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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. 1310 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 76817 TC A Transvaginal us, obstetric 0.00 1.75 1.70 NA NA 0.06 XXX 76817 26 A Transvaginal us, obstetric 0.75 0.25 0.25 0.25 0.25 0.03 XXX 76818 A Fetal biophys profile w/nst 1.05 2.18 2.14 NA NA 0.15 XXX 76818 TC A Fetal biophys profile w/nst 0.00 1.86 1.80 NA NA 0.10 XXX 76818 26 A Fetal biophys profile w/nst 1.05 0.32 0.34 0.32 0.34 0.05 XXX 76819 A Fetal biophys profil w/o nst 0.77 1.61 1.69 NA NA 0.13 XXX 76819 TC A Fetal biophys profil w/o nst 0.00 1.36 1.43 NA NA 0.10 XXX 76819 26 A Fetal biophys profil w/o nst 0.77 0.25 0.26 0.25 0.26 0.03 XXX 76820 A Umbilical artery echo 0.50 0.56 0.87 NA NA 0.15 XXX 76820 TC A Umbilical artery echo 0.00 0.41 0.71 NA NA 0.12 XXX 76820 26 A Umbilical artery echo 0.50 0.15 0.16 0.15 0.16 0.03 XXX 76821 A Middle cerebral artery echo 0.70 1.83 1.85 NA NA 0.15 XXX 76821 TC A Middle cerebral artery echo 0.00 1.62 1.62 NA NA 0.12 XXX 76821 26 A Middle cerebral artery echo 0.70 0.21 0.23 0.21 0.23 0.03 XXX 76825 A Echo exam of fetal heart 1.67 4.31 3.89 NA NA 0.18 XXX 76825 TC A Echo exam of fetal heart 0.00 3.78 3.34 NA NA 0.11 XXX 76825 26 A Echo exam of fetal heart 1.67 0.53 0.55 0.53 0.55 0.07 XXX 76826 A Echo exam of fetal heart 0.83 2.67 2.25 NA NA 0.08 XXX 76826 TC A Echo exam of fetal heart 0.00 2.42 1.99 NA NA 0.05 XXX 76826 26 A Echo exam of fetal heart 0.83 0.25 0.26 0.25 0.26 0.03 XXX 76827 A Echo exam of fetal heart 0.58 1.05 1.28 NA NA 0.14 XXX 76827 TC A Echo exam of fetal heart 0.00 0.87 1.09 NA NA 0.12 XXX 76827 26 A Echo exam of fetal heart 0.58 0.18 0.19 0.18 0.19 0.02 XXX 76828 A Echo exam of fetal heart 0.56 0.62 0.81 NA NA 0.11 XXX 76828 TC A Echo exam of fetal heart 0.00 0.46 0.63 NA NA 0.08 XXX 76828 26 A Echo exam of fetal heart 0.56 0.16 0.18 0.16 0.18 0.03 XXX 76830 A Transvaginal us, non-ob 0.69 2.73 2.49 NA NA 0.13 XXX 76830 TC A Transvaginal us, non-ob 0.00 2.49 2.25 NA NA 0.10 XXX 76830 26 A Transvaginal us, non-ob 0.69 0.24 0.24 0.24 0.24 0.03 XXX 76831 A Echo exam, uterus 0.72 2.68 2.46 NA NA 0.13 XXX 76831 TC A Echo exam, uterus 0.00 2.46 2.23 NA NA 0.10 XXX 76831 26 A Echo