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apc_fee_schedule12202006

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					State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
00100     Anesth, salivary gland                 N            N          0000       0.0000          0.00         0.00        0.00
00102     Anesth, repair of cleft lip            N            N          0000       0.0000          0.00         0.00        0.00
00103     Anesth, blepharoplasty                 N            N          0000       0.0000          0.00         0.00        0.00
00104     Anesth, electroshock                   N            N          0000       0.0000          0.00         0.00        0.00
00120     Anesth, ear surgery                    N            N          0000       0.0000          0.00         0.00        0.00
00124     Anesth, ear exam                       N            N          0000       0.0000          0.00         0.00        0.00
00126     Anesth, tympanotomy                    N            N          0000       0.0000          0.00         0.00        0.00
00140     Anesth, procedures on eye              N            N          0000       0.0000          0.00         0.00        0.00
00142     Anesth, lens surgery                   N            N          0000       0.0000          0.00         0.00        0.00
00144     Anesth, corneal transplant             N            N          0000       0.0000          0.00         0.00        0.00
00145     Anesth, vitreoretinal surg             N            N          0000       0.0000          0.00         0.00        0.00
00147     Anesth, iridectomy                     N            N          0000       0.0000          0.00         0.00        0.00
00148     Anesth, eye exam                       N            N          0000       0.0000          0.00         0.00        0.00
00160     Anesth, nose/sinus surgery             N            N          0000       0.0000          0.00         0.00        0.00
00162     Anesth, nose/sinus surgery             N            N          0000       0.0000          0.00         0.00        0.00
00164     Anesth, biopsy of nose                 N            N          0000       0.0000          0.00         0.00        0.00
00170     Anesth, procedure on mouth             N            N          0000       0.0000          0.00         0.00        0.00
00172     Anesth, cleft palate repair            N            N          0000       0.0000          0.00         0.00        0.00
00174     Anesth, pharyngeal surgery             N            N          0000       0.0000          0.00         0.00        0.00
00176     Anesth, pharyngeal surgery             C            C          0000       0.0000          0.00         0.00        0.00
00190     Anesth, face/skull bone surg           N            N          0000       0.0000          0.00         0.00        0.00
00192     Anesth, facial bone surgery            C            C          0000       0.0000          0.00         0.00        0.00
00210     Anesth, open head surgery              N            N          0000       0.0000          0.00         0.00        0.00
00212     Anesth, skull drainage                 N            N          0000       0.0000          0.00         0.00        0.00
00214     Anesth, skull drainage                 C            C          0000       0.0000          0.00         0.00        0.00
00215     Anesth, skull repair/fract             C            C          0000       0.0000          0.00         0.00        0.00
00216     Anesth, head vessel surgery            N            N          0000       0.0000          0.00         0.00        0.00
00218     Anesth, special head surgery           N            N          0000       0.0000          0.00         0.00        0.00
00220     Anesth, intrcrn nerve                  N            N          0000       0.0000          0.00         0.00        0.00
00222     Anesth, head nerve surgery             N            N          0000       0.0000          0.00         0.00        0.00
00300     Anesth, head/neck/ptrunk               N            N          0000       0.0000          0.00         0.00        0.00
00320     Anesth, neck organ, 1 & over           N            N          0000       0.0000          0.00         0.00        0.00
00322     Anesth, biopsy of thyroid              N            N          0000       0.0000          0.00         0.00        0.00
00326     Anesth, larynx/trach, < 1 yr           N            N          0000       0.0000          0.00         0.00        0.00
00350     Anesth, neck vessel surgery            N            N          0000       0.0000          0.00         0.00        0.00
00352     Anesth, neck vessel surgery            N            N          0000       0.0000          0.00         0.00        0.00
00400     Anesth, skin, ext/per/atrunk           N            N          0000       0.0000          0.00         0.00        0.00
00402     Anesth, surgery of breast              N            N          0000       0.0000          0.00         0.00        0.00
00404     Anesth, surgery of breast              C            C          0000       0.0000          0.00         0.00        0.00
00406     Anesth, surgery of breast              C            C          0000       0.0000          0.00         0.00        0.00
00410     Anesth, correct heart rhythm           N            N          0000       0.0000          0.00         0.00        0.00
00450     Anesth, surgery of shoulder            N            N          0000       0.0000          0.00         0.00        0.00
00452     Anesth, surgery of shoulder            C            C          0000       0.0000          0.00         0.00        0.00
00454     Anesth, collar bone biopsy             N            N          0000       0.0000          0.00         0.00        0.00
00470     Anesth, removal of rib                 N            N          0000       0.0000          0.00         0.00        0.00
00472     Anesth, chest wall repair              N            N          0000       0.0000          0.00         0.00        0.00
00474     Anesth, surgery of rib(s)              C            C          0000       0.0000          0.00         0.00        0.00
00500     Anesth, esophageal surgery             N            N          0000       0.0000          0.00         0.00        0.00
00520     Anesth, chest procedure                N            N          0000       0.0000          0.00         0.00        0.00
00522     Anesth, chest lining biopsy            N            N          0000       0.0000          0.00         0.00        0.00
00524     Anesth, chest drainage                 C            C          0000       0.0000          0.00         0.00        0.00
00528     Anesth, chest partition view           N            N          0000       0.0000          0.00         0.00        0.00
00529     Anesth, chest partition view           N            N          0000       0.0000          0.00         0.00        0.00
00530     Anesth, pacemaker insertion            N            N          0000       0.0000          0.00         0.00        0.00
00532     Anesth, vascular access                N            N          0000       0.0000          0.00         0.00        0.00
00534     Anesth, cardioverter/defib             N            N          0000       0.0000          0.00         0.00        0.00
00537     Anesth, cardiac electrophys            N            N          0000       0.0000          0.00         0.00        0.00
00539     Anesth, trach-bronch reconst           N            N          0000       0.0000          0.00         0.00        0.00
00540     Anesth, chest surgery                  C            C          0000       0.0000          0.00         0.00        0.00
00541     Anesth, one lung ventilation           N            N          0000       0.0000          0.00         0.00        0.00
00542     Anesth, release of lung                C            C          0000       0.0000          0.00         0.00        0.00
00546     Anesth, lung,chest wall surg           C            C          0000       0.0000          0.00         0.00        0.00
00548     Anesth, trachea,bronchi surg           N            N          0000       0.0000          0.00         0.00        0.00
00550     Anesth, sternal debridement            N            N          0000       0.0000          0.00         0.00        0.00
00560     Anesth, heart surg w/o pump            C            C          0000       0.0000          0.00         0.00        0.00
00561     Anesth, heart surg < age 1             C            C          0000       0.0000          0.00         0.00        0.00
00562     Anesth, heart surg w/pump              C            C          0000       0.0000          0.00         0.00        0.00
00563     Anesth, heart surg w/arrest            N            N          0000       0.0000          0.00         0.00        0.00
00566     Anesth, cabg w/o pump                  N            N          0000       0.0000          0.00         0.00        0.00
00580     Anesth, heart/lung transplnt           C            C          0000       0.0000          0.00         0.00        0.00
00600     Anesth, spine, cord surgery            N            N          0000       0.0000          0.00         0.00        0.00
00604     Anesth, sitting procedure              C            C          0000       0.0000          0.00         0.00        0.00
00620     Anesth, spine, cord surgery            N            N          0000       0.0000          0.00         0.00        0.00
00622     Anesth, removal of nerves              C            C          0000       0.0000          0.00         0.00        0.00
00630     Anesth, spine, cord surgery            N            N          0000       0.0000          0.00         0.00        0.00
00632     Anesth, removal of nerves              C            C          0000       0.0000          0.00         0.00        0.00
00634     Anesth for chemonucleolysis            N            N          0000       0.0000          0.00         0.00        0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    1 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
00635     Anesth, lumbar puncture                N            N          0000       0.0000          0.00         0.00        0.00
00640     Anesth, spine manipulation             N            N          0000       0.0000          0.00         0.00        0.00
00670     Anesth, spine, cord surgery            C            C          0000       0.0000          0.00         0.00        0.00
00700     Anesth, abdominal wall surg            N            N          0000       0.0000          0.00         0.00        0.00
00702     Anesth, for liver biopsy               N            N          0000       0.0000          0.00         0.00        0.00
00730     Anesth, abdominal wall surg            N            N          0000       0.0000          0.00         0.00        0.00
00740     Anesth, upper gi visualize             N            N          0000       0.0000          0.00         0.00        0.00
00750     Anesth, repair of hernia               N            N          0000       0.0000          0.00         0.00        0.00
00752     Anesth, repair of hernia               N            N          0000       0.0000          0.00         0.00        0.00
00754     Anesth, repair of hernia               N            N          0000       0.0000          0.00         0.00        0.00
00756     Anesth, repair of hernia               N            N          0000       0.0000          0.00         0.00        0.00
00770     Anesth, blood vessel repair            N            N          0000       0.0000          0.00         0.00        0.00
00790     Anesth, surg upper abdomen             N            N          0000       0.0000          0.00         0.00        0.00
00792     Anesth, hemorr/excise liver            C            C          0000       0.0000          0.00         0.00        0.00
00794     Anesth, pancreas removal               C            C          0000       0.0000          0.00         0.00        0.00
00796     Anesth, for liver transplant           C            C          0000       0.0000          0.00         0.00        0.00
00797     Anesth, surgery for obesity            N            N          0000       0.0000          0.00         0.00        0.00
00800     Anesth, abdominal wall surg            N            N          0000       0.0000          0.00         0.00        0.00
00802     Anesth, fat layer removal              C            C          0000       0.0000          0.00         0.00        0.00
00810     Anesth, low intestine scope            N            N          0000       0.0000          0.00         0.00        0.00
00820     Anesth, abdominal wall surg            N            N          0000       0.0000          0.00         0.00        0.00
00830     Anesth, repair of hernia               N            N          0000       0.0000          0.00         0.00        0.00
00832     Anesth, repair of hernia               N            N          0000       0.0000          0.00         0.00        0.00
00834     Anesth, hernia repair< 1 yr            N            N          0000       0.0000          0.00         0.00        0.00
00836     Anesth hernia repair preemie           N            N          0000       0.0000          0.00         0.00        0.00
00840     Anesth, surg lower abdomen             N            N          0000       0.0000          0.00         0.00        0.00
00842     Anesth, amniocentesis                  N            N          0000       0.0000          0.00         0.00        0.00
00844     Anesth, pelvis surgery                 C            C          0000       0.0000          0.00         0.00        0.00
00846     Anesth, hysterectomy                   C            C          0000       0.0000          0.00         0.00        0.00
00848     Anesth, pelvic organ surg              C            C          0000       0.0000          0.00         0.00        0.00
00851     Anesth, tubal ligation                 N            N          0000       0.0000          0.00         0.00        0.00
00860     Anesth, surgery of abdomen             N            N          0000       0.0000          0.00         0.00        0.00
00862     Anesth, kidney/ureter surg             N            N          0000       0.0000          0.00         0.00        0.00
00864     Anesth, removal of bladder             C            C          0000       0.0000          0.00         0.00        0.00
00865     Anesth, removal of prostate            C            C          0000       0.0000          0.00         0.00        0.00
00866     Anesth, removal of adrenal             C            C          0000       0.0000          0.00         0.00        0.00
00868     Anesth, kidney transplant              C            C          0000       0.0000          0.00         0.00        0.00
00870     Anesth, bladder stone surg             N            N          0000       0.0000          0.00         0.00        0.00
00872     Anesth kidney stone destruct           N            N          0000       0.0000          0.00         0.00        0.00
00873     Anesth kidney stone destruct           N            N          0000       0.0000          0.00         0.00        0.00
00880     Anesth, abdomen vessel surg            N            N          0000       0.0000          0.00         0.00        0.00
00882     Anesth, major vein ligation            C            C          0000       0.0000          0.00         0.00        0.00
00902     Anesth, anorectal surgery              N            N          0000       0.0000          0.00         0.00        0.00
00904     Anesth, perineal surgery               C            C          0000       0.0000          0.00         0.00        0.00
00906     Anesth, removal of vulva               N            N          0000       0.0000          0.00         0.00        0.00
00908     Anesth, removal of prostate            C            C          0000       0.0000          0.00         0.00        0.00
00910     Anesth, bladder surgery                N            N          0000       0.0000          0.00         0.00        0.00
00912     Anesth, bladder tumor surg             N            N          0000       0.0000          0.00         0.00        0.00
00914     Anesth, removal of prostate            N            N          0000       0.0000          0.00         0.00        0.00
00916     Anesth, bleeding control               N            N          0000       0.0000          0.00         0.00        0.00
00918     Anesth, stone removal                  N            N          0000       0.0000          0.00         0.00        0.00
00920     Anesth, genitalia surgery              N            N          0000       0.0000          0.00         0.00        0.00
00921     Anesth, vasectomy                      N            N          0000       0.0000          0.00         0.00        0.00
00922     Anesth, sperm duct surgery             N            N          0000       0.0000          0.00         0.00        0.00
00924     Anesth, testis exploration             N            N          0000       0.0000          0.00         0.00        0.00
00926     Anesth, removal of testis              N            N          0000       0.0000          0.00         0.00        0.00
00928     Anesth, removal of testis              N            N          0000       0.0000          0.00         0.00        0.00
00930     Anesth, testis suspension              N            N          0000       0.0000          0.00         0.00        0.00
00932     Anesth, amputation of penis            C            C          0000       0.0000          0.00         0.00        0.00
00934     Anesth, penis, nodes removal           C            C          0000       0.0000          0.00         0.00        0.00
00936     Anesth, penis, nodes removal           C            C          0000       0.0000          0.00         0.00        0.00
00938     Anesth, insert penis device            N            N          0000       0.0000          0.00         0.00        0.00
00940     Anesth, vaginal procedures             N            N          0000       0.0000          0.00         0.00        0.00
00942     Anesth, surg on vag/urethral           N            N          0000       0.0000          0.00         0.00        0.00
00944     Anesth, vaginal hysterectomy           C            C          0000       0.0000          0.00         0.00        0.00
00948     Anesth, repair of cervix               N            N          0000       0.0000          0.00         0.00        0.00
00950     Anesth, vaginal endoscopy              N            N          0000       0.0000          0.00         0.00        0.00
00952     Anesth, hysteroscope/graph             N            N          0000       0.0000          0.00         0.00        0.00
01112     Anesth, bone aspirate/bx               N            N          0000       0.0000          0.00         0.00        0.00
01120     Anesth, pelvis surgery                 N            N          0000       0.0000          0.00         0.00        0.00
01130     Anesth, body cast procedure            N            N          0000       0.0000          0.00         0.00        0.00
01140     Anesth, amputation at pelvis           C            C          0000       0.0000          0.00         0.00        0.00
01150     Anesth, pelvic tumor surgery           C            C          0000       0.0000          0.00         0.00        0.00
01160     Anesth, pelvis procedure               N            N          0000       0.0000          0.00         0.00        0.00
01170     Anesth, pelvis surgery                 N            N          0000       0.0000          0.00         0.00        0.00
01173     Anesth, fx repair, pelvis              N            N          0000       0.0000          0.00         0.00        0.00
01180     Anesth, pelvis nerve removal           N            N          0000       0.0000          0.00         0.00        0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    2 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
01190     Anesth, pelvis nerve removal           N            N          0000       0.0000          0.00         0.00        0.00
01200     Anesth, hip joint procedure            N            N          0000       0.0000          0.00         0.00        0.00
01202     Anesth, arthroscopy of hip             N            N          0000       0.0000          0.00         0.00        0.00
01210     Anesth, hip joint surgery              N            N          0000       0.0000          0.00         0.00        0.00
01212     Anesth, hip disarticulation            C            C          0000       0.0000          0.00         0.00        0.00
01214     Anesth, hip arthroplasty               C            C          0000       0.0000          0.00         0.00        0.00
01215     Anesth, revise hip repair              N            N          0000       0.0000          0.00         0.00        0.00
01220     Anesth, procedure on femur             N            N          0000       0.0000          0.00         0.00        0.00
01230     Anesth, surgery of femur               N            N          0000       0.0000          0.00         0.00        0.00
01232     Anesth, amputation of femur            C            C          0000       0.0000          0.00         0.00        0.00
01234     Anesth, radical femur surg             C            C          0000       0.0000          0.00         0.00        0.00
01250     Anesth, upper leg surgery              N            N          0000       0.0000          0.00         0.00        0.00
01260     Anesth, upper leg veins surg           N            N          0000       0.0000          0.00         0.00        0.00
01270     Anesth, thigh arteries surg            N            N          0000       0.0000          0.00         0.00        0.00
01272     Anesth, femoral artery surg            C            C          0000       0.0000          0.00         0.00        0.00
01274     Anesth, femoral embolectomy            C            C          0000       0.0000          0.00         0.00        0.00
01320     Anesth, knee area surgery              N            N          0000       0.0000          0.00         0.00        0.00
01340     Anesth, knee area procedure            N            N          0000       0.0000          0.00         0.00        0.00
01360     Anesth, knee area surgery              N            N          0000       0.0000          0.00         0.00        0.00
01380     Anesth, knee joint procedure           N            N          0000       0.0000          0.00         0.00        0.00
01382     Anesth, dx knee arthroscopy            N            N          0000       0.0000          0.00         0.00        0.00
01390     Anesth, knee area procedure            N            N          0000       0.0000          0.00         0.00        0.00
01392     Anesth, knee area surgery              N            N          0000       0.0000          0.00         0.00        0.00
01400     Anesth, knee joint surgery             N            N          0000       0.0000          0.00         0.00        0.00
01402     Anesth, knee arthroplasty              C            C          0000       0.0000          0.00         0.00        0.00
01404     Anesth, amputation at knee             C            C          0000       0.0000          0.00         0.00        0.00
01420     Anesth, knee joint casting             N            N          0000       0.0000          0.00         0.00        0.00
01430     Anesth, knee veins surgery             N            N          0000       0.0000          0.00         0.00        0.00
01432     Anesth, knee vessel surg               N            N          0000       0.0000          0.00         0.00        0.00
01440     Anesth, knee arteries surg             N            N          0000       0.0000          0.00         0.00        0.00
01442     Anesth, knee artery surg               C            C          0000       0.0000          0.00         0.00        0.00
01444     Anesth, knee artery repair             C            C          0000       0.0000          0.00         0.00        0.00
01462     Anesth, lower leg procedure            N            N          0000       0.0000          0.00         0.00        0.00
01464     Anesth, ankle/ft arthroscopy           N            N          0000       0.0000          0.00         0.00        0.00
01470     Anesth, lower leg surgery              N            N          0000       0.0000          0.00         0.00        0.00
01472     Anesth, achilles tendon surg           N            N          0000       0.0000          0.00         0.00        0.00
01474     Anesth, lower leg surgery              N            N          0000       0.0000          0.00         0.00        0.00
01480     Anesth, lower leg bone surg            N            N          0000       0.0000          0.00         0.00        0.00
01482     Anesth, radical leg surgery            N            N          0000       0.0000          0.00         0.00        0.00
01484     Anesth, lower leg revision             N            N          0000       0.0000          0.00         0.00        0.00
01486     Anesth, ankle replacement              C            C          0000       0.0000          0.00         0.00        0.00
01490     Anesth, lower leg casting              N            N          0000       0.0000          0.00         0.00        0.00
01500     Anesth, leg arteries surg              N            N          0000       0.0000          0.00         0.00        0.00
01502     Anesth, lwr leg embolectomy            C            C          0000       0.0000          0.00         0.00        0.00
01520     Anesth, lower leg vein surg            N            N          0000       0.0000          0.00         0.00        0.00
01522     Anesth, lower leg vein surg            N            N          0000       0.0000          0.00         0.00        0.00
01610     Anesth, surgery of shoulder            N            N          0000       0.0000          0.00         0.00        0.00
01620     Anesth, shoulder procedure             N            N          0000       0.0000          0.00         0.00        0.00
01622     Anes dx shoulder arthroscopy           N            N          0000       0.0000          0.00         0.00        0.00
01630     Anesth, surgery of shoulder            N            N          0000       0.0000          0.00         0.00        0.00
01632     Anesth, surgery of shoulder            C            C          0000       0.0000          0.00         0.00        0.00
01634     Anesth, shoulder joint amput           C            C          0000       0.0000          0.00         0.00        0.00
01636     Anesth, forequarter amput              C            C          0000       0.0000          0.00         0.00        0.00
01638     Anesth, shoulder replacement           C            C          0000       0.0000          0.00         0.00        0.00
01650     Anesth, shoulder artery surg           N            N          0000       0.0000          0.00         0.00        0.00
01652     Anesth, shoulder vessel surg           C            C          0000       0.0000          0.00         0.00        0.00
01654     Anesth, shoulder vessel surg           C            C          0000       0.0000          0.00         0.00        0.00
01656     Anesth, arm-leg vessel surg            C            C          0000       0.0000          0.00         0.00        0.00
01670     Anesth, shoulder vein surg             N            N          0000       0.0000          0.00         0.00        0.00
01680     Anesth, shoulder casting               N            N          0000       0.0000          0.00         0.00        0.00
01682     Anesth, airplane cast                  N            N          0000       0.0000          0.00         0.00        0.00
01710     Anesth, elbow area surgery             N            N          0000       0.0000          0.00         0.00        0.00
01712     Anesth, uppr arm tendon surg           N            N          0000       0.0000          0.00         0.00        0.00
01714     Anesth, uppr arm tendon surg           N            N          0000       0.0000          0.00         0.00        0.00
01716     Anesth, biceps tendon repair           N            N          0000       0.0000          0.00         0.00        0.00
01730     Anesth, uppr arm procedure             N            N          0000       0.0000          0.00         0.00        0.00
01732     Anesth, dx elbow arthroscopy           N            N          0000       0.0000          0.00         0.00        0.00
01740     Anesth, upper arm surgery              N            N          0000       0.0000          0.00         0.00        0.00
01742     Anesth, humerus surgery                N            N          0000       0.0000          0.00         0.00        0.00
01744     Anesth, humerus repair                 N            N          0000       0.0000          0.00         0.00        0.00
01756     Anesth, radical humerus surg           C            C          0000       0.0000          0.00         0.00        0.00
01758     Anesth, humeral lesion surg            N            N          0000       0.0000          0.00         0.00        0.00
01760     Anesth, elbow replacement              N            N          0000       0.0000          0.00         0.00        0.00
01770     Anesth, uppr arm artery surg           N            N          0000       0.0000          0.00         0.00        0.00
01772     Anesth, uppr arm embolectomy           N            N          0000       0.0000          0.00         0.00        0.00
01780     Anesth, upper arm vein surg            N            N          0000       0.0000          0.00         0.00        0.00
01782     Anesth, uppr arm vein repair           N            N          0000       0.0000          0.00         0.00        0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    3 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
01810     Anesth, lower arm surgery              N            N          0000        0.0000        0.00          0.00         0.00
01820     Anesth, lower arm procedure            N            N          0000        0.0000        0.00          0.00         0.00
01829     Anesth, dx wrist arthroscopy           N            N          0000        0.0000        0.00          0.00         0.00
01830     Anesth, lower arm surgery              N            N          0000        0.0000        0.00          0.00         0.00
01832     Anesth, wrist replacement              N            N          0000        0.0000        0.00          0.00         0.00
01840     Anesth, lwr arm artery surg            N            N          0000        0.0000        0.00          0.00         0.00
01842     Anesth, lwr arm embolectomy            N            N          0000        0.0000        0.00          0.00         0.00
01844     Anesth, vascular shunt surg            N            N          0000        0.0000        0.00          0.00         0.00
01850     Anesth, lower arm vein surg            N            N          0000        0.0000        0.00          0.00         0.00
01852     Anesth, lwr arm vein repair            N            N          0000        0.0000        0.00          0.00         0.00
01860     Anesth, lower arm casting              N            N          0000        0.0000        0.00          0.00         0.00
01905     Anes, spine inject, x-ray/re           N            N          0000        0.0000        0.00          0.00         0.00
01916     Anesth, dx arteriography               N            N          0000        0.0000        0.00          0.00         0.00
01920     Anesth, catheterize heart              N            N          0000        0.0000        0.00          0.00         0.00
01922     Anesth, cat or MRI scan                N            N          0000        0.0000        0.00          0.00         0.00
01924     Anes, ther interven rad, art           N            N          0000        0.0000        0.00          0.00         0.00
01925     Anes, ther interven rad, car           N            N          0000        0.0000        0.00          0.00         0.00
01926     Anes, tx interv rad hrt/cran           N            N          0000        0.0000        0.00          0.00         0.00
01930     Anes, ther interven rad, vei           N            N          0000        0.0000        0.00          0.00         0.00
01931     Anes, ther interven rad, tip           N            N          0000        0.0000        0.00          0.00         0.00
01932     Anes, tx interv rad, th vein           N            N          0000        0.0000        0.00          0.00         0.00
01933     Anes, tx interv rad, cran v            N            N          0000        0.0000        0.00          0.00         0.00
01951     Anesth, burn, less 4 percent           N            N          0000        0.0000        0.00          0.00         0.00
01952     Anesth, burn, 4-9 percent              N            N          0000        0.0000        0.00          0.00         0.00
01953     Anesth, burn, each 9 percent           N            N          0000        0.0000        0.00          0.00         0.00
01958     Anesth, antepartum manipul             N            N          0000        0.0000        0.00          0.00         0.00
01960     Anesth, vaginal delivery               N            N          0000        0.0000        0.00          0.00         0.00
01961     Anesth, cs delivery                    N            N          0000        0.0000        0.00          0.00         0.00
01962     Anesth, emer hysterectomy              N            N          0000        0.0000        0.00          0.00         0.00
01963     Anesth, cs hysterectomy                N            N          0000        0.0000        0.00          0.00         0.00
01965     Anesth, inc/missed ab proc             N            N          0000        0.0000        0.00          0.00         0.00
01966     Anesth, induced ab procedure           N            N          0000        0.0000        0.00          0.00         0.00
01967     Anesth/analg, vag delivery             N            N          0000        0.0000        0.00          0.00         0.00
01968     Anes/analg cs deliver add-on           N            N          0000        0.0000        0.00          0.00         0.00
01969     Anesth/analg cs hyst add-on            N            N          0000        0.0000        0.00          0.00         0.00
01990     Support for organ donor                C            C          0000        0.0000        0.00          0.00         0.00
01991     Anesth, nerve block/inj                N            N          0000        0.0000        0.00          0.00         0.00
01992     Anesth, n block/inj, prone             N            N          0000        0.0000        0.00          0.00         0.00
01995     Regional anesthesia limb               N            1          0000        0.0000        0.00          0.00         0.00          X
01996     Hosp manage cont drug admin            N            N          0000        0.0000        0.00          0.00         0.00
01999     Unlisted anesth procedure              N            1          0000        0.0000        0.00          0.00         0.00
10021     Fna w/o image                          T            T          0002        0.9357       43.14         98.35        112.73
10022     Fna w/image                            T            T          0036        2.1838       100.67        229.54       263.10
10040     Acne surgery                           T            T          0010        0.5923       27.31         62.26        71.36
10060     Drainage of skin abscess               T            T          0006        1.5100       69.61         158.72       181.92
10061     Drainage of skin abscess               T            T          0006        1.5100       69.61         158.72       181.92
10080     Drainage of pilonidal cyst             T            T          0006        1.5100       69.61         158.72       181.92
10081     Drainage of pilonidal cyst             T            T          0007       11.6717       538.07       1,226.81     1,406.21
10120     Remove foreign body                    T            T          0006        1.5100       69.61         158.72       181.92
10121     Remove foreign body                    T            T          0021       14.9984       691.43       1,576.48     1,807.01
10140     Drainage of hematoma/fluid             T            T          0007       11.6717       538.07       1,226.81     1,406.21
10160     Puncture drainage of lesion            T            T          0018        1.1010       50.76         115.73       132.65
10180     Complex drainage, wound                T            T          0008       16.2953       751.21       1,712.80     1,963.26
11000     Debride infected skin                  T            T          0013        1.0603       48.88         111.45       127.74
11001     Debride infected skin add-on           T            T          0012        0.8477       39.08         89.10        102.13
11004     Debride genitalia & perineum           C            C          0000        0.0000        0.00          0.00         0.00
11005     Debride abdom wall                     C            C          0000        0.0000        0.00          0.00         0.00
11006     Debride genit/per/abdom wall           C            C          0000        0.0000        0.00          0.00         0.00
11008     Remove mesh from abd wall              C            C          0000        0.0000        0.00          0.00         0.00
11010     Debride skin, fx                       T            T          0019        4.1481       191.23        436.01       499.76
11011     Debride skin/muscle, fx                T            T          0019        4.1481       191.23        436.01       499.76
11012     Debride skin/muscle/bone, fx           T            T          0019        4.1481       191.23        436.01       499.76
11040     Debride skin, partial                  T            T          0015        1.6338       75.32         171.73       196.84
11041     Debride skin, full                     T            T          0015        1.6338       75.32         171.73       196.84
11042     Debride skin/tissue                    T            T          0016        2.5080       115.62        263.62       302.16
11043     Debride tissue/muscle                  T            T          0016        2.5080       115.62        263.62       302.16
11044     Debride tissue/muscle/bone             T            T          0682        6.7313       310.31        707.53       810.99
11055     Trim skin lesion                       T            T          0012        0.8477       39.08         89.10        102.13
11056     Trim skin lesions, 2 to 4              T            T          0012        0.8477       39.08         89.10        102.13
11057     Trim skin lesions, over 4              T            T          0013        1.0603       48.88         111.45       127.74
11100     Biopsy, skin lesion                    T            T          0018        1.1010       50.76         115.73       132.65
11101     Biopsy, skin add-on                    T            T          0018        1.1010       50.76         115.73       132.65
11200     Removal of skin tags                   T            T          0013        1.0603       48.88         111.45       127.74
11201     Remove skin tags add-on                T            T          0015        1.6338       75.32         171.73       196.84
11300     Shave skin lesion                      T            T          0012        0.8477       39.08         89.10        102.13
11301     Shave skin lesion                      T            T          0012        0.8477       39.08         89.10        102.13
11302     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    4 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
11303     Shave skin lesion                      T            T          0015        1.6338       75.32         171.73       196.84
11305     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74
11306     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74
11307     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74
11308     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74
11310     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74
11311     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74
11312     Shave skin lesion                      T            T          0013        1.0603       48.88         111.45       127.74
11313     Shave skin lesion                      T            T          0016        2.5080       115.62        263.62       302.16
11400     Exc tr-ext b9+marg 0.5 < cm            T            T          0019        4.1481       191.23        436.01       499.76
11401     Exc tr-ext b9+marg 0.6-1 cm            T            T          0019        4.1481       191.23        436.01       499.76
11402     Exc tr-ext b9+marg 1.1-2 cm            T            T          0019        4.1481       191.23        436.01       499.76
11403     Exc tr-ext b9+marg 2.1-3 cm            T            T          0020        6.9410       319.98        729.57       836.25
11404     Exc tr-ext b9+marg 3.1-4 cm            T            T          0021       14.9984       691.43       1,576.48     1,807.01
11406     Exc tr-ext b9+marg > 4.0 cm            T            T          0021       14.9984       691.43       1,576.48     1,807.01
11420     Exc h-f-nk-sp b9+marg 0.5 <            T            T          0020        6.9410       319.98        729.57       836.25
11421     Exc h-f-nk-sp b9+marg 0.6-1            T            T          0020        6.9410       319.98        729.57       836.25
11422     Exc h-f-nk-sp b9+marg 1.1-2            T            T          0020        6.9410       319.98        729.57       836.25
11423     Exc h-f-nk-sp b9+marg 2.1-3            T            T          0021       14.9984       691.43       1,576.48     1,807.01
11424     Exc h-f-nk-sp b9+marg 3.1-4            T            T          0021       14.9984       691.43       1,576.48     1,807.01
11426     Exc h-f-nk-sp b9+marg > 4 cm           T            T          0022       19.5716       902.25       2,057.17     2,357.99
11440     Exc face-mm b9+marg 0.5 < cm           T            T          0019        4.1481       191.23        436.01       499.76
11441     Exc face-mm b9+marg 0.6-1 cm           T            T          0019        4.1481       191.23        436.01       499.76
11442     Exc face-mm b9+marg 1.1-2 cm           T            T          0020        6.9410       319.98        729.57       836.25
11443     Exc face-mm b9+marg 2.1-3 cm           T            T          0020        6.9410       319.98        729.57       836.25
11444     Exc face-mm b9+marg 3.1-4 cm           T            T          0020        6.9410       319.98        729.57       836.25
11446     Exc face-mm b9+marg > 4 cm             T            T          0022       19.5716       902.25       2,057.17     2,357.99
11450     Removal, sweat gland lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11451     Removal, sweat gland lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11462     Removal, sweat gland lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11463     Removal, sweat gland lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11470     Removal, sweat gland lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11471     Removal, sweat gland lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11600     Exc tr-ext mlg+marg 0.5 < cm           T            T          0019        4.1481       191.23        436.01       499.76
11601     Exc tr-ext mlg+marg 0.6-1 cm           T            T          0019        4.1481       191.23        436.01       499.76
11602     Exc tr-ext mlg+marg 1.1-2 cm           T            T          0019        4.1481       191.23        436.01       499.76
11603     Exc tr-ext mlg+marg 2.1-3 cm           T            T          0020        6.9410       319.98        729.57       836.25
11604     Exc tr-ext mlg+marg 3.1-4 cm           T            T          0020        6.9410       319.98        729.57       836.25
11606     Exc tr-ext mlg+marg > 4 cm             T            T          0021       14.9984       691.43       1,576.48     1,807.01
11620     Exc h-f-nk-sp mlg+marg 0.5 <           T            T          0020        6.9410       319.98        729.57       836.25
11621     Exc h-f-nk-sp mlg+marg 0.6-1           T            T          0019        4.1481       191.23        436.01       499.76
11622     Exc h-f-nk-sp mlg+marg 1.1-2           T            T          0020        6.9410       319.98        729.57       836.25
11623     Exc h-f-nk-sp mlg+marg 2.1-3           T            T          0021       14.9984       691.43       1,576.48     1,807.01
11624     Exc h-f-nk-sp mlg+marg 3.1-4           T            T          0021       14.9984       691.43       1,576.48     1,807.01
11626     Exc h-f-nk-sp mlg+mar > 4 cm           T            T          0022       19.5716       902.25       2,057.17     2,357.99
11640     Exc face-mm malig+marg 0.5 <           T            T          0020        6.9410       319.98        729.57       836.25
11641     Exc face-mm malig+marg 0.6-1           T            T          0020        6.9410       319.98        729.57       836.25
11642     Exc face-mm malig+marg 1.1-2           T            T          0020        6.9410       319.98        729.57       836.25
11643     Exc face-mm malig+marg 2.1-3           T            T          0020        6.9410       319.98        729.57       836.25
11644     Exc face-mm malig+marg 3.1-4           T            T          0021       14.9984       691.43       1,576.48     1,807.01
11646     Exc face-mm mlg+marg > 4 cm            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11719     Trim nail(s)                           T            T          0009        0.7513       34.63         78.97        90.52
11720     Debride nail, 1-5                      T            T          0009        0.7513       34.63         78.97        90.52
11721     Debride nail, 6 or more                T            T          0009        0.7513       34.63         78.97        90.52
11730     Removal of nail plate                  T            T          0013        1.0603       48.88         111.45       127.74
11732     Remove nail plate, add-on              T            T          0012        0.8477       39.08         89.10        102.13
11740     Drain blood from under nail            T            T          0009        0.7513       34.63         78.97        90.52
11750     Removal of nail bed                    T            T          0019        4.1481       191.23        436.01       499.76
11752     Remove nail bed/finger tip             T            T          0022       19.5716       902.25       2,057.17     2,357.99
11755     Biopsy, nail unit                      T            T          0019        4.1481       191.23        436.01       499.76
11760     Repair of nail bed                     T            T          0024        1.5513       71.51         163.06       186.90
11762     Reconstruction of nail bed             T            T          0024        1.5513       71.51         163.06       186.90
11765     Excision of nail fold, toe             T            T          0015        1.6338       75.32         171.73       196.84
11770     Removal of pilonidal lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11771     Removal of pilonidal lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11772     Removal of pilonidal lesion            T            T          0022       19.5716       902.25       2,057.17     2,357.99
11900     Injection into skin lesions            T            T          0012        0.8477       39.08         89.10        102.13
11901     Added skin lesions injection           T            T          0012        0.8477       39.08         89.10        102.13
11920     Correct skin color defects             T            1          0000        0.0000        0.00          0.00         0.00
11921     Correct skin color defects             T            1          0000        0.0000        0.00          0.00         0.00
11922     Correct skin color defects             T            1          0000        0.0000        0.00          0.00         0.00
11950     Therapy for contour defects            T            1          0000        0.0000        0.00          0.00         0.00
11951     Therapy for contour defects            T            1          0000        0.0000        0.00          0.00         0.00
11952     Therapy for contour defects            T            1          0000        0.0000        0.00          0.00         0.00
11954     Therapy for contour defects            T            1          0000        0.0000        0.00          0.00         0.00
11960     Insert tissue expander(s)              T            T          0027       18.1956       838.82       1,912.54     2,192.21
11970     Replace tissue expander                T            T          0027       18.1956       838.82       1,912.54     2,192.21

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    5 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
11971     Remove tissue expander(s)              T            T          0022       19.5716       902.25       2,057.17     2,357.99
11975     Insert contraceptive cap               E            3          0000        0.0000        M01           M01          M01
11976     Removal of contraceptive cap           T            T          0019        4.1481       191.23        436.01       499.76
11977     Removal/reinsert contra cap            E            3          0000        0.0000        M01           M01          M01
11980     Implant hormone pellet(s)              X            X          0340        0.6137       28.29         64.51        73.94
11981     Insert drug implant device             X            X          0340        0.6137       28.29         64.51        73.94
11982     Remove drug implant device             X            X          0340        0.6137       28.29         64.51        73.94
11983     Remove/insert drug implant             X            X          0340        0.6137       28.29         64.51        73.94
12001     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12002     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12004     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12005     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12006     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12007     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12011     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12013     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12014     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12015     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12016     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12017     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12018     Repair superficial wound(s)            T            T          0024        1.5513       71.51         163.06       186.90
12020     Closure of split wound                 T            T          0024        1.5513       71.51         163.06       186.90
12021     Closure of split wound                 T            T          0024        1.5513       71.51         163.06       186.90
12031     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12032     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12034     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12035     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12036     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12037     Layer closure of wound(s)              T            T          0025        5.3051       244.57        557.62       639.16
12041     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12042     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12044     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12045     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12046     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12047     Layer closure of wound(s)              T            T          0025        5.3051       244.57        557.62       639.16
12051     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12052     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12053     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12054     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12055     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12056     Layer closure of wound(s)              T            T          0024        1.5513       71.51         163.06       186.90
12057     Layer closure of wound(s)              T            T          0025        5.3051       244.57        557.62       639.16
13100     Repair of wound or lesion              T            T          0025        5.3051       244.57        557.62       639.16
13101     Repair of wound or lesion              T            T          0025        5.3051       244.57        557.62       639.16
13102     Repair wound/lesion add-on             T            T          0024        1.5513       71.51         163.06       186.90
13120     Repair of wound or lesion              T            T          0024        1.5513       71.51         163.06       186.90
13121     Repair of wound or lesion              T            T          0024        1.5513       71.51         163.06       186.90
13122     Repair wound/lesion add-on             T            T          0024        1.5513       71.51         163.06       186.90
13131     Repair of wound or lesion              T            T          0024        1.5513       71.51         163.06       186.90
13132     Repair of wound or lesion              T            T          0024        1.5513       71.51         163.06       186.90
13133     Repair wound/lesion add-on             T            T          0024        1.5513       71.51         163.06       186.90
13150     Repair of wound or lesion              T            T          0025        5.3051       244.57        557.62       639.16
13151     Repair of wound or lesion              T            T          0024        1.5513       71.51         163.06       186.90
13152     Repair of wound or lesion              T            T          0025        5.3051       244.57        557.62       639.16
13153     Repair wound/lesion add-on             T            T          0024        1.5513       71.51         163.06       186.90
13160     Late closure of wound                  T            T          0027       18.1956       838.82       1,912.54     2,192.21
14000     Skin tissue rearrangement              T            T          0686       13.4973       622.23       1,418.70     1,626.15
14001     Skin tissue rearrangement              T            T          0027       18.1956       838.82       1,912.54     2,192.21
14020     Skin tissue rearrangement              T            T          0686       13.4973       622.23       1,418.70     1,626.15
14021     Skin tissue rearrangement              T            T          0027       18.1956       838.82       1,912.54     2,192.21
14040     Skin tissue rearrangement              T            T          0686       13.4973       622.23       1,418.70     1,626.15
14041     Skin tissue rearrangement              T            T          0027       18.1956       838.82       1,912.54     2,192.21
14060     Skin tissue rearrangement              T            T          0027       18.1956       838.82       1,912.54     2,192.21
14061     Skin tissue rearrangement              T            T          0686       13.4973       622.23       1,418.70     1,626.15
14300     Skin tissue rearrangement              T            T          0027       18.1956       838.82       1,912.54     2,192.21
14350     Skin tissue rearrangement              T            T          0027       18.1956       838.82       1,912.54     2,192.21
15000     Skin graft                             T            1          0025        5.3051        0.00          0.00         0.00          X
15001     Skin graft add-on                      T            1          0025        5.3051        0.00          0.00         0.00          X
15040     Harvest cultured skin graft            T            T          0024        1.5513       71.51         163.06       186.90
15050     Skin pinch graft                       T            T          0025        5.3051       244.57        557.62       639.16
15100     Skin split graft                       T            T          0027       18.1956       838.82       1,912.54     2,192.21
15101     Skin split graft add-on                T            T          0027       18.1956       838.82       1,912.54     2,192.21
15110     Epidrm autogrft trnk/arm/leg           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15111     Epidrm autogrft t/a/l add-on           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15115     Epidrm a-grft face/nck/hf/g            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15116     Epidrm a-grft f/n/hf/g addl            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15120     Skin split graft                       T            T          0027       18.1956       838.82       1,912.54     2,192.21

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    6 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
15121     Skin split graft add-on                T            T          0027       18.1956       838.82       1,912.54     2,192.21
15130     Derm autograft, trnk/arm/leg           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15131     Derm autograft t/a/l add-on            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15135     Derm autograft face/nck/hf/g           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15136     Derm autograft, f/n/hf/g add           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15150     Cult epiderm grft t/arm/leg            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15151     Cult epiderm grft t/a/l addl           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15152     Cult epiderm graft t/a/l +%            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15155     Cult epiderm graft, f/n/hf/g           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15156     Cult epidrm grft f/n/hfg add           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15157     Cult epiderm grft f/n/hfg +%           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15170     Acell graft trunk/arms/legs            T            T          0024        1.5513       71.51         163.06       186.90
15171     Acell graft t/arm/leg add-on           T            T          0024        1.5513       71.51         163.06       186.90
15175     Acellular graft, f/n/hf/g              T            T          0024        1.5513       71.51         163.06       186.90
15176     Acell graft, f/n/hf/g add-on           T            T          0024        1.5513       71.51         163.06       186.90
15200     Skin full graft                        T            T          0027       18.1956       838.82       1,912.54     2,192.21
15201     Skin full graft add-on                 T            T          0025        5.3051       244.57        557.62       639.16
15220     Skin full graft                        T            T          0027       18.1956       838.82       1,912.54     2,192.21
15221     Skin full graft add-on                 T            T          0025        5.3051       244.57        557.62       639.16
15240     Skin full graft                        T            T          0686       13.4973       622.23       1,418.70     1,626.15
15241     Skin full graft add-on                 T            T          0025        5.3051       244.57        557.62       639.16
15260     Skin full graft                        T            T          0686       13.4973       622.23       1,418.70     1,626.15
15261     Skin full graft add-on                 T            T          0025        5.3051       244.57        557.62       639.16
15300     Apply skinallogrft, t/arm/lg           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15301     Apply sknallogrft t/a/l addl           T            T          0025        5.3051       244.57        557.62       639.16
15320     Apply skin allogrft f/n/hf/g           T            T          0025        5.3051       244.57        557.62       639.16
15321     Aply sknallogrft f/n/hfg add           T            T          0025        5.3051       244.57        557.62       639.16
15330     Aply acell alogrft t/arm/leg           T            T          0025        5.3051       244.57        557.62       639.16
15331     Aply acell grft t/a/l add-on           T            T          0025        5.3051       244.57        557.62       639.16
15335     Apply acell graft, f/n/hf/g            T            T          0025        5.3051       244.57        557.62       639.16
15336     Aply acell grft f/n/hf/g add           T            T          0025        5.3051       244.57        557.62       639.16
15340     Apply cult skin substitute             T            T          0024        1.5513       71.51         163.06       186.90
15341     Apply cult skin sub add-on             T            T          0024        1.5513       71.51         163.06       186.90
15360     Apply cult derm sub, t/a/l             T            T          0024        1.5513       71.51         163.06       186.90
15361     Aply cult derm sub t/a/l add           T            T          0024        1.5513       71.51         163.06       186.90
15365     Apply cult derm sub f/n/hf/g           T            T          0024        1.5513       71.51         163.06       186.90
15366     Apply cult derm f/hf/g add             T            T          0024        1.5513       71.51         163.06       186.90
15400     Skin heterograft                       T            T          0025        5.3051       244.57        557.62       639.16
15401     Skin heterograft add-on                T            T          0025        5.3051       244.57        557.62       639.16
15420     Apply skin xgraft, f/n/hf/g            T            T          0025        5.3051       244.57        557.62       639.16
15421     Apply skn xgrft f/n/hf/g add           T            T          0025        5.3051       244.57        557.62       639.16
15430     Apply acellular xenograft              T            T          0025        5.3051       244.57        557.62       639.16
15431     Apply acellular xgraft add             T            T          0025        5.3051       244.57        557.62       639.16
15570     Form skin pedicle flap                 T            T          0027       18.1956       838.82       1,912.54     2,192.21
15572     Form skin pedicle flap                 T            T          0027       18.1956       838.82       1,912.54     2,192.21
15574     Form skin pedicle flap                 T            T          0027       18.1956       838.82       1,912.54     2,192.21
15576     Form skin pedicle flap                 T            T          0686       13.4973       622.23       1,418.70     1,626.15
15600     Skin graft                             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15610     Skin graft                             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15620     Skin graft                             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15630     Skin graft                             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15650     Transfer skin pedicle flap             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15732     Muscle-skin graft, head/neck           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15734     Muscle-skin graft, trunk               T            T          0027       18.1956       838.82       1,912.54     2,192.21
15736     Muscle-skin graft, arm                 T            T          0027       18.1956       838.82       1,912.54     2,192.21
15738     Muscle-skin graft, leg                 T            T          0027       18.1956       838.82       1,912.54     2,192.21
15740     Island pedicle flap graft              T            T          0686       13.4973       622.23       1,418.70     1,626.15
15750     Neurovascular pedicle graft            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15756     Free myo/skin flap microvasc           C            C          0000        0.0000        0.00          0.00         0.00
15757     Free skin flap, microvasc              C            C          0000        0.0000        0.00          0.00         0.00
15758     Free fascial flap, microvasc           C            C          0000        0.0000        0.00          0.00         0.00
15760     Composite skin graft                   T            T          0027       18.1956       838.82       1,912.54     2,192.21
15770     Derma-fat-fascia graft                 T            T          0027       18.1956       838.82       1,912.54     2,192.21
15775     Hair transplant punch grafts           T            1          0000        0.0000        0.00          0.00         0.00
15776     Hair transplant punch grafts           T            1          0000        0.0000        0.00          0.00         0.00
15780     Abrasion treatment of skin             T            T          0022       19.5716       902.25       2,057.17     2,357.99
15781     Abrasion treatment of skin             T            1          0000        0.0000        0.00          0.00         0.00
15782     Abrasion treatment of skin             T            1          0000        0.0000        0.00          0.00         0.00
15783     Abrasion treatment of skin             T            1          0000        0.0000        0.00          0.00         0.00
15786     Abrasion, lesion, single               T            1          0000        0.0000        0.00          0.00         0.00
15787     Abrasion, lesions, add-on              T            1          0000        0.0000        0.00          0.00         0.00
15788     Chemical peel, face, epiderm           T            1          0000        0.0000        0.00          0.00         0.00
15789     Chemical peel, face, dermal            T            1          0000        0.0000        0.00          0.00         0.00
15792     Chemical peel, nonfacial               T            1          0000        0.0000        0.00          0.00         0.00
15793     Chemical peel, nonfacial               T            1          0000        0.0000        0.00          0.00         0.00
15819     Plastic surgery, neck                  T            1          0000        0.0000        0.00          0.00         0.00
15820     Revision of lower eyelid               T            T          0027       18.1956       838.82       1,912.54     2,192.21

