[Federal Register: September 8, 1998 (Volume 63, Number 173)] [Proposed Rules] [Page 47751-47800] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr08se98-38] [[pp. 47751-47800]] Medicare Program; Prospective Payment System for Hospital Outpatient Services [[Continued from page 47750]] [[Page 47750]] L2390... A Offset knee joint each. ......... ......... ......... ........... ........... L2395... A Offset knee joint heavy ......... ......... ......... ........... ........... duty. L2397... A Suspension sleeve lower ......... ......... ......... ........... ........... ext. L2405... A Knee joint drop lock ea ......... ......... ......... ........... ........... jnt. L2415... A Knee joint cam lock ......... ......... ......... ........... ........... each joi. L2425... A Knee disc/dial lock/adj ......... ......... ......... ........... ........... flex. L2430... A Knee jnt ratchet lock ......... ......... ......... ........... ........... ea jnt. L2435... A Knee joint polycentric ......... ......... ......... ........... ........... joint. L2492... A Knee lift loop drop ......... ......... ......... ........... ........... lock rin. L2500... A Thi/glut/ischia wgt ......... ......... ......... ........... ........... bearing. L2510... A Th/wght bear quad-lat ......... ......... ......... ........... ........... brim m. L2520... A Th/wght bear quad-lat ......... ......... ......... ........... ........... brim c. L2525... A Th/wght bear nar m-l ......... ......... ......... ........... ........... brim mo. L2526... A Th/wght bear nar m-l ......... ......... ......... ........... ........... brim cu. L2530... A Thigh/wght bear lacer ......... ......... ......... ........... ........... non-mo. L2540... A Thigh/wght bear lacer ......... ......... ......... ........... ........... molded. L2550... A Thigh/wght bear high ......... ......... ......... ........... ........... roll cu. L2570... A Hip clevis type 2 posit ......... ......... ......... ........... ........... jnt. L2580... A Pelvic control pelvic ......... ......... ......... ........... ........... sling. L2600... A Hip clevis/thrust ......... ......... ......... ........... ........... bearing fr. L2610... A Hip clevis/thrust ......... ......... ......... ........... ........... bearing lo. L2620... A Pelvic control hip ......... ......... ......... ........... ........... heavy dut. L2622... A Hip joint adjustable ......... ......... ......... ........... ........... flexion. L2624... A Hip adj flex ext abduct ......... ......... ......... ........... ........... cont. L2627... A Plastic mold recipro ......... ......... ......... ........... ........... hip & c. L2628... A Metal frame recipro hip ......... ......... ......... ........... ........... & ca. L2630... A Pelvic control band & ......... ......... ......... ........... ........... belt u. L2640... A Pelvic control band & ......... ......... ......... ........... ........... belt b. L2650... A Pelv & thor control ......... ......... ......... ........... ........... gluteal. L2660... A Thoracic control ......... ......... ......... ........... ........... thoracic ba. L2670... A Thorac cont paraspinal ......... ......... ......... ........... ........... uprig. L2680... A Thorac cont lat support ......... ......... ......... ........... ........... upri. L2750... A Plating chrome/nickel ......... ......... ......... ........... ........... pr bar. L2755... A Carbon graphite ......... ......... ......... ........... ........... lamination. L2760... A Extension per extension ......... ......... ......... ........... ........... per. L2770... A Low ext orthosis per ......... ......... ......... ........... ........... bar/jnt. L2780... A Non-corrosive finish... ......... ......... ......... ........... ........... L2785... A Drop lock retainer each ......... ......... ......... ........... ........... L2795... A Knee control full ......... ......... ......... ........... ........... kneecap. L2800... A Knee cap medial or ......... ......... ......... ........... ........... lateral p. L2810... A Knee control condylar ......... ......... ......... ........... ........... pad. L2820... A Soft interface below ......... ......... ......... ........... ........... knee se. L2830... A Soft interface above ......... ......... ......... ........... ........... knee se. L2840... A Tibial length sock fx ......... ......... ......... ........... ........... or equ. L2850... A Femoral lgth sock fx or ......... ......... ......... ........... ........... equa. L2860... A Torsion mechanism knee/ ......... ......... ......... ........... ........... ankle. L2999... A Lower extremity ......... ......... ......... ........... ........... orthosis NOS. L3000... A Ft insert ucb berkeley ......... ......... ......... ........... ........... shell. L3001... A Foot insert remov ......... ......... ......... ........... ........... molded spe. L3002... A Foot insert plastazote ......... ......... ......... ........... ........... or eq. L3003... A Foot insert silicone ......... ......... ......... ........... ........... gel eac. L3010... A Foot longitudinal arch ......... ......... ......... ........... ........... suppo. L3020... A Foot longitud/ ......... ......... ......... ........... ........... metatarsal sup. L3030... A Foot arch support remov ......... ......... ......... ........... ........... prem. L3040... A Ft arch suprt premold ......... ......... ......... ........... ........... longit. L3050... A Foot arch supp premold ......... ......... ......... ........... ........... metat. L3060... A Foot arch supp longitud/ ......... ......... ......... ........... ........... meta. L3070... A Arch suprt att to sho ......... ......... ......... ........... ........... longit. L3080... A Arch supp att to shoe ......... ......... ......... ........... ........... metata. L3090... A Arch supp att to shoe ......... ......... ......... ........... ........... long/m. L3100... A Hallus-valgus nght ......... ......... ......... ........... ........... dynamic s. L3140... A Abduction rotation bar ......... ......... ......... ........... ........... shoe. L3150... A Abduct rotation bar w/o ......... ......... ......... ........... ........... shoe. L3160... A Shoe styled positioning ......... ......... ......... ........... ........... dev. L3170... A Foot plastic heel ......... ......... ......... ........... ........... stabilizer. L3201... A Oxford w supinat/pronat ......... ......... ......... ........... ........... inf. L3202... A Oxford w/ supinat/ ......... ......... ......... ........... ........... pronator c. L3203... A Oxford w/ supinator/ ......... ......... ......... ........... ........... pronator. L3204... A Hightop w/ supp/ ......... ......... ......... ........... ........... pronator inf. L3206... A Hightop w/ supp/ ......... ......... ......... ........... ........... pronator chi. L3207... A Hightop w/ supp/ ......... ......... ......... ........... ........... pronator jun. L3208... A Surgical boot each ......... ......... ......... ........... ........... infant. L3209... A Surgical boot each ......... ......... ......... ........... ........... child. L3211... A Surgical boot each ......... ......... ......... ........... ........... junior. L3212... A Benesch boot pair ......... ......... ......... ........... ........... infant. [[Page 47751]] L3213... A Benesch boot pair child ......... ......... ......... ........... ........... L3214... A Benesch boot pair ......... ......... ......... ........... ........... junior. L3215... A Orthopedic ftwear ......... ......... ......... ........... ........... ladies oxf. L3216... A Orthoped ladies shoes ......... ......... ......... ........... ........... dpth i. L3217... A Ladies shoes hightop ......... ......... ......... ........... ........... depth i. L3218... A Ladies surgical boot ......... ......... ......... ........... ........... each. L3219... A Orthopedic mens shoes ......... ......... ......... ........... ........... oxford. L3221... A Orthopedic mens shoes ......... ......... ......... ........... ........... dpth i. L3222... A Mens shoes hightop ......... ......... ......... ........... ........... depth inl. L3223... A Mens surgical boot each ......... ......... ......... ........... ........... L3224... A Woman's shoe oxford ......... ......... ......... ........... ........... brace. L3225... A Man's shoe oxford brace ......... ......... ......... ........... ........... L3230... A Custom shoes depth ......... ......... ......... ........... ........... inlay. L3250... A Custom mold shoe remov ......... ......... ......... ........... ........... prost. L3251... A Shoe molded to pt ......... ......... ......... ........... ........... silicone s. L3252... A Shoe molded plastazote ......... ......... ......... ........... ........... cust. L3253... A Shoe molded plastazote ......... ......... ......... ........... ........... cust. L3254... A Orth foot non-stndard ......... ......... ......... ........... ........... size/w. L3255... A Orth foot non-standard ......... ......... ......... ........... ........... size/. L3257... A Orth foot add charge ......... ......... ......... ........... ........... split s. L3260... A Ambulatory surgical ......... ......... ......... ........... ........... boot eac. L3265... A Plastazote sandal each. ......... ......... ......... ........... ........... L3300... A Sho lift taper to ......... ......... ......... ........... ........... metatarsal. L3310... A Shoe lift elev heel/ ......... ......... ......... ........... ........... sole neo. L3320... A Shoe lift elev heel/ ......... ......... ......... ........... ........... sole cor. L3330... A Lifts elevation metal ......... ......... ......... ........... ........... extens. L3332... A Shoe lifts tapered to ......... ......... ......... ........... ........... one-ha. L3334... A Shoe lifts elevation ......... ......... ......... ........... ........... heel /i. L3340... A Shoe wedge sach........ ......... ......... ......... ........... ........... L3350... A Shoe heel wedge........ ......... ......... ......... ........... ........... L3360... A Shoe sole wedge outside ......... ......... ......... ........... ........... sole. L3370... A Shoe sole wedge between ......... ......... ......... ........... ........... sole. L3380... A Shoe clubfoot wedge.... ......... ......... ......... ........... ........... L3390... A Shoe outflare wedge.... ......... ......... ......... ........... ........... L3400... A Shoe metatarsal bar ......... ......... ......... ........... ........... wedge ro. L3410... A Shoe metatarsal bar ......... ......... ......... ........... ........... between. L3420... A Full sole/heel wedge ......... ......... ......... ........... ........... btween. L3430... A Sho heel count plast ......... ......... ......... ........... ........... reinfor. L3440... A Heel leather reinforced ......... ......... ......... ........... ........... L3450... A Shoe heel sach cushion ......... ......... ......... ........... ........... type. L3455... A Shoe heel new leather ......... ......... ......... ........... ........... standa. L3460... A Shoe heel new rubber ......... ......... ......... ........... ........... standar. L3465... A Shoe heel thomas with ......... ......... ......... ........... ........... wedge. L3470... A Shoe heel thomas extend ......... ......... ......... ........... ........... to b. L3480... A Shoe heel pad & depress ......... ......... ......... ........... ........... for. L3485... A Shoe heel pad removable ......... ......... ......... ........... ........... for. L3500... A Shoe misc add insole ......... ......... ......... ........... ........... leather. L3510... A Shoe misc addition ......... ......... ......... ........... ........... insole ru. L3520... A Shoe insole felt cver w/ ......... ......... ......... ........... ........... lea. L3530... A Shoe misc additions ......... ......... ......... ........... ........... sole hal. L3540... A Shoe misc additions ......... ......... ......... ........... ........... sole ful. L3550... A Shoe misc add toe tap ......... ......... ......... ........... ........... standa. L3560... A Shoe misc add toe tap ......... ......... ......... ........... ........... horses. L3570... A Shoe special extension ......... ......... ......... ........... ........... to in. L3580... A Shoe convert instep ......... ......... ......... ........... ........... velcro c. L3590... A Shoe convert firm to ......... ......... ......... ........... ........... soft cn. L3595... A Shoe misc additions ......... ......... ......... ........... ........... march ba. L3600... A Trans shoe calip plate ......... ......... ......... ........... ........... exist. L3610... A Trans shoe caliper ......... ......... ......... ........... ........... plate new. L3620... A Trans shoe solid ......... ......... ......... ........... ........... stirrup exi. L3630... A Trans shoe solid ......... ......... ......... ........... ........... stirrup new. L3640... A Shoe dennis browne ......... ......... ......... ........... ........... splint bo. L3649... A Unlist proc orth shoe ......... ......... ......... ........... ........... modif/. L3650... A Shlder fig 8 abduct ......... ......... ......... ........... ........... restrain. L3660... A Abduct restrainer ......... ......... ......... ........... ........... canvas & web. L3670... A Acromio/clavicular ......... ......... ......... ........... ........... canvas & we. L3700... A Elbow orthoses elas w ......... ......... ......... ........... ........... stays. L3710... A Elbow elastic with ......... ......... ......... ........... ........... metal joi. L3720... A Forearm/arm cuffs free ......... ......... ......... ........... ........... motio. L3730... A Forearm/arm cuffs ext/ ......... ......... ......... ........... ........... flex a. L3740... A Cuffs adj lock w/ ......... ......... ......... ........... ........... active con. L3800... A Whfo short opponen no ......... ......... ......... ........... ........... attach. L3805... A Whfo long opponens no ......... ......... ......... ........... ........... attach. L3810... A Whfo thumb abduction ......... ......... ......... ........... ........... bar. L3815... A Whfo second m.p. ......... ......... ......... ........... ........... abduction a. [[Page 47752]] L3820... A Whfo ip ext asst w/ mp ......... ......... ......... ........... ........... ext s. L3825... A Whfo m.p. extension ......... ......... ......... ........... ........... stop. L3830... A Whfo m.p. extension ......... ......... ......... ........... ........... assist. L3835... A Whfo m.p. spring ......... ......... ......... ........... ........... extension a. L3840... A Whfo spring swivel ......... ......... ......... ........... ........... thumb. L3845... A Whfo thumb ip ext ass w/ ......... ......... ......... ........... ........... mp. L3850... A Action wrist w/ ......... ......... ......... ........... ........... dorsiflex as. L3855... A Whfo adj m.p. flexion ......... ......... ......... ........... ........... contro. L3860... A Whfo adj m.p. flex ctrl ......... ......... ......... ........... ........... & i. L3890... A Torsion mechanism wrist/ ......... ......... ......... ........... ........... elbo. L3900... A Hinge extension/flex ......... ......... ......... ........... ........... wrist/f. L3901... A Hinge ext/flex wrist ......... ......... ......... ........... ........... finger. L3902... A Whfo ext power compress ......... ......... ......... ........... ........... gas. L3904... A Whfo electric custom ......... ......... ......... ........... ........... fitted. L3906... A Wrist gauntlet molded ......... ......... ......... ........... ........... to pt. L3907... A Whfo wrst gauntlt thmb ......... ......... ......... ........... ........... spica. L3908... A Wrist cock-up non- ......... ......... ......... ........... ........... molded. L3910... A Whfo swanson design.... ......... ......... ......... ........... ........... L3912... A Flex glove w/elastic ......... ......... ......... ........... ........... finger. L3914... A WHO wrist extension ......... ......... ......... ........... ........... cock-up. L3916... A Whfo wrist extens w/ ......... ......... ......... ........... ........... outrigg. L3918... A HFO knuckle bender..... ......... ......... ......... ........... ........... L3920... A Knuckle bender with ......... ......... ......... ........... ........... outrigge. L3922... A Knuckle bend 2 seg to ......... ......... ......... ........... ........... flex j. L3924... A Oppenheimer............ ......... ......... ......... ........... ........... L3926... A Thomas suspension...... ......... ......... ......... ........... ........... L3928... A Finger extension w/ ......... ......... ......... ........... ........... clock sp. L3930... A Finger extension with ......... ......... ......... ........... ........... wrist. L3932... A Safety pin spring wire. ......... ......... ......... ........... ........... L3934... A Safety pin modified.... ......... ......... ......... ........... ........... L3936... A Palmer................. ......... ......... ......... ........... ........... L3938... A Dorsal wrist........... ......... ......... ......... ........... ........... L3940... A Dorsal wrist w/ ......... ......... ......... ........... ........... outrigger at. L3942... A Reverse knuckle bender. ......... ......... ......... ........... ........... L3944... A Reverse knuckle bend w/ ......... ......... ......... ........... ........... outr. L3946... A HFO composite elastic.. ......... ......... ......... ........... ........... L3948... A Finger knuckle bender.. ......... ......... ......... ........... ........... L3950... A Oppenheimer w/ knuckle ......... ......... ......... ........... ........... bend. L3952... A Oppenheimer w/ rev ......... ......... ......... ........... ........... knuckle 2. L3954... A Spreading hand......... ......... ......... ......... ........... ........... L3956... A Add joint upper ext ......... ......... ......... ........... ........... orthosis. L3960... A Sewho airplan desig ......... ......... ......... ........... ........... abdu pos. L3962... A Sewho erbs palsey ......... ......... ......... ........... ........... design abd. L3963... A Molded w/ articulating ......... ......... ......... ........... ........... elbow. L3964... A Seo mobile arm sup att ......... ......... ......... ........... ........... to wc. L3965... A Arm supp att to wc ......... ......... ......... ........... ........... rancho ty. L3966... A Mobile arm supports ......... ......... ......... ........... ........... reclinin. L3968... A Friction dampening arm ......... ......... ......... ........... ........... supp. L3969... A Monosuspension arm/hand ......... ......... ......... ........... ........... supp. L3970... A Elevat proximal arm ......... ......... ......... ........... ........... support. L3972... A Offset/lat rocker arm w/ ......... ......... ......... ........... ........... ela. L3974... A Mobile arm support ......... ......... ......... ........... ........... supinator. L3980... A Upp ext fx orthosis ......... ......... ......... ........... ........... humeral. L3982... A Upper ext fx orthosis ......... ......... ......... ........... ........... rad/ul. L3984... A Upper ext fx orthosis ......... ......... ......... ........... ........... wrist. L3985... A Forearm hand fx orth w/ ......... ......... ......... ........... ........... wr h. L3986... A Humeral rad/ulna wrist ......... ......... ......... ........... ........... fx or. L3995... A Sock fracture or equal ......... ......... ......... ........... ........... each. L3999... A Upper limb orthosis NOS ......... ......... ......... ........... ........... L4000... A Repl girdle milwaukee ......... ......... ......... ........... ........... orth. L4010... A Replace trilateral ......... ......... ......... ........... ........... socket br. L4020... A Replace quadlat socket ......... ......... ......... ........... ........... brim. L4030... A Replace socket brim ......... ......... ......... ........... ........... cust fit. L4040... A Replace molded thigh ......... ......... ......... ........... ........... lacer. L4045... A Replace non-molded ......... ......... ......... ........... ........... thigh lac. L4050... A Replace molded calf ......... ......... ......... ........... ........... lacer. L4055... A Replace non-molded calf ......... ......... ......... ........... ........... lace. L4060... A Replace high roll cuff. ......... ......... ......... ........... ........... L4070... A Replace prox & dist ......... ......... ......... ........... ........... upright. L4080... A Repl met band kafo-afo ......... ......... ......... ........... ........... prox. L4090... A Repl met band kafo-afo ......... ......... ......... ........... ........... calf/. L4100... A Repl leath cuff kafo ......... ......... ......... ........... ........... prox th. L4110... A Repl leath cuff kafo- ......... ......... ......... ........... ........... afo cal. L4130... A Replace pretibial shell ......... ......... ......... ........... ........... L4205... A Ortho dvc repair per 15 ......... ......... ......... ........... ........... min. [[Page 47753]] L4210... A Orth dev repair/repl ......... ......... ......... ........... ........... minor p. L4310... A Mult-podus/eq orth prep ......... ......... ......... ........... ........... mgmt. L4320... A Low ext mgmt sys ft pos ......... ......... ......... ........... ........... afo. L4350... A Pneumatic ankle cntrl ......... ......... ......... ........... ........... splint. L4360... A Pneumatic walking ......... ......... ......... ........... ........... splint. L4370... A Pneumatic full leg ......... ......... ......... ........... ........... splint. L4380... A Pneumatic knee splint.. ......... ......... ......... ........... ........... L4390... A Replace multi-podus ......... ......... ......... ........... ........... splint. L4392... A Replace ankle contrac ......... ......... ......... ........... ........... splint. L4394... A Replace foot drop ......... ......... ......... ........... ........... splint. L4396... A Ankle contracture ......... ......... ......... ........... ........... splint. L4398... A Foot drop splint ......... ......... ......... ........... ........... recumbent. L5000... A Sho insert w arch toe ......... ......... ......... ........... ........... filler. L5010... A Mold socket ank hgt w/ ......... ......... ......... ........... ........... toe f. L5020... A Tibial tubercle hgt w/ ......... ......... ......... ........... ........... toe f. L5050... A Ank symes mold sckt ......... ......... ......... ........... ........... sach ft. L5060... A Symes met fr leath ......... ......... ......... ........... ........... socket ar. L5100... A Molded socket shin sach ......... ......... ......... ........... ........... foot. L5105... A Plast socket jts/thgh ......... ......... ......... ........... ........... lacer. L5150... A Mold sckt ext knee shin ......... ......... ......... ........... ........... sach. L5160... A Mold socket bent knee ......... ......... ......... ........... ........... shin s. L5200... A Kne sing axis fric shin ......... ......... ......... ........... ........... sach. L5210... A No knee/ankle joints w/ ......... ......... ......... ........... ........... ft b. L5220... A No knee joint with ......... ......... ......... ........... ........... artic ali. L5230... A Fem focal defic ......... ......... ......... ........... ........... constant fri. L5250... A Hip canad sing axi cons ......... ......... ......... ........... ........... fric. L5270... A Tilt table locking hip ......... ......... ......... ........... ........... sing. L5280... A Hemipelvect canad sing ......... ......... ......... ........... ........... axis. L5300... A Bk sach soft cover & ......... ......... ......... ........... ........... finish. L5310... A Knee disart sach soft ......... ......... ......... ........... ........... cv/fin. L5320... A Ak open end sach soft ......... ......... ......... ........... ........... cv/fin. L5330... A Hip canadian sach sft ......... ......... ......... ........... ........... cv/fin. L5340... A Hemipelvectomy canad cv/ ......... ......... ......... ........... ........... fin. L5400... A Postop dress & 1 cast ......... ......... ......... ........... ........... chg bk. L5410... A Postop dsg bk ea add ......... ......... ......... ........... ........... cast ch. L5420... A Postop dsg & 1 cast chg ......... ......... ......... ........... ........... ak/d. L5430... A Postop dsg ak ea add ......... ......... ......... ........... ........... cast ch. L5450... A Postop app non-wgt bear ......... ......... ......... ........... ........... dsg. L5460... A Postop app non-wgt bear ......... ......... ......... ........... ........... dsg. L5500... A Init bk ptb plaster ......... ......... ......... ........... ........... direct. L5505... A Init ak ischal plstr ......... ......... ......... ........... ........... direct. L5510... A Prep BK ptb plaster ......... ......... ......... ........... ........... molded. L5520... A Prep BK ptb thermopls ......... ......... ......... ........... ........... direct. L5530... A Prep BK ptb thermopls ......... ......... ......... ........... ........... molded. L5535... A Prep BK ptb open end ......... ......... ......... ........... ........... socket. L5540... A Prep BK ptb laminated ......... ......... ......... ........... ........... socket. L5560... A Prep AK ischial plast ......... ......... ......... ........... ........... molded. L5570... A Prep AK ischial direct ......... ......... ......... ........... ........... form. L5580... A Prep AK ischial thermo ......... ......... ......... ........... ........... mold. L5585... A Prep AK ischial open ......... ......... ......... ........... ........... end. L5590... A Prep AK ischial ......... ......... ......... ........... ........... laminated. L5595... A Hip disartic sach ......... ......... ......... ........... ........... thermopls. L5600... A Hip disart sach laminat ......... ......... ......... ........... ........... mold. L5610... A Above knee hydracadence ......... ......... ......... ........... ........... L5611... A Ak 4 bar link w/fric ......... ......... ......... ........... ........... swing. L5613... A Ak 4 bar ling w/hydraul ......... ......... ......... ........... ........... swig. L5614... A 4-bar link above knee w/ ......... ......... ......... ........... ........... swng. L5616... A Ak univ multiplex sys ......... ......... ......... ........... ........... frict. L5617... A AK/BK self-aligning ......... ......... ......... ........... ........... unit ea. L5618... A Test socket symes...... ......... ......... ......... ........... ........... L5620... A Test socket below knee. ......... ......... ......... ........... ........... L5622... A Test socket knee ......... ......... ......... ........... ........... disarticula. L5624... A Test socket above knee. ......... ......... ......... ........... ........... L5626... A Test socket hip ......... ......... ......... ........... ........... disarticulat. L5628... A Test socket ......... ......... ......... ........... ........... hemipelvectomy. L5629... A Below knee acrylic ......... ......... ......... ........... ........... socket. L5630... A Syme typ expandabl wall ......... ......... ......... ........... ........... sckt. L5631... A Ak/knee disartic ......... ......... ......... ........... ........... acrylic soc. L5632... A Symes type ptb brim ......... ......... ......... ........... ........... design s. L5634... A Symes