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Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
10021 $238.25 1
10022 $225.54 1
10030 $1,224.81
10040 $161.55 1
10060 $185.30 1
10061 $330.24 1
10080 $285.27 1
10081 $429.23 1
10120 $242.19 1
10121 $438.41 1
10140 $259.65 1
10160 $207.71 1
10180 $400.80 1
11000 $85.95 1
11001 $32.85 1
11004 $981.93 1
11005 $1,343.10 1
11006 $1,190.13 1
11008 $473.19 1
11010 $790.50 1
11011 $854.10 1
11012 $1,151.66 1
11042 $185.63 1
11043 $368.31 1
11044 $512.97 1
11045 $66.41 1
11046 $118.94 1
11047 $204.60 1
11055 $74.75 1
11056 $91.44 1
11057 $102.62 1
11100 $163.68 1
11101 $52.01 6
11200 $139.91 1
11201 $29.91 1
11300 $152.97 1
11301 $189.32 1
11302 $223.32 1
11303 $246.38 1
11305 $154.49 1
11306 $191.61 1
11307 $226.94 1
11308 $238.13 1
11310 $179.16 1
11311 $176.84 1
3/1/2015 1 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
11312 $253.85 1
11313 $294.66 1
11400 $196.86 1
11401 $237.12 1
11402 $264.27 1
11403 $307.83 1
11404 $349.38 1
11406 $510.60 1
11420 $193.52 1
11421 $249.89 1
11422 $280.11 1
11423 $324.42 1
11424 $376.22 1
11426 $542.64 1
11440 $212.64 1
11441 $268.58 1
11442 $300.41 1
11443 $359.13 1
11444 $452.96 1
11446 $632.64 1
11450 $621.38 1
11451 $785.51 1
11462 $599.82 1
11463 $800.04 1
11470 $665.46 1
11471 $818.82 1
11600 $305.79 1
11601 $363.63 1
11602 $393.32 1
11603 $451.91 1
11604 $504.00 1
11606 $727.85 1
11620 $309.45 1
11621 $366.20 1
11622 $408.00 1
11623 $480.89 1
11624 $543.41 1
11626 $660.75 1
11640 $318.24 1
11641 $378.57 1
11642 $431.97 1
11643 $512.61 1
11644 $635.04 1
11646 $835.58 1
11719 $21.65 1
3/1/2015 2 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
11720 $50.49 1
11721 $69.84 1
11730 $154.92 1
11732 $56.19 4
11740 $77.85 1
11750 $351.53 1
11752 $519.09 1
11755 $209.82 1
11760 $362.87 1
11762 $447.86 1
11765 $262.64 1
11770 $449.01 1
11771 $939.30 1
11772 $1,141.28 1
11900 $87.54 1
11901 $110.30 1
11920 $274.34 1
11921 $317.64 1
11922 $97.35 1
11950 $125.88 1
11951 $172.08 1
11952 $209.01 1
11954 $257.00 1
11960 $1,540.43 1
11970 $997.91 1
11971 $751.46 1
11976 $228.95 1
11980 $149.58 1
11981 $229.05 1
11982 $259.32 1
11983 $359.99 1
12001 $142.46 1
12002 $174.74 1
12004 $206.48 1
12005 $268.22 1
12006 $320.57 1
12007 $374.99 1
12011 $175.04 1
12013 $192.11 1
12014 $228.00 1
12015 $275.94 1
12016 $344.04 1
12017 $258.53 1
12018 $294.29 1
12020 $449.94 1
3/1/2015 3 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
12021 $265.22 1
12031 $376.44 1
12032 $480.56 1
12034 $498.24 1
12035 $612.65 1
12036 $677.57 1
12037 $780.35 1
12041 $384.39 1
12042 $459.14 1
12044 $572.84 1
12045 $648.33 1
12046 $786.06 1
12047 $897.92 1
12051 $409.98 1
12052 $468.03 1
12053 $550.40 1
12054 $586.88 1
12055 $762.39 1
12056 $803.25 1
12057 $937.46 1
13100 $532.44 1
13101 $628.86 1
13102 $196.31 3
13120 $556.94 1
13121 $677.96 1
13122 $214.95 3
13131 $613.58 1
13132 $759.56 1
13133 $287.75 3
13151 $674.82 1
13152 $809.10 1
13153 $313.22 2
13160 $1,343.04 1
14000 $1,002.23 1
14001 $1,293.66 1
14020 $1,118.52 1
14021 $1,400.79 1
14040 $1,222.53 1
14041 $1,512.80 1
14060 $1,247.85 1
14061 $1,627.20 1
14301 $1,741.11 1
14302 $369.95 1
14350 $1,123.22 1
15002 $561.39 1
3/1/2015 4 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
15003 $123.54 1
15004 $646.64 1
15005 $203.82 1
15040 $409.04 1
15050 $913.86 1
15100 $1,403.24 1
15101 $302.31 20
15110 $1,335.59 1
15111 $196.22 1
15115 $1,346.90 1
15116 $277.49 1
15120 $1,381.31 1
15121 $337.77 20
15130 $1,108.41 1
15131 $155.55 4
15135 $1,361.85 1
15136 $157.40 4
15150 $1,167.77 1
15151 $205.55 2
15152 $254.27 4
15155 $1,098.57 1
15156 $278.16 2
15157 $250.19 4
15200 $1,343.15 1
15201 $238.71 10
15220 $1,240.65 1
15221 $220.70 10
15240 $1,503.53 1
15241 $298.59 10
15260 $1,623.63 1
15261 $344.96 10
15271 $226.64 1
15272 $43.85 1
15273 $484.31 1
15274 $116.18 1
15275 $238.26 1
15276 $54.62 1
15277 $526.40 1
15278 $139.05 1
15570 $1,482.11 1
15572 $1,436.60 1
15574 $1,479.12 1
15576 $1,296.78 1
15600 $515.45 1
15610 $569.67 1
3/1/2015 5 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
15620 $703.40 1
15630 $736.56 1
15650 $815.72 1
15731 $1,835.34 1
15732 $2,072.43 1
15734 $2,478.21 1
15736 $2,160.96 1
15738 $2,303.91 1
15740 $1,643.25 1
15750 $1,525.32 1
15756 $3,858.83 1
15757 $3,816.33 1
15758 $3,810.66 1
15760 $1,373.88 1
15770 $1,102.43 1
15775 $461.88 1
15776 $774.33 1
15777 $359.40 1
15780 $1,362.45 1
15781 $887.49 1
15782 $1,023.23 1
15783 $771.93 1
15786 $383.69 1
15787 $76.44 1
15788 $726.17 1
15789 $887.31 1
15792 $683.27 1
15793 $782.61 1
15819 $1,299.84 1
15820 $901.17 1
15821 $960.63 1
15822 $707.72 1
15823 $957.74 1
15824 $0.00 1
15825 $0.00 1
15826 $0.00 1
15828 $0.00 1
15829 $0.00 1
15830 $1,945.40 1
15832 $1,505.07 1
15833 $1,432.04 1
15834 $1,458.48 1
15835 $1,539.83 1
15836 $1,295.12 1
15837 $1,465.62 1
3/1/2015 6 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
15838 $934.37 1
15839 $1,435.41 1
15840 $1,646.91 1
15841 $2,640.17 1
15842 $4,037.52 1
15845 $1,607.75 1
15851 $156.60 1
15852 $79.26 1
15860 $186.50 1
15876 $0.00 1
15877 $0.00 1
15878 $0.00 1
15879 $0.00 1
15920 $1,001.66 1
15922 $1,281.68 1
15931 $1,153.97 1
15933 $1,412.88 1
15934 $1,557.08 1
15935 $1,830.44 1
15936 $1,480.05 1
15937 $1,709.58 1
15940 $1,167.03 1
15941 $1,492.70 1
15944 $1,479.95 1
15945 $1,607.10 1
15946 $2,711.43 1
15950 $983.66 1
15951 $1,441.58 1
15952 $1,482.75 1
15953 $1,634.46 1
15956 $1,908.90 1
15958 $1,948.74 1
16000 $110.33 1
16020 $130.32 1
16025 $239.69 1
16030 $295.85 1
16035 $322.25 1
16036 $136.77 1
17000 $104.90 1
17003 $9.14 13
17004 $237.71 1
17106 $545.88 1
17107 $689.75 1
17108 $1,031.72 1
17110 $173.79 1
3/1/2015 7 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
17111 $206.87 1
17250 $125.15 1
17260 $150.36 1
17261 $227.64 1
17262 $277.43 1
17263 $303.06 1
17264 $326.57 1
17266 $369.38 1
17270 $239.19 1
17271 $259.91 1
17272 $295.35 1
17273 $330.62 1
17274 $389.40 1
17276 $450.66 1
17280 $223.22 1
17281 $282.36 1
17282 $325.11 1
17283 $388.59 1
17284 $445.95 1
17286 $576.63 1
17311 $1,050.03 1
17312 $616.11 1
17313 $981.83 1
17314 $590.18 1
17315 $126.93 1
17340 $83.27 1
17360 $205.16 1
17380 $0.00 1
19000 $180.02 1
19001 $43.70 1
19020 $765.48 1
19030 $263.60 1
19081 $1,048.68
19082 $857.25
19083 $1,032.21
19084 $825.00
19085 $1,632.53
19086 $1,290.42
19100 $247.07 1
19101 $557.46 1
19105 $3,925.16 1
19110 $792.84 1
19112 $753.54 1
19120 $817.50 1
19125 $911.07 1
3/1/2015 8 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
19126 $279.53 1
19260 $2,035.38 1
19271 $2,741.73 1
19272 $3,013.44 1
19281 $379.40
19282 $265.74
19283 $431.88
19284 $319.34
19285 $701.39
19286 $595.59
19287 $1,376.52
19288 $1,099.80
19296 $6,153.09 1
19297 $163.29 1
19298 $1,660.94 1
19300 $859.92 1
19301 $1,105.62 1
19302 $1,526.90 1
19303 $1,714.44 1
19304 $964.82 1
19305 $1,909.40 1
19306 $2,032.59 1
19307 $2,028.38 1
19316 $1,274.99 1
19318 $1,818.09 1
19324 $826.19 1
19325 $1,054.89 1
19328 $814.22 1
19330 $1,043.99 1
19340 $1,651.82 1
19342 $1,515.56 1
19350 $1,337.69 1
19355 $1,169.37 1
19357 $2,465.19 1
19361 $2,601.84 1
19364 $4,568.33 1
19366 $2,344.83 1
19367 $2,959.76 1
19368 $3,646.83 1
19369 $3,383.85 1
19370 $1,126.94 1
19371 $1,290.50 1
19380 $1,270.76 1
19396 $467.69 1
20005 $498.36 1
3/1/2015 9 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
20100 $1,031.96 1
20101 $734.42 1
20102 $798.02 1
20103 $940.92 1
20150 $1,456.26 1
20200 $337.73 1
20205 $474.92 1
20206 $372.75 1
20220 $266.97 1
20225 $830.01 1
20240 $356.88 1
20245 $1,019.94 1
20250 $671.91 1
20251 $718.01 1
20500 $167.70 1
20501 $186.96 1
20520 $327.08 1
20525 $775.35 1
20526 $125.90 1
20527 $137.58 1
20550 $94.91 2
20551 $97.11 1
20552 $87.32 1
20553 $101.36 1
20555 $546.38 1
20600 $76.08 1
20604 $115.49
20605 $79.37 1
20606 $128.19
20610 $97.23 1
20611 $149.21
20612 $97.74 1
20615 $396.35 1
20650 $331.98 1
20660 $439.61 1
20661 $870.44 1
20662 $775.52 1
20663 $644.01 1
20664 $1,553.93 1
20665 $166.47 1
20670 $605.48 1
20680 $1,003.44 1
20690 $996.26 1
20692 $1,857.84 1
20693 $739.77 1
3/1/2015 10 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
20694 $693.68 1
20696 $2,026.04 1
20697 $3,313.73 1
20802 $4,668.09 1
20805 $5,435.81 1
20808 $6,583.80 1
20816 $3,487.97 1
20822 $2,978.76 1
20824 $3,382.44 1
20827 $3,062.13 1
20838 $3,425.42 1
20900 $677.16 1
20902 $482.36 1
20910 $749.48 1
20912 $785.42 1
20920 $645.68 1
20922 $1,004.58 1
20924 $842.43 1
20926 $712.22 1
20931 $203.09 1
20937 $293.93 1
20938 $330.92 1
20950 $394.22 1
20955 $4,194.27 1
20956 $4,489.98 1
20957 $3,398.64 1
20962 $3,266.96 1
20969 $4,575.36 1
20970 $4,858.25 1
20972 $3,700.14 1
20973 $4,071.51 1
20974 $125.13 1
20975 $307.50 1
20979 $82.79 1
20982 $5,884.10 1
20983 $10,858.41
20985 $250.59 1
21010 $1,262.01 1
21011 $563.21 1
21012 $561.00 1
21013 $843.57 1
21014 $862.32 1
21015 $1,170.87 1
21016 $1,700.01 1
21025 $1,467.50 1
3/1/2015 11 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
21026 $1,009.94 1
21029 $1,247.72 1
21030 $848.82 1
21031 $644.28 1
21032 $653.42 1
21034 $2,177.19 1
21040 $856.92 1
21044 $1,456.56 1
21045 $2,031.96 1
21046 $1,856.22 1
21047 $2,201.00 1
21048 $1,906.05 1
21049 $2,006.69 1
21050 $1,395.63 1
21060 $1,345.92 1
21070 $1,023.62 1
21073 $644.40 1
21076 $1,668.44 1
21077 $4,187.97 1
21079 $2,814.39 1
21080 $3,146.91 1
21081 $2,913.69 1
21082 $2,758.22 1
21083 $2,625.24 1
21084 $3,005.61 1
21085 $1,261.10 1
21086 $3,111.09 1
21087 $3,111.09 1
21100 $1,860.56 1
21110 $1,316.99 1
21116 $236.40 1
21120 $975.38 1
21121 $1,309.97 1
21122 $1,025.94 1
21123 $1,238.24 1
21125 $5,018.97 1
21127 $6,932.61 1
21137 $1,175.04 1
21138 $1,411.43 1
21139 $1,855.46 1
21141 $2,242.68 1
21142 $2,395.65 1
21143 $2,419.62 1
21145 $2,718.75 1
21146 $2,831.04 1
3/1/2015 12 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
21147 $2,993.43 1
21150 $2,776.29 1
21151 $3,407.46 1
21154 $3,666.17 1
21155 $3,783.47 1
21159 $3,872.13 1
21160 $4,202.57 1
21172 $2,841.71 1
21175 $4,164.95 1
21179 $2,104.74 1
21180 $2,532.74 1
21181 $1,220.52 1
21182 $3,172.31 1
21183 $3,580.32 1
21184 $4,007.81 1
21188 $2,578.49 1
21193 $1,964.28 1
21194 $2,487.98 1
21195 $2,224.94 1
21196 $2,435.49 1
21198 $1,920.09 1
21199 $1,663.43 1
21206 $2,045.30 1
21208 $3,083.24 1
21209 $1,313.48 1
21210 $3,704.63 1
21215 $6,575.73 1
21230 $1,262.54 1
21235 $1,176.81 1
21240 $1,864.98 1
21242 $1,708.29 1
21243 $2,833.07 1
21244 $1,758.50 1
21245 $1,804.80 1
21246 $1,491.53 1
21247 $2,521.62 1
21248 $1,834.49 1
21249 $2,525.52 1
21255 $2,166.81 1
21256 $1,914.48 1
21260 $1,837.32 1
21261 $3,261.83 1
21263 $3,013.95 1
21267 $2,520.74 1
21268 $3,038.18 1
3/1/2015 13 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
21270 $1,536.75 1
21275 $1,381.82 1
21280 $910.26 1
21282 $610.31 1
21295 $306.09 1
21296 $684.60 1
21310 $208.79 1
21315 $447.98 1
21320 $413.10 1
21325 $774.69 1
21330 $935.58 1
21335 $1,186.49 1
21336 $1,049.46 1
21337 $656.10 1
21338 $1,224.41 1
21339 $1,391.52 1
21340 $1,279.79 1
21343 $1,995.62 1
21344 $2,294.72 1
21345 $1,271.69 1
21346 $1,479.20 1
21347 $1,869.48 1
21348 $1,998.35 1
21355 $786.96 1
21356 $816.54 1
21360 $881.96 1
21365 $1,839.20 1
21366 $1,929.56 1
21385 $1,118.94 1
21386 $1,148.57 1
21387 $1,169.25 1
21390 $1,294.14 1
21395 $1,668.35 1
21400 $312.99 1
21401 $796.31 1
21406 $942.15 1
21407 $1,052.09 1
21408 $1,485.48 1
21421 $1,365.72 1
21422 $1,110.90 1
21423 $1,308.72 1
21431 $1,288.65 1
21432 $1,052.76 1
21433 $2,885.45 1
21435 $2,083.98 1
3/1/2015 14 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
21436 $3,384.02 1
21440 $935.36 1
21445 $1,262.58 1
21450 $1,013.18 1
21451 $1,337.24 1
21452 $926.18 1
21453 $1,491.41 1
21454 $949.25 1
21461 $3,436.35 1
21462 $3,660.26 1
21465 $1,548.65 1
21470 $2,005.13 1
21480 $158.10 1
21485 $1,146.42 1
21490 $1,528.85 1
21495 $1,021.13 1
21497 $1,196.16 1
21501 $737.99 1
21502 $864.00 1
21510 $745.41 1
21550 $422.12 1
21552 $752.67 1
21554 $1,231.80 1
21555 $679.28 1
21556 $884.48 1
21557 $1,608.57 1
21558 $2,267.15 1
21600 $932.07 1
21610 $2,183.99 1
21615 $1,067.91 1
21616 $1,257.59 1
21620 $851.19 1
21627 $910.28 1
21630 $2,001.72 1
21632 $2,062.65 1
21685 $1,641.14 1
21700 $632.16 1
21705 $945.57 1
21720 $790.29 1
21725 $904.01 1
21740 $1,773.87 1
21750 $1,170.39 1
21805 $449.94 1
21811 $1,034.40
21812 $1,240.73
3/1/2015 15 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
21813 $1,687.85
21820 $232.20 1
21825 $913.94 1
21920 $411.62 1
21925 $734.72 1
21930 $776.01 1
21931 $792.74 1
21932 $1,116.81 1
21933 $1,249.65 1
21935 $1,730.34 1
21936 $2,392.79 1
22010 $1,637.69 1
22015 $1,546.74 1
22100 $1,657.89 1
22101 $1,381.95 1
22102 $1,346.04 1
22103 $245.87 1
22110 $1,818.45 1
22112 $2,022.59 1
22114 $1,673.93 1
22116 $250.68 1
22206 $4,275.63 1
22207 $4,164.18 1
22208 $995.72 1
22210 $3,133.52 1
22212 $2,563.16 1
22214 $2,557.04 1
22216 $639.23 1
22220 $2,764.89 1
22222 $2,641.23 1
22224 $2,706.90 1
22226 $634.46 1
22305 $313.44 1
22310 $511.10 1
22315 $1,493.06 1
22318 $2,944.20 1
22319 $3,348.42 1
22325 $2,493.66 1
22326 $2,648.70 1
22327 $2,638.55 1
22328 $508.23 1
22505 $222.53 1
22510 $2,793.59
22511 $2,767.26
22512 $1,555.91
3/1/2015 16 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
22513 $11,575.28
22514 $11,510.42
22515 $6,980.00
22532 $3,115.05 1
22533 $2,828.79 1
22534 $633.78 1
22548 $3,595.44 1
22551 $3,042.21 1
22552 $718.71 1
22554 $2,207.55 1
22556 $2,935.61 1
22558 $2,666.93 1
22585 $583.35 1
22586 $3,662.19 1
22590 $2,812.14 1
22595 $2,686.74 1
22600 $2,274.84 1
22610 $2,209.71 1
22612 $2,761.53 1
22614 $700.25 1
22630 $2,776.29 1
22632 $577.37 1
22633 $3,256.37 1
22634 $885.60 1
22800 $2,332.67 1
22802 $3,621.51 1
22804 $4,215.72 1
22808 $3,234.66 1
22810 $3,518.42 1
22812 $3,754.97 1
22818 $3,693.33 1
22819 $5,060.03 1
22830 $1,404.50 1
22840 $1,354.83 1
22842 $1,358.09 1
22843 $1,452.59 1
22844 $1,736.10 1
22845 $1,315.43 1
22846 $1,364.76 1
22847 $1,374.06 1
22848 $632.85 1
22849 $2,273.87 1
22850 $1,253.21 1
22851 $726.69 1
22852 $1,198.70 1
3/1/2015 17 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
22855 $1,943.94 1
22856 $2,790.84 1
22857 $3,013.07 1
22858 $880.43
22861 $3,292.76 1
22862 $2,832.17 1
22864 $3,818.07 1
22865 $3,480.24 1
22900 $952.25 1
22901 $1,126.47 1
22902 $721.98 1
22903 $741.98 1
22904 $1,785.45 1
22905 $2,256.44 1
23000 $955.38 1
23020 $1,149.08 1
23030 $718.01 1
23031 $689.84 1
23035 $1,136.13 1
23040 $1,200.54 1
23044 $955.83 1
23065 $349.82 1
23066 $905.76 1
23071 $704.64 1
23073 $1,166.78 1
23075 $766.16 1
23076 $903.83 1
23077 $1,925.49 1
23078 $2,416.37 1
23100 $832.70 1
23101 $748.05 1
23105 $1,060.83 1
23106 $826.37 1
23107 $1,098.68 1
23120 $970.53 1
23125 $1,187.82 1
23130 $1,016.49 1
23140 $882.21 1
23145 $1,164.65 1
23146 $1,037.72 1
23150 $1,107.81 1
23155 $1,330.02 1
23156 $1,135.29 1
23170 $935.28 1
23172 $944.33 1
3/1/2015 18 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
23174 $1,267.82 1
23180 $1,117.44 1
23182 $1,100.19 1
23184 $1,227.18 1
23190 $954.00 1
23195 $1,265.84 1
23200 $2,562.12 1
23210 $3,014.40 1
23220 $3,306.72 1
23330 $391.70 1
23333 $755.52
23334 $1,791.86
23335 $2,137.13
23350 $208.11 1
23395 $2,146.35 1
23397 $1,924.20 1
23400 $1,631.90 1
23405 $1,039.92 1
23406 $1,286.52 1
23410 $1,373.73 1
23412 $1,422.93 1
23415 $1,165.85 1
23420 $1,618.44 1
23430 $1,244.24 1
23440 $1,262.45 1
23450 $1,595.90 1
23455 $1,677.93 1
23460 $1,834.95 1
23462 $1,794.05 1
23465 $1,887.39 1
23466 $1,885.80 1
23470 $2,018.13 1
23472 $2,445.99 1
23473 $2,734.83 1
23474 $2,959.01 1
23480 $1,378.44 1
23485 $1,599.44 1
23490 $1,447.97 1
23491 $1,702.25 1
23500 $352.91 1
23505 $577.31 1
23515 $1,199.36 1
23520 $379.10 1
23525 $631.50 1
23530 $956.94 1
3/1/2015 19 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
23532 $1,042.68 1
23540 $365.36 1
23545 $551.63 1
23550 $941.30 1
23552 $1,084.59 1
23570 $377.88 1