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    7 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
15821     Revision of lower eyelid               T            T          0027       18.1956       838.82       1,912.54     2,192.21
15822     Revision of upper eyelid               T            T          0027       18.1956       838.82       1,912.54     2,192.21
15823     Revision of upper eyelid               T            T          0027       18.1956       838.82       1,912.54     2,192.21
15824     Removal of forehead wrinkles           T            1          0000        0.0000        0.00          0.00         0.00
15825     Removal of neck wrinkles               T            1          0000        0.0000        0.00          0.00         0.00
15826     Removal of brow wrinkles               T            1          0000        0.0000        0.00          0.00         0.00
15828     Removal of face wrinkles               T            1          0000        0.0000        0.00          0.00         0.00
15829     Removal of skin wrinkles               T            1          0000        0.0000        0.00          0.00         0.00
15831     Excise excessive skin tissue           T            1          0022       19.5716        0.00          0.00         0.00          X
15832     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15833     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15834     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15835     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15836     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15837     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15838     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15839     Excise excessive skin tissue           T            1          0000        0.0000        0.00          0.00         0.00
15840     Graft for face nerve palsy             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15841     Graft for face nerve palsy             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15842     Flap for face nerve palsy              T            T          0686       13.4973       622.23       1,418.70     1,626.15
15845     Skin and muscle repair, face           T            T          0027       18.1956       838.82       1,912.54     2,192.21
15850     Removal of sutures                     T            T          0016        2.5080       115.62        263.62       302.16
15851     Removal of sutures                     T            T          0016        2.5080       115.62        263.62       302.16
15852     Dressing change not for burn           X            X          0340        0.6137       28.29         64.51        73.94
15860     Test for blood flow in graft           X            X          0359        0.8036       37.05         84.47        96.82
15876     Suction assisted lipectomy             T            1          0000        0.0000        0.00          0.00         0.00
15877     Suction assisted lipectomy             T            1          0000        0.0000        0.00          0.00         0.00
15878     Suction assisted lipectomy             T            1          0000        0.0000        0.00          0.00         0.00
15879     Suction assisted lipectomy             T            1          0000        0.0000        0.00          0.00         0.00
15920     Removal of tail bone ulcer             T            T          0019        4.1481       191.23        436.01       499.76
15922     Removal of tail bone ulcer             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15931     Remove sacrum pressure sore            T            T          0022       19.5716       902.25       2,057.17     2,357.99
15933     Remove sacrum pressure sore            T            T          0022       19.5716       902.25       2,057.17     2,357.99
15934     Remove sacrum pressure sore            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15935     Remove sacrum pressure sore            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15936     Remove sacrum pressure sore            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15937     Remove sacrum pressure sore            T            T          0027       18.1956       838.82       1,912.54     2,192.21
15940     Remove hip pressure sore               T            T          0022       19.5716       902.25       2,057.17     2,357.99
15941     Remove hip pressure sore               T            T          0022       19.5716       902.25       2,057.17     2,357.99
15944     Remove hip pressure sore               T            T          0027       18.1956       838.82       1,912.54     2,192.21
15945     Remove hip pressure sore               T            T          0027       18.1956       838.82       1,912.54     2,192.21
15946     Remove hip pressure sore               T            T          0027       18.1956       838.82       1,912.54     2,192.21
15950     Remove thigh pressure sore             T            T          0022       19.5716       902.25       2,057.17     2,357.99
15951     Remove thigh pressure sore             T            T          0022       19.5716       902.25       2,057.17     2,357.99
15952     Remove thigh pressure sore             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15953     Remove thigh pressure sore             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15956     Remove thigh pressure sore             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15958     Remove thigh pressure sore             T            T          0027       18.1956       838.82       1,912.54     2,192.21
15999     Removal of pressure sore               T            1          0000        0.0000        0.00          0.00         0.00
16000     Initial treatment of burn(s)           T            T          0012        0.8477       39.08         89.10        102.13
16020     Treatment of burn(s)                   T            T          0013        1.0603       48.88         111.45       127.74
16025     Treatment of burn(s)                   T            T          0013        1.0603       48.88         111.45       127.74
16030     Treatment of burn(s)                   T            T          0015        1.6338       75.32         171.73       196.84
16035     Incision of burn scab, initi           C            C          0000        0.0000        0.00          0.00         0.00
16036     Escharotomy; add’l incision            C            C          0000        0.0000        0.00          0.00         0.00
17000     Destroy benign/premlg lesion           T            T          0010        0.5923       27.31         62.26        71.36
17003     Destroy lesions, 2-14                  T            T          0010        0.5923       27.31         62.26        71.36
17004     Destroy lesions, 15 or more            T            T          0011        2.2274       102.68        234.12       268.36
17106     Destruction of skin lesions            T            T          0011        2.2274       102.68        234.12       268.36
17107     Destruction of skin lesions            T            T          0011        2.2274       102.68        234.12       268.36
17108     Destruction of skin lesions            T            T          0011        2.2274       102.68        234.12       268.36
17110     Destruct lesion, 1-14                  T            T          0013        1.0603       48.88         111.45       127.74
17111     Destruct lesion, 15 or more            T            T          0013        1.0603       48.88         111.45       127.74
17250     Chemical cautery, tissue               T            T          0013        1.0603       48.88         111.45       127.74
17260     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17261     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17262     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17263     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17264     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17266     Destruction of skin lesions            T            T          0016        2.5080       115.62        263.62       302.16
17270     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17271     Destruction of skin lesions            T            T          0013        1.0603       48.88         111.45       127.74
17272     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17273     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84
17274     Destruction of skin lesions            T            T          0016        2.5080       115.62        263.62       302.16
17276     Destruction of skin lesions            T            T          0016        2.5080       115.62        263.62       302.16
17280     Destruction of skin lesions            T            T          0015        1.6338       75.32         171.73       196.84

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                    8 of 171
State of Wyoming Oupatient Prospective Payment System                                                                            Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                               Critical
                                               October                                               General     Children's                Change
                                                           WY 2007                                                             Access
  CPT/                                           2006                             APC Relative       Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                   Hospital
 HCPCS                                          Status                              Weight          Outpatient   Outpatient                 2006
                                                           Indicator                                                          Outpatient
                                              Indicator                                                Fee          Fee                   Schedule
                                                                                                                                 Fee
                                             (FYI Only)
17281     Destruction of skin lesions            T            T          0015        1.6338           75.32        171.73       196.84
17282     Destruction of skin lesions            T            T          0015        1.6338           75.32        171.73       196.84
17283     Destruction of skin lesions            T            T          0015        1.6338           75.32        171.73       196.84
17284     Destruction of skin lesions            T            T          0016        2.5080           115.62       263.62       302.16
17286     Destruction of skin lesions            T            T          0015        1.6338           75.32        171.73       196.84
17304     1 stage mohs, up to 5 spec             T            1          0694        3.8832            0.00         0.00         0.00          X
17305     2 stage mohs, up to 5 spec             T            1          0694        3.8832            0.00         0.00         0.00          X
17306     3 stage mohs, up to 5 spec             T            1          0694        3.8832            0.00         0.00         0.00          X
17307     Mohs addl stage up to 5 spec           T            1          0694        3.8832            0.00         0.00         0.00          X
17310     Mohs any stage > 5 spec each           T            1          0694        3.8832            0.00         0.00         0.00          X
17340     Cryotherapy of skin                    T            T          0012        0.8477           39.08        89.10        102.13
17360     Skin peel therapy                      T            1          0000        0.0000            0.00         0.00         0.00
17380     Hair removal by electrolysis           T            1          0000        0.0000            0.00         0.00         0.00
17999     Skin tissue procedure                  T            1          0000        0.0000            0.00         0.00         0.00
19000     Drainage of breast lesion              T            T          0004        1.7771           81.92        186.79       214.11
19001     Drain breast lesion add-on             T            T          0004        1.7771           81.92        186.79       214.11
19020     Incision of breast lesion              T            T          0008       16.2953           751.21      1,712.80     1,963.26
19030     Injection for breast x-ray             N            N          0000        0.0000            0.00         0.00         0.00
19100     Bx breast percut w/o image             T            T          0005        3.5834           165.19       376.65       431.73
19101     Biopsy of breast, open                 T            T          0028       19.4351           895.96      2,042.82     2,341.54
19102     Bx breast percut w/image               T            T          0005        3.5834           165.19       376.65       431.73
19103     Bx breast percut w/device              T            T          0658        5.9888           276.08       629.48       721.53
19110     Nipple exploration                     T            T          0028       19.4351           895.96      2,042.82     2,341.54
19112     Excise breast duct fistula             T            T          0028       19.4351           895.96      2,042.82     2,341.54
19120     Removal of breast lesion               T            T          0028       19.4351           895.96      2,042.82     2,341.54
19125     Excision, breast lesion                T            T          0028       19.4351           895.96      2,042.82     2,341.54
19126     Excision, addl breast lesion           T            T          0028       19.4351           895.96      2,042.82     2,341.54
19140     Removal of breast tissue               T            1          0028       19.4351            0.00         0.00         0.00          X
19160     Partial mastectomy                     T            1          0028       19.4351            0.00         0.00         0.00          X
19162     P-mastectomy w/ln removal              T            1          0693       42.2886            0.00         0.00         0.00          X
19180     Removal of breast                      T            1          0029       31.4826            0.00         0.00         0.00          X
19182     Removal of breast                      T            1          0029       31.4826            0.00         0.00         0.00          X
19200     Removal of breast                      C            1          0000        0.0000            0.00         0.00         0.00          X
19220     Removal of breast                      C            1          0000        0.0000            0.00         0.00         0.00          X
19240     Removal of breast                      T            1          0030       39.9779            0.00         0.00         0.00          X
19260     Removal of chest wall lesion           T            T          0021       14.9984           691.43      1,576.48     1,807.01
19271     Revision of chest wall                 C            C          0000        0.0000            0.00         0.00         0.00
19272     Extensive chest wall surgery           C            C          0000        0.0000            0.00         0.00         0.00
19290     Place needle wire, breast              N            N          0000        0.0000            0.00         0.00         0.00
19291     Place needle wire, breast              N            N          0000        0.0000            0.00         0.00         0.00
19295     Place breast clip, percut              S            S          0657        1.6092           74.18        169.14       193.88
19296     Place po breast cath for rad           S            S          1524       54.6118     *    2,517.60     5,740.25     6,579.63
19297     Place breast cath for rad              S            S          1523       46.2099     *    2,130.28     4,857.12     5,567.37
19298     Place breast rad tube/caths            S            S          1524       54.6118     *    2,517.60     5,740.25     6,579.63
19316     Suspension of breast                   T            T          0029       31.4826          1,451.35     3,309.14     3,793.02
19318     Reduction of large breast              T            T          0693       42.2886          1,949.50     4,444.95     5,094.93
19324     Enlarge breast                         T            1          0000        0.0000            0.00         0.00         0.00
19325     Enlarge breast with implant            T            T          0648       53.5307          2,467.77     5,626.61     6,449.38
19328     Removal of breast implant              T            T          0029       31.4826          1,451.35     3,309.14     3,793.02
19330     Removal of implant material            T            T          0029       31.4826          1,451.35     3,309.14     3,793.02
19340     Immediate breast prosthesis            T            T          0030       39.9779          1,842.98     4,202.08     4,816.54
19342     Delayed breast prosthesis              T            T          0648       53.5307          2,467.77     5,626.61     6,449.38
19350     Breast reconstruction                  T            T          0028       19.4351           895.96      2,042.82     2,341.54
19355     Correct inverted nipple(s)             T            1          0000        0.0000            0.00         0.00         0.00
19357     Breast reconstruction                  T            T          0648       53.5307          2,467.77     5,626.61     6,449.38
19361     Breast reconstruction                  C            C          0000        0.0000            0.00         0.00         0.00
19364     Breast reconstruction                  C            C          0000        0.0000            0.00         0.00         0.00
19366     Breast reconstruction                  T            T          0029       31.4826          1,451.35     3,309.14     3,793.02
19367     Breast reconstruction                  C            C          0000        0.0000            0.00         0.00         0.00
19368     Breast reconstruction                  C            C          0000        0.0000            0.00         0.00         0.00
19369     Breast reconstruction                  C            C          0000        0.0000            0.00         0.00         0.00
19370     Surgery of breast capsule              T            T          0029       31.4826          1,451.35     3,309.14     3,793.02
19371     Removal of breast capsule              T            T          0029       31.4826          1,451.35     3,309.14     3,793.02
19380     Revise breast reconstruction           T            T          0030       39.9779          1,842.98     4,202.08     4,816.54
19396     Design custom breast implant           T            T          0029       31.4826          1,451.35     3,309.14     3,793.02
19499     Breast surgery procedure               T            1          0000        0.0000            0.00         0.00         0.00
20000     Incision of abscess                    T            T          0006        1.5100           69.61        158.72       181.92
20005     Incision of deep abscess               T            T          0049       20.3891           939.94      2,143.10     2,456.48
20100     Explore wound, neck                    T            T          0023        4.7662           219.72       500.98       574.23
20101     Explore wound, chest                   T            T          0027       18.1956           838.82      1,912.54     2,192.21
20102     Explore wound, abdomen                 T            T          0027       18.1956           838.82      1,912.54     2,192.21
20103     Explore wound, extremity               T            T          0023        4.7662           219.72       500.98       574.23
20150     Excise epiphyseal bar                  T            T          0051       36.6106          1,687.75     3,848.14     4,410.85
20200     Muscle biopsy                          T            T          0021       14.9984           691.43      1,576.48     1,807.01
20205     Deep muscle biopsy                     T            T          0021       14.9984           691.43      1,576.48     1,807.01
20206     Needle biopsy, muscle                  T            T          0005        3.5834           165.19       376.65       431.73
20220     Bone biopsy, trocar/needle             T            T          0019        4.1481           191.23       436.01       499.76

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                       9 of 171
State of Wyoming Oupatient Prospective Payment System                                                                            Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                               Critical
                                               October                                               General     Children's                Change
                                                           WY 2007                                                             Access
  CPT/                                           2006                             APC Relative       Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                   Hospital
 HCPCS                                          Status                              Weight          Outpatient   Outpatient                 2006
                                                           Indicator                                                          Outpatient
                                              Indicator                                                Fee          Fee                   Schedule
                                                                                                                                 Fee
                                             (FYI Only)
20225     Bone biopsy, trocar/needle             T            T          0020        6.9410           319.98       729.57       836.25
20240     Bone biopsy, excisional                T            T          0022       19.5716           902.25      2,057.17     2,357.99
20245     Bone biopsy, excisional                T            T          0022       19.5716           902.25      2,057.17     2,357.99
20250     Open bone biopsy                       T            T          0049       20.3891           939.94      2,143.10     2,456.48
20251     Open bone biopsy                       T            T          0049       20.3891           939.94      2,143.10     2,456.48
20500     Injection of sinus tract               T            T          0251        2.0789           95.84        218.51       250.47
20501     Inject sinus tract for x-ray           N            N          0000        0.0000            0.00         0.00         0.00
20520     Removal of foreign body                T            T          0019        4.1481           191.23       436.01       499.76
20525     Removal of foreign body                T            T          0022       19.5716           902.25      2,057.17     2,357.99
20526     Ther injection, carp tunnel            T            T          0204        2.2667           104.49       238.25       273.09
20550     Inj tendon sheath/ligament             T            T          0204        2.2667           104.49       238.25       273.09
20551     Inj tendon origin/insertion            T            T          0204        2.2667           104.49       238.25       273.09
20552     Inj trigger point, 1/2 muscl           T            T          0204        2.2667           104.49       238.25       273.09
20553     Inject trigger points, =/> 3           T            T          0204        2.2667           104.49       238.25       273.09
20600     Drain/inject, joint/bursa              T            T          0204        2.2667           104.49       238.25       273.09
20605     Drain/inject, joint/bursa              T            T          0204        2.2667           104.49       238.25       273.09
20610     Drain/inject, joint/bursa              T            T          0204        2.2667           104.49       238.25       273.09
20612     Aspirate/inj ganglion cyst             T            T          0204        2.2667           104.49       238.25       273.09
20615     Treatment of bone cyst                 T            T          0004        1.7771           81.92        186.79       214.11
20650     Insert and remove bone pin             T            T          0049       20.3891           939.94      2,143.10     2,456.48
20660     Apply, rem fixation device             C            C          0000        0.0000            0.00         0.00         0.00
20661     Application of head brace              C            C          0000        0.0000            0.00         0.00         0.00
20662     Application of pelvis brace            T            T          0049       20.3891           939.94      2,143.10     2,456.48
20663     Application of thigh brace             T            T          0049       20.3891           939.94      2,143.10     2,456.48
20664     Halo brace application                 C            C          0000        0.0000            0.00         0.00         0.00
20665     Removal of fixation device             X            X          0340        0.6137           28.29        64.51        73.94
20670     Removal of support implant             T            T          0021       14.9984           691.43      1,576.48     1,807.01
20680     Removal of support implant             T            T          0022       19.5716           902.25      2,057.17     2,357.99
20690     Apply bone fixation device             T            T          0050       23.9367          1,103.48     2,515.99     2,883.89
20692     Apply bone fixation device             T            T          0050       23.9367          1,103.48     2,515.99     2,883.89
20693     Adjust bone fixation device            T            T          0049       20.3891           939.94      2,143.10     2,456.48
20694     Remove bone fixation device            T            T          0049       20.3891           939.94      2,143.10     2,456.48
20802     Replantation, arm, complete            C            C          0000        0.0000            0.00         0.00         0.00
20805     Replant forearm, complete              C            C          0000        0.0000            0.00         0.00         0.00
20808     Replantation hand, complete            C            C          0000        0.0000            0.00         0.00         0.00
20816     Replantation digit, complete           C            C          0000        0.0000            0.00         0.00         0.00
20822     Replantation digit, complete           T            T          0054       25.1321          1,158.59     2,641.64     3,027.92
20824     Replantation thumb, complete           C            C          0000        0.0000            0.00         0.00         0.00
20827     Replantation thumb, complete           C            C          0000        0.0000            0.00         0.00         0.00
20838     Replantation foot, complete            C            C          0000        0.0000            0.00         0.00         0.00
20900     Removal of bone for graft              T            T          0050       23.9367          1,103.48     2,515.99     2,883.89
20902     Removal of bone for graft              T            T          0050       23.9367          1,103.48     2,515.99     2,883.89
20910     Remove cartilage for graft             T            T          0027       18.1956           838.82      1,912.54     2,192.21
20912     Remove cartilage for graft             T            T          0027       18.1956           838.82      1,912.54     2,192.21
20920     Removal of fascia for graft            T            T          0686       13.4973           622.23      1,418.70     1,626.15
20922     Removal of fascia for graft            T            T          0027       18.1956           838.82      1,912.54     2,192.21
20924     Removal of tendon for graft            T            T          0050       23.9367          1,103.48     2,515.99     2,883.89
20926     Removal of tissue for graft            T            T          0686       13.4973           622.23      1,418.70     1,626.15
20930     Spinal bone allograft                  C            C          0000        0.0000            0.00         0.00         0.00
20931     Spinal bone allograft                  C            C          0000        0.0000            0.00         0.00         0.00
20936     Spinal bone autograft                  C            C          0000        0.0000            0.00         0.00         0.00
20937     Spinal bone autograft                  C            C          0000        0.0000            0.00         0.00         0.00
20938     Spinal bone autograft                  C            C          0000        0.0000            0.00         0.00         0.00
20950     Fluid pressure, muscle                 T            T          0006        1.5100           69.61        158.72       181.92
20955     Fibula bone graft, microvasc           C            C          0000        0.0000            0.00         0.00         0.00
20956     Iliac bone graft, microvasc            C            C          0000        0.0000            0.00         0.00         0.00
20957     Mt bone graft, microvasc               C            C          0000        0.0000            0.00         0.00         0.00
20962     Other bone graft, microvasc            C            C          0000        0.0000            0.00         0.00         0.00
20969     Bone/skin graft, microvasc             C            C          0000        0.0000            0.00         0.00         0.00
20970     Bone/skin graft, iliac crest           C            C          0000        0.0000            0.00         0.00         0.00
20972     Bone/skin graft, metatarsal            T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
20973     Bone/skin graft, great toe             T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
20974     Electrical bone stimulation            A            3          0000        0.0000            M01          M01          M01
20975     Electrical bone stimulation            X            X          0340        0.6137           28.29        64.51        73.94
20979     Us bone stimulation                    X            X          0340        0.6137           28.29        64.51        73.94
20982     Ablate, bone tumor(s) perq             T            T          1557       31.0867     *    1,433.10     3,267.52     3,745.33
20999     Musculoskeletal surgery                T            1          0000        0.0000            0.00         0.00         0.00
21010     Incision of jaw joint                  T            T          0254       23.3114          1,074.66     2,450.26     2,808.56
21015     Resection of facial tumor              T            T          0253       16.0740           741.01      1,689.54     1,936.60
21025     Excision of bone, lower jaw            T            T          0256       37.0000          1,705.70     3,889.07     4,457.76
21026     Excision of facial bone(s)             T            T          0256       37.0000          1,705.70     3,889.07     4,457.76
21029     Contour of face bone lesion            T            T          0256       37.0000          1,705.70     3,889.07     4,457.76
21030     Excise max/zygoma b9 tumor             T            T          0254       23.3114          1,074.66     2,450.26     2,808.56
21031     Remove exostosis, mandible             T            T          0254       23.3114          1,074.66     2,450.26     2,808.56
21032     Remove exostosis, maxilla              T            T          0254       23.3114          1,074.66     2,450.26     2,808.56
21034     Excise max/zygoma mlg tumor            T            T          0256       37.0000          1,705.70     3,889.07     4,457.76
21040     Excise mandible lesion                 T            T          0254       23.3114          1,074.66     2,450.26     2,808.56

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                      10 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
21044     Removal of jaw bone lesion             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21045     Extensive jaw surgery                  C            C          0000        0.0000         0.00         0.00         0.00
21046     Remove mandible cyst complex           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21047     Excise lwr jaw cyst w/repair           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21048     Remove maxilla cyst complex            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21049     Excis uppr jaw cyst w/repair           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21050     Removal of jaw joint                   T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21060     Remove jaw joint cartilage             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21070     Remove coronoid process                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21076     Prepare face/oral prosthesis           T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21077     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21079     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21080     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21081     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21082     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21083     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21084     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21085     Prepare face/oral prosthesis           T            T          0253       16.0740        741.01      1,689.54     1,936.60
21086     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21087     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21088     Prepare face/oral prosthesis           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21089     Prepare face/oral prosthesis           T            1          0000        0.0000         0.00         0.00         0.00
21100     Maxillofacial fixation                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21110     Interdental fixation                   T            T          0252        8.1033        373.56       851.74       976.29
21116     Injection, jaw joint x-ray             N            N          0000        0.0000         0.00         0.00         0.00
21120     Reconstruction of chin                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21121     Reconstruction of chin                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21122     Reconstruction of chin                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21123     Reconstruction of chin                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21125     Augmentation, lower jaw bone           T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21127     Augmentation, lower jaw bone           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21137     Reduction of forehead                  T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21138     Reduction of forehead                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21139     Reduction of forehead                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21141     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21142     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21143     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21145     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21146     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21147     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21150     Reconstruct midface, lefort            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21151     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21154     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21155     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21159     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21160     Reconstruct midface, lefort            C            C          0000        0.0000         0.00         0.00         0.00
21172     Reconstruct orbit/forehead             C            C          0000        0.0000         0.00         0.00         0.00
21175     Reconstruct orbit/forehead             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21179     Reconstruct entire forehead            C            C          0000        0.0000         0.00         0.00         0.00
21180     Reconstruct entire forehead            C            C          0000        0.0000         0.00         0.00         0.00
21181     Contour cranial bone lesion            T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21182     Reconstruct cranial bone               C            C          0000        0.0000         0.00         0.00         0.00
21183     Reconstruct cranial bone               C            C          0000        0.0000         0.00         0.00         0.00
21184     Reconstruct cranial bone               C            C          0000        0.0000         0.00         0.00         0.00
21188     Reconstruction of midface              C            C          0000        0.0000         0.00         0.00         0.00
21193     Reconst lwr jaw w/o graft              C            C          0000        0.0000         0.00         0.00         0.00
21194     Reconst lwr jaw w/graft                C            C          0000        0.0000         0.00         0.00         0.00
21195     Reconst lwr jaw w/o fixation           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21196     Reconst lwr jaw w/fixation             C            C          0000        0.0000         0.00         0.00         0.00
21198     Reconstr lwr jaw segment               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21199     Reconstr lwr jaw w/advance             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21206     Reconstruct upper jaw bone             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21208     Augmentation of facial bones           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21209     Reduction of facial bones              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21210     Face bone graft                        T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21215     Lower jaw bone graft                   T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21230     Rib cartilage graft                    T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21235     Ear cartilage graft                    T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21240     Reconstruction of jaw joint            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21242     Reconstruction of jaw joint            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21243     Reconstruction of jaw joint            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21244     Reconstruction of lower jaw            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21245     Reconstruction of jaw                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21246     Reconstruction of jaw                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21247     Reconstruct lower jaw bone             C            C          0000        0.0000         0.00         0.00         0.00
21248     Reconstruction of jaw                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21249     Reconstruction of jaw                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   11 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
21255     Reconstruct lower jaw bone             C            C          0000        0.0000         0.00         0.00         0.00
21256     Reconstruction of orbit                C            C          0000        0.0000         0.00         0.00         0.00
21260     Revise eye sockets                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21261     Revise eye sockets                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21263     Revise eye sockets                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21267     Revise eye sockets                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21268     Revise eye sockets                     C            C          0000        0.0000         0.00         0.00         0.00
21270     Augmentation, cheek bone               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21275     Revision, orbitofacial bones           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21280     Revision of eyelid                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21282     Revision of eyelid                     T            T          0253       16.0740        741.01      1,689.54     1,936.60
21295     Revision of jaw muscle/bone            T            T          0252        8.1033        373.56       851.74       976.29
21296     Revision of jaw muscle/bone            T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21299     Cranio/maxillofacial surgery           T            1          0000        0.0000         0.00         0.00         0.00
21300     Treatment of skull fracture            T            1          0253       16.0740         0.00         0.00         0.00          X
21310     Treatment of nose fracture             T            T          0251        2.0789        95.84        218.51       250.47
21315     Treatment of nose fracture             T            T          0251        2.0789        95.84        218.51       250.47
21320     Treatment of nose fracture             T            T          0252        8.1033        373.56       851.74       976.29
21325     Treatment of nose fracture             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21330     Treatment of nose fracture             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21335     Treatment of nose fracture             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21336     Treat nasal septal fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
21337     Treat nasal septal fracture            T            T          0253       16.0740        741.01      1,689.54     1,936.60
21338     Treat nasoethmoid fracture             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21339     Treat nasoethmoid fracture             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21340     Treatment of nose fracture             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21343     Treatment of sinus fracture            C            C          0000        0.0000         0.00         0.00         0.00
21344     Treatment of sinus fracture            C            C          0000        0.0000         0.00         0.00         0.00
21345     Treat nose/jaw fracture                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21346     Treat nose/jaw fracture                C            C          0000        0.0000         0.00         0.00         0.00
21347     Treat nose/jaw fracture                C            C          0000        0.0000         0.00         0.00         0.00
21348     Treat nose/jaw fracture                C            C          0000        0.0000         0.00         0.00         0.00
21355     Treat cheek bone fracture              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21356     Treat cheek bone fracture              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21360     Treat cheek bone fracture              C            C          0000        0.0000         0.00         0.00         0.00
21365     Treat cheek bone fracture              C            C          0000        0.0000         0.00         0.00         0.00
21366     Treat cheek bone fracture              C            C          0000        0.0000         0.00         0.00         0.00
21385     Treat eye socket fracture              C            C          0000        0.0000         0.00         0.00         0.00
21386     Treat eye socket fracture              C            C          0000        0.0000         0.00         0.00         0.00
21387     Treat eye socket fracture              C            C          0000        0.0000         0.00         0.00         0.00
21390     Treat eye socket fracture              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21395     Treat eye socket fracture              C            C          0000        0.0000         0.00         0.00         0.00
21400     Treat eye socket fracture              T            T          0252        8.1033        373.56       851.74       976.29
21401     Treat eye socket fracture              T            T          0253       16.0740        741.01      1,689.54     1,936.60
21406     Treat eye socket fracture              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21407     Treat eye socket fracture              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21408     Treat eye socket fracture              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21421     Treat mouth roof fracture              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21422     Treat mouth roof fracture              C            C          0000        0.0000         0.00         0.00         0.00
21423     Treat mouth roof fracture              C            C          0000        0.0000         0.00         0.00         0.00
21431     Treat craniofacial fracture            C            C          0000        0.0000         0.00         0.00         0.00
21432     Treat craniofacial fracture            C            C          0000        0.0000         0.00         0.00         0.00
21433     Treat craniofacial fracture            C            C          0000        0.0000         0.00         0.00         0.00
21435     Treat craniofacial fracture            C            C          0000        0.0000         0.00         0.00         0.00
21436     Treat craniofacial fracture            C            C          0000        0.0000         0.00         0.00         0.00
21440     Treat dental ridge fracture            T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21445     Treat dental ridge fracture            T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21450     Treat lower jaw fracture               T            T          0251        2.0789        95.84        218.51       250.47
21451     Treat lower jaw fracture               T            T          0252        8.1033        373.56       851.74       976.29
21452     Treat lower jaw fracture               T            T          0253       16.0740        741.01      1,689.54     1,936.60
21453     Treat lower jaw fracture               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21454     Treat lower jaw fracture               T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
21461     Treat lower jaw fracture               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21462     Treat lower jaw fracture               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21465     Treat lower jaw fracture               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21470     Treat lower jaw fracture               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21480     Reset dislocated jaw                   T            T          0251        2.0789        95.84        218.51       250.47
21485     Reset dislocated jaw                   T            T          0253       16.0740        741.01      1,689.54     1,936.60
21490     Repair dislocated jaw                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
21495     Treat hyoid bone fracture              T            T          0253       16.0740        741.01      1,689.54     1,936.60
21497     Interdental wiring                     T            T          0253       16.0740        741.01      1,689.54     1,936.60
21499     Head surgery procedure                 T            1          0000        0.0000         0.00         0.00         0.00
21501     Drain neck/chest lesion                T            T          0008       16.2953        751.21      1,712.80     1,963.26
21502     Drain chest lesion                     T            T          0049       20.3891        939.94      2,143.10     2,456.48
21510     Drainage of bone lesion                C            C          0000        0.0000         0.00         0.00         0.00
21550     Biopsy of neck/chest                   T            T          0021       14.9984        691.43      1,576.48     1,807.01
21555     Remove lesion, neck/chest              T            T          0022       19.5716        902.25      2,057.17     2,357.99

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   12 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
21556     Remove lesion, neck/chest              T            T          0022       19.5716        902.25      2,057.17     2,357.99
21557     Remove tumor, neck/chest               T            T          0022       19.5716        902.25      2,057.17     2,357.99
21600     Partial removal of rib                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
21610     Partial removal of rib                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
21615     Removal of rib                         C            C          0000        0.0000         0.00         0.00         0.00
21616     Removal of rib and nerves              C            C          0000        0.0000         0.00         0.00         0.00
21620     Partial removal of sternum             C            C          0000        0.0000         0.00         0.00         0.00
21627     Sternal debridement                    C            C          0000        0.0000         0.00         0.00         0.00
21630     Extensive sternum surgery              C            C          0000        0.0000         0.00         0.00         0.00
21632     Extensive sternum surgery              C            C          0000        0.0000         0.00         0.00         0.00
21685     Hyoid myotomy & suspension             T            T          0252        8.1033        373.56       851.74       976.29
21700     Revision of neck muscle                T            T          0049       20.3891        939.94      2,143.10     2,456.48
21705     Revision of neck muscle/rib            C            C          0000        0.0000         0.00         0.00         0.00
21720     Revision of neck muscle                T            T          0049       20.3891        939.94      2,143.10     2,456.48
21725     Revision of neck muscle                T            T          0006        1.5100        69.61        158.72       181.92
21740     Reconstruction of sternum              C            C          0000        0.0000         0.00         0.00         0.00
21742     Repair stern/nuss w/o scope            T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
21743     Repair sternum/nuss w/scope            T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
21750     Repair of sternum separation           C            C          0000        0.0000         0.00         0.00         0.00
21800     Treatment of rib fracture              T            T          0043        1.7200        79.29        180.79       207.23
21805     Treatment of rib fracture              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
21810     Treatment of rib fracture(s)           C            C          0000        0.0000         0.00         0.00         0.00
21820     Treat sternum fracture                 T            T          0043        1.7200        79.29        180.79       207.23
21825     Treat sternum fracture                 C            C          0000        0.0000         0.00         0.00         0.00
21899     Neck/chest surgery procedure           T            1          0000        0.0000         0.00         0.00         0.00
21920     Biopsy soft tissue of back             T            T          0020        6.9410        319.98       729.57       836.25
21925     Biopsy soft tissue of back             T            T          0022       19.5716        902.25      2,057.17     2,357.99
21930     Remove lesion, back or flank           T            T          0022       19.5716        902.25      2,057.17     2,357.99
21935     Remove tumor, back                     T            T          0022       19.5716        902.25      2,057.17     2,357.99
22010     I&d, p-spine, c/t/cerv-thor            C            C          0000        0.0000         0.00         0.00         0.00
22015     I&d, p-spine, l/s/ls                   C            C          0000        0.0000         0.00         0.00         0.00
22100     Remove part of neck vertebra           T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
22101     Remove part, thorax vertebra           T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
22102     Remove part, lumbar vertebra           T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
22103     Remove extra spine segment             T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
22110     Remove part of neck vertebra           C            C          0000        0.0000         0.00         0.00         0.00
22112     Remove part, thorax vertebra           C            C          0000        0.0000         0.00         0.00         0.00
22114     Remove part, lumbar vertebra           C            C          0000        0.0000         0.00         0.00         0.00
22116     Remove extra spine segment             C            C          0000        0.0000         0.00         0.00         0.00
22210     Revision of neck spine                 C            C          0000        0.0000         0.00         0.00         0.00
22212     Revision of thorax spine               C            C          0000        0.0000         0.00         0.00         0.00
22214     Revision of lumbar spine               C            C          0000        0.0000         0.00         0.00         0.00
22216     Revise, extra spine segment            C            C          0000        0.0000         0.00         0.00         0.00
22220     Revision of neck spine                 C            C          0000        0.0000         0.00         0.00         0.00
22222     Revision of thorax spine               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
22224     Revision of lumbar spine               C            C          0000        0.0000         0.00         0.00         0.00
22226     Revise, extra spine segment            C            C          0000        0.0000         0.00         0.00         0.00
22305     Treat spine process fracture           T            T          0043        1.7200        79.29        180.79       207.23
22310     Treat spine fracture                   T            T          0043        1.7200        79.29        180.79       207.23
22315     Treat spine fracture                   T            T          0043        1.7200        79.29        180.79       207.23
22318     Treat odontoid fx w/o graft            C            C          0000        0.0000         0.00         0.00         0.00
22319     Treat odontoid fx w/graft              C            C          0000        0.0000         0.00         0.00         0.00
22325     Treat spine fracture                   C            C          0000        0.0000         0.00         0.00         0.00
22326     Treat neck spine fracture              C            C          0000        0.0000         0.00         0.00         0.00
22327     Treat thorax spine fracture            C            C          0000        0.0000         0.00         0.00         0.00
22328     Treat each add spine fx                C            C          0000        0.0000         0.00         0.00         0.00
22505     Manipulation of spine                  T            T          0045       14.3413        661.13      1,507.41     1,727.84
22520     Percut vertebroplasty thor             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
22521     Percut vertebroplasty lumb             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
22522     Percut vertebroplasty add’l            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
22523     Percut kyphoplasty, thor               T            T          0052       43.5555       2,007.91     4,578.12     5,247.57
22524     Percut kyphoplasty, lumbar             T            T          0052       43.5555       2,007.91     4,578.12     5,247.57
22525     Percut kyphoplasty, add-on             T            T          0052       43.5555       2,007.91     4,578.12     5,247.57
22532     Lat thorax spine fusion                C            C          0000        0.0000         0.00         0.00         0.00
22533     Lat lumbar spine fusion                C            C          0000        0.0000         0.00         0.00         0.00
22534     Lat thor/lumb, add’l seg               C            C          0000        0.0000         0.00         0.00         0.00
22548     Neck spine fusion                      C            C          0000        0.0000         0.00         0.00         0.00
22554     Neck spine fusion                      C            C          0000        0.0000         0.00         0.00         0.00
22556     Thorax spine fusion                    C            C          0000        0.0000         0.00         0.00         0.00
22558     Lumbar spine fusion                    C            C          0000        0.0000         0.00         0.00         0.00
22585     Additional spinal fusion               C            C          0000        0.0000         0.00         0.00         0.00
22590     Spine & skull spinal fusion            C            C          0000        0.0000         0.00         0.00         0.00
22595     Neck spinal fusion                     C            C          0000        0.0000         0.00         0.00         0.00
22600     Neck spine fusion                      C            C          0000        0.0000         0.00         0.00         0.00
22610     Thorax spine fusion                    C            C          0000        0.0000         0.00         0.00         0.00
22612     Lumbar spine fusion                    T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
22614     Spine fusion, extra segment            T            T          0208       42.5200       1,960.17     4,469.28     5,122.81

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   13 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
22630     Lumbar spine fusion                    C            C          0000        0.0000         0.00         0.00         0.00
22632     Spine fusion, extra segment            C            C          0000        0.0000         0.00         0.00         0.00
22800     Fusion of spine                        C            C          0000        0.0000         0.00         0.00         0.00
22802     Fusion of spine                        C            C          0000        0.0000         0.00         0.00         0.00
22804     Fusion of spine                        C            C          0000        0.0000         0.00         0.00         0.00
22808     Fusion of spine                        C            C          0000        0.0000         0.00         0.00         0.00
22810     Fusion of spine                        C            C          0000        0.0000         0.00         0.00         0.00
22812     Fusion of spine                        C            C          0000        0.0000         0.00         0.00         0.00
22818     Kyphectomy, 1-2 segments               C            C          0000        0.0000         0.00         0.00         0.00
22819     Kyphectomy, 3 or more                  C            C          0000        0.0000         0.00         0.00         0.00
22830     Exploration of spinal fusion           C            C          0000        0.0000         0.00         0.00         0.00
22840     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22841     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22842     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22843     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22844     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22845     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22846     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22847     Insert spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22848     Insert pelv fixation device            C            C          0000        0.0000         0.00         0.00         0.00
22849     Reinsert spinal fixation               C            C          0000        0.0000         0.00         0.00         0.00
22850     Remove spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22851     Apply spine prosth device              C            C          0000        0.0000         0.00         0.00         0.00
22852     Remove spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22855     Remove spine fixation device           C            C          0000        0.0000         0.00         0.00         0.00
22899     Spine surgery procedure                T            1          0000        0.0000         0.00         0.00         0.00
22900     Remove abdominal wall lesion           T            T          0022       19.5716        902.25      2,057.17     2,357.99
22999     Abdomen surgery procedure              T            1          0000        0.0000         0.00         0.00         0.00
23000     Removal of calcium deposits            T            T          0021       14.9984        691.43      1,576.48     1,807.01
23020     Release shoulder joint                 T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
23030     Drain shoulder lesion                  T            T          0008       16.2953        751.21      1,712.80     1,963.26
23031     Drain shoulder bursa                   T            T          0008       16.2953        751.21      1,712.80     1,963.26
23035     Drain shoulder bone lesion             T            T          0049       20.3891        939.94      2,143.10     2,456.48
23040     Exploratory shoulder surgery           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23044     Exploratory shoulder surgery           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23065     Biopsy shoulder tissues                T            T          0021       14.9984        691.43      1,576.48     1,807.01
23066     Biopsy shoulder tissues                T            T          0022       19.5716        902.25      2,057.17     2,357.99
23075     Removal of shoulder lesion             T            T          0021       14.9984        691.43      1,576.48     1,807.01
23076     Removal of shoulder lesion             T            T          0022       19.5716        902.25      2,057.17     2,357.99
23077     Remove tumor of shoulder               T            T          0022       19.5716        902.25      2,057.17     2,357.99
23100     Biopsy of shoulder joint               T            T          0049       20.3891        939.94      2,143.10     2,456.48
23101     Shoulder joint surgery                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23105     Remove shoulder joint lining           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23106     Incision of collarbone joint           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23107     Explore treat shoulder joint           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23120     Partial removal, collar bone           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
23125     Removal of collar bone                 T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
23130     Remove shoulder bone, part             T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
23140     Removal of bone lesion                 T            T          0049       20.3891        939.94      2,143.10     2,456.48
23145     Removal of bone lesion                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23146     Removal of bone lesion                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23150     Removal of humerus lesion              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23155     Removal of humerus lesion              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23156     Removal of humerus lesion              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23170     Remove collar bone lesion              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23172     Remove shoulder blade lesion           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23174     Remove humerus lesion                  T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23180     Remove collar bone lesion              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23182     Remove shoulder blade lesion           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23184     Remove humerus lesion                  T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23190     Partial removal of scapula             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23195     Removal of head of humerus             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23200     Removal of collar bone                 C            C          0000        0.0000         0.00         0.00         0.00
23210     Removal of shoulder blade              C            C          0000        0.0000         0.00         0.00         0.00
23220     Partial removal of humerus             C            C          0000        0.0000         0.00         0.00         0.00
23221     Partial removal of humerus             C            C          0000        0.0000         0.00         0.00         0.00
23222     Partial removal of humerus             C            C          0000        0.0000         0.00         0.00         0.00
23330     Remove shoulder foreign body           T            T          0020        6.9410        319.98       729.57       836.25
23331     Remove shoulder foreign body           T            T          0022       19.5716        902.25      2,057.17     2,357.99
23332     Remove shoulder foreign body           C            C          0000        0.0000         0.00         0.00         0.00
23350     Injection for shoulder x-ray           N            N          0000        0.0000         0.00         0.00         0.00
23395     Muscle transfer,shoulder/arm           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
23397     Muscle transfers                       T            T          0052       43.5555       2,007.91     4,578.12     5,247.57
23400     Fixation of shoulder blade             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23405     Incision of tendon & muscle            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23406     Incise tendon(s) & muscle(s)           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
23410     Repair rotator cuff, acute             T            T          0052       43.5555       2,007.91     4,578.12     5,247.57

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   14 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
23412     Repair rotator cuff, chronic           T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23415     Release of shoulder ligament           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
23420     Repair of shoulder                     T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23430     Repair biceps tendon                   T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23440     Remove/transplant tendon               T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23450     Repair shoulder capsule                T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23455     Repair shoulder capsule                T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23460     Repair shoulder capsule                T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23462     Repair shoulder capsule                T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23465     Repair shoulder capsule                T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23466     Repair shoulder capsule                T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
23470     Reconstruct shoulder joint             T            T          0425      104.7352       4,828.29    11,008.72    12,618.50
23472     Reconstruct shoulder joint             C            C          0000       0.0000          0.00         0.00         0.00
23480     Revision of collar bone                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
23485     Revision of collar bone                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
23490     Reinforce clavicle                     T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
23491     Reinforce shoulder bones               T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
23500     Treat clavicle fracture                T            T          0043       1.7200         79.29        180.79       207.23
23505     Treat clavicle fracture                T            T          0043       1.7200         79.29        180.79       207.23
23515     Treat clavicle fracture                T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23520     Treat clavicle dislocation             T            T          0043       1.7200         79.29        180.79       207.23
23525     Treat clavicle dislocation             T            T          0043       1.7200         79.29        180.79       207.23
23530     Treat clavicle dislocation             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23532     Treat clavicle dislocation             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23540     Treat clavicle dislocation             T            T          0043       1.7200         79.29        180.79       207.23
23545     Treat clavicle dislocation             T            T          0043       1.7200         79.29        180.79       207.23
23550     Treat clavicle dislocation             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23552     Treat clavicle dislocation             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23570     Treat shoulder blade fx                T            T          0043       1.7200         79.29        180.79       207.23
23575     Treat shoulder blade fx                T            T          0043       1.7200         79.29        180.79       207.23
23585     Treat scapula fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23600     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
23605     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
23615     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23616     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23620     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
23625     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
23630     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23650     Treat shoulder dislocation             T            T          0043       1.7200         79.29        180.79       207.23
23655     Treat shoulder dislocation             T            T          0045      14.3413         661.13      1,507.41     1,727.84
23660     Treat shoulder dislocation             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23665     Treat dislocation/fracture             T            T          0043       1.7200         79.29        180.79       207.23
23670     Treat dislocation/fracture             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23675     Treat dislocation/fracture             T            T          0043       1.7200         79.29        180.79       207.23
23680     Treat dislocation/fracture             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
23700     Fixation of shoulder                   T            T          0045      14.3413         661.13      1,507.41     1,727.84
23800     Fusion of shoulder joint               T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
23802     Fusion of shoulder joint               T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
23900     Amputation of arm & girdle             C            C          0000       0.0000          0.00         0.00         0.00
23920     Amputation at shoulder joint           C            C          0000       0.0000          0.00         0.00         0.00
23921     Amputation follow-up surgery           T            T          0025       5.3051         244.57       557.62       639.16
23929     Shoulder surgery procedure             T            1          0000       0.0000          0.00         0.00         0.00
23930     Drainage of arm lesion                 T            T          0008      16.2953         751.21      1,712.80     1,963.26
23931     Drainage of arm bursa                  T            T          0008      16.2953         751.21      1,712.80     1,963.26
23935     Drain arm/elbow bone lesion            T            T          0049      20.3891         939.94      2,143.10     2,456.48
24000     Exploratory elbow surgery              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24006     Release elbow joint                    T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24065     Biopsy arm/elbow soft tissue           T            T          0021      14.9984         691.43      1,576.48     1,807.01
24066     Biopsy arm/elbow soft tissue           T            T          0021      14.9984         691.43      1,576.48     1,807.01
24075     Remove arm/elbow lesion                T            T          0021      14.9984         691.43      1,576.48     1,807.01
24076     Remove arm/elbow lesion                T            T          0022      19.5716         902.25      2,057.17     2,357.99
24077     Remove tumor of arm/elbow              T            T          0022      19.5716         902.25      2,057.17     2,357.99
24100     Biopsy elbow joint lining              T            T          0049      20.3891         939.94      2,143.10     2,456.48
24101     Explore/treat elbow joint              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24102     Remove elbow joint lining              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24105     Removal of elbow bursa                 T            T          0049      20.3891         939.94      2,143.10     2,456.48
24110     Remove humerus lesion                  T            T          0049      20.3891         939.94      2,143.10     2,456.48
24115     Remove/graft bone lesion               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24116     Remove/graft bone lesion               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24120     Remove elbow lesion                    T            T          0049      20.3891         939.94      2,143.10     2,456.48
24125     Remove/graft bone lesion               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24126     Remove/graft bone lesion               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24130     Removal of head of radius              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24134     Removal of arm bone lesion             T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24136     Remove radius bone lesion              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24138     Remove elbow bone lesion               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24140     Partial removal of arm bone            T            T          0050      23.9367        1,103.48     2,515.99     2,883.89

