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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. 1322 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 78466 A Heart infarct image 0.69 4.44 4.06 NA NA 0.17 XXX 78466 TC A Heart infarct image 0.00 4.14 3.77 NA NA 0.14 XXX 78466 26 A Heart infarct image 0.69 0.30 0.29 0.30 0.29 0.03 XXX 78468 A Heart infarct image (ef) 0.80 5.59 5.19 NA NA 0.22 XXX 78468 TC A Heart infarct image (ef) 0.00 5.19 4.82 NA NA 0.19 XXX 78468 26 A Heart infarct image (ef) 0.80 0.40 0.37 0.40 0.37 0.03 XXX 78469 A Heart infarct image (3D) 0.92 5.94 5.85 NA NA 0.31 XXX 78469 TC A Heart infarct image (3D) 0.00 5.51 5.45 NA NA 0.28 XXX 78469 26 A Heart infarct image (3D) 0.92 0.43 0.40 0.43 0.40 0.03 XXX 78472 A Gated heart, planar, single 0.98 5.89 5.89 NA NA 0.34 XXX 78472 TC A Gated heart, planar, single 0.00 5.45 5.48 NA NA 0.30 XXX 78472 26 A Gated heart, planar, single 0.98 0.44 0.41 0.44 0.41 0.04 XXX 78473 A Gated heart, multiple 1.47 7.59 7.91 NA NA 0.48 XXX 78473 TC A Gated heart, multiple 0.00 6.90 7.26 NA NA 0.42 XXX 78473 26 A Gated heart, multiple 1.47 0.69 0.65 0.69 0.65 0.06 XXX 78478 A Heart wall motion add-on 0.50 0.78 1.03 NA NA 0.12 XXX 78478 TC A Heart wall motion add-on 0.00 0.53 0.79 NA NA 0.10 XXX 78478 26 A Heart wall motion add-on 0.50 0.25 0.24 0.25 0.24 0.02 XXX 78480 A Heart function add-on 0.30 0.68 0.96 NA NA 0.12 XXX 78480 TC A Heart function add-on 0.00 0.53 0.79 NA NA 0.10 XXX 78480 26 A Heart function add-on 0.30 0.15 0.17 0.15 0.17 0.02 XXX 78481 A Heart first pass, single 0.98 4.84 5.04 NA NA 0.31 XXX 78481 TC A Heart first pass, single 0.00 4.33 4.57 NA NA 0.28 XXX 78481 26 A Heart first pass, single 0.98 0.51 0.47 0.51 0.47 0.03 XXX 78483 A Heart first pass, multiple 1.47 6.54 7.02 NA NA 0.46 XXX 78483 TC A Heart first pass, multiple 0.00 5.75 6.29 NA NA 0.41 XXX 78483 26 A Heart first pass, multiple 1.47 0.79 0.73 0.79 0.73 0.05 XXX 78491 C Heart image (pet), single 0.00 0.00 0.00 NA NA 0.00 XXX 78491 TC C Heart image (pet), single 0.00 0.00 0.00 NA NA 0.00 XXX 78491 26 A Heart image (pet), single 1.50 0.70 0.67 0.70 0.67 0.06 XXX 78492 C Heart image (pet), multiple 0.00 0.00 0.00 NA NA 0.00 XXX 78492 TC C Heart image (pet), multiple 0.00 0.00 0.00 NA NA 0.00 XXX 78492 26 A Heart image (pet), multiple 1.87 0.92 0.87 0.92 0.87 0.07 XXX 78494 A Heart image, spect 1.19 5.92 6.32 NA NA 0.35 XXX 78494 TC A Heart image, spect 0.00 5.38 5.81 NA NA 0.30 XXX 78494 26 A Heart image, spect 1.19 0.54 0.51 0.54 0.51 0.05 XXX 78496 A Heart first pass add-on 0.50 0.86 2.47 NA NA 0.32 ZZZ 78496 TC A Heart first pass add-on 0.00 0.62 2.24 NA NA 0.30 ZZZ 78496 26 A Heart first pass add-on 0.50 0.24 0.23 0.24 0.23 0.02 ZZZ 78499 C Cardiovascular nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78499 TC C Cardiovascular nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78499 26 C Cardiovascular nuclear exam 0.00 0.00 0.00 0.00 0.00 0.00 XXX 78580 A Lung perfusion imaging 0.74 5.08 4.74 NA NA 0.21 XXX 78580 TC A Lung perfusion imaging 0.00 4.79 4.46 NA NA 0.18 XXX 78580 26 A Lung perfusion imaging 0.74 0.29 0.28 0.29 0.28 0.03 XXX 78584 A Lung V/Q image single breath 0.99 3.01 3.14 NA NA 0.21 XXX 78584 TC A Lung V/Q image single breath 0.00 2.62 2.77 NA NA 0.17 XXX 78584 26 A Lung V/Q image single breath 0.99 0.39 0.37 0.39 0.37 0.04 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. 