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CMS-1403-FC ADDENDUM C: Codes with Interim RVUs Physi- cian Work Fully Imple- mented Non- Facility PE Year 2009 Transitional Non- Facility PE Fully Imple- mented Facility PE Year 2009 Transitional 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. 1368 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 14000 A Skin tissue rearrangement 6.19 8.60 8.43 5.81 5.74 0.59 090 14001 A Skin tissue rearrangement 8.58 10.67 10.38 7.25 7.22 0.82 090 14020 A Skin tissue rearrangement 7.02 9.71 9.46 6.68 6.66 0.64 090 14021 A Skin tissue rearrangement 9.52 11.78 11.35 8.09 8.16 0.81 090 14040 A Skin tissue rearrangement 8.44 10.26 9.92 7.15 7.18 0.62 090 14041 A Skin tissue rearrangement 10.63 12.75 12.24 8.65 8.68 0.73 090 14060 A Skin tissue rearrangement 9.07 9.79 9.56 7.36 7.40 0.68 090 14061 A Skin tissue rearrangement 11.25 13.79 13.27 9.28 9.36 0.76 090 15570 A Form skin pedicle flap 10.00 10.39 10.65 6.74 6.76 1.34 090 15572 A Form skin pedicle flap 9.94 10.35 10.16 7.34 7.14 1.20 090 15574 A Form skin pedicle flap 10.52 10.72 10.73 7.47 7.57 1.20 090 15576 A Form skin pedicle flap 9.24 9.75 9.78 6.71 6.77 0.87 090 17106 A Destruction of skin lesions 3.61 4.63 4.63 3.02 3.11 0.35 090 17107 A Destruction of skin lesions 4.68 5.75 6.13 3.63 4.10 0.63 090 17108 A Destruction of skin lesions 6.37 7.04 7.61 4.44 5.26 0.54 090 20696 A Comp multiplane ext fixation 17.32 NA NA 7.96 7.96 2.86 090 20697 A Comp ext fixate strut change 0.00 33.08 33.08 0.00 0.00 0.01 000 20900 A Removal of bone for graft 3.00 6.25 6.81 2.14 3.04 0.94 000 20902 A Removal of bone for graft 4.58 NA NA 2.70 3.75 1.30 000 21025 A Excision of bone, lower jaw 9.87 10.70 11.11 7.37 7.88 1.32 090 22856 A Cerv artific diskectomy 23.90 NA NA 13.63 13.63 5.62 090 22861 A Revise cerv artific disc 33.21 NA NA 13.54 13.54 5.49 090 22864 A Remove cerv artif disc 29.25 NA NA 12.22 12.22 7.04 090 23120 A Partial removal, collar bone 7.23 NA NA 6.03 6.16 1.23 090 23410 A Repair rotator cuff, acute 11.23 NA NA 7.73 8.17 2.17 090 23412 A Repair rotator cuff, chronic 11.77 NA NA 7.97 8.47 2.32 090 23415 A Release of shoulder ligament 9.07 NA NA 6.82 7.13 1.74 090 23420 A Repair of shoulder 13.35 NA NA 9.05 9.52 2.32 090 25116 A Remove wrist/forearm lesion 7.38 NA NA 6.26 8.00 1.11 090 25310 A Transplant forearm tendon 7.94 NA NA 6.25 7.97 1.21 090 27027 A Buttock fasciotomy 12.90 NA NA 7.57 7.57 1.89 090 27057 A Buttock fasciotomy w/dbrdmt 14.77 NA NA 8.32 8.32 1.52 090 27062 A Remove femur lesion/bursa 5.66 NA NA 4.70 4.83 0.93 090 27215 I Treat pelvic fracture(s) 10.45 NA NA 6.57 6.71 1.98 090 27216 I Treat pelvic ring fracture 15.73 NA NA 9.48 9.53 2.64 090 27217 I Treat pelvic ring fracture 14.65 NA NA 9.00 9.31 2.42 090 27218 I Treat pelvic ring fracture 20.93 NA NA 11.73 11.68 3.49 090 27244 A Treat thigh fracture 18.00 NA NA 10.79 10.95 2.78 090 27245 A Treat thigh fracture 18.00 NA NA 10.82 11.58 3.53 090 27250 A Treat hip dislocation 3.82 NA NA 0.74 1.72 0.62 000

