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

Codes: 40000 - 40999 | 41000 - 41999 | 42000 - 42999 | 43000 - 43999 | 44000 - 44999 |
  45000 - 45999 | 46000 - 46999 | 47000 - 47999 | 48000 - 48999 | 49000 - 49999 |

# 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.

40000 - 40999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  40490   103.90 98.71 113.52
# 40490   64.19 60.98 70.13
  40500   405.74 385.45 443.27
# 40500   308.23 292.82 336.74
  40510   403.67 383.49 441.01
# 40510   309.29 293.83 337.90
  40520   430.84 409.30 470.70
# 40520   314.17 298.46 343.23
  40525   491.73 467.14 537.21
  40527   582.04 552.94 635.88
  40530   467.75 444.36 511.01
# 40530   355.26 337.50 388.13
  40650   364.58 346.35 398.30
# 40650   248.95 236.50 271.98
  40652   424.19 402.98 463.43
# 40652   307.17 291.81 335.58
  40654   493.53 468.85 539.18
# 40654   368.15 349.74 402.20
  40700   817.95 777.05 893.61
  40701   1,017.88 966.99 1,112.04
  40702   790.53 751.00 863.65
  40720   879.66 835.68 961.03
  40761   930.93 884.38 1,017.04
  40800   154.58 146.85 168.88
# 40800   106.52 101.19 116.37
  40801   242.69 230.56 265.14
# 40801   189.40 179.93 206.92
  40804   165.76 157.47 181.09
# 40804   109.34 103.87 119.45
  40805   262.56 249.43 286.84
# 40805   197.43 187.56 215.69
  40806   80.23 76.22 87.65
# 40806   29.03 27.58 31.72
  40808   135.83 129.04 148.40
# 40808   88.46 84.04 96.65
  40810   154.98 147.23 169.31
# 40810   106.57 101.24 116.43
  40812   223.18 212.02 243.82
# 40812   169.19 160.73 184.84
  40814   305.80 290.51 334.09
# 40814   261.22 248.16 285.38
  40816   321.93 305.83 351.70
# 40816   273.17 259.51 298.44
  40818   283.43 269.26 309.65
# 40818   234.33 222.61 256.00
  40819   239.76 227.77 261.94
# 40819   198.31 188.39 216.65
  40820   194.44 184.72 212.43
# 40820   135.58 128.80 148.12
  40830   198.13 188.22 216.45
# 40830   137.53 130.65 150.25
  40831   261.06 248.01 285.21
# 40831   196.63 186.80 214.82
  40840   678.04 644.14 740.76
# 40840   566.24 537.93 618.62
  40842   682.92 648.77 746.09
# 40842   559.28 531.32 611.02
  40843   880.37 836.35 961.80
# 40843   722.60 686.47 789.44
  40844   1,156.38 1,098.56 1,263.34
# 40844   994.43 944.71 1,086.42
  40845   1,282.48 1,218.36 1,401.11
# 40845   1,133.07 1,076.42 1,237.88

41000 - 41999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  41000   130.32 123.80 142.37
# 41000   96.54 91.71 105.47
  41005   170.25 161.74 186.00
# 41005   106.51 101.18 116.36
  41006   291.98 277.38 318.99
# 41006   227.55 216.17 248.60
  41007   295.45 280.68 322.78
# 41007   217.44 206.57 237.56
  41008   296.18 281.37 323.58
# 41008   234.88 223.14 256.61
  41009   315.82 300.03 345.03
# 41009   256.26 243.45 279.97
  41010   157.29 149.43 171.84
# 41010   92.16 87.55 100.68
  41015   343.43 326.26 375.20
# 41015   290.49 275.97 317.37
  41016   353.86 336.17 386.60
# 41016   299.18 284.22 326.85
  41017   355.95 338.15 388.87
# 41017   301.62 286.54 329.52
  41018   409.57 389.09 447.45
# 41018   349.67 332.19 382.02
  41100   136.83 129.99 149.49
# 41100   98.18 93.27 107.26
  41105   135.09 128.34 147.59
# 41105   97.13 92.27 106.11
  41108   113.79 108.10 124.32
# 41108   77.56 73.68 84.73
  41110   163.55 155.37 178.68
# 41110   112.00 106.40 122.36
  41112   262.68 249.55 286.98
# 41112   213.23 202.57 232.96
  41113   289.87 275.38 316.69
# 41113   238.67 226.74 260.75
  41114   558.00 530.10 609.62
  41115   187.36 177.99 204.69
# 41115   128.16 121.75 140.01
  41116   249.80 237.31 272.91
# 41116   186.41 177.09 203.65
  41120   907.51 862.13 991.45
  41130   1,102.77 1,047.63 1,204.77
  41135   1,846.38 1,754.06 2,017.17
  41140   1,923.50 1,827.33 2,101.43
  41145   2,375.19 2,256.43 2,594.89
  41150   1,886.74 1,792.40 2,061.26
  41153   2,031.32 1,929.75 2,219.21
  41155   2,479.77 2,355.78 2,709.15
  41250   174.97 166.22 191.15
# 41250   115.06 109.31 125.71
  41251   196.46 186.64 214.64
# 41251   138.65 131.72 151.48
  41252   248.92 236.47 271.94
# 41252   185.19 175.93 202.32
  41500   386.36 367.04 422.10
  41510   391.05 371.50 427.23
  41520   271.84 258.25 296.99
# 41520   223.77 212.58 244.47
  41800   153.35 145.68 167.53
# 41800   96.23 91.42 105.13
  41805   157.62 149.74 172.20
# 41805   128.71 122.27 140.61
  41806   247.45 235.08 270.34
# 41806   211.58 201.00 231.15
  41822   229.89 218.40 251.16
# 41822   152.22 144.61 166.30
  41823   337.41 320.54 368.62
# 41823   272.98 259.33 298.23
  41825   161.09 153.04 176.00
# 41825   120.69 114.66 131.86
  41826   195.50 185.73 213.59
# 41826   165.20 156.94 180.48
  41827   337.44 320.57 368.66
# 41827   260.82 247.78 284.95
  41828   252.35 239.73 275.69
# 41828   209.16 198.70 228.51
  41830   308.46 293.04 337.00
# 41830   248.56 236.13 271.55
  41872   288.98 274.53 315.71
# 41872   225.60 214.32 246.47
  41874   294.81 280.07 322.08
# 41874   225.50 214.23 246.36

