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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. 1286 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 70350 TC A X-ray head for orthodontia 0.00 0.27 0.30 NA NA 0.02 XXX 70350 26 A X-ray head for orthodontia 0.17 0.06 0.06 0.06 0.06 0.01 XXX 70355 A Panoramic x-ray of jaws 0.20 0.30 0.38 NA NA 0.05 XXX 70355 TC A Panoramic x-ray of jaws 0.00 0.23 0.31 NA NA 0.04 XXX 70355 26 A Panoramic x-ray of jaws 0.20 0.07 0.07 0.07 0.07 0.01 XXX 70360 A X-ray exam of neck 0.17 0.56 0.54 NA NA 0.03 XXX 70360 TC A X-ray exam of neck 0.00 0.50 0.48 NA NA 0.02 XXX 70360 26 A X-ray exam of neck 0.17 0.06 0.06 0.06 0.06 0.01 XXX 70370 A Throat x-ray & fluoroscopy 0.32 1.69 1.63 NA NA 0.08 XXX 70370 TC A Throat x-ray & fluoroscopy 0.00 1.58 1.52 NA NA 0.07 XXX 70370 26 A Throat x-ray & fluoroscopy 0.32 0.11 0.11 0.11 0.11 0.01 XXX 70371 A Speech evaluation, complex 0.84 1.46 1.69 NA NA 0.16 XXX 70371 TC A Speech evaluation, complex 0.00 1.19 1.42 NA NA 0.12 XXX 70371 26 A Speech evaluation, complex 0.84 0.27 0.27 0.27 0.27 0.04 XXX 70373 A Contrast x-ray of larynx 0.44 1.54 1.64 NA NA 0.13 XXX 70373 TC A Contrast x-ray of larynx 0.00 1.42 1.52 NA NA 0.11 XXX 70373 26 A Contrast x-ray of larynx 0.44 0.12 0.12 0.12 0.12 0.02 XXX 70380 A X-ray exam of salivary gland 0.17 0.81 0.79 NA NA 0.05 XXX 70380 TC A X-ray exam of salivary gland 0.00 0.75 0.73 NA NA 0.04 XXX 70380 26 A X-ray exam of salivary gland 0.17 0.06 0.06 0.06 0.06 0.01 XXX 70390 A X-ray exam of salivary duct 0.38 2.32 2.22 NA NA 0.13 XXX 70390 TC A X-ray exam of salivary duct 0.00 2.17 2.08 NA NA 0.11 XXX 70390 26 A X-ray exam of salivary duct 0.38 0.15 0.14 0.15 0.14 0.02 XXX 70450 A Ct head/brain w/o dye 0.85 4.87 4.92 NA NA 0.29 XXX 70450 TC A Ct head/brain w/o dye 0.00 4.54 4.60 NA NA 0.25 XXX 70450 26 A Ct head/brain w/o dye 0.85 0.33 0.32 0.33 0.32 0.04 XXX 70460 A Ct head/brain w/dye 1.13 6.44 6.35 NA NA 0.35 XXX 70460 TC A Ct head/brain w/dye 0.00 6.00 5.93 NA NA 0.30 XXX 70460 26 A Ct head/brain w/dye 1.13 0.44 0.42 0.44 0.42 0.05 XXX 70470 A Ct head/brain w/o & w/dye 1.27 7.85 7.78 NA NA 0.43 XXX 70470 TC A Ct head/brain w/o & w/dye 0.00 7.36 7.31 NA NA 0.37 XXX 70470 26 A Ct head/brain w/o & w/dye 1.27 0.49 0.47 0.49 0.47 0.06 XXX 70480 A Ct orbit/ear/fossa w/o dye 1.28 8.40 7.60 NA NA 0.31 XXX 70480 TC A Ct orbit/ear/fossa w/o dye 0.00 7.91 7.13 NA NA 0.25 XXX 70480 26 A Ct orbit/ear/fossa w/o dye 1.28 0.49 0.47 0.49 0.47 0.06 XXX 70481 A Ct orbit/ear/fossa w/dye 1.38 9.87 8.95 NA NA 0.36 XXX 70481 TC A Ct orbit/ear/fossa w/dye 0.00 9.34 8.44 NA NA 0.30 XXX 70481 26 A Ct orbit/ear/fossa w/dye 1.38 0.53 0.51 0.53 0.51 0.06 XXX 70482 A Ct orbit/ear/fossa w/o&w/dye 1.45 11.29 10.37 NA NA 0.43 XXX 70482 TC A Ct orbit/ear/fossa w/o&w/dye 0.00 10.74 9.84 NA NA 0.37 XXX 70482 26 A Ct orbit/ear/fossa w/o&w/dye 1.45 0.55 0.53 0.55 0.53 0.06 XXX 70486 A Ct maxillofacial w/o dye 1.14 6.73 6.34 NA NA 0.30 XXX 70486 TC A Ct maxillofacial w/o dye 0.00 6.30 5.92 NA NA 0.25 XXX 70486 26 A Ct maxillofacial w/o dye 1.14 0.43 0.42 0.43 0.42 0.05 XXX 70487 A Ct maxillofacial w/dye 1.30 8.27 7.75 NA NA 0.36 XXX 70487 TC A Ct maxillofacial w/dye 0.00 7.76 7.26 NA NA 0.30 XXX 70487 26 A Ct maxillofacial w/dye 1.30 0.51 0.49 0.51 0.49 0.06 XXX 70488 A Ct maxillofacial w/o & w/dye 1.42 10.26 9.60 NA NA 0.43 XXX

