WAIS Document Retrieval[Federal Register: September 8, 1998 (Volume 63, Number 173)]
[Proposed Rules]               
[Page 47751-47800]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08se98-38]
 
[[pp. 47751-47800]] Medicare Program; Prospective Payment System for Hospital 
Outpatient Services

[[Continued from page 47750]]

[[Page 47750]]

L2390...  A                   Offset knee joint each.  .........  .........  .........  ...........  ...........
L2395...  A                   Offset knee joint heavy  .........  .........  .........  ...........  ...........
                               duty.
L2397...  A                   Suspension sleeve lower  .........  .........  .........  ...........  ...........
                               ext.
L2405...  A                   Knee joint drop lock ea  .........  .........  .........  ...........  ...........
                               jnt.
L2415...  A                   Knee joint cam lock      .........  .........  .........  ...........  ...........
                               each joi.
L2425...  A                   Knee disc/dial lock/adj  .........  .........  .........  ...........  ...........
                               flex.
L2430...  A                   Knee jnt ratchet lock    .........  .........  .........  ...........  ...........
                               ea jnt.
L2435...  A                   Knee joint polycentric   .........  .........  .........  ...........  ...........
                               joint.
L2492...  A                   Knee lift loop drop      .........  .........  .........  ...........  ...........
                               lock rin.
L2500...  A                   Thi/glut/ischia wgt      .........  .........  .........  ...........  ...........
                               bearing.
L2510...  A                   Th/wght bear quad-lat    .........  .........  .........  ...........  ...........
                               brim m.
L2520...  A                   Th/wght bear quad-lat    .........  .........  .........  ...........  ...........
                               brim c.
L2525...  A                   Th/wght bear nar m-l     .........  .........  .........  ...........  ...........
                               brim mo.
L2526...  A                   Th/wght bear nar m-l     .........  .........  .........  ...........  ...........
                               brim cu.
L2530...  A                   Thigh/wght bear lacer    .........  .........  .........  ...........  ...........
                               non-mo.
L2540...  A                   Thigh/wght bear lacer    .........  .........  .........  ...........  ...........
                               molded.
L2550...  A                   Thigh/wght bear high     .........  .........  .........  ...........  ...........
                               roll cu.
L2570...  A                   Hip clevis type 2 posit  .........  .........  .........  ...........  ...........
                               jnt.
L2580...  A                   Pelvic control pelvic    .........  .........  .........  ...........  ...........
                               sling.
L2600...  A                   Hip clevis/thrust        .........  .........  .........  ...........  ...........
                               bearing fr.
L2610...  A                   Hip clevis/thrust        .........  .........  .........  ...........  ...........
                               bearing lo.
L2620...  A                   Pelvic control hip       .........  .........  .........  ...........  ...........
                               heavy dut.
L2622...  A                   Hip joint adjustable     .........  .........  .........  ...........  ...........
                               flexion.
L2624...  A                   Hip adj flex ext abduct  .........  .........  .........  ...........  ...........
                               cont.
L2627...  A                   Plastic mold recipro     .........  .........  .........  ...........  ...........
                               hip & c.
L2628...  A                   Metal frame recipro hip  .........  .........  .........  ...........  ...........
                               & ca.
L2630...  A                   Pelvic control band &    .........  .........  .........  ...........  ...........
                               belt u.
L2640...  A                   Pelvic control band &    .........  .........  .........  ...........  ...........
                               belt b.
L2650...  A                   Pelv & thor control      .........  .........  .........  ...........  ...........
                               gluteal.
L2660...  A                   Thoracic control         .........  .........  .........  ...........  ...........
                               thoracic ba.
L2670...  A                   Thorac cont paraspinal   .........  .........  .........  ...........  ...........
                               uprig.
L2680...  A                   Thorac cont lat support  .........  .........  .........  ...........  ...........
                               upri.
L2750...  A                   Plating chrome/nickel    .........  .........  .........  ...........  ...........
                               pr bar.
L2755...  A                   Carbon graphite          .........  .........  .........  ...........  ...........
                               lamination.
L2760...  A                   Extension per extension  .........  .........  .........  ...........  ...........
                               per.
L2770...  A                   Low ext orthosis per     .........  .........  .........  ...........  ...........
                               bar/jnt.
L2780...  A                   Non-corrosive finish...  .........  .........  .........  ...........  ...........
L2785...  A                   Drop lock retainer each  .........  .........  .........  ...........  ...........
L2795...  A                   Knee control full        .........  .........  .........  ...........  ...........
                               kneecap.
L2800...  A                   Knee cap medial or       .........  .........  .........  ...........  ...........
                               lateral p.
L2810...  A                   Knee control condylar    .........  .........  .........  ...........  ...........
                               pad.
L2820...  A                   Soft interface below     .........  .........  .........  ...........  ...........
                               knee se.
L2830...  A                   Soft interface above     .........  .........  .........  ...........  ...........
                               knee se.
L2840...  A                   Tibial length sock fx    .........  .........  .........  ...........  ...........
                               or equ.
L2850...  A                   Femoral lgth sock fx or  .........  .........  .........  ...........  ...........
                               equa.
L2860...  A                   Torsion mechanism knee/  .........  .........  .........  ...........  ...........
                               ankle.
L2999...  A                   Lower extremity          .........  .........  .........  ...........  ...........
                               orthosis NOS.
L3000...  A                   Ft insert ucb berkeley   .........  .........  .........  ...........  ...........
                               shell.
L3001...  A                   Foot insert remov        .........  .........  .........  ...........  ...........
                               molded spe.
L3002...  A                   Foot insert plastazote   .........  .........  .........  ...........  ...........
                               or eq.
L3003...  A                   Foot insert silicone     .........  .........  .........  ...........  ...........
                               gel eac.
L3010...  A                   Foot longitudinal arch   .........  .........  .........  ...........  ...........
                               suppo.
L3020...  A                   Foot longitud/           .........  .........  .........  ...........  ...........
                               metatarsal sup.
L3030...  A                   Foot arch support remov  .........  .........  .........  ...........  ...........
                               prem.
L3040...  A                   Ft arch suprt premold    .........  .........  .........  ...........  ...........
                               longit.
L3050...  A                   Foot arch supp premold   .........  .........  .........  ...........  ...........
                               metat.
L3060...  A                   Foot arch supp longitud/ .........  .........  .........  ...........  ...........
                               meta.
L3070...  A                   Arch suprt att to sho    .........  .........  .........  ...........  ...........
                               longit.
L3080...  A                   Arch supp att to shoe    .........  .........  .........  ...........  ...........
                               metata.
L3090...  A                   Arch supp att to shoe    .........  .........  .........  ...........  ...........
                               long/m.
L3100...  A                   Hallus-valgus nght       .........  .........  .........  ...........  ...........
                               dynamic s.
L3140...  A                   Abduction rotation bar   .........  .........  .........  ...........  ...........
                               shoe.
L3150...  A                   Abduct rotation bar w/o  .........  .........  .........  ...........  ...........
                               shoe.
L3160...  A                   Shoe styled positioning  .........  .........  .........  ...........  ...........
                               dev.
L3170...  A                   Foot plastic heel        .........  .........  .........  ...........  ...........
                               stabilizer.
L3201...  A                   Oxford w supinat/pronat  .........  .........  .........  ...........  ...........
                               inf.
L3202...  A                   Oxford w/ supinat/       .........  .........  .........  ...........  ...........
                               pronator c.
L3203...  A                   Oxford w/ supinator/     .........  .........  .........  ...........  ...........
                               pronator.
L3204...  A                   Hightop w/ supp/         .........  .........  .........  ...........  ...........
                               pronator inf.
L3206...  A                   Hightop w/ supp/         .........  .........  .........  ...........  ...........
                               pronator chi.
L3207...  A                   Hightop w/ supp/         .........  .........  .........  ...........  ...........
                               pronator jun.
L3208...  A                   Surgical boot each       .........  .........  .........  ...........  ...........
                               infant.
L3209...  A                   Surgical boot each       .........  .........  .........  ...........  ...........
                               child.
L3211...  A                   Surgical boot each       .........  .........  .........  ...........  ...........
                               junior.
L3212...  A                   Benesch boot pair        .........  .........  .........  ...........  ...........
                               infant.

[[Page 47751]]

L3213...  A                   Benesch boot pair child  .........  .........  .........  ...........  ...........
L3214...  A                   Benesch boot pair        .........  .........  .........  ...........  ...........
                               junior.
L3215...  A                   Orthopedic ftwear        .........  .........  .........  ...........  ...........
                               ladies oxf.
L3216...  A                   Orthoped ladies shoes    .........  .........  .........  ...........  ...........
                               dpth i.
L3217...  A                   Ladies shoes hightop     .........  .........  .........  ...........  ...........
                               depth i.
L3218...  A                   Ladies surgical boot     .........  .........  .........  ...........  ...........
                               each.
L3219...  A                   Orthopedic mens shoes    .........  .........  .........  ...........  ...........
                               oxford.
L3221...  A                   Orthopedic mens shoes    .........  .........  .........  ...........  ...........
                               dpth i.
L3222...  A                   Mens shoes hightop       .........  .........  .........  ...........  ...........
                               depth inl.
L3223...  A                   Mens surgical boot each  .........  .........  .........  ...........  ...........
L3224...  A                   Woman's shoe oxford      .........  .........  .........  ...........  ...........
                               brace.
L3225...  A                   Man's shoe oxford brace  .........  .........  .........  ...........  ...........
L3230...  A                   Custom shoes depth       .........  .........  .........  ...........  ...........
                               inlay.
L3250...  A                   Custom mold shoe remov   .........  .........  .........  ...........  ...........
                               prost.
L3251...  A                   Shoe molded to pt        .........  .........  .........  ...........  ...........
                               silicone s.
L3252...  A                   Shoe molded plastazote   .........  .........  .........  ...........  ...........
                               cust.
L3253...  A                   Shoe molded plastazote   .........  .........  .........  ...........  ...........
                               cust.
L3254...  A                   Orth foot non-stndard    .........  .........  .........  ...........  ...........
                               size/w.
L3255...  A                   Orth foot non-standard   .........  .........  .........  ...........  ...........
                               size/.
L3257...  A                   Orth foot add charge     .........  .........  .........  ...........  ...........
                               split s.
L3260...  A                   Ambulatory surgical      .........  .........  .........  ...........  ...........
                               boot eac.
L3265...  A                   Plastazote sandal each.  .........  .........  .........  ...........  ...........
L3300...  A                   Sho lift taper to        .........  .........  .........  ...........  ...........
                               metatarsal.
L3310...  A                   Shoe lift elev heel/     .........  .........  .........  ...........  ...........
                               sole neo.
L3320...  A                   Shoe lift elev heel/     .........  .........  .........  ...........  ...........
                               sole cor.
L3330...  A                   Lifts elevation metal    .........  .........  .........  ...........  ...........
                               extens.
L3332...  A                   Shoe lifts tapered to    .........  .........  .........  ...........  ...........
                               one-ha.
L3334...  A                   Shoe lifts elevation     .........  .........  .........  ...........  ...........
                               heel /i.
L3340...  A                   Shoe wedge sach........  .........  .........  .........  ...........  ...........
L3350...  A                   Shoe heel wedge........  .........  .........  .........  ...........  ...........
L3360...  A                   Shoe sole wedge outside  .........  .........  .........  ...........  ...........
                               sole.
L3370...  A                   Shoe sole wedge between  .........  .........  .........  ...........  ...........
                               sole.
L3380...  A                   Shoe clubfoot wedge....  .........  .........  .........  ...........  ...........
L3390...  A                   Shoe outflare wedge....  .........  .........  .........  ...........  ...........
L3400...  A                   Shoe metatarsal bar      .........  .........  .........  ...........  ...........
                               wedge ro.
L3410...  A                   Shoe metatarsal bar      .........  .........  .........  ...........  ...........
                               between.
L3420...  A                   Full sole/heel wedge     .........  .........  .........  ...........  ...........
                               btween.
L3430...  A                   Sho heel count plast     .........  .........  .........  ...........  ...........
                               reinfor.
L3440...  A                   Heel leather reinforced  .........  .........  .........  ...........  ...........
L3450...  A                   Shoe heel sach cushion   .........  .........  .........  ...........  ...........
                               type.
L3455...  A                   Shoe heel new leather    .........  .........  .........  ...........  ...........
                               standa.
L3460...  A                   Shoe heel new rubber     .........  .........  .........  ...........  ...........
                               standar.
L3465...  A                   Shoe heel thomas with    .........  .........  .........  ...........  ...........
                               wedge.
L3470...  A                   Shoe heel thomas extend  .........  .........  .........  ...........  ...........
                               to b.
L3480...  A                   Shoe heel pad & depress  .........  .........  .........  ...........  ...........
                               for.
L3485...  A                   Shoe heel pad removable  .........  .........  .........  ...........  ...........
                               for.
L3500...  A                   Shoe misc add insole     .........  .........  .........  ...........  ...........
                               leather.
L3510...  A                   Shoe misc addition       .........  .........  .........  ...........  ...........
                               insole ru.
L3520...  A                   Shoe insole felt cver w/ .........  .........  .........  ...........  ...........
                                lea.
L3530...  A                   Shoe misc additions      .........  .........  .........  ...........  ...........
                               sole hal.
L3540...  A                   Shoe misc additions      .........  .........  .........  ...........  ...........
                               sole ful.
L3550...  A                   Shoe misc add toe tap    .........  .........  .........  ...........  ...........
                               standa.
L3560...  A                   Shoe misc add toe tap    .........  .........  .........  ...........  ...........
                               horses.
L3570...  A                   Shoe special extension   .........  .........  .........  ...........  ...........
                               to in.
L3580...  A                   Shoe convert instep      .........  .........  .........  ...........  ...........
                               velcro c.
L3590...  A                   Shoe convert firm to     .........  .........  .........  ...........  ...........
                               soft cn.
L3595...  A                   Shoe misc additions      .........  .........  .........  ...........  ...........
                               march ba.
L3600...  A                   Trans shoe calip plate   .........  .........  .........  ...........  ...........
                               exist.
L3610...  A                   Trans shoe caliper       .........  .........  .........  ...........  ...........
                               plate new.
L3620...  A                   Trans shoe solid         .........  .........  .........  ...........  ...........
                               stirrup exi.
L3630...  A                   Trans shoe solid         .........  .........  .........  ...........  ...........
                               stirrup new.
L3640...  A                   Shoe dennis browne       .........  .........  .........  ...........  ...........
                               splint bo.
L3649...  A                   Unlist proc orth shoe    .........  .........  .........  ...........  ...........
                               modif/.
L3650...  A                   Shlder fig 8 abduct      .........  .........  .........  ...........  ...........
                               restrain.
L3660...  A                   Abduct restrainer        .........  .........  .........  ...........  ...........
                               canvas & web.
L3670...  A                   Acromio/clavicular       .........  .........  .........  ...........  ...........
                               canvas & we.
L3700...  A                   Elbow orthoses elas w    .........  .........  .........  ...........  ...........
                               stays.
L3710...  A                   Elbow elastic with       .........  .........  .........  ...........  ...........
                               metal joi.
L3720...  A                   Forearm/arm cuffs free   .........  .........  .........  ...........  ...........
                               motio.
L3730...  A                   Forearm/arm cuffs ext/   .........  .........  .........  ...........  ...........
                               flex a.
L3740...  A                   Cuffs adj lock w/        .........  .........  .........  ...........  ...........
                               active con.
L3800...  A                   Whfo short opponen no    .........  .........  .........  ...........  ...........
                               attach.
L3805...  A                   Whfo long opponens no    .........  .........  .........  ...........  ...........
                               attach.
L3810...  A                   Whfo thumb abduction     .........  .........  .........  ...........  ...........
                               bar.
L3815...  A                   Whfo second m.p.         .........  .........  .........  ...........  ...........
                               abduction a.

[[Page 47752]]

L3820...  A                   Whfo ip ext asst w/ mp   .........  .........  .........  ...........  ...........
                               ext s.
L3825...  A                   Whfo m.p. extension      .........  .........  .........  ...........  ...........
                               stop.
L3830...  A                   Whfo m.p. extension      .........  .........  .........  ...........  ...........
                               assist.
L3835...  A                   Whfo m.p. spring         .........  .........  .........  ...........  ...........
                               extension a.
L3840...  A                   Whfo spring swivel       .........  .........  .........  ...........  ...........
                               thumb.
L3845...  A                   Whfo thumb ip ext ass w/ .........  .........  .........  ...........  ...........
                                mp.
L3850...  A                   Action wrist w/          .........  .........  .........  ...........  ...........
                               dorsiflex as.
L3855...  A                   Whfo adj m.p. flexion    .........  .........  .........  ...........  ...........
                               contro.
L3860...  A                   Whfo adj m.p. flex ctrl  .........  .........  .........  ...........  ...........
                               & i.
L3890...  A                   Torsion mechanism wrist/ .........  .........  .........  ...........  ...........
                               elbo.
L3900...  A                   Hinge extension/flex     .........  .........  .........  ...........  ...........
                               wrist/f.
L3901...  A                   Hinge ext/flex wrist     .........  .........  .........  ...........  ...........
                               finger.
L3902...  A                   Whfo ext power compress  .........  .........  .........  ...........  ...........
                               gas.
L3904...  A                   Whfo electric custom     .........  .........  .........  ...........  ...........
                               fitted.
L3906...  A                   Wrist gauntlet molded    .........  .........  .........  ...........  ...........
                               to pt.
L3907...  A                   Whfo wrst gauntlt thmb   .........  .........  .........  ...........  ...........
                               spica.
L3908...  A                   Wrist cock-up non-       .........  .........  .........  ...........  ...........
                               molded.
L3910...  A                   Whfo swanson design....  .........  .........  .........  ...........  ...........
L3912...  A                   Flex glove w/elastic     .........  .........  .........  ...........  ...........
                               finger.
L3914...  A                   WHO wrist extension      .........  .........  .........  ...........  ...........
                               cock-up.
L3916...  A                   Whfo wrist extens w/     .........  .........  .........  ...........  ...........
                               outrigg.
L3918...  A                   HFO knuckle bender.....  .........  .........  .........  ...........  ...........
L3920...  A                   Knuckle bender with      .........  .........  .........  ...........  ...........
                               outrigge.
L3922...  A                   Knuckle bend 2 seg to    .........  .........  .........  ...........  ...........
                               flex j.
L3924...  A                   Oppenheimer............  .........  .........  .........  ...........  ...........
L3926...  A                   Thomas suspension......  .........  .........  .........  ...........  ...........
L3928...  A                   Finger extension w/      .........  .........  .........  ...........  ...........
                               clock sp.
L3930...  A                   Finger extension with    .........  .........  .........  ...........  ...........
                               wrist.
L3932...  A                   Safety pin spring wire.  .........  .........  .........  ...........  ...........
L3934...  A                   Safety pin modified....  .........  .........  .........  ...........  ...........
L3936...  A                   Palmer.................  .........  .........  .........  ...........  ...........
L3938...  A                   Dorsal wrist...........  .........  .........  .........  ...........  ...........
L3940...  A                   Dorsal wrist w/          .........  .........  .........  ...........  ...........
                               outrigger at.
L3942...  A                   Reverse knuckle bender.  .........  .........  .........  ...........  ...........
L3944...  A                   Reverse knuckle bend w/  .........  .........  .........  ...........  ...........
                               outr.
L3946...  A                   HFO composite elastic..  .........  .........  .........  ...........  ...........
L3948...  A                   Finger knuckle bender..  .........  .........  .........  ...........  ...........
L3950...  A                   Oppenheimer w/ knuckle   .........  .........  .........  ...........  ...........
                               bend.
L3952...  A                   Oppenheimer w/ rev       .........  .........  .........  ...........  ...........
                               knuckle 2.
L3954...  A                   Spreading hand.........  .........  .........  .........  ...........  ...........
L3956...  A                   Add joint upper ext      .........  .........  .........  ...........  ...........
                               orthosis.
L3960...  A                   Sewho airplan desig      .........  .........  .........  ...........  ...........
                               abdu pos.
L3962...  A                   Sewho erbs palsey        .........  .........  .........  ...........  ...........
                               design abd.
L3963...  A                   Molded w/ articulating   .........  .........  .........  ...........  ...........
                               elbow.
L3964...  A                   Seo mobile arm sup att   .........  .........  .........  ...........  ...........
                               to wc.
L3965...  A                   Arm supp att to wc       .........  .........  .........  ...........  ...........
                               rancho ty.
L3966...  A                   Mobile arm supports      .........  .........  .........  ...........  ...........
                               reclinin.
L3968...  A                   Friction dampening arm   .........  .........  .........  ...........  ...........
                               supp.
L3969...  A                   Monosuspension arm/hand  .........  .........  .........  ...........  ...........
                               supp.
L3970...  A                   Elevat proximal arm      .........  .........  .........  ...........  ...........
                               support.
L3972...  A                   Offset/lat rocker arm w/ .........  .........  .........  ...........  ...........
                                ela.
L3974...  A                   Mobile arm support       .........  .........  .........  ...........  ...........
                               supinator.
L3980...  A                   Upp ext fx orthosis      .........  .........  .........  ...........  ...........
                               humeral.
L3982...  A                   Upper ext fx orthosis    .........  .........  .........  ...........  ...........
                               rad/ul.
L3984...  A                   Upper ext fx orthosis    .........  .........  .........  ...........  ...........
                               wrist.
L3985...  A                   Forearm hand fx orth w/  .........  .........  .........  ...........  ...........
                               wr h.
L3986...  A                   Humeral rad/ulna wrist   .........  .........  .........  ...........  ...........
                               fx or.
L3995...  A                   Sock fracture or equal   .........  .........  .........  ...........  ...........
                               each.
L3999...  A                   Upper limb orthosis NOS  .........  .........  .........  ...........  ...........
L4000...  A                   Repl girdle milwaukee    .........  .........  .........  ...........  ...........
                               orth.
L4010...  A                   Replace trilateral       .........  .........  .........  ...........  ...........
                               socket br.
L4020...  A                   Replace quadlat socket   .........  .........  .........  ...........  ...........
                               brim.
L4030...  A                   Replace socket brim      .........  .........  .........  ...........  ...........
                               cust fit.
L4040...  A                   Replace molded thigh     .........  .........  .........  ...........  ...........
                               lacer.
L4045...  A                   Replace non-molded       .........  .........  .........  ...........  ...........
                               thigh lac.
L4050...  A                   Replace molded calf      .........  .........  .........  ...........  ...........
                               lacer.
L4055...  A                   Replace non-molded calf  .........  .........  .........  ...........  ...........
                               lace.
L4060...  A                   Replace high roll cuff.  .........  .........  .........  ...........  ...........
L4070...  A                   Replace prox & dist      .........  .........  .........  ...........  ...........
                               upright.
L4080...  A                   Repl met band kafo-afo   .........  .........  .........  ...........  ...........
                               prox.
L4090...  A                   Repl met band kafo-afo   .........  .........  .........  ...........  ...........
                               calf/.
L4100...  A                   Repl leath cuff kafo     .........  .........  .........  ...........  ...........
                               prox th.
L4110...  A                   Repl leath cuff kafo-    .........  .........  .........  ...........  ...........
                               afo cal.
L4130...  A                   Replace pretibial shell  .........  .........  .........  ...........  ...........
L4205...  A                   Ortho dvc repair per 15  .........  .........  .........  ...........  ...........
                               min.

[[Page 47753]]

L4210...  A                   Orth dev repair/repl     .........  .........  .........  ...........  ...........
                               minor p.
L4310...  A                   Mult-podus/eq orth prep  .........  .........  .........  ...........  ...........
                               mgmt.
L4320...  A                   Low ext mgmt sys ft pos  .........  .........  .........  ...........  ...........
                               afo.
L4350...  A                   Pneumatic ankle cntrl    .........  .........  .........  ...........  ...........
                               splint.
L4360...  A                   Pneumatic walking        .........  .........  .........  ...........  ...........
                               splint.
L4370...  A                   Pneumatic full leg       .........  .........  .........  ...........  ...........
                               splint.
L4380...  A                   Pneumatic knee splint..  .........  .........  .........  ...........  ...........
L4390...  A                   Replace multi-podus      .........  .........  .........  ...........  ...........
                               splint.
L4392...  A                   Replace ankle contrac    .........  .........  .........  ...........  ...........
                               splint.
L4394...  A                   Replace foot drop        .........  .........  .........  ...........  ...........
                               splint.
L4396...  A                   Ankle contracture        .........  .........  .........  ...........  ...........
                               splint.
L4398...  A                   Foot drop splint         .........  .........  .........  ...........  ...........
                               recumbent.
L5000...  A                   Sho insert w arch toe    .........  .........  .........  ...........  ...........
                               filler.
L5010...  A                   Mold socket ank hgt w/   .........  .........  .........  ...........  ...........
                               toe f.
L5020...  A                   Tibial tubercle hgt w/   .........  .........  .........  ...........  ...........
                               toe f.
L5050...  A                   Ank symes mold sckt      .........  .........  .........  ...........  ...........
                               sach ft.
L5060...  A                   Symes met fr leath       .........  .........  .........  ...........  ...........
                               socket ar.
L5100...  A                   Molded socket shin sach  .........  .........  .........  ...........  ...........
                               foot.
L5105...  A                   Plast socket jts/thgh    .........  .........  .........  ...........  ...........
                               lacer.
L5150...  A                   Mold sckt ext knee shin  .........  .........  .........  ...........  ...........
                               sach.
L5160...  A                   Mold socket bent knee    .........  .........  .........  ...........  ...........
                               shin s.
L5200...  A                   Kne sing axis fric shin  .........  .........  .........  ...........  ...........
                               sach.
L5210...  A                   No knee/ankle joints w/  .........  .........  .........  ...........  ...........
                               ft b.
L5220...  A                   No knee joint with       .........  .........  .........  ...........  ...........
                               artic ali.
L5230...  A                   Fem focal defic          .........  .........  .........  ...........  ...........
                               constant fri.
L5250...  A                   Hip canad sing axi cons  .........  .........  .........  ...........  ...........
                               fric.
L5270...  A                   Tilt table locking hip   .........  .........  .........  ...........  ...........
                               sing.
L5280...  A                   Hemipelvect canad sing   .........  .........  .........  ...........  ...........
                               axis.
L5300...  A                   Bk sach soft cover &     .........  .........  .........  ...........  ...........
                               finish.
L5310...  A                   Knee disart sach soft    .........  .........  .........  ...........  ...........
                               cv/fin.
L5320...  A                   Ak open end sach soft    .........  .........  .........  ...........  ...........
                               cv/fin.
L5330...  A                   Hip canadian sach sft    .........  .........  .........  ...........  ...........
                               cv/fin.
L5340...  A                   Hemipelvectomy canad cv/ .........  .........  .........  ...........  ...........
                               fin.
L5400...  A                   Postop dress & 1 cast    .........  .........  .........  ...........  ...........
                               chg bk.
L5410...  A                   Postop dsg bk ea add     .........  .........  .........  ...........  ...........
                               cast ch.
L5420...  A                   Postop dsg & 1 cast chg  .........  .........  .........  ...........  ...........
                               ak/d.
L5430...  A                   Postop dsg ak ea add     .........  .........  .........  ...........  ...........
                               cast ch.
L5450...  A                   Postop app non-wgt bear  .........  .........  .........  ...........  ...........
                               dsg.
L5460...  A                   Postop app non-wgt bear  .........  .........  .........  ...........  ...........
                               dsg.
L5500...  A                   Init bk ptb plaster      .........  .........  .........  ...........  ...........
                               direct.
L5505...  A                   Init ak ischal plstr     .........  .........  .........  ...........  ...........
                               direct.
L5510...  A                   Prep BK ptb plaster      .........  .........  .........  ...........  ...........
                               molded.
L5520...  A                   Prep BK ptb thermopls    .........  .........  .........  ...........  ...........
                               direct.
L5530...  A                   Prep BK ptb thermopls    .........  .........  .........  ...........  ...........
                               molded.
L5535...  A                   Prep BK ptb open end     .........  .........  .........  ...........  ...........
                               socket.
L5540...  A                   Prep BK ptb laminated    .........  .........  .........  ...........  ...........
                               socket.
L5560...  A                   Prep AK ischial plast    .........  .........  .........  ...........  ...........
                               molded.
L5570...  A                   Prep AK ischial direct   .........  .........  .........  ...........  ...........
                               form.
L5580...  A                   Prep AK ischial thermo   .........  .........  .........  ...........  ...........
                               mold.
L5585...  A                   Prep AK ischial open     .........  .........  .........  ...........  ...........
                               end.
L5590...  A                   Prep AK ischial          .........  .........  .........  ...........  ...........
                               laminated.
L5595...  A                   Hip disartic sach        .........  .........  .........  ...........  ...........
                               thermopls.
L5600...  A                   Hip disart sach laminat  .........  .........  .........  ...........  ...........
                               mold.
L5610...  A                   Above knee hydracadence  .........  .........  .........  ...........  ...........
L5611...  A                   Ak 4 bar link w/fric     .........  .........  .........  ...........  ...........
                               swing.
L5613...  A                   Ak 4 bar ling w/hydraul  .........  .........  .........  ...........  ...........
                               swig.
L5614...  A                   4-bar link above knee w/ .........  .........  .........  ...........  ...........
                               swng.
L5616...  A                   Ak univ multiplex sys    .........  .........  .........  ...........  ...........
                               frict.
L5617...  A                   AK/BK self-aligning      .........  .........  .........  ...........  ...........
                               unit ea.
L5618...  A                   Test socket symes......  .........  .........  .........  ...........  ...........
L5620...  A                   Test socket below knee.  .........  .........  .........  ...........  ...........
L5622...  A                   Test socket knee         .........  .........  .........  ...........  ...........
                               disarticula.
L5624...  A                   Test socket above knee.  .........  .........  .........  ...........  ...........
L5626...  A                   Test socket hip          .........  .........  .........  ...........  ...........
                               disarticulat.
L5628...  A                   Test socket              .........  .........  .........  ...........  ...........
                               hemipelvectomy.
L5629...  A                   Below knee acrylic       .........  .........  .........  ...........  ...........
                               socket.
L5630...  A                   Syme typ expandabl wall  .........  .........  .........  ...........  ...........
                               sckt.
L5631...  A                   Ak/knee disartic         .........  .........  .........  ...........  ...........
                               acrylic soc.
L5632...  A                   Symes type ptb brim      .........  .........  .........  ...........  ...........
                               design s.
L5634...  A                   Symes type poster        .........  .........  .........  ...........  ...........
                               opening so.
L5636...  A                   Symes type medial        .........  .........  .........  ...........  ...........
                               opening so.
L5637...  A                   Below knee total         .........  .........  .........  ...........  ...........
                               contact.
L5638...  A                   Below knee leather       .........  .........  .........  ...........  ...........
                               socket.
L5639...  A                   Below knee wood socket.  .........  .........  .........  ...........  ...........
L5640...  A                   Knee disarticulat        .........  .........  .........  ...........  ...........
                               leather so.

