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					                                                                              8/14/2012




                      OUTPATIENT REHABILITATION THERAPY CODES
                          2012 RELATIVE VALUE UNITS (RVUs)
CPT/HCPCS                                        Physician Non-Facility    Malpractice
  Code      Status        Short Description      Work RVU    PE RVU           RVU
                                                     A1        A2              A3

  0019T       C      Extracorp shock wv tx ms nos       0.00        0.00           0.00
  0183T       C      Wound ultrasound                   0.00        0.00           0.00
  64550       A      Apply neurostimulator              0.18        0.28           0.01
  90901       A      Biofeedback train any meth         0.41        0.73           0.01
  92506       A      Speech/hearing evaluation          0.86        3.95           0.05
  92507       A      Speech/hearing therapy             1.30        0.83           0.07
  92508       A      Speech/hearing therapy             0.33        0.32           0.01
  92520       A      Laryngeal function studies         0.75        1.28           0.04
  92526       A      Oral function therapy              1.34        1.03           0.07
  92597       A      Oral speech device eval            1.26        1.11           0.07
  92605       B      Ex for nonspeech device rx         0.00        0.00           0.00
  92606       B      Non-speech device service          0.00        0.00           0.00
  92607       A      Ex for speech device rx 1hr        1.85        2.24           0.10
  92608       A      Ex for speech device rx addl       0.70        0.61           0.04
  92609       A      Use of speech device service       1.50        1.40           0.07
  92610       A      Evaluate swallowing function       1.30        1.26           0.07
  92611       A      Motion fluoroscopy/swallow         1.34        1.47           0.08
  92612       A      Endoscopy swallow tst (fees)       1.27        3.65           0.07
  92614       A      Laryngoscopic sensory test         1.27        3.13           0.07
  92616       A      Fees w/laryngeal sense test        1.88        4.02           0.10
  95831       A      Limb muscle testing manual         0.28        0.52           0.03
  95832       A      Hand muscle testing manual         0.29        0.46           0.03
  95833       A      Body muscle testing manual         0.47        0.61           0.01
  95834       A      Body muscle testing manual         0.60        0.79           0.03
  95851       A      Range of motion measurements       0.16        0.36           0.01
  95852       A      Range of motion measurements       0.11        0.35           0.01
  95992       A      Canalith repositioning proc        0.75        0.44           0.05
  96105       A      Assessment of aphasia              1.75        1.20           0.04
  96111       A      Developmental test extend          2.60        0.89           0.16
  96125       A      Cognitive test by hc pro           1.70        1.14           0.07
  97001       A      Pt evaluation                      1.20        0.91           0.05
  97002       A      Pt re-evaluation                   0.60        0.57           0.03
  97003       A      Ot evaluation                      1.20        1.17           0.05
  97004       A      Ot re-evaluation                   0.60        0.86           0.03
  97010       B      Hot or cold packs therapy          0.00        0.00           0.00
  97012       A      Mechanical traction therapy        0.25        0.20           0.01
  97016       A      Vasopneumatic device therapy       0.18        0.35           0.01
  97018       A      Paraffin bath therapy              0.06        0.23           0.01
  97022       A      Whirlpool therapy                  0.17        0.47           0.01
  97024       A      Diathermy eg microwave             0.06        0.12           0.01




                                        Page 1 of 121
                                                                              8/14/2012




                      OUTPATIENT REHABILITATION THERAPY CODES
                          2012 RELATIVE VALUE UNITS (RVUs)
CPT/HCPCS                                        Physician Non-Facility    Malpractice
  Code      Status        Short Description      Work RVU    PE RVU           RVU
                                                     A1        A2              A3

  97026       R      Infrared therapy                    0.06       0.10           0.01
  97028       A      Ultraviolet therapy                 0.08       0.12           0.01
  97032       A      Electrical stimulation              0.25       0.28           0.01
  97033       A      Electric current therapy            0.26       0.63           0.01
  97034       A      Contrast bath therapy               0.21       0.28           0.01
  97035       A      Ultrasound therapy                  0.21       0.14           0.01
  97036       A      Hydrotherapy                        0.28       0.62           0.01
  97039       C      Physical therapy treatment          0.00       0.00           0.00
  97110       A      Therapeutic exercises               0.45       0.44           0.01
  97112       A      Neuromuscular reeducation           0.45       0.48           0.01
  97113       A      Aquatic therapy/exercises           0.44       0.75           0.01
  97116       A      Gait training therapy               0.40       0.39           0.01
  97124       A      Massage therapy                     0.35       0.38           0.01
  97139       C      Physical medicine procedure         0.00       0.00           0.00
  97140       A      Manual therapy                      0.43       0.40           0.01
  97150       A      Group therapeutic procedures        0.27       0.30           0.01
  97530       A      Therapeutic activities              0.44       0.54           0.01
  97532       A      Cognitive skills development        0.44       0.30           0.01
  97533       A      Sensory integration                 0.44       0.38           0.01
  97535       A      Self care mngment training          0.45       0.52           0.01
  97537       A      Community/work reintegration        0.45       0.39           0.01
  97542       A      Wheelchair mngment training         0.45       0.41           0.01
  97597       A      Rmvl devital tis 20 cm/<            0.51       1.65           0.05
  97598       A      Rmvl devital tis addl 20 cm<        0.24       0.46           0.03
  97602       B      Wound(s) care non-selective         0.00       0.00           0.00
  97605       A      Neg press wound tx < 50 cm          0.55       0.57           0.08
  97606       A      Neg press wound tx > 50 cm          0.60       0.58           0.10
  97750       A      Physical performance test           0.45       0.47           0.03
  97755       A      Assistive technology assess         0.62       0.38           0.03
  97760       A      Orthotic mgmt and training          0.45       0.60           0.03
  97761       A      Prosthetic training                 0.45       0.46           0.03
  97762       A      C/o for orthotic/prosth use         0.25       1.04           0.01
  97799       C      Physical medicine procedure         0.00       0.00           0.00
  G0281       A      Elec stim unattend for press        0.18       0.20           0.01
  G0283       A      Elec stim other than wound          0.18       0.20           0.01
  G0329       A      Electromagntic tx for ulcers        0.06       0.22           0.01




                                         Page 2 of 121
                                                                                8/14/2012




      2012 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI)

Contractor   Locality                                             Practice
   No.         No.             Locality Name            Work      Expense     Malpractice
                                                         B1          B2           B3

  10102      00         Alabama                           1.000       0.878           0.474
  00831      01         Alaska                            1.500       1.067           0.661
  03102      00         Arizona                           1.000       0.978           1.015
  00520      13         Arkansas                          1.000       0.865           0.450
  01102      03         Marin/Napa/Solano, CA             1.051       1.248           0.456
  01102      05         San Francisco, CA                 1.072       1.360           0.516
  01102      06         San Mateo, CA                     1.072       1.354           0.516
  01102      07         Oakland/Berkley, CA               1.058       1.254           0.516
  01102      09         Santa Clara, CA                   1.077       1.337           0.516
  01102      99         Rest of California*               1.024       1.085           0.547
  01192      17         Ventura, CA                       1.034       1.193           0.605
  01192      18         Los Angeles, CA                   1.036       1.154           0.642
  01192      26         Anaheim/Santa Ana, CA             1.044       1.218           0.676
  01192      99         Rest of California*               1.024       1.085           0.547
  04102      01         Colorado                          1.000       1.004           0.872
  13102      00         Connecticut                       1.024       1.110           1.235
  12202      01         DC + MD/VA Suburbs                1.049       1.198           1.130
  12102      01         Delaware                          1.012       1.044           0.672
  09102      03         Fort Lauderdale, FL               1.000       1.051           1.982
  09102      04         Miami, FL                         1.000       1.054           2.815
  09102      99         Rest of Florida                   1.000       0.968           1.553
  10202      01         Atlanta, GA                       1.002       1.015           0.949
  10202      99         Rest of Georgia                   1.000       0.898           0.928
  01202      01         Hawaii/Guam                       1.000       1.154           0.700
  05130      00         Idaho                             1.000       0.894           0.603
  00952      12         East St. Louis, IL                1.000       0.936           1.934
  00952      15         Suburban Chicago, IL              1.025       1.072           1.706
  00952      16         Chicago, IL                       1.030       1.051           2.077
  00952      99         Rest of Illinois                  1.000       0.909           1.336
  00630      00         Indiana                           1.000       0.923           0.613
  05102      00         Iowa                              1.000       0.887           0.456
  05202      00         Kansas                            1.000       0.894           0.957
  00660      00         Kentucky                          1.000       0.871           0.752
  00528      01         New Orleans, LA                   1.000       0.976           0.921
  00528      99         Rest of Louisiana                 1.000       0.877           0.744
  14102      03         Southern Maine                    1.000       1.024           0.676
  14102      99         Rest of Maine                     1.000       0.904           0.676




                                        Page 3 of 121
                                                                                 8/14/2012




      2012 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI)

Contractor   Locality                                              Practice
   No.         No.             Locality Name             Work      Expense     Malpractice
                                                          B1          B2           B3

  12302      01         Baltimore/Surr. Cntys, MD          1.027       1.097          1.206
  12302      99         Rest of Maryland                   1.011       1.035          0.987
  14202      01         Metropolitan Boston                1.014       1.149          0.790
  14202      99         Rest of Massachusetts              1.013       1.062          0.790
  00953      01         Detroit, MI                        1.022       1.023          1.814
  00953      99         Rest of Michigan                   1.000       0.923          1.069
  00954      00         Minnesota                          1.000       1.012          0.282
  00512      00         Mississippi                        1.000       0.866          0.761
  05302      01         Metropolitan St. Louis, MO         1.000       0.964          1.064
  05302      02         Metropolitan Kansas City, MO       1.000       0.953          1.233
  05302      99         Rest of Missouri*                  1.000       0.851          1.023
  03202      01         Montana                            1.000       1.000          1.103
  05402      00         Nebraska                           1.000       0.904          0.322
  01302      00         Nevada                             1.000       1.058          1.232
  14302      40         New Hampshire                      1.000       1.044          0.860
  12402      01         Northern NJ                        1.044       1.186          1.045
  12402      99         Rest of New Jersey                 1.021       1.126          1.045
  04202      05         New Mexico                         1.000       0.916          0.997
  13202      01         Manhattan, NY                      1.062       1.162          1.271
  13202      02         NYC Suburbs/Long I., NY            1.049       1.212          1.441
  13202      03         Poughkpsie/N NYC Suburbs, NY       1.011       1.065          1.081
  13282      99         Rest of New York                   1.000       0.939          0.562
  13292      04         Queens, NY                         1.062       1.195          1.491
  05535      00         North Carolina                     1.000       0.927          0.695
  03302      01         North Dakota                       1.000       1.000          0.517
  00883      00         Ohio                               1.000       0.927          1.240
  04302      00         Oklahoma                           1.000       0.856          0.734
  00835      01         Portland, OR                       1.005       1.044          0.625
  00835      99         Rest of Oregon                     1.000       0.962          0.625
  12502      01         Metropolitan Philadelphia, PA      1.014       1.059          1.624
  12502      99         Rest of Pennsylvania               1.000       0.913          1.123
  9202       20         Puerto Rico                        1.000       0.678          0.249
  14402      01         Rhode Island                       1.017       1.052          1.187
  00880      01         South Carolina                     1.000       0.909          0.520
  03402      02         South Dakota                       1.000       1.000          0.432
  10302      35         Tennessee                          1.000       0.898          0.523
  04402      09         Brazoria, TX                       1.009       0.987          0.923




                                         Page 4 of 121
                                                                                  8/14/2012




      2012 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI)

Contractor   Locality                                               Practice
   No.         No.             Locality Name              Work      Expense     Malpractice
                                                           B1          B2           B3

  04402      11         Dallas, TX                          1.009       1.017         0.834
  04402      15         Galveston, TX                       1.009       0.996         0.985
  04402      18         Houston, TX                         1.009       1.002         0.923
  04402      20         Beaumont, TX                        1.000       0.896         0.923
  04402      28         Fort Worth, TX                      1.000       0.979         0.826
  04402      31         Austin, TX                          1.000       1.009         0.751
  04402      99         Rest of Texas                       1.000       0.912         0.809
  03502      09         Utah                                1.000       0.916         1.102
  14502      50         Vermont                             1.000       1.008         0.554
  09202      50         Virgin Islands                      1.000       1.002         1.010
  00904      00         Virginia                            1.000       0.977         0.731
  00836      02         Seattle (King Cnty), WA             1.025       1.144         0.881
  00836      99         Rest of Washington                  1.000       1.012         0.861
  00884      16         West Virginia                       1.000       0.828         1.229
  00951      00         Wisconsin                           1.000       0.960         0.547
  03602      21         Wyoming                             1.000       1.000         1.233




                                          Page 5 of 121
                                                                                               8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description              Alabama         Alaska          Arizona
                                                               10102           00831           03102
                                                                00              01              00
  0019T         C      Extracorp shock wv tx ms nos                    0.00            0.00            0.00
  0183T         C      Wound ultrasound                                0.00            0.00            0.00
  64550         A      Apply neurostimulator                          14.66           19.58           15.79
  90901         A      Biofeedback train any meth                     35.93           47.67           38.60
  92506         A      Speech/hearing evaluation                     148.12          188.49          162.49
  92507         A      Speech/hearing therapy                         70.18           98.09           74.30
  92508         A      Speech/hearing therapy                         20.96           28.70           22.23
  92520         A      Laryngeal function studies                     64.43           85.68           69.52
  92526         A      Oral function therapy                          77.52          107.40           82.32
  92597         A      Oral speech device eval                        77.19          106.22           82.26
  92605         B      Ex for nonspeech device rx                      0.00            0.00            0.00
  92606         B      Non-speech device service                       0.00            0.00            0.00
  92607         A      Ex for speech device rx 1hr                   131.53          178.06          140.99
  92608         A      Ex for speech device rx addl                   42.70           58.79           45.51
  92609         A      Use of speech device service                   94.02          129.00          100.08
  92610         A      Evaluate swallowing function                   83.03          113.71           88.61
  92611         A      Motion fluoroscopy/swallow                     90.83          123.60           97.31
  92612         A      Endoscopy swallow tst (fees)                  153.44          198.98          167.15
  92614         A      Laryngoscopic sensory test                    137.90          180.09          149.84
  92616         A      Fees w/laryngeal sense test                   185.74          244.23          201.27
  95831         A      Limb muscle testing manual                     25.55           33.86           27.88
  95832         A      Hand muscle testing manual                     24.10           32.19           26.22
  95833         A      Body muscle testing manual                     34.39           46.38           36.65
  95834         A      Body muscle testing manual                     44.52           60.00           47.76
  95851         A      Range of motion measurements                   16.37           21.47           17.78
  95852         A      Range of motion measurements                   14.37           18.55           15.74
  95992         A      Canalith repositioning proc                    39.48           55.40           41.90
  96105         A      Assessment of aphasia                          96.07          133.83          100.89
  96111         A      Developmental test extend                     117.68          168.67          123.65
  96125         A      Cognitive test by hc pro                       93.06          129.77           98.23
  97001         A      Pt evaluation                                  68.85           95.44           72.87
  97002         A      Pt re-evaluation                               37.94           52.01           40.43
  97003         A      Ot evaluation                                  76.62          104.88           81.52
  97004         A      Ot re-evaluation                               46.61           62.54           50.09
  97010         B      Hot or cold packs therapy                       0.00            0.00            0.00
  97012         A      Mechanical traction therapy                    14.65           20.25           15.51
  97016         A      Vasopneumatic device therapy                   16.75           22.13           18.12
  97018         A      Paraffin bath therapy                           9.08           11.64           10.04
  97022         A      Whirlpool therapy                              19.99           25.97           21.78
  97024         A      Diathermy eg microwave                          5.79            7.65            6.38
  97026         R      Infrared therapy                                5.19            6.92            5.72
  97028         A      Ultraviolet therapy                             6.47            8.67            7.06
  97032         A      Electrical stimulation                         17.04           23.16           18.18
  97033         A      Electric current therapy                       27.84           36.38           30.17
  97034         A      Contrast bath therapy                          15.68           21.12           16.81
  97035         A      Ultrasound therapy                             11.49           16.03           12.15
  97036         A      Hydrotherapy                                   28.22           37.04           30.52
  97039         C      Physical therapy treatment                      0.00            0.00            0.00


                                              Page 6 of 121
                                                                                                         8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                Alabama          Alaska           Arizona
                                                                       10102            00831            03102
                                                                        00               01               00
   97110           A       Therapeutic exercises                               28.63            39.18            30.31
   97112           A       Neuromuscular reeducation                           29.82            40.63            31.64
   97113           A       Aquatic therapy/exercises                           37.55            49.93            40.29
   97116           A       Gait training therapy                               25.43            34.81            26.94
   97124           A       Massage therapy                                     23.43            31.90            24.91
   97139           C       Physical medicine procedure                          0.00             0.00             0.00
   97140           A       Manual therapy                                      26.75            36.71            28.30
   97150           A       Group therapeutic procedures                        18.32            24.91            19.52
   97530           A       Therapeutic activities                              31.28            42.30            33.30
   97532           A       Cognitive skills development                        24.10            33.59            25.31
   97533           A       Sensory integration                                 26.49            36.49            27.97
   97535           A       Self care mngment training                          31.02            42.09            32.97
   97537           A       Community/work reintegration                        27.13            37.36            28.65
   97542           A       Wheelchair mngment training                         27.73            38.09            29.31
   97597           A       Rmvl devital tis 20 cm/<                            67.48            87.09            74.01
   97598           A       Rmvl devital tis addl 20 cm<                        22.40            29.63            24.52
   97602           B       Wound(s) care non-selective                          0.00             0.00             0.00
   97605           A       Neg press wound tx < 50 cm                          37.05            50.58            40.46
   97606           A       Neg press wound tx > 50 cm                          39.37            53.95            43.18
   97750           A       Physical performance test                           29.85            40.72            32.00
   97755           A       Assistive technology assess                         32.94            46.13            34.79
   97760           A       Orthotic mgmt and training                          33.73            45.44            36.33
   97761           A       Prosthetic training                                 29.55            40.36            31.67
   97762           A       C/o for orthotic/prosth use                         39.75            50.76            43.48
   97799           C       Physical medicine procedure                          0.00             0.00             0.00
   G0281           A       Elec stim unattend for press                        12.27            16.68            13.13
   G0283           A       Elec stim other than wound                          12.27            16.68            13.13
   G0329           A       Electromagntic tx for ulcers                         8.78            11.28             9.71

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 7 of 121
                                                                                                 8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                      Marin/Napa/So San Francisco,
  Code        Status           Short Description              Arkansas           lano, CA         CA
                                                                00520              01102          01102
                                                                 13                  03            05
  0019T         C      Extracorp shock wv tx ms nos                     0.00            0.00              0.00
  0183T         C      Wound ultrasound                                 0.00            0.00              0.00
  64550         A      Apply neurostimulator                           14.52           18.49             19.71
  90901         A      Biofeedback train any meth                      35.60           45.83             48.93
  92506         A      Speech/hearing evaluation                      146.34          199.33            215.11
  92507         A      Speech/hearing therapy                          69.76           82.85             87.09
  92508         A      Speech/hearing therapy                          20.81           25.55             27.03
  92520         A      Laryngeal function studies                      63.83           81.82             87.32
  92526         A      Oral function therapy                           77.01           92.78             97.80
  92597         A      Oral speech device eval                         76.64           93.31             98.59
  92605         B      Ex for nonspeech device rx                       0.00            0.00              0.00
  92606         B      Non-speech device service                        0.00            0.00              0.00
  92607         A      Ex for speech device rx 1hr                    130.45          162.89            172.95
  92608         A      Ex for speech device rx addl                    42.40           51.57             54.48
  92609         A      Use of speech device service                    93.35          114.22            120.77
  92610         A      Evaluate swallowing function                    82.42          101.12            106.99
  92611         A      Motion fluoroscopy/swallow                      90.12          111.62            118.35
  92612         A      Endoscopy swallow tst (fees)                   151.77          201.57            216.53
  92614         A      Laryngoscopic sensory test                     136.46          179.48            192.46
  92616         A      Fees w/laryngeal sense test                    183.88          239.57            256.44
  95831         A      Limb muscle testing manual                      25.30           32.57             34.82
  95832         A      Hand muscle testing manual                      23.87           30.38             32.40
  95833         A      Body muscle testing manual                      34.11           42.88             45.56
  95834         A      Body muscle testing manual                      44.14           55.49             58.99
  95851         A      Range of motion measurements                    16.20           21.17             22.68
  95852         A      Range of motion measurements                    14.20           18.96             20.39
  95992         A      Canalith repositioning proc                     39.25           46.30             48.61
  96105         A      Assessment of aphasia                           95.51          114.20            120.11
  96111         A      Developmental test extend                      117.15          133.30            138.88
  96125         A      Cognitive test by hc pro                        92.50          110.33            116.03
  97001         A      Pt evaluation                                   68.40           82.36             86.79
  97002         A      Pt re-evaluation                                37.66           46.14             48.81
  97003         A      Ot evaluation                                   76.06           93.40             98.82
  97004         A      Ot re-evaluation                                46.20           58.46             62.23
  97010         B      Hot or cold packs therapy                        0.00            0.00              0.00
  97012         A      Mechanical traction therapy                     14.55           17.59             18.56
  97016         A      Vasopneumatic device therapy                    16.58           21.46             22.95
  97018         A      Paraffin bath therapy                            8.97           12.07             13.01
  97022         A      Whirlpool therapy                               19.78           26.20             28.14
  97024         A      Diathermy eg microwave                           5.73            7.40              7.92
  97026         R      Infrared therapy                                 5.14            6.55              6.99
  97028         A      Ultraviolet therapy                              6.41            8.11              8.65
  97032         A      Electrical stimulation                          16.91           20.99             22.26
  97033         A      Electric current therapy                        27.55           36.22             38.83
  97034         A      Contrast bath therapy                           15.54           19.56             20.80
  97035         A      Ultrasound therapy                              11.42           13.61             14.32
  97036         A      Hydrotherapy                                    27.94           36.51             39.09
  97039         C      Physical therapy treatment                       0.00            0.00              0.00


                                              Page 8 of 121
                                                                                                           8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                               Marin/Napa/So San Francisco,
  Code           Status              Short Description                Arkansas            lano, CA         CA
                                                                        00520               01102          01102
                                                                         13                   03            05
   97110           A       Therapeutic exercises                                28.42              34.94           36.96
   97112           A       Neuromuscular reeducation                            29.60              36.64           38.82
   97113           A       Aquatic therapy/exercises                            37.21              47.75           50.95
   97116           A       Gait training therapy                                25.25              31.03           32.82
   97124           A       Massage therapy                                      23.25              28.82           30.54
   97139           C       Physical medicine procedure                           0.00               0.00            0.00
   97140           A       Manual therapy                                       26.57              32.53           34.38
   97150           A       Group therapeutic procedures                         18.18              22.56           23.91
   97530           A       Therapeutic activities                               31.03              38.83           41.23
   97532           A       Cognitive skills development                         23.96              28.64           30.12
   97533           A       Sensory integration                                  26.32              32.04           33.82
   97535           A       Self care mngment training                           30.78              38.34           40.67
   97537           A       Community/work reintegration                         26.95              32.82           34.65
   97542           A       Wheelchair mngment training                          27.54              33.67           35.57
   97597           A       Rmvl devital tis 20 cm/<                             66.71              89.11           95.87
   97598           A       Rmvl devital tis addl 20 cm<                         22.17              28.59           30.58
   97602           B       Wound(s) care non-selective                           0.00               0.00            0.00
   97605           A       Neg press wound tx < 50 cm                           36.73              45.13           47.86
   97606           A       Neg press wound tx > 50 cm                           39.03              47.65           50.50
   97750           A       Physical performance test                            29.61              36.53           38.70
   97755           A       Assistive technology assess                          32.75              38.79           40.74
   97760           A       Orthotic mgmt and training                           33.44              42.05           44.72
   97761           A       Prosthetic training                                  29.32              36.10           38.24
   97762           A       C/o for orthotic/prosth use                          39.28              53.28           57.44
   97799           C       Physical medicine procedure                           0.00               0.00            0.00
   G0281           A       Elec stim unattend for press                         12.17              15.09           16.00
   G0283           A       Elec stim other than wound                           12.17              15.09           16.00
   G0329           A       Electromagntic tx for ulcers                          8.67              11.65           12.55

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 9 of 121
                                                                                                 8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                    Oakland/Berkl   Santa Clara,
  Code        Status           Short Description         San Mateo, CA          ey, CA           CA
                                                              01102              01102          01102
                                                               06                 07              09
  0019T         C      Extracorp shock wv tx ms nos                   0.00            0.00               0.00
  0183T         C      Wound ultrasound                               0.00            0.00               0.00
  64550         A      Apply neurostimulator                         19.65           18.61              19.52
  90901         A      Biofeedback train any meth                    48.78           46.10              48.43
  92506         A      Speech/hearing evaluation                    214.30          200.45             212.16
  92507         A      Speech/hearing therapy                        86.92           83.47              86.66
  92508         A      Speech/hearing therapy                        26.96           25.72              26.84
  92520         A      Laryngeal function studies                    87.06           82.35              86.45
  92526         A      Oral function therapy                         97.59           93.45              97.23
  92597         A      Oral speech device eval                       98.36           93.98              97.93
  92605         B      Ex for nonspeech device rx                     0.00            0.00               0.00
  92606         B      Non-speech device service                      0.00            0.00               0.00
  92607         A      Ex for speech device rx 1hr                  172.49          163.99             171.51
  92608         A      Ex for speech device rx addl                  54.36           51.95              54.12
  92609         A      Use of speech device service                 120.48          115.00             119.93
  92610         A      Evaluate swallowing function                 106.73          101.83             106.23
  92611         A      Motion fluoroscopy/swallow                   118.05          112.41             117.42
  92612         A      Endoscopy swallow tst (fees)                 215.79          202.76             213.89
  92614         A      Laryngoscopic sensory test                   191.82          180.56             190.23
  92616         A      Fees w/laryngeal sense test                  255.62          241.04             253.62
  95831         A      Limb muscle testing manual                    34.71           32.81              34.46
  95832         A      Hand muscle testing manual                    32.31           30.60              32.09
  95833         A      Body muscle testing manual                    45.44           43.14              45.17
  95834         A      Body muscle testing manual                    58.83           55.85              58.47
  95851         A      Range of motion measurements                  22.61           21.30              22.42
  95852         A      Range of motion measurements                  20.32           19.08              20.14
  95992         A      Canalith repositioning proc                   48.52           46.67              48.40
  96105         A      Assessment of aphasia                        119.86          114.94             119.46
  96111         A      Developmental test extend                    138.70          134.43             138.62
  96125         A      Cognitive test by hc pro                     115.80          111.11             115.43
  97001         A      Pt evaluation                                 86.60           82.93              86.28
  97002         A      Pt re-evaluation                              48.69           46.46              48.46
  97003         A      Ot evaluation                                 98.59           94.03              98.11
  97004         A      Ot re-evaluation                              62.05           58.84              61.66
  97010         B      Hot or cold packs therapy                      0.00            0.00               0.00
  97012         A      Mechanical traction therapy                   18.52           17.72              18.44
  97016         A      Vasopneumatic device therapy                  22.87           21.60              22.70
  97018         A      Paraffin bath therapy                         12.96           12.15              12.84
  97022         A      Whirlpool therapy                             28.04           26.36              27.80
  97024         A      Diathermy eg microwave                         7.90            7.46               7.84
  97026         R      Infrared therapy                               6.97            6.60               6.93
  97028         A      Ultraviolet therapy                            8.63            8.18               8.57
  97032         A      Electrical stimulation                        22.20           21.13              22.08
  97033         A      Electric current therapy                      38.70           36.43              38.38
  97034         A      Contrast bath therapy                         20.74           19.69              20.62
  97035         A      Ultrasound therapy                            14.29           13.71              14.25
  97036         A      Hydrotherapy                                  38.97           36.72              38.66
  97039         C      Physical therapy treatment                     0.00            0.00               0.00


                                             Page 10 of 121
                                                                                                                8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                                 Oakland/Berkl     Santa Clara,
  Code           Status              Short Description                San Mateo, CA          ey, CA             CA
                                                                          01102               01102            01102
                                                                           06                  07                09
   97110           A       Therapeutic exercises                                  36.87             35.16              36.70
   97112           A       Neuromuscular reeducation                              38.72             36.87              38.52
   97113           A       Aquatic therapy/exercises                              50.80             48.03              50.44
   97116           A       Gait training therapy                                  32.74             31.23              32.59
   97124           A       Massage therapy                                        30.46             29.00              30.30
   97139           C       Physical medicine procedure                             0.00              0.00               0.00
   97140           A       Manual therapy                                         34.30             32.73              34.14
   97150           A       Group therapeutic procedures                           23.85             22.70              23.73
   97530           A       Therapeutic activities                                 41.12             39.07              40.88
   97532           A       Cognitive skills development                           30.06             28.83              29.96
   97533           A       Sensory integration                                    33.74             32.24              33.60
   97535           A       Self care mngment training                             40.56             38.58              40.34
   97537           A       Community/work reintegration                           34.57             33.03              34.42
   97542           A       Wheelchair mngment training                            35.49             33.88              35.33
   97597           A       Rmvl devital tis 20 cm/<                               95.53             89.67              94.66
   97598           A       Rmvl devital tis addl 20 cm<                           30.48             28.80              30.26
   97602           B       Wound(s) care non-selective                             0.00              0.00               0.00
   97605           A       Neg press wound tx < 50 cm                             47.74             45.54              47.51
   97606           A       Neg press wound tx > 50 cm                             50.38             48.12              50.15
   97750           A       Physical performance test                              38.61             36.79              38.41
   97755           A       Assistive technology assess                            40.66             39.07              40.55
   97760           A       Orthotic mgmt and training                             44.60             42.34              44.33
   97761           A       Prosthetic training                                    38.15             36.37              37.96
   97762           A       C/o for orthotic/prosth use                            57.23             53.57              56.67
   97799           C       Physical medicine procedure                             0.00              0.00               0.00
   G0281           A       Elec stim unattend for press                           15.96             15.19              15.88
   G0283           A       Elec stim other than wound                             15.96             15.19              15.88
   G0329           A       Electromagntic tx for ulcers                           12.50             11.73              12.39

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 11 of 121
                                                                                                     8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                      Rest of                            Los Angeles,
  Code        Status           Short Description              California*       Ventura, CA           CA
                                                                 01102             01192              01192
                                                                  99                17                 18
  0019T         C      Extracorp shock wv tx ms nos                      0.00              0.00               0.00
  0183T         C      Wound ultrasound                                  0.00              0.00               0.00
  64550         A      Apply neurostimulator                            16.80             17.91              17.56
  90901         A      Biofeedback train any meth                       41.44             44.28              43.35
  92506         A      Speech/hearing evaluation                       176.78            191.69             186.57
  92507         A      Speech/hearing therapy                           77.27             80.90              79.97
  92508         A      Speech/hearing therapy                           23.51             24.81              24.42
  92520         A      Laryngeal function studies                       74.16             79.20              77.60
  92526         A      Oral function therapy                            86.05             90.43              89.24
  92597         A      Oral speech device eval                          86.21             90.86              89.56
  92605         B      Ex for nonspeech device rx                        0.00              0.00               0.00
  92606         B      Non-speech device service                         0.00              0.00               0.00
  92607         A      Ex for speech device rx 1hr                     149.07            158.13             155.41
  92608         A      Ex for speech device rx addl                     47.67             50.23              49.52
  92609         A      Use of speech device service                    105.29            111.08             109.42
  92610         A      Evaluate swallowing function                     93.15             98.36              96.86
  92611         A      Motion fluoroscopy/swallow                      102.48            108.50             106.74
  92612         A      Endoscopy swallow tst (fees)                    180.37            194.35             189.68
  92614         A      Laryngoscopic sensory test                      161.16            173.24             169.26
  92616         A      Fees w/laryngeal sense test                     215.85            231.47             226.38
  95831         A      Limb muscle testing manual                       29.52             31.59              30.95
  95832         A      Hand muscle testing manual                       27.65             29.50              28.95
  95833         A      Body muscle testing manual                       39.10             41.52              40.75
  95834         A      Body muscle testing manual                       50.65             53.81              52.84
  95851         A      Range of motion measurements                     19.06             20.46              20.00
  95852         A      Range of motion measurements                     16.95             18.29              17.85
  95992         A      Canalith repositioning proc                      43.32             45.29              44.82
  96105         A      Assessment of aphasia                           106.06            111.14             109.72
  96111         A      Developmental test extend                       126.47            130.94             130.14
  96125         A      Cognitive test by hc pro                        102.66            107.56             106.26
  97001         A      Pt evaluation                                    76.36             80.22              79.15
  97002         A      Pt re-evaluation                                 42.52             44.88              44.20
  97003         A      Ot evaluation                                    85.97             90.77              89.37
  97004         A      Ot re-evaluation                                 53.23             56.66              55.59
  97010         B      Hot or cold packs therapy                         0.00              0.00               0.00
  97012         A      Mechanical traction therapy                      16.29             17.13              16.89
  97016         A      Vasopneumatic device therapy                     19.39             20.75              20.31
  97018         A      Paraffin bath therapy                            10.77             11.66              11.37
  97022         A      Whirlpool therapy                                23.47             25.27              24.67
  97024         A      Diathermy eg microwave                            6.71              7.19               7.05
  97026         R      Infrared therapy                                  5.97              6.38               6.26
  97028         A      Ultraviolet therapy                               7.41              7.89               7.75
  97032         A      Electrical stimulation                           19.24             20.37              20.03
  97033         A      Electric current therapy                         32.51             34.94              34.13
  97034         A      Contrast bath therapy                            17.85             18.97              18.62
  97035         A      Ultrasound therapy                               12.68             13.28              13.12
  97036         A      Hydrotherapy                                     32.84             35.24              34.45
  97039         C      Physical therapy treatment                        0.00              0.00               0.00


                                             Page 12 of 121
                                                                                                                8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                               Rest of                              Los Angeles,
  Code           Status              Short Description                 California*        Ventura, CA            CA
                                                                          01102              01192               01192
                                                                           99                 17                  18
   97110           A       Therapeutic exercises                                  32.12              33.91               33.37
   97112           A       Neuromuscular reeducation                              33.60              35.53               34.94
   97113           A       Aquatic therapy/exercises                              43.22              46.15               45.19
   97116           A       Gait training therapy                                  28.53              30.12               29.64
   97124           A       Massage therapy                                        26.42              27.95               27.49
   97139           C       Physical medicine procedure                             0.00               0.00                0.00
   97140           A       Manual therapy                                         29.95              31.58               31.09
   97150           A       Group therapeutic procedures                           20.68              21.89               21.52
   97530           A       Therapeutic activities                                 35.46              37.62               36.95
   97532           A       Cognitive skills development                           26.60              27.87               27.52
   97533           A       Sensory integration                                    29.56              31.12               30.66
   97535           A       Self care mngment training                             35.07              37.16               36.51
   97537           A       Community/work reintegration                           30.27              31.88               31.41
   97542           A       Wheelchair mngment training                            31.01              32.69               32.19
   97597           A       Rmvl devital tis 20 cm/<                               79.64              85.98               83.89
   97598           A       Rmvl devital tis addl 20 cm<                           25.91              27.74               27.19
   97602           B       Wound(s) care non-selective                             0.00               0.00                0.00
   97605           A       Neg press wound tx < 50 cm                             41.71              44.15               43.53
   97606           A       Neg press wound tx > 50 cm                             44.19              46.73               46.13
   97750           A       Physical performance test                              33.60              35.54               34.99
   97755           A       Assistive technology assess                            36.20              37.87               37.44
   97760           A       Orthotic mgmt and training                             38.40              40.82               40.09
   97761           A       Prosthetic training                                    33.23              35.13               34.59
   97762           A       C/o for orthotic/prosth use                            47.31              51.24               49.88
   97799           C       Physical medicine procedure                             0.00               0.00                0.00
   G0281           A       Elec stim unattend for press                           13.85              14.66               14.42
   G0283           A       Elec stim other than wound                             13.85              14.66               14.42
   G0329           A       Electromagntic tx for ulcers                           10.40              11.25               10.98

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 13 of 121
                                                                                                8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                 Anaheim/Sant        Rest of
  Code        Status           Short Description            a Ana, CA        California*       Colorado
                                                              01192             01192            04102
                                                               26                99               01
  0019T         C      Extracorp shock wv tx ms nos                   0.00              0.00             0.00
  0183T         C      Wound ultrasound                               0.00              0.00             0.00
  64550         A      Apply neurostimulator                         18.23             16.80            15.99
  90901         A      Biofeedback train any meth                    45.06             41.44            39.20
  92506         A      Speech/hearing evaluation                    195.47            176.78           165.74
  92507         A      Speech/hearing therapy                        82.22             77.27            74.69
  92508         A      Speech/hearing therapy                        25.22             23.51            22.46
  92520         A      Laryngeal function studies                    80.64             74.16            70.46
  92526         A      Oral function therapy                         91.93             86.05            82.89
  92597         A      Oral speech device eval                       92.40             86.21            82.90
  92605         B      Ex for nonspeech device rx                     0.00              0.00             0.00
  92606         B      Non-speech device service                      0.00              0.00             0.00
  92607         A      Ex for speech device rx 1hr                  160.91            149.07           142.49
  92608         A      Ex for speech device rx addl                  51.08             47.67            45.86
  92609         A      Use of speech device service                 112.95            105.29           100.98
  92610         A      Evaluate swallowing function                 100.04             93.15            89.39
  92611         A      Motion fluoroscopy/swallow                   110.40            102.48            98.22
  92612         A      Endoscopy swallow tst (fees)                 198.06            180.37           170.04
  92614         A      Laryngoscopic sensory test                   176.50            161.16           152.27
  92616         A      Fees w/laryngeal sense test                  235.77            215.85           204.34
  95831         A      Limb muscle testing manual                    32.20             29.52            28.19
  95832         A      Hand muscle testing manual                    30.07             27.65            26.48
  95833         A      Body muscle testing manual                    42.22             39.10            37.14
  95834         A      Body muscle testing manual                    54.76             50.65            48.31
  95851         A      Range of motion measurements                  20.84             19.06            18.05
  95852         A      Range of motion measurements                  18.65             16.95            16.00
  95992         A      Canalith repositioning proc                   46.04             43.32            42.05
  96105         A      Assessment of aphasia                        112.86            106.06           101.76
  96111         A      Developmental test extend                    132.97            126.47           123.66
  96125         A      Cognitive test by hc pro                     109.28            102.66            98.90
  97001         A      Pt evaluation                                 81.52             76.36            73.43
  97002         A      Pt re-evaluation                              45.64             42.52            40.79
  97003         A      Ot evaluation                                 92.30             85.97            82.31
  97004         A      Ot re-evaluation                              57.67             53.23            50.70
  97010         B      Hot or cold packs therapy                      0.00              0.00             0.00
  97012         A      Mechanical traction therapy                   17.41             16.29            15.64
  97016         A      Vasopneumatic device therapy                  21.14             19.39            18.38
  97018         A      Paraffin bath therapy                         11.90             10.77            10.20
  97022         A      Whirlpool therapy                             25.76             23.47            22.14
  97024         A      Diathermy eg microwave                         7.34              6.71             6.44
  97026         R      Infrared therapy                               6.51              5.97             5.76
  97028         A      Ultraviolet therapy                            8.05              7.41             7.12
  97032         A      Electrical stimulation                        20.72             19.24            18.37
  97033         A      Electric current therapy                      35.59             32.51            30.68
  97034         A      Contrast bath therapy                         19.30             17.85            17.01
  97035         A      Ultrasound therapy                            13.50             12.68            12.23
  97036         A      Hydrotherapy                                  35.88             32.84            31.02
  97039         C      Physical therapy treatment                     0.00              0.00             0.00


                                             Page 14 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                             Anaheim/Sant         Rest of
  Code           Status              Short Description                  a Ana, CA         California*        Colorado
                                                                          01192              01192             04102
                                                                           26                 99                01
   97110           A       Therapeutic exercises                                  34.46              32.12             30.65
   97112           A       Neuromuscular reeducation                              36.12              33.60             32.02
   97113           A       Aquatic therapy/exercises                              46.96              43.22             40.90
   97116           A       Gait training therapy                                  30.61              28.53             27.24
   97124           A       Massage therapy                                        28.42              26.42             25.20
   97139           C       Physical medicine procedure                             0.00               0.00              0.00
   97140           A       Manual therapy                                         32.09              29.95             28.60
   97150           A       Group therapeutic procedures                           22.26              20.68             19.74
   97530           A       Therapeutic activities                                 38.25              35.46             33.73
   97532           A       Cognitive skills development                           28.30              26.60             25.53
   97533           A       Sensory integration                                    31.62              29.56             28.26
   97535           A       Self care mngment training                             37.78              35.07             33.38
   97537           A       Community/work reintegration                           32.39              30.27             28.94
   97542           A       Wheelchair mngment training                            33.22              31.01             29.62
   97597           A       Rmvl devital tis 20 cm/<                               87.68              79.64             75.23
   97598           A       Rmvl devital tis addl 20 cm<                           28.29              25.91             24.78
   97602           B       Wound(s) care non-selective                             0.00               0.00              0.00
   97605           A       Neg press wound tx < 50 cm                             45.02              41.71             40.57
   97606           A       Neg press wound tx > 50 cm                             47.67              44.19             43.21
   97750           A       Physical performance test                              36.17              33.60             32.27
   97755           A       Assistive technology assess                            38.48              36.20             34.98
   97760           A       Orthotic mgmt and training                             41.56              38.40             36.71
   97761           A       Prosthetic training                                    35.75              33.23             31.93
   97762           A       C/o for orthotic/prosth use                            52.23              47.31             44.35
   97799           C       Physical medicine procedure                             0.00               0.00              0.00
   G0281           A       Elec stim unattend for press                           14.92              13.85             13.26
   G0283           A       Elec stim other than wound                             14.92              13.85             13.26
   G0329           A       Electromagntic tx for ulcers                           11.48              10.40              9.86

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 15 of 121
                                                                                                   8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                       DC + MD/VA
  Code        Status           Short Description              Connecticut        Suburbs          Delaware
                                                                 13102             12202            12102
                                                                  00                01               01
  0019T         C      Extracorp shock wv tx ms nos                      0.00              0.00             0.00
  0183T         C      Wound ultrasound                                  0.00              0.00             0.00
  64550         A      Apply neurostimulator                            17.27             18.23            16.38
  90901         A      Biofeedback train any meth                       42.29             44.79            40.29
  92506         A      Speech/hearing evaluation                       181.31            193.70           171.13
  92507         A      Speech/hearing therapy                           79.61             82.95            75.88
  92508         A      Speech/hearing therapy                           24.01             25.22            22.97
  92520         A      Laryngeal function studies                       76.18             80.51            72.23
  92526         A      Oral function therapy                            88.56             92.54            84.36
  92597         A      Oral speech device eval                          88.80             92.94            84.45
  92605         B      Ex for nonspeech device rx                        0.00              0.00             0.00
  92606         B      Non-speech device service                         0.00              0.00             0.00
  92607         A      Ex for speech device rx 1hr                     153.32            161.24           145.61
  92608         A      Ex for speech device rx addl                     49.13             51.41            46.70
  92609         A      Use of speech device service                    108.12            113.34           103.02
  92610         A      Evaluate swallowing function                     95.86            100.49            91.16
  92611         A      Motion fluoroscopy/swallow                      105.61            110.86           100.22
  92612         A      Endoscopy swallow tst (fees)                    185.11            196.87           175.05
  92614         A      Laryngoscopic sensory test                      165.46            175.67           156.57
  92616         A      Fees w/laryngeal sense test                     221.61            234.90           209.90
  95831         A      Limb muscle testing manual                       30.67             32.36            28.81
  95832         A      Hand muscle testing manual                       28.75             30.27            27.02
  95833         A      Body muscle testing manual                       39.85             42.04            38.09
  95834         A      Body muscle testing manual                       52.02             54.79            49.43
  95851         A      Range of motion measurements                     19.60             20.78            18.53
  95852         A      Range of motion measurements                     17.48             18.58            16.46
  95992         A      Canalith repositioning proc                      44.87             46.64            42.61
  96105         A      Assessment of aphasia                           108.01            112.96           103.84
  96111         A      Developmental test extend                       130.97            135.28           124.85
  96125         A      Cognitive test by hc pro                        105.27            109.88           100.67
  97001         A      Pt evaluation                                    78.31             81.88            74.82
  97002         A      Pt re-evaluation                                 43.71             45.82            41.61
  97003         A      Ot evaluation                                    88.13             92.48            84.06
  97004         A      Ot re-evaluation                                 54.67             57.65            51.91
  97010         B      Hot or cold packs therapy                         0.00              0.00             0.00
  97012         A      Mechanical traction therapy                      16.69             17.47            15.95
  97016         A      Vasopneumatic device therapy                     19.92             21.08            18.87
  97018         A      Paraffin bath therapy                            11.20             11.91            10.47
  97022         A      Whirlpool therapy                                24.10             25.62            22.79
  97024         A      Diathermy eg microwave                            7.05              7.42             6.56
  97026         R      Infrared therapy                                  6.29              6.60             5.85
  97028         A      Ultraviolet therapy                               7.74              8.13             7.25
  97032         A      Electrical stimulation                           19.71             20.73            18.79
  97033         A      Electric current therapy                         33.29             35.36            31.57
  97034         A      Contrast bath therapy                            18.32             19.30            17.41
  97035         A      Ultrasound therapy                               13.03             13.59            12.44
  97036         A      Hydrotherapy                                     33.60             35.66            31.91
  97039         C      Physical therapy treatment                        0.00              0.00             0.00


                                             Page 16 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                                 DC + MD/VA
  Code           Status              Short Description                 Connecticut         Suburbs           Delaware
                                                                          13102              12202             12102
                                                                           00                 01                01
   97110           A       Therapeutic exercises                                  32.73              34.39             31.36
   97112           A       Neuromuscular reeducation                              34.24              36.03             32.79
   97113           A       Aquatic therapy/exercises                              44.09              46.68             42.04
   97116           A       Gait training therapy                                  29.10              30.57             27.87
   97124           A       Massage therapy                                        26.98              28.38             25.79
   97139           C       Physical medicine procedure                             0.00               0.00              0.00
   97140           A       Manual therapy                                         30.52              32.05             29.25
   97150           A       Group therapeutic procedures                           21.17              22.26             20.19
   97530           A       Therapeutic activities                                 36.16              38.11             34.57
   97532           A       Cognitive skills development                           27.09              28.33             26.05
   97533           A       Sensory integration                                    30.11              31.59             28.89
   97535           A       Self care mngment training                             35.75              37.66             34.21
   97537           A       Community/work reintegration                           30.84              32.36             29.59
   97542           A       Wheelchair mngment training                            31.60              33.17             30.30
   97597           A       Rmvl devital tis 20 cm/<                               82.22              87.42             77.34
   97598           A       Rmvl devital tis addl 20 cm<                           27.01              28.48             25.30
   97602           B       Wound(s) care non-selective                             0.00               0.00              0.00
   97605           A       Neg press wound tx < 50 cm                             44.07              45.96             41.03
   97606           A       Neg press wound tx > 50 cm                             47.03              48.92             43.57
   97750           A       Physical performance test                              34.70              36.39             32.89
   97755           A       Assistive technology assess                            37.23              38.79             35.55
   97760           A       Orthotic mgmt and training                             39.61              41.69             37.51
   97761           A       Prosthetic training                                    34.33              35.98             32.53
   97762           A       C/o for orthotic/prosth use                            48.43              51.72             45.80
   97799           C       Physical medicine procedure                             0.00               0.00              0.00
   G0281           A       Elec stim unattend for press                           14.25              14.97             13.54
   G0283           A       Elec stim other than wound                             14.25              14.97             13.54
   G0329           A       Electromagntic tx for ulcers                           10.82              11.50             10.11