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. 1287 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 70488 TC A Ct maxillofacial w/o & w/dye 0.00 9.72 9.08 NA NA 0.37 XXX 70488 26 A Ct maxillofacial w/o & w/dye 1.42 0.54 0.52 0.54 0.52 0.06 XXX 70490 A Ct soft tissue neck w/o dye 1.28 6.43 6.12 NA NA 0.31 XXX 70490 TC A Ct soft tissue neck w/o dye 0.00 5.94 5.64 NA NA 0.25 XXX 70490 26 A Ct soft tissue neck w/o dye 1.28 0.49 0.48 0.49 0.48 0.06 XXX 70491 A Ct soft tissue neck w/dye 1.38 7.96 7.51 NA NA 0.36 XXX 70491 TC A Ct soft tissue neck w/dye 0.00 7.42 7.00 NA NA 0.30 XXX 70491 26 A Ct soft tissue neck w/dye 1.38 0.54 0.51 0.54 0.51 0.06 XXX 70492 A Ct sft tsue nck w/o & w/dye 1.45 9.93 9.35 NA NA 0.43 XXX 70492 TC A Ct sft tsue nck w/o & w/dye 0.00 9.38 8.82 NA NA 0.37 XXX 70492 26 A Ct sft tsue nck w/o & w/dye 1.45 0.55 0.53 0.55 0.53 0.06 XXX 70496 A Ct angiography, head 1.75 16.89 15.49 NA NA 0.66 XXX 70496 TC A Ct angiography, head 0.00 16.20 14.83 NA NA 0.58 XXX 70496 26 A Ct angiography, head 1.75 0.69 0.66 0.69 0.66 0.08 XXX 70498 A Ct angiography, neck 1.75 16.99 15.57 NA NA 0.66 XXX 70498 TC A Ct angiography, neck 0.00 16.28 14.90 NA NA 0.58 XXX 70498 26 A Ct angiography, neck 1.75 0.71 0.67 0.71 0.67 0.08 XXX 70540 A Mri orbit/face/neck w/o dye 1.35 13.99 13.44 NA NA 0.45 XXX 70540 TC A Mri orbit/face/neck w/o dye 0.00 13.49 12.95 NA NA 0.39 XXX 70540 26 A Mri orbit/face/neck w/o dye 1.35 0.50 0.49 0.50 0.49 0.06 XXX 70542 A Mri orbit/face/neck w/dye 1.62 15.00 14.78 NA NA 0.54 XXX 70542 TC A Mri orbit/face/neck w/dye 0.00 14.39 14.19 NA NA 0.47 XXX 70542 26 A Mri orbit/face/neck w/dye 1.62 0.61 0.59 0.61 0.59 0.07 XXX 70543 A Mri orbt/fac/nck w/o & w/dye 2.15 18.51 20.32 NA NA 0.94 XXX 70543 TC A Mri orbt/fac/nck w/o & w/dye 0.00 17.70 19.54 NA NA 0.84 XXX 70543 26 A Mri orbt/fac/nck w/o & w/dye 2.15 0.81 0.78 0.81 0.78 0.10 XXX 70544 A Mr angiography head w/o dye 1.20 15.64 14.65 NA NA 0.64 XXX 70544 TC A Mr angiography head w/o dye 0.00 15.18 14.21 NA NA 0.59 XXX 70544 26 A Mr angiography head w/o dye 1.20 0.46 0.44 0.46 0.44 0.05 XXX 70545 A Mr angiography head w/dye 1.20 15.54 14.58 NA NA 0.64 XXX 70545 TC A Mr angiography head w/dye 0.00 15.08 14.14 NA NA 0.59 XXX 70545 26 A Mr angiography head w/dye 1.20 0.46 0.44 0.46 0.44 0.05 XXX 70546 A Mr angiograph head w/o&w/dye 1.80 23.69 23.57 NA NA 0.67 XXX 70546 TC A Mr angiograph head w/o&w/dye 0.00 23.01 22.91 NA NA 0.59 XXX 70546 26 A Mr angiograph head w/o&w/dye 1.80 0.68 0.66 0.68 0.66 0.08 XXX 70547 A Mr angiography neck w/o dye 1.20 15.57 14.61 NA NA 0.64 XXX 70547 TC A Mr angiography neck w/o dye 0.00 15.12 14.17 NA NA 0.59 XXX 70547 26 A Mr angiography neck w/o dye 1.20 0.45 0.44 0.45 0.44 0.05 XXX 70548 A Mr angiography neck w/dye 1.20 16.43 15.25 NA NA 0.64 XXX 70548 TC A Mr angiography neck w/dye 0.00 15.97 14.81 NA NA 0.59 XXX 70548 26 A Mr angiography neck w/dye 1.20 0.46 0.44 0.46 0.44 0.05 XXX 70549 A Mr angiograph neck w/o&w/dye 1.80 23.72 23.59 NA NA 0.67 XXX 70549 TC A Mr angiograph neck w/o&w/dye 0.00 23.03 22.93 NA NA 0.59 XXX 70549 26 A Mr angiograph neck w/o&w/dye 1.80 0.69 0.66 0.69 0.66 0.08 XXX 70551 A Mri brain w/o dye 1.48 14.28 13.66 NA NA 0.66 XXX 70551 TC A Mri brain w/o dye 0.00 13.72 13.12 NA NA 0.59 XXX 70551 26 A Mri brain w/o dye 1.48 0.56 0.54 0.56 0.54 0.07 XXX 70552 A Mri brain w/dye 1.78 15.43 15.11 NA NA 0.78 XXX

