Upstate Medicare Division -
2007 Fee Schedule - Revised 7-13-07

Codes: 10000 - 10999 | 11000 - 11999 | 12000 - 12999 | 13000 - 13999 | 14000 - 14999 |
  15000 - 15999 | 16000 - 16999 | 17000 - 17999 | 18000 - 18999 | 19000 - 19999 |

# These amounts apply when service is performed in a facility setting.
C The payment for the technical component is capped at the OPPS amount.
  Limiting charge applies to unassigned claims by non-participating providers.
  All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2006 by the American Medical Association.

10000 - 10999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  10021   120.26 114.25 131.39
# 10021   63.14 59.98 68.98
  10022   129.16 122.70 141.11
# 10022   59.15 56.19 64.62
  10040   79.77 75.78 87.15
# 10040   71.07 67.52 77.65
  10060   88.51 84.08 96.69
# 10060   77.36 73.49 84.51
  10061   155.00 147.25 169.34
# 10061   141.77 134.68 154.88
  10080   147.46 140.09 161.10
# 10080   81.99 77.89 89.57
  10081   226.71 215.37 247.68
# 10081   142.08 134.98 155.23
  10120   118.93 112.98 129.93
# 10120   78.88 74.94 86.18
  10121   223.04 211.89 243.67
# 10121   161.75 153.66 176.71
  10140   123.30 117.14 134.71
# 10140   102.40 97.28 111.87
  10160   103.03 97.88 112.56
# 10160   82.83 78.69 90.49
  10180   192.72 183.08 210.54
# 10180   153.71 146.02 167.92

