Smart Money: Understand Your Payer Contracts, Finances and

American Academy of Ophthalmic Executives®

Smart Money: Understand Your Payer Contracts, Finances and RevenueSPE 35 - Oct. 12, 2019 South, Room 211 | 1:30 to 4:30 p.m.

Moscone Center | San Francisco, CA

AMERICAN ACADEMY

OF OPHTHALMOLOGY®

AAOE Program of 2019

Master Class (SPE 35)

Smart Money: Understand Your Payer Contracts, Finances and Revenue

Presented by:

Senior Instructor Ann Hulett, CMPE

Co-instructorSara Burns Rapuano, MBA, OCS, CPC, COE

AAOE Program I Saturday, Oct. 12, 2019 I San Francisco, CA

Moscone Center | 1:30 - 4:30 p.m. I South, Room 211

Protecting Sight. Empowering Lives."'

AAOE 2019 | Master Class Presenters Ann M. Hulett, CMPE CEO — Eyehealth Northwest, PC

Ann Hulett is the CEO of EyeHealth Northwest in Portland, Ore., comprised of 26 ophthalmologists, 10 ODs, two ASCs and over 350 employees. She has 25 years’ experience as a medical practice administrator, 14 in ophthalmology. She worked as the administrator at Rocky Mountain Eye Center in Pueblo, Colo., during which time she served five years on the AAOE Board and received the Academy's Secretariat Award. She has also worked as CFO and CEO of a large cardiology practice in New Mexico. Having started her career as a CPA, Ann enjoys working in areas of finance as well as group governance and physician communications.

Sara Burns Rapuano, MBA, CPC, OCS, COE Sara Burns Rapuano is an ophthalmology practice management consultant. She has over 20 years’ experience at Wills Eye Hospital in Philadelphia working with physician practices as well as ASCs. In addition to the day to day financial and operational management issues, she has experience in implementation of practice management software and electronic health records, medical coding and compliance, third-party payer contracting, and medical practice consolidation. She has lectured both locally and nationally on operational and reimbursement issues.

1

Smart Money: Understand Your Payer Contracts, Finances

and Revenues

Ann M. Hulett, CMPE

Sara B. Rapuano, MBA, CPC, OCS, COE

2

Financial Disclosures

• Ann Hulett is the CEO of EyeHealth Northwest in Portland, Oregon and has

no financial disclosures. Ann has 27 years of experience in practice

management with 16 of those years in Ophthalmology. She is a member of

the AAOE Board of Directors

• Sara Rapuano is an Ophthalmology Practice Management Consultant. Sara

served 22 years as a practice administrator with Wills Eye rising to the

position of Chief Operating Officer. She has now an independent practice

management consultant following.

3

Our Focus for Today…Revenue

• How we are paid – CMS and Contracts

o Understanding RVUs and how to use them in your practice.

o Understanding how to look at your contracts and know how they are impacting your

revenue.

o How to protect and improve your contracting position.

• How our Revenue is generated - Physician Production

o Understanding the generation of revenue

o Understanding your practice in relation to others

o How to facilitate and lead the practice dialogue on revenue

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A Good Time to Grow Our Understanding

• Medical Group Managers Association reported this year a

five year trend of Operating Expenses outpacing Revenue

2:1.

• The arrival of the Quality Payment Program (QPP) is

putting pressures on our contracting position.

• Now is the time to “financially know your practice.”

5

Max 2019 Ophth 1.88%

Incl Exceptional

How MIPS is Turning Out Max 2020 Ophth

1.68% Including

Exceptional

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Relative Value UnitsSara B. Rapuano, MBA, OCS, CPC, COE

The Building Blocks of Your Practice Revenue

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WHAT are the Components of RVU?

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Work RVU

• Represents the relative time and intensity associated with furnishing a

Medicare physician service.

• This is the portion that is meant to compensate the doctor. For that reason, it

if often used in compensation agreements.

• It considers time, technical skill, mental effort and judgement and stress due

to the potential risk to the patient.

• wRVU averages 50.9% of the Total RVU, although the actual percentage

varies, often significantly, by procedure.

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Practice Expense RVU – PE RVU

• Represents the practice expenses typically associated with providing a

physician service, such as space, equipment, supplies and staff expenses.

• There are both direct and indirect expenses used in providing a service.

o Direct would be clinical (non-physician) labor, medical supplies and

medical equipment.

o Indirect - administrative staff, office expense and other costs.

• This is effectively practice overhead.

• PE represents 44.8% on average of the total RVU, although it too varies by

procedure.

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Malpractice RVU

• Proportional cost of malpractice insurance associated with providing a

service.

• Also a form of overhead of a practice.

• Averages 4.3% of the total RVU.

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Geographic Practice Cost Indices (GPCI)

• Each component of RVU has a multiplier to adjust for geographical cost

differences for each component of RVU.

• This is meant to adjust for cost of living and differing professional liability

environments throughout the country.

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Place of Service (POS)

• In the MPFS there are different practice expense RVUs assigned to a facility

and a non facility.

• The PE for an in facility service is lower than the PE for a non-facility or office

setting.

• While the overall cost of providing most services in a facility may be higher,

the burden of the expense is shifted to the facility and they are paid

separately so the practice expense is lower.

• This difference is often called the “site of service differential.”

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Conversion Factor (CF)

• Represents the national amount Medicare allows

for each RVU.

• In 2019, the CF is $36.0391.

• In 2020, the CF will be $36.0896.

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Medicare Physician Fee Schedule Calculation

[(wRVU x wGPCI)

+(PE RVU x PE GPCI)

+(MP RVU x MP GPCI)]

x

Conversion Factor15

A sample spreadsheet with the 2019 National Payment rates is shown (and is linked here). In your analysis you will want to

use your locality GPCI adjusted rates. You can recreate this easily by downloading the entire fee schedule from the CMS

Website and creating a pivot table in excel for each category of service. If you perform only a limited set of procedures, you

may find it faster to use the Part B Physicians Fee Schedule Tool which will help you obtain your locality rates directly.

Visit Code RVU Detail 2019

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../2019%20MCR%20RVU%20FIles.xlsx

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1693-F.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/

Eye Codes vs. E&M (2019 rates)

99213 92012

Physician Work Units .97 0.92

Practice Expense Units 1.05 1.53

Med Malpractice Units .07 0.04

Total Unit Value 2.09 2.49

Conversion Factor 36.0391 36.0391

National CMS Allowable $75.32 $89.74

While documentation may differ, many physicians use both the intermediate eye code or

the level 3 E&M code for follow up visits.

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Diagnostic Code RVU Detail 2019

Diagnostic testing services also have low wRVU as a percentage of total RVUs. Again, this is because the

practice expense component represents a high cost for ophthalmology diagnostic testing services. For

example, compare the RVU components for gonioscopy and a corneal topography. We can see that the

work value for the physician is similar, however, since a topographer is a more expensive piece of

equipment than a gonioscopy lens, the total reimbursement for the topography is $38.56 whereas the

gonioscopy only reimburses $28.11.

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Some Years…Big ChangeCataract (66984): 2019 to 2020

2019 2020

Work Units (wRVU) 8.52 7.35

Practice Expense (PE) 9.04 7.58

Medical Malpractice (ME) 0.60 0.52

Total Relative Value Units 18.16 15.45

Conversion Factor $36.0391 $36.0896

National Medicare Allowable $654.47 $557.58

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Some Years…Big ChangeComplex Cat (66982): 2019 to 2020

2019 2020

Work Units (wRVU) 11.08 10.25

Practice Expense (PE) 10.69 10.19

Medical Malpractice (ME) 0.79 0.78

Total Relative Value Units 22.56 21.22

Conversion Factor $36.0391 $36.0896

National Medicare Allowable $813.04 $765.82

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Who Maintains This System?

• The Medicare physicians fee schedule changes each year based upon the recommendations

of the RVS Update Committee (RUC) of the American Medical Association (AMA).

• The RUC is comprised of representatives from all specialties in medicine. They review the

work value and practice expense values.

• The AAO provides feedback on proposed changes as well.

• Theoretically, if there are technological advances that make a procedure or service easier or

less time consuming, then the wRVU will decrease. (Thus, the decrease in cataract

reimbursement slated for 2020.)

• If costs related to providing a service increase, then the PE RVU will increase.

• To read more about the functions of the RUC committee visit the AMA website.

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https://www.ama-assn.org/about/rvs-update-committee-ruc/rvs-update-committee-ruc

WHY You Need to Understand RVUs

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Why?

• To understand how you can anticipate and adapt to changes in Medicare

revenue each year.

• To identify services that are overpriced and underpriced by Medicare.

• To use RVU analysis to evaluate commercial contracts.

• To measure physician work value for potential use in physician compensation

model revisions.

• To equip ourselves for evaluating an Alternative Payment Model, whether it

be payment for episodes of care or lump sum payment for providing eye care

for a contracted patient population.

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Anticipate Changes in Revenue

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../RVU%20Projected%20Revenue%20Change.xlsx

Evaluating Commercial Contracts

Understand the contract’s inherent conversion factor.

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Medicare Revenue Analysis

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../RVU%20Projected%20Revenue%20Change.xlsx

Commercial Contract Avg Realized CFA hypothetical calculation would look like this:

CPT Service Your Fee Total RVU 2019 Your

CF

99204 New E&M, Level 4 $384 4.63 $ 82.94

92004 New Comprehensive Eye

Exam

$305 4.20 $ 72.62

92014 Est. Comprehensive Eye

Exam

$265 3.57 $ 74.23

66984 Cataract Surgery $1,900 18.16 $104.63

92134 OCT - Retina $ 60 1.16 $ 51.72

Your worksheet should include all of the CPT codes you billed during the year including the

number of times the code was used.

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Thinking About Your Avg Realized Conversion

Factor?

• Does your practice have/want to have a consistent conversion factor by

which your fee schedule is established?

o You can’t decide until you prepare a spreadsheet with your highest dollar and most

frequently used codes showing your conversion factor by code.

• Do you have codes with conversion factors (or fees) that are too low or way

out of the current payment market?

o Too low leaves money on the table.

o Too high artificially inflates charges and write-offs.

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Evaluate Existing Contract Rates

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Evaluating New Contract Opportunities

• The proposed Conversion Factor for 2020 is 36.0896.

• All contract offerings should be reviewed relative to the 36.0896 CMS CF.

• The carriers are by and large benchmarking from the RVU system and relate

their offerings relative to the CMS CF.

• Your practice volume for services is an important issue.

• Contracts should be reviewed within context of Financial Class - Medicare

Advantage, Medicaid, Commercial, etc.

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Using RVUs for Provider Compensation

Models

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Compensation Model Options

• Guaranteed Base Salary

• Split Based Upon Ownership

• Split Based Upon Actual Collections

• Split Based Upon work RVUs

• A combination of the above

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Guaranteed Base Salary

• Most often used in an academic setting, or for part time ophthalmologists or

optometrists who work a set number of hours.

• Benefits: Can anticipate salary expense and budget expenses appropriately.

Allows physicians to focus on research and teaching responsibilities.

• Risks: No incentive to see more patients, so may not meet revenue budget.

33

Split Based On Ownership

• Used in small single specialty practices comprised of physicians in the same

stage of practice.

• Benefits: There is a real incentive to work as a team to raise the whole

practice. Physicians share patients and call equally.

• Risks: Individual is not incented to work more as they only reap a small

percentage of each additional dollar they generate. Also does not allow for

individual physician personal lifestyle choices.

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Split Based On Collections

• This is the eat-what-you-kill model.

• Benefits: Incentive for each physician to work as hard as he personally

chooses.

• Risks: There is no adjustment for differing resource requirements for various

specialties. Physicians are helped or hurt by the billing office effectiveness.

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Split Based On Work Units

• Works well in larger, multi-specialty practices or as an incentive based model

in an academic setting.

• Benefits: No adjustment for different payer mixes so physicians who treat the

Medicaid and Charity patients are appropriately rewarded for that.

• Risks: There are no set wRVUs for cosmetic procedures and new

technology/ Category II CPT codes.

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Challenges of Using RVU Work UnitsRecognizing the contribution of private pay services that do not

have established work units. Such as…

▪ LASIK

▪ Lipiview/Lipiflow

▪ Toric and Multi-Focal IOLs

▪ Femtosecond Laser Cataracts

▪ OPTOS

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Challenges of using RVU Work Units

As with charges…

You need to consider whether Modified Services should

have their work units modified for purposes of production.

▪ Multiple Procedure Modifier

▪ Co-Managed Services Modifier

▪ Professional Component Only

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Using GPCI Adjusted PE Units as a

Benchmark for Overhead

A practice could use the RVU tables to create a benchmark for

overhead. Steps to do this would include:

• Listing all CPTs performed separated by place of service

• List the non-facility or facility PE as appropriate

• List volume performed per CPT per location

• Multiply the PE by the volume performed

• Compare to actual practice overhead

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(Projected Volume per CPT 1 x PE RVU for CPT 1 x GPCI x CF) + (Projected Volume per CPT 2

x PE RVU for CPT 2 x GPCI x CF) etc. = Overhead Budget

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../Overhead%20Budget%20Derived%20from%20wRVU%20Numbers.xlsx

Using RVUs to Evaluate Alternative

Payment Models

An Unknown for Ophthalmology

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Cataract Episode Paymento What services are to be included in the episode?