exam, uterus 0.72 0.22 0.23 0.22 0.23 0.03 XXX 76856 A Us exam, pelvic, complete 0.69 2.77 2.51 NA NA 0.13 XXX 76856 TC A Us exam, pelvic, complete 0.00 2.51 2.26 NA NA 0.10 XXX 76856 26 A Us exam, pelvic, complete 0.69 0.26 0.25 0.26 0.25 0.03 XXX 76857 A Us exam, pelvic, limited 0.38 2.46 2.31 NA NA 0.08 XXX 76857 TC A Us exam, pelvic, limited 0.00 2.30 2.16 NA NA 0.06 XXX 76857 26 A Us exam, pelvic, limited 0.38 0.16 0.15 0.16 0.15 0.02 XXX 76870 A Us exam, scrotum 0.64 2.80 2.53 NA NA 0.13 XXX 76870 TC A Us exam, scrotum 0.00 2.55 2.29 NA NA 0.10 XXX 76870 26 A Us exam, scrotum 0.64 0.25 0.24 0.25 0.24 0.03 XXX 76872 A Us, transrectal 0.69 3.36 3.10 NA NA 0.14 XXX 76872 TC A Us, transrectal 0.00 3.07 2.82 NA NA 0.10 XXX 76872 26 A Us, transrectal 0.69 0.29 0.28 0.29 0.28 0.04 XXX 76873 A Echograp trans r, pros study 1.55 3.35 3.16 NA NA 0.25 XXX 76873 TC A Echograp trans r, pros study 0.00 2.76 2.60 NA NA 0.16 XXX 76873 26 A Echograp trans r, pros study 1.55 0.59 0.56 0.59 0.56 0.09 XXX 76880 A Us exam, extremity 0.59 3.13 2.75 NA NA 0.11 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. 1311 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 76880 TC A Us exam, extremity 0.00 2.94 2.56 NA NA 0.08 XXX 76880 26 A Us exam, extremity 0.59 0.19 0.19 0.19 0.19 0.03 XXX 76885 A Us exam infant hips, dynamic 0.74 3.25 2.88 NA NA 0.13 XXX 76885 TC A Us exam infant hips, dynamic 0.00 2.97 2.61 NA NA 0.10 XXX 76885 26 A Us exam infant hips, dynamic 0.74 0.28 0.27 0.28 0.27 0.03 XXX 76886 A Us exam infant hips, static 0.62 2.18 2.04 NA NA 0.11 XXX 76886 TC A Us exam infant hips, static 0.00 1.97 1.83 NA NA 0.08 XXX 76886 26 A Us exam infant hips, static 0.62 0.21 0.21 0.21 0.21 0.03 XXX 76930 A Echo guide, cardiocentesis 0.67 1.97 1.93 NA NA 0.12 XXX 76930 TC A Echo guide, cardiocentesis 0.00 1.63 1.61 NA NA 0.10 XXX 76930 26 A Echo guide, cardiocentesis 0.67 0.34 0.32 0.34 0.32 0.02 XXX 76932 C Echo guide for heart biopsy 0.00 0.00 0.00 NA NA 0.00 XXX 76932 TC C Echo guide for heart biopsy 0.00 0.00 0.00 NA NA 0.00 XXX 76932 26 A Echo guide for heart biopsy 0.67 0.35 0.32 0.35 0.32 0.02 XXX 76936 A Echo guide for artery repair 1.99 6.02 6.26 NA NA 0.47 XXX 76936 TC A Echo guide for artery repair 0.00 5.26 