rebased rates. EAPG base rates reflect Sole Community Hospital Adjustments consistent with SFY 2022 eligibilty and "]
["SFY 2022 DGME factors, and will be updated prior to July 1, 2022."]

{"sheet":"Table 2 | EAPG Rate Factors","index":6,"n_rows":661,"n_cols":5,"rows_kept":661,"flags":["formulas_cached_only"]}
[null,"Washington State Health Care Authority",null,null,"Illustrative Example Medicaid FFS Allowed Amount"]
[null,"EAPG Calculator Version 1.0 - DRAFT",null,null,"Does Not Represent Actual Claim Payment"]
[null,"Medicaid FFS Rates Effective January 01, 2025",null,null,"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,"Table 2: EAPG Rate Factors"]
[]
[]
["EAPG Code","EAPG Description","Normalized EAPG v3.16 Weight"]
["0002","SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION",1.038973]
["0003","LEVEL I SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX",{"v":0.26905,"d":"0.269050"}]
["0004","LEVEL II SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX",1.806402]
["0005","NAIL PROCEDURES",0.107912]
["0009","LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS",0.733126]
["0010","LEVEL II SKIN EXCISIONS, BIOPSIES, AND REPAIRS",1.890455]
["0011","LEVEL III SKIN EXCISIONS, BIOPSIES, AND REPAIRS",{"v":2.90914,"d":"2.909140"}]
["0016","SIMPLE WOUND REPAIR AND TREATMENT",0.307549]
["0017","INTERMEDIATE WOUND REPAIR AND TREATMENT",0.618588]
["0018","COMPLEX WOUND REPAIR AND TREATMENT",1.650587]
["0019","MOHS MICROGRAPHIC SURGERY",1.568236]
["0020","LEVEL I BREAST PROCEDURES",2.302094]
["0021","LEVEL II BREAST PROCEDURES",5.328085]
["0022","LEVEL III BREAST PROCEDURES",{"v":11.20579,"d":"11.205790"}]
["0023","LEVEL I FOREARM AND WRIST PROCEDURES",2.846037]
["0024","LEVEL II FOREARM AND WRIST PROCEDURES",9.339335]
["0025","LEVEL I SHOULDER AND UPPER ARM PROCEDURES",7.341545]
["0026","LEVEL I KNEE AND LOWER LEG PROCEDURES",5.130701]
["0027","LEVEL I HIP AND FEMUR PROCEDURES",5.631725]
["0028","LEVEL I SPINE PROCEDURES",7.657025]
["0029","LEVEL II SPINE PROCEDURES",16.867845]
["0033","LEVEL I HAND PROCEDURES",2.179164]
["0034","LEVEL II HAND PROCEDURES",3.613688]
["0035","LEVEL I FOOT PROCEDURES",3.549207]
["0036","LEVEL II FOOT PROCEDURES",8.605113]
["0037","LEVEL I ARTHROSCOPY",3.678183]
["0038","LEVEL II ARTHROSCOPY",9.200434]
["0039","CAST APPLICATION OR REPLACEMENT",0.309849]
["0040","MINOR SPLINT AND STRAPPING APPLICATION",0.071523]
["0041","CLOSED TREATMENT FX AND DISLOCATION",0.730933]
["0043","OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES",8.740312]
["0044","BONE OR JOINT MANIPULATION UNDER ANESTHESIA",1.624262]
["0046","LEVEL I ARTHROPLASTY",5.713818]
["0047","LEVEL II ARTHROPLASTY",15.339401]
["0049","LEVEL I JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES",0.395778]
["0050","LEVEL II JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES",0.810389]
["0051","MUSCULOSKELETAL EXCISIONS, BIOPSIES, AND DRAINAGE PROCEDURES",2.870437]
["0052","LEVEL II KNEE AND LOWER LEG PROCEDURES",11.487917]
["0053","SPINE INJECTIONS AND OTHER RELATED PROCEDURES",1.407401]
["0054","FIXATION DEVICE INSERTION OR REPLACEMENT PROCEDURES",3.960624]
["0055","LEVEL II HIP AND FEMUR PROCEDURES",24.006759]
["0056","SKIN AND CONNECTIVE TISSUE GRAFTING AND FLAP PROCEDURES",3.222154]
["0057","LEVEL III SPINE PROCEDURES",21.608307]
["0058","LEVEL II SHOULDER AND UPPER ARM PROCEDURES",15.856688]
["0059","ARTERIOVENOUS FISTULA CREATION OR REVISION FOR HEMODIALYSIS",5.804728]
["0060","PULMONARY FUNCTION TESTS",{"v":0.16836,"d":"0.168360"}]
["0062","LEVEL I ENDOSCOPY OF THE UPPER AIRWAY",1.250753]
["0063","LEVEL II ENDOSCOPY OF THE UPPER AIRWAY",{"v":3.20249,"d":"3.202490"}]
["0064","LEVEL I LOWER AIRWAY ENDOSCOPY",2.701497]
["0066","PULMONARY REHABILITATIVE SERVICES",0.058542]
["0067","VENTILATION ASSISTANCE AND MANAGEMENT",1.059022]
["0068","THORACENTESIS, RELATED BIOPSY AND PLEURAL DRAINAGE PROCEDURES",1.567353]
["0069","LEVEL I THORACIC AND CHEST PROCEDURES",3.690236]
["0070","LEVEL II THORACIC AND CHEST PROCEDURES",{"v":8.55375,"d":"8.553750"}]
["0071","LEVEL II LOWER AIRWAY ENDOSCOPY",5.604984]
["0072","TRACHEOSTOMY AND RELATED TRACHEAL PROCEDURES",3.389967]
["0073","DIAPHRAGMATIC PROCEDURES AND RELATED HERNIA REPAIR",11.434577]
["0074","REVISION, REPLACEMENT OR REMOVAL OF CARDIAC DEVICE COMPONENT",2.795856]
["0075","LEVEL I CENTRAL VENOUS ACCESS PROCEDURES",1.850364]
["0076","REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE",1.202729]
["0077","LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES",5.884047]
["0078","LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION",3.571845]
["0079","LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES",9.697616]
["0080","EXERCISE TOLERANCE TESTS",0.275747]
["0081","ECHOCARDIOGRAPHY",0.763533]
["0082","CARDIAC ELECTROPHYSIOLOGIC TESTS AND MONITORING",26.889956]
["0083","LEVEL II CENTRAL VENOUS ACCESS PROCEDURES",3.614191]
["0084","DIAGNOSTIC CARDIAC CATHETERIZATION",3.873301]
["0085","LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES",18.049476]
["0086","PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT",13.655152]
["0087","REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES",11.503116]
["0090","LEVEL I VARICOSE VEIN AND RELATED PROCEDURES",0.931372]
["0091","LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION",6.028477]
["0092","RESUSCITATION",{"v":1.49497,"d":"1.494970"}]
["0093","CARDIOVERSION",1.062997]
["0094","CARDIAC REHABILITATION",0.246826]
["0096","ATRIAL AND VENTRICULAR RECORDING AND PACING",10.196355]
["0097","AICD AND RELATED CARDIAC DEVICE INSERTION OR REPLACEMENT",40.942137]
["0099","LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES",{"v":14.15,"d":"14.150000"}]
["0102","CONSULTATIVE TELEHEALTH ASSESSMENTS MEDICAL VISIT INDICATOR",{"v":0,"d":"0.000000"}]
["0103","LEVEL II VARICOSE VEIN AND RELATED PROCEDURES",4.204874]
["0104","MAJOR OPEN CORONARY ARTERY PROCEDURES INCLUDING CABG",35.527383]
["0105","MAJOR OPEN CARDIAC AND CARDIAC VALVE PROCEDURES",{"v":20.2731,"d":"20.273100"}]
["0106","MAJOR OPEN ABDOMINAL AND THORACIC VASCULAR PROCEDURES",19.404415]
["0107","CHOLECYSTECTOMY AND RELATED BILIARY PROCEDURES",5.674839]
["0108","OTHER INTRA-ABDOMINAL AND INTRAPERITONEAL SURGICAL PROCEDURES",6.127549]
["0109","ANCILLARY DRUG ADMINISTRATION",0.072696]
["0110","PHARMACOTHERAPY BY EXTENDED INFUSION",0.843779]
["0111","PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION",0.498531]
["0113","LEVEL I BLOOD PRODUCT EXCHANGE SERVICES",0.757393]
["0114","LEVEL II BLOOD PRODUCT EXCHANGE SERVICES",2.815635]
["0115","DEEP LYMPH STRUCTURE PROCEDURES",4.755849]
["0116","ALLERGY TESTS",0.070019]
["0117","HOME INFUSION",0.211935]
["0118","NUTRITION THERAPY",0.323411]
["0119","IMMUNOTHERAPY PREPARATION SERVICES",0.993434]
["0120","IMMUNOTHERAPY",74.367422]
["0121","LEVEL II PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES",{"v":16.62941,"d":"16.629410"}]
["0122","PERCUTANEOUS INTRA-ABDOMINAL OR INTRATHORACIC VASCULAR PROCEDURES",29.420181]
["0123","PERIPHERAL VASCULAR BYPASS PROCEDURES",8.107855]
["0124","BONE MARROW BIOPSIES",1.954715]
["0125","LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES",5.290874]
["0126","LEVEL II ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES",6.708202]
["0127","LEVEL I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES",3.287569]
["0128","LEVEL II SMALL AND LARGE INTESTINE SURGICAL PROCEDURES",8.302852]
["0129","ESOPHAGOGASTRIC RESTRICTIVE PROCEDURES AND GASTRIC FUNDOPLICATION",8.619238]
["0130","ALIMENTARY TESTS AND TUBE INSERTION OR PLACEMENT",1.106371]
["0134","LEVEL I UPPER GI ENDOSCOPY",1.573827]
["0135","LEVEL II UPPER GI ENDOSCOPY",3.410727]
["0136","LEVEL I LOWER GI ENDOSCOPY",1.597341]
["0137","LEVEL II LOWER GI ENDOSCOPY",3.367386]
["0138","LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES",4.199347]
["0141","LEVEL I ANAL AND RECTAL PROCEDURES",2.423707]
["0142","LEVEL II ANAL AND RECTAL PROCEDURES",3.696803]
["0150","ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES",1.216009]
["0151","LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES",4.144672]
["0152","LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES",10.499987]
["0153","LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES",7.069055]
["0154","LEVEL III UPPER GI ENDOSCOPY",{"v":6.04904,"d":"6.049040"}]
["0155","LEVEL III BLOOD PRODUCT EXCHANGE SERVICES",6.883218]
["0156","OCULAR IMAGING AND RELATED SERVICES",0.094221]
["0157","REPRODUCTIVE PATHOLOGY TESTS",0.119883]
["0158","PATHOLOGY CONSULTATION AND INTERPRETATION",0.060593]
["0159","MINOR UROLOGY SERVICES",0.118529]
["0161","URINARY STUDIES AND PROCEDURES",0.625226]
["0166","LEVEL I URETHRAL PROCEDURES",4.833479]
["0167","LEVEL II URETHRAL PROCEDURES",8.798412]
["0168","DIALYSIS PROCEDURES",1.259176]
["0170","LEVEL I KIDNEY AND URETERAL PROCEDURES",2.483431]
["0171","LEVEL II KIDNEY AND URETERAL PROCEDURES",4.840944]
["0172","LEVEL III KIDNEY AND URETERAL PROCEDURES",11.410535]
["0173","LEVEL I BLADDER AND URETERAL PROCEDURES",2.567528]
["0174","LEVEL II BLADDER AND URETERAL PROCEDURES",6.802043]
["0176","LEVEL I PROSTATE PROCEDURES",2.508881]
["0177","MINOR DERMATOLOGY SERVICES",0.036059]
["0178","ANTEPARTUM PROCEDURES",1.070833]
["0179","ECTOPIC PREGNANCY PROCEDURES",6.098866]
["0180","TESTICULAR AND EPIDIDYMAL PROCEDURES",3.387635]
["0182","INSERTION OF PENILE PROSTHESIS",22.603406]
["0183","LEVEL I PENILE PROCEDURES",3.230463]
["0184","LEVEL II PROSTATE PROCEDURES",7.063574]
["0187","LEVEL II PENILE PROCEDURES",5.252047]
["0188","LEVEL I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES",4.005268]
["0189","LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES",9.428226]
["0190","ARTIFICIAL FERTILIZATION",0.677462]
["0191","LEVEL I FETAL PROCEDURES",0.303114]
["0192","LEVEL II FETAL PROCEDURES",1.653293]
["0194","ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES",2.906245]
["0195","VAGINAL DELIVERY PROCEDURES",3.571738]
["0202","CESAREAN DELIVERY PROCEDURES",4.289913]
["0203","GLOBAL ANTEPARTUM AND POSTPARTUM VISITS",0.405469]
["0204","LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES",{"v":6.81054,"d":"6.810540"}]
["0205","OBSTETRICAL PROCEDURES",3.120828]
["0206","LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES",9.826484]
["0207","LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES",3.738298]
["0208","LEVEL II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES",6.951008]
["0209","OTHER GYNECOLOGICAL PROCEDURES",0.753124]
["0210","EXTENDED EEG STUDIES",0.833462]
["0211","ELECTROENCEPHALOGRAM",0.525503]
["0212","ELECTROCONVULSIVE THERAPY",0.803021]
["0213","NERVE AND MUSCLE TESTS",0.224442]
["0214","LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP",0.716255]
["0217","LEVEL I PERIPHERAL NERVE PROCEDURES",2.263123]
["0218","LEVEL II PERIPHERAL NERVE PROCEDURES",7.752612]
["0220","LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP",1.908583]
["0222","SLEEP STUDIES ATTENDED",1.253741]
["0223","LEVEL I NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION",9.760819]
["0224","LEVEL II NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION",33.985223]
["0225","OTHER INTRACRANIAL NEUROSURGERY PROCEDURES",{"v":7.3861,"d":"7.386100"}]
["0226","SLEEP STUDIES UNATTENDED",0.232546]
["0227","LEVEL I CRANIOFACIAL BONE PROCEDURES",{"v":4.92705,"d":"4.927050"}]
["0228","LEVEL II CRANIOFACIAL BONE PROCEDURES",7.329963]
["0229","MINOR AUDIOMETRY TESTS AND AUDIOLOGY SCREENING SERVICES",0.056942]
["0230","MINOR OPHTHALMOLOGICAL PROCEDURES AND DIAGNOSTIC SERVICES",0.518535]
["0233","CATARACT AND OTHER INTROCULAR LENS PROCEDURES",2.836433]
["0234","LEVEL I ANTERIOR CHAMBER EYE PROCEDURES",1.512607]
["0235","LEVEL II ANTERIOR CHAMBER EYE PROCEDURES",5.544768]
["0237","LEVEL I INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES",1.782546]
["0238","LEVEL II INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES",5.303237]
["0239","EXTRAOCULAR MUSCLE PROCEDURES",3.610941]
["0241","OCULAR RECONSTRUCTIVE PROCEDURES W OR W/O OCULAR DEVICE",4.590988]
["0243","CLASS I THERAPEUTIC RADIOPHARMACEUTICALS",0.038362]
["0244","CLASS II THERAPEUTIC RADIOPHARMACEUTICALS",0.745496]
["0245","CLASS III THERAPEUTIC RADIOPHARMACEUTICALS",21.780632]
["0246","CLASS IV THERAPEUTIC RADIOPHARMACEUTICALS",65.516997]
["0247","LEVEL I CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES",0.873155]
["0248","LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES",{"v":5.34531,"d":"5.345310"}]
["0249","MINOR EAR, NOSE, MOUTH AND THROAT PROCEDURES",0.182809]
["0250","COCHLEAR DEVICE IMPLANTATION",46.149948]
["0251","OTORHINOLARYNGOLOGIC FUNCTION TESTS",0.238356]
["0252","LEVEL I EAR, NOSE, MOUTH AND THROAT PROCEDURES",1.511565]
["0253","LEVEL II EAR, NOSE, MOUTH AND THROAT PROCEDURES",4.785694]
["0254","LEVEL III EAR, NOSE, MOUTH AND THROAT PROCEDURES",5.739764]
["0255","LEVEL IV EAR, NOSE, MOUTH AND THROAT PROCEDURES",7.518152]
["0256","TONSIL AND ADENOID PROCEDURES",3.287244]
["0257","AUDIOMETRY",0.134441]
["0258","LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES",2.206108]
["0259","LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES",2.723812]
["0260","CASE MANAGEMENT AND CARE PLANNING SERVICES",0.170494]
["0261","ESRD CASE MANAGEMENT",0.988291]
["0262","CLEFT LIP AND PALATE REPAIR",4.318963]
["0263","THYROID AND PARATHYROID PROCEDURES",6.952767]
["0264","MAJOR CRANIOTOMY AND CRANIECTOMY SURGICAL PROCEDURES",6.338554]
["0265","PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES",18.490673]
["0266","OPEN INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES",7.881574]
["0267","OTHER CRANIOTOMY PROCEDURES INCLUDING CRANIOPLASTY",10.541221]
["0268","CRANIAL AND SPINAL SHUNT PROCEDURES",9.209535]
["0269","LEVEL II ANCILLARY THERAPEUTIC SERVICES",0.063538]
["0270","OCCUPATIONAL THERAPY",0.303864]
["0271","PHYSICAL THERAPY",0.393806]
["0272","SPEECH THERAPY AND EVALUATION",0.380109]
["0276","PROCEDURES FOR REVISION OR REMOVAL OF NEUROSTIMULATOR DEVICES",6.175805]
["0277","LEVEL I VASCULAR RADIOLOGICAL PROCEDURES",1.386197]
["0278","INJECTION(S) FOR RADIOLOGICAL IMAGING",0.498314]
["0279","LEVEL II VASCULAR RADIOLOGICAL PROCEDURES",3.004643]
["0280","LEVEL III VASCULAR RADIOLOGICAL PROCEDURES",{"v":6.77379,"d":"6.773790"}]
["0282","MAGNETIC RESONANCE ANGIOGRAPHY",0.821457]
["0284","MYELOGRAPHY AND DISCOGRAPHY IMAGING PROCEDURES",0.964673]
["0286","MAMMOGRAPHY AND OTHER RELATED PROCEDURES",0.083324]
["0288","LEVEL I DIAGNOSTIC ULTRASOUND",0.181991]
["0289","LEVEL II DIAGNOSTIC ULTRASOUND",0.276279]
["0290","PET SCANS",2.154244]
["0291","BONE DENSITY AND RELATED PROCEDURES",0.130591]
["0293","MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST",0.418984]
["0295","MAGNETIC RESONANCE IMAGING WITH CONTRAST",0.734163]
["0297","MAGNETOCEPHALOGRAPHY",{"v":4.10131,"d":"4.101310"}]
["0299","LEVEL I COMPUTED TOMOGRAPHY",0.191919]
["0300","LEVEL II COMPUTED TOMOGRAPHY",0.519963]
["0301","COMPUTED TOMOGRAPHY- OTHER",0.098915]
["0302","COMPUTED TOMOGRAPHIC ANGIOGRAPHY",0.636583]
["0304","MINOR SPECIMEN COLLECTION SERVICES",{"v":0.00384,"d":"0.003840"}]
["0305","LEVEL I SURGICAL PATHOLOGY TESTS",{"v":0.03639,"d":"0.036390"}]
["0306","LEVEL II SURGICAL PATHOLOGY TESTS",0.066494]
["0307","INSERTION OR REMOVAL OF DRUG DELIVERY DEVICE",0.530954]
["0308","LEVEL III PATHOLOGY TESTS",0.065288]
["0309","ADAPTIVE BEHAVIORAL HEALTH TREATMENT SERVICES",0.079572]
["0310","DEVELOPMENTAL AND NEUROPSYCHOLOGICAL TESTING",0.952719]
["0312","BEHAVIORAL AND SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM",0.501667]
["0315","COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY",0.199404]
["0316","INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY",0.240495]
["0317","FAMILY PSYCHOTHERAPY",0.248249]
["0318","GROUP PSYCHOTHERAPY",0.352189]
["0319","ACTIVITY THERAPY",0.283915]
["0320","BEHAVIORAL HEALTH - CASE MANAGEMENT AND TREATMENT PLAN DEVELOPMENT",0.110572]
["0321","CRISIS INTERVENTION",0.279337]
["0322","MEDICATION ADMINISTRATION AND OBSERVATION",0.056231]
["0323","BEHAVIORAL HEALTH ASSESSMENT",0.432344]
["0324","SCREENING FOR BEHAVIORAL CHANGE OR RISK ASSESSMENT",0.039625]
["0325","PREVENTION COUNSELING",0.128588]
["0327","INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT",0.477103]
["0328","DAY REHABILITATION, HALF DAY",0.520433]
["0329","DAY REHABILITATION, FULL DAY",0.861522]
["0331","LEVEL I DIAGNOSTIC NUCLEAR MEDICINE",0.631382]
["0332","LEVEL II DIAGNOSTIC NUCLEAR MEDICINE",1.586543]
["0333","BEHAVIORAL HEALTH RESIDENTIAL TREATMENT",0.861522]
["0334","LEVEL I DEVICE PLACEMENT FOR RADIATION THERAPY",1.351662]
["0335","LEVEL I BRACHYTHERAPY SOURCES",0.689466]
["0336","LEVEL II BRACHYTHERAPY SOURCES",6.147142]
["0337","LEVEL III BRACHYTHERAPY SOURCES",20.967904]
["0338","LEVEL II DEVICE PLACEMENT FOR RADIATION THERAPY",2.880984]
["0339","LEVEL III DEVICE PLACEMENT FOR RADIATION THERAPY",7.365792]
["0340","THERAPEUTIC NUCLEAR MEDICINE",0.513944]
["0343","LEVEL I RADIATION THERAPY",0.301115]
["0346","RADIOSURGERY",{"v":9.80232,"d":"9.802320"}]
["0347","LEVEL II RADIATION THERAPY",0.801118]
["0348","LEVEL III RADIATION THERAPY",2.372393]
["0350","ADJUNCTIVE DENTAL SERVICES",0.384167]
["0352","LEVEL I PERIODONTICS",1.751854]
["0353","LEVEL I PROSTHODONTICS, FIXED",0.169512]
["0354","LEVEL II PROSTHODONTICS, FIXED",0.634097]
["0355","LEVEL III PROSTHODONTICS, FIXED",0.784436]
["0356","LEVEL I PROSTHODONTICS, REMOVABLE",0.343547]
["0357","LEVEL II PROSTHODONTICS, REMOVABLE",0.424763]
["0358","LEVEL III PROSTHODONTICS, REMOVABLE",0.505881]
["0359","LEVEL I MAXILLOFACIAL PROSTHETICS",0.095473]
["0360","LEVEL II MAXILLOFACIAL PROSTHETICS",0.498409]
["0361","LEVEL I DENTAL RESTORATIONS",{"v":2.92015,"d":"2.920150"}]
["0362","LEVEL II DENTAL RESTORATIONS",3.162815]
["0363","LEVEL III DENTAL RESTORATIONS",3.479127]
["0364","LEVEL I ENDODONTICS",0.232833]
["0365","LEVEL II ENDODONTICS",0.418766]
["0366","LEVEL III ENDODONTICS",0.421814]
["0367","LEVEL I ORAL AND MAXILLOFACIAL PROCEDURES",3.163596]
["0368","LEVEL II ORAL AND MAXILLOFACIAL PROCEDURES",4.649123]
["0369","LEVEL III ORAL AND MAXILLOFACIAL PROCEDURES",6.497528]
["0370","LEVEL IV ORAL AND MAXILLOFACIAL PROCEDURES",11.786723]
["0371","LEVEL I ORTHODONTICS",3.866714]
["0372","SEALANT",0.068759]
["0373","LEVEL I DENTAL IMAGING",0.050972]
["0374","LEVEL II DENTAL IMAGING",0.194637]
["0375","DENTAL ANESTHESIA",0.058136]
["0376","DIAGNOSTIC DENTAL PROCEDURES",{"v":0.17457,"d":"0.174570"}]
["0377","PREVENTIVE DENTAL PROCEDURES",0.183299]
["0378","LEVEL II PERIODONTICS",{"v":1.85893,"d":"1.858930"}]
["0379","LEVEL II ORTHODONTICS",0.608041]
["0380","ANESTHESIA",0.039342]
["0381","LEVEL I DENTAL IMPLANTS",2.147316]
["0382","LEVEL II DENTAL IMPLANTS",2.362058]
["0384","LEVEL III CHEMISTRY TESTS",0.180524]
["0385","LEVEL I MOLECULAR PATHOLOGY AND GENETIC TESTS",0.071276]
["0386","LEVEL II MOLECULAR PATHOLOGY AND GENETIC TESTS",0.195451]
["0387","LEVEL III MOLECULAR PATHOLOGY AND GENETIC TESTS",0.664759]
["0388","LEVEL III MICROBIOLOGY TESTS",0.178261]
["0389","LEVEL II CONVENTIONAL RADIOLOGY",0.198627]
["0390","LEVEL I PATHOLOGY TESTS",0.015801]
["0391","LEVEL II PATHOLOGY TESTS",0.047484]
["0392","PAP SMEARS",0.028427]
["0393","LEVEL II BLOOD AND TISSUE TYPING TESTS",0.043103]
["0394","LEVEL I IMMUNOLOGY TESTS",{"v":0.01716,"d":"0.017160"}]
["0395","LEVEL II IMMUNOLOGY TESTS",0.049836]
["0396","LEVEL I MICROBIOLOGY TESTS",0.011859]
["0397","LEVEL II MICROBIOLOGY TESTS",0.045209]
["0398","LEVEL I ENDOCRINOLOGY TESTS",0.020699]
["0399","LEVEL II ENDOCRINOLOGY TESTS",0.053262]
["0400","LEVEL I CHEMISTRY TESTS",0.019999]
["0401","LEVEL II CHEMISTRY TESTS",0.052607]
["0402","BASIC CHEMISTRY TESTS",0.008034]
["0403","ORGAN OR DISEASE ORIENTED PANELS",0.013621]
["0404","TOXICOLOGY TESTS",0.018053]
["0405","THERAPEUTIC DRUG MONITORING",0.017262]
["0406","LEVEL I CLOTTING TESTS",{"v":0.00612,"d":"0.006120"}]
["0407","LEVEL II CLOTTING TESTS",0.029762]
["0408","LEVEL I HEMATOLOGY TESTS",0.009288]
["0409","LEVEL II HEMATOLOGY TESTS",0.019934]
["0410","URINALYSIS",0.004529]
["0412","ANCILLARY RESPIRATORY THERAPY AND OTHER PULMONARY TESTS AND SERVICES",0.085637]
["0413","CARDIOGRAM",0.043395]
["0414","LEVEL I IMMUNIZATION",0.044531]
["0415","LEVEL II IMMUNIZATION",0.180561]
["0417","MINOR FEMALE REPRODUCTIVE PROCEDURES",0.324576]
["0418","AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS",0.112364]
["0419","ANCILLARY OPHTHALMOLOGY OR OPTOMETRY SERVICES",0.119702]
["0420","ELECTRONIC ANALYSIS FOR CARDIAC, NEUROLOGICAL AND OTHER DEVICES",0.241112]
["0421","TUBE REPLACEMENT, REVISION OR REMOVAL",{"v":0.32862,"d":"0.328620"}]
["0423","VASCULAR ACCESS BY NEEDLE OR CATHETER",{"v":1.04564,"d":"1.045640"}]
["0427","BIOFEEDBACK AND OTHER TRAINING",0.262892]
["0428","PATIENT EDUCATION, INDIVIDUAL",0.108004]
["0429","PATIENT EDUCATION, GROUP",0.075563]
["0430","CLASS I CHEMOTHERAPY DRUGS",{"v":0,"d":"0.000000"}]
["0431","CLASS II CHEMOTHERAPY DRUGS",0.118315]
["0432","CLASS III CHEMOTHERAPY DRUGS",0.259964]
["0433","CLASS IV CHEMOTHERAPY DRUGS",0.374287]
["0434","CLASS V CHEMOTHERAPY DRUGS",0.949614]
["0435","CLASS I PHARMACOTHERAPY",{"v":0,"d":"0.000000"}]
["0436","CLASS II PHARMACOTHERAPY",0.137718]
["0437","CLASS III PHARMACOTHERAPY",0.262513]
["0438","CLASS IV PHARMACOTHERAPY",{"v":0.5914,"d":"0.591400"}]
["0439","CLASS V PHARMACOTHERAPY",0.868051]
["0440","CLASS VI PHARMACOTHERAPY",1.455793]
["0441","CLASS VI CHEMOTHERAPY DRUGS",{"v":1.32774,"d":"1.327740"}]
["0443","CLASS VII CHEMOTHERAPY DRUGS",1.708937]
["0444","CLASS VII PHARMACOTHERAPY",1.847174]
["0448","EXPANDED HOURS ACCESS",{"v":0.0715,"d":"0.071500"}]
["0449","ADDITIONAL UNDIFFERENTIATED MEDICAL VISITS/SERVICES",{"v":0,"d":"0.000000"}]
["0450","OBSERVATION",1.325518]
["0452","DIABETES SUPPLIES",{"v":0,"d":"0.000000"}]
["0453","MOTORIZED WHEELCHAIR",{"v":0,"d":"0.000000"}]
["0454","TPN FORMULAE",{"v":0,"d":"0.000000"}]
["0455","IMPLANTED TISSUE OF ANY TYPE",{"v":0,"d":"0.000000"}]
["0456","MOTORIZED WHEELCHAIR ACCESSORIES",{"v":0,"d":"0.000000"}]
["0458","ALLERGY THERAPY",0.038212]
["0459","VACCINE ADMINISTRATION",{"v":0.06326,"d":"0.063260"}]
["0460","CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY",2.731443]
["0461","CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY",4.332749]
["0462","CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY",7.358889]
["0463","CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY",9.755101]
["0464","CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY",{"v":15.02509,"d":"15.025090"}]
["0465","CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY",30.413823]
["0466","CLASS XIV COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY",46.955601]
["0470","OBSTETRICAL ULTRASOUND",0.167289]
["0471","LEVEL I CONVENTIONAL RADIOLOGY",0.094203]
["0472","ULTRASOUND GUIDANCE",0.186195]
["0473","CT GUIDANCE",0.153121]
["0474","RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES",0.295804]
["0475","MRI GUIDANCE",0.417131]
["0476","LEVEL I RADIATION TREATMENT PREPARATION AND PLANNING",0.193364]
["0477","LEVEL II RADIATION TREATMENT PREPARATION AND PLANNING",0.315131]
["0478","LEVEL III RADIATION TREATMENT PREPARATION AND PLANNING",1.812334]
["0483","RADIATION THERAPY MANAGEMENT",0.519959]
["0485","CORNEAL TISSUE PROCESSING",4.326571]
["0486","LEVEL I BLOOD AND TISSUE TYPING TESTS",0.007064]
["0488","MINOR DEVICE EVALUATION AND INTERROGATION",{"v":0.06338,"d":"0.063380"}]
["0490","INCIDENTAL SERVICES FOR QUALITY OR PERFORMANCE MEASUREMENT",{"v":0,"d":"0.000000"}]
["0491","MEDICAL VISIT INDICATOR",{"v":0,"d":"0.000000"}]
["0493","LEVEL I ANCILLARY THERAPEUTIC SERVICES",0.053146]
["0494","COMPLEX BLOOD COLLECTION SERVICES",{"v":0.09654,"d":"0.096540"}]
["0495","MINOR CHEMOTHERAPY DRUGS",{"v":0,"d":"0.000000"}]
["0496","MINOR PHARMACOTHERAPY",{"v":0,"d":"0.000000"}]
["0497","TELEHEALTH FACILITATION",0.013442]
["0498","PEN FORMULAE",{"v":0,"d":"0.000000"}]
["0499","BLOOD PROCESSING, STORAGE AND RELATED SERVICES",0.043758]
["0510","MAJOR SIGNS, SYMPTOMS AND FINDINGS",0.580703]
["0518","BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM",0.315301]
["0519","NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM",0.228092]
["0520","SPINAL DIAGNOSES AND INJURIES",0.235336]
["0521","NERVOUS SYSTEM MALIGNANCY",0.246561]
["0522","DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS",0.214681]
["0523","MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES",0.204365]
["0524","OTHER CENTRAL NERVOUS SYSTEM DIAGNOSES",0.247755]
["0526","TRANSIENT ISCHEMIA",0.382854]
["0527","PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DIAGNOSES",0.216267]
["0528","ANOXIC AND OTHER SEVERE BRAIN DAMAGE OR COMA",0.290626]
["0529","SEIZURE",0.308967]
["0530","HEADACHES OTHER THAN MIGRAINE",0.242262]
["0531","MIGRAINE",0.213026]
["0532","HEAD TRAUMA WITH OR WITHOUT LOC/COMA LESS THAN 1 HR",0.317887]
["0533","AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT",0.227397]
["0534","NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION W/O INFARC",0.200428]
["0535","CVA AND PRECEREBRAL OCCLUSION W INFARCT",0.348015]
["0536","CEREBRAL PALSY",{"v":0.21433,"d":"0.214330"}]
["0537","MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC",0.351495]
["0538","HEAD TRAUMA WITH LOC/COMA MORE THEN 1 HR",0.711358]
["0539","INTRACRANIAL HEMORRHAGE",0.412411]
["0545","PERIPHERAL, CRANIAL, AND AUTONOMIC NERVE INJURIES",0.254511]
["0548","PERIPHERAL AND OTHER VASCULAR RELATED INJURIES",0.335578]
["0550","ACUTE MAJOR EYE INFECTIONS",0.198528]
["0551","CATARACTS",0.170058]
["0552","GLAUCOMA",0.211257]
["0553","OTHER OPHTHALMIC SYSTEM DIAGNOSES",0.201519]
["0555","CONJUNCTIVITIS",0.183779]
["0556","OCULAR AND PERIOCULAR MALIGNANCY",0.236422]
["0557","OTHER EYE INFECTION DIAGNOSES",0.160831]
["0558","MALFUNCTION, REACTION, OR COMPLICATION OF OCULAR DEVICE OR PROCEDURE",{"v":0.19161,"d":"0.191610"}]
["0560","EAR, NOSE, MOUTH, THROAT, CRANIAL AND FACIAL MALIGNANCIES",{"v":0.2351,"d":"0.235100"}]
["0561","VERTIGO AND OTHER LABYRINTH DISORDERS",0.333824]
["0562","INFECTIONS OF UPPER RESPIRATORY TRACT AND OTITIS MEDIA",0.257814]
["0563","DENTAL AND ORAL DIAGNOSES AND INJURIES",0.198554]
["0564","OTHER EAR, NOSE, MOUTH, THROAT AND CRANIOFACIAL DIAGNOSES",0.212092]
["0566","MALFUNCTION, REACTION, OR COMPLICATION OF OTOLARYNGOLOGIC DEVICE OR PROCEDURE",0.176754]
["0570","CYSTIC FIBROSIS - PULMONARY DISEASE",0.516037]
["0571","RESPIRATORY MALIGNANCY",0.260204]
["0572","BRONCHIOLITIS AND RSV PNEUMONIA",0.562745]
["0574","CHRONIC OBSTRUCTIVE PULMONARY DISEASE",0.455719]
["0575","ASTHMA",0.386201]
["0576","OTHER RESPIRATORY SYSTEM DIAGNOSES",0.332163]
["0579","STATUS ASTHMATICUS",0.556128]
["0580","MAJOR CHEST AND RESPIRATORY TRAUMA",0.597283]
["0581","PULMONARY INFECTION DIAGNOSES INCLUDING PNEUMONIA",0.472779]
["0582","INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES",0.343911]
["0583","MALFUNCTION, REACTION, OR COMPLICATION OF PULMONARY DEVICE OR PROCEDURE",0.498822]
["0584","ACUTE BRONCHITIS",0.404821]
["0585","AFTERCARE, OPEN WOUNDS AND OTHER TRAUMATIC INJURIES",0.188469]
["0586","PULMONARY EMBOLISM",0.280685]
["0587","RESPIRATORY FAILURE",{"v":0.74346,"d":"0.743460"}]
["0589","MALFUNCTION, REACTION, OR COMPLICATION OF CARDIOVASCULAR DEVICE OR PROC",0.376544]
["0591","ACUTE MYOCARDIAL INFARCTION",0.719117]
["0592","OTHER CARDIOVASCULAR SYSTEM DIAGNOSES",0.314306]
["0594","HEART FAILURE",0.372519]
["0595","CARDIAC ARREST OR OTHER CAUSES OF MORTALITY",0.561143]
["0596","PERIPHERAL AND OTHER VASCULAR DIAGNOSES",0.237675]
["0597","PHLEBITIS",0.272015]
["0598","ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS",0.234733]
["0599","HYPERTENSION",0.227162]
["0600","CARDIAC STRUCTURAL AND VALVULAR DIAGNOSES",0.226656]
["0601","CARDIAC ARRHYTHMIA AND CONDUCTION DIAGNOSES",0.327843]
["0602","ATRIAL FIBRILLATION",0.233301]
["0604","CHEST PAIN",0.678831]
["0605","SYNCOPE AND COLLAPSE",{"v":0.48725,"d":"0.487250"}]
["0607","CARDIOMYOPATHY DIAGNOSES",0.221831]
["0608","ACUTE AND SUBACUTE ENDOCARDITIS",{"v":0.22709,"d":"0.227090"}]
["0610","CONTUSIONS TO EXTERNAL ORGANS OTHER THAN HEAD TRAUMA",0.391129]
["0616","DIVERTICULITIS AND DIVERTICULOSIS",0.352528]
["0617","GASTROINTESTINAL HEMORRHAGE AND RELATED POSTPROCEDURAL HEMORRHAGE DIAGNOSES",0.488794]
["0618","INTESTINAL OBSTRUCTION DIAGNOSES",0.498561]
["0619","GASTROINTESTINAL AND PERITONEAL INFECTION DIAGNOSES",0.379996]
["0620","DIGESTIVE MALIGNANCY",0.313699]
["0621","PEPTIC ULCER AND GASTRITIS",{"v":0.46902,"d":"0.469020"}]
["0623","ESOPHAGITIS AND OTHER ESOPHAGEAL DIAGNOSES",{"v":0.27156,"d":"0.271560"}]
["0624","OTHER GASTROINTESTINAL SYSTEM DIAGNOSES",0.291928]
["0626","INFLAMMATORY BOWEL DISEASE",0.226616]
["0627","NON-BACTERIAL GASTROENTERITIS, NAUSEA AND VOMITING",0.328961]
["0628","ABDOMINAL PAIN",0.379665]
["0629","MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE",{"v":0.38829,"d":"0.388290"}]
["0630","CONSTIPATION",0.333745]
["0631","HERNIA",0.249662]
["0632","IRRITABLE BOWEL SYNDROME",0.196918]
["0633","ALCOHOLIC LIVER DISEASE",{"v":0.28197,"d":"0.281970"}]
["0634","MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS",0.367922]
["0635","PANCREAS DIAGNOSES EXCEPT MALIGNANCY",0.366614]
["0636","HEPATITIS WITHOUT COMA",0.273187]
["0637","GALLBLADDER AND BILIARY TRACT DIAGNOSES",0.331394]
["0638","CHOLECYSTITIS",0.412306]
["0639","OTHER HEPATOBILIARY SYSTEM DIAGNOSES",0.298781]
["0641","HEPATIC COMA AND MAJOR ACUTE LIVER DIAGNOSES",0.272883]
["0642","GASTROINTESTINAL VASCULAR INSUFFICIENCY",0.391499]
["0647","FRACTURES, DISLOCATIONS, OTHER INJURIES - UPPER EXTREMITY INCLUDING SHOULDER",0.437299]
["0648","FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE",0.466605]
["0649","OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY",0.447971]
["0650","FRACTURES, DISLOCATIONS, OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR",0.435093]
["0651","FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP",{"v":0.49844,"d":"0.498440"}]
["0652","OTHER INJURIES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE",0.254347]
["0653","MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FX DUE TO MALIGNANCY",0.335518]
["0654","OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS",{"v":0.22906,"d":"0.229060"}]
["0655","CONNECTIVE TISSUE DIAGNOSES",0.210319]
["0656","FRACTURES, DISLOCATIONS, OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST",0.475392]
["0657","FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK",0.272567]
["0658","SCIATICA",{"v":0.29817,"d":"0.298170"}]
["0659","MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE",0.306471]
["0660","OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES",0.271628]
["0662","OSTEOPOROSIS",0.209323]
["0663","PAIN RELATED DIAGNOSES",0.245645]
["0670","NON-PRESSURE CHRONIC SKIN ULCERS",0.254772]
["0671","MAJOR SKIN DIAGNOSES",0.217768]
["0672","MALIGNANT BREAST DIAGNOSES",0.233928]
["0673","CELLULITIS AND OTHER BACTERIAL SKIN INFECTIONS",0.276926]
["0674","OPEN WOUNDS, PUNCTURES AND OTHER OPEN TRAUMATIC INJURIES",0.259382]
["0675","OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DIAGNOSES",0.168995]
["0676","PRESSURE ULCERS",0.246153]
["0690","MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DIAGNOSES",0.257885]
["0691","INBORN ERRORS OF METABOLISM",0.201715]
["0692","OTHER ENDOCRINE SYSTEM DIAGNOSES",{"v":0.24039,"d":"0.240390"}]
["0694","ELECTROLYTE DISORDERS",0.392405]
["0695","OBESITY",0.187671]
["0696","THYROID AND PARATHYROID DIAGNOSES",0.211131]
["0710","DIABETES WITH OPHTHALMIC MANIFESTATIONS",0.215129]
["0711","DIABETES WITH OTHER MANIFESTATIONS AND COMPLICATIONS",0.270618]
["0712","DIABETES WITH NEUROLOGIC MANIFESTATIONS",0.216741]
["0713","DIABETES WITHOUT COMPLICATIONS",0.199813]
["0714","DIABETES WITH RENAL MANIFESTATIONS",{"v":0.22328,"d":"0.223280"}]
["0715","DIABETES WITH VASCULAR COMPLICATIONS INCLUDING FOOT AND OTHER SKIN ULCERS",0.239317]
["0720","CHRONIC KIDNEY DISEASE",0.240196]
["0721","KIDNEY AND URINARY TRACT MALIGNANCY",0.250472]
["0722","NEPHRITIS AND NEPHROSIS",0.292773]
["0723","COMPLEX KIDNEY AND URINARY TRACT INFECTIONS",0.394198]
["0724","URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION",0.246859]
["0725","MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC",0.386302]
["0726","OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS",0.272294]
["0727","ACUTE LOWER URINARY TRACT INFECTIONS",0.373205]
["0729","ACUTE KIDNEY INJURY",0.500922]
["0740","MALE REPRODUCTIVE SYSTEM MALIGNANCY",0.242976]
["0741","OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES",0.233125]
["0743","PROSTATITIS",0.209951]
["0744","MALE REPRODUCTIVE SYSTEM INFECTIONS",0.214517]
["0750","FEMALE REPRODUCTIVE SYSTEM MALIGNANCY",0.284582]
["0751","FEMALE REPRODUCTIVE SYSTEM INFECTIONS",0.285609]
["0752","OTHER FEMALE REPRODUCTIVE SYSTEM AND MENSTRUAL DIAGNOSES",0.222393]
["0760","LABOR AND DELIVERY RELATED DIAGNOSES",0.347358]
["0761","POSTPARTUM AND POST ABORTION DIAGNOSES",0.345392]
["0762","PRETERM LABOR DIAGNOSES",0.607946]
["0763","ABORTION RELATED DIAGNOSES",0.553736]
["0764","FALSE LABOR",0.333887]
["0765","OTHER ANTEPARTUM DIAGNOSES",{"v":0.38756,"d":"0.387560"}]
["0766","ROUTINE PRENATAL CARE",{"v":0.28586,"d":"0.285860"}]
["0767","COMPLICATIONS OF TREATMENT AFFECTING PREGNANCY",0.512688]
["0770","NORMAL NEONATE",{"v":0.2289,"d":"0.228900"}]
["0771","NEONATAL DIAGNOSES",0.366246]
["0777","SUPERFICIAL INJURY TO SKIN AND SUBCUTANEOUS TISSUE",0.284252]
["0780","OTHER HEMATOLOGICAL DIAGNOSES",0.373224]
["0781","COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES",0.235974]
["0783","SICKLE CELL ANEMIA CRISIS",0.487037]
["0785","ANEMIA, BLOOD AND BLOOD-FORMING ORGAN DISORDERS",0.290401]
["0787","AFTERCARE, BURNS, CORROSIONS, OTHER INJURIES RELATED TO THE SKIN AND SUB TIS",0.173005]
["0800","ACUTE LEUKEMIA",0.397011]
["0801","LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA",0.317746]
["0802","RADIOTHERAPY",0.234703]
["0803","CHEMOTHERAPY",0.386914]
["0804","LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR",0.286306]
["0805","SEPTICEMIA AND DISSEMINATED INFECTIONS",0.907949]
["0806","INTRAOPERATIVE, POST-OPERATIVE OR POST-TRAUMATIC INFECTIONS AND COMPLICATIONS",0.327316]
["0807","FEVER AND OTHER INFLAMMATORY CONDITIONS",0.551391]
["0808","VIRAL ILLNESS",{"v":0.39034,"d":"0.390340"}]
["0809","OTHER INFECTIOUS AND PARASITIC DISEASES",0.252247]
["0810","H. PYLORI INFECTION",0.245268]
["0812","VIRAL MENINGITIS",0.333444]
["0820","SCHIZOPHRENIA",0.335777]
["0821","MAJOR DEPRESSIVE DIAGNOSES AND  OTHER OR UNSPECIFIED PSYCHOSES",0.252748]
["0822","PERSONALITY AND IMPULSE CONTROL DIAGNOSES",0.334741]
["0823","BIPOLAR DISORDERS",0.252836]
["0824","DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES",0.212968]
["0825","ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES",0.238867]
["0826","ACUTE ANXIETY AND DELIRIUM STATES",0.337452]
["0827","ORGANIC BEHAVIORAL HEALTH DISTURBANCES",0.209067]
["0828","INTELLECTUAL DISABILITY",0.247067]
["0829","CHILDHOOD BEHAVIORAL DIAGNOSES",0.260536]
["0830","EATING DISORDERS",0.247338]
["0831","OTHER BEHAVIORAL HEALTH DIAGNOSES",0.338852]
["0832","INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE",0.758439]
["0840","OPIOID ABUSE AND DEPENDENCE",0.276128]
["0841","COCAINE ABUSE AND DEPENDENCE",0.488801]
["0842","ALCOHOL ABUSE AND DEPENDENCE",0.451547]
["0843","OTHER DRUG ABUSE AND DEPENDENCE",0.440083]
["0850","ALLERGIC REACTIONS",0.389867]
["0851","POISONING OR TOXIC EFFECTS OF MEDICINAL AGENTS",0.403921]
["0852","OTHER COMPLICATIONS OF TREATMENT",0.280263]
["0853","OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES",0.280947]
["0854","TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES",0.312501]
["0860","EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS",0.295541]
["0861","PARTIAL THICKNESS BURNS",{"v":0.2502,"d":"0.250200"}]
["0867","ENCOUNTERS FOR CONTACT WITH HEALTH SERVICES",0.200303]
["0869","AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES",0.215281]
["0870","REHABILITATION",0.141509]
["0871","SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS",{"v":0.27596,"d":"0.275960"}]
["0872","OTHER AFTERCARE AND CONVALESCENCE",0.275827]
["0873","NEONATAL AFTERCARE",0.183479]
["0874","AFTERCARE FOR JOINT REPLACEMENT",0.212758]
["0875","CONTRACEPTIVE MANAGEMENT",0.243996]
["0876","ADULT PREVENTIVE MEDICINE",0.270266]
["0877","CHILD PREVENTIVE MEDICINE",{"v":0.21661,"d":"0.216610"}]
["0878","GYNECOLOGIC PREVENTIVE MEDICINE",{"v":0.18102,"d":"0.181020"}]
["0879","PREVENTIVE OR SCREENING ENCOUNTER",0.242496]
["0880","HIV INFECTION",0.331859]
["0881","AIDS",0.342664]
["0882","GENETIC COUNSELING",0.240004]
["0883","ALTERATION IN CONSCIOUSNESS",0.602534]
["0993","INPATIENT ONLY PROCEDURES",{"v":0,"d":"0.000000"}]
["0994","USER CUSTOMIZABLE INPATIENT PROCEDURES",{"v":0,"d":"0.000000"}]
["0999","UNASSIGNED",{"v":0,"d":"0.000000"}]
["1001","DURABLE MEDICAL EQUIPMENT AND SUPPLIES - LEVEL 1",{"v":0,"d":"0.000000"}]
["1002","DURABLE MEDICAL EQUIPMENT AND SUPPLIES - LEVEL 2",{"v":0,"d":"0.000000"}]
["1003","DURABLE MEDICAL EQUIPMENT AND SUPPLIES - LEVEL 3",{"v":0,"d":"0.000000"}]
["1004","DURABLE MEDICAL EQUIPMENT - LEVEL 4",{"v":0,"d":"0.000000"}]
["1005","DURABLE MEDICAL EQUIPMENT - LEVEL 5",{"v":0,"d":"0.000000"}]
["1006","DURABLE MEDICAL EQUIPMENT - LEVEL 6",{"v":0,"d":"0.000000"}]
["1007","DURABLE MEDICAL EQUIPMENT - LEVEL 7",{"v":0,"d":"0.000000"}]
["1008","DURABLE MEDICAL EQUIPMENT - LEVEL 8",{"v":0,"d":"0.000000"}]
["1009","DURABLE MEDICAL EQUIPMENT - LEVEL 9",{"v":0,"d":"0.000000"}]
["1010","DURABLE MEDICAL EQUIPMENT - LEVEL 10",{"v":0,"d":"0.000000"}]
["1011","DURABLE MEDICAL EQUIPMENT - LEVEL 11",{"v":0,"d":"0.000000"}]
["1012","DURABLE MEDICAL EQUIPMENT - LEVEL 12",{"v":0,"d":"0.000000"}]
["1013","DURABLE MEDICAL EQUIPMENT - LEVEL 13",{"v":0,"d":"0.000000"}]
["1014","DURABLE MEDICAL EQUIPMENT - LEVEL 14",{"v":0,"d":"0.000000"}]
["1015","DURABLE MEDICAL EQUIPMENT - LEVEL 15",{"v":0,"d":"0.000000"}]
["1016","DURABLE MEDICAL EQUIPMENT - LEVEL 16",{"v":0,"d":"0.000000"}]
["1017","DURABLE MEDICAL EQUIPMENT - LEVEL 17",{"v":0,"d":"0.000000"}]
["1018","DURABLE MEDICAL EQUIPMENT - LEVEL 18",{"v":0,"d":"0.000000"}]
["1019","DURABLE MEDICAL EQUIPMENT - LEVEL 19",{"v":0,"d":"0.000000"}]
["1020","DURABLE MEDICAL EQUIPMENT - LEVEL 20",{"v":0,"d":"0.000000"}]
["1021","DURABLE MEDICAL EQUIPMENT - OXYGEN AND RELATED EQUIPMENT",{"v":0,"d":"0.000000"}]
["1030","AMBULANCE SERVICES",{"v":0,"d":"0.000000"}]
["1090","USER DEFINED 340B DRUGS",{"v":0,"d":"0.000000"}]
["2000","DIAGNOSTIC RADIOPHARMACEUTICAL",{"v":0,"d":"0.000000"}]
["2001","DIAGNOSTIC CONTRAST MEDIA",{"v":0,"d":"0.000000"}]
["2002","INCIDENTAL IMAGING SERVICES",{"v":0,"d":"0.000000"}]
["2003","INCIDENTAL PHYSICIAN REPORT OR TECHNICAL SERVICES",{"v":0,"d":"0.000000"}]
["2004","INCIDENTAL MINOR DIAGNOSTIC TESTS",{"v":0,"d":"0.000000"}]
["2005","INCIDENTAL MEDICAL VISIT SERVICES",{"v":0,"d":"0.000000"}]
["2006","INCIDENTAL IMPLANTABLE OR OTHER RELATED DEVICES",{"v":0,"d":"0.000000"}]
["2007","INCIDENTAL BEHAVIORAL HEALTH SERVICES",{"v":0,"d":"0.000000"}]
["2020","NONINVASIVE VENTILATION SUPPORT",0.204132]
["2030","MINOR MUSCULOSKELETAL PROCEDURES",0.316679]
["2061","LEVEL I BLOOD PRODUCTS",0.244744]
["2062","LEVEL II BLOOD PRODUCTS",0.615087]
["3033","INGUINAL, FEMORAL AND UMBILICAL HERNIA REPAIR",5.763026]
["3035","ABDOMINAL HERNIA REPAIR",7.362162]
["3050","TRANSPLANT PROCEDURES",{"v":8.1856,"d":"8.185600"}]
["4001","EMERGING TECHNOLOGY PROCEDURES",{"v":1.39865,"d":"1.398650"}]
["4010","LEVEL I OPIOID TREATMENT PROGRAM SERVICES",{"v":0,"d":"0.000000"}]
["4011","LEVEL II OPIOID TREATMENT PROGRAM SERVICES",{"v":0,"d":"0.000000"}]
[]
["Notes:"]
["1. EAPG national weights were calculated by 3M™ Health Information Systems for EAPG version 3.16."]
