NJ PIP Fee Schedule Exhibit 7: Hospital Outpatient Surgical Facility Fees
Exhibit 7 prices the facility half of a surgical procedure performed in a hospital outpatient surgical facility. Its 1,263 rows carry a North and a South amount for each code, and that amount is the maximum reimbursable to the facility. The surgeon's own service is priced separately, on Exhibit 1.
The schedule001
Exhibit 7 in full, all 1,263 rows
How to read this table
- North, South
- The facility fee, chosen by the region where the service was rendered (11:3-29.4(b)).
- not listed
- The source file leaves the cell empty. 11:3-29.4(a) and 29.4(e) price a service that is not on this schedule, and FAQ Answer 8 confirms the rule puts no restriction on which procedures may be performed in an HOSF. 38 rows are in this state.
- X
- Not subject to multiple procedure reductions, under 11:3-29.5(d)2. 135 rows.
- N1
- Packaged item, no separate payment. The item is paid inside another procedure. 105 rows.
- AS
- Ancillary service, separately payable rather than integral to the surgery. 126 rows.
Category III and HCPCS codes
2 rows| Code | Description | North | South | Flags |
|---|---|---|---|---|
| 0232T | not shown | $182.27 | $156.22 | AS |
| G0289 | ARTHRO, LOOSE BODY + CHONDRO | $0.00 | $0.00 | X N1 |
Surgery, CPT 10000 to 69999
849 rows| Code | North | South | Flags |
|---|---|---|---|
| 10060 | $404.79 | $346.94 | |
| 10061 | $404.79 | $346.94 | |
| 10120 | $741.84 | $635.83 | |
| 10121 | $4,909.21 | $4,207.68 | |
| 10140 | $3,533.67 | $3,028.71 | |
| 10160 | $404.79 | $346.94 | |
| 10180 | $5,485.22 | $4,701.38 | |
| 11000 | $741.84 | $635.83 | |
| 11001 | $247.20 | $211.88 | |
| 11010 | $1,381.84 | $1,184.38 | |
| 11011 | $1,381.84 | $1,184.38 | |
| 11012 | $1,381.84 | $1,184.38 | |
| 11042 | $741.84 | $635.83 | |
| 11043 | $741.84 | $635.83 | |
| 11044 | $2,306.26 | $1,976.70 | |
| 11045 | $741.84 | $635.83 | |
| 11046 | $741.84 | $635.83 | |
| 11047 | $2,306.26 | $1,976.70 | |
| 11055 | $247.20 | $211.88 | |
| 11056 | $247.20 | $211.88 | |
| 11057 | $247.20 | $211.88 | |
| 11100 | $406.64 | $348.53 | |
| 11101 | $247.20 | $211.88 | |
| 11200 | $247.20 | $211.88 | |
| 11300 | $247.20 | $211.88 | |
| 11301 | $247.20 | $211.88 | |
| 11302 | $247.20 | $211.88 | |
| 11305 | $247.20 | $211.88 | |
| 11306 | $247.20 | $211.88 | |
| 11310 | $247.20 | $211.88 | |
| 11311 | $247.20 | $211.88 | |
| 11400 | $1,381.84 | $1,184.38 | |
| 11401 | $1,381.84 | $1,184.38 | |
| 11402 | $1,381.84 | $1,184.38 | |
| 11403 | $2,306.26 | $1,976.70 | |
| 11404 | $4,909.21 | $4,042.57 | |
| 11406 | $4,909.21 | $4,042.57 | |
| 11420 | $2,306.26 | $1,976.70 | |
| 11421 | $2,306.26 | $1,976.70 | |
| 11422 | $2,306.26 | $1,976.70 | |
| 11423 | $4,909.21 | $4,207.68 | |
| 11424 | $4,909.21 | $4,207.68 | |
| 11426 | $6,489.68 | $5,562.30 | |
| 11440 | $1,381.84 | $1,184.38 | |
| 11441 | $1,381.84 | $1,184.38 | |
| 11442 | $2,306.26 | $1,976.70 | |
| 11443 | $2,306.26 | $1,976.70 | |
| 11444 | $2,306.26 | $1,976.70 | |
| 11719 | $117.49 | $100.70 | |
| 11720 | $247.20 | $211.88 | |
| 11721 | $247.20 | $211.88 | |
| 11730 | $247.20 | $211.88 | |
| 11732 | $247.20 | $211.88 | |
| 11740 | $117.49 | $100.70 | |
| 11750 | $1,381.84 | $1,184.38 | |
| 11752 | $6,489.68 | $5,562.30 | |
| 11760 | $361.97 | $310.24 | |
| 11762 | $4,673.83 | $4,005.94 | |
| 11765 | $247.20 | $211.88 | |
| 11900 | $247.20 | $211.88 | |
| 11901 | $247.20 | $211.88 | |
| 11950 | $361.97 | $310.24 | |
| 11951 | $361.97 | $310.24 | |
| 11960 | $6,050.71 | $5,186.06 | |
| 11981 | $182.27 | $156.22 | AS |
| 11982 | $182.27 | $156.22 | AS |
| 12001 | $361.97 | $310.24 | |
| 12002 | $361.97 | $310.24 | |
| 12004 | $361.97 | $310.24 | |
| 12005 | $361.97 | $310.24 | |
| 12006 | $361.97 | $310.24 | |
| 12011 | $361.97 | $310.24 | |
| 12013 | $361.97 | $310.24 | |
| 12014 | $361.97 | $310.24 | |
| 12015 | $361.97 | $310.24 | |
| 12016 | $361.97 | $310.24 | |
| 12017 | $361.97 | $310.24 | |
| 12018 | $361.97 | $310.24 | |
| 12020 | $1,260.61 | $1,080.47 | |
| 12021 | $858.58 | $735.89 | |
| 12031 | $361.97 | $310.24 | |
| 12032 | $858.58 | $735.89 | |
| 12034 | $361.97 | $310.24 | |
| 12035 | $361.97 | $310.24 | |
| 12036 | $858.58 | $735.89 | |
| 12037 | $858.58 | $735.89 | |
| 12041 | $361.97 | $310.24 | |
| 12042 | $361.97 | $310.24 | |
| 12044 | $361.97 | $310.24 | |
| 12045 | $858.58 | $735.89 | |
| 12046 | $858.58 | $735.89 | |
| 12047 | $858.58 | $735.89 | |
| 12051 | $858.58 | $735.89 | |
| 12052 | $361.97 | $310.24 | |
| 12053 | $361.97 | $310.24 | |
| 12054 | $361.97 | $310.24 | |
| 12055 | $858.58 | $735.89 | |
| 12056 | $858.58 | $735.89 | |
| 12057 | $858.58 | $735.89 | |
| 13100 | $1,260.61 | $1,080.47 | |
| 13101 | $1,260.61 | $1,080.47 | |
| 13102 | $1,260.61 | $1,080.47 | |
| 13120 | $858.58 | $735.89 | |
| 13121 | $858.58 | $735.89 | |
| 13122 | $361.97 | $310.24 | |
| 13131 | $858.58 | $735.89 | |
| 13132 | $1,260.61 | $1,080.47 | |
| 13133 | $858.58 | $735.89 | |
| 13150 | $1,260.61 | $1,080.47 | |
| 13151 | $1,260.61 | $1,080.47 | |
| 13152 | $1,260.61 | $1,080.47 | |
| 13153 | $858.58 | $735.89 | |
| 13160 | $6,050.71 | $5,186.06 | |
| 14000 | $4,673.83 | $4,005.94 | |
| 14001 | $4,673.83 | $4,005.94 | |
| 14020 | $4,673.83 | $4,005.94 | |
| 14021 | $4,673.83 | $4,005.94 | |
| 14040 | $4,673.83 | $4,005.94 | |
| 14041 | $4,673.83 | $4,005.94 | |
| 14060 | $4,673.83 | $4,005.94 | |
| 14061 | $4,673.83 | $4,005.94 | |
| 14301 | $6,050.71 | $5,186.06 | |
| 14302 | $6,050.71 | $5,186.06 | |
| 15002 | $1,260.61 | $1,080.47 | |
| 15003 | $1,260.61 | $1,080.47 | |
| 15004 | $1,260.61 | $1,080.47 | |
| 15005 | $1,260.61 | $1,080.47 | |
| 15050 | $1,260.61 | $1,080.47 | |
| 15100 | $6,050.71 | $5,186.06 | |
| 15101 | $6,050.71 | $5,186.06 | |
| 15120 | $6,050.71 | $5,186.06 | |
| 15121 | $6,050.71 | $5,186.06 | |
| 15130 | $4,673.83 | $4,005.94 | |
| 15170 | $1,260.61 | $1,080.47 | |
| 15171 | $858.58 | $735.89 | |
| 15175 | $1,260.61 | $1,080.47 | |
| 15220 | $4,673.83 | $4,005.94 | |
| 15221 | $1,260.61 | $1,080.47 | |
| 15240 | $4,673.83 | $4,005.94 | |
| 15241 | $1,260.61 | $1,080.47 | |
| 15260 | $4,673.83 | $4,005.94 | |
| 15330 | $1,260.61 | $1,080.47 | |
| 15331 | $1,260.61 | $1,080.47 | |
| 15340 | $858.58 | $735.89 | |
| 15341 | $858.58 | $735.89 | |
| 15365 | $858.58 | $735.89 | |
| 15366 | $858.58 | $735.89 | |
| 15430 | $1,260.61 | $1,080.47 | |
| 15431 | $1,260.61 | $1,080.47 | |
| 15570 | $6,050.71 | $5,186.06 | |
