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Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
10060 incision & drainage abscess simple/single $42.18 4/1/2014
10060 incision & drainage abscess simple/single $45.40 4/1/2012 3/31/2014
10060 incision & drainage abscess simple/single $50.44 3/31/2012
10060 incision & drainage abscess simple/single $37.63 Facility 4/1/2014
10061 incision&drainage abscess complicated/multiple $78.24 4/1/2012
10061 incision&drainage abscess complicated/multiple $86.93 3/31/2012
10061 incision&drainage abscess complicated/multiple $70.73 Facility 4/1/2014
10120 incision&removal foreign body subq tiss simple $58.66 4/1/2012
10120 incision&removal foreign body subq tiss simple $65.18 3/31/2012
10120 incision&removal foreign body subq tiss simple $39.18 Facility 4/1/2014
10121 incision&removal foreign body subq tiss compl $109.29 4/1/2014
10121 incision&removal foreign body subq tiss compl $111.14 4/1/2012 3/31/2014
10121 incision&removal foreign body subq tiss compl $123.49 3/31/2012
10121 incision&removal foreign body subq tiss compl $81.21 Facility 4/1/2014
10140 i&d hematoma seroma/fluid collection $63.66 4/1/2012
10140 i&d hematoma seroma/fluid collection $70.73 3/31/2012
10140 i&d hematoma seroma/fluid collection $50.79 Facility 4/1/2014
10160 puncture aspiration abscess hematoma bulla/cyst $52.25 4/1/2012
10160 puncture aspiration abscess hematoma bulla/cyst $58.06 3/31/2012
10160 puncture aspiration abscess hematoma bulla/cyst $40.84 Facility 4/1/2014
10180 incision&drainage complex po wound infection $96.98 4/1/2012
10180 incision&drainage complex po wound infection $107.75 3/31/2012
10180 incision&drainage complex po wound infection $76.62 Facility 4/1/2014
11000 dbrdmt extensv eczema/infect skn up 10% bdy surf $22.38 4/1/2012
11000 dbrdmt extensv eczema/infect skn up 10% bdy surf $24.87 3/31/2012
11000 dbrdmt extensv eczema/infect skn up 10% bdy surf $15.23 Facility 4/1/2014
11010 dbrdmt w/rmvl fm fx&/dislc skin&subq tissus $194.18 4/1/2012
11010 dbrdmt w/rmvl fm fx&/dislc skin&subq tissus $219.87 3/31/2012
11010 dbrdmt w/rmvl fm fx&/dislc skin&subq tissus $125.18 Facility 4/1/2014
11011 dbrdmt w/rmvl fm fx&/dislc skn subq t/m/f musc $229.82 4/1/2012
11011 dbrdmt w/rmvl fm fx&/dislc skn subq t/m/f musc $255.36 3/31/2012
11011 dbrdmt w/rmvl fm fx&/dislc skn subq t/m/f musc $135.35 Facility 4/1/2014
11012 dbrdmt fx&/dislc subq t/m/f bone $333.51 4/1/2012
11012 dbrdmt fx&/dislc subq t/m/f bone $370.57 3/31/2012
11012 dbrdmt fx&/dislc subq t/m/f bone $199.42 Facility 4/1/2014
11042 debridement subcutaneous tissue 20 sq cm/< $37.49 4/1/2012
11042 debridement subcutaneous tissue 20 sq cm/< $41.65 3/31/2012
11042 debridement subcutaneous tissue 20 sq cm/< $28.89 Facility 4/1/2014
11043 debridement muscle & fascia 20 sq cm/< $115.48 4/1/2012
11043 debridement muscle & fascia 20 sq cm/< $128.31 3/31/2012
11043 debridement muscle & fascia 20 sq cm/< $88.41 Facility 4/1/2014
11044 debridement bone muscle &/fascia 20 sq cm/< $156.02 4/1/2012
11044 debridement bone muscle &/fascia 20 sq cm/< $173.35 3/31/2012
11044 debridement bone muscle &/fascia 20 sq cm/< $120.80 Facility 4/1/2014
11045 dbrdmt subcutaneous tissue ea addl 20 sq cm $26.11 4/1/2012
11045 dbrdmt subcutaneous tissue ea addl 20 sq cm $16.78 1/1/2011 3/31/2012
11045 dbrdmt subcutaneous tissue ea addl 20 sq cm $15.10 Facility 4/1/2012
11045 dbrdmt subcutaneous tissue ea addl 20 sq cm $29.01 Facility 1/1/2011 3/31/2012
11046 debridement muscle &/fascia ea addl 20 sq cm $45.56 4/1/2012
11046 debridement muscle &/fascia ea addl 20 sq cm $35.82 1/1/2011 3/31/2012
11046 debridement muscle &/fascia ea addl 20 sq cm $32.24 Facility 4/1/2012
11046 debridement muscle &/fascia ea addl 20 sq cm $50.62 Facility 1/1/2011 3/31/2012
Podiatry Fee Schedule
Effective September 1, 2010 (updated for April 1, 2014)
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
11047 debridement bone each additional 20 sq cm $39.64 4/1/2012
11047 debridement bone each additional 20 sq cm $62.19 1/1/2011 3/31/2012
11047 debridement bone each additional 20 sq cm $29.66 Facility 4/1/2014
11047 debridement bone each additional 20 sq cm $55.97 Facility 4/1/2012 3/31/2014
11047 debridement bone each additional 20 sq cm $83.10 Facility 1/1/2011 3/31/2012
11055 paring/cutting benign hyperkeratotic lesion 1 $19.76 4/1/2012
11055 paring/cutting benign hyperkeratotic lesion 1 $21.96 3/31/2012
11055 paring/cutting benign hyperkeratotic lesion 1 $15.95 Facility 4/1/2014
11055 paring/cutting benign hyperkeratotic lesion 1 $17.40 Facility 4/1/2012 3/31/2014
11055 paring/cutting benign hyperkeratotic lesion 1 $19.33 Facility 1/1/2012 3/31/2012
11056 paring/cutting benign hyperkeratotic lesion 2-4 $24.49 4/1/2012
11056 paring/cutting benign hyperkeratotic lesion 2-4 $27.21 3/31/2012
11056 paring/cutting benign hyperkeratotic lesion 2-4 $20.09 Facility 4/1/2012
11056 paring/cutting benign hyperkeratotic lesion 2-4 $22.32 Facility 1/1/2012 3/31/2012
11057 paring/cutting benign hyperkeratotic lesion >4 $29.67 4/1/2012
11057 paring/cutting benign hyperkeratotic lesion >4 $32.97 3/31/2012
11057 paring/cutting benign hyperkeratotic lesion >4 $20.30 Facility 4/1/2014
11100 bx skin subcutaneous&/mucous membrane 1 lesion $41.25 4/1/2012
11100 bx skin subcutaneous&/mucous membrane 1 lesion $45.83 3/31/2012
11100 bx skin subcutaneous&/mucous membrane 1 lesion $21.11 Facility 4/1/2014
11101 biopsy skin subq&/mucous membrane ea addl lesn $13.66 4/1/2012
11101 biopsy skin subq&/mucous membrane ea addl lesn $15.18 3/31/2012
11101 biopsy skin subq&/mucous membrane ea addl lesn $10.73 Facility 4/1/2014
11200 removal skn tags mlt fibrq tags any area upw/15 $31.37 4/1/2012
11200 removal skn tags mlt fibrq tags any area upw/15 $37.45 3/31/2012
11200 removal skn tags mlt fibrq tags any area upw/15 $26.83 Facility 4/1/2014
11201 removal sk tgs mlt fibrq tags any area ea 10 $8.07 4/1/2012
11201 removal sk tgs mlt fibrq tags any area ea 10 $15.75 3/31/2012
11201 removal sk tgs mlt fibrq tags any area ea 10 $7.42 Facility 4/1/2014
11201 removal sk tgs mlt fibrq tags any area ea 10 $14.14 Facility 4/1/2012 3/31/2014
11201 removal sk tgs mlt fibrq tags any area ea 10 $15.71 Facility 1/1/2012 3/31/2012
11300 shaving skin les 1 trunk/arm/leg diam 0.5cm/< $28.02 4/1/2012
11300 shaving skin les 1 trunk/arm/leg diam 0.5cm/< $31.13 3/31/2012
11300 shaving skin les 1 trunk/arm/leg diam 0.5cm/< $12.97 Facility 4/1/2014
11300 shaving skin les 1 trunk/arm/leg diam 0.5cm/< $25.38 Facility 4/1/2012 3/31/2014
11300 shaving skin les 1 trunk/arm/leg diam 0.5cm/< $28.20 Facility 1/1/2012 3/31/2012
11301 shvg skin les 1 trunk/arm/leg diam 0.6-1.0 cm $33.97 4/1/2012
11301 shvg skin les 1 trunk/arm/leg diam 0.6-1.0 cm $42.00 3/31/2012
11301 shvg skin les 1 trunk/arm/leg diam 0.6-1.0 cm $22.11 Facility 4/1/2014
11302 shvg skn lesion 1 trunk/arm/leg diam 1.1-2.0 cm $40.66 4/1/2012
11302 shvg skn lesion 1 trunk/arm/leg diam 1.1-2.0 cm $50.05 3/31/2012
11302 shvg skn lesion 1 trunk/arm/leg diam 1.1-2.0 cm $27.02 Facility 4/1/2014
11303 shvg skin lesion 1 trunk/arm/leg diam >2.0 cm $48.87 4/1/2012
11303 shvg skin lesion 1 trunk/arm/leg diam >2.0 cm $59.38 3/31/2012
11303 shvg skin lesion 1 trunk/arm/leg diam >2.0 cm $31.66 Facility 4/1/2014
11305 shaving skin lesion 1 s/n/h/f/g diam 0.5 cm/< $26.72 4/1/2012
11305 shaving skin lesion 1 s/n/h/f/g diam 0.5 cm/< $32.15 3/31/2012
11305 shaving skin lesion 1 s/n/h/f/g diam 0.5 cm/< $28.49 Facility 4/1/2012
11305 shaving skin lesion 1 s/n/h/f/g diam 0.5 cm/< $31.65 Facility 1/1/2012 3/31/2012
11306 shaving skin lesion 1 s/n/h/f/g diam 0.6-1.0 cm $36.68 4/1/2013
11306 shaving skin lesion 1 s/n/h/f/g diam 0.6-1.0 cm $36.38 4/1/2012 3/31/2013
11306 shaving skin lesion 1 s/n/h/f/g diam 0.6-1.0 cm $44.01 3/31/2012
11306 shaving skin lesion 1 s/n/h/f/g diam 0.6-1.0 cm $25.63 Facility 4/1/2014
11307 shaving skin lesion 1 s/n/h/f/g diam 1.1-2.0 cm $42.47 4/1/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
11307 shaving skin lesion 1 s/n/h/f/g diam 1.1-2.0 cm $51.26 3/31/2012
11307 shaving skin lesion 1 s/n/h/f/g diam 1.1-2.0 cm $29.48 Facility 4/1/2014
11308 shaving skin lesion 1 s/n/h/f/g diam >2.0 cm $50.53 4/1/2012
11308 shaving skin lesion 1 s/n/h/f/g diam >2.0 cm $62.40 3/31/2012
11308 shaving skin lesion 1 s/n/h/f/g diam >2.0 cm $36.56 Facility 4/1/2014
11310 shaving skin lesion 1 f/e/e/n/l/m diam 0.5 cm/< $31.79 4/1/2012
11310 shaving skin lesion 1 f/e/e/n/l/m diam 0.5 cm/< $38.46 3/31/2012
11310 shaving skin lesion 1 f/e/e/n/l/m diam 0.5 cm/< $18.97 Facility 4/1/2014
11311 shvg skin lesion 1 f/e/e/n/l/m diam 0.6-1.0 cm $39.64 4/1/2012
11311 shvg skin lesion 1 f/e/e/n/l/m diam 0.6-1.0 cm $48.12 3/31/2012
11311 shvg skin lesion 1 f/e/e/n/l/m diam 0.6-1.0 cm $27.63 Facility 4/1/2014
11312 shvg skin lesion 1 f/e/e/n/l/m diam 1.1-2.0 cm $45.43 4/1/2012
11312 shvg skin lesion 1 f/e/e/n/l/m diam 1.1-2.0 cm $55.91 3/31/2012
11312 shvg skin lesion 1 f/e/e/n/l/m diam 1.1-2.0 cm $31.31 Facility 4/1/2014
11313 shaving skin lesion 1 f/e/e/n/l/m diam >2.0 cm $59.66 4/1/2012
11313 shaving skin lesion 1 f/e/e/n/l/m diam >2.0 cm $70.78 3/31/2012
11313 shaving skin lesion 1 f/e/e/n/l/m diam >2.0 cm $42.12 Facility 4/1/2014
11420 exc b9 les mrgn xcp sk tg s/n/h/f/g 0.5 cm/< $47.44 4/1/2012