23575 $659.15 1
23585 $1,639.79 1
23600 $528.02 1
23605 $759.81 1
23615 $1,476.66 1
23616 $2,083.08 1
23620 $438.71 1
23625 $623.09 1
23630 $1,301.96 1
23650 $507.27 1
23655 $661.59 1
23660 $963.47 1
23665 $694.73 1
23670 $1,467.84 1
23675 $909.75 1
23680 $1,556.28 1
23700 $327.63 1
23800 $1,725.87 1
23802 $2,162.54 1
23900 $2,344.40 1
23920 $1,897.44 1
23921 $754.70 1
23930 $571.85 1
23931 $460.85 1
23935 $838.13 1
24000 $791.66 1
24006 $1,181.24 1
24065 $410.85 1
24066 $1,022.64 1
24071 $680.67 1
24073 $1,166.22 1
24075 $798.69 1
24076 $904.94 1
24077 $1,742.85 1
24079 $2,237.78 1
24100 $693.68 1
24101 $827.76 1
24102 $1,020.68 1
24105 $577.20 1
3/1/2015 20 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
24110 $980.34 1
24115 $1,236.03 1
24116 $1,448.58 1
24120 $872.58 1
24125 $1,036.88 1
24126 $1,084.16 1
24130 $840.09 1
24134 $1,252.62 1
24136 $980.09 1
24138 $1,125.05 1
24140 $1,173.26 1
24145 $989.00 1
24147 $1,035.17 1
24149 $1,949.42 1
24150 $2,631.06 1
24152 $2,281.70 1
24155 $1,432.98 1
24160 $2,106.98 1
24164 $1,213.04 1
24200 $334.95 1
24201 $909.90 1
24220 $255.48 1
24300 $681.56 1
24301 $1,235.63 1
24305 $947.90 1
24310 $779.09 1
24320 $1,310.69 1
24330 $1,202.51 1
24331 $1,319.19 1
24332 $1,021.79 1
24340 $1,016.55 1
24341 $1,237.25 1
24342 $1,292.10 1
24343 $1,170.57 1
24344 $1,843.31 1
24345 $1,182.17 1
24346 $1,843.31 1
24357 $709.29 1
24358 $863.64 1
24359 $1,090.97 1
24360 $1,510.85 1
24361 $1,691.42 1
24362 $1,783.10 1
24363 $2,437.92 1
24365 $1,069.25 1
3/1/2015 21 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
24366 $1,132.88 1
24370 $2,602.23 1
24371 $3,034.19 1
24400 $1,366.46 1
24410 $1,777.55 1
24420 $1,664.90 1
24430 $1,768.14 1
24435 $1,798.38 1
24470 $1,122.14 1
24495 $913.05 1
24498 $1,457.72 1
24500 $582.59 1
24505 $818.57 1
24515 $1,462.04 1
24516 $1,439.09 1
24530 $618.05 1
24535 $1,008.56 1
24538 $1,242.30 1
24545 $1,554.27 1
24546 $1,737.20 1
24560 $517.19 1
24565 $878.69 1
24566 $1,195.77 1
24575 $1,222.52 1
24576 $551.12 1
24577 $906.48 1
24579 $1,392.06 1
24582 $1,345.92 1
24586 $1,813.13 1
24587 $1,831.32 1
24600 $592.28 1
24605 $777.45 1
24615 $1,181.82 1
24620 $900.11 1
24635 $1,117.20 1
24640 $225.93 1
24650 $421.79 1
24655 $707.49 1
24665 $1,080.92 1
24666 $1,219.52 1
24670 $471.62 1
24675 $745.32 1
24685 $1,085.49 1
24800 $1,389.71 1
24802 $1,683.09 1
3/1/2015 22 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
24900 $1,211.81 1
24920 $1,228.28 1
24925 $854.85 1
24930 $1,300.43 1
24931 $1,234.85 1
24935 $1,556.94 1
25000 $550.14 1
25001 $562.64 1
25020 $938.45 1
25023 $1,819.07 1
25024 $1,295.90 1
25025 $2,066.46 1
25028 $859.25 1
25031 $602.75 1
25035 $963.86 1
25040 $929.12 1
25065 $408.05 1
25066 $592.97 1
25071 $710.91 1
25073 $884.78 1
25075 $774.86 1
25076 $855.21 1
25077 $1,485.38 1
25078 $1,958.42 1
25085 $750.02 1
25100 $572.39 1
25101 $664.07 1
25105 $789.74 1
25107 $1,017.18 1
25109 $883.26 1
25110 $561.12 1
25111 $525.12 1
25112 $633.02 1
25115 $1,251.20 1
25116 $984.27 1
25118 $624.26 1
25119 $827.72 1
25120 $819.71 1
25125 $997.50 1
25126 $996.11 1
25130 $730.67 1
25135 $929.97 1
25136 $820.28 1
25145 $859.77 1
25150 $946.05 1
3/1/2015 23 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
25151 $979.26 1
25170 $2,498.67 1
25210 $798.42 1
25215 $1,018.49 1
25230 $711.98 1
25240 $699.75 1
25246 $258.39 1
25248 $687.95 1
25250 $883.16 1
25251 $1,167.32 1
25259 $678.06 1
25260 $1,038.90 1
25263 $1,044.78 1
25265 $1,253.19 1
25270 $803.87 1
25272 $924.78 1
25274 $1,121.03 1
25275 $1,106.28 1
25280 $923.96 1
25290 $716.49 1
25295 $860.24 1
25300 $1,143.72 1
25301 $1,062.14 1
25310 $1,020.06 1
25312 $1,188.48 1
25315 $1,293.48 1
25316 $1,532.94 1
25320 $1,627.49 1
25332 $1,388.46 1
25335 $1,583.15 1
25337 $1,465.26 1
25350 $1,113.26 1
25355 $1,283.61 1
25360 $1,084.53 1
25365 $1,534.58 1
25370 $1,687.68 1
25375 $1,599.45 1
25390 $1,272.68 1
25391 $1,673.76 1
25392 $1,659.17 1
25393 $1,854.27 1
25394 $1,331.33 1
25400 $1,333.04 1
25405 $1,722.14 1
25415 $1,625.57 1
3/1/2015 24 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
25420 $1,966.83 1
25425 $1,616.30 1
25426 $1,892.30 1
25430 $1,223.25 1
25431 $1,283.81 1
25440 $1,271.04 1
25441 $1,528.86 1
25442 $1,306.46 1
25443 $1,308.99 1
25444 $1,383.62 1
25445 $1,197.03 1
25446 $1,942.16 1
25447 $1,366.05 1
25449 $1,704.77 1
25450 $796.64 1
25455 $944.60 1
25490 $1,113.84 1
25491 $1,239.66 1
25492 $1,516.38 1
25500 $440.46 1
25505 $818.28 1
25515 $1,113.53 1
25520 $938.28 1
25525 $1,305.68 1
25526 $1,603.05 1
25530 $423.56 1
25535 $802.41 1
25545 $1,032.44 1
25560 $447.86 1
25565 $849.86 1
25574 $1,120.52 1
25575 $1,499.87 1
25600 $529.29 1
25605 $892.85 1
25606 $1,101.80 1
25607 $1,217.43 1
25608 $1,368.18 1
25609 $1,739.36 1
25622 $489.87 1
25624 $785.31 1
25628 $1,191.86 1
25630 $494.09 1
25635 $731.99 1
25645 $950.40 1
25650 $516.23 1
3/1/2015 25 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
25651 $794.30 1
25652 $1,034.63 1
25660 $668.61 1
25670 $1,000.34 1
25671 $879.98 1
25675 $709.64 1
25676 $1,048.98 1
25680 $765.29 1
25685 $1,233.32 1
25690 $797.21 1
25695 $1,058.75 1
25800 $1,210.35 1
25805 $1,416.08 1
25810 $1,433.06 1
25820 $1,010.66 1
25825 $1,244.49 1
25830 $1,577.46 1
25900 $1,172.24 1
25905 $1,174.83 1
25907 $1,023.89 1
25909 $1,147.49 1
25915 $1,561.91 1
25920 $1,162.49 1
25922 $1,017.98 1
25924 $1,134.86 1
25927 $1,341.56 1
25929 $923.96 1
25931 $1,228.73 1
26010 $420.02 1
26011 $622.61 1
26020 $712.08 1
26025 $694.23 1
26030 $808.34 1
26034 $887.81 1
26035 $1,432.49 1
26037 $931.77 1
26040 $507.75 1
26045 $772.89 1
26055 $892.80 1
26060 $428.18 1
26070 $516.95 1
26075 $546.24 1
26080 $637.77 1
26100 $554.16 1
26105 $557.42 1
3/1/2015 26 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
26110 $525.30 1
26111 $690.54 1
26113 $902.46 1
26115 $813.53 1
26116 $868.11 1
26117 $1,233.27 1
26118 $1,754.51 1
26121 $985.46 1
26123 $1,374.39 1
26125 $460.41 1
26130 $767.96 1
26135 $901.19 1
26140 $827.52 1
26145 $843.66 1
26160 $919.85 1
26170 $664.49 1
26180 $724.55 1
26185 $881.93 1
26200 $736.94 1
26205 $1,005.00 1
26210 $724.22 1
26215 $938.87 1
26230 $819.03 1
26235 $810.60 1
26236 $722.88 1
26250 $1,775.61 1
26260 $1,347.95 1
26262 $1,058.37 1
26320 $566.93 1
26340 $538.47 1
26341 $160.56 1
26350 $1,137.81 1
26352 $1,312.43 1
26356 $1,761.32 1
26357 $1,417.40 1
26358 $1,438.94 1
26370 $1,216.92 1
26372 $1,441.49 1
26373 $1,326.32 1
26390 $1,369.55 1
26392 $1,590.98 1
26410 $901.14 1
26412 $1,120.79 1
26415 $1,071.00 1
26416 $1,447.77 1
3/1/2015 27 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
26418 $919.31 1
26420 $1,134.60 1
26426 $824.24 1
26428 $1,179.54 1
26432 $798.65 1
26433 $848.78 1
26434 $1,049.52 1
26437 $999.51 1
26440 $986.51 1
26442 $1,551.71 1
26445 $914.75 1
26449 $1,140.59 1
26450 $650.48 1
26455 $646.29 1
26460 $627.06 1
26471 $980.34 1
26474 $972.51 1
26476 $944.57 1
26477 $915.92 1
26478 $987.59 1
26479 $973.89 1
26480 $1,196.37 1
26483 $1,352.15 1
26485 $1,291.98 1
26489 $1,526.46 1
26490 $1,299.63 1
26492 $1,443.63 1
26494 $1,254.83 1
26496 $1,369.20 1
26497 $1,416.51 1
26498 $1,895.39 1
26499 $1,308.51 1
26500 $998.37 1
26502 $1,155.35 1
26508 $1,020.00 1
26510 $946.76 1
26516 $1,119.08 1
26517 $1,349.31 1
26518 $1,319.94 1
26520 $1,037.75 1
26525 $1,038.24 1
26530 $884.28 1
26531 $1,026.42 1
26535 $688.17 1
26536 $1,134.86 1
3/1/2015 28 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
26540 $1,052.48 1
26541 $1,291.95 1
26542 $1,089.66 1
26545 $1,150.70 1
26546 $1,606.86 1
26548 $1,220.73 1
26550 $2,729.52 1
26551 $5,534.87 1
26553 $4,335.77 1
26554 $5,073.69 1
26555 $2,264.88 1
26556 $4,785.75 1
26560 $955.89 1
26561 $1,501.10 1
26562 $2,156.78 1
26565 $1,103.15 1
26567 $1,089.05 1
26568 $1,467.21 1
26580 $2,506.17 1
26587 $1,624.76 1
26590 $2,335.22 1
26591 $688.71 1
26593 $958.16 1
26596 $1,212.99 1
26600 $473.61 1
26605 $521.34 1
26607 $757.64 1
26608 $780.56 1
26615 $949.34 1
26641 $612.36 1
26645 $704.06 1
26650 $786.21 1
26665 $1,039.43 1
26670 $545.46 1
26675 $748.38 1
26676 $820.76 1
26685 $949.89 1
26686 $1,040.70 1
26700 $520.41 1
26705 $683.94 1
26706 $708.78 1
26715 $939.45 1
26720 $318.27 1
26725 $546.39 1
26727 $769.35 1
3/1/2015 29 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
26735 $982.65 1
26740 $369.51 1
26742 $595.28 1
26746 $1,223.13 1
26750 $295.76 1
26755 $507.03 1
26756 $680.31 1
26765 $821.67 1
26770 $443.27 1
26775 $620.84 1
26776 $725.49 1
26785 $897.99 1
26820 $1,284.96 1
26841 $1,166.16 1
26842 $1,267.97 1
26843 $1,203.00 1
26844 $1,292.43 1
26850 $1,108.32 1
26852 $1,279.23 1
26860 $900.96 1
26861 $174.12 1
26862 $1,165.08 1
26863 $381.30 1
26910 $1,158.44 1
26951 $1,048.23 1
26952 $1,035.00 1
26990 $1,042.35 1
26991 $1,148.76 1
26992 $1,589.10 1
27000 $687.08 1
27001 $899.13 1
27003 $995.63 1
27005 $1,210.16 1
27006 $1,226.66 1
27025 $1,516.77 1
27027 $1,483.19 1
27030 $1,572.05 1
27033 $1,628.75 1
27035 $1,725.47 1
27036 $1,692.95 1
27040 $555.96 1
27041 $1,145.72 1
27043 $792.56 1
27045 $1,260.90 1
27047 $773.81 1
3/1/2015 30 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27048 $1,025.60 1
27049 $2,259.65 1
27050 $666.23 1
27052 $966.42 1
27054 $1,139.55 1
27057 $1,709.01 1
27059 $3,077.78 1
27060 $774.32 1
27062 $760.16 1
27065 $859.76 1
27066 $1,358.57 1
27067 $1,739.70 1
27070 $1,415.07 1
27071 $1,526.40 1
27075 $3,562.65 1
27076 $4,318.47 1
27077 $4,822.98 1
27078 $3,513.75 1
27080 $861.96 1
27086 $477.29 1
27087 $1,043.69 1
27090 $1,381.16 1
27091 $2,688.56 1
27093 $297.86 1
27095 $384.08 1
27096 $253.92 1
27097 $1,141.85 1
27098 $1,162.38 1
27100 $1,383.92 1
27105 $1,453.13 1
27110 $1,627.08 1
27111 $1,510.59 1
27120 $2,194.52 1
27122 $1,842.26 1
27125 $1,904.52 1
27130 $2,281.64 1
27132 $2,819.33 1
27134 $3,230.40 1
27137 $2,480.04 1
27138 $2,576.57 1
27140 $1,507.53 1
27146 $2,162.09 1
27147 $2,486.01 1
27151 $2,692.04 1
27156 $2,904.23 1
3/1/2015 31 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27158 $2,370.21 1
27161 $2,042.81 1
27165 $2,300.93 1
27170 $1,981.56 1
27175 $1,120.67 1
27176 $1,542.11 1
27177 $1,875.57 1
27178 $1,542.11 1
27179 $1,641.86 1
27181 $1,890.71 1
27185 $937.83 1
27187 $1,662.81 1
27193 $780.96 1
27194 $1,186.58 1
27200 $294.45 1
27202 $892.40 1
27220 $880.67 1
27222 $1,640.90 1
27226 $1,779.39 1
27227 $2,799.33 1
27228 $3,195.29 1
27230 $784.37 1
27232 $1,265.12 1
27235 $1,527.80 1
27236 $2,010.11 1
27238 $762.36 1
27240 $1,605.30 1
27244 $2,070.69 1
27245 $2,069.76 1
27246 $638.28 1
27248 $1,246.38 1
27250 $305.91 1
27252 $1,274.51 1
27253 $1,578.24 1
27254 $2,146.59 1
27256 $497.76 1
27257 $572.21 1
27258 $1,869.72 1
27259 $2,625.32 1
27265 $651.81 1
27266 $971.37 1
27267 $717.84 1
27268 $900.44 1
27269 $2,096.60 1
27275 $302.45 1
3/1/2015 32 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27279 $913.97
27280 $1,852.23 1
27282 $1,260.09 1
27284 $2,593.47 1
27286 $2,797.86 1
27290 $2,747.69 1
27295 $2,127.18 1
27301 $1,085.87 1
27303 $1,062.42 1
27305 $797.39 1
27306 $587.27 1
27307 $799.23 1
27310 $1,220.39 1
27323 $435.20 1
27324 $662.60 1
27325 $861.44 1
27326 $855.09 1
27327 $749.25 1
27328 $1,044.38 1
27329 $1,744.89 1
27330 $690.12 1
27331 $790.28 1
27332 $1,074.30 1
27333 $977.63 1
27334 $1,139.96 1
27335 $1,274.37 1
27337 $702.44 1
27339 $1,268.63 1
27340 $614.61 1
27345 $798.45 1
27347 $878.81 1
27350 $1,084.29 1
27355 $1,005.99 1
27356 $1,237.19 1
27357 $1,360.65 1
27358 $476.76 1
27360 $1,420.20 1
27364 $2,646.51 1
27365 $3,490.01 1
27370 $245.55 1
27372 $989.55 1
27380 $985.53 1
27381 $1,325.40 1
27385 $950.66 1
27386 $1,379.31 1
3/1/2015 33 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27390 $745.77 1
27391 $963.56 1
27392 $1,192.82 1
27393 $850.11 1
27394 $1,084.26 1
27395 $1,473.98 1
27396 $1,029.14 1
27397 $1,537.38 1
27400 $1,163.84 1
27403 $1,069.44 1
27405 $1,128.17 1
27407 $1,328.01 1
27409 $1,621.29 1
27412 $2,793.41 1
27415 $2,318.13 1
27416 $1,649.28 1
27418 $1,380.39 1
27420 $1,234.16 1
27422 $1,239.21 1
27424 $1,253.69 1
27425 $744.35 1
27427 $1,191.45 1
27428 $1,871.61 1
27429 $2,102.46 1
27430 $1,226.04 1
27435 $1,342.16 1
27437 $1,106.67 1
27438 $1,404.59 1
27440 $1,338.86 1
27441 $1,383.98 1
27442 $1,455.00 1
27443 $1,370.37 1
27445 $2,106.36 1
27446 $1,948.46 1
27447 $2,281.08 1
27448 $1,267.73 1
27450 $1,690.73 1
27454 $2,192.99 1
27455 $1,584.30 1
27457 $1,616.72 1
27465 $2,107.37 1
27466 $1,996.46 1
27468 $2,267.00 1
27470 $1,972.95 1
27472 $2,125.61 1
3/1/2015 34 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27475 $1,107.78 1
27477 $1,229.37 1
27479 $1,548.90 1
27485 $1,123.65 1
27486 $2,362.19 1
27487 $2,958.08 1
27488 $2,015.66 1
27495 $1,894.37 1
27496 $907.07 1
27497 $995.82 1
27498 $1,095.33 1
27499 $1,172.88 1
27500 $860.36 1
27501 $835.98 1
27502 $1,278.78 1
27503 $1,342.43 1
27506 $2,248.20 1
27507 $1,633.31 1
27508 $865.49 1
27509 $1,067.64 1
27510 $1,140.81 1
27511 $1,678.13 1
27513 $2,093.25 1
27514 $1,626.86 1
27516 $840.87 1
27517 $1,147.98 1
27519 $1,505.30 1
27520 $525.00 1
27524 $1,259.19 1
27530 $490.65 1
27532 $1,024.59 1
27535 $1,508.18 1
27536 $2,000.16 1
27538 $778.73 1
27540 $1,356.38 1
27550 $827.18 1
27552 $1,040.51 1
27556 $1,478.27 1
27557 $1,770.56 1
27558 $2,022.45 1
27560 $585.89 1
27562 $805.07 1
27566 $1,501.76 1
27570 $251.01 1
27580 $2,409.72 1
3/1/2015 35 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27590 $1,385.22 1
27591 $1,626.08 1
27592 $1,172.01 1
27594 $858.36 1
27596 $1,231.16 1
27598 $1,227.59 1
27600 $697.64 1
27601 $749.90 1
27602 $839.63 1
27603 $866.88 1
27604 $796.67 1
27605 $543.63 1
27606 $473.81 1
27607 $1,017.33 1
27610 $1,083.54 1
27612 $929.01 1
27613 $401.87 1
27614 $929.87 1
27615 $1,714.89 1
27616 $2,139.39 1
27618 $734.16 1
27619 $781.49 1
27620 $756.57 1
27625 $963.62 1
27626 $1,018.79 1
27630 $907.52 1
27632 $694.16 1
27634 $1,148.73 1
27635 $977.24 1
27637 $1,279.73 1
27638 $1,304.58 1
27640 $1,397.58 1
27641 $1,110.57 1
27645 $3,014.40 1
27646 $2,612.51 1
27647 $1,652.31 1
27648 $258.08 1
27650 $1,086.20 1
27652 $1,128.59 1
27654 $1,162.88 1
27656 $1,035.29 1
27658 $613.53 1
27659 $786.36 1
27664 $596.85 1
27665 $671.16 1
3/1/2015 36 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27675 $788.36 1
27676 $976.13 1
27680 $711.35 1
27681 $913.44 1
27685 $1,071.69 1
27686 $935.72 1
27687 $748.61 1
27690 $1,030.85 1
27691 $1,243.01 1
27692 $175.02 1
27695 $782.76 1
27696 $901.62 1
27698 $1,054.43 1
27700 $936.38 1
27702 $1,620.54 1
27703 $1,857.30 1
27704 $957.89 1
27705 $1,251.60 1
27707 $666.17 1
27709 $1,971.11 1
27712 $1,861.20 1
27715 $1,770.29 1
27720 $1,463.49 1
27722 $1,495.55 1
27724 $2,132.37 1
27725 $2,054.43 1
27726 $1,621.76 1
27727 $1,370.13 1
27730 $979.59 1
27732 $743.49 1
27734 $1,097.82 1
27740 $1,187.33 1
27742 $1,304.43 1
27745 $1,268.76 1
27750 $564.98 1
27752 $885.99 1
27756 $960.30 1
27758 $1,492.47 1
27759 $1,674.96 1
27760 $540.02 1
27762 $775.35 1
27766 $1,019.63 1
27767 $457.16 1
27768 $731.13 1
27769 $1,216.67 1
3/1/2015 37 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
27780 $495.51 1
27781 $693.54 1
27784 $1,197.72 1
27786 $513.08 1
27788 $687.95 1
27792 $1,089.30 1
27808 $541.41 1
27810 $765.29 1
27814 $1,289.73 1
27816 $520.55 1
27818 $790.65 1
27822 $1,398.33 1
27823 $1,596.42 1
27824 $509.10 1
27825 $900.60 1
27826 $1,385.07 1
27827 $1,806.08 1
27828 $2,168.61 1
27829 $1,136.55 1
27830 $613.56 1
27831 $663.48 1
27832 $1,266.69 1
27840 $601.20 1
27842 $825.11 1
27846 $1,222.89 1
27848 $1,359.65 1
27860 $286.50 1
27870 $1,721.67 1
27871 $1,140.32 1
27880 $1,583.58 1
27881 $1,475.10 1
27882 $1,032.35 1
27884 $985.23 1
27886 $1,127.54 1
27888 $1,158.30 1
27889 $1,115.30 1
27892 $915.87 1
27893 $1,017.95 1
27894 $1,454.31 1
28001 $450.87 1
28002 $712.82 1
28003 $1,147.05 1
28005 $941.13 1
28008 $697.64 1
28010 $373.23 1
3/1/2015 38 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
28011 $521.91 1
28020 $888.39 1