[[Page 47754]]

L5642...  A                   Above knee leather       .........  .........  .........  ...........  ...........
                               socket.
L5643...  A                   Hip flex inner socket    .........  .........  .........  ...........  ...........
                               ext fr.
L5644...  A                   Above knee wood socket.  .........  .........  .........  ...........  ...........
L5645...  A                   Ak flexibl inner socket  .........  .........  .........  ...........  ...........
                               ext.
L5646...  A                   Below knee air cushion   .........  .........  .........  ...........  ...........
                               socke.
L5647...  A                   Below knee suction       .........  .........  .........  ...........  ...........
                               socket.
L5648...  A                   Above knee air cushion   .........  .........  .........  ...........  ...........
                               socke.
L5649...  A                   Isch containmt/narrow m- .........  .........  .........  ...........  ...........
                               l so.
L5650...  A                   Tot contact ak/knee      .........  .........  .........  ...........  ...........
                               disart s.
L5651...  A                   Ak flex inner socket     .........  .........  .........  ...........  ...........
                               ext fra.
L5652...  A                   Suction susp ak/knee     .........  .........  .........  ...........  ...........
                               disart.
L5653...  A                   Knee disart expand wall  .........  .........  .........  ...........  ...........
                               sock.
L5654...  A                   Socket insert symes....  .........  .........  .........  ...........  ...........
L5655...  A                   Socket insert below      .........  .........  .........  ...........  ...........
                               knee.
L5656...  A                   Socket insert knee       .........  .........  .........  ...........  ...........
                               articulat.
L5658...  A                   Socket insert above      .........  .........  .........  ...........  ...........
                               knee.
L5660...  A                   Sock insrt syme          .........  .........  .........  ...........  ...........
                               silicone gel.
L5661...  A                   Multi-durometer symes..  .........  .........  .........  ...........  ...........
L5662...  A                   Socket insert bk         .........  .........  .........  ...........  ...........
                               silicone ge.
L5663...  A                   Sock knee disartic       .........  .........  .........  ...........  ...........
                               silicone.
L5664...  A                   Socket insert ak         .........  .........  .........  ...........  ...........
                               silicone ge.
L5665...  A                   Multi-durometer below    .........  .........  .........  ...........  ...........
                               knee.
L5666...  A                   Below knee cuff          .........  .........  .........  ...........  ...........
                               suspension.
L5667...  A                   Socket insert w lock     .........  .........  .........  ...........  ...........
                               lower.
L5668...  A                   Socket insert w/o lock   .........  .........  .........  ...........  ...........
                               lower.
L5669...  A                   Below knee socket w/o    .........  .........  .........  ...........  ...........
                               lock.
L5670...  A                   Bk molded supracondylar  .........  .........  .........  ...........  ...........
                               susp.
L5672...  A                   Bk removable medial      .........  .........  .........  ...........  ...........
                               brim sus.
L5674...  A                   Bk latex sleeve          .........  .........  .........  ...........  ...........
                               suspension/e.
L5675...  A                   Bk latex sleeve susp/eq  .........  .........  .........  ...........  ...........
                               hvy.
L5676...  A                   Bk knee joints single    .........  .........  .........  ...........  ...........
                               axis p.
L5677...  A                   Bk knee joints           .........  .........  .........  ...........  ...........
                               polycentric p.
L5678...  A                   Bk joint covers pair...  .........  .........  .........  ...........  ...........
L5680...  A                   Bk thigh lacer non-      .........  .........  .........  ...........  ...........
                               molded.
L5682...  A                   Bk thigh lacer glut/     .........  .........  .........  ...........  ...........
                               ischia m.
L5684...  A                   Bk fork strap..........  .........  .........  .........  ...........  ...........
L5686...  A                   Bk back check..........  .........  .........  .........  ...........  ...........
L5688...  A                   Bk waist belt webbing..  .........  .........  .........  ...........  ...........
L5690...  A                   Bk waist belt padded     .........  .........  .........  ...........  ...........
                               and lin.
L5692...  A                   Ak pelvic control belt   .........  .........  .........  ...........  ...........
                               light.
L5694...  A                   Ak pelvic control belt   .........  .........  .........  ...........  ...........
                               pad/l.
L5695...  A                   Ak sleeve susp neoprene/ .........  .........  .........  ...........  ...........
                               equa.
L5696...  A                   Ak/knee disartic pelvic  .........  .........  .........  ...........  ...........
                               join.
L5697...  A                   Ak/knee disartic pelvic  .........  .........  .........  ...........  ...........
                               band.
L5698...  A                   Ak/knee disartic         .........  .........  .........  ...........  ...........
                               silesian ba.
L5699...  A                   Shoulder harness.......  .........  .........  .........  ...........  ...........
L5700...  A                   Replace socket below     .........  .........  .........  ...........  ...........
                               knee.
L5701...  A                   Replace socket above     .........  .........  .........  ...........  ...........
                               knee.
L5702...  A                   Replace socket hip.....  .........  .........  .........  ...........  ...........
L5704...  A                   Custom shape covr below  .........  .........  .........  ...........  ...........
                               knee.
L5705...  A                   Custm shape cover above  .........  .........  .........  ...........  ...........
                               knee.
L5706...  A                   Custm shape cvr knee     .........  .........  .........  ...........  ...........
                               disart.
L5707...  A                   Custm shape cover hip    .........  .........  .........  ...........  ...........
                               disart.
L5710...  A                   Kne-shin exo sng axi     .........  .........  .........  ...........  ...........
                               mnl loc.
L5711...  A                   Knee-shin exo mnl lock   .........  .........  .........  ...........  ...........
                               ultra.
L5712...  A                   Knee-shin exo frict swg  .........  .........  .........  ...........  ...........
                               & st.
L5714...  A                   Knee-shin exo variable   .........  .........  .........  ...........  ...........
                               frict.
L5716...  A                   Knee-shin exo mech       .........  .........  .........  ...........  ...........
                               stance ph.
L5718...  A                   Knee-shin exo frct swg   .........  .........  .........  ...........  ...........
                               & sta.
L5722...  A                   Knee-shin pneum swg      .........  .........  .........  ...........  ...........
                               frct exo.
L5724...  A                   Knee-shin exo fluid      .........  .........  .........  ...........  ...........
                               swing ph.
L5726...  A                   Knee-shin ext jnts fld   .........  .........  .........  ...........  ...........
                               swg e.
L5728...  A                   Knee-shin fluid swg &    .........  .........  .........  ...........  ...........
                               stance.
L5780...  A                   Knee-shin pneum/hydra    .........  .........  .........  ...........  ...........
                               pneum.
L5785...  A                   Exoskeletal bk ultralt   .........  .........  .........  ...........  ...........
                               mater.
L5790...  A                   Exoskeletal ak ultra-    .........  .........  .........  ...........  ...........
                               light m.
L5795...  A                   Exoskel hip ultra-light  .........  .........  .........  ...........  ...........
                               mate.
L5810...  A                   Endoskel knee-shin mnl   .........  .........  .........  ...........  ...........
                               lock.
L5811...  A                   Endo knee-shin mnl lck   .........  .........  .........  ...........  ...........
                               ultra.
L5812...  A                   Endo knee-shin frct swg  .........  .........  .........  ...........  ...........
                               & st.
L5814...  A                   Endo knee-shin hydral    .........  .........  .........  ...........  ...........
                               swg ph.
L5816...  A                   Endo knee-shin polyc     .........  .........  .........  ...........  ...........
                               mch sta.
L5818...  A                   Endo knee-shin frct swg  .........  .........  .........  ...........  ...........
                               & st.
L5822...  A                   Endo knee-shin pneum     .........  .........  .........  ...........  ...........
                               swg frc.
L5824...  A                   Endo knee-shin fluid     .........  .........  .........  ...........  ...........
                               swing p.

[[Page 47755]]

L5826...  A                   Pediatric knee joint...  .........  .........  .........  ...........  ...........
L5828...  A                   Endo knee-shin fluid     .........  .........  .........  ...........  ...........
                               swg/sta.
L5830...  A                   Endo knee-shin pneum/    .........  .........  .........  ...........  ...........
                               swg pha.
L5840...  A                   Multi-axial knee/shin    .........  .........  .........  ...........  ...........
                               system.
L5845...  A                   Knee-shin sys stance     .........  .........  .........  ...........  ...........
                               flexion.
L5846...  A                   Knee-shin sys            .........  .........  .........  ...........  ...........
                               microprocessor.
L5850...  A                   Endo ak/hip knee extens  .........  .........  .........  ...........  ...........
                               assi.
L5855...  A                   Mech hip extension       .........  .........  .........  ...........  ...........
                               assist.
L5910...  A                   Endo below knee          .........  .........  .........  ...........  ...........
                               alignable sy.
L5920...  A                   Endo ak/hip alignable    .........  .........  .........  ...........  ...........
                               system.
L5925...  A                   Above knee manual lock.  .........  .........  .........  ...........  ...........
L5930...  A                   High activity knee       .........  .........  .........  ...........  ...........
                               frame.
L5940...  A                   Endo bk ultra-light      .........  .........  .........  ...........  ...........
                               material.
L5950...  A                   Endo ak ultra-light      .........  .........  .........  ...........  ...........
                               material.
L5960...  A                   Endo hip ultra-light     .........  .........  .........  ...........  ...........
                               materia.
L5962...  A                   Below knee flex cover    .........  .........  .........  ...........  ...........
                               system.
L5964...  A                   Above knee flex cover    .........  .........  .........  ...........  ...........
                               system.
L5966...  A                   Hip flexible cover       .........  .........  .........  ...........  ...........
                               system.
L5970...  A                   Foot external keel sach  .........  .........  .........  ...........  ...........
                               foot.
L5972...  A                   Flexible keel foot.....  .........  .........  .........  ...........  ...........
L5974...  A                   Foot single axis ankle/  .........  .........  .........  ...........  ...........
                               foot.
L5976...  A                   Energy storing foot....  .........  .........  .........  ...........  ...........
L5978...  A                   Ft prosth multiaxial     .........  .........  .........  ...........  ...........
                               ankl/ft.
L5979...  A                   Multi-axial ankle/ft     .........  .........  .........  ...........  ...........
                               prosth.
L5980...  A                   Flex foot system.......  .........  .........  .........  ...........  ...........
L5981...  A                   Flex-walk sys low ext    .........  .........  .........  ...........  ...........
                               prosth.
L5982...  A                   Exoskeletal axial        .........  .........  .........  ...........  ...........
                               rotation u.
L5984...  A                   Endoskeletal axial       .........  .........  .........  ...........  ...........
                               rotation.
L5985...  A                   Lwr ext dynamic prosth   .........  .........  .........  ...........  ...........
                               pylon.
L5986...  A                   Multi-axial rotation     .........  .........  .........  ...........  ...........
                               unit.
L5987...  A                   Shank ft w vert load     .........  .........  .........  ...........  ...........
                               pylon.
L5999...  A                   Lowr extremity prosthes  .........  .........  .........  ...........  ...........
                               NOS.
L6000...  A                   Par hand robin-aids      .........  .........  .........  ...........  ...........
                               thum rem.
L6010...  A                   Hand robin-aids little/  .........  .........  .........  ...........  ...........
                               ring.
L6020...  A                   Part hand robin-aids no  .........  .........  .........  ...........  ...........
                               fing.
L6050...  A                   Wrst MLd sck flx hng     .........  .........  .........  ...........  ...........
                               tri pad.
L6055...  A                   Wrst mold sock w/exp     .........  .........  .........  ...........  ...........
                               interfa.
L6100...  A                   Elb mold sock flex       .........  .........  .........  ...........  ...........
                               hinge pad.
L6110...  A                   Elbow mold sock          .........  .........  .........  ...........  ...........
                               suspension t.
L6120...  A                   Elbow mold doub splt     .........  .........  .........  ...........  ...........
                               soc ste.
L6130...  A                   Elbow stump activated    .........  .........  .........  ...........  ...........
                               lock h.
L6200...  A                   Elbow mold outsid lock   .........  .........  .........  ...........  ...........
                               hinge.
L6205...  A                   Elbow molded w/ expand   .........  .........  .........  ...........  ...........
                               inter.
L6250...  A                   Elbow inter loc elbow    .........  .........  .........  ...........  ...........
                               forarm.
L6300...  A                   Shlder disart int lock   .........  .........  .........  ...........  ...........
                               elbow.
L6310...  A                   Shoulder passive restor  .........  .........  .........  ...........  ...........
                               comp.
L6320...  A                   Shoulder passive restor  .........  .........  .........  ...........  ...........
                               cap.
L6350...  A                   Thoracic intern lock     .........  .........  .........  ...........  ...........
                               elbow.
L6360...  A                   Thoracic passive restor  .........  .........  .........  ...........  ...........
                               comp.
L6370...  A                   Thoracic passive restor  .........  .........  .........  ...........  ...........
                               cap.
L6380...  A                   Postop dsg cast chg      .........  .........  .........  ...........  ...........
                               wrst/elb.
L6382...  A                   Postop dsg cast chg elb  .........  .........  .........  ...........  ...........
                               dis/.
L6384...  A                   Postop dsg cast chg      .........  .........  .........  ...........  ...........
                               shlder/t.
L6386...  A                   Postop ea cast chg &     .........  .........  .........  ...........  ...........
                               realign.
L6388...  A                   Postop applicat rigid    .........  .........  .........  ...........  ...........
                               dsg on.
L6400...  A                   Below elbow prosth tiss  .........  .........  .........  ...........  ...........
                               shap.
L6450...  A                   Elb disart prosth tiss   .........  .........  .........  ...........  ...........
                               shap.
L6500...  A                   Above elbow prosth tiss  .........  .........  .........  ...........  ...........
                               shap.
L6550...  A                   Shldr disar prosth tiss  .........  .........  .........  ...........  ...........
                               shap.
L6570...  A                   Scap thorac prosth tiss  .........  .........  .........  ...........  ...........
                               shap.
L6580...  A                   Wrist/elbow bowden       .........  .........  .........  ...........  ...........
                               cable mol.
L6582...  A                   Wrist/elbow bowden cbl   .........  .........  .........  ...........  ...........
                               dir f.
L6584...  A                   Elbow fair lead cable    .........  .........  .........  ...........  ...........
                               molded.
L6586...  A                   Elbow fair lead cable    .........  .........  .........  ...........  ...........
                               dir fo.
L6588...  A                   Shdr fair lead cable     .........  .........  .........  ...........  ...........
                               molded.
L6590...  A                   Shdr fair lead cable     .........  .........  .........  ...........  ...........
                               direct.
L6600...  A                   Polycentric hinge pair.  .........  .........  .........  ...........  ...........
L6605...  A                   Single pivot hinge pair  .........  .........  .........  ...........  ...........
L6610...  A                   Flexible metal hinge     .........  .........  .........  ...........  ...........
                               pair.
L6615...  A                   Disconnect locking       .........  .........  .........  ...........  ...........
                               wrist uni.
L6616...  A                   Disconnect insert        .........  .........  .........  ...........  ...........
                               locking wr.
L6620...  A                   Flexion-friction wrist   .........  .........  .........  ...........  ...........
                               unit.
L6623...  A                   Spring-ass rot wrst w/   .........  .........  .........  ...........  ...........
                               latch.
L6625...  A                   Rotation wrst w/ cable   .........  .........  .........  ...........  ...........
                               lock.
L6628...  A                   Quick disconn hook       .........  .........  .........  ...........  ...........
                               adapter o.

[[Page 47756]]

L6629...  A                   Lamination collar w/     .........  .........  .........  ...........  ...........
                               couplin.
L6630...  A                   Stainless steel any      .........  .........  .........  ...........  ...........
                               wrist.
L6632...  A                   Latex suspension sleeve  .........  .........  .........  ...........  ...........
                               each.
L6635...  A                   Lift assist for elbow..  .........  .........  .........  ...........  ...........
L6637...  A                   Nudge control elbow      .........  .........  .........  ...........  ...........
                               lock.
L6640...  A                   Shoulder abduction       .........  .........  .........  ...........  ...........
                               joint pai.
L6641...  A                   Excursion amplifier      .........  .........  .........  ...........  ...........
                               pulley t.
L6642...  A                   Excursion amplifier      .........  .........  .........  ...........  ...........
                               lever ty.
L6645...  A                   Shoulder flexion-        .........  .........  .........  ...........  ...........
                               abduction j.
L6650...  A                   Shoulder universal       .........  .........  .........  ...........  ...........
                               joint.
L6655...  A                   Standard control cable   .........  .........  .........  ...........  ...........
                               extra.
L6660...  A                   Heavy duty control       .........  .........  .........  ...........  ...........
                               cable.
L6665...  A                   Teflon or equal cable    .........  .........  .........  ...........  ...........
                               lining.
L6670...  A                   Hook to hand cable       .........  .........  .........  ...........  ...........
                               adapter.
L6672...  A                   Harness chest/shlder     .........  .........  .........  ...........  ...........
                               saddle.
L6675...  A                   Harness figure of 8      .........  .........  .........  ...........  ...........
                               sing con.
L6676...  A                   Harness figure of 8      .........  .........  .........  ...........  ...........
                               dual con.
L6680...  A                   Test sock wrist disart/  .........  .........  .........  ...........  ...........
                               bel e.
L6682...  A                   Test sock elbw disart/   .........  .........  .........  ...........  ...........
                               above.
L6684...  A                   Test socket shldr        .........  .........  .........  ...........  ...........
                               disart/tho.
L6686...  A                   Suction socket.........  .........  .........  .........  ...........  ...........
L6687...  A                   Frame typ socket bel     .........  .........  .........  ...........  ...........
                               elbow/w.
L6688...  A                   Frame typ sock above     .........  .........  .........  ...........  ...........
                               elb/dis.
L6689...  A                   Frame typ socket         .........  .........  .........  ...........  ...........
                               shoulder di.
L6690...  A                   Frame typ sock           .........  .........  .........  ...........  ...........
                               interscap-tho.
L6691...  A                   Removable insert each..  .........  .........  .........  ...........  ...........
L6692...  A                   Silicone gel insert or   .........  .........  .........  ...........  ...........
                               equal.
L6700...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#3.
L6705...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#5.
L6710...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#5x.
L6715...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#5xa.
L6720...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#6.
L6725...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#7.
L6730...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#7lo.
L6735...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#8.
L6740...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#8x.
L6745...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#88x.
L6750...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#10p.
L6755...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#10x.
L6765...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#12p.
L6770...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#99x.
L6775...  A                   Terminal device          .....<SUP>....  .....<SUP>....  .....<SUP>....  .....<SUP>......  .....<SUP>......
                               model<SUP>#555.
L6780...  A                   Terminal device model    <SUP>.........  <SUP>.........  <SUP>.........  <SUP>...........  <SUP>...........
                               <SUP>#ss555.
L6790...  A                   Hooks-accu hook or       .........  .........  .........  ...........  ...........
                               equal.
L6795...  A                   Hooks-2 load or equal..  .........  .........  .........  ...........  ...........
L6800...  A                   Hooks-aprl vc or equal.  .........  .........  .........  ...........  ...........
L6805...  A                   Modifier wrist flexion   .........  .........  .........  ...........  ...........
                               unit.
L6806...  A                   Trs grip vc or equal...  .........  .........  .........  ...........  ...........
L6807...  A                   Term device grip1/2 or   .........  .........  .........  ...........  ...........
                               equal.
L6808...  A                   Term device infant or    .........  .........  .........  ...........  ...........
                               child.
L6809...  A                   Trs super sport passive  .........  .........  .........  ...........  ...........
L6810...  A                   Pincher tool otto bock   .........  .........  .........  ...........  ...........
                               or eq.
L6825...  A                   Hands dorrance vo......  .........  .........  .........  ...........  ...........
L6830...  A                   Hand aprl vc...........  .........  .........  .........  ...........  ...........
L6835...  A                   Hand sierra vo.........  .........  .........  .........  ...........  ...........
L6840...  A                   Hand becker imperial...  .........  .........  .........  ...........  ...........
L6845...  A                   Hand becker lock grip..  .........  .........  .........  ...........  ...........
L6850...  A                   Term dvc-hand becker     .........  .........  .........  ...........  ...........
                               plylite.
L6855...  A                   Hand robin-aids vo.....  .........  .........  .........  ...........  ...........
L6860...  A                   Hand robin-aids vo soft  .........  .........  .........  ...........  ...........
L6865...  A                   Hand passive hand......  .........  .........  .........  ...........  ...........
L6867...  A                   Hand detroit infant      .........  .........  .........  ...........  ...........
                               hand.
L6868...  A                   Passive inf hand         .........  .........  .........  ...........  ...........
                               steeper/hos.
L6870...  A                   Hand child mitt........  .........  .........  .........  ...........  ...........
L6872...  A                   Hand nyu child hand....  .........  .........  .........  ...........  ...........
L6873...  A                   Hand mech inf steeper    .........  .........  .........  ...........  ...........
                               or equ.
L6875...  A                   Hand bock vc...........  .........  .........  .........  ...........  ...........
L6880...  A                   Hand bock vo...........  .........  .........  .........  ...........  ...........
L6890...  A                   Production glove.......  .........  .........  .........  ...........  ...........
L6895...  A                   Custom glove...........  .........  .........  .........  ...........  ...........
L6900...  A                   Hand restorat thumb/1    .........  .........  .........  ...........  ...........
                               finger.
L6905...  A                   Hand restoration         .........  .........  .........  ...........  ...........
                               multiple fi.
L6910...  A                   Hand restoration no      .........  .........  .........  ...........  ...........
                               fingers.
L6915...  A                   Hand restoration         .........  .........  .........  ...........  ...........
                               replacmnt g.
L6920...  A                   Wrist disarticul switch  .........  .........  .........  ...........  ...........
                               ctrl.

[[Page 47757]]

L6925...  A                   Wrist disart             .........  .........  .........  ...........  ...........
                               myoelectronic c.
L6930...  A                   Below elbow switch       .........  .........  .........  ...........  ...........
                               control.
L6935...  A                   Below elbow              .........  .........  .........  ...........  ...........
                               myoelectronic ct.
L6940...  A                   Elbow disarticulation    .........  .........  .........  ...........  ...........
                               switch.
L6945...  A                   Elbow disart             .........  .........  .........  ...........  ...........
                               myoelectronic c.
L6950...  A                   Above elbow switch       .........  .........  .........  ...........  ...........
                               control.
L6955...  A                   Above elbow              .........  .........  .........  ...........  ...........
                               myoelectronic ct.
L6960...  A                   Shldr disartic switch    .........  .........  .........  ...........  ...........
                               contro.
L6965...  A                   Shldr disartic           .........  .........  .........  ...........  ...........
                               myoelectronic.
L6970...  A                   Interscapular-thor       .........  .........  .........  ...........  ...........
                               switch ct.
L6975...  A                   Interscap-thor           .........  .........  .........  ...........  ...........
                               myoelectronic.
L7010...  A                   Hand otto back steeper/  .........  .........  .........  ...........  ...........
                               eq sw.
L7015...  A                   Hand sys teknik village  .........  .........  .........  ...........  ...........
                               swit.
L7020...  A                   Electronic greifer       .........  .........  .........  ...........  ...........
                               switch ct.
L7025...  A                   Electron hand            .........  .........  .........  ...........  ...........
                               myoelectronic.
L7030...  A                   Hand sys teknik vill     .........  .........  .........  ...........  ...........
                               myoelec.
L7035...  A                   Electron greifer         .........  .........  .........  ...........  ...........
                               myoelectro.
L7040...  A                   Prehensile actuator      .........  .........  .........  ...........  ...........
                               hosmer s.
L7045...  A                   Electron hook child      .........  .........  .........  ...........  ...........
                               michigan.
L7170...  A                   Electronic elbow hosmer  .........  .........  .........  ...........  ...........
                               swit.
L7180...  A                   Electronic elbow utah    .........  .........  .........  ...........  ...........
                               myoele.
L7185...  A                   Electron elbow           .........  .........  .........  ...........  ...........
                               adolescent sw.
L7186...  A                   Electron elbow child     .........  .........  .........  ...........  ...........
                               switch.
L7190...  A                   Elbow adolescent         .........  .........  .........  ...........  ...........
                               myoelectron.
L7191...  A                   Elbow child              .........  .........  .........  ...........  ...........
                               myoelectronic ct.
L7260...  A                   Electron wrist rotator   .........  .........  .........  ...........  ...........
                               otto.
L7261...  A                   Electron wrist rotator   .........  .........  .........  ...........  ...........
                               utah.
L7266...  A                   Servo control steeper    .........  .........  .........  ...........  ...........
                               or equ.
L7272...  A                   Analogue control unb or  .........  .........  .........  ...........  ...........
                               equa.
L7274...  A                   Proportional ctl 12      .........  .........  .........  ...........  ...........
                               volt uta.
L7360...  A                   Six volt bat otto bock/  .........  .........  .........  ...........  ...........
                               eq ea.
L7362...  A                   Battery chrgr six volt   .........  .........  .........  ...........  ...........
                               otto.
L7364...  A                   Twelve volt battery      .........  .........  .........  ...........  ...........
                               utah/equ.
L7366...  A                   Battery chrgr 12 volt    .........  .........  .........  ...........  ...........
                               utah/e.
L7499...  A                   Upper extremity          .........  .........  .........  ...........  ...........
                               prosthes NOS.
L7500...  A                   Prosthetic dvc repair    .........  .........  .........  ...........  ...........
                               hourly.
L7510...  A                   Prosthetic device        .........  .........  .........  ...........  ...........
                               repair rep.
L7520...  A                   Repair prosthesis per    .........  .........  .........  ...........  ...........
                               15 min.
L7900...  A                   Vacuum erection system.  .........  .........  .........  ...........  ...........
L8000...  A                   Mastectomy bra.........  .........  .........  .........  ...........  ...........
L8010...  A                   Mastectomy sleeve......  .........  .........  .........  ...........  ...........
L8020...  A                   Mastectomy form........  .........  .........  .........  ...........  ...........
L8030...  A                   Breast prosthesis        .........  .........  .........  ...........  ...........
                               silicone/e.
L8039...  A                   Breast prosthesis NOS..  .........  .........  .........  ...........  ...........
L8100...  A                   Elas suprt stock bk med  .........  .........  .........  ...........  ...........
                               wgt.
L8110...  A                   Elastic supp stocking    .........  .........  .........  ...........  ...........
                               bk hvy.
L8120...  A                   Elastic supp stockng bk  .........  .........  .........  ...........  ...........
                               surg.
L8130...  A                   Elastic supp stocking    .........  .........  .........  ...........  ...........
                               ak med.
L8140...  A                   Elastic supp stocking    .........  .........  .........  ...........  ...........
                               ak hvy.
L8150...  A                   Elastic supp stockng ak  .........  .........  .........  ...........  ...........
                               surg.
L8160...  A                   Supp stocking full lgth  .........  .........  .........  ...........  ...........
                               med.
L8170...  A                   Supp stocking full lgth  .........  .........  .........  ...........  ...........
                               hvy.
L8180...  A                   Supp stocking heavy      .........  .........  .........  ...........  ...........
                               surg wei.
L8190...  A                   Elas stocking leotards   .........  .........  .........  ...........  ...........
                               med w.
L8200...  A                   Elas stocking leotards   .........  .........  .........  ...........  ...........
                               surg.
L8210...  A                   Elastic stocking custom  .........  .........  .........  ...........  ...........
                               made.
L8220...  A                   Elastic stocking         .........  .........  .........  ...........  ...........
                               lymphedema.
L8230...  A                   Elastic stocking garter  .........  .........  .........  ...........  ...........
                               belt.
L8239...  A                   Elastic support NOS....  .........  .........  .........  ...........  ...........
L8300...  A                   Truss single w/          .........  .........  .........  ...........  ...........
                               standard pad.
L8310...  A                   Truss double w/          .........  .........  .........  ...........  ...........
                               standard pad.
L8320...  A                   Truss addition to std    .........  .........  .........  ...........  ...........
                               pad wa.
L8330...  A                   Truss add to std pad     .........  .........  .........  ...........  ...........
                               scrotal.
L8400...  A                   Sheath below knee......  .........  .........  .........  ...........  ...........
L8410...  A                   Sheath above knee......  .........  .........  .........  ...........  ...........
L8415...  A                   Sheath upper limb......  .........  .........  .........  ...........  ...........
L8417...  A                   Pros sheath/sock w gel   .........  .........  .........  ...........  ...........
                               cushn.
L8420...  A                   Sock wool below knee...  .........  .........  .........  ...........  ...........
L8430...  A                   Sock wool above knee...  .........  .........  .........  ...........  ...........
L8435...  A                   Sock wool upper limb...  .........  .........  .........  ...........  ...........
L8440...  A                   Shrinker below knee....  .........  .........  .........  ...........  ...........
L8460...  A                   Shrinker above knee....  .........  .........  .........  ...........  ...........
L8465...  A                   Shrinker upper limb....  .........  .........  .........  ...........  ...........
L8470...  A                   Stump sock single below  .........  .........  .........  ...........  ...........
                               knee.
L8480...  A                   Stump sock single above  .........  .........  .........  ...........  ...........
                               knee.

[[Page 47758]]

L8485...  A                   Stump sock fitting uppr  .........  .........  .........  ...........  ...........
                               limb.
L8490...  A                   Air seal suction reten   .........  .........  .........  ...........  ...........
                               systm.
L8499...  A                   Unlisted misc            .........  .........  .........  ...........  ...........
                               prosthetic ser.
L8500...  A                   Artificial larynx......  .........  .........  .........  ...........  ...........
L8501...  A                   Tracheostomy speaking    .........  .........  .........  ...........  ...........
                               valve.
L8600...  A                   Implant breast silicone/ .........  .........  .........  ...........  ...........
                               eq.
L8603...  A                   Collagen imp urinary     .........  .........  .........  ...........  ...........
                               2.5 CC.
L8610...  A                   Ocular implant.........  .........  .........  .........  ...........  ...........
L8612...  A                   Aqueous shunt            .........  .........  .........  ...........  ...........
                               prosthesis.
L8613...  A                   Ossicular implant......  .........  .........  .........  ...........  ...........
L8614...  A                   Cochlear device/system.  .........  .........  .........  ...........  ...........
L8619...  A                   Replace cochlear         .........  .........  .........  ...........  ...........
                               processor.
L8630...  A                   Metacarpophalangeal      .........  .........  .........  ...........  ...........
                               implant.
L8641...  A                   Metatarsal joint         .........  .........  .........  ...........  ...........
                               implant.
L8642...  A                   Hallux implant.........  .........  .........  .........  ...........  ...........
L8658...  A                   Interphalangeal joint    .........  .........  .........  ...........  ...........
                               implnt.
L8670...  A                   Vascular graft,          .........  .........  .........  ...........  ...........
                               synthetic.
L8699...  A                   Prosthetic implant NOS.  .........  .........  .........  ...........  ...........
M0064...  X                   Visit for drug                 090       0.85     $45.05       $12.43        $9.01
                               monitoring.
M0075...  E                   Cellular therapy.......  .........  .........  .........  ...........  ...........
M0076...  E                   Prolotherapy...........  .........  .........  .........  ...........  ...........
M0100...  E                   Intragastric             .........  .........  .........  ...........  ...........
                               hypothermia.
M0101...  E                   Foot care hygienic/pm..  .........  .........  .........  ...........  ...........
M0300...  E                   IV chelation therapy...  .........  .........  .........  ...........  ...........
M0301...  E                   Fabric wrapping of       .........  .........  .........  ...........  ...........
                               aneurysm.
M0302...  E                   Assessment of cardiac    .........  .........  .........  ...........  ...........
                               output.
P2028...  A                   Cephalin floculation     .........  .........  .........  ...........  ...........
                               test.
P2029...  A                   Congo red blood test...  .........  .........  .........  ...........  ...........
P2031...  E                   Hair analysis..........  .........  .........  .........  ...........  ...........
P2033...  A                   Blood thymol turbidity.  .........  .........  .........  ...........  ...........
P2038...  A                   Blood mucoprotein......  .........  .........  .........  ...........  ...........
P3000...  A                   Screen pap by tech w md  .........  .........  .........  ...........  ...........
                               supv.
P3001...  A                   Screening pap smear by   .........  .........  .........  ...........  ...........
                               phys.
P7001...  E                   Culture bacterial urine  .........  .........  .........  ...........  ...........
P9010...  N                   Whole blood for          .........  .........  .........  ...........  ...........
                               transfusion.
P9011...  N                   Blood split unit.......  .........  .........  .........  ...........  ...........
P9012...  N                   Cryoprecipitate each     .........  .........  .........  ...........  ...........
                               unit.
P9013...  N                   Unit/s blood fibrinogen  .........  .........  .........  ...........  ...........
P9014...  N                   Gamma globulin 1 ML....  .........  .........  .........  ...........  ...........
P9015...  N                   Rh immune globulin 1 ML  .........  .........  .........  ...........  ...........
P9016...  N                   Leukocyte poor blood,    .........  .........  .........  ...........  ...........
                               unit.
P9017...  N                   One donor fresh frozn    .........  .........  .........  ...........  ...........
                               plasma.
P9018...  N                   Plasma protein fract,    .........  .........  .........  ...........  ...........
                               unit.
P9019...  N                   Platelet concentrate     .........  .........  .........  ...........  ...........
                               unit.
P9020...  N                   Platelet rich plasma     .........  .........  .........  ...........  ...........
                               unit.
P9021...  N                   Red blood cells unit...  .........  .........  .........  ...........  ...........
P9022...  N                   Washed red blood cells   .........  .........  .........  ...........  ...........
                               unit.
P9603...  N                   One-way allow prorated   .........  .........  .........  ...........  ...........
                               miles.
P9604...  N                   One-way allow prorated   .........  .........  .........  ...........  ...........
                               trip.
P9610...  E                   Urine specimen collect   .........  .........  .........  ...........  ...........
                               singl.
P9615...  E                   Urine specimen collect   .........  .........  .........  ...........  ...........
                               mult.
Q0034...  X                   Admin of influenza             901       0.07      $3.92        $2.49         $.78
                               vaccine.
Q0035...  X                   Cardiokymography.......        950       0.35     $18.61       $15.82        $3.72
Q0068...  T                   Extracorpeal                   369       4.33    $229.19       $97.18       $45.84
                               plasmapheresis.
Q0081...  X                   Infusion ther other            906       1.46     $77.38       $42.49       $15.48
                               than che.
Q0082...  X                   Activity therapy w/      .........  .........  .........  ...........  ...........
                               partial h.
Q0083...  S                   Chemo by other than            987       0.65     $34.28       $13.33        $6.86
                               infusion.
Q0084...  S                   Chemotherapy by                989       1.72     $91.09       $40.68       $18.22
                               infusion.
Q0085...  S                   Chemo by both infusion         989       1.72     $91.09       $40.68       $18.22
                               and o.
Q0086...  A                   Physical therapy         .........  .........  .........  ...........  ...........
                               evaluation/.
Q0091...  T                   Obtaining screen pap           561       1.52     $80.32       $24.63       $16.06
                               smear.
Q0092...  N                   Set up port xray         .........  .........  .........  ...........  ...........
                               equipment.
Q0111...  A                   Wet mounts/ w            .........  .........  .........  ...........  ...........
                               preparations.
Q0112...  A                   Potassium hydroxide      .........  .........  .........  ...........  ...........
                               preps.
Q0113...  A                   Pinworm examinations...  .........  .........  .........  ...........  ...........
Q0114...  A                   Fern test..............  .........  .........  .........  ...........  ...........
Q0115...  A                   Post-coital mucous exam  .........  .........  .........  ...........  ...........
Q0132...  A                   Dispensing fee DME neb   .........  .........  .........  ...........  ...........
                               drug.
Q0136...  N                   Non esrd epoetin alpha   .........  .........  .........  ...........  ...........
                               inj.
Q0144...  E                   Azithromycin dihydrate,  .........  .........  .........  ...........  ...........
                               oral.
Q0156...  N                   Human albumin 5%.......  .........  .........  .........  ...........  ...........
Q0157...  N                   Human albumin 25%......  .........  .........  .........  ...........  ...........
Q9920...  A                   Epoetin with hct <= 20.  .........  .........  .........  ...........  ...........
Q9921...  A                   Epoetin with hct = 21..  .........  .........  .........  ...........  ...........
Q9922...  A                   Epoetin with hct = 22..  .........  .........  .........  ...........  ...........