11420 exc b9 les mrgn xcp sk tg s/n/h/f/g 0.5 cm/< $54.88 3/31/2012
11420 exc b9 les mrgn xcp sk tg s/n/h/f/g 0.5 cm/< $33.96 Facility 4/1/2014
11421 exc b9 les mrgn xcp sk tg s/n/h/f/g 0.6-1.0cm $63.33 4/1/2012
11421 exc b9 les mrgn xcp sk tg s/n/h/f/g 0.6-1.0cm $70.37 3/31/2012
11421 exc b9 les mrgn xcp sk tg s/n/h/f/g 0.6-1.0cm $45.19 Facility 4/1/2014
11422 exc b9 les mrgn xcp sk tg s/n/h/f/g 1.1-2.0cm $70.82 4/1/2012
11422 exc b9 les mrgn xcp sk tg s/n/h/f/g 1.1-2.0cm $78.69 3/31/2012
11422 exc b9 les mrgn xcp sk tg s/n/h/f/g 1.1-2.0cm $52.78 Facility 4/1/2014
11423 exc b9 les mrgn xcp sk tg s/n/h/f/g 2.1-3.0cm $82.75 4/1/2012
11423 exc b9 les mrgn xcp sk tg s/n/h/f/g 2.1-3.0cm $91.94 3/31/2012
11423 exc b9 les mrgn xcp sk tg s/n/h/f/g 2.1-3.0cm $62.18 Facility 4/1/2014
11426 exc b9 les mrgn xcp sk tg s/n/h/f/g > 4.0cm $135.69 4/1/2012
11426 exc b9 les mrgn xcp sk tg s/n/h/f/g > 4.0cm $150.77 3/31/2012
11426 exc b9 les mrgn xcp sk tg s/n/h/f/g > 4.0cm $107.08 Facility 4/1/2014
11719 trimming nondystrophic nails any number $8.52 4/1/2012
11719 trimming nondystrophic nails any number $9.47 3/31/2012
11719 trimming nondystrophic nails any number $6.80 Facility 4/1/2012
11719 trimming nondystrophic nails any number $7.55 Facility 1/1/2012 3/31/2012
11720 debridement nail any method 1-5 $17.59 4/1/2012
11720 debridement nail any method 1-5 $19.54 3/31/2012
11720 debridement nail any method 1-5 $12.92 Facility 4/1/2012
11720 debridement nail any method 1-5 $14.35 Facility 1/1/2012 3/31/2012
11721 debridement nail any method 6/> $21.60 4/1/2012
11721 debridement nail any method 6/> $24.00 3/31/2012
11721 debridement nail any method 6/> $13.98 Facility 4/1/2014
11730 avulsion nail plate partial/complete simple 1 $40.93 4/1/2012
11730 avulsion nail plate partial/complete simple 1 $45.48 3/31/2012
11730 avulsion nail plate partial/complete simple 1 $29.02 Facility 4/1/2014
11732 avulsion nail plate partial/comp simple ea addl $19.03 4/1/2012
11732 avulsion nail plate partial/comp simple ea addl $21.14 3/31/2012
11732 avulsion nail plate partial/comp simple ea addl $17.97 Facility 4/1/2012
11732 avulsion nail plate partial/comp simple ea addl $19.97 Facility 1/1/2012 3/31/2012
11740 evacuation subungual hematoma $18.50 4/1/2012
11740 evacuation subungual hematoma $20.55 3/31/2012
11740 evacuation subungual hematoma $12.83 Facility 4/1/2014
11750 excision nail matrix permanent removal $87.99 4/1/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
11750 excision nail matrix permanent removal $97.77 3/31/2012
11750 excision nail matrix permanent removal $64.57 Facility 4/1/2014
11752 exc nail matrix prm rmvl w/amp tuft dstl phalanx $100.84 4/1/2012
11752 exc nail matrix prm rmvl w/amp tuft dstl phalanx $138.65 3/31/2012
11755 biopsy nail unit separate procedure $55.20 4/1/2012
11755 biopsy nail unit separate procedure $61.33 3/31/2012
11755 biopsy nail unit separate procedure $37.91 Facility 4/1/2014
11760 repair nail bed $73.40 4/1/2012
11760 repair nail bed $91.15 3/31/2012
11760 repair nail bed $59.76 Facility 4/1/2014
11762 reconstruction nail bed w/graft $103.14 4/1/2012
11762 reconstruction nail bed w/graft $123.30 3/31/2012
11762 reconstruction nail bed w/graft $94.37 Facility 4/1/2014
11765 wedge excision skin nail fold $51.86 4/1/2012
11765 wedge excision skin nail fold $57.62 3/31/2012
11765 wedge excision skin nail fold $25.73 Facility 4/1/2014
11900 injection intralesional up to & includ 7 lesions $22.73 4/1/2012
11900 injection intralesional up to & includ 7 lesions $25.26 3/31/2012
11900 injection intralesional up to & includ 7 lesions $13.16 Facility 4/1/2014
11901 injection intralesional >7 lesions $25.52 4/1/2012
11901 injection intralesional >7 lesions $31.54 3/31/2012
11901 injection intralesional >7 lesions $20.49 Facility 4/1/2014
12001 simple repair scalp/neck/ax/genit/trunk 2.5cm/< $64.72 4/1/2012
12001 simple repair scalp/neck/ax/genit/trunk 2.5cm/< $71.91 3/31/2012
12001 simple repair scalp/neck/ax/genit/trunk 2.5cm/< $43.60 Facility 4/1/2014
12001 simple repair scalp/neck/ax/genit/trunk 2.5cm/< $41.92 Facility 4/1/2012 3/31/2014
12001 simple repair scalp/neck/ax/genit/trunk 2.5cm/< $46.58 Facility 1/1/2012 3/31/2012
12044 repair intermediate n/h/f/xtrnl gent 7.6-12.5cm $112.21 4/1/2012
12044 repair intermediate n/h/f/xtrnl gent 7.6-12.5cm $146.64 3/31/2012
12044 repair intermediate n/h/f/xtrnl gent 7.6-12.5cm $86.07 Facility 4/1/2014
12047 repair intermediate n/h/f/xtrnl gent >30.0 cm $193.25 4/1/2014
12047 repair intermediate n/h/f/xtrnl gent >30.0 cm $197.73 4/1/2012 3/31/2014
12047 repair intermediate n/h/f/xtrnl gent >30.0 cm $219.70 3/31/2012
12047 repair intermediate n/h/f/xtrnl gent >30.0 cm $140.32 Facility 4/1/2014
13132 repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm $207.19 4/1/2012
13132 repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm $230.21 3/31/2012
13132 repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm $178.94 Facility 4/1/2014
13133 repair complex f/c/c/m/n/ax/g/h/f ea addl 5 cm/< $68.61 4/1/2012
13133 repair complex f/c/c/m/n/ax/g/h/f ea addl 5 cm/< $76.23 3/31/2012
13133 repair complex f/c/c/m/n/ax/g/h/f ea addl 5 cm/< $58.38 Facility 4/1/2014
14040 adjt tis trns/reargmt f/c/c/m/n/a/g/h/f 10sqcm/< $316.60 4/1/2012
14040 adjt tis trns/reargmt f/c/c/m/n/a/g/h/f 10sqcm/< $351.78 3/31/2012
14040 adjt tis trns/reargmt f/c/c/m/n/a/g/h/f 10sqcm/< $266.45 Facility 4/1/2014
14041 adjt/reargmt f/c/c/m/n/ax/g/h/f 10.1-30.0 sq cm $388.01 4/1/2014
14041 adjt/reargmt f/c/c/m/n/ax/g/h/f 10.1-30.0 sq cm $205.64 4/1/2012 3/31/2014
14041 adjt/reargmt f/c/c/m/n/ax/g/h/f 10.1-30.0 sq cm $431.12 3/31/2012
14041 adjt/reargmt f/c/c/m/n/ax/g/h/f 10.1-30.0 sq cm $356.84 Facility 4/1/2014
14301 adjnt tis trnsfr/reargmt any area 30.1-60 sq cm $464.70 4/1/2014
14301 adjnt tis trnsfr/reargmt any area 30.1-60 sq cm $374.30 4/1/2012 3/31/2014
14301 adjnt tis trnsfr/reargmt any area 30.1-60 sq cm $415.89 3/31/2012
14301 adjnt tis trnsfr/reargmt any area 30.1-60 sq cm $393.65 Facility 4/1/2014
14302 adjt tis trnsfr/reargmt defec ea addl 30 sqcm/< $102.15 4/1/2014
14302 adjt tis trnsfr/reargmt defec ea addl 30 sqcm/< $82.45 4/1/2012 3/31/2014
14302 adjt tis trnsfr/reargmt defec ea addl 30 sqcm/< $91.61 3/31/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
15120 split agrft f/s/n/h/f/g/m/d gt 1st 100 cm/</1 % $364.78 4/1/2012
15120 split agrft f/s/n/h/f/g/m/d gt 1st 100 cm/</1 % $405.31 3/31/2012
15120 split agrft f/s/n/h/f/g/m/d gt 1st 100 cm/</1 % $317.05 Facility 4/1/2014
15121 split agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 1 % $125.35 4/1/2014
15121 split agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 1 % $66.43 4/1/2012 3/31/2014
15121 split agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 1 % $139.27 3/31/2012
15121 split agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 1 % $82.16 Facility 4/1/2014
15121 split agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 1 % $114.07 Facility 4/1/2012 3/31/2014
15121 split agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea 1 % $126.74 Facility 1/1/2012 3/31/2012
15275 sub grft f/s/n/h/f/g/m/d <100scm 1st 25 scm $68.49 4/1/2014
15275 sub grft f/s/n/h/f/g/m/d <100scm 1st 25 scm $45.59 Facility 4/1/2014
15276 sub grft f/s/n/h/f/g/m/d <100scm ea addl 25 scm $15.09 4/1/2014
15276 sub grft f/s/n/h/f/g/m/d <100scm ea addl 25 scm $11.27 Facility 4/1/2014
15320 algrft temp closure f/s/n/h/f/g/m/d 1st 100cm $180.71 12/31/2011
15850 removal sutures under anesthesia same surgeon $35.78 4/1/2012
15850 removal sutures under anesthesia same surgeon $67.50 3/31/2012
15851 removal sutures under anesthesia other surgeon $43.51 4/1/2012
15851 removal sutures under anesthesia other surgeon $48.34 3/31/2012
15851 removal sutures under anesthesia other surgeon $21.27 Facility 4/1/2014
15851 removal sutures under anesthesia other surgeon $39.36 Facility 4/1/2012 3/31/2014
15851 removal sutures under anesthesia other surgeon $43.73 Facility 1/1/2012 3/31/2012
16000 initial tx 1st degree burn local tx $30.97 4/1/2012
16000 initial tx 1st degree burn local tx $34.41 3/31/2012
16000 initial tx 1st degree burn local tx $21.23 Facility 4/1/2014
16020 drs&/dbrdmt prtl-thkns burns 1st/sbsq small $36.32 4/1/2012
16020 drs&/dbrdmt prtl-thkns burns 1st/sbsq small $40.36 3/31/2012
16020 drs&/dbrdmt prtl-thkns burns 1st/sbsq small $24.80 Facility 4/1/2014
16020 drs&/dbrdmt prtl-thkns burns 1st/sbsq small $36.32 Facility 4/1/2012 3/31/2014
16020 drs&/dbrdmt prtl-thkns burns 1st/sbsq small $40.30 Facility 3/31/2012
17000 destruction premalignant lesion 1st $31.71 4/1/2012
17000 destruction premalignant lesion 1st $35.23 3/31/2012
17000 destruction premalignant lesion 1st $19.96 Facility 4/1/2014
17003 destruction premalignant lesion 2-14 ea $5.60 4/1/2012
17003 destruction premalignant lesion 2-14 ea $6.22 3/31/2012
17003 destruction premalignant lesion 2-14 ea $2.32 Facility 4/1/2014
17003 destruction premalignant lesion 2-14 ea $3.74 Facility 4/1/2012 3/31/2014
17003 destruction premalignant lesion 2-14 ea $4.15 Facility 1/1/2012 3/31/2012
17110 destruction benign lesions up to 14 $41.55 4/1/2012
17110 destruction benign lesions up to 14 $46.17 3/31/2012
17110 destruction benign lesions up to 14 $23.69 Facility 4/1/2014
