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CMS-1403-FC Physi- cian Work Fully Implemented Non- Facility PE Year 2009 Transitional Non- Facility PE Fully Imple- mented Facility PE Year 2009 Transi- tional Facility PE 1 CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare payment. 1172 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 15040 A Harvest cultured skin graft 2.00 3.86 4.05 1.02 1.05 0.24 000 15050 A Skin pinch graft 5.37 7.54 7.40 5.01 5.05 0.57 090 15100 A Skin splt grft, trnk/arm/leg 9.74 9.78 10.51 6.79 7.07 1.28 090 15101 A Skin splt grft t/a/l, add-on 1.72 2.44 2.77 0.87 0.95 0.24 ZZZ 15110 A Epidrm autogrft trnk/arm/leg 10.88 8.49 9.06 6.19 6.41 1.31 090 15111 A Epidrm autogrft t/a/l add-on 1.85 0.91 1.01 0.67 0.70 0.26 ZZZ 15115 A Epidrm a-grft face/nck/hf/g 11.19 9.04 9.11 6.67 6.86 1.15 090 15116 A Epidrm a-grft f/n/hf/g addl 2.50 1.34 1.40 1.01 1.04 0.33 ZZZ 15120 A Skn splt a-grft fac/nck/hf/g 10.96 11.31 11.19 7.55 7.63 1.16 090 15121 A Skn splt a-grft f/n/hf/g add 2.67 3.36 3.65 1.27 1.42 0.36 ZZZ 15130 A Derm autograft, trnk/arm/leg 7.41 7.84 8.36 5.55 5.76 0.97 090 15131 A Derm autograft t/a/l add-on 1.50 0.75 0.83 0.58 0.59 0.21 ZZZ 15135 A Derm autograft face/nck/hf/g 10.91 9.23 9.41 6.92 7.24 1.23 090 15136 A Derm autograft, f/n/hf/g add 1.50 0.56 0.64 0.42 0.48 0.20 ZZZ 15150 A Cult epiderm grft t/arm/leg 9.30 6.61 7.09 5.45 5.71 1.14 090 15151 A Cult epiderm grft t/a/l addl 2.00 0.91 1.01 0.73 0.76 0.28 ZZZ 15152 A Cult epiderm graft t/a/l +% 2.50 1.38 1.43 1.18 1.15 0.35 ZZZ 15155 A Cult epiderm graft, f/n/hf/g 10.05 7.11 7.30 5.86 6.15 1.05 090 15156 A Cult epidrm grft f/n/hfg add 2.75 1.41 1.45 1.21 1.22 0.36 ZZZ 15157 A Cult epiderm grft f/n/hfg +% 3.00 1.59 1.64 1.30 1.31 0.39 ZZZ 15170 A Acell graft trunk/arms/legs 5.99 4.19 4.11 2.81 2.71 0.55 090 15171 A Acell graft t/arm/leg add-on 1.55 0.67 0.67 0.53 0.56 0.19 ZZZ 15175 A Acellular graft, f/n/hf/g 7.99 4.53 4.77 3.26 3.45 0.82 090 15176 A Acell graft, f/n/hf/g add-on 2.45 1.11 1.11 0.87 0.90 0.29 ZZZ 15200 A Skin full graft, trunk 8.97 10.14 9.98 6.65 6.55 0.98 090 15201 A Skin full graft trunk add-on 1.32 2.04 2.18 0.55 0.57 0.19 ZZZ 15220 A Skin full graft sclp/arm/leg 7.95 10.45 10.16 6.82 6.80 0.84 090 15221 A Skin full graft add-on 1.19 1.99 2.08 0.54 0.55 0.16 ZZZ 15240 A Skin full grft face/genit/hf 10.15 12.09 11.64 9.06 8.80 0.92 090 15241 A Skin full graft add-on 1.86 2.52 2.50 0.86 0.87 0.23 ZZZ 15260 A Skin full graft een & lips 11.39 13.14 12.44 9.58 9.35 0.69 090 15261 A Skin full graft add-on 2.23 2.95 2.89 1.21 1.26 0.21 ZZZ 15300 A Apply skinallogrft, t/arm/lg 4.65 3.50 3.43 2.24 2.24 0.49 090 15301 A Apply sknallogrft t/a/l addl 1.00 0.50 0.49 0.37 0.37 0.14 ZZZ 15320 A Apply skin allogrft f/n/hf/g 5.36 3.76 3.73 2.38 2.42 0.58 090 15321 A Aply sknallogrft f/n/hfg add 1.50 0.73 0.72 0.55 0.56 0.21 ZZZ 15330 A Aply acell alogrft t/arm/leg 3.99 3.54 3.46 2.23 2.24 0.49 090 15331 A Aply acell grft t/a/l add-on 1.00 0.50 0.49 0.38 0.38 0.14 ZZZ 15335 A Apply acell graft, f/n/hf/g 4.50 3.26 3.32 2.01 2.13 0.55 090 15336 A Aply acell grft f/n/hf/g add 1.43 0.62 0.64 0.43 0.46 0.20 ZZZ 15340 A Apply cult skin substitute 3.76 3.65 3.75 2.63 2.67 0.41 010 15341 A Apply cult skin sub add-on 0.50 0.62 0.62 0.14 0.16 0.06 ZZZ 15360 A Apply cult derm sub, t/a/l 3.93 4.64 4.61 3.41 3.34 0.43 090 15361 A Aply cult derm sub t/a/l add 1.15 0.51 0.53 0.34 0.37 0.14 ZZZ 15365 A Apply cult derm sub f/n/hf/g 4.21 4.02 4.16 2.96 3.02 0.46 090 15366 A Apply cult derm f/hf/g add 1.45 0.59 0.62 0.40 0.45 0.17 ZZZ 15400 A Apply skin xenograft, t/a/l 4.38 5.26 4.96 4.01 4.02 0.47 090 15401 A Apply skn xenogrft t/a/l add 1.00 0.99 1.22 0.34 0.36 0.14 ZZZ