["2. Normalized version 3.16 EAPG national weights have been scaled by a factor of 0.983249 and include a 1.15 chemotherapy policy"]
["adjuster. The chemotherapy policy adjuster applies to the following EAPGs: 0430, 0431, 0432, 0433, 0434, 0441, 0443, 0460, 0461, 0462, 0463, 0464, 0465, 0466."]
["3. Portions of these documents have been reproduced with permission of 3M Company. © 2022 3M. All Rights Reserved."]

{"sheet":"Table 3 | Age Adjustor","index":7,"n_rows":9,"n_cols":14,"rows_kept":9,"flags":["formulas_cached_only"]}
[null,null,"Washington State Health Care Authority",{"$nulls":10},"Illustrative Example Medicaid FFS Allowed Amount"]
[null,null,"EAPG Calculator Version 1.0 - DRAFT",{"$nulls":10},"Does Not Represent Actual Claim Payment"]
[null,null,"Medicaid FFS Rates Effective January 01, 2025",{"$nulls":10},"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,null,"Table 3: Age Adjuster"]
[]
[]
[]
[null,"Pediatric Max Age","Policy Adjustor for Ages Below 18"]
[null,17,1.35]

{"sheet":"Table 4 | Grouper Settings","index":8,"n_rows":112,"n_cols":3,"rows_kept":112,"flags":["formulas_cached_only"]}
[null,"Washington State Health Care Authority","Illustrative Example Medicaid FFS Allowed Amount"]
[null,"EAPG Calculator Version 1.0 - DRAFT","Does Not Represent Actual Claim Payment"]
[null,"Medicaid FFS Rates Effective January 01, 2025","SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,"Table 4: Washington Medicaid EAPG v3.16 Grouper Settings"]
[]
[null,"Schedule Information"]
[null,"Grouper Version","Enhanced APG System Version 3.16 (January 1, 2021)"]
[null,"Payer Logic Indicator","None"]
[null,"Payer Exceptions","None"]
[null,"Reimbursement scheme","None"]
[]
[null,"Grouping - General"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Direct admit observation logic","Yes"]
[null,"Repeat ancillary procedure discounting","Yes"]
[null,"Repeat ancillary discounting for drug","No"]
[null,"Repeat ancillary discounting for DME","No"]
[null,"Bilateral discounting","Yes"]
[null,"Terminated procedure discounting","Yes"]
[null,"Cross-type multiple procedure discounting","No"]
[null,"Radiology procedure packaging","No"]
[null,"Observation hours option","8 or More Observation Hours Required"]
[]
[null,"Grouping - Visits"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Multiple Medical Visits Option:","0 - Do not allow assignment of multiple medical visits"]
[null,"Visits per claim:","Multiple"]
[null,"Single visit per claim revenue codes:","450, 451, 452, 456, 459, 762"]
[]
[null,"Grouping - EAPG Type Processing"]
[]
[null,"Same Procedure Consolidation for:"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Significant Procedure","Yes"]
[null,"Physical Therapy and Rehab","Yes"]
[null,"Behavioral Health and Counseling","Yes"]
[null,"Dental","Yes"]
[null,"Radiologic Procedure","Yes"]
[null,"Diagnostic Significant Procedure","Yes"]
[]
[null,"Clinical Procedure Consolidation for:"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Significant Procedure","Yes"]
[null,"Physical Therapy and Rehab","Yes"]
[null,"Behavioral Health and Counseling","Yes"]
[null,"Dental","Yes"]
[null,"Radiologic Procedure","Yes"]
[null,"Diagnostic Significant Procedure","Yes"]
[]
[null,"Multiple Procedure Discounting for:"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Significant Procedure","Yes"]
[null,"Physical Therapy and Rehab","Yes"]
[null,"Behavioral Health and Counseling","Yes"]
[null,"Dental","Yes"]
[null,"Radiologic Procedure","Yes"]
[null,"Diagnostic Significant Procedure","Yes"]
[]
[null,"Medical Visit Processed with:"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Significant Procedure","No"]
[null,"Physical Therapy and Rehab","Yes"]
[null,"Behavioral Health and Counseling","No"]
[null,"Dental","No"]
[null,"Radiologic Procedure","Yes"]
[null,"Diagnostic Significant Procedure","No"]
[]
[null,"Grouping - Modifiers"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Use modifier -25","No"]
[null,"Use modifier -27","Yes"]
[null,"Use modifier -59","No"]
[null,"Use therapy modifiers -GN, -GO, and -GP","No"]
[null,"Use anatomical or select modifiers","No"]
[null,"Ignore all modifiers","No"]
[null,"Use never event modifiers, -PA, -PB, -PC","No"]
[null,"Use modifier -57","No"]
[null,"Use distinct procedure modifiers","No"]
[null,"Use modifier -JW","No"]
[null,"Use distinct medical visit","No"]
[]
[null,"Grouping - Per Diem"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Direct per diem option:","0 - Do not apply direct per diem criteria"]
[null,"Indirect per diem option:","0 - Do not apply indirect per diem criteria"]
[]
[null,"Grouping - Inpatient Only / Never Pay"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Inpatient only HCPCS codes (default of additional) to group to EAPG 994","Use default setting"]
[null,"Never pay HCPCS codes","Use default setting"]
[null,"Never pay EAPGs","Use default setting"]
[]
[null,"Grouping - Packaging"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"EAPGs added to packaging","Use default setting"]
[null,"EAPGs deleted from packaging","Use default setting"]
[]
[null,"Grouping - Acuity"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"Acuity secondary diagnosis codes","Use default setting"]
[null,"Acuity EAPGs","Use default setting"]
[]
[null,"Grouping  - Conditional"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"EAPGs conditional upon diagnosis code","Use default setting"]
[null,"Significant procedure or therapy EAPGs allowing medical visit","Use default setting"]
[null,"User-defined 340B drug list","Use default setting"]
[]
[null,"Grouping - Consolidation"]
[null,"EAPG Grouper Schedule Setting","EAPG v3.16 Grouper Preference"]
[null,"EAPGs excluded from same significant procedure consolidation","Use default setting"]
[null,"Conditional EAPGs diagnosis codes required range list","Use default setting"]

{"sheet":"Table 5a | OPPS Fee Schedule","index":9,"n_rows":18605,"n_cols":8,"rows_kept":4500,"cut":true,"merged":[[5,0,5,7],[6,0,6,7],[7,0,7,7],[8,0,8,7],[9,0,9,7],[10,0,10,7]],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0},"flags":["formulas_cached_only"]}
[null,null,"Washington State Health Care Authority",{"$nulls":4},"Illustrative Example Medicaid FFS Allowed Amount"]
[null,null,"EAPG Calculator Version 1.0 - DRAFT",{"$nulls":4},"Does Not Represent Actual Claim Payment"]
[null,null,"Medicaid FFS Rates Effective January 01, 2025",{"$nulls":4},"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
[null,null,"Table 5a: HCA OPPS Fee Schedule"]
[]
["Washington State Health Care Authority (HCA)"]
["Outpatient Prospective Payment Systems (OPPS)"]
["Effective dates of service on and after January 01, 2025"]
[]
["Link to Legend for Codes"]
[]
["Auth","CPT","DESCRPT","Cov","Units","Pricing","Fee","Comments"]
[null,"00100","Anesth salivary gland","1","1","E"]
[null,"00102","Anesth repair of cleft lip","1","1","E"]
[null,"00103","Anesth blepharoplasty","1","1","E"]
[null,"00104","Anesth electroshock","1","1","E"]
[null,"00120","Anesth ear surgery","1","1","E"]
[null,"00124","Anesth ear exam","1","1","E"]
[null,"00126","Anesth tympanotomy","1","1","E"]
[null,"00140","Anesth procedures on eye","1","1","E"]
[null,"00142","Anesth lens surgery","1","1","E"]
[null,"00144","Anesth corneal transplant","1","1","E"]
[null,"00145","Anesth vitreoretinal surg","1","1","E"]
[null,"00147","Anesth iridectomy","1","1","E"]
[null,"00148","Anesth eye exam","1","1","E"]
[null,"00160","Anesth nose/sinus surgery","1","1","E"]
[null,"00162","Anesth nose/sinus surgery","1","1","E"]
[null,"00164","Anesth biopsy of nose","1","1","E"]
[null,"00170","Anesth procedure on mouth","1","1","E"]
[null,"00172","Anesth cleft palate repair","1","1","E"]
[null,"00174","Anesth pharyngeal surgery","1","1","E"]
[null,"00176","Anesth pharyngeal surgery","1","1","E"]
[null,"00190","Anesth face/skull bone surg","1","1","E"]
["*PA","00192","Anesth facial bone surgery","1","1","E",null,"*PA required if for Transhealth"]
[null,"00210","Anesth cranial surg nos","1","1","E"]
[null,"00211","Anesth cran surg hemotoma","1","1","E"]
[null,"00212","Anesth skull drainage","1","1","E"]
[null,"00214","Anesth skull drainage","1","1","E"]
[null,"00215","Anesth skull repair/fract","1","1","E"]
[null,"00216","Anesth head vessel surgery","1","1","E"]
[null,"00218","Anesth special head surgery","1","1","E"]
[null,"00220","Anesth intrcrn nerve","1","1","E"]
[null,"00222","Anesth head nerve surgery","1","1","E"]
[null,"00300","Anesth head/neck/ptrunk","1","1","E"]
[null,"00320","Anesth neck organ 1yr/>","1","1","E"]
[null,"00322","Anesth biopsy of thyroid","1","1","E"]
[null,"00326","Anesth larynx/trach < 1 yr","1","1","E"]
[null,"00350","Anesth neck vessel surgery","1","1","E"]
[null,"00352","Anesth neck vessel surgery","1","1","E"]
[null,"00400","Anesth skin ext/per/atrunk","1","1","E"]
[null,"00402","Anesth surgery of breast","1","1","E"]
[null,"00404","Anesth surgery of breast","1","1","E"]
[null,"00406","Anesth surgery of breast","1","1","E"]
[null,"00410","Anesth correct heart rhythm","1","1","E"]
[null,"00450","Anesth surgery of shoulder","1","1","E"]
[null,"00454","Anesth collar bone biopsy","1","1","E"]
[null,"00470","Anesth removal of rib","1","1","E"]
[null,"00472","Anesth chest wall repair","1","1","E"]
[null,"00474","Anesth surgery of rib","1","1","E"]
[null,"00500","Anesth esophageal surgery","1","1","E"]
[null,"00520","Anesth chest procedure","1","1","E"]
[null,"00522","Anesth chest lining biopsy","1","1","E"]
[null,"00524","Anesth chest drainage","1","1","E"]
[null,"00528","Anes mediascpy & dx thorscpy","1","1","E"]
[null,"00529","Anes medscpy&thorscpy 1 lung","1","1","E"]
[null,"00530","Anesth pacemaker insertion","1","1","E"]
[null,"00532","Anesth vascular access","1","1","E"]
[null,"00534","Anesth cardioverter/defib","1","1","E"]
[null,"00537","Anesth cardiac electrophys","1","1","E"]
[null,"00539","Anesth trach-bronch reconst","1","1","E"]
[null,"00540","Anesth chest surgery","1","1","E"]
[null,"00541","Anesth one lung ventilation","1","1","E"]
[null,"00542","Anesth remvl pleura","1","1","E"]
[null,"00546","Anesth lung chest wall surg","1","1","E"]
[null,"00548","Anesth trachea bronchi surg","1","1","E"]
[null,"00550","Anesth sternal debridement","1","1","E"]
[null,"00560","Anesth heart surg w/o pump","1","1","E"]
[null,"00561","Anesth heart surg < 1 yr","1","1","E"]
[null,"00562","Anesth hrt surg w/pmp age 1+","1","1","E"]
[null,"00563","Anesth heart surg w/arrest","1","1","E"]
[null,"00566","Anesth cabg w/o pump","1","1","E"]
[null,"00567","Anesth cabg w/pump","1","1","E"]
[null,"00580","Anesth heart/lung transplnt","1","1","E"]
[null,"00600","Anesth spine cord surgery","1","1","E"]
[null,"00604","Anesth sitting procedure","1","1","E"]
[null,"00620","Anesth spine cord surgery","1","1","E"]
[null,"00625","Anes spine tranthor w/o vent","1","1","E"]
[null,"00626","Anes spine transthor w/vent","1","1","E"]
[null,"00630","Anesth spine cord surgery","1","1","E"]
[null,"00632","Anesth removal of nerves","1","1","E"]
[null,"00635","Anesth lumbar puncture","1","1","E"]
[null,"00640","Anesth spine manipulation","1","1","E"]
[null,"00670","Anesth spine cord surgery","1","1","E"]
[null,"00700","Anesth abdominal wall surg","1","1","E"]
[null,"00702","Anesth for liver biopsy","1","1","E"]
[null,"00730","Anesth abdominal wall surg","1","1","E"]
[null,"00731","Anes upr gi ndsc px nos","1","1","E"]
[null,"00732","Anes upr gi ndsc px ercp","1","1","E"]
[null,"00750","Anesth repair of hernia","1","1","E"]
[null,"00752","Anesth repair of hernia","1","1","E"]
[null,"00754","Anesth repair of hernia","1","1","E"]
[null,"00756","Anesth repair of hernia","1","1","E"]
[null,"00770","Anesth blood vessel repair","1","1","E"]
[null,"00790","Anesth surg upper abdomen","1","1","E"]
[null,"00792","Anesth hemorr/excise liver","1","1","E"]
[null,"00794","Anesth pancreas removal","1","1","E"]
[null,"00796","Anesth for liver transplant","1","1","E"]
["PA","00797","Anesth surgery for obesity","1","1","E",null,"For HCA approved Bariatric Services only"]
[null,"00800","Anesth abdominal wall surg","1","1","E"]
[null,"00802","Anesth fat layer removal","1","1","E"]
[null,"00811","Anes lwr intst ndsc nos","1","1","E"]
[null,"00812","Anes lwr intst scr colsc","1","1","E"]
[null,"00813","Anes upr lwr gi ndsc px","1","1","E"]
[null,"00820","Anesth abdominal wall surg","1","1","E"]
[null,"00830","Anesth repair of hernia","1","1","E"]
[null,"00832","Anesth repair of hernia","1","1","E"]
[null,"00834","Anesth hernia repair < 1 yr","1","1","E"]
[null,"00836","Anesth hernia repair preemie","1","1","E"]
[null,"00840","Anesth surg lower abdomen","1","1","E"]
[null,"00842","Anesth amniocentesis","1","1","E"]
[null,"00844","Anesth pelvis surgery","1","1","E"]
[null,"00846","Anesth hysterectomy","1","1","E"]
[null,"00848","Anesth pelvic organ surg","1","1","E"]
[null,"00851","Anesth tubal ligation","1","1","E"]
[null,"00860","Anesth surgery of abdomen","1","1","E"]
[null,"00862","Anesth kidney/ureter surg","1","1","E"]
[null,"00864","Anesth removal of bladder","1","1","E"]
[null,"00865","Anesth removal of prostate","1","1","E"]
[null,"00866","Anesth removal of adrenal","1","1","E"]
[null,"00868","Anesth kidney transplant","1","1","E"]
[null,"00870","Anesth bladder stone surg","1","1","E"]
[null,"00872","Anesth kidney stone destruct","1","1","E"]
[null,"00873","Anesth kidney stone destruct","1","1","E"]
[null,"00880","Anesth abdomen vessel surg","1","1","E"]
[null,"00882","Anesth major vein ligation","1","1","E"]
[null,"00902","Anesth anorectal surgery","1","1","E"]
[null,"00904","Anesth perineal surgery","1","1","E"]
[null,"00906","Anesth removal of vulva","1","1","E"]
[null,"00908","Anesth removal of prostate","1","1","E"]
[null,"00910","Anesth bladder surgery","1","1","E"]
[null,"00912","Anesth bladder tumor surg","1","1","E"]
[null,"00914","Anesth removal of prostate","1","1","E"]
[null,"00916","Anesth bleeding control","1","1","E"]
[null,"00918","Anesth stone removal","1","1","E"]
[null,"00920","Anesth genitalia surgery","1","1","E"]
[null,"00921","Anesth vasectomy","1","1","E"]
[null,"00922","Anesth sperm duct surgery","1","1","E"]
[null,"00924","Anesth testis exploration","1","1","E"]
[null,"00926","Anesth removal of testis","1","1","E"]
[null,"00928","Anesth removal of testis","1","1","E"]
[null,"00930","Anesth testis suspension","1","1","E"]
[null,"00932","Anesth amputation of penis","1","1","E"]
[null,"00934","Anesth penis nodes removal","1","1","E"]
[null,"00936","Anesth penis nodes removal","1","1","E"]
[null,"00938","Anesth insert penis device","1","1","E"]
[null,"00940","Anesth vaginal procedures","1","1","E"]
[null,"00942","Anesth surg on vag/urethral","1","1","E"]
[null,"00944","Anesth vaginal hysterectomy","1","1","E"]
[null,"00948","Anesth repair of cervix","1","1","E"]
[null,"00950","Anesth vaginal endoscopy","1","1","E"]
[null,"00952","Anesth hysteroscope/graph","1","1","E"]
[null,"01112","Anesth bone aspirate/bx","1","1","E"]
[null,"01120","Anesth pelvis surgery","1","1","E"]
[null,"01130","Anesth body cast procedure","1","1","E"]
[null,"01140","Anesth amputation at pelvis","1","1","E"]
[null,"01150","Anesth pelvic tumor surgery","1","1","E"]
[null,"01160","Anesth pelvis procedure","1","1","E"]
[null,"01170","Anesth pelvis surgery","1","1","E"]
[null,"01173","Anesth fx repair pelvis","1","1","E"]
[null,"01200","Anesth hip joint procedure","1","1","E"]
[null,"01202","Anesth arthroscopy of hip","1","1","E"]
[null,"01210","Anesth hip joint surgery","1","1","E"]
[null,"01212","Anesth hip disarticulation","1","1","E"]
[null,"01214","Anesth hip arthroplasty","1","1","E"]
[null,"01215","Anesth revise hip repair","1","1","E"]
[null,"01220","Anesth procedure on femur","1","1","E"]
[null,"01230","Anesth surgery of femur","1","1","E"]
[null,"01232","Anesth amputation of femur","1","1","E"]
[null,"01234","Anesth radical femur surg","1","1","E"]
[null,"01250","Anesth upper leg surgery","1","1","E"]
[null,"01260","Anesth upper leg veins surg","1","1","E"]
[null,"01270","Anesth thigh arteries surg","1","1","E"]
[null,"01272","Anesth femoral artery surg","1","1","E"]
[null,"01274","Anesth femoral embolectomy","1","1","E"]
[null,"01320","Anesth knee area surgery","1","1","E"]
[null,"01340","Anesth knee area procedure","1","1","E"]
[null,"01360","Anesth knee area surgery","1","1","E"]
[null,"01380","Anesth knee joint procedure","1","1","E"]
[null,"01382","Anesth dx knee arthroscopy","1","1","E"]
[null,"01390","Anesth knee area procedure","1","1","E"]
[null,"01392","Anesth knee area surgery","1","1","E"]
[null,"01400","Anesth knee joint surgery","1","1","E"]
[null,"01402","Anesth knee arthroplasty","1","1","E"]
[null,"01404","Anesth amputation at knee","1","1","E"]
[null,"01420","Anesth knee joint casting","1","1","E"]
[null,"01430","Anesth knee veins surgery","1","1","E"]
[null,"01432","Anesth knee vessel surg","1","1","E"]
[null,"01440","Anesth knee arteries surg","1","1","E"]
[null,"01442","Anesth knee artery surg","1","1","E"]
[null,"01444","Anesth knee artery repair","1","1","E"]
[null,"01462","Anesth lower leg procedure","1","1","E"]
[null,"01464","Anesth ankle/ft arthroscopy","1","1","E"]
[null,"01470","Anesth lower leg surgery","1","1","E"]
[null,"01472","Anesth achilles tendon surg","1","1","E"]
[null,"01474","Anesth lower leg surgery","1","1","E"]
[null,"01480","Anesth lower leg bone surg","1","1","E"]
[null,"01482","Anesth radical leg surgery","1","1","E"]
[null,"01484","Anesth lower leg revision","1","1","E"]
[null,"01486","Anesth ankle replacement","1","1","E"]
[null,"01490","Anesth lower leg casting","1","1","E"]
[null,"01500","Anesth leg arteries surg","1","1","E"]
[null,"01502","Anesth lwr leg embolectomy","1","1","E"]
[null,"01520","Anesth lower leg vein surg","1","1","E"]
[null,"01522","Anesth lower leg vein surg","1","1","E"]
[null,"01610","Anesth surgery of shoulder","1","1","E"]
[null,"01620","Anesth shoulder procedure","1","1","E"]
[null,"01622","Anes dx shoulder arthroscopy","1","1","E"]
[null,"01630","Anesth surgery of shoulder","1","1","E"]
[null,"01634","Anesth shoulder joint amput","1","1","E"]
[null,"01636","Anesth forequarter amput","1","1","E"]
[null,"01638","Anesth shoulder replacement","1","1","E"]
[null,"01650","Anesth shoulder artery surg","1","1","E"]
[null,"01652","Anesth shoulder vessel surg","1","1","E"]
[null,"01654","Anesth shoulder vessel surg","1","1","E"]
[null,"01656","Anesth arm-leg vessel surg","1","1","E"]
[null,"01670","Anesth shoulder vein surg","1","1","E"]
[null,"01680","Anesth shoulder casting","1","1","E"]
[null,"01710","Anesth elbow area surgery","1","1","E"]
[null,"01712","Anesth uppr arm tendon surg","1","1","E"]
[null,"01714","Anesth uppr arm tendon surg","1","1","E"]
[null,"01716","Anesth biceps tendon repair","1","1","E"]
[null,"01730","Anesth uppr arm procedure","1","1","E"]
[null,"01732","Anesth dx elbow arthroscopy","1","1","E"]
[null,"01740","Anesth upper arm surgery","1","1","E"]
[null,"01742","Anesth humerus surgery","1","1","E"]
[null,"01744","Anesth humerus repair","1","1","E"]
[null,"01756","Anesth radical humerus surg","1","1","E"]
[null,"01758","Anesth humeral lesion surg","1","1","E"]
[null,"01760","Anesth elbow replacement","1","1","E"]
[null,"01770","Anesth uppr arm artery surg","1","1","E"]
[null,"01772","Anesth uppr arm embolectomy","1","1","E"]
[null,"01780","Anesth upper arm vein surg","1","1","E"]
[null,"01782","Anesth uppr arm vein repair","1","1","E"]
[null,"01810","Anesth lower arm surgery","1","1","E"]
[null,"01820","Anesth lower arm procedure","1","1","E"]
[null,"01829","Anesth dx wrist arthroscopy","1","1","E"]
[null,"01830","Anesth lower arm surgery","1","1","E"]
[null,"01832","Anesth wrist replacement","1","1","E"]
[null,"01840","Anesth lwr arm artery surg","1","1","E"]
[null,"01842","Anesth lwr arm embolectomy","1","1","E"]
[null,"01844","Anesth vascular shunt surg","1","1","E"]
[null,"01850","Anesth lower arm vein surg","1","1","E"]
[null,"01852","Anesth lwr arm vein repair","1","1","E"]
[null,"01860","Anesth lower arm casting","1","1","E"]
[null,"01916","Anesth dx arteriography","1","1","E"]
[null,"01920","Anesth catheterize heart","1","1","E"]
["L","01922","Anesth cat or mri scan","1","1","E"]
[null,"01924","Anes ther interven rad art","1","1","E"]
[null,"01925","Anes ther interven rad car","1","1","E"]
[null,"01926","Anes tx interv rad hrt/cran","1","1","E"]
[null,"01930","Anes ther interven rad vei","1","1","E"]
[null,"01931","Anes ther interven rad tip","1","1","E"]
[null,"01932","Anes tx interv rad th vein","1","1","E"]
[null,"01933","Anes tx interv rad cran vein","1","1","E"]
[null,"01937","Anes drg/aspir crv/thrc","0","0"]
[null,"01938","Anes drg/aspir lmbr/sac","1","1","E"]
[null,"01939","Anes nulyt agt crv/thrc","1","1","E"]
[null,"01940","Anes nulyt agt lmbr/sac","1","1","E"]
[null,"01941","Anes neuromd/ntrvrt crv/thrc","1","1","E"]
[null,"01942","Anes neuromd/ntrvrt lmbr/sac","1","1","E"]
[null,"01951","Anesth burn less 4 percent","1","1","E"]
[null,"01952","Anesth burn 4-9 percent","1","1","E"]
[null,"01953","Anesth burn each 9 percent","1","1","E"]
[null,"01958","Anesth antepartum manipul","1","1","E"]
[null,"01960","Anesth vaginal delivery","1","1","E"]
[null,"01961","Anesth cs delivery","1","1","E"]
[null,"01962","Anesth emer hysterectomy","1","1","E"]
[null,"01963","Anesth cs hysterectomy","1","1","E"]
[null,"01965","Anesth inc/missed ab proc","1","1","E"]
[null,"01966","Anesth induced ab procedure","1","1","E"]
[null,"01967","Anesth/analg vag delivery","1","1","E"]
[null,"01968","Anes/analg cs deliver add-on","1","1","E"]
[null,"01969","Anesth/analg cs hyst add-on","1","1","E"]
[null,"01990","Support for organ donor","0","0"]
[null,"01991","Anesth nerve block/inj","1","1","E"]
[null,"01992","Anesth n block/inj prone","1","1","E"]
[null,"01996","Hosp manage cont drug admin","1","1","E"]
[null,"01999","Unlisted anesth procedure","1","1","E"]
[null,"10004","Fna bx w/o img gdn ea addl","1","1","E"]
[null,"10005","Fna bx w/us gdn 1st les","1","1","E"]
[null,"10006","Fna bx w/us gdn ea addl","1","1","E"]
[null,"10007","Fna bx w/fluor gdn 1st les","1","1","E"]
[null,"10008","Fna bx w/fluor gdn ea addl","1","1","E"]
[null,"10009","Fna bx w/ct gdn 1st les","1","1","E"]
[null,"10010","Fna bx w/ct gdn ea addl","1","1","E"]
[null,"10011","Fna bx w/mr gdn 1st les","1","1","E"]
[null,"10012","Fna bx w/mr gdn ea addl","1","1","E"]
[null,"10021","Fna w/o image","1","1","E"]
[null,"10022","Fna w/image","0","0"]
[null,"10030","Guide cathet fluid drainage","1","1","E"]
[null,"10035","Perq dev soft tiss 1st imag","1","1","E"]
[null,"10036","Perq dev soft tiss add imag","1","1","E"]
[null,"10040","Acne surgery","1","1","E"]
[null,"10060","Drainage of skin abscess","1","1","E"]
[null,"10061","Drainage of skin abscess","1","1","E"]
[null,"10080","Drainage of pilonidal cyst","1","1","E"]
[null,"10081","Drainage of pilonidal cyst","1","1","E"]
[null,"10120","Remove foreign body","1","1","E"]
[null,"10121","Remove foreign body","1","1","E"]
[null,"10140","Drainage of hematoma/fluid","1","1","E"]
[null,"10160","Puncture drainage of lesion","1","1","E"]
[null,"10180","Complex drainage wound","1","1","E"]
[null,"11000","Debride infected skin","1","1","E"]
[null,"11001","Debride infected skin add-on","1","1","E"]
[null,"11010","Debride skin at fx site","1","1","E"]
[null,"11011","Debride skin musc at fx site","1","1","E"]
[null,"11012","Deb skin bone at fx site","1","1","E"]
[null,"11042","Deb subq tissue 20 sq cm/<","1","1","E"]
[null,"11043","Deb musc/fascia 20 sq cm/<","1","1","E"]
[null,"11044","Deb bone 20 sq cm/<","1","1","E"]
[null,"11045","Deb subq tissue add-on","1","1","E"]
[null,"11046","Deb musc/fascia add-on","1","1","E"]
[null,"11047","Deb bone add-on","1","1","E"]
[null,"11055","Trim skin lesion","1","1","E"]
[null,"11056","Trim skin lesions 2 to 4","1","1","E"]
[null,"11057","Trim skin lesions over 4","1","1","E"]
[null,"11100","Biopsy skin lesion","0","0"]
[null,"11101","Biopsy skin add-on","0","0"]
[null,"11102","Tangntl bx skin single les","1","1","E"]
[null,"11103","Tangntl bx skin ea sep/addl","1","1","E"]
[null,"11104","Punch bx skin single lesion","1","1","E"]
[null,"11105","Punch bx skin ea sep/addl","1","1","E"]
[null,"11106","Incal bx skn single les","1","1","E"]
[null,"11107","Incal bx skn ea sep/addl","1","1","E"]
[null,"11200","Removal of skin tags","0","0"]
[null,"11201","Remove skin tags add-on","0","0"]
[null,"11300","Shave skin lesion","1","1","E"]
[null,"11301","Shave skin lesion","1","1","E"]
[null,"11302","Shave skin lesion","1","1","E"]
[null,"11303","Shave skin lesion","1","1","E"]
[null,"11305","Shave skin lesion","1","1","E"]
[null,"11306","Shave skin lesion","1","1","E"]
[null,"11307","Shave skin lesion","1","1","E"]
[null,"11308","Shave skin lesion","1","1","E"]
[null,"11310","Shave skin lesion","1","1","E"]
[null,"11311","Shave skin lesion","1","1","E"]
[null,"11312","Shave skin lesion","1","1","E"]
[null,"11313","Shave skin lesion","1","1","E"]
[null,"11400","Exc tr-ext b9+marg 0.5 < cm","1","1","E"]
[null,"11401","Exc tr-ext b9+marg 0.6-1 cm","1","1","E"]
[null,"11402","Exc tr-ext b9+marg 1.1-2 cm","1","1","E"]
[null,"11403","Exc tr-ext b9+marg 2.1-3 cm","1","1","E"]
[null,"11404","Exc tr-ext b9+marg 3.1-4 cm","1","1","E"]
["*PA","11406","Exc tr-ext b9+marg > 4.0 cm","1","1","E",null,"*PA required if for Transhealth"]
[null,"11420","Exc h-f-nk-sp b9+marg 0.5 <","1","1","E"]
[null,"11421","Exc h-f-nk-sp b9+marg 0.6-1","1","1","E"]
[null,"11422","Exc h-f-nk-sp b9+marg 1.1-2","1","1","E"]
[null,"11423","Exc h-f-nk-sp b9+marg 2.1-3","1","1","E"]
[null,"11424","Exc h-f-nk-sp b9+marg 3.1-4","1","1","E"]
[null,"11426","Exc h-f-nk-sp b9+marg > 4 cm","1","1","E"]
[null,"11440","Exc face-mm b9+marg 0.5 < cm","1","1","E"]
[null,"11441","Exc face-mm b9+marg 0.6-1 cm","1","1","E"]
[null,"11442","Exc face-mm b9+marg 1.1-2 cm","1","1","E"]
[null,"11443","Exc face-mm b9+marg 2.1-3 cm","1","1","E"]
[null,"11444","Exc face-mm b9+marg 3.1-4 cm","1","1","E"]
[null,"11446","Exc face-mm b9+marg > 4 cm","1","1","E"]
[null,"11450","Removal sweat gland lesion","1","1","E"]
[null,"11451","Removal sweat gland lesion","1","1","E"]
[null,"11462","Removal sweat gland lesion","1","1","E"]
[null,"11463","Removal sweat gland lesion","1","1","E"]
[null,"11470","Removal sweat gland lesion","1","1","E"]
[null,"11471","Removal sweat gland lesion","1","1","E"]
[null,"11600","Exc tr-ext mal+marg 0.5 < cm","1","1","E"]
[null,"11601","Exc tr-ext mal+marg 0.6-1 cm","1","1","E"]
[null,"11602","Exc tr-ext mal+marg 1.1-2 cm","1","1","E"]
[null,"11603","Exc tr-ext mal+marg 2.1-3 cm","1","1","E"]
[null,"11604","Exc tr-ext mal+marg 3.1-4 cm","1","1","E"]
[null,"11606","Exc tr-ext mal+marg > 4 cm","1","1","E"]
[null,"11620","Exc h-f-nk-sp mal+marg 0.5 <","1","1","E"]
[null,"11621","Exc s/n/h/f/g mal+mrg 0.6-1","1","1","E"]
[null,"11622","Exc s/n/h/f/g mal+mrg 1.1-2","1","1","E"]
[null,"11623","Exc s/n/h/f/g mal+mrg 2.1-3","1","1","E"]
[null,"11624","Exc s/n/h/f/g mal+mrg 3.1-4","1","1","E"]
[null,"11626","Exc s/n/h/f/g mal+mrg > 4 cm","1","1","E"]
[null,"11640","Exc f/e/e/n/l mal+mrg 0.5cm<","1","1","E"]
[null,"11641","Exc f/e/e/n/l mal+mrg 0.6-1","1","1","E"]
[null,"11642","Exc f/e/e/n/l mal+mrg 1.1-2","1","1","E"]
[null,"11643","Exc f/e/e/n/l mal+mrg 2.1-3","1","1","E"]
[null,"11644","Exc f/e/e/n/l mal+mrg 3.1-4","1","1","E"]
[null,"11646","Exc f/e/e/n/l mal+mrg > 4 cm","1","1","E"]
[null,"11719","Trim nail(s)","1","1","E"]
[null,"11720","Debride nail 1-5","1","1","E"]
[null,"11721","Debride nail 6 or more","1","1","E"]
[null,"11730","Removal of nail plate","1","1","E"]
[null,"11732","Remove nail plate add-on","1","1","E"]
[null,"11740","Drain blood from under nail","1","1","E"]
[null,"11750","Removal of nail bed","1","1","E"]
[null,"11755","Biopsy nail unit","1","1","E"]
[null,"11760","Repair of nail bed","1","1","E"]
[null,"11762","Reconstruction of nail bed","1","1","E"]
[null,"11765","Excision of nail fold toe","1","1","E"]
[null,"11770","Removal of pilonidal lesion","1","1","E"]
[null,"11771","Removal of pilonidal lesion","1","1","E"]
[null,"11772","Removal of pilonidal lesion","1","1","E"]
[null,"11900","Injection into skin lesions","1","1","E"]
[null,"11901","Added skin lesions injection","1","1","E"]
["L","11920","Correct skin color defects","1","1","E"]
["L","11921","Correct skin color defects","1","1","E"]
[null,"11922","Correct skin color defects","0","0"]
[null,"11950","Therapy for contour defects","0","0"]
[null,"11951","Therapy for contour defects","0","0"]
[null,"11952","Therapy for contour defects","0","0"]
[null,"11954","Therapy for contour defects","0","0"]
["L","11960","Insert tissue expander(s)","1","1","E"]
["L","11970","Replace tissue expander","1","1","E"]
["L","11971","Remove tissue expander(s)","1","1","E"]
[null,"11976","Removal of contraceptive cap","1","1","E"]
["L","11980","Implant hormone pellet(s)","1","1","E"]
["L","11981","Insert drug implant device","1","1","E"]
["L","11982","Remove drug implant device","1","1","E"]
["L","11983","Remove/insert drug implant","1","1","E"]
[null,"12001","Repair superficial wound(s)","1","1","E"]
[null,"12002","Repair superficial wound(s)","1","1","E"]
[null,"12004","Repair superficial wound(s)","1","1","E"]
[null,"12005","Repair superficial wound(s)","1","1","E"]
[null,"12006","Repair superficial wound(s)","1","1","E"]
[null,"12007","Repair superficial wound(s)","1","1","E"]
[null,"12011","Repair superficial wound(s)","1","1","E"]
[null,"12013","Repair superficial wound(s)","1","1","E"]
[null,"12014","Repair superficial wound(s)","1","1","E"]
[null,"12015","Repair superficial wound(s)","1","1","E"]
[null,"12016","Repair superficial wound(s)","1","1","E"]
[null,"12017","Repair superficial wound(s)","1","1","E"]
[null,"12018","Repair superficial wound(s)","1","1","E"]
[null,"12020","Closure of split wound","1","1","E"]
[null,"12021","Closure of split wound","1","1","E"]
[null,"12031","Intmd wnd repair s/a/t/ext","1","1","E"]
[null,"12032","Intmd wnd repair s/a/t/ext","1","1","E"]
[null,"12034","Intmd wnd repair s/tr/ext","1","1","E"]
[null,"12035","Intmd wnd repair s/a/t/ext","1","1","E"]
[null,"12036","Intmd wnd repair s/a/t/ext","1","1","E"]
[null,"12037","Intmd wnd repair s/tr/ext","1","1","E"]
[null,"12041","Intmd wnd repair n-hf/genit","1","1","E"]
[null,"12042","Intmd wnd repair n-hf/genit","1","1","E"]
[null,"12044","Intmd wnd repair n-hf/genit","1","1","E"]
[null,"12045","Intmd wnd repair n-hf/genit","1","1","E"]
[null,"12046","Intmd wnd repair n-hf/genit","1","1","E"]
[null,"12047","Intmd wnd repair n-hf/genit","1","1","E"]
[null,"12051","Intmd wnd repair face/mm","1","1","E"]
[null,"12052","Intmd wnd repair face/mm","1","1","E"]
[null,"12053","Intmd wnd repair face/mm","1","1","E"]
[null,"12054","Intmd wnd repair face/mm","1","1","E"]
[null,"12055","Intmd wnd repair face/mm","1","1","E"]
[null,"12056","Intmd wnd repair face/mm","1","1","E"]
[null,"12057","Intmd wnd repair face/mm","1","1","E"]
["*PA","13100","Repair of wound or lesion","1","1","E",null,"*PA required if for Transhealth, per policy eff 01/01/2023"]
["*PA","13101","Repair of wound or lesion","1","1","E",null,"*PA required if for Transhealth, per policy eff 01/01/2023"]
["*PA","13102","Repair wound/lesion add-on","1","1","E",null,"*PA required if for Transhealth, per policy eff 01/01/2023"]
[null,"13120","Repair of wound or lesion","1","1","E"]
[null,"13121","Repair of wound or lesion","1","1","E"]
[null,"13122","Repair wound/lesion add-on","1","1","E"]
[null,"13131","Repair of wound or lesion","1","1","E"]
["*PA","13132","Repair of wound or lesion","1","1","E",null,"*PA required if for Transhealth, per policy eff 11/01/2021"]
["*PA","13133","Repair wound/lesion add-on","1","1","E",null,"*PA required if for Transhealth, per policy eff 11/01/2021"]
[null,"13151","Repair of wound or lesion","1","1","E"]
[null,"13152","Repair of wound or lesion","1","1","E"]
[null,"13153","Repair wound/lesion add-on","1","1","E"]
[null,"13160","Late closure of wound","1","1","E"]
[null,"14000","Skin tissue rearrangement","1","1","E"]
[null,"14001","Skin tissue rearrangement","1","1","E"]
[null,"14020","Skin tissue rearrangement","1","1","E"]
[null,"14021","Skin tissue rearrangement","1","1","E"]
[null,"14040","Skin tissue rearrangement","1","1","E"]
["*PA","14041","Skin tissue rearrangement","1","1","E",null,"*PA required if for Transhealth, per policy eff 11/01/2021"]
[null,"14060","Skin tissue rearrangement","1","1","E"]
[null,"14061","Skin tissue rearrangement","1","1","E"]
[null,"14301","Skin tissue rearrangement","1","1","E"]
[null,"14302","Skin tissue rearrange add-on","1","1","E"]
[null,"14350","Skin tissue rearrangement","1","1","E"]
[null,"15002","Wound prep trk/arm/leg","1","1","E"]
[null,"15003","Wound prep addl 100 cm","1","1","E"]
[null,"15004","Wound prep f/n/hf/g","1","1","E"]
[null,"15005","Wnd prep f/n/hf/g addl cm","1","1","E"]
[null,"15011","HRV SKN CLL SSP AGRFT 1ST 25","0","0"]
[null,"15012","HRV SKN CLL SSP AGRFT EA ADD","0","0"]
[null,"15013","PREPJ SKN CLL SSP AGRFT 1ST","0","0"]
[null,"15014","PREPJ SKN CLL SSP AGRFT EA","0","0"]
[null,"15015","APP SKN CL SSP AGRFT T/A/L 1","0","0"]
[null,"15016","APP SKN CL SSP AGRF T/A/L EA","0","0"]
[null,"15017","APP SKN CLL SSP F/N/G/HF 1ST","0","0"]
[null,"15018","APP SKN CLL SSP F/N/G/HF EA","0","0"]
[null,"15040","Harvest cultured skin graft","1","1","E"]
[null,"15050","Skin pinch graft","1","1","E"]
["*PA","15100","Skin splt grft trnk/arm/leg","1","1","E",null,"*PA required if for Transhealth"]
["*PA","15101","Skin splt grft t/a/l add-on","1","1","E",null,"*PA required if for Transhealth"]
[null,"15110","Epidrm autogrft trnk/arm/leg","1","1","E"]
[null,"15111","Epidrm autogrft t/a/l add-on","1","1","E"]
[null,"15115","Epidrm a-grft face/nck/hf/g","1","1","E"]
[null,"15116","Epidrm a-grft f/n/hf/g addl","1","1","E"]
[null,"15120","Skn splt a-grft fac/nck/hf/g","1","1","E"]
[null,"15121","Skn splt a-grft f/n/hf/g add","1","1","E"]
[null,"15130","Derm autograft trnk/arm/leg","1","1","E"]
[null,"15131","Derm autograft t/a/l add-on","1","1","E"]
[null,"15135","Derm autograft face/nck/hf/g","1","1","E"]
[null,"15136","Derm autograft f/n/hf/g add","1","1","E"]
[null,"15150","Cult skin grft t/arm/leg","1","1","E"]
[null,"15151","Cult skin grft t/a/l addl","1","1","E"]
[null,"15152","Cult skin graft t/a/l +%","1","1","E"]
[null,"15155","Cult skin graft f/n/hf/g","1","1","E"]
[null,"15156","Cult skin grft f/n/hfg add","1","1","E"]
[null,"15157","Cult epiderm grft f/n/hfg +%","1","1","E"]
[null,"15200","Skin full graft trunk","1","1","E"]
[null,"15201","Skin full graft trunk add-on","1","1","E"]
[null,"15220","Skin full graft sclp/arm/leg","1","1","E"]
[null,"15221","Skin full graft add-on","1","1","E"]
[null,"15240","Skin full grft face/genit/hf","1","1","E"]
[null,"15241","Skin full graft add-on","1","1","E"]
[null,"15260","Skin full graft een & lips","1","1","E"]
[null,"15261","Skin full graft add-on","1","1","E"]
["*PA","15271","Skin sub graft trnk/arm/leg","1","1","E",null,"*PA required if for Transhealth"]
[null,"15272","Skin sub graft t/a/l add-on","1","1","E"]
["*PA","15273","Skin sub grft t/arm/lg child","1","1","E",null,"*PA required if for Transhealth"]
["*PA","15274","Skn sub grft t/a/l child add","1","1","E",null,"*PA required if for Transhealth"]
[null,"15275","Skin sub graft face/nk/hf/g","1","1","E"]
[null,"15276","Skin sub graft f/n/hf/g addl","1","1","E"]
[null,"15277","Skn sub grft f/n/hf/g child","1","1","E"]
[null,"15278","Skn sub grft f/n/hf/g ch add","1","1","E"]
[null,"15570","Form skin pedicle flap","1","1","E"]
[null,"15572","Form skin pedicle flap","1","1","E"]
[null,"15574","Form skin pedicle flap","1","1","E"]
[null,"15576","Form skin pedicle flap","1","1","E"]
[null,"15600","Skin graft","1","1","E"]
[null,"15610","Skin graft","1","1","E"]
[null,"15620","Skin graft","1","1","E"]
[null,"15630","Skin graft","1","1","E"]
[null,"15650","Transfer skin pedicle flap","1","1","E"]
[null,"15730","Mdfc flap w/prsrv vasc pedcl","1","1","E"]
[null,"15731","Forehead flap w/vasc pedicle","1","1","E"]
["*PA","15733","Musc myoq/fscq flp h&n pedcl","1","1","E",null,"*PA required if for Transhealth"]
["*PA","15734","Muscle-skin graft trunk","1","1","E",null,"*PA required if for Transhealth"]
[null,"15736","Muscle-skin graft arm","1","1","E"]
[null,"15738","Muscle-skin graft leg","1","1","E"]
[null,"15740","Island pedicle flap graft","1","1","E"]
["*PA","15750","Neurovascular pedicle graft","1","1","E",null,"*PA required if for Transhealth"]
[null,"15760","Composite skin graft","1","1","E"]
[null,"15769","Grfg autol soft tiss dir exc","1","1","E"]
[null,"15770","Derma-fat-fascia graft","1","1","E"]
["*PA","15771","Grfg autol fat lipo 50 cc/<","1","1","E",null,"*PA required if for Transhealth"]
["*PA","15772","Grfg autol fat lipo ea addl","1","1","E",null,"*PA required if for Transhealth"]
[null,"15773","Grfg autol fat lipo 25 cc/<","1","1","E"]
[null,"15774","Gfrg autol fat lipo ea addl","1","1","E"]
[null,"15775","Hair transplant punch grafts","0","0"]
[null,"15776","Hair transplant punch grafts","0","0"]
["PA","15777","Acellular derm matrix implt","1","1","E"]
[null,"15778","Impl absrb msh/prsth dly cls","0","0"]
[null,"15780","Abrasion treatment of skin","1","1","E"]
[null,"15781","Abrasion treatment of skin","1","1","E"]
[null,"15782","Abrasion treatment of skin","1","1","E"]
[null,"15783","Abrasion treatment of skin","1","1","E"]
[null,"15786","Abrasion lesion single","1","1","E"]
[null,"15787","Abrasion lesions add-on","1","1","E"]
[null,"15788","Chemical peel face epiderm","1","1","E"]
[null,"15789","Chemical peel face dermal","1","1","E"]
[null,"15792","Chemical peel nonfacial","1","1","E"]
[null,"15793","Chemical peel nonfacial","1","1","E"]
[null,"15819","PLASTIC SURGERY NECK","0","0"]
[null,"15820","Revision of lower eyelid","0","0"]
[null,"15821","Revision of lower eyelid","0","0"]
["EPA/PA","15822","Revision of upper eyelid","1","1","E"]
["EPA/PA","15823","Revision of upper eyelid","1","1","E"]