17111 destruction benign lesions 15/> $50.75 4/1/2012
17111 destruction benign lesions 15/> $56.39 3/31/2012
17111 destruction benign lesions 15/> $30.36 Facility 4/1/2014
17250 chemical cauterization granulation tissue $31.28 4/1/2012
17250 chemical cauterization granulation tissue $34.75 3/31/2012
17250 chemical cauterization granulation tissue $15.14 Facility 4/1/2014
17250 chemical cauterization granulation tissue $30.61 Facility 4/1/2012 3/31/2014
17250 chemical cauterization granulation tissue $34.01 Facility 1/1/2012 3/31/2012
20550 injection 1 tendon sheath/ligament aponeurosis $26.01 4/1/2012
20550 injection 1 tendon sheath/ligament aponeurosis $28.90 3/31/2012
20550 injection 1 tendon sheath/ligament aponeurosis $18.21 Facility 4/1/2014
20551 injection single tendon origin/insertion $25.68 4/1/2012
20551 injection single tendon origin/insertion $28.53 3/31/2012
20551 injection single tendon origin/insertion $19.83 Facility 4/1/2014
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
20552 injection single/mlt trigger point 1/2 muscles $25.68 4/1/2012
20552 injection single/mlt trigger point 1/2 muscles $28.53 3/31/2012
20552 injection single/mlt trigger point 1/2 muscles $15.76 Facility 4/1/2014
20600 arthrocentesis aspir&/injection small jt/bursa $24.03 4/1/2012
20600 arthrocentesis aspir&/injection small jt/bursa $26.70 3/31/2012
20600 arthrocentesis aspir&/injection small jt/bursa $18.53 Facility 4/1/2014
20605 arthrocentesis aspir&/injection interm jt/burs $25.60 4/1/2012
20605 arthrocentesis aspir&/injection interm jt/burs $28.44 3/31/2012
20605 arthrocentesis aspir&/injection interm jt/burs $19.06 Facility 4/1/2014
20612 aspiration&/injection ganglion cyst any locatj $25.34 4/1/2012
20612 aspiration&/injection ganglion cyst any locatj $28.15 3/31/2012
20612 aspiration&/injection ganglion cyst any locatj $19.53 Facility 4/1/2014
20670 removal implant superficial separate procedure $221.90 4/1/2012
20670 removal implant superficial separate procedure $246.55 3/31/2012
20670 removal implant superficial separate procedure $68.65 Facility 4/1/2014
20670 removal implant superficial separate procedure $123.91 Facility 4/1/2012 3/31/2014
20670 removal implant superficial separate procedure $137.68 Facility 1/1/2012 3/31/2012
20680 removal implant deep $254.55 4/1/2012
20680 removal implant deep $282.83 3/31/2012
20680 removal implant deep $126.98 Facility 4/1/2014
20690 application uniplane external fixation system $110.87 4/1/2012
20690 application uniplane external fixation system $123.19 3/31/2012
20692 application multiplane external fixation system $404.24 4/1/2012
20692 application multiplane external fixation system $449.16 3/31/2012
20694 removal external fixation system under anes $198.87 4/1/2012
20694 removal external fixation system under anes $220.97 3/31/2012
20694 removal external fixation system under anes $148.55 Facility 4/1/2014
20975 electrical stimulation bone healing invasive $80.51 4/1/2012
20975 electrical stimulation bone healing invasive $90.90 3/31/2012
27600 dcmprn fasct leg ant&/lat compartments only $185.17 4/1/2012
27600 dcmprn fasct leg ant&/lat compartments only $205.74 3/31/2012
27603 incision&drainage leg/ankle abscess/hematoma $218.88 4/1/2014
27603 incision&drainage leg/ankle abscess/hematoma $116.01 4/1/2012 3/31/2014
27603 incision&drainage leg/ankle abscess/hematoma $243.20 3/31/2012
27603 incision&drainage leg/ankle abscess/hematoma $164.83 Facility 4/1/2014
27604 incision&drainage leg/ankle infected bursa $187.15 4/1/2014
27604 incision&drainage leg/ankle infected bursa $99.19 4/1/2012 3/31/2014
27604 incision&drainage leg/ankle infected bursa $207.95 3/31/2012
27604 incision&drainage leg/ankle infected bursa $152.74 Facility 4/1/2014
27605 tenotomy prq achilles tendon spx local anes $181.28 4/1/2012
27605 tenotomy prq achilles tendon spx local anes $201.42 3/31/2012
27605 tenotomy prq achilles tendon spx local anes $94.26 Facility 4/1/2014
27605 tenotomy prq achilles tendon spx local anes $158.81 Facility 4/1/2012 3/31/2014
27605 tenotomy prq achilles tendon spx local anes $176.45 Facility 1/1/2012 3/31/2012
27606 tenotomy prq achilles tendon spx general anes $137.03 4/1/2012
27606 tenotomy prq achilles tendon spx general anes $152.26 3/31/2012
27607 incision leg/ankle $258.91 4/1/2014
27607 incision leg/ankle $137.22 4/1/2012 3/31/2014
27607 incision leg/ankle $287.67 3/31/2012
27610 arthrotomy ankle w/expl drainage/removal fb $279.99 4/1/2014
27610 arthrotomy ankle w/expl drainage/removal fb $283.84 4/1/2012 3/31/2014
27610 arthrotomy ankle w/expl drainage/removal fb $315.38 3/31/2012
27612 arthrt pst capsul rls ankle w/wo achll tdn lngth $244.08 4/1/2014
27612 arthrt pst capsul rls ankle w/wo achll tdn lngth $247.76 4/1/2012 3/31/2014
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
27612 arthrt pst capsul rls ankle w/wo achll tdn lngth $275.29 3/31/2012
27613 biopsy soft tissue leg/ankle area superficial $94.08 4/1/2014
27613 biopsy soft tissue leg/ankle area superficial $49.86 4/1/2012 3/31/2014
27613 biopsy soft tissue leg/ankle area superficial $104.53 3/31/2012
27613 biopsy soft tissue leg/ankle area superficial $70.86 Facility 4/1/2014
27614 biopsy soft tissue leg/ankle area deep $226.75 4/1/2014
27614 biopsy soft tissue leg/ankle area deep $120.18 4/1/2012 3/31/2014
27614 biopsy soft tissue leg/ankle area deep $251.94 3/31/2012
27614 biopsy soft tissue leg/ankle area deep $183.08 Facility 4/1/2014
27615 rad resection tumor soft tissue leg/ankle <5cm $399.50 4/1/2014
27615 rad resection tumor soft tissue leg/ankle <5cm $211.73 4/1/2012 3/31/2014
27615 rad resection tumor soft tissue leg/ankle <5cm $443.89 3/31/2012
27616 rad rescj tum soft tissue leg/ankle 5 cm/> $563.24 4/1/2014
27616 rad rescj tum soft tissue leg/ankle 5 cm/> $241.10 4/1/2012 3/31/2014
27616 rad rescj tum soft tissue leg/ankle 5 cm/> $505.45 3/31/2012
27618 exc tumor soft tissue leg/ankle subq <3cm $197.34 4/1/2012
27618 exc tumor soft tissue leg/ankle subq <3cm $219.27 3/31/2012
27618 exc tumor soft tissue leg/ankle subq <3cm $164.55 Facility 4/1/2014
27619 exc tumor soft tissue leg/ankle subfascial <5cm $320.21 4/1/2012
27619 exc tumor soft tissue leg/ankle subfascial <5cm $355.79 3/31/2012
27619 exc tumor soft tissue leg/ankle subfascial <5cm $262.42 Facility 4/1/2014
27620 arthrt ankle w/expl w/wo bx w/wo rmvl loose/fb $207.50 4/1/2012
27620 arthrt ankle w/expl w/wo bx w/wo rmvl loose/fb $230.55 3/31/2012
27625 arthrotomy w/synovectomy ankle $269.47 4/1/2012
27625 arthrotomy w/synovectomy ankle $299.41 3/31/2012
27626 arthrotomy w/synovectomy ankle tenosynovectomy $290.15 4/1/2014
27626 arthrotomy w/synovectomy ankle tenosynovectomy $153.78 4/1/2012 3/31/2014
27626 arthrotomy w/synovectomy ankle tenosynovectomy $322.39 3/31/2012
27630 excision lesion tendon sheath/capsule leg&/ank $217.72 4/1/2012
27630 excision lesion tendon sheath/capsule leg&/ank $241.91 3/31/2012
27630 excision lesion tendon sheath/capsule leg&/ank $166.10 Facility 4/1/2014
27632 excision tumor soft tissue leg/ankle subq 3 cm/> $181.59 4/1/2014
27632 excision tumor soft tissue leg/ankle subq 3 cm/> $77.65 4/1/2012 3/31/2014
27632 excision tumor soft tissue leg/ankle subq 3 cm/> $162.79 3/31/2012
27634 exc tumor soft tissue leg/ankle subfasc 5 cm/> $296.50 4/1/2014
27634 exc tumor soft tissue leg/ankle subfasc 5 cm/> $126.89 4/1/2012 3/31/2014
27634 exc tumor soft tissue leg/ankle subfasc 5 cm/> $266.01 3/31/2012
27648 injection ankle arthrography $75.42 4/1/2014
27648 injection ankle arthrography $39.97 4/1/2012 3/31/2014
27648 injection ankle arthrography $83.80 3/31/2012
27648 injection ankle arthrography $23.63 Facility 4/1/2014
27648 injection ankle arthrography $44.08 Facility 4/1/2012 3/31/2014
27648 injection ankle arthrography $48.98 Facility 1/1/2012 3/31/2012
27650 repair primary open/prq ruptured achilles tendon $314.98 4/1/2014
27650 repair primary open/prq ruptured achilles tendon $166.93 4/1/2012 3/31/2014
27650 repair primary open/prq ruptured achilles tendon $349.97 3/31/2012
27652 rpr primary open/prq ruptured achilles w/graft $336.08 4/1/2012
27652 rpr primary open/prq ruptured achilles w/graft $373.42 3/31/2012
27654 repair secondary achilles tendon w/wo graft $353.64 4/1/2012
27654 repair secondary achilles tendon w/wo graft $392.93 3/31/2012
27658 repair flexor tendon leg primary w/o graft each $172.85 1/1/2014
27676 repair dislocating peroneal tendon w/fib osteot $277.38 4/1/2014
27676 repair dislocating peroneal tendon w/fib osteot $253.58 4/1/2012 3/31/2014
27676 repair dislocating peroneal tendon w/fib osteot $301.25 3/31/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
27680 tenolysis flxr/xtnsr tendon leg&/ankle 1 each $197.24 1/1/2014
27685 lngth/shrt tendon leg/ankle 1 tendon spx $263.07 4/1/2012
27685 lngth/shrt tendon leg/ankle 1 tendon spx $292.30 3/31/2012
27685 lngth/shrt tendon leg/ankle 1 tendon spx $217.13 Facility 4/1/2014
27687 gastrocnemius recession $210.33 4/1/2012
27687 gastrocnemius recession $233.70 1/1/2012 3/31/2012
27691 tr/trnspl 1 tdn w/musc redirion/rerouting dp $324.61 4/1/2012
27691 tr/trnspl 1 tdn w/musc redirion/rerouting dp $360.68 3/31/2012
27698 repair secondary disrupted ligament ankle coltrl $359.63 4/1/2012
27698 repair secondary disrupted ligament ankle coltrl $399.59 3/31/2012