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   15 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
24145     Partial removal of radius              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24147     Partial removal of elbow               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24149     Radical resection of elbow             T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24150     Extensive humerus surgery              T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
24151     Extensive humerus surgery              T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
24152     Extensive radius surgery               T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
24153     Extensive radius surgery               T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
24155     Removal of elbow joint                 T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24160     Remove elbow joint implant             T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24164     Remove radius head implant             T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24200     Removal of arm foreign body            T            T          0019       4.1481         191.23       436.01       499.76
24201     Removal of arm foreign body            T            T          0021      14.9984         691.43      1,576.48     1,807.01
24220     Injection for elbow x-ray              N            N          0000       0.0000          0.00         0.00         0.00
24300     Manipulate elbow w/anesth              T            T          0045      14.3413         661.13      1,507.41     1,727.84
24301     Muscle/tendon transfer                 T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24305     Arm tendon lengthening                 T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24310     Revision of arm tendon                 T            T          0049      20.3891         939.94      2,143.10     2,456.48
24320     Repair of arm tendon                   T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24330     Revision of arm muscles                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24331     Revision of arm muscles                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24332     Tenolysis, triceps                     T            T          0049      20.3891         939.94      2,143.10     2,456.48
24340     Repair of biceps tendon                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24341     Repair arm tendon/muscle               T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24342     Repair of ruptured tendon              T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24343     Repr elbow lat ligmnt w/tiss           T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24344     Reconstruct elbow lat ligmnt           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24345     Repr elbw med ligmnt w/tissu           T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24346     Reconstruct elbow med ligmnt           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24350     Repair of tennis elbow                 T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24351     Repair of tennis elbow                 T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24352     Repair of tennis elbow                 T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24354     Repair of tennis elbow                 T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24356     Revision of tennis elbow               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24360     Reconstruct elbow joint                T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
24361     Reconstruct elbow joint                T            T          0425      104.7352       4,828.29    11,008.72    12,618.50
24362     Reconstruct elbow joint                T            T          0048      43.3955        2,000.53     4,561.30     5,228.29
24363     Replace elbow joint                    T            T          0425      104.7352       4,828.29    11,008.72    12,618.50
24365     Reconstruct head of radius             T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
24366     Reconstruct head of radius             T            T          0425      104.7352       4,828.29    11,008.72    12,618.50
24400     Revision of humerus                    T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24410     Revision of humerus                    T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24420     Revision of humerus                    T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24430     Repair of humerus                      T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24435     Repair humerus with graft              T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24470     Revision of elbow joint                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24495     Decompression of forearm               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
24498     Reinforce humerus                      T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
24500     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24505     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24515     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24516     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24530     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24535     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24538     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24545     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24546     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24560     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24565     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24566     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24575     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24576     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24577     Treat humerus fracture                 T            T          0043       1.7200         79.29        180.79       207.23
24579     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24582     Treat humerus fracture                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24586     Treat elbow fracture                   T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24587     Treat elbow fracture                   T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24600     Treat elbow dislocation                T            T          0043       1.7200         79.29        180.79       207.23
24605     Treat elbow dislocation                T            T          0045      14.3413         661.13      1,507.41     1,727.84
24615     Treat elbow dislocation                T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24620     Treat elbow fracture                   T            T          0043       1.7200         79.29        180.79       207.23
24635     Treat elbow fracture                   T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24640     Treat elbow dislocation                T            T          0043       1.7200         79.29        180.79       207.23
24650     Treat radius fracture                  T            T          0043       1.7200         79.29        180.79       207.23
24655     Treat radius fracture                  T            T          0043       1.7200         79.29        180.79       207.23
24665     Treat radius fracture                  T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24666     Treat radius fracture                  T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
24670     Treat ulnar fracture                   T            T          0043       1.7200         79.29        180.79       207.23

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   16 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
24675     Treat ulnar fracture                   T            T          0043        1.7200        79.29        180.79       207.23
24685     Treat ulnar fracture                   T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
24800     Fusion of elbow joint                  T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
24802     Fusion/graft of elbow joint            T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
24900     Amputation of upper arm                C            C          0000        0.0000         0.00         0.00         0.00
24920     Amputation of upper arm                C            C          0000        0.0000         0.00         0.00         0.00
24925     Amputation follow-up surgery           T            T          0049       20.3891        939.94      2,143.10     2,456.48
24930     Amputation follow-up surgery           C            C          0000        0.0000         0.00         0.00         0.00
24931     Amputate upper arm & implant           C            C          0000        0.0000         0.00         0.00         0.00
24935     Revision of amputation                 T            T          0052       43.5555       2,007.91     4,578.12     5,247.57
24940     Revision of upper arm                  C            C          0000        0.0000         0.00         0.00         0.00
24999     Upper arm/elbow surgery                T            1          0000        0.0000         0.00         0.00         0.00
25000     Incision of tendon sheath              T            T          0049       20.3891        939.94      2,143.10     2,456.48
25001     Incise flexor carpi radialis           T            T          0049       20.3891        939.94      2,143.10     2,456.48
25020     Decompress forearm 1 space             T            T          0049       20.3891        939.94      2,143.10     2,456.48
25023     Decompress forearm 1 space             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25024     Decompress forearm 2 spaces            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25025     Decompress forearm 2 spaces            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25028     Drainage of forearm lesion             T            T          0049       20.3891        939.94      2,143.10     2,456.48
25031     Drainage of forearm bursa              T            T          0049       20.3891        939.94      2,143.10     2,456.48
25035     Treat forearm bone lesion              T            T          0049       20.3891        939.94      2,143.10     2,456.48
25040     Explore/treat wrist joint              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25065     Biopsy forearm soft tissues            T            T          0021       14.9984        691.43      1,576.48     1,807.01
25066     Biopsy forearm soft tissues            T            T          0022       19.5716        902.25      2,057.17     2,357.99
25075     Removal forearm lesion subcu           T            T          0021       14.9984        691.43      1,576.48     1,807.01
25076     Removal forearm lesion deep            T            T          0022       19.5716        902.25      2,057.17     2,357.99
25077     Remove tumor, forearm/wrist            T            T          0022       19.5716        902.25      2,057.17     2,357.99
25085     Incision of wrist capsule              T            T          0049       20.3891        939.94      2,143.10     2,456.48
25100     Biopsy of wrist joint                  T            T          0049       20.3891        939.94      2,143.10     2,456.48
25101     Explore/treat wrist joint              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25105     Remove wrist joint lining              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25107     Remove wrist joint cartilage           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25110     Remove wrist tendon lesion             T            T          0049       20.3891        939.94      2,143.10     2,456.48
25111     Remove wrist tendon lesion             T            T          0053       15.6396        720.99      1,643.88     1,884.26
25112     Reremove wrist tendon lesion           T            T          0053       15.6396        720.99      1,643.88     1,884.26
25115     Remove wrist/forearm lesion            T            T          0049       20.3891        939.94      2,143.10     2,456.48
25116     Remove wrist/forearm lesion            T            T          0049       20.3891        939.94      2,143.10     2,456.48
25118     Excise wrist tendon sheath             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25119     Partial removal of ulna                T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25120     Removal of forearm lesion              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25125     Remove/graft forearm lesion            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25126     Remove/graft forearm lesion            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25130     Removal of wrist lesion                T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25135     Remove & graft wrist lesion            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25136     Remove & graft wrist lesion            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25145     Remove forearm bone lesion             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25150     Partial removal of ulna                T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25151     Partial removal of radius              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25170     Extensive forearm surgery              T            T          0052       43.5555       2,007.91     4,578.12     5,247.57
25210     Removal of wrist bone                  T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
25215     Removal of wrist bones                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
25230     Partial removal of radius              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25240     Partial removal of ulna                T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25246     Injection for wrist x-ray              N            N          0000        0.0000         0.00         0.00         0.00
25248     Remove forearm foreign body            T            T          0049       20.3891        939.94      2,143.10     2,456.48
25250     Removal of wrist prosthesis            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25251     Removal of wrist prosthesis            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25259     Manipulate wrist w/anesthes            T            T          0043        1.7200        79.29        180.79       207.23
25260     Repair forearm tendon/muscle           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25263     Repair forearm tendon/muscle           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25265     Repair forearm tendon/muscle           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25270     Repair forearm tendon/muscle           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25272     Repair forearm tendon/muscle           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25274     Repair forearm tendon/muscle           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25275     Repair forearm tendon sheath           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25280     Revise wrist/forearm tendon            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25290     Incise wrist/forearm tendon            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25295     Release wrist/forearm tendon           T            T          0049       20.3891        939.94      2,143.10     2,456.48
25300     Fusion of tendons at wrist             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25301     Fusion of tendons at wrist             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
25310     Transplant forearm tendon              T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
25312     Transplant forearm tendon              T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
25315     Revise palsy hand tendon(s)            T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
25316     Revise palsy hand tendon(s)            T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
25320     Repair/revise wrist joint              T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
25332     Revise wrist joint                     T            T          0047       31.2345       1,439.91     3,283.06     3,763.13
25335     Realignment of hand                    T            T          0051       36.6106       1,687.75     3,848.14     4,410.85

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   17 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
25337     Reconstruct ulna/radioulnar            T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25350     Revision of radius                     T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25355     Revision of radius                     T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25360     Revision of ulna                       T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
25365     Revise radius & ulna                   T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
25370     Revise radius or ulna                  T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25375     Revise radius & ulna                   T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25390     Shorten radius or ulna                 T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
25391     Lengthen radius or ulna                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25392     Shorten radius & ulna                  T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
25393     Lengthen radius & ulna                 T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25394     Repair carpal bone, shorten            T            T          0053      15.6396         720.99      1,643.88     1,884.26
25400     Repair radius or ulna                  T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
25405     Repair/graft radius or ulna            T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
25415     Repair radius & ulna                   T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
25420     Repair/graft radius & ulna             T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25425     Repair/graft radius or ulna            T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25426     Repair/graft radius & ulna             T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25430     Vasc graft into carpal bone            T            T          0054      25.1321        1,158.59     2,641.64     3,027.92
25431     Repair nonunion carpal bone            T            T          0054      25.1321        1,158.59     2,641.64     3,027.92
25440     Repair/graft wrist bone                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25441     Reconstruct wrist joint                T            T          0425      104.7352       4,828.29    11,008.72    12,618.50
25442     Reconstruct wrist joint                T            T          0425      104.7352       4,828.29    11,008.72    12,618.50
25443     Reconstruct wrist joint                T            T          0048      43.3955        2,000.53     4,561.30     5,228.29
25444     Reconstruct wrist joint                T            T          0048      43.3955        2,000.53     4,561.30     5,228.29
25445     Reconstruct wrist joint                T            T          0048      43.3955        2,000.53     4,561.30     5,228.29
25446     Wrist replacement                      T            T          0425      104.7352       4,828.29    11,008.72    12,618.50
25447     Repair wrist joint(s)                  T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
25449     Remove wrist joint implant             T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
25450     Revision of wrist joint                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25455     Revision of wrist joint                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25490     Reinforce radius                       T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25491     Reinforce ulna                         T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25492     Reinforce radius and ulna              T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25500     Treat fracture of radius               T            T          0043       1.7200         79.29        180.79       207.23
25505     Treat fracture of radius               T            T          0043       1.7200         79.29        180.79       207.23
25515     Treat fracture of radius               T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25520     Treat fracture of radius               T            T          0043       1.7200         79.29        180.79       207.23
25525     Treat fracture of radius               T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25526     Treat fracture of radius               T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25530     Treat fracture of ulna                 T            T          0043       1.7200         79.29        180.79       207.23
25535     Treat fracture of ulna                 T            T          0043       1.7200         79.29        180.79       207.23
25545     Treat fracture of ulna                 T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25560     Treat fracture radius & ulna           T            T          0043       1.7200         79.29        180.79       207.23
25565     Treat fracture radius & ulna           T            T          0043       1.7200         79.29        180.79       207.23
25574     Treat fracture radius & ulna           T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25575     Treat fracture radius/ulna             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25600     Treat fracture radius/ulna             T            T          0043       1.7200         79.29        180.79       207.23
25605     Treat fracture radius/ulna             T            T          0043       1.7200         79.29        180.79       207.23
25611     Treat fracture radius/ulna             T            1          0046      37.8852          0.00         0.00         0.00          X
25620     Treat fracture radius/ulna             T            1          0046      37.8852          0.00         0.00         0.00          X
25622     Treat wrist bone fracture              T            T          0043       1.7200         79.29        180.79       207.23
25624     Treat wrist bone fracture              T            T          0043       1.7200         79.29        180.79       207.23
25628     Treat wrist bone fracture              T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25630     Treat wrist bone fracture              T            T          0043       1.7200         79.29        180.79       207.23
25635     Treat wrist bone fracture              T            T          0043       1.7200         79.29        180.79       207.23
25645     Treat wrist bone fracture              T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25650     Treat wrist bone fracture              T            T          0043       1.7200         79.29        180.79       207.23
25651     Pin ulnar styloid fracture             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25652     Treat fracture ulnar styloid           T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25660     Treat wrist dislocation                T            T          0043       1.7200         79.29        180.79       207.23
25670     Treat wrist dislocation                T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25671     Pin radioulnar dislocation             T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25675     Treat wrist dislocation                T            T          0043       1.7200         79.29        180.79       207.23
25676     Treat wrist dislocation                T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25680     Treat wrist fracture                   T            T          0043       1.7200         79.29        180.79       207.23
25685     Treat wrist fracture                   T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25690     Treat wrist dislocation                T            T          0043       1.7200         79.29        180.79       207.23
25695     Treat wrist dislocation                T            T          0046      37.8852        1,746.51     3,982.11     4,564.41
25800     Fusion of wrist joint                  T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25805     Fusion/graft of wrist joint            T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25810     Fusion/graft of wrist joint            T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25820     Fusion of hand bones                   T            T          0053      15.6396         720.99      1,643.88     1,884.26
25825     Fuse hand bones with graft             T            T          0054      25.1321        1,158.59     2,641.64     3,027.92
25830     Fusion, radioulnar jnt/ulna            T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
25900     Amputation of forearm                  C            C          0000       0.0000          0.00         0.00         0.00
25905     Amputation of forearm                  C            C          0000       0.0000          0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   18 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
25907     Amputation follow-up surgery           T            T          0049       20.3891        939.94      2,143.10     2,456.48
25909     Amputation follow-up surgery           C            C          0000        0.0000         0.00         0.00         0.00
25915     Amputation of forearm                  C            C          0000        0.0000         0.00         0.00         0.00
25920     Amputate hand at wrist                 C            C          0000        0.0000         0.00         0.00         0.00
25922     Amputate hand at wrist                 T            T          0049       20.3891        939.94      2,143.10     2,456.48
25924     Amputation follow-up surgery           C            C          0000        0.0000         0.00         0.00         0.00
25927     Amputation of hand                     C            C          0000        0.0000         0.00         0.00         0.00
25929     Amputation follow-up surgery           T            T          0686       13.4973        622.23      1,418.70     1,626.15
25931     Amputation follow-up surgery           C            C          0000        0.0000         0.00         0.00         0.00
25999     Forearm or wrist surgery               T            1          0000        0.0000         0.00         0.00         0.00
26010     Drainage of finger abscess             T            T          0006        1.5100        69.61        158.72       181.92
26011     Drainage of finger abscess             T            T          0007       11.6717        538.07      1,226.81     1,406.21
26020     Drain hand tendon sheath               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26025     Drainage of palm bursa                 T            T          0053       15.6396        720.99      1,643.88     1,884.26
26030     Drainage of palm bursa(s)              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26034     Treat hand bone lesion                 T            T          0053       15.6396        720.99      1,643.88     1,884.26
26035     Decompress fingers/hand                T            T          0053       15.6396        720.99      1,643.88     1,884.26
26037     Decompress fingers/hand                T            T          0053       15.6396        720.99      1,643.88     1,884.26
26040     Release palm contracture               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26045     Release palm contracture               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26055     Incise finger tendon sheath            T            T          0053       15.6396        720.99      1,643.88     1,884.26
26060     Incision of finger tendon              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26070     Explore/treat hand joint               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26075     Explore/treat finger joint             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26080     Explore/treat finger joint             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26100     Biopsy hand joint lining               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26105     Biopsy finger joint lining             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26110     Biopsy finger joint lining             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26115     Removal hand lesion subcut             T            T          0022       19.5716        902.25      2,057.17     2,357.99
26116     Removal hand lesion, deep              T            T          0022       19.5716        902.25      2,057.17     2,357.99
26117     Remove tumor, hand/finger              T            T          0022       19.5716        902.25      2,057.17     2,357.99
26121     Release palm contracture               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26123     Release palm contracture               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26125     Release palm contracture               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26130     Remove wrist joint lining              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26135     Revise finger joint, each              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26140     Revise finger joint, each              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26145     Tendon excision, palm/finger           T            T          0053       15.6396        720.99      1,643.88     1,884.26
26160     Remove tendon sheath lesion            T            T          0053       15.6396        720.99      1,643.88     1,884.26
26170     Removal of palm tendon, each           T            T          0053       15.6396        720.99      1,643.88     1,884.26
26180     Removal of finger tendon               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26185     Remove finger bone                     T            T          0053       15.6396        720.99      1,643.88     1,884.26
26200     Remove hand bone lesion                T            T          0053       15.6396        720.99      1,643.88     1,884.26
26205     Remove/graft bone lesion               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26210     Removal of finger lesion               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26215     Remove/graft finger lesion             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26230     Partial removal of hand bone           T            T          0053       15.6396        720.99      1,643.88     1,884.26
26235     Partial removal, finger bone           T            T          0053       15.6396        720.99      1,643.88     1,884.26
26236     Partial removal, finger bone           T            T          0053       15.6396        720.99      1,643.88     1,884.26
26250     Extensive hand surgery                 T            T          0053       15.6396        720.99      1,643.88     1,884.26
26255     Extensive hand surgery                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26260     Extensive finger surgery               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26261     Extensive finger surgery               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26262     Partial removal of finger              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26320     Removal of implant from hand           T            T          0021       14.9984        691.43      1,576.48     1,807.01
26340     Manipulate finger w/anesth             T            T          0043        1.7200        79.29        180.79       207.23
26350     Repair finger/hand tendon              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26352     Repair/graft hand tendon               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26356     Repair finger/hand tendon              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26357     Repair finger/hand tendon              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26358     Repair/graft hand tendon               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26370     Repair finger/hand tendon              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26372     Repair/graft hand tendon               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26373     Repair finger/hand tendon              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26390     Revise hand/finger tendon              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26392     Repair/graft hand tendon               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26410     Repair hand tendon                     T            T          0053       15.6396        720.99      1,643.88     1,884.26
26412     Repair/graft hand tendon               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26415     Excision, hand/finger tendon           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26416     Graft hand or finger tendon            T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26418     Repair finger tendon                   T            T          0053       15.6396        720.99      1,643.88     1,884.26
26420     Repair/graft finger tendon             T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26426     Repair finger/hand tendon              T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26428     Repair/graft finger tendon             T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26432     Repair finger tendon                   T            T          0053       15.6396        720.99      1,643.88     1,884.26
26433     Repair finger tendon                   T            T          0053       15.6396        720.99      1,643.88     1,884.26
26434     Repair/graft finger tendon             T            T          0054       25.1321       1,158.59     2,641.64     3,027.92

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   19 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
26437     Realignment of tendons                 T            T          0053       15.6396        720.99      1,643.88     1,884.26
26440     Release palm/finger tendon             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26442     Release palm & finger tendon           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26445     Release hand/finger tendon             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26449     Release forearm/hand tendon            T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26450     Incision of palm tendon                T            T          0053       15.6396        720.99      1,643.88     1,884.26
26455     Incision of finger tendon              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26460     Incise hand/finger tendon              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26471     Fusion of finger tendons               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26474     Fusion of finger tendons               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26476     Tendon lengthening                     T            T          0053       15.6396        720.99      1,643.88     1,884.26
26477     Tendon shortening                      T            T          0053       15.6396        720.99      1,643.88     1,884.26
26478     Lengthening of hand tendon             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26479     Shortening of hand tendon              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26480     Transplant hand tendon                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26483     Transplant/graft hand tendon           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26485     Transplant palm tendon                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26489     Transplant/graft palm tendon           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26490     Revise thumb tendon                    T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26492     Tendon transfer with graft             T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26494     Hand tendon/muscle transfer            T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26496     Revise thumb tendon                    T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26497     Finger tendon transfer                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26498     Finger tendon transfer                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26499     Revision of finger                     T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26500     Hand tendon reconstruction             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26502     Hand tendon reconstruction             T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26504     Hand tendon reconstruction             T            1          0054       25.1321         0.00         0.00         0.00          X
26508     Release thumb contracture              T            T          0053       15.6396        720.99      1,643.88     1,884.26
26510     Thumb tendon transfer                  T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26516     Fusion of knuckle joint                T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26517     Fusion of knuckle joints               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26518     Fusion of knuckle joints               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26520     Release knuckle contracture            T            T          0053       15.6396        720.99      1,643.88     1,884.26
26525     Release finger contracture             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26530     Revise knuckle joint                   T            T          0047       31.2345       1,439.91     3,283.06     3,763.13
26531     Revise knuckle with implant            T            T          0048       43.3955       2,000.53     4,561.30     5,228.29
26535     Revise finger joint                    T            T          0047       31.2345       1,439.91     3,283.06     3,763.13
26536     Revise/implant finger joint            T            T          0048       43.3955       2,000.53     4,561.30     5,228.29
26540     Repair hand joint                      T            T          0053       15.6396        720.99      1,643.88     1,884.26
26541     Repair hand joint with graft           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26542     Repair hand joint with graft           T            T          0053       15.6396        720.99      1,643.88     1,884.26
26545     Reconstruct finger joint               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26546     Repair nonunion hand                   T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26548     Reconstruct finger joint               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26550     Construct thumb replacement            T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26551     Great toe-hand transfer                C            C          0000        0.0000         0.00         0.00         0.00
26553     Single transfer, toe-hand              C            C          0000        0.0000         0.00         0.00         0.00
26554     Double transfer, toe-hand              C            C          0000        0.0000         0.00         0.00         0.00
26555     Positional change of finger            T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26556     Toe joint transfer                     C            C          0000        0.0000         0.00         0.00         0.00
26560     Repair of web finger                   T            T          0053       15.6396        720.99      1,643.88     1,884.26
26561     Repair of web finger                   T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26562     Repair of web finger                   T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26565     Correct metacarpal flaw                T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26567     Correct finger deformity               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26568     Lengthen metacarpal/finger             T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26580     Repair hand deformity                  T            T          0053       15.6396        720.99      1,643.88     1,884.26
26587     Reconstruct extra finger               T            T          0053       15.6396        720.99      1,643.88     1,884.26
26590     Repair finger deformity                T            T          0053       15.6396        720.99      1,643.88     1,884.26
26591     Repair muscles of hand                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26593     Release muscles of hand                T            T          0053       15.6396        720.99      1,643.88     1,884.26
26596     Excision constricting tissue           T            T          0053       15.6396        720.99      1,643.88     1,884.26
26600     Treat metacarpal fracture              T            T          0043        1.7200        79.29        180.79       207.23
26605     Treat metacarpal fracture              T            T          0043        1.7200        79.29        180.79       207.23
26607     Treat metacarpal fracture              T            T          0043        1.7200        79.29        180.79       207.23
26608     Treat metacarpal fracture              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26615     Treat metacarpal fracture              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26641     Treat thumb dislocation                T            T          0043        1.7200        79.29        180.79       207.23
26645     Treat thumb fracture                   T            T          0043        1.7200        79.29        180.79       207.23
26650     Treat thumb fracture                   T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26665     Treat thumb fracture                   T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26670     Treat hand dislocation                 T            T          0043        1.7200        79.29        180.79       207.23
26675     Treat hand dislocation                 T            T          0043        1.7200        79.29        180.79       207.23
26676     Pin hand dislocation                   T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26685     Treat hand dislocation                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26686     Treat hand dislocation                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   20 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
26700     Treat knuckle dislocation              T            T          0043        1.7200        79.29        180.79       207.23
26705     Treat knuckle dislocation              T            T          0043        1.7200        79.29        180.79       207.23
26706     Pin knuckle dislocation                T            T          0043        1.7200        79.29        180.79       207.23
26715     Treat knuckle dislocation              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26720     Treat finger fracture, each            T            T          0043        1.7200        79.29        180.79       207.23
26725     Treat finger fracture, each            T            T          0043        1.7200        79.29        180.79       207.23
26727     Treat finger fracture, each            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26735     Treat finger fracture, each            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26740     Treat finger fracture, each            T            T          0043        1.7200        79.29        180.79       207.23
26742     Treat finger fracture, each            T            T          0043        1.7200        79.29        180.79       207.23
26746     Treat finger fracture, each            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26750     Treat finger fracture, each            T            T          0043        1.7200        79.29        180.79       207.23
26755     Treat finger fracture, each            T            T          0043        1.7200        79.29        180.79       207.23
26756     Pin finger fracture, each              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26765     Treat finger fracture, each            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26770     Treat finger dislocation               T            T          0043        1.7200        79.29        180.79       207.23
26775     Treat finger dislocation               T            T          0045       14.3413        661.13      1,507.41     1,727.84
26776     Pin finger dislocation                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26785     Treat finger dislocation               T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
26820     Thumb fusion with graft                T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26841     Fusion of thumb                        T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26842     Thumb fusion with graft                T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26843     Fusion of hand joint                   T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26844     Fusion/graft of hand joint             T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26850     Fusion of knuckle                      T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26852     Fusion of knuckle with graft           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26860     Fusion of finger joint                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26861     Fusion of finger jnt, add-on           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26862     Fusion/graft of finger joint           T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26863     Fuse/graft added joint                 T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26910     Amputate metacarpal bone               T            T          0054       25.1321       1,158.59     2,641.64     3,027.92
26951     Amputation of finger/thumb             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26952     Amputation of finger/thumb             T            T          0053       15.6396        720.99      1,643.88     1,884.26
26989     Hand/finger surgery                    T            1          0000        0.0000         0.00         0.00         0.00
26990     Drainage of pelvis lesion              T            T          0049       20.3891        939.94      2,143.10     2,456.48
26991     Drainage of pelvis bursa               T            T          0049       20.3891        939.94      2,143.10     2,456.48
26992     Drainage of bone lesion                C            C          0000        0.0000         0.00         0.00         0.00
27000     Incision of hip tendon                 T            T          0049       20.3891        939.94      2,143.10     2,456.48
27001     Incision of hip tendon                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27003     Incision of hip tendon                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27005     Incision of hip tendon                 C            C          0000        0.0000         0.00         0.00         0.00
27006     Incision of hip tendons                C            C          0000        0.0000         0.00         0.00         0.00
27025     Incision of hip/thigh fascia           C            C          0000        0.0000         0.00         0.00         0.00
27030     Drainage of hip joint                  C            C          0000        0.0000         0.00         0.00         0.00
27033     Exploration of hip joint               T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27035     Denervation of hip joint               T            T          0052       43.5555       2,007.91     4,578.12     5,247.57
27036     Excision of hip joint/muscle           C            C          0000        0.0000         0.00         0.00         0.00
27040     Biopsy of soft tissues                 T            T          0020        6.9410        319.98       729.57       836.25
27041     Biopsy of soft tissues                 T            T          0020        6.9410        319.98       729.57       836.25
27047     Remove hip/pelvis lesion               T            T          0022       19.5716        902.25      2,057.17     2,357.99
27048     Remove hip/pelvis lesion               T            T          0022       19.5716        902.25      2,057.17     2,357.99
27049     Remove tumor, hip/pelvis               T            T          0022       19.5716        902.25      2,057.17     2,357.99
27050     Biopsy of sacroiliac joint             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27052     Biopsy of hip joint                    T            T          0049       20.3891        939.94      2,143.10     2,456.48
27054     Removal of hip joint lining            C            C          0000        0.0000         0.00         0.00         0.00
27060     Removal of ischial bursa               T            T          0049       20.3891        939.94      2,143.10     2,456.48
27062     Remove femur lesion/bursa              T            T          0049       20.3891        939.94      2,143.10     2,456.48
27065     Removal of hip bone lesion             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27066     Removal of hip bone lesion             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27067     Remove/graft hip bone lesion           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27070     Partial removal of hip bone            C            C          0000        0.0000         0.00         0.00         0.00
27071     Partial removal of hip bone            C            C          0000        0.0000         0.00         0.00         0.00
27075     Extensive hip surgery                  C            C          0000        0.0000         0.00         0.00         0.00
27076     Extensive hip surgery                  C            C          0000        0.0000         0.00         0.00         0.00
27077     Extensive hip surgery                  C            C          0000        0.0000         0.00         0.00         0.00
27078     Extensive hip surgery                  C            C          0000        0.0000         0.00         0.00         0.00
27079     Extensive hip surgery                  C            C          0000        0.0000         0.00         0.00         0.00
27080     Removal of tail bone                   T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27086     Remove hip foreign body                T            T          0020        6.9410        319.98       729.57       836.25
27087     Remove hip foreign body                T            T          0049       20.3891        939.94      2,143.10     2,456.48
27090     Removal of hip prosthesis              C            C          0000        0.0000         0.00         0.00         0.00
27091     Removal of hip prosthesis              C            C          0000        0.0000         0.00         0.00         0.00
27093     Injection for hip x-ray                N            N          0000        0.0000         0.00         0.00         0.00
27095     Injection for hip x-ray                N            N          0000        0.0000         0.00         0.00         0.00
27096     Inject sacroiliac joint                B            B          0000        0.0000         0.00         0.00         0.00
27097     Revision of hip tendon                 T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27098     Transfer tendon to pelvis              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   21 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
27100     Transfer of abdominal muscle           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27105     Transfer of spinal muscle              T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27110     Transfer of iliopsoas muscle           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27111     Transfer of iliopsoas muscle           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27120     Reconstruction of hip socket           C            C          0000        0.0000         0.00         0.00         0.00
27122     Reconstruction of hip socket           C            C          0000        0.0000         0.00         0.00         0.00
27125     Partial hip replacement                C            C          0000        0.0000         0.00         0.00         0.00
27130     Total hip arthroplasty                 C            C          0000        0.0000         0.00         0.00         0.00
27132     Total hip arthroplasty                 C            C          0000        0.0000         0.00         0.00         0.00
27134     Revise hip joint replacement           C            C          0000        0.0000         0.00         0.00         0.00
27137     Revise hip joint replacement           C            C          0000        0.0000         0.00         0.00         0.00
27138     Revise hip joint replacement           C            C          0000        0.0000         0.00         0.00         0.00
27140     Transplant femur ridge                 C            C          0000        0.0000         0.00         0.00         0.00
27146     Incision of hip bone                   C            C          0000        0.0000         0.00         0.00         0.00
27147     Revision of hip bone                   C            C          0000        0.0000         0.00         0.00         0.00
27151     Incision of hip bones                  C            C          0000        0.0000         0.00         0.00         0.00
27156     Revision of hip bones                  C            C          0000        0.0000         0.00         0.00         0.00
27158     Revision of pelvis                     C            C          0000        0.0000         0.00         0.00         0.00
27161     Incision of neck of femur              C            C          0000        0.0000         0.00         0.00         0.00
27165     Incision/fixation of femur             C            C          0000        0.0000         0.00         0.00         0.00
27170     Repair/graft femur head/neck           C            C          0000        0.0000         0.00         0.00         0.00
27175     Treat slipped epiphysis                C            C          0000        0.0000         0.00         0.00         0.00
27176     Treat slipped epiphysis                C            C          0000        0.0000         0.00         0.00         0.00
27177     Treat slipped epiphysis                C            C          0000        0.0000         0.00         0.00         0.00
27178     Treat slipped epiphysis                C            C          0000        0.0000         0.00         0.00         0.00
27179     Revise head/neck of femur              C            C          0000        0.0000         0.00         0.00         0.00
27181     Treat slipped epiphysis                C            C          0000        0.0000         0.00         0.00         0.00
27185     Revision of femur epiphysis            C            C          0000        0.0000         0.00         0.00         0.00
27187     Reinforce hip bones                    C            C          0000        0.0000         0.00         0.00         0.00
27193     Treat pelvic ring fracture             T            T          0043        1.7200        79.29        180.79       207.23
27194     Treat pelvic ring fracture             T            T          0045       14.3413        661.13      1,507.41     1,727.84
27200     Treat tail bone fracture               T            T          0043        1.7200        79.29        180.79       207.23
27202     Treat tail bone fracture               T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27215     Treat pelvic fracture(s)               C            C          0000        0.0000         0.00         0.00         0.00
27216     Treat pelvic ring fracture             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27217     Treat pelvic ring fracture             C            C          0000        0.0000         0.00         0.00         0.00
27218     Treat pelvic ring fracture             C            C          0000        0.0000         0.00         0.00         0.00
27220     Treat hip socket fracture              T            T          0043        1.7200        79.29        180.79       207.23
27222     Treat hip socket fracture              C            C          0000        0.0000         0.00         0.00         0.00
27226     Treat hip wall fracture                C            C          0000        0.0000         0.00         0.00         0.00
27227     Treat hip fracture(s)                  C            C          0000        0.0000         0.00         0.00         0.00
27228     Treat hip fracture(s)                  C            C          0000        0.0000         0.00         0.00         0.00
27230     Treat thigh fracture                   T            T          0043        1.7200        79.29        180.79       207.23
27232     Treat thigh fracture                   C            C          0000        0.0000         0.00         0.00         0.00
27235     Treat thigh fracture                   T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27236     Treat thigh fracture                   C            C          0000        0.0000         0.00         0.00         0.00
27238     Treat thigh fracture                   T            T          0043        1.7200        79.29        180.79       207.23
27240     Treat thigh fracture                   C            C          0000        0.0000         0.00         0.00         0.00
27244     Treat thigh fracture                   C            C          0000        0.0000         0.00         0.00         0.00
27245     Treat thigh fracture                   C            C          0000        0.0000         0.00         0.00         0.00
27246     Treat thigh fracture                   T            T          0043        1.7200        79.29        180.79       207.23
27248     Treat thigh fracture                   C            C          0000        0.0000         0.00         0.00         0.00
27250     Treat hip dislocation                  T            T          0043        1.7200        79.29        180.79       207.23
27252     Treat hip dislocation                  T            T          0045       14.3413        661.13      1,507.41     1,727.84
27253     Treat hip dislocation                  C            C          0000        0.0000         0.00         0.00         0.00
27254     Treat hip dislocation                  C            C          0000        0.0000         0.00         0.00         0.00
27256     Treat hip dislocation                  T            T          0043        1.7200        79.29        180.79       207.23
27257     Treat hip dislocation                  T            T          0045       14.3413        661.13      1,507.41     1,727.84
27258     Treat hip dislocation                  C            C          0000        0.0000         0.00         0.00         0.00
27259     Treat hip dislocation                  C            C          0000        0.0000         0.00         0.00         0.00
27265     Treat hip dislocation                  T            T          0043        1.7200        79.29        180.79       207.23
27266     Treat hip dislocation                  T            T          0045       14.3413        661.13      1,507.41     1,727.84
27275     Manipulation of hip joint              T            T          0045       14.3413        661.13      1,507.41     1,727.84
27280     Fusion of sacroiliac joint             C            C          0000        0.0000         0.00         0.00         0.00
27282     Fusion of pubic bones                  C            C          0000        0.0000         0.00         0.00         0.00
27284     Fusion of hip joint                    C            C          0000        0.0000         0.00         0.00         0.00
27286     Fusion of hip joint                    C            C          0000        0.0000         0.00         0.00         0.00
27290     Amputation of leg at hip               C            C          0000        0.0000         0.00         0.00         0.00
27295     Amputation of leg at hip               C            C          0000        0.0000         0.00         0.00         0.00
27299     Pelvis/hip joint surgery               T            1          0000        0.0000         0.00         0.00         0.00
27301     Drain thigh/knee lesion                T            T          0008       16.2953        751.21      1,712.80     1,963.26
27303     Drainage of bone lesion                C            C          0000        0.0000         0.00         0.00         0.00
27305     Incise thigh tendon & fascia           T            T          0049       20.3891        939.94      2,143.10     2,456.48
27306     Incision of thigh tendon               T            T          0049       20.3891        939.94      2,143.10     2,456.48
27307     Incision of thigh tendons              T            T          0049       20.3891        939.94      2,143.10     2,456.48
27310     Exploration of knee joint              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27315     Partial removal, thigh nerve           T            1          0220       17.3203         0.00         0.00         0.00          X