type poster ......... ......... ......... ........... ........... opening so. L5636... A Symes type medial ......... ......... ......... ........... ........... opening so. L5637... A Below knee total ......... ......... ......... ........... ........... contact. L5638... A Below knee leather ......... ......... ......... ........... ........... socket. L5639... A Below knee wood socket. ......... ......... ......... ........... ........... L5640... A Knee disarticulat ......... ......... ......... ........... ........... leather so. [[Page 47754]] L5642... A Above knee leather ......... ......... ......... ........... ........... socket. L5643... A Hip flex inner socket ......... ......... ......... ........... ........... ext fr. L5644... A Above knee wood socket. ......... ......... ......... ........... ........... L5645... A Ak flexibl inner socket ......... ......... ......... ........... ........... ext. L5646... A Below knee air cushion ......... ......... ......... ........... ........... socke. L5647... A Below knee suction ......... ......... ......... ........... ........... socket. L5648... A Above knee air cushion ......... ......... ......... ........... ........... socke. L5649... A Isch containmt/narrow m- ......... ......... ......... ........... ........... l so. L5650... A Tot contact ak/knee ......... ......... ......... ........... ........... disart s. L5651... A Ak flex inner socket ......... ......... ......... ........... ........... ext fra. L5652... A Suction susp ak/knee ......... ......... ......... ........... ........... disart. L5653... A Knee disart expand wall ......... ......... ......... ........... ........... sock. L5654... A Socket insert symes.... ......... ......... ......... ........... ........... L5655... A Socket insert below ......... ......... ......... ........... ........... knee. L5656... A Socket insert knee ......... ......... ......... ........... ........... articulat. L5658... A Socket insert above ......... ......... ......... ........... ........... knee. L5660... A Sock insrt syme ......... ......... ......... ........... ........... silicone gel. L5661... A Multi-durometer symes.. ......... ......... ......... ........... ........... L5662... A Socket insert bk ......... ......... ......... ........... ........... silicone ge. L5663... A Sock knee disartic ......... ......... ......... ........... ........... silicone. L5664... A Socket insert ak ......... ......... ......... ........... ........... silicone ge. L5665... A Multi-durometer below ......... ......... ......... ........... ........... knee. L5666... A Below knee cuff ......... ......... ......... ........... ........... suspension. L5667... A Socket insert w lock ......... ......... ......... ........... ........... lower. L5668... A Socket insert w/o lock ......... ......... ......... ........... ........... lower. L5669... A Below knee socket w/o ......... ......... ......... ........... ........... lock. L5670... A Bk molded supracondylar ......... ......... ......... ........... ........... susp. L5672... A Bk removable medial ......... ......... ......... ........... ........... brim sus. L5674... A Bk latex sleeve ......... ......... ......... ........... ........... suspension/e. L5675... A Bk latex sleeve susp/eq ......... ......... ......... ........... ........... hvy. L5676... A Bk knee joints single ......... ......... ......... ........... ........... axis p. L5677... A Bk knee joints ......... ......... ......... ........... ........... polycentric p. L5678... A Bk joint covers pair... ......... ......... ......... ........... ........... L5680... A Bk thigh lacer non- ......... ......... ......... ........... ........... molded. L5682... A Bk thigh lacer glut/ ......... ......... ......... ........... ........... ischia m. L5684... A Bk fork strap.......... ......... ......... ......... ........... ........... L5686... A Bk back check.......... ......... ......... ......... ........... ........... L5688... A Bk waist belt webbing.. ......... ......... ......... ........... ........... L5690... A Bk waist belt padded ......... ......... ......... ........... ........... and lin. L5692... A Ak pelvic control belt ......... ......... ......... ........... ........... light. L5694... A Ak pelvic control belt ......... ......... ......... ........... ........... pad/l. L5695... A Ak sleeve susp neoprene/ ......... ......... ......... ........... ........... equa. L5696... A Ak/knee disartic pelvic ......... ......... ......... ........... ........... join. L5697... A Ak/knee disartic pelvic ......... ......... ......... ........... ........... band. L5698... A Ak/knee disartic ......... ......... ......... ........... ........... silesian ba. L5699... A Shoulder harness....... ......... ......... ......... ........... ........... L5700... A Replace socket below ......... ......... ......... ........... ........... knee. L5701... A Replace socket above ......... ......... ......... ........... ........... knee. L5702... A Replace socket hip..... ......... ......... ......... ........... ........... L5704... A Custom shape covr below ......... ......... ......... ........... ........... knee. L5705... A Custm shape cover above ......... ......... ......... ........... ........... knee. L5706... A Custm shape cvr knee ......... ......... ......... ........... ........... disart. L5707... A Custm shape cover hip ......... ......... ......... ........... ........... disart. L5710... A Kne-shin exo sng axi ......... ......... ......... ........... ........... mnl loc. L5711... A Knee-shin exo mnl lock ......... ......... ......... ........... ........... ultra. L5712... A Knee-shin exo frict swg ......... ......... ......... ........... ........... & st. L5714... A Knee-shin exo variable ......... ......... ......... ........... ........... frict. L5716... A Knee-shin exo mech ......... ......... ......... ........... ........... stance ph. L5718... A Knee-shin exo frct swg ......... ......... ......... ........... ........... & sta. L5722... A Knee-shin pneum swg ......... ......... ......... ........... ........... frct exo. L5724... A Knee-shin exo fluid ......... ......... ......... ........... ........... swing ph. L5726... A Knee-shin ext jnts fld ......... ......... ......... ........... ........... swg e. L5728... A Knee-shin fluid swg & ......... ......... ......... ........... ........... stance. L5780... A Knee-shin pneum/hydra ......... ......... ......... ........... ........... pneum. L5785... A Exoskeletal bk ultralt ......... ......... ......... ........... ........... mater. L5790... A Exoskeletal ak ultra- ......... ......... ......... ........... ........... light m. L5795... A Exoskel hip ultra-light ......... ......... ......... ........... ........... mate. L5810... A Endoskel knee-shin mnl ......... ......... ......... ........... ........... lock. L5811... A Endo knee-shin mnl lck ......... ......... ......... ........... ........... ultra. L5812... A Endo knee-shin frct swg ......... ......... ......... ........... ........... & st. L5814... A Endo knee-shin hydral ......... ......... ......... ........... ........... swg ph. L5816... A Endo knee-shin polyc ......... ......... ......... ........... ........... mch sta. L5818... A Endo knee-shin frct swg ......... ......... ......... ........... ........... & st. L5822... A Endo knee-shin pneum ......... ......... ......... ........... ........... swg frc. L5824... A Endo knee-shin fluid ......... ......... ......... ........... ........... swing p. [[Page 47755]] L5826... A Pediatric knee joint... ......... ......... ......... ........... ........... L5828... A Endo knee-shin fluid ......... ......... ......... ........... ........... swg/sta. L5830... A Endo knee-shin pneum/ ......... ......... ......... ........... ........... swg pha. L5840... A Multi-axial knee/shin ......... ......... ......... ........... ........... system. L5845... A Knee-shin sys stance ......... ......... ......... ........... ........... flexion. L5846... A Knee-shin sys ......... ......... ......... ........... ........... microprocessor. L5850... A Endo ak/hip knee extens ......... ......... ......... ........... ........... assi. L5855... A Mech hip extension ......... ......... ......... ........... ........... assist. L5910... A Endo below knee ......... ......... ......... ........... ........... alignable sy. L5920... A Endo ak/hip alignable ......... ......... ......... ........... ........... system. L5925... A Above knee manual lock. ......... ......... ......... ........... ........... L5930... A High activity knee ......... ......... ......... ........... ........... frame. L5940... A Endo bk ultra-light ......... ......... ......... ........... ........... material. L5950... A Endo ak ultra-light ......... ......... ......... ........... ........... material. L5960... A Endo hip ultra-light ......... ......... ......... ........... ........... materia. L5962... A Below knee flex cover ......... ......... ......... ........... ........... system. L5964... A Above knee flex cover ......... ......... ......... ........... ........... system. L5966... A Hip flexible cover ......... ......... ......... ........... ........... system. L5970... A Foot external keel sach ......... ......... ......... ........... ........... foot. L5972... A Flexible keel foot..... ......... ......... ......... ........... ........... L5974... A Foot single axis ankle/ ......... ......... ......... ........... ........... foot. L5976... A Energy storing foot.... ......... ......... ......... ........... ........... L5978... A Ft prosth multiaxial ......... ......... ......... ........... ........... ankl/ft. L5979... A Multi-axial ankle/ft ......... ......... ......... ........... ........... prosth. L5980... A Flex foot system....... ......... ......... ......... ........... ........... L5981... A Flex-walk sys low ext ......... ......... ......... ........... ........... prosth. L5982... A Exoskeletal axial ......... ......... ......... ........... ........... rotation u. L5984... A Endoskeletal axial ......... ......... ......... ........... ........... rotation. L5985... A Lwr ext dynamic prosth ......... ......... ......... ........... ........... pylon. L5986... A Multi-axial rotation ......... ......... ......... ........... ........... unit. L5987... A Shank ft w vert load ......... ......... ......... ........... ........... pylon. L5999... A Lowr extremity prosthes ......... ......... ......... ........... ........... NOS. L6000... A Par hand robin-aids ......... ......... ......... ........... ........... thum rem. L6010... A Hand robin-aids little/ ......... ......... ......... ........... ........... ring. L6020... A Part hand robin-aids no ......... ......... ......... ........... ........... fing. L6050... A Wrst MLd sck flx hng ......... ......... ......... ........... ........... tri pad. L6055... A Wrst mold sock w/exp ......... ......... ......... ........... ........... interfa. L6100... A Elb mold sock flex ......... ......... ......... ........... ........... hinge pad. L6110... A Elbow mold sock ......... ......... ......... ........... ........... suspension t. L6120... A Elbow mold doub splt ......... ......... ......... ........... ........... soc ste. L6130... A Elbow stump activated ......... ......... ......... ........... ........... lock h. L6200... A Elbow mold outsid lock ......... ......... ......... ........... ........... hinge. L6205... A Elbow molded w/ expand ......... ......... ......... ........... ........... inter. L6250... A Elbow inter loc elbow ......... ......... ......... ........... ........... forarm. L6300... A Shlder disart int lock ......... ......... ......... ........... ........... elbow. L6310... A Shoulder passive restor ......... ......... ......... ........... ........... comp. L6320... A Shoulder passive restor ......... ......... ......... ........... ........... cap. L6350... A Thoracic intern lock ......... ......... ......... ........... ........... elbow. L6360... A Thoracic passive restor ......... ......... ......... ........... ........... comp. L6370... A Thoracic passive restor ......... ......... ......... ........... ........... cap. L6380... A Postop dsg cast chg ......... ......... ......... ........... ........... wrst/elb. L6382... A Postop dsg cast chg elb ......... ......... ......... ........... ........... dis/. L6384... A Postop dsg cast chg ......... ......... ......... ........... ........... shlder/t. L6386... A Postop ea cast chg & ......... ......... ......... ........... ........... realign. L6388... A Postop applicat rigid ......... ......... ......... ........... ........... dsg on. L6400... A Below elbow prosth tiss ......... ......... ......... ........... ........... shap. L6450... A Elb disart prosth tiss ......... ......... ......... ........... ........... shap. L6500... A Above elbow prosth tiss ......... ......... ......... ........... ........... shap. L6550... A Shldr disar prosth tiss ......... ......... ......... ........... ........... shap. L6570... A Scap thorac prosth tiss ......... ......... ......... ........... ........... shap. L6580... A Wrist/elbow bowden ......... ......... ......... ........... ........... cable mol. L6582... A Wrist/elbow bowden cbl ......... ......... ......... ........... ........... dir f. L6584... A Elbow fair lead cable ......... ......... ......... ........... ........... molded. L6586... A Elbow fair lead cable ......... ......... ......... ........... ........... dir fo. L6588... A Shdr fair lead cable ......... ......... ......... ........... ........... molded. L6590... A Shdr fair lead cable ......... ......... ......... ........... ........... direct. L6600... A Polycentric hinge pair. ......... ......... ......... ........... ........... L6605... A Single pivot hinge pair ......... ......... ......... ........... ........... L6610... A Flexible metal hinge ......... ......... ......... ........... ........... pair. L6615... A Disconnect locking ......... ......... ......... ........... ........... wrist uni. L6616... A Disconnect insert ......... ......... ......... ........... ........... locking wr. L6620... A Flexion-friction wrist ......... ......... ......... ........... ........... unit. L6623... A Spring-ass rot wrst w/ ......... ......... ......... ........... ........... latch. L6625... A Rotation wrst w/ cable ......... ......... ......... ........... ........... lock. L6628... A Quick disconn hook ......... ......... ......... ........... ........... adapter o. [[Page 47756]] L6629... A Lamination collar w/ ......... ......... ......... ........... ........... couplin. L6630... A Stainless steel any ......... ......... ......... ........... ........... wrist. L6632... A Latex suspension sleeve ......... ......... ......... ........... ........... each. L6635... A Lift assist for elbow.. ......... ......... ......... ........... ........... L6637... A Nudge control elbow ......... ......... ......... ........... ........... lock. L6640... A Shoulder abduction ......... ......... ......... ........... ........... joint pai. L6641... A Excursion amplifier ......... ......... ......... ........... ........... pulley t. L6642... A Excursion amplifier ......... ......... ......... ........... ........... lever ty. L6645... A Shoulder flexion- ......... ......... ......... ........... ........... abduction j. L6650... A Shoulder universal ......... ......... ......... ........... ........... joint. L6655... A Standard control cable ......... ......... ......... ........... ........... extra. L6660... A Heavy duty control ......... ......... ......... ........... ........... cable. L6665... A Teflon or equal cable ......... ......... ......... ........... ........... lining. L6670... A Hook to hand cable ......... ......... ......... ........... ........... adapter. L6672... A Harness chest/shlder ......... ......... ......... ........... ........... saddle. L6675... A Harness figure of 8 ......... ......... ......... ........... ........... sing con. L6676... A Harness figure of 8 ......... ......... ......... ........... ........... dual con. L6680... A Test sock wrist disart/ ......... ......... ......... ........... ........... bel e. L6682... A Test sock elbw disart/ ......... ......... ......... ........... ........... above. L6684... A Test socket shldr ......... ......... ......... ........... ........... disart/tho. L6686... A Suction socket......... ......... ......... ......... ........... ........... L6687... A Frame typ socket bel ......... ......... ......... ........... ........... elbow/w. L6688... A Frame typ sock above ......... ......... ......... ........... ........... elb/dis. L6689... A Frame typ socket ......... ......... ......... ........... ........... shoulder di. L6690... A Frame typ sock ......... ......... ......... ........... ........... interscap-tho. L6691... A Removable insert each.. ......... ......... ......... ........... ........... L6692... A Silicone gel insert or ......... ......... ......... ........... ........... equal. L6700... A Terminal device model ......... ......... ......... ........... ........... #3. L6705... A Terminal device model ......... ......... ......... ........... ........... #5. L6710... A Terminal device model ......... ......... ......... ........... ........... #5x. L6715... A Terminal device model ......... ......... ......... ........... ........... #5xa. L6720... A Terminal device model ......... ......... ......... ........... ........... #6. L6725... A Terminal device model ......... ......... ......... ........... ........... #7. L6730... A Terminal device model ......... ......... ......... ........... ........... #7lo. L6735... A Terminal device model ......... ......... ......... ........... ........... #8. L6740... A Terminal device model ......... ......... ......... ........... ........... #8x. L6745... A Terminal device model ......... ......... ......... ........... ........... #88x. L6750... A Terminal device model ......... ......... ......... ........... ........... #10p. L6755... A Terminal device model ......... ......... ......... ........... ........... #10x. L6765... A Terminal device model ......... ......... ......... ........... ........... #12p. L6770... A Terminal device model ......... ......... ......... ........... ........... #99x. L6775... A Terminal device ......... ......... ......... ........... ........... model#555. L6780... A Terminal device model ......... ......... ......... ........... ........... #ss555. L6790... A Hooks-accu hook or ......... ......... ......... ........... ........... equal. L6795... A Hooks-2 load or equal.. ......... ......... ......... ........... ........... L6800... A Hooks-aprl vc or equal. ......... ......... ......... ........... ........... L6805... A Modifier wrist flexion ......... ......... ......... ........... ........... unit. L6806... A Trs grip vc or equal... ......... ......... ......... ........... ........... L6807... A Term device grip1/2 or ......... ......... ......... ........... ........... equal. L6808... A Term device infant or ......... ......... ......... ........... ........... child. L6809... A Trs super sport passive ......... ......... ......... ........... ........... L6810... A Pincher tool otto bock ......... ......... ......... ........... ........... or eq. L6825... A Hands dorrance vo...... ......... ......... ......... ........... ........... L6830... A Hand aprl vc........... ......... ......... ......... ........... ........... L6835... A Hand sierra vo......... ......... ......... ......... ........... ........... L6840... A Hand becker imperial... ......... ......... ......... ........... ........... L6845... A Hand becker lock grip.. ......... ......... ......... ........... ........... L6850... A Term dvc-hand becker ......... ......... ......... ........... ........... plylite. L6855... A Hand robin-aids vo..... ......... ......... ......... ........... ........... L6860... A Hand robin-aids vo soft ......... ......... ......... ........... ........... L6865... A Hand passive hand...... ......... ......... ......... ........... ........... L6867... A Hand detroit infant ......... ......... ......... ........... ........... hand. L6868... A Passive inf hand ......... ......... ......... ........... ........... steeper/hos. L6870... A Hand child mitt........ ......... ......... ......... ........... ........... L6872... A Hand nyu child hand.... ......... ......... ......... ........... ........... L6873... A Hand mech inf steeper ......... ......... ......... ........... ........... or equ. L6875... A Hand bock vc........... ......... ......... ......... ........... ........... L6880... A Hand bock vo........... ......... ......... ......... ........... ........... L6890... A Production glove....... ......... ......... ......... ........... ........... L6895... A Custom glove........... ......... ......... ......... ........... ........... L6900... A Hand restorat thumb/1 ......... ......... ......... ........... ........... finger. L6905... A Hand restoration ......... ......... ......... ........... ........... multiple fi. L6910... A Hand restoration no ......... ......... ......... ........... ........... fingers. L6915... A Hand restoration ......... ......... ......... ........... ........... replacmnt g. L6920... A Wrist disarticul switch ......... ......... ......... ........... ........... ctrl. [[Page 47757]] L6925... A Wrist disart ......... ......... ......... ........... ........... myoelectronic c. L6930... A Below elbow switch ......... ......... ......... ........... ........... control. L6935... A Below elbow ......... ......... ......... ........... ........... myoelectronic ct. L6940... A Elbow disarticulation ......... ......... ......... ........... ........... switch. L6945... A Elbow disart ......... ......... ......... ........... ........... myoelectronic c. L6950... A Above elbow switch ......... ......... ......... ........... ........... control. L6955... A Above elbow ......... ......... ......... ........... ........... myoelectronic ct. L6960... A Shldr disartic switch ......... ......... ......... ........... ........... contro. L6965... A Shldr disartic ......... ......... ......... ........... ........... myoelectronic. L6970... A Interscapular-thor ......... ......... ......... ........... ........... switch ct. L6975... A Interscap-thor ......... ......... ......... ........... ........... myoelectronic. L7010... A Hand otto back steeper/ ......... ......... ......... ........... ........... eq sw. L7015... A Hand sys teknik village ......... ......... ......... ........... ........... swit. L7020... A Electronic greifer ......... ......... ......... ........... ........... switch ct. L7025... A Electron hand ......... ......... ......... ........... ........... myoelectronic. L7030... A Hand sys teknik vill ......... ......... ......... ........... ........... myoelec. L7035... A Electron greifer ......... ......... ......... ........... ........... myoelectro. L7040... A Prehensile actuator ......... ......... ......... ........... ........... hosmer s. L7045... A Electron hook child ......... ......... ......... ........... ........... michigan. L7170... A Electronic elbow hosmer ......... ......... ......... ........... ........... swit. L7180... A Electronic elbow utah ......... ......... ......... ........... ........... myoele. L7185... A Electron elbow ......... ......... ......... ........... ........... adolescent sw. L7186... A Electron elbow child ......... ......... ......... ........... ........... switch. L7190... A Elbow adolescent ......... ......... ......... ........... ........... myoelectron. L7191... A Elbow child ......... ......... ......... ........... ........... myoelectronic ct. L7260... A Electron wrist rotator ......... ......... ......... ........... ........... otto. L7261... A Electron wrist rotator ......... ......... ......... ........... ........... utah. L7266... A Servo control steeper ......... ......... ......... ........... ........... or equ. L7272... A Analogue control unb or ......... ......... ......... ........... ........... equa. L7274... A Proportional ctl 12 ......... ......... ......... ........... ........... volt uta. L7360... A Six volt bat otto bock/ ......... ......... ......... ........... ........... eq ea. L7362... A Battery chrgr six volt ......... ......... ......... ........... ........... otto. L7364... A Twelve volt battery ......... ......... ......... ........... ........... utah/equ. L7366... A Battery chrgr 12 volt ......... ......... ......... ........... ........... utah/e. L7499... A Upper extremity ......... ......... ......... ........... ........... prosthes NOS. L7500... A Prosthetic dvc repair ......... ......... ......... ........... ........... hourly. L7510... A Prosthetic device ......... ......... ......... ........... ........... repair rep. L7520... A Repair prosthesis per ......... ......... ......... ........... ........... 15 min. L7900... A Vacuum erection system. ......... ......... ......... ........... ........... L8000... A Mastectomy bra......... ......... ......... ......... ........... ........... L8010... A Mastectomy sleeve...... ......... ......... ......... ........... ........... L8020... A Mastectomy form........ ......... ......... ......... ........... ........... L8030... A Breast prosthesis ......... ......... ......... ........... ........... silicone/e. L8039... A Breast prosthesis NOS.. ......... ......... ......... ........... ........... L8100... A Elas suprt stock bk med ......... ......... ......... ........... ........... wgt. L8110... A Elastic supp stocking ......... ......... ......... ........... ........... bk hvy. L8120... A Elastic supp stockng bk ......... ......... ......... ........... ........... surg. L8130... A Elastic supp stocking ......... ......... ......... ........... ........... ak med. L8140... A Elastic supp stocking ......... ......... ......... ........... ........... ak hvy. L8150... A Elastic supp stockng ak ......... ......... ......... ........... ........... surg. L8160... A Supp stocking full lgth ......... ......... ......... ........... ........... med. L8170... A Supp stocking full lgth ......... ......... ......... ........... ........... hvy. L8180... A Supp stocking heavy ......... ......... ......... ........... ........... surg wei. L8190... A Elas stocking leotards ......... ......... ......... ........... ........... med w. L8200... A Elas stocking leotards ......... ......... ......... ........... ........... surg. L8210... A Elastic stocking custom ......... ......... ......... ........... ........... made. L8220... A Elastic stocking ......... ......... ......... ........... ........... lymphedema. L8230... A Elastic stocking garter ......... ......... ......... ........... ........... belt. L8239... A Elastic support NOS.... ......... ......... ......... ........... ........... L8300... A Truss single w/ ......... ......... ......... ........... ........... standard pad. L8310... A Truss double w/ ......... ......... ......... ........... ........... standard pad. L8320... A Truss addition to std ......... ......... ......... ........... ........... pad wa. L8330... A Truss add to std pad ......... ......... ......... ........... ........... scrotal. L8400... A Sheath below knee...... ......... ......... ......... ........... ........... L8410... A Sheath above knee...... ......... ......... ......... ........... ........... L8415... A Sheath upper limb...... ......... ......... ......... ........... ........... L8417... A Pros sheath/sock w gel ......... ......... ......... ........... ........... cushn. L8420... A Sock wool below knee... ......... ......... ......... ........... ........... L8430... A Sock wool above knee... ......... ......... ......... ........... ........... L8435... A Sock wool upper limb... ......... ......... ......... ........... ........... L8440... A Shrinker below knee.... ......... ......... ......... ........... ........... L8460... A Shrinker above knee.... ......... ......... ......... ........... ........... L8465... A Shrinker upper limb.... ......... ......... ......... ........... ........... L8470... A Stump sock single below ......... ......... ......... ........... ........... knee. L8480... A Stump sock single above ......... ......... ......... ........... ........... knee. [[Page 47758]] L8485... A Stump sock fitting uppr ......... ......... ......... ........... ........... limb. L8490... A Air seal suction reten ......... ......... ......... ........... ........... systm. L8499... A Unlisted misc ......... ......... ......... ........... ........... prosthetic ser. L8500... A Artificial larynx...... ......... ......... ......... ........... ........... L8501... A Tracheostomy speaking ......... ......... ......... ........... ........... valve. L8600... A Implant breast silicone/ ......... ......... ......... ........... ........... eq. L8603... A Collagen imp urinary ......... ......... ......... ........... ........... 