27720 repair nonunion/malunion tibia w/o graft $388.50 4/1/2012
27720 repair nonunion/malunion tibia w/o graft $431.67 3/31/2012
27829 open tx distal tibiofibular joint disruption $278.24 4/1/2012
27829 open tx distal tibiofibular joint disruption $309.16 3/31/2012
27870 arthrodesis ankle open $458.26 4/1/2012
27870 arthrodesis ankle open $509.18 3/31/2012
28001 incision&drainage bursa foot $101.64 4/1/2014
28001 incision&drainage bursa foot $111.38 4/1/2012 3/31/2014
28001 incision&drainage bursa foot $123.75 3/31/2012
28001 incision&drainage bursa foot $84.92 Facility 4/1/2014
28002 i&d below fascia foot 1 bursal space $207.14 4/1/2012
28002 i&d below fascia foot 1 bursal space $230.16 3/31/2012
28002 i&d below fascia foot 1 bursal space $151.68 Facility 4/1/2014
28003 i&d below fascia foot multiple areas $287.62 4/1/2012
28003 i&d below fascia foot multiple areas $319.58 3/31/2012
28003 i&d below fascia foot multiple areas $249.60 Facility 4/1/2014
28005 incision bone cortex foot $272.93 4/1/2012
28005 incision bone cortex foot $303.26 3/31/2012
28008 fasciotomy foot&/toe $176.49 4/1/2012
28008 fasciotomy foot&/toe $196.10 3/31/2012
28008 fasciotomy foot&/toe $138.89 Facility 4/1/2014
28010 tenotomy percutaneous toe single tendon $98.96 4/1/2012
28010 tenotomy percutaneous toe single tendon $109.95 3/31/2012
28011 tenotomy percutaneous toe multiple tendon $140.04 4/1/2012
28011 tenotomy percutaneous toe multiple tendon $155.60 3/31/2012
28020 arthrt w/expl drg/rmvl loose/fb ntrtrsl/tars jt $196.24 4/1/2012
28020 arthrt w/expl drg/rmvl loose/fb ntrtrsl/tars jt $234.40 3/31/2012
28020 arthrt w/expl drg/rmvl loose/fb ntrtrsl/tars jt $165.72 Facility 4/1/2014
28022 arthrt w/expl drg/rmvl loose/fb mttarphlngl jt $175.75 4/1/2014
28022 arthrt w/expl drg/rmvl loose/fb mttarphlngl jt $193.10 4/1/2012 3/31/2014
28022 arthrt w/expl drg/rmvl loose/fb mttarphlngl jt $214.55 3/31/2012
28022 arthrt w/expl drg/rmvl loose/fb mttarphlngl jt $153.99 Facility 4/1/2014
28024 arthrt w/expl drg/rmvl loose/fb iphal jt $184.63 4/1/2012
28024 arthrt w/expl drg/rmvl loose/fb iphal jt $205.14 3/31/2012
28024 arthrt w/expl drg/rmvl loose/fb iphal jt $149.20 Facility 4/1/2014
28035 release tarsal tunnel $210.03 4/1/2012
28035 release tarsal tunnel $233.37 3/31/2012
28035 release tarsal tunnel $166.29 Facility 4/1/2014
28039 excision tumor soft tis foot/toe subq 1.5 cm/> $210.91 4/1/2012
28039 excision tumor soft tis foot/toe subq 1.5 cm/> $188.94 3/31/2012
28039 excision tumor soft tis foot/toe subq 1.5 cm/> $151.75 Facility 4/1/2014
28041 exc tumor soft tissue foot/toe subfasc 1.5 cm/> $199.48 4/1/2012
28041 exc tumor soft tissue foot/toe subfasc 1.5 cm/> $179.04 3/31/2012
28043 excision tumor soft tissue foot/toe subq <1.5cm $141.10 4/1/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28043 excision tumor soft tissue foot/toe subq <1.5cm $156.78 3/31/2012
28043 excision tumor soft tissue foot/toe subq <1.5cm $120.57 Facility 4/1/2014
28045 exc tumor soft tissue foot/toe subfasc <1.5cm $196.41 4/1/2012
28045 exc tumor soft tissue foot/toe subfasc <1.5cm $218.23 3/31/2012
28045 exc tumor soft tissue foot/toe subfasc <1.5cm $150.84 Facility 4/1/2014
28046 rad resection tumor soft tissue foot/toe <3cm $341.42 4/1/2012
28046 rad resection tumor soft tissue foot/toe <3cm $402.42 3/31/2012
28046 rad resection tumor soft tissue foot/toe <3cm $304.24 Facility 4/1/2014
28047 rad resection tumor soft tissue foot/toe 3 cm/> $423.84 4/1/2012
28047 rad resection tumor soft tissue foot/toe 3 cm/> $380.83 3/31/2012
28050 arthrt w/bx intertarsal/tarsometatarsal joint $162.94 4/1/2013
28050 arthrt w/bx intertarsal/tarsometatarsal joint $280.50 4/1/2012 3/31/2013
28050 arthrt w/bx intertarsal/tarsometatarsal joint $203.58 3/31/2012
28050 arthrt w/bx intertarsal/tarsometatarsal joint $141.83 Facility 4/1/2014
28052 arthrtomy w/bx metatarsophalangeal joint $156.85 4/1/2012
28052 arthrtomy w/bx metatarsophalangeal joint $190.47 3/31/2012
28052 arthrtomy w/bx metatarsophalangeal joint $132.83 Facility 4/1/2014
28054 arthrtomy w/bx interphalangeal joint $160.18 4/1/2012
28054 arthrtomy w/bx interphalangeal joint $177.98 3/31/2012
28054 arthrtomy w/bx interphalangeal joint $119.92 Facility 4/1/2014
28055 neurectomy intrinsic musculature of foot $176.22 4/1/2012
28055 neurectomy intrinsic musculature of foot $195.80 3/31/2012
28060 fasciectomy plantar fascia partial spx $207.54 4/1/2012
28060 fasciectomy plantar fascia partial spx $230.60 3/31/2012
28060 fasciectomy plantar fascia partial spx $165.25 Facility 4/1/2014
28062 fasciotomy plantar fascia radical spx $259.92 4/1/2012
28062 fasciotomy plantar fascia radical spx $288.80 3/31/2012
28062 fasciotomy plantar fascia radical spx $192.45 Facility 4/1/2014
28070 synvct intertarsal/tarsometatarsal jt ea spx $185.00 4/1/2012
28070 synvct intertarsal/tarsometatarsal jt ea spx $228.55 3/31/2012
28070 synvct intertarsal/tarsometatarsal jt ea spx $162.27 Facility 4/1/2014
28072 synovectomy metatarsophalangeal joint each $179.94 4/1/2012
28072 synovectomy metatarsophalangeal joint each $222.98 3/31/2012
28072 synovectomy metatarsophalangeal joint each $160.13 Facility 4/1/2014
28080 excision interdigital morton neuroma single each $195.81 4/1/2012
28080 excision interdigital morton neuroma single each $217.57 3/31/2012
28080 excision interdigital morton neuroma single each $129.69 Facility 4/1/2014
28086 synovectomy tendon sheath foot flexor $224.41 4/1/2012
28086 synovectomy tendon sheath foot flexor $254.24 3/31/2012
28086 synovectomy tendon sheath foot flexor $170.84 Facility 4/1/2014
28088 synovectomy tendon sheath foot extensor $169.85 4/1/2012
28088 synovectomy tendon sheath foot extensor $204.76 3/31/2012
28088 synovectomy tendon sheath foot extensor $139.65 Facility 4/1/2014
28090 exc lesion tendon sheath/capsule w/synvct foot $186.53 4/1/2012
28090 exc lesion tendon sheath/capsule w/synvct foot $207.26 3/31/2012
28090 exc lesion tendon sheath/capsule w/synvct foot $142.34 Facility 4/1/2014
28092 exc lesion tendon sheath/capsule w/synvct toe ea $170.10 4/1/2012
28092 exc lesion tendon sheath/capsule w/synvct toe ea $189.00 3/31/2012
28092 exc lesion tendon sheath/capsule w/synvct toe ea $128.40 Facility 4/1/2014
28100 excision/curettage cyst/tumor talus/calcaneus $240.56 4/1/2012
28100 excision/curettage cyst/tumor talus/calcaneus $274.03 3/31/2012
28100 excision/curettage cyst/tumor talus/calcaneus $187.48 Facility 4/1/2014
28102 exc/curtg cst/b9 tum talus/clcns w/iliac/agrft $249.22 4/1/2012
28102 exc/curtg cst/b9 tum talus/clcns w/iliac/agrft $276.91 3/31/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28103 exc/curettage cyst/tumor talus/calcaneus algrft $202.64 4/1/2012
28103 exc/curettage cyst/tumor talus/calcaneus algrft $225.15 3/31/2012
28104 exc/curtg bone cyst/b9 tumortarsal/metatarsal $206.78 4/1/2012
28104 exc/curtg bone cyst/b9 tumortarsal/metatarsal $229.75 3/31/2012
28104 exc/curtg bone cyst/b9 tumortarsal/metatarsal $164.07 Facility 4/1/2014
28106 exc/curtg cst/b9 tum tarsal/metar w/iliac/agrft $212.34 4/1/2012
28106 exc/curtg cst/b9 tum tarsal/metar w/iliac/agrft $235.93 3/31/2012
28107 exc/curtg cst/b9 tum tarsal/metar w/algrft $214.69 4/1/2012
28107 exc/curtg cst/b9 tum tarsal/metar w/algrft $253.37 3/31/2012
28107 exc/curtg cst/b9 tum tarsal/metar w/algrft $177.03 Facility 4/1/2014
28108 exc/curtg cst/b9 tum phalanges foot $173.09 4/1/2012
28108 exc/curtg cst/b9 tum phalanges foot $192.32 3/31/2012
28108 exc/curtg cst/b9 tum phalanges foot $133.88 Facility 4/1/2014
28110 ostectomy prtl 5th metar head spx $182.24 4/1/2012
28110 ostectomy prtl 5th metar head spx $202.49 3/31/2012
28110 ostectomy prtl 5th metar head spx $132.06 Facility 4/1/2014
28111 ostectomy complete 1st metatarsal head $210.42 4/1/2012
28111 ostectomy complete 1st metatarsal head $233.80 3/31/2012
28111 ostectomy complete 1st metatarsal head $157.47 Facility 4/1/2014
28112 ostectomy complete other metatarsal head 2/3/4 $197.50 4/1/2012
28112 ostectomy complete other metatarsal head 2/3/4 $219.44 3/31/2012
28112 ostectomy complete other metatarsal head 2/3/4 $146.08 Facility 4/1/2014
28113 ostectomy complete 5th metatarsal head $233.06 4/1/2012
28113 ostectomy complete 5th metatarsal head $258.96 3/31/2012
28113 ostectomy complete 5th metatarsal head $163.63 Facility 4/1/2014
28114 ostc compl all metar heads w/prtl prox phalangc $431.99 4/1/2012
28114 ostc compl all metar heads w/prtl prox phalangc $479.99 3/31/2012
28114 ostc compl all metar heads w/prtl prox phalangc $329.13 Facility 4/1/2014
28116 ostectomy tarsal coalition $305.70 4/1/2012
28116 ostectomy tarsal coalition $339.67 3/31/2012
28116 ostectomy tarsal coalition $235.82 Facility 4/1/2014
28118 ostectomy calcaneus $235.61 4/1/2012
28118 ostectomy calcaneus $261.79 3/31/2012
28118 ostectomy calcaneus $187.69 Facility 4/1/2014
28119 ostectomy calcaneus spur w/wo plntar fascial rls $210.96 4/1/2012
28119 ostectomy calcaneus spur w/wo plntar fascial rls $234.40 3/31/2012
28119 ostectomy calcaneus spur w/wo plntar fascial rls $165.71 Facility 4/1/2014
28120 partial excision bone talus/calcaneus $238.82 4/1/2012
28120 partial excision bone talus/calcaneus $265.35 3/31/2012
28120 partial excision bone talus/calcaneus $177.89 Facility 4/1/2014