["PA","15824","Removal of forehead wrinkles","1","1","E",null,"*Covered only for Transhealth / PA required"]
[null,"15825","Removal of neck wrinkles","0","0"]
[null,"15826","Removal of brow wrinkles","0","0"]
["*PA","15828","Removal of face wrinkles","1","1","E",null,"*PA required if for Transhealth"]
["*PA","15829","Removal of skin wrinkles","1","1","E",null,"*PA required if for Transhealth,EFF 03/01/2023"]
["PA","15830","Exc skin abd","1","1","E"]
[null,"15832","Excise excessive skin tissue","0","0"]
[null,"15833","Excise excessive skin tissue","0","0"]
[null,"15834","Excise excessive skin tissue","0","0"]
[null,"15835","Excise excessive skin tissue","0","0"]
[null,"15836","Excise excessive skin tissue","0","0"]
[null,"15837","Excise excessive skin tissue","0","0"]
[null,"15838","Excise excessive skin tissue","0","0"]
["*PA","15839","Excise excessive skin tissue","1","1","E",null,"*PA required if for Transhealth"]
[null,"15840","Graft for face nerve palsy","1","1","E"]
[null,"15841","Graft for face nerve palsy","1","1","E"]
[null,"15842","Flap for face nerve palsy","1","1","E"]
[null,"15845","Skin and muscle repair face","1","1","E"]
[null,"15847","Exc skin abd add-on","0","0"]
[null,"15851","Removal of sutures","1","1","E"]
[null,"15852","Dressing change not for burn","1","1","E"]
[null,"15853","Removal sutr/stapl xreq anes","1","1","E"]
[null,"15854","Removal sutr&stapl xreq anes","1","1","E"]
[null,"15860","Test for blood flow in graft","1","1","E"]
["*PA","15876","Suction assisted lipectomy","1","1","E",null,"*PA required if for Transhealth"]
[null,"15877","Suction assisted lipectomy","0","0"]
[null,"15878","Suction assisted lipectomy","0","0"]
["*PA","15879","Suction assisted lipectomy","1","1","E",null,"*PA required if for Transhealth"]
[null,"15920","Removal of tail bone ulcer","1","1","E"]
[null,"15922","Removal of tail bone ulcer","1","1","E"]
[null,"15931","Remove sacrum pressure sore","1","1","E"]
[null,"15933","Remove sacrum pressure sore","1","1","E"]
[null,"15934","Remove sacrum pressure sore","1","1","E"]
[null,"15935","Remove sacrum pressure sore","1","1","E"]
[null,"15936","Remove sacrum pressure sore","1","1","E"]
[null,"15937","Remove sacrum pressure sore","1","1","E"]
[null,"15940","Remove hip pressure sore","1","1","E"]
[null,"15941","Remove hip pressure sore","1","1","E"]
[null,"15944","Remove hip pressure sore","1","1","E"]
[null,"15945","Remove hip pressure sore","1","1","E"]
[null,"15946","Remove hip pressure sore","1","1","E"]
[null,"15950","Remove thigh pressure sore","1","1","E"]
[null,"15951","Remove thigh pressure sore","1","1","E"]
[null,"15952","Remove thigh pressure sore","1","1","E"]
[null,"15953","Remove thigh pressure sore","1","1","E"]
[null,"15956","Remove thigh pressure sore","1","1","E"]
[null,"15958","Remove thigh pressure sore","1","1","E"]
[null,"15999","Removal of pressure sore","1","1","E"]
[null,"16000","Initial treatment of burn(s)","1","1","E"]
[null,"16020","Dress/debrid p-thick burn s","1","1","E"]
[null,"16025","Dress/debrid p-thick burn m","1","1","E"]
[null,"16030","Dress/debrid p-thick burn l","1","1","E"]
[null,"16035","Incision of burn scab initi","1","1","E"]
[null,"17000","Destruct premalg lesion","1","1","E"]
[null,"17003","Destruct premalg les 2-14","1","1","E"]
[null,"17004","Destroy premal lesions 15/>","1","1","E"]
[null,"17106","Destruction of skin lesions","1","1","E"]
[null,"17107","Destruction of skin lesions","1","1","E"]
[null,"17108","Destruction of skin lesions","1","1","E"]
[null,"17110","Destruct b9 lesion 1-14","1","1","E"]
[null,"17111","Destruct lesion 15 or more","1","1","E"]
[null,"17250","Chemical cautery tissue","1","1","E"]
[null,"17260","Destruction of skin lesions","1","1","E"]
[null,"17261","Destruction of skin lesions","1","1","E"]
[null,"17262","Destruction of skin lesions","1","1","E"]
[null,"17263","Destruction of skin lesions","1","1","E"]
[null,"17264","Destruction of skin lesions","1","1","E"]
[null,"17266","Destruction of skin lesions","1","1","E"]
[null,"17270","Destruction of skin lesions","1","1","E"]
[null,"17271","Destruction of skin lesions","1","1","E"]
[null,"17272","Destruction of skin lesions","1","1","E"]
[null,"17273","Destruction of skin lesions","1","1","E"]
[null,"17274","Destruction of skin lesions","1","1","E"]
[null,"17276","Destruction of skin lesions","1","1","E"]
[null,"17280","Destruction of skin lesions","1","1","E"]
[null,"17281","Destruction of skin lesions","1","1","E"]
[null,"17282","Destruction of skin lesions","1","1","E"]
[null,"17283","Destruction of skin lesions","1","1","E"]
[null,"17284","Destruction of skin lesions","1","1","E"]
[null,"17286","Destruction of skin lesions","1","1","E"]
[null,"17311","Mohs 1 stage h/n/hf/g","1","1","E"]
[null,"17312","Mohs addl stage","1","1","E"]
[null,"17313","Mohs 1 stage t/a/l","1","1","E"]
[null,"17314","Mohs addl stage t/a/l","1","1","E"]
[null,"17315","Mohs surg addl block","1","1","E"]
[null,"17340","Cryotherapy of skin","1","1","E"]
[null,"17360","Skin peel therapy","0","0"]
["*PA","17380","Hair removal by electrolysis","1","1","E",null,"*Covered only for Transhealth / PA required"]
["PA","17999","Skin tissue procedure","1","1","E"]
[null,"19000","Drainage of breast lesion","1","1","E"]
[null,"19001","Drain breast lesion add-on","1","1","E"]
[null,"19020","Incision of breast lesion","1","1","E"]
[null,"19030","Injection for breast x-ray","1","1","E"]
[null,"19081","Bx breast 1st lesion strtctc","1","1","E"]
[null,"19082","Bx breast add lesion strtctc","1","1","E"]
[null,"19083","Bx breast 1st lesion us imag","1","1","E"]
[null,"19084","Bx breast add lesion us imag","1","1","E"]
[null,"19085","Bx breast 1st lesion mr imag","1","1","E"]
[null,"19086","Bx breast add lesion mr imag","1","1","E"]
[null,"19100","Bx breast percut w/o image","1","1","E"]
[null,"19101","Biopsy of breast open","1","1","E"]
[null,"19105","Cryosurg ablate fa each","0","0"]
[null,"19110","Nipple exploration","1","1","E"]
[null,"19112","Excise breast duct fistula","1","1","E"]
["*PA","19120","Removal of breast lesion","1","1","E",null,"*PA required if for Transhealth"]
[null,"19125","Excision breast lesion","1","1","E"]
[null,"19126","Excision addl breast lesion","1","1","E"]
[null,"19281","Perq device breast 1st imag","1","1","E"]
[null,"19282","Perq device breast ea imag","1","1","E"]
[null,"19283","Perq dev breast 1st strtctc","1","1","E"]
[null,"19284","Perq dev breast add strtctc","1","1","E"]
[null,"19285","Perq dev breast 1st us imag","1","1","E"]
[null,"19286","Perq dev breast add us imag","1","1","E"]
["PA","19287","Perq dev breast 1st mr guide","1","1","E"]
["PA","19288","Perq dev breast add mr guide","1","1","E"]
[null,"19294","Prep tum cav iort prtl mast","0","0"]
[null,"19296","Place po breast cath for rad","1","1","E"]
[null,"19297","Place breast cath for rad","1","1","E"]
[null,"19298","Place breast rad tube/caths","1","1","E"]
["EPA","19300","Removal of breast tissue","1","1","E"]
["L","19301","Partial mastectomy","1","1","E"]
["L","19302","P-mastectomy w/ln removal","1","1","E"]
["L/PA*","19303","Mast simple complete","1","1","E",null,"*PA required if for Transhealth"]
[null,"19305","Mast radical","0","0"]
[null,"19306","Mast rad urban type","0","0"]
[null,"19307","Mast mod rad","1","1","E"]
["*PA","19316","Suspension of breast","1","1","E",null,"*PA required if for Transhealth"]
["EPA","19318","Reduction of large breast","1","1","E"]
["*PA","19325","Enlarge breast with implant","1","1","E",null,"*Covered only for Transhealth / PA required"]
["L","19328","Removal of breast implant","1","1","E"]
["L","19330","Removal of implant material","1","1","E"]
["L/PA*","19340","Immediate breast prosthesis","1","1","E",null,"*PA required if for Transhealth"]
["*PA","19342","Delayed breast prosthesis","1","1","E",null,"*PA required if for Transhealth"]
["L/PA*","19350","Breast reconstruction","1","1","E",null,"*PA required if for Transhealth"]
["*PA","19355","Correct inverted nipple(s)","1","1","E",null,"*PA required if for Transhealth"]
["L/PA*","19357","Breast reconstruction","1","1","E",null,"*PA required if for Transhealth"]
[null,"19361","Breast reconstr w/lat flap","0","0"]
["L/PA*","19364","Breast reconstruction","1","1","E",null,"*PA required if for Transhealth"]
[null,"19368","Breast reconstruction","0","0"]
["L/PA*","19370","Surgery of breast capsule","1","1","E",null,"*PA required if for Transhealth"]
["L/PA*","19371","Removal of breast capsule","1","1","E",null,"*PA required if for Transhealth"]
["*PA","19380","Revise breast reconstruction","1","1","E",null,"*PA required if for Transhealth"]
["*PA","19396","Design custom breast implant","1","1","E",null,"*PA required if for Transhealth"]
[null,"19499","Breast surgery procedure","1","1","E"]
[null,"20005","I&d abscess subfascial","0","0"]
[null,"20100","Explore wound neck","1","1","E"]
[null,"20101","Explore wound chest","1","1","E"]
[null,"20102","Explore wound abdomen","1","1","E"]
[null,"20103","Explore wound extremity","1","1","E"]
[null,"20150","Excise epiphyseal bar","1","1","E"]
[null,"20200","Muscle biopsy","1","1","E"]
[null,"20205","Deep muscle biopsy","1","1","E"]
[null,"20206","Needle biopsy muscle","1","1","E"]
[null,"20220","Bone biopsy trocar/needle","1","1","E"]
[null,"20225","Bone biopsy trocar/needle","1","1","E"]
[null,"20240","Bone biopsy excisional","1","1","E"]
[null,"20245","Bone biopsy excisional","1","1","E"]
[null,"20250","Open bone biopsy","1","1","E"]
[null,"20251","Open bone biopsy","1","1","E"]
[null,"20500","Injection of sinus tract","1","1","E"]
[null,"20501","Inject sinus tract for x-ray","1","1","E"]
[null,"20520","Removal of foreign body","1","1","E"]
[null,"20525","Removal of foreign body","1","1","E"]
[null,"20526","Ther injection carp tunnel","1","1","E"]
[null,"20527","Inj dupuytren cord w/enzyme","1","1","E"]
[null,"20550","Inj tendon sheath/ligament","1","1","E"]
[null,"20551","Inj tendon origin/insertion","1","1","E"]
[null,"20552","Inj trigger point 1/2 muscl","1","1","E"]
[null,"20553","Inject trigger points =/> 3","1","1","E"]
[null,"20555","Place ndl musc/tis for rt","1","1","E"]
[null,"20560","Ndl insj w/o njx 1 or 2 musc","0","0"]
[null,"20561","Ndl insj w/o njx 3+ musc","0","0"]
[null,"20600","Drain/inject joint/bursa","1","1","E"]
[null,"20604","Drain/inj joint/bursa w/us","1","1","E"]
[null,"20605","Drain/inject joint/bursa","1","1","E"]
[null,"20606","Drain/inj joint/bursa w/us","1","1","E"]
[null,"20610","Drain/inject joint/bursa","1","1","E"]
[null,"20611","Drain/inj joint/bursa w/us","1","1","E"]
[null,"20612","Aspirate/inj ganglion cyst","1","1","E"]
[null,"20615","Treatment of bone cyst","1","1","E"]
[null,"20650","Insert and remove bone pin","1","1","E"]
[null,"20660","Apply rem fixation device","1","1","E"]
[null,"20661","Application of head brace","0","0"]
[null,"20662","Application of pelvis brace","1","1","E"]
[null,"20663","Application of thigh brace","1","1","E"]
[null,"20664","Application of halo","1","1","E"]
[null,"20665","Removal of fixation device","1","1","E"]
[null,"20670","Removal of support implant","1","1","E"]
[null,"20680","Removal of support implant","1","1","E"]
[null,"20690","Apply bone fixation device","1","1","E"]
[null,"20692","Apply bone fixation device","1","1","E"]
[null,"20693","Adjust bone fixation device","1","1","E"]
[null,"20694","Remove bone fixation device","1","1","E"]
[null,"20696","Comp multiplane ext fixation","1","1","E"]
[null,"20697","Comp ext fixate strut change","1","1","E"]
[null,"20700","Mnl prep&insj dp rx dlvr dev","0","0"]
[null,"20701","Rmvl deep rx delivery device","0","0"]
[null,"20702","Mnl prep&insj imed rx dev","0","0"]
[null,"20703","Rmvl imed rx delivery device","0","0"]
[null,"20704","Mnl prep&insj i-artic rx dev","0","0"]
[null,"20705","Rmvl i-artic rx delivery dev","0","0"]
[null,"20802","Replantation arm complete","0","0"]
[null,"20805","Replant forearm complete","0","0"]
[null,"20808","Replantation hand complete","0","0"]
[null,"20816","Replantation digit complete","0","0"]
[null,"20822","Replantation digit complete","1","1","E"]
[null,"20824","Replantation thumb complete","0","0"]
[null,"20827","Replantation thumb complete","1","1","E"]
[null,"20838","Replantation foot complete","0","0"]
[null,"20900","Removal of bone for graft","1","1","E"]
[null,"20902","Removal of bone for graft","1","1","E"]
[null,"20910","Remove cartilage for graft","1","1","E"]
[null,"20912","Remove cartilage for graft","1","1","E"]
[null,"20920","Removal of fascia for graft","1","1","E"]
[null,"20922","Removal of fascia for graft","1","1","E"]
[null,"20924","Removal of tendon for graft","1","1","E"]
[null,"20930","Sp bone algrft morsel add-on","1","1","E"]
[null,"20931","Sp bone algrft struct add-on","1","1","E"]
[null,"20932","Osteoart algrft w/surf & b1","1","1","E"]
[null,"20933","Hemicrt intrclry algrft prtl","1","1","E"]
[null,"20934","Intercalary algrft compl","1","1","E"]
[null,"20936","Sp bone agrft local add-on","1","1","E"]
[null,"20937","Sp bone agrft morsel add-on","1","1","E"]
[null,"20938","Sp bone agrft struct add-on","1","1","E"]
[null,"20939","Bone marrow aspir bone grfg","0","0"]
[null,"20950","Fluid pressure muscle","1","1","E"]
[null,"20955","Fibula bone graft microvasc","0","0"]
[null,"20956","Iliac bone graft microvasc","0","0"]
[null,"20957","Mt bone graft microvasc","1","1","E"]
[null,"20962","Other bone graft microvasc","0","0"]
[null,"20969","Bone/skin graft microvasc","0","0"]
[null,"20970","Bone/skin graft iliac crest","0","0"]
[null,"20972","Bone/skin graft metatarsal","1","1","E"]
[null,"20973","Bone/skin graft great toe","1","1","E"]
[null,"20974","Electrical bone stimulation","1","1","F","49.24"]
["PA","20975","Electrical bone stimulation","1","1","E"]
[null,"20979","Us bone stimulation","1","1","F","33.38"]
[null,"20982","Ablate bone tumor(s) perq","1","1","E"]
[null,"20983","Ablate bone tumor(s) perq","1","1","E"]
[null,"20985","Cptr-asst dir ms px","0","0"]
["PA","20999","Musculoskeletal surgery","1","1","E"]
[null,"21010","Incision of jaw joint","1","1","E"]
[null,"21011","Exc face les sc < 2 cm","1","1","E"]
[null,"21012","Exc face les sbq 2 cm/>","1","1","E"]
[null,"21013","Exc face tum deep < 2 cm","1","1","E"]
[null,"21014","Exc face tum deep 2 cm/>","1","1","E"]
[null,"21015","Resect face tum < 2 cm","1","1","E"]
[null,"21016","Resect face tum 2 cm/>","1","1","E"]
[null,"21025","Excision of bone lower jaw","1","1","E"]
[null,"21026","Excision of facial bone(s)","1","1","E"]
[null,"21029","Contour of face bone lesion","1","1","E"]
[null,"21030","Excise max/zygoma b9 tumor","1","1","E"]
["PA","21031","Remove exostosis mandible","1","1","E"]
["PA","21032","Remove exostosis maxilla","1","1","E"]
[null,"21034","Excise max/zygoma mal tumor","1","1","E"]
[null,"21040","Excise mandible lesion","1","1","E"]
[null,"21044","Removal of jaw bone lesion","1","1","E"]
["PA","21045","Extensive jaw surgery","1","1","E"]
[null,"21046","Remove mandible cyst complex","1","1","E"]
[null,"21047","Excise lwr jaw cyst w/repair","1","1","E"]
[null,"21048","Remove maxilla cyst complex","1","1","E"]
[null,"21049","Excis uppr jaw cyst w/repair","1","1","E"]
["PA","21050","Removal of jaw joint","1","1","E"]
["PA","21060","Remove jaw joint cartilage","1","1","E"]
["PA","21070","Remove coronoid process","1","1","E"]
[null,"21073","Mnpj of tmj w/anesth","1","1","E"]
["PA","21076","Prepare face/oral prosthesis","1","1","E"]
[null,"21077","Prepare face/oral prosthesis","1","1","E"]
[null,"21079","Prepare face/oral prosthesis","1","1","E"]
[null,"21080","Prepare face/oral prosthesis","1","1","E"]
["PA","21081","Prepare face/oral prosthesis","1","1","E"]
[null,"21082","Prepare face/oral prosthesis","1","1","E"]
[null,"21083","Prepare face/oral prosthesis","1","1","E"]
[null,"21084","Prepare face/oral prosthesis","1","1","E"]
["PA","21085","Prepare face/oral prosthesis","1","1","E"]
[null,"21086","Prepare face/oral prosthesis","1","1","E"]
[null,"21087","Prepare face/oral prosthesis","1","1","E"]
[null,"21088","Prepare face/oral prosthesis","1","1","E"]
[null,"21089","Prepare face/oral prosthesis","1","1","E"]
[null,"21100","Maxillofacial fixation","1","1","E"]
[null,"21110","Interdental fixation","1","1","E"]
[null,"21116","Injection jaw joint x-ray","1","1","E"]
["PA","21120","Reconstruction of chin","1","1","E"]
["PA","21121","Reconstruction of chin","1","1","E"]
["PA","21122","Reconstruction of chin","1","1","E"]
[null,"21123","Reconstruction of chin","1","1","E"]
["*PA","21125","Augmentation lower jaw bone","1","1","E",null,"*PA required if for Transhealth"]
[null,"21127","Augmentation lower jaw bone","1","1","E"]
[null,"21137","Reduction of forehead","1","1","E"]
[null,"21138","Reduction of forehead","1","1","E"]
[null,"21139","Reduction of forehead","1","1","E"]
["PA/EPA","21141","LEFORT I-1 PIECE W/O GRAFT ","1","1","E",null,"Please see Orthodontic Services Billing Guide for EPA"]
["PA/EPA","21142","Reconstruct midface lefort","1","1","E",null,"Please see Orthodontic Services Billing Guide for EPA"]
["PA","21143","Reconstruct midface lefort","1","1","E"]
["PA","21145","Reconstruct midface lefort","1","1","E"]
["PA","21146","Reconstruct midface lefort","1","1","E"]
["PA","21147","Reconstruct midface lefort","1","1","E"]
["PA","21150","Reconstruct midface lefort","1","1","E"]
["PA/EPA","21151","Reconstruct midface lefort","0","0"]
["PA/EPA","21154","Reconstruct midface lefort","0","0"]
["PA/EPA","21155","Reconstruct midface lefort","0","0"]
["PA/EPA","21159","Reconstruct midface lefort","0","0"]
["PA/EPA","21160","Reconstruct midface lefort","0","0"]
[null,"21172","Reconstruct orbit/forehead","1","1","E"]
[null,"21175","Reconstruct orbit/forehead","1","1","E"]
[null,"21179","Reconstruct entire forehead","0","0"]
[null,"21180","Reconstruct entire forehead","0","0"]
[null,"21181","Contour cranial bone lesion","1","1","E"]
[null,"21182","Reconstruct cranial bone","0","0"]
[null,"21183","Reconstruct cranial bone","0","0"]
[null,"21184","Reconstruct cranial bone","0","0"]
[null,"21188","Reconstruction of midface","0","0"]
["PA","21193","Reconst lwr jaw w/o graft","1","1","E"]
[null,"21194","Reconst lwr jaw w/graft","0","0"]
["PA","21195","Reconst lwr jaw w/o fixation","1","1","E"]
["PA/EPA","21196","Reconst lwr jaw w/fixation ","1","1","E",null,"Please see Orthodontic Services Billing Guide for EPA"]
["PA","21198","Reconstr lwr jaw segment","1","1","E"]
["PA","21199","Reconstr lwr jaw w/advance","1","1","E"]
["PA","21206","Reconstruct upper jaw bone","1","1","E"]
["*PA","21208","Augmentation of facial bones","1","1","E",null,"*PA required if for Transhealth"]
["PA","21209","Reduction of facial bones","1","1","E"]
["*PA","21210","Face bone graft","1","1","E",null,"*PA required if for Transhealth"]
["PA","21215","Lower jaw bone graft","1","1","E"]
["PA","21230","Rib cartilage graft","1","1","E"]
["*PA","21235","Ear cartilage graft","1","1","E",null,"*PA required if for Transhealth"]
["PA","21240","Reconstruction of jaw joint","1","1","E"]
["PA","21242","Reconstruction of jaw joint","1","1","E"]
["PA","21243","Reconstruction of jaw joint","1","1","E"]
["PA","21244","Reconstruction of lower jaw","1","1","E"]
["PA","21245","Reconstruction of jaw","1","1","E"]
["PA","21246","Reconstruction of jaw","1","1","E"]
[null,"21247","Reconstruct lower jaw bone","0","0"]
["PA","21248","Reconstruction of jaw","1","1","E"]
["PA","21249","Reconstruction of jaw","1","1","E"]
["PA","21255","Reconstruct lower jaw bone","1","1","E"]
[null,"21256","Reconstruction of orbit","1","1","E"]
[null,"21260","Revise eye sockets","1","1","E"]
[null,"21261","Revise eye sockets","1","1","E"]
[null,"21263","Revise eye sockets","1","1","E"]
[null,"21267","Revise eye sockets","1","1","E"]
[null,"21268","Revise eye sockets","0","0"]
["*PA","21270","Augmentation cheek bone","1","1","E",null,"*PA required if for Transhealth"]
[null,"21275","Revision orbitofacial bones","1","1","E"]
[null,"21280","Revision of eyelid","1","1","E"]
[null,"21282","Revision of eyelid","1","1","E"]
["PA","21295","Revision of jaw muscle/bone","1","1","E"]
["PA","21296","Revision of jaw muscle/bone","1","1","E"]
[null,"21299","Cranio/maxillofacial surgery","1","1","E"]
[null,"21315","Treatment of nose fracture","1","1","E"]
[null,"21320","Treatment of nose fracture","1","1","E"]
[null,"21325","Treatment of nose fracture","1","1","E"]
[null,"21330","Treatment of nose fracture","1","1","E"]
[null,"21335","Treatment of nose fracture","1","1","E"]
[null,"21336","Treat nasal septal fracture","1","1","E"]
[null,"21337","Treat nasal septal fracture","1","1","E"]
[null,"21338","Treat nasoethmoid fracture","1","1","E"]
[null,"21339","Treat nasoethmoid fracture","1","1","E"]
[null,"21340","Treatment of nose fracture","1","1","E"]
[null,"21343","Treatment of sinus fracture","1","1","E"]
[null,"21344","Treatment of sinus fracture","0","0"]
[null,"21345","Treat nose/jaw fracture","1","1","E"]
[null,"21346","Treat nose/jaw fracture","1","1","E"]
[null,"21347","Treat nose/jaw fracture","0","0"]
[null,"21348","Treat nose/jaw fracture","0","0"]
[null,"21355","Treat cheek bone fracture","1","1","E"]
[null,"21356","Treat cheek bone fracture","1","1","E"]
[null,"21360","Treat cheek bone fracture","1","1","E"]
[null,"21365","Treat cheek bone fracture","1","1","E"]
[null,"21366","Treat cheek bone fracture","0","0"]
[null,"21385","Treat eye socket fracture","1","1","E"]
[null,"21386","Treat eye socket fracture","1","1","E"]
[null,"21387","Treat eye socket fracture","1","1","E"]
[null,"21390","Treat eye socket fracture","1","1","E"]
[null,"21395","Treat eye socket fracture","1","1","E"]
[null,"21400","Treat eye socket fracture","1","1","E"]
[null,"21401","Treat eye socket fracture","1","1","E"]
[null,"21406","Treat eye socket fracture","1","1","E"]
[null,"21407","Treat eye socket fracture","1","1","E"]
[null,"21408","Treat eye socket fracture","1","1","E"]
[null,"21421","Treat mouth roof fracture","1","1","E"]
[null,"21422","Treat mouth roof fracture","1","1","E"]
[null,"21423","Treat mouth roof fracture","0","0"]
[null,"21431","Treat craniofacial fracture","0","0"]
[null,"21432","Treat craniofacial fracture","0","0"]
[null,"21433","Treat craniofacial fracture","0","0"]
[null,"21435","Treat craniofacial fracture","0","0"]
[null,"21436","Treat craniofacial fracture","0","0"]
[null,"21440","Treat dental ridge fracture","1","1","E"]
[null,"21445","Treat dental ridge fracture","1","1","E"]
[null,"21450","Treat lower jaw fracture","1","1","E"]
[null,"21451","Treat lower jaw fracture","1","1","E"]
[null,"21452","Treat lower jaw fracture","1","1","E"]
[null,"21453","Treat lower jaw fracture","1","1","E"]
[null,"21454","Treat lower jaw fracture","1","1","E"]
[null,"21461","Treat lower jaw fracture","1","1","E"]
[null,"21462","Treat lower jaw fracture","1","1","E"]
[null,"21465","Treat lower jaw fracture","1","1","E"]
[null,"21470","Treat lower jaw fracture","1","1","E"]
[null,"21480","Reset dislocated jaw","1","1","E"]
[null,"21485","Reset dislocated jaw","1","1","E"]
[null,"21490","Repair dislocated jaw","1","1","E"]
[null,"21497","Interdental wiring","1","1","E"]
[null,"21499","Head surgery procedure","1","1","E"]
[null,"21501","Drain neck/chest lesion","1","1","E"]
[null,"21502","Drain chest lesion","1","1","E"]
[null,"21510","Drainage of bone lesion","0","0"]
[null,"21550","Biopsy of neck/chest","1","1","E"]
[null,"21552","Exc neck les sc 3 cm/>","1","1","E"]
[null,"21554","Exc neck tum deep 5 cm/>","1","1","E"]
[null,"21555","Exc neck les sc < 3 cm","1","1","E"]
[null,"21556","Exc neck tum deep < 5 cm","1","1","E"]
[null,"21557","Resect neck tum < 5 cm","1","1","E"]
[null,"21558","Resect neck tum 5 cm/>","1","1","E"]
[null,"21600","Partial removal of rib","1","1","E"]
[null,"21601","Exc chest wall tumor w/ribs","1","1","E"]
[null,"21602","Exc ch wal tum w/o lymphadec","1","1","E"]
[null,"21603","Exc ch wal tum w/lymphadec","1","1","E"]
[null,"21610","Partial removal of rib","1","1","E"]
[null,"21615","Removal of rib","0","0"]
[null,"21616","Removal of rib and nerves","0","0"]
[null,"21620","Partial removal of sternum","0","0"]
[null,"21627","Sternal debridement","1","1","E"]
[null,"21630","RADICAL RESECTION STERNUM","0","0"]
[null,"21632","EXTENSIVE STERNUM SURGERY","0","0"]
["L","21685","Hyoid myotomy & suspension","1","1","E"]
[null,"21700","Revision of neck muscle","1","1","E"]
[null,"21705","Revision of neck muscle/rib","0","0"]
[null,"21720","Revision of neck muscle","1","1","E"]
[null,"21725","Revision of neck muscle","1","1","E"]
[null,"21740","Reconstruction of sternum","0","0"]
[null,"21742","Repair stern/nuss w/o scope","1","1","E"]
[null,"21743","Repair sternum/nuss w/scope","1","1","E"]
[null,"21750","Repair of sternum separation","0","0"]
[null,"21811","Optx of rib fx w/fixj scope","1","1","E"]
[null,"21812","Treatment of rib fracture","1","1","E"]
[null,"21813","Treatment of rib fracture","1","1","E"]
[null,"21820","Treat sternum fracture","1","1","E"]
[null,"21825","Treat sternum fracture","1","1","E"]
[null,"21899","Neck/chest surgery procedure","1","1","E"]
[null,"21920","Biopsy soft tissue of back","1","1","E"]
[null,"21925","Biopsy soft tissue of back","1","1","E"]
[null,"21930","Exc back les sc < 3 cm","1","1","E"]
[null,"21931","Exc back les sc 3 cm/>","1","1","E"]
[null,"21932","Exc back tum deep < 5 cm","1","1","E"]
[null,"21933","Exc back tum deep 5 cm/>","1","1","E"]
[null,"21935","Resect back tum < 5 cm","1","1","E"]
[null,"21936","Resect back tum 5 cm/>","1","1","E"]
[null,"22010","I&d p-spine c/t/cerv-thor","0","0"]
[null,"22015","I&d p-spine l/s/ls","0","0"]
[null,"22100","Remove part of neck vertebra","1","1","E"]
[null,"22101","Remove part thorax vertebra","1","1","E"]
[null,"22102","Remove part lumbar vertebra","1","1","E"]
[null,"22103","Remove extra spine segment","1","1","E"]
[null,"22110","Remove part of neck vertebra","0","0"]
[null,"22112","Remove part thorax vertebra","0","0"]
[null,"22114","Remove part lumbar vertebra","0","0"]
[null,"22116","Remove extra spine segment","0","0"]
[null,"22206","Cut spine 3 col thor","1","1","E"]
[null,"22207","Cut spine 3 col lumb","1","1","E"]
[null,"22208","Cut spine 3 col addl seg","1","1","E"]
[null,"22210","Revision of neck spine","0","0"]
[null,"22212","Revision of thorax spine","0","0"]
[null,"22214","Revision of lumbar spine","0","0"]
[null,"22216","Revise extra spine segment","0","0"]
[null,"22220","Revision of neck spine","0","0"]
[null,"22222","Revision of thorax spine","1","1","E"]
[null,"22224","Revision of lumbar spine","0","0"]
[null,"22226","Revise extra spine segment","0","0"]
[null,"22310","Treat spine fracture","1","1","E"]
[null,"22315","Treat spine fracture","1","1","E"]
[null,"22318","Treat odontoid fx w/o graft","0","0"]
[null,"22319","Treat odontoid fx w/graft","0","0"]
[null,"22325","Treat spine fracture","0","0"]
[null,"22326","Treat neck spine fracture","0","0"]
[null,"22327","Treat thorax spine fracture","0","0"]
[null,"22328","Treat each add spine fx","0","0"]
[null,"22505","Manipulation of spine","1","1","E"]
[null,"22510","Perq cervicothoracic inject","0","0"]
[null,"22511","Perq lumbosacral injection","0","0"]
[null,"22512","Vertebroplasty addl inject","0","0"]
[null,"22513","Perq vertebral augmentation","0","0"]
["PA","22526","Idet single level","1","1","E"]
["PA","22527","Idet 1 or more levels","1","1","E"]
[null,"22532","Lat thorax spine fusion","0","0"]
[null,"22533","Lat lumbar spine fusion","0","0"]
[null,"22534","Lat thor/lumb addl seg","0","0"]
[null,"22548","Neck spine fusion","0","0"]
[null,"22551","Neck spine fuse&remov bel c2","0","0"]
[null,"22552","Addl neck spine fusion","0","0"]
["L","22554","Neck spine fusion","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22556","Thorax spine fusion","0","0"]
["L","22558","Lumbar spine fusion","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22585","Additional spinal fusion","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22586","Prescrl fuse w/ instr l5/s1","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22590","Spine & skull spinal fusion","0","0"]
[null,"22595","Neck spinal fusion","0","0"]
["L","22600","Neck spine fusion","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22610","Thorax spine fusion","0","0"]
["L","22612","Lumbar spine fusion","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22614","Spine fusion extra segment","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22630","Lumbar spine fusion","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22632","Spine fusion extra segment","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22633","Lumbar spine fusion combined","0","0"]
[null,"22634","Spine fusion extra segment","0","0"]
[null,"22800","Fusion of spine","0","0"]
[null,"22802","Fusion of spine","0","0"]
[null,"22804","Fusion of spine","0","0"]
[null,"22808","Fusion of spine","0","0"]
[null,"22810","Fusion of spine","0","0"]
[null,"22812","Fusion of spine","0","0"]
[null,"22818","Kyphectomy 1-2 segments","0","0"]
[null,"22819","Kyphectomy 3 or more","0","0"]
["L","22830","Exploration of spinal fusion","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22836","ANT THRC VRT BODY TETHRG <7","0","0"]
[null,"22837","ANT THRC VRT BODY TETHRG 8+","0","0"]
[null,"22838","REV RPLC/RMV THRC VRT TETHRG","0","0"]
["L","22840","Insert spine fixation device","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22841","Insert spine fixation device","0","0"]
[null,"22842","Insert spine fixation device","0","0"]
[null,"22843","Insert spine fixation device","0","0"]
[null,"22844","Insert spine fixation device","0","0"]
["L","22845","Insert spine fixation device","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22846","Insert spine fixation device","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22847","Insert spine fixation device","0","0"]
[null,"22848","Insert pelv fixation device","0","0"]
[null,"22849","Reinsert spinal fixation","0","0"]
["L","22850","Remove spine fixation device","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22852","Remove spine fixation device","0","0"]
["CPA","22853","Insj biomechanical device","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","22854","Insj biomechanical device","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22855","Remove spine fixation device","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","22856","Cerv artific diskectomy","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22857","Lumbar artif diskectomy","0","0"]
["CPA","22858","Second level cer diskectomy","1","1","E"]
["CPA","22859","Insj biomechanical device","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22860","Tot disc arthrp 2ntrspc lmbr","0","0"]
[null,"22861","Revise cerv artific disc","0","0"]
[null,"22862","Revise lumbar artif disc","0","0"]
[null,"22864","Remove cerv artif disc","0","0"]
[null,"22865","Remove lumb artif disc","0","0"]
["CPA","22867","Insj stablj dev w/dcmprn","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","22868","Insj stablj dev w/dcmprn","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","22869","Insj stablj dev w/o dcmprn","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","22870","Insj stablj dev w/o dcmprn","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","22899","Spine surgery procedure","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"22900","Exc abdl tum deep < 5 cm","1","1","E"]
[null,"22901","Exc abdl tum deep 5 cm/>","1","1","E"]
[null,"22902","Exc abd les sc < 3 cm","1","1","E"]
[null,"22903","Exc abd les sc 3 cm/>","1","1","E"]
[null,"22904","Resect abd tum < 5 cm","1","1","E"]
[null,"22905","Resect abd tum 5 cm/>","1","1","E"]
[null,"22999","Abdomen surgery procedure","1","1","E"]
[null,"23000","Removal of calcium deposits","1","1","E"]
[null,"23020","Release shoulder joint","1","1","E"]
[null,"23030","Drain shoulder lesion","1","1","E"]
[null,"23031","Drain shoulder bursa","1","1","E"]
[null,"23035","Drain shoulder bone lesion","1","1","E"]
[null,"23040","Exploratory shoulder surgery","1","1","E"]
[null,"23044","Exploratory shoulder surgery","1","1","E"]
[null,"23065","Biopsy shoulder tissues","1","1","E"]
[null,"23066","Biopsy shoulder tissues","1","1","E"]
[null,"23071","Exc shoulder les sc 3 cm/>","1","1","E"]
[null,"23073","Exc shoulder tum deep 5 cm/>","1","1","E"]
[null,"23075","Exc shoulder les sc < 3 cm","1","1","E"]
[null,"23076","Exc shoulder tum deep < 5 cm","1","1","E"]
[null,"23077","Resect shoulder tum < 5 cm","1","1","E"]
[null,"23078","Resect shoulder tum 5 cm/>","1","1","E"]
["L","23100","Biopsy of shoulder joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23101","Shoulder joint surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23105","Remove shoulder joint lining","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23106","Incision of collarbone joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23107","Explore treat shoulder joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23120","Partial removal collar bone","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23125","Removal of collar bone","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23130","Remove shoulder bone part","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"23140","Removal of bone lesion","1","1","E"]
[null,"23145","Removal of bone lesion","1","1","E"]
[null,"23146","Removal of bone lesion","1","1","E"]
[null,"23150","Removal of humerus lesion","1","1","E"]
[null,"23155","Removal of humerus lesion","1","1","E"]
[null,"23156","Removal of humerus lesion","1","1","E"]
[null,"23170","Remove collar bone lesion","1","1","E"]
[null,"23172","Remove shoulder blade lesion","1","1","E"]
[null,"23174","Remove humerus lesion","1","1","E"]
[null,"23180","Remove collar bone lesion","1","1","E"]
[null,"23182","Remove shoulder blade lesion","1","1","E"]
[null,"23184","Remove humerus lesion","1","1","E"]
[null,"23190","Partial removal of scapula","1","1","E"]
[null,"23195","Removal of head of humerus","1","1","E"]
[null,"23200","Resect clavicle tumor","0","0"]
[null,"23210","Resect scapula tumor","0","0"]
[null,"23220","Resect prox humerus tumor","0","0"]
[null,"23330","Remove shoulder foreign body","1","1","E"]
[null,"23333","Remove shoulder fb deep","1","1","E"]
[null,"23334","Shoulder prosthesis removal","1","1","E"]
[null,"23335","Shoulder prosthesis removal","1","1","E"]
[null,"23350","Injection for shoulder x-ray","1","1","E"]
[null,"23395","Muscle transfer shoulder/arm","1","1","E"]
[null,"23397","Muscle transfers","1","1","E"]
[null,"23400","Fixation of shoulder blade","1","1","E"]
["L","23405","Incision of tendon & muscle","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23406","Incise tendon(s) & muscle(s)","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23410","Repair rotator cuff acute","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23412","Repair rotator cuff chronic","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23415","Release of shoulder ligament","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23420","Repair of shoulder","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23430","Repair biceps tendon","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23440","Remove/transplant tendon","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23450","Repair shoulder capsule","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23455","Repair shoulder capsule","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23460","Repair shoulder capsule","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23462","Repair shoulder capsule","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23465","Repair shoulder capsule","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23466","Repair shoulder capsule","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23470","Reconstruct shoulder joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","23472","Reconstruct shoulder joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","23473","Revis reconst shoulder joint","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"23474","Revis reconst shoulder joint","0","0"]
[null,"23480","Revision of collar bone","1","1","E"]
[null,"23485","Revision of collar bone","1","1","E"]
[null,"23490","Reinforce clavicle","1","1","E"]
[null,"23491","Reinforce shoulder bones","1","1","E"]
[null,"23500","Treat clavicle fracture","1","1","E"]
[null,"23505","Treat clavicle fracture","1","1","E"]
[null,"23515","Treat clavicle fracture","1","1","E"]
[null,"23520","Treat clavicle dislocation","1","1","E"]
[null,"23525","Treat clavicle dislocation","1","1","E"]
[null,"23530","Treat clavicle dislocation","1","1","E"]
[null,"23532","Treat clavicle dislocation","1","1","E"]
[null,"23540","Treat clavicle dislocation","1","1","E"]
[null,"23545","Treat clavicle dislocation","1","1","E"]
[null,"23550","Treat clavicle dislocation","1","1","E"]
[null,"23552","Treat clavicle dislocation","1","1","E"]
[null,"23570","Treat shoulder blade fx","1","1","E"]
[null,"23575","Treat shoulder blade fx","1","1","E"]
[null,"23585","Treat scapula fracture","1","1","E"]
[null,"23600","Treat humerus fracture","1","1","E"]
[null,"23605","Treat humerus fracture","1","1","E"]
[null,"23615","Treat humerus fracture","1","1","E"]
[null,"23616","Treat humerus fracture","1","1","E"]
[null,"23620","Treat humerus fracture","1","1","E"]
[null,"23625","Treat humerus fracture","1","1","E"]
[null,"23630","Treat humerus fracture","1","1","E"]
[null,"23650","Treat shoulder dislocation","1","1","E"]
[null,"23655","Treat shoulder dislocation","1","1","E"]
[null,"23660","Treat shoulder dislocation","1","1","E"]
[null,"23665","Treat dislocation/fracture","1","1","E"]
[null,"23670","Treat dislocation/fracture","1","1","E"]
[null,"23675","Treat dislocation/fracture","1","1","E"]
[null,"23680","Treat dislocation/fracture","1","1","E"]
[null,"23700","Fixation of shoulder","1","1","E"]
[null,"23800","Fusion of shoulder joint","1","1","E"]
[null,"23802","Fusion of shoulder joint","1","1","E"]
[null,"23900","Amputation of arm & girdle","0","0"]
[null,"23920","Amputation at shoulder joint","0","0"]
[null,"23921","Amputation follow-up surgery","1","1","E"]
