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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. 1330 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 88362 A Nerve teasing preparations 2.17 4.92 4.87 NA NA 0.15 XXX 88362 TC A Nerve teasing preparations 0.00 4.32 4.19 NA NA 0.06 XXX 88362 26 A Nerve teasing preparations 2.17 0.60 0.68 0.60 0.68 0.09 XXX 88365 A Insitu hybridization (fish) 1.20 3.34 3.03 NA NA 0.05 XXX 88365 TC A Insitu hybridization (fish) 0.00 3.02 2.67 NA NA 0.02 XXX 88365 26 A Insitu hybridization (fish) 1.20 0.32 0.36 0.32 0.36 0.03 XXX 88367 A Insitu hybridization, auto 1.30 5.52 5.16 NA NA 0.12 XXX 88367 TC A Insitu hybridization, auto 0.00 5.23 4.81 NA NA 0.06 XXX 88367 26 A Insitu hybridization, auto 1.30 0.29 0.35 0.29 0.35 0.06 XXX 88368 A Insitu hybridization, manual 1.40 4.89 4.27 NA NA 0.12 XXX 88368 TC A Insitu hybridization, manual 0.00 4.63 3.93 NA NA 0.06 XXX 88368 26 A Insitu hybridization, manual 1.40 0.26 0.34 0.26 0.34 0.06 XXX 88371 26 A Protein, western blot tissue 0.37 0.12 0.12 0.12 0.12 0.01 XXX 88372 26 A Protein analysis w/probe 0.37 0.11 0.12 0.11 0.12 0.01 XXX 88380 A Microdissection, laser 1.56 3.69 3.69 NA NA 0.14 XXX 88380 TC A Microdissection, laser 0.00 3.19 3.19 NA NA 0.07 XXX 88380 26 A Microdissection, laser 1.56 0.50 0.50 0.50 0.50 0.07 XXX 88381 A Microdissection, manual 1.18 4.61 4.61 NA NA 0.08 XXX 88381 TC A Microdissection, manual 0.00 4.23 4.23 NA NA 0.02 XXX 88381 26 A Microdissection, manual 1.18 0.38 0.38 0.38 0.38 0.06 XXX 88384 C Eval molecular probes, 11-50 0.00 0.00 0.00 NA NA 0.00 XXX 88384 TC C Eval molecular probes, 11-50 0.00 0.00 0.00 NA NA 0.00 XXX 88384 26 C Eval molecular probes, 11-50 0.00 0.00 0.00 0.00 0.00 0.00 XXX 88385 A Eval molecul probes, 51-250 1.50 14.59 12.74 NA NA 0.12 XXX 88385 TC A Eval molecul probes, 51-250 0.00 14.35 12.40 NA NA 0.06 XXX 88385 26 A Eval molecul probes, 51-250 1.50 0.24 0.34 0.24 0.34 0.06 XXX 88386 A Eval molecul probes, 251-500 1.88 19.41 16.35 NA NA 0.16 XXX 88386 TC A Eval molecul probes, 251-500 0.00 18.72 15.63 NA NA 0.08 XXX 88386 26 A Eval molecul probes, 251-500 1.88 0.69 0.72 0.69 0.72 0.08 XXX 88399 C Surgical pathology procedure 0.00 0.00 0.00 NA NA 0.00 XXX 88399 TC C Surgical pathology procedure 0.00 0.00 0.00 NA NA 0.00 XXX 88399 26 C Surgical pathology procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX 89049 A Chct for mal hyperthermia 1.40 5.56 5.07 0.47 0.42 0.06 XXX 89060 26 A Exam,synovial fluid crystals 0.37 0.12 0.13 0.12 0.13 0.01 XXX 89100 A Sample intestinal contents 0.60 7.36 5.99 0.52 0.44 0.03 XXX 89105 A Sample intestinal contents 0.50 7.62 6.28 0.46 0.39 0.02 XXX 89130 A Sample stomach contents 0.45 6.45 5.29 0.38 0.32 0.02 XXX 89132 A Sample stomach contents 0.19 7.95 6.36 0.37 0.30 0.01 XXX 89135 A Sample stomach contents 0.79 8.69 7.01 0.69 0.58 0.04 XXX 89136 A Sample stomach contents 0.21 6.53 5.34 0.31 0.25 0.01 XXX 89140 A Sample stomach contents 0.94 6.66 5.53 0.51 0.45 0.04 XXX 89141 A Sample stomach contents 0.85 6.85 5.85 0.52 0.47 0.03 XXX 89220 A Sputum specimen collection 0.00 0.37 0.39 NA NA 0.02 XXX 89230 A Collect sweat for test 0.00 0.08 0.09 NA NA 0.02 XXX 89240 C Pathology lab procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90281 I Human ig, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90283 I Human ig, iv 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90284 X Human ig, sc 0.00 0.00 0.00 0.00 0.00 0.00 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. 