SCI-McDuffie Part 5

Effective March 1, 2023

General Outpatient Clinic 51000022 HC ASTHMA/COPD/TB EDUCATION FOLLOWUP $107
General Outpatient Clinic 51000031 HC TRANS CARE MGMT 14 DAY DISCH $216
General Outpatient Clinic 51000032 HC TRANS CARE MGMT 7 DAY DISCH $239
General Outpatient Clinic 51000044 HC CHRNC CARE MGMT SVC 1ST 20 $132
General Outpatient Clinic 51000045 HC CPLX CHRNC CARE 1ST 60 MIN $235
General Outpatient Clinic 51000046 HC CPLX CHRNC CARE EA ADDL 30 $95
MRI 61000059 HC MRI MRA UPPER EXTREMITY WO CONTRAST $3,528
MRI 61000060 HC MRI MRA UPPER EXTREMITY W & WO CONTRAST $3,528
MRI 61000062 HC MRI FETA EA ADD'L GESTATION $491
MRI 61000001 HC MRI TEMPOROMANDIBULAR JOINT $3,525
MRI 61000002 HC MRI MRA BRAIN (COMPONENT) $1,839
MRI 61000004 HC MRI CHEST $3,823
MRI 61000005 HC MRI CHEST WITH CONTRAST(S) $3,883
MRI 61000006 HC MRI CHEST W,W/O CONTRAST(S) $4,502
MRI 61000007 HC MRI CERVICAL W/WO CONTRAST $4,502
MRI 61000008 HC MRI THORACIC W/WO CONTRAST $4,502
MRI 61000009 HC MRI LUMBAR W/WO CONTRAST $4,502
MRI 61000010 HC MRI PELVIS $3,528
MRI 61000011 HC MRI PELVIS/LIMITED BONE $1,839
MRI 61000012 HC MRI PELVIS WITH CONTRAST(S) $4,008
MRI 61000013 HC MRI PELVIS W/WO CONTRAST(S) $4,502
MRI 61000014 HC MRI MRA PELVIS $3,528
MRI 61000015 HC MRI UPPER EXTR.(NO JOINT) $3,525
MRI 61000016 HC MRI UPPER EXTR (NO JOINT) WITH $4,016
MRI 61000017 HC MRI UPPER EXTREMITY $3,525
MRI 61000018 HC MRI UPPER EXTREMITY W/WO CONTR $4,502
MRI 61000019 HC MRI SHOULDER $3,525
MRI 61000020 HC MRI JOINT UPPER EXTREMITY $3,675
MRI 61000021 HC MRI JOINT UPPER EXTREM WITH $4,018
MRI 61000022 HC MRI JOINT UPPER EXT W/WO CONTR $4,502
MRI 61000023 HC MRI MRA UPPER EXTREMITY W CONTRAST $3,528
MRI 61000024 HC MRI LOWER EXTREMITY $3,525
MRI 61000025 HC MRI LOWER EXT (NOT JOINT) WITH $4,016
MRI 61000026 HC MRI LOWER EXTREMITY W/WO CONTR $4,502
MRI 61000027 HC MRI JOINT(S) FOR PROSTH WRKUP $593
MRI 61000028 HC MRI JOINT LOWER EXTREMITY $3,675
MRI 61000028 HC MRI JOINT LOWER EXTREMITY $3,675
MRI 61000029 HC MRI JOINT LOWER EXTREMITY WITH $4,016
MRI 61000030 HC MRI JOINT LOWER EXT W/WO CONTR $4,502
MRI 61000031 HC MRI ABDOMEN KIDNEY SIZE $2,720
MRI 61000032 HC MRI ABDOMEN WITHOUT CONTRAST $3,823
MRI 61000033 HC MRI ABDOMEN WITH CONTRAST $4,016
MRI 61000034 HC MRI ABDOMEN W/WO CONTRAST $4,502
MRI 61000035 HC MRI CARDIAC FOR MORPHOLOGY $3,528
MRI 61000036 HC MRI 3-D RENDERING,AT MODALITY $749
MRI 61000037 HC MRI 3-D RENDERING,REMOTE WKSTN $749
MRI 61000038 HC MRI NOVA QUANT. BLD FLOW $891
MRI 61000038 HC MRI NOVA QUANT. BLD FLOW $891
MRI 61000039 HC MRI GUIDED NEEDLE PLACEMENT $3,528
MRI 61000039 HC MRI GUIDED NEEDLE PLACEMENT $3,528
MRI 61000040 HC MRI BREAST CAD $149
MRI 61000041 HC MRI MRA ABDOMEN WITH CONTRAST $3,528
MRI 61000042 HC MRI MRA ABDOMEN $3,528
MRI 61000043 HC MRI MRA ABDOMEN W/WO CONTRAST $3,528
MRI 61000044 HC MRI BREAST UNILAT W/WO CONTRAS $3,528
MRI 61000045 HC MRI BREAST BILAT W/WO CONTRAST $4,255
MRI 61000046 HC MRI MRA CHEST WITH CONTRAST $3,528
MRI 61000047 HC MRI MRA CHEST $3,528
MRI 61000048 HC MRI MRA CHEST W/WO CONTRAST $3,528
MRI 61000049 HC MRI MRA LOWER EXTREM WITH CONT $3,528
MRI 61000050 HC MRI MRA LOWER EXTREMITY $3,528
MRI 61000051 HC MRI MRA LOWER EXTREM W/WO CONT $3,528
MRI 61000052 HC MRI MRA PELVIS WITH CONTRAST $3,528
MRI 61000053 HC MRI MRA PELVIS WO CONTR $3,528
MRI 61000054 HC MRI MRA PELVIS WITH,W/O CONTR. $3,528
MRI 61000055 HC CARDIAC MRI W/STRESS IMG $3,528
MRI 61000056 HC CARDIAC MRI FOR MORPH W/DYE $3,812
MRI 61000057 HC CARD MRI W/STRESS IMG & DYE $3,812
MRI 61000058 HC MRI FOR TISSUE ABLATION $3,528
MRI 61000061 HC MRI FETAL SINGLE-1ST GESTATION $491
MRI 61000063 HC CARD MRI VELOCITY FLW MAP ADD-ON $3,812
MRI 61000064 HC MR ELASTOGRAPHY $436