28022 $793.02 1
28024 $748.20 1
28035 $856.23 1
28039 $826.47 1
28041 $748.02 1
28043 $643.79 1
28045 $797.52 1
28046 $1,196.00 1
28047 $1,794.80 1
28050 $771.44 1
28052 $705.50 1
28054 $602.99 1
28055 $611.30 1
28060 $836.45 1
28062 $939.71 1
28070 $857.51 1
28072 $837.90 1
28080 $850.40 1
28086 $899.45 1
28088 $703.61 1
28090 $762.33 1
28092 $682.56 1
28100 $994.65 1
28102 $1,013.85 1
28103 $628.73 1
28104 $864.48 1
28106 $688.22 1
28107 $830.22 1
28108 $715.41 1
28110 $749.79 1
28111 $804.44 1
28112 $795.35 1
28113 $961.62 1
28114 $1,765.38 1
28116 $1,224.81 1
28118 $965.81 1
28119 $849.09 1
28120 $1,103.84 1
28122 $970.88 1
28124 $767.69 1
28126 $637.67 1
28130 $980.46 1
28140 $971.36 10
3/1/2015 39 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
28150 $691.77 1
28153 $665.22 1
28160 $681.29 1
28171 $1,367.22 1
28173 $1,236.60 1
28175 $787.43 1
28190 $412.16 1
28192 $759.20 1
28193 $861.62 1
28200 $791.30 1
28202 $956.76 1
28208 $769.20 1
28210 $936.86 1
28220 $727.89 1
28222 $809.91 1
28225 $657.51 1
28226 $708.20 1
28230 $705.93 1
28232 $624.81 1
28234 $661.40 1
28238 $1,099.31 1
28240 $712.17 1
28250 $946.40 1
28260 $1,118.27 1
28261 $1,627.35 1
28262 $2,454.89 1
28264 $1,358.30 1
28270 $796.16 1
28272 $635.94 1
28280 $832.14 1
28285 $864.27 1
28286 $723.24 1
28288 $976.13 1
28289 $1,193.19 1
28290 $962.25 1
28292 $1,276.71 1
28293 $1,680.29 1
28294 $1,229.16 1
28296 $1,152.83 1
28297 $1,319.54 1
28298 $1,166.97 1
28299 $1,456.95 1
28300 $1,081.11 1
28302 $1,199.45 1
28304 $1,356.20 1
3/1/2015 40 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
28305 $1,049.12 1
28306 $999.53 1
28307 $1,173.60 1
28308 $914.39 1
28309 $1,509.78 1
28310 $886.64 1
28312 $839.43 1
28313 $862.07 1
28315 $781.13 1
28320 $999.41 1
28322 $1,294.26 1
28340 $931.23 1
28341 $1,080.60 1
28344 $911.49 1
28345 $840.87 1
28360 $1,317.51 1
28400 $402.83 1
28405 $649.49 1
28406 $870.99 1
28415 $1,839.56 1
28420 $2,109.12 1
28430 $384.38 1
28435 $534.12 1
28436 $744.23 1
28445 $1,780.95 1
28446 $2,063.34 1
28450 $348.78 1
28455 $465.59 1
28456 $524.93 1
28465 $1,015.61 1
28470 $354.68 1
28475 $414.77 1
28476 $574.01 1
28485 $859.83 1
28490 $234.54 1
28495 $289.32 1
28496 $721.10 1
28505 $1,100.87 1
28510 $199.92 1
28515 $261.71 1
28525 $905.15 1
28530 $185.10 1
28531 $548.27 1
28540 $307.29 1
28545 $485.21 1
3/1/2015 41 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
28546 $941.85 1
28555 $1,450.07 1
28570 $281.63 1
28575 $596.82 1
28576 $657.98 1
28585 $1,382.91 1
28600 $350.64 1
28605 $537.59 1
28606 $648.92 1
28615 $1,303.07 1
28630 $253.31 1
28635 $276.17 1
28636 $574.79 1
28645 $1,063.13 1
28660 $189.24 1
28665 $250.74 1
28666 $321.41 1
28675 $962.21 1
28705 $2,089.37 1
28715 $1,559.94 1
28725 $1,288.05 1
28730 $1,206.60 1
28735 $1,287.72 1
28737 $1,134.27 1
28740 $1,383.27 1
28750 $1,332.69 1
28755 $822.56 1
28760 $1,285.58 1
28800 $898.16 1
28805 $1,219.17 1
28810 $720.80 1
28820 $924.32 1
28825 $881.24 1
28890 $521.24 1
29000 $513.35 1
29010 $364.37 1
29015 $451.46 1
29035 $364.29 1
29040 $349.41 1
29044 $407.58 1
29046 $376.91 1
29049 $121.19 1
29055 $363.17 1
29058 $205.94 1
29065 $156.95 1
3/1/2015 42 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
29075 $141.45 1
29085 $155.48 1
29086 $123.29 1
29105 $143.51 1
29125 $102.50 1
29126 $124.29 1
29130 $65.48 1
29131 $82.34 1
29200 $47.06 1
29240 $45.41 1
29260 $45.77 1
29280 $46.32 1
29305 $404.75 1
29325 $448.47 1
29345 $224.21 1
29355 $231.00 1
29358 $263.94 1
29365 $200.63 1
29405 $132.39 1
29425 $126.12 1
29435 $193.08 1
29440 $69.60 1
29445 $220.11 1
29450 $231.23 1
29505 $134.04 1
29515 $115.38 1
29520 $48.72 1
29530 $44.30 1
29540 $40.44 1
29550 $30.17 1
29580 $83.63 1
29581 $98.48 1
29582 $111.57 1
29583 $70.31 1
29584 $111.57 1
29700 $99.06 1
29705 $110.54 1
29710 $205.71 1
29720 $139.76 1
29730 $103.92 1
29740 $165.00 1
29750 $157.41 1
29800 $855.44 1
29804 $1,061.88 1
29805 $787.50 1
3/1/2015 43 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
29806 $1,782.66 1
29807 $1,740.71 1
29819 $980.75 1
29820 $883.74 1
29821 $961.28 1
29822 $933.39 1
29823 $1,016.12 1
29824 $1,097.06 1
29825 $951.86 1
29826 $298.58 1
29827 $1,742.22 1
29828 $1,502.91 1
29830 $762.71 1
29834 $799.04 1
29835 $841.04 1
29836 $966.30 1
29837 $864.74 1
29838 $970.31 1
29840 $754.37 1
29843 $808.11 1
29844 $811.23 1
29845 $947.97 1
29846 $856.65 1
29847 $910.41 1
29848 $843.45 1
29850 $1,045.14 1
29851 $1,569.92 1
29855 $1,313.07 1
29856 $1,678.73 1
29860 $1,118.54 1
29861 $1,184.91 1
29862 $1,331.03 1
29863 $1,327.73 1
29866 $1,765.94 1
29867 $2,156.69 1
29868 $2,831.87 1
29870 $957.90 1
29871 $858.60 1
29873 $872.42 1
29874 $897.02 1
29875 $825.68 1
29876 $1,102.73 1
29877 $1,038.11 1
29879 $1,106.96 1
29880 $937.58 1
3/1/2015 44 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
29881 $900.60 1
29882 $1,174.08 1
29883 $1,414.17 1
29884 $1,016.06 1
29885 $1,263.14 1
29886 $1,067.61 1
29887 $1,246.29 1
29888 $1,650.36 1
29889 $2,060.51 1
29891 $1,125.39 1
29892 $1,005.74 1
29893 $982.29 1
29894 $829.02 1
29895 $797.34 1
29897 $840.30 1
29898 $934.91 1
29899 $1,748.55 1
29900 $668.69 1
29901 $859.91 1
29902 $794.55 1
29904 $1,071.59 1
29905 $1,043.22 1
29906 $1,185.60 1
29907 $1,472.79 1
29914 $1,642.44 1
29915 $1,671.92 1
29916 $1,676.34 1
30000 $368.09 1
30020 $372.50 1
30100 $226.80 1
30110 $370.34 1
30115 $698.22 1
30117 $1,392.86 1
30118 $1,246.71 1
30120 $838.47 1
30124 $461.24 1
30125 $985.44 1
30130 $612.33 1
30140 $707.19 1
30150 $1,251.00 1
30160 $1,257.47 1
30200 $181.77 1
30210 $241.41 1
30220 $482.07 1
30300 $366.33 1
3/1/2015 45 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
30310 $330.95 1
30320 $730.50 1
30400 $1,625.63 1
30410 $1,912.76 1
30420 $2,230.47 1
30430 $1,400.42 1
30435 $2,022.14 1
30450 $2,431.31 1
30460 $1,329.65 1
30462 $2,324.39 1
30465 $1,594.64 1
30520 $1,008.75 1
30540 $1,113.15 1
30545 $1,357.83 1
30560 $428.03 1
30580 $1,064.01 1
30600 $922.67 1
30620 $1,006.08 1
30630 $1,014.92 1
30801 $364.22 1
30802 $465.99 1
30901 $154.37 1
30903 $330.24 1
30905 $413.33 1
30906 $450.84 1
30915 $936.60 1
30920 $1,358.72 1
30930 $198.96 1
31000 $293.78 1
31002 $310.77 1
31020 $779.27 1
31030 $1,117.71 1
31032 $931.92 1
31040 $1,247.88 1
31050 $783.81 1
31051 $1,043.16 1
31070 $707.51 1
31075 $1,265.06 1
31080 $1,671.18 1
31081 $2,610.71 1
31084 $1,872.18 1
31085 $2,378.36 1
31086 $1,819.92 1
31087 $1,759.92 1
31090 $1,653.29 1
3/1/2015 46 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
31200 $902.06 1
31201 $1,198.23 1
31205 $1,423.95 1
31225 $3,066.95 1
31230 $3,396.12 1
31231 $333.90 1
31233 $422.01 1
31235 $480.56 1
31237 $416.54 1
31238 $416.87 1
31239 $991.49 1
31240 $265.53 1
31254 $452.27 1
31255 $663.59 1
31256 $327.77 1
31267 $526.64 1
31276 $836.19 1
31287 $383.85 1
31288 $446.30 1
31290 $1,921.82 1
31291 $2,063.31 1
31292 $1,644.51 1
31293 $1,785.96 1
31294 $2,045.60 1
31295 $3,234.77 1
31296 $3,282.06 1
31297 $3,220.32 1
31300 $2,061.20 1
31320 $1,056.30 1
31360 $3,406.62 1
31365 $4,223.57 1
31367 $3,602.22 1
31368 $3,995.93 1
31370 $3,381.89 1
31375 $3,210.86 1
31380 $3,163.05 1
31382 $3,471.59 1
31390 $4,678.83 1
31395 $4,920.72 1
31400 $1,622.03 1
31420 $1,362.12 1
31500 $182.03 1
31502 $56.76 1
31505 $131.96 1
31510 $342.33 1
3/1/2015 47 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
31511 $342.30 1
31512 $335.09 1
31513 $219.95 1
31515 $333.69 1
31520 $260.27 1
31525 $409.13 1
31526 $260.81 1
31527 $326.15 1
31528 $240.51 1
31529 $270.02 1
31530 $327.08 1
31531 $354.18 1
31535 $316.56 1
31536 $351.47 1
31540 $404.49 1
31541 $441.60 1
31545 $604.25 1
31546 $920.55 1
31560 $523.86 1
31561 $572.90 1
31570 $554.06 1
31571 $417.35 1
31575 $184.74 1
31576 $360.11 1
31577 $391.52 1
31578 $449.66 1
31579 $341.04 1
31580 $1,987.17 1
31582 $3,088.05 1
31584 $2,469.03 1
31587 $1,646.09 1
31588 $1,860.51 1
31590 $1,435.50 1
31595 $1,242.21 1
31600 $672.78 1
31601 $468.75 1
31603 $376.65 1
31605 $311.66 1
31610 $1,173.75 1
31611 $877.26 1
31612 $143.07 1
31613 $740.13 1
31614 $1,232.79 1
31615 $294.54 1
31620 $455.87 1
3/1/2015 48 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
31622 $499.67 1
31623 $525.84 1
31624 $498.23 1
31625 $530.22 1
31626 $715.82 1
31627 $2,221.32 1
31628 $590.84 1
31629 $933.59 1
31630 $330.98 1
31631 $387.35 1
31632 $113.06 4
31633 $140.57 4
31634 $2,966.96 1
31635 $559.55 1
31636 $367.02 1
31637 $120.08 1
31638 $421.86 1
31640 $421.43 1
31641 $423.50 1
31643 $287.87 1
31645 $514.89 1
31646 $463.13 1
31647 $367.04 1
31648 $328.71 1
31649 $110.00 1
31651 $120.08 1
31660 $337.83 1
31661 $353.64 1
31717 $413.46 1
31720 $82.80 1
31725 $145.07 1
31730 $1,941.51 1
31750 $2,251.49 1
31755 $2,789.94 1
31760 $2,377.97 1
31766 $2,730.98 1
31770 $2,316.74 1
31775 $1,996.08 1
31780 $1,992.53 1
31781 $2,411.09 1
31785 $1,779.02 1
31786 $2,714.36 1
31800 $1,158.39 1
31805 $1,407.95 1
31820 $704.52 1
3/1/2015 49 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
31825 $981.03 1
31830 $722.42 1
32035 $1,241.82 1
32036 $1,330.05 1
32096 $1,384.59 1
32097 $1,384.22 1
32098 $1,310.82 1
32100 $1,391.58 1
32110 $2,515.92 1
32120 $1,490.72 1
32124 $1,594.31 1
32140 $1,719.20 1
32141 $2,629.20 1
32150 $1,730.36 1
32151 $1,744.14 1
32160 $1,349.37 1
32200 $1,971.11 1
32215 $1,377.98 1
32220 $2,720.10 1
32225 $1,705.07 1
32310 $1,543.23 1
32320 $2,748.95 1
32400 $243.53 1
32405 $710.96 1
32440 $2,696.42 1
32442 $5,352.86 1
32445 $6,163.38 1
32480 $2,547.26 1
32482 $2,731.14 1
32484 $2,484.26 1
32486 $4,078.35 1
32488 $4,188.99 1
32491 $2,553.71 1
32501 $426.93 1
32503 $3,136.40 1
32504 $3,599.96 1
32505 $1,603.40 1
32506 $273.90 1
32507 $272.97 1
32540 $2,991.20 1
32550 $1,249.41 1
32551 $287.25 1
32552 $305.61 1
32553 $937.74 1
32554 $319.49 1
3/1/2015 50 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
32555 $457.59 1
32556 $876.87 1
32557 $808.10 1
32560 $390.45 1
32561 $150.95 1
32562 $137.75 1
32601 $530.57 1
32604 $840.84 1
32606 $796.91 1
32607 $532.41 1
32608 $655.07 1
32609 $445.89 1
32650 $1,138.74 1
32651 $1,889.57 1
32652 $2,867.97 1
32653 $1,821.89 1
32654 $1,945.55 1
32655 $1,642.67 1
32656 $1,379.85 1
32658 $1,234.14 1
32659 $1,257.17 1
32661 $1,381.94 1
32662 $1,538.70 1
32663 $2,418.81 1
32664 $1,468.97 1
32665 $2,143.98 1
32666 $1,497.71 1
32667 $274.44 1
32668 $273.90 1
32669 $2,323.02 1
32670 $2,772.66 1
32671 $3,099.47 1
32672 $2,625.81 1
32673 $2,100.27 1
32674 $376.67 1
32701 $368.28 1
32800 $1,644.33 1
32810 $1,560.86 1
32815 $4,848.00 1
32820 $2,414.34 1
32851 $5,711.01 1
32852 $6,272.09 1
32853 $7,997.45 1
32854 $8,483.61 1
32900 $2,460.66 1
3/1/2015 51 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
32905 $2,322.84 1
32906 $2,872.83 1
32940 $2,145.95 1
32960 $201.60 1
32997 $553.68 1
32998 $4,654.44 1
33010 $206.82 1
33011 $209.96 1
33015 $863.73 1
33020 $1,517.42 1
33025 $1,375.28 1
33030 $3,464.97 1
33031 $4,264.95 1
33050 $1,737.29 1
33120 $3,632.24 1
33130 $2,403.72 1
33140 $2,751.95 1
33141 $227.51 1
33202 $1,339.44 1
33203 $1,392.51 1
33206 $788.96 1
33207 $842.19 1
33208 $911.55 1
33210 $307.85 1
33211 $313.95 1
33212 $568.14 1
33213 $594.03 1
33214 $832.61 1
33215 $529.11 1
33216 $650.39 1
33217 $638.84 1
33218 $681.18 1
33220 $683.07 1
33221 $634.11 1
33222 $590.69 1
33223 $715.74 1
33224 $886.62 1
33225 $805.83 1
33226 $850.94 1
33227 $598.50 1
33228 $623.12 1
33229 $653.24 1
33230 $673.40 1
33231 $709.79 1
33233 $411.00 1
3/1/2015 52 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
33234 $849.06 1
33235 $1,103.75 1
33236 $1,346.64 1
33237 $1,448.15 1
33238 $1,603.23 1
33240 $643.46 1
33241 $387.77 1
33243 $2,363.84 1
33244 $1,486.40 1
33249 $1,585.74 1
33250 $2,561.28 1
33251 $2,813.79 1
33254 $2,357.15 1
33255 $2,842.13 1
33256 $3,383.70 1
33257 $998.72 1
33258 $1,134.39 1
33259 $1,448.40 1
33261 $2,813.79 1
33262 $655.23 1
33263 $683.15 1
33264 $711.44 1
33265 $2,339.87 1
33266 $3,202.98 1
33270 $1,004.19
33271 $843.47
33272 $620.55
33273 $686.18
33282 $404.93 1
33284 $358.59 1
33300 $4,238.10 1
33305 $7,117.31 1
33310 $2,070.78 1
33315 $3,319.67 1
33320 $1,844.84 1
33321 $2,083.47 1
33322 $2,393.76 1
33330 $2,484.77 1
33335 $3,284.04 1
33361 $2,355.05 1
33362 $2,580.02 1
33363 $2,706.03 1
33364 $2,810.75 1
33365 $3,086.12 1
33366 $3,346.22
3/1/2015 53 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
33367 $1,087.11 1
33368 $1,308.21 1
33369 $1,726.07 1
33400 $3,941.42 1
33401 $2,500.74 1
33403 $2,565.81 1
33404 $3,077.54 1
33405 $3,922.19 1
33406 $4,977.20 1
33410 $4,386.03 1
33411 $5,809.11 1
33412 $5,533.62 1
33413 $5,701.41 1
33414 $3,734.19 1
33415 $3,508.98 1
33416 $3,511.58 1
33417 $2,870.96 1
33418 $3,190.86
33419 $751.80
33420 $2,400.77 1
33422 $2,906.01 1
33425 $4,725.30 1
33426 $4,114.55 1
33427 $4,225.64 1
33430 $4,834.59 1
33460 $4,248.45 1
33463 $5,354.88 1
33464 $4,217.52 1
33465 $4,770.84 1
33468 $4,260.27 1
33470 $2,139.17 1
33471 $2,032.80 1
33474 $3,777.60 1
33475 $4,076.16 1
33476 $2,637.92 1
33478 $2,718.08 1
33496 $2,908.59 1
33500 $2,724.60 1
33501 $1,944.35 1
33502 $2,204.40 1
33503 $2,286.00 1
33504 $2,531.25 1
33505 $3,588.65 1
33506 $3,753.98 1
33507 $2,992.04 1
3/1/2015 54 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
33508 $27.12 1
33510 $3,335.37 1
33511 $3,665.58 1
33512 $4,172.52 1
33513 $4,298.04 1
33514 $4,547.36 1
33516 $4,776.23 1
33517 $325.56 1
33518 $715.89 1
33519 $945.95 1
33521 $1,134.21 1
33522 $1,274.39 1
33523 $1,463.45 1
33530 $916.52 1
33533 $3,226.71 1
33534 $3,798.23 1
33535 $4,237.38 1
33536 $4,575.35 1
33542 $4,541.81 1
33545 $5,387.25 1
33548 $5,120.30 1
33572 $400.82 1
33600 $2,998.61 1
33602 $2,906.28 1
33606 $2,738.93 1
33608 $3,115.73 1
33610 $3,098.66 1
33611 $3,017.27 1
33612 $3,480.23 1
33615 $3,490.35 1
33617 $3,751.95 1
33619 $4,203.35 1
33620 $2,644.28 1
33621 $1,619.07 1
33622 $5,920.07 1
33641 $2,826.36 1
33645 $3,002.15 1
33647 $3,153.50 1
33660 $3,076.77 1
33665 $3,323.75 1
33670 $3,457.67 1
33675 $3,453.06 1
33676 $3,130.49 1
33677 $3,253.46 1
33681 $3,190.85 1
3/1/2015 55 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
33684 $3,307.23 1
33688 $3,276.23 1
33690 $2,085.12 1
33692 $3,031.98 1
33694 $3,389.06 1
33697 $3,646.16 1
33702 $2,676.39 1
33710 $3,643.14 1
33720 $2,698.46 1
33722 $2,835.78 1
33724 $2,668.95 1
33726 $3,561.27 1
33730 $3,505.05 1
33732 $2,875.22 1
33735 $2,255.39 1
33736 $2,427.60 1
33737 $1,993.26 1
33750 $2,297.90 1
33755 $2,020.13 1
33762 $1,972.07 1
33764 $2,020.13 1
33766 $2,425.88 1
33767 $2,462.10 1
33768 $648.68 1
33770 $3,278.43 1
33771 $3,379.20 1
33774 $3,140.28 1
33775 $2,857.19 1
33776 $3,018.96 1
33777 $2,920.65 1
33778 $3,631.19 1
33779 $3,605.91 1
33780 $3,671.31 1
33781 $3,585.87 1
33782 $5,657.07 1
33783 $5,410.70 1
33786 $3,522.68 1
33788 $2,677.94 1
33800 $1,798.10 1
33802 $1,970.52 1
33803 $1,769.54 1
33813 $1,904.09 1
33814 $2,655.02 1
33820 $1,673.48 1
33822 $1,571.73 1
3/1/2015 56 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
33824 $2,035.25 1
33840 $1,902.47 1
33845 $2,302.64 1
33851 $1,954.28 1
33852 $2,416.23 1
33853 $3,172.71 1
33860 $5,562.39 1
33863 $5,462.57 1
33864 $5,602.43 1
33870 $4,368.17 1
33875 $4,773.95 1
33877 $6,364.49 1
33880 $3,157.77 1
33881 $2,713.86 1
33883 $1,960.40 1
33884 $731.46 1
33886 $1,695.89 1
33889 $1,401.84 1
33891 $1,723.70 1
33910 $4,561.70 1
33915 $2,241.33 1
33916 $7,345.85 1
33917 $2,537.96 1
33920 $3,161.48 1
33922 $2,399.96 1
33924 $499.08 1
33925 $3,007.49 1
33926 $4,409.70 1
33935 $8,652.30 1
33945 $8,440.25 1
33946 $528.48
33947 $583.80
33948 $415.46
33949 $404.45
33951 $771.50
33952 $749.04
33953 $859.98
33954 $837.15
33955 $1,549.02
33956 $1,471.68
33957 $343.59
33958 $333.09
33959 $436.67
33962 $411.81
33963 $872.51
3/1/2015 57 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
33964 $896.18
33965 $343.59
33966 $414.89
33967 $449.33 1
33968 $56.97 1
33969 $504.87
33970 $617.12 1
33971 $1,224.12 1
33973 $893.94 1
33974 $1,544.16 1
