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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. 1324 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 78610 A Brain flow imaging only 0.30 4.43 4.34 NA NA 0.11 XXX 78610 TC A Brain flow imaging only 0.00 4.31 4.21 NA NA 0.10 XXX 78610 26 A Brain flow imaging only 0.30 0.12 0.13 0.12 0.13 0.01 XXX 78630 A Cerebrospinal fluid scan 0.68 8.56 7.76 NA NA 0.30 XXX 78630 TC A Cerebrospinal fluid scan 0.00 8.30 7.50 NA NA 0.27 XXX 78630 26 A Cerebrospinal fluid scan 0.68 0.26 0.26 0.26 0.26 0.03 XXX 78635 A CSF ventriculography 0.61 8.59 7.15 NA NA 0.16 XXX 78635 TC A CSF ventriculography 0.00 8.35 6.91 NA NA 0.14 XXX 78635 26 A CSF ventriculography 0.61 0.24 0.24 0.24 0.24 0.02 XXX 78645 A CSF shunt evaluation 0.57 8.45 7.26 NA NA 0.20 XXX 78645 TC A CSF shunt evaluation 0.00 8.23 7.04 NA NA 0.18 XXX 78645 26 A CSF shunt evaluation 0.57 0.22 0.22 0.22 0.22 0.02 XXX 78647 A Cerebrospinal fluid scan 0.90 8.54 7.98 NA NA 0.35 XXX 78647 TC A Cerebrospinal fluid scan 0.00 8.21 7.65 NA NA 0.31 XXX 78647 26 A Cerebrospinal fluid scan 0.90 0.33 0.33 0.33 0.33 0.04 XXX 78650 A CSF leakage imaging 0.61 8.55 7.64 NA NA 0.27 XXX 78650 TC A CSF leakage imaging 0.00 8.31 7.41 NA NA 0.24 XXX 78650 26 A CSF leakage imaging 0.61 0.24 0.23 0.24 0.23 0.03 XXX 78660 A Nuclear exam of tear flow 0.53 4.24 3.77 NA NA 0.14 XXX 78660 TC A Nuclear exam of tear flow 0.00 4.04 3.57 NA NA 0.12 XXX 78660 26 A Nuclear exam of tear flow 0.53 0.20 0.20 0.20 0.20 0.02 XXX 78699 C Nervous system nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78699 TC C Nervous system nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78699 26 C Nervous system nuclear exam 0.00 0.00 0.00 0.00 0.00 0.00 XXX 78700 A Kidney imaging, morphol 0.45 4.34 4.06 NA NA 0.18 XXX 78700 TC A Kidney imaging, morphol 0.00 4.16 3.89 NA NA 0.16 XXX 78700 26 A Kidney imaging, morphol 0.45 0.18 0.17 0.18 0.17 0.02 XXX 78701 A Kidney imaging with flow 0.49 5.31 4.92 NA NA 0.20 XXX 78701 TC A Kidney imaging with flow 0.00 5.12 4.74 NA NA 0.18 XXX 78701 26 A Kidney imaging with flow 0.49 0.19 0.18 0.19 0.18 0.02 XXX 78707 A K flow/funct image w/o drug 0.96 5.47 5.31 NA NA 0.27 XXX 78707 TC A K flow/funct image w/o drug 0.00 5.10 4.95 NA NA 0.23 XXX 78707 26 A K flow/funct image w/o drug 0.96 0.37 0.36 0.37 0.36 0.04 XXX 78708 A K flow/funct image w/drug 1.21 3.49 3.85 NA NA 0.28 XXX 78708 TC A K flow/funct image w/drug 0.00 3.02 3.39 NA NA 0.23 XXX 78708 26 A K flow/funct image w/drug 1.21 0.47 0.46 0.47 0.46 0.05 XXX 78709 A K flow/funct image, multiple 1.41 8.86 7.90 NA NA 0.29 XXX 78709 TC A K flow/funct image, multiple 0.00 8.31 7.37 NA NA 0.23 XXX 78709 26 A K flow/funct image, multiple 1.41 0.55 0.53 0.55 0.53 0.06 XXX 78710 A Kidney imaging (3D) 0.66 5.25 5.48 NA NA 0.34 XXX 78710 TC A Kidney imaging (3D) 0.00 4.99 5.23 NA NA 0.31 XXX 78710 26 A Kidney imaging (3D) 0.66 0.26 0.25 0.26 0.25 0.03 XXX 78725 A Kidney function study 0.38 2.32 2.22 NA NA 0.13 XXX 78725 TC A Kidney function study 0.00 2.19 2.09 NA NA 0.11 XXX 78725 26 A Kidney function study 0.38 0.13 0.13 0.13 0.13 0.02 XXX 78730 A Urinary bladder retention 0.15 1.92 1.85 NA NA 0.10 ZZZ 78730 TC A Urinary bladder retention 0.00 1.86 1.77 NA NA 0.08 ZZZ 78730 26 A Urinary bladder retention 0.15 0.06 0.08 0.06 0.08 0.02 ZZZ

