2017 PROPOSED - Physician Payment Rates

Similar documents
BILLING FACILITY FEES

CODING SHEETS CHRONIC INTRACTABLE SPASTICITY. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE

CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE

Pain Management. the primary procedure allowable reimbursement; 50% of add-on. Injection/Destruction Procedures

October 3, RE: Appropriate use of CPT and Dear Ms. Kotowicz:

Report therapeutic hip injection under fluoro with and 77002

Coding Pain Management Services

Procedure $ 3,560 $ 1,476 Arthroscopy, shoulder, surgical; with rotator cuff repair 5.5% 241.1%

Marvel J. Hammer. Radiology codes with a PC/TC indicator of 1 = Diagnostic Tests for Radiology Services

Physician Coding and Payment Guide 2015

Workers Compensation Insurance

CPT Changes in Spine 2012

Workers Compensation Medical Costs in NH Significantly Higher

Intrathecal Baclofen for CNS Spasticity

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.

TABLE OF CONTENTS CPT

Ambulatory Surgery Center Coding and Payment Guide 2015

2012 Anesthesia Pain Management & Critical Care Changes By: Bellinger P. Moody, RHIA, CPC, CCP, CPC-I Executive Vice President of Compliance

Coding Trends for Infusions and Injections. Injections

Alaska Workers Compensation Fee Schedule Comparative Survey

15 CPT & Coding Issues for. Orthopedics and Spine ASC Facilities. Stephanie Ellis, R.N., CPC

Coding for Ancillary Services and Providers

Laser Treatment Policy

Codes for Qualis Health Rev. updated 12/26/ Arthrodesis lateral extracavitary thoracic Arthrodesis lateral extracavitary lumbar

2013 CPT Codes - Surgery

How to Get Paid for. Today s s Agenda:

SPINE ANATOMY AND PROCEDURES. Tulsa Spine & Specialty Hospital 6901 S. Olympia Avenue Tulsa, Oklahoma 74132

CPT Code Changes for 2013

Anthem Central Region Clinical Claims Edit

Aetna Injection Policy For Back Pain

Coding for Spinal Procedures

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN

OHIP BILLING for ANESTHESIOLOGY. (Updated September 13, 2011)

UPMC For Reference Only PHYSICIAN ASSISTANT 2014

An Algorithmic Approach for Clinical Management of Chronic Spinal Pain

How To Treat Pain With Pain Management

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN

Spinal Injections. North American Spine Society Public Education Series

Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete limited

Image-guided Spine Procedures for Relief of Severe Lower Back Pain:

Billing, Coding and Documentation for MSK US Ken Mautner, MD Emory Sports Medicine Center Atlanta, GA

Regional Anesthesia Fellowship at Wake Forest University

DEPARTMENT OF LABOR AND EMPLOYMENT. Division of Workers Compensation 7 CCR WORKERS COMPENSATION RULES OF PROCEDURE

1. ANESTHESIA. Intensity/Complexity Fee $ (per 15 minutes Level Code or part thereof)

Common Regional Nerve Blocks Quick Guide developed by UWHC Acute Pain Service Jan 2011

MEDICAL POLICY SUBJECT: SPINAL INJECTIONS (EPIDURAL AND FACET INJECTIONS) FOR PAIN MANAGEMENT

MONTANA. September 2015

Physicians at-a-glance

Horizon Blue Cross Blue Shield of NJ Radiology Rules Bank

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management

Guidelines for Core Clinical Privileges Certified Registered Nurse Anesthetists

Non Surgical Management of Back pain. Dr Pankaj Wadhwa MBBS,MD(Anaesth),DNB,Dip.Acu, FIPP, Fellowship in Pain Management.

Diagnostic Radiology. Computed Tomographic Colonography

Cooled RF Systems. Cooled RF Systems. Reimbursement Guide

Local Coverage Determination (LCD) for Epidural (L29165)

Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)

The Nervous System: The Spinal Cord and Spinal Nerves

Prerequisites. Authorization, Notification and Referral. Limitations ANESTHESIA SERVICES

Updated Guide to Billing for Regional Anesthesia (United States)

Board encourages physicians to treat patients pain responsibly

TRUTH IN DAMAGES IN PERSONAL INJURY CASES

Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:

Injection, Tendon Sheath, Ligament, Ganglion Cyst, Carpal and Tarsal Tunnel Supplemental Instructions Article (A47720) Contractor Information

Chapter 13: The Spinal Cord, Spinal Nerves, and Spinal Reflexes

Anatomy of the Spine. Figure 1. (left) The spine has three natural curves that form an S-shape; strong muscles keep our spine in alignment.