| 15572 | $6,050.71 | $5,186.06 | |
| 15574 | $6,050.71 | $5,186.06 | |
| 15576 | $6,050.71 | $5,186.06 | |
| 15620 | $6,050.71 | $5,186.06 | |
| 15732 | $6,050.71 | $5,186.06 | |
| 15734 | $6,050.71 | $5,186.06 | |
| 15736 | $6,050.71 | $5,186.06 | |
| 15738 | $6,050.71 | $5,186.06 | |
| 15770 | $6,050.71 | $5,186.06 | |
| 15780 | $6,489.68 | $5,562.30 | |
| 15781 | $1,381.84 | $1,184.38 | |
| 15782 | $1,381.84 | $1,184.38 | |
| 15786 | $247.20 | $211.88 | |
| 15787 | $247.20 | $211.88 | |
| 15823 | $6,050.71 | $5,186.06 | |
| 15830 | $6,489.68 | $5,562.30 | |
| 15832 | $6,489.68 | $5,562.30 | |
| 15851 | $741.84 | $635.83 | |
| 15852 | $182.27 | $156.22 | AS |
| 15940 | $6,489.68 | $5,562.30 | |
| 15941 | $6,489.68 | $5,562.30 | |
| 15944 | $6,050.71 | $5,186.06 | |
| 15945 | $6,050.71 | $5,186.06 | |
| 15946 | $6,050.71 | $5,186.06 | |
| 15950 | $6,489.68 | $5,562.30 | |
| 15951 | $6,489.68 | $5,562.30 | |
| 15952 | $4,673.83 | $4,005.94 | |
| 15953 | $4,673.83 | $4,005.94 | |
| 15956 | $4,673.83 | $4,005.94 | |
| 15958 | $4,673.83 | $4,005.94 | |
| 16000 | $247.20 | $211.88 | |
| 16020 | $406.64 | $348.53 | |
| 16025 | $406.64 | $348.53 | |
| 16030 | $406.64 | $348.53 | |
| 17000 | $247.20 | $211.88 | |
| 17003 | $117.49 | $100.70 | |
| 17004 | $741.84 | $635.83 | |
| 17106 | $741.84 | $635.83 | |
| 17107 | $741.84 | $635.83 | |
| 17108 | $741.84 | $635.83 | |
| 17110 | $247.20 | $211.88 | |
| 17111 | $406.64 | $348.53 | |
| 17250 | $406.64 | $348.53 | |
| 17261 | $406.64 | $348.53 | |
| 17262 | $406.64 | $348.53 | |
| 19000 | $1,244.88 | $1,066.98 | |
| 19120 | $6,949.27 | $5,956.21 | |
| 19125 | $6,949.27 | $5,956.21 | |
| 19290 | $0.00 | $0.00 | N1 |
| 20100 | $2,150.53 | $1,843.22 | |
| 20101 | $6,050.71 | $5,186.06 | |
| 20102 | $6,050.71 | $5,186.06 | |
| 20103 | $3,533.67 | $3,028.71 | |
| 20520 | $6,238.69 | $5,347.18 | |
| 20525 | $6,489.68 | $5,562.30 | |
| 20526 | $724.57 | $621.03 | |
| 20550 | $724.57 | $621.03 | |
| 20551 | $724.57 | $621.03 | |
| 20552 | $724.57 | $621.03 | |
| 20553 | $724.57 | $621.03 | |
| 20600 | $724.57 | $621.03 | |
| 20605 | $724.57 | $621.03 | |
| 20610 | $724.57 | $621.03 | |
| 20612 | $724.57 | $621.03 | |
| 20615 | $1,244.88 | $1,066.98 | |
| 20650 | $6,238.69 | $5,347.18 | |
| 20660 | $1,494.88 | $1,281.26 | |
| 20662 | $6,238.69 | $5,347.18 | |
| 20663 | $6,238.69 | $5,347.18 | |
| 20665 | $182.27 | $156.22 | AS |
| 20670 | $4,909.21 | $4,207.68 | |
| 20680 | $6,489.68 | $5,562.30 | |
| 20690 | $8,755.84 | $7,504.63 | |
| 20692 | $8,755.84 | $7,504.63 | |
| 20693 | $6,238.69 | $5,347.18 | |
| 20694 | $6,238.69 | $5,347.18 | |
| 20696 | $8,755.84 | $7,504.63 | |
| 20697 | $5,657.91 | $4,849.39 | |
| 20900 | $8,755.84 | $7,504.63 | |
| 20902 | $8,755.84 | $7,504.63 | |
| 20910 | $6,050.71 | $5,186.06 | |
| 20912 | $6,050.71 | $5,186.06 | |
| 20920 | $4,673.83 | $4,005.94 | |
| 20922 | $4,673.83 | $4,005.94 | |
| 20924 | $8,755.84 | $7,504.63 | |
| 20926 | $1,260.61 | $1,080.47 | |
| 20950 | $404.79 | $346.94 | |
| 20975 | $0.00 | $0.00 | N1 |
| 20979 | $182.27 | $156.22 | AS |
| 20985 | $0.00 | $0.00 | N1 |
| 21060 | $12,135.56 | $10,401.38 | |
| 21070 | $12,135.56 | $10,401.38 | |
| 21073 | $2,150.53 | $1,843.22 | |
| 21085 | $4,708.37 | $4,035.54 | |
| 21110 | $2,150.53 | $1,843.22 | |
| 21116 | $0.00 | $0.00 | N1 |
| 21209 | $12,135.56 | $10,401.38 | |
| 21210 | $12,135.56 | $10,401.38 | |
| 21240 | $12,135.56 | $10,401.38 | |
| 21242 | $12,135.56 | $10,401.38 | |
| 21243 | $12,135.56 | $10,401.38 | |
| 21244 | $12,135.56 | $10,401.38 | |
| 21245 | $12,135.56 | $10,401.38 | |
| 21246 | $12,135.56 | $10,401.38 | |
| 21248 | $12,135.56 | $10,401.38 | |
| 21249 | $12,135.56 | $10,401.38 | |
| 21310 | $307.68 | $263.71 | |
| 21315 | $4,708.37 | $4,035.54 | |
| 21320 | $4,708.37 | $4,035.54 | |
| 21325 | $6,964.52 | $5,969.29 | |
| 21330 | $6,964.52 | $5,969.29 | |
| 21335 | $6,964.52 | $5,969.29 | |
| 21356 | $6,964.52 | $5,969.29 | |
| 21360 | $6,964.52 | $5,969.29 | |
| 21365 | $12,135.56 | $10,401.38 | |
| 21385 | $12,135.56 | $10,401.38 | |
| 21386 | $12,135.56 | $10,401.38 | |
| 21390 | $12,135.56 | $10,401.38 | |
| 21395 | $12,135.56 | $10,401.38 | |
| 21400 | $2,150.53 | $1,843.22 | |
| 21401 | $4,708.37 | $4,035.54 | |
| 21406 | $12,135.56 | $10,401.38 | |
| 21407 | $12,135.56 | $10,401.38 | |
| 21408 | $12,135.56 | $10,401.38 | |
| 21450 | $965.03 | $827.13 | |
| 21451 | $2,150.53 | $1,843.22 | |
| 21452 | $4,708.37 | $4,035.54 | |
| 21453 | $12,135.56 | $10,401.38 | |
| 21454 | $6,964.52 | $5,969.29 | |
| 21461 | $12,135.56 | $10,401.38 | |
| 21462 | $12,135.56 | $10,401.38 | |
| 21465 | $12,135.56 | $10,401.38 | |
| 21470 | $12,135.56 | $10,401.38 | |
| 21800 | $428.68 | $367.42 | |
| 21820 | $428.68 | $367.42 | |
| 22222 | $13,940.72 | $11,948.58 | |
| 22305 | $428.68 | $367.42 | |
| 22310 | $1,494.88 | $1,281.26 | |
| 22315 | $5,657.91 | $4,849.39 | |
| 22505 | $4,222.92 | $3,619.46 | |
| 22520 | $8,755.84 | $7,504.63 | |
| 22521 | $8,755.84 | $7,504.63 | |
| 22522 | $8,755.84 | $7,504.63 | |
| 22612 | $13,940.72 | $11,948.58 | |
| 22614 | $13,940.72 | $11,948.58 | |
| 22851 | $6,238.69 | $5,347.18 | |
| 23120 | $8,755.84 | $7,504.63 | |
| 23125 | $8,755.84 | $7,504.63 | |
| 23130 | $12,850.12 | $11,013.83 | |
| 23331 | $6,489.68 | $5,562.30 | |
| 23350 | $0.00 | $0.00 | N1 |
| 23405 | $8,755.84 | $7,504.63 | |
| 23406 | $8,755.84 | $7,504.63 | |
| 23410 | $12,850.12 | $11,013.83 | |
| 23412 | $12,850.12 | $11,013.83 | |
| 23415 | $12,850.12 | $11,013.83 | |
| 23420 | $12,850.12 | $11,013.83 | |
| 23430 | $12,850.12 | $11,013.83 | |
| 23440 | $12,850.12 | $11,013.83 | |
| 23470 | $19,460.64 | $17,581.99 | |
| 23480 | $12,850.12 | $11,013.83 | |
| 23485 | $24,164.43 | $20,711.32 | |
| 23500 | $428.68 | $367.42 | |
| 23505 | $5,657.91 | $4,849.39 | |
| 23515 | $18,168.29 | $15,572.03 | |
| 23520 | $1,494.88 | $1,281.26 | |
| 23525 | $1,494.88 | $1,281.26 | |
| 23530 | $13,070.23 | $11,202.49 | |
| 23540 | $428.68 | $367.42 | |
| 23545 | $1,494.88 | $1,281.26 | |
| 23550 | $13,070.23 | $11,202.49 | |
| 23552 | $13,070.23 | $11,202.49 | |
| 23570 | $428.68 | $367.42 | |
| 23600 | $428.68 | $367.42 | |
| 23605 | $5,657.91 | $4,849.39 | |
| 23615 | $18,168.29 | $15,572.03 | |
| 23616 | $18,168.29 | $15,572.03 | |
| 23620 | $428.68 | $367.42 | |
| 23625 | $5,657.91 | $4,849.39 | |
| 23630 | $18,168.29 | $15,572.03 | |
| 23650 | $428.68 | $367.42 | |