2.5 CC. L8610... A Ocular implant......... ......... ......... ......... ........... ........... L8612... A Aqueous shunt ......... ......... ......... ........... ........... prosthesis. L8613... A Ossicular implant...... ......... ......... ......... ........... ........... L8614... A Cochlear device/system. ......... ......... ......... ........... ........... L8619... A Replace cochlear ......... ......... ......... ........... ........... processor. L8630... A Metacarpophalangeal ......... ......... ......... ........... ........... implant. L8641... A Metatarsal joint ......... ......... ......... ........... ........... implant. L8642... A Hallux implant......... ......... ......... ......... ........... ........... L8658... A Interphalangeal joint ......... ......... ......... ........... ........... implnt. L8670... A Vascular graft, ......... ......... ......... ........... ........... synthetic. L8699... A Prosthetic implant NOS. ......... ......... ......... ........... ........... M0064... X Visit for drug 090 0.85 $45.05 $12.43 $9.01 monitoring. M0075... E Cellular therapy....... ......... ......... ......... ........... ........... M0076... E Prolotherapy........... ......... ......... ......... ........... ........... M0100... E Intragastric ......... ......... ......... ........... ........... hypothermia. M0101... E Foot care hygienic/pm.. ......... ......... ......... ........... ........... M0300... E IV chelation therapy... ......... ......... ......... ........... ........... M0301... E Fabric wrapping of ......... ......... ......... ........... ........... aneurysm. M0302... E Assessment of cardiac ......... ......... ......... ........... ........... output. P2028... A Cephalin floculation ......... ......... ......... ........... ........... test. P2029... A Congo red blood test... ......... ......... ......... ........... ........... P2031... E Hair analysis.......... ......... ......... ......... ........... ........... P2033... A Blood thymol turbidity. ......... ......... ......... ........... ........... P2038... A Blood mucoprotein...... ......... ......... ......... ........... ........... P3000... A Screen pap by tech w md ......... ......... ......... ........... ........... supv. P3001... A Screening pap smear by ......... ......... ......... ........... ........... phys. P7001... E Culture bacterial urine ......... ......... ......... ........... ........... P9010... N Whole blood for ......... ......... ......... ........... ........... transfusion. P9011... N Blood split unit....... ......... ......... ......... ........... ........... P9012... N Cryoprecipitate each ......... ......... ......... ........... ........... unit. P9013... N Unit/s blood fibrinogen ......... ......... ......... ........... ........... P9014... N Gamma globulin 1 ML.... ......... ......... ......... ........... ........... P9015... N Rh immune globulin 1 ML ......... ......... ......... ........... ........... P9016... N Leukocyte poor blood, ......... ......... ......... ........... ........... unit. P9017... N One donor fresh frozn ......... ......... ......... ........... ........... plasma. P9018... N Plasma protein fract, ......... ......... ......... ........... ........... unit. P9019... N Platelet concentrate ......... ......... ......... ........... ........... unit. P9020... N Platelet rich plasma ......... ......... ......... ........... ........... unit. P9021... N Red blood cells unit... ......... ......... ......... ........... ........... P9022... N Washed red blood cells ......... ......... ......... ........... ........... unit. P9603... N One-way allow prorated ......... ......... ......... ........... ........... miles. P9604... N One-way allow prorated ......... ......... ......... ........... ........... trip. P9610... E Urine specimen collect ......... ......... ......... ........... ........... singl. P9615... E Urine specimen collect ......... ......... ......... ........... ........... mult. Q0034... X Admin of influenza 901 0.07 $3.92 $2.49 $.78 vaccine. Q0035... X Cardiokymography....... 950 0.35 $18.61 $15.82 $3.72 Q0068... T Extracorpeal 369 4.33 $229.19 $97.18 $45.84 plasmapheresis. Q0081... X Infusion ther other 906 1.46 $77.38 $42.49 $15.48 than che. Q0082... X Activity therapy w/ ......... ......... ......... ........... ........... partial h. Q0083... S Chemo by other than 987 0.65 $34.28 $13.33 $6.86 infusion. Q0084... S Chemotherapy by 989 1.72 $91.09 $40.68 $18.22 infusion. Q0085... S Chemo by both infusion 989 1.72 $91.09 $40.68 $18.22 and o. Q0086... A Physical therapy ......... ......... ......... ........... ........... evaluation/. Q0091... T Obtaining screen pap 561 1.52 $80.32 $24.63 $16.06 smear. Q0092... N Set up port xray ......... ......... ......... ........... ........... equipment. Q0111... A Wet mounts/ w ......... ......... ......... ........... ........... preparations. Q0112... A Potassium hydroxide ......... ......... ......... ........... ........... preps. Q0113... A Pinworm examinations... ......... ......... ......... ........... ........... Q0114... A Fern test.............. ......... ......... ......... ........... ........... Q0115... A Post-coital mucous exam ......... ......... ......... ........... ........... Q0132... A Dispensing fee DME neb ......... ......... ......... ........... ........... drug. Q0136... N Non esrd epoetin alpha ......... ......... ......... ........... ........... inj. Q0144... E Azithromycin dihydrate, ......... ......... ......... ........... ........... oral. Q0156... N Human albumin 5%....... ......... ......... ......... ........... ........... Q0157... N Human albumin 25%...... ......... ......... ......... ........... ........... Q9920... A Epoetin with hct <= 20. ......... ......... ......... ........... ........... Q9921... A Epoetin with hct = 21.. ......... ......... ......... ........... ........... Q9922... A Epoetin with hct = 22.. ......... ......... ......... ........... ........... [[Page 47759]] Q9923... A Epoetin with hct = 23.. ......... ......... ......... ........... ........... Q9924... A Epoetin with hct = 24.. ......... ......... ......... ........... ........... Q9925... A Epoetin with hct = 25.. ......... ......... ......... ........... ........... Q9926... A Epoetin with hct = 26.. ......... ......... ......... ........... ........... Q9927... A Epoetin with hct = 27.. ......... ......... ......... ........... ........... Q9928... A Epoetin with hct = 28.. ......... ......... ......... ........... ........... Q9929... A Epoetin with hct = 29.. ......... ......... ......... ........... ........... Q9930... A Epoetin with hct = 30.. ......... ......... ......... ........... ........... Q9931... A Epoetin with hct = 31.. ......... ......... ......... ........... ........... Q9932... A Epoetin with hct = 32.. ......... ......... ......... ........... ........... Q9933... A Epoetin with hct = 33.. ......... ......... ......... ........... ........... Q9934... A Epoetin with hct = 34.. ......... ......... ......... ........... ........... Q9935... A Epoetin with hct = 35.. ......... ......... ......... ........... ........... Q9936... A Epoetin with hct = 36.. ......... ......... ......... ........... ........... Q9937... A Epoetin with hct = 37.. ......... ......... ......... ........... ........... Q9938... A Epoetin with hct = 38.. ......... ......... ......... ........... ........... Q9939... A Epoetin with hct = 39.. ......... ......... ......... ........... ........... Q9940... A Epoetin with hct >= 40. ......... ......... ......... ........... ........... R0070... N Transport portable x- ......... ......... ......... ........... ........... ray. R0075... N Transport port x-ray ......... ......... ......... ........... ........... multipl. R0076... N Transport portable EKG. ......... ......... ......... ........... ........... V2020... A Vision svcs frames ......... ......... ......... ........... ........... purchases. V2025... E Eyeglasses delux frames ......... ......... ......... ........... ........... V2100... A Lens spher single plano ......... ......... ......... ........... ........... 4.00. V2101... A Single visn sphere 4.12- ......... ......... ......... ........... ........... 7.00. V2102... A Singl visn sphere 7.12- ......... ......... ......... ........... ........... 20.00. V2103... A Spherocylindr 4.00d/12- ......... ......... ......... ........... ........... 2.00d. V2104... A Spherocylindr 4.00d/ ......... ......... ......... ........... ........... 2.12-4d. V2105... A Spherocylinder 4.00d/ ......... ......... ......... ........... ........... 4.25-6d. V2106... A Spherocylinder 4.00d/ ......... ......... ......... ........... ........... >6.00d. V2107... A Spherocylinder 4.25d/12- ......... ......... ......... ........... ........... 2d. V2108... A Spherocylinder 4.25d/ ......... ......... ......... ........... ........... 2.12-4d. V2109... A Spherocylinder 4.25d/ ......... ......... ......... ........... ........... 4.25-6d. V2110... A Spherocylinder 4.25d/ ......... ......... ......... ........... ........... over 6d. V2111... A Spherocylindr 7.25d/.25- ......... ......... ......... ........... ........... 2.25. V2112... A Spherocylindr 7.25d/ ......... ......... ......... ........... ........... 2.25-4d. V2113... A Spherocylindr 7.25d/ ......... ......... ......... ........... ........... 4.25-6d. V2114... A Spherocylinder over ......... ......... ......... ........... ........... 12.00d. V2115... A Lens lenticular bifocal ......... ......... ......... ........... ........... V2116... A Nonaspheric lens ......... ......... ......... ........... ........... bifocal. V2117... A Aspheric lens bifocal.. ......... ......... ......... ........... ........... V2118... A Lens aniseikonic single ......... ......... ......... ........... ........... V2199... A Lens single vision not ......... ......... ......... ........... ........... oth c. V2200... A Lens spher bifoc plano ......... ......... ......... ........... ........... 4.00d. V2201... A Lens sphere bifocal ......... ......... ......... ........... ........... 4.12-7.0. V2202... A Lens sphere bifocal ......... ......... ......... ........... ........... 7.12-20. V2203... A Lens sphcyl bifocal ......... ......... ......... ........... ........... 4.00d/.1. V2204... A Lens sphcy bifocal ......... ......... ......... ........... ........... 4.00d/2.1. V2205... A Lens sphcy bifocal ......... ......... ......... ........... ........... 4.00d/4.2. V2206... A Lens sphcy bifocal ......... ......... ......... ........... ........... 4.00d/ove. V2207... A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ........... 7d/. V2208... A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ........... 7/2. V2209... A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ........... 7/4. V2210... A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ........... 7/ov. V2211... A Lens sphcy bifo 7.25-12/ ......... ......... ......... ........... ........... .25-. V2212... A Lens sphcyl bifo 7.25- ......... ......... ......... ........... ........... 12/2.2. V2213... A Lens sphcyl bifo 7.25- ......... ......... ......... ........... ........... 12/4.2. V2214... A Lens sphcyl bifocal ......... ......... ......... ........... ........... over 12. V2215... A Lens lenticular bifocal ......... ......... ......... ........... ........... V2216... A Lens lenticular ......... ......... ......... ........... ........... nonaspheric. V2217... A Lens lenticular ......... ......... ......... ........... ........... aspheric bif. V2218... A Lens aniseikonic ......... ......... ......... ........... ........... bifocal. V2219... A Lens bifocal seg width ......... ......... ......... ........... ........... over. V2220... A Lens bifocal add over ......... ......... ......... ........... ........... 3.25d. V2299... A Lens bifocal speciality ......... ......... ......... ........... ........... V2300... A Lens sphere trifocal ......... ......... ......... ........... ........... 4.00d. V2301... A Lens sphere trifocal ......... ......... ......... ........... ........... 4.12-7. V2302... A Lens sphere trifocal ......... ......... ......... ........... ........... 7.12-20. V2303... A Lens sphcy trifocal 4.0/ ......... ......... ......... ........... ........... .12-. V2304... A Lens sphcy trifocal 4.0/ ......... ......... ......... ........... ........... 2.25. V2305... A Lens sphcy trifocal 4.0/ ......... ......... ......... ........... ........... 4.25. V2306... A Lens sphcyl trifocal ......... ......... ......... ........... ........... 4.00/>6. V2307... A Lens sphcy trifocal ......... ......... ......... ........... ........... 4.25-7/. V2308... A Lens sphc trifocal 4.25- ......... ......... ......... ........... ........... 7/2. V2309... A Lens sphc trifocal 4.25- ......... ......... ......... ........... ........... 7/4. [[Page 47760]] V2310... A Lens sphc trifocal 4.25- ......... ......... ......... ........... ........... 7/>6. V2311... A Lens sphc trifo 7.25-12/ ......... ......... ......... ........... ........... .25-. V2312... A Lens sphc trifo 7.25-12/ ......... ......... ......... ........... ........... 2.25. V2313... A Lens sphc trifo 7.25-12/ ......... ......... ......... ........... ........... 4.25. V2314... A Lens sphcyl trifocal ......... ......... ......... ........... ........... over 12. V2315... A Lens lenticular ......... ......... ......... ........... ........... trifocal. V2316... A Lens lenticular ......... ......... ......... ........... ........... nonaspheric. V2317... A Lens lenticular ......... ......... ......... ........... ........... aspheric tri. V2318... A Lens aniseikonic ......... ......... ......... ........... ........... trifocal. V2319... A Lens trifocal seg width ......... ......... ......... ........... ........... > 28. V2320... A Lens trifocal add over ......... ......... ......... ........... ........... 3.25d. V2399... A Lens trifocal ......... ......... ......... ........... ........... speciality. V2410... A Lens variab asphericity ......... ......... ......... ........... ........... sing. V2430... A Lens variable ......... ......... ......... ........... ........... asphericity bi. V2499... A Variable asphericity ......... ......... ......... ........... ........... lens. V2500... A Contact lens pmma ......... ......... ......... ........... ........... spherical. V2501... A Cntct lens pmma-toric/ ......... ......... ......... ........... ........... prism. V2502... A Contact lens pmma ......... ......... ......... ........... ........... bifocal. V2503... A Cntct lens pmma color ......... ......... ......... ........... ........... vision. V2510... A Cntct gas permeable ......... ......... ......... ........... ........... sphericl. V2511... A Cntct toric prism ......... ......... ......... ........... ........... ballast. V2512... A Cntct lens gas permbl ......... ......... ......... ........... ........... bifocl. V2513... A Contact lens extended ......... ......... ......... ........... ........... wear. V2520... A Contact lens ......... ......... ......... ........... ........... hydrophilic. V2521... A Cntct lens hydrophilic ......... ......... ......... ........... ........... toric. V2522... A Cntct lens hydrophil ......... ......... ......... ........... ........... bifocl. V2523... A Cntct lens hydrophil ......... ......... ......... ........... ........... extend. V2530... A Contact lens gas ......... ......... ......... ........... ........... impermeable. V2531... A Contact lens gas ......... ......... ......... ........... ........... permeable. V2599... A Contact lens/es other ......... ......... ......... ........... ........... type. V2600... A Hand held low vision ......... ......... ......... ........... ........... aids. V2610... A Single lens spectacle ......... ......... ......... ........... ........... mount. V2615... A Telescop/othr compound ......... ......... ......... ........... ........... lens. V2623... A Plastic eye prosth ......... ......... ......... ........... ........... custom. V2624... A Polishing artifical eye ......... ......... ......... ........... ........... V2625... A Enlargemnt of eye ......... ......... ......... ........... ........... prosthesis. V2626... A Reduction of eye ......... ......... ......... ........... ........... prosthesis. V2627... A Scleral cover shell.... ......... ......... ......... ........... ........... V2628... A Fabrication & fitting.. ......... ......... ......... ........... ........... V2629... A Prosthetic eye other ......... ......... ......... ........... ........... type. V2630... N Anter chamber intraocul ......... ......... ......... ........... ........... lens. V2631... N Iris support intraoclr ......... ......... ......... ........... ........... lens. V2632... N Post chmbr intraocular ......... ......... ......... ........... ........... lens. V2700... A Balance lens........... ......... ......... ......... ........... ........... V2710... A Glass/plastic slab off ......... ......... ......... ........... ........... prism. V2715... A Prism lens/es.......... ......... ......... ......... ........... ........... V2718... A Fresnell prism press-on ......... ......... ......... ........... ........... lens. V2730... A Special base curve..... ......... ......... ......... ........... ........... V2740... A Rose tint plastic...... ......... ......... ......... ........... ........... V2741... A Non-rose tint plastic.. ......... ......... ......... ........... ........... V2742... A Rose tint glass........ ......... ......... ......... ........... ........... V2743... A Non-rose tint glass.... ......... ......... ......... ........... ........... V2744... A Tint photochromatic ......... ......... ......... ........... ........... lens/es. V2750... A Anti-reflective coating ......... ......... ......... ........... ........... V2755... A UV lens/es............. ......... ......... ......... ........... ........... V2760... A Scratch resistant ......... ......... ......... ........... ........... coating. V2770... A Occluder lens/es....... ......... ......... ......... ........... ........... V2780... A Oversize lens/es....... ......... ......... ......... ........... ........... V2781... A Progressive lens per ......... ......... ......... ........... ........... lens. V2785... N Corneal tissue ......... ......... ......... ........... ........... processing. V2799... A Miscellaneous vision ......... ......... ......... ........... ........... service. V5008... E Hearing screening...... ......... ......... ......... ........... ........... V5010... E Assessment for hearing ......... ......... ......... ........... ........... aid. V5011... E Hearing aid fitting/ ......... ......... ......... ........... ........... checking. V5014... E Hearing aid repair/ ......... ......... ......... ........... ........... modifying. V5020... E Conformity evaluation.. ......... ......... ......... ........... ........... V5030... E Body-worn hearing aid ......... ......... ......... ........... ........... air. V5040... E Body-worn hearing aid ......... ......... ......... ........... ........... bone. V5050... E Body-worn hearing aid ......... ......... ......... ........... ........... in ear. V5060... E Behind ear hearing aid. ......... ......... ......... ........... ........... V5070... E Glasses air conduction. ......... ......... ......... ........... ........... V5080... E Glasses bone conduction ......... ......... ......... ........... ........... V5090... E Hearing aid dispensing ......... ......... ......... ........... ........... fee. V5100... E Body-worn bilat hearing ......... ......... ......... ........... ........... aid. V5110... E Hearing aid dispensing ......... ......... ......... ........... ........... fee. [[Page 47761]] V5120... E Body-worn binaur ......... ......... ......... ........... ........... hearing aid. V5130... E In ear binaural hearing ......... ......... ......... ........... ........... aid. V5140... E Behind ear binaur ......... ......... ......... ........... ........... hearing ai. V5150... E Glasses binaural ......... ......... ......... ........... ........... hearing aid. V5160... E Dispensing fee binaural ......... ......... ......... ........... ........... V5170... E Within ear cros hearing ......... ......... ......... ........... ........... aid. V5180... E Behind ear cros hearing ......... ......... ......... ........... ........... aid. V5190... E Glasses cros hearing ......... ......... ......... ........... ........... aid. V5200... E Cros hearing aid ......... ......... ......... ........... ........... dispens fee. V5210... E In ear bicros hearing ......... ......... ......... ........... ........... aid. V5220... E Behind ear bicros ......... ......... ......... ........... ........... hearing ai. V5230... E Glasses bicros hearing ......... ......... ......... ........... ........... aid. V5240... E Dispensing fee bicros.. ......... ......... ......... ........... ........... V5299... A Hearing service........ ......... ......... ......... ........... ........... V5336... E Repair communication ......... ......... ......... ........... ........... device. V5362... A Speech screening....... ......... ......... ......... ........... ........... V5363... A Language screening..... ......... ......... ......... ........... ........... V5364... A Dysphagia screening.... ......... ......... ......... ........... ........... ---------------------------------------------------------------------------------------------------------------- Addendum C.--Proposed Hospital Outpatient Payment for Procedures by APC ---------------------------------------------------------------------------------------------------------------- Proposed National Minimum APC CPT \1\/ HCPCS Description Status indicator Relative payment unadjusted unadjusted HCPCS weight rate coinsurance coinsurance ----------\2\--------------------------------------------------------------------------------------------------- 031.. (1)De S 1.34 $67.90 $13.58 $13.58 ntal proc edur es 031.. D0150 Comprehensive oral evaluation 031.. D0240 Intraoral occlusal film 031.. D0250 Extraoral first film 031.. D0260 Extraoral ea additional film 031.. D0270 Dental bitewing single film 031.. D0272 Dental bitewings two films 031.. D0274 Dental bitewings four films 031.. D0460 Pulp vitality test 031.. D0471 Diagnostic photographs 031.. D0501 Histopathologic examinations 031.. D0502 Other oral pathology procedure 031.. D0999 Unspecified diagnostic procedure 031.. D1510 Space maintainer fxd unilat 031.. D1515 Fixed bilat space maintainer 031.. D1520 Remove unilat space maintain 031.. D1525 Remove bilat space maintain 031.. D1550 Recement space maintainer 031.. D2970 Temporary- fractured tooth 031.. D2999 Dental unspec restorative pr 031.. D3460 Endodontic endosseous implan 031.. D3999 Endodontic procedure 031.. D4250 Mucogingival surg per quadra 031.. D4260 Osseous surgery per quadrant 031.. D4263 Bone replce graft first site 031.. D4264 Bone replce graft each add 031.. D4270 Pedicle soft tissue graft pr 031.. D4271 Free soft tissue graft proc 031.. D4273 Subepithelial tissue graft 031.. D4355 Full mouth debridement 031.. D4381 Localized chemo delivery 031.. D5911 Facial moulage sectional 031.. D5912 Facial moulage complete 031.. D5983 Radiation applicator 031.. D5984 Radiation shield 031.. D5985 Radiation cone locator 031.. D5987 Commissure splint 031.. D6920 Dental connector bar 031.. D7110 Oral surgery single tooth 031.. D7120 Each add tooth extraction 031.. D7130 Tooth root removal 031.. D7210 Rem imp tooth w mucoper flp 031.. D7220 Impact tooth remov soft tiss 031.. D7230 Impact tooth remov part bony 031.. D7240 Impact tooth remov comp bony 031.. D7241 Impact tooth rem bony w/comp 031.. D7250 Tooth root removal 031.. D7260 Oral antral fistula closure 031.. D7291 Transseptal fiberotomy [[Page 47762]] 031.. D7940 Reshaping bone orthognathic 031.. D9630 Other drugs/ medicaments 031.. D9930 Treatment of complications 031.. D9940 Dental occlusal guard 031.. D9950 Occlusion analysis 031.. D9951 Limited occlusal adjustment 031.. D9952 Complete occlusal adjustment 031.. K0445 Auricular prosthesis 061.. (1)Le X 1.04 $52.70 $36.61 $10.54 vel I Chem othe rape utic agen ts 061.. J8610 Methotrexate oral 2.5 MG 061.. J8999 Oral prescription drug chemo 061.. J9015 Aldesleukin/single use vial 061.. J9070 Cyclophosphamide 100 MG inj 061.. J9080 Cyclophosphamide 200 MG inj 061.. J9090 Cyclophosphamide 500 MG inj 061.. J9093 Cyclophosphamide lyophilized 061.. J9094 Cyclophosphamide lyophilized 061.. J9095 Cyclophosphamide lyophilized 061.. J9100 Cytarabine hcl 100 MG inj 061.. J9110 Cytarabine hcl 500 MG inj 061.. J9120 Dactinomycin actinomycin d 061.. J9130 Dacarbazine 10 MG inj 061.. J9140 Dacarbazine 200 MG inj 061.. J9165 Diethylstilbestrol injection 061.. J9170 Docetaxel 061.. J9181 Etoposide 10 MG inj 061.. J9190 Fluorouracil injection 061.. J9201 Gemcitabine HCl 061.. J9206 Irinotecan injection 061.. J9214 Interferon alfa-2b inj 061.. J9215 Interferon alfa-n3 inj 061.. J9218 Leuprolide acetate injection 061.. J9230 Mechlorethamine hcl inj 061.. J9250 Methotrexate sodium inj 061.. J9260 Methotrexate sodium inj 061.. J9266 Pegaspargase/singl dose vial 061.. J9350 Topotecan 061.. J9360 Vinblastine sulfate inj 061.. J9390 Vinorelbine tartrate/ 10 mg 061.. J9600 Porfimer sodium 061.. J9999 Chemotherapy drug 062.. (1)Le X 1.69 $85.63 $36.61 $17.13 vel II Chem othe rape utic agen ts 062.. J9000 Doxorubic hcl 10 MG vl chemo 062.. J9020 Asparaginase injection 062.. J9060 Cisplatin 10 MG injection 062.. J9065 Inj cladribine per 1 MG 062.. J9091 Cyclophosphamide 1.0 grm inj 062.. J9092 Cyclophosphamide 2.0 grm inj 062.. J9096 Cyclophosphamide lyophilized 062.. J9097 Cyclophosphamide lyophilized 062.. J9150 Daunorubicin 062.. J9211 Idarubicin hcl injection 062.. J9213 Interferon alfa-2a inj 062.. J9265 Paclitaxel injection 062.. J9268 Pentostatin injection 062.. J9370 Vincristine sulfate 1 MG inj 063.. (1)Le X 2.89 $146.43 $110.97 $29.29 vel III Chem othe rape utic agen ts 063.. J9031 Bcg live intravesical vac 063.. J9040 Bleomycin sulfate injection 063.. J9045 Carboplatin injection 063.. J9050 Carmus bischl nitro inj 063.. J9062 Cisplatin 50 MG injection 063.. J9182 Etoposide 100 MG inj 063.. J9185 Fludarabine phosphate inj 063.. J9200 Floxuridine injection 063.. J9202 Goserelin acetate implant 063.. J9208 Ifosfomide injection 063.. J9209 Mesna injection 063.. J9216 Interferon gamma 1-b inj 063.. J9270 Plicamycin (mithramycin) inj 063.. J9280 Mitomycin 5 MG inj 063.. J9320 Streptozocin injection 063.. J9340 Thiotepa injection 063.. J9375 Vincristine sulfate 2 MG inj [[Page 47763]] 063.. J9380 Vincristine sulfate 5 MG inj 064.. (1)Le X 4.17 $211.29 $140.12 $42.26 vel IV Chem othe rape utic agen ts 064.. J0640 Leucovorin calcium injection 064.. J9217 Leuprolide acetate suspnsion 064.. J9245 Inj melphalan hydrochl 50 MG 064.. J9290 Mitomycin 20 MG inj 064.. J9291 Mitomycin 40 MG inj 064.. J9293 Mitoxantrone hydrochl / 5 MG 089.. (1)Ne X 2.54 $128.7 $37.29 $25.74 urop sych olog ical Test ing 089.. 