Chapter 15. Sympathetic Nervous System

(Formerly Sacroiliac Joint Arthrography and Injection)

CHAP2-CPTcodes _final doc Revision Date: 1/1/2016

Dial-In Instructions

76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete limited

CERVICAL PROCEDURES PHYSICIAN CODING

Lectures of Human Anatomy

COOLIEF* Cooled Radiofrequency Systems COOLIEF* COOLED RADIOFREQUENCY REIMBURSEMENT GUIDE

Managing Chronic Pain

30. BASIC PEDIATRIC REGIONAL ANESTHESIA

Anatomy and Terminology of the Spine. Bones of the Spine (Vertebrae)

Oregon CPT Preapproval Grid

LUMBAR PARAVERTEBRAL (PSOAS COMPARTMENT) BLOCK BY ANDRÉ P BOEZAART MD, PHD

DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN. Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA

Minimally Invasive Spine Surgery

5/24/2010. The 10 Ways to Improve Coding

Central Venous Lines, PICCs, Ports and Pumps

Peripheral nervous system (PNS) Consists of: 12 pairs of cranial nerves 31 pairs of spinal nerves The autonomic nervous system

James A. Sanfilippo, M.D. CONSENT FOR SPINAL SURGERY PATIENT: DATE:

Ephraim K. Brenman, D.O.

Complete Guide for Interventional Radiology

BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS

Procedure Codes. CT Angiography, Head, with contrast material(s), including noncontrast images, if performed, and image postprocessing 70496

Covered CPT Codes: 64490, 64491, 64492, 64493, 64494, 64495, 64622, 64623, 64626, 64627, 77003

Neurostimulation: Orthopaedic Institute of Ohio 801 Medical Drive Lima, Ohio

28. INTERVENTIONAL CHRONIC PAIN TREATMENT IN MATURE THEATERS OF OPERATION

Name of Policy: Treatment of Cervicogenic Headache and Occipital Neuralgia

ULTRASOUND GUIDED FEMORAL NERVE BLOCK ANAESTHESIA TUTORIAL OF THE WEEK 284

Clinical Privileges Profile Diagnostic Radiology. Greene Memorial Hospital

Autonomic Nervous System of the Neck. Adam Koleśnik, MD Department of Descriptive and Clinical Anatomy Center of Biostructure Research, MUW

Transcription:

Injection, therapeutic (eg, local anesthetic; corticosteroid), carpal tunnel 20526 $78.69 $59.29 $79.18 $59.47 $79.06 $59.74 0.5% tendon sheath, ligament injection 20550 $59.65 $42.76 $60.19 $42.99 $54.02 $40.78-10.3% -5.1% Tendon origin/insertion 20551 $61.45 $43.84 $61.98 $44.07 $61.18 $43.29-1.3% -1.8% Single or multiple trigger point(s), one or two muscle group(s) 20552 $56.42 $39.17 $56.25 $39.05 $56.17 $38.99 Single or multiple trigger point(s), three or more muscle groups 20553 $65.04 $44.20 $64.85 $44.43 $64.40 $44.00-0.7% -1.0% Small joint injection 20600 $48.51 $36.65 $48.73 $36.54 $48.65 $36.49 Intermediate joint injection 20605 $51.03 $38.45 $51.23 $38.34 $50.44 $37.92-1.5% -1.1% Major joint injection 20610 $61.09 $47.43 $61.62 $47.65 $61.18 $47.58-0.7% Vertbroplasty (Thoracic) 22510 $1,780.86 $455.28 $1,803.93 $469.35 $1,684.65 $450.05-6.6% -4.1% Vertbroplasty (Lumbar) 22511 $1,765.05 $426.89 $1,786.02 $440.68 $1,669.27 $422.50-6.5% -4.1% Vertbroplasty - Additional 22512 $989.61 $207.34 $1,001.03 $218.19 $960.20 $215.72-4.1% -1.1% Percut kyphoplasty, thor 22513 $7,453.69 $519.60 $7,504.15 $560.71 $7,198.31 $539.49-4.1% -3.8% Percut kyphoplasty, thor 22514 $7,423.50 $485.82 $7,495.91 $522.73 $7,160.03 $501.21-4.5% -4.1% Percut kyphoplasty, Additional 22515 $4,507.14 $216.68 $4,541.90 $236.82 $4,369.21 $233.61-3.8% -1.4% IDET, single level 22526 $2,421.92 $347.12 $2,432.71 $362.58 $2,327.53 $347.38-4.3% -4.2% IDET, 1 or more levels 22527 $2,015.87 $157.39 $2,018.54 $164.81 $1,964.05 $164.21-2.7% -0.4% Percut kyphoplasty, lumbar 22534 $373.35 $367.95 $376.71 2.4% Injection procedure for HIP arthrography without anesthesia 27093 $191.53 $72.23 $191.32 $72.73 $188.18 $71.91-1.6% -1.1%