33975 $2,285.82 1
33976 $2,795.52 1
33977 $1,965.18 1
33978 $2,340.50 1
33979 $3,412.07 1
33980 $3,102.80 1
33981 $1,464.69 1
33982 $3,441.12 1
33983 $4,056.68 1
33984 $497.85
33985 $952.26
33986 $908.99
33987 $364.64
33988 $1,354.01
33989 $860.64
33990 $761.75 1
33991 $1,106.09 1
33992 $371.88 1
33993 $326.66 1
34001 $1,735.44 1
34051 $1,576.14 1
34101 $1,057.92 1
34111 $1,052.94 1
34151 $2,473.56 1
34201 $1,822.70 1
34203 $1,681.34 1
34401 $2,568.74 1
34421 $1,280.61 1
34451 $2,885.88 1
34471 $1,915.05 1
34490 $1,071.21 1
34501 $1,580.79 1
34502 $2,666.81 1
34510 $2,066.70 1
34520 $1,753.76 1
3/1/2015 58 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
34530 $1,915.98 1
34800 $1,985.07 1
34802 $2,194.08 1
34803 $2,266.98 1
34804 $2,191.88 1
34805 $2,122.23 1
34806 $178.20 1
34808 $371.69 1
34812 $598.50 1
34813 $420.68 1
34820 $870.00 1
34825 $1,217.48 1
34826 $363.77 1
34830 $3,139.01 1
34831 $3,376.11 1
34832 $3,376.11 1
34833 $1,083.45 1
34834 $480.92 1
34900 $1,571.22 1
35001 $1,993.43 1
35002 $2,016.53 1
35005 $2,013.57 1
35011 $1,765.97 1
35013 $2,196.83 1
35021 $2,208.66 1
35022 $2,531.97 1
35045 $1,741.50 1
35081 $3,088.76 1
35082 $3,879.11 1
35091 $3,183.93 1
35092 $4,628.43 1
35102 $3,347.18 1
35103 $3,986.91 1
35111 $2,361.81 1
35112 $3,281.25 1
35121 $2,911.56 1
35122 $3,789.08 1
35131 $2,455.53 1
35132 $2,910.03 1
35141 $1,956.99 1
35142 $2,333.07 1
35151 $2,197.68 1
35152 $2,485.50 1
35180 $1,515.99 1
35182 $2,869.46 1
3/1/2015 59 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
35184 $1,948.61 1
35188 $1,857.69 1
35189 $2,685.93 1
35190 $1,331.72 1
35201 $1,668.32 1
35206 $1,353.14 1
35207 $1,256.45 1
35211 $2,384.85 1
35216 $3,560.46 1
35221 $2,540.97 1
35226 $1,461.98 1
35231 $2,097.72 1
35236 $1,719.02 1
35241 $2,509.52 1
35246 $2,756.36 1
35251 $3,000.06 1
35256 $1,794.11 1
35261 $1,881.54 1
35266 $1,520.58 1
35271 $2,408.58 1
35276 $2,552.94 1
35281 $2,856.50 1
35286 $1,642.47 1
35301 $1,998.20 1
35302 $1,990.34 1
35303 $2,193.65 1
35304 $2,270.28 1
35305 $2,166.02 1
35306 $797.15 1
35311 $2,741.21 1
35321 $1,567.22 1
35331 $2,570.67 1
35341 $2,407.59 1
35351 $2,263.44 1
35355 $1,831.47 1
35361 $2,707.79 1
35363 $3,094.91 1
35371 $1,445.94 1
35372 $1,735.04 1
35390 $283.35 1
35400 $265.43 1
35450 $888.66 1
35452 $607.28 1
35458 $867.12 1
35460 $552.90 1
3/1/2015 60 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
35471 $4,083.45 1
35472 $2,990.75 1
35475 $2,478.63 1
35476 $2,262.87 1
35500 $567.33 1
35501 $2,662.91 1
35506 $2,269.08 1
35508 $2,361.93 1
35509 $2,517.77 1
35510 $2,189.22 1
35511 $1,994.48 1
35512 $2,422.41 1
35515 $2,676.80 1
35516 $2,172.02 1
35518 $2,032.77 1
35521 $2,180.81 1
35522 $2,152.76 1
35523 $2,280.06 1
35525 $2,029.20 1
35526 $3,052.56 1
35531 $3,586.40 1
35533 $2,681.24 1
35535 $3,390.23 1
35536 $3,009.80 1
35537 $4,176.44 1
35538 $4,160.51 1
35539 $3,907.85 1
35540 $4,544.93 1
35556 $2,477.06 1
35558 $2,164.41 1
35560 $3,035.63 1
35563 $2,666.99 1
35565 $2,347.31 1
35566 $2,960.67 1
35570 $2,693.54 1
35571 $2,355.32 1
35572 $612.02 1
35583 $2,569.89 1
35585 $2,975.96 1
35587 $2,428.40 1
35600 $445.11 1
35601 $2,484.98 1
35606 $2,084.46 1
35612 $1,855.70 1
35616 $1,961.40 1
3/1/2015 61 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
35621 $1,949.81 1
35623 $2,336.24 1
35626 $2,767.59 1
35631 $3,282.99 1
35632 $3,218.75 1
35633 $3,576.08 1
35634 $3,250.61 1
35636 $2,838.83 1
35637 $3,084.74 1
35638 $3,123.08 1
35642 $2,009.18 1
35645 $1,680.03 1
35646 $3,040.86 1
35647 $2,741.42 1
35650 $1,926.54 1
35654 $2,431.79 1
35656 $1,917.20 1
35661 $1,917.95 1
35663 $2,238.21 1
35665 $2,073.05 1
35666 $2,234.61 1
35671 $1,971.59 1
35681 $141.57 1
35682 $627.98 1
35683 $732.47 1
35685 $354.33 1
35686 $288.26 1
35691 $1,678.04 1
35693 $1,476.54 1
35694 $1,753.41 1
35695 $1,821.56 1
35697 $262.85 1
35700 $271.74 1
35701 $968.34 1
35721 $796.52 1
35741 $890.51 1
35761 $672.02 1
35800 $1,226.70 1
35820 $3,481.40 1
35840 $2,052.65 1
35860 $1,473.65 1
35870 $2,211.87 1
35875 $1,046.48 1
35876 $1,667.42 1
35879 $1,629.60 1
3/1/2015 62 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
35881 $1,798.05 1
35883 $2,139.87 1
35884 $2,208.14 1
35901 $864.48 1
35903 $988.56 1
35905 $3,113.99 1
35907 $3,390.71 1
36002 $265.85 1
36005 $511.10 1
36010 $799.44 1
36011 $1,325.85 1
36012 $1,369.26 1
36013 $1,234.61 1
36014 $1,287.56 1
36015 $1,364.66 1
36100 $792.57 1
36120 $671.42 1
36140 $698.66 1
36147 $1,326.93 1
36148 $415.08 1
36160 $786.23 1
36200 $1,002.68 1
36215 $1,790.15 1
36216 $1,872.02 1
36217 $3,013.29 1
36218 $295.37 3
36221 $1,745.09 1
36222 $2,028.84 1
36223 $2,429.85 1
36224 $3,030.98 1
36225 $2,348.64 1
36226 $2,960.27 1
36227 $428.03 1
36228 $2,014.16 1
36245 $2,175.35 1
36246 $1,433.96 1
36247 $2,512.08 1
36248 $243.08 3
36251 $2,268.69 1
36252 $2,475.38 1
36253 $3,587.27 1
36254 $3,518.66 1
36260 $1,104.69 1
36261 $619.65 1
36262 $517.73 1
3/1/2015 63 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
36400 $44.31 1
36405 $41.67 1
36406 $32.85 1
36410 $26.96 1
36420 $81.23 1
36425 $65.99 1
36430 $54.87 1
36440 $96.65 1
36450 $196.73 1
36455 $222.90 1
36460 $571.40 1
36468 $0.00 1
36470 $241.83 1
36471 $284.03 1
36475 $2,444.07 1
36476 $482.73 1
36478 $1,918.01 1
36479 $499.49 1
36481 $3,256.40 1
36500 $306.78 1
36510 $149.60 1
36511 $149.84 1
36512 $152.60 1
36513 $161.24 1
36514 $841.26 1
36515 $3,221.42 1
36516 $3,257.60 1
36522 $2,180.99 1
36555 $403.17 1
36556 $374.36 1
36557 $1,646.64 1
36558 $1,250.00 1
36560 $1,699.17 1
36561 $1,880.72 1
36563 $2,146.26 1
36565 $1,560.86 1
36566 $8,735.85 1
36568 $481.17 1
36569 $396.63 1
36570 $1,875.44 1
36571 $2,087.90 1
36575 $263.52 1
36576 $631.11 1
36578 $836.13 1
36580 $342.41 1
3/1/2015 64 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
36581 $1,219.43 1
36582 $1,753.49 1
36583 $2,188.68 1
36584 $323.61 1
36585 $1,844.01 1
36589 $270.66 1
36590 $481.79 1
36591 $36.83 1
36592 $41.25 1
36593 $48.42 1
36595 $930.89 1
36596 $212.39 1
36597 $205.38 1
36598 $173.93 1
36600 $49.94 1
36620 $83.03 1
36625 $172.98 1
36640 $192.17 1
36660 $98.46 1
36680 $98.96 1
36800 $207.08 1
36810 $363.68 1
36815 $241.74 1
36818 $1,215.00 1
36819 $1,289.58 1
36820 $1,280.18 1
36821 $1,166.45 1
36823 $2,393.88 1
36825 $1,406.18 1
36830 $1,173.42 1
36831 $1,084.86 1
36832 $1,329.75 1
36833 $1,422.39 1
36835 $864.44 1
36838 $2,019.62 1
36860 $329.67 1
36861 $229.20 1
36870 $2,900.01 1
37140 $4,000.16 1
37145 $3,708.41 1
37160 $3,808.97 1
37180 $3,664.85 1
37181 $4,000.16 1
37182 $1,383.03 1
37183 $9,301.82 1
3/1/2015 65 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
37184 $3,632.73 1
37185 $1,153.25 1
37186 $2,198.13 1
37187 $3,285.96 1
37188 $2,796.62 1
37191 $4,160.85 1
37192 $2,657.36 1
37193 $2,551.08 1
37197 $2,421.87 1
37200 $365.52 1
37202 $522.18 1
37211 $688.01 1
37212 $600.98 1
37213 $419.64 1
37214 $231.80 1
37215 $1,898.42 1
37217 $1,966.50
37218 $1,419.59
37220 $5,018.45 1
37221 $7,386.20 1
37222 $1,417.49 1
37223 $4,108.17 1
37224 $6,081.02 1
37225 $17,411.94 1
37226 $14,322.02 1
37227 $23,502.06 1
37228 $8,638.91 1
37229 $17,191.52 1
37230 $13,165.04 1
37231 $21,105.26 1
37232 $1,937.24 1
37233 $2,353.74 1
37234 $6,134.58 1
37235 $6,596.90 1
37236 $6,567.53
37237 $3,936.36
37238 $6,496.07
37239 $3,208.91
37241 $7,247.78
37242 $12,200.82
37243 $15,399.45
37244 $10,794.24
37250 $187.35 1
37251 $141.02 1
37500 $1,125.95 1
3/1/2015 66 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
37565 $1,226.15 1
37600 $1,256.57 1
37605 $1,385.19 1
37606 $847.22 1
37607 $654.74 1
37609 $510.44 1
37615 $841.92 1
37616 $1,919.27 1
37617 $2,322.06 1
37618 $656.94 1
37619 $2,834.34 1
37650 $812.57 1
37660 $2,264.46 1
37700 $430.19 1
37718 $757.89 1
37722 $833.00 1
37735 $1,030.71 1
37760 $1,069.22 1
37761 $961.97 1
37765 $1,091.16 1
37766 $1,297.91 1
37780 $446.03 1
37785 $598.86 1
37788 $2,060.66 1
37790 $792.69 1
38100 $1,977.26 1
38101 $2,004.68 1
38102 $451.44 1
38115 $2,185.41 1
38120 $1,800.84 1
38200 $221.12 1
38205 $131.63 1
38206 $132.74 1
38220 $261.38 1
38221 $264.42 1
38230 $325.41 1
38232 $343.80 1
38240 $357.77 1
38241 $268.97 1
38242 $191.04 1
38243 $190.64 1
38300 $447.11 1
38305 $784.95 1
38308 $752.34 1
38380 $923.90 1
3/1/2015 67 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
38381 $1,379.30 1
38382 $1,160.57 1
38500 $549.74 1
38505 $203.10 1
38510 $861.48 1
38520 $781.82 1
38525 $740.43 1
38530 $924.60 1
38542 $863.03 1
38550 $860.30 1
38555 $1,718.18 1
38562 $1,185.17 1
38564 $1,197.51 1
38570 $900.18 1
38571 $1,317.33 1
38572 $1,667.79 1
38700 $1,338.51 1
38720 $2,243.42 1
38724 $2,417.88 1
38740 $1,181.48 1
38745 $1,492.29 1
38746 $375.18 1
38747 $461.42 1
38760 $1,429.56 1
38765 $2,195.16 1
38770 $1,340.18 1
38780 $1,709.16 1
38790 $140.06 1
38792 $64.34 1
38794 $490.07 1
38900 $237.69 1
39000 $845.57 1
39010 $1,354.20 1
39200 $1,520.85 1
39220 $1,958.49 1
39400 $874.05 1
39501 $1,452.53 1
39503 $10,640.10 1
39540 $1,491.33 1
39541 $1,625.85 1
39545 $1,532.60 1
39560 $1,363.98 1
39561 $2,121.09 1
40490 $207.20 1
40500 $822.11 1
3/1/2015 68 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
40510 $792.26 1
40520 $800.58 1
40525 $912.75 1
40527 $1,022.13 1
40530 $882.42 1
40650 $710.72 1
40652 $801.54 1
40654 $927.44 1
40700 $1,670.49 1
40701 $1,575.81 1
40702 $1,586.31 1
40720 $1,708.64 1
40761 $1,619.01 1
40800 $345.84 1
40801 $522.36 1
40804 $345.72 1
40805 $533.70 1
40806 $174.24 1
40808 $304.77 1
40810 $337.89 1
40812 $475.28 1
40814 $637.47 1
40816 $664.88 1
40818 $587.60 1
40819 $517.59 1
40820 $432.39 1
40830 $434.55 1
40831 $552.48 1
40840 $1,338.20 1
40842 $1,357.70 1
40843 $1,805.31 1
40844 $2,134.34 1
40845 $2,427.36 1
41000 $267.39 1
41005 $368.91 1
41006 $632.43 1
41007 $621.98 1
41008 $626.72 1
41009 $665.52 1
41010 $328.35 1
41015 $749.63 1
41016 $728.64 1
41017 $739.88 1
41018 $837.63 1
41019 $749.70 1
3/1/2015 69 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
41100 $275.93 1
41105 $280.64 1
41108 $242.57 1
41110 $346.59 1
41112 $551.69 1
41113 $604.89 1
41114 $1,061.04 1
41115 $403.11 1
41116 $541.88 1
41120 $1,725.89 1
41130 $2,142.68 1
41135 $3,574.37 1
41140 $3,583.34 1
41145 $4,538.58 1
41150 $3,603.92 1
41153 $3,938.88 1
41155 $4,969.61 1
41250 $438.57 1
41251 $480.51 1
41252 $519.33 1
41500 $747.14 1
41510 $643.41 1
41512 $1,046.00 1
41520 $584.82 1
41530 $5,123.84 1
41800 $435.63 1
41805 $406.79 1
41806 $586.73 1
41820 $0.00 1
41821 $0.00 1
41822 $511.31 1
41823 $749.94 1
41825 $347.03 1
41826 $520.14 1
41827 $731.99 1
41828 $511.22 1
41830 $653.24 1
41850 $0.00 1
41870 $0.00 1
41872 $616.76 1
41874 $624.75 1
42000 $257.55 1
42100 $247.49 1
42104 $353.57 1
42106 $449.85 1
3/1/2015 70 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
42107 $758.97 1
42120 $1,641.50 1
42140 $411.74 1
42145 $1,168.32 1
42160 $380.19 1
42180 $398.94 1
42182 $525.89 1
42200 $1,408.58 1
42205 $1,473.21 1
42210 $1,796.34 1
42215 $1,193.34 1
42220 $891.02 1
42225 $1,446.20 1
42226 $1,472.15 1
42227 $1,381.17 1
42235 $1,207.65 1
42260 $1,429.43 1
42280 $272.52 1
42281 $335.04 1
42300 $342.60 1
42305 $715.26 1
42310 $264.75 1
42320 $407.84 1
42330 $380.63 1
42335 $613.17 1
42340 $765.90 1
42400 $171.65 1
42405 $489.36 1
42408 $741.51 1
42409 $544.19 1
42410 $1,035.15 1
42415 $1,757.55 1
42420 $1,975.04 1
42425 $1,388.90 1
42426 $2,252.97 1
42440 $684.42 1
42450 $744.33 1
42500 $712.80 1
42505 $914.30 1
42507 $845.18 1
42509 $1,397.12 1
42510 $1,038.24 1
42550 $216.74 1
42600 $785.07 1
42650 $136.49 1
3/1/2015 71 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
42660 $213.96 1
42665 $507.45 1
42700 $310.70 1
42720 $749.88 1
42725 $1,360.16 1
42800 $259.88 1
42804 $316.47 1
42806 $355.88 1
42808 $370.55 1
42809 $284.97 1
42810 $633.84 1
42815 $927.05 1
42820 $480.02 1
42821 $498.20 1
42825 $431.82 1
42826 $415.34 1
42830 $342.26 1
42831 $367.95 1
42835 $318.38 1
42836 $397.97 1
42842 $1,641.44 1
42844 $2,259.80 1
42845 $3,669.14 1
42860 $310.97 1
42870 $946.91 1
42890 $2,328.68 1
42892 $3,099.71 1
42894 $3,882.95 1
42900 $562.61 1
42950 $1,301.33 1
42953 $1,566.41 1
42955 $1,233.62 1
42960 $282.47 1
42961 $699.39 1
42962 $860.25 1
42970 $685.31 1
42971 $757.52 1
42972 $848.72 1
43020 $963.62 1
43030 $864.63 1
43045 $2,255.54 1
43100 $1,040.36 1
43101 $1,827.35 1
43107 $4,423.32 1
43108 $8,131.71 1
3/1/2015 72 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
43112 $4,670.94 1
43113 $7,611.69 1
43116 $8,726.94 1
43117 $4,271.54 1
43118 $6,625.64 1
43121 $4,988.39 1
43122 $4,416.33 1
43123 $8,231.28 1
43124 $6,653.28 1
43130 $1,319.24 1
43135 $2,586.44 1
43180 $936.59
43191 $254.67
43192 $283.10
43193 $282.54
43194 $319.86
43195 $308.97
43196 $326.64
43197 $303.39
43198 $341.75
43200 $434.49 1
43201 $444.87 1
43202 $582.23 1
43204 $242.07 1
43205 $249.08 1
43206 $532.34
43211 $419.30
43212 $337.37
43213 $1,970.33
43214 $336.45
43215 $659.69 1
43216 $674.10 1
43217 $721.71 1
43220 $1,803.17 1
43226 $612.51 1
43227 $637.97 1
43229 $1,167.50
43231 $650.09 1
43232 $771.81 1
43233 $396.68
43235 $505.22 1
43236 $627.92 1
43237 $344.45 1
43238 $411.08 1
43239 $643.38 1
3/1/2015 73 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
43240 $684.09 1
43241 $252.86 1
43242 $462.27 1
43243 $416.99 1
43244 $431.69 1
43245 $990.84 1
43246 $353.31 1
43247 $659.72 1
43248 $664.83 1
43249 $1,724.73 1
43250 $738.75 1
43251 $809.94 1
43252 $597.72
43253 $462.27
43254 $474.56
43255 $698.21 1
43257 $410.18 1
43259 $397.47 1
43260 $563.76 1
43261 $590.15 1
43262 $623.28 1
43263 $625.67 1
43264 $635.40 1
43265 $753.72 1
43266 $399.08
43270 $1,217.42
43273 $205.92 1
43274 $804.39
43275 $656.03
43276 $837.14
43277 $659.28
43278 $753.18
43279 $2,225.18 1
43280 $1,854.78 1
43281 $2,655.72 1
43282 $2,987.55 1
43283 $276.18 1
43300 $1,019.34 1
43305 $1,815.87 1
43310 $2,562.72 1
43312 $2,790.23 1
43313 $4,202.55 1
43314 $4,536.65 1
43320 $2,403.29 1
43325 $2,312.01 1
3/1/2015 74 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
43327 $1,400.33 1
43328 $1,966.35 1
43330 $2,294.45 1
43331 $2,330.22 1
43332 $1,996.47 1
43333 $2,173.56 1
43334 $2,169.54 1
43335 $2,337.39 1
43336 $2,624.40 1
43337 $2,819.91 1
43338 $201.90 1
43340 $2,371.22 1
43341 $2,545.97 1
43351 $2,388.59 1
43352 $1,850.82 1
43360 $4,106.04 1
43361 $4,445.54 1
43400 $2,620.52 1
43401 $2,705.24 1
43405 $2,646.05 1
43410 $1,803.75 1
43415 $4,429.92 1
43420 $1,692.99 1
43425 $2,511.14 1
43450 $343.58 1
43453 $1,547.99 1
43460 $366.54 1
43500 $1,337.73 1
43501 $2,312.01 1
43502 $2,626.07 1
43510 $1,620.95 1
43520 $1,174.80 1
43605 $1,428.65 1
43610 $1,681.79 1
43611 $2,091.92 1
43620 $3,388.43 1
43621 $3,910.16 1
43622 $3,993.84 1
43631 $2,491.01 1
43632 $3,495.47 1
43633 $3,302.25 1
43634 $3,670.14 1
43635 $194.96 1
43640 $2,017.02 1
43641 $2,065.58 1
3/1/2015 75 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
43644 $2,972.67 1
43645 $3,178.01 1
43651 $1,119.24 1
43652 $1,309.88 1
43653 $973.52 1
43752 $67.74 1
43753 $35.36 1
43754 $207.90 1
43755 $226.80 1
43756 $328.17 1
43757 $469.71 1
43760 $775.97 1
43761 $190.46 1
43770 $1,912.38 1
43771 $2,174.10 1
43772 $1,628.33 1
43773 $2,195.63 1
43774 $1,641.68 1
43800 $1,592.49 1
43810 $1,751.24 1
43820 $2,300.34 1
43825 $2,251.50 1
43830 $1,189.52 1
43831 $1,010.51 1
43832 $1,781.45 1
43840 $2,328.59 1
43843 $2,202.68 1
43845 $3,374.16 1
43846 $2,768.21 1
43847 $3,103.79 1
43848 $3,305.28 1
43850 $2,805.47 1
43855 $2,912.30 1
43860 $2,810.15 1
43865 $2,946.15 1
43870 $1,216.55 1
43880 $2,735.25 1
43886 $610.58 1
43887 $552.18 1
43888 $778.16 1
44005 $1,872.06 1
44010 $1,476.21 1
44015 $247.26 1
44020 $1,668.74 1
44021 $1,668.05 1
3/1/2015 76 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
44025 $1,685.03 1
44050 $1,600.46 1
44055 $2,549.42 1
44100 $186.59 1
44110 $1,455.20 1
44111 $1,678.76 1
44120 $2,095.62 1
44121 $417.95 1
44125 $2,016.45 1
44126 $4,254.68 1
44127 $4,923.54 1
44128 $423.45 1
