HOPD
CPT /	Status			Payment
HCPCS	Indicator	Description	APC	Rate
Key	A	Paid under another fee schedule or rate
	C	Inpatient only
	E	Code not used by Medicare, service not covered, etc.
	F	Corneal tissue acquisition cost
	G	Drug eligible for pass-through payment
	H	Device eligible for pass-through payment
	J	New drug eligible for pass-through payment
	N	Service is packaged into APC rate
	P	Code unique to partial hospitalization
	S	Significant procedure, not discounted when multiple
	T	Procedure, discounted when multiple "T" procedures performed
	V	Visit to clinic or emergency department
	X	Ancillary service
	#	New technology APCs (range is 0970-0984)
		Note that drugs have payment rates displayed because the BBRA identifies 95 percent of average wholesale price (AWP) as the payment we must make for drugs and biologicals, including radiopharmaceuticals. Payment for devices is based on the individual hospital's charge for the device, reduced to cost by that hospital's cost-to-charge ratio. New technology is paid according to the new technology ambulatory payment class in which it is placed, based on our best information about costs.
A4642	G	Satumomab pendetide per dose	0704	$712.50
A9500	G	TC 99M sestamibi, per syringe	1600	$109.25
A9502	G	TC 99M tetrofosmin, per dose	0705	$136.80
A9503	G	TC 99M medronate, per dose	1601	$38.38
A9504	G	TC 99M apcitide, per vial	1602	$47.50
A9505	G	TL 201, mCi	1603	$28.50
A9507	G	Capromab pendetide per dose	1604	$1,008.90
A9600	G	SR 89 chloride, per mCi	0701	$783.75
A9605	G	SM 153 lexidronam, 50 mCi	0702	$910.42
C1000	H	PerclosClosr ProstarArt Vas	1000
C1001	H	AcuNav-diagnstic ultrsnd ca	1001
C1005	H	Sensar post.chamb IOL	1005
C1006	H	ARRAY post chamb IOL	1006
C1007	H	Ams 700 penile prosthesis	1007
C1008	H	Urolume-implt uretheral stent	1008
C1024	J	Quinupristin 150 mg/dalfopriston 350 mg	1024	$102.05
C1025	H	Marinr CS catheter	1025
C1026	H	RF Perfrmr cath 5F RF Marinr	1026
C1027	H	Magic WALLSTENTstent-Short	1027
C1028	H	Prcis Twst trnsvg anch sys	1028
C1029	H	CRE guided balloon dil cath	1029
C1030	H	Cthtr:Mrshal,Blu Max Utr Dmnd	1030
C1031	H	MR Comp/mod LeVeen ned elect	1031
C1033	H	Sonicath mdl 37-410	1033
C1034	H	SURPASS, Long30 SURPASS-cath	1034
C1036	H	R port/reservoir impl dev	1036
C1037	H	Vaxcelchronic dialysis cath	1037
C1039	H	WALLSTENT: Esoph stent	1039
C1040	H	WALLSTENT: TIPS  (shunt)	1040
C1042	H	WALLSTENT:Bil,Entrl,Ilc.1K	1042
C1043	H	Rotablater ADVANCER w/Burr cath	1043
C1044	H	Bioz.Com: monitor	1044
C1045	G	I-131 MIBG (ioben-sulfate) O.5mCi	1045	$1,140.00
C1047	H	NOGA-STAR catheter	1047
C1048	H	NeuroCyberneticPros: gen	1048
C1050	H	Prosorba column	1410
C1053	H	EnSite 3000 catheter	1053
C1057	H	Micromark Tissue Marker	1057
C1059	H	Carticel,auto cult-chndr cyte	1059
C1060	H	ASC multi-link tristor stent	1060