▪ Diagnostic testing, pre-op evals, surgery, post-op visits, etc.

o What service triggers the start of the episode of care and how long does it

last?

o How many of these services do you normally provide each patient?

o What are the cumulative work units and total units for those services?

o What is your practice conversion factor?

o Multiplying the two, what is your minimum required compensation for the

episode?

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Future Thoughts

Being Paid to Care for a “Population”

o What patients are covered by the contract offering?

o What historical services have you provided those patients?

o What is the total RVU value of those services?

o What is your practice conversion factor?

o Multiplying the two, what is your minimum required

compensation for the contract?

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Reference Tools• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNProducts/downloads/MedcrephysFeeSchedfctsht.pdf

• https://www.ama-assn.org/practice-management/medicare/medicare-physician-payment-schedules

• www.cms.gov/apps/physician-fee-schedule

• RVUs

Applications for Medical Practice SuccessFrank Cohen, MBA, MPA

• Ann Hulett's Contact Information: [email protected]

• Sara Rapuano's Contact Information:

[email protected]

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https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedcrephysFeeSchedfctsht.pdf

https://www.ama-assn.org/practice-management/medicare/medicare-physician-payment-schedules

http://www.cms.gov/apps/physician-fee-schedule

Evaluating Your ContractsAnn Hulett, CMPE

A Deeper Look

46

A Timely Effort • The Conversion Factor is legislated to be flat for the next six

years.

• One of the largest service codes used in Ophthalmology (66984)

has just been reduced by 15%.

• All is not bleak… the demand for our services is on the increase

and projected to continue for twenty years.

• MIPS has motivated discussion about alternative payment

models.

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For Your Reference…A Checklist

48

49

For Your Reference…A Checklist

50

Review…What Kind of Contract Is It?

They pay differently and can be negotiated differently.

o Medicare Advantage

o Medicaid

o Commercial Product

o A “Select” or Narrowed Network Product?

More frequently, carriers are moving to one contract document with individual

addendums to address payment for each service line.

51

Medicare Advantage Contracts

• Growing presence all over the country.

• Empowered to include step-therapy as of 2019.

• Potential to receive slightly more than Medicare FFS

in some areas.

• Driven to receive a high-star rating in order to receive

CMS bonuses and attract members. Quality measures

come into play.

• Potential to negotiate is greater on new offerings.

52

53

Medicaid Contracts

• Managed Medicaid contracts are common in all but about ten

states.

▪ A commercial carrier is managing a Medicaid pot of

money and contracting with you independent of the

State.

• What is the basis for the fee:

▪ 100% of the state Medicaid schedule or

▪ 100% of the CMS Medicare schedule?

▪ Bonuses for quality and cost measures?

54

Commercial Contracts

• Higher conversion factors are the

norm.

• It is estimated that the Medicare CF of

$36/unit covers as little as 70% of

practice costs.

• CMS FFS 2020

92014…3.55 RVUs …$128.12

92012…2.45 RVUs …$89.86

• We rely on commercial contracts to

make up the rest and pay the doctors.

AcademetricsTM Median*

Operating Expenses

Per Encounter

$116.04

*2018 data for all practices

55

A “Select” Commercial Contract

• Large employer negotiates a discount on their

group health insurance in exchange for limiting the

doctors/hospitals/ASCs that are “in network”.

• Insurance company receives less from employer,

offers you chance to be “in network” and in

exchange pays you a lower conversion factor for

the opportunity to continue caring for this group of

people.

56

Another Select or “Narrow” Approach

• Local hospital system creates an Accountable Care Organization

(ACO) or Clinically Integrated Network (CIN) usually comprised of

their employed physicians and necessary independent specialty

groups (like us).

• They partner with an insurance company that may or may not be

owned by the same system.

• The insurance carrier pays you a different CF for seeing patients

through the ACO/CIN. May be better, may be worse, may have

incentives.

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Okay Let’s Take a Look at…

the Conversion Factor (CF)

• The Conversion Factor for 2019 is $36.04 and proposed to be $36.0896 for

2020, a .1% increase.

• All contract offerings, regardless of type, should be reviewed for their relation

to the $36.

• All carriers are by and large using the RVU system and relate their offerings

to the CMS Conversion Factor.

Contracts should be reviewed within context of Financial Class - Medicare

Advantage, Medicaid, Commercial, etc.

58

Review…


• Are all providers paid the same Conversion Factor rate?

o Some contracts pay ODs at a reduced rate similar to how other mid-level

providers are paid. This is an operational consideration.

o The reduction maybe expressed as a lower CF or a % reduction.

• There are likely different Conversion Factors for different service lines in the

contract

• Most Medicare Advantage carriers are imposing the Sequestration 2% - but

you need to know.

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Review…


• The only increase to Medicare reimbursement is now coming

through the Quality Payment Program bonus percentage.

• When all of your contracts are based on the CF, the bonus has no

impact. This is a negotiation point.

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Review…

Geographic Practice Cost Indicator

• GPCIs are applied to all three categories of units.

• Physician Work and Practice Expense matter the most.

• If your GPCI is higher than 1.0, you want to negotiate your contract to include

the GPCI.

• If your GPCI is less than 1.0, you do not want it included.

What’s your GPCI?

61

Review…

Which Year of RVUs?

• A stated base year. This can work in your advantage.

• “Current Year” What does that mean…the units that were effective

at the beginning of the year?

• Carving Out Codes

▪ Something to think about for services that are key to your practice

success.

▪ Possible if you are critical players to a carriers network.

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Review…

Special Service Considerations

• Prokera

• Cornea Transplant Tissue

• Lipiflow

• Istents - Multiples

63

Review…

Withholds or Incentives?

• If you are participating in a narrow or select network product, you need to

know if there are incentives for performing well on the annual diabetic eye

exam measure.

• Is the whole network having a withhold imposed based on measure

performance?

• Don’t wait until your EOB does not have the expected payment on it to find

out there is a withhold in the contract.

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Review…

PART B Drugs

• What percentage of ASP is the contract paying?

• Retina practices – How is Avastin being paid?

• Is there a payment policy outside of the contract that you

need to be aware of? For instance, step therapy

requirements for Retina.

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Review…

Multiple Procedure Reduction

How are modified services handled?o Modifier 50 - Bilateral

o Modifier 51 - Multiple Services

o Modifier 25 - Same Day Services

o Third Service Deductions?

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Review…Don’t Forget Your ASC!

When you are presented with a new contract

offering--such as a new Medicare Advantage

product coming into the market--you need to

pursue a participation contract for your ASC (if

you have one) at the same time as you are

negotiating the practice contract.

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And Verify…

• When the first payments from dates of service under the new

agreement begin to arrive, take out your calculator and verify the

payments are what they should be under the contract terms.

• Contract terms and conversion factors can easily be entered

incorrectly by the carrier.

• Special negotiated items can fall off the radar.

68

Provider Production

The Driver of all Revenue…Our Most Valuable Resource

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Measuring Production

What To Measure

• Days Worked

• Patient Encounters

• Encounters Per Day

• New Patient

Encounters

• Surgeries/Procedures

What To Measure

• Work RVUs

• Charges

• Receipts

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Patient Encounters…not appointments

Total

Eye codes (920xx)

plus

E&M codes (992xx)

plus

Post-op exams (99024)

May include

Consults and Lasik evals

Office Visits only

No procedures, testing or

surgery

Calculation

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Average Patients Seen per Day

Total Encounters

divided by

Office Days

Worked

Count days worked

in increments of

• .25

• .50

• .75

• 1.00

Calculation

72

New Patient Percentage

Calculation

Sum of

New Eye Codes

(92002, 92004)

New E&M Codes

(99201 through 99205)

____________

Total Patient Encounters

How We Use the Data

To measure practice health

To support strategic decisions

To balance provider and location

schedules


13.7%


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Collections per Provider

Calculation

Medical Collections

(no drugs, no optical)

____________

FTE Provider

Different specialties, different comparisons

How We Use the Data

• To assess individual potential for practice

growth.

• To stimulate thought on what factors go

into driving collections higher.


$1.1 Million (MDs)**

$363,000 (ODs)


**Median for all specialties combined

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Production Generates What?

Practice Level

• Total RVUs

• Aggregate Work Units

• Total Charges

o By Department

• Total Receipts

o By Department

Physician Level

• Work Units

• Charges

• Receipts

• Ancillary Receipts

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Monitoring and Reporting

Making it work for your practice.

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Reporting Production

• Report on the basis the practice is paid - RVUs

• Report on the basis physicians are paid – varies from

practice to practice

• Monthly Production Report for Each Provider

• Trended Production Information is Best

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Format for Reporting?

•Excel

•Graphs

•Both!

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Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Total 2018

DOCTOR:

PRODUCTION

New patient visits 53 23 47 21 28 24 9 22 6 4 20 28 285

Established visits 363 206 366 313 377 374 167 403 251 390 353 367 3,930

No charge exams 112 78 106 96 81 93 63 87 59 73 49 75 972

TOTAL VISITS 528 307 519 430 486 491 239 512 316 467 422 470 5,187

Laser surgeries 9 12 7 8 7 11 14 7 4 4 8 4 95

Cataract surgeries 31 23 27 20 23 24 18 20 15 18 18 20 257

Premium IOL 8 4 11 3 4 5 5 2 - 4 3 49

Other surgeries 3 6 3 2 5 5 2 3 4 4 2 1 40

TOTAL SURGERIES 43 41 37 30 35 40 34 30 23 26 28 25 392

MEDICAL CHARGES

New patients 13,472 7,004 12,086 6,204 7,483 6,990 2,631 6,103 2,052 1,032 4,517 7,685 77,259

Established patients 97,153 54,282 97,221 82,305 103,286 97,529 43,148 107,891 67,844 107,494 93,314 101,426 1,052,893

Testing 25,157 15,034 21,080 20,672 24,354 20,192 10,388 24,228 16,108 18,982 16,906 22,455 235,556

Drugs 575 600 1,175

Other office chgs 632 173 440 (60) 332 231 133 284 164 256 277 189 3,051

Laser surgeries 7,550 11,625 5,425 6,800 6,775 10,718 11,225 5,493 3,875 3,100 8,325 5,987 86,898

Cataract surgeries 59,283 43,874 51,084 38,556 43,874 46,124 34,772 38,198 28,738 34,772 32,699 37,185 489,159

Premium IOL 6,840 3,420 9,405 2,565 3,420 4,275 4,275 1,710 - 3,420 2,565 4,250 46,145

Other surgeries 1,774 2,265 1,383 470 982 1,455 484 2,184 2,789 1,963 2,623 2,350 20,722

Contact lens 355 279 1,473 1,187 449 464 125 379 842 280 174 250 6,257

TOTAL MEDICAL 212,791 137,956 199,597 158,699 190,955 187,978 107,181 186,470 122,412 171,299 161,400 182,377 2,019,115

OPTICAL CHARGES

Frames 6,984 4,570 7,217 8,689 10,372 5,830 4,635 6,616 5,341 5,591 7,812 10,677 84,334

Lenses 19,640 16,897 22,174 25,360 34,282 18,570 18,573 18,781 17,738 15,249 19,054 35,695 262,013

Other Optical 110 100 60 40 20 100 80 150 50 40 80 830

TOTAL OPTICAL 26,734 21,467 29,491 34,109 44,694 24,420 23,308 25,477 23,229 20,890 26,906 46,452 347,177

TOTAL CHARGES 239,525 159,423 229,088 192,808 235,649 212,398 130,489 211,946 145,641 192,189 188,306 228,829 2,366,292

OFFICE DAYS 15.50 9.00 15.00 12.50 15.00 14.50 6.50 15.50 10.00 15.00 16.00 15.00 159.50

ENCOUNTERS PER DAY 34.06 34.11 34.60 34.40 32.40 33.86 36.77 33.03 31.60 31.13 26.38 31.33 32.52

SURGERY ENCOUNTERS 43 41 37 30 35 40 34 30 23 26 28 25 392

SURGERY DAYS 3.00 2.50 2.50 2.00 2.00 2.00 1.50 2.00 1.50 2.00 2.00 2.00 25.00

PRODUCTION REPORT - GROSS CHARGES

TRENDED EXCEL PRESENTATION – CAN BE AT THE GROUP LEVEL OR PROVIDER LEVEL

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Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18

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Graphs to

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Easily See

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Monthly Charge TrendYou Can Use Trendlines to Add Emphasis

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Monthly Payment Trend

Up and Down!

82

$550,000

$1,035,000

$648,000

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

Comparative Payments YTD

Doctor 1

Doctor 2

Doctor 3

A Snapshot Look at YTD Comparison

83

$-

$50,000

$100,000

$150,000

$200,000

$250,000

Total Accounts Receivable - Doctor 2

Doctor 2

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

$200,000

Doctor 2 - Charge Trend

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Doctor 2 - Payment Trend

A Per Physician Page

84

Revenue Allocation – Type of Service

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

Visit Revenue Trend

Doctor 1

Doctor 2

Doctor 3

All

$0$10,000$20,000$30,000$40,000$50,000$60,000$70,000$80,000$90,000

Billable Meds Revenue Trend

Doctor 1

Doctor 2

Doctor 3

All

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

Procedure Revenue Trend

Doctor 1

Doctor 2

Doctor 3

All

$0

$100,000

$200,000

$300,000

$400,000

$500,000

Total Revenue Trend

Doctor 1

Doctor 2

Doctor 3

All

Trends and

Doctor

Comparison

Useful for a

2 -4 Doc

Practice

85

Would a Single-Page KPI Report Facilitate

Discussion?