44130 $2,243.97 1
44132 $0.00 1
44133 $0.00 1
44135 $0.00 1
44136 $0.00 1
44139 $208.86 1
44140 $2,295.66 1
44141 $3,116.40 1
44143 $2,846.24 1
44144 $3,029.85 1
44145 $2,826.75 1
44146 $3,611.84 1
44147 $3,330.12 1
44150 $3,184.11 1
44151 $3,694.85 1
44155 $3,520.14 1
44156 $3,972.87 1
44157 $3,749.93 1
44158 $3,506.87 1
44160 $2,120.57 1
44180 $1,570.11 1
44186 $1,115.34 1
44187 $1,871.61 1
44188 $2,077.05 1
44202 $2,370.05 1
44203 $423.45 1
44204 $2,621.09 1
44205 $2,278.53 1
44206 $2,991.42 1
44207 $3,097.55 1
44208 $3,379.97 1
44210 $3,008.31 1
44211 $3,652.16 1
3/1/2015 77 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
44212 $3,453.83 1
44213 $323.18 1
44227 $2,853.92 1
44300 $1,437.44 1
44310 $1,775.73 1
44312 $992.27 1
44314 $1,696.29 1
44316 $2,433.21 1
44320 $2,047.95 1
44322 $1,693.34 1
44340 $1,056.38 1
44345 $1,787.75 1
44346 $2,010.50 1
44360 $254.88 1
44361 $281.69 1
44363 $337.94 1
44364 $359.46 1
44365 $309.51 1
44366 $422.64 1
44369 $432.23 1
44370 $467.67 1
44372 $422.45 1
44373 $338.67 1
44376 $494.91 1
44377 $525.23 1
44378 $671.24 1
44379 $715.61 1
44380 $112.10 1
44382 $133.28 1
44385 $425.36 1
44386 $565.91 1
44388 $568.46 1
44389 $635.16 1
44390 $743.79 1
44391 $801.00 1
44392 $706.07 1
44394 $799.91 1
44500 $39.90 1
44602 $2,422.37 1
44603 $2,779.34 1
44604 $1,813.44 1
44605 $2,232.24 1
44615 $1,829.84 1
44620 $1,477.23 1
44625 $1,727.82 1
3/1/2015 78 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
44626 $2,742.59 1
44640 $2,395.62 1
44650 $2,485.44 1
44660 $2,250.35 1
44661 $2,637.09 1
44680 $1,824.08 1
44700 $1,722.92 1
44701 $288.84 1
44720 $477.42 1
44721 $667.13 1
44800 $1,302.84 1
44820 $1,454.94 1
44850 $1,283.22 1
44900 $1,328.87 1
44950 $1,098.23 1
44955 $143.90 1
44960 $1,495.86 1
44970 $1,023.69 1
45000 $702.56 1
45005 $442.14 1
45020 $957.59 1
45100 $499.26 1
45108 $625.26 1
45110 $3,125.04 1
45111 $1,845.02 1
45112 $3,176.94 1
45113 $3,128.96 1
45114 $3,132.24 1
45116 $2,568.71 1
45119 $3,285.29 1
45120 $2,736.14 1
45121 $2,727.44 1
45123 $1,882.73 1
45126 $4,502.48 1
45130 $1,823.30 1
45135 $2,363.96 1
45136 $2,984.07 1
45150 $586.02 1
45160 $1,753.43 1
45171 $1,002.11 1
45172 $1,351.74 1
45190 $1,156.02 1
45300 $198.12 1
45303 $1,531.79 1
45305 $314.31 1
3/1/2015 79 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
45307 $360.92 1
45308 $356.79 1
45309 $354.42 1
45315 $405.48 1
45317 $390.99 1
45320 $400.17 1
45321 $180.56 1
45327 $203.36 1
45330 $219.96 1
45331 $260.72 1
45332 $467.39 1
45333 $475.11 1
45334 $268.83 1
45335 $438.65 1
45337 $235.73 1
45338 $510.68 1
45340 $773.63 1
45341 $255.78 1
45342 $387.68 1
45378 $625.61 1
45379 $806.10 1
45380 $745.20 2
45381 $747.42 1
45382 $966.71 1
45384 $749.37 1
45385 $842.48 1
45386 $1,065.74 1
45391 $483.95 1
45392 $616.74 1
45395 $3,334.31 1
45397 $3,621.42 1
45400 $1,908.68 1
45402 $2,560.26 1
45500 $862.13 1
45505 $992.54 1
45520 $251.57 1
45540 $1,783.58 1
45541 $1,584.83 1
45550 $2,454.57 1
45560 $1,135.35 1
45562 $1,959.36 1
45563 $2,826.95 1
45800 $2,125.52 1
45805 $2,281.59 1
45820 $1,841.36 1
3/1/2015 80 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
45825 $2,389.22 1
45900 $343.52 1
45905 $282.51 1
45910 $323.51 1
45915 $537.11 1
45990 $181.95 1
46020 $452.90 1
46030 $226.83 1
46040 $880.10 1
46045 $726.63 1
46050 $324.65 1
46060 $791.37 1
46070 $352.17 1
46080 $405.42 1
46083 $283.80 1
46200 $725.01 1
46220 $334.35 1
46221 $436.82 1
46230 $444.48 1
46250 $757.44 1
46255 $831.23 1
46257 $700.31 1
46258 $788.15 1
46260 $795.39 1
46261 $866.28 1
46262 $921.83 1
46270 $833.69 1
46275 $880.02 1
46280 $777.92 1
46285 $870.27 1
46288 $913.89 1
46320 $298.40 1
46500 $385.61 1
46505 $465.30 1
46600 $140.90 1
46604 $990.83 1
46606 $360.26 1
46608 $384.39 1
46610 $364.71 1
46611 $281.64 1
46612 $444.45 1
46614 $207.20 1
46615 $236.03 1
46700 $1,085.58 1
46705 $775.19 1
3/1/2015 81 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
46706 $297.45 1
46707 $790.79 1
46710 $1,726.86 1
46712 $3,227.97 1
46715 $917.28 1
46716 $1,716.92 1
46730 $3,353.06 1
46735 $3,264.56 1
46740 $3,668.72 1
46742 $3,589.37 1
46744 $6,055.17 1
46746 $5,711.67 1
46748 $6,131.30 1
46750 $1,246.41 1
46751 $922.79 1
46753 $949.17 1
46754 $471.32 1
46760 $1,801.29 1
46761 $1,528.77 1
46762 $1,520.88 1
46900 $391.14 1
46910 $412.50 1
46916 $365.91 1
46917 $717.24 1
46922 $431.28 1
46924 $858.30 1
46930 $332.34 1
46940 $372.38 1
46942 $351.66 1
46945 $499.83 1
46946 $512.24 1
46947 $640.76 1
47000 $575.67 1
47001 $180.30 1
47010 $2,055.03 1
47015 $1,991.66 1
47100 $1,439.54 1
47120 $3,998.48 1
47122 $5,911.79 1
47125 $5,286.47 1
47130 $5,686.64 1
47135 $8,400.08 1
47136 $7,224.54 1
47140 $5,182.16 1
47141 $7,339.49 1
3/1/2015 82 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
47142 $8,096.06 1
47146 $573.38 1
47147 $662.54 1
47300 $1,940.33 1
47350 $2,344.25 1
47360 $3,215.18 1
47361 $5,205.47 1
47362 $2,489.27 1
47370 $2,138.00 1
47371 $2,158.61 1
47380 $2,465.54 1
47381 $2,199.59 1
47382 $7,899.33 1
47383 $11,924.10
47400 $3,712.02 1
47420 $2,298.59 1
47425 $2,346.54 1
47460 $2,175.63 1
47480 $1,490.91 1
47490 $541.02 1
47500 $158.51 1
47505 $61.01 1
47510 $770.70 1
47511 $944.15 1
47525 $820.61 1
47530 $2,179.59 1
47550 $286.94 1
47552 $518.16 1
47553 $513.80 1
47554 $806.21 1
47555 $610.17 1
47556 $692.15 1
47560 $466.38 1
47561 $510.47 1
47562 $1,122.38 1
47563 $1,219.62 1
47564 $1,900.79 1
47570 $1,329.98 1
47600 $1,825.40 1
47605 $1,922.66 1
47610 $2,151.60 1
47612 $2,178.02 1
47620 $2,371.82 1
47630 $878.55 1
47700 $1,800.47 1
3/1/2015 83 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
47701 $2,983.68 1
47711 $2,660.73 1
47712 $3,442.16 1
47715 $2,282.60 1
47720 $1,977.20 1
47721 $2,324.24 1
47740 $2,252.91 1
47741 $2,535.68 1
47760 $3,879.54 1
47765 $5,243.46 1
47780 $4,248.48 1
47785 $5,591.42 1
47800 $2,712.59 1
47801 $1,665.33 1
47802 $2,621.24 1
47900 $2,354.99 1
48000 $3,238.62 1
48001 $3,984.83 1
48020 $2,020.71 1
48100 $1,503.86 1
48102 $852.14 1
48105 $4,895.28 1
48120 $1,895.70 1
48140 $2,682.87 1
48145 $2,810.94 1
48146 $3,226.28 1
48148 $2,143.80 1
48150 $5,351.06 1
48152 $4,971.00 1
48153 $5,320.95 1
48154 $4,993.83 1
48155 $3,108.47 1
48400 $186.48 1
48500 $1,971.03 1
48510 $1,878.15 1
48520 $1,871.27 1
48540 $2,255.45 1
48545 $2,311.32 1
48547 $3,090.00 1
48548 $2,868.72 1
48552 $410.43 1
48554 $4,348.65 1
48556 $2,176.43 1
49000 $1,312.91 1
49002 $1,789.26 1
3/1/2015 84 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
49010 $1,590.57 1
49020 $2,723.58 1
49040 $1,709.49 1
49060 $1,874.72 1
49062 $1,262.61 1
49082 $308.63 1
49083 $464.48 1
49084 $187.52 1
49180 $261.99 1
49203 $2,040.42 1
49204 $2,611.23 1
49205 $3,002.81 1
49215 $3,728.22 1
49220 $1,666.65 1
49250 $991.82 1
49255 $1,338.66 1
49320 $547.73 1
49321 $582.23 1
49322 $618.32 1
49323 $1,079.52 1
49324 $665.12 1
49325 $710.16 1
49326 $328.32 1
49327 $226.11 1
49400 $222.33 1
49402 $1,460.64 1
49405 $1,383.36
49406 $1,385.01
49407 $1,160.52
49411 $870.32 1
49412 $142.11 1
49418 $2,261.01 1
49419 $750.63 1
49421 $398.06 1
49422 $647.49 1
49423 $866.03 1
49424 $231.15 1
49425 $1,231.34 1
49426 $1,044.78 1
49427 $74.24 1
49428 $950.43 1
49429 $786.47 1
49435 $206.43 1
49436 $317.07 1
49440 $1,644.95 1
3/1/2015 85 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
49441 $1,845.80 1
49442 $1,528.86 1
49446 $1,578.41 1
49450 $1,050.87 1
49451 $1,146.96 1
49452 $1,420.22 1
49460 $1,153.91 1
49465 $256.05 1
49491 $1,282.16 1
49492 $1,381.70 1
49495 $595.80 1
49496 $879.69 1
49500 $696.27 1
49501 $1,034.69 1
49505 $884.33 1
49507 $996.29 1
49520 $1,077.12 1
49521 $1,221.83 1
49525 $973.89 1
49540 $1,148.27 1
49550 $980.24 1
49553 $1,075.76 1
49555 $1,014.39 1
49557 $1,233.75 1
49560 $1,256.28 1
49561 $1,591.85 1
49565 $1,309.31 1
49566 $1,605.05 1
49568 $462.33 1
49570 $702.02 1
49572 $876.92 1
49580 $561.33 1
49582 $820.31 1
49585 $753.80 1
49587 $805.67 1
49590 $974.67 1
49600 $1,190.03 1
49605 $8,534.72 1
49606 $1,948.86 1
49610 $1,175.97 1
49611 $868.77 1
49650 $725.82 1
49651 $945.14 1
49652 $1,269.72 1
49653 $1,585.01 1
3/1/2015 86 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
49654 $1,444.59 1
49655 $1,765.50 1
49656 $1,571.70 1
49657 $2,261.45 1
49900 $1,382.91 1
49904 $2,406.93 1
49905 $604.19 1
50010 $1,242.12 1
50020 $1,648.95 1
50040 $1,511.64 1
50045 $1,519.34 1
50060 $1,859.39 1
50065 $1,972.98 1
50070 $1,933.41 1
50075 $2,378.28 1
50080 $1,418.15 1
50081 $2,083.40 1
50100 $1,848.45 1
50120 $1,548.17 1
50125 $1,602.78 1
50130 $1,685.31 1
50135 $1,831.79 1
50200 $972.96 1
50205 $1,277.24 1
50220 $1,722.51 1
50225 $1,968.89 1
50230 $2,099.09 1
50234 $2,125.59 1
50236 $2,395.28 1
50240 $2,161.05 1
50250 $1,983.83 1
50280 $1,563.63 1
50290 $1,463.34 1
50320 $2,558.66 1
50327 $373.37 1
50328 $327.03 1
50329 $317.34 1
50340 $1,612.25 1
50360 $4,129.85 1
50365 $4,818.87 1
50370 $2,033.61 1
50380 $3,412.86 1
50382 $1,876.29 1
50384 $1,494.65 1
50385 $1,803.62 1
3/1/2015 87 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
50386 $1,174.43 1
50387 $857.79 1
50389 $468.51 1
50390 $159.06 1
50391 $197.91 1
50392 $293.40 1
50393 $356.96 1
50394 $164.87 1
50395 $294.14 1
50396 $194.39 1
50398 $787.22 1
50400 $1,885.94 1
50405 $2,279.55 1
50500 $1,881.59 1
50520 $1,689.65 1
50525 $2,478.77 1
50526 $2,286.47 1
50540 $1,872.03 1
50541 $1,499.01 1
50542 $1,901.43 1
50543 $2,426.19 1
50544 $2,032.79 1
50545 $2,188.77 1
50546 $1,968.90 1
50547 $2,716.80 1
50548 $2,201.18 1
50551 $581.66 1
50553 $622.65 1
50555 $667.62 1
50557 $678.53 1
50561 $768.29 1
50562 $949.44 1
50570 $804.72 1
50572 $870.81 1
50574 $925.34 1
50575 $1,169.69 1
50576 $923.18 1
50580 $994.70 1
50590 $1,157.33 1
50592 $4,950.20 1
50593 $7,292.70 1
50600 $1,531.85 1
50605 $1,653.87 1
50610 $1,542.03 1
50620 $1,474.85 1
3/1/2015 88 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
50630 $1,455.87 1
50650 $1,689.18 1
50660 $1,865.16 1
50684 $167.63 1
50686 $252.41 1
50688 $129.17 1
50690 $157.40 1
50700 $1,509.24 1
50715 $2,051.79 1
50722 $1,690.94 1
50725 $1,823.37 1
50727 $829.38 1
50728 $1,135.92 1
50740 $2,099.76 1
50750 $1,881.59 1
50760 $1,870.50 1
50770 $1,881.59 1
50780 $1,825.98 1
50782 $1,826.67 1
50783 $1,839.71 1
50785 $1,985.45 1
50800 $1,515.75 1
50810 $2,395.04 1
50815 $1,993.70 1
50820 $2,157.95 1
50825 $2,700.96 1
50830 $2,942.16 1
50840 $2,003.81 1
50845 $2,034.99 1
50860 $1,541.93 1
50900 $1,383.93 1
50920 $1,436.27 1
50930 $1,798.92 1
50940 $1,445.84 1
50945 $1,588.55 1
50947 $2,269.91 1
50948 $2,081.96 1
50951 $608.16 1
50953 $644.34 1
50955 $688.80 1
50957 $695.37 1
50961 $626.24 1
50970 $608.45 1
50972 $587.87 1
50974 $774.57 1
3/1/2015 89 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
50976 $763.55 1
50980 $585.17 1
51020 $759.09 1
51030 $763.13 1
51040 $467.99 1
51045 $807.29 1
51050 $766.37 1
51060 $944.54 1
51065 $940.67 1
51080 $662.16 1
51100 $99.83 1
51101 $198.87 1
51102 $363.54 1
51500 $1,035.00 1
51520 $966.21 1
51525 $1,402.10 1
51530 $1,275.42 1
51535 $1,269.77 1
51550 $1,583.82 1
51555 $2,081.49 1
51565 $2,132.99 1
51570 $2,420.21 1
51575 $2,976.47 1
51580 $3,095.16 1
51585 $3,447.32 1
51590 $3,161.00 1
51595 $3,576.44 1
51596 $3,838.13 1
51597 $3,757.88 1
51600 $289.14 1
51605 $61.38 1
51610 $170.28 1
51700 $132.63 1
51701 $86.10 1
51702 $110.42 1
51703 $206.81 1
51705 $144.75 1
51710 $204.98 1
51715 $467.01 1
51720 $174.71 1
51725 $296.42 1
51726 $413.57 1
51727 $490.08 1
51728 $493.20 1
51729 $535.65 1
3/1/2015 90 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
51736 $24.77 1
51741 $25.32 1
51784 $303.56 1
51785 $402.24 1
51792 $331.52 1
51797 $175.85 1
51798 $29.64 1
51800 $1,703.99 1
51820 $2,077.91 1
51840 $1,070.04 1
51841 $1,260.74 1
51845 $953.24 1
51860 $1,231.50 1
51865 $1,474.92 1
51880 $767.61 1
51900 $1,356.60 1
51920 $1,242.75 1
51925 $1,910.57 1
51940 $2,679.45 1
51960 $2,269.05 1
51980 $1,159.97 1
51990 $1,226.45 1
51992 $1,380.14 1
52000 $326.36 1
52001 $597.56 1
52005 $420.96 1
52007 $699.80 1
52010 $579.56 1
52204 $583.02 1
52214 $1,035.81 1
52224 $1,087.04 1
52234 $402.41 1
52235 $472.71 1
52240 $642.09 1
52250 $392.31 1
52260 $345.56 1
52265 $579.51 1
52270 $563.91 1
52275 $761.18 1
52276 $433.11 1
52277 $530.28 1
52281 $432.32 1
52282 $553.29 1
52283 $442.16 1
52285 $446.78 1
3/1/2015 91 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
52287 $494.75 1
52290 $399.71 1
52300 $459.50 1
52301 $476.30 1
52305 $456.18 1
52310 $387.84 1
52315 $660.92 1
52317 $1,272.75 1
52318 $776.55 1
52320 $403.77 1
52325 $525.89 1
52327 $430.05 1
52330 $783.27 1
52332 $768.99 1
52334 $418.85 1
52341 $464.39 1
52342 $507.03 1
52343 $564.27 1
52344 $606.36 1
52345 $646.25 1
52346 $733.71 1
52351 $495.96 1
52352 $581.63 1
52353 $642.09 1
52354 $682.35 1
52355 $764.70 1
52356 $680.70
52400 $779.57 1
52402 $437.09 1
52441 $1,939.77
52442 $1,477.59
52450 $762.08 1
52500 $793.53 1
52601 $1,378.05 1
52630 $648.80 1
52640 $509.49 1
52647 $2,803.41 1
52648 $2,886.56 1
52649 $1,340.33 1
52700 $715.59 1
53000 $241.50 1
53010 $476.52 1
53020 $157.70 1
53025 $110.87 1
53040 $637.19 1
3/1/2015 92 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
53060 $298.38 1
53080 $682.10 1
53085 $1,055.97 1
53200 $255.08 1
53210 $1,258.28 1
53215 $1,513.95 1
53220 $742.97 1
53230 $987.56 1
53235 $1,028.66 1
53240 $689.36 1
53250 $642.21 1
53260 $325.07 1
53265 $351.72 1
53270 $332.07 1
53275 $427.91 1
53400 $1,305.48 1
53405 $1,423.98 1
53410 $1,597.13 1
53415 $1,843.58 1
53420 $1,369.73 1
53425 $1,526.30 1
53430 $1,573.77 1
53431 $1,882.76 1
53440 $1,226.45 1
53442 $1,273.56 1
53444 $1,291.95 1
53445 $1,225.92 1
53446 $1,043.90 1
53447 $1,316.48 1
53448 $2,087.73 1
53449 $994.74 1
53450 $665.19 1
53460 $743.34 1
53500 $1,221.50 1
53502 $791.49 1
53505 $790.38 1
53510 $1,026.50 1
53515 $1,296.69 1
53520 $903.87 1
53600 $134.12 1
53601 $129.53 1
53605 $106.20 1
53620 $186.30 1
53621 $175.14 1
53660 $111.36 1
3/1/2015 93 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
53661 $109.14 1
53665 $63.96 1
53850 $3,254.13 1
53852 $3,003.96 1
53855 $1,211.00 1
53860 $2,448.48 1
54000 $236.63 1
54001 $295.97 1
54015 $498.06 1
54050 $211.52 1
54055 $190.22 1
54056 $226.43 1
54057 $215.57 1
54060 $286.44 1
54065 $349.91 1
54100 $316.77 1
54105 $424.41 1
54110 $1,015.14 1
54111 $1,305.39 1
54112 $1,528.65 1
54115 $730.64 1
54120 $1,029.72 1
54125 $1,323.95 1
54130 $1,945.59 1
54135 $2,468.04 1
54150 $247.91 1
54160 $351.29 1
54161 $319.82 1
54162 $410.96 1
54163 $354.06 1
54164 $312.89 1
54200 $170.55 1
54205 $864.36 1
54220 $329.00 1
54230 $155.82 1
54231 $226.13 1
54235 $145.76 1
54240 $158.27 1
54250 $194.54 1
54300 $1,044.71 1
54304 $1,221.80 1
54308 $1,163.21 1
54312 $1,332.32 1
54316 $1,627.46 1
54318 $1,151.22 1
3/1/2015 94 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
54322 $1,271.85 1
54324 $1,580.58 1
54326 $1,541.85 1
54328 $1,531.74 1
54332 $1,653.45 1
54336 $1,939.68 1
54340 $927.06 1
54344 $1,544.54 1
54348 $1,639.61 1
54352 $2,311.52 1
54360 $1,174.73 1
54380 $1,301.91 1
54385 $1,711.76 1
54390 $2,004.56 1
54400 $861.65 1
54401 $1,062.69 1
54405 $1,316.82 1
54406 $1,190.39 1
54408 $1,286.88 1
54410 $1,398.99 1
54411 $1,672.28 1
54415 $861.20 1
54416 $1,153.02 1
54417 $1,464.53 1
54420 $1,146.27 1
54430 $1,041.06 1
54435 $675.99 1
54450 $112.53 1
54500 $122.18 1
54505 $340.34 1
54512 $884.40 1
54520 $533.15 1
54522 $960.06 1
54530 $821.36 1
54535 $1,213.10 1
54550 $800.46 1
54560 $1,071.32 1
54600 $735.05 1
54620 $488.55 1
54640 $783.14 1
54650 $1,157.31 1
54660 $579.39 1
54670 $657.29 1
54680 $1,282.07 1
54690 $1,070.78 1
3/1/2015 95 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
54692 $1,237.80 1
54700 $352.16 1
54800 $206.70 1
54830 $605.48 1
54840 $520.86 1
54860 $680.37 1
54861 $921.00 1
54865 $581.55 1
54900 $1,295.30 1
54901 $1,707.03 1
55000 $188.45 1
55040 $551.69 1
55041 $831.18 1
55060 $619.61 1
55100 $346.44 1
55110 $630.92 1
55120 $580.53 1