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   22 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
27320     Partial removal, thigh nerve           T            1          0220      17.3203          0.00         0.00         0.00          X
27323     Biopsy, thigh soft tissues             T            T          0021      14.9984         691.43      1,576.48     1,807.01
27324     Biopsy, thigh soft tissues             T            T          0022      19.5716         902.25      2,057.17     2,357.99
27327     Removal of thigh lesion                T            T          0022      19.5716         902.25      2,057.17     2,357.99
27328     Removal of thigh lesion                T            T          0022      19.5716         902.25      2,057.17     2,357.99
27329     Remove tumor, thigh/knee               T            T          0022      19.5716         902.25      2,057.17     2,357.99
27330     Biopsy, knee joint lining              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27331     Explore/treat knee joint               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27332     Removal of knee cartilage              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27333     Removal of knee cartilage              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27334     Remove knee joint lining               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27335     Remove knee joint lining               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27340     Removal of kneecap bursa               T            T          0049      20.3891         939.94      2,143.10     2,456.48
27345     Removal of knee cyst                   T            T          0049      20.3891         939.94      2,143.10     2,456.48
27347     Remove knee cyst                       T            T          0049      20.3891         939.94      2,143.10     2,456.48
27350     Removal of kneecap                     T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27355     Remove femur lesion                    T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27356     Remove femur lesion/graft              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27357     Remove femur lesion/graft              T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27358     Remove femur lesion/fixation           T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27360     Partial removal, leg bone(s)           T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27365     Extensive leg surgery                  C            C          0000       0.0000          0.00         0.00         0.00
27370     Injection for knee x-ray               N            N          0000       0.0000          0.00         0.00         0.00
27372     Removal of foreign body                T            T          0022      19.5716         902.25      2,057.17     2,357.99
27380     Repair of kneecap tendon               T            T          0049      20.3891         939.94      2,143.10     2,456.48
27381     Repair/graft kneecap tendon            T            T          0049      20.3891         939.94      2,143.10     2,456.48
27385     Repair of thigh muscle                 T            T          0049      20.3891         939.94      2,143.10     2,456.48
27386     Repair/graft of thigh muscle           T            T          0049      20.3891         939.94      2,143.10     2,456.48
27390     Incision of thigh tendon               T            T          0049      20.3891         939.94      2,143.10     2,456.48
27391     Incision of thigh tendons              T            T          0049      20.3891         939.94      2,143.10     2,456.48
27392     Incision of thigh tendons              T            T          0049      20.3891         939.94      2,143.10     2,456.48
27393     Lengthening of thigh tendon            T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27394     Lengthening of thigh tendons           T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27395     Lengthening of thigh tendons           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27396     Transplant of thigh tendon             T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27397     Transplants of thigh tendons           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27400     Revise thigh muscles/tendons           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27403     Repair of knee cartilage               T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27405     Repair of knee ligament                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27407     Repair of knee ligament                T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27409     Repair of knee ligaments               T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27412     Autochondrocyte implant knee           T            T          0042      44.2075        2,037.97     4,646.65     5,326.12
27415     Osteochondral knee allograft           T            T          0042      44.2075        2,037.97     4,646.65     5,326.12
27418     Repair degenerated kneecap             T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27420     Revision of unstable kneecap           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27422     Revision of unstable kneecap           T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27424     Revision/removal of kneecap            T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27425     Lat retinacular release open           T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27427     Reconstruction, knee                   T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
27428     Reconstruction, knee                   T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
27429     Reconstruction, knee                   T            T          0052      43.5555        2,007.91     4,578.12     5,247.57
27430     Revision of thigh muscles              T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27435     Incision of knee joint                 T            T          0051      36.6106        1,687.75     3,848.14     4,410.85
27437     Revise kneecap                         T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
27438     Revise kneecap with implant            T            T          0048      43.3955        2,000.53     4,561.30     5,228.29
27440     Revision of knee joint                 T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
27441     Revision of knee joint                 T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
27442     Revision of knee joint                 T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
27443     Revision of knee joint                 T            T          0047      31.2345        1,439.91     3,283.06     3,763.13
27445     Revision of knee joint                 C            C          0000       0.0000          0.00         0.00         0.00
27446     Revision of knee joint                 T            T          0681      135.4643       6,244.90    14,238.65    16,320.74
27447     Total knee arthroplasty                C            C          0000       0.0000          0.00         0.00         0.00
27448     Incision of thigh                      C            C          0000       0.0000          0.00         0.00         0.00
27450     Incision of thigh                      C            C          0000       0.0000          0.00         0.00         0.00
27454     Realignment of thigh bone              C            C          0000       0.0000          0.00         0.00         0.00
27455     Realignment of knee                    C            C          0000       0.0000          0.00         0.00         0.00
27457     Realignment of knee                    C            C          0000       0.0000          0.00         0.00         0.00
27465     Shortening of thigh bone               C            C          0000       0.0000          0.00         0.00         0.00
27466     Lengthening of thigh bone              C            C          0000       0.0000          0.00         0.00         0.00
27468     Shorten/lengthen thighs                C            C          0000       0.0000          0.00         0.00         0.00
27470     Repair of thigh                        C            C          0000       0.0000          0.00         0.00         0.00
27472     Repair/graft of thigh                  C            C          0000       0.0000          0.00         0.00         0.00
27475     Surgery to stop leg growth             T            T          0050      23.9367        1,103.48     2,515.99     2,883.89
27477     Surgery to stop leg growth             C            C          0000       0.0000          0.00         0.00         0.00
27479     Surgery to stop leg growth             C            C          0000       0.0000          0.00         0.00         0.00
27485     Surgery to stop leg growth             C            C          0000       0.0000          0.00         0.00         0.00
27486     Revise/replace knee joint              C            C          0000       0.0000          0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   23 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
27487     Revise/replace knee joint              C            C          0000        0.0000         0.00         0.00         0.00
27488     Removal of knee prosthesis             C            C          0000        0.0000         0.00         0.00         0.00
27495     Reinforce thigh                        C            C          0000        0.0000         0.00         0.00         0.00
27496     Decompression of thigh/knee            T            T          0049       20.3891        939.94      2,143.10     2,456.48
27497     Decompression of thigh/knee            T            T          0049       20.3891        939.94      2,143.10     2,456.48
27498     Decompression of thigh/knee            T            T          0049       20.3891        939.94      2,143.10     2,456.48
27499     Decompression of thigh/knee            T            T          0049       20.3891        939.94      2,143.10     2,456.48
27500     Treatment of thigh fracture            T            T          0043        1.7200        79.29        180.79       207.23
27501     Treatment of thigh fracture            T            T          0043        1.7200        79.29        180.79       207.23
27502     Treatment of thigh fracture            T            T          0043        1.7200        79.29        180.79       207.23
27503     Treatment of thigh fracture            T            T          0043        1.7200        79.29        180.79       207.23
27506     Treatment of thigh fracture            C            C          0000        0.0000         0.00         0.00         0.00
27507     Treatment of thigh fracture            C            C          0000        0.0000         0.00         0.00         0.00
27508     Treatment of thigh fracture            T            T          0043        1.7200        79.29        180.79       207.23
27509     Treatment of thigh fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27510     Treatment of thigh fracture            T            T          0043        1.7200        79.29        180.79       207.23
27511     Treatment of thigh fracture            C            C          0000        0.0000         0.00         0.00         0.00
27513     Treatment of thigh fracture            C            C          0000        0.0000         0.00         0.00         0.00
27514     Treatment of thigh fracture            C            C          0000        0.0000         0.00         0.00         0.00
27516     Treat thigh fx growth plate            T            T          0043        1.7200        79.29        180.79       207.23
27517     Treat thigh fx growth plate            T            T          0043        1.7200        79.29        180.79       207.23
27519     Treat thigh fx growth plate            C            C          0000        0.0000         0.00         0.00         0.00
27520     Treat kneecap fracture                 T            T          0043        1.7200        79.29        180.79       207.23
27524     Treat kneecap fracture                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27530     Treat knee fracture                    T            T          0043        1.7200        79.29        180.79       207.23
27532     Treat knee fracture                    T            T          0043        1.7200        79.29        180.79       207.23
27535     Treat knee fracture                    C            C          0000        0.0000         0.00         0.00         0.00
27536     Treat knee fracture                    C            C          0000        0.0000         0.00         0.00         0.00
27538     Treat knee fracture(s)                 T            T          0043        1.7200        79.29        180.79       207.23
27540     Treat knee fracture                    C            C          0000        0.0000         0.00         0.00         0.00
27550     Treat knee dislocation                 T            T          0043        1.7200        79.29        180.79       207.23
27552     Treat knee dislocation                 T            T          0045       14.3413        661.13      1,507.41     1,727.84
27556     Treat knee dislocation                 C            C          0000        0.0000         0.00         0.00         0.00
27557     Treat knee dislocation                 C            C          0000        0.0000         0.00         0.00         0.00
27558     Treat knee dislocation                 C            C          0000        0.0000         0.00         0.00         0.00
27560     Treat kneecap dislocation              T            T          0043        1.7200        79.29        180.79       207.23
27562     Treat kneecap dislocation              T            T          0045       14.3413        661.13      1,507.41     1,727.84
27566     Treat kneecap dislocation              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27570     Fixation of knee joint                 T            T          0045       14.3413        661.13      1,507.41     1,727.84
27580     Fusion of knee                         C            C          0000        0.0000         0.00         0.00         0.00
27590     Amputate leg at thigh                  C            C          0000        0.0000         0.00         0.00         0.00
27591     Amputate leg at thigh                  C            C          0000        0.0000         0.00         0.00         0.00
27592     Amputate leg at thigh                  C            C          0000        0.0000         0.00         0.00         0.00
27594     Amputation follow-up surgery           T            T          0049       20.3891        939.94      2,143.10     2,456.48
27596     Amputation follow-up surgery           C            C          0000        0.0000         0.00         0.00         0.00
27598     Amputate lower leg at knee             C            C          0000        0.0000         0.00         0.00         0.00
27599     Leg surgery procedure                  T            1          0000        0.0000         0.00         0.00         0.00
27600     Decompression of lower leg             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27601     Decompression of lower leg             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27602     Decompression of lower leg             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27603     Drain lower leg lesion                 T            T          0008       16.2953        751.21      1,712.80     1,963.26
27604     Drain lower leg bursa                  T            T          0049       20.3891        939.94      2,143.10     2,456.48
27605     Incision of achilles tendon            T            T          0055       19.9374        919.11      2,095.62     2,402.06
27606     Incision of achilles tendon            T            T          0049       20.3891        939.94      2,143.10     2,456.48
27607     Treat lower leg bone lesion            T            T          0049       20.3891        939.94      2,143.10     2,456.48
27610     Explore/treat ankle joint              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27612     Exploration of ankle joint             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27613     Biopsy lower leg soft tissue           T            T          0020        6.9410        319.98       729.57       836.25
27614     Biopsy lower leg soft tissue           T            T          0022       19.5716        902.25      2,057.17     2,357.99
27615     Remove tumor, lower leg                T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27618     Remove lower leg lesion                T            T          0021       14.9984        691.43      1,576.48     1,807.01
27619     Remove lower leg lesion                T            T          0022       19.5716        902.25      2,057.17     2,357.99
27620     Explore/treat ankle joint              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27625     Remove ankle joint lining              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27626     Remove ankle joint lining              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27630     Removal of tendon lesion               T            T          0049       20.3891        939.94      2,143.10     2,456.48
27635     Remove lower leg bone lesion           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27637     Remove/graft leg bone lesion           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27638     Remove/graft leg bone lesion           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27640     Partial removal of tibia               T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27641     Partial removal of fibula              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27645     Extensive lower leg surgery            C            C          0000        0.0000         0.00         0.00         0.00
27646     Extensive lower leg surgery            C            C          0000        0.0000         0.00         0.00         0.00
27647     Extensive ankle/heel surgery           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27648     Injection for ankle x-ray              N            N          0000        0.0000         0.00         0.00         0.00
27650     Repair achilles tendon                 T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27652     Repair/graft achilles tendon           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   24 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
27654     Repair of achilles tendon              T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27656     Repair leg fascia defect               T            T          0049       20.3891        939.94      2,143.10     2,456.48
27658     Repair of leg tendon, each             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27659     Repair of leg tendon, each             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27664     Repair of leg tendon, each             T            T          0049       20.3891        939.94      2,143.10     2,456.48
27665     Repair of leg tendon, each             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27675     Repair lower leg tendons               T            T          0049       20.3891        939.94      2,143.10     2,456.48
27676     Repair lower leg tendons               T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27680     Release of lower leg tendon            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27681     Release of lower leg tendons           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27685     Revision of lower leg tendon           T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27686     Revise lower leg tendons               T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27687     Revision of calf tendon                T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27690     Revise lower leg tendon                T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27691     Revise lower leg tendon                T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27692     Revise additional leg tendon           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27695     Repair of ankle ligament               T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27696     Repair of ankle ligaments              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27698     Repair of ankle ligament               T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27700     Revision of ankle joint                T            T          0047       31.2345       1,439.91     3,283.06     3,763.13
27702     Reconstruct ankle joint                C            C          0000        0.0000         0.00         0.00         0.00
27703     Reconstruction, ankle joint            C            C          0000        0.0000         0.00         0.00         0.00
27704     Removal of ankle implant               T            T          0049       20.3891        939.94      2,143.10     2,456.48
27705     Incision of tibia                      T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27707     Incision of fibula                     T            T          0049       20.3891        939.94      2,143.10     2,456.48
27709     Incision of tibia & fibula             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27712     Realignment of lower leg               C            C          0000        0.0000         0.00         0.00         0.00
27715     Revision of lower leg                  C            C          0000        0.0000         0.00         0.00         0.00
27720     Repair of tibia                        C            C          0000        0.0000         0.00         0.00         0.00
27722     Repair/graft of tibia                  C            C          0000        0.0000         0.00         0.00         0.00
27724     Repair/graft of tibia                  C            C          0000        0.0000         0.00         0.00         0.00
27725     Repair of lower leg                    C            C          0000        0.0000         0.00         0.00         0.00
27727     Repair of lower leg                    C            C          0000        0.0000         0.00         0.00         0.00
27730     Repair of tibia epiphysis              T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27732     Repair of fibula epiphysis             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27734     Repair lower leg epiphyses             T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27740     Repair of leg epiphyses                T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27742     Repair of leg epiphyses                T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27745     Reinforce tibia                        T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27750     Treatment of tibia fracture            T            T          0043        1.7200        79.29        180.79       207.23
27752     Treatment of tibia fracture            T            T          0043        1.7200        79.29        180.79       207.23
27756     Treatment of tibia fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27758     Treatment of tibia fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27759     Treatment of tibia fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27760     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27762     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27766     Treatment of ankle fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27780     Treatment of fibula fracture           T            T          0043        1.7200        79.29        180.79       207.23
27781     Treatment of fibula fracture           T            T          0043        1.7200        79.29        180.79       207.23
27784     Treatment of fibula fracture           T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27786     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27788     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27792     Treatment of ankle fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27808     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27810     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27814     Treatment of ankle fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27816     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27818     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
27822     Treatment of ankle fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27823     Treatment of ankle fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27824     Treat lower leg fracture               T            T          0043        1.7200        79.29        180.79       207.23
27825     Treat lower leg fracture               T            T          0043        1.7200        79.29        180.79       207.23
27826     Treat lower leg fracture               T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27827     Treat lower leg fracture               T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27828     Treat lower leg fracture               T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27829     Treat lower leg joint                  T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27830     Treat lower leg dislocation            T            T          0043        1.7200        79.29        180.79       207.23
27831     Treat lower leg dislocation            T            T          0043        1.7200        79.29        180.79       207.23
27832     Treat lower leg dislocation            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27840     Treat ankle dislocation                T            T          0043        1.7200        79.29        180.79       207.23
27842     Treat ankle dislocation                T            T          0045       14.3413        661.13      1,507.41     1,727.84
27846     Treat ankle dislocation                T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27848     Treat ankle dislocation                T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
27860     Fixation of ankle joint                T            T          0045       14.3413        661.13      1,507.41     1,727.84
27870     Fusion of ankle joint, open            T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27871     Fusion of tibiofibular joint           T            T          0051       36.6106       1,687.75     3,848.14     4,410.85
27880     Amputation of lower leg                C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   25 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
27881     Amputation of lower leg                C            C          0000        0.0000         0.00         0.00         0.00
27882     Amputation of lower leg                C            C          0000        0.0000         0.00         0.00         0.00
27884     Amputation follow-up surgery           T            T          0049       20.3891        939.94      2,143.10     2,456.48
27886     Amputation follow-up surgery           C            C          0000        0.0000         0.00         0.00         0.00
27888     Amputation of foot at ankle            C            C          0000        0.0000         0.00         0.00         0.00
27889     Amputation of foot at ankle            T            T          0050       23.9367       1,103.48     2,515.99     2,883.89
27892     Decompression of leg                   T            T          0049       20.3891        939.94      2,143.10     2,456.48
27893     Decompression of leg                   T            T          0049       20.3891        939.94      2,143.10     2,456.48
27894     Decompression of leg                   T            T          0049       20.3891        939.94      2,143.10     2,456.48
27899     Leg/ankle surgery procedure            T            1          0000        0.0000         0.00         0.00         0.00
28001     Drainage of bursa of foot              T            T          0007       11.6717        538.07      1,226.81     1,406.21
28002     Treatment of foot infection            T            T          0049       20.3891        939.94      2,143.10     2,456.48
28003     Treatment of foot infection            T            T          0049       20.3891        939.94      2,143.10     2,456.48
28005     Treat foot bone lesion                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28008     Incision of foot fascia                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28010     Incision of toe tendon                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28011     Incision of toe tendons                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28020     Exploration of foot joint              T            T          0055       19.9374        919.11      2,095.62     2,402.06
28022     Exploration of foot joint              T            T          0055       19.9374        919.11      2,095.62     2,402.06
28024     Exploration of toe joint               T            T          0055       19.9374        919.11      2,095.62     2,402.06
28030     Removal of foot nerve                  T            1          0220       17.3203         0.00         0.00         0.00          X
28035     Decompression of tibia nerve           T            T          0220       17.3203        798.47      1,820.54     2,086.75
28043     Excision of foot lesion                T            T          0021       14.9984        691.43      1,576.48     1,807.01
28045     Excision of foot lesion                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28046     Resection of tumor, foot               T            T          0055       19.9374        919.11      2,095.62     2,402.06
28050     Biopsy of foot joint lining            T            T          0055       19.9374        919.11      2,095.62     2,402.06
28052     Biopsy of foot joint lining            T            T          0055       19.9374        919.11      2,095.62     2,402.06
28054     Biopsy of toe joint lining             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28060     Partial removal, foot fascia           T            T          0055       19.9374        919.11      2,095.62     2,402.06
28062     Removal of foot fascia                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28070     Removal of foot joint lining           T            T          0055       19.9374        919.11      2,095.62     2,402.06
28072     Removal of foot joint lining           T            T          0055       19.9374        919.11      2,095.62     2,402.06
28080     Removal of foot lesion                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28086     Excise foot tendon sheath              T            T          0055       19.9374        919.11      2,095.62     2,402.06
28088     Excise foot tendon sheath              T            T          0055       19.9374        919.11      2,095.62     2,402.06
28090     Removal of foot lesion                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28092     Removal of toe lesions                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28100     Removal of ankle/heel lesion           T            T          0055       19.9374        919.11      2,095.62     2,402.06
28102     Remove/graft foot lesion               T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28103     Remove/graft foot lesion               T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28104     Removal of foot lesion                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28106     Remove/graft foot lesion               T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28107     Remove/graft foot lesion               T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28108     Removal of toe lesions                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28110     Part removal of metatarsal             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28111     Part removal of metatarsal             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28112     Part removal of metatarsal             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28113     Part removal of metatarsal             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28114     Removal of metatarsal heads            T            T          0055       19.9374        919.11      2,095.62     2,402.06
28116     Revision of foot                       T            T          0055       19.9374        919.11      2,095.62     2,402.06
28118     Removal of heel bone                   T            T          0055       19.9374        919.11      2,095.62     2,402.06
28119     Removal of heel spur                   T            T          0055       19.9374        919.11      2,095.62     2,402.06
28120     Part removal of ankle/heel             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28122     Partial removal of foot bone           T            T          0055       19.9374        919.11      2,095.62     2,402.06
28124     Partial removal of toe                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28126     Partial removal of toe                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28130     Removal of ankle bone                  T            T          0055       19.9374        919.11      2,095.62     2,402.06
28140     Removal of metatarsal                  T            T          0055       19.9374        919.11      2,095.62     2,402.06
28150     Removal of toe                         T            T          0055       19.9374        919.11      2,095.62     2,402.06
28153     Partial removal of toe                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28160     Partial removal of toe                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28171     Extensive foot surgery                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28173     Extensive foot surgery                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28175     Extensive foot surgery                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28190     Removal of foot foreign body           T            T          0019        4.1481        191.23       436.01       499.76
28192     Removal of foot foreign body           T            T          0021       14.9984        691.43      1,576.48     1,807.01
28193     Removal of foot foreign body           T            T          0020        6.9410        319.98       729.57       836.25
28200     Repair of foot tendon                  T            T          0055       19.9374        919.11      2,095.62     2,402.06
28202     Repair/graft of foot tendon            T            T          0055       19.9374        919.11      2,095.62     2,402.06
28208     Repair of foot tendon                  T            T          0055       19.9374        919.11      2,095.62     2,402.06
28210     Repair/graft of foot tendon            T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28220     Release of foot tendon                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28222     Release of foot tendons                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28225     Release of foot tendon                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28226     Release of foot tendons                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28230     Incision of foot tendon(s)             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28232     Incision of toe tendon                 T            T          0055       19.9374        919.11      2,095.62     2,402.06

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   26 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
28234     Incision of foot tendon                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28238     Revision of foot tendon                T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28240     Release of big toe                     T            T          0055       19.9374        919.11      2,095.62     2,402.06
28250     Revision of foot fascia                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28260     Release of midfoot joint               T            T          0055       19.9374        919.11      2,095.62     2,402.06
28261     Revision of foot tendon                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28262     Revision of foot and ankle             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28264     Release of midfoot joint               T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28270     Release of foot contracture            T            T          0055       19.9374        919.11      2,095.62     2,402.06
28272     Release of toe joint, each             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28280     Fusion of toes                         T            T          0055       19.9374        919.11      2,095.62     2,402.06
28285     Repair of hammertoe                    T            T          0055       19.9374        919.11      2,095.62     2,402.06
28286     Repair of hammertoe                    T            T          0055       19.9374        919.11      2,095.62     2,402.06
28288     Partial removal of foot bone           T            T          0055       19.9374        919.11      2,095.62     2,402.06
28289     Repair hallux rigidus                  T            T          0055       19.9374        919.11      2,095.62     2,402.06
28290     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28292     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28293     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28294     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28296     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28297     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28298     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28299     Correction of bunion                   T            T          0057       27.3981       1,263.05     2,879.81     3,300.92
28300     Incision of heel bone                  T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28302     Incision of ankle bone                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28304     Incision of midfoot bones              T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28305     Incise/graft midfoot bones             T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28306     Incision of metatarsal                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28307     Incision of metatarsal                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28308     Incision of metatarsal                 T            T          0055       19.9374        919.11      2,095.62     2,402.06
28309     Incision of metatarsals                T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28310     Revision of big toe                    T            T          0055       19.9374        919.11      2,095.62     2,402.06
28312     Revision of toe                        T            T          0055       19.9374        919.11      2,095.62     2,402.06
28313     Repair deformity of toe                T            T          0055       19.9374        919.11      2,095.62     2,402.06
28315     Removal of sesamoid bone               T            T          0055       19.9374        919.11      2,095.62     2,402.06
28320     Repair of foot bones                   T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28322     Repair of metatarsals                  T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28340     Resect enlarged toe tissue             T            T          0055       19.9374        919.11      2,095.62     2,402.06
28341     Resect enlarged toe                    T            T          0055       19.9374        919.11      2,095.62     2,402.06
28344     Repair extra toe(s)                    T            T          0055       19.9374        919.11      2,095.62     2,402.06
28345     Repair webbed toe(s)                   T            T          0055       19.9374        919.11      2,095.62     2,402.06
28360     Reconstruct cleft foot                 T            T          0056       40.5436       1,869.06     4,261.54     4,884.69
28400     Treatment of heel fracture             T            T          0043        1.7200        79.29        180.79       207.23
28405     Treatment of heel fracture             T            T          0043        1.7200        79.29        180.79       207.23
28406     Treatment of heel fracture             T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28415     Treat heel fracture                    T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28420     Treat/graft heel fracture              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28430     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
28435     Treatment of ankle fracture            T            T          0043        1.7200        79.29        180.79       207.23
28436     Treatment of ankle fracture            T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28445     Treat ankle fracture                   T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28450     Treat midfoot fracture, each           T            T          0043        1.7200        79.29        180.79       207.23
28455     Treat midfoot fracture, each           T            T          0043        1.7200        79.29        180.79       207.23
28456     Treat midfoot fracture                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28465     Treat midfoot fracture, each           T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28470     Treat metatarsal fracture              T            T          0043        1.7200        79.29        180.79       207.23
28475     Treat metatarsal fracture              T            T          0043        1.7200        79.29        180.79       207.23
28476     Treat metatarsal fracture              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28485     Treat metatarsal fracture              T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28490     Treat big toe fracture                 T            T          0043        1.7200        79.29        180.79       207.23
28495     Treat big toe fracture                 T            T          0043        1.7200        79.29        180.79       207.23
28496     Treat big toe fracture                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28505     Treat big toe fracture                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28510     Treatment of toe fracture              T            T          0043        1.7200        79.29        180.79       207.23
28515     Treatment of toe fracture              T            T          0043        1.7200        79.29        180.79       207.23
28525     Treat toe fracture                     T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28530     Treat sesamoid bone fracture           T            T          0043        1.7200        79.29        180.79       207.23
28531     Treat sesamoid bone fracture           T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28540     Treat foot dislocation                 T            T          0043        1.7200        79.29        180.79       207.23
28545     Treat foot dislocation                 T            T          0045       14.3413        661.13      1,507.41     1,727.84
28546     Treat foot dislocation                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28555     Repair foot dislocation                T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28570     Treat foot dislocation                 T            T          0043        1.7200        79.29        180.79       207.23
28575     Treat foot dislocation                 T            T          0043        1.7200        79.29        180.79       207.23
28576     Treat foot dislocation                 T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28585     Repair foot dislocation                T            T          0046       37.8852       1,746.51     3,982.11     4,564.41
28600     Treat foot dislocation                 T            T          0043        1.7200        79.29        180.79       207.23

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   27 of 171
State of Wyoming Oupatient Prospective Payment System                                                                            Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                               Critical
                                               October                                               General     Children's                Change
                                                           WY 2007                                                             Access
  CPT/                                           2006                             APC Relative       Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                   Hospital
 HCPCS                                          Status                              Weight          Outpatient   Outpatient                 2006
                                                           Indicator                                                          Outpatient
                                              Indicator                                                Fee          Fee                   Schedule
                                                                                                                                 Fee
                                             (FYI Only)
28605     Treat foot dislocation                 T            T          0043        1.7200           79.29        180.79       207.23
28606     Treat foot dislocation                 T            T          0046       37.8852          1,746.51     3,982.11     4,564.41
28615     Repair foot dislocation                T            T          0046       37.8852          1,746.51     3,982.11     4,564.41
28630     Treat toe dislocation                  T            T          0043        1.7200           79.29        180.79       207.23
28635     Treat toe dislocation                  T            T          0045       14.3413           661.13      1,507.41     1,727.84
28636     Treat toe dislocation                  T            T          0046       37.8852          1,746.51     3,982.11     4,564.41
28645     Repair toe dislocation                 T            T          0046       37.8852          1,746.51     3,982.11     4,564.41
28660     Treat toe dislocation                  T            T          0043        1.7200           79.29        180.79       207.23
28665     Treat toe dislocation                  T            T          0045       14.3413           661.13      1,507.41     1,727.84
28666     Treat toe dislocation                  T            T          0046       37.8852          1,746.51     3,982.11     4,564.41
28675     Repair of toe dislocation              T            T          0046       37.8852          1,746.51     3,982.11     4,564.41
28705     Fusion of foot bones                   T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28715     Fusion of foot bones                   T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28725     Fusion of foot bones                   T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28730     Fusion of foot bones                   T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28735     Fusion of foot bones                   T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28737     Revision of foot bones                 T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28740     Fusion of foot bones                   T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28750     Fusion of big toe joint                T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28755     Fusion of big toe joint                T            T          0055       19.9374           919.11      2,095.62     2,402.06
28760     Fusion of big toe joint                T            T          0056       40.5436          1,869.06     4,261.54     4,884.69
28800     Amputation of midfoot                  C            C          0000        0.0000            0.00         0.00         0.00
28805     Amputation thru metatarsal             C            C          0000        0.0000            0.00         0.00         0.00
28810     Amputation toe & metatarsal            T            T          0055       19.9374           919.11      2,095.62     2,402.06
28820     Amputation of toe                      T            T          0055       19.9374           919.11      2,095.62     2,402.06
28825     Partial amputation of toe              T            T          0055       19.9374           919.11      2,095.62     2,402.06
28890     High energy eswt, plantar f            T            T          1547       14.2831     *     658.45      1,501.30     1,720.83
28899     Foot/toes surgery procedure            T            1          0000        0.0000            0.00         0.00         0.00
29000     Application of body cast               S            S          0058        1.0803           49.80        113.55       130.15
29010     Application of body cast               S            S          0426        2.2146           102.09       232.78       266.82
29015     Application of body cast               S            S          0426        2.2146           102.09       232.78       266.82
29020     Application of body cast               S            S          0058        1.0803           49.80        113.55       130.15
29025     Application of body cast               S            S          0058        1.0803           49.80        113.55       130.15
29035     Application of body cast               S            S          0426        2.2146           102.09       232.78       266.82
29040     Application of body cast               S            S          0058        1.0803           49.80        113.55       130.15
29044     Application of body cast               S            S          0426        2.2146           102.09       232.78       266.82
29046     Application of body cast               S            S          0426        2.2146           102.09       232.78       266.82
29049     Application of figure eight            S            S          0058        1.0803           49.80        113.55       130.15
29055     Application of shoulder cast           S            S          0426        2.2146           102.09       232.78       266.82
29058     Application of shoulder cast           S            S          0058        1.0803           49.80        113.55       130.15
29065     Application of long arm cast           S            S          0426        2.2146           102.09       232.78       266.82
29075     Application of forearm cast            S            S          0426        2.2146           102.09       232.78       266.82
29085     Apply hand/wrist cast                  S            S          0058        1.0803           49.80        113.55       130.15
29086     Apply finger cast                      S            S          0058        1.0803           49.80        113.55       130.15
29105     Apply long arm splint                  S            S          0058        1.0803           49.80        113.55       130.15
29125     Apply forearm splint                   S            S          0058        1.0803           49.80        113.55       130.15
29126     Apply forearm splint                   S            S          0058        1.0803           49.80        113.55       130.15
29130     Application of finger splint           S            S          0058        1.0803           49.80        113.55       130.15
29131     Application of finger splint           S            S          0058        1.0803           49.80        113.55       130.15
29200     Strapping of chest                     S            S          0058        1.0803           49.80        113.55       130.15
29220     Strapping of low back                  S            S          0058        1.0803           49.80        113.55       130.15
29240     Strapping of shoulder                  S            S          0058        1.0803           49.80        113.55       130.15
29260     Strapping of elbow or wrist            S            S          0058        1.0803           49.80        113.55       130.15
29280     Strapping of hand or finger            S            S          0058        1.0803           49.80        113.55       130.15
29305     Application of hip cast                S            S          0426        2.2146           102.09       232.78       266.82
29325     Application of hip casts               S            S          0426        2.2146           102.09       232.78       266.82
29345     Application of long leg cast           S            S          0426        2.2146           102.09       232.78       266.82
29355     Application of long leg cast           S            S          0426        2.2146           102.09       232.78       266.82
29358     Apply long leg cast brace              S            S          0426        2.2146           102.09       232.78       266.82
29365     Application of long leg cast           S            S          0426        2.2146           102.09       232.78       266.82
29405     Apply short leg cast                   S            S          0426        2.2146           102.09       232.78       266.82
29425     Apply short leg cast                   S            S          0426        2.2146           102.09       232.78       266.82
29435     Apply short leg cast                   S            S          0426        2.2146           102.09       232.78       266.82
29440     Addition of walker to cast             S            S          0058        1.0803           49.80        113.55       130.15
29445     Apply rigid leg cast                   S            S          0426        2.2146           102.09       232.78       266.82
29450     Application of leg cast                S            S          0058        1.0803           49.80        113.55       130.15
29505     Application, long leg splint           S            S          0058        1.0803           49.80        113.55       130.15
29515     Application lower leg splint           S            S          0058        1.0803           49.80        113.55       130.15
29520     Strapping of hip                       S            S          0058        1.0803           49.80        113.55       130.15
29530     Strapping of knee                      S            S          0058        1.0803           49.80        113.55       130.15
29540     Strapping of ankle and/or ft           S            S          0058        1.0803           49.80        113.55       130.15
29550     Strapping of toes                      S            S          0058        1.0803           49.80        113.55       130.15
29580     Application of paste boot              S            S          0058        1.0803           49.80        113.55       130.15
29590     Application of foot splint             S            S          0058        1.0803           49.80        113.55       130.15
29700     Removal/revision of cast               S            S          0058        1.0803           49.80        113.55       130.15
29705     Removal/revision of cast               S            S          0058        1.0803           49.80        113.55       130.15
29710     Removal/revision of cast               S            S          0426        2.2146           102.09       232.78       266.82

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                      28 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
29715     Removal/revision of cast               S            S          0058        1.0803        49.80        113.55       130.15
29720     Repair of body cast                    S            S          0058        1.0803        49.80        113.55       130.15
29730     Windowing of cast                      S            S          0058        1.0803        49.80        113.55       130.15
29740     Wedging of cast                        S            S          0058        1.0803        49.80        113.55       130.15
29750     Wedging of clubfoot cast               S            S          0058        1.0803        49.80        113.55       130.15
29799     Casting/strapping procedure            S            1          0000        0.0000         0.00         0.00         0.00
29800     Jaw arthroscopy/surgery                T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29804     Jaw arthroscopy/surgery                T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29805     Shoulder arthroscopy, dx               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29806     Shoulder arthroscopy/surgery           T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29807     Shoulder arthroscopy/surgery           T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29819     Shoulder arthroscopy/surgery           T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29820     Shoulder arthroscopy/surgery           T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29821     Shoulder arthroscopy/surgery           T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29822     Shoulder arthroscopy/surgery           T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29823     Shoulder arthroscopy/surgery           T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29824     Shoulder arthroscopy/surgery           T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29825     Shoulder arthroscopy/surgery           T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29826     Shoulder arthroscopy/surgery           T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29827     Arthroscop rotator cuff repr           T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29830     Elbow arthroscopy                      T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29834     Elbow arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29835     Elbow arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29836     Elbow arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29837     Elbow arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29838     Elbow arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29840     Wrist arthroscopy                      T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29843     Wrist arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29844     Wrist arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29845     Wrist arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29846     Wrist arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29847     Wrist arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29848     Wrist endoscopy/surgery                T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29850     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29851     Knee arthroscopy/surgery               T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29855     Tibial arthroscopy/surgery             T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29856     Tibial arthroscopy/surgery             T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29860     Hip arthroscopy, dx                    T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29861     Hip arthroscopy/surgery                T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29862     Hip arthroscopy/surgery                T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29863     Hip arthroscopy/surgery                T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29866     Autgrft implnt, knee w/scope           T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29867     Allgrft implnt, knee w/scope           T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29868     Meniscal trnspl, knee w/scpe           T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29870     Knee arthroscopy, dx                   T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29871     Knee arthroscopy/drainage              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29873     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29874     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29875     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29876     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29877     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29879     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29880     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29881     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29882     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29883     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29884     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29885     Knee arthroscopy/surgery               T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29886     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29887     Knee arthroscopy/surgery               T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29888     Knee arthroscopy/surgery               T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29889     Knee arthroscopy/surgery               T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29891     Ankle arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29892     Ankle arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29893     Scope, plantar fasciotomy              T            T          0055       19.9374        919.11      2,095.62     2,402.06
29894     Ankle arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29895     Ankle arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29897     Ankle arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29898     Ankle arthroscopy/surgery              T            T          0041       28.0686       1,293.96     2,950.29     3,381.70
29899     Ankle arthroscopy/surgery              T            T          0042       44.2075       2,037.97     4,646.65     5,326.12
29900     Mcp joint arthroscopy, dx              T            T          0053       15.6396        720.99      1,643.88     1,884.26
29901     Mcp joint arthroscopy, surg            T            T          0053       15.6396        720.99      1,643.88     1,884.26
29902     Mcp joint arthroscopy, surg            T            T          0053       15.6396        720.99      1,643.88     1,884.26
29999     Arthroscopy of joint                   T            1          0000        0.0000         0.00         0.00         0.00
30000     Drainage of nose lesion                T            T          0251        2.0789        95.84        218.51       250.47
30020     Drainage of nose lesion                T            T          0251        2.0789        95.84        218.51       250.47
30100     Intranasal biopsy                      T            T          0252        8.1033        373.56       851.74       976.29

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   29 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
30110     Removal of nose polyp(s)               T            T          0253       16.0740        741.01      1,689.54     1,936.60
30115     Removal of nose polyp(s)               T            T          0253       16.0740        741.01      1,689.54     1,936.60
30117     Removal of intranasal lesion           T            T          0253       16.0740        741.01      1,689.54     1,936.60
30118     Removal of intranasal lesion           T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
30120     Revision of nose                       T            T          0253       16.0740        741.01      1,689.54     1,936.60
30124     Removal of nose lesion                 T            T          0252        8.1033        373.56       851.74       976.29
30125     Removal of nose lesion                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30130     Removal of turbinate bones             T            T          0253       16.0740        741.01      1,689.54     1,936.60
30140     Removal of turbinate bones             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
30150     Partial removal of nose                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30160     Removal of nose                        T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30200     Injection treatment of nose            T            T          0252        8.1033        373.56       851.74       976.29
30210     Nasal sinus therapy                    T            T          0252        8.1033        373.56       851.74       976.29
30220     Insert nasal septal button             T            T          0252        8.1033        373.56       851.74       976.29
30300     Remove nasal foreign body              X            X          0340        0.6137        28.29        64.51        73.94
30310     Remove nasal foreign body              T            T          0253       16.0740        741.01      1,689.54     1,936.60
30320     Remove nasal foreign body              T            T          0253       16.0740        741.01      1,689.54     1,936.60
30400     Reconstruction of nose                 T            1          0000        0.0000         0.00         0.00         0.00
30410     Reconstruction of nose                 T            1          0000        0.0000         0.00         0.00         0.00
30420     Reconstruction of nose                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30430     Revision of nose                       T            1          0000        0.0000         0.00         0.00         0.00
30435     Revision of nose                       T            1          0000        0.0000         0.00         0.00         0.00
30450     Revision of nose                       T            1          0000        0.0000         0.00         0.00         0.00
30460     Revision of nose                       T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30462     Revision of nose                       T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30465     Repair nasal stenosis                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30520     Repair of nasal septum                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
30540     Repair nasal defect                    T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30545     Repair nasal defect                    T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30560     Release of nasal adhesions             T            T          0251        2.0789        95.84        218.51       250.47
30580     Repair upper jaw fistula               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30600     Repair mouth/nose fistula              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30620     Intranasal reconstruction              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
30630     Repair nasal septum defect             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
30801     Cauterization, inner nose              T            T          0252        8.1033        373.56       851.74       976.29
30802     Cauterization, inner nose              T            T          0252        8.1033        373.56       851.74       976.29
30901     Control of nosebleed                   T            T          0250        1.2241        56.43        128.67       147.48
30903     Control of nosebleed                   T            T          0250        1.2241        56.43        128.67       147.48
30905     Control of nosebleed                   T            T          0250        1.2241        56.43        128.67       147.48
30906     Repeat control of nosebleed            T            T          0250        1.2241        56.43        128.67       147.48
30915     Ligation, nasal sinus artery           T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
30920     Ligation, upper jaw artery             T            T          0092       26.5104       1,222.13     2,786.51     3,193.97
30930     Therapy, fracture of nose              T            T          0253       16.0740        741.01      1,689.54     1,936.60
30999     Nasal surgery procedure                T            1          0000        0.0000         0.00         0.00         0.00
31000     Irrigation, maxillary sinus            T            T          0251        2.0789        95.84        218.51       250.47
31002     Irrigation, sphenoid sinus             T            T          0252        8.1033        373.56       851.74       976.29
31020     Exploration, maxillary sinus           T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31030     Exploration, maxillary sinus           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31032     Explore sinus, remove polyps           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31040     Exploration behind upper jaw           T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31050     Exploration, sphenoid sinus            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31051     Sphenoid sinus surgery                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31070     Exploration of frontal sinus           T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31075     Exploration of frontal sinus           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31080     Removal of frontal sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31081     Removal of frontal sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31084     Removal of frontal sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31085     Removal of frontal sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31086     Removal of frontal sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31087     Removal of frontal sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31090     Exploration of sinuses                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31200     Removal of ethmoid sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31201     Removal of ethmoid sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31205     Removal of ethmoid sinus               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31225     Removal of upper jaw                   C            C          0000        0.0000         0.00         0.00         0.00
31230     Removal of upper jaw                   C            C          0000        0.0000         0.00         0.00         0.00
31231     Nasal endoscopy, dx                    T            T          0072        1.4448        66.61        151.86       174.07
31233     Nasal/sinus endoscopy, dx              T            T          0072        1.4448        66.61        151.86       174.07
31235     Nasal/sinus endoscopy, dx              T            T          0074       15.4603        712.72      1,625.03     1,862.66
31237     Nasal/sinus endoscopy, surg            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31238     Nasal/sinus endoscopy, surg            T            T          0074       15.4603        712.72      1,625.03     1,862.66
31239     Nasal/sinus endoscopy, surg            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31240     Nasal/sinus endoscopy, surg            T            T          0074       15.4603        712.72      1,625.03     1,862.66
31254     Revision of ethmoid sinus              T            T          0075       21.2258        978.51      2,231.04     2,557.28
31255     Removal of ethmoid sinus               T            T          0075       21.2258        978.51      2,231.04     2,557.28
31256     Exploration maxillary sinus            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31267     Endoscopy, maxillary sinus             T            T          0075       21.2258        978.51      2,231.04     2,557.28

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   30 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
31276     Sinus endoscopy, surgical              T            T          0075       21.2258        978.51      2,231.04     2,557.28
31287     Nasal/sinus endoscopy, surg            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31288     Nasal/sinus endoscopy, surg            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31290     Nasal/sinus endoscopy, surg            C            C          0000        0.0000         0.00         0.00         0.00
31291     Nasal/sinus endoscopy, surg            C            C          0000        0.0000         0.00         0.00         0.00
31292     Nasal/sinus endoscopy, surg            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31293     Nasal/sinus endoscopy, surg            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31294     Nasal/sinus endoscopy, surg            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31299     Sinus surgery procedure                T            1          0000        0.0000         0.00         0.00         0.00
31300     Removal of larynx lesion               T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31320     Diagnostic incision, larynx            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31360     Removal of larynx                      C            C          0000        0.0000         0.00         0.00         0.00
31365     Removal of larynx                      C            C          0000        0.0000         0.00         0.00         0.00
31367     Partial removal of larynx              C            C          0000        0.0000         0.00         0.00         0.00
31368     Partial removal of larynx              C            C          0000        0.0000         0.00         0.00         0.00
31370     Partial removal of larynx              C            C          0000        0.0000         0.00         0.00         0.00
31375     Partial removal of larynx              C            C          0000        0.0000         0.00         0.00         0.00
31380     Partial removal of larynx              C            C          0000        0.0000         0.00         0.00         0.00
31382     Partial removal of larynx              C            C          0000        0.0000         0.00         0.00         0.00
31390     Removal of larynx & pharynx            C            C          0000        0.0000         0.00         0.00         0.00
31395     Reconstruct larynx & pharynx           C            C          0000        0.0000         0.00         0.00         0.00
31400     Revision of larynx                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31420     Removal of epiglottis                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31500     Insert emergency airway                S            S          0094        2.4582        113.32       258.38       296.16
31502     Change of windpipe airway              T            T          0121        2.2374        103.14       235.17       269.56
31505     Diagnostic laryngoscopy                T            T          0071        0.8034        37.04        84.45        96.79
31510     Laryngoscopy with biopsy               T            T          0074       15.4603        712.72      1,625.03     1,862.66
31511     Remove foreign body, larynx            T            T          0072        1.4448        66.61        151.86       174.07
31512     Removal of larynx lesion               T            T          0074       15.4603        712.72      1,625.03     1,862.66
31513     Injection into vocal cord              T            T          0072        1.4448        66.61        151.86       174.07
31515     Laryngoscopy for aspiration            T            T          0074       15.4603        712.72      1,625.03     1,862.66
31520     Diagnostic laryngoscopy                T            T          0072        1.4448        66.61        151.86       174.07
31525     Diagnostic laryngoscopy                T            T          0074       15.4603        712.72      1,625.03     1,862.66
31526     Diagnostic laryngoscopy                T            T          0075       21.2258        978.51      2,231.04     2,557.28
31527     Laryngoscopy for treatment             T            T          0075       21.2258        978.51      2,231.04     2,557.28
31528     Laryngoscopy and dilation              T            T          0074       15.4603        712.72      1,625.03     1,862.66
31529     Laryngoscopy and dilation              T            T          0074       15.4603        712.72      1,625.03     1,862.66
31530     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31531     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31535     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31536     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31540     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31541     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31545     Remove vc lesion w/scope               T            T          0075       21.2258        978.51      2,231.04     2,557.28
31546     Remove vc lesion scope/graft           T            T          0075       21.2258        978.51      2,231.04     2,557.28
31560     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31561     Operative laryngoscopy                 T            T          0075       21.2258        978.51      2,231.04     2,557.28
31570     Laryngoscopy with injection            T            T          0074       15.4603        712.72      1,625.03     1,862.66
31571     Laryngoscopy with injection            T            T          0075       21.2258        978.51      2,231.04     2,557.28
31575     Diagnostic laryngoscopy                T            T          0072        1.4448        66.61        151.86       174.07
31576     Laryngoscopy with biopsy               T            T          0075       21.2258        978.51      2,231.04     2,557.28
31577     Remove foreign body, larynx            T            T          0073        4.2171        194.41       443.26       508.08
31578     Removal of larynx lesion               T            T          0075       21.2258        978.51      2,231.04     2,557.28
31579     Diagnostic laryngoscopy                T            T          0073        4.2171        194.41       443.26       508.08
31580     Revision of larynx                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31582     Revision of larynx                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31584     Treat larynx fracture                  C            C          0000        0.0000         0.00         0.00         0.00
31587     Revision of larynx                     C            C          0000        0.0000         0.00         0.00         0.00
31588     Revision of larynx                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31590     Reinnervate larynx                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31595     Larynx nerve surgery                   T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31599     Larynx surgery procedure               T            1          0000        0.0000         0.00         0.00         0.00
31600     Incision of windpipe                   T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31601     Incision of windpipe                   T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31603     Incision of windpipe                   T            T          0252        8.1033        373.56       851.74       976.29
31605     Incision of windpipe                   T            T          0252        8.1033        373.56       851.74       976.29
31610     Incision of windpipe                   T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31611     Surgery/speech prosthesis              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31612     Puncture/clear windpipe                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31613     Repair windpipe opening                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31614     Repair windpipe opening                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31615     Visualization of windpipe              T            T          0076        9.4030        433.48       988.35      1,132.87
31620     Endobronchial us add-on                S            S          0670       28.7546       1,325.59     3,022.40     3,464.35
31622     Dx bronchoscope/wash                   T            T          0076        9.4030        433.48       988.35      1,132.87
31623     Dx bronchoscope/brush                  T            T          0076        9.4030        433.48       988.35      1,132.87
31624     Dx bronchoscope/lavage                 T            T          0076        9.4030        433.48       988.35      1,132.87
31625     Bronchoscopy w/biopsy(s)               T            T          0076        9.4030        433.48       988.35      1,132.87

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   31 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
31628     Bronchoscopy/lung bx, each             T            T          0076        9.4030        433.48       988.35      1,132.87
31629     Bronchoscopy/needle bx, each           T            T          0076        9.4030        433.48       988.35      1,132.87
31630     Bronchoscopy dilate/fx repr            T            T          0415       22.0722       1,017.53     2,320.01     2,659.26
31631     Bronchoscopy, dilate w/stent           T            T          0415       22.0722       1,017.53     2,320.01     2,659.26
31632     Bronchoscopy/lung bx, add’l            T            T          0076        9.4030        433.48       988.35      1,132.87
31633     Bronchoscopy/needle bx add’l           T            T          0076        9.4030        433.48       988.35      1,132.87
31635     Bronchoscopy w/fb removal              T            T          0076        9.4030        433.48       988.35      1,132.87
31636     Bronchoscopy, bronch stents            T            T          0415       22.0722       1,017.53     2,320.01     2,659.26
31637     Bronchoscopy, stent add-on             T            T          0076        9.4030        433.48       988.35      1,132.87
31638     Bronchoscopy, revise stent             T            T          0415       22.0722       1,017.53     2,320.01     2,659.26
31640     Bronchoscopy w/tumor excise            T            T          0415       22.0722       1,017.53     2,320.01     2,659.26
31641     Bronchoscopy, treat blockage           T            T          0415       22.0722       1,017.53     2,320.01     2,659.26
31643     Diag bronchoscope/catheter             T            T          0076        9.4030        433.48       988.35      1,132.87
31645     Bronchoscopy, clear airways            T            T          0076        9.4030        433.48       988.35      1,132.87
31646     Bronchoscopy, reclear airway           T            T          0076        9.4030        433.48       988.35      1,132.87
31656     Bronchoscopy, inj for x-ray            T            T          0076        9.4030        433.48       988.35      1,132.87
31700     Insertion of airway catheter           T            1          0072        1.4448         0.00         0.00         0.00          X
31708     Instill airway contrast dye            N            1          0000        0.0000         0.00         0.00         0.00          X
31710     Insertion of airway catheter           N            1          0000        0.0000         0.00         0.00         0.00          X
31715     Injection for bronchus x-ray           N            N          0000        0.0000         0.00         0.00         0.00
31717     Bronchial brush biopsy                 T            T          0073        4.2171        194.41       443.26       508.08
31720     Clearance of airways                   T            T          0071        0.8034        37.04        84.45        96.79
31725     Clearance of airways                   C            C          0000        0.0000         0.00         0.00         0.00
31730     Intro, windpipe wire/tube              T            T          0073        4.2171        194.41       443.26       508.08
31750     Repair of windpipe                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31755     Repair of windpipe                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
31760     Repair of windpipe                     C            C          0000        0.0000         0.00         0.00         0.00
31766     Reconstruction of windpipe             C            C          0000        0.0000         0.00         0.00         0.00
31770     Repair/graft of bronchus               C            C          0000        0.0000         0.00         0.00         0.00
31775     Reconstruct bronchus                   C            C          0000        0.0000         0.00         0.00         0.00
31780     Reconstruct windpipe                   C            C          0000        0.0000         0.00         0.00         0.00
31781     Reconstruct windpipe                   C            C          0000        0.0000         0.00         0.00         0.00
31785     Remove windpipe lesion                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31786     Remove windpipe lesion                 C            C          0000        0.0000         0.00         0.00         0.00
31800     Repair of windpipe injury              C            C          0000        0.0000         0.00         0.00         0.00
31805     Repair of windpipe injury              C            C          0000        0.0000         0.00         0.00         0.00
31820     Closure of windpipe lesion             T            T          0253       16.0740        741.01      1,689.54     1,936.60
31825     Repair of windpipe defect              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31830     Revise windpipe scar                   T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
31899     Airways surgical procedure             T            1          0000        0.0000         0.00         0.00         0.00
32000     Drainage of chest                      T            T          0070        3.2141        148.17       337.83       387.23
32002     Treatment of collapsed lung            T            T          0070        3.2141        148.17       337.83       387.23
32005     Treat lung lining chemically           T            T          0070        3.2141        148.17       337.83       387.23
32019     Insert pleural catheter                T            T          0427       10.0109        461.50      1,052.25     1,206.11
32020     Insertion of chest tube                T            T          0070        3.2141        148.17       337.83       387.23
32035     Exploration of chest                   C            C          0000        0.0000         0.00         0.00         0.00
32036     Exploration of chest                   C            C          0000        0.0000         0.00         0.00         0.00
32095     Biopsy through chest wall              C            C          0000        0.0000         0.00         0.00         0.00
32100     Exploration/biopsy of chest            C            C          0000        0.0000         0.00         0.00         0.00
32110     Explore/repair chest                   C            C          0000        0.0000         0.00         0.00         0.00
32120     Re-exploration of chest                C            C          0000        0.0000         0.00         0.00         0.00
32124     Explore chest free adhesions           C            C          0000        0.0000         0.00         0.00         0.00
32140     Removal of lung lesion(s)              C            C          0000        0.0000         0.00         0.00         0.00
32141     Remove/treat lung lesions              C            C          0000        0.0000         0.00         0.00         0.00
32150     Removal of lung lesion(s)              C            C          0000        0.0000         0.00         0.00         0.00
32151     Remove lung foreign body               C            C          0000        0.0000         0.00         0.00         0.00
32160     Open chest heart massage               C            C          0000        0.0000         0.00         0.00         0.00
32200     Drain, open, lung lesion               C            C          0000        0.0000         0.00         0.00         0.00
32201     Drain, percut, lung lesion             T            T          0070        3.2141        148.17       337.83       387.23
32215     Treat chest lining                     C            C          0000        0.0000         0.00         0.00         0.00
32220     Release of lung                        C            C          0000        0.0000         0.00         0.00         0.00
32225     Partial release of lung                C            C          0000        0.0000         0.00         0.00         0.00
32310     Removal of chest lining                C            C          0000        0.0000         0.00         0.00         0.00
32320     Free/remove chest lining               C            C          0000        0.0000         0.00         0.00         0.00
32400     Needle biopsy chest lining             T            T          0685        6.0034        276.76       631.02       723.29
32402     Open biopsy chest lining               C            C          0000        0.0000         0.00         0.00         0.00
32405     Biopsy, lung or mediastinum            T            T          0685        6.0034        276.76       631.02       723.29
32420     Puncture/clear lung                    T            T          0070        3.2141        148.17       337.83       387.23
32440     Removal of lung                        C            C          0000        0.0000         0.00         0.00         0.00
32442     Sleeve pneumonectomy                   C            C          0000        0.0000         0.00         0.00         0.00
32445     Removal of lung                        C            C          0000        0.0000         0.00         0.00         0.00
32480     Partial removal of lung                C            C          0000        0.0000         0.00         0.00         0.00
32482     Bilobectomy                            C            C          0000        0.0000         0.00         0.00         0.00
32484     Segmentectomy                          C            C          0000        0.0000         0.00         0.00         0.00
32486     Sleeve lobectomy                       C            C          0000        0.0000         0.00         0.00         0.00
32488     Completion pneumonectomy               C            C          0000        0.0000         0.00         0.00         0.00
32491     Lung volume reduction                  C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   32 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
32500     Partial removal of lung                C            C          0000       0.0000          0.00         0.00         0.00
32501     Repair bronchus add-on                 C            C          0000       0.0000          0.00         0.00         0.00
32503     Resect apical lung tumor               C            C          0000       0.0000          0.00         0.00         0.00
32504     Resect apical lung tum/chest           C            C          0000       0.0000          0.00         0.00         0.00
32540     Removal of lung lesion                 C            C          0000       0.0000          0.00         0.00         0.00
32601     Thoracoscopy, diagnostic               T            T          0069      30.9541        1,426.98     3,253.59     3,729.35
32602     Thoracoscopy, diagnostic               T            T          0069      30.9541        1,426.98     3,253.59     3,729.35
32603     Thoracoscopy, diagnostic               T            T          0069      30.9541        1,426.98     3,253.59     3,729.35
32604     Thoracoscopy, diagnostic               T            T          0069      30.9541        1,426.98     3,253.59     3,729.35
32605     Thoracoscopy, diagnostic               T            T          0069      30.9541        1,426.98     3,253.59     3,729.35
32606     Thoracoscopy, diagnostic               T            T          0069      30.9541        1,426.98     3,253.59     3,729.35
32650     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32651     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32652     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32653     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32654     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32655     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32656     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32657     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32658     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32659     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32660     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32661     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32662     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32663     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32664     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32665     Thoracoscopy, surgical                 C            C          0000       0.0000          0.00         0.00         0.00
32800     Repair lung hernia                     C            C          0000       0.0000          0.00         0.00         0.00
32810     Close chest after drainage             C            C          0000       0.0000          0.00         0.00         0.00
32815     Close bronchial fistula                C            C          0000       0.0000          0.00         0.00         0.00
32820     Reconstruct injured chest              C            C          0000       0.0000          0.00         0.00         0.00
32850     Donor pneumonectomy                    C            C          0000       0.0000          0.00         0.00         0.00
32851     Lung transplant, single                C            C          0000       0.0000          0.00         0.00         0.00
32852     Lung transplant with bypass            C            C          0000       0.0000          0.00         0.00         0.00
32853     Lung transplant, double                C            C          0000       0.0000          0.00         0.00         0.00
32854     Lung transplant with bypass            C            C          0000       0.0000          0.00         0.00         0.00
32855     Prepare donor lung, single             C            C          0000       0.0000          0.00         0.00         0.00
32856     Prepare donor lung, double             C            C          0000       0.0000          0.00         0.00         0.00
32900     Removal of rib(s)                      C            C          0000       0.0000          0.00         0.00         0.00
32905     Revise & repair chest wall             C            C          0000       0.0000          0.00         0.00         0.00
32906     Revise & repair chest wall             C            C          0000       0.0000          0.00         0.00         0.00
32940     Revision of lung                       C            C          0000       0.0000          0.00         0.00         0.00
32960     Therapeutic pneumothorax               T            T          0070       3.2141         148.17       337.83       387.23
32997     Total lung lavage                      C            C          0000       0.0000          0.00         0.00         0.00
32999     Chest surgery procedure                T            1          0000       0.0000          0.00         0.00         0.00
33010     Drainage of heart sac                  T            T          0070       3.2141         148.17       337.83       387.23
33011     Repeat drainage of heart sac           T            T          0070       3.2141         148.17       337.83       387.23
33015     Incision of heart sac                  C            C          0000       0.0000          0.00         0.00         0.00
33020     Incision of heart sac                  C            C          0000       0.0000          0.00         0.00         0.00
33025     Incision of heart sac                  C            C          0000       0.0000          0.00         0.00         0.00
33030     Partial removal of heart sac           C            C          0000       0.0000          0.00         0.00         0.00
33031     Partial removal of heart sac           C            C          0000       0.0000          0.00         0.00         0.00
33050     Removal of heart sac lesion            C            C          0000       0.0000          0.00         0.00         0.00
33120     Removal of heart lesion                C            C          0000       0.0000          0.00         0.00         0.00
33130     Removal of heart lesion                C            C          0000       0.0000          0.00         0.00         0.00
33140     Heart revascularize (tmr)              C            C          0000       0.0000          0.00         0.00         0.00
33141     Heart tmr w/other procedure            C            C          0000       0.0000          0.00         0.00         0.00
33200     Insertion of heart pacemaker           C            1          0000       0.0000          0.00         0.00         0.00          X
33201     Insertion of heart pacemaker           C            1          0000       0.0000          0.00         0.00         0.00          X
33206     Insertion of heart pacemaker           T            T          0089      117.0463       5,395.83    12,302.74    14,101.74
33207     Insertion of heart pacemaker           T            T          0089      117.0463       5,395.83    12,302.74    14,101.74
33208     Insertion of heart pacemaker           T            T          0655      136.8448       6,308.55    14,383.76    16,487.06
33210     Insertion of heart electrode           T            T          0106      55.9362        2,578.66     5,879.45     6,739.19
33211     Insertion of heart electrode           T            T          0106      55.9362        2,578.66     5,879.45     6,739.19
33212     Insertion of pulse generator           T            T          0090      90.2017        4,158.30     9,481.10    10,867.50
33213     Insertion of pulse generator           T            T          0654      112.0279       5,164.49    11,775.25    13,497.12
33214     Upgrade of pacemaker system            T            T          0655      136.8448       6,308.55    14,383.76    16,487.06
33215     Reposition pacing-defib lead           T            T          0105      21.9865        1,013.58     2,311.00     2,648.93
33216     Insert lead pace-defib, one            T            T          0106      55.9362        2,578.66     5,879.45     6,739.19
33217     Insert lead pace-defib, dual           T            T          0106      55.9362        2,578.66     5,879.45     6,739.19
33218     Repair lead pace-defib, one            T            T          0106      55.9362        2,578.66     5,879.45     6,739.19
33220     Repair lead pace-defib, dual           T            T          0106      55.9362        2,578.66     5,879.45     6,739.19
33222     Revise pocket, pacemaker               T            T          0027      18.1956         838.82      1,912.54     2,192.21
33223     Revise pocket, pacing-defib            T            T          0027      18.1956         838.82      1,912.54     2,192.21
33224     Insert pacing lead & connect           T            T          0418      169.3514       7,807.10    17,800.53    20,403.46
33225     L ventric pacing lead add-on           T            T          0418      169.3514       7,807.10    17,800.53    20,403.46
33226     Reposition l ventric lead              T            T          0105      21.9865        1,013.58     2,311.00     2,648.93