[[Page 47759]]

Q9923...  A                   Epoetin with hct = 23..  .........  .........  .........  ...........  ...........
Q9924...  A                   Epoetin with hct = 24..  .........  .........  .........  ...........  ...........
Q9925...  A                   Epoetin with hct = 25..  .........  .........  .........  ...........  ...........
Q9926...  A                   Epoetin with hct = 26..  .........  .........  .........  ...........  ...........
Q9927...  A                   Epoetin with hct = 27..  .........  .........  .........  ...........  ...........
Q9928...  A                   Epoetin with hct = 28..  .........  .........  .........  ...........  ...........
Q9929...  A                   Epoetin with hct = 29..  .........  .........  .........  ...........  ...........
Q9930...  A                   Epoetin with hct = 30..  .........  .........  .........  ...........  ...........
Q9931...  A                   Epoetin with hct = 31..  .........  .........  .........  ...........  ...........
Q9932...  A                   Epoetin with hct = 32..  .........  .........  .........  ...........  ...........
Q9933...  A                   Epoetin with hct = 33..  .........  .........  .........  ...........  ...........
Q9934...  A                   Epoetin with hct = 34..  .........  .........  .........  ...........  ...........
Q9935...  A                   Epoetin with hct = 35..  .........  .........  .........  ...........  ...........
Q9936...  A                   Epoetin with hct = 36..  .........  .........  .........  ...........  ...........
Q9937...  A                   Epoetin with hct = 37..  .........  .........  .........  ...........  ...........
Q9938...  A                   Epoetin with hct = 38..  .........  .........  .........  ...........  ...........
Q9939...  A                   Epoetin with hct = 39..  .........  .........  .........  ...........  ...........
Q9940...  A                   Epoetin with hct >= 40.  .........  .........  .........  ...........  ...........
R0070...  N                   Transport portable x-    .........  .........  .........  ...........  ...........
                               ray.
R0075...  N                   Transport port x-ray     .........  .........  .........  ...........  ...........
                               multipl.
R0076...  N                   Transport portable EKG.  .........  .........  .........  ...........  ...........
V2020...  A                   Vision svcs frames       .........  .........  .........  ...........  ...........
                               purchases.
V2025...  E                   Eyeglasses delux frames  .........  .........  .........  ...........  ...........
V2100...  A                   Lens spher single plano  .........  .........  .........  ...........  ...........
                               4.00.
V2101...  A                   Single visn sphere 4.12- .........  .........  .........  ...........  ...........
                               7.00.
V2102...  A                   Singl visn sphere 7.12-  .........  .........  .........  ...........  ...........
                               20.00.
V2103...  A                   Spherocylindr 4.00d/12-  .........  .........  .........  ...........  ...........
                               2.00d.
V2104...  A                   Spherocylindr 4.00d/     .........  .........  .........  ...........  ...........
                               2.12-4d.
V2105...  A                   Spherocylinder 4.00d/    .........  .........  .........  ...........  ...........
                               4.25-6d.
V2106...  A                   Spherocylinder 4.00d/    .........  .........  .........  ...........  ...........
                               >6.00d.
V2107...  A                   Spherocylinder 4.25d/12- .........  .........  .........  ...........  ...........
                               2d.
V2108...  A                   Spherocylinder 4.25d/    .........  .........  .........  ...........  ...........
                               2.12-4d.
V2109...  A                   Spherocylinder 4.25d/    .........  .........  .........  ...........  ...........
                               4.25-6d.
V2110...  A                   Spherocylinder 4.25d/    .........  .........  .........  ...........  ...........
                               over 6d.
V2111...  A                   Spherocylindr 7.25d/.25- .........  .........  .........  ...........  ...........
                               2.25.
V2112...  A                   Spherocylindr 7.25d/     .........  .........  .........  ...........  ...........
                               2.25-4d.
V2113...  A                   Spherocylindr 7.25d/     .........  .........  .........  ...........  ...........
                               4.25-6d.
V2114...  A                   Spherocylinder over      .........  .........  .........  ...........  ...........
                               12.00d.
V2115...  A                   Lens lenticular bifocal  .........  .........  .........  ...........  ...........
V2116...  A                   Nonaspheric lens         .........  .........  .........  ...........  ...........
                               bifocal.
V2117...  A                   Aspheric lens bifocal..  .........  .........  .........  ...........  ...........
V2118...  A                   Lens aniseikonic single  .........  .........  .........  ...........  ...........
V2199...  A                   Lens single vision not   .........  .........  .........  ...........  ...........
                               oth c.
V2200...  A                   Lens spher bifoc plano   .........  .........  .........  ...........  ...........
                               4.00d.
V2201...  A                   Lens sphere bifocal      .........  .........  .........  ...........  ...........
                               4.12-7.0.
V2202...  A                   Lens sphere bifocal      .........  .........  .........  ...........  ...........
                               7.12-20.
V2203...  A                   Lens sphcyl bifocal      .........  .........  .........  ...........  ...........
                               4.00d/.1.
V2204...  A                   Lens sphcy bifocal       .........  .........  .........  ...........  ...........
                               4.00d/2.1.
V2205...  A                   Lens sphcy bifocal       .........  .........  .........  ...........  ...........
                               4.00d/4.2.
V2206...  A                   Lens sphcy bifocal       .........  .........  .........  ...........  ...........
                               4.00d/ove.
V2207...  A                   Lens sphcy bifocal 4.25- .........  .........  .........  ...........  ...........
                               7d/.
V2208...  A                   Lens sphcy bifocal 4.25- .........  .........  .........  ...........  ...........
                               7/2.
V2209...  A                   Lens sphcy bifocal 4.25- .........  .........  .........  ...........  ...........
                               7/4.
V2210...  A                   Lens sphcy bifocal 4.25- .........  .........  .........  ...........  ...........
                               7/ov.
V2211...  A                   Lens sphcy bifo 7.25-12/ .........  .........  .........  ...........  ...........
                               .25-.
V2212...  A                   Lens sphcyl bifo 7.25-   .........  .........  .........  ...........  ...........
                               12/2.2.
V2213...  A                   Lens sphcyl bifo 7.25-   .........  .........  .........  ...........  ...........
                               12/4.2.
V2214...  A                   Lens sphcyl bifocal      .........  .........  .........  ...........  ...........
                               over 12.
V2215...  A                   Lens lenticular bifocal  .........  .........  .........  ...........  ...........
V2216...  A                   Lens lenticular          .........  .........  .........  ...........  ...........
                               nonaspheric.
V2217...  A                   Lens lenticular          .........  .........  .........  ...........  ...........
                               aspheric bif.
V2218...  A                   Lens aniseikonic         .........  .........  .........  ...........  ...........
                               bifocal.
V2219...  A                   Lens bifocal seg width   .........  .........  .........  ...........  ...........
                               over.
V2220...  A                   Lens bifocal add over    .........  .........  .........  ...........  ...........
                               3.25d.
V2299...  A                   Lens bifocal speciality  .........  .........  .........  ...........  ...........
V2300...  A                   Lens sphere trifocal     .........  .........  .........  ...........  ...........
                               4.00d.
V2301...  A                   Lens sphere trifocal     .........  .........  .........  ...........  ...........
                               4.12-7.
V2302...  A                   Lens sphere trifocal     .........  .........  .........  ...........  ...........
                               7.12-20.
V2303...  A                   Lens sphcy trifocal 4.0/ .........  .........  .........  ...........  ...........
                               .12-.
V2304...  A                   Lens sphcy trifocal 4.0/ .........  .........  .........  ...........  ...........
                               2.25.
V2305...  A                   Lens sphcy trifocal 4.0/ .........  .........  .........  ...........  ...........
                               4.25.
V2306...  A                   Lens sphcyl trifocal     .........  .........  .........  ...........  ...........
                               4.00/>6.
V2307...  A                   Lens sphcy trifocal      .........  .........  .........  ...........  ...........
                               4.25-7/.
V2308...  A                   Lens sphc trifocal 4.25- .........  .........  .........  ...........  ...........
                               7/2.
V2309...  A                   Lens sphc trifocal 4.25- .........  .........  .........  ...........  ...........
                               7/4.

[[Page 47760]]

V2310...  A                   Lens sphc trifocal 4.25- .........  .........  .........  ...........  ...........
                               7/>6.
V2311...  A                   Lens sphc trifo 7.25-12/ .........  .........  .........  ...........  ...........
                               .25-.
V2312...  A                   Lens sphc trifo 7.25-12/ .........  .........  .........  ...........  ...........
                               2.25.
V2313...  A                   Lens sphc trifo 7.25-12/ .........  .........  .........  ...........  ...........
                               4.25.
V2314...  A                   Lens sphcyl trifocal     .........  .........  .........  ...........  ...........
                               over 12.
V2315...  A                   Lens lenticular          .........  .........  .........  ...........  ...........
                               trifocal.
V2316...  A                   Lens lenticular          .........  .........  .........  ...........  ...........
                               nonaspheric.
V2317...  A                   Lens lenticular          .........  .........  .........  ...........  ...........
                               aspheric tri.
V2318...  A                   Lens aniseikonic         .........  .........  .........  ...........  ...........
                               trifocal.
V2319...  A                   Lens trifocal seg width  .........  .........  .........  ...........  ...........
                               > 28.
V2320...  A                   Lens trifocal add over   .........  .........  .........  ...........  ...........
                               3.25d.
V2399...  A                   Lens trifocal            .........  .........  .........  ...........  ...........
                               speciality.
V2410...  A                   Lens variab asphericity  .........  .........  .........  ...........  ...........
                               sing.
V2430...  A                   Lens variable            .........  .........  .........  ...........  ...........
                               asphericity bi.
V2499...  A                   Variable asphericity     .........  .........  .........  ...........  ...........
                               lens.
V2500...  A                   Contact lens pmma        .........  .........  .........  ...........  ...........
                               spherical.
V2501...  A                   Cntct lens pmma-toric/   .........  .........  .........  ...........  ...........
                               prism.
V2502...  A                   Contact lens pmma        .........  .........  .........  ...........  ...........
                               bifocal.
V2503...  A                   Cntct lens pmma color    .........  .........  .........  ...........  ...........
                               vision.
V2510...  A                   Cntct gas permeable      .........  .........  .........  ...........  ...........
                               sphericl.
V2511...  A                   Cntct toric prism        .........  .........  .........  ...........  ...........
                               ballast.
V2512...  A                   Cntct lens gas permbl    .........  .........  .........  ...........  ...........
                               bifocl.
V2513...  A                   Contact lens extended    .........  .........  .........  ...........  ...........
                               wear.
V2520...  A                   Contact lens             .........  .........  .........  ...........  ...........
                               hydrophilic.
V2521...  A                   Cntct lens hydrophilic   .........  .........  .........  ...........  ...........
                               toric.
V2522...  A                   Cntct lens hydrophil     .........  .........  .........  ...........  ...........
                               bifocl.
V2523...  A                   Cntct lens hydrophil     .........  .........  .........  ...........  ...........
                               extend.
V2530...  A                   Contact lens gas         .........  .........  .........  ...........  ...........
                               impermeable.
V2531...  A                   Contact lens gas         .........  .........  .........  ...........  ...........
                               permeable.
V2599...  A                   Contact lens/es other    .........  .........  .........  ...........  ...........
                               type.
V2600...  A                   Hand held low vision     .........  .........  .........  ...........  ...........
                               aids.
V2610...  A                   Single lens spectacle    .........  .........  .........  ...........  ...........
                               mount.
V2615...  A                   Telescop/othr compound   .........  .........  .........  ...........  ...........
                               lens.
V2623...  A                   Plastic eye prosth       .........  .........  .........  ...........  ...........
                               custom.
V2624...  A                   Polishing artifical eye  .........  .........  .........  ...........  ...........
V2625...  A                   Enlargemnt of eye        .........  .........  .........  ...........  ...........
                               prosthesis.
V2626...  A                   Reduction of eye         .........  .........  .........  ...........  ...........
                               prosthesis.
V2627...  A                   Scleral cover shell....  .........  .........  .........  ...........  ...........
V2628...  A                   Fabrication & fitting..  .........  .........  .........  ...........  ...........
V2629...  A                   Prosthetic eye other     .........  .........  .........  ...........  ...........
                               type.
V2630...  N                   Anter chamber intraocul  .........  .........  .........  ...........  ...........
                               lens.
V2631...  N                   Iris support intraoclr   .........  .........  .........  ...........  ...........
                               lens.
V2632...  N                   Post chmbr intraocular   .........  .........  .........  ...........  ...........
                               lens.
V2700...  A                   Balance lens...........  .........  .........  .........  ...........  ...........
V2710...  A                   Glass/plastic slab off   .........  .........  .........  ...........  ...........
                               prism.
V2715...  A                   Prism lens/es..........  .........  .........  .........  ...........  ...........
V2718...  A                   Fresnell prism press-on  .........  .........  .........  ...........  ...........
                               lens.
V2730...  A                   Special base curve.....  .........  .........  .........  ...........  ...........
V2740...  A                   Rose tint plastic......  .........  .........  .........  ...........  ...........
V2741...  A                   Non-rose tint plastic..  .........  .........  .........  ...........  ...........
V2742...  A                   Rose tint glass........  .........  .........  .........  ...........  ...........
V2743...  A                   Non-rose tint glass....  .........  .........  .........  ...........  ...........
V2744...  A                   Tint photochromatic      .........  .........  .........  ...........  ...........
                               lens/es.
V2750...  A                   Anti-reflective coating  .........  .........  .........  ...........  ...........
V2755...  A                   UV lens/es.............  .........  .........  .........  ...........  ...........
V2760...  A                   Scratch resistant        .........  .........  .........  ...........  ...........
                               coating.
V2770...  A                   Occluder lens/es.......  .........  .........  .........  ...........  ...........
V2780...  A                   Oversize lens/es.......  .........  .........  .........  ...........  ...........
V2781...  A                   Progressive lens per     .........  .........  .........  ...........  ...........
                               lens.
V2785...  N                   Corneal tissue           .........  .........  .........  ...........  ...........
                               processing.
V2799...  A                   Miscellaneous vision     .........  .........  .........  ...........  ...........
                               service.
V5008...  E                   Hearing screening......  .........  .........  .........  ...........  ...........
V5010...  E                   Assessment for hearing   .........  .........  .........  ...........  ...........
                               aid.
V5011...  E                   Hearing aid fitting/     .........  .........  .........  ...........  ...........
                               checking.
V5014...  E                   Hearing aid repair/      .........  .........  .........  ...........  ...........
                               modifying.
V5020...  E                   Conformity evaluation..  .........  .........  .........  ...........  ...........
V5030...  E                   Body-worn hearing aid    .........  .........  .........  ...........  ...........
                               air.
V5040...  E                   Body-worn hearing aid    .........  .........  .........  ...........  ...........
                               bone.
V5050...  E                   Body-worn hearing aid    .........  .........  .........  ...........  ...........
                               in ear.
V5060...  E                   Behind ear hearing aid.  .........  .........  .........  ...........  ...........
V5070...  E                   Glasses air conduction.  .........  .........  .........  ...........  ...........
V5080...  E                   Glasses bone conduction  .........  .........  .........  ...........  ...........
V5090...  E                   Hearing aid dispensing   .........  .........  .........  ...........  ...........
                               fee.
V5100...  E                   Body-worn bilat hearing  .........  .........  .........  ...........  ...........
                               aid.
V5110...  E                   Hearing aid dispensing   .........  .........  .........  ...........  ...........
                               fee.

[[Page 47761]]

V5120...  E                   Body-worn binaur         .........  .........  .........  ...........  ...........
                               hearing aid.
V5130...  E                   In ear binaural hearing  .........  .........  .........  ...........  ...........
                               aid.
V5140...  E                   Behind ear binaur        .........  .........  .........  ...........  ...........
                               hearing ai.
V5150...  E                   Glasses binaural         .........  .........  .........  ...........  ...........
                               hearing aid.
V5160...  E                   Dispensing fee binaural  .........  .........  .........  ...........  ...........
V5170...  E                   Within ear cros hearing  .........  .........  .........  ...........  ...........
                               aid.
V5180...  E                   Behind ear cros hearing  .........  .........  .........  ...........  ...........
                               aid.
V5190...  E                   Glasses cros hearing     .........  .........  .........  ...........  ...........
                               aid.
V5200...  E                   Cros hearing aid         .........  .........  .........  ...........  ...........
                               dispens fee.
V5210...  E                   In ear bicros hearing    .........  .........  .........  ...........  ...........
                               aid.
V5220...  E                   Behind ear bicros        .........  .........  .........  ...........  ...........
                               hearing ai.
V5230...  E                   Glasses bicros hearing   .........  .........  .........  ...........  ...........
                               aid.
V5240...  E                   Dispensing fee bicros..  .........  .........  .........  ...........  ...........
V5299...  A                   Hearing service........  .........  .........  .........  ...........  ...........
V5336...  E                   Repair communication     .........  .........  .........  ...........  ...........
                               device.
V5362...  A                   Speech screening.......  .........  .........  .........  ...........  ...........
V5363...  A                   Language screening.....  .........  .........  .........  ...........  ...........
V5364...  A                   Dysphagia screening....  .........  .........  .........  ...........  ...........
----------------------------------------------------------------------------------------------------------------

          

  

  <hbond><hbond><hbond><hbond><hbond><hbond><hbond><hbond><hbond><hbond>
<hbond><hbond>

          

                     Addendum C.--Proposed Hospital Outpatient Payment for Procedures by APC
----------------------------------------------------------------------------------------------------------------
                                                                       Proposed      National         Minimum
 APC   CPT \1\/    HCPCS Description    Status indicator   Relative     payment     unadjusted      unadjusted
         HCPCS                                              weight       rate       coinsurance     coinsurance
----------\2\---------------------------------------------------------------------------------------------------
031..  Dental procedures               S                        1.34      $67.90          $13.58          $13.58
031..     D0150  Comprehensive oral
                  evaluation
031..     D0240  Intraoral occlusal
                  film
031..     D0250  Extraoral first film
031..     D0260  Extraoral ea
                  additional film
031..     D0270  Dental bitewing
                  single film
031..     D0272  Dental bitewings two
                  films
031..     D0274  Dental bitewings
                  four films
031..     D0460  Pulp vitality test
031..     D0471  Diagnostic
                  photographs
031..     D0501  Histopathologic
                  examinations
031..     D0502  Other oral pathology
                  procedure
031..     D0999  Unspecified
                  diagnostic
                  procedure
031..     D1510  Space maintainer fxd
                  unilat
031..     D1515  Fixed bilat space
                  maintainer
031..     D1520  Remove unilat space
                  maintain
031..     D1525  Remove bilat space
                  maintain
031..     D1550  Recement space
                  maintainer
031..     D2970  Temporary- fractured
                  tooth
031..     D2999  Dental unspec
                  restorative pr
031..     D3460  Endodontic
                  endosseous implan
031..     D3999  Endodontic procedure
031..     D4250  Mucogingival surg
                  per quadra
031..     D4260  Osseous surgery per
                  quadrant
031..     D4263  Bone replce graft
                  first site
031..     D4264  Bone replce graft
                  each add
031..     D4270  Pedicle soft tissue
                  graft pr
031..     D4271  Free soft tissue
                  graft proc
031..     D4273  Subepithelial tissue
                  graft
031..     D4355  Full mouth
                  debridement
031..     D4381  Localized chemo
                  delivery
031..     D5911  Facial moulage
                  sectional
031..     D5912  Facial moulage
                  complete
031..     D5983  Radiation applicator
031..     D5984  Radiation shield
031..     D5985  Radiation cone
                  locator
031..     D5987  Commissure splint
031..     D6920  Dental connector bar
031..     D7110  Oral surgery single
                  tooth
031..     D7120  Each add tooth
                  extraction
031..     D7130  Tooth root removal
031..     D7210  Rem imp tooth w
                  mucoper flp
031..     D7220  Impact tooth remov
                  soft tiss
031..     D7230  Impact tooth remov
                  part bony
031..     D7240  Impact tooth remov
                  comp bony
031..     D7241  Impact tooth rem
                  bony w/comp
031..     D7250  Tooth root removal
031..     D7260  Oral antral fistula
                  closure
031..     D7291  Transseptal
                  fiberotomy

[[Page 47762]]

031..     D7940  Reshaping bone
                  orthognathic
031..     D9630  Other drugs/
                  medicaments
031..     D9930  Treatment of
                  complications
031..     D9940  Dental occlusal
                  guard
031..     D9950  Occlusion analysis
031..     D9951  Limited occlusal
                  adjustment
031..     D9952  Complete occlusal
                  adjustment
031..     K0445  Auricular prosthesis
061..  Level I Chemotherapeutic        X                        1.04      $52.70          $36.61          $10.54
       agents
061..     J8610  Methotrexate oral
                  2.5 MG
061..     J8999  Oral prescription
                  drug chemo
061..     J9015  Aldesleukin/single
                  use vial
061..     J9070  Cyclophosphamide 100
                  MG inj
061..     J9080  Cyclophosphamide 200
                  MG inj
061..     J9090  Cyclophosphamide 500
                  MG inj
061..     J9093  Cyclophosphamide
                  lyophilized
061..     J9094  Cyclophosphamide
                  lyophilized
061..     J9095  Cyclophosphamide
                  lyophilized
061..     J9100  Cytarabine hcl 100
                  MG inj
061..     J9110  Cytarabine hcl 500
                  MG inj
061..     J9120  Dactinomycin
                  actinomycin d
061..     J9130  Dacarbazine 10 MG
                  inj
061..     J9140  Dacarbazine 200 MG
                  inj
061..     J9165  Diethylstilbestrol
                  injection
061..     J9170  Docetaxel
061..     J9181  Etoposide 10 MG inj
061..     J9190  Fluorouracil
                  injection
061..     J9201  Gemcitabine HCl
061..     J9206  Irinotecan injection
061..     J9214  Interferon alfa-2b
                  inj
061..     J9215  Interferon alfa-n3
                  inj
061..     J9218  Leuprolide acetate
                  injection
061..     J9230  Mechlorethamine hcl
                  inj
061..     J9250  Methotrexate sodium
                  inj
061..     J9260  Methotrexate sodium
                  inj
061..     J9266  Pegaspargase/singl
                  dose vial
061..     J9350  Topotecan
061..     J9360  Vinblastine sulfate
                  inj
061..     J9390  Vinorelbine tartrate/
                  10 mg
061..     J9600  Porfimer sodium
061..     J9999  Chemotherapy drug
062..  Level II Chemotherapeutic       X                        1.69      $85.63          $36.61          $17.13
       agents
062..     J9000  Doxorubic hcl 10 MG
                  vl chemo
062..     J9020  Asparaginase
                  injection
062..     J9060  Cisplatin 10 MG
                  injection
062..     J9065  Inj cladribine per 1
                  MG
062..     J9091  Cyclophosphamide 1.0
                  grm inj
062..     J9092  Cyclophosphamide 2.0
                  grm inj
062..     J9096  Cyclophosphamide
                  lyophilized
062..     J9097  Cyclophosphamide
                  lyophilized
062..     J9150  Daunorubicin
062..     J9211  Idarubicin hcl
                  injection
062..     J9213  Interferon alfa-2a
                  inj
062..     J9265  Paclitaxel injection
062..     J9268  Pentostatin
                  injection
062..     J9370  Vincristine sulfate
                  1 MG inj
063..  Level III Chemotherapeutic      X                        2.89     $146.43         $110.97          $29.29
       agents
063..     J9031  Bcg live
                  intravesical vac
063..     J9040  Bleomycin sulfate
                  injection
063..     J9045  Carboplatin
                  injection
063..     J9050  Carmus bischl nitro
                  inj
063..     J9062  Cisplatin 50 MG
                  injection
063..     J9182  Etoposide 100 MG inj
063..     J9185  Fludarabine
                  phosphate inj
063..     J9200  Floxuridine
                  injection
063..     J9202  Goserelin acetate
                  implant
063..     J9208  Ifosfomide injection
063..     J9209  Mesna injection
063..     J9216  Interferon gamma 1-b
                  inj
063..     J9270  Plicamycin
                  (mithramycin) inj
063..     J9280  Mitomycin 5 MG inj
063..     J9320  Streptozocin
                  injection
063..     J9340  Thiotepa injection
063..     J9375  Vincristine sulfate
                  2 MG inj

[[Page 47763]]

063..     J9380  Vincristine sulfate
                  5 MG inj
064..  Level IV Chemotherapeutic       X                        4.17     $211.29         $140.12          $42.26
       agents
064..     J0640  Leucovorin calcium
                  injection
064..     J9217  Leuprolide acetate
                  suspnsion
064..     J9245  Inj melphalan
                  hydrochl 50 MG
064..     J9290  Mitomycin 20 MG inj
064..     J9291  Mitomycin 40 MG inj
064..     J9293  Mitoxantrone
                  hydrochl / 5 MG
089..  Neuropsychological Testing      X                        2.54      $128.7          $37.29          $25.74
089..     96100  PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF PERSONALITY, PSYCHOPATHOLOGY,
                  EMOTIONALITY, INTELLECTUAL ABILITIES, EG, WAIS-R, RORSCHACH, MMPI) WITH INTERPRETATION AND
                  REPORT, PER HOUR
089..     96105  ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE
                  FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG,
                  BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPORT
089..     96110  DEVELOPMENTAL TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY LANGUAGE MILESTONE
                  SCREEN), WITH INTERPRETATION AND REPORT
089..     96111  DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, ADAPTIVE AND/
                  OR COGNITIVE FUNCTIONING BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS, EG, BAYLEY SCALES OF
                  INFANT DEVELOPMENT) WITH INTERPRETATION AND REPORT, PER HOUR
089..     96115  NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDGMENT, EG,
                  ACQUIRED KNOWLEDGE, ATTENTION, MEMORY, VISUAL SPATIAL ABILITIES, LANGUAGE FUNCTIONS, PLANNING)
                  WITH INTERPRETATION AND REPORT, PER HOUR
089..     96117  NEUROPSYCHOLOGICAL TESTING BATTERY (EG, HALSTEAD-REITAN, LURIA, WAIS-R) WITH INTERPRETATION AND
                  REPORT, PER HOUR
090..  Monitoring psychiatric drugs    X                        0.85      $43.07          $12.43           $8.61
090..     90862  PHARMACOLOGIC MANAGEMENT, INCLUDING PRESCRIPTION, USE, AND REVIEW OF MEDICATION WITH NO MORE
                  THAN MINIMAL MEDICAL PSYCHOTHERAPY
090..     M0064  Visit for drug monitoring
091..  Brief Individual Psychotherapy  S                        1.09      $55.23          $14.01          $11.05
091..     90804  INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE
                  OR OUTPATIENT FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT;
091..     90805  INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE
                  OR OUTPATIENT FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH
                  MEDICAL EVALUATION AND MANAGEMENT SERVICES
091..     90810  INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE
                  INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT
                  FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT;
091..     90811  INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE
                  INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT
                  FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH M
091..     90899  UNLISTED PSYCHIATRIC SERVICE OR PROCEDURE
092..  Extended Individual             S                        1.57      $79.55          $21.92          $15.91
       Psychotherapy
092..     90801  PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION
092..     90802  INTERACTIVE PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION USING PLAY EQUIPMENT, PHYSICAL
                  DEVICES, LANGUAGE INTERPRETER, OR OTHER MECHANISMS OF COMMUNICATION
092..     90806  INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE
                  OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT;
092..     90807  INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE
                  OR OUTPATIENT FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH
                  MEDICAL EVALUATION AND MANAGEMENT SERVICES
092..     90808  INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE
                  OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT;
092..     90809  INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE
                  OR OUTPATIENT FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH
                  MEDICAL EVALUATION AND MANAGEMENT SERVICES
092..     90812  INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE
                  INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT
                  FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT;
092..     90813  INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE
                  INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT
                  FACILITY, APPROXIMATELY 45 TO 50 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH M
092..     90814  INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE
                  INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT
                  FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT;
092..     90815  INDIVIDUAL PSYCHOTHERAPY, INTERACTIVE, USING PLAY EQUIPMENT, PHYSICAL DEVICES, LANGUAGE
                  INTERPRETER, OR OTHER MECHANISMS OF NON-VERBAL COMMUNICATION, IN AN OFFICE OR OUTPATIENT
                  FACILITY, APPROXIMATELY 75 TO 80 MINUTES FACE-TO-FACE WITH THE PATIENT; WITH M
092..     90845  PSYCHOANALYSIS
092..     90865  NARCOSYNTHESIS FOR PSYCHIATRIC DIAGNOSTIC AND THERAPEUTIC PURPOSES (EG, SODIUM AMOBARBITAL
                  (AMYTAL) INTERVIEW
092..     90880  HYPNOTHERAPY
093..  Family Psychotherapy
                                       S                        1.54      $78.03          $20.11          $15.61

[[Page 47764]]

093..     90846  FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT)
093..     90847  FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT)
094..  Group Psychotherapy             S                        1.24      $62.83          $20.11          $12.57
094..     90849  MULTIPLE-FAMILY GROUP PSYCHOTHERAPY
094..     90853  GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)
094..     90857  INTERACTIVE GROUP PSYCHOTHERAPY
121..  Level I needle biopsy/          T                        0.67      $33.95          $20.91           $6.79
       aspiration
121..     17999  UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
121..     19000  PUNCTURE ASPIRATION OF CYST OF BREAST;
121..     19001  PUNCTURE ASPIRATION OF CYST OF BREAST; EACH ADDITIONAL CYST
121..     20615  ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST
121..     55000  PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF MEDICATION
121..     60001  ASPIRATION AND/OR INJECTION, THYROID CYST
121..     60699  UNLISTED PROCEDURE, ENDOCRINE SYSTEM
121..     85095  BONE MARROW; ASPIRATION ONLY
121..     85102  BONE MARROW BIOPSY, NEEDLE OR TROCAR
121..     88170  FINE NEEDLE ASPIRATION WITH OR WITHOUT PREPARATION OF SMEARS; SUPERFICIAL TISSUE (EG, THYROID,
                  BREAST, PROSTATE
121..     88171  FINE NEEDLE ASPIRATION WITH OR WITHOUT PREPARATION OF SMEARS; DEEP TISSUE UNDER RADIOLOGIC
                  GUIDANCE
122..  Level II needle biopsy/         T                        4.87     $246.76         $115.03          $49.35
       aspiration
122..     19100  BIOPSY OF BREAST; NEEDLE CORE (SEPARATE PROCEDURE)
122..     20206  BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
122..     32400  BIOPSY, PLEURA; PERCUTANEOUS NEEDLE
122..     32405  BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE
122..     38505  BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY)
122..     42400  BIOPSY OF SALIVARY GLAND; NEEDLE
122..     47000  BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS
122..     47399  UNLISTED PROCEDURE, LIVER
122..     48102  BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE
122..     48999  UNLISTED PROCEDURE, PANCREAS
122..     49180  BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUS NEEDLE
122..     50200  RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE
122..     50390  ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS
122..     54500  BIOPSY OF TESTIS, NEEDLE (SEPARATE PROCEDURE)
122..     54800  BIOPSY OF EPIDIDYMIS, NEEDLE
122..     60100  BIOPSY THYROID, PERCUTANEOUS CORE NEEDLE
122..     62269  BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE
122..     67415  FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS
131..  Level I incision & drainage     T                        1.94      $98.30          $36.61          $19.66
131..     10040  ACNE SURGERY (EG, MARSUPIALIZATION, OPENING OR REMOVAL OF MULTIPLE MILIA, COMEDONES, CYSTS,
                  PUSTULES)
131..     10060  INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR
                  SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE
131..     10061  INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR
                  SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE
131..     10080  INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE
131..     10081  INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED
131..     10120  INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE
131..     10140  INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION
131..     10160  PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
131..     10180  INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION
131..     11976  REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
131..     20000  INCISION OF SOFT TISSUE ABSCESS (EG, SECONDARY TO OSTEOMYELITIS); SUPERFICIAL
131..     26010  DRAINAGE OF FINGER ABSCESS; SIMPLE
131..     26011  DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
131..     69000  DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE
131..     69005  DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED
131..     69020  DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
132..  Level II incision & drainage    T                        6.04     $306.04         $134.13          $61.21
132..     19020  MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
132..     20950  MONITORING OF INTERSTITIAL FLUID PRESSURE (INCLUDES INSERTION OF DEVICE, EG, WICK CATHETER
                  TECHNIQUE, NEEDLE MANOMETER TECHNIQUE) IN DETECTION OF MUSCLE COMPARTMENT SYNDROME
132..     21501  INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;
132..     21700  DIVISION OF SCALENUS ANTICUS; WITHOUT RESECTION OF CERVICAL RIB
132..     21720  DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITHOUT CAST APPLICATION
132..     21725  DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITH CAST APPLICATION
132..     23030  INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA
132..     23031  INCISION AND DRAINAGE, SHOULDER AREA; INFECTED BURSA
132..     23930  INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
132..     23931  INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; INFECTED BURSA
132..     27301  INCISION AND DRAINAGE OF DEEP ABSCESS, INFECTED BURSA, OR HEMATOMA, THIGH OR KNEE REGION
132..     27603  INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA
132..     28001  INCISION AND DRAINAGE, INFECTED BURSA, FOOT
132..     38300  DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE

[[Page 47765]]