| 23655 | $4,222.92 | $3,619.46 | |
| 23700 | $4,222.92 | $3,619.46 | |
| 24220 | $0.00 | $0.00 | N1 |
| 24300 | $4,222.92 | $3,619.46 | |
| 24305 | $8,755.84 | $7,504.63 | |
| 24340 | $12,850.12 | $11,013.83 | |
| 24341 | $12,850.12 | $11,013.83 | |
| 24342 | $12,850.12 | $11,013.83 | |
| 24343 | $8,755.84 | $7,504.63 | |
| 24500 | $428.68 | $367.42 | |
| 24505 | $428.68 | $367.42 | |
| 24515 | $18,168.29 | $15,572.03 | |
| 24516 | $18,168.29 | $15,572.03 | |
| 24530 | $428.68 | $367.42 | |
| 24535 | $1,494.88 | $1,281.26 | |
| 24545 | $18,168.29 | $15,572.03 | |
| 24546 | $18,168.29 | $15,572.03 | |
| 24560 | $428.68 | $367.42 | |
| 24565 | $428.68 | $367.42 | |
| 24575 | $18,168.29 | $15,572.03 | |
| 24576 | $428.68 | $367.42 | |
| 24577 | $428.68 | $367.42 | |
| 24579 | $18,168.29 | $15,572.03 | |
| 25000 | $6,238.69 | $5,347.18 | |
| 25001 | $6,238.69 | $5,347.18 | |
| 25020 | $8,755.84 | $7,504.63 | |
| 25023 | $8,755.84 | $7,504.63 | |
| 25024 | $8,755.84 | $7,504.63 | |
| 25025 | $8,755.84 | $7,504.63 | |
| 25118 | $8,755.84 | $7,504.63 | |
| 25215 | $8,755.84 | $7,504.63 | |
| 25246 | $0.00 | $0.00 | N1 |
| 25259 | $5,657.91 | $4,849.39 | |
| 25260 | $8,755.84 | $7,504.63 | |
| 25263 | $8,755.84 | $7,504.63 | |
| 25265 | $8,755.84 | $7,504.63 | |
| 25270 | $8,755.84 | $7,504.63 | |
| 25272 | $8,755.84 | $7,504.63 | |
| 25274 | $8,755.84 | $7,504.63 | |
| 25295 | $6,238.69 | $5,347.18 | |
| 25500 | $428.68 | $367.42 | |
| 25505 | $1,494.88 | $1,281.26 | |
| 25515 | $13,070.23 | $11,202.49 | |
| 25525 | $13,070.23 | $11,202.49 | |
| 25526 | $13,070.23 | $11,202.49 | |
| 25530 | $428.68 | $367.42 | |
| 25535 | $428.68 | $367.42 | |
| 25545 | $13,070.23 | $11,202.49 | |
| 25560 | $428.68 | $367.42 | |
| 25565 | $1,494.88 | $1,281.26 | |
| 25574 | $18,168.29 | $15,572.03 | |
| 25575 | $18,168.29 | $15,572.03 | |
| 25600 | $428.68 | $367.42 | |
| 25605 | $1,494.88 | $1,281.26 | |
| 25606 | $7,210.82 | $6,180.39 | |
| 25607 | $18,168.29 | $15,572.03 | |
| 25608 | $18,168.29 | $15,572.03 | |
| 25609 | $18,168.29 | $15,572.03 | |
| 25622 | $428.68 | $367.42 | |
| 25624 | $1,494.88 | $1,281.26 | |
| 25628 | $13,070.23 | $11,202.49 | |
| 25630 | $428.68 | $367.42 | |
| 25635 | $428.68 | $367.42 | |
| 25645 | $13,070.23 | $11,202.49 | |
| 25650 | $428.68 | $367.42 | |
| 25652 | $13,070.23 | $11,202.49 | |
| 25670 | $7,210.82 | $6,180.39 | |
| 25671 | $7,210.82 | $6,180.39 | |
| 25676 | $7,210.82 | $6,180.39 | |
| 25680 | $428.68 | $367.42 | |
| 25685 | $7,210.82 | $6,180.39 | |
| 26055 | $4,660.94 | $3,994.89 | |
| 26116 | $4,909.21 | $4,207.68 | |
| 26140 | $4,660.94 | $3,994.89 | |
| 26145 | $4,660.94 | $3,994.89 | |
| 26340 | $1,494.88 | $1,281.26 | |
| 26410 | $4,660.94 | $3,994.89 | |
| 26418 | $4,660.94 | $3,994.89 | |
| 26445 | $4,660.94 | $3,994.89 | |
| 26480 | $8,083.67 | $6,928.51 | |
| 26525 | $4,660.94 | $3,994.89 | |
| 26540 | $4,660.94 | $3,994.89 | |
| 26600 | $428.68 | $367.42 | |
| 26605 | $428.68 | $367.42 | |
| 26607 | $5,657.91 | $4,849.39 | |
| 26608 | $7,210.82 | $6,180.39 | |
| 26615 | $13,070.23 | $11,202.49 | |
| 26720 | $428.68 | $367.42 | |
| 26725 | $428.68 | $367.42 | |
| 26727 | $7,210.82 | $6,180.39 | |
| 26735 | $7,210.82 | $6,180.39 | |
| 26740 | $428.68 | $367.42 | |
| 26742 | $428.68 | $367.42 | |
| 26746 | $7,210.82 | $6,180.39 | |
| 26750 | $428.68 | $367.42 | |
| 26755 | $428.68 | $367.42 | |
| 27093 | $0.00 | $0.00 | N1 |
| 27095 | $0.00 | $0.00 | N1 |
| 27193 | $428.68 | $367.42 | |
| 27194 | $4,222.92 | $3,619.46 | |
| 27275 | $4,222.92 | $3,619.46 | |
| 27403 | $8,755.84 | $7,504.63 | |
| 27405 | $12,850.12 | $11,013.83 | |
| 27420 | $12,850.12 | $11,013.83 | |
| 27422 | $12,850.12 | $11,013.83 | |
| 27424 | $12,850.12 | $11,013.83 | |
| 27500 | $1,494.88 | $1,281.26 | |
| 27501 | $428.68 | $367.42 | |
| 27502 | $5,657.91 | $4,849.39 | |
| 27503 | $428.68 | $367.42 | |
| 27508 | $428.68 | $367.42 | |
| 27509 | $7,210.82 | $6,180.39 | |
| 27510 | $1,494.88 | $1,281.26 | |
| 27520 | $428.68 | $367.42 | |
| 27524 | $13,070.23 | $11,202.49 | |
| 27530 | $428.68 | $367.42 | |
| 27532 | $5,657.91 | $4,849.39 | |
| 27538 | $428.68 | $367.42 | |
| 27570 | $4,222.92 | $3,619.46 | |
| 27685 | $8,755.84 | $7,504.63 | |
| 27686 | $8,755.84 | $7,504.63 | |
| 27690 | $12,850.12 | $11,013.83 | |
| 27691 | $12,850.12 | $11,013.83 | |
| 27692 | $12,850.12 | $11,013.83 | |
| 27695 | $8,755.84 | $7,504.63 | |
| 27696 | $8,755.84 | $7,504.63 | |
| 27698 | $8,755.84 | $7,504.63 | |
| 27750 | $428.68 | $367.42 | |
| 27752 | $5,657.91 | $4,849.39 | |
| 27758 | $13,070.23 | $11,202.49 | |
| 27759 | $18,168.29 | $15,572.03 | |
| 27760 | $428.68 | $367.42 | |
| 27762 | $5,657.91 | $4,849.39 | |
| 27766 | $13,070.23 | $11,202.49 | |
| 27786 | $428.68 | $367.42 | |
| 27788 | $428.68 | $367.42 | |
| 27792 | $13,070.23 | $11,202.49 | |
| 27808 | $428.68 | $367.42 | |
| 27810 | $428.68 | $367.42 | |
| 27814 | $13,070.23 | $11,202.49 | |
| 27816 | $428.68 | $367.42 | |
| 27818 | $1,494.88 | $1,281.26 | |
| 27822 | $13,070.23 | $11,202.49 | |
| 27823 | $18,168.29 | $15,572.03 | |
| 27824 | $428.68 | $367.42 | |
| 27825 | $5,657.91 | $4,849.39 | |
| 27826 | $13,070.23 | $11,202.49 | |
| 27827 | $18,168.29 | $15,572.03 | |
| 27828 | $18,168.29 | $15,572.03 | |
| 27829 | $13,070.23 | $11,202.49 | |
| 27840 | $428.68 | $367.42 | |
| 27842 | $4,222.92 | $3,619.46 | |
| 27846 | $13,070.23 | $11,202.49 | |
| 27848 | $13,070.23 | $11,202.49 | |
| 27860 | $4,222.92 | $3,619.46 | |
| 28120 | $6,135.71 | $5,258.91 | |
| 28122 | $6,135.71 | $5,258.91 | |
| 28400 | $428.68 | $367.42 | |
| 28405 | $5,657.91 | $4,849.39 | |
| 28415 | $18,168.29 | $15,572.03 | |
| 28420 | $13,070.23 | $11,202.49 | |
| 28430 | $428.68 | $367.42 | |
| 28435 | $428.68 | $367.42 | |
| 28436 | $7,210.82 | $6,180.39 | |
| 28445 | $13,070.23 | $11,202.49 | |
| 28470 | $428.68 | $367.42 | |
| 28475 | $428.68 | $367.42 | |
| 28476 | $7,210.82 | $6,180.39 | |
| 28485 | $13,070.23 | $11,202.49 | |
| 28725 | $15,005.30 | $12,861.03 | |
| 28730 | $15,005.30 | $12,861.03 | |
| 28740 | $15,005.30 | $12,861.03 | |
| 28750 | $15,005.30 | $12,861.03 | |
| 29065 | $691.49 | $592.68 | X |
| 29075 | $691.49 | $592.68 | X |
| 29085 | $304.17 | $260.71 | X |
| 29086 | $304.17 | $260.71 | X |
| 29105 | $304.17 | $260.71 | X |
| 29125 | $304.17 | $260.71 | X |
| 29126 | $304.17 | $260.71 | X |
| 29130 | $304.17 | $260.71 | X |
| 29131 | $304.17 | $260.71 | X |
| 29200 | $304.17 | $260.71 | X |