CMS-1403-FC CPT 1 / HCPCS Mod Status Description Physi- cian Work RVUs 2 Fully Imple- mented Non- Facility PE 27650 A Repair achilles tendon 9.00 NA NA 6.68 6.90 1.59 090 27654 A Repair of achilles tendon 10.32 NA NA 6.75 6.86 1.58 090 27690 A Revise lower leg tendon 8.96 NA NA 6.15 6.22 1.33 090 27691 A Revise lower leg tendon 10.28 NA NA 7.36 7.48 1.64 090 28120 A Part removal of ankle/heel 5.64 7.89 7.75 3.94 4.06 0.77 090 28122 A Partial removal of foot bone 7.56 8.29 7.95 4.75 4.89 0.98 090 28296 A Correction of bunion 8.16 9.09 8.87 4.95 5.08 1.19 090 28725 A Fusion of foot bones 11.97 NA NA 6.84 7.21 1.87 090 28730 A Fusion of foot bones 12.21 NA NA 7.85 8.02 1.71 090 28825 A Partial amputation of toe 5.85 7.90 7.69 4.09 3.95 0.50 090 29888 A Knee arthroscopy/surgery 14.14 NA NA 8.87 9.23 2.42 090 35535 A Artery bypass graft 38.00 NA NA 13.58 13.58 5.23 090 35570 A Artery bypass graft 29.00 NA NA 10.95 10.95 3.91 090 35632 A Artery bypass graft 36.00 NA NA 12.97 12.97 4.97 090 35633 A Artery bypass graft 38.98 NA NA 13.88 13.88 5.39 090 35634 A Artery bypass graft 35.20 NA NA 12.73 12.73 4.86 090 36820 A Av fusion/forearm vein 14.39 NA NA 5.46 5.71 1.95 090 36821 A Av fusion direct any site 12.00 NA NA 5.05 4.96 1.23 090 36825 A Artery-vein autograft 10.00 NA NA 4.39 4.56 1.35 090 38542 A Explore deep node(s), neck 7.85 NA NA 4.48 4.49 0.60 090 41512 A Tongue suspension 6.75 NA NA 8.46 8.46 0.45 090 41530 A Tongue base vol reduction 4.38 73.12 73.12 5.57 5.57 0.31 010 42145 A Repair palate, pharynx/uvula 9.63 NA NA 7.54 7.55 0.65 090 42415 A Excise parotid gland/lesion 17.99 NA NA 9.01 9.50 1.43 090 42420 A Excise parotid gland/lesion 20.87 NA NA 10.01 10.63 1.65 090 42440 A Excise submaxillary gland 7.05 NA NA 4.29 4.42 0.59 090 43273 A Endoscopic pancreatoscopy 2.24 1.08 1.08 1.08 1.08 0.16 ZZZ 43279 A Lap myotomy, heller 22.00 NA NA 8.07 8.07 2.62 090 46930 A Destroy internal hemorrhoids 1.56 3.02 3.54 1.79 2.09 0.16 090 47525 A Change bile duct catheter 1.54 13.38 13.84 1.29 1.67 0.33 010 49507 A Prp i/hern init block >5 yr 9.97 NA NA 4.59 4.56 1.27 090 49521 A Rerepair ing hernia, blocked 12.36 NA NA 5.16 5.19 1.59 090 49587 A Rpr umbil hern, block > 5 yr 7.96 NA NA 3.96 3.91 0.99 090 49652 A Lap vent/abd hernia repair 12.80 NA NA 5.43 5.43 1.64 090 49653 A Lap vent/abd hern proc comp 16.10 NA NA 6.71 6.71 1.99 090 49654 A Lap inc hernia repair 14.95 NA NA 6.02 6.02 1.83 090 49655 A Lap inc hern repair comp 18.00 NA NA 7.23 7.23 2.22 090 49656 A Lap inc hernia repair recur 15.00 NA NA 6.03 6.03 1.86 090 49657 A Lap inc hern recur comp 22.00 NA NA 8.32 8.32 2.73 090 51102 A Drain bl w/cath insertion 2.70 3.72 3.72 1.38 1.38 0.28 000 52341 A Cysto w/ureter stricture tx 5.35 NA NA 2.93 2.75 0.43 000 52342 A Cysto w/up stricture tx 5.85 NA NA 3.15 2.96 0.46 000 52343 A Cysto w/renal stricture tx 6.55 NA NA 3.46 3.25 0.51 000 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. RVUs 2 Year 2009 Transitional Non- Facility PE RVUs 2 Fully Imple- mented Facility PE RVUs 2 Year 2009 Transitional Facility PE RVUs 2 1369 Mal- Practice RVUs 2 Global