C1061	H	ASC Viking Guiding cath	1061
C1063	H	EndoTak Endurance EZ, RX pmkr	1063
C1067	H	Megalink biliary stent	1067
C1068	H	Pulsar DDD pmkr	1068
C1069	H	Discovery DR, pmaker	1069
C1071	H	Pulsar Max, Pulsar SR pmkr	1071
C1072	H	RX Esprit-cor blln dil cath	1072
C1073	H	Guidant: blln dil cath	1073
C1074	H	RX/OTW Viatrac-peri dil cath	1074
C1075	H	Guidant : lead	1075
C1076	H	Ventak mini sc pmkr	1076
C1077	H	Ventak VR Prizm VR, SC pmkr	1077
C1078	H	Ventak: Prizm, AVIIIDR pmker	1078
C1079	G	CO 57/58 .5mCi	1079	$ 253.84
C1084	G	Denileukin diftitox, 300 mcg	1084	$ 942.88
C1086	G	Temozolomide, 5mg	1086	$ 5.70
C1087	G	I-123, per mCi capsule	1087	$ 0.84
C1089	G	CO 57/58, .5 mCi	1089	$ 97.85
C1090	G	In I-111 Chloride, per mCi	1090	$ 152.00
C1091	G	IN 111 Oxyquinoline, per 5 mCi	1091	$ 508.25
C1092	G	IN 111 Pentetate, per 1.5 mCi	1092	$ 769.50
C1094	J	TC 99M Albumin aggr, per vial	1094	$ 34.20
C1095	G	TC 99M Depreotide, per vial	1095	$ 760.00
C1096	J	TC 99M Exametazime, per vial	1096	$ 427.50
C1097	G	TC 99M Mebrofenin, per vial	1097	$ 46.76
C1098	J	TC 99M Pentetate, per vial	1098	$ 22.80
C1099	J	TC 99M Pyrophosphate, per vial	1099	$ 42.75
C1100	H	Medtronic AVE GT1 guidewire	1100
C1101	H	MedtronicAVE Zuma guidecath	1101
C1102	H	Syngergy Neurostim Genrtr	1102
C1103	H	Micro Jewel Defibrillator	1103
C1104	H	RF Conductor Ablative Cath	1104
C1105	H	Sigma 300VDD pacmker	1105
C1106	H	SynergyEZ Pt Progrmr	1106
C1107	H	Torqr, Solist cath	1107
C1109	H	RF Performr ablatn cath	1109
C1110	H	Stable Mapper, cath electrd	1110
C1111	H	AneuRxAort-Uni-Ilicstnt&cath	1111
C1112	H	AneuRx Stent graft/del.cath	1112
C1113	H	Tlnt Endo Sprng Stnt Grft Sys	1113
C1114	H	TalntSprgStnt+Graf endo pros	1114
C1115	H	5038S,5038,5038L pace lead	1115
C1116	H	CapSureSP pacing Lead	1116
C1118	H	Sigma300DR LegIIDR,pacemkr	1118
C1119	H	Sprint6932,6943 defib lead	1119
C1120	H	Sprint6942,6945 defib lead	1120
C1121	H	Gem defibrillator	1121
C1122	G	TC 99M arcitumomab per dose	1122	$ 926.25
C1123	H	Gem II VR defibrillator	1123
C1124	H	InterStim Test Stim Kit	1124
C1125	H	Kappa 400SR,Ttopaz II SR pmkr	1125
C1126	H	Kappa 700 DR pacemakr	1126
C1127	H	Kappa 700SR,pmkr sgl chamber	1127
C1128	H	Kappa 700D,Ruby IID pmkr	1128
C1129	H	Kappa 700VDD,pacmkr	1129
C1130	H	Sigm200D,LGCY IID sc pmkr	1130
C1131	H	Sigma 200DR, pmker	1131
C1132	H	Sigma300,200SR Leg II:sc pac	1132
C1133	H	Sigma SR, Vita SR, pmaker	1133
C1134	H	Sigma 300D pmker	1134
C1137	H	CardioSEAL implant syst	1137
C1143	H	AddVent mod 2060BL,VDD	1143
C1144	H	Afnty SP 5130,Integrity SR,pmkr	1144
C1145	H	Angio-Seal 6fr vas mod#610091	1145
C1146	H	Angio-Seal 8fr vasc clos dev	1146
C1147	H	AV Plus DX 1368: lead /TD>	1147
C1148	H	Contour MD sc defib	1148
C1149	H	Entity DC 5226R-pmker	1149
C1151	H	Passiveplus DX lead, 4mdls	1151
C1152	H	Pasve+Dxlead 1346T,1342 1346	1152