28122 prtl exc b1 tarsal/metar b1 xcp talus/calcaneus $273.39 4/1/2012
28122 prtl exc b1 tarsal/metar b1 xcp talus/calcaneus $303.77 3/31/2012
28122 prtl exc b1 tarsal/metar b1 xcp talus/calcaneus $228.27 Facility 4/1/2014
28124 partical excision bone phalanx toe $192.48 4/1/2012
28124 partical excision bone phalanx toe $213.87 3/31/2012
28124 partical excision bone phalanx toe $152.93 Facility 4/1/2014
28126 resection partial/complete phalangeal base each $154.31 4/1/2012
28126 resection partial/complete phalangeal base each $171.45 3/31/2012
28126 resection partial/complete phalangeal base each $117.17 Facility 4/1/2014
28130 talectomy astragalectomy $269.75 4/1/2012
28130 talectomy astragalectomy $317.00 3/31/2012
28140 metatarsectomy $252.53 4/1/2012
28140 metatarsectomy $290.34 3/31/2012
28140 metatarsectomy $212.59 Facility 4/1/2014
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28150 phalangectomy toe each toe $174.17 4/1/2012
28150 phalangectomy toe each toe $193.52 3/31/2012
28150 phalangectomy toe each toe $133.10 Facility 4/1/2014
28153 resection condyle distal end phalanx each toe $160.20 4/1/2012
28153 resection condyle distal end phalanx each toe $178.00 3/31/2012
28153 resection condyle distal end phalanx each toe $114.90 Facility 4/1/2014
28160 hemiphalangectomy/interphalangeal joint exc toe $164.92 4/1/2012
28160 hemiphalangectomy/interphalangeal joint exc toe $183.24 3/31/2012
28160 hemiphalangectomy/interphalangeal joint exc toe $127.13 Facility 4/1/2014
28171 rad rescj tumor tarsal except talus/calcaneus $276.66 4/1/2012
28171 rad rescj tumor tarsal except talus/calcaneus $307.06 3/31/2012
28173 radical resection tumor metatarsal $295.12 4/1/2012
28173 radical resection tumor metatarsal $430.20 3/31/2012
28173 radical resection tumor metatarsal $256.16 Facility 4/1/2014
28175 radical resection tumor phalanx or toe $210.24 4/1/2012
28175 radical resection tumor phalanx or toe $250.55 3/31/2012
28175 radical resection tumor phalanx or toe $177.77 Facility 4/1/2014
28190 removal foreign body foot subcutaneous $100.56 4/1/2012
28190 removal foreign body foot subcutaneous $111.73 3/31/2012
28190 removal foreign body foot subcutaneous $61.99 Facility 4/1/2014
28192 removal foreign body foot deep $193.10 4/1/2012
28192 removal foreign body foot deep $214.55 3/31/2012
28192 removal foreign body foot deep $149.58 Facility 4/1/2014
28193 removal foreign body foot complicated $202.60 4/1/2014
28193 removal foreign body foot complicated $219.74 4/1/2012 3/31/2014
28193 removal foreign body foot complicated $244.16 3/31/2012
28193 removal foreign body foot complicated $175.33 Facility 4/1/2014
28200 rpr tdn flxr foot 1/2 w/o free grafg each tendon $190.40 4/1/2012
28200 rpr tdn flxr foot 1/2 w/o free grafg each tendon $211.56 3/31/2012
28200 rpr tdn flxr foot 1/2 w/o free grafg each tendon $147.63 Facility 4/1/2014
28202 rpr tendon flxr foot sec w/free graft ea tendon $250.99 4/1/2014
28202 rpr tendon flxr foot sec w/free graft ea tendon $259.51 4/1/2012 3/31/2014
28202 rpr tendon flxr foot sec w/free graft ea tendon $288.34 3/31/2012
28202 rpr tendon flxr foot sec w/free graft ea tendon $206.83 Facility 4/1/2014
28208 repair tendon extensor foot 1/2 each tendon $182.01 4/1/2012
28208 repair tendon extensor foot 1/2 each tendon $202.23 3/31/2012
28208 repair tendon extensor foot 1/2 each tendon $139.06 Facility 4/1/2014
28210 rpr tendon xtnsr foot sec w/free graft ea tendon $224.86 4/1/2012
28210 rpr tendon xtnsr foot sec w/free graft ea tendon $265.52 3/31/2012
28210 rpr tendon xtnsr foot sec w/free graft ea tendon $189.31 Facility 4/1/2014
28220 tenolysis flexor foot single tendon $164.08 4/1/2012
28220 tenolysis flexor foot single tendon $201.10 3/31/2012
28220 tenolysis flexor foot single tendon $143.79 Facility 4/1/2014
28222 tenolysis flexor foot multiple tendons $194.37 4/1/2012
28222 tenolysis flexor foot multiple tendons $233.97 3/31/2012
28222 tenolysis flexor foot multiple tendons $176.36 Facility 4/1/2014
28225 tenolysis extensor foot single tendon $140.87 4/1/2012
28225 tenolysis extensor foot single tendon $175.55 3/31/2012
28225 tenolysis extensor foot single tendon $118.47 Facility 4/1/2014
28226 tenolysis extensor foot multiple tendon $166.14 4/1/2012
28226 tenolysis extensor foot multiple tendon $207.00 3/31/2012
28226 tenolysis extensor foot multiple tendon $149.10 Facility 4/1/2014
28230 tx opn tendon flexor foot single/mult tendon spx $174.48 4/1/2012
28230 tx opn tendon flexor foot single/mult tendon spx $193.87 3/31/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28230 tx opn tendon flexor foot single/mult tendon spx $142.49 Facility 4/1/2014
28232 tx open tendon flexor toe 1 tendon spx $154.48 4/1/2012
28232 tx open tendon flexor toe 1 tendon spx $171.64 3/31/2012
28232 tx open tendon flexor toe 1 tendon spx $120.01 Facility 4/1/2014
28234 tenotomy open extensor foot/toe each tendon $158.81 4/1/2012
28234 tenotomy open extensor foot/toe each tendon $176.46 3/31/2012
28234 tenotomy open extensor foot/toe each tendon $120.18 Facility 4/1/2014
28238 rcnstj pst tibl tdn w/exc accessory tarsl navclr $282.09 4/1/2012
28238 rcnstj pst tibl tdn w/exc accessory tarsl navclr $313.43 3/31/2012
28238 rcnstj pst tibl tdn w/exc accessory tarsl navclr $231.79 Facility 4/1/2014
28240 tenotomy lengthening/rls abductor hallucis musc $160.47 4/1/2014
28240 tenotomy lengthening/rls abductor hallucis musc $177.10 4/1/2012 3/31/2014
28240 tenotomy lengthening/rls abductor hallucis musc $196.78 3/31/2012
28240 tenotomy lengthening/rls abductor hallucis musc $141.81 Facility 4/1/2014
28250 division plantar fascia&muscle spx $207.62 4/1/2012
28250 division plantar fascia&muscle spx $440.90 3/31/2012
28250 division plantar fascia&muscle spx $183.44 Facility 4/1/2014
28250 division plantar fascia&muscle spx $338.18 Facility 4/1/2012 3/31/2014
28250 division plantar fascia&muscle spx $375.76 Facility 1/1/2012 3/31/2012
28260 capsulotomy midfoot medial release only spx $259.43 4/1/2012
28260 capsulotomy midfoot medial release only spx $310.67 3/31/2012
28260 capsulotomy midfoot medial release only spx $237.84 Facility 4/1/2014
28261 capsulotomy midfoot w/tendon lengthening $369.53 4/1/2012
28261 capsulotomy midfoot w/tendon lengthening $451.41 3/31/2012
28261 capsulotomy midfoot w/tendon lengthening $348.26 Facility 4/1/2014
28262 capsul midfoot w/pst talotibl capsul&tdn lngth $535.35 4/1/2012
28262 capsul midfoot w/pst talotibl capsul&tdn lngth $636.81 3/31/2012
28262 capsul midfoot w/pst talotibl capsul&tdn lngth $492.50 Facility 4/1/2014
28264 capsulotomy midtarsal $329.95 4/1/2012
28264 capsulotomy midtarsal $393.75 3/31/2012
28264 capsulotomy midtarsal $322.65 Facility 4/1/2014
28270 capsul mttarphlngl jt w/wo tenorrhaphy ea jt spx $191.88 4/1/2012
28270 capsul mttarphlngl jt w/wo tenorrhaphy ea jt spx $213.20 3/31/2012
28270 capsul mttarphlngl jt w/wo tenorrhaphy ea jt spx $153.56 Facility 4/1/2014
28272 capsulotomy iphal joint each joint spx $141.78 4/1/2014
28272 capsulotomy iphal joint each joint spx $157.91 4/1/2012 3/31/2014
28272 capsulotomy iphal joint each joint spx $175.45 3/31/2012
28272 capsulotomy iphal joint each joint spx $120.19 Facility 4/1/2014
28280 syndactylization toes $203.34 4/1/2014
28280 syndactylization toes $215.39 4/1/2012 3/31/2014
28280 syndactylization toes $239.32 3/31/2012
28280 syndactylization toes $174.77 Facility 4/1/2014
28285 correction hammertoe $186.71 4/1/2012
28285 correction hammertoe $207.46 3/31/2012
28285 correction hammertoe $145.22 Facility 4/1/2014
28286 correction cock-up 5th toe w/plastic closure $166.69 4/1/2012
28286 correction cock-up 5th toe w/plastic closure $204.06 3/31/2012
28286 correction cock-up 5th toe w/plastic closure $141.69 Facility 4/1/2014
28288 ostc prtl exostc/condylc metar head $233.15 4/1/2012
28288 ostc prtl exostc/condylc metar head $259.05 3/31/2012
28288 ostc prtl exostc/condylc metar head $172.21 Facility 4/1/2014
28289 hallux rigidus correct w/cheilectomy 1st mp jt $301.58 4/1/2012
28289 hallux rigidus correct w/cheilectomy 1st mp jt $335.09 3/31/2012
28289 hallux rigidus correct w/cheilectomy 1st mp jt $232.33 Facility 4/1/2014
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28290 corrj hallux valgus w/wo sesmdc smpl exostectomy $232.57 4/1/2012
28290 corrj hallux valgus w/wo sesmdc smpl exostectomy $258.41 3/31/2012
28290 corrj hallux valgus w/wo sesmdc smpl exostectomy $188.20 Facility 4/1/2014
28292 keller/mcbride/mayo procedure $314.40 4/1/2012
28292 keller/mcbride/mayo procedure $349.33 3/31/2012
28292 keller/mcbride/mayo procedure $227.45 Facility 4/1/2014
28293 corrj hallux valgus w/wo sesmdc rescj jt w/implt $421.78 4/1/2012
28293 corrj hallux valgus w/wo sesmdc rescj jt w/implt $468.64 3/31/2012
28293 corrj hallux valgus w/wo sesmdc rescj jt w/implt $277.38 Facility 4/1/2014
28294 corrj hallux valgus w/wo sesmdc w/tdn trnspls $287.84 4/1/2012
28294 corrj hallux valgus w/wo sesmdc w/tdn trnspls $340.91 3/31/2012
28294 corrj hallux valgus w/wo sesmdc w/tdn trnspls $243.68 Facility 4/1/2014
28296 corrj hallux valgus w/wo sesmdc w/metar osteot $326.91 4/1/2012
28296 corrj hallux valgus w/wo sesmdc w/metar osteot $363.23 3/31/2012
28296 corrj hallux valgus w/wo sesmdc w/metar osteot $267.41 Facility 4/1/2014