CMS-1403-FC Physi- cian Work Fully Implemented Non- Facility PE Year 2009 Transitional Non- Facility PE Fully Imple- mented Facility PE Year 2009 Transi- tional Facility PE 1 CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare payment. 1173 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 15420 A Apply skin xgraft, f/n/hf/g 4.89 5.93 5.65 4.63 4.43 0.52 090 15421 A Apply skn xgrft f/n/hf/g add 1.50 1.16 1.20 0.50 0.53 0.21 ZZZ 15430 A Apply acellular xenograft 5.93 6.28 6.45 5.76 5.99 0.66 090 15431 C Apply acellular xgraft add 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 15570 A Form skin pedicle flap 10.00 10.39 10.65 6.74 6.76 1.34 090 15572 A Form skin pedicle flap 9.94 10.35 10.16 7.34 7.14 1.20 090 15574 A Form skin pedicle flap 10.52 10.72 10.73 7.47 7.57 1.20 090 15576 A Form skin pedicle flap 9.24 9.75 9.78 6.71 6.77 0.87 090 15600 A Skin graft 1.95 5.22 5.83 2.74 2.82 0.27 090 15610 A Skin graft 2.46 5.49 5.30 3.06 3.16 0.35 090 15620 A Skin graft 3.62 6.38 6.75 3.90 3.90 0.35 090 15630 A Skin graft 3.95 7.00 7.03 4.33 4.30 0.34 090 15650 A Transfer skin pedicle flap 4.64 7.70 7.58 4.76 4.63 0.42 090 15731 A Forehead flap w/vasc pedicle 14.12 12.79 12.79 10.17 10.17 1.28 090 15732 A Muscle-skin graft, head/neck 19.70 14.87 15.70 11.44 11.66 2.00 090 15734 A Muscle-skin graft, trunk 19.62 15.76 16.39 12.06 12.17 2.62 090 15736 A Muscle-skin graft, arm 16.92 13.74 14.90 10.09 10.40 2.46 090 15738 A Muscle-skin graft, leg 18.92 13.97 15.00 10.52 10.85 2.66 090 15740 A Island pedicle flap graft 11.57 13.73 12.86 9.70 9.36 0.63 090 15750 A Neurovascular pedicle graft 12.73 NA NA 8.86 8.93 1.42 090 15756 A Free myo/skin flap microvasc 36.74 NA NA 19.31 19.67 4.62 090 15757 A Free skin flap, microvasc 36.95 NA NA 18.53 19.34 3.90 090 15758 A Free fascial flap, microvasc 36.70 NA NA 18.62 19.41 4.24 090 15760 A Composite skin graft 9.68 10.47 10.38 7.21 7.24 0.85 090 15770 A Derma-fat-fascia graft 8.73 NA NA 6.78 6.77 1.05 090 15775 R Hair transplant punch grafts 3.95 3.48 3.68 1.68 1.59 0.52 000 15776 R Hair transplant punch grafts 5.53 4.91 5.04 2.25 2.40 0.72 000 15780 A Abrasion treatment of skin 8.50 11.29 11.38 6.62 7.05 0.67 090 15781 A Abrasion treatment of skin 4.91 8.21 7.91 5.41 5.41 0.34 090 15782 A Abrasion treatment of skin 4.36 8.99 9.23 5.20 5.55 0.34 090 15783 A Abrasion treatment of skin 4.33 7.50 7.36 4.75 4.62 0.28 090 15786 A Abrasion, lesion, single 2.05 3.81 3.70 1.29 1.30 0.11 010 15787 A Abrasion, lesions, add-on 0.33 0.76 0.84 0.10 0.12 0.04 ZZZ 15788 R Chemical peel, face, epiderm 2.09 8.69 8.22 3.84 3.66 0.11 090 15789 R Chemical peel, face, dermal 4.91 9.02 8.81 5.68 5.47 0.20 090 15792 R Chemical peel, nonfacial 1.86 8.64 8.27 4.45 4.46 0.13 090 15793 A Chemical peel, nonfacial 3.82 7.99 7.58 4.90 4.78 0.19 090 15819 A Plastic surgery, neck 10.45 NA NA 7.06 7.11 0.97 090 15820 A Revision of lower eyelid 6.09 6.55 6.67 5.37 5.43 0.40 090 15821 A Revision of lower eyelid 6.66 6.72 6.89 5.45 5.53 0.45 090 15822 A Revision of upper eyelid 4.51 5.30 5.45 4.19 4.27 0.37 090 15823 A Revision of upper eyelid 8.12 7.57 7.66 6.32 6.37 0.50 090 15824 R Removal of forehead wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 000 15825 R Removal of neck wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 000 15826 R Removal of brow wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 000 15828 R Removal of face wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 000 15829 R Removal of skin wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 000 15830 R Exc skin abd 16.90 NA NA 10.13 10.13 2.93 090

