initial 2013 hcpcs reimbursement rates … initial 2013...1 of 1 initial 2013 hcpcs reimbursement...

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Initial 2013 HCPCS Reimbursement Rates Implemented on March 28, 2013 Information posted April 2, 2013

This is an update to an article titled “Proposed Reimbursement Rates for Texas Medicaid to Be Effective January 1, 2013, and April 1, 2013,” which was published on this website on February 28, 2013. The initial reimbursement rates for 2013 Healthcare Common Procedure Coding System (HCPCS) procedure codes were implemented on March 28, 2013.

The tables on the following pages include the 2013 HCPCS procedure codes with initial reimbursement rates:

Ambulatory surgical center services

Texas Health Steps dental services

Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

Medical services

Nonclinical laboratory services

Physician-administered drugs (non-oncology)

Physician-administered drugs (oncology)

Hospital outpatient imaging services

Radiation therapy

Radiology services

Surgery and assistant surgery

Claims for any of these procedure codes with dates of service on or after January 1, 2013, which were processed before the implementation date will be reprocessed, and providers may receive additional payment, which will be reflected on Remittance and Status (R&S) Reports.

http://www.tmhp.com/News_Items/2013/02-Feb/02-28-13%20Proposed%20Reimbursement%20Rates%20for%20Texas%20Medicaid%20to%20Be%20Effective%20January%201.pdf

http://www.tmhp.com/News_Items/2013/02-Feb/02-28-13%20Proposed%20Reimbursement%20Rates%20for%20Texas%20Medicaid%20to%20Be%20Effective%20January%201.pdf

http://www.tmhp.com/News_Items/2013/06-Jun/06-18-13%20Reminder%202013%20HCPCS%20Dental%20Fluoride.pdf

Type of

Service (TOS)*

Procedure

Code

Age

Range

Current

Medicaid Fee

Current

Adjusted Fee

1/1/13

Medicaid Fee

1/1/13

Adjusted Fee

F 24370 0-999 Not a Benefit Not a Benefit Group 9 Group 9F 24371 0-999 Not a Benefit Not a Benefit Group 9 Group 9F 31647 0-999 Not a Benefit Not a Benefit Group 5 Group 5F 31648 0-999 Not a Benefit Not a Benefit Group 5 Group 5F 31649 0-999 Not a Benefit Not a Benefit Group 1 Group 1F 31651 0-999 Not a Benefit Not a Benefit Group 5 Group 5F 32554 0-999 Not a Benefit Not a Benefit $185.12 $172.16F 32555 0-999 Not a Benefit Not a Benefit $185.12 $172.16F 32556 0-999 Not a Benefit Not a Benefit $185.12 $172.16F 32557 0-999 Not a Benefit Not a Benefit $185.12 $172.16F 37197 0-999 Not a Benefit Not a Benefit Group 8 Group 8F 37211 0-999 Not a Benefit Not a Benefit Group 1 Group 1F 37212 0-999 Not a Benefit Not a Benefit Group 1 Group 1F 38243 0-999 Not a Benefit Not a Benefit Group 3 Group 3F 43206 0-999 Not a Benefit Not a Benefit Group 2 Group 2F 43252 0-999 Not a Benefit Not a Benefit Group 2 Group 2F 52287 0-999 Not a Benefit Not a Benefit Group 3 Group 3F 64615 0-999 Not a Benefit Not a Benefit $35.60 $33.11

AMBULATORY SURGICAL CENTERS

TOS*: F = Ambulatory Surgical Center

Type of

Service

(TOS)* Procedure Code

Age

Range

Current

Medicaid Fee

Current

Adjusted Fee

1/1/2013

Medicaid Fee

1/1/2013

Adjusted Fee

W D0360 0-999 $288.75 $282.98 Not a Benefit Not a BenefitW D0362 0-999 $173.25 $169.79 Not a Benefit Not a BenefitW D0367 0-999 Not a Benefit Not a Benefit $269.32 $269.32W D1203 0-999 $15.00 $14.70 Not a Benefit Not a BenefitW D1204 0-999 $15.00 $14.70 Not a Benefit Not a BenefitW D1208 0-999 Not a Benefit Not a Benefit $14.70 $14.70W D4271 0-999 $206.25 $202.13 Not a Benefit Not a BenefitW D4277 0-999 Not a Benefit Not a Benefit $67.38 $67.38W D4278 0-999 Not a Benefit Not a Benefit $67.38 $67.38W D6970 0-999 $100.00 $98.00 Not a Benefit Not a BenefitW D6972 0-999 $81.25 $79.63 Not a Benefit Not a BenefitW D6973 0-999 $56.25 $55.13 Not a Benefit Not a BenefitW D6976 0-999 $50.00 $49.00 Not a Benefit Not a BenefitW D6977 0-999 $40.63 $39.82 Not a Benefit Not a Benefit

THSTEPS DENTAL SERVICES

TOS*: W = Therapeutic Dental

Type of

Service

(TOS)*

Procedure

Code

Age

Range

Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/13

Medicaid

Fee

1/1/13 Adjusted

Fee

9 A4435 0-20Not A Benefit

Not A Benefit $17.00 $17.00

9 A4435 21-999Not A Benefit


J E0670 0-20Not A Benefit

Not A Benefit $2,922.96 $2,922.96


Not A Benefit $2,922.96 $2,922.96

L E0670 0-20Not A Benefit

Not A Benefit $292.30 $292.30


Not A Benefit $292.30 $292.30


Not A Benefit $363.35 $334.28


Not A Benefit $363.35 $334.28





9 L5859 0-20Not A Benefit

Not A Benefit $27,870.31 $25,640.69


Not A Benefit $27,870.31 $25,640.69


Not A Benefit $1,205.40 $1,126.55


Not A Benefit $1,205.40 $1,126.55

DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, & SUPPLIES

TOS* 9 = Other/DME Purchase- Used, J = DME Purchase- New, L = DME Rental - Monthly