11000 - 11999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  11000   43.82 41.63 47.87
# 11000   29.55 28.07 32.28
  11001   19.25 18.29 21.03
# 11001   14.72 13.98 16.08
  11004   514.80 489.06 562.42
  11005   691.85 657.26 755.85
  11006   638.60 606.67 697.67
  11008   250.71 238.17 273.90
  11010   397.41 377.54 434.17
# 11010   248.34 235.92 271.31
  11011   461.39 438.32 504.07
# 11011   266.00 252.70 290.61
  11012   657.74 624.85 718.58
# 11012   391.30 371.74 427.50
  11040   38.07 36.17 41.60
# 11040   25.53 24.25 27.89
  11041   46.67 44.34 50.99
# 11041   33.44 31.77 36.54
  11042   64.35 61.13 70.30
# 11042   44.15 41.94 48.23
  11043   231.69 220.11 253.13
# 11043   202.79 192.65 221.55
  11044   310.59 295.06 339.32
# 11044   280.98 266.93 306.97
  11055   37.98 36.08 41.49
# 11055   21.61 20.53 23.61
  11056   46.99 44.64 51.34
# 11056   30.27 28.76 33.07
  11057   57.64 54.76 62.97
# 11057   39.18 37.22 42.80
  11100   77.53 73.65 84.70
# 11100   41.66 39.58 45.52
  11101   26.72 25.38 29.19
# 11101   21.49 20.42 23.48
  11200   65.88 62.59 71.98
# 11200   55.78 52.99 60.94
  11201   15.93 15.13 17.40
# 11201   14.54 13.81 15.88
  11300   54.41 51.69 59.44
# 11300   25.50 24.23 27.86
  11301   71.95 68.35 78.60
# 11301   43.05 40.90 47.04
  11302   86.34 82.02 94.32
# 11302   53.25 50.59 58.18
  11303   103.07 97.92 112.61
# 11303   62.67 59.54 68.47
  11305   56.20 53.39 61.40
# 11305   33.56 31.88 36.66
  11306   76.59 72.76 83.67
# 11306   49.77 47.28 54.37
  11307   89.56 85.08 97.84
# 11307   57.87 54.98 63.23
  11308   104.70 99.47 114.39
# 11308   71.61 68.03 78.23
  11310   67.12 63.76 73.32
# 11310   37.17 35.31 40.61
  11311   83.55 79.37 91.28
# 11311   53.95 51.25 58.94
  11312   96.43 91.61 105.35
# 11312   61.95 58.85 67.68
  11313   124.03 117.83 135.50
# 11313   83.28 79.12 90.99
  11400   99.34 94.37 108.53
# 11400   62.42 59.30 68.20
  11401   117.41 111.54 128.27
# 11401   81.54 77.46 89.08
  11402   130.50 123.98 142.58
# 11402   90.45 85.93 98.82
  11403   150.70 143.17 164.65
# 11403   114.13 108.42 124.68
  11404   171.60 163.02 187.47
# 11404   127.02 120.67 138.77
  11406   236.72 224.88 258.61
# 11406   187.61 178.23 204.96
  11420   98.37 93.45 107.47
# 11420   68.77 65.33 75.13
  11421   125.69 119.41 137.32
# 11421   91.90 87.31 100.41
  11422   139.88 132.89 152.82
# 11422   108.19 102.78 118.20
  11423   164.95 156.70 180.21
# 11423   126.64 120.31 138.36
  11424   188.60 179.17 206.05
# 11424   147.15 139.79 160.76
  11426   270.92 257.37 295.98
# 11426   223.90 212.71 244.62
  11440   111.76 106.17 122.10
# 11440   82.51 78.38 90.14
  11441   136.29 129.48 148.90
# 11441   107.03 101.68 116.93
  11442   152.32 144.70 166.41
# 11442   118.53 112.60 129.49
  11443   185.38 176.11 202.53
# 11443   147.77 140.38 161.44
  11444   234.31 222.59 255.98
# 11444   190.43 180.91 208.05
  11446   313.73 298.04 342.75
# 11446   268.45 255.03 293.28
  11450   291.68 277.10 318.67
# 11450   189.29 179.83 206.80
  11451   387.24 367.88 423.06
# 11451   252.11 239.50 275.43
  11462   287.46 273.09 314.05
# 11462   181.93 172.83 198.75
  11463   397.59 377.71 434.37
# 11463   257.93 245.03 281.78
  11470   315.53 299.75 344.71
# 11470   217.32 206.45 237.42
  11471   409.99 389.49 447.91
# 11471   276.95 263.10 302.57
  11600   148.98 141.53 162.76
# 11600   91.86 87.27 100.36
  11601   172.65 164.02 188.62
# 11601   117.28 111.42 128.13
  11602   186.09 176.79 203.31
# 11602   126.89 120.55 138.63
  11603   214.03 203.33 233.83
# 11603   149.60 142.12 163.44
  11604   237.62 225.74 259.60
# 11604   164.83 156.59 180.08
  11606   332.43 315.81 363.18
# 11606   245.36 233.09 268.05
  11620   149.11 141.65 162.90
# 11620   91.64 87.06 100.12
  11621   173.38 164.71 189.42
# 11621   118.35 112.43 129.29
  11622   195.33 185.56 213.39
# 11622   135.77 128.98 148.33
  11623   232.21 220.60 253.69
# 11623   167.78 159.39 183.30
  11624   264.99 251.74 289.50
# 11624   193.25 183.59 211.13
  11626   330.78 314.24 361.38
# 11626   249.63 237.15 272.72
  11640   153.88 146.19 168.12
# 11640   98.51 93.58 107.62
  11641   187.17 177.81 204.48
# 11641   130.75 124.21 142.84
  11642   216.33 205.51 236.34
# 11642   153.29 145.63 167.47
  11643   257.92 245.02 281.77
# 11643   191.05 181.50 208.73
  11644   322.10 306.00 351.90
# 11644   241.30 229.24 263.63
  11646   428.55 407.12 468.19
# 11646   345.31 328.04 377.25
  11719   15.94 15.14 17.41
# 11719   8.63 8.20 9.43
  11720   24.89 23.65 27.20
# 11720   15.83 15.04 17.30
  11721   36.71 34.87 40.10
# 11721   27.30 25.94 29.83
  11730   79.71 75.72 87.08
# 11730   54.98 52.23 60.06
  11732   37.46 35.59 40.93
# 11732   28.06 26.66 30.66
  11740   34.76 33.02 37.97
# 11740   26.40 25.08 28.84
  11750   169.95 161.45 185.67
# 11750   149.75 142.26 163.60
  11752   241.69 229.61 264.05
# 11752   230.20 218.69 251.49
  11755   107.11 101.75 117.01
# 11755   75.07 71.32 82.02
  11760   158.44 150.52 173.10
# 11760   119.08 113.13 130.10
  11762   216.34 205.52 236.35
# 11762   184.65 175.42 201.73
  11765   96.28 91.47 105.19
# 11765   55.18 52.42 60.28
  11770   219.35 208.38 239.64
# 11770   150.74 143.20 164.68
  11771   428.05 406.65 467.65
# 11771   341.33 324.26 372.90
  11772   534.18 507.47 583.59
# 11772   449.21 426.75 490.76
  11900   43.39 41.22 47.40
# 11900   25.98 24.68 28.38
  11901   54.16 51.45 59.17
# 11901   40.93 38.88 44.71
  11920   178.73 169.79 195.26
# 11920   99.67 94.69 108.89
  11921   200.38 190.36 218.91
# 11921   117.84 111.95 128.74
  11922   56.40 53.58 61.62
# 11922   27.15 25.79 29.66
  11950   67.58 64.20 73.83
# 11950   43.55 41.37 47.58
  11951   92.78 88.14 101.36
# 11951   61.44 58.37 67.13
  11952   125.38 119.11 136.98
# 11952   86.72 82.38 94.74
  11954   148.28 140.87 162.00
# 11954   99.52 94.54 108.72
  11960   773.24 734.58 844.77
  11970   510.02 484.52 557.20
  11971   420.60 399.57 459.51
# 11971   252.38 239.76 275.72
  11976   125.84 119.55 137.48
# 11976   87.88 83.49 96.01
  11980   92.00 87.40 100.51
# 11980   72.84 69.20 79.58
  11981   114.73 108.99 125.34
# 11981   76.42 72.60 83.49
  11982   133.54 126.86 145.89
# 11982   93.14 88.48 101.75
  11983   201.25 191.19 219.87
# 11983   168.51 160.08 184.09