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   33 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
33233     Removal of pacemaker system            T            T          0105       21.9865       1,013.58     2,311.00     2,648.93
33234     Removal of pacemaker system            T            T          0105       21.9865       1,013.58     2,311.00     2,648.93
33235     Removal pacemaker electrode            T            T          0105       21.9865       1,013.58     2,311.00     2,648.93
33236     Remove electrode/thoracotomy           C            C          0000        0.0000         0.00         0.00         0.00
33237     Remove electrode/thoracotomy           C            C          0000        0.0000         0.00         0.00         0.00
33238     Remove electrode/thoracotomy           C            C          0000        0.0000         0.00         0.00         0.00
33240     Insert pulse generator                 B            B          0000        0.0000         0.00         0.00         0.00
33241     Remove pulse generator                 T            T          0105       21.9865       1,013.58     2,311.00     2,648.93
33243     Remove eltrd/thoracotomy               C            C          0000        0.0000         0.00         0.00         0.00
33244     Remove eltrd, transven                 T            T          0105       21.9865       1,013.58     2,311.00     2,648.93
33245     Insert epic eltrd pace-defib           C            1          0000        0.0000         0.00         0.00         0.00          X
33246     Insert epic eltrd/generator            C            1          0000        0.0000         0.00         0.00         0.00          X
33249     Eltrd/insert pace-defib                B            B          0000        0.0000         0.00         0.00         0.00
33250     Ablate heart dysrhythm focus           C            C          0000        0.0000         0.00         0.00         0.00
33251     Ablate heart dysrhythm focus           C            C          0000        0.0000         0.00         0.00         0.00
33253     Reconstruct atria                      C            1          0000        0.0000         0.00         0.00         0.00          X
33261     Ablate heart dysrhythm focus           C            C          0000        0.0000         0.00         0.00         0.00
33282     Implant pat-active ht record           S            S          0680       74.9052       3,453.13     7,873.29     9,024.58
33284     Remove pat-active ht record            T            T          0109       11.1714        515.00      1,174.23     1,345.93
33300     Repair of heart wound                  C            C          0000        0.0000         0.00         0.00         0.00
33305     Repair of heart wound                  C            C          0000        0.0000         0.00         0.00         0.00
33310     Exploratory heart surgery              C            C          0000        0.0000         0.00         0.00         0.00
33315     Exploratory heart surgery              C            C          0000        0.0000         0.00         0.00         0.00
33320     Repair major blood vessel(s)           C            C          0000        0.0000         0.00         0.00         0.00
33321     Repair major vessel                    C            C          0000        0.0000         0.00         0.00         0.00
33322     Repair major blood vessel(s)           C            C          0000        0.0000         0.00         0.00         0.00
33330     Insert major vessel graft              C            C          0000        0.0000         0.00         0.00         0.00
33332     Insert major vessel graft              C            C          0000        0.0000         0.00         0.00         0.00
33335     Insert major vessel graft              C            C          0000        0.0000         0.00         0.00         0.00
33400     Repair of aortic valve                 C            C          0000        0.0000         0.00         0.00         0.00
33401     Valvuloplasty, open                    C            C          0000        0.0000         0.00         0.00         0.00
33403     Valvuloplasty, w/cp bypass             C            C          0000        0.0000         0.00         0.00         0.00
33404     Prepare heart-aorta conduit            C            C          0000        0.0000         0.00         0.00         0.00
33405     Replacement of aortic valve            C            C          0000        0.0000         0.00         0.00         0.00
33406     Replacement of aortic valve            C            C          0000        0.0000         0.00         0.00         0.00
33410     Replacement of aortic valve            C            C          0000        0.0000         0.00         0.00         0.00
33411     Replacement of aortic valve            C            C          0000        0.0000         0.00         0.00         0.00
33412     Replacement of aortic valve            C            C          0000        0.0000         0.00         0.00         0.00
33413     Replacement of aortic valve            C            C          0000        0.0000         0.00         0.00         0.00
33414     Repair of aortic valve                 C            C          0000        0.0000         0.00         0.00         0.00
33415     Revision, subvalvular tissue           C            C          0000        0.0000         0.00         0.00         0.00
33416     Revise ventricle muscle                C            C          0000        0.0000         0.00         0.00         0.00
33417     Repair of aortic valve                 C            C          0000        0.0000         0.00         0.00         0.00
33420     Revision of mitral valve               C            C          0000        0.0000         0.00         0.00         0.00
33422     Revision of mitral valve               C            C          0000        0.0000         0.00         0.00         0.00
33425     Repair of mitral valve                 C            C          0000        0.0000         0.00         0.00         0.00
33426     Repair of mitral valve                 C            C          0000        0.0000         0.00         0.00         0.00
33427     Repair of mitral valve                 C            C          0000        0.0000         0.00         0.00         0.00
33430     Replacement of mitral valve            C            C          0000        0.0000         0.00         0.00         0.00
33460     Revision of tricuspid valve            C            C          0000        0.0000         0.00         0.00         0.00
33463     Valvuloplasty, tricuspid               C            C          0000        0.0000         0.00         0.00         0.00
33464     Valvuloplasty, tricuspid               C            C          0000        0.0000         0.00         0.00         0.00
33465     Replace tricuspid valve                C            C          0000        0.0000         0.00         0.00         0.00
33468     Revision of tricuspid valve            C            C          0000        0.0000         0.00         0.00         0.00
33470     Revision of pulmonary valve            C            C          0000        0.0000         0.00         0.00         0.00
33471     Valvotomy, pulmonary valve             C            C          0000        0.0000         0.00         0.00         0.00
33472     Revision of pulmonary valve            C            C          0000        0.0000         0.00         0.00         0.00
33474     Revision of pulmonary valve            C            C          0000        0.0000         0.00         0.00         0.00
33475     Replacement, pulmonary valve           C            C          0000        0.0000         0.00         0.00         0.00
33476     Revision of heart chamber              C            C          0000        0.0000         0.00         0.00         0.00
33478     Revision of heart chamber              C            C          0000        0.0000         0.00         0.00         0.00
33496     Repair, prosth valve clot              C            C          0000        0.0000         0.00         0.00         0.00
33500     Repair heart vessel fistula            C            C          0000        0.0000         0.00         0.00         0.00
33501     Repair heart vessel fistula            C            C          0000        0.0000         0.00         0.00         0.00
33502     Coronary artery correction             C            C          0000        0.0000         0.00         0.00         0.00
33503     Coronary artery graft                  C            C          0000        0.0000         0.00         0.00         0.00
33504     Coronary artery graft                  C            C          0000        0.0000         0.00         0.00         0.00
33505     Repair artery w/tunnel                 C            C          0000        0.0000         0.00         0.00         0.00
33506     Repair artery, translocation           C            C          0000        0.0000         0.00         0.00         0.00
33507     Repair art, intramural                 C            C          0000        0.0000         0.00         0.00         0.00
33508     Endoscopic vein harvest                N            N          0000        0.0000         0.00         0.00         0.00
33510     CABG, vein, single                     C            C          0000        0.0000         0.00         0.00         0.00
33511     CABG, vein, two                        C            C          0000        0.0000         0.00         0.00         0.00
33512     CABG, vein, three                      C            C          0000        0.0000         0.00         0.00         0.00
33513     CABG, vein, four                       C            C          0000        0.0000         0.00         0.00         0.00
33514     CABG, vein, five                       C            C          0000        0.0000         0.00         0.00         0.00
33516     Cabg, vein, six or more                C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   34 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
33517     CABG, artery-vein, single              C            C          0000       0.0000          0.00         0.00        0.00
33518     CABG, artery-vein, two                 C            C          0000       0.0000          0.00         0.00        0.00
33519     CABG, artery-vein, three               C            C          0000       0.0000          0.00         0.00        0.00
33521     CABG, artery-vein, four                C            C          0000       0.0000          0.00         0.00        0.00
33522     CABG, artery-vein, five                C            C          0000       0.0000          0.00         0.00        0.00
33523     Cabg, art-vein, six or more            C            C          0000       0.0000          0.00         0.00        0.00
33530     Coronary artery, bypass/reop           C            C          0000       0.0000          0.00         0.00        0.00
33533     CABG, arterial, single                 C            C          0000       0.0000          0.00         0.00        0.00
33534     CABG, arterial, two                    C            C          0000       0.0000          0.00         0.00        0.00
33535     CABG, arterial, three                  C            C          0000       0.0000          0.00         0.00        0.00
33536     Cabg, arterial, four or more           C            C          0000       0.0000          0.00         0.00        0.00
33542     Removal of heart lesion                C            C          0000       0.0000          0.00         0.00        0.00
33545     Repair of heart damage                 C            C          0000       0.0000          0.00         0.00        0.00
33548     Restore/remodel, ventricle             C            C          0000       0.0000          0.00         0.00        0.00
33572     Open coronary endarterectomy           C            C          0000       0.0000          0.00         0.00        0.00
33600     Closure of valve                       C            C          0000       0.0000          0.00         0.00        0.00
33602     Closure of valve                       C            C          0000       0.0000          0.00         0.00        0.00
33606     Anastomosis/artery-aorta               C            C          0000       0.0000          0.00         0.00        0.00
33608     Repair anomaly w/conduit               C            C          0000       0.0000          0.00         0.00        0.00
33610     Repair by enlargement                  C            C          0000       0.0000          0.00         0.00        0.00
33611     Repair double ventricle                C            C          0000       0.0000          0.00         0.00        0.00
33612     Repair double ventricle                C            C          0000       0.0000          0.00         0.00        0.00
33615     Repair, modified fontan                C            C          0000       0.0000          0.00         0.00        0.00
33617     Repair single ventricle                C            C          0000       0.0000          0.00         0.00        0.00
33619     Repair single ventricle                C            C          0000       0.0000          0.00         0.00        0.00
33641     Repair heart septum defect             C            C          0000       0.0000          0.00         0.00        0.00
33645     Revision of heart veins                C            C          0000       0.0000          0.00         0.00        0.00
33647     Repair heart septum defects            C            C          0000       0.0000          0.00         0.00        0.00
33660     Repair of heart defects                C            C          0000       0.0000          0.00         0.00        0.00
33665     Repair of heart defects                C            C          0000       0.0000          0.00         0.00        0.00
33670     Repair of heart chambers               C            C          0000       0.0000          0.00         0.00        0.00
33681     Repair heart septum defect             C            C          0000       0.0000          0.00         0.00        0.00
33684     Repair heart septum defect             C            C          0000       0.0000          0.00         0.00        0.00
33688     Repair heart septum defect             C            C          0000       0.0000          0.00         0.00        0.00
33690     Reinforce pulmonary artery             C            C          0000       0.0000          0.00         0.00        0.00
33692     Repair of heart defects                C            C          0000       0.0000          0.00         0.00        0.00
33694     Repair of heart defects                C            C          0000       0.0000          0.00         0.00        0.00
33697     Repair of heart defects                C            C          0000       0.0000          0.00         0.00        0.00
33702     Repair of heart defects                C            C          0000       0.0000          0.00         0.00        0.00
33710     Repair of heart defects                C            C          0000       0.0000          0.00         0.00        0.00
33720     Repair of heart defect                 C            C          0000       0.0000          0.00         0.00        0.00
33722     Repair of heart defect                 C            C          0000       0.0000          0.00         0.00        0.00
33730     Repair heart-vein defect(s)            C            C          0000       0.0000          0.00         0.00        0.00
33732     Repair heart-vein defect               C            C          0000       0.0000          0.00         0.00        0.00
33735     Revision of heart chamber              C            C          0000       0.0000          0.00         0.00        0.00
33736     Revision of heart chamber              C            C          0000       0.0000          0.00         0.00        0.00
33737     Revision of heart chamber              C            C          0000       0.0000          0.00         0.00        0.00
33750     Major vessel shunt                     C            C          0000       0.0000          0.00         0.00        0.00
33755     Major vessel shunt                     C            C          0000       0.0000          0.00         0.00        0.00
33762     Major vessel shunt                     C            C          0000       0.0000          0.00         0.00        0.00
33764     Major vessel shunt & graft             C            C          0000       0.0000          0.00         0.00        0.00
33766     Major vessel shunt                     C            C          0000       0.0000          0.00         0.00        0.00
33767     Major vessel shunt                     C            C          0000       0.0000          0.00         0.00        0.00
33768     Cavopulmonary shunting                 C            C          0000       0.0000          0.00         0.00        0.00
33770     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33771     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33774     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33775     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33776     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33777     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33778     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33779     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33780     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33781     Repair great vessels defect            C            C          0000       0.0000          0.00         0.00        0.00
33786     Repair arterial trunk                  C            C          0000       0.0000          0.00         0.00        0.00
33788     Revision of pulmonary artery           C            C          0000       0.0000          0.00         0.00        0.00
33800     Aortic suspension                      C            C          0000       0.0000          0.00         0.00        0.00
33802     Repair vessel defect                   C            C          0000       0.0000          0.00         0.00        0.00
33803     Repair vessel defect                   C            C          0000       0.0000          0.00         0.00        0.00
33813     Repair septal defect                   C            C          0000       0.0000          0.00         0.00        0.00
33814     Repair septal defect                   C            C          0000       0.0000          0.00         0.00        0.00
33820     Revise major vessel                    C            C          0000       0.0000          0.00         0.00        0.00
33822     Revise major vessel                    C            C          0000       0.0000          0.00         0.00        0.00
33824     Revise major vessel                    C            C          0000       0.0000          0.00         0.00        0.00
33840     Remove aorta constriction              C            C          0000       0.0000          0.00         0.00        0.00
33845     Remove aorta constriction              C            C          0000       0.0000          0.00         0.00        0.00
33851     Remove aorta constriction              C            C          0000       0.0000          0.00         0.00        0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   35 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
33852     Repair septal defect                   C            C          0000        0.0000         0.00         0.00         0.00
33853     Repair septal defect                   C            C          0000        0.0000         0.00         0.00         0.00
33860     Ascending aortic graft                 C            C          0000        0.0000         0.00         0.00         0.00
33861     Ascending aortic graft                 C            C          0000        0.0000         0.00         0.00         0.00
33863     Ascending aortic graft                 C            C          0000        0.0000         0.00         0.00         0.00
33870     Transverse aortic arch graft           C            C          0000        0.0000         0.00         0.00         0.00
33875     Thoracic aortic graft                  C            C          0000        0.0000         0.00         0.00         0.00
33877     Thoracoabdominal graft                 C            C          0000        0.0000         0.00         0.00         0.00
33880     Endovasc taa repr incl subcl           C            C          0000        0.0000         0.00         0.00         0.00
33881     Endovasc taa repr w/o subcl            C            C          0000        0.0000         0.00         0.00         0.00
33883     Insert endovasc prosth, taa            C            C          0000        0.0000         0.00         0.00         0.00
33884     Endovasc prosth, taa, add-on           C            C          0000        0.0000         0.00         0.00         0.00
33886     Endovasc prosth, delayed               C            C          0000        0.0000         0.00         0.00         0.00
33889     Artery transpose/endovas taa           C            C          0000        0.0000         0.00         0.00         0.00
33891     Car-car bp grft/endovas taa            C            C          0000        0.0000         0.00         0.00         0.00
33910     Remove lung artery emboli              C            C          0000        0.0000         0.00         0.00         0.00
33915     Remove lung artery emboli              C            C          0000        0.0000         0.00         0.00         0.00
33916     Surgery of great vessel                C            C          0000        0.0000         0.00         0.00         0.00
33917     Repair pulmonary artery                C            C          0000        0.0000         0.00         0.00         0.00
33920     Repair pulmonary atresia               C            C          0000        0.0000         0.00         0.00         0.00
33922     Transect pulmonary artery              C            C          0000        0.0000         0.00         0.00         0.00
33924     Remove pulmonary shunt                 C            C          0000        0.0000         0.00         0.00         0.00
33925     Rpr pul art unifocal w/o cpb           C            C          0000        0.0000         0.00         0.00         0.00
33926     Repr pul art, unifocal w/cpb           C            C          0000        0.0000         0.00         0.00         0.00
33930     Removal of donor heart/lung            C            C          0000        0.0000         0.00         0.00         0.00
33933     Prepare donor heart/lung               C            C          0000        0.0000         0.00         0.00         0.00
33935     Transplantation, heart/lung            C            C          0000        0.0000         0.00         0.00         0.00
33940     Removal of donor heart                 C            C          0000        0.0000         0.00         0.00         0.00
33944     Prepare donor heart                    C            C          0000        0.0000         0.00         0.00         0.00
33945     Transplantation of heart               C            C          0000        0.0000         0.00         0.00         0.00
33960     External circulation assist            C            C          0000        0.0000         0.00         0.00         0.00
33961     External circulation assist            C            C          0000        0.0000         0.00         0.00         0.00
33967     Insert ia percut device                C            C          0000        0.0000         0.00         0.00         0.00
33968     Remove aortic assist device            C            C          0000        0.0000         0.00         0.00         0.00
33970     Aortic circulation assist              C            C          0000        0.0000         0.00         0.00         0.00
33971     Aortic circulation assist              C            C          0000        0.0000         0.00         0.00         0.00
33973     Insert balloon device                  C            C          0000        0.0000         0.00         0.00         0.00
33974     Remove intra-aortic balloon            C            C          0000        0.0000         0.00         0.00         0.00
33975     Implant ventricular device             C            C          0000        0.0000         0.00         0.00         0.00
33976     Implant ventricular device             C            C          0000        0.0000         0.00         0.00         0.00
33977     Remove ventricular device              C            C          0000        0.0000         0.00         0.00         0.00
33978     Remove ventricular device              C            C          0000        0.0000         0.00         0.00         0.00
33979     Insert intracorporeal device           C            C          0000        0.0000         0.00         0.00         0.00
33980     Remove intracorporeal device           C            C          0000        0.0000         0.00         0.00         0.00
33999     Cardiac surgery procedure              T            1          0000        0.0000         0.00         0.00         0.00
34001     Removal of artery clot                 C            C          0000        0.0000         0.00         0.00         0.00
34051     Removal of artery clot                 C            C          0000        0.0000         0.00         0.00         0.00
34101     Removal of artery clot                 T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34111     Removal of arm artery clot             T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34151     Removal of artery clot                 C            C          0000        0.0000         0.00         0.00         0.00
34201     Removal of artery clot                 T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34203     Removal of leg artery clot             T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34401     Removal of vein clot                   C            C          0000        0.0000         0.00         0.00         0.00
34421     Removal of vein clot                   T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34451     Removal of vein clot                   C            C          0000        0.0000         0.00         0.00         0.00
34471     Removal of vein clot                   T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34490     Removal of vein clot                   T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34501     Repair valve, femoral vein             T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34502     Reconstruct vena cava                  C            C          0000        0.0000         0.00         0.00         0.00
34510     Transposition of vein valve            T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34520     Cross-over vein graft                  T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34530     Leg vein fusion                        T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
34800     Endovas aaa repr w/sm tube             C            C          0000        0.0000         0.00         0.00         0.00
34802     Endovas aaa repr w/2-p part            C            C          0000        0.0000         0.00         0.00         0.00
34803     Endovas aaa repr w/3-p part            C            C          0000        0.0000         0.00         0.00         0.00
34804     Endovas aaa repr w/1-p part            C            C          0000        0.0000         0.00         0.00         0.00
34805     Endovas aaa repr w/long tube           C            C          0000        0.0000         0.00         0.00         0.00
34808     Endovas iliac a device addon           C            C          0000        0.0000         0.00         0.00         0.00
34812     Xpose for endoprosth, femorl           C            C          0000        0.0000         0.00         0.00         0.00
34813     Femoral endovas graft add-on           C            C          0000        0.0000         0.00         0.00         0.00
34820     Xpose for endoprosth, iliac            C            C          0000        0.0000         0.00         0.00         0.00
34825     Endovasc extend prosth, init           C            C          0000        0.0000         0.00         0.00         0.00
34826     Endovasc exten prosth, add’l           C            C          0000        0.0000         0.00         0.00         0.00
34830     Open aortic tube prosth repr           C            C          0000        0.0000         0.00         0.00         0.00
34831     Open aortoiliac prosth repr            C            C          0000        0.0000         0.00         0.00         0.00
34832     Open aortofemor prosth repr            C            C          0000        0.0000         0.00         0.00         0.00
34833     Xpose for endoprosth, iliac            C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   36 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
34834     Xpose, endoprosth, brachial            C            C          0000        0.0000         0.00         0.00         0.00
34900     Endovasc iliac repr w/graft            C            C          0000        0.0000         0.00         0.00         0.00
35001     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35002     Repair artery rupture, neck            C            C          0000        0.0000         0.00         0.00         0.00
35005     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35011     Repair defect of artery                T            T          0653       36.9427       1,703.06     3,883.05     4,450.86
35013     Repair artery rupture, arm             C            C          0000        0.0000         0.00         0.00         0.00
35021     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35022     Repair artery rupture, chest           C            C          0000        0.0000         0.00         0.00         0.00
35045     Repair defect of arm artery            C            C          0000        0.0000         0.00         0.00         0.00
35081     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35082     Repair artery rupture, aorta           C            C          0000        0.0000         0.00         0.00         0.00
35091     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35092     Repair artery rupture, aorta           C            C          0000        0.0000         0.00         0.00         0.00
35102     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35103     Repair artery rupture, groin           C            C          0000        0.0000         0.00         0.00         0.00
35111     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35112     Repair artery rupture,spleen           C            C          0000        0.0000         0.00         0.00         0.00
35121     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35122     Repair artery rupture, belly           C            C          0000        0.0000         0.00         0.00         0.00
35131     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35132     Repair artery rupture, groin           C            C          0000        0.0000         0.00         0.00         0.00
35141     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35142     Repair artery rupture, thigh           C            C          0000        0.0000         0.00         0.00         0.00
35151     Repair defect of artery                C            C          0000        0.0000         0.00         0.00         0.00
35152     Repair artery rupture, knee            C            C          0000        0.0000         0.00         0.00         0.00
35180     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35182     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35184     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35188     Repair blood vessel lesion             T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
35189     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35190     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35201     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35206     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35207     Repair blood vessel lesion             T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
35211     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35216     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35221     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35226     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35231     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35236     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35241     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35246     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35251     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35256     Repair blood vessel lesion             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35261     Repair blood vessel lesion             T            T          0653       36.9427       1,703.06     3,883.05     4,450.86
35266     Repair blood vessel lesion             T            T          0653       36.9427       1,703.06     3,883.05     4,450.86
35271     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35276     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35281     Repair blood vessel lesion             C            C          0000        0.0000         0.00         0.00         0.00
35286     Repair blood vessel lesion             T            T          0653       36.9427       1,703.06     3,883.05     4,450.86
35301     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35311     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35321     Rechanneling of artery                 T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35331     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35341     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35351     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35355     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35361     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35363     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35371     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35372     Rechanneling of artery                 C            C          0000        0.0000         0.00         0.00         0.00
35381     Rechanneling of artery                 C            1          0000        0.0000         0.00         0.00         0.00          X
35390     Reoperation, carotid add-on            C            C          0000        0.0000         0.00         0.00         0.00
35400     Angioscopy                             C            C          0000        0.0000         0.00         0.00         0.00
35450     Repair arterial blockage               C            C          0000        0.0000         0.00         0.00         0.00
35452     Repair arterial blockage               C            C          0000        0.0000         0.00         0.00         0.00
35454     Repair arterial blockage               C            C          0000        0.0000         0.00         0.00         0.00
35456     Repair arterial blockage               C            C          0000        0.0000         0.00         0.00         0.00
35458     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35459     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35460     Repair venous blockage                 T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35470     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35471     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35472     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35473     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35474     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   37 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
35475     Repair arterial blockage               T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35476     Repair venous blockage                 T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35480     Atherectomy, open                      C            C          0000        0.0000         0.00         0.00         0.00
35481     Atherectomy, open                      C            C          0000        0.0000         0.00         0.00         0.00
35482     Atherectomy, open                      C            C          0000        0.0000         0.00         0.00         0.00
35483     Atherectomy, open                      C            C          0000        0.0000         0.00         0.00         0.00
35484     Atherectomy, open                      T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35485     Atherectomy, open                      T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35490     Atherectomy, percutaneous              T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35491     Atherectomy, percutaneous              T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35492     Atherectomy, percutaneous              T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35493     Atherectomy, percutaneous              T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35494     Atherectomy, percutaneous              T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35495     Atherectomy, percutaneous              T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35500     Harvest vein for bypass                T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
35501     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35506     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35507     Artery bypass graft                    C            1          0000        0.0000         0.00         0.00         0.00          X
35508     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35509     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35510     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35511     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35512     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35515     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35516     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35518     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35521     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35522     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35525     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35526     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35531     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35533     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35536     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35541     Artery bypass graft                    C            1          0000        0.0000         0.00         0.00         0.00          X
35546     Artery bypass graft                    C            1          0000        0.0000         0.00         0.00         0.00          X
35548     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35549     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35551     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35556     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35558     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35560     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35563     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35565     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35566     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35571     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35572     Harvest femoropopliteal vein           N            N          0000        0.0000         0.00         0.00         0.00
35583     Vein bypass graft                      C            C          0000        0.0000         0.00         0.00         0.00
35585     Vein bypass graft                      C            C          0000        0.0000         0.00         0.00         0.00
35587     Vein bypass graft                      C            C          0000        0.0000         0.00         0.00         0.00
35600     Harvest artery for cabg                C            C          0000        0.0000         0.00         0.00         0.00
35601     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35606     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35612     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35616     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35621     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35623     Bypass graft, not vein                 C            C          0000        0.0000         0.00         0.00         0.00
35626     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35631     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35636     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35641     Artery bypass graft                    C            1          0000        0.0000         0.00         0.00         0.00          X
35642     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35645     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35646     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35647     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35650     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35651     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35654     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35656     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35661     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35663     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35665     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35666     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35671     Artery bypass graft                    C            C          0000        0.0000         0.00         0.00         0.00
35681     Composite bypass graft                 C            C          0000        0.0000         0.00         0.00         0.00
35682     Composite bypass graft                 C            C          0000        0.0000         0.00         0.00         0.00
35683     Composite bypass graft                 C            C          0000        0.0000         0.00         0.00         0.00
35685     Bypass graft patency/patch             T            T          0093       23.3101       1,074.60     2,450.12     2,808.40

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   38 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
35686     Bypass graft/av fist patency           T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35691     Arterial transposition                 C            C          0000        0.0000         0.00         0.00         0.00
35693     Arterial transposition                 C            C          0000        0.0000         0.00         0.00         0.00
35694     Arterial transposition                 C            C          0000        0.0000         0.00         0.00         0.00
35695     Arterial transposition                 C            C          0000        0.0000         0.00         0.00         0.00
35697     Reimplant artery each                  C            C          0000        0.0000         0.00         0.00         0.00
35700     Reoperation, bypass graft              C            C          0000        0.0000         0.00         0.00         0.00
35701     Exploration, carotid artery            C            C          0000        0.0000         0.00         0.00         0.00
35721     Exploration, femoral artery            C            C          0000        0.0000         0.00         0.00         0.00
35741     Exploration popliteal artery           C            C          0000        0.0000         0.00         0.00         0.00
35761     Exploration of artery/vein             T            T          0115       36.9806       1,704.81     3,887.03     4,455.42
35800     Explore neck vessels                   C            C          0000        0.0000         0.00         0.00         0.00
35820     Explore chest vessels                  C            C          0000        0.0000         0.00         0.00         0.00
35840     Explore abdominal vessels              C            C          0000        0.0000         0.00         0.00         0.00
35860     Explore limb vessels                   T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
35870     Repair vessel graft defect             C            C          0000        0.0000         0.00         0.00         0.00
35875     Removal of clot in graft               T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
35876     Removal of clot in graft               T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
35879     Revise graft w/vein                    T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
35881     Revise graft w/vein                    T            T          0088       36.5126       1,683.23     3,837.84     4,399.04
35901     Excision, graft, neck                  C            C          0000        0.0000         0.00         0.00         0.00
35903     Excision, graft, extremity             T            T          0115       36.9806       1,704.81     3,887.03     4,455.42
35905     Excision, graft, thorax                C            C          0000        0.0000         0.00         0.00         0.00
35907     Excision, graft, abdomen               C            C          0000        0.0000         0.00         0.00         0.00
36000     Place needle in vein                   N            N          0000        0.0000         0.00         0.00         0.00
36002     Pseudoaneurysm injection trt           S            S          0267        2.5543        117.75       268.48       307.74
36005     Injection ext venography               N            N          0000        0.0000         0.00         0.00         0.00
36010     Place catheter in vein                 N            N          0000        0.0000         0.00         0.00         0.00
36011     Place catheter in vein                 N            N          0000        0.0000         0.00         0.00         0.00
36012     Place catheter in vein                 N            N          0000        0.0000         0.00         0.00         0.00
36013     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36014     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36015     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36100     Establish access to artery             N            N          0000        0.0000         0.00         0.00         0.00
36120     Establish access to artery             N            N          0000        0.0000         0.00         0.00         0.00
36140     Establish access to artery             N            N          0000        0.0000         0.00         0.00         0.00
36145     Artery to vein shunt                   N            N          0000        0.0000         0.00         0.00         0.00
36160     Establish access to aorta              N            N          0000        0.0000         0.00         0.00         0.00
36200     Place catheter in aorta                N            N          0000        0.0000         0.00         0.00         0.00
36215     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36216     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36217     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36218     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36245     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36246     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36247     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36248     Place catheter in artery               N            N          0000        0.0000         0.00         0.00         0.00
36260     Insertion of infusion pump             T            T          0623       27.1472       1,251.49     2,853.44     3,270.69
36261     Revision of infusion pump              T            T          0623       27.1472       1,251.49     2,853.44     3,270.69
36262     Removal of infusion pump               T            T          0622       21.2464        979.46      2,233.21     2,559.77
36299     Vessel injection procedure             N            1          0000        0.0000         0.00         0.00         0.00
36400     Bl draw < 3 yrs fem/jugular            N            N          0000        0.0000         0.00         0.00         0.00
36405     Bl draw < 3 yrs scalp vein             N            N          0000        0.0000         0.00         0.00         0.00
36406     Bl draw < 3 yrs other vein             N            N          0000        0.0000         0.00         0.00         0.00
36410     Non-routine bl draw > 3 yrs            N            N          0000        0.0000         0.00         0.00         0.00
36415     Routine venipuncture                   A            3          0000        0.0000         M01          M01          M01
36416     Capillary blood draw                   N            N          0000        0.0000         0.00         0.00         0.00
36420     Vein access cutdown < 1 yr             T            T          0035        0.0834         3.84         8.77        10.05
36425     Vein access cutdown > 1 yr             T            T          0035        0.0834         3.84         8.77        10.05
36430     Blood transfusion service              S            S          0110        3.6419        167.89       382.80       438.78
36440     Bl push transfuse, 2 yr or <           S            S          0110        3.6419        167.89       382.80       438.78
36450     Bl exchange/transfuse, nb              S            S          0110        3.6419        167.89       382.80       438.78
36455     Bl exchange/transfuse non-nb           S            S          0110        3.6419        167.89       382.80       438.78
36460     Transfusion service, fetal             S            S          0110        3.6419        167.89       382.80       438.78
36468     Injection(s), spider veins             T            1          0000        0.0000         0.00         0.00         0.00
36469     Injection(s), spider veins             T            1          0000        0.0000         0.00         0.00         0.00
36470     Injection therapy of vein              T            1          0000        0.0000         0.00         0.00         0.00
36471     Injection therapy of veins             T            1          0000        0.0000         0.00         0.00         0.00
36475     Endovenous rf, 1st vein                T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
36476     Endovenous rf, vein add-on             T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
36478     Endovenous laser, 1st vein             T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
36479     Endovenous laser vein addon            T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
36481     Insertion of catheter, vein            N            N          0000        0.0000         0.00         0.00         0.00
36500     Insertion of catheter, vein            N            N          0000        0.0000         0.00         0.00         0.00
36510     Insertion of catheter, vein            N            N          0000        0.0000         0.00         0.00         0.00
36511     Apheresis wbc                          S            S          0111       12.0768        556.74      1,269.39     1,455.01
36512     Apheresis rbc                          S            S          0111       12.0768        556.74      1,269.39     1,455.01

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   39 of 171
State of Wyoming Oupatient Prospective Payment System                                                                            Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                               Critical
                                               October                                               General     Children's                Change
                                                           WY 2007                                                             Access
  CPT/                                           2006                             APC Relative       Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                   Hospital
 HCPCS                                          Status                              Weight          Outpatient   Outpatient                 2006
                                                           Indicator                                                          Outpatient
                                              Indicator                                                Fee          Fee                   Schedule
                                                                                                                                 Fee
                                             (FYI Only)
36513     Apheresis platelets                    S            S          0111       12.0768           556.74      1,269.39     1,455.01
36514     Apheresis plasma                       S            S          0111       12.0768           556.74      1,269.39     1,455.01
36515     Apheresis, adsorp/reinfuse             S            S          0112       26.3750          1,215.89     2,772.28     3,177.66
36516     Apheresis, selective                   S            S          0112       26.3750          1,215.89     2,772.28     3,177.66
36522     Photopheresis                          S            S          0112       26.3750          1,215.89     2,772.28     3,177.66
36540     Collect blood venous device            N            N          0000        0.0000            0.00         0.00         0.00
36550     Declot vascular device                 T            T          0676        2.2742           104.84       239.04       274.00
36555     Insert non-tunnel cv cath              T            T          0621        8.2313           379.46       865.19       991.71
36556     Insert non-tunnel cv cath              T            T          0621        8.2313           379.46       865.19       991.71
36557     Insert tunneled cv cath                T            T          0622       21.2464           979.46      2,233.21     2,559.77
36558     Insert tunneled cv cath                T            T          0622       21.2464           979.46      2,233.21     2,559.77
36560     Insert tunneled cv cath                T            T          0623       27.1472          1,251.49     2,853.44     3,270.69
36561     Insert tunneled cv cath                T            T          0623       27.1472          1,251.49     2,853.44     3,270.69
36563     Insert tunneled cv cath                T            T          0623       27.1472          1,251.49     2,853.44     3,270.69
36565     Insert tunneled cv cath                T            T          0623       27.1472          1,251.49     2,853.44     3,270.69
36566     Insert tunneled cv cath                T            T          1564       79.8172     *    3,679.57     8,389.59     9,616.38
36568     Insert picc cath                       T            T          0621        8.2313           379.46       865.19       991.71
36569     Insert picc cath                       T            T          0621        8.2313           379.46       865.19       991.71
36570     Insert picvad cath                     T            T          0622       21.2464           979.46      2,233.21     2,559.77
36571     Insert picvad cath                     T            T          0622       21.2464           979.46      2,233.21     2,559.77
36575     Repair tunneled cv cath                T            T          0621        8.2313           379.46       865.19       991.71
36576     Repair tunneled cv cath                T            T          0621        8.2313           379.46       865.19       991.71
36578     Replace tunneled cv cath               T            T          0622       21.2464           979.46      2,233.21     2,559.77
36580     Replace cvad cath                      T            T          0621        8.2313           379.46       865.19       991.71
36581     Replace tunneled cv cath               T            T          0622       21.2464           979.46      2,233.21     2,559.77
36582     Replace tunneled cv cath               T            T          0623       27.1472          1,251.49     2,853.44     3,270.69
36583     Replace tunneled cv cath               T            T          0623       27.1472          1,251.49     2,853.44     3,270.69
36584     Replace picc cath                      T            T          0621        8.2313           379.46       865.19       991.71
36585     Replace picvad cath                    T            T          0622       21.2464           979.46      2,233.21     2,559.77
36589     Removal tunneled cv cath               T            T          0621        8.2313           379.46       865.19       991.71
36590     Removal tunneled cv cath               T            T          0621        8.2313           379.46       865.19       991.71
36595     Mech remov tunneled cv cath            T            T          0622       21.2464           979.46      2,233.21     2,559.77
36596     Mech remov tunneled cv cath            T            T          0621        8.2313           379.46       865.19       991.71
36597     Reposition venous catheter             T            T          0621        8.2313           379.46       865.19       991.71
36598     Inj w/fluor, eval cv device            X            X          0340        0.6137           28.29        64.51        73.94
36600     Withdrawal of arterial blood           N            N          0000        0.0000            0.00         0.00         0.00
36620     Insertion catheter, artery             N            N          0000        0.0000            0.00         0.00         0.00
36625     Insertion catheter, artery             N            N          0000        0.0000            0.00         0.00         0.00
36640     Insertion catheter, artery             T            T          0623       27.1472          1,251.49     2,853.44     3,270.69
36660     Insertion catheter, artery             C            C          0000        0.0000            0.00         0.00         0.00
36680     Insert needle, bone cavity             T            T          0002        0.9357           43.14        98.35        112.73
36800     Insertion of cannula                   T            T          0115       36.9806          1,704.81     3,887.03     4,455.42
36810     Insertion of cannula                   T            T          0115       36.9806          1,704.81     3,887.03     4,455.42
36815     Insertion of cannula                   T            T          0115       36.9806          1,704.81     3,887.03     4,455.42
36818     Av fuse, uppr arm, cephalic            T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36819     Av fuse, uppr arm, basilic             T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36820     Av fusion/forearm vein                 T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36821     Av fusion direct any site              T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36822     Insertion of cannula(s)                C            C          0000        0.0000            0.00         0.00         0.00
36823     Insertion of cannula(s)                C            C          0000        0.0000            0.00         0.00         0.00
36825     Artery-vein autograft                  T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36830     Artery-vein nonautograft               T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36831     Open thrombect av fistula              T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36832     Av fistula revision, open              T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36833     Av fistula revision                    T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36834     Repair A-V aneurysm                    T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36835     Artery to vein shunt                   T            T          0115       36.9806          1,704.81     3,887.03     4,455.42
36838     Dist revas ligation, hemo              T            T          0088       36.5126          1,683.23     3,837.84     4,399.04
36860     External cannula declotting            T            T          0676        2.2742           104.84       239.04       274.00
36861     Cannula declotting                     T            T          0115       36.9806          1,704.81     3,887.03     4,455.42
36870     Percut thrombect av fistula            T            T          0653       36.9427          1,703.06     3,883.05     4,450.86
37140     Revision of circulation                C            C          0000        0.0000            0.00         0.00         0.00
37145     Revision of circulation                C            C          0000        0.0000            0.00         0.00         0.00
37160     Revision of circulation                C            C          0000        0.0000            0.00         0.00         0.00
37180     Revision of circulation                C            C          0000        0.0000            0.00         0.00         0.00
37181     Splice spleen/kidney veins             C            C          0000        0.0000            0.00         0.00         0.00
37182     Insert hepatic shunt (tips)            C            C          0000        0.0000            0.00         0.00         0.00
37183     Remove hepatic shunt (tips)            T            T          0229       66.3380          3,058.18     6,972.79     7,992.40
37184     Prim art mech thrombectomy             T            T          0653       36.9427          1,703.06     3,883.05     4,450.86
37185     Prim art m-thrombect add-on            T            T          0103       15.0428           693.47      1,581.15     1,812.36
37186     Sec art m-thrombect add-on             T            T          0103       15.0428           693.47      1,581.15     1,812.36
37187     Venous mech thrombectomy               T            T          0653       36.9427          1,703.06     3,883.05     4,450.86
37188     Venous m-thrombectomy add-on           T            T          0653       36.9427          1,703.06     3,883.05     4,450.86
37195     Thrombolytic therapy, stroke           T            T          0676        2.2742           104.84       239.04       274.00
37200     Transcatheter biopsy                   T            T          0685        6.0034           276.76       631.02       723.29
37201     Transcatheter therapy infuse           T            T          0676        2.2742           104.84       239.04       274.00
37202     Transcatheter therapy infuse           T            T          0676        2.2742           104.84       239.04       274.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                      40 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
37203     Transcatheter retrieval                T            T          0103       15.0428        693.47      1,581.15     1,812.36
37204     Transcatheter occlusion                T            T          0115       36.9806       1,704.81     3,887.03     4,455.42
37205     Transcath iv stent, percut             T            T          0229       66.3380       3,058.18     6,972.79     7,992.40
37206     Transcath iv stent/perc addl           T            T          0229       66.3380       3,058.18     6,972.79     7,992.40
37207     Transcath iv stent, open               T            T          0229       66.3380       3,058.18     6,972.79     7,992.40
37208     Transcath iv stent/open addl           T            T          0229       66.3380       3,058.18     6,972.79     7,992.40
37209     Exchange arterial catheter             T            T          0103       15.0428        693.47      1,581.15     1,812.36
37215     Transcath stent, cca w/eps             C            C          0000        0.0000         0.00         0.00         0.00
37216     Transcath stent, cca w/o eps           C            C          0000        0.0000         0.00         0.00         0.00
37250     Iv us first vessel add-on              S            S          0416       16.4464        758.18      1,728.68     1,981.46
37251     Iv us each add vessel add-on           S            S          0416       16.4464        758.18      1,728.68     1,981.46
37500     Endoscopy ligate perf veins            T            T          0092       26.5104       1,222.13     2,786.51     3,193.97
37501     Vascular endoscopy procedure           T            1          0000        0.0000         0.00         0.00         0.00
37565     Ligation of neck vein                  T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
37600     Ligation of neck artery                T            T          0093       23.3101       1,074.60     2,450.12     2,808.40
37605     Ligation of neck artery                T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37606     Ligation of neck artery                T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37607     Ligation of a-v fistula                T            T          0092       26.5104       1,222.13     2,786.51     3,193.97
37609     Temporal artery procedure              T            T          0021       14.9984        691.43      1,576.48     1,807.01
37615     Ligation of neck artery                T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37616     Ligation of chest artery               C            C          0000        0.0000         0.00         0.00         0.00
37617     Ligation of abdomen artery             C            C          0000        0.0000         0.00         0.00         0.00
37618     Ligation of extremity artery           C            C          0000        0.0000         0.00         0.00         0.00
37620     Revision of major vein                 T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37650     Revision of major vein                 T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37660     Revision of major vein                 C            C          0000        0.0000         0.00         0.00         0.00
37700     Revise leg vein                        T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37718     Ligate/strip short leg vein            T            T          0092       26.5104       1,222.13     2,786.51     3,193.97
37722     Ligate/strip long leg vein             T            T          0092       26.5104       1,222.13     2,786.51     3,193.97
37735     Removal of leg veins/lesion            T            T          0092       26.5104       1,222.13     2,786.51     3,193.97
37760     Ligation, leg veins, open              T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37765     Phleb veins - extrem - to 20           T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37766     Phleb veins - extrem 20+               T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37780     Revision of leg vein                   T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37785     Ligate/divide/excise vein              T            T          0091       28.8805       1,331.39     3,035.63     3,479.52
37788     Revascularization, penis               C            C          0000        0.0000         0.00         0.00         0.00
37790     Penile venous occlusion                T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
37799     Vascular surgery procedure             T            1          0000        0.0000         0.00         0.00         0.00
38100     Removal of spleen, total               C            C          0000        0.0000         0.00         0.00         0.00
38101     Removal of spleen, partial             C            C          0000        0.0000         0.00         0.00         0.00
38102     Removal of spleen, total               C            C          0000        0.0000         0.00         0.00         0.00
38115     Repair of ruptured spleen              C            C          0000        0.0000         0.00         0.00         0.00
38120     Laparoscopy, splenectomy               T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
38129     Laparoscope proc, spleen               T            1          0000        0.0000         0.00         0.00         0.00
38200     Injection for spleen x-ray             N            N          0000        0.0000         0.00         0.00         0.00
38204     Bl donor search management             N            N          0000        0.0000         0.00         0.00         0.00
38205     Harvest allogenic stem cells           S            S          0111       12.0768        556.74      1,269.39     1,455.01
38206     Harvest auto stem cells                S            S          0111       12.0768        556.74      1,269.39     1,455.01
38207     Cryopreserve stem cells                E            3          0000        0.0000         M01          M01          M01
38208     Thaw preserved stem cells              E            3          0000        0.0000         M01          M01          M01
38209     Wash harvest stem cells                E            1          0000        0.0000         0.00         0.00         0.00
38210     T-cell depletion of harvest            E            1          0000        0.0000         0.00         0.00         0.00
38211     Tumor cell deplete of harvst           E            1          0000        0.0000         0.00         0.00         0.00
38212     Rbc depletion of harvest               E            1          0000        0.0000         0.00         0.00         0.00
38213     Platelet deplete of harvest            E            1          0000        0.0000         0.00         0.00         0.00
38214     Volume deplete of harvest              E            1          0000        0.0000         0.00         0.00         0.00
38215     Harvest stem cell concentrte           E            1          0000        0.0000         0.00         0.00         0.00
38220     Bone marrow aspiration                 T            T          0003        2.6756        123.35       281.23       322.36
38221     Bone marrow biopsy                     T            T          0003        2.6756        123.35       281.23       322.36
38230     Bone marrow collection                 S            S          0123       24.4820       1,128.62     2,573.30     2,949.59
38240     Bone marrow/stem transplant            S            S          0123       24.4820       1,128.62     2,573.30     2,949.59
38241     Bone marrow/stem transplant            S            S          0123       24.4820       1,128.62     2,573.30     2,949.59
38242     Lymphocyte infuse transplant           S            S          0111       12.0768        556.74      1,269.39     1,455.01
38300     Drainage, lymph node lesion            T            T          0007       11.6717        538.07      1,226.81     1,406.21
38305     Drainage, lymph node lesion            T            T          0008       16.2953        751.21      1,712.80     1,963.26
38308     Incision of lymph channels             T            T          0113       21.4112        987.06      2,250.53     2,579.62
38380     Thoracic duct procedure                C            C          0000        0.0000         0.00         0.00         0.00
38381     Thoracic duct procedure                C            C          0000        0.0000         0.00         0.00         0.00
38382     Thoracic duct procedure                C            C          0000        0.0000         0.00         0.00         0.00
38500     Biopsy/removal, lymph nodes            T            T          0113       21.4112        987.06      2,250.53     2,579.62
38505     Needle biopsy, lymph nodes             T            T          0005        3.5834        165.19       376.65       431.73
38510     Biopsy/removal, lymph nodes            T            T          0113       21.4112        987.06      2,250.53     2,579.62
38520     Biopsy/removal, lymph nodes            T            T          0113       21.4112        987.06      2,250.53     2,579.62
38525     Biopsy/removal, lymph nodes            T            T          0113       21.4112        987.06      2,250.53     2,579.62
38530     Biopsy/removal, lymph nodes            T            T          0113       21.4112        987.06      2,250.53     2,579.62
38542     Explore deep node(s), neck             T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
38550     Removal, neck/armpit lesion            T            T          0113       21.4112        987.06      2,250.53     2,579.62