55150 $804.02 1
55175 $589.13 1
55180 $1,123.49 1
55200 $693.83 1
55250 $609.20 1
55300 $305.52 1
55400 $810.81 1
55450 $573.78 1
55500 $651.69 1
55520 $764.93 1
55530 $574.59 1
55535 $698.94 1
55540 $940.85 1
55550 $695.61 1
55600 $684.14 1
55605 $845.78 1
55650 $1,165.92 1
55680 $560.57 1
55700 $347.90 1
55705 $434.28 1
55706 $605.96 1
55720 $733.61 1
55725 $1,030.37 1
55801 $1,780.95 1
55810 $2,156.49 1
55812 $2,626.02 1
55815 $2,878.31 1
55821 $1,424.19 1
3/1/2015 96 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
55831 $1,542.12 1
55840 $1,911.20 1
55842 $1,908.80 1
55845 $2,225.40 1
55860 $1,426.28 1
55862 $1,771.80 1
55865 $2,177.78 1
55866 $2,827.82 1
55870 $283.26 1
55873 $11,111.07 1
55875 $1,239.74 1
55876 $216.51 1
55920 $723.11 1
56405 $177.68 1
56420 $195.80 1
56440 $295.65 1
56441 $234.81 1
56442 $76.05 1
56501 $210.68 1
56515 $367.88 1
56605 $133.01 1
56606 $60.80 1
56620 $859.47 1
56625 $1,052.43 1
56630 $1,557.29 1
56631 $1,980.60 1
56632 $2,325.78 1
56633 $2,044.02 1
56634 $2,222.91 1
56637 $2,560.44 1
56640 $2,608.77 1
56700 $301.62 1
56740 $492.93 1
56800 $391.92 1
56805 $1,854.27 1
56810 $422.46 1
56820 $182.63 1
56821 $240.66 1
57000 $298.76 1
57010 $699.69 1
57020 $149.49 1
57022 $272.15 1
57023 $504.24 1
57061 $183.50 1
57065 $319.76 1
3/1/2015 97 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
57100 $145.37 1
57105 $221.46 1
57106 $813.12 1
57107 $2,435.42 1
57109 $2,983.67 1
57110 $1,451.15 1
57111 $2,599.85 1
57112 $3,194.18 1
57120 $824.22 1
57130 $285.30 1
57135 $309.95 1
57150 $72.03 1
57155 $679.76 1
57156 $312.00 1
57160 $122.48 1
57170 $97.59 1
57180 $226.43 1
57200 $493.13 1
57210 $596.93 1
57220 $515.46 1
57230 $637.59 1
57240 $1,088.78 1
57250 $1,097.61 1
57260 $1,353.39 1
57265 $1,481.88 1
57267 $417.63 1
57268 $783.20 1
57270 $1,296.45 1
57280 $1,551.33 1
57282 $808.71 1
57283 $1,119.26 1
57284 $1,324.67 1
57285 $1,090.26 1
57287 $1,100.58 1
57288 $1,159.94 1
57289 $1,187.40 1
57291 $856.97 1
57292 $1,322.79 1
57295 $772.31 1
57296 $1,517.52 1
57300 $935.82 1
57305 $1,570.22 1
57307 $1,833.99 1
57308 $1,034.09 1
57310 $747.00 1
3/1/2015 98 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
57311 $851.21 1
57320 $858.62 1
57330 $1,204.79 1
57335 $1,778.46 1
57400 $216.36 1
57410 $177.44 1
57415 $259.28 1
57420 $193.50 1
57421 $256.98 1
57423 $1,486.26 1
57425 $1,574.03 1
57426 $1,369.10 1
57452 $176.55 1
57454 $247.58 1
57455 $231.56 1
57456 $217.41 1
57460 $450.60 1
57461 $511.86 1
57500 $204.47 1
57505 $163.61 1
57510 $211.26 1
57511 $234.56 1
57513 $235.67 1
57520 $496.95 1
57522 $424.74 1
57530 $568.53 1
57531 $3,148.89 1
57540 $1,301.49 1
57545 $1,330.74 1
57550 $656.31 1
57555 $972.35 1
57556 $918.60 1
57558 $201.42 1
57700 $498.96 1
57720 $493.76 1
57800 $98.37 1
58100 $175.22 1
58110 $78.12 1
58120 $418.07 1
58140 $1,509.17 1
58145 $892.80 1
58146 $1,868.07 1
58150 $1,670.39 1
58152 $2,048.07 1
58180 $1,577.46 1
3/1/2015 99 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
58200 $2,294.72 1
58210 $3,104.52 1
58240 $4,899.92 1
58260 $1,340.97 1
58262 $1,499.01 1
58263 $1,604.46 1
58267 $1,716.78 1
58270 $1,432.65 1
58275 $1,607.16 1
58280 $1,704.50 1
58285 $2,438.90 1
58290 $1,862.85 1
58291 $2,018.49 1
58292 $2,129.09 1
58293 $2,213.69 1
58294 $1,972.73 1
58301 $152.43 1
58321 $121.88 1
58322 $137.61 1
58323 $25.04 1
58340 $187.88 1
58345 $451.26 1
58346 $704.63 1
58350 $154.80 1
58353 $1,576.64 1
58356 $2,943.54 1
58400 $709.70 1
58410 $1,301.04 1
58520 $1,297.88 1
58540 $1,471.77 1
58541 $1,162.25 1
58542 $1,330.65 1
58543 $1,344.45 1
58544 $1,475.61 1
58545 $1,485.80 1
58546 $1,822.70 1
58548 $3,201.11 1
58550 $1,432.05 1
58552 $1,618.02 1
58553 $1,842.20 1
58554 $2,172.15 1
58555 $484.97 1
58558 $636.06 1
58559 $555.14 1
58560 $627.26 1
3/1/2015 100 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
58561 $889.95 1
58562 $660.72 1
58563 $2,606.79 1
58565 $2,930.42 1
58570 $1,268.22 1
58571 $1,489.23 1
58572 $1,662.41 1
58573 $2,008.13 1
58600 $587.76 1
58605 $532.62 1
58611 $125.81 1
58615 $393.93 1
58660 $1,102.05 1
58661 $1,065.05 1
58662 $1,160.43 1
58670 $590.16 1
58671 $588.32 1
58672 $1,190.70 1
58673 $1,295.49 1
58700 $1,289.85 1
58720 $1,215.81 1
58740 $1,454.63 1
58750 $1,478.69 1
58752 $1,382.10 1
58760 $1,311.32 1
58770 $1,380.48 1
58800 $511.59 1
58805 $652.13 1
58820 $502.08 1
58822 $1,132.46 1
58825 $1,285.04 1
58900 $666.39 1
58920 $1,156.73 1
58925 $1,231.22 1
58940 $870.50 1
58943 $1,970.18 1
58950 $1,900.77 1
58951 $2,439.02 1
58952 $2,771.40 1
58953 $3,424.28 1
58954 $3,713.64 1
58956 $2,325.56 1
58957 $2,682.17 1
58958 $2,938.23 1
58960 $1,645.16 1
3/1/2015 101 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
58970 $359.99 1
58976 $387.15 1
59000 $209.82 1
59001 $314.03 1
59012 $354.74 1
59015 $266.36 1
59020 $117.87 1
59025 $80.16 1
59030 $161.60 1
59050 $89.15 1
59051 $73.19 1
59070 $694.67 1
59072 $751.67 1
59074 $668.15 1
59076 $751.67 1
59100 $1,444.82 1
59120 $1,374.33 1
59121 $1,375.70 1
59130 $1,347.27 1
59135 $1,330.59 1
59136 $1,522.76 1
59140 $689.28 1
59150 $1,332.98 1
59151 $1,294.97 1
59160 $347.19 1
59200 $120.80 1
59300 $327.89 1
59320 $265.53 1
59325 $422.78 1
59350 $493.16 1
59400 $3,600.06 1
59409 $1,422.95 1
59410 $1,814.19 1
59412 $180.98 1
59414 $160.70 1
59425 $774.68 1
59426 $1,384.01 1
59430 $314.34 1
59510 $3,984.54 1
59514 $1,600.34 1
59515 $2,195.78 1
59525 $850.79 1
59610 $3,782.67 1
59612 $1,603.34 1
59614 $1,992.74 1
3/1/2015 102 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
59618 $4,044.63 1
59620 $1,660.41 1
59622 $2,256.77 1
59812 $542.03 1
59820 $643.02 1
59821 $649.25 1
59830 $751.38 1
59840 $371.46 1
59841 $656.43 1
59850 $556.32 1
59851 $683.61 1
59852 $803.91 1
59855 $715.56 1
59856 $843.15 1
59857 $829.01 1
59866 $347.46 1
59870 $804.81 1
59871 $231.12 1
60000 $258.90 1
60100 $182.72 1
60200 $1,102.89 1
60210 $1,188.02 1
60212 $1,698.27 1
60220 $1,184.78 1
60225 $1,568.18 1
60240 $1,549.73 1
60252 $2,226.69 1
60254 $2,819.16 1
60260 $1,838.75 1
60270 $2,316.63 1
60271 $1,780.50 1
60280 $731.52 1
60281 $969.90 1
60300 $190.11 1
60500 $1,630.92 1
60502 $2,183.13 1
60505 $2,337.87 1
60512 $417.21 1
60520 $1,785.98 1
60521 $1,930.91 1
60522 $2,341.53 1
60540 $1,778.57 1
60545 $2,055.74 1
60600 $2,413.11 1
60605 $3,425.33 1
3/1/2015 103 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
60650 $2,016.27 1
61000 $196.46 1
61001 $131.10 1
61020 $186.27 1
61026 $172.74 1
61050 $140.63 1
61055 $204.66 1
61070 $97.07 1
61105 $834.00 1
61107 $583.05 1
61108 $1,648.01 1
61120 $1,358.58 1
61140 $2,291.58 1
61150 $2,491.17 1
61151 $1,820.81 1
61154 $2,302.71 1
61156 $2,291.19 1
61210 $687.92 1
61215 $900.74 1
61250 $1,583.61 1
61253 $1,704.80 1
61304 $2,984.10 1
61305 $3,704.97 1
61312 $3,810.77 1
61313 $3,618.27 1
61314 $3,326.90 1
61315 $3,786.03 1
61316 $163.80 1
61320 $3,461.78 1
61321 $3,930.02 1
61322 $4,355.15 1
61323 $4,413.11 1
61330 $2,477.94 1
61332 $2,864.82 1
61333 $2,927.63 1
61340 $2,656.56 1
61343 $4,017.00 1
61345 $3,765.87 1
61450 $3,552.42 1
61458 $3,672.83 1
61460 $3,885.56 1
61480 $3,586.08 1
61500 $2,336.40 1
61501 $2,049.72 1
61510 $3,986.82 1
3/1/2015 104 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
61512 $4,666.41 1
61514 $3,495.75 1
61516 $3,399.26 1
61517 $164.19 1
61518 $5,038.08 1
61519 $5,409.53 1
61520 $6,833.25 1
61521 $5,801.99 1
61522 $4,040.49 1
61524 $3,843.23 1
61526 $6,770.93 1
61530 $5,706.66 1
61531 $2,233.98 1
61533 $2,798.15 1
61534 $3,025.40 1
61535 $1,822.83 1
61536 $4,774.40 1
61537 $4,510.85 1
61538 $4,949.06 1
61539 $4,365.39 1
61540 $4,031.28 1
61541 $3,968.93 1
61543 $4,012.88 1
61544 $3,512.09 1
61545 $5,890.83 1
61546 $4,266.98 1
61548 $2,823.15 1
61550 $1,627.68 1
61552 $1,795.89 1
61556 $3,138.71 1
61557 $3,086.78 1
61558 $3,107.48 1
61559 $4,407.62 1
61563 $3,655.22 1
61564 $4,445.48 1
61566 $4,154.81 1
61567 $4,381.35 1
61570 $3,442.23 1
61571 $3,668.70 1
61575 $4,636.74 1
61576 $5,671.55 1
61580 $4,274.79 1
61581 $4,361.52 1
61582 $5,398.28 1
61583 $5,218.44 1
3/1/2015 105 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
61584 $5,145.74 1
61585 $5,862.77 1
61586 $4,320.80 1
61590 $5,134.74 1
61591 $5,341.94 1
61592 $5,741.99 1
61595 $4,052.87 1
61596 $4,057.58 1
61597 $5,297.22 1
61598 $5,158.44 1
61600 $3,624.44 1
61601 $4,310.64 1
61605 $3,623.96 1
61606 $5,561.64 1
61607 $4,632.95 1
61608 $5,906.79 1
61610 $3,485.15 1
61611 $601.20 1
61612 $2,256.20 1
61613 $6,022.59 1
61615 $4,908.90 1
61616 $5,935.91 1
61618 $2,313.05 1
61619 $2,518.61 1
61623 $984.74 1
61624 $2,001.68 1
61626 $1,454.63 1
61630 $2,305.46 1
61635 $2,408.36 1
61680 $4,113.63 1
61682 $7,715.16 1
61684 $5,267.13 1
61686 $8,366.46 1
61690 $4,035.29 1
61692 $6,798.81 1
61697 $7,787.93 1
61698 $8,619.65 1
61700 $6,272.72 1
61702 $7,479.80 1
61703 $2,495.39 1
61705 $4,820.73 1
61708 $4,712.46 1
61710 $3,979.95 1
61711 $4,761.65 1
61720 $2,333.63 1
3/1/2015 106 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
61735 $2,926.68 1
61750 $2,571.78 1
61751 $2,517.51 1
61760 $2,912.99 1
61770 $2,996.01 1
61781 $436.68 1
61782 $294.98 1
61783 $426.38 1
61790 $1,595.96 1
61791 $2,061.08 1
61796 $1,853.24 1
61797 $413.73 1
61798 $2,536.95 1
61799 $568.98 1
61800 $285.39 1
61850 $1,798.40 1
61860 $2,885.96 1
61863 $2,749.86 1
61864 $533.97 1
61867 $4,180.95 1
61868 $931.41 1
61870 $2,172.05 1
61880 $1,017.15 1
61885 $909.63 1
61886 $1,505.73 1
61888 $710.27 1
62000 $1,885.08 1
62005 $2,334.72 1
62010 $2,816.79 1
62100 $2,895.95 1
62115 $2,286.27 1
62117 $3,625.73 1
62120 $2,746.65 1
62121 $2,791.28 1
62140 $1,856.52 1
62141 $2,060.97 1
62142 $1,594.14 1
62143 $1,892.30 1
62145 $2,565.32 1
62146 $2,255.39 1
62147 $2,685.47 1
62148 $237.38 1
62160 $356.52 1
62161 $2,793.74 1
62162 $3,481.16 1
3/1/2015 107 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
62163 $2,241.33 1
62164 $3,845.46 1
62165 $2,734.52 1
62180 $2,947.29 1
62190 $952.94 1
62192 $1,767.68 1
62194 $876.18 1
62200 $2,532.15 1
62201 $2,192.99 1
62220 $1,858.13 1
62223 $1,886.76 1
62225 $941.06 1
62230 $1,524.27 1
62252 $144.62 1
62256 $1,079.60 1
62258 $2,036.97 1
62263 $1,001.91 1
62264 $665.51 1
62267 $400.98 1
62268 $429.86 1
62269 $440.82 1
62270 $257.42 1
62272 $326.85 1
62273 $276.41 1
62280 $479.66 1
62281 $375.75 1
62282 $470.37 1
62284 $291.95 1
62287 $938.84 1
62290 $531.72 5
62291 $535.74 1
62292 $941.66 1
62294 $1,287.11 1
62302 $390.17
62303 $405.08
62304 $385.25
62305 $420.26
62310 $380.10 1
62311 $350.13 1
62318 $362.76 1
62319 $266.37 1
62350 $673.86 1
62351 $1,503.00 1
62355 $455.48 1
62360 $512.60 1
3/1/2015 108 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
62361 $767.16 1
62362 $656.72 1
62365 $507.15 1
62367 $64.77 1
62368 $90.06 1
62369 $190.61 1
62370 $201.83 1
63001 $2,231.36 1
63003 $2,211.66 1
63005 $2,100.02 1
63011 $1,922.34 1
63012 $2,102.48 1
63015 $2,669.06 1
63016 $2,715.23 1
63017 $2,238.27 1
63020 $2,060.09 1
63030 $1,694.39 1
63035 $341.76 1
63040 $2,462.16 1
63042 $2,261.64 1
63045 $2,274.09 1
63046 $2,129.10 1
63047 $1,935.71 1
63048 $379.17 1
63050 $2,608.20 1
63051 $3,015.29 1
63055 $2,933.66 1
63056 $2,616.89 1
63057 $570.53 1
63064 $3,157.13 1
63066 $386.30 1
63075 $2,390.78 1
63076 $443.24 1
63077 $2,639.37 1
63078 $327.21 1
63081 $3,105.45 1
63082 $477.69 1
63085 $3,384.63 1
63086 $340.41 1
63087 $4,258.62 1
63088 $468.92 1
63090 $3,357.41 1
63091 $306.99 1
63101 $4,151.96 1
63102 $4,011.05 1
3/1/2015 109 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
63103 $527.40 1
63170 $2,928.57 1
63172 $2,606.69 1
63173 $3,177.56 1
63180 $2,729.16 1
63182 $3,000.12 1
63185 $1,988.97 1
63190 $2,168.15 1
63191 $2,527.61 1
63194 $2,933.54 1
63195 $1,879.70 1
63196 $2,185.04 1
63197 $3,149.96 1
63198 $2,573.82 1
63199 $2,699.45 1
63200 $2,778.17 1
63250 $5,505.06 1
63251 $5,623.65 1
63252 $5,623.13 1
63265 $3,009.62 1
63266 $3,104.13 1
63267 $2,439.59 1
63268 $2,644.01 1
63270 $3,832.88 1
63271 $3,789.09 1
63272 $3,409.43 1
63273 $3,438.06 1
63275 $3,271.58 1
63276 $3,236.15 1
63277 $2,772.29 1
63278 $2,920.07 1
63280 $3,883.49 1
63281 $3,817.53 1
63282 $3,583.22 1
63283 $3,496.88 1
63285 $4,840.14 1
63286 $4,785.80 1
63287 $5,082.08 1
63290 $5,169.60 1
63295 $625.89 1
63300 $3,313.91 1
63301 $3,984.45 1
63302 $4,019.96 1
63303 $4,279.86 1
63304 $4,341.62 1
3/1/2015 110 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
63305 $4,625.30 1
63306 $3,456.32 1
63307 $3,738.53 1
63308 $588.93 1
63600 $1,476.99 1
63610 $633.15 1
63615 $1,749.27 1
63620 $2,033.90 1
63621 $471.06 1
63650 $2,098.83 1
63655 $1,456.11 1
63661 $932.88 1
63662 $1,476.60 1
63663 $1,263.33 1
63664 $1,506.69 1
63685 $622.04 1
63688 $627.38 1
63700 $1,977.92 1
63702 $2,564.72 1
63704 $2,518.58 1
63706 $2,856.68 1
63707 $1,608.17 1
63709 $1,933.04 1
63710 $1,892.58 1
63740 $1,740.09 1
63741 $1,203.66 1
63744 $1,213.50 1
63746 $1,083.54 1
64400 $206.82 1
64402 $212.85 1
64405 $164.57 1
64408 $186.27 1
64410 $190.67 1
64412 $227.70 1
64413 $209.12 1
64415 $186.53 1
64416 $128.00 1
64417 $204.83 1
64418 $233.75 1
64420 $178.92 1
64421 $238.14 1
64425 $210.03 1
64430 $223.40 1
64435 $216.96 1
64445 $215.63 1
3/1/2015 111 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
64446 $128.55 1
64447 $189.26 1
64448 $113.93 1
64449 $135.92 1
64450 $127.32 1
64455 $75.21 6
64479 $374.15 1
64480 $179.43 2
64483 $346.43 1
64484 $137.96 2
64486 $196.64
64487 $239.75
64488 $241.58
64489 $335.72
64490 $302.18 1
64491 $149.85 1
64492 $150.41 1
64493 $273.38 1
64494 $138.15 1
64495 $138.69 1
64505 $167.94 1
64508 $107.55 1
64510 $201.69 1
64517 $286.65 1
64520 $293.91 1
64530 $302.01 1
64550 $24.93 1
64553 $339.60 1
64555 $337.82 1
64561 $1,295.99 1
64565 $303.84 1
64566 $191.27 1
64568 $1,161.15 1
64569 $1,385.10 1
64570 $1,170.20 1
64575 $535.28 1
64580 $508.20 1
64581 $1,087.46 1
64585 $392.10 1
64590 $424.34 1
64595 $392.09 1
64600 $619.85 1
64605 $951.47 1
64610 $1,230.39 1
64611 $198.09 1
3/1/2015 112 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
64612 $215.36 1
64615 $254.57 1
64616 $213.12
64617 $307.01
64620 $328.43 1
64630 $379.53 1
64632 $136.11 8
64633 $659.82 1
64634 $293.78 1
64635 $654.39 1
64636 $268.80 1
64640 $211.07 1
64642 $234.48
64643 $157.11
64644 $270.11
64645 $189.98
64646 $255.78
64647 $295.05
64650 $125.91 1
64653 $157.11 1
64680 $499.67 1
64681 $640.22 1
64702 $821.58 1
64704 $511.86 1
64708 $826.74 1
64712 $952.31 1
64713 $1,206.35 1
64714 $1,066.55 1
64716 $877.85 1
64718 $981.80 1
64719 $661.62 1
64721 $710.97 1
64722 $617.85 1
64726 $445.16 1
64727 $315.17 1
64732 $624.93 1
64734 $888.53 1
64736 $656.06 1
64738 $761.03 1
64740 $748.56 1
64742 $752.13 1
64744 $883.46 1
64746 $737.27 1
64755 $1,577.27 1
64760 $873.87 1
3/1/2015 113 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
64763 $866.19 1
64766 $931.67 1
64771 $983.69 1
64772 $957.63 1
64774 $693.98 1
64776 $636.87 1
64778 $229.94 1
64782 $737.58 1
64783 $365.39 1
64784 $1,208.73 1
64786 $1,827.62 1
64787 $408.83 1
64788 $686.21 1
64790 $1,441.01 1
64792 $1,795.71 1
64795 $331.88 1
64802 $1,071.30 1
64804 $1,612.14 1
64809 $1,986.54 1
64818 $893.34 1
64820 $1,200.81 1
64821 $1,128.53 1
64822 $1,128.53 1
64823 $1,323.08 1
64831 $1,132.65 1
64832 $566.43 1
64834 $1,221.50 1
64835 $1,372.43 1
64836 $1,357.01 1
64837 $634.52 1
64840 $1,604.45 1
64856 $1,696.44 1
64857 $1,756.17 1
64858 $1,992.45 1
64859 $421.59 1
64861 $2,116.98 1
64862 $1,850.21 1
64864 $1,437.72 1
64865 $1,827.42 1
64866 $1,896.38 1
64868 $1,673.57 1
64872 $202.07 1
64874 $275.61 1
64876 $273.15 1
64885 $1,849.46 1
3/1/2015 114 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
64886 $2,146.04 1
64890 $1,813.89 1
64891 $1,933.25 1
64892 $1,775.79 1
64893 $1,883.76 1
64895 $2,243.19 1
64896 $2,905.04 1
64897 $2,096.99 1
64898 $2,286.81 1
64901 $934.71 1
64902 $1,081.98 1
64905 $1,699.73 1
64907 $2,641.23 1
64910 $1,368.78 1
64911 $1,679.90 1
65091 $996.80 1
65093 $986.10 1
