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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. 1232 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 41007 A Drainage of mouth lesion 3.14 5.49 5.42 2.87 2.91 0.31 090 41008 A Drainage of mouth lesion 3.40 5.55 5.34 2.93 3.00 0.42 090 41009 A Drainage of mouth lesion 3.63 5.84 5.64 3.21 3.31 0.47 090 41010 A Incision of tongue fold 1.08 3.87 3.77 1.57 1.58 0.07 010 41015 A Drainage of mouth lesion 4.00 6.19 6.00 3.97 4.02 0.46 090 41016 A Drainage of mouth lesion 4.11 6.27 6.12 4.15 4.18 0.53 090 41017 A Drainage of mouth lesion 4.11 6.37 6.20 4.18 4.22 0.53 090 41018 A Drainage of mouth lesion 5.14 6.76 6.62 4.54 4.56 0.68 090 41019 A Place needles h&n for rt 8.84 NA NA 3.53 3.53 0.59 000 41100 A Biopsy of tongue 1.39 2.66 2.61 1.19 1.25 0.15 010 41105 A Biopsy of tongue 1.44 2.66 2.58 1.22 1.25 0.13 010 41108 A Biopsy of floor of mouth 1.07 2.49 2.39 1.09 1.10 0.10 010 41110 A Excision of tongue lesion 1.53 3.61 3.46 1.65 1.65 0.13 010 41112 A Excision of tongue lesion 2.77 5.22 5.05 3.25 3.25 0.28 090 41113 A Excision of tongue lesion 3.23 5.49 5.32 3.42 3.44 0.34 090 41114 A Excision of tongue lesion 8.71 NA NA 6.49 6.68 0.83 090 41115 A Excision of tongue fold 1.76 4.27 4.03 1.78 1.81 0.18 010 41116 A Excision of mouth lesion 2.47 5.50 5.22 2.81 2.81 0.23 090 41120 A Partial removal of tongue 10.91 NA NA 14.40 14.66 0.79 090 41130 A Partial removal of tongue 15.51 NA NA 15.96 16.06 0.93 090 41135 A Tongue and neck surgery 29.83 NA NA 22.25 22.55 1.89 090 41140 A Removal of tongue 28.81 NA NA 24.17 24.86 2.27 090 41145 A Tongue removal, neck surgery 37.59 NA NA 29.46 29.80 2.55 090 41150 A Tongue, mouth, jaw surgery 29.52 NA NA 23.45 23.82 1.95 090 41153 A Tongue, mouth, neck surgery 33.28 NA NA 24.40 24.62 2.01 090 41155 A Tongue, jaw, & neck surgery 43.96 NA NA 28.46 28.11 2.34 090 41250 A Repair tongue laceration 1.93 3.70 3.47 1.57 1.47 0.18 010 41251 A Repair tongue laceration 2.29 3.26 3.27 1.70 1.66 0.22 010 41252 A Repair tongue laceration 2.99 4.42 4.30 2.06 2.12 0.29 010 4148F I Hep A vac injxn admin/recvd 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4149F I Hep B vac injxn admin/recvd 0.00 0.00 0.00 0.00 0.00 0.00 XXX 41500 A Fixation of tongue 3.74 NA NA 6.99 7.12 0.30 090 41510 A Tongue to lip surgery 3.45 NA NA 6.10 6.57 0.20 090 41512 A Tongue suspension 6.75 NA NA 8.46 8.46 0.45 090 41520 A Reconstruction, tongue fold 2.77 5.68 5.43 3.23 3.34 0.27 090 41530 A Tongue base vol reduction 4.38 73.12 73.12 5.57 5.57 0.31 010 41599 C Tongue and mouth surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 41800 A Drainage of gum lesion 1.21 4.72 4.20 2.09 1.89 0.12 010 41805 A Removal foreign body, gum 1.28 4.83 4.30 2.83 2.68 0.13 010 41806 A Removal foreign body,jawbone 2.73 5.86 5.30 3.40 3.32 0.37 010 41820 R Excision, gum, each quadrant 0.00 0.00 0.00 0.00 0.00 0.00 000 41821 R Excision of gum flap 0.00 0.00 0.00 0.00 0.00 0.00 000 41822 R Excision of gum lesion 2.35 4.54 4.39 1.78 1.81 0.31 010 41823 R Excision of gum lesion 3.63 6.66 6.40 3.92 3.95 0.47 090 41825 A Excision of gum lesion 1.35 3.66 3.52 1.48 1.68 0.15 010 41826 A Excision of gum lesion 2.35 5.09 4.43 2.61 2.49 0.30 010 41827 A Excision of gum lesion 3.72 6.68 6.40 3.47 3.52 0.35 090 41828 R Excision of gum lesion 3.11 4.06 4.00 1.68 2.01 0.44 010

