|
3d bn img algor drvd fr MRI
|
HCPCS G0566 |
— |
—
|
— |
0 |
|
Aco annual medicare visit (awv), initial g0438aco
|
HCPCS G0438 |
$121.80 |
$243.00
|
$432.00 |
5 |
|
Aco annual medicare visit (awv), subsq g0439aco
|
HCPCS G0439 |
$141.00 |
$160.50
|
$290.40 |
5 |
|
Aco depression screen annual medicare g0444aco
|
HCPCS G0444 |
— |
—
|
— |
0 |
|
Administration vaccine hepatitis b
|
HCPCS G0010 |
$12.00 |
$12.00
|
$99.00 |
12 |
|
Administration vaccine influenza virus
|
HCPCS G0008 |
$12.00 |
$12.00
|
$41.25 |
12 |
|
Administration vaccine pneumococcal
|
HCPCS G0009 |
$12.00 |
$12.00
|
$72.60 |
12 |
|
Alcohol/sub misuse assess
|
HCPCS G2011 |
— |
—
|
— |
0 |
|
Alcohol/subs interv >30 min
|
HCPCS G0397 |
— |
—
|
— |
0 |
|
Annual alcohol screen 15 min
|
HCPCS G0442 |
— |
—
|
— |
0 |
|
Autolog prp diab wound ulcer
|
HCPCS G0465 |
— |
—
|
— |
0 |
|
Autolog prp not diab ulcer
|
HCPCS G0460 |
— |
—
|
— |
0 |
|
Behavior counsel obesity 15min medicare g0447
|
HCPCS G0447 |
$20.40 |
$20.40
|
$20.40 |
1 |
|
Blinded conv. tx mdd clin tr
|
HCPCS G2000 |
— |
—
|
— |
0 |
|
Ca screen;flexi sigmoidscope
|
HCPCS G0104 |
$598.20 |
$1,206.00
|
$1,296.00 |
5 |
|
Cervical or vaginal cancer screening g0101
|
HCPCS G0101 |
$48.00 |
$156.75
|
$276.00 |
5 |
|
Chemo extend IV infus w/pump
|
HCPCS G0498 |
$527.40 |
$696.00
|
$841.60 |
4 |
|
Cont intraop neuro monitor
|
HCPCS G0453 |
$335.25 |
$335.25
|
$335.25 |
2 |
|
Counseling visit to discuss need for ldct g0296
|
HCPCS G0296 |
— |
—
|
— |
0 |
|
Demonstrate use home inr mon
|
HCPCS G0248 |
— |
—
|
— |
0 |
|
Dermal filler injection(s)
|
HCPCS G0429 |
— |
—
|
— |
0 |
|
Diabetes training group per 30 min g0109
|
HCPCS G0136 |
— |
—
|
— |
0 |
|
Diab manage trn ind/group
|
HCPCS G0109 |
$16.80 |
$93.00
|
$679.20 |
9 |
|
Drug test def 15-21 classes
|
HCPCS G0482 |
$436.80 |
$436.80
|
$436.80 |
1 |
|
Drug test def 1-7 classes
|
HCPCS G0480 |
$239.40 |
$437.40
|
$610.80 |
9 |
|
Drug test def 22+ classes
|
HCPCS G0483 |
$634.20 |
$634.20
|
$634.20 |
1 |
|
Drug test def 8-14 classes
|
HCPCS G0481 |
$239.40 |
$440.40
|
$610.80 |
7 |
|
Dstry eye lesn,fdr vssl tech
|
HCPCS G0186 |
— |
—
|
— |
0 |
|
EKG for initial prevent exam g0403
|
HCPCS G0403 |
— |
—
|
— |
0 |
|
EKG interpret & report preve g0405
|
HCPCS G0405 |
— |
—
|
— |
0 |
|
EKG tracing for initial prev
|
HCPCS G0404 |
— |
—
|
— |
0 |
|
Elec stim unattend for press
|
HCPCS G0281 |
— |
—
|
— |
0 |
|
Extrnl counterpulse, per tx
|
HCPCS G0166 |
$573.75 |
$573.75
|
$1,424.40 |
2 |
|
Facility svs dental rehab
|
HCPCS G0330 |
— |
—
|
— |
0 |
|
Fecal microbiota prep instil
|
HCPCS G0455 |
$883.50 |
$883.50
|
$1,059.00 |
2 |
|
Followup eval of foot pt lop
|
HCPCS G0246 |
— |
—
|
— |
0 |
|