Injection procedure for HIP arthrography with anesthesia 27095 $246.14 $85.16 $247.21 $85.63 $245.42 $85.86-0.7% 0.3% (G0260) Injection procedure for Sacroiliac joint, arthrography 27096 $163.50 $86.96 $165.52 $87.42 $160.99 $85.86-2.7% -1.8% Percutaneous epidural adhesiolysis - 2 or 3 days 62263 $646.80 $344.24 $669.98 $351.47 $613.54 $333.07-8.4% -5.2% Percutaneous epidural adhesiolysis 1 day 62264 $428.33 $245.07 $437.10 $248.65 $425.37 $244.70-2.7% -1.6% Percutaneous aspiration, spinal cord cyst or syrinx 62268 $271.30 $269.07 $266.17-1.1% Biopsy of spinal cord, percutaneous needle 62269 $278.48 $280.17 $274.75-1.9% Spinal puncture, diagnostic 62270 $162.42 $80.49 $162.30 $80.61 $159.91 $80.49-1.5% Spinal puncture, therapeutic 62272 $205.90 $86.24 $207.44 $87.06 $203.20 $86.58-2.0% -0.6% Epidural, blood patch 62273 $177.15 $117.50 $179.14 $118.59 $174.58 $116.98-2.5% -1.4% Subarachnoid neurolytic injection 62280 $306.15 $162.78 $315.29 $168.03 $306.59 $165.28-2.8% -1.6% Neurolytic epidural, C/T 62281 $238.60 $157.75 $248.65 $163.38 $245.77 $161.70-1.2% -1.0% Neurolytic epidural, L/S 62282 $300.76 $150.56 $300.60 $150.84 $299.80 $150.26-0.3% -0.4% Injection procedure myelography 62284 $186.49 $89.12 $185.95 $88.85 $188.18 $90.15 1.2% 1.5% Disc decompression 62287 $589.67 $589.01 $588.86 0.0% Diskogrsphy each level: lumbar 62290 $341.37 $177.51 $343.23 $179.14 $333.07 $175.30-3.0% -2.1% Diskogrsphy each level: C/T 62291 $344.60 $177.15 $339.65 $176.99 $334.50 $174.22-1.5% -1.6% Chemonucleolysis 62292 $601.17 $601.55 $595.30-1.0% Cervical epidural 62310 $245.43 $112.11 $247.93 $113.22

CPT Description Lumbar epidural 62311 $226.02 $92.35 $228.94 $93.15 Epidural or subarachnoid, catheterization, C/T 62318 $234.29 $102.05 $243.99 $104.62 Catheterization, epidural, L/S 62319 $171.04 $98.82 $175.92 $100.68 Cervical or Thoracic interlaminar epidural; without fluoro 623X5 $155.98 $104.82 Cervical or Thoracic interlaminar epidural; with fluoro 623X6 $238.26 $113.41 Lumbar or sacral (caudal) interlaminar epidural injection(s); 623X7 without fluoro $145.25 $90.87 Lumbar or sacral (caudal) interlaminar epidural injection(s); 623X8 with fluoro $233.61 $103.75 Cervical or thoracic continuous interlaminar epidural 623X9 Injection(s),; without fluoro $137.02 $95.52 Cervical or thoracic continuous interlaminar epidural 62X10 Injection(s),; with fluoro $211.43 $110.19 Njx interlaminar L/S without imaging guidance 62X11 $143.82 $94.09 Lumbar or sacral (caudal) continuous interlaminar epidural 62X12 Injection(s),; Without fluoro $214.65 $99.81 Lumbar or sacral (caudal) continuous interlaminar epidural 630X1 Injection(s),; With fluoro $688.31 Tunneled intrathecal or epidural catheter for long-term medication administration via an external pump or implantable reservoir; w/o laminectomy 62350 $413.95 $419.19 $411.41-1.9% Removal or previously implanted intrathecal or epidural catheter 62355 $278.84 $275.52 $275.11 Implant or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir 62360 $314.78 $327.11 $318.76-2.6% Implantation or replacement of device for epidural drug infusion; non-programmable pump 62361 $446.29 $377.63 $439.32 16.3% Implant spine infusion pump 62362 $399.22 $405.21 $396.75-2.1% Remove spine infusion device 62365 $307.95 $310.27 $306.95-1.1%