28297 corrj hallux valgus w/wo sesmdc lapidus-typ px $342.89 4/1/2012
28297 corrj hallux valgus w/wo sesmdc lapidus-typ px $380.99 3/31/2012
28297 corrj hallux valgus w/wo sesmdc lapidus-typ px $282.43 Facility 4/1/2014
28298 corrj hallux valgus w/wo sesmdc phalanx osteot $292.35 4/1/2012
28298 corrj hallux valgus w/wo sesmdc phalanx osteot $324.83 3/31/2012
28298 corrj hallux valgus w/wo sesmdc phalanx osteot $236.61 Facility 4/1/2014
28299 corrj hallux valgus w/wo sesmdc 2 osteot $378.29 4/1/2012
28299 corrj hallux valgus w/wo sesmdc 2 osteot $420.32 3/31/2012
28299 corrj hallux valgus w/wo sesmdc 2 osteot $305.16 Facility 4/1/2014
28300 osteotomy calcaneus w/wo internal fixation $304.01 4/1/2012
28300 osteotomy calcaneus w/wo internal fixation $337.79 3/31/2012
28302 osteotomy talus $300.49 4/1/2012
28302 osteotomy talus $333.88 3/31/2012
28304 osteotomy tarsal bones oth/thn calcaneus/talus $308.92 4/1/2012
28304 osteotomy tarsal bones oth/thn calcaneus/talus $361.44 3/31/2012
28304 osteotomy tarsal bones oth/thn calcaneus/talus $273.04 Facility 4/1/2014
28305 osteot tarsal oth/thn calcaneus/talus w/agrft $313.16 4/1/2012
28305 osteot tarsal oth/thn calcaneus/talus w/agrft $347.96 3/31/2012
28306 osteot w/wo lngth shrt/corrj 1st metar $226.30 4/1/2012
28306 osteot w/wo lngth shrt/corrj 1st metar $270.02 3/31/2012
28306 osteot w/wo lngth shrt/corrj 1st metar $183.12 Facility 4/1/2014
28307 osteot w/wo lngth shrt/corrj metar xcp 1st toe $303.62 4/1/2012
28307 osteot w/wo lngth shrt/corrj metar xcp 1st toe $337.35 3/31/2012
28307 osteot w/wo lngth shrt/corrj metar xcp 1st toe $210.44 Facility 4/1/2014
28308 osteot w/wo lngth shrt/corrj metar xcp 1st ea $218.25 4/1/2012
28308 osteot w/wo lngth shrt/corrj metar xcp 1st ea $242.50 3/31/2012
28308 osteot w/wo lngth shrt/corrj metar xcp 1st ea $163.24 Facility 4/1/2014
28309 osteot w/wo lngth shrt/angular corrj metar mlt $382.98 4/1/2012
28309 osteot w/wo lngth shrt/angular corrj metar mlt $442.08 3/31/2012
28310 osteot shrt corrj prox phalanx 1st toe $217.27 4/1/2012
28310 osteot shrt corrj prox phalanx 1st toe $241.41 3/31/2012
28310 osteot shrt corrj prox phalanx 1st toe $163.67 Facility 4/1/2014
28312 osteot shrt corrj oth phalanges any toe $177.47 4/1/2012
28312 osteot shrt corrj oth phalanges any toe $219.03 3/31/2012
28312 osteot shrt corrj oth phalanges any toe $148.25 Facility 4/1/2014
28313 rcnstj angular dfrm toe soft tiss px only $203.96 4/1/2012
28313 rcnstj angular dfrm toe soft tiss px only $226.62 3/31/2012
28313 rcnstj angular dfrm toe soft tiss px only $177.20 Facility 4/1/2014
28315 sesamoidectomy first toe spx $191.64 4/1/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28315 sesamoidectomy first toe spx $212.93 3/31/2012
28315 sesamoidectomy first toe spx $148.99 Facility 4/1/2014
28320 repair nonunion/malunion tarsal bones $306.60 4/1/2012
28320 repair nonunion/malunion tarsal bones $340.67 3/31/2012
28322 rpr non/malunion metarsal w/wo bone graft $313.96 4/1/2012
28322 rpr non/malunion metarsal w/wo bone graft $358.43 3/31/2012
28322 rpr non/malunion metarsal w/wo bone graft $267.85 Facility 4/1/2014
28340 rcnstj toe macrodactyly soft tissue resection $240.33 4/1/2012
28340 rcnstj toe macrodactyly soft tissue resection $284.77 3/31/2012
28340 rcnstj toe macrodactyly soft tissue resection $204.61 Facility 4/1/2014
28341 rcnstj toe macrodactyly requiring bone resection $276.44 4/1/2012
28341 rcnstj toe macrodactyly requiring bone resection $326.18 3/31/2012
28341 rcnstj toe macrodactyly requiring bone resection $242.02 Facility 4/1/2014
28344 reconstruction toe polydactyly $176.00 4/1/2012
28344 reconstruction toe polydactyly $361.43 3/31/2012
28344 reconstruction toe polydactyly $141.74 Facility 4/1/2014
28344 reconstruction toe polydactyly $266.45 Facility 4/1/2012 3/31/2014
28344 reconstruction toe polydactyly $296.05 Facility 1/1/2012 3/31/2012
28345 rcnstj toe syndactyly w/wo skin graft each web $216.65 4/1/2012
28345 rcnstj toe syndactyly w/wo skin graft each web $257.18 3/31/2012
28345 rcnstj toe syndactyly w/wo skin graft each web $192.14 Facility 4/1/2014
28360 reconstruction cleft foot $437.21 4/1/2012
28360 reconstruction cleft foot $470.22 3/31/2012
28400 closed tx calcaneal fracture w/o manipulation $101.77 4/1/2012
28400 closed tx calcaneal fracture w/o manipulation $114.00 3/31/2012
28400 closed tx calcaneal fracture w/o manipulation $92.36 Facility 4/1/2014
28405 closed tx calcaneal fracture w/manipulation $169.13 4/1/2012
28405 closed tx calcaneal fracture w/manipulation $186.57 3/31/2012
28405 closed tx calcaneal fracture w/manipulation $165.72 Facility 4/1/2014
28406 prq skeletal fixj calcaneal fracture w/manj $236.66 4/1/2012
28406 prq skeletal fixj calcaneal fracture w/manj $262.95 3/31/2012
28415 open treatment calcaneal fracture $534.20 4/1/2012
28415 open treatment calcaneal fracture $593.55 3/31/2012
28420 open treatment calcaneal fracture w bone graft $541.68 4/1/2012
28420 open treatment calcaneal fracture w bone graft $601.87 3/31/2012
28430 closed tx talus fracture w/o manipulation $96.26 4/1/2012
28430 closed tx talus fracture w/o manipulation $107.37 3/31/2012
28430 closed tx talus fracture w/o manipulation $82.79 Facility 4/1/2014
28435 closed tx talus fracture w/manipulation $130.37 4/1/2012
28435 closed tx talus fracture w/manipulation $148.34 3/31/2012
28435 closed tx talus fracture w/manipulation $128.10 Facility 4/1/2014
28436 prq skeletal fixation talus fracture w/manj $189.88 4/1/2012
28436 prq skeletal fixation talus fracture w/manj $210.98 3/31/2012
28445 open treatment talus fracture $490.42 4/1/2012
28445 open treatment talus fracture $544.91 3/31/2012
28446 open osteochondral autograft talus $472.12 4/1/2012
28446 open osteochondral autograft talus $563.55 3/31/2012
28450 tx tarsal bone fx xcp talus&calcn w/o manj $88.06 4/1/2013
28450 tx tarsal bone fx xcp talus&calcn w/o manj $78.71 4/1/2012 3/31/2013
28450 tx tarsal bone fx xcp talus&calcn w/o manj $98.91 3/31/2012
28450 tx tarsal bone fx xcp talus&calcn w/o manj $77.67 Facility 4/1/2014
28455 tx tarsal bone fx xcp talus&calcn w/manj $116.33 4/1/2014
28455 tx tarsal bone fx xcp talus&calcn w/manj $120.97 4/1/2012 3/31/2014
28455 tx tarsal bone fx xcp talus&calcn w/manj $134.41 3/31/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28456 prq skel fixj tarsl fx xcp talus&calcns w/manj $120.88 4/1/2012
28456 prq skel fixj tarsl fx xcp talus&calcns w/manj $134.31 3/31/2012
28465 open tx tarsal fracture xcp talus &calcaneus ea $241.41 4/1/2012
28465 open tx tarsal fracture xcp talus &calcaneus ea $297.67 3/31/2012
28470 closed tx metatarsal fracture w/o manipulation $89.96 4/1/2012
28470 closed tx metatarsal fracture w/o manipulation $99.96 3/31/2012
28470 closed tx metatarsal fracture w/o manipulation $78.92 Facility 4/1/2014
28475 cltx metar fx w/manj $112.70 4/1/2012
28475 cltx metar fx w/manj $125.22 3/31/2012
28475 cltx metar fx w/manj $110.75 Facility 4/1/2014
28476 prq skel fixj metar fx w/manj $147.98 4/1/2012
28476 prq skel fixj metar fx w/manj $164.42 3/31/2012
28485 open treatment metatarsal fracture each $229.74 4/1/2012
28485 open treatment metatarsal fracture each $255.27 3/31/2012
28490 cltx fx grt toe phlx/phlg w/o manj $56.41 4/1/2012
28490 cltx fx grt toe phlx/phlg w/o manj $62.68 3/31/2012
28490 cltx fx grt toe phlx/phlg w/o manj $47.94 Facility 4/1/2014
28495 cltx fx grt toe phlx/phlg w/manj $66.10 4/1/2012
28495 cltx fx grt toe phlx/phlg w/manj $78.16 3/31/2012
28495 cltx fx grt toe phlx/phlg w/manj $64.30 Facility 4/1/2014
28496 prq skel fixj fx grt toe phlx/phlg w/manj $180.19 4/1/2012
28496 prq skel fixj fx grt toe phlx/phlg w/manj $200.85 3/31/2012
28496 prq skel fixj fx grt toe phlx/phlg w/manj $98.05 Facility 4/1/2014
28505 open tx fracture great toe/phalanx/phalanges $206.51 4/1/2012
28505 open tx fracture great toe/phalanx/phalanges $305.41 3/31/2012
28505 open tx fracture great toe/phalanx/phalanges $138.33 Facility 4/1/2014
28510 cltx fx phlx/phlg oth/thn grt toe w/o manj $46.04 4/1/2012
28510 cltx fx phlx/phlg oth/thn grt toe w/o manj $54.20 3/31/2012
28515 cltx fx phlx/phlg oth/thn grt toe w/manj $63.47 4/1/2012
28515 cltx fx phlx/phlg oth/thn grt toe w/manj $70.52 3/31/2012
28525 open tx fracture phalanx/phalanges not great toe $234.89 4/1/2012
28525 open tx fracture phalanx/phalanges not great toe $260.99 3/31/2012
28525 open tx fracture phalanx/phalanges not great toe $121.11 Facility 4/1/2014
28530 closed treatment sesamoid fracture $44.15 4/1/2012
28530 closed treatment sesamoid fracture $60.30 3/31/2012
28531 open tx sesamoid fracture w/wo internal fixation $164.25 4/1/2012
28531 open tx sesamoid fracture w/wo internal fixation $185.26 3/31/2012
28531 open tx sesamoid fracture w/wo internal fixation $79.84 Facility 4/1/2014
28531 open tx sesamoid fracture w/wo internal fixation $161.08 Facility 4/1/2012 3/31/2014
28531 open tx sesamoid fracture w/wo internal fixation $178.98 Facility 1/1/2012 3/31/2012
28540 cltx tarsal dislc oth/thn talotarsal w/o anes $78.71 4/1/2013
28540 cltx tarsal dislc oth/thn talotarsal w/o anes $83.70 4/1/2012 3/31/2013
28540 cltx tarsal dislc oth/thn talotarsal w/o anes $93.00 3/31/2012
28545 cltx tarsal dislc oth/thn talotarsal w/anes $86.54 4/1/2012
28545 cltx tarsal dislc oth/thn talotarsal w/anes $108.12 3/31/2012
