2017 PROPOSED - Physician Payment Rates

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Clare Garrison
7 years ago
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1 Injection, therapeutic (eg, local anesthetic; corticosteroid), carpal tunnel $78.69 $59.29 $79.18 $59.47 $79.06 $ % tendon sheath, ligament injection $59.65 $42.76 $60.19 $42.99 $54.02 $ % -5.1% Tendon origin/insertion $61.45 $43.84 $61.98 $44.07 $61.18 $ % -1.8% Single or multiple trigger point(s), one or two muscle group(s) $56.42 $39.17 $56.25 $39.05 $56.17 $38.99 Single or multiple trigger point(s), three or more muscle groups $65.04 $44.20 $64.85 $44.43 $64.40 $ % -1.0% Small joint injection $48.51 $36.65 $48.73 $36.54 $48.65 $36.49 Intermediate joint injection $51.03 $38.45 $51.23 $38.34 $50.44 $ % -1.1% Major joint injection $61.09 $47.43 $61.62 $47.65 $61.18 $ % Vertbroplasty (Thoracic) $1, $ $1, $ $1, $ % -4.1% Vertbroplasty (Lumbar) $1, $ $1, $ $1, $ % -4.1% Vertbroplasty - Additional $ $ $1, $ $ $ % -1.1% Percut kyphoplasty, thor $7, $ $7, $ $7, $ % -3.8% Percut kyphoplasty, thor $7, $ $7, $ $7, $ % -4.1% Percut kyphoplasty, Additional $4, $ $4, $ $4, $ % -1.4% IDET, single level $2, $ $2, $ $2, $ % -4.2% IDET, 1 or more levels $2, $ $2, $ $1, $ % -0.4% Percut kyphoplasty, lumbar $ $ $ % Injection procedure for HIP arthrography without anesthesia $ $72.23 $ $72.73 $ $ % -1.1%

2 Injection procedure for HIP arthrography with anesthesia $ $85.16 $ $85.63 $ $ % 0.3% (G0260) Injection procedure for Sacroiliac joint, arthrography $ $86.96 $ $87.42 $ $ % -1.8% Percutaneous epidural adhesiolysis - 2 or 3 days $ $ $ $ $ $ % -5.2% Percutaneous epidural adhesiolysis 1 day $ $ $ $ $ $ % -1.6% Percutaneous aspiration, spinal cord cyst or syrinx $ $ $ % Biopsy of spinal cord, percutaneous needle $ $ $ % Spinal puncture, diagnostic $ $80.49 $ $80.61 $ $ % Spinal puncture, therapeutic $ $86.24 $ $87.06 $ $ % -0.6% Epidural, blood patch $ $ $ $ $ $ % -1.4% Subarachnoid neurolytic injection $ $ $ $ $ $ % -1.6% Neurolytic epidural, C/T $ $ $ $ $ $ % -1.0% Neurolytic epidural, L/S $ $ $ $ $ $ % -0.4% Injection procedure myelography $ $89.12 $ $88.85 $ $ % 1.5% Disc decompression $ $ $ % Diskogrsphy each level: lumbar $ $ $ $ $ $ % -2.1% Diskogrsphy each level: C/T $ $ $ $ $ $ % -1.6% Chemonucleolysis $ $ $ % Cervical epidural $ $ $ $113.22

3 CPT Description Lumbar epidural $ $92.35 $ $93.15 Epidural or subarachnoid, catheterization, C/T $ $ $ $ Catheterization, epidural, L/S $ $98.82 $ $ Cervical or Thoracic interlaminar epidural; without fluoro 623X5 $ $ Cervical or Thoracic interlaminar epidural; with fluoro 623X6 $ $ Lumbar or sacral (caudal) interlaminar epidural injection(s); 623X7 without fluoro $ $90.87 Lumbar or sacral (caudal) interlaminar epidural injection(s); 623X8 with fluoro $ $ Cervical or thoracic continuous interlaminar epidural 623X9 Injection(s),; without fluoro $ $95.52 Cervical or thoracic continuous interlaminar epidural 62X10 Injection(s),; with fluoro $ $ Njx interlaminar L/S without imaging guidance 62X11 $ $94.09 Lumbar or sacral (caudal) continuous interlaminar epidural 62X12 Injection(s),; Without fluoro $ $99.81 Lumbar or sacral (caudal) continuous interlaminar epidural 630X1 Injection(s),; With fluoro $ Tunneled intrathecal or epidural catheter for long-term medication administration via an external pump or implantable reservoir; w/o laminectomy $ $ $ % Removal or previously implanted intrathecal or epidural catheter $ $ $ Implant or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir $ $ $ % Implantation or replacement of device for epidural drug infusion; non-programmable pump $ $ $ % Implant spine infusion pump $ $ $ % Remove spine infusion device $ $ $ %