Sometimes too much data distracts from your

objective for the conversation.

86

What’s the Difference Between

a

“Key Performance Indicator”

and a

“Benchmark”?

87

What Should Be On the Report?

Practice-Wide Report


• New Patient Percentage

• Collections per Encounter

• Expenses per Encounter

• Days in A/R/% over 90 Days

• Receipts

• Operating Expenses

Physician Report


• New Patient Percentage

• Days Worked

• Encounters per Day

• Surgeries

• Premium Services

• New Pt Wait Time

• Receipts

88

Jul-19 Jul-18 Variance YTD 2019 YTD 2018 Variance 6 MO AVG 12 MO AVG

MD OFFICE DAYS 89 83 6 1,174 1,207 (33) -2.8% 100 98

OD OFFICE DAYS 23 22 1 323 338 (15) -4.4% 28 27

New Pt Visits 569 516 53 7,401 7,584 (183) -2.4% 616 617

MD Visits 3,085 2,881 204 40,841 40,830 11 0.0% 3,389 3,403

OD Visits 376 404 (28) 5,429 4,999 430 8.6% 470 452

Total Visits 3,461 3,285 176 46,270 45,829 441 1.0% 3,859 3,856

New Patient % 16.0% 16.5% 15.9% 16.0%

Accounts Receivable 1,450,000$ 1,375,000$ 1,395,000$ 1,389,000$

Days in AR 26.0 24.9 26.2 25.7

% Over 90 Days 15.9% 14.0% 14.3% 13.5%

Cash Balance 875,000$ 925,000$ 858,000$ 915,000$

Line of Credit Balance 175,000$ 75,000$

Medical Receipts 753,744$ 779,052$ (25,308)$ 9,588,787$ 9,637,749$ (48,962)$ -0.5% 808,267$ 799,066$

Optical Receipts 175,278$ 182,953$ (7,675)$ 2,202,939$ 2,264,469$ (61,530)$ -2.7% 183,188$ 183,578$

Staff Comp and Benefits 331,166$ 261,172$ 69,994$ 3,436,846$ 3,138,985$ 297,861$ 9.5% 292,035$ 286,404$

Total Operating Expenses 488,648$ 486,434$ 2,214$ 5,413,918$ 5,074,920$ 338,998$ 6.7% 460,358$ 451,160$

Net Operating Income 326,857$ 286,772$ 40,085$ 4,780,472$ 5,131,870$ (351,398)$ -6.8% 396,363$ 398,373$

Medical Receipt per Visit 207.24$ 210.30$ (3.06)$ -1.5% 210.49$ 208.08$

Cost Per Visit 117.01$ 110.74$ 6.27$ 5.7% 120.32$ 117.65$

Wait Time New Appts - A 10.6 13.1 13.5

Wait Time New Appts - B 21.5 19.7 18.3

Optical Jobs - Office A 422 372 50 4,612 4,494 118 2.6% 389 384

Optical Jobs - Office B 220 218 2 2,389 2,535 (146) -5.8% 192 199

SAMPLE KPI REPORT

89

90

91

Collections per Encounter

Calculation

Medical Collections

(no drugs, no optical)

_______divided by ________

Total Encounters

How We Use the DataMedical Collections per encounter is an

indicator of:

o Changes in Payor Mix

o Impact of Medicare Fee Schedule Changes

o Impact of Premium Services

o Impact of Surgical Volume


$214.93


92

Operating Expenses per Encounter

Calculations

Total

Operating Expenses

_____________

Total Encounters

How We Use The Data

• Compare location to location

• Watch the trend year to year

• Are our expenditures conscious expenditures?

• Are we spending our money in a way that paysoff?


$116.04


93

Calculation

Total Accounts Receivable

Average Charges per Day

[Total Charges ÷ 365]

How We Use the Data

Overall look at how well the collection

processes are going.

It might prompt us to look further:

• A/R by Payer

• % of Claims Successful on First Pass

• Rejection Rate

• Denial Rate by Payor and by CPT

Accounts Receivable – Days in A/R


25 days


94

Percentage of A/R Greater Than 90 Days Old

Calculation

Total A/R Balances

Greater than 90 Days

Since Date of Service

__________

Total A/R Balance

How We Use The Data

To assess our revenue cycle

procedures.

Do we have a problem with:

• Prior-Authorizations

• Point of Service Collections

• Denial/Reject Follow-Up


11.9%


95

Successful KPI Reports

• Timely – Out by Mid-Month

• Consistent – Calculated the Same Every Month

• Trended - Rolling Averages or Graphs

• Responsive to Your/The Practice Goals

96

Successful KPI Reports

• Timely – Out by Mid-Month

• Consistent – Calculated the Same Every Month

• Trended - Rolling Averages or Graphs

• Responsive to Your/The Practice Goals

97

In Closing

Financially Knowing Your Practice Empowers You.

98

Ever ask “is our physician productivity

on par with similar practices”?

The Academy’s AcadeMetrics™

benchmarking and salary tools help you

find the right answers.

Good news: It’s FREE to members!

.

“The Academy’s benchmarking

and salary tools are one of the

best ways to run an efficient

and profitable practice.”ANTHONY P. JOHNSON, MD, FACS

Jervey Eye Group PA

AAOE Board Member and

Benchmarking Pro

99

Handouts & Resources

Access your handouts to this course at:https://www.aao.org/practice-management/annual-meeting-

courses/master-classes

100

1:30 to 4:30 p.m.

https://www.aao.org/practice-management/annual-meeting-courses/master-classes

101

AMERICAN ACADEMY

OF OPHTHALMOLOGY®

Handouts & Resources

SaturdayJ October 12, 2019 I SPE351:30 to 4:30 p.m.

Smart Money: Understand Your Payer Contracts, Finances and RevenueSenior Instructor: Ann Hulett, CMPECo-Instructors: Derek A. Preece, MBA and Sara Burns Rapuano, MBA, OCS, CPC

Protecting Sight. Empowering Lives."' 102

Financially Analyzing a Contract

Considerations What to Look For

PayerMedicare Advantage

Commercial

Commercial Select

Medicaid

Medicare Advantage Non-Exclusive

Commercial Non-Exclusive

Commercial Select Exclusive

Medicaid Non-Exclusive

Facilities In NetworkAre surgical cases required to be done at "in-network"

facilities?

Effective Date

Termination Date and Process When can they change the rates?

Medicare Advantage 102% of Medicare

Commercial $68/rvu

Commercial Select $66/rvu

Medicaid 100% of Medicare

Year of RVUs UsedUpdating to a new year may or may not be positive depending on how your top codes have changed in

relative value.

GPCI to Apply? Yes No If your GPCI is more than 1.0 then you want GPCIs to be

included.

Sequestration Reduction (Medicare Advantage Only)

For a few years, not all Medicare Advantage Plans passed along the Sequestration. Most do now.

Other Bonus/Withholds

Are there quality or cost savings incentive arrangements in the agreement? If so, are they "upside" bonuses or is there a withhold serving to reduce the amount you are

initially paid for each service?

Part B Drug ReimbursementOften expressed as a % of CMS Quarterly Published

Average Sales Price

Step TherapyRequired on Part-B Drugs?

This may be a "payment policy" as opposed to being included in the contract. However, you should be aware of any Part B step-therapy requirements. Most impactful

for Retina practices.

DMEPOS 2018 Medicare DMEPOS Rates for post-cataract eyeglasses.

Eye Codes Carved Out Yes No Some payers may establish separate reimbursement rates

for eyecodes.

Multiple Procedure TreatmentSome contracts have greater reductions for subsequent

procedures.

Payment on New CodesHow will a service for which CMS has not established a

value be handled?

Payment on Category 3 CodesThere is variability between payers as to how they treat

these codes. For example

OD Conversion FactorSame as MDOther

Some payers reduce the payment for OD Services. It may be expressed in a lower conversion factor or a %

reduction.

Required first treatment drugs may have a reimbursement rate that differs from the % of

ASP.

50% Reduction

Seen in narrow or clinically integrated network agreements.

106% of ASP

Financial Management

1.1.2019

Evergreen - 90 Day Notice of Rate Change

2% on Provider Portion

MD Conversion Factor

CMS 2018

Sample Contents

Healthcare America

Are Practice Affiliated ASCs contracted?

Virtually all Payer Contracts in the practice are a function of the Medicare Conversion Factor and of the RBRVS system.

Provider Network

In some cases, payers are marketing a discounted product to employee groups in exchange for their accessing a

more limited or select network. Reimbursements to the providers may be less for these service lines.

Product Lines IncludedMany payers are moving to a combined contract for all

service lines.

8/5/2019 Financial Checklist Worksheet AUG. 2019103

MTD MTD MTD YTD YTD YTD YTD %

Oct-18 Oct-17 Change Oct-18 Oct-17 Change Change

DOCTOR:

DR. #:

MEDICAL ACTIVITY

================

New patient visits 32 49 (17) 192 323 (131) -40.6%

Established visits 336 335 1 1,830 1,998 (168) -8.4%

No charge exams 62 85 (23) 405 452 (47) -10.4%

New Patient % 7.4% 10.4% 7.9% 11.6%

TOTAL VISITS 430 469 (39) 2,427 2,773 (346) -12.5%

Laser procedures 9 - 9 51 38 13 34.2%

Cataract surgeries 22 25 (3) 144 172 (28) -16.3%

Premium cataracts 5 5 - 24 25 (1) -4.0%

Other surgeries 2 8 (6) 24 49 (25) -51.0%

Refractive surgeries - - - - - - 0.0%

TOTAL SURGERIES 33 33 - 219 259 (40) -15.4%

MEDICAL CHARGES

================

New patients 8,024 13,029 (5,005) 51,324 92,766 (41,442) -44.7%

Established patients 81,313 80,061 1,252 453,457 473,853 (20,396) -4.3%

Testing 21,744 27,138 (5,394) 128,632 151,199 (22,567) -14.9%

Drugs 40 - 40 160 90 70 77.8%

Other office chgs 90 177 (87) 735 2,222 (1,487) -66.9%

Laser surgeries 6,975 - 6,975 41,300 30,250 11,050 36.5%

Cataract surgeries 41,624 48,016 (6,392) 273,164 324,964 (51,800) -15.9%

Premium Cataract 3,275 3,275 - 15,720 16,375 (655) -4.0%

Other surgeries 119 2,366 (2,247) 5,898 13,459 (7,561) -56.2%

Refractive surgeries - - - - - - 0.0%

ER Stipends - - - - - - 0.0%

Contact lens 7,036 7,231 (195) 43,160 47,155 (3,995) -8.5%

TOTAL MEDICAL CHARGES 170,240 181,293 (11,053) 1,013,550 1,152,333 (138,783) -12.0%

OPTICAL CHARGES

======================

Frames 20,454 16,802 3,652 92,420 80,399 12,021 15.0%

Lenses 36,382 43,637 (7,255) 210,344 207,100 3,244 1.6%

Other Optical 380 120 260 1,190 502 688 137.1%

TOTAL OPTICAL CHARGES 57,216 60,559 (3,343) 303,954 288,001 15,953 5.5%

TOTAL ALL CHARGES 227,456 241,852 (14,396) 1,317,503 1,440,334 (122,831) -8.5%

TOTAL ALL RECEIPTS 128,462 146,516 (18,054) 697,912 762,834 (64,922) -8.5%

SUMMARY SECTION

===============

TOTAL ENCOUNTERS 430 469 (39) 2,427 2,773 (346) -12.5%

OFFICE DAYS 14.50 15.25 (0.75) 82.75 90.75 (8.00) -8.8%

ENCOUNTERS PER DAY 29.66 30.75 (1.10) 29.33 30.56 1.23 -4.0%

SURGERY ENCOUNTERS 33 33 - 219 259 (40) -15.4%

SURGERY DAYS 2.25 2.25 - 12.00 13.00 1.00 7.7%

PRODUCTION DATA

7/31/2019 Sample Production Report OCT. 2018104

Jul-19 Jul-18 Variance YTD 2019 YTD 2018 Variance 6 MO AVG 12 MO AVG

MD OFFICE DAYS 89 83 6 1,174 1,207 (33) -2.8% 100 98

OD OFFICE DAYS 23 22 1 323 338 (15) -4.4% 28 27

New Pt Visits 569 516 53 7,401 7,584 (183) -2.4% 616 617

MD Visits 3,085 2,881 204 40,841 40,830 11 0.0% 3,389 3,403

OD Visits 376 404 (28) 5,429 4,999 430 8.6% 470 452

Total Visits 3,461 3,285 176 46,270 45,829 441 1.0% 3,859 3,856

New Patient % 16.0% 16.5% 15.9% 16.0%

Accounts Receivable 1,450,000$ 1,375,000$ 1,395,000$ 1,389,000$

Days in AR 26.0 24.9 26.2 25.7

% Over 90 Days 15.9% 14.0% 14.3% 13.5%

Cash Balance 875,000$ 925,000$ 858,000$ 915,000$

Line of Credit Balance 175,000$ 75,000$

Medical Receipts 753,744$ 779,052$ (25,308)$ 9,588,787$ 9,637,749$ (48,962)$ -0.5% 808,267$ 799,066$