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   41 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
38555     Removal, neck/armpit lesion            T            T          0113       21.4112        987.06      2,250.53     2,579.62
38562     Removal, pelvic lymph nodes            C            C          0000        0.0000         0.00         0.00         0.00
38564     Removal, abdomen lymph nodes           C            C          0000        0.0000         0.00         0.00         0.00
38570     Laparoscopy, lymph node biop           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
38571     Laparoscopy, lymphadenectomy           T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
38572     Laparoscopy, lymphadenectomy           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
38589     Laparoscope proc, lymphatic            T            1          0000        0.0000         0.00         0.00         0.00
38700     Removal of lymph nodes, neck           T            T          0113       21.4112        987.06      2,250.53     2,579.62
38720     Removal of lymph nodes, neck           T            T          0113       21.4112        987.06      2,250.53     2,579.62
38724     Removal of lymph nodes, neck           C            C          0000        0.0000         0.00         0.00         0.00
38740     Remove armpit lymph nodes              T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
38745     Remove armpit lymph nodes              T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
38746     Remove thoracic lymph nodes            C            C          0000        0.0000         0.00         0.00         0.00
38747     Remove abdominal lymph nodes           C            C          0000        0.0000         0.00         0.00         0.00
38760     Remove groin lymph nodes               T            T          0113       21.4112        987.06      2,250.53     2,579.62
38765     Remove groin lymph nodes               C            C          0000        0.0000         0.00         0.00         0.00
38770     Remove pelvis lymph nodes              C            C          0000        0.0000         0.00         0.00         0.00
38780     Remove abdomen lymph nodes             C            C          0000        0.0000         0.00         0.00         0.00
38790     Inject for lymphatic x-ray             N            N          0000        0.0000         0.00         0.00         0.00
38792     Identify sentinel node                 N            N          0000        0.0000         0.00         0.00         0.00
38794     Access thoracic lymph duct             N            N          0000        0.0000         0.00         0.00         0.00
38999     Blood/lymph system procedure           S            1          0000        0.0000         0.00         0.00         0.00
39000     Exploration of chest                   C            C          0000        0.0000         0.00         0.00         0.00
39010     Exploration of chest                   C            C          0000        0.0000         0.00         0.00         0.00
39200     Removal chest lesion                   C            C          0000        0.0000         0.00         0.00         0.00
39220     Removal chest lesion                   C            C          0000        0.0000         0.00         0.00         0.00
39400     Visualization of chest                 T            T          0069       30.9541       1,426.98     3,253.59     3,729.35
39499     Chest procedure                        C            1          0000        0.0000         0.00         0.00         0.00
39501     Repair diaphragm laceration            C            C          0000        0.0000         0.00         0.00         0.00
39502     Repair paraesophageal hernia           C            C          0000        0.0000         0.00         0.00         0.00
39503     Repair of diaphragm hernia             C            C          0000        0.0000         0.00         0.00         0.00
39520     Repair of diaphragm hernia             C            C          0000        0.0000         0.00         0.00         0.00
39530     Repair of diaphragm hernia             C            C          0000        0.0000         0.00         0.00         0.00
39531     Repair of diaphragm hernia             C            C          0000        0.0000         0.00         0.00         0.00
39540     Repair of diaphragm hernia             C            C          0000        0.0000         0.00         0.00         0.00
39541     Repair of diaphragm hernia             C            C          0000        0.0000         0.00         0.00         0.00
39545     Revision of diaphragm                  C            C          0000        0.0000         0.00         0.00         0.00
39560     Resect diaphragm, simple               C            C          0000        0.0000         0.00         0.00         0.00
39561     Resect diaphragm, complex              C            C          0000        0.0000         0.00         0.00         0.00
39599     Diaphragm surgery procedure            C            1          0000        0.0000         0.00         0.00         0.00
40490     Biopsy of lip                          T            T          0251        2.0789        95.84        218.51       250.47
40500     Partial excision of lip                T            T          0253       16.0740        741.01      1,689.54     1,936.60
40510     Partial excision of lip                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40520     Partial excision of lip                T            T          0253       16.0740        741.01      1,689.54     1,936.60
40525     Reconstruct lip with flap              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40527     Reconstruct lip with flap              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40530     Partial removal of lip                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40650     Repair lip                             T            T          0252        8.1033        373.56       851.74       976.29
40652     Repair lip                             T            T          0252        8.1033        373.56       851.74       976.29
40654     Repair lip                             T            T          0252        8.1033        373.56       851.74       976.29
40700     Repair cleft lip/nasal                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
40701     Repair cleft lip/nasal                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
40702     Repair cleft lip/nasal                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
40720     Repair cleft lip/nasal                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
40761     Repair cleft lip/nasal                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
40799     Lip surgery procedure                  T            1          0000        0.0000         0.00         0.00         0.00
40800     Drainage of mouth lesion               T            T          0251        2.0789        95.84        218.51       250.47
40801     Drainage of mouth lesion               T            T          0252        8.1033        373.56       851.74       976.29
40804     Removal, foreign body, mouth           X            X          0340        0.6137        28.29        64.51        73.94
40805     Removal, foreign body, mouth           T            T          0252        8.1033        373.56       851.74       976.29
40806     Incision of lip fold                   T            T          0251        2.0789        95.84        218.51       250.47
40808     Biopsy of mouth lesion                 T            T          0251        2.0789        95.84        218.51       250.47
40810     Excision of mouth lesion               T            T          0253       16.0740        741.01      1,689.54     1,936.60
40812     Excise/repair mouth lesion             T            T          0253       16.0740        741.01      1,689.54     1,936.60
40814     Excise/repair mouth lesion             T            T          0253       16.0740        741.01      1,689.54     1,936.60
40816     Excision of mouth lesion               T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40818     Excise oral mucosa for graft           T            T          0251        2.0789        95.84        218.51       250.47
40819     Excise lip or cheek fold               T            T          0252        8.1033        373.56       851.74       976.29
40820     Treatment of mouth lesion              T            T          0253       16.0740        741.01      1,689.54     1,936.60
40830     Repair mouth laceration                T            T          0251        2.0789        95.84        218.51       250.47
40831     Repair mouth laceration                T            T          0252        8.1033        373.56       851.74       976.29
40840     Reconstruction of mouth                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40842     Reconstruction of mouth                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40843     Reconstruction of mouth                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
40844     Reconstruction of mouth                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
40845     Reconstruction of mouth                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
40899     Mouth surgery procedure                T            1          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   42 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
41000     Drainage of mouth lesion               T            T          0253       16.0740        741.01      1,689.54     1,936.60
41005     Drainage of mouth lesion               T            T          0251        2.0789        95.84        218.51       250.47
41006     Drainage of mouth lesion               T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41007     Drainage of mouth lesion               T            T          0253       16.0740        741.01      1,689.54     1,936.60
41008     Drainage of mouth lesion               T            T          0253       16.0740        741.01      1,689.54     1,936.60
41009     Drainage of mouth lesion               T            T          0251        2.0789        95.84        218.51       250.47
41010     Incision of tongue fold                T            T          0252        8.1033        373.56       851.74       976.29
41015     Drainage of mouth lesion               T            T          0251        2.0789        95.84        218.51       250.47
41016     Drainage of mouth lesion               T            T          0252        8.1033        373.56       851.74       976.29
41017     Drainage of mouth lesion               T            T          0252        8.1033        373.56       851.74       976.29
41018     Drainage of mouth lesion               T            T          0252        8.1033        373.56       851.74       976.29
41100     Biopsy of tongue                       T            T          0252        8.1033        373.56       851.74       976.29
41105     Biopsy of tongue                       T            T          0253       16.0740        741.01      1,689.54     1,936.60
41108     Biopsy of floor of mouth               T            T          0252        8.1033        373.56       851.74       976.29
41110     Excision of tongue lesion              T            T          0253       16.0740        741.01      1,689.54     1,936.60
41112     Excision of tongue lesion              T            T          0253       16.0740        741.01      1,689.54     1,936.60
41113     Excision of tongue lesion              T            T          0253       16.0740        741.01      1,689.54     1,936.60
41114     Excision of tongue lesion              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41115     Excision of tongue fold                T            T          0252        8.1033        373.56       851.74       976.29
41116     Excision of mouth lesion               T            T          0253       16.0740        741.01      1,689.54     1,936.60
41120     Partial removal of tongue              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41130     Partial removal of tongue              C            C          0000        0.0000         0.00         0.00         0.00
41135     Tongue and neck surgery                C            C          0000        0.0000         0.00         0.00         0.00
41140     Removal of tongue                      C            C          0000        0.0000         0.00         0.00         0.00
41145     Tongue removal, neck surgery           C            C          0000        0.0000         0.00         0.00         0.00
41150     Tongue, mouth, jaw surgery             C            C          0000        0.0000         0.00         0.00         0.00
41153     Tongue, mouth, neck surgery            C            C          0000        0.0000         0.00         0.00         0.00
41155     Tongue, jaw, & neck surgery            C            C          0000        0.0000         0.00         0.00         0.00
41250     Repair tongue laceration               T            T          0251        2.0789        95.84        218.51       250.47
41251     Repair tongue laceration               T            T          0251        2.0789        95.84        218.51       250.47
41252     Repair tongue laceration               T            T          0252        8.1033        373.56       851.74       976.29
41500     Fixation of tongue                     T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41510     Tongue to lip surgery                  T            T          0253       16.0740        741.01      1,689.54     1,936.60
41520     Reconstruction, tongue fold            T            T          0252        8.1033        373.56       851.74       976.29
41599     Tongue and mouth surgery               T            1          0000        0.0000         0.00         0.00         0.00
41800     Drainage of gum lesion                 T            T          0251        2.0789        95.84        218.51       250.47
41805     Removal foreign body, gum              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41806     Removal foreign body,jawbone           T            T          0253       16.0740        741.01      1,689.54     1,936.60
41820     Excision, gum, each quadrant           T            T          0252        8.1033        373.56       851.74       976.29
41821     Excision of gum flap                   T            T          0252        8.1033        373.56       851.74       976.29
41822     Excision of gum lesion                 T            T          0253       16.0740        741.01      1,689.54     1,936.60
41823     Excision of gum lesion                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41825     Excision of gum lesion                 T            T          0253       16.0740        741.01      1,689.54     1,936.60
41826     Excision of gum lesion                 T            T          0253       16.0740        741.01      1,689.54     1,936.60
41827     Excision of gum lesion                 T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41828     Excision of gum lesion                 T            T          0253       16.0740        741.01      1,689.54     1,936.60
41830     Removal of gum tissue                  T            T          0253       16.0740        741.01      1,689.54     1,936.60
41850     Treatment of gum lesion                T            T          0253       16.0740        741.01      1,689.54     1,936.60
41870     Gum graft                              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
41872     Repair gum                             T            T          0253       16.0740        741.01      1,689.54     1,936.60
41874     Repair tooth socket                    T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
                                                                                                  APC by       APC by       APC by
41899     Dental surgery procedure               T            2          0000        0.0000        report       report       report         X
42000     Drainage mouth roof lesion             T            T          0251        2.0789        95.84        218.51       250.47
42100     Biopsy roof of mouth                   T            T          0252        8.1033        373.56       851.74       976.29
42104     Excision lesion, mouth roof            T            T          0253       16.0740        741.01      1,689.54     1,936.60
42106     Excision lesion, mouth roof            T            T          0253       16.0740        741.01      1,689.54     1,936.60
42107     Excision lesion, mouth roof            T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42120     Remove palate/lesion                   T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42140     Excision of uvula                      T            T          0252        8.1033        373.56       851.74       976.29
42145     Repair palate, pharynx/uvula           T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42160     Treatment mouth roof lesion            T            T          0253       16.0740        741.01      1,689.54     1,936.60
42180     Repair palate                          T            T          0251        2.0789        95.84        218.51       250.47
42182     Repair palate                          T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42200     Reconstruct cleft palate               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42205     Reconstruct cleft palate               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42210     Reconstruct cleft palate               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42215     Reconstruct cleft palate               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42220     Reconstruct cleft palate               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42225     Reconstruct cleft palate               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42226     Lengthening of palate                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42227     Lengthening of palate                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42235     Repair palate                          T            T          0253       16.0740        741.01      1,689.54     1,936.60
42260     Repair nose to lip fistula             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42280     Preparation, palate mold               T            T          0251        2.0789        95.84        218.51       250.47
42281     Insertion, palate prosthesis           T            T          0253       16.0740        741.01      1,689.54     1,936.60
42299     Palate/uvula surgery                   T            1          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   43 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
42300     Drainage of salivary gland             T            T          0253       16.0740        741.01      1,689.54     1,936.60
42305     Drainage of salivary gland             T            T          0253       16.0740        741.01      1,689.54     1,936.60
42310     Drainage of salivary gland             T            T          0251        2.0789        95.84        218.51       250.47
42320     Drainage of salivary gland             T            T          0251        2.0789        95.84        218.51       250.47
42330     Removal of salivary stone              T            T          0253       16.0740        741.01      1,689.54     1,936.60
42335     Removal of salivary stone              T            T          0253       16.0740        741.01      1,689.54     1,936.60
42340     Removal of salivary stone              T            T          0253       16.0740        741.01      1,689.54     1,936.60
42400     Biopsy of salivary gland               T            T          0005        3.5834        165.19       376.65       431.73
42405     Biopsy of salivary gland               T            T          0253       16.0740        741.01      1,689.54     1,936.60
42408     Excision of salivary cyst              T            T          0253       16.0740        741.01      1,689.54     1,936.60
42409     Drainage of salivary cyst              T            T          0253       16.0740        741.01      1,689.54     1,936.60
42410     Excise parotid gland/lesion            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42415     Excise parotid gland/lesion            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42420     Excise parotid gland/lesion            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42425     Excise parotid gland/lesion            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42426     Excise parotid gland/lesion            C            C          0000        0.0000         0.00         0.00         0.00
42440     Excise submaxillary gland              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42450     Excise sublingual gland                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42500     Repair salivary duct                   T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42505     Repair salivary duct                   T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42507     Parotid duct diversion                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42508     Parotid duct diversion                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42509     Parotid duct diversion                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42510     Parotid duct diversion                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42550     Injection for salivary x-ray           N            N          0000        0.0000         0.00         0.00         0.00
42600     Closure of salivary fistula            T            T          0253       16.0740        741.01      1,689.54     1,936.60
42650     Dilation of salivary duct              T            T          0252        8.1033        373.56       851.74       976.29
42660     Dilation of salivary duct              T            T          0251        2.0789        95.84        218.51       250.47
42665     Ligation of salivary duct              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42699     Salivary surgery procedure             T            1          0000        0.0000         0.00         0.00         0.00
42700     Drainage of tonsil abscess             T            T          0251        2.0789        95.84        218.51       250.47
42720     Drainage of throat abscess             T            T          0253       16.0740        741.01      1,689.54     1,936.60
42725     Drainage of throat abscess             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42800     Biopsy of throat                       T            T          0253       16.0740        741.01      1,689.54     1,936.60
42802     Biopsy of throat                       T            T          0253       16.0740        741.01      1,689.54     1,936.60
42804     Biopsy of upper nose/throat            T            T          0253       16.0740        741.01      1,689.54     1,936.60
42806     Biopsy of upper nose/throat            T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42808     Excise pharynx lesion                  T            T          0253       16.0740        741.01      1,689.54     1,936.60
42809     Remove pharynx foreign body            X            X          0340        0.6137        28.29        64.51        73.94
42810     Excision of neck cyst                  T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42815     Excision of neck cyst                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42820     Remove tonsils and adenoids            T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42821     Remove tonsils and adenoids            T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42825     Removal of tonsils                     T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42826     Removal of tonsils                     T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42830     Removal of adenoids                    T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42831     Removal of adenoids                    T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42835     Removal of adenoids                    T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42836     Removal of adenoids                    T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42842     Extensive surgery of throat            T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42844     Extensive surgery of throat            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42845     Extensive surgery of throat            C            C          0000        0.0000         0.00         0.00         0.00
42860     Excision of tonsil tags                T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42870     Excision of lingual tonsil             T            T          0258       21.8761       1,008.49     2,299.40     2,635.63
42890     Partial removal of pharynx             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42892     Revision of pharyngeal walls           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42894     Revision of pharyngeal walls           C            C          0000        0.0000         0.00         0.00         0.00
42900     Repair throat wound                    T            T          0252        8.1033        373.56       851.74       976.29
42950     Reconstruction of throat               T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42953     Repair throat, esophagus               C            C          0000        0.0000         0.00         0.00         0.00
42955     Surgical opening of throat             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
42960     Control throat bleeding                T            T          0250        1.2241        56.43        128.67       147.48
42961     Control throat bleeding                C            C          0000        0.0000         0.00         0.00         0.00
42962     Control throat bleeding                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
42970     Control nose/throat bleeding           T            T          0250        1.2241        56.43        128.67       147.48
42971     Control nose/throat bleeding           C            C          0000        0.0000         0.00         0.00         0.00
42972     Control nose/throat bleeding           T            T          0253       16.0740        741.01      1,689.54     1,936.60
42999     Throat surgery procedure               T            1          0000        0.0000         0.00         0.00         0.00
43020     Incision of esophagus                  T            T          0252        8.1033        373.56       851.74       976.29
43030     Throat muscle surgery                  T            T          0253       16.0740        741.01      1,689.54     1,936.60
43045     Incision of esophagus                  C            C          0000        0.0000         0.00         0.00         0.00
43100     Excision of esophagus lesion           C            C          0000        0.0000         0.00         0.00         0.00
43101     Excision of esophagus lesion           C            C          0000        0.0000         0.00         0.00         0.00
43107     Removal of esophagus                   C            C          0000        0.0000         0.00         0.00         0.00
43108     Removal of esophagus                   C            C          0000        0.0000         0.00         0.00         0.00
43112     Removal of esophagus                   C            C          0000        0.0000         0.00         0.00         0.00
43113     Removal of esophagus                   C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   44 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
43116     Partial removal of esophagus           C            C          0000        0.0000         0.00         0.00         0.00
43117     Partial removal of esophagus           C            C          0000        0.0000         0.00         0.00         0.00
43118     Partial removal of esophagus           C            C          0000        0.0000         0.00         0.00         0.00
43121     Partial removal of esophagus           C            C          0000        0.0000         0.00         0.00         0.00
43122     Partial removal of esophagus           C            C          0000        0.0000         0.00         0.00         0.00
43123     Partial removal of esophagus           C            C          0000        0.0000         0.00         0.00         0.00
43124     Removal of esophagus                   C            C          0000        0.0000         0.00         0.00         0.00
43130     Removal of esophagus pouch             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
43135     Removal of esophagus pouch             C            C          0000        0.0000         0.00         0.00         0.00
43200     Esophagus endoscopy                    T            T          0141        8.0662        371.85       847.84       971.82
43201     Esoph scope w/submucous inj            T            T          0141        8.0662        371.85       847.84       971.82
43202     Esophagus endoscopy, biopsy            T            T          0141        8.0662        371.85       847.84       971.82
43204     Esoph scope w/sclerosis inj            T            T          0141        8.0662        371.85       847.84       971.82
43205     Esophagus endoscopy/ligation           T            T          0141        8.0662        371.85       847.84       971.82
43215     Esophagus endoscopy                    T            T          0141        8.0662        371.85       847.84       971.82
43216     Esophagus endoscopy/lesion             T            T          0141        8.0662        371.85       847.84       971.82
43217     Esophagus endoscopy                    T            T          0141        8.0662        371.85       847.84       971.82
43219     Esophagus endoscopy                    T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
43220     Esoph endoscopy, dilation              T            T          0141        8.0662        371.85       847.84       971.82
43226     Esoph endoscopy, dilation              T            T          0141        8.0662        371.85       847.84       971.82
43227     Esoph endoscopy, repair                T            T          0141        8.0662        371.85       847.84       971.82
43228     Esoph endoscopy, ablation              T            T          0422       24.0525       1,108.82     2,528.16     2,897.85
43231     Esoph endoscopy w/us exam              T            T          0141        8.0662        371.85       847.84       971.82
43232     Esoph endoscopy w/us fn bx             T            T          0141        8.0662        371.85       847.84       971.82
43234     Upper GI endoscopy, exam               T            T          0141        8.0662        371.85       847.84       971.82
43235     Uppr gi endoscopy, diagnosis           T            T          0141        8.0662        371.85       847.84       971.82
43236     Uppr gi scope w/submuc inj             T            T          0141        8.0662        371.85       847.84       971.82
43237     Endoscopic us exam, esoph              T            T          0141        8.0662        371.85       847.84       971.82
43238     Uppr gi endoscopy w/us fn bx           T            T          0141        8.0662        371.85       847.84       971.82
43239     Upper GI endoscopy, biopsy             T            T          0141        8.0662        371.85       847.84       971.82
43240     Esoph endoscope w/drain cyst           T            T          0141        8.0662        371.85       847.84       971.82
43241     Upper GI endoscopy with tube           T            T          0141        8.0662        371.85       847.84       971.82
43242     Uppr gi endoscopy w/us fn bx           T            T          0141        8.0662        371.85       847.84       971.82
43243     Upper gi endoscopy & inject            T            T          0141        8.0662        371.85       847.84       971.82
43244     Upper GI endoscopy/ligation            T            T          0141        8.0662        371.85       847.84       971.82
43245     Uppr gi scope dilate strictr           T            T          0141        8.0662        371.85       847.84       971.82
43246     Place gastrostomy tube                 T            T          0141        8.0662        371.85       847.84       971.82
43247     Operative upper GI endoscopy           T            T          0141        8.0662        371.85       847.84       971.82
43248     Uppr gi endoscopy/guide wire           T            T          0141        8.0662        371.85       847.84       971.82
43249     Esoph endoscopy, dilation              T            T          0141        8.0662        371.85       847.84       971.82
43250     Upper GI endoscopy/tumor               T            T          0141        8.0662        371.85       847.84       971.82
43251     Operative upper GI endoscopy           T            T          0141        8.0662        371.85       847.84       971.82
43255     Operative upper GI endoscopy           T            T          0141        8.0662        371.85       847.84       971.82
43256     Uppr gi endoscopy w/stent              T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
43257     Uppr gi scope w/thrml txmnt            T            T          0422       24.0525       1,108.82     2,528.16     2,897.85
43258     Operative upper GI endoscopy           T            T          0141        8.0662        371.85       847.84       971.82
43259     Endoscopic ultrasound exam             T            T          0141        8.0662        371.85       847.84       971.82
43260     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43261     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43262     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43263     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43264     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43265     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43267     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43268     Endo cholangiopancreatograph           T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
43269     Endo cholangiopancreatograph           T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
43271     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43272     Endo cholangiopancreatograph           T            T          0151       18.6171        858.25      1,956.84     2,242.99
43280     Laparoscopy, fundoplasty               T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
43289     Laparoscope proc, esoph                T            1          0000        0.0000         0.00         0.00         0.00
43300     Repair of esophagus                    C            C          0000        0.0000         0.00         0.00         0.00
43305     Repair esophagus and fistula           C            C          0000        0.0000         0.00         0.00         0.00
43310     Repair of esophagus                    C            C          0000        0.0000         0.00         0.00         0.00
43312     Repair esophagus and fistula           C            C          0000        0.0000         0.00         0.00         0.00
43313     Esophagoplasty congenital              C            C          0000        0.0000         0.00         0.00         0.00
43314     Tracheo-esophagoplasty cong            C            C          0000        0.0000         0.00         0.00         0.00
43320     Fuse esophagus & stomach               C            C          0000        0.0000         0.00         0.00         0.00
43324     Revise esophagus & stomach             C            C          0000        0.0000         0.00         0.00         0.00
43325     Revise esophagus & stomach             C            C          0000        0.0000         0.00         0.00         0.00
43326     Revise esophagus & stomach             C            C          0000        0.0000         0.00         0.00         0.00
43330     Repair of esophagus                    C            C          0000        0.0000         0.00         0.00         0.00
43331     Repair of esophagus                    C            C          0000        0.0000         0.00         0.00         0.00
43340     Fuse esophagus & intestine             C            C          0000        0.0000         0.00         0.00         0.00
43341     Fuse esophagus & intestine             C            C          0000        0.0000         0.00         0.00         0.00
43350     Surgical opening, esophagus            C            C          0000        0.0000         0.00         0.00         0.00
43351     Surgical opening, esophagus            C            C          0000        0.0000         0.00         0.00         0.00
43352     Surgical opening, esophagus            C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   45 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
43360     Gastrointestinal repair                C            C          0000        0.0000         0.00         0.00         0.00
43361     Gastrointestinal repair                C            C          0000        0.0000         0.00         0.00         0.00
43400     Ligate esophagus veins                 C            C          0000        0.0000         0.00         0.00         0.00
43401     Esophagus surgery for veins            C            C          0000        0.0000         0.00         0.00         0.00
43405     Ligate/staple esophagus                C            C          0000        0.0000         0.00         0.00         0.00
43410     Repair esophagus wound                 C            C          0000        0.0000         0.00         0.00         0.00
43415     Repair esophagus wound                 C            C          0000        0.0000         0.00         0.00         0.00
43420     Repair esophagus opening               C            C          0000        0.0000         0.00         0.00         0.00
43425     Repair esophagus opening               C            C          0000        0.0000         0.00         0.00         0.00
43450     Dilate esophagus                       T            T          0140        5.2970        244.19       556.77       638.18
43453     Dilate esophagus                       T            T          0140        5.2970        244.19       556.77       638.18
43456     Dilate esophagus                       T            T          0140        5.2970        244.19       556.77       638.18
43458     Dilate esophagus                       T            T          0140        5.2970        244.19       556.77       638.18
43460     Pressure treatment esophagus           C            C          0000        0.0000         0.00         0.00         0.00
43496     Free jejunum flap, microvasc           C            C          0000        0.0000         0.00         0.00         0.00
43499     Esophagus surgery procedure            T            1          0000        0.0000         0.00         0.00         0.00
43500     Surgical opening of stomach            C            C          0000        0.0000         0.00         0.00         0.00
43501     Surgical repair of stomach             C            C          0000        0.0000         0.00         0.00         0.00
43502     Surgical repair of stomach             C            C          0000        0.0000         0.00         0.00         0.00
43510     Surgical opening of stomach            T            T          0141        8.0662        371.85       847.84       971.82
43520     Incision of pyloric muscle             C            C          0000        0.0000         0.00         0.00         0.00
43600     Biopsy of stomach                      T            T          0141        8.0662        371.85       847.84       971.82
43605     Biopsy of stomach                      C            C          0000        0.0000         0.00         0.00         0.00
43610     Excision of stomach lesion             C            C          0000        0.0000         0.00         0.00         0.00
43611     Excision of stomach lesion             C            C          0000        0.0000         0.00         0.00         0.00
43620     Removal of stomach                     C            C          0000        0.0000         0.00         0.00         0.00
43621     Removal of stomach                     C            C          0000        0.0000         0.00         0.00         0.00
43622     Removal of stomach                     C            C          0000        0.0000         0.00         0.00         0.00
43631     Removal of stomach, partial            C            C          0000        0.0000         0.00         0.00         0.00
43632     Removal of stomach, partial            C            C          0000        0.0000         0.00         0.00         0.00
43633     Removal of stomach, partial            C            C          0000        0.0000         0.00         0.00         0.00
43634     Removal of stomach, partial            C            C          0000        0.0000         0.00         0.00         0.00
43635     Removal of stomach, partial            C            C          0000        0.0000         0.00         0.00         0.00
43640     Vagotomy & pylorus repair              C            C          0000        0.0000         0.00         0.00         0.00
43641     Vagotomy & pylorus repair              C            C          0000        0.0000         0.00         0.00         0.00
43644     Lap gastric bypass/roux-en-y           C            C          0000        0.0000         0.00         0.00         0.00
43645     Lap gastr bypass incl smll i           C            C          0000        0.0000         0.00         0.00         0.00
43651     Laparoscopy, vagus nerve               T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
43652     Laparoscopy, vagus nerve               T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
43653     Laparoscopy, gastrostomy               T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
43659     Laparoscope proc, stom                 T            1          0000        0.0000         0.00         0.00         0.00
43750     Place gastrostomy tube                 T            T          0141        8.0662        371.85       847.84       971.82
43752     Nasal/orogastric w/stent               X            X          0272        1.3291        61.27        139.70       160.13
43760     Change gastrostomy tube                T            T          0121        2.2374        103.14       235.17       269.56
43761     Reposition gastrostomy tube            T            T          0122        6.9179        318.92       727.14       833.47
43770     Lap, place gastr adjust band           C            C          0000        0.0000         0.00         0.00         0.00
43771     Lap, revise adjust gast band           C            C          0000        0.0000         0.00         0.00         0.00
43772     Lap, remove adjust gast band           C            C          0000        0.0000         0.00         0.00         0.00
43773     Lap, change adjust gast band           C            C          0000        0.0000         0.00         0.00         0.00
43774     Lap remov adj gast band/port           C            C          0000        0.0000         0.00         0.00         0.00
43800     Reconstruction of pylorus              C            C          0000        0.0000         0.00         0.00         0.00
43810     Fusion of stomach and bowel            C            C          0000        0.0000         0.00         0.00         0.00
43820     Fusion of stomach and bowel            C            C          0000        0.0000         0.00         0.00         0.00
43825     Fusion of stomach and bowel            C            C          0000        0.0000         0.00         0.00         0.00
43830     Place gastrostomy tube                 T            T          0422       24.0525       1,108.82     2,528.16     2,897.85
43831     Place gastrostomy tube                 T            T          0141        8.0662        371.85       847.84       971.82
43832     Place gastrostomy tube                 C            C          0000        0.0000         0.00         0.00         0.00
43840     Repair of stomach lesion               C            C          0000        0.0000         0.00         0.00         0.00
43842     V-band gastroplasty                    E            C          0000        0.0000         0.00         0.00         0.00
43843     Gastroplasty w/o v-band                C            C          0000        0.0000         0.00         0.00         0.00
43845     Gastroplasty duodenal switch           C            C          0000        0.0000         0.00         0.00         0.00
43846     Gastric bypass for obesity             C            C          0000        0.0000         0.00         0.00         0.00
43847     Gastric bypass incl small i            C            C          0000        0.0000         0.00         0.00         0.00
43848     Revision gastroplasty                  C            C          0000        0.0000         0.00         0.00         0.00
43850     Revise stomach-bowel fusion            C            C          0000        0.0000         0.00         0.00         0.00
43855     Revise stomach-bowel fusion            C            C          0000        0.0000         0.00         0.00         0.00
43860     Revise stomach-bowel fusion            C            C          0000        0.0000         0.00         0.00         0.00
43865     Revise stomach-bowel fusion            C            C          0000        0.0000         0.00         0.00         0.00
43870     Repair stomach opening                 T            T          0141        8.0662        371.85       847.84       971.82
43880     Repair stomach-bowel fistula           C            C          0000        0.0000         0.00         0.00         0.00
43886     Revise gastric port, open              T            T          0025        5.3051        244.57       557.62       639.16
43887     Remove gastric port, open              T            T          0025        5.3051        244.57       557.62       639.16
43888     Change gastric port, open              T            T          0686       13.4973        622.23      1,418.70     1,626.15
43999     Stomach surgery procedure              T            1          0000        0.0000         0.00         0.00         0.00
44005     Freeing of bowel adhesion              C            C          0000        0.0000         0.00         0.00         0.00
44010     Incision of small bowel                C            C          0000        0.0000         0.00         0.00         0.00
44015     Insert needle cath bowel               C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   46 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
44020     Explore small intestine                C            C          0000        0.0000         0.00         0.00         0.00
44021     Decompress small bowel                 C            C          0000        0.0000         0.00         0.00         0.00
44025     Incision of large bowel                C            C          0000        0.0000         0.00         0.00         0.00
44050     Reduce bowel obstruction               C            C          0000        0.0000         0.00         0.00         0.00
44055     Correct malrotation of bowel           C            C          0000        0.0000         0.00         0.00         0.00
44100     Biopsy of bowel                        T            T          0141        8.0662        371.85       847.84       971.82
44110     Excise intestine lesion(s)             C            C          0000        0.0000         0.00         0.00         0.00
44111     Excision of bowel lesion(s)            C            C          0000        0.0000         0.00         0.00         0.00
44120     Removal of small intestine             C            C          0000        0.0000         0.00         0.00         0.00
44121     Removal of small intestine             C            C          0000        0.0000         0.00         0.00         0.00
44125     Removal of small intestine             C            C          0000        0.0000         0.00         0.00         0.00
44126     Enterectomy w/o taper, cong            C            C          0000        0.0000         0.00         0.00         0.00
44127     Enterectomy w/taper, cong              C            C          0000        0.0000         0.00         0.00         0.00
44128     Enterectomy cong, add-on               C            C          0000        0.0000         0.00         0.00         0.00
44130     Bowel to bowel fusion                  C            C          0000        0.0000         0.00         0.00         0.00
44132     Enterectomy, cadaver donor             C            1          0000        0.0000         0.00         0.00         0.00
44133     Enterectomy, live donor                C            1          0000        0.0000         0.00         0.00         0.00
44135     Intestine transplnt, cadaver           C            1          0000        0.0000         0.00         0.00         0.00
44136     Intestine transplant, live             C            1          0000        0.0000         0.00         0.00         0.00
44137     Remove intestinal allograft            C            1          0000        0.0000         0.00         0.00         0.00
44139     Mobilization of colon                  C            C          0000        0.0000         0.00         0.00         0.00
44140     Partial removal of colon               C            C          0000        0.0000         0.00         0.00         0.00
44141     Partial removal of colon               C            C          0000        0.0000         0.00         0.00         0.00
44143     Partial removal of colon               C            C          0000        0.0000         0.00         0.00         0.00
44144     Partial removal of colon               C            C          0000        0.0000         0.00         0.00         0.00
44145     Partial removal of colon               C            C          0000        0.0000         0.00         0.00         0.00
44146     Partial removal of colon               C            C          0000        0.0000         0.00         0.00         0.00
44147     Partial removal of colon               C            C          0000        0.0000         0.00         0.00         0.00
44150     Removal of colon                       C            C          0000        0.0000         0.00         0.00         0.00
44151     Removal of colon/ileostomy             C            C          0000        0.0000         0.00         0.00         0.00
44152     Removal of colon/ileostomy             C            1          0000        0.0000         0.00         0.00         0.00          X
44153     Removal of colon/ileostomy             C            1          0000        0.0000         0.00         0.00         0.00          X
44155     Removal of colon/ileostomy             C            C          0000        0.0000         0.00         0.00         0.00
44156     Removal of colon/ileostomy             C            C          0000        0.0000         0.00         0.00         0.00
44160     Removal of colon                       C            C          0000        0.0000         0.00         0.00         0.00
44180     Lap, enterolysis                       T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
44186     Lap, jejunostomy                       T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
44187     Lap, ileo/jejuno-stomy                 C            C          0000        0.0000         0.00         0.00         0.00
44188     Lap, colostomy                         C            C          0000        0.0000         0.00         0.00         0.00
44202     Lap resect s/intestine singl           C            C          0000        0.0000         0.00         0.00         0.00
44203     Lap resect s/intestine, addl           C            C          0000        0.0000         0.00         0.00         0.00
44204     Laparo partial colectomy               C            C          0000        0.0000         0.00         0.00         0.00
44205     Lap colectomy part w/ileum             C            C          0000        0.0000         0.00         0.00         0.00
44206     Lap part colectomy w/stoma             T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
44207     L colectomy/coloproctostomy            T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
44208     L colectomy/coloproctostomy            T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
44210     Laparo total proctocolectomy           C            C          0000        0.0000         0.00         0.00         0.00
44211     Laparo total proctocolectomy           C            C          0000        0.0000         0.00         0.00         0.00
44212     Laparo total proctocolectomy           C            C          0000        0.0000         0.00         0.00         0.00
44213     Lap, mobil splenic fl add-on           T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
44227     Lap, close enterostomy                 C            C          0000        0.0000         0.00         0.00         0.00
44238     Laparoscope proc, intestine            T            1          0000        0.0000         0.00         0.00         0.00
44300     Open bowel to skin                     C            C          0000        0.0000         0.00         0.00         0.00
44310     Ileostomy/jejunostomy                  C            C          0000        0.0000         0.00         0.00         0.00
44312     Revision of ileostomy                  T            T          0027       18.1956        838.82      1,912.54     2,192.21
44314     Revision of ileostomy                  C            C          0000        0.0000         0.00         0.00         0.00
44316     Devise bowel pouch                     C            C          0000        0.0000         0.00         0.00         0.00
44320     Colostomy                              C            C          0000        0.0000         0.00         0.00         0.00
44322     Colostomy with biopsies                C            C          0000        0.0000         0.00         0.00         0.00
44340     Revision of colostomy                  T            T          0027       18.1956        838.82      1,912.54     2,192.21
44345     Revision of colostomy                  C            C          0000        0.0000         0.00         0.00         0.00
44346     Revision of colostomy                  C            C          0000        0.0000         0.00         0.00         0.00
44360     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44361     Small bowel endoscopy/biopsy           T            T          0142        9.0564        417.50       951.92      1,091.12
44363     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44364     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44365     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44366     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44369     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44370     Small bowel endoscopy/stent            T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
44372     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44373     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44376     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44377     Small bowel endoscopy/biopsy           T            T          0142        9.0564        417.50       951.92      1,091.12
44378     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44379     S bowel endoscope w/stent              T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
44380     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   47 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
44382     Small bowel endoscopy                  T            T          0142        9.0564        417.50       951.92      1,091.12
44383     Ileoscopy w/stent                      T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
44385     Endoscopy of bowel pouch               T            T          0143        8.5588        394.56       899.62      1,031.16
44386     Endoscopy, bowel pouch/biop            T            T          0143        8.5588        394.56       899.62      1,031.16
44388     Colonoscopy                            T            T          0143        8.5588        394.56       899.62      1,031.16
44389     Colonoscopy with biopsy                T            T          0143        8.5588        394.56       899.62      1,031.16
44390     Colonoscopy for foreign body           T            T          0143        8.5588        394.56       899.62      1,031.16
44391     Colonoscopy for bleeding               T            T          0143        8.5588        394.56       899.62      1,031.16
44392     Colonoscopy & polypectomy              T            T          0143        8.5588        394.56       899.62      1,031.16
44393     Colonoscopy, lesion removal            T            T          0143        8.5588        394.56       899.62      1,031.16
44394     Colonoscopy w/snare                    T            T          0143        8.5588        394.56       899.62      1,031.16
44397     Colonoscopy w/stent                    T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
44500     Intro, gastrointestinal tube           T            T          0121        2.2374        103.14       235.17       269.56
44602     Suture, small intestine                C            C          0000        0.0000         0.00         0.00         0.00
44603     Suture, small intestine                C            C          0000        0.0000         0.00         0.00         0.00
44604     Suture, large intestine                C            C          0000        0.0000         0.00         0.00         0.00
44605     Repair of bowel lesion                 C            C          0000        0.0000         0.00         0.00         0.00
44615     Intestinal stricturoplasty             C            C          0000        0.0000         0.00         0.00         0.00
44620     Repair bowel opening                   C            C          0000        0.0000         0.00         0.00         0.00
44625     Repair bowel opening                   C            C          0000        0.0000         0.00         0.00         0.00
44626     Repair bowel opening                   C            C          0000        0.0000         0.00         0.00         0.00
44640     Repair bowel-skin fistula              C            C          0000        0.0000         0.00         0.00         0.00
44650     Repair bowel fistula                   C            C          0000        0.0000         0.00         0.00         0.00
44660     Repair bowel-bladder fistula           C            C          0000        0.0000         0.00         0.00         0.00
44661     Repair bowel-bladder fistula           C            C          0000        0.0000         0.00         0.00         0.00
44680     Surgical revision, intestine           C            C          0000        0.0000         0.00         0.00         0.00
44700     Suspend bowel w/prosthesis             C            C          0000        0.0000         0.00         0.00         0.00
44701     Intraop colon lavage add-on            N            N          0000        0.0000         0.00         0.00         0.00
44715     Prepare donor intestine                C            1          0000        0.0000         0.00         0.00         0.00
44720     Prep donor intestine/venous            C            1          0000        0.0000         0.00         0.00         0.00
44721     Prep donor intestine/artery            C            1          0000        0.0000         0.00         0.00         0.00
44799     Unlisted procedure intestine           T            1          0000        0.0000         0.00         0.00         0.00
44800     Excision of bowel pouch                C            C          0000        0.0000         0.00         0.00         0.00
44820     Excision of mesentery lesion           C            C          0000        0.0000         0.00         0.00         0.00
44850     Repair of mesentery                    C            C          0000        0.0000         0.00         0.00         0.00
44899     Bowel surgery procedure                C            1          0000        0.0000         0.00         0.00         0.00
44900     Drain app abscess, open                C            C          0000        0.0000         0.00         0.00         0.00
44901     Drain app abscess, percut              T            T          0037        9.6103        443.03      1,010.14     1,157.85
44950     Appendectomy                           C            C          0000        0.0000         0.00         0.00         0.00
44955     Appendectomy add-on                    C            C          0000        0.0000         0.00         0.00         0.00
44960     Appendectomy                           C            C          0000        0.0000         0.00         0.00         0.00
44970     Laparoscopy, appendectomy              T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
44979     Laparoscope proc, app                  T            1          0000        0.0000         0.00         0.00         0.00
45000     Drainage of pelvic abscess             T            T          0148        3.5047        161.57       368.38       422.25
45005     Drainage of rectal abscess             T            T          0155       15.9499        735.29      1,676.49     1,921.64
45020     Drainage of rectal abscess             T            T          0155       15.9499        735.29      1,676.49     1,921.64
45100     Biopsy of rectum                       T            T          0149       18.0878        833.85      1,901.21     2,179.22
45108     Removal of anorectal lesion            T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
45110     Removal of rectum                      C            C          0000        0.0000         0.00         0.00         0.00
45111     Partial removal of rectum              C            C          0000        0.0000         0.00         0.00         0.00
45112     Removal of rectum                      C            C          0000        0.0000         0.00         0.00         0.00
45113     Partial proctectomy                    C            C          0000        0.0000         0.00         0.00         0.00
45114     Partial removal of rectum              C            C          0000        0.0000         0.00         0.00         0.00
45116     Partial removal of rectum              C            C          0000        0.0000         0.00         0.00         0.00
45119     Remove rectum w/reservoir              C            C          0000        0.0000         0.00         0.00         0.00
45120     Removal of rectum                      C            C          0000        0.0000         0.00         0.00         0.00
45121     Removal of rectum and colon            C            C          0000        0.0000         0.00         0.00         0.00
45123     Partial proctectomy                    C            C          0000        0.0000         0.00         0.00         0.00
45126     Pelvic exenteration                    C            C          0000        0.0000         0.00         0.00         0.00
45130     Excision of rectal prolapse            C            C          0000        0.0000         0.00         0.00         0.00
45135     Excision of rectal prolapse            C            C          0000        0.0000         0.00         0.00         0.00
45136     Excise ileoanal reservior              C            C          0000        0.0000         0.00         0.00         0.00
45150     Excision of rectal stricture           T            T          0149       18.0878        833.85      1,901.21     2,179.22
45160     Excision of rectal lesion              T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
45170     Excision of rectal lesion              T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
45190     Destruction, rectal tumor              T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
45300     Proctosigmoidoscopy dx                 T            T          0146        4.7086        217.07       494.92       567.29
45303     Proctosigmoidoscopy dilate             T            T          0147        7.9652        367.20       837.22       959.65
45305     Proctosigmoidoscopy w/bx               T            T          0147        7.9652        367.20       837.22       959.65
45307     Proctosigmoidoscopy fb                 T            T          0428       20.0871        926.02      2,111.36     2,420.09
45308     Proctosigmoidoscopy removal            T            T          0147        7.9652        367.20       837.22       959.65
45309     Proctosigmoidoscopy removal            T            T          0147        7.9652        367.20       837.22       959.65
45315     Proctosigmoidoscopy removal            T            T          0147        7.9652        367.20       837.22       959.65
45317     Proctosigmoidoscopy bleed              T            T          0147        7.9652        367.20       837.22       959.65
45320     Proctosigmoidoscopy ablate             T            T          0428       20.0871        926.02      2,111.36     2,420.09
45321     Proctosigmoidoscopy volvul             T            T          0428       20.0871        926.02      2,111.36     2,420.09
45327     Proctosigmoidoscopy w/stent            T            T          0384       26.8955       1,239.88     2,826.99     3,240.37