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. 1233 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 41830 R Removal of gum tissue 3.38 5.90 5.68 3.12 3.25 0.44 010 41850 R Treatment of gum lesion 0.00 0.00 0.00 0.00 0.00 0.00 000 41870 R Gum graft 0.00 0.00 0.00 0.00 0.00 0.00 000 41872 R Repair gum 2.90 5.88 5.68 3.29 3.34 0.30 090 41874 R Repair tooth socket 3.13 5.68 5.48 2.78 2.89 0.45 090 41899 C Dental surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 4192F I Pt not rcvng glucoco thxpy 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4193F I Pt rcvng10mg daily predniso 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4195F I Pt rcvng anti-rheum thxpy RA 0.00 0.00 0.00 0.00 0.00 0.00 XXX 4196F I Ptnot rcvng anti-rhm thxpyRA 0.00 0.00 0.00 0.00 0.00 0.00 XXX 42000 A Drainage mouth roof lesion 1.25 2.47 2.50 1.22 1.23 0.12 010 42100 A Biopsy roof of mouth 1.33 2.26 2.22 1.28 1.30 0.13 010 42104 A Excision lesion, mouth roof 1.66 3.54 3.30 1.68 1.65 0.16 010 42106 A Excision lesion, mouth roof 2.12 4.43 4.14 2.10 2.19 0.25 010 42107 A Excision lesion, mouth roof 4.48 6.58 6.38 3.79 3.84 0.44 090 42120 A Remove palate/lesion 11.70 NA NA 12.31 12.20 0.52 090 42140 A Excision of uvula 1.65 4.51 4.32 2.11 2.11 0.13 090 42145 A Repair palate, pharynx/uvula 9.63 NA NA 7.54 7.55 0.65 090 42160 A Treatment mouth roof lesion 1.82 3.80 3.92 1.74 1.88 0.17 010 42180 A Repair palate 2.52 3.34 3.28 1.90 1.96 0.21 010 42182 A Repair palate 3.84 4.06 4.02 2.48 2.63 0.40 010 42200 A Reconstruct cleft palate 12.41 NA NA 8.65 9.07 1.27 090 42205 A Reconstruct cleft palate 13.57 NA NA 8.84 9.17 1.58 090 42210 A Reconstruct cleft palate 14.91 NA NA 10.15 10.50 2.17 090 42215 A Reconstruct cleft palate 8.88 NA NA 7.46 7.88 1.31 090 42220 A Reconstruct cleft palate 7.07 NA NA 5.91 6.14 0.73 090 42225 A Reconstruct cleft palate 9.66 NA NA 12.07 13.35 0.86 090 42226 A Lengthening of palate 10.24 NA NA 11.73 12.50 1.01 090 42227 A Lengthening of palate 9.81 NA NA 11.18 12.30 0.98 090 42235 A Repair palate 7.92 NA NA 9.61 10.19 0.72 090 42260 A Repair nose to lip fistula 10.10 9.60 9.77 6.02 6.29 1.26 090 42280 A Preparation, palate mold 1.56 2.22 2.16 0.85 0.93 0.19 010 42281 A Insertion, palate prosthesis 1.95 2.99 2.91 1.70 1.75 0.17 010 42299 C Palate/uvula surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY 42300 A Drainage of salivary gland 1.95 3.09 3.03 1.74 1.76 0.16 010 42305 A Drainage of salivary gland 6.23 NA NA 4.17 4.31 0.51 090 42310 A Drainage of salivary gland 1.58 2.30 2.29 1.42 1.45 0.13 010 42320 A Drainage of salivary gland 2.37 3.71 3.61 1.91 1.96 0.21 010 42330 A Removal of salivary stone 2.23 3.39 3.34 1.76 1.79 0.19 010 42335 A Removal of salivary stone 3.35 5.74 5.54 2.90 2.96 0.29 090 42340 A Removal of salivary stone 4.64 6.62 6.49 3.51 3.63 0.42 090 42400 A Biopsy of salivary gland 0.78 1.96 1.88 0.66 0.67 0.06 000 42405 A Biopsy of salivary gland 3.31 3.98 4.00 2.22 2.28 0.28 010 42408 A Excision of salivary cyst 4.58 6.39 6.29 3.34 3.41 0.45 090 42409 A Drainage of salivary cyst 2.85 5.23 5.06 2.54 2.60 0.27 090 42410 A Excise parotid gland/lesion 9.46 NA NA 5.50 5.70 0.91 090 42415 A Excise parotid gland/lesion 17.99 NA NA 9.01 9.50 1.43 090