132..     38305  DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; EXTENSIVE
132..     38999  UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM
132..     51080  DRAINAGE OF PERIVESICAL OR PREVESICAL SPACE ABSCESS
132..     54015  INCISION AND DRAINAGE OF PENIS, DEEP
132..     54115  REMOVAL FOREIGN BODY FROM DEEP PENILE TISSUE (EG, PLASTIC IMPLANT)
132..     55100  DRAINAGE OF SCROTAL WALL ABSCESS
137..  Nail procedures                 T                        0.46      $23.31           $4.66           $4.66
137..     11719  TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
137..     11720  DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE
137..     11721  DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE
137..     11740  EVACUATION OF SUBUNGUAL HEMATOMA
137..     11755  BIOPSY OF NAIL UNIT, ANY METHOD (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL NAIL
                  FOLDS) (SEPARATE PROCEDURE)
141..  Level I Destruction of lesion   T                        0.59      $29.90           $9.49           $5.98
141..     17000  DESTRUCTION BY ANY METHOD, INCLUDING LASER, WITH OR WITHOUT SURGICAL CURETTEMENT, ALL BENIGN OR
                  PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES) OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR
                  PROLIFERATIVE LESIONS, INCLUDING LOCAL ANESTHESIA; FIRST LESION
141..     17003  DESTRUCTION BY ANY METHOD, INCLUDING LASER, WITH OR WITHOUT SURGICAL CURETTEMENT, ALL BENIGN OR
                  PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES) OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR
                  PROLIFERATIVE LESIONS, INCLUDING LOCAL ANESTHESIA; SECOND THROUGH 14 LE
141..     17106  DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ
                  CM
141..     17110  DESTRUCTION BY ANY METHOD OF FLAT WARTS, MOLLUSCUM CONTAGIOSUM, OR MILIA; UP TO 14 LESIONS
142..  Level II Destruction of lesion  T                        3.77     $191.02          $73.00          $38.20
142..     17004  DESTRUCTION BY ANY METHOD, INCLUDING LASER, WITH OR WITHOUT SURGICAL CURETTEMENT, ALL BENIGN OR
                  PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES) OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR
                  PROLIFERATIVE LESIONS, INCLUDING LOCAL ANESTHESIA; 15 OR MORE LESIONS
142..     17107  DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); 10.0-50.0 SQ CM
142..     17108  DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); OVER 50.0 SQ CM
142..     17111  DESTRUCTION BY ANY METHOD OF FLAT WARTS, MOLLUSCUM CONTAGIOSUM, OR MILIA; 15 OR MORE LESIONS
151..  Level I debridement/            T                        1.74      $88.16          $35.71          $17.63
       destruction
151..     11000  DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
151..     11001  DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE
151..     11040  DEBRIDEMENT; SKIN, PARTIAL THICKNESS
151..     11041  DEBRIDEMENT; SKIN, FULL THICKNESS
151..     11042  DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE
151..     11055  PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION
151..     11056  PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); TWO TO FOUR LESIONS
151..     11057  PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE THAN FOUR LESIONS
151..     11200  REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
151..     11201  REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL TEN LESIONS
151..     11300  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5
                  CM OR LESS
151..     11301  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6
                  TO 1.0 CM
151..     11302  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1
                  TO 2.0 CM
151..     11303  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER
                  2.0 CM
151..     11305  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA;
                  LESION DIAMETER 0.5 CM OR LESS
151..     11306  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA;
                  LESION DIAMETER 0.6 TO 1.0 CM
151..     11307  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA;
                  LESION DIAMETER 1.1 TO 2.0 CM
151..     11308  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA;
                  LESION DIAMETER OVER 2.0 CM
151..     11310  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS
                  MEMBRANE; LESION DIAMETER 0.5 CM OR LESS
151..     11311  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS
                  MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
151..     11312  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS
                  MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM
151..     11313  SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS
                  MEMBRANE; LESION DIAMETER OVER 2.0 CM
151..     11730  AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
151..     11731  AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SECOND NAIL PLATE
151..     11732  AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE
151..     11765  WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN TOENAIL)
151..     11900  INJECTION, INTRALESIONAL; UP TO AND INCLUDING SEVEN LESIONS
151..     11901  INJECTION, INTRALESIONAL; MORE THAN SEVEN LESIONS
151..     15783  DERMABRASION; SUPERFICIAL, ANY SITE, (EG, TATTOO REMOVAL)
151..     15786  ABRASION; SINGLE LESION (EG, KERATOSIS, SCAR)
151..     15787  ABRASION; EACH ADDITIONAL FOUR LESIONS OR LESS
151..     15788  CHEMICAL PEEL, FACIAL; EPIDERMAL
151..     15789  CHEMICAL PEEL, FACIAL; DERMAL
151..     15792  CHEMICAL PEEL, NONFACIAL; EPIDERMAL
151..     15793  CHEMICAL PEEL, NONFACIAL; DERMAL

[[Page 47766]]

151..     15810  SALABRASION; 20 SQ CM OR LESS
151..     15850  REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), SAME SURGEON
151..     15851  REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), OTHER SURGEON
151..     15852  DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA (OTHER THAN LOCAL)
151..     16000  INITIAL TREATMENT, FIRST DEGREE BURN, WHEN NO MORE THAN LOCAL TREATMENT IS REQUIRED
151..     16020  DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, OFFICE OR HOSPITAL,
                  SMALL
151..     16025  DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, MEDIUM (EG, WHOLE FACE
                  OR WHOLE EXTREMITY)
151..     16030  DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, LARGE (EG, MORE THAN
                  ONE EXTREMITY)
151..     17250  CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH, SINUS OR FISTULA)
151..     17260  DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS
151..     17261  DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM
151..     17262  DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM
151..     17263  DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR LEGS; LESION DIAMETER 2.1 TO 3.0 CM
151..     17264  DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR LEGS; LESION DIAMETER 3.1 TO 4.0 CM
151..     17266  DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 4.0 CM
151..     17270  DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER
                  0.5 CM OR LESS
151..     17271  DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER
                  0.6 TO 1.0 CM
151..     17272  DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER
                  1.1 TO 2.0 CM
151..     17273  DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER
                  2.1 TO 3.0 CM
151..     17274  DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER
                  3.1 TO 4.0 CM
151..     17276  DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER
                  OVER 4.0 CM
151..     17280  DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;
                  LESION DIAMETER 0.5 CM OR LESS
151..     17281  DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;
                  LESION DIAMETER 0.6 TO 1.0 CM
151..     17282  DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;
                  LESION DIAMETER 1.1 TO 2.0 CM
151..     17283  DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;
                  LESION DIAMETER 2.1 TO 3.0 CM
151..     17284  DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;
                  LESION DIAMETER 3.1 TO 4.0 CM
151..     17286  DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;
                  LESION DIAMETER OVER 4.0 CM
151..     17340  CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE
151..     17360  CHEMICAL EXFOLIATION FOR ACNE (EG, ACNE PASTE, ACID)
151..     17380  ELECTROLYSIS EPILATION, EACH 1/2 HOUR
151..     42809  REMOVAL OF FOREIGN BODY FROM PHARYNX
151..     69220  DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINE CLEANING)
152..  Level II debridement/           T                       10.43     $528.48         $261.71          $105.7
       destruction
152..     16010  DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; UNDER ANESTHESIA, SMALL
152..     16015  DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; UNDER ANESTHESIA, MEDIUM OR LARGE, OR WITH
                  MAJOR DEBRIDEMENT
152..     46900  DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; CHEMICAL
152..     46910  DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; ELECTRODESICCATION
152..     46916  DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; CRYOSURGERY
152..     46917  DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; LASER SURGERY
152..     46922  DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; SURGICAL EXCISION
152..     46924  DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), EXTENSIVE, ANY METHOD
152..     54050  DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; CHEMICAL
152..     54055  DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; ELECTRODESICCATION
152..     54056  DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; CRYOSURGERY
152..     54057  DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; LASER SURGERY
152..     54060  DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), SIMPLE; SURGICAL EXCISION
152..     54065  DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC
                  VESICLE), EXTENSIVE, ANY METHOD
152..     56501  DESTRUCTION OF LESION(S), VULVA; SIMPLE, ANY METHOD
152..     56515  DESTRUCTION OF LESION(S), VULVA; EXTENSIVE, ANY METHOD
161..  Level I excision/biopsy         T                        3.50     $177.34          $75.48          $35.47
161..     11100  BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS
                  OTHERWISE LISTED (SEPARATE PROCEDURE); SINGLE LESION
161..     11101  BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS
                  OTHERWISE LISTED (SEPARATE PROCEDURE); EACH SEPARATE/ADDITIONAL LESION

[[Page 47767]]

161..     11400  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION
                  DIAMETER 0.5 CM OR LESS
161..     11401  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION
                  DIAMETER 0.6 TO 1.0 CM
161..     11402  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION
                  DIAMETER 1.1 TO 2.0 CM
161..     11403  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION
                  DIAMETER 2.1 TO 3.0 CM
161..     11420  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET,
                  GENITALIA; LESION DIAMETER 0.5 CM OR LESS
161..     11421  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET,
                  GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM
161..     11422  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET,
                  GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM
161..     11423  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET,
                  GENITALIA; LESION DIAMETER 2.1 TO 3.0 CM
161..     11440  EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS,
                  MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS
161..     11441  EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS,
                  MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
161..     11442  EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS,
                  MUCOUS MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM
161..     11443  EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS,
                  MUCOUS MEMBRANE; LESION DIAMETER 2.1 TO 3.0 CM
161..     11600  EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER 0.5 CM OR LESS
161..     11601  EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM
161..     11602  EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM
161..     11603  EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER 2.1 TO 3.0 CM
161..     11620  EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS
161..     11621  EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM
161..     11622  EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM
161..     11623  EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 2.1 TO 3.0 CM
161..     11640  EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER 0.5 CM OR LESS
161..     11641  EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER 0.6 TO 1.0 CM
161..     11642  EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER 1.1 TO 2.0 CM
161..     11643  EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER 2.1 TO 3.0 CM
161..     11750  EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR
                  PERMANENT REMOVAL;
161..     20520  REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE
161..     21550  BIOPSY, SOFT TISSUE OF NECK OR THORAX
161..     21920  BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL
161..     23065  BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL
161..     24065  BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUPERFICIAL
161..     24200  REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS
161..     25065  BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; SUPERFICIAL
161..     27613  BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; SUPERFICIAL
161..     28190  REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
161..     56605  BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); ONE LESION
161..     56606  BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION
161..     58999  UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)
161..     69100  BIOPSY EXTERNAL EAR
161..     69105  BIOPSY EXTERNAL AUDITORY CANAL
162..  Level II excision/biopsy        T                        5.67     $287.30         $125.43          $57.46
162..     11043  DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE
162..     11044  DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE
162..     11404  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION
                  DIAMETER 3.1 TO 4.0 CM
162..     11424  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET,
                  GENITALIA; LESION DIAMETER 3.1 TO 4.0 CM
162..     11444  EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS,
                  MUCOUS MEMBRANE; LESION DIAMETER 3.1 TO 4.0 CM
162..     11604  EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER 3.1 TO 4.0 CM
162..     11770  EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
162..     16035  ESCHAROTOMY
162..     16040  EXCISION BURN WOUND, WITHOUT SKIN GRAFTING, EMPLOYING ALLOPLASTIC DRESSING (EG, SYNTHETIC
                  MESH), ANY ANATOMIC SITE; UP TO ONE PERCENT TOTAL BODY SURFACE AREA
162..     16041  EXCISION BURN WOUND, WITHOUT SKIN GRAFTING, EMPLOYING ALLOPLASTIC DRESSING (EG, SYNTHETIC
                  MESH), ANY ANATOMIC SITE; GREATER THAN ONE PERCENT AND UP TO NINE PERCENT TOTAL BODY SURFACE
                  AREA
162..     16042  EXCISION BURN WOUND, WITHOUT SKIN GRAFTING, EMPLOYING ALLOPLASTIC DRESSING (EG, SYNTHETIC
                  MESH), ANY ANATOMIC SITE; EACH ADDITIONAL NINE PERCENT TOTAL BODY SURFACE AREA, OR PART
                  THEREOF
162..     17304  CHEMOSURGERY (MOHS` MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL
                  EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF
                  SPECIMENS BY THE SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; FI
162..     17305  CHEMOSURGERY (MOHS` MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL
                  EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF
                  SPECIMENS BY THE SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; SE

[[Page 47768]]

162..     17306  CHEMOSURGERY (MOHS` MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL
                  EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF
                  SPECIMENS BY THE SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; TH
162..     17307  CHEMOSURGERY (MOHS` MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL
                  EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF
                  SPECIMENS BY THE SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; AD
162..     17310  CHEMOSURGERY (MOHS` MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL
                  EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF
                  SPECIMENS BY THE SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; MO
162..     20200  BIOPSY, MUSCLE; SUPERFICIAL
162..     20205  BIOPSY, MUSCLE; DEEP
162..     20220  BIOPSY, BONE, TROCAR, OR NEEDLE; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS)
162..     20225  BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (VERTEBRAL BODY, FEMUR)
162..     20670  REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
162..     23000  REMOVAL OF SUBDELTOID (OR INTRATENDINOUS) CALCAREOUS DEPOSITS, OPEN METHOD
162..     23075  EXCISION, TUMOR, SHOULDER AREA; SUBCUTANEOUS
162..     24075  EXCISION, TUMOR, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS
162..     25075  EXCISION, TUMOR, FOREARM AND/OR WRIST AREA; SUBCUTANEOUS
162..     27040  BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL
162..     27323  BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL
162..     28043  EXCISION, TUMOR, FOOT; SUBCUTANEOUS
162..     37609  LIGATION OR BIOPSY, TEMPORAL ARTERY
162..     37799  UNLISTED PROCEDURE, VASCULAR SURGERY
162..     54100  BIOPSY OF PENIS; CUTANEOUS (SEPARATE PROCEDURE)
162..     54105  BIOPSY OF PENIS; DEEP STRUCTURES
162..     67350  BIOPSY OF EXTRAOCULAR MUSCLE
162..     67399  UNLISTED PROCEDURE, OCULAR MUSCLE
162..     68100  BIOPSY OF CONJUNCTIVA
162..     68110  EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM
162..     68115  EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM
162..     68135  DESTRUCTION OF LESION, CONJUNCTIVA
162..     68399  UNLISTED PROCEDURE, CONJUNCTIVA
163..  Level III excision/biopsy       T                       10.69     $541.66         $264.65         $108.33
163..     10121  INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED
163..     11010  DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR
                  DISLOCATION(S); SKIN AND SUBCUTANEOUS TISSUES
163..     11011  DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR
                  DISLOCATION(S); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE
163..     11012  DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR
                  DISLOCATION(S); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE
163..     11406  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION
                  DIAMETER OVER
163..     11426  EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET,
                  GENITALIA; LESION DIAMETER OVER 4.0 CM
163..     11446  EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS,
                  MUCOUS MEMBRANE; LESION DIAMETER OVER 4.0 CM
163..     11450  EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR
                  INTERMEDIATE REPAIR
163..     11451  EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH COMPLEX REPAIR
163..     11462  EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH SIMPLE OR
                  INTERMEDIATE REPAIR
163..     11463  EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH COMPLEX REPAIR
163..     11470  EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL;
                  WITH SIMPLE OR INTERMEDIATE REPAIR
163..     11471  EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL;
                  WITH COMPLEX REPAIR
163..     11606  EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER OVER 4.0 CM
163..     11624  EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 3.1 TO 4.0 CM
163..     11626  EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 4.0 CM
163..     11644  EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER 3.1 TO 4.0 CM
163..     11646  EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER OVER 4.0 CM
163..     11752  EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR
                  PERMANENT REMOVAL; WITH AMPUTATION OF TUFT OF DISTAL PHALANX
163..     11771  EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
163..     11772  EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED
163..     11971  REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION OF PROSTHESIS
163..     15780  DERMABRASION; TOTAL FACE (EG, FOR ACNE SCARRING, FINE WRINKLING, RHYTIDS, GENERAL KERATOSIS)
163..     15781  DERMABRASION; SEGMENTAL, FACE
163..     15782  DERMABRASION; REGIONAL, OTHER THAN FACE
163..     15811  SALABRASION; OVER 20 SQ CM
163..     15838  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); SUBMENTAL FAT PAD
163..     15920  EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH PRIMARY SUTURE
163..     15931  EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE;
163..     15933  EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
163..     15940  EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE;
163..     15941  EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY (ISCHIECTOMY)
163..     15950  EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE;
163..     15951  EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY
163..     15999  UNLISTED PROCEDURE, EXCISION PRESSURE ULCER

[[Page 47769]]

163..     20240  BIOPSY, EXCISIONAL; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS, TROCHANTER OF
                  FEMUR)
163..     20245  BIOPSY, EXCISIONAL; DEEP (EG, HUMERUS, ISCHIUM, FEMUR)
163..     20525  REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
163..     20680  REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
163..     21555  EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; SUBCUTANEOUS
163..     21556  EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; DEEP, SUBFASCIAL, INTRAMUSCULAR
163..     21925  BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP
163..     21930  EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK
163..     21935  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLANK
163..     22900  EXCISION, ABDOMINAL WALL TUMOR, SUBFASCIAL (EG, DESMOID)
163..     22999  UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
163..     23066  BIOPSY, SOFT TISSUE OF SHOULDER AREA; DEEP
163..     23076  EXCISION, TUMOR, SHOULDER AREA; DEEP, SUBFASCIAL, OR INTRAMUSCULAR
163..     23077  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF SHOULDER AREA
163..     23330  REMOVAL OF FOREIGN BODY, SHOULDER; SUBCUTANEOUS
163..     23331  REMOVAL OF FOREIGN BODY, SHOULDER; DEEP (EG, NEER PROSTHESIS REMOVAL)
163..     24066  BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP
163..     24076  EXCISION, TUMOR, UPPER ARM OR ELBOW AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR
163..     24077  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR ELBOW AREA
163..     24201  REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP
163..     25066  BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; DEEP
163..     25076  EXCISION, TUMOR, FOREARM AND/OR WRIST AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR
163..     25077  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/OR WRIST AREA
163..     26115  EXCISION, TUMOR OR VASCULAR MALFORMATION, HAND OR FINGER; SUBCUTANEOUS
163..     26116  EXCISION, TUMOR OR VASCULAR MALFORMATION, HAND OR FINGER; DEEP, SUBFASCIAL, INTRAMUSCULAR
163..     26117  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER
163..     26320  REMOVAL OF IMPLANT FROM FINGER OR HAND
163..     27041  BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; DEEP
163..     27047  EXCISION, TUMOR, PELVIS AND HIP AREA; SUBCUTANEOUS
163..     27048  EXCISION, TUMOR, PELVIS AND HIP AREA; DEEP, SUBFASCIAL, INTRAMUSCULAR
163..     27049  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF PELVIS AND HIP AREA
163..     27324  BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; DEEP
163..     27327  EXCISION, TUMOR, THIGH OR KNEE AREA; SUBCUTANEOUS
163..     27328  EXCISION, TUMOR, THIGH OR KNEE AREA; DEEP, SUBFASCIAL, OR INTRAMUSCULAR
163..     27329  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF THIGH OR KNEE AREA
163..     27372  REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
163..     27614  BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP
163..     27618  EXCISION, TUMOR, LEG OR ANKLE AREA; SUBCUTANEOUS
163..     27619  EXCISION, TUMOR, LEG OR ANKLE AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR
163..     28192  REMOVAL OF FOREIGN BODY, FOOT; DEEP
163..     28193  REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED
163..     69110  EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR
163..     69145  EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL
163..     69205  REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
181..  Level I skin repair             T                        2.19     $110.97          $43.84          $22.19
181..     11760  REPAIR OF NAIL BED
181..     11762  RECONSTRUCTION OF NAIL BED WITH GRAFT
181..     11920  TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS OF
                  SKIN, INCLUDING MICROPIGMENTATION; 6.0 SQ CM OR LESS
181..     11921  TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS OF
                  SKIN, INCLUDING MICROPIGMENTATION; 6.1 TO 20.0 SQ CM
181..     11922  TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS OF
                  SKIN, INCLUDING MICROPIGMENTATION; EACH ADDITIONAL 20.0 SQ CM
181..     11950  SUBCUTANEOUS INJECTION OF ''FILLING'' MATERIAL (EG, COLLAGEN); 1 CC OR LESS
181..     11951  SUBCUTANEOUS INJECTION OF ''FILLING'' MATERIAL (EG, COLLAGEN); 1.1 TO 5.0 CC
181..     11952  SUBCUTANEOUS INJECTION OF ''FILLING'' MATERIAL (EG, COLLAGEN); 5.1 TO 10.0 CC
181..     11954  SUBCUTANEOUS INJECTION OF ''FILLING'' MATERIAL (EG, COLLAGEN); OVER 10.0 CC
181..     12001  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR
                  EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS
181..     12002  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR
                  EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
181..     12004  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR
                  EXTREMITIES (INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
181..     12005  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR
                  EXTREMITIES (INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
181..     12006  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR
                  EXTREMITIES (INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM
181..     12007  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR
                  EXTREMITIES (INCLUDING HANDS AND FEET); OVER 30.0 CM
181..     12011  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
                  2.5 CM OR LESS
181..     12013  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
                  2.6 CM TO 5.0 CM
181..     12014  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
                  5.1 CM TO 7.5 CM
181..     12015  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
                  7.6 CM TO 12.5 CM
181..     12016  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
                  12.6 CM TO 20.0 CM

[[Page 47770]]

181..     12017  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
                  20.1 CM TO 30.0 CM
181..     12018  SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES;
                  OVER 30.0 CM
181..     12020  TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
181..     12021  TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING
181..     12031  LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET);
                  2.5 CM OR LESS
181..     12032  LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET);
                  2.6 CM TO 7.5 CM
181..     12034  LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET);
                  7.6 CM TO 12.5 CM
181..     12035  LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET);
                  12.6 CM TO 20.0 CM
181..     12036  LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET);
                  20.1 CM TO 30.0 CM
181..     12041  LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS
181..     12042  LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM
181..     12044  LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 7.6 CM TO 12.5 CM
181..     12045  LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 12.6 CM TO 20.0 CM
181..     12046  LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 20.1 CM TO 30.0 CM
181..     12051  LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR
                  LESS
181..     12052  LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO
                  5.0 CM
181..     12053  LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO
                  7.5 CM
181..     12054  LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO
                  12.5 CM
181..     12055  LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 12.6 CM TO
                  20.0 CM
181..     12056  LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 20.1 CM TO
                  30.0 CM
181..     20500  INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE PROCEDURE)
182..  Level II skin repair            T                          4.     $202.68          $84.98          $40.54
182..     13100  REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM
182..     13101  REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
182..     13120  REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM
182..     13121  REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM
182..     13131  REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET;
                  1.1 CM TO 2.5 CM
182..     13132  REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET;
                  2.6 CM TO 7.5 CM
182..     13150  REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.0 CM OR LESS
182..     13151  REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM
182..     13152  REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM
182..     13160  SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED
182..     13300  REPAIR, UNUSUAL, COMPLICATED, OVER 7.5 CM, ANY AREA
182..     43870  CLOSURE OF GASTROSTOMY, SURGICAL
183..  Level III skin repair           T                       11.17     $565.98         $286.46         $113.20
183..     11960  INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN BREAST, INCLUDING SUBSEQUENT EXPANSION
183..     11970  REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS
183..     12037  LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET);
                  OVER 30.0 CM
183..     12047  LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; OVER 30.0 CM
183..     12057  LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; OVER 30.0
                  CM
183..     14000  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
183..     14001  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
183..     14020  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/ OR LEGS; DEFECT 10 SQ CM OR LESS
183..     14021  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/ OR LEGS; DEFECT 10.1 SQ CM TO 30.0
                  SQ CM
183..     14040  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE,
                  GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
183..     14041  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE,
                  GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM
183..     14060  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR
                  LESS
183..     14061  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM
                  TO 30.0 SQ CM
183..     14300  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, MORE THAN 30 SQ CM, UNUSUAL OR COMPLICATED, ANY AREA
183..     14350  FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATION OF RECIPIENT SITE
183..     15000  EXCISIONAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF ESSENTIALLY INTACT SKIN
                  (INCLUDING SUBCUTANEOUS TISSUES), SCAR, OR OTHER LESION PRIOR TO REPAIR WITH FREE SKIN GRAFT
                  (LIST AS SEPARATE SERVICE IN ADDITION TO SKIN GRAFT)
183..     15050  PINCH GRAFT, SINGLE OR MULTIPLE, TO COVER SMALL ULCER, TIP OF DIGIT, OR OTHER MINIMAL OPEN AREA
                  (EXCEPT ON FACE), UP TO DEFECT SIZE 2 CM DIAMETER
183..     15100  SPLIT GRAFT, TRUNK, SCALP, ARMS, LEGS, HANDS, AND/OR FEET (EXCEPT MULTIPLE DIGITS); 100 SQ CM
                  OR LESS, OR EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
183..     15101  SPLIT GRAFT, TRUNK, SCALP, ARMS, LEGS, HANDS, AND/OR FEET (EXCEPT MULTIPLE DIGITS); EACH
                  ADDITIONAL 100 SQ CM, OR EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN, OR PART
                  THEREOF
183..     15120  SPLIT GRAFT, FACE, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, AND/OR MULTIPLE DIGITS; 100
                  SQ CM OR LESS, OR EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
183..     15121  SPLIT GRAFT, FACE, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, AND/OR MULTIPLE DIGITS; EACH
                  ADDITIONAL 100 SQ CM, OR EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN, OR PART
                  THEREOF
183..     15200  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; 20 SQ CM OR LESS
183..     15201  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH ADDITIONAL 20
                  SQ CM
183..     15220  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS;
                  20 SQ CM OR LESS
183..     15221  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS;
                  EACH ADDITIONAL 20 SQ CM
183..     15240  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN,
                  MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS

[[Page 47771]]

183..     15241  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN,
                  MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; EACH ADDITIONAL 20 SQ CM
183..     15260  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR
                  LIPS; 20 SQ CM OR LESS
183..     15261  FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR
                  LIPS; EACH ADDITIONAL 20 SQ CM
183..     15350  APPLICATION OF ALLOGRAFT, SKIN
183..     15400  APPLICATION OF XENOGRAFT, SKIN
183..     15570  FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; TRUNK
183..     15572  FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; SCALP, ARMS, OR LEGS
183..     15574  FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; FOREHEAD, CHEEKS, CHIN, MOUTH,
                  NECK, AXILLAE, GENITALIA, HANDS OR FEET
183..     15576  FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE, EARS, LIPS, OR
                  INTRAORAL
183..     15580  CROSS FINGER FLAP, INCLUDING FREE GRAFT TO DONOR SITE
183..     15600  DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT TRUNK
183..     15610  DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT SCALP, ARMS, OR LEGS
183..     15620  DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT FOREHEAD, CHEEKS, CHIN, NECK,
                  AXILLAE, GENITALIA, HANDS (EXCEPT 15625), OR FEET
183..     15625  DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); SECTION PEDICLE OF CROSS FINGER FLAP
183..     15630  DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
183..     15650  TRANSFER, INTERMEDIATE, OF ANY PEDICLE FLAP (EG, ABDOMEN TO WRIST, ``WALKING'' TUBE), ANY
                  LOCATION
183..     15775  PUNCH GRAFT FOR HAIR TRANSPLANT; 1 TO 15 PUNCH GRAFTS
183..     15776  PUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN 15 PUNCH GRAFTS
183..     15819  CERVICOPLASTY
183..     15820  BLEPHAROPLASTY, LOWER EYELID
183..     15821  BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FAT PAD
183..     15822  BLEPHAROPLASTY, UPPER EYELID
183..     15823  BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
183..     15825  RHYTIDECTOMY; NECK WITH PLATYSMAL TIGHTENING (PLATYSMAL FLAP, ``P-FLAP'')
183..     15829  RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTEM (SMAS) FLAP
183..     15835  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); BUTTOCK
183..     20910  CARTILAGE GRAFT; COSTOCHONDRAL
183..     20912  CARTILAGE GRAFT; NASAL SEPTUM
183..     20920  FASCIA LATA GRAFT; BY STRIPPER
183..     20922  FASCIA LATA GRAFT; BY INCISION AND AREA EXPOSURE, COMPLEX OR SHEET
183..     20926  TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS)
183..     23921  DISARTICULATION OF SHOULDER; SECONDARY CLOSURE OR SCAR REVISION
183..     25929  TRANSMETACARPAL AMPUTATION; SECONDARY CLOSURE OR SCAR REVISION
183..     44312  REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
183..     44340  REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
183..     65270  REPAIR OF LACERATION; CONJUNCTIVA, WITH OR WITHOUT NONPERFORATING LACERATION SCLERA, DIRECT
                  CLOSURE
184..  Level IV skin repair            T                       15.17     $768.66         $396.40         $153.73
184..     15732  MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD AND NECK (EG, TEMPORALIS, MASSETER,
                  STERNOCLEIDOMASTOID, LEVATOR SCAPULAE)
184..     15734  MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
184..     15736  MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; UPPER EXTREMITY
184..     15738  MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY
184..     15740  FLAP; ISLAND PEDICLE
184..     15750  FLAP; NEUROVASCULAR PEDICLE
184..     15760  GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR OR NASAL ALA), INCLUDING PRIMARY CLOSURE,
                  DONOR AREA
184..     15770  GRAFT; DERMA-FAT-FASCIA
184..     15824  RHYTIDECTOMY; FOREHEAD
184..     15826  RHYTIDECTOMY; GLABELLAR FROWN LINES
184..     15828  RHYTIDECTOMY; CHEEK, CHIN, AND NECK
184..     15831  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ABDOMEN
                  (ABDOMINOPLASTY)
184..     15832  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); THIGH
184..     15833  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); LEG
184..     15834  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); HIP
184..     15836  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ARM
184..     15837  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); FOREARM OR HAND
184..     15839  EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); OTHER AREA
184..     15840  GRAFT FOR FACIAL NERVE PARALYSIS; FREE FASCIA GRAFT (INCLUDING OBTAINING FASCIA)
184..     15841  GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT (INCLUDING OBTAINING GRAFT)
184..     15842  GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT BY MICROSURGICAL TECHNIQUE
184..     15845  GRAFT FOR FACIAL NERVE PARALYSIS; REGIONAL MUSCLE TRANSFER
184..     15876  SUCTION ASSISTED LIPECTOMY; HEAD AND NECK
184..     15877  SUCTION ASSISTED LIPECTOMY; TRUNK
184..     15878  SUCTION ASSISTED LIPECTOMY; UPPER EXTREMITY
184..     15879  SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY
184..     15922  EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH FLAP CLOSURE
184..     15934  EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE
184..     15935  EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
184..     15936  EXCISION, SACRAL PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE
184..     15937  EXCISION, SACRAL PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE; WITH OSTECTOMY
184..     15944  EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE

[[Page 47772]]

184..     15945  EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
184..     15946  EXCISION, ISCHIAL PRESSURE ULCER, WITH OSTECTOMY, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE
184..     15952  EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE
184..     15953  EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY
184..     15956  EXCISION, TROCHANTERIC PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE
184..     15958  EXCISION, TROCHANTERIC PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE; WITH OSTECTOMY
197..  Incision/excision breast        T                       12.13     $614.62         $310.75         $122.92
197..     19101  BIOPSY OF BREAST; INCISIONAL
197..     19110  NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPILLOMA
                  LACTIFEROUS DUCT
197..     19112  EXCISION OF LACTIFEROUS DUCT FISTULA
197..     19120  EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR ABERRANT BREAST TISSUE, DUCT
                  LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19140), MALE OR FEMALE, ONE OR MORE LESIONS
197..     19125  EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER; SINGLE
                  LESION
197..     19126  EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER; EACH
                  ADDITIONAL LESION SEPARATELY IDENTIFIED BY A RADIOLOGICAL MARKER
197..     19140  MASTECTOMY FOR GYNECOMASTIA
197..     19290  PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST
197..     19291  PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; EACH ADDITIONAL LESION
197..     19396  PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT
197..     19499  UNLISTED PROCEDURE, BREAST
198..  Breast reconstruction/          T                       19.17     $971.33         $530.20         $194.27
       mastectomy
198..     19160  MASTECTOMY, PARTIAL;
198..     19162  MASTECTOMY, PARTIAL; WITH AXILLARY LYMPHADENECTOMY
198..     19180  MASTECTOMY, SIMPLE, COMPLETE
198..     19182  MASTECTOMY, SUBCUTANEOUS
198..     19316  MASTOPEXY
198..     19318  REDUCTION MAMMAPLASTY
198..     19324  MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT
198..     19325  MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT
198..     19328  REMOVAL OF INTACT MAMMARY IMPLANT
198..     19330  REMOVAL OF MAMMARY IMPLANT MATERIAL
198..     19340  IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION
198..     19342  DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION
198..     19350  NIPPLE/AREOLA RECONSTRUCTION
198..     19355  CORRECTION OF INVERTED NIPPLES
198..     19357  BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING SUBSEQUENT
                  EXPANSION
198..     19366  BREAST RECONSTRUCTION WITH OTHER TECHNIQUE
198..     19370  OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST
198..     19371  PERIPROSTHETIC CAPSULECTOMY, BREAST
198..     19380  REVISION OF RECONSTRUCTED BREAST
200..  Arthrocentesis & Ligament/      T                        1.89      $95.77          $39.10          $19.15
       Tendon Injection
200..     20550  INJECTION, TENDON SHEATH, LIGAMENT, TRIGGER POINTS OR GANGLION CYST
200..     20600  ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT, BURSA OR GANGLION CYST (EG, FINGERS,
                  TOES)
200..     20605  ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; INTERMEDIATE JOINT, BURSA OR GANGLION CYST (EG,
                  TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA)
200..     20610  ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE
                  JOINT, SUBACROMIAL BURSA)
207..  Closed treatment fracture       T                        1.70      $86.14          $31.64          $17.23
       finger/toe/trunk
207..     21800  CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EACH
207..     21820  CLOSED TREATMENT OF STERNUM FRACTURE
207..     21899  UNLISTED PROCEDURE, NECK OR THORAX
207..     22305  CLOSED TREATMENT OF VERTEBRAL PROCESS FRACTURE(S)
207..     22310  CLOSED TREATMENT OF VERTEBRAL BODY FRACTURE(S), WITHOUT MANIPULATION, REQUIRING AND INCLUDING
                  CASTING OR BRACING
207..     22315  CLOSED TREATMENT OF VERTEBRAL FRACTURE(S) AND/OR DISLOCATION(S) REQUIRING CASTING OR BRACING,
                  WITH AND INCLUDING CASTING AND/OR BRACING, WITH OR WITHOUT ANESTHESIA, BY MANIPULATION OR
                  TRACTION
207..     22899  UNLISTED PROCEDURE, SPINE
207..     23500  CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION
207..     23505  CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATION
207..     23520  CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
207..     23525  WITH MANIPULATION
207..     23540  CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
207..     23545  CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITH MANIPULATION
207..     23570  CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION
207..     23575  CLOSED TREATMENT OF SCAPULAR FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION
                  (WITH OR WITHOUT SHOULDER JOINT INVOLVEMENT)
207..     23650  CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA
207..     23929  UNLISTED PROCEDURE, SHOULDER
207..     26700  CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT
                  ANESTHESIA
207..     26720  CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB;
                  WITHOUT MANIPULATION, EACH
207..     26725  CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB;
                  WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION, EACH

[[Page 47773]]