MRI 61000064 HC MR ELASTOGRAPHY $436
MRI 61000065 HC MRI BREAST W/O CON - BILATERAL
MRI 61000066 HC MRI BREAST SCREENING - LIMITED W/WO $675
MRI 61000003 HC MRI BRAIN W/WO CONTRAST $4,502
MRI 61100001 HC MRI ORBITS, FACE AND NECK $3,823
MRI 61100002 HC MRI INT AUDITORY CANALS $4,502
MRI 61100003 HC MRI ORBIT,FACE,NECK WITH CONT $3,823
MRI 61100004 HC MRI ORBIT,FACE,NECK W,W/O CONT $4,122
MRI 61100005 HC MRI STEALTH BRAIN PROTOCOL $2,213
MRI 61100006 HC MRI BRAIN WITHOUT CONTRAST $3,675
MRI 61100007 HC MRI BRAIN WITH CONTRAST $3,883
MRI 61100008 HC MRI BRAIN W/WO CONT W/STEALTH PROTOCOL $4,502
MRI 61200001 HC MRI CERVICAL WO,REDUCED SERVIC $1,839
MRI 61200002 HC MRI CERVICAL WITHOUT CONTRAST $3,675
MRI 61200003 HC MRI CERVICAL WITH CONTRAST $3,883
MRI 61200004 HC MRI THORACIC WO,REDUCED SERVIC $1,839
MRI 61200005 HC MRI THORACIC WITHOUT CONTRAST $3,675
MRI 61200006 HC MRI THORACIC WITH CONTRAST $3,883
MRI 61200007 HC MRI LUMBAR WO,REDUCED SERVICE $1,839
MRI 61200008 HC MRI LUMBAR WITHOUT CONTRAST $3,675
MRI 61200009 HC MRI LUMBAR WITH CONTRAST $3,883
MRI 61200010 HC MRI CERVICAL MET W/WO CONTRAST $4,066
MRI 61200011 HC MRI THORACIC MET W/WO CONTRAST $4,066
MRI 61200012 HC MRI LUMBAR MET W/WO CONTRAST $3,908
MRI 61400001 HC MRI BREAST UNILAT WITH CONTRAS $3,528
MRI 61400002 HC MRI BREAST UNILATERAL $3,528
MRI 61400003 HC MRI BREAST BILAT WITH CONTRAST $4,107
MRI 61400004 HC MRI BREAST BILATERAL $4,107
MRI 61500001 HC MRI MRA HEAD LIMITED/COMPONENT $1,839
MRI 61500002 HC MRI MRA HEAD WITHOUT CONTRAST $3,528
MRI 61500003 HC MRI MRA HEAD WITH CONTRAST $3,823
MRI 61500004 HC MRI MRA HEAD WITH,W/O CONTRAST $4,122
MRI 61500005 HC MRI MRA NECK $3,528
MRI 61500006 HC MRI MRA NECK WITH CONTRAST $3,823
MRI 61500007 HC MRI MRA NECK WITH,W/O CONTRAST $4,122
MRI 61800001 HC MRI MRA SPINAL CANAL $3,528
MRI 62100001 HC WIRE BREAST LOCALIZATION MRI $200
Contrast 63600010 HC IOHEXOL (OMNIPAQUE) 300MG IODINE/ML SOLUTION $178
Radiopharm Drug 63600001 HC REGADENOSON 0.1 MG (LEXISCAN) $100
Wound Therapy 63600002 HC APLIGRAF SKIN SUB PER 1 SQ CM $308
Wound Therapy 63600003 HC OASIS SKIN SUB 3X3.5 CM $385
Wound Therapy 63600004 HC OASIS SKIN SUB 3X7 CM $385
Wound Therapy 63600005 HC DERMAGRAFT SKIN SUB PER 1 SQ C $223
Wound Therapy 63600006 HC DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIG $450
Wound Therapy 63600008 HC EPIFIX 1 SQ CM $1,073
Wound Therapy 63600009 HC PURAPLY 2X4 $2,066
Wound Therapy 63600011 HC AMNIO WOUND PER SQ CM $743
Wound Therapy 63600012 HC EPICORD 2X3 $2,260
Wound Therapy 63600013 HC PURAPLY AM 1.6 $2,066
Wound Therapy 63600014 HC PURAPLY AM 2X2 $3,443
Wound Therapy 63600015 HC PURAPLY AM 2X4 $4,361
Wound Therapy 63600016 HC PURAPLY AM 5X5 $5,789
Wound Therapy 63600017 HC PURAPLY AM 6X9 $12,120
Wound Therapy 63600018 HC PURAPLY AM 8X16 $28,854
Wound Therapy 63600019 HC PURAPLY 5X5 $3,443
Wound Therapy 63600020 HC NEOX CORD 1K OR RT 2X1 $1,067
Wound Therapy 63600021 HC NEOX CORD 1K OR RT 2X2 $2,147
Wound Therapy 63600022 HC NEOX CORD 1K OR RT 3X2 $2,161
Wound Therapy 63600023 HC NEOX CORD 1K OR RT 3X3 $2,523
Wound Therapy 63600024 HC NEOX CORD 1K OR RT 4X3 $2,704
Wound Therapy 63600025 HC NEOX CORD 1K OR RT 6X3 $3,609
Wound Therapy 63600026 HC NEOX CORD 1K OR RT 8X3 $5,598
Wound Therapy 63600027 HC EPIFIX 14 MM DISK $807
Wound Therapy 63600028 HC EPIFIX 18 MM DISK $1,850
Wound Therapy 63600029 HC EPIFIX 2X2 $2,565
Wound Therapy 63600030 HC EPIFIX 2X3 $2,070
Wound Therapy 63600031 HC EPIFIX MESH 2X3 $1,990
Wound Therapy 63600032 HC EPIFIX 2X4 $2,325
Wound Therapy 63600033 HC EPIFIX 3X4 $4,140
Wound Therapy 63600034 HC EPIFIX 4X4 $5,237
Wound Therapy 63600035 HC EPIFIX 5X6 $9,759
Wound Therapy 63600036 HC EPIFIX 7X7 $16,327