| 29240 | $304.17 | $260.71 | X |
| 29260 | $304.17 | $260.71 | X |
| 29280 | $304.17 | $260.71 | X |
| 29345 | $691.49 | $592.68 | X |
| 29355 | $691.49 | $592.68 | X |
| 29365 | $691.49 | $592.68 | X |
| 29405 | $691.49 | $592.68 | X |
| 29425 | $691.49 | $592.68 | X |
| 29450 | $304.17 | $260.71 | X |
| 29505 | $304.17 | $260.71 | X |
| 29515 | $304.17 | $260.71 | X |
| 29520 | $304.17 | $260.71 | X |
| 29530 | $304.17 | $260.71 | X |
| 29540 | $304.17 | $260.71 | X |
| 29550 | $304.17 | $260.71 | X |
| 29580 | $304.17 | $260.71 | X |
| 29581 | $304.17 | $260.71 | X |
| 29590 | $304.17 | $260.71 | X |
| 29700 | $304.17 | $260.71 | X |
| 29705 | $304.17 | $260.71 | X |
| 29710 | $691.49 | $592.68 | X |
| 29740 | $304.17 | $260.71 | X |
| 29800 | $8,137.61 | $6,974.74 | |
| 29804 | $8,137.61 | $6,974.74 | |
| 29805 | $8,137.61 | $6,974.74 | |
| 29806 | $13,154.68 | $11,274.87 | |
| 29807 | $13,154.68 | $11,274.87 | |
| 29819 | $13,154.68 | $11,274.87 | |
| 29820 | $13,154.68 | $11,274.87 | |
| 29821 | $13,154.68 | $11,274.87 | |
| 29822 | $8,137.61 | $6,974.74 | |
| 29823 | $13,154.68 | $11,274.87 | |
| 29824 | $8,137.61 | $6,974.74 | |
| 29825 | $13,154.68 | $11,274.87 | |
| 29826 | $13,154.68 | $11,274.87 | |
| 29827 | $13,154.68 | $11,274.87 | |
| 29828 | $13,154.68 | $11,274.87 | |
| 29830 | $8,137.61 | $6,974.74 | |
| 29834 | $8,137.61 | $6,974.74 | |
| 29835 | $8,137.61 | $6,974.74 | |
| 29837 | $8,137.61 | $6,974.74 | |
| 29840 | $8,137.61 | $6,974.74 | |
| 29844 | $8,137.61 | $6,974.74 | |
| 29845 | $8,137.61 | $6,974.74 | |
| 29846 | $8,137.61 | $6,974.74 | |
| 29847 | $13,154.68 | $11,274.87 | |
| 29848 | $8,137.61 | $6,974.74 | |
| 29850 | $8,137.61 | $6,974.74 | |
| 29855 | $13,154.68 | $11,274.87 | |
| 29860 | $13,154.68 | $11,274.87 | |
| 29861 | $13,154.68 | $11,274.87 | |
| 29862 | $13,154.68 | $11,274.87 | |
| 29863 | $13,154.68 | $11,274.87 | |
| 29870 | $8,137.61 | $6,974.74 | |
| 29871 | $8,137.61 | $6,974.74 | |
| 29873 | $8,137.61 | $6,974.74 | |
| 29874 | $8,137.61 | $6,974.74 | |
| 29875 | $8,137.61 | $6,974.74 | |
| 29876 | $8,137.61 | $6,974.74 | |
| 29877 | $8,137.61 | $6,974.74 | |
| 29879 | $8,137.61 | $6,974.74 | |
| 29880 | $8,137.61 | $6,974.74 | |
| 29881 | $8,137.61 | $6,974.74 | |
| 29882 | $8,137.61 | $6,974.74 | |
| 29883 | $8,137.61 | $6,974.74 | |
| 29884 | $8,137.61 | $6,974.74 | |
| 29886 | $8,137.61 | $6,974.74 | |
| 29887 | $8,137.61 | $6,974.74 | |
| 29888 | $24,164.43 | $20,711.32 | |
| 29889 | $24,164.43 | $20,711.32 | |
| 29891 | $13,154.68 | $11,274.87 | |
| 29894 | $8,137.61 | $6,974.74 | |
| 29895 | $8,137.61 | $6,974.74 | |
| 29897 | $8,137.61 | $6,974.74 | |
| 29898 | $8,137.61 | $6,974.74 | |
| 29899 | $13,154.68 | $11,274.87 | |
| 30100 | $2,150.53 | $1,843.22 | |
| 30130 | $4,708.37 | $4,035.54 | |
| 30140 | $6,964.52 | $5,969.29 | |
| 30200 | $2,150.53 | $1,843.22 | |
| 30300 | $182.27 | $156.22 | AS |
| 30310 | $4,708.37 | $4,035.54 | |
| 30520 | $6,964.52 | $5,969.29 | |
| 30802 | $4,708.37 | $4,035.54 | |
| 30901 | $307.68 | $263.71 | |
| 30903 | $307.68 | $263.71 | |
| 30905 | $307.68 | $263.71 | |
| 30930 | $4,708.37 | $4,035.54 | |
| 31000 | $965.03 | $827.13 | |
| 31020 | $6,964.52 | $5,969.29 | |
| 31231 | $546.21 | $468.15 | |
| 31237 | $5,959.12 | $5,107.56 | |
| 31238 | $5,959.12 | $5,107.56 | |
| 31255 | $8,403.49 | $7,202.63 | |
| 31256 | $8,403.49 | $7,202.63 | |
| 31267 | $8,403.49 | $7,202.63 | |
| 31500 | $642.80 | $550.94 | X |
| 31505 | $252.44 | $216.37 | |
| 31515 | $5,959.12 | $5,107.56 | |
| 31525 | $5,959.12 | $5,107.56 | |
| 31575 | $546.21 | $468.15 | |
| 31579 | $1,147.30 | $983.35 | |
| 31600 | $6,964.52 | $5,969.29 | |
| 31605 | $2,150.53 | $1,843.22 | |
| 31622 | $2,851.45 | $2,443.97 | |
| 31624 | $2,851.45 | $2,443.97 | |
| 31645 | $2,851.45 | $2,443.97 | |
| 31646 | $2,851.45 | $2,443.97 | |
| 32405 | $2,643.63 | $2,265.85 | |
| 32551 | $1,510.65 | $1,294.77 | |
| 32601 | $9,461.41 | $8,109.37 | |
| 33210 | $9,299.39 | $8,275.58 | |
| 33212 | $12,451.20 | $11,516.42 | |
| 36000 | $0.00 | $0.00 | N1 |
| 36005 | $0.00 | $0.00 | N1 |
| 36010 | $0.00 | $0.00 | N1 |
| 36011 | $0.00 | $0.00 | N1 |
| 36013 | $0.00 | $0.00 | N1 |
| 36014 | $0.00 | $0.00 | N1 |
| 36140 | $0.00 | $0.00 | N1 |
| 36200 | $0.00 | $0.00 | N1 |
| 36215 | $0.00 | $0.00 | N1 |
| 36216 | $0.00 | $0.00 | N1 |
| 36217 | $0.00 | $0.00 | N1 |
| 36218 | $0.00 | $0.00 | N1 |
| 36245 | $0.00 | $0.00 | N1 |
| 36246 | $0.00 | $0.00 | N1 |
| 36247 | $0.00 | $0.00 | N1 |
| 36248 | $0.00 | $0.00 | N1 |
| 36400 | $0.00 | $0.00 | N1 |
| 36406 | $0.00 | $0.00 | N1 |
| 36410 | $0.00 | $0.00 | N1 |
| 36425 | $72.62 | $62.24 | AS |
| 36430 | $921.03 | $789.41 | X |
| 36471 | $247.20 | $211.88 | |
| 36513 | $3,363.75 | $2,883.07 | X |
| 36514 | $3,363.75 | $2,883.07 | X |
| 36515 | $8,540.97 | $7,320.46 | X |
| 36555 | $3,087.37 | $2,646.18 | |
| 36556 | $3,087.37 | $2,646.18 | |
| 36558 | $5,241.41 | $4,907.68 | |
| 36569 | $3,087.37 | $2,646.18 | |
| 36571 | $5,241.41 | $4,907.68 | |
| 36576 | $3,087.37 | $2,646.18 | |
| 36578 | $5,241.41 | $4,907.68 | |
| 36580 | $3,087.37 | $2,646.18 | |
| 36584 | $3,087.37 | $2,646.18 | |
| 36589 | $1,718.86 | $1,473.23 | |
| 36592 | $171.82 | $147.27 | |
| 36593 | $637.44 | $546.35 | |
| 36598 | $637.44 | $546.35 | |
| 36600 | $72.62 | $62.24 | |
| 36620 | $0.00 | $0.00 | N1 |
| 36625 | $0.00 | $0.00 | N1 |
| 36800 | $8,505.69 | $7,354.12 | |
| 36810 | $8,505.69 | $7,354.12 | |
| 36815 | $8,505.69 | $7,354.12 | |
| 36818 | $11,329.30 | $9,710.33 | |
| 36833 | $11,329.30 | $9,710.33 | |
| 36860 | $637.44 | $546.35 | |
| 37204 | $19,232.98 | $16,856.39 | |
| 37609 | $4,909.21 | $4,207.68 | |
| 37620 | $11,946.47 | $10,239.31 | |
| 37650 | $7,454.87 | $6,389.56 | |
| 38200 | $0.00 | $0.00 | N1 |
| 43235 | $2,411.81 | $2,067.16 | |
| 43236 | $2,411.81 | $2,067.16 | |
| 43239 | $2,411.81 | $2,067.16 | |
| 43246 | $2,411.81 | $2,067.16 | |
| 43248 | $2,411.81 | $2,067.16 | |
| 43249 | $2,411.81 | $2,067.16 | |
| 43255 | $2,411.81 | $2,067.16 | |
| 43259 | $2,411.81 | $2,067.16 | |
| 43260 | $6,309.66 | $5,408.00 | |
| 43450 | $1,782.37 | $1,527.67 | |
| 43760 | $637.44 | $546.35 | |
| 43830 | $4,529.06 | $3,881.86 | |
| 44500 | $1,718.86 | $1,473.23 | |
| 46040 | $6,610.91 | $5,666.21 | |
| 46600 | $182.27 | $156.22 | AS |
| 47000 | $2,643.63 | $2,265.85 | |
| 49080 | $1,510.65 | $1,294.77 | |
| 49320 | $10,495.79 | $8,995.94 | |