96100 (5)PS YCHO LOGI CAL TEST ING (INC LUDE S PSYC HODI AGNO STIC ASSE SSME NT OF PERS ONAL ITY, PSYC HOPA THOL OGY, EMOT IONA LITY , INTE LLEC TUAL ABIL ITIE S, EG, WAIS- R, RORS CHAC H, MMPI ) WITH INTE RPRE TATI ON AND REPO RT, PER HOUR 089.. 96105 (5)AS SESS MENT OF APHA SIA (INC LUDE S ASSE SSME NT OF EXPR ESSI VE AND RECE PTIV E SPEE CH AND LANG UAGE FUNC TION , LANG UAGE COMP REHE NSIO N, SPEE CH PROD UCTI ON ABIL ITY, READ ING, SPEL LING , WRIT ING, EG, BY BOST ON DIAG NOST IC APHA SIA EXAM INAT ION) WITH INTE RPRE TATI ON AND REPO RT 089.. 96110 (5)DE VELO PMEN TAL TEST ING; LIMI TED (EG, DEVE LOPM ENTA L SCRE ENIN G TEST II, EARL Y LANG UAGE MILE STON E SCRE EN), WITH INTE RPRE TATI ON AND REPO RT 089.. 96111 (5)DE VELO PMEN TAL TEST ING; EXTE NDED (INC LUDE S ASSE SSME NT OF MOTO R, LANG UAGE , SOCI AL, ADAP TIVE AND/ OR COGN ITIV E FUNC TION ING BY STAN DARD IZED DEVE LOPM ENTA L INST RUME NTS, EG, BAYL EY SCAL ES OF INFA NT DEVE LOPM ENT) WITH INTE RPRE TATI ON AND REPO RT, PER HOUR 089.. 96115 (5)NE UROB EHAV IORA L STAT US EXAM (CLI NICA L ASSE SSME NT OF THIN KING , REAS ONIN G AND JUDG MENT , EG, ACQU IRED KNOW LEDG E, ATTE NTIO N, MEMO RY, VISU AL SPAT IAL ABIL ITIE S, LANG UAGE FUNC TION S, PLAN NING ) WITH INTE RPRE TATI ON AND REPO RT, PER HOUR 089.. 96117 (5)NE UROP SYCH OLOG ICAL TEST ING BATT ERY (EG, HALS TEAD- REIT AN, LURI A, WAIS- R) WITH INTE RPRE TATI ON AND REPO RT, PER HOUR 090.. (1)Mo X 0.85 $43.07 $12.43 $8.61 nito ring psyc hiat ric drug s 090.. 90862 (5)PH ARMA COLO GIC MANA GEME NT, INCL UDIN G PRES CRIP TION , USE, AND REVI EW OF MEDI CATI ON WITH NO MORE THAN MINI MAL MEDI CAL PSYC HOTH ERAP Y 090.. M0064 (5)Vi sit for drug moni tori ng 091.. (1)Br S 1.09 $55.23 $14.01 $11.05 ief Indi vidu al Psyc hoth erap y 091.. 90804 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INSI GHT ORIE NTED , BEHA VIOR MODI FYIN G AND/ OR SUPP ORTI VE, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 20 TO 30 MINU TES FACE- TO- FACE WITH THE PATI ENT; 091.. 90805 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INSI GHT ORIE NTED , BEHA VIOR MODI FYIN G AND/ OR SUPP ORTI VE, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 20 TO 30 MINU TES FACE- TO- FACE WITH THE PATI ENT; WITH MEDI CAL EVAL UATI ON AND MANA GEME NT SERV ICES 091.. 90810 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INTE RACT IVE, USIN G PLAY EQUI PMEN T, PHYS ICAL DEVI CES, LANG UAGE INTE RPRE TER, OR OTHE R MECH ANIS MS OF NON- VERB AL COMM UNIC ATIO N, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 20 TO 30 MINU TES FACE- TO- FACE WITH THE PATI ENT; 091.. 90811 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INTE RACT IVE, USIN G PLAY EQUI PMEN T, PHYS ICAL DEVI CES, LANG UAGE INTE RPRE TER, OR OTHE R MECH ANIS MS OF NON- VERB AL COMM UNIC ATIO N, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 20 TO 30 MINU TES FACE- TO- FACE WITH THE PATI ENT; WITH M 091.. 90899 (5)UN LIST ED PSYC HIAT RIC SERV ICE OR PROC EDUR E 092.. (1)Ex S 1.57 $79.55 $21.92 $15.91 tend ed Indi vidu al Psyc hoth erap y 092.. 90801 (5)PS YCHI ATRI C DIAG NOST IC INTE RVIE W EXAM INAT ION 092.. 90802 (5)IN TERA CTIV E PSYC HIAT RIC DIAG NOST IC INTE RVIE W EXAM INAT ION USIN G PLAY EQUI PMEN T, PHYS ICAL DEVI CES, LANG UAGE INTE RPRE TER, OR OTHE R MECH ANIS MS OF COMM UNIC ATIO N 092.. 90806 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INSI GHT ORIE NTED , BEHA VIOR MODI FYIN G AND/ OR SUPP ORTI VE, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 45 TO 50 MINU TES FACE- TO- FACE WITH THE PATI ENT; 092.. 90807 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INSI GHT ORIE NTED , BEHA VIOR MODI FYIN G AND/ OR SUPP ORTI VE, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 45 TO 50 MINU TES FACE- TO- FACE WITH THE PATI ENT; WITH MEDI CAL EVAL UATI ON AND MANA GEME NT SERV ICES 092.. 90808 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INSI GHT ORIE NTED , BEHA VIOR MODI FYIN G AND/ OR SUPP ORTI VE, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 75 TO 80 MINU TES FACE- TO- FACE WITH THE PATI ENT; 092.. 90809 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INSI GHT ORIE NTED , BEHA VIOR MODI FYIN G AND/ OR SUPP ORTI VE, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 75 TO 80 MINU TES FACE- TO- FACE WITH THE PATI ENT; WITH MEDI CAL EVAL UATI ON AND MANA GEME NT SERV ICES 092.. 90812 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INTE RACT IVE, USIN G PLAY EQUI PMEN T, PHYS ICAL DEVI CES, LANG UAGE INTE RPRE TER, OR OTHE R MECH ANIS MS OF NON- VERB AL COMM UNIC ATIO N, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 45 TO 50 MINU TES FACE- TO- FACE WITH THE PATI ENT; 092.. 90813 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INTE RACT IVE, USIN G PLAY EQUI PMEN T, PHYS ICAL DEVI CES, LANG UAGE INTE RPRE TER, OR OTHE R MECH ANIS MS OF NON- VERB AL COMM UNIC ATIO N, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 45 TO 50 MINU TES FACE- TO- FACE WITH THE PATI ENT; WITH M 092.. 90814 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INTE RACT IVE, USIN G PLAY EQUI PMEN T, PHYS ICAL DEVI CES, LANG UAGE INTE RPRE TER, OR OTHE R MECH ANIS MS OF NON- VERB AL COMM UNIC ATIO N, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 75 TO 80 MINU TES FACE- TO- FACE WITH THE PATI ENT; 092.. 90815 (5)IN DIVI DUAL PSYC HOTH ERAP Y, INTE RACT IVE, USIN G PLAY EQUI PMEN T, PHYS ICAL DEVI CES, LANG UAGE INTE RPRE TER, OR OTHE R MECH ANIS MS OF NON- VERB AL COMM UNIC ATIO N, IN AN OFFI CE OR OUTP ATIE NT FACI LITY , APPR OXIM ATEL Y 75 TO 80 MINU TES FACE- TO- FACE WITH THE PATI ENT; WITH M 092.. 90845 (5)PS YCHO ANAL YSIS 092.. 90865 (5)NA RCOS YNTH ESIS FOR PSYC HIAT RIC DIAG NOST IC AND THER APEU TIC PURP OSES (EG, SODI UM AMOB ARBI TAL (AMY TAL) INTE RVIE W 092.. 90880 (5)HY PNOT HERA PY 093.. (1)Fa mily Psyc hoth erap y S 1.54 $78.03 $20.11 $15.61 [[Page 47764]] 093.. 90846 (5)FA MILY PSYC HOTH ERAP Y (WIT HOUT THE PATI ENT PRES ENT) 093.. 90847 (5)FA MILY PSYC HOTH ERAP Y (CON JOIN T PSYC HOTH ERAP Y) (WIT H PATI ENT PRES ENT) 094.. (1)Gr S 1.24 $62.83 $20.11 $12.57 oup Psyc hoth erap y 094.. 90849 (5)MU LTIP LE- FAMI LY GROU P PSYC HOTH ERAP Y 094.. 90853 (5)GR OUP PSYC HOTH ERAP Y (OTH ER THAN OF A MULT IPLE- FAMI LY GROU P) 094.. 90857 (5)IN TERA CTIV E GROU P PSYC HOTH ERAP Y 121.. (1)Le T 0.67 $33.95 $20.91 $6.79 vel I need le biop sy/ aspi rati on 121.. 17999 (5)UN LIST ED PROC EDUR E, SKIN , MUCO US MEMB RANE AND SUBC UTAN EOUS TISS UE 121.. 19000 (5)PU NCTU RE ASPI RATI ON OF CYST OF BREA ST; 121.. 19001 (5)PU NCTU RE ASPI RATI ON OF CYST OF BREA ST; EACH ADDI TION AL CYST 121.. 20615 (5)AS PIRA TION AND INJE CTIO N FOR TREA TMEN T OF BONE CYST 121.. 55000 (5)PU NCTU RE ASPI RATI ON OF HYDR OCEL E, TUNI CA VAGI NALI S, WITH OR WITH OUT INJE CTIO N OF MEDI CATI ON 121.. 60001 (5)AS PIRA TION AND/ OR INJE CTIO N, THYR OID CYST 121.. 60699 (5)UN LIST ED PROC EDUR E, ENDO CRIN E SYST EM 121.. 85095 (5)BO NE MARR OW; ASPI RATI ON ONLY 121.. 85102 (5)BO NE MARR OW BIOP SY, NEED LE OR TROC AR 121.. 88170 (5)FI NE NEED LE ASPI RATI ON WITH OR WITH OUT PREP ARAT ION OF SMEA RS; SUPE RFIC IAL TISS UE (EG, THYR OID, BREA ST, PROS TATE 121.. 88171 (5)FI NE NEED LE ASPI RATI ON WITH OR WITH OUT PREP ARAT ION OF SMEA RS; DEEP TISS UE UNDE R RADI OLOG IC GUID ANCE 122.. (1)Le T 4.87 $246.76 $115.03 $49.35 vel II need le biop sy/ aspi rati on 122.. 19100 (5)BI OPSY OF BREA ST; NEED LE CORE (SEP ARAT E PROC EDUR E) 122.. 20206 (5)BI OPSY , MUSC LE, PERC UTAN EOUS NEED LE 122.. 32400 (5)BI OPSY , PLEU RA; PERC UTAN EOUS NEED LE 122.. 32405 (5)BI OPSY , LUNG OR MEDI ASTI NUM, PERC UTAN EOUS NEED LE 122.. 38505 (5)BI OPSY OR EXCI SION OF LYMP H NODE (S); BY NEED LE, SUPE RFIC IAL (EG, CERV ICAL , INGU INAL , AXIL LARY ) 122.. 42400 (5)BI OPSY OF SALI VARY GLAN D; NEED LE 122.. 47000 (5)BI OPSY OF LIVE R, NEED LE; PERC UTAN EOUS 122.. 47399 (5)UN LIST ED PROC EDUR E, LIVE R 122.. 48102 (5)BI OPSY OF PANC REAS , PERC UTAN EOUS NEED LE 122.. 48999 (5)UN LIST ED PROC EDUR E, PANC REAS 122.. 49180 (5)BI OPSY , ABDO MINA L OR RETR OPER ITON EAL MASS , PERC UTAN EOUS NEED LE 122.. 50200 (5)RE NAL BIOP SY; PERC UTAN EOUS , BY TROC AR OR NEED LE 122.. 50390 (5)AS PIRA TION AND/ OR INJE CTIO N OF RENA L CYST OR PELV IS BY NEED LE, PERC UTAN EOUS 122.. 54500 (5)BI OPSY OF TEST IS, NEED LE (SEP ARAT E PROC EDUR E) 122.. 54800 (5)BI OPSY OF EPID IDYM IS, NEED LE 122.. 60100 (5)BI OPSY THYR OID, PERC UTAN EOUS CORE NEED LE 122.. 62269 (5)BI OPSY OF SPIN AL CORD , PERC UTAN EOUS NEED LE 122.. 67415 (5)FI NE NEED LE ASPI RATI ON OF ORBI TAL CONT ENTS 131.. (1)Le T 1.94 $98.30 $36.61 $19.66 vel I inci sion & drai nage 131.. 10040 (5)AC NE SURG ERY (EG, MARS UPIA LIZA TION , OPEN ING OR REMO VAL OF MULT IPLE MILI A, COME DONE S, CYST S, PUST ULES ) 131.. 10060 (5)IN CISI ON AND DRAI NAGE OF ABSC ESS (EG, CARB UNCL E, SUPP URAT IVE HIDR ADEN ITIS , CUTA NEOU S OR SUBC UTAN EOUS ABSC ESS, CYST , FURU NCLE , OR PARO NYCH IA); SIMP LE OR SING LE 131.. 10061 (5)IN CISI ON AND DRAI NAGE OF ABSC ESS (EG, CARB UNCL E, SUPP URAT IVE HIDR ADEN ITIS , CUTA NEOU S OR SUBC UTAN EOUS ABSC ESS, CYST , FURU NCLE , OR PARO NYCH IA); COMP LICA TED OR MULT IPLE 131.. 10080 (5)IN CISI ON AND DRAI NAGE OF PILO NIDA L CYST ; SIMP LE 131.. 10081 (5)IN CISI ON AND DRAI NAGE OF PILO NIDA L CYST ; COMP LICA TED 131.. 10120 (5)IN CISI ON AND REMO VAL OF FORE IGN BODY , SUBC UTAN EOUS TISS UES; SIMP LE 131.. 10140 (5)IN CISI ON AND DRAI NAGE OF HEMA TOMA , SERO MA OR FLUI D COLL ECTI ON 131.. 10160 (5)PU NCTU RE ASPI RATI ON OF ABSC ESS, HEMA TOMA , BULL A, OR CYST 131.. 10180 (5)IN CISI ON AND DRAI NAGE , COMP LEX, POST OPER ATIV E WOUN D INFE CTIO N 131.. 11976 (5)RE MOVA L, IMPL ANTA BLE CONT RACE PTIV E CAPS ULES 131.. 20000 (5)IN CISI ON OF SOFT TISS UE ABSC ESS (EG, SECO NDAR Y TO OSTE OMYE LITI S); SUPE RFIC IAL 131.. 26010 (5)DR AINA GE OF FING ER ABSC ESS; SIMP LE 131.. 26011 (5)DR AINA GE OF FING ER ABSC ESS; COMP LICA TED (EG, FELO N) 131.. 69000 (5)DR AINA GE EXTE RNAL EAR, ABSC ESS OR HEMA TOMA ; SIMP LE 131.. 69005 (5)DR AINA GE EXTE RNAL EAR, ABSC ESS OR HEMA TOMA ; COMP LICA TED 131.. 69020 (5)DR AINA GE EXTE RNAL AUDI TORY CANA L, ABSC ESS 132.. (1)Le T 6.04 $306.04 $134.13 $61.21 vel II inci sion & drai nage 132.. 19020 (5)MA STOT OMY WITH EXPL ORAT ION OR DRAI NAGE OF ABSC ESS, DEEP 132.. 20950 (5)MO NITO RING OF INTE RSTI TIAL FLUI D PRES SURE (INC LUDE S INSE RTIO N OF DEVI CE, EG, WICK CATH ETER TECH NIQU E, NEED LE MANO METE R TECH NIQU E) IN DETE CTIO N OF MUSC LE COMP ARTM ENT SYND ROME 132.. 21501 (5)IN CISI ON AND DRAI NAGE , DEEP ABSC ESS OR HEMA TOMA , SOFT TISS UES OF NECK OR THOR AX; 132.. 21700 (5)DI VISI ON OF SCAL ENUS ANTI CUS; WITH OUT RESE CTIO N OF CERV ICAL RIB 132.. 21720 (5)DI VISI ON OF STER NOCL EIDO MAST OID FOR TORT ICOL LIS, OPEN OPER ATIO N; WITH OUT CAST APPL ICAT ION 132.. 21725 (5)DI VISI ON OF STER NOCL EIDO MAST OID FOR TORT ICOL LIS, OPEN OPER ATIO N; WITH CAST APPL ICAT ION 132.. 23030 (5)IN CISI ON AND DRAI NAGE , SHOU LDER AREA ; DEEP ABSC ESS OR HEMA TOMA 132.. 23031 (5)IN CISI ON AND DRAI NAGE , SHOU LDER AREA ; INFE CTED BURS A 132.. 23930 (5)IN CISI ON AND DRAI NAGE , UPPE R ARM OR ELBO W AREA ; DEEP ABSC ESS OR HEMA TOMA 132.. 23931 (5)IN CISI ON AND DRAI NAGE , UPPE R ARM OR ELBO W AREA ; INFE CTED BURS A 132.. 27301 (5)IN CISI ON AND DRAI NAGE OF DEEP ABSC ESS, INFE CTED BURS A, OR HEMA TOMA , THIG H OR KNEE REGI ON 132.. 27603 (5)IN CISI ON AND DRAI NAGE , LEG OR ANKL E; DEEP ABSC ESS OR HEMA TOMA 132.. 28001 (5)IN CISI ON AND DRAI NAGE , INFE CTED BURS A, FOOT 132.. 38300 (5)DR AINA GE OF LYMP H NODE ABSC ESS OR LYMP HADE NITI S; SIMP LE [[Page 47765]] 132.. 38305 (5)DR AINA GE OF LYMP H NODE ABSC ESS OR LYMP HADE NITI S; EXTE NSIV E 132.. 38999 (5)UN LIST ED PROC EDUR E, HEMI C OR LYMP HATI C SYST EM 132.. 51080 (5)DR AINA GE OF PERI VESI CAL OR PREV ESIC AL SPAC E ABSC ESS 132.. 54015 (5)IN CISI ON AND DRAI NAGE OF PENI S, DEEP 132.. 54115 (5)RE MOVA L FORE IGN BODY FROM DEEP PENI LE TISS UE (EG, PLAS TIC IMPL ANT) 132.. 55100 (5)DR AINA GE OF SCRO TAL WALL ABSC ESS 137.. (1)Na T 0.46 $23.31 $4.66 $4.66 il proc edur es 137.. 11719 (5)TR IMMI NG OF NOND YSTR OPHI C NAIL S, ANY NUMB ER 137.. 11720 (5)DE BRID EMEN T OF NAIL (S) BY ANY METH OD(S ); ONE TO FIVE 137.. 11721 (5)DE BRID EMEN T OF NAIL (S) BY ANY METH OD(S ); SIX OR MORE 137.. 11740 (5)EV ACUA TION OF SUBU NGUA L HEMA TOMA 137.. 11755 (5)BI OPSY OF NAIL UNIT , ANY METH OD (EG, PLAT E, BED, MATR IX, HYPO NYCH IUM, PROX IMAL AND LATE RAL NAIL FOLD S) (SEP ARAT E PROC EDUR E) 141.. (1)Le T 0.59 $29.90 $9.49 $5.98 vel I Dest ruct ion of lesi on 141.. 17000 (5)DE STRU CTIO N BY ANY METH OD, INCL UDIN G LASE R, WITH OR WITH OUT SURG ICAL CURE TTEM ENT, ALL BENI GN OR PREM ALIG NANT LESI ONS (EG, ACTI NIC KERA TOSE S) OTHE R THAN SKIN TAGS OR CUTA NEOU S VASC ULAR PROL IFER ATIV E LESI ONS, INCL UDIN G LOCA L ANES THES IA; FIRS T LESI ON 141.. 17003 (5)DE STRU CTIO N BY ANY METH OD, INCL UDIN G LASE R, WITH OR WITH OUT SURG ICAL CURE TTEM ENT, ALL BENI GN OR PREM ALIG NANT LESI ONS (EG, ACTI NIC KERA TOSE S) OTHE R THAN SKIN TAGS OR CUTA NEOU S VASC ULAR PROL IFER ATIV E LESI ONS, INCL UDIN G LOCA L ANES THES IA; SECO ND THRO UGH 14 LE 141.. 17106 (5)DE STRU CTIO N OF CUTA NEOU S VASC ULAR PROL IFER ATIV E LESI ONS (EG, LASE R TECH NIQU E); LESS THAN 10 SQ CM 141.. 17110 (5)DE STRU CTIO N BY ANY METH OD OF FLAT WART S, MOLL USCU M CONT AGIO SUM, OR MILI A; UP TO 14 LESI ONS 142.. (1)Le T 3.77 $191.02 $73.00 $38.20 vel II Dest ruct ion of lesi on 142.. 17004 (5)DE STRU CTIO N BY ANY METH OD, INCL UDIN G LASE R, WITH OR WITH OUT SURG ICAL CURE TTEM ENT, ALL BENI GN OR PREM ALIG NANT LESI ONS (EG, ACTI NIC KERA TOSE S) OTHE R THAN SKIN TAGS OR CUTA NEOU S VASC ULAR PROL IFER ATIV E LESI ONS, INCL UDIN G LOCA L ANES THES IA; 15 OR MORE LESI ONS 142.. 17107 (5)DE STRU CTIO N OF CUTA NEOU S VASC ULAR PROL IFER ATIV E LESI ONS (EG, LASE R TECH NIQU E); 10.0 -50. 0 SQ CM 142.. 17108 (5)DE STRU CTIO N OF CUTA NEOU S VASC ULAR PROL IFER ATIV E LESI ONS (EG, LASE R TECH NIQU E); OVER 50.0 SQ CM 142.. 17111 (5)DE STRU CTIO N BY ANY METH OD OF FLAT WART S, MOLL USCU M CONT AGIO SUM, OR MILI A; 15 OR MORE LESI ONS 151.. (1)Le T 1.74 $88.16 $35.71 $17.63 vel I debr idem ent/ dest ruct ion 151.. 11000 (5)DE BRID EMEN T OF EXTE NSIV E ECZE MATO US OR INFE CTED SKIN ; UP TO 10% OF BODY SURF ACE 151.. 11001 (5)DE BRID EMEN T OF EXTE NSIV E ECZE MATO US OR INFE CTED SKIN ; EACH ADDI TION AL 10% OF THE BODY SURF ACE 151.. 11040 (5)DE BRID EMEN T; SKIN , PART IAL THIC KNES S 151.. 11041 (5)DE BRID EMEN T; SKIN , FULL THIC KNES S 151.. 11042 (5)DE BRID EMEN T; SKIN , AND SUBC UTAN EOUS TISS UE 151.. 11055 (5)PA RING OR CUTT ING OF BENI GN HYPE RKER ATOT IC LESI ON (EG, CORN OR CALL US); SING LE LESI ON 151.. 11056 (5)PA RING OR CUTT ING OF BENI GN HYPE RKER ATOT IC LESI ON (EG, CORN OR CALL US); TWO TO FOUR LESI ONS 151.. 11057 (5)PA RING OR CUTT ING OF BENI GN HYPE RKER ATOT IC LESI ON (EG, CORN OR CALL US); MORE THAN FOUR LESI ONS 151.. 11200 (5)RE MOVA L OF SKIN TAGS , MULT IPLE FIBR OCUT ANEO US TAGS , ANY AREA ; UP TO AND INCL UDIN G 15 LESI ONS 151.. 11201 (5)RE MOVA L OF SKIN TAGS , MULT IPLE FIBR OCUT ANEO US TAGS , ANY AREA ; EACH ADDI TION AL TEN LESI ONS 151.. 11300 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 0.5 CM OR LESS 151.. 11301 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 0.6 TO 1.0 CM 151.. 11302 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 1.1 TO 2.0 CM 151.. 11303 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER OVER 2.0 CM 151.. 11305 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.5 CM OR LESS 151.. 11306 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.6 TO 1.0 CM 151.. 11307 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 1.1 TO 2.0 CM 151.. 11308 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER OVER 2.0 CM 151.. 11310 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 0.5 CM OR LESS 151.. 11311 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 0.6 TO 1.0 CM 151.. 11312 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 1.1 TO 2.0 CM 151.. 11313 (5)SH AVIN G OF EPID ERMA L OR DERM AL LESI ON, SING LE LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER OVER 2.0 CM 151.. 11730 (5)AV ULSI ON OF NAIL PLAT E, PART IAL OR COMP LETE , SIMP LE; SING LE 151.. 11731 (5)AV ULSI ON OF NAIL PLAT E, PART IAL OR COMP LETE , SIMP LE; SECO ND NAIL PLAT E 151.. 11732 (5)AV ULSI ON OF NAIL PLAT E, PART IAL OR COMP LETE , SIMP LE; EACH ADDI TION AL NAIL PLAT E 151.. 11765 (5)WE DGE EXCI SION OF SKIN OF NAIL FOLD (EG, FOR INGR OWN TOEN AIL) 151.. 11900 (5)IN JECT ION, INTR ALES IONA L; UP TO AND INCL UDIN G SEVE N LESI ONS 151.. 11901 (5)IN JECT ION, INTR ALES IONA L; MORE THAN SEVE N LESI ONS 151.. 15783 (5)DE RMAB RASI ON; SUPE RFIC IAL, ANY SITE , (EG, TATT OO REMO VAL) 151.. 15786 (5)AB RASI ON; SING LE LESI ON (EG, KERA TOSI S, SCAR ) 151.. 15787 (5)AB RASI ON; EACH ADDI TION AL FOUR LESI ONS OR LESS 151.. 15788 (5)CH EMIC AL PEEL , FACI AL; EPID ERMA L 151.. 15789 (5)CH EMIC AL PEEL , FACI AL; DERM AL 151.. 15792 (5)CH EMIC AL PEEL , NONF ACIA L; EPID ERMA L 151.. 15793 (5)CH EMIC AL PEEL , NONF ACIA L; DERM AL [[Page 47766]] 151.. 15810 (5)SA LABR ASIO N; 20 SQ CM OR LESS 151.. 15850 (5)RE MOVA L OF SUTU RES UNDE R ANES THES IA (OTH ER THAN LOCA L), SAME SURG EON 151.. 15851 (5)RE MOVA L OF SUTU RES UNDE R ANES THES IA (OTH ER THAN LOCA L), OTHE R SURG EON 151.. 15852 (5)DR ESSI NG CHAN GE (FOR OTHE R THAN BURN S) UNDE R ANES THES IA (OTH ER THAN LOCA L) 151.. 16000 (5)IN ITIA L TREA TMEN T, FIRS T DEGR EE BURN , WHEN NO MORE THAN LOCA L TREA TMEN T IS REQU IRED 151.. 16020 (5)DR ESSI NGS AND/ OR DEBR IDEM ENT, INIT IAL OR SUBS EQUE NT; WITH OUT ANES THES IA, OFFI CE OR HOSP ITAL , SMAL L 151.. 16025 (5)DR ESSI NGS AND/ OR DEBR IDEM ENT, INIT IAL OR SUBS EQUE NT; WITH OUT ANES THES IA, MEDI UM (EG, WHOL E FACE OR WHOL E EXTR EMIT Y) 151.. 16030 (5)DR ESSI NGS AND/ OR DEBR IDEM ENT, INIT IAL OR SUBS EQUE NT; WITH OUT ANES THES IA, LARG E (EG, MORE THAN ONE EXTR EMIT Y) 151.. 17250 (5)CH EMIC AL CAUT ERIZ ATIO N OF GRAN ULAT ION TISS UE (PRO UD FLES H, SINU S OR FIST ULA) 151.. 17260 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 0.5 CM OR LESS 151.. 17261 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 0.6 TO 1.0 CM 151.. 17262 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 1.1 TO 2.0 CM 151.. 17263 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 2.1 TO 3.0 CM 151.. 17264 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 3.1 TO 4.0 CM 151.. 17266 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER OVER 4.0 CM 151.. 17270 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.5 CM OR LESS 151.. 17271 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.6 TO 1.0 CM 151.. 17272 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 1.1 TO 2.0 CM 151.. 17273 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 2.1 TO 3.0 CM 151.. 17274 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 3.1 TO 4.0 CM 151.. 17276 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER OVER 4.0 CM 151.. 17280 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 0.5 CM OR LESS 151.. 17281 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 0.6 TO 1.0 CM 151.. 17282 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 1.1 TO 2.0 CM 151.. 17283 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 2.1 TO 3.0 CM 151.. 17284 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 3.1 TO 4.0 CM 151.. 17286 (5)DE STRU CTIO N, MALI GNAN T LESI ON, ANY METH OD, FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER OVER 4.0 CM 151.. 17340 (5)CR YOTH ERAP Y (CO2 SLUS H, LIQU ID N2) FOR ACNE 151.. 17360 (5)CH EMIC AL EXFO LIAT ION FOR ACNE (EG, ACNE PAST E, ACID ) 151.. 17380 (5)EL ECTR OLYS IS EPIL ATIO N, EACH 1/2 HOUR 151.. 42809 (5)RE MOVA L OF FORE IGN BODY FROM PHAR YNX 151.. 69220 (5)DE BRID EMEN T, MAST OIDE CTOM Y CAVI TY, SIMP LE (EG, ROUT INE CLEA NING ) 152.. (1)Le T 10.43 $528.48 $261.71 $105.7 vel II debr idem ent/ dest ruct ion 152.. 16010 (5)DR ESSI NGS AND/ OR DEBR IDEM ENT, INIT IAL OR SUBS EQUE NT; UNDE R ANES THES IA, SMAL L 152.. 16015 (5)DR ESSI NGS AND/ OR DEBR IDEM ENT, INIT IAL OR SUBS EQUE NT; UNDE R ANES THES IA, MEDI UM OR LARG E, OR WITH MAJO R DEBR IDEM ENT 152.. 46900 (5)DE STRU CTIO N OF LESI ON(S ), ANUS (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; CHEM ICAL 152.. 46910 (5)DE STRU CTIO N OF LESI ON(S ), ANUS (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; ELEC TROD ESIC CATI ON 152.. 46916 (5)DE STRU CTIO N OF LESI ON(S ), ANUS (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; CRYO SURG ERY 152.. 46917 (5)DE STRU CTIO N OF LESI ON(S ), ANUS (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; LASE R SURG ERY 152.. 46922 (5)DE STRU CTIO N OF LESI ON(S ), ANUS (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; SURG ICAL EXCI SION 152.. 46924 (5)DE STRU CTIO N OF LESI ON(S ), ANUS (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , EXTE NSIV E, ANY METH OD 152.. 54050 (5)DE STRU CTIO N OF LESI ON(S ), PENI S (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; CHEM ICAL 152.. 54055 (5)DE STRU CTIO N OF LESI ON(S ), PENI S (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; ELEC TROD ESIC CATI ON 152.. 54056 (5)DE STRU CTIO N OF LESI ON(S ), PENI S (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; CRYO SURG ERY 152.. 54057 (5)DE STRU CTIO N OF LESI ON(S ), PENI S (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; LASE R SURG ERY 152.. 54060 (5)DE STRU CTIO N OF LESI ON(S ), PENI S (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , SIMP LE; SURG ICAL EXCI SION 152.. 54065 (5)DE STRU CTIO N OF LESI ON(S ), PENI S (EG, COND YLOM A, PAPI LLOM A, MOLL USCU M CONT AGIO SUM, HERP ETIC VESI CLE) , EXTE NSIV E, ANY METH OD 152.. 56501 (5)DE STRU CTIO N OF LESI ON(S ), VULV A; SIMP LE, ANY METH OD 152.. 56515 (5)DE STRU CTIO N OF LESI ON(S ), VULV A; EXTE NSIV E, ANY METH OD 161.. (1)Le T 3.50 $177.34 $75.48 $35.47 vel I exci sion/ biop sy 161.. 11100 (5)BI OPSY OF SKIN , SUBC UTAN EOUS TISS UE AND/ OR MUCO US MEMB RANE (INC LUDI NG SIMP LE CLOS URE) , UNLE SS OTHE RWIS E LIST ED (SEP ARAT E PROC EDUR E); SING LE LESI ON 161.. 11101 (5)BI OPSY OF SKIN , SUBC UTAN EOUS TISS UE AND/ OR MUCO US MEMB RANE (INC LUDI NG SIMP LE CLOS URE) , UNLE SS OTHE RWIS E LIST ED (SEP ARAT E PROC EDUR E); EACH SEPA RATE/ ADDI TION AL LESI ON [[Page 47767]] 161.. 11400 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 0.5 CM OR LESS 161.. 11401 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 0.6 TO 1.0 CM 161.. 11402 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 1.1 TO 2.0 CM 161.. 11403 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 2.1 TO 3.0 CM 161.. 11420 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.5 CM OR LESS 161.. 11421 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.6 TO 1.0 CM 161.. 11422 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 1.1 TO 2.0 CM 161.. 11423 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 2.1 TO 3.0 CM 161.. 11440 (5)EX CISI ON, OTHE R BENI GN LESI ON (UNL ESS LIST ED ELSE WHER E), FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 0.5 CM OR LESS 161.. 11441 (5)EX CISI ON, OTHE R BENI GN LESI ON (UNL ESS LIST ED ELSE WHER E), FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 0.6 TO 1.0 CM 161.. 11442 (5)EX CISI ON, OTHE R BENI GN LESI ON (UNL ESS LIST ED ELSE WHER E), FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 1.1 TO 2.0 CM 161.. 11443 (5)EX CISI ON, OTHE R BENI GN LESI ON (UNL ESS LIST ED ELSE WHER E), FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 2.1 TO 3.0 CM 161.. 11600 (5)EX CISI ON, MALI GNAN T LESI ON, TRUN K, ARMS , OR LEGS ; LESI ON DIAM ETER 0.5 CM OR LESS 161.. 11601 (5)EX CISI ON, MALI GNAN T LESI ON, TRUN K, ARMS , OR LEGS ; LESI ON DIAM ETER 0.6 TO 1.0 CM 161.. 11602 (5)EX CISI ON, MALI GNAN T LESI ON, TRUN K, ARMS , OR LEGS ; LESI ON DIAM ETER 1.1 TO 2.0 CM 161.. 11603 (5)EX CISI ON, MALI GNAN T LESI ON, TRUN K, ARMS , OR LEGS ; LESI ON DIAM ETER 2.1 TO 3.0 CM 161.. 11620 (5)EX CISI ON, MALI GNAN T LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.5 CM OR LESS 161.. 11621 (5)EX CISI ON, MALI GNAN T LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 0.6 TO 1.0 CM 161.. 11622 (5)EX CISI ON, MALI GNAN T LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 1.1 TO 2.0 CM 161.. 11623 (5)EX CISI ON, MALI GNAN T LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 2.1 TO 3.0 CM 161.. 11640 (5)EX CISI ON, MALI GNAN T LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS ; LESI ON DIAM ETER 0.5 CM OR LESS 161.. 11641 (5)EX CISI ON, MALI GNAN T LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS ; LESI ON DIAM ETER 0.6 TO 1.0 CM 161.. 11642 (5)EX CISI ON, MALI GNAN T LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS ; LESI ON DIAM ETER 1.1 TO 2.0 CM 161.. 11643 (5)EX CISI ON, MALI GNAN T LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS ; LESI ON DIAM ETER 2.1 TO 3.0 CM 161.. 11750 (5)EX CISI ON OF NAIL AND NAIL MATR IX, PART IAL OR COMP LETE , (EG, INGR OWN OR DEFO RMED NAIL ) FOR PERM ANEN T REMO VAL; 161.. 20520 (5)RE MOVA L OF FORE IGN BODY IN MUSC LE OR TEND ON SHEA TH; SIMP LE 161.. 21550 (5)BI OPSY , SOFT TISS UE OF NECK OR THOR AX 161.. 21920 (5)BI OPSY , SOFT TISS UE OF BACK OR FLAN K; SUPE RFIC IAL 161.. 23065 (5)BI OPSY , SOFT TISS UE OF SHOU LDER AREA ; SUPE RFIC IAL 161.. 24065 (5)BI OPSY , SOFT TISS UE OF UPPE R ARM OR ELBO W AREA ; SUPE RFIC IAL 161.. 24200 (5)RE MOVA L OF FORE IGN BODY , UPPE R ARM OR ELBO W AREA ; SUBC UTAN EOUS 161.. 25065 (5)BI OPSY , SOFT TISS UE OF FORE ARM AND/ OR WRIS T; SUPE RFIC IAL 161.. 27613 (5)BI OPSY , SOFT TISS UE OF LEG OR ANKL E AREA ; SUPE RFIC IAL 161.. 28190 (5)RE MOVA L OF FORE IGN BODY , FOOT ; SUBC UTAN EOUS 161.. 56605 (5)BI OPSY OF VULV A OR PERI NEUM (SEP ARAT E PROC EDUR E); ONE LESI ON 161.. 56606 (5)BI OPSY OF VULV A OR PERI NEUM (SEP ARAT E PROC EDUR E); EACH SEPA RATE ADDI TION AL LESI ON 161.. 58999 (5)UN LIST ED PROC EDUR E, FEMA LE GENI TAL SYST EM (NON OBST ETRI CAL) 161.. 69100 (5)BI OPSY EXTE RNAL EAR 161.. 69105 (5)BI OPSY EXTE RNAL AUDI TORY CANA L 162.. (1)Le T 5.67 $287.30 $125.43 $57.46 vel II exci sion/ biop sy 162.. 11043 (5)DE BRID EMEN T; SKIN , SUBC UTAN EOUS TISS UE, AND MUSC LE 162.. 11044 (5)DE BRID EMEN T; SKIN , SUBC UTAN EOUS TISS UE, MUSC LE, AND BONE 162.. 11404 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER 3.1 TO 4.0 CM 162.. 11424 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 3.1 TO 4.0 CM 162.. 11444 (5)EX CISI ON, OTHE R BENI GN LESI ON (UNL ESS LIST ED ELSE WHER E), FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER 3.1 TO 4.0 CM 162.. 11604 (5)EX CISI ON, MALI GNAN T LESI ON, TRUN K, ARMS , OR LEGS ; LESI ON DIAM ETER 3.1 TO 4.0 CM 162.. 11770 (5)EX CISI ON OF PILO NIDA L CYST OR SINU S; SIMP LE 162.. 16035 (5)ES CHAR OTOM Y 162.. 16040 (5)EX CISI ON BURN WOUN D, WITH OUT SKIN GRAF TING , EMPL OYIN G ALLO PLAS TIC DRES SING (EG, SYNT HETI C MESH ), ANY ANAT OMIC SITE ; UP TO ONE PERC ENT TOTA L BODY SURF ACE AREA 162.. 