Wound Therapy 63600037 HC EPIFIX MESH 3.5X3.5 $2,160
Wound Therapy 63600038 HC EPIFIX MESH 4X4.5 $2,341
Wound Therapy 63600039 HC EPIFIX XL 4X10 $6,141
Wound Therapy 63600040 HC EPIFIX XL 6X10 $7,769
Wound Therapy 63600041 HC EPIFIX XL 9X9 $10,900
Wound Therapy 63600042 HC EPIFIX XL 6X16 $14,020
Wound Therapy 63600043 HC EPIFIX XL 9X15 $17,638
Wound Therapy 63600044 HC EPIFIX XL 9X20 $21,156
Wound Therapy 63600045 HC EPICORD 3X5 $5,644
Wound Therapy 63600046 HC PURAPLY AM 4X6 $8,683
Wound Therapy 63600047 HC KYLEENA IUD $1,890
Ortho Clinic 70000001 HC ARM TRACTION $101
Ortho Clinic 70000002 HC BALANCE TRACTION $95
Ortho Clinic 70000003 HC BUCK'S TRACTION $96
Ortho Clinic 70000004 HC CERVICAL TRACTION $73
Ortho Clinic 70000005 HC 90-90 TRACTION $101
Ortho Clinic 70000006 HC SKELETAL TRACTION $126
Wound Therapy 70000007 HC DEBRIDEMENT $24
Post Op 71000027 HC MOR PACU INJECTION IV EACH ADDITIONAL $255
Post Op 71000030 HC WC PACU INJECTION IV EACH ADDITIONAL $255
Post Op 71000001 HC RECOVERY ROOM UP TO 30 MINUTES $539
Post Op 71000002 HC RECOVERY ROOM 30 MINUTES - 1 HOUR $717
Post Op 71000003 HC RECOVERY ROOM 1 HOUR - 1 HOUR 30 MINUTES $905
Post Op 71000004 HC RECOVERY ROOM 1 HOUR 30 MINUTES - 2 HOURS $1,098
Post Op 71000005 HC RECOVERY ROOM 2 HOURS - 2 HOURS 30 MINUTES $1,292
Post Op 71000006 HC RECOVERY ROOM 2 HOURS 30 MINUTES - 3 HOURS $1,476
Post Op 71000007 HC RECOVERY ROOM 3 HOURS - 3 HOURS 30 MINUTES $1,665
Post Op 71000008 HC RECOVERY ROOM 3 HOURS 30 MINUTES - 4 HOURS $1,856
Post Op 71000009 HC RECOVERY ROOM 4 HOURS - 4 HOURS 30 MINUTES $2,044
Post Op 71000010 HC RECOVERY ROOM 4 HOURS 30 MINUTES - 5 HOURS $2,240
Post Op 71000011 HC RECOVERY ROOM 5 HOURS - 5 HOURS 30 MINUTES $2,427
Post Op 71000012 HC RECOVERY ROOM 5 HOURS 30 MINUTES - 6 HOURS $2,614
Post Op 71000013 HC RECOVERY ROOM 6 HOURS - 6 HOURS 30 MINUTES $2,801
Post Op 71000014 HC RECOVERY ROOM 6 HOURS 30 MINUTES - 7 HOURS $2,989
Post Op 71000015 HC RECOVERY ROOM 7 HOURS - 7 HOURS 30 MINUTES $3,179
Post Op 71000016 HC RECOVERY ROOM 7 HOURS 30 MINUTES - 8 HOURS $3,366
Post Op 71000017 HC RECOVERY ROOM 8 HOURS - 8 HOURS 30 MINUTES $3,553
Post Op 71000018 HC RECOVERY ROOM 8 HOURS 30 MINUTES - 9 HOURS $3,579
Post Op 71000019 HC RECOVERY ROOM 9 HOURS - 9 HOURS 30 MINUTES $3,756
Post Op 71000021 HC PHASE II RECOVERY $74
Post Op 71000022 HC INJECTION SC/IM $255
Post Op 71000023 HC INJECTION $255
Post Op 71000025 HC MOR PACU INJECTION SQ/IM $255
Post Op 71000026 HC MOR PACU INJECTION $255
Post Op 71000028 HC WC PACU INJECTION SQ/IM $255
Post Op 71000029 HC WC PACU INJECTION $255
Post Op 71000031 HC PHASE II RECOVERY UP TO 30 MINUTES $270
Post Op 71000032 HC PHASE II RECOVERY 30 MINUTES - 1 HOUR $359
Post Op 71000033 HC PHASE II RECOVERY 1 HOUR - 1 HOUR 30 MINUTES $452
Post Op 71000034 HC PHASE II RECOVERY 1 HOUR 30 MINUTES - 2 HOURS $549
Post Op 71000035 HC PHASE II RECOVERY 2 HOURS - 2 HOUR 30 MINUTES $647
Post Op 71000036 HC PHASE II RECOVERY 2 HOURS 30 MINUTES - 3 HOURS $738
Post Op 71000037 HC PHASE II RECOVERY 3 HOURS - 3 HOURS 30 MINUTES $833
Post Op 71000038 HC PHASE II RECOVERY 3 HOURS 30 MINUTES - 4 HOURS $929
Post Op 71000039 HC PHASE II RECOVERY 4 HOURS - 4 HOURS 30 MINUTES $1,022
Post Op 71000040 HC PHASE II RECOVERY 4 HOURS 30 MINUTES - 5 HOURS $1,121
Post Op 71000041 HC PHASE II RECOVERY 5 HOURS - 5 HOURS 30 MINUTES $1,214
Post Op 71000042 HC PHASE II RECOVERY UP TO 30 MINUTES $270
Post Op 71000043 HC PHASE II RECOVERY 30 MINUTES - 1 HOUR $359
Post Op 71000044 HC PHASE II RECOVERY 1 HOUR - 1 HOUR 30 MINUTES $452
Post Op 71000045 HC PHASE II RECOVERY 1 HOUR 30 MINUTES - 2 HOURS $549
Post Op 71000046 HC PHASE II RECOVERY 2 HOURS - 2 HOUR 30 MINUTES $647
Post Op 71000047 HC PHASE II RECOVERY 2 HOURS 30 MINUTES - 3 HOURS $738