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 17 of 121
                                                                                                     8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION
                                                                 Fort
CPT/HCPCS                                                     Lauderdale,
  Code        Status           Short Description                  FL            Miami, FL        Rest of Florida
                                                                 09102            09102               09102
                                                                  03               04                  99
  0019T         C      Extracorp shock wv tx ms nos                      0.00             0.00                0.00
  0183T         C      Wound ultrasound                                  0.00             0.00                0.00
  64550         A      Apply neurostimulator                            16.82            17.13               15.88
  90901         A      Biofeedback train any meth                       40.74            41.10               38.54
  92506         A      Speech/hearing evaluation                       173.95           175.77              162.06
  92507         A      Speech/hearing therapy                           78.66            80.73               75.30
  92508         A      Speech/hearing therapy                           23.35            23.67               22.30
  92520         A      Laryngeal function studies                       74.02            75.28               69.82
  92526         A      Oral function therapy                            87.18            89.27               83.25
  92597         A      Oral speech device eval                          87.32            89.42               83.16
  92605         B      Ex for nonspeech device rx                        0.00             0.00                0.00
  92606         B      Non-speech device service                         0.00             0.00                0.00
  92607         A      Ex for speech device rx 1hr                     149.85           152.91              142.06
  92608         A      Ex for speech device rx addl                     48.35            49.54               46.04
  92609         A      Use of speech device service                    105.86           107.99              100.88
  92610         A      Evaluate swallowing function                     94.05            96.16               89.46
  92611         A      Motion fluoroscopy/swallow                      103.59           106.01               98.27
  92612         A      Endoscopy swallow tst (fees)                    178.52           180.88              167.19
  92614         A      Laryngoscopic sensory test                      159.92           162.23              150.06
  92616         A      Fees w/laryngeal sense test                     214.55           217.79              201.73
  95831         A      Limb muscle testing manual                       30.16            31.06               28.25
  95832         A      Hand muscle testing manual                       28.35            29.25               26.61
  95833         A      Body muscle testing manual                       38.49            38.84               36.62
  95834         A      Body muscle testing manual                       50.71            51.64               48.04
  95851         A      Range of motion measurements                     19.00            19.32               17.84
  95852         A      Range of motion measurements                     16.94            17.26               15.80
  95992         A      Canalith repositioning proc                      44.64            46.10               42.67
  96105         A      Assessment of aphasia                           105.19           106.45              101.22
  96111         A      Developmental test extend                       131.13           135.76              126.28
  96125         A      Cognitive test by hc pro                        103.37           105.47               99.13
  97001         A      Pt evaluation                                    76.77            78.28               73.47
  97002         A      Pt re-evaluation                                 42.84            43.75               40.79
  97003         A      Ot evaluation                                    86.07            87.61               82.04
  97004         A      Ot re-evaluation                                 53.21            54.15               50.34
  97010         B      Hot or cold packs therapy                         0.00             0.00                0.00
  97012         A      Mechanical traction therapy                      16.34            16.64               15.63
  97016         A      Vasopneumatic device therapy                     19.32            19.64               18.19
  97018         A      Paraffin bath therapy                            10.94            11.25               10.15
  97022         A      Whirlpool therapy                                23.27            23.61               21.80
  97024         A      Diathermy eg microwave                            7.01             7.31                6.52
  97026         R      Infrared therapy                                  6.29             6.59                5.87
  97028         A      Ultraviolet therapy                               7.69             7.99                7.21
  97032         A      Electrical stimulation                           19.20            19.51               18.26
  97033         A      Electric current therapy                         32.06            32.41               30.14
  97034         A      Contrast bath therapy                            17.84            18.15               16.90
  97035         A      Ultrasound therapy                               12.83            13.13               12.29
  97036         A      Hydrotherapy                                     32.38            32.73               30.49
  97039         C      Physical therapy treatment                        0.00             0.00                0.00


                                             Page 18 of 121
                                                                                                                8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION
                                                                          Fort
CPT/HCPCS                                                              Lauderdale,
  Code           Status              Short Description                     FL             Miami, FL         Rest of Florida
                                                                          09102             09102                09102
                                                                           03                04                   99
   97110           A       Therapeutic exercises                                  31.73             32.06                30.34
   97112           A       Neuromuscular reeducation                              33.16             33.50                31.66
   97113           A       Aquatic therapy/exercises                              42.48             42.84                40.22
   97116           A       Gait training therapy                                  28.24             28.56                26.99
   97124           A       Massage therapy                                        26.18             26.50                24.96
   97139           C       Physical medicine procedure                             0.00              0.00                 0.00
   97140           A       Manual therapy                                         29.62             29.94                28.34
   97150           A       Group therapeutic procedures                           20.60             20.91                19.60
   97530           A       Therapeutic activities                                 34.97             35.31                33.30
   97532           A       Cognitive skills development                           26.38             26.70                25.39
   97533           A       Sensory integration                                    29.25             29.57                28.03
   97535           A       Self care mngment training                             34.59             34.93                32.98
   97537           A       Community/work reintegration                           29.94             30.27                28.70
   97542           A       Wheelchair mngment training                            30.66             30.98                29.35
   97597           A       Rmvl devital tis 20 cm/<                               79.76             81.34                74.37
   97598           A       Rmvl devital tis addl 20 cm<                           26.65             27.55                24.91
   97602           B       Wound(s) care non-selective                             0.00              0.00                 0.00
   97605           A       Neg press wound tx < 50 cm                             44.51             46.84                41.73
   97606           A       Neg press wound tx > 50 cm                             47.92             50.81                44.82
   97750           A       Physical performance test                              34.15             35.05                32.39
   97755           A       Assistive technology assess                            36.72             37.61                35.21
   97760           A       Orthotic mgmt and training                             38.80             39.72                36.67
   97761           A       Prosthetic training                                    33.80             34.69                32.06
   97762           A       C/o for orthotic/prosth use                            46.39             46.78                43.30
   97799           C       Physical medicine procedure                             0.00              0.00                 0.00
   G0281           A       Elec stim unattend for press                           13.96             14.26                13.25
   G0283           A       Elec stim other than wound                             13.96             14.26                13.25
   G0329           A       Electromagntic tx for ulcers                           10.59             10.89                 9.82

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 19 of 121
                                                                                                   8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                       Rest of
  Code        Status           Short Description              Atlanta, GA       Georgia         Hawaii/Guam
                                                                 10202           10202             01202
                                                                  01              99                01
  0019T         C      Extracorp shock wv tx ms nos                      0.00            0.00           0.00
  0183T         C      Wound ultrasound                                  0.00            0.00           0.00
  64550         A      Apply neurostimulator                            16.14           15.00          17.36
  90901         A      Biofeedback train any meth                       39.53           36.58          42.87
  92506         A      Speech/hearing evaluation                       167.41          151.59         185.62
  92507         A      Speech/hearing therapy                           75.27           71.83          78.52
  92508         A      Speech/hearing therapy                           22.63           21.33          24.04
  92520         A      Laryngeal function studies                       71.09           65.92          76.76
  92526         A      Oral function therapy                            83.55           79.30          87.74
  92597         A      Oral speech device eval                          83.58           79.03          88.16
  92605         B      Ex for nonspeech device rx                        0.00            0.00           0.00
  92606         B      Non-speech device service                         0.00            0.00           0.00
  92607         A      Ex for speech device rx 1hr                     143.71          134.60         153.34
  92608         A      Ex for speech device rx addl                     46.24           43.73          48.74
  92609         A      Use of speech device service                    101.79           96.06         107.72
  92610         A      Evaluate swallowing function                     90.13           84.97          95.41
  92611         A      Motion fluoroscopy/swallow                       99.07           93.07         105.26
  92612         A      Endoscopy swallow tst (fees)                    171.68          157.00         188.27
  92614         A      Laryngoscopic sensory test                      153.71          141.11         167.84
  92616         A      Fees w/laryngeal sense test                     206.23          190.02         224.28
  95831         A      Limb muscle testing manual                       28.48           26.37          30.67
  95832         A      Hand muscle testing manual                       26.75           24.88          28.65
  95833         A      Body muscle testing manual                       37.43           34.96          40.20
  95834         A      Body muscle testing manual                       48.73           45.52          52.17
  95851         A      Range of motion measurements                     18.22           16.77          19.82
  95852         A      Range of motion measurements                     16.17           14.76          17.73
  95992         A      Canalith repositioning proc                      42.40           40.56          44.00
  96105         A      Assessment of aphasia                           102.43           97.51         107.65
  96111         A      Developmental test extend                       124.59          120.76         127.27
  96125         A      Cognitive test by hc pro                         99.63           94.92         104.31
  97001         A      Pt evaluation                                    73.98           70.24          77.78
  97002         A      Pt re-evaluation                                 41.12           38.79          43.53
  97003         A      Ot evaluation                                    82.96           78.19          87.99
  97004         A      Ot re-evaluation                                 51.14           47.66          54.92
  97010         B      Hot or cold packs therapy                         0.00            0.00           0.00
  97012         A      Mechanical traction therapy                      15.76           14.94          16.60
  97016         A      Vasopneumatic device therapy                     18.55           17.14          20.11
  97018         A      Paraffin bath therapy                            10.32            9.39          11.31
  97022         A      Whirlpool therapy                                22.36           20.47          24.49
  97024         A      Diathermy eg microwave                            6.52            6.03           6.99
  97026         R      Infrared therapy                                  5.82            5.41           6.21
  97028         A      Ultraviolet therapy                               7.20            6.71           7.67
  97032         A      Electrical stimulation                           18.52           17.38          19.75
  97033         A      Electric current therapy                         30.96           28.42          33.83
  97034         A      Contrast bath therapy                            17.16           16.02          18.38
  97035         A      Ultrasound therapy                               12.32           11.74          12.89
  97036         A      Hydrotherapy                                     31.29           28.80          34.12
  97039         C      Physical therapy treatment                        0.00            0.00           0.00


                                             Page 20 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                                 Rest of
  Code           Status              Short Description                 Atlanta, GA        Georgia          Hawaii/Guam
                                                                          10202            10202              01202
                                                                           01               99                 01
   97110           A       Therapeutic exercises                                  30.87            29.08            32.84
   97112           A       Neuromuscular reeducation                              32.25            30.30            34.41
   97113           A       Aquatic therapy/exercises                              41.24            38.22            44.67
   97116           A       Gait training therapy                                  27.44            25.85            29.17
   97124           A       Massage therapy                                        25.39            23.84            27.08
   97139           C       Physical medicine procedure                             0.00             0.00             0.00
   97140           A       Manual therapy                                         28.81            27.18            30.59
   97150           A       Group therapeutic procedures                           19.90            18.68            21.21
   97530           A       Therapeutic activities                                 33.99            31.80            36.43
   97532           A       Cognitive skills development                           25.69            24.46            27.00
   97533           A       Sensory integration                                    28.46            26.91            30.14
   97535           A       Self care mngment training                             33.64            31.53            35.98
   97537           A       Community/work reintegration                           29.14            27.55            30.87
   97542           A       Wheelchair mngment training                            29.84            28.16            31.66
   97597           A       Rmvl devital tis 20 cm/<                               76.01            69.37            83.36
   97598           A       Rmvl devital tis addl 20 cm<                           25.05            23.18            26.95
   97602           B       Wound(s) care non-selective                             0.00             0.00             0.00
   97605           A       Neg press wound tx < 50 cm                             41.03            38.67            43.02
   97606           A       Neg press wound tx > 50 cm                             43.73            41.31            45.59
   97750           A       Physical performance test                              32.55            30.63            34.49
   97755           A       Assistive technology assess                            35.24            33.67            36.74
   97760           A       Orthotic mgmt and training                             37.05            34.60            39.60
   97761           A       Prosthetic training                                    32.21            30.32            34.10
   97762           A       C/o for orthotic/prosth use                            44.78            40.61            49.60
   97799           C       Physical medicine procedure                             0.00             0.00             0.00
   G0281           A       Elec stim unattend for press                           13.37            12.56            14.22
   G0283           A       Elec stim other than wound                             13.37            12.56            14.22
   G0329           A       Electromagntic tx for ulcers                            9.97             9.08            10.92

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 21 of 121
                                                                                                   8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                    East St. Louis,      Suburban
  Code        Status           Short Description              Idaho                IL            Chicago, IL
                                                              05130               00952             00952
                                                               00                  12                15
  0019T         C      Extracorp shock wv tx ms nos                   0.00                0.00              0.00
  0183T         C      Wound ultrasound                               0.00                0.00              0.00
  64550         A      Apply neurostimulator                         14.85               15.71             17.08
  90901         A      Biofeedback train any meth                    36.37               37.87             41.52
  92506         A      Speech/hearing evaluation                    150.50              158.41            177.04
  92507         A      Speech/hearing therapy                        70.94               75.30             79.71
  92508         A      Speech/hearing therapy                        21.18               22.09             23.77
  92520         A      Laryngeal function studies                    65.30               68.94             75.19
  92526         A      Oral function therapy                         78.39               83.03             88.40
  92597         A      Oral speech device eval                       78.10               82.86             88.53
  92605         B      Ex for nonspeech device rx                     0.00                0.00              0.00
  92606         B      Non-speech device service                      0.00                0.00              0.00
  92607         A      Ex for speech device rx 1hr                  133.18              140.92            152.08
  92608         A      Ex for speech device rx addl                  43.21               45.89             49.00
  92609         A      Use of speech device service                  95.09              100.27            107.48
  92610         A      Evaluate swallowing function                  84.03               89.00             95.40
  92611         A      Motion fluoroscopy/swallow                    91.98               97.71            105.03
  92612         A      Endoscopy swallow tst (fees)                 155.73              164.12            181.56
  92614         A      Laryngoscopic sensory test                   139.91              147.56            162.58
  92616         A      Fees w/laryngeal sense test                  188.37              198.65            218.08
  95831         A      Limb muscle testing manual                    25.97               28.07             30.48
  95832         A      Hand muscle testing manual                    24.48               26.50             28.64
  95833         A      Body muscle testing manual                    34.76               36.09             39.24
  95834         A      Body muscle testing manual                    45.08               47.57             51.50
  95851         A      Range of motion measurements                  16.61               17.57             19.30
  95852         A      Range of motion measurements                  14.60               15.55             17.19
  95992         A      Canalith repositioning proc                   39.94               42.84             45.12
  96105         A      Assessment of aphasia                         96.90              100.43            107.16
  96111         A      Developmental test extend                    118.86              127.39            132.48
  96125         A      Cognitive test by hc pro                      93.99               98.79            104.97
  97001         A      Pt evaluation                                 69.56               73.13             77.97
  97002         A      Pt re-evaluation                              38.38               40.56             43.47
  97003         A      Ot evaluation                                 77.47               81.41             87.46
  97004         A      Ot re-evaluation                              47.21               49.80             54.06
  97010         B      Hot or cold packs therapy                      0.00                0.00              0.00
  97012         A      Mechanical traction therapy                   14.80               15.54             16.60
  97016         A      Vasopneumatic device therapy                  16.98               17.94             19.63
  97018         A      Paraffin bath therapy                          9.25               10.03             11.07
  97022         A      Whirlpool therapy                             20.29               21.42             23.66
  97024         A      Diathermy eg microwave                         5.90                6.52              7.05
  97026         R      Infrared therapy                               5.29                5.89              6.32
  97028         A      Ultraviolet therapy                            6.58                7.20              7.75
  97032         A      Electrical stimulation                        17.23               18.09             19.52
  97033         A      Electric current therapy                      28.23               29.58             32.64
  97034         A      Contrast bath therapy                         15.87               16.73             18.12
  97035         A      Ultrasound therapy                            11.61               12.27             13.02
  97036         A      Hydrotherapy                                  28.60               29.94             32.97
  97039         C      Physical therapy treatment                     0.00                0.00              0.00


                                             Page 22 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                              East St. Louis,       Suburban
  Code           Status              Short Description                 Idaho                 IL             Chicago, IL
                                                                       05130                00952              00952
                                                                        00                   12                 15
   97110           A       Therapeutic exercises                               28.91                29.99              32.34
   97112           A       Neuromuscular reeducation                           30.13                31.27              33.79
   97113           A       Aquatic therapy/exercises                           38.00                39.53              43.30
   97116           A       Gait training therapy                               25.69                26.70              28.77
   97124           A       Massage therapy                                     23.68                24.68              26.66
   97139           C       Physical medicine procedure                          0.00                 0.00               0.00
   97140           A       Manual therapy                                      27.01                28.04              30.18
   97150           A       Group therapeutic procedures                        18.52                19.41              20.95
   97530           A       Therapeutic activities                              31.61                32.84              35.64
   97532           A       Cognitive skills development                        24.31                25.19              26.88
   97533           A       Sensory integration                                 26.75                27.74              29.80
   97535           A       Self care mngment training                          31.35                32.54              35.25
   97537           A       Community/work reintegration                        27.39                28.40              30.51
   97542           A       Wheelchair mngment training                         28.00                29.04              31.24
   97597           A       Rmvl devital tis 20 cm/<                            68.59                73.22              80.90
   97598           A       Rmvl devital tis addl 20 cm<                        22.78                24.80              26.90
   97602           B       Wound(s) care non-selective                          0.00                 0.00               0.00
   97605           A       Neg press wound tx < 50 cm                          37.71                42.15              44.63
   97606           A       Neg press wound tx > 50 cm                          40.12                45.48              47.90
   97750           A       Physical performance test                           30.23                32.27              34.59
   97755           A       Assistive technology assess                         33.28                35.18              37.24
   97760           A       Orthotic mgmt and training                          34.19                36.41              39.33
   97761           A       Prosthetic training                                 29.93                31.95              34.23
   97762           A       C/o for orthotic/prosth use                         40.36                42.30              47.25
   97799           C       Physical medicine procedure                          0.00                 0.00               0.00
   G0281           A       Elec stim unattend for press                        12.42                13.16              14.16
   G0283           A       Elec stim other than wound                          12.42                13.16              14.16
   G0329           A       Electromagntic tx for ulcers                         8.94                 9.71              10.70

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 23 of 121
                                                                                                      8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description              Chicago, IL       Rest of Illinois     Indiana
                                                                 00952               00952            00630
                                                                  16                   99              00
  0019T         C      Extracorp shock wv tx ms nos                      0.00                 0.00            0.00
  0183T         C      Wound ultrasound                                  0.00                 0.00            0.00
  64550         A      Apply neurostimulator                            17.03                15.24           15.13
  90901         A      Biofeedback train any meth                       41.20                37.00           37.10
  92506         A      Speech/hearing evaluation                       174.99               153.76          154.41
  92507         A      Speech/hearing therapy                           80.22                73.11           71.79
  92508         A      Speech/hearing therapy                           23.72                21.59           21.49
  92520         A      Laryngeal function studies                       74.91                66.95           66.58
  92526         A      Oral function therapy                            88.77                80.66           79.43
  92597         A      Oral speech device eval                          88.83                80.41           79.22
  92605         B      Ex for nonspeech device rx                        0.00                 0.00            0.00
  92606         B      Non-speech device service                         0.00                 0.00            0.00
  92607         A      Ex for speech device rx 1hr                     152.06               136.82          135.43
  92608         A      Ex for speech device rx addl                     49.19                44.52           43.83
  92609         A      Use of speech device service                    107.62                97.56           96.50
  92610         A      Evaluate swallowing function                     95.60                86.42           85.29
  92611         A      Motion fluoroscopy/swallow                      105.22                94.73           93.46
  92612         A      Endoscopy swallow tst (fees)                    180.05               159.34          159.36
  92614         A      Laryngoscopic sensory test                      161.44               143.25          143.02
  92616         A      Fees w/laryngeal sense test                     216.79               192.92          192.37
  95831         A      Limb muscle testing manual                       30.54                26.98           26.49
  95832         A      Hand muscle testing manual                       28.74                25.47           24.95
  95833         A      Body muscle testing manual                       39.01                35.33           35.37
  95834         A      Body muscle testing manual                       51.42                46.23           45.87
  95851         A      Range of motion measurements                     19.19                17.04           16.96
  95852         A      Range of motion measurements                     17.08                15.03           14.95
  95992         A      Canalith repositioning proc                      45.57                41.42           40.39
  96105         A      Assessment of aphasia                           107.11                98.51           98.10
  96111         A      Developmental test extend                       134.30               123.31          119.80
  96125         A      Cognitive test by hc pro                        105.33                96.32           95.14
  97001         A      Pt evaluation                                    78.16                71.27           70.48
  97002         A      Pt re-evaluation                                 43.55                39.42           38.96
  97003         A      Ot evaluation                                    87.46                79.32           78.65
  97004         A      Ot re-evaluation                                 53.92                48.40           48.07
  97010         B      Hot or cold packs therapy                         0.00                 0.00            0.00
  97012         A      Mechanical traction therapy                      16.63                15.15           15.00
  97016         A      Vasopneumatic device therapy                     19.54                17.41           17.33
  97018         A      Paraffin bath therapy                            11.04                 9.61            9.48
  97022         A      Whirlpool therapy                                23.48                20.78           20.76
  97024         A      Diathermy eg microwave                            7.10                 6.21            6.02
  97026         R      Infrared therapy                                  6.39                 5.59            5.39
  97028         A      Ultraviolet therapy                               7.80                 6.89            6.70
  97032         A      Electrical stimulation                           19.49                17.63           17.51
  97033         A      Electric current therapy                         32.36                28.80           28.85
  97034         A      Contrast bath therapy                            18.09                16.27           16.15
  97035         A      Ultrasound therapy                               13.08                11.93           11.75
  97036         A      Hydrotherapy                                     32.70                29.17           29.22
  97039         C      Physical therapy treatment                        0.00                 0.00            0.00


                                             Page 24 of 121
                                                                                                                8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                 Chicago, IL        Rest of Illinois     Indiana
                                                                          00952                00952            00630
                                                                           16                    99              00
   97110           A       Therapeutic exercises                                  32.22                29.39            29.35
   97112           A       Neuromuscular reeducation                              33.65                30.62            30.61
   97113           A       Aquatic therapy/exercises                              42.96                38.64            38.75
   97116           A       Gait training therapy                                  28.68                26.14            26.08
   97124           A       Massage therapy                                        26.57                24.13            24.06
   97139           C       Physical medicine procedure                             0.00                 0.00             0.00
   97140           A       Manual therapy                                         30.09                27.47            27.41
   97150           A       Group therapeutic procedures                           20.90                18.93            18.82
   97530           A       Therapeutic activities                                 35.45                32.14            32.15
   97532           A       Cognitive skills development                           26.86                24.71            24.61
   97533           A       Sensory integration                                    29.73                27.19            27.12
   97535           A       Self care mngment training                             35.09                31.86            31.86
   97537           A       Community/work reintegration                           30.44                27.84            27.78
   97542           A       Wheelchair mngment training                            31.15                28.46            28.41
   97597           A       Rmvl devital tis 20 cm/<                               80.44                70.68            70.24
   97598           A       Rmvl devital tis addl 20 cm<                           26.99                23.77            23.25
   97602           B       Wound(s) care non-selective                             0.00                 0.00             0.00
   97605           A       Neg press wound tx < 50 cm                             45.33                39.99            38.30
   97606           A       Neg press wound tx > 50 cm                             48.85                42.92            40.73
   97750           A       Physical performance test                              34.71                31.22            30.71
   97755           A       Assistive technology assess                            37.45                34.22            33.67
   97760           A       Orthotic mgmt and training                             39.36                35.25            34.79
   97761           A       Prosthetic training                                    34.35                30.91            30.39
   97762           A       C/o for orthotic/prosth use                            46.68                41.14            41.39
   97799           C       Physical medicine procedure                             0.00                 0.00             0.00
   G0281           A       Elec stim unattend for press                           14.17                12.77            12.62
   G0283           A       Elec stim other than wound                             14.17                12.77            12.62
   G0329           A       Electromagntic tx for ulcers                           10.68                 9.30             9.16

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 25 of 121
                                                                                              8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description              Iowa           Kansas          Kentucky
                                                              05102           05202            00660
                                                               00              00               00
  0019T         C      Extracorp shock wv tx ms nos                   0.00            0.00             0.00
  0183T         C      Wound ultrasound                               0.00            0.00             0.00
  64550         A      Apply neurostimulator                         14.74           14.97            14.68
  90901         A      Biofeedback train any meth                    36.15           36.49            35.85
  92506         A      Speech/hearing evaluation                    149.30          151.10           147.66
  92507         A      Speech/hearing therapy                        70.39           71.79            70.65
  92508         A      Speech/hearing therapy                        21.05           21.30            20.98
  92520         A      Laryngeal function studies                    64.79           65.78            64.50
  92526         A      Oral function therapy                         77.79           79.23            77.94
  92597         A      Oral speech device eval                       77.49           78.94            77.59
  92605         B      Ex for nonspeech device rx                     0.00            0.00             0.00
  92606         B      Non-speech device service                      0.00            0.00             0.00
  92607         A      Ex for speech device rx 1hr                  132.15          134.39           131.94
  92608         A      Ex for speech device rx addl                  42.86           43.69            42.93
  92609         A      Use of speech device service                  94.41           95.94            94.35
  92610         A      Evaluate swallowing function                  83.38           84.87            83.40
  92611         A      Motion fluoroscopy/swallow                    91.23           92.95            91.24
  92612         A      Endoscopy swallow tst (fees)                 154.51          156.58           153.23
  92614         A      Laryngoscopic sensory test                   138.81          140.75           137.81
  92616         A      Fees w/laryngeal sense test                  186.91          189.58           185.73
  95831         A      Limb muscle testing manual                    25.70           26.33            25.71
  95832         A      Hand muscle testing manual                    24.22           24.85            24.28
  95833         A      Body muscle testing manual                    34.57           34.89            34.34
  95834         A      Body muscle testing manual                    44.74           45.44            44.61
  95851         A      Range of motion measurements                  16.47           16.73            16.37
  95852         A      Range of motion measurements                  14.47           14.72            14.38
  95992         A      Canalith repositioning proc                   39.59           40.55            39.85
  96105         A      Assessment of aphasia                         96.42           97.38            96.17
  96111         A      Developmental test extend                    117.85          120.79           118.98
  96125         A      Cognitive test by hc pro                      93.37           94.83            93.45
  97001         A      Pt evaluation                                 69.10           70.16            69.10
  97002         A      Pt re-evaluation                              38.10           38.74            38.09
  97003         A      Ot evaluation                                 76.95           78.08            76.81
  97004         A      Ot re-evaluation                              46.85           47.57            46.69
  97010         B      Hot or cold packs therapy                      0.00            0.00             0.00
  97012         A      Mechanical traction therapy                   14.70           14.92            14.69
  97016         A      Vasopneumatic device therapy                  16.85           17.10            16.76
  97018         A      Paraffin bath therapy                          9.14            9.37             9.12
  97022         A      Whirlpool therapy                             20.13           20.41            19.98
  97024         A      Diathermy eg microwave                         5.82            6.02             5.86
  97026         R      Infrared therapy                               5.22            5.41             5.26
  97028         A      Ultraviolet therapy                            6.50            6.70             6.54
  97032         A      Electrical stimulation                        17.12           17.36            17.07
  97033         A      Electric current therapy                      28.03           28.35            27.78
  97034         A      Contrast bath therapy                         15.76           15.99            15.70
  97035         A      Ultrasound therapy                            11.53           11.73            11.55
  97036         A      Hydrotherapy                                  28.40           28.72            28.17
  97039         C      Physical therapy treatment                     0.00            0.00             0.00


                                             Page 26 of 121
                                                                                                         8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                 Iowa            Kansas           Kentucky
                                                                       05102            05202             00660
                                                                        00               00                00
   97110           A       Therapeutic exercises                               28.76            29.03             28.62
   97112           A       Neuromuscular reeducation                           29.96            30.25             29.80
   97113           A       Aquatic therapy/exercises                           37.78            38.12             37.47
   97116           A       Gait training therapy                               25.54            25.81             25.43
   97124           A       Massage therapy                                     23.54            23.80             23.43
   97139           C       Physical medicine procedure                          0.00             0.00              0.00
   97140           A       Manual therapy                                      26.87            27.13             26.75
   97150           A       Group therapeutic procedures                        18.40            18.64             18.34
   97530           A       Therapeutic activities                              31.44            31.73             31.24
   97532           A       Cognitive skills development                        24.19            24.43             24.13
   97533           A       Sensory integration                                 26.60            26.87             26.50
   97535           A       Self care mngment training                          31.17            31.47             30.99
   97537           A       Community/work reintegration                        27.25            27.51             27.14
   97542           A       Wheelchair mngment training                         27.85            28.12             27.73
   97597           A       Rmvl devital tis 20 cm/<                            67.95            69.20             67.56
   97598           A       Rmvl devital tis addl 20 cm<                        22.52            23.14             22.57
   97602           B       Wound(s) care non-selective                          0.00             0.00              0.00
   97605           A       Neg press wound tx < 50 cm                          37.17            38.67             37.67
   97606           A       Neg press wound tx > 50 cm                          39.49            41.33             40.18
   97750           A       Physical performance test                           29.97            30.60             30.02
   97755           A       Assistive technology assess                         33.04            33.64             33.14
   97760           A       Orthotic mgmt and training                          33.90            34.55             33.87
   97761           A       Prosthetic training                                 29.67            30.29             29.72
   97762           A       C/o for orthotic/prosth use                         40.06            40.48             39.60
   97799           C       Physical medicine procedure                          0.00             0.00              0.00
   G0281           A       Elec stim unattend for press                        12.32            12.54             12.31
   G0283           A       Elec stim other than wound                          12.32            12.54             12.31
   G0329           A       Electromagntic tx for ulcers                         8.84             9.06              8.82

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 27 of 121
                                                                                               8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                 New Orleans,        Rest of         Southern
  Code        Status           Short Description              LA             Louisiana         Maine
                                                              00528            00528            14102
                                                               01               99               03
  0019T         C      Extracorp shock wv tx ms nos                   0.00             0.00             0.00
  0183T         C      Wound ultrasound                               0.00             0.00             0.00
  64550         A      Apply neurostimulator                         15.74            14.74            16.12
  90901         A      Biofeedback train any meth                    38.52            36.00            39.63
  92506         A      Speech/hearing evaluation                    162.06           148.45           168.10
  92507         A      Speech/hearing therapy                        74.02            70.80            74.79
  92508         A      Speech/hearing therapy                        22.18            21.04            22.62
  92520         A      Laryngeal function studies                    69.30            64.75            71.06
  92526         A      Oral function therapy                         82.02            78.13            83.12
  92597         A      Oral speech device eval                       81.96            77.79            83.19
  92605         B      Ex for nonspeech device rx                     0.00             0.00             0.00
  92606         B      Non-speech device service                      0.00             0.00             0.00
  92607         A      Ex for speech device rx 1hr                  140.52           132.37           143.34
  92608         A      Ex for speech device rx addl                  45.34            43.05            46.01
  92609         A      Use of speech device service                  99.76            94.62           101.46
  92610         A      Evaluate swallowing function                  88.30            83.63            89.78
  92611         A      Motion fluoroscopy/swallow                    96.95            91.52            98.69
  92612         A      Endoscopy swallow tst (fees)                 166.68           153.96           172.06
  92614         A      Laryngoscopic sensory test                   149.40           138.43           153.93
  92616         A      Fees w/laryngeal sense test                  200.67           186.52           206.41
  95831         A      Limb muscle testing manual                    27.75            25.81            28.35
  95832         A      Hand muscle testing manual                    26.09            24.36            26.59
  95833         A      Body muscle testing manual                    36.58            34.46            37.49
  95834         A      Body muscle testing manual                    47.61            44.76            48.65
  95851         A      Range of motion measurements                  17.72            16.45            18.22
  95852         A      Range of motion measurements                  15.68            14.45            16.17
  95992         A      Canalith repositioning proc                   41.71            39.93            42.01
  96105         A      Assessment of aphasia                        100.68            96.40           102.31
  96111         A      Developmental test extend                    123.08           119.12           123.20
  96125         A      Cognitive test by hc pro                      97.93            93.67            99.21
  97001         A      Pt evaluation                                 72.64            69.28            73.71
  97002         A      Pt re-evaluation                              40.30            38.20            40.98
  97003         A      Ot evaluation                                 81.28            77.04            82.78
  97004         A      Ot re-evaluation                              49.93            46.85            51.09
  97010         B      Hot or cold packs therapy                      0.00             0.00             0.00
  97012         A      Mechanical traction therapy                   15.47            14.73            15.71
  97016         A      Vasopneumatic device therapy                  18.07            16.83            18.56
  97018         A      Paraffin bath therapy                         10.00             9.16            10.29
  97022         A      Whirlpool therapy                             21.71            20.07            22.40
  97024         A      Diathermy eg microwave                         6.34             5.88             6.45
  97026         R      Infrared therapy                               5.68             5.28             5.76
  97028         A      Ultraviolet therapy                            7.02             6.56             7.14
  97032         A      Electrical stimulation                        18.12            17.12            18.50
  97033         A      Electric current therapy                      30.09            27.91            31.04
  97034         A      Contrast bath therapy                         16.76            15.76            17.14
  97035         A      Ultrasound therapy                            12.11            11.58            12.26
  97036         A      Hydrotherapy                                  30.44            28.29            31.37
  97039         C      Physical therapy treatment                     0.00             0.00             0.00


                                             Page 28 of 121
                                                                                                             8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                             New Orleans,         Rest of          Southern
  Code           Status              Short Description                    LA              Louisiana          Maine
                                                                          00528             00528             14102
                                                                           01                99                03
   97110           A       Therapeutic exercises                                  30.25             28.70             30.88
   97112           A       Neuromuscular reeducation                              31.58             29.90             32.28
   97113           A       Aquatic therapy/exercises                              40.21             37.62             41.35
   97116           A       Gait training therapy                                  26.88             25.51             27.44
   97124           A       Massage therapy                                        24.85             23.51             25.39
   97139           C       Physical medicine procedure                             0.00              0.00              0.00
   97140           A       Manual therapy                                         28.24             26.83             28.81
   97150           A       Group therapeutic procedures                           19.47             18.40             19.88
   97530           A       Therapeutic activities                                 33.23             31.35             34.03
   97532           A       Cognitive skills development                           25.26             24.19             25.66
   97533           A       Sensory integration                                    27.91             26.57             28.45
   97535           A       Self care mngment training                             32.91             31.09             33.67
   97537           A       Community/work reintegration                           28.59             27.21             29.14
   97542           A       Wheelchair mngment training                            29.25             27.81             29.84
   97597           A       Rmvl devital tis 20 cm/<                               73.74             67.88             76.02
   97598           A       Rmvl devital tis addl 20 cm<                           24.39             22.66             24.89
   97602           B       Wound(s) care non-selective                             0.00              0.00              0.00
   97605           A       Neg press wound tx < 50 cm                             40.16             37.76             40.43
   97606           A       Neg press wound tx > 50 cm                             42.83             40.27             42.94
   97750           A       Physical performance test                              31.87             30.11             32.39
   97755           A       Assistive technology assess                            34.67             33.21             35.04
   97760           A       Orthotic mgmt and training                             36.19             33.99             36.92
   97761           A       Prosthetic training                                    31.54             29.81             32.04
   97762           A       C/o for orthotic/prosth use                            43.37             39.81             44.99
   97799           C       Physical medicine procedure                             0.00              0.00              0.00
   G0281           A       Elec stim unattend for press                           13.08             12.35             13.33
   G0283           A       Elec stim other than wound                             13.08             12.35             13.33
   G0329           A       Electromagntic tx for ulcers                            9.66              8.86              9.94

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 29 of 121
                                                                                                  8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                    Baltimore/Surr.      Rest of
  Code        Status           Short Description          Rest of Maine        Cntys, MD         Maryland
                                                              14102               12302            12302
                                                               99                  01               99
  0019T         C      Extracorp shock wv tx ms nos                   0.00                0.00             0.00
  0183T         C      Wound ultrasound                               0.00                0.00             0.00
  64550         A      Apply neurostimulator                         14.97               17.16            16.39
  90901         A      Biofeedback train any meth                    36.65               42.00            40.16
  92506         A      Speech/hearing evaluation                    151.96              179.61           170.43
  92507         A      Speech/hearing therapy                        71.40               79.31            76.33
  92508         A      Speech/hearing therapy                        21.31               23.89            22.97
  92520         A      Laryngeal function studies                    65.83               75.65            72.25
  92526         A      Oral function therapy                         78.91               88.17            84.75
  92597         A      Oral speech device eval                       78.65               88.37            84.81
  92605         B      Ex for nonspeech device rx                     0.00                0.00             0.00
  92606         B      Non-speech device service                      0.00                0.00             0.00
  92607         A      Ex for speech device rx 1hr                  134.20              152.41           145.93
  92608         A      Ex for speech device rx addl                  43.52               48.89            46.92
  92609         A      Use of speech device service                  95.75              107.58           103.29
  92610         A      Evaluate swallowing function                  84.63               95.36            91.48
  92611         A      Motion fluoroscopy/swallow                    92.68              105.01           100.59
  92612         A      Endoscopy swallow tst (fees)                 157.15              183.56           174.64
  92614         A      Laryngoscopic sensory test                   141.15              164.14           156.32
  92616         A      Fees w/laryngeal sense test                  189.99              219.93           209.67
  95831         A      Limb muscle testing manual                    26.22               30.44            28.96
  95832         A      Hand muscle testing manual                    24.72               28.54            27.19
  95833         A      Body muscle testing manual                    35.00               39.62            38.00
  95834         A      Body muscle testing manual                    45.42               51.70            49.49
  95851         A      Range of motion measurements                  16.75               19.45            18.52
  95852         A      Range of motion measurements                  14.74               17.32            16.45
  95992         A      Canalith repositioning proc                   40.22               44.70            42.99
  96105         A      Assessment of aphasia                         97.41              107.62           103.84
  96111         A      Developmental test extend                    119.56              130.69           126.20
  96125         A      Cognitive test by hc pro                      94.55              104.87           101.01
  97001         A      Pt evaluation                                 70.00               77.98            75.03
  97002         A      Pt re-evaluation                              38.65               43.49            41.74
  97003         A      Ot evaluation                                 78.00               87.69            84.19
  97004         A      Ot re-evaluation                              47.58               54.32            51.95
  97010         B      Hot or cold packs therapy                      0.00                0.00             0.00
  97012         A      Mechanical traction therapy                   14.89               16.62            15.98
  97016         A      Vasopneumatic device therapy                  17.13               19.77            18.86
  97018         A      Paraffin bath therapy                          9.35               11.10            10.50
  97022         A      Whirlpool therapy                             20.48               23.90            22.74
  97024         A      Diathermy eg microwave                         5.96                6.99             6.63
  97026         R      Infrared therapy                               5.35                6.24             5.92
  97028         A      Ultraviolet therapy                            6.65                7.69             7.32
  97032         A      Electrical stimulation                        17.36               19.60            18.80
  97033         A      Electric current therapy                      28.46               33.02            31.48
  97034         A      Contrast bath therapy                         15.99               18.21            17.43
  97035         A      Ultrasound therapy                            11.69               12.98            12.49
  97036         A      Hydrotherapy                                  28.84               33.35            31.81
  97039         C      Physical therapy treatment                     0.00                0.00             0.00


                                             Page 30 of 121
                                                                                                                8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                                 Baltimore/Surr.       Rest of
  Code           Status              Short Description                Rest of Maine         Cntys, MD          Maryland
                                                                          14102                12302             12302
                                                                           99                   01                99
   97110           A       Therapeutic exercises                                  29.09                32.57             31.32
   97112           A       Neuromuscular reeducation                              30.32                34.06             32.73
   97113           A       Aquatic therapy/exercises                              38.28                43.80             41.90
   97116           A       Gait training therapy                                  25.85                28.96             27.84
   97124           A       Massage therapy                                        23.84                26.83             25.77
   97139           C       Physical medicine procedure                             0.00                 0.00              0.00
   97140           A       Manual therapy                                         27.17                30.38             29.22
   97150           A       Group therapeutic procedures                           18.65                21.05             20.20
   97530           A       Therapeutic activities                                 31.82                35.95             34.50
   97532           A       Cognitive skills development                           24.44                26.99             26.05
   97533           A       Sensory integration                                    26.90                29.98             28.86
   97535           A       Self care mngment training                             31.55                35.56             34.14
   97537           A       Community/work reintegration                           27.55                30.70             29.56
   97542           A       Wheelchair mngment training                            28.16                31.45             30.27
   97597           A       Rmvl devital tis 20 cm/<                               69.28                81.49             77.36
   97598           A       Rmvl devital tis addl 20 cm<                           23.01                26.80             25.47
   97602           B       Wound(s) care non-selective                             0.00                 0.00              0.00
   97605           A       Neg press wound tx < 50 cm                             38.10                43.79             41.69
   97606           A       Neg press wound tx > 50 cm                             40.57                46.74             44.44
   97750           A       Physical performance test                              30.47                34.51             33.05
   97755           A       Assistive technology assess                            33.49                37.09             35.73
   97760           A       Orthotic mgmt and training                             34.47                39.37             37.63
   97761           A       Prosthetic training                                    30.16                34.14             32.70
   97762           A       C/o for orthotic/prosth use                            40.74                47.98             45.58
   97799           C       Physical medicine procedure                             0.00                 0.00              0.00
   G0281           A       Elec stim unattend for press                           12.51                14.17             13.58
   G0283           A       Elec stim other than wound                             12.51                14.17             13.58
   G0329           A       Electromagntic tx for ulcers                            9.04                10.72             10.15

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 31 of 121
                                                                                                8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                 Metropolitan          Rest of
  Code        Status           Short Description            Boston           Massachusetts      Detroit, MI
                                                              14202              14202             00953
                                                               01                 99                01
  0019T         C      Extracorp shock wv tx ms nos                   0.00               0.00              0.00
  0183T         C      Wound ultrasound                               0.00               0.00              0.00
  64550         A      Apply neurostimulator                         17.43              16.60             16.63
  90901         A      Biofeedback train any meth                    42.97              40.79             40.30
  92506         A      Speech/hearing evaluation                    185.51             173.78            170.54
  92507         A      Speech/hearing therapy                        79.21              76.71             78.45
  92508         A      Speech/hearing therapy                        24.17              23.21             23.24
  92520         A      Laryngeal function studies                    77.02              73.21             73.13
  92526         A      Oral function therapy                         88.41              85.32             86.80
  92597         A      Oral speech device eval                       88.78              85.45             86.80
  92605         B      Ex for nonspeech device rx                     0.00               0.00              0.00
  92606         B      Non-speech device service                      0.00               0.00              0.00
  92607         A      Ex for speech device rx 1hr                  154.14             147.45            148.53
  92608         A      Ex for speech device rx addl                  49.09              47.26             48.06
  92609         A      Use of speech device service                 108.41             104.21            105.25
  92610         A      Evaluate swallowing function                  96.03              92.25             93.42
  92611         A      Motion fluoroscopy/swallow                   105.89             101.49            102.74
  92612         A      Endoscopy swallow tst (fees)                 188.46             177.61            175.60
  92614         A      Laryngoscopic sensory test                   168.13             158.82            157.49
  92616         A      Fees w/laryngeal sense test                  224.79             212.83            211.55
  95831         A      Limb muscle testing manual                    30.81              29.26             29.70
  95832         A      Hand muscle testing manual                    28.81              27.43             27.96
  95833         A      Body muscle testing manual                    40.35              38.52             38.21
  95834         A      Body muscle testing manual                    52.41              50.05             50.23
  95851         A      Range of motion measurements                  19.87              18.80             18.72
  95852         A      Range of motion measurements                  17.75              16.71             16.63
  95992         A      Canalith repositioning proc                   44.44              43.11             44.50
  96105         A      Assessment of aphasia                        108.41             104.79            105.13
  96111         A      Developmental test extend                    128.85             126.12            131.31
  96125         A      Cognitive test by hc pro                     105.14             101.71            103.15
  97001         A      Pt evaluation                                 78.35              75.62             76.52
  97002         A      Pt re-evaluation                              43.81              42.10             42.57
  97003         A      Ot evaluation                                 88.52              85.01             85.57
  97004         A      Ot re-evaluation                              55.15              52.58             52.67
  97010         B      Hot or cold packs therapy                      0.00               0.00              0.00
  97012         A      Mechanical traction therapy                   16.72              16.12             16.28
  97016         A      Vasopneumatic device therapy                  20.17              19.13             19.07
  97018         A      Paraffin bath therapy                         11.33              10.65             10.71
  97022         A      Whirlpool therapy                             24.52              23.12             22.90
  97024         A      Diathermy eg microwave                         7.03               6.68              6.88
  97026         R      Infrared therapy                               6.25               5.95              6.19
  97028         A      Ultraviolet therapy                            7.72               7.37              7.58
  97032         A      Electrical stimulation                        19.85              19.01             19.06
  97033         A      Electric current therapy                      33.88              32.01             31.60
  97034         A      Contrast bath therapy                         18.47              17.63             17.67
  97035         A      Ultrasound therapy                            12.99              12.57             12.80
  97036         A      Hydrotherapy                                  34.18              32.34             31.95
  97039         C      Physical therapy treatment                     0.00               0.00              0.00


                                             Page 32 of 121
                                                                                                             8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                             Metropolitan          Rest of
  Code           Status              Short Description                  Boston           Massachusetts       Detroit, MI
                                                                         14202               14202              00953
                                                                           01                 99                 01
   97110           A       Therapeutic exercises                                 33.01               31.69              31.59
   97112           A       Neuromuscular reeducation                             34.57               33.14              32.99
   97113           A       Aquatic therapy/exercises                             44.79               42.55              42.04
   97116           A       Gait training therapy                                 29.33               28.16              28.11
   97124           A       Massage therapy                                       27.21               26.07              26.02
   97139           C       Physical medicine procedure                            0.00                0.00               0.00
   97140           A       Manual therapy                                        30.75               29.55              29.50
   97150           A       Group therapeutic procedures                          21.32               20.42              20.46
   97530           A       Therapeutic activities                                36.57               34.96              34.73
   97532           A       Cognitive skills development                          27.19               26.28              26.37
   97533           A       Sensory integration                                   30.32               29.18              29.16
   97535           A       Self care mngment training                            36.14               34.58              34.38
   97537           A       Community/work reintegration                          31.05               29.88              29.85
   97542           A       Wheelchair mngment training                           31.84               30.61              30.55
   97597           A       Rmvl devital tis 20 cm/<                              83.48               78.57              78.28
   97598           A       Rmvl devital tis addl 20 cm<                          27.08               25.71              26.22
   97602           B       Wound(s) care non-selective                            0.00                0.00               0.00
   97605           A       Neg press wound tx < 50 cm                            43.43               41.72              43.92
   97606           A       Neg press wound tx > 50 cm                            46.08               44.34              47.24
   97750           A       Physical performance test                             34.72               33.31              33.87
   97755           A       Assistive technology assess                           37.07               35.92              36.65
   97760           A       Orthotic mgmt and training                            39.80               38.01              38.40
   97761           A       Prosthetic training                                   34.33               32.95              33.52
   97762           A       C/o for orthotic/prosth use                           49.57               46.48              45.53
   97799           C       Physical medicine procedure                            0.00                0.00               0.00
   G0281           A       Elec stim unattend for press                          14.30               13.70              13.84
   G0283           A       Elec stim other than wound                            14.30               13.70              13.84
   G0329           A       Electromagntic tx for ulcers                          10.94               10.29              10.37