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   48 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
45330     Diagnostic sigmoidoscopy               T            T          0146        4.7086        217.07       494.92       567.29
45331     Sigmoidoscopy and biopsy               T            T          0146        4.7086        217.07       494.92       567.29
45332     Sigmoidoscopy w/fb removal             T            T          0146        4.7086        217.07       494.92       567.29
45333     Sigmoidoscopy & polypectomy            T            T          0147        7.9652        367.20       837.22       959.65
45334     Sigmoidoscopy for bleeding             T            T          0147        7.9652        367.20       837.22       959.65
45335     Sigmoidoscopy w/submuc inj             T            T          0146        4.7086        217.07       494.92       567.29
45337     Sigmoidoscopy & decompress             T            T          0146        4.7086        217.07       494.92       567.29
45338     Sigmoidoscopy w/tumr remove            T            T          0147        7.9652        367.20       837.22       959.65
45339     Sigmoidoscopy w/ablate tumr            T            T          0147        7.9652        367.20       837.22       959.65
45340     Sig w/balloon dilation                 T            T          0147        7.9652        367.20       837.22       959.65
45341     Sigmoidoscopy w/ultrasound             T            T          0147        7.9652        367.20       837.22       959.65
45342     Sigmoidoscopy w/us guide bx            T            T          0147        7.9652        367.20       837.22       959.65
45345     Sigmoidoscopy w/stent                  T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
45355     Surgical colonoscopy                   T            T          0143        8.5588        394.56       899.62      1,031.16
45378     Diagnostic colonoscopy                 T            T          0143        8.5588        394.56       899.62      1,031.16
45379     Colonoscopy w/fb removal               T            T          0143        8.5588        394.56       899.62      1,031.16
45380     Colonoscopy and biopsy                 T            T          0143        8.5588        394.56       899.62      1,031.16
45381     Colonoscopy, submucous inj             T            T          0143        8.5588        394.56       899.62      1,031.16
45382     Colonoscopy/control bleeding           T            T          0143        8.5588        394.56       899.62      1,031.16
45383     Lesion removal colonoscopy             T            T          0143        8.5588        394.56       899.62      1,031.16
45384     Lesion remove colonoscopy              T            T          0143        8.5588        394.56       899.62      1,031.16
45385     Lesion removal colonoscopy             T            T          0143        8.5588        394.56       899.62      1,031.16
45386     Colonoscopy dilate stricture           T            T          0143        8.5588        394.56       899.62      1,031.16
45387     Colonoscopy w/stent                    T            T          0384       26.8955       1,239.88     2,826.99     3,240.37
45391     Colonoscopy w/endoscope us             T            T          0143        8.5588        394.56       899.62      1,031.16
45392     Colonoscopy w/endoscopic fnb           T            T          0143        8.5588        394.56       899.62      1,031.16
45395     Lap, removal of rectum                 C            C          0000        0.0000         0.00         0.00         0.00
45397     Lap, remove rectum w/pouch             C            C          0000        0.0000         0.00         0.00         0.00
45400     Laparoscopic proctopexy                C            C          0000        0.0000         0.00         0.00         0.00
45402     Lap proctopexy w/sig resect            C            C          0000        0.0000         0.00         0.00         0.00
45499     Laparoscope proc, rectum               T            1          0000        0.0000         0.00         0.00         0.00
45500     Repair of rectum                       T            T          0149       18.0878        833.85      1,901.21     2,179.22
45505     Repair of rectum                       T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
45520     Treatment of rectal prolapse           T            T          0098        1.1444        52.76        120.29       137.88
45540     Correct rectal prolapse                C            C          0000        0.0000         0.00         0.00         0.00
45541     Correct rectal prolapse                T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
45550     Repair rectum/remove sigmoid           C            C          0000        0.0000         0.00         0.00         0.00
45560     Repair of rectocele                    T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
45562     Exploration/repair of rectum           C            C          0000        0.0000         0.00         0.00         0.00
45563     Exploration/repair of rectum           C            C          0000        0.0000         0.00         0.00         0.00
45800     Repair rect/bladder fistula            C            C          0000        0.0000         0.00         0.00         0.00
45805     Repair fistula w/colostomy             C            C          0000        0.0000         0.00         0.00         0.00
45820     Repair rectourethral fistula           C            C          0000        0.0000         0.00         0.00         0.00
45825     Repair fistula w/colostomy             C            C          0000        0.0000         0.00         0.00         0.00
45900     Reduction of rectal prolapse           T            T          0148        3.5047        161.57       368.38       422.25
45905     Dilation of anal sphincter             T            T          0149       18.0878        833.85      1,901.21     2,179.22
45910     Dilation of rectal narrowing           T            T          0149       18.0878        833.85      1,901.21     2,179.22
45915     Remove rectal obstruction              T            T          0148        3.5047        161.57       368.38       422.25
45990     Surg dx exam, anorectal                T            T          0148        3.5047        161.57       368.38       422.25
45999     Rectum surgery procedure               T            1          0000        0.0000         0.00         0.00         0.00
46020     Placement of seton                     T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46030     Removal of rectal marker               T            T          0148        3.5047        161.57       368.38       422.25
46040     Incision of rectal abscess             T            T          0149       18.0878        833.85      1,901.21     2,179.22
46045     Incision of rectal abscess             T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46050     Incision of anal abscess               T            T          0148        3.5047        161.57       368.38       422.25
46060     Incision of rectal abscess             T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46070     Incision of anal septum                T            T          0155       15.9499        735.29      1,676.49     1,921.64
46080     Incision of anal sphincter             T            T          0149       18.0878        833.85      1,901.21     2,179.22
46083     Incise external hemorrhoid             T            T          0148        3.5047        161.57       368.38       422.25
46200     Removal of anal fissure                T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46210     Removal of anal crypt                  T            T          0149       18.0878        833.85      1,901.21     2,179.22
46211     Removal of anal crypts                 T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46220     Removal of anal tag                    T            T          0149       18.0878        833.85      1,901.21     2,179.22
46221     Ligation of hemorrhoid(s)              T            T          0148        3.5047        161.57       368.38       422.25
46230     Removal of anal tags                   T            T          0149       18.0878        833.85      1,901.21     2,179.22
46250     Hemorrhoidectomy                       T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46255     Hemorrhoidectomy                       T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46257     Remove hemorrhoids & fissure           T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46258     Remove hemorrhoids & fistula           T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46260     Hemorrhoidectomy                       T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46261     Remove hemorrhoids & fissure           T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46262     Remove hemorrhoids & fistula           T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46270     Removal of anal fistula                T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46275     Removal of anal fistula                T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46280     Removal of anal fistula                T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46285     Removal of anal fistula                T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46288     Repair anal fistula                    T            T          0150       23.8736       1,100.57     2,509.35     2,876.29

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   49 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
46320     Removal of hemorrhoid clot             T            T          0148        3.5047        161.57       368.38       422.25
46500     Injection into hemorrhoid(s)           T            T          0155       15.9499        735.29      1,676.49     1,921.64
46505     Chemodenervation anal musc             T            T          0148        3.5047        161.57       368.38       422.25
46600     Diagnostic anoscopy                    X            X          0340        0.6137        28.29        64.51        73.94
46604     Anoscopy and dilation                  T            T          0147        7.9652        367.20       837.22       959.65
46606     Anoscopy and biopsy                    T            T          0146        4.7086        217.07       494.92       567.29
46608     Anoscopy, remove for body              T            T          0147        7.9652        367.20       837.22       959.65
46610     Anoscopy, remove lesion                T            T          0428       20.0871        926.02      2,111.36     2,420.09
46611     Anoscopy                               T            T          0147        7.9652        367.20       837.22       959.65
46612     Anoscopy, remove lesions               T            T          0428       20.0871        926.02      2,111.36     2,420.09
46614     Anoscopy, control bleeding             T            T          0146        4.7086        217.07       494.92       567.29
46615     Anoscopy                               T            T          0428       20.0871        926.02      2,111.36     2,420.09
46700     Repair of anal stricture               T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46705     Repair of anal stricture               C            C          0000        0.0000         0.00         0.00         0.00
46706     Repr of anal fistula w/glue            T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46710     Repr per/vag pouch sngl proc           C            C          0000        0.0000         0.00         0.00         0.00
46712     Repr per/vag pouch dbl proc            C            C          0000        0.0000         0.00         0.00         0.00
46715     Rep perf anoper fistu                  C            C          0000        0.0000         0.00         0.00         0.00
46716     Rep perf anoper/vestib fistu           C            C          0000        0.0000         0.00         0.00         0.00
46730     Construction of absent anus            C            C          0000        0.0000         0.00         0.00         0.00
46735     Construction of absent anus            C            C          0000        0.0000         0.00         0.00         0.00
46740     Construction of absent anus            C            C          0000        0.0000         0.00         0.00         0.00
46742     Repair of imperforated anus            C            C          0000        0.0000         0.00         0.00         0.00
46744     Repair of cloacal anomaly              C            C          0000        0.0000         0.00         0.00         0.00
46746     Repair of cloacal anomaly              C            C          0000        0.0000         0.00         0.00         0.00
46748     Repair of cloacal anomaly              C            C          0000        0.0000         0.00         0.00         0.00
46750     Repair of anal sphincter               T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46751     Repair of anal sphincter               C            C          0000        0.0000         0.00         0.00         0.00
46753     Reconstruction of anus                 T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46754     Removal of suture from anus            T            T          0149       18.0878        833.85      1,901.21     2,179.22
46760     Repair of anal sphincter               T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46761     Repair of anal sphincter               T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46762     Implant artificial sphincter           T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46900     Destruction, anal lesion(s)            T            T          0016        2.5080        115.62       263.62       302.16
46910     Destruction, anal lesion(s)            T            T          0017       17.9937        829.51      1,891.32     2,167.88
46916     Cryosurgery, anal lesion(s)            T            T          0013        1.0603        48.88        111.45       127.74
46917     Laser surgery, anal lesions            T            T          0695       20.2372        932.93      2,127.13     2,438.18
46922     Excision of anal lesion(s)             T            T          0695       20.2372        932.93      2,127.13     2,438.18
46924     Destruction, anal lesion(s)            T            T          0695       20.2372        932.93      2,127.13     2,438.18
46934     Destruction of hemorrhoids             T            T          0155       15.9499        735.29      1,676.49     1,921.64
46935     Destruction of hemorrhoids             T            T          0155       15.9499        735.29      1,676.49     1,921.64
46936     Destruction of hemorrhoids             T            T          0149       18.0878        833.85      1,901.21     2,179.22
46937     Cryotherapy of rectal lesion           T            T          0149       18.0878        833.85      1,901.21     2,179.22
46938     Cryotherapy of rectal lesion           T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46940     Treatment of anal fissure              T            T          0149       18.0878        833.85      1,901.21     2,179.22
46942     Treatment of anal fissure              T            T          0148        3.5047        161.57       368.38       422.25
46945     Ligation of hemorrhoids                T            T          0155       15.9499        735.29      1,676.49     1,921.64
46946     Ligation of hemorrhoids                T            T          0155       15.9499        735.29      1,676.49     1,921.64
46947     Hemorrhoidopexy by stapling            T            T          0150       23.8736       1,100.57     2,509.35     2,876.29
46999     Anus surgery procedure                 T            1          0000        0.0000         0.00         0.00         0.00
47000     Needle biopsy of liver                 T            T          0685        6.0034        276.76       631.02       723.29
47001     Needle biopsy, liver add-on            N            N          0000        0.0000         0.00         0.00         0.00
47010     Open drainage, liver lesion            C            C          0000        0.0000         0.00         0.00         0.00
47011     Percut drain, liver lesion             T            T          0037        9.6103        443.03      1,010.14     1,157.85
47015     Inject/aspirate liver cyst             C            C          0000        0.0000         0.00         0.00         0.00
47100     Wedge biopsy of liver                  C            C          0000        0.0000         0.00         0.00         0.00
47120     Partial removal of liver               C            C          0000        0.0000         0.00         0.00         0.00
47122     Extensive removal of liver             C            C          0000        0.0000         0.00         0.00         0.00
47125     Partial removal of liver               C            C          0000        0.0000         0.00         0.00         0.00
47130     Partial removal of liver               C            C          0000        0.0000         0.00         0.00         0.00
47133     Removal of donor liver                 C            C          0000        0.0000         0.00         0.00         0.00
47135     Transplantation of liver               C            C          0000        0.0000         0.00         0.00         0.00
47136     Transplantation of liver               C            C          0000        0.0000         0.00         0.00         0.00
47140     Partial removal, donor liver           C            C          0000        0.0000         0.00         0.00         0.00
47141     Partial removal, donor liver           C            C          0000        0.0000         0.00         0.00         0.00
47142     Partial removal, donor liver           C            C          0000        0.0000         0.00         0.00         0.00
47143     Prep donor liver, whole                C            C          0000        0.0000         0.00         0.00         0.00
47144     Prep donor liver, 3-segment            C            C          0000        0.0000         0.00         0.00         0.00
47145     Prep donor liver, lobe split           C            C          0000        0.0000         0.00         0.00         0.00
47146     Prep donor liver/venous                C            C          0000        0.0000         0.00         0.00         0.00
47147     Prep donor liver/arterial              C            C          0000        0.0000         0.00         0.00         0.00
47300     Surgery for liver lesion               C            C          0000        0.0000         0.00         0.00         0.00
47350     Repair liver wound                     C            C          0000        0.0000         0.00         0.00         0.00
47360     Repair liver wound                     C            C          0000        0.0000         0.00         0.00         0.00
47361     Repair liver wound                     C            C          0000        0.0000         0.00         0.00         0.00
47362     Repair liver wound                     C            C          0000        0.0000         0.00         0.00         0.00
47370     Laparo ablate liver tumor rf           T            T          0132       63.6859       2,935.92     6,694.02     7,672.88

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   50 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
47371     Laparo ablate liver cryosurg           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
47379     Laparoscope procedure, liver           T            1          0000        0.0000         0.00         0.00         0.00
47380     Open ablate liver tumor rf             C            C          0000        0.0000         0.00         0.00         0.00
47381     Open ablate liver tumor cryo           C            C          0000        0.0000         0.00         0.00         0.00
47382     Percut ablate liver rf                 T            T          0423       39.5881       1,825.01     4,161.11     4,769.57
47399     Liver surgery procedure                T            1          0000        0.0000         0.00         0.00         0.00
47400     Incision of liver duct                 C            C          0000        0.0000         0.00         0.00         0.00
47420     Incision of bile duct                  C            C          0000        0.0000         0.00         0.00         0.00
47425     Incision of bile duct                  C            C          0000        0.0000         0.00         0.00         0.00
47460     Incise bile duct sphincter             C            C          0000        0.0000         0.00         0.00         0.00
47480     Incision of gallbladder                C            C          0000        0.0000         0.00         0.00         0.00
47490     Incision of gallbladder                T            T          0152       18.2391        840.82      1,917.11     2,197.45
47500     Injection for liver x-rays             N            N          0000        0.0000         0.00         0.00         0.00
47505     Injection for liver x-rays             N            N          0000        0.0000         0.00         0.00         0.00
47510     Insert catheter, bile duct             T            T          0152       18.2391        840.82      1,917.11     2,197.45
47511     Insert bile duct drain                 T            T          0152       18.2391        840.82      1,917.11     2,197.45
47525     Change bile duct catheter              T            T          0427       10.0109        461.50      1,052.25     1,206.11
47530     Revise/reinsert bile tube              T            T          0427       10.0109        461.50      1,052.25     1,206.11
47550     Bile duct endoscopy add-on             C            C          0000        0.0000         0.00         0.00         0.00
47552     Biliary endoscopy thru skin            T            T          0152       18.2391        840.82      1,917.11     2,197.45
47553     Biliary endoscopy thru skin            T            T          0152       18.2391        840.82      1,917.11     2,197.45
47554     Biliary endoscopy thru skin            T            T          0152       18.2391        840.82      1,917.11     2,197.45
47555     Biliary endoscopy thru skin            T            T          0152       18.2391        840.82      1,917.11     2,197.45
47556     Biliary endoscopy thru skin            T            T          0152       18.2391        840.82      1,917.11     2,197.45
47560     Laparoscopy w/cholangio                T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
47561     Laparo w/cholangio/biopsy              T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
47562     Laparoscopic cholecystectomy           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
47563     Laparo cholecystectomy/graph           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
47564     Laparo cholecystectomy/explr           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
47570     Laparo cholecystoenterostomy           C            C          0000        0.0000         0.00         0.00         0.00
47579     Laparoscope proc, biliary              T            1          0000        0.0000         0.00         0.00         0.00
47600     Removal of gallbladder                 C            C          0000        0.0000         0.00         0.00         0.00
47605     Removal of gallbladder                 C            C          0000        0.0000         0.00         0.00         0.00
47610     Removal of gallbladder                 C            C          0000        0.0000         0.00         0.00         0.00
47612     Removal of gallbladder                 C            C          0000        0.0000         0.00         0.00         0.00
47620     Removal of gallbladder                 C            C          0000        0.0000         0.00         0.00         0.00
47630     Remove bile duct stone                 T            T          0152       18.2391        840.82      1,917.11     2,197.45
47700     Exploration of bile ducts              C            C          0000        0.0000         0.00         0.00         0.00
47701     Bile duct revision                     C            C          0000        0.0000         0.00         0.00         0.00
47711     Excision of bile duct tumor            C            C          0000        0.0000         0.00         0.00         0.00
47712     Excision of bile duct tumor            C            C          0000        0.0000         0.00         0.00         0.00
47715     Excision of bile duct cyst             C            C          0000        0.0000         0.00         0.00         0.00
47716     Fusion of bile duct cyst               C            1          0000        0.0000         0.00         0.00         0.00          X
47720     Fuse gallbladder & bowel               C            C          0000        0.0000         0.00         0.00         0.00
47721     Fuse upper gi structures               C            C          0000        0.0000         0.00         0.00         0.00
47740     Fuse gallbladder & bowel               C            C          0000        0.0000         0.00         0.00         0.00
47741     Fuse gallbladder & bowel               C            C          0000        0.0000         0.00         0.00         0.00
47760     Fuse bile ducts and bowel              C            C          0000        0.0000         0.00         0.00         0.00
47765     Fuse liver ducts & bowel               C            C          0000        0.0000         0.00         0.00         0.00
47780     Fuse bile ducts and bowel              C            C          0000        0.0000         0.00         0.00         0.00
47785     Fuse bile ducts and bowel              C            C          0000        0.0000         0.00         0.00         0.00
47800     Reconstruction of bile ducts           C            C          0000        0.0000         0.00         0.00         0.00
47801     Placement, bile duct support           C            C          0000        0.0000         0.00         0.00         0.00
47802     Fuse liver duct & intestine            C            C          0000        0.0000         0.00         0.00         0.00
47900     Suture bile duct injury                C            C          0000        0.0000         0.00         0.00         0.00
47999     Bile tract surgery procedure           T            1          0000        0.0000         0.00         0.00         0.00
48000     Drainage of abdomen                    C            C          0000        0.0000         0.00         0.00         0.00
48001     Placement of drain, pancreas           C            C          0000        0.0000         0.00         0.00         0.00
48005     Resect/debride pancreas                C            1          0000        0.0000         0.00         0.00         0.00          X
48020     Removal of pancreatic stone            C            C          0000        0.0000         0.00         0.00         0.00
48100     Biopsy of pancreas, open               C            C          0000        0.0000         0.00         0.00         0.00
48102     Needle biopsy, pancreas                T            T          0685        6.0034        276.76       631.02       723.29
48120     Removal of pancreas lesion             C            C          0000        0.0000         0.00         0.00         0.00
48140     Partial removal of pancreas            C            C          0000        0.0000         0.00         0.00         0.00
48145     Partial removal of pancreas            C            C          0000        0.0000         0.00         0.00         0.00
48146     Pancreatectomy                         C            C          0000        0.0000         0.00         0.00         0.00
48148     Removal of pancreatic duct             C            C          0000        0.0000         0.00         0.00         0.00
48150     Partial removal of pancreas            C            C          0000        0.0000         0.00         0.00         0.00
48152     Pancreatectomy                         C            C          0000        0.0000         0.00         0.00         0.00
48153     Pancreatectomy                         C            C          0000        0.0000         0.00         0.00         0.00
48154     Pancreatectomy                         C            C          0000        0.0000         0.00         0.00         0.00
48155     Removal of pancreas                    C            C          0000        0.0000         0.00         0.00         0.00
48160     Pancreas removal/transplant            E            3          0000        0.0000         M01          M01          M01
48180     Fuse pancreas and bowel                C            1          0000        0.0000         0.00         0.00         0.00          X
48400     Injection, intraop add-on              C            C          0000        0.0000         0.00         0.00         0.00
48500     Surgery of pancreatic cyst             C            C          0000        0.0000         0.00         0.00         0.00
48510     Drain pancreatic pseudocyst            C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   51 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
48511     Drain pancreatic pseudocyst            T            T          0037        9.6103        443.03      1,010.14     1,157.85
48520     Fuse pancreas cyst and bowel           C            C          0000        0.0000         0.00         0.00         0.00
48540     Fuse pancreas cyst and bowel           C            C          0000        0.0000         0.00         0.00         0.00
48545     Pancreatorrhaphy                       C            C          0000        0.0000         0.00         0.00         0.00
48547     Duodenal exclusion                     C            C          0000        0.0000         0.00         0.00         0.00
48550     Donor pancreatectomy                   E            3          0000        0.0000         M01          M01          M01
48551     Prep donor pancreas                    C            C          0000        0.0000         0.00         0.00         0.00
48552     Prep donor pancreas/venous             C            C          0000        0.0000         0.00         0.00         0.00
48554     Transpl allograft pancreas             C            C          0000        0.0000         0.00         0.00         0.00
48556     Removal, allograft pancreas            C            C          0000        0.0000         0.00         0.00         0.00
48999     Pancreas surgery procedure             T            1          0000        0.0000         0.00         0.00         0.00
49000     Exploration of abdomen                 C            C          0000        0.0000         0.00         0.00         0.00
49002     Reopening of abdomen                   C            C          0000        0.0000         0.00         0.00         0.00
49010     Exploration behind abdomen             C            C          0000        0.0000         0.00         0.00         0.00
49020     Drain abdominal abscess                C            C          0000        0.0000         0.00         0.00         0.00
49021     Drain abdominal abscess                T            T          0037        9.6103        443.03      1,010.14     1,157.85
49040     Drain, open, abdom abscess             C            C          0000        0.0000         0.00         0.00         0.00
49041     Drain, percut, abdom abscess           T            T          0037        9.6103        443.03      1,010.14     1,157.85
49060     Drain, open, retrop abscess            C            C          0000        0.0000         0.00         0.00         0.00
49061     Drain, percut, retroper absc           T            T          0037        9.6103        443.03      1,010.14     1,157.85
49062     Drain to peritoneal cavity             C            C          0000        0.0000         0.00         0.00         0.00
49080     Puncture, peritoneal cavity            T            T          0070        3.2141        148.17       337.83       387.23
49081     Removal of abdominal fluid             T            T          0070        3.2141        148.17       337.83       387.23
49085     Remove abdomen foreign body            T            1          0153       22.4936         0.00         0.00         0.00          X
49180     Biopsy, abdominal mass                 T            T          0685        6.0034        276.76       631.02       723.29
49200     Removal of abdominal lesion            T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
49201     Remove abdom lesion, complex           C            C          0000        0.0000         0.00         0.00         0.00
49215     Excise sacral spine tumor              C            C          0000        0.0000         0.00         0.00         0.00
49220     Multiple surgery, abdomen              C            C          0000        0.0000         0.00         0.00         0.00
49250     Excision of umbilicus                  T            T          0153       22.4936       1,036.95     2,364.30     2,710.03
49255     Removal of omentum                     C            C          0000        0.0000         0.00         0.00         0.00
49320     Diag laparo separate proc              T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
49321     Laparoscopy, biopsy                    T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
49322     Laparoscopy, aspiration                T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
49323     Laparo drain lymphocele                T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
49329     Laparo proc, abdm/per/oment            T            1          0000        0.0000         0.00         0.00         0.00
49400     Air injection into abdomen             N            N          0000        0.0000         0.00         0.00         0.00
49419     Insrt abdom cath for chemotx           T            T          0115       36.9806       1,704.81     3,887.03     4,455.42
49420     Insert abdom drain, temp               T            T          0652       29.3648       1,353.72     3,086.53     3,537.87
49421     Insert abdom drain, perm               T            T          0652       29.3648       1,353.72     3,086.53     3,537.87
49422     Remove perm cannula/catheter           T            T          0105       21.9865       1,013.58     2,311.00     2,648.93
49423     Exchange drainage catheter             T            T          0427       10.0109        461.50      1,052.25     1,206.11
49424     Assess cyst, contrast inject           N            N          0000        0.0000         0.00         0.00         0.00
49425     Insert abdomen-venous drain            C            C          0000        0.0000         0.00         0.00         0.00
49426     Revise abdomen-venous shunt            T            T          0153       22.4936       1,036.95     2,364.30     2,710.03
49427     Injection, abdominal shunt             N            N          0000        0.0000         0.00         0.00         0.00
49428     Ligation of shunt                      C            C          0000        0.0000         0.00         0.00         0.00
49429     Removal of shunt                       T            T          0105       21.9865       1,013.58     2,311.00     2,648.93
49491     Rpr hern preemie reduc                 T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49492     Rpr ing hern premie, blocked           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49495     Rpr ing hernia baby, reduc             T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49496     Rpr ing hernia baby, blocked           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49500     Rpr ing hernia, init, reduce           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49501     Rpr ing hernia, init blocked           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49505     Prp i/hern init reduc >5 yr            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49507     Prp i/hern init block >5 yr            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49520     Rerepair ing hernia, reduce            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49521     Rerepair ing hernia, blocked           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49525     Repair ing hernia, sliding             T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49540     Repair lumbar hernia                   T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49550     Rpr rem hernia, init, reduce           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49553     Rpr fem hernia, init blocked           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49555     Rerepair fem hernia, reduce            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49557     Rerepair fem hernia, blocked           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49560     Rpr ventral hern init, reduc           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49561     Rpr ventral hern init, block           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49565     Rerepair ventrl hern, reduce           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49566     Rerepair ventrl hern, block            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49568     Hernia repair w/mesh                   T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49570     Rpr epigastric hern, reduce            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49572     Rpr epigastric hern, blocked           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49580     Rpr umbil hern, reduc < 5 yr           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49582     Rpr umbil hern, block < 5 yr           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49585     Rpr umbil hern, reduc > 5 yr           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49587     Rpr umbil hern, block > 5 yr           T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49590     Repair spigelian hernia                T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
49600     Repair umbilical lesion                T            T          0154       28.6432       1,320.45     3,010.69     3,450.93

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   52 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
49605     Repair umbilical lesion                C            C          0000        0.0000         0.00         0.00         0.00
49606     Repair umbilical lesion                C            C          0000        0.0000         0.00         0.00         0.00
49610     Repair umbilical lesion                C            C          0000        0.0000         0.00         0.00         0.00
49611     Repair umbilical lesion                C            C          0000        0.0000         0.00         0.00         0.00
49650     Laparo hernia repair initial           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
49651     Laparo hernia repair recur             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
49659     Laparo proc, hernia repair             T            1          0000        0.0000         0.00         0.00         0.00
49900     Repair of abdominal wall               C            C          0000        0.0000         0.00         0.00         0.00
49904     Omental flap, extra-abdom              C            C          0000        0.0000         0.00         0.00         0.00
49905     Omental flap, intra-abdom              C            C          0000        0.0000         0.00         0.00         0.00
49906     Free omental flap, microvasc           C            C          0000        0.0000         0.00         0.00         0.00
49999     Abdomen surgery procedure              T            1          0000        0.0000         0.00         0.00         0.00
50010     Exploration of kidney                  C            C          0000        0.0000         0.00         0.00         0.00
50020     Renal abscess, open drain              T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
50021     Renal abscess, percut drain            T            T          0037        9.6103        443.03      1,010.14     1,157.85
50040     Drainage of kidney                     C            C          0000        0.0000         0.00         0.00         0.00
50045     Exploration of kidney                  C            C          0000        0.0000         0.00         0.00         0.00
50060     Removal of kidney stone                C            C          0000        0.0000         0.00         0.00         0.00
50065     Incision of kidney                     C            C          0000        0.0000         0.00         0.00         0.00
50070     Incision of kidney                     C            C          0000        0.0000         0.00         0.00         0.00
50075     Removal of kidney stone                C            C          0000        0.0000         0.00         0.00         0.00
50080     Removal of kidney stone                T            T          0429       42.0802       1,939.90     4,423.05     5,069.82
50081     Removal of kidney stone                T            T          0429       42.0802       1,939.90     4,423.05     5,069.82
50100     Revise kidney blood vessels            C            C          0000        0.0000         0.00         0.00         0.00
50120     Exploration of kidney                  C            C          0000        0.0000         0.00         0.00         0.00
50125     Explore and drain kidney               C            C          0000        0.0000         0.00         0.00         0.00
50130     Removal of kidney stone                C            C          0000        0.0000         0.00         0.00         0.00
50135     Exploration of kidney                  C            C          0000        0.0000         0.00         0.00         0.00
50200     Biopsy of kidney                       T            T          0685        6.0034        276.76       631.02       723.29
50205     Biopsy of kidney                       C            C          0000        0.0000         0.00         0.00         0.00
50220     Remove kidney, open                    C            C          0000        0.0000         0.00         0.00         0.00
50225     Removal kidney open, complex           C            C          0000        0.0000         0.00         0.00         0.00
50230     Removal kidney open, radical           C            C          0000        0.0000         0.00         0.00         0.00
50234     Removal of kidney & ureter             C            C          0000        0.0000         0.00         0.00         0.00
50236     Removal of kidney & ureter             C            C          0000        0.0000         0.00         0.00         0.00
50240     Partial removal of kidney              C            C          0000        0.0000         0.00         0.00         0.00
50250     Cryoablate renal mass open             C            C          0000        0.0000         0.00         0.00         0.00
50280     Removal of kidney lesion               C            C          0000        0.0000         0.00         0.00         0.00
50290     Removal of kidney lesion               C            C          0000        0.0000         0.00         0.00         0.00
50300     Remove cadaver donor kidney            C            C          0000        0.0000         0.00         0.00         0.00
50320     Remove kidney, living donor            C            C          0000        0.0000         0.00         0.00         0.00
50323     Prep cadaver renal allograft           C            C          0000        0.0000         0.00         0.00         0.00
50325     Prep donor renal graft                 C            C          0000        0.0000         0.00         0.00         0.00
50327     Prep renal graft/venous                C            C          0000        0.0000         0.00         0.00         0.00
50328     Prep renal graft/arterial              C            C          0000        0.0000         0.00         0.00         0.00
50329     Prep renal graft/ureteral              C            C          0000        0.0000         0.00         0.00         0.00
50340     Removal of kidney                      C            C          0000        0.0000         0.00         0.00         0.00
50360     Transplantation of kidney              C            C          0000        0.0000         0.00         0.00         0.00
50365     Transplantation of kidney              C            C          0000        0.0000         0.00         0.00         0.00
50370     Remove transplanted kidney             C            C          0000        0.0000         0.00         0.00         0.00
50380     Reimplantation of kidney               C            C          0000        0.0000         0.00         0.00         0.00
50382     Change ureter stent, percut            T            T          0161       18.5804        856.56      1,952.99     2,238.57
50384     Remove ureter stent, percut            T            T          0161       18.5804        856.56      1,952.99     2,238.57
50387     Change ext/int ureter stent            T            T          0122        6.9179        318.92       727.14       833.47
50389     Remove renal tube w/fluoro             T            T          0156        2.6123        120.43       274.58       314.73
50390     Drainage of kidney lesion              T            T          0685        6.0034        276.76       631.02       723.29
50391     Instll rx agnt into rnal tub           T            T          0156        2.6123        120.43       274.58       314.73
50392     Insert kidney drain                    T            T          0161       18.5804        856.56      1,952.99     2,238.57
50393     Insert ureteral tube                   T            T          0161       18.5804        856.56      1,952.99     2,238.57
50394     Injection for kidney x-ray             N            N          0000        0.0000         0.00         0.00         0.00
50395     Create passage to kidney               T            T          0161       18.5804        856.56      1,952.99     2,238.57
50396     Measure kidney pressure                T            T          0164        1.1600        53.48        121.93       139.76
50398     Change kidney tube                     T            T          0122        6.9179        318.92       727.14       833.47
50400     Revision of kidney/ureter              C            C          0000        0.0000         0.00         0.00         0.00
50405     Revision of kidney/ureter              C            C          0000        0.0000         0.00         0.00         0.00
50500     Repair of kidney wound                 C            C          0000        0.0000         0.00         0.00         0.00
50520     Close kidney-skin fistula              C            C          0000        0.0000         0.00         0.00         0.00
50525     Repair renal-abdomen fistula           C            C          0000        0.0000         0.00         0.00         0.00
50526     Repair renal-abdomen fistula           C            C          0000        0.0000         0.00         0.00         0.00
50540     Revision of horseshoe kidney           C            C          0000        0.0000         0.00         0.00         0.00
50541     Laparo ablate renal cyst               T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
50542     Laparo ablate renal mass               T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
50543     Laparo partial nephrectomy             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
50544     Laparoscopy, pyeloplasty               T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
50545     Laparo radical nephrectomy             C            C          0000        0.0000         0.00         0.00         0.00
50546     Laparoscopic nephrectomy               C            C          0000        0.0000         0.00         0.00         0.00
50547     Laparo removal donor kidney            C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   53 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
50548     Laparo remove w/ureter                 C            C          0000        0.0000         0.00         0.00         0.00
50549     Laparoscope proc, renal                T            1          0000        0.0000         0.00         0.00         0.00
50551     Kidney endoscopy                       T            T          0160        6.9387        319.87       729.33       835.97
50553     Kidney endoscopy                       T            T          0161       18.5804        856.56      1,952.99     2,238.57
50555     Kidney endoscopy & biopsy              T            T          0160        6.9387        319.87       729.33       835.97
50557     Kidney endoscopy & treatment           T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
50561     Kidney endoscopy & treatment           T            T          0161       18.5804        856.56      1,952.99     2,238.57
50562     Renal scope w/tumor resect             T            T          0160        6.9387        319.87       729.33       835.97
50570     Kidney endoscopy                       T            T          0160        6.9387        319.87       729.33       835.97
50572     Kidney endoscopy                       T            T          0160        6.9387        319.87       729.33       835.97
50574     Kidney endoscopy & biopsy              T            T          0160        6.9387        319.87       729.33       835.97
50575     Kidney endoscopy                       T            T          0163       33.5963       1,548.79     3,531.31     4,047.68
50576     Kidney endoscopy & treatment           T            T          0161       18.5804        856.56      1,952.99     2,238.57
50580     Kidney endoscopy & treatment           C            C          0000        0.0000         0.00         0.00         0.00
50590     Fragmenting of kidney stone            T            T          0169       42.4073       1,954.98     4,457.43     5,109.23
50592     Perc rf ablate renal tumor             T            T          0423       39.5881       1,825.01     4,161.11     4,769.57
50600     Exploration of ureter                  C            C          0000        0.0000         0.00         0.00         0.00
50605     Insert ureteral support                C            C          0000        0.0000         0.00         0.00         0.00
50610     Removal of ureter stone                C            C          0000        0.0000         0.00         0.00         0.00
50620     Removal of ureter stone                C            C          0000        0.0000         0.00         0.00         0.00
50630     Removal of ureter stone                C            C          0000        0.0000         0.00         0.00         0.00
50650     Removal of ureter                      C            C          0000        0.0000         0.00         0.00         0.00
50660     Removal of ureter                      C            C          0000        0.0000         0.00         0.00         0.00
50684     Injection for ureter x-ray             N            N          0000        0.0000         0.00         0.00         0.00
50686     Measure ureter pressure                T            T          0164        1.1600        53.48        121.93       139.76
50688     Change of ureter tube                  T            T          0122        6.9179        318.92       727.14       833.47
50690     Injection for ureter x-ray             N            N          0000        0.0000         0.00         0.00         0.00
50700     Revision of ureter                     C            C          0000        0.0000         0.00         0.00         0.00
50715     Release of ureter                      C            C          0000        0.0000         0.00         0.00         0.00
50722     Release of ureter                      C            C          0000        0.0000         0.00         0.00         0.00
50725     Release/revise ureter                  C            C          0000        0.0000         0.00         0.00         0.00
50727     Revise ureter                          C            C          0000        0.0000         0.00         0.00         0.00
50728     Revise ureter                          C            C          0000        0.0000         0.00         0.00         0.00
50740     Fusion of ureter & kidney              C            C          0000        0.0000         0.00         0.00         0.00
50750     Fusion of ureter & kidney              C            C          0000        0.0000         0.00         0.00         0.00
50760     Fusion of ureters                      C            C          0000        0.0000         0.00         0.00         0.00
50770     Splicing of ureters                    C            C          0000        0.0000         0.00         0.00         0.00
50780     Reimplant ureter in bladder            C            C          0000        0.0000         0.00         0.00         0.00
50782     Reimplant ureter in bladder            C            C          0000        0.0000         0.00         0.00         0.00
50783     Reimplant ureter in bladder            C            C          0000        0.0000         0.00         0.00         0.00
50785     Reimplant ureter in bladder            C            C          0000        0.0000         0.00         0.00         0.00
50800     Implant ureter in bowel                C            C          0000        0.0000         0.00         0.00         0.00
50810     Fusion of ureter & bowel               C            C          0000        0.0000         0.00         0.00         0.00
50815     Urine shunt to intestine               C            C          0000        0.0000         0.00         0.00         0.00
50820     Construct bowel bladder                C            C          0000        0.0000         0.00         0.00         0.00
50825     Construct bowel bladder                C            C          0000        0.0000         0.00         0.00         0.00
50830     Revise urine flow                      C            C          0000        0.0000         0.00         0.00         0.00
50840     Replace ureter by bowel                C            C          0000        0.0000         0.00         0.00         0.00
50845     Appendico-vesicostomy                  C            C          0000        0.0000         0.00         0.00         0.00
50860     Transplant ureter to skin              C            C          0000        0.0000         0.00         0.00         0.00
50900     Repair of ureter                       C            C          0000        0.0000         0.00         0.00         0.00
50920     Closure ureter/skin fistula            C            C          0000        0.0000         0.00         0.00         0.00
50930     Closure ureter/bowel fistula           C            C          0000        0.0000         0.00         0.00         0.00
50940     Release of ureter                      C            C          0000        0.0000         0.00         0.00         0.00
50945     Laparoscopy ureterolithotomy           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
50947     Laparo new ureter/bladder              T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
50948     Laparo new ureter/bladder              T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
50949     Laparoscope proc, ureter               T            1          0000        0.0000         0.00         0.00         0.00
50951     Endoscopy of ureter                    T            T          0160        6.9387        319.87       729.33       835.97
50953     Endoscopy of ureter                    T            T          0160        6.9387        319.87       729.33       835.97
50955     Ureter endoscopy & biopsy              T            T          0161       18.5804        856.56      1,952.99     2,238.57
50957     Ureter endoscopy & treatment           T            T          0161       18.5804        856.56      1,952.99     2,238.57
50961     Ureter endoscopy & treatment           T            T          0161       18.5804        856.56      1,952.99     2,238.57
50970     Ureter endoscopy                       T            T          0160        6.9387        319.87       729.33       835.97
50972     Ureter endoscopy & catheter            T            T          0160        6.9387        319.87       729.33       835.97
50974     Ureter endoscopy & biopsy              T            T          0161       18.5804        856.56      1,952.99     2,238.57
50976     Ureter endoscopy & treatment           T            T          0161       18.5804        856.56      1,952.99     2,238.57
50980     Ureter endoscopy & treatment           T            T          0161       18.5804        856.56      1,952.99     2,238.57
51000     Drainage of bladder                    T            T          0164        1.1600        53.48        121.93       139.76
51005     Drainage of bladder                    T            T          0164        1.1600        53.48        121.93       139.76
51010     Drainage of bladder                    T            T          0165       16.5343        762.23      1,737.92     1,992.05
51020     Incise & treat bladder                 T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
51030     Incise & treat bladder                 T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
51040     Incise & drain bladder                 T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
51045     Incise bladder/drain ureter            T            T          0160        6.9387        319.87       729.33       835.97
51050     Removal of bladder stone               T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
51060     Removal of ureter stone                C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   54 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
51065     Remove ureter calculus                 T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
51080     Drainage of bladder abscess            T            T          0008       16.2953        751.21      1,712.80     1,963.26
51500     Removal of bladder cyst                T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
51520     Removal of bladder lesion              T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
51525     Removal of bladder lesion              C            C          0000        0.0000         0.00         0.00         0.00
51530     Removal of bladder lesion              C            C          0000        0.0000         0.00         0.00         0.00
51535     Repair of ureter lesion                C            C          0000        0.0000         0.00         0.00         0.00
51550     Partial removal of bladder             C            C          0000        0.0000         0.00         0.00         0.00
51555     Partial removal of bladder             C            C          0000        0.0000         0.00         0.00         0.00
51565     Revise bladder & ureter(s)             C            C          0000        0.0000         0.00         0.00         0.00
51570     Removal of bladder                     C            C          0000        0.0000         0.00         0.00         0.00
51575     Removal of bladder & nodes             C            C          0000        0.0000         0.00         0.00         0.00
51580     Remove bladder/revise tract            C            C          0000        0.0000         0.00         0.00         0.00
51585     Removal of bladder & nodes             C            C          0000        0.0000         0.00         0.00         0.00
51590     Remove bladder/revise tract            C            C          0000        0.0000         0.00         0.00         0.00
51595     Remove bladder/revise tract            C            C          0000        0.0000         0.00         0.00         0.00
51596     Remove bladder/create pouch            C            C          0000        0.0000         0.00         0.00         0.00
51597     Removal of pelvic structures           C            C          0000        0.0000         0.00         0.00         0.00
51600     Injection for bladder x-ray            N            N          0000        0.0000         0.00         0.00         0.00
51605     Preparation for bladder xray           N            N          0000        0.0000         0.00         0.00         0.00
51610     Injection for bladder x-ray            N            N          0000        0.0000         0.00         0.00         0.00
51700     Irrigation of bladder                  T            T          0164        1.1600        53.48        121.93       139.76
51701     Insert bladder catheter                X            X          0340        0.6137        28.29        64.51        73.94
51702     Insert temp bladder cath               X            X          0340        0.6137        28.29        64.51        73.94
51703     Insert bladder cath, complex           T            T          0164        1.1600        53.48        121.93       139.76
51705     Change of bladder tube                 T            T          0121        2.2374        103.14       235.17       269.56
51710     Change of bladder tube                 T            T          0122        6.9179        318.92       727.14       833.47
51715     Endoscopic injection/implant           T            T          0168       28.1985       1,299.95     2,963.94     3,397.36
51720     Treatment of bladder lesion            T            T          0156        2.6123        120.43       274.58       314.73
51725     Simple cystometrogram                  T            T          0156        2.6123        120.43       274.58       314.73
51726     Complex cystometrogram                 T            T          0156        2.6123        120.43       274.58       314.73
51736     Urine flow measurement                 T            T          0164        1.1600        53.48        121.93       139.76
51741     Electro-uroflowmetry, first            T            T          0164        1.1600        53.48        121.93       139.76
51772     Urethra pressure profile               T            T          0156        2.6123        120.43       274.58       314.73
51784     Anal/urinary muscle study              T            T          0164        1.1600        53.48        121.93       139.76
51785     Anal/urinary muscle study              T            T          0164        1.1600        53.48        121.93       139.76
51792     Urinary reflex study                   T            T          0164        1.1600        53.48        121.93       139.76
51795     Urine voiding pressure study           T            T          0164        1.1600        53.48        121.93       139.76
51797     Intraabdominal pressure test           T            T          0164        1.1600        53.48        121.93       139.76
51798     Us urine capacity measure              X            X          0340        0.6137        28.29        64.51        73.94
51800     Revision of bladder/urethra            C            C          0000        0.0000         0.00         0.00         0.00
51820     Revision of urinary tract              C            C          0000        0.0000         0.00         0.00         0.00
51840     Attach bladder/urethra                 C            C          0000        0.0000         0.00         0.00         0.00
51841     Attach bladder/urethra                 C            C          0000        0.0000         0.00         0.00         0.00
51845     Repair bladder neck                    C            C          0000        0.0000         0.00         0.00         0.00
51860     Repair of bladder wound                C            C          0000        0.0000         0.00         0.00         0.00
51865     Repair of bladder wound                C            C          0000        0.0000         0.00         0.00         0.00
51880     Repair of bladder opening              T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
51900     Repair bladder/vagina lesion           C            C          0000        0.0000         0.00         0.00         0.00
51920     Close bladder-uterus fistula           C            C          0000        0.0000         0.00         0.00         0.00
51925     Hysterectomy/bladder repair            C            C          0000        0.0000         0.00         0.00         0.00
51940     Correction of bladder defect           C            C          0000        0.0000         0.00         0.00         0.00
51960     Revision of bladder & bowel            C            C          0000        0.0000         0.00         0.00         0.00
51980     Construct bladder opening              C            C          0000        0.0000         0.00         0.00         0.00
51990     Laparo urethral suspension             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
51992     Laparo sling operation                 T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
51999     Laparoscope proc, bladder              T            1          0000        0.0000         0.00         0.00         0.00
52000     Cystoscopy                             T            T          0160        6.9387        319.87       729.33       835.97
52001     Cystoscopy, removal of clots           T            T          0160        6.9387        319.87       729.33       835.97
52005     Cystoscopy & ureter catheter           T            T          0161       18.5804        856.56      1,952.99     2,238.57
52007     Cystoscopy and biopsy                  T            T          0161       18.5804        856.56      1,952.99     2,238.57
52010     Cystoscopy & duct catheter             T            T          0160        6.9387        319.87       729.33       835.97
52204     Cystoscopy                             T            T          0161       18.5804        856.56      1,952.99     2,238.57
52214     Cystoscopy and treatment               T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
52224     Cystoscopy and treatment               T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
52234     Cystoscopy and treatment               T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
52235     Cystoscopy and treatment               T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
52240     Cystoscopy and treatment               T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
52250     Cystoscopy and radiotracer             T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
52260     Cystoscopy and treatment               T            T          0161       18.5804        856.56      1,952.99     2,238.57
52265     Cystoscopy and treatment               T            T          0160        6.9387        319.87       729.33       835.97
52270     Cystoscopy & revise urethra            T            T          0161       18.5804        856.56      1,952.99     2,238.57
52275     Cystoscopy & revise urethra            T            T          0161       18.5804        856.56      1,952.99     2,238.57
52276     Cystoscopy and treatment               T            T          0161       18.5804        856.56      1,952.99     2,238.57
52277     Cystoscopy and treatment               T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
52281     Cystoscopy and treatment               T            T          0161       18.5804        856.56      1,952.99     2,238.57
52282     Cystoscopy, implant stent              T            T          0163       33.5963       1,548.79     3,531.31     4,047.68

