Rev. 9/10/12 10060 Drainage of skin abscess
MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 10060 10061 10120 10121 10140 10160 10180 11000 11001 11010 11011 11012 11042 11043 11044 11045 11046 11047 11055 11056 11057 11100 11101 11200 11201 11300 11301 11302 11305 11306 11307 11308 11400 Mod Short Description Drainage of skin abscess Drainage of skin abscess Remove foreign body Remove foreign body Drainage of hematoma/fluid Puncture drainage of lesion Complex drainage wound Debride infected skin Debride infected skin add-on Debride skin at fx site Debride skin musc at fx site Deb skin bone at fx site Deb subq tissue 20 sq cm/< Deb musc/fascia 20 sq cm/< Deb bone 20 sq cm/< Deb subq tissue add-on Deb musc/fascia add-on Deb bone add-on Trim skin lesion Trim skin lesions 2 to 4 Trim skin lesions over 4 Biopsy skin lesion Biopsy skin add-on Removal of skin tags Remove skin tags add-on Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Exc tr-ext b9+marg 0.5 < cm HCPCS Action Code Non-Fac Fee $49.52 $88.93 $69.73 $129.55 $69.34 $58.24 $110.73 $24.75 $11.29 $232.54 $274.53 $399.52 $43.98 $120.63 $157.46 $18.02 $31.30 $51.50 $20.59 $26.14 $32.29 $41.40 $15.06 $36.65 $9.31 $30.30 $39.62 $47.53 $31.49 $42.78 $49.52 $59.22 $57.63 Fac Fee PA Comments $43.98 $82.40 $45.75 $95.28 $59.63 $47.94 $90.92 $17.62 $8.91 $148.16 $159.05 $235.32 $33.47 $104.99 $143.61 $10.50 $22.18 $38.62 $12.87 $18.03 $23.57 $23.97 $12.29 $31.10 $8.52 $14.85 $25.16 $30.91 $20.01 $29.32 $33.68 $42.20 $35.46 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 1 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 11401 11402 11403 11404 11406 11420 11421 11422 11423 11424 11426 11606 11620 11621 11622 11623 11624 11626 11720 11721 11730 11732 11740 11750 11752 11755 11760 11762 11900 11901 12001 12002 12004 Mod Short Description Exc tr-ext b9+marg 0.6-1 cm Exc tr-ext b9+marg 1.1-2 cm Exc tr-ext b9+marg 2.1-3 cm Exc tr-ext b9+marg 3.1-4 cm Exc tr-ext b9+marg > 4.0 cm Exc h-f-nk-sp b9+marg 0.5 < Exc h-f-nk-sp b9+marg 0.6-1 Exc h-f-nk-sp b9+marg 1.1-2 Exc h-f-nk-sp b9+marg 2.1-3 Exc h-f-nk-sp b9+marg 3.1-4 Exc h-f-nk-sp b9+marg > 4 cm Exc tr-ext mlg+marg > 4 cm Exc h-f-nk-sp mlg+marg 0.5 < Exc h-f-nk-sp mlg+marg 0.6-1 Exc h-f-nk-sp mlg+marg 1.1-2 Exc h-f-nk-sp mlg+marg 2.1-3 Exc h-f-nk-sp mlg+marg 3.1-4 Exc h-f-nk-sp mlg+mar > 4 cm Debride nail 1-5 Debride nail 6 or more Removal of nail plate Remove nail plate add-on Drain blood from under nail Removal of nail bed Remove nail bed/finger tip Biopsy nail unit Repair of nail bed Reconstruction of nail bed Injection into skin lesions Added skin lesions injection Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) HCPCS Action Code Non-Fac Fee $67.15 $76.66 $86.36 $98.64 $121.81 $56.25 $71.70 $80.22 $95.08 $108.74 $152.52 $155.49 $76.86 $90.92 $103.00 $121.81 $140.23 $185.79 $13.87 $20.81 $45.56 $21.39 $19.01 $84.18 $119.25 $59.82 $87.54 $121.61 $23.57 $29.52 $76.06 $80.82 $94.67 Fac Fee PA Comments $46.56 $53.88 $64.97 $72.70 $93.70 $39.62 $52.69 $61.79 $72.50 $84.77 $125.19 $109.35 $44.17 $61.79 $71.70 $86.96 $101.22 $141.42 $9.51 $16.23 $33.68 $17.04 $15.06 $76.06 $119.25 $43.98 $70.92 $110.93 $14.85 $23.37 $51.89 $58.04 $68.53 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 2 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 12005 12006 12007 12020 12021 12041 12042 12044 12045 12046 12047 13120 13121 13131 13132 13133 13160 14040 14041 14350 15004 15005 15050 15115 15120 15135 15155 15275 15276 15277 15278 15851 15852 Mod Short Description Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Closure of split wound Closure of split wound Intmd wnd repair n-hf/genit INTMD WND REPAIR N-HF/GENIT INTMD WND REPAIR N-HF/GENIT INTMD WND REPAIR N-HF/GENIT INTMD WND REPAIR N-HF/GENIT INTMD WND REPAIR N-HF/GENIT Repair of wound or lesion Repair of wound or lesion Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Late closure of wound Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Wound prep f/n/hf/g Wnd prep f/n/hf/g addl cm Skin pinch graft Epidrm a-grft face/nck/hf/g