12000 - 12999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  12001   129.40 122.93 141.37
# 12001   89.00 84.55 97.23
  12002   137.30 130.44 150.01
# 12002   99.33 94.36 108.51
  12004   160.94 152.89 175.82
# 12004   116.71 110.87 127.50
  12005   200.75 190.71 219.32
# 12005   145.72 138.43 159.19
  12006   249.21 236.75 272.26
# 12006   185.12 175.86 202.24
  12007   281.17 267.11 307.18
# 12007   212.21 201.60 231.84
  12011   136.77 129.93 149.42
# 12011   91.84 87.25 100.34
  12013   150.46 142.94 164.38
# 12013   105.18 99.92 114.91
  12014   177.39 168.52 193.80
# 12014   126.54 120.21 138.24
  12015   222.72 211.58 243.32
# 12015   159.33 151.36 174.06
  12016   263.65 250.47 288.04
# 12016   194.69 184.96 212.70
  12017   235.27 223.51 257.04
  12018   281.16 267.10 307.17
  12020   229.73 218.24 250.98
# 12020   163.21 155.05 178.31
  12021   133.08 126.43 145.39
# 12021   117.76 111.87 128.65
  12031   171.88 163.29 187.78
# 12031   118.94 112.99 129.94
  12032   234.86 223.12 256.59
# 12032   155.80 148.01 170.21
  12034   229.65 218.17 250.90
# 12034   161.74 153.65 176.70
  12035   308.40 292.98 336.93
# 12035   201.48 191.41 220.12
  12036   344.11 326.90 375.94
# 12036   238.23 226.32 260.27
  12037   386.91 367.56 422.69
# 12037   276.51 262.68 302.08
  12041   186.23 176.92 203.46
# 12041   131.20 124.64 143.34
  12042   222.61 211.48 243.20
# 12042   155.05 147.30 169.40
  12044   244.70 232.47 267.34
# 12044   173.30 164.64 189.34
  12045   316.10 300.30 345.35
# 12045   212.32 201.70 231.96
  12046   377.50 358.63 412.42
# 12046   250.72 238.18 273.91
  12047   392.84 373.20 429.18
# 12047   276.17 262.36 301.71
  12051   211.14 200.58 230.67
# 12051   144.62 137.39 158.00
  12052   226.94 215.59 247.93
# 12052   160.08 152.08 174.89
  12053   243.98 231.78 266.55
# 12053   171.19 162.63 187.02
  12054   265.82 252.53 290.41
# 12054   186.41 177.09 203.65
  12055   332.18 315.57 362.91
# 12055   236.75 224.91 258.65
  12056   424.33 403.11 463.58
# 12056   294.42 279.70 321.66
  12057   442.98 420.83 483.95
# 12057   340.59 323.56 372.09

13000 - 13999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  13100   257.97 245.07 281.83
# 13100   195.28 185.52 213.35
  13101   314.13 298.42 343.18
# 13101   236.81 224.97 258.72
  13102   88.22 83.81 96.38
# 13102   65.58 62.30 71.65
  13120   268.24 254.83 293.05
# 13120   203.81 193.62 222.66
  13121   340.15 323.14 371.61
# 13121   260.05 247.05 284.11
  13122   104.60 99.37 114.28
# 13122   74.99 71.24 81.93
  13131   293.94 279.24 321.13
# 13131   231.60 220.02 253.02
  13132   452.61 429.98 494.48
# 13132   381.56 362.48 416.85
  13133   139.11 132.15 151.97
# 13133   114.73 108.99 125.34
  13150   307.17 291.81 335.58
# 13150   235.07 223.32 256.82
  13151   333.58 316.90 364.44
# 13151   270.20 256.69 295.19
  13152   449.71 427.22 491.30
# 13152   366.47 348.15 400.37
  13153   155.42 147.65 169.80
# 13153   125.82 119.53 137.46
  13160   691.50 656.93 755.47

14000 - 14999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  14000   531.08 504.53 580.21
# 14000   443.66 421.48 484.70
  14001   691.15 656.59 755.08
# 14001   599.21 569.25 654.64
  14020   590.02 560.52 644.60
# 14020   508.52 483.09 555.55
  14021   771.91 733.31 843.31
# 14021   694.59 659.86 758.84
  14040   622.66 591.53 680.26
# 14040   553.01 525.36 604.16
  14041   846.45 804.13 924.75
# 14041   759.73 721.74 830.00
  14060   640.55 608.52 699.80
# 14060   583.78 554.59 637.78
# 14061   823.47 782.30 899.65
  14061