42000 - 42999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  42000   132.89 126.25 145.19
# 42000   88.31 83.89 96.47
  42100   122.24 116.13 133.55
# 42100   95.08 90.33 103.88
  42104   156.63 148.80 171.12
# 42104   114.84 109.10 125.47
  42106   201.29 191.23 219.91
# 42106   160.54 152.51 175.39
  42107   368.27 349.86 402.34
# 42107   298.27 283.36 325.86
  42120   819.64 778.66 895.46
  42140   193.46 183.79 211.36
# 42140   131.11 124.55 143.23
  42145   599.89 569.90 655.39
  42160   209.24 198.78 228.60
# 42160   140.28 133.27 153.26
  42180   199.64 189.66 218.11
# 42180   161.68 153.60 176.64
  42182   277.37 263.50 303.03
# 42182   241.15 229.09 263.45
  42200   793.52 753.84 866.92
  42205   831.35 789.78 908.25
  42210   948.17 900.76 1,035.87
  42215   636.78 604.94 695.68
  42220   495.93 471.13 541.80
  42225   902.36 857.24 985.83
  42226   858.29 815.38 937.69
  42227   850.06 807.56 928.69
  42235   687.83 653.44 751.46
  42260   726.28 689.97 793.47
# 42260   612.04 581.44 668.66
  42280   128.55 122.12 140.44
# 42280   95.12 90.36 103.91
  42281   163.95 155.75 179.11
# 42281   133.30 126.64 145.64
  42300   169.62 161.14 185.31
# 42300   131.66 125.08 143.84
  42305   380.78 361.74 416.00
  42310   135.11 128.35 147.60
# 42310   108.99 103.54 119.07
  42320   202.35 192.23 221.06
# 42320   156.03 148.23 170.46
  42330   191.03 181.48 208.70
# 42330   143.31 136.14 156.56
  42335   296.92 282.07 324.38
# 42335   226.92 215.57 247.91
  42340   381.43 362.36 416.71
# 42340   299.59 284.61 327.30
  42400   87.60 83.22 95.70
# 42400   52.07 49.47 56.89
  42405   257.22 244.36 281.01
# 42405   201.50 191.43 220.14
  42408   375.07 356.32 409.77
# 42408   288.70 274.27 315.41
  42409   266.13 252.82 290.74
# 42409   196.82 186.98 215.03
  42410   551.31 523.74 602.30
  42415   1,001.38 951.31 1,094.01
  42420   1,152.11 1,094.50 1,258.68
  42425   758.76 720.82 828.94
  42426   1,231.80 1,170.21 1,345.74
  42440   411.19 390.63 449.22
  42450   374.88 356.14 409.56
# 42450   312.53 296.90 341.44
  42500   357.36 339.49 390.41
# 42500   299.20 284.24 326.88
  42505   471.30 447.74 514.90
# 42505   404.43 384.21 441.84
  42507   444.87 422.63 486.02
  42508   624.27 593.06 682.02
  42509   763.00 724.85 833.58
  42510   557.70 529.82 609.29
  42550   146.26 138.95 159.79
# 42550   58.14 55.23 63.51
  42600   404.94 384.69 442.39
# 42600   313.69 298.01 342.71
  42650   67.27 63.91 73.50
# 42650   51.95 49.35 56.75
  42660   88.64 84.21 96.84
# 42660   69.49 66.02 75.92
  42665   243.46 231.29 265.98
# 42665   180.42 171.40 197.11
  42700   152.71 145.07 166.83
# 42700   117.18 111.32 128.02
  42720   390.40 370.88 426.51
# 42720   350.70 333.17 383.15
  42725   714.41 678.69 780.49
  42800   127.88 121.49 139.71
# 42800   97.92 93.02 106.97
  42802   213.86 203.17 233.65
# 42802   123.30 117.14 134.71
  42804   172.12 163.51 188.04
# 42804   102.47 97.35 111.95
  42806   195.08 185.33 213.13
# 42806   121.24 115.18 132.46
  42808   190.92 181.37 208.58
# 42808   147.39 140.02 161.02
  42809   145.98 138.68 159.48
# 42809   112.19 106.58 122.57
  42810   319.09 303.14 348.61
# 42810   242.12 230.01 264.51
  42815   479.40 455.43 523.74
  42820   258.25 245.34 282.14
  42821   271.16 257.60 296.24
  42825   227.93 216.53 249.01
  42826   223.43 212.26 244.10
  42830   180.10 171.10 196.77
  42831   194.59 184.86 212.59
  42835   164.64 156.41 179.87
  42836   214.65 203.92 234.51
  42842   811.05 770.50 886.08
  42844   1,175.55 1,116.77 1,284.29
  42845   1,926.57 1,830.24 2,104.78
  42860   162.24 154.13 177.25
  42870   490.02 465.52 535.35
  42890   1,162.94 1,104.79 1,270.51
  42892   1,512.60 1,436.97 1,652.52
  42894   1,954.18 1,856.47 2,134.94
  42900   311.33 295.76 340.12
  42950   696.16 661.35 760.55
  42953   905.77 860.48 989.55
  42955   650.14 617.63 710.27
  42960   149.89 142.40 163.76
  42961   371.17 352.61 405.50
  42962   459.71 436.72 502.23
  42970   346.16 328.85 378.18
  42971   405.67 385.39 443.20
  42972   460.28 437.27 502.86