| 49421 | $7,481.94 | $6,471.31 | |
| 49505 | $8,982.66 | $7,699.03 | |
| 50392 | $4,772.16 | $4,090.22 | |
| 50394 | $0.00 | $0.00 | N1 |
| 51600 | $0.00 | $0.00 | N1 |
| 51610 | $0.00 | $0.00 | N1 |
| 51700 | $553.11 | $474.07 | |
| 51701 | $182.27 | $156.22 | AS |
| 51702 | $182.27 | $156.22 | AS |
| 51703 | $301.69 | $258.58 | |
| 51705 | $553.11 | $474.07 | |
| 51720 | $872.10 | $747.48 | |
| 51725 | $872.10 | $747.48 | |
| 51726 | $872.10 | $747.48 | |
| 51741 | $301.69 | $258.58 | |
| 51784 | $301.69 | $258.58 | |
| 51797 | $553.11 | $474.07 | |
| 51798 | $182.27 | $156.22 | AS |
| 52000 | $2,020.50 | $1,731.77 | |
| 52005 | $7,150.85 | $6,128.99 | |
| 52204 | $7,150.85 | $6,128.99 | |
| 52281 | $4,772.16 | $4,090.22 | |
| 52310 | $4,772.16 | $4,090.22 | |
| 52332 | $7,150.85 | $6,128.99 | |
| 52351 | $7,150.85 | $6,128.99 | |
| 53600 | $874.07 | $749.17 | |
| 53601 | $301.69 | $258.58 | |
| 53660 | $301.69 | $258.58 | |
| 53661 | $301.69 | $258.58 | |
| 54235 | $872.10 | $747.48 | |
| 57452 | $443.98 | $380.53 | |
| 57500 | $1,783.00 | $1,528.21 | |
| 57511 | $443.98 | $380.53 | |
| 58340 | $0.00 | $0.00 | N1 |
| 58558 | $6,268.18 | $5,372.45 | |
| 59000 | $983.13 | $842.64 | |
| 59025 | $443.98 | $380.53 | |
| 59841 | $5,615.09 | $4,812.69 | |
| 61790 | $5,195.44 | $4,453.01 | |
| 62263 | $2,060.68 | $1,766.21 | |
| 62264 | $3,474.53 | $2,978.02 | |
| 62270 | $1,054.25 | $903.60 | |
| 62273 | $2,060.68 | $1,766.21 | |
| 62280 | $2,060.68 | $1,766.21 | |
| 62281 | $2,060.68 | $1,766.21 | |
| 62282 | $2,060.68 | $1,766.21 | |
| 62284 | $0.00 | $0.00 | N1 |
| 62287 | $10,121.96 | $8,675.52 | |
| 62290 | $0.00 | $0.00 | N1 |
| 62291 | $0.00 | $0.00 | N1 |
| 62292 | $2,060.68 | $1,766.21 | |
| 62310 | $2,060.68 | $1,766.21 | |
| 62311 | $2,060.68 | $1,766.21 | |
| 62318 | $2,060.68 | $1,766.21 | |
| 62319 | $3,474.53 | $2,978.02 | |
| 62350 | $11,382.48 | $9,755.92 | |
| 62355 | $3,474.53 | $2,978.02 | |
| 62360 | $11,382.48 | $9,755.92 | |
| 62362 | $22,227.97 | $20,941.63 | |
| 62365 | $10,121.96 | $8,675.52 | |
| 62367 | $657.70 | $563.72 | X |
| 62368 | $657.70 | $563.72 | X |
| 63020 | $13,940.72 | $11,948.58 | |
| 63030 | $13,940.72 | $11,948.58 | |
| 63035 | $13,940.72 | $11,948.58 | |
| 63040 | $13,940.72 | $11,948.58 | |
| 63042 | $13,940.72 | $11,948.58 | |
| 63045 | $13,940.72 | $11,948.58 | |
| 63046 | $13,940.72 | $11,948.58 | |
| 63047 | $13,940.72 | $11,948.58 | |
| 63048 | $13,940.72 | $11,948.58 | |
| 63056 | $13,940.72 | $11,948.58 | |
| 63057 | $13,940.72 | $11,948.58 | |
| 63075 | $13,940.72 | $11,948.58 | |
| 63076 | $13,940.72 | $11,948.58 | |
| 63650 | $17,950.74 | $9,545.51 | X |
| 63655 | $13,352.79 | $12,138.59 | X |
| 63685 | $23,191.56 | $22,061.87 | X |
| 63688 | $7,898.33 | $6,769.65 | |
| 64400 | $724.57 | $621.03 | |
| 64402 | $724.57 | $621.03 | |
| 64405 | $1,054.25 | $903.60 | |
| 64412 | $2,060.68 | $1,766.21 | |
| 64413 | $1,054.25 | $903.60 | |
| 64415 | $1,054.25 | $903.60 | |
| 64416 | $2,060.68 | $1,766.21 | |
| 64417 | $1,054.25 | $903.60 | |
| 64418 | $1,054.25 | $903.60 | |
| 64420 | $1,054.25 | $903.60 | |
| 64421 | $2,060.68 | $1,766.21 | |
| 64425 | $1,054.25 | $903.60 | |
| 64430 | $2,060.68 | $1,766.21 | |
| 64435 | $1,054.25 | $903.60 | |
| 64445 | $2,060.68 | $1,766.21 | |
| 64446 | $2,060.68 | $1,766.21 | |
| 64447 | $1,054.25 | $903.60 | |
| 64448 | $2,060.68 | $1,766.21 | |
| 64449 | $2,060.68 | $1,766.21 | |
| 64450 | $1,054.25 | $903.60 | |
| 64455 | $724.57 | $621.03 | |
| 64479 | $2,060.68 | $1,766.21 | |
| 64480 | $1,054.25 | $903.60 | |
| 64483 | $2,060.68 | $1,766.21 | |
| 64484 | $1,054.25 | $903.60 | |
| 64490 | $2,060.68 | $1,766.21 | |
| 64491 | $724.57 | $621.03 | |
| 64492 | $724.57 | $621.03 | |
| 64493 | $2,060.68 | $1,766.21 | |
| 64494 | $724.57 | $621.03 | |
| 64495 | $724.57 | $621.03 | |
| 64505 | $724.57 | $621.03 | |
| 64510 | $2,060.68 | $1,766.21 | |
| 64517 | $2,060.68 | $1,766.21 | |
| 64520 | $2,060.68 | $1,766.21 | |
| 64555 | $10,600.82 | $9,545.51 | X |
| 64561 | $10,600.82 | $9,545.51 | X |
| 64565 | $10,600.82 | $9,545.51 | X |
| 64600 | $3,474.53 | $2,978.02 | |
| 64605 | $5,195.44 | $4,453.01 | |
| 64610 | $5,195.44 | $4,453.01 | |
| 64612 | $724.57 | $621.03 | |
| 64613 | $1,054.25 | $903.60 | |
| 64614 | $1,054.25 | $903.60 | |
| 64620 | $2,060.68 | $1,766.21 | |
| 64622 | $3,474.53 | $2,978.02 | |
| 64623 | $2,060.68 | $1,766.21 | |
| 64626 | $2,060.68 | $1,766.21 | |
| 64627 | $724.57 | $621.03 | |
| 64640 | $2,060.68 | $1,766.21 | |
| 64680 | $2,060.68 | $1,766.21 | |
| 64702 | $5,195.44 | $4,453.01 | |
| 64704 | $5,195.44 | $4,453.01 | |
| 64708 | $5,195.44 | $4,453.01 | |
| 64712 | $5,195.44 | $4,453.01 | |
| 64713 | $5,195.44 | $4,453.01 | |
| 64714 | $5,195.44 | $4,453.01 | |
| 64716 | $5,195.44 | $4,453.01 | |
| 64718 | $5,195.44 | $4,453.01 | |
| 64719 | $5,195.44 | $4,453.01 | |
| 64721 | $5,195.44 | $4,453.01 | |
| 65205 | $263.33 | $225.70 | X |
| 65210 | $263.33 | $225.70 | X |
| 65220 | $263.33 | $225.70 | X |
| 65222 | $263.33 | $225.70 | X |
| 65265 | $6,362.61 | $5,453.39 | |
| 67412 | $5,433.49 | $4,657.04 | |
| 69210 | $182.27 | $156.22 | AS |
| 69310 | $12,135.56 | $10,401.38 | |
| 69320 | $12,135.56 | $10,401.38 | |
| 69666 | $12,135.56 | $10,401.38 | |
| 69667 | $12,135.56 | $10,401.38 | |
| 69990 | $0.00 | $0.00 | N1 |
Radiology, CPT 70000 to 79999
374 rows| Code | North | South | Flags |
|---|---|---|---|
| 70030 | $177.57 | $152.20 | AS |
| 70100 | $177.57 | $152.20 | AS |
| 70110 | $177.57 | $152.20 | AS |
| 70120 | $177.57 | $152.20 | AS |
| 70130 | $177.57 | $152.20 | AS |
| 70140 | $177.57 | $152.20 | AS |
| 70150 | $177.57 | $152.20 | AS |
| 70160 | $177.57 | $152.20 | AS |
| 70190 | $177.57 | $152.20 | AS |
| 70200 | $177.57 | $152.20 | AS |
| 70210 | $177.57 | $152.20 | AS |
| 70220 | $177.57 | $152.20 | AS |
| 70250 | $177.57 | $152.20 | AS |
| 70260 | $299.09 | $256.35 | AS |
| 70300 | $120.17 | $103.00 | AS |
| 70310 | $120.17 | $103.00 | AS |
| 70320 | $120.17 | $103.00 | AS |
| 70328 | $177.57 | $152.20 | AS |
| 70330 | $177.57 | $152.20 | AS |
| 70332 | $1,084.37 | $929.42 | |
| 70336 | $1,352.04 | $1,158.83 | |
| 70350 | $177.57 | $152.20 | AS |
| 70355 | $120.17 | $103.00 | AS |
| 70360 | $177.57 | $152.20 | AS |
| 70450 | $764.27 | $655.06 | |
| 70460 | $1,182.03 | $1,013.12 | |
| 70470 | $1,317.77 | $1,129.46 | |
| 70480 | $764.27 | $655.06 | |
| 70481 | $1,182.03 | $1,013.12 | |
| 70482 | $1,317.77 | $1,129.46 | |