1331 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 90287 I Botulinum antitoxin 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90288 I Botulism ig, iv 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90291 I Cmv ig, iv 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90296 E Diphtheria antitoxin 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90371 E Hep b ig, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90375 E Rabies ig, im/sc 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90376 E Rabies ig, heat treated 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90378 X Rsv ig, im, 50mg 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90379 I Rsv ig, iv 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90384 I Rh ig, full-dose, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90385 E Rh ig, minidose, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90386 I Rh ig, iv 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90389 I Tetanus ig, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90393 E Vaccina ig, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90396 E Varicella-zoster ig, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90399 I Immune globulin 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90465 A Immune admin 1 inj, < 8 yrs 0.17 0.43 0.40 NA NA 0.01 XXX 90466 A Immune admin addl inj, < 8 y 0.15 0.13 0.13 0.04 0.06 0.01 ZZZ 90467 R Immune admin o or n, < 8 yrs 0.17 0.21 0.20 0.07 0.08 0.01 XXX 90468 R Immune admin o/n, addl < 8 y 0.15 0.12 0.12 0.04 0.05 0.01 ZZZ 90471 A Immunization admin 0.17 0.43 0.40 NA NA 0.01 XXX 90472 A Immunization admin, each add 0.15 0.13 0.13 0.04 0.06 0.01 ZZZ 90473 R Immune admin oral/nasal 0.17 0.21 0.20 0.05 0.05 0.01 XXX 90474 R Immune admin oral/nasal addl 0.15 0.09 0.09 0.04 0.05 0.01 ZZZ 90476 E Adenovirus vaccine, type 4 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90477 E Adenovirus vaccine, type 7 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90581 E Anthrax vaccine, sc 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90585 E Bcg vaccine, percut 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90586 E Bcg vaccine, intravesical 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90632 E Hep a vaccine, adult im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90633 E Hep a vacc, ped/adol, 2 dose 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90634 E Hep a vacc, ped/adol, 3 dose 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90636 E Hep a/hep b vacc, adult im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90645 E Hib vaccine, hboc, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90646 E Hib vaccine, prp-d, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90647 E Hib vaccine, prp-omp, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90648 E Hib vaccine, prp-t, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90649 E Hpv vaccine 4 valent, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90650 E Hpv vaccine 2 valent, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90655 X Flu vaccine no preserv 6-35m 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90656 X Flu vaccine no preserv 3 & > 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90657 X Flu vaccine, 3 yrs, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90658 X Flu vaccine, 3 yrs & >, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90660 X Flu vaccine, nasal 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90661 X Flu vacc cell cult prsv free 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90662 X Flu vacc prsv free inc antig 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90663 X Flu vacc pandemic 0.00 0.00 0.00 0.00 0.00 0.00 XXX 90665 E Lyme disease vaccine, im 0.00 0.00 0.00 0.00 0.00 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 />