Post Op 71000048 HC PHASE II RECOVERY 3 HOURS - 3 HOURS 30 MINUTES $833
Post Op 71000049 HC PHASE II RECOVERY 3 HOURS 30 MINUTES - 4 HOURS $929
Post Op 71000050 HC PHASE II RECOVERY 4 HOURS - 4 HOURS 30 MINUTES $1,022
Post Op 71000051 HC PHASE II RECOVERY 4 HOURS 30 MINUTES - 5 HOURS $1,121
Post Op 71000052 HC PHASE II RECOVERY 5 HOURS - 5 HOURS 30 MINUTES $1,214
Post Op 71000053 HC RECOVERY ROOM UP TO 30 MINUTES $539
Post Op 71000054 HC RECOVERY ROOM 30 MINUTES - 1 HOUR $717
Post Op 71000055 HC RECOVERY ROOM 1 HOUR - 1 HOUR 30 MINUTES $905
Post Op 71000056 HC RECOVERY ROOM 1 HOUR 30 MINUTES - 2 HOURS $1,098
Post Op 71000057 HC RECOVERY ROOM 2 HOURS - 2 HOURS 30 MINUTES $1,292
Post Op 71000058 HC RECOVERY ROOM 2 HOURS 30 MINUTES - 3 HOURS $1,476
Post Op 71000059 HC RECOVERY ROOM 3 HOURS - 3 HOURS 30 MINUTES $1,665
Post Op 71000060 HC RECOVERY ROOM 3 HOURS 30 MINUTES - 4 HOURS $1,856
Post Op 71000061 HC RECOVERY ROOM 4 HOURS - 4 HOURS 30 MINUTES $2,044
Post Op 71000062 HC RECOVERY ROOM 4 HOURS 30 MINUTES - 5 HOURS $2,240
Post Op 71000063 HC RECOVERY ROOM 5 HOURS - 5 HOURS 30 MINUTES $2,427
Post Op 71000064 HC RECOVERY ROOM 5 HOURS 30 MINUTES - 6 HOURS $2,614
Post Op 71000065 HC RECOVERY ROOM 6 HOURS - 6 HOURS 30 MINUTES $2,801
Post Op 71000066 HC RECOVERY ROOM 6 HOURS 30 MINUTES - 7 HOURS $2,989
Post Op 71000067 HC RECOVERY ROOM 7 HOURS - 7 HOURS 30 MINUTES $3,179
Post Op 71000068 HC RECOVERY ROOM 7 HOURS 30 MINUTES - 8 HOURS $3,366
Post Op 71000069 HC RECOVERY ROOM 8 HOURS - 8 HOURS 30 MINUTES $3,553
Emergency Department 72000011 HC EMERGENCY VAGINAL DELIVERY $1,312
L&D 72000001 HC AMNIOCENTESIS, DIAGNOSTIC $416
L&D 72000002 HC AMNIO-REDUCTION $927
L&D 72000003 HC CORDOCENTESIS $416
L&D 72000004 HC EXT. CEPHALIC VERSION $2,407
L&D 72000005 HC INDUCTION/AUGMENTATION $142
L&D 72000006 HC EPIDURAL INJECTION $467
L&D 72000007 HC DELIVERY LEVEL I $1,312
L&D 72000008 HC DELIVERY LEVEL II $1,949
L&D 72000009 HC DELIVERY LEVEL III $2,277
L&D 72000010 HC DELIVERY LEVEL IV $2,315
L&D Observation 72100001 HC MONITOR FETAL SCALP ELECTRODE $174
L&D Observation 72100002 HC LABOR INTENSIVE MONITOR(PER HR $65
L&D Observation 72100003 HC LBR INTENS MONITOR LVL II $74
L&D Observation 72100004 HC LDR TRIAGE ROOM/TX.ROOM-PER HR $158
L&D Observation 72100005 HC FETAL MONITORING $208
L&D Observation 72100006 HC LB/INTEN MONITOR UP TO 6 HOURS $560
L&D Observation 72100007 HC L/D RECOVERY ROOM/ 1ST HOUR $567
EKG 73000001 HC EKG $354
EKG 73000002 HC EKG WITH TRACING/RHYTHM STRIP $354
EKG 73000003 HC ERGONOVINE TEST $436
EKG 73000004 HC EVENT MONITOR-HOOK UP $227
EKG 73000005 HC SIGNALED AVERAGED EKG $625
EKG 73100001 HC HOLTER MONITOR-24 HOUR $838
EKG 73100002 HC HOLTER MONITOR-48 HOUR $1,094
EKG 73100003 HC SCANNING HOLTER MONITOR $720
EEG 74000008 HC DIGITAL ANALYSIS OF EEG $140
EEG 74000001 HC EEG EXTENDED MONITOR 41-60 MIN $961
EEG 74000002 HC EEG GREATER THAN 1 HOUR $1,154
EEG 74000003 HC EEG AWAKE AND DROWSY $772
EEG 74000004 HC EEG AWAKE AND ASLEEP $772
EEG 74000005 HC SLEEP EEG $983
EEG 74000006 HC DEATH EEG $983
EEG 74000007 HC EEG 24 HOUR MONITORING $1,602
Endoscopy 75000039 HC EGD W/EUS GUIDED TRANS NDL ASPIRAP/BX $1,955
Endoscopy 75000041 HC EGD W/PH MONITORING PLACEMENT $1,316
Endoscopy 75000001 HC CONVERT PERC G-TUBE > J-TUBE $1,503
Endoscopy 75000002 HC PERC GI TUBE PLACEMENT $2,444
Endoscopy 75000003 HC INSERTION OF NASOGASTRIC TUBE $324
Endoscopy 75000004 HC HEMORRHOID BANDING $486
Endoscopy 75000005 HC LARYNGSCOPY $486
Endoscopy 75000006 HC GASTRIC LAVAGE $486
Endoscopy 75000007 HC INSERTION OF CHEST TUBE $512
Endoscopy 75000008 HC PEG TUBE CHANGE/POSITIONING $608
Endoscopy 75000009 HC PROCTOSCOPY $679
Endoscopy 75000010 HC SIGMOIDOSCOPY FLEX NO STENT $1,044
