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CMS-1403-FC CPT 1 / HCPCS Mod Status Description Physi- cian Work RVUs 2 Fully Imple- mented Non- Facility PE 93282 26 A Icd device prog eval, 1 sngl 0.85 0.45 0.43 0.45 0.43 0.03 XXX 93283 26 A Icd device progr eval, dual 1.05 0.56 0.56 0.56 0.56 0.04 XXX 93284 26 A Icd device progr eval, mult 1.25 0.67 0.67 0.67 0.67 0.04 XXX 93285 26 A Ilr device eval progr 0.52 0.28 0.28 0.28 0.28 0.02 XXX 93286 26 A Pre-op pm device eval 0.30 0.10 0.10 0.10 0.10 0.02 XXX 93287 26 A Pre-op icd device eval 0.45 0.15 0.15 0.15 0.15 0.01 XXX 93288 26 A Pm device eval in person 0.43 0.23 0.23 0.23 0.23 0.01 XXX 93289 26 A Icd device interrogate 0.78 0.41 0.41 0.41 0.41 0.02 XXX 93290 26 A Icm device eval 0.43 0.14 0.14 0.14 0.14 0.02 XXX 93291 26 A Ilr device interrogate 0.43 0.23 0.23 0.23 0.23 0.02 XXX 93292 26 A Wcd device interrogate 0.43 0.23 0.23 0.23 0.23 0.01 XXX 93293 26 A Pm phone r-strip device eval 0.32 0.15 0.13 0.15 0.13 0.02 XXX 93294 A Pm device interrogate remote 0.65 0.34 0.34 0.34 0.34 0.03 XXX 93295 A Icd device interrogat remote 1.17 0.63 0.63 0.63 0.63 0.04 XXX 93296 A Pm/icd remote tech serv 0.00 1.00 1.00 NA NA 0.01 XXX 93297 A Icm device interrogat remote 0.52 0.17 0.17 0.17 0.17 0.02 XXX 93298 A Ilr device interrogat remote 0.52 0.28 0.28 0.28 0.28 0.02 XXX 93299 C Icm/ilr remote tech serv 0.00 0.00 0.00 0.00 0.00 0.00 XXX 93306 26 A Tte w/doppler, complete 1.30 0.65 0.65 0.65 0.65 0.04 XXX 93350 26 A Stress tte only 1.46 0.76 0.71 0.76 0.71 0.05 XXX 93351 A Stress tte complete 1.75 5.60 5.60 NA NA 0.33 XXX 93352 A Admin ecg contrast agent 0.19 0.84 0.84 NA NA 0.04 XXX 95803 26 C Actigraphy testing 0.00 0.00 0.00 0.00 0.00 0.00 XXX 95992 B Canalith repositioning proc 0.75 0.36 0.36 0.25 0.25 0.02 XXX 97802 A Medical nutrition, indiv, in 0.53 0.21 0.27 0.14 0.22 0.01 XXX 97803 A Med nutrition, indiv, subseq 0.45 0.18 0.25 0.11 0.20 0.01 XXX 99475 A Ped crit care age 2-5, init 11.25 2.83 2.83 2.83 2.83 0.79 XXX 99476 A Ped crit care age 2-5, subsq 6.75 1.70 1.70 1.70 1.70 0.38 XXX G0402 A Initial preventive exam 1.34 1.13 1.13 NA NA 0.10 XXX G0403 A EKG for initial prevent exam 0.17 0.33 0.38 NA NA 0.03 XXX G0404 A EKG tracing for initial prev 0.00 0.28 0.36 NA NA 0.02 XXX G0405 A EKG interpret & report preve 0.17 0.05 0.05 0.05 0.05 0.01 XXX G0412 A Open tx iliac spine uni/bil 10.45 NA NA 6.57 6.71 1.98 090 G0413 A Pelvic ring fracture uni/bil 15.73 NA NA 9.48 9.53 2.64 090 G0414 A Pelvic ring fx treat int fix 14.65 NA NA 9.00 9.31 2.42 090 G0415 A Open tx post pelvic fxcture 20.93 NA NA 11.73 11.68 3.49 090 G0416 A Sat biopsy prostate 1-20 spc 3.09 13.96 13.96 NA NA 0.54 XXX G0416 TC A Sat biopsy prostate 1-20 spc 0.00 12.14 12.14 NA NA 0.30 XXX G0416 26 A Sat biopsy prostate 1-20 spc 3.09 1.82 1.82 1.82 1.82 0.24 XXX G0417 A Sat biopsy prostate 21-40 5.86 27.26 27.26 NA NA 1.06 XXX G0417 TC A Sat biopsy prostate 21-40 0.00 23.71 23.71 NA NA 0.60 XXX G0417 26 A Sat biopsy prostate 21-40 5.86 3.55 3.55 3.55 3.55 0.46 XXX G0418 A Sat biopsy prostate 41-60 10.30 46.56 46.56 NA NA 1.80 XXX 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 1372 Mal- Practice RVUs 2 Global

CMS-1403-FC 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. 1373 Mal- Practice RVUs 2 Global CPT 1 / HCPCS Mod Status Description RVUs 2 RVUs 2 RVUs 2 RVUs 2 RVUs 2 G0418 TC A Sat biopsy prostate 41-60 0.00 40.50 40.50 NA NA 1.03 XXX G0418 26 A Sat biopsy prostate 41-60 10.30 6.06 6.06 6.06 6.06 0.77 XXX G0419 A Sat biopsy prostate: >60 11.61 55.86 55.86 NA NA 2.16 XXX G0419 TC A Sat biopsy prostate: >60 0.00 48.60 48.60 NA NA 1.23 XXX G0419 26 A Sat biopsy prostate: >60 11.61 7.26 7.26 7.26 7.26 0.93 XXX