| 70486 | $764.27 | $655.06 | |
| 70487 | $1,182.03 | $1,013.12 | |
| 70488 | $1,317.77 | $1,129.46 | |
| 70490 | $764.27 | $655.06 | |
| 70491 | $1,182.03 | $1,013.12 | |
| 70492 | $1,317.77 | $1,129.46 | |
| 70496 | $1,334.69 | $1,143.96 | |
| 70498 | $1,334.69 | $1,143.96 | |
| 70540 | $1,352.04 | $1,158.83 | |
| 70542 | $1,722.84 | $1,476.64 | |
| 70543 | $2,103.77 | $1,803.14 | |
| 70544 | $1,352.04 | $1,158.83 | |
| 70545 | $1,722.84 | $1,476.64 | |
| 70546 | $2,103.77 | $1,803.14 | |
| 70547 | $1,352.04 | $1,158.83 | |
| 70548 | $1,722.84 | $1,476.64 | |
| 70549 | $2,103.77 | $1,803.14 | |
| 70551 | $1,352.04 | $1,158.83 | |
| 70552 | $1,722.84 | $1,476.64 | |
| 70553 | $2,103.77 | $1,803.14 | |
| 70554 | $1,352.04 | $1,158.83 | |
| 70555 | $1,352.04 | $1,158.83 | X |
| 71010 | $177.57 | $152.20 | |
| 71020 | $177.57 | $152.20 | |
| 71021 | $177.57 | $152.20 | AS |
| 71022 | $177.57 | $152.20 | AS |
| 71030 | $177.57 | $152.20 | AS |
| 71035 | $177.57 | $152.20 | AS |
| 71040 | $906.64 | $777.08 | |
| 71090 | $0.00 | $0.00 | N1 |
| 71100 | $177.57 | $152.20 | AS |
| 71101 | $177.57 | $152.20 | AS |
| 71110 | $177.57 | $152.20 | AS |
| 71111 | $299.09 | $256.35 | AS |
| 71120 | $177.57 | $152.20 | AS |
| 71130 | $177.57 | $152.20 | AS |
| 71250 | $764.27 | $655.06 | |
| 71260 | $1,182.03 | $1,013.12 | |
| 71270 | $1,317.77 | $1,129.46 | |
| 71275 | $1,334.69 | $1,143.96 | |
| 71550 | $1,352.04 | $1,158.83 | |
| 71552 | $2,103.77 | $1,803.14 | |
| 72010 | $299.09 | $256.35 | AS |
| 72020 | $177.57 | $152.20 | AS |
| 72040 | $177.57 | $152.20 | AS |
| 72050 | $299.09 | $256.35 | AS |
| 72052 | $299.09 | $256.35 | AS |
| 72069 | $177.57 | $152.20 | AS |
| 72070 | $177.57 | $152.20 | AS |
| 72072 | $177.57 | $152.20 | AS |
| 72074 | $177.57 | $152.20 | AS |
| 72080 | $177.57 | $152.20 | AS |
| 72090 | $299.09 | $256.35 | AS |
| 72100 | $177.57 | $152.20 | AS |
| 72110 | $299.09 | $256.35 | AS |
| 72114 | $299.09 | $256.35 | AS |
| 72120 | $177.57 | $152.20 | AS |
| 72125 | $764.27 | $655.06 | |
| 72126 | $1,182.03 | $1,013.12 | |
| 72127 | $1,317.77 | $1,129.46 | |
| 72128 | $764.27 | $655.06 | |
| 72129 | $1,182.03 | $1,013.12 | |
| 72130 | $1,317.77 | $1,129.46 | |
| 72131 | $764.27 | $655.06 | |
| 72132 | $1,182.03 | $1,013.12 | |
| 72133 | $1,317.77 | $1,129.46 | |
| 72141 | $1,352.04 | $1,158.83 | |
| 72142 | $1,722.84 | $1,476.64 | |
| 72146 | $1,352.04 | $1,158.83 | |
| 72147 | $1,722.84 | $1,476.64 | |
| 72148 | $1,352.04 | $1,158.83 | |
| 72149 | $1,722.84 | $1,476.64 | |
| 72156 | $2,103.77 | $1,803.14 | |
| 72157 | $2,103.77 | $1,803.14 | |
| 72158 | $2,103.77 | $1,803.14 | |
| 72170 | $177.57 | $152.20 | AS |
| 72190 | $177.57 | $152.20 | AS |
| 72191 | $1,334.69 | $1,143.96 | |
| 72192 | $764.27 | $655.06 | |
| 72193 | $1,182.03 | $1,013.12 | |
| 72194 | $1,317.77 | $1,129.46 | |
| 72195 | $1,352.04 | $1,158.83 | |
| 72196 | $1,722.84 | $1,476.64 | |
| 72197 | $2,103.77 | $1,803.14 | |
| 72200 | $177.57 | $152.20 | AS |
| 72202 | $177.57 | $152.20 | AS |
| 72220 | $177.57 | $152.20 | AS |
| 72240 | $1,967.75 | $1,686.56 | |
| 72255 | $1,967.75 | $1,686.56 | |
| 72265 | $1,967.75 | $1,686.56 | |
| 72270 | $1,967.75 | $1,686.56 | |
| 72275 | $0.00 | $0.00 | N1 |
| 72285 | $6,593.09 | $5,650.93 | |
| 72291 | $0.00 | $0.00 | N1 |
| 72295 | $6,593.09 | $5,650.93 | |
| 73000 | $177.57 | $152.20 | AS |
| 73010 | $177.57 | $152.20 | AS |
| 73020 | $177.57 | $152.20 | AS |
| 73030 | $177.57 | $152.20 | AS |
| 73040 | $1,084.37 | $929.42 | |
| 73050 | $177.57 | $152.20 | AS |
| 73060 | $177.57 | $152.20 | AS |
| 73070 | $177.57 | $152.20 | AS |
| 73080 | $177.57 | $152.20 | AS |
| 73090 | $177.57 | $152.20 | AS |
| 73092 | $177.57 | $152.20 | AS |
| 73100 | $177.57 | $152.20 | AS |
| 73110 | $177.57 | $152.20 | AS |
| 73115 | $1,084.37 | $929.42 | |
| 73120 | $177.57 | $152.20 | AS |
| 73130 | $177.57 | $152.20 | AS |
| 73140 | $177.57 | $152.20 | AS |
| 73200 | $764.27 | $655.06 | |
| 73201 | $1,182.03 | $1,013.12 | |
| 73202 | $1,317.77 | $1,129.46 | |
| 73206 | $1,334.69 | $1,143.96 | |
| 73218 | $1,352.04 | $1,158.83 | |
| 73219 | $1,722.84 | $1,476.64 | |
| 73220 | $2,103.77 | $1,803.14 | |
| 73221 | $1,352.04 | $1,158.83 | |
| 73222 | $1,722.84 | $1,476.64 | |
| 73223 | $2,103.77 | $1,803.14 | |
| 73500 | $177.57 | $152.20 | AS |
| 73510 | $177.57 | $152.20 | AS |
| 73520 | $177.57 | $152.20 | AS |
| 73525 | $1,084.37 | $929.42 | |
| 73530 | $0.00 | $0.00 | N1 |
| 73540 | $177.57 | $152.20 | AS |
| 73542 | $1,084.37 | $929.42 | |
| 73550 | $177.57 | $152.20 | AS |
| 73560 | $177.57 | $152.20 | AS |
| 73562 | $177.57 | $152.20 | AS |
| 73564 | $177.57 | $152.20 | AS |
| 73565 | $177.57 | $152.20 | AS |
| 73580 | $1,084.37 | $929.42 | |
| 73590 | $177.57 | $152.20 | AS |
| 73592 | $177.57 | $152.20 | AS |
| 73600 | $177.57 | $152.20 | AS |
| 73610 | $177.57 | $152.20 | AS |
| 73615 | $1,084.37 | $929.42 | |
| 73620 | $177.57 | $152.20 | AS |
| 73630 | $177.57 | $152.20 | AS |
| 73650 | $177.57 | $152.20 | AS |
| 73660 | $177.57 | $152.20 | AS |
| 73700 | $764.27 | $655.06 | |
| 73701 | $1,182.03 | $1,013.12 | |
| 73706 | $1,334.69 | $1,143.96 | |
| 73718 | $1,352.04 | $1,158.83 | |
| 73719 | $1,722.84 | $1,476.64 | |
| 73720 | $2,103.77 | $1,803.14 | |
| 73721 | $1,352.04 | $1,158.83 | |
| 73722 | $1,722.84 | $1,476.64 | |
| 73723 | $2,103.77 | $1,803.14 | |
| 74000 | $177.57 | $152.20 | AS |
| 74010 | $177.57 | $152.20 | AS |
| 74020 | $177.57 | $152.20 | AS |
| 74022 | $299.09 | $256.35 | AS |
| 74150 | $764.27 | $655.06 | |
| 74160 | $1,182.03 | $1,013.12 | |
| 74170 | $1,317.77 | $1,129.46 | |
| 74175 | $1,334.69 | $1,143.96 | |
| 74176 | $764.27 | $655.06 | |
| 74177 | $1,182.03 | $1,013.12 | |
| 74178 | $1,317.77 | $1,129.46 | |
| 74181 | $1,352.04 | $1,158.83 | |
| 74183 | $2,103.77 | $1,803.14 | |
| 74220 | $341.90 | $293.04 | X |
| 74230 | $341.90 | $293.04 | X |
| 74241 | $341.90 | $293.04 | X |
| 74246 | $341.90 | $293.04 | X |
| 74280 | $559.77 | $479.78 | X |
| 74290 | $341.90 | $293.04 | X |
| 74330 | $0.00 | $0.00 | N1 |
| 74400 | $694.37 | $595.14 | X |
| 74410 | $694.37 | $595.14 | X |
| 74415 | $694.37 | $595.14 | X |
| 74420 | $694.37 | $595.14 | X |
| 74425 | $694.37 | $595.14 | |
| 74430 | $694.37 | $595.14 | |
| 74450 | $694.37 | $595.14 | |
| 74455 | $694.37 | $595.14 | |
| 74475 | $4,772.16 | $4,090.22 | |
| 74480 | $4,772.16 | $4,090.22 | |
| 74485 | $4,772.16 | $4,090.22 | |