Type of Service

(TOS)*

Procedure

Code

Age

Range POS**

Current

Medicaid Fee

Current

Adjusted Fee

1/1/13

Medicaid

RVU***

1/1/13

Medicaid

Conversion

Factor

1/1/13

Medicaid Fee

1/1/13 Adjusted

Fee

1 95017 0-20 NF Not A Benefit Not A Benefit 2.52 $28.0672 $70.73 $70.731 95017 0-20 F Not A Benefit Not A Benefit 0.11 $28.0672 $3.09 $3.091 95017 21-999 NF Not A Benefit Not A Benefit 2.52 $26.7305 $67.36 $67.361 95017 21-999 F Not A Benefit Not A Benefit 0.11 $26.7305 $2.94 $2.941 95018 0-20 NF Not A Benefit Not A Benefit 0.86 $28.0672 $24.14 $24.141 95018 0-20 F Not A Benefit Not A Benefit 0.21 $28.0672 $5.89 $5.891 95018 21-999 NF Not A Benefit Not A Benefit 0.86 $26.7305 $22.99 $22.991 95018 21-999 F Not A Benefit Not A Benefit 0.21 $26.7305 $5.61 $5.611 95076 0-20 NF Not A Benefit Not A Benefit 3.42 $28.0672 $95.99 $95.991 95076 0-20 F Not A Benefit Not A Benefit 2.10 $28.0672 $58.94 $58.941 95076 21-999 NF Not A Benefit Not A Benefit 3.42 $26.7305 $91.42 $91.421 95076 21-999 F Not A Benefit Not A Benefit 2.10 $26.7305 $56.13 $56.13

MEDICAL SERVICES

TOS*: 1 = Medical Services

**Place of Service (POS): NF = Non-Facility, F = Facility

***RVU = Relative Value Unit

Type of Service

(TOS)*

Procedure

Code

Age

Range

Current

Medicaid Fee

Current

Adjusted Fee

1/1/13 Medicaid

RVU**

1/1/13 Medicaid

Conversion

Factor

1/1/13 Medicaid

Fee

1/1/13 Adjusted

Fee

5 81201 0-999 Not a Benefit Not a Benefit $948.74 $948.745 81202 0-999 Not a Benefit Not a Benefit $53.50 $53.505 81203 0-999 Not a Benefit Not a Benefit $759.61 $759.615 81235 0-999 Not a Benefit Not a Benefit $303.56 $303.565 81252 0-999 Not a Benefit Not a Benefit $157.92 $157.925 81253 0-999 Not a Benefit Not a Benefit $95.86 $95.865 81254 0-999 Not a Benefit Not a Benefit $67.64 $67.645 81321 0-999 Not a Benefit Not a Benefit $378.30 $378.305 81322 0-999 Not a Benefit Not a Benefit $115.55 $115.555 81323 0-999 Not a Benefit Not a Benefit $731.36 $731.365 81324 0-999 Not a Benefit Not a Benefit $561.90 $561.905 81325 0-999 Not a Benefit Not a Benefit $180.59 $180.595 81326 0-999 Not a Benefit Not a Benefit $53.50 $53.505 86711 0-999 Not a Benefit Not a Benefit $19.98 $19.985 86828 0-999 Not a Benefit Not a Benefit $54.93 $54.935 86829 0-999 Not a Benefit Not a Benefit $41.20 $41.205 86830 0-999 Not a Benefit Not a Benefit $112.09 $112.095 86831 0-999 Not a Benefit Not a Benefit $96.08 $96.085 86832 0-999 Not a Benefit Not a Benefit $176.15 $176.155 86833 0-999 Not a Benefit Not a Benefit $160.10 $160.105 86834 0-999 Not a Benefit Not a Benefit $496.41 $496.415 86835 0-999 Not a Benefit Not a Benefit $174.62 $174.625 87631 0-999 Not a Benefit Not a Benefit $287.63 $287.635 87632 0-999 Not a Benefit Not a Benefit $541.91 $541.915 87633 0-999 Not a Benefit Not a Benefit $254.39 $254.395 87910 0-999 Not a Benefit Not a Benefit $254.39 $254.395 87912 0-20 Not a Benefit Not a Benefit $434.75 $434.755 87912 21-999 Not a Benefit Not a Benefit $413.13 $413.135 95782 0-20 Not a Benefit Not a Benefit 31.35 $28.0672 $879.91 $879.91I 95782 0-20 Not a Benefit Not a Benefit 3.75 $28.0672 $105.25 $105.25T 95782 0-20 Not a Benefit Not a Benefit 27.60 $28.0672 $774.65 $774.655 95783 0-20 Not a Benefit Not a Benefit 32.83 $28.0672 $921.45 $921.45I 95783 0-20 Not a Benefit Not a Benefit 4.09 $28.0672 $114.79 $114.79T 95783 0-20 Not a Benefit Not a Benefit 28.74 $28.0672 $806.65 $806.655 95907 0-20 Not a Benefit Not a Benefit 2.78 $28.0672 $78.03 $78.035 95907 21-999 Not a Benefit Not a Benefit 2.78 $26.7305 $74.31 $74.31I 95907 0-20 Not a Benefit Not a Benefit 1.52 $28.0672 $42.66 $42.66I 95907 21-999 Not a Benefit Not a Benefit 1.52 $26.7305 $40.63 $40.63T 95907 0-20 Not a Benefit Not a Benefit 1.26 $28.0672 $35.36 $35.36T 95907 21-999 Not a Benefit Not a Benefit 1.26 $26.7305 $33.68 $33.685 95908 0-20 Not a Benefit Not a Benefit 3.43 $28.0672 $96.27 $96.275 95908 21-999 Not a Benefit Not a Benefit 3.43 $26.7305 $91.69 $91.69