["PA","23929","Shoulder surgery procedure","1","1","E",null,"PA age 21+. No PA age <21"]
[null,"23930","Drainage of arm lesion","1","1","E"]
[null,"23931","Drainage of arm bursa","1","1","E"]
[null,"23935","Drain arm/elbow bone lesion","1","1","E"]
[null,"24000","Exploratory elbow surgery","1","1","E"]
[null,"24006","Release elbow joint","1","1","E"]
[null,"24065","Biopsy arm/elbow soft tissue","1","1","E"]
[null,"24066","Biopsy arm/elbow soft tissue","1","1","E"]
[null,"24071","Exc arm/elbow les sc 3 cm/>","1","1","E"]
[null,"24073","Ex arm/elbow tum deep 5 cm/>","1","1","E"]
[null,"24075","Exc arm/elbow les sc < 3 cm","1","1","E"]
[null,"24076","Ex arm/elbow tum deep < 5 cm","1","1","E"]
[null,"24077","Resect arm/elbow tum < 5 cm","1","1","E"]
[null,"24079","Resect arm/elbow tum 5 cm/>","1","1","E"]
[null,"24100","Biopsy elbow joint lining","1","1","E"]
[null,"24101","Explore/treat elbow joint","1","1","E"]
[null,"24102","Remove elbow joint lining","1","1","E"]
[null,"24105","Removal of elbow bursa","1","1","E"]
[null,"24110","Remove humerus lesion","1","1","E"]
[null,"24115","Remove/graft bone lesion","1","1","E"]
[null,"24116","Remove/graft bone lesion","1","1","E"]
[null,"24120","Remove elbow lesion","1","1","E"]
[null,"24125","Remove/graft bone lesion","1","1","E"]
[null,"24126","Remove/graft bone lesion","1","1","E"]
[null,"24130","Removal of head of radius","1","1","E"]
[null,"24134","Removal of arm bone lesion","1","1","E"]
[null,"24136","Remove radius bone lesion","1","1","E"]
[null,"24138","Remove elbow bone lesion","1","1","E"]
[null,"24140","Partial removal of arm bone","1","1","E"]
[null,"24145","Partial removal of radius","1","1","E"]
[null,"24147","Partial removal of elbow","1","1","E"]
[null,"24149","Radical resection of elbow","1","1","E"]
[null,"24150","Resect distal humerus tumor","1","1","E"]
[null,"24152","Resect radius tumor","1","1","E"]
[null,"24155","Removal of elbow joint","1","1","E"]
[null,"24160","Remove elbow joint implant","1","1","E"]
[null,"24164","Remove radius head implant","1","1","E"]
[null,"24200","Removal of arm foreign body","1","1","E"]
[null,"24201","Removal of arm foreign body","1","1","E"]
[null,"24220","Injection for elbow x-ray","1","1","E"]
[null,"24300","Manipulate elbow w/anesth","1","1","E"]
[null,"24301","Muscle/tendon transfer","1","1","E"]
[null,"24305","Arm tendon lengthening","1","1","E"]
[null,"24310","Revision of arm tendon","1","1","E"]
[null,"24320","Repair of arm tendon","1","1","E"]
[null,"24330","Revision of arm muscles","1","1","E"]
[null,"24331","Revision of arm muscles","1","1","E"]
[null,"24332","Tenolysis triceps","1","1","E"]
[null,"24340","Repair of biceps tendon","1","1","E"]
[null,"24341","Repair arm tendon/muscle","1","1","E"]
[null,"24342","Repair of ruptured tendon","1","1","E"]
[null,"24343","Repr elbow lat ligmnt w/tiss","1","1","E"]
[null,"24344","Reconstruct elbow lat ligmnt","1","1","E"]
[null,"24345","Repr elbw med ligmnt w/tissu","1","1","E"]
[null,"24346","Reconstruct elbow med ligmnt","1","1","E"]
["L","24357","Repair elbow perc","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","24358","Repair elbow w/deb open","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","24359","Repair elbow deb/attch open","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"24360","Reconstruct elbow joint","1","1","E"]
[null,"24361","Reconstruct elbow joint","1","1","E"]
[null,"24362","Reconstruct elbow joint","1","1","E"]
["L","24363","Replace elbow joint","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"24365","Reconstruct head of radius","1","1","E"]
[null,"24366","Reconstruct head of radius","1","1","E"]
[null,"24370","Revise reconst elbow joint","1","1","E"]
[null,"24371","Revise reconst elbow joint","1","1","E"]
[null,"24400","Revision of humerus","1","1","E"]
[null,"24410","Revision of humerus","1","1","E"]
[null,"24420","Revision of humerus","1","1","E"]
[null,"24430","Repair of humerus","1","1","E"]
[null,"24435","Repair humerus with graft","1","1","E"]
[null,"24470","Revision of elbow joint","1","1","E"]
[null,"24495","Decompression of forearm","1","1","E"]
[null,"24498","Reinforce humerus","1","1","E"]
[null,"24500","Treat humerus fracture","1","1","E"]
[null,"24505","Treat humerus fracture","1","1","E"]
[null,"24515","Treat humerus fracture","1","1","E"]
[null,"24516","Treat humerus fracture","1","1","E"]
[null,"24530","Treat humerus fracture","1","1","E"]
[null,"24535","Treat humerus fracture","1","1","E"]
[null,"24538","Treat humerus fracture","1","1","E"]
[null,"24545","Treat humerus fracture","1","1","E"]
[null,"24546","Treat humerus fracture","1","1","E"]
[null,"24560","Treat humerus fracture","1","1","E"]
[null,"24565","Treat humerus fracture","1","1","E"]
[null,"24566","Treat humerus fracture","1","1","E"]
[null,"24575","Treat humerus fracture","1","1","E"]
[null,"24576","Treat humerus fracture","1","1","E"]
[null,"24577","Treat humerus fracture","1","1","E"]
[null,"24579","Treat humerus fracture","1","1","E"]
[null,"24582","Treat humerus fracture","1","1","E"]
[null,"24586","Treat elbow fracture","1","1","E"]
[null,"24587","Treat elbow fracture","1","1","E"]
[null,"24600","Treat elbow dislocation","1","1","E"]
[null,"24605","Treat elbow dislocation","1","1","E"]
[null,"24615","Treat elbow dislocation","1","1","E"]
[null,"24620","Treat elbow fracture","1","1","E"]
[null,"24635","Treat elbow fracture","1","1","E"]
[null,"24640","Treat elbow dislocation","1","1","E"]
[null,"24650","Treat radius fracture","1","1","E"]
[null,"24655","Treat radius fracture","1","1","E"]
[null,"24665","Treat radius fracture","1","1","E"]
[null,"24666","Treat radius fracture","1","1","E"]
[null,"24670","Treat ulnar fracture","1","1","E"]
[null,"24675","Treat ulnar fracture","1","1","E"]
[null,"24685","Treat ulnar fracture","1","1","E"]
[null,"24800","Fusion of elbow joint","1","1","E"]
[null,"24802","Fusion/graft of elbow joint","1","1","E"]
[null,"24900","Amputation of upper arm","0","0"]
[null,"24920","Amputation of upper arm","0","0"]
[null,"24925","Amputation follow-up surgery","1","1","E"]
[null,"24930","Amputation follow-up surgery","0","0"]
[null,"24931","Amputate upper arm & implant","0","0"]
[null,"24935","Revision of amputation","1","1","E"]
[null,"24940","Revision of upper arm","0","0"]
["L","24999","Upper arm/elbow surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","25000","Incision of tendon sheath","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","25001","Incise flexor carpi radialis","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"25020","Decompress forearm 1 space","1","1","E"]
[null,"25023","Decompress forearm 1 space","1","1","E"]
[null,"25024","Decompress forearm 2 spaces","1","1","E"]
[null,"25025","Decompress forearm 2 spaces","1","1","E"]
[null,"25028","Drainage of forearm lesion","1","1","E"]
[null,"25031","Drainage of forearm bursa","1","1","E"]
[null,"25035","Treat forearm bone lesion","1","1","E"]
[null,"25040","Explore/treat wrist joint","1","1","E"]
[null,"25065","Biopsy forearm soft tissues","1","1","E"]
[null,"25066","Biopsy forearm soft tissues","1","1","E"]
[null,"25071","Exc forearm les sc 3 cm/>","1","1","E"]
[null,"25073","Exc forearm tum deep 3 cm/>","1","1","E"]
[null,"25075","Exc forearm les sc < 3 cm","1","1","E"]
[null,"25076","Exc forearm tum deep < 3 cm","1","1","E"]
[null,"25077","Resect forearm/wrist tum<3cm","1","1","E"]
[null,"25078","Resect forarm/wrist tum 3cm>","1","1","E"]
[null,"25085","Incision of wrist capsule","1","1","E"]
[null,"25100","Biopsy of wrist joint","1","1","E"]
[null,"25101","Explore/treat wrist joint","1","1","E"]
[null,"25105","Remove wrist joint lining","1","1","E"]
[null,"25107","Remove wrist joint cartilage","1","1","E"]
[null,"25109","Excise tendon forearm/wrist","1","1","E"]
[null,"25110","Remove wrist tendon lesion","1","1","E"]
[null,"25111","Remove wrist tendon lesion","1","1","E"]
[null,"25112","Reremove wrist tendon lesion","1","1","E"]
[null,"25115","Remove wrist/forearm lesion","1","1","E"]
[null,"25116","Remove wrist/forearm lesion","1","1","E"]
[null,"25118","Excise wrist tendon sheath","1","1","E"]
[null,"25119","Partial removal of ulna","1","1","E"]
[null,"25120","Removal of forearm lesion","1","1","E"]
[null,"25125","Remove/graft forearm lesion","1","1","E"]
[null,"25126","Remove/graft forearm lesion","1","1","E"]
[null,"25130","Removal of wrist lesion","1","1","E"]
[null,"25135","Remove & graft wrist lesion","1","1","E"]
[null,"25136","Remove & graft wrist lesion","1","1","E"]
[null,"25145","Remove forearm bone lesion","1","1","E"]
[null,"25150","Partial removal of ulna","1","1","E"]
[null,"25151","Partial removal of radius","1","1","E"]
[null,"25170","Resect radius/ulnar tumor","1","1","E"]
[null,"25210","Removal of wrist bone","1","1","E"]
[null,"25215","Removal of wrist bones","1","1","E"]
[null,"25230","Partial removal of radius","1","1","E"]
[null,"25240","Partial removal of ulna","1","1","E"]
[null,"25246","Injection for wrist x-ray","1","1","E"]
[null,"25248","Remove forearm foreign body","1","1","E"]
[null,"25250","Removal of wrist prosthesis","1","1","E"]
[null,"25251","Removal of wrist prosthesis","1","1","E"]
[null,"25259","Manipulate wrist w/anesthes","1","1","E"]
[null,"25260","Repair forearm tendon/muscle","1","1","E"]
[null,"25263","Repair forearm tendon/muscle","1","1","E"]
[null,"25265","Repair forearm tendon/muscle","1","1","E"]
[null,"25270","Repair forearm tendon/muscle","1","1","E"]
[null,"25272","Repair forearm tendon/muscle","1","1","E"]
[null,"25274","Repair forearm tendon/muscle","1","1","E"]
[null,"25275","Repair forearm tendon sheath","1","1","E"]
[null,"25280","Revise wrist/forearm tendon","1","1","E"]
[null,"25290","Incise wrist/forearm tendon","1","1","E"]
[null,"25295","Release wrist/forearm tendon","1","1","E"]
[null,"25300","Fusion of tendons at wrist","1","1","E"]
[null,"25301","Fusion of tendons at wrist","1","1","E"]
[null,"25310","Transplant forearm tendon","1","1","E"]
[null,"25312","Transplant forearm tendon","1","1","E"]
[null,"25315","Revise palsy hand tendon(s)","1","1","E"]
[null,"25316","Revise palsy hand tendon(s)","1","1","E"]
[null,"25320","Repair/revise wrist joint","1","1","E"]
[null,"25332","Revise wrist joint","1","1","E"]
[null,"25335","Realignment of hand","1","1","E"]
[null,"25337","Reconstruct ulna/radioulnar","1","1","E"]
[null,"25350","Revision of radius","1","1","E"]
[null,"25355","Revision of radius","1","1","E"]
[null,"25360","Revision of ulna","1","1","E"]
[null,"25365","Revise radius & ulna","1","1","E"]
[null,"25370","Revise radius or ulna","1","1","E"]
[null,"25375","Revise radius & ulna","1","1","E"]
[null,"25390","Shorten radius or ulna","1","1","E"]
[null,"25391","Lengthen radius or ulna","1","1","E"]
[null,"25392","Shorten radius & ulna","1","1","E"]
[null,"25393","Lengthen radius & ulna","1","1","E"]
[null,"25394","Repair carpal bone shorten","1","1","E"]
[null,"25400","Repair radius or ulna","1","1","E"]
[null,"25405","Repair/graft radius or ulna","1","1","E"]
[null,"25415","Repair radius & ulna","1","1","E"]
[null,"25420","Repair/graft radius & ulna","1","1","E"]
[null,"25425","Repair/graft radius or ulna","1","1","E"]
[null,"25426","Repair/graft radius & ulna","1","1","E"]
[null,"25430","Vasc graft into carpal bone","1","1","E"]
[null,"25431","Repair nonunion carpal bone","1","1","E"]
[null,"25440","Repair/graft wrist bone","1","1","E"]
[null,"25441","Reconstruct wrist joint","1","1","E"]
[null,"25442","Reconstruct wrist joint","1","1","E"]
[null,"25443","Reconstruct wrist joint","1","1","E"]
[null,"25444","Reconstruct wrist joint","1","1","E"]
[null,"25445","Reconstruct wrist joint","1","1","E"]
[null,"25446","Wrist replacement","1","1","E"]
[null,"25447","ARTHRP NTRCRP/CRP/MTCR NTRPS","1","1","E"]
[null,"25448","ARTHRP NTRCRPL/CRP/MTCRP SSP","1","1","E"]
[null,"25449","Remove wrist joint implant","1","1","E"]
["L","25450","Revision of wrist joint","1","1","E"]
["L","25455","Revision of wrist joint","1","1","E"]
[null,"25490","Reinforce radius","1","1","E"]
[null,"25491","Reinforce ulna","1","1","E"]
[null,"25492","Reinforce radius and ulna","1","1","E"]
[null,"25500","Treat fracture of radius","1","1","E"]
[null,"25505","Treat fracture of radius","1","1","E"]
[null,"25515","Treat fracture of radius","1","1","E"]
[null,"25520","Treat fracture of radius","1","1","E"]
[null,"25525","Treat fracture of radius","1","1","E"]
[null,"25526","Treat fracture of radius","1","1","E"]
[null,"25530","Treat fracture of ulna","1","1","E"]
[null,"25535","Treat fracture of ulna","1","1","E"]
[null,"25545","Treat fracture of ulna","1","1","E"]
[null,"25560","Treat fracture radius & ulna","1","1","E"]
[null,"25565","Treat fracture radius & ulna","1","1","E"]
[null,"25574","Treat fracture radius & ulna","1","1","E"]
[null,"25575","Treat fracture radius/ulna","1","1","E"]
[null,"25600","Treat fracture radius/ulna","1","1","E"]
[null,"25605","Treat fracture radius/ulna","1","1","E"]
[null,"25606","Treat fx distal radial","1","1","E"]
[null,"25607","Treat fx rad extra-articul","1","1","E"]
[null,"25608","Treat fx rad intra-articul","1","1","E"]
[null,"25609","Treat fx radial 3+ frag","1","1","E"]
[null,"25622","Treat wrist bone fracture","1","1","E"]
[null,"25624","Treat wrist bone fracture","1","1","E"]
[null,"25628","Treat wrist bone fracture","1","1","E"]
[null,"25630","Treat wrist bone fracture","1","1","E"]
[null,"25635","Treat wrist bone fracture","1","1","E"]
[null,"25645","Treat wrist bone fracture","1","1","E"]
[null,"25650","Treat wrist bone fracture","1","1","E"]
[null,"25651","Pin ulnar styloid fracture","1","1","E"]
[null,"25652","Treat fracture ulnar styloid","1","1","E"]
[null,"25660","Treat wrist dislocation","1","1","E"]
[null,"25670","Treat wrist dislocation","1","1","E"]
[null,"25671","Pin radioulnar dislocation","1","1","E"]
[null,"25675","Treat wrist dislocation","1","1","E"]
[null,"25676","Treat wrist dislocation","1","1","E"]
[null,"25680","Treat wrist fracture","1","1","E"]
[null,"25685","Treat wrist fracture","1","1","E"]
[null,"25690","Treat wrist dislocation","1","1","E"]
[null,"25695","Treat wrist dislocation","1","1","E"]
[null,"25800","Fusion of wrist joint","1","1","E"]
[null,"25805","Fusion/graft of wrist joint","1","1","E"]
[null,"25810","Fusion/graft of wrist joint","1","1","E"]
[null,"25820","Fusion of hand bones","1","1","E"]
[null,"25825","Fuse hand bones with graft","1","1","E"]
[null,"25830","Fusion radioulnar jnt/ulna","1","1","E"]
[null,"25900","Amputation of forearm","0","0"]
[null,"25905","Amputation of forearm","0","0"]
[null,"25907","Amputation follow-up surgery","1","1","E"]
[null,"25909","Amputation follow-up surgery","1","1","E"]
[null,"25915","Amputation of forearm","0","0"]
[null,"25920","Amputate hand at wrist","0","0"]
[null,"25922","Amputate hand at wrist","1","1","E"]
[null,"25924","Amputation follow-up surgery","0","0"]
[null,"25927","Amputation of hand","0","0"]
[null,"25929","Amputation follow-up surgery","1","1","E"]
[null,"25931","Amputation follow-up surgery","1","1","E"]
[null,"25999","Forearm or wrist surgery","1","1","E"]
[null,"26010","Drainage of finger abscess","1","1","E"]
[null,"26011","Drainage of finger abscess","1","1","E"]
[null,"26020","Drain hand tendon sheath","1","1","E"]
[null,"26025","Drainage of palm bursa","1","1","E"]
[null,"26030","Drainage of palm bursas","1","1","E"]
[null,"26034","Treat hand bone lesion","1","1","E"]
[null,"26035","Decompress fingers/hand","1","1","E"]
[null,"26037","Decompress fingers/hand","1","1","E"]
[null,"26040","Release palm contracture","1","1","E"]
[null,"26045","Release palm contracture","1","1","E"]
[null,"26055","Incise finger tendon sheath","1","1","E"]
[null,"26060","Incision of finger tendon","1","1","E"]
[null,"26070","Explore/treat hand joint","1","1","E"]
[null,"26075","Explore/treat finger joint","1","1","E"]
[null,"26080","Explore/treat finger joint","1","1","E"]
[null,"26100","Biopsy hand joint lining","1","1","E"]
[null,"26105","Biopsy finger joint lining","1","1","E"]
[null,"26110","Biopsy finger joint lining","1","1","E"]
[null,"26111","Exc hand les sc 1.5 cm/>","1","1","E"]
[null,"26113","Exc hand tum deep 1.5 cm/>","1","1","E"]
[null,"26115","Exc hand les sc < 1.5 cm","1","1","E"]
[null,"26116","Exc hand tum deep < 1.5 cm","1","1","E"]
[null,"26117","Exc hand tum ra < 3 cm","1","1","E"]
[null,"26118","Exc hand tum ra 3 cm/>","1","1","E"]
[null,"26121","Release palm contracture","1","1","E"]
[null,"26123","Release palm contracture","1","1","E"]
[null,"26125","Release palm contracture","1","1","E"]
[null,"26130","Remove wrist joint lining","1","1","E"]
[null,"26135","Revise finger joint each","1","1","E"]
[null,"26140","Revise finger joint each","1","1","E"]
[null,"26145","Tendon excision palm/finger","1","1","E"]
[null,"26160","Remove tendon sheath lesion","1","1","E"]
[null,"26170","Removal of palm tendon each","1","1","E"]
[null,"26180","Removal of finger tendon","1","1","E"]
[null,"26185","Remove finger bone","1","1","E"]
[null,"26200","Remove hand bone lesion","1","1","E"]
[null,"26205","Remove/graft bone lesion","1","1","E"]
[null,"26210","Removal of finger lesion","1","1","E"]
[null,"26215","Remove/graft finger lesion","1","1","E"]
[null,"26230","Partial removal of hand bone","1","1","E"]
[null,"26235","Partial removal finger bone","1","1","E"]
[null,"26236","Partial removal finger bone","1","1","E"]
[null,"26250","Extensive hand surgery","1","1","E"]
[null,"26260","Resect prox finger tumor","1","1","E"]
[null,"26262","Resect distal finger tumor","1","1","E"]
[null,"26320","Removal of implant from hand","1","1","E"]
[null,"26340","Manipulate finger w/anesth","1","1","E"]
[null,"26341","Manipulat palm cord post inj","1","1","E"]
[null,"26350","Repair finger/hand tendon","1","1","E"]
[null,"26352","Repair/graft hand tendon","1","1","E"]
[null,"26356","Repair finger/hand tendon","1","1","E"]
[null,"26357","Repair finger/hand tendon","1","1","E"]
[null,"26358","Repair/graft hand tendon","1","1","E"]
[null,"26370","Repair finger/hand tendon","1","1","E"]
[null,"26372","Repair/graft hand tendon","1","1","E"]
[null,"26373","Repair finger/hand tendon","1","1","E"]
[null,"26390","Revise hand/finger tendon","1","1","E"]
[null,"26392","Repair/graft hand tendon","1","1","E"]
[null,"26410","Repair hand tendon","1","1","E"]
[null,"26412","Repair/graft hand tendon","1","1","E"]
[null,"26415","Excision hand/finger tendon","1","1","E"]
[null,"26416","Graft hand or finger tendon","1","1","E"]
[null,"26418","Repair finger tendon","1","1","E"]
[null,"26420","Repair/graft finger tendon","1","1","E"]
[null,"26426","Repair finger/hand tendon","1","1","E"]
[null,"26428","Repair/graft finger tendon","1","1","E"]
[null,"26432","Repair finger tendon","1","1","E"]
[null,"26433","Repair finger tendon","1","1","E"]
[null,"26434","Repair/graft finger tendon","1","1","E"]
[null,"26437","Realignment of tendons","1","1","E"]
[null,"26440","Release palm/finger tendon","1","1","E"]
[null,"26442","Release palm & finger tendon","1","1","E"]
[null,"26445","Release hand/finger tendon","1","1","E"]
[null,"26449","Release forearm/hand tendon","1","1","E"]
[null,"26450","Incision of palm tendon","1","1","E"]
[null,"26455","Incision of finger tendon","1","1","E"]
[null,"26460","Incise hand/finger tendon","1","1","E"]
[null,"26471","Fusion of finger tendons","1","1","E"]
[null,"26474","Fusion of finger tendons","1","1","E"]
[null,"26476","Tendon lengthening","1","1","E"]
[null,"26477","Tendon shortening","1","1","E"]
[null,"26478","Lengthening of hand tendon","1","1","E"]
[null,"26479","Shortening of hand tendon","1","1","E"]
[null,"26480","Transplant hand tendon","1","1","E"]
[null,"26483","Transplant/graft hand tendon","1","1","E"]
[null,"26485","Transplant palm tendon","1","1","E"]
[null,"26489","Transplant/graft palm tendon","1","1","E"]
[null,"26490","Revise thumb tendon","1","1","E"]
[null,"26492","Tendon transfer with graft","1","1","E"]
[null,"26494","Hand tendon/muscle transfer","1","1","E"]
[null,"26496","Revise thumb tendon","1","1","E"]
[null,"26497","Finger tendon transfer","1","1","E"]
[null,"26498","Finger tendon transfer","1","1","E"]
[null,"26499","Revision of finger","1","1","E"]
[null,"26500","Hand tendon reconstruction","1","1","E"]
[null,"26502","Hand tendon reconstruction","1","1","E"]
[null,"26508","Release thumb contracture","1","1","E"]
[null,"26510","Thumb tendon transfer","1","1","E"]
[null,"26516","Fusion of knuckle joint","1","1","E"]
[null,"26517","Fusion of knuckle joints","1","1","E"]
[null,"26518","Fusion of knuckle joints","1","1","E"]
[null,"26520","Release knuckle contracture","1","1","E"]
[null,"26525","Release finger contracture","1","1","E"]
[null,"26530","Revise knuckle joint","1","1","E"]
[null,"26531","Revise knuckle with implant","1","1","E"]
[null,"26535","Revise finger joint","1","1","E"]
[null,"26536","Revise/implant finger joint","1","1","E"]
[null,"26540","Repair hand joint","1","1","E"]
[null,"26541","Repair hand joint with graft","1","1","E"]
[null,"26542","Repair hand joint with graft","1","1","E"]
[null,"26545","Reconstruct finger joint","1","1","E"]
[null,"26546","Repair nonunion hand","1","1","E"]
[null,"26548","Reconstruct finger joint","1","1","E"]
[null,"26550","Construct thumb replacement","1","1","E"]
[null,"26551","Great toe-hand transfer","0","0"]
[null,"26553","Single transfer toe-hand","0","0"]
[null,"26554","Double transfer toe-hand","0","0"]
[null,"26555","Positional change of finger","1","1","E"]
[null,"26556","Toe joint transfer","0","0"]
[null,"26560","Repair of web finger","1","1","E"]
[null,"26561","Repair of web finger","1","1","E"]
[null,"26562","Repair of web finger","1","1","E"]
[null,"26565","Correct metacarpal flaw","1","1","E"]
[null,"26567","Correct finger deformity","1","1","E"]
[null,"26568","Lengthen metacarpal/finger","1","1","E"]
[null,"26580","Repair hand deformity","1","1","E"]
[null,"26587","Reconstruct extra finger","1","1","E"]
[null,"26590","Repair finger deformity","1","1","E"]
[null,"26591","Repair muscles of hand","1","1","E"]
[null,"26593","Release muscles of hand","1","1","E"]
[null,"26596","Excision constricting tissue","1","1","E"]
[null,"26600","Treat metacarpal fracture","1","1","E"]
[null,"26605","Treat metacarpal fracture","1","1","E"]
[null,"26607","Treat metacarpal fracture","1","1","E"]
[null,"26608","Treat metacarpal fracture","1","1","E"]
[null,"26615","Treat metacarpal fracture","1","1","E"]
[null,"26641","Treat thumb dislocation","1","1","E"]
[null,"26645","Treat thumb fracture","1","1","E"]
[null,"26650","Treat thumb fracture","1","1","E"]
[null,"26665","Treat thumb fracture","1","1","E"]
[null,"26670","Treat hand dislocation","1","1","E"]
[null,"26675","Treat hand dislocation","1","1","E"]
[null,"26676","Pin hand dislocation","1","1","E"]
[null,"26685","Treat hand dislocation","1","1","E"]
[null,"26686","Treat hand dislocation","1","1","E"]
[null,"26700","Treat knuckle dislocation","1","1","E"]
[null,"26705","Treat knuckle dislocation","1","1","E"]
[null,"26706","Pin knuckle dislocation","1","1","E"]
[null,"26715","Treat knuckle dislocation","1","1","E"]
[null,"26720","Treat finger fracture each","1","1","E"]
[null,"26725","Treat finger fracture each","1","1","E"]
[null,"26727","Treat finger fracture each","1","1","E"]
[null,"26735","Treat finger fracture each","1","1","E"]
[null,"26740","Treat finger fracture each","1","1","E"]
[null,"26742","Treat finger fracture each","1","1","E"]
[null,"26746","Treat finger fracture each","1","1","E"]
[null,"26750","Treat finger fracture each","1","1","E"]
[null,"26755","Treat finger fracture each","1","1","E"]
[null,"26756","Pin finger fracture each","1","1","E"]
[null,"26765","Treat finger fracture each","1","1","E"]
[null,"26770","Treat finger dislocation","1","1","E"]
[null,"26775","Treat finger dislocation","1","1","E"]
[null,"26776","Pin finger dislocation","1","1","E"]
[null,"26785","Treat finger dislocation","1","1","E"]
[null,"26820","Thumb fusion with graft","1","1","E"]
[null,"26841","Fusion of thumb","1","1","E"]
[null,"26842","Thumb fusion with graft","1","1","E"]
[null,"26843","Fusion of hand joint","1","1","E"]
[null,"26844","Fusion/graft of hand joint","1","1","E"]
[null,"26850","Fusion of knuckle","1","1","E"]
[null,"26852","Fusion of knuckle with graft","1","1","E"]
[null,"26860","Fusion of finger joint","1","1","E"]
[null,"26861","Fusion of finger jnt add-on","1","1","E"]
[null,"26862","Fusion/graft of finger joint","1","1","E"]
[null,"26863","Fuse/graft added joint","1","1","E"]
[null,"26910","Amputate metacarpal bone","1","1","E"]
[null,"26951","Amputation of finger/thumb","1","1","E"]
[null,"26952","Amputation of finger/thumb","1","1","E"]
[null,"26989","Hand/finger surgery","1","1","E"]
[null,"26990","Drainage of pelvis lesion","1","1","E"]
[null,"26991","Drainage of pelvis bursa","1","1","E"]
[null,"26992","Drainage of bone lesion","1","1","E"]
[null,"27000","Incision of hip tendon","1","1","E"]
[null,"27001","Incision of hip tendon","1","1","E"]
[null,"27003","Incision of hip tendon","1","1","E"]
[null,"27005","Incision of hip tendon","0","0"]
[null,"27006","Incision of hip tendons","1","1","E"]
[null,"27025","Incision of hip/thigh fascia","1","1","E"]
[null,"27027","Buttock fasciotomy","1","1","E"]
[null,"27030","Drainage of hip joint","0","0"]
[null,"27033","Exploration of hip joint","1","1","E"]
[null,"27035","Denervation of hip joint","1","1","E"]
[null,"27036","Excision of hip joint/muscle","0","0"]
[null,"27040","Biopsy of soft tissues","1","1","E"]
[null,"27041","Biopsy of soft tissues","1","1","E"]
[null,"27043","Exc hip pelvis les sc 3 cm/>","1","1","E"]
[null,"27045","Exc hip/pelv tum deep 5 cm/>","1","1","E"]
[null,"27047","Exc hip/pelvis les sc < 3 cm","1","1","E"]
[null,"27048","Exc hip/pelv tum deep < 5 cm","1","1","E"]
[null,"27049","Resect hip/pelv tum < 5 cm","1","1","E"]
[null,"27050","Biopsy of sacroiliac joint","1","1","E"]
[null,"27052","Biopsy of hip joint","1","1","E"]
[null,"27054","Removal of hip joint lining","0","0"]
[null,"27057","Buttock fasciotomy w/dbrdmt","1","1","E"]
[null,"27059","Resect hip/pelv tum 5 cm/>","1","1","E"]
[null,"27060","Removal of ischial bursa","1","1","E"]
[null,"27062","Remove femur lesion/bursa","1","1","E"]
[null,"27065","Remove hip bone les super","1","1","E"]
[null,"27066","Remove hip bone les deep","1","1","E"]
[null,"27067","Remove/graft hip bone lesion","1","1","E"]
[null,"27070","Part remove hip bone super","0","0"]
[null,"27071","Part removal hip bone deep","0","0"]
[null,"27075","Resect hip tumor","0","0"]
[null,"27076","Resect hip tum incl acetabul","0","0"]
[null,"27077","Resect hip tum w/innom bone","0","0"]
[null,"27078","Rsect hip tum incl femur","0","0"]
[null,"27080","Removal of tail bone","1","1","E"]
[null,"27086","Remove hip foreign body","1","1","E"]
[null,"27087","Remove hip foreign body","1","1","E"]
[null,"27090","Removal of hip prosthesis","0","0"]
[null,"27091","Removal of hip prosthesis","0","0"]
[null,"27093","Injection for hip x-ray","1","1","E"]
[null,"27095","Injection for hip x-ray","1","1","E"]
[null,"27096","Inject sacroiliac joint","0","0"]
[null,"27097","Revision of hip tendon","1","1","E"]
[null,"27098","Transfer tendon to pelvis","1","1","E"]
[null,"27100","Transfer of abdominal muscle","1","1","E"]
[null,"27105","Transfer of spinal muscle","1","1","E"]
[null,"27110","Transfer of iliopsoas muscle","1","1","E"]
[null,"27111","Transfer of iliopsoas muscle","1","1","E"]
[null,"27120","Reconstruction of hip socket","0","0"]
[null,"27122","Reconstruction of hip socket","0","0"]
[null,"27125","Partial hip replacement","0","0"]
["PA","27130","Total hip arthroplasty","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27132","Total hip arthroplasty","0","0"]
[null,"27134","Revise hip joint replacement","0","0"]
[null,"27137","Revise hip joint replacement","0","0"]
[null,"27138","Revise hip joint replacement","0","0"]
[null,"27140","Transplant femur ridge","0","0"]
[null,"27146","Incision of hip bone","0","0"]
[null,"27147","Revision of hip bone","0","0"]
[null,"27151","Incision of hip bones","0","0"]
[null,"27156","Revision of hip bones","0","0"]
[null,"27158","Revision of pelvis","0","0"]
[null,"27161","Incision of neck of femur","0","0"]
[null,"27165","Incision/fixation of femur","0","0"]
[null,"27170","Repair/graft femur head/neck","0","0"]
[null,"27175","Treat slipped epiphysis","0","0"]
[null,"27176","Treat slipped epiphysis","0","0"]
[null,"27177","Treat slipped epiphysis","0","0"]
[null,"27178","Treat slipped epiphysis","0","0"]
[null,"27179","Revise head/neck of femur","1","1","E"]
[null,"27181","Treat slipped epiphysis","0","0"]
["L","27185","Revision of femur epiphysis","1","1","E",null,"0 through 17 years of age"]
[null,"27187","Reinforce hip bones","0","0"]
[null,"27197","Clsd tx pelvic ring fx","1","1","E"]
[null,"27198","Clsd tx pelvic ring fx","1","1","E"]
[null,"27200","Treat tail bone fracture","1","1","E"]
[null,"27202","Treat tail bone fracture","1","1","E"]
[null,"27215","Treat pelvic fracture(s)","0","0"]
[null,"27216","Treat pelvic ring fracture","0","0"]
[null,"27217","Treat pelvic ring fracture","0","0"]
[null,"27218","Treat pelvic ring fracture","0","0"]
[null,"27220","Treat hip socket fracture","1","1","E"]
[null,"27222","Treat hip socket fracture","0","0"]
[null,"27226","Treat hip wall fracture","0","0"]
[null,"27227","Treat hip fracture(s)","0","0"]
[null,"27228","Treat hip fracture(s)","0","0"]
[null,"27230","Treat thigh fracture","1","1","E"]
[null,"27232","Treat thigh fracture","0","0"]
[null,"27235","Treat thigh fracture","1","1","E"]
[null,"27236","Treat thigh fracture","0","0"]
[null,"27238","Treat thigh fracture","1","1","E"]
[null,"27240","Treat thigh fracture","0","0"]
[null,"27244","Treat thigh fracture","0","0"]
[null,"27245","Treat thigh fracture","0","0"]
[null,"27246","Treat thigh fracture","1","1","E"]
[null,"27248","Treat thigh fracture","0","0"]
[null,"27250","Treat hip dislocation","1","1","E"]
[null,"27252","Treat hip dislocation","1","1","E"]
[null,"27253","Treat hip dislocation","0","0"]
[null,"27254","Treat hip dislocation","0","0"]
[null,"27256","Treat hip dislocation","1","1","E"]
[null,"27257","Treat hip dislocation","1","1","E"]
[null,"27258","Treat hip dislocation","0","0"]
[null,"27259","Treat hip dislocation","0","0"]
[null,"27265","Treat hip dislocation","1","1","E"]
[null,"27266","Treat hip dislocation","1","1","E"]
[null,"27267","Cltx thigh fx","1","1","E"]
[null,"27268","Cltx thigh fx w/mnpj","1","1","E"]
[null,"27269","Optx thigh fx","1","1","E"]
[null,"27275","Manipulation of hip joint","1","1","E"]
[null,"27278","ARTHRD SI JT PRQ WO TFXJ DEV","0","0"]
["CPA","27279","Arthrodesis sacroiliac joint","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27280","Fusion of sacroiliac joint","0","0"]
[null,"27282","Fusion of pubic bones","0","0"]
[null,"27284","Fusion of hip joint","0","0"]
[null,"27286","Fusion of hip joint","0","0"]
[null,"27290","Amputation of leg at hip","0","0"]
[null,"27295","Amputation of leg at hip","0","0"]
["CPA","27299","Pelvis/hip joint surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27301","Drain thigh/knee lesion","1","1","E"]
[null,"27303","Drainage of bone lesion","1","1","E"]
[null,"27305","Incise thigh tendon & fascia","1","1","E"]
[null,"27306","Incision of thigh tendon","1","1","E"]
[null,"27307","Incision of thigh tendons","1","1","E"]
["L","27310","Exploration of knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27323","Biopsy thigh soft tissues","1","1","E"]
[null,"27324","Biopsy thigh soft tissues","1","1","E"]
[null,"27325","Neurectomy hamstring","1","1","E"]
[null,"27326","Neurectomy popliteal","1","1","E"]
[null,"27327","Exc thigh/knee les sc < 3 cm","1","1","E"]
[null,"27328","Exc thigh/knee tum deep <5cm","1","1","E"]
[null,"27329","Resect thigh/knee tum < 5 cm","1","1","E"]
["L","27330","Biopsy knee joint lining","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27331","Explore/treat knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27332","Removal of knee cartilage","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27333","Removal of knee cartilage","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27334","Remove knee joint lining","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27335","Remove knee joint lining","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27337","Exc thigh/knee les sc 3 cm/>","1","1","E"]
[null,"27339","Exc thigh/knee tum dep 5cm/>","1","1","E"]
["CPA","27340","Removal of kneecap bursa","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","27345","Removal of knee cyst","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","27347","Remove knee cyst","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27350","Removal of kneecap","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27355","Remove femur lesion","1","1","E"]
[null,"27356","Remove femur lesion/graft","1","1","E"]
[null,"27357","Remove femur lesion/graft","1","1","E"]
[null,"27358","Remove femur lesion/fixation","1","1","E"]
[null,"27360","Partial removal leg bone(s)","1","1","E"]
[null,"27364","Resect thigh/knee tum 5 cm/>","1","1","E"]
[null,"27365","Resect femur/knee tumor","0","0"]
[null,"27369","Njx cntrst kne arthg/ct/mri","1","1","E"]
[null,"27370","Injection for knee x-ray","0","0"]
[null,"27372","Removal of foreign body","1","1","E"]
[null,"27380","Repair of kneecap tendon","1","1","E"]
[null,"27381","Repair/graft kneecap tendon","1","1","E"]
[null,"27385","Repair of thigh muscle","1","1","E"]
[null,"27386","Repair/graft of thigh muscle","1","1","E"]
["L","27390","Incision of thigh tendon","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27391","Incision of thigh tendons","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27392","Incision of thigh tendons","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27393","Lengthening of thigh tendon","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27394","Lengthening of thigh tendons","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27395","Lengthening of thigh tendons","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27396","Transplant of thigh tendon","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27397","Transplants of thigh tendons","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27400","Revise thigh muscles/tendons","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27403","Repair of knee cartilage","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27405","Repair of knee ligament","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27407","Repair of knee ligament","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27409","Repair of knee ligaments","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27412","Autochondrocyte implant knee","0","0"]
["CPA","27415","Osteochondral knee allograft","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","27416","Osteochondral knee autograft","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27418","Repair degenerated kneecap","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27420","Revision of unstable kneecap","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27422","Revision of unstable kneecap","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27424","Revision/removal of kneecap","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27425","Lat retinacular release open","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27427","Reconstruction knee","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27428","Reconstruction knee","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27429","Reconstruction knee","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27430","Revision of thigh muscles","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27435","Incision of knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27437","Revise kneecap","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27438","Revise kneecap with implant","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27440","Revision of knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27441","Revision of knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27442","Revision of knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27443","Revision of knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27445","Revision of knee joint","0","0"]
["L","27446","Revision of knee joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27447","Total knee arthroplasty","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27448","Incision of thigh","0","0"]
[null,"27450","Incision of thigh","0","0"]
[null,"27454","Realignment of thigh bone","0","0"]
["L","27455","Realignment of knee","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","27457","Realignment of knee","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"27465","Shortening of thigh bone","0","0"]
[null,"27466","Lengthening of thigh bone","0","0"]
[null,"27468","Shorten/lengthen thighs","0","0"]
[null,"27470","Repair of thigh","0","0"]
[null,"27472","Repair/graft of thigh","0","0"]
["L","27475","Surgery to stop leg growth","1","1","E"]
["L","27477","Surgery to stop leg growth","1","1","E"]
["L","27479","Surgery to stop leg growth","1","1","E"]
[null,"27485","Surgery to stop leg growth","0","0"]
[null,"27486","Revise/replace knee joint","0","0"]
[null,"27487","Revise/replace knee joint","0","0"]
[null,"27488","Removal of knee prosthesis","0","0"]
[null,"27495","Reinforce thigh","0","0"]
[null,"27496","Decompression of thigh/knee","1","1","E"]
[null,"27497","Decompression of thigh/knee","1","1","E"]
[null,"27498","Decompression of thigh/knee","1","1","E"]
[null,"27499","Decompression of thigh/knee","1","1","E"]
[null,"27500","Treatment of thigh fracture","1","1","E"]
[null,"27501","Treatment of thigh fracture","1","1","E"]
[null,"27502","Treatment of thigh fracture","1","1","E"]
[null,"27503","Treatment of thigh fracture","1","1","E"]
[null,"27506","Treatment of thigh fracture","0","0"]
[null,"27507","Treatment of thigh fracture","0","0"]