16041 (5)EX CISI ON BURN WOUN D, WITH OUT SKIN GRAF TING , EMPL OYIN G ALLO PLAS TIC DRES SING (EG, SYNT HETI C MESH ), ANY ANAT OMIC SITE ; GREA TER THAN ONE PERC ENT AND UP TO NINE PERC ENT TOTA L BODY SURF ACE AREA 162.. 16042 (5)EX CISI ON BURN WOUN D, WITH OUT SKIN GRAF TING , EMPL OYIN G ALLO PLAS TIC DRES SING (EG, SYNT HETI C MESH ), ANY ANAT OMIC SITE ; EACH ADDI TION AL NINE PERC ENT TOTA L BODY SURF ACE AREA , OR PART THER EOF 162.. 17304 (5)CH EMOS URGE RY (MOH S` MICR OGRA PHIC TECH NIQU E), INCL UDIN G REMO VAL OF ALL GROS S TUMO R, SURG ICAL EXCI SION OF TISS UE SPEC IMEN S, MAPP ING, COLO R CODI NG OF SPEC IMEN S, MICR OSCO PIC EXAM INAT ION OF SPEC IMEN S BY THE SURG EON, AND COMP LETE HIST OPAT HOLO GIC PREP ARAT ION; FI 162.. 17305 (5)CH EMOS URGE RY (MOH S` MICR OGRA PHIC TECH NIQU E), INCL UDIN G REMO VAL OF ALL GROS S TUMO R, SURG ICAL EXCI SION OF TISS UE SPEC IMEN S, MAPP ING, COLO R CODI NG OF SPEC IMEN S, MICR OSCO PIC EXAM INAT ION OF SPEC IMEN S BY THE SURG EON, AND COMP LETE HIST OPAT HOLO GIC PREP ARAT ION; SE [[Page 47768]] 162.. 17306 (5)CH EMOS URGE RY (MOH S` MICR OGRA PHIC TECH NIQU E), INCL UDIN G REMO VAL OF ALL GROS S TUMO R, SURG ICAL EXCI SION OF TISS UE SPEC IMEN S, MAPP ING, COLO R CODI NG OF SPEC IMEN S, MICR OSCO PIC EXAM INAT ION OF SPEC IMEN S BY THE SURG EON, AND COMP LETE HIST OPAT HOLO GIC PREP ARAT ION; TH 162.. 17307 (5)CH EMOS URGE RY (MOH S` MICR OGRA PHIC TECH NIQU E), INCL UDIN G REMO VAL OF ALL GROS S TUMO R, SURG ICAL EXCI SION OF TISS UE SPEC IMEN S, MAPP ING, COLO R CODI NG OF SPEC IMEN S, MICR OSCO PIC EXAM INAT ION OF SPEC IMEN S BY THE SURG EON, AND COMP LETE HIST OPAT HOLO GIC PREP ARAT ION; AD 162.. 17310 (5)CH EMOS URGE RY (MOH S` MICR OGRA PHIC TECH NIQU E), INCL UDIN G REMO VAL OF ALL GROS S TUMO R, SURG ICAL EXCI SION OF TISS UE SPEC IMEN S, MAPP ING, COLO R CODI NG OF SPEC IMEN S, MICR OSCO PIC EXAM INAT ION OF SPEC IMEN S BY THE SURG EON, AND COMP LETE HIST OPAT HOLO GIC PREP ARAT ION; MO 162.. 20200 (5)BI OPSY , MUSC LE; SUPE RFIC IAL 162.. 20205 (5)BI OPSY , MUSC LE; DEEP 162.. 20220 (5)BI OPSY , BONE , TROC AR, OR NEED LE; SUPE RFIC IAL (EG, ILIU M, STER NUM, SPIN OUS PROC ESS, RIBS ) 162.. 20225 (5)BI OPSY , BONE , TROC AR, OR NEED LE; DEEP (VER TEBR AL BODY , FEMU R) 162.. 20670 (5)RE MOVA L OF IMPL ANT; SUPE RFIC IAL, (EG, BURI ED WIRE , PIN OR ROD) (SEP ARAT E PROC EDUR E) 162.. 23000 (5)RE MOVA L OF SUBD ELTO ID (OR INTR ATEN DINO US) CALC AREO US DEPO SITS , OPEN METH OD 162.. 23075 (5)EX CISI ON, TUMO R, SHOU LDER AREA ; SUBC UTAN EOUS 162.. 24075 (5)EX CISI ON, TUMO R, UPPE R ARM OR ELBO W AREA ; SUBC UTAN EOUS 162.. 25075 (5)EX CISI ON, TUMO R, FORE ARM AND/ OR WRIS T AREA ; SUBC UTAN EOUS 162.. 27040 (5)BI OPSY , SOFT TISS UE OF PELV IS AND HIP AREA ; SUPE RFIC IAL 162.. 27323 (5)BI OPSY , SOFT TISS UE OF THIG H OR KNEE AREA ; SUPE RFIC IAL 162.. 28043 (5)EX CISI ON, TUMO R, FOOT ; SUBC UTAN EOUS 162.. 37609 (5)LI GATI ON OR BIOP SY, TEMP ORAL ARTE RY 162.. 37799 (5)UN LIST ED PROC EDUR E, VASC ULAR SURG ERY 162.. 54100 (5)BI OPSY OF PENI S; CUTA NEOU S (SEP ARAT E PROC EDUR E) 162.. 54105 (5)BI OPSY OF PENI S; DEEP STRU CTUR ES 162.. 67350 (5)BI OPSY OF EXTR AOCU LAR MUSC LE 162.. 67399 (5)UN LIST ED PROC EDUR E, OCUL AR MUSC LE 162.. 68100 (5)BI OPSY OF CONJ UNCT IVA 162.. 68110 (5)EX CISI ON OF LESI ON, CONJ UNCT IVA; UP TO 1 CM 162.. 68115 (5)EX CISI ON OF LESI ON, CONJ UNCT IVA; OVER 1 CM 162.. 68135 (5)DE STRU CTIO N OF LESI ON, CONJ UNCT IVA 162.. 68399 (5)UN LIST ED PROC EDUR E, CONJ UNCT IVA 163.. (1)Le T 10.69 $541.66 $264.65 $108.33 vel III exci sion/ biop sy 163.. 10121 (5)IN CISI ON AND REMO VAL OF FORE IGN BODY , SUBC UTAN EOUS TISS UES; COMP LICA TED 163.. 11010 (5)DE BRID EMEN T INCL UDIN G REMO VAL OF FORE IGN MATE RIAL ASSO CIAT ED WITH OPEN FRAC TURE (S) AND/ OR DISL OCAT ION( S); SKIN AND SUBC UTAN EOUS TISS UES 163.. 11011 (5)DE BRID EMEN T INCL UDIN G REMO VAL OF FORE IGN MATE RIAL ASSO CIAT ED WITH OPEN FRAC TURE (S) AND/ OR DISL OCAT ION( S); SKIN , SUBC UTAN EOUS TISS UE, MUSC LE FASC IA, AND MUSC LE 163.. 11012 (5)DE BRID EMEN T INCL UDIN G REMO VAL OF FORE IGN MATE RIAL ASSO CIAT ED WITH OPEN FRAC TURE (S) AND/ OR DISL OCAT ION( S); SKIN , SUBC UTAN EOUS TISS UE, MUSC LE FASC IA, MUSC LE, AND BONE 163.. 11406 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), TRUN K, ARMS OR LEGS ; LESI ON DIAM ETER OVER 163.. 11426 (5)EX CISI ON, BENI GN LESI ON, EXCE PT SKIN TAG (UNL ESS LIST ED ELSE WHER E), SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER OVER 4.0 CM 163.. 11446 (5)EX CISI ON, OTHE R BENI GN LESI ON (UNL ESS LIST ED ELSE WHER E), FACE , EARS , EYEL IDS, NOSE , LIPS , MUCO US MEMB RANE ; LESI ON DIAM ETER OVER 4.0 CM 163.. 11450 (5)EX CISI ON OF SKIN AND SUBC UTAN EOUS TISS UE FOR HIDR ADEN ITIS , AXIL LARY ; WITH SIMP LE OR INTE RMED IATE REPA IR 163.. 11451 (5)EX CISI ON OF SKIN AND SUBC UTAN EOUS TISS UE FOR HIDR ADEN ITIS , AXIL LARY ; WITH COMP LEX REPA IR 163.. 11462 (5)EX CISI ON OF SKIN AND SUBC UTAN EOUS TISS UE FOR HIDR ADEN ITIS , INGU INAL ; WITH SIMP LE OR INTE RMED IATE REPA IR 163.. 11463 (5)EX CISI ON OF SKIN AND SUBC UTAN EOUS TISS UE FOR HIDR ADEN ITIS , INGU INAL ; WITH COMP LEX REPA IR 163.. 11470 (5)EX CISI ON OF SKIN AND SUBC UTAN EOUS TISS UE FOR HIDR ADEN ITIS , PERI ANAL , PERI NEAL , OR UMBI LICA L; WITH SIMP LE OR INTE RMED IATE REPA IR 163.. 11471 (5)EX CISI ON OF SKIN AND SUBC UTAN EOUS TISS UE FOR HIDR ADEN ITIS , PERI ANAL , PERI NEAL , OR UMBI LICA L; WITH COMP LEX REPA IR 163.. 11606 (5)EX CISI ON, MALI GNAN T LESI ON, TRUN K, ARMS , OR LEGS ; LESI ON DIAM ETER OVER 4.0 CM 163.. 11624 (5)EX CISI ON, MALI GNAN T LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER 3.1 TO 4.0 CM 163.. 11626 (5)EX CISI ON, MALI GNAN T LESI ON, SCAL P, NECK , HAND S, FEET , GENI TALI A; LESI ON DIAM ETER OVER 4.0 CM 163.. 11644 (5)EX CISI ON, MALI GNAN T LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS ; LESI ON DIAM ETER 3.1 TO 4.0 CM 163.. 11646 (5)EX CISI ON, MALI GNAN T LESI ON, FACE , EARS , EYEL IDS, NOSE , LIPS ; LESI ON DIAM ETER OVER 4.0 CM 163.. 11752 (5)EX CISI ON OF NAIL AND NAIL MATR IX, PART IAL OR COMP LETE , (EG, INGR OWN OR DEFO RMED NAIL ) FOR PERM ANEN T REMO VAL; WITH AMPU TATI ON OF TUFT OF DIST AL PHAL ANX 163.. 11771 (5)EX CISI ON OF PILO NIDA L CYST OR SINU S; EXTE NSIV E 163.. 11772 (5)EX CISI ON OF PILO NIDA L CYST OR SINU S; COMP LICA TED 163.. 11971 (5)RE MOVA L OF TISS UE EXPA NDER (S) WITH OUT INSE RTIO N OF PROS THES IS 163.. 15780 (5)DE RMAB RASI ON; TOTA L FACE (EG, FOR ACNE SCAR RING , FINE WRIN KLIN G, RHYT IDS, GENE RAL KERA TOSI S) 163.. 15781 (5)DE RMAB RASI ON; SEGM ENTA L, FACE 163.. 15782 (5)DE RMAB RASI ON; REGI ONAL , OTHE R THAN FACE 163.. 15811 (5)SA LABR ASIO N; OVER 20 SQ CM 163.. 15838 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); SUBM ENTA L FAT PAD 163.. 15920 (5)EX CISI ON, COCC YGEA L PRES SURE ULCE R, WITH COCC YGEC TOMY ; WITH PRIM ARY SUTU RE 163.. 15931 (5)EX CISI ON, SACR AL PRES SURE ULCE R, WITH PRIM ARY SUTU RE; 163.. 15933 (5)EX CISI ON, SACR AL PRES SURE ULCE R, WITH PRIM ARY SUTU RE; WITH OSTE CTOM Y 163.. 15940 (5)EX CISI ON, ISCH IAL PRES SURE ULCE R, WITH PRIM ARY SUTU RE; 163.. 15941 (5)EX CISI ON, ISCH IAL PRES SURE ULCE R, WITH PRIM ARY SUTU RE; WITH OSTE CTOM Y (ISC HIEC TOMY ) 163.. 15950 (5)EX CISI ON, TROC HANT ERIC PRES SURE ULCE R, WITH PRIM ARY SUTU RE; 163.. 15951 (5)EX CISI ON, TROC HANT ERIC PRES SURE ULCE R, WITH PRIM ARY SUTU RE; WITH OSTE CTOM Y 163.. 15999 (5)UN LIST ED PROC EDUR E, EXCI SION PRES SURE ULCE R [[Page 47769]] 163.. 20240 (5)BI OPSY , EXCI SION AL; SUPE RFIC IAL (EG, ILIU M, STER NUM, SPIN OUS PROC ESS, RIBS , TROC HANT ER OF FEMU R) 163.. 20245 (5)BI OPSY , EXCI SION AL; DEEP (EG, HUME RUS, ISCH IUM, FEMU R) 163.. 20525 (5)RE MOVA L OF FORE IGN BODY IN MUSC LE OR TEND ON SHEA TH; DEEP OR COMP LICA TED 163.. 20680 (5)RE MOVA L OF IMPL ANT; DEEP (EG, BURI ED WIRE , PIN, SCRE W, META L BAND , NAIL , ROD OR PLAT E) 163.. 21555 (5)EX CISI ON TUMO R, SOFT TISS UE OF NECK OR THOR AX; SUBC UTAN EOUS 163.. 21556 (5)EX CISI ON TUMO R, SOFT TISS UE OF NECK OR THOR AX; DEEP , SUBF ASCI AL, INTR AMUS CULA R 163.. 21925 (5)BI OPSY , SOFT TISS UE OF BACK OR FLAN K; DEEP 163.. 21930 (5)EX CISI ON, TUMO R, SOFT TISS UE OF BACK OR FLAN K 163.. 21935 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF BACK OR FLAN K 163.. 22900 (5)EX CISI ON, ABDO MINA L WALL TUMO R, SUBF ASCI AL (EG, DESM OID) 163.. 22999 (5)UN LIST ED PROC EDUR E, ABDO MEN, MUSC ULOS KELE TAL SYST EM 163.. 23066 (5)BI OPSY , SOFT TISS UE OF SHOU LDER AREA ; DEEP 163.. 23076 (5)EX CISI ON, TUMO R, SHOU LDER AREA ; DEEP , SUBF ASCI AL, OR INTR AMUS CULA R 163.. 23077 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF SHOU LDER AREA 163.. 23330 (5)RE MOVA L OF FORE IGN BODY , SHOU LDER ; SUBC UTAN EOUS 163.. 23331 (5)RE MOVA L OF FORE IGN BODY , SHOU LDER ; DEEP (EG, NEER PROS THES IS REMO VAL) 163.. 24066 (5)BI OPSY , SOFT TISS UE OF UPPE R ARM OR ELBO W AREA ; DEEP 163.. 24076 (5)EX CISI ON, TUMO R, UPPE R ARM OR ELBO W AREA ; DEEP , SUBF ASCI AL OR INTR AMUS CULA R 163.. 24077 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF UPPE R ARM OR ELBO W AREA 163.. 24201 (5)RE MOVA L OF FORE IGN BODY , UPPE R ARM OR ELBO W AREA ; DEEP 163.. 25066 (5)BI OPSY , SOFT TISS UE OF FORE ARM AND/ OR WRIS T; DEEP 163.. 25076 (5)EX CISI ON, TUMO R, FORE ARM AND/ OR WRIS T AREA ; DEEP , SUBF ASCI AL OR INTR AMUS CULA R 163.. 25077 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF FORE ARM AND/ OR WRIS T AREA 163.. 26115 (5)EX CISI ON, TUMO R OR VASC ULAR MALF ORMA TION , HAND OR FING ER; SUBC UTAN EOUS 163.. 26116 (5)EX CISI ON, TUMO R OR VASC ULAR MALF ORMA TION , HAND OR FING ER; DEEP , SUBF ASCI AL, INTR AMUS CULA R 163.. 26117 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF HAND OR FING ER 163.. 26320 (5)RE MOVA L OF IMPL ANT FROM FING ER OR HAND 163.. 27041 (5)BI OPSY , SOFT TISS UE OF PELV IS AND HIP AREA ; DEEP 163.. 27047 (5)EX CISI ON, TUMO R, PELV IS AND HIP AREA ; SUBC UTAN EOUS 163.. 27048 (5)EX CISI ON, TUMO R, PELV IS AND HIP AREA ; DEEP , SUBF ASCI AL, INTR AMUS CULA R 163.. 27049 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF PELV IS AND HIP AREA 163.. 27324 (5)BI OPSY , SOFT TISS UE OF THIG H OR KNEE AREA ; DEEP 163.. 27327 (5)EX CISI ON, TUMO R, THIG H OR KNEE AREA ; SUBC UTAN EOUS 163.. 27328 (5)EX CISI ON, TUMO R, THIG H OR KNEE AREA ; DEEP , SUBF ASCI AL, OR INTR AMUS CULA R 163.. 27329 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF THIG H OR KNEE AREA 163.. 27372 (5)RE MOVA L OF FORE IGN BODY , DEEP , THIG H REGI ON OR KNEE AREA 163.. 27614 (5)BI OPSY , SOFT TISS UE OF LEG OR ANKL E AREA ; DEEP 163.. 27618 (5)EX CISI ON, TUMO R, LEG OR ANKL E AREA ; SUBC UTAN EOUS 163.. 27619 (5)EX CISI ON, TUMO R, LEG OR ANKL E AREA ; DEEP , SUBF ASCI AL OR INTR AMUS CULA R 163.. 28192 (5)RE MOVA L OF FORE IGN BODY , FOOT ; DEEP 163.. 28193 (5)RE MOVA L OF FORE IGN BODY , FOOT ; COMP LICA TED 163.. 69110 (5)EX CISI ON EXTE RNAL EAR; PART IAL, SIMP LE REPA IR 163.. 69145 (5)EX CISI ON SOFT TISS UE LESI ON, EXTE RNAL AUDI TORY CANA L 163.. 69205 (5)RE MOVA L FORE IGN BODY FROM EXTE RNAL AUDI TORY CANA L; WITH GENE RAL ANES THES IA 181.. (1)Le T 2.19 $110.97 $43.84 $22.19 vel I skin repa ir 181.. 11760 (5)RE PAIR OF NAIL BED 181.. 11762 (5)RE CONS TRUC TION OF NAIL BED WITH GRAF T 181.. 11920 (5)TA TTOO ING, INTR ADER MAL INTR ODUC TION OF INSO LUBL E OPAQ UE PIGM ENTS TO CORR ECT COLO R DEFE CTS OF SKIN , INCL UDIN G MICR OPIG MENT ATIO N; 6.0 SQ CM OR LESS 181.. 11921 (5)TA TTOO ING, INTR ADER MAL INTR ODUC TION OF INSO LUBL E OPAQ UE PIGM ENTS TO CORR ECT COLO R DEFE CTS OF SKIN , INCL UDIN G MICR OPIG MENT ATIO N; 6.1 TO 20.0 SQ CM 181.. 11922 (5)TA TTOO ING, INTR ADER MAL INTR ODUC TION OF INSO LUBL E OPAQ UE PIGM ENTS TO CORR ECT COLO R DEFE CTS OF SKIN , INCL UDIN G MICR OPIG MENT ATIO N; EACH ADDI TION AL 20.0 SQ CM 181.. 11950 (5)SU BCUT ANEO US INJE CTIO N OF ''FI LLIN G'' MATE RIAL (EG, COLL AGEN ); 1 CC OR LESS 181.. 11951 (5)SU BCUT ANEO US INJE CTIO N OF ''FI LLIN G'' MATE RIAL (EG, COLL AGEN ); 1.1 TO 5.0 CC 181.. 11952 (5)SU BCUT ANEO US INJE CTIO N OF ''FI LLIN G'' MATE RIAL (EG, COLL AGEN ); 5.1 TO 10.0 CC 181.. 11954 (5)SU BCUT ANEO US INJE CTIO N OF ''FI LLIN G'' MATE RIAL (EG, COLL AGEN ); OVER 10.0 CC 181.. 12001 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF SCAL P, NECK , AXIL LAE, EXTE RNAL GENI TALI A, TRUN K AND/ OR EXTR EMIT IES (INC LUDI NG HAND S AND FEET ); 2.5 CM OR LESS 181.. 12002 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF SCAL P, NECK , AXIL LAE, EXTE RNAL GENI TALI A, TRUN K AND/ OR EXTR EMIT IES (INC LUDI NG HAND S AND FEET ); 2.6 CM TO 7.5 CM 181.. 12004 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF SCAL P, NECK , AXIL LAE, EXTE RNAL GENI TALI A, TRUN K AND/ OR EXTR EMIT IES (INC LUDI NG HAND S AND FEET ); 7.6 CM TO 12.5 CM 181.. 12005 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF SCAL P, NECK , AXIL LAE, EXTE RNAL GENI TALI A, TRUN K AND/ OR EXTR EMIT IES (INC LUDI NG HAND S AND FEET ); 12.6 CM TO 20.0 CM 181.. 12006 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF SCAL P, NECK , AXIL LAE, EXTE RNAL GENI TALI A, TRUN K AND/ OR EXTR EMIT IES (INC LUDI NG HAND S AND FEET ); 20.1 CM TO 30.0 CM 181.. 12007 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF SCAL P, NECK , AXIL LAE, EXTE RNAL GENI TALI A, TRUN K AND/ OR EXTR EMIT IES (INC LUDI NG HAND S AND FEET ); OVER 30.0 CM 181.. 12011 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 2.5 CM OR LESS 181.. 12013 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 2.6 CM TO 5.0 CM 181.. 12014 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 5.1 CM TO 7.5 CM 181.. 12015 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 7.6 CM TO 12.5 CM 181.. 12016 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 12.6 CM TO 20.0 CM [[Page 47770]] 181.. 12017 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 20.1 CM TO 30.0 CM 181.. 12018 (5)SI MPLE REPA IR OF SUPE RFIC IAL WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; OVER 30.0 CM 181.. 12020 (5)TR EATM ENT OF SUPE RFIC IAL WOUN D DEHI SCEN CE; SIMP LE CLOS URE 181.. 12021 (5)TR EATM ENT OF SUPE RFIC IAL WOUN D DEHI SCEN CE; WITH PACK ING 181.. 12031 (5)LA YER CLOS URE OF WOUN DS OF SCAL P, AXIL LAE, TRUN K AND/ OR EXTR EMIT IES (EXC LUDI NG HAND S AND FEET ); 2.5 CM OR LESS 181.. 12032 (5)LA YER CLOS URE OF WOUN DS OF SCAL P, AXIL LAE, TRUN K AND/ OR EXTR EMIT IES (EXC LUDI NG HAND S AND FEET ); 2.6 CM TO 7.5 CM 181.. 12034 (5)LA YER CLOS URE OF WOUN DS OF SCAL P, AXIL LAE, TRUN K AND/ OR EXTR EMIT IES (EXC LUDI NG HAND S AND FEET ); 7.6 CM TO 12.5 CM 181.. 12035 (5)LA YER CLOS URE OF WOUN DS OF SCAL P, AXIL LAE, TRUN K AND/ OR EXTR EMIT IES (EXC LUDI NG HAND S AND FEET ); 12.6 CM TO 20.0 CM 181.. 12036 (5)LA YER CLOS URE OF WOUN DS OF SCAL P, AXIL LAE, TRUN K AND/ OR EXTR EMIT IES (EXC LUDI NG HAND S AND FEET ); 20.1 CM TO 30.0 CM 181.. 12041 (5)LA YER CLOS URE OF WOUN DS OF NECK , HAND S, FEET AND/ OR EXTE RNAL GENI TALI A; 2.5 CM OR LESS 181.. 12042 (5)LA YER CLOS URE OF WOUN DS OF NECK , HAND S, FEET AND/ OR EXTE RNAL GENI TALI A; 2.6 CM TO 7.5 CM 181.. 12044 (5)LA YER CLOS URE OF WOUN DS OF NECK , HAND S, FEET AND/ OR EXTE RNAL GENI TALI A; 7.6 CM TO 12.5 CM 181.. 12045 (5)LA YER CLOS URE OF WOUN DS OF NECK , HAND S, FEET AND/ OR EXTE RNAL GENI TALI A; 12.6 CM TO 20.0 CM 181.. 12046 (5)LA YER CLOS URE OF WOUN DS OF NECK , HAND S, FEET AND/ OR EXTE RNAL GENI TALI A; 20.1 CM TO 30.0 CM 181.. 12051 (5)LA YER CLOS URE OF WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 2.5 CM OR LESS 181.. 12052 (5)LA YER CLOS URE OF WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 2.6 CM TO 5.0 CM 181.. 12053 (5)LA YER CLOS URE OF WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 5.1 CM TO 7.5 CM 181.. 12054 (5)LA YER CLOS URE OF WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 7.6 CM TO 12.5 CM 181.. 12055 (5)LA YER CLOS URE OF WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 12.6 CM TO 20.0 CM 181.. 12056 (5)LA YER CLOS URE OF WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; 20.1 CM TO 30.0 CM 181.. 20500 (5)IN JECT ION OF SINU S TRAC T; THER APEU TIC (SEP ARAT E PROC EDUR E) 182.. (1)Le T 4. $202.68 $84.98 $40.54 vel II skin repa ir 182.. 13100 (5)RE PAIR , COMP LEX, TRUN K; 1.1 CM TO 2.5 CM 182.. 13101 (5)RE PAIR , COMP LEX, TRUN K; 2.6 CM TO 7.5 CM 182.. 13120 (5)RE PAIR , COMP LEX, SCAL P, ARMS , AND/ OR LEGS ; 1.1 CM TO 2.5 CM 182.. 13121 (5)RE PAIR , COMP LEX, SCAL P, ARMS , AND/ OR LEGS ; 2.6 CM TO 7.5 CM 182.. 13131 (5)RE PAIR , COMP LEX, FORE HEAD , CHEE KS, CHIN , MOUT H, NECK , AXIL LAE, GENI TALI A, HAND S AND/ OR FEET ; 1.1 CM TO 2.5 CM 182.. 13132 (5)RE PAIR , COMP LEX, FORE HEAD , CHEE KS, CHIN , MOUT H, NECK , AXIL LAE, GENI TALI A, HAND S AND/ OR FEET ; 2.6 CM TO 7.5 CM 182.. 13150 (5)RE PAIR , COMP LEX, EYEL IDS, NOSE , EARS AND/ OR LIPS ; 1.0 CM OR LESS 182.. 13151 (5)RE PAIR , COMP LEX, EYEL IDS, NOSE , EARS AND/ OR LIPS ; 1.1 CM TO 2.5 CM 182.. 13152 (5)RE PAIR , COMP LEX, EYEL IDS, NOSE , EARS AND/ OR LIPS ; 2.6 CM TO 7.5 CM 182.. 13160 (5)SE COND ARY CLOS URE OF SURG ICAL WOUN D OR DEHI SCEN CE, EXTE NSIV E OR COMP LICA TED 182.. 13300 (5)RE PAIR , UNUS UAL, COMP LICA TED, OVER 7.5 CM, ANY AREA 182.. 43870 (5)CL OSUR E OF GAST ROST OMY, SURG ICAL 183.. (1)Le T 11.17 $565.98 $286.46 $113.20 vel III skin repa ir 183.. 11960 (5)IN SERT ION OF TISS UE EXPA NDER (S) FOR OTHE R THAN BREA ST, INCL UDIN G SUBS EQUE NT EXPA NSIO N 183.. 11970 (5)RE PLAC EMEN T OF TISS UE EXPA NDER WITH PERM ANEN T PROS THES IS 183.. 12037 (5)LA YER CLOS URE OF WOUN DS OF SCAL P, AXIL LAE, TRUN K AND/ OR EXTR EMIT IES (EXC LUDI NG HAND S AND FEET ); OVER 30.0 CM 183.. 12047 (5)LA YER CLOS URE OF WOUN DS OF NECK , HAND S, FEET AND/ OR EXTE RNAL GENI TALI A; OVER 30.0 CM 183.. 12057 (5)LA YER CLOS URE OF WOUN DS OF FACE , EARS , EYEL IDS, NOSE , LIPS AND/ OR MUCO US MEMB RANE S; OVER 30.0 CM 183.. 14000 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, TRUN K; DEFE CT 10 SQ CM OR LESS 183.. 14001 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, TRUN K; DEFE CT 10.1 SQ CM TO 30.0 SQ CM 183.. 14020 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, SCAL P, ARMS AND/ OR LEGS ; DEFE CT 10 SQ CM OR LESS 183.. 14021 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, SCAL P, ARMS AND/ OR LEGS ; DEFE CT 10.1 SQ CM TO 30.0 SQ CM 183.. 14040 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, FORE HEAD , CHEE KS, CHIN , MOUT H, NECK , AXIL LAE, GENI TALI A, HAND S AND/ OR FEET ; DEFE CT 10 SQ CM OR LESS 183.. 14041 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, FORE HEAD , CHEE KS, CHIN , MOUT H, NECK , AXIL LAE, GENI TALI A, HAND S AND/ OR FEET ; DEFE CT 10.1 SQ CM TO 30.0 SQ CM 183.. 14060 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, EYEL IDS, NOSE , EARS AND/ OR LIPS ; DEFE CT 10 SQ CM OR LESS 183.. 14061 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, EYEL IDS, NOSE , EARS AND/ OR LIPS ; DEFE CT 10.1 SQ CM TO 30.0 SQ CM 183.. 14300 (5)AD JACE NT TISS UE TRAN SFER OR REAR RANG EMEN T, MORE THAN 30 SQ CM, UNUS UAL OR COMP LICA TED, ANY AREA 183.. 14350 (5)FI LLET ED FING ER OR TOE FLAP , INCL UDIN G PREP ARAT ION OF RECI PIEN T SITE 183.. 15000 (5)EX CISI ONAL PREP ARAT ION OR CREA TION OF RECI PIEN T SITE BY EXCI SION OF ESSE NTIA LLY INTA CT SKIN (INC LUDI NG SUBC UTAN EOUS TISS UES) , SCAR , OR OTHE R LESI ON PRIO R TO REPA IR WITH FREE SKIN GRAF T (LIS T AS SEPA RATE SERV ICE IN ADDI TION TO SKIN GRAF T) 183.. 15050 (5)PI NCH GRAF T, SING LE OR MULT IPLE , TO COVE R SMAL L ULCE R, TIP OF DIGI T, OR OTHE R MINI MAL OPEN AREA (EXC EPT ON FACE ), UP TO DEFE CT SIZE 2 CM DIAM ETER 183.. 15100 (5)SP LIT GRAF T, TRUN K, SCAL P, ARMS , LEGS , HAND S, AND/ OR FEET (EXC EPT MULT IPLE DIGI TS); 100 SQ CM OR LESS , OR EACH ONE PERC ENT OF BODY AREA OF INFA NTS AND CHIL DREN (EXC EPT 1505 0) 183.. 15101 (5)SP LIT GRAF T, TRUN K, SCAL P, ARMS , LEGS , HAND S, AND/ OR FEET (EXC EPT MULT IPLE DIGI TS); EACH ADDI TION AL 100 SQ CM, OR EACH ONE PERC ENT OF BODY AREA OF INFA NTS AND CHIL DREN , OR PART THER EOF 183.. 15120 (5)SP LIT GRAF T, FACE , EYEL IDS, MOUT H, NECK , EARS , ORBI TS, GENI TALI A, AND/ OR MULT IPLE DIGI TS; 100 SQ CM OR LESS , OR EACH ONE PERC ENT OF BODY AREA OF INFA NTS AND CHIL DREN (EXC EPT 1505 0) 183.. 15121 (5)SP LIT GRAF T, FACE , EYEL IDS, MOUT H, NECK , EARS , ORBI TS, GENI TALI A, AND/ OR MULT IPLE DIGI TS; EACH ADDI TION AL 100 SQ CM, OR EACH ONE PERC ENT OF BODY AREA OF INFA NTS AND CHIL DREN , OR PART THER EOF 183.. 15200 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , TRUN K; 20 SQ CM OR LESS 183.. 15201 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , TRUN K; EACH ADDI TION AL 20 SQ CM 183.. 15220 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , SCAL P, ARMS , AND/ OR LEGS ; 20 SQ CM OR LESS 183.. 15221 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , SCAL P, ARMS , AND/ OR LEGS ; EACH ADDI TION AL 20 SQ CM 183.. 15240 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , FORE HEAD , CHEE KS, CHIN , MOUT H, NECK , AXIL LAE, GENI TALI A, HAND S, AND/ OR FEET ; 20 SQ CM OR LESS [[Page 47771]] 183.. 15241 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , FORE HEAD , CHEE KS, CHIN , MOUT H, NECK , AXIL LAE, GENI TALI A, HAND S, AND/ OR FEET ; EACH ADDI TION AL 20 SQ CM 183.. 15260 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , NOSE , EARS , EYEL IDS, AND/ OR LIPS ; 20 SQ CM OR LESS 183.. 15261 (5)FU LL THIC KNES S GRAF T, FREE , INCL UDIN G DIRE CT CLOS URE OF DONO R SITE , NOSE , EARS , EYEL IDS, AND/ OR LIPS ; EACH ADDI TION AL 20 SQ CM 183.. 15350 (5)AP PLIC ATIO N OF ALLO GRAF T, SKIN 183.. 15400 (5)AP PLIC ATIO N OF XENO GRAF T, SKIN 183.. 15570 (5)FO RMAT ION OF DIRE CT OR TUBE D PEDI CLE, WITH OR WITH OUT TRAN SFER ; TRUN K 183.. 15572 (5)FO RMAT ION OF DIRE CT OR TUBE D PEDI CLE, WITH OR WITH OUT TRAN SFER ; SCAL P, ARMS , OR LEGS 183.. 15574 (5)FO RMAT ION OF DIRE CT OR TUBE D PEDI CLE, WITH OR WITH OUT TRAN SFER ; FORE HEAD , CHEE KS, CHIN , MOUT H, NECK , AXIL LAE, GENI TALI A, HAND S OR FEET 183.. 15576 (5)FO RMAT ION OF DIRE CT OR TUBE D PEDI CLE, WITH OR WITH OUT TRAN SFER ; EYEL IDS, NOSE , EARS , LIPS , OR INTR AORA L 183.. 15580 (5)CR OSS FING ER FLAP , INCL UDIN G FREE GRAF T TO DONO R SITE 183.. 15600 (5)DE LAY OF FLAP OR SECT IONI NG OF FLAP (DIV ISIO N AND INSE T); AT TRUN K 183.. 15610 (5)DE LAY OF FLAP OR SECT IONI NG OF FLAP (DIV ISIO N AND INSE T); AT SCAL P, ARMS , OR LEGS 183.. 15620 (5)DE LAY OF FLAP OR SECT IONI NG OF FLAP (DIV ISIO N AND INSE T); AT FORE HEAD , CHEE KS, CHIN , NECK , AXIL LAE, GENI TALI A, HAND S (EXC EPT 1562 5), OR FEET 183.. 15625 (5)DE LAY OF FLAP OR SECT IONI NG OF FLAP (DIV ISIO N AND INSE T); SECT ION PEDI CLE OF CROS S FING ER FLAP 183.. 15630 (5)DE LAY OF FLAP OR SECT IONI NG OF FLAP (DIV ISIO N AND INSE T); AT EYEL IDS, NOSE , EARS , OR LIPS 183.. 15650 (5)TR ANSF ER, INTE RMED IATE , OF ANY PEDI CLE FLAP (EG, ABDO MEN TO WRIS T, ``WA LKIN G'' TUBE ), ANY LOCA TION 183.. 15775 (5)PU NCH GRAF T FOR HAIR TRAN SPLA NT; 1 TO 15 PUNC H GRAF TS 183.. 15776 (5)PU NCH GRAF T FOR HAIR TRAN SPLA NT; MORE THAN 15 PUNC H GRAF TS 183.. 15819 (5)CE RVIC OPLA STY 183.. 15820 (5)BL EPHA ROPL ASTY , LOWE R EYEL ID 183.. 15821 (5)BL EPHA ROPL ASTY , LOWE R EYEL ID; WITH EXTE NSIV E HERN IATE D FAT PAD 183.. 15822 (5)BL EPHA ROPL ASTY , UPPE R EYEL ID 183.. 15823 (5)BL EPHA ROPL ASTY , UPPE R EYEL ID; WITH EXCE SSIV E SKIN WEIG HTIN G DOWN LID 183.. 15825 (5)RH YTID ECTO MY; NECK WITH PLAT YSMA L TIGH TENI NG (PLA TYSM AL FLAP , ``P- FLAP '') 183.. 15829 (5)RH YTID ECTO MY; SUPE RFIC IAL MUSC ULOA PONE UROT IC SYST EM (SMA S) FLAP 183.. 15835 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); BUTT OCK 183.. 20910 (5)CA RTIL AGE GRAF T; COST OCHO NDRA L 183.. 20912 (5)CA RTIL AGE GRAF T; NASA L SEPT UM 183.. 20920 (5)FA SCIA LATA GRAF T; BY STRI PPER 183.. 20922 (5)FA SCIA LATA GRAF T; BY INCI SION AND AREA EXPO SURE , COMP LEX OR SHEE T 183.. 20926 (5)TI SSUE GRAF TS, OTHE R (EG, PARA TENO N, FAT, DERM IS) 183.. 23921 (5)DI SART ICUL ATIO N OF SHOU LDER ; SECO NDAR Y CLOS URE OR SCAR REVI SION 183.. 25929 (5)TR ANSM ETAC ARPA L AMPU TATI ON; SECO NDAR Y CLOS URE OR SCAR REVI SION 183.. 44312 (5)RE VISI ON OF ILEO STOM Y; SIMP LE (REL EASE OF SUPE RFIC IAL SCAR ) (SEP ARAT E PROC EDUR E) 183.. 44340 (5)RE VISI ON OF COLO STOM Y; SIMP LE (REL EASE OF SUPE RFIC IAL SCAR ) (SEP ARAT E PROC EDUR E) 183.. 65270 (5)RE PAIR OF LACE RATI ON; CONJ UNCT IVA, WITH OR WITH OUT NONP ERFO RATI NG LACE RATI ON SCLE RA, DIRE CT CLOS URE 184.. (1)Le T 15.17 $768.66 $396.40 $153.73 vel IV skin repa ir 184.. 15732 (5)MU SCLE , MYOC UTAN EOUS , OR FASC IOCU TANE OUS FLAP ; HEAD AND NECK (EG, TEMP ORAL IS, MASS ETER , STER NOCL EIDO MAST OID, LEVA TOR SCAP ULAE ) 184.. 15734 (5)MU SCLE , MYOC UTAN EOUS , OR FASC IOCU TANE OUS FLAP ; TRUN K 184.. 15736 (5)MU SCLE , MYOC UTAN EOUS , OR FASC IOCU TANE OUS FLAP ; UPPE R EXTR EMIT Y 184.. 15738 (5)MU SCLE , MYOC UTAN EOUS , OR FASC IOCU TANE OUS FLAP ; LOWE R EXTR EMIT Y 184.. 15740 (5)FL AP; ISLA ND PEDI CLE 184.. 15750 (5)FL AP; NEUR OVAS CULA R PEDI CLE 184.. 15760 (5)GR AFT; COMP OSIT E (EG, FULL THIC KNES S OF EXTE RNAL EAR OR NASA L ALA) , INCL UDIN G PRIM ARY CLOS URE, DONO R AREA 184.. 15770 (5)GR AFT; DERM A- FAT- FASC IA 184.. 15824 (5)RH YTID ECTO MY; FORE HEAD 184.. 15826 (5)RH YTID ECTO MY; GLAB ELLA R FROW N LINE S 184.. 15828 (5)RH YTID ECTO MY; CHEE K, CHIN , AND NECK 184.. 15831 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); ABDO MEN (ABD OMIN OPLA STY) 184.. 15832 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); THIG H 184.. 15833 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); LEG 184.. 15834 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); HIP 184.. 15836 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); ARM 184.. 15837 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); FORE ARM OR HAND 184.. 15839 (5)EX CISI ON, EXCE SSIV E SKIN AND SUBC UTAN EOUS TISS UE (INC LUDI NG LIPE CTOM Y); OTHE R AREA 184.. 15840 (5)GR AFT FOR FACI AL NERV E PARA LYSI S; FREE FASC IA GRAF T (INC LUDI NG OBTA ININ G FASC IA) 184.. 15841 (5)GR AFT FOR FACI AL NERV E PARA LYSI S; FREE MUSC LE GRAF T (INC LUDI NG OBTA ININ G GRAF T) 184.. 15842 (5)GR AFT FOR FACI AL NERV E PARA LYSI S; FREE MUSC LE GRAF T BY MICR OSUR GICA L TECH NIQU E 184.. 15845 (5)GR AFT FOR FACI AL NERV E PARA LYSI S; REGI ONAL MUSC LE TRAN SFER 184.. 15876 (5)SU CTIO N ASSI STED LIPE CTOM Y; HEAD AND NECK 184.. 15877 (5)SU CTIO N ASSI STED LIPE CTOM Y; TRUN K 184.. 15878 (5)SU CTIO N ASSI STED LIPE CTOM Y; UPPE R EXTR EMIT Y 184.. 15879 (5)SU CTIO N ASSI STED LIPE CTOM Y; LOWE R EXTR EMIT Y 184.. 15922 (5)EX CISI ON, COCC YGEA L PRES SURE ULCE R, WITH COCC YGEC TOMY ; WITH FLAP CLOS URE 184.. 15934 (5)EX CISI ON, SACR AL PRES SURE ULCE R, WITH SKIN FLAP CLOS URE 184.. 15935 (5)EX CISI ON, SACR AL PRES SURE ULCE R, WITH SKIN FLAP CLOS URE; WITH OSTE CTOM Y 184.. 15936 (5)EX CISI ON, SACR AL PRES SURE ULCE R, WITH MUSC LE OR MYOC UTAN EOUS FLAP CLOS URE 184.. 15937 (5)EX CISI ON, SACR AL PRES SURE ULCE R, WITH MUSC LE OR MYOC UTAN EOUS FLAP CLOS URE; WITH OSTE CTOM Y 184.. 15944 (5)EX CISI ON, ISCH IAL PRES SURE ULCE R, WITH SKIN FLAP CLOS URE [[Page 47772]] 184.. 15945 (5)EX CISI ON, ISCH IAL PRES SURE ULCE R, WITH SKIN FLAP CLOS URE; WITH OSTE CTOM Y 184.. 15946 (5)EX CISI ON, ISCH IAL PRES SURE ULCE R, WITH OSTE CTOM Y, WITH MUSC LE OR MYOC UTAN EOUS FLAP CLOS URE 184.. 15952 (5)EX CISI ON, TROC HANT ERIC PRES SURE ULCE R, WITH SKIN FLAP CLOS URE 184.. 15953 (5)EX CISI ON, TROC HANT ERIC PRES SURE ULCE R, WITH SKIN FLAP CLOS URE; WITH OSTE CTOM Y 184.. 15956 (5)EX CISI ON, TROC HANT ERIC PRES SURE ULCE R, WITH MUSC LE OR MYOC UTAN EOUS FLAP CLOS URE 184.. 