Skn splt a-grft fac/nck/hf/g Derm autograft face/nck/hf/g CULT SKIN GRAFT F/N/HF/G SKIN SUB GRAFT FACE/NK/HF/G SKIN SUB GRAFT F/N/HF/G ADDL SKN SUB GRFT F/N/HF/G CHILD SKN SUB GRFT F/N/HF/G CH ADD Removal of sutures Dressing change not for burn HCPCS Action Code Non-Fac Fee $118.06 $146.78 $166.18 $133.71 $77.44 $101.22 $122.42 $131.32 $184.60 $223.83 $229.38 $152.72 $186.79 $166.59 $241.26 $79.83 NA $342.86 $452.01 NA $197.47 $61.40 $233.54 $400.31 $430.43 $428.43 $354.35 $90.13 $19.61 $173.52 $47.93 $51.50 NA Fac Fee PA Comments $85.76 $109.35 $126.38 $96.06 $69.12 $73.09 $86.57 $99.24 $125.38 $149.36 $164.59 $117.06 $145.98 $133.30 $206.60 $67.34 $379.91 $310.98 $413.98 $358.51 $142.02 $47.14 $197.68 $363.06 $371.99 $393.78 $337.32 $59.23 $14.46 $125.78 $31.89 $24.36 $25.36 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 3 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 16000 16020 16035 16036 17000 17003 17004 17106 17107 17108 17110 17111 17250 17270 17271 17272 17273 17274 17276 17999 20005 20103 20200 20205 20206 20220 20240 20245 20500 20501 20520 20525 20550 Mod Short Description Initial treatment of burn(s) Dress/debrid p-thick burn s Incision of burn scab initi Escharotomy addl incision Destruct premalg lesion Destruct premalg les 2-14 DESTROY PREMAL LESIONS 15/> Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruct b9 lesion 1-14 Destruct lesion 15 or more Chemical cautery tissue Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Skin tissue procedure I&D abscess subfascial Explore wound extremity Muscle biopsy Deep muscle biopsy Needle biopsy muscle Bone biopsy trocar/needle Bone biopsy excisional Bone biopsy excisional Injection of sinus tract Inject sinus tract for x-ray Removal of foreign body Removal of foreign body Inj tendon sheath/ligament HCPCS Action Code Non-Fac Fee $36.24 $42.98 NA NA $31.69 $5.35 $103.19 $188.96 $336.73 $455.77 $45.95 $52.30 $35.26 $60.82 $65.95 $76.06 $85.96 $104.19 $124.99 M $145.98 $289.98 $93.70 $130.33 $150.14 $117.26 NA NA $71.70 $73.69 $98.64 $260.87 $30.70 Fac Fee $24.36 $28.91 $114.48 $45.56 $23.17 $4.55 $88.93 $163.81 $302.07 $423.88 $27.72 $35.26 $17.83 $44.37 $50.11 $58.43 $66.15 $81.80 $99.83 M $121.42 $186.98 $48.33 $76.66 $33.47 $42.39 $123.39 $310.38 $57.05 $20.81 $75.86 $131.32 $21.20 PA Comments Documentation required. * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 4 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 20551 20552 20553 20600 20605 20612 20615 20650 20670 20680 20690 20692 20693 20694 20900 20924 20926 20972 20973 20999 26010 27603 27604 27605 27606 27607 27610 27612 27613 27614 27615 27618 27619 Mod Short Description Inj tendon origin/insertion Inj trigger point 1/2 muscl Inject trigger points =/> 3 Drain/inject joint/bursa Drain/inject joint/bursa Aspirate/inj ganglion cyst Treatment of bone cyst Insert and remove bone pin Removal of support implant Removal of support implant Apply bone fixation device Apply bone fixation device Adjust bone fixation device Remove bone fixation device Removal of bone for graft Removal of tendon for graft Removal of tissue for graft Bone/skin graft metatarsal Bone/skin graft great toe Musculoskeletal surgery Drainage of finger abscess Drain lower leg lesion Drain lower leg bursa Incision of achilles tendon Incision of achilles tendon Treat lower leg bone lesion Explore/treat ankle joint Exploration of ankle joint Biopsy lower leg soft tissue Biopsy lower leg soft tissue Resect leg/ankle tum < 5 cm Exc leg/ankle tum < 3 cm Exc leg/ankle tum deep <5 cm HCPCS Action Code Non-Fac Fee $29.91 $28.33 $31.88 $27.53 $30.11 $29.91 $118.84 $97.25 $269.19 $251.75 NA NA NA $238.09 $296.33 NA NA NA NA M $144.59 $261.07 $222.83 $217.48 NA NA NA NA $111.12 $268.98 NA $234.32 NA Fac Fee $22.97 $18.03 $20.01 $21.59 $22.19 $22.97 $85.76 $81.02 $81.80 $151.13 $131.13 $222.44 $243.44 $176.49 $241.65 $265.62 $220.86 $1,364.15 $1,514.48 M $66.35 $194.92 $180.65 $111.12 $162.23 $306.23 $331.77 $288.40 $82.80 $215.51 $471.22 $194.11 $309.20 PA Comments Documentation required. * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 5 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 27620 27625 27626 27630 27632 27634 27635 27638 27640 27641 27647 27648 27650 27654 27658 27659 27664 27665 27675 27676 27680 27681 27685 27686 27687 27690 27691 27692 27695 27696 27698 27700 27702 Mod Short Description Explore/treat ankle joint Remove ankle joint lining Remove ankle joint lining Removal of tendon lesion EXC LEG/ANKLE LES SC 3 CM/> EXC LEG/ANKLE TUM DEP 5 CM/> Remove lower leg bone lesion Remove/graft leg bone lesion Partial removal of tibia Partial removal of fibula Resect talus/calcaneus tum Injection for ankle x-ray Repair achilles tendon Repair of achilles tendon Repair of leg tendon each Repair of leg tendon each Repair of leg tendon each Repair of leg tendon each Repair lower leg tendons Repair lower leg tendons Release of lower leg tendon Release of lower leg tendons Revision of lower leg tendon Revise lower leg tendons Revision of calf tendon Revise lower leg tendon Revise lower leg tendon Revise additional leg tendon Repair of ankle ligament Repair of ankle ligaments Repair of ankle ligament Revision of ankle joint Reconstruct ankle joint HCPCS Action Code Non-Fac Fee NA NA NA $259.68 NA NA NA NA NA NA NA $90.51 NA NA NA NA NA NA NA NA NA NA $292.56 NA NA NA NA NA NA NA NA NA NA Fac Fee PA Comments $246.00 $317.92 $343.06 $196.50 $221.45 $360.89 $313.76 $410.01 $466.86 $377.33 $427.85 $27.14 $372.38 $371.19 $204.60 $268.39 $196.09 $223.03 $277.91 $327.82 $233.33 $275.13 $256.32 $301.08 $248.78 $324.85 $383.68 $61.79 $266.22 $316.72 $352.18 $322.47 $525.10 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 6 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 27703 27704 27760 27762 27766 27767 27768 27769 27786 27788 27792 27808 27810 27814 27816 27818 27822 27823 27824 27825 27826 27827 27828 27829 27840 27842 27846 27848 27860 27870 27871 27899 28001 Mod Short Description Reconstruction ankle joint Removal of ankle implant Cltx medial ankle fx Cltx med ankle fx w/mnpj Optx medial ankle fx Cltx post ankle fx Cltx post ankle fx w/mnpj Optx post ankle fx Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg joint Treat ankle dislocation Treat ankle dislocation Treat ankle dislocation Treat ankle dislocation Fixation of ankle joint Fusion of ankle joint, open Fusion of tibiofibular joint Leg/ankle surgery procedure Drainage of bursa of foot HCPCS Action Code Non-Fac Fee NA NA $162.03 $246.41 NA $127.76 NA NA $153.91 $214.71 NA $160.43 $241.65 NA $152.72 $251.55 NA NA $146.78 $273.74 NA NA NA NA NA NA NA NA NA NA NA M $119.84 Fac Fee $591.66 $287.01 $140.43 $225.41 $337.32 $127.76 $199.66 $347.03 $131.52 $194.92 $315.92 $138.65 $219.86 $417.75 $133.51 $227.58 $466.86 $529.46 $136.87 $249.58 $373.38 $579.76 $653.45 $262.06 $174.30 $244.22 $384.87 $452.80 $93.49 $530.84 $363.48 M $99.44 PA Comments Documentation required. * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 7 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 28002 28003 28005 28008 28010 28011 28020 28022 28024 28035 28039 28041 28043 28045 28046 28047 28050 28052 28054 28055 28060 28062 28070 28072 28080 28086 28088 28090 28092 28100 28103 28104 28107 Mod Short Description Treatment of foot infection Treatment of foot infection Treat foot bone lesion Incision of foot fascia Incision of toe tendon Incision of toe tendons Exploration of foot joint Exploration of foot joint Exploration of toe joint Decompression of tibia nerve EXC FOOT/TOE TUM SC 1.5 CM/> EXC FOOT/TOE TUM DEP 1.5CM/> Exc foot/toe tum sc < 1.5 cm Exc foot/toe tum deep < 1.5 cm Resect foot/toe tumor < 3 cm RESECT FOOT/TOE TUMOR 3 CM/> Biopsy of foot joint lining Biopsy of foot joint lining Biopsy of toe joint lining Neurectomy foot Partial removal, foot fascia Removal of foot fascia Removal of foot joint lining Removal of foot joint lining Removal of foot lesion Excise foot tendon sheath Excise foot tendon sheath Removal of foot lesion Removal of toe lesions Removal of ankle/heel lesion Remove/graft foot lesion Removal of foot