[null,"27508","Treatment of thigh fracture","1","1","E"]
[null,"27509","Treatment of thigh fracture","1","1","E"]
[null,"27510","Treatment of thigh fracture","1","1","E"]
[null,"27511","Treatment of thigh fracture","0","0"]
[null,"27513","Treatment of thigh fracture","0","0"]
[null,"27514","Treatment of thigh fracture","0","0"]
[null,"27516","Treat thigh fx growth plate","1","1","E"]
[null,"27517","Treat thigh fx growth plate","1","1","E"]
[null,"27519","Treat thigh fx growth plate","0","0"]
[null,"27520","Treat kneecap fracture","1","1","E"]
[null,"27524","Treat kneecap fracture","1","1","E"]
[null,"27530","Treat knee fracture","1","1","E"]
[null,"27532","Treat knee fracture","1","1","E"]
[null,"27535","Treat knee fracture","0","0"]
[null,"27536","Treat knee fracture","1","1","E"]
[null,"27538","Treat knee fracture(s)","1","1","E"]
[null,"27540","Treat knee fracture","0","0"]
[null,"27550","Treat knee dislocation","1","1","E"]
[null,"27552","Treat knee dislocation","1","1","E"]
[null,"27556","Treat knee dislocation","0","0"]
[null,"27557","Treat knee dislocation","0","0"]
[null,"27558","Treat knee dislocation","0","0"]
[null,"27560","Treat kneecap dislocation","1","1","E"]
[null,"27562","Treat kneecap dislocation","1","1","E"]
[null,"27566","Treat kneecap dislocation","1","1","E"]
[null,"27570","Fixation of knee joint","1","1","E"]
[null,"27580","Fusion of knee","0","0"]
[null,"27590","Amputate leg at thigh","0","0"]
[null,"27591","Amputate leg at thigh","0","0"]
[null,"27592","Amputate leg at thigh","0","0"]
[null,"27594","Amputation follow-up surgery","1","1","E"]
[null,"27596","Amputation follow-up surgery","0","0"]
[null,"27598","Amputate lower leg at knee","0","0"]
["L","27599","Leg surgery procedure","1","1","E",null,"PA age 21+. No PA age <21"]
[null,"27600","Decompression of lower leg","1","1","E"]
[null,"27601","Decompression of lower leg","1","1","E"]
[null,"27602","Decompression of lower leg","1","1","E"]
[null,"27603","Drain lower leg lesion","1","1","E"]
[null,"27604","Drain lower leg bursa","1","1","E"]
[null,"27605","Incision of achilles tendon","1","1","E"]
[null,"27606","Incision of achilles tendon","1","1","E"]
[null,"27607","Treat lower leg bone lesion","1","1","E"]
[null,"27610","Explore/treat ankle joint","1","1","E"]
[null,"27612","Exploration of ankle joint","1","1","E"]
[null,"27613","Biopsy lower leg soft tissue","1","1","E"]
[null,"27614","Biopsy lower leg soft tissue","1","1","E"]
[null,"27615","Resect leg/ankle tum < 5 cm","1","1","E"]
[null,"27616","Resect leg/ankle tum 5 cm/>","1","1","E"]
[null,"27618","Exc leg/ankle tum < 3 cm","1","1","E"]
[null,"27619","Exc leg/ankle tum deep <5 cm","1","1","E"]
[null,"27620","Explore/treat ankle joint","1","1","E"]
[null,"27625","Remove ankle joint lining","1","1","E"]
[null,"27626","Remove ankle joint lining","1","1","E"]
[null,"27630","Removal of tendon lesion","1","1","E"]
[null,"27632","Exc leg/ankle les sc 3 cm/>","1","1","E"]
[null,"27634","Exc leg/ankle tum dep 5 cm/>","1","1","E"]
[null,"27635","Remove lower leg bone lesion","1","1","E"]
[null,"27637","Remove/graft leg bone lesion","1","1","E"]
[null,"27638","Remove/graft leg bone lesion","1","1","E"]
[null,"27640","Partial removal of tibia","1","1","E"]
[null,"27641","Partial removal of fibula","1","1","E"]
[null,"27645","Resect tibia tumor","0","0"]
[null,"27646","Resect fibula tumor","0","0"]
[null,"27647","Resect talus/calcaneus tum","1","1","E"]
[null,"27648","Injection for ankle x-ray","1","1","E"]
[null,"27650","Repair achilles tendon","1","1","E"]
[null,"27652","Repair/graft achilles tendon","1","1","E"]
[null,"27654","Repair of achilles tendon","1","1","E"]
[null,"27656","Repair leg fascia defect","1","1","E"]
[null,"27658","Repair of leg tendon each","1","1","E"]
[null,"27659","Repair of leg tendon each","1","1","E"]
[null,"27664","Repair of leg tendon each","1","1","E"]
[null,"27665","Repair of leg tendon each","1","1","E"]
[null,"27675","Repair lower leg tendons","1","1","E"]
[null,"27676","Repair lower leg tendons","1","1","E"]
[null,"27680","Release of lower leg tendon","1","1","E"]
[null,"27681","Release of lower leg tendons","1","1","E"]
[null,"27685","Revision of lower leg tendon","1","1","E"]
[null,"27686","Revise lower leg tendons","1","1","E"]
[null,"27687","Revision of calf tendon","1","1","E"]
[null,"27690","Revise lower leg tendon","1","1","E"]
[null,"27691","Revise lower leg tendon","1","1","E"]
[null,"27692","Revise additional leg tendon","1","1","E"]
[null,"27695","Repair of ankle ligament","1","1","E"]
[null,"27696","Repair of ankle ligaments","1","1","E"]
[null,"27698","Repair of ankle ligament","1","1","E"]
["L","27700","Revision of ankle joint","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","27702","Reconstruct ankle joint","1","1","E",null,"CPA age 21+, No PA age <21"]
[null,"27703","Reconstruction ankle joint","0","0"]
[null,"27704","Removal of ankle implant","1","1","E"]
[null,"27705","Incision of tibia","1","1","E"]
[null,"27707","Incision of fibula","1","1","E"]
[null,"27709","Incision of tibia & fibula","1","1","E"]
[null,"27712","Realignment of lower leg","0","0"]
[null,"27715","Revision of lower leg","1","1","E"]
[null,"27720","Repair of tibia","1","1","E"]
[null,"27724","Repair/graft of tibia","1","1","E"]
[null,"27745","Reinforce tibia","1","1","E"]
[null,"27767","Cltx post ankle fx","1","1","E"]
[null,"27808","Treatment of ankle fracture","1","1","E"]
[null,"27826","Treat lower leg fracture","1","1","E"]
[null,"27846","Treat ankle dislocation","1","1","E"]
[null,"27886","Amputation follow-up surgery","1","1","E"]
[null,"27888","Amputation of foot at ankle","0","0"]
[null,"28005","Treat foot bone lesion","1","1","E"]
[null,"28041","Exc foot/toe tum dep 1.5cm/>","1","1","E"]
[null,"28060","Partial removal foot fascia","1","1","E"]
[null,"28100","Removal of ankle/heel lesion","1","1","E"]
[null,"28112","Part removal of metatarsal","1","1","E"]
[null,"28126","Partial removal of toe","1","1","E"]
[null,"28190","Removal of foot foreign body","1","1","E"]
[null,"28192","Removal of foot foreign body","1","1","E"]
[null,"28226","Release of foot tendons","1","1","E"]
[null,"28262","Revision of foot and ankle","1","1","E"]
[null,"28291","Corrj halux rigdus w/implt","0","0"]
[null,"28305","Incise/graft midfoot bones","1","1","E"]
[null,"28320","Repair of foot bones","1","1","E"]
[null,"28406","Treatment of heel fracture","1","1","E"]
[null,"28455","Treat midfoot fracture each","1","1","E"]
[null,"28456","Treat midfoot fracture","1","1","E"]
[null,"28505","Treat big toe fracture","1","1","E"]
[null,"28555","Repair foot dislocation","1","1","E"]
[null,"28630","Treat toe dislocation","1","1","E"]
[null,"28715","Fusion of foot bones","1","1","E"]
[null,"28800","Amputation of midfoot","0","0"]
[null,"29015","Application of body cast","1","1","E"]
[null,"29075","Application of forearm cast","1","1","E"]
[null,"29085","Apply hand/wrist cast","1","1","E"]
[null,"29260","Strapping of elbow or wrist","1","1","E"]
[null,"29425","Apply short leg cast","1","1","E"]
[null,"29540","Strapping of ankle and/or ft","1","1","E"]
[null,"29730","Windowing of cast","1","1","E"]
["L","29819","Shoulder arthroscopy/surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","29828","Arthroscopy biceps tenodesis","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","29834","Elbow arthroscopy/surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","29846","Wrist arthroscopy/surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","29862","Hip arthr0 w/debridement","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","29875","Knee arthroscopy/surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","29885","Knee arthroscopy/surgery","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"29895","Ankle arthroscopy/surgery","1","1","E"]
[null,"29906","Subtalar arthro w/deb","1","1","E"]
[null,"30110","Removal of nose polyp(s)","1","1","E"]
[null,"30150","Partial removal of nose","1","1","E"]
[null,"30160","Removal of nose","1","1","E"]
["*PA","30420","Reconstruction of nose","1","1","E",null,"*Covered only for Transhealth / PA required"]
[null,"30520","Repair of nasal septum","1","1","E"]
[null,"30802","Ablate inf turbinate submuc","1","1","E"]
[null,"31000","Irrigation maxillary sinus","1","1","E"]
[null,"31075","Exploration of frontal sinus","1","1","E"]
[null,"31201","Removal of ethmoid sinus","1","1","E"]
[null,"31240","Nasal/sinus endoscopy surg","1","1","E"]
[null,"31241","Nsl/sins ndsc w/artery lig","1","1","E"]
[null,"31267","Endoscopy maxillary sinus","1","1","E"]
[null,"31299","Sinus surgery procedure","1","1","E"]
[null,"31382","Partial removal of larynx","0","0"]
[null,"31511","Remove foreign body larynx","1","1","E"]
[null,"31529","Laryngoscopy and dilation","1","1","E"]
[null,"31551","Laryngoplasty laryngeal sten","1","1","E"]
[null,"31573","Largsc w/ther injection","1","1","E"]
[null,"31574","Largsc w/njx augmentation","1","1","E"]
[null,"31590","Reinnervate larynx","1","1","E"]
[null,"31610","Incision of windpipe","1","1","E"]
[null,"31625","Bronchoscopy w/biopsy(s)","1","1","E"]
[null,"31634","Bronch w/balloon occlusion","1","1","E"]
[null,"31646","Bronchoscopy reclear airway","1","1","E"]
[null,"31661","Bronch thermoplsty 2/> lobes","0","0"]
[null,"31770","Repair/graft of bronchus","0","0"]
[null,"31775","Reconstruct bronchus","0","0"]
["PA","31830","Revise windpipe scar","1","1","E"]
[null,"32120","Re-exploration of chest","0","0"]
[null,"32220","Release of lung","0","0"]
[null,"32480","Partial removal of lung","0","0"]
[null,"32503","Resect apical lung tumor","0","0"]
[null,"32556","Insert cath pleura w/o image","1","1","E"]
[null,"32608","Thoracoscopy w/bx nodule","1","1","E"]
[null,"32609","Thoracoscopy w/bx pleura","1","1","E"]
[null,"32671","Thoracoscopy pneumonectomy","0","0"]
[null,"32850","Donor pneumonectomy","0","0"]
[null,"32906","Revise & repair chest wall","0","0"]
[null,"33018","Prcrd drg 0-5yr or w/anomly","1","1","E"]
[null,"33140","Heart revascularize (tmr)","0","0"]
[null,"33212","Insert pulse gen sngl lead","1","1","E"]
[null,"33222","Revise pocket pacemaker","1","1","E"]
[null,"33223","Revise pocket for defib","1","1","E"]
[null,"33233","Removal of pm generator","1","1","E"]
[null,"33244","Remove eltrd transven","1","1","E"]
[null,"33259","Ablate atria w/bypass add-on","0","0"]
[null,"33269","Excl laa thrscp any method","0","0"]
[null,"33278","RMVL PHRNC NRV STIM SYS","0","0"]
[null,"33288","RMV&RPLCMT PHRNC NRV STIM LD","0","0"]
[null,"33330","Insert major vessel graft","0","0"]
[null,"33366","Trcath replace aortic valve","0","0"]
[null,"33369","Replace aortic valve w/byp","0","0"]
[null,"33414","Repair of aortic valve","0","0"]
[null,"33426","Repair of mitral valve","0","0"]
[null,"33474","Revision of pulmonary valve","0","0"]
[null,"33503","Coronary artery graft","0","0"]
[null,"33512","Cabg vein three","0","0"]
[null,"33523","Cabg art-vein six or more","0","0"]
[null,"33530","Coronary artery bypass/reop","0","0"]
[null,"33600","Closure of valve","0","0"]
[null,"33619","Repair single ventricle","0","0"]
[null,"33675","Close mult vsd","0","0"]
[null,"33697","Repair of heart defects","0","0"]
[null,"33736","Revision of heart chamber","0","0"]
[null,"33766","Major vessel shunt","0","0"]
[null,"33778","Repair great vessels defect","0","0"]
[null,"33779","Repair great vessels defect","0","0"]
[null,"33803","Repair vessel defect","0","0"]
[null,"33852","Repair septal defect","0","0"]
[null,"33875","Thoracic aortic graft","0","0"]
[null,"33897","Perq trluml angp nt/recr coa","1","1","E"]
[null,"33917","Repair pulmonary artery","0","0"]
[null,"33940","Removal of donor heart","0","0"]
[null,"33953","Ecmo/ecls insj prph cannula","0","0"]
[null,"33954","Ecmo/ecls insj prph cannula","0","0"]
[null,"33965","Ecmo/ecls rmvl perph cannula","0","0"]
[null,"33975","Implant ventricular device","0","0"]
[null,"33984","Ecmo/ecls rmvl prph cannula","0","0"]
[null,"33993 ","Reposition vad diff session","0","0"]
[null,"34201","Removal of artery clot","1","1","E"]
[null,"34510","Transposition of vein valve","1","1","E"]
[null,"34707","Evasc rpr ilio-iliac ndgft","0","0"]
[null,"34708","Evasc rpr ilio-iliac rpt","0","0"]
[null,"34718","Evasc rpr n/a a-iliac ndgft","0","0"]
[null,"34841","Endovasc visc aorta 1 graft","0","0"]
[null,"35081","Repair defect of artery","0","0"]
[null,"35122","Repair artery rupture belly","0","0"]
[null,"35184","Repair blood vessel lesion","1","1","E"]
[null,"35221","Repair blood vessel lesion","0","0"]
[null,"35271","Repair blood vessel lesion","0","0"]
[null,"35276","Repair blood vessel lesion","0","0"]
[null,"35351","Rechanneling of artery","0","0"]
[null,"35501","Artery bypass graft","0","0"]
[null,"35521","Artery bypass graft","0","0"]
[null,"35540","Artery bypass graft","0","0"]
[null,"35583","Vein bypass graft","0","0"]
[null,"35626","Artery bypass graft","0","0"]
[null,"35645","Artery bypass graft","0","0"]
[null,"35646","Artery bypass graft","0","0"]
[null,"35681","Composite bypass graft","0","0"]
[null,"35697","Reimplant artery each","0","0"]
[null,"35876","Removal of clot in graft","1","1","E"]
[null,"36002","Pseudoaneurysm injection trt","1","1","E"]
[null,"36140","Establish access to artery","1","1","E"]
[null,"36223","Place cath carotid/inom art","1","1","E"]
[null,"36248","Ins cath abd/l-ext art addl","1","1","E"]
[null,"36251","Ins cath ren art 1st unilat","1","1","E"]
[null,"36416","Capillary blood draw","1","1","E"]
[null,"36455","Bl exchange/transfuse non-nb","1","1","E"]
["CPA","36474","Endovenous mchnchem add-on","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"36510","Insertion of catheter vein","1","1","E"]
[null,"36557","Insert tunneled cv cath","1","1","E"]
[null,"36570","Insert picvad cath","1","1","E"]
[null,"36582","Replace tunneled cv cath","1","1","E"]
[null,"36583","Replace tunneled cv cath","1","1","E"]
[null,"36596","Mech remov tunneled cv cath","1","1","E"]
[null,"36800","Insertion of cannula","1","1","E"]
[null,"36831","Open thrombect av fistula","1","1","E"]
[null,"36901","Intro cath dialysis circuit","1","1","E"]
[null,"37140","Revision of circulation","0","0"]
[null,"37187","Venous mech thrombectomy","1","1","E"]
[null,"37212","Thrombolytic venous therapy","0","0"]
[null,"37213","Thromblytic art/ven therapy","0","0"]
[null,"37223","Iliac revasc w/stent add-on","1","1","E"]
[null,"37232","Tib/per revasc add-on","1","1","E"]
[null,"37242","Vasc embolize/occlude artery","1","1","E"]
[null,"37248","Trluml balo angiop 1st vein","0","0"]
[null,"37617","Ligation of abdomen artery","0","0"]
["CPA","37761","Ligate leg veins open","1","1","E",null,"CPA age 21+. No PA age <21. Please see the Physician-Related Billing Guide"]
[null,"38101","Removal of spleen partial","0","0"]
[null,"38102","Removal of spleen total","0","0"]
[null,"38208","Thaw preserved stem cells","1","1","E"]
[null,"38221","Bone marrow biopsy","1","1","E"]
["L","38241","Bn marrow/stm transplt auto","1","1","E",null,"COE"]
[null,"38505","Needle biopsy lymph nodes","1","1","E"]
[null,"38562","Removal pelvic lymph nodes","0","0"]
[null,"38724","Removal of lymph nodes neck","0","0"]
[null,"38792","Ra tracer id of sentinl node","1","1","E"]
[null,"38794","Access thoracic lymph duct","1","1","E"]
[null,"39501","Repair diaphragm laceration","0","0"]
[null,"40520","Partial excision of lip","1","1","E"]
[null,"40702","Repair cleft lip/nasal","1","1","E"]
[null,"40808","Biopsy of mouth lesion","1","1","E"]
[null,"40831","Repair mouth laceration","1","1","E"]
[null,"41006","Drainage of mouth lesion","1","1","E"]
[null,"41016","Drainage of mouth lesion","1","1","E"]
[null,"41105","Biopsy of tongue","1","1","E"]
[null,"41135","Tongue and neck surgery","0","0"]
[null,"41500","Fixation of tongue","0","0"]
[null,"41820","Excision gum each quadrant","1","1","E"]
[null,"41850","Treatment of gum lesion","1","1","E"]
[null,"42107","Excision lesion mouth roof","1","1","E"]
[null,"42210","Reconstruct cleft palate","1","1","E"]
[null,"42281","Insertion palate prosthesis","1","1","E"]
["L","42299","Palate/uvula surgery","1","1","E"]
[null,"42405","Biopsy of salivary gland","1","1","E"]
[null,"42450","Excise sublingual gland","1","1","E"]
[null,"42660","Dilation of salivary duct","1","1","E"]
[null,"42808","Excise pharynx lesion","1","1","E"]
[null,"42831","Removal of adenoids","1","1","E"]
[null,"42892","Revision of pharyngeal walls","1","1","E"]
[null,"42971","Control nose/throat bleeding","0","0"]
[null,"42972","Control nose/throat bleeding","1","1","E"]
[null,"43112","Removal of esophagus","0","0"]
[null,"43195","Esophagoscopy rigid balloon","1","1","E"]
[null,"43200","Esophagus endoscopy","1","1","E"]
[null,"43213","Esophagoscopy retro balloon","1","1","E"]
[null,"43231","Esoph endoscopy w/us exam","1","1","E"]
[null,"43241","Upper GI endoscopy with tube","1","1","E"]
[null,"43250","Upper GI endoscopy/tumor","1","1","E"]
[null,"43251","Operative upper GI endoscopy","1","1","E"]
[null,"43262","Endo cholangiopancreatograph","1","1","E"]
[null,"43276","Ercp stent exchange w/dilate","1","1","E"]
[null,"43287","Esphg dstl 2/3 w/laps moblj","0","0"]
[null,"43325","Revise esophagus & stomach","0","0"]
[null,"43360","Gastrointestinal repair","0","0"]
[null,"43460","Pressure treatment esophagus","0","0"]
[null,"43610","Excision of stomach lesion","0","0"]
[null,"43611","Excision of stomach lesion","0","0"]
[null,"43640","Vagotomy & pylorus repair","0","0"]
["PA","43659","Laparoscope proc stom","1","1","E"]
[null,"43762","Rplc gtube no revj trc","1","1","E"]
[null,"43810","Fusion of stomach and bowel","0","0"]
[null,"43847","Gastric bypass incl small i","0","0"]
["PA","43887","Remove gastric port open","1","1","E"]
[null,"44111","Excision of bowel lesion(s)","0","0"]
[null,"44120","Removal of small intestine","0","0"]
[null,"44137","Remove intestinal allograft","0","0"]
[null,"44155","Removal of colon/ileostomy","0","0"]
[null,"44204","Laparo partial colectomy","0","0"]
[null,"44310","Ileostomy/jejunostomy","0","0"]
[null,"44360","Small bowel endoscopy","1","1","E"]
[null,"44373","Small bowel endoscopy","1","1","E"]
[null,"44385","Endoscopy of bowel pouch","1","1","E"]
[null,"44386","Endoscopy bowel pouch/biop","1","1","E"]
[null,"44403","Colonoscopy w/resection","1","1","E"]
[null,"44605","Repair of bowel lesion","0","0"]
[null,"44715","Prepare donor intestine","0","0"]
[null,"44979","Laparoscope proc app","1","1","E"]
[null,"45114","Partial removal of rectum","0","0"]
[null,"45160","Excision of rectal lesion","1","1","E"]
[null,"45309","Proctosigmoidoscopy removal","1","1","E"]
[null,"45320","Proctosigmoidoscopy ablate","1","1","E"]
[null,"45335","Sigmoidoscopy w/submuc inj","1","1","E"]
[null,"45350","Sgmdsc w/band ligation","0","0"]
[null,"45388","Colonoscopy w/ablation","1","1","E"]
["PA","45399","Unlisted procedure colon","1","1","E"]
[null,"45563","Exploration/repair of rectum","0","0"]
[null,"46020","Placement of seton","1","1","E"]
[null,"46200","Removal of anal fissure","1","1","E"]
[null,"46220","Excise anal ext tag/papilla","1","1","E"]
[null,"46262","Remove in/ex hem grps w/fist","1","1","E"]
[null,"46600","Diagnostic anoscopy","1","1","E"]
[null,"46614","Anoscopy control bleeding","1","1","E"]
[null,"46746","Repair of cloacal anomaly","0","0"]
[null,"46910","Destruction anal lesion(s)","1","1","E"]
[null,"46946","Int hrhc lig 2+hroid w/o img","1","1","E"]
[null,"47122","Extensive removal of liver","0","0"]
[null,"47125","Partial removal of liver","0","0"]
[null,"47145","Prep donor liver lobe split","0","0"]
[null,"47371","Laparo ablate liver cryosurg","1","1","E"]
[null,"47490","Incision of gallbladder","1","1","E"]
[null,"47537","Removal biliary drg cath","1","1","E"]
[null,"47552","Biliary endoscopy thru skin","1","1","E"]
[null,"47600","Removal of gallbladder","0","0"]
[null,"47715","Excision of bile duct cyst","0","0"]
[null,"47720","Fuse gallbladder & bowel","0","0"]
[null,"47802","Fuse liver duct & intestine","0","0"]
[null,"48146","Pancreatectomy","0","0"]
[null,"48500","Surgery of pancreatic cyst","0","0"]
[null,"48554","Transpl allograft pancreas","0","0"]
[null,"49060","Drain open retrop abscess","0","0"]
[null,"49188","OPN EXC/DST NTRA-ABD 10.1-20","1","1","E"]
[null,"49320","Diag laparo separate proc","1","1","E"]
[null,"49321","Laparoscopy biopsy","1","1","E"]
[null,"49402","Remove foreign body adbomen","1","1","E"]
[null,"49423","Exchange drainage catheter","1","1","E"]
[null,"49441","Place duod/jej tube perc","1","1","E"]
[null,"49492","Rpr ing hern premie blocked","1","1","E"]
[null,"49525","Repair ing hernia sliding","1","1","E"]
[null,"49555","Rerepair fem hernia reduce","1","1","E"]
[null,"49617","Rpr aa hrn rcr > 10 rdc","1","1","E"]
[null,"49618","Rpr aa hrn rcr > 10 ncr/strn","1","1","E"]
[null,"50010","Exploration of kidney","0","0"]
[null,"50081","Removal of kidney stone","1","1","E"]
[null,"50225","Removal kidney open complex","0","0"]
[null,"50323","Prep cadaver renal allograft","0","0"]
[null,"50380","Reimplantation of kidney","0","0"]
[null,"50395","Create passage to kidney","0","0"]
[null,"50435","Exchange nephrostomy cath","1","1","E"]
[null,"50436","Dilat xst trc ndurlgc px","1","1","E"]
[null,"50543","Laparo partial nephrectomy","1","1","E"]
[null,"50555","Kidney endoscopy & biopsy","1","1","E"]
[null,"50580","Kidney endoscopy & treatment","1","1","E"]
[null,"50630","Removal of ureter stone","0","0"]
[null,"50695","Plmt ureteral stent prq","1","1","E"]
[null,"50740","Fusion of ureter & kidney","0","0"]
[null,"50810","Fusion of ureter & bowel","0","0"]
[null,"50815","Urine shunt to intestine","0","0"]
[null,"50930","Closure ureter/bowel fistula","0","0"]
[null,"50970","Ureter endoscopy","1","1","E"]
[null,"51050","Removal of bladder stone","1","1","E"]
[null,"51525","Removal of bladder lesion","0","0"]
[null,"51585","Removal of bladder & nodes","0","0"]
[null,"51701","Insert bladder catheter","1","1","E"]
[null,"51726","Complex cystometrogram","1","1","E"]
[null,"51727","Cystometrogram w/up","1","1","E"]
[null,"51798","Us urine capacity measure","1","1","E"]
[null,"51900","Repair bladder/vagina lesion","0","0"]
["PA","52000","Cystoscopy","1","1","E",null,"*PA required if for Transhealth"]
[null,"52235","Cystoscopy and treatment","1","1","E"]
[null,"52281","Cystoscopy and treatment","1","1","E"]
[null,"52305","Cystoscopy and treatment","1","1","E"]
[null,"52332","Cystoscopy and treatment","1","1","E"]
[null,"52334","Create passage to kidney","1","1","E"]
[null,"52353","Cystouretero w/lithotripsy","1","1","E"]
[null,"52500","Revision of bladder neck","1","1","E"]
[null,"53010","Incision of urethra","1","1","E"]
[null,"53215","Removal of urethra","1","1","E"]
[null,"53400","Revise urethra stage 1","1","1","E"]
[null,"53442","Remove/revise male sling","1","1","E"]
[null,"53453","Tprnl balo cntnc dev rmvl ea","0","0"]
[null,"53454","Tprnl balo cntnc dev adjmt","0","0"]
[null,"53601","Dilate urethra stricture","1","1","E"]
[null,"53854","Trurl dstrj prst8 tiss rf wv","1","1","E"]
[null,"54050","Destruction penis lesion(s)","1","1","E"]
[null,"54111","Treat penis lesion graft","1","1","E"]
["L","54161","Circum 28 days or older","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"54235","Penile injection","1","1","E"]
[null,"54322","Reconstruction of urethra","1","1","E"]
[null,"54324","Reconstruction of urethra","1","1","E"]
[null,"54360","Penis plastic surgery","1","1","E"]
[null,"54411","Remov/replc penis pros comp","0","0"]
[null,"54500","Biopsy of testis","1","1","E"]
[null,"54600","Reduce testis torsion","1","1","E"]
[null,"54699","Laparoscope proc testis","1","1","E"]
[null,"54901","Fusion of spermatic ducts","1","1","E"]
["*PA","55180","Revision of scrotum","1","1","E",null,"*PA required if for Transhealth"]
[null,"55200","Incision of sperm duct","1","1","E"]
[null,"55550","Laparo ligate spermatic vein","1","1","E"]
[null,"55801","Removal of prostate","0","0"]
[null,"55862","Extensive prostate surgery","0","0"]
[null,"55880","Abltj mal prst8 tiss hifu","0","0"]
[null,"56440","Surgery for vulva lesion","1","1","E"]
[null,"56630","Extensive vulva surgery","0","0"]
["*PA","56800","Repair of vagina","1","1","E",null,"*PA required if for Transhealth"]
["*PA","56805","Repair clitoris","1","1","E",null,"*PA required if for Transhealth"]
["*PA","57061","Destroy vag lesions simple","1","1","E",null,"*PA required if for Transhealth"]
[null,"57120","Closure of vagina","1","1","E"]
[null,"57200","Repair of vagina","1","1","E"]
[null,"57268","Repair of bowel bulge","1","1","E"]
[null,"57289","Repair bladder & vagina","1","1","E"]
[null,"57311","Repair urethrovaginal lesion","0","0"]
[null,"57423","Repair paravag defect lap","1","1","E"]
["*PA","57425","Laparoscopy surg colpopexy","1","1","E",null,"*PA required if for Transhealth"]
[null,"57500","Biopsy of cervix","1","1","E"]
[null,"57545","Remove cervix/repair pelvis","0","0"]
[null,"58110","Bx done w/colposcopy add-on","1","1","E"]
[null,"58210","Extensive hysterectomy","0","0"]
["CPA","58290","Vag hyst complex","1","1","E"]
[null,"58340","Catheter for hysterography","1","1","E"]
["CPA/PA/EPA","58544","Lsh w/t/o uterus above 250 g","1","1","E"]
[null,"58545","Laparoscopic myomectomy","1","1","E"]
[null,"58559","Hysteroscopy lysis","1","1","E"]
["CPA/PA/EPA","58573","Tlh w/t/o uterus over 250 g","1","1","E"]
[null,"58660","Laparoscopy lysis","1","1","E"]
[null,"58700","Removal of fallopian tube","0","0"]
[null,"58822","Drain ovary abscess percut","0","0"]
[null,"58952","Resect ovarian malignancy","0","0"]
[null,"58999","Genital surgery procedure","1","1","E"]
[null,"59000","Amniocentesis diagnostic","1","1","E"]
[null,"59070","Transabdom amnioinfus w/us","1","1","E"]
[null,"59151","Treat ectopic pregnancy","1","1","E"]
[null,"59412","Antepartum manipulation","1","1","E"]
[null,"59610","Vbac delivery","0","0"]
[null,"59812","Treatment of miscarriage","1","1","E"]
[null,"59898","Laparo proc ob care/deliver","1","1","E"]
[null,"60240","Removal of thyroid","1","1","E"]
[null,"60252","Removal of thyroid","1","1","E"]
[null,"60502","Re-explore parathyroids","1","1","E"]
[null,"60605","Remove carotid body lesion","0","0"]
[null,"61026","Injection into brain canal","1","1","E"]
[null,"61150","Pierce skull for drainage","0","0"]
[null,"61305","Open skull for exploration","0","0"]
[null,"61323","Decompressive lobectomy","0","0"]
[null,"61460","Incise skull for surgery","0","0"]
[null,"61480","Incise skull for surgery","0","0"]
[null,"61519","Remove brain lining lesion","0","0"]
[null,"61534","Removal of brain lesion","0","0"]
[null,"61544","Remove & treat brain lesion","0","0"]
[null,"61559","Excision of skull/sutures","0","0"]
[null,"61581","Craniofacial approach skull","0","0"]
[null,"61595","Transtemporal approach/skull","0","0"]
[null,"61608","Resect/excise cranial lesion","0","0"]
[null,"61618","Repair dura","0","0"]
[null,"61626","Transcath occlusion non-cns","1","1","E"]
[null,"61684","Intracranial vessel surgery","0","0"]
[null,"61705","Revise circulation to head","0","0"]
[null,"61750","Incise skull/brain biopsy","0","0"]
["EPA/PA","61796","Srs, cranial lesion simple","1","1","E"]
[null,"61868","Implant neuroelectrde addl","0","0"]
[null,"62005","Treat skull fracture","0","0"]
[null,"62010","Treatment of head injury","0","0"]
[null,"62143","Replace skull plate/flap","0","0"]
[null,"62165","Remove pituit tumor w/scope","0","0"]
[null,"62225","Replace/irrigate catheter","1","1","E"]
[null,"62269","Needle biopsy spinal cord","1","1","E"]
["L","62290","Inject for spine disk x-ray","1","1","E",null,"PA age 21+. No PA age <21"]
["CPA/EPA","62321","Njx interlaminar crv/thrc","1","1","E",null,"CPA age 21+. No PA age <21 EPA**"]
[null,"62350","Implant spinal canal cath","1","1","E"]
[null,"62351","Implant spinal canal cath","1","1","E"]
[null,"62370","Anl sp inf pmp w/mdreprg&fil","1","1","E"]
["L","63017","Removal of spinal lamina","1","1","E",null,"CPA age 21+. No PA age <21"]
["L","63046","Removal of spinal lamina","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"63078","Spine disk surgery thorax","0","0"]
[null,"63088","Remove vertebral body add-on","0","0"]
[null,"63185","Incise spinal column/nerves","0","0"]
["L","63267","Excise intraspinal lesion","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"63268","Excise intraspinal lesion","0","0"]
[null,"63280","Biopsy/excise spinal tumor","0","0"]
[null,"63300","Removal of vertebral body","0","0"]
[null,"63600","Remove spinal cord lesion","1","1","E"]
["PA","63663","Revise spine eltrd perq aray","1","1","E"]
[null,"63710","Graft repair of spine defect","0","0"]
[null,"64416","Njx aa&/strd brach plex nfs","1","1","E"]
[null,"64446","Njx aa&/strd sciatic nrv nfs","1","1","E"]
[null,"64447","Njx aa&/strd femoral nerve","1","1","E"]
[null,"64463","Pvb thoracic cont infusion","0","0"]
["CPA","64483","Inj foramen epidural l/s","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","64493","Inj paravert f jnt l/s 1 lev","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"64550","Apply neurostimulator","0","0"]
["PA","64580","Implant neuroelectrodes","1","1","E"]
[null,"64597","INS/RPLCM PRQ ELTRD RA PN EA","0","0"]
["PA","64611","Chemodenerv saliv glands","1","1","E"]
[null,"64624","Dstrj nulyt agt gnclr nrv","0","0"]
["CPA","64636","Destroy l/s facet jnt addl","1","1","E",null,"CPA age 21+. No PA age <21"]
["PA","64653","Chemodenerv eccrine glands","1","1","E"]
["CPA","64716","Revision of cranial nerve","1","1","E",null,"CPA age 21+. No PA age <21"]
[null,"64736","Incision of chin nerve","1","1","E"]
[null,"64766","Incise hip/thigh nerve","1","1","E"]
[null,"64786","Remove sciatic nerve lesion","1","1","E"]
[null,"64820","Remove sympathetic nerves","1","1","E"]
[null,"64821","Remove sympathetic nerves","1","1","E"]
[null,"64840","Repair of leg nerve","1","1","E"]
[null,"64872","Subsequent repair of nerve","1","1","E"]
[null,"64895","Nerve graft hand or foot","1","1","E"]
[null,"64911","Neurorraphy w/vein autograft","1","1","E"]
[null,"65110","Removal of eye","1","1","E"]
[null,"65175","Removal of ocular implant","1","1","E"]
[null,"65272","Repair of eye wound","1","1","E"]
[null,"65273","Repair of eye wound","0","0"]
[null,"65426","Removal of eye lesion","1","1","E"]
[null,"65767","Corneal tissue transplant","0","0"]
[null,"65778","Cover eye w/membrane","1","1","E"]
[null,"65820","Relieve inner eye pressure","1","1","E"]
[null,"65920","Remove implant of eye","1","1","E"]
[null,"66172","Incision of eye","1","1","E"]
[null,"66225","Repair/graft eye lesion","1","1","E"]
[null,"66250","Follow-up surgery of eye","1","1","E"]
[null,"66682","Repair iris & ciliary body","1","1","E"]
[null,"66770","Removal of inner eye lesion","1","1","E"]
[null,"66930","Extraction of lens","1","1","E"]
["PA","66989","Xcpsl ctrc rmvl cplx insj 1+","1","1","E"]
[null,"67028","Injection eye drug","1","1","E"]
[null,"67101","Repair detached retina","1","1","E"]
[null,"67141","Treatment of retina","1","1","E"]
[null,"67145","Treatment of retina","1","1","E"]
[null,"67229","Tr retinal les preterm inf","1","1","E"]
["EPA","67320","Revise eye muscle(s) add-on","1","1","E"]
[null,"67399","Eye muscle surgery procedure","1","1","E"]
[null,"67440","Explore/drain eye socket","1","1","E"]
[null,"67516","SPRCHOROIDAL SPC NJX RX AGT","0","0"]
[null,"67820","Revise eyelashes","1","1","E"]
["PA","67900","Repair brow defect","1","1","E"]
["EPA/PA","67901","Repair eyelid defect","1","1","E"]
[null,"67914","Repair eyelid defect","1","1","E"]
[null,"67935","Repair eyelid wound","1","1","E"]
[null,"67999","Revision of eyelid","1","1","E"]
[null,"68320","Revise/graft eyelid lining","1","1","E"]
["PA","68371","Harvest eye tissue alograft","1","1","E"]
[null,"68525","Biopsy of tear sac","1","1","E"]
[null,"68760","Close tear duct opening","1","1","E"]
[null,"68761","Close tear duct opening","1","1","E"]
[null,"68850","Injection for tear sac x-ray","1","1","E"]
[null,"69120","Removal of external ear","1","1","E"]
[null,"69220","Clean out mastoid cavity","1","1","E"]
["EPA/PA","69433","Create eardrum opening","1","1","E",null," EPA/PA required for age 16 and younger. Please see the Physicians -Related Billing Guide"]
[null,"69535","Remove part of temporal bone","0","0"]
[null,"69610","Repair of eardrum","1","1","E"]
[null,"69642","Revise middle ear & mastoid","1","1","E"]
[null,"69644","Revise middle ear & mastoid","1","1","E"]
[null,"69670","Remove mastoid air cells","1","1","E"]
["PA","69717","Temple bone implant revision","1","1","E"]
[null,"69740","Repair facial nerve","1","1","E"]
["PA/EPA","69930","Implant cochlear device","1","1","E",null,"EPA/PA - 0 through 20 years of age. PA age 21+. No PA age <21. Please see the Physician-Related Billing Guide"]
[null,"70015","Contrast x-ray of brain","1","1","E"]
[null,"70160","X-ray exam of nasal bones","1","1","E"]
[null,"70300","X-ray exam of teeth","1","1","E"]
[null,"70310","X-ray exam of teeth","1","1","E"]
[null,"70370","Throat x-ray & fluoroscopy","1","1","E"]
[null,"70482","Ct orbit/ear/fossa w/o&w/dye","1","1","E"]
["CPA/EPA/PA","70540","Mri orbit/face/neck w/o dye","1","1","E",null,"CPA age 21+. No PA age <21"]
["CPA","70551","Mri brain w/o dye","1","1","E"]
[null,"71046","X-ray exam chest 2 views","1","1","E"]
[null,"71250","Ct thorax w/o dye","1","1","E"]
[null,"72020","X-ray exam of spine","1","1","E"]
[null,"72040","X-ray exam of neck spine","1","1","E"]
[null,"72083","X-ray exam entire spi 4/5 vw","1","1","E"]
[null,"72128","Ct chest spine w/o dye","1","1","E"]
["CPA","72149","Mri lumbar spine w/dye","1","1","E"]
["CPA","72192","Ct pelvis w/o dye","1","1","E"]
[null,"72220","X-ray exam of tailbone","1","1","E"]
[null,"73020","X-ray exam of shoulder","1","1","E"]
[null,"73092","X-ray exam of arm infant","1","1","E"]
[null,"73100","X-ray exam of wrist","1","1","E"]
[null,"73206","Ct angio upr extrm w/o&w/dye","1","1","E"]
[null,"73502","X-ray exam hip uni 2-3 views","1","1","E"]
[null,"73562","X-ray exam of knee 3","1","1","E"]
[null,"73620","X-ray exam of foot","1","1","E"]
[null,"73719","Mri lower extremity w/dye","1","1","E"]
[null,"74022","X-ray exam complete abdomen","1","1","E"]
[null,"74181","Mri abdomen w/o dye","1","1","E"]
[null,"74182","Mri abdomen w/dye","1","1","E"]
[null,"74240","X-ray xm upr gi trc 1cntrst","1","1","E"]
[null,"74280","X-ray xm colon 2cntrst std","1","1","E"]
[null,"74355","X-ray guide intestinal tube","1","1","E"]
[null,"74440","X-ray male genital tract","1","1","E"]
[null,"74742","X-ray fallopian tube","1","1","E"]
[null,"75559","Cardiac mri w/stress img","1","1","E"]
[null,"75716","Artery x-rays arms/legs","1","1","E"]
[null,"75726","Artery x-rays abdomen","1","1","E"]
[null,"75801","Lymph vessel x-ray arm/leg","1","1","E"]
[null,"75827","Vein x-ray chest","1","1","E"]
[null,"75885","Vein x-ray liver","1","1","E"]
[null,"75970","Vascular biopsy","1","1","E"]
[null,"76017","MR SFTY MED PHYSICS XM CSTMZ","0","0"]
[null,"76145","Med physic dos eval rad exps","0","0"]
["PA","76499","Radiographic procedure","1","1","E"]
[null,"76506","Echo exam of head","1","1","E"]
[null,"76536","Us exam of head and neck","1","1","E"]
[null,"76776","Us exam k transpl w/doppler","1","1","E"]
[null,"76814","Ob us nuchal meas add-on","1","1","E"]
[null,"76826","Echo exam of fetal heart","1","1","E"]
[null,"76873","Echograp trans r pros study","1","1","E"]
[null,"76940","Us guide tissue ablation","1","1","E"]
["L","76978","Us trgt dyn mbubb 1st les","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L","76979","Us trgt dyn mbubb ea addl","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"77003","Fluoroguide for spine inject","1","1","E"]
["CPA","77046","Mri breast c- unilateral","1","1","E"]
[null,"77062","Breast tomosynthesis bi","0","0"]
[null,"77075","X-rays bone survey complete","1","1","E"]
[null,"77089","Tbs dxa cal w/i&r fx risk","0","0"]
[null,"77290","Set radiation therapy field","1","1","E"]
[null,"77317","Brachytx isodose intermed","1","1","E"]
[null,"77318","Brachytx isodose complex","1","1","E"]
["EPA/PA","77371","Srs multisource","1","1","E"]
[null,"77407","Radiation treatment delivery","1","1","E"]
["EPA/PA","77435","Sbrt management","1","1","E"]
[null,"77605","Hyperthermia treatment","1","1","E"]
[null,"77768","Hdr rdncl skn surf brachytx","0","0"]
[null,"78013","Thyroid imaging w/blood flow","1","1","E"]
[null,"78075","Adrenal nuclear imaging","1","1","E"]
[null,"78099","Endocrine nuclear procedure","1","1","E"]
[null,"78130","Red cell survival study","1","1","E"]
[null,"78216","Liver & spleen image/flow","1","1","E"]
[null,"78264","Gastric emptying study","1","1","E"]
[null,"78278","Acute GI blood loss imaging","1","1","E"]
[null,"78399","Musculoskeletal nuclear exam","1","1","E"]
[null,"78445","Vascular flow imaging","1","1","E"]
["CPA","78466","Heart infarct image","1","1","E"]
["CPA","78468","Heart infarct image (ef)","1","1","E"]
[null,"78496","Heart first pass add-on","1","1","E"]
[null,"78601","Brain image w/flow < 4 views","1","1","E"]
[null,"78650","CSF leakage imaging","1","1","E"]
[null,"78730","Urinary bladder retention","1","1","E"]
[null,"78808","Iv inj ra drug dx study","1","1","E"]
["CPA","78832","Rp loclzj tum spect w/ct 2","1","1","E"]
[null,"79445","Nuclear rx intra-arterial","1","1","E"]
[null,"79999","Nuclear medicine therapy","1","1","E"]
[null,"80074","Acute hepatitis panel","1","1","E"]
[null,"80157","Assay carbamazepine free","1","1","E"]
[null,"80168","Assay of ethosuximide","1","1","E"]
[null,"80179","Drug assay salicylate","1","1","E"]
[null,"80189","Drug assay itraconzaole","1","1","E"]
[null,"80200","Assay of tobramycin","1","1","E"]
[null,"80280","Drug assay vedolizumab","1","1","E"]
[null,"80299","Quantitative assay drug","1","1","E"]
[null,"80325","Amphetamines 3or 4","0","0"]
[null,"80334","Antidepressants class 6/more","0","0"]
[null,"80343","Antipsychotics nos 4-6","0","0"]
[null,"80352","Cannabinoid synthetic 7/more","0","0"]
[null,"80361","Opiates 1 or more","0","0"]
[null,"80370","Skel musc relaxant 3 or more","0","0"]
[null,"80402","Acth stimulation panel","1","1","E"]
[null,"80406","Acth stimulation panel","1","1","E"]