<strong>CMS</strong>-1403-FC<br />

Physi-<br />

cian<br />

Work<br />

Fully<br />

Implemented<br />

Non-<br />

Facility<br />

PE<br />

Year<br />

2009<br />

Transitional<br />

Non-<br />

Facility<br />

PE<br />

Fully<br />

Imple-<br />

mented<br />

Facility<br />

PE<br />

Year<br />

2009<br />

Transi-<br />

tional<br />

Facility<br />

PE<br />

1 CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights<br />

Reserved. Applicable FARS/DFARS apply.<br />

2 If values are reflected for codes not payable by Medicare, please note that these values have <strong>been</strong><br />

established as a courtesy to the general public and are not used for Medicare<br />

payment.<br />

1172<br />

Mal-<br />

Practice<br />

RVUs 2 Global<br />

CPT 1 /<br />

HCPCS Mod Status Description<br />

RVUs 2<br />

RVUs 2<br />

RVUs 2<br />

RVUs 2<br />

RVUs 2<br />

15040 A Harvest cultured skin graft 2.00 3.86 4.05 1.02 1.05 0.24 000<br />

15050 A Skin pinch graft 5.37 7.54 7.40 5.01 5.05 0.57 090<br />

15100 A Skin splt grft, trnk/arm/leg 9.74 9.78 10.51 6.79 7.07 1.28 090<br />

15101 A Skin splt grft t/a/l, add-on 1.72 2.44 2.77 0.87 0.95 0.24 ZZZ<br />

15110 A Epidrm autogrft trnk/arm/leg 10.88 8.49 9.06 6.19 6.41 1.31 090<br />

15111 A Epidrm autogrft t/a/l add-on 1.85 0.91 1.01 0.67 0.70 0.26 ZZZ<br />

15115 A Epidrm a-grft face/nck/hf/g 11.19 9.04 9.11 6.67 6.86 1.15 090<br />

15116 A Epidrm a-grft f/n/hf/g addl 2.50 1.34 1.40 1.01 1.04 0.33 ZZZ<br />

15120 A Skn splt a-grft fac/nck/hf/g 10.96 11.31 11.19 7.55 7.63 1.16 090<br />

15121 A Skn splt a-grft f/n/hf/g add 2.67 3.36 3.65 1.27 1.42 0.36 ZZZ<br />

15130 A Derm autograft, trnk/arm/leg 7.41 7.84 8.36 5.55 5.76 0.97 090<br />

15131 A Derm autograft t/a/l add-on 1.50 0.75 0.83 0.58 0.59 0.21 ZZZ<br />

15135 A Derm autograft face/nck/hf/g 10.91 9.23 9.41 6.92 7.24 1.23 090<br />

15136 A Derm autograft, f/n/hf/g add 1.50 0.56 0.64 0.42 0.48 0.20 ZZZ<br />

15150 A Cult epiderm grft t/arm/leg 9.30 6.61 7.09 5.45 5.71 1.14 090<br />

15151 A Cult epiderm grft t/a/l addl 2.00 0.91 1.01 0.73 0.76 0.28 ZZZ<br />

15152 A Cult epiderm graft t/a/l +% 2.50 1.38 1.43 1.18 1.15 0.35 ZZZ<br />

15155 A Cult epiderm graft, f/n/hf/g 10.05 7.11 7.30 5.86 6.15 1.05 090<br />