C1153	H	Regency SC+ 2402L pmker	1153
C1154	H	SPL:SPOI,02,04- defib lead	1154
C1155	H	SpyglassTM angiograph cath	1155
C1156	H	Tr 1102TrSR+ 2260L,2264L,5131	1156
C1157	H	Trilogy DCT 23/8L pmkr	1157
C1158	H	TVL lead SV01,SV02,SV04	1158
C1159	H	TVL RV02,RV06,RV07: lead	1159
C1160	H	TVL-ADX 1559: lead	1160
C1161	H	Tendril DX, 1388 pacing lead	1161
C1162	H	TempoDr, TrilogyDR+DC pmkr	1162
C1163	H	Tendril SDX, 488T pacing lead	1163
C1164	H	Iodine-125 brachytx seed	1164
C1166	G	Cytarabine liposomal, 10 mg	1166	$ 371.45
C1167	J	Epirubicin hcl, 2 mg	1167	$ 24.94
C1170	H	ABBI disp biopsy device	1170
C1171	H	Autosuture site marker stple	1171
C1172	H	Spacemaker dissect ballon	1172
C1173	H	Cor stntS540,S670,o-wire stn	1173
C1174	H	Bard brachytx needle	1174
C1178	G	Busulfan IV, 6 mg	1178	$ 26.48
C1188	G	I 131, per capsule	1188	$ 0.82
C1200	G	TC 99M Sodium Glucoheptonate, per vial	1200	$ 113.05
C1201	G	TC 99M Succimer, per vial	1201	$ 135.66
C1202	G	TC 99M Sulfur Colloid, per vial	1202	$ 76.00
C1203	G	Verteporfin for inj	1203	$ 1,458.25
C1205	G	TC 99M Disofenin, per vial	1205	$ 427.50
C1207	G	Octreotide acetate depot 1mg	1207	$ 135.10
C1302	H	SQ01, DP-3238: lead	1302
C1304	H	Sonicath mdl 37-416,-418	1304
C1305	H	WALLSTENT:UniPls dlvry sys	1305
C1306	H	NeuroCyberneticPros: lead	1306
C1311	H	Trilogy DR+/DAO pmkr	1311
C1312	H	Magic WALLSTENTstent-Mini	1312
C1313	H	Magic WALLSTENT stent-Medium	1313
C1314	H	Magic WALLSTENT stent-Long	1314
C1315	H	Vigor DR, Meridian DR pmkr	1315
C1316	H	Meridian DDD pmkr	1316
C1317	H	Discovery SR, pmkr	1317
C1318	H	Meridian SR pmakr	1318
C1319	H	WALLSTENT:Bil,Entrl,18C	1319
C1320	H	WALLSTENT:Unistep-dlvry sys	1320
C1324	H	Ligasure disposable electrode	1324
C1325	H	Pallidium -103 seed	1325
C1326	H	Angio-jet rheolytic thromb cath	1326
C1328	H	Mattrix NS recvr/trnsmtr	1328
C1333	H	PALMZA Corinthian bill stent	1333
C1334	H	PALMAZ Schatz Crown stent	1334
C1335	H	PALMAZ SchatzMini Crown stnt	1335
C1336	H	CrossFlex LC Stent	1336
C1348	G	I 131 per mCi solution, per vial	1348	$ 146.57
C1350	H	ProstaSeed, I125, per source	1350
C1351	H	CapSure Fix lead	1351
C1352	H	Gem II defib	1352
C1353	H	Itrel Interstm neurostim+ext	1353
C1354	H/TD>	Kappa 400DR,Diamond II 820DR	1354
C1355	H	Kappa 600DR, Vita DR	1355
C1356	H	Profile MD V-186HV3 sc defib	1356
C1357	H	Angstrom MD V-190HV3 sc defib	1357
C1358	H	Affinity DC 5230R-Pacemaker	1358
C1359	H	Pulsar,Pulsar Max DR,pmkr	1359
C1361	H	Reveal Cardiac Recorder	1108
C1362	H	Herculink,OTW SDS bil stent	1411
J0130	G	Abciximab inj, 10 mg	1605	$ 513.02
J0205	G	Alglucerase inj, per 10 u	0900	$ 37.53
J0207	G	Amifostine, 500 mg	7000	$ 350.31
J0256	G	Alpha 1 proteinase inhibitor, 10 mg	0901	$ 2.09
J0286	G	Amphotericin B lipid complex, 50 mg	7001	$ 95.00
J0350	G	Anistreplase, 30 u	1606	$ 2,693.80