NONCLINICAL LABORATORY SERVICES

Type of Service

(TOS)*

Procedure

Code

Age

Range

Current

Medicaid Fee

Current

Adjusted Fee

1/1/13 Medicaid

RVU**

1/1/13 Medicaid

Conversion

Factor

1/1/13 Medicaid

Fee

1/1/13 Adjusted

Fee


I 95908 0-20 Not a Benefit Not a Benefit 1.91 $28.0672 $53.61 $53.61I 95908 21-999 Not a Benefit Not a Benefit 1.91 $26.7305 $51.06 $51.06T 95908 0-20 Not a Benefit Not a Benefit 1.52 $28.0672 $42.66 $42.66T 95908 21-999 Not a Benefit Not a Benefit 1.52 $26.7305 $40.63 $40.635 95909 0-20 Not a Benefit Not a Benefit 4.11 $28.0672 $115.36 $115.365 95909 21-999 Not a Benefit Not a Benefit 4.11 $26.7305 $109.86 $109.86I 95909 0-20 Not a Benefit Not a Benefit 2.28 $28.0672 $63.99 $63.99I 95909 21-999 Not a Benefit Not a Benefit 2.28 $26.7305 $60.95 $60.95T 95909 0-20 Not a Benefit Not a Benefit 1.83 $28.0672 $51.36 $51.36T 95909 21-999 Not a Benefit Not a Benefit 1.83 $26.7305 $48.92 $48.925 95910 0-20 Not a Benefit Not a Benefit 5.41 $28.0672 $151.84 $151.845 95910 21-999 Not a Benefit Not a Benefit 5.41 $26.7305 $144.61 $144.61I 95910 0-20 Not a Benefit Not a Benefit 3.05 $28.0672 $85.60 $85.60I 95910 21-999 Not a Benefit Not a Benefit 3.05 $26.7305 $81.53 $81.53T 95910 0-20 Not a Benefit Not a Benefit 2.36 $28.0672 $66.24 $66.24T 95910 21-999 Not a Benefit Not a Benefit 2.36 $26.7305 $63.08 $63.085 95911 0-20 Not a Benefit Not a Benefit 6.54 $28.0672 $183.56 $183.565 95911 21-999 Not a Benefit Not a Benefit 6.54 $26.7305 $174.82 $174.82I 95911 0-20 Not a Benefit Not a Benefit 3.80 $28.0672 $106.66 $106.66I 95911 21-999 Not a Benefit Not a Benefit 3.80 $26.7305 $101.58 $101.58T 95911 0-20 Not a Benefit Not a Benefit 2.74 $28.0672 $76.90 $76.90T 95911 21-999 Not a Benefit Not a Benefit 2.74 $26.7305 $73.24 $73.245 95912 0-20 Not a Benefit Not a Benefit 7.67 $28.0672 $215.28 $215.285 95912 21-999 Not a Benefit Not a Benefit 7.67 $26.7305 $205.02 $205.02I 95912 0-20 Not a Benefit Not a Benefit 4.57 $28.0672 $128.27 $128.27I 95912 21-999 Not a Benefit Not a Benefit 4.57 $26.7305 $122.16 $122.16T 95912 0-20 Not a Benefit Not a Benefit 3.10 $28.0672 $87.01 $87.01T 95912 21-999 Not a Benefit Not a Benefit 3.10 $26.7305 $82.86 $82.865 95913 0-20 Not a Benefit Not a Benefit 8.88 $28.0672 $249.24 $249.245 95913 21-999 Not a Benefit Not a Benefit 8.88 $26.7305 $237.37 $237.37I 95913 0-20 Not a Benefit Not a Benefit 5.41 $28.0672 $151.84 $151.84I 95913 21-999 Not a Benefit Not a Benefit 5.41 $26.7305 $144.61 $144.61T 95913 0-20 Not a Benefit Not a Benefit 3.47 $28.0672 $97.39 $97.39T 95913 21-999 Not a Benefit Not a Benefit 3.47 $26.7305 $92.75 $92.755 95924 0-20 Not a Benefit Not a Benefit 4.33 $28.0672 $121.53 $121.535 95924 21-999 Not a Benefit Not a Benefit 4.33 $26.7305 $115.74 $115.74I 95924 0-20 Not a Benefit Not a Benefit 2.54 $28.0672 $71.29 $71.29I 95924 21-999 Not a Benefit Not a Benefit 2.54 $26.7305 $67.90 $67.90T 95924 0-20 Not a Benefit Not a Benefit 1.79 $28.0672 $50.24 $50.24T 95924 21-999 Not a Benefit Not a Benefit 1.79 $26.7305 $47.85 $47.855 95940 0-20 Not a Benefit Not a Benefit 0.93 $28.0672 $26.10 $26.105 95940 21-999 Not a Benefit Not a Benefit 0.93 $26.7305 $24.86 $24.86

Type of Service

(TOS)*

Procedure

Code

Age

Range

Current

Medicaid Fee

Current

Adjusted Fee

1/1/13 Medicaid

RVU**

1/1/13 Medicaid

Conversion

Factor

1/1/13 Medicaid

Fee

1/1/13 Adjusted

Fee


5 95941 0-20 Not a Benefit Not a Benefit $130.71 $130.715 95941 21-999 Not a Benefit Not a Benefit $130.71 $130.715 95943 0-20 Not a Benefit Not a Benefit $148.62 $148.625 95943 21-999 Not a Benefit Not a Benefit $148.62 $148.62I 95943 0-20 Not a Benefit Not a Benefit $73.77 $73.77I 95943 21-999 Not a Benefit Not a Benefit $73.77 $73.77T 95943 0-20 Not a Benefit Not a Benefit $74.84 $74.84T 95943 21-999 Not a Benefit Not a Benefit $74.84 $74.84

TOS*: 5 = Laboratory, I = Professional Component, T = Technical Component

RVU** = Relative Value Unit

Type of Service

(TOS)*

Procedure

Code Modifier

Provider

Type

Age

Range

Current

Medicaid

Fee

Current

Adjusted Fee

1/1/13

Medicaid

Fee

1/1/13

Adjusted Fee

1 C9294 0-999 Not a Benefit Not a Benefit $31.31 $31.311 J1050 U1 0-999 Not a Benefit Not a Benefit $64.98 $64.981 J1050 0-999 Not a Benefit Not a Benefit $0.19 $0.191 J7178 0-999 Not a Benefit Not a Benefit $0.01 $0.011 90672 0-999 Not a Benefit Not a Benefit $17.45 $17.45S 90672 0-999 Not a Benefit Not a Benefit $17.45 $17.451 Q4134 0-999 Not a Benefit Not a Benefit $31.24 $31.241 Q4135 0-999 Not a Benefit Not a Benefit $2.11 $2.111 Q4136 0-999 Not a Benefit Not a Benefit $2.07 $2.07