5.53 NA NA 0.34 XXX 76936 26 A Echo guide for artery repair 1.99 0.76 0.73 0.76 0.73 0.13 XXX 76937 A Us guide, vascular access 0.30 0.62 0.59 NA NA 0.13 ZZZ 76937 TC A Us guide, vascular access 0.00 0.51 0.48 NA NA 0.10 ZZZ 76937 26 A Us guide, vascular access 0.30 0.11 0.11 0.11 0.11 0.03 ZZZ 76940 C Us guide, tissue ablation 0.00 0.00 0.00 NA NA 0.00 XXX 76940 TC C Us guide, tissue ablation 0.00 0.00 0.00 NA NA 0.00 XXX 76940 26 A Us guide, tissue ablation 2.00 0.70 0.69 0.70 0.69 0.31 XXX 76941 C Echo guide for transfusion 0.00 0.00 0.00 NA NA 0.00 XXX 76941 TC C Echo guide for transfusion 0.00 0.00 0.00 NA NA 0.00 XXX 76941 26 A Echo guide for transfusion 1.34 0.43 0.44 0.43 0.44 0.07 XXX 76942 A Echo guide for biopsy 0.67 4.70 4.30 NA NA 0.13 XXX 76942 TC A Echo guide for biopsy 0.00 4.45 4.05 NA NA 0.10 XXX 76942 26 A Echo guide for biopsy 0.67 0.25 0.25 0.25 0.25 0.03 XXX 76945 C Echo guide, villus sampling 0.00 0.00 0.00 NA NA 0.00 XXX 76945 TC C Echo guide, villus sampling 0.00 0.00 0.00 NA NA 0.00 XXX 76945 26 A Echo guide, villus sampling 0.67 0.22 0.22 0.22 0.22 0.03 XXX 76946 A Echo guide for amniocentesis 0.38 0.44 0.75 NA NA 0.12 XXX 76946 TC A Echo guide for amniocentesis 0.00 0.33 0.63 NA NA 0.10 XXX 76946 26 A Echo guide for amniocentesis 0.38 0.11 0.12 0.11 0.12 0.02 XXX 76948 A Echo guide, ova aspiration 0.38 0.45 0.75 NA NA 0.12 XXX 76948 TC A Echo guide, ova aspiration 0.00 0.34 0.63 NA NA 0.10 XXX 76948 26 A Echo guide, ova aspiration 0.38 0.11 0.12 0.11 0.12 0.02 XXX 76950 A Echo guidance radiotherapy 0.58 1.20 1.28 NA NA 0.10 XXX 76950 TC A Echo guidance radiotherapy 0.00 1.00 1.08 NA NA 0.07 XXX 76950 26 A Echo guidance radiotherapy 0.58 0.20 0.20 0.20 0.20 0.03 XXX 76965 A Echo guidance radiotherapy 1.34 1.22 2.42 NA NA 0.37 XXX 76965 TC A Echo guidance radiotherapy 0.00 0.68 1.91 NA NA 0.29 XXX 76965 26 A Echo guidance radiotherapy 1.34 0.54 0.51 0.54 0.51 0.08 XXX 76970 A Ultrasound exam follow-up 0.40 2.02 1.81 NA NA 0.08 XXX 76970 TC A Ultrasound exam follow-up 0.00 1.90 1.69 NA NA 0.06 XXX 76970 26 A Ultrasound exam follow-up 0.40 0.12 0.12 0.12 0.12 0.02 XXX 76975 C GI endoscopic ultrasound 0.00 0.00 0.00 NA NA 0.00 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 />