Endoscopy 75000011 HC ESOPHAGEAL DILATION $1,955
Endoscopy 75000012 HC SIGMOIDOSCOPY WITH OTHER PROC $1,270
Endoscopy 75000013 HC SMALL INTESTINAL ENDOSCOPY $1,293
Endoscopy 75000014 HC 24 HOUR PH MONITORING $1,316
Endoscopy 75000015 HC PEG(PERCUTANEOUS ENDO GASTRO) $1,944
Endoscopy 75000016 HC CENTRAL LINE INSERTION $2,149
Endoscopy 75000017 HC ESOPHAGEAL MANOMETRY $2,647
Endoscopy 75000018 HC GASTROSCOPY $2,647
Endoscopy 75000019 HC ANOSCOPY $2,711
Endoscopy 75000021 HC GASTROSCOPY W OTHER PROCEDURE $3,027
Endoscopy 75000024 HC COLONOSCOPY $3,405
Endoscopy 75000025 HC COLONOSCOPY W OTHER PROCEDURE $3,781
Endoscopy 75000026 HC GASTROSCOPY W FLEXIBLE SIGMOID $3,781
Endoscopy 75000027 HC CHOLANGIOSCOPY $3,845
Endoscopy 75000030 HC COLONOSCOPY WITH GASTROSCOPY $4,636
Endoscopy 75000031 HC SIGMOIDOSCOPY FLEX WITH STENT $4,992
Endoscopy 75000036 HC GASTROSCOPY W STENT PLACEMENT $15,100
Endoscopy 75000037 HC ERCP $5,470
Endoscopy 75000038 HC ERCP WITH STENT INSERTION, REPOSITION OR REMOVAL $9,940
Endoscopy 75000040 HC ESOPHAGUS MOTILITY STUDY $722
Endoscopy 75000042 HC GI WIRELESS CAPSULE MEASURE $2,510
Endoscopy 75000043 HC ENDOSCOPY OF BOWEL POUCH $1,342
Endoscopy 75000044 HC ENDOSCOPY OF BOWEL POUCH/BIOP $1,342
Endoscopy 75000045 HC ESOPH IMPED FUNCTION TEST $440
Endoscopy 75000046 HC ESOPH IMPED FUNCT TEST > 1H $792
Endoscopy 75000047 HC SIGMOIDOSCOPY W/ULTRASOUND $1,706
Endoscopy 75000048 HC SIGMOIDOSCOPY W/US GUIDE BX $1,706
Procedurals 76100040 HC NEG PRES WND TX (SNAP) <50 SQ CM $1,218
Procedurals 76100042 HC NEG PRES WND TX (DISPOSABLE) <50 SQ CM $1,384
Procedurals 76100044 HC OUTPATIENT HEMODIALYSIS ACUTE RENAL FAILURE $1,094
Procedurals 76100045 HC THER/PROPH/DIAG INJ, SC/IM $255
Procedurals 76100046 HC INIT THER/PROP/DIAG IV PUSH OP $255
Procedurals 76100047 HC THER/PROPH/DIAG/INJ ADD-ON O/P $255
Procedurals 76100048 HC VENOUS PORT FLUSH $316
Procedurals 76100049 HC ON-BODY INJECTOR APPLY FOR TIMED SQ INJ $255
Procedurals 76100001 HC BLOOD COLLECTION FROM PORT $66
Procedurals 76100003 HC INSERT BLADDER CATHETER $174
Procedurals 76100005 HC CAPSULE ENDOSCOPY COMPLETE $2,059
Procedurals 76100006 HC CAPSULE ENDOSCOPY ESOPHAGEAL $1,924
Procedurals 76100007 HC AGILE PATENCY EXAM $216
Procedurals 76100008 HC EYE EXAM WITH ANES COMPLETE $2,009
Procedurals 76100009 HC OPTHALMIC IMAGE ANTERIOR SEG $92
Procedurals 76100011 HC FUNDUS PHOTOGRAPHY $131
Procedurals 76100012 HC OTOLARYNGOLOGIC EXAM $481
IV Therapy 76100013 HC INJECTION SC/IM $255
IV Therapy 76100014 HC INJECTION IV INITIAL $362
IV Therapy 76100015 HC SECRETIN IV PROCEDURE 1 HOUR $510
IV Therapy 76100016 HC CORTROSYN IV PROCEDURE 1 HOUR $621
IV Therapy 76100017 HC CORTROSYN IV PROCEDURE 2 HOURS $834
IV Therapy 76100018 HC CORTROSYN IV PROCEDURE 3 HOURS $1,131
IV Therapy 76100019 HC INJECTION IV EACH ADDITIONAL DRUG $255
IV Therapy 76100020 HC IRRIGATION VASCULAR ACCESS $316
Procedurals 76100021 HC NSW DEBRIDEM WO A/SESSION $651
Procedurals 76100022 HC NEG PRESS WOUND TX, < 50 CM $753
Procedurals 76100023 HC NEG PRESS WOUND TX, > 50 CM $1,384
Dialysis 76100025 HC OUTPATIENT HEMODIALYSIS ESRD $1,094
Procedurals 76100029 HC PEG TUBE REMOVAL $717
Procedurals 76100030 HC INSULIN CHALLENGE TEST $834
IV Therapy 76100031 HC SECRETIN IV PROCEDURE 2 HOUR $834
IV Therapy 76100032 HC INJECTION IV INITIAL $732
IV Therapy 76100038 HC INJECTION IV INITIAL RADIOPHARMACEUTICAL $255
IV Therapy 76100039 HC IRRIGATION VASCULAR ACCESS $316
Procedurals 76100041 HC NEG PRES WND TX (SNAP) >50 SQ CM $1,218
Procedurals 76100043 HC NEG PRES WND TX (DISPOSABLE) >50 SQ CM $1,384
Lactation Therapy 76100051 HC LACTATION EDUCATION/COUNSELING $143
Lactation Therapy 76100052 HC LACTATION F/U EDUCATION/COUNSELING $143