65101 $1,159.73 1
65103 $1,208.76 1
65105 $1,334.97 1
65110 $1,921.89 1
65112 $2,229.09 1
65114 $2,338.65 1
65125 $715.61 1
65130 $1,149.96 1
65135 $1,166.61 1
65140 $1,269.08 1
65150 $906.80 1
65155 $1,329.17 1
65175 $1,031.73 1
65205 $87.62 1
65210 $107.66 1
65220 $91.47 1
65222 $104.90 1
65235 $1,122.12 1
65260 $1,509.56 1
65265 $1,700.36 1
65270 $418.34 1
65272 $788.01 1
65273 $599.69 1
65275 $908.87 1
65280 $1,060.65 1
65285 $1,748.79 1
65286 $1,105.16 1
65290 $773.33 1
3/1/2015 115 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
65400 $1,067.85 1
65410 $224.48 1
65420 $809.61 1
65426 $1,024.34 1
65430 $180.29 1
65435 $124.10 1
65436 $609.99 1
65450 $511.64 1
65600 $619.65 2
65710 $1,743.27 1
65730 $1,934.28 1
65750 $1,945.35 1
65755 $1,934.67 1
65756 $1,869.41 1
65770 $2,219.55 1
65772 $708.81 1
65775 $869.01 1
65778 $2,150.64 1
65779 $1,914.59 1
65780 $1,400.15 1
65781 $2,102.45 1
65782 $1,813.86 1
65800 $187.74 1
65810 $734.33 1
65815 $1,001.40 1
65820 $1,176.98 1
65850 $1,322.67 1
65855 $531.78 1
65860 $486.39 1
65865 $745.64 1
65870 $930.66 1
65875 $991.29 1
65880 $1,044.74 1
65900 $1,518.99 1
65920 $1,242.06 1
65930 $1,005.83 1
66020 $291.42 1
66030 $260.12 1
66130 $1,093.46 1
66150 $1,372.49 1
66155 $1,379.13 1
66160 $1,555.10 1
66170 $1,891.13 1
66172 $2,383.94 1
66174 $1,494.32 1
3/1/2015 116 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
66175 $1,565.10 1
66179 $1,698.69
66180 $1,793.39 1
66183 $1,623.20
66184 $1,236.11
66185 $1,330.98 1
66220 $1,171.34 1
66225 $1,469.09 1
66250 $1,175.12 1
66500 $556.53 1
66505 $610.04 1
66600 $1,309.80 1
66605 $1,665.93 1
66625 $675.51 1
66630 $896.78 1
66635 $905.84 1
66680 $815.72 1
66682 $1,002.57 1
66700 $707.99 1
66710 $691.97 1
66711 $1,009.89 1
66720 $746.52 1
66740 $687.56 1
66761 $465.08 1
66762 $746.09 1
66770 $831.42 1
66820 $617.93 1
66821 $518.90 1
66825 $1,195.77 1
66830 $1,122.66 1
66840 $1,099.01 1
66850 $1,249.26 1
66852 $1,331.30 1
66920 $1,189.19 1
66930 $1,350.12 1
66940 $1,233.17 1
66982 $1,253.94 1
66983 $1,151.88 1
66984 $1,008.57 1
66985 $1,212.99 1
66986 $1,431.20 1
66990 $143.58 1
67005 $744.35 1
67010 $855.33 1
67015 $914.12 1
3/1/2015 117 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
67025 $1,142.18 1
67027 $1,342.92 1
67028 $160.46 1
67030 $838.08 1
67031 $610.56 1
67036 $1,419.99 1
67039 $1,522.67 1
67040 $1,645.41 1
67041 $1,819.97 1
67042 $1,819.97 1
67043 $1,920.62 1
67101 $1,232.39 1
67105 $1,131.56 1
67107 $1,915.65 1
67108 $2,531.55 1
67110 $1,366.86 1
67112 $2,092.26 1
67113 $2,752.77 1
67115 $787.26 1
67120 $1,032.59 1
67121 $1,431.77 1
67141 $824.76 1
67145 $829.82 1
67208 $943.13 1
67210 $816.87 1
67218 $2,181.90 1
67220 $842.28 1
67221 $452.01 1
67225 $46.76 1
67227 $961.74 1
67228 $1,576.73 1
67229 $1,839.90 1
67250 $1,228.88 1
67255 $1,076.19 1
67311 $942.38 1
67312 $1,122.54 1
67314 $1,061.16 1
67316 $1,264.67 1
67318 $1,110.90 1
67320 $510.18 1
67331 $484.28 1
67332 $525.57 1
67334 $477.41 1
67335 $236.28 1
67340 $568.31 1
3/1/2015 118 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
67343 $1,030.74 1
67345 $390.29 1
67346 $307.47 1
67400 $1,464.02 1
67405 $1,251.44 1
67412 $1,341.00 1
67413 $1,345.34 1
67414 $2,090.43 1
67415 $165.65 1
67420 $2,564.28 1
67430 $1,961.22 1
67440 $1,898.24 1
67445 $2,213.73 1
67450 $1,979.42 1
67500 $124.37 1
67505 $140.48 1
67515 $152.78 1
67550 $1,520.00 1
67560 $1,557.83 1
67570 $1,844.01 1
67700 $417.95 1
67710 $347.76 1
67715 $372.12 1
67800 $199.73 1
67801 $255.08 1
67805 $316.92 1
67808 $581.43 1
67810 $270.62 1
67820 $78.21 1
67825 $202.46 1
67830 $416.64 1
67835 $691.43 1
67840 $430.64 1
67850 $337.47 1
67875 $267.77 1
67880 $719.36 1
67882 $885.74 1
67900 $1,008.90 1
67901 $1,188.30 1
67902 $1,145.66 1
67903 $932.45 1
67904 $1,152.15 1
67906 $801.59 1
67908 $774.39 1
67909 $844.85 1
3/1/2015 119 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
67911 $886.85 1
67912 $1,387.13 1
67914 $737.49 1
67915 $456.89 1
67916 $929.87 1
67917 $946.46 1
67921 $720.45 1
67922 $452.46 1
67923 $927.12 1
67924 $989.18 1
67930 $572.66 1
67935 $936.92 1
67938 $374.88 1
67950 $900.51 1
67961 $904.04 1
67966 $1,210.38 1
67971 $1,143.15 1
67973 $1,471.22 1
67974 $1,467.21 1
67975 $1,083.45 1
68020 $188.10 1
68040 $97.70 1
68100 $265.56 1
68110 $353.00 1
68115 $486.29 1
68130 $843.59 1
68135 $246.83 1
68200 $64.40 1
68320 $1,135.89 1
68325 $1,043.37 1
68326 $1,019.04 1
68328 $1,118.46 1
68330 $947.81 1
68335 $1,022.28 1
68340 $853.73 1
68360 $831.68 1
68362 $1,036.22 1
68371 $649.70 1
68400 $444.09 1
68420 $502.58 1
68440 $159.71 1
68500 $1,537.17 1
68505 $1,530.12 1
68510 $700.20 1
68520 $1,083.63 1
3/1/2015 120 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
68525 $418.77 1
68530 $670.55 1
68540 $1,463.91 1
68550 $1,792.71 1
68700 $952.71 1
68705 $370.40 1
68720 $1,192.95 1
68745 $1,197.11 1
68750 $1,240.05 1
68760 $314.21 1
68761 $231.39 1
68770 $992.91 1
68801 $194.13 1
68810 $378.24 1
68811 $324.72 1
68815 $704.15 1
68816 $1,158.06 1
68840 $200.64 1
68850 $96.86 1
69000 $298.46 1
69005 $346.91 1
69020 $371.87 1
69100 $159.81 1
69105 $224.55 1
69110 $736.71 1
69120 $651.95 1
69140 $1,423.62 1
69145 $637.89 1
69150 $1,721.33 1
69155 $2,738.18 1
69200 $195.78 1
69205 $165.60 1
69210 $78.93 1
69220 $218.70 1
69222 $352.11 1
69300 $1,181.43 1
69310 $1,774.59 1
69320 $2,493.89 1
69420 $307.67 1
69421 $244.59 1
69424 $204.30 1
69433 $325.22 1
69436 $263.55 1
69440 $1,123.44 1
69450 $886.41 1
3/1/2015 121 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
69501 $1,198.16 1
69502 $1,597.64 1
69505 $1,963.64 1
69511 $2,011.76 1
69530 $2,705.61 1
69535 $4,420.61 1
69540 $333.29 1
69550 $1,697.33 1
69552 $2,571.93 1
69554 $4,149.36 1
69601 $1,716.06 1
69602 $1,783.32 1
69603 $2,058.08 1
69604 $1,822.76 1
69605 $2,552.75 1
69610 $625.26 1
69620 $1,120.82 1
69631 $1,445.01 1
69632 $1,763.27 1
69633 $1,706.31 1
69635 $2,012.97 1
69636 $2,253.66 1
69637 $2,302.61 1
69641 $1,704.83 1
69642 $2,193.93 1
69643 $2,009.79 1
69644 $2,423.28 1
69645 $2,381.21 1
69646 $2,524.55 1
69650 $1,315.79 1
69660 $1,525.02 1
69661 $1,982.93 1
69662 $1,908.68 1
69666 $1,327.05 1
69667 $1,325.93 1
69670 $1,544.66 1
69676 $1,359.23 1
69700 $1,121.07 1
69711 $1,411.31 1
69714 $1,773.36 1
69715 $2,187.72 1
69717 $1,857.59 1
69718 $2,209.97 1
69720 $1,962.80 1
69725 $3,100.22 1
3/1/2015 122 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
69740 $1,920.48 1
69745 $2,040.99 1
69801 $317.97 1
69805 $1,733.00 1
69806 $1,552.41 1
69820 $1,401.90 1
69840 $1,459.55 1
69905 $1,501.41 1
69910 $1,671.12 1
69915 $2,536.01 1
69930 $2,018.48 1
69950 $2,946.66 1
69955 $3,264.35 1
69960 $3,180.38 1
69970 $3,537.18 1
69990 $406.22 1
70010 $120.89 1
70015 $240.77 1
70030 $42.99 1
70100 $51.27 1
70110 $58.89 1
70120 $52.92 1
70130 $85.08 1
70134 $79.74 1
70140 $46.28 1
70150 $64.40 1
70160 $50.73 1
70170 $0.00 1
70190 $54.54 1
70200 $65.48 1
70210 $46.31 1
70220 $57.78 1
70240 $47.21 1
70250 $55.59 1
70260 $69.80 1
70300 $23.78 1
70310 $60.14 1
70320 $83.97 1
70328 $48.51 1
70330 $73.64 1
70332 $128.76 1
70336 $496.07 1
70350 $31.22 1
70355 $32.27 1
70360 $43.55 1
3/1/2015 123 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
70370 $125.81 1
70371 $139.88 1
70373 $118.61 1
70380 $56.63 1
70390 $145.77 1
70450 $180.00 1
70460 $251.55 1
70470 $297.18 1
70480 $361.23 1
70481 $427.19 1
70482 $467.40 1
70486 $217.02 1
70487 $261.50 1
70488 $317.61 1
70490 $298.82 1
70491 $365.31 1
70492 $430.38 1
70496 $458.99 1
70498 $456.23 1
70540 $554.84 1
70542 $625.11 1
70543 $763.10 1
70544 $608.66 1
70545 $598.35 1
70546 $930.66 1
70547 $610.50 1
70548 $641.25 1
70549 $934.53 1
70551 $356.31 1
70552 $497.06 1
70553 $585.92 1
70554 $701.66 1
70555 $0.00 1
70557 $0.00 1
70558 $0.00 1
70559 $0.00 1
71010 $35.25 1
71015 $42.93 1
71020 $43.47 1
71021 $52.79 1
71022 $64.88 1
71023 $99.18 1
71030 $64.32 1
71034 $131.10 1
71035 $50.72 1
3/1/2015 124 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
71100 $47.34 1
71101 $56.10 1
71110 $57.75 1
71111 $73.14 1
71120 $45.71 1
71130 $56.54 1
71250 $278.99 1
71260 $355.23 1
71270 $426.08 1
71275 $466.05 1
71550 $642.30 1
71551 $710.73 1
71552 $900.47 1
71555 $617.99 1
72010 $109.58 2
72020 $34.19 1
72040 $52.13 1
72050 $69.66 1
72052 $87.62 1
72069 $50.46 1
72070 $49.37 1
72072 $53.42 1
72074 $60.60 1
72080 $53.04 1
72090 $67.68 1
72100 $54.89 1
72110 $76.65 1
72114 $97.62 1
72120 $63.54 1
72125 $285.53 1
72126 $355.62 1
72127 $418.71 1
72128 $279.02 1
72129 $355.26 1
72130 $419.25 1
72131 $277.35 1
72132 $354.53 1
72133 $419.63 1
72141 $345.81 1
72142 $502.22 1
72146 $345.81 1
72147 $498.90 1
72148 $344.16 1
72149 $496.14 1
72156 $589.23 1
3/1/2015 125 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
72157 $591.62 1
72158 $588.30 1
72159 $649.13 1
72170 $43.37 1
72190 $59.87 1
72191 $472.70 1
72192 $226.94 1
72193 $349.83 1
72194 $403.32 1
72195 $582.65 1
72196 $638.55 1
72197 $786.11 1
72198 $624.08 1
72200 $44.10 1
72202 $51.26 1
72220 $43.55 1
72240 $153.57 1
72255 $152.10 1
72265 $143.39 1
72270 $198.02 1
72275 $179.60 1
72285 $178.40 1
72295 $152.42 1
73000 $43.94 1
73010 $47.24 1
73020 $36.77 2
73030 $45.56 1
73040 $156.75 1
73050 $56.03 1
73060 $42.26 1
73070 $43.40 2
73080 $49.44 1
73085 $153.06 1
73090 $40.25 2
73092 $42.47 2
73100 $46.14 1
73110 $55.52 1
73115 $166.70 1
73120 $40.80 2
73130 $47.42 1
73140 $48.59 2
73200 $277.35 1
73201 $344.85 1
73202 $430.38 1
73206 $506.96 1
3/1/2015 126 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
73218 $564.23 1
73219 $627.50 1
73220 $775.07 1
73221 $365.36 1
73222 $587.18 1
73223 $728.10 1
73225 $627.32 1
73500 $41.70 2
73510 $58.22 1
73520 $62.37 1
73525 $158.40 1
73530 $0.00 1
73540 $61.55 1
73550 $42.81 2
73560 $46.13 2
73562 $53.85 1
73564 $62.99 1
73565 $51.65 1
73580 $178.47 1
73590 $41.34 2
73592 $42.47 2
73600 $42.47 1
73610 $49.44 1
73615 $154.35 1
73620 $40.25 2
73630 $45.21 1
73650 $41.91 2
73660 $43.62 1
73700 $277.35 1
73701 $349.83 1
73702 $422.84 1
73706 $544.56 1
73718 $565.34 2
73719 $627.87 1
73720 $780.03 1
73721 $364.80 1
73722 $592.52 1
73723 $731.42 1
73725 $625.71 1
74000 $36.90 1
74010 $54.50 1
74020 $57.75 1
74022 $68.16 1
74150 $232.67 1
74160 $357.39 1
3/1/2015 127 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
74170 $406.71 1
74174 $605.39 1
74175 $476.55 1
74176 $311.70 1
74177 $484.29 1
74178 $547.52 1
74181 $515.43 1
74182 $705.95 1
74183 $787.77 1
74185 $625.74 1
74190 $0.00 1
74210 $120.39 1
74220 $137.73 1
74230 $199.49 1
74235 $0.00 1
74240 $177.32 1
74241 $182.10 1
74245 $265.89 1
74246 $199.77 1
74247 $218.93 1
74249 $284.69 1
74250 $162.02 1
74251 $648.71 1
74260 $542.03 1
74261 $755.87 1
74262 $845.01 1
74270 $232.74 1
74280 $329.67 1
74283 $325.23 1
74290 $108.86 1
74300 $0.00 1
74301 $0.00 1
74305 $0.00 1
74320 $144.78 1
74327 $208.97 1
74328 $0.00 1
74329 $0.00 1
74330 $0.00 1
74340 $0.00 1
74355 $0.00 1
74360 $0.00 1
74363 $0.00 1
74400 $169.35 1
74410 $164.57 1
74415 $211.34 1
3/1/2015 128 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
74420 $0.00 1
74425 $0.00 1
74430 $57.68 1
74440 $123.32 1
74445 $0.00 1
74450 $0.00 1
74455 $126.15 1
74470 $0.00 1
74475 $143.67 1
74480 $143.67 1
74485 $141.84 1
74710 $62.43 1
74740 $117.42 1
74742 $0.00 1
74775 $0.00 1
75557 $493.74 1
75559 $670.85 1
75561 $658.70 1
75563 $781.05 1
75565 $85.95 1
75571 $156.32 1
75572 $442.05 1
75573 $602.99 1
75574 $649.44 1
75600 $313.71 1
75605 $219.48 1
75625 $220.95 1
75630 $273.50 1
75635 $590.70 1
75658 $265.98 1
75705 $367.34 1
75710 $251.72 1
75716 $294.15 1
75726 $236.25 1
75731 $265.53 1
75733 $284.40 1
75736 $259.07 1
75741 $238.01 1
75743 $266.34 1
75746 $238.10 1
75756 $270.68 1
75774 $137.70 1
75791 $499.20 1
75801 $0.00 1
75803 $0.00 1
3/1/2015 129 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
75805 $0.00 1
75807 $0.00 1
75809 $153.92 1
75810 $0.00 1
75820 $181.35 1
75822 $215.75 1
75825 $216.90 1
75827 $217.83 1
75831 $219.86 1
75833 $271.76 1
75840 $232.56 1
75842 $282.83 1
75860 $226.86 1
75870 $232.01 1
75872 $233.12 1
75880 $226.47 1
75885 $247.55 1
75887 $250.86 1
75889 $225.39 1
75891 $228.15 1
75893 $185.10 1
75894 $0.00 1
75896 $0.00 1
75898 $0.00 1
75901 $271.55 1
75902 $111.87 1
75945 $0.00 1
75946 $0.00 1
75952 $0.00 1
75953 $0.00 1
75954 $0.00 1
75956 $0.00 1
75957 $0.00 1
75958 $0.00 1
75959 $0.00 1
75962 $215.85 1
75964 $134.94 1
75966 $269.30 1
75968 $138.08 1
75970 $0.00 1
75978 $213.65 1
75980 $0.00 1
75982 $0.00 1
75984 $165.86 1
75989 $190.13 1
3/1/2015 130 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
76000 $73.74 1
76001 $0.00 1
76010 $40.77 1
76080 $86.22 1
76098 $25.89 1
76100 $144.90 1
76101 $207.50 1
76102 $272.51 1
76120 $142.10 1
76125 $0.00 1
76376 $35.76 1
76377 $100.01 1
76380 $227.67 1
76506 $185.88 2
76510 $263.40 1
76511 $159.42 1
76512 $143.96 1
76513 $149.37 1
76514 $24.21 1
76516 $122.51 1
76519 $131.34 2
76529 $124.11 1
76536 $181.40 1
76604 $138.14 1
76641 $170.07
76642 $140.33
76700 $192.23 1
76705 $143.60 1
76770 $176.51 1
76775 $89.66 1
76776 $244.79 1
76800 $214.91 1
76801 $196.53 1
76802 $104.36 3
76805 $225.26 1
76810 $150.69 3
76811 $288.96 1
76812 $326.91 3
76813 $193.10 1
76814 $130.25 3
76815 $133.74 1
76816 $181.65 1
76817 $153.83 1
76818 $192.93 4
76819 $140.54 1
3/1/2015 131 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
76820 $75.06 4
76821 $146.73 1
76825 $436.83 1
76826 $258.11 1
76827 $120.23 4
76828 $84.90 1
76830 $192.23 1
76831 $187.02 1
76856 $171.60 1
76857 $73.40 1
76870 $103.92 1
76872 $145.83 1
76873 $258.80 1
76881 $182.21 1
76882 $57.03 1
76885 $224.93 1
76886 $167.12 1
76930 $0.00 1
76932 $0.00 1
76936 $436.49 1
76937 $51.26 1
76940 $0.00 1
76941 $0.00 1
76942 $94.67 1
76945 $0.00 1
76946 $52.23 1
76948 $52.23 1
76965 $140.36 1
76970 $146.85 1
76975 $0.00 1
76977 $11.70 1
76998 $0.00 1
77001 $109.32 1
77002 $143.67 1
77003 $133.08 1
77011 $341.10 1
77012 $194.06 1
77013 $0.00 1
77014 $181.67 1
77021 $639.30 1
77022 $0.00 1
77051 $14.45 1
77052 $14.45 1
77053 $90.57 1
77054 $118.97 1
3/1/2015 132 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
77055 $139.92 1
77056 $179.79 1
77057 $128.31 1
77058 $840.35 1
77059 $831.51 1
77063 $87.24
77071 $77.04 1
77072 $36.33 1
77073 $57.38 1
77074 $99.26 1
77075 $135.39 1
77076 $148.20 1
77077 $59.90 1
77078 $176.55 1
77080 $64.50 1
77081 $44.03 1
77084 $608.19 1
77085 $87.54
77086 $55.70
77261 $118.74 1
77262 $177.23 1
77263 $260.09 1
77280 $419.63 1
77285 $660.83 1
77290 $789.45 1
77293 $718.77
77295 $758.34 1
77300 $98.25 10
77301 $3,009.69 1
77306 $225.15
77307 $441.86
77316 $289.41
77317 $379.13
77318 $547.55
77321 $142.83 1
77331 $99.32 1
77332 $127.85 1
77333 $82.25 1
77334 $235.53 1
77336 $119.51 1
77338 $784.31 1
77370 $182.12 1
77372 $1,644.53 1
77373 $2,087.93 1
77401 $32.40 1
3/1/2015 133 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
77417 $16.94 8
77422 $52.29 1
77423 $101.82 1
77427 $292.86 1
77431 $160.22 1
77432 $656.91 1
77435 $991.17 1
77469 $503.16 1
77470 $241.89 1
77600 $625.76 1
77605 $1,183.38 1
77610 $1,595.24 1
77615 $1,569.71 1
77620 $731.43 1
77750 $576.20 1
77761 $602.73 1
77762 $885.53 1
77763 $1,136.33 1
77776 $728.40 1
77777 $913.34 1
77778 $1,354.10 1
77785 $371.13 1
77786 $761.31 1
77787 $1,214.22 1
77789 $183.96 1
77790 $150.23 1
78012 $128.40 1
78013 $304.89 1
78014 $387.17 1
78015 $353.75 1
78016 $454.05 1
78018 $500.21 1
78020 $134.19 1
78070 $482.99 1
78071 $575.33 1
78072 $658.28 1
78075 $727.43 1
78102 $272.75 1
78103 $353.81 1
78104 $392.40 1
78110 $165.42 1
78111 $154.88 1
78120 $150.99 1
78121 $169.07 1
78122 $153.95 1
3/1/2015 134 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
78130 $252.75 1
78135 $564.27 1
78140 $217.59 1
78185 $340.92 1
78190 $630.93 1
78191 $268.77 1
78195 $572.39 1
78201 $303.11 1
78202 $322.16 1
78205 $338.03 1
78206 $552.89 1
78215 $312.06 1
78216 $202.37 1
78226 $532.80 1
78227 $721.83 1