<strong>CMS</strong>-1403-FC<br />

CPT 1 /<br />

HCPCS Mod Status Description<br />

Physi-<br />

cian<br />

Work<br />

RVUs 2<br />

Fully<br />

Imple-<br />

mented<br />

Non-<br />

Facility<br />

PE<br />

27650 A Repair achilles tendon 9.00 NA NA 6.68 6.90 1.59 090<br />

27654 A Repair of achilles tendon 10.32 NA NA 6.75 6.86 1.58 090<br />

27690 A Revise lower leg tendon 8.96 NA NA 6.15 6.22 1.33 090<br />

27691 A Revise lower leg tendon 10.28 NA NA 7.36 7.48 1.64 090<br />

28120 A Part removal of ankle/heel 5.64 7.89 7.75 3.94 4.06 0.77 090<br />

28122 A Partial removal of foot bone 7.56 8.29 7.95 4.75 4.89 0.98 090<br />

28296 A Correction of bunion 8.16 9.09 8.87 4.95 5.08 1.19 090<br />

28725 A Fusion of foot bones 11.97 NA NA 6.84 7.21 1.87 090<br />

28730 A Fusion of foot bones 12.21 NA NA 7.85 8.02 1.71 090<br />

28825 A Partial amputation of toe 5.85 7.90 7.69 4.09 3.95 0.50 090<br />

29888 A Knee arthroscopy/surgery 14.14 NA NA 8.87 9.23 2.42 090<br />

35535 A Artery bypass graft 38.00 NA NA 13.58 13.58 5.23 090<br />

35570 A Artery bypass graft 29.00 NA NA 10.95 10.95 3.91 090<br />

35632 A Artery bypass graft 36.00 NA NA 12.97 12.97 4.97 090<br />

35633 A Artery bypass graft 38.98 NA NA 13.88 13.88 5.39 090<br />

35634 A Artery bypass graft 35.20 NA NA 12.73 12.73 4.86 090<br />

36820 A Av fusion/forearm vein 14.39 NA NA 5.46 5.71 1.95 090<br />

36821 A Av fusion direct any site 12.00 NA NA 5.05 4.96 1.23 090<br />

36825 A Artery-vein autograft 10.00 NA NA 4.39 4.56 1.35 090<br />

38542 A Explore deep node(s), neck 7.85 NA NA 4.48 4.49 0.60 090<br />

41512 A Tongue suspension 6.75 NA NA 8.46 8.46 0.45 090<br />

41530 A Tongue base vol reduction 4.38 73.12 73.12 5.57 5.57 0.31 010<br />

42145 A Repair palate, pharynx/uvula 9.63 NA NA 7.54 7.55 0.65 090<br />

42415 A Excise parotid gland/lesion 17.99 NA NA 9.01 9.50 1.43 090<br />

42420 A Excise parotid gland/lesion 20.87 NA NA 10.01 10.63 1.65 090<br />

42440 A Excise submaxillary gland 7.05 NA NA 4.29 4.42 0.59 090<br />

43273 A Endoscopic pancreatoscopy 2.24 1.08 1.08 1.08 1.08 0.16 ZZZ<br />

43279 A Lap myotomy, heller 22.00 NA NA 8.07 8.07 2.62 090<br />

46930 A Destroy internal hemorrhoids 1.56 3.02 3.54 1.79 2.09 0.16 090<br />

47525 A Change bile duct catheter 1.54 13.38 13.84 1.29 1.67 0.33 010<br />

49507 A Prp i/hern init block >5 yr 9.97 NA NA 4.59 4.56 1.27 090<br />

49521 A Rerepair ing hernia, blocked 12.36 NA NA 5.16 5.19 1.59 090<br />

49587 A Rpr umbil hern, block > 5 yr 7.96 NA NA 3.96 3.91 0.99 090<br />

49652 A Lap vent/abd hernia repair 12.80 NA NA 5.43 5.43 1.64 090<br />

49653 A Lap vent/abd hern proc comp 16.10 NA NA 6.71 6.71 1.99 090<br />

49654 A Lap inc hernia repair 14.95 NA NA 6.02 6.02 1.83 090<br />

49655 A Lap inc hern repair comp 18.00 NA NA 7.23 7.23 2.22 090<br />

49656 A Lap inc hernia repair recur 15.00 NA NA 6.03 6.03 1.86 090<br />

49657 A Lap inc hern recur comp 22.00 NA NA 8.32 8.32 2.73 090<br />

51102 A Drain bl w/cath insertion 2.70 3.72 3.72 1.38 1.38 0.28 000<br />

52341 A Cysto w/ureter stricture tx 5.35 NA NA 2.93 2.75 0.43 000<br />

52342 A Cysto w/up stricture tx 5.85 NA NA 3.15 2.96 0.46 000<br />

52343 A Cysto w/renal stricture tx 6.55 NA NA 3.46 3.25 0.51 000<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 />

RVUs 2<br />

Year<br />

2009<br />

Transitional<br />

Non-<br />

Facility<br />

PE<br />

RVUs 2<br />

Fully<br />

Imple-<br />

mented<br />

Facility<br />

PE<br />

RVUs 2<br />

Year<br />

2009<br />

Transitional<br />

Facility<br />

PE<br />

RVUs 2<br />

1369<br />

Mal-<br />

Practice<br />

RVUs 2 Global

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