15958 (5)EX CISI ON, TROC HANT ERIC PRES SURE ULCE R, WITH MUSC LE OR MYOC UTAN EOUS FLAP CLOS URE; WITH OSTE CTOM Y 197.. (1)In T 12.13 $614.62 $310.75 $122.92 cisi on/ exci sion brea st 197.. 19101 (5)BI OPSY OF BREA ST; INCI SION AL 197.. 19110 (5)NI PPLE EXPL ORAT ION, WITH OR WITH OUT EXCI SION OF A SOLI TARY LACT IFER OUS DUCT OR A PAPI LLOM A LACT IFER OUS DUCT 197.. 19112 (5)EX CISI ON OF LACT IFER OUS DUCT FIST ULA 197.. 19120 (5)EX CISI ON OF CYST , FIBR OADE NOMA , OR OTHE R BENI GN OR MALI GNAN T TUMO R ABER RANT BREA ST TISS UE, DUCT LESI ON, NIPP LE OR AREO LAR LESI ON (EXC EPT 1914 0), MALE OR FEMA LE, ONE OR MORE LESI ONS 197.. 19125 (5)EX CISI ON OF BREA ST LESI ON IDEN TIFI ED BY PREO PERA TIVE PLAC EMEN T OF RADI OLOG ICAL MARK ER; SING LE LESI ON 197.. 19126 (5)EX CISI ON OF BREA ST LESI ON IDEN TIFI ED BY PREO PERA TIVE PLAC EMEN T OF RADI OLOG ICAL MARK ER; EACH ADDI TION AL LESI ON SEPA RATE LY IDEN TIFI ED BY A RADI OLOG ICAL MARK ER 197.. 19140 (5)MA STEC TOMY FOR GYNE COMA STIA 197.. 19290 (5)PR EOPE RATI VE PLAC EMEN T OF NEED LE LOCA LIZA TION WIRE , BREA ST 197.. 19291 (5)PR EOPE RATI VE PLAC EMEN T OF NEED LE LOCA LIZA TION WIRE , BREA ST; EACH ADDI TION AL LESI ON 197.. 19396 (5)PR EPAR ATIO N OF MOUL AGE FOR CUST OM BREA ST IMPL ANT 197.. 19499 (5)UN LIST ED PROC EDUR E, BREA ST 198.. (1)Br T 19.17 $971.33 $530.20 $194.27 east reco nstr ucti on/ mast ecto my 198.. 19160 (5)MA STEC TOMY , PART IAL; 198.. 19162 (5)MA STEC TOMY , PART IAL; WITH AXIL LARY LYMP HADE NECT OMY 198.. 19180 (5)MA STEC TOMY , SIMP LE, COMP LETE 198.. 19182 (5)MA STEC TOMY , SUBC UTAN EOUS 198.. 19316 (5)MA STOP EXY 198.. 19318 (5)RE DUCT ION MAMM APLA STY 198.. 19324 (5)MA MMAP LAST Y, AUGM ENTA TION ; WITH OUT PROS THET IC IMPL ANT 198.. 19325 (5)MA MMAP LAST Y, AUGM ENTA TION ; WITH PROS THET IC IMPL ANT 198.. 19328 (5)RE MOVA L OF INTA CT MAMM ARY IMPL ANT 198.. 19330 (5)RE MOVA L OF MAMM ARY IMPL ANT MATE RIAL 198.. 19340 (5)IM MEDI ATE INSE RTIO N OF BREA ST PROS THES IS FOLL OWIN G MAST OPEX Y, MAST ECTO MY OR IN RECO NSTR UCTI ON 198.. 19342 (5)DE LAYE D INSE RTIO N OF BREA ST PROS THES IS FOLL OWIN G MAST OPEX Y, MAST ECTO MY OR IN RECO NSTR UCTI ON 198.. 19350 (5)NI PPLE/ AREO LA RECO NSTR UCTI ON 198.. 19355 (5)CO RREC TION OF INVE RTED NIPP LES 198.. 19357 (5)BR EAST RECO NSTR UCTI ON, IMME DIAT E OR DELA YED, WITH TISS UE EXPA NDER , INCL UDIN G SUBS EQUE NT EXPA NSIO N 198.. 19366 (5)BR EAST RECO NSTR UCTI ON WITH OTHE R TECH NIQU E 198.. 19370 (5)OP EN PERI PROS THET IC CAPS ULOT OMY, BREA ST 198.. 19371 (5)PE RIPR OSTH ETIC CAPS ULEC TOMY , BREA ST 198.. 19380 (5)RE VISI ON OF RECO NSTR UCTE D BREA ST 200.. (1)Ar T 1.89 $95.77 $39.10 $19.15 thro cent esis & Liga ment/ Tend on Inje ctio n 200.. 20550 (5)IN JECT ION, TEND ON SHEA TH, LIGA MENT , TRIG GER POIN TS OR GANG LION CYST 200.. 20600 (5)AR THRO CENT ESIS , ASPI RATI ON AND/ OR INJE CTIO N; SMAL L JOIN T, BURS A OR GANG LION CYST (EG, FING ERS, TOES ) 200.. 20605 (5)AR THRO CENT ESIS , ASPI RATI ON AND/ OR INJE CTIO N; INTE RMED IATE JOIN T, BURS A OR GANG LION CYST (EG, TEMP OROM ANDI BULA R, ACRO MIOC LAVI CULA R, WRIS T, ELBO W OR ANKL E, OLEC RANO N BURS A) 200.. 20610 (5)AR THRO CENT ESIS , ASPI RATI ON AND/ OR INJE CTIO N; MAJO R JOIN T OR BURS A (EG, SHOU LDER , HIP, KNEE JOIN T, SUBA CROM IAL BURS A) 207.. (1)Cl T 1.70 $86.14 $31.64 $17.23 osed trea tmen t frac ture fing er/ toe/ trun k 207.. 21800 (5)CL OSED TREA TMEN T OF RIB FRAC TURE , UNCO MPLI CATE D, EACH 207.. 21820 (5)CL OSED TREA TMEN T OF STER NUM FRAC TURE 207.. 21899 (5)UN LIST ED PROC EDUR E, NECK OR THOR AX 207.. 22305 (5)CL OSED TREA TMEN T OF VERT EBRA L PROC ESS FRAC TURE (S) 207.. 22310 (5)CL OSED TREA TMEN T OF VERT EBRA L BODY FRAC TURE (S), WITH OUT MANI PULA TION , REQU IRIN G AND INCL UDIN G CAST ING OR BRAC ING 207.. 22315 (5)CL OSED TREA TMEN T OF VERT EBRA L FRAC TURE (S) AND/ OR DISL OCAT ION( S) REQU IRIN G CAST ING OR BRAC ING, WITH AND INCL UDIN G CAST ING AND/ OR BRAC ING, WITH OR WITH OUT ANES THES IA, BY MANI PULA TION OR TRAC TION 207.. 22899 (5)UN LIST ED PROC EDUR E, SPIN E 207.. 23500 (5)CL OSED TREA TMEN T OF CLAV ICUL AR FRAC TURE ; WITH OUT MANI PULA TION 207.. 23505 (5)CL OSED TREA TMEN T OF CLAV ICUL AR FRAC TURE ; WITH MANI PULA TION 207.. 23520 (5)CL OSED TREA TMEN T OF STER NOCL AVIC ULAR DISL OCAT ION; WITH OUT MANI PULA TION 207.. 23525 (5)WI TH MANI PULA TION 207.. 23540 (5)CL OSED TREA TMEN T OF ACRO MIOC LAVI CULA R DISL OCAT ION; WITH OUT MANI PULA TION 207.. 23545 (5)CL OSED TREA TMEN T OF ACRO MIOC LAVI CULA R DISL OCAT ION; WITH MANI PULA TION 207.. 23570 (5)CL OSED TREA TMEN T OF SCAP ULAR FRAC TURE ; WITH OUT MANI PULA TION 207.. 23575 (5)CL OSED TREA TMEN T OF SCAP ULAR FRAC TURE ; WITH MANI PULA TION , WITH OR WITH OUT SKEL ETAL TRAC TION (WIT H OR WITH OUT SHOU LDER JOIN T INVO LVEM ENT) 207.. 23650 (5)CL OSED TREA TMEN T OF SHOU LDER DISL OCAT ION, WITH MANI PULA TION ; WITH OUT ANES THES IA 207.. 23929 (5)UN LIST ED PROC EDUR E, SHOU LDER 207.. 26700 (5)CL OSED TREA TMEN T OF META CARP OPHA LANG EAL DISL OCAT ION, SING LE, WITH MANI PULA TION ; WITH OUT ANES THES IA 207.. 26720 (5)CL OSED TREA TMEN T OF PHAL ANGE AL SHAF T FRAC TURE , PROX IMAL OR MIDD LE PHAL ANX, FING ER OR THUM B; WITH OUT MANI PULA TION , EACH 207.. 26725 (5)CL OSED TREA TMEN T OF PHAL ANGE AL SHAF T FRAC TURE , PROX IMAL OR MIDD LE PHAL ANX, FING ER OR THUM B; WITH MANI PULA TION , WITH OR WITH OUT SKIN OR SKEL ETAL TRAC TION , EACH [[Page 47773]] 207.. 26740 (5)CL OSED TREA TMEN T OF ARTI CULA R FRAC TURE , INVO LVIN G META CARP OPHA LANG EAL OR INTE RPHA LANG EAL JOIN T; WITH OUT MANI PULA TION , EACH 207.. 26750 (5)CL OSED TREA TMEN T OF DIST AL PHAL ANGE AL FRAC TURE , FING ER OR THUM B; WITH OUT MANI PULA TION , EACH 207.. 26755 (5)CL OSED TREA TMEN T OF DIST AL PHAL ANGE AL FRAC TURE , FING ER OR THUM B; WITH MANI PULA TION , EACH 207.. 26770 (5)CL OSED TREA TMEN T OF INTE RPHA LANG EAL JOIN T DISL OCAT ION, SING LE, WITH MANI PULA TION ; WITH OUT ANES THES IA 207.. 26989 (5)UN LIST ED PROC EDUR E, HAND S OR FING ERS 207.. 27200 (5)CL OSED TREA TMEN T OF COCC YGEA L FRAC TURE 207.. 27299 (5)UN LIST ED PROC EDUR E, PELV IS OR HIP JOIN T 207.. 28490 (5)CL OSED TREA TMEN T OF FRAC TURE GREA T TOE, PHAL ANX OR PHAL ANGE S; WITH OUT MANI PULA TION 207.. 28495 (5)CL OSED TREA TMEN T OF FRAC TURE GREA T TOE, PHAL ANX OR PHAL ANGE S; WITH MANI PULA TION 207.. 28510 (5)CL OSED TREA TMEN T OF FRAC TURE , PHAL ANX OR PHAL ANGE S, OTHE R THAN GREA T TOE; WITH OUT MANI PULA TION , EACH 207.. 28515 (5)CL OSED TREA TMEN T OF FRAC TURE , PHAL ANX OR PHAL ANGE S, OTHE R THAN GREA T TOE; WITH MANI PULA TION , EACH 207.. 28630 (5)CL OSED TREA TMEN T OF META TARS OPHA LANG EAL JOIN T DISL OCAT ION; WITH OUT ANES THES IA 207.. 28660 (5)CL OSED TREA TMEN T OF INTE RPHA LANG EAL JOIN T DISL OCAT ION; WITH OUT ANES THES IA 207.. 28899 (5)UN LIST ED PROC EDUR E, FOOT OR TOES 207.. 31585 (5)TR EATM ENT OF CLOS ED LARY NGEA L FRAC TURE ; WITH OUT MANI PULA TION 207.. 31599 (5)UN LIST ED PROC EDUR E, LARY NX 209.. (1)Cl T 1.94 $98.30 $37.29 $19.66 osed trea tmen t frac ture/ disl ocat ion/ exce pt fing er/ toe/ trun k 209.. 23600 (5)CL OSED TREA TMEN T OF PROX IMAL HUME RAL (SUR GICA L OR ANAT OMIC AL NECK ) FRAC TURE ; WITH OUT MANI PULA TION 209.. 23605 (5)CL OSED TREA TMEN T OF PROX IMAL HUME RAL (SUR GICA L OR ANAT OMIC AL NECK ) FRAC TURE ; WITH MANI PULA TION , WITH OR WITH OUT SKEL ETAL TRAC TION 209.. 23620 (5)CL OSED TREA TMEN T OF GREA TER TUBE ROSI TY FRAC TURE ; WITH OUT MANI PULA TION 209.. 23625 (5)CL OSED TREA TMEN T OF GREA TER TUBE ROSI TY FRAC TURE ; WITH MANI PULA TION 209.. 23665 (5)CL OSED TREA TMEN T OF SHOU LDER DISL OCAT ION, WITH FRAC TURE OF GREA TER TUBE ROSI TY, WITH MANI PULA TION 209.. 23675 (5)CL OSED TREA TMEN T OF SHOU LDER DISL OCAT ION, WITH SURG ICAL OR ANAT OMIC AL NECK FRAC TURE , WITH MANI PULA TION 209.. 24500 (5)CL OSED TREA TMEN T OF HUME RAL SHAF T FRAC TURE ; WITH OUT MANI PULA TION 209.. 24505 (5)CL OSED TREA TMEN T OF HUME RAL SHAF T FRAC TURE ; WITH MANI PULA TION , WITH OR WITH OUT SKEL ETAL TRAC TION 209.. 24530 (5)CL OSED TREA TMEN T OF SUPR ACON DYLA R OR TRAN SCON DYLA R HUME RAL FRAC TURE , WITH OR WITH OUT INTE RCON DYLA R EXTE NSIO N; WITH OUT MANI PULA TION 209.. 24535 (5)CL OSED TREA TMEN T OF SUPR ACON DYLA R OR TRAN SCON DYLA R HUME RAL FRAC TURE , WITH OR WITH OUT INTE RCON DYLA R EXTE NSIO N; WITH MANI PULA TION , WITH OR WITH OUT SKIN OR SKEL ETAL TRAC TION 209.. 24560 (5)CL OSED TREA TMEN T OF HUME RAL EPIC ONDY LAR FRAC TURE , MEDI AL OR LATE RAL; WITH OUT MANI PULA TION 209.. 24565 (5)CL OSED TREA TMEN T OF HUME RAL EPIC ONDY LAR FRAC TURE , MEDI AL OR LATE RAL; WITH MANI PULA TION 209.. 24576 (5)CL OSED TREA TMEN T OF HUME RAL COND YLAR FRAC TURE , MEDI AL OR LATE RAL; WITH OUT MANI PULA TION 209.. 24577 (5)CL OSED TREA TMEN T OF HUME RAL COND YLAR FRAC TURE , MEDI AL OR LATE RAL; WITH MANI PULA TION 209.. 24600 (5)TR EATM ENT OF CLOS ED ELBO W DISL OCAT ION; WITH OUT ANES THES IA 209.. 24620 (5)CL OSED TREA TMEN T OF MONT EGGI A TYPE OF FRAC TURE DISL OCAT ION AT ELBO W (FRA CTUR E PROX IMAL END OF ULNA WITH DISL OCAT ION OF RADI AL HEAD ), WITH MANI PULA TION 209.. 24640 (5)CL OSED TREA TMEN T OF RADI AL HEAD SUBL UXAT ION IN CHIL D, ``NU RSEM AID ELBO W'', WITH MANI PULA TION 209.. 24650 (5)CL OSED TREA TMEN T OF RADI AL HEAD OR NECK FRAC TURE ; WITH OUT MANI PULA TION 209.. 24655 (5)CL OSED TREA TMEN T OF RADI AL HEAD OR NECK FRAC TURE ; WITH MANI PULA TION 209.. 24670 (5)CL OSED TREA TMEN T OF ULNA R FRAC TURE , PROX IMAL END (OLE CRAN ON PROC ESS) ; WITH OUT MANI PULA TION 209.. 24675 (5)CL OSED TREA TMEN T OF ULNA R FRAC TURE , PROX IMAL END (OLE CRAN ON PROC ESS) ; WITH MANI PULA TION 209.. 24999 (5)UN LIST ED PROC EDUR E, HUME RUS OR ELBO W 209.. 25500 (5)CL OSED TREA TMEN T OF RADI AL SHAF T FRAC TURE ; WITH OUT MANI PULA TION 209.. 25505 (5)CL OSED TREA TMEN T OF RADI AL SHAF T FRAC TURE ; WITH MANI PULA TION 209.. 25520 (5)CL OSED TREA TMEN T OF RADI AL SHAF T FRAC TURE , WITH DISL OCAT ION OF DIST AL RADI O- ULNA R JOIN T (GAL EAZZ I FRAC TURE/ DISL OCAT ION) 209.. 25530 (5)CL OSED TREA TMEN T OF ULNA R SHAF T FRAC TURE ; WITH OUT MANI PULA TION 209.. 25535 (5)CL OSED TREA TMEN T OF ULNA R SHAF T FRAC TURE ; WITH MANI PULA TION 209.. 25560 (5)CL OSED TREA TMEN T OF RADI AL AND ULNA R SHAF T FRAC TURE S; WITH OUT MANI PULA TION 209.. 25565 (5)CL OSED TREA TMEN T OF RADI AL AND ULNA R SHAF T FRAC TURE S; WITH MANI PULA TION 209.. 25600 (5)CL OSED TREA TMEN T OF DIST AL RADI AL FRAC TURE (EG, COLL ES OR SMIT H TYPE ) OR EPIP HYSE AL SEPA RATI ON, WITH OR WITH OUT FRAC TURE OF ULNA R STYL OID; WITH OUT MANI PULA TION 209.. 25605 (5)CL OSED TREA TMEN T OF DIST AL RADI AL FRAC TURE (EG, COLL ES OR SMIT H TYPE ) OR EPIP HYSE AL SEPA RATI ON, WITH OR WITH OUT FRAC TURE OF ULNA R STYL OID; WITH MANI PULA TION 209.. 25622 (5)CL OSED TREA TMEN T OF CARP AL SCAP HOID (NAV ICUL AR) FRAC TURE ; WITH OUT MANI PULA TION 209.. 25624 (5)CL OSED TREA TMEN T OF CARP AL SCAP HOID (NAV ICUL AR) FRAC TURE ; WITH MANI PULA TION 209.. 25630 (5)CL OSED TREA TMEN T OF CARP AL BONE FRAC TURE (EXC LUDI NG CARP AL SCAP HOID (NAV ICUL AR)) ; WITH OUT MANI PULA TION , EACH BONE 209.. 25635 (5)CL OSED TREA TMEN T OF CARP AL BONE FRAC TURE (EXC LUDI NG CARP AL SCAP HOID (NAV ICUL AR)) ; WITH MANI PULA TION , EACH BONE 209.. 25650 (5)CL OSED TREA TMEN T OF ULNA R STYL OID FRAC TURE 209.. 25660 (5)CL OSED TREA TMEN T OF RADI OCAR PAL OR INTE RCAR PAL DISL OCAT ION, ONE OR MORE BONE S, WITH MANI PULA TION 209.. 25675 (5)CL OSED TREA TMEN T OF DIST AL RADI OULN AR DISL OCAT ION WITH MANI PULA TION 209.. 25680 (5)CL OSED TREA TMEN T OF TRAN S- SCAP HOPE RILU NAR TYPE OF FRAC TURE DISL OCAT ION, WITH MANI PULA TION 209.. 25690 (5)CL OSED TREA TMEN T OF LUNA TE DISL OCAT ION, WITH MANI PULA TION 209.. 25999 (5)UN LIST ED PROC EDUR E, FORE ARM OR WRIS T 209.. 26600 (5)CL OSED TREA TMEN T OF META CARP AL FRAC TURE , SING LE; WITH OUT MANI PULA TION , EACH BONE 209.. 26605 (5)CL OSED TREA TMEN T OF META CARP AL FRAC TURE , SING LE; WITH MANI PULA TION , EACH BONE 209.. 26607 (5)CL OSED TREA TMEN T OF META CARP AL FRAC TURE , WITH MANI PULA TION , WITH INTE RNAL OR EXTE RNAL FIXA TION , EACH BONE 209.. 26641 (5)CL OSED TREA TMEN T OF CARP OMET ACAR PAL DISL OCAT ION, THUM B, WITH MANI PULA TION 209.. 26645 (5)CL OSED TREA TMEN T OF CARP OMET ACAR PAL FRAC TURE DISL OCAT ION, THUM B (BEN NETT FRAC TURE ), WITH MANI PULA TION 209.. 26670 (5)CL OSED TREA TMEN T OF CARP OMET ACAR PAL DISL OCAT ION, OTHE R THAN THUM B (BEN NETT FRAC TURE ), SING LE, WITH MANI PULA TION ; WITH OUT ANES THES IA [[Page 47774]] 209.. 26706 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF META CARP OPHA LANG EAL DISL OCAT ION, SING LE, WITH MANI PULA TION 209.. 26742 (5)CL OSED TREA TMEN T OF ARTI CULA R FRAC TURE , INVO LVIN G META CARP OPHA LANG EAL OR INTE RPHA LANG EAL JOIN T; WITH MANI PULA TION , EACH 209.. 27193 (5)CL OSED TREA TMEN T OF PELV IC RING FRAC TURE , DISL OCAT ION, DIAS TASI S OR SUBL UXAT ION; WITH OUT MANI PULA TION 209.. 27220 (5)CL OSED TREA TMEN T OF ACET ABUL UM (HIP SOCK ET) FRAC TURE (S); WITH OUT MANI PULA TION 209.. 27230 (5)CL OSED TREA TMEN T OF FEMO RAL FRAC TURE , PROX IMAL END, NECK ; WITH OUT MANI PULA TION 209.. 27238 (5)CL OSED TREA TMEN T OF INTE RTRO CHAN TERI C, PERT ROCH ANTE RIC, OR SUBT ROCH ANTE RIC FEMO RAL FRAC TURE ; WITH OUT MANI PULA TION 209.. 27246 (5)CL OSED TREA TMEN T OF GREA TER TROC HANT ERIC FRAC TURE , WITH OUT MANI PULA TION 209.. 27250 (5)CL OSED TREA TMEN T OF HIP DISL OCAT ION, TRAU MATI C; WITH OUT ANES THES IA 209.. 27256 (5)TR EATM ENT OF SPON TANE OUS HIP DISL OCAT ION (DEV ELOP MENT AL, INCL UDIN G CONG ENIT AL OR PATH OLOG ICAL ), BY ABDU CTIO N, SPLI NT OR TRAC TION ; WITH OUT ANES THES IA, WITH OUT MANI PULA TION 209.. 27265 (5)CL OSED TREA TMEN T OF POST HIP ARTH ROPL ASTY DISL OCAT ION; WITH OUT ANES THES IA 209.. 27500 (5)CL OSED TREA TMEN T OF FEMO RAL SHAF T FRAC TURE , WITH OUT MANI PULA TION 209.. 27501 (5)CL OSED TREA TMEN T OF SUPR ACON DYLA R OR TRAN SCON DYLA R FEMO RAL FRAC TURE WITH OR WITH OUT INTE RCON DYLA R EXTE NSIO N, WITH OUT MANI PULA TION 209.. 27502 (5)CL OSED TREA TMEN T OF FEMO RAL SHAF T FRAC TURE , WITH MANI PULA TION , WITH OR WITH OUT SKIN OR SKEL ETAL TRAC TION 209.. 27503 (5)CL OSED TREA TMEN T OF SUPR ACON DYLA R OR TRAN SCON DYLA R FEMO RAL FRAC TURE WITH OR WITH OUT INTE RCON DYLA R EXTE NSIO N, WITH MANI PULA TION , WITH OR WITH OUT SKIN OR SKEL ETAL TRAC TION 209.. 27508 (5)CL OSED TREA TMEN T OF FEMO RAL FRAC TURE , DIST AL END, MEDI AL OR LATE RAL COND YLE, WITH OUT MANI PULA TION 209.. 27510 (5)CL OSED TREA TMEN T OF FEMO RAL FRAC TURE , DIST AL END, MEDI AL OR LATE RAL COND YLE, WITH MANI PULA TION 209.. 27516 (5)CL OSED TREA TMEN T OF DIST AL FEMO RAL EPIP HYSE AL SEPA RATI ON; WITH OUT MANI PULA TION 209.. 27517 (5)CL OSED TREA TMEN T OF DIST AL FEMO RAL EPIP HYSE AL SEPA RATI ON; WITH MANI PULA TION , WITH OR WITH OUT SKIN OR SKEL ETAL TRAC TION 209.. 27520 (5)CL OSED TREA TMEN T OF PATE LLAR FRAC TURE , WITH OUT MANI PULA TION 209.. 27530 (5)CL OSED TREA TMEN T OF TIBI AL FRAC TURE , PROX IMAL (PLA TEAU ); WITH OUT MANI PULA TION 209.. 27532 (5)CL OSED TREA TMEN T OF TIBI AL FRAC TURE , PROX IMAL (PLA TEAU ); WITH OR WITH OUT MANI PULA TION , WITH SKEL ETAL TRAC TION 209.. 27538 (5)CL OSED TREA TMEN T OF INTE RCON DYLA R SPIN E(S) AND/ OR TUBE ROSI TY FRAC TURE (S) OF KNEE , WITH OR WITH OUT MANI PULA TION 209.. 27550 (5)CL OSED TREA TMEN T OF KNEE DISL OCAT ION; WITH OUT ANES THES IA 209.. 27560 (5)CL OSED TREA TMEN T OF PATE LLAR DISL OCAT ION; WITH OUT ANES THES IA 209.. 27599 (5)UN LIST ED PROC EDUR E, FEMU R OR KNEE 209.. 27750 (5)CL OSED TREA TMEN T OF TIBI AL SHAF T FRAC TURE (WIT H OR WITH OUT FIBU LAR FRAC TURE ); WITH OUT MANI PULA TION 209.. 27752 (5)CL OSED TREA TMEN T OF TIBI AL SHAF T FRAC TURE (WIT H OR WITH OUT FIBU LAR FRAC TURE ); WITH MANI PULA TION , WITH OR WITH OUT SKEL ETAL TRAC TION 209.. 27760 (5)CL OSED TREA TMEN T OF MEDI AL MALL EOLU S FRAC TURE ; WITH OUT MANI PULA TION 209.. 27762 (5)CL OSED TREA TMEN T OF MEDI AL MALL EOLU S FRAC TURE ; WITH MANI PULA TION , WITH OR WITH OUT SKIN OR SKEL ETAL TRAC TION 209.. 27780 (5)CL OSED TREA TMEN T OF PROX IMAL FIBU LA OR SHAF T FRAC TURE ; WITH OUT MANI PULA TION 209.. 27781 (5)CL OSED TREA TMEN T OF PROX IMAL FIBU LA OR SHAF T FRAC TURE ; WITH MANI PULA TION 209.. 27786 (5)CL OSED TREA TMEN T OF DIST AL FIBU LAR FRAC TURE (LAT ERAL MALL EOLU S); WITH OUT MANI PULA TION 209.. 27788 (5)CL OSED TREA TMEN T OF DIST AL FIBU LAR FRAC TURE (LAT ERAL MALL EOLU S); WITH MANI PULA TION 209.. 27808 (5)CL OSED TREA TMEN T OF BIMA LLEO LAR ANKL E FRAC TURE , (INC LUDI NG POTT S); WITH OUT MANI PULA TION 209.. 27810 (5)CL OSED TREA TMEN T OF BIMA LLEO LAR ANKL E FRAC TURE , (INC LUDI NG POTT S); WITH MANI PULA TION 209.. 27816 (5)CL OSED TREA TMEN T OF TRIM ALLE OLAR ANKL E FRAC TURE ; WITH OUT MANI PULA TION 209.. 27818 (5)CL OSED TREA TMEN T OF TRIM ALLE OLAR ANKL E FRAC TURE ; WITH MANI PULA TION 209.. 27824 (5)CL OSED TREA TMEN T OF FRAC TURE OF WEIG HT BEAR ING ARTI CULA R PORT ION OF DIST AL TIBI A (EG, PILO N OR TIBI AL PLAF OND) , WITH OR WITH OUT ANES THES IA; WITH OUT MANI PULA TION 209.. 27825 (5)CL OSED TREA TMEN T OF FRAC TURE OF WEIG HT BEAR ING ARTI CULA R PORT ION OF DIST AL TIBI A (EG, PILO N OR TIBI AL PLAF OND) , WITH OR WITH OUT ANES THES IA; WITH SKEL ETAL TRAC TION AND/ OR REQU IRIN G MANI PULA TION 209.. 27830 (5)CL OSED TREA TMEN T OF PROX IMAL TIBI OFIB ULAR JOIN T DISL OCAT ION; WITH OUT ANES THES IA 209.. 27840 (5)CL OSED TREA TMEN T OF ANKL E DISL OCAT ION; WITH OUT ANES THES IA 209.. 27899 (5)UN LIST ED PROC EDUR E, LEG OR ANKL E 209.. 28400 (5)CL OSED TREA TMEN T OF CALC ANEA L FRAC TURE ; WITH OUT MANI PULA TION 209.. 28405 (5)CL OSED TREA TMEN T OF CALC ANEA L FRAC TURE ; WITH MANI PULA TION 209.. 28430 (5)CL OSED TREA TMEN T OF TALU S FRAC TURE ; WITH OUT MANI PULA TION 209.. 28435 (5)CL OSED TREA TMEN T OF TALU S FRAC TURE ; WITH MANI PULA TION 209.. 28450 (5)TR EATM ENT OF TARS AL BONE FRAC TURE (EXC EPT TALU S AND CALC ANEU S); WITH OUT MANI PULA TION , EACH 209.. 28455 (5)TR EATM ENT OF TARS AL BONE FRAC TURE (EXC EPT TALU S AND CALC ANEU S); WITH MANI PULA TION , EACH 209.. 28470 (5)CL OSED TREA TMEN T OF META TARS AL FRAC TURE ; WITH OUT MANI PULA TION , EACH 209.. 28475 (5)CL OSED TREA TMEN T OF META TARS AL FRAC TURE ; WITH MANI PULA TION , EACH 209.. 28530 (5)CL OSED TREA TMEN T OF SESA MOID FRAC TURE 209.. 28540 (5)CL OSED TREA TMEN T OF TARS AL BONE DISL OCAT ION, OTHE R THAN TALO TARS AL; WITH OUT ANES THES IA 209.. 28570 (5)CL OSED TREA TMEN T OF TALO TARS AL JOIN T DISL OCAT ION; WITH OUT ANES THES IA 209.. 28600 (5)CL OSED TREA TMEN T OF TARS OMET ATAR SAL JOIN T DISL OCAT ION; WITH OUT ANES THES IA 209.. 31586 (5)TR EATM ENT OF CLOS ED LARY NGEA L FRAC TURE ; WITH CLOS ED MANI PULA TIVE REDU CTIO N 210.. (1)Bo T 10.46 $530.00 $283.40 $106.00 ne/ join t mani pula tion unde r anes thes ia 210.. 22505 (5)MA NIPU LATI ON OF SPIN E REQU IRIN G ANES THES IA, ANY REGI ON 210.. 23655 (5)CL OSED TREA TMEN T OF SHOU LDER DISL OCAT ION, WITH MANI PULA TION ; REQU IRIN G ANES THES IA 210.. 23700 (5)MA NIPU LATI ON UNDE R ANES THES IA, SHOU LDER JOIN T, INCL UDIN G APPL ICAT ION OF FIXA TION APPA RATU S (DIS LOCA TION EXCL UDED ) 210.. 24605 (5)TR EATM ENT OF CLOS ED ELBO W DISL OCAT ION; REQU IRIN G ANES THES IA 210.. 26675 (5)CL OSED TREA TMEN T OF CARP OMET ACAR PAL DISL OCAT ION, OTHE R THAN THUM B (BEN NETT FRAC TURE ), SING LE, WITH MANI PULA TION ; REQU IRIN G ANES THES IA 210.. 26705 (5)CL OSED TREA TMEN T OF META CARP OPHA LANG EAL DISL OCAT ION, SING LE, WITH MANI PULA TION ; REQU IRIN G ANES THES IA 210.. 26775 (5)CL OSED TREA TMEN T OF INTE RPHA LANG EAL JOIN T DISL OCAT ION, SING LE, WITH MANI PULA TION ; REQU IRIN G ANES THES IA [[Page 47775]] 210.. 27194 (5)CL OSED TREA TMEN T OF PELV IC RING FRAC TURE , DISL OCAT ION, DIAS TASI S OR SUBL UXAT ION; WITH MANI PULA TION , REQU IRIN G MORE THAN LOCA L ANES THES IA 210.. 27252 (5)CL OSED TREA TMEN T OF HIP DISL OCAT ION, TRAU MATI C; REQU IRIN G ANES THES IA 210.. 27257 (5)TR EATM ENT OF SPON TANE OUS HIP DISL OCAT ION (DEV ELOP MENT AL, INCL UDIN G CONG ENIT AL OR PATH OLOG ICAL ), BY ABDU CTIO N, SPLI NT OR TRAC TION ; WITH MANI PULA TION , REQU IRIN G ANES THES IA 210.. 27275 (5)MA NIPU LATI ON, HIP JOIN T, REQU IRIN G GENE RAL ANES THES IA 210.. 27552 (5)CL OSED TREA TMEN T OF KNEE DISL OCAT ION; REQU IRIN G ANES THES IA 210.. 27562 (5)CL OSED TREA TMEN T OF PATE LLAR DISL OCAT ION; REQU IRIN G ANES THES IA 210.. 27570 (5)MA NIPU LATI ON OF KNEE JOIN T UNDE R GENE RAL ANES THES IA (INC LUDE S APPL ICAT ION OF TRAC TION OR OTHE R FIXA TION DEVI CES) 210.. 27831 (5)CL OSED TREA TMEN T OF PROX IMAL TIBI OFIB ULAR JOIN T DISL OCAT ION; REQU IRIN G ANES THES IA 210.. 27842 (5)CL OSED TREA TMEN T OF ANKL E DISL OCAT ION; REQU IRIN G ANES THES IA, WITH OR WITH OUT PERC UTAN EOUS SKEL ETAL FIXA TION 210.. 27860 (5)MA NIPU LATI ON OF ANKL E UNDE R GENE RAL ANES THES IA (INC LUDE S APPL ICAT ION OF TRAC TION OR OTHE R FIXA TION APPA RATU S) 210.. 28545 (5)CL OSED TREA TMEN T OF TARS AL BONE DISL OCAT ION, OTHE R THAN TALO TARS AL; REQU IRIN G ANES THES IA 210.. 28575 (5)CL OSED TREA TMEN T OF TALO TARS AL JOIN T DISL OCAT ION; REQU IRIN G ANES THES IA 210.. 28605 (5)CL OSED TREA TMEN T OF TARS OMET ATAR SAL JOIN T DISL OCAT ION; REQU IRIN G ANES THES IA 210.. 28635 (5)CL OSED TREA TMEN T OF META TARS OPHA LANG EAL JOIN T DISL OCAT ION; REQU IRIN G ANES THES IA 210.. 28665 (5)CL OSED TREA TMEN T OF INTE RPHA LANG EAL JOIN T DISL OCAT ION; REQU IRIN G ANES THES IA 216.. (1)Op T 20.13 $1,019.98 $520.82 $204.00 en/ perc utan eous trea tmen t frac ture or disl ocat ion 216.. 21336 (5)OP EN TREA TMEN T OF NASA L SEPT AL FRAC TURE , WITH OR WITH OUT STAB ILIZ ATIO N 216.. 21805 (5)OP EN TREA TMEN T OF RIB FRAC TURE WITH OUT FIXA TION , EACH 216.. 23515 (5)OP EN TREA TMEN T OF CLAV ICUL AR FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 23530 (5)OP EN TREA TMEN T OF STER NOCL AVIC ULAR DISL OCAT ION, ACUT E OR CHRO NIC; 216.. 23532 (5)OP EN TREA TMEN T OF STER NOCL AVIC ULAR DISL OCAT ION, ACUT E OR CHRO NIC; WITH FASC IAL GRAF T (INC LUDE S OBTA ININ G GRAF T) 216.. 23550 (5)OP EN TREA TMEN T OF ACRO MIOC LAVI CULA R DISL OCAT ION, ACUT E OR CHRO NIC; 216.. 23552 (5)OP EN TREA TMEN T OF ACRO MIOC LAVI CULA R DISL OCAT ION, ACUT E OR CHRO NIC; WITH FASC IAL GRAF T (INC LUDE S OBTA ININ G GRAF T) 216.. 23585 (5)OP EN TREA TMEN T OF SCAP ULAR FRAC TURE (BOD Y, GLEN OID OR ACRO MION ) WITH OR WITH OUT INTE RNAL FIXA TION 216.. 23615 (5)OP EN TREA TMEN T OF PROX IMAL HUME RAL (SUR GICA L OR ANAT OMIC AL NECK ) FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , WITH OR WITH OUT REPA IR OF TUBE ROSI TY(- IES) ; 216.. 23616 (5)OP EN TREA TMEN T OF PROX IMAL HUME RAL (SUR GICA L OR ANAT OMIC AL NECK ) FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , WITH OR WITH OUT REPA IR OF TUBE ROSI TY(- IES) ; WITH PROX IMAL HUME RAL PROS THET IC REPL ACEM ENT 216.. 23630 (5)OP EN TREA TMEN T OF GREA TER TUBE ROSI TY FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 23660 (5)OP EN TREA TMEN T OF ACUT E SHOU LDER DISL OCAT ION 216.. 23670 (5)OP EN TREA TMEN T OF SHOU LDER DISL OCAT ION, WITH FRAC TURE OF GREA TER TUBE ROSI TY, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 23680 (5)OP EN TREA TMEN T OF SHOU LDER DISL OCAT ION, WITH SURG ICAL OR ANAT OMIC AL NECK FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 24515 (5)OP EN TREA TMEN T OF HUME RAL SHAF T FRAC TURE WITH PLAT E/ SCRE WS, WITH OR WITH OUT CERC LAGE 216.. 24516 (5)OP EN TREA TMEN T OF HUME RAL SHAF T FRAC TURE , WITH INSE RTIO N OF INTR AMED ULLA RY IMPL ANT, WITH OR WITH OUT CERC LAGE AND/ OR LOCK ING SCRE WS 216.. 24538 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF SUPR ACON DYLA R OR TRAN SCON DYLA R HUME RAL FRAC TURE , WITH OR WITH OUT INTE RCON DYLA R EXTE NSIO N 216.. 24545 (5)OP EN TREA TMEN T OF HUME RAL SUPR ACON DYLA R OR TRAN SCON DYLA R FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION ; WITH OUT INTE RCON DYLA R EXTE NSIO N 216.. 24546 (5)OP EN TREA TMEN T OF HUME RAL SUPR ACON DYLA R OR TRAN SCON DYLA R FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION ; WITH INTE RCON DYLA R EXTE NSIO N 216.. 24566 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF HUME RAL EPIC ONDY LAR FRAC TURE , MEDI AL OR LATE RAL, WITH MANI PULA TION 216.. 24575 (5)OP EN TREA TMEN T OF HUME RAL EPIC ONDY LAR FRAC TURE , MEDI AL OR LATE RAL, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 24579 (5)OP EN TREA TMEN T OF HUME RAL COND YLAR FRAC TURE , MEDI AL OR LATE RAL, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 24582 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF HUME RAL COND YLAR FRAC TURE , MEDI AL OR LATE RAL, WITH MANI PULA TION 216.. 24586 (5)OP EN TREA TMEN T OF PERI ARTI CULA R FRAC TURE AND/ OR DISL OCAT ION OF THE ELBO W (FRA CTUR E DIST AL HUME RUS AND PROX IMAL ULNA AND/ OR PROX IMAL RADI US); 216.. 24587 (5)OP EN TREA TMEN T OF PERI ARTI CULA R FRAC TURE AND/ OR DISL OCAT ION OF THE ELBO W (FRA CTUR E DIST AL HUME RUS AND PROX IMAL ULNA AND/ OR PROX IMAL RADI US); WITH IMPL ANT ARTH ROPL ASTY 216.. 24615 (5)OP EN TREA TMEN T OF ACUT E OR CHRO NIC ELBO W DISL OCAT ION 216.. 24635 (5)OP EN TREA TMEN T OF MONT EGGI A TYPE OF FRAC TURE DISL OCAT ION AT ELBO W (FRA CTUR E PROX IMAL END OF ULNA WITH DISL OCAT ION OF RADI AL HEAD ), WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 24665 (5)OP EN TREA TMEN T OF RADI AL HEAD OR NECK FRAC TURE , WITH OR WITH OUT INTE RNAL FIXA TION OR RADI AL HEAD EXCI SION ; 216.. 24666 (5)OP EN TREA TMEN T OF RADI AL HEAD OR NECK FRAC TURE , WITH OR WITH OUT INTE RNAL FIXA TION OR RADI AL HEAD EXCI SION ; WITH RADI AL HEAD PROS THET IC REPL ACEM ENT 216.. 24685 (5)OP EN TREA TMEN T OF ULNA R FRAC TURE PROX IMAL END (OLE CRAN ON PROC ESS) , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 25515 (5)OP EN TREA TMEN T OF RADI AL SHAF T FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 25525 (5)OP EN TREA TMEN T OF RADI AL SHAF T FRAC TURE , WITH INTE RNAL AND/ OR EXTE RNAL FIXA TION AND CLOS ED TREA TMEN T OF DISL OCAT ION OF DIST AL RADI O- ULNA R JOIN T (GAL EAZZ I FRAC TURE/ DISL OCAT ION) , WITH OR WITH OUT PERC UTAN EOUS SKEL ETAL FIXA TION 216.. 25526 (5)OP EN TREA TMEN T OF RADI AL SHAF T FRAC TURE , WITH INTE RNAL AND/ OR EXTE RNAL FIXA TION AND OPEN TREA TMEN T, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION OF DIST AL RADI O- ULNA R JOIN T (GAL EAZZ I FRAC TURE/ DISL OCAT ION) , INCL UDES REPA IR OF TRIA NGUL AR CART ILAG E 216.. 25545 (5)OP EN TREA TMEN T OF ULNA R SHAF T FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 25574 (5)OP EN TREA TMEN T OF RADI AL AND ULNA R SHAF T FRAC TURE S, WITH INTE RNAL OR EXTE RNAL FIXA TION ; OF RADI US OR ULNA [[Page 47776]] 216.. 25575 (5)OP EN TREA TMEN T OF RADI AL AND ULNA R SHAF T FRAC TURE S, WITH INTE RNAL OR EXTE RNAL FIXA TION ; OF RADI US AND ULNA 216.. 25611 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF DIST AL RADI AL FRAC TURE (EG, COLL ES OR SMIT H TYPE ) OR EPIP HYSE AL SEPA RATI ON, WITH OR WITH OUT FRAC TURE OF ULNA R STYL OID, REQU IRIN G MANI PULA TION , WITH OR WITH OUT EXTE RNAL FIXA TION 216.. 25620 (5)OP EN TREA TMEN T OF DIST AL RADI AL FRAC TURE (EG, COLL ES OR SMIT H TYPE ) OR EPIP HYSE AL SEPA RATI ON, WITH OR WITH OUT FRAC TURE OF ULNA R STYL OID, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 25628 (5)OP EN TREA TMEN T OF CARP AL SCAP HOID (NAV ICUL AR) FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 25645 (5)OP EN TREA TMEN T OF CARP AL BONE FRAC TURE (EXC LUDI NG CARP AL SCAP HOID (NAV ICUL AR)) , EACH BONE 216.. 