Optical Receipts 175,278$ 182,953$ (7,675)$ 2,202,939$ 2,264,469$ (61,530)$ -2.7% 183,188$ 183,578$

Staff Comp and Benefits 331,166$ 261,172$ 69,994$ 3,436,846$ 3,138,985$ 297,861$ 9.5% 292,035$ 286,404$

Total Operating Expenses 488,648$ 486,434$ 2,214$ 5,413,918$ 5,074,920$ 338,998$ 6.7% 460,358$ 451,160$

Net Operating Income 326,857$ 286,772$ 40,085$ 4,780,472$ 5,131,870$ (351,398)$ -6.8% 396,363$ 398,373$

Medical Receipt per Visit 207.24$ 210.30$ (3.06)$ -1.5% 210.49$ 208.08$

Cost Per Visit 117.01$ 110.74$ 6.27$ 5.7% 120.32$ 117.65$

Wait Time New Appts - A 10.6 13.1 13.5

Wait Time New Appts - B 21.5 19.7 18.3

Optical Jobs - Office A 422 372 50 4,612 4,494 118 2.6% 389 384

Optical Jobs - Office B 220 218 2 2,389 2,535 (146) -5.8% 192 199

SAMPLE KPI REPORT

$-

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

$900,000

$1,000,000

Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19

Medical Receipts vs Operating Expenses

8/13/2019 Sample KPIs Practice V3 JULY 19105

2018 2017

Total Days Worked: 194 192

Patients Per Day: 30.2 29.6

Avg. Days Booked Out: 13.7 16.4

RVU's: 11,259 10,770

Dr. Brown Practice Evaluation

5145 5151

565 597 915 939

0

2000

4000

6000

2018 2017

Patient Encounters

Total Encounters New Patient Encounters Optical Encounters

2017

2018

Average Revenue Per Visit

Optical Contact Lens Medical

11% 18% 12% 18%

22.3% 1.4%

26.7%

37.6%

0.3%

3.2%

8.5%

Payer Mix

106

Medicare Administrative Contractor Locality

Number

Locality Name PW GPCI PE GPCI MP GPCI

ADDENDUM E: CY 2019 GEOGRAPHIC

PRACTICE COST INDICES (GPCIs) BY STATE

AND MEDICARE LOCALITY

2019

10112 0 ALABAMA 1 0.89 0.492

2102 1 ALASKA** 1.5 1.117 0.708

3102 0 ARIZONA 1 0.971 0.834

7102 13 ARKANSAS 1 0.872 0.576

1112 54 BAKERSFIELD, CA 1.02 1.074 0.618

1112 55 CHICO, CA 1.02 1.074 0.562

1182 71 EL CENTRO, CA 1.02 1.074 0.57

1112 56 FRESNO, CA 1.02 1.074 0.562

1112 57 HANFORD-CORCORAN, CA 1.021 1.074 0.562

1182 18 LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY), CA 1.046 1.177 0.694

1182 26 LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY), CA 1.046 1.177 0.694

1112 58 MADERA, CA 1.02 1.074 0.562

1112 59 MERCED, CA 1.02 1.074 0.562

1112 60 MODESTO, CA 1.02 1.074 0.562

1112 51 NAPA, CA 1.055 1.256 0.458

1182 17 OXNARD-THOUSAND OAKS-VENTURA, CA 1.024 1.176 0.673

1112 61 REDDING, CA 1.02 1.074 0.562

1112 62 RIVERSIDE-SAN BERNARDINO-ONTARIO, CA 1.021 1.074 0.753

1112 63 SACRAMENTO--ROSEVILLE--ARDEN-ARCADE, CA 1.027 1.092 0.562

1112 64 SALINAS, CA 1.026 1.101 0.562

1182 72 SAN DIEGO-CARLSBAD, CA 1.023 1.116 0.57

1112 7 SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY), CA 1.075 1.325 0.421

1112 52 SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY), CA 1.065 1.291 0.458

1112 5 SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY), CA 1.075 1.325 0.421

1112 6 SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY), CA 1.075 1.325 0.421

1112 65 SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY), CA 1.052 1.214 0.562

1112 9 SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY), CA 1.083 1.354 0.388

107

1182 73 SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE, CA 1.02 1.084 0.562