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 33 of 121
                                                                                                  8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                      Rest of
  Code        Status           Short Description              Michigan         Minnesota        Mississippi
                                                                00953            00954             00512
                                                                 99               00                00
  0019T         C      Extracorp shock wv tx ms nos                     0.00             0.00              0.00
  0183T         C      Wound ultrasound                                 0.00             0.00              0.00
  64550         A      Apply neurostimulator                           15.29            15.87             14.64
  90901         A      Biofeedback train any meth                      37.25            39.20             35.73
  92506         A      Speech/hearing evaluation                      155.19           165.81            147.00
  92507         A      Speech/hearing therapy                          72.87            73.51             70.53
  92508         A      Speech/hearing therapy                          21.65            22.35             20.92
  92520         A      Laryngeal function studies                      67.20            70.00             64.29
  92526         A      Oral function therapy                           80.52            81.76             77.78
  92597         A      Oral speech device eval                         80.31            81.79             77.42
  92605         B      Ex for nonspeech device rx                       0.00             0.00              0.00
  92606         B      Non-speech device service                        0.00             0.00              0.00
  92607         A      Ex for speech device rx 1hr                    136.98           141.09            131.59
  92608         A      Ex for speech device rx addl                    44.45            45.22             42.84
  92609         A      Use of speech device service                    97.59            99.95             94.14
  92610         A      Evaluate swallowing function                    86.38            88.32             83.20
  92611         A      Motion fluoroscopy/swallow                      94.70            97.01             91.01
  92612         A      Endoscopy swallow tst (fees)                   160.45           169.63            152.63
  92614         A      Laryngoscopic sensory test                     144.11           151.72            137.30
  92616         A      Fees w/laryngeal sense test                    193.92           203.42            185.08
  95831         A      Limb muscle testing manual                      26.96            27.73             25.64
  95832         A      Hand muscle testing manual                      25.41            26.00             24.21
  95833         A      Body muscle testing manual                      35.53            37.11             34.24
  95834         A      Body muscle testing manual                      46.33            47.92             44.49
  95851         A      Range of motion measurements                    17.12            17.94             16.32
  95852         A      Range of motion measurements                    15.10            15.90             14.32
  95992         A      Canalith repositioning proc                     41.17            41.16             39.79
  96105         A      Assessment of aphasia                           98.72           101.29             95.97
  96111         A      Developmental test extend                      122.28           120.69            118.88
  96125         A      Cognitive test by hc pro                        96.23            97.80             93.28
  97001         A      Pt evaluation                                   71.25            72.67             68.96
  97002         A      Pt re-evaluation                                39.42            40.34             38.00
  97003         A      Ot evaluation                                   79.42            81.63             76.63
  97004         A      Ot re-evaluation                                48.53            50.33             46.55
  97010         B      Hot or cold packs therapy                        0.00             0.00              0.00
  97012         A      Mechanical traction therapy                     15.16            15.49             14.66
  97016         A      Vasopneumatic device therapy                    17.49            18.28             16.70
  97018         A      Paraffin bath therapy                            9.63            10.06              9.08
  97022         A      Whirlpool therapy                               20.92            22.07             19.90
  97024         A      Diathermy eg microwave                           6.18             6.27              5.84
  97026         R      Infrared therapy                                 5.55             5.58              5.25
  97028         A      Ultraviolet therapy                              6.86             6.95              6.52
  97032         A      Electrical stimulation                          17.67            18.25             17.02
  97033         A      Electric current therapy                        29.01            30.65             27.68
  97034         A      Contrast bath therapy                           16.31            16.89             15.66
  97035         A      Ultrasound therapy                              11.91            12.07             11.53
  97036         A      Hydrotherapy                                    29.37            30.98             28.07
  97039         C      Physical therapy treatment                       0.00             0.00              0.00


                                             Page 34 of 121
                                                                                                             8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                               Rest of
  Code           Status              Short Description                 Michigan          Minnesota         Mississippi
                                                                         00953             00954              00512
                                                                          99                00                 00
   97110           A       Therapeutic exercises                                 29.50             30.57              28.55
   97112           A       Neuromuscular reeducation                             30.76             31.95              29.72
   97113           A       Aquatic therapy/exercises                             38.90             40.91              37.34
   97116           A       Gait training therapy                                 26.23             27.14              25.37
   97124           A       Massage therapy                                       24.22             25.10              23.37
   97139           C       Physical medicine procedure                            0.00              0.00               0.00
   97140           A       Manual therapy                                        27.57             28.51              26.69
   97150           A       Group therapeutic procedures                          18.98             19.62              18.29
   97530           A       Therapeutic activities                                32.31             33.67              31.15
   97532           A       Cognitive skills development                          24.77             25.41              24.08
   97533           A       Sensory integration                                   27.28             28.16              26.44
   97535           A       Self care mngment training                            32.02             33.32              30.90
   97537           A       Community/work reintegration                          27.93             28.85              27.07
   97542           A       Wheelchair mngment training                           28.56             29.54              27.66
   97597           A       Rmvl devital tis 20 cm/<                              71.02             74.68              67.29
   97598           A       Rmvl devital tis addl 20 cm<                          23.71             24.30              22.51
   97602           B       Wound(s) care non-selective                            0.00              0.00               0.00
   97605           A       Neg press wound tx < 50 cm                            39.54             39.12              37.59
   97606           A       Neg press wound tx > 50 cm                            42.28             41.36              40.11
   97750           A       Physical performance test                             31.17             31.79              29.95
   97755           A       Assistive technology assess                           34.13             34.48              33.08
   97760           A       Orthotic mgmt and training                            35.26             36.27              33.78
   97761           A       Prosthetic training                                   30.86             31.45              29.65
   97762           A       C/o for orthotic/prosth use                           41.55             44.43              39.42
   97799           C       Physical medicine procedure                            0.00              0.00               0.00
   G0281           A       Elec stim unattend for press                          12.77             13.11              12.28
   G0283           A       Elec stim other than wound                            12.77             13.11              12.28
   G0329           A       Electromagntic tx for ulcers                           9.32              9.72               8.79

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 35 of 121
                                                                                                  8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION
                                                                             Metropolitan
CPT/HCPCS                                                 Metropolitan       Kansas City,        Rest of
  Code        Status           Short Description          St. Louis, MO          MO             Missouri*
                                                              05302             05302             05302
                                                               01                 02               99
  0019T         C      Extracorp shock wv tx ms nos                   0.00               0.00             0.00
  0183T         C      Wound ultrasound                               0.00               0.00             0.00
  64550         A      Apply neurostimulator                         15.68              15.63            14.59
  90901         A      Biofeedback train any meth                    38.27              38.05            35.45
  92506         A      Speech/hearing evaluation                    160.69             159.50           145.43
  92507         A      Speech/hearing therapy                        74.02              74.11            70.73
  92508         A      Speech/hearing therapy                        22.09              22.03            20.85
  92520         A      Laryngeal function studies                    68.98              68.73            64.00
  92526         A      Oral function therapy                         81.94              81.96            77.88
  92597         A      Oral speech device eval                       81.84              81.83            77.48
  92605         B      Ex for nonspeech device rx                     0.00               0.00             0.00
  92606         B      Non-speech device service                      0.00               0.00             0.00
  92607         A      Ex for speech device rx 1hr                  140.09             139.83           131.34
  92608         A      Ex for speech device rx addl                  45.29              45.29            42.89
  92609         A      Use of speech device service                  99.53              99.41            94.05
  92610         A      Evaluate swallowing function                  88.13              88.06            83.18
  92611         A      Motion fluoroscopy/swallow                    96.74              96.65            90.98
  92612         A      Endoscopy swallow tst (fees)                 165.53             164.56           151.39
  92614         A      Laryngoscopic sensory test                   148.47             147.70           136.33
  92616         A      Fees w/laryngeal sense test                  199.52             198.59           183.92
  95831         A      Limb muscle testing manual                    27.68              27.66            25.64
  95832         A      Hand muscle testing manual                    26.05              26.05            24.24
  95833         A      Body muscle testing manual                    36.38              36.20            34.02
  95834         A      Body muscle testing manual                    47.43              47.31            44.35
  95851         A      Range of motion measurements                  17.62              17.54            16.22
  95852         A      Range of motion measurements                  15.59              15.52            14.23
  95992         A      Canalith repositioning proc                   41.78              41.90            40.01
  96105         A      Assessment of aphasia                        100.39             100.17            95.72
  96111         A      Developmental test extend                    123.50             124.08           119.85
  96125         A      Cognitive test by hc pro                      97.81              97.78            93.32
  97001         A      Pt evaluation                                 72.52              72.46            68.95
  97002         A      Pt re-evaluation                              40.21              40.17            37.98
  97003         A      Ot evaluation                                 81.05              80.90            76.48
  97004         A      Ot re-evaluation                              49.73              49.58            46.38
  97010         B      Hot or cold packs therapy                      0.00               0.00             0.00
  97012         A      Mechanical traction therapy                   15.43              15.42            14.65
  97016         A      Vasopneumatic device therapy                  17.97              17.90            16.61
  97018         A      Paraffin bath therapy                          9.95               9.92             9.05
  97022         A      Whirlpool therapy                             21.57              21.45            19.75
  97024         A      Diathermy eg microwave                         6.34               6.35             5.87
  97026         R      Infrared therapy                               5.69               5.71             5.29
  97028         A      Ultraviolet therapy                            7.02               7.04             6.55
  97032         A      Electrical stimulation                        18.06              18.01            16.97
  97033         A      Electric current therapy                      29.88              29.71            27.45
  97034         A      Contrast bath therapy                         16.70              16.65            15.61
  97035         A      Ultrasound therapy                            12.10              12.11            11.55
  97036         A      Hydrotherapy                                  30.24              30.06            27.84
  97039         C      Physical therapy treatment                     0.00               0.00             0.00


                                             Page 36 of 121
                                                                                                               8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION
                                                                                          Metropolitan
CPT/HCPCS                                                             Metropolitan        Kansas City,        Rest of
  Code           Status              Short Description                St. Louis, MO           MO             Missouri*
                                                                          05302              05302             05302
                                                                           01                  02               99
   97110           A       Therapeutic exercises                                  30.12              30.01             28.41
   97112           A       Neuromuscular reeducation                              31.43              31.31             29.57
   97113           A       Aquatic therapy/exercises                              39.95              39.72             37.05
   97116           A       Gait training therapy                                  26.77              26.69             25.26
   97124           A       Massage therapy                                        24.74              24.66             23.27
   97139           C       Physical medicine procedure                             0.00               0.00              0.00
   97140           A       Manual therapy                                         28.12              28.03             26.57
   97150           A       Group therapeutic procedures                           19.40              19.34             18.23
   97530           A       Therapeutic activities                                 33.06              32.91             30.97
   97532           A       Cognitive skills development                           25.18              25.13             24.01
   97533           A       Sensory integration                                    27.81              27.72             26.33
   97535           A       Self care mngment training                             32.74              32.60             30.73
   97537           A       Community/work reintegration                           28.48              28.39             26.96
   97542           A       Wheelchair mngment training                            29.13              29.04             27.54
   97597           A       Rmvl devital tis 20 cm/<                               73.31              72.98             66.89
   97598           A       Rmvl devital tis addl 20 cm<                           24.35              24.35             22.54
   97602           B       Wound(s) care non-selective                             0.00               0.00              0.00
   97605           A       Neg press wound tx < 50 cm                             40.32              40.57             38.02
   97606           A       Neg press wound tx > 50 cm                             43.08              43.43             40.70
   97750           A       Physical performance test                              31.83              31.82             29.98
   97755           A       Assistive technology assess                            34.66              34.69             33.16
   97760           A       Orthotic mgmt and training                             36.09              36.04             33.74
   97761           A       Prosthetic training                                    31.50              31.50             29.69
   97762           A       C/o for orthotic/prosth use                            43.00              42.66             38.98
   97799           C       Physical medicine procedure                             0.00               0.00              0.00
   G0281           A       Elec stim unattend for press                           13.05              13.03             12.27
   G0283           A       Elec stim other than wound                             13.05              13.03             12.27
   G0329           A       Electromagntic tx for ulcers                            9.62               9.60              8.76

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 37 of 121
                                                                                               8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description              Montana         Nebraska         Nevada
                                                               03202            05402           01302
                                                                01               00              00
  0019T         C      Extracorp shock wv tx ms nos                    0.00             0.00            0.00
  0183T         C      Wound ultrasound                                0.00             0.00            0.00
  64550         A      Apply neurostimulator                          16.03            14.85           16.63
  90901         A      Biofeedback train any meth                     39.18            36.53           40.66
  92506         A      Speech/hearing evaluation                     165.60           151.36          173.62
  92507         A      Speech/hearing therapy                         75.13            70.56           77.07
  92508         A      Speech/hearing therapy                         22.50            21.19           23.18
  92520         A      Laryngeal function studies                     70.60            65.35           73.30
  92526         A      Oral function therapy                          83.30            78.07           85.64
  92597         A      Oral speech device eval                        83.30            77.81           85.80
  92605         B      Ex for nonspeech device rx                      0.00             0.00            0.00
  92606         B      Non-speech device service                       0.00             0.00            0.00
  92607         A      Ex for speech device rx 1hr                   142.97           132.99          147.83
  92608         A      Ex for speech device rx addl                   46.09            43.03           47.47
  92609         A      Use of speech device service                  101.34            94.90          104.41
  92610         A      Evaluate swallowing function                   89.76            83.79           92.56
  92611         A      Motion fluoroscopy/swallow                     98.65            91.72          101.90
  92612         A      Endoscopy swallow tst (fees)                  170.09           156.31          177.61
  92614         A      Laryngoscopic sensory test                    152.39           140.31          158.88
  92616         A      Fees w/laryngeal sense test                   204.58           188.78          212.95
  95831         A      Limb muscle testing manual                     28.36            25.86           29.51
  95832         A      Hand muscle testing manual                     26.65            24.35           27.69
  95833         A      Body muscle testing manual                     37.14            34.88           38.38
  95834         A      Body muscle testing manual                     48.44            45.06           50.13
  95851         A      Range of motion measurements                   18.07            16.63           18.83
  95852         A      Range of motion measurements                   16.03            14.62           16.77
  95992         A      Canalith repositioning proc                    42.38            39.62           43.47
  96105         A      Assessment of aphasia                         101.91            96.93          104.46
  96111         A      Developmental test extend                     124.80           117.64          127.26
  96125         A      Cognitive test by hc pro                       99.29            93.71          101.85
  97001         A      Pt evaluation                                  73.70            69.39           75.71
  97002         A      Pt re-evaluation                               40.95            38.29           42.21
  97003         A      Ot evaluation                                  82.55            77.39           85.08
  97004         A      Ot re-evaluation                               50.82            47.21           52.65
  97010         B      Hot or cold packs therapy                       0.00             0.00            0.00
  97012         A      Mechanical traction therapy                    15.69            14.77           16.13
  97016         A      Vasopneumatic device therapy                   18.42            17.01           19.15
  97018         A      Paraffin bath therapy                          10.25             9.23           10.74
  97022         A      Whirlpool therapy                              22.16            20.36           23.13
  97024         A      Diathermy eg microwave                          6.50             5.84            6.78
  97026         R      Infrared therapy                                5.82             5.23            6.06
  97028         A      Ultraviolet therapy                             7.18             6.53            7.46
  97032         A      Electrical stimulation                         18.42            17.23           19.01
  97033         A      Electric current therapy                       30.67            28.34           31.96
  97034         A      Contrast bath therapy                          17.05            15.87           17.65
  97035         A      Ultrasound therapy                             12.29            11.57           12.61
  97036         A      Hydrotherapy                                   31.01            28.72           32.28
  97039         C      Physical therapy treatment                      0.00             0.00            0.00


                                             Page 38 of 121
                                                                                                          8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                 Montana          Nebraska          Nevada
                                                                        03202             05402            01302
                                                                         01                00               00
   97110           A       Therapeutic exercises                                30.67             28.97            31.58
   97112           A       Neuromuscular reeducation                            32.03             30.20            33.02
   97113           A       Aquatic therapy/exercises                            40.88             38.16            42.40
   97116           A       Gait training therapy                                27.27             25.72            28.08
   97124           A       Massage therapy                                      25.22             23.72            26.02
   97139           C       Physical medicine procedure                           0.00              0.00             0.00
   97140           A       Manual therapy                                       28.63             27.05            29.46
   97150           A       Group therapeutic procedures                         19.78             18.53            20.41
   97530           A       Therapeutic activities                               33.73             31.70            34.84
   97532           A       Cognitive skills development                         25.56             24.32            26.20
   97533           A       Sensory integration                                  28.29             26.78            29.08
   97535           A       Self care mngment training                           33.39             31.43            34.46
   97537           A       Community/work reintegration                         28.97             27.43            29.78
   97542           A       Wheelchair mngment training                          29.65             28.04            30.50
   97597           A       Rmvl devital tis 20 cm/<                             75.40             68.68            78.88
   97598           A       Rmvl devital tis addl 20 cm<                         24.95             22.65            25.99
   97602           B       Wound(s) care non-selective                           0.00              0.00             0.00
   97605           A       Neg press wound tx < 50 cm                           41.13             37.14            42.60
   97606           A       Neg press wound tx > 50 cm                           43.92             39.37            45.50
   97750           A       Physical performance test                            32.44             30.11            33.50
   97755           A       Assistive technology assess                          35.16             33.12            36.05
   97760           A       Orthotic mgmt and training                           36.87             34.11            38.18
   97761           A       Prosthetic training                                  32.10             29.80            33.14
   97762           A       C/o for orthotic/prosth use                          44.28             40.62            46.38
   97799           C       Physical medicine procedure                           0.00              0.00             0.00
   G0281           A       Elec stim unattend for press                         13.31             12.39            13.75
   G0283           A       Elec stim other than wound                           13.31             12.39            13.75
   G0329           A       Electromagntic tx for ulcers                          9.91              8.92            10.38

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 39 of 121
                                                                                                    8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                       New                              Rest of New
  Code        Status           Short Description              Hampshire        Northern NJ         Jersey
                                                                14302             12402             12402
                                                                 40                01                99
  0019T         C      Extracorp shock wv tx ms nos                     0.00              0.00              0.00
  0183T         C      Wound ultrasound                                 0.00              0.00              0.00
  64550         A      Apply neurostimulator                           16.37             18.06             17.34
  90901         A      Biofeedback train any meth                      40.19             44.39             42.58
  92506         A      Speech/hearing evaluation                      171.10            191.79            183.05
  92507         A      Speech/hearing therapy                          75.79             82.19             79.48
  92508         A      Speech/hearing therapy                          22.90             25.00             24.09
  92520         A      Laryngeal function studies                      72.18             79.75             76.54
  92526         A      Oral function therapy                           84.26             91.69             88.53
  92597         A      Oral speech device eval                         84.38             92.07             88.82
  92605         B      Ex for nonspeech device rx                       0.00              0.00              0.00
  92606         B      Non-speech device service                        0.00              0.00              0.00
  92607         A      Ex for speech device rx 1hr                    145.50            159.72            153.70
  92608         A      Ex for speech device rx addl                    46.67             50.92             49.13
  92609         A      Use of speech device service                   102.85            112.31            108.28
  92610         A      Evaluate swallowing function                    91.07             99.55             95.96
  92611         A      Motion fluoroscopy/swallow                     100.19            109.80            105.75
  92612         A      Endoscopy swallow tst (fees)                   174.98            194.96            186.52
  92614         A      Laryngoscopic sensory test                     156.50            173.97            166.59
  92616         A      Fees w/laryngeal sense test                    209.77            232.64            222.96
  95831         A      Limb muscle testing manual                      28.89             32.01             30.73
  95832         A      Hand muscle testing manual                      27.10             29.94             28.78
  95833         A      Body muscle testing manual                      37.97             41.68             40.07
  95834         A      Body muscle testing manual                      49.37             54.28             52.20
  95851         A      Range of motion measurements                    18.53             20.57             19.71
  95852         A      Range of motion measurements                    16.47             18.39             17.59
  95992         A      Canalith repositioning proc                     42.63             46.19             44.71
  96105         A      Assessment of aphasia                          103.38            112.05            108.23
  96111         A      Developmental test extend                      124.81            134.01            130.16
  96125         A      Cognitive test by hc pro                       100.42            108.92            105.26
  97001         A      Pt evaluation                                   74.65             81.16             78.36
  97002         A      Pt re-evaluation                                41.56             45.40             43.76
  97003         A      Ot evaluation                                   83.88             91.65             88.32
  97004         A      Ot re-evaluation                                51.86             57.11             54.88
  97010         B      Hot or cold packs therapy                        0.00              0.00              0.00
  97012         A      Mechanical traction therapy                     15.91             17.31             16.71
  97016         A      Vasopneumatic device therapy                    18.86             20.88             20.03
  97018         A      Paraffin bath therapy                           10.51             11.77             11.26
  97022         A      Whirlpool therapy                               22.78             25.37             24.28
  97024         A      Diathermy eg microwave                           6.60              7.33              7.04
  97026         R      Infrared therapy                                 5.89              6.52              6.27
  97028         A      Ultraviolet therapy                              7.28              8.04              7.74
  97032         A      Electrical stimulation                          18.75             20.54             19.78
  97033         A      Electric current therapy                        31.53             35.03             33.54
  97034         A      Contrast bath therapy                           17.39             19.12             18.39
  97035         A      Ultrasound therapy                              12.42             13.47             13.02
  97036         A      Hydrotherapy                                    31.86             35.33             33.85
  97039         C      Physical therapy treatment                       0.00              0.00              0.00


                                             Page 40 of 121
                                                                                                               8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                New                                Rest of New
  Code           Status              Short Description                 Hampshire         Northern NJ          Jersey
                                                                         14302              12402              12402
                                                                          40                 01                 99
   97110           A       Therapeutic exercises                                 31.25              34.11              32.86
   97112           A       Neuromuscular reeducation                             32.67              35.72              34.39
   97113           A       Aquatic therapy/exercises                             41.92              46.27              44.39
   97116           A       Gait training therapy                                 27.77              30.31              29.20
   97124           A       Massage therapy                                       25.71              28.13              27.08
   97139           C       Physical medicine procedure                            0.00               0.00               0.00
   97140           A       Manual therapy                                        29.14              31.78              30.63
   97150           A       Group therapeutic procedures                          20.14              22.06              21.24
   97530           A       Therapeutic activities                                34.46              37.79              36.34
   97532           A       Cognitive skills development                          25.93              28.10              27.14
   97533           A       Sensory integration                                   28.77              31.33              30.21
   97535           A       Self care mngment training                            34.09              37.34              35.92
   97537           A       Community/work reintegration                          29.47              32.09              30.94
   97542           A       Wheelchair mngment training                           30.18              32.90              31.71
   97597           A       Rmvl devital tis 20 cm/<                              77.46              86.51              82.74
   97598           A       Rmvl devital tis addl 20 cm<                          25.39              28.17              27.04
   97602           B       Wound(s) care non-selective                            0.00               0.00               0.00
   97605           A       Neg press wound tx < 50 cm                            41.32              45.40              43.81
   97606           A       Neg press wound tx > 50 cm                            43.96              48.29              46.64
   97750           A       Physical performance test                             32.90              36.03              34.72
   97755           A       Assistive technology assess                           35.48              38.44              37.18
   97760           A       Orthotic mgmt and training                            37.52              41.28              39.70
   97761           A       Prosthetic training                                   32.54              35.63              34.34
   97762           A       C/o for orthotic/prosth use                           45.76              51.22              48.90
   97799           C       Physical medicine procedure                            0.00               0.00               0.00
   G0281           A       Elec stim unattend for press                          13.53              14.83              14.28
   G0283           A       Elec stim other than wound                            13.53              14.83              14.28
   G0329           A       Electromagntic tx for ulcers                          10.15              11.37              10.87

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 41 of 121
                                                                                                   8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION
                                                                                                  NYC
CPT/HCPCS                                                                                     Suburbs/Long
  Code        Status           Short Description              New Mexico        Manhattan, NY    I., NY
                                                                 04202              13202          13202
                                                                  05                 01             02
  0019T         C      Extracorp shock wv tx ms nos                      0.00               0.00           0.00
  0183T         C      Wound ultrasound                                  0.00               0.00           0.00
  64550         A      Apply neurostimulator                            15.20              18.01          18.47
  90901         A      Biofeedback train any meth                       37.06              44.13          45.24
  92506         A      Speech/hearing evaluation                       154.12             189.48         196.11
  92507         A      Speech/hearing therapy                           72.50              82.85          84.09
  92508         A      Speech/hearing therapy                           21.55              25.02          25.47
  92520         A      Laryngeal function studies                       66.79              79.47          81.55
  92526         A      Oral function therapy                            80.10              92.20          93.77
  92597         A      Oral speech device eval                          79.87              92.48          94.21
  92605         B      Ex for nonspeech device rx                        0.00               0.00           0.00
  92606         B      Non-speech device service                         0.00               0.00           0.00
  92607         A      Ex for speech device rx 1hr                     136.20             159.80         163.37
  92608         A      Ex for speech device rx addl                     44.20              51.16          52.12
  92609         A      Use of speech device service                     97.08             112.62         114.75
  92610         A      Evaluate swallowing function                     85.91              99.86         101.83
  92611         A      Motion fluoroscopy/swallow                       94.16             110.04         112.41
  92612         A      Endoscopy swallow tst (fees)                    159.40             193.30         199.35
  92614         A      Laryngoscopic sensory test                      143.19             172.73         177.90
  92616         A      Fees w/laryngeal sense test                     192.72             231.28         237.87
  95831         A      Limb muscle testing manual                       26.76              31.99          32.92
  95832         A      Hand muscle testing manual                       25.23              29.97          30.80
  95833         A      Body muscle testing manual                       35.36              41.55          42.44
  95834         A      Body muscle testing manual                       46.07              54.23          55.49
  95851         A      Range of motion measurements                     17.01              20.45          21.05
  95852         A      Range of motion measurements                     15.00              18.25          18.86
  95992         A      Canalith repositioning proc                      40.94              46.68          47.38
  96105         A      Assessment of aphasia                            98.34             112.45         113.95
  96111         A      Developmental test extend                       121.68             136.11         137.40
  96125         A      Cognitive test by hc pro                         95.78             109.57         111.16
  97001         A      Pt evaluation                                    70.91              81.53          82.84
  97002         A      Pt re-evaluation                                 39.21              45.53          46.41
  97003         A      Ot evaluation                                    79.02              91.82          93.57
  97004         A      Ot re-evaluation                                 48.25              57.00          58.37
  97010         B      Hot or cold packs therapy                         0.00               0.00           0.00
  97012         A      Mechanical traction therapy                      15.08              17.38          17.67
  97016         A      Vasopneumatic device therapy                     17.38              20.78          21.36
  97018         A      Paraffin bath therapy                             9.55              11.70          12.12
  97022         A      Whirlpool therapy                                20.78              25.17          25.95
  97024         A      Diathermy eg microwave                            6.12               7.35           7.58
  97026         R      Infrared therapy                                  5.50               6.56           6.76
  97028         A      Ultraviolet therapy                               6.80               8.07           8.30
  97032         A      Electrical stimulation                           17.58              20.54          20.97
  97033         A      Electric current therapy                         28.83              34.75          35.76
  97034         A      Contrast bath therapy                            16.22              19.10          19.54
  97035         A      Ultrasound therapy                               11.85              13.56          13.76
  97036         A      Hydrotherapy                                     29.20              35.08          36.07
  97039         C      Physical therapy treatment                        0.00               0.00           0.00


                                             Page 42 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION
                                                                                                            NYC
CPT/HCPCS                                                                                               Suburbs/Long
  Code           Status              Short Description                 New Mexico         Manhattan, NY    I., NY
                                                                          04202               13202           13202
                                                                           05                  01              02
   97110           A       Therapeutic exercises                                  29.37               34.10           34.71
   97112           A       Neuromuscular reeducation                              30.62               35.68           36.36
   97113           A       Aquatic therapy/exercises                              38.70               46.00           47.14
   97116           A       Gait training therapy                                  26.11               30.32           30.86
   97124           A       Massage therapy                                        24.10               28.11           28.66
   97139           C       Physical medicine procedure                             0.00                0.00            0.00
   97140           A       Manual therapy                                         27.45               31.80           32.35
   97150           A       Group therapeutic procedures                           18.88               22.06           22.51
   97530           A       Therapeutic activities                                 32.15               37.70           38.48
   97532           A       Cognitive skills development                           24.67               28.20           28.58
   97533           A       Sensory integration                                    27.16               31.37           31.88
   97535           A       Self care mngment training                             31.87               37.27           38.01
   97537           A       Community/work reintegration                           27.82               32.12           32.65
   97542           A       Wheelchair mngment training                            28.44               32.92           33.47
   97597           A       Rmvl devital tis 20 cm/<                               70.50               85.86           88.73
   97598           A       Rmvl devital tis addl 20 cm<                           23.53               28.17           29.02
   97602           B       Wound(s) care non-selective                             0.00                0.00            0.00
   97605           A       Neg press wound tx < 50 cm                             39.21               45.89           47.08
   97606           A       Neg press wound tx > 50 cm                             41.90               48.95           50.26
   97750           A       Physical performance test                              30.99               36.15           36.93
   97755           A       Assistive technology assess                            33.97               38.74           39.29
   97760           A       Orthotic mgmt and training                             35.04               41.30           42.29
   97761           A       Prosthetic training                                    30.68               35.76           36.52
   97762           A       C/o for orthotic/prosth use                            41.27               50.60           52.32
   97799           C       Physical medicine procedure                             0.00                0.00            0.00
   G0281           A       Elec stim unattend for press                           12.70               14.85           15.17
   G0283           A       Elec stim other than wound                             12.70               14.85           15.17
   G0329           A       Electromagntic tx for ulcers                            9.24               11.30           11.71

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 43 of 121
                                                                                                 8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION
                                                          Poughkpsie/N
CPT/HCPCS                                                 NYC Suburbs,       Rest of New
  Code        Status           Short Description              NY                York           Queens, NY
                                                              13202             13282             13292
                                                               03                99                04
  0019T         C      Extracorp shock wv tx ms nos                   0.00              0.00              0.00
  0183T         C      Wound ultrasound                               0.00              0.00              0.00
  64550         A      Apply neurostimulator                         16.71             15.27             18.40
  90901         A      Biofeedback train any meth                    40.94             37.48             45.02
  92506         A      Speech/hearing evaluation                    174.62            156.48            194.29
  92507         A      Speech/hearing therapy                        77.40             72.12             84.31
  92508         A      Speech/hearing therapy                        23.32             21.65             25.45
  92520         A      Laryngeal function studies                    73.68             67.20             81.20
  92526         A      Oral function therapy                         86.03             79.87             93.89
  92597         A      Oral speech device eval                       86.17             79.70             94.25
  92605         B      Ex for nonspeech device rx                     0.00              0.00              0.00
  92606         B      Non-speech device service                      0.00              0.00              0.00
  92607         A      Ex for speech device rx 1hr                  148.54            136.48            163.06
  92608         A      Ex for speech device rx addl                  47.67             44.09             52.15
  92609         A      Use of speech device service                 104.94             97.14            114.72
  92610         A      Evaluate swallowing function                  92.99             85.86            101.80
  92611         A      Motion fluoroscopy/swallow                   102.34             94.12            112.29
  92612         A      Endoscopy swallow tst (fees)                 178.59            161.23            197.92
  92614         A      Laryngoscopic sensory test                   159.74            144.61            176.77
  92616         A      Fees w/laryngeal sense test                  214.10            194.39            236.55
  95831         A      Limb muscle testing manual                    29.59             26.72             32.79
  95832         A      Hand muscle testing manual                    27.76             25.15             30.72
  95833         A      Body muscle testing manual                    38.65             35.69             42.31
  95834         A      Body muscle testing manual                    50.39             46.25             55.34
  95851         A      Range of motion measurements                  18.92             17.14             20.93
  95852         A      Range of motion measurements                  16.84             15.12             18.72
  95992         A      Canalith repositioning proc                   43.60             40.55             47.55
  96105         A      Assessment of aphasia                        105.19             98.68            114.10
  96111         A      Developmental test extend                    127.62            120.00            138.31
  96125         A      Cognitive test by hc pro                     102.40             95.64            111.37
  97001         A      Pt evaluation                                 76.12             70.89             82.93
  97002         A      Pt re-evaluation                              42.41             39.21             46.40
  97003         A      Ot evaluation                                 85.55             79.20             93.50
  97004         A      Ot re-evaluation                              52.93             48.48             58.19
  97010         B      Hot or cold packs therapy                      0.00              0.00              0.00
  97012         A      Mechanical traction therapy                   16.22             15.09             17.68
  97016         A      Vasopneumatic device therapy                  19.25             17.50             21.25
  97018         A      Paraffin bath therapy                         10.77              9.58             12.03
  97022         A      Whirlpool therapy                             23.26             21.00             25.77
  97024         A      Diathermy eg microwave                         6.78              6.07              7.56
  97026         R      Infrared therapy                               6.06              5.43              6.74
  97028         A      Ultraviolet therapy                            7.47              6.75              8.28
  97032         A      Electrical stimulation                        19.12             17.65             20.93
  97033         A      Electric current therapy                      32.15             29.18             35.53
  97034         A      Contrast bath therapy                         17.74             16.29             19.49
  97035         A      Ultrasound therapy                            12.67             11.81             13.79
  97036         A      Hydrotherapy                                  32.48             29.54             35.85
  97039         C      Physical therapy treatment                     0.00              0.00              0.00


                                             Page 44 of 121
                                                                                                               8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION
                                                                      Poughkpsie/N
CPT/HCPCS                                                             NYC Suburbs,        Rest of New
  Code           Status              Short Description                    NY                 York            Queens, NY
                                                                          13202              13282              13292
                                                                           03                 99                 04
   97110           A       Therapeutic exercises                                  31.80              29.57              34.67
   97112           A       Neuromuscular reeducation                              33.25              30.85              36.30
   97113           A       Aquatic therapy/exercises                              42.70              39.14              46.92
   97116           A       Gait training therapy                                  28.27              26.27              30.83
   97124           A       Massage therapy                                        26.19              24.25              28.62
   97139           C       Physical medicine procedure                             0.00               0.00               0.00
   97140           A       Manual therapy                                         29.67              27.61              32.32
   97150           A       Group therapeutic procedures                           20.53              18.97              22.47
   97530           A       Therapeutic activities                                 35.08              32.43              38.38
   97532           A       Cognitive skills development                           26.38              24.76              28.62
   97533           A       Sensory integration                                    29.28              27.31              31.87
   97535           A       Self care mngment training                             34.70              32.13              37.93
   97537           A       Community/work reintegration                           29.99              27.97              32.64
   97542           A       Wheelchair mngment training                            30.72              28.61              33.45
   97597           A       Rmvl devital tis 20 cm/<                               79.20              71.05              88.09
   97598           A       Rmvl devital tis addl 20 cm<                           26.04              23.45              28.91
   97602           B       Wound(s) care non-selective                             0.00               0.00               0.00
   97605           A       Neg press wound tx < 50 cm                             42.53              38.47              47.13
   97606           A       Neg press wound tx > 50 cm                             45.35              40.87              50.36
   97750           A       Physical performance test                              33.63              30.91              36.91
   97755           A       Assistive technology assess                            36.21              33.82              39.39
   97760           A       Orthotic mgmt and training                             38.34              35.07              42.19
   97761           A       Prosthetic training                                    33.26              30.59              36.50
   97762           A       C/o for orthotic/prosth use                            46.67              41.94              51.85
   97799           C       Physical medicine procedure                             0.00               0.00               0.00
   G0281           A       Elec stim unattend for press                           13.81              12.71              15.15
   G0283           A       Elec stim other than wound                             13.81              12.71              15.15
   G0329           A       Electromagntic tx for ulcers                           10.41               9.27              11.62

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 45 of 121
                                                                                            8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description         North Carolina North Dakota        Ohio
                                                              05535          03302          00883
                                                               00             01             00
  0019T         C      Extracorp shock wv tx ms nos                   0.00           0.00           0.00
  0183T         C      Wound ultrasound                               0.00           0.00           0.00
  64550         A      Apply neurostimulator                         15.20          15.83          15.38
  90901         A      Biofeedback train any meth                    37.23          38.98          37.41
  92506         A      Speech/hearing evaluation                    155.09         164.60         156.02
  92507         A      Speech/hearing therapy                        72.09          73.73          73.39
  92508         A      Speech/hearing therapy                        21.57          22.30          21.75
  92520         A      Laryngeal function studies                    66.86          69.80          67.60
  92526         A      Oral function therapy                         79.77          81.90          81.06
  92597         A      Oral speech device eval                       79.57          81.90          80.87
  92605         B      Ex for nonspeech device rx                     0.00           0.00           0.00
  92606         B      Non-speech device service                      0.00           0.00           0.00
  92607         A      Ex for speech device rx 1hr                  136.01         140.97         137.87
  92608         A      Ex for speech device rx addl                  44.02          45.29          44.76
  92609         A      Use of speech device service                  96.89          99.94          98.18
  92610         A      Evaluate swallowing function                  85.66          88.37          86.96
  92611         A      Motion fluoroscopy/swallow                    93.89          97.05          95.37
  92612         A      Endoscopy swallow tst (fees)                 160.05         168.70         161.35
  92614         A      Laryngoscopic sensory test                   143.64         151.00         144.94
  92616         A      Fees w/laryngeal sense test                  193.20         202.58         195.05
  95831         A      Limb muscle testing manual                    26.65          27.76          27.20
  95832         A      Hand muscle testing manual                    25.09          26.06          25.65
  95833         A      Body muscle testing manual                    35.48          36.94          35.67
  95834         A      Body muscle testing manual                    46.06          47.84          46.62
  95851         A      Range of motion measurements                  17.04          17.88          17.23
  95852         A      Range of motion measurements                  15.02          15.83          15.21
  95992         A      Canalith repositioning proc                   40.59          41.38          41.52
  96105         A      Assessment of aphasia                         98.38         101.11          99.12
  96111         A      Developmental test extend                    120.36         121.61         123.33
  96125         A      Cognitive test by hc pro                      95.49          97.90          96.79
  97001         A      Pt evaluation                                 70.74          72.70          71.67
  97002         A      Pt re-evaluation                              39.12          40.35          39.67
  97003         A      Ot evaluation                                 78.94          81.55          79.87
  97004         A      Ot re-evaluation                              48.27          50.22          48.82
  97010         B      Hot or cold packs therapy                      0.00           0.00           0.00
  97012         A      Mechanical traction therapy                   15.06          15.49          15.24
  97016         A      Vasopneumatic device therapy                  17.41          18.22          17.59
  97018         A      Paraffin bath therapy                          9.54          10.05           9.72
  97022         A      Whirlpool therapy                             20.85          21.96          21.04
  97024         A      Diathermy eg microwave                         6.07           6.30           6.25
  97026         R      Infrared therapy                               5.43           5.62           5.62
  97028         A      Ultraviolet therapy                            6.75           6.98           6.93
  97032         A      Electrical stimulation                        17.58          18.22          17.77
  97033         A      Electric current therapy                      28.96          30.47          29.15
  97034         A      Contrast bath therapy                         16.22          16.85          16.40
  97035         A      Ultrasound therapy                            11.80          12.09          11.99
  97036         A      Hydrotherapy                                  29.33          30.81          29.52
  97039         C      Physical therapy treatment                     0.00           0.00           0.00


                                             Page 46 of 121
                                                                                                          8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                North Carolina North Dakota         Ohio
                                                                          05535           03302           00883
                                                                           00              01              00
   97110           A       Therapeutic exercises                                  29.44           30.47           29.62
   97112           A       Neuromuscular reeducation                              30.70           31.83           30.88
   97113           A       Aquatic therapy/exercises                              38.88           40.68           39.06
   97116           A       Gait training therapy                                  26.16           27.07           26.34
   97124           A       Massage therapy                                        24.14           25.02           24.33
   97139           C       Physical medicine procedure                             0.00            0.00            0.00
   97140           A       Manual therapy                                         27.49           28.43           27.68
   97150           A       Group therapeutic procedures                           18.89           19.58           19.08
   97530           A       Therapeutic activities                                 32.25           33.53           32.44
   97532           A       Cognitive skills development                           24.68           25.36           24.86
   97533           A       Sensory integration                                    27.20           28.09           27.39
   97535           A       Self care mngment training                             31.96           33.19           32.15
   97537           A       Community/work reintegration                           27.86           28.77           28.04
   97542           A       Wheelchair mngment training                            28.49           29.45           28.68
   97597           A       Rmvl devital tis 20 cm/<                               70.60           74.40           71.53
   97598           A       Rmvl devital tis addl 20 cm<                           23.39           24.35           23.95
   97602           B       Wound(s) care non-selective                             0.00            0.00            0.00
   97605           A       Neg press wound tx < 50 cm                             38.60           39.53           40.08
   97606           A       Neg press wound tx > 50 cm                             41.09           41.92           42.94
   97750           A       Physical performance test                              30.86           31.84           31.41
   97755           A       Assistive technology assess                            33.80           34.57           34.36
   97760           A       Orthotic mgmt and training                             34.96           36.27           35.51
   97761           A       Prosthetic training                                    30.54           31.50           31.10
   97762           A       C/o for orthotic/prosth use                            41.56           44.08           41.75
   97799           C       Physical medicine procedure                             0.00            0.00            0.00
   G0281           A       Elec stim unattend for press                           12.67           13.11           12.86
   G0283           A       Elec stim other than wound                             12.67           13.11           12.86
   G0329           A       Electromagntic tx for ulcers                            9.22            9.71            9.41

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 47 of 121
                                                                                                   8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                                         Rest of
  Code        Status           Short Description              Oklahoma         Portland, OR       Oregon
                                                                04302             00835            00835
                                                                 00                 01              99
  0019T         C      Extracorp shock wv tx ms nos                     0.00               0.00            0.00
  0183T         C      Wound ultrasound                                 0.00               0.00            0.00
  64550         A      Apply neurostimulator                           14.53              16.32           15.51
  90901         A      Biofeedback train any meth                      35.47              40.18           38.07
  92506         A      Speech/hearing evaluation                      145.61             170.85          159.68
  92507         A      Speech/hearing therapy                          70.18              75.45           72.92
  92508         A      Speech/hearing therapy                          20.81              22.87           21.92
  92520         A      Laryngeal function studies                      63.82              71.99           68.29
  92526         A      Oral function therapy                           77.37              83.93           80.83
  92597         A      Oral speech device eval                         76.98              84.04           80.72
  92605         B      Ex for nonspeech device rx                       0.00               0.00            0.00
  92606         B      Non-speech device service                        0.00               0.00            0.00
  92607         A      Ex for speech device rx 1hr                    130.73             145.01          138.44
  92608         A      Ex for speech device rx addl                    42.60              46.47           44.65
  92609         A      Use of speech device service                    93.60             102.55           98.39
  92610         A      Evaluate swallowing function                    82.71              90.73           87.00
  92611         A      Motion fluoroscopy/swallow                      90.44              99.78           95.45
  92612         A      Endoscopy swallow tst (fees)                   151.32             174.64          164.23
  92614         A      Laryngoscopic sensory test                     136.17             156.16          147.21
  92616         A      Fees w/laryngeal sense test                    183.62             209.29          197.75
  95831         A      Limb muscle testing manual                      25.43              28.69           27.20
  95832         A      Hand muscle testing manual                      24.02              26.90           25.57
  95833         A      Body muscle testing manual                      34.02              37.97           36.18
  95834         A      Body muscle testing manual                      44.19              49.24           46.93
  95851         A      Range of motion measurements                    16.18              18.48           17.45
  95852         A      Range of motion measurements                    14.19              16.41           15.42
  95992         A      Canalith repositioning proc                     39.60              42.36           41.00
  96105         A      Assessment of aphasia                           95.53             103.36           99.71
  96111         A      Developmental test extend                      118.43             123.97          121.04
  96125         A      Cognitive test by hc pro                        92.83             100.15           96.68
  97001         A      Pt evaluation                                   68.61              74.45           71.71
  97002         A      Pt re-evaluation                                37.78              41.42           39.72
  97003         A      Ot evaluation                                   76.18              83.69           80.22
  97004         A      Ot re-evaluation                                46.23              51.72           49.22
  97010         B      Hot or cold packs therapy                        0.00               0.00            0.00
  97012         A      Mechanical traction therapy                     14.59              15.87           15.27
  97016         A      Vasopneumatic device therapy                    16.57              18.81           17.80
  97018         A      Paraffin bath therapy                            8.99              10.44            9.79
  97022         A      Whirlpool therapy                               19.73              22.73           21.39
  97024         A      Diathermy eg microwave                           5.79               6.53            6.18
  97026         R      Infrared therapy                                 5.21               5.82            5.53
  97028         A      Ultraviolet therapy                              6.47               7.21            6.87
  97032         A      Electrical stimulation                          16.92              18.71           17.89
  97033         A      Electric current therapy                        27.46              31.49           29.69
  97034         A      Contrast bath therapy                           15.56              17.35           16.53
  97035         A      Ultrasound therapy                              11.48              12.37           11.94
  97036         A      Hydrotherapy                                    27.84              31.82           30.04
  97039         C      Physical therapy treatment                       0.00               0.00            0.00


                                             Page 48 of 121
                                                                                                             8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                                                   Rest of
  Code           Status              Short Description                 Oklahoma          Portland, OR       Oregon
                                                                         04302              00835            00835
                                                                          00                  01              99
   97110           A       Therapeutic exercises                                 28.39              31.24            29.94
   97112           A       Neuromuscular reeducation                             29.55              32.66            31.25
   97113           A       Aquatic therapy/exercises                             37.08              41.92            39.75
   97116           A       Gait training therapy                                 25.23              27.75            26.60
   97124           A       Massage therapy                                       23.23              25.69            24.57
   97139           C       Physical medicine procedure                            0.00               0.00             0.00
   97140           A       Manual therapy                                        26.54              29.14            27.95
   97150           A       Group therapeutic procedures                          18.18              20.11            19.23
   97530           A       Therapeutic activities                                30.96              34.45            32.87
   97532           A       Cognitive skills development                          23.97              25.92            25.01
   97533           A       Sensory integration                                   26.30              28.77            27.63
   97535           A       Self care mngment training                            30.72              34.08            32.56
   97537           A       Community/work reintegration                          26.93              29.46            28.30
   97542           A       Wheelchair mngment training                           27.51              30.18            28.95
   97597           A       Rmvl devital tis 20 cm/<                              66.68              77.14            72.45
   97598           A       Rmvl devital tis addl 20 cm<                          22.32              25.19            23.87
   97602           B       Wound(s) care non-selective                            0.00               0.00             0.00
   97605           A       Neg press wound tx < 50 cm                            37.33              40.77            39.09
   97606           A       Neg press wound tx > 50 cm                            39.82              43.26            41.54
   97750           A       Physical performance test                             29.76              32.73            31.34
   97755           A       Assistive technology assess                           32.92              35.35            34.18
   97760           A       Orthotic mgmt and training                            33.55              37.35            35.60
   97761           A       Prosthetic training                                   29.47              32.38            31.02
   97762           A       C/o for orthotic/prosth use                           39.06              45.72            42.78
   97799           C       Physical medicine procedure                            0.00               0.00             0.00
   G0281           A       Elec stim unattend for press                          12.20              13.48            12.89
   G0283           A       Elec stim other than wound                            12.20              13.48            12.89
   G0329           A       Electromagntic tx for ulcers                           8.70              10.08             9.46