207..     26740  CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT;
                  WITHOUT MANIPULATION, EACH
207..     26750  CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT MANIPULATION, EACH
207..     26755  CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH MANIPULATION, EACH
207..     26770  CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT
                  ANESTHESIA
207..     26989  UNLISTED PROCEDURE, HANDS OR FINGERS
207..     27200  CLOSED TREATMENT OF COCCYGEAL FRACTURE
207..     27299  UNLISTED PROCEDURE, PELVIS OR HIP JOINT
207..     28490  CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITHOUT MANIPULATION
207..     28495  CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION
207..     28510  CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITHOUT MANIPULATION,
                  EACH
207..     28515  CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITH MANIPULATION,
                  EACH
207..     28630  CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
207..     28660  CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA
207..     28899  UNLISTED PROCEDURE, FOOT OR TOES
207..     31585  TREATMENT OF CLOSED LARYNGEAL FRACTURE; WITHOUT MANIPULATION
207..     31599  UNLISTED PROCEDURE, LARYNX
209..  Closed treatment fracture/      T                        1.94      $98.30          $37.29          $19.66
       dislocation/except finger/toe/
       trunk
209..     23600  CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITHOUT
                  MANIPULATION
209..     23605  CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITH MANIPULATION,
                  WITH OR WITHOUT SKELETAL TRACTION
209..     23620  CLOSED TREATMENT OF GREATER TUBEROSITY FRACTURE; WITHOUT MANIPULATION
209..     23625  CLOSED TREATMENT OF GREATER TUBEROSITY FRACTURE; WITH MANIPULATION
209..     23665  CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER TUBEROSITY, WITH
                  MANIPULATION
209..     23675  CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, WITH
                  MANIPULATION
209..     24500  CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION
209..     24505  CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETAL
                  TRACTION
209..     24530  CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT
                  INTERCONDYLAR EXTENSION; WITHOUT MANIPULATION
209..     24535  CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT
                  INTERCONDYLAR EXTENSION; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION
209..     24560  CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPULATION
209..     24565  CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULATION
209..     24576  CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPULATION
209..     24577  CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULATION
209..     24600  TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA
209..     24620  CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL END OF
                  ULNA WITH DISLOCATION OF RADIAL HEAD), WITH MANIPULATION
209..     24640  CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, ``NURSEMAID ELBOW'', WITH MANIPULATION
209..     24650  CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION
209..     24655  CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION
209..     24670  CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (OLECRANON PROCESS); WITHOUT MANIPULATION
209..     24675  CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (OLECRANON PROCESS); WITH MANIPULATION
209..     24999  UNLISTED PROCEDURE, HUMERUS OR ELBOW
209..     25500  CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT MANIPULATION
209..     25505  CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION
209..     25520  CLOSED TREATMENT OF RADIAL SHAFT FRACTURE, WITH DISLOCATION OF DISTAL RADIO-ULNAR JOINT
                  (GALEAZZI FRACTURE/DISLOCATION)
209..     25530  CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION
209..     25535  CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
209..     25560  CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION
209..     25565  CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
209..     25600  CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION,
                  WITH OR WITHOUT FRACTURE OF ULNAR STYLOID; WITHOUT MANIPULATION
209..     25605  CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION,
                  WITH OR WITHOUT FRACTURE OF ULNAR STYLOID; WITH MANIPULATION
209..     25622  CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITHOUT MANIPULATION
209..     25624  CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION
209..     25630  CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)); WITHOUT
                  MANIPULATION, EACH BONE
209..     25635  CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)); WITH
                  MANIPULATION, EACH BONE
209..     25650  CLOSED TREATMENT OF ULNAR STYLOID FRACTURE
209..     25660  CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES, WITH
                  MANIPULATION
209..     25675  CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIPULATION
209..     25680  CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH MANIPULATION
209..     25690  CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION
209..     25999  UNLISTED PROCEDURE, FOREARM OR WRIST
209..     26600  CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE
209..     26605  CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE
209..     26607  CLOSED TREATMENT OF METACARPAL FRACTURE, WITH MANIPULATION, WITH INTERNAL OR EXTERNAL FIXATION,
                  EACH BONE
209..     26641  CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH MANIPULATION
209..     26645  CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH
                  MANIPULATION
209..     26670  CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE), SINGLE,
                  WITH MANIPULATION; WITHOUT ANESTHESIA

[[Page 47774]]

209..     26706  PERCUTANEOUS SKELETAL FIXATION OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION
209..     26742  CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT;
                  WITH MANIPULATION, EACH
209..     27193  CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; WITHOUT
                  MANIPULATION
209..     27220  CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITHOUT MANIPULATION
209..     27230  CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITHOUT MANIPULATION
209..     27238  CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE;
                  WITHOUT MANIPULATION
209..     27246  CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITHOUT MANIPULATION
209..     27250  CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT ANESTHESIA
209..     27256  TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL),
                  BY ABDUCTION, SPLINT OR TRACTION; WITHOUT ANESTHESIA, WITHOUT MANIPULATION
209..     27265  CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA
209..     27500  CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION
209..     27501  CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITHOUT
                  INTERCONDYLAR EXTENSION, WITHOUT MANIPULATION
209..     27502  CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL
                  TRACTION
209..     27503  CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITHOUT
                  INTERCONDYLAR EXTENSION, WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION
209..     27508  CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITHOUT
                  MANIPULATION
209..     27510  CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITH MANIPULATION
209..     27516  CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION
209..     27517  CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITH MANIPULATION, WITH OR WITHOUT
                  SKIN OR SKELETAL TRACTION
209..     27520  CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION
209..     27530  CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION
209..     27532  CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT MANIPULATION, WITH
                  SKELETAL TRACTION
209..     27538  CLOSED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF KNEE, WITH OR
                  WITHOUT MANIPULATION
209..     27550  CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA
209..     27560  CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA
209..     27599  UNLISTED PROCEDURE, FEMUR OR KNEE
209..     27750  CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITHOUT
                  MANIPULATION
209..     27752  CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITH
                  MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION
209..     27760  CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT MANIPULATION
209..     27762  CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN OR
                  SKELETAL TRACTION
209..     27780  CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION
209..     27781  CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION
209..     27786  CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION
209..     27788  CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH MANIPULATION
209..     27808  CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, (INCLUDING POTTS); WITHOUT MANIPULATION
209..     27810  CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, (INCLUDING POTTS); WITH MANIPULATION
209..     27816  CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION
209..     27818  CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION
209..     27824  CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR
                  TIBIAL PLAFOND), WITH OR WITHOUT ANESTHESIA; WITHOUT MANIPULATION
209..     27825  CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR
                  TIBIAL PLAFOND), WITH OR WITHOUT ANESTHESIA; WITH SKELETAL TRACTION AND/OR REQUIRING
                  MANIPULATION
209..     27830  CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; WITHOUT ANESTHESIA
209..     27840  CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA
209..     27899  UNLISTED PROCEDURE, LEG OR ANKLE
209..     28400  CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION
209..     28405  CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION
209..     28430  CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION
209..     28435  CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION
209..     28450  TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITHOUT MANIPULATION, EACH
209..     28455  TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITH MANIPULATION, EACH
209..     28470  CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH
209..     28475  CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH
209..     28530  CLOSED TREATMENT OF SESAMOID FRACTURE
209..     28540  CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; WITHOUT ANESTHESIA
209..     28570  CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
209..     28600  CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA
209..     31586  TREATMENT OF CLOSED LARYNGEAL FRACTURE; WITH CLOSED MANIPULATIVE REDUCTION
210..  Bone/joint manipulation under   T                       10.46     $530.00         $283.40         $106.00
       anesthesia
210..     22505  MANIPULATION OF SPINE REQUIRING ANESTHESIA, ANY REGION
210..     23655  CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA
210..     23700  MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS
                  (DISLOCATION EXCLUDED)
210..     24605  TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA
210..     26675  CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE), SINGLE,
                  WITH MANIPULATION; REQUIRING ANESTHESIA
210..     26705  CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING
                  ANESTHESIA
210..     26775  CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING
                  ANESTHESIA

[[Page 47775]]

210..     27194  CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; WITH
                  MANIPULATION, REQUIRING MORE THAN LOCAL ANESTHESIA
210..     27252  CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA
210..     27257  TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL),
                  BY ABDUCTION, SPLINT OR TRACTION; WITH MANIPULATION, REQUIRING ANESTHESIA
210..     27275  MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA
210..     27552  CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA
210..     27562  CLOSED TREATMENT OF PATELLAR DISLOCATION; REQUIRING ANESTHESIA
210..     27570  MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER
                  FIXATION DEVICES)
210..     27831  CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; REQUIRING ANESTHESIA
210..     27842  CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA, WITH OR WITHOUT PERCUTANEOUS
                  SKELETAL FIXATION
210..     27860  MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER
                  FIXATION APPARATUS)
210..     28545  CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; REQUIRING ANESTHESIA
210..     28575  CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
210..     28605  CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA
210..     28635  CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
210..     28665  CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA
216..  Open/percutaneous treatment     T                       20.13   $1,019.98         $520.82         $204.00
       fracture or dislocation
216..     21336  OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
216..     21805  OPEN TREATMENT OF RIB FRACTURE WITHOUT FIXATION, EACH
216..     23515  OPEN TREATMENT OF CLAVICULAR FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     23530  OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
216..     23532  OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDES
                  OBTAINING GRAFT)
216..     23550  OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
216..     23552  OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDES
                  OBTAINING GRAFT)
216..     23585  OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) WITH OR WITHOUT INTERNAL
                  FIXATION
216..     23615  OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, WITH OR WITHOUT
                  INTERNAL OR EXTERNAL FIXATION, WITH OR WITHOUT REPAIR OF TUBEROSITY(-IES);
216..     23616  OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, WITH OR WITHOUT
                  INTERNAL OR EXTERNAL FIXATION, WITH OR WITHOUT REPAIR OF TUBEROSITY(-IES); WITH PROXIMAL
                  HUMERAL PROSTHETIC REPLACEMENT
216..     23630  OPEN TREATMENT OF GREATER TUBEROSITY FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     23660  OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION
216..     23670  OPEN TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER TUBEROSITY, WITH OR WITHOUT
                  INTERNAL OR EXTERNAL FIXATION
216..     23680  OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, WITH OR
                  WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     24515  OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE
216..     24516  OPEN TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR
                  WITHOUT CERCLAGE AND/OR LOCKING SCREWS
216..     24538  PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR
                  WITHOUT INTERCONDYLAR EXTENSION
216..     24545  OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION; WITHOUT INTERCONDYLAR EXTENSION
216..     24546  OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION; WITH INTERCONDYLAR EXTENSION
216..     24566  PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH
                  MANIPULATION
216..     24575  OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION
216..     24579  OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION
216..     24582  PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH
                  MANIPULATION
216..     24586  OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DISTAL
                  HUMERUS AND PROXIMAL ULNA AND/ OR PROXIMAL RADIUS);
216..     24587  OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DISTAL
                  HUMERUS AND PROXIMAL ULNA AND/ OR PROXIMAL RADIUS); WITH IMPLANT ARTHROPLASTY
216..     24615  OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION
216..     24635  OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL END OF
                  ULNA WITH DISLOCATION OF RADIAL HEAD), WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     24665  OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, WITH OR WITHOUT INTERNAL FIXATION OR RADIAL
                  HEAD EXCISION;
216..     24666  OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, WITH OR WITHOUT INTERNAL FIXATION OR RADIAL
                  HEAD EXCISION; WITH RADIAL HEAD PROSTHETIC REPLACEMENT
216..     24685  OPEN TREATMENT OF ULNAR FRACTURE PROXIMAL END (OLECRANON PROCESS), WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION
216..     25515  OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     25525  OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH INTERNAL AND/ OR EXTERNAL FIXATION AND CLOSED
                  TREATMENT OF DISLOCATION OF DISTAL RADIO-ULNAR JOINT (GALEAZZI FRACTURE/DISLOCATION), WITH OR
                  WITHOUT PERCUTANEOUS SKELETAL FIXATION
216..     25526  OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH INTERNAL AND/ OR EXTERNAL FIXATION AND OPEN
                  TREATMENT, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION OF DISTAL RADIO-ULNAR JOINT (GALEAZZI
                  FRACTURE/DISLOCATION), INCLUDES REPAIR OF TRIANGULAR CARTILAGE
216..     25545  OPEN TREATMENT OF ULNAR SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     25574  OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL OR EXTERNAL FIXATION; OF
                  RADIUS OR ULNA

[[Page 47776]]

216..     25575  OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL OR EXTERNAL FIXATION; OF
                  RADIUS AND ULNA
216..     25611  PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR
                  EPIPHYSEAL SEPARATION, WITH OR WITHOUT FRACTURE OF ULNAR STYLOID, REQUIRING MANIPULATION, WITH
                  OR WITHOUT EXTERNAL FIXATION
216..     25620  OPEN TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION,
                  WITH OR WITHOUT FRACTURE OF ULNAR STYLOID, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     25628  OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION
216..     25645  OPEN TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)), EACH BONE
216..     25670  OPEN TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES
216..     25676  OPEN TREATMENT OF DISTAL RADIOULNAR DISLOCATION, ACUTE OR CHRONIC
216..     25685  OPEN TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION
216..     25695  OPEN TREATMENT OF LUNATE DISLOCATION
216..     26608  PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
216..     26615  OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION,
                  EACH BONE
216..     26650  PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT
                  FRACTURE), WITH MANIPULATION, WITH OR WITHOUT EXTERNAL FIXATION
216..     26665  OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH OR
                  WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     26676  PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT
                  FRACTURE), SINGLE, WITH MANIPULATION
216..     26685  OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE); SINGLE,
                  WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     26686  OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE); COMPLEX,
                  MULTIPLE OR DELAYED REDUCTION
216..     26715  OPEN TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION
216..     26727  PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE
                  PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
216..     26735  OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH
                  OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH
216..     26746  OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT,
                  WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH
216..     26756  PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, EACH
216..     26765  OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION, EACH
216..     26776  PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION
216..     26785  OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION, SINGLE
216..     27202  OPEN TREATMENT OF COCCYGEAL FRACTURE
216..     27509  PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, OR
                  SUPRACONDYLAR OR TRANSCONDYLAR, WITH OR WITHOUT INTERCONDYLAR EXTENSION, OR DISTAL FEMORAL
                  EPIPHYSEAL SEPARATION
216..     27556  OPEN TREATMENT OF KNEE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITHOUT
                  PRIMARY LIGAMENTOUS REPAIR OR AUGMENTATION/RECONSTRUCTION
216..     27566  OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL PATELLECTOMY
216..     27615  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE AREA
216..     27756  PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) (EG,
                  PINS OR SCREWS)
216..     27758  OPEN TREATMENT OF TIBIAL SHAFT FRACTURE, (WITH OR WITHOUT FIBULAR FRACTURE) WITH PLATE/SCREWS,
                  WITH OR WITHOUT CERCLAGE
216..     27759  OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY
                  IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
216..     27766  OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     27784  OPEN TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION
216..     27792  OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION
216..     27814  OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     27822  OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION,
                  MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
216..     27823  OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION,
                  MEDIAL AND/OR LATERAL MALLEOLUS; WITH FIXATION OF POSTERIOR LIP
216..     27826  OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTAL TIBIA (EG,
                  PILON OR TIBIAL PLAFOND), WITH INTERNAL OR EXTERNAL FIXATION; OF FIBULA ONLY
216..     27827  OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTAL TIBIA (EG,
                  PILON OR TIBIAL PLAFOND), WITH INTERNAL OR EXTERNAL FIXATION; OF TIBIA ONLY
216..     27828  OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTAL TIBIA (EG,
                  PILON OR TIBIAL PLAFOND), WITH INTERNAL OR EXTERNAL FIXATION; OF BOTH TIBIA AND FIBULA
216..     27829  OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, WITH OR WITHOUT INTERNAL
                  OR EXTERNAL FIXATION
216..     27832  OPEN TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION, OR WITH EXCISION OF PROXIMAL FIBULA
216..     27846  OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION; WITHOUT
                  REPAIR OR INTERNAL FIXATION
216..     27848  OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION; WITH
                  REPAIR OR INTERNAL OR EXTERNAL FIXATION
216..     28406  PERCUTANEOUS SKELETAL FIXATION OF CALCANEAL FRACTURE, WITH MANIPULATION
216..     28415  OPEN TREATMENT OF CALCANEAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION;
216..     28420  OPEN TREATMENT OF CALCANEAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITH
                  PRIMARY ILIAC OR OTHER AUTOGENOUS BONE GRAFT (INCLUDES OBTAINING GRAFT)
216..     28436  PERCUTANEOUS SKELETAL FIXATION OF TALUS FRACTURE, WITH MANIPULATION
216..     28445  OPEN TREATMENT OF TALUS FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     28456  PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), WITH
                  MANIPULATION, EACH

[[Page 47777]]

216..     28465  OPEN TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), WITH OR WITHOUT INTERNAL
                  OR EXTERNAL FIXATION, EACH
216..     28476  PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
216..     28485  OPEN TREATMENT OF METATARSAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH
216..     28496  PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH MANIPULATION
216..     28505  OPEN TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH OR WITHOUT INTERNAL OR
                  EXTERNAL FIXATION
216..     28525  OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, WITH OR WITHOUT
                  INTERNAL OR EXTERNAL FIXATION, EACH
216..     28531  OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT INTERNAL FIXATION
216..     28546  PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL, WITH
                  MANIPULATION
216..     28555  OPEN TREATMENT OF TARSAL BONE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     28576  PERCUTANEOUS SKELETAL FIXATION OF TALOTARSAL JOINT DISLOCATION, WITH MANIPULATION
216..     28585  OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
216..     28606  PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION
216..     28615  OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION
216..     28636  PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
216..     28645  OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION
216..     28666  PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
216..     28675  OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL
                  FIXATION
217..  Arthroplasty                    T                       20.48   $1,037.71         $526.81         $207.54
217..     24360  ARTHROPLASTY, ELBOW; WITH MEMBRANE
217..     24365  ARTHROPLASTY, RADIAL HEAD;
217..     25332  ARTHROPLASTY, WRIST, WITH OR WITHOUT INTERPOSITION, WITH OR WITHOUT EXTERNAL OR INTERNAL
                  FIXATION
217..     25447  INTERPOSITION ARTHROPLASTY, INTERCARPAL OR CARPOMETACARPAL JOINTS
217..     25449  REVISION OF ARTHROPLASTY, INCLUDING REMOVAL OF IMPLANT, WRIST JOINT
217..     26530  ARTHROPLASTY, METACARPOPHALANGEAL JOINT; SINGLE, EACH
217..     26535  ARTHROPLASTY INTERPHALANGEAL JOINT; SINGLE, EACH
217..     27266  CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL ANESTHESIA
217..     27437  ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS
217..     27440  ARTHROPLASTY, KNEE, TIBIAL PLATEAU;
217..     27441  ARTHROPLASTY, KNEE, TIBIAL PLATEAU; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY
217..     27442  ARTHROPLASTY, KNEE, FEMORAL CONDYLES OR TIBIAL PLATEAUS;
217..     27443  ARTHROPLASTY, KNEE, FEMORAL CONDYLES OR TIBIAL PLATEAUS; WITH DEBRIDEMENT AND PARTIAL
                  SYNOVECTOMY
217..     27700  ARTHROPLASTY, ANKLE;
218..  Arthroplasty with prosthesis    T                       27.49   $1,392.90         $715.52         $278.58
218..     21243  ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH PROSTHETIC JOINT REPLACEMENT
218..     24361  ARTHROPLASTY, ELBOW; WITH DISTAL HUMERAL PROSTHETIC REPLACEMENT
218..     24362  ARTHROPLASTY, ELBOW; WITH IMPLANT AND FASCIA LATA LIGAMENT RECONSTRUCTION
218..     24363  ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND PROXIMAL ULNAR PROSTHETIC REPLACEMENT (``TOTAL
                  ELBOW'')
218..     24366  ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT
218..     25441  ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS
218..     25442  ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL ULNA
218..     25443  ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; SCAPHOID (NAVICULAR)
218..     25444  ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; LUNATE
218..     25445  ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM
218..     25446  ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS AND PARTIAL OR ENTIRE CARPUS (``TOTAL
                  WRIST'')
218..     26531  ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, SINGLE, EACH
218..     26536  ARTHROPLASTY INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, SINGLE, EACH
218..     27438  ARTHROPLASTY, PATELLA; WITH PROSTHESIS
226..  Maxillofacial prostheses        T                        1.59      $80.56          $21.92          $16.11
226..     21076  IMPRESSION AND CUSTOM PREPARATION; SURGICAL OBTURATOR PROSTHESIS
226..     21077  IMPRESSION AND CUSTOM PREPARATION; ORBITAL PROSTHESIS
226..     21079  IMPRESSION AND CUSTOM PREPARATION; INTERIM OBTURATOR PROSTHESIS
226..     21080  IMPRESSION AND CUSTOM PREPARATION; DEFINITIVE OBTURATOR PROSTHESIS
226..     21081  IMPRESSION AND CUSTOM PREPARATION; MANDIBULAR RESECTION PROSTHESIS
226..     21082  IMPRESSION AND CUSTOM PREPARATION; PALATAL AUGMENTATION PROSTHESIS
226..     21083  IMPRESSION AND CUSTOM PREPARATION; PALATAL LIFT PROSTHESIS
226..     21084  IMPRESSION AND CUSTOM PREPARATION; SPEECH AID PROSTHESIS
226..     21086  IMPRESSION AND CUSTOM PREPARATION; AURICULAR PROSTHESIS
226..     21087  IMPRESSION AND CUSTOM PREPARATION; NASAL PROSTHESIS
226..     21088  IMPRESSION AND CUSTOM PREPARATION; FACIAL PROSTHESIS
226..     21089  UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE
231..  Level I skull and facial bone   T                       12.02     $609.05          $299.9         $121.81
       procedures
231..     21015  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP
231..     21025  EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); MANDIBLE
231..     21026  EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); FACIAL BONE(S)
231..     21029  REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)
231..     21030  EXCISION OF BENIGN TUMOR OR CYST OF FACIAL BONE OTHER THAN MANDIBLE
231..     21031  EXCISION OF TORUS MANDIBULARIS
231..     21032  EXCISION OF MAXILLARY TORUS PALATINUS
231..     21040  EXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE; SIMPLE
231..     21041  EXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE; COMPLEX
231..     21100  APPLICATION OF HALO TYPE APPLIANCE FOR MAXILLOFACIAL FIXATION, INCLUDES REMOVAL (SEPARATE
                  PROCEDURE)

[[Page 47778]]

231..     21110  APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE OR DISLOCATION,
                  INCLUDES
231..     21120  GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC MATERIAL)
231..     21125  AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL
231..     21280  MEDIAL CANTHOPEXY (SEPARATE PROCEDURE)
231..     21282  LATERAL CANTHOPEXY
231..     21295  REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY);
                  EXTRAORAL APPROACH
231..     21296  REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY);
                  INTRAORAL APPROACH
231..     21299  UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDURE
231..     21300  CLOSED TREATMENT OF SKULL FRACTURE WITHOUT OPERATION
231..     21310  CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION
231..     21315  CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION
231..     21320  CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION
231..     21325  OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED
231..     21337  CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
231..     21355  PERCUTANEOUS TREATMENT OF FRACTURE OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD,
                  WITH MANIPULATION
231..     21400  CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT ''BLOWOUT''; WITHOUT MANIPULATION
231..     21401  CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT ``BLOWOUT''; WITH MANIPULATION
231..     21440  CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)
231..     21451  CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATION
231..     21480  CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT
231..     21485  CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; COMPLICATED (EG, RECURRENT REQUIRING
                  INTERMAXILLARY FIXATION OR SPLINTING), INITIAL OR SUBSEQUENT
231..     21493  CLOSED TREATMENT OF HYOID FRACTURE; WITHOUT MANIPULATION
231..     21494  CLOSED TREATMENT OF HYOID FRACTURE; WITH MANIPULATION
231..     21497  INTERDENTAL WIRING, FOR CONDITION OTHER THAN FRACTURE
231..     21499  UNLISTED MUSCULOSKELETAL PROCEDURE, HEAD
231..     41822  EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
231..     41823  EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES
232..  Level II skull and facial bone  T                       23.93   $1,212.52         $639.35         $242.50
       procedures
232..     21010  ARTHROTOMY, TEMPOROMANDIBULAR JOINT
232..     21034  EXCISION OF MALIGNANT TUMOR OF FACIAL BONE OTHER THAN MANDIBLE
232..     21044  EXCISION OF MALIGNANT TUMOR OF MANDIBLE
232..     21050  CONDYLECTOMY, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
232..     21060  MENISCECTOMY, PARTIAL OR COMPLETE, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)
232..     21070  CORONOIDECTOMY (SEPARATE PROCEDURE)
232..     21121  GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE
232..     21122  GENIOPLASTY; SLIDING OSTEOTOMIES, TWO OR MORE OSTEOTOMIES (EG, WEDGE EXCISION OR BONE WEDGE
                  REVERSAL FOR ASYMMETRICAL CHIN)
232..     21123  GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONE GRAFTS (INCLUDES OBTAINING
                  AUTOGRAFTS)
232..     21127  AUGMENTATION, MANDIBULAR BODY OR ANGLE; WITH BONE GRAFT, ONLAY OR INTERPOSITIONAL (INCLUDES
                  OBTAINING AUTOGRAFT)
232..     21181  RECONSTRUCTION BY CONTOURING OF BENIGN TUMOR OF CRANIAL BONES (EG, FIBROUS DYSPLASIA),
                  EXTRACRANIAL
232..     21206  OSTEOTOMY, MAXILLA, SEGMENTAL (EG, WASSMUND OR SCHUCHARD)
232..     21208  OSTEOPLASTY, FACIAL BONES; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, OR PROSTHETIC IMPLANT)
232..     21209  OSTEOPLASTY, FACIAL BONES; REDUCTION
232..     21210  GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDES OBTAINING GRAFT)
232..     21215  GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)
232..     21230  GRAFT; RIB CARTILAGE, AUTOGENOUS, TO FACE, CHIN, NOSE OR EAR (INCLUDES OBTAINING GRAFT)
232..     21235  GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)
232..     21240  ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR WITHOUT AUTOGRAFT (INCLUDES OBTAINING GRAFT)
232..     21242  ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH ALLOGRAFT
232..     21244  RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH TRANSOSTEAL BONE PLATE (EG, MANDIBULAR STAPLE BONE
                  PLATE)
232..     21245  RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; PARTIAL
232..     21246  RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; COMPLETE
232..     21248  RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER); PARTIAL
232..     21249  RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER); COMPLETE
232..     21260  PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; EXTRACRANIAL APPROACH
232..     21267  ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS; EXTRACRANIAL
                  APPROACH
232..     21270  MALAR AUGMENTATION, PROSTHETIC MATERIAL
232..     21275  SECONDARY REVISION OF ORBITOCRANIOFACIAL RECONSTRUCTION
232..     21330  OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH INTERNAL AND/OR EXTERNAL SKELETAL FIXATION
232..     21335  OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANT OPEN TREATMENT OF FRACTURED SEPTUM
232..     21338  OPEN TREATMENT OF NASOETHMOID FRACTURE; WITHOUT EXTERNAL FIXATION
232..     21339  OPEN TREATMENT OF NASOETHMOID FRACTURE; WITH EXTERNAL FIXATION
232..     21340  PERCUTANEOUS TREATMENT OF NASOETHMOID COMPLEX FRACTURE, WITH SPLINT, WIRE OR HEADCAP FIXATION,
                  INCLUDING REPAIR OF CANTHAL LIGAMENTS AND/OR THE NASOLACRIMAL APPARATUS
232..     21343  OPEN TREATMENT OF DEPRESSED FRONTAL SINUS FRACTURE
232..     21345  CLOSED TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE), WITH INTERDENTAL WIRE
                  FIXATION OR FIXATION OF DENTURE OR SPLINT
232..     21421  CLOSED TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE), WITH INTERDENTAL WIRE
                  FIXATION OR FIXATION OF DENTURE OR SPLINT
232..     21445  OPEN TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)

[[Page 47779]]

232..     21450  CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITHOUT MANIPULATION
232..     21452  PERCUTANEOUS TREATMENT OF MANDIBULAR FRACTURE, WITH EXTERNAL FIXATION
232..     21453  CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION
232..     21454  OPEN TREATMENT OF MANDIBULAR FRACTURE WITH EXTERNAL FIXATION
232..     21461  OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT INTERDENTAL FIXATION
232..     21462  OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTAL FIXATION
232..     21465  OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE
232..     21490  OPEN TREATMENT OF TEMPOROMANDIBULAR DISLOCATION
232..     67420  ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMOVAL OF LESION
232..     67430  ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMOVAL OF FOREIGN
                  BODY
232..     67440  ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH DRAINAGE
232..     67450  ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); FOR EXPLORATION, WITH OR
                  WITHOUT BIOPSY
251..  Level I musculoskeletal         T                       14.26     $722.55         $366.12         $144.51
       procedures
251..     20005  INCISION OF SOFT TISSUE ABSCESS (EG, SECONDARY TO OSTEOMYELITIS); DEEP OR COMPLICATED
251..     20250  BIOPSY, VERTEBRAL BODY, OPEN; THORACIC
251..     20251  BIOPSY, VERTEBRAL BODY, OPEN; LUMBAR OR CERVICAL
251..     20650  INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING REMOVAL (SEPARATE
                  PROCEDURE)
251..     20693  ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN(S) OR
                  WIRE(S) AND/OR NEW RING(S) OR BAR(S))
251..     20694  REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
251..     20975  ELECTRICAL STIMULATION TO AID BONE HEALING; INVASIVE (OPERATIVE)
251..     23100  ARTHROTOMY WITH BIOPSY, GLENOHUMERAL JOINT
251..     23140  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA;
251..     23935  INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERUS OR
                  ELBOW
251..     24100  ARTHROTOMY, ELBOW; WITH SYNOVIAL BIOPSY ONLY
251..     24105  EXCISION, OLECRANON BURSA
251..     24110  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS;
251..     24120  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR OLECRANON
                  PROCESS;
251..     24310  TENOTOMY, OPEN, ELBOW TO SHOULDER, SINGLE, EACH
251..     24925  AMPUTATION, ARM THROUGH HUMERUS; SECONDARY CLOSURE OR SCAR REVISION
251..     25000  TENDON SHEATH INCISION; AT RADIAL STYLOID (EG, FOR DEQUERVAIN'S DISEASE)
251..     25020  DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST; FLEXOR OR EXTENSOR COMPARTMENT
251..     25028  INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA
251..     25031  INCISION AND DRAINAGE, FOREARM AND/OR WRIST; INFECTED BURSA
251..     25035  INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM
                  AND/OR WRIST
251..     25085  CAPSULOTOMY, WRIST (EG, FOR CONTRACTURE)
251..     25100  ARTHROTOMY, WRIST JOINT; WITH BIOPSY
251..     25110  EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST
251..     25115  RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS,
                  FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS
251..     25116  RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS,
                  FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT
                  TRANSPOSITION OF DORSAL RETINACULUM
251..     25248  EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST
251..     25295  TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
251..     25907  AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; SECONDARY CLOSURE OR SCAR REVISION
251..     25922  DISARTICULATION THROUGH WRIST; SECONDARY CLOSURE OR SCAR REVISION
251..     26990  INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA
251..     26991  INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; INFECTED BURSA
251..     27000  TENOTOMY, ADDUCTOR OF HIP, SUBCUTANEOUS, CLOSED (SEPARATE PROCEDURE)
251..     27050  ARTHROTOMY, WITH BIOPSY; SACROILIAC JOINT
251..     27052  ARTHROTOMY, WITH BIOPSY; HIP JOINT
251..     27060  EXCISION; ISCHIAL BURSA
251..     27062  EXCISION; TROCHANTERIC BURSA OR CALCIFICATION
251..     27065  EXCISION OF BONE CYST OR BENIGN TUMOR; SUPERFICIAL (WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATER
                  TROCHANTER OF FEMUR) WITH OR WITHOUT AUTOGRAFT
251..     27086  REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE
251..     27087  REMOVAL OF FOREIGN BODY, PELVIS OR HIP; DEEP
251..     27305  FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN
251..     27306  TENOTOMY, SUBCUTANEOUS, CLOSED, ADDUCTOR OR HAMSTRING, (SEPARATE PROCEDURE); SINGLE
251..     27307  TENOTOMY, SUBCUTANEOUS, CLOSED, ADDUCTOR OR HAMSTRING, (SEPARATE PROCEDURE); MULTIPLE
251..     27340  EXCISION, PREPATELLAR BURSA
251..     27345  EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (BAKER'S CYST)
251..     27380  SUTURE OF INFRAPATELLAR TENDON; PRIMARY
251..     27381  SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
251..     27385  SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
251..     27386  SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL
                  OR TENDON GRAFT
251..     27390  TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; SINGLE
251..     27391  TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE, ONE LEG
251..     27392  TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE, BILATERAL
251..     27496  DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR OR ADDUCTOR);
251..     27497  DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR OR ADDUCTOR);
                  WITH DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE
251..     27498  DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS;

[[Page 47780]]