1112 66 SANTA CRUZ-WATSONVILLE, CA 1.03 1.161 0.562

1182 74 SANTA MARIA-SANTA BARBARA, CA 1.032 1.126 0.562

1112 67 SANTA ROSA, CA 1.024 1.13 0.562

1112 68 STOCKTON-LODI, CA 1.02 1.074 0.562

1112 53 VALLEJO-FAIRFIELD, CA 1.055 1.256 0.458

1112 69 VISALIA-PORTERVILLE, CA 1.02 1.074 0.562

1112 70 YUBA CITY, CA 1.02 1.074 0.562

1112 75 REST OF CALIFORNIA, CA 1.02 1.074 0.562

4112 1 COLORADO 1 1.018 1.042

13102 0 CONNECTICUT 1.021 1.112 1.255

12202 1 DC + MD/VA SUBURBS 1.045 1.205 1.261

12102 1 DELAWARE 1.007 1.019 1.119

9102 3 FORT LAUDERDALE, FL 1 1.012 1.797

9102 4 MIAMI, FL 1 1.029 2.566

9102 99 REST OF FLORIDA 1 0.952 1.358

10212 1 ATLANTA, GA 1 0.997 1.088

10212 99 REST OF GEORGIA 1 0.899 1.073

1212 1 HAWAII, GUAM 1.001 1.146 0.614

2202 0 IDAHO 1 0.902 0.512

6102 16 CHICAGO, IL 1.008 1.034 1.925

6102 12 EAST ST. LOUIS, IL 1 0.936 1.785

6102 15 SUBURBAN CHICAGO, IL 1.009 1.053 1.565

6102 99 REST OF ILLINOIS 1 0.919 1.208

8102 0 INDIANA 1 0.919 0.379

5102 0 IOWA 1 0.907 0.423

5202 0 KANSAS 1 0.911 0.615

15102 0 KENTUCKY 1 0.88 0.819

7202 1 NEW ORLEANS, LA 1 0.966 1.273

7202 99 REST OF LOUISIANA 1 0.887 1.199

14112 3 SOUTHERN MAINE 1 1.007 0.67

14112 99 REST OF MAINE 1 0.922 0.67

12302 1 BALTIMORE/SURR. CNTYS, MD 1.023 1.095 1.295

12302 99 REST OF MARYLAND 1.009 1.033 1.082

108

14212 1 METROPOLITAN BOSTON, MA 1.033 1.179 1.061

14212 99 REST OF MASSACHUSETTS 1.02 1.067 1.061

8202 1 DETROIT, MI 1 0.989 1.691

8202 99 REST OF MICHIGAN 1 0.919 1.018

6202 0 MINNESOTA 1 1.011 0.362

7302 0 MISSISSIPPI 1 0.87 0.37

5302 2 METROPOLITAN KANSAS CITY, MO 1 0.963 1.073

5302 1 METROPOLITAN ST. LOUIS, MO 1 0.959 1.053

5302 99 REST OF MISSOURI 1 0.863 0.993

3202 1 MONTANA*** 1 1 1.631

5402 0 NEBRASKA 1 0.91 0.318

1312 0 NEVADA*** 1.002 1.017 0.909

14312 40 NEW HAMPSHIRE 1 1.045 1.05

12402 1 NORTHERN NJ 1.041 1.18 0.938

12402 99 REST OF NEW JERSEY 1.024 1.123 0.938

4212 5 NEW MEXICO 1 0.921 1.247

13202 1 MANHATTAN, NY 1.052 1.18 1.615

13202 2 NYC SUBURBS/LONG ISLAND, NY 1.041 1.205 2.149

13202 3 POUGHKPSIE/N NYC SUBURBS, NY 1.016 1.07 1.313

13292 4 QUEENS, NY 1.052 1.2 2.121

13282 99 REST OF NEW YORK 1 0.95 0.595

11502 0 NORTH CAROLINA 1 0.931 0.695

3302 1 NORTH DAKOTA*** 1 1 0.54

15202 0 OHIO 1 0.917 1.005

4312 0 OKLAHOMA 1 0.891 0.954

2302 1 PORTLAND, OR 1.01 1.054 0.783

2302 99 REST OF OREGON 1 0.967 0.783

12502 1 METROPOLITAN PHILADELPHIA, PA 1.022 1.074 1.379

12502 99 REST OF PENNSYLVANIA 1 0.936 1.033

9202 20 PUERTO RICO 1 1.007 0.99

14412 1 RHODE ISLAND 1.027 1.05 0.999

11202 1 SOUTH CAROLINA 1 0.912 0.553

3402 2 SOUTH DAKOTA*** 1 1 0.389

10312 35 TENNESSEE 1 0.901 0.526

109

4412 31 AUSTIN, TX 1 1.021 0.747

4412 20 BEAUMONT, TX 1 0.924 0.839

4412 9 BRAZORIA, TX 1.02 0.997 0.839

4412 11 DALLAS, TX 1.012 1.014 0.768

4412 28 FORT WORTH, TX 1.007 0.986 0.747

4412 15 GALVESTON, TX 1.02 1.011 0.839

4412 18 HOUSTON, TX 1.02 1.012 0.936

4412 99 REST OF TEXAS 1 0.938 0.796

3502 9 UTAH 1 0.927 1.165

14512 50 VERMONT 1 1.015 0.595

11302 0 VIRGINIA 1 0.986 0.908

9202 50 VIRGIN ISLANDS 1 1.007 0.99

2402 2 SEATTLE (KING CNTY), WA 1.027 1.146 0.931

2402 99 REST OF WASHINGTON 1 1.011 0.902

11402 16 WEST VIRGINIA 1 0.857 1.296

6302 0 WISCONSIN 1 0.957 0.347

3602 21 WYOMING*** 1 1 0.88

110

Components of RVUs For Eye Codes and Evaluation Management Visit Codes

CPT1/

HCPCS Mod Status

Not Used for

Medicare

Payment Description

Work

RVUs2

Non-

Facility

PE

RVUs2

Facility

PE

RVUs2

Mal-

Practice

RVUs2

Total Non-

Facility

RVUs2

Total Facility

RVUs2

92002 A Eye exam new patient 0.88 1.46 0.45 0.03 2.37 1.36

92004 A Eye exam new patient 1.82 2.37 0.92 0.07 4.26 2.81

92012 A Eye exam establish patient 0.92 1.53 0.53 0.04 2.49 1.49

92014 A Eye exam&tx estab pt 1/>vst 1.42 2.09 0.77 0.06 3.57 2.25

99201 A Office/outpatient visit new 0.48 0.76 0.23 0.05 1.29 0.76





99211 A Office/outpatient visit est 0.18 0.45 0.07 0.01 0.64 0.26





99241 I + Office consultation 0.64 0.66 0.24 0.04 1.34 0.92





111

Components of RVUs For Eye Codes and Evaluation Management Visit Codes

Global

National Non

Facility

Payment

National

Facilty

Payment

Locality Non

Facility

Payment

Locality

Facilty

Payment

XXX

$85.41 $49.01 $90.41 $51.32

XXX $153.53 $101.27 $162.25 $106.12

XXX $89.74 $53.70 $95.09 $56.39

XXX $128.66 $81.09 $136.18 $85.09

XXX $46.49 $27.39 $49.58 $29.07

XXX $77.48 $51.54 $82.35 $54.49

XXX $109.92 $77.48 $116.93 $82.10

XXX $166.86 $131.18 $176.96 $138.64

XXX $209.75 $171.19 $222.30 $180.88

XXX $23.07 $9.37 $24.54 $9.84

XXX $45.77 $25.95 $48.70 $27.41

XXX $75.32 $51.90 $79.85 $54.69

XXX $110.28 $80.01 $116.73 $84.22

XXX $147.76 $112.80 $156.39 $118.84

XXX $48.29 $33.16 $51.11 $34.85

XXX $90.82 $69.56 $95.91 $73.07

XXX $124.33 $97.31 $131.22 $102.19

XXX $185.96 $156.41 $196.04 $164.30

XXX $226.69 $193.53 $238.81 $203.20

112

CPT1/

HCPCS

Description

Work

RVUs2

Non-

Facility

PE

RVUs2

Facility

PE

RVUs2

Mal-

Practice

RVUs2

Total Non-

Facility

RVUs2

Total

Facility

RVUs2

Global Work RVU as%

Total Non

Facility RVU

Work RVU

as% Total

Facility

RVU

National

Non

Facility

Payment

National

Facilty

Payment

Locality Non

Facility

Payment

Locality

Facilty

Payment

76510 Ophth us b & quant a 0.70 2.43 NA 0.02 3.15 NA XXX 22.22% NA $113.52 $120.83

76511 Ophth us quant a only 0.64 1.27 NA 0.02 1.93 NA XXX 33.16% NA $69.56 $73.72

76512 Ophth us b w/non-quant a 0.56 1.15 NA 0.02 1.73 NA XXX 32.37% NA $62.35 $66.13

76513 Echo exam of eye water bath 0.66 2.10 NA 0.02 2.78 NA XXX 23.74% NA $100.19 $106.59

76514 Echo exam of eye thickness 0.14 0.20 NA 0.02 0.36 NA XXX 38.89% NA $12.97 $13.89

76516 Echo exam of eye 0.40 1.11 NA 0.02 1.53 NA XXX 26.14% NA $55.14 $58.69

76519 Echo exam of eye 0.54 1.31 NA 0.02 1.87 NA XXX 28.88% NA $67.39 $71.59

92020 Special eye evaluation 0.37 0.40 0.22 0.01 0.78 0.60 XXX 47.44% 61.67% $28.11 $21.62 $29.61 $22.64

92025 Corneal topography 0.35 0.70 NA 0.02 1.07 NA XXX 32.71% NA $38.56 $40.98

92060 Special eye evaluation 0.69 1.11 NA 0.02 1.82 NA XXX 37.91% NA $65.59 $69.37

92065 Orthoptic/pleoptic training 0.37 1.12 NA 0.02 1.51 NA XXX 24.50% NA $54.42 $57.97

92071 Contact lens fitting for tx 0.61 0.44 0.32 0.02 1.07 0.95 XXX 57.01% 64.21% $38.56 $34.24 $40.49 $35.85

92072 Fit contac lens for managmnt 1.97 1.68 0.80 0.07 3.72 2.84 XXX 52.96% 69.37% $134.07 $102.35 $141.06 $107.00

92081 Visual field examination(s) 0.30 0.64 NA 0.02 0.96 NA XXX 31.25% NA $34.60 $36.82



92100 Serial tonometry exam(s) 0.61 1.69 0.33 0.02 2.32 0.96 XXX 26.29% 63.54% $83.61 $34.60 $88.87 $36.23

92132 Cmptr ophth dx img ant segmt 0.30 0.57 NA 0.02 0.89 NA XXX 33.71% NA $32.07 $34.11

92133 Cmptr ophth img optic nerve 0.40 0.63 NA 0.02 1.05 NA XXX 38.10% NA $37.84 $40.11

92134 Cptr ophth dx img post segmt 0.45 0.69 NA 0.02 1.16 NA XXX 38.79% NA $41.81 $44.28

92136 Ophthalmic biometry 0.54 1.42 NA 0.02 1.98 NA XXX 27.27% NA $71.36 $75.85

92145 Corneal hysteresis deter 0.17 0.30 NA 0.02 0.49 NA XXX 34.69% NA $17.66 $18.87

92225 Special eye exam initial 0.38 0.39 0.22 0.01 0.78 0.61 XXX 48.72% 62.30% $28.11 $21.98 $29.59 $23.01

92226 Special eye exam subsequent 0.33 0.38 0.20 0.01 0.72 0.54 XXX 45.83% 61.11% $25.95 $19.46 $27.36 $20.39

92227 Remote dx retinal imaging 0.00 0.39 NA 0.01 0.40 NA XXX 0.00% NA $14.42 $15.59

92228 Remote retinal imaging mgmt 0.37 0.58 NA 0.02 0.97 NA XXX 38.14% NA $34.96 $37.07

92230 Eye exam with photos 0.60 1.20 0.32 0.03 1.83 0.95 XXX 32.79% 63.16% $65.95 $34.24 $70.04 $35.98

92235 Fluorescein angrph uni/bi 0.75 1.82 NA 0.02 2.59 NA XXX 28.96% NA $93.34 $99.06

Diagnostic Tests

113

92240 Icg angiography uni/bi 0.80 4.97 NA 0.06 5.83 NA XXX 13.72% NA $210.11 $224.82

92242 Fluorescein icg angiography 0.95 5.54 NA 0.02 6.51 NA XXX 14.59% NA $234.61 $250.42

92250 Eye exam with photos 0.40 1.01 NA 0.02 1.43 NA XXX 27.97% NA $51.54 $54.82

92260 Ophthalmoscopy/dynamometry 0.20 0.34 0.10 0.01 0.55 0.31 XXX 36.36% 64.52% $19.82 $11.17 $21.02 $11.73

92265 Eye muscle evaluation 0.81 1.65 NA 0.02 2.48 NA XXX 32.66% NA $89.38 $94.69

92270 Electro-oculography 0.81 1.85 NA 0.04 2.70 NA XXX 30.00% NA $97.31 $103.43

92273 Full field erg w/i&r 0.69 3.07 NA 0.02 3.78 NA XXX 18.25% NA $136.23 $145.24

92274 Multifocal erg w/i&r 0.61 1.93 NA 0.02 2.56 NA XXX 23.83% NA $92.26 $98.16

92283 Color vision examination 0.17 1.33 NA 0.02 1.52 NA XXX 11.18% NA $54.78 $58.73

92284 Dark adaptation eye exam 0.24 1.48 NA 0.02 1.74 NA XXX 13.79% NA $62.71 $67.12

92285 Eye photography 0.05 0.54 NA 0.02 0.61 NA XXX 8.20% NA $21.98 $23.74

92286 Internal eye photography 0.40 0.68 NA 0.02 1.10 NA XXX 36.36% NA $39.64 $42.05

92287 Internal eye photography 0.81 3.29 NA 0.03 4.13 NA XXX 19.61% NA $148.84 $158.67

29.91% 0.00%

114

CPT1/

HCPCS Description

Work

RVUs2

Non-

Facility

PE

RVUs2

Facility

PE

RVUs2

Mal-

Practice

RVUs2

Total Non-

Facility

RVUs2

Total

Facility

RVUs2

Global

Work RVU as%

Total Non

Facility RVU

Work RVU

as% Total

Facility

RVU

National

Non Facility

Payment

National

Facilty

Payment

Locality Non

Facility

Payment

Locality

Facilty

Payment

65091 Revise eye 7.26 NA 10.62 0.52 NA 18.40 090 39.46% $663.12 $704.30

65093 Revise eye with implant 7.04 NA 10.65 0.52 NA 18.21 090 38.66% $656.27 $697.36

65101 Removal of eye 8.30 NA 12.47 0.60 NA 21.37 090 38.84% $770.16 $818.19

65103 Remove eye/insert implant 8.84 NA 12.76 0.65 NA 22.25 090 39.73% $801.87 $851.79

65105 Remove eye/attach implant 9.93 NA 13.83 0.73 NA 24.49 090 40.55% $882.60 $937.32

65110 Removal of eye 15.70 NA 18.21 1.14 NA 35.05 090 44.79% $1,263.17 $1,339.75

65112 Remove eye/revise socket 18.51 NA 20.74 1.33 NA 40.58 090 45.61% $1,462.47 $1,550.62

65114 Remove eye/revise socket 19.65 NA 21.46 1.41 NA 42.52 090 46.21% $1,532.38 $1,624.45

65125 Revise ocular implant 3.27 9.52 4.81 0.24 13.03 8.32 090 25.10% 39.30% $469.59 $299.85 $500.85 $318.54

65130 Insert ocular implant 8.42 NA 12.14 0.61 NA 21.17 090 39.77% $762.95 $810.33

65135 Insert ocular implant 8.60 NA 12.25 0.62 NA 21.47 090 40.06% $773.76 $821.72