Observation 76200001 HC OBSERVATION LOW INTENSITY $35
Observation 76200002 HC OBSERVATION HIGH INTENSITY $74
Observation 76200003 HC DIRECT ADMIT OBSERVATION $201
CT Scan 77000001 HC COUNSELING VISIT FOR LUNG CA SCREENING $189
Nutritional Service 94200025 HC IBT (BEHAVIOR COUNSEL OBESITY) 15 MIN AMBULATORY $126
Nutritional Service 94200026 HC IBT (BEHAVIOR COUNSEL OBESITY) GRP 30 MIN AMB $126
Nutritional Service 94200024 HC IBT (BEHAVIOR COUNSEL OBESITY) 15 MIN $126
Vaccine Administration 26000032 HC ADMINISTRATION HEP B VACCINE $255
Vaccine Administration 77100008 HC ADMINISTRATION OF VACCINE $255
Vaccine Administration 77100009 HC ADMINISTRATION OF ADDL VACCINE $255
Vaccine Administration 77100010 HC ADMINISTRATION FLU VACCINE $255
Vaccine Administration 77100011 HC ADMINISTRATION PNEUMONIA VACCINE $255
Vaccine Administration 77100001 HC ADMINISTRATION OF VACCINE $255
Vaccine Administration 77100002 HC ADMINISTRATION OF ADDL VACCINE $255
Vaccine Administration 77100003 HC ADMINISTRATION FLU VACCINE $255
Vaccine Administration 77100004 HC ADMINISTRATION PNEUMONIA VACCINE $255
Vaccine Administration 77100005 HC ADMINISTRATION FLU VACCINE $255
Vaccine Administration 77100006 HC ADMINISTRATION PNEUMONIA VACCINE $255
Vaccine Administration 77100007 HC ADMINISTRATION HEP B VACCINE $255
Vaccine Administration 77100012 HC PFIZER VACCINE ADMIN 1ST DOSE $54
Vaccine Administration 77100013 HC PFIZER VACCINE ADMIN 2ND DOSE $54
Vaccine Administration 77100014 HC MODERNA VACCINE ADMIN 1ST DOSE $54
Vaccine Administration 77100015 HC MODERNA VACCINE ADMIN 2ND DOSE $54
Vaccine Administration 77100016 HC JANSSEN COVID VACCINE ADMIN $54
Vaccine Administration 77100017 HC BAMLANIVIMAB + ESESVIMAB ADMIN $776
Vaccine Administration 77100018 HC CASIRIVI AND IMDEVI INJ ADMIN $776
Vaccine Administration 77100019 HC PFIZER VACCINE ADMIN 3RD DOSE $54
Vaccine Administration 77100020 HC MODERNA VACCINE ADMIN 3RD DOSE $54
Vaccine Administration 77100021 HC SOTROVIMAB INFUSION ADMIN $776
Vaccine Administration 77100022 HC BEBTELOVIMAB INFUSION ADMIN $776
Dialysis 80100001 HC INPATIENT HEMODIALYSIS $1,094
Dialysis 80100002 HC CRRT $1,094
Dialysis 80100003 HC PERITONEAL DIALYSIS (PD) $1,094
ECT 90100001 HC ECT-SINGLE OR MULTIPLE $898
ECT 90100002 HC ECT-MULTIPLE $1,006
Physical Therapy 91700001 HC BIOFEEDBACK TRAINING 1ST 15 MIN $217
Physical Therapy 91700002 HC BFB TRAINING EA ADDL 15 MIN $68
Procedurals 92000001 HC NST $213
Procedurals 92000002 HC SLIT LAMP EXAM $126
Sleep Lab 92000003 HC SLEEP LATENCY TEST $3,875
Sleep Lab 92000004 HC SLEEP APNEA SCREENING (ATTEND) $2,707
Sleep Lab 92000006 HC POLYSOMNOGRAPHY $4,558
Sleep Lab 92000007 HC POLYSOMNOGRAPHY W/CPAP/BIPAP $5,234
Intra-Op 92000008 HC INTRAOP NEUROPHYS MONITORING 15 MIN $198
Neurodiagnostic 92000009 HC GALVANIC SKIN RESPONSE $182
Neurodiagnostic 92000010 HC BLINK REFLEX TEST $86
Neurodiagnostic 92000011 HC NEUROSTIM PROGRAM AND ANALYSIS $203
Vascular Lab 92000012 HC ANALYZE NEUROSTIM COMPLEX $190
Vascular Lab 92100038 HC PERIPH VEN W/REFLUX TEST BILAT $1,544
Vascular Lab 92100039 HC PERIPH VENOUS LIMITED W/WO REFLUX $932
Vascular Lab 92100055 HC ARTERIAL SINGLE LEVEL (ABI) VEIN CTR $502
Vascular Lab 92100001 HC CAROTID DUPLEX IMAGING $1,253
Vascular Lab 92100002 HC CAROTID SCAN - LIMITED STUDY $795
Vascular Lab 92100003 HC TRANSCRANIAL DOPPLER $998
Vascular Lab 92100004 HC TRANSCRANIAL DOPPLER LIMITED $969
Vascular Lab 92100005 HC UPR/L XTREMITY ART 1-2 LEVELS $502
Vascular Lab 92100006 HC UPR/L XTREMITY ART 1-2 LEVELS $614
Vascular Lab 92100007 HC UPR/L XTREMITY ART 3+ LEVELS $834
Vascular Lab 92100008 HC UPR/L XTREMITY ART 3+ LEVELS $834
Vascular Lab 92100009 HC PERIPHERAL ARTERIAL EXERCISE $1,004
Vascular Lab 92100010 HC DUPLEX LOWER EXT ARTERY COMP $878