PHYSICIAN ADMINISTERED DRUGS - NON-ONCOLOGY

TOS*: 1 = Medical Services, S = THSteps Medical Services

Provider Type: 71 = Family Planning Clinic

Modifier: U1 = Required when used for family planning purposes,example: Depo Provera 1 mg and billed for 150 units

Type of Service (TOS)*

Procedure

Code

Age

Range

Current

Medicaid Fee

Current

Adjusted Fee

1/1/13

Medicaid Fee

1/1/13

Adjusted Fee

1 J9002 0-999 Not a Benefit Not a Benefit $539.08 $539.08

PHYSICIAN ADMINISTERED DRUGS - ONCOLOGY

TOS*: 1 = Medical Services

Type of

Service

(TOS)*

Procedure

Code Age Range

Current

Medicaid Fee

1/1/13

Medicaid

Fee

4 78012 0-999 Not a Benefit $114.034 78013 0-999 Not a Benefit $150.044 78014 0-999 Not a Benefit $232.944 78071 0-999 Not a Benefit $322.044 91112 0-999 Not a Benefit $302.60

HOSPITAL OUTPATIENT IMAGING SERVICES

TOS*: 4 = Radiology

Type of Service

(TOS)*

Procedure

Code

Age

Range

Current

Medicaid Fee

Current

Adjusted Fee

1/1/13

Medicaid

RVU**

1/1/13

Medicaid

Conversion

Factor

1/1/13

Medicaid Fee

1/1/13

Adjusted Fee

6 32701 0-20 Not a Benefit Not a Benefit 6.55 $28.0672 $183.84 $183.846 32701 21-999 Not a Benefit Not a Benefit 6.55 $26.7305 $175.08 $175.08

**RVU = Relative Value Unit

RADIATION THERAPY

TOS*: 6 = Radiation Therapy

Type of Service

(TOS)* Procedure Code

Age

Range

Current Medicaid

Fee

Current Adjusted

Fee

1/1/13

Medicaid

RVU***

1/1/13

Medicaid

Conversion

Factor

1/1/13

Medicaid

Fee

1/1/13

Adjusted Fee

4 78012 0-20 Not A Benefit Not A Benefit 2.45 $28.0672 $68.76 $68.764 78012 21-999 Not A Benefit Not A Benefit 2.45 $26.7305 $65.49 $65.49I 78012 0-20 Not A Benefit Not A Benefit 0.27 $28.0672 $7.58 $7.58I 78012 21-999 Not A Benefit Not A Benefit 0.27 $26.7305 $7.22 $7.22T 78012 0-20 Not A Benefit Not A Benefit 2.18 $28.0672 $61.19 $61.19T 78012 21-999 Not A Benefit Not A Benefit 2.18 $26.7305 $58.27 $58.274 78013 0-20 Not A Benefit Not A Benefit 6.19 $28.0672 $173.74 $173.744 78013 21-999 Not A Benefit Not A Benefit 6.19 $26.7305 $165.46 $165.46I 78013 0-20 Not A Benefit Not A Benefit 0.52 $28.0672 $14.59 $14.59I 78013 21-999 Not A Benefit Not A Benefit 0.52 $26.7305 $13.90 $13.90T 78013 0-20 Not A Benefit Not A Benefit 5.67 $28.0672 $159.14 $159.14T 78013 21-999 Not A Benefit Not A Benefit 5.67 $26.7305 $151.56 $151.564 78014 0-20 Not A Benefit Not A Benefit 7.17 $28.0672 $201.24 $201.244 78014 21-999 Not A Benefit Not A Benefit 7.17 $26.7305 $191.66 $191.66I 78014 0-20 Not A Benefit Not A Benefit 0.70 $28.0672 $19.65 $19.65I 78014 21-999 Not A Benefit Not A Benefit 0.70 $26.7305 $18.71 $18.71T 78014 0-20 Not A Benefit Not A Benefit 6.47 $28.0672 $181.59 $181.59T 78014 21-999 Not A Benefit Not A Benefit 6.47 $26.7305 $172.95 $172.954 78071 0-20 Not A Benefit Not A Benefit 10.68 $28.0672 $299.76 $299.764 78071 21-999 Not A Benefit Not A Benefit 10.68 $26.7305 $285.48 $285.48I 78071 0-20 Not A Benefit Not A Benefit 1.66 $28.0672 $46.59 $46.59I 78071 21-999 Not A Benefit Not A Benefit 1.66 $26.7305 $44.37 $44.37T 78071 0-20 Not A Benefit Not A Benefit 9.02 $28.0672 $253.17 $253.17T 78071 21-999 Not A Benefit Not A Benefit 9.02 $26.7305 $241.11 $241.11I 78072 0-20 Not A Benefit Not A Benefit 2.30 $28.0672 $64.55 $64.55I 78072 21-999 Not A Benefit Not A Benefit 2.30 $26.7305 $61.48 $61.484 91112 0-20 Not A Benefit Not A Benefit 34.93 $28.0672 $980.39 $980.394 91112 21-999 Not A Benefit Not A Benefit 34.93 $26.7305 $933.70 $933.70I 91112 0-20 Not A Benefit Not A Benefit 3.29 $28.0672 $92.34 $92.34I 91112 21-999 Not A Benefit Not A Benefit 3.29 $26.7305 $87.94 $87.94T 91112 0-20 Not A Benefit Not A Benefit 31.64 $28.0672 $888.05 $888.05T 91112 21-999 Not A Benefit Not A Benefit 31.64 $26.7305 $845.75 $845.75