[null,"80420","Dexamethasone panel","1","1","E"]
[null,"80436","Metyrapone panel","1","1","E"]
[null,"81002","Urinalysis nonauto w/o scope","1","1","E"]
["L","81105","Hpa-1 genotyping","1","1","E"]
["L","81121","Idh2 common variants","1","1","E"]
["PA","81170","Abl1 gene","1","1","E"]
["L/PA","81179","Atxn2 gene detc abnor allele","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L/PA","81180","Atxn3 gene detc abnor allele","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L/PA","81189","Cstb gene full gene sequence","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["PA","81202","Apc gene known fam variants","1","1","E"]
["L/EPA/PA","81212","Brca1&2 185&5385&6174 var","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L/PA","81221","Cftr gene known fam variants","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"81230","Cyp3a4 gene common variants","0","0"]
["L/PA","81239","Dmpk gene charac alleles","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L","81248","G6pd known familial variant","1","1","E"]
["L","81249","G6pd full gene sequence","1","1","E"]
["L","81258","Hba1/hba2 gene fam vrnt","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"81267","Chimerism anal no cell selec","0","0"]
[null,"81276","Kras gene addl variants","0","0"]
["PA","81288","Mlh1 gene","1","1","E"]
["L/PA","81297","Msh2 gene dup/delete variant","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"81306","Nudt15 gene common variants","1","1","E"]
["PA","81315","Pml/raralpha com breakpoints","1","1","E"]
["L/PA","81316","Pml/raralpha 1 breakpoint","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L/PA","81325","Pmp22 gene full sequence","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L/PA","81334","Runx1 gene targeted seq alys","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L/PA","81343","Ppp2r2b gen detc abnor allel","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"81352","Tp53 gene trgt sequence alys","0","0"]
[null,"81371","Hla i & ii type verify lr","1","1","E"]
[null,"81380","Hla i typing 1 locus hr","1","1","E"]
["PA","81405","Mopath procedure level 6","1","1","E"]
["PA","81406","Mopath procedure level 7","1","1","E"]
["PA","81416","Exome sequence analysis","1","1","E"]
["PA","81430","Hearing loss sequence analys","1","1","E"]
[null,"81439","Inherited cardmypthy 5 gns","0","0"]
["PA/EPA","81451","Tgsap hl neo 5-50 rna alys","1","1","E"]
["PA","81464","SO GSAP CLL FR MCRSTL INS","1","1","E"]
[null,"81504","Oncology tissue of origin","0","0"]
[null,"81514","Nfct ds bv&vaginitis dna alg","0","0"]
[null,"81515","NFCT DS BV&VAGINITIS DNA ALG","0","0"]
["PA","81528","Oncology colorectal scr","1","1","E"]
["PA/EPA","81546","Onc thyr mrna 10,196 gen alg","1","1","E",null,"1 per client per lifetime"]
[null,"82009","Test for acetone/ketones","1","1","E"]
[null,"82043","Microalbumin quantitative","1","1","E"]
[null,"82105","Alpha-fetoprotein serum","1","1","E"]
[null,"82136","Amino acids quant 2-5","1","1","E"]
[null,"82164","Angiotensin I enzyme test","1","1","E"]
[null,"82232","Assay of beta-2 protein","1","1","E"]
[null,"82252","Fecal bilirubin test","1","1","E"]
[null,"82308","Assay of calcitonin","1","1","E"]
[null,"82373","Assay c-d transfer measure","1","1","E"]
[null,"82384","Assay three catecholamines","1","1","E"]
[null,"82465","Assay bld/serum cholesterol","1","1","E"]
[null,"82530","Cortisol free","1","1","E"]
[null,"82570","Assay of urine creatinine","1","1","E"]
[null,"82575","Creatinine clearance test","1","1","E"]
[null,"82627","Dehydroepiandrosterone","1","1","E"]
[null,"82658","Enzyme cell activity ra","1","1","E"]
[null,"82693","Assay of ethylene glycol","1","1","E"]
[null,"82735","Assay of fluoride","1","1","E"]
[null,"82784","Assay iga/igd/igg/igm each","1","1","E"]
[null,"82938","Gastrin test","1","1","E"]
[null,"82952","GTT-added samples","1","1","E"]
[null,"82955","Assay of g6pd enzyme","1","1","E"]
[null,"83001","Gonadotropin (FSH)","1","1","E"]
[null,"83015","Heavy metal screen","1","1","E"]
[null,"83033","Fetal hemoglobin assay qual","1","1","E"]
[null,"83090","Assay of homocystine","1","1","E"]
[null,"83519","Ria nonantibody","1","1","E"]
[null,"83570","Assay of idh enzyme","1","1","E"]
[null,"83632","Placental lactogen","1","1","E"]
[null,"83633","Test urine for lactose","1","1","E"]
[null,"83698","Assay lipoprotein pla2","1","1","E"]
[null,"83735","Assay of magnesium","1","1","E"]
[null,"83872","Assay synovial fluid mucin","1","1","E"]
[null,"83918","Organic acids total quant","1","1","E"]
[null,"83970","Assay of parathormone","1","1","E"]
[null,"84075","Assay alkaline phosphatase","1","1","E"]
[null,"84110","Assay of porphobilinogen","1","1","E"]
[null,"84112","Placenta alpha micro ig c/v","0","0"]
[null,"84140","Assay of pregnenolone","1","1","E"]
[null,"84155","Assay of protein serum","1","1","E"]
[null,"84202","Assay RBC protoporphyrin","1","1","E"]
[null,"84235","Assay of endocrine hormone","1","1","E"]
[null,"84295","Assay of serum sodium","1","1","E"]
[null,"84375","Chromatogram assay sugars","1","1","E"]
[null,"84432","Assay of thyroglobulin","1","1","E"]
[null,"84433","Asy thiopurin s-mthyltrnsfrs","1","1","E"]
[null,"84450","Transferase (AST) (SGOT)","1","1","E"]
[null,"84485","Assay duodenal fluid trypsin","1","1","E"]
[null,"84550","Assay of blood/uric acid","1","1","E"]
[null,"84590","Assay of vitamin a","1","1","E"]
[null,"84704","Hcg free betachain test","1","1","E"]
[null,"85014","Hematocrit","1","1","E"]
[null,"85048","Automated leukocyte count","1","1","E"]
[null,"85049","Automated platelet count","1","1","E"]
[null,"85230","Blood clot factor VII test","1","1","E"]
[null,"85280","Blood clot factor XII test","1","1","E"]
[null,"85305","Blood clot inhibitor assay","1","1","E"]
[null,"85362","Fibrin degradation products","1","1","E"]
[null,"85396","Clotting assay whole blood","1","1","E"]
[null,"85460","Hemoglobin fetal","1","1","E"]
[null,"85549","Muramidase","1","1","E"]
[null,"85555","RBC osmotic fragility","1","1","E"]
[null,"85730","Thromboplastin time partial","1","1","E"]
[null,"85999","Hematology procedure","1","1","E"]
[null,"86023","Immunoglobulin assay","1","1","E"]
[null,"86052","Aquaporin-4 antb cba each","1","1","E"]
[null,"86146","Glycoprotein antibody","1","1","E"]
[null,"86161","Complement/function activity","1","1","E"]
[null,"86255","Fluorescent antibody screen","1","1","E"]
[null,"86256","Fluorescent antibody titer","1","1","E"]
[null,"86308","Heterophile antibodies","1","1","E"]
[null,"86328"," IA NFCT AB SARSCOV2 COVID19","1","1","E"]
[null,"86341","Islet cell antibody","1","1","E"]
[null,"86360","T cell absolute count/ratio","1","1","E"]
[null,"86382","Neutralization test viral","1","1","E"]
[null,"86431","Rheumatoid factor quant","1","1","E"]
[null,"86590","Streptokinase antibody","1","1","E"]
[null,"86592","Syphilis test non-trep qual","1","1","E"]
[null,"86615","Bordetella antibody","1","1","E"]
[null,"86635","Coccidioides antibody","1","1","E"]
[null,"86654","Encephalitis antibody","1","1","E"]
[null,"86687","Htlv-i antibody","1","1","E"]
[null,"86698","Histoplasma","1","1","E"]
[null,"86709","Hep a antibody igm","1","1","E"]
[null,"86735","Mumps antibody","1","1","E"]
[null,"86738","Mycoplasma antibody","1","1","E"]
[null,"86762","Rubella antibody","1","1","E"]
[null,"86784","Trichinella antibody","1","1","E"]
[null,"86804","Hep c ab test confirm","1","1","E"]
["L","86821","Lymphocyte culture mixed","1","1","E"]
["L","86834","Hla class i semiquant panel","1","1","E",null,"COE"]
[null,"86890","Autologous blood process","1","1","E"]
[null,"86911","Blood typing antigen system","0","0"]
[null,"86920","Compatibility test spin","1","1","E"]
[null,"86941","Hemolysins/agglutinins","1","1","E"]
[null,"86976","Rbc pretreatment serum","1","1","E"]
[null,"87046","Stool cultr bacteria each","1","1","E"]
[null,"87086","Urine culture/colony count","1","1","E"]
[null,"87116","Mycobacteria culture","1","1","E"]
[null,"87154","Cul typ id bld pthgn 6+ trgt","0","0"]
[null,"87168","Macroscopic exam arthropod","1","1","E"]
[null,"87185","Microbe susceptible enzyme","1","1","E"]
[null,"87209","Smear complex stain","1","1","E"]
[null,"87260","Adenovirus ag if","1","1","E"]
[null,"87275","Influenza b ag if","1","1","E"]
[null,"87299","Antibody detection nos if","1","1","E"]
[null,"87332","Cytomegalovirus ag eia","1","1","E"]
[null,"87380","Hepatitis delta ag eia","1","1","E"]
[null,"87427","Shiga-like toxin ag eia","1","1","E"]
[null,"87428"," SARSCOV & INF VIR A&B AG IA","1","1","E"]
[null,"87475","Lyme dis dna dir probe","1","1","E"]
[null,"87486","Chylmd pneum dna amp probe","1","1","E"]
[null,"87498","Enterovirus dna amp probe","1","1","E"]
[null,"87511","Gardner vag dna amp probe","1","1","E"]
[null,"87525","Hepatitis g dna dir probe","1","1","E"]
["L","87534","Hiv-1 dna dir probe","1","1","E"]
[null,"87550","Mycobacteria dna dir probe","1","1","E"]
[null,"87551","Mycobacteria dna amp probe","1","1","E"]
[null,"87564","MTB RIFAMPIN RST AMP PRB TQ","1","1","E"]
[null,"87631","Resp virus 3-11 targets","1","1","E"]
[null,"87637"," SARSCOV2&INF A&B&RSV AMP PRB","1","1","E"]
[null,"87662","Zika virus dna/rna amp probe","1","1","E"]
[null,"87806","Hiv antigen w/hiv antibodies","1","1","E"]
[null,"87900","Phenotype infect agent drug","1","1","E"]
[null,"87913"," NFCT AGT GNTYP ALYS SARSCOV2","1","1","E"]
["PA","87999","Microbiology procedure","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"88027","Autopsy (necropsy) complete","0","0"]
[null,"88106","Cytopath fl nongyn filter","1","1","E"]
[null,"88142","Cytopath c/v thin layer","1","1","E"]
[null,"88161","Cytopath smear other source","1","1","E"]
[null,"88175","Cytopath c/v auto fluid redo","1","1","E"]
[null,"88230","Tissue culture lymphocyte","1","1","E"]
[null,"88249","Chromosome analysis 100","1","1","E"]
[null,"88261","Chromosome analysis 5","1","1","E"]
[null,"88274","Cytogenetics 25-99","1","1","E"]
[null,"88302","Tissue exam by pathologist","1","1","E"]
[null,"88319","Enzyme histochemistry","1","1","E"]
[null,"88341","Immunohisto antibody slide","1","1","E"]
[null,"88350","Immunofluor antb addl stain","1","1","E"]
[null,"88371","Protein western blot tissue","1","1","E"]
[null,"88388","TISS EX MOLECUL STUDY ADD-ON","0","0"]
[null,"88399","Surgical pathology procedure","1","1","E"]
[null,"89055","Leukocyte assessment fecal","1","1","E"]
[null,"89251","Cultr oocyte/embryo <4 days","0","0"]
[null,"89264","Identify sperm tissue","0","0"]
[null,"89320","Semen anal vol/count/mot","0","0"]
[null,"89342","Storage/year embryo(s)","0","0"]
[null,"90281","Human ig im","0","0"]
[null,"90376","Rabies ig heat treated","1","1","E"]
[null,"90377","Rabies ig ht&sol human im/sc","1","1","E"]
[null,"90396","Varicella-zoster ig im","1","1","E"]
[null,"90477","Adenovirus vaccine type 7","0","0"]
[null,"90619","Menacwy-tt vaccine im","0","0"]
[null,"90630","FLU VACC IIV4 NO PRESERV ID","0","0"]
[null,"90648","Hib vaccine prp-t im","1","1","E",null,"Professional Administered Drug Fee Schedule"]
[null,"90658","Flu vaccine 3 yrs & > im","1","1","E"]
[null,"90671","Pcv15 vaccine im","1","1","E",null,"Free from DOH, under VFC, for ages 0 years to 19 years, 19+ years of age"]
[null,"90672","Flu vaccine 4 valent nasal","1","1","E",null,"Professional Administered Drug Fee Schedule"]
["L","90682","Riv4 vacc recombinant dna im","1","1","E"]
[null,"90691","Typhoid vaccine im","1","1","E",null,"1 per 2 years"]
[null,"90710","Mmrv vaccine sc","0","0"]
["L/PA","90734","Menacwyd/menacwycrm vacc im","1","1","E",null,"Professional Administered Drug Fee Schedule"]
[null,"90748","Hep b/hib vaccine im","0","0"]
[null,"90832","Psytx pt&/family 30 minutes","0","0"]
[null,"90846","Family psytx w/o patient","1","1","E"]
[null,"90847","Family psytx w/patient","0","0"]
[null,"90875","Psychophysiological therapy","0","0"]
[null,"90912","Bfb training 1st 15 min","1","1","E"]
[null,"90953","Esrd serv 1 visit p mo <2","0","0"]
[null,"90962","Esrd serv 1 visit p mo 20+","0","0"]
[null,"90989","Dialysis training complete","0","0"]
[null,"91034","Gastroesophageal reflux test","1","1","E"]
["PA","91113","Gi trc img intral colon i&r","1","1","E"]
[null,"91117","Colon motility 6 hr study","1","1","E"]
[null,"91305","Sarscov2 vac 30 mcg trs-sucr","0","0"]
[null,"91321","SARSCOV2 VAC 25 MCG/.25ML IM","1","1","E",null,"19+ Years of Age"]
[null,"92020","Special eye evaluation","1","1","E"]
[null,"92133","CPTRZD OPH DX IMG PST SGM ON","1","1","E"]
[null,"92227","Remote dx retinal imaging","0","0"]
[null,"92265","Eye muscle evaluation","1","1","E"]
[null,"92287","Internal eye photography","1","1","E"]
[null,"92310","Contact lens fitting","0","0"]
[null,"92326","Replacement of contact lens","0","0"]
[null,"92370","Repair & adjust spectacles","0","0"]
[null,"92516","Facial nerve function test","1","1","E"]
[null,"92526","Oral function therapy","1","1","F","49.24"]
[null,"92542","Positional nystagmus test","1","1","E"]
[null,"92552","Pure tone audiometry air","1","1","E"]
[null,"92567","Tympanometry","1","1","E"]
[null,"92568","Acoustic refl threshold tst","1","1","E"]
[null,"92583","Select picture audiometry","0","0"]
[null,"92595","Electro hearng aid tst both","0","0"]
[null,"92607","Ex for speech device rx 1hr","1","1","F","72.36"]
[null,"92616","Fees w/laryngeal sense test","1","1","E"]
[null,"92627","Eval aud funcj ea addl 15","1","1","F","11.75"]
[null,"92920","Prq cardiac angioplast 1 art","1","1","E"]
["EPA","92937","Prq revasc byp graft 1 vsl","1","1","E"]
["EPA","92944","Prq card revasc chronic addl","1","1","E"]
[null,"92974","Cath place cardio brachytx","1","1","E"]
[null,"92998","Pul art balloon repr percut","1","1","E"]
[null,"93025","Microvolt t-wave assess","0","0"]
[null,"93224","Ecg monit/reprt up to 48 hrs","0","0"]
[null,"93244","Ext ecg>48hr<7d rev&interpj","1","1","E"]
[null,"93270","Remote 30 day ecg rev/report","1","1","E"]
[null,"93284","Icd device progr eval mult","1","1","E"]
[null,"93285","Ilr device eval progr","1","1","E"]
[null,"93294","Pm device interrogate remote","0","0"]
[null,"93308","Tte f-up or lmtd","1","1","E"]
[null,"93320","Doppler echo exam heart","1","1","E"]
[null,"93452","Left hrt cath w/ventrclgrphy","1","1","E"]
[null,"93461","R&l hrt art/ventricle angio","1","1","E"]
[null,"93566","Inject r ventr/atrial angio","1","1","E"]
[null,"93580","Transcath closure of asd","1","1","E"]
[null,"93581","Transcath closure of vsd","1","1","E"]
[null,"93592","Perq transcath closure each","0","0"]
[null,"93602","Intra-atrial recording","1","1","E"]
[null,"93621","Electrophysiology evaluation","1","1","E"]
[null,"93650","Ablate heart dysrhythm focus","1","1","E"]
[null,"93701","Bioimpedance cv analysis","0","0"]
[null,"93788","Ambl bp mntr w/sw a/r","1","1","E"]
[null,"93886","Intracranial study","1","1","E"]
[null,"93888","Intracranial study","1","1","E"]
[null,"93923","Upr/lxtr art stdy 3+ lvls","1","1","E"]
[null,"93976","Vascular study","1","1","E"]
[null,"94002","Vent mgmt inpat init day","1","1","E"]
[null,"94015","Patient recorded spirometry","1","1","E"]
[null,"94453","Hast w/oxygen titrate","0","0"]
[null,"94642","Aerosol inhalation treatment","1","1","F","34.79"]
[null,"94680","Exhaled air analysis o2","1","1","E"]
[null,"94681","Exhaled air analysis o2/co2","1","1","E"]
[null,"94772","Breath recording infant","1","1","E"]
[null,"95012","Exhaled nitric oxide meas","0","0"]
[null,"95060","Eye allergy tests","1","1","E"]
[null,"95130","Immunotherapy insect venom","0","0"]
[null,"95148","Antigen therapy services","1","1","E"]
[null,"95705","Eeg w/o vid 2-12 hr unmntr","1","1","E"]
[null,"95714","Veeg ea 12-26 hr unmntr","1","1","E"]
[null,"95715","Veeg ea 12-26hr intmt mntr","1","1","E"]
[null,"95724","Eeg phy/qhp>60<84 hr w/veeg","1","1","E"]
["L","95806","Sleep study unatt&resp efft","1","1","E",null,"COE"]
[null,"95822","Eeg coma or sleep only","1","1","E"]
[null,"95861","Muscle test 2 limbs","1","1","E"]
[null,"95872","Muscle test one fiber","1","1","E"]
[null,"95908","Motor&/sens 3-4 nrv cndj tst","1","1","E"]
[null,"95923","Autonomic nerv function test","1","1","E"]
[null,"95924","Ans parasymp & symp w/tilt","1","1","E"]
[null,"95938","Somatosensory testing","1","1","E"]
[null,"95962","Electrode stim brain add-on","1","1","E"]
[null,"95976","Alys smpl cn npgt prgrmg","1","1","E"]
[null,"95990","Spin/brain pump refil & main","1","1","E"]
[null,"96020","Functional brain mapping","0","0"]
[null,"96112","Devel tst phys/qhp 1st hr","1","1","E"]
["L/EPA","96130","Psycl tst eval phys/qhp 1st","1","1","E",null,"Please see the Physician-Related Billing Guide"]
["L/EPA","96131","Psycl tst eval phys/qhp ea","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"96159","Hlth bhv ivntj indiv ea addl","1","1","E"]
[null,"96202","Mlt fam grp bhv train 1st 60","0","0"]
[null,"96370","Sc ther infusion addl hr","1","1","E"]
[null,"96380","ADMN RSV MONOC ANTB IM CNSL","1","1","E"]
[null,"96415","Chemo iv infusion addl hr","1","1","E"]
[null,"96450","Chemotherapy into cns","1","1","E"]
[null,"96570","Photodynmc tx 30 min add-on","0","0"]
[null,"96571","Photodynamic tx addl 15 min","0","0"]
[null,"96920","Laser tx skin < 250 sq cm","1","1","E"]
[null,"96999","Dermatological procedure","1","1","E"]
[null,"97028","Ultraviolet therapy","1","1","F","4.85"]
[null,"97112","Neuromuscular reeducation","1","4","F","19.58"]
[null,"97150","Group therapeutic procedures","1","1","F","10.44"]
[null,"97161","Pt eval low complex 20 min","1","1","F","58.37"]
[null,"97170","Athletic trn eval mod cmplx","0","0"]
[null,"97171","Athletic trn eval high cmplx","0","0"]
[null,"97550","CAREGIVER TRAING 1ST 30 MIN","0","0"]
[null,"97608","Neg press wound tx >50 cm","1","1","E"]
[null,"97814","ACUP 1/> W/ESTIM EA ADDL 15","0","0"]
[null,"98004","SYNCH AUDIO-VIDEO EST SF 10","0","0"]
[null,"98013","SYNCH AUDIO-ONLY EST LOW 20","0","0"]
[null,"98940","Chiropractic manipulation","1","1","E",null,"0 – 20 Yrs of age only"]
[null,"98972","NQHP OL DIG ASSMT&MGMT 21+","0","0"]
[null,"98975","REM THER MNTR 1ST SET-UP&EDU","0","0"]
[null,"99026","In-hospital on call service","0","0"]
[null,"99078","Group health education","0","0"]
[null,"99151","Mod sed same phys/qhp <5 yrs","1","1","E"]
[null,"99174","Ocular photoscreening","1","1","E"]
[null,"99195","Phlebotomy","1","1","E"]
[null,"99214","Office/outpatient visit est","1","1","E"]
[null,"99235","Observ/hosp same date","0","0"]
[null,"99236","Observ/hosp same date","0","0"]
[null,"99254","Inpatient consultation","0","0"]
[null,"99292","Critical care addl 30 min","1","1","E"]
[null,"99316","Nursing fac discharge day","0","0"]
[null,"99358 ","Mod sed oth phys/qhp 5/>yrs","0","0"]
[null,"99378","Hospice care supervision","0","0"]
[null,"99384","Prev visit new age 12-17","0","0"]
[null,"99404","Preventive counseling indiv","0","0"]
[null,"99406","Behav chng smoking 3-10 min","0","0"]
[null,"99418","Prolng ip/obs e/m ea 15 min","1","1","E"]
[null,"99439","Chrnc care mgmt svc ea addl","1","1","E"]
[null,"99451","Ntrprof ph1/ntrnet/ehr 5/>","1","1","E"]
[null,"99460","Init nb em per day hosp","0","0"]
[null,"99469","Neonate crit care subsq","0","0"]
[null,"99479","Ic lbw inf 1500-2500 g subsq","0","0"]
[null,"99491","Chrnc care mgmt svc 30 min","0","0"]
["PA/EPA","99492","2nd psyc collab care mgmt","1","1","E"]
[null,"99501","Home visit postnatal","0","0"]
[null,"99511","Home visit fecal/enema mgmt","0","0"]
[null,"A0090","Interest escort in non er","0","0"]
[null,"A0190","Noner transport meals recip","0","0"]
[null,"A0394","Als IV drug therapy supplies","0","0"]
[null,"A0428","bls","0","0"]
[null,"A0888","Noncovered ambulance mileage","0","0"]
[null,"A0998","Ambulance response/treatment","0","0"]
[null,"A2014","Omeza collag per 100 mg","0","0"]
[null,"A2018","Permeaderm c, per sq cm","0","0"]
[null,"A2027","Matriderm per sq cm","0","0"]
[null,"A4211","Supp for self-adm injections","0","0"]
[null,"A4222","Infusion supplies with pump","0","0"]
[null,"A4234","J-cell batt for glucose mon","0","0"]
[null,"A4248","Chlorhexidine antisept","1","1","E"]
[null,"A4250","Urine reagent strips/tablets","0","0"]
[null,"A4262","Temporary tear duct plug","1","1","E"]
[null,"A4271","Home lancing/test cartridges","0","0"]
[null,"A4290","Sacral nerve stim test lead","0","0"]
[null,"A4314","Cath w/drainage 2-way latex","0","0"]
[null,"A4330","Stool collection pouch","0","0"]
[null,"A4340","Indwelling catheter special","0","0"]
[null,"A4354","Cath insertion tray w/bag","0","0"]
[null,"A4355","Bladder irrigation tubing","0","0"]
[null,"A4366","Ostomy vent","0","0"]
[null,"A4377","Drainable plstic pch w/o fp","0","0"]
[null,"A4387","Ost clsd pouch w att st barr","0","0"]
[null,"A4394","Ostomy pouch liq deodorant","0","0"]
[null,"A4409","Ost skn barr convex <=4 sq i","0","0"]
[null,"A4418","Ost pch clsd w/o bar w filtr","0","0"]
[null,"A4427","Ost pch drain/barr lk flng/f","0","0"]
[null,"A4428","Urine ost pouch w faucet/tap","0","0"]
[null,"A4437","Irr supply sleev disp per mo","1","1","E"]
[null,"A4459","Manual pump enema, reusable","0","0"]
[null,"A4483","Moisture exchanger","0","0"]
[null,"A4543","Supply trans elec nerve stim","0","0"]
[null,"A4558","Conductive gel or paste","0","0"]
[null,"A4570","Splint","0","0"]
[null,"A4601","Lith ion batt, non-pros use","0","0"]
[null,"A4604","Tubing with heating element","0","0"]
[null,"A4616","Tubing (oxygen) per foot","0","0"]
[null,"A4627","Spacer bag/reservoir","0","0"]
[null,"A4638","Repl batt pulse gen sys","0","0"]
[null,"A4652","Microcapillary tube sealant","0","0"]
[null,"A4674","Chem/antisept solution, 8oz","0","0"]
[null,"A4720","Dialysat sol fld vol > 249cc","1","1","E"]
[null,"A4723","Dialys sol fld vol > 2999cc","1","1","E"]
[null,"A4740","Shunt accessory","1","1","E"]
[null,"A4773","Occult blood test strips","1","1","E"]
[null,"A4927","Non-sterile gloves","1","1","E"]
[null,"A5054","Clsd ostomy pouch w/flange","0","0"]
[null,"A5073","Urinary pouch on barr w/flng","0","0"]
[null,"A5114","Foam/fabric leg strap","0","0"]
[null,"A5503","Diabetic shoe w/roller/rockr","0","0"]
[null,"A5514","Mult den insert dir carv/cam","0","0"]
[null,"A6000","Wound warming wound cover","0","0"]
[null,"A6196","Alginate dressing <=16 sq in","0","0"]
[null,"A6208","Contact layer > 48 sq in","0","0"]
[null,"A6217","Non-sterile gauze>16<=48 sq","0","0"]
[null,"A6229","Gauze >16<=48 sq in watr/sal","0","0"]
[null,"A6238","Hydrocolld drg >16<=48 w/bdr","0","0"]
[null,"A6247","Hydrogel drg > 48 sq in w/b","0","0"]
[null,"A6257","Transparent film <= 16 sq in","0","0"]
[null,"A6258","Transparent film >16<=48 in","0","0"]
[null,"A6407","Packing strips, non-impreg","0","0"]
[null,"A6448","Lt compres band <3\"/yd","0","0"]
[null,"A6455","Self-adher band >=5\"/yd","0","0"]
[null,"A6505","Cmprsburngarment glove-elbow","0","0"]
[null,"A6520","G com garmnt glove nghttime","0","0"]
[null,"A6529","G com garmt bra night custm","0","0"]
[null,"A6538","Gc stocking full lngth 40-50","0","0"]
[null,"A6539","Gc stocking waistlngth 18-30","0","0"]
[null,"A6554","Grad com stocking bk 40+","0","0"]
[null,"A6563","G com stckng waist30-40 cust","0","0"]
[null,"A6572","Grad com garment toe caps","0","0"]
[null,"A6581","Gradient comp glove","0","0"]
[null,"A6590","Urinary cath disp suc pump","0","0"]
[null,"A6600","G com bandge hgh dn foam sht","0","0"]
[null,"A6609","G compression bandaging","0","0"]
[null,"A6610","G com stcking bk 18-30 custm","0","0"]
[null,"A7008","Disposable nebulizer prefill","0","0"]
[null,"A7018","Water distilled w/nebulizer","0","0"]
[null,"A7030","CPAP full face mask","0","0"]
[null,"A7039","Filter, non disposable w pap","0","0"]
[null,"A7045","Repl exhalation port for PAP","0","0"]
[null,"A7521","Trach/laryn tube cuffed","0","0"]
[null,"A8002","Soft protect helmet custom","0","0"]
[null,"A8003","Hard protect helmet custom","0","0"]
[null,"A9269","Programable ingest capsule","0","0"]
[null,"A9279","Monitoring feature/deviceNOC","0","0"]
[null,"A9292","Pres dig visual therapy fda","0","0"]
[null,"A9506","Tc-99m graphite crucible","0","0"]
[null,"A9517","I131 iodide cap, rx","1","1","E"]
[null,"A9531","I131 max 100uCi","1","1","E"]
["PA","A9543","Y90 ibritumomab, rx","1","1","E"]
[null,"A9546","Co57/58","1","1","E"]
[null,"A9556","Ga67 gallium","1","1","E"]
[null,"A9566","Tc99m fanolesomab","1","1","E"]
[null,"A9576","Inj prohance multipack","1","1","E"]
[null,"A9585","Gadobutrol injection","1","1","E"]
[null,"A9594","Gallium ga-68 psma-11, ucla","0","0"]
[null,"A9604","Sm 153 lexidronam","1","1","E"]
[null,"A9699","Radiopharm rx agent noc","0","0"]
[null,"A9999","DME supply or accessory, nos","0","0"]
[null,"B4083","Enteral stomach tube levine","0","0"]
[null,"B4149","EF blenderized foods","0","0"]
[null,"B4160","EF ped caloric dense>/=0.7kc","0","0"]
[null,"B4185","Pn soln nos 10 grams lipids","0","0"]
[null,"B4224","Parenteral administration ki","0","0"]
[null,"C1052","Hemostatic agent, gi, topic","0","0"]
[null,"C1713","Anchor/screw bn/bn,tis/bn","1","1","E"]
[null,"C1714","Cath, trans atherectomy, dir","1","1","E"]
[null,"C1726","Cath, bal dil, non-vascular","1","1","E"]
[null,"C1735","Cath renal denerv radiofreq","0","0"]
[null,"C1751","Cath, inf, per/cent/midline","1","1","E"]
[null,"C1760","Closure dev, vasc","1","1","E"]
[null,"C1769","Guide wire","1","1","E"]
[null,"C1780","Lens, intraocular (new tech)","1","1","E"]
[null,"C1789","Prosthesis, breast, imp","1","1","E"]
[null,"C1813","Prosthesis, penile, inflatab","0","0"]
["EPA/PA","C1822","Gen, neuro, hf, rechg bat","1","1","A",null,"Invoice Required.  See OPPS billing guide and PHYS billing guide for policy."]
[null,"C1833","Cardiac monitor sys","0","0"]
[null,"C1880","Vena cava filter","1","1","E"]
[null,"C1891","Infusion pump,non-prog, perm","1","1","E"]
[null,"C1900","Lead, coronary venous","1","1","E"]
[null,"C2619","Pmkr, dual, non rate-resp","1","1","E"]
[null,"C2628","Catheter, occlusion","1","1","E"]
[null,"C2629","Intro/sheath, laser","1","1","E"]
[null,"C2640","Brachytx, stranded, P-103","1","1","E"]
[null,"C5272","Low cost skin substitute app","0","0"]
[null,"C7502","Perc bx breast lesions mr","0","0"]
[null,"C7511","Bronch/bpsy(s) w/ navigation","0","0"]
[null,"C7520","Cor/gft angio w/ilic/fem ang","0","0"]
[null,"C7529","R&l hrt gft ang w/flow resrv","0","0"]
[null,"C7539","Insrt a & v pm w/l vent lead","0","0"]
[null,"C7540","Rmv&rplc pm dul w/l vnt lead","0","0"]
[null,"C7549","Chge urtr stent w/ dil stric","0","0"]
[null,"C7558","Cor angio/vent w/drug admin","0","0"]
[null,"C7902","Hopd mntl hlt, ea addl","0","0"]
["CPA","C8903","MRI w/cont, breast,  uni","1","1","E"]
[null,"C8914","MRA w/o fol w/cont, lwr ext","1","1","E"]
[null,"C8927","TEE w or w/o fol w/cont, mon","1","1","E"]
[null,"C8936","MRA, w/o&w/dye, upper extr","1","1","E"]
[null,"C8937","Cad breast mri","0","0"]
["PA","C9033","Inj, akynzeo","0","0"]
[null,"C9044","Injection, cemiplimab-rwlc","0","0"]
[null,"C9067","Gallium ga-68 dotatoc","0","0"]
[null,"C9170","Inj, tarlatamab-dlle, 1 mg","0","0"]
["PA","C9285","Patch, lidocaine/tetracaine","1","1","E"]
[null,"C9359","Implnt,bon void filler-putty","0","0"]
[null,"C9459","Flutemetamol f18","0","0"]
["PA","C9460","Injection, cangrelor (Kengreal)","1","1","E"]
["EPA","C9602","Perc d-e cor stent ather s","1","1","E"]
["PA","C9727","Insert palate implants","1","1","E"]
[null,"C9744","Abd us w/contrast","0","0"]
[null,"C9761","Cysto, litho, vacuum kidney","0","0"]
[null,"C9772","Revasc lithotrip tibi/perone","0","0"]
[null,"C9781","Arthro/shoul surg; w/spacer","1","1","E",null,"65+ years of age"]
[null,"C9793","Pre-plan 3d model w/ccta","0","0"]
[null,"C9794","Complex simulation w/pet-ct","0","0"]
[null,"C9899","Inpt implant pros dev,no cov","0","0"]
[null,"D0190","Screening of a patient","1","1","E",null,"DENTAL"]
[null,"D0272","Dental bitewings two images","1","1","E",null,"DENTAL"]
["L","D0340","Cephalometric image","1","1","E",null,"DENTAL"]
[null,"D0371","Sialoendoscopy capt & interp","0","0"]
[null,"D0385","Max mri image capture","0","0"]
[null,"D0396","3d print of 3d surface scan","0","0"]
[null,"D0411","Hba1c in office testing","0","0"]
[null,"D0425","Caries susceptibility test","0","0"]
[null,"D0477","Spec stains not for microorg","0","0"]
[null,"D0486","Access of transep cytol samp","0","0"]
[null,"D0703","2d oral/facial photo image","0","0"]
[null,"D0804","3d facial scan indirect","0","0"]
[null,"D1321","Couns for high risk sub use","0","0"]
["PA","D1516","Fixed bilat space maint, max","1","1","E"]
["PA","D1517","Fixed bilat space maint, man","1","1","E"]
[null,"D1557","Removal of bilateral space maintainer-maxillary","1","1","E",null,"DENTAL"]
[null,"D2161","Amalgam 4 or > surfaces perm","1","1","E",null,"DENTAL"]
[null,"D2394","Post >=4srfc resinbase cmpst","1","1","E",null,"DENTAL"]
[null,"D2620","Inlay porcelain/ceramic 2 su","0","0"]
[null,"D2662","Dental onlay resin 2 surface","0","0"]
["L/PA","D2750","Crown porcelain w/ h noble m","1","1","E",null,"DENTAL"]
[null,"D2791","Crown full cast base metal","0","0"]
[null,"D2792","Crown full cast noble metal","0","0"]
["L","D2930","Prefab stnlss steel crwn pri","1","1","E",null,"DENTAL"]
[null,"D2951","Tooth pin retention","0","0"]
[null,"D2962","Lab labial veneer porcelain","0","0"]
[null,"D2990","Resin infiltration of lesion","0","0"]
["L","D3230","Pulpal therapy anterior prim","1","1","E",null,"DENTAL"]
["L/PA","D3347","Retreat root canal bicuspid","1","1","E",null,"DENTAL"]
[null,"D3421","Root surgery bicuspid","0","0"]
[null,"D3425","Root surgery molar","0","0"]
[null,"D3470","Intentional replantation","0","0"]
[null,"D3920","Tooth splitting","0","0"]
[null,"D4240","Gingival flap proc w/ planin","0","0"]
[null,"D4266","Guided tiss regen resorble","0","0"]
[null,"D4278","Soft tissue graft addl tooth","0","0"]
[null,"D4355","Full mouth debridement","1","1","F","98.00","0 through 20 years of age"]
["PA","D5110","Dentures complete maxillary","1","1","E",null,"DENTAL"]
["PA","D5211","Dentures maxill part resin","1","1","E",null,"DENTAL"]
[null,"D5226","Mandibular part denture flex","0","0"]
[null,"D5410","Dentures adjust cmplt maxil","1","1","F","33.62","21+ years of age"]
[null,"D5520","Replace denture teeth complt","1","1","E",null,"DENTAL"]
[null,"D5670","Replc tth&acrlc on mtl frmwk","0","0"]
[null,"D5740","Denture reln part maxil chr","0","0"]
[null,"D5820","Denture interm part maxill","0","0"]
[null,"D5867","Replacement of precision att","0","0"]
[null,"D5875","Prosthesis modification","0","0"]
[null,"D5919","Facial prosthesis","0","0"]
[null,"D5931","Surgical obturator","0","0"]
[null,"D5953","Adult speech aid","0","0"]
[null,"D5985","Radiation cone locator","0","0"]
[null,"D5999","Maxillofacial prosthesis","0","0"]
[null,"D6056","Prefabricated abutment","0","0"]
[null,"D6065","Implant supported crown","0","0"]
[null,"D6066","Implant supported mtl crown","0","0"]
[null,"D6075","Implant supported retainer","0","0"]
[null,"D6084","Imp crown porc to titanium","0","0"]
[null,"D6096","Remove broken imp ret screw","0","0"]
[null,"D6105","Remove implant body","0","0"]
[null,"D6116","Imp/abut fixed dent part max","0","0"]
[null,"D6190","Radio/surgical implant index","0","0"]
[null,"D6205","Pontic-indirect resin based","0","0"]
[null,"D6210","Prosthodont high noble metal","0","0"]
[null,"D6250","Bridge resin w/high noble","0","0"]
[null,"D6602","Cst hgh nble mtl inlay 2 srf","0","0"]
[null,"D6611","Onlay cst hgh nbl mtl >=3srf","0","0"]
[null,"D6721","Crown resin w/base metal","0","0"]
[null,"D6782","Crown 3/4 cast noble metal","0","0"]
["PA","D6930","Dental recement bridge","1","1","E",null,"DENTAL"]
[null,"D7220","Impact tooth remov soft tiss","1","1","E",null,"DENTAL"]
[null,"D7230","Impact tooth remov part bony","1","1","E",null,"DENTAL"]
[null,"D7270","Tooth reimplantation","1","1","E",null,"DENTAL"]
[null,"D7288","Brush biopsy","1","1","F","59.84","0 through 20 years of age"]
[null,"D7297","Corticotomy, 4 or more teeth","0","0"]
[null,"D7350","Vestibuloplasty exten graft","0","0"]
[null,"D7441","Malig tumor > 1.25 cm","0","0"]
[null,"D7509","Marsupialization odon cyst","0","0"]
[null,"D7610","Maxilla open reduct simple","0","0"]
[null,"D7620","Clsd reduct simpl maxilla fx","0","0"]
[null,"D7720","Clsd reduct compd maxilla fx","0","0"]
[null,"D7820","Closed tmp manipulation","0","0"]
[null,"D7865","Tmj reshaping components","0","0"]
["L/PA","D7880","Occlusal orthotic appliance","1","1","E",null,"DENTAL"]
[null,"D7939","Indexing for osteotomy","0","0"]
[null,"D7949","Reconstruct midface w/graft","0","0"]
[null,"D7962","Lingual frenectomy","1","1","E",null,"PA age 7-12. No PA age < 7"]
["L/PA","D7963","Frenuloplasty","1","1","F","97.00","DENTAL"]
[null,"D7990","Emergency tracheotomy","0","0"]
["L/PA","D8010","Limited dental tx primary","1","1","E",null,"DENTAL"]
[null,"D8670","Periodic orthodontc tx visit","0","0"]
[null,"D8701","Repair fixed retainer max","0","0"]
[null,"D9211","Regional block anesthesia","0","0"]
["PA","D9248","Sedation (non-iv)","1","1","E",null,"DENTAL"]
[null,"D9612","Thera par drugs 2 or > admin","1","1","F","69.88","21+ years of age"]
[null,"D9920","Behavior management","0","0"]
[null,"D9930","Treatment of complications","1","1","F","60.70","0 through 20 years of age"]
[null,"D9942","Repair/reline occlusal guard","0","0"]
[null,"D9951","Limited occlusal adjustment","0","0"]
[null,"D9970","Enamel microabrasion","0","0"]
[null,"D9990","Trans or sign language svcs","0","0"]
[null,"E0105","Cane adjust/fixed quad/3 pro","0","0"]
[null,"E0130","Walker rigid adjust/fixed ht","0","0"]
[null,"E0135","Walker folding adjust/fixed","0","0"]
[null,"E0153","Forearm crutch platform atta","0","0"]
[null,"E0162","Sitz bath chair","0","0"]
[null,"E0181","Press pad alternating w/ pum","0","0"]
[null,"E0190","Positioning cushion","0","0"]
[null,"E0202","Phototherapy light w/ photom","0","0"]
[null,"E0231","Wound warming device","0","0"]
[null,"E0244","Toilet seat raised","0","0"]
[null,"E0245","Tub stool or bench","0","0"]
[null,"E0260","Hosp bed semi-electr w/ matt","0","0"]
[null,"E0275","Bed pan standard","0","0"]
[null,"E0295","Hosp bed semi-elect w/o matt","0","0"]
[null,"E0303","Hosp bed hvy dty xtra wide","0","0"]
[null,"E0371","Nonpower mattress overlay","0","0"]
[null,"E0435","Oxygen system liquid portabl","0","0"]
[null,"E0447","Port o2 cont, liq over 4 lpm","0","0"]
[null,"E0455","Oxygen tent excl croup/ped t","0","0"]
[null,"E0470","RAD w/o backup non-inv intfc","0","0"]
[null,"E0486","Oral device/appliance cusfab","0","0"]
[null,"E0555","Humidifier for use w/ regula","0","0"]
[null,"E0580","Nebulizer for use w/ regulat","0","0"]
[null,"E0607","Blood glucose monitor home","0","0"]
[null,"E0625","Patient lift bathroom or toi","0","0"]
[null,"E0640","Fixed patient lift system","0","0"]
[null,"E0641","Multi-position stnd fram sys","0","0"]
[null,"E0665","Pneumatic appliance full arm","0","0"]
[null,"E0675","Pneumatic compression device","0","0"]
[null,"E0691","Uvl pnl 2 sq ft or less","0","0"]
[null,"E0716","Supp and acces intravag pelv","0","0"]
[null,"E0736","Transcut tibial nerv stimula","0","0"]
[null,"E0747","Elec osteogen stim not spine","0","0"]
[null,"E0764","Functional neuromuscularstim","0","0"]
[null,"E0769","Electric wound treatment dev","0","0"]
[null,"E0785","Replacement impl pump cathet","0","0"]
[null,"E0856","Cervic collar w air bladder","0","0"]
[null,"E0920","Fracture frame attached to b","0","0"]
[null,"E0946","Fracture frame dual w cross","0","0"]
[null,"E0956","W/c lateral trunk/hip suppor","0","0"]
[null,"E0969","Wheelchair narrowing device","0","0"]
[null,"E0983","Add pwr joystick","0","0"]
[null,"E0984","Add pwr tiller","0","0"]
[null,"E1003","Pwr seat recline","0","0"]
[null,"E1012","Ctr mount pwr elev leg rest","0","0"]
[null,"E1030","W/c vent tray gimbaled","0","0"]
[null,"E1070","Wheelchair detachable foot r","0","0"]
[null,"E1092","Wheelchair wide w/ leg rests","0","0"]
[null,"E1170","Whlchr ampu fxd arm leg rest","0","0"]
[null,"E1222","Wheelchair spec size w/ leg","0","0"]
[null,"E1223","Wheelchair spec size w foot","0","0"]
[null,"E1232","Folding ped wc tilt-in-space","0","0"]
[null,"E1270","Wheelchair lightweight leg r","0","0"]
[null,"E1300","Whirlpool portable","0","0"]
[null,"E1358","DC power adapter, port conc","0","0"]
[null,"E1510","Kidney dialysate delivry sys","0","0"]
[null,"E1590","Hemodialysis machine","0","0"]
[null,"E1630","Reciprocating peritoneal dia","0","0"]
[null,"E1632","Wearable artificial kidney","0","0"]
[null,"E1702","Repl measr scales jaw motion","0","0"]
[null,"E1808","Adjust wrist flexion device","0","0"]
[null,"E1820","Soft interface material","0","0"]
[null,"E1830","Adjust toe ext & flex device","0","0"]
[null,"E2101","Bld glucose monitor w lance","0","0"]
[null,"E2205","Manual wc accessory, handrim","0","0"]
[null,"E2214","Pneumatic caster tire each","0","0"]
[null,"E2215","Pneumatic caster tire tube","0","0"]
[null,"E2225","Caster wheel excludes tire","0","0"]
[null,"E2294","Contour seat for ped size wc","0","0"]
[null,"E2322","Mult mech switches","0","0"]
[null,"E2331","Attendant control","0","0"]
[null,"E2364","U1nonsealed leadacid battery","0","0"]
[null,"E2371","Gr27 sealed leadacid battery","0","0"]
[null,"E2382","Tube, pneum wheel drive tire","0","0"]
[null,"E2383","Insert, pneum wheel drive","0","0"]
[null,"E2392","Solid caster tire, integrate","0","0"]
[null,"E2504","SGD prerec msg>20min <=40min","0","0"]
[null,"E2602","Gen w/c cushion wdth >=22 in","0","0"]
[null,"E2611","Gen use back cush wdth <22in","0","0"]
[null,"E2621","WC planar back cush wd>=22in","0","0"]
[null,"E2630","Monosuspension arm/hand supp","0","0"]
[null,"G0008","Admin influenza virus vac","1","1","E"]
[null,"G0009","Admin pneumococcal vaccine","1","1","E"]
[null,"G0023","Pin service 60m per month","0","0"]
[null,"G0035","Pt ed pos 23","0","0"]
[null,"G0044","Pt mitral stenosis","0","0"]
[null,"G0053","Adv rheum pt care mvp","0","0"]
[null,"G0063","Cardiology ss","0","0"]
[null,"G0076","Care manag h vst new pt 20 m","0","0"]
[null,"G0085","Care man h v ext pt 75 m","0","0"]
[null,"G0089","Adm subq drug 1st home visit","0","0"]