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 49 of 121
                                                                                                   8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION
                                                          Metropolitan
CPT/HCPCS                                                 Philadelphia,        Rest of
  Code        Status           Short Description               PA            Pennsylvania       Puerto Rico
                                                              12502              12502             9202
                                                               01                 99                20
  0019T         C      Extracorp shock wv tx ms nos                   0.00               0.00              0.00
  0183T         C      Wound ultrasound                               0.00               0.00              0.00
  64550         A      Apply neurostimulator                         16.86              15.21             12.67
  90901         A      Biofeedback train any meth                    41.02              37.02             30.89
  92506         A      Speech/hearing evaluation                    174.83             153.94            120.85
  92507         A      Speech/hearing therapy                        78.66              72.72             64.00
  92508         A      Speech/hearing therapy                        23.48              21.56             18.70
  92520         A      Laryngeal function studies                    74.24              66.83             55.41
  92526         A      Oral function therapy                         87.25              80.29             69.97
  92597         A      Oral speech device eval                       87.37              80.06             69.10
  92605         B      Ex for nonspeech device rx                     0.00               0.00              0.00
  92606         B      Non-speech device service                      0.00               0.00              0.00
  92607         A      Ex for speech device rx 1hr                  150.12             136.40            115.51
  92608         A      Ex for speech device rx addl                  48.36              44.31             38.24
  92609         A      Use of speech device service                 106.10              97.24             83.96
  92610         A      Evaluate swallowing function                  94.16              86.08             73.92
  92611         A      Motion fluoroscopy/swallow                   103.66              94.35             80.21
  92612         A      Endoscopy swallow tst (fees)                 179.27             159.33            128.05
  92614         A      Laryngoscopic sensory test                   160.53             143.17            116.05
  92616         A      Fees w/laryngeal sense test                  215.32             192.74            157.61
  95831         A      Limb muscle testing manual                    30.07              26.84             21.79
  95832         A      Hand muscle testing manual                    28.25              25.31             20.74
  95833         A      Body muscle testing manual                    38.76              35.34             30.16
  95834         A      Body muscle testing manual                    50.84              46.12             38.91
  95851         A      Range of motion measurements                  19.05              17.02             13.84
  95852         A      Range of motion measurements                  16.97              15.00             11.91
  95992         A      Canalith repositioning proc                   44.51              41.11             36.11
  96105         A      Assessment of aphasia                        105.87              98.39             87.60
  96111         A      Developmental test extend                    130.66             122.27            110.39
  96125         A      Cognitive test by hc pro                     103.64              95.97             84.77
  97001         A      Pt evaluation                                 76.98              71.04             62.27
  97002         A      Pt re-evaluation                              42.91              39.28             33.83
  97003         A      Ot evaluation                                 86.35              79.12             68.27
  97004         A      Ot re-evaluation                              53.37              48.29             40.52
  97010         B      Hot or cold packs therapy                      0.00               0.00              0.00
  97012         A      Mechanical traction therapy                   16.39              15.11             13.21
  97016         A      Vasopneumatic device therapy                  19.38              17.39             14.29
  97018         A      Paraffin bath therapy                         10.91               9.57              7.43
  97022         A      Whirlpool therapy                             23.36              20.77             16.72
  97024         A      Diathermy eg microwave                         6.95               6.15              4.90
  97026         R      Infrared therapy                               6.23               5.53              4.43
  97028         A      Ultraviolet therapy                            7.64               6.83              5.58
  97032         A      Electrical stimulation                        19.27              17.59             15.06
  97033         A      Electric current therapy                      32.24              28.81             23.47
  97034         A      Contrast bath therapy                         17.89              16.23             13.69
  97035         A      Ultrasound therapy                            12.85              11.88             10.46
  97036         A      Hydrotherapy                                  32.57              29.18             23.92
  97039         C      Physical therapy treatment                     0.00               0.00              0.00


                                             Page 50 of 121
                                                                                                                 8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION
                                                                      Metropolitan
CPT/HCPCS                                                             Philadelphia,         Rest of
  Code           Status              Short Description                     PA             Pennsylvania        Puerto Rico
                                                                          12502               12502              9202
                                                                           01                  99                 20
   97110           A       Therapeutic exercises                                  31.94               29.37             25.56
   97112           A       Neuromuscular reeducation                              33.39               30.62             26.48
   97113           A       Aquatic therapy/exercises                              42.77               38.67             32.37
   97116           A       Gait training therapy                                  28.42               26.12             22.70
   97124           A       Massage therapy                                        26.33               24.10             20.77
   97139           C       Physical medicine procedure                             0.00                0.00              0.00
   97140           A       Manual therapy                                         29.81               27.45             23.95
   97150           A       Group therapeutic procedures                           20.69               18.90             16.20
   97530           A       Therapeutic activities                                 35.20               32.14             27.52
   97532           A       Cognitive skills development                           26.55               24.68             21.98
   97533           A       Sensory integration                                    29.44               27.17             23.83
   97535           A       Self care mngment training                             34.83               31.86             27.40
   97537           A       Community/work reintegration                           30.14               27.82             24.40
   97542           A       Wheelchair mngment training                            30.86               28.44             24.86
   97597           A       Rmvl devital tis 20 cm/<                               79.84               70.55             55.86
   97598           A       Rmvl devital tis addl 20 cm<                           26.52               23.61             19.04
   97602           B       Wound(s) care non-selective                             0.00                0.00              0.00
   97605           A       Neg press wound tx < 50 cm                             43.95               39.49             32.55
   97606           A       Neg press wound tx > 50 cm                             47.14               42.27             34.66
   97750           A       Physical performance test                              34.13               31.07             26.42
   97755           A       Assistive technology assess                            36.75               34.06             30.13
   97760           A       Orthotic mgmt and training                             38.82               35.11             29.42
   97761           A       Prosthetic training                                    33.77               30.76             26.19
   97762           A       C/o for orthotic/prosth use                            46.67               41.21             32.59
   97799           C       Physical medicine procedure                             0.00                0.00              0.00
   G0281           A       Elec stim unattend for press                           13.97               12.72             10.83
   G0283           A       Elec stim other than wound                             13.97               12.72             10.83
   G0329           A       Electromagntic tx for ulcers                           10.55                9.26              7.20

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 51 of 121
                                                                                                 8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                     South
  Code        Status           Short Description          Rhode Island       Carolina         South Dakota
                                                              14402           00880               03402
                                                               01               01                 02
  0019T         C      Extracorp shock wv tx ms nos                   0.00             0.00               0.00
  0183T         C      Wound ultrasound                               0.00             0.00               0.00
  64550         A      Apply neurostimulator                         16.66            14.97              15.80
  90901         A      Biofeedback train any meth                    40.74            36.72              38.95
  92506         A      Speech/hearing evaluation                    173.23           152.37             164.46
  92507         A      Speech/hearing therapy                        77.55            71.17              73.53
  92508         A      Speech/hearing therapy                        23.29            21.31              22.27
  92520         A      Laryngeal function studies                    73.41            65.84              69.68
  92526         A      Oral function therapy                         86.10            78.72              81.70
  92597         A      Oral speech device eval                       86.19            78.47              81.70
  92605         B      Ex for nonspeech device rx                     0.00             0.00               0.00
  92606         B      Non-speech device service                      0.00             0.00               0.00
  92607         A      Ex for speech device rx 1hr                  148.29           134.05             140.68
  92608         A      Ex for speech device rx addl                  47.69            43.41              45.18
  92609         A      Use of speech device service                 104.88            95.61              99.74
  92610         A      Evaluate swallowing function                  92.95            84.47              88.17
  92611         A      Motion fluoroscopy/swallow                   102.26            92.51              96.82
  92612         A      Endoscopy swallow tst (fees)                 177.49           157.40             168.49
  92614         A      Laryngoscopic sensory test                   158.87           141.31             150.79
  92616         A      Fees w/laryngeal sense test                  213.07           190.14             202.29
  95831         A      Limb muscle testing manual                    29.52            26.15              27.67
  95832         A      Hand muscle testing manual                    27.72            24.63              25.97
  95833         A      Body muscle testing manual                    38.52            35.05              36.91
  95834         A      Body muscle testing manual                    50.27            45.40              47.75
  95851         A      Range of motion measurements                  18.83            16.76              17.85
  95852         A      Range of motion measurements                  16.74            14.75              15.80
  95992         A      Canalith repositioning proc                   43.74            40.03              41.24
  96105         A      Assessment of aphasia                        105.16            97.40             101.00
  96111         A      Developmental test extend                    128.34           118.87             121.14
  96125         A      Cognitive test by hc pro                     102.50            94.37              97.70
  97001         A      Pt evaluation                                 76.14            69.89              72.55
  97002         A      Pt re-evaluation                              42.39            38.59              40.27
  97003         A      Ot evaluation                                 85.45            77.93              81.40
  97004         A      Ot re-evaluation                              52.78            47.56              50.14
  97010         B      Hot or cold packs therapy                      0.00             0.00               0.00
  97012         A      Mechanical traction therapy                   16.22            14.87              15.46
  97016         A      Vasopneumatic device therapy                  19.17            17.13              18.19
  97018         A      Paraffin bath therapy                         10.72             9.34              10.02
  97022         A      Whirlpool therapy                             23.12            20.51              21.93
  97024         A      Diathermy eg microwave                         6.78             5.93               6.27
  97026         R      Infrared therapy                               6.06             5.31               5.59
  97028         A      Ultraviolet therapy                            7.47             6.61               6.95
  97032         A      Electrical stimulation                        19.08            17.35              18.19
  97033         A      Electric current therapy                      31.96            28.52              30.44
  97034         A      Contrast bath therapy                         17.70            15.99              16.83
  97035         A      Ultrasound therapy                            12.69            11.66              12.06
  97036         A      Hydrotherapy                                  32.30            28.89              30.78
  97039         C      Physical therapy treatment                     0.00             0.00               0.00


                                             Page 52 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                                  South
  Code           Status              Short Description                Rhode Island        Carolina         South Dakota
                                                                          14402            00880               03402
                                                                           01                01                 02
   97110           A       Therapeutic exercises                                  31.74            29.11               30.44
   97112           A       Neuromuscular reeducation                              33.17            30.35               31.80
   97113           A       Aquatic therapy/exercises                              42.49            38.36               40.65
   97116           A       Gait training therapy                                  28.22            25.86               27.04
   97124           A       Massage therapy                                        26.13            23.85               24.99
   97139           C       Physical medicine procedure                             0.00             0.00                0.00
   97140           A       Manual therapy                                         29.61            27.19               28.40
   97150           A       Group therapeutic procedures                           20.49            18.65               19.55
   97530           A       Therapeutic activities                                 34.97            31.86               33.50
   97532           A       Cognitive skills development                           26.38            24.44               25.33
   97533           A       Sensory integration                                    29.24            26.91               28.06
   97535           A       Self care mngment training                             34.60            31.58               33.16
   97537           A       Community/work reintegration                           29.95            27.56               28.74
   97542           A       Wheelchair mngment training                            30.66            28.18               29.42
   97597           A       Rmvl devital tis 20 cm/<                               78.76            69.30               74.26
   97598           A       Rmvl devital tis addl 20 cm<                           25.99            22.93               24.27
   97602           B       Wound(s) care non-selective                             0.00             0.00                0.00
   97605           A       Neg press wound tx < 50 cm                             42.68            37.77               39.30
   97606           A       Neg press wound tx > 50 cm                             45.58            40.14               41.63
   97750           A       Physical performance test                              33.62            30.39               31.76
   97755           A       Assistive technology assess                            36.28            33.39               34.48
   97760           A       Orthotic mgmt and training                             38.27            34.41               36.18
   97761           A       Prosthetic training                                    33.26            30.08               31.42
   97762           A       C/o for orthotic/prosth use                            46.30            40.86               44.06
   97799           C       Physical medicine procedure                             0.00             0.00                0.00
   G0281           A       Elec stim unattend for press                           13.80            12.49               13.08
   G0283           A       Elec stim other than wound                             13.80            12.49               13.08
   G0329           A       Electromagntic tx for ulcers                           10.36             9.03                9.68

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 53 of 121
                                                                                                    8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description              Tennessee        Brazoria, TX       Dallas, TX
                                                                10302             04402             04402
                                                                 35                 09                11
  0019T         C      Extracorp shock wv tx ms nos                     0.00               0.00              0.00
  0183T         C      Wound ultrasound                                 0.00               0.00              0.00
  64550         A      Apply neurostimulator                           14.86              15.90             16.16
  90901         A      Biofeedback train any meth                      36.45              38.92             39.63
  92506         A      Speech/hearing evaluation                      150.90             163.81            167.69
  92507         A      Speech/hearing therapy                          70.86              74.73             75.37
  92508         A      Speech/hearing therapy                          21.19              22.40             22.69
  92520         A      Laryngeal function studies                      65.36              70.02             71.20
  92526         A      Oral function therapy                           78.34              82.82             83.66
  92597         A      Oral speech device eval                         78.06              82.76             83.68
  92605         B      Ex for nonspeech device rx                       0.00               0.00              0.00
  92606         B      Non-speech device service                        0.00               0.00              0.00
  92607         A      Ex for speech device rx 1hr                    133.22             141.93            143.92
  92608         A      Ex for speech device rx addl                    43.18              45.79             46.29
  92609         A      Use of speech device service                    95.09             100.75            101.97
  92610         A      Evaluate swallowing function                    84.01              89.18             90.25
  92611         A      Motion fluoroscopy/swallow                      91.97              97.92             99.18
  92612         A      Endoscopy swallow tst (fees)                   156.04             168.44            171.95
  92614         A      Laryngoscopic sensory test                     140.14             150.97            153.95
  92616         A      Fees w/laryngeal sense test                    188.65             202.76            206.56
  95831         A      Limb muscle testing manual                      25.96              28.03             28.47
  95832         A      Hand muscle testing manual                      24.47              26.36             26.73
  95833         A      Body muscle testing manual                      34.82              36.95             37.54
  95834         A      Body muscle testing manual                      45.10              48.09             48.80
  95851         A      Range of motion measurements                    16.63              17.90             18.24
  95852         A      Range of motion measurements                    14.62              15.85             16.18
  95992         A      Canalith repositioning proc                     39.87              42.11             42.41
  96105         A      Assessment of aphasia                           96.96             101.67            102.78
  96111         A      Developmental test extend                      118.55             124.22            124.64
  96125         A      Cognitive test by hc pro                        93.96              98.88             99.83
  97001         A      Pt evaluation                                   69.55              73.36             74.13
  97002         A      Pt re-evaluation                                38.38              40.70             41.19
  97003         A      Ot evaluation                                   77.50              82.09             83.13
  97004         A      Ot re-evaluation                                47.24              50.44             51.23
  97010         B      Hot or cold packs therapy                        0.00               0.00              0.00
  97012         A      Mechanical traction therapy                     14.80              15.62             15.79
  97016         A      Vasopneumatic device therapy                    17.00              18.25             18.58
  97018         A      Paraffin bath therapy                            9.25              10.10             10.31
  97022         A      Whirlpool therapy                               20.33              21.94             22.39
  97024         A      Diathermy eg microwave                           5.89               6.41              6.50
  97026         R      Infrared therapy                                 5.28               5.73              5.81
  97028         A      Ultraviolet therapy                              6.57               7.09              7.19
  97032         A      Electrical stimulation                          17.25              18.31             18.56
  97033         A      Electric current therapy                        28.28              30.41             31.02
  97034         A      Contrast bath therapy                           15.88              16.93             17.19
  97035         A      Ultrasound therapy                              11.61              12.23             12.34
  97036         A      Hydrotherapy                                    28.66              30.76             31.36
  97039         C      Physical therapy treatment                       0.00               0.00              0.00


                                             Page 54 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                 Tennessee         Brazoria, TX       Dallas, TX
                                                                         10302              04402             04402
                                                                          35                  09                11
   97110           A       Therapeutic exercises                                 28.94              30.55             30.97
   97112           A       Neuromuscular reeducation                             30.17              31.89             32.35
   97113           A       Aquatic therapy/exercises                             38.08              40.62             41.36
   97116           A       Gait training therapy                                 25.71              27.15             27.52
   97124           A       Massage therapy                                       23.71              25.10             25.46
   97139           C       Physical medicine procedure                            0.00               0.00              0.00
   97140           A       Manual therapy                                        27.04              28.52             28.90
   97150           A       Group therapeutic procedures                          18.54              19.67             19.94
   97530           A       Therapeutic activities                                31.66              33.57             34.09
   97532           A       Cognitive skills development                          24.32              25.50             25.78
   97533           A       Sensory integration                                   26.77              28.19             28.55
   97535           A       Self care mngment training                            31.39              33.24             33.74
   97537           A       Community/work reintegration                          27.42              28.87             29.24
   97542           A       Wheelchair mngment training                           28.03              29.54             29.93
   97597           A       Rmvl devital tis 20 cm/<                              68.68              74.52             76.05
   97598           A       Rmvl devital tis addl 20 cm<                          22.76              24.64             25.02
   97602           B       Wound(s) care non-selective                            0.00               0.00              0.00
   97605           A       Neg press wound tx < 50 cm                            37.57              40.55             40.89
   97606           A       Neg press wound tx > 50 cm                            39.93              43.23             43.52
   97750           A       Physical performance test                             30.22              32.19             32.58
   97755           A       Assistive technology assess                           33.25              35.00             35.30
   97760           A       Orthotic mgmt and training                            34.19              36.55             37.08
   97761           A       Prosthetic training                                   29.91              31.85             32.23
   97762           A       C/o for orthotic/prosth use                           40.48              43.84             44.87
   97799           C       Physical medicine procedure                            0.00               0.00              0.00
   G0281           A       Elec stim unattend for press                          12.42              13.22             13.39
   G0283           A       Elec stim other than wound                            12.42              13.22             13.39
   G0329           A       Electromagntic tx for ulcers                           8.94               9.77              9.96

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 55 of 121
                                                                                                  8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description          Galveston, TX      Houston, TX       Beaumont, TX
                                                              04402             04402              04402
                                                               15                18                 20
  0019T         C      Extracorp shock wv tx ms nos                   0.00              0.00               0.00
  0183T         C      Wound ultrasound                               0.00              0.00               0.00
  64550         A      Apply neurostimulator                         16.01             16.05              14.98
  90901         A      Biofeedback train any meth                    39.16             39.29              36.53
  92506         A      Speech/hearing evaluation                    165.12            165.82             151.31
  92507         A      Speech/hearing therapy                        75.13             75.15              71.76
  92508         A      Speech/hearing therapy                        22.52             22.56              21.31
  92520         A      Laryngeal function studies                    70.49             70.67              65.82
  92526         A      Oral function therapy                         83.29             83.35              79.22
  92597         A      Oral speech device eval                       83.25             83.33              78.94
  92605         B      Ex for nonspeech device rx                     0.00              0.00               0.00
  92606         B      Non-speech device service                      0.00              0.00               0.00
  92607         A      Ex for speech device rx 1hr                  142.83            143.07             134.43
  92608         A      Ex for speech device rx addl                  46.06             46.10              43.69
  92609         A      Use of speech device service                 101.32            101.46              95.95
  92610         A      Evaluate swallowing function                  89.71             89.82              84.88
  92611         A      Motion fluoroscopy/swallow                    98.54             98.67              92.96
  92612         A      Endoscopy swallow tst (fees)                 169.70            170.30             156.74
  92614         A      Laryngoscopic sensory test                   152.08            152.57             140.88
  92616         A      Fees w/laryngeal sense test                  204.20            204.81             189.73
  95831         A      Limb muscle testing manual                    28.25             28.29              26.33
  95832         A      Hand muscle testing manual                    26.56             26.59              24.84
  95833         A      Body muscle testing manual                    37.16             37.26              34.92
  95834         A      Body muscle testing manual                    48.39             48.49              45.46
  95851         A      Range of motion measurements                  18.03             18.09              16.74
  95852         A      Range of motion measurements                  15.98             16.03              14.73
  95992         A      Canalith repositioning proc                   42.35             42.34              40.52
  96105         A      Assessment of aphasia                        102.12            102.29              97.42
  96111         A      Developmental test extend                    124.83            124.67             120.67
  96125         A      Cognitive test by hc pro                      99.38             99.46              94.83
  97001         A      Pt evaluation                                 73.74             73.82              70.17
  97002         A      Pt re-evaluation                              40.94             40.99              38.75
  97003         A      Ot evaluation                                 82.55             82.69              78.10
  97004         A      Ot re-evaluation                              50.77             50.88              47.59
  97010         B      Hot or cold packs therapy                      0.00              0.00               0.00
  97012         A      Mechanical traction therapy                   15.70             15.72              14.92
  97016         A      Vasopneumatic device therapy                  18.38             18.43              17.12
  97018         A      Paraffin bath therapy                         10.19             10.22               9.37
  97022         A      Whirlpool therapy                             22.11             22.18              20.43
  97024         A      Diathermy eg microwave                         6.46              6.47               6.02
  97026         R      Infrared therapy                               5.79              5.79               5.41
  97028         A      Ultraviolet therapy                            7.15              7.15               6.70
  97032         A      Electrical stimulation                        18.41             18.45              17.36
  97033         A      Electric current therapy                      30.62             30.73              28.38
  97034         A      Contrast bath therapy                         17.04             17.08              16.00
  97035         A      Ultrasound therapy                            12.29             12.30              11.73
  97036         A      Hydrotherapy                                  30.97             31.08              28.75
  97039         C      Physical therapy treatment                     0.00              0.00               0.00


                                             Page 56 of 121
                                                                                                                8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                Galveston, TX       Houston, TX        Beaumont, TX
                                                                          04402              04402               04402
                                                                           15                 18                  20
   97110           A       Therapeutic exercises                                  30.71              30.78               29.05
   97112           A       Neuromuscular reeducation                              32.06              32.14               30.27
   97113           A       Aquatic therapy/exercises                              40.87              41.00               38.16
   97116           A       Gait training therapy                                  27.29              27.35               25.82
   97124           A       Massage therapy                                        25.24              25.29               23.82
   97139           C       Physical medicine procedure                             0.00               0.00                0.00
   97140           A       Manual therapy                                         28.66              28.72               27.15
   97150           A       Group therapeutic procedures                           19.78              19.82               18.65
   97530           A       Therapeutic activities                                 33.75              33.84               31.76
   97532           A       Cognitive skills development                           25.62              25.66               24.44
   97533           A       Sensory integration                                    28.33              28.39               26.88
   97535           A       Self care mngment training                             33.42              33.50               31.49
   97537           A       Community/work reintegration                           29.01              29.07               27.53
   97542           A       Wheelchair mngment training                            29.69              29.75               28.14
   97597           A       Rmvl devital tis 20 cm/<                               75.13              75.36               69.25
   97598           A       Rmvl devital tis addl 20 cm<                           24.84              24.87               23.14
   97602           B       Wound(s) care non-selective                             0.00               0.00                0.00
   97605           A       Neg press wound tx < 50 cm                             40.90              40.84               38.62
   97606           A       Neg press wound tx > 50 cm                             43.62              43.53               41.25
   97750           A       Physical performance test                              32.39              32.43               30.59
   97755           A       Assistive technology assess                            35.18              35.20               33.63
   97760           A       Orthotic mgmt and training                             36.80              36.86               34.56
   97761           A       Prosthetic training                                    32.06              32.09               30.29
   97762           A       C/o for orthotic/prosth use                            44.18              44.37               40.54
   97799           C       Physical medicine procedure                             0.00               0.00                0.00
   G0281           A       Elec stim unattend for press                           13.30              13.32               12.54
   G0283           A       Elec stim other than wound                             13.30              13.32               12.54
   G0329           A       Electromagntic tx for ulcers                            9.85               9.88                9.07

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 57 of 121
                                                                                                   8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description         Fort Worth, TX      Austin, TX        Rest of Texas
                                                              04402            04402               04402
                                                               28                31                 99
  0019T         C      Extracorp shock wv tx ms nos                   0.00              0.00               0.00
  0183T         C      Wound ultrasound                               0.00              0.00               0.00
  64550         A      Apply neurostimulator                         15.74             16.00              15.09
  90901         A      Biofeedback train any meth                    38.56             39.28              36.89
  92506         A      Speech/hearing evaluation                    162.30            166.21             153.27
  92507         A      Speech/hearing therapy                        73.87             74.54              71.94
  92508         A      Speech/hearing therapy                        22.18             22.48              21.44
  92520         A      Laryngeal function studies                    69.31             70.51              66.36
  92526         A      Oral function therapy                         81.90             82.77              79.51
  92597         A      Oral speech device eval                       81.84             82.80              79.27
  92605         B      Ex for nonspeech device rx                     0.00              0.00               0.00
  92606         B      Non-speech device service                      0.00              0.00               0.00
  92607         A      Ex for speech device rx 1hr                  140.42            142.46             135.26
  92608         A      Ex for speech device rx addl                  45.28             45.80              43.86
  92609         A      Use of speech device service                  99.68            100.93              96.44
  92610         A      Evaluate swallowing function                  88.20             89.31              85.29
  92611         A      Motion fluoroscopy/swallow                    96.84             98.14              93.45
  92612         A      Endoscopy swallow tst (fees)                 166.82            170.37             158.46
  92614         A      Laryngoscopic sensory test                   149.50            152.51             142.32
  92616         A      Fees w/laryngeal sense test                  200.76            204.61             191.53
  95831         A      Limb muscle testing manual                    27.70             28.16              26.50
  95832         A      Hand muscle testing manual                    26.04             26.44              24.98
  95833         A      Body muscle testing manual                    36.61             37.20              35.21
  95834         A      Body muscle testing manual                    47.59             48.32              45.77
  95851         A      Range of motion measurements                  17.72             18.07              16.90
  95852         A      Range of motion measurements                  15.69             16.02              14.88
  95992         A      Canalith repositioning proc                   41.60             41.92              40.56
  96105         A      Assessment of aphasia                        100.68            101.80              97.92
  96111         A      Developmental test extend                    122.65            123.15             120.53
  96125         A      Cognitive test by hc pro                      97.82             98.81              95.18
  97001         A      Pt evaluation                                 72.57             73.38              70.47
  97002         A      Pt re-evaluation                              40.26             40.77              38.94
  97003         A      Ot evaluation                                 81.24             82.31              78.54
  97004         A      Ot re-evaluation                              49.92             50.73              47.95
  97010         B      Hot or cold packs therapy                      0.00              0.00               0.00
  97012         A      Mechanical traction therapy                   15.46             15.63              14.99
  97016         A      Vasopneumatic device therapy                  18.07             18.40              17.27
  97018         A      Paraffin bath therapy                          9.99             10.20               9.46
  97022         A      Whirlpool therapy                             21.73             22.18              20.65
  97024         A      Diathermy eg microwave                         6.32              6.42               6.04
  97026         R      Infrared therapy                               5.66              5.73               5.42
  97028         A      Ultraviolet therapy                            7.00              7.10               6.72
  97032         A      Electrical stimulation                        18.12             18.38              17.48
  97033         A      Electric current therapy                      30.12             30.74              28.68
  97034         A      Contrast bath therapy                         16.76             17.02              16.12
  97035         A      Ultrasound therapy                            12.09             12.21              11.77
  97036         A      Hydrotherapy                                  30.47             31.08              29.05
  97039         C      Physical therapy treatment                     0.00              0.00               0.00


                                             Page 58 of 121
                                                                                                                8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                Fort Worth, TX      Austin, TX        Rest of Texas
                                                                          04402             04402               04402
                                                                            28                31                 99
   97110           A       Therapeutic exercises                                  30.26             30.68               29.25
   97112           A       Neuromuscular reeducation                              31.59             32.06               30.49
   97113           A       Aquatic therapy/exercises                              40.25             40.99               38.53
   97116           A       Gait training therapy                                  26.89             27.26               26.00
   97124           A       Massage therapy                                        24.86             25.22               23.98
   97139           C       Physical medicine procedure                             0.00              0.00                0.00
   97140           A       Manual therapy                                         28.25             28.63               27.33
   97150           A       Group therapeutic procedures                           19.47             19.75               18.78
   97530           A       Therapeutic activities                                 33.25             33.78               32.01
   97532           A       Cognitive skills development                           25.25             25.54               24.56
   97533           A       Sensory integration                                    27.92             28.28               27.05
   97535           A       Self care mngment training                             32.93             33.43               31.73
   97537           A       Community/work reintegration                           28.59             28.97               27.70
   97542           A       Wheelchair mngment training                            29.26             29.65               28.32
   97597           A       Rmvl devital tis 20 cm/<                               73.75             75.30               69.96
   97598           A       Rmvl devital tis addl 20 cm<                           24.34             24.73               23.27
   97602           B       Wound(s) care non-selective                             0.00              0.00                0.00
   97605           A       Neg press wound tx < 50 cm                             39.96             40.34               38.62
   97606           A       Neg press wound tx > 50 cm                             42.56             42.90               41.18
   97750           A       Physical performance test                              31.82             32.23               30.73
   97755           A       Assistive technology assess                            34.61             34.92               33.73
   97760           A       Orthotic mgmt and training                             36.15             36.69               34.77
   97761           A       Prosthetic training                                    31.49             31.88               30.42
   97762           A       C/o for orthotic/prosth use                            43.45             44.48               41.07
   97799           C       Physical medicine procedure                             0.00              0.00                0.00
   G0281           A       Elec stim unattend for press                           13.07             13.25               12.61
   G0283           A       Elec stim other than wound                             13.07             13.25               12.61
   G0329           A       Electromagntic tx for ulcers                            9.65              9.85                9.15

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 59 of 121
                                                                                                 8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description              Utah           Vermont         Virgin Islands
                                                              03502           14502              09202
                                                               09              50                  50
  0019T         C      Extracorp shock wv tx ms nos                   0.00            0.00                0.00
  0183T         C      Wound ultrasound                               0.00            0.00                0.00
  64550         A      Apply neurostimulator                         15.23           15.92               16.02
  90901         A      Biofeedback train any meth                    37.09           39.19               39.20
  92506         A      Speech/hearing evaluation                    154.30          165.74              165.71
  92507         A      Speech/hearing therapy                        72.75           74.05               74.96
  92508         A      Speech/hearing therapy                        21.58           22.40               22.49
  92520         A      Laryngeal function studies                    66.94           70.20               70.56
  92526         A      Oral function therapy                         80.35           82.27               83.15
  92597         A      Oral speech device eval                       80.12           82.29               83.15
  92605         B      Ex for nonspeech device rx                     0.00            0.00                0.00
  92606         B      Non-speech device service                      0.00            0.00                0.00
  92607         A      Ex for speech device rx 1hr                  136.56          141.71              142.80
  92608         A      Ex for speech device rx addl                  44.35           45.51               46.01
  92609         A      Use of speech device service                  97.33          100.41              101.21
  92610         A      Evaluate swallowing function                  86.16           88.80               89.63
  92611         A      Motion fluoroscopy/swallow                    94.44           97.55               98.50
  92612         A      Endoscopy swallow tst (fees)                 159.65          169.78              170.12
  92614         A      Laryngoscopic sensory test                   143.44          151.94              152.38
  92616         A      Fees w/laryngeal sense test                  193.08          203.80              204.53
  95831         A      Limb muscle testing manual                    26.87           27.94               28.30
  95832         A      Hand muscle testing manual                    25.34           26.22               26.59
  95833         A      Body muscle testing manual                    35.39           37.12               37.15
  95834         A      Body muscle testing manual                    46.18           48.09               48.40
  95851         A      Range of motion measurements                  17.05           17.99               18.07
  95852         A      Range of motion measurements                  15.03           15.94               16.02
  95992         A      Canalith repositioning proc                   41.12           41.57               42.25
  96105         A      Assessment of aphasia                         98.48          101.49              101.87
  96111         A      Developmental test extend                    122.25          122.05              124.35
  96125         A      Cognitive test by hc pro                      96.03           98.30               99.15
  97001         A      Pt evaluation                                 71.09           73.01               73.60
  97002         A      Pt re-evaluation                              39.32           40.54               40.89
  97003         A      Ot evaluation                                 79.20           81.93               82.47
  97004         A      Ot re-evaluation                              48.36           50.49               50.78
  97010         B      Hot or cold packs therapy                      0.00            0.00                0.00
  97012         A      Mechanical traction therapy                   15.12           15.56               15.67
  97016         A      Vasopneumatic device therapy                  17.41           18.32               18.41
  97018         A      Paraffin bath therapy                          9.59           10.12               10.23
  97022         A      Whirlpool therapy                             20.82           22.10               22.16
  97024         A      Diathermy eg microwave                         6.16            6.35                6.48
  97026         R      Infrared therapy                               5.54            5.66                5.80
  97028         A      Ultraviolet therapy                            6.84            7.03                7.16
  97032         A      Electrical stimulation                        17.61           18.30               18.40
  97033         A      Electric current therapy                      28.87           30.65               30.68
  97034         A      Contrast bath therapy                         16.25           16.94               17.04
  97035         A      Ultrasound therapy                            11.89           12.14               12.27
  97036         A      Hydrotherapy                                  29.24           30.99               31.02
  97039         C      Physical therapy treatment                     0.00            0.00                0.00


                                             Page 60 of 121
                                                                                                            8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                 Utah            Vermont          Virgin Islands
                                                                       03502            14502               09202
                                                                        09               50                   50
   97110           A       Therapeutic exercises                               29.41            30.60               30.67
   97112           A       Neuromuscular reeducation                           30.66            31.97               32.03
   97113           A       Aquatic therapy/exercises                           38.74            40.90               40.90
   97116           A       Gait training therapy                               26.15            27.18               27.26
   97124           A       Massage therapy                                     24.14            25.14               25.22
   97139           C       Physical medicine procedure                          0.00             0.00                0.00
   97140           A       Manual therapy                                      27.48            28.55               28.62
   97150           A       Group therapeutic procedures                        18.92            19.67               19.77
   97530           A       Therapeutic activities                              32.19            33.69               33.74
   97532           A       Cognitive skills development                        24.71            25.46               25.55
   97533           A       Sensory integration                                 27.20            28.20               28.28
   97535           A       Self care mngment training                          31.90            33.35               33.40
   97537           A       Community/work reintegration                        27.85            28.89               28.96
   97542           A       Wheelchair mngment training                         28.48            29.57               29.64
   97597           A       Rmvl devital tis 20 cm/<                            70.68            74.91               75.35
   97598           A       Rmvl devital tis addl 20 cm<                        23.64            24.52               24.89
   97602           B       Wound(s) care non-selective                          0.00             0.00                0.00
   97605           A       Neg press wound tx < 50 cm                          39.49            39.79               40.91
   97606           A       Neg press wound tx > 50 cm                          42.26            42.21               43.64
   97750           A       Physical performance test                           31.10            32.01               32.38
   97755           A       Assistive technology assess                         34.08            34.71               35.09
   97760           A       Orthotic mgmt and training                          35.15            36.47               36.81
   97761           A       Prosthetic training                                 30.78            31.67               32.04
   97762           A       C/o for orthotic/prosth use                         41.31            44.38               44.32
   97799           C       Physical medicine procedure                          0.00             0.00                0.00
   G0281           A       Elec stim unattend for press                        12.74            13.18               13.29
   G0283           A       Elec stim other than wound                          12.74            13.18               13.29
   G0329           A       Electromagntic tx for ulcers                         9.28             9.78                9.89

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 61 of 121
                                                                                                    8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS                                                                      Seattle (King       Rest of
  Code        Status           Short Description              Virginia          Cnty), WA         Washington
                                                               00904               00836             00836
                                                                 00                 02                99
  0019T         C      Extracorp shock wv tx ms nos                     0.00               0.00              0.00
  0183T         C      Wound ultrasound                                 0.00               0.00              0.00
  64550         A      Apply neurostimulator                           15.69              17.48             16.06
  90901         A      Biofeedback train any meth                      38.48              43.03             39.39
  92506         A      Speech/hearing evaluation                      161.87             185.31            166.80
  92507         A      Speech/hearing therapy                          73.59              79.77             74.89
  92508         A      Speech/hearing therapy                          22.12              24.27             22.55
  92520         A      Laryngeal function studies                      69.09              77.21             70.79
  92526         A      Oral function therapy                           81.60              88.96             83.14
  92597         A      Oral speech device eval                         81.54              89.28             83.17
  92605         B      Ex for nonspeech device rx                       0.00               0.00              0.00
  92606         B      Non-speech device service                        0.00               0.00              0.00
  92607         A      Ex for speech device rx 1hr                    139.95             154.77            143.06
  92608         A      Ex for speech device rx addl                    45.11              49.37             46.01
  92609         A      Use of speech device service                    99.35             108.95            101.33
  92610         A      Evaluate swallowing function                    87.89              96.52             89.70
  92611         A      Motion fluoroscopy/swallow                      96.49             106.39             98.59
  92612         A      Endoscopy swallow tst (fees)                   166.35             188.53            171.01
  92614         A      Laryngoscopic sensory test                     149.06             168.29            153.10
  92616         A      Fees w/laryngeal sense test                    200.16             225.12            205.39
  95831         A      Limb muscle testing manual                      27.57              30.92             28.32
  95832         A      Hand muscle testing manual                      25.91              28.93             26.60
  95833         A      Body muscle testing manual                      36.53              40.45             37.30
  95834         A      Body muscle testing manual                      47.44              52.59             48.51
  95851         A      Range of motion measurements                    17.67              19.90             18.14
  95852         A      Range of motion measurements                    15.63              17.77             16.09
  95992         A      Canalith repositioning proc                     41.40              44.80             42.15
  96105         A      Assessment of aphasia                          100.47             108.98            102.07
  96111         A      Developmental test extend                      122.08             130.16            123.84
  96125         A      Cognitive test by hc pro                        97.52             105.80             99.18
  97001         A      Pt evaluation                                   72.35              78.80             73.66
  97002         A      Pt re-evaluation                                40.12              44.03             40.94
  97003         A      Ot evaluation                                   81.00              88.92             82.61
  97004         A      Ot re-evaluation                                49.77              55.32             50.93
  97010         B      Hot or cold packs therapy                        0.00               0.00              0.00
  97012         A      Mechanical traction therapy                     15.41              16.81             15.69
  97016         A      Vasopneumatic device therapy                    18.01              20.21             18.48
  97018         A      Paraffin bath therapy                            9.94              11.35             10.26
  97022         A      Whirlpool therapy                               21.66              24.53             22.27
  97024         A      Diathermy eg microwave                           6.28               7.07              6.47
  97026         R      Infrared therapy                                 5.62               6.29              5.78
  97028         A      Ultraviolet therapy                              6.96               7.76              7.15
  97032         A      Electrical stimulation                          18.07              19.92             18.45
  97033         A      Electric current therapy                        30.05              33.90             30.84
  97034         A      Contrast bath therapy                           16.71              18.53             17.09
  97035         A      Ultrasound therapy                              12.05              13.08             12.26
  97036         A      Hydrotherapy                                    30.40              34.21             31.18
  97039         C      Physical therapy treatment                       0.00               0.00              0.00


                                             Page 62 of 121
                                                                                                              8/14/2012


           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS                                                                               Seattle (King        Rest of
  Code           Status              Short Description                 Virginia          Cnty), WA          Washington
                                                                        00904               00836              00836
                                                                          00                 02                 99
   97110           A       Therapeutic exercises                                30.20               33.13              30.77
   97112           A       Neuromuscular reeducation                            31.53               34.69              32.14
   97113           A       Aquatic therapy/exercises                            40.17               44.86              41.10
   97116           A       Gait training therapy                                26.83               29.44              27.34
   97124           A       Massage therapy                                      24.80               27.31              25.30
   97139           C       Physical medicine procedure                           0.00                0.00               0.00
   97140           A       Manual therapy                                       28.19               30.88              28.71
   97150           A       Group therapeutic procedures                         19.42               21.40              19.82
   97530           A       Therapeutic activities                               33.18               36.68              33.87
   97532           A       Cognitive skills development                         25.20               27.33              25.60
   97533           A       Sensory integration                                  27.86               30.45              28.36
   97535           A       Self care mngment training                           32.86               36.25              33.52
   97537           A       Community/work reintegration                         28.54               31.19              29.04
   97542           A       Wheelchair mngment training                          29.20               31.96              29.73
   97597           A       Rmvl devital tis 20 cm/<                             73.47               83.54              75.66
   97598           A       Rmvl devital tis addl 20 cm<                         24.21               27.18              24.89
   97602           B       Wound(s) care non-selective                           0.00                0.00               0.00
   97605           A       Neg press wound tx < 50 cm                           39.67               43.78              40.70
   97606           A       Neg press wound tx > 50 cm                           42.20               46.52              43.33
   97750           A       Physical performance test                            31.69               34.90              32.39
   97755           A       Assistive technology assess                          34.49               37.33              35.07
   97760           A       Orthotic mgmt and training                           36.02               39.96              36.86
   97761           A       Prosthetic training                                  31.36               34.51              32.04
   97762           A       C/o for orthotic/prosth use                          43.34               49.52              44.63
   97799           C       Physical medicine procedure                           0.00                0.00               0.00
   G0281           A       Elec stim unattend for press                         13.03               14.37              13.31
   G0283           A       Elec stim other than wound                           13.03               14.37              13.31
   G0329           A       Electromagntic tx for ulcers                          9.61               10.96               9.91

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 63 of 121
                                                                                               8/14/2012


          2012 MEDICARE PART B FEE SCHEDULE
              OUTPATIENT REHABILITATION

CPT/HCPCS
  Code        Status           Short Description          West Virginia      Wisconsin        Wyoming
                                                              00884            00951           03602
                                                               16               00              21
  0019T         C      Extracorp shock wv tx ms nos                   0.00             0.00            0.00
  0183T         C      Wound ultrasound                               0.00             0.00            0.00
  64550         A      Apply neurostimulator                         14.44            15.46           16.08
  90901         A      Biofeedback train any meth                    34.95            38.00           39.22
  92506         A      Speech/hearing evaluation                    142.69           159.27          165.82
  92507         A      Speech/hearing therapy                        70.57            72.67           75.44
  92508         A      Speech/hearing therapy                        20.67            21.87           22.54
  92520         A      Laryngeal function studies                    63.28            68.10           70.78
  92526         A      Oral function therapy                         77.57            80.57           83.61
  92597         A      Oral speech device eval                       77.10            80.46           83.61
  92605         B      Ex for nonspeech device rx                     0.00             0.00            0.00
  92606         B      Non-speech device service                      0.00             0.00            0.00
  92607         A      Ex for speech device rx 1hr                  130.28           138.03          143.41
  92608         A      Ex for speech device rx addl                  42.69            44.50           46.27
  92609         A      Use of speech device service                  93.44            98.11          101.65
  92610         A      Evaluate swallowing function                  82.69            86.72           90.07
  92611         A      Motion fluoroscopy/swallow                    90.39            95.13           99.00
  92612         A      Endoscopy swallow tst (fees)                 149.02           163.80          170.40
  92614         A      Laryngoscopic sensory test                   134.37           146.81          152.70
  92616         A      Fees w/laryngeal sense test                  181.47           197.21          205.02
  95831         A      Limb muscle testing manual                    25.44            27.08           28.49
  95832         A      Hand muscle testing manual                    24.09            25.46           26.79
  95833         A      Body muscle testing manual                    33.61            36.12           37.18
  95834         A      Body muscle testing manual                    43.94            46.80           48.57
  95851         A      Range of motion measurements                  16.01            17.40           18.12
  95852         A      Range of motion measurements                  14.03            15.37           16.08
  95992         A      Canalith repositioning proc                   40.02            40.84           42.60
  96105         A      Assessment of aphasia                         95.06            99.52          102.09
  96111         A      Developmental test extend                    120.27           120.56          125.51
  96125         A      Cognitive test by hc pro                      92.92            96.42           99.60
  97001         A      Pt evaluation                                 68.58            71.51           73.92
  97002         A      Pt re-evaluation                              37.74            39.61           41.08
  97003         A      Ot evaluation                                 75.91            80.01           82.77
  97004         A      Ot re-evaluation                              45.92            49.08           50.95
  97010         B      Hot or cold packs therapy                      0.00             0.00            0.00
  97012         A      Mechanical traction therapy                   14.56            15.23           15.74
  97016         A      Vasopneumatic device therapy                  16.41            17.75           18.46
  97018         A      Paraffin bath therapy                          8.94             9.74           10.29
  97022         A      Whirlpool therapy                             19.45            21.33           22.20
  97024         A      Diathermy eg microwave                         5.84             6.15            6.55
  97026         R      Infrared therapy                               5.28             5.50            5.87
  97028         A      Ultraviolet therapy                            6.52             6.83            7.23
  97032         A      Electrical stimulation                        16.82            17.84           18.46
  97033         A      Electric current therapy                      27.02            29.62           30.71
  97034         A      Contrast bath therapy                         15.46            16.48           17.10
  97035         A      Ultrasound therapy                            11.51            11.91           12.33
  97036         A      Hydrotherapy                                  27.42            29.98           31.05
  97039         C      Physical therapy treatment                     0.00             0.00            0.00


                                             Page 64 of 121
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           2012 MEDICARE PART B FEE SCHEDULE
               OUTPATIENT REHABILITATION

CPT/HCPCS
  Code           Status              Short Description                West Virginia       Wisconsin         Wyoming
                                                                          00884             00951            03602
                                                                           16                00               21
   97110           A       Therapeutic exercises                                  28.14             29.88            30.71
   97112           A       Neuromuscular reeducation                              29.26             31.19            32.07
   97113           A       Aquatic therapy/exercises                              36.53             39.67            40.92
   97116           A       Gait training therapy                                  25.02             26.54            27.31
   97124           A       Massage therapy                                        23.04             24.52            25.27
   97139           C       Physical medicine procedure                             0.00              0.00             0.00
   97140           A       Manual therapy                                         26.33             27.89            28.67
   97150           A       Group therapeutic procedures                           18.06             19.18            19.82
   97530           A       Therapeutic activities                                 30.61             32.81            33.78
   97532           A       Cognitive skills development                           23.85             24.97            25.61
   97533           A       Sensory integration                                    26.10             27.58            28.33
   97535           A       Self care mngment training                             30.39             32.49            33.44
   97537           A       Community/work reintegration                           26.73             28.25            29.01
   97542           A       Wheelchair mngment training                            27.29             28.90            29.69
   97597           A       Rmvl devital tis 20 cm/<                               65.95             72.21            75.62
   97598           A       Rmvl devital tis addl 20 cm<                           22.39             23.76            25.09
   97602           B       Wound(s) care non-selective                             0.00              0.00             0.00
   97605           A       Neg press wound tx < 50 cm                             38.13             38.84            41.48
   97606           A       Neg press wound tx > 50 cm                             40.95             41.24            44.36
   97750           A       Physical performance test                              29.82             31.23            32.57
   97755           A       Assistive technology assess                            33.07             34.08            35.30
   97760           A       Orthotic mgmt and training                             33.48             35.48            37.00
   97761           A       Prosthetic training                                    29.54             30.91            32.23
   97762           A       C/o for orthotic/prosth use                            38.24             42.68            44.33
   97799           C       Physical medicine procedure                             0.00              0.00             0.00
   G0281           A       Elec stim unattend for press                           12.18             12.85            13.35
   G0283           A       Elec stim other than wound                             12.18             12.85            13.35
   G0329           A       Electromagntic tx for ulcers                            8.66              9.42             9.95

Conversion Factor                                        $34.0376
((A1 x B1)+(A2 x B2)+(A3 x B3)) x Conversion Factor




Status             A       Active code - separately payable under
                           the fee schedule if covered
                   B       Bundled code - payment is always
                           bundled into payment for other
                           services. No separate payment is
                           made for this service
                   C       Contractor-priced code - contractor will
                           establish RVUs and payment for these
                           services
                   R       Restricted service - special coverage
                           instructions apply. If the service is
                           covered and no RVUs are shown, it is
                           contractor-priced.