lesion Remove/graft foot lesion HCPCS Action Code Non-Fac Fee $202.44 $312.37 NA $189.56 $110.52 $159.05 $232.74 $207.79 $201.64 $230.76 $254.53 NA $154.69 $212.54 NA NA $192.92 $185.79 $170.94 NA $226.00 $274.73 $218.87 $213.73 $181.43 $268.00 $202.63 $200.85 $185.21 $286.23 NA $224.02 $254.13 Fac Fee PA Comments $178.27 $292.36 $314.75 $162.82 $110.52 $159.05 $195.31 $181.04 $175.89 $195.70 $182.23 $239.47 $142.02 $177.27 $356.74 $504.30 $167.17 $156.49 $141.42 $209.18 $194.11 $225.02 $190.95 $189.37 $153.11 $202.44 $165.59 $167.37 $151.52 $221.25 $238.09 $192.92 $207.98 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 8 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 28108 28110 28111 28112 28113 28114 28116 28118 28119 28120 28122 28124 28126 28130 28140 28150 28153 28160 28171 28173 28175 28190 28192 28193 28200 28202 28208 28210 28220 28222 28225 28226 28230 Mod Short Description Removal of toe lesions Part removal of metatarsal Part removal of metatarsal Part removal of metatarsal Part removal of metatarsal Removal of metatarsal heads Revision of foot Removal of heel bone Removal of heel spur Part removal of ankle/heel Partial removal of foot bone Partial removal of toe Partial removal of toe Removal of ankle bone Removal of metatarsal Removal of toe Partial removal of toe Partial removal of toe Resect tarsal tumor Resect metatarsal tumor Resect phalanx of toe tumor Removal of foot foreign body Removal of foot foreign body Removal of foot foreign body Repair of foot tendon Repair/graft of foot tendon Repair of foot tendon Repair/graft of foot tendon Release of foot tendon Release of foot tendons Release of foot tendon Release of foot tendons Incision of foot tendon(s) HCPCS Action Code Non-Fac Fee $183.82 $194.92 $236.90 $216.09 $227.38 $452.60 $308.60 $258.49 $228.19 $266.61 $299.30 $205.99 $162.03 NA $298.30 $187.18 $167.17 $174.11 NA NA NA $110.52 $212.54 $239.08 $204.02 $296.52 $193.31 $265.03 $193.53 $228.77 $166.39 $196.09 $187.37 Fac Fee PA Comments $157.27 $155.30 $184.80 $171.73 $192.73 $388.03 $276.32 $220.66 $194.31 $209.57 $268.20 $179.46 $137.87 $318.70 $249.38 $156.49 $134.89 $149.75 $324.05 $299.49 $207.57 $72.50 $176.08 $205.60 $173.52 $242.45 $163.41 $221.45 $168.76 $206.60 $139.04 $175.30 $167.56 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 9 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 28232 28234 28238 28240 28250 28260 28261 28262 28264 28270 28272 28280 28285 28286 28288 28289 28290 28292 28293 28294 28296 28297 28298 28299 28300 28302 28304 28305 28306 28307 28308 28309 28310 Mod Short Description Incision of toe tendon Incision of foot tendon Revision of foot tendon Release of big toe Revision of foot fascia Release of midfoot joint Revision of foot tendon Revision of foot and ankle Release of midfoot joint Release of foot contracture Release of toe joint each Fusion of toes Repair of hammertoe Repair of hammertoe Partial removal of foot bone Repair hallux rigidus Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Incision of heel bone Incision of ankle bone Incision of midfoot bones Incise/graft midfoot bones Incision of metatarsal Incision of metatarsal Incision of metatarsal Incision of metatarsals Revision of big toe HCPCS Action Code Non-Fac Fee $165.40 $167.97 $317.72 $189.56 $245.03 $305.63 $433.98 $633.64 $388.62 $203.43 $167.17 $241.06 $198.86 $196.50 $224.41 $317.92 $252.35 $305.43 $416.75 $338.51 $367.03 $385.45 $321.08 $410.42 NA NA $364.06 NA $268.20 $361.89 $232.54 NA $235.32 Fac Fee PA Comments $141.42 $141.81 $271.75 $166.78 $215.31 $279.10 $408.04 $581.15 $379.71 $180.44 $140.84 $205.99 $170.34 $165.98 $203.43 $273.94 $221.84 $267.20 $324.64 $284.43 $312.76 $331.98 $277.10 $356.74 $358.91 $353.77 $320.28 $366.25 $215.31 $248.00 $191.54 $451.02 $191.73 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 10 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 28312 28315 28320 28322 28340 28341 28344 28345 28360 28400 28405 28406 28415 28430 28435 28436 28445 28450 28455 28456 28465 28470 28475 28476 28485 28490 28495 