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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. 1262 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 58262 A Vag hyst including t/o 15.81 NA NA 6.52 6.75 1.80 090 58263 A Vag hyst w/t/o & vag repair 17.10 NA NA 6.95 7.20 1.95 090 58267 A Vag hyst w/urinary repair 18.23 NA NA 7.31 7.59 2.07 090 58270 A Vag hyst w/enterocele repair 15.20 NA NA 6.19 6.42 1.74 090 58275 A Hysterectomy/revise vagina 16.90 NA NA 6.95 7.17 1.92 090 58280 A Hysterectomy/revise vagina 18.20 NA NA 7.28 7.54 2.07 090 58285 A Extensive hysterectomy 23.30 NA NA 8.53 8.91 2.71 090 58290 A Vag hyst complex 20.17 NA NA 7.71 8.08 2.30 090 58291 A Vag hyst incl t/o, complex 21.96 NA NA 8.30 8.72 2.53 090 58292 A Vag hyst t/o & repair, compl 23.25 NA NA 8.61 9.07 2.68 090 58293 A Vag hyst w/uro repair, compl 24.23 NA NA 8.85 9.32 2.79 090 58294 A Vag hyst w/enterocele, compl 21.45 NA NA 8.00 8.41 2.40 090 58300 N Insert intrauterine device 1.01 0.78 0.94 0.34 0.35 0.12 XXX 58301 A Remove intrauterine device 1.27 1.05 1.12 0.37 0.40 0.15 000 58321 A Artificial insemination 0.92 1.02 1.05 0.29 0.31 0.10 000 58322 A Artificial insemination 1.10 1.03 1.08 0.32 0.35 0.13 000 58323 A Sperm washing 0.23 0.16 0.25 0.07 0.08 0.03 000 58340 A Catheter for hysterography 0.88 2.13 2.39 0.58 0.60 0.09 000 58345 A Reopen fallopian tube 4.67 NA NA 2.16 2.24 0.41 010 58346 A Insert heyman uteri capsule 7.48 NA NA 3.85 3.88 0.56 090 58350 A Reopen fallopian tube 1.03 1.35 1.38 0.89 0.90 0.12 010 58353 A Endometr ablate, thermal 3.57 22.36 25.75 1.76 1.84 0.43 010 58356 A Endometrial cryoablation 6.36 42.50 47.35 1.97 2.16 0.82 010 58400 A Suspension of uterus 7.06 NA NA 3.97 3.97 0.75 090 58410 A Suspension of uterus 13.70 NA NA 5.79 5.96 1.45 090 58520 A Repair of ruptured uterus 13.38 NA NA 5.68 5.78 1.47 090 58540 A Revision of uterus 15.61 NA NA 6.43 6.58 1.79 090 58541 A Lsh, uterus 250 g or less 14.57 NA NA 6.37 6.37 1.68 090 58542 A Lsh w/t/o ut 250 g or less 16.43 NA NA 6.94 6.94 1.69 090 58543 A Lsh uterus above 250 g 16.74 NA NA 7.01 7.01 1.73 090 58544 A Lsh w/t/o uterus above 250 g 18.24 NA NA 7.41 7.41 1.89 090 58545 A Laparoscopic myomectomy 15.45 NA NA 6.10 6.39 1.78 090 58546 A Laparo-myomectomy, complex 19.84 NA NA 7.41 7.80 2.31 090 58548 A Lap radical hyst 31.45 NA NA 11.70 11.70 3.52 090 58550 A Laparo-asst vag hysterectomy 14.97 NA NA 6.38 6.62 1.73 090 58552 A Laparo-vag hyst incl t/o 16.78 NA NA 6.85 7.16 1.73 090 58553 A Laparo-vag hyst, complex 19.96 NA NA 7.44 7.83 2.31 090 58554 A Laparo-vag hyst w/t/o, compl 22.98 NA NA 8.65 9.11 2.28 090 58555 A Hysteroscopy, dx, sep proc 3.33 2.77 2.63 1.29 1.35 0.40 000 58558 A Hysteroscopy, biopsy 4.74 3.66 3.29 1.74 1.85 0.57 000 58559 A Hysteroscopy, lysis 6.16 NA NA 2.16 2.31 0.74 000 58560 A Hysteroscopy, resect septum 6.99 NA NA 2.40 2.58 0.84 000 58561 A Hysteroscopy, remove myoma 9.99 NA NA 3.29 3.54 1.21 000 58562 A Hysteroscopy, remove fb 5.20 3.57 3.27 1.84 1.98 0.63 000 58563 A Hysteroscopy, ablation 6.16 36.52 41.54 2.16 2.31 0.74 000 58565 A Hysteroscopy, sterilization 7.06 41.19 43.39 3.48 3.59 1.19 090 58570 A Tlh, uterus 250 g or less 15.75 NA NA 6.72 6.72 1.82 090 58571 A Tlh w/t/o 250 g or less 17.56 NA NA 7.25 7.25 1.81 090