1310<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 />

76817 TC A Transvaginal us, obstetric 0.00 1.75 1.70 NA NA 0.06 XXX<br />

76817 26 A Transvaginal us, obstetric 0.75 0.25 0.25 0.25 0.25 0.03 XXX<br />

76818 A Fetal biophys profile w/nst 1.05 2.18 2.14 NA NA 0.15 XXX<br />

76818 TC A Fetal biophys profile w/nst 0.00 1.86 1.80 NA NA 0.10 XXX<br />

76818 26 A Fetal biophys profile w/nst 1.05 0.32 0.34 0.32 0.34 0.05 XXX<br />

76819 A Fetal biophys profil w/o nst 0.77 1.61 1.69 NA NA 0.13 XXX<br />

76819 TC A Fetal biophys profil w/o nst 0.00 1.36 1.43 NA NA 0.10 XXX<br />

76819 26 A Fetal biophys profil w/o nst 0.77 0.25 0.26 0.25 0.26 0.03 XXX<br />

76820 A Umbilical artery echo 0.50 0.56 0.87 NA NA 0.15 XXX<br />

76820 TC A Umbilical artery echo 0.00 0.41 0.71 NA NA 0.12 XXX<br />

76820 26 A Umbilical artery echo 0.50 0.15 0.16 0.15 0.16 0.03 XXX<br />

76821 A Middle cerebral artery echo 0.70 1.83 1.85 NA NA 0.15 XXX<br />

76821 TC A Middle cerebral artery echo 0.00 1.62 1.62 NA NA 0.12 XXX<br />

76821 26 A Middle cerebral artery echo 0.70 0.21 0.23 0.21 0.23 0.03 XXX<br />

76825 A Echo exam of fetal heart 1.67 4.31 3.89 NA NA 0.18 XXX<br />

76825 TC A Echo exam of fetal heart 0.00 3.78 3.34 NA NA 0.11 XXX<br />

76825 26 A Echo exam of fetal heart 1.67 0.53 0.55 0.53 0.55 0.07 XXX<br />

76826 A Echo exam of fetal heart 0.83 2.67 2.25 NA NA 0.08 XXX<br />

76826 TC A Echo exam of fetal heart 0.00 2.42 1.99 NA NA 0.05 XXX<br />

76826 26 A Echo exam of fetal heart 0.83 0.25 0.26 0.25 0.26 0.03 XXX<br />

76827 A Echo exam of fetal heart 0.58 1.05 1.28 NA NA 0.14 XXX<br />

76827 TC A Echo exam of fetal heart 0.00 0.87 1.09 NA NA 0.12 XXX<br />

76827 26 A Echo exam of fetal heart 0.58 0.18 0.19 0.18 0.19 0.02 XXX<br />

76828 A Echo exam of fetal heart 0.56 0.62 0.81 NA NA 0.11 XXX<br />

76828 TC A Echo exam of fetal heart 0.00 0.46 0.63 NA NA 0.08 XXX<br />

76828 26 A Echo exam of fetal heart 0.56 0.16 0.18 0.16 0.18 0.03 XXX<br />

76830 A Transvaginal us, non-ob 0.69 2.73 2.49 NA NA 0.13 XXX<br />

76830 TC A Transvaginal us, non-ob 0.00 2.49 2.25 NA NA 0.10 XXX<br />

76830 26 A Transvaginal us, non-ob 0.69 0.24 0.24 0.24 0.24 0.03 XXX<br />

76831 A Echo exam, uterus 0.72 2.68 2.46 NA NA 0.13 XXX<br />

76831 TC A Echo exam, uterus 0.00 2.46 2.23 NA NA 0.10 XXX<br />

76831 26 A Echo exam, uterus 0.72 0.22 0.23 0.22 0.23 0.03 XXX<br />

76856 A Us exam, pelvic, complete 0.69 2.77 2.51 NA NA 0.13 XXX<br />

76856 TC A Us exam, pelvic, complete 0.00 2.51 2.26 NA NA 0.10 XXX<br />

76856 26 A Us exam, pelvic, complete 0.69 0.26 0.25 0.26 0.25 0.03 XXX<br />

76857 A Us exam, pelvic, limited 0.38 2.46 2.31 NA NA 0.08 XXX<br />

76857 TC A Us exam, pelvic, limited 0.00 2.30 2.16 NA NA 0.06 XXX<br />

76857 26 A Us exam, pelvic, limited 0.38 0.16 0.15 0.16 0.15 0.02 XXX<br />

76870 A Us exam, scrotum 0.64 2.80 2.53 NA NA 0.13 XXX<br />

76870 TC A Us exam, scrotum 0.00 2.55 2.29 NA NA 0.10 XXX<br />

76870 26 A Us exam, scrotum 0.64 0.25 0.24 0.25 0.24 0.03 XXX<br />

76872 A Us, transrectal 0.69 3.36 3.10 NA NA 0.14 XXX<br />

76872 TC A Us, transrectal 0.00 3.07 2.82 NA NA 0.10 XXX<br />

76872 26 A Us, transrectal 0.69 0.29 0.28 0.29 0.28 0.04 XXX<br />

76873 A Echograp trans r, pros study 1.55 3.35 3.16 NA NA 0.25 XXX<br />

76873 TC A Echograp trans r, pros study 0.00 2.76 2.60 NA NA 0.16 XXX<br />

76873 26 A Echograp trans r, pros study 1.55 0.59 0.56 0.59 0.56 0.09 XXX<br />

76880 A Us exam, extremity 0.59 3.13 2.75 NA NA 0.11 XXX

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