[null,"G0106","Colon ca screen;barium enema","0","0"]
[null,"G0124","Screen c/v thin layer by MD","0","0"]
[null,"G0143","Scr c/v cyto,thinlayer,rescr","1","1","E"]
[null,"G0155","HHCP-svs of csw,ea 15 min","0","0"]
[null,"G0168","Wound closure by adhesive","0","0"]
[null,"G0219","PET img wholbod melano nonco","0","0"]
[null,"G0249","Provide INR test mater/equip","0","0"]
[null,"G0250","MD INR test revie inter mgmt","0","0"]
[null,"G0271","Group MNT 2 or more 30 mins","0","0"]
[null,"G0289","Arthro, loose body + chondro","1","1","E"]
[null,"G0303","Pre-op service LVRS 10-15dos","1","1","E"]
[null,"G0314","Counsel immune <21 16-30 m","0","0"]
[null,"G0327","Colon ca scrn;bld-bsd biomrk","0","0"]
[null,"G0342","Laparoscopy islet cell trans","0","0"]
[null,"G0384","Lev 5 hosp type B ED visit","1","1","E"]
[null,"G0390","Trauma Respons w/hosp criti","0","0"]
[null,"G0405","EKG interpret & report preve","0","0"]
[null,"G0414","Pelvic ring fx treat int fix","1","1","E"]
[null,"G0433","ELISA HIV-1/HIV-2 screen","0","0"]
[null,"G0442","Annual alcohol screen 15 min","0","0"]
[null,"G0453","Cont intraop neuro monitor","0","0"]
[null,"G0468","FQHC visit, IPPE or AWV","0","0"]
[null,"G0481","Drug test def 8-14 classes","1","1","E"]
[null,"G0482","Drug test def 15-21 classes","1","1","E"]
[null,"G0498"," Chemo extend iv infus w/pump","0","0"]
[null,"G0513","Prolong prev svcs, first 30m","0","0"]
[null,"G0523","Mgt nw pt dem mod-high cmplx","0","0"]
[null,"G0532","Take home supp nasal spray","0","0"]
[null,"G0541","No pt prsnt train initial 30","0","0"]
[null,"G0550","Phone/inter for dx/treat >5m","0","0"]
[null,"G0559","Unrelat prac follow up visit","0","0"]
[null,"G0560","Safety plan interven","0","0"]
[null,"G0915","No improve visual funct","0","0"]
[null,"G1008","Cdsm cranberry pk","0","0"]
[null,"G1018","Cdsm infinx","0","0"]
[null,"G1027","Pt hemo < 3mo","0","0"]
[null,"G2007","Post-d/c h vst ext pt 30 m","0","0"]
[null,"G2020","Hi inten serv for SIP model","0","0"]
[null,"G2074","Med assist tx no drug","0","0"]
[null,"G2075","Med tx meds nos","0","0"]
[null,"G2086","Off base opioid tx 70min","0","0"]
[null,"G2097","Child dx uri 3d of other dx","0","0"]
[null,"G2113","Pred>5 mg >6m, no chg da","0","0"]
[null,"G2128","No aspirin med rsn","0","0"]
[null,"G2143","Fs odi 9-15mo > 22","0","0"]
[null,"G2152","Res change sc =0","0","0"]
[null,"G2177","Bronch w rx antibx 30d","0","0"]
[null,"G2178","Pt not elig low neuro ex","0","0"]
[null,"G2187","Clin ind img hd trauma","0","0"]
[null,"G2196","Screen unhlthy etoh use","0","0"]
[null,"G2208","No trtmt chemo and her2","0","0"]
[null,"G2250","Remot img sub by pt, non e/m","1","1","E"]
[null,"G4004","Endocrinology ss","0","0"]
[null,"G4013","Mentl/behav health ss","0","0"]
[null,"G4022","Otolaryngology ss","0","0"]
[null,"G4023","Pathology ss","0","0"]
[null,"G4032","Rheumatology ss","0","0"]
[null,"G6004","Radiation treatment delivery","1","1","E"]
[null,"G6013","Radiation treatment delivery","1","1","E"]
[null,"G8400","Pt w/DXA no document or orde","0","0"]
[null,"G8420","Calc BMI norm parameters","0","0"]
[null,"G8451","Pt w/abn lvef inelig b-bloc","0","0"]
[null,"G8482","Flu immunize order/admin","0","0"]
[null,"G8483","Flu imm no admin doc rea","0","0"]
[null,"G8542","Doc funct no deficiencies","0","0"]
[null,"G8566","Pt inelig ref oto eval","0","0"]
[null,"G8598","Asp therp used","0","0"]
[null,"G8650","Rafs crs ki no scor no surv","0","0"]
[null,"G8661","Fun stat score LS pt no elg","0","0"]
[null,"G8708","Antibiotic not pres","0","0"]
[null,"G8733","Doc pos elder mal scrn plan","0","0"]
[null,"G8734","Doc neg elder mal no plan","0","0"]
[null,"G8785","BP scrn no perf at interval","0","0"]
[null,"G8826","Pt disch home day #2 EVAR","0","0"]
[null,"G8844","No ahi rdi rei ini dx no rsn","0","0"]
[null,"G8858","Not ref for oto eval","0","0"]
[null,"G8877","No brst cncr dx min invasive","0","0"]
[null,"G8911","Pt doc no fall in ASC","0","0"]
[null,"G8924","Spiro EV1/FVC <60% COPD sym","0","0"]
[null,"G8934","Lvef <=40% or dep lv sys fcn","0","0"]
[null,"G8955","Most recent assess vol mgmt","0","0"]
[null,"G8969","Pt rsn no pres Wrfrn or othr","0","0"]
[null,"G9008","Mccd,phys coor-care ovrsght","0","0"]
[null,"G9038","Co-management services","1","1","E"]
[null,"G9058","Onc prac mgmt disagree w/gui","0","0"]
[null,"G9067","Onc dx nsclc dx unknown nos","0","0"]
[null,"G9077","Onc dx prostate T1no progres","0","0"]
[null,"G9078","Onc dx prostate T2no progres","0","0"]
[null,"G9089","Onc dx colon extent unknown","0","0"]
[null,"G9098","Onc dx esophageal mets recur","0","0"]
[null,"G9107","Onc dx pancreatic unresectab","0","0"]
[null,"G9116","Onc dx ovarian recurrence","0","0"]
[null,"G9131","Onc dx brst unknown NOS","0","0"]
[null,"G9140","Frontier extended stay demo","0","0"]
[null,"G9147","Outpt IV insulin tx any mea","0","0"]
[null,"G9187","BPCI home visit","0","0"]
[null,"G9226","3 comp foot exam completed","0","0"]
[null,"G9254","Doc pt dischg >2d","0","0"]
[null,"G9280","Pne not given norsn","0","0"]
[null,"G9289","Doc type nsm lung ca","0","0"]
[null,"G9298","Eval risk vte card 30d prior","0","0"]
[null,"G9312","Surgical site infection","0","0"]
[null,"G9322","No cnt ct nuc med doc 12mo","0","0"]
[null,"G9341","Srch for ct w in 12 mos","0","0"]
[null,"G9355","No early ind/delivery","0","0"]
[null,"G9458","Tob user recd cess interv","0","0"]
[null,"G9476","Volun service at hospice","0","0"]
[null,"G9485","Remote E/M new pt 60mins","0","0"]
[null,"G9501","Rad exp time w/o fluor doc","0","0"]
[null,"G9512","Indiv pdc > 0.8","0","0"]
[null,"G9521","Er and ip hosp <2 in 12 mos","0","0"]
[null,"G9522","Er/ip hosp =/>2 in 12 mos","0","0"]
[null,"G9538","Adv brain image ordered","0","0"]
[null,"G9555","Doc med reas no follow imag","0","0"]
[null,"G9582","Door to punc time >2hr, nrg","0","0"]
[null,"G9605","Surv score no improv w/tx","0","0"]
[null,"G9624","No etoh scr/no counc/nrg","0","0"]
[null,"G9642","Current cig smoker","0","0"]
[null,"G9655","Toc tool incl key elem","0","0"]
[null,"G9656","Pt direct anesth loc to pacu","0","0"]
[null,"G9668","Doc med rsn no stat tx/presc","0","0"]
[null,"G9684","Acute care urinary tract inf","0","0"]
[null,"G9693","Pt use hosp during msmt per","0","0"]
[null,"G9704","Ajcc br ca stg i: t1 mic/t1a","0","0"]
[null,"G9713","Pt use hosp during msmt per","0","0"]
[null,"G9724","Pt w/doc use anticoag mst yr","0","0"]
[null,"G9734","Refused to participate","0","0"]
[null,"G9735","Pt unbl cmplt shld fs prom","0","0"]
[null,"G9752","Urgent surgery","0","0"]
[null,"G9762","Pt had hpv b/t 9-13 yr","0","0"]
[null,"G9771","Anes end, 1 temp >35.5(95.9)","0","0"]
[null,"G9782","Hx dx fam/pure hypercholes","0","0"]
[null,"G9790","Most rct bp >/= 140/90","0","0"]
[null,"G9813","Pt not died w/in 30d of proc","0","0"]
[null,"G9831","Ajcc stg brt ca dx ii or iii","0","0"]
[null,"G9832","Brt ca dx i, no t1/t1a/t1b","0","0"]
[null,"G9846","Pt died from cancer","0","0"]
[null,"G9874","4 em core sessions","0","0"]
[null,"G9883","2 em ongoing ms mo 16-18 wl","0","0"]
[null,"G9893","No mac exam","0","0"]
[null,"G9902","Pt scrn tbco and id as user","0","0"]
[null,"G9914","Pt receiving anti-tnf agent","0","0"]
[null,"G9923","Safty cncrns scrn and neg","0","0"]
[null,"G9925","No scrn prov rsn nos","0","0"]
[null,"G9943","Bk pn nt msr vas scl pre/pst","0","0"]
[null,"G9959","Systemic antimicro not presc","0","0"]
[null,"G9970","Pvdr rfrd pt no rprt rcvd","0","0"]
[null,"G9982","Remote E/M new pt 60mins","0","0"]
[null,"G9992","Pall serv during meas","0","0"]
[null,"H0051","Traditional healing service","0","0"]
["PA","J0122","Inj., eravacycline, 1 mg","1","1","E"]
[null,"J0136","Inj, acetaminophen (b braun), 10 mg","1","1","E"]
[null,"J0139","Inj, adalimumab, 1 mg","1","1","E"]
["PA","J0180","Injection, agalsidase beta, 1 mg","1","1","E"]
[null,"J0211","Inj, nithiodote, 3mg / 125mg","0","0"]
["PA","J0224","Inj. lumasiran, 0.5 mg","1","1","A",null,"Invoice Required"]
[null,"J0282","Amiodarone HCl","1","1","E"]
[null,"J0330","Succinycholine chloride inj","1","1","E"]
[null,"J0402","Inj, abilify asimtufii, 1 mg","1","1","E"]
[null,"J0456","Azithromycin","1","1","E"]
["PA","J0491","Inj anifrolumab-fnia 1mg","1","1","E"]
[null,"J0571","Buprenorphine oral 1mg","0","0"]
["CPA/PA","J0585","Injection, onabotulinumotoxinA","1","1","E",null,"CPA/PA all ages"]
[null,"J0595","Butorphanol tartrate 1 mg","1","1","E"]
[null,"J0605","Sucroferric oxyhydroxide 5mg","1","1","E"]
[null,"J0615","Calcium acetate, oral, 23 mg","1","1","E"]
[null,"J0650","Inj, levothyroxine, nos, 10mcg","1","1","E"]
[null,"J0651","Inj, levothyroxine, freskabi, 10mcg","1","1","E"]
[null,"J0691","Inj lefamulin 1 mg","0","0"]
[null,"J0702","Betamethasone acet&sod phosp","1","1","E"]
[null,"J0720","Chloramphenicol sodium injec","1","1","E"]
[null,"J0743","Cilastatin sodium injection","1","1","E"]
[null,"J0795","Corticorelin ovine triflutal","1","1","E"]
[null,"J0850","Cytomegalovirus imm IV /vial","1","1","E"]
[null,"J0881","Darbepoetin alfa, non-esrd","1","1","E"]
[null,"J0882","Darbepoetin alfa, esrd use","1","1","E"]
[null,"J0892","Argatroban dialysis (accord), 1 mg ","1","1","E"]
[null,"J0911","Inst tauro 1.35mg/hep 100u","1","1","E"]
[null,"J1100","Dexamethasone sodium phos","1","1","E"]
[null,"J1190","Dexrazoxane HCl injection","1","1","E"]
[null,"J1245","Dipyridamole injection","1","1","E"]
["PA","J1302","Inj, sutimlimab-jome, 10 mg","1","1","A",null,"Invoice Required"]
[null,"J1324","Injection, enfuvirtide, 1 mg","1","1","E"]
["PA","J1325","Epoprostenol injection","1","1","E"]
["PA","J1413","Inj delandistrogene mox rokl","1","1","A",null,"Invoice Required"]
[null,"J1437","Inj, ferric derisomaltose, 10 mg","1","1","E"]
["PA","J1448","Injection, trilaciclib, 1mg","1","1","E"]
[null,"J1459","Inj IVIG privigen 500 mg","1","1","E"]
[null,"J1559","Hizentra injection","1","1","E"]
[null,"J1568","Octagam injection","1","1","E"]
[null,"J1600","Gold sodium thiomaleate inj","1","1","E"]
["PA","J1602","Golimumab for iv use 1mg","1","1","E"]
[null,"J1640","Hemin, 1 mg","1","1","E"]
[null,"J1720","Hydrocortisone sodium succ i","1","1","E"]
["PA","J1745","Infliximab injection","1","1","E"]
[null,"J1790","Droperidol injection","1","1","E"]
[null,"J1817","Insulin for insulin pump use","1","1","E"]
["PA","J1930","Lanreotide injection","1","1","E"]
[null,"J1950","Leuprolide acetate /3.75 MG","1","1","E"]
[null,"J1951","Inj fensolvi 0.25 mg","1","1","E"]
[null,"J2003","Inj, lidocaine hcl, 1 mg","1","1","E"]
[null,"J2175","Meperidine hydrochl /100 MG","1","1","E"]
[null,"J2247","Inj, micafungin (par pharm), 1 mg","1","1","E"]
["PA","J2267","Inj, mirikizumab-mrkz, 1 mg","1","1","E"]
[null,"J2300","Inj nalbuphine hydrochloride","1","1","E"]
["PA","J2327","Inj risankizumab-rzaa 1 mg","1","1","E"]
[null,"J2359","Injection, olanzapine, 0.5 mg","1","1","E"]
[null,"J2360","Orphenadrine injection","1","1","E"]
[null,"J2426","Inj, invega sustenna, 1 mgj","1","1","E"]
[null,"J2470","Inj pantoprazole sodium 40mg","1","1","E"]
["PA","J2508","Pegunigalsidase alfa-iwxj","1","1","A",null,"Invoice Required"]
[null,"J2560","Phenobarbital sodium inj","1","1","E"]
[null,"J2679","Inj fluphenazine hcl 1.25 mg","1","1","E"]
[null,"J2760","Phentolaine mesylate inj","1","1","E"]
[null,"J2785","Regadenoson injection","1","1","E"]
["PA","J2786","Injection, reslizumab, 1 mg ","1","1","E"]
["PA","J2797","Inj., rolapitant, 0.5 mg","1","1","E"]
[null,"J2820","Sargramostim injection","1","1","E"]
["PA","J2998","Injection, plasminogen, human-tvmh, 1 mg","1","1","A",null,"Invoice Required"]
["PA","J3090","Inj tedizolid phosphate (Silvextro)","1","1","E"]
[null,"J3240","Thyrotropin injection","1","1","E"]
["PA","J3262","Tocilizumab injection","1","1","E"]
["PA","J3316","inj., triptorelin xr 3.75 mg  ","1","1","E"]
[null,"J3355","Urofollitropin, 75 iu","1","1","E"]
["PA","J3392","Inj, exagamglogene autotem","1","1","A",null,"Invioce Required"]
[null,"J3411","Thiamine hcl 100 mg","1","1","E"]
[null,"J3472","Ovine, 1000 USP units","1","1","E"]
[null,"J3485","Injection, zidovudine, 10 mg","1","1","E"]
[null,"J7042","5% dextrose/normal saline","1","1","E"]
[null,"J7165","Injection, human-lans, per i.u","1","1","E"]
["PA","J7180","Factor XIII anti-hem factor","1","1","E"]
[null,"J7181","Factor xiii recomb a-subunit","1","1","E"]
[null,"J7192","Factor viii recombinant NOS","1","1","E"]
["PA","J7201","Factor ix fc fusion recomb","1","1","E"]
["PA","J7211","Inj, kovaltry, 1 i.u.","1","1","E"]
[null,"J7300","Intraut copper contraceptive","1","1","E"]
["PA","J7313","Fluocinol acet intravit imp (Iluvien)","1","1","E"]
[null,"J7324","Orthovisc inj per dose","0","0"]
["PA","J7336","Capsaicin 8% patch","1","1","E"]
["PA","J7340","Carbidopa levodopa enteral (Duopa)","1","1","E"]
[null,"J7500","Azathioprine oral 50mg","0","0"]
[null,"J7510","Prednisolone oral per 5 mg","1","1","E"]
[null,"J7520","Sirolimus, oral","1","1","E"]
[null,"J7608","Acetylcysteine non-comp unit","0","0"]
[null,"J7622","Beclomethasone comp unit","0","0"]
[null,"J7634","Budesonide comp con","0","0"]
[null,"J7639","Dornase alfa non-comp unit","1","1","A"]
[null,"J7645","Ipratropium bromide comp","0","0"]
[null,"J7665","Mannitol for inhaler","0","0"]
[null,"J7680","Terbutaline sulf comp con","0","0"]
[null,"J7999","Compounded drug, noc","0","0"]
[null,"J8541","Oral, Dexamethasone (hemady), 0.25 mg","0","0"]
[null,"J8650","Nabilone oral","0","0"]
["PA","J9019","Erwinaze injection","1","1","E"]
[null,"J9030","Bcg live intravesical 1mg","1","1","E"]
["PA","J9032","Injection, belinostat, 10mg (Beleodaq)","1","1","E"]
["PA","J9042","Brentuximab vedotin inj","1","1","E"]
[null,"J9052","Inj, carmustine (accord)","1","1","E"]
[null,"J9064","Inj, cabazitaxel (sandoz)","0","0"]
[null,"J9100","Cytarabine hcl 100 MG inj","1","1","E"]
["PA","J9153","Inj daunorubicin, cytarabine","1","1","E"]
[null,"J9179","Eribulin mesylate injection","1","1","E"]
["PA","J9205","Injection, irinotecan liposome, 1 mg ","1","1","E"]
[null,"J9206","Irinotecan injection","1","1","E"]
[null,"J9217","Leuprolide acetate suspnsion","1","1","E"]
[null,"J9245","Inj melphalan hydrochl 50 MG","1","1","E"]
["PA","J9262","Inj, omacetaxine mep, 0.01mg","1","1","E"]
["PA","J9273","Inj tisotu vedotin-tftv, 1mg","1","1","E"]
["PA","J9295","Injection, necitumumab, 1 mg ","1","1","E"]
[null,"J9305","Pemetrexed injection","1","1","E"]
[null,"J9314","Romidepsin non-lyophilized","0","0"]
["PA","J9316","Pertuzu, trastuzu, 10 mg","1","1","E"]
["PA","J9325","Injection, talimogene laherparepvec, per 1 million plaque forming units ","1","1","E"]
["PA","J9345","Injection, retifanlimab-dlwr, 1 mg","1","1","E"]
[null,"J9355","Trastuzumab injection","1","1","E"]
["PA","J9380","Injection, teclistamab-cqyv, 0.5 mg","1","1","E"]
[null,"K0001","Standard wheelchair","0","0"]
[null,"K0010","Stnd wt frame power whlchr","0","0"]
[null,"K0020","Fixed adjust armrest pair","0","0"]
[null,"K0037","High mount flip-up footrest","0","0"]
[null,"K0046","Elevat legrst low extension","0","0"]
[null,"K0070","Rear whl compl pneum tire","0","0"]
[null,"K0455","Pump uninterrupted infusion","0","0"]
[null,"K0607","Repl batt for AED","0","0"]
[null,"K0744","Absorp drg <= 16 suc pump","0","0"]
[null,"K0808","POV group 2 vhd 451-600 lbs","0","0"]
[null,"K0823","PWC gp 2 std cap chair","0","0"]
[null,"K0824","PWC gp 2 hd seat/back","0","0"]
[null,"K0836","PWC gp2 std sing pow opt cap","0","0"]
[null,"K0849","PWC gp 3 std cap chair","0","0"]
[null,"K0858","PWC gp3 hd sing pow opt s/b","0","0"]
[null,"K0870","PWC gp 4 hd seat/back","0","0"]
[null,"K0890","PWC gp5 ped sing pow opt s/b","0","0"]
[null,"K1034","Covid test self-admn/collect","0","0"]
[null,"L0150","Cerv semi-rig adj molded chn","1","1","E"]
[null,"L0160","Cerv semi-rig wire occ/mand","0","0"]
[null,"L0452","tlso flex custom fab thoraci","0","0"]
[null,"L0466","TLSO rigid frame pre soft ap","0","0"]
[null,"L0486","TLSO rigidlined cust fab two","0","0"]
[null,"L0625","LO flexibl L1-below L5 pre","1","1","E"]
[null,"L0634","LSO flexion control custom","0","0"]
[null,"L0643","Lso sag ctr rigi pos pre ots","0","0"]
[null,"L0830","Halo cerv into milwaukee typ","0","0"]
[null,"L0970","Tlso corset front","0","0"]
[null,"L0999","Add to spinal orthosis NOS","0","0"]
[null,"L1040","Lumbar or lumbar rib pad","0","0"]
[null,"L1120","Covers for upright each","0","0"]
[null,"L1280","Rib gusset (elastic) each","0","0"]
[null,"L1630","Abduct control hip semi-flex","0","0"]
[null,"L1686","HO post-op hip abduction","0","0"]
[null,"L1820","Ko elas w/ condyle pads & jo","0","0"]
[null,"L1821","Ko elas w/ condyle pads otf","0","0"]
[null,"L1844","Ko w/adj jt rot cntrl molded","0","0"]
[null,"L1900","Afo sprng wir drsflx calf bd","0","0"]
[null,"L1940","Afo molded to patient plasti","0","0"]
[null,"L2000","Kafo sing fre stirr thi/calf","0","0"]
[null,"L2037","Kafo plas sing free knee mol","0","0"]
[null,"L2108","Afo tib fx cast molded to pt","0","0"]
[null,"L2180","Plas shoe insert w ank joint","0","0"]
[null,"L2182","Drop lock knee","0","0"]
[null,"L2230","Split flat caliper stirr & p","0","0"]
[null,"L2300","Abduction bar jointed adjust","0","0"]
[null,"L2375","Torsion ank & half solid sti","0","0"]
[null,"L2425","Knee disc/dial lock/adj flex","0","0"]
[null,"L2550","Thigh/wght bear high roll cu","0","0"]
[null,"L2628","Metal frame recipro hip & ca","0","0"]
[null,"L2760","Extension per extension per","0","0"]
[null,"L2768","Ortho sidebar disconnect","0","0"]
[null,"L2850","Femoral lgth sock fx or equa","0","0"]
[null,"L3030","Foot arch support remov prem","0","0"]
[null,"L3140","Abduction rotation bar shoe","0","0"]
[null,"L3206","Hightop w/ supp/pronator chi","0","0"]
[null,"L3216","Orthoped ladies shoes dpth i","0","0"]
[null,"L3251","Shoe molded to pt silicone s","0","0"]
[null,"L3310","Shoe lift elev heel/sole neo","0","0"]
[null,"L3320","Shoe lift elev heel/sole cor","0","0"]
[null,"L3390","Shoe outflare wedge","0","0"]
[null,"L3465","Shoe heel thomas with wedge","0","0"]
[null,"L3550","O shoe add standard toe tap","0","0"]
[null,"L3630","Trans shoe solid stirrup new","0","0"]
[null,"L3677","SO hard plastic stabilizer","0","0"]
[null,"L3762","Rigid EO wo joints","0","0"]
[null,"L3900","Hinge extension/flex wrist/f","0","0"]
[null,"L3901","Hinge ext/flex wrist finger","0","0"]
[null,"L3917","Prefab metacarpl fx orthosis","0","0"]
[null,"L3930"," Hfo nontorsion jnts pre ots","0","0"]
[null,"L3971","SEWHO cap design w/jnt(s) CF","0","0"]
[null,"L3995","Sock fracture or equal each","0","0"]
[null,"L4050","Replace molded calf lacer","0","0"]
[null,"L4205","Ortho dvc repair per 15 min","0","0"]
[null,"L4394","Replace foot drop spint","0","0"]
[null,"L4396","Static AFO","0","0"]
[null,"L5100","Molded socket shin sach foot","0","0"]
[null,"L5270","Tilt table locking hip sing","0","0"]
[null,"L5420","Postop dsg & 1 cast chg ak/d","0","0"]
[null,"L5535","Prep BK ptb open end socket","0","0"]
[null,"L5610","Above knee hydracadence","0","0"]
[null,"L5622","Test socket knee disarticula","0","0"]
[null,"L5636","Symes type medial opening so","0","0"]
[null,"L5637","Below knee total contact","0","0"]
[null,"L5647","Below knee suction socket","0","0"]
[null,"L5658","Socket insert above knee","0","0"]
[null,"L5676","Bk knee joints single axis p","0","0"]
[null,"L5685","Below knee sus/seal sleeve","0","0"]
[null,"L5698","Ak/knee disartic silesian ba","0","0"]
[null,"L5707","Custom shape cvr hip disart","0","0"]
[null,"L5726","Knee-shin ext jnts fld swg e","0","0"]
[null,"L5728","Knee-shin fluid swg & stance","0","0"]
[null,"L5811","Endo knee-shin mnl lck ultra","0","0"]
[null,"L5830","Endo knee-shin pneum/swg pha","0","0"]
[null,"L5858","Stance phase only","0","0"]
[null,"L5960","Endo hip ultra-light materia","0","0"]
[null,"L5972","Flexible keel foot","0","0"]
[null,"L5982","Exoskeletal axial rotation u","0","0"]
[null,"L6000","Part hand thumb rem","0","0"]
[null,"L6010","Part hand little/ring","0","0"]
[null,"L6200","Elbow mold outsid lock hinge","0","0"]
[null,"L6380","Postop dsg cast chg wrst/elb","0","0"]
[null,"L6570","Scap thorac prosth tiss shap","0","0"]
[null,"L6610","Flexible metal hinge pair","0","0"]
[null,"L6623","Spring-ass rot wrst w/ latch","0","0"]
[null,"L6645","Shoulder flexion-abduction j","0","0"]
[null,"L6672","Harness chest/shlder saddle","0","0"]
[null,"L6675","Harness figure of 8 sing con","0","0"]
[null,"L6689","Frame typ socket shoulder di","0","0"]
[null,"L6698","Below/above elbow lock mech","0","0"]
[null,"L6713","Ped term dev, hand, vol open","0","0"]
[null,"L6882","Microprocessor control uplmb","0","0"]
[null,"L6915","Hand restoration replacmnt g","0","0"]
[null,"L6960","Shldr disartic switch contro","0","0"]
[null,"L7170","Electronic elbow hosmer swit","0","0"]
[null,"L7180","Electronic elbow sequential","0","0"]
[null,"L7364","Twelve volt battery utah/equ","0","0"]
[null,"L7405","Add UE prost s/d acrylic","0","0"]
[null,"L8001","Breast prosthesis bra & form","0","0"]
[null,"L8035","Custom breast prosthesis","0","0"]
[null,"L8047","Nasal septal prosthesis","0","0"]
[null,"L8415","Sheath upper limb","0","0"]
[null,"L8480","Pros sock single ply AK","0","0"]
[null,"L8509","Trach-esoph voice pros md in","0","0"]
[null,"L8513","Trach pros cleaning device","0","0"]
["PA","L8608","Arg ii ext com/sup/acc misc","1","1","E"]
[null,"L8618","Coch implant tran cable repl","0","0"]
[null,"L8629","CID transmit coil and cable","0","0"]
["EPA/PA","L8679","IMP NEUROSTI PLS GN ANY TYPE","1","1","E",null,"See OPPS/PHYS billing guides for policy. May require invoice"]
["EPA/PA","L8688","Implt nrostm pls gen dua non","1","1","E",null,"See OPPS/PHYS billing guides for policy. May require invoice"]
["PA","L8699","Prosthetic implant NOS","1","1","E"]
["PA","L8701","Pow ue rom dev ewh uprt cust","1","1","E"]
[null,"M0005","Promot wellness mvp","0","0"]
[null,"M1003","Tb scr 12 mo pri fst bio dz","0","0"]
[null,"M1012","Dc eoc doc med rec","0","0"]
[null,"M1028","Doc of pt prm hda dx and otr","0","0"]
[null,"M1040","Pt dx lum idi or cong scol","0","0"]
[null,"M1055","Aspirin used","0","0"]
[null,"M1070","Pt not scrn fut fall no rsn","0","0"]
[null,"M1072","Rom rad therapy anal, pc","0","0"]
[null,"M1081","Rom rad therapy breast, tc","0","0"]
[null,"M1094","Rom rad therapy lung, pc","0","0"]
[null,"M1101","Rom rad therapy prostate, tc","0","0"]
[null,"M1113","Oc ni pt 1-2 vis","0","0"]
[null,"M1122","Docu dx degen neuro","0","0"]
[null,"M1131","Docu dx degen neuro","0","0"]
[null,"M1147","Care not poss med rsn","0","0"]
[null,"M1148","Pt self dschg","0","0"]
[null,"M1160","Pt anphx due to mengb bef 13","0","0"]
[null,"M1169","Doc med rsn no flu vax","0","0"]
[null,"M1178","Doc med rsn no pcv","0","0"]
[null,"M1187","Pt w/ esrd","0","0"]
[null,"M1196","Ixv nrs vrs iqa >=4","0","0"]
[null,"M1205","Isa red >=2 fr ixv","0","0"]
[null,"M1214","Spiro results wth obs doc","0","0"]
[null,"M1215","Med rsn for no doc spiro","0","0"]
[null,"M1224","Iop dec <20% from base","0","0"]
[null,"M1233","Pt no hcv aby or result","0","0"]
[null,"M1242","Pt no resp imprt to me","0","0"]
[null,"M1251","Pts proxy cmplt hu surv","0","0"]
[null,"M1260","Pt not doc <= 1 yr dialysis","0","0"]
[null,"M1268","Pt ac stat kid trnsplt wtlst","0","0"]
[null,"M1279","Pre-htn/htn, no f/u, not gvn","0","0"]
[null,"M1280","Bilat mast/hx bi /unilat mas","0","0"]
[null,"M1289","No pt tbco cess interv rng","0","0"]
[null,"M1298","Doc pt preg dur msrmt pd","0","0"]
[null,"M1307","Doc pt pal or hospice","0","0"]
[null,"M1316","Tobacco non-user","0","0"]
[null,"M1325","Doc med rsn not seen","0","0"]
[null,"M1334","Pts act pvd 2 wks 2 wks","0","0"]
[null,"M1343","Pt pam lvl 4 base or srt lin","0","0"]
[null,"M1344","No bsln/2nd pam score 4-12mo","0","0"]
[null,"M1353","Pts no cmplt suicd saf pln","0","0"]
[null,"M1362","Pt died dur meas pd","0","0"]
[null,"M1371","Mst rec gsa<7","0","0"]
[null,"M1380","2 rx in perf pd any com meds","0","0"]
[null,"M1389","Pt rsn no exm","0","0"]
[null,"M1398","Bslne and  fu promis doc","0","0"]
[null,"M1407","Pt died dur perf pd","0","0"]
[null,"M1408","Gmln brca bef dx ca","0","0"]
[null,"M1420","Complete ophthalmologic mvp","0","0"]
[null,"P2029","Congo red blood test","0","0"]
[null,"P9012","Cryoprecipitate each unit","1","1","E"]
[null,"P9026","Cryo fib comp path redu each","1","1","E"]
[null,"P9038","RBC irradiated","1","1","E"]
[null,"P9048","Plasmaprotein fract,5%,250ml","1","1","E"]
[null,"P9058","RBC, l/r, cmv-neg, irrad","1","1","E"]
[null,"P9059","Plasma, frz between 8-24hour","1","1","E"]
[null,"P9612","Catheterize for urine spec","1","1","E"]
[null,"Q0111","Wet mounts/ w preparations","1","1","E"]
[null,"Q0161","Chlorpromazine hcl 5mg oral","1","1","E"]
[null,"Q0177","Hydroxyzine pamoate 25mg","1","1","E"]
["PA","Q0482","Microprcsr cu combo vad, rep","1","1","E"]
["PA","Q0491","Emr pwr source combo vad rep","1","1","E"]
["PA","Q0500","Filters elec/combo vad, rep","1","1","E"]
["PA","Q0501","Shwr cov elec/combo vad, rep","1","1","E"]
[null,"Q0511","Sup fee antiem,antica,immuno","0","0"]
[null,"Q0521","Supply fee hiv prep fda appr","0","0"]
["L","Q2035","Afluria vacc, 3 yrs & >, im","1","1","E"]
["PA","Q2055","Idecabtagene vicleucel car","1","1","A",null,"Invoice Required"]
[null,"Q4001","Cast sup body cast plaster","0","0"]
[null,"Q4010","Cast sup sht arm adult fbrgl","0","0"]
[null,"Q4019","Cast sup lng arm splnt ped p","0","0"]
[null,"Q4020","Cast sup lng arm splnt ped f","0","0"]
[null,"Q4029","Cast sup long leg plaster","0","0"]
[null,"Q4038","Cast sup shrt leg fiberglass","0","0"]
[null,"Q4047","Cast sup sht leg splnt ped p","0","0"]
[null,"Q4101","Apligraf","1","1","E"]
[null,"Q4111 ","Gammagraft ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4122 ","Dermacell ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4132 ","Grafix core, grafixpl core ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4133 ","Grafix stravix prime pl sqcm ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4142","Xcm biologic tiss matrix 1cm","0","0"]
[null,"Q4152 ","Dermapure 1 square cm ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4161 ","Bio-connekt per square cm ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4170 ","Cygnus, per sq cm ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4179 ","Flowerderm, per sq cm ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4188 ","Amnioarmor 1 sq cm ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4193 ","Coll-e-derm 1 sq cm ","1","1","E",null,"Payable  in OPPS only"]
[null,"Q4199","Cygnus matrix, per sq cm","0","0"]
[null,"Q4209","Surgraft per sq cm","1","1","E"]
[null,"Q4219","Surgigraft dual per sq cm","1","1","E"]
[null,"Q4230","Cogenex flow amnion 0.5 cc","0","0"]
[null,"Q4239","Amnio-maxx or lite per sq cm","1","1","E"]
[null,"Q4250","Amnioamp-mp per sq cm","1","1","E"]
[null,"Q4259","Celera per sq cm","0","0"]
[null,"Q4268","Surgraft ft per sq cm","0","0"]
[null,"Q4269","Surgraft xt per sq cm","0","0"]
[null,"Q4279","Vendaje ac, per sq cm","1","1","E"]
[null,"Q4288","Dermabind ch, per sq cm","1","1","E"]
[null,"Q4297","Emerge matrix, per sq cm","1","1","E"]
[null,"Q4306","Americ amnion ac per sq cm","0","0"]
[null,"Q4315","Regenelink amniotic mem allo","0","0"]
[null,"Q4324","Amniotx, per sq cm","0","0"]
[null,"Q4333","Ardeograft, per sq cm","0","0"]
[null,"Q4334","Amnioplast 1, per sq cm","0","0"]
[null,"Q4343","Dermacyte ac matrx per sq cm","0","0"]
[null,"Q5004","Hospice in SNF","0","0"]
[null,"Q5009","Hospice care, NOS","0","0"]
[null,"Q5108","Injection, fulphila","1","1","E"]
[null,"Q5117","Inj., kanjinti, 10 mg","1","1","E"]
[null,"Q5126","Inj alymsys 10 mg","1","1","E"]
[null,"Q5135","Inj, tocilizumab-aazg (tyenne), biosimilar, 1 mg","1","1","E"]
[null,"Q5136","Inj. denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg","0","0"]
[null,"Q5145","Inj, abrilada, 1 mg","0","0"]
[null,"Q9956","Inj octafluoropropane mic,ml","1","1","E"]
[null,"Q9967","LOCM 300-399mg/ml iodine,1ml","1","1","E"]
[null,"Q9995","inj. emicizumab-kxwh, 0.5 mg","0","0"]
["PA","S0093","Morphine 500 mg","1","1","E"]
[null,"S1034","Art pancreas system","0","0"]
[null,"S2117","Arthroereisis, subtalar ","0","0"]
[null,"S2118","Total hip resurfacing","0","0"]
[null,"S8032","Low dose CT lung screening","0","0"]
[null,"S9152","Speech therapy, re-eval","0","0"]
[null,"S9563","Ht inj immuno diem","0","0"]
[null,"T1041","Comm bh clinic svc per month","0","0"]
[null,"V2101","Single visn sphere 4.12-7.00","0","0"]
[null,"V2110","Spherocylinder 4.25d/over 6d","0","0"]
[null,"V2200","Lens spher bifoc plano 4.00d","0","0"]
[null,"V2201","Lens sphere bifocal 4.12-7.0","0","0"]
[null,"V2210","Lens sphcy bifocal 4.25-7/ov","0","0"]
[null,"V2221","Lenticular lens, bifocal","0","0"]
[null,"V2307","Lens sphcy trifocal 4.25-7/.","0","0"]
[null,"V2318","Lens aniseikonic trifocal","0","0"]
[null,"V2501","Cntct lens pmma-toric/prism","0","0"]
[null,"V2522","Cntct lens hydrophil bifocl","0","0"]
[null,"V2610","Single lens spectacle mount","0","0"]
[null,"V2615","Telescop/othr compound lens","0","0"]
[null,"V2631","Iris support intraoclr lens","1","1","E"]
[null,"V2745","Tint, any color/solid/grad","0","0"]
[null,"V2781","Progressive lens per lens","0","0"]
[null,"V2797","Vis item/svc in other code","0","0"]
[null,"V5050","Hearing aid monaural in ear","0","0"]
[null,"V5130","In ear binaural hearing aid","0","0"]
[null,"V5190","Glasses cros hearing aid","0","0"]
[null,"V5210","In ear bicros hearing aid","0","0"]
[null,"V5240","Dispensing fee bicros","0","0"]
[null,"V5249","Hearing aid, binaural, itc","0","0"]
[null,"V5258","Hearing aid, digit, bin, cic","0","0"]
[null,"V5267","Hearing aid supply/accessory","0","0"]
[null,"V5281","Ald fm/dm system, monaural","0","0"]
[null,"V5290","Ald transmitter microphone","0","0"]
[null,"0013A","Adm sarscov2 100mcg/0.5ml3rd","0","0"]
[null,"0014A","Fee covid-19 vac 2 res","0","0"]
[null,"0044A","Adm sarscov2 5mcg/0.5ml bst","0","0"]
[null,"0071A","Adm sarscv2 10mcg trs-sucr 1","0","0"]
[null,"0092A","Adm sarscov2 50 mcg/.5 ml2nd","0","0"]
[null,"0012F","Cap bacterial assess","0","0"]
[null,"0509F","Urine incon plan docd","0","0"]
[null,"0525F","Initial visit for episode","0","0"]
[null,"0555F","Symptom mgmnt plan care docd","0","0"]
[null,"0556F","Plan care lipid control docd","0","0"]
[null,"1002F","Assess anginal symptom/level","0","0"]
[null,"1012F","Angina absent","0","0"]
[null,"1035F","Smokeless tobacco user","0","0"]
[null,"1060F","Doc perm/cont/parox atr fib","0","0"]
[null,"1101F","Pt falls assess-docd le1/yr","0","0"]
[null,"1125F","Amnt pain noted pain prsnt","0","0"]
[null,"1150F","Doc pt rsk death w/in 1yr","0","0"]
[null,"1151F","Doc no pt rsk death w/in 1yr","0","0"]
[null,"1180F","Thromboemb risk assessed","0","0"]
[null,"1451F","Sympt show clin import drop","0","0"]
[null,"1502F","Pt queried pain fxn w/ instr","0","0"]
[null,"2014F","Mental status assess","0","0"]
[null,"2024F","7 field photo interp doc rev","0","0"]
[null,"2035F","Tymp memb motion examd","0","0"]
[null,"3015F","Cerv cancer screen docd","0","0"]
[null,"3016F","Pt scrnd unhlthy OH use","0","0"]
[null,"3027F","Spirom fev/fvc>=70%/w/o copd","0","0"]
[null,"3048F","Ldl-c <100 mg/dl","0","0"]
[null,"3062F","Pos macroalbuminuria rev","0","0"]
[null,"3080F","Diast bp >= 90 mm hg","0","0"]
[null,"3092F","Mdd in remission","0","0"]
[null,"3112F","Ct/mri brain done >24 hrs","0","0"]
[null,"3150F","Forceps esoph biopsy done","0","0"]
[null,"3155F","Cytogen test marrow b/4 tx","0","0"]
[null,"3230F","Note hring tst w/in 6 mon","0","0"]
[null,"3271F","Low risk prostate cancer","0","0"]
[null,"3285F","IOP down <15% of pre-svc lvl","0","0"]
[null,"3315F","Er+ or pr+ breast cancer","0","0"]
[null,"3324F","Mri ct scan ord rvwd rqstd","0","0"]
[null,"3344F","Mammo assess susp docd","0","0"]
[null,"3374F","Ajcc brst cncr stage 1 docd","0","0"]
[null,"3376F","AJCC brstcncr stage 2 docd","0","0"]
[null,"3395F","Quant nonher2 ihc brst cx","0","0"]
[null,"3476F","Disease progn RA good docd","0","0"]
[null,"3498F","Cd4+ cell >=15% (hiv)","0","0"]
[null,"3515F","Pt has docd immun to hep C","0","0"]
[null,"3573F","Pt not consid poss risk fx","0","0"]
[null,"3754F","Screening tests dm done","0","0"]
[null,"3763F","Patient is not dysarthric","0","0"]
[null,"3775F","Adenoma detected screening","0","0"]
[null,"4018F","Therapy exercise joint rx","0","0"]
[null,"4030F","Oxygen therapy rx","0","0"]
[null,"4045F","Empiric antibiotic rx","0","0"]
[null,"4054F","Hemodialysis via catheter","0","0"]
[null,"4066F","ECT provided","0","0"]
[null,"4086F","Aspirin/clopidogrel rxd","0","0"]
[null,"4131F","Syst antimicrobial thx rx","0","0"]
[null,"4132F","No syst antimicrobial thx rx","0","0"]
[null,"4148F","Hep A vac injxn admin/recvd","0","0"]
[null,"4163F","Pt couns 4 txmnt opt prost","0","0"]
[null,"4175F","Vis of >= 20/40 w/in 90 days","0","0"]
[null,"4186F","No cont ppi or h2ra rcvd","0","0"]
[null,"4195F","Pt rcvng anti-rheum thxpy RA","0","0"]
[null,"4242F","Sprvsd xrcz bk pn >12 weeks","0","0"]
[null,"4266F","No wet-dry drssings rx recmd","0","0"]
[null,"4267F","Comprssion thxpy prescribed","0","0"]
[null,"4290F","Pt scrned for inj drug use","0","0"]
[null,"4325F","Med txmnt options rvwd w/pt","0","0"]
[null,"4480F","Pt rcvng ace/arb b-blockertx","0","0"]
[null,"4550F","noninvas resp support talk","0","0"]
[null,"4561F","Pt w/coronary artery stent","0","0"]
[null,"5062F","Mammo result com to pt 5 day","0","0"]
[null,"6040F","Appro rad ds dvcs techs docd","0","0"]
[null,"6045F","Radxps in end rprt4fluro pxd","0","0"]
[null,"7010F","Pt info into recall system","0","0"]
[null,"9007F"," Other carot sten 120 days/>","0","0"]
[null,"0013M","Onc mrna 5 gen recr urthl ca","0","0"]
[null,"0071T","U/s leiomyomata ablate <200","0","0"]
[null,"0106T","Touch quant sensory test","0","0"]
[null,"0175T","Cad cxr remote","0","0"]
[null,"0201T","Perq sacral augmt bilat inj","0","0"]
[null,"0202T","Post vert arthrplst 1 lumbar","0","0"]
["CPA","0215T","Njx paravert w/us cer/thor","1","1","E"]
[null,"0234T","Trluml perip athrc renal art","1","1","E"]
[null,"0267T","Implt/rpl crtd sns dev lead","0","0"]
[null,"0278T","Tempr","0","0"]
[null,"0338T","Trnscth renal symp denrv unl","0","0"]
[null,"0351T","Intraop oct brst/node spec","0","0"]
[null,"0387T","Leadless c pm ins/rpl ventr","0","0"]
[null,"0389T","Prog eval inper leadls pm","0","0"]
[null,"0406T","Sin ndsc plmt drg elut mplnt","0","0"]
[null,"0415T","Repos car modulj tranvns elt","0","0"]
[null,"0439T","Myocrd contrast prfuj echo","0","0"]
[null,"0448T","Remvl insj impltbl gluc sens","0","0"]
[null,"0480T","Fxjl abl lsr ea addl 100sqcm","0","0"]
[null,"0494T","Prep & cannulj cdvr don lung","0","0"]
[null,"0511T","Rmval & reinsrt of sinus tarsi implant","0","0"]
[null,"0512T","Esw integ wnd hlg 1st wnd","0","0"]
[null,"0522T","Prgrmg dev eval wcs ip","0","0"]
[null,"0531T","Removal iims electrode only","0","0"]
[null,"0544T","Tcat mv annulus rcnstj","0","0"]
[null,"0557T","B1 STR & FX RSK I&R","0","0"]
[null,"0566T","Autol cell implt adps njx","0","0"]
[null,"0575T","Prgrmg dev eval icds ss ip","0","0"]
[null,"0584T","Perq islet cell transplant","0","0"]
[null,"0585T","Laps islet cell transplant","0","0"]
[null,"0594T","Osteot hum xtrnl lngth dev","0","0"]
[null,"0607T","Rem mntr pulm flu mntr setup","0","0"]
[null,"0613T","Perq tcat intratrl septl sht","0","0"]
[null,"0622T","Trabeculostomy int lsr w/scp","0","0"]
[null,"0631T","Tc vis lit hyperspectral img","0","0"]
[null,"0640T","NCNTC NR IFR SPCTRSC WND","0","0"]
[null,"0651T","MAG CTRLD CAPSULE ENDOSCOPY","0","0"]
[null,"0652T","EGD FLX TRANSNASAL DX BR/WA","0","0"]
[null,"0661T","RMVL&RIMPLTJ ANT SGM IMPLT","0","0"]
[null,"0670T","BKBENCH RCNSTJ DON UTER ARTL","0","0"]
[null,"0679T","Laps rmvl lead isdss","0","0"]
[null,"0688T","Tx amblyopia assmt w/report","0","0"]
[null,"0697T","Quan mr tis wo mri mlt orgn","0","0"]
[null,"0708T","Id ca immntx prep & 1st njx","0","0"]
[null,"0718T","ADRC THER PRTL RC TEAR NJX","0","0"]
[null,"0719T","PST VRT JT RPLCMT LMBR 1 SGM","0","0"]
[null,"0728T","DX ALYS VSTBLR IMPLT UNI 1ST","0","0"]
[null,"0737T","XENOGRAFT IMPLTJ ARTCLR SURF","0","0"]
[null,"0746T","Car ablt rad arr cnv loc map","0","0"]
[null,"0755T","Dgtz gls mcrscp sld level vi","0","0"]
[null,"0760T","Dgtz gls mcrscp sl imm 1st","0","0"]
[null,"0777T","R-t prs sensing edrl gdn sys","0","0"]
[null,"0786T","INSJ/RPLCMT PRQ RA SAC NSTIM","0","0"]
[null,"0787T","REVJ/RMVL NEA SAC W/NSTIM","0","0"]
[null,"0796T","Tcat ins 2chmbr ldls pm ra","0","0"]
[null,"0805T","Tcat s&ivc prstc vl impl prq","0","0"]
[null,"0815T","US REMS B1 DNS HIPS PLVS/SPI","0","0"]
[null,"0824T","TCAT RMV 1CHMBR LDLS PM RA","0","0"]
[null,"0833T","DGTZ GLS MCRSCP CYTP OTH PRP","0","0"]
[null,"0842T","DGTZ GLS MCRSCP PTH CSLT EA","0","0"]
[null,"0851T","DGTZ GLS MCRSCP MPHMTRC 1ST","0","0"]
[null,"0852T","DGTZ GLS MCRSCP MPHMTRC EA 1","0","0"]
[null,"0861T","RMVL PG WCS LV BOTH COMPNT","0","0"]
[null,"0870T","Imp subq prtl ascts pmp sys","0","0"]
[null,"0879T","Augmnt alys ch ct ild prep","0","0"]
[null,"0888T","Histotripsy mal renal tissue","0","0"]
[null,"0897T","N-invas augmnt arrhyt alys","0","0"]
[null,"0906T","COMS THER 1ST APPL<=50 SQ CM","0","0"]
[null,"0915T","INSJ PERM CCM-D SYS PG&ELTRD","0","0"]
[null,"0921T","RMVL PERM CCM-D SYS 1 DFB LD","0","0"]
[null,"0925T","RLCJ SKIN POCKET CCM-D PG","0","0"]
[null,"0926T","PRGRMG DEV EVAL CCM-D IP","0","0"]
[null,"0927T","INTERROG DEV EVAL CCM-D IP","0","0"]
[null,"0928T","REM INTERROG DEV CCM-D PHYS","0","0"]
[null,"0929T","REM INTERROG DEV CCM-D TECH","0","0"]
[null,"0930T","EPHYS EVAL CCM-D LD 1ST IMPL","0","0"]
[null,"0931T","EPHYS EVAL CCM-D LD SEPARATE","0","0"]
[null,"0932T","N-INVS DET HRT FAIL AUG ECHO","0","0"]
[null,"0933T","TCAT IMPL WRLS L ATR PRS SNR","0","0"]
[null,"0934T","REM MNTR WRLS L ATR PRS SNR","0","0"]
[null,"0935T","CYSTO W/RNL PEL SYMP DNRVTJ","0","0"]
[null,"0936T","PHOTOBIOMODULATION THER RTA","0","0"]
[null,"0937T","XTRNL ECG REC>15D<30D","0","0"]
[null,"0938T","XTRNL ECG REC>15D<30D REC","0","0"]
[null,"0939T","XTRNL ECG REC>15D<30D SCAN","0","0"]
[null,"0940T","XTRNL ECG REC>15D<30D R&I","0","0"]