Electronic analysis of programmable pump 62367 $42.04 $26.23 $42.64 $26.51 $41.14 $25.76-3.5% -2.8% Electronic analysis of programmable pump with reprogramming 62368 $57.85 $36.29 $58.40 $36.54 $57.24 $36.49-2.0% Implant neuroelectrodes (NA=National price is Not Available) 63650 $1,354.69 $425.45 $1,370.42 $429.93 $1,325.83 $422.50-3.3% -1.7% Implant neuroelectrodes (NA=National price is Not Available) 63655 $857.37 $859.87 $858.96 Remove spine eltrd perq aray 63661 $591.11 $330.95 $596.18 $333.20 $589.57 $331.64-1.1% -0.5% Remove spine eltrd plate 63662 $868.51 $872.05 $867.19-0.6% Remove spine eltrd perq aray 63663 $804.55 $465.70 $818.31 $471.85 $797.07 $464.00-2.6% -1.7% Remove spine eltrd plate 63664 $888.28 $896.41 $894.74-0.2% Implant neuroreceiver 63685 $378.74 $381.21 $376.71-1.2% Revise/remove neuroreceiver 63688 $382.69 $383.36 $382.44-0.2% Injection, anesthetic agent; Trigeminal nerve, any division or branch 64400 $129.36 $72.59 $130.77 $73.45 $128.79 $72.98-1.5% -0.6% Facial nerve 64402 $131.88 $79.77 $133.64 $81.33 $135.95 $83.00 1.7% 2.1% Greater occipital nerve 64405 $102.77 $65.04 $103.54 $65.21 $102.32 $65.11-1.2% Vagus nerve 64408 $118.58 $88.04 $107.48 $78.46 $121.28 $89.44 12.8% 14.0% Phrenic nerve 64410 $122.53 $70.07 $128.98 $73.09 $137.73 $77.99 6.8% 6.7% 64412 Spinal accessory nerve $144.81 $74.02 Cervical plexus 64413 $131.16 $84.08 $130.41 $83.84 $129.51 $83.71-0.7% Brachial plexus 64415 $119.66 $66.48 $124.68 $68.07 $118.06 $66.54-5.3% -2.2%

Axillary nerve 64417 $131.52 $72.59 $136.50 $74.52 $129.15 $71.91-5.4% -3.5% Suprascapular nerve 64418 $149.12 $78.69 $149.04 $79.18 $146.32 $77.99-1.8% -1.5% Intercostal, single 64420 $114.27 $69.71 $115.72 $70.58 $111.98 $69.40-3.2% -1.7% Intercostal, multiple, regional block 64421 $152.36 $93.79 $155.13 $95.30 $151.33 $93.73-2.5% -1.6% Ilioinguinal, Iliohypogastric 64425 $134.03 $95.58 $136.50 $97.09 $133.80 $96.24-2.0% -0.9% Pudendal nerve 64430 Pudendal nerve $141.88 $84.91 $138.09 $83.00-2.7% -2.2% Sciatic nerve 64445 $137.63 $74.02 $140.80 $75.24 $137.38 $74.41-2.4% -1.1% Other peripheral nerve or branch 64450 $81.93 $47.07 $81.69 $47.29 $80.85 $46.51-1.0% -1.7% Cervical transforaminal epidural injections 64479 $240.40 $136.55 $242.20 $137.22 $237.55 $135.95-1.9% -0.9% Cervical transforaminal epidural injections add-on 64480 $114.63 $65.04 $116.08 $65.57 $114.12 $65.11-1.7% -0.7% L/S transforaminal epidural injections 64483 $223.15 $116.07 $225.36 $116.80 $220.37 $115.91-2.2% -0.8% L/S transforaminal epidural injections add-on 64484 $89.47 $53.90 $90.29 $54.10 $88.01 $52.95-2.5% -2.1% C/T facet joint injections, 1st Level (Old 64470) 64490 $193.68 $109.96 $195.62 $110.71 $191.40 $109.47-2.2% -1.1% C/T facet joint injections, 2nd Level (Old 64472) 64491 $95.94 $62.52 $96.38 $62.70 $94.45 $61.89-2.0% -1.3% C/T facet joint injections, 3rd Level 64492 $96.30 $62.88 $97.09 $63.42 $95.16 $62.61-2.0% -1.3% Paravertebral facet joint or facet joint nerve; L/S, 1st Level 64493 $175.71 $94.15 $177.71 $94.94 $173.15 $93.02-2.6% -2.0% Paravertebral facet joint or facet joint nerve; L/S, 2nd Level 64494 $88.40 $53.54 $89.21 $54.10 $87.65 $53.66-1.8% -0.8% Paravertebral facet joint or facet joint nerve; L/S, 3rd Level 64495 $88.76 $54.26 $89.57 $54.82 $88.01 $54.38-1.7% -0.8%