28546 prq skel fixj tarsl dislc xcp talotarsal w/manj $176.00 4/1/2012
28546 prq skel fixj tarsl dislc xcp talotarsal w/manj $213.36 3/31/2012
28546 prq skel fixj tarsl dislc xcp talotarsal w/manj $134.94 Facility 4/1/2014
28555 open treatment tarsal bone dislocation $286.39 4/1/2012
28555 open treatment tarsal bone dislocation $393.60 3/31/2012
28555 open treatment tarsal bone dislocation $217.72 Facility 4/1/2014
28570 closed tx talotarsal joint dislc w/o anes $71.83 4/1/2012
28570 closed tx talotarsal joint dislc w/o anes $82.74 3/31/2012
28570 closed tx talotarsal joint dislc w/o anes $70.37 Facility 4/1/2014
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28575 closed tx talotarsal joint dislocation w/anes $126.68 4/1/2012
28575 closed tx talotarsal joint dislocation w/anes $149.86 3/31/2012
28576 prq skel fixj talotarsal jt dislc w/manj $150.84 4/1/2012
28576 prq skel fixj talotarsal jt dislc w/manj $185.00 3/31/2012
28585 open treatment talotarsal joint dislocation $277.25 4/1/2014
28585 open treatment talotarsal joint dislocation $365.33 4/1/2012 3/31/2014
28585 open treatment talotarsal joint dislocation $405.92 3/31/2012
28585 open treatment talotarsal joint dislocation $253.06 Facility 4/1/2014
28600 closed tx tarsometatarsal dislocation w/o anes $82.89 4/1/2012
28600 closed tx tarsometatarsal dislocation w/o anes $96.65 3/31/2012
28600 closed tx tarsometatarsal dislocation w/o anes $80.78 Facility 4/1/2014
28605 closed tx tarsometatarsal dislocation w/anes $104.25 4/1/2012
28605 closed tx tarsometatarsal dislocation w/anes $125.64 3/31/2012
28606 prq skel fixj tars jt dislc w/manj $173.97 4/1/2012
28606 prq skel fixj tars jt dislc w/manj $193.30 3/31/2012
28615 open treatment tarsometatarsal joint dislocation $285.65 4/1/2012
28615 open treatment tarsometatarsal joint dislocation $371.42 3/31/2012
28630 cltx metatarsophlngl jt dislc w/o anes $58.40 4/1/2012
28630 cltx metatarsophlngl jt dislc w/o anes $68.13 3/31/2012
28630 cltx metatarsophlngl jt dislc w/o anes $49.15 Facility 4/1/2014
28635 cltx metatarsophlngl jt dislc req anes $70.32 4/1/2012
28635 cltx metatarsophlngl jt dislc req anes $81.46 3/31/2012
28635 cltx metatarsophlngl jt dislc req anes $62.36 Facility 4/1/2014
28636 prq skel fixj metatarsophlngl jt dislc w/manj $117.85 4/1/2012
28636 prq skel fixj metatarsophlngl jt dislc w/manj $137.74 3/31/2012
28636 prq skel fixj metatarsophlngl jt dislc w/manj $97.56 Facility 4/1/2014
28645 open tx metatarsophalangeal joint dislocation $246.70 4/1/2012
28645 open tx metatarsophalangeal joint dislocation $274.11 3/31/2012
28645 open tx metatarsophalangeal joint dislocation $135.86 Facility 4/1/2014
28660 cltx interphalangeal joint dislocation w/o anes $44.18 4/1/2012
28660 cltx interphalangeal joint dislocation w/o anes $50.10 3/31/2012
28660 cltx interphalangeal joint dislocation w/o anes $36.56 Facility 4/1/2014
28665 cltx interphalangeal joint dislocation req anes $60.80 4/1/2012
28665 cltx interphalangeal joint dislocation req anes $71.66 3/31/2012
28666 prq skel fixj interphalangeal joint dislc w/manj $148.49 4/1/2012
28666 prq skel fixj interphalangeal joint dislc w/manj $164.99 3/31/2012
28666 prq skel fixj interphalangeal joint dislc w/manj $94.92 Facility 4/1/2014
28675 open treatment interphalangeal joint dislocation $173.87 4/1/2012
28675 open treatment interphalangeal joint dislocation $258.01 3/31/2012
28675 open treatment interphalangeal joint dislocation $112.35 Facility 4/1/2014
28705 arthrodesis pantalar $576.21 4/1/2012
28705 arthrodesis pantalar $644.33 3/31/2012
28715 arthrodesis triple $419.36 4/1/2014
28715 arthrodesis triple $429.35 4/1/2012 3/31/2014
28715 arthrodesis triple $477.05 3/31/2012
28725 arthrodesis subtalar $364.58 4/1/2012
28725 arthrodesis subtalar $405.09 3/31/2012
28730 arthrd midtarsl/tarsometatarsal mult/transvrs $351.15 4/1/2012
28730 arthrd midtarsl/tarsometatarsal mult/transvrs $410.35 3/31/2012
28735 arthrd midtarsl/tars mlt/transvrs w/osteot $341.95 4/1/2012
28735 arthrd midtarsl/tars mlt/transvrs w/osteot $392.76 3/31/2012
28737 arthrd w/tdn lngth&advmnt tarsl nvclr-cuneifor $301.28 4/1/2012
28737 arthrd w/tdn lngth&advmnt tarsl nvclr-cuneifor $348.83 3/31/2012
28740 arthrodesis midtarsometatarsal single joint $358.03 4/1/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
28740 arthrodesis midtarsometatarsal single joint $397.81 3/31/2012
28740 arthrodesis midtarsometatarsal single joint $263.71 Facility 4/1/2014
28750 arthrodesis great toe metatarsophalangeal joint $352.91 4/1/2012
28750 arthrodesis great toe metatarsophalangeal joint $392.12 3/31/2012
28750 arthrodesis great toe metatarsophalangeal joint $252.68 Facility 4/1/2014
28755 arthrodesis great toe interphalangeal joint $205.34 4/1/2012
28755 arthrodesis great toe interphalangeal joint $228.16 3/31/2012
28755 arthrodesis great toe interphalangeal joint $153.87 Facility 4/1/2014
28760 arthrd w/xtnsr hallucis longus tr 1st metar nck $319.81 4/1/2012
28760 arthrd w/xtnsr hallucis longus tr 1st metar nck $355.34 3/31/2012
28760 arthrd w/xtnsr hallucis longus tr 1st metar nck $241.57 Facility 4/1/2014
28800 amputation foot midtarsal $255.47 4/1/2012
28800 amputation foot midtarsal $283.85 3/31/2012
28805 amputation foot transmetarsal $328.63 4/1/2012
28805 amputation foot transmetarsal $365.14 3/31/2012
28810 amputation metatarsal w/toe single $195.48 4/1/2012
28810 amputation metatarsal w/toe single $217.20 3/31/2012
28820 amputation toe metatarsophalangeal joint $222.62 4/1/2012
28820 amputation toe metatarsophalangeal joint $247.36 3/31/2012
28820 amputation toe metatarsophalangeal joint $147.93 Facility 4/1/2014
28825 amputation toe interphalangeal joint $191.76 4/1/2012
28825 amputation toe interphalangeal joint $213.07 3/31/2012
28825 amputation toe interphalangeal joint $126.96 Facility 4/1/2014
28890 eswt hi nrg phys/qhp w/us gdn invg plntar fascia $156.15 4/1/2012
28890 eswt hi nrg phys/qhp w/us gdn invg plntar fascia $173.50 3/31/2012
28890 eswt hi nrg phys/qhp w/us gdn invg plntar fascia $97.85 Facility 4/1/2014
28899 unlisted procedure foot/toes $89.22 4/1/2012
28899 unlisted procedure foot/toes $168.33 3/31/2012
29405 application short leg cast below knee-toe $37.35 4/1/2012
29405 application short leg cast below knee-toe $41.50 3/31/2012
29405 application short leg cast below knee-toe $28.68 Facility 4/1/2014
29425 application short leg cast walking/ambulatory $40.35 4/1/2012
29425 application short leg cast walking/ambulatory $44.83 3/31/2012
29425 application short leg cast walking/ambulatory $32.00 Facility 4/1/2014
29450 appl clubfoot cast molding/manj long/short leg $64.58 4/1/2012
29450 appl clubfoot cast molding/manj long/short leg $93.45 3/31/2012
29450 appl clubfoot cast molding/manj long/short leg $58.40 Facility 4/1/2014
29515 application short leg splint calf foot $29.26 4/1/2012
29515 application short leg splint calf foot $32.51 3/31/2012
29515 application short leg splint calf foot $21.70 Facility 4/1/2014
29540 strapping ankle &/foot $17.77 4/1/2012
29540 strapping ankle &/foot $19.74 3/31/2012
29540 strapping ankle &/foot $14.94 Facility 4/1/2014
29550 strapping toes $17.15 4/1/2012
29550 strapping toes $19.06 3/31/2012
29550 strapping toes $16.73 Facility 4/1/2012
29550 strapping toes $18.59 Facility 1/1/2012 3/31/2012
29580 strapping unna boot $21.92 4/1/2012
29580 strapping unna boot $24.36 3/31/2012
29580 strapping unna boot $16.79 Facility 4/1/2014
29582 appl mltlayr compres thgh leg ankle ft when done $30.59 4/1/2012
29582 appl mltlayr compres thgh leg ankle ft when done $33.99 1/1/2012 3/31/2012
29582 appl mltlayr compres thgh leg ankle ft when done $7.11 Facility 4/1/2012
29582 appl mltlayr compres thgh leg ankle ft when done $7.90 Facility 1/1/2012 3/31/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
29892 ankle arthroscopy/surgery $304.39 1/1/2013
29893 endoscopic plantar fasciotomy $242.45 4/1/2012
29893 endoscopic plantar fasciotomy $269.39 3/31/2012
29893 endoscopic plantar fasciotomy $166.43 Facility 4/1/2014
36415 collection venous blood venipuncture $2.70
64450 injection anes other peripheral nerve/branch $45.14 4/1/2012
64450 injection anes other peripheral nerve/branch $50.15 3/31/2012
64450 injection anes other peripheral nerve/branch $32.25 Facility 4/1/2014
64455 njx anes&/steroid plantar common digital nerve $23.27 4/1/2012
64455 njx anes&/steroid plantar common digital nerve $25.85 3/31/2012
64455 njx anes&/steroid plantar common digital nerve $17.35 Facility 4/1/2014
64550 application surface neurostimulator $7.91 1/1/2013
64550 application surface neurostimulator $4.18 Facility 1/1/2013
64632 dstrj neurolytic plantar common digital nerve $38.31 4/1/2012
64632 dstrj neurolytic plantar common digital nerve $42.57 3/31/2012
64632 dstrj neurolytic plantar common digital nerve $30.75 Facility 4/1/2014
64704 neuroplasty nerve hand/foot $143.19 4/1/2012
64704 neuroplasty nerve hand/foot $159.10 3/31/2012
64708 neurp major prph nrv arm/leg opn oth/thn spec $206.55 4/1/2012
64708 neurp major prph nrv arm/leg opn oth/thn spec $229.50 3/31/2012
64712 neurp major prph nrv opn arm/leg sciatic nrv $231.83 4/1/2012
64712 neurp major prph nrv opn arm/leg sciatic nrv $257.59 3/31/2012
64726 decompression plantar digital nerve $127.01 4/1/2012