65140 Attach ocular implant 9.46 NA 13.18 0.68 NA 23.32 090 40.57% $840.43 $892.37

65150 Revise ocular implant 6.43 NA 9.91 0.46 NA 16.80 090 38.27% $605.46 $643.27

65155 Reinsert ocular implant 10.10 NA 13.57 0.73 NA 24.40 090 41.39% $879.35 $933.52

65175 Removal of ocular implant 7.40 NA 11.12 0.53 NA 19.05 090 38.85% $686.54 $729.31

65205 Remove foreign body from eye 0.49 0.79 0.50 0.03 1.31 1.02 000 37.40% 48.04% $47.21 $36.76 $50.12 $38.89




65235 Remove foreign body from eye 9.01 NA 10.60 0.65 NA 20.26 090 44.47% $730.15 $774.44

65260 Remove foreign body from eye 12.54 NA 13.96 0.91 NA 27.41 090 45.75% $987.83 $1,047.43

65265 Remove foreign body from eye 14.34 NA 15.41 1.04 NA 30.79 090 46.57% $1,109.64 $1,176.32

65270 Repair of eye wound 1.95 5.70 1.92 0.14 7.79 4.01 010 25.03% 48.63% $280.74 $144.52 $299.40 $153.10


65273 Repair of eye wound 5.16 NA 5.31 0.38 NA 10.85 090 47.56% $391.02 $414.47


65280 Repair of eye wound 9.10 NA 9.35 0.65 NA 19.10 090 47.64% $688.35 $729.38

65285 Repair of eye wound 15.36 NA 15.09 1.12 NA 31.57 090 48.65% $1,137.75 $1,205.47


65290 Repair of eye socket wound 6.53 NA 6.96 0.47 NA 13.96 090 46.78% $503.11 $533.26

Eye Procedures

115

65400 Removal of eye lesion 7.50 11.40 9.10 0.54 19.44 17.14 090 38.58% 43.76% $700.60 $617.71 $744.32 $655.30

65410 Biopsy of cornea 1.47 2.53 1.38 0.11 4.11 2.96 000 35.77% 49.66% $148.12 $106.68 $157.54 $113.02



65430 Corneal smear 1.47 1.73 1.36 0.11 3.31 2.94 000 44.41% 50.00% $119.29 $105.95 $126.57 $112.25

65435 Curette/treat cornea 0.92 1.34 1.00 0.06 2.32 1.98 000 39.66% 46.46% $83.61 $71.36 $88.73 $75.57

65436 Curette/treat cornea 4.82 5.88 5.38 0.35 11.05 10.55 090 43.62% 45.69% $398.23 $380.21 $422.52 $403.16

65450 Treatment of corneal lesion 3.47 5.57 5.42 0.26 9.30 9.15 090 37.31% 37.92% $335.16 $329.76 $356.32 $350.51

65600 Revision of cornea 4.20 6.88 5.24 0.30 11.38 9.74 090 36.91% 43.12% $410.12 $351.02 $435.90 $372.42

65710 Corneal transplant 14.45 NA 16.26 1.05 NA 31.76 090 45.50% $1,144.60 $1,213.76




65756 Corneal trnspl endothelial 16.84 NA 15.59 1.22 NA 33.65 090 50.04% $1,212.72 $1,284.31

65757 Prep corneal endo allograft 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ $0.00 $0.00 $0.00 $0.00

65770 Revise cornea with implant 19.74 NA 18.51 1.38 NA 39.63 090 49.81% $1,428.23 $1,512.09

65771 Radial keratotomy 0.00 0.00 0.00 0.00 0.00 0.00 XXX $0.00 $0.00 $0.00 $0.00

65772 Correction of astigmatism 5.09 7.42 6.09 0.37 12.88 11.55 090 39.52% 44.07% $464.18 $416.25 $493.06 $441.58

65775 Correction of astigmatism 6.91 NA 8.41 0.50 NA 15.82 090 43.68% $570.14 $604.88

65778 Cover eye w/membrane 1.00 39.02 0.52 0.06 40.08 1.58 000 2.50% 63.29% $1,444.45 $56.94 $1,550.12 $59.94

65779 Cover eye w/membrane suture 2.50 31.82 1.63 0.19 34.51 4.32 000 7.24% 57.87% $1,243.71 $155.69 $1,333.15 $164.61

65780 Ocular reconst transplant 7.81 NA 10.58 0.56 NA 18.95 090 41.21% $682.94 $725.00

65781 Ocular reconst transplant 18.14 NA 18.46 1.31 NA 37.91 090 47.85% $1,366.24 $1,447.75

65782 Ocular reconst transplant 15.43 NA 16.13 1.12 NA 32.68 090 47.22% $1,177.76 $1,248.31

65785 Impltj ntrstrml crnl rng seg 5.39 63.78 6.80 0.39 69.56 12.58 090 7.75% 42.85% $2,506.88 $453.37 $2,686.57 $481.11

65800 Drainage of eye 1.53 1.78 0.95 0.11 3.42 2.59 000 44.74% 59.07% $123.25 $93.34 $130.72 $98.59

65810 Drainage of eye 5.82 NA 6.99 0.42 NA 13.23 090 43.99% $476.80 $505.79

65815 Drainage of eye 6.00 11.83 7.14 0.43 18.26 13.57 090 32.86% 44.22% $658.07 $489.05 $700.25 $518.72

65820 Relieve inner eye pressure 8.91 NA 11.98 0.65 NA 21.54 090 41.36% $776.28 $824.17

65850 Incision of eye 11.39 NA 11.67 0.81 NA 23.87 090 47.72% $860.25 $911.47

65855 Trabeculoplasty laser surg 3.00 3.79 2.69 0.22 7.01 5.91 010 42.80% 50.76% $252.63 $212.99 $268.13 $225.55

65860 Incise inner eye adhesions 3.59 4.96 3.33 0.26 8.81 7.18 090 40.75% 50.00% $317.50 $258.76 $337.13 $274.04

65865 Incise inner eye adhesions 5.77 NA 7.27 0.42 NA 13.46 090 42.87% $485.09 $514.79


116



65900 Remove eye lesion 12.51 NA 14.21 0.91 NA 27.63 090 45.28% $995.76 $1,056.01

65920 Remove implant of eye 9.99 NA 11.70 0.72 NA 22.41 090 44.58% $807.64 $856.59

65930 Remove blood clot from eye 8.39 NA 9.10 0.60 NA 18.09 090 46.38% $651.95 $691.06

66020 Injection treatment of eye 1.64 3.67 1.98 0.12 5.43 3.74 010 30.20% 43.85% $195.69 $134.79 $208.42 $143.01

66030 Injection treatment of eye 1.30 3.47 1.76 0.10 4.87 3.16 010 26.69% 41.14% $175.51 $113.88 $187.16 $120.97

66130 Remove eye lesion 7.83 11.55 7.76 0.57 19.95 16.16 090 39.25% 48.45% $718.98 $582.39 $763.78 $617.08

66150 Glaucoma surgery 10.53 NA 13.65 0.76 NA 24.94 090 42.22% $898.82 $953.95

66155 Glaucoma surgery 10.52 NA 13.64 0.76 NA 24.92 090 42.22% $898.09 $953.19

66160 Glaucoma surgery 12.39 NA 14.81 0.90 NA 28.10 090 44.09% $1,012.70 $1,074.31

66170 Glaucoma surgery 13.94 NA 16.17 1.01 NA 31.12 090 44.79% $1,121.54 $1,189.51

66172 Incision of eye 14.84 NA 17.98 1.08 NA 33.90 090 43.78% $1,221.73 $1,296.19

66174 Translum dil eye canal 12.85 NA 13.16 0.93 NA 26.94 090 47.70% $970.89 $1,028.88

66175 Trnslum dil eye canal w/stnt 13.60 NA 13.63 0.99 NA 28.22 090 48.19% $1,017.02 $1,077.68

66179 Aqueous shunt eye w/o graft 14.00 NA 15.65 1.01 NA 30.66 090 45.66% $1,104.96 $1,171.59

66180 Aqueous shunt eye w/graft 15.00 NA 16.26 1.09 NA 32.35 090 46.37% $1,165.86 $1,236.01

66183 Insert ant drainage device 13.20 NA 15.13 0.96 NA 29.29 090 45.07% $1,055.59 $1,119.51

66184 Revision of aqueous shunt 9.58 NA 12.07 0.69 NA 22.34 090 42.88% $805.11 $854.32

66185 Revise aqueous shunt eye 10.58 NA 12.71 0.76 NA 24.05 090 43.99% $866.74 $919.41

66225 Repair/graft eye lesion 12.63 NA 12.94 0.91 NA 26.48 090 47.70% $954.32 $1,011.27

66250 Follow-up surgery of eye 7.10 13.80 8.22 0.51 21.41 15.83 090 33.16% 44.85% $771.60 $570.50 $821.00 $605.02

66500 Incision of iris 3.83 NA 6.10 0.27 NA 10.20 090 37.55% $367.60 $390.59

66505 Incision of iris 4.22 NA 6.64 0.31 NA 11.17 090 37.78% $402.56 $427.85

66600 Remove iris and lesion 10.12 NA 13.09 0.73 NA 23.94 090 42.27% $862.78 $915.68

66605 Removal of iris 14.22 NA 15.09 1.03 NA 30.34 090 46.87% $1,093.43 $1,159.01

66625 Removal of iris 5.30 NA 6.51 0.39 NA 12.20 090 43.44% $439.68 $466.57



66680 Repair iris & ciliary body 6.39 NA 7.86 0.46 NA 14.71 090 43.44% $530.14 $562.45

66682 Repair iris & ciliary body 7.33 NA 10.53 0.53 NA 18.39 090 39.86% $662.76 $703.89

66700 Destruction ciliary body 5.14 7.34 5.65 0.38 12.86 11.17 090 39.97% 46.02% $463.46 $402.56 $492.30 $426.89

66710 Ciliary transsleral therapy 5.14 7.08 5.65 0.38 12.60 11.17 090 40.79% 46.02% $454.09 $402.56 $482.24 $426.89

66711 Ciliary endoscopic ablation 7.93 NA 9.78 0.57 NA 18.28 090 43.38% $658.79 $698.95

117



66761 Revision of iris 3.00 5.28 3.49 0.22 8.50 6.71 010 35.29% 44.71% $306.33 $241.82 $325.80 $256.51

66762 Revision of iris 5.38 7.80 6.32 0.39 13.57 12.09 090 39.65% 44.50% $489.05 $435.71 $519.44 $462.16

66770 Removal of inner eye lesion 6.13 8.50 7.14 0.44 15.07 13.71 090 40.68% 44.71% $543.11 $494.10 $576.65 $524.01

66820 Incision secondary cataract 4.01 NA 7.17 0.28 NA 11.46 090 34.99% $413.01 $439.13

66821 After cataract laser surgery 3.42 5.75 5.18 0.25 9.42 8.85 090 36.31% 38.64% $339.49 $318.95 $360.95 $338.89

66825 Reposition intraocular lens 9.01 NA 12.19 0.65 NA 21.85 090 41.24% $787.45 $835.99

66830 Removal of lens lesion 9.47 NA 9.98 0.70 NA 20.15 090 47.00% $726.19 $769.87

66840 Removal of lens material 9.18 NA 9.95 0.66 NA 19.79 090 46.39% $713.21 $756.04



66920 Extraction of lens 10.13 NA 10.55 0.73 NA 21.41 090 47.31% $771.60 $817.74



66982 Cataract surgery complex 11.08 NA 10.69 0.79 NA 22.56 090 49.11% $813.04 $861.13

66983 Cataract surg w/iol 1 stage 10.43 NA 10.04 0.62 NA 21.09 090 49.45% $760.06 $803.58

66984 Cataract surg w/iol 1 stage 8.52 NA 9.04 0.60 NA 18.16 090 46.92% $654.47 $693.53

66985 Insert lens prosthesis 9.98 NA 11.17 0.71 NA 21.86 090 45.65% $787.81 $835.21

66986 Exchange lens prosthesis 12.26 NA 12.68 0.89 NA 25.83 090 47.46% $930.89 $986.58

66990 Ophthalmic endoscope add-on 1.51 NA 0.94 0.11 NA 2.56 ZZZ 58.98% $92.26 $97.47

66999 Eye surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY $0.00 $0.00 $0.00 $0.00

67005 Partial removal of eye fluid 5.89 NA 7.12 0.42 NA 13.43 090 43.86% $484.01 $513.40

67010 Partial removal of eye fluid 7.06 NA 7.85 0.51 NA 15.42 090 45.78% $555.72 $589.22

67015 Release of eye fluid 7.14 NA 8.92 0.52 NA 16.58 090 43.06% $597.53 $634.08

67025 Replace eye fluid 8.11 12.16 9.28 0.58 20.85 17.97 090 38.90% 45.13% $751.42 $647.62 $798.20 $686.72

67027 Implant eye drug system 11.62 NA 11.77 0.83 NA 24.22 090 47.98% $872.87 $924.81

67028 Injection eye drug 1.44 1.34 1.28 0.11 2.89 2.83 000 49.83% 50.88% $104.15 $101.99 $110.37 $108.05

67030 Incise inner eye strands 6.11 NA 8.66 0.44 NA 15.21 090 40.17% $548.15 $582.10

67031 Laser surgery eye strands 4.47 6.31 5.34 0.33 11.11 10.14 090 40.23% 44.08% $400.39 $365.44 $425.27 $387.73

67036 Removal of inner eye fluid 12.13 NA 12.60 0.88 NA 25.61 090 47.36% $922.96 $978.20

67039 Laser treatment of retina 13.20 NA 13.27 0.96 NA 27.43 090 48.12% $988.55 $1,047.52

67040 Laser treatment of retina 14.50 NA 14.09 1.05 NA 29.64 090 48.92% $1,068.20 $1,131.61

67041 Vit for macular pucker 16.33 NA 15.23 1.19 NA 32.75 090 49.86% $1,180.28 $1,250.10

118

67042 Vit for macular hole 16.33 NA 15.23 1.19 NA 32.75 090 49.86% $1,180.28 $1,250.10

67043 Vit for membrane dissect 17.40 NA 15.90 1.25 NA 34.55 090 50.36% $1,245.15 $1,318.42

67101 Repair detached retina crtx 3.50 5.64 4.34 0.26 9.40 8.10 010 37.23% 43.21% $338.77 $291.92 $360.14 $309.82

67105 Repair detached retina pc 3.39 4.81 4.18 0.25 8.45 7.82 010 40.12% 43.35% $304.53 $281.83 $323.46 $299.08

67107 Repair detached retina 16.00 NA 15.03 1.16 NA 32.19 090 49.70% $1,160.10 $1,228.71

67108 Repair detached retina 17.13 NA 15.73 1.24 NA 34.10 090 50.23% $1,228.93 $1,301.40

67110 Repair detached retina 10.25 14.10 12.13 0.74 25.09 23.12 090 40.85% 44.33% $904.22 $833.22 $960.06 $883.81