<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 />

1233<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 />

41830 R Removal of gum tissue 3.38 5.90 5.68 3.12 3.25 0.44 010<br />

41850 R Treatment of gum lesion 0.00 0.00 0.00 0.00 0.00 0.00 000<br />

41870 R Gum graft 0.00 0.00 0.00 0.00 0.00 0.00 000<br />

41872 R Repair gum 2.90 5.88 5.68 3.29 3.34 0.30 090<br />

41874 R Repair tooth socket 3.13 5.68 5.48 2.78 2.89 0.45 090<br />

41899 C Dental surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY<br />

4192F I Pt not rcvng glucoco thxpy 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

4193F I Pt rcvng10mg daily predniso 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

4195F I Pt rcvng anti-rheum thxpy RA 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

4196F I Ptnot rcvng anti-rhm thxpyRA 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

42000 A Drainage mouth roof lesion 1.25 2.47 2.50 1.22 1.23 0.12 010<br />

42100 A Biopsy roof of mouth 1.33 2.26 2.22 1.28 1.30 0.13 010<br />

42104 A Excision lesion, mouth roof 1.66 3.54 3.30 1.68 1.65 0.16 010<br />

42106 A Excision lesion, mouth roof 2.12 4.43 4.14 2.10 2.19 0.25 010<br />

42107 A Excision lesion, mouth roof 4.48 6.58 6.38 3.79 3.84 0.44 090<br />

42120 A Remove palate/lesion 11.70 NA NA 12.31 12.20 0.52 090<br />

42140 A Excision of uvula 1.65 4.51 4.32 2.11 2.11 0.13 090<br />

42145 A Repair palate, pharynx/uvula 9.63 NA NA 7.54 7.55 0.65 090<br />

42160 A Treatment mouth roof lesion 1.82 3.80 3.92 1.74 1.88 0.17 010<br />

42180 A Repair palate 2.52 3.34 3.28 1.90 1.96 0.21 010<br />

42182 A Repair palate 3.84 4.06 4.02 2.48 2.63 0.40 010<br />

42200 A Reconstruct cleft palate 12.41 NA NA 8.65 9.07 1.27 090<br />

42205 A Reconstruct cleft palate 13.57 NA NA 8.84 9.17 1.58 090<br />

42210 A Reconstruct cleft palate 14.91 NA NA 10.15 10.50 2.17 090<br />

42215 A Reconstruct cleft palate 8.88 NA NA 7.46 7.88 1.31 090<br />

42220 A Reconstruct cleft palate 7.07 NA NA 5.91 6.14 0.73 090<br />

42225 A Reconstruct cleft palate 9.66 NA NA 12.07 13.35 0.86 090<br />

42226 A Lengthening of palate 10.24 NA NA 11.73 12.50 1.01 090<br />

42227 A Lengthening of palate 9.81 NA NA 11.18 12.30 0.98 090<br />

42235 A Repair palate 7.92 NA NA 9.61 10.19 0.72 090<br />

42260 A Repair nose to lip fistula 10.10 9.60 9.77 6.02 6.29 1.26 090<br />

42280 A Preparation, palate mold 1.56 2.22 2.16 0.85 0.93 0.19 010<br />

42281 A Insertion, palate prosthesis 1.95 2.99 2.91 1.70 1.75 0.17 010<br />

42299 C Palate/uvula surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY<br />

42300 A Drainage of salivary gland 1.95 3.09 3.03 1.74 1.76 0.16 010<br />

42305 A Drainage of salivary gland 6.23 NA NA 4.17 4.31 0.51 090<br />

42310 A Drainage of salivary gland 1.58 2.30 2.29 1.42 1.45 0.13 010<br />

42320 A Drainage of salivary gland 2.37 3.71 3.61 1.91 1.96 0.21 010<br />

42330 A Removal of salivary stone 2.23 3.39 3.34 1.76 1.79 0.19 010<br />

42335 A Removal of salivary stone 3.35 5.74 5.54 2.90 2.96 0.29 090<br />

42340 A Removal of salivary stone 4.64 6.62 6.49 3.51 3.63 0.42 090<br />

42400 A Biopsy of salivary gland 0.78 1.96 1.88 0.66 0.67 0.06 000<br />

42405 A Biopsy of salivary gland 3.31 3.98 4.00 2.22 2.28 0.28 010<br />

42408 A Excision of salivary cyst 4.58 6.39 6.29 3.34 3.41 0.45 090<br />

42409 A Drainage of salivary cyst 2.85 5.23 5.06 2.54 2.60 0.27 090<br />

42410 A Excise parotid gland/lesion 9.46 NA NA 5.50 5.70 0.91 090<br />

42415 A Excise parotid gland/lesion 17.99 NA NA 9.01 9.50 1.43 090

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