64726 decompression plantar digital nerve $141.12 3/31/2012
64782 exc neuroma hand/foot xcp digital nerve $194.90 4/1/2012
64782 exc neuroma hand/foot xcp digital nerve $216.55 3/31/2012
64783 exc neuroma hand/foot ea nrv xcp sm dgt $102.65 4/1/2012
64783 exc neuroma hand/foot ea nrv xcp sm dgt $107.93 3/31/2012
64784 exc neuroma major peripheral nrv xcp sciatic $308.15 4/1/2012
64784 exc neuroma major peripheral nrv xcp sciatic $342.39 3/31/2012
64787 implantation nerve end bone/muscle $118.65 4/1/2012
64787 implantation nerve end bone/muscle $131.83 3/31/2012
64788 exc neurofibroma/neurolemmoma cutan nrv $147.15 4/1/2012
64788 exc neurofibroma/neurolemmoma cutan nrv $163.50 3/31/2012
93922 non-invas physiologic std extremity art 2 level $56.24 4/1/2012
93922 non-invas physiologic std extremity art 2 level $62.49 3/31/2012
93922 TC non-invas physiologic std extremity art 2 level $28.12 4/1/2012
93922 TC non-invas physiologic std extremity art 2 level $31.24 3/31/2012
93922 26 non-invas physiologic std extremity art 2 level $28.12 4/1/2012
93922 26 non-invas physiologic std extremity art 2 level $31.24 3/31/2012
93965 n-invas physiologic std xtr veins compl bi std $53.23 4/1/2012
93965 n-invas physiologic std xtr veins compl bi std $64.32 3/31/2012
93965 TC n-invas physiologic std xtr veins compl bi std $44.72 4/1/2012
93965 TC n-invas physiologic std xtr veins compl bi std $32.16 3/31/2012
93965 26 n-invas physiologic std xtr veins compl bi std $8.51 4/1/2012
93965 26 n-invas physiologic std xtr veins compl bi std $32.16 3/31/2012
97597 debridement open wound 20 sq cm/< $25.77 4/1/2012
97597 debridement open wound 20 sq cm/< $28.63 3/31/2012
97597 debridement open wound 20 sq cm/< $20.54 Facility 4/1/2012
97597 debridement open wound 20 sq cm/< $22.82 Facility 3/31/2012
97598 debridement open wound each additional 20 sq cm $23.66 4/1/2014
97598 debridement open wound each additional 20 sq cm $20.71 4/1/2012 3/31/2014
97598 debridement open wound each additional 20 sq cm $23.01 1/1/2012 3/31/2012
97598 debridement open wound each additional 20 sq cm $35.64 12/31/2011
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
97598 debridement open wound each additional 20 sq cm $9.64 Facility 4/1/2012
97598 debridement open wound each additional 20 sq cm $10.71 Facility 1/1/2012 3/31/2012
99024 postop follow up visit related to original px $10.51 4/1/2012
99024 postop follow up visit related to original px $11.68 3/31/2012
99058 svc prv emer basis in office disrupting svcs $4.77 4/1/2012
99058 svc prv emer basis in office disrupting svcs $10.00 3/31/2012
99070 supplies&materials above/beyond prov by phys/qhp $810.00 4/1/2012
99070 supplies&materials above/beyond prov by phys/qhp $900.00 3/31/2012
99199 unlisted special service procedure/report $3.78 4/1/2012
99199 unlisted special service procedure/report $7.14 3/31/2012
99201 office outpatient new 10 minutes $19.73 4/1/2012
99201 office outpatient new 10 minutes $21.92 3/31/2012
99201 office outpatient new 10 minutes $10.91 Facility 4/1/2014
99202 office outpatient new 20 minutes $30.47 4/1/2012
99202 office outpatient new 20 minutes $33.86 3/31/2012
99202 office outpatient new 20 minutes $21.52 Facility 4/1/2014
99203 office outpatient new 30 minutes $44.68 4/1/2012
99203 office outpatient new 30 minutes $49.64 3/31/2012
99203 office outpatient new 30 minutes $33.05 Facility 4/1/2014
99204 office outpatient new 45 minutes $68.68 4/1/2012
99204 office outpatient new 45 minutes $76.31 3/31/2012
99204 office outpatient new 45 minutes $49.06 Facility 4/1/2014
99205 office outpatient new 60 minutes $78.61 4/1/2012
99205 office outpatient new 60 minutes $96.04 3/31/2012
99205 office outpatient new 60 minutes $65.30 Facility 4/1/2014
99211 office outpatient visit 5 minutes $11.85 4/1/2012
99211 office outpatient visit 5 minutes $13.17 3/31/2012
99211 office outpatient visit 5 minutes $7.94 Facility 4/1/2012
99211 office outpatient visit 5 minutes $8.82 Facility 1/1/2012 3/31/2012
99212 office outpatient visit 10 minutes $18.18 4/1/2012
99212 office outpatient visit 10 minutes $20.20 3/31/2012
99212 office outpatient visit 10 minutes $11.08 Facility 4/1/2014
99213 office outpatient visit 15 minutes $29.62 4/1/2012
99213 office outpatient visit 15 minutes $32.91 3/31/2012
99213 office outpatient visit 15 minutes $16.35 Facility 4/1/2014
99214 office outpatient visit 25 minutes $44.56 4/1/2012
99214 office outpatient visit 25 minutes $49.51 3/31/2012
99214 office outpatient visit 25 minutes $27.12 Facility 4/1/2014
99215 office outpatient visit 40 minutes $60.31 4/1/2012
99215 office outpatient visit 40 minutes $67.01 3/31/2012
99215 office outpatient visit 40 minutes $43.47 Facility 4/1/2014
99217 observation care discharge management $32.43 4/1/2012
99217 observation care discharge management $36.06 3/31/2012
99221 initial hospital care/day 30 minutes $43.02 4/1/2012
99221 initial hospital care/day 30 minutes $47.80 3/31/2012
99222 initial hospital care/day 50 minutes $59.13 4/1/2012
99222 initial hospital care/day 50 minutes $65.70 3/31/2012
99223 initial hospital care/day 70 minutes $87.03 4/1/2012
99223 initial hospital care/day 70 minutes $96.70 3/31/2012
99231 sbsq hospital care/day 15 minutes $21.56 4/1/2012
99231 sbsq hospital care/day 15 minutes $23.96 3/31/2012
99232 sbsq hospital care/day 25 minutes $32.08 4/1/2012
99232 sbsq hospital care/day 25 minutes $35.64 3/31/2012
99233 sbsq hospital care/day 35 minutes $45.99 4/1/2012
Procedure
CodeModifier Code Description Rate Location
Effective
DateEnd Date
99233 sbsq hospital care/day 35 minutes $51.10 3/31/2012
99238 hospital discharge day management 30 min/< $32.48 4/1/2012
99238 hospital discharge day management 30 min/< $36.13 3/31/2012
99239 hospital discharge day management > 30 min $44.29 4/1/2012
99239 hospital discharge day management > 30 min $51.99 3/31/2012
99304 initial nursing facility care/day 25 minutes $15.96 4/1/2012
99304 initial nursing facility care/day 25 minutes $33.46 3/31/2012
99305 initial nursing facility care/day 35 minutes $40.01 4/1/2012
99305 initial nursing facility care/day 35 minutes $44.45 3/31/2012
99306 initial nursing facility care/day 45 minutes $49.38 4/1/2014
99306 initial nursing facility care/day 45 minutes $26.17 4/1/2012 3/31/2014
99306 initial nursing facility care/day 45 minutes $54.87 3/31/2012
99307 sbsq nursing facility care/day e/m stable 10 min $18.96 4/1/2012
99307 sbsq nursing facility care/day e/m stable 10 min $21.07 3/31/2012
99308 sbsq nursing facil care/day minor complj 15 min $29.12 4/1/2012
99308 sbsq nursing facil care/day minor complj 15 min $32.36 3/31/2012
99324 domicil/rest home new pt visit low sever 20 min $26.69 4/1/2012
99324 domicil/rest home new pt visit low sever 20 min $29.65 3/31/2012
99325 domicil/rest home new pt visit mod sever 30 min $39.18 4/1/2012
99325 domicil/rest home new pt visit mod sever 30 min $43.53 3/31/2012
99326 domicil/rest home new pt hi-mod sever 45 minutes $56.92 4/1/2014
99326 domicil/rest home new pt hi-mod sever 45 minutes $30.17 4/1/2012 3/31/2014
99326 domicil/rest home new pt hi-mod sever 45 minutes $63.24 3/31/2012
99327 domicil/rest home new pt visit hi sever 60 min $75.01 4/1/2014
99327 domicil/rest home new pt visit hi sever 60 min $39.75 4/1/2012 3/31/2014
99327 domicil/rest home new pt visit hi sever 60 min $83.34 3/31/2012
99328 dom/r-home e/m new pt signif new prob 75 minutes $92.91 4/1/2014
99328 dom/r-home e/m new pt signif new prob 75 minutes $49.25 4/1/2012 3/31/2014
99328 dom/r-home e/m new pt signif new prob 75 minutes $103.24 3/31/2012
99341 home visit new patient low severity 20 minutes $27.00 4/1/2012
99341 home visit new patient low severity 20 minutes $30.00 3/31/2012
99342 home visit new patient mod severity 30 minutes $40.50 4/1/2012
99342 home visit new patient mod severity 30 minutes $45.00 3/31/2012
99343 home vst new patient mod-hi severity 45 minutes $57.45 4/1/2014
99343 home vst new patient mod-hi severity 45 minutes $32.20 4/1/2012 3/31/2014
99343 home vst new patient mod-hi severity 45 minutes $67.50 3/31/2012
99344 home visit new patient hi severity 60 minutes $75.43 4/1/2014
99344 home visit new patient hi severity 60 minutes $42.93 4/1/2012 3/31/2014
99344 home visit new patient hi severity 60 minutes $90.00 3/31/2012
99345 home visit new pt unstabl/signif new prob 75 min $93.39 4/1/2014
99345 home visit new pt unstabl/signif new prob 75 min $53.67 4/1/2012 3/31/2014
99345 home visit new pt unstabl/signif new prob 75 min $112.50 3/31/2012
99348 home visit est pt low-mod severity 25 minutes $38.34 4/1/2012
99348 home visit est pt low-mod severity 25 minutes $42.60 3/31/2012
G0127 Trimming of dystrophic nail(s), any number $7.25 4/1/2012
G0127 Trimming of dystrophic nail(s), any number $8.05 3/31/2012
G0127 Trimming of dystrophic nail(s), any number $6.80 Facility 4/1/2012
G0127 Trimming of dystrophic nail(s), any number $7.55 Facility 1/1/2012 3/31/2012
G0440 Skin/dermal substitute, initial 25 sq cm or less $113.28 1/1/2011 12/31/2011
G0440 Skin/dermal substitute, initial 25 sq cm or less $167.98 Facility 1/1/2011 12/31/2011
G0441 Skin/dermal substitute, each additional 25 sq cm $24.81 1/1/2011 12/31/2011
G0441 Skin/dermal substitute, each additional 25 sq cm $44.76 Facility 1/1/2011 12/31/2011