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. 1263 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 58572 A Tlh, uterus over 250 g 19.96 NA NA 7.94 7.94 2.31 090 58573 A Tlh w/t/o uterus over 250 g 22.98 NA NA 8.82 8.82 2.28 090 58578 C Laparo proc, uterus 0.00 0.00 0.00 0.00 0.00 0.00 YYY 58579 C Hysteroscope procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 58600 A Division of fallopian tube 5.86 NA NA 2.93 3.04 0.66 090 58605 A Division of fallopian tube 5.25 NA NA 2.75 2.85 0.59 090 58611 A Ligate oviduct(s) add-on 1.45 NA NA 0.43 0.46 0.18 ZZZ 58615 A Occlude fallopian tube(s) 3.91 NA NA 2.03 2.20 0.47 010 58660 A Laparoscopy, lysis 11.54 NA NA 4.68 4.84 1.40 090 58661 A Laparoscopy, remove adnexa 11.30 NA NA 4.19 4.44 1.34 010 58662 A Laparoscopy, excise lesions 12.08 NA NA 4.95 5.17 1.43 090 58670 A Laparoscopy, tubal cautery 5.86 NA NA 3.03 3.10 0.67 090 58671 A Laparoscopy, tubal block 5.86 NA NA 3.02 3.09 0.68 090 58672 A Laparoscopy, fimbrioplasty 12.88 NA NA 4.87 5.21 1.60 090 58673 A Laparoscopy, salpingostomy 13.99 NA NA 5.41 5.71 1.70 090 58679 C Laparo proc, oviduct-ovary 0.00 0.00 0.00 0.00 0.00 0.00 YYY 58700 A Removal of fallopian tube 12.84 NA NA 5.67 5.76 1.51 090 58720 A Removal of ovary/tube(s) 12.08 NA NA 5.28 5.42 1.39 090 58740 A Adhesiolysis tube, ovary 14.79 NA NA 6.31 6.53 1.72 090 58750 A Repair oviduct 15.56 NA NA 6.32 6.59 1.85 090 58752 A Revise ovarian tube(s) 15.56 NA NA 6.72 6.79 1.81 090 58760 A Fimbrioplasty 13.85 NA NA 5.91 6.12 1.80 090 58770 A Create new tubal opening 14.69 NA NA 5.48 5.85 1.74 090 58800 A Drainage of ovarian cyst(s) 4.54 3.31 3.40 2.80 2.83 0.43 090 58805 A Drainage of ovarian cyst(s) 6.34 NA NA 3.62 3.60 0.69 090 58820 A Drain ovary abscess, open 4.62 NA NA 2.99 3.07 0.52 090 58822 A Drain ovary abscess, percut 11.71 NA NA 5.76 5.64 1.16 090 58823 A Drain pelvic abscess, percut 3.37 19.82 20.24 1.29 1.25 0.24 000 58825 A Transposition, ovary(s) 11.70 NA NA 5.16 5.33 1.32 090 58900 A Biopsy of ovary(s) 6.51 NA NA 3.65 3.64 0.69 090 58920 A Partial removal of ovary(s) 11.87 NA NA 5.08 5.21 1.43 090 58925 A Removal of ovarian cyst(s) 12.33 NA NA 5.46 5.53 1.41 090 58940 A Removal of ovary(s) 8.12 NA NA 4.16 4.15 0.91 090 58943 A Removal of ovary(s) 19.42 NA NA 7.53 7.82 2.23 090 58950 A Resect ovarian malignancy 18.24 NA NA 7.56 7.79 2.05 090 58951 A Resect ovarian malignancy 24.15 NA NA 9.04 9.42 2.64 090 58952 A Resect ovarian malignancy 27.15 NA NA 10.29 10.68 3.03 090 58953 A Tah, rad dissect for debulk 33.97 NA NA 12.31 12.90 3.84 090 58954 A Tah rad debulk/lymph remove 36.97 NA NA 13.26 13.90 4.18 090 58956 A Bso, omentectomy w/tah 22.65 NA NA 8.98 9.34 4.01 090 58957 A Resect recurrent gyn mal 26.06 NA NA 10.02 10.02 2.95 090 58958 A Resect recur gyn mal w/lym 29.06 NA NA 11.03 11.03 3.29 090 58960 A Exploration of abdomen 15.68 NA NA 6.59 6.80 1.80 090 58970 A Retrieval of oocyte 3.52 1.88 2.00 1.33 1.37 0.43 000 58974 C Transfer of embryo 0.00 0.00 0.00 0.00 0.00 0.00 000 58976 A Transfer of embryo 3.82 2.45 2.51 1.63 1.68 0.47 000 58999 C Genital surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY 59000 A Amniocentesis, diagnostic 1.30 1.74 1.83 0.57 0.59 0.31 000
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<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 />
1262<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 />
58262 A Vag hyst including t/o 15.81 NA NA 6.52 6.75 1.80 090<br />