                                                      Page 65 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Alabama      Alaska       Arizona
                                                                  10102        00831        03102
                                                                    00           01           00
   92506            A       Speech/hearing evaluation                118.61       152.63       129.62
   92507            A       Speech/hearing therapy                    63.98        90.56        67.39
   92508            A       Speech/hearing therapy                    18.57        25.79        19.57
   92526            A       Oral function therapy                     69.83        98.05        73.74
   92597            A       Oral speech device eval                   68.90        96.14        73.02
   92607            A       Ex for speech device rx 1hr              114.79       157.72       122.35
   92609            A       Use of speech device service              83.57       116.29        88.43
   96125            A       Cognitive test by hc pro                  84.54       119.42        88.74
   97001            A       Pt evaluation                             62.05        87.18        65.29
   97002            A       Pt re-evaluation                          33.68        46.83        35.69
   97003            A       Ot evaluation                             67.88        94.26        71.78
   97004            A       Ot re-evaluation                          40.18        54.73        42.93
   97012            A       Mechanical traction therapy               13.15        18.44        13.85
   97016            A       Vasopneumatic device therapy              14.13        18.95        15.21
   97018            A       Paraffin bath therapy                      7.36         9.55         8.13
   97022            A       Whirlpool therapy                         16.48        21.71        17.87
   97024            A       Diathermy eg microwave                     4.89         6.56         5.38
   97026            R       Infrared therapy                           4.44         6.01         4.88
   97028            A       Ultraviolet therapy                        5.57         7.58         6.06
   97032            A       Electrical stimulation                    14.95        20.62        15.85
   97033            A       Electric current therapy                  23.13        30.66        24.92
   97034            A       Contrast bath therapy                     13.59        18.57        14.48
   97035            A       Ultrasound therapy                        10.45        14.76        10.99
   97036            A       Hydrotherapy                              23.59        31.41        25.36
   97110            A       Therapeutic exercises                     25.34        35.19        26.65
   97112            A       Neuromuscular reeducation                 26.24        36.27        27.65
   97113            A       Aquatic therapy/exercises                 31.95        43.12        34.05
   97116            A       Gait training therapy                     22.52        31.27        23.70
   97124            A       Massage therapy                           20.59        28.45        21.75
   97140            A       Manual therapy                            23.76        33.07        24.97
   97150            A       Group therapeutic procedures              16.08        22.18        17.03
   97530            A       Therapeutic activities                    27.24        37.40        28.80
   97533            A       Sensory integration                       23.66        33.04        24.81
   97535            A       Self care mngment training                27.13        37.36        28.65
   97537            A       Community/work reintegration              24.22        33.82        25.40
   97542            A       Wheelchair mngment training               24.67        34.37        25.90
   97750            A       Physical performance test                 26.34        36.45        28.09
   97755            A       Assistive technology assess               30.10        42.68        31.63
   97760            A       Orthotic mgmt and training                29.25        39.99        31.33
   97761            A       Prosthetic training                       26.11        36.18        27.84
   97762            A       C/o for orthotic/prosth use               31.98        41.32        34.82
   G0281            A       Elec stim unattend for press              10.77        14.86        11.47
   G0283            A       Elec stim other than wound                10.77        14.86        11.47
   G0329            A       Electromagntic tx for ulcers               7.13         9.28         7.88

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  66 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                      Marin/Napa/So San Francisco,
  Code           Status             Short Description            Arkansas        lano, CA         CA
                                                                   00520           01102          01102
                                                                     13              03             05
   92506            A       Speech/hearing evaluation                 117.26          157.39         169.40
   92507            A       Speech/hearing therapy                     63.65           74.04          77.48
   92508            A       Speech/hearing therapy                     18.45           22.16          23.33
   92526            A       Oral function therapy                      69.43           81.84          85.88
   92597            A       Oral speech device eval                    68.47           81.52          85.74
   92607            A       Ex for speech device rx 1hr               113.96          139.10         147.03
   92609            A       Use of speech device service               83.04           99.35         104.57
   96125            A       Cognitive test by hc pro                   84.11           98.22         102.84
   97001            A       Pt evaluation                              61.71           72.70          76.26
   97002            A       Pt re-evaluation                           33.47           40.09          42.21
   97003            A       Ot evaluation                              67.45           80.98          85.28
   97004            A       Ot re-evaluation                           39.87           49.33          52.28
   97012            A       Mechanical traction therapy                13.08           15.47          16.24
   97016            A       Vasopneumatic device therapy               14.01           17.75          18.89
   97018            A       Paraffin bath therapy                       7.27            9.63          10.35
   97022            A       Whirlpool therapy                          16.32           21.21          22.70
   97024            A       Diathermy eg microwave                      4.85            6.12           6.53
   97026            R       Infrared therapy                            4.40            5.49           5.84
   97028            A       Ultraviolet therapy                         5.53            6.84           7.26
   97032            A       Electrical stimulation                     14.85           18.02          19.02
   97033            A       Electric current therapy                   22.91           29.53          31.54
   97034            A       Contrast bath therapy                      13.48           16.59          17.56
   97035            A       Ultrasound therapy                         10.39           12.13          12.70
   97036            A       Hydrotherapy                               23.37           29.92          31.92
   97110            A       Therapeutic exercises                      25.19           30.27          31.87
   97112            A       Neuromuscular reeducation                  26.07           31.55          33.26
   97113            A       Aquatic therapy/exercises                  31.69           39.79          42.27
   97116            A       Gait training therapy                      22.38           26.89          28.31
   97124            A       Massage therapy                            20.46           24.78          26.14
   97140            A       Manual therapy                             23.62           28.28          29.75
   97150            A       Group therapeutic procedures               15.97           19.37          20.44
   97530            A       Therapeutic activities                     27.05           33.10          34.98
   97533            A       Sensory integration                        23.52           28.00          29.42
   97535            A       Self care mngment training                 26.95           32.82          34.65
   97537            A       Community/work reintegration               24.08           28.68          30.14
   97542            A       Wheelchair mngment training                24.52           29.32          30.83
   97750            A       Physical performance test                  26.15           31.54          33.26
   97755            A       Assistive technology assess                29.95           34.75          36.34
   97760            A       Orthotic mgmt and training                 29.03           35.68          37.78
   97761            A       Prosthetic training                        25.93           31.22          32.92
   97762            A       C/o for orthotic/prosth use                31.63           42.23          45.40
   G0281            A       Elec stim unattend for press               10.70           12.97          13.69
   G0283            A       Elec stim other than wound                 10.70           12.97          13.69
   G0329            A       Electromagntic tx for ulcers                7.05            9.31          10.00

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  67 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                        Oakland/Berkl   Santa Clara,
  Code           Status             Short Description            San Mateo, CA      ey, CA           CA
                                                                     01102           01102          01102
                                                                       06              07             09
   92506            A       Speech/hearing evaluation                   168.79          158.30          167.22
   92507            A       Speech/hearing therapy                       77.35           74.62           77.21
   92508            A       Speech/hearing therapy                       23.28           22.30           23.19
   92526            A       Oral function therapy                        85.73           82.46           85.51
   92597            A       Oral speech device eval                      85.57           82.14           85.30
   92607            A       Ex for speech device rx 1hr                 146.69          140.09          146.03
   92609            A       Use of speech device service                104.35          100.06          104.00
   96125            A       Cognitive test by hc pro                    102.66           98.94          102.46
   97001            A       Pt evaluation                                76.12           73.22           75.93
   97002            A       Pt re-evaluation                             42.12           40.38           41.98
   97003            A       Ot evaluation                                85.11           81.55           84.80
   97004            A       Ot re-evaluation                             52.15           49.66           51.87
   97012            A       Mechanical traction therapy                  16.21           15.58           16.17
   97016            A       Vasopneumatic device therapy                 18.84           17.86           18.72
   97018            A       Paraffin bath therapy                        10.31            9.70           10.23
   97022            A       Whirlpool therapy                            22.62           21.34           22.45
   97024            A       Diathermy eg microwave                        6.51            6.18            6.47
   97026            R       Infrared therapy                              5.82            5.54            5.79
   97028            A       Ultraviolet therapy                           7.24            6.90            7.20
   97032            A       Electrical stimulation                       18.98           18.14           18.90
   97033            A       Electric current therapy                     31.44           29.71           31.21
   97034            A       Contrast bath therapy                        17.52           16.70           17.43
   97035            A       Ultrasound therapy                           12.68           12.22           12.65
   97036            A       Hydrotherapy                                 31.82           30.11           31.60
   97110            A       Therapeutic exercises                        31.80           30.47           31.69
   97112            A       Neuromuscular reeducation                    33.19           31.75           33.05
   97113            A       Aquatic therapy/exercises                    42.15           40.03           41.90
   97116            A       Gait training therapy                        28.25           27.07           28.15
   97124            A       Massage therapy                              26.08           24.94           25.98
   97140            A       Manual therapy                               29.69           28.47           29.59
   97150            A       Group therapeutic procedures                 20.40           19.50           20.31
   97530            A       Therapeutic activities                       34.90           33.31           34.74
   97533            A       Sensory integration                          29.37           28.19           29.28
   97535            A       Self care mngment training                   34.57           33.03           34.42
   97537            A       Community/work reintegration                 30.08           28.87           29.98
   97542            A       Wheelchair mngment training                  30.77           29.51           30.67
   97750            A       Physical performance test                    33.19           31.78           33.06
   97755            A       Assistive technology assess                  36.28           35.02           36.23
   97760            A       Orthotic mgmt and training                   37.69           35.94           37.50
   97761            A       Prosthetic training                          32.85           31.46           32.72
   97762            A       C/o for orthotic/prosth use                  45.25           42.47           44.84
   G0281            A       Elec stim unattend for press                 13.66           13.06           13.60
   G0283            A       Elec stim other than wound                   13.66           13.06           13.60
   G0329            A       Electromagntic tx for ulcers                  9.97            9.38            9.88

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  68 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                         Rest of                      Los Angeles,
  Code           Status             Short Description            California*    Ventura, CA        CA
                                                                    01102          01192          01192
                                                                      99             17             18
   92506            A       Speech/hearing evaluation                  140.31         151.60          147.78
   92507            A       Speech/hearing therapy                      69.60          72.47           71.82
   92508            A       Speech/hearing therapy                      20.55          21.57           21.28
   92526            A       Oral function therapy                       76.54          79.97           79.13
   92597            A       Oral speech device eval                     75.96          79.59           78.66
   92607            A       Ex for speech device rx 1hr                128.39         135.39          133.41
   92609            A       Use of speech device service                92.36          96.87           95.67
   96125            A       Cognitive test by hc pro                    92.13          95.99           95.06
   97001            A       Pt evaluation                               67.96          70.98           70.22
   97002            A       Pt re-evaluation                            37.26          39.09           38.61
   97003            A       Ot evaluation                               75.16          78.90           77.88
   97004            A       Ot re-evaluation                            45.29          47.93           47.15
   97012            A       Mechanical traction therapy                 14.44          15.10           14.93
   97016            A       Vasopneumatic device therapy                16.15          17.20           16.88
   97018            A       Paraffin bath therapy                        8.65           9.32            9.11
   97022            A       Whirlpool therapy                           19.13          20.50           20.06
   97024            A       Diathermy eg microwave                       5.60           5.97            5.87
   97026            R       Infrared therapy                             5.05           5.36            5.28
   97028            A       Ultraviolet therapy                          6.30           6.68            6.57
   97032            A       Electrical stimulation                      16.66          17.53           17.28
   97033            A       Electric current therapy                    26.70          28.54           27.95
   97034            A       Contrast bath therapy                       15.26          16.12           15.87
   97035            A       Ultrasound therapy                          11.38          11.86           11.75
   97036            A       Hydrotherapy                                27.12          28.94           28.36
   97110            A       Therapeutic exercises                       28.06          29.44           29.05
   97112            A       Neuromuscular reeducation                   29.17          30.66           30.23
   97113            A       Aquatic therapy/exercises                   36.30          38.53           37.83
   97116            A       Gait training therapy                       24.93          26.16           25.81
   97124            A       Massage therapy                             22.91          24.10           23.76
   97140            A       Manual therapy                              26.25          27.52           27.17
   97150            A       Group therapeutic procedures                17.91          18.85           18.58
   97530            A       Therapeutic activities                      30.48          32.14           31.64
   97533            A       Sensory integration                         26.05          27.26           26.93
   97535            A       Self care mngment training                  30.27          31.88           31.41
   97537            A       Community/work reintegration                26.67          27.92           27.58
   97542            A       Wheelchair mngment training                 27.23          28.53           28.17
   97750            A       Physical performance test                   29.26          30.77           30.37
   97755            A       Assistive technology assess                 32.69          34.01           33.71
   97760            A       Orthotic mgmt and training                  32.86          34.73           34.20
   97761            A       Prosthetic training                         28.98          30.46           30.08
   97762            A       C/o for orthotic/prosth use                 37.71          40.68           39.67
   G0281            A       Elec stim unattend for press                12.00          12.63           12.46
   G0283            A       Elec stim other than wound                  12.00          12.63           12.46
   G0329            A       Electromagntic tx for ulcers                 8.37           9.02            8.82

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  69 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                        Anaheim/Sant     Rest of
  Code           Status             Short Description             a Ana, CA      California*    Colorado
                                                                     01192          01192         04102
                                                                       26             99            01
   92506            A       Speech/hearing evaluation                   154.53         140.31        132.00
   92507            A       Speech/hearing therapy                       73.61          69.60         67.60
   92508            A       Speech/hearing therapy                       21.91          20.55         19.73
   92526            A       Oral function therapy                        81.25          76.54         74.09
   92597            A       Oral speech device eval                      80.90          75.96         73.41
   92607            A       Ex for speech device rx 1hr                 137.69         128.39        123.35
   92609            A       Use of speech device service                 98.44          92.36         89.02
   96125            A       Cognitive test by hc pro                     97.47          92.13         89.16
   97001            A       Pt evaluation                                72.09          67.96         65.65
   97002            A       Pt re-evaluation                             39.73          37.26         35.92
   97003            A       Ot evaluation                                80.17          75.16         72.32
   97004            A       Ot re-evaluation                             48.75          45.29         43.36
   97012            A       Mechanical traction therapy                  15.33          14.44         13.93
   97016            A       Vasopneumatic device therapy                 17.51          16.15         15.39
   97018            A       Paraffin bath therapy                         9.51           8.65          8.23
   97022            A       Whirlpool therapy                            20.88          19.13         18.13
   97024            A       Diathermy eg microwave                        6.09           5.60          5.41
   97026            R       Infrared therapy                              5.47           5.05          4.90
   97028            A       Ultraviolet therapy                           6.80           6.30          6.10
   97032            A       Electrical stimulation                       17.82          16.66         15.98
   97033            A       Electric current therapy                     29.06          26.70         25.29
   97034            A       Contrast bath therapy                        16.40          15.26         14.62
   97035            A       Ultrasound therapy                           12.05          11.38         11.03
   97036            A       Hydrotherapy                                 29.46          27.12         25.72
   97110            A       Therapeutic exercises                        29.90          28.06         26.89
   97112            A       Neuromuscular reeducation                    31.15          29.17         27.92
   97113            A       Aquatic therapy/exercises                    39.19          36.30         34.50
   97116            A       Gait training therapy                        26.57          24.93         23.91
   97124            A       Massage therapy                              24.48          22.91         21.95
   97140            A       Manual therapy                               27.95          26.25         25.19
   97150            A       Group therapeutic procedures                 19.15          17.91         17.18
   97530            A       Therapeutic activities                       32.66          30.48         29.11
   97533            A       Sensory integration                          27.68          26.05         25.01
   97535            A       Self care mngment training                   32.39          30.27         28.94
   97537            A       Community/work reintegration                 28.35          26.67         25.61
   97542            A       Wheelchair mngment training                  28.97          27.23         26.12
   97750            A       Physical performance test                    31.30          29.26         28.25
   97755            A       Assistive technology assess                  34.54          32.69         31.73
   97760            A       Orthotic mgmt and training                   35.34          32.86         31.59
   97761            A       Prosthetic training                          30.98          28.98         28.00
   97762            A       C/o for orthotic/prosth use                  41.45          37.71         35.46
   G0281            A       Elec stim unattend for press                 12.85          12.00         11.55
   G0283            A       Elec stim other than wound                   12.85          12.00         11.55
   G0329            A       Electromagntic tx for ulcers                  9.20           8.37          7.98

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  70 of 121
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  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                       DC + MD/VA
  Code           Status             Short Description            Connecticut     Suburbs       Delaware
                                                                    13102          12202         12102
                                                                      00             01            01
   92506            A       Speech/hearing evaluation                  144.01         153.43        136.04
   92507            A       Speech/hearing therapy                      71.77          74.49         68.50
   92508            A       Speech/hearing therapy                      20.99          21.95         20.12
   92526            A       Oral function therapy                       78.83          82.04         75.21
   92597            A       Oral speech device eval                     78.31          81.63         74.59
   92607            A       Ex for speech device rx 1hr                132.16         138.41        125.71
   92609            A       Use of speech device service                94.90          99.07         90.58
   96125            A       Cognitive test by hc pro                    94.50          98.26         90.54
   97001            A       Pt evaluation                               69.71          72.60         66.73
   97002            A       Pt re-evaluation                            38.33          40.01         36.55
   97003            A       Ot evaluation                               77.08          80.55         73.66
   97004            A       Ot re-evaluation                            46.54          48.88         44.27
   97012            A       Mechanical traction therapy                 14.80          15.43         14.17
   97016            A       Vasopneumatic device therapy                16.61          17.52         15.76
   97018            A       Paraffin bath therapy                        9.03           9.56          8.43
   97022            A       Whirlpool therapy                           19.66          20.83         18.61
   97024            A       Diathermy eg microwave                       5.91           6.20          5.49
   97026            R       Infrared therapy                             5.35           5.59          4.96
   97028            A       Ultraviolet therapy                          6.61           6.91          6.18
   97032            A       Electrical stimulation                      17.07          17.87         16.30
   97033            A       Electric current therapy                    27.33          28.94         25.98
   97034            A       Contrast bath therapy                       15.67          16.45         14.92
   97035            A       Ultrasound therapy                          11.71          12.16         11.19
   97036            A       Hydrotherapy                                27.75          29.34         26.40
   97110            A       Therapeutic exercises                       28.57          29.91         27.46
   97112            A       Neuromuscular reeducation                   29.71          31.13         28.52
   97113            A       Aquatic therapy/exercises                   37.01          39.03         35.37
   97116            A       Gait training therapy                       25.41          26.59         24.40
   97124            A       Massage therapy                             23.39          24.50         22.41
   97140            A       Manual therapy                              26.74          27.97         25.70
   97150            A       Group therapeutic procedures                18.33          19.20         17.52
   97530            A       Therapeutic activities                      31.06          32.61         29.78
   97533            A       Sensory integration                         26.52          27.72         25.51
   97535            A       Self care mngment training                  30.84          32.36         29.59
   97537            A       Community/work reintegration                27.16          28.38         26.12
   97542            A       Wheelchair mngment training                 27.72          28.99         26.66
   97750            A       Physical performance test                   30.26          31.60         28.71
   97755            A       Assistive technology assess                 33.64          34.91         32.17
   97760            A       Orthotic mgmt and training                  33.95          35.57         32.18
   97761            A       Prosthetic training                         29.98          31.29         28.45
   97762            A       C/o for orthotic/prosth use                 38.60          41.12         36.56
   G0281            A       Elec stim unattend for press                12.36          12.93         11.76
   G0283            A       Elec stim other than wound                  12.36          12.93         11.76
   G0329            A       Electromagntic tx for ulcers                 8.75           9.26          8.16

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  71 of 121
                                                                                                       8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                            Fort
  Code           Status             Short Description            Lauderdale, FL   Miami, FL     Rest of Florida
                                                                     09102          09102            09102
                                                                       03             04               99
   92506            A       Speech/hearing evaluation                    138.62        140.34           129.52
   92507            A       Speech/hearing therapy                        71.24         73.29            68.46
   92508            A       Speech/hearing therapy                        20.49         20.80            19.67
   92526            A       Oral function therapy                         77.97         80.03            74.76
   92597            A       Oral speech device eval                       77.39         79.46            74.02
   92607            A       Ex for speech device rx 1hr                  129.82        132.82           123.61
   92609            A       Use of speech device service                  93.34         95.43            89.35
   96125            A       Cognitive test by hc pro                      93.17         95.24            89.74
   97001            A       Pt evaluation                                 68.63         70.12            65.98
   97002            A       Pt re-evaluation                              37.74         38.63            36.09
   97003            A       Ot evaluation                                 75.61         77.12            72.40
   97004            A       Ot re-evaluation                              45.52         46.44            43.26
   97012            A       Mechanical traction therapy                   14.55         14.85            13.98
   97016            A       Vasopneumatic device therapy                  16.19         16.50            15.30
   97018            A       Paraffin bath therapy                          8.89          9.19             8.25
   97022            A       Whirlpool therapy                             19.07         19.39            17.93
   97024            A       Diathermy eg microwave                         5.94          6.23             5.54
   97026            R       Infrared therapy                               5.40          5.69             5.04
   97028            A       Ultraviolet therapy                            6.62          6.91             6.22
   97032            A       Electrical stimulation                        16.70         17.00            15.96
   97033            A       Electric current therapy                      26.43         26.76            24.95
   97034            A       Contrast bath therapy                         15.33         15.64            14.60
   97035            A       Ultrasound therapy                            11.58         11.87            11.14
   97036            A       Hydrotherapy                                  26.84         27.17            25.38
   97110            A       Therapeutic exercises                         27.80         28.11            26.72
   97112            A       Neuromuscular reeducation                     28.87         29.19            27.71
   97113            A       Aquatic therapy/exercises                     35.77         36.11            34.04
   97116            A       Gait training therapy                         24.75         25.07            23.78
   97124            A       Massage therapy                               22.78         23.10            21.83
   97140            A       Manual therapy                                26.04         26.36            25.05
   97150            A       Group therapeutic procedures                  17.91         18.22            17.13
   97530            A       Therapeutic activities                        30.14         30.46            28.85
   97533            A       Sensory integration                           25.85         26.16            24.90
   97535            A       Self care mngment training                    29.94         30.27            28.70
   97537            A       Community/work reintegration                  26.46         26.77            25.48
   97542            A       Wheelchair mngment training                   26.99         27.31            25.98
   97750            A       Physical performance test                     29.95         30.84            28.52
   97755            A       Assistive technology assess                   33.32         34.20            32.08
   97760            A       Orthotic mgmt and training                    33.44         34.34            31.73
   97761            A       Prosthetic training                           29.68         30.57            28.27
   97762            A       C/o for orthotic/prosth use                   37.09         37.45            34.74
   G0281            A       Elec stim unattend for press                  12.17         12.47            11.60
   G0283            A       Elec stim other than wound                    12.17         12.47            11.60
   G0329            A       Electromagntic tx for ulcers                   8.62          8.92             8.01

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  72 of 121
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  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                       Rest of
  Code           Status             Short Description            Atlanta, GA    Georgia      Hawaii/Guam
                                                                    10202        10202          01202
                                                                      01           99             01
   92506            A       Speech/hearing evaluation                  133.29       121.40         146.83
   92507            A       Speech/hearing therapy                      68.10        65.49          70.37
   92508            A       Speech/hearing therapy                      19.87        18.88          20.90
   92526            A       Oral function therapy                       74.65        71.43          77.62
   92597            A       Oral speech device eval                     74.00        70.54          77.26
   92607            A       Ex for speech device rx 1hr                124.37       117.48         131.34
   92609            A       Use of speech device service                89.70        85.36          93.97
   96125            A       Cognitive test by hc pro                    89.78        86.21          93.12
   97001            A       Pt evaluation                               66.12        63.29          68.84
   97002            A       Pt re-evaluation                            36.20        34.44          37.93
   97003            A       Ot evaluation                               72.86        69.25          76.50
   97004            A       Ot re-evaluation                            43.72        41.09          46.47
   97012            A       Mechanical traction therapy                 14.03        13.41          14.64
   97016            A       Vasopneumatic device therapy                15.53        14.47          16.68
   97018            A       Paraffin bath therapy                        8.33         7.63           9.06
   97022            A       Whirlpool therapy                           18.30        16.88          19.87
   97024            A       Diathermy eg microwave                       5.48         5.11           5.82
   97026            R       Infrared therapy                             4.96         4.65           5.23
   97028            A       Ultraviolet therapy                          6.16         5.79           6.50
   97032            A       Electrical stimulation                      16.10        15.24          17.00
   97033            A       Electric current therapy                    25.51        23.61          27.65
   97034            A       Contrast bath therapy                       14.74        13.88          15.63
   97035            A       Ultrasound therapy                          11.11        10.67          11.51
   97036            A       Hydrotherapy                                25.94        24.06          28.03
   97110            A       Therapeutic exercises                       27.07        25.72          28.52
   97112            A       Neuromuscular reeducation                   28.11        26.64          29.70
   97113            A       Aquatic therapy/exercises                   34.76        32.49          37.31
   97116            A       Gait training therapy                       24.07        22.87          25.34
   97124            A       Massage therapy                             22.11        20.94          23.35
   97140            A       Manual therapy                              25.35        24.12          26.66
   97150            A       Group therapeutic procedures                17.30        16.38          18.27
   97530            A       Therapeutic activities                      29.32        27.67          31.12
   97533            A       Sensory integration                         25.18        24.00          26.41
   97535            A       Self care mngment training                  29.14        27.55          30.87
   97537            A       Community/work reintegration                25.78        24.57          27.04
   97542            A       Wheelchair mngment training                 26.29        25.03          27.63
   97750            A       Physical performance test                   28.49        27.04          29.88
   97755            A       Assistive technology assess                 31.96        30.76          33.01
   97760            A       Orthotic mgmt and training                  31.86        30.02          33.71
   97761            A       Prosthetic training                         28.24        26.81          29.58
   97762            A       C/o for orthotic/prosth use                 35.80        32.67          39.39
   G0281            A       Elec stim unattend for press                11.64        11.03          12.26
   G0283            A       Elec stim other than wound                  11.64        11.03          12.26
   G0329            A       Electromagntic tx for ulcers                 8.07         7.40           8.76

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  73 of 121
                                                                                                    8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                    East St. Louis,    Suburban
  Code           Status             Short Description            Idaho             IL          Chicago, IL
                                                                 05130            00952           00952
                                                                   00               12              15
   92506            A       Speech/hearing evaluation               120.45           126.95          141.00
   92507            A       Speech/hearing therapy                   64.63            68.69           72.13
   92508            A       Speech/hearing therapy                   18.74            19.54           20.85
   92526            A       Oral function therapy                    70.55            74.83           79.00
   92597            A       Oral speech device eval                  69.66            74.02           78.40
   92607            A       Ex for speech device rx 1hr             116.14           123.08          131.65
   92609            A       Use of speech device service             84.44            89.12           94.71
   96125            A       Cognitive test by hc pro                 85.32            89.71           94.57
   97001            A       Pt evaluation                            62.64            65.88           69.67
   97002            A       Pt re-evaluation                         34.05            36.02           38.27
   97003            A       Ot evaluation                            68.57            72.09           76.79
   97004            A       Ot re-evaluation                         40.67            42.95           46.21
   97012            A       Mechanical traction therapy              13.28            13.95           14.78
   97016            A       Vasopneumatic device therapy             14.32            15.15           16.44
   97018            A       Paraffin bath therapy                     7.50             8.20            8.97
   97022            A       Whirlpool therapy                        16.72            17.68           19.37
   97024            A       Diathermy eg microwave                    4.99             5.57            5.96
   97026            R       Infrared therapy                          4.53             5.09            5.41
   97028            A       Ultraviolet therapy                       5.67             6.25            6.66
   97032            A       Electrical stimulation                   15.10            15.86           16.97
   97033            A       Electric current therapy                 23.43            24.56           26.89
   97034            A       Contrast bath therapy                    13.74            14.50           15.57
   97035            A       Ultrasound therapy                       10.55            11.15           11.74
   97036            A       Hydrotherapy                             23.89            25.00           27.32
   97110            A       Therapeutic exercises                    25.56            26.49           28.32
   97112            A       Neuromuscular reeducation                26.48            27.44           29.42
   97113            A       Aquatic therapy/exercises                32.30            33.56           36.46
   97116            A       Gait training therapy                    22.72            23.59           25.21
   97124            A       Massage therapy                          20.79            21.65           23.19
   97140            A       Manual therapy                           23.97            24.85           26.53
   97150            A       Group therapeutic procedures             16.24            17.02           18.21
   97530            A       Therapeutic activities                   27.51            28.54           30.71
   97533            A       Sensory integration                      23.85            24.71           26.33
   97535            A       Self care mngment training               27.39            28.40           30.51
   97537            A       Community/work reintegration             24.42            25.29           26.95
   97542            A       Wheelchair mngment training              24.88            25.77           27.50
   97750            A       Physical performance test                26.66            28.52           30.30
   97755            A       Assistive technology assess              30.39            32.16           33.77
   97760            A       Orthotic mgmt and training               29.63            31.63           33.86
   97761            A       Prosthetic training                      26.43            28.28           30.03
   97762            A       C/o for orthotic/prosth use              32.45            34.02           37.76
   G0281            A       Elec stim unattend for press             10.90            11.56           12.33
   G0283            A       Elec stim other than wound               10.90            11.56           12.33
   G0329            A       Electromagntic tx for ulcers              7.27             7.96            8.69

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  74 of 121
                                                                                                      8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Chicago, IL    Rest of Illinois   Indiana
                                                                    00952            00952          00630
                                                                      16               99             00
   92506            A       Speech/hearing evaluation                  139.66            123.21        123.39
   92507            A       Speech/hearing therapy                      72.79             66.69         65.27
   92508            A       Speech/hearing therapy                      20.86             19.11         18.98
   92526            A       Oral function therapy                       79.56             72.69         71.34
   92597            A       Oral speech device eval                     78.90             71.83         70.50
   92607            A       Ex for speech device rx 1hr                132.03            119.50        117.84
   92609            A       Use of speech device service                95.10             86.73         85.50
   96125            A       Cognitive test by hc pro                    95.13             87.50         86.19
   97001            A       Pt evaluation                               70.02             64.24         63.33
   97002            A       Pt re-evaluation                            38.45             35.01         34.48
   97003            A       Ot evaluation                               77.00             70.27         69.46
   97004            A       Ot re-evaluation                            46.23             41.74         41.31
   97012            A       Mechanical traction therapy                 14.84             13.61         13.43
   97016            A       Vasopneumatic device therapy                16.41             14.70         14.58
   97018            A       Paraffin bath therapy                        8.98              7.83          7.67
   97022            A       Whirlpool therapy                           19.28             17.15         17.07
   97024            A       Diathermy eg microwave                       6.03              5.28          5.08
   97026            R       Infrared therapy                             5.49              4.82          4.61
   97028            A       Ultraviolet therapy                          6.73              5.96          5.76
   97032            A       Electrical stimulation                      16.98             15.46         15.32
   97033            A       Electric current therapy                    26.73             23.92         23.90
   97034            A       Contrast bath therapy                       15.58             14.10         13.95
   97035            A       Ultrasound therapy                          11.83             10.85         10.66
   97036            A       Hydrotherapy                                27.16             24.37         24.35
   97110            A       Therapeutic exercises                       28.29             25.98         25.89
   97112            A       Neuromuscular reeducation                   29.36             26.91         26.84
   97113            A       Aquatic therapy/exercises                   36.26             32.84         32.86
   97116            A       Gait training therapy                       25.19             23.12         23.01
   97124            A       Massage therapy                             23.17             21.19         21.08
   97140            A       Manual therapy                              26.51             24.37         24.27
   97150            A       Group therapeutic procedures                18.22             16.61         16.47
   97530            A       Therapeutic activities                      30.62             27.96         27.91
   97533            A       Sensory integration                         26.33             24.25         24.14
   97535            A       Self care mngment training                  30.44             27.84         27.78
   97537            A       Community/work reintegration                26.95             24.82         24.71
   97542            A       Wheelchair mngment training                 27.48             25.29         25.19
   97750            A       Physical performance test                   30.51             27.59         27.02
   97755            A       Assistive technology assess                 34.05             31.29         30.68
   97760            A       Orthotic mgmt and training                  34.00             30.60         30.08
   97761            A       Prosthetic training                         30.24             27.36         26.78
   97762            A       C/o for orthotic/prosth use                 37.37             33.10         33.22
   G0281            A       Elec stim unattend for press                12.38             11.22         11.05
   G0283            A       Elec stim other than wound                  12.38             11.22         11.05
   G0329            A       Electromagntic tx for ulcers                 8.71              7.60          7.43

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  75 of 121
                                                                                             8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Iowa        Kansas       Kentucky
                                                                 05102        05202         00660
                                                                   00           00            00
   92506            A       Speech/hearing evaluation               119.49       121.05        118.38
   92507            A       Speech/hearing therapy                   64.13        65.47         64.50
   92508            A       Speech/hearing therapy                   18.63        18.86         18.60
   92526            A       Oral function therapy                    70.02        71.40         70.30
   92597            A       Oral speech device eval                  69.11        70.50         69.36
   92607            A       Ex for speech device rx 1hr             115.24       117.35        115.34
   92609            A       Use of speech device service             83.84        85.29         83.98
   96125            A       Cognitive test by hc pro                 84.76        86.16         85.00
   97001            A       Pt evaluation                            62.23        63.24         62.36
   97002            A       Pt re-evaluation                         33.79        34.41         33.86
   97003            A       Ot evaluation                            68.11        69.18         68.14
   97004            A       Ot re-evaluation                         40.36        41.03         40.31
   97012            A       Mechanical traction therapy              13.19        13.40         13.21
   97016            A       Vasopneumatic device therapy             14.21        14.44         14.17
   97018            A       Paraffin bath therapy                     7.41         7.62          7.41
   97022            A       Whirlpool therapy                        16.58        16.84         16.49
   97024            A       Diathermy eg microwave                    4.91         5.11          4.97
   97026            R       Infrared therapy                          4.46         4.65          4.52
   97028            A       Ultraviolet therapy                       5.60         5.79          5.65
   97032            A       Electrical stimulation                   15.00        15.23         14.99
   97033            A       Electric current therapy                 23.27        23.55         23.11
   97034            A       Contrast bath therapy                    13.64        13.86         13.63
   97035            A       Ultrasound therapy                       10.47        10.67         10.52
   97036            A       Hydrotherapy                             23.72        24.01         23.57
   97110            A       Therapeutic exercises                    25.44        25.68         25.36
   97112            A       Neuromuscular reeducation                26.34        26.60         26.25
   97113            A       Aquatic therapy/exercises                32.11        32.42         31.91
   97116            A       Gait training therapy                    22.60        22.84         22.54
   97124            A       Massage therapy                          20.67        20.91         20.62
   97140            A       Manual therapy                           23.85        24.09         23.79
   97150            A       Group therapeutic procedures             16.14        16.36         16.12
   97530            A       Therapeutic activities                   27.36        27.63         27.24
   97533            A       Sensory integration                      23.74        23.97         23.68
   97535            A       Self care mngment training               27.25        27.51         27.14
   97537            A       Community/work reintegration             24.30        24.54         24.24
   97542            A       Wheelchair mngment training              24.76        25.00         24.69
   97750            A       Physical performance test                26.43        27.02         26.54
   97755            A       Assistive technology assess              30.17        30.75         30.32
   97760            A       Orthotic mgmt and training               29.37        29.99         29.43
   97761            A       Prosthetic training                      26.20        26.79         26.31
   97762            A       C/o for orthotic/prosth use              32.21        32.57         31.89
   G0281            A       Elec stim unattend for press             10.81        11.02         10.83
   G0283            A       Elec stim other than wound               10.81        11.02         10.83
   G0329            A       Electromagntic tx for ulcers              7.18         7.39          7.19

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  76 of 121
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  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                        New Orleans,     Rest of      Southern
  Code           Status             Short Description                LA          Louisiana      Maine
                                                                     00528         00528         14102
                                                                       01            99            03
   92506            A       Speech/hearing evaluation                   129.26        118.97        133.68
   92507            A       Speech/hearing therapy                       67.12         64.60         67.56
   92508            A       Speech/hearing therapy                       19.52         18.65         19.83
   92526            A       Oral function therapy                        73.47         70.44         74.15
   92597            A       Oral speech device eval                      72.74         69.51         73.51
   92607            A       Ex for speech device rx 1hr                 121.92        115.65        123.83
   92609            A       Use of speech device service                 88.13         84.17         89.26
   96125            A       Cognitive test by hc pro                     88.46         85.16         89.28
   97001            A       Pt evaluation                                65.09         62.48         65.78
   97002            A       Pt re-evaluation                             35.56         33.94         36.01
   97003            A       Ot evaluation                                71.56         68.31         72.58
   97004            A       Ot re-evaluation                             42.79         40.44         43.59
   97012            A       Mechanical traction therapy                  13.81         13.24         13.97
   97016            A       Vasopneumatic device therapy                 15.16         14.22         15.51
   97018            A       Paraffin bath therapy                         8.09          7.44          8.28
   97022            A       Whirlpool therapy                            17.81         16.56         18.30
   97024            A       Diathermy eg microwave                        5.35          4.98          5.41
   97026            R       Infrared therapy                              4.85          4.53          4.89
   97028            A       Ultraviolet therapy                           6.03          5.66          6.09
   97032            A       Electrical stimulation                       15.80         15.03         16.06
   97033            A       Electric current therapy                     24.86         23.21         25.55
   97034            A       Contrast bath therapy                        14.44         13.67         14.70
   97035            A       Ultrasound therapy                           10.95         10.54         11.04
   97036            A       Hydrotherapy                                 25.29         23.66         25.97
   97110            A       Therapeutic exercises                        26.59         25.42         27.05
   97112            A       Neuromuscular reeducation                    27.59         26.32         28.09
   97113            A       Aquatic therapy/exercises                    33.98         32.02         34.81
   97116            A       Gait training therapy                        23.65         22.60         24.04
   97124            A       Massage therapy                              21.69         20.67         22.08
   97140            A       Manual therapy                               24.92         23.84         25.32
   97150            A       Group therapeutic procedures                 16.98         16.16         17.26
   97530            A       Therapeutic activities                       28.74         27.32         29.32
   97533            A       Sensory integration                          24.76         23.74         25.14
   97535            A       Self care mngment training                   28.59         27.21         29.14
   97537            A       Community/work reintegration                 25.35         24.30         25.74
   97542            A       Wheelchair mngment training                  25.85         24.75         26.26
   97750            A       Physical performance test                    27.97         26.60         28.29
   97755            A       Assistive technology assess                  31.51         30.37         31.73
   97760            A       Orthotic mgmt and training                   31.21         29.51         31.69
   97761            A       Prosthetic training                          27.72         26.38         28.03
   97762            A       C/o for orthotic/prosth use                  34.74         32.05         35.93
   G0281            A       Elec stim unattend for press                 11.42         10.86         11.59
   G0283            A       Elec stim other than wound                   11.42         10.86         11.59
   G0329            A       Electromagntic tx for ulcers                  7.84          7.22          8.02

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  77 of 121
                                                                                                      8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                        Baltimore/Surr.    Rest of
  Code           Status             Short Description            Rest of Maine     Cntys, MD       Maryland
                                                                     14102            12302          12302
                                                                       99               01             99
   92506            A       Speech/hearing evaluation                   121.58            142.73        135.64
   92507            A       Speech/hearing therapy                       65.01             71.56         69.02
   92508            A       Speech/hearing therapy                       18.85             20.91         20.15
   92526            A       Oral function therapy                        70.99             78.56         75.68
   92597            A       Oral speech device eval                      70.11             78.00         75.04
   92607            A       Ex for speech device rx 1hr                 116.96            131.50        126.21
   92609            A       Use of speech device service                 84.98             94.51         90.96
   96125            A       Cognitive test by hc pro                     85.78             94.22         90.97
   97001            A       Pt evaluation                                63.00             69.48         67.02
   97002            A       Pt re-evaluation                             34.27             38.17         36.72
   97003            A       Ot evaluation                                69.00             76.77         73.89
   97004            A       Ot re-evaluation                             40.96             46.29         44.38
   97012            A       Mechanical traction therapy                  13.35             14.75         14.22
   97016            A       Vasopneumatic device therapy                 14.43             16.50         15.78
   97018            A       Paraffin bath therapy                         7.58              8.95          8.48
   97022            A       Whirlpool therapy                            16.86             19.52         18.60
   97024            A       Diathermy eg microwave                        5.04              5.87          5.57
   97026            R       Infrared therapy                              4.58              5.31          5.04
   97028            A       Ultraviolet therapy                           5.72              6.57          6.26
   97032            A       Electrical stimulation                       15.20             16.99         16.34
   97033            A       Electric current therapy                     23.62             27.14         25.93
   97034            A       Contrast bath therapy                        13.84             15.59         14.96
   97035            A       Ultrasound therapy                           10.61             11.67         11.26
   97036            A       Hydrotherapy                                 24.07             27.56         26.35
   97110            A       Therapeutic exercises                        25.70             28.46         27.45
   97112            A       Neuromuscular reeducation                    26.62             29.58         28.50
   97113            A       Aquatic therapy/exercises                    32.51             36.79         35.29
   97116            A       Gait training therapy                        22.85             25.31         24.41
   97124            A       Massage therapy                              20.91             23.29         22.42
   97140            A       Manual therapy                               24.10             26.64         25.70
   97150            A       Group therapeutic procedures                 16.34             18.25         17.55
   97530            A       Therapeutic activities                       27.67             30.91         29.74
   97533            A       Sensory integration                          23.98             26.43         25.52
   97535            A       Self care mngment training                   27.55             30.70         29.56
   97537            A       Community/work reintegration                 24.55             27.06         26.13
   97542            A       Wheelchair mngment training                  25.01             27.62         26.65
   97750            A       Physical performance test                    26.85             30.12         28.91
   97755            A       Assistive technology assess                  30.56             33.55         32.38
   97760            A       Orthotic mgmt and training                   29.85             33.76         32.35
   97761            A       Prosthetic training                          26.62             29.84         28.65
   97762            A       C/o for orthotic/prosth use                  32.74             38.27         36.42
   G0281            A       Elec stim unattend for press                 10.97             12.30         11.81
   G0283            A       Elec stim other than wound                   10.97             12.30         11.81
   G0329            A       Electromagntic tx for ulcers                  7.35              8.67          8.21

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  78 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                        Metropolitan       Rest of
  Code           Status             Short Description              Boston        Massachusetts
                                                                    14202            14202
                                                                      01               99
   92506            A       Speech/hearing evaluation                   146.89           138.09
   92507            A       Speech/hearing therapy                       71.10            69.21
   92508            A       Speech/hearing therapy                       21.04            20.32
   92526            A       Oral function therapy                        78.34            76.01
   92597            A       Oral speech device eval                      77.93            75.42
   92607            A       Ex for speech device rx 1hr                 132.24           127.21
   92609            A       Use of speech device service                 94.72            91.56
   96125            A       Cognitive test by hc pro                     93.99            91.40
   97001            A       Pt evaluation                                69.45            67.39
   97002            A       Pt re-evaluation                             38.23            36.95
   97003            A       Ot evaluation                                77.08            74.44
   97004            A       Ot re-evaluation                             46.74            44.81
   97012            A       Mechanical traction therapy                  14.76            14.31
   97016            A       Vasopneumatic device therapy                 16.75            15.96
   97018            A       Paraffin bath therapy                         9.09             8.57
   97022            A       Whirlpool therapy                            19.92            18.87
   97024            A       Diathermy eg microwave                        5.86             5.59
   97026            R       Infrared therapy                              5.27             5.05
   97028            A       Ultraviolet therapy                           6.55             6.28
   97032            A       Electrical stimulation                       17.11            16.48
   97033            A       Electric current therapy                     27.72            26.31
   97034            A       Contrast bath therapy                        15.73            15.10
   97035            A       Ultrasound therapy                           11.62            11.31
   97036            A       Hydrotherapy                                 28.12            26.73
   97110            A       Therapeutic exercises                        28.71            27.71
   97112            A       Neuromuscular reeducation                    29.88            28.80
   97113            A       Aquatic therapy/exercises                    37.45            35.77
   97116            A       Gait training therapy                        25.51            24.63
   97124            A       Massage therapy                              23.49            22.64
   97140            A       Manual therapy                               26.84            25.94
   97150            A       Group therapeutic procedures                 18.39            17.71
   97530            A       Therapeutic activities                       31.29            30.08
   97533            A       Sensory integration                          26.60            25.74
   97535            A       Self care mngment training                   31.05            29.88
   97537            A       Community/work reintegration                 27.24            26.36
   97542            A       Wheelchair mngment training                  27.83            26.90
   97750            A       Physical performance test                    30.12            29.06
   97755            A       Assistive technology assess                  33.35            32.49
   97760            A       Orthotic mgmt and training                   33.94            32.59
   97761            A       Prosthetic training                          29.83            28.79
   97762            A       C/o for orthotic/prosth use                  39.40            37.08
   G0281            A       Elec stim unattend for press                 12.35            11.90
   G0283            A       Elec stim other than wound                   12.35            11.90
   G0329            A       Electromagntic tx for ulcers                  8.79             8.30

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  79 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                        Rest of
  Code           Status             Short Description            Detroit, MI    Michigan      Minnesota
                                                                    00953         00953         00954
                                                                      01            99            00
   92506            A       Speech/hearing evaluation                  136.16        124.16        131.80
   92507            A       Speech/hearing therapy                      71.22         66.35         66.36
   92508            A       Speech/hearing therapy                      20.45         19.14         19.60
   92526            A       Oral function therapy                       77.83         72.43         72.89
   92597            A       Oral speech device eval                     77.14         71.59         72.24
   92607            A       Ex for speech device rx 1hr                129.03        119.39        121.80
   92609            A       Use of speech device service                93.06         86.59         87.90
   96125            A       Cognitive test by hc pro                    93.23         87.27         87.99
   97001            A       Pt evaluation                               68.60         64.11         64.83
   97002            A       Pt re-evaluation                            37.61         34.94         35.44
   97003            A       Ot evaluation                               75.39         70.23         71.55
   97004            A       Ot re-evaluation                            45.18         41.78         42.93
   97012            A       Mechanical traction therapy                 14.54         13.59         13.77
   97016            A       Vasopneumatic device therapy                16.02         14.74         15.26
   97018            A       Paraffin bath therapy                        8.71          7.83          8.08
   97022            A       Whirlpool therapy                           18.81         17.22         18.02
   97024            A       Diathermy eg microwave                       5.84          5.23          5.24
   97026            R       Infrared therapy                             5.32          4.76          4.72
   97028            A       Ultraviolet therapy                          6.53          5.91          5.92
   97032            A       Electrical stimulation                      16.63         15.47         15.84
   97033            A       Electric current therapy                    26.11         24.06         25.22
   97034            A       Contrast bath therapy                       15.23         14.11         14.48
   97035            A       Ultrasound therapy                          11.58         10.81         10.86
   97036            A       Hydrotherapy                                26.55         24.50         25.64
   97110            A       Therapeutic exercises                       27.76         26.05         26.78
   97112            A       Neuromuscular reeducation                   28.81         26.99         27.81
   97113            A       Aquatic therapy/exercises                   35.51         33.01         34.45
   97116            A       Gait training therapy                       24.72         23.17         23.79
   97124            A       Massage therapy                             22.72         21.23         21.83
   97140            A       Manual therapy                              26.02         24.43         25.07
   97150            A       Group therapeutic procedures                17.84         16.62         17.04
   97530            A       Therapeutic activities                      30.03         28.06         29.02
   97533            A       Sensory integration                         25.85         24.29         24.89
   97535            A       Self care mngment training                  29.85         27.93         28.85
   97537            A       Community/work reintegration                26.46         24.87         25.49
   97542            A       Wheelchair mngment training                 26.98         25.34         26.01
   97750            A       Physical performance test                   29.78         27.48         27.75
   97755            A       Assistive technology assess                 33.34         31.15         31.21
   97760            A       Orthotic mgmt and training                  33.18         30.55         31.11
   97761            A       Prosthetic training                         29.52         27.25         27.49
   97762            A       C/o for orthotic/prosth use                 36.47         33.38         35.47
   G0281            A       Elec stim unattend for press                12.10         11.20         11.39
   G0283            A       Elec stim other than wound                  12.10         11.20         11.39
   G0329            A       Electromagntic tx for ulcers                 8.45          7.59          7.82