| 75561 | $2,103.77 | $1,803.14 | |
| 75572 | $1,012.70 | $867.98 | X |
| 75574 | $1,012.70 | $867.98 | X |
| 75605 | $7,990.03 | $6,848.25 | |
| 75625 | $7,990.03 | $6,848.25 | |
| 75630 | $7,990.03 | $6,848.25 | |
| 75635 | $1,334.69 | $1,143.96 | |
| 75650 | $12,970.25 | $11,116.79 | |
| 75665 | $7,990.03 | $6,848.25 | |
| 75671 | $12,970.25 | $11,116.79 | |
| 75676 | $7,990.03 | $6,848.25 | |
| 75680 | $7,990.03 | $6,848.25 | |
| 75685 | $7,990.03 | $6,848.25 | |
| 75705 | $7,990.03 | $6,848.25 | |
| 75710 | $7,990.03 | $6,848.25 | |
| 75716 | $7,990.03 | $6,848.25 | |
| 75722 | $7,990.03 | $6,848.25 | |
| 75724 | $7,990.03 | $6,848.25 | |
| 75726 | $7,990.03 | $6,848.25 | |
| 75736 | $7,990.03 | $6,848.25 | |
| 75743 | $7,990.03 | $6,848.25 | |
| 75774 | $0.00 | $0.00 | N1 |
| 75809 | $299.09 | $256.35 | |
| 75820 | $2,833.55 | $2,428.63 | |
| 75822 | $2,833.55 | $2,428.63 | |
| 75825 | $7,990.03 | $6,848.25 | |
| 75894 | $0.00 | $0.00 | N1 |
| 75898 | $299.09 | $256.35 | |
| 75940 | $0.00 | $0.00 | N1 |
| 75960 | $0.00 | $0.00 | N1 |
| 75961 | $0.00 | $0.00 | N1 |
| 75962 | $12,095.18 | $10,542.37 | |
| 75964 | $0.00 | $0.00 | N1 |
| 75978 | $8,317.24 | $7,228.17 | |
| 75984 | $0.00 | $0.00 | N1 |
| 75989 | $0.00 | $0.00 | N1 |
| 76000 | $329.21 | $282.16 | |
| 76001 | $0.00 | $0.00 | N1 |
| 76010 | $177.57 | $152.20 | AS |
| 76080 | $906.64 | $777.08 | |
| 76098 | $1,605.07 | $1,375.71 | |
| 76100 | $299.09 | $256.35 | AS |
| 76102 | $906.64 | $777.08 | AS |
| 76120 | $329.21 | $282.16 | AS |
| 76125 | $0.00 | $0.00 | N1 |
| 76376 | $0.00 | $0.00 | N1 |
| 76377 | $0.00 | $0.00 | N1 |
| 76380 | $447.45 | $383.51 | X |
| 76506 | $245.43 | $210.36 | X |
| 76510 | $691.93 | $593.05 | |
| 76511 | $379.59 | $325.35 | X |
| 76512 | $379.59 | $325.35 | X |
| 76514 | $72.62 | $62.24 | AS |
| 76516 | $245.43 | $210.36 | X |
| 76519 | $379.59 | $325.35 | X |
| 76536 | $379.59 | $325.35 | X |
| 76604 | $245.43 | $210.36 | |
| 76645 | $245.43 | $210.36 | X |
| 76700 | $379.59 | $325.35 | |
| 76705 | $379.59 | $325.35 | |
| 76770 | $379.59 | $325.35 | |
| 76775 | $379.59 | $325.35 | |
| 76776 | $379.59 | $325.35 | |
| 76800 | $379.59 | $325.35 | X |
| 76801 | $379.59 | $325.35 | X |
| 76805 | $379.59 | $325.35 | X |
| 76810 | $379.59 | $325.35 | X |
| 76811 | $603.18 | $516.98 | X |
| 76814 | $245.43 | $210.36 | X |
| 76815 | $245.43 | $210.36 | X |
| 76816 | $245.43 | $210.36 | X |
| 76817 | $245.43 | $210.36 | X |
| 76818 | $379.59 | $325.35 | X |
| 76819 | $379.59 | $325.35 | X |
| 76820 | $245.43 | $210.36 | X |
| 76821 | $245.43 | $210.36 | X |
| 76826 | $1,586.46 | $1,359.76 | X |
| 76827 | $245.43 | $210.36 | X |
| 76828 | $245.43 | $210.36 | X |
| 76830 | $379.59 | $325.35 | X |
| 76856 | $379.59 | $325.35 | |
| 76857 | $245.43 | $210.36 | |
| 76870 | $379.59 | $325.35 | |
| 76872 | $379.59 | $325.35 | X |
| 76881 | $379.59 | $325.35 | X |
| 76882 | $245.43 | $210.36 | X |
| 76937 | $0.00 | $0.00 | N1 |
| 76942 | $0.00 | $0.00 | N1 |
| 76998 | $0.00 | $0.00 | N1 |
| 77001 | $0.00 | $0.00 | N1 |
| 77002 | $0.00 | $0.00 | N1 |
| 77003 | $0.00 | $0.00 | N1 |
| 77011 | $0.00 | $0.00 | N1 |
| 77012 | $0.00 | $0.00 | N1 |
| 77032 | $0.00 | $0.00 | N1 |
| 77072 | $177.57 | $152.20 | AS |
| 77073 | $177.57 | $152.20 | AS |
| 77074 | $299.09 | $256.35 | AS |
| 77075 | $299.09 | $256.35 | AS |
| 77076 | $299.09 | $256.35 | AS |
| 77077 | $177.57 | $152.20 | AS |
| 77080 | $278.03 | $238.30 | X |
| 77081 | $126.60 | $108.51 | X |
| 77082 | $177.57 | $152.20 | X |
| 77280 | $411.92 | $353.06 | AS |
| 77285 | $1,070.85 | $917.82 | AS |
| 77290 | $1,070.85 | $917.82 | AS |
| 77295 | $3,653.77 | $3,131.64 | AS |
| 77300 | $411.92 | $353.06 | AS |
| 77305 | $411.92 | $353.06 | AS |
| 77310 | $411.92 | $353.06 | AS |
| 77315 | $1,070.85 | $917.82 | AS |
| 77321 | $1,070.85 | $917.82 | AS |
| 77331 | $411.92 | $353.06 | AS |
| 77332 | $787.38 | $674.86 | AS |
| 77333 | $787.38 | $674.86 | AS |
| 77334 | $787.38 | $674.86 | AS |
| 77336 | $411.92 | $353.06 | AS |
| 77371 | $30,204.85 | $25,888.56 | X |
| 77403 | $385.67 | $330.55 | X |
| 77413 | $632.95 | $542.50 | X |
| 77414 | $632.95 | $542.50 | X |
| 77417 | $0.00 | $0.00 | N1 |
| 77470 | $1,532.02 | $1,313.09 | X |
| 78006 | $865.36 | $741.70 | X |
| 78007 | $865.36 | $741.70 | X |
| 78102 | $1,013.33 | $868.52 | X |
| 78103 | $1,013.33 | $868.52 | X |
| 78215 | $1,045.30 | $895.93 | X |
| 78220 | $1,045.30 | $895.93 | X |
| 78223 | $1,045.30 | $895.93 | X |
| 78232 | $943.46 | $808.64 | X |
| 78300 | $964.75 | $826.89 | X |
| 78305 | $964.75 | $826.89 | X |
| 78306 | $964.75 | $826.89 | X |
| 78315 | $964.75 | $826.89 | X |
| 78320 | $964.75 | $826.89 | X |
| 78445 | $789.90 | $677.02 | X |
| 78451 | $2,995.98 | $2,567.85 | X |
| 78452 | $2,995.98 | $2,567.85 | X |
| 78469 | $1,148.83 | $984.67 | X |
| 78472 | $1,148.83 | $984.67 | X |
| 78481 | $1,148.83 | $984.67 | X |
| 78494 | $1,148.83 | $984.67 | X |
| 78580 | $776.02 | $665.13 | X |
| 78584 | $1,261.32 | $1,081.07 | X |
| 78585 | $1,261.32 | $1,081.07 | X |
| 78588 | $1,261.32 | $1,081.07 | X |
| 78594 | $776.02 | $665.13 | X |
| 78596 | $1,261.32 | $1,081.07 | X |
| 78607 | $2,350.85 | $2,014.92 | X |
| 78707 | $1,267.39 | $1,086.28 | X |
| 78708 | $1,267.39 | $1,086.28 | X |
| 78709 | $1,267.39 | $1,086.28 | X |
| 78802 | $1,872.66 | $1,605.05 | X |
| 78803 | $1,872.66 | $1,605.05 | X |
| 78805 | $1,872.66 | $1,605.05 | X |
| 78806 | $1,872.66 | $1,605.05 | X |
| 78815 | $4,108.15 | $3,521.09 | X |
| 79101 | $883.62 | $757.35 | X |
Pathology and laboratory, CPT 80000 to 89999
1 rows| Code | North | South | Flags |
|---|---|---|---|
| 88141 | not listed | not listed | N1 |
Medicine, CPT 90000 to 99999
37 rows| Code | North | South | Flags |
|---|---|---|---|
| 92070 | not listed | not listed | N1 |
| 92504 | not listed | not listed | N1 |
| 92547 | not listed | not listed | N1 |
| 92621 | not listed | not listed | N1 |
| 93314 | not listed | not listed | N1 |
| 93320 | not listed | not listed | N1 |
| 93321 | not listed | not listed | N1 |
| 93325 | not listed | not listed | N1 |
| 93463 | not listed | not listed | N1 |
| 93464 | not listed | not listed | N1 |
| 93563 | not listed | not listed | N1 |
| 93564 | not listed | not listed | N1 |
| 93565 | not listed | not listed | N1 |
| 93566 | not listed | not listed | N1 |
| 93567 | not listed | not listed | N1 |
| 93568 | not listed | not listed | N1 |
| 93609 | not listed | not listed | N1 |