J0476	G	Baclofen intrathecal trial, 50 mcg	7021	$ 11.12
J0585	G	Botulinum toxin a, per unit	0902	$ 4.39
J0640	G	Leucovorin calcium inj, 50 mg	0725	$ 49.73
J0850	G	Cytomegalovirus imm IV, 50 mg	0903	$ 370.50
J1190	G	Dexrazoxane hcl inj, 250 mg	0726	$ 161.11
J1260	G	Dolasetron mesylate, 10 mg	0750	$ 14.81
J1325	G	Epoprostenol inj 0.5 mg	7003	$ 16.53
J1327	G	Eptifibatide inj, 5 mg	1607	$ 6.28
J1436	G	Etidronate disodium inj 300 mg	0727	$ 63.65
J1438	G	Etanercept inj, 25 mg	1608	$ 134.42
J1440	G	Filgrastim 300 mcg inj	0728	$ 171.38
J1561	G	Immune globulin 500 mg	0905	$ 27.28
J1562	G	Immune globulin 5 gms	7004	$ 391.88
J1565	G	RSV-ivig, 50 mg	0906	$ 427.98
J1620	G	Gonadorelin hcl, 100 mcg	7005	$ 14.80
J1626	G	Granisetron hcl inj 10 mcg	0764	$ 1.85
J1670	G	Tetanus immune globulin inj up to 250 u	0908	$ 102.60
J1745	G	Infliximab inj 10 mg	7043	$ 58.08
J1785	G	Imiglucerase, unit	0916	$ 3.75
J1825	G	Interferon beta-1a, 33 mcg	0909	$ 204.73
J1830	G	Interferon beta-1b , .25 mg	0910	$ 57.00
J1950	G	Leuprolide acetate, 3.75 mg	0800	$ 85.89
J2275	G	Morphine sulfate (preservative free) per 10 mg inj	7010	$ 7.41
J2352	G	Octreotide acetate inj 1mg	7031	$ 115.34
J2355	G	Oprelvekin inj, 5 mg	7011	$ 236.31
J2405	G	Ondansetron hcl inj 1 mg	0768	$ 6.09
J2430	G	Pamidronate disodium , 30 mg	0730	$ 232.51
J2765	G	Metoclopramide hcl inj up to 10 mg	0754	$ 2.00
J2790	G	Rho (D) immune globulin inj, 1 dose pkg	0884	$ 35.91
J2792	G	Rho(D) immune globulin h, sd, 100 iu	1609	$ 20.55
J2820	G	Sargramostim inj 50 mcg	0731	$ 27.42
J3010	G	Fentanyl citrate inj 0.1 mg	7014	$ 0.98
J3240	G	Thyrotropin inj, 0.9 mg	1610	$ 404.18
J3245	G	Tirofiban hydrochloride 12.5 mg	7041	$ 399.00
J3280	G	Thiethylperazine maleate inj up to 10 mg	0755	$ 5.02
J3305	G	Trimetrexate glucoronate 25 mg	7045	$ 69.83
J7190	G	Factor viii per iu	0925	$ 0.88
J7191	G	Factor VIII (porcine) per iu	0926	$ 2.09
J7192	G	Factor viii recombinant per iu	0927	$ 1.17
J7194	G	Factor ix complex per iu	0928	$ 0.71
J7197	G	Antithrombin iii inj per iu	0930	$ 0.82
J7198	G	Anti-inhibitor per iu	0929	$ 1.43
J7310	G	Ganciclovir long act implant 4.5 mg	0913	$ 4,750.00
J7315	G	Sodium hyaluronate, 20 mg	7315	$ 125.59
J7320	G	Hylan G-F 20 inj, 16 mg	1611	$ 204.87
J7500	G	Azathioprine oral 50mg	0886	$ 1.24
J7501	G	Azathioprine parenteral 100 mg	0887	$ 107.91
J7502	G	Cyclosporine oral 100 mg	0888	$ 5.80
J7504	G	Lymphocyte immune globulin 250 mg	0890	$ 249.13
J7505	G	Muromonab-CD3, 5 mg	7038	$ 741.00
J7507	G	Tacrolimus oral per 1 mg	0891	$ 2.66
J7513	G	Daclizumab, parenteral, 25 mg	1612	$ 397.29
J7516	G	Cyclosporin parenteral 250mg	0889	$ 15.81
J8510	G	Busulfan, oral, 2 mg	7015	$ 1.73
J8520	G	Capecitabine, oral, 150 mg	7042	$ 1.94
J8530	G	Cyclophosphamide oral 25 mg	0801	$ 2.12
J8560	G	Etoposide oral 50 mg	0802	$ 45.95
J8600	G	Melphalan oral 2 mg	0803	$ 2.07