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  80 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY
                                                                                                Metropolitan
CPT/HCPCS                                                                       Metropolitan    Kansas City,
  Code           Status             Short Description            Mississippi    St. Louis, MO       MO
                                                                    00512           05302          05302
                                                                      00              01             02
   92506            A       Speech/hearing evaluation                  117.89          128.29          127.47
   92507            A       Speech/hearing therapy                      64.41           67.21           67.38
   92508            A       Speech/hearing therapy                      18.57           19.47           19.44
   92526            A       Oral function therapy                       70.19           73.49           73.61
   92597            A       Oral speech device eval                     69.24           72.74           72.83
   92607            A       Ex for speech device rx 1hr                115.08          121.72          121.66
   92609            A       Use of speech device service                83.82           88.04           88.05
   96125            A       Cognitive test by hc pro                    84.88           88.45           88.54
   97001            A       Pt evaluation                               62.26           65.05           65.08
   97002            A       Pt re-evaluation                            33.80           35.54           35.55
   97003            A       Ot evaluation                               68.01           71.45           71.41
   97004            A       Ot re-evaluation                            40.21           42.67           42.60
   97012            A       Mechanical traction therapy                 13.19           13.79           13.79
   97016            A       Vasopneumatic device therapy                14.12           15.10           15.06
   97018            A       Paraffin bath therapy                        7.39            8.06            8.06
   97022            A       Whirlpool therapy                           16.44           17.71           17.64
   97024            A       Diathermy eg microwave                       4.95            5.36            5.38
   97026            R       Infrared therapy                             4.51            4.87            4.89
   97028            A       Ultraviolet therapy                          5.63            6.04            6.06
   97032            A       Electrical stimulation                      14.96           15.76           15.74
   97033            A       Electric current therapy                    23.04           24.72           24.60
   97034            A       Contrast bath therapy                       13.60           14.40           14.38
   97035            A       Ultrasound therapy                          10.50           10.96           10.97
   97036            A       Hydrotherapy                                23.50           25.15           25.03
   97110            A       Therapeutic exercises                       25.30           26.51           26.44
   97112            A       Neuromuscular reeducation                   26.19           27.49           27.41
   97113            A       Aquatic therapy/exercises                   31.82           33.80           33.64
   97116            A       Gait training therapy                       22.50           23.57           23.52
   97124            A       Massage therapy                             20.57           21.63           21.58
   97140            A       Manual therapy                              23.74           24.84           24.79
   97150            A       Group therapeutic procedures                16.08           16.94           16.91
   97530            A       Therapeutic activities                      27.17           28.63           28.53
   97533            A       Sensory integration                         23.64           24.69           24.64
   97535            A       Self care mngment training                  27.07           28.48           28.39
   97537            A       Community/work reintegration                24.20           25.28           25.22
   97542            A       Wheelchair mngment training                 24.64           25.77           25.71
   97750            A       Physical performance test                   26.48           27.97           28.01
   97755            A       Assistive technology assess                 30.28           31.54           31.61
   97760            A       Orthotic mgmt and training                  29.36           31.17           31.17
   97761            A       Prosthetic training                         26.26           27.72           27.77
   97762            A       C/o for orthotic/prosth use                 31.76           34.47           34.23
   G0281            A       Elec stim unattend for press                10.81           11.41           11.41
   G0283            A       Elec stim other than wound                  10.81           11.41           11.41
   G0329            A       Electromagntic tx for ulcers                 7.16            7.82            7.81

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  81 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                         Rest of
  Code           Status             Short Description            Missouri*     Montana      Nebraska
                                                                   05302        03202         05402
                                                                     99           01            00
   92506            A       Speech/hearing evaluation                 116.83       131.99        120.98
   92507            A       Speech/hearing therapy                     64.72        68.07         64.17
   92508            A       Speech/hearing therapy                     18.53        19.78         18.73
   92526            A       Oral function therapy                      70.42        74.53         70.15
   92597            A       Oral speech device eval                    69.44        73.85         69.27
   92607            A       Ex for speech device rx 1hr               115.11       123.91        115.76
   92609            A       Use of speech device service               83.91        89.42         84.13
   96125            A       Cognitive test by hc pro                   85.07        89.59         84.94
   97001            A       Pt evaluation                              62.36        65.95         62.39
   97002            A       Pt re-evaluation                           33.85        36.10         33.91
   97003            A       Ot evaluation                              68.00        72.59         68.39
   97004            A       Ot re-evaluation                           40.15        43.50         40.60
   97012            A       Mechanical traction therapy                13.20        13.99         13.23
   97016            A       Vasopneumatic device therapy               14.08        15.44         14.31
   97018            A       Paraffin bath therapy                       7.39         8.29          7.46
   97022            A       Whirlpool therapy                          16.35        18.16         16.74
   97024            A       Diathermy eg microwave                      5.00         5.48          4.92
   97026            R       Infrared therapy                            4.56         4.97          4.46
   97028            A       Ultraviolet therapy                         5.68         6.16          5.60
   97032            A       Electrical stimulation                     14.94        16.03         15.08
   97033            A       Electric current therapy                   22.88        25.31         23.50
   97034            A       Contrast bath therapy                      13.58        14.67         13.72
   97035            A       Ultrasound therapy                         10.54        11.10         10.49
   97036            A       Hydrotherapy                               23.35        25.73         23.95
   97110            A       Therapeutic exercises                      25.22        26.92         25.58
   97112            A       Neuromuscular reeducation                  26.09        27.95         26.50
   97113            A       Aquatic therapy/exercises                  31.62        34.50         32.39
   97116            A       Gait training therapy                      22.44        23.95         22.72
   97124            A       Massage therapy                            20.52        21.99         20.79
   97140            A       Manual therapy                             23.67        25.22         23.98
   97150            A       Group therapeutic procedures               16.06        17.22         16.22
   97530            A       Therapeutic activities                     27.06        29.14         27.55
   97533            A       Sensory integration                        23.58        25.05         23.86
   97535            A       Self care mngment training                 26.96        28.97         27.43
   97537            A       Community/work reintegration               24.14        25.65         24.43
   97542            A       Wheelchair mngment training                24.57        26.16         24.89
   97750            A       Physical performance test                  26.57        28.44         26.49
   97755            A       Assistive technology assess                30.40        31.93         30.20
   97760            A       Orthotic mgmt and training                 29.40        31.76         29.49
   97761            A       Prosthetic training                        26.35        28.19         26.26
   97762            A       C/o for orthotic/prosth use                31.45        35.43         32.62
   G0281            A       Elec stim unattend for press               10.82        11.61         10.85
   G0283            A       Elec stim other than wound                 10.82        11.61         10.85
   G0329            A       Electromagntic tx for ulcers                7.17         8.03          7.23

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  82 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                       New
  Code           Status             Short Description            Nevada       Hampshire     Northern NJ
                                                                  01302         14302          12402
                                                                    00            40             01
   92506            A       Speech/hearing evaluation                138.05        136.01         151.93
   92507            A       Speech/hearing therapy                    69.60         68.42          73.82
   92508            A       Speech/hearing therapy                    20.29         20.05          21.77
   92526            A       Oral function therapy                     76.36         75.11          81.29
   92597            A       Oral speech device eval                   75.80         74.52          80.87
   92607            A       Ex for speech device rx 1hr              127.66        125.60         137.12
   92609            A       Use of speech device service              91.80         90.42          98.18
   96125            A       Cognitive test by hc pro                  91.59         90.30          97.41
   97001            A       Pt evaluation                             67.52         66.56          71.97
   97002            A       Pt re-evaluation                          37.08         36.49          39.65
   97003            A       Ot evaluation                             74.54         73.49          79.84
   97004            A       Ot re-evaluation                          44.91         44.22          48.43
   97012            A       Mechanical traction therapy               14.33         14.13          15.29
   97016            A       Vasopneumatic device therapy              16.00         15.75          17.35
   97018            A       Paraffin bath therapy                      8.67          8.46           9.45
   97022            A       Whirlpool therapy                         18.90         18.61          20.63
   97024            A       Diathermy eg microwave                     5.70          5.53           6.12
   97026            R       Infrared therapy                           5.16          5.00           5.52
   97028            A       Ultraviolet therapy                        6.38          6.21           6.83
   97032            A       Electrical stimulation                    16.49         16.26          17.72
   97033            A       Electric current therapy                  26.28         25.93          28.67
   97034            A       Contrast bath therapy                     15.13         14.90          16.30
   97035            A       Ultrasound therapy                        11.35         11.17          12.06
   97036            A       Hydrotherapy                              26.70         26.35          29.08
   97110            A       Therapeutic exercises                     27.62         27.34          29.67
   97112            A       Neuromuscular reeducation                 28.70         28.40          30.88
   97113            A       Aquatic therapy/exercises                 35.65         35.26          38.70
   97116            A       Gait training therapy                     24.57         24.30          26.38
   97124            A       Massage therapy                           22.60         22.33          24.30
   97140            A       Manual therapy                            25.86         25.59          27.75
   97150            A       Group therapeutic procedures              17.71         17.48          19.03
   97530            A       Therapeutic activities                    29.98         29.66          32.34
   97533            A       Sensory integration                       25.66         25.40          27.50
   97535            A       Self care mngment training                29.78         29.47          32.09
   97537            A       Community/work reintegration              26.27         26.00          28.15
   97542            A       Wheelchair mngment training               26.81         26.54          28.76
   97750            A       Physical performance test                 29.27         28.72          31.29
   97755            A       Assistive technology assess               32.62         32.11          34.60
   97760            A       Orthotic mgmt and training                32.78         32.19          35.22
   97761            A       Prosthetic training                       29.00         28.45          30.99
   97762            A       C/o for orthotic/prosth use               37.02         36.52          40.73
   G0281            A       Elec stim unattend for press              11.95         11.75          12.81
   G0283            A       Elec stim other than wound                11.95         11.75          12.81
   G0329            A       Electromagntic tx for ulcers               8.40          8.20           9.15

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  83 of 121
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        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                        Rest of New
  Code           Status             Short Description              Jersey       New Mexico     Manhattan, NY
                                                                    12402          04202           13202
                                                                      99             05              01
   92506            A       Speech/hearing evaluation                  145.21         123.34          150.42
   92507            A       Speech/hearing therapy                      71.53          66.03           74.64
   92508            A       Speech/hearing therapy                      21.02          19.05           21.85
   92526            A       Oral function therapy                       78.67          72.07           82.02
   92597            A       Oral speech device eval                     78.18          71.22           81.50
   92607            A       Ex for speech device rx 1hr                132.24         118.74          137.65
   92609            A       Use of speech device service                94.86          86.17           98.78
   96125            A       Cognitive test by hc pro                    94.34          86.90           98.30
   97001            A       Pt evaluation                               69.64          63.82           72.53
   97002            A       Pt re-evaluation                            38.30          34.77           39.89
   97003            A       Ot evaluation                               77.11          69.90           80.25
   97004            A       Ot re-evaluation                            46.64          41.55           48.50
   97012            A       Mechanical traction therapy                 14.79          13.53           15.40
   97016            A       Vasopneumatic device therapy                16.67          14.65           17.32
   97018            A       Paraffin bath therapy                        9.05           7.76            9.42
   97022            A       Whirlpool therapy                           19.77          17.12           20.52
   97024            A       Diathermy eg microwave                       5.89           5.19            6.16
   97026            R       Infrared therapy                             5.32           4.72            5.57
   97028            A       Ultraviolet therapy                          6.59           5.87            6.88
   97032            A       Electrical stimulation                      17.09          15.40           17.78
   97033            A       Electric current therapy                    27.50          23.92           28.52
   97034            A       Contrast bath therapy                       15.70          14.03           16.33
   97035            A       Ultrasound therapy                          11.68          10.76           12.18
   97036            A       Hydrotherapy                                27.91          24.37           28.95
   97110            A       Therapeutic exercises                       28.64          25.95           29.75
   97112            A       Neuromuscular reeducation                   29.79          26.88           30.94
   97113            A       Aquatic therapy/exercises                   37.21          32.85           38.59
   97116            A       Gait training therapy                       25.47          23.07           26.46
   97124            A       Massage therapy                             23.44          21.14           24.36
   97140            A       Manual therapy                              26.80          24.33           27.84
   97150            A       Group therapeutic procedures                18.36          16.54           19.09
   97530            A       Therapeutic activities                      31.17          27.94           32.36
   97533            A       Sensory integration                         26.57          24.20           27.61
   97535            A       Self care mngment training                  30.94          27.82           32.12
   97537            A       Community/work reintegration                27.20          24.78           28.27
   97542            A       Wheelchair mngment training                 27.78          25.24           28.86
   97750            A       Physical performance test                   30.22          27.33           31.51
   97755            A       Assistive technology assess                 33.54          31.01           34.98
   97760            A       Orthotic mgmt and training                  33.95          30.37           35.36
   97761            A       Prosthetic training                         29.93          27.09           31.21
   97762            A       C/o for orthotic/prosth use                 38.94          33.17           40.32
   G0281            A       Elec stim unattend for press                12.36          11.14           12.87
   G0283            A       Elec stim other than wound                  12.36          11.14           12.87
   G0329            A       Electromagntic tx for ulcers                 8.76           7.53            9.13

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  84 of 121
                                                                                                   8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY
                                                                     NYC      Poughkpsie/N
CPT/HCPCS                                                        Suburbs/Long NYC Suburbs,    Rest of New
  Code           Status             Short Description               I., NY        NY             York
                                                                     13202        13202          13282
                                                                       02           03             99
   92506            A       Speech/hearing evaluation                   155.37       138.82         124.91
   92507            A       Speech/hearing therapy                       75.53        69.88          65.48
   92508            A       Speech/hearing therapy                       22.17        20.42          19.09
   92526            A       Oral function therapy                        83.15        76.69          71.64
   92597            A       Oral speech device eval                      82.77        76.11          70.83
   92607            A       Ex for speech device rx 1hr                 140.27       128.24         118.58
   92609            A       Use of speech device service                100.31        92.26          85.95
   96125            A       Cognitive test by hc pro                     99.40        92.07          86.53
   97001            A       Pt evaluation                                73.45        67.87          63.62
   97002            A       Pt re-evaluation                             40.53        37.25          34.66
   97003            A       Ot evaluation                                81.50        74.94          69.85
   97004            A       Ot re-evaluation                             49.50        45.13          41.61
   97012            A       Mechanical traction therapy                  15.60        14.41          13.49
   97016            A       Vasopneumatic device therapy                 17.75        16.08          14.71
   97018            A       Paraffin bath therapy                         9.75         8.69           7.75
   97022            A       Whirlpool therapy                            21.10        19.00          17.24
   97024            A       Diathermy eg microwave                        6.35         5.70           5.11
   97026            R       Infrared therapy                              5.73         5.15           4.63
   97028            A       Ultraviolet therapy                           7.06         6.38           5.79
   97032            A       Electrical stimulation                       18.08        16.58          15.41
   97033            A       Electric current therapy                     29.27        26.44          24.14
   97034            A       Contrast bath therapy                        16.65        15.21          14.05
   97035            A       Ultrasound therapy                           12.32        11.40          10.70
   97036            A       Hydrotherapy                                 29.67        26.86          24.58
   97110            A       Therapeutic exercises                        30.17        27.82          26.06
   97112            A       Neuromuscular reeducation                    31.41        28.90          27.01
   97113            A       Aquatic therapy/exercises                    39.41        35.90          33.15
   97116            A       Gait training therapy                        26.84        24.74          23.16
   97124            A       Massage therapy                              24.74        22.74          21.21
   97140            A       Manual therapy                               28.22        26.04          24.42
   97150            A       Group therapeutic procedures                 19.41        17.82          16.57
   97530            A       Therapeutic activities                       32.91        30.19          28.11
   97533            A       Sensory integration                          27.96        25.84          24.28
   97535            A       Self care mngment training                   32.65        29.99          27.97
   97537            A       Community/work reintegration                 28.62        26.46          24.86
   97542            A       Wheelchair mngment training                  29.24        27.00          25.34
   97750            A       Physical performance test                    32.08        29.37          27.16
   97755            A       Assistive technology assess                  35.37        32.77          30.79
   97760            A       Orthotic mgmt and training                   36.10        32.90          30.27
   97761            A       Prosthetic training                          31.77        29.10          26.92
   97762            A       C/o for orthotic/prosth use                  41.59        37.25          33.63
   G0281            A       Elec stim unattend for press                 13.11        12.00          11.11
   G0283            A       Elec stim other than wound                   13.11        12.00          11.11
   G0329            A       Electromagntic tx for ulcers                  9.44         8.41           7.51

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  85 of 121
                                                                                                    8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Queens, NY     North Carolina North Dakota
                                                                    13292           05535         03302
                                                                      04              00            01
   92506            A       Speech/hearing evaluation                  154.12          123.93        130.99
   92507            A       Speech/hearing therapy                      75.86           65.55         66.67
   92508            A       Speech/hearing therapy                      22.20           19.04         19.58
   92526            A       Oral function therapy                       83.41           71.64         73.14
   92597            A       Oral speech device eval                     82.96           70.81         72.46
   92607            A       Ex for speech device rx 1hr                140.28          118.34        121.91
   92609            A       Use of speech device service               100.48           85.84         88.03
   96125            A       Cognitive test by hc pro                    99.78           86.50         88.20
   97001            A       Pt evaluation                               73.68           63.56         64.96
   97002            A       Pt re-evaluation                            40.60           34.62         35.50
   97003            A       Ot evaluation                               81.61           69.72         71.59
   97004            A       Ot re-evaluation                            49.45           41.48         42.90
   97012            A       Mechanical traction therapy                 15.65           13.48         13.79
   97016            A       Vasopneumatic device therapy                17.69           14.65         15.24
   97018            A       Paraffin bath therapy                        9.69            7.72          8.09
   97022            A       Whirlpool therapy                           20.99           17.15         17.96
   97024            A       Diathermy eg microwave                       6.34            5.12          5.28
   97026            R       Infrared therapy                             5.73            4.65          4.77
   97028            A       Ultraviolet therapy                          7.06            5.80          5.96
   97032            A       Electrical stimulation                      18.09           15.37         15.83
   97033            A       Electric current therapy                    29.12           24.00         25.11
   97034            A       Contrast bath therapy                       16.64           14.01         14.47
   97035            A       Ultrasound therapy                          12.37           10.70         10.90
   97036            A       Hydrotherapy                                29.54           24.44         25.53
   97110            A       Therapeutic exercises                       30.20           25.97         26.73
   97112            A       Neuromuscular reeducation                   31.42           26.91         27.75
   97113            A       Aquatic therapy/exercises                   39.29           32.96         34.30
   97116            A       Gait training therapy                       26.86           23.08         23.75
   97124            A       Massage therapy                             24.75           21.14         21.79
   97140            A       Manual therapy                              28.25           24.34         25.02
   97150            A       Group therapeutic procedures                19.42           16.53         17.02
   97530            A       Therapeutic activities                      32.89           27.99         28.94
   97533            A       Sensory integration                         28.00           24.21         24.85
   97535            A       Self care mngment training                  32.64           27.86         28.77
   97537            A       Community/work reintegration                28.67           24.78         25.45
   97542            A       Wheelchair mngment training                 29.28           25.26         25.96
   97750            A       Physical performance test                   32.13           27.15         27.84
   97755            A       Assistive technology assess                 35.53           30.81         31.33
   97760            A       Orthotic mgmt and training                  36.09           30.23         31.16
   97761            A       Prosthetic training                         31.82           26.91         27.59
   97762            A       C/o for orthotic/prosth use                 41.27           33.36         35.23
   G0281            A       Elec stim unattend for press                13.12           11.10         11.41
   G0283            A       Elec stim other than wound                  13.12           11.10         11.41
   G0329            A       Electromagntic tx for ulcers                 9.39            7.49          7.83

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  86 of 121
                                                                                                8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Ohio        Oklahoma      Portland, OR
                                                                 00883         04302          00835
                                                                   00            00             01
   92506            A       Speech/hearing evaluation               124.86        116.84          135.76
   92507            A       Speech/hearing therapy                   66.84         64.14           68.08
   92508            A       Speech/hearing therapy                   19.23         18.47           20.03
   92526            A       Oral function therapy                    72.94         69.87           74.78
   92597            A       Oral speech device eval                  72.11         68.89           74.17
   92607            A       Ex for speech device rx 1hr             120.20        114.42          125.11
   92609            A       Use of speech device service             87.14         83.40           90.11
   96125            A       Cognitive test by hc pro                 87.80         84.52           90.03
   97001            A       Pt evaluation                            64.49         61.98           66.37
   97002            A       Pt re-evaluation                         35.18         33.63           36.35
   97003            A       Ot evaluation                            70.64         67.66           73.30
   97004            A       Ot re-evaluation                         42.04         39.96           44.08
   97012            A       Mechanical traction therapy              13.66         13.13           14.09
   97016            A       Vasopneumatic device therapy             14.83         14.02           15.70
   97018            A       Paraffin bath therapy                     7.91          7.32            8.40
   97022            A       Whirlpool therapy                        17.33         16.31           18.55
   97024            A       Diathermy eg microwave                    5.30          4.91            5.46
   97026            R       Infrared therapy                          4.83          4.48            4.93
   97028            A       Ultraviolet therapy                       5.98          5.60            6.15
   97032            A       Electrical stimulation                   15.56         14.88           16.23
   97033            A       Electric current therapy                 24.18         22.87           25.90
   97034            A       Contrast bath therapy                    14.20         13.52           14.86
   97035            A       Ultrasound therapy                       10.88         10.46           11.13
   97036            A       Hydrotherapy                             24.62         23.33           26.31
   97110            A       Therapeutic exercises                    26.15         25.18           27.33
   97112            A       Neuromuscular reeducation                27.10         26.06           28.40
   97113            A       Aquatic therapy/exercises                33.15         31.62           35.25
   97116            A       Gait training therapy                    23.27         22.39           24.29
   97124            A       Massage therapy                          21.33         20.47           22.31
   97140            A       Manual therapy                           24.52         23.63           25.58
   97150            A       Group therapeutic procedures             16.71         16.00           17.44
   97530            A       Therapeutic activities                   28.18         27.03           29.66
   97533            A       Sensory integration                      24.39         23.53           25.39
   97535            A       Self care mngment training               28.04         26.93           29.46
   97537            A       Community/work reintegration             24.97         24.09           26.00
   97542            A       Wheelchair mngment training              25.44         24.53           26.53
   97750            A       Physical performance test                27.71         26.34           28.56
   97755            A       Assistive technology assess              31.36         30.16           31.97
   97760            A       Orthotic mgmt and training               30.78         29.18           32.02
   97761            A       Prosthetic training                      27.47         26.12           28.29
   97762            A       C/o for orthotic/prosth use              33.54         31.49           36.48
   G0281            A       Elec stim unattend for press             11.28         10.75           11.70
   G0283            A       Elec stim other than wound               11.28         10.75           11.70
   G0329            A       Electromagntic tx for ulcers              7.67          7.10            8.13

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  87 of 121
                                                                                                   8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY
                                                                              Metropolitan
CPT/HCPCS                                                        Rest of      Philadelphia,     Rest of
  Code           Status             Short Description            Oregon            PA         Pennsylvania
                                                                  00835           12502           12502
                                                                    99              01              99
   92506            A       Speech/hearing evaluation                127.34          139.23          123.25
   92507            A       Speech/hearing therapy                    66.12           71.18           66.27
   92508            A       Speech/hearing therapy                    19.30           20.59           19.07
   92526            A       Oral function therapy                     72.39           77.96           72.29
   92597            A       Oral speech device eval                   71.64           77.37           71.43
   92607            A       Ex for speech device rx 1hr              120.11          129.94          119.00
   92609            A       Use of speech device service              86.93           93.49           86.36
   96125            A       Cognitive test by hc pro                  87.35           93.36           87.11
   97001            A       Pt evaluation                             64.26           68.78           63.97
   97002            A       Pt re-evaluation                          35.06           37.78           34.85
   97003            A       Ot evaluation                             70.64           75.81           70.03
   97004            A       Ot re-evaluation                          42.18           45.62           41.61
   97012            A       Mechanical traction therapy               13.63           14.59           13.55
   97016            A       Vasopneumatic device therapy              14.93           16.23           14.67
   97018            A       Paraffin bath therapy                      7.90            8.84            7.79
   97022            A       Whirlpool therapy                         17.54           19.13           17.12
   97024            A       Diathermy eg microwave                     5.20            5.87            5.22
   97026            R       Infrared therapy                           4.71            5.33            4.76
   97028            A       Ultraviolet therapy                        5.88            6.56            5.90
   97032            A       Electrical stimulation                    15.60           16.75           15.42
   97033            A       Electric current therapy                  24.53           26.56           23.92
   97034            A       Contrast bath therapy                     14.24           15.37           14.06
   97035            A       Ultrasound therapy                        10.80           11.59           10.79
   97036            A       Hydrotherapy                              24.97           26.98           24.36
   97110            A       Therapeutic exercises                     26.34           27.98           25.95
   97112            A       Neuromuscular reeducation                 27.32           29.06           26.89
   97113            A       Aquatic therapy/exercises                 33.61           36.01           32.84
   97116            A       Gait training therapy                     23.41           24.90           23.09
   97124            A       Massage therapy                           21.46           22.91           21.15
   97140            A       Manual therapy                            24.67           26.21           24.34
   97150            A       Group therapeutic procedures              16.77           17.98           16.56
   97530            A       Therapeutic activities                    28.45           30.34           27.94
   97533            A       Sensory integration                       24.52           26.01           24.22
   97535            A       Self care mngment training                28.30           30.14           27.82
   97537            A       Community/work reintegration              25.11           26.63           24.79
   97542            A       Wheelchair mngment training               25.60           27.17           25.26
   97750            A       Physical performance test                 27.50           29.90           27.42
   97755            A       Assistive technology assess               31.07           33.33           31.11
   97760            A       Orthotic mgmt and training                30.69           33.41           30.45
   97761            A       Prosthetic training                       27.25           29.63           27.18
   97762            A       C/o for orthotic/prosth use               34.26           37.30           33.13
   G0281            A       Elec stim unattend for press              11.25           12.17           11.17
   G0283            A       Elec stim other than wound                11.25           12.17           11.17
   G0329            A       Electromagntic tx for ulcers               7.66            8.57            7.55

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  88 of 121
                                                                                                   8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Puerto Rico    Rhode Island South Carolina
                                                                    9202            14402         00880
                                                                     20               01            01
   92506            A       Speech/hearing evaluation                   98.06          137.87        121.82
   92507            A       Speech/hearing therapy                      59.21           70.12         64.75
   92508            A       Speech/hearing therapy                      16.86           20.42         18.84
   92526            A       Oral function therapy                       64.03           76.88         70.75
   92597            A       Oral speech device eval                     62.69           76.25         69.88
   92607            A       Ex for speech device rx 1hr                102.59          128.24        116.72
   92609            A       Use of speech device service                75.88           92.35         84.78
   96125            A       Cognitive test by hc pro                    78.19           92.29         85.56
   97001            A       Pt evaluation                               57.02           68.00         62.85
   97002            A       Pt re-evaluation                            30.54           37.29         34.18
   97003            A       Ot evaluation                               61.52           74.98         68.88
   97004            A       Ot re-evaluation                            35.56           45.08         40.91
   97012            A       Mechanical traction therapy                 12.06           14.43         13.33
   97016            A       Vasopneumatic device therapy                12.27           16.03         14.43
   97018            A       Paraffin bath therapy                        6.11            8.66          7.56
   97022            A       Whirlpool therapy                           14.01           18.91         16.87
   97024            A       Diathermy eg microwave                       4.20            5.70          5.00
   97026            R       Infrared therapy                             3.86            5.17          4.54
   97028            A       Ultraviolet therapy                          4.88            6.40          5.68
   97032            A       Electrical stimulation                      13.44           16.58         15.18
   97033            A       Electric current therapy                    19.84           26.32         23.65
   97034            A       Contrast bath therapy                       12.08           15.19         13.82
   97035            A       Ultrasound therapy                           9.66           11.43         10.57
   97036            A       Hydrotherapy                                20.35           26.75         24.09
   97110            A       Therapeutic exercises                       23.02           27.80         25.70
   97112            A       Neuromuscular reeducation                   23.71           28.87         26.63
   97113            A       Aquatic therapy/exercises                   28.04           35.78         32.56
   97116            A       Gait training therapy                       20.45           24.72         22.84
   97124            A       Massage therapy                             18.57           22.72         20.91
   97140            A       Manual therapy                              21.64           26.03         24.10
   97150            A       Group therapeutic procedures                14.47           17.81         16.33
   97530            A       Therapeutic activities                      24.41           30.14         27.68
   97533            A       Sensory integration                         21.64           25.84         23.97
   97535            A       Self care mngment training                  24.40           29.95         27.56
   97537            A       Community/work reintegration                22.15           26.46         24.54
   97542            A       Wheelchair mngment training                 22.50           26.99         25.01
   97750            A       Physical performance test                   23.71           29.41         26.75
   97755            A       Assistive technology assess                 27.93           32.88         30.45
   97760            A       Orthotic mgmt and training                  25.96           32.90         29.77
   97761            A       Prosthetic training                         23.53           29.14         26.52
   97762            A       C/o for orthotic/prosth use                 26.59           36.99         32.82
   G0281            A       Elec stim unattend for press                 9.67           12.01         10.94
   G0283            A       Elec stim other than wound                   9.67           12.01         10.94
   G0329            A       Electromagntic tx for ulcers                 5.93            8.39          7.32

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  89 of 121
                                                                                                    8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            South Dakota    Tennessee     Brazoria, TX
                                                                     03402         10302          04402
                                                                       02            35             09
   92506            A       Speech/hearing evaluation                   130.84        120.71          130.63
   92507            A       Speech/hearing therapy                       66.47         64.52           67.76
   92508            A       Speech/hearing therapy                       19.55         18.75           19.71
   92526            A       Oral function therapy                        72.93         70.47           74.17
   92597            A       Oral speech device eval                      72.25         69.58           73.44
   92607            A       Ex for speech device rx 1hr                 121.62        116.10          123.12
   92609            A       Use of speech device service                 87.83         84.40           88.99
   96125            A       Cognitive test by hc pro                     88.00         85.24           89.31
   97001            A       Pt evaluation                                64.81         62.60           65.71
   97002            A       Pt re-evaluation                             35.41         34.02           35.91
   97003            A       Ot evaluation                                71.45         68.56           72.26
   97004            A       Ot re-evaluation                             42.82         40.67           43.22
   97012            A       Mechanical traction therapy                  13.76         13.27           13.94
   97016            A       Vasopneumatic device therapy                 15.21         14.33           15.31
   97018            A       Paraffin bath therapy                         8.06          7.49            8.17
   97022            A       Whirlpool therapy                            17.93         16.74           17.99
   97024            A       Diathermy eg microwave                        5.25          4.97            5.40
   97026            R       Infrared therapy                              4.74          4.51            4.89
   97028            A       Ultraviolet therapy                           5.93          5.65            6.09
   97032            A       Electrical stimulation                       15.80         15.11           15.96
   97033            A       Electric current therapy                     25.08         23.47           25.12
   97034            A       Contrast bath therapy                        14.44         13.74           14.58
   97035            A       Ultrasound therapy                           10.87         10.54           11.05
   97036            A       Hydrotherapy                                 25.51         23.92           25.55
   97110            A       Therapeutic exercises                        26.70         25.58           26.86
   97112            A       Neuromuscular reeducation                    27.72         26.50           27.86
   97113            A       Aquatic therapy/exercises                    34.27         32.35           34.32
   97116            A       Gait training therapy                        23.72         22.73           23.88
   97124            A       Massage therapy                              21.76         20.80           21.91
   97140            A       Manual therapy                               24.99         23.98           25.16
   97150            A       Group therapeutic procedures                 17.00         16.25           17.15
   97530            A       Therapeutic activities                       28.91         27.53           29.03
   97533            A       Sensory integration                          24.82         23.87           25.00
   97535            A       Self care mngment training                   28.74         27.42           28.87
   97537            A       Community/work reintegration                 25.42         24.44           25.60
   97542            A       Wheelchair mngment training                  25.93         24.89           26.10
   97750            A       Physical performance test                    27.76         26.63           28.24
   97755            A       Assistive technology assess                  31.25         30.35           31.81
   97760            A       Orthotic mgmt and training                   31.07         29.61           31.52
   97761            A       Prosthetic training                          27.50         26.40           27.99
   97762            A       C/o for orthotic/prosth use                  35.21         32.53           35.10
   G0281            A       Elec stim unattend for press                 11.38         10.89           11.54
   G0283            A       Elec stim other than wound                   11.38         10.89           11.54
   G0329            A       Electromagntic tx for ulcers                  7.81          7.26            7.92

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  90 of 121
                                                                                                     8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Dallas, TX     Galveston, TX   Houston, TX
                                                                   04402            04402          04402
                                                                     11               15             18
   92506            A       Speech/hearing evaluation                  133.51          131.65         132.14
   92507            A       Speech/hearing therapy                      68.18           68.10          68.08
   92508            A       Speech/hearing therapy                      19.93           19.81          19.83
   92526            A       Oral function therapy                       74.75           74.56          74.57
   92597            A       Oral speech device eval                     74.08           73.84          73.87
   92607            A       Ex for speech device rx 1hr                124.53          123.84         123.98
   92609            A       Use of speech device service                89.85           89.46          89.53
   96125            A       Cognitive test by hc pro                    89.97           89.72          89.74
   97001            A       Pt evaluation                               66.26           66.03          66.06
   97002            A       Pt re-evaluation                            36.26           36.11          36.13
   97003            A       Ot evaluation                               73.01           72.64          72.71
   97004            A       Ot re-evaluation                            43.79           43.48          43.55
   97012            A       Mechanical traction therapy                 14.06           14.01          14.02
   97016            A       Vasopneumatic device therapy                15.55           15.42          15.45
   97018            A       Paraffin bath therapy                        8.32            8.24           8.26
   97022            A       Whirlpool therapy                           18.32           18.12          18.17
   97024            A       Diathermy eg microwave                       5.46            5.45           5.44
   97026            R       Infrared therapy                             4.94            4.94           4.93
   97028            A       Ultraviolet therapy                          6.15            6.13           6.13
   97032            A       Electrical stimulation                      16.14           16.04          16.06
   97033            A       Electric current therapy                    25.57           25.28          25.36
   97034            A       Contrast bath therapy                       14.77           14.67          14.69
   97035            A       Ultrasound therapy                          11.13           11.11          11.11
   97036            A       Hydrotherapy                                26.00           25.72          25.79
   97110            A       Therapeutic exercises                       27.16           26.98          27.02
   97112            A       Neuromuscular reeducation                   28.20           27.99          28.05
   97113            A       Aquatic therapy/exercises                   34.87           34.52          34.61
   97116            A       Gait training therapy                       24.15           23.99          24.03
   97124            A       Massage therapy                             22.17           22.02          22.05
   97140            A       Manual therapy                              25.44           25.27          25.31
   97150            A       Group therapeutic procedures                17.35           17.24          17.26
   97530            A       Therapeutic activities                      29.41           29.18          29.24
   97533            A       Sensory integration                         25.26           25.11          25.15
   97535            A       Self care mngment training                  29.24           29.01          29.07
   97537            A       Community/work reintegration                25.86           25.71          25.74
   97542            A       Wheelchair mngment training                 26.38           26.21          26.26
   97750            A       Physical performance test                   28.51           28.41          28.42
   97755            A       Assistive technology assess                 32.01           31.96          31.96
   97760            A       Orthotic mgmt and training                  31.88           31.72          31.74
   97761            A       Prosthetic training                         28.25           28.16          28.16
   97762            A       C/o for orthotic/prosth use                 35.87           35.36          35.50
   G0281            A       Elec stim unattend for press                11.66           11.60          11.61
   G0283            A       Elec stim other than wound                  11.66           11.60          11.61
   G0329            A       Electromagntic tx for ulcers                 8.06            7.99           8.00

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  91 of 121
                                                                                                   8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Beaumont, TX Fort Worth, TX   Austin, TX
                                                                     04402         04402         04402
                                                                       20            28            31
   92506            A       Speech/hearing evaluation                   121.19        129.40         132.29
   92507            A       Speech/hearing therapy                       65.43         66.96          67.42
   92508            A       Speech/hearing therapy                       18.87         19.51          19.73
   92526            A       Oral function therapy                        71.37         73.32          73.93
   92597            A       Oral speech device eval                      70.48         72.60          73.27
   92607            A       Ex for speech device rx 1hr                 117.35        121.76         123.22
   92609            A       Use of speech device service                 85.28         88.01          88.91
   96125            A       Cognitive test by hc pro                     86.14         88.32          89.02
   97001            A       Pt evaluation                                63.23         64.99          65.56
   97002            A       Pt re-evaluation                             34.40         35.51          35.87
   97003            A       Ot evaluation                                69.18         71.49          72.26
   97004            A       Ot re-evaluation                             41.04         42.76          43.34
   97012            A       Mechanical traction therapy                  13.40         13.79          13.92
   97016            A       Vasopneumatic device therapy                 14.45         15.16          15.40
   97018            A       Paraffin bath therapy                         7.62          8.07           8.22
   97022            A       Whirlpool therapy                            16.85         17.81          18.15
   97024            A       Diathermy eg microwave                        5.10          5.32           5.39
   97026            R       Infrared therapy                              4.64          4.82           4.87
   97028            A       Ultraviolet therapy                           5.78          6.00           6.07
   97032            A       Electrical stimulation                       15.23         15.79          15.98
   97033            A       Electric current therapy                     23.57         24.88          25.33
   97034            A       Contrast bath therapy                        13.87         14.43          14.62
   97035            A       Ultrasound therapy                           10.66         10.93          11.01
   97036            A       Hydrotherapy                                 24.03         25.31          25.76
   97110            A       Therapeutic exercises                        25.70         26.59          26.91
   97112            A       Neuromuscular reeducation                    26.61         27.59          27.94
   97113            A       Aquatic therapy/exercises                    32.45         34.00          34.55
   97116            A       Gait training therapy                        22.85         23.64          23.92
   97124            A       Massage therapy                              20.92         21.69          21.96
   97140            A       Manual therapy                               24.10         24.91          25.19
   97150            A       Group therapeutic procedures                 16.37         16.97          17.17
   97530            A       Therapeutic activities                       27.64         28.75          29.14
   97533            A       Sensory integration                          23.98         24.75          25.02
   97535            A       Self care mngment training                   27.53         28.59          28.97
   97537            A       Community/work reintegration                 24.55         25.34          25.62
   97542            A       Wheelchair mngment training                  25.01         25.84          26.13
   97750            A       Physical performance test                    27.01         27.91          28.19
   97755            A       Assistive technology assess                  30.74         31.44          31.66
   97760            A       Orthotic mgmt and training                   29.98         31.16          31.54
   97761            A       Prosthetic training                          26.78         27.66          27.93
   97762            A       C/o for orthotic/prosth use                  32.61         34.78          35.55
   G0281            A       Elec stim unattend for press                 11.02         11.41          11.53
   G0283            A       Elec stim other than wound                   11.02         11.41          11.53
   G0329            A       Electromagntic tx for ulcers                  7.39          7.82           7.96

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  92 of 121
                                                                                                8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Rest of Texas   Utah        Vermont
                                                                     04402       03502        14502
                                                                       99          09           50
   92506            A       Speech/hearing evaluation                   122.61      123.51       131.86
   92507            A       Speech/hearing therapy                       65.50       66.28        66.93
   92508            A       Speech/hearing therapy                       18.96       19.09        19.66
   92526            A       Oral function therapy                        71.52       72.32        73.43
   92597            A       Oral speech device eval                      70.66       71.47        72.77
   92607            A       Ex for speech device rx 1hr                 117.87      119.10       122.50
   92609            A       Use of speech device service                 85.58       86.42        88.40
   96125            A       Cognitive test by hc pro                     86.33       87.15        88.52
   97001            A       Pt evaluation                                63.41       64.00        65.20
   97002            A       Pt re-evaluation                             34.52       34.88        35.66
   97003            A       Ot evaluation                                69.46       70.08        71.89
   97004            A       Ot re-evaluation                             41.27       41.66        43.12
   97012            A       Mechanical traction therapy                  13.44       13.56        13.84
   97016            A       Vasopneumatic device therapy                 14.55       14.69        15.32
   97018            A       Paraffin bath therapy                         7.67        7.80         8.15
   97022            A       Whirlpool therapy                            17.00       17.15        18.07
   97024            A       Diathermy eg microwave                        5.11        5.22         5.32
   97026            R       Infrared therapy                              4.65        4.76         4.80
   97028            A       Ultraviolet therapy                           5.79        5.90         6.00
   97032            A       Electrical stimulation                       15.30       15.43        15.90
   97033            A       Electric current therapy                     23.79       23.96        25.25
   97034            A       Contrast bath therapy                        13.94       14.07        14.54
   97035            A       Ultrasound therapy                           10.68       10.80        10.94
   97036            A       Hydrotherapy                                 24.24       24.40        25.67
   97110            A       Therapeutic exercises                        25.84       25.98        26.83
   97112            A       Neuromuscular reeducation                    26.77       26.92        27.86
   97113            A       Aquatic therapy/exercises                    32.71       32.89        34.46
   97116            A       Gait training therapy                        22.97       23.11        23.84
   97124            A       Massage therapy                              21.04       21.17        21.88
   97140            A       Manual therapy                               24.22       24.36        25.12
   97150            A       Group therapeutic procedures                 16.45       16.58        17.10
   97530            A       Therapeutic activities                       27.82       27.98        29.06
   97533            A       Sensory integration                          24.10       24.24        24.94
   97535            A       Self care mngment training                   27.70       27.85        28.89
   97537            A       Community/work reintegration                 24.67       24.81        25.54
   97542            A       Wheelchair mngment training                  25.14       25.28        26.06
   97750            A       Physical performance test                    27.09       27.43        27.98
   97755            A       Assistive technology assess                  30.78       31.11        31.45
   97760            A       Orthotic mgmt and training                   30.11       30.47        31.32
   97761            A       Prosthetic training                          26.85       27.20        27.72
   97762            A       C/o for orthotic/prosth use                  33.00       33.20        35.46
   G0281            A       Elec stim unattend for press                 11.06       11.18        11.46
   G0283            A       Elec stim other than wound                   11.06       11.18        11.46
   G0329            A       Electromagntic tx for ulcers                  7.44        7.56         7.89

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  93 of 121
                                                                                                      8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                                                       Seattle (King
  Code           Status             Short Description            Virgin Islands   Virginia       Cnty), WA
                                                                     09202         00904            00836
                                                                       50            00               02
   92506            A       Speech/hearing evaluation                    132.03        129.03          146.86
   92507            A       Speech/hearing therapy                        67.89         66.69           71.69
   92508            A       Speech/hearing therapy                        19.76         19.46           21.16
   92526            A       Oral function therapy                         74.36         73.04           78.93
   92597            A       Oral speech device eval                       73.69         72.31           78.48
   92607            A       Ex for speech device rx 1hr                  123.70        121.33          132.96
   92609            A       Use of speech device service                  89.27         87.72           95.32
   96125            A       Cognitive test by hc pro                      89.43         88.04           94.70
   97001            A       Pt evaluation                                 65.84         64.79           69.94
   97002            A       Pt re-evaluation                              36.03         35.39           38.48
   97003            A       Ot evaluation                                 72.49         71.27           77.53
   97004            A       Ot re-evaluation                              43.45         42.62           46.95
   97012            A       Mechanical traction therapy                   13.97         13.75           14.86
   97016            A       Vasopneumatic device therapy                  15.42         15.10           16.80
   97018            A       Paraffin bath therapy                          8.27          8.03            9.11
   97022            A       Whirlpool therapy                             18.15         17.76           19.96
   97024            A       Diathermy eg microwave                         5.46          5.28            5.90
   97026            R       Infrared therapy                               4.94          4.79            5.31
   97028            A       Ultraviolet therapy                            6.14          5.96            6.60
   97032            A       Electrical stimulation                        16.02         15.74           17.20
   97033            A       Electric current therapy                      25.31         24.81           27.77
   97034            A       Contrast bath therapy                         14.65         14.38           15.80
   97035            A       Ultrasound therapy                            11.07         10.89           11.72
   97036            A       Hydrotherapy                                  25.73         25.24           28.18
   97110            A       Therapeutic exercises                         26.92         26.54           28.85
   97112            A       Neuromuscular reeducation                     27.94         27.54           30.02
   97113            A       Aquatic therapy/exercises                     34.50         33.93           37.55
   97116            A       Gait training therapy                         23.93         23.59           25.64
   97124            A       Massage therapy                               21.98         21.64           23.61
   97140            A       Manual therapy                                25.21         24.86           26.98
   97150            A       Group therapeutic procedures                  17.21         16.92           18.48
   97530            A       Therapeutic activities                        29.13         28.69           31.42
   97533            A       Sensory integration                           25.04         24.70           26.75
   97535            A       Self care mngment training                    28.96         28.54           31.19
   97537            A       Community/work reintegration                  25.64         25.29           27.39
   97542            A       Wheelchair mngment training                   26.15         25.79           27.97
   97750            A       Physical performance test                     28.37         27.79           30.33
   97755            A       Assistive technology assess                   31.85         31.33           33.63
   97760            A       Orthotic mgmt and training                    31.70         31.03           34.12
   97761            A       Prosthetic training                           28.11         27.54           30.03
   97762            A       C/o for orthotic/prosth use                   35.46         34.70           39.39
   G0281            A       Elec stim unattend for press                  11.59         11.36           12.42
   G0283            A       Elec stim other than wound                    11.59         11.36           12.42
   G0329            A       Electromagntic tx for ulcers                   8.01          7.78            8.82

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  94 of 121
                                                                                                    8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS                                                         Rest of
  Code           Status             Short Description            Washington     West Virginia   Wisconsin
                                                                    00836           00884         00951
                                                                      99              16            00
   92506            A       Speech/hearing evaluation                  132.78          114.86        127.01
   92507            A       Speech/hearing therapy                      67.74           64.72         65.89
   92508            A       Speech/hearing therapy                      19.79           18.41         19.26
   92526            A       Oral function therapy                       74.27           70.31         72.16
   92597            A       Oral speech device eval                     73.62           69.28         71.39
   92607            A       Ex for speech device rx 1hr                123.77          114.50        119.73
   92609            A       Use of speech device service                89.28           83.58         86.67
   96125            A       Cognitive test by hc pro                    89.37           84.89         87.11
   97001            A       Pt evaluation                               65.82           62.17         64.08
   97002            A       Pt re-evaluation                            36.03           33.73         34.95
   97003            A       Ot evaluation                               72.54           67.67         70.45
   97004            A       Ot re-evaluation                            43.52           39.86         42.06
   97012            A       Mechanical traction therapy                 13.97           13.16         13.60
   97016            A       Vasopneumatic device therapy                15.46           13.94         14.89
   97018            A       Paraffin bath therapy                        8.28            7.32          7.87
   97022            A       Whirlpool therapy                           18.22           16.14         17.49
   97024            A       Diathermy eg microwave                       5.44            5.00          5.17
   97026            R       Infrared therapy                             4.92            4.57          4.68
   97028            A       Ultraviolet therapy                          6.12            5.68          5.85
   97032            A       Electrical stimulation                      16.04           14.85         15.56
   97033            A       Electric current therapy                    25.42           22.58         24.48
   97034            A       Contrast bath therapy                       14.67           13.48         14.20
   97035            A       Ultrasound therapy                          11.06           10.53         10.77
   97036            A       Hydrotherapy                                25.84           23.05         24.91
   97110            A       Therapeutic exercises                       26.98           25.04         26.29
   97112            A       Neuromuscular reeducation                   28.01           25.88         27.27
   97113            A       Aquatic therapy/exercises                   34.65           31.25         33.54
   97116            A       Gait training therapy                       23.98           22.28         23.36
   97124            A       Massage therapy                             22.02           20.36         21.41
   97140            A       Manual therapy                              25.26           23.51         24.63
   97150            A       Group therapeutic procedures                17.23           15.95         16.73
   97530            A       Therapeutic activities                      29.22           26.81         28.40
   97533            A       Sensory integration                         25.09           23.43         24.48
   97535            A       Self care mngment training                  29.04           26.73         28.25
   97537            A       Community/work reintegration                25.69           23.98         25.06
   97542            A       Wheelchair mngment training                 26.20           24.40         25.55
   97750            A       Physical performance test                   28.34           26.51         27.39
   97755            A       Assistive technology assess                 31.80           30.39         30.97
   97760            A       Orthotic mgmt and training                  31.70           29.25         30.58
   97761            A       Prosthetic training                         28.08           26.30         27.15
   97762            A       C/o for orthotic/prosth use                 35.67           30.91         34.18
   G0281            A       Elec stim unattend for press                11.59           10.77         11.21
   G0283            A       Elec stim other than wound                  11.59           10.77         11.21
   G0329            A       Electromagntic tx for ulcers                 8.02            7.11          7.62