67113 Repair retinal detach cplx 19.00 NA 17.70 1.36 NA 38.06 090 49.92% $1,371.65 $1,452.49

67115 Release encircling material 6.11 NA 7.64 0.44 NA 14.19 090 43.06% $511.39 $542.62

67120 Remove eye implant material 7.10 11.25 8.22 0.51 18.86 15.83 090 37.65% 44.85% $679.70 $570.50 $722.30 $605.02

67121 Remove eye implant material 12.25 NA 12.67 0.89 NA 25.81 090 47.46% $930.17 $985.83

67141 Treatment of retina 6.15 8.33 7.25 0.44 14.92 13.84 090 41.22% 44.44% $537.70 $498.78 $570.80 $529.00

67145 Treatment of retina 6.32 8.25 7.37 0.45 15.02 14.14 090 42.08% 44.70% $541.31 $509.59 $574.47 $540.41

67208 Treatment of retinal lesion 7.65 8.87 8.22 0.55 17.07 16.42 090 44.82% 46.59% $615.19 $591.76 $652.42 $627.26

67210 Treatment of retinal lesion 6.36 7.90 7.39 0.46 14.72 14.21 090 43.21% 44.76% $530.50 $512.12 $562.89 $543.15

67218 Treatment of retinal lesion 20.36 NA 17.55 1.47 NA 39.38 090 51.70% $1,419.22 $1,502.24

67220 Treatment of choroid lesion 6.36 8.36 7.39 0.46 15.18 14.21 090 41.90% 44.76% $547.07 $512.12 $580.69 $543.15

67221 Ocular photodynamic ther 3.45 4.37 2.35 0.25 8.07 6.05 000 42.75% 57.02% $290.84 $218.04 $308.64 $230.45

67225 Eye photodynamic ther add-on 0.47 0.34 0.30 0.03 0.84 0.80 ZZZ 55.95% 58.75% $30.27 $28.83 $31.96 $30.41

67227 Dstrj extensive retinopathy 3.50 4.58 3.54 0.26 8.34 7.30 010 41.97% 47.95% $300.57 $263.09 $319.11 $278.85

67228 Treatment x10sv retinopathy 4.39 5.02 4.01 0.32 9.73 8.72 010 45.12% 50.34% $350.66 $314.26 $371.90 $332.81

67229 Tr retinal les preterm inf 16.30 NA 15.66 1.18 NA 33.14 090 49.19% $1,194.34 $1,265.14

67250 Reinforce eye wall 9.61 NA 12.31 0.69 NA 22.61 090 42.50% $814.84 $864.72

67255 Reinforce/graft eye wall 8.38 NA 10.44 0.60 NA 19.42 090 43.15% $699.88 $742.56

67299 Eye surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY $0.00 $0.00 $0.00 $0.00

67311 Revise eye muscle 7.77 NA 8.63 0.56 NA 16.96 090 45.81% $611.22 $648.05

67312 Revise two eye muscles 9.66 NA 9.87 0.70 NA 20.23 090 47.75% $729.07 $772.61

67314 Revise eye muscle 8.79 NA 9.68 0.63 NA 19.10 090 46.02% $688.35 $729.74

67316 Revise two eye muscles 10.93 NA 11.02 0.79 NA 22.74 090 48.07% $819.53 $868.37

67318 Revise eye muscle(s) 9.12 NA 10.18 0.66 NA 19.96 090 45.69% $719.34 $762.74

67320 Revise eye muscle(s) add-on 5.40 NA 3.37 0.40 NA 9.17 ZZZ 58.89% $330.48 $349.21

67331 Eye surgery follow-up add-on 5.13 NA 3.19 0.38 NA 8.70 ZZZ 58.97% $313.54 $331.31

67332 Rerevise eye muscles add-on 5.56 NA 3.47 0.41 NA 9.44 ZZZ 58.90% $340.21 $359.47

67334 Revise eye muscle w/suture 5.05 NA 3.17 0.37 NA 8.59 ZZZ 58.79% $309.58 $327.09

119

67335 Eye suture during surgery 2.49 NA 1.54 0.18 NA 4.21 ZZZ 59.14% $151.72 $160.26

67340 Revise eye muscle add-on 6.00 NA 3.76 0.43 NA 10.19 ZZZ 58.88% $367.24 $387.90

67343 Release eye tissue 8.47 NA 9.42 0.65 NA 18.54 090 45.69% $668.16 $708.88

67345 Destroy nerve of eye muscle 3.01 3.53 2.79 0.42 6.96 6.22 010 43.25% 48.39% $250.83 $224.16 $268.37 $239.73

67346 Biopsy eye muscle 2.87 NA 2.42 0.21 NA 5.50 000 52.18% $198.22 $209.81

67399 Unlisted px extraocular musc 0.00 0.00 0.00 0.00 0.00 0.00 YYY $0.00 $0.00 $0.00 $0.00

67400 Explore/biopsy eye socket 11.20 NA 14.76 0.83 NA 26.79 090 41.81% $965.49 $1,025.07

67405 Explore/drain eye socket 9.20 NA 12.86 0.80 NA 22.86 090 40.24% $823.85 $876.37

67412 Explore/treat eye socket 10.30 NA 13.58 0.80 NA 24.68 090 41.73% $889.44 $944.75

67413 Explore/treat eye socket 10.24 NA 13.66 0.80 NA 24.70 090 41.46% $890.17 $945.64

67414 Explr/decompress eye socket 17.94 NA 18.78 1.40 NA 38.12 090 47.06% $1,373.81 $1,457.24

67415 Aspiration orbital contents 1.76 NA 1.08 0.13 NA 2.97 000 59.26% $107.04 $113.09

67420 Explore/treat eye socket 21.87 NA 22.59 1.82 NA 46.28 090 47.26% $1,667.89 $1,770.33

67430 Explore/treat eye socket 15.29 NA 19.54 1.11 NA 35.94 090 42.54% $1,295.25 $1,374.64

67440 Explore/drain eye socket 14.84 NA 18.86 1.08 NA 34.78 090 42.67% $1,253.44 $1,330.26

67445 Explr/decompress eye socket 19.12 NA 19.72 1.48 NA 40.32 090 47.42% $1,453.10 $1,541.06

67450 Explore/biopsy eye socket 15.41 NA 19.62 1.12 NA 36.15 090 42.63% $1,302.81 $1,382.65

67500 Inject/treat eye socket 1.18 0.75 0.46 0.09 2.02 1.73 000 58.42% 68.21% $72.80 $62.35 $76.96 $65.74



67550 Insert eye socket implant 11.77 NA 15.10 0.95 NA 27.82 090 42.31% $1,002.61 $1,065.19

67560 Revise eye socket implant 12.18 NA 15.38 0.95 NA 28.51 090 42.72% $1,027.47 $1,091.12

67570 Decompress optic nerve 14.40 NA 17.37 2.18 NA 33.95 090 42.42% $1,223.53 $1,311.04

67599 Orbit surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00 YYY $0.00 $0.00 $0.00 $0.00

67700 Drainage of eyelid abscess 1.40 6.31 1.80 0.11 7.82 3.31 010 17.90% 42.30% $281.83 $119.29 $301.27 $126.70

67710 Incision of eyelid 1.07 5.41 1.62 0.08 6.56 2.77 010 16.31% 38.63% $236.42 $99.83 $252.79 $106.09

67715 Incision of eyelid fold 1.27 5.66 1.67 0.14 7.07 3.08 010 17.96% 41.23% $254.80 $111.00 $272.81 $118.37

67800 Remove eyelid lesion 1.41 2.13 1.42 0.10 3.64 2.93 010 38.74% 48.12% $131.18 $105.59 $139.35 $111.87

67801 Remove eyelid lesions 1.91 2.59 1.74 0.14 4.64 3.79 010 41.16% 50.40% $167.22 $136.59 $177.56 $144.66

67805 Remove eyelid lesions 2.27 3.32 2.23 0.17 5.76 4.67 010 39.41% 48.61% $207.59 $168.30 $220.56 $178.37

67808 Remove eyelid lesion(s) 4.60 NA 5.48 0.37 NA 10.45 090 44.02% $376.61 $399.92

67810 Biopsy eyelid & lid margin 1.18 3.67 0.71 0.14 4.99 2.03 000 23.65% 58.13% $179.84 $73.16 $192.47 $77.90

67820 Revise eyelashes 0.32 0.59 0.65 0.02 0.93 0.99 000 34.41% 32.32% $33.52 $35.68 $35.62 $37.94


120


67835 Revise eyelashes 5.70 NA 6.35 0.42 NA 12.47 090 45.71% $449.41 $476.60

67840 Remove eyelid lesion 2.09 5.66 2.24 0.16 7.91 4.49 010 26.42% 46.55% $285.07 $161.82 $304.01 $171.63

67850 Treat eyelid lesion 1.74 4.21 1.92 0.18 6.13 3.84 010 28.38% 45.31% $220.92 $138.39 $235.99 $147.35

67875 Closure of eyelid by suture 1.35 3.50 1.29 0.11 4.96 2.75 000 27.22% 49.09% $178.75 $99.11 $190.66 $105.12

67880 Revision of eyelid 4.60 8.17 5.52 0.35 13.12 10.47 090 35.06% 43.94% $472.83 $377.33 $503.05 $400.48


67900 Repair brow defect 6.82 10.87 7.05 0.59 18.28 14.46 090 37.31% 47.16% $658.79 $521.13 $701.25 $553.39

67901 Repair eyelid defect 7.59 13.73 8.35 0.60 21.92 16.54 090 34.63% 45.89% $789.98 $596.09 $840.81 $632.57

67902 Repair eyelid defect 9.82 NA 9.94 0.78 NA 20.54 090 47.81% $740.24 $785.19



67906 Repair eyelid defect 6.93 NA 7.01 0.50 NA 14.44 090 47.99% $520.40 $551.42


67909 Revise eyelid defect 5.57 9.34 6.44 0.45 15.36 12.46 090 36.26% 44.70% $553.56 $449.05 $589.03 $476.78

67911 Revise eyelid defect 7.50 NA 7.90 0.57 NA 15.97 090 46.96% $575.54 $610.34

67912 Correction eyelid w/implant 6.36 18.43 6.89 0.63 25.42 13.88 090 25.02% 45.82% $916.11 $500.22 $978.91 $532.25









67930 Repair eyelid wound 3.65 6.50 2.89 0.28 10.43 6.82 010 35.00% 53.52% $375.89 $245.79 $399.94 $260.21

67935 Repair eyelid wound 6.36 10.04 5.68 0.56 16.96 12.60 090 37.50% 50.48% $611.22 $454.09 $650.69 $481.93

67938 Remove eyelid foreign body 1.38 5.72 1.84 0.09 7.19 3.31 010 19.19% 41.69% $259.12 $119.29 $276.70 $126.52




67971 Reconstruction of eyelid 10.01 NA 9.79 0.78 NA 20.58 090 48.64% $741.68 $786.38

67973 Reconstruction of eyelid 13.13 NA 12.33 1.01 NA 26.47 090 49.60% $953.95 $1,011.04

67974 Reconstruction of eyelid 13.10 NA 12.34 0.97 NA 26.41 090 49.60% $951.79 $1,008.34

121

67975 Reconstruction of eyelid 9.35 NA 9.39 0.73 NA 19.47 090 48.02% $701.68 $744.11

67999 Revision of eyelid 0.00 0.00 0.00 0.00 0.00 0.00 YYY $0.00 $0.00 $0.00 $0.00

68020 Incise/drain eyelid lining 1.42 1.92 1.63 0.10 3.44 3.15 010 41.28% 45.08% $123.97 $113.52 $131.59 $120.36

68040 Treatment of eyelid lesions 0.85 0.88 0.51 0.05 1.78 1.41 000 47.75% 60.28% $64.15 $50.82 $67.85 $53.53

68100 Biopsy of eyelid lining 1.35 3.52 1.30 0.10 4.97 2.75 000 27.16% 49.09% $179.11 $99.11 $190.94 $105.01

68110 Remove eyelid lining lesion 1.82 4.61 2.27 0.13 6.56 4.22 010 27.74% 43.13% $236.42 $152.09 $251.93 $161.36




68200 Treat eyelid by injection 0.49 0.65 0.46 0.04 1.18 0.99 000 41.53% 49.49% $42.53 $35.68 $45.19 $37.84

68320 Revise/graft eyelid lining 6.64 13.68 8.19 0.50 20.82 15.33 090 31.89% 43.31% $750.33 $552.48 $798.91 $586.42

68325 Revise/graft eyelid lining 8.63 NA 9.44 0.62 NA 18.69 090 46.17% $673.57 $714.06



68330 Revise eyelid lining 5.78 11.19 6.90 0.42 17.39 13.10 090 33.24% 44.12% $626.72 $472.11 $666.88 $500.83


68340 Separate eyelid adhesions 4.97 10.70 6.01 0.36 16.03 11.34 090 31.00% 43.83% $577.71 $408.68 $615.10 $433.57

68360 Revise eyelid lining 5.17 9.69 6.12 0.44 15.30 11.73 090 33.79% 44.08% $551.40 $422.74 $587.35 $449.17

68362 Revise eyelid lining 8.61 NA 9.42 0.64 NA 18.67 090 46.12% $672.85 $713.54

68371 Harvest eye tissue alograft 5.09 NA 6.28 0.37 NA 11.74 010 43.36% $423.10 $448.94

68399 Eyelid lining surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY $0.00 $0.00 $0.00 $0.00

68400 Incise/drain tear gland 1.74 6.37 1.89 0.13 8.24 3.76 010 21.12% 46.28% $296.96 $135.51 $317.11 $143.70

68420 Incise/drain tear sac 2.35 6.75 2.25 0.18 9.28 4.78 010 25.32% 49.16% $334.44 $172.27 $356.77 $182.59

68440 Incise tear duct opening 0.99 1.86 1.75 0.07 2.92 2.81 010 33.90% 35.23% $105.23 $101.27 $111.94 $107.68

68500 Removal of tear gland 12.77 NA 14.18 0.92 NA 27.87 090 45.82% $1,004.41 $1,064.92

68505 Partial removal tear gland 12.69 NA 14.13 0.92 NA 27.74 090 45.75% $999.72 $1,060.04

68510 Biopsy of tear gland 4.60 7.88 3.37 0.36 12.84 8.33 000 35.83% 55.22% $462.74 $300.21 $492.32 $317.76

68520 Removal of tear sac 8.78 NA 10.12 0.70 NA 19.60 090 44.80% $706.37 $749.88

68525 Biopsy of tear sac 4.42 NA 2.74 0.36 NA 7.52 000 58.78% $271.01 $286.74

68530 Clearance of tear duct 3.70 8.29 3.32 0.27 12.26 7.29 010 30.18% 50.75% $441.84 $262.73 $470.57 $278.20

68540 Remove tear gland lesion 12.18 NA 13.45 0.88 NA 26.51 090 45.94% $955.40 $1,012.94

68550 Remove tear gland lesion 15.16 NA 16.27 1.10 NA 32.53 090 46.60% $1,172.35 $1,242.79