251..     27499  DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS; WITH DEBRIDEMENT OF
                  NONVIABLE MUSCLE AND/OR NERVE
251..     27594  AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; SECONDARY CLOSURE OR SCAR REVISION
251..     27600  DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
251..     27601  DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY
251..     27602  DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S)
251..     27604  INCISION AND DRAINAGE, LEG OR ANKLE; INFECTED BURSA
251..     27606  TENOTOMY, ACHILLES TENDON, SUBCUTANEOUS (SEPARATE PROCEDURE); GENERAL ANESTHESIA
251..     27607  INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), LEG OR
                  ANKLE
251..     27630  EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE
251..     27656  REPAIR, FASCIAL DEFECT OF LEG
251..     27658  REPAIR OR SUTURE OF FLEXOR TENDON OF LEG; PRIMARY, WITHOUT GRAFT, SINGLE, EACH
251..     27659  REPAIR OR SUTURE OF FLEXOR TENDON OF LEG; SECONDARY WITH OR WITHOUT GRAFT, SINGLE TENDON, EACH
251..     27664  REPAIR OR SUTURE OF EXTENSOR TENDON OF LEG; PRIMARY, WITHOUT GRAFT, SINGLE, EACH
251..     27675  REPAIR FOR DISLOCATING PERONEAL TENDONS; WITHOUT FIBULAR OSTEOTOMY
251..     27704  REMOVAL OF ANKLE IMPLANT
251..     27707  OSTEOTOMY; FIBULA
251..     27884  AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR REVISION
251..     27892  DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY, WITH DEBRIDEMENT OF
                  NONVIABLE MUSCLE AND/OR NERVE
251..     27893  DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY, WITH DEBRIDEMENT OF NONVIABLE
                  MUSCLE AND/OR NERVE
251..     27894  DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S), WITH
                  DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE
251..     28002  DEEP DISSECTION BELOW FASCIA, FOR DEEP INFECTION OF FOOT, WITH OR WITHOUT TENDON SHEATH
                  INVOLVEMENT; SINGLE BURSAL SPACE, SPECIFY
251..     28003  DEEP DISSECTION BELOW FASCIA, FOR DEEP INFECTION OF FOOT, WITH OR WITHOUT TENDON SHEATH
                  INVOLVEMENT; MULTIPLE AREAS
252..  Level II Musculoskeletal        T                       19.39     $982.48         $509.18          $196.5
       Procedures
252..     20690  APPLICATION OF A UNIPLANE (PINS OR WIRES IN ONE PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM
252..     20692  APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL
                  FIXATION SYSTEM (EG, ILIZAROV, MONTICELLI TYPE)
252..     20900  BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
252..     20902  BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
252..     20924  TENDON GRAFT, FROM A DISTANCE (EG, PALMARIS, TOE EXTENSOR, PLANTARIS)
252..     21502  INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX; WITH PARTIAL
                  RIB OSTECTOMY
252..     21600  EXCISION OF RIB, PARTIAL
252..     21610  COSTOTRANSVERSECTOMY (SEPARATE PROCEDURE)
252..     23040  ARTHROTOMY, GLENOHUMERAL JOINT, FOR INFECTION, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF
                  FOREIGN BODY
252..     23044  ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, FOR INFECTION, WITH EXPLORATION,
                  DRAINAGE, OR REMOVAL OF FOREIGN BODY
252..     23101  ARTHROTOMY WITH BIOPSY, OR WITH EXCISION OF TORN CARTILAGE, ACROMIOCLAVICULAR, STERNOCLAVICULAR
                  JOINT
252..     23105  ARTHROTOMY WITH SYNOVECTOMY; GLENOHUMERAL JOINT
252..     23106  ARTHROTOMY WITH SYNOVECTOMY; STERNOCLAVICULAR JOINT
252..     23107  ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL OF LOOSE OR
                  FOREIGN BODY
252..     23145  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH AUTOGRAFT
                  (INCLUDES OBTAINING GRAFT)
252..     23146  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH ALLOGRAFT
252..     23150  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS;
252..     23155  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH AUTOGRAFT
                  (INCLUDES OBTAINING GRAFT)
252..     23156  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH ALLOGRAFT
252..     23170  SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), CLAVICLE
252..     23172  SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SCAPULA
252..     23174  SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERAL HEAD TO SURGICAL NECK
252..     23180  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS), CLAVICLE
252..     23182  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS), SCAPULA
252..     23184  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS), PROXIMAL HUMERUS
252..     23190  OSTECTOMY OF SCAPULA, PARTIAL (EG, SUPERIOR MEDIAL ANGLE)
252..     23405  TENOMYOTOMY, SHOULDER AREA; SINGLE
252..     23406  TENOMYOTOMY, SHOULDER AREA; MULTIPLE THROUGH SAME INCISION
252..     24000  ARTHROTOMY, ELBOW, FOR INFECTION, WITH EXPLORATION, DRAINAGE OR REMOVAL OF FOREIGN BODY
252..     24006  ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULAR RELEASE (SEPARATE PROCEDURE)
252..     24101  ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF
                  LOOSE OR FOREIGN BODY
252..     24102  ARTHROTOMY, ELBOW; WITH SYNOVECTOMY
252..     24115  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH AUTOGRAFT (INCLUDES OBTAINING
                  GRAFT)
252..     24116  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH ALLOGRAFT
252..     24125  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR OLECRANON
                  PROCESS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
252..     24126  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR OLECRANON
                  PROCESS; WITH ALLOGRAFT
252..     24130  EXCISION, RADIAL HEAD
252..     24134  SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SHAFT OR DISTAL HUMERUS

[[Page 47781]]

252..     24136  SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), RADIAL HEAD OR NECK
252..     24138  SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), OLECRANON PROCESS
252..     24140  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS), HUMERUS
252..     24145  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS), RADIAL HEAD OR NECK
252..     24147  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS), OLECRANON PROCESS
252..     24160  IMPLANT REMOVAL; ELBOW JOINT
252..     24164  IMPLANT REMOVAL; RADIAL HEAD
252..     24301  MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW, SINGLE (EXCLUDING 24320-24331)
252..     24305  TENDON LENGTHENING, UPPER ARM OR ELBOW, SINGLE, EACH
252..     24350  FASCIOTOMY, LATERAL OR MEDIAL (EG, ``TENNIS ELBOW'' OR EPICONDYLITIS);
252..     24351  FASCIOTOMY, LATERAL OR MEDIAL (EG, ``TENNIS ELBOW'' OR EPICONDYLITIS); WITH EXTENSOR ORIGIN
                  DETACHMENT
252..     24352  FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' OR EPICONDYLITIS); WITH ANNULAR LIGAMENT
                  RESECTION
252..     24354  FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' OR EPICONDYLITIS); WITH STRIPPING
252..     24356  FASCIOTOMY, LATERAL OR MEDIAL (EG, ''TENNIS ELBOW'' OR EPICONDYLITIS); WITH PARTIAL OSTECTOMY
252..     24400  OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION
252..     24410  MULTIPLE OSTEOTOMIES WITH REALIGNMENT ON INTRAMEDULLARY ROD, HUMERAL SHAFT (SOFIELD TYPE
                  PROCEDURE)
252..     24495  DECOMPRESSION FASCIOTOMY, FOREARM, WITH BRACHIAL ARTERY EXPLORATION
252..     25023  DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST; WITH DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR
                  NERVE
252..     25040  ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN
                  BODY
252..     25101  ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT
                  REMOVAL OF LOOSE OR FOREIGN BODY
252..     25105  ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY
252..     25107  ARTHROTOMY, DISTAL RADIOULNAR JOINT FOR REPAIR OF TRIANGULAR CARTILAGE COMPLEX
252..     25118  SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;
252..     25119  SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; WITH RESECTION OF DISTAL ULNA
252..     25120  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK OF
                  RADIUS AND OLECRANON PROCESS);
252..     25125  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK OF
                  RADIUS AND OLECRANON PROCESS); WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
252..     25126  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK OF
                  RADIUS AND OLECRANON PROCESS); WITH ALLOGRAFT
252..     25130  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES;
252..     25135  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH AUTOGRAFT (INCLUDES
                  OBTAINING GRAFT)
252..     25136  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH ALLOGRAFT
252..     25145  SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM AND/OR WRIST
252..     25150  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS); ULNA
252..     25151  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS); RADIUS
252..     25230  RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)
252..     25240  EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPE OR MATCHED RESECTION)
252..     25250  REMOVAL OF WRIST PROSTHESIS; (SEPARATE PROCEDURE)
252..     25251  REMOVAL OF WRIST PROSTHESIS; COMPLICATED, INCLUDING ''TOTAL WRIST''
252..     25260  REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE
252..     25263  REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH TENDON OR
                  MUSCLE
252..     25265  REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE GRAFT (INCLUDES
                  OBTAINING GRAFT), EACH TENDON OR MUSCLE
252..     25270  REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR
                  MUSCLE
252..     25272  REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH TENDON OR
                  MUSCLE
252..     25274  REPAIR, TENDON OR MUSCLE, EXTENSOR, SECONDARY, WITH TENDON GRAFT (INCLUDES OBTAINING GRAFT),
                  FOREARM AND/OR WRIST, EACH TENDON OR MUSCLE
252..     25280  LENGTHENING OR SHORTENING OF FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH
                  TENDON
252..     25290  TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
252..     25300  TENODESIS AT WRIST; FLEXORS OF FINGERS
252..     25301  TENODESIS AT WRIST; EXTENSORS OF FINGERS
252..     25360  OSTEOTOMY; ULNA
252..     25365  OSTEOTOMY; RADIUS AND ULNA
252..     25400  REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
252..     25415  REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
252..     27001  TENOTOMY, ADDUCTOR OF HIP, SUBCUTANEOUS, OPEN
252..     27003  TENOTOMY, ADDUCTOR, SUBCUTANEOUS, OPEN, WITH OBTURATOR NEURECTOMY
252..     27066  EXCISION OF BONE CYST OR BENIGN TUMOR; DEEP, WITH OR WITHOUT AUTOGRAFT
252..     27067  EXCISION OF BONE CYST OR BENIGN TUMOR; WITH AUTOGRAFT REQUIRING SEPARATE INCISION
252..     27080  COCCYGECTOMY, PRIMARY
252..     27097  HAMSTRING RECESSION, PROXIMAL
252..     27098  ADDUCTOR TRANSFER TO ISCHIUM
252..     27310  ARTHROTOMY, KNEE, FOR INFECTION, WITH EXPLORATION, DRAINAGE OR REMOVAL OF FOREIGN BODY
252..     27330  ARTHROTOMY, KNEE; WITH SYNOVIAL BIOPSY ONLY
252..     27331  ARTHROTOMY, KNEE; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF
                  LOOSE OR FOREIGN BODIES
252..     27332  ARTHROTOMY, KNEE, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY); MEDIAL OR LATERAL
252..     27333  ARTHROTOMY, KNEE, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY); MEDIAL AND LATERAL
252..     27334  ARTHROTOMY, KNEE, WITH SYNOVECTOMY; ANTERIOR OR POSTERIOR
252..     27335  ARTHROTOMY, KNEE, WITH SYNOVECTOMY; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL AREA
252..     27350  PATELLECTOMY OR HEMIPATELLECTOMY

[[Page 47782]]

252..     27355  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR;
252..     27356  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH ALLOGRAFT
252..     27357  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH AUTOGRAFT (INCLUDES OBTAINING
                  GRAFT)
252..     27358  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH INTERNAL FIXATION (LIST IN
                  ADDITION TO 27355, 27356, OR 27357)
252..     27360  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS), FEMUR, PROXIMAL TIBIA AND/ OR FIBULA
252..     27393  LENGTHENING OF HAMSTRING TENDON; SINGLE
252..     27394  LENGTHENING OF HAMSTRING TENDON; MULTIPLE, ONE LEG
252..     27396  TRANSPLANT, HAMSTRING TENDON TO PATELLA; SINGLE
252..     27403  ARTHROTOMY WITH OPEN MENISCUS REPAIR
252..     27425  LATERAL RETINACULAR RELEASE (ANY METHOD)
252..     27610  ARTHROTOMY, ANKLE, FOR INFECTION, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY
252..     27612  ARTHROTOMY, ANKLE, POSTERIOR CAPSULAR RELEASE, WITH OR WITHOUT ACHILLES TENDON LENGTHENING
252..     27620  ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF
                  LOOSE OR FOREIGN BODY
252..     27625  ARTHROTOMY, ANKLE, WITH SYNOVECTOMY;
252..     27626  ARTHROTOMY, ANKLE, WITH SYNOVECTOMY; INCLUDING TENOSYNOVECTOMY
252..     27635  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;
252..     27637  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH AUTOGRAFT (INCLUDES
                  OBTAINING GRAFT)
252..     27638  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH ALLOGRAFT
252..     27641  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS OR EXOSTOSIS); FIBULA
252..     27665  REPAIR OR SUTURE OF EXTENSOR TENDON OF LEG; SECONDARY WITH OR WITHOUT GRAFT, SINGLE TENDON,
                  EACH
252..     27676  REPAIR FOR DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY
252..     27680  TENOLYSIS, INCLUDING TIBIA, FIBULA, AND ANKLE FLEXOR; SINGLE
252..     27681  TENOLYSIS, INCLUDING TIBIA, FIBULA, AND ANKLE FLEXOR; MULTIPLE (THROUGH SAME INCISION), EACH
252..     27685  LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE (SEPARATE PROCEDURE)
252..     27686  LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE (THROUGH SAME INCISION), EACH
252..     27687  GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
252..     27695  SUTURE, PRIMARY, TORN, RUPTURED OR SEVERED LIGAMENT, ANKLE; COLLATERAL
252..     27696  SUTURE, PRIMARY, TORN, RUPTURED OR SEVERED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS
252..     27698  SUTURE, SECONDARY REPAIR, TORN, RUPTURED OR SEVERED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-
                  JONES PROCEDURE)
252..     27709  OSTEOTOMY; TIBIA AND FIBULA
252..     27730  EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL TIBIA
252..     27732  EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL FIBULA
252..     27734  EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL TIBIA AND FIBULA
252..     27740  EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, COMBINED, PROXIMAL AND DISTAL TIBIA AND
                  FIBULA;
252..     27889  ANKLE DISARTICULATION
253..  Level III Musculoskeletal       T                       26.33   $1,334.13         $699.24         $266.83
       Procedures
253..     23020  CAPSULAR CONTRACTURE RELEASE (SEVER TYPE PROCEDURE)
253..     23120  CLAVICULECTOMY; PARTIAL
253..     23130  ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL
253..     23415  CORACOACROMIAL LIGAMENT RELEASE, WITH OR WITHOUT ACROMIOPLASTY
253..     23480  OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION;
253..     23485  OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR NONUNION OR
                  MALUNION (INCLUDES OBTAINING GRAFT AND/OR NECESSARY FIXATION)
253..     23490  PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
                  METHYLMETHACRYLATE; CLAVICLE
253..     23491  PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
                  METHYLMETHACRYLATE; PROXIMAL HUMERUS AND HUMERAL HEAD
253..     23800  ARTHRODESIS, SHOULDER JOINT; WITH OR WITHOUT LOCAL BONE GRAFT
253..     23802  ARTHRODESIS, SHOULDER JOINT; WITH PRIMARY AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
253..     24155  RESECTION OF ELBOW JOINT (ARTHRECTOMY)
253..     24320  TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT FREE GRAFT, ELBOW TO SHOULDER, SINGLE (SEDDON-
                  BROOKES TYPE PROCEDURE)
253..     24330  FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT);
253..     24331  FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT); WITH EXTENSOR ADVANCEMENT
253..     24340  TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)
253..     24341  REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY
                  (EXCLUDES ROTATOR CUFF)
253..     24342  REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
253..     24420  OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING) (EXCLUDING 64876)
253..     24430  REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
253..     24435  REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING
                  GRAFT)
253..     24470  HEMIEPIPHYSEAL ARREST (EG, FOR CUBITUS VARUS OR VALGUS, DISTAL HUMERUS)
253..     24498  PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING), WITH OR WITHOUT
                  METHYLMETHACRYLATE, HUMERUS
253..     24800  ARTHRODESIS, ELBOW JOINT; WITH OR WITHOUT LOCAL AUTOGRAFT OR ALLOGRAFT
253..     24802  ARTHRODESIS, ELBOW JOINT; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT OTHER THAN LOCALLY OBTAINED)
253..     25310  TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH
                  TENDON
253..     25312  TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; WITH
                  TENDON GRAFT(S) (INCLUDES OBTAINING GRAFT), EACH TENDON
253..     25315  FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM AND/OR WRIST;
253..     25316  FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM AND/OR WRIST; WITH
                  TENDON(S) TRANSFER
253..     25320  CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, ANY METHOD (EG, CAPSULODESIS, LIGAMENT REPAIR, TENDON
                  TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR CARPAL
                  INSTABILITY

[[Page 47783]]

253..     25335  CENTRALIZATION OF WRIST ON ULNA (EG, RADIAL CLUB HAND)
253..     25337  RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY
                  BY SOFT TISSUE STABILIZATION (EG, TENDON TRANSFER, TENDON GRAFT OR WEAVE, OR TENODESIS) WITH
                  OR WITHOUT OPEN REDUCTION OF DISTAL RADIOULNAR JOINT
253..     25350  OSTEOTOMY, RADIUS; DISTAL THIRD
253..     25355  OSTEOTOMY, RADIUS; MIDDLE OR PROXIMAL THIRD
253..     25370  MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE PROCEDURE); RADIUS
                  OR ULNA
253..     25375  MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE PROCEDURE); RADIUS
                  AND ULNA
253..     25425  REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA
253..     25426  REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS AND ULNA
253..     25440  REPAIR OF NONUNION, SCAPHOID (NAVICULAR) BONE, WITH OR WITHOUT RADIAL STYLOIDECTOMY (INCLUDES
                  OBTAINING GRAFT AND NECESSARY FIXATION)
253..     25450  EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS OR ULNA
253..     25455  EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS AND ULNA
253..     25490  PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
                  METHYLMETHACRYLATE; RADIUS
253..     25491  PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
                  METHYLMETHACRYLATE; ULNA
253..     25492  PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
                  METHYLMETHACRYLATE; RADIUS AND VLNA
253..     25800  ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITHOUT BONE GRAFT
253..     25805  ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITH SLIDING GRAFT
253..     25810  ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITH ILIAC OR OTHER
                  AUTOGRAFT (INCLUDES OBTAINING GRAFT)
253..     25830  DISTAL RADIOULNAR JOINT ARTHRODESIS AND SEGMENTAL RESECTION OF ULNA (EG, SAUVE-KAPANDJI
                  PROCEDURE), WITH OR WITHOUT BONE GRAFT
253..     27033  ARTHROTOMY, HIP, WITH EXPLORATION OR REMOVAL OF LOOSE OR FOREIGN BODY
253..     27100  TRANSFER EXTERNAL OBLIQUE MUSCLE TO GREATER TROCHANTER INCLUDING FASCIAL OR TENDON EXTENSION
                  (GRAFT)
253..     27105  TRANSFER PARASPINAL MUSCLE TO HIP (INCLUDES FASCIAL OR TENDON EXTENSION GRAFT)
253..     27110  TRANSFER ILIOPSOAS; TO GREATER TROCHANTER
253..     27111  TRANSFER ILIOPSOAS; TO FEMORAL NECK
253..     27395  LENGTHENING OF HAMSTRING TENDON; MULTIPLE, BILATERAL
253..     27397  TRANSPLANT, HAMSTRING TENDON TO PATELLA; MULTIPLE
253..     27400  TENDON OR MUSCLE TRANSFER, HAMSTRINGS TO FEMUR (EGGERS TYPE PROCEDURE)
253..     27405  REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL
253..     27407  REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE
253..     27409  REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL AND CRUCIATE LIGAMENTS
253..     27418  ANTERIOR TIBIAL TUBERCLEPLASTY (EG, FOR CHONDROMALACIA PATELLAE)
253..     27420  RECONSTRUCTION FOR RECURRENT DISLOCATING PATELLA; (HAUSER TYPE PROCEDURE)
253..     27422  RECONSTRUCTION FOR RECURRENT DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE
                  ADVANCEMENT OR RELEASE (CAMPBELL, GOLDWAITE TYPE PROCEDURE)
253..     27424  RECONSTRUCTION FOR RECURRENT DISLOCATING PATELLA; WITH PATELLECTOMY
253..     27430  QUADRICEPSPLASTY (BENNETT OR THOMPSON TYPE)
253..     27435  CAPSULOTOMY, KNEE, POSTERIOR CAPSULAR RELEASE
253..     27640  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS OR EXOSTOSIS); TIBIA
253..     27647  RADICAL RESECTION OF TUMOR, BONE; TALUS OR CALCANEUS
253..     27650  REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
253..     27652  REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INCLUDES OBTAINING
                  GRAFT)
253..     27654  REPAIR, SECONDARY, RUPTURED ACHILLES TENDON, WITH OR WITHOUT GRAFT
253..     27690  TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); SUPERFICIAL
                  (EG, ANTERIOR TIBIAL EXTENSORS INTO MIDFOOT)
253..     27691  TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG,
                  ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS,
                  FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
253..     27692  TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); EACH ADDITIONAL
                  TENDON
253..     27705  OSTEOTOMY; TIBIA
253..     27742  EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, COMBINED, PROXIMAL AND DISTAL TIBIA AND
                  FIBULA; AND DISTAL FEMUR
253..     27745  PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT
                  METHYLMETHACRYLATE, TIBIA
253..     27870  ARTHRODESIS, ANKLE, ANY METHOD
253..     27871  ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL
254..  Level IV Musculoskeletal        T                       34.37   $1,741.51         $937.11         $348.30
       Procedures
254..     23410  REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF); ACUTE
254..     23412  REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF); CHRONIC
254..     23420  REPAIR OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLASTY)
254..     23430  TENODESIS OF LONG TENDON OF BICEPS
254..     23450  CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE OR MAGNUSON TYPE OPERATION
254..     23455  CAPSULORRHAPHY, ANTERIOR; BANKART TYPE OPERATION WITH OR WITHOUT STAPLING
254..     23460  CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
254..     23462  CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
254..     23465  CAPSULORRHAPHY FOR RECURRENT DISLOCATION, POSTERIOR, WITH OR WITHOUT BONE BLOCK
254..     23466  CAPSULORRHAPHY WITH ANY TYPE MULTI-DIRECTIONAL INSTABILITY
254..     27427  LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
254..     27428  LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN)
254..     27429  LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN) AND EXTRA-ARTICULAR
261..  Level I Hand Musculoskeletal    T                       10.54     $534.06         $261.48         $106.81
       Procedures
261..     25111  EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY

[[Page 47784]]

261..     25112  EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT
261..     25820  INTERCARPAL FUSION; WITHOUT BONE GRAFT
261..     26020  DRAINAGE OF TENDON SHEATH, ONE DIGIT AND/OR PALM
261..     26025  DRAINAGE OF PALMAR BURSA; SINGLE, ULNAR OR RADIAL
261..     26030  DRAINAGE OF PALMAR BURSA; MULTIPLE OR COMPLICATED
261..     26034  INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HAND OR
                  FINGER
261..     26035  DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJURY (EG, GREASE GUN)
261..     26037  DECOMPRESSIVE FASCIOTOMY, HAND (EXCLUDES 26035)
261..     26055  TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
261..     26060  TENOTOMY, PERCUTANEOUS, SINGLE, EACH DIGIT
261..     26070  ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY; CARPOMETACARPAL JOINT
261..     26075  ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY; METACARPOPHALANGEAL JOINT
261..     26080  ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY; INTERPHALANGEAL JOINT, EACH
261..     26100  ARTHROTOMY WITH SYNOVIAL BIOPSY; CARPOMETACARPAL JOINT
261..     26105  ARTHROTOMY WITH SYNOVIAL BIOPSY; METACARPOPHALANGEAL JOINT
261..     26110  ARTHROTOMY WITH SYNOVIAL BIOPSY; INTERPHALANGEAL JOINT, EACH
261..     26130  SYNOVECTOMY, CARPOMETACARPAL JOINT
261..     26140  SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION, EACH
                  INTERPHALANGEAL
261..     26145  SYNOVECTOMY TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR, PALM OR FINGER, SINGLE, EACH
                  DIGIT
261..     26160  EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLION), HAND OR
                  FINGER
261..     26170  EXCISION OF TENDON, PALM, FLEXOR, SINGLE (SEPARATE PROCEDURE), EACH
261..     26180  EXCISION OF TENDON, FINGER, FLEXOR (SEPARATE PROCEDURE)
261..     26185  SESAMOIDECTOMY, THUMB OR FINGER (SEPARATE PROCEDURE)
261..     26200  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL;
261..     26210  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR DISTAL PHALANX OF
                  FINGER;
261..     26215  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR DISTAL PHALANX OF
                  FINGER; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
261..     26230  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS); METACARPAL
261..     26235  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS); PROXIMAL OR MIDDLE PHALANX OF FINGER
261..     26236  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS); DISTAL PHALANX OF FINGER
261..     26250  RADICAL RESECTION (OSTECTOMY) FOR TUMOR, METACARPAL;
261..     26260  RADICAL RESECTION (OSTECTOMY) FOR TUMOR, PROXIMAL OR MIDDLE PHALANX OF FINGER;
261..     26261  RADICAL RESECTION (OSTECTOMY) FOR TUMOR, PROXIMAL OR MIDDLE PHALANX OF FINGER; WITH AUTOGRAFT
                  (INCLUDES OBTAINING GRAFT)
261..     26262  RADICAL RESECTION (OSTECTOMY) FOR TUMOR, DISTAL PHALANX OF FINGER
261..     26410  EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH
                  TENDON
261..     26418  EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT,
                  EACH TENDON
261..     26432  EXTENSOR TENDON REPAIR, DISTAL INSERTION (``MALLET FINGER''), CLOSED, SPLINTING WITH OR WITHOUT
                  PERCUTANEOUS PINNING
261..     26433  EXTENSOR TENDON REPAIR, DISTAL INSERTION (``MALLET FINGER''), OPEN, PRIMARY OR SECONDARY
                  REPAIR; WITHOUT GRAFT
261..     26437  EXTENSOR TENDON REALIGNMENT, HAND
261..     26440  TENOLYSIS, SIMPLE, FLEXOR TENDON; PALM OR FINGER, SINGLE, EACH TENDON
261..     26445  TENOLYSIS, EXTENSOR TENDON, DORSUM OF HAND OR FINGER; EACH TENDON
261..     26450  TENOTOMY, FLEXOR, SINGLE, PALM, OPEN, EACH
261..     26455  TENOTOMY, FLEXOR, SINGLE, FINGER, OPEN, EACH
261..     26460  TENOTOMY, EXTENSOR, HAND OR FINGER, SINGLE, OPEN, EACH
261..     26471  TENODESIS; FOR PROXIMAL INTERPHALANGEAL JOINT STABILIZATION
261..     26474  TENODESIS; FOR DISTAL JOINT STABILIZATION
261..     26476  TENDON LENGTHENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH
261..     26477  TENDON SHORTENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH
261..     26478  TENDON LENGTHENING, FLEXOR, HAND OR FINGER, SINGLE, EACH
261..     26479  TENDON SHORTENING, FLEXOR, HAND OR FINGER, SINGLE, EACH
261..     26500  TENDON PULLEY RECONSTRUCTION; WITH LOCAL TISSUES (SEPARATE PROCEDURE)
261..     26508  THENAR MUSCLE RELEASE FOR THUMB CONTRACTURE
261..     26520  CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE; METACARPOPHALANGEAL JOINT, SINGLE, EACH
261..     26525  CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE; INTERPHALANGEAL JOINT, SINGLE, EACH
261..     26540  REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
261..     26542  RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH LOCAL TISSUE (EG,
                  ADDUCTOR ADVANCEMENT)
261..     26560  REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS
261..     26587  RECONSTRUCTION OF SUPERNUMERARY DIGIT, SOFT TISSUE AND BONE
261..     26593  RELEASE, INTRINSIC MUSCLES OF HAND (SPECIFY)
261..     26951  AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING
                  NEURECTOMIES; WITH DIRECT CLOSURE
261..     26952  AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING
                  NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)
262..  Level II Hand Musculoskeletal   T                       18.35     $929.78         $480.82         $185.96
       Procedures
262..     25210  CARPECTOMY; ONE BONE
262..     25215  CARPECTOMY; ALL BONES OF PROXIMAL ROW
262..     25825  INTERCARPAL FUSION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
262..     26040  FASCIOTOMY, PALMAR, FOR DUPUYTREN'S CONTRACTURE; PERCUTANEOUS
262..     26045  FASCIOTOMY, PALMAR, FOR DUPUYTREN'S CONTRACTURE; OPEN, PARTIAL
262..     26121  FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN
                  GRAFTING (INCLUDES OBTAINING GRAFT)

[[Page 47785]]

262..     26123  FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL
                  JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES
                  OBTAINING GRAFT);
262..     26125  FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL
                  JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES
                  OBTAINING GRAFT); EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION
262..     26135  SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR HOOD
                  RECONSTRUCTION, EACH DIGIT
262..     26205  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL; WITH AUTOGRAFT (INCLUDES
                  OBTAINING GRAFT)
262..     26255  RADICAL RESECTION (OSTECTOMY) FOR TUMOR, METACARPAL; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
262..     26350  FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, NOT IN ''NO MAN'S LAND''; PRIMARY OR SECONDARY
                  WITHOUT FREE GRAFT, EACH TENDON
262..     26352  FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, NOT IN ''NO MAN'S LAND''; SECONDARY WITH FREE
                  GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON
262..     26356  FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN ''NO MAN'S LAND''; PRIMARY, EACH TENDON
262..     26357  FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN ''NO MAN'S LAND''; SECONDARY, EACH TENDON
262..     26358  FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN ''NO MAN'S LAND''; SECONDARY WITH FREE GRAFT
                  (INCLUDES OBTAINING GRAFT), EACH TENDON
262..     26370  PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT SUBLIMIS; PRIMARY
262..     26372  PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT SUBLIMIS; SECONDARY WITH FREE GRAFT
                  (INCLUDES OBTAINING GRAFT)
262..     26373  PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT SUBLIMIS; SECONDARY WITHOUT FREE GRAFT
262..     26390  FLEXOR TENDON EXCISION, IMPLANTATION OF PLASTIC TUBE OR ROD FOR DELAYED TENDON GRAFT, HAND OR
                  FINGER
262..     26392  REMOVAL OF TUBE OR ROD AND INSERTION OF FLEXOR TENDON GRAFT (INCLUDES OBTAINING GRAFT), HAND OR
                  FINGER
262..     26412  EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES
                  OBTAINING GRAFT), EACH TENDON
262..     26415  EXTENSOR TENDON EXCISION, IMPLANTATION OF PLASTIC TUBE OR ROD FOR DELAYED EXTENSOR TENDON
                  GRAFT, HAND OR FINGER
262..     26416  REMOVAL OF TUBE OR ROD AND INSERTION OF EXTENSOR TENDON GRAFT (INCLUDES OBTAINING GRAFT), HAND
                  OR FINGER
262..     26420  EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, PRIMARY OR SECONDARY; WITH FREE GRAFT
                  (INCLUDES OBTAINING GRAFT) EACH TENDON
262..     26426  EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, SECONDARY (BOUTONNIERE DEFORMITY); USING LOCAL
                  TISSUES
262..     26428  EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, SECONDARY (BOUTONNIERE DEFORMITY); WITH FREE GRAFT
                  (INCLUDES OBTAINING GRAFT)
262..     26434  EXTENSOR TENDON REPAIR, DISTAL INSERTION (''MALLET FINGER''), OPEN, PRIMARY OR SECONDARY
                  REPAIR; WITH FREE GRAFT (INCLUDES OBTAINING GRAFT)
262..     26442  TENOLYSIS, SIMPLE, FLEXOR TENDON; PALM AND FINGER, EACH TENDON
262..     26449  TENOLYSIS, COMPLEX, EXTENSOR TENDON, DORSUM OF HAND OR FINGER, INCLUDING HAND AND FOREARM
262..     26480  TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL AREA OR DORSUM OF HAND, SINGLE; WITHOUT FREE
                  GRAFT, EACH
262..     26483  TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL AREA OR DORSUM OF HAND, SINGLE; WITH FREE TENDON
                  GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON
262..     26485  TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, EACH TENDON; WITHOUT FREE TENDON GRAFT
262..     26489  TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, EACH TENDON; WITH FREE TENDON GRAFT (INCLUDES
                  OBTAINING GRAFT), EACH TENDON
262..     26490  OPPONENSPLASTY; SUBLIMIS TENDON TRANSFER TYPE
262..     26492  OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT (INCLUDES OBTAINING GRAFT)
262..     26494  OPPONENSPLASTY; HYPOTHENAR MUSCLE TRANSFER
262..     26496  OPPONENSPLASTY; OTHER METHODS
262..     26497  TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION; RING AND SMALL FINGER
262..     26498  TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION; ALL FOUR FINGERS
262..     26499  CORRECTION CLAW FINGER, OTHER METHODS
262..     26502  TENDON PULLEY RECONSTRUCTION; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT) (SEPARATE
                  PROCEDURE)
262..     26504  TENDON PULLEY RECONSTRUCTION; WITH TENDON PROSTHESIS (SEPARATE PROCEDURE)
262..     26510  CROSS INTRINSIC TRANSFER
262..     26516  CAPSULODESIS FOR M-P JOINT STABILIZATION; SINGLE DIGIT
262..     26517  CAPSULODESIS FOR M-P JOINT STABILIZATION; TWO DIGITS
262..     26518  CAPSULODESIS FOR M-P JOINT STABILIZATION; THREE OR FOUR DIGITS
262..     26541  RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH TENDON OR FASCIAL
                  GRAFT (INCLUDES OBTAINING GRAFT)
262..     26545  RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, INCLUDING GRAFT, EACH JOINT
262..     26546  REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDES OBTAINING BONE GRAFT WITH OR WITHOUT
                  EXTERNAL OR INTERNAL FIXATION)
262..     26548  REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT
262..     26550  POLLICIZATION OF A DIGIT
262..     26555  POSITIONAL CHANGE OF OTHER FINGER
262..     26561  REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS AND GRAFTS
262..     26562  REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; COMPLEX (EG, INVOLVING BONE, NAILS)
262..     26565  OSTEOTOMY FOR CORRECTION OF DEFORMITY; METACARPAL
262..     26567  OSTEOTOMY FOR CORRECTION OF DEFORMITY; PHALANX OF FINGER
262..     26568  OSTEOPLASTY FOR LENGTHENING OF METACARPAL OR PHALANX
262..     26580  REPAIR CLEFT HAND
262..     26585  REPAIR BIFID DIGIT
262..     26590  REPAIR MACRODACTYLIA
262..     26591  REPAIR, INTRINSIC MUSCLES OF HAND (SPECIFY)
262..     26596  EXCISION OF CONSTRICTING RING OF FINGER, WITH MULTIPLE Z-PLASTIES
262..     26597  RELEASE OF SCAR CONTRACTURE, FLEXOR OR EXTENSOR, WITH SKIN GRAFTS, REARRANGEMENT FLAPS, OR Z-
                  PLASTIES, HAND AND/OR FINGER