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  95 of 121
                                                                              8/14/2012


        2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                      POLICY

CPT/HCPCS
  Code           Status             Short Description            Wyoming
                                                                  03602
                                                                    21
   92506            A       Speech/hearing evaluation                132.21
   92507            A       Speech/hearing therapy                    68.38
   92508            A       Speech/hearing therapy                    19.82
   92526            A       Oral function therapy                     74.84
   92597            A       Oral speech device eval                   74.16
   92607            A       Ex for speech device rx 1hr              124.35
   92609            A       Use of speech device service              89.73
   96125            A       Cognitive test by hc pro                  89.90
   97001            A       Pt evaluation                             66.17
   97002            A       Pt re-evaluation                          36.23
   97003            A       Ot evaluation                             72.81
   97004            A       Ot re-evaluation                          43.64
   97012            A       Mechanical traction therapy               14.03
   97016            A       Vasopneumatic device therapy              15.48
   97018            A       Paraffin bath therapy                      8.33
   97022            A       Whirlpool therapy                         18.20
   97024            A       Diathermy eg microwave                     5.53
   97026            R       Infrared therapy                           5.01
   97028            A       Ultraviolet therapy                        6.21
   97032            A       Electrical stimulation                    16.08
   97033            A       Electric current therapy                  25.35
   97034            A       Contrast bath therapy                     14.72
   97035            A       Ultrasound therapy                        11.14
   97036            A       Hydrotherapy                              25.78
   97110            A       Therapeutic exercises                     26.97
   97112            A       Neuromuscular reeducation                 27.99
   97113            A       Aquatic therapy/exercises                 34.54
   97116            A       Gait training therapy                     23.99
   97124            A       Massage therapy                           22.03
   97140            A       Manual therapy                            25.27
   97150            A       Group therapeutic procedures              17.27
   97530            A       Therapeutic activities                    29.18
   97533            A       Sensory integration                       25.10
   97535            A       Self care mngment training                29.01
   97537            A       Community/work reintegration              25.69
   97542            A       Wheelchair mngment training               26.20
   97750            A       Physical performance test                 28.57
   97755            A       Assistive technology assess               32.06
   97760            A       Orthotic mgmt and training                31.89
   97761            A       Prosthetic training                       28.32
   97762            A       C/o for orthotic/prosth use               35.48
   G0281            A       Elec stim unattend for press              11.65
   G0283            A       Elec stim other than wound                11.65
   G0329            A       Electromagntic tx for ulcers               8.08

Conversion Factor                                     $34.0376
MPPR Factor                                                25%
((A1 x B1)+((A2 x B2) x .8)+(A3 x B3)) x Conversion Factor




                                                  96 of 121
           2012 MEDICARE PART B FEE SCHEDULE
  "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR POLICY
                     PE RVU RANKING
CPT/HCPCS
  Code       Status          Short Description    PE RVU
  92506        A     Speech/hearing evaluation       3.95
  92607        A     Ex for speech device rx 1hr     2.24
  92609        A     Use of speech device service    1.40
  97003        A     Ot evaluation                   1.17
  96125        A     Cognitive test by hc pro        1.14
  92597        A     Oral speech device eval         1.11
  97762        A     C/o for orthotic/prosth use     1.04
  92526        A     Oral function therapy           1.03
  97001        A     Pt evaluation                   0.91
  97004        A     Ot re-evaluation                0.86
  92507        A     Speech/hearing therapy          0.83
  97113        A     Aquatic therapy/exercises       0.75
  97033        A     Electric current therapy        0.63
  97036        A     Hydrotherapy                    0.62
  97760        A     Orthotic mgmt and training      0.60
  97002        A     Pt re-evaluation                0.57
  97530        A     Therapeutic activities          0.54
  97535        A     Self care mngment training      0.52
  97112        A     Neuromuscular reeducation       0.48
  97750        A     Physical performance test       0.47
  97022        A     Whirlpool therapy               0.47
  97761        A     Prosthetic training             0.46
  97110        A     Therapeutic exercises           0.44
  97542        A     Wheelchair mngment training     0.41
  97140        A     Manual therapy                  0.40
  97537        A     Community/work reintegration    0.39
  97116        A     Gait training therapy           0.39
  97533        A     Sensory integration             0.38
  97755        A     Assistive technology assess     0.38
  97124        A     Massage therapy                 0.38
  97016        A     Vasopneumatic device therapy    0.35
  92508        A     Speech/hearing therapy          0.32
  97150        A     Group therapeutic procedures    0.30
  97032        A     Electrical stimulation          0.28
  97034        A     Contrast bath therapy           0.28
  97018        A     Paraffin bath therapy           0.23
  G0329        A     Electromagntic tx for ulcers    0.22
  97012        A     Mechanical traction therapy     0.20
  G0281        A     Elec stim unattend for press    0.20
  G0283        A     Elec stim other than wound      0.20
  97035        A     Ultrasound therapy              0.14
  97024        A     Diathermy eg microwave          0.12
  97028        A     Ultraviolet therapy             0.12
  97026        R     Infrared therapy                0.10
                                                                                                                       8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS
  Code        Status            Short Description              Alabama              Alaska          Arizona         Arkansas
                                                                     10102           00831           03102            00520
                                                                      00              01              00               13
   92506         A     Speech/hearing evaluation                           118.05          143.46          131.49           116.30
   92607         A     Ex for speech device rx 1hr                          66.94           81.35           74.57            65.95
   92609         A     Use of speech device service                         41.84           50.85           46.60            41.22
   97003         A     Ot evaluation                                        34.97           42.49           38.95            34.45
   96125         A     Cognitive test by hc pro                             34.07           41.40           37.95            33.56
   92597         A     Oral speech device eval                              33.17           40.31           36.95            32.68
   97762         A     C/o for orthotic/prosth use                          31.08           37.77           34.62            30.62
   92526         A     Oral function therapy                                30.78           37.41           34.29            30.33
   97001         A     Pt evaluation                                        27.20           33.05           30.29            26.79
   97004         A     Ot re-evaluation                                     25.70           31.23           28.63            25.32
   92507         A     Speech/hearing therapy                               24.80           30.14           27.63            24.44
   97113         A     Aquatic therapy/exercises                            22.41           27.24           24.97            22.08
   97033         A     Electric current therapy                             18.83           22.88           20.97            18.55
   97036         A     Hydrotherapy                                         18.53           22.52           20.64            18.25
   97760         A     Orthotic mgmt and training                           17.93           21.79           19.97            17.67
   97002         A     Pt re-evaluation                                     17.03           20.70           18.97            16.78
   97530         A     Therapeutic activities                               16.14           19.61           17.98            15.90
   97535         A     Self care mngment training                           15.54           18.89           17.31            15.31
   97112         A     Neuromuscular reeducation                            14.34           17.43           15.98            14.13
   97750         A     Physical performance test                            14.05           17.07           15.65            13.84
   97022         A     Whirlpool therapy                                    14.05           17.07           15.65            13.84
   97761         A     Prosthetic training                                  13.75           16.71           15.31            13.54
   97110         A     Therapeutic exercises                                13.15           15.98           14.65            12.95
   97542         A     Wheelchair mngment training                          12.25           14.89           13.65            12.07
   97140         A     Manual therapy                                       11.95           14.53           13.32            11.78
   97537         A     Community/work reintegration                         11.66           14.16           12.98            11.48
   97116         A     Gait training therapy                                11.66           14.16           12.98            11.48
   97533         A     Sensory integration                                  11.36           13.80           12.65            11.19
   97755         A     Assistive technology assess                          11.36           13.80           12.65            11.19
   97124         A     Massage therapy                                      11.36           13.80           12.65            11.19
   97016         A     Vasopneumatic device therapy                         10.46           12.71           11.65            10.30
   92508         A     Speech/hearing therapy                                9.56           11.62           10.65             9.42
   97150         A     Group therapeutic procedures                          8.97           10.90            9.99             8.83
   97032         A     Electrical stimulation                                8.37           10.17            9.32             8.24
   97034         A     Contrast bath therapy                                 8.37           10.17            9.32             8.24
   97018         A     Paraffin bath therapy                                 6.87            8.35            7.66             6.77
   G0329         A     Electromagntic tx for ulcers                          6.57            7.99            7.32             6.48
   97012         A     Mechanical traction therapy                           5.98            7.26            6.66             5.89
   G0281         A     Elec stim unattend for press                          5.98            7.26            6.66             5.89
   G0283         A     Elec stim other than wound                            5.98            7.26            6.66             5.89
   97035         A     Ultrasound therapy                                    4.18            5.08            4.66             4.12
   97024         A     Diathermy eg microwave                                3.59            4.36            3.99             3.53
   97028         A     Ultraviolet therapy                                   3.59            4.36            3.99             3.53
   97026         R     Infrared therapy                                      2.99            3.63            3.33             2.94

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                         98 of 121
                                                                                                                 8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                      Marin/Napa/So     San                     Oakland/Berkl
  Code        Status            Short Description                lano, CA    Francisco, CA San Mateo, CA    ey, CA
                                                                   01102         01102          01102          01102
                                                                     03           05             06             07
   92506         A     Speech/hearing evaluation                      167.79           182.85         182.04      168.60
   92607         A     Ex for speech device rx 1hr                     95.15           103.69         103.23       95.61
   92609         A     Use of speech device service                    59.47            64.81          64.52       59.76
   97003         A     Ot evaluation                                   49.70            54.16          53.92       49.94
   96125         A     Cognitive test by hc pro                        48.43            52.77          52.54       48.66
   92597         A     Oral speech device eval                         47.15            51.38          51.16       47.38
   97762         A     C/o for orthotic/prosth use                     44.18            48.14          47.93       44.39
   92526         A     Oral function therapy                           43.75            47.68          47.47       43.96
   97001         A     Pt evaluation                                   38.66            42.12          41.94       38.84
   97004         A     Ot re-evaluation                                36.53            39.81          39.63       36.71
   92507         A     Speech/hearing therapy                          35.26            38.42          38.25       35.43
   97113         A     Aquatic therapy/exercises                       31.86            34.72          34.57       32.01
   97033         A     Electric current therapy                        26.76            29.16          29.03       26.89
   97036         A     Hydrotherapy                                    26.34            28.70          28.57       26.46
   97760         A     Orthotic mgmt and training                      25.49            27.77          27.65       25.61
   97002         A     Pt re-evaluation                                24.21            26.39          26.27       24.33
   97530         A     Therapeutic activities                          22.94            25.00          24.89       23.05
   97535         A     Self care mngment training                      22.09            24.07          23.97       22.20
   97112         A     Neuromuscular reeducation                       20.39            22.22          22.12       20.49
   97750         A     Physical performance test                       19.97            21.76          21.66       20.06
   97022         A     Whirlpool therapy                               19.97            21.76          21.66       20.06
   97761         A     Prosthetic training                             19.54            21.29          21.20       19.63
   97110         A     Therapeutic exercises                           18.69            20.37          20.28       18.78
   97542         A     Wheelchair mngment training                     17.42            18.98          18.90       17.50
   97140         A     Manual therapy                                  16.99            18.52          18.43       17.07
   97537         A     Community/work reintegration                    16.57            18.05          17.97       16.65
   97116         A     Gait training therapy                           16.57            18.05          17.97       16.65
   97533         A     Sensory integration                             16.14            17.59          17.51       16.22
   97755         A     Assistive technology assess                     16.14            17.59          17.51       16.22
   97124         A     Massage therapy                                 16.14            17.59          17.51       16.22
   97016         A     Vasopneumatic device therapy                    14.87            16.20          16.13       14.94
   92508         A     Speech/hearing therapy                          13.59            14.81          14.75       13.66
   97150         A     Group therapeutic procedures                    12.74            13.89          13.83       12.80
   97032         A     Electrical stimulation                          11.89            12.96          12.90       11.95
   97034         A     Contrast bath therapy                           11.89            12.96          12.90       11.95
   97018         A     Paraffin bath therapy                            9.77            10.65          10.60        9.82
   G0329         A     Electromagntic tx for ulcers                     9.35            10.18          10.14        9.39
   97012         A     Mechanical traction therapy                      8.50             9.26           9.22        8.54
   G0281         A     Elec stim unattend for press                     8.50             9.26           9.22        8.54
   G0283         A     Elec stim other than wound                       8.50             9.26           9.22        8.54
   97035         A     Ultrasound therapy                               5.95             6.48           6.45        5.98
   97024         A     Diathermy eg microwave                           5.10             5.55           5.53        5.12
   97028         A     Ultraviolet therapy                              5.10             5.55           5.53        5.12
   97026         R     Infrared therapy                                 4.25             4.63           4.61        4.27

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                         99 of 121
                                                                                                                            8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                      Santa Clara,         Rest of                            Los Angeles,
  Code        Status            Short Description                  CA              California*       Ventura, CA            CA
                                                                  01102               01102             01192             01192
                                                                     09                99                17                 18
   92506         A     Speech/hearing evaluation                          179.76            145.88            160.40             155.15
   92607         A     Ex for speech device rx 1hr                        101.94             82.72             90.96              87.99
   92609         A     Use of speech device service                        63.71             51.70             56.85              54.99
   97003         A     Ot evaluation                                       53.24             43.21             47.51              45.96
   96125         A     Cognitive test by hc pro                            51.88             42.10             46.29              44.78
   92597         A     Oral speech device eval                             50.51             40.99             45.07              43.60
   97762         A     C/o for orthotic/prosth use                         47.33             38.41             42.23              40.85
   92526         A     Oral function therapy                               46.87             38.04             41.83              40.46
   97001         A     Pt evaluation                                       41.41             33.61             36.95              35.74
   97004         A     Ot re-evaluation                                    39.14             31.76             34.92              33.78
   92507         A     Speech/hearing therapy                              37.77             30.65             33.70              32.60
   97113         A     Aquatic therapy/exercises                           34.13             27.70             30.46              29.46
   97033         A     Electric current therapy                            28.67             23.27             25.58              24.75
   97036         A     Hydrotherapy                                        28.22             22.90             25.18              24.35
   97760         A     Orthotic mgmt and training                          27.30             22.16             24.36              23.57
   97002         A     Pt re-evaluation                                    25.94             21.05             23.15              22.39
   97530         A     Therapeutic activities                              24.57             19.94             21.93              21.21
   97535         A     Self care mngment training                          23.66             19.20             21.12              20.43
   97112         A     Neuromuscular reeducation                           21.84             17.73             19.49              18.85
   97750         A     Physical performance test                           21.39             17.36             19.09              18.46
   97022         A     Whirlpool therapy                                   21.39             17.36             19.09              18.46
   97761         A     Prosthetic training                                 20.93             16.99             18.68              18.07
   97110         A     Therapeutic exercises                               20.02             16.25             17.87              17.28
   97542         A     Wheelchair mngment training                         18.66             15.14             16.65              16.10
   97140         A     Manual therapy                                      18.20             14.77             16.24              15.71
   97537         A     Community/work reintegration                        17.75             14.40             15.84              15.32
   97116         A     Gait training therapy                               17.75             14.40             15.84              15.32
   97533         A     Sensory integration                                 17.29             14.03             15.43              14.93
   97755         A     Assistive technology assess                         17.29             14.03             15.43              14.93
   97124         A     Massage therapy                                     17.29             14.03             15.43              14.93
   97016         A     Vasopneumatic device therapy                        15.93             12.93             14.21              13.75
   92508         A     Speech/hearing therapy                              14.56             11.82             12.99              12.57
   97150         A     Group therapeutic procedures                        13.65             11.08             12.18              11.78
   97032         A     Electrical stimulation                              12.74             10.34             11.37              11.00
   97034         A     Contrast bath therapy                               12.74             10.34             11.37              11.00
   97018         A     Paraffin bath therapy                               10.47              8.49              9.34               9.03
   G0329         A     Electromagntic tx for ulcers                        10.01              8.12              8.93               8.64
   97012         A     Mechanical traction therapy                          9.10              7.39              8.12               7.86
   G0281         A     Elec stim unattend for press                         9.10              7.39              8.12               7.86
   G0283         A     Elec stim other than wound                           9.10              7.39              8.12               7.86
   97035         A     Ultrasound therapy                                   6.37              5.17              5.68               5.50
   97024         A     Diathermy eg microwave                               5.46              4.43              4.87               4.71
   97028         A     Ultraviolet therapy                                  5.46              4.43              4.87               4.71
   97026         R     Infrared therapy                                     4.55              3.69              4.06               3.93

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        100 of 121
                                                                                                                          8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                      Anaheim/Sant         Rest of
  Code        Status            Short Description                a Ana, CA         California*       Colorado         Connecticut
                                                                   01192              01192            04102             13102
                                                                     26                99               01                00
   92506         A     Speech/hearing evaluation                          163.76            145.88           134.99            149.24
   92607         A     Ex for speech device rx 1hr                         92.87             82.72            76.55             84.63
   92609         A     Use of speech device service                        58.04             51.70            47.84             52.89
   97003         A     Ot evaluation                                       48.51             43.21            39.98             44.20
   96125         A     Cognitive test by hc pro                            47.26             42.10            38.96             43.07
   92597         A     Oral speech device eval                             46.02             40.99            37.93             41.94
   97762         A     C/o for orthotic/prosth use                         43.12             38.41            35.54             39.29
   92526         A     Oral function therapy                               42.70             38.04            35.20             38.92
   97001         A     Pt evaluation                                       37.73             33.61            31.10             34.38
   97004         A     Ot re-evaluation                                    35.65             31.76            29.39             32.49
   92507         A     Speech/hearing therapy                              34.41             30.65            28.36             31.36
   97113         A     Aquatic therapy/exercises                           31.09             27.70            25.63             28.34
   97033         A     Electric current therapy                            26.12             23.27            21.53             23.80
   97036         A     Hydrotherapy                                        25.70             22.90            21.19             23.42
   97760         A     Orthotic mgmt and training                          24.87             22.16            20.50             22.67
   97002         A     Pt re-evaluation                                    23.63             21.05            19.48             21.54
   97530         A     Therapeutic activities                              22.39             19.94            18.45             20.40
   97535         A     Self care mngment training                          21.56             19.20            17.77             19.65
   97112         A     Neuromuscular reeducation                           19.90             17.73            16.40             18.14
   97750         A     Physical performance test                           19.49             17.36            16.06             17.76
   97022         A     Whirlpool therapy                                   19.49             17.36            16.06             17.76
   97761         A     Prosthetic training                                 19.07             16.99            15.72             17.38
   97110         A     Therapeutic exercises                               18.24             16.25            15.04             16.62
   97542         A     Wheelchair mngment training                         17.00             15.14            14.01             15.49
   97140         A     Manual therapy                                      16.58             14.77            13.67             15.11
   97537         A     Community/work reintegration                        16.17             14.40            13.33             14.73
   97116         A     Gait training therapy                               16.17             14.40            13.33             14.73
   97533         A     Sensory integration                                 15.75             14.03            12.99             14.36
   97755         A     Assistive technology assess                         15.75             14.03            12.99             14.36
   97124         A     Massage therapy                                     15.75             14.03            12.99             14.36
   97016         A     Vasopneumatic device therapy                        14.51             12.93            11.96             13.22
   92508         A     Speech/hearing therapy                              13.27             11.82            10.94             12.09
   97150         A     Group therapeutic procedures                        12.44             11.08            10.25             11.33
   97032         A     Electrical stimulation                              11.61             10.34             9.57             10.58
   97034         A     Contrast bath therapy                               11.61             10.34             9.57             10.58
   97018         A     Paraffin bath therapy                                9.54              8.49             7.86              8.69
   G0329         A     Electromagntic tx for ulcers                         9.12              8.12             7.52              8.31
   97012         A     Mechanical traction therapy                          8.29              7.39             6.83              7.56
   G0281         A     Elec stim unattend for press                         8.29              7.39             6.83              7.56
   G0283         A     Elec stim other than wound                           8.29              7.39             6.83              7.56
   97035         A     Ultrasound therapy                                   5.80              5.17             4.78              5.29
   97024         A     Diathermy eg microwave                               4.97              4.43             4.10              4.53
   97028         A     Ultraviolet therapy                                  4.97              4.43             4.10              4.53
   97026         R     Infrared therapy                                     4.15              3.69             3.42              3.78

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        101 of 121
                                                                                                                           8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                      DC + MD/VA                               Fort
  Code        Status            Short Description               Suburbs            Delaware         Lauderdale, FL      Miami, FL
                                                                  12202              12102              09102             09102
                                                                     01               01                  03               04
   92506         A     Speech/hearing evaluation                          161.07           140.36              141.31           141.71
   92607         A     Ex for speech device rx 1hr                         91.34            79.60               80.13            80.36
   92609         A     Use of speech device service                        57.09            49.75               50.08            50.23
   97003         A     Ot evaluation                                       47.71            41.58               41.86            41.97
   96125         A     Cognitive test by hc pro                            46.49            40.51               40.78            40.90
   92597         A     Oral speech device eval                             45.26            39.44               39.71            39.82
   97762         A     C/o for orthotic/prosth use                         42.41            36.96               37.20            37.31
   92526         A     Oral function therapy                               42.00            36.60               36.85            36.95
   97001         A     Pt evaluation                                       37.11            32.34               32.55            32.65
   97004         A     Ot re-evaluation                                    35.07            30.56               30.77            30.85
   92507         A     Speech/hearing therapy                              33.84            29.49               29.69            29.78
   97113         A     Aquatic therapy/exercises                           30.58            26.65               26.83            26.91
   97033         A     Electric current therapy                            25.69            22.39               22.54            22.60
   97036         A     Hydrotherapy                                        25.28            22.03               22.18            22.24
   97760         A     Orthotic mgmt and training                          24.47            21.32               21.46            21.53
   97002         A     Pt re-evaluation                                    23.24            20.26               20.39            20.45
   97530         A     Therapeutic activities                              22.02            19.19               19.32            19.37
   97535         A     Self care mngment training                          21.20            18.48               18.60            18.66
   97112         A     Neuromuscular reeducation                           19.57            17.06               17.17            17.22
   97750         A     Physical performance test                           19.17            16.70               16.81            16.86
   97022         A     Whirlpool therapy                                   19.17            16.70               16.81            16.86
   97761         A     Prosthetic training                                 18.76            16.35               16.46            16.50
   97110         A     Therapeutic exercises                               17.94            15.64               15.74            15.79
   97542         A     Wheelchair mngment training                         16.72            14.57               14.67            14.71
   97140         A     Manual therapy                                      16.31            14.21               14.31            14.35
   97537         A     Community/work reintegration                        15.90            13.86               13.95            13.99
   97116         A     Gait training therapy                               15.90            13.86               13.95            13.99
   97533         A     Sensory integration                                 15.50            13.50               13.59            13.63
   97755         A     Assistive technology assess                         15.50            13.50               13.59            13.63
   97124         A     Massage therapy                                     15.50            13.50               13.59            13.63
   97016         A     Vasopneumatic device therapy                        14.27            12.44               12.52            12.56
   92508         A     Speech/hearing therapy                              13.05            11.37               11.45            11.48
   97150         A     Group therapeutic procedures                        12.23            10.66               10.73            10.76
   97032         A     Electrical stimulation                              11.42             9.95               10.02            10.05
   97034         A     Contrast bath therapy                               11.42             9.95               10.02            10.05
   97018         A     Paraffin bath therapy                                9.38             8.17                8.23             8.25
   G0329         A     Electromagntic tx for ulcers                         8.97             7.82                7.87             7.89
   97012         A     Mechanical traction therapy                          8.16             7.11                7.15             7.18
   G0281         A     Elec stim unattend for press                         8.16             7.11                7.15             7.18
   G0283         A     Elec stim other than wound                           8.16             7.11                7.15             7.18
   97035         A     Ultrasound therapy                                   5.71             4.97                5.01             5.02
   97024         A     Diathermy eg microwave                               4.89             4.26                4.29             4.31
   97028         A     Ultraviolet therapy                                  4.89             4.26                4.29             4.31
   97026         R     Infrared therapy                                     4.08             3.55                3.58             3.59

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        102 of 121
                                                                                                                          8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                                                            Rest of
  Code        Status            Short Description              Rest of Florida     Atlanta, GA       Georgia         Hawaii/Guam
                                                                    09102             10202           10202             01202
                                                                     99                01              99                01
   92506         A     Speech/hearing evaluation                          130.15            136.47          120.73         155.15
   92607         A     Ex for speech device rx 1hr                         73.80             77.39           68.47          87.99
   92609         A     Use of speech device service                        46.13             48.37           42.79          54.99
   97003         A     Ot evaluation                                       38.55             40.42           35.76          45.96
   96125         A     Cognitive test by hc pro                            37.56             39.38           34.84          44.78
   92597         A     Oral speech device eval                             36.57             38.35           33.93          43.60
   97762         A     C/o for orthotic/prosth use                         34.27             35.93           31.79          40.85
   92526         A     Oral function therapy                               33.94             35.58           31.48          40.46
   97001         A     Pt evaluation                                       29.98             31.44           27.81          35.74
   97004         A     Ot re-evaluation                                    28.34             29.71           26.29          33.78
   92507         A     Speech/hearing therapy                              27.35             28.67           25.37          32.60
   97113         A     Aquatic therapy/exercises                           24.71             25.91           22.92          29.46
   97033         A     Electric current therapy                            20.76             21.77           19.26          24.75
   97036         A     Hydrotherapy                                        20.43             21.42           18.95          24.35
   97760         A     Orthotic mgmt and training                          19.77             20.73           18.34          23.57
   97002         A     Pt re-evaluation                                    18.78             19.69           17.42          22.39
   97530         A     Therapeutic activities                              17.79             18.66           16.51          21.21
   97535         A     Self care mngment training                          17.13             17.97           15.89          20.43
   97112         A     Neuromuscular reeducation                           15.82             16.58           14.67          18.85
   97750         A     Physical performance test                           15.49             16.24           14.37          18.46
   97022         A     Whirlpool therapy                                   15.49             16.24           14.37          18.46
   97761         A     Prosthetic training                                 15.16             15.89           14.06          18.07
   97110         A     Therapeutic exercises                               14.50             15.20           13.45          17.28
   97542         A     Wheelchair mngment training                         13.51             14.16           12.53          16.10
   97140         A     Manual therapy                                      13.18             13.82           12.23          15.71
   97537         A     Community/work reintegration                        12.85             13.47           11.92          15.32
   97116         A     Gait training therapy                               12.85             13.47           11.92          15.32
   97533         A     Sensory integration                                 12.52             13.13           11.61          14.93
   97755         A     Assistive technology assess                         12.52             13.13           11.61          14.93
   97124         A     Massage therapy                                     12.52             13.13           11.61          14.93
   97016         A     Vasopneumatic device therapy                        11.53             12.09           10.70          13.75
   92508         A     Speech/hearing therapy                              10.54             11.06            9.78          12.57
   97150         A     Group therapeutic procedures                         9.88             10.36            9.17          11.78
   97032         A     Electrical stimulation                               9.23              9.67            8.56          11.00
   97034         A     Contrast bath therapy                                9.23              9.67            8.56          11.00
   97018         A     Paraffin bath therapy                                7.58              7.95            7.03           9.03
   G0329         A     Electromagntic tx for ulcers                         7.25              7.60            6.72           8.64
   97012         A     Mechanical traction therapy                          6.59              6.91            6.11           7.86
   G0281         A     Elec stim unattend for press                         6.59              6.91            6.11           7.86
   G0283         A     Elec stim other than wound                           6.59              6.91            6.11           7.86
   97035         A     Ultrasound therapy                                   4.61              4.84            4.28           5.50
   97024         A     Diathermy eg microwave                               3.95              4.15            3.67           4.71
   97028         A     Ultraviolet therapy                                  3.95              4.15            3.67           4.71
   97026         R     Infrared therapy                                     3.29              3.45            3.06           3.93

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        103 of 121
                                                                                                                             8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                                          East St. Louis,      Suburban
  Code        Status            Short Description               Idaho                    IL            Chicago, IL       Chicago, IL
                                                                 05130                  00952             00952             00952
                                                                     00                  12                15                16
   92506         A     Speech/hearing evaluation                          120.20              125.84            144.13            141.31
   92607         A     Ex for speech device rx 1hr                         68.16               71.36             81.73             80.13
   92609         A     Use of speech device service                        42.60               44.60             51.08             50.08
   97003         A     Ot evaluation                                       35.60               37.28             42.69             41.86
   96125         A     Cognitive test by hc pro                            34.69               36.32             41.60             40.78
   92597         A     Oral speech device eval                             33.78               35.36             40.50             39.71
   97762         A     C/o for orthotic/prosth use                         31.65               33.13             37.95             37.20
   92526         A     Oral function therapy                               31.34               32.81             37.58             36.85
   97001         A     Pt evaluation                                       27.69               28.99             33.20             32.55
   97004         A     Ot re-evaluation                                    26.17               27.40             31.38             30.77
   92507         A     Speech/hearing therapy                              25.26               26.44             30.29             29.69
   97113         A     Aquatic therapy/exercises                           22.82               23.89             27.37             26.83
   97033         A     Electric current therapy                            19.17               20.07             22.99             22.54
   97036         A     Hydrotherapy                                        18.87               19.75             22.62             22.18
   97760         A     Orthotic mgmt and training                          18.26               19.12             21.89             21.46
   97002         A     Pt re-evaluation                                    17.34               18.16             20.80             20.39
   97530         A     Therapeutic activities                              16.43               17.20             19.70             19.32
   97535         A     Self care mngment training                          15.82               16.57             18.97             18.60
   97112         A     Neuromuscular reeducation                           14.61               15.29             17.51             17.17
   97750         A     Physical performance test                           14.30               14.97             17.15             16.81
   97022         A     Whirlpool therapy                                   14.30               14.97             17.15             16.81
   97761         A     Prosthetic training                                 14.00               14.66             16.78             16.46
   97110         A     Therapeutic exercises                               13.39               14.02             16.05             15.74
   97542         A     Wheelchair mngment training                         12.48               13.06             14.96             14.67
   97140         A     Manual therapy                                      12.17               12.74             14.60             14.31
   97537         A     Community/work reintegration                        11.87               12.43             14.23             13.95
   97116         A     Gait training therapy                               11.87               12.43             14.23             13.95
   97533         A     Sensory integration                                 11.56               12.11             13.87             13.59
   97755         A     Assistive technology assess                         11.56               12.11             13.87             13.59
   97124         A     Massage therapy                                     11.56               12.11             13.87             13.59
   97016         A     Vasopneumatic device therapy                        10.65               11.15             12.77             12.52
   92508         A     Speech/hearing therapy                               9.74               10.19             11.68             11.45
   97150         A     Group therapeutic procedures                         9.13                9.56             10.95             10.73
   97032         A     Electrical stimulation                               8.52                8.92             10.22             10.02
   97034         A     Contrast bath therapy                                8.52                8.92             10.22             10.02
   97018         A     Paraffin bath therapy                                7.00                7.33              8.39              8.23
   G0329         A     Electromagntic tx for ulcers                         6.69                7.01              8.03              7.87
   97012         A     Mechanical traction therapy                          6.09                6.37              7.30              7.15
   G0281         A     Elec stim unattend for press                         6.09                6.37              7.30              7.15
   G0283         A     Elec stim other than wound                           6.09                6.37              7.30              7.15
   97035         A     Ultrasound therapy                                   4.26                4.46              5.11              5.01
   97024         A     Diathermy eg microwave                               3.65                3.82              4.38              4.29
   97028         A     Ultraviolet therapy                                  3.65                3.82              4.38              4.29
   97026         R     Infrared therapy                                     3.04                3.19              3.65              3.58

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        104 of 121
                                                                                                                     8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS
  Code        Status            Short Description              Rest of Illinois     Indiana         Iowa           Kansas
                                                                    00952            00630          05102           05202
                                                                      99              00             00              00
   92506         A     Speech/hearing evaluation                           122.21          124.10         119.26          120.20
   92607         A     Ex for speech device rx 1hr                          69.31           70.37          67.63           68.16
   92609         A     Use of speech device service                         43.32           43.98          42.27           42.60
   97003         A     Ot evaluation                                        36.20           36.76          35.32           35.60
   96125         A     Cognitive test by hc pro                             35.27           35.82          34.42           34.69
   92597         A     Oral speech device eval                              34.34           34.87          33.51           33.78
   97762         A     C/o for orthotic/prosth use                          32.18           32.67          31.40           31.65
   92526         A     Oral function therapy                                31.87           32.36          31.10           31.34
   97001         A     Pt evaluation                                        28.16           28.59          27.47           27.69
   97004         A     Ot re-evaluation                                     26.61           27.02          25.96           26.17
   92507         A     Speech/hearing therapy                               25.68           26.08          25.06           25.26
   97113         A     Aquatic therapy/exercises                            23.21           23.56          22.64           22.82
   97033         A     Electric current therapy                             19.49           19.79          19.02           19.17
   97036         A     Hydrotherapy                                         19.18           19.48          18.72           18.87
   97760         A     Orthotic mgmt and training                           18.56           18.85          18.11           18.26
   97002         A     Pt re-evaluation                                     17.64           17.91          17.21           17.34
   97530         A     Therapeutic activities                               16.71           16.97          16.30           16.43
   97535         A     Self care mngment training                           16.09           16.34          15.70           15.82
   97112         A     Neuromuscular reeducation                            14.85           15.08          14.49           14.61
   97750         A     Physical performance test                            14.54           14.77          14.19           14.30
   97022         A     Whirlpool therapy                                    14.54           14.77          14.19           14.30
   97761         A     Prosthetic training                                  14.23           14.45          13.89           14.00
   97110         A     Therapeutic exercises                                13.61           13.82          13.28           13.39
   97542         A     Wheelchair mngment training                          12.69           12.88          12.38           12.48
   97140         A     Manual therapy                                       12.38           12.57          12.08           12.17
   97537         A     Community/work reintegration                         12.07           12.25          11.77           11.87
   97116         A     Gait training therapy                                12.07           12.25          11.77           11.87
   97533         A     Sensory integration                                  11.76           11.94          11.47           11.56
   97755         A     Assistive technology assess                          11.76           11.94          11.47           11.56
   97124         A     Massage therapy                                      11.76           11.94          11.47           11.56
   97016         A     Vasopneumatic device therapy                         10.83           11.00          10.57           10.65
   92508         A     Speech/hearing therapy                                9.90           10.05           9.66            9.74
   97150         A     Group therapeutic procedures                          9.28            9.43           9.06            9.13
   97032         A     Electrical stimulation                                8.66            8.80           8.45            8.52
   97034         A     Contrast bath therapy                                 8.66            8.80           8.45            8.52
   97018         A     Paraffin bath therapy                                 7.12            7.23           6.94            7.00
   G0329         A     Electromagntic tx for ulcers                          6.81            6.91           6.64            6.69
   97012         A     Mechanical traction therapy                           6.19            6.28           6.04            6.09
   G0281         A     Elec stim unattend for press                          6.19            6.28           6.04            6.09
   G0283         A     Elec stim other than wound                            6.19            6.28           6.04            6.09
   97035         A     Ultrasound therapy                                    4.33            4.40           4.23            4.26
   97024         A     Diathermy eg microwave                                3.71            3.77           3.62            3.65
   97028         A     Ultraviolet therapy                                   3.71            3.77           3.62            3.65
   97026         R     Infrared therapy                                      3.09            3.14           3.02            3.04

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        105 of 121
                                                                                                                          8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                                          New Orleans,        Rest of         Southern
  Code        Status            Short Description              Kentucky                LA             Louisiana         Maine
                                                                 00660                 00528            00528            14102
                                                                     00                 01               99               03
   92506         A     Speech/hearing evaluation                          117.10             131.22           117.91           137.68
   92607         A     Ex for speech device rx 1hr                         66.41              74.41            66.87            78.07
   92609         A     Use of speech device service                        41.51              46.51            41.79            48.80
   97003         A     Ot evaluation                                       34.69              38.87            34.93            40.78
   96125         A     Cognitive test by hc pro                            33.80              37.87            34.03            39.73
   92597         A     Oral speech device eval                             32.91              36.87            33.13            38.69
   97762         A     C/o for orthotic/prosth use                         30.83              34.55            31.05            36.25
   92526         A     Oral function therapy                               30.54              34.22            30.75            35.90
   97001         A     Pt evaluation                                       26.98              30.23            27.16            31.72
   97004         A     Ot re-evaluation                                    25.50              28.57            25.67            29.97
   92507         A     Speech/hearing therapy                              24.61              27.57            24.78            28.93
   97113         A     Aquatic therapy/exercises                           22.24              24.92            22.39            26.14
   97033         A     Electric current therapy                            18.68              20.93            18.81            21.96
   97036         A     Hydrotherapy                                        18.38              20.60            18.51            21.61
   97760         A     Orthotic mgmt and training                          17.79              19.93            17.91            20.91
   97002         A     Pt re-evaluation                                    16.90              18.94            17.02            19.87
   97530         A     Therapeutic activities                              16.01              17.94            16.12            18.82
   97535         A     Self care mngment training                          15.42              17.27            15.52            18.12
   97112         A     Neuromuscular reeducation                           14.23              15.95            14.33            16.73
   97750         A     Physical performance test                           13.93              15.61            14.03            16.38
   97022         A     Whirlpool therapy                                   13.93              15.61            14.03            16.38
   97761         A     Prosthetic training                                 13.64              15.28            13.73            16.03
   97110         A     Therapeutic exercises                               13.04              14.62            13.13            15.34
   97542         A     Wheelchair mngment training                         12.16              13.62            12.24            14.29
   97140         A     Manual therapy                                      11.86              13.29            11.94            13.94
   97537         A     Community/work reintegration                        11.56              12.96            11.64            13.59
   97116         A     Gait training therapy                               11.56              12.96            11.64            13.59
   97533         A     Sensory integration                                 11.27              12.62            11.34            13.24
   97755         A     Assistive technology assess                         11.27              12.62            11.34            13.24
   97124         A     Massage therapy                                     11.27              12.62            11.34            13.24
   97016         A     Vasopneumatic device therapy                        10.38              11.63            10.45            12.20
   92508         A     Speech/hearing therapy                               9.49              10.63             9.55            11.15
   97150         A     Group therapeutic procedures                         8.89               9.97             8.96            10.46
   97032         A     Electrical stimulation                               8.30               9.30             8.36             9.76
   97034         A     Contrast bath therapy                                8.30               9.30             8.36             9.76
   97018         A     Paraffin bath therapy                                6.82               7.64             6.87             8.02
   G0329         A     Electromagntic tx for ulcers                         6.52               7.31             6.57             7.67
   97012         A     Mechanical traction therapy                          5.93               6.64             5.97             6.97
   G0281         A     Elec stim unattend for press                         5.93               6.64             5.97             6.97
   G0283         A     Elec stim other than wound                           5.93               6.64             5.97             6.97
   97035         A     Ultrasound therapy                                   4.15               4.65             4.18             4.88
   97024         A     Diathermy eg microwave                               3.56               3.99             3.58             4.18
   97028         A     Ultraviolet therapy                                  3.56               3.99             3.58             4.18
   97026         R     Infrared therapy                                     2.96               3.32             2.99             3.49

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        106 of 121
                                                                                                                            8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                                          Baltimore/Surr.      Rest of         Metropolitan
  Code        Status            Short Description              Rest of Maine         Cntys, MD         Maryland           Boston
                                                                   14102                12302            12302             14202
                                                                     99                  01               99                 01
   92506         A     Speech/hearing evaluation                          121.54              147.49           139.15             154.48
   92607         A     Ex for speech device rx 1hr                         68.92               83.64            78.91              87.60
   92609         A     Use of speech device service                        43.08               52.27            49.32              54.75
   97003         A     Ot evaluation                                       36.00               43.69            41.22              45.76
   96125         A     Cognitive test by hc pro                            35.08               42.57            40.16              44.58
   92597         A     Oral speech device eval                             34.15               41.45            39.10              43.41
   97762         A     C/o for orthotic/prosth use                         32.00               38.83            36.64              40.67
   92526         A     Oral function therapy                               31.69               38.46            36.29              40.28
   97001         A     Pt evaluation                                       28.00               33.98            32.06              35.59
   97004         A     Ot re-evaluation                                    26.46               32.11            30.30              33.63
   92507         A     Speech/hearing therapy                              25.54               30.99            29.24              32.46
   97113         A     Aquatic therapy/exercises                           23.08               28.00            26.42              29.33
   97033         A     Electric current therapy                            19.39               23.52            22.19              24.64
   97036         A     Hydrotherapy                                        19.08               23.15            21.84              24.25
   97760         A     Orthotic mgmt and training                          18.46               22.40            21.14              23.47
   97002         A     Pt re-evaluation                                    17.54               21.28            20.08              22.29
   97530         A     Therapeutic activities                              16.62               20.16            19.02              21.12
   97535         A     Self care mngment training                          16.00               19.42            18.32              20.34
   97112         A     Neuromuscular reeducation                           14.77               17.92            16.91              18.77
   97750         A     Physical performance test                           14.46               17.55            16.56              18.38
   97022         A     Whirlpool therapy                                   14.46               17.55            16.56              18.38
   97761         A     Prosthetic training                                 14.15               17.18            16.21              17.99
   97110         A     Therapeutic exercises                               13.54               16.43            15.50              17.21
   97542         A     Wheelchair mngment training                         12.62               15.31            14.44              16.03
   97140         A     Manual therapy                                      12.31               14.94            14.09              15.64
   97537         A     Community/work reintegration                        12.00               14.56            13.74              15.25
   97116         A     Gait training therapy                               12.00               14.56            13.74              15.25
   97533         A     Sensory integration                                 11.69               14.19            13.39              14.86
   97755         A     Assistive technology assess                         11.69               14.19            13.39              14.86
   97124         A     Massage therapy                                     11.69               14.19            13.39              14.86
   97016         A     Vasopneumatic device therapy                        10.77               13.07            12.33              13.69
   92508         A     Speech/hearing therapy                               9.85               11.95            11.27              12.51
   97150         A     Group therapeutic procedures                         9.23               11.20            10.57              11.73
   97032         A     Electrical stimulation                               8.62               10.45             9.86              10.95
   97034         A     Contrast bath therapy                                8.62               10.45             9.86              10.95
   97018         A     Paraffin bath therapy                                7.08                8.59             8.10               9.00
   G0329         A     Electromagntic tx for ulcers                         6.77                8.21             7.75               8.60
   97012         A     Mechanical traction therapy                          6.15                7.47             7.05               7.82
   G0281         A     Elec stim unattend for press                         6.15                7.47             7.05               7.82
   G0283         A     Elec stim other than wound                           6.15                7.47             7.05               7.82
   97035         A     Ultrasound therapy                                   4.31                5.23             4.93               5.48
   97024         A     Diathermy eg microwave                               3.69                4.48             4.23               4.69
   97028         A     Ultraviolet therapy                                  3.69                4.48             4.23               4.69
   97026         R     Infrared therapy                                     3.08                3.73             3.52               3.91

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        107 of 121
                                                                                                                       8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                         Rest of                              Rest of
  Code        Status            Short Description              Massachusetts        Detroit, MI       Michigan
                                                                     14202             00953            00953
                                                                      99                01               99
   92506         A     Speech/hearing evaluation                           142.78            137.54           124.10
   92607         A     Ex for speech device rx 1hr                          80.97             78.00            70.37
   92609         A     Use of speech device service                         50.61             48.75            43.98
   97003         A     Ot evaluation                                        42.29             40.74            36.76
   96125         A     Cognitive test by hc pro                             41.21             39.70            35.82
   92597         A     Oral speech device eval                              40.12             38.65            34.87
   97762         A     C/o for orthotic/prosth use                          37.59             36.21            32.67
   92526         A     Oral function therapy                                37.23             35.87            32.36
   97001         A     Pt evaluation                                        32.89             31.69            28.59
   97004         A     Ot re-evaluation                                     31.09             29.95            27.02
   92507         A     Speech/hearing therapy                               30.00             28.90            26.08
   97113         A     Aquatic therapy/exercises                            27.11             26.12            23.56
   97033         A     Electric current therapy                             22.77             21.94            19.79
   97036         A     Hydrotherapy                                         22.41             21.59            19.48
   97760         A     Orthotic mgmt and training                           21.69             20.89            18.85
   97002         A     Pt re-evaluation                                     20.60             19.85            17.91
   97530         A     Therapeutic activities                               19.52             18.80            16.97
   97535         A     Self care mngment training                           18.80             18.11            16.34
   97112         A     Neuromuscular reeducation                            17.35             16.71            15.08
   97750         A     Physical performance test                            16.99             16.37            14.77
   97022         A     Whirlpool therapy                                    16.99             16.37            14.77
   97761         A     Prosthetic training                                  16.63             16.02            14.45
   97110         A     Therapeutic exercises                                15.91             15.32            13.82
   97542         A     Wheelchair mngment training                          14.82             14.28            12.88
   97140         A     Manual therapy                                       14.46             13.93            12.57
   97537         A     Community/work reintegration                         14.10             13.58            12.25
   97116         A     Gait training therapy                                14.10             13.58            12.25
   97533         A     Sensory integration                                  13.74             13.23            11.94
   97755         A     Assistive technology assess                          13.74             13.23            11.94
   97124         A     Massage therapy                                      13.74             13.23            11.94
   97016         A     Vasopneumatic device therapy                         12.65             12.19            11.00
   92508         A     Speech/hearing therapy                               11.57             11.14            10.05
   97150         A     Group therapeutic procedures                         10.84             10.45             9.43
   97032         A     Electrical stimulation                               10.12              9.75             8.80
   97034         A     Contrast bath therapy                                10.12              9.75             8.80
   97018         A     Paraffin bath therapy                                 8.31              8.01             7.23
   G0329         A     Electromagntic tx for ulcers                          7.95              7.66             6.91
   97012         A     Mechanical traction therapy                           7.23              6.96             6.28
   G0281         A     Elec stim unattend for press                          7.23              6.96             6.28
   G0283         A     Elec stim other than wound                            7.23              6.96             6.28
   97035         A     Ultrasound therapy                                    5.06              4.87             4.40
   97024         A     Diathermy eg microwave                                4.34              4.18             3.77
   97028         A     Ultraviolet therapy                                   4.34              4.18             3.77
   97026         R     Infrared therapy                                      3.61              3.48             3.14