RADIOLOGY SERVICES

TOS*: 4 = Radiology, I = Professional Component, T = Technical Component


Type of Service

(TOS)*

Procedure

Code Place of Service Age Range

Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee

2 C9600 F/NF 0-20Not a

BenefitNot a

Benefit $664.63 $664.63

2 C9600 F/NF 21-999Not a

BenefitNot a

Benefit $632.98 $632.98

2 C9601 F/NF 0-20Not a

BenefitNot a

Benefit $184.68 $184.68

2 C9601 F/NF 21-999Not a

BenefitNot a

Benefit $175.89 $175.89

2 C9602 F/NF 0-20Not a

BenefitNot a

Benefit $542.26 $542.26

2 C9602 F/NF 21-999Not a

BenefitNot a

Benefit $516.43 $516.43

2 C9603 F/NF 0-20Not a

BenefitNot a

Benefit $144.83 $144.83

2 C9603 F/NF 21-999Not a

BenefitNot a

Benefit $137.93 $137.93

2 C9604 F/NF 0-20Not a

BenefitNot a

Benefit $542.26 $542.26

2 C9604 F/NF 21-999Not a

BenefitNot a

Benefit $516.43 $516.43

2 C9605 F/NF 0-20Not a

BenefitNot a

Benefit $664.63 $664.63

2 C9605 F/NF 21-999Not a

BenefitNot a

Benefit $632.98 $632.98

2 C9606 F/NF 0-20Not a

BenefitNot a

Benefit $145.67 $145.67

2 C9606 F/NF 21-999Not a

BenefitNot a

Benefit $138.73 $138.73

2 C9607 F/NF 0-20Not a

BenefitNot a

Benefit $542.26 $542.26

2 C9607 F/NF 21-999Not a

BenefitNot a

Benefit $516.43 $516.43

2 C9608 F/NF 0-20Not a

BenefitNot a

Benefit $144.83 $144.83

2 C9608 F/NF 21-999Not a

BenefitNot a

Benefit $137.93 $137.93

2 22586 F/NF 0-20Not a

BenefitNot a

Benefit 45.23 $28.0672 $1,269.48 $1,269.48

2 22586 F/NF 21-999Not a

BenefitNot a

Benefit 45.23 $26.7305 $1,209.02 $1,209.02

8 22586 F/NF 0-20Not a

BenefitNot a

Benefit 7.24 $28.0672 $203.21 $203.21

8 22586 F/NF 21-999Not a

BenefitNot a

Benefit 7.24 $26.7305 $193.53 $193.53

2 23473 F/NF 0-20Not a

BenefitNot a

Benefit 48.22 $28.0672 $1,353.40 $1,353.40

2 23473 F/NF 21-999Not a

BenefitNot a

Benefit 48.22 $26.7305 $1,288.94 $1,288.94

8 23473 F/NF 0-20Not a

BenefitNot a

Benefit 7.72 $28.0672 $216.68 $216.68

8 23473 F/NF 21-999Not a

BenefitNot a

Benefit 7.72 $26.7305 $206.36 $206.36

SURGERY AND ASSISTANT SURGERY

Type of Service

(TOS)*

Procedure


Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee


2 23474 F/NF 0-20Not a

BenefitNot a

Benefit 52.09 $28.0672 $1,462.02 $1,462.02

2 23474 F/NF 21-999Not a

BenefitNot a

Benefit 52.09 $26.7305 $1,392.39 $1,392.39

8 23474 F/NF 0-20Not a

BenefitNot a

Benefit 8.33 $28.0672 $233.80 $233.80

8 23474 F/NF 21-999Not a

BenefitNot a

Benefit 8.33 $26.7305 $222.67 $222.67

2 24370 F/NF 0-20Not a

BenefitNot a

Benefit 45.57 $28.0672 $1,279.02 $1,279.02

2 24370 F/NF 21-999Not a

BenefitNot a

Benefit 45.57 $26.7305 $1,218.11 $1,218.11

8 24370 F/NF 0-20Not a

BenefitNot a

Benefit 7.29 $28.0672 $204.61 $204.61

8 24370 F/NF 21-999Not a

BenefitNot a

Benefit 7.29 $26.7305 $194.87 $194.87

2 24371 F/NF 0-20Not a

BenefitNot a

Benefit 52.51 $28.0672 $1,473.81 $1,473.81

2 24371 F/NF 21-999Not a

BenefitNot a

Benefit 52.51 $26.7305 $1,403.62 $1,403.62

8 24371 F/NF 0-20Not a

BenefitNot a

Benefit 8.40 $28.0672 $235.76 $235.76

8 24371 F/NF 21-999Not a

BenefitNot a

Benefit 8.40 $26.7305 $224.54 $224.54

2 31660 F/NF21-999 (only)

Not a Benefit

Not a Benefit 6.65 $26.7305 $177.76 $177.76

2 31661 F/NF21-999 (only)