J8610	G	Methotrexate oral 2.5 mg	0826	$ 2.92
J9000	G	Doxorubicin hcl 10 mg vl chemo	0847	$ 15.79
J9001	G	Doxorubicin hcl liposome inj 10 mg	7046	$ 311.72
J9015	G	Aldesleukin/single use vial	0807	$ 569.76
J9020	G	Asparaginase inj 10,000 u	0814	$ 57.41
J9031	G	Bcg live intravesical vac	0809	$ 159.39
J9040	G	Bleomycin sulfate inj 15 u	0857	$ 294.48
J9045	G	Carboplatin inj 50 mg	0811	$ 98.90
J9050	G	Carmus bischl nitro inj 100 mg	0812	$ 103.27
J9060	G	Cisplatin 10 mg inj	0813	$ 42.18
J9065	G	Cladribine, 1mg	0858	$ 53.47
J9070	G	Cyclophosphamide 100 mg inj	0815	$ 6.13
J9093	G	Cyclophosphamide lyophilized 100 mg	0816	$ 6.13
J9100	G	Cytarabine hcl 100 mg inj	0817	$ 5.94
J9120	G	Dactinomycin 0.5 mg	0818	$ 12.73
J9130	G	Dacarbazine 10 mg inj	0819	$ 1.13
J9150	G	Daunorubicin 10 mg	0820	$ 80.04
J9151	G	Daunorubicin citrate liposom 10 mg	0821	$ 64.60
J9165	G	Diethylstilbestrol inj 250 mg	0822	$ 4.20
J9170	G	Docetaxel, 20 mg	0823	$ 283.65
J9181	G	Etoposide 10 mg inj	0824	$ 4.06
J9185	G	Fludarabine phosphate inj 50 mg	0842	$ 237.03
J9190	G	Fluorouracil inj 500 mg	0859	$ 2.75
J9200	G	Floxuridine inj 500 mg	0827	$ 129.56
J9201	G	Gemcitabine hcl 200 mg	0828	$ 88.46
J9202	G	Goserelin acetate implant 3.6 mg	0810	$ 446.49
J9206	G	Irinotecan inj 20 mg	0830	$ 117.81
J9208	G	Ifosfomide inj 1 gm	0831	$ 141.50
J9209	G	Mesna inj 200 mg	0732	$ 36.51
J9211	G	Idarubicin hcl inj 5 mg	0832	$ 341.38
J9212	G	Interferon alfacon-1, 1 mcg	0833	$ 3.91
J9213	G	Interferon alfa-2a inj recombinant 3 million u	0834	$ 33.22
J9214	G	Interferon alfa-2b inj recombinant, 1 million	0836	$ 11.28
J9215	G	Interferon alfa-n3 inj, human leukocyte derived, 250,000 iu	0865	$ 7.86
J9216	G	Interferon gamma 1-b inj, 3 million u	0838	$ 199.50
J9218	G	Leuprolide acetate inj 1 mg	0861	$ 22.90
J9230	G	Mechlorethamine hcl inj 10 mg	0839	$ 11.01
J9245	G	Melphalan hydrochl 50 mg	0840	$ 363.48
J9250	G	Methotrexate sodium inj 5 mg	0841	$ 0.45
J9265	G	Paclitaxel inj, 30 mg	0863	$ 173.50
J9266	G	Pegaspargase, singl dose vial	0843	$ 1,321.65
J9268	G	Pentostatin inj, 10 mg	0844	$ 1,562.75
J9270	G	Plicamycin (mithramycin) inj 2.5 mg	0860	$ 93.80
J9280	G	Mitomycin 5 mg inj	0862	$ 121.65
J9293	G	Mitoxantrone hcl, 5 mg	0864	$ 223.02
J9310	G	Rituximab, 100 mg	0849	$ 420.29
J9320	G	Streptozocin inj, 1 gm	0850	$ 65.79
J9340	G	Thiotepa inj, 15 mg	0851	$ 100.30
J9350	G	Topotecan, 4 mg	0852	$ 573.75
J9355	G	Trastuzumab, 10 mg	1613	$ 48.85
J9357	G	Valrubicin, 200 mg	1614	$ 423.23
J9360	G	Vinblastine sulfate inj, 1 mg	0853	$ 4.11
J9370	G	Vincristine sulfate 1 mg inj	0854	$ 30.16
J9390	G	Vinorelbine tartrate, 10 mg	0855	$ 75.51
J9600	G	Porfimer sodium, 75 mg	0856	$ 2,603.67
L8614	H	Cochlear Implant System 1002
Q0136	G	Non esrd epoetin alpha inj, 1000 u	0733	$ 11.40
Q0160	G	Factor IX non-recombinant, per iu	0931	$ 0.72