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. 1325 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 78740 A Ureteral reflux study 0.57 5.67 4.84 NA NA 0.15 XXX 78740 TC A Ureteral reflux study 0.00 5.44 4.62 NA NA 0.12 XXX 78740 26 A Ureteral reflux study 0.57 0.23 0.22 0.23 0.22 0.03 XXX 78761 A Testicular imaging w/flow 0.71 5.08 4.68 NA NA 0.20 XXX 78761 TC A Testicular imaging w/flow 0.00 4.80 4.41 NA NA 0.17 XXX 78761 26 A Testicular imaging w/flow 0.71 0.28 0.27 0.28 0.27 0.03 XXX 78799 C Genitourinary nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78799 TC C Genitourinary nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX 78799 26 C Genitourinary nuclear exam 0.00 0.00 0.00 0.00 0.00 0.00 XXX 78800 A Tumor imaging, limited area 0.66 4.30 4.13 NA NA 0.22 XXX 78800 TC A Tumor imaging, limited area 0.00 4.06 3.90 NA NA 0.18 XXX 78800 26 A Tumor imaging, limited area 0.66 0.24 0.23 0.24 0.23 0.04 XXX 78801 A Tumor imaging, mult areas 0.79 6.00 5.64 NA NA 0.27 XXX 78801 TC A Tumor imaging, mult areas 0.00 5.71 5.35 NA NA 0.22 XXX 78801 26 A Tumor imaging, mult areas 0.79 0.29 0.29 0.29 0.29 0.05 XXX 78802 A Tumor imaging, whole body 0.86 8.12 7.57 NA NA 0.34 XXX 78802 TC A Tumor imaging, whole body 0.00 7.79 7.25 NA NA 0.30 XXX 78802 26 A Tumor imaging, whole body 0.86 0.33 0.32 0.33 0.32 0.04 XXX 78803 A Tumor imaging (3D) 1.09 8.58 8.18 NA NA 0.40 XXX 78803 TC A Tumor imaging (3D) 0.00 8.15 7.77 NA NA 0.35 XXX 78803 26 A Tumor imaging (3D) 1.09 0.43 0.41 0.43 0.41 0.05 XXX 78804 A Tumor imaging, whole body 1.07 14.78 13.97 NA NA 0.34 XXX 78804 TC A Tumor imaging, whole body 0.00 14.36 13.56 NA NA 0.30 XXX 78804 26 A Tumor imaging, whole body 1.07 0.42 0.41 0.42 0.41 0.04 XXX 78805 A Abscess imaging, ltd area 0.73 4.21 4.08 NA NA 0.21 XXX 78805 TC A Abscess imaging, ltd area 0.00 3.93 3.81 NA NA 0.18 XXX 78805 26 A Abscess imaging, ltd area 0.73 0.28 0.27 0.28 0.27 0.03 XXX 78806 A Abscess imaging, whole body 0.86 8.32 7.94 NA NA 0.39 XXX 78806 TC A Abscess imaging, whole body 0.00 7.99 7.62 NA NA 0.35 XXX 78806 26 A Abscess imaging, whole body 0.86 0.33 0.32 0.33 0.32 0.04 XXX 78807 A Nuclear localization/abscess 1.09 8.59 8.20 NA NA 0.39 XXX 78807 TC A Nuclear localization/abscess 0.00 8.17 7.78 NA NA 0.35 XXX 78807 26 A Nuclear localization/abscess 1.09 0.42 0.42 0.42 0.42 0.04 XXX 78808 A Iv inj ra drug dx study 0.18 1.01 1.01 NA NA 0.04 XXX 78811 C Pet image, ltd area 0.00 0.00 0.00 NA NA 0.00 XXX 78811 TC C Pet image, ltd area 0.00 0.00 0.00 NA NA 0.00 XXX 78811 26 A Pet image, ltd area 1.54 0.60 0.58 0.60 0.58 0.11 XXX 78812 C Pet image, skull-thigh 0.00 0.00 0.00 NA NA 0.00 XXX 78812 TC C Pet image, skull-thigh 0.00 0.00 0.00 NA NA 0.00 XXX 78812 26 A Pet image, skull-thigh 1.93 0.76 0.73 0.76 0.73 0.11 XXX 78813 C Pet image, full body 0.00 0.00 0.00 NA NA 0.00 XXX 78813 TC C Pet image, full body 0.00 0.00 0.00 NA NA 0.00 XXX 78813 26 A Pet image, full body 2.00 0.78 0.76 0.78 0.76 0.11 XXX 78814 C Pet image w/ct, lmtd 0.00 0.00 0.00 NA NA 0.00 XXX 78814 TC C Pet image w/ct, lmtd 0.00 0.00 0.00 NA NA 0.00 XXX 78814 26 A Pet image w/ct, lmtd 2.20 0.85 0.83 0.85 0.83 0.11 XXX 78815 C Pet image w/ct, skull-thigh 0.00 0.00 0.00 NA NA 0.00 XXX 78815 TC C Pet image w/ct, skull-thigh 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 />