[[Page 47786]]

262..     26820  FUSION IN OPPOSITION, THUMB, WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)
262..     26841  ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION;
262..     26842  ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT
                  (INCLUDES OBTAINING GRAFT)
262..     26843  ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER THAN THUMB;
262..     26844  ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER THAN THUMB; WITH AUTOGRAFT (INCLUDES
                  OBTAINING GRAFT)
262..     26850  ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
262..     26852  ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT
                  (INCLUDES OBTAINING GRAFT)
262..     26860  ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
262..     26861  ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH ADDITIONAL
                  INTERPHALANGEAL JOINT
262..     26862  ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES
                  OBTAINING GRAFT)
262..     26863  ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES
                  OBTAINING GRAFT), EACH ADDITIONAL JOINT
262..     26910  AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT
                  INTEROSSEOUS TRANSFER
271..  Level I Foot Musculoskeletal    T                       14.41     $730.15         $368.38         $146.03
       Procedures
271..     27605  TENOTOMY, ACHILLES TENDON, SUBCUTANEOUS (SEPARATE PROCEDURE); *LOCAL ANESTHESIA
271..     28005  INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOOT
271..     28008  FASCIOTOMY, FOOT AND/OR TOE
271..     28010  TENOTOMY, SUBCUTANEOUS, TOE; SINGLE
271..     28011  TENOTOMY, SUBCUTANEOUS, TOE; MULTIPLE
271..     28020  ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERTARSAL OR
                  TARSOMETATARSAL JOINT
271..     28022  ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY;
                  METATARSOPHALANGEAL JOINT
271..     28024  ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHALANGEAL
                  JOINT
271..     28045  EXCISION, TUMOR, FOOT; DEEP, SUBFASCIAL, INTRAMUSCULAR
271..     28046  RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT
271..     28050  ARTHROTOMY FOR SYNOVIAL BIOPSY; INTERTARSAL OR TARSOMETATARSAL JOINT
271..     28052  ARTHROTOMY FOR SYNOVIAL BIOPSY; METATARSOPHALANGEAL JOINT
271..     28054  ARTHROTOMY FOR SYNOVIAL BIOPSY; INTERPHALANGEAL JOINT
271..     28080  EXCISION OF INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH
271..     28086  SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
271..     28088  SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR
271..     28090  EXCISION OF LESION OF TENDON OR FIBROUS SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) (CYST OR
                  GANGLION); FOOT
271..     28092  EXCISION OF LESION OF TENDON OR FIBROUS SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) (CYST OR
                  GANGLION); TOES
271..     28100  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;
271..     28104  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL BONES, EXCEPT TALUS OR
                  CALCANEUS;
271..     28108  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT
271..     28111  OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD
271..     28112  OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)
271..     28113  OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD
271..     28114  OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITH PARTIAL PROXIMAL PHALANGECTOMY,
                  EXCLUDING FIRST METATARSAL (CLAYTON TYPE PROCEDURE)
271..     28116  OSTECTOMY, EXCISION OF TARSAL COALITION
271..     28118  OSTECTOMY, CALCANEUS;
271..     28119  OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE
271..     28120  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) OF BONE (EG,
                  FOR OSTEOMYELITIS OR TALAR BOSSING), TALUS OR CALCANEUS
271..     28122  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS OR TARSAL BOSSING), TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
271..     28124  PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR
                  OSTEOMYELITIS OR DORSAL BOSSING), PHALANX OF TOE
271..     28126  RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, SINGLE TOE, EACH
271..     28130  TALECTOMY (ASTRAGALECTOMY)
271..     28140  METATARSECTOMY
271..     28150  PHALANGECTOMY OF TOE, SINGLE, EACH
271..     28153  RESECTION, HEAD OF PHALANX, TOE
271..     28160  HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, SINGLE, EACH
271..     28171  RADICAL RESECTION OF TUMOR, BONE; TARSAL (EXCEPT TALUS OR CALCANEUS)
271..     28173  RADICAL RESECTION OF TUMOR, BONE; METATARSAL
271..     28175  RADICAL RESECTION OF TUMOR, BONE; PHALANX OF TOE
271..     28200  REPAIR OR SUTURE OF TENDON, FOOT, FLEXOR, SINGLE; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT,
                  EACH TENDON
271..     28208  REPAIR OR SUTURE OF TENDON, FOOT, EXTENSOR, SINGLE; PRIMARY OR SECONDARY, EACH TENDON
271..     28210  REPAIR OR SUTURE OF TENDON, FOOT, EXTENSOR, SINGLE; SECONDARY WITH FREE GRAFT, EACH TENDON
                  (INCLUDES OBTAINING GRAFT)
271..     28220  TENOLYSIS, FLEXOR, FOOT; SINGLE
271..     28222  TENOLYSIS, FLEXOR, FOOT; MULTIPLE (THROUGH SAME INCISION)
271..     28225  TENOLYSIS, EXTENSOR, FOOT; SINGLE
271..     28226  TENOLYSIS, EXTENSOR, FOOT; MULTIPLE (THROUGH SAME INCISION)
271..     28230  TENOTOMY, OPEN, FLEXOR; FOOT, SINGLE OR MULTIPLE (SEPARATE PROCEDURE)
271..     28232  TENOTOMY, OPEN, FLEXOR; TOE, SINGLE (SEPARATE PROCEDURE)
271..     28234  TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE
271..     28240  TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE
271..     28270  CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, SINGLE, EACH JOINT
                  (SEPARATE PROCEDURE)

[[Page 47787]]

271..     28272  CAPSULOTOMY; INTERPHALANGEAL JOINT, SINGLE, EACH JOINT (SEPARATE PROCEDURE)
271..     28280  WEBBING OPERATION (CREATE SYNDACTYLISM OF TOES) (KELIKIAN TYPE PROCEDURE)
271..     28285  HAMMERTOE OPERATION, ONE TOE (EG, INTERPHALANGEAL FUSION, FILLETING, PHALANGECTOMY)
271..     28286  COCK-UP FIFTH TOE OPERATION WITH PLASTIC SKIN CLOSURE (RUIZ-MORA TYPE PROCEDURE)
271..     28310  OSTEOTOMY FOR SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST TOE
                  (SEPARATE PROCEDURE)
271..     28312  OSTEOTOMY FOR SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY TOE
271..     28313  RECONSTRUCTION, ANGULAR DEFORMITY OF TOE (OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES), SOFT
                  TISSUE PROCEDURES ONLY
271..     28315  SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)
271..     28340  RECONSTRUCTION, TOE, MACRODACTYLY; SOFT TISSUE RESECTION
271..     28341  RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE RESECTION
271..     28737  ARTHRODESIS, MIDTARSAL NAVICULAR-CUNEIFORM, WITH TENDON LENGTHENING AND ADVANCEMENT (MILLER
                  TYPE PROCEDURE)
271..     28750  ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
271..     28755  ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
271..     28810  AMPUTATION, METATARSAL, WITH TOE, SINGLE
271..     28820  AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
271..     28825  AMPUTATION, TOE; INTERPHALANGEAL JOINT
271..     29893  ENDOSCOPIC PLANTAR FASCIOTOMY
272..  Level II Foot Musculoskeletal   T                       16.56     $839.09         $409.74         $167.82
       Procedures
272..     28060  FASCIECTOMY, EXCISION OF PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
272..     28062  FASCIECTOMY, EXCISION OF PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)
272..     28070  SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL JOINT, EACH
272..     28072  SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH
272..     28102  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ILIAC OR OTHER
                  AUTOGRAFT (INCLUDES OBTAINING GRAFT)
272..     28103  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ALLOGRAFT
272..     28106  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL BONES, EXCEPT TALUS OR
                  CALCANEUS; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)
272..     28107  EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL BONES, EXCEPT TALUS OR
                  CALCANEUS; WITH ALLOGRAFT
272..     28202  REPAIR OR SUTURE OF TENDON, FOOT, FLEXOR, SINGLE; SECONDARY WITH FREE GRAFT, EACH TENDON
                  (INCLUDES OBTAINING GRAFT)
272..     28238  ADVANCEMENT OF POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY NAVICULAR BONE (KIDNER TYPE
                  PROCEDURE)
272..     28250  DIVISION OF PLANTAR FASCIA AND MUSCLE (''STEINDLER STRIPPING'') (SEPARATE PROCEDURE)
272..     28260  CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)
272..     28261  CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING
272..     28262  CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND TENDON(S)
                  LENGTHENING AS FOR RESISTANT CLUBFOOT DEFORMITY
272..     28264  CAPSULOTOMY, MIDTARSAL (HEYMAN TYPE PROCEDURE)
272..     28288  OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, SINGLE, METATARSAL HEAD, FIRST THROUGH FIFTH,
                  EACH METATARSAL HEAD
272..     28300  OSTEOTOMY; CALCANEUS (DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION
272..     28302  OSTEOTOMY; TALUS
272..     28304  OSTEOTOMY, MIDTARSAL BONES, OTHER THAN CALCANEUS OR TALUS;
272..     28305  OSTEOTOMY, MIDTARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT (INCLUDES OBTAINING
                  GRAFT) (FOWLER TYPE)
272..     28306  OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT LENGTHENING, FOR SHORTENING OR
                  ANGULAR CORRECTION; FIRST METATARSAL
272..     28307  OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT LENGTHENING, FOR SHORTENING OR
                  ANGULAR CORRECTION; FIRST METATARSAL WITH AUTOGRAFT
272..     28308  OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT LENGTHENING, FOR SHORTENING OR
                  ANGULAR CORRECTION; OTHER THAN FIRST METATARSAL
272..     28309  OSTEOTOMY, METATARSALS, MULTIPLE, FOR CAVUS FOOT (SWANSON TYPE PROCEDURE)
272..     28320  REPAIR OF NONUNION OR MALUNION; TARSAL BONES (EG, CALCANEUS, TALUS)
272..     28322  REPAIR OF NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING
                  GRAFT)
272..     28344  RECONSTRUCTION, TOE(S); POLYDACTYLY
272..     28345  RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKIN GRAFT(S), EACH WEB
272..     28360  RECONSTRUCTION, CLEFT FOOT
272..     28705  PANTALAR ARTHRODESIS
272..     28715  TRIPLE ARTHRODESIS
272..     28725  SUBTALAR ARTHRODESIS
272..     28730  ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;
272..     28735  ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOMY AS FOR
                  FLATFOOT CORRECTION
272..     28740  ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
272..     28760  ARTHRODESIS, GREAT TOE, INTERPHALANGEAL JOINT, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRST
                  METATARSAL NECK (JONES TYPE PROCEDURE)
276..  Bunion Procedures               T                       19.19     $972.35         $500.14         $194.47
276..     28110  OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE)
276..     28290  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; SIMPLE EXOSTECTOMY (SILVER
                  TYPE PROCEDURE)
276..     28292  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; KELLER, MCBRIDE, OR MAYO
                  TYPE PROCEDURE
276..     28293  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; RESECTION OF JOINT WITH
                  IMPLANT

[[Page 47788]]

276..     28294  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; WITH TENDON TRANSPLANTS
                  (JOPLIN TYPE PROCEDURE)
276..     28296  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; WITH METATARSAL OSTEOTOMY
                  (EG, MITCHELL, CHEVRON, OR CONCENTRIC TYPE PROCEDURES)
276..     28297  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; LAPIDUS TYPE PROCEDURE
276..     28298  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; BY PHALANX OSTEOTOMY
276..     28299  HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; BY OTHER METHODS (EG, DOUBLE
                  OSTEOTOMY)
280..  Diagnostic Arthroscopy          T                        22.2   $1,124.86         $581.72         $224.97
280..     29800  ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE
                  PROCEDURE)
280..     29815  ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
280..     29830  ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
280..     29840  ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
280..     29870  ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
280..     29909  UNLISTED PROCEDURE, ARTHROSCOPY
281..  Level I Surgical Arthroscopy    T                       22.65   $1,147.66         $590.20         $229.53
281..     29804  ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL
281..     29819  ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
281..     29820  ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL
281..     29821  ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE
281..     29822  ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED
281..     29823  ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE
281..     29825  ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR WITHOUT
                  MANIPULATION
281..     29826  ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY,
                  WITH OR WITHOUT CORACOACROMIAL RELEASE
281..     29834  ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
281..     29835  ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL
281..     29836  ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE
281..     29837  ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED
281..     29838  ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE
281..     29843  ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
281..     29844  ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL
281..     29845  ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE
281..     29846  ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR OF TRIANGULAR FIBROCARTILAGE AND/OR JOINT
                  DEBRIDEMENT
281..     29847  ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR FRACTURE OR INSTABILITY
281..     29848  ARTHROSCOPY, WRIST, SURGICAL; WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT
281..     29860  ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
281..     29861  ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
281..     29862  ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY),
                  ABRASION ARTHROPLASTY, AND/OR RESECTION OF LABRUM
281..     29863  ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY
281..     29874  ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHONDRITIS
                  DISSECANS FRAGMENTATION, CHONDRAL FRAGMENTATION)
281..     29875  ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE
                  PROCEDURE)
281..     29877  ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY)
281..     29879  ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY) OR
                  MULTIPLE DRILLING
281..     29880  ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL
                  SHAVING)
281..     29881  ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL
                  SHAVING)
281..     29884  ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT MANIPULATION (SEPARATE
                  PROCEDURE)
281..     29886  ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION
281..     29894  ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOSE BODY OR
                  FOREIGN BODY
281..     29895  ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL
281..     29897  ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED
281..     29898  ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSIVE
282..  Level II Surgical Arthroscopy   T                       23.94   $1,213.03         $614.04         $242.61
282..     29871  ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
282..     29876  ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, TWO OR MORE COMPARTMENTS (EG, MEDIAL OR
                  LATERAL)
282..     29882  ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)
282..     29883  ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)
282..     29885  ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH BONE GRAFTING, WITH OR
                  WITHOUT INTERNAL FIXATION (INCLUDING DEBRIDEMENT OF BASE OF LESION)
282..     29887  ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL
                  FIXATION
282..     29891  ARTHROSCOPY, ANKLE, SURGICAL; EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, INCLUDING
                  DRILLING OF THE DEFECT
286..  Arthroscopically-Aided          T                       26.76   $1,355.91         $802.41         $271.18
       Procedures
286..     29850  ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE
                  KNEE, WITH OR WITHOUT MANIPULATION; WITHOUT INTERNAL OR EXTERNAL FIXATION (INCLUDES
                  ARTHROSCOPY)
286..     29851  ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE
                  KNEE, WITH OR WITHOUT MANIPULATION; WITH INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)
286..     29855  ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, WITH OR
                  WITHOUT INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)
286..     29856  ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR
                  WITHOUT INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)

[[Page 47789]]

286..     29888  ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION
286..     29889  ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/ AUGMENTATION OR RECONSTRUCTION
286..     29892  ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR DOME FRACTURE,
                  OR TIBIAL PLAFOND FRACTURE, WITH OR WITHOUT INTERNAL FIXATION (INCLUDES ARTHROSCOPY)
311..  Level I ENT Procedures          T                        1.43      $72.46          $20.57          $14.49
311..     30000  DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH
311..     30020  DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM
311..     30100  BIOPSY, INTRANASAL
311..     30110  EXCISION, NASAL POLYP(S), SIMPLE
311..     30117  EXCISION OR DESTRUCTION, ANY METHOD (INCLUDING LASER), INTRANASAL LESION; INTERNAL APPROACH
311..     30124  EXCISION DERMOID CYST, NOSE; SIMPLE, SKIN, SUBCUTANEOUS
311..     30210  DISPLACEMENT THERAPY (PROETZ TYPE)
311..     30220  INSERTION, NASAL SEPTAL PROSTHESIS (BUTTON)
311..     30300  REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE
311..     30560  LYSIS INTRANASAL SYNECHIA
311..     31000  LAVAGE BY CANNULATION; MAXILLARY SINUS (ANTRUM PUNCTURE OR NATURAL OSTIUM)
311..     31002  LAVAGE BY CANNULATION; SPHENOID SINUS
311..     31603  TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL
311..     31605  TRACHEOSTOMY, EMERGENCY PROCEDURE; CRICOTHYROID MEMBRANE
311..     40490  BIOPSY OF LIP
311..     40799  UNLISTED PROCEDURE, LIPS
311..     40800  DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
311..     40801  DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
311..     40804  REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
311..     40805  REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
311..     40806  INCISION OF LABIAL FRENUM (FRENOTOMY)
311..     40808  BIOPSY, VESTIBULE OF MOUTH
311..     40810  EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITHOUT REPAIR
311..     40812  EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH SIMPLE REPAIR
311..     40820  DESTRUCTION OF LESION OR SCAR OF VESTIBULE OF MOUTH BY PHYSICAL METHODS (EG, LASER, THERMAL,
                  CRYO, CHEMICAL)
311..     40899  UNLISTED PROCEDURE, VESTIBULE OF MOUTH
311..     41000  INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH;
                  LINGUAL
311..     41005  INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH;
                  SUBLINGUAL, SUPERFICIAL
311..     41100  BIOPSY OF TONGUE; ANTERIOR TWO-THIRDS
311..     41105  BIOPSY OF TONGUE; POSTERIOR ONE-THIRD
311..     41108  BIOPSY OF FLOOR OF MOUTH
311..     41110  EXCISION OF LESION OF TONGUE WITHOUT CLOSURE
311..     41115  EXCISION OF LINGUAL FRENUM (FRENECTOMY)
311..     41599  UNLISTED PROCEDURE, TONGUE, FLOOR OF MOUTH
311..     41805  REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
311..     41806  REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; BONE
311..     41820  GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT
311..     41821  OPERCULECTOMY, EXCISION PERICORONAL TISSUES
311..     41825  EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITHOUT REPAIR
311..     41826  EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH SIMPLE REPAIR
311..     41828  EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA, EACH QUADRANT (SPECIFY)
311..     41830  ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS OR SEQUESTRECTOMY
311..     41850  DESTRUCTION OF LESION (EXCEPT EXCISION), DENTOALVEOLAR STRUCTURES
311..     41870  PERIODONTAL MUCOSAL GRAFTING
311..     41872  GINGIVOPLASTY, EACH QUADRANT (SPECIFY)
311..     41874  ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
311..     41899  UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES
311..     42000  DRAINAGE OF ABSCESS OF PALATE, UVULA
311..     42100  BIOPSY OF PALATE, UVULA
311..     42104  EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
311..     42106  EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE
311..     42140  UVULECTOMY, EXCISION OF UVULA
311..     42160  DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO OR CHEMICAL)
311..     42280  MAXILLARY IMPRESSION FOR PALATAL PROSTHESIS
311..     42281  INSERTION OF PIN-RETAINED PALATAL PROSTHESIS
311..     42299  UNLISTED PROCEDURE, PALATE, UVULA
311..     42330  SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID, UNCOMPLICATED, INTRAORAL
311..     42335  SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
311..     42650  DILATION SALIVARY DUCT
311..     42660  DILATION AND CATHETERIZATION OF SALIVARY DUCT, WITH OR WITHOUT INJECTION
311..     42665  LIGATION SALIVARY DUCT, INTRAORAL
311..     42699  UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS
311..     69200  REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA
311..     69210  REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS
311..     69222  DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA OR MORE THAN ROUTINE CLEANING)
311..     69399  UNLISTED PROCEDURE, EXTERNAL EAR
311..     69400  EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITH CATHETERIZATION
311..     69405  EUSTACHIAN TUBE CATHETERIZATION, TRANSTYMPANIC
311..     69410  FOCAL APPLICATION OF PHASE CONTROL SUBSTANCE, MIDDLE EAR (BAFFLE TECHNIQUE)

[[Page 47790]]

311..     69420  MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
311..     69424  VENTILATING TUBE REMOVAL WHEN ORIGINALLY INSERTED BY ANOTHER PHYSICIAN
311..     69540  EXCISION AURAL POLYP
311..     69610  TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OR PERFORATION FOR CLOSURE, WITH OR
                  WITHOUT PATCH
311..     69799  UNLISTED PROCEDURE, MIDDLE EAR
311..     92502  OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
312..  Level II ENT Procedures         T                        7.26     $367.86         $178.31          $73.57
312..     30801  CAUTERIZATION AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD,
                  (SEPARATE PROCEDURE); SUPERFICIAL
312..     30802  CAUTERIZATION AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD,
                  (SEPARATE PROCEDURE); INTRAMURAL
312..     30930  FRACTURE NASAL TURBINATE(S), THERAPEUTIC
312..     31612  TRACHEAL PUNCTURE, PERCUTANEOUS WITH TRANSTRACHEAL ASPIRATION AND/OR INJECTION
12...     40830  CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS
312..     40831  CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM OR COMPLEX
312..     41250  REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONGUE
312..     41251  REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE-THIRD OF TONGUE
312..     41252  REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLEX
312..     41500  FIXATION OF TONGUE, MECHANICAL, OTHER THAN SUTURE (EG, K-WIRE)
312..     41510  SUTURE OF TONGUE TO LIP FOR MICROGNATHIA (DOUGLAS TYPE PROCEDURE)
312..     41800  DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES
312..     42300  DRAINAGE OF ABSCESS; PAROTID, SIMPLE
312..     42305  DRAINAGE OF ABSCESS; PAROTID, COMPLICATED
312..     42310  DRAINAGE OF ABSCESS; SUBMAXILLARY OR SUBLINGUAL, INTRAORAL
312..     42320  DRAINAGE OF ABSCESS; SUBMAXILLARY, EXTERNAL
312..     42405  BIOPSY OF SALIVARY GLAND; INCISIONAL
312..     42700  INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
312..     42720  INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, INTRAORAL APPROACH
312..     42800  BIOPSY; OROPHARYNX
312..     42802  BIOPSY; HYPOPHARYNX
312..     42804  BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE
312..     42806  BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY LESION
312..     42808  EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD
312..     60000  INCISION AND DRAINAGE OF THYROGLOSSAL CYST, INFECTED
312..     69421  MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
312..     69433  TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), LOCAL OR TOPICAL ANESTHESIA
312..     69436  TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
313..  Level III ENT Procedures        T                       15.81     $801.08         $411.09         $160.22
313..     30115  EXCISION, NASAL POLYP(S), EXTENSIVE
313..     30118  EXCISION OR DESTRUCTION, ANY METHOD (INCLUDING LASER), INTRANASAL LESION; EXTERNAL APPROACH
                  (LATERAL RHINOTOMY)
313..     30120  EXCISION OR SURGICAL PLANING OF SKIN OF NOSE FOR RHINOPHYMA
313..     30125  EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE OR CARTILAGE
313..     30130  EXCISION TURBINATE, PARTIAL OR COMPLETE
313..     30140  SUBMUCOUS RESECTION TURBINATE, PARTIAL OR COMPLETE
313..     30150  RHINECTOMY; PARTIAL
313..     30160  RHINECTOMY; TOTAL
313..     30310  REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
313..     30320  REMOVAL FOREIGN BODY, INTRANASAL; BY LATERAL RHINOTOMY
313..     30430  RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OF NASAL TIP WORK)
313..     30520  SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR
                  REPLACEMENT WITH GRAFT
313..     30540  REPAIR CHOANAL ATRESIA; INTRANASAL
313..     30580  REPAIR FISTULA; OROMAXILLARY (COMBINE WITH 31030 IF ANTROTOMY IS INCLUDED)
313..     30600  REPAIR FISTULA; ORONASAL
313..     30620  SEPTAL OR OTHER INTRANASAL DERMATOPLASTY (DOES NOT INCLUDE OBTAINING GRAFT)
313..     30630  REPAIR NASAL SEPTAL PERFORATIONS
313..     31020  SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL
313..     31030  SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITHOUT REMOVAL OF ANTROCHOANAL
                  POLYPS
313..     31032  SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITH REMOVAL OF ANTROCHOANAL POLYPS
313..     31050  SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;
313..     31051  SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; WITH MUCOSAL STRIPPING OR REMOVAL OF POLYP(S)
313..     31070  SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE OPERATION)
313..     31200  ETHMOIDECTOMY; INTRANASAL, ANTERIOR
313..     31320  LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); DIAGNOSTIC
313..     31595  SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SEPARATE PROCEDURE), UNILATERAL
313..     31611  CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBSEQUENT INSERTION OF AN ALARYNGEAL SPEECH
                  PROSTHESIS (EG, VOICE BUTTON, BLOM-SINGER PROSTHESIS)
313..     31613  TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION
313..     31614  TRACHEOSTOMA REVISION; COMPLEX, WITH FLAP ROTATION
313..     31820  SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR
313..     31825  SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTIC REPAIR
313..     31830  REVISION OF TRACHEOSTOMY SCAR
313..     40500  VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT

[[Page 47791]]

313..     40510  EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH PRIMARY CLOSURE
313..     40520  EXCISION OF LIP; V-EXCISION WITH PRIMARY DIRECT LINEAR CLOSURE
313..     40525  EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER OR FAN)
313..     40527  EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP (ABBE-ESTLANDER)
313..     40530  RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUT RECONSTRUCTION
313..     40650  REPAIR LIP, FULL THICKNESS; VERMILION ONLY
313..     40652  REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HEIGHT
313..     40654  REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX
313..     40814  EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH COMPLEX REPAIR
313..     40816  EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; COMPLEX, WITH EXCISION OF
                  UNDERLYING MUSCLE
313..     40818  EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT
313..     40819  EXCISION OF FRENUM, LABIAL OR BUCCAL (FRENUMECTOMY, FRENULECTOMY, FRENECTOMY)
313..     40840  VESTIBULOPLASTY; ANTERIOR
313..     40842  VESTIBULOPLASTY; POSTERIOR, UNILATERAL
313..     41006  INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH;
                  SUBLINGUAL, DEEP, SUPRAMYLOHYOID
313..     41007  INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH;
                  SUBMENTAL SPACE
313..     41008  INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH;
                  SUBMANDIBULAR
313..     41009  INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH;
                  MASTICATOR SPACE
313..     41010  INCISION OF LINGUAL FRENUM (FRENOTOMY)
313..     41015  EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBLINGUAL
313..     41016  EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMENTAL
313..     41017  EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMANDIBULAR
313..     41018  EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; MASTICATOR
                  SPACE
313..     41112  EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS
313..     41113  EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD
313..     41114  EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUE FLAP
313..     41116  EXCISION, LESION OF FLOOR OF MOUTH
313..     41120  GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
313..     41520  FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)
313..     41827  EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH COMPLEX
                  REPAIR
313..     42107  EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE
313..     42120  RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION
313..     42180  REPAIR, LACERATION OF PALATE; UP TO 2 CM
313..     42182  REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX
313..     42200  PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
313..     42205  PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY
313..     42215  PALATOPLASTY FOR CLEFT PALATE; MAJOR REVISION
313..     42220  PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENING PROCEDURE
313..     42235  REPAIR OF ANTERIOR PALATE, INCLUDING VOMER FLAP
313..     42260  REPAIR OF NASOLABIAL FISTULA
313..     42325  FISTULIZATION OF SUBLINGUAL SALIVARY CYST (RANULA);
313..     42326  FISTULIZATION OF SUBLINGUAL SALIVARY CYST (RANULA); WITH PROSTHESIS
313..     42340  SIALOLITHOTOMY; PAROTID, EXTRAORAL OR COMPLICATED INTRAORAL
313..     42408  EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA)
313..     42409  MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)
313..     42410  EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITHOUT NERVE DISSECTION
313..     42440  EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND
313..     42450  EXCISION OF SUBLINGUAL GLAND
313..     42500  PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
313..     42505  PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; SECONDARY OR COMPLICATED
313..     42507  PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE);
313..     42508  PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF ONE SUBMANDIBULAR
                  GLAND
313..     42510  PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH LIGATION OF BOTH SUBMANDIBULAR
                  (WHARTON'S) DUCTS
313..     42600  CLOSURE SALIVARY FISTULA
313..     42725  INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, EXTERNAL APPROACH
313..     42810  EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINED TO SKIN AND SUBCUTANEOUS TISSUES
313..     42815  EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA, EXTENDING BENEATH SUBCUTANEOUS TISSUES AND/
                  OR INTO PHARYNX
313..     42900  SUTURE PHARYNX FOR WOUND OR INJURY
313..     42950  PHARYNGOPLASTY (PLASTIC OR RECONSTRUCTIVE OPERATION ON PHARYNX)
313..     42955  PHARYNGOSTOMY (FISTULIZATION OF PHARYNX, EXTERNAL FOR FEEDING)
313..     42962  CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); WITH SECONDARY
                  SURGICAL INTERVENTION
313..     42972  CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTADENOIDECTOMY); WITH
                  SECONDARY SURGICAL INTERVENTION
313..     43020  ESOPHAGOTOMY, CERVICAL APPROACH, WITH REMOVAL OF FOREIGN BODY
313..     43030  CRICOPHARYNGEAL MYOTOMY
313..     69120  EXCISION EXTERNAL EAR; COMPLETE AMPUTATION
313..     69140  EXCISION EXOSTOSIS(ES), EXTERNAL AUDITORY CANAL
313..     69300  OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION
313..     69440  MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION
313..     69450  TYMPANOLYSIS, TRANSCANAL
313..     69620  MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
314..  Level IV ENT Procedures         T                       25.65   $1,299.67         $693.37         $259.93
314..     30400  RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP

[[Page 47792]]

314..     30410  RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL AND ALAR
                  CARTILAGES, AND/OR ELEVATION OF NASAL TIP
314..     30420  RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
314..     30435  RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)
314..     30450  RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)
314..     30460  RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING
                  COLUMELLAR LENGTHENING; TIP ONLY
314..     30462  RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING
                  COLUMELLAR LENGTHENING; TIP, SEPTUM, OSTEOTOMIES
314..     30545  REPAIR CHOANAL ATRESIA; TRANSPALATINE
314..     31040  PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH
314..     31075  SINUSOTOMY FRONTAL; TRANSORBITAL, UNILATERAL (FOR MUCOCELE OR OSTEOMA, LYNCH TYPE)
314..     31080  SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT OSTEOPLASTIC FLAP, BROW INCISION (INCLUDES ABLATION)
314..     31081  SINUSOTOMY FRONTAL; OBLITERATIVE, WITHOUT OSTEOPLASTIC FLAP, CORONAL INCISION (INCLUDES
                  ABLATION)
314..     31084  SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
314..     31085  SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
314..     31086  SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION
314..     31087  SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
314..     31090  SINUSOTOMY COMBINED, THREE OR MORE SINUSES (UNILATERAL)
314..     31201  ETHMOIDECTOMY; INTRANASAL, TOTAL
314..     31205  ETHMOIDECTOMY; EXTRANASAL, TOTAL
314..     31300  LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); WITH REMOVAL OF TUMOR OR LARYNGOCELE, CORDECTOMY
314..     31400  ARYTENOIDECTOMY OR ARYTENOIDOPEXY, EXTERNAL APPROACH
314..     31420  EPIGLOTTIDECTOMY
314..     31588  LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR BURNS, RECONSTRUCTION AFTER PARTIAL
                  LARYNGECTOMY)
314..     31590  LARYNGEAL REINNERVATION BY NEUROMUSCULAR PEDICLE
314..     31750  TRACHEOPLASTY; CERVICAL
314..     31755  TRACHEOPLASTY; TRACHEOPHARYNGEAL FISTULIZATION, EACH STAGE
314..     40700  PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE, UNILATERAL
314..     40701  PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE STAGE PROCEDURE
314..     40702  PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE OF TWO STAGES
314..     40720  PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; SECONDARY, BY RECREATION OF DEFECT AND RECLOSURE
314..     40761  PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; WITH CROSS LIP PEDICLE FLAP (ABBE-ESTLANDER TYPE),
                  INCLUDING SECTIONING AND INSERTING OF PEDICLE
314..     40843  VESTIBULOPLASTY; POSTERIOR, BILATERAL
314..     40844  VESTIBULOPLASTY; ENTIRE ARCH
314..     40845  VESTIBULOPLASTY; COMPLEX (INCLUDING RIDGE EXTENSION, MUSCLE REPOSITIONING)
314..     42210  PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT TO ALVEOLAR
                  RIDGE (INCLUDES OBTAINING GRAFT)
314..     42225  PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
314..     42226  LENGTHENING OF PALATE, AND PHARYNGEAL FLAP
314..     42227  LENGTHENING OF PALATE, WITH ISLAND FLAP
314..     42415  EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND PRESERVATION OF
                  FACIAL NERVE
314..     42420  EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH DISSECTION AND PRESERVATION OF FACIAL
                  NERVE
314..     42425  EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, EN BLOC REMOVAL WITH SACRIFICE OF FACIAL
                  NERVE
314..     42509  PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF BOTH SUBMANDIBULAR
                  GLANDS
314..     42842  RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; WITHOUT CLOSURE
314..     42844  RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; CLOSURE WITH LOCAL
                  FLAP (EG, TONGUE, BUCCAL)
314..     42890  LIMITED PHARYNGECTOMY
314..     42892  RESECTION OF LATERAL PHARYNGEAL WALL OR PYRIFORM SINUS, DIRECT CLOSURE BY ADVANCEMENT OF
                  LATERAL AND POSTERIOR PHARYNGEAL WALLS
314..     69150  RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITHOUT NECK DISSECTION
314..     69310  RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO TRAUMA,
                  INFECTION) (SEPARATE PROCEDURE)
314..     69320  RECONSTRUCTION EXTERNAL AUDITORY CANAL FOR CONGENITAL ATRESIA, SINGLE STAGE
314..     69501  TRANSMASTOID ANTROTOMY (''SIMPLE'' MASTOIDECTOMY)
314..     69502  MASTOIDECTOMY; COMPLETE
314..     69505  MASTOIDECTOMY; MODIFIED RADICAL
314..     69511  MASTOIDECTOMY; RADICAL
314..     69530  PETROUS APICECTOMY INCLUDING RADICAL MASTOIDECTOMY
314..     69550  EXCISION AURAL GLOMUS TUMOR; TRANSCANAL
314..     69552  EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID
314..     69601  REVISION MASTOIDECTOMY; RESULTING IN COMPLETE MASTOIDECTOMY
314..     69602  REVISION MASTOIDECTOMY; RESULTING IN MODIFIED RADICAL MASTOIDECTOMY
314..     69603  REVISION MASTOIDECTOMY; RESULTING IN RADICAL MASTOIDECTOMY
314..     69604  REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY
314..     69605  REVISION MASTOIDECTOMY; WITH APICECTOMY
314..     69631  TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR
                  SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION
314..     69632  TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR
                  SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION (EG, POSTFENESTRATION)
314..     69633  TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR
                  SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS
                  (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS (PORP), TOTAL OSSICULAR REPL