58263 A Vag hyst w/t/o & vag repair 17.10 NA NA 6.95 7.20 1.95 090<br />
58267 A Vag hyst w/urinary repair 18.23 NA NA 7.31 7.59 2.07 090<br />
58270 A Vag hyst w/enterocele repair 15.20 NA NA 6.19 6.42 1.74 090<br />
58275 A Hysterectomy/revise vagina 16.90 NA NA 6.95 7.17 1.92 090<br />
58280 A Hysterectomy/revise vagina 18.20 NA NA 7.28 7.54 2.07 090<br />
58285 A Extensive hysterectomy 23.30 NA NA 8.53 8.91 2.71 090<br />
58290 A Vag hyst complex 20.17 NA NA 7.71 8.08 2.30 090<br />
58291 A Vag hyst incl t/o, complex 21.96 NA NA 8.30 8.72 2.53 090<br />
58292 A Vag hyst t/o & repair, compl 23.25 NA NA 8.61 9.07 2.68 090<br />
58293 A Vag hyst w/uro repair, compl 24.23 NA NA 8.85 9.32 2.79 090<br />
58294 A Vag hyst w/enterocele, compl 21.45 NA NA 8.00 8.41 2.40 090<br />
58300 N Insert intrauterine device 1.01 0.78 0.94 0.34 0.35 0.12 XXX<br />
58301 A Remove intrauterine device 1.27 1.05 1.12 0.37 0.40 0.15 000<br />
58321 A Artificial insemination 0.92 1.02 1.05 0.29 0.31 0.10 000<br />
58322 A Artificial insemination 1.10 1.03 1.08 0.32 0.35 0.13 000<br />
58323 A Sperm washing 0.23 0.16 0.25 0.07 0.08 0.03 000<br />
58340 A Catheter for hysterography 0.88 2.13 2.39 0.58 0.60 0.09 000<br />
58345 A Reopen fallopian tube 4.67 NA NA 2.16 2.24 0.41 010<br />
58346 A Insert heyman uteri capsule 7.48 NA NA 3.85 3.88 0.56 090<br />
58350 A Reopen fallopian tube 1.03 1.35 1.38 0.89 0.90 0.12 010<br />
58353 A Endometr ablate, thermal 3.57 22.36 25.75 1.76 1.84 0.43 010<br />
58356 A Endometrial cryoablation 6.36 42.50 47.35 1.97 2.16 0.82 010<br />
58400 A Suspension of uterus 7.06 NA NA 3.97 3.97 0.75 090<br />
58410 A Suspension of uterus 13.70 NA NA 5.79 5.96 1.45 090<br />
58520 A Repair of ruptured uterus 13.38 NA NA 5.68 5.78 1.47 090<br />
58540 A Revision of uterus 15.61 NA NA 6.43 6.58 1.79 090<br />
58541 A Lsh, uterus 250 g or less 14.57 NA NA 6.37 6.37 1.68 090<br />
58542 A Lsh w/t/o ut 250 g or less 16.43 NA NA 6.94 6.94 1.69 090<br />
58543 A Lsh uterus above 250 g 16.74 NA NA 7.01 7.01 1.73 090<br />
58544 A Lsh w/t/o uterus above 250 g 18.24 NA NA 7.41 7.41 1.89 090<br />
58545 A Laparoscopic myomectomy 15.45 NA NA 6.10 6.39 1.78 090<br />
58546 A Laparo-myomectomy, complex 19.84 NA NA 7.41 7.80 2.31 090<br />
58548 A Lap radical hyst 31.45 NA NA 11.70 11.70 3.52 090<br />
58550 A Laparo-asst vag hysterectomy 14.97 NA NA 6.38 6.62 1.73 090<br />
58552 A Laparo-vag hyst incl t/o 16.78 NA NA 6.85 7.16 1.73 090<br />
58553 A Laparo-vag hyst, complex 19.96 NA NA 7.44 7.83 2.31 090<br />
58554 A Laparo-vag hyst w/t/o, compl 22.98 NA NA 8.65 9.11 2.28 090<br />
58555 A Hysteroscopy, dx, sep proc 3.33 2.77 2.63 1.29 1.35 0.40 000<br />
58558 A Hysteroscopy, biopsy 4.74 3.66 3.29 1.74 1.85 0.57 000<br />
58559 A Hysteroscopy, lysis 6.16 NA NA 2.16 2.31 0.74 000<br />
58560 A Hysteroscopy, resect septum 6.99 NA NA 2.40 2.58 0.84 000<br />
58561 A Hysteroscopy, remove myoma 9.99 NA NA 3.29 3.54 1.21 000<br />
58562 A Hysteroscopy, remove fb 5.20 3.57 3.27 1.84 1.98 0.63 000<br />
58563 A Hysteroscopy, ablation 6.16 36.52 41.54 2.16 2.31 0.74 000<br />
58565 A Hysteroscopy, sterilization 7.06 41.19 43.39 3.48 3.59 1.19 090<br />
58570 A Tlh, uterus 250 g or less 15.75 NA NA 6.72 6.72 1.82 090<br />
58571 A Tlh w/t/o 250 g or less 17.56 NA NA 7.25 7.25 1.81 090