28496 28505 28510 28515 28525 28530 Mod Short Description Revision of toe Removal of sesamoid bone Repair of foot bones Repair of metatarsals Resect enlarged toe tissue Resect enlarged toe Repair extra toe(s) Repair webbed toe(s) Reconstruct cleft foot Treatment of heel fracture Treatment of heel fracture Treatment of heel fracture Treat heel fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treat ankle fracture Treat midfoot fracture each Treat midfoot fracture each Treat midfoot fracture Treat midfoot fracture each Treat metatarsal fracture Treat metatarsal fracture Treat metatarsal fracture Treat metatarsal fracture Treat big toe fracture Treat big toe fracture Treat big toe fracture Treat big toe fracture Treatment of toe fracture Treatment of toe fracture Treat toe fracture Treat sesamoid bone fracture HCPCS Action Code Non-Fac Fee $210.35 $205.60 NA $372.38 $282.65 $324.05 $208.38 $255.91 NA $121.81 $200.66 NA NA $114.88 $155.10 NA NA $104.99 $137.87 NA NA $107.35 $133.71 NA NA $64.37 $78.44 $217.09 $247.19 $54.66 $70.12 $224.61 $52.30 Fac Fee PA Comments $174.50 $174.69 $343.27 $315.92 $238.87 $281.86 $166.39 $225.80 $517.38 $110.32 $196.50 $281.66 $632.45 $98.44 $152.33 $226.80 $579.18 $92.31 $137.87 $144.20 $285.82 $93.89 $131.32 $176.29 $237.48 $56.85 $76.25 $116.67 $163.81 $54.66 $70.12 $143.61 $52.30 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 11 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 28531 28540 28545 28546 28555 28570 28575 28576 28585 28600 28605 28606 28615 28630 28635 28636 28645 28660 28665 28666 28675 28705 28715 28725 28730 28735 28737 28740 28750 28755 28760 28800 28805 Mod Short Description Treat sesamoid bone fracture Treat foot dislocation Treat foot dislocation Treat foot dislocation Repair foot dislocation Treat foot dislocation Treat foot dislocation Treat foot dislocation Repair foot dislocation Treat foot dislocation Treat foot dislocation Treat foot dislocation Repair foot dislocation Treat toe dislocation Treat toe dislocation Treat toe dislocation Repair toe dislocation Treat toe dislocation Treat toe dislocation Treat toe dislocation Repair of toe dislocation Fusion of foot bones Fusion of foot bones Fusion of foot bones Fusion of foot bones Fusion of foot bones Revision of foot bones Fusion of foot bones Fusion of big toe joint Fusion of big toe joint Fusion of big toe joint Amputation of midfoot Amputation thru metatarsal HCPCS Action Code Non-Fac Fee $197.47 $93.29 $102.41 $210.95 $341.89 $85.57 $150.53 NA $328.21 $98.64 $123.61 NA NA $68.73 $83.19 $140.23 $192.92 $51.89 $71.50 NA $208.57 NA NA NA NA NA NA $398.52 $403.29 $227.80 $332.37 NA NA Fac Fee PA Comments $94.28 $93.29 $102.41 $160.65 $257.90 $83.79 $150.53 $178.86 $298.69 $96.06 $123.61 $206.19 $339.11 $57.44 $73.28 $115.48 $159.65 $42.59 $71.50 $112.51 $133.30 $679.79 $495.58 $430.02 $414.78 $403.08 $354.96 $311.18 $299.10 $181.04 $283.65 $300.27 $301.47 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 12 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 28810 28820 28825 28890 28899 29345 29355 29405 29425 29435 29440 29445 29450 29505 29515 29540 29550 29580 29581 29582 29700 29730 29740 29750 29799 29891 29892 29893 29894 29895 29897 29898 29899 Mod Short Description Amputation toe & metatarsal Amputation of toe Partial amputation of toe High energy eswt plantar f Foot/toes surgery procedure Application of long leg cast Application of long leg cast Apply short leg cast Apply short leg cast Apply short leg cast Addition of walker to cast Apply rigid leg cast Application of leg cast Application long leg splint Application lower leg splint Strapping of ankle and/or ft Strapping of toes Application of paste boot Apply multlay comprs lwr leg APPLY MULTLAY COMPRS UPR LEG Removal/revision of cast Windowing of cast Wedging of cast Wedging of clubfoot cast Casting/strapping procedure Ankle arthroscopy/surgery Ankle arthroscopy/surgery Scope plantar fasciotomy Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery HCPCS Action Code Non-Fac Fee NA $249.19 $219.67 $186.98 M $67.54 $69.34 $43.98 $47.34 $58.24 $26.55 $76.47 $75.66 $38.62 $33.47 $19.61 $18.81 $25.55 $47.54 $40.61 $30.50 $33.27 $48.53 $50.11 M NA NA $240.46 NA NA NA NA NA Fac Fee $228.58 $174.30 $149.94 $114.88 M $53.47 $57.63 $33.88 $37.63 $45.75 $18.23 $59.63 $68.14 $24.17 $25.36 $17.43 $16.04 $19.61 $17.63 $8.91 $18.42 $24.17 $35.46 $40.60 M $342.86 $359.70 $194.92 $274.14 $268.98 $282.07 $312.95 $532.04 PA Comments Documentation required. Documentation required. * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 13 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 64450 64455 64632 64640 64702 64704 64722 64726 64727 64774 64776 64778 64782 64783 64787 64788 64795 64831 64832 64834 64837 64872 64999 73600 73600 73600 73610 73610 73610 73615 73615 73615 73620 Mod TC 26 TC 26 TC 26 Short Description N block other peripheral N block inj plantar digit N block inj common digit Injection treatment of nerve Revise finger/toe nerve Revise hand/foot nerve Relieve pressure on nerve(s) Release foot/toe nerve Internal nerve revision Remove skin nerve lesion Remove digit nerve lesion Digit nerve surgery add-on Remove limb nerve lesion Limb nerve surgery add-on Implant nerve end Remove skin nerve lesion Biopsy of nerve Repair of digit nerve Repair nerve add-on Repair of hand or foot nerve Repair nerve add-on Subsequent repair of nerve Nervous system surgery X-ray exam of ankle X-ray exam of ankle X-ray exam of ankle X-ray exam of ankle X-ray exam of ankle X-ray exam of ankle Contrast x-ray of ankle Contrast x-ray of ankle Contrast x-ray of ankle X-ray exam of foot HCPCS Action Code Non-Fac Fee $52.30 $26.94 $43.58 $143.40 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA M $14.46 $10.10 $4.36 $15.65 $10.89 $4.75 $59.02 NA $44.17 NA $14.85 $14.46 Fac Fee $37.24 $21.39 $37.24 $97.06 $172.33 $168.17 $162.82 $148.75 $100.62 $192.92 $189.37 $100.42 $215.12 $120.03 $138.65 $174.30 $100.83 $355.15 $186.98 $372.77 $207.18 $66.56 M NA NA $4.36 NA NA $4.75 PA Comments Documentation required. $14.85 NA * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 14 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 73620 73620 73630 73630 73630 73650 73650 73650 73660 73660 73660 77071 81001 81002 82948 82962 85013 89060 89060 90471 90714 90714 93922 93922 93922 93923 93923 93923 93965 93965 93965 96372 Mod Short Description TC 26 X-ray exam of foot X-ray exam of foot X-ray exam of foot X-ray exam of foot X-ray exam of foot X-ray exam of heel X-ray exam of heel X-ray exam of heel X-ray exam of toe(s) X-ray exam of toe(s) X-ray exam of toe(s) X-ray stress view Urinalysis auto w/scope Urinalysis nonauto w/o scope Reagent strip/blood glucose Glucose blood test Spun microhematocrit Exam synovial fluid crystals Exam synovial fluid crystals Immunization admin Td vaccine no prsrv >/= 7 im TC 26 TC 26 TC 26 26 TC 26 26 TC 26 TC Td vaccine no prsrv >/= 7 im Upr/l xtremity art 2 levels Upr/l xtremity art 2 levels Upr/l xtremity art 2 levels Upr/l xtr art stdy 3+ lvls Upr/l xtr art stdy 3+ lvls Upr/l xtr art stdy 3+ lvls Extremity study Extremity study Extremity study Ther/proph/diag inj sc/im HCPCS Action Code P Non-Fac Fee Fac Fee $10.10 $4.36 $15.65 $10.89 $4.75 $14.07 $9.71 $4.36 $12.29 $8.71 $3.56 $15.84 $2.64 $1.10 $1.32 $2.64 $2.50 $3.56 $10.69 $7.00 $0.00 NA $4.36 NA NA $4.75 NA NA $4.36 NA NA $3.56 $15.84 # # # # # # $10.69 NA # $19.92 $61.21 $54.27 $6.94 $94.09 $12.68 $81.41 $65.17 $9.71 $55.46 $11.49 # NA NA $6.94 NA $12.68 NA NA $9.71 NA NA PA Comments ages 7-18 years ages 19-64 years; ASP rate update eff. 4/1/12 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 15 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 96374 97012 97014 97016 97018 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039 97110 97112 97116 97124 97140 97597 97598 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99221 Mod Short Description Ther/proph/diag inj iv push Mechanical traction therapy Electric stimulation therapy Vasopneumatic device therapy Paraffin bath therapy Whirlpool therapy Diathermy eg microwave