<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 />

93282 26 A Icd device prog eval, 1 sngl 0.85 0.45 0.43 0.45 0.43 0.03 XXX<br />

93283 26 A Icd device progr eval, dual 1.05 0.56 0.56 0.56 0.56 0.04 XXX<br />

93284 26 A Icd device progr eval, mult 1.25 0.67 0.67 0.67 0.67 0.04 XXX<br />

93285 26 A Ilr device eval progr 0.52 0.28 0.28 0.28 0.28 0.02 XXX<br />

93286 26 A Pre-op pm device eval 0.30 0.10 0.10 0.10 0.10 0.02 XXX<br />

93287 26 A Pre-op icd device eval 0.45 0.15 0.15 0.15 0.15 0.01 XXX<br />

93288 26 A Pm device eval in person 0.43 0.23 0.23 0.23 0.23 0.01 XXX<br />

93289 26 A Icd device interrogate 0.78 0.41 0.41 0.41 0.41 0.02 XXX<br />

93290 26 A Icm device eval 0.43 0.14 0.14 0.14 0.14 0.02 XXX<br />

93291 26 A Ilr device interrogate 0.43 0.23 0.23 0.23 0.23 0.02 XXX<br />

93292 26 A Wcd device interrogate 0.43 0.23 0.23 0.23 0.23 0.01 XXX<br />

93293 26 A Pm phone r-strip device eval 0.32 0.15 0.13 0.15 0.13 0.02 XXX<br />

93294 A Pm device interrogate remote 0.65 0.34 0.34 0.34 0.34 0.03 XXX<br />

93295 A Icd device interrogat remote 1.17 0.63 0.63 0.63 0.63 0.04 XXX<br />

93296 A Pm/icd remote tech serv 0.00 1.00 1.00 NA NA 0.01 XXX<br />

93297 A Icm device interrogat remote 0.52 0.17 0.17 0.17 0.17 0.02 XXX<br />

93298 A Ilr device interrogat remote 0.52 0.28 0.28 0.28 0.28 0.02 XXX<br />

93299 C Icm/ilr remote tech serv 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

93306 26 A Tte w/doppler, complete 1.30 0.65 0.65 0.65 0.65 0.04 XXX<br />

93350 26 A Stress tte only 1.46 0.76 0.71 0.76 0.71 0.05 XXX<br />

93351 A Stress tte complete 1.75 5.60 5.60 NA NA 0.33 XXX<br />

93352 A Admin ecg contrast agent 0.19 0.84 0.84 NA NA 0.04 XXX<br />

95803 26 C Actigraphy testing 0.00 0.00 0.00 0.00 0.00 0.00 XXX<br />

95992 B Canalith repositioning proc 0.75 0.36 0.36 0.25 0.25 0.02 XXX<br />

97802 A Medical nutrition, indiv, in 0.53 0.21 0.27 0.14 0.22 0.01 XXX<br />

97803 A Med nutrition, indiv, subseq 0.45 0.18 0.25 0.11 0.20 0.01 XXX<br />

99475 A Ped crit care age 2-5, init 11.25 2.83 2.83 2.83 2.83 0.79 XXX<br />

99476 A Ped crit care age 2-5, subsq 6.75 1.70 1.70 1.70 1.70 0.38 XXX<br />

G0402 A Initial preventive exam 1.34 1.13 1.13 NA NA 0.10 XXX<br />

G0403 A EKG for initial prevent exam 0.17 0.33 0.38 NA NA 0.03 XXX<br />

G0404 A EKG tracing for initial prev 0.00 0.28 0.36 NA NA 0.02 XXX<br />

G0405 A EKG interpret & report preve 0.17 0.05 0.05 0.05 0.05 0.01 XXX<br />

G0412 A Open tx iliac spine uni/bil 10.45 NA NA 6.57 6.71 1.98 090<br />

G0413 A Pelvic ring fracture uni/bil 15.73 NA NA 9.48 9.53 2.64 090<br />

G0414 A Pelvic ring fx treat int fix 14.65 NA NA 9.00 9.31 2.42 090<br />

G0415 A Open tx post pelvic fxcture 20.93 NA NA 11.73 11.68 3.49 090<br />

G0416 A Sat biopsy prostate 1-20 spc 3.09 13.96 13.96 NA NA 0.54 XXX<br />

G0416 TC A Sat biopsy prostate 1-20 spc 0.00 12.14 12.14 NA NA 0.30 XXX<br />

G0416 26 A Sat biopsy prostate 1-20 spc 3.09 1.82 1.82 1.82 1.82 0.24 XXX<br />

G0417 A Sat biopsy prostate 21-40 5.86 27.26 27.26 NA NA 1.06 XXX<br />

G0417 TC A Sat biopsy prostate 21-40 0.00 23.71 23.71 NA NA 0.60 XXX<br />

G0417 26 A Sat biopsy prostate 21-40 5.86 3.55 3.55 3.55 3.55 0.46 XXX<br />

G0418 A Sat biopsy prostate 41-60 10.30 46.56 46.56 NA NA 1.80 XXX<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 />

1372<br />

Mal-<br />

Practice<br />

RVUs 2 Global

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