4 Electronic analysis of programmable pump $42.04 $26.23 $42.64 $26.51 $41.14 $ % -2.8% Electronic analysis of programmable pump with reprogramming $57.85 $36.29 $58.40 $36.54 $57.24 $ % Implant neuroelectrodes (NA=National price is Not Available) $1, $ $1, $ $1, $ % -1.7% Implant neuroelectrodes (NA=National price is Not Available) $ $ $ Remove spine eltrd perq aray $ $ $ $ $ $ % -0.5% Remove spine eltrd plate $ $ $ % Remove spine eltrd perq aray $ $ $ $ $ $ % -1.7% Remove spine eltrd plate $ $ $ % Implant neuroreceiver $ $ $ % Revise/remove neuroreceiver $ $ $ % Injection, anesthetic agent; Trigeminal nerve, any division or branch $ $72.59 $ $73.45 $ $ % -0.6% Facial nerve $ $79.77 $ $81.33 $ $ % 2.1% Greater occipital nerve $ $65.04 $ $65.21 $ $ % Vagus nerve $ $88.04 $ $78.46 $ $ % 14.0% Phrenic nerve $ $70.07 $ $73.09 $ $ % 6.7% Spinal accessory nerve $ $74.02 Cervical plexus $ $84.08 $ $83.84 $ $ % Brachial plexus $ $66.48 $ $68.07 $ $ % -2.2%

5 Axillary nerve $ $72.59 $ $74.52 $ $ % -3.5% Suprascapular nerve $ $78.69 $ $79.18 $ $ % -1.5% Intercostal, single $ $69.71 $ $70.58 $ $ % -1.7% Intercostal, multiple, regional block $ $93.79 $ $95.30 $ $ % -1.6% Ilioinguinal, Iliohypogastric $ $95.58 $ $97.09 $ $ % -0.9% Pudendal nerve Pudendal nerve $ $84.91 $ $ % -2.2% Sciatic nerve $ $74.02 $ $75.24 $ $ % -1.1% Other peripheral nerve or branch $81.93 $47.07 $81.69 $47.29 $80.85 $ % -1.7% Cervical transforaminal epidural injections $ $ $ $ $ $ % -0.9% Cervical transforaminal epidural injections add-on $ $65.04 $ $65.57 $ $ % -0.7% L/S transforaminal epidural injections $ $ $ $ $ $ % -0.8% L/S transforaminal epidural injections add-on $89.47 $53.90 $90.29 $54.10 $88.01 $ % -2.1% C/T facet joint injections, 1st Level (Old 64470) $ $ $ $ $ $ % -1.1% C/T facet joint injections, 2nd Level (Old 64472) $95.94 $62.52 $96.38 $62.70 $94.45 $ % -1.3% C/T facet joint injections, 3rd Level $96.30 $62.88 $97.09 $63.42 $95.16 $ % -1.3% Paravertebral facet joint or facet joint nerve; L/S, 1st Level $ $94.15 $ $94.94 $ $ % -2.0% Paravertebral facet joint or facet joint nerve; L/S, 2nd Level $88.40 $53.54 $89.21 $54.10 $87.65 $ % -0.8% Paravertebral facet joint or facet joint nerve; L/S, 3rd Level $88.76 $54.26 $89.57 $54.82 $88.01 $ % -0.8%

6 Injection, anesthetic agent; sphenopalatine ganglion $ $88.76 $ $89.93 $ $ % 0.6% Injection, anesthetic agent; Carotid sinus (separate procedure) $63.60 $74.74 $63.77 $75.60 $61.53 $ % -2.5% Injection, anesthetic agent; Stellate ganglion (cervical sympathetic) $ $75.82 $ $76.67 $ $ % -2.0% Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) $ $83.37 $ $84.20 $ $ % -1.4% Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring $ $94.86 $ $96.02 $ $ % -2.4% Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch $ $ $ $ $ $ % -0.6% Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale $ $ $ $ $ $ % -16.8% Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring $ $ $ $ $ $ % -0.9% Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial spasm) $ $ $ $ $ $ % -1.3% Destruction by neurolytic agent, intercostal nerve $ $ $ $ $ $ % -1.4% Destruction by neurolytic agent; pudendal nerve $ $ $ $ $ $ % -1.4% Destroy cerv/thor facet jnt $ $ $ $ $ $ % -1.8% Destroy c/th facet jnt addl $ $70.43 $ $71.30 $ $ % -1.7% Destroy lumb/sac facet jnt $ $ $ $ $ $ % -1.7% Destroy l/s facet jnt addl $ $62.16 $ $62.34 $ $ % -0.7% Destruction by neurolytic agent; other peripheral nerve or branch $ $95.58 $ $96.02 $ $ % -0.9% Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus $ $ $ $ $ $ % -2.0% Contrast x-ray, lower spine $92.35 $92.79 $ %

7 Contrast x-ray of spine $ $ $ % Epidurography $ $ $ Diskography C/T Radiological supervision and interpretation $ $ $ % Diskography lumbar radiological supervision and interpretation $99.18 $99.96 $ % Radiological examination, hip, arthrography, radiological supervision and interpretation $ $ $ % Fluoroscopic examination $47.43 $47.65 $47.58 Ultrasonic guidance for needle placement $61.45 $61.98 $ % Fluoroscopic guidance for spine injection $85.88 $87.06 $ % $43.84 $26.95 $44.43 $27.23 $43.65 $ % -1.5% $75.10 $50.67 $75.60 $50.88 $75.13 $ % $ $77.26 $ $77.75 $ $ % $ $ $ $ $ $ % -0.4% $ $ $ $ $ $ % $20.12 $9.34 $20.06 $9.32 $20.03 $ $43.84 $25.87 $44.07 $25.80 $43.65 $ % $73.66 $51.74 $73.45 $51.59 $73.34 $ $ $79.05 $ $79.18 $ $ % 0.3% $ $ $ $ $ $ % 0.8%

BILLING FACILITY FEES

BILLING FACILITY FEES Medicare ASC Payment Groups Once an ASC is approved for Medicare participation, the ASC can only be reimbursed for procedures that are on a list of procedures that Medicare will reimburse