1325<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 />

78740 A Ureteral reflux study 0.57 5.67 4.84 NA NA 0.15 XXX<br />

78740 TC A Ureteral reflux study 0.00 5.44 4.62 NA NA 0.12 XXX<br />

78740 26 A Ureteral reflux study 0.57 0.23 0.22 0.23 0.22 0.03 XXX<br />

78761 A Testicular imaging w/flow 0.71 5.08 4.68 NA NA 0.20 XXX<br />

78761 TC A Testicular imaging w/flow 0.00 4.80 4.41 NA NA 0.17 XXX<br />

78761 26 A Testicular imaging w/flow 0.71 0.28 0.27 0.28 0.27 0.03 XXX<br />

78799 C Genitourinary nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78799 TC C Genitourinary nuclear exam 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78799 26 C Genitourinary nuclear exam 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

78800 A Tumor imaging, limited area 0.66 4.30 4.13 NA NA 0.22 XXX<br />

78800 TC A Tumor imaging, limited area 0.00 4.06 3.90 NA NA 0.18 XXX<br />

78800 26 A Tumor imaging, limited area 0.66 0.24 0.23 0.24 0.23 0.04 XXX<br />

78801 A Tumor imaging, mult areas 0.79 6.00 5.64 NA NA 0.27 XXX<br />

78801 TC A Tumor imaging, mult areas 0.00 5.71 5.35 NA NA 0.22 XXX<br />

78801 26 A Tumor imaging, mult areas 0.79 0.29 0.29 0.29 0.29 0.05 XXX<br />

78802 A Tumor imaging, whole body 0.86 8.12 7.57 NA NA 0.34 XXX<br />

78802 TC A Tumor imaging, whole body 0.00 7.79 7.25 NA NA 0.30 XXX<br />

78802 26 A Tumor imaging, whole body 0.86 0.33 0.32 0.33 0.32 0.04 XXX<br />

78803 A Tumor imaging (3D) 1.09 8.58 8.18 NA NA 0.40 XXX<br />

78803 TC A Tumor imaging (3D) 0.00 8.15 7.77 NA NA 0.35 XXX<br />

78803 26 A Tumor imaging (3D) 1.09 0.43 0.41 0.43 0.41 0.05 XXX<br />

78804 A Tumor imaging, whole body 1.07 14.78 13.97 NA NA 0.34 XXX<br />

78804 TC A Tumor imaging, whole body 0.00 14.36 13.56 NA NA 0.30 XXX<br />

78804 26 A Tumor imaging, whole body 1.07 0.42 0.41 0.42 0.41 0.04 XXX<br />

78805 A Abscess imaging, ltd area 0.73 4.21 4.08 NA NA 0.21 XXX<br />

78805 TC A Abscess imaging, ltd area 0.00 3.93 3.81 NA NA 0.18 XXX<br />

78805 26 A Abscess imaging, ltd area 0.73 0.28 0.27 0.28 0.27 0.03 XXX<br />

78806 A Abscess imaging, whole body 0.86 8.32 7.94 NA NA 0.39 XXX<br />

78806 TC A Abscess imaging, whole body 0.00 7.99 7.62 NA NA 0.35 XXX<br />

78806 26 A Abscess imaging, whole body 0.86 0.33 0.32 0.33 0.32 0.04 XXX<br />

78807 A Nuclear localization/abscess 1.09 8.59 8.20 NA NA 0.39 XXX<br />

78807 TC A Nuclear localization/abscess 0.00 8.17 7.78 NA NA 0.35 XXX<br />

78807 26 A Nuclear localization/abscess 1.09 0.42 0.42 0.42 0.42 0.04 XXX<br />

78808 A Iv inj ra drug dx study 0.18 1.01 1.01 NA NA 0.04 XXX<br />

78811 C Pet image, ltd area 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78811 TC C Pet image, ltd area 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78811 26 A Pet image, ltd area 1.54 0.60 0.58 0.60 0.58 0.11 XXX<br />

78812 C Pet image, skull-thigh 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78812 TC C Pet image, skull-thigh 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78812 26 A Pet image, skull-thigh 1.93 0.76 0.73 0.76 0.73 0.11 XXX<br />

78813 C Pet image, full body 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78813 TC C Pet image, full body 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78813 26 A Pet image, full body 2.00 0.78 0.76 0.78 0.76 0.11 XXX<br />

78814 C Pet image w/ct, lmtd 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78814 TC C Pet image w/ct, lmtd 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78814 26 A Pet image w/ct, lmtd 2.20 0.85 0.83 0.85 0.83 0.11 XXX<br />

78815 C Pet image w/ct, skull-thigh 0.00 0.00 0.00 NA NA 0.00 XXX<br />

78815 TC C Pet image w/ct, skull-thigh 0.00 0.00 0.00 NA NA 0.00 XXX

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