<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 />

1286<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 />

70350 TC A X-ray head for orthodontia 0.00 0.27 0.30 NA NA 0.02 XXX<br />

70350 26 A X-ray head for orthodontia 0.17 0.06 0.06 0.06 0.06 0.01 XXX<br />

70355 A Panoramic x-ray of jaws 0.20 0.30 0.38 NA NA 0.05 XXX<br />

70355 TC A Panoramic x-ray of jaws 0.00 0.23 0.31 NA NA 0.04 XXX<br />

70355 26 A Panoramic x-ray of jaws 0.20 0.07 0.07 0.07 0.07 0.01 XXX<br />

70360 A X-ray exam of neck 0.17 0.56 0.54 NA NA 0.03 XXX<br />

70360 TC A X-ray exam of neck 0.00 0.50 0.48 NA NA 0.02 XXX<br />

70360 26 A X-ray exam of neck 0.17 0.06 0.06 0.06 0.06 0.01 XXX<br />

70370 A Throat x-ray & fluoroscopy 0.32 1.69 1.63 NA NA 0.08 XXX<br />

70370 TC A Throat x-ray & fluoroscopy 0.00 1.58 1.52 NA NA 0.07 XXX<br />

70370 26 A Throat x-ray & fluoroscopy 0.32 0.11 0.11 0.11 0.11 0.01 XXX<br />

70371 A Speech evaluation, complex 0.84 1.46 1.69 NA NA 0.16 XXX<br />

70371 TC A Speech evaluation, complex 0.00 1.19 1.42 NA NA 0.12 XXX<br />

70371 26 A Speech evaluation, complex 0.84 0.27 0.27 0.27 0.27 0.04 XXX<br />

70373 A Contrast x-ray of larynx 0.44 1.54 1.64 NA NA 0.13 XXX<br />

70373 TC A Contrast x-ray of larynx 0.00 1.42 1.52 NA NA 0.11 XXX<br />

70373 26 A Contrast x-ray of larynx 0.44 0.12 0.12 0.12 0.12 0.02 XXX<br />

70380 A X-ray exam of salivary gland 0.17 0.81 0.79 NA NA 0.05 XXX<br />

70380 TC A X-ray exam of salivary gland 0.00 0.75 0.73 NA NA 0.04 XXX<br />

70380 26 A X-ray exam of salivary gland 0.17 0.06 0.06 0.06 0.06 0.01 XXX<br />

70390 A X-ray exam of salivary duct 0.38 2.32 2.22 NA NA 0.13 XXX<br />

70390 TC A X-ray exam of salivary duct 0.00 2.17 2.08 NA NA 0.11 XXX<br />

70390 26 A X-ray exam of salivary duct 0.38 0.15 0.14 0.15 0.14 0.02 XXX<br />