| 93623 | not listed | not listed | N1 |
| 93641 | not listed | not listed | N1 |
| 94760 | not listed | not listed | N1 |
| 94761 | not listed | not listed | N1 |
| 95873 | not listed | not listed | N1 |
| 95874 | not listed | not listed | N1 |
| 95920 | not listed | not listed | N1 |
| 95955 | not listed | not listed | N1 |
| 95957 | not listed | not listed | N1 |
| 96368 | not listed | not listed | N1 |
| 99143 | not listed | not listed | N1 |
| 99144 | not listed | not listed | N1 |
| 99145 | not listed | not listed | N1 |
| 99148 | not listed | not listed | N1 |
| 99149 | not listed | not listed | N1 |
| 99150 | not listed | not listed | N1 |
| 99175 | not listed | not listed | N1 |
| 99292 | not listed | not listed | N1 |
| 99354 | not listed | not listed | N1 |
| 99355 | not listed | not listed | N1 |
Source
- The schedule: N.J.A.C. 11:3-29 Appendix, Exhibit 7, published by the New Jersey Department of Banking and Insurance and effective for treatment rendered on or after January 4, 2013. It has not been amended since.
- Official files: the Department’s auto medical fee schedule page, the rule text and the Department’s own FAQ.
- This page: parsed from the Department’s Excel file, with every row count and every figure cross-checked against the Department’s PDF of the same exhibit. Free to download as one CSV of all seven exhibits, 7,553 rows, no sign-up.
Amounts are the maximum reimbursable under the New Jersey PIP fee schedule, not what a provider billed and not what an insurer paid. N.J.A.C. 11:3-29 caps reimbursement at the lesser of the provider’s charge or the scheduled amount, and 11:3-29.6 bars a provider from billing a patient the difference. This page reproduces the schedule; it does not decide whether a service was medically necessary, correctly coded, or covered. Verify any figure against the Department’s own file before relying on it. Descriptions are not shown for the CPT codes: the State's short descriptor for a CPT code is text licensed from the American Medical Association. The HCPCS rows keep the State's descriptors. Current Procedural Terminology (CPT) is copyright 2010 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.
Reading exhibit 7002
What the rule says about this schedule
What is a hospital outpatient surgical facility fee?
It is the money the hospital is paid for hosting the surgery, as distinct from the money the surgeon is paid for performing it. 11:3-29.5(b) makes the Exhibit 7 amount the maximum reimbursable for an outpatient procedure performed in a hospital outpatient surgical facility, and that one amount is meant to cover everything on the facility's side of the case.
11:3-29.5(a)1 through 8 lists what is inside it: operating and recovery rooms, patient preparation and waiting areas, the work of nurses and technical staff, drugs and biologicals, surgical dressings, supplies, splints, casts, appliances and equipment, diagnostic and therapeutic items, administrative and housekeeping services, blood and blood products, anesthesia materials, and implantable DME and prosthetics. A line billed separately for something on that list is being billed twice.
When does Exhibit 7 apply instead of the technical component on Exhibit 1?
FAQ Answer 20 draws the line by why the patient is there. If the patient was admitted to the hospital outpatient facility for a surgical procedure, the Exhibit 7 fee applies. If a physician simply referred the patient to have an imaging study done at the hospital outpatient department, the TC rows on the physicians' column of Exhibit 1 apply instead.
The Department reaches that answer through 11:3-29.4(g), which interprets the fee schedules in accordance with the Medicare Claims Processing Manual, and points specifically at chapter 13, sections 20.2.1 through 20.2.3. X-rays and MRIs carry fees on both schedules, so the choice is not cosmetic: the two numbers are different, and the reason for the visit decides which is right.
Where does Exhibit 7 not apply at all?
In three places, each named by the rule. Exhibit 7 facility fees do not apply to services provided in a hospital emergency room (11:3-29.4(a)2, billed with ER). They do not apply to trauma services at a Level I or Level II trauma hospital (29.4(a)1, billed with TS). And they do not cover physician services, which stay on Exhibit 1.
FAQ Answer 19 adds a fourth boundary that carriers and providers argue about by name. A rehabilitation hospital's outpatient bill meeting the definition of hospital outpatient services does not make the HOSF rate apply to everything done there. Exhibit 7 prices the items in 29.5(a)1 through 8 when they are provided in connection with a surgical service listed on the schedule. Outpatient physical therapy at such a facility is priced under the physicians' fee schedule and the daily maximum, not under Exhibit 7 and not as a usual and customary claim.
How are multiple procedures in one session paid?
11:3-29.5(d) sets its own formula for facilities, separate from the physicians' one. When several procedures happen in the same operative session in an ASC or an HOSF, the facility fee for the highest paying procedure is reimbursed at 100 percent and every additional procedure at 50 percent.
Two details decide real cases. A procedure performed bilaterally in one session is reported as two procedures and is subject to that reduction (29.5(d)1), which is the opposite of how the physicians' column treats a bilateral procedure. And the codes marked X in the flag column are exempt from the reduction entirely, because Medicare exempts them and 29.5(d)2 carries that exemption across. 135 rows on this exhibit are marked X.
Are the North and South columns correct for Exhibit 7?
They are published by the State, and the rule is inconsistent about them. 11:3-29.3(a) defines the North and South regions for Exhibit 1, Exhibit 2 and Exhibit 4, and does not name Exhibit 7. The exhibit carries North and South columns anyway.
What grounds using them is 11:3-29.4(b), which speaks generally of the region determining the proper fee set forth in the schedules, by where the service was rendered, or for elective care given to a New Jersey resident outside the State, by where the insured lives. We publish the columns as the Department published them, and say the inconsistency out loud rather than papering over a gap in the rule.
The other exhibits003
The rest of the New Jersey PIP fee schedule
Exhibit 1