Vascular Lab 92100011 HC PERIPH ARTER IMAGE/LOWER/LTD $614
Vascular Lab 92100012 HC US LOWER EXTREMITY ARTERY, UNI $844
Vascular Lab 92100013 HC DUPLEX UPPER EXT ARTERY COMP $834
Vascular Lab 92100014 HC US UPPER EXTREMITY ARTERY, BIL $933
Vascular Lab 92100015 HC ARTERIAL IMAGING UPPER LTD $614
Vascular Lab 92100016 HC US UPPER EXTREMITY ARTERY, UNI $867
Vascular Lab 92100018 HC PERIPHERAL VENOUS BILATERAL $1,544
Vascular Lab 92100019 HC PERIPH VEN W/REFLUX TEST BILAT $1,544
Vascular Lab 92100020 HC US EXTREMITY VEINS, UNILATERAL $932
Vascular Lab 92100023 HC US VISCERAL OR SCROTAL VESSELS $691
Vascular Lab 92100024 HC ABDOMINAL DUPLEX COMPLETE $1,125
Vascular Lab 92100025 HC US VISCERAL OR SCROTAL VESSELS $581
Vascular Lab 92100026 HC ABDOMINAL DUPLEX LIMITED $933
Vascular Lab 92100027 HC DPLX AO, IVC, ILIAC OR BPG COM $890
Vascular Lab 92100028 HC DPLX AO, IVC, ILIAC OR BPG LIM $360
Vascular Lab 92100029 HC DUPLEX SCAN-HEMODIALYSIS ACCESS $707
Vascular Lab 92100030 HC ABI SCREENING EXAM $27
Vascular Lab 92100031 HC AAA SCREENING EXAM $54
Vascular Lab 92100032 HC CIMT SCREENING EXAM $122
Vascular Lab 92100033 HC US EXTREMITY VEINS, UNILATERAL $932
Vascular Lab 92100034 HC TCD VASOREACTIVITY STUDY $641
Vascular Lab 92100035 HC TCD EMBOLI DETECT W/O INJ $641
Vascular Lab 92100036 HC TCD EMBOLI DETECT W/INJ $641
Vascular Lab 92100040 HC US DUPLEX ART LOWER EXTREMITY BILAT COMP $878
Vascular Lab 92100041 HC US DUPLEX ART LOWER EXTREMITY LIMITED $844
Vascular Lab 92100042 HC CAROTID DUPLEX IMAGING $1,253
Vascular Lab 92100043 HC DUPLEX LOWER EXT ARTERY COMP $878
Vascular Lab 92100044 HC US EXTREMITY VEINS, UNILATERAL $932
Vascular Lab 92100045 HC DPLX AO, IVC, ILIAC OR BPG LIM $360
Vascular Lab 92100046 HC US DUPLEX ART LOWER EXTREMITY BILAT COMP $878
Vascular Lab 92100047 HC PERIPHERAL VENOUS BILATERAL $1,544
Vascular Lab 92100048 HC PERIPH VENOUS LIMITED W/WO REFLUX (VEIN CTR) $932
Vascular Lab 92100049 HC DUPLEX SCAN-HEMODIALYSIS ACCESS $707
Vascular Lab 92100056 HC ABDOMINAL DUPLEX LIMITED $1,125
Vascular Lab 92100057 HC ABDOMINAL DUPLEX LIMITED $933
Vascular Lab 92100058 HC DUPLEX UPPER EXT ARTERY COMP $834
Vascular Lab 92100059 HC ARTERIAL IMAGING UPPER LTD $614
Neurodiagnostic 92200001 HC FACIAL NERVE-ONE SIDE $473
Neurodiagnostic 92200002 HC FACIAL NERVE-BILATERAL $473
Neurodiagnostic 92200007 HC REPETITIVE STIMULATION $252
Neurodiagnostic 92200008 HC EMG - 1 EXTREMITY $194
Neurodiagnostic 92200009 HC EMG - 2 EXTREMITIES $473
Neurodiagnostic 92200010 HC EMG - 3 EXTREMITIES $961
Neurodiagnostic 92200011 HC EMG - 4 EXTREMITIES $1,126
Neurodiagnostic 92200012 HC MUSC TST DONE W/NERV TST LIM $224
Neurodiagnostic 92200013 HC MUSC TEST DONE W/N TEST COMP $258
Neurodiagnostic 92200014 HC MUSC TST DONE W/N TST NONEXT $224
Neurodiagnostic 92200015 HC EMG LIMITED 1 MUSCLE NONPARASPINAL $96
Neurodiagnostic 92200016 HC NERVE CONDUCTION 3-4 STUDIES $896
Neurodiagnostic 92200017 HC NERVE CONDUCTION 5-6 STUDIES $1,345
Neurodiagnostic 92200018 HC NERVE CONDUCTION 7-8 STUDIES $1,793
Neurodiagnostic 92200019 HC NERVE CONDUCTION 9-10 STUDIES $2,241
Neurodiagnostic 92200020 HC NERVE CONDUCTION 11-12 STUDIES $2,689
Neurodiagnostic 92200021 HC NERVE CONDUCTION 13 OR MORE STUDIES $3,137
Neurodiagnostic 92200022 HC NERVE CONDUCTION 1-2 STUDIES $448
Neurodiagnostic 92200023 HC MOTOR &/SENS NRVE CNDJ TEST $675
Procedurals 92400002 HC ALLERGY TESTING - PERQ OR INTRADERMAL $54
Procedurals 92400001 HC INGESTION CHALLENGE TEST (INITIAL 120 MIN) $840
Procedurals 92900001 HC CST (4S) $213
Nutritional Service 94000001 HC Tube Feeding FOLLOW-UP $53
Nutritional Service 94000002 HC THERAPY MED NUTRITION F/U 15MN 97803 $62
Nutritional Service 94000003 HC NUTRIENT INTAKE ANALYSIS $27