68700 Repair tear ducts 7.87 NA 8.72 0.58 NA 17.17 090 45.84% $618.79 $656.21

68705 Revise tear duct opening 2.11 4.72 2.45 0.16 6.99 4.72 010 30.19% 44.70% $251.91 $170.10 $268.36 $180.50

122

68720 Create tear sac drain 9.96 NA 10.87 0.77 NA 21.60 090 46.11% $778.44 $825.85

68745 Create tear duct drain 9.90 NA 11.08 0.71 NA 21.69 090 45.64% $781.69 $828.78

68750 Create tear duct drain 10.10 NA 11.60 0.79 NA 22.49 090 44.91% $810.52 $860.25

68760 Close tear duct opening 1.78 4.01 2.24 0.13 5.92 4.15 010 30.07% 42.89% $213.35 $149.56 $227.23 $158.72

68761 Close tear duct opening 1.41 2.72 1.86 0.09 4.22 3.36 010 33.41% 41.96% $152.09 $121.09 $161.69 $128.40

68770 Close tear system fistula 8.29 NA 8.99 0.60 NA 17.88 090 46.36% $644.38 $683.12

68801 Dilate tear duct opening 0.82 1.70 1.35 0.05 2.57 2.22 010 31.91% 36.94% $92.62 $80.01 $98.49 $84.94

68810 Probe nasolacrimal duct 1.54 2.82 1.99 0.11 4.47 3.64 010 34.45% 42.31% $161.09 $131.18 $171.34 $139.21

68811 Probe nasolacrimal duct 1.74 NA 1.99 0.14 NA 3.87 010 44.96% $139.47 $148.07

68815 Probe nasolacrimal duct 2.70 8.30 3.40 0.21 11.21 6.31 010 24.09% 42.79% $404.00 $227.41 $431.14 $241.48

68816 Probe nl duct w/balloon 2.10 18.24 2.23 0.16 20.50 4.49 010 10.24% 46.77% $738.80 $161.82 $791.30 $171.61

68840 Explore/irrigate tear ducts 1.30 2.28 1.92 0.09 3.67 3.31 010 35.42% 39.27% $132.26 $119.29 $140.60 $126.67

68850 Injection for tear sac x-ray 0.80 0.92 0.72 0.07 1.79 1.59 000 44.69% 50.31% $64.51 $57.30 $68.55 $60.81

68899 Tear duct system surgery 0.00 0.00 0.00 0.00 0.00 0.00 YYY $0.00 $0.00 $0.00 $0.00

34.55% 46.10%

123

CPT1/

HCPCS

Description

Work

RVUs2

Non-

Facility

PE

RVUs2

Facility

PE

RVUs2

Mal-

Practice

RVUs2

Total Non-

Facility

RVUs2

Total

Facility

RVUs2

Work RVU

as% Total

Non Facility

RVU

National

Non Facility

Payment

National

Facilty

Payment

Locality Non

Facility

Payment

Locality

Facilty

Payment

11102 Tangntl bx skin single les 0.66 2.05 0.39 0.09 2.80 1.14 23.57% $100.91 $41.09 $108.13 $43.88

11103 Tangntl bx skin ea sep/addl 0.38 1.08 0.23 0.05 1.51 0.66 25.17% $54.42 $23.79 $58.28 $25.38

11104 Punch bx skin single lesion 0.83 2.58 0.49 0.11 3.52 1.43 23.58% $126.86 $51.54 $135.90 $55.00

11105 Punch bx skin ea sep/addl 0.45 1.22 0.27 0.06 1.73 0.78 26.01% $62.35 $28.11 $66.78 $30.01

11106 Incal bx skn single les 1.01 3.11 0.59 0.14 4.26 1.74 23.71% $153.53 $62.71 $164.53 $66.99

11107 Incal bx skn ea sep/addl 0.54 1.43 0.32 0.07 2.04 0.93 26.47% $73.52 $33.52 $78.72 $35.75

11310 Shave skin lesion 0.5 cm/< 0.80 2.32 0.45 0.11 3.23 1.36 24.77% $116.41 $49.01 $124.73 $52.35

11311 Shave skin lesion 0.6-1.0 cm 1.10 2.61 0.63 0.15 3.86 1.88 28.50% $139.11 $67.75 $148.99 $72.35

11312 Shave skin lesion 1.1-2.0 cm 1.30 3.03 0.74 0.19 4.52 2.23 28.76% $162.90 $80.37 $174.60 $85.97

11313 Shave skin lesion >2.0 cm 1.68 3.37 0.96 0.25 5.30 2.89 31.70% $191.01 $104.15 $204.74 $111.46

11440 Exc face-mm b9+marg 0.5 cm/< 1.05 2.73 1.78 0.13 3.91 2.96 26.85% $140.91 $106.68 $150.80 $114.03

11441 Exc face-mm b9+marg 0.6-1 cm 1.53 3.08 2.01 0.22 4.83 3.76 31.68% $174.07 $135.51 $186.50 $145.09




11446 Exc face-mm b9+marg >4 cm 4.80 5.59 3.76 0.77 11.16 9.33 43.01% $402.20 $336.25 $431.43 $360.60

11640 Exc f/e/e/n/l mal+mrg 0.5cm< 1.67 3.82 1.69 0.25 5.74 3.61 29.09% $206.86 $130.10 $221.79 $139.35

11641 Exc f/e/e/n/l mal+mrg 0.6-1 2.17 4.28 2.00 0.33 6.78 4.50 32.01% $244.35 $162.18 $261.99 $173.74

11642 Exc f/e/e/n/l mal+mrg 1.1-2 2.62 4.70 2.27 0.41 7.73 5.30 33.89% $278.58 $191.01 $298.79 $204.74

11643 Exc f/e/e/n/l mal+mrg 2.1-3 3.42 5.14 2.67 0.53 9.09 6.62 37.62% $327.60 $238.58 $351.25 $255.65

11644 Exc f/e/e/n/l mal+mrg 3.1-4 4.34 6.19 3.18 0.69 11.22 8.21 38.68% $404.36 $295.89 $433.73 $317.23

11646 Exc f/e/e/n/l mal+mrg >4 cm 6.26 7.34 4.09 1.04 14.64 11.39 42.76% $527.61 $410.49 $566.36 $440.56

11960 Insert tissue expander(s) 11.49 NA 14.18 2.04 NA 27.71 $998.66 $1,073.43

14040 Tis trnfr f/c/c/m/n/a/g/h/f 8.60 11.83 8.23 1.27 21.70 18.10 39.63% $782.05 $652.32 $837.76 $698.42

14041 Tis trnfr f/c/c/m/n/a/g/h/f 10.83 14.28 9.84 1.64 26.75 22.31 40.49% $964.05 $804.04 $1,033.12 $861.26

14060 Tis trnfr e/n/e/l 10 sq cm/< 9.23 11.54 8.73 1.34 22.11 19.30 41.75% $796.82 $695.56 $853.22 $744.46

15260 Skin full graft een & lips 11.64 15.55 11.32 1.69 28.88 24.65 40.30% $1,040.81 $888.38 $1,114.59 $950.87

15275 Skin sub graft face/nk/hf/g 1.83 2.36 0.73 0.18 4.37 2.74 41.88% $157.49 $98.75 $167.69 $104.60

15576 Pedicle e/n/e/l/ntroral 9.37 12.22 8.46 1.34 22.93 19.17 40.86% $826.38 $690.88 $884.70 $739.16

15630 Delay flap eye/nos/ear/lip 4.08 8.38 5.16 0.63 13.09 9.87 31.17% $471.75 $355.71 $505.94 $381.31

Oculoplastics Non-Eye

124

15733 Musc myoq/fscq flp h&n pedcl 15.68 NA 12.31 2.13 NA 30.12 $1,085.51 $1,159.85

15760 Composite skin graft 9.86 12.95 8.95 1.45 24.26 20.26 40.64% $874.31 $730.16 $936.47 $781.64

15770 Derma-fat-fascia graft 8.96 NA 8.75 1.38 NA 19.09 $688.00 $737.27

15788 Chemical peel face epiderm 2.09 10.34 4.40 0.32 12.75 6.81 16.39% $459.50 $245.43 $493.10 $263.19

15820 Revision of lower eyelid 6.27 9.24 7.58 0.70 16.21 14.55 38.68% $584.19 $524.38 $623.37 $559.12

15821 Revision of lower eyelid 6.84 9.89 8.05 0.65 17.38 15.54 39.36% $626.36 $560.06 $667.04 $595.82

15822 Revision of upper eyelid 4.62 7.63 6.01 0.49 12.74 11.12 36.26% $459.14 $400.76 $489.84 $427.14

15823 Revision of upper eyelid 6.81 10.00 8.14 0.56 17.37 15.51 39.21% $626.00 $558.97 $665.72 $593.72

15824 Removal of forehead wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

15826 Removal of brow wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

15828 Removal of face wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

15829 Removal of skin wrinkles 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00

17000 Destruct premalg lesion 0.61 1.16 0.84 0.08 1.85 1.53 32.97% $66.67 $55.14 $71.34 $58.96

17003 Destruct premalg les 2-14 0.04 0.11 0.02 0.01 0.16 0.07 25.00% $5.77 $2.52 $6.23 $2.74

17280 Destruction of skin lesions 1.22 2.57 1.18 0.18 3.97 2.58 30.73% $143.08 $92.98 $153.36 $99.55






20910 Remove cartilage for graft 5.53 NA 6.80 1.13 NA 13.46 $485.09 $523.04

20920 Removal of fascia for graft 5.51 NA 4.99 1.01 NA 11.51 $414.82 $446.28

20922 Removal of fascia for graft 6.93 8.62 5.65 1.47 17.02 14.05 40.72% $613.39 $506.36 $661.95 $546.99

20926 Removal of tissue for graft 5.79 NA 5.32 0.96 NA 12.07 $435.00 $466.88

21172 Reconstruct orbit/forehead 28.20 NA 20.91 11.48 NA 60.59 $2,183.64 $2,418.54

21235 Ear cartilage graft 7.50 12.15 7.62 1.12 20.77 16.24 36.11% $748.53 $585.28 $802.18 $626.84

21338 Open nasoethmoid fx w/o fixj 6.87 NA 11.02 0.99 NA 18.88 $680.43 $728.78

21339 Open nasoethmoid fx w/ fixj 8.50 NA 11.72 1.16 NA 21.38 $770.53 $824.36

21340 Perq tx nasoethmoid fx 11.49 NA 8.20 1.65 NA 21.34 $769.09 $822.59

21343 Open tx dprsd front sinus fx 14.32 NA 14.46 2.04 NA 30.82 $1,110.74 $1,188.51

21355 Perq tx malar fracture 4.45 7.10 4.08 0.64 12.19 9.17 36.51% $439.32 $330.48 $470.52 $353.63

21365 Opn tx complx malar fx 16.77 NA 12.49 2.69 NA 31.95 $1,151.47 $1,234.80

21366 Opn tx complx malar w/grft 18.60 NA 14.99 3.00 NA 36.59 $1,318.69 $1,414.37

21385 Opn tx orbit fx transantral 9.57 NA 10.49 1.59 NA 21.65 $780.26 $837.53

125

21386 Opn tx orbit fx periorbital 9.57 NA 8.80 1.61 NA 19.98 $720.07 $773.11

21387 Opn tx orbit fx combined 10.11 NA 10.80 1.67 NA 22.58 $813.77 $873.39

21390 Opn tx orbit periorbtl implt 11.23 NA 10.27 1.46 NA 22.96 $827.47 $883.69

21395 Opn tx orbit periorbt w/grft 14.70 NA 11.88 2.49 NA 29.07 $1,047.67 $1,125.00

21400 Closed tx orbit w/o manipulj 1.50 3.99 2.85 0.24 5.73 4.59 26.18% $206.50 $165.42 $221.61 $177.49

21401 Closed tx orbit w/manipulj 3.68 10.45 4.93 0.62 14.75 9.23 24.95% $531.58 $332.65 $570.83 $357.17

21406 Opn tx orbit fx w/o implant 7.42 NA 7.87 1.25 NA 16.54 $596.10 $640.03

21407 Opn tx orbit fx w/implant 9.02 NA 8.27 1.24 NA 18.53 $667.81 $713.95

21408 Opn tx orbit fx w/bone grft 12.78 NA 11.00 2.17 NA 25.95 $935.23 $1,004.32

30130 Excise inferior turbinate 3.47 NA 7.07 0.48 NA 11.02 $397.16 $425.31

30930 Ther fx nasal inf turbinate 1.31 NA 1.94 0.18 NA 3.43 $123.62 $132.29

31020 Exploration maxillary sinus 3.07 10.18 6.93 0.44 13.69 10.44 22.43% $493.38 $376.25 $528.97 $403.17

31030 Exploration maxillary sinus 6.01 12.19 8.05 0.94 19.14 15.00 31.40% $689.79 $540.59 $739.90 $579.66

31070 Exploration of frontal sinus 4.40 NA 7.64 0.63 NA 12.67 $456.62 $489.08

31075 Exploration of frontal sinus 9.51 NA 11.61 1.34 NA 22.46 $809.45 $866.24

31200 Removal of ethmoid sinus 5.14 NA 11.13 0.47 NA 16.74 $603.30 $643.47

31201 Removal of ethmoid sinus 8.60 NA 11.63 1.25 NA 21.48 $774.13 $829.03

31205 Removal of ethmoid sinus 10.58 NA 14.62 0.91 NA 26.11 $940.99 $1,000.79

31225 Removal of upper jaw 26.70 NA 22.17 3.93 NA 52.80 $1,902.89 $2,036.84

31230 Removal of upper jaw 30.82 NA 23.13 4.40 NA 58.35 $2,102.91 $2,249.10

31231 Nasal endoscopy dx 1.10 4.43 0.60 0.16 5.69 1.86 19.33% $205.06 $67.03 $219.93 $71.69

31239 Nasal/sinus endoscopy surg 9.04 NA 7.61 0.92 NA 17.57 $633.22 $673.24

37609 Temporal artery procedure 3.05 5.21 2.28 0.61 8.87 5.94 34.39% $319.67 $214.08 $344.31 $230.90

40818 Excise oral mucosa for graft 2.83 7.32 4.73 0.35 10.50 7.91 26.95% $378.41 $285.07 $404.96 $304.71

42299 Palate/uvula surgery 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 $0.00

61330 Decompress eye socket 25.30 NA 16.97 9.98 NA 52.25 $1,883.07 $2,084.67

61333 Explore orbit/remove lesion 29.27 NA 18.17 12.20 NA 59.64 $2,149.40 $2,387.67

61563 Excision of skull tumor 28.44 NA 18.05 11.04 NA 57.53 $2,073.36 $2,294.81

61564 Excision of skull tumor 34.74 NA 21.66 14.55 NA 70.95 $2,557.01 $2,841.02

61615 Resect/excise lesion skull 35.77 NA 31.57 14.58 NA 81.92 $2,952.36 $3,264.02

64612 Destroy nerve face muscle 1.41 2.12 1.68 0.30 3.83 3.39 36.81% $138.03 $122.17 $148.90 $131.87

64742 Incision of facial nerve 6.85 NA 6.77 0.49 NA 14.11 $508.52 $538.69

126

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