Not a Benefit

Not a Benefit 7.03 $26.7305 $187.92 $187.92

2 31647 F/NF 0-20Not a

BenefitNot a

Benefit 6.63 $28.0672 $186.09 $186.09

2 31647 F/NF 21-999Not a

BenefitNot a

Benefit 6.63 $26.7305 $177.22 $177.22

2 31648 F/NF 0-20Not a

BenefitNot a

Benefit 6.93 $28.0672 $194.51 $194.51

2 31648 F/NF 21-999Not a

BenefitNot a

Benefit 6.93 $26.7305 $185.24 $185.24

2 31649 F/NF 0-20Not a

BenefitNot a

Benefit 2.18 $28.0672 $61.19 $61.19

2 31649 F/NF 21-999Not a

BenefitNot a

Benefit 2.18 $26.7305 $58.27 $58.27

2 31651 F/NF 0-20Not a

BenefitNot a

Benefit 2.31 $28.0672 $64.84 $64.84

2 31651 F/NF 21-999Not a

BenefitNot a

Benefit 2.31 $26.7305 $61.75 $61.75

2 32554 F 0-20Not a

BenefitNot a

Benefit 2.64 $28.0672 $74.10 $74.10

2 32554 NF 0-20Not a

BenefitNot a

Benefit 26.31 $28.0672 $738.45 $738.45

2 32554 F 21-999Not a

BenefitNot a

Benefit 2.64 $26.7305 $70.57 $70.57

2 32554 NF 21-999Not a

BenefitNot a

Benefit 26.31 $26.7305 $703.28 $703.28

Type of Service

(TOS)*

Procedure


Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee


2 32555 F 0-20Not a

BenefitNot a

Benefit 3.31 $28.0672 $92.90 $92.90

2 32555 NF 0-20Not a

BenefitNot a

Benefit 16.91 $28.0672 $474.62 $474.62

2 32555 F 21-999Not a

BenefitNot a

Benefit 3.31 $26.7305 $88.48 $88.48

2 32555 NF 21-999Not a

BenefitNot a

Benefit 16.91 $26.7305 $452.01 $452.01

2 32556 F 0-20Not a

BenefitNot a

Benefit 3.63 $28.0672 $101.88 $101.88

2 32556 NF 0-20Not a

BenefitNot a

Benefit 17.81 $28.0672 $499.88 $499.88

2 32556 F 21-999Not a

BenefitNot a

Benefit 3.63 $26.7305 $97.03 $97.03

2 32556 NF 21-999Not a

BenefitNot a

Benefit 17.81 $26.7305 $476.07 $476.07

2 32557 F 0-20Not a

BenefitNot a

Benefit 4.88 $28.0672 $136.97 $136.97

2 32557 NF 0-20Not a

BenefitNot a

Benefit 32.69 $28.0672 $917.52 $917.52

2 32557 F 21-999Not a

BenefitNot a

Benefit 4.88 $26.7305 $130.44 $130.44

2 32557 NF 21-999Not a

BenefitNot a

Benefit 32.69 $26.7305 $873.82 $873.82

2 33361 F/NF 0-20Not a

BenefitNot a

Benefit 39.73 $28.0672 $1,115.11 $1,115.11

2 33361 F/NF 21-999Not a

BenefitNot a

Benefit 39.73 $26.7305 $1,062.00 $1,062.00

2 33362 F/NF 0-20Not a

BenefitNot a

Benefit 43.46 $28.0672 $1,219.80 $1,219.80

2 33362 F/NF 21-999Not a

BenefitNot a

Benefit 43.46 $26.7305 $1,161.71 $1,161.71

2 33363 F/NF 0-20Not a

BenefitNot a

Benefit 45.00 $28.0672 $1,263.02 $1,263.02

2 33363 F/NF 21-999Not a

BenefitNot a

Benefit 45.00 $26.7305 $1,202.87 $1,202.87

2 33364 F/NF 0-20Not a

BenefitNot a

Benefit 47.88 $28.0672 $1,343.86 $1,343.86

2 33364 F/NF 21-999Not a

BenefitNot a

Benefit 47.88 $26.7305 $1,279.86 $1,279.86

2 33365 F/NF 0-20Not a

BenefitNot a

Benefit 52.51 $28.0672 $1,473.81 $1,473.81

2 33365 F/NF 21-999Not a

BenefitNot a

Benefit 52.51 $26.7305 $1,403.62 $1,403.62

2 33367 F/NF 0-20Not a

BenefitNot a

Benefit 18.44 $28.0672 $517.56 $517.56

2 33367 F/NF 21-999Not a

BenefitNot a

Benefit 18.44 $26.7305 $492.91 $492.91

2 33368 F/NF 0-20Not a

BenefitNot a

Benefit 22.35 $28.0672 $627.30 $627.30

2 33368 F/NF 21-999Not a

BenefitNot a

Benefit 22.35 $26.7305 $597.43 $597.43

Type of Service

(TOS)*

Procedure


Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee


2 33369 F/NF 0-20Not a

BenefitNot a

Benefit 29.51 $28.0672 $828.26 $828.26

2 33369 F/NF 21-999Not a

BenefitNot a

Benefit 29.51 $26.7305 $788.82 $788.82

2 33990 F/NF 0-20Not a

BenefitNot a

Benefit 12.92 $28.0672 $362.63 $362.63

2 33990 F/NF 21-999Not a

BenefitNot a

Benefit 12.92 $26.7305 $345.36 $345.36

8 33990 F/NF 0-20Not a

BenefitNot a

Benefit 2.07 $28.0672 $58.10 $58.10

8 33990 F/NF 21-999Not a

BenefitNot a

Benefit 2.07 $26.7305 $55.33 $55.33

2 33991 F/NF 0-20Not a

BenefitNot a

Benefit 18.83 $28.0672 $528.51 $528.51

2 33991 F/NF 21-999Not a

BenefitNot a

Benefit 18.83 $26.7305 $503.34 $503.34

8 33991 F/NF 0-20Not a

BenefitNot a

Benefit 3.01 $28.0672 $84.48 $84.48

8 33991 F/NF 21-999Not a

BenefitNot a

Benefit 3.01 $26.7305 $80.46 $80.46

2 33992 F/NF 0-20Not a

BenefitNot a

Benefit 6.15 $28.0672 $172.61 $172.61

2 33992 F/NF 21-999Not a

BenefitNot a

Benefit 6.15 $26.7305 $164.39 $164.39

8 33992 F/NF 0-20Not a

BenefitNot a

Benefit 0.98 $28.0672 $27.51 $27.51