Q0161	G	Factor IX recombinant, per iu	0932	$ 1.12
Q0163	G	Diphenhydramine hcl 50mg	1400	$ 1.18
Q0164	G	Prochlorperazine maleate 5mg	1401	$ 1.31
Q0166	G	Granisetron hcl 1 mg oral	0765	$ 44.70
Q0167	G	Dronabinol 2.5mg oral	0762	$ 3.20
Q0169	G	Promethazine hcl 12.5mg oral	1402	$ 0.03
Q0171	G	Chlorpromazine hcl 10mg oral	1403	$ 0.55
Q0173	G	Trimethobenzamide hcl 250mg	1404	$ 0.36
Q0174	G	Thiethylperazine maleate10mg	1405	$ 0.69
Q0175	G	Perphenazine 4mg oral	1406	$ 0.71
Q0177	G	Hydroxyzine pamoate 25mg	1407	$ 0.20
Q0179	G	Ondansetron hcl 8mg oral	0769	$ 25.15
Q0180	G	Dolasetron mesylate oral, 100 mg	0763	$ 65.21
Q0181	G	Unspecified oral anti-emetic	0761	$ 0.60
Q0187	G	Factor viia recombinant, per 1.2 mg	1409	$ 1,596.00
Q2002	G	Elliot's B solution, per ml	7022	$ 14.25
Q2003	G	Aprotinin, 10,000 kiu	7019	$ 196.35
Q2004	G	Tx bladder calculi, per 500 ml	7023	$ 23.54
Q2005	G	Corticorelin ovine triflutate, per 0.1 mg	7024	$ 353.88
Q2006	G	Digoxin immune FAB (Ovine),per 40 mg vial	7025	$ 530.44
Q2007	G	Ethanolamine oleate, 100 mg	7026	$ 27.21
Q2008	G	Fomepizole, 1.5 mg	7027	$ 1.09
Q2009	G	Fosphenytoin, 50 mg	7028	$ 8.55
Q2010	G	Glatiramer acetate, 20 mg	7029	$ 27.40
Q2011	G	Hemin, 1 mg	7030	$ 0.90
Q2012	G	Pegademase bovine inj 25 I.U	7039	$ 139.33
Q2013	G	Pentastarch 10% inj, 100 ml	7040	$ 15.11
Q2014	G	Sermorelin acetate, 0.5 mg	7032	$ 15.78
Q2015	G	Somatrem, 5 mg	7033	$ 199.50
Q2016	G	Somatropin, 1 mg (any derivation)	7034	$ 39.90
Q2017	G	Teniposide, 50 mg	7035	$ 195.28
Q2018	G	Urofollitropin, 75 I.U.	7037	$ 69.73
Q2019	G	Basiliximab, 20 mg	1615	$ 1,250.01
Q2020	G	Histrelin Acetate, 0.5 mg	1616	$ 14.91
Q2021	G	Lepirdin, 50 mg	1617	$ 124.49
Q2022	G	von Willebrand factor complex, human, per iu	1618	$ 0.95
Q3002	G	Ga 67, per mCi	1619	$ 25.97
Q3003	G	TC 99M Bicisate, per vial	1620	$ 417.53
Q3004	G	Xe 133, per mCi	1621	$ 3.04
Q3005	G	TC 99M Mertiatide, per vial	1622	$ 185.82
Q3006	G	TC 99M Gluceptate	1623	$ 22.61
Q3007	G	Sodium P32, per mCi	1624	$ 74.10
Q3008	G	IN 111 Pentetreotide, per mCi	1625	$ 283.42
Q3009	G	TC 99M Oxidronate, per vial	1626	$ 38.38
Q3010	G	TC-99 labeled red blood cell, per test	1627	$ 38.95
Q3011	G	P32 chromic, per mCi	1628	$ 137.12
77520	#S	Proton beam delivery	0974	$ 400.02
77523	#S	Proton beam delivery	0976	$ 875.19
C1088	#T	LaserOptic tx sys	0980	$ 1,875.00
C1300	#S	Hyperbaric Oxygen per 30 Min	0971	$ 75.16
G0160	#S	Cryo. ablation, prostate	0981	$ 2,249.80

 

 

Corrections to Status Indicators and other Corrections
	HOPD
CPT /	Status		Payment
HCPCS	Indicator	Description	APC	Rate
20979	E	US bone stimulation
31375	C	Partial removal of larynx
33282	T	Implant pat-active ht record	0089	$ 314.68
33284	T	Remove pat-active ht record	0089	$ 314.68
35481	T	Atherectomy, open	0081	$ 938.71
36550	T	Declot vascular device	0970	$ 25.21