G0180 home health certification
|
HCPCS G0180 |
$93.60 |
$93.60
|
$93.60 |
1 |
|
Glaucoma scrn hgh risk direc
|
HCPCS G0117 |
— |
—
|
— |
0 |
|
Glaucoma scrn hgh risk direc
|
HCPCS G0118 |
— |
—
|
— |
0 |
|
Group mnt 2 or more 30 mins
|
HCPCS G0271 |
— |
—
|
— |
0 |
|
Hbot, full body chamber, 30m
|
HCPCS G0277 |
$430.80 |
$756.60
|
$1,117.80 |
8 |
|
Home health re-certification physician g0179
|
HCPCS G0179 |
— |
—
|
— |
0 |
|
Home sleep test/type 2 porta
|
HCPCS G0398 |
$1,238.40 |
$1,572.00
|
$1,676.40 |
3 |
|
Home sleep test/type 3 porta
|
HCPCS G0399 |
$148.80 |
$1,073.40
|
$1,621.20 |
5 |
|
Home sleep test/type 4 porta
|
HCPCS G0400 |
$2,075.20 |
$2,075.20
|
$2,075.20 |
1 |
|
Iliac/fem angio cath insert
|
HCPCS G0278 |
$2,881.20 |
$2,980.50
|
$6,619.20 |
4 |
|
Initial foot exam pt lops
|
HCPCS G0245 |
— |
—
|
— |
0 |
|
Injection of HIV prep drug
|
HCPCS G0012 |
— |
—
|
— |
0 |
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
HCPCS G0260 |
$1,242.00 |
$2,521.20
|
$4,453.20 |
9 |
|
Insert drug del implant, >=4
|
HCPCS G0516 |
— |
—
|
— |
0 |
|
Intens cardiac rehab no exer
|
HCPCS G0423 |
— |
—
|
— |
0 |
|
Intens cardiac rehab w/exerc
|
HCPCS G0422 |
— |
—
|
— |
0 |
|
Mnt subs tx for change dx
|
HCPCS G0270 |
$24.60 |
$24.60
|
$59.40 |
2 |
|
Monthly tx for dmht 20mins
|
HCPCS G0553 |
— |
—
|
— |
0 |
|
Non-cov proc, clinical trial
|
HCPCS G0294 |
— |
—
|
— |
0 |
|
Non-cov surg proc,clin trial
|
HCPCS G0293 |
— |
—
|
— |
0 |
|
Observation direct referral from physician office for admission
|
HCPCS G0379 |
$85.20 |
$138.00
|
$551.25 |
12 |
|
Observation per hour
|
HCPCS G0378 |
$111.60 |
$793.20
|
$3,767.25 |
13 |
|
Off base opioid tx, 60 m
|
HCPCS G2087 |
— |
—
|
— |
0 |
|
Off base opioid tx 70min
|
HCPCS G2086 |
— |
—
|
— |
0 |
|
Opps service,sched team conf
|
HCPCS G0175 |
— |
—
|
— |
0 |
|
Oth resp proc, group
|
HCPCS G0239 |
$38.40 |
$144.00
|
$473.60 |
10 |
|
Oth resp proc, indiv
|
HCPCS G0238 |
$49.20 |
$54.60
|
$79.80 |
4 |
|
Pelvic ring fracture uni/bil
|
HCPCS G0413 |
— |
—
|
— |
0 |
|
Pet not otherwise specified
|
HCPCS G0235 |
$1,300.80 |
$1,300.80
|
$1,300.80 |
1 |
|
Pild/placebo control clin tr
|
HCPCS G0276 |
— |
—
|
— |
0 |
|
Placement occlusive device venous/arterial access site post procedure
|
HCPCS G0269 |
$335.40 |
$1,051.50
|
$2,893.80 |
9 |
|
Post op service lvrs min 6
|
HCPCS G0305 |
$598.40 |
$598.40
|
$697.80 |
2 |
|
Pre-op service lvrs 10-15dos
|
HCPCS G0303 |
— |
—
|
— |
0 |
|
Pre-op service lvrs 1-9 dos
|
HCPCS G0304 |
— |
—
|
— |
0 |
|
Pre-op service lvrs complete
|
HCPCS G0302 |
— |
—
|
— |
0 |
|
Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment
|
HCPCS G0402 |
$130.50 |
$130.50
|
$208.20 |
2 |
|
Prostate biopsy, any mthd
|