[[Page 47793]]

314..     69635  TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR
                  SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
314..     69636  TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR
                  SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION
314..     69637  TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR
                  SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC
                  PROSTHESIS (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS (PORP), TOTAL
314..     69641  TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE
                  REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
314..     69642  TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE
                  REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION
314..     69643  TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE
                  REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
314..     69644  TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE
                  REPAIR); WITH INTACT OR RECONSTRUCTED CANAL WALL, WITH OSSICULAR CHAIN RECONSTRUCTION
314..     69645  TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE
                  REPAIR); RADICAL OR COMPLETE, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
314..     69646  TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE
                  REPAIR); RADICAL OR COMPLETE, WITH OSSICULAR CHAIN RECONSTRUCTION
314..     69650  STAPES MOBILIZATION
314..     69660  STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE
                  OF FOREIGN MATERIAL;
314..     69661  STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE
                  OF FOREIGN MATERIAL; WITH FOOTPLATE DRILL OUT
314..     69662  REVISION OF STAPEDECTOMY OR STAPEDOTOMY
314..     69666  REPAIR OVAL WINDOW FISTULA
314..     69667  REPAIR ROUND WINDOW FISTULA
314..     69670  MASTOID OBLITERATION (SEPARATE PROCEDURE)
314..     69676  TYMPANIC NEURECTOMY
314..     69700  CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE PROCEDURE)
314..     69711  REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL BONE
314..     69720  DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERAL TO GENICULATE GANGLION
314..     69725  DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; INCLUDING MEDIAL TO GENICULATE GANGLION
314..     69740  SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION; LATERAL TO
                  GENICULATE GANGLION
314..     69745  SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION; INCLUDING MEDIAL TO
                  GENICULATE GANGLION
314..     69801  LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE
                  PROCEDURES OR PERFUSION OF VESTIBULOACTIVE DRUGS (SINGLE OR MULTIPLE PERFUSIONS); TRANSCANAL
314..     69802  LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE
                  PROCEDURES OR PERFUSION OF VESTIBULOACTIVE DRUGS (SINGLE OR MULTIPLE PERFUSIONS); WITH
                  MASTOIDECTOMY
314..     69805  ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT
314..     69806  ENDOLYMPHATIC SAC OPERATION; WITH SHUNT
314..     69820  FENESTRATION SEMICIRCULAR CANAL
314..     69840  REVISION FENESTRATION OPERATION
314..     69905  LABYRINTHECTOMY; TRANSCANAL
314..     69910  LABYRINTHECTOMY; WITH MASTOIDECTOMY
314..     69915  VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROACH
314..     69949  UNLISTED PROCEDURE, INNER EAR
317..  Implantation of Cochlear        T
       Device
317..     69930  COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY
318..  Nasal Cauterization/Packing     T                        2.07     $104.89          $38.65          $20.98
318..     30901  CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
318..     30903  CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD
318..     30905  CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERIZATION, ANY
                  METHOD; INITIAL
318..     30906  CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERIZATION, ANY
                  METHOD;
318..     30999  UNLISTED PROCEDURE, NOSE
318..     42960  CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); SIMPLE
318..     42970  CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTADENOIDECTOMY); SIMPLE,
                  WITH POSTERIOR NASAL PACKS, WITH OR WITHOUT ANTERIOR PACKS AND/OR CAUTERIZATION
318..     42999  UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS
319..  Tonsil/Adenoid Procedures       T                       17.30     $876.58         $480.02         $175.32
319..     42820  TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12
319..     42821  TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
319..     42825  TONSILLECTOMY, PRIMARY OR SECONDARY; UNDER AGE 12
319..     42826  TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER
319..     42830  ADENOIDECTOMY, PRIMARY; UNDER AGE 12
319..     42831  ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
319..     42835  ADENOIDECTOMY, SECONDARY; UNDER AGE 12
319..     42836  ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER
319..     42860  EXCISION OF TONSIL TAGS
319..     42870  EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)
320..  Thoracentesis/Lavage            T                        3.17     $160.62          $79.33          $32.12
       Procedures
320..     32000  THORACENTESIS, PUNCTURE OF PLEURAL CAVITY FOR ASPIRATION, INITIAL OR SUBSEQUENT

[[Page 47794]]

320..     32002  THORACENTESIS WITH INSERTION OF TUBE WITH OR WITHOUT WATER SEAL (EG, FOR PNEUMOTHORAX)
                  (SEPARATE
320..     32020  TUBE THORACOSTOMY WITH OR WITHOUT WATER SEAL (EG, FOR ABSCESS, HEMOTHORAX, EMPYEMA) (SEPARATE
                  PROCEDURE)
320..     32420  PNEUMONOCENTESIS, PUNCTURE OF LUNG FOR ASPIRATION
320..     32960  PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL INJECTION OF AIR
320..     32999  UNLISTED PROCEDURE, LUNGS AND PLEURA
320..     33010  PERICARDIOCENTESIS; INITIAL
320..     33011  PERICARDIOCENTESIS; SUBSEQUENT
320..     33999  UNLISTED PROCEDURE, CARDIAC SURGERY
320..     49080  PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR THERAPEUTIC);
                  INITIAL
320..     49081  PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR THERAPEUTIC);
                  SUBSEQUENT
331..  Level I Endoscopy Upper Airway  T                        0.69      $34.96          $14.01           $6.99
331..     31231  NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
331..     31299  UNLISTED PROCEDURE, ACCESSORY SINUSES
331..     31505  LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC
331..     31575  LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC
331..     31579  LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY
331..     92511  NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE PROCEDURE)
332..  Level II Endoscopy Upper        T                        9.74     $493.52         $244.98          $98.70
       Airway
332..     31233  NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR MEATUS OR CANINE
                  FOSSA PUNCTURE)
332..     31235  NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF SPHENOIDAL FACE OR
                  CANNULATION OF OSTIUM)
332..     31237  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
332..     31238  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF EPISTAXIS
332..     31240  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
332..     31510  LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH BIOPSY
332..     31511  LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OF FOREIGN BODY
332..     31512  LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OF LESION
332..     31513  LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH VOCAL CORD INJECTION
332..     31515  LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION
332..     31520  LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, NEWBORN
332..     31525  LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
332..     31526  LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE
332..     31528  LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATATION, INITIAL
332..     31529  LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATATION, SUBSEQUENT
332..     31576  LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY
332..     31577  LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF FOREIGN BODY
332..     31578  LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF LESION
332..     31700  CATHETERIZATION, TRANSGLOTTIC (SEPARATE PROCEDURE)
332..     31717  CATHETERIZATION WITH BRONCHIAL BRUSH BIOPSY
332..     31720  CATHETER ASPIRATION (SEPARATE PROCEDURE); NASOTRACHEAL
332..     31730  TRANSTRACHEAL (PERCUTANEOUS) INTRODUCTION OF NEEDLE WIRE DILATOR/ STENT OR INDWELLING TUBE FOR
                  OXYGEN
333..  Level III Endoscopy Upper       T                       17.24     $873.54         $464.20         $174.71
       Airway
333..     31239  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY
333..     31254  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, PARTIAL (ANTERIOR)
333..     31255  NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND POSTERIOR)
333..     31256  NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
333..     31267  NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM
                  MAXILLARY SINUS
333..     31276  NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUS EXPLORATION, WITH OR WITHOUT REMOVAL OF
                  TISSUE FROM FRONTAL SINUS
333..     31287  NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
333..     31288  NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID
                  SINUS
333..     31527  LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH INSERTION OF OBTURATOR
333..     31530  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL;
333..     31531  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; WITH OPERATING MICROSCOPE
333..     31535  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
333..     31536  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE
333..     31540  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR
                  EPIGLOTTIS;
333..     31541  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR
                  EPIGLOTTIS; WITH OPERATING MICROSCOPE
333..     31560  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY;
333..     31561  LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE
333..     31570  LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC;
333..     31571  LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE
336..  Endoscopy Lower Airway          T                        7.44     $376.98         $197.98          $75.40
336..     31615  TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMY INCISION
336..     31622  BRONCHOSCOPY; DIAGNOSTIC, (FLEXIBLE OR RIGID), WITH OR WITHOUT CELL WASHING OR BRUSHING
336..     31625  BRONCHOSCOPY; WITH BIOPSY
336..     31628  BRONCHOSCOPY; WITH TRANSBRONCHIAL LUNG BIOPSY, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE
336..     31629  BRONCHOSCOPY; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY
336..     31630  BRONCHOSCOPY; WITH TRACHEAL OR BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE
336..     31631  BRONCHOSCOPY; WITH TRACHEAL DILATION AND PLACEMENT OF TRACHEAL STENT
336..     31635  BRONCHOSCOPY; WITH REMOVAL OF FOREIGN BODY
336..     31640  BRONCHOSCOPY; WITH EXCISION OF TUMOR

[[Page 47795]]

336..     31641  BRONCHOSCOPY; WITH DESTRUCTION OF TUMOR OR RELIEF OF STENOSIS BY ANY METHOD OTHER THAN EXCISION
                  (EG, LASER)
336..     31645  BRONCHOSCOPY; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL (EG, DRAINAGE OF
                  LUNG ABSCESS)
336..     31646  BRONCHOSCOPY; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, SUBSEQUENT
336..     31656  BRONCHOSCOPY; WITH INJECTION OF CONTRAST MATERIAL FOR SEGMENTAL BRONCHOGRAPHY (FIBERSCOPE ONLY)
336..     31899  UNLISTED PROCEDURE, TRACHEA, BRONCHI
339..  Injection of Sclerosing         T                        1.02      $51.68          $19.66          $10.34
       Solution
339..     36468  SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS (TELANGIECTASIA); LIMB OR
                  TRUNK
339..     36469  SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS (TELANGIECTASIA); FACE
339..     36470  INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN
339..     36471  INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS, SAME LEG
339..     45520  PERIRECTAL INJECTION OF SCLEROSING SOLUTION FOR PROLAPSE
341..  Level I Needle and Catheter     T                         .13       $6.59           $2.94           $1.32
       Placement
341..     36410  VENIPUNCTURE, CHILD OVER AGE 3 YEARS OR ADULT, NECESSITATING PHYSICIAN'S SKILL (SEPARATE
                  PROCEDURE), FOR DIAGNOSTIC OR THERAPEUTIC PURPOSES. NOT TO BE USED FOR ROUTINE VENIPUNCTURE.
341..     36420  VENIPUNCTURE, CUTDOWN; UNDER AGE 1 YEAR
341..     36425  VENIPUNCTURE, CUTDOWN; AGE 1 OR OVER
342..  Level II Needle and Catheter    T                        3.20     $162.14          $80.23          $32.43
       Placement
342..     36010  INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA
342..     36011  SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; FIRST ORDER BRANCH (EG, RENAL VEIN, JUGULAR VEIN)
342..     36012  SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER, OR MORE SELECTIVE, BRANCH (EG, LEFT
                  ADRENAL VEIN, PETROSAL SINUS)
342..     36013  INTRODUCTION OF CATHETER, RIGHT HEART OR MAIN PULMONARY ARTERY
342..     36014  SELECTIVE CATHETER PLACEMENT, LEFT OR RIGHT PULMONARY ARTERY
342..     36015  SELECTIVE CATHETER PLACEMENT, SEGMENTAL OR SUBSEGMENTAL PULMONARY ARTERY
342..     36100  INTRODUCTION OF NEEDLE OR INTRACATHETER, CAROTID OR VERTEBRAL ARTERY
342..     36120  INTRODUCTION OF NEEDLE OR INTRACATHETER; RETROGRADE BRACHIAL ARTERY
342..     36140  INTRODUCTION OF NEEDLE OR INTRACATHETER; EXTREMITY ARTERY
342..     36160  INTRODUCTION OF NEEDLE OR INTRACATHETER, AORTIC, TRANSLUMBAR
342..     36200  INTRODUCTION OF CATHETER, AORTA
342..     36500  VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD SAMPLING
342..     36620  ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE
                  PROCEDURE); PERCUTANEOUS
342..     36625  ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE
                  PROCEDURE); CUTDOWN
342..     38794  CANNULATION, THORACIC DUCT
343..  Level III Needle and Catheter   T                        9.52     $482.37         $224.87          $96.47
       Placement
343..     36215  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER THORACIC OR BRACHIOCEPHALIC
                  BRANCH, WITHIN A VASCULAR FAMILY
343..     36216  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER THORACIC OR BRACHIOCEPHALIC
                  BRANCH, WITHIN A VASCULAR FAMILY
343..     36217  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE THORACIC
                  OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY
343..     36218  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD ORDER, AND
                  BEYOND, THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY (USE IN ADDITION TO 36216
                  OR 36217 AS APPROPRIATE)
343..     36245  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER ABDOMINAL, PELVIC, OR LOWER
                  EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
343..     36246  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER ABDOMINAL, PELVIC, OR LOWER
                  EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
343..     36247  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE ABDOMINAL,
                  PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
343..     36248  SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD ORDER, AND
                  BEYOND, ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY (USE IN
                  ADDITION TO 36246 OR 36247 AS APPROPRIATE)
343..     36481  PERCUTANEOUS PORTAL VEIN CATHETERIZATION BY ANY METHOD
343..     93508  CATHETER PLACEMENT IN CORONARY ARTERY(S), ARTERIAL CORONARY CONDUIT(S), AND/OR VENOUS CORONARY
                  BYPASS GRAFT(S) FOR CORONARY ANGIOGRAPHY WITHOUT CONCOMITANT LEFT HEART CATHETERIZATION
346..  Placement Transvenous Caths/    T                        4.83     $244.73         $120.23          $48.95
       Cutdown
346..     36488  PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL
                  VENOUS PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); PERCUTANEOUS, AGE 2 YEARS
                  OR UNDER
346..     36489  PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL
                  VENOUS PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); PERCUTANEOUS, OVER AGE 2
346..     36490  PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL
                  VENOUS PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); CUTDOWN, AGE 2 YEARS OR
                  UNDER
346..     36491  PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL
                  VENOUS PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); CUTDOWN, OVER AGE 2
346..     36493  REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GUIDANCE
346..     36640  ARTERIAL CATHETERIZATION FOR PROLONGED INFUSION THERAPY (CHEMOTHERAPY), CUTDOWN
347..  Injection Procedures for        T                        2.93     $148.46          $62.15          $29.69
       Interventional Radiology
347..     19030  INJECTION PROCEDURE ONLY FOR MAMMARY DUCTOGRAM OR GALACTOGRAM
347..     20501  INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM)
347..     21116  INJECTION PROCEDURE FOR TEMPOROMANDIBULAR JOINT ARTHROGRAPHY

[[Page 47796]]

347..     23350  INJECTION PROCEDURE FOR SHOULDER ARTHROGRAPHY
347..     24220  INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
347..     25246  INJECTION PROCEDURE FOR WRIST ARTHROGRAPHY
347..     27093  INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITHOUT ANESTHESIA
347..     27095  INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA
347..     27370  INJECTION PROCEDURE FOR KNEE ARTHROGRAPHY
347..     27648  INJECTION PROCEDURE FOR ANKLE ARTHROGRAPHY
347..     30200  INJECTION INTO TURBINATE(S), THERAPEUTIC
347..     31708  INSTILLATION OF CONTRAST MATERIAL FOR LARYNGOGRAPHY OR BRONCHOGRAPHY, WITHOUT CATHETERIZATION
347..     31710  CATHETERIZATION FOR BRONCHOGRAPHY, WITH OR WITHOUT INSTILLATION OF CONTRAST MATERIAL
347..     31715  TRANSTRACHEAL INJECTION FOR BRONCHOGRAPHY
347..     36005  INJECTION PROCEDURE FOR CONTRAST VENOGRAPHY (INCLUDING INTRODUCTION OF NEEDLE OR INTRACATHETER)
347..     38200  INJECTION PROCEDURE FOR SPLENOPORTOGRAPHY
347..     38790  INJECTION PROCEDURE FOR LYMPHANGIOGRAPHY
347..     42550  INJECTION PROCEDURE FOR SIALOGRAPHY
347..     47500  INJECTION PROCEDURE FOR PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY
347..     47505  INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH AN EXISTING CATHETER (EG, PERCUTANEOUS
                  TRANSHEPATIC OR T-TUBE)
347..     49400  INJECTION OF AIR OR CONTRAST INTO PERITONEAL CAVITY (SEPARATE PROCEDURE)
347..     49424  CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST VIA PREVIOUSLY PLACED CATHETER (SEPARATE
                  PROCEDURE)
347..     49427  INJECTION PROCEDURE (EG, CONTRAST MEDIA) FOR EVALUATION OF PREVIOUSLY PLACED PERITONEAL-VENOUS
                  SHUNT
347..     50392  INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION,
                  PERCUTANEOUS
347..     50393  INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR
                  INJECTION, PERCUTANEOUS
347..     50394  INJECTION PROCEDURE FOR PYELOGRAPHY (AS NEPHROSTOGRAM, PYELOSTOGRAM, ANTEGRADE
                  PYELOURETEROGRAMS) THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING URETERAL CATHETER
347..     50395  INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER WITH DILATION TO ESTABLISH NEPHROSTOMY
                  TRACT, PERCUTANEOUS
347..     50684  INJECTION PROCEDURE FOR URETEROGRAPHY OR URETEROPYELOGRAPHY THROUGH URETEROSTOMY OR INDWELLING
                  URETERAL CATHETER
347..     50690  INJECTION PROCEDURE FOR VISUALIZATION OF ILEAL CONDUIT AND/OR URETEROPYELOGRAPHY, EXCLUSIVE OF
                  RADIOLOGIC SERVICE
347..     51600  INJECTION PROCEDURE FOR CYSTOGRAPHY OR VOIDING URETHROCYSTOGRAPHY
347..     51605  INJECTION PROCEDURE AND PLACEMENT OF CHAIN FOR CONTRAST AND/OR CHAIN URETHROCYSTOGRAPHY
347..     51610  INJECTION PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPHY
347..     54230  INJECTION PROCEDURE FOR CORPORA CAVERNOSOGRAPHY
347..     55300  VASOTOMY FOR VASOGRAMS, SEMINAL VESICULOGRAMS, OR EPIDIDYMOGRAMS, UNILATERAL OR BILATERAL
347..     58340  CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR HYSTEROSONOGRAPHY OR
                  HYSTEROSALPINGOGRAPHY
347..     62284  INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTERIZED AXIAL TOMOGRAPHY, SPINAL (OTHER THAN C1-
                  C2 AND POSTERIOR FOSSA)
347..     62290  INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; LUMBAR
347..     62291  INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; CERVICAL
347..     68850  INJECTION OF CONTRAST MEDIUM FOR DACRYOCYSTOGRAPHY
360..  Removal/Revision, Pacemaker/    T                        6.09     $308.58         $140.12          $61.72
       Vascular Device
360..     33222  REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER
360..     33223  REVISION OR RELOCATION OF SKIN POCKET FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
360..     36261  REVISION OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
360..     36262  REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
360..     36299  UNLISTED PROCEDURE, VASCULAR INJECTION
360..     36531  REVISION OF IMPLANTABLE INTRAVENOUS INFUSION PUMP
360..     36532  REMOVAL OF IMPLANTABLE INTRAVENOUS INFUSION PUMP
360..     36534  REVISION OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR
419..     44377  SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM;
                  WITH BIOPSY, SINGLE OR MULTIPLE
419..     44378  SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM;
                  WITH CONTROL OF BLEEDING, ANY METHOD
419..     44799  UNLISTED PROCEDURE, INTESTINE
426..  Diagnostic Lower GI Endoscopy   T                        6.85     $347.09         $187.81          $69.42
426..     44380  ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR
                  WASHING (SEPARATE PROCEDURE)
426..     44382  ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
426..     44385  ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; DIAGNOSTIC, WITH OR
                  WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
426..     44386  ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; WITH BIOPSY, SINGLE OR
                  MULTIPLE
426..     44388  COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR
                  WASHING (SEPARATE PROCEDURE)
426..     44389  COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
426..     45378  COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
                  SPECIMEN(S) BY BRUSHING OR WASHING, WITH OR WITHOUT COLON DECOMPRESSION (SEPARATE PROCEDURE)
426..     45380  COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH BIOPSY, SINGLE OR MULTIPLE
426..     G0105  Colorectal Ca screening, pt at high risk
427..  Therapeutic Lower GI Endoscopy  T                        8.22      $416.5         $224.19           $83.3
427..     44390  COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF FOREIGN BODY

[[Page 47797]]

427..     44391  COLONOSCOPY THROUGH STOMA; WITH CONTROL OF BLEEDING, ANY METHOD
427..     44392  COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY
                  FORCEPS OR BIPOLAR CAUTERY
427..     44394  COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE
                  TECHNIQUE
427..     45355  COLONOSCOPY, RIGID OR FLEXIBLE, TRANSABDOMINAL VIA COLOTOMY, SINGLE OR MULTIPLE
427..     45379  COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF FOREIGN BODY
427..     45382  COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH CONTROL OF BLEEDING, ANY METHOD
427..     45384  COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR
                  OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
427..     45385  COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR
                  OTHER LESION(S) BY SNARE TECHNIQUE
437..  Therapeutic Anoscopy            T                        2.91     $147.45          $76.61          $29.49
437..     46608  ANOSCOPY; WITH REMOVAL OF FOREIGN BODY
437..     46610  ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY FORCEPS OR BIPOLAR
                  CAUTERY
437..     46611  ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE TECHNIQUE
437..     46612  ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT BIOPSY FORCEPS,
                  BIPOLAR CAUTERY OR SNARE TECHNIQUE
437..     46614  ANOSCOPY; WITH CONTROL OF BLEEDING, ANY METHOD
437..     46615  ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY
                  HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
446..  Diagnostic Sigmoidoscopy        T                        2.59     $131.23          $65.09          $26.25
446..     45300  PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING
                  OR WASHING (SEPARATE PROCEDURE)
446..     45305  PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE
446..     45330  SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR
                  WASHING (SEPARATE PROCEDURE)
446..     45331  SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
446..     G0104  Colorectal Ca screening
447..  Therapeutic                     T                        6.87     $348.10         $184.76          $69.62
       Proctosigmoidoscopy
447..     45303  PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION, ANY METHOD
447..     45307  PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY
447..     45308  PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY
                  FORCEPS OR BIPOLAR CAUTERY
447..     45309  PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE
                  TECHNIQUE
447..     45315  PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT
                  BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
447..     45317  PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING, ANY METHOD
447..     45320  PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT
                  AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE (EG, LASER)
447..     45321  PROCTOSIGMOIDOSCOPY, RIGID; WITH DECOMPRESSION OF VOLVULUS
448..  Therapeutic Flexible            T                        5.37     $272.09         $141.25          $54.42
       Sigmoidoscopy
448..     45332  SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY
448..     45333  SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY
                  FORCEPS OR BIPOLAR CAUTERY
448..     45334  SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
448..     45337  SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION OF VOLVULUS, ANY METHOD
448..     45338  SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE
                  TECHNIQUE
449..  Complex GI Endoscopy            T                         7.8     $395.22         $215.38          $79.04
449..     43219  ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF PLASTIC TUBE OR STENT
449..     43228  ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S), NOT
                  AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
449..     43258  UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR
                  JEJUNUM AS APPROPRIATE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE
                  TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
449..     43259  UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR
                  JEJUNUM AS APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION
449..     43272  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF TUMOR(S), POLYP(S), OR
                  OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE
                  TECHNIQUE
449..     44369  SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM;
                  WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY
                  FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
449..     44393  COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE
                  TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
449..     45339  SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE
                  TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
449..     45383  COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ABLATION OF TUMOR(S), POLYP(S), OR
                  OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE
                  TECHNIQUE
451..  Level I Anal/Rectal Procedures  T                        2.56     $129.71          $54.24          $25.94
451..     46070  INCISION, ANAL SEPTUM (INFANT)
451..     46083  INCISION OF THROMBOSED HEMORRHOID, EXTERNAL
451..     46220  PAPILLECTOMY OR EXCISION OF SINGLE TAG, ANUS (SEPARATE PROCEDURE)

[[Page 47798]]

451..     46221  HEMORRHOIDECTOMY, BY SIMPLE LIGATURE (EG, RUBBER BAND)
451..     46230  EXCISION OF EXTERNAL HEMORRHOID TAGS AND/OR MULTIPLE PAPILLAE
451..     46320  ENUCLEATION OR EXCISION OF EXTERNAL THROMBOTIC HEMORRHOID
451..     46500  INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS
451..     46934  DESTRUCTION OF HEMORRHOIDS, ANY METHOD; INTERNAL
451..     46935  DESTRUCTION OF HEMORRHOIDS, ANY METHOD; EXTERNAL
451..     46936  DESTRUCTION OF HEMORRHOIDS, ANY METHOD; INTERNAL AND EXTERNAL
451..     46940  CURETTAGE OR CAUTERIZATION OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER (SEPARATE
                  PROCEDURE); INITIAL
451..     46942  CURETTAGE OR CAUTERIZATION OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER (SEPARATE
                  PROCEDURE); SUBSEQUENT
451..     46945  LIGATION OF INTERNAL HEMORRHOIDS; SINGLE PROCEDURE
451..     46946  LIGATION OF INTERNAL HEMORRHOIDS; MULTIPLE PROCEDURES
452..  Level II Anal/Rectal            T                        4.82     $244.23         $109.61          $48.85
       Procedures
452..     45000  TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
452..     45005  INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM
452..     45020  INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR RETRORECTAL ABSCESS
452..     45100  BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)
452..     45900  REDUCTION OF PROCIDENTIA (SEPARATE PROCEDURE) UNDER ANESTHESIA
452..     45905  DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL
452..     45910  DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL
452..     45915  REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
452..     45999  UNLISTED PROCEDURE, RECTUM
452..     46030  REMOVAL OF ANAL SETON, OTHER MARKER
452..     46040  INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE)
452..     46050  INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL
452..     46080  SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)
452..     46210  CRYPTECTOMY; SINGLE
452..     46754  REMOVAL OF THIERSCH WIRE OR SUTURE, ANAL CANAL
452..     46999  UNLISTED PROCEDURE, ANUS
453..  Level III Anal/Rectal           T                       16.87     $854.79         $445.22         $170.96
       Procedures
453..     45108  ANORECTAL MYOMECTOMY
453..     45150  DIVISION OF STRICTURE OF RECTUM
453..     45160  EXCISION OF RECTAL TUMOR BY PROCTOTOMY, TRANSSACRAL OR TRANSCOCCYGEAL APPROACH
453..     45170  EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH
453..     45190  DESTRUCTION OF RECTAL TUMOR, ANY METHOD (EG, ELECTRODESICCATION) TRANSANAL APPROACH
453..     45500  PROCTOPLASTY; FOR STENOSIS
453..     45505  PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
453..     45560  REPAIR OF RECTOCELE (SEPARATE PROCEDURE)
453..     46045  INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL, UNDER
                  ANESTHESIA
453..     46060  INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS, WITH FISTULECTOMY OR FISTULOTOMY,
                  SUBMUSCULAR, WITH OR WITHOUT PLACEMENT OF SETON
453..     46200  FISSURECTOMY, WITH OR WITHOUT SPHINCTEROTOMY
453..     46211  CRYPTECTOMY; MULTIPLE (SEPARATE PROCEDURE)
453..     46250  HEMORRHOIDECTOMY, EXTERNAL, COMPLETE
453..     46255  HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE;
453..     46257  HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISSURECTOMY
453..     46258  HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISTULECTOMY, WITH OR WITHOUT
                  FISSURECTOMY
453..     46260  HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE;
453..     46261  HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISSURECTOMY
453..     46262  HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISTULECTOMY, WITH OR
                  WITHOUT FISSURECTOMY
453..     46270  SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
453..     46275  SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBMUSCULAR
453..     46280  SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); COMPLEX OR MULTIPLE, WITH OR
                  WITHOUT PLACEMENT OF SETON
453..     46285  SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE
453..     46288  CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP
453..     46700  ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; ADULT
453..     46750  SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT
453..     46753  GRAFT (THIERSCH OPERATION) FOR RECTAL INCONTINENCE AND/OR PROLAPSE
453..     46760  SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; MUSCLE TRANSPLANT
453..     46761  SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; LEVATOR MUSCLE IMBRICATION (PARK POSTERIOR
                  ANAL REPAIR)
453..     46762  SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; IMPLANTATION ARTIFICIAL SPHINCTER
453..     46937  CRYOSURGERY OF RECTAL TUMOR; BENIGN
453..     46938  CRYOSURGERY OF RECTAL TUMOR; MALIGNANT
456..  Endoscopic Retrograde           T                        9.78     $495.55         $257.19          $99.11
       Cholangiopancreatography
       (ERCP)
456..     43260  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR WITHOUT COLLECTION
                  OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
456..     43261  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE
456..     43262  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY
456..     43263  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PRESSURE MEASUREMENT OF SPHINCTER
                  OF ODDI (PANCREATIC DUCT OR COMMON BILE DUCT)
456..     43264  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF
                  STONE(S) FROM BILIARY AND/OR PANCREATIC DUCTS

[[Page 47799]]

456..     43265  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE DESTRUCTION,
                  LITHOTRIPSY OF STONE(S), ANY METHOD
456..     43267  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF
                  NASOBILIARY OR NASOPANCREATIC DRAINAGE TUBE
456..     43268  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF
                  TUBE OR STENT INTO BILE OR PANCREATIC DUCT
456..     43269  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF
                  FOREIGN BODY AND/OR CHANGE OF TUBE OR STENT
456..     43271  ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE BALLOON
                  DILATION OF AMPULLA, BILIARY AND/OR PANCREATIC DUCT(S)
458..  Percutaneous Biliary            T                        7.23     $366.34         $181.59          $73.27
       Endoscopic Procedures
458..     47510  INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC CATHETER FOR BILIARY DRAINAGE
458..     47511  INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR INTERNAL AND EXTERNAL BILIARY DRAINAGE
458..     47552  BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; DIAGNOSTIC, WITH OR WITHOUT
                  COLLECTION OF SPECIMEN(S) BY BRUSHING AND/OR WASHING (SEPARATE PROCEDURE)
458..     47553  BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH BIOPSY, SINGLE OR MULTIPLE
458..     47554  BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH REMOVAL OF STONE(S)
458..     47555  BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF BILIARY DUCT
                  STRICTURE(S) WITHOUT STENT
458..     47556  BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF BILIARY DUCT
                  STRICTURE(S) WITH STENT
458..     47630  BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE (EG, BURHENNE
                  TECHNIQUE)
459..  Peritoneal and Abdominal        T                       18.06     $915.09         $496.52         $183.02
       Procedures
459..     49085  REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY
459..     49250  UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
459..     49420  INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS; TEMPORARY
459..     49421  INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS; PERMANENT
459..     49423  EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGE CATHETER UNDER RADIOLOGICAL GUIDANCE
                  (SEPARATE PROCEDURE)
459..     49426  REVISION OF PERITONEAL-VENOUS SHUNT
466..  Hernia/Hydrocele Procedures     T                       21.43   $1,085.85         $562.97         $217.17
466..     49495  REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE
466..     49496  REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTOMY;
                  INCARCERATED OR STRANGULATED
466..     49500  REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT HYDROCELECTOMY;
                  REDUCIBLE
466..     49501  REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT HYDROCELECTOMY;
                  INCARCERATED OR STRANGULATED
466..     49505  REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
466..     49507  REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED
466..     49520  REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
466..     49521  REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
466..     49525  REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
466..     49540  REPAIR LUMBAR HERNIA
466..     49550  REPAIR INITIAL FEMORAL HERNIA, ANY AGE, REDUCIBLE;
466..     49553  REPAIR INITIAL FEMORAL HERNIA, ANY AGE, REDUCIBLE; INCARCERATED OR STRANGULATED
466..     49555  REPAIR RECURRENT FEMORAL HERNIA; REDUCIBLE
466..     49557  REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED
466..     49560  REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
466..     49561  REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED
466..     49565  REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
466..     49566  REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED
466..     49568  IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL OR VENTRAL HERNIA REPAIR (LIST
                  SEPARATELY IN ADDITION TO CODE FOR THE INCISIONAL OR VENTRAL HERNIA REPAIR)
466..     49570  REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE)
466..     49572  REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED
466..     49580  REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE
466..     49582  REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED
466..     49585  REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
466..     49587  REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED
466..     49590  REPAIR SPIGELIAN HERNIA
466..     49600  REPAIR OF SMALL OMPHALOCELE, WITH PRIMARY CLOSURE
466..     51500  EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL HERNIA REPAIR
466..     55040  EXCISION OF HYDROCELE; UNILATERAL
466..     55041  EXCISION OF HYDROCELE; BILATERAL
470..  Tube Procedures                 T                        2.22     $112.49          $54.92          $22.50
470..     31502  TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT
470..     43760  CHANGE OF GASTROSTOMY TUBE
470..     43761  REPOSITIONING OF THE GASTRIC FEEDING TUBE THROUGH THE DUODENUM FOR ENTERIC NUTRITION
470..     43999  UNLISTED PROCEDURE, STOMACH
470..     47525  CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER
470..     47530  REVISION AND/OR REINSERTION OF TRANSHEPATIC TUBE
470..     47999  UNLISTED PROCEDURE, BILIARY TRACT
470..     49422  REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER
470..     49429  REMOVAL OF PERITONEAL-VENOUS SHUNT


[[Continued on page 47801]]