15156 A Cult epidrm grft f/n/hfg add 2.75 1.41 1.45 1.21 1.22 0.36 ZZZ<br />

15157 A Cult epiderm grft f/n/hfg +% 3.00 1.59 1.64 1.30 1.31 0.39 ZZZ<br />

15170 A Acell graft trunk/arms/legs 5.99 4.19 4.11 2.81 2.71 0.55 090<br />

15171 A Acell graft t/arm/leg add-on 1.55 0.67 0.67 0.53 0.56 0.19 ZZZ<br />

15175 A Acellular graft, f/n/hf/g 7.99 4.53 4.77 3.26 3.45 0.82 090<br />

15176 A Acell graft, f/n/hf/g add-on 2.45 1.11 1.11 0.87 0.90 0.29 ZZZ<br />

15200 A Skin full graft, trunk 8.97 10.14 9.98 6.65 6.55 0.98 090<br />

15201 A Skin full graft trunk add-on 1.32 2.04 2.18 0.55 0.57 0.19 ZZZ<br />

15220 A Skin full graft sclp/arm/leg 7.95 10.45 10.16 6.82 6.80 0.84 090<br />

15221 A Skin full graft add-on 1.19 1.99 2.08 0.54 0.55 0.16 ZZZ<br />

15240 A Skin full grft face/genit/hf 10.15 12.09 11.64 9.06 8.80 0.92 090<br />

15241 A Skin full graft add-on 1.86 2.52 2.50 0.86 0.87 0.23 ZZZ<br />

15260 A Skin full graft een & lips 11.39 13.14 12.44 9.58 9.35 0.69 090<br />

15261 A Skin full graft add-on 2.23 2.95 2.89 1.21 1.26 0.21 ZZZ<br />

15300 A Apply skinallogrft, t/arm/lg 4.65 3.50 3.43 2.24 2.24 0.49 090<br />

15301 A Apply sknallogrft t/a/l addl 1.00 0.50 0.49 0.37 0.37 0.14 ZZZ<br />

15320 A Apply skin allogrft f/n/hf/g 5.36 3.76 3.73 2.38 2.42 0.58 090<br />

15321 A Aply sknallogrft f/n/hfg add 1.50 0.73 0.72 0.55 0.56 0.21 ZZZ<br />

15330 A Aply acell alogrft t/arm/leg 3.99 3.54 3.46 2.23 2.24 0.49 090<br />

15331 A Aply acell grft t/a/l add-on 1.00 0.50 0.49 0.38 0.38 0.14 ZZZ<br />

15335 A Apply acell graft, f/n/hf/g 4.50 3.26 3.32 2.01 2.13 0.55 090<br />

15336 A Aply acell grft f/n/hf/g add 1.43 0.62 0.64 0.43 0.46 0.20 ZZZ<br />

15340 A Apply cult skin substitute 3.76 3.65 3.75 2.63 2.67 0.41 010<br />

15341 A Apply cult skin sub add-on 0.50 0.62 0.62 0.14 0.16 0.06 ZZZ<br />

15360 A Apply cult derm sub, t/a/l 3.93 4.64 4.61 3.41 3.34 0.43 090<br />

15361 A Aply cult derm sub t/a/l add 1.15 0.51 0.53 0.34 0.37 0.14 ZZZ<br />

15365 A Apply cult derm sub f/n/hf/g 4.21 4.02 4.16 2.96 3.02 0.46 090<br />

15366 A Apply cult derm f/hf/g add 1.45 0.59 0.62 0.40 0.45 0.17 ZZZ<br />

15400 A Apply skin xenograft, t/a/l 4.38 5.26 4.96 4.01 4.02 0.47 090<br />

15401 A Apply skn xenogrft t/a/l add 1.00 0.99 1.22 0.34 0.36 0.14 ZZZ

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