37618	C	Ligation of extremity artery
47570	C	Laparo cholecystoenterostomy
61795	S	Brain surgery using computer	0302	$ 398.08
61886	T	Implant neurostim arrays	0222	$ 1,235.45
69930	T	Cochlear device implantation	0256	$ 1,231.00
71555	S	Magnetic image, chest (mra)	0284	$ 388.87
73725	S	Magnetic image/lower (mra)	0284	$ 388.87
74185	S	Magnetic image/abdomen (MRA)	0284	$ 388.87
75945	S	Intravascular us	0267	$ 131.88
75946	S	Intravascular us add-on	0267	$ 131.88
75993	T	Atherectomy, x-ray exam	0081	$ 938.71
75994	T	Atherectomy, x-ray exam	0081	$ 938.71
75996	T	Atherectomy, x-ray exam	0081	$ 938.71
77520	S	Proton beam delivery	0974	$ 400.02
77523	S	Proton beam delivery	0976	$ 875.19
78267	A	Breath test attain/anal, c-14
78268	A	Breath test analysis, c-14
90287	E	Botulinum antitoxin
90384	E	Rh ig, full-dose, im
90386	E	Rh ig, iv
92978	S	Intravasc us, heart add-on	0267	$ 131.88
92979	S	Intravasc us, heart add-on	0267	$ 131.88
96570	T	Photodynamic Tx, 30 min	0973	$ 250.19
96571	T	Photodynamic Tx, addl 15 min	0973	$ 250.19
99173	E	Visual screening test
99183	E	Hyperbaric oxygen therapy
A4206	E
A4207	E
A4208	E
A4209	E
A4211	E
A4212	E
A4213	E
A4215	E
A4220	E
A4230	A
A4231	A
A4232	A
A4244	E
A4245	E
A4246	E
A4247	E
A4263	N	Permanent tear duct plug
A4570	N	Splint
A4580	N	Cast supplies (plaster)
A4590	N	Special casting material
C1009	J	Plasma, cryoprecipitate-reduced, unit	1009	$ 41.80
C1010	J	Blood, L/R, CMV-neg	1010	$ 139.65
C1011	G	Platelets, L/R, CMV-neg, unit	1011	$ 575.00
C1012	J	Platelet concentrate, L/R, irradiated, unit	1012	$ 93.10
C1013	J	Platelet concentrate, L/R, unit	1013	$ 57.00
C1014	J	Platelets, aph/pher, L/R, unit	1014	$ 433.20
C1016	J	Blood, L/R, froz/deglycerol/washed	1016	$ 346.75
C1017	G	Platelets, aph/pher, L/R, CMV-neg, unit	1017	$ 452.20
C1018	G	Blood, L/R, irradiated	1018	$ 152.00
C1019	J	Platelets, aph/pher, L/R, irradiated, unit	1019	$ 467.40
C1360	T	Ocular photodynamic therapy	0235	$ 142.55
D0277	S	Vert bitewings-sev to eight	0330	$ 73.22
D0472	S	Gross exam, prep & report	0330	$ 73.22
D0473	S	Micro exam, prep & report	0330	$ 73.22
D0474	S	Micro w exam of surg margins	0330	$ 73.22
D0480	S	Cytopath smear prep & report	0330	$ 73.22
D4268	S	Surgical revision procedure	0330	$ 73.22
D9248	N	Sedation (non-iv)
E0218	E
E0246	E
E0270	E
E0273	E
E0274	E
E0315	E
E0350	E
E0352	E
E0370	E
E0425	E
E0430	E
E0435	E
E0440	E
E0602	E
E0616	E
E0625	E
E0700	E
E0710	E
E0740	E
E0746	E
E0749	N	Elec osteogen stim implanted
E0751	N	Pulse generator or receiver
E0753	N	Neurostimulator electrodes
E0755	E
E0760	E
E0782	N	Non-programble infusion pump
E0783	N	Programmable infusion pump
E0785	N	Replacement impl pump cathet
E0950	E
E0951	E
E0952	E
E0953	E
E0954	E
E0958	E
E0959	E
E0961	E
E0966	E
E0967	E
E0968	E
E0969	E
E0970	E
E0971	E
E0973	E
E0974	E
E0975	E
E0976	E
E0977	E