8 33992 F/NF 21-999Not a

BenefitNot a

Benefit 0.98 $26.7305 $26.20 $26.20

2 33993 F/NF 0-20Not a

BenefitNot a

Benefit 5.40 $28.0672 $151.56 $151.56

2 33993 F/NF 21-999Not a

BenefitNot a

Benefit 5.40 $26.7305 $144.34 $144.34

8 33993 F/NF 0-20Not a

BenefitNot a

Benefit 0.86 $28.0672 $24.14 $24.14

8 33993 F/NF 21-999Not a

BenefitNot a

Benefit 0.86 $26.7305 $22.99 $22.99

2 36221 F 0-20Not a

BenefitNot a

Benefit 6.39 $28.0672 $179.35 $179.35

2 36221 NF 0-20Not a

BenefitNot a

Benefit 34.02 $28.0672 $954.85 $954.85

2 36221 F 21-999Not a

BenefitNot a

Benefit 6.39 $26.7305 $170.81 $170.81

2 36221 NF 21-999Not a

BenefitNot a

Benefit 34.02 $26.7305 $909.37 $909.37

2 36222 F 0-20Not a

BenefitNot a

Benefit 8.64 $28.0672 $242.50 $242.50

2 36222 NF 0-20Not a

BenefitNot a

Benefit 42.59 $28.0672 $1,195.38 $1,195.38

2 36222 F 21-999Not a

BenefitNot a

Benefit 8.64 $26.7305 $230.95 $230.95

2 36222 NF 21-999Not a

BenefitNot a

Benefit 42.59 $26.7305 $1,138.45 $1,138.45

Type of Service

(TOS)*

Procedure


Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee


2 36223 F 0-20Not a

BenefitNot a

Benefit 9.34 $28.0672 $262.15 $262.15

2 36223 NF 0-20Not a

BenefitNot a

Benefit 46.42 $28.0672 $1,302.88 $1,302.88

2 36223 F 21-999Not a

BenefitNot a

Benefit 9.34 $26.7305 $249.66 $249.66

2 36223 NF 21-999Not a

BenefitNot a

Benefit 46.42 $26.7305 $1,240.83 $1,240.83

2 36224 F 0-20Not a

BenefitNot a

Benefit 10.18 $28.0672 $285.72 $285.72

2 36224 NF 0-20Not a

BenefitNot a

Benefit 50.44 $28.0672 $1,415.71 $1,415.71

2 36224 F 21-999Not a

BenefitNot a

Benefit 10.18 $26.7305 $272.12 $272.12

2 36224 NF 21-999Not a

BenefitNot a

Benefit 50.44 $26.7305 $1,348.29 $1,348.29

2 36225 F 0-20Not a

BenefitNot a

Benefit 9.30 $28.0672 $261.02 $261.02

2 36225 NF 0-20Not a

BenefitNot a

Benefit 46.05 $28.0672 $1,292.49 $1,292.49

2 36225 F 21-999Not a

BenefitNot a

Benefit 9.30 $26.7305 $248.59 $248.59

2 36225 NF 21-999Not a

BenefitNot a

Benefit 46.05 $26.7305 $1,230.94 $1,230.94

2 36226 F 0-20Not a

BenefitNot a

Benefit 10.20 $28.0672 $286.29 $286.29

2 36226 NF 0-20Not a

BenefitNot a

Benefit 51.45 $28.0672 $1,444.06 $1,444.06

2 36226 F 21-999Not a

BenefitNot a

Benefit 10.20 $26.7305 $272.65 $272.65

2 36226 NF 21-999Not a

BenefitNot a

Benefit 51.45 $26.7305 $1,375.28 $1,375.28

2 36227 F 0-20Not a

BenefitNot a

Benefit 3.22 $28.0672 $90.38 $90.38

2 36227 NF 0-20Not a

BenefitNot a

Benefit 7.42 $28.0672 $208.26 $208.26

2 36227 F 21-999Not a

BenefitNot a

Benefit 3.22 $26.7305 $86.07 $86.07

2 36227 NF 21-999Not a

BenefitNot a

Benefit 7.42 $26.7305 $198.34 $198.34

2 36228 F 0-20Not a

BenefitNot a

Benefit 6.57 $28.0672 $184.40 $184.40

2 36228 NF 0-20Not a

BenefitNot a

Benefit 35.41 $28.0672 $993.86 $993.86

2 36228 F 21-999Not a

BenefitNot a

Benefit 6.57 $26.7305 $175.62 $175.62

2 36228 NF 21-999Not a

BenefitNot a

Benefit 35.41 $26.7305 $946.53 $946.53

2 37197 F 0-20Not a

BenefitNot a

Benefit 9.03 $28.0672 $253.45 $253.45

2 37197 NF 0-20Not a

BenefitNot a

Benefit 49.81 $28.0672 $1,398.03 $1,398.03

Type of Service

(TOS)*

Procedure


Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee


2 37197 F 21-999Not a

BenefitNot a

Benefit 9.03 $26.7305 $241.38 $241.38

2 37197 NF 21-999Not a

BenefitNot a

Benefit 49.81 $26.7305 $1,331.45 $1,331.45

2 37211 F/NF 0-20Not a

BenefitNot a

Benefit 11.96 $28.0672 $335.68 $335.68

2 37211 F/NF 21-999Not a

BenefitNot a

Benefit 11.96 $26.7305 $319.70 $319.70

2 37212 F/NF 0-20Not a

BenefitNot a

Benefit 10.56 $28.0672 $296.39 $296.39

2 37212 F/NF 21-999Not a

BenefitNot a

Benefit 10.56 $26.7305 $282.27 $282.27

2 37213 F/NF 0-20Not a

BenefitNot a

Benefit 7.38 $28.0672 $207.14 $207.14

2 37213 F/NF 21-999Not a

BenefitNot a

Benefit 7.38 $26.7305 $197.27 $197.27

2 37214 F/NF 0-20Not a

BenefitNot a

Benefit 4.33 $28.0672 $121.53 $121.53

2 37214 F/NF 21-999Not a

BenefitNot a

Benefit 4.33 $26.7305 $115.74 $115.74

2 38243 F/NF 0-20Not a

BenefitNot a

Benefit 3.41 $28.0672 $95.71 $95.71

2 38243 F/NF 21-999Not a

BenefitNot a

Benefit 3.41 $26.7305 $91.15 $91.15

2 43206 F 0-20Not a

BenefitNot a

Benefit $97.39 $97.39

2 43206 NF 0-20Not a