[null,"0941T","CYSTO FLX INS&XPNS URTL SCAF","0","0"]
[null,"0942T","CYSTO FLX RMV&RPLC URTL SCAF","0","0"]
[null,"0943T","CYSTO FLX RMVL URTL SCAFFOLD","0","0"]
[null,"0944T","3D CNTR SIMULA TRGT LVR LES","0","0"]
[null,"0945T","INTRAOP ASSMT ABNL TUM TISS","0","0"]
[null,"0946T","ORTHO IMPL MVMT ALYS PAIR CT","1","1","E"]
[null,"0947T","MRGFUS STRTCTC BL-BR DISRPJ","0","0"]
[null,"0001U","Rbc dna hea 35 ag 11 bld grp","0","0"]
[null,"0002U","Onc clrct 3 ur metab alg plp","0","0"]
[null,"0003U","Onc ovar 5 prtn ser alg scor","0","0"]
["PA","0005U","Onco prst8 3 gene ur alg","1","1","E"]
[null,"0006U","RX MNTR 120+ DRUGS & SBSTS","0","0"]
[null,"0007U","RX TEST PRSMV UR W/DEF CONF","0","0"]
[null,"0008U","HPYLORI DETCJ ABX RSTNC DNA","0","0"]
[null,"0009U","ONC BRST CA ERBB2 AMP/NONAMP","0","0"]
[null,"0010U","NFCT DS STRN TYP WHL GEN SEQ","0","0"]
[null,"0011U","RX MNTR LC-MS/MS ORAL FLUID","0","0"]
[null,"0016U","ONC HMTLMF NEO RNA BCR/ABL1","0","0"]
[null,"0017U","ONC HMTLMF NEO JAK2 MUT DNA","0","0"]
[null,"0022U","Tgsap nsm lung neo dna&rna23","0","0"]
[null,"0035U","Neuro csf prion prtn qual","0","0"]
[null,"0036U","Xome tum & nml spec seq alys","0","0"]
[null,"0037U","Trgt gen seq dna 324 genes","0","0"]
[null,"0038U","Vitamin d srm microsamp quan","0","0"]
[null,"0039U","Dna antb 2strand hi avidity","0","0"]
[null,"0040U","Bcr/abl1 gene major bp quan","0","0"]
[null,"0041U","B brgdrferi antb 5 prtn igm","0","0"]
[null,"0042U","B brgdrferi antb 12 prtn igg","0","0"]
[null,"0043U","Tbrf b grp antb 4 prtn igm","0","0"]
[null,"0044U","Tbrf b grp antb 4 prtn igg","0","0"]
[null,"0045U","Onc brst dux carc is 12 gene","0","0"]
[null,"0046U","Flt3 gene itd variants quan","0","0"]
["L/PA/EPA","0047U","Onc prst8 mrna 17 gene alg","1","1","E",null,"Please see the Physician-Related Billing Guide"]
[null,"0048U","Onc sld org neo dna 468 gene","0","0"]
[null,"0049U","Npm1 gene analysis quan","0","0"]
[null,"0050U","Trgt gen seq dna 194 genes","0","0"]
[null,"0051U","Rx mntr lc-ms/ms ur 31 pnl","0","0"]
[null,"0052U","Lpoprtn bld w/5 maj classes","0","0"]
[null,"0054U","Bone srgry cmptr fluor image","0","0"]
[null,"0055U","Rx mntr 14+ drugs & sbsts","0","0"]
[null,"0057U","Card hrt trnspl 96 dna seq","0","0"]
[null,"0058U","Hem aml dna gene reargmt","0","0"]
[null,"0059U","Onc sld org neo mrna 51 gene","0","0"]
[null,"0060U","Cryopreservation ovary tiss","0","0"]
[null,"0061U","Onc merkel cll carc srm quan","0","0"]
[null,"0062U","Ai sle igg&igm alys 80 bmrk ","0","0"]
[null,"0063U","Neuro autism 32 amines alg ","0","0"]
[null,"0064U","Antb tp total&rpr ia qual","0","0"]
[null,"0065U","Syfls tst nontreponemal antb ","0","0"]
[null,"0066U","PAMG-1 IA CERVICO-VAG FLUID","0","0"]
[null,"0067U","Onc brst imhchem prfl 4 bmrk ","0","0"]
[null,"0068U","Candida species pnl amp prb ","0","0"]
[null,"0069U","Onc clrct microrna mir-31- 3p ","0","0"]
[null,"0070U","Cyp2d6 gen com&slct rar vrnt ","0","0"]
[null,"0071U","Cyp2d6 full gene sequence ","0","0"]
[null,"0072U","Cyp2d6 gen cyp2d6-2d7 hybrid","0","0"]
[null,"0073U","Cyp2d6 gen cyp2d7-2d6 hybrid","0","0"]
[null,"0074U","Cyp2d6 nonduplicated gene ","0","0"]
[null,"0075U","Cyp2d6 5' gene dup/mlt ","0","0"]
[null,"0076U","Cyp2d6 3' gene dup/mlt ","0","0"]
[null,"0077U","Ig paraprotein qual bld/ur ","0","0"]
[null,"0079U","Cmprtv dna alys mlt snps ","0","0"]
[null,"0084U","Rbc dna gnotyp 10 bld groups","0","0"]
[null,"0086U","Nfct ds bact&fng org id 6+","0","0"]
[null,"0087U","CRD HRT TRNSPL MRNA 1283 GEN","0","0"]
[null,"0088U","Trnsplj kdn algrft rej 1494","0","0"]
[null,"0089U","ONC MLNMA PRAME & LINC00518","0","0"]
[null,"0090U","Onc cutan mlnma mrna 23 gene","0","0"]
[null,"0091U","ONC CLRCT SCR WHL BLD ALG","0","0"]
[null,"0092U","Onc lng 3 prtn bmrk plsm alg","0","0"]
[null,"0093U","RX MNTR 65 COM DRUGS URINE","0","0"]
[null,"0094U","Genome rapid sequence alys","0","0"]
[null,"0095U","EE 2 PRTN BMRK M B P ELISA EST","0","0"]
[null,"0096U","Hpv hi risk types male urine","0","0"]
[null,"0101U","HERED COLON CA DO 15 GENES","0","0"]
[null,"0102U","Hered brst ca rltd do 17 gen","0","0"]
[null,"0103U","HERED OVA CA PNL 24 GENES","0","0"]
[null,"0104U","Hered pan ca pnl 32 genes","0","0"]
[null,"0105U","NEPH CKD MULT ECLIA TUM NEC","1","1","E"]
[null,"0106U","GSTR EMPTG 7 TIMED BRTH SPEC","1","1","E"]
[null,"0107U","C DIFF TOX AG DETCJ IA STOOL","1","1","E"]
[null,"0108U","GI BARRETT ESOPH 9 PRTN BMRK","1","1","E"]
[null,"0109U","ID ASPERGILLUS DNA 4 SPECIES","1","1","E"]
[null,"0110U","RX MNTR 1+ORAL ONC RX&SBSTS","1","1","E"]
[null,"0111U","ONC COLON CA KRAS&NRAS ALYS","1","1","E"]
[null,"0112U","IADI 16S&18S RRNA GENES","1","1","E"]
[null,"0113U","ONC PRST8 PCA3&TMPRSS2- ERG","1","1","E"]
[null,"0114U","GI BARRETTS ESOPH VIM&CCNA1","1","1","E"]
[null,"0115U","RESPIR IADNA 18 VIRAL&2 BACT","1","1","E"]
[null,"0116U","RX MNTR NZM IA 35+ORAL FLU","1","1","E"]
[null,"0117U","PAIN MGMT 11 ENDOGENOUS ANAL","1","1","E"]
[null,"0118U","TRNSPLJ DON-DRV CLL-FR DNA","1","1","E"]
[null,"0119U","CRD CERAMIDES LIQ CHROM PLSM","1","1","E"]
[null,"0120U","ONC B CLL LYMPHM MRNA 58 GEN","1","1","E"]
[null,"0121U","SC DIS VCAM-1 WHOLE BLOOD","1","1","E"]
[null,"0122U","SC DIS P-SELECTIN WHL BLOOD","1","1","E"]
[null,"0123U","MCHNL FRAGILITY RBC PRFLG","1","1","E"]
[null,"0129U","HERED BRST CA RLTD DO PANEL","1","1","E"]
[null,"0130U","HERED COLON CA DO MRNA PNL","1","1","E"]
[null,"0131U","HERED BRST CA RLTD DO PNL 13","1","1","E"]
[null,"0132U","HERED OVA CA RLTD DO PNL 17","1","1","E"]
[null,"0133U","HERED PRST8 CA RLTD DO 11","1","1","E"]
[null,"0134U","HERED PAN CA MRNA PNL 18 GEN","1","1","E"]
[null,"0135U","HERED GYN CA MRNA PNL 12 GEN","1","1","E"]
[null,"0136U","ATM MRNA SEQ ALYS","1","1","E"]
[null,"0137U","PALB2 MRNA SEQ ALYS","1","1","E"]
[null,"0138U","BRCA1 BRCA2 MRNA SEQ ALYS","1","1","E"]
[null,"0140U","Nfct ds fungi dna 15 trgt","0","0"]
[null,"0141U","Nfct ds bact&fng gram pos","0","0"]
[null,"0142U","Nfct ds bact&fng gram neg","0","0"]
[null,"0152U","Nfct bct fng prst dna >1000","0","0"]
[null,"0153U","Onc breast mrna 101 genes","0","0"]
[null,"0154U","Fgfr3 gene analysis","0","0"]
[null,"0155U","Pik3ca gene analysis","0","0"]
[null,"0156U","Copy number sequence alys","0","0"]
[null,"0157U","Apc mrna seq alys","0","0"]
[null,"0158U","Mlh1 mrna seq alys","0","0"]
[null,"0159U","Msh2 mrna seq alys","0","0"]
[null,"0160U","Msh6 mrna seq alys","0","0"]
[null,"0161U","Pms2 mrna seq alys","0","0"]
[null,"0162U","Hered colon ca trgt mrna pnl","0","0"]
[null,"0172U","Onc sld tum alys brca1 brca2","0","0"]
[null,"0173U","Psyc gen alys panel 14 genes","0","0"]
[null,"0174U","Onc solid tumor 30 prtn trgt","0","0"]
[null,"0175U","Psyc gen alys panel 15 genes","0","0"]
[null,"0176U","Cdtb&vinculin igg antb ia","0","0"]
[null,"0177U","Onc brst ca dna pik3ca 11","0","0"]
[null,"0178U","Peanut allg asmt epi clin rx","0","0"]
[null,"0179U","Onc nonsm cll lng ca alys 23","0","0"]
[null,"0180U","Abo gnotyp abo 7 exons","0","0"]
[null,"0181U","Co gnotyp aqp1 exon 1","0","0"]
[null,"0182U","Crom gnotyp cd55 exons 1-10","0","0"]
[null,"0183U","Di gnotyp slc4a1 exon 19","0","0"]
[null,"0184U","Do gnotyp art4 exon 2","0","0"]
[null,"0185U","Fut1 gnotyp fut1 exon 4","0","0"]
[null,"0186U","Fut2 gnotyp fut2 exon 2","0","0"]
[null,"0187U","Fy gnotyp ackr1 exons 1-2","0","0"]
[null,"0188U","Ge gnotyp gypc exons 1-4","0","0"]
[null,"0189U","Gypa gnotyp ntrns 1 5 exon 2","0","0"]
[null,"0190U","Gypb gnotyp ntrns 1 5 seux 3","0","0"]
[null,"0191U","In gnotyp cd44 exons 2 3 6","0","0"]
[null,"0192U","Jk gnotyp slc14a1 exon 9","0","0"]
[null,"0193U","Jr gnotyp abcg2 exons 2-26","0","0"]
[null,"0194U","Kel gnotyp kel exon 8","0","0"]
[null,"0195U","Klf1 targeted sequencing","0","0"]
[null,"0196U","Lu gnotyp bcam exon 3","0","0"]
[null,"0197U","Lw gnotyp icam4 exon 1","0","0"]
[null,"0198U","Rhd&rhce gntyp rhd1-10&rhce5","0","0"]
[null,"0199U","Sc gnotyp ermap exons 4 12","0","0"]
[null,"0200U","Xk gnotyp xk exons 1-3","0","0"]
[null,"0201U","Yt gnotyp ache exon 2","0","0"]
[null,"0203U","AI IBD MRNA XPRSN PRFL 17","0","0"]
[null,"0205U","OPH AMD ALYS 3 GENE VARIANTS","0","0"]
[null,"0206U","NEURO ALZHEIMER CELL AGGREGJ","0","0"]
[null,"0207U","NEURO ALZHEIMER QUAN IMAGING","0","0"]
[null,"0209U","CYTOG CONST ALYS INTERROG","0","0"]
[null,"0210U","SYPHILIS TST ANTB IA QUAN","0","0"]
[null,"0211U","ONC PAN-TUM DNA&RNA GNRJ SEQ","0","0"]
[null,"0212U","RARE DS GEN DNA ALYS PROBAND","0","0"]
[null,"0213U","RARE DS GEN DNA ALYS EA COMP","0","0"]
[null,"0214U","RARE DS XOM DNA ALYS PROBAND","0","0"]
[null,"0215U","RARE DS XOM DNA ALYS EA COMP","0","0"]
[null,"0216U","NEURO INH ATAXIA DNA 12 COM","0","0"]
[null,"0217U","NEURO INH ATAXIA DNA 51 GENE","0","0"]
[null,"0218U","NEURO MUSC DYS DMD SEQ ALYS","0","0"]
[null,"0219U","NFCT AGT HIV GNRJ SEQ ALYS","0","0"]
[null,"0220U","ONC BRST CA AI ASSMT 12 FEAT","0","0"]
[null,"0221U","ABO GNOTYP NEXT GNRJ SEQ ABO","0","0"]
[null,"0222U","RHD&RHCE GNTYP NEXT GNRJ SEQ","0","0"]
[null,"0227U","Rx asy prsmv 30+rx/metablt","0","0"]
[null,"0228U","Onc prst8 ma molec prfl alg","0","0"]
[null,"0229U","Bcat1 promoter mthyltn alys","0","0"]
[null,"0230U","Ar full sequence analysis","0","0"]
[null,"0231U","Cacna1a full gene analysis","0","0"]
[null,"0232U","Cstb full gene analysis","0","0"]
[null,"0233U","Fxn gene analysis","0","0"]
[null,"0234U","Mecp2 full gene analysis","0","0"]
[null,"0235U","Pten full gene analysis","0","0"]
[null,"0236U","Smn1&smn2 full gene analysis","0","0"]
[null,"0237U","Car ion chnlpthy gen seq pnl","0","0"]
[null,"0238U","Onc lnch syn gen dna seq aly","0","0"]
[null,"0239U","Trgt gen seq alys pnl 311+","0","0"]
[null,"0242U","TRGT GEN SEQ ALYS PNL 55-74","0","0"]
[null,"0243U","OB PE BIOCHEM ASSAY PGF ALG","0","0"]
[null,"0244U","ONC SOLID ORGN DNA 257 GENES","0","0"]
[null,"0245U","ONC THYR MUT ALYS 10 GEN&37","0","0"]
[null,"0246U","RBC DNA GNOTYP 16 BLD GROUPS","0","0"]
[null,"0247U","OB PRTRM BRTH IBP4 SHBG MEAS","0","0"]
[null,"0248U","Onc brn sphrd cll 12 rx pnl","0","0"]
[null,"0249U","Onc brst alys 32 phsprtn alg","0","0"]
[null,"0250U","Onc sld org neo dna 505 gene","0","0"]
[null,"0251U","Hepcidin-25 elisa serum/plsm","0","0"]
[null,"0252U","Ftl aneuploidy str alys dna","0","0"]
[null,"0253U","Rprdtve med rna gen prfl 238","0","0"]
[null,"0254U","Reprdtve med alys 24 chrmsm","0","0"]
[null,"0255U","Andrology infertility assmt","0","0"]
[null,"0256U","Tma/tmao prfl ms/ms ur alg","0","0"]
[null,"0257U","Vlcad leuk nzm actv whl bld","0","0"]
[null,"0258U","Ai psor mrna 50-100 gen alg","0","0"]
[null,"0259U","Neph ckd nuc mrs meas gfr","0","0"]
[null,"0260U","Rare ds id opt genome mapg","0","0"]
[null,"0261U","Onc clrct ca img alys w/ai","0","0"]
[null,"0262U","Onc sld tum rtpcr 7 gen","0","0"]
[null,"0263U","Neuro asd meas 16 c metblt","0","0"]
[null,"0264U","Rare ds id opt genome mapg","0","0"]
[null,"0265U","Rar do whl gn&mtcdrl dna als","0","0"]
[null,"0266U","Unxpl cnst hrtbl do gn xprsn","0","0"]
[null,"0267U","Rare do id opt gen mapg&seq","0","0"]
[null,"0268U","Hem ahus gen seq alys 15 gen","0","0"]
[null,"0269U","Hem aut dm cgen trmbctpna 14","0","0"]
[null,"0270U","Hem cgen coagj do 20 genes","0","0"]
[null,"0271U","Hem cgen neutropenia 23 gen","0","0"]
[null,"0272U","Hem genetic bld do 51 genes","0","0"]
[null,"0273U","Hem gen hyprfibrnlysis 8 gen","0","0"]
[null,"0274U","Hem gen pltlt do 43 genes","0","0"]
[null,"0275U","Hem heprn nduc trmbctpna srm","0","0"]
[null,"0276U","Hem inh thrombocytopenia 23","0","0"]
[null,"0277U","Hem gen pltlt funcj do 31","0","0"]
[null,"0278U","Hem gen thrombosis 12 genes","0","0"]
[null,"0279U","Hem vw factor&clgn iii bndg","0","0"]
[null,"0280U","Hem vw factor&clgn iv bndg","0","0"]
[null,"0281U","Hem vwd propeptide ag lvl","0","0"]
[null,"0282U","Rbc dna gntyp 12 bld grp gen","0","0"]
[null,"0283U","Vw factor type 2b eval plsm","0","0"]
[null,"0284U","Vw factor type 2n eval plsm","0","0"]
[null,"0285U","Onc rsps radj cll fr dna tox","0","0"]
[null,"0286U","Cep72 nudt15&tpmt gene alys","0","0"]
[null,"0287U","Onc thyr dna&mrna 112 genes","0","0"]
[null,"0288U","Onc lung mrna quan pcr 11&3","0","0"]
[null,"0289U","Neuro alzheimer mrna 24 gen","0","0"]
[null,"0290U","Pain mgmt mrna gen xprsn 36","0","0"]
[null,"0291U","Psyc mood do mrna 144 genes","0","0"]
[null,"0292U","Psyc strs do mrna 72 genes","0","0"]
[null,"0293U","Psyc suicidal idea mrna 54","0","0"]
[null,"0294U","Lngvty&mrtlty rsk mrna 18gen","0","0"]
[null,"0295U","Onc brst dux carc 7 proteins","0","0"]
[null,"0296U","Onc orl&/orop ca 20 mlc feat","0","0"]
[null,"0297U","Onc pan tum whl gen seq dna","0","0"]
[null,"0298U","Onc pan tum whl trns seq rna","0","0"]
[null,"0299U","Onc pan tum whl gen opt mapg","0","0"]
[null,"0300U","Onc pan tum whl gen seq&opt","0","0"]
[null,"0301U","Iadna bartonella ddpcr","0","0"]
[null,"0302U","Iadna brtnla ddpcr flwg liq","0","0"]
[null,"0303U","Hem rbc ads whl bld hypoxic","0","0"]
[null,"0304U","Hem rbc ads whl bld normoxic","0","0"]
[null,"0305U","Hem rbc fnclty&dfrm shr strs","0","0"]
[null,"0306U","Onc mrd nxt-gnrj alys 1st","0","0"]
[null,"0307U","Onc mrd nxt-gnrj alys sbsq","0","0"]
[null,"0308U","Crd cad alys 3 prtn 3 param","0","0"]
[null,"0309U","Crd cv ds aly 4 prtn plm alg","0","0"]
[null,"0310U","Ped vsclts kd alys 3 bmrks","0","0"]
[null,"0311U","Nfct ds bct quan antmcrb sc","0","0"]
[null,"0312U","Ai ds sle alys 8 igg autoant","0","0"]
[null,"0313U","Onc pncrs dna&mrna seq 74","0","0"]
[null,"0314U","Onc cutan mlnma mrna 35 gene","0","0"]
[null,"0315U","Onc cutan sq cll ca mrna 40","0","0"]
[null,"0316U","B brgdrferi lyme ds ospa evl","0","0"]
[null,"0317U","Onc lung ca 4-prb fish assay","0","0"]
[null,"0318U","Ped whl gen mthyltn alys 50+","0","0"]
[null,"0319U","Neph rna pretrnspl perph bld","0","0"]
[null,"0320U","Neph rna psttrnspl perph bld","0","0"]
[null,"0321U","Iadna gu pthgn 20bct&fng org","0","0"]
[null,"0322U","Neuro asd meas 14 acyl carn","0","0"]
[null,"0323U","IADNA CNS PTHGN NEXT GEN SEQ","0","0"]
[null,"0324U","Onc ovar sphrd cell 4 rx pnl","0","0"]
[null,"0325U","Onc ovar sphrd cell parp","0","0"]
[null,"0326U","TRGT GEN SEQ ALYS PNL 83+","0","0"]
[null,"0327U","FTL ANEUPLOIDY TRSMY DNA SEQ","0","0"]
[null,"0328U","DRUG ASSAY 120+ RX&METABLT","0","0"]
[null,"0329U","ONC NEO XOME&TRNS SEQ ALYS","0","0"]
[null,"0330U","IADNA VAG PTHGN PANEL 27 ORG","0","0"]
[null,"0331U","ONC HL NEO OPT GEN MAPPING","0","0"]
[null,"0332U","ONC PAN TUM GEN PRFLG 8 DNA","0","0"]
[null,"0333U","ONC LVR SURVEILANC HCC CFDNA","0","0"]
[null,"0334U","ONC SLD ORGN TGSA DNA 84/+","0","0"]
[null,"0335U","RARE DS WHL GEN SEQ FETAL","0","0"]
[null,"0336U","RARE DS WHL GEN SEQ BLD/SLV","0","0"]
[null,"0337U","ONC PLSM CELL DO&MYELOMA ID","0","0"]
[null,"0338U","ONC SLD TUM CRCG TUM CL SLCT","0","0"]
[null,"0339U","ONC PRST8 MRNA HOXC6 & DLX1","0","0"]
[null,"0340U","ONC PAN CA ALYS MRD PLASMA","0","0"]
[null,"0341U","FTL ANEUP DNA SEQ CMPR ALYS","0","0"]
[null,"0342U","ONC PNCRTC CA MULT IA ECLIA","0","0"]
[null,"0343U","ONC PRST8 XOM ALY 442 SNCRNA","0","0"]
[null,"0344U","HEP NAFLD SEMIQ EVL 28 LIPID","0","0"]
[null,"0345U","PSYC GENOM ALYS PNL 15 GEN","0","0"]
[null,"0346U","BETA AMYL Aβ40&Aβ42 LC-MS/MS","0","0"]
[null,"0347U","RX METAB/PCX DNA 16 GEN ALYS","0","0"]
[null,"0348U","RX METAB/PCX DNA 25 GEN ALYS","0","0"]
[null,"0349U","RX METAB/PCX DNA 27GEN RX IA","0","0"]
[null,"0350U","RX METAB/PCX DNA 27 GEN ALYS","0","0"]
[null,"0351U","NFCT DS BCT/VIRAL TRAIL IP10","0","0"]
[null,"0352U","NFCT DS BV&VAGINITIS AMP PRB","0","0"]
[null,"0355U","Apol1 risk variants","0","0"]
[null,"0356U","Onc orop 17 dna ddpcr alg","0","0"]
[null,"0357U","ONC MLNMA AI QUAN ALYS 142","0","0"]
[null,"0358U","Neuro alys b-amyl 1-42&1-40","0","0"]
[null,"0359U","Onc prst8 ca alys all psa","0","0"]
[null,"0360U","Onc lung elisa 7 autoant alg","0","0"]
[null,"0361U","Neurflmnt lt chn dig ia quan","0","0"]
[null,"0362U","Onc pap thyr ca rna 82&10","0","0"]
[null,"0363U","Onc urthl mrna 5 gen alg","0","0"]
[null,"0364U","Onc hl neo gen seq alys alg","0","0"]
[null,"0365U","ONC BLDR 10 UR HRBR URTHL CA","0","0"]
[null,"0366U","Onc bldr 10 prb recr bldr ca","0","0"]
[null,"0367U","Onc bldr 10 flwg trurl rescj","0","0"]
[null,"0368U","Onc clrct ca mut&mthyltn mrk","0","0"]
[null,"0369U","Iadna gi pthgn 31 org&21 arg","0","0"]
[null,"0370U","Iadna surg wnd pthgn 34&21","0","0"]
[null,"0371U","Iadna gu pthgn semiq dna16&1","0","0"]
[null,"0372U","Nfct ds gu pthgn arg detcj","0","0"]
[null,"0373U","Iadna rsp tr nfct 17 8 13&16","0","0"]
[null,"0374U","Iadna gu pthgn 21 org&21arg","0","0"]
[null,"0375U","Onc ovrn bchm asy 7 prtn alg","0","0"]
[null,"0376U","Onc prst8 ca img alys 128","0","0"]
[null,"0377U","Cv ds quan advsrm/plsm lprtn","0","0"]
[null,"0378U","Rfc1 repeat xpnsj vrnt alys","0","0"]
[null,"0379U","Tgsap sl or neo dna523&rna55","0","0"]
[null,"0380U","RX METB ADVRS TRGT SQ ALY 20","0","0"]
[null,"0381U","Maple syrup ur ds mntr quan","0","0"]
[null,"0382U","Hyprphenylalninmia mntr quan","0","0"]
[null,"0383U","Tyrosinemia typ i mntr quan","0","0"]
[null,"0384U","Neph ckd rsk hi stg kdn ds","0","0"]
[null,"0385U","Neph ckd alg rsk dbtc kdn ds","0","0"]
[null,"0386U","GI BARRETT ESOPH MTHYLTN ALY","0","0"]
[null,"0387U","Onc mlnma ambra1&amlo","0","0"]
[null,"0388U","Onc nonsm cll lng ca 37 gen","0","0"]
[null,"0389U","Ped fbrl kd ifi27&mcemp1 rna","0","0"]
[null,"0390U","Ob pe kdr eng&rbp4 ia alg","0","0"]
[null,"0391U","Onc sld tum dna&rna 437 gen","0","0"]
[null,"0392U","Rx metab genrx ia 16 genes","0","0"]
[null,"0393U","Neu prksn msfl a-syncln prtn","0","0"]
[null,"0394U","Pfas 16 pfas compnd lc ms/ms","0","0"]
[null,"0395U","Onc lng multiomics plsm alg","0","0"]
[null,"0397U","ONC NONSM CLL LNG CA 109","0","0"]
[null,"0398U","Gi baret esph dna mthyln aly","0","0"]
[null,"0399U","Neuro cere folate defncy srm","0","0"]
[null,"0400U","Ob xpnd car scr 145 genes","0","0"]
[null,"0401U","Crd c hrt ds 9 gen 12 vrnts","0","0"]
[null,"0402U","NFCT AGT STI MULT AMP PRB TQ","0","0"]
[null,"0403U","ONC PRST8 MRNA 18 GEN DRE UR","0","0"]
[null,"0404U","ONC BRST SEMIQ MEAS THYM KN","0","0"]
[null,"0405U","ONC PNCRTC 59 MTHLTN BLK MRK","0","0"]
[null,"0406U","ONC LUNG FLOW CYTMTRY 5 MRK","0","0"]
[null,"0407U","NEPH DBTC CKD MULT ECLIA ALG","0","0"]
[null,"0408U","IAAD BLK AC WV BSNSR SARSCV2","0","0"]
[null,"0409U","ONC SLD TUM DNA 80 & RNA 36","0","0"]
[null,"0410U","ONC PNCRTC DNA WHL GN SEQ 5-","0","0"]
[null,"0411U","PSYC GENOM ALYS PNL 15 GEN","0","0"]
[null,"0412U","BETA AMYLOID Aβ42/40 IMPRCIP","0","0"]
[null,"0413U","ONC HL NEO OPT GEN MAPG DNA","0","0"]
[null,"0414U","ONC LNG AUG ALG ALY WHL SLD8","0","0"]
[null,"0415U","CV DS ACS BLD ALG 5 YR SCORE","0","0"]
[null,"0417U","RARE DS ALYS 335 NUC GENES","0","0"]
[null,"0418U","ONC BRST AUG ALG ALY WHL SL8","0","0"]
[null,"0419U","NRPSYC GEN SEQ VRNT ALY 13","0","0"]
[null,"0420U","ONC URTHL MRNA XPRSN 6 SNP","0","0"]
[null,"0421U","ONC CLRCT SCR SGL AMP 8 RNA","0","0"]
[null,"0422U","ONC PAN SOLID TUM ALYS DNA","0","0"]
[null,"0423U","PSYC GENOMIC ALYS PNL 26 GEN","0","0"]
[null,"0424U","ONC PRST8 XOM ALYS 53 SNCRNA","0","0"]
[null,"0425U","GENOM RPD SEQ ALYS EA CMPRTR","0","0"]
[null,"0426U","GENOME ULTRA-RAPID SEQ ALYS","0","0"]
[null,"0427U","MONOCYTE DSTRBJ WDTH WHL BLD","0","0"]
[null,"0428U","ONC BRST CTDNA ALYS 56/> GEN","0","0"]
[null,"0429U","HPV OROP SWAB 14 HI-RISK TYP","0","0"]
[null,"0430U","GI MALABS AAT CALPRO PNCRTC","0","0"]
[null,"0431U","GLY RCPTR ALPHA1 IGG SRM/CSF","0","0"]
[null,"0432U","KLHL11 ANTB SR/CSF ASY QUAL","0","0"]
[null,"0433U","ONC PRST8 5 DNA REG MRK PCR","0","0"]
[null,"0434U","RX METAB ADVRS VRNT ALYS 25","0","0"]
[null,"0435U","ONC CHEMO RX CYTOX CSC 14 RX","0","0"]
[null,"0436U","ONC LNG PLSM ALYS 388 PRTN","0","0"]
[null,"0437U","PSYC ANXIETY DO MRNA 15 BMRK","0","0"]
[null,"0438U","RX METAB ADVRS VRNT ALYS 33","0","0"]
[null,"0439U","Crd chd dna alys 5 snp 3 dna","0","0"]
[null,"0440U","Crd chd dna alys 10 snp 6dna","0","0"]
[null,"0441U","Nfct ds bct fngl/viral semiq","0","0"]
[null,"0442U","Nfct ds respir nfctj mxa&crp","0","0"]
[null,"0443U","Neurflmnt lt chn ultrsens ia","0","0"]
[null,"0444U","Onc sld orgn neo tgsap 361","0","0"]
[null,"0445U","Abeta42 & ptau181 eclia csf","0","0"]
[null,"0446U","Ai ds sle alys 10 cytokine","0","0"]
[null,"0447U","Ai ds sle alys 11 cytokine","0","0"]
[null,"0448U","ONC LNG&CLN CA DNA QUAL NGS","0","0"]
[null,"0449U","Car scr sev inh cond 5 genes","0","0"]
[null,"0450U","Onc mm lc-ms/ms monoc p-prtn","0","0"]
[null,"0451U","Onc mm lc-ms/ms pep ion quan","0","0"]
[null,"0452U","Onc bldr mthyl penk lte-qmsp","0","0"]
[null,"0453U","Onc clrct ca cfdna qpcr asy","0","0"]
[null,"0454U","Rare ds id opt genome mapg","0","0"]
[null,"0455U","Nfct agt sti mult amp prb ur","0","0"]
[null,"0456U","AI RA NGS 19 GENES ANTI-CCP","0","0"]
[null,"0457U","Pfas 9 cmpnd lcms/ms pls/sr","0","0"]
[null,"0458U","Onc brst ca s100 a8&a9 elisa","0","0"]
[null,"0459U","Abeta42 & ttau eclia csf","0","0"]
[null,"0460U","Onc whl bld/bucc rtpcr 24gen","0","0"]
[null,"0461U","Onc rxgenom alys rtpcr 24gen","0","0"]
[null,"0462U","Melatonin lvl tst slp std7/9","0","0"]
[null,"0463U","Onc crvx mrna genxprsn 14bmk","0","0"]
[null,"0464U","Onc clrct scr qrtsa dna mrk","0","0"]
[null,"0465U","Onc urthl carc dna qmsp 2gen","0","0"]
[null,"0466U","Crd cad dna gwas 564856 snp","0","0"]
[null,"0467U","Onc bldr dna ngs 60gen&aneup","0","0"]
[null,"0468U","Hep nash mir34a5p a2m ykl40","0","0"]
[null,"0469U","Rare ds whl gen seq ftl samp","0","0"]
[null,"0470U","Onc orop detcj mrd 8 dna hpv","0","0"]
[null,"0471U","Onc clrc ca 35 vrn kras&nras","0","0"]
[null,"0472U","Ca vi psp&sp1 antb sjogren","0","0"]
[null,"0473U","Onc sld tum bld/slv 648 gene","0","0"]
[null,"0474U","Hered pan ca gsap 88gene ngs","0","0"]
[null,"0475U","Hered prst8 ca gsap 23 genes","0","0"]
[null,"0476U","Rx metab psyc 14gen&cyp2d6","0","0"]
[null,"0477U","Rx metab psy 14&cyp2d6 gn-rx","0","0"]
[null,"0478U","Onc nsclc dna&rna dpcr 9gens","0","0"]
[null,"0479U","Tau phosphorylated ptau217","0","0"]
[null,"0480U","Nfct ds csf metag ngs alys","0","0"]
[null,"0481U","Idh1 idh2&tert promoter ngs","0","0"]
[null,"0482U","Ob pe biochem asy sflt1&plgf","0","0"]
[null,"0483U","Nfct ds ng gyra s91f pt mut","0","0"]
[null,"0484U","Nfct ds mgen 23s rrna pt mut","0","0"]
[null,"0485U","Onc sol tum cfdna&rna ngs gm","0","0"]
[null,"0486U","Onc pan sol tum ngs cfctdna","0","0"]
[null,"0487U","Onc sol tum cfcdna tgsap 84","0","0"]
[null,"0488U","Ob fetal ag nipt cfdna alys","0","0"]
[null,"0489U","Ob sgnipt cfdna seq alys 1+","0","0"]
[null,"0490U","Onc cutan/uveal mlnma cd146","0","0"]
[null,"0491U","Onc sol tum ctc slct er prtn","0","0"]
[null,"0492U","Onc sol tum ctc slctn pd-l1","0","0"]
[null,"0493U","Trnspl med quan dd-cfdna ngs","0","0"]
[null,"0494U","Rbc ag ftl rhd gene alys ngs","0","0"]
[null,"0495U","Onc prst8 alys crcg plsm prt","0","0"]
[null,"0496U","Onc clrct cfdna 8/7 genes","0","0"]
[null,"0497U","Onc prst8 mrna rt-pcr 6genes","0","0"]
[null,"0498U","Onc clrct ngs mut detc 43gen","0","0"]
[null,"0499U","Onc clrct&lng dna ngs 8genes","0","0"]
[null,"0500U","Autoinflam ds vexas synd dna","0","0"]
[null,"0501U","Onc clrc bld quan meas cfdna","0","0"]
[null,"0502U","Hpv e6/e7 mrk hirsk typ crv","0","0"]
[null,"0503U","Neuro alz ds bamyl&tau prtn","0","0"]
[null,"0504U","Nfct ds uti id 17 path orgs","0","0"]
[null,"0505U","Nfct ds vag infctj id 32orgs","0","0"]
[null,"0506U","Gi barretts esophgl cell 89","0","0"]
[null,"0507U","Onc ovr dna whole gen w/5hmc","0","0"]
[null,"0508U","Trnsplj med ddcfdna 40 snps","0","0"]
[null,"0509U","Trnsplj med ddcfdna<12 snps","0","0"]
[null,"0510U","Onc pncrtc ca alg alys 16gen","0","0"]
[null,"0511U","Onc sol tum 3dmicroenvir 36+","0","0"]
[null,"0512U","Onc prst8 alys dgtz img msi","0","0"]
[null,"0513U","Onc prst8 alg alys msi&hrd","0","0"]
[null,"0514U","Gi ibd ia quan deter adl lvl","0","0"]
[null,"0515U","Gi ibd ia quan deter ifx lvl","0","0"]
[null,"0516U","Rx metab rxgenomic gnotyp 40","0","0"]
[null,"0517U","Ther rx mntr 80+ psyactiv rx","0","0"]
[null,"0518U","Ther rx mntr 90+ pn&mtl hlth","0","0"]
[null,"0519U","Ther rx mntr meds p/d/a 110+","0","0"]
[null,"0520U","Ther rx mntr 200+ rx/sbsts","0","0"]
[null,"0521U","RF IGA&IGM CCP ANTB SR-A IA","0","0"]
[null,"0522U","CA VI PSP&SP1 ANTB CL SEMIQL","0","0"]
[null,"0523U","ONC SOLTUM DNA NGS SNV 22GEN","0","0"]
[null,"0524U","OB PE SFLT-1/PLGF IA SRM/PLS","0","0"]
[null,"0525U","ONC SPHRD CELL CUL 11-RX PNL","0","0"]
[null,"0526U","NEFRO RNL TRNSPL QUAN CXCL10","0","0"]
[null,"0527U","HSV 1&2 VZV AMP PRB TQ PTHGN","0","0"]
[null,"0528U","LRT IAD 18BCT/8VIR&7ARG RNA","0","0"]
[null,"0529U","HEM VTE SNP F2&F5 GEN LEIDEN","0","0"]
[null,"0530U","ONC PAN-SOL TUM CTDNA 77 GEN","0","0"]
{"$rows_empty":14}
["Source:"]
["HCA Outpatient Prospective Payment Systems (OPPS) fee schedule downloaded from the provider billing guides and fee schedule website "]
["(https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules)."]

{"sheet":"Table 5b | OPPS Fee Sch Legend","index":10,"n_rows":45,"n_cols":2,"rows_kept":45,"merged":[[6,0,6,1],[7,0,7,1],[8,0,8,1],[9,0,9,1],[24,0,24,1],[33,0,33,1],[39,0,39,1],[40,0,40,1]],"flags":["formulas_cached_only"]}
[null,"Washington State Health Care Authority"]
[null,"EAPG Calculator Version 1.0 - DRAFT"]
[null,"Medicaid FFS Rates Effective January 01, 2025"]
[null,"Table 5b: HCA OPPS Fee Schedule Legend"]
[]
[]
["OUTPATIENT FEE SCHEDULE LEGEND"]
["Return to Fee Schedule"]
[]
["COV"]
[0,"Non-Covered, all hospitals"]
[1,"Covered for all hospitals, paid according to hospital's specific methodology."]
[]
["PRICING*","* A single unit in OPPS equals the national average units per episode of care"]
["A","Procedure code paid by acquisition cost - Invoice Required"]
["E","Procedure code paid via EAPG pricing"]
["F","Procedure code paid via fee established by HCA"]
[]
["AUTH*","* See specific program billing instructions for details"]
["CPA","Contractor Prior Auth required - Current Vendor is COMAGINE"]
["EPA","Expedited Prior Authorization required"]
["L ","The use of this procedure code may have certain restrictions ie; ages, authorization requirements, diagnosis, facilities.  Please see the program specific publications for details prior to providing this service."]
["PA","Prior Authorization required"]
[]
["COMMENTS"]
["ABA","Please see Applied Behavioral Analysis (ABA) Billing Guide for coverage"]
["BR","By Report"]
["COE ","Allowed only in HCA approved Center of Excellence"]
["CVP","Vaccine Free from DOH Child Vaccine Program"]
["DENTAL","Refer to the dental fee schedule and the dental Medicaid Provider Guide for information on what is covered in dental and any limitation on that coverage, including prior authorization."]
["PROFESSIONAL SERVICES","Please see Professional Services Billing Guide for limitations"]
["TELEHEALTH","For telehealth use: HCA does not pay facility fees for audio only telehealth"]
[]
["MID-QUARTER UPDATES"]
["SPC","Special Payment Consideration - Effective dates have changed refer to \"what's changed\" tab for specifics"]
["C","Covered"]
["NC","Non-Covered"]
[]
[]
["**If a code is not listed, it is not covered under the Outpatient Hospital Fee Schedule**"]
["**MUE is based on CMS guidelines, and does not guarantee Medicaid coverage**"]
[]
["Source:"]
["HCA Outpatient Prospective Payment Systems (OPPS) fee schedule downloaded from the provider billing guides and fee schedule website "]
["(https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules)."]

{"sheet":"Table 6 | Bundled Revenue Codes","index":11,"n_rows":41,"n_cols":5,"rows_kept":41,"flags":["formulas_cached_only"]}
["Washington State Health Care Authority",{"$nulls":3},"Illustrative Example Medicaid FFS Allowed Amount"]
["EAPG Calculator Version 1.0 - DRAFT",{"$nulls":3},"Does Not Represent Actual Claim Payment"]
["Medicaid FFS Rates Effective January 01, 2025",{"$nulls":3},"SUBJECT TO CHANGE BASED ON RATE COMPONENT UPDATES"]
["Table 6: Bundled Revenue Code List"]
[]
["Bundled Revenue Codes","Revenue Code Description"]
["0264","IV Therapy-IV Therapy/Supplies"]
["0269","IV Therapy-Other IV Therapy"]
["0270","Medical/Surgical Supplies And Devices-General Classification"]
["0271","Medical/Surgical Supplies And Devices-Non Sterile Supply"]
["0272","Medical/Surgical Supplies And Devices-Sterile Supply"]
["0273","Medical/Surgical Supplies And Devices-Take Home Supplies"]
["0279","Medical/Surgical Supplies And Devices-Other Supplies/Devices"]
["0289","Oncology-Other Oncology"]
["0290","DME (Other Than Renal)-General Classification"]
["0370","Anesthesia-General Classification"]
["0371","Anesthesia-Anesthesia Incident To Radiology"]
["0372","Anesthesia-Anesthesia Incident To Other Dx Services"]
["0379","Anesthesia-Other Anesthesia"]
["0399","Administration, Processing, And Storage For Blood And Blood Components-Other Blood Handling"]
["0560","Home Health (HH) Medical Social Services-General Classification"]
["0569","Home Health (HH) Medical Social Services-Other Med. Social Service"]
["0621","Medical/Surgical Supplies And Devices-Extension of 027X-Supplies Incident To Radiology"]
["0622","Medical/Surgical Supplies And Devices-Extension of 027X-Supplies Incident To Other Dx Services"]
["0624","Medical/Surgical Supplies And Devices-Extension of 027X-FDA Investigational Devices"]
["0630","Drugs requiring specific identification-general classification"]
["0631","Pharmacy-Extension of 025X-Single Source Drug"]
["0632","Pharmacy-Extension of 025X-Multiple Source Drug"]
["0633","Pharmacy-Extension of 025X-Restrictive Prescription"]
["0681","Trauma Response-Level I Trauma"]
["0682","Trauma Response-Level II Trauma"]
["0683","Trauma Response-Level III Trauma"]
["0684","Trauma Response-Level IV Trauma"]
["0689","Trauma Response-Other Trauma Response"]
["0700","Cast Room-General Classification"]
["0710","Recovery Room-General Classification"]
["0810","Acquisition of Body Components-General Classification"]
["0819","Acquisition of Body Components-Other Donor"]
[]
["Source:"]
["Bundled Revenue Codes based on codes documented by HCA MMIS."]

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["Washington State Health Care Authority"]
["EAPG Conversion Factors"]
["Effective January 01, 2025 and after"]
[]
["NPI","FACILITY NAME","STATEWIDE STANDARDIZED AMOUNT","FY 2025 WAGE INDEX","MEDICAL EDUCATION ADJUSTMENT (GME)","EAPG CONVERSION FACTOR"]
[1003367491,"Unity Center of Behavioral Health-Portland",378.91,1.1387,{"v":1.0115600302344046,"d":"1.011560"},415.19]
[1003991845,"Providence Portland Medical Center",378.91,null,null,404.19]
[1013074061,"EvergreenHealth Monroe (Valley General Hosp)",378.91,1.1961,{"v":1,"d":"1.000000"},423.49]
[1033107214,"Swedish Memorial Hospital Edmonds Campus - Edmonds",378.91,1.1961,{"v":1,"d":"1.000000"},423.49]
[1033174933,"Evergreen Hosp Med Ctr-Kirkland",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1053357244,"Skagit Valley Hospital",378.91,1.1112,{"v":1.0141530209019705,"d":"1.014153"},409.91]
[1053359729,"Harborview Medical Center-Seattle",378.91,1.1961,{"v":1.0989210594515046,"d":"1.098921"},465.38]
[1053373480,"Multicare Yakima Valley Memorial  Hosp - Yakima",378.91,1.1112,{"v":1.0004229010144938,"d":"1.000423"},404.36]
[1073510277,"St John Medical Ctr - Longview",378.91,{"v":1.12,"d":"1.1200"},{"v":1,"d":"1.000000"},406.19]
[1073566246,"Cascade Valley Hosp - Arlington",378.91,1.1961,{"v":1,"d":"1.000000"},423.49]
[1093713091,"St Francis Hosp-Federal Way-thru 09/21/2022",378.91,1.1882,{"v":1.0049590228951106,"d":"1.004959"},423.79]
[1114015971,"Providence ST Vincent Med Ctr_Retro 12/06/2021 new Domain: 2212635",378.91,null,null,404.19]
[1134146939,"Columbia Memorial Hospital - Astoria",378.91,null,null,404.19]
[1134178999,"PeaceHealth Southwest Washington Medical Center",378.91,1.1387,{"v":1.014029405204781,"d":"1.014029"},{"v":416.2,"d":"416.20"}]
[1144471715,"Providence Sacred Heart Med Ctr  - Spokane",378.91,1.1112,{"v":1.030632518588234,"d":"1.030633"},416.57]
[1154378859,"Grays Harbor Community Hosp-Aberdeen",378.91,1.1112,{"v":1,"d":"1.000000"},505.24]
[1154563963,"Bonner General Hospital - Sandpoint",378.91,null,null,404.19]
[1164493847,"Fred Hutchinson Cancer Center",378.91,1.1882,{"v":1.0025613571118583,"d":"1.002561"},422.78]
[1225090954,"St Joseph Regional Medical Center - Lewiston",378.91,1.1088,{"v":1,"d":"1.000000"},403.65]
[1225289895,"Providence Holy Family Hospital - Spokane",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1245756410,"CHI Franciscan Rehabilitation Hospital",378.91,1.2224,{"v":1,"d":"1.000000"},429.47]
[1255327201,"Auburn Regional Med Ctr - Auburn",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1255429338,"Providence Hood River Memorial Hospital",378.91,null,null,404.19]
[1306842752,"Mid-Columbia Medical Center",378.91,null,null,404.19]
[1306845557,"Olympic Medical Center - Port Angeles",378.91,1.1112,{"v":1.0005012261034247,"d":"1.000501"},505.49]
[1306883228,"Confluence Health Hospital",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1306952726,"Multicare Mary Bridge Children's Hosp & Health Ctr -Tacoma",378.91,1.2224,{"v":1,"d":"1.000000"},429.47]
[1306992151,"Swedish Med Ctr 1st Hill Campus & Ballard - Seattle",378.91,1.1961,{"v":1.0139882692278401,"d":"1.013988"},429.42]
[1326002049,"U of W Medical Ctr - Seattle",378.91,1.1961,{"v":1.0626273201906504,"d":"1.062627"},450.01]
[1326564071,"Multicare Covington Medical Center",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1346250594,"Providence St Peter Hospital - Olympia",378.91,1.1816,{"v":1.01469511308803,"d":"1.014695"},426.37]
[1356496582,"Swedish Med Ctr Cherry Hill Campus - Seattle",378.91,1.1961,{"v":1.0261860511610974,"d":"1.026186"},434.58]
[1356528269,"Deaconess Med Ctr  - Spokane",378.91,1.1112,{"v":1.0071593570705315,"d":"1.007159"},407.08]
[1366556227,"Tacoma General Allenmore Hospital/MultiCare Tacoma Hospital - Tacoma",378.91,1.2222,{"v":1.005105071029396,"d":"1.005105"},431.62]
[1376624981,"Providence Centralia Hospital - Centralia",378.91,1.1816,{"v":1.0096347747454828,"d":"1.009635"},424.24]
[1386895886,"St Mary Medical Ctr - Walla Walla",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1447406699,"St Anthony Hospital",378.91,1.2222,{"v":1,"d":"1.000000"},429.43]
[1467536276,"Seattle Children's Hosp & Regional Med Ctr-Seattle",378.91,1.1882,{"v":1.030499576964024,"d":"1.030500"},434.56]
[1487904546,"St Joseph Hosp - Bellingham",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1487917233,"Peace Island Medical Center ",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1497752091,"Providence St Lukes Rehabilitation Medical Center",378.91,1.1112,{"v":1.0659330812861856,"d":"1.065933"},430.84]
[1518912609,"Harrison Memorial Hosp-Bremerton",378.91,1.2755,{"v":1.0166551895706595,"d":"1.016655"},{"v":448.9,"d":"448.90"}]
[1538345251,"Valley Hosp Med Ctr - Spokane",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1548734205,"PeaceHealth Southwest Medical Center",378.91,1.1387,{"v":1.014029405204781,"d":"1.014029"},{"v":416.2,"d":"416.20"}]
[1558333682,"St Anne Host AKA Highline Medical Center - Burien",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1578058137,"Trios Health ",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1598971855,"Overlake Hospital Med Ctr - Bellevue",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1609824010,"Oregon Health Sciences University Hosp - Portland ",378.91,1.1387,{"v":1.0559368880101423,"d":"1.055937"},{"v":433.4,"d":"433.40"}]
[1619988144,"Gritman Medical Center - Moscow",378.91,null,null,404.19]
[1649209230,"Valley Medical Ctr - Renton",378.91,1.1882,{"v":1.006107576664484,"d":"1.006108"},424.27]
[1689672693,"St Clare Hospital - Tacoma",378.91,1.2222,{"v":1,"d":"1.000000"},429.43]
[1700037801,"Providence Regional Medical Center - Everett",378.91,1.1961,{"v":1.0186470576809075,"d":"1.018647"},431.39]
[1700809829,"Legacy Salmon Creek - Salmon Creek - End 05/31/2024",378.91,1.1387,{"v":1.0072546316169553,"d":"1.007255"},413.42]
[1710913140,"Island Hospital - Anacortes",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1780608216,"Legacy Good Samaritan Hospital - Portland",378.91,null,null,404.19]
[1801851258,"Virginia Mason - Seattle",378.91,1.1882,{"v":1.0263865995857018,"d":"1.026387"},432.82]
[1801887658,"Adventist Medical Center - Portland",378.91,null,null,404.19]
[1831112358,"Legacy Emanuel Hospital - Portland",378.91,1.1387,{"v":1.0115600302344046,"d":"1.011560"},415.19]
[1841231461,"Good Samaritan - Puyallup",378.91,1.2222,{"v":1.0047094791344227,"d":"1.004709"},431.45]
[1841258639,"MultiCare Capital Medical Center ",378.91,1.1816,{"v":1,"d":"1.000000"},{"v":420.2,"d":"420.20"}]
[1841390077,"Madigan Army Medical Center",378.91,1.2224,{"v":1,"d":"1.000000"},429.47]
[1851686059,"Swedish Issaquah Campus",378.91,1.1882,{"v":1.00000791557196,"d":"1.000008"},{"v":421.7,"d":"421.70"}]
[1851817308,"Toppenish Community Hospital",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1861432726,"Overlake Hospital Med Ctr-Bellevue",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1861522088,"Kaiser Permanente Central Hospital",378.91,1.1882,{"v":1,"d":"1.000000"},{"v":421.7,"d":"421.70"}]
[1861995714,"PeaceHealth United General Medical Ctr",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1902818883,"Samaritan Hospital - Moses Lk",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[1952309098,"St Joseph Med Ctr - Tacoma",378.91,1.2222,{"v":1.0030763680751418,"d":"1.003076"},430.75]
[1972507580,"Kadlec Medical Center ",378.91,1.1112,{"v":1.0093153936456831,"d":"1.009315"},407.96]
[1982793139,"Shriner's Hospital for Children - Portland",378.91,null,null,404.19]
[1992798409,"Kootenai Medical Center - Coeur D'Alene",378.91,null,null,404.19]
[1992848857,"Shriner's Hospital for Children - Spokane",378.91,1.1112,{"v":1,"d":"1.000000"},404.19]
[9999999999,"OUT-OF-STATE",378.91,null,null,404.19]

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["REV",null,"Source:","[RevCode] tab"]
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