E0978	E
E0979	E
E0980	E
E0990	E
E0991	E
E0992	E
E0993	E
E0994	E
E0995	E
E0996	E
E0997	E
E0998	E
E0999	E
E1000	E
E1001	E
E1050	E
E1060	E
E1065	E
E1066	E
E1069	E
E1070	E
E1083	E
E1084	E
E1085	E
E1086	E
E1087	E
E1088	E
E1089	E
E1090	E
E1091	E
E1092	E
E1093	E
E1100	E
E1110	E
E1130	E
E1140	E
E1150	E
E1160	E
E1170	E
E1171	E
E1172	E
E1180	E
E1190	E
E1195	E
E1200	E
E1210	E
E1211	E
E1212	E
E1213	E
E1220	E
E1221	E
E1222	E
E1223	E
E1224	E
E1225	E
E1226	E
E1227	E
E1228	E
E1240	E
E1250	E
E1260	E
E1270	E
E1280	E
E1285	E
E1290	E
E1295	E
E1296	E
E1297	E
E1298	E
E1300	E
E1377	E
E1378	E
E1379	E
E1380	E
E1381	E
E1382	E
E1383	E
E1384	E
E1385	E
G0016	E
G0102	N	Prostate ca screening; dre
G0103	A
G0104	S	CA screen; flexible sigmoidscope	0159	$ 137.22
G0105	S	Colorectal screen; high risk ind	0158	$ 386.93
G0107	E	CA screen; fecal blood test
G0122	S	Colon ca scrn; barium enema	0157	$ 86.79
G0123	A
G0124	A
G0125	S	Lung Image (PET)	0981	$ 2,249.80
G0126	S	Lung Image (PET) staging	0981	$ 2,249.80
G0143	A
G0144	A
G0145	A
G0147	A
G0148	A
G0160	T	Cryosurgery ablation of prostate	0981	$2,249.80
G0163	S	PET for rec of colorectal cancer	0981	$2,249.80
G0164	S	PET for lymphoma staging	0981	$ 2,249.80
G0165	S	PET, rec of melanoma/met cancer	0981	$2,249.80
G0167	E	Hyperbaric oz tx;no md reqrd
G0168	T	Wound closure by adhesive	0970	$25.21
G0169	T	Removal tissue; no anesthesia	0013	$     44.12
G0170	T	Skin biograft	0025	$   181.34
G0171	T	Skin biograft add-on	0025	$   181.34
L3000	E
L3001	E
L3002	E
L3003	E
L3010	E
L3020	E
L3030	E
L3040	E
L3050	E
L3060	E
L3070	E
L3080	E
L3090	E
L3100	E
L3140	E
L3150	E
L3160	E
L3170	E
L3201	E
L3202	E
L3203	E
L3204	E
L3206	E
L3207	E
L3208	E
L3209	E
L3211	E
L3212	E
L3213	E
L3214	E
L3215	E
L3216	E
L3217	E
L3218	E
L3219	E
L3221	E
L3222	E
L3223	E
L3230	E
L3250	E
L3251	E
L3252	E
L3253	E
L3254	E
L3255	E
L3257	E
L3260	E
L3265	E
L3300	E
L3310	E
L3320	E
L3330	E
L3332	E
L3334	E
L3340	E
L3350	E
L3360	E
L3370	E
L3380	E
L3390	E
L3400	E
L3410	E
L3420	E
L3430	E
L3440	E
L3450	E
L3455	E
L3460	E
L3465	E
L3470	E
L3480	E
L3485	E
L3500	E
L3510	E
L3520	E
L3530	E
L3540	E
L3550	E
L3560	E
L3570	E
L3580	E
L3590	E
L3595	E
L3600	E
L3610	E
L3620	E
L3630	E
L3640	E
L3649	E
L3890	E
L8100	E
L8110	E
L8120	E
L8130	E
L8140	E
L8150	E
L8160	E
L8170	E
L8180	E
L8190	E
L8195	E
L8200	E
L8210	E
L8220	E
L8230	E
L8239	E
L8600	N	Implant breast silicone/eq
L8603	N	Collagen imp urinary 2.5 CC
L8610	N	Ocular implant
L8612	N	Aqueous shunt prosthesis
L8613	N	Ossicular implant
L8630	N	Metacarpophalangeal implant
L8641	N	Metatarsal joint implant
L8642	N	Hallux implant
L8658	N	Interphalangeal joint implnt
L8670	N	Vascular graft, synthetic
L8699	N	Prosthetic implant NOS
P9011	E	Blood split unit
P9023	S	Frozen plasma, pooled, sd, unit	0949	$   142.50
Q2001	N
V2781	E
V2785	F	Corneal tissue processing
V5299	E