1330<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 />

88362 A Nerve teasing preparations 2.17 4.92 4.87 NA NA 0.15 XXX<br />

88362 TC A Nerve teasing preparations 0.00 4.32 4.19 NA NA 0.06 XXX<br />

88362 26 A Nerve teasing preparations 2.17 0.60 0.68 0.60 0.68 0.09 XXX<br />

88365 A Insitu hybridization (fish) 1.20 3.34 3.03 NA NA 0.05 XXX<br />

88365 TC A Insitu hybridization (fish) 0.00 3.02 2.67 NA NA 0.02 XXX<br />

88365 26 A Insitu hybridization (fish) 1.20 0.32 0.36 0.32 0.36 0.03 XXX<br />

88367 A Insitu hybridization, auto 1.30 5.52 5.16 NA NA 0.12 XXX<br />

88367 TC A Insitu hybridization, auto 0.00 5.23 4.81 NA NA 0.06 XXX<br />

88367 26 A Insitu hybridization, auto 1.30 0.29 0.35 0.29 0.35 0.06 XXX<br />

88368 A Insitu hybridization, manual 1.40 4.89 4.27 NA NA 0.12 XXX<br />

88368 TC A Insitu hybridization, manual 0.00 4.63 3.93 NA NA 0.06 XXX<br />

88368 26 A Insitu hybridization, manual 1.40 0.26 0.34 0.26 0.34 0.06 XXX<br />

88371 26 A Protein, western blot tissue 0.37 0.12 0.12 0.12 0.12 0.01 XXX<br />

88372 26 A Protein analysis w/probe 0.37 0.11 0.12 0.11 0.12 0.01 XXX<br />

88380 A Microdissection, laser 1.56 3.69 3.69 NA NA 0.14 XXX<br />

88380 TC A Microdissection, laser 0.00 3.19 3.19 NA NA 0.07 XXX<br />

88380 26 A Microdissection, laser 1.56 0.50 0.50 0.50 0.50 0.07 XXX<br />

88381 A Microdissection, manual 1.18 4.61 4.61 NA NA 0.08 XXX<br />

88381 TC A Microdissection, manual 0.00 4.23 4.23 NA NA 0.02 XXX<br />

88381 26 A Microdissection, manual 1.18 0.38 0.38 0.38 0.38 0.06 XXX<br />

88384 C Eval molecular probes, 11-50 0.00 0.00 0.00 NA NA 0.00 XXX<br />

88384 TC C Eval molecular probes, 11-50 0.00 0.00 0.00 NA NA 0.00 XXX<br />

88384 26 C Eval molecular probes, 11-50 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

88385 A Eval molecul probes, 51-250 1.50 14.59 12.74 NA NA 0.12 XXX<br />

88385 TC A Eval molecul probes, 51-250 0.00 14.35 12.40 NA NA 0.06 XXX<br />

88385 26 A Eval molecul probes, 51-250 1.50 0.24 0.34 0.24 0.34 0.06 XXX<br />

88386 A Eval molecul probes, 251-500 1.88 19.41 16.35 NA NA 0.16 XXX<br />

88386 TC A Eval molecul probes, 251-500 0.00 18.72 15.63 NA NA 0.08 XXX<br />

88386 26 A Eval molecul probes, 251-500 1.88 0.69 0.72 0.69 0.72 0.08 XXX<br />

88399 C Surgical pathology procedure 0.00 0.00 0.00 NA NA 0.00 XXX<br />

88399 TC C Surgical pathology procedure 0.00 0.00 0.00 NA NA 0.00 XXX<br />

88399 26 C Surgical pathology procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

89049 A Chct for mal hyperthermia 1.40 5.56 5.07 0.47 0.42 0.06 XXX<br />

89060 26 A Exam,synovial fluid crystals 0.37 0.12 0.13 0.12 0.13 0.01 XXX<br />

89100 A Sample intestinal contents 0.60 7.36 5.99 0.52 0.44 0.03 XXX<br />

89105 A Sample intestinal contents 0.50 7.62 6.28 0.46 0.39 0.02 XXX<br />

89130 A Sample stomach contents 0.45 6.45 5.29 0.38 0.32 0.02 XXX<br />

89132 A Sample stomach contents 0.19 7.95 6.36 0.37 0.30 0.01 XXX<br />

89135 A Sample stomach contents 0.79 8.69 7.01 0.69 0.58 0.04 XXX<br />

89136 A Sample stomach contents 0.21 6.53 5.34 0.31 0.25 0.01 XXX<br />

89140 A Sample stomach contents 0.94 6.66 5.53 0.51 0.45 0.04 XXX<br />

89141 A Sample stomach contents 0.85 6.85 5.85 0.52 0.47 0.03 XXX<br />

89220 A Sputum specimen collection 0.00 0.37 0.39 NA NA 0.02 XXX<br />

89230 A Collect sweat for test 0.00 0.08 0.09 NA NA 0.02 XXX<br />

89240 C Pathology lab procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

90281 I Human ig, im 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

90283 I Human ig, iv 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

90284 X Human ig, sc 0.00 0.00 0.00 0.00 0.00 0.00 XXX

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