1323 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 78585 A Lung V/Q imaging 1.09 8.58 7.95 NA NA 0.35 XXX 78585 TC A Lung V/Q imaging 0.00 8.16 7.54 NA NA 0.30 XXX 78585 26 A Lung V/Q imaging 1.09 0.42 0.41 0.42 0.41 0.05 XXX 78586 A Aerosol lung image, single 0.40 4.12 3.78 NA NA 0.16 XXX 78586 TC A Aerosol lung image, single 0.00 3.97 3.63 NA NA 0.14 XXX 78586 26 A Aerosol lung image, single 0.40 0.15 0.15 0.15 0.15 0.02 XXX 78587 A Aerosol lung image, multiple 0.49 5.38 4.80 NA NA 0.16 XXX 78587 TC A Aerosol lung image, multiple 0.00 5.19 4.61 NA NA 0.14 XXX 78587 26 A Aerosol lung image, multiple 0.49 0.19 0.19 0.19 0.19 0.02 XXX 78588 A Perfusion lung image 1.09 8.60 7.36 NA NA 0.23 XXX 78588 TC A Perfusion lung image 0.00 8.18 6.95 NA NA 0.18 XXX 78588 26 A Perfusion lung image 1.09 0.42 0.41 0.42 0.41 0.05 XXX 78591 A Vent image, 1 breath, 1 proj 0.40 4.11 3.84 NA NA 0.16 XXX 78591 TC A Vent image, 1 breath, 1 proj 0.00 3.95 3.69 NA NA 0.14 XXX 78591 26 A Vent image, 1 breath, 1 proj 0.40 0.16 0.15 0.16 0.15 0.02 XXX 78593 A Vent image, 1 proj, gas 0.49 4.79 4.50 NA NA 0.20 XXX 78593 TC A Vent image, 1 proj, gas 0.00 4.60 4.32 NA NA 0.18 XXX 78593 26 A Vent image, 1 proj, gas 0.49 0.19 0.18 0.19 0.18 0.02 XXX 78594 A Vent image, mult proj, gas 0.53 5.29 5.28 NA NA 0.27 XXX 78594 TC A Vent image, mult proj, gas 0.00 5.09 5.08 NA NA 0.25 XXX 78594 26 A Vent image, mult proj, gas 0.53 0.20 0.20 0.20 0.20 0.02 XXX 78596 A Lung differential function 1.27 8.68 8.41 NA NA 0.42 XXX 78596 TC A Lung differential function 0.00 8.24 7.97 NA NA 0.37 XXX 78596 26 A Lung differential function 1.27 0.44 0.44 0.44 0.44 0.05 XXX 78599 C Respiratory nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78599 TC C Respiratory nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78599 26 C Respiratory nuclear exam 0.00 0.00 0.00 0.00 0.00 0.00 XXX 78600 A Brain image < 4 views 0.44 4.46 4.12 NA NA 0.16 XXX 78600 TC A Brain image < 4 views 0.00 4.29 3.95 NA NA 0.14 XXX 78600 26 A Brain image < 4 views 0.44 0.17 0.17 0.17 0.17 0.02 XXX 78601 A Brain image w/flow < 4 views 0.51 5.35 4.91 NA NA 0.20 XXX 78601 TC A Brain image w/flow < 4 views 0.00 5.15 4.72 NA NA 0.18 XXX 78601 26 A Brain image w/flow < 4 views 0.51 0.20 0.19 0.20 0.19 0.02 XXX 78605 A Brain image 4+ views 0.53 4.84 4.53 NA NA 0.20 XXX 78605 TC A Brain image 4+ views 0.00 4.62 4.32 NA NA 0.18 XXX 78605 26 A Brain image 4+ views 0.53 0.22 0.21 0.22 0.21 0.02 XXX 78606 A Brain image w/flow 4 + views 0.64 8.39 7.34 NA NA 0.24 XXX 78606 TC A Brain image w/flow 4 + views 0.00 8.15 7.10 NA NA 0.21 XXX 78606 26 A Brain image w/flow 4 + views 0.64 0.24 0.24 0.24 0.24 0.03 XXX 78607 A Brain imaging (3D) 1.23 8.66 8.26 NA NA 0.40 XXX 78607 TC A Brain imaging (3D) 0.00 8.19 7.80 NA NA 0.35 XXX 78607 26 A Brain imaging (3D) 1.23 0.47 0.46 0.47 0.46 0.05 XXX 78608 C Brain imaging (PET) 0.00 0.00 0.00 NA NA 0.00 XXX 78608 TC C Brain imaging (PET) 0.00 0.00 0.00 NA NA 0.00 XXX 78608 26 A Brain imaging (PET) 1.50 0.58 0.56 0.58 0.56 0.06 XXX 78609 N Brain imaging (PET) 1.50 0.00 0.49 NA NA 0.06 XXX 78609 TC N Brain imaging (PET) 0.00 0.00 0.00 NA NA 0.00 XXX 78609 26 N Brain imaging (PET) 1.50 0.00 0.49 0.00 0.49 0.06 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 />