Infrared therapy Ultraviolet therapy Electrical stimulation Electric current therapy Contrast bath therapy Ultrasound therapy Hydrotherapy Physical therapy treatment Therapeutic exercises Neuromuscular reeducation Gait training therapy Massage therapy Manual therapy Rmvl devital tis 20 cm/< Rmvl devital tis addl 20 cm< Office/outpatient visit new Office/outpatient visit new Office/outpatient visit new Office/outpatient visit new Office/outpatient visit new Office/outpatient visit est Office/outpatient visit est Office/outpatient visit est Office/outpatient visit est Office/outpatient visit est Initial hospital care HCPCS Action Code Non-Fac Fee $29.91 $7.72 $7.52 $7.33 $3.36 $7.72 $2.77 $2.58 $3.16 $8.32 $10.69 $7.33 $6.33 $12.07 $6.13 $14.65 $15.26 $12.87 $11.68 $13.68 $41.99 $14.06 $19.20 $34.07 $50.71 $71.70 $91.12 $11.29 $20.20 $28.19 $43.18 $62.79 NA Fac Fee PA Comments NA $7.72 $7.52 $7.33 $3.36 $7.72 $2.77 $2.58 $3.16 $8.32 $10.69 $7.33 $6.33 $12.07 $6.13 $14.65 $15.26 $12.87 $11.68 $13.68 $14.06 $6.73 $12.48 $24.56 $37.83 $56.05 $74.67 $4.75 $12.68 $19.07 $30.91 $49.52 $35.65 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 16 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 99222 99223 99231 99232 99233 99238 99239 99241 99242 99243 99244 99245 99251 99252 99253 99254 99255 99281 99281 99281 99282 99282 99282 99283 99283 99283 99284 99284 99284 99285 99285 99285 99304 Mod UA UD UA UD UA UD UA UD UA UD Short Description Initial hospital care Initial hospital care Subsequent hospital care Subsequent hospital care Subsequent hospital care Hospital discharge day Hospital discharge day Office consultation Office consultation Office consultation Office consultation Office consultation Inpatient consultation Inpatient consultation Inpatient consultation Inpatient consultation Inpatient consultation Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Nursing facility care init HCPCS Action Code Non-Fac Fee NA NA NA NA NA NA NA $26.33 $48.14 $64.18 $90.51 $117.06 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA $34.46 Fac Fee PA Comments $59.02 $82.21 $17.82 $29.11 $41.40 $37.04 $50.50 $18.03 $36.65 $49.11 $72.50 $96.47 $18.81 $37.83 $51.69 $74.28 $102.41 $8.71 $96.43 $41.94 $14.46 $96.43 $41.94 $32.49 $96.43 $41.94 $50.71 $96.43 $41.94 $79.44 $96.43 $41.94 $34.46 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 17 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code 99305 99306 99307 99308 99309 99310 99324 99325 99326 99327 99328 99334 99335 99336 99337 99341 99342 99343 99344 99345 99347 99348 99349 99350 99499 J0290 J0295 J0690 J0692 J0694 J0696 J0697 J0698 Mod Short Description Nursing facility care init Nursing facility care init Nursing fac care subseq Nursing fac care subseq Nursing fac care subseq Nursing fac care subseq Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit est pat Domicil/r-home visit est pat Domicil/r-home visit est pat Domicil/r-home visit est pat Home visit new patient Home visit new patient Home visit new patient Home visit new patient Home visit new patient Home visit est patient Home visit est patient Home visit est patient Home visit est patient Unlisted e&m service Ampicillin 500 MG inj Ampicillin sodium per 1.5 gm Cefazolin sodium injection Cefepime HCl for injection Cefoxitin sodium injection Ceftriaxone sodium injection Sterile cefuroxime injection Cefotaxime sodium injection HCPCS Action Code P P P P P P P P Non-Fac Fee $45.75 $56.46 $17.82 $29.52 $41.59 $52.09 $30.70 $44.96 $65.17 $85.76 $106.16 $23.78 $37.63 $58.04 $85.37 $30.50 $44.96 $65.56 $85.96 $106.37 $23.78 $37.63 $58.24 $85.96 M $2.77 $2.97 $0.69 $2.93 $6.13 $0.82 $2.32 $1.84 Fac Fee $45.75 $56.46 $17.82 $29.52 $41.59 $52.09 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA M # # # # # # # # PA Comments Documentation required. ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 18 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code J0702 J0710 J0715 J0743 J1020 J1030 J1040 J1094 J1100 J1200 J1335 J1450 J1580 J1670 J1700 J1710 J1720 J1840 J1890 J1956 J2010 J2175 J2180 J2185 J2270 J2300 J2310 J2460 J2510 J2540 J2543 J2650 J2700 Mod Short Description Betamethasone acet&sod phosp Cephapirin sodium injection Ceftizoxime sodium / 500 MG Cilastatin sodium injection Methylprednisolone 20 MG inj Methylprednisolone 40 MG inj Methylprednisolone 80 MG inj Inj dexamethasone acetate Dexamethasone sodium phos Diphenhydramine hcl injectio Ertapenem injection Fluconazole Garamycin gentamicin inj Tetanus immune globulin inj Hydrocortisone acetate inj Hydrocortisone sodium ph inj Hydrocortisone sodium succ i Kanamycin sulfate 500 MG inj Cephalothin sodium injection Levofloxacin injection Lincomycin injection Meperidine hydrochl /100 MG Meperidine/promethazine inj Meropenem Morphine sulfate injection Inj nalbuphine hydrochloride Inj naloxone hydrochloride Oxytetracycline injection Penicillin g procaine inj Penicillin g potassium inj Piperacillin/tazobactam Prednisolone acetate inj Oxacillin sodium injeciton HCPCS Action Code P P P P P P P P P P P P P P P P P P P P P P P Non-Fac Fee Fac Fee $5.50 $1.56 $5.24 $10.29 $3.17 $3.35 $6.49 $0.23 $0.12 $0.70 $29.92 $4.56 $1.25 $251.62 $0.66 $4.69 $4.11 $7.69 $8.64 $3.99 $6.41 $1.76 $3.79 $1.72 $1.74 $0.91 $8.15 $0.94 $12.72 $0.71 $3.03 $0.52 $2.81 PA # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # Comments ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 corrected 4/4/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 19 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code J2920 J2930 J3070 J3301 J3302 J3303 J3360 J3370 J3410 J3490 Q4029 Q4030 Q4031 Q4032 Q4033 Q4034 Q4035 Q4036 Q4037 Q4038 Q4039 Q4040 Q4041 Q4042 Q4043 Q4044 Q4045 Q4046 Q4047 Q4048 Q4050 Q4051 Q4101 Mod Short Description Methylprednisolone injection Methylprednisolone injection Pentazocine injection Triamcinolone acet inj NOS Triamcinolone diacetate inj Triamcinolone hexacetonl inj Diazepam injection Vancomycin hcl injection Hydroxyzine hcl injection Drugs unclassified injection Cast sup long leg plaster Cast sup long leg fiberglass Cast sup lng leg ped plaster Cast sup lng leg ped fbrgls Cast sup lng leg cylinder pl Cast sup lng leg cylinder fb Cast sup lngleg cylndr ped p Cast sup lngleg cylndr ped f Cast sup shrt leg plaster Cast sup shrt leg fiberglass Cast sup shrt leg ped plster Cast sup shrt leg ped fbrgls Cast sup lng leg splnt plstr Cast sup lng leg splnt fbrgl Cast sup lng leg splnt ped p Cast sup lng leg splnt ped f Cast sup sht leg splnt plstr Cast sup sht leg splnt fbrgl Cast sup sht leg splnt ped p Cast sup sht leg splnt ped f Cast supplies unlisted Splint supplies misc Apligraf HCPCS Action Code P P P P P P P P P Non-Fac Fee Fac Fee $1.94 $2.87 $13.68 $1.70 $0.28 $1.72 $1.02 $2.73 $1.27 M $21.19 $55.78 $10.60 $27.89 $19.76 $49.17 $9.89 $24.59 $12.06 $30.21 $6.04 $15.11 $14.66 $25.03 $7.33 $12.52 $8.51 $13.69 $4.25 $6.85 M M $36.56 PA # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # Comments ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 Documentation required. Documentation required. Documentation required. ASP rate update eff. 4/1/12 * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 20 of 21 MDCH Podiatrist Database April 2012 Rev. 9/10/12 HCPCS Code Q4102 Q4106 Q4110 Q4122 Q4123 Q4124 Q4125 Q4126 Q4127 Q4128 Q4129 Q4130 Mod Short Description Oasis wound matrix Dermagraft Primatrix DERMACELL ALLOSKIN OASIS TRI-LAYER WOUND MATRIX ARTHROFLEX MEMODERM TALYMED FLEXHD OR ALLOPATCH HD UNITE BIOMATRIX STRATTICE TM HCPCS Action Code P P P Non-Fac Fee Fac Fee $7.41 $41.31 $31.49 M M M M M M M M M PA # # # # # # # # # # # # Comments ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 ASP rate update eff. 4/1/12 Documentation required. Documentation required. Documentation required. Documentation required. Documentation required. Documentation required. Documentation required. Documentation required. Documentation required. * CPT codes, descriptions and two digit modifiers only are Copyright American Medical Association. All rights reserved. Page 21 of 21
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