70450 A Ct head/brain w/o dye 0.85 4.87 4.92 NA NA 0.29 XXX<br />

70450 TC A Ct head/brain w/o dye 0.00 4.54 4.60 NA NA 0.25 XXX<br />

70450 26 A Ct head/brain w/o dye 0.85 0.33 0.32 0.33 0.32 0.04 XXX<br />

70460 A Ct head/brain w/dye 1.13 6.44 6.35 NA NA 0.35 XXX<br />

70460 TC A Ct head/brain w/dye 0.00 6.00 5.93 NA NA 0.30 XXX<br />

70460 26 A Ct head/brain w/dye 1.13 0.44 0.42 0.44 0.42 0.05 XXX<br />

70470 A Ct head/brain w/o & w/dye 1.27 7.85 7.78 NA NA 0.43 XXX<br />

70470 TC A Ct head/brain w/o & w/dye 0.00 7.36 7.31 NA NA 0.37 XXX<br />

70470 26 A Ct head/brain w/o & w/dye 1.27 0.49 0.47 0.49 0.47 0.06 XXX<br />

70480 A Ct orbit/ear/fossa w/o dye 1.28 8.40 7.60 NA NA 0.31 XXX<br />

70480 TC A Ct orbit/ear/fossa w/o dye 0.00 7.91 7.13 NA NA 0.25 XXX<br />

70480 26 A Ct orbit/ear/fossa w/o dye 1.28 0.49 0.47 0.49 0.47 0.06 XXX<br />

70481 A Ct orbit/ear/fossa w/dye 1.38 9.87 8.95 NA NA 0.36 XXX<br />

70481 TC A Ct orbit/ear/fossa w/dye 0.00 9.34 8.44 NA NA 0.30 XXX<br />

70481 26 A Ct orbit/ear/fossa w/dye 1.38 0.53 0.51 0.53 0.51 0.06 XXX<br />

70482 A Ct orbit/ear/fossa w/o&w/dye 1.45 11.29 10.37 NA NA 0.43 XXX<br />

70482 TC A Ct orbit/ear/fossa w/o&w/dye 0.00 10.74 9.84 NA NA 0.37 XXX<br />

70482 26 A Ct orbit/ear/fossa w/o&w/dye 1.45 0.55 0.53 0.55 0.53 0.06 XXX<br />

70486 A Ct maxillofacial w/o dye 1.14 6.73 6.34 NA NA 0.30 XXX<br />

70486 TC A Ct maxillofacial w/o dye 0.00 6.30 5.92 NA NA 0.25 XXX<br />

70486 26 A Ct maxillofacial w/o dye 1.14 0.43 0.42 0.43 0.42 0.05 XXX<br />

70487 A Ct maxillofacial w/dye 1.30 8.27 7.75 NA NA 0.36 XXX<br />

70487 TC A Ct maxillofacial w/dye 0.00 7.76 7.26 NA NA 0.30 XXX<br />

70487 26 A Ct maxillofacial w/dye 1.30 0.51 0.49 0.51 0.49 0.06 XXX<br />

70488 A Ct maxillofacial w/o & w/dye 1.42 10.26 9.60 NA NA 0.43 XXX

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