78230 $277.14 1
78231 $207.78 1
78232 $159.44 1
78258 $352.71 1
78261 $406.94 1
78262 $391.29 1
78264 $465.32 1
78270 $163.19 1
78271 $145.52 1
78272 $155.90 1
78278 $562.23 1
78282 $0.00 1
78290 $535.47 1
78291 $400.37 1
78300 $290.12 1
78305 $370.80 1
78306 $405.00 1
78315 $558.50 1
78320 $366.41 1
78414 $0.00 1
78428 $290.42 1
78445 $288.86 1
78451 $547.97 1
78452 $758.79 1
78453 $488.37 1
78454 $699.39 1
78456 $514.71 1
78457 $281.60 1
78458 $329.45 1
78459 $0.00 1
3/1/2015 135 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
78466 $312.84 1
78468 $310.26 1
78469 $365.31 1
78472 $369.45 1
78473 $462.95 1
78481 $279.78 1
78483 $380.82 1
78491 $0.00 1
78492 $0.00 1
78494 $359.18 1
78496 $71.01 1
78579 $295.86 1
78580 $382.92 1
78582 $538.16 1
78597 $324.71 1
78598 $492.30 1
78600 $295.76 1
78601 $345.54 1
78605 $319.17 1
78606 $534.81 1
78607 $566.45 1
78608 $0.00 1
78610 $279.96 1
78630 $546.53 1
78635 $548.30 1
78645 $520.92 1
78647 $563.30 1
78650 $537.80 1
78660 $282.53 1
78700 $274.92 1
78701 $338.03 1
78707 $372.80 1
78708 $279.23 1
78709 $579.96 1
78710 $316.94 1
78725 $173.76 1
78730 $123.14 1
78740 $351.15 1
78761 $338.96 1
78800 $306.08 1
78801 $418.74 1
78802 $522.30 1
78803 $547.89 1
78804 $916.56 1
78805 $292.16 1
3/1/2015 136 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
78806 $536.30 1
78807 $547.71 1
78808 $70.97 1
78811 $0.00 1
78812 $0.00 1
78813 $0.00 1
78814 $0.00 1
78815 $0.00 1
78816 $0.00 1
79005 $213.27 1
79101 $222.41 1
79200 $210.77 1
79300 $0.00 1
79403 $298.35 1
79440 $201.56 1
79445 $0.00 1
80500 $36.05 1
80502 $113.31 1
85060 $38.69 1
85097 $138.06 1
85396 $32.18 1
86077 $87.60 1
86078 $87.06 1
86079 $85.40 1
86486 $8.10 1
86490 $10.86 1
86510 $9.77 1
86580 $12.53 1
88104 $115.85 1
88106 $136.04 1
88108 $130.95 1
88112 $99.83 1
88120 $962.39 1
88121 $855.74 1
88125 $41.57 1
88141 $50.33 1
88160 $103.79 1
88161 $93.84 1
88162 $154.56 1
88172 $87.47 1
88173 $233.09 1
88177 $47.57 1
88182 $168.17 1
88184 $145.65 1
88185 $88.76 25
3/1/2015 137 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
88187 $111.60 8
88188 $142.56 15
88189 $175.20 25
88291 $49.07 1
88300 $24.36 1
88302 $50.25 1
88304 $71.09 1
88305 $112.22 1
88307 $471.78 1
88309 $715.65 1
88311 $32.94 1
88312 $150.68 1
88313 $105.30 1
88314 $115.47 1
88319 $137.25 1
88321 $149.10 1
88323 $233.49 1
88325 $333.50 1
88329 $91.17 1
88331 $158.46 1
88332 $69.95 1
88333 $167.66 1
88334 $103.23 1
88341 $104.46
88342 $139.37 1
88344 $180.14
88346 $170.04 1
88347 $142.98 1
88348 $535.25 1
88355 $268.26 1
88356 $314.60 1
88358 $129.57 1
88360 $208.88 1
88361 $260.69 1
88362 $459.78 1
88363 $35.49 1
88364 $150.14
88365 $241.28 1
88366 $229.65
88367 $165.29 1
88368 $167.25 1
88369 $113.69
88373 $93.41
88374 $315.21
88375 $74.40
3/1/2015 138 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
88377 $328.83
88380 $203.85 1
88381 $192.50 1
88387 $66.03 1
88388 $53.04 1
89049 $375.59 1
89220 $24.68 1
89230 $4.23 1
90460 $39.32 1
90461 $20.01 1
90471 $39.32 1
90472 $20.01 1
90473 $39.32 1
90474 $20.01 1
90785 $21.93 1
90791 $201.59 1
90792 $227.51 1
90832 $98.31 1
90833 $101.07 1
90834 $129.92 1
90836 $128.22 1
90837 $195.51 1
90838 $169.80 1
90839 $204.14
90840 $97.76
90845 $140.06 1
90846 $157.25 1
90847 $164.46 1
90849 $54.84 1
90853 $39.56 1
90865 $260.40 1
90870 $274.94 1
90880 $155.94 1
90901 $59.19 1
90911 $132.24 1
90935 $114.17 1
90937 $163.43 1
90945 $134.48 1
90947 $194.81 1
90951 $1,476.08 1
90954 $1,286.18 1
90955 $718.68 1
90956 $502.67 1
90957 $1,013.16 1
90958 $682.58 1
3/1/2015 139 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
90959 $464.18 1
90960 $445.17 1
90961 $375.02 1
90962 $288.24 1
90963 $856.32 1
90964 $745.92 1
90965 $711.29 1
90966 $372.63 1
90967 $28.35 29
90968 $24.56 29
90969 $24.02 29
90970 $12.30 29
90997 $148.58 1
91010 $279.48 1
91013 $38.01 1
91020 $366.51 1
91022 $266.15 1
91030 $214.53 1
91034 $294.17 1
91035 $757.92 1
91037 $254.01 1
91038 $713.96 1
91040 $687.66 1
91065 $127.47 1
91110 $1,398.54 1
91111 $1,147.04 1
91112 $1,701.54 1
91117 $224.37 1
91120 $676.05 1
91122 $354.00 1
91132 $233.39 1
91133 $270.17 1
91200 $56.04
92002 $125.64 1
92004 $229.64 1
92012 $132.20 1
92014 $191.24 1
92018 $226.14 1
92019 $111.87 1
92020 $41.21 1
92025 $59.28 1
92060 $100.71 1
92065 $83.55 1
92071 $58.86 1
92072 $208.40 1
3/1/2015 140 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
92081 $53.28 1
92082 $74.67 1
92083 $99.92 1
92100 $124.61 1
92132 $54.32 1
92133 $68.43 1
92134 $70.08 1
92136 $140.18 1
92140 $97.71 1
92145 $24.77
92225 $41.75 2
92226 $38.51 2
92227 $23.01 1
92228 $55.38 1
92230 $90.18 2
92235 $170.13 2
92240 $395.04 1
92250 $122.66 1
92260 $28.77 1
92265 $133.11 1
92270 $143.24 1
92275 $227.63 1
92283 $87.74 1
92284 $97.58 1
92285 $32.70 1
92286 $59.75 1
92287 $213.77 1
92311 $156.62 1
92312 $182.30 1
92313 $150.98 1
92315 $112.89 1
92316 $142.16 1
92317 $117.86 1
92325 $66.11 1
92326 $55.05 1
92502 $153.15 1
92504 $47.04 1
92507 $122.57 1
92508 $36.30 1
92511 $213.17 1
92512 $95.79 1
92516 $109.98 1
92520 $117.74 1
92521 $167.69
92522 $143.42
3/1/2015 141 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
92523 $293.46
92524 $141.95
92526 $132.99 1
92540 $157.97 1
92541 $34.89 1
92542 $40.85 1
92543 $25.43 1
92544 $24.60 1
92545 $22.98 1
92546 $160.47 1
92547 $10.31 1
92548 $161.06 1
92550 $32.40 1
92552 $48.98 1
92553 $57.83 1
92555 $36.27 1
92556 $58.37 1
92557 $57.77 1
92561 $58.92 1
92562 $72.18 1
92563 $48.42 1
92564 $44.57 1
92565 $24.68 1
92567 $22.70 1
92568 $24.21 1
92570 $49.56 1
92571 $42.90 1
92572 $48.98 1
92575 $110.85 1
92576 $55.05 1
92577 $25.23 1
92579 $69.77 1
92582 $111.41 1
92583 $79.37 1
92584 $115.28 1
92585 $210.41 2
92586 $130.19 2
92587 $33.87 2
92588 $51.23 2
92596 $65.55 1
92597 $112.32 1
92601 $216.51 1
92602 $138.59 1
92603 $232.25 1
92604 $137.57 1
3/1/2015 142 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
92607 $193.68 1
92608 $82.47 1
92609 $171.41 1
92610 $131.78 1
92611 $135.95 1
92612 $270.11 1
92613 $61.28 1
92614 $225.36 1
92615 $52.94 1
92616 $321.42 1
92617 $65.39 1
92620 $145.82 1
92621 $34.61 1
92625 $108.45 1
92626 $139.35 1
92627 $34.08 4
92640 $175.77 1
92920 $942.90 1
92924 $1,118.61 1
92928 $1,046.24 1
92933 $1,170.93 1
92937 $1,045.70 1
92941 $1,172.57 1
92943 $1,170.72 1
92950 $484.26 1
92953 $18.05 1
92960 $324.87 1
92961 $444.77 1
92970 $309.18 1
92971 $173.15 1
92973 $306.41 1
92974 $279.06 1
92975 $676.70 1
92977 $93.53 1
92978 $0.00 1
92979 $0.00 1
92986 $2,288.24 1
92987 $2,351.99 1
92990 $1,868.31 1
92997 $1,145.88 1
92998 $560.88 1
93000 $26.97 1
93005 $13.62 1
93010 $13.35 4
93015 $119.03 1
3/1/2015 143 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
93016 $34.82 1
93017 $61.68 1
93018 $22.53 1
93024 $175.44 1
93025 $254.93 1
93040 $20.39 1
93041 $9.21 1
93042 $11.18 1
93224 $143.70 1
93225 $42.35 1
93226 $59.48 1
93227 $41.88 1
93228 $41.15 1
93229 $1,052.52 1
93260 $104.51
93261 $95.85
93268 $320.30 1
93270 $14.73 1
93271 $265.89 1
93272 $39.68 1
93278 $47.84 1
93279 $77.40 1
93280 $91.38 1
93281 $106.08 1
93282 $98.99 1
93283 $127.04 1
93284 $139.59 1
93285 $66.00 1
93286 $42.80 1
93287 $56.73 1
93288 $58.97 1
93289 $101.64 1
93290 $48.11 1
93291 $55.83 1
93292 $50.31 1
93293 $83.64 1
93294 $53.46 1
93295 $106.74 1
93296 $40.70 1
93297 $41.70 1
93298 $41.70 1
93303 $369.68 1
93304 $240.75 1
93306 $353.66 1
93307 $202.73 1
3/1/2015 144 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
93308 $194.15 1
93312 $476.85 1
93313 $36.00 1
93314 $456.23 1
93315 $0.00 1
93316 $60.50 1
93317 $0.00 1
93318 $0.00 1
93320 $85.20 1
93321 $43.58 1
93325 $41.51 2
93350 $374.76 1
93351 $421.07 1
93352 $53.46 1
93355 $359.46
93451 $1,243.10 1
93452 $1,415.46 1
93453 $1,824.39 1
93454 $1,432.71 1
93455 $1,668.65 1
93456 $1,795.08 1
93457 $2,025.53 1
93458 $1,716.77 1
93459 $1,897.29 1
93460 $2,039.33 1
93461 $2,330.88 1
93462 $357.60 1
93463 $157.71 1
93464 $428.72 1
93503 $209.27 1
93505 $1,224.59 1
93530 $0.00 1
93531 $0.00 1
93532 $0.00 1
93533 $0.00 1
93561 $0.00 1
93562 $0.00 1
93563 $100.76 1
93564 $106.98 1
93565 $78.89 1
93566 $273.51 1
93567 $228.59 1
93568 $246.42 1
93571 $0.00 1
93572 $0.00 1
3/1/2015 145 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
93580 $1,676.22 1
93581 $2,306.15 1
93582 $1,156.74
93583 $1,289.55
93600 $0.00 1
93602 $0.00 1
93603 $0.00 1
93609 $0.00 1
93610 $0.00 1
93612 $0.00 1
93613 $682.26 1
93615 $0.00 1
93616 $0.00 1
93618 $0.00 1
93619 $0.00 1
93620 $0.00 1
93621 $0.00 1
93622 $0.00 1
93623 $0.00 1
93624 $0.00 1
93631 $0.00 1
93640 $0.00 1
93641 $0.00 1
93642 $699.69 1
93644 $488.87
93650 $1,035.99 1
93653 $1,460.07 1
93654 $1,942.46 1
93655 $729.48 1
93656 $1,950.17 1
93657 $728.93 1
93660 $246.65 1
93662 $0.00 1
93701 $38.49 1
93702 $177.14
93724 $428.16 1
93750 $89.48 1
93784 $84.45 1
93786 $46.77 1
93788 $8.66 1
93790 $29.04 1
93797 $25.49 1
93798 $39.51 1
93880 $316.71 1
93882 $202.47 1
3/1/2015 146 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
93886 $449.30 1
93888 $233.78 1
93890 $454.68 1
93892 $527.18 1
93893 $540.98 1
93922 $140.46 1
93923 $217.67 1
93924 $271.53 1
93925 $408.78 1
93926 $241.88 1
93930 $328.68 1
93931 $204.69 1
93965 $188.91 1
93970 $310.07 1
93971 $190.59 1
93975 $441.71 1
93976 $256.13 1
93978 $300.32 1
93979 $189.77 1
93980 $186.18 1
93981 $112.53 1
93982 $68.94 1
93990 $254.78 1
94002 $147.96 1
94003 $106.80 1
94004 $76.83 1
94010 $56.81 1
94011 $158.07 1
94012 $262.91 1
94013 $49.02 1
94014 $87.54 1
94015 $47.88 1
94016 $39.68 1
94060 $95.31 1
94070 $92.94 1
94200 $40.34 1
94250 $41.43 1
94375 $61.56 1
94400 $88.47 1
94450 $103.95 1
94452 $90.29 1
94453 $125.31 1
94610 $89.82 1
94620 $87.36 1
94621 $256.05 1
3/1/2015 147 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
94640 $29.10 3
94644 $68.31 1
94645 $21.92 1
94660 $98.39 1
94662 $54.93 1
94664 $27.44 1
94667 $41.61 1
94668 $45.12 1
94669 $55.98
94680 $89.81 1
94681 $83.82 1
94690 $77.96 1
94726 $82.62 1
94727 $66.06 1
94728 $61.64 1
94729 $85.50 1
94750 $126.87 1
94760 $5.34 1
94761 $8.10 1
94762 $38.49 1
94770 $11.73 1
94780 $98.10 1
94781 $36.00 1
95004 $10.29 120
95012 $30.75 1
95017 $12.41 1
95018 $29.42 1
95024 $12.51 40
95027 $7.53 1
95028 $21.36 10
95044 $9.21 20
95052 $10.86 10
95056 $69.42 5
95060 $55.05 2
95065 $39.59 2
95070 $47.33 1
95071 $54.51 1
95076 $180.06 1
95079 $127.97 1
95115 $14.18 1
95117 $16.38 1
95144 $19.61 5
95145 $34.52 25
95146 $61.04 25
95147 $54.96 25
3/1/2015 148 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
95148 $82.04 25
95149 $109.65 25
95165 $20.16 25
95170 $15.18 25
95180 $207.60 5
95250 $246.00 1
95251 $67.50 1
95782 $1,427.82 1
95783 $1,946.16 1
95800 $280.22 1
95801 $143.30 1
95803 $220.44 1
95805 $654.69 1
95806 $261.68 1
95807 $730.80 1
95808 $938.69 1
95810 $969.32 1
95811 $1,018.13 1
95812 $652.50 1
95813 $781.44 1
95816 $559.32 1
95819 $638.13 1
95822 $577.37 1
95824 $0.00 1
95827 $1,224.60 1
95829 $2,938.20 1
95830 $386.15 1
95831 $48.71 1
95832 $48.51 1
95833 $58.53 1
95834 $79.50 1
95851 $28.83 3
95852 $25.61 1
95857 $84.21 1
95860 $191.99 1
95861 $269.49 1
95863 $333.59 1
95864 $378.69 1
95865 $225.98 1
95866 $207.90 1
95867 $145.49 1
95868 $206.72 1
95869 $127.56 1
95870 $137.69 1
95872 $309.68 1
3/1/2015 149 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
95873 $116.70 1
95874 $112.28 1
95875 $188.81 1
95885 $91.32 1
95886 $142.05 1
95887 $127.38 1
95905 $112.25 1
95907 $151.59 1
95908 $194.64 1
95909 $230.52 1
95910 $306.50 1
95911 $364.43 1
95912 $406.71 1
95913 $460.68 1
95921 $136.47 1
95922 $156.26 1
95923 $298.32 1
95924 $238.43 1
95925 $245.69 1
95926 $224.88 1
95927 $238.14 1
95928 $404.15 1
95929 $401.76 1
95930 $200.51 1
95933 $131.45 1
95937 $129.69 20
95938 $532.25 1
95939 $786.12 1
95940 $52.25 1
95950 $512.42 1
95951 $0.00 1
95953 $653.87 1
95954 $716.76 1
95955 $333.14 1
95956 $2,605.22 1
95957 $494.34 1
95958 $908.87 1
95961 $453.35 1
95962 $397.91 1
95965 $0.00 1
95966 $0.00 1
95967 $0.00 1
95970 $105.15 1
95971 $90.44 1
95972 $87.47 1
3/1/2015 150 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
95973 $63.66 1
95974 $331.56 1
95975 $177.33 1
95978 $396.68 1
95979 $172.46 1
95980 $76.95 1
95981 $50.34 1
95982 $85.13 1
95990 $141.42 1
95991 $188.97 1
95992 $66.18 1
96000 $150.66 1
96001 $160.97 1
96002 $34.70 1
96003 $29.60 1
96004 $186.75 1
96020 $0.00 1
96101 $122.96 4
96102 $99.18 1
96103 $42.81 1
96105 $161.61 1
96111 $199.65 1
96116 $145.41 3
96118 $150.57 3
96119 $125.81 3
96120 $74.85 1
96125 $182.87 1
96127 $8.66
96150 $33.63 1
96151 $32.00 1
96152 $30.02 1
96153 $7.40 1
96154 $29.48 1
96360 $90.32 1
96361 $23.97 1
96365 $109.41 1
96366 $29.36 1
96367 $47.01 4
96368 $32.13 1
96369 $303.48 1
96370 $23.84 1
96371 $140.13 1
96372 $39.32 1
96373 $30.48 1
96374 $89.21 1
3/1/2015 151 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
96375 $35.01 1
96401 $117.14 1
96402 $50.33 1
96405 $126.95 1
96406 $184.68 1
96409 $173.63 1
96411 $96.90 2
96413 $212.04 1
96415 $43.70 7
96416 $219.89 1
96417 $98.00 1
96420 $163.23 1
96422 $267.45 1
96423 $124.20 8
96425 $284.21 1
96440 $1,354.70 1
96446 $322.35 1
96450 $285.33 1
96521 $216.57 1
96522 $179.01 1
96523 $38.97 1
96542 $186.80 1
96567 $209.73 1
96570 $95.25 1
96571 $42.02 1
96900 $32.40 1
96904 $98.15 1
96910 $111.41 1
96912 $142.89 1
96913 $201.26 1
96920 $241.02 1
96921 $266.57 1
96922 $368.94 1
97001 $116.10 1
97002 $64.95 1
97003 $131.93 1
97004 $81.53 1
97012 $24.83 1
97016 $29.91 1
97018 $17.40 1
97022 $36.56 1
97024 $10.22 1
97026 $9.66 1
97028 $11.84 1
97032 $29.79 1
3/1/2015 152 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
97033 $50.78 1
97034 $28.20 1
97035 $19.92 1
97036 $52.22 1
97110 $50.28 1
97112 $51.57 1
97113 $66.50 1
97116 $43.92 1
97124 $41.60 1
97140 $46.08 1
97150 $26.97 1
97530 $53.79 1
97532 $41.09 1
97533 $44.96 1
97535 $53.78 1
97537 $46.61 1
97542 $47.15 1
97545 $0.00 1
97546 $0.00 1
97597 $119.42 1
97598 $39.93 1
97605 $70.37 1
97606 $83.73 1
97610 $191.49
97750 $51.39 1
97755 $55.53 1
97760 $59.12 1
97761 $51.39 1
97762 $74.54 1
97802 $54.02 5
97803 $46.05 5
97804 $24.83 6
98925 $48.60 1
98926 $70.67 1
98927 $92.18 1
98928 $113.13 1
98929 $135.20 1
98940 $43.28 1
98941 $63.12 1
98942 $82.43 1
99170 $249.99 1
99175 $26.88 1
99183 $180.17 1
99184 $373.16
99195 $158.54 1
3/1/2015 153 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
99201 $68.64 1
99202 $117.08 1
99203 $171.71 1
99204 $260.49 1
99205 $327.62 1
99211 $31.02 1
99212 $68.64 1
99213 $113.34 2
99214 $168.65 2
99215 $228.42 1
99217 $114.50 1
99218 $159.12 1
99219 $214.01 1
99220 $293.84 1
99221 $162.44 1
99222 $217.31 1
99223 $321.35 1
99224 $61.94 1
99225 $114.32 1
99226 $165.99 1
99231 $61.38 1
99232 $113.76 1
99233 $164.34 1
99234 $212.40 1
99235 $266.73 1
99236 $344.00 1
99238 $115.05 1
99239 $168.74 1
99281 $32.97
99282 $65.24
99283 $98.93
99284 $188.66
99285 $280.19
99291 $436.68 1
99292 $194.49 4
99304 $143.93 1
99305 $205.02 1
99306 $261.14 1
99307 $69.30 1
99308 $106.95 1
99309 $142.23 1
99310 $212.21 1
99315 $113.76 1
99316 $164.51 1
99318 $150.08 1
3/1/2015 154 of 156
Ryan White Part A
Outpatient Medical Billing Rates
CPT Code FeeAllowable
Units
99324 $86.21 1
99325 $126.08 1
99326 $217.64 1
99327 $290.51 1
99328 $340.50 1
99334 $93.84 1
99335 $148.40 1
99336 $210.36 1
99337 $300.81 1
99341 $85.65 1
99342 $125.34 1
99343 $203.81 1
99344 $285.48 1
99345 $345.84 1
99347 $86.78 1
99348 $131.54 1
99349 $200.63 1
99350 $277.55 1
99354 $156.80 1
99355 $152.37 1
99356 $144.36 1
99357 $142.34 1
99406 $22.44 1
99407 $42.84 1
99455 $0.00 1
99456 $0.00 1
99460 $155.63 1
99461 $140.31 1
99462 $64.76 1
99463 $188.81 1
99464 $116.90 1
99465 $236.31 1
99466 $388.34 1
99467 $195.18 1
99468 $1,440.17 1
99469 $624.03 1
99471 $1,387.95 1
99472 $644.28 1
99475 $909.69 1
99476 $547.95 1
99477 $568.55 1
99478 $222.96 1
99479 $195.39 1
99480 $187.82 1
99490 $67.14
3/1/2015 155 of 156