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        108 of 121
                                                                                                                             8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING
                                                                                                                        Metropolitan
CPT/HCPCS                                                                                            Metropolitan       Kansas City,
  Code        Status            Short Description              Minnesota           Mississippi       St. Louis, MO          MO
                                                                 00954                00512              05302             05302
                                                                     00                00                 01                 02
   92506         A     Speech/hearing evaluation                          136.06            116.43             129.61             128.13
   92607         A     Ex for speech device rx 1hr                         77.16             66.03              73.50              72.66
   92609         A     Use of speech device service                        48.22             41.27              45.94              45.41
   97003         A     Ot evaluation                                       40.30             34.49              38.39              37.95
   96125         A     Cognitive test by hc pro                            39.27             33.60              37.41              36.98
   92597         A     Oral speech device eval                             38.24             32.72              36.42              36.01
   97762         A     C/o for orthotic/prosth use                         35.82             30.66              34.12              33.74
   92526         A     Oral function therapy                               35.48             30.36              33.80              33.41
   97001         A     Pt evaluation                                       31.35             26.82              29.86              29.52
   97004         A     Ot re-evaluation                                    29.62             25.35              28.22              27.90
   92507         A     Speech/hearing therapy                              28.59             24.47              27.23              26.92
   97113         A     Aquatic therapy/exercises                           25.83             22.11              24.61              24.33
   97033         A     Electric current therapy                            21.70             18.57              20.67              20.44
   97036         A     Hydrotherapy                                        21.36             18.28              20.34              20.11
   97760         A     Orthotic mgmt and training                          20.67             17.69              19.69              19.46
   97002         A     Pt re-evaluation                                    19.63             16.80              18.70              18.49
   97530         A     Therapeutic activities                              18.60             15.92              17.72              17.52
   97535         A     Self care mngment training                          17.91             15.33              17.06              16.87
   97112         A     Neuromuscular reeducation                           16.53             14.15              15.75              15.57
   97750         A     Physical performance test                           16.19             13.85              15.42              15.25
   97022         A     Whirlpool therapy                                   16.19             13.85              15.42              15.25
   97761         A     Prosthetic training                                 15.85             13.56              15.09              14.92
   97110         A     Therapeutic exercises                               15.16             12.97              14.44              14.27
   97542         A     Wheelchair mngment training                         14.12             12.09              13.45              13.30
   97140         A     Manual therapy                                      13.78             11.79              13.12              12.98
   97537         A     Community/work reintegration                        13.43             11.50              12.80              12.65
   97116         A     Gait training therapy                               13.43             11.50              12.80              12.65
   97533         A     Sensory integration                                 13.09             11.20              12.47              12.33
   97755         A     Assistive technology assess                         13.09             11.20              12.47              12.33
   97124         A     Massage therapy                                     13.09             11.20              12.47              12.33
   97016         A     Vasopneumatic device therapy                        12.06             10.32              11.48              11.35
   92508         A     Speech/hearing therapy                              11.02              9.43              10.50              10.38
   97150         A     Group therapeutic procedures                        10.33              8.84               9.84               9.73
   97032         A     Electrical stimulation                               9.64              8.25               9.19               9.08
   97034         A     Contrast bath therapy                                9.64              8.25               9.19               9.08
   97018         A     Paraffin bath therapy                                7.92              6.78               7.55               7.46
   G0329         A     Electromagntic tx for ulcers                         7.58              6.48               7.22               7.14
   97012         A     Mechanical traction therapy                          6.89              5.90               6.56               6.49
   G0281         A     Elec stim unattend for press                         6.89              5.90               6.56               6.49
   G0283         A     Elec stim other than wound                           6.89              5.90               6.56               6.49
   97035         A     Ultrasound therapy                                   4.82              4.13               4.59               4.54
   97024         A     Diathermy eg microwave                               4.13              3.54               3.94               3.89
   97028         A     Ultraviolet therapy                                  4.13              3.54               3.94               3.89
   97026         R     Infrared therapy                                     3.44              2.95               3.28               3.24

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        109 of 121
                                                                                                                      8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                       Rest of
  Code        Status            Short Description              Missouri*           Montana         Nebraska         Nevada
                                                                 05302              03202            05402           01302
                                                                     99              01               00              00
   92506         A     Speech/hearing evaluation                          114.42          134.45           121.54          142.25
   92607         A     Ex for speech device rx 1hr                         64.88           76.24            68.92           80.67
   92609         A     Use of speech device service                        40.55           47.65            43.08           50.42
   97003         A     Ot evaluation                                       33.89           39.82            36.00           42.13
   96125         A     Cognitive test by hc pro                            33.02           38.80            35.08           41.05
   92597         A     Oral speech device eval                             32.15           37.78            34.15           39.97
   97762         A     C/o for orthotic/prosth use                         30.12           35.40            32.00           37.45
   92526         A     Oral function therapy                               29.83           35.06            31.69           37.09
   97001         A     Pt evaluation                                       26.36           30.97            28.00           32.77
   97004         A     Ot re-evaluation                                    24.91           29.27            26.46           30.97
   92507         A     Speech/hearing therapy                              24.04           28.25            25.54           29.89
   97113         A     Aquatic therapy/exercises                           21.72           25.53            23.08           27.01
   97033         A     Electric current therapy                            18.25           21.44            19.39           22.69
   97036         A     Hydrotherapy                                        17.96           21.10            19.08           22.33
   97760         A     Orthotic mgmt and training                          17.38           20.42            18.46           21.61
   97002         A     Pt re-evaluation                                    16.51           19.40            17.54           20.53
   97530         A     Therapeutic activities                              15.64           18.38            16.62           19.45
   97535         A     Self care mngment training                          15.06           17.70            16.00           18.73
   97112         A     Neuromuscular reeducation                           13.90           16.34            14.77           17.29
   97750         A     Physical performance test                           13.61           16.00            14.46           16.93
   97022         A     Whirlpool therapy                                   13.61           16.00            14.46           16.93
   97761         A     Prosthetic training                                 13.32           15.66            14.15           16.57
   97110         A     Therapeutic exercises                               12.75           14.98            13.54           15.85
   97542         A     Wheelchair mngment training                         11.88           13.96            12.62           14.76
   97140         A     Manual therapy                                      11.59           13.62            12.31           14.40
   97537         A     Community/work reintegration                        11.30           13.27            12.00           14.04
   97116         A     Gait training therapy                               11.30           13.27            12.00           14.04
   97533         A     Sensory integration                                 11.01           12.93            11.69           13.68
   97755         A     Assistive technology assess                         11.01           12.93            11.69           13.68
   97124         A     Massage therapy                                     11.01           12.93            11.69           13.68
   97016         A     Vasopneumatic device therapy                        10.14           11.91            10.77           12.60
   92508         A     Speech/hearing therapy                               9.27           10.89             9.85           11.52
   97150         A     Group therapeutic procedures                         8.69           10.21             9.23           10.80
   97032         A     Electrical stimulation                               8.11            9.53             8.62           10.08
   97034         A     Contrast bath therapy                                8.11            9.53             8.62           10.08
   97018         A     Paraffin bath therapy                                6.66            7.83             7.08            8.28
   G0329         A     Electromagntic tx for ulcers                         6.37            7.49             6.77            7.92
   97012         A     Mechanical traction therapy                          5.79            6.81             6.15            7.20
   G0281         A     Elec stim unattend for press                         5.79            6.81             6.15            7.20
   G0283         A     Elec stim other than wound                           5.79            6.81             6.15            7.20
   97035         A     Ultrasound therapy                                   4.06            4.77             4.31            5.04
   97024         A     Diathermy eg microwave                               3.48            4.08             3.69            4.32
   97028         A     Ultraviolet therapy                                  3.48            4.08             3.69            4.32
   97026         R     Infrared therapy                                     2.90            3.40             3.08            3.60

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        110 of 121
                                                                                                                           8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                        New                                 Rest of New
  Code        Status            Short Description              Hampshire           Northern NJ         Jersey          New Mexico
                                                                 14302                12402             12402             04202
                                                                     40                01                99                05
   92506         A     Speech/hearing evaluation                          140.36            159.46            151.39            123.15
   92607         A     Ex for speech device rx 1hr                         79.60             90.43             85.85             69.84
   92609         A     Use of speech device service                        49.75             56.52             53.66             43.65
   97003         A     Ot evaluation                                       41.58             47.23             44.84             36.48
   96125         A     Cognitive test by hc pro                            40.51             46.02             43.69             35.54
   92597         A     Oral speech device eval                             39.44             44.81             42.54             34.61
   97762         A     C/o for orthotic/prosth use                         36.96             41.98             39.86             32.43
   92526         A     Oral function therapy                               36.60             41.58             39.48             32.11
   97001         A     Pt evaluation                                       32.34             36.74             34.88             28.37
   97004         A     Ot re-evaluation                                    30.56             34.72             32.96             26.81
   92507         A     Speech/hearing therapy                              29.49             33.51             31.81             25.88
   97113         A     Aquatic therapy/exercises                           26.65             30.28             28.74             23.38
   97033         A     Electric current therapy                            22.39             25.43             24.15             19.64
   97036         A     Hydrotherapy                                        22.03             25.03             23.76             19.33
   97760         A     Orthotic mgmt and training                          21.32             24.22             23.00             18.71
   97002         A     Pt re-evaluation                                    20.26             23.01             21.85             17.77
   97530         A     Therapeutic activities                              19.19             21.80             20.70             16.84
   97535         A     Self care mngment training                          18.48             20.99             19.93             16.21
   97112         A     Neuromuscular reeducation                           17.06             19.38             18.40             14.97
   97750         A     Physical performance test                           16.70             18.97             18.01             14.65
   97022         A     Whirlpool therapy                                   16.70             18.97             18.01             14.65
   97761         A     Prosthetic training                                 16.35             18.57             17.63             14.34
   97110         A     Therapeutic exercises                               15.64             17.76             16.86             13.72
   97542         A     Wheelchair mngment training                         14.57             16.55             15.71             12.78
   97140         A     Manual therapy                                      14.21             16.15             15.33             12.47
   97537         A     Community/work reintegration                        13.86             15.74             14.95             12.16
   97116         A     Gait training therapy                               13.86             15.74             14.95             12.16
   97533         A     Sensory integration                                 13.50             15.34             14.56             11.85
   97755         A     Assistive technology assess                         13.50             15.34             14.56             11.85
   97124         A     Massage therapy                                     13.50             15.34             14.56             11.85
   97016         A     Vasopneumatic device therapy                        12.44             14.13             13.41             10.91
   92508         A     Speech/hearing therapy                              11.37             12.92             12.26              9.98
   97150         A     Group therapeutic procedures                        10.66             12.11             11.50              9.35
   97032         A     Electrical stimulation                               9.95             11.30             10.73              8.73
   97034         A     Contrast bath therapy                                9.95             11.30             10.73              8.73
   97018         A     Paraffin bath therapy                                8.17              9.28              8.82              7.17
   G0329         A     Electromagntic tx for ulcers                         7.82              8.88              8.43              6.86
   97012         A     Mechanical traction therapy                          7.11              8.07              7.67              6.24
   G0281         A     Elec stim unattend for press                         7.11              8.07              7.67              6.24
   G0283         A     Elec stim other than wound                           7.11              8.07              7.67              6.24
   97035         A     Ultrasound therapy                                   4.97              5.65              5.37              4.36
   97024         A     Diathermy eg microwave                               4.26              4.84              4.60              3.74
   97028         A     Ultraviolet therapy                                  4.26              4.84              4.60              3.74
   97026         R     Infrared therapy                                     3.55              4.04              3.83              3.12

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        111 of 121
                                                                                                                     8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING
                                                                                 NYC      Poughkpsie/N
CPT/HCPCS                                                                    Suburbs/Long NYC Suburbs,           Rest of New
  Code        Status            Short Description              Manhattan, NY    I., NY        NY                    York
                                                                   13202           13202          13202             13282
                                                                     01             02             03                99
   92506         A     Speech/hearing evaluation                          156.23         162.95         143.19            126.25
   92607         A     Ex for speech device rx 1hr                         88.60          92.41          81.20             71.59
   92609         A     Use of speech device service                        55.37          57.75          50.75             44.75
   97003         A     Ot evaluation                                       46.28          48.27          42.41             37.39
   96125         A     Cognitive test by hc pro                            45.09          47.03          41.33             36.44
   92597         A     Oral speech device eval                             43.90          45.79          40.24             35.48
   97762         A     C/o for orthotic/prosth use                         41.13          42.90          37.70             33.24
   92526         A     Oral function therapy                               40.74          42.49          37.34             32.92
   97001         A     Pt evaluation                                       35.99          37.54          32.99             29.08
   97004         A     Ot re-evaluation                                    34.01          35.48          31.18             27.49
   92507         A     Speech/hearing therapy                              32.83          34.24          30.09             26.53
   97113         A     Aquatic therapy/exercises                           29.66          30.94          27.19             23.97
   97033         A     Electric current therapy                            24.92          25.99          22.84             20.14
   97036         A     Hydrotherapy                                        24.52          25.58          22.48             19.82
   97760         A     Orthotic mgmt and training                          23.73          24.75          21.75             19.18
   97002         A     Pt re-evaluation                                    22.54          23.51          20.66             18.22
   97530         A     Therapeutic activities                              21.36          22.28          19.58             17.26
   97535         A     Self care mngment training                          20.57          21.45          18.85             16.62
   97112         A     Neuromuscular reeducation                           18.98          19.80          17.40             15.34
   97750         A     Physical performance test                           18.59          19.39          17.04             15.02
   97022         A     Whirlpool therapy                                   18.59          19.39          17.04             15.02
   97761         A     Prosthetic training                                 18.19          18.98          16.68             14.70
   97110         A     Therapeutic exercises                               17.40          18.15          15.95             14.06
   97542         A     Wheelchair mngment training                         16.22          16.91          14.86             13.10
   97140         A     Manual therapy                                      15.82          16.50          14.50             12.78
   97537         A     Community/work reintegration                        15.43          16.09          14.14             12.46
   97116         A     Gait training therapy                               15.43          16.09          14.14             12.46
   97533         A     Sensory integration                                 15.03          15.68          13.78             12.15
   97755         A     Assistive technology assess                         15.03          15.68          13.78             12.15
   97124         A     Massage therapy                                     15.03          15.68          13.78             12.15
   97016         A     Vasopneumatic device therapy                        13.84          14.44          12.69             11.19
   92508         A     Speech/hearing therapy                              12.66          13.20          11.60             10.23
   97150         A     Group therapeutic procedures                        11.87          12.38          10.88              9.59
   97032         A     Electrical stimulation                              11.07          11.55          10.15              8.95
   97034         A     Contrast bath therapy                               11.07          11.55          10.15              8.95
   97018         A     Paraffin bath therapy                                9.10           9.49           8.34              7.35
   G0329         A     Electromagntic tx for ulcers                         8.70           9.08           7.98              7.03
   97012         A     Mechanical traction therapy                          7.91           8.25           7.25              6.39
   G0281         A     Elec stim unattend for press                         7.91           8.25           7.25              6.39
   G0283         A     Elec stim other than wound                           7.91           8.25           7.25              6.39
   97035         A     Ultrasound therapy                                   5.54           5.78           5.08              4.47
   97024         A     Diathermy eg microwave                               4.75           4.95           4.35              3.84
   97028         A     Ultraviolet therapy                                  4.75           4.95           4.35              3.84
   97026         R     Infrared therapy                                     3.96           4.13           3.63              3.20

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        112 of 121
                                                                                                                      8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS
  Code        Status            Short Description              Queens, NY          North Carolina North Dakota       Ohio
                                                                  13292                05535          03302          00883
                                                                     04                 00             01             00
   92506         A     Speech/hearing evaluation                          160.67             124.63         134.45         124.63
   92607         A     Ex for speech device rx 1hr                         91.11              70.68          76.24          70.68
   92609         A     Use of speech device service                        56.94              44.17          47.65          44.17
   97003         A     Ot evaluation                                       47.59              36.92          39.82          36.92
   96125         A     Cognitive test by hc pro                            46.37              35.97          38.80          35.97
   92597         A     Oral speech device eval                             45.15              35.02          37.78          35.02
   97762         A     C/o for orthotic/prosth use                         42.30              32.81          35.40          32.81
   92526         A     Oral function therapy                               41.90              32.50          35.06          32.50
   97001         A     Pt evaluation                                       37.01              28.71          30.97          28.71
   97004         A     Ot re-evaluation                                    34.98              27.14          29.27          27.14
   92507         A     Speech/hearing therapy                              33.76              26.19          28.25          26.19
   97113         A     Aquatic therapy/exercises                           30.51              23.66          25.53          23.66
   97033         A     Electric current therapy                            25.63              19.88          21.44          19.88
   97036         A     Hydrotherapy                                        25.22              19.56          21.10          19.56
   97760         A     Orthotic mgmt and training                          24.40              18.93          20.42          18.93
   97002         A     Pt re-evaluation                                    23.18              17.99          19.40          17.99
   97530         A     Therapeutic activities                              21.96              17.04          18.38          17.04
   97535         A     Self care mngment training                          21.15              16.41          17.70          16.41
   97112         A     Neuromuscular reeducation                           19.52              15.15          16.34          15.15
   97750         A     Physical performance test                           19.12              14.83          16.00          14.83
   97022         A     Whirlpool therapy                                   19.12              14.83          16.00          14.83
   97761         A     Prosthetic training                                 18.71              14.51          15.66          14.51
   97110         A     Therapeutic exercises                               17.90              13.88          14.98          13.88
   97542         A     Wheelchair mngment training                         16.68              12.94          13.96          12.94
   97140         A     Manual therapy                                      16.27              12.62          13.62          12.62
   97537         A     Community/work reintegration                        15.86              12.31          13.27          12.31
   97116         A     Gait training therapy                               15.86              12.31          13.27          12.31
   97533         A     Sensory integration                                 15.46              11.99          12.93          11.99
   97755         A     Assistive technology assess                         15.46              11.99          12.93          11.99
   97124         A     Massage therapy                                     15.46              11.99          12.93          11.99
   97016         A     Vasopneumatic device therapy                        14.24              11.04          11.91          11.04
   92508         A     Speech/hearing therapy                              13.02              10.10          10.89          10.10
   97150         A     Group therapeutic procedures                        12.20               9.47          10.21           9.47
   97032         A     Electrical stimulation                              11.39               8.83           9.53           8.83
   97034         A     Contrast bath therapy                               11.39               8.83           9.53           8.83
   97018         A     Paraffin bath therapy                                9.36               7.26           7.83           7.26
   G0329         A     Electromagntic tx for ulcers                         8.95               6.94           7.49           6.94
   97012         A     Mechanical traction therapy                          8.13               6.31           6.81           6.31
   G0281         A     Elec stim unattend for press                         8.13               6.31           6.81           6.31
   G0283         A     Elec stim other than wound                           8.13               6.31           6.81           6.31
   97035         A     Ultrasound therapy                                   5.69               4.42           4.77           4.42
   97024         A     Diathermy eg microwave                               4.88               3.79           4.08           3.79
   97028         A     Ultraviolet therapy                                  4.88               3.79           4.08           3.79
   97026         R     Infrared therapy                                     4.07               3.16           3.40           3.16

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        113 of 121
                                                                                                                           8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING
                                                                                                                      Metropolitan
CPT/HCPCS                                                                                             Rest of         Philadelphia,
  Code        Status            Short Description              Oklahoma            Portland, OR       Oregon               PA
                                                                 04302                00835            00835              12502
                                                                     00                 01              99                 01
   92506         A     Speech/hearing evaluation                          115.09             140.36          129.34             142.38
   92607         A     Ex for speech device rx 1hr                         65.27              79.60           73.35              80.74
   92609         A     Use of speech device service                        40.79              49.75           45.84              50.46
   97003         A     Ot evaluation                                       34.09              41.58           38.31              42.17
   96125         A     Cognitive test by hc pro                            33.22              40.51           37.33              41.09
   92597         A     Oral speech device eval                             32.34              39.44           36.35              40.01
   97762         A     C/o for orthotic/prosth use                         30.30              36.96           34.05              37.49
   92526         A     Oral function therapy                               30.01              36.60           33.73              37.13
   97001         A     Pt evaluation                                       26.51              32.34           29.80              32.80
   97004         A     Ot re-evaluation                                    25.06              30.56           28.16              31.00
   92507         A     Speech/hearing therapy                              24.18              29.49           27.18              29.92
   97113         A     Aquatic therapy/exercises                           21.85              26.65           24.56              27.03
   97033         A     Electric current therapy                            18.36              22.39           20.63              22.71
   97036         A     Hydrotherapy                                        18.06              22.03           20.30              22.35
   97760         A     Orthotic mgmt and training                          17.48              21.32           19.65              21.63
   97002         A     Pt re-evaluation                                    16.61              20.26           18.66              20.55
   97530         A     Therapeutic activities                              15.73              19.19           17.68              19.46
   97535         A     Self care mngment training                          15.15              18.48           17.03              18.74
   97112         A     Neuromuscular reeducation                           13.99              17.06           15.72              17.30
   97750         A     Physical performance test                           13.69              16.70           15.39              16.94
   97022         A     Whirlpool therapy                                   13.69              16.70           15.39              16.94
   97761         A     Prosthetic training                                 13.40              16.35           15.06              16.58
   97110         A     Therapeutic exercises                               12.82              15.64           14.41              15.86
   97542         A     Wheelchair mngment training                         11.95              14.57           13.43              14.78
   97140         A     Manual therapy                                      11.65              14.21           13.10              14.42
   97537         A     Community/work reintegration                        11.36              13.86           12.77              14.06
   97116         A     Gait training therapy                               11.36              13.86           12.77              14.06
   97533         A     Sensory integration                                 11.07              13.50           12.44              13.70
   97755         A     Assistive technology assess                         11.07              13.50           12.44              13.70
   97124         A     Massage therapy                                     11.07              13.50           12.44              13.70
   97016         A     Vasopneumatic device therapy                        10.20              12.44           11.46              12.62
   92508         A     Speech/hearing therapy                               9.32              11.37           10.48              11.53
   97150         A     Group therapeutic procedures                         8.74              10.66            9.82              10.81
   97032         A     Electrical stimulation                               8.16               9.95            9.17              10.09
   97034         A     Contrast bath therapy                                8.16               9.95            9.17              10.09
   97018         A     Paraffin bath therapy                                6.70               8.17            7.53               8.29
   G0329         A     Electromagntic tx for ulcers                         6.41               7.82            7.20               7.93
   97012         A     Mechanical traction therapy                          5.83               7.11            6.55               7.21
   G0281         A     Elec stim unattend for press                         5.83               7.11            6.55               7.21
   G0283         A     Elec stim other than wound                           5.83               7.11            6.55               7.21
   97035         A     Ultrasound therapy                                   4.08               4.97            4.58               5.05
   97024         A     Diathermy eg microwave                               3.50               4.26            3.93               4.33
   97028         A     Ultraviolet therapy                                  3.50               4.26            3.93               4.33
   97026         R     Infrared therapy                                     2.91               3.55            3.27               3.60

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        114 of 121
                                                                                                                         8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                        Rest of
  Code        Status            Short Description              Pennsylvania        Puerto Rico       Rhode Island South Carolina
                                                                   12502              9202              14402           00880
                                                                     99                20                 01             01
   92506         A     Speech/hearing evaluation                          122.75             91.16             141.44         122.21
   92607         A     Ex for speech device rx 1hr                         69.61             51.69              80.21          69.31
   92609         A     Use of speech device service                        43.51             32.31              50.13          43.32
   97003         A     Ot evaluation                                       36.36             27.00              41.89          36.20
   96125         A     Cognitive test by hc pro                            35.43             26.31              40.82          35.27
   92597         A     Oral speech device eval                             34.49             25.62              39.75          34.34
   97762         A     C/o for orthotic/prosth use                         32.32             24.00              37.24          32.18
   92526         A     Oral function therapy                               32.01             23.77              36.88          31.87
   97001         A     Pt evaluation                                       28.28             21.00              32.58          28.16
   97004         A     Ot re-evaluation                                    26.73             19.85              30.79          26.61
   92507         A     Speech/hearing therapy                              25.79             19.15              29.72          25.68
   97113         A     Aquatic therapy/exercises                           23.31             17.31              26.86          23.21
   97033         A     Electric current therapy                            19.58             14.54              22.56          19.49
   97036         A     Hydrotherapy                                        19.27             14.31              22.20          19.18
   97760         A     Orthotic mgmt and training                          18.65             13.85              21.48          18.56
   97002         A     Pt re-evaluation                                    17.71             13.15              20.41          17.64
   97530         A     Therapeutic activities                              16.78             12.46              19.34          16.71
   97535         A     Self care mngment training                          16.16             12.00              18.62          16.09
   97112         A     Neuromuscular reeducation                           14.92             11.08              17.19          14.85
   97750         A     Physical performance test                           14.61             10.85              16.83          14.54
   97022         A     Whirlpool therapy                                   14.61             10.85              16.83          14.54
   97761         A     Prosthetic training                                 14.30             10.62              16.47          14.23
   97110         A     Therapeutic exercises                               13.67             10.15              15.76          13.61
   97542         A     Wheelchair mngment training                         12.74              9.46              14.68          12.69
   97140         A     Manual therapy                                      12.43              9.23              14.32          12.38
   97537         A     Community/work reintegration                        12.12              9.00              13.96          12.07
   97116         A     Gait training therapy                               12.12              9.00              13.96          12.07
   97533         A     Sensory integration                                 11.81              8.77              13.61          11.76
   97755         A     Assistive technology assess                         11.81              8.77              13.61          11.76
   97124         A     Massage therapy                                     11.81              8.77              13.61          11.76
   97016         A     Vasopneumatic device therapy                        10.88              8.08              12.53          10.83
   92508         A     Speech/hearing therapy                               9.94              7.38              11.46           9.90
   97150         A     Group therapeutic procedures                         9.32              6.92              10.74           9.28
   97032         A     Electrical stimulation                               8.70              6.46              10.03           8.66
   97034         A     Contrast bath therapy                                8.70              6.46              10.03           8.66
   97018         A     Paraffin bath therapy                                7.15              5.31               8.24           7.12
   G0329         A     Electromagntic tx for ulcers                         6.84              5.08               7.88           6.81
   97012         A     Mechanical traction therapy                          6.22              4.62               7.16           6.19
   G0281         A     Elec stim unattend for press                         6.22              4.62               7.16           6.19
   G0283         A     Elec stim other than wound                           6.22              4.62               7.16           6.19
   97035         A     Ultrasound therapy                                   4.35              3.23               5.01           4.33
   97024         A     Diathermy eg microwave                               3.73              2.77               4.30           3.71
   97028         A     Ultraviolet therapy                                  3.73              2.77               4.30           3.71
   97026         R     Infrared therapy                                     3.11              2.31               3.58           3.09

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        115 of 121
                                                                                                                           8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS
  Code        Status            Short Description              South Dakota        Tennessee        Brazoria, TX       Dallas, TX
                                                                   03402             10302             04402             04402
                                                                     02               35                 09                11
   92506         A     Speech/hearing evaluation                          134.45           120.73             132.70            136.73
   92607         A     Ex for speech device rx 1hr                         76.24            68.47              75.25             77.54
   92609         A     Use of speech device service                        47.65            42.79              47.03             48.46
   97003         A     Ot evaluation                                       39.82            35.76              39.31             40.50
   96125         A     Cognitive test by hc pro                            38.80            34.84              38.30             39.46
   92597         A     Oral speech device eval                             37.78            33.93              37.29             38.42
   97762         A     C/o for orthotic/prosth use                         35.40            31.79              34.94             36.00
   92526         A     Oral function therapy                               35.06            31.48              34.60             35.65
   97001         A     Pt evaluation                                       30.97            27.81              30.57             31.50
   97004         A     Ot re-evaluation                                    29.27            26.29              28.89             29.77
   92507         A     Speech/hearing therapy                              28.25            25.37              27.88             28.73
   97113         A     Aquatic therapy/exercises                           25.53            22.92              25.20             25.96
   97033         A     Electric current therapy                            21.44            19.26              21.16             21.81
   97036         A     Hydrotherapy                                        21.10            18.95              20.83             21.46
   97760         A     Orthotic mgmt and training                          20.42            18.34              20.16             20.77
   97002         A     Pt re-evaluation                                    19.40            17.42              19.15             19.73
   97530         A     Therapeutic activities                              18.38            16.51              18.14             18.69
   97535         A     Self care mngment training                          17.70            15.89              17.47             18.00
   97112         A     Neuromuscular reeducation                           16.34            14.67              16.13             16.62
   97750         A     Physical performance test                           16.00            14.37              15.79             16.27
   97022         A     Whirlpool therapy                                   16.00            14.37              15.79             16.27
   97761         A     Prosthetic training                                 15.66            14.06              15.45             15.92
   97110         A     Therapeutic exercises                               14.98            13.45              14.78             15.23
   97542         A     Wheelchair mngment training                         13.96            12.53              13.77             14.19
   97140         A     Manual therapy                                      13.62            12.23              13.44             13.85
   97537         A     Community/work reintegration                        13.27            11.92              13.10             13.50
   97116         A     Gait training therapy                               13.27            11.92              13.10             13.50
   97533         A     Sensory integration                                 12.93            11.61              12.77             13.15
   97755         A     Assistive technology assess                         12.93            11.61              12.77             13.15
   97124         A     Massage therapy                                     12.93            11.61              12.77             13.15
   97016         A     Vasopneumatic device therapy                        11.91            10.70              11.76             12.12
   92508         A     Speech/hearing therapy                              10.89             9.78              10.75             11.08
   97150         A     Group therapeutic procedures                        10.21             9.17              10.08             10.38
   97032         A     Electrical stimulation                               9.53             8.56               9.41              9.69
   97034         A     Contrast bath therapy                                9.53             8.56               9.41              9.69
   97018         A     Paraffin bath therapy                                7.83             7.03               7.73              7.96
   G0329         A     Electromagntic tx for ulcers                         7.49             6.72               7.39              7.62
   97012         A     Mechanical traction therapy                          6.81             6.11               6.72              6.92
   G0281         A     Elec stim unattend for press                         6.81             6.11               6.72              6.92
   G0283         A     Elec stim other than wound                           6.81             6.11               6.72              6.92
   97035         A     Ultrasound therapy                                   4.77             4.28               4.70              4.85
   97024         A     Diathermy eg microwave                               4.08             3.67               4.03              4.15
   97028         A     Ultraviolet therapy                                  4.08             3.67               4.03              4.15
   97026         R     Infrared therapy                                     3.40             3.06               3.36              3.46

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        116 of 121
                                                                                                                         8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS
  Code        Status            Short Description              Galveston, TX       Houston, TX       Beaumont, TX Fort Worth, TX
                                                                   04402              04402              04402          04402
                                                                     15                18                 20             28
   92506         A     Speech/hearing evaluation                          133.91            134.72             120.47         131.63
   92607         A     Ex for speech device rx 1hr                         75.94             76.40              68.31          74.64
   92609         A     Use of speech device service                        47.46             47.75              42.70          46.65
   97003         A     Ot evaluation                                       39.66             39.90              35.68          38.99
   96125         A     Cognitive test by hc pro                            38.65             38.88              34.77          37.99
   92597         A     Oral speech device eval                             37.63             37.86              33.85          36.99
   97762         A     C/o for orthotic/prosth use                         35.26             35.47              31.72          34.66
   92526         A     Oral function therapy                               34.92             35.13              31.41          34.32
   97001         A     Pt evaluation                                       30.85             31.04              27.75          30.32
   97004         A     Ot re-evaluation                                    29.16             29.33              26.23          28.66
   92507         A     Speech/hearing therapy                              28.14             28.31              25.31          27.66
   97113         A     Aquatic therapy/exercises                           25.43             25.58              22.87          24.99
   97033         A     Electric current therapy                            21.36             21.49              19.21          20.99
   97036         A     Hydrotherapy                                        21.02             21.15              18.91          20.66
   97760         A     Orthotic mgmt and training                          20.34             20.46              18.30          19.99
   97002         A     Pt re-evaluation                                    19.32             19.44              17.38          18.99
   97530         A     Therapeutic activities                              18.31             18.42              16.47          17.99
   97535         A     Self care mngment training                          17.63             17.73              15.86          17.33
   97112         A     Neuromuscular reeducation                           16.27             16.37              14.64          15.99
   97750         A     Physical performance test                           15.93             16.03              14.33          15.66
   97022         A     Whirlpool therapy                                   15.93             16.03              14.33          15.66
   97761         A     Prosthetic training                                 15.59             15.69              14.03          15.33
   97110         A     Therapeutic exercises                               14.92             15.01              13.42          14.66
   97542         A     Wheelchair mngment training                         13.90             13.98              12.50          13.66
   97140         A     Manual therapy                                      13.56             13.64              12.20          13.33
   97537         A     Community/work reintegration                        13.22             13.30              11.89          13.00
   97116         A     Gait training therapy                               13.22             13.30              11.89          13.00
   97533         A     Sensory integration                                 12.88             12.96              11.59          12.66
   97755         A     Assistive technology assess                         12.88             12.96              11.59          12.66
   97124         A     Massage therapy                                     12.88             12.96              11.59          12.66
   97016         A     Vasopneumatic device therapy                        11.87             11.94              10.67          11.66
   92508         A     Speech/hearing therapy                              10.85             10.91               9.76          10.66
   97150         A     Group therapeutic procedures                        10.17             10.23               9.15          10.00
   97032         A     Electrical stimulation                               9.49              9.55               8.54           9.33
   97034         A     Contrast bath therapy                                9.49              9.55               8.54           9.33
   97018         A     Paraffin bath therapy                                7.80              7.84               7.01           7.66
   G0329         A     Electromagntic tx for ulcers                         7.46              7.50               6.71           7.33
   97012         A     Mechanical traction therapy                          6.78              6.82               6.10           6.66
   G0281         A     Elec stim unattend for press                         6.78              6.82               6.10           6.66
   G0283         A     Elec stim other than wound                           6.78              6.82               6.10           6.66
   97035         A     Ultrasound therapy                                   4.75              4.77               4.27           4.67
   97024         A     Diathermy eg microwave                               4.07              4.09               3.66           4.00
   97028         A     Ultraviolet therapy                                  4.07              4.09               3.66           4.00
   97026         R     Infrared therapy                                     3.39              3.41               3.05           3.33

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        117 of 121
                                                                                                                       8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS
  Code        Status            Short Description              Austin, TX          Rest of Texas      Utah           Vermont
                                                                 04402                 04402          03502           14502
                                                                     31                 99             09              50
   92506         A     Speech/hearing evaluation                          135.66             122.62         123.15          135.52
   92607         A     Ex for speech device rx 1hr                         76.93              69.53          69.84           76.85
   92609         A     Use of speech device service                        48.08              43.46          43.65           48.03
   97003         A     Ot evaluation                                       40.18              36.32          36.48           40.14
   96125         A     Cognitive test by hc pro                            39.15              35.39          35.54           39.11
   92597         A     Oral speech device eval                             38.12              34.46          34.61           38.08
   97762         A     C/o for orthotic/prosth use                         35.72              32.28          32.43           35.68
   92526         A     Oral function therapy                               35.37              31.97          32.11           35.34
   97001         A     Pt evaluation                                       31.25              28.25          28.37           31.22
   97004         A     Ot re-evaluation                                    29.54              26.70          26.81           29.51
   92507         A     Speech/hearing therapy                              28.51              25.77          25.88           28.48
   97113         A     Aquatic therapy/exercises                           25.76              23.28          23.38           25.73
   97033         A     Electric current therapy                            21.64              19.56          19.64           21.62
   97036         A     Hydrotherapy                                        21.29              19.25          19.33           21.27
   97760         A     Orthotic mgmt and training                          20.61              18.63          18.71           20.59
   97002         A     Pt re-evaluation                                    19.58              17.69          17.77           19.56
   97530         A     Therapeutic activities                              18.55              16.76          16.84           18.53
   97535         A     Self care mngment training                          17.86              16.14          16.21           17.84
   97112         A     Neuromuscular reeducation                           16.49              14.90          14.97           16.47
   97750         A     Physical performance test                           16.14              14.59          14.65           16.13
   97022         A     Whirlpool therapy                                   16.14              14.59          14.65           16.13
   97761         A     Prosthetic training                                 15.80              14.28          14.34           15.78
   97110         A     Therapeutic exercises                               15.11              13.66          13.72           15.10
   97542         A     Wheelchair mngment training                         14.08              12.73          12.78           14.07
   97140         A     Manual therapy                                      13.74              12.42          12.47           13.72
   97537         A     Community/work reintegration                        13.39              12.11          12.16           13.38
   97116         A     Gait training therapy                               13.39              12.11          12.16           13.38
   97533         A     Sensory integration                                 13.05              11.80          11.85           13.04
   97755         A     Assistive technology assess                         13.05              11.80          11.85           13.04
   97124         A     Massage therapy                                     13.05              11.80          11.85           13.04
   97016         A     Vasopneumatic device therapy                        12.02              10.86          10.91           12.01
   92508         A     Speech/hearing therapy                              10.99               9.93           9.98           10.98
   97150         A     Group therapeutic procedures                        10.30               9.31           9.35           10.29
   97032         A     Electrical stimulation                               9.62               8.69           8.73            9.61
   97034         A     Contrast bath therapy                                9.62               8.69           8.73            9.61
   97018         A     Paraffin bath therapy                                7.90               7.14           7.17            7.89
   G0329         A     Electromagntic tx for ulcers                         7.56               6.83           6.86            7.55
   97012         A     Mechanical traction therapy                          6.87               6.21           6.24            6.86
   G0281         A     Elec stim unattend for press                         6.87               6.21           6.24            6.86
   G0283         A     Elec stim other than wound                           6.87               6.21           6.24            6.86
   97035         A     Ultrasound therapy                                   4.81               4.35           4.36            4.80
   97024         A     Diathermy eg microwave                               4.12               3.73           3.74            4.12
   97028         A     Ultraviolet therapy                                  4.12               3.73           3.74            4.12
   97026         R     Infrared therapy                                     3.43               3.10           3.12            3.43

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        118 of 121
                                                                                                                           8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                                                           Seattle (King       Rest of
  Code        Status            Short Description              Virgin Islands      Virginia          Cnty), WA         Washington
                                                                   09202            00904               00836             00836
                                                                     50               00                 02                99
   92506         A     Speech/hearing evaluation                          134.72           131.36             153.81            136.06
   92607         A     Ex for speech device rx 1hr                         76.40            74.49              87.22             77.16
   92609         A     Use of speech device service                        47.75            46.56              54.51             48.22
   97003         A     Ot evaluation                                       39.90            38.91              45.56             40.30
   96125         A     Cognitive test by hc pro                            38.88            37.91              44.39             39.27
   92597         A     Oral speech device eval                             37.86            36.91              43.22             38.24
   97762         A     C/o for orthotic/prosth use                         35.47            34.58              40.50             35.82
   92526         A     Oral function therapy                               35.13            34.25              40.11             35.48
   97001         A     Pt evaluation                                       31.04            30.26              35.43             31.35
   97004         A     Ot re-evaluation                                    29.33            28.60              33.49             29.62
   92507         A     Speech/hearing therapy                              28.31            27.60              32.32             28.59
   97113         A     Aquatic therapy/exercises                           25.58            24.94              29.20             25.83
   97033         A     Electric current therapy                            21.49            20.95              24.53             21.70
   97036         A     Hydrotherapy                                        21.15            20.62              24.14             21.36
   97760         A     Orthotic mgmt and training                          20.46            19.95              23.36             20.67
   97002         A     Pt re-evaluation                                    19.44            18.96              22.20             19.63
   97530         A     Therapeutic activities                              18.42            17.96              21.03             18.60
   97535         A     Self care mngment training                          17.73            17.29              20.25             17.91
   97112         A     Neuromuscular reeducation                           16.37            15.96              18.69             16.53
   97750         A     Physical performance test                           16.03            15.63              18.30             16.19
   97022         A     Whirlpool therapy                                   16.03            15.63              18.30             16.19
   97761         A     Prosthetic training                                 15.69            15.30              17.91             15.85
   97110         A     Therapeutic exercises                               15.01            14.63              17.13             15.16
   97542         A     Wheelchair mngment training                         13.98            13.63              15.96             14.12
   97140         A     Manual therapy                                      13.64            13.30              15.58             13.78
   97537         A     Community/work reintegration                        13.30            12.97              15.19             13.43
   97116         A     Gait training therapy                               13.30            12.97              15.19             13.43
   97533         A     Sensory integration                                 12.96            12.64              14.80             13.09
   97755         A     Assistive technology assess                         12.96            12.64              14.80             13.09
   97124         A     Massage therapy                                     12.96            12.64              14.80             13.09
   97016         A     Vasopneumatic device therapy                        11.94            11.64              13.63             12.06
   92508         A     Speech/hearing therapy                              10.91            10.64              12.46             11.02
   97150         A     Group therapeutic procedures                        10.23             9.98              11.68             10.33
   97032         A     Electrical stimulation                               9.55             9.31              10.90              9.64
   97034         A     Contrast bath therapy                                9.55             9.31              10.90              9.64
   97018         A     Paraffin bath therapy                                7.84             7.65               8.96              7.92
   G0329         A     Electromagntic tx for ulcers                         7.50             7.32               8.57              7.58
   97012         A     Mechanical traction therapy                          6.82             6.65               7.79              6.89
   G0281         A     Elec stim unattend for press                         6.82             6.65               7.79              6.89
   G0283         A     Elec stim other than wound                           6.82             6.65               7.79              6.89
   97035         A     Ultrasound therapy                                   4.77             4.66               5.45              4.82
   97024         A     Diathermy eg microwave                               4.09             3.99               4.67              4.13
   97028         A     Ultraviolet therapy                                  4.09             3.99               4.67              4.13
   97026         R     Infrared therapy                                     3.41             3.33               3.89              3.44

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        119 of 121
                                                                                                                    8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS
  Code        Status            Short Description              West Virginia       Wisconsin        Wyoming
                                                                   00884             00951           03602
                                                                     16               00              21
   92506         A     Speech/hearing evaluation                          111.32           129.07          134.45
   92607         A     Ex for speech device rx 1hr                         63.13            73.19           76.24
   92609         A     Use of speech device service                        39.46            45.75           47.65
   97003         A     Ot evaluation                                       32.97            38.23           39.82
   96125         A     Cognitive test by hc pro                            32.13            37.25           38.80
   92597         A     Oral speech device eval                             31.28            36.27           37.78
   97762         A     C/o for orthotic/prosth use                         29.31            33.98           35.40
   92526         A     Oral function therapy                               29.03            33.66           35.06
   97001         A     Pt evaluation                                       25.65            29.74           30.97
   97004         A     Ot re-evaluation                                    24.24            28.10           29.27
   92507         A     Speech/hearing therapy                              23.39            27.12           28.25
   97113         A     Aquatic therapy/exercises                           21.14            24.51           25.53
   97033         A     Electric current therapy                            17.76            20.59           21.44
   97036         A     Hydrotherapy                                        17.47            20.26           21.10
   97760         A     Orthotic mgmt and training                          16.91            19.61           20.42
   97002         A     Pt re-evaluation                                    16.06            18.63           19.40
   97530         A     Therapeutic activities                              15.22            17.65           18.38
   97535         A     Self care mngment training                          14.66            16.99           17.70
   97112         A     Neuromuscular reeducation                           13.53            15.68           16.34
   97750         A     Physical performance test                           13.25            15.36           16.00
   97022         A     Whirlpool therapy                                   13.25            15.36           16.00
   97761         A     Prosthetic training                                 12.96            15.03           15.66
   97110         A     Therapeutic exercises                               12.40            14.38           14.98
   97542         A     Wheelchair mngment training                         11.56            13.40           13.96
   97140         A     Manual therapy                                      11.27            13.07           13.62
   97537         A     Community/work reintegration                        10.99            12.74           13.27
   97116         A     Gait training therapy                               10.99            12.74           13.27
   97533         A     Sensory integration                                 10.71            12.42           12.93
   97755         A     Assistive technology assess                         10.71            12.42           12.93
   97124         A     Massage therapy                                     10.71            12.42           12.93
   97016         A     Vasopneumatic device therapy                         9.86            11.44           11.91
   92508         A     Speech/hearing therapy                               9.02            10.46           10.89
   97150         A     Group therapeutic procedures                         8.45             9.80           10.21
   97032         A     Electrical stimulation                               7.89             9.15            9.53
   97034         A     Contrast bath therapy                                7.89             9.15            9.53
   97018         A     Paraffin bath therapy                                6.48             7.52            7.83
   G0329         A     Electromagntic tx for ulcers                         6.20             7.19            7.49
   97012         A     Mechanical traction therapy                          5.64             6.54            6.81
   G0281         A     Elec stim unattend for press                         5.64             6.54            6.81
   G0283         A     Elec stim other than wound                           5.64             6.54            6.81
   97035         A     Ultrasound therapy                                   3.95             4.57            4.77
   97024         A     Diathermy eg microwave                               3.38             3.92            4.08
   97028         A     Ultraviolet therapy                                  3.38             3.92            4.08
   97026         R     Infrared therapy                                     2.82             3.27            3.40

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        120 of 121
                                                                                   8/14/2012


       2012 MEDICARE PART B FEE SCHEDULE
 "ALWAYS THERAPY" SERVICES SUBJECT TO THE MPPR
                     POLICY
        PE COMPONENT PAYMENT RANKING

CPT/HCPCS                                                      Payment     PE
  Code        Status            Short Description              Ranking   Ranking


   92506         A     Speech/hearing evaluation                92506    92506
   92607         A     Ex for speech device rx 1hr              92607    92607
   92609         A     Use of speech device service             92609    92609
   97003         A     Ot evaluation                            97003    97003
   96125         A     Cognitive test by hc pro                 96125    96125
   92597         A     Oral speech device eval                  92597    92597
   97762         A     C/o for orthotic/prosth use              97762    97762
   92526         A     Oral function therapy                    92526    92526
   97001         A     Pt evaluation                            97001    97001
   97004         A     Ot re-evaluation                         97004    97004
   92507         A     Speech/hearing therapy                   92507    92507
   97113         A     Aquatic therapy/exercises                97113    97113
   97033         A     Electric current therapy                 97033    97033
   97036         A     Hydrotherapy                             97036    97036
   97760         A     Orthotic mgmt and training               97760    97760
   97002         A     Pt re-evaluation                         97002    97002
   97530         A     Therapeutic activities                   97530    97530
   97535         A     Self care mngment training               97535    97535
   97112         A     Neuromuscular reeducation                97112    97112
   97750         A     Physical performance test                97750    97750
   97022         A     Whirlpool therapy                        97022    97022
   97761         A     Prosthetic training                      97761    97761
   97110         A     Therapeutic exercises                    97110    97110
   97542         A     Wheelchair mngment training              97542    97542
   97140         A     Manual therapy                           97140    97140
   97537         A     Community/work reintegration             97537    97537
   97116         A     Gait training therapy                    97116    97116
   97533         A     Sensory integration                      97533    97533
   97755         A     Assistive technology assess              97755    97755
   97124         A     Massage therapy                          97124    97124
   97016         A     Vasopneumatic device therapy             97016    97016
   92508         A     Speech/hearing therapy                   92508    92508
   97150         A     Group therapeutic procedures             97150    97150
   97032         A     Electrical stimulation                   97032    97032
   97034         A     Contrast bath therapy                    97034    97034
   97018         A     Paraffin bath therapy                    97018    97018
   G0329         A     Electromagntic tx for ulcers             G0329    G0329
   97012         A     Mechanical traction therapy              97012    97012
   G0281         A     Elec stim unattend for press             G0281    G0281
   G0283         A     Elec stim other than wound               G0283    G0283
   97035         A     Ultrasound therapy                       97035    97035
   97024         A     Diathermy eg microwave                   97024    97024
   97028         A     Ultraviolet therapy                      97028    97028
   97026         R     Infrared therapy                         97026    97026

Conversion Factor                                   $34.0376
(A2 x B2) x Conversion Factor


                                                        121 of 121

				
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