HCPCS G0416 |
$97.80 |
$308.40
|
$826.20 |
12 |
|
Provide inr test mater/equip
|
HCPCS G0249 |
— |
—
|
— |
0 |
|
Pr prolonged e&m service office outpatient each 15 minutes (g2212)
|
HCPCS G2212 |
— |
—
|
— |
0 |
|
Pr visit complexity e&m service serious/complex condition
|
HCPCS G2211 |
— |
—
|
— |
0 |
|
Psychoeducation 45 min +
|
HCPCS G0177 |
— |
—
|
— |
0 |
|
Psychthrp grp 45-50min mcr
|
HCPCS G0410 |
$46.80 |
$46.80
|
$46.80 |
1 |
|
Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan
|
HCPCS G0283 |
$34.20 |
$114.00
|
$173.40 |
9 |
|
Remove drug implant
|
HCPCS G0517 |
— |
—
|
— |
0 |
|
Remove w insert drug implant
|
HCPCS G0518 |
— |
—
|
— |
0 |
|
Replacment pt electronic sys
|
HCPCS G0555 |
— |
—
|
— |
0 |
|
Risk ascvd tst once pr 12 mo
|
HCPCS G0537 |
— |
—
|
— |
0 |
|
Routine footcare pt w lops
|
HCPCS G0247 |
— |
—
|
— |
0 |
|
Scr c/v cyto,thinlayer,rescr
|
HCPCS G0145 |
$78.00 |
$78.00
|
$189.60 |
9 |
|
Scr c/v cyto,thinlayer,rescr
|
HCPCS G0144 |
— |
—
|
— |
0 |
|
Screen cerv/vag thin layer
|
HCPCS G0123 |
$61.20 |
$61.20
|
$145.20 |
9 |
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
HCPCS G0328 |
$100.20 |
$241.20
|
$292.00 |
3 |
|
Screening hepatitis b non-obstetric high risk
|
HCPCS G0499 |
$42.60 |
$63.00
|
$172.00 |
9 |
|
Screening hepatitis c antibody high risk
|
HCPCS G0472 |
$34.80 |
$46.80
|
$251.20 |
6 |
|
Screening HIV antigen/antibody combination assay
|
HCPCS G0475 |
$76.20 |
$76.20
|
$76.20 |
1 |
|
Screening prostate cancer PSA
|
HCPCS G0103 |
$32.40 |
$96.00
|
$120.00 |
10 |
|
Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time
|
HCPCS G0500 |
$617.25 |
$667.50
|
$667.50 |
3 |
|
Single energy x-ray study
|
HCPCS G0130 |
— |
—
|
— |
0 |
|
Software meas of cardiac vol
|
HCPCS G0183 |
— |
—
|
— |
0 |
|
Stereoscopic x-ray guidance
|
HCPCS G6002 |
— |
—
|
— |
0 |
|
Supply of digital device
|
HCPCS G0552 |
— |
—
|
— |
0 |
|
Therapeutic procd strg endur
|
HCPCS G0237 |
$49.20 |
$93.60
|
$186.00 |
3 |
|
Therapy activity per session >= 45 minutes
|
HCPCS G0176 |
— |
—
|
— |
0 |
|
Tomosynthesis breast diagnostic left
|
HCPCS G0279 |
$65.40 |
$123.00
|
$136.80 |
7 |
|
Training self management diabetes individual outpatient department per 30 minutes
|
HCPCS G0108 |
$70.80 |
$121.20
|
$400.20 |
10 |
|
Trauma partial team response w/critical care services level 4
|
HCPCS G0390 |
$3,300.00 |
$6,448.80
|
$9,021.00 |
8 |
|
Trim nail(s)
|
HCPCS G0127 |
$57.75 |
$105.60
|
$117.60 |
6 |
|
Unsched dialysis esrd pt hos
|
HCPCS G0257 |
$684.60 |
$1,560.60
|
$2,160.60 |
8 |
|
Visit established high 40-54 minutes/level 5
|
HCPCS G0463 |
$465.60 |
$465.60
|
$465.60 |
1 |
|
Wound closure by adhesive
|
HCPCS G0168 |
$486.00 |
$486.00
|
$486.00 |
1 |