BenefitNot a

Benefit $248.68 $248.68

2 43206 F 21-999Not a

BenefitNot a

Benefit $92.75 $92.75

2 43206 NF 21-999Not a

BenefitNot a

Benefit $236.83 $236.83

2 43252 F 0-20Not a

BenefitNot a

Benefit $143.98 $143.98

2 43252 NF 0-20Not a

BenefitNot a

Benefit $296.67 $296.67

2 43252 F 21-999Not a

BenefitNot a

Benefit $137.13 $137.13

2 43252 NF 21-999Not a

BenefitNot a

Benefit $282.54 $282.54

2 52287 F 0-20Not a

BenefitNot a

Benefit 4.90 $28.0672 $137.53 $137.53

2 52287 NF 0-20Not a

BenefitNot a

Benefit 9.16 $28.0672 $257.10 $257.10

2 52287 F 21-999Not a

BenefitNot a

Benefit 4.90 $26.7305 $130.98 $130.98

2 52287 NF 21-999Not a

BenefitNot a

Benefit 9.16 $26.7305 $244.85 $244.85

2 64615 F 0-20Not a

BenefitNot a

Benefit 3.81 $28.0672 $106.94 $106.94

2 64615 NF 0-20Not a

BenefitNot a

Benefit 4.23 $28.0672 $118.72 $118.72

Type of Service

(TOS)*

Procedure


Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee


2 64615 F 21-999Not a

BenefitNot a

Benefit 3.81 $26.7305 $101.84 $101.84

2 64615 NF 21-999Not a

BenefitNot a

Benefit 4.23 $26.7305 $113.07 $113.07

2 92920 F/NF 0-20Not a

BenefitNot a

Benefit 15.98 $28.0672 $448.51 $448.51

2 92920 F/NF 21-999Not a

BenefitNot a

Benefit 15.98 $26.7305 $427.15 $427.15

2 92921 F/NF 0-20Not a

BenefitNot a

Benefit $131.92 $131.92

2 92921 F/NF 21-999Not a

BenefitNot a

Benefit $125.63 $125.63

2 92924 F/NF 0-20Not a

BenefitNot a

Benefit 18.99 $28.0672 $533.00 $533.00

2 92924 F/NF 21-999Not a

BenefitNot a

Benefit 18.99 $26.7305 $507.61 $507.61

2 92925 F/NF 0-20Not a

BenefitNot a

Benefit $144.83 $144.83

2 92925 F/NF 21-999Not a

BenefitNot a

Benefit $137.93 $137.93

2 92928 F/NF 0-20Not a

BenefitNot a

Benefit 17.74 $28.0672 $497.91 $497.91

2 92928 F/NF 21-999Not a

BenefitNot a

Benefit 17.74 $26.7305 $474.20 $474.20

2 92929 F/NF 0-20Not a

BenefitNot a

Benefit $184.68 $184.68

2 92929 F/NF 21-999Not a

BenefitNot a

Benefit $175.89 $175.89

2 92933 F/NF 0-20Not a

BenefitNot a

Benefit 19.85 $28.0672 $557.13 $557.13

2 92933 F/NF 21-999Not a

BenefitNot a

Benefit 19.85 $26.7305 $530.60 $530.60

2 92934 F/NF 0-20Not a

BenefitNot a

Benefit $184.68 $184.68

2 92934 F/NF 21-999Not a

BenefitNot a

Benefit $175.89 $175.89

2 92937 F/NF 0-20Not a

BenefitNot a

Benefit 17.73 $28.0672 $497.63 $497.63

2 92937 F/NF 21-999Not a

BenefitNot a

Benefit 17.73 $26.7305 $473.93 $473.93

2 92938 F/NF 0-20Not a

BenefitNot a

Benefit N/A N/A $184.68 $184.68

2 92938 F/NF 21-999Not a

BenefitNot a

Benefit $175.89 $175.89

2 92941 F/NF 0-20Not a

BenefitNot a

Benefit 19.89 $28.0672 $558.26 $558.26

2 92941 F/NF 21-999Not a

BenefitNot a

Benefit 19.89 $26.7305 $531.67 $531.67

2 92943 F/NF 0-20Not a

BenefitNot a

Benefit 19.89 $28.0672 $558.26 $558.26

2 92943 F/NF 21-999Not a

BenefitNot a

Benefit 19.89 $26.7305 $531.67 $531.67

Type of Service

(TOS)*

Procedure


Current

Medicaid

Fee

Current

Adjusted

Fee

1/1/2013

Medicaid

RVU**

1/1/2013

Medicaid

Conversion

Factor

1/1/2013

Medicaid

Fee

1/1/2013

Adjusted

Fee


2 92944 F/NF 0-20Not a

BenefitNot a

Benefit $184.68 $184.68

2 92944 F/NF 21-999Not a

BenefitNot a

Benefit $175.89 $175.89

2 93653 F/NF 0-20Not a

BenefitNot a

Benefit 24.16 $28.0672 $678.10 $678.10

2 93653 F/NF 21-999Not a

BenefitNot a

Benefit 24.16 $26.7305 $645.81 $645.81

2 93654 F/NF 0-20Not a

BenefitNot a

Benefit 32.24 $28.0672 $904.89 $904.89

2 93654 F/NF 21-999Not a

BenefitNot a

Benefit 32.24 $26.7305 $861.79 $861.79

2 93655 F/NF 0-20Not a

BenefitNot a

Benefit 12.08 $28.0672 $339.05 $339.05

2 93655 F/NF 21-999Not a

BenefitNot a

Benefit 12.08 $26.7305 $322.90 $322.90

2 93656 F/NF 0-20Not a

BenefitNot a

Benefit 32.25 $28.0672 $905.17 $905.17

2 93656 F/NF 21-999Not a

BenefitNot a

Benefit 32.25 $26.7305 $862.06 $862.06

2 93657 F/NF 0-20Not a

BenefitNot a

Benefit 12.09 $28.0672 $339.33 $339.33

2 93657 F/NF 21-999Not a

BenefitNot a

Benefit 12.09 $26.7305 $323.17 $323.17TOS*: 2 = Surgery, 8 = Assistant Surgery


Place of Service: F = Facility (example: hospital or clinic), NF = Nonfacility (example: office)

initial 2013 hcpcs reimbursement rates … initial 2013...1 of 1 initial 2013 hcpcs reimbursement...

Documents