43000 - 43999

NOTE PROCEDURE MOD PAR AMOUNT NON-PAR AMOUNT LIMITING CHARGE
  43020   478.73 454.79 523.01
  43030   467.18 443.82 510.39
  43045   1,172.22 1,113.61 1,280.65
  43100   555.89 528.10 607.32
  43101   906.50 861.18 990.36
  43107   2,252.43 2,139.81 2,460.78
  43108   3,515.49 3,339.72 3,840.68
  43112   2,412.08 2,291.48 2,635.20
  43113   3,470.61 3,297.08 3,791.64
  43116   3,927.63 3,731.25 4,290.94
  43117   2,198.71 2,088.77 2,402.09
  43118   2,928.61 2,782.18 3,199.51
  43121   2,360.77 2,242.73 2,579.14
  43122   2,227.02 2,115.67 2,433.02
  43123   3,524.83 3,348.59 3,850.88
  43124   2,990.91 2,841.36 3,267.56
  43130   701.93 666.83 766.85
  43135   1,246.99 1,184.64 1,362.34
  43200   196.09 186.29 214.23
# 43200   93.70 89.02 102.37
  43201   244.30 232.09 266.90
# 43201   114.04 108.34 124.59
  43202   257.67 244.79 281.51
# 43202   101.30 96.24 110.68
  43204   192.43 182.81 210.23
  43205   193.73 184.04 211.65
  43215   136.72 129.88 149.36
  43216   140.89 133.85 153.93
# 43216   125.22 118.96 136.80
  43217   344.05 326.85 375.88
# 43217   149.01 141.56 162.79
  43219   150.32 142.80 164.22
  43220   111.09 105.54 121.37
  43226   122.69 116.56 134.04
  43227   183.46 174.29 200.43
  43228   193.44 183.77 211.34
  43231   164.03 155.83 179.20
  43232   229.19 217.73 250.39
  43234   255.03 242.28 278.62
# 43234   104.58 99.35 114.25
  43235   267.03 253.68 291.73
# 43235   124.93 118.68 136.48
  43236   330.31 313.79 360.86
# 43236   151.29 143.73 165.29
  43237   207.13 196.77 226.29
  43238   255.26 242.50 278.88
  43239   304.98 289.73 333.19
# 43239   148.26 140.85 161.98
  43240   345.80 328.51 377.79
  43241   134.70 127.97 147.17
  43242   366.15 347.84 400.02
  43243   231.27 219.71 252.67
  43244   255.55 242.77 279.19
  43245   163.36 155.19 178.47
  43246   218.69 207.76 238.92
  43247   173.57 164.89 189.62
  43248   162.86 154.72 177.93
  43249   150.44 142.92 164.36
  43250   164.47 156.25 179.69
  43251   188.86 179.42 206.33
  43255   244.33 232.11 266.93
  43256   220.31 209.29 240.68
  43257   271.91 258.31 297.06
  43258   230.52 218.99 251.84
  43259   261.39 248.32 285.57
  43260   300.33 285.31 328.11
  43261   315.87 300.08 345.09
  43262   370.80 352.26 405.10