25670 (5)OP EN TREA TMEN T OF RADI OCAR PAL OR INTE RCAR PAL DISL OCAT ION, ONE OR MORE BONE S 216.. 25676 (5)OP EN TREA TMEN T OF DIST AL RADI OULN AR DISL OCAT ION, ACUT E OR CHRO NIC 216.. 25685 (5)OP EN TREA TMEN T OF TRAN S- SCAP HOPE RILU NAR TYPE OF FRAC TURE DISL OCAT ION 216.. 25695 (5)OP EN TREA TMEN T OF LUNA TE DISL OCAT ION 216.. 26608 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF META CARP AL FRAC TURE , EACH BONE 216.. 26615 (5)OP EN TREA TMEN T OF META CARP AL FRAC TURE , SING LE, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , EACH BONE 216.. 26650 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF CARP OMET ACAR PAL FRAC TURE DISL OCAT ION, THUM B (BEN NETT FRAC TURE ), WITH MANI PULA TION , WITH OR WITH OUT EXTE RNAL FIXA TION 216.. 26665 (5)OP EN TREA TMEN T OF CARP OMET ACAR PAL FRAC TURE DISL OCAT ION, THUM B (BEN NETT FRAC TURE ), WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 26676 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF CARP OMET ACAR PAL DISL OCAT ION, OTHE R THAN THUM B (BEN NETT FRAC TURE ), SING LE, WITH MANI PULA TION 216.. 26685 (5)OP EN TREA TMEN T OF CARP OMET ACAR PAL DISL OCAT ION, OTHE R THAN THUM B (BEN NETT FRAC TURE ); SING LE, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 26686 (5)OP EN TREA TMEN T OF CARP OMET ACAR PAL DISL OCAT ION, OTHE R THAN THUM B (BEN NETT FRAC TURE ); COMP LEX, MULT IPLE OR DELA YED REDU CTIO N 216.. 26715 (5)OP EN TREA TMEN T OF META CARP OPHA LANG EAL DISL OCAT ION, SING LE, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 26727 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF UNST ABLE PHAL ANGE AL SHAF T FRAC TURE , PROX IMAL OR MIDD LE PHAL ANX, FING ER OR THUM B, WITH MANI PULA TION , EACH 216.. 26735 (5)OP EN TREA TMEN T OF PHAL ANGE AL SHAF T FRAC TURE , PROX IMAL OR MIDD LE PHAL ANX, FING ER OR THUM B, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , EACH 216.. 26746 (5)OP EN TREA TMEN T OF ARTI CULA R FRAC TURE , INVO LVIN G META CARP OPHA LANG EAL OR INTE RPHA LANG EAL JOIN T, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , EACH 216.. 26756 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF DIST AL PHAL ANGE AL FRAC TURE , FING ER OR THUM B, EACH 216.. 26765 (5)OP EN TREA TMEN T OF DIST AL PHAL ANGE AL FRAC TURE , FING ER OR THUM B, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , EACH 216.. 26776 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF INTE RPHA LANG EAL JOIN T DISL OCAT ION, SING LE, WITH MANI PULA TION 216.. 26785 (5)OP EN TREA TMEN T OF INTE RPHA LANG EAL JOIN T DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , SING LE 216.. 27202 (5)OP EN TREA TMEN T OF COCC YGEA L FRAC TURE 216.. 27509 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF FEMO RAL FRAC TURE , DIST AL END, MEDI AL OR LATE RAL COND YLE, OR SUPR ACON DYLA R OR TRAN SCON DYLA R, WITH OR WITH OUT INTE RCON DYLA R EXTE NSIO N, OR DIST AL FEMO RAL EPIP HYSE AL SEPA RATI ON 216.. 27556 (5)OP EN TREA TMEN T OF KNEE DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION ; WITH OUT PRIM ARY LIGA MENT OUS REPA IR OR AUGM ENTA TION/ RECO NSTR UCTI ON 216.. 27566 (5)OP EN TREA TMEN T OF PATE LLAR DISL OCAT ION, WITH OR WITH OUT PART IAL OR TOTA L PATE LLEC TOMY 216.. 27615 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF LEG OR ANKL E AREA 216.. 27756 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF TIBI AL SHAF T FRAC TURE (WIT H OR WITH OUT FIBU LAR FRAC TURE ) (EG, PINS OR SCRE WS) 216.. 27758 (5)OP EN TREA TMEN T OF TIBI AL SHAF T FRAC TURE , (WIT H OR WITH OUT FIBU LAR FRAC TURE ) WITH PLAT E/ SCRE WS, WITH OR WITH OUT CERC LAGE 216.. 27759 (5)OP EN TREA TMEN T OF TIBI AL SHAF T FRAC TURE (WIT H OR WITH OUT FIBU LAR FRAC TURE ) BY INTR AMED ULLA RY IMPL ANT, WITH OR WITH OUT INTE RLOC KING SCRE WS AND/ OR CERC LAGE 216.. 27766 (5)OP EN TREA TMEN T OF MEDI AL MALL EOLU S FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 27784 (5)OP EN TREA TMEN T OF PROX IMAL FIBU LA OR SHAF T FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 27792 (5)OP EN TREA TMEN T OF DIST AL FIBU LAR FRAC TURE (LAT ERAL MALL EOLU S), WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 27814 (5)OP EN TREA TMEN T OF BIMA LLEO LAR ANKL E FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 27822 (5)OP EN TREA TMEN T OF TRIM ALLE OLAR ANKL E FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , MEDI AL AND/ OR LATE RAL MALL EOLU S; WITH OUT FIXA TION OF POST ERIO R LIP 216.. 27823 (5)OP EN TREA TMEN T OF TRIM ALLE OLAR ANKL E FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , MEDI AL AND/ OR LATE RAL MALL EOLU S; WITH FIXA TION OF POST ERIO R LIP 216.. 27826 (5)OP EN TREA TMEN T OF FRAC TURE OF WEIG HT BEAR ING ARTI CULA R SURF ACE/ PORT ION OF DIST AL TIBI A (EG, PILO N OR TIBI AL PLAF OND) , WITH INTE RNAL OR EXTE RNAL FIXA TION ; OF FIBU LA ONLY 216.. 27827 (5)OP EN TREA TMEN T OF FRAC TURE OF WEIG HT BEAR ING ARTI CULA R SURF ACE/ PORT ION OF DIST AL TIBI A (EG, PILO N OR TIBI AL PLAF OND) , WITH INTE RNAL OR EXTE RNAL FIXA TION ; OF TIBI A ONLY 216.. 27828 (5)OP EN TREA TMEN T OF FRAC TURE OF WEIG HT BEAR ING ARTI CULA R SURF ACE/ PORT ION OF DIST AL TIBI A (EG, PILO N OR TIBI AL PLAF OND) , WITH INTE RNAL OR EXTE RNAL FIXA TION ; OF BOTH TIBI A AND FIBU LA 216.. 27829 (5)OP EN TREA TMEN T OF DIST AL TIBI OFIB ULAR JOIN T (SYN DESM OSIS ) DISR UPTI ON, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 27832 (5)OP EN TREA TMEN T OF PROX IMAL TIBI OFIB ULAR JOIN T DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , OR WITH EXCI SION OF PROX IMAL FIBU LA 216.. 27846 (5)OP EN TREA TMEN T OF ANKL E DISL OCAT ION, WITH OR WITH OUT PERC UTAN EOUS SKEL ETAL FIXA TION ; WITH OUT REPA IR OR INTE RNAL FIXA TION 216.. 27848 (5)OP EN TREA TMEN T OF ANKL E DISL OCAT ION, WITH OR WITH OUT PERC UTAN EOUS SKEL ETAL FIXA TION ; WITH REPA IR OR INTE RNAL OR EXTE RNAL FIXA TION 216.. 28406 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF CALC ANEA L FRAC TURE , WITH MANI PULA TION 216.. 28415 (5)OP EN TREA TMEN T OF CALC ANEA L FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION ; 216.. 28420 (5)OP EN TREA TMEN T OF CALC ANEA L FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION ; WITH PRIM ARY ILIA C OR OTHE R AUTO GENO US BONE GRAF T (INC LUDE S OBTA ININ G GRAF T) 216.. 28436 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF TALU S FRAC TURE , WITH MANI PULA TION 216.. 28445 (5)OP EN TREA TMEN T OF TALU S FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 28456 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF TARS AL BONE FRAC TURE (EXC EPT TALU S AND CALC ANEU S), WITH MANI PULA TION , EACH [[Page 47777]] 216.. 28465 (5)OP EN TREA TMEN T OF TARS AL BONE FRAC TURE (EXC EPT TALU S AND CALC ANEU S), WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , EACH 216.. 28476 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF META TARS AL FRAC TURE , WITH MANI PULA TION , EACH 216.. 28485 (5)OP EN TREA TMEN T OF META TARS AL FRAC TURE , WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , EACH 216.. 28496 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF FRAC TURE GREA T TOE, PHAL ANX OR PHAL ANGE S, WITH MANI PULA TION 216.. 28505 (5)OP EN TREA TMEN T OF FRAC TURE GREA T TOE, PHAL ANX OR PHAL ANGE S, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 28525 (5)OP EN TREA TMEN T OF FRAC TURE , PHAL ANX OR PHAL ANGE S, OTHE R THAN GREA T TOE, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION , EACH 216.. 28531 (5)OP EN TREA TMEN T OF SESA MOID FRAC TURE , WITH OR WITH OUT INTE RNAL FIXA TION 216.. 28546 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF TARS AL BONE DISL OCAT ION, OTHE R THAN TALO TARS AL, WITH MANI PULA TION 216.. 28555 (5)OP EN TREA TMEN T OF TARS AL BONE DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 28576 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF TALO TARS AL JOIN T DISL OCAT ION, WITH MANI PULA TION 216.. 28585 (5)OP EN TREA TMEN T OF TALO TARS AL JOIN T DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 28606 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF TARS OMET ATAR SAL JOIN T DISL OCAT ION, WITH MANI PULA TION 216.. 28615 (5)OP EN TREA TMEN T OF TARS OMET ATAR SAL JOIN T DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 28636 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF META TARS OPHA LANG EAL JOIN T DISL OCAT ION, WITH MANI PULA TION 216.. 28645 (5)OP EN TREA TMEN T OF META TARS OPHA LANG EAL JOIN T DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 216.. 28666 (5)PE RCUT ANEO US SKEL ETAL FIXA TION OF INTE RPHA LANG EAL JOIN T DISL OCAT ION, WITH MANI PULA TION 216.. 28675 (5)OP EN TREA TMEN T OF INTE RPHA LANG EAL JOIN T DISL OCAT ION, WITH OR WITH OUT INTE RNAL OR EXTE RNAL FIXA TION 217.. (1)Ar T 20.48 $1,037.71 $526.81 $207.54 thro plas ty 217.. 24360 (5)AR THRO PLAS TY, ELBO W; WITH MEMB RANE 217.. 24365 (5)AR THRO PLAS TY, RADI AL HEAD ; 217.. 25332 (5)AR THRO PLAS TY, WRIS T, WITH OR WITH OUT INTE RPOS ITIO N, WITH OR WITH OUT EXTE RNAL OR INTE RNAL FIXA TION 217.. 25447 (5)IN TERP OSIT ION ARTH ROPL ASTY , INTE RCAR PAL OR CARP OMET ACAR PAL JOIN TS 217.. 25449 (5)RE VISI ON OF ARTH ROPL ASTY , INCL UDIN G REMO VAL OF IMPL ANT, WRIS T JOIN T 217.. 26530 (5)AR THRO PLAS TY, META CARP OPHA LANG EAL JOIN T; SING LE, EACH 217.. 26535 (5)AR THRO PLAS TY INTE RPHA LANG EAL JOIN T; SING LE, EACH 217.. 27266 (5)CL OSED TREA TMEN T OF POST HIP ARTH ROPL ASTY DISL OCAT ION; REQU IRIN G REGI ONAL OR GENE RAL ANES THES IA 217.. 27437 (5)AR THRO PLAS TY, PATE LLA; WITH OUT PROS THES IS 217.. 27440 (5)AR THRO PLAS TY, KNEE , TIBI AL PLAT EAU; 217.. 27441 (5)AR THRO PLAS TY, KNEE , TIBI AL PLAT EAU; WITH DEBR IDEM ENT AND PART IAL SYNO VECT OMY 217.. 27442 (5)AR THRO PLAS TY, KNEE , FEMO RAL COND YLES OR TIBI AL PLAT EAUS ; 217.. 27443 (5)AR THRO PLAS TY, KNEE , FEMO RAL COND YLES OR TIBI AL PLAT EAUS ; WITH DEBR IDEM ENT AND PART IAL SYNO VECT OMY 217.. 27700 (5)AR THRO PLAS TY, ANKL E; 218.. (1)Ar T 27.49 $1,392.90 $715.52 $278.58 thro plas ty with pros thes is 218.. 21243 (5)AR THRO PLAS TY, TEMP OROM ANDI BULA R JOIN T, WITH PROS THET IC JOIN T REPL ACEM ENT 218.. 24361 (5)AR THRO PLAS TY, ELBO W; WITH DIST AL HUME RAL PROS THET IC REPL ACEM ENT 218.. 24362 (5)AR THRO PLAS TY, ELBO W; WITH IMPL ANT AND FASC IA LATA LIGA MENT RECO NSTR UCTI ON 218.. 24363 (5)AR THRO PLAS TY, ELBO W; WITH DIST AL HUME RUS AND PROX IMAL ULNA R PROS THET IC REPL ACEM ENT (``T OTAL ELBO W'') 218.. 24366 (5)AR THRO PLAS TY, RADI AL HEAD ; WITH IMPL ANT 218.. 25441 (5)AR THRO PLAS TY WITH PROS THET IC REPL ACEM ENT; DIST AL RADI US 218.. 25442 (5)AR THRO PLAS TY WITH PROS THET IC REPL ACEM ENT; DIST AL ULNA 218.. 25443 (5)AR THRO PLAS TY WITH PROS THET IC REPL ACEM ENT; SCAP HOID (NAV ICUL AR) 218.. 25444 (5)AR THRO PLAS TY WITH PROS THET IC REPL ACEM ENT; LUNA TE 218.. 25445 (5)AR THRO PLAS TY WITH PROS THET IC REPL ACEM ENT; TRAP EZIU M 218.. 25446 (5)AR THRO PLAS TY WITH PROS THET IC REPL ACEM ENT; DIST AL RADI US AND PART IAL OR ENTI RE CARP US (``T OTAL WRIS T'') 218.. 26531 (5)AR THRO PLAS TY, META CARP OPHA LANG EAL JOIN T; WITH PROS THET IC IMPL ANT, SING LE, EACH 218.. 26536 (5)AR THRO PLAS TY INTE RPHA LANG EAL JOIN T; WITH PROS THET IC IMPL ANT, SING LE, EACH 218.. 27438 (5)AR THRO PLAS TY, PATE LLA; WITH PROS THES IS 226.. (1)Ma T 1.59 $80.56 $21.92 $16.11 xill ofac ial pros thes es 226.. 21076 (5)IM PRES SION AND CUST OM PREP ARAT ION; SURG ICAL OBTU RATO R PROS THES IS 226.. 21077 (5)IM PRES SION AND CUST OM PREP ARAT ION; ORBI TAL PROS THES IS 226.. 21079 (5)IM PRES SION AND CUST OM PREP ARAT ION; INTE RIM OBTU RATO R PROS THES IS 226.. 21080 (5)IM PRES SION AND CUST OM PREP ARAT ION; DEFI NITI VE OBTU RATO R PROS THES IS 226.. 21081 (5)IM PRES SION AND CUST OM PREP ARAT ION; MAND IBUL AR RESE CTIO N PROS THES IS 226.. 21082 (5)IM PRES SION AND CUST OM PREP ARAT ION; PALA TAL AUGM ENTA TION PROS THES IS 226.. 21083 (5)IM PRES SION AND CUST OM PREP ARAT ION; PALA TAL LIFT PROS THES IS 226.. 21084 (5)IM PRES SION AND CUST OM PREP ARAT ION; SPEE CH AID PROS THES IS 226.. 21086 (5)IM PRES SION AND CUST OM PREP ARAT ION; AURI CULA R PROS THES IS 226.. 21087 (5)IM PRES SION AND CUST OM PREP ARAT ION; NASA L PROS THES IS 226.. 21088 (5)IM PRES SION AND CUST OM PREP ARAT ION; FACI AL PROS THES IS 226.. 21089 (5)UN LIST ED MAXI LLOF ACIA L PROS THET IC PROC EDUR E 231.. (1)Le T 12.02 $609.05 $299.9 $121.81 vel I skul l and faci al bone proc edur es 231.. 21015 (5)RA DICA L RESE CTIO N OF TUMO R (EG, MALI GNAN T NEOP LASM ), SOFT TISS UE OF FACE OR SCAL P 231.. 21025 (5)EX CISI ON OF BONE (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) ; MAND IBLE 231.. 21026 (5)EX CISI ON OF BONE (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) ; FACI AL BONE (S) 231.. 21029 (5)RE MOVA L BY CONT OURI NG OF BENI GN TUMO R OF FACI AL BONE (EG, FIBR OUS DYSP LASI A) 231.. 21030 (5)EX CISI ON OF BENI GN TUMO R OR CYST OF FACI AL BONE OTHE R THAN MAND IBLE 231.. 21031 (5)EX CISI ON OF TORU S MAND IBUL ARIS 231.. 21032 (5)EX CISI ON OF MAXI LLAR Y TORU S PALA TINU S 231.. 21040 (5)EX CISI ON OF BENI GN CYST OR TUMO R OF MAND IBLE ; SIMP LE 231.. 21041 (5)EX CISI ON OF BENI GN CYST OR TUMO R OF MAND IBLE ; COMP LEX 231.. 21100 (5)AP PLIC ATIO N OF HALO TYPE APPL IANC E FOR MAXI LLOF ACIA L FIXA TION , INCL UDES REMO VAL (SEP ARAT E PROC EDUR E) [[Page 47778]] 231.. 21110 (5)AP PLIC ATIO N OF INTE RDEN TAL FIXA TION DEVI CE FOR COND ITIO NS OTHE R THAN FRAC TURE OR DISL OCAT ION, INCL UDES 231.. 21120 (5)GE NIOP LAST Y; AUGM ENTA TION (AUT OGRA FT, ALLO GRAF T, PROS THET IC MATE RIAL ) 231.. 21125 (5)AU GMEN TATI ON, MAND IBUL AR BODY OR ANGL E; PROS THET IC MATE RIAL 231.. 21280 (5)ME DIAL CANT HOPE XY (SEP ARAT E PROC EDUR E) 231.. 21282 (5)LA TERA L CANT HOPE XY 231.. 21295 (5)RE DUCT ION OF MASS ETER MUSC LE AND BONE (EG, FOR TREA TMEN T OF BENI GN MASS ETER IC HYPE RTRO PHY) ; EXTR AORA L APPR OACH 231.. 21296 (5)RE DUCT ION OF MASS ETER MUSC LE AND BONE (EG, FOR TREA TMEN T OF BENI GN MASS ETER IC HYPE RTRO PHY) ; INTR AORA L APPR OACH 231.. 21299 (5)UN LIST ED CRAN IOFA CIAL AND MAXI LLOF ACIA L PROC EDUR E 231.. 21300 (5)CL OSED TREA TMEN T OF SKUL L FRAC TURE WITH OUT OPER ATIO N 231.. 21310 (5)CL OSED TREA TMEN T OF NASA L BONE FRAC TURE WITH OUT MANI PULA TION 231.. 21315 (5)CL OSED TREA TMEN T OF NASA L BONE FRAC TURE ; WITH OUT STAB ILIZ ATIO N 231.. 21320 (5)CL OSED TREA TMEN T OF NASA L BONE FRAC TURE ; WITH STAB ILIZ ATIO N 231.. 21325 (5)OP EN TREA TMEN T OF NASA L FRAC TURE ; UNCO MPLI CATE D 231.. 21337 (5)CL OSED TREA TMEN T OF NASA L SEPT AL FRAC TURE , WITH OR WITH OUT STAB ILIZ ATIO N 231.. 21355 (5)PE RCUT ANEO US TREA TMEN T OF FRAC TURE OF MALA R AREA , INCL UDIN G ZYGO MATI C ARCH AND MALA R TRIP OD, WITH MANI PULA TION 231.. 21400 (5)CL OSED TREA TMEN T OF FRAC TURE OF ORBI T, EXCE PT ''BL OWOU T''; WITH OUT MANI PULA TION 231.. 21401 (5)CL OSED TREA TMEN T OF FRAC TURE OF ORBI T, EXCE PT ``BL OWOU T''; WITH MANI PULA TION 231.. 21440 (5)CL OSED TREA TMEN T OF MAND IBUL AR OR MAXI LLAR Y ALVE OLAR RIDG E FRAC TURE (SEP ARAT E PROC EDUR E) 231.. 21451 (5)CL OSED TREA TMEN T OF MAND IBUL AR FRAC TURE ; WITH MANI PULA TION 231.. 21480 (5)CL OSED TREA TMEN T OF TEMP OROM ANDI BULA R DISL OCAT ION; INIT IAL OR SUBS EQUE NT 231.. 21485 (5)CL OSED TREA TMEN T OF TEMP OROM ANDI BULA R DISL OCAT ION; COMP LICA TED (EG, RECU RREN T REQU IRIN G INTE RMAX ILLA RY FIXA TION OR SPLI NTIN G), INIT IAL OR SUBS EQUE NT 231.. 21493 (5)CL OSED TREA TMEN T OF HYOI D FRAC TURE ; WITH OUT MANI PULA TION 231.. 21494 (5)CL OSED TREA TMEN T OF HYOI D FRAC TURE ; WITH MANI PULA TION 231.. 21497 (5)IN TERD ENTA L WIRI NG, FOR COND ITIO N OTHE R THAN FRAC TURE 231.. 21499 (5)UN LIST ED MUSC ULOS KELE TAL PROC EDUR E, HEAD 231.. 41822 (5)EX CISI ON OF FIBR OUS TUBE ROSI TIES , DENT OALV EOLA R STRU CTUR ES 231.. 41823 (5)EX CISI ON OF OSSE OUS TUBE ROSI TIES , DENT OALV EOLA R STRU CTUR ES 232.. (1)Le T 23.93 $1,212.52 $639.35 $242.50 vel II skul l and faci al bone proc edur es 232.. 21010 (5)AR THRO TOMY , TEMP OROM ANDI BULA R JOIN T 232.. 21034 (5)EX CISI ON OF MALI GNAN T TUMO R OF FACI AL BONE OTHE R THAN MAND IBLE 232.. 21044 (5)EX CISI ON OF MALI GNAN T TUMO R OF MAND IBLE 232.. 21050 (5)CO NDYL ECTO MY, TEMP OROM ANDI BULA R JOIN T (SEP ARAT E PROC EDUR E) 232.. 21060 (5)ME NISC ECTO MY, PART IAL OR COMP LETE , TEMP OROM ANDI BULA R JOIN T (SEP ARAT E PROC EDUR E) 232.. 21070 (5)CO RONO IDEC TOMY (SEP ARAT E PROC EDUR E) 232.. 21121 (5)GE NIOP LAST Y; SLID ING OSTE OTOM Y, SING LE PIEC E 232.. 21122 (5)GE NIOP LAST Y; SLID ING OSTE OTOM IES, TWO OR MORE OSTE OTOM IES (EG, WEDG E EXCI SION OR BONE WEDG E REVE RSAL FOR ASYM METR ICAL CHIN ) 232.. 21123 (5)GE NIOP LAST Y; SLID ING, AUGM ENTA TION WITH INTE RPOS ITIO NAL BONE GRAF TS (INC LUDE S OBTA ININ G AUTO GRAF TS) 232.. 21127 (5)AU GMEN TATI ON, MAND IBUL AR BODY OR ANGL E; WITH BONE GRAF T, ONLA Y OR INTE RPOS ITIO NAL (INC LUDE S OBTA ININ G AUTO GRAF T) 232.. 21181 (5)RE CONS TRUC TION BY CONT OURI NG OF BENI GN TUMO R OF CRAN IAL BONE S (EG, FIBR OUS DYSP LASI A), EXTR ACRA NIAL 232.. 21206 (5)OS TEOT OMY, MAXI LLA, SEGM ENTA L (EG, WASS MUND OR SCHU CHAR D) 232.. 21208 (5)OS TEOP LAST Y, FACI AL BONE S; AUGM ENTA TION (AUT OGRA FT, ALLO GRAF T, OR PROS THET IC IMPL ANT) 232.. 21209 (5)OS TEOP LAST Y, FACI AL BONE S; REDU CTIO N 232.. 21210 (5)GR AFT, BONE ; NASA L, MAXI LLAR Y OR MALA R AREA S (INC LUDE S OBTA ININ G GRAF T) 232.. 21215 (5)GR AFT, BONE ; MAND IBLE (INC LUDE S OBTA ININ G GRAF T) 232.. 21230 (5)GR AFT; RIB CART ILAG E, AUTO GENO US, TO FACE , CHIN , NOSE OR EAR (INC LUDE S OBTA ININ G GRAF T) 232.. 21235 (5)GR AFT; EAR CART ILAG E, AUTO GENO US, TO NOSE OR EAR (INC LUDE S OBTA ININ G GRAF T) 232.. 21240 (5)AR THRO PLAS TY, TEMP OROM ANDI BULA R JOIN T, WITH OR WITH OUT AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 232.. 21242 (5)AR THRO PLAS TY, TEMP OROM ANDI BULA R JOIN T, WITH ALLO GRAF T 232.. 21244 (5)RE CONS TRUC TION OF MAND IBLE , EXTR AORA L, WITH TRAN SOST EAL BONE PLAT E (EG, MAND IBUL AR STAP LE BONE PLAT E) 232.. 21245 (5)RE CONS TRUC TION OF MAND IBLE OR MAXI LLA, SUBP ERIO STEA L IMPL ANT; PART IAL 232.. 21246 (5)RE CONS TRUC TION OF MAND IBLE OR MAXI LLA, SUBP ERIO STEA L IMPL ANT; COMP LETE 232.. 21248 (5)RE CONS TRUC TION OF MAND IBLE OR MAXI LLA, ENDO STEA L IMPL ANT (EG, BLAD E, CYLI NDER ); PART IAL 232.. 21249 (5)RE CONS TRUC TION OF MAND IBLE OR MAXI LLA, ENDO STEA L IMPL ANT (EG, BLAD E, CYLI NDER ); COMP LETE 232.. 21260 (5)PE RIOR BITA L OSTE OTOM IES FOR ORBI TAL HYPE RTEL ORIS M, WITH BONE GRAF TS; EXTR ACRA NIAL APPR OACH 232.. 21267 (5)OR BITA L REPO SITI ONIN G, PERI ORBI TAL OSTE OTOM IES, UNIL ATER AL, WITH BONE GRAF TS; EXTR ACRA NIAL APPR OACH 232.. 21270 (5)MA LAR AUGM ENTA TION , PROS THET IC MATE RIAL 232.. 21275 (5)SE COND ARY REVI SION OF ORBI TOCR ANIO FACI AL RECO NSTR UCTI ON 232.. 21330 (5)OP EN TREA TMEN T OF NASA L FRAC TURE ; COMP LICA TED, WITH INTE RNAL AND/ OR EXTE RNAL SKEL ETAL FIXA TION 232.. 21335 (5)OP EN TREA TMEN T OF NASA L FRAC TURE ; WITH CONC OMIT ANT OPEN TREA TMEN T OF FRAC TURE D SEPT UM 232.. 21338 (5)OP EN TREA TMEN T OF NASO ETHM OID FRAC TURE ; WITH OUT EXTE RNAL FIXA TION 232.. 21339 (5)OP EN TREA TMEN T OF NASO ETHM OID FRAC TURE ; WITH EXTE RNAL FIXA TION 232.. 21340 (5)PE RCUT ANEO US TREA TMEN T OF NASO ETHM OID COMP LEX FRAC TURE , WITH SPLI NT, WIRE OR HEAD CAP FIXA TION , INCL UDIN G REPA IR OF CANT HAL LIGA MENT S AND/ OR THE NASO LACR IMAL APPA RATU S 232.. 21343 (5)OP EN TREA TMEN T OF DEPR ESSE D FRON TAL SINU S FRAC TURE 232.. 21345 (5)CL OSED TREA TMEN T OF NASO MAXI LLAR Y COMP LEX FRAC TURE (LEF ORT II TYPE ), WITH INTE RDEN TAL WIRE FIXA TION OR FIXA TION OF DENT URE OR SPLI NT 232.. 21421 (5)CL OSED TREA TMEN T OF PALA TAL OR MAXI LLAR Y FRAC TURE (LEF ORT I TYPE ), WITH INTE RDEN TAL WIRE FIXA TION OR FIXA TION OF DENT URE OR SPLI NT 232.. 21445 (5)OP EN TREA TMEN T OF MAND IBUL AR OR MAXI LLAR Y ALVE OLAR RIDG E FRAC TURE (SEP ARAT E PROC EDUR E) [[Page 47779]] 232.. 21450 (5)CL OSED TREA TMEN T OF MAND IBUL AR FRAC TURE ; WITH OUT MANI PULA TION 232.. 21452 (5)PE RCUT ANEO US TREA TMEN T OF MAND IBUL AR FRAC TURE , WITH EXTE RNAL FIXA TION 232.. 21453 (5)CL OSED TREA TMEN T OF MAND IBUL AR FRAC TURE WITH INTE RDEN TAL FIXA TION 232.. 21454 (5)OP EN TREA TMEN T OF MAND IBUL AR FRAC TURE WITH EXTE RNAL FIXA TION 232.. 21461 (5)OP EN TREA TMEN T OF MAND IBUL AR FRAC TURE ; WITH OUT INTE RDEN TAL FIXA TION 232.. 21462 (5)OP EN TREA TMEN T OF MAND IBUL AR FRAC TURE ; WITH INTE RDEN TAL FIXA TION 232.. 21465 (5)OP EN TREA TMEN T OF MAND IBUL AR COND YLAR FRAC TURE 232.. 21490 (5)OP EN TREA TMEN T OF TEMP OROM ANDI BULA R DISL OCAT ION 232.. 67420 (5)OR BITO TOMY WITH BONE FLAP OR WIND OW, LATE RAL APPR OACH (EG, KROE NLEI N); WITH REMO VAL OF LESI ON 232.. 67430 (5)OR BITO TOMY WITH BONE FLAP OR WIND OW, LATE RAL APPR OACH (EG, KROE NLEI N); WITH REMO VAL OF FORE IGN BODY 232.. 67440 (5)OR BITO TOMY WITH BONE FLAP OR WIND OW, LATE RAL APPR OACH (EG, KROE NLEI N); WITH DRAI NAGE 232.. 67450 (5)OR BITO TOMY WITH BONE FLAP OR WIND OW, LATE RAL APPR OACH (EG, KROE NLEI N); FOR EXPL ORAT ION, WITH OR WITH OUT BIOP SY 251.. (1)Le T 14.26 $722.55 $366.12 $144.51 vel I musc ulos kele tal proc edur es 251.. 20005 (5)IN CISI ON OF SOFT TISS UE ABSC ESS (EG, SECO NDAR Y TO OSTE OMYE LITI S); DEEP OR COMP LICA TED 251.. 20250 (5)BI OPSY , VERT EBRA L BODY , OPEN ; THOR ACIC 251.. 20251 (5)BI OPSY , VERT EBRA L BODY , OPEN ; LUMB AR OR CERV ICAL 251.. 20650 (5)IN SERT ION OF WIRE OR PIN WITH APPL ICAT ION OF SKEL ETAL TRAC TION , INCL UDIN G REMO VAL (SEP ARAT E PROC EDUR E) 251.. 20693 (5)AD JUST MENT OR REVI SION OF EXTE RNAL FIXA TION SYST EM REQU IRIN G ANES THES IA (EG, NEW PIN( S) OR WIRE (S) AND/ OR NEW RING (S) OR BAR( S)) 251.. 20694 (5)RE MOVA L, UNDE R ANES THES IA, OF EXTE RNAL FIXA TION SYST EM 251.. 20975 (5)EL ECTR ICAL STIM ULAT ION TO AID BONE HEAL ING; INVA SIVE (OPE RATI VE) 251.. 23100 (5)AR THRO TOMY WITH BIOP SY, GLEN OHUM ERAL JOIN T 251.. 23140 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF CLAV ICLE OR SCAP ULA; 251.. 23935 (5)IN CISI ON, DEEP , WITH OPEN ING OF BONE CORT EX (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , HUME RUS OR ELBO W 251.. 24100 (5)AR THRO TOMY , ELBO W; WITH SYNO VIAL BIOP SY ONLY 251.. 24105 (5)EX CISI ON, OLEC RANO N BURS A 251.. 24110 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R, HUME RUS; 251.. 24120 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF HEAD OR NECK OF RADI US OR OLEC RANO N PROC ESS; 251.. 24310 (5)TE NOTO MY, OPEN , ELBO W TO SHOU LDER , SING LE, EACH 251.. 24925 (5)AM PUTA TION , ARM THRO UGH HUME RUS; SECO NDAR Y CLOS URE OR SCAR REVI SION 251.. 25000 (5)TE NDON SHEA TH INCI SION ; AT RADI AL STYL OID (EG, FOR DEQU ERVA IN'S DISE ASE) 251.. 25020 (5)DE COMP RESS ION FASC IOTO MY, FORE ARM AND/ OR WRIS T; FLEX OR OR EXTE NSOR COMP ARTM ENT 251.. 25028 (5)IN CISI ON AND DRAI NAGE , FORE ARM AND/ OR WRIS T; DEEP ABSC ESS OR HEMA TOMA 251.. 25031 (5)IN CISI ON AND DRAI NAGE , FORE ARM AND/ OR WRIS T; INFE CTED BURS A 251.. 25035 (5)IN CISI ON, DEEP , WITH OPEN ING OF BONE CORT EX (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , FORE ARM AND/ OR WRIS T 251.. 25085 (5)CA PSUL OTOM Y, WRIS T (EG, FOR CONT RACT URE) 251.. 25100 (5)AR THRO TOMY , WRIS T JOIN T; WITH BIOP SY 251.. 25110 (5)EX CISI ON, LESI ON OF TEND ON SHEA TH, FORE ARM AND/ OR WRIS T 251.. 25115 (5)RA DICA L EXCI SION OF BURS A, SYNO VIA OF WRIS T, OR FORE ARM TEND ON SHEA THS (EG, TENO SYNO VITI S, FUNG US, TBC, OR OTHE R GRAN ULOM AS, RHEU MATO ID ARTH RITI S); FLEX ORS 251.. 25116 (5)RA DICA L EXCI SION OF BURS A, SYNO VIA OF WRIS T, OR FORE ARM TEND ON SHEA THS (EG, TENO SYNO VITI S, FUNG US, TBC, OR OTHE R GRAN ULOM AS, RHEU MATO ID ARTH RITI S); EXTE NSOR S, WITH OR WITH OUT TRAN SPOS ITIO N OF DORS AL RETI NACU LUM 251.. 25248 (5)EX PLOR ATIO N WITH REMO VAL OF DEEP FORE IGN BODY , FORE ARM OR WRIS T 251.. 25295 (5)TE NOLY SIS, FLEX OR OR EXTE NSOR TEND ON, FORE ARM AND/ OR WRIS T, SING LE, EACH TEND ON 251.. 25907 (5)AM PUTA TION , FORE ARM, THRO UGH RADI US AND ULNA ; SECO NDAR Y CLOS URE OR SCAR REVI SION 251.. 25922 (5)DI SART ICUL ATIO N THRO UGH WRIS T; SECO NDAR Y CLOS URE OR SCAR REVI SION 251.. 26990 (5)IN CISI ON AND DRAI NAGE , PELV IS OR HIP JOIN T AREA ; DEEP ABSC ESS OR HEMA TOMA 251.. 26991 (5)IN CISI ON AND DRAI NAGE , PELV IS OR HIP JOIN T AREA ; INFE CTED BURS A 251.. 27000 (5)TE NOTO MY, ADDU CTOR OF HIP, SUBC UTAN EOUS , CLOS ED (SEP ARAT E PROC EDUR E) 251.. 27050 (5)AR THRO TOMY , WITH BIOP SY; SACR OILI AC JOIN T 251.. 27052 (5)AR THRO TOMY , WITH BIOP SY; HIP JOIN T 251.. 27060 (5)EX CISI ON; ISCH IAL BURS A 251.. 27062 (5)EX CISI ON; TROC HANT ERIC BURS A OR CALC IFIC ATIO N 251.. 27065 (5)EX CISI ON OF BONE CYST OR BENI GN TUMO R; SUPE RFIC IAL (WIN G OF ILIU M, SYMP HYSI S PUBI S, OR GREA TER TROC HANT ER OF FEMU R) WITH OR WITH OUT AUTO GRAF T 251.. 27086 (5)RE MOVA L OF FORE IGN BODY , PELV IS OR HIP; SUBC UTAN EOUS TISS UE 251.. 27087 (5)RE MOVA L OF FORE IGN BODY , PELV IS OR HIP; DEEP 251.. 27305 (5)FA SCIO TOMY , ILIO TIBI AL (TEN OTOM Y), OPEN 251.. 27306 (5)TE NOTO MY, SUBC UTAN EOUS , CLOS ED, ADDU CTOR OR HAMS TRIN G, (SEP ARAT E PROC EDUR E); SING LE 251.. 27307 (5)TE NOTO MY, SUBC UTAN EOUS , CLOS ED, ADDU CTOR OR HAMS TRIN G, (SEP ARAT E PROC EDUR E); MULT IPLE 251.. 27340 (5)EX CISI ON, PREP ATEL LAR BURS A 251.. 27345 (5)EX CISI ON OF SYNO VIAL CYST OF POPL ITEA L SPAC E (BAK ER'S CYST ) 251.. 27380 (5)SU TURE OF INFR APAT ELLA R TEND ON; PRIM ARY 251.. 27381 (5)SU TURE OF INFR APAT ELLA R TEND ON; SECO NDAR Y RECO NSTR UCTI ON, INCL UDIN G FASC IAL OR TEND ON GRAF T 251.. 27385 (5)SU TURE OF QUAD RICE PS OR HAMS TRIN G MUSC LE RUPT URE; PRIM ARY 251.. 27386 (5)SU TURE OF QUAD RICE PS OR HAMS TRIN G MUSC LE RUPT URE; SECO NDAR Y RECO NSTR UCTI ON, INCL UDIN G FASC IAL OR TEND ON GRAF T 251.. 27390 (5)TE NOTO MY, OPEN , HAMS TRIN G, KNEE TO HIP; SING LE 251.. 27391 (5)TE NOTO MY, OPEN , HAMS TRIN G, KNEE TO HIP; MULT IPLE , ONE LEG 251.. 27392 (5)TE NOTO MY, OPEN , HAMS TRIN G, KNEE TO HIP; MULT IPLE , BILA TERA L 251.. 27496 (5)DE COMP RESS ION FASC IOTO MY, THIG H AND/ OR KNEE , ONE COMP ARTM ENT (FLE XOR OR EXTE NSOR OR ADDU CTOR ); 251.. 27497 (5)DE COMP RESS ION FASC IOTO MY, THIG H AND/ OR KNEE , ONE COMP ARTM ENT (FLE XOR OR EXTE NSOR OR ADDU CTOR ); WITH DEBR IDEM ENT OF NONV IABL E MUSC LE AND/ OR NERV E 251.. 27498 (5)DE COMP RESS ION FASC IOTO MY, THIG H AND/ OR KNEE , MULT IPLE COMP ARTM ENTS ; [[Page 47780]] 251.. 27499 (5)DE COMP RESS ION FASC IOTO MY, THIG H AND/ OR KNEE , MULT IPLE COMP ARTM ENTS ; WITH DEBR IDEM ENT OF NONV IABL E MUSC LE AND/ OR NERV E 251.. 27594 (5)AM PUTA TION , THIG H, THRO UGH FEMU R, ANY LEVE L; SECO NDAR Y CLOS URE OR SCAR REVI SION 251.. 27600 (5)DE COMP RESS ION FASC IOTO MY, LEG; ANTE RIOR AND/ OR LATE RAL COMP ARTM ENTS ONLY 251.. 27601 (5)DE COMP RESS ION FASC IOTO MY, LEG; POST ERIO R COMP ARTM ENT( S) ONLY 251.. 27602 (5)DE COMP RESS ION FASC IOTO MY, LEG; ANTE RIOR AND/ OR LATE RAL, AND POST ERIO R COMP ARTM ENT( S) 251.. 27604 (5)IN CISI ON AND DRAI NAGE , LEG OR ANKL E; INFE CTED BURS A 251.. 27606 (5)TE NOTO MY, ACHI LLES TEND ON, SUBC UTAN EOUS (SEP ARAT E PROC EDUR E); GENE RAL ANES THES IA 251.. 27607 (5)IN CISI ON, DEEP , WITH OPEN ING OF BONE CORT EX (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , LEG OR ANKL E 251.. 27630 (5)EX CISI ON OF LESI ON OF TEND ON SHEA TH OR CAPS ULE (EG, CYST OR GANG LION ), LEG AND/ OR ANKL E 251.. 27656 (5)RE PAIR , FASC IAL DEFE CT OF LEG 251.. 27658 (5)RE PAIR OR SUTU RE OF FLEX OR TEND ON OF LEG; PRIM ARY, WITH OUT GRAF T, SING LE, EACH 251.. 27659 (5)RE PAIR OR SUTU RE OF FLEX OR TEND ON OF LEG; SECO NDAR Y WITH OR WITH OUT GRAF T, SING LE TEND ON, EACH 251.. 