Injection, anesthetic agent; sphenopalatine ganglion 64505 $106.00 $88.76 $107.13 $89.93 $107.68 $90.51 0.5% 0.6% Injection, anesthetic agent; Carotid sinus (separate procedure) 64508 $63.60 $74.74 $63.77 $75.60 $61.53 $73.70-3.5% -2.5% Injection, anesthetic agent; Stellate ganglion (cervical sympathetic) 64510 $130.08 $75.82 $131.49 $76.67 $128.07 $75.13-2.6% -2.0% Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) 64520 $190.09 $83.37 $192.04 $84.20 $187.10 $83.00-2.6% -1.4% Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring 64530 $194.40 $94.86 $196.70 $96.02 $190.68 $93.73-3.1% -2.4% Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch 64600 $395.27 $224.23 $403.78 $228.58 $399.25 $227.17-1.1% -0.6% Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale 64605 $605.84 $363.65 $773.17 $429.93 $619.98 $357.75-19.8% -16.8% Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring 64610 $749.93 $500.91 $769.94 $512.34 $758.79 $507.65-1.4% -0.9% Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial spasm) 64612 $133.31 $119.66 $135.07 $121.10 $133.08 $119.49-1.5% -1.3% Destruction by neurolytic agent, intercostal nerve 64620 $209.85 $177.51 $211.03 $178.42 $207.50 $176.01-1.7% -1.4% Destruction by neurolytic agent; pudendal nerve 64630 $238.24 $198.35 $238.97 $199.56 $235.04 $196.76-1.6% -1.4% Destroy cerv/thor facet jnt 64633 $429.41 $233.21 $434.95 $235.39 $422.86 $231.11-2.8% -1.8% Destroy c/th facet jnt addl 64634 $192.96 $70.43 $195.62 $71.30 $189.97 $70.12-2.9% -1.7% Destroy lumb/sac facet jnt 64635 $425.45 $230.69 $429.93 $232.16 $418.57 $228.25-2.6% -1.7% Destroy l/s facet jnt addl 64636 $176.07 $62.16 $177.71 $62.34 $172.79 $61.89-2.8% -0.7% Destruction by neurolytic agent; other peripheral nerve or branch 64640 $135.47 $95.58 $136.15 $96.02 $133.80 $95.16-1.7% -0.9% Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus 64680 $319.81 $173.20 $317.79 $171.97 $308.74 $168.50-2.8% -2.0% Contrast x-ray, lower spine 72265 $92.35 $92.79 $91.58-1.3%

Contrast x-ray of spine 72270 $128.28 $128.26 $127.00-1.0% Epidurography 72275 $116.07 $116.80 $116.63 Diskography C/T Radiological supervision and interpretation 72285 $115.35 $115.72 $113.41-2.0% Diskography lumbar radiological supervision and interpretation 72295 $99.18 $99.96 $98.02-1.9% Radiological examination, hip, arthrography, radiological supervision and interpretation 73525 $102.05 $102.47 $101.60-0.8% Fluoroscopic examination 76000 $47.43 $47.65 $47.58 Ultrasonic guidance for needle placement 76942 $61.45 $61.98 $61.53-0.7% Fluoroscopic guidance for spine injection 77003 $85.88 $87.06 $83.71-3.8% 99201 $43.84 $26.95 $44.43 $27.23 $43.65 $26.83-1.8% -1.5% 99202 $75.10 $50.67 $75.60 $50.88 $75.13 $50.80-0.6% 99203 $108.88 $77.26 $109.28 $77.75 $109.11 $77.99 0.3% 99204 $166.01 $131.16 $166.24 $131.49 $165.28 $130.94-0.6% -0.4% 99205 $208.05 $170.32 $208.52 $170.90 $208.21 $171.01 0.1% 99211 $20.12 $9.34 $20.06 $9.32 $20.03 $9.30 99212 $43.84 $25.87 $44.07 $25.80 $43.65 $25.76-1.0% 99213 $73.66 $51.74 $73.45 $51.59 $73.34 $51.52 99214 $108.16 $79.05 $108.20 $79.18 $108.40 $79.42 0.2% 0.3% 99215 $145.89 $112.11 $145.82 $111.78 $145.96 $112.69 0.1% 0.8%