1323<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 />

78585 A Lung V/Q imaging 1.09 8.58 7.95 NA NA 0.35 XXX<br />

78585 TC A Lung V/Q imaging 0.00 8.16 7.54 NA NA 0.30 XXX<br />

78585 26 A Lung V/Q imaging 1.09 0.42 0.41 0.42 0.41 0.05 XXX<br />

78586 A Aerosol lung image, single 0.40 4.12 3.78 NA NA 0.16 XXX<br />

78586 TC A Aerosol lung image, single 0.00 3.97 3.63 NA NA 0.14 XXX<br />

78586 26 A Aerosol lung image, single 0.40 0.15 0.15 0.15 0.15 0.02 XXX<br />

78587 A Aerosol lung image, multiple 0.49 5.38 4.80 NA NA 0.16 XXX<br />

78587 TC A Aerosol lung image, multiple 0.00 5.19 4.61 NA NA 0.14 XXX<br />

78587 26 A Aerosol lung image, multiple 0.49 0.19 0.19 0.19 0.19 0.02 XXX<br />

78588 A Perfusion lung image 1.09 8.60 7.36 NA NA 0.23 XXX<br />

78588 TC A Perfusion lung image 0.00 8.18 6.95 NA NA 0.18 XXX<br />

78588 26 A Perfusion lung image 1.09 0.42 0.41 0.42 0.41 0.05 XXX<br />

78591 A Vent image, 1 breath, 1 proj 0.40 4.11 3.84 NA NA 0.16 XXX<br />

78591 TC A Vent image, 1 breath, 1 proj 0.00 3.95 3.69 NA NA 0.14 XXX<br />

78591 26 A Vent image, 1 breath, 1 proj 0.40 0.16 0.15 0.16 0.15 0.02 XXX<br />

78593 A Vent image, 1 proj, gas 0.49 4.79 4.50 NA NA 0.20 XXX<br />

78593 TC A Vent image, 1 proj, gas 0.00 4.60 4.32 NA NA 0.18 XXX<br />

78593 26 A Vent image, 1 proj, gas 0.49 0.19 0.18 0.19 0.18 0.02 XXX<br />

78594 A Vent image, mult proj, gas 0.53 5.29 5.28 NA NA 0.27 XXX<br />

78594 TC A Vent image, mult proj, gas 0.00 5.09 5.08 NA NA 0.25 XXX<br />

78594 26 A Vent image, mult proj, gas 0.53 0.20 0.20 0.20 0.20 0.02 XXX<br />

78596 A Lung differential function 1.27 8.68 8.41 NA NA 0.42 XXX<br />

78596 TC A Lung differential function 0.00 8.24 7.97 NA NA 0.37 XXX<br />

78596 26 A Lung differential function 1.27 0.44 0.44 0.44 0.44 0.05 XXX<br />

78599 C Respiratory nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78599 TC C Respiratory nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78599 26 C Respiratory nuclear exam 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

78600 A Brain image < 4 views 0.44 4.46 4.12 NA NA 0.16 XXX<br />

78600 TC A Brain image < 4 views 0.00 4.29 3.95 NA NA 0.14 XXX<br />

78600 26 A Brain image < 4 views 0.44 0.17 0.17 0.17 0.17 0.02 XXX<br />

78601 A Brain image w/flow < 4 views 0.51 5.35 4.91 NA NA 0.20 XXX<br />

78601 TC A Brain image w/flow < 4 views 0.00 5.15 4.72 NA NA 0.18 XXX<br />

78601 26 A Brain image w/flow < 4 views 0.51 0.20 0.19 0.20 0.19 0.02 XXX<br />

78605 A Brain image 4+ views 0.53 4.84 4.53 NA NA 0.20 XXX<br />

78605 TC A Brain image 4+ views 0.00 4.62 4.32 NA NA 0.18 XXX<br />

78605 26 A Brain image 4+ views 0.53 0.22 0.21 0.22 0.21 0.02 XXX<br />

78606 A Brain image w/flow 4 + views 0.64 8.39 7.34 NA NA 0.24 XXX<br />

78606 TC A Brain image w/flow 4 + views 0.00 8.15 7.10 NA NA 0.21 XXX<br />

78606 26 A Brain image w/flow 4 + views 0.64 0.24 0.24 0.24 0.24 0.03 XXX<br />

78607 A Brain imaging (3D) 1.23 8.66 8.26 NA NA 0.40 XXX<br />

78607 TC A Brain imaging (3D) 0.00 8.19 7.80 NA NA 0.35 XXX<br />

78607 26 A Brain imaging (3D) 1.23 0.47 0.46 0.47 0.46 0.05 XXX<br />

78608 C Brain imaging (PET) 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78608 TC C Brain imaging (PET) 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78608 26 A Brain imaging (PET) 1.50 0.58 0.56 0.58 0.56 0.06 XXX<br />

78609 N Brain imaging (PET) 1.50 0.00 0.49 NA NA 0.06 XXX<br />

78609 TC N Brain imaging (PET) 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78609 26 N Brain imaging (PET) 1.50 0.00 0.49 0.00 0.49 0.06 XXX

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