27664 (5)RE PAIR OR SUTU RE OF EXTE NSOR TEND ON OF LEG; PRIM ARY, WITH OUT GRAF T, SING LE, EACH 251.. 27675 (5)RE PAIR FOR DISL OCAT ING PERO NEAL TEND ONS; WITH OUT FIBU LAR OSTE OTOM Y 251.. 27704 (5)RE MOVA L OF ANKL E IMPL ANT 251.. 27707 (5)OS TEOT OMY; FIBU LA 251.. 27884 (5)AM PUTA TION , LEG, THRO UGH TIBI A AND FIBU LA; SECO NDAR Y CLOS URE OR SCAR REVI SION 251.. 27892 (5)DE COMP RESS ION FASC IOTO MY, LEG; ANTE RIOR AND/ OR LATE RAL COMP ARTM ENTS ONLY , WITH DEBR IDEM ENT OF NONV IABL E MUSC LE AND/ OR NERV E 251.. 27893 (5)DE COMP RESS ION FASC IOTO MY, LEG; POST ERIO R COMP ARTM ENT( S) ONLY , WITH DEBR IDEM ENT OF NONV IABL E MUSC LE AND/ OR NERV E 251.. 27894 (5)DE COMP RESS ION FASC IOTO MY, LEG; ANTE RIOR AND/ OR LATE RAL, AND POST ERIO R COMP ARTM ENT( S), WITH DEBR IDEM ENT OF NONV IABL E MUSC LE AND/ OR NERV E 251.. 28002 (5)DE EP DISS ECTI ON BELO W FASC IA, FOR DEEP INFE CTIO N OF FOOT , WITH OR WITH OUT TEND ON SHEA TH INVO LVEM ENT; SING LE BURS AL SPAC E, SPEC IFY 251.. 28003 (5)DE EP DISS ECTI ON BELO W FASC IA, FOR DEEP INFE CTIO N OF FOOT , WITH OR WITH OUT TEND ON SHEA TH INVO LVEM ENT; MULT IPLE AREA S 252.. (1)Le T 19.39 $982.48 $509.18 $196.5 vel II Musc ulos kele tal Proc edur es 252.. 20690 (5)AP PLIC ATIO N OF A UNIP LANE (PIN S OR WIRE S IN ONE PLAN E), UNIL ATER AL, EXTE RNAL FIXA TION SYST EM 252.. 20692 (5)AP PLIC ATIO N OF A MULT IPLA NE (PIN S OR WIRE S IN MORE THAN ONE PLAN E), UNIL ATER AL, EXTE RNAL FIXA TION SYST EM (EG, ILIZ AROV , MONT ICEL LI TYPE ) 252.. 20900 (5)BO NE GRAF T, ANY DONO R AREA ; MINO R OR SMAL L (EG, DOWE L OR BUTT ON) 252.. 20902 (5)BO NE GRAF T, ANY DONO R AREA ; MAJO R OR LARG E 252.. 20924 (5)TE NDON GRAF T, FROM A DIST ANCE (EG, PALM ARIS , TOE EXTE NSOR , PLAN TARI S) 252.. 21502 (5)IN CISI ON AND DRAI NAGE , DEEP ABSC ESS OR HEMA TOMA , SOFT TISS UES OF NECK OR THOR AX; WITH PART IAL RIB OSTE CTOM Y 252.. 21600 (5)EX CISI ON OF RIB, PART IAL 252.. 21610 (5)CO STOT RANS VERS ECTO MY (SEP ARAT E PROC EDUR E) 252.. 23040 (5)AR THRO TOMY , GLEN OHUM ERAL JOIN T, FOR INFE CTIO N, WITH EXPL ORAT ION, DRAI NAGE , OR REMO VAL OF FORE IGN BODY 252.. 23044 (5)AR THRO TOMY , ACRO MIOC LAVI CULA R, STER NOCL AVIC ULAR JOIN T, FOR INFE CTIO N, WITH EXPL ORAT ION, DRAI NAGE , OR REMO VAL OF FORE IGN BODY 252.. 23101 (5)AR THRO TOMY WITH BIOP SY, OR WITH EXCI SION OF TORN CART ILAG E, ACRO MIOC LAVI CULA R, STER NOCL AVIC ULAR JOIN T 252.. 23105 (5)AR THRO TOMY WITH SYNO VECT OMY; GLEN OHUM ERAL JOIN T 252.. 23106 (5)AR THRO TOMY WITH SYNO VECT OMY; STER NOCL AVIC ULAR JOIN T 252.. 23107 (5)AR THRO TOMY , GLEN OHUM ERAL JOIN T, WITH JOIN T EXPL ORAT ION, WITH OR WITH OUT REMO VAL OF LOOS E OR FORE IGN BODY 252.. 23145 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF CLAV ICLE OR SCAP ULA; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 23146 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF CLAV ICLE OR SCAP ULA; WITH ALLO GRAF T 252.. 23150 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF PROX IMAL HUME RUS; 252.. 23155 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF PROX IMAL HUME RUS; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 23156 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF PROX IMAL HUME RUS; WITH ALLO GRAF T 252.. 23170 (5)SE QUES TREC TOMY (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , CLAV ICLE 252.. 23172 (5)SE QUES TREC TOMY (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , SCAP ULA 252.. 23174 (5)SE QUES TREC TOMY (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , HUME RAL HEAD TO SURG ICAL NECK 252.. 23180 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S), CLAV ICLE 252.. 23182 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S), SCAP ULA 252.. 23184 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S), PROX IMAL HUME RUS 252.. 23190 (5)OS TECT OMY OF SCAP ULA, PART IAL (EG, SUPE RIOR MEDI AL ANGL E) 252.. 23405 (5)TE NOMY OTOM Y, SHOU LDER AREA ; SING LE 252.. 23406 (5)TE NOMY OTOM Y, SHOU LDER AREA ; MULT IPLE THRO UGH SAME INCI SION 252.. 24000 (5)AR THRO TOMY , ELBO W, FOR INFE CTIO N, WITH EXPL ORAT ION, DRAI NAGE OR REMO VAL OF FORE IGN BODY 252.. 24006 (5)AR THRO TOMY OF THE ELBO W, WITH CAPS ULAR EXCI SION FOR CAPS ULAR RELE ASE (SEP ARAT E PROC EDUR E) 252.. 24101 (5)AR THRO TOMY , ELBO W; WITH JOIN T EXPL ORAT ION, WITH OR WITH OUT BIOP SY, WITH OR WITH OUT REMO VAL OF LOOS E OR FORE IGN BODY 252.. 24102 (5)AR THRO TOMY , ELBO W; WITH SYNO VECT OMY 252.. 24115 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R, HUME RUS; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 24116 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R, HUME RUS; WITH ALLO GRAF T 252.. 24125 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF HEAD OR NECK OF RADI US OR OLEC RANO N PROC ESS; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 24126 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF HEAD OR NECK OF RADI US OR OLEC RANO N PROC ESS; WITH ALLO GRAF T 252.. 24130 (5)EX CISI ON, RADI AL HEAD 252.. 24134 (5)SE QUES TREC TOMY (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , SHAF T OR DIST AL HUME RUS [[Page 47781]] 252.. 24136 (5)SE QUES TREC TOMY (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , RADI AL HEAD OR NECK 252.. 24138 (5)SE QUES TREC TOMY (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , OLEC RANO N PROC ESS 252.. 24140 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S), HUME RUS 252.. 24145 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S), RADI AL HEAD OR NECK 252.. 24147 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S), OLEC RANO N PROC ESS 252.. 24160 (5)IM PLAN T REMO VAL; ELBO W JOIN T 252.. 24164 (5)IM PLAN T REMO VAL; RADI AL HEAD 252.. 24301 (5)MU SCLE OR TEND ON TRAN SFER , ANY TYPE , UPPE R ARM OR ELBO W, SING LE (EXC LUDI NG 2432 0- 2433 1) 252.. 24305 (5)TE NDON LENG THEN ING, UPPE R ARM OR ELBO W, SING LE, EACH 252.. 24350 (5)FA SCIO TOMY , LATE RAL OR MEDI AL (EG, ``TE NNIS ELBO W'' OR EPIC ONDY LITI S); 252.. 24351 (5)FA SCIO TOMY , LATE RAL OR MEDI AL (EG, ``TE NNIS ELBO W'' OR EPIC ONDY LITI S); WITH EXTE NSOR ORIG IN DETA CHME NT 252.. 24352 (5)FA SCIO TOMY , LATE RAL OR MEDI AL (EG, ''TE NNIS ELBO W'' OR EPIC ONDY LITI S); WITH ANNU LAR LIGA MENT RESE CTIO N 252.. 24354 (5)FA SCIO TOMY , LATE RAL OR MEDI AL (EG, ''TE NNIS ELBO W'' OR EPIC ONDY LITI S); WITH STRI PPIN G 252.. 24356 (5)FA SCIO TOMY , LATE RAL OR MEDI AL (EG, ''TE NNIS ELBO W'' OR EPIC ONDY LITI S); WITH PART IAL OSTE CTOM Y 252.. 24400 (5)OS TEOT OMY, HUME RUS, WITH OR WITH OUT INTE RNAL FIXA TION 252.. 24410 (5)MU LTIP LE OSTE OTOM IES WITH REAL IGNM ENT ON INTR AMED ULLA RY ROD, HUME RAL SHAF T (SOF IELD TYPE PROC EDUR E) 252.. 24495 (5)DE COMP RESS ION FASC IOTO MY, FORE ARM, WITH BRAC HIAL ARTE RY EXPL ORAT ION 252.. 25023 (5)DE COMP RESS ION FASC IOTO MY, FORE ARM AND/ OR WRIS T; WITH DEBR IDEM ENT OF NONV IABL E MUSC LE AND/ OR NERV E 252.. 25040 (5)AR THRO TOMY , RADI OCAR PAL OR MIDC ARPA L JOIN T, WITH EXPL ORAT ION, DRAI NAGE , OR REMO VAL OF FORE IGN BODY 252.. 25101 (5)AR THRO TOMY , WRIS T JOIN T; WITH JOIN T EXPL ORAT ION, WITH OR WITH OUT BIOP SY, WITH OR WITH OUT REMO VAL OF LOOS E OR FORE IGN BODY 252.. 25105 (5)AR THRO TOMY , WRIS T JOIN T; WITH SYNO VECT OMY 252.. 25107 (5)AR THRO TOMY , DIST AL RADI OULN AR JOIN T FOR REPA IR OF TRIA NGUL AR CART ILAG E COMP LEX 252.. 25118 (5)SY NOVE CTOM Y, EXTE NSOR TEND ON SHEA TH, WRIS T, SING LE COMP ARTM ENT; 252.. 25119 (5)SY NOVE CTOM Y, EXTE NSOR TEND ON SHEA TH, WRIS T, SING LE COMP ARTM ENT; WITH RESE CTIO N OF DIST AL ULNA 252.. 25120 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF RADI US OR ULNA (EXC LUDI NG HEAD OR NECK OF RADI US AND OLEC RANO N PROC ESS) ; 252.. 25125 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF RADI US OR ULNA (EXC LUDI NG HEAD OR NECK OF RADI US AND OLEC RANO N PROC ESS) ; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 25126 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF RADI US OR ULNA (EXC LUDI NG HEAD OR NECK OF RADI US AND OLEC RANO N PROC ESS) ; WITH ALLO GRAF T 252.. 25130 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF CARP AL BONE S; 252.. 25135 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF CARP AL BONE S; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 25136 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF CARP AL BONE S; WITH ALLO GRAF T 252.. 25145 (5)SE QUES TREC TOMY (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , FORE ARM AND/ OR WRIS T 252.. 25150 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S); ULNA 252.. 25151 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S); RADI US 252.. 25230 (5)RA DIAL STYL OIDE CTOM Y (SEP ARAT E PROC EDUR E) 252.. 25240 (5)EX CISI ON DIST AL ULNA PART IAL OR COMP LETE (EG, DARR ACH TYPE OR MATC HED RESE CTIO N) 252.. 25250 (5)RE MOVA L OF WRIS T PROS THES IS; (SEP ARAT E PROC EDUR E) 252.. 25251 (5)RE MOVA L OF WRIS T PROS THES IS; COMP LICA TED, INCL UDIN G ''TO TAL WRIS T'' 252.. 25260 (5)RE PAIR , TEND ON OR MUSC LE, FLEX OR, FORE ARM AND/ OR WRIS T; PRIM ARY, SING LE, EACH TEND ON OR MUSC LE 252.. 25263 (5)RE PAIR , TEND ON OR MUSC LE, FLEX OR, FORE ARM AND/ OR WRIS T; SECO NDAR Y, SING LE, EACH TEND ON OR MUSC LE 252.. 25265 (5)RE PAIR , TEND ON OR MUSC LE, FLEX OR, FORE ARM AND/ OR WRIS T; SECO NDAR Y, WITH FREE GRAF T (INC LUDE S OBTA ININ G GRAF T), EACH TEND ON OR MUSC LE 252.. 25270 (5)RE PAIR , TEND ON OR MUSC LE, EXTE NSOR , FORE ARM AND/ OR WRIS T; PRIM ARY, SING LE, EACH TEND ON OR MUSC LE 252.. 25272 (5)RE PAIR , TEND ON OR MUSC LE, EXTE NSOR , FORE ARM AND/ OR WRIS T; SECO NDAR Y, SING LE, EACH TEND ON OR MUSC LE 252.. 25274 (5)RE PAIR , TEND ON OR MUSC LE, EXTE NSOR , SECO NDAR Y, WITH TEND ON GRAF T (INC LUDE S OBTA ININ G GRAF T), FORE ARM AND/ OR WRIS T, EACH TEND ON OR MUSC LE 252.. 25280 (5)LE NGTH ENIN G OR SHOR TENI NG OF FLEX OR OR EXTE NSOR TEND ON, FORE ARM AND/ OR WRIS T, SING LE, EACH TEND ON 252.. 25290 (5)TE NOTO MY, OPEN , FLEX OR OR EXTE NSOR TEND ON, FORE ARM AND/ OR WRIS T, SING LE, EACH TEND ON 252.. 25300 (5)TE NODE SIS AT WRIS T; FLEX ORS OF FING ERS 252.. 25301 (5)TE NODE SIS AT WRIS T; EXTE NSOR S OF FING ERS 252.. 25360 (5)OS TEOT OMY; ULNA 252.. 25365 (5)OS TEOT OMY; RADI US AND ULNA 252.. 25400 (5)RE PAIR OF NONU NION OR MALU NION , RADI US OR ULNA ; WITH OUT GRAF T (EG, COMP RESS ION TECH NIQU E) 252.. 25415 (5)RE PAIR OF NONU NION OR MALU NION , RADI US AND ULNA ; WITH OUT GRAF T (EG, COMP RESS ION TECH NIQU E) 252.. 27001 (5)TE NOTO MY, ADDU CTOR OF HIP, SUBC UTAN EOUS , OPEN 252.. 27003 (5)TE NOTO MY, ADDU CTOR , SUBC UTAN EOUS , OPEN , WITH OBTU RATO R NEUR ECTO MY 252.. 27066 (5)EX CISI ON OF BONE CYST OR BENI GN TUMO R; DEEP , WITH OR WITH OUT AUTO GRAF T 252.. 27067 (5)EX CISI ON OF BONE CYST OR BENI GN TUMO R; WITH AUTO GRAF T REQU IRIN G SEPA RATE INCI SION 252.. 27080 (5)CO CCYG ECTO MY, PRIM ARY 252.. 27097 (5)HA MSTR ING RECE SSIO N, PROX IMAL 252.. 27098 (5)AD DUCT OR TRAN SFER TO ISCH IUM 252.. 27310 (5)AR THRO TOMY , KNEE , FOR INFE CTIO N, WITH EXPL ORAT ION, DRAI NAGE OR REMO VAL OF FORE IGN BODY 252.. 27330 (5)AR THRO TOMY , KNEE ; WITH SYNO VIAL BIOP SY ONLY 252.. 27331 (5)AR THRO TOMY , KNEE ; WITH JOIN T EXPL ORAT ION, WITH OR WITH OUT BIOP SY, WITH OR WITH OUT REMO VAL OF LOOS E OR FORE IGN BODI ES 252.. 27332 (5)AR THRO TOMY , KNEE , WITH EXCI SION OF SEMI LUNA R CART ILAG E (MEN ISCE CTOM Y); MEDI AL OR LATE RAL 252.. 27333 (5)AR THRO TOMY , KNEE , WITH EXCI SION OF SEMI LUNA R CART ILAG E (MEN ISCE CTOM Y); MEDI AL AND LATE RAL 252.. 27334 (5)AR THRO TOMY , KNEE , WITH SYNO VECT OMY; ANTE RIOR OR POST ERIO R 252.. 27335 (5)AR THRO TOMY , KNEE , WITH SYNO VECT OMY; ANTE RIOR AND POST ERIO R INCL UDIN G POPL ITEA L AREA 252.. 27350 (5)PA TELL ECTO MY OR HEMI PATE LLEC TOMY [[Page 47782]] 252.. 27355 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF FEMU R; 252.. 27356 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF FEMU R; WITH ALLO GRAF T 252.. 27357 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF FEMU R; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 27358 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF FEMU R; WITH INTE RNAL FIXA TION (LIS T IN ADDI TION TO 2735 5, 2735 6, OR 2735 7) 252.. 27360 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S), FEMU R, PROX IMAL TIBI A AND/ OR FIBU LA 252.. 27393 (5)LE NGTH ENIN G OF HAMS TRIN G TEND ON; SING LE 252.. 27394 (5)LE NGTH ENIN G OF HAMS TRIN G TEND ON; MULT IPLE , ONE LEG 252.. 27396 (5)TR ANSP LANT , HAMS TRIN G TEND ON TO PATE LLA; SING LE 252.. 27403 (5)AR THRO TOMY WITH OPEN MENI SCUS REPA IR 252.. 27425 (5)LA TERA L RETI NACU LAR RELE ASE (ANY METH OD) 252.. 27610 (5)AR THRO TOMY , ANKL E, FOR INFE CTIO N, WITH EXPL ORAT ION, DRAI NAGE , OR REMO VAL OF FORE IGN BODY 252.. 27612 (5)AR THRO TOMY , ANKL E, POST ERIO R CAPS ULAR RELE ASE, WITH OR WITH OUT ACHI LLES TEND ON LENG THEN ING 252.. 27620 (5)AR THRO TOMY , ANKL E, WITH JOIN T EXPL ORAT ION, WITH OR WITH OUT BIOP SY, WITH OR WITH OUT REMO VAL OF LOOS E OR FORE IGN BODY 252.. 27625 (5)AR THRO TOMY , ANKL E, WITH SYNO VECT OMY; 252.. 27626 (5)AR THRO TOMY , ANKL E, WITH SYNO VECT OMY; INCL UDIN G TENO SYNO VECT OMY 252.. 27635 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R, TIBI A OR FIBU LA; 252.. 27637 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R, TIBI A OR FIBU LA; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 252.. 27638 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R, TIBI A OR FIBU LA; WITH ALLO GRAF T 252.. 27641 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S OR EXOS TOSI S); FIBU LA 252.. 27665 (5)RE PAIR OR SUTU RE OF EXTE NSOR TEND ON OF LEG; SECO NDAR Y WITH OR WITH OUT GRAF T, SING LE TEND ON, EACH 252.. 27676 (5)RE PAIR FOR DISL OCAT ING PERO NEAL TEND ONS; WITH FIBU LAR OSTE OTOM Y 252.. 27680 (5)TE NOLY SIS, INCL UDIN G TIBI A, FIBU LA, AND ANKL E FLEX OR; SING LE 252.. 27681 (5)TE NOLY SIS, INCL UDIN G TIBI A, FIBU LA, AND ANKL E FLEX OR; MULT IPLE (THR OUGH SAME INCI SION ), EACH 252.. 27685 (5)LE NGTH ENIN G OR SHOR TENI NG OF TEND ON, LEG OR ANKL E; SING LE (SEP ARAT E PROC EDUR E) 252.. 27686 (5)LE NGTH ENIN G OR SHOR TENI NG OF TEND ON, LEG OR ANKL E; MULT IPLE (THR OUGH SAME INCI SION ), EACH 252.. 27687 (5)GA STRO CNEM IUS RECE SSIO N (EG, STRA YER PROC EDUR E) 252.. 27695 (5)SU TURE , PRIM ARY, TORN , RUPT URED OR SEVE RED LIGA MENT , ANKL E; COLL ATER AL 252.. 27696 (5)SU TURE , PRIM ARY, TORN , RUPT URED OR SEVE RED LIGA MENT , ANKL E; BOTH COLL ATER AL LIGA MENT S 252.. 27698 (5)SU TURE , SECO NDAR Y REPA IR, TORN , RUPT URED OR SEVE RED LIGA MENT , ANKL E, COLL ATER AL (EG, WATS ON- JONE S PROC EDUR E) 252.. 27709 (5)OS TEOT OMY; TIBI A AND FIBU LA 252.. 27730 (5)EP IPHY SEAL ARRE ST BY EPIP HYSI ODES IS OR STAP LING ; DIST AL TIBI A 252.. 27732 (5)EP IPHY SEAL ARRE ST BY EPIP HYSI ODES IS OR STAP LING ; DIST AL FIBU LA 252.. 27734 (5)EP IPHY SEAL ARRE ST BY EPIP HYSI ODES IS OR STAP LING ; DIST AL TIBI A AND FIBU LA 252.. 27740 (5)EP IPHY SEAL ARRE ST BY EPIP HYSI ODES IS OR STAP LING , COMB INED , PROX IMAL AND DIST AL TIBI A AND FIBU LA; 252.. 27889 (5)AN KLE DISA RTIC ULAT ION 253.. (1)Le T 26.33 $1,334.13 $699.24 $266.83 vel III Musc ulos kele tal Proc edur es 253.. 23020 (5)CA PSUL AR CONT RACT URE RELE ASE (SEV ER TYPE PROC EDUR E) 253.. 23120 (5)CL AVIC ULEC TOMY ; PART IAL 253.. 23130 (5)AC ROMI OPLA STY OR ACRO MION ECTO MY, PART IAL 253.. 23415 (5)CO RACO ACRO MIAL LIGA MENT RELE ASE, WITH OR WITH OUT ACRO MIOP LAST Y 253.. 23480 (5)OS TEOT OMY, CLAV ICLE , WITH OR WITH OUT INTE RNAL FIXA TION ; 253.. 23485 (5)OS TEOT OMY, CLAV ICLE , WITH OR WITH OUT INTE RNAL FIXA TION ; WITH BONE GRAF T FOR NONU NION OR MALU NION (INC LUDE S OBTA ININ G GRAF T AND/ OR NECE SSAR Y FIXA TION ) 253.. 23490 (5)PR OPHY LACT IC TREA TMEN T (NAI LING , PINN ING, PLAT ING OR WIRI NG) WITH OR WITH OUT METH YLME THAC RYLA TE; CLAV ICLE 253.. 23491 (5)PR OPHY LACT IC TREA TMEN T (NAI LING , PINN ING, PLAT ING OR WIRI NG) WITH OR WITH OUT METH YLME THAC RYLA TE; PROX IMAL HUME RUS AND HUME RAL HEAD 253.. 23800 (5)AR THRO DESI S, SHOU LDER JOIN T; WITH OR WITH OUT LOCA L BONE GRAF T 253.. 23802 (5)AR THRO DESI S, SHOU LDER JOIN T; WITH PRIM ARY AUTO GENO US GRAF T (INC LUDE S OBTA ININ G GRAF T) 253.. 24155 (5)RE SECT ION OF ELBO W JOIN T (ART HREC TOMY ) 253.. 24320 (5)TE NOPL ASTY , WITH MUSC LE TRAN SFER , WITH OR WITH OUT FREE GRAF T, ELBO W TO SHOU LDER , SING LE (SED DON- BROO KES TYPE PROC EDUR E) 253.. 24330 (5)FL EXOR- PLAS TY, ELBO W (EG, STEI NDLE R TYPE ADVA NCEM ENT) ; 253.. 24331 (5)FL EXOR- PLAS TY, ELBO W (EG, STEI NDLE R TYPE ADVA NCEM ENT) ; WITH EXTE NSOR ADVA NCEM ENT 253.. 24340 (5)TE NODE SIS OF BICE PS TEND ON AT ELBO W (SEP ARAT E PROC EDUR E) 253.. 24341 (5)RE PAIR , TEND ON OR MUSC LE, UPPE R ARM OR ELBO W, EACH TEND ON OR MUSC LE, PRIM ARY OR SECO NDAR Y (EXC LUDE S ROTA TOR CUFF ) 253.. 24342 (5)RE INSE RTIO N OF RUPT URED BICE PS OR TRIC EPS TEND ON, DIST AL, WITH OR WITH OUT TEND ON GRAF T 253.. 24420 (5)OS TEOP LAST Y, HUME RUS (EG, SHOR TENI NG OR LENG THEN ING) (EXC LUDI NG 6487 6) 253.. 24430 (5)RE PAIR OF NONU NION OR MALU NION , HUME RUS; WITH OUT GRAF T (EG, COMP RESS ION TECH NIQU E) 253.. 24435 (5)RE PAIR OF NONU NION OR MALU NION , HUME RUS; WITH ILIA C OR OTHE R AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 253.. 24470 (5)HE MIEP IPHY SEAL ARRE ST (EG, FOR CUBI TUS VARU S OR VALG US, DIST AL HUME RUS) 253.. 24498 (5)PR OPHY LACT IC TREA TMEN T (NAI LING , PINN ING, PLAT ING OR WIRI NG), WITH OR WITH OUT METH YLME THAC RYLA TE, HUME RUS 253.. 24800 (5)AR THRO DESI S, ELBO W JOIN T; WITH OR WITH OUT LOCA L AUTO GRAF T OR ALLO GRAF T 253.. 24802 (5)AR THRO DESI S, ELBO W JOIN T; WITH AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T OTHE R THAN LOCA LLY OBTA INED ) 253.. 25310 (5)TE NDON TRAN SPLA NTAT ION OR TRAN SFER , FLEX OR OR EXTE NSOR , FORE ARM AND/ OR WRIS T, SING LE; EACH TEND ON 253.. 25312 (5)TE NDON TRAN SPLA NTAT ION OR TRAN SFER , FLEX OR OR EXTE NSOR , FORE ARM AND/ OR WRIS T, SING LE; WITH TEND ON GRAF T(S) (INC LUDE S OBTA ININ G GRAF T), EACH TEND ON 253.. 25315 (5)FL EXOR ORIG IN SLID E (EG, FOR CERE BRAL PALS Y, VOLK MANN CONT RACT URE) , FORE ARM AND/ OR WRIS T; 253.. 25316 (5)FL EXOR ORIG IN SLID E (EG, FOR CERE BRAL PALS Y, VOLK MANN CONT RACT URE) , FORE ARM AND/ OR WRIS T; WITH TEND ON(S ) TRAN SFER 253.. 25320 (5)CA PSUL ORRH APHY OR RECO NSTR UCTI ON, WRIS T, ANY METH OD (EG, CAPS ULOD ESIS , LIGA MENT REPA IR, TEND ON TRAN SFER OR GRAF T) (INC LUDE S SYNO VECT OMY, CAPS ULOT OMY AND OPEN REDU CTIO N) FOR CARP AL INST ABIL ITY [[Page 47783]] 253.. 25335 (5)CE NTRA LIZA TION OF WRIS T ON ULNA (EG, RADI AL CLUB HAND ) 253.. 25337 (5)RE CONS TRUC TION FOR STAB ILIZ ATIO N OF UNST ABLE DIST AL ULNA OR DIST AL RADI OULN AR JOIN T, SECO NDAR Y BY SOFT TISS UE STAB ILIZ ATIO N (EG, TEND ON TRAN SFER , TEND ON GRAF T OR WEAV E, OR TENO DESI S) WITH OR WITH OUT OPEN REDU CTIO N OF DIST AL RADI OULN AR JOIN T 253.. 25350 (5)OS TEOT OMY, RADI US; DIST AL THIR D 253.. 25355 (5)OS TEOT OMY, RADI US; MIDD LE OR PROX IMAL THIR D 253.. 25370 (5)MU LTIP LE OSTE OTOM IES, WITH REAL IGNM ENT ON INTR AMED ULLA RY ROD (SOF IELD TYPE PROC EDUR E); RADI US OR ULNA 253.. 25375 (5)MU LTIP LE OSTE OTOM IES, WITH REAL IGNM ENT ON INTR AMED ULLA RY ROD (SOF IELD TYPE PROC EDUR E); RADI US AND ULNA 253.. 25425 (5)RE PAIR OF DEFE CT WITH AUTO GRAF T; RADI US OR ULNA 253.. 25426 (5)RE PAIR OF DEFE CT WITH AUTO GRAF T; RADI US AND ULNA 253.. 25440 (5)RE PAIR OF NONU NION , SCAP HOID (NAV ICUL AR) BONE , WITH OR WITH OUT RADI AL STYL OIDE CTOM Y (INC LUDE S OBTA ININ G GRAF T AND NECE SSAR Y FIXA TION ) 253.. 25450 (5)EP IPHY SEAL ARRE ST BY EPIP HYSI ODES IS OR STAP LING ; DIST AL RADI US OR ULNA 253.. 25455 (5)EP IPHY SEAL ARRE ST BY EPIP HYSI ODES IS OR STAP LING ; DIST AL RADI US AND ULNA 253.. 25490 (5)PR OPHY LACT IC TREA TMEN T (NAI LING , PINN ING, PLAT ING OR WIRI NG) WITH OR WITH OUT METH YLME THAC RYLA TE; RADI US 253.. 25491 (5)PR OPHY LACT IC TREA TMEN T (NAI LING , PINN ING, PLAT ING OR WIRI NG) WITH OR WITH OUT METH YLME THAC RYLA TE; ULNA 253.. 25492 (5)PR OPHY LACT IC TREA TMEN T (NAI LING , PINN ING, PLAT ING OR WIRI NG) WITH OR WITH OUT METH YLME THAC RYLA TE; RADI US AND VLNA 253.. 25800 (5)AR THRO DESI S, WRIS T JOIN T (INC LUDI NG RADI OCAR PAL AND/ OR ULNO CARP AL FUSI ON); WITH OUT BONE GRAF T 253.. 25805 (5)AR THRO DESI S, WRIS T JOIN T (INC LUDI NG RADI OCAR PAL AND/ OR ULNO CARP AL FUSI ON); WITH SLID ING GRAF T 253.. 25810 (5)AR THRO DESI S, WRIS T JOIN T (INC LUDI NG RADI OCAR PAL AND/ OR ULNO CARP AL FUSI ON); WITH ILIA C OR OTHE R AUTO GRAF T (INC LUDE S OBTA ININ G GRAF T) 253.. 25830 (5)DI STAL RADI OULN AR JOIN T ARTH RODE SIS AND SEGM ENTA L RESE CTIO N OF ULNA (EG, SAUV E- KAPA NDJI PROC EDUR E), WITH OR WITH OUT BONE GRAF T 253.. 27033 (5)AR THRO TOMY , HIP, WITH EXPL ORAT ION OR REMO VAL OF LOOS E OR FORE IGN BODY 253.. 27100 (5)TR ANSF ER EXTE RNAL OBLI QUE MUSC LE TO GREA TER TROC HANT ER INCL UDIN G FASC IAL OR TEND ON EXTE NSIO N (GRA FT) 253.. 27105 (5)TR ANSF ER PARA SPIN AL MUSC LE TO HIP (INC LUDE S FASC IAL OR TEND ON EXTE NSIO N GRAF T) 253.. 27110 (5)TR ANSF ER ILIO PSOA S; TO GREA TER TROC HANT ER 253.. 27111 (5)TR ANSF ER ILIO PSOA S; TO FEMO RAL NECK 253.. 27395 (5)LE NGTH ENIN G OF HAMS TRIN G TEND ON; MULT IPLE , BILA TERA L 253.. 27397 (5)TR ANSP LANT , HAMS TRIN G TEND ON TO PATE LLA; MULT IPLE 253.. 27400 (5)TE NDON OR MUSC LE TRAN SFER , HAMS TRIN GS TO FEMU R (EGG ERS TYPE PROC EDUR E) 253.. 27405 (5)RE PAIR , PRIM ARY, TORN LIGA MENT AND/ OR CAPS ULE, KNEE ; COLL ATER AL 253.. 27407 (5)RE PAIR , PRIM ARY, TORN LIGA MENT AND/ OR CAPS ULE, KNEE ; CRUC IATE 253.. 27409 (5)RE PAIR , PRIM ARY, TORN LIGA MENT AND/ OR CAPS ULE, KNEE ; COLL ATER AL AND CRUC IATE LIGA MENT S 253.. 27418 (5)AN TERI OR TIBI AL TUBE RCLE PLAS TY (EG, FOR CHON DROM ALAC IA PATE LLAE ) 253.. 27420 (5)RE CONS TRUC TION FOR RECU RREN T DISL OCAT ING PATE LLA; (HAU SER TYPE PROC EDUR E) 253.. 27422 (5)RE CONS TRUC TION FOR RECU RREN T DISL OCAT ING PATE LLA; WITH EXTE NSOR REAL IGNM ENT AND/ OR MUSC LE ADVA NCEM ENT OR RELE ASE (CAM PBEL L, GOLD WAIT E TYPE PROC EDUR E) 253.. 27424 (5)RE CONS TRUC TION FOR RECU RREN T DISL OCAT ING PATE LLA; WITH PATE LLEC TOMY 253.. 27430 (5)QU ADRI CEPS PLAS TY (BEN NETT OR THOM PSON TYPE ) 253.. 27435 (5)CA PSUL OTOM Y, KNEE , POST ERIO R CAPS ULAR RELE ASE 253.. 27640 (5)PA RTIA L EXCI SION (CRA TERI ZATI ON, SAUC ERIZ ATIO N, OR DIAP HYSE CTOM Y) OF BONE (EG, FOR OSTE OMYE LITI S OR EXOS TOSI S); TIBI A 253.. 27647 (5)RA DICA L RESE CTIO N OF TUMO R, BONE ; TALU S OR CALC ANEU S 253.. 27650 (5)RE PAIR , PRIM ARY, OPEN OR PERC UTAN EOUS , RUPT URED ACHI LLES TEND ON; 253.. 27652 (5)RE PAIR , PRIM ARY, OPEN OR PERC UTAN EOUS , RUPT URED ACHI LLES TEND ON; WITH GRAF T (INC LUDE S OBTA ININ G GRAF T) 253.. 27654 (5)RE PAIR , SECO NDAR Y, RUPT URED ACHI LLES TEND ON, WITH OR WITH OUT GRAF T 253.. 27690 (5)TR ANSF ER OR TRAN SPLA NT OF SING LE TEND ON (WIT H MUSC LE REDI RECT ION OR RERO UTIN G); SUPE RFIC IAL (EG, ANTE RIOR TIBI AL EXTE NSOR S INTO MIDF OOT) 253.. 27691 (5)TR ANSF ER OR TRAN SPLA NT OF SING LE TEND ON (WIT H MUSC LE REDI RECT ION OR RERO UTIN G); DEEP (EG, ANTE RIOR TIBI AL OR POST ERIO R TIBI AL THRO UGH INTE ROSS EOUS SPAC E, FLEX OR DIGI TORU M LONG US, FLEX OR HALL UCIS LONG US, OR PERO NEAL TEND ON TO MIDF OOT OR HIND FOOT ) 253.. 27692 (5)TR ANSF ER OR TRAN SPLA NT OF SING LE TEND ON (WIT H MUSC LE REDI RECT ION OR RERO UTIN G); EACH ADDI TION AL TEND ON 253.. 27705 (5)OS TEOT OMY; TIBI A 253.. 27742 (5)EP IPHY SEAL ARRE ST BY EPIP HYSI ODES IS OR STAP LING , COMB INED , PROX IMAL AND DIST AL TIBI A AND FIBU LA; AND DIST AL FEMU R 253.. 27745 (5)PR OPHY LACT IC TREA TMEN T (NAI LING , PINN ING, PLAT ING OR WIRI NG) WITH OR WITH OUT METH YLME THAC RYLA TE, TIBI A 253.. 27870 (5)AR THRO DESI S, ANKL E, ANY METH OD 253.. 27871 (5)AR THRO DESI S, TIBI OFIB ULAR JOIN T, PROX IMAL OR DIST AL 254.. (1)Le T 34.37 $1,741.51 $937.11 $348.30 vel IV Musc ulos kele tal Proc edur es 254.. 23410 (5)RE PAIR OF RUPT URED MUSC ULOT ENDI NOUS CUFF (EG, ROTA TOR CUFF ); ACUT E 254.. 23412 (5)RE PAIR OF RUPT URED MUSC ULOT ENDI NOUS CUFF (EG, ROTA TOR CUFF ); CHRO NIC 254.. 23420 (5)RE PAIR OF COMP LETE SHOU LDER (ROT ATOR ) CUFF AVUL SION , CHRO NIC (INC LUDE S ACRO MIOP LAST Y) 254.. 23430 (5)TE NODE SIS OF LONG TEND ON OF BICE PS 254.. 23450 (5)CA PSUL ORRH APHY , ANTE RIOR ; PUTT I- PLAT T PROC EDUR E OR MAGN USON TYPE OPER ATIO N 254.. 23455 (5)CA PSUL ORRH APHY , ANTE RIOR ; BANK ART TYPE OPER ATIO N WITH OR WITH OUT STAP LING 254.. 23460 (5)CA PSUL ORRH APHY , ANTE RIOR , ANY TYPE ; WITH BONE BLOC K 254.. 23462 (5)CA PSUL ORRH APHY , ANTE RIOR , ANY TYPE ; WITH CORA COID PROC ESS TRAN SFER 254.. 23465 (5)CA PSUL ORRH APHY FOR RECU RREN T DISL OCAT ION, POST ERIO R, WITH OR WITH OUT BONE BLOC K 254.. 23466 (5)CA PSUL ORRH APHY WITH ANY TYPE MULT I- DIRE CTIO NAL INST ABIL ITY 254.. 27427 (5)LI GAME NTOU S RECO NSTR UCTI ON (AUG MENT ATIO N), KNEE ; EXTR A- ARTI CULA R 254.. 27428 (5)LI GAME NTOU S RECO NSTR UCTI ON (AUG MENT ATIO N), KNEE ; INTR A- ARTI CULA R (OPE N) 254.. 27429 (5)LI GAME NTOU S RECO NSTR UCTI ON (AUG MENT ATIO N), KNEE ; INTR A- ARTI CULA R (OPE N) AND EXTR A- ARTI CULA R 261.. (1)Le T 10.54 $534.06 $261.48 $106.81 vel I Hand Musc ulos kele tal Proc edur es 261.. 25111 (5)EX CISI ON OF GANG LION , WRIS T (DOR SAL OR VOLA R); PRIM ARY [[Page 47784]] 261.. 25112 (5)EX CISI ON OF GANG LION , WRIS T (DOR SAL OR VOLA R); RECU RREN T 261.. 25820 (5)IN TERC ARPA L FUSI ON; WITH OUT BONE GRAF T 261.. 26020 (5)DR AINA GE OF TEND ON SHEA TH, ONE DIGI T AND/ OR PALM 261.. 26025 (5)DR AINA GE OF PALM AR BURS A; SING LE, ULNA R OR RADI AL 261.. 26030 (5)DR AINA GE OF PALM AR BURS A; MULT IPLE OR COMP LICA TED 261.. 26034 (5)IN CISI ON, DEEP , WITH OPEN ING OF BONE CORT EX (EG, FOR OSTE OMYE LITI S OR BONE ABSC ESS) , HAND OR FING ER 261.. 26035 (5)DE COMP RESS ION FING ERS AND/ OR HAND , INJE CTIO N INJU RY (EG, GREA SE GUN) 261.. 26037 (5)DE COMP RESS IVE FASC IOTO MY, HAND (EXC LUDE S 2603 5) 261.. 26055 (5)TE NDON SHEA TH INCI SION (EG, FOR TRIG GER FING ER) 261.. 26060 (5)TE NOTO MY, PERC UTAN EOUS , SING LE, EACH DIGI T 261.. 26070 (5)AR THRO TOMY , WITH EXPL ORAT ION, DRAI NAGE , OR REMO VAL OF FORE IGN BODY ; CARP OMET ACAR PAL JOIN T 261.. 26075 (5)AR THRO TOMY , WITH EXPL ORAT ION, DRAI NAGE , OR REMO VAL OF FORE IGN BODY ; META CARP OPHA LANG EAL JOIN T 261.. 26080 (5)AR THRO TOMY , WITH EXPL ORAT ION, DRAI NAGE , OR REMO VAL OF FORE IGN BODY ; INTE RPHA LANG EAL JOIN T, EACH 261.. 26100 (5)AR THRO TOMY WITH SYNO VIAL BIOP SY; CARP OMET ACAR PAL JOIN T 261.. 26105 (5)AR THRO TOMY WITH SYNO VIAL BIOP SY; META CARP OPHA LANG EAL JOIN T 261.. 26110 (5)AR THRO TOMY WITH SYNO VIAL BIOP SY; INTE RPHA LANG EAL JOIN T, EACH 261.. 26130 (5)SY NOVE CTOM Y, CARP OMET ACAR PAL JOIN T 261.. 26140 (5)SY NOVE CTOM Y, PROX IMAL INTE RPHA LANG EAL JOIN T, INCL UDIN G EXTE NSOR RECO NSTR UCTI ON, EACH INTE RPHA LANG EAL 261.. 26145 (5)SY NOVE CTOM Y TEND ON SHEA TH, RADI CAL (TEN OSYN OVEC TOMY ), FLEX OR, PALM OR FING ER, SING LE, EACH DIGI T 261.. 26160 (5)EX CISI ON OF LESI ON OF TEND ON SHEA TH OR CAPS ULE (EG, CYST , MUCO US CYST , OR GANG LION ), HAND OR FING ER 261.. 26170 (5)EX CISI ON OF TEND ON, PALM , FLEX OR, SING LE (SEP ARAT E PROC EDUR E), EACH 261.. 26180 (5)EX CISI ON OF TEND ON, FING ER, FLEX OR (SEP ARAT E PROC EDUR E) 261.. 26185 (5)SE SAMO IDEC TOMY , THUM B OR FING ER (SEP ARAT E PROC EDUR E) 261.. 26200 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF META CARP AL; 261.. 26210 (5)EX CISI ON OR CURE TTAG E OF BONE CYST OR BENI GN TUMO R OF PROX IMAL , MIDD LE, OR DIST AL