Nutritional Service 94000004 HC NUTRITION ASSESSMENT-LIMITED $46
Nutritional Service 94000005 HC NUTRITION ASSESSMENT-FOLLOW-UP $46
Nutritional Service 94000006 HC NUTRITION ASSESS-COMPREHENSIVE $123
Laboratory 94000007 HC PHLEBOTOMY, THERAPEUTIC $123
Nutritional Service 94000009 HC MNT IP BARIATRIC SURGERY $46
Patient Teaching 94000010 HC GENETIC COUNSELING 30 MIN $216
Nutritional Service 94200021 HC MNT EACH 15 MIN 97802 $62
Nutritional Service 94200022 HC MNT F/U EACH 15 MIN 97803 $62
Nutritional Service 94200023 HC MNT GRP EACH 30 MIN 97804 $62
Nutritional Service 94200001 HC MNT EACH 15 MIN 97802 $62
Nutritional Service 94200002 HC TUBE FEEDING ASSESSMENT $107
Nutritional Service 94200003 HC MNT F/U EACH 15 MIN $62
Nutritional Service 94200004 HC MNT GRP EACH 30 MIN $62
Patient Teaching 94200005 HC PULM EDUCATION READMISSION REDUCTION $230
Patient Teaching 94200006 HC PAT EDUCAT(SPIROM,BREATH,WALK) $242
Patient Teaching 94200007 HC SMOKE/TOBACCO COUNSELING 3-10 $105
Patient Teaching 94200008 HC SMOKE/TOBACCO COUNSEL > 10 MIN $135
Nutritional Service 94200009 HC DIET INSTRUCTION(0-15 MIN) $27
Nutritional Service 94200010 HC DIET INSTRUCTION(16-30 MIN) $53
Nutritional Service 94200011 HC MNT F/U IND EA 15MN $62
Nutritional Service 94200012 HC DIET INSTRUCTION(31-45 MIN) $80
Nutritional Service 94200013 HC DIET INSTRUCTION(46-60 MIN) $99
Patient Teaching 94200014 HC SMOKING CESSATION $105
Nutritional Service 94200016 HC DIET INSTRUCTION(61-75 MIN) $115
Patient Teaching 94200017 HC DIABETES IND TRAINING 30 MIN G0108 $112
Patient Teaching 94200018 HC DIABETES/MNT GRP TRAINING G0109 $57
Patient Teaching 94200018 HC DIABETES/MNT GRP TRAINING G0109 $57
Patient Teaching 94200019 HC GESTATIONAL DIABETES TR 30MIN G0108 $112
Patient Teaching 94200020 HC GESTATIONAL DIABETES CLASS/30M G0109 $57
Patient Teaching 94200027 HC OSTOMY CARE EDUCATION $230
Patient Teaching 94200029 HC GROUP MNT 2 OR MORE 30 MINS $57
Cardiac and Pulmonary Rehab 94300003 HC RT ASSIST COPD EDUCATION $20
Cardiac and Pulmonary Rehab 94300004 HC CARDIAC REHAB II UNMONITORED EXER/EDUC SESSION $324
Cardiac and Pulmonary Rehab 94300005 HC CARDIAC REHAB II UNMONITORED EXER ONLY $324
Cardiac and Pulmonary Rehab 94300001 HC CARDIAC REHAB PHASE II $324
Cardiac and Pulmonary Rehab 94300002 HC CR II MODIFIED $41
Cardiac and Pulmonary Rehab 94300006 HC CARDIAC REHAB PHASE II EDUC/DISCHG PLN/GRAD $324
Cardiac and Pulmonary Rehab 94300007 HC CARDIAC REHAB PHASE II INITIAL EVAL/EDUCATION $324
Cardiac and Pulmonary Rehab 94300008 HC PAD REHAB PER SESSION $324
Cardiac and Pulmonary Rehab 94300009 HC PAD/SET INITIAL EVAL/ORIENTATION $324
Cardiac and Pulmonary Rehab 94300010 HC COM/MM CR PHASE2 EVAL/EDU $324
Cardiac and Pulmonary Rehab 94300011 HC CR II MODIFIED - INITIAL $41
Cardiac and Pulmonary Rehab 94600003 HC SPECIALTY BED-KINETIC CONCEPT $117
Cardiac and Pulmonary Rehab 41000074 HC PULM REHAB COPD EDUC $709
Cardiac and Pulmonary Rehab 94800001 HC PULM REHAB W/O CONT OX MONITORING $709
Cardiac and Pulmonary Rehab 94800002 HC PULM REHAB W CONT OX MONITORING $709
Cardiac and Pulmonary Rehab 94800003 HC PULM REHAB DISCHARGE PLANNING $709
Cardiac and Pulmonary Rehab 94800004 HC PULM REHAB EVALUATION $709
Cardiac and Pulmonary Rehab 94800005 HC PULM REHAB PHASE II EDUC $709
Service Epic CDM Code Epic CDM Description 3/1/2023 Rate
Emergency 45000014 HC ER VISIT LEVEL 1 (McDuffie) $284
Emergency 45000015 HC ER VISIT LEVEL 2 (McDuffie) $448
Emergency 45000016 HC ER VISIT LEVEL 3 (McDuffie) $754
Emergency 45000017 HC ER VISIT LEVEL 4 (McDuffie) $1,344
Emergency 45000018 HC ER VISIT LEVEL 5 (McDuffie) $2,453
Emergency 45000019 HC ER CRITICAL CARE $3,675
Emergency 45000020 HC ER LEVEL VI EA ADD 30 MIN $559