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   55 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
52283     Cystoscopy and treatment               T            T          0161      18.5804         856.56      1,952.99     2,238.57
52285     Cystoscopy and treatment               T            T          0161      18.5804         856.56      1,952.99     2,238.57
52290     Cystoscopy and treatment               T            T          0161      18.5804         856.56      1,952.99     2,238.57
52300     Cystoscopy and treatment               T            T          0161      18.5804         856.56      1,952.99     2,238.57
52301     Cystoscopy and treatment               T            T          0161      18.5804         856.56      1,952.99     2,238.57
52305     Cystoscopy and treatment               T            T          0161      18.5804         856.56      1,952.99     2,238.57
52310     Cystoscopy and treatment               T            T          0160       6.9387         319.87       729.33       835.97
52315     Cystoscopy and treatment               T            T          0161      18.5804         856.56      1,952.99     2,238.57
52317     Remove bladder stone                   T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52318     Remove bladder stone                   T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52320     Cystoscopy and treatment               T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52325     Cystoscopy, stone removal              T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52327     Cystoscopy, inject material            T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52330     Cystoscopy and treatment               T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52332     Cystoscopy and treatment               T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52334     Create passage to kidney               T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52341     Cysto w/ureter stricture tx            T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52342     Cysto w/up stricture tx                T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52343     Cysto w/renal stricture tx             T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52344     Cysto/uretero, stricture tx            T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52345     Cysto/uretero w/up stricture           T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52346     Cystouretero w/renal strict            T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52351     Cystouretero & or pyeloscope           T            T          0161      18.5804         856.56      1,952.99     2,238.57
52352     Cystouretero w/stone remove            T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52353     Cystouretero w/lithotripsy             T            T          0163      33.5963        1,548.79     3,531.31     4,047.68
52354     Cystouretero w/biopsy                  T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52355     Cystouretero w/excise tumor            T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52400     Cystouretero w/congen repr             T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52402     Cystourethro cut ejacul duct           T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52450     Incision of prostate                   T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52500     Revision of bladder neck               T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52510     Dilation prostatic urethra             T            T          0161      18.5804         856.56      1,952.99     2,238.57
52601     Prostatectomy (TURP)                   T            T          0163      33.5963        1,548.79     3,531.31     4,047.68
52606     Control postop bleeding                T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52612     Prostatectomy, first stage             T            T          0163      33.5963        1,548.79     3,531.31     4,047.68
52614     Prostatectomy, second stage            T            T          0163      33.5963        1,548.79     3,531.31     4,047.68
52620     Remove residual prostate               T            T          0163      33.5963        1,548.79     3,531.31     4,047.68
52630     Remove prostate regrowth               T            T          0163      33.5963        1,548.79     3,531.31     4,047.68
52640     Relieve bladder contracture            T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
52647     Laser surgery of prostate              T            T          0429      42.0802        1,939.90     4,423.05     5,069.82
52648     Laser surgery of prostate              T            T          0429      42.0802        1,939.90     4,423.05     5,069.82
52700     Drainage of prostate abscess           T            T          0162      23.3383        1,075.90     2,453.09     2,811.80
53000     Incision of urethra                    T            T          0166      17.7635         818.90      1,867.12     2,140.15
53010     Incision of urethra                    T            T          0166      17.7635         818.90      1,867.12     2,140.15
53020     Incision of urethra                    T            T          0166      17.7635         818.90      1,867.12     2,140.15
53025     Incision of urethra                    T            T          0166      17.7635         818.90      1,867.12     2,140.15
53040     Drainage of urethra abscess            T            T          0166      17.7635         818.90      1,867.12     2,140.15
53060     Drainage of urethra abscess            T            T          0166      17.7635         818.90      1,867.12     2,140.15
53080     Drainage of urinary leakage            T            T          0166      17.7635         818.90      1,867.12     2,140.15
53085     Drainage of urinary leakage            T            T          0166      17.7635         818.90      1,867.12     2,140.15
53200     Biopsy of urethra                      T            T          0166      17.7635         818.90      1,867.12     2,140.15
53210     Removal of urethra                     T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53215     Removal of urethra                     T            T          0166      17.7635         818.90      1,867.12     2,140.15
53220     Treatment of urethra lesion            T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53230     Removal of urethra lesion              T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53235     Removal of urethra lesion              T            T          0166      17.7635         818.90      1,867.12     2,140.15
53240     Surgery for urethra pouch              T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53250     Removal of urethra gland               T            T          0166      17.7635         818.90      1,867.12     2,140.15
53260     Treatment of urethra lesion            T            T          0166      17.7635         818.90      1,867.12     2,140.15
53265     Treatment of urethra lesion            T            T          0166      17.7635         818.90      1,867.12     2,140.15
53270     Removal of urethra gland               T            T          0166      17.7635         818.90      1,867.12     2,140.15
53275     Repair of urethra defect               T            T          0166      17.7635         818.90      1,867.12     2,140.15
53400     Revise urethra, stage 1                T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53405     Revise urethra, stage 2                T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53410     Reconstruction of urethra              T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53415     Reconstruction of urethra              C            C          0000       0.0000          0.00         0.00         0.00
53420     Reconstruct urethra, stage 1           T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53425     Reconstruct urethra, stage 2           T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53430     Reconstruction of urethra              T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53431     Reconstruct urethra/bladder            T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53440     Male sling procedure                   S            S          0385      73.7498        3,399.87     7,751.84     8,885.38
53442     Remove/revise male sling               T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53444     Insert tandem cuff                     S            S          0385      73.7498        3,399.87     7,751.84     8,885.38
53445     Insert uro/ves nck sphincter           S            S          0386      126.9292       5,851.44    13,341.53    15,292.43
53446     Remove uro sphincter                   T            T          0168      28.1985        1,299.95     2,963.94     3,397.36
53447     Remove/replace ur sphincter            S            S          0386      126.9292       5,851.44    13,341.53    15,292.43
53448     Remov/replc ur sphinctr comp           C            C          0000       0.0000          0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   56 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
53449     Repair uro sphincter                   T            T          0168       28.1985       1,299.95     2,963.94     3,397.36
53450     Revision of urethra                    T            T          0168       28.1985       1,299.95     2,963.94     3,397.36
53460     Revision of urethra                    T            T          0166       17.7635        818.90      1,867.12     2,140.15
53500     Urethrlys, transvag w/ scope           T            T          0168       28.1985       1,299.95     2,963.94     3,397.36
53502     Repair of urethra injury               T            T          0166       17.7635        818.90      1,867.12     2,140.15
53505     Repair of urethra injury               T            T          0168       28.1985       1,299.95     2,963.94     3,397.36
53510     Repair of urethra injury               T            T          0166       17.7635        818.90      1,867.12     2,140.15
53515     Repair of urethra injury               T            T          0168       28.1985       1,299.95     2,963.94     3,397.36
53520     Repair of urethra defect               T            T          0168       28.1985       1,299.95     2,963.94     3,397.36
53600     Dilate urethra stricture               T            T          0156        2.6123        120.43       274.58       314.73
53601     Dilate urethra stricture               T            T          0164        1.1600        53.48        121.93       139.76
53605     Dilate urethra stricture               T            T          0161       18.5804        856.56      1,952.99     2,238.57
53620     Dilate urethra stricture               T            T          0165       16.5343        762.23      1,737.92     1,992.05
53621     Dilate urethra stricture               T            T          0164        1.1600        53.48        121.93       139.76
53660     Dilation of urethra                    T            T          0164        1.1600        53.48        121.93       139.76
53661     Dilation of urethra                    T            T          0164        1.1600        53.48        121.93       139.76
53665     Dilation of urethra                    T            T          0166       17.7635        818.90      1,867.12     2,140.15
53850     Prostatic microwave thermotx           T            T          0675       44.8197       2,066.19     4,711.00     5,399.88
53852     Prostatic rf thermotx                  T            T          0675       44.8197       2,066.19     4,711.00     5,399.88
53853     Prostatic water thermother             T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
53899     Urology surgery procedure              T            1          0000        0.0000         0.00         0.00         0.00
54000     Slitting of prepuce                    T            T          0166       17.7635        818.90      1,867.12     2,140.15
54001     Slitting of prepuce                    T            T          0166       17.7635        818.90      1,867.12     2,140.15
54015     Drain penis lesion                     T            T          0008       16.2953        751.21      1,712.80     1,963.26
54050     Destruction, penis lesion(s)           T            T          0013        1.0603        48.88        111.45       127.74
54055     Destruction, penis lesion(s)           T            T          0017       17.9937        829.51      1,891.32     2,167.88
54056     Cryosurgery, penis lesion(s)           T            T          0012        0.8477        39.08        89.10        102.13
54057     Laser surg, penis lesion(s)            T            T          0017       17.9937        829.51      1,891.32     2,167.88
54060     Excision of penis lesion(s)            T            T          0017       17.9937        829.51      1,891.32     2,167.88
54065     Destruction, penis lesion(s)           T            T          0695       20.2372        932.93      2,127.13     2,438.18
54100     Biopsy of penis                        T            T          0021       14.9984        691.43      1,576.48     1,807.01
54105     Biopsy of penis                        T            T          0022       19.5716        902.25      2,057.17     2,357.99
54110     Treatment of penis lesion              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54111     Treat penis lesion, graft              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54112     Treat penis lesion, graft              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54115     Treatment of penis lesion              T            T          0008       16.2953        751.21      1,712.80     1,963.26
54120     Partial removal of penis               T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54125     Removal of penis                       C            C          0000        0.0000         0.00         0.00         0.00
54130     Remove penis & nodes                   C            C          0000        0.0000         0.00         0.00         0.00
54135     Remove penis & nodes                   C            C          0000        0.0000         0.00         0.00         0.00
54150     Circumcision                           T            T          0180       19.7721        911.49      2,078.25     2,382.14
54152     Circumcision                           T            1          0180       19.7721         0.00         0.00         0.00          X
54160     Circumcision                           T            T          0180       19.7721        911.49      2,078.25     2,382.14
54161     Circumcision                           T            T          0180       19.7721        911.49      2,078.25     2,382.14
54162     Lysis penil circumic lesion            T            T          0180       19.7721        911.49      2,078.25     2,382.14
54163     Repair of circumcision                 T            T          0180       19.7721        911.49      2,078.25     2,382.14
54164     Frenulotomy of penis                   T            T          0180       19.7721        911.49      2,078.25     2,382.14
54200     Treatment of penis lesion              T            T          0156        2.6123        120.43       274.58       314.73
54205     Treatment of penis lesion              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54220     Treatment of penis lesion              T            T          0156        2.6123        120.43       274.58       314.73
54230     Prepare penis study                    N            N          0000        0.0000         0.00         0.00         0.00
54231     Dynamic cavernosometry                 T            T          0165       16.5343        762.23      1,737.92     1,992.05
54235     Penile injection                       T            T          0164        1.1600        53.48        121.93       139.76
54240     Penis study                            T            1          0000        0.0000         0.00         0.00         0.00
54250     Penis study                            T            1          0000        0.0000         0.00         0.00         0.00
54300     Revision of penis                      T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54304     Revision of penis                      T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54308     Reconstruction of urethra              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54312     Reconstruction of urethra              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54316     Reconstruction of urethra              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54318     Reconstruction of urethra              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54322     Reconstruction of urethra              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54324     Reconstruction of urethra              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54326     Reconstruction of urethra              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54328     Revise penis/urethra                   T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54332     Revise penis/urethra                   C            C          0000        0.0000         0.00         0.00         0.00
54336     Revise penis/urethra                   C            C          0000        0.0000         0.00         0.00         0.00
54340     Secondary urethral surgery             T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54344     Secondary urethral surgery             T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54348     Secondary urethral surgery             T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54352     Reconstruct urethra/penis              T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54360     Penis plastic surgery                  T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54380     Repair penis                           T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54385     Repair penis                           T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54390     Repair penis and bladder               C            C          0000        0.0000         0.00         0.00         0.00
54400     Insert semi-rigid prosthesis           S            1          0000        0.0000         0.00         0.00         0.00
54401     Insert self-contd prosthesis           S            1          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   57 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
54405     Insert multi-comp penis pros           S            1          0000        0.0000         0.00         0.00         0.00
54406     Remove muti-comp penis pros            T            1          0000        0.0000         0.00         0.00         0.00
54408     Repair multi-comp penis pros           T            1          0000        0.0000         0.00         0.00         0.00
54410     Remove/replace penis prosth            S            1          0000        0.0000         0.00         0.00         0.00
54411     Remov/replc penis pros, comp           C            1          0000        0.0000         0.00         0.00         0.00
54415     Remove self-contd penis pros           T            1          0000        0.0000         0.00         0.00         0.00
54416     Remv/repl penis contain pros           S            1          0000        0.0000         0.00         0.00         0.00
54417     Remv/replc penis pros, compl           C            1          0000        0.0000         0.00         0.00         0.00
54420     Revision of penis                      T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54430     Revision of penis                      C            C          0000        0.0000         0.00         0.00         0.00
54435     Revision of penis                      T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54440     Repair of penis                        T            T          0181       30.9472       1,426.67     3,252.86     3,728.52
54450     Preputial stretching                   T            T          0156        2.6123        120.43       274.58       314.73
54500     Biopsy of testis                       T            T          0037        9.6103        443.03      1,010.14     1,157.85
54505     Biopsy of testis                       T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54512     Excise lesion testis                   T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54520     Removal of testis                      T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54522     Orchiectomy, partial                   T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54530     Removal of testis                      T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
54535     Extensive testis surgery               C            C          0000        0.0000         0.00         0.00         0.00
54550     Exploration for testis                 T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
54560     Exploration for testis                 T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54600     Reduce testis torsion                  T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54620     Suspension of testis                   T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54640     Suspension of testis                   T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
54650     Orchiopexy (Fowler-Stephens)           C            C          0000        0.0000         0.00         0.00         0.00
54660     Revision of testis                     T            1          0000        0.0000         0.00         0.00         0.00
54670     Repair testis injury                   T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54680     Relocation of testis(es)               T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54690     Laparoscopy, orchiectomy               T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
54692     Laparoscopy, orchiopexy                T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
54699     Laparoscope proc, testis               T            1          0000        0.0000         0.00         0.00         0.00
54700     Drainage of scrotum                    T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54800     Biopsy of epididymis                   T            T          0004        1.7771        81.92        186.79       214.11
54820     Exploration of epididymis              T            1          0183       23.3500         0.00         0.00         0.00          X
54830     Remove epididymis lesion               T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54840     Remove epididymis lesion               T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54860     Removal of epididymis                  T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54861     Removal of epididymis                  T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54900     Fusion of spermatic ducts              T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
54901     Fusion of spermatic ducts              T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55000     Drainage of hydrocele                  T            T          0004        1.7771        81.92        186.79       214.11
55040     Removal of hydrocele                   T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
55041     Removal of hydroceles                  T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
55060     Repair of hydrocele                    T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55100     Drainage of scrotum abscess            T            T          0008       16.2953        751.21      1,712.80     1,963.26
55110     Explore scrotum                        T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55120     Removal of scrotum lesion              T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55150     Removal of scrotum                     T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55175     Revision of scrotum                    T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55180     Revision of scrotum                    T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55200     Incision of sperm duct                 T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55250     Removal of sperm duct(s)               T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55300     Prepare, sperm duct x-ray              N            N          0000        0.0000         0.00         0.00         0.00
55400     Repair of sperm duct                   T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55450     Ligation of sperm duct                 T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55500     Removal of hydrocele                   T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55520     Removal of sperm cord lesion           T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55530     Revise spermatic cord veins            T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55535     Revise spermatic cord veins            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
55540     Revise hernia & sperm veins            T            T          0154       28.6432       1,320.45     3,010.69     3,450.93
55550     Laparo ligate spermatic vein           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
55559     Laparo proc, spermatic cord            T            1          0000        0.0000         0.00         0.00         0.00
55600     Incise sperm duct pouch                T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55605     Incise sperm duct pouch                C            C          0000        0.0000         0.00         0.00         0.00
55650     Remove sperm duct pouch                C            C          0000        0.0000         0.00         0.00         0.00
55680     Remove sperm pouch lesion              T            T          0183       23.3500       1,076.44     2,454.32     2,813.21
55700     Biopsy of prostate                     T            T          0184        4.4432        204.83       467.02       535.32
55705     Biopsy of prostate                     T            T          0184        4.4432        204.83       467.02       535.32
55720     Drainage of prostate abscess           T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
55725     Drainage of prostate abscess           T            T          0162       23.3383       1,075.90     2,453.09     2,811.80
55801     Removal of prostate                    C            C          0000        0.0000         0.00         0.00         0.00
55810     Extensive prostate surgery             C            C          0000        0.0000         0.00         0.00         0.00
55812     Extensive prostate surgery             C            C          0000        0.0000         0.00         0.00         0.00
55815     Extensive prostate surgery             C            C          0000        0.0000         0.00         0.00         0.00
55821     Removal of prostate                    C            C          0000        0.0000         0.00         0.00         0.00
55831     Removal of prostate                    C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   58 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
55840     Extensive prostate surgery             C            C          0000       0.0000          0.00         0.00         0.00
55842     Extensive prostate surgery             C            C          0000       0.0000          0.00         0.00         0.00
55845     Extensive prostate surgery             C            C          0000       0.0000          0.00         0.00         0.00
55859     Percut/needle insert, pros             T            1          0163      33.5963          0.00         0.00         0.00          X
55860     Surgical exposure, prostate            T            T          0165      16.5343         762.23      1,737.92     1,992.05
55862     Extensive prostate surgery             C            C          0000       0.0000          0.00         0.00         0.00
55865     Extensive prostate surgery             C            C          0000       0.0000          0.00         0.00         0.00
55866     Laparo radical prostatectomy           C            C          0000       0.0000          0.00         0.00         0.00
55870     Electroejaculation                     T            1          0000       0.0000          0.00         0.00         0.00
55873     Cryoablate prostate                    T            T          0674      111.3747       5,134.37    11,706.59    13,418.42
55899     Genital surgery procedure              T            1          0000       0.0000          0.00         0.00         0.00
55970     Sex transformation, M to F             E            1          0000       0.0000          0.00         0.00         0.00
55980     Sex transformation, F to M             E            1          0000       0.0000          0.00         0.00         0.00
56405     I & D of vulva/perineum                T            T          0189       2.3805         109.74       250.21       286.80
56420     Drainage of gland abscess              T            T          0189       2.3805         109.74       250.21       286.80
56440     Surgery for vulva lesion               T            T          0194      20.6573         952.30      2,171.29     2,488.79
56441     Lysis of labial lesion(s)              T            T          0193      14.6385         674.83      1,538.65     1,763.65
56501     Destroy, vulva lesions, sim            T            T          0017      17.9937         829.51      1,891.32     2,167.88
56515     Destroy vulva lesion/s compl           T            T          0695      20.2372         932.93      2,127.13     2,438.18
56605     Biopsy of vulva/perineum               T            T          0019       4.1481         191.23       436.01       499.76
56606     Biopsy of vulva/perineum               T            T          0019       4.1481         191.23       436.01       499.76
56620     Partial removal of vulva               T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
56625     Complete removal of vulva              T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
56630     Extensive vulva surgery                C            C          0000       0.0000          0.00         0.00         0.00
56631     Extensive vulva surgery                C            C          0000       0.0000          0.00         0.00         0.00
56632     Extensive vulva surgery                C            C          0000       0.0000          0.00         0.00         0.00
56633     Extensive vulva surgery                C            C          0000       0.0000          0.00         0.00         0.00
56634     Extensive vulva surgery                C            C          0000       0.0000          0.00         0.00         0.00
56637     Extensive vulva surgery                C            C          0000       0.0000          0.00         0.00         0.00
56640     Extensive vulva surgery                C            C          0000       0.0000          0.00         0.00         0.00
56700     Partial removal of hymen               T            T          0194      20.6573         952.30      2,171.29     2,488.79
56720     Incision of hymen                      T            1          0193      14.6385          0.00         0.00         0.00          X
56740     Remove vagina gland lesion             T            T          0194      20.6573         952.30      2,171.29     2,488.79
56800     Repair of vagina                       T            T          0194      20.6573         952.30      2,171.29     2,488.79
56805     Repair clitoris                        T            T          0193      14.6385         674.83      1,538.65     1,763.65
56810     Repair of perineum                     T            T          0194      20.6573         952.30      2,171.29     2,488.79
56820     Exam of vulva w/scope                  T            T          0188       1.2615         58.16        132.60       151.99
56821     Exam/biopsy of vulva w/scope           T            T          0189       2.3805         109.74       250.21       286.80
57000     Exploration of vagina                  T            T          0193      14.6385         674.83      1,538.65     1,763.65
57010     Drainage of pelvic abscess             T            T          0193      14.6385         674.83      1,538.65     1,763.65
57020     Drainage of pelvic fluid               T            T          0192       4.1597         191.76       437.23       501.16
57022     I & d vaginal hematoma, pp             T            T          0007      11.6717         538.07      1,226.81     1,406.21
57023     I & d vag hematoma, non-ob             T            T          0008      16.2953         751.21      1,712.80     1,963.26
57061     Destroy vag lesions, simple            T            T          0194      20.6573         952.30      2,171.29     2,488.79
57065     Destroy vag lesions, complex           T            T          0194      20.6573         952.30      2,171.29     2,488.79
57100     Biopsy of vagina                       T            T          0192       4.1597         191.76       437.23       501.16
57105     Biopsy of vagina                       T            T          0194      20.6573         952.30      2,171.29     2,488.79
57106     Remove vagina wall, partial            T            T          0194      20.6573         952.30      2,171.29     2,488.79
57107     Remove vagina tissue, part             T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57109     Vaginectomy partial w/nodes            T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57110     Remove vagina wall, complete           C            C          0000       0.0000          0.00         0.00         0.00
57111     Remove vagina tissue, compl            C            C          0000       0.0000          0.00         0.00         0.00
57112     Vaginectomy w/nodes, compl             C            C          0000       0.0000          0.00         0.00         0.00
57120     Closure of vagina                      T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57130     Remove vagina lesion                   T            T          0194      20.6573         952.30      2,171.29     2,488.79
57135     Remove vagina lesion                   T            T          0194      20.6573         952.30      2,171.29     2,488.79
57150     Treat vagina infection                 T            T          0191       0.1702          7.85        17.89        20.51
57155     Insert uteri tandems/ovoids            T            T          0192       4.1597         191.76       437.23       501.16
57160     Insert pessary/other device            T            T          0188       1.2615         58.16        132.60       151.99
57170     Fitting of diaphragm/cap               T            T          0191       0.1702          7.85        17.89        20.51
57180     Treat vaginal bleeding                 T            T          0189       2.3805         109.74       250.21       286.80
57200     Repair of vagina                       T            T          0194      20.6573         952.30      2,171.29     2,488.79
57210     Repair vagina/perineum                 T            T          0194      20.6573         952.30      2,171.29     2,488.79
57220     Revision of urethra                    T            T          0202      41.2319        1,900.79     4,333.89     4,967.62
57230     Repair of urethral lesion              T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57240     Repair bladder & vagina                T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57250     Repair rectum & vagina                 T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57260     Repair of vagina                       T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57265     Extensive repair of vagina             T            T          0202      41.2319        1,900.79     4,333.89     4,967.62
57267     Insert mesh/pelvic flr addon           T            T          0154      28.6432        1,320.45     3,010.69     3,450.93
57268     Repair of bowel bulge                  T            T          0195      26.7972        1,235.35     2,816.65     3,228.53
57270     Repair of bowel pouch                  C            C          0000       0.0000          0.00         0.00         0.00
57280     Suspension of vagina                   C            C          0000       0.0000          0.00         0.00         0.00
57282     Colpopexy, extraperitoneal             C            C          0000       0.0000          0.00         0.00         0.00
57283     Colpopexy, intraperitoneal             C            C          0000       0.0000          0.00         0.00         0.00
57284     Repair paravaginal defect              T            T          0202      41.2319        1,900.79     4,333.89     4,967.62
57287     Revise/remove sling repair             T            T          0202      41.2319        1,900.79     4,333.89     4,967.62

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   59 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
57288     Repair bladder defect                  T            T          0202       41.2319       1,900.79     4,333.89     4,967.62
57289     Repair bladder & vagina                T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57291     Construction of vagina                 T            1          0000        0.0000         0.00         0.00         0.00
57292     Construct vagina with graft            C            1          0000        0.0000         0.00         0.00         0.00
57295     Change vaginal graft                   T            1          0000        0.0000         0.00         0.00         0.00
57300     Repair rectum-vagina fistula           T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57305     Repair rectum-vagina fistula           C            C          0000        0.0000         0.00         0.00         0.00
57307     Fistula repair & colostomy             C            C          0000        0.0000         0.00         0.00         0.00
57308     Fistula repair, transperine            C            C          0000        0.0000         0.00         0.00         0.00
57310     Repair urethrovaginal lesion           T            T          0202       41.2319       1,900.79     4,333.89     4,967.62
57311     Repair urethrovaginal lesion           C            C          0000        0.0000         0.00         0.00         0.00
57320     Repair bladder-vagina lesion           T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57330     Repair bladder-vagina lesion           T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57335     Repair vagina                          C            C          0000        0.0000         0.00         0.00         0.00
57400     Dilation of vagina                     T            T          0194       20.6573        952.30      2,171.29     2,488.79
57410     Pelvic examination                     T            T          0193       14.6385        674.83      1,538.65     1,763.65
57415     Remove vaginal foreign body            T            T          0194       20.6573        952.30      2,171.29     2,488.79
57420     Exam of vagina w/scope                 T            T          0189        2.3805        109.74       250.21       286.80
57421     Exam/biopsy of vag w/scope             T            T          0189        2.3805        109.74       250.21       286.80
57425     Laparoscopy, surg, colpopexy           T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
57452     Exam of cervix w/scope                 T            T          0189        2.3805        109.74       250.21       286.80
57454     Bx/curett of cervix w/scope            T            T          0189        2.3805        109.74       250.21       286.80
57455     Biopsy of cervix w/scope               T            T          0189        2.3805        109.74       250.21       286.80
57456     Endocerv curettage w/scope             T            T          0189        2.3805        109.74       250.21       286.80
57460     Bx of cervix w/scope, leep             T            T          0193       14.6385        674.83      1,538.65     1,763.65
57461     Conz of cervix w/scope, leep           T            T          0194       20.6573        952.30      2,171.29     2,488.79
57500     Biopsy of cervix                       T            T          0192        4.1597        191.76       437.23       501.16
57505     Endocervical curettage                 T            T          0189        2.3805        109.74       250.21       286.80
57510     Cauterization of cervix                T            T          0193       14.6385        674.83      1,538.65     1,763.65
57511     Cryocautery of cervix                  T            T          0189        2.3805        109.74       250.21       286.80
57513     Laser surgery of cervix                T            T          0193       14.6385        674.83      1,538.65     1,763.65
57520     Conization of cervix                   T            T          0194       20.6573        952.30      2,171.29     2,488.79
57522     Conization of cervix                   T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57530     Removal of cervix                      T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57531     Removal of cervix, radical             C            C          0000        0.0000         0.00         0.00         0.00
57540     Removal of residual cervix             C            C          0000        0.0000         0.00         0.00         0.00
57545     Remove cervix/repair pelvis            C            C          0000        0.0000         0.00         0.00         0.00
57550     Removal of residual cervix             T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57555     Remove cervix/repair vagina            T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
57556     Remove cervix, repair bowel            T            T          0202       41.2319       1,900.79     4,333.89     4,967.62
57700     Revision of cervix                     T            T          0194       20.6573        952.30      2,171.29     2,488.79
57720     Revision of cervix                     T            T          0194       20.6573        952.30      2,171.29     2,488.79
57800     Dilation of cervical canal             T            T          0193       14.6385        674.83      1,538.65     1,763.65
57820     D & c of residual cervix               T            1          0196       17.0012         0.00         0.00         0.00          X
58100     Biopsy of uterus lining                T            T          0188        1.2615        58.16        132.60       151.99
58110     Bx done w/colposcopy add-on            T            T          0188        1.2615        58.16        132.60       151.99
58120     Dilation and curettage                 T            T          0196       17.0012        783.76      1,787.00     2,048.30
58140     Myomectomy abdom method                C            C          0000        0.0000         0.00         0.00         0.00
58145     Myomectomy vag method                  T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
58146     Myomectomy abdom complex               C            C          0000        0.0000         0.00         0.00         0.00
58150     Total hysterectomy                     C            C          0000        0.0000         0.00         0.00         0.00
58152     Total hysterectomy                     C            C          0000        0.0000         0.00         0.00         0.00
58180     Partial hysterectomy                   C            C          0000        0.0000         0.00         0.00         0.00
58200     Extensive hysterectomy                 C            C          0000        0.0000         0.00         0.00         0.00
58210     Extensive hysterectomy                 C            C          0000        0.0000         0.00         0.00         0.00
58240     Removal of pelvis contents             C            C          0000        0.0000         0.00         0.00         0.00
58260     Vaginal hysterectomy                   C            C          0000        0.0000         0.00         0.00         0.00
58262     Vag hyst including t/o                 C            C          0000        0.0000         0.00         0.00         0.00
58263     Vag hyst w/t/o & vag repair            C            C          0000        0.0000         0.00         0.00         0.00
58267     Vag hyst w/urinary repair              C            C          0000        0.0000         0.00         0.00         0.00
58270     Vag hyst w/enterocele repair           C            C          0000        0.0000         0.00         0.00         0.00
58275     Hysterectomy/revise vagina             C            C          0000        0.0000         0.00         0.00         0.00
58280     Hysterectomy/revise vagina             C            C          0000        0.0000         0.00         0.00         0.00
58285     Extensive hysterectomy                 C            C          0000        0.0000         0.00         0.00         0.00
58290     Vag hyst complex                       C            C          0000        0.0000         0.00         0.00         0.00
58291     Vag hyst incl t/o, complex             C            C          0000        0.0000         0.00         0.00         0.00
58292     Vag hyst t/o & repair, compl           C            C          0000        0.0000         0.00         0.00         0.00
58293     Vag hyst w/uro repair, compl           C            C          0000        0.0000         0.00         0.00         0.00
58294     Vag hyst w/enterocele, compl           C            C          0000        0.0000         0.00         0.00         0.00
58300     Insert intrauterine device             E            3          0000        0.0000         M01          M01          M01
58301     Remove intrauterine device             T            T          0189        2.3805        109.74       250.21       286.80
58321     Artificial insemination                T            1          0000        0.0000         0.00         0.00         0.00
58322     Artificial insemination                T            1          0000        0.0000         0.00         0.00         0.00
58323     Sperm washing                          T            1          0000        0.0000         0.00         0.00         0.00
58340     Catheter for hysterography             N            1          0000        0.0000         0.00         0.00         0.00
58345     Reopen fallopian tube                  T            1          0000        0.0000         0.00         0.00         0.00
58346     Insert heyman uteri capsule            T            1          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   60 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
58350     Reopen fallopian tube                  T            1          0000        0.0000         0.00         0.00         0.00
58353     Endometr ablate, thermal               T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
58356     Endometrial cryoablation               T            T          0202       41.2319       1,900.79     4,333.89     4,967.62
58400     Suspension of uterus                   C            C          0000        0.0000         0.00         0.00         0.00
58410     Suspension of uterus                   C            C          0000        0.0000         0.00         0.00         0.00
58520     Repair of ruptured uterus              C            C          0000        0.0000         0.00         0.00         0.00
58540     Revision of uterus                     C            C          0000        0.0000         0.00         0.00         0.00
58545     Laparoscopic myomectomy                T            T          0130       31.8753       1,469.45     3,350.41     3,840.34
58546     Laparo-myomectomy, complex             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58550     Laparo-asst vag hysterectomy           T            T          0132       63.6859       2,935.92     6,694.02     7,672.88
58552     Laparo-vag hyst incl t/o               T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58553     Laparo-vag hyst, complex               T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58554     Laparo-vag hyst w/t/o, compl           T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58555     Hysteroscopy, dx, sep proc             T            T          0190       20.9198        964.40      2,198.88     2,520.42
58558     Hysteroscopy, biopsy                   T            T          0190       20.9198        964.40      2,198.88     2,520.42
58559     Hysteroscopy, lysis                    T            T          0190       20.9198        964.40      2,198.88     2,520.42
58560     Hysteroscopy, resect septum            T            T          0387       32.3170       1,489.81     3,396.84     3,893.55
58561     Hysteroscopy, remove myoma             T            T          0387       32.3170       1,489.81     3,396.84     3,893.55
58562     Hysteroscopy, remove fb                T            T          0190       20.9198        964.40      2,198.88     2,520.42
58563     Hysteroscopy, ablation                 T            T          0387       32.3170       1,489.81     3,396.84     3,893.55
58565     Hysteroscopy, sterilization            T            T          0202       41.2319       1,900.79     4,333.89     4,967.62
58578     Laparo proc, uterus                    T            1          0000        0.0000         0.00         0.00         0.00
58579     Hysteroscope procedure                 T            1          0000        0.0000         0.00         0.00         0.00
58600     Division of fallopian tube             T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
58605     Division of fallopian tube             C            C          0000        0.0000         0.00         0.00         0.00
58611     Ligate oviduct(s) add-on               C            C          0000        0.0000         0.00         0.00         0.00
58615     Occlude fallopian tube(s)              T            T          0194       20.6573        952.30      2,171.29     2,488.79
58660     Laparoscopy, lysis                     T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58661     Laparoscopy, remove adnexa             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58662     Laparoscopy, excise lesions            T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58670     Laparoscopy, tubal cautery             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58671     Laparoscopy, tubal block               T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58672     Laparoscopy, fimbrioplasty             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58673     Laparoscopy, salpingostomy             T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
58679     Laparo proc, oviduct-ovary             T            1          0000        0.0000         0.00         0.00         0.00
58700     Removal of fallopian tube              C            C          0000        0.0000         0.00         0.00         0.00
58720     Removal of ovary/tube(s)               C            C          0000        0.0000         0.00         0.00         0.00
58740     Revise fallopian tube(s)               C            C          0000        0.0000         0.00         0.00         0.00
58750     Repair oviduct                         C            1          0000        0.0000         0.00         0.00         0.00
58752     Revise ovarian tube(s)                 C            1          0000        0.0000         0.00         0.00         0.00
58760     Remove tubal obstruction               C            1          0000        0.0000         0.00         0.00         0.00
58770     Create new tubal opening               T            1          0000        0.0000         0.00         0.00         0.00
58800     Drainage of ovarian cyst(s)            T            T          0193       14.6385        674.83      1,538.65     1,763.65
58805     Drainage of ovarian cyst(s)            C            C          0000        0.0000         0.00         0.00         0.00
58820     Drain ovary abscess, open              T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
58822     Drain ovary abscess, percut            C            C          0000        0.0000         0.00         0.00         0.00
58823     Drain pelvic abscess, percut           T            T          0193       14.6385        674.83      1,538.65     1,763.65
58825     Transposition, ovary(s)                C            C          0000        0.0000         0.00         0.00         0.00
58900     Biopsy of ovary(s)                     T            T          0193       14.6385        674.83      1,538.65     1,763.65
58920     Partial removal of ovary(s)            T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
58925     Removal of ovarian cyst(s)             T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
58940     Removal of ovary(s)                    C            C          0000        0.0000         0.00         0.00         0.00
58943     Removal of ovary(s)                    C            C          0000        0.0000         0.00         0.00         0.00
58950     Resect ovarian malignancy              C            C          0000        0.0000         0.00         0.00         0.00
58951     Resect ovarian malignancy              C            C          0000        0.0000         0.00         0.00         0.00
58952     Resect ovarian malignancy              C            C          0000        0.0000         0.00         0.00         0.00
58953     Tah, rad dissect for debulk            C            C          0000        0.0000         0.00         0.00         0.00
58954     Tah rad debulk/lymph remove            C            C          0000        0.0000         0.00         0.00         0.00
58956     Bso, omentectomy w/tah                 C            C          0000        0.0000         0.00         0.00         0.00
58960     Exploration of abdomen                 C            C          0000        0.0000         0.00         0.00         0.00
58970     Retrieval of oocyte                    T            1          0000        0.0000         0.00         0.00         0.00
58974     Transfer of embryo                     T            1          0000        0.0000         0.00         0.00         0.00
58976     Transfer of embryo                     T            1          0000        0.0000         0.00         0.00         0.00
58999     Genital surgery procedure              T            1          0000        0.0000         0.00         0.00         0.00
59000     Amniocentesis, diagnostic              T            T          0198        1.3622        62.80        143.18       164.12
59001     Amniocentesis, therapeutic             T            T          0192        4.1597        191.76       437.23       501.16
59012     Fetal cord puncture,prenatal           T            T          0198        1.3622        62.80        143.18       164.12
59015     Chorion biopsy                         T            T          0198        1.3622        62.80        143.18       164.12
59020     Fetal contract stress test             T            T          0192        4.1597        191.76       437.23       501.16
59025     Fetal non-stress test                  T            T          0198        1.3622        62.80        143.18       164.12
59030     Fetal scalp blood sample               T            T          0198        1.3622        62.80        143.18       164.12
59050     Fetal monitor w/report                 M            1          0000        0.0000         0.00         0.00         0.00
59051     Fetal monitor/interpret only           B            B          0000        0.0000         0.00         0.00         0.00
59070     Transabdom amnioinfus w/us             T            T          0198        1.3622        62.80        143.18       164.12
59072     Umbilical cord occlud w/us             T            T          0198        1.3622        62.80        143.18       164.12
59074     Fetal fluid drainage w/us              T            T          0198        1.3622        62.80        143.18       164.12
59076     Fetal shunt placement, w/us            T            T          0198        1.3622        62.80        143.18       164.12

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   61 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
59100     Remove uterus lesion                   T            T          0195       26.7972       1,235.35     2,816.65     3,228.53
59120     Treat ectopic pregnancy                C            C          0000        0.0000         0.00         0.00         0.00
59121     Treat ectopic pregnancy                C            C          0000        0.0000         0.00         0.00         0.00
59130     Treat ectopic pregnancy                C            C          0000        0.0000         0.00         0.00         0.00
59135     Treat ectopic pregnancy                C            C          0000        0.0000         0.00         0.00         0.00
59136     Treat ectopic pregnancy                C            C          0000        0.0000         0.00         0.00         0.00
59140     Treat ectopic pregnancy                C            C          0000        0.0000         0.00         0.00         0.00
59150     Treat ectopic pregnancy                T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
59151     Treat ectopic pregnancy                T            T          0131       43.0498       1,984.60     4,524.96     5,186.64
59160     D & c after delivery                   T            T          0196       17.0012        783.76      1,787.00     2,048.30
59200     Insert cervical dilator                T            T          0189        2.3805        109.74       250.21       286.80
59300     Episiotomy or vaginal repair           T            T          0193       14.6385        674.83      1,538.65     1,763.65
59320     Revision of cervix                     T            T          0194       20.6573        952.30      2,171.29     2,488.79
59325     Revision of cervix                     C            C          0000        0.0000         0.00         0.00         0.00
59350     Repair of uterus                       C            C          0000        0.0000         0.00         0.00         0.00
59400     Obstetrical care                       B            B          0000        0.0000         0.00         0.00         0.00
59409     Obstetrical care                       T            T          0194       20.6573        952.30      2,171.29     2,488.79
59410     Obstetrical care                       B            B          0000        0.0000         0.00         0.00         0.00
59412     Antepartum manipulation                T            T          0700        4.1398        190.84       435.13       498.76
59414     Deliver placenta                       T            T          0193       14.6385        674.83      1,538.65     1,763.65
59425     Antepartum care only                   B            B          0000        0.0000         0.00         0.00         0.00
59426     Antepartum care only                   B            B          0000        0.0000         0.00         0.00         0.00
59430     Care after delivery                    B            B          0000        0.0000         0.00         0.00         0.00
59510     Cesarean delivery                      B            B          0000        0.0000         0.00         0.00         0.00
59514     Cesarean delivery only                 C            C          0000        0.0000         0.00         0.00         0.00
59515     Cesarean delivery                      E            1          0000        0.0000         0.00         0.00         0.00
59525     Remove uterus after cesarean           C            C          0000        0.0000         0.00         0.00         0.00
59610     Vbac delivery                          E            1          0000        0.0000         0.00         0.00         0.00
59612     Vbac delivery only                     T            T          0194       20.6573        952.30      2,171.29     2,488.79
59614     Vbac care after delivery               E            1          0000        0.0000         0.00         0.00         0.00
59618     Attempted vbac delivery                E            1          0000        0.0000         0.00         0.00         0.00
59620     Attempted vbac delivery only           C            C          0000        0.0000         0.00         0.00         0.00
59622     Attempted vbac after care              E            1          0000        0.0000         0.00         0.00         0.00
59812     Treatment of miscarriage               T            T          0201       17.4749        805.59      1,836.79     2,105.38
59820     Care of miscarriage                    T            T          0201       17.4749        805.59      1,836.79     2,105.38
59821     Treatment of miscarriage               T            T          0201       17.4749        805.59      1,836.79     2,105.38
59830     Treat uterus infection                 C            C          0000        0.0000         0.00         0.00         0.00
59840     Abortion                               T            T          0200       18.9518        873.68      1,992.02     2,283.31
59841     Abortion                               T            T          0200       18.9518        873.68      1,992.02     2,283.31
59850     Abortion                               C            C          0000        0.0000         0.00         0.00         0.00
59851     Abortion                               C            C          0000        0.0000         0.00         0.00         0.00
59852     Abortion                               C            C          0000        0.0000         0.00         0.00         0.00
59855     Abortion                               C            C          0000        0.0000         0.00         0.00         0.00
59856     Abortion                               C            C          0000        0.0000         0.00         0.00         0.00
59857     Abortion                               C            C          0000        0.0000         0.00         0.00         0.00
59866     Abortion (mpr)                         T            T          0198        1.3622        62.80        143.18       164.12
59870     Evacuate mole of uterus                T            T          0201       17.4749        805.59      1,836.79     2,105.38
59871     Remove cerclage suture                 T            T          0194       20.6573        952.30      2,171.29     2,488.79
59897     Fetal invas px w/us                    T            1          0000        0.0000         0.00         0.00         0.00
59898     Laparo proc, ob care/deliver           T            1          0000        0.0000         0.00         0.00         0.00
59899     Maternity care procedure               T            1          0000        0.0000         0.00         0.00         0.00
60000     Drain thyroid/tongue cyst              T            T          0252        8.1033        373.56       851.74       976.29
60001     Aspirate/inject thyriod cyst           T            T          0004        1.7771        81.92        186.79       214.11
60100     Biopsy of thyroid                      T            T          0004        1.7771        81.92        186.79       214.11
60200     Remove thyroid lesion                  T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60210     Partial thyroid excision               T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60212     Partial thyroid excision               T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60220     Partial removal of thyroid             T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60225     Partial removal of thyroid             T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60240     Removal of thyroid                     T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60252     Removal of thyroid                     T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
60254     Extensive thyroid surgery              C            C          0000        0.0000         0.00         0.00         0.00
60260     Repeat thyroid surgery                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
60270     Removal of thyroid                     C            C          0000        0.0000         0.00         0.00         0.00
60271     Removal of thyroid                     C            C          0000        0.0000         0.00         0.00         0.00
60280     Remove thyroid duct lesion             T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60281     Remove thyroid duct lesion             T            T          0114       40.4596       1,865.19     4,252.71     4,874.57
60500     Explore parathyroid glands             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
60502     Re-explore parathyroids                C            C          0000        0.0000         0.00         0.00         0.00
60505     Explore parathyroid glands             C            C          0000        0.0000         0.00         0.00         0.00
60512     Autotransplant parathyroid             T            1          0000        0.0000         0.00         0.00         0.00
60520     Removal of thymus gland                C            C          0000        0.0000         0.00         0.00         0.00
60521     Removal of thymus gland                C            C          0000        0.0000         0.00         0.00         0.00
60522     Removal of thymus gland                C            C          0000        0.0000         0.00         0.00         0.00
60540     Explore adrenal gland                  C            C          0000        0.0000         0.00         0.00         0.00
60545     Explore adrenal gland                  C            C          0000        0.0000         0.00         0.00         0.00
60600     Remove carotid body lesion             C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   62 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
60605     Remove carotid body lesion             C            C          0000        0.0000         0.00         0.00         0.00
60650     Laparoscopy adrenalectomy              C            C          0000        0.0000         0.00         0.00         0.00
60659     Laparo proc, endocrine                 T            1          0000        0.0000         0.00         0.00         0.00
60699     Endocrine surgery procedure            T            1          0000        0.0000         0.00         0.00         0.00
61000     Remove cranial cavity fluid            T            T          0212        2.7712        127.75       291.28       333.87
61001     Remove cranial cavity fluid            T            T          0212        2.7712        127.75       291.28       333.87
61020     Remove brain cavity fluid              T            T          0212        2.7712        127.75       291.28       333.87
61026     Injection into brain canal             T            T          0212        2.7712        127.75       291.28       333.87
61050     Remove brain canal fluid               T            T          0212        2.7712        127.75       291.28       333.87
61055     Injection into brain canal             T            T          0212        2.7712        127.75       291.28       333.87
61070     Brain canal shunt procedure            T            T          0212        2.7712        127.75       291.28       333.87
61105     Twist drill hole                       C            C          0000        0.0000         0.00         0.00         0.00
61107     Drill skull for implantation           C            C          0000        0.0000         0.00         0.00         0.00
61108     Drill skull for drainage               C            C          0000        0.0000         0.00         0.00         0.00
61120     Burr hole for puncture                 C            C          0000        0.0000         0.00         0.00         0.00
61140     Pierce skull for biopsy                C            C          0000        0.0000         0.00         0.00         0.00
61150     Pierce skull for drainage              C            C          0000        0.0000         0.00         0.00         0.00
61151     Pierce skull for drainage              C            C          0000        0.0000         0.00         0.00         0.00
61154     Pierce skull & remove clot             C            C          0000        0.0000         0.00         0.00         0.00
61156     Pierce skull for drainage              C            C          0000        0.0000         0.00         0.00         0.00
61210     Pierce skull, implant device           C            C          0000        0.0000         0.00         0.00         0.00
61215     Insert brain-fluid device              T            T          0224       41.1421       1,896.65     4,324.45     4,956.80
61250     Pierce skull & explore                 C            C          0000        0.0000         0.00         0.00         0.00
61253     Pierce skull & explore                 C            C          0000        0.0000         0.00         0.00         0.00
61304     Open skull for exploration             C            C          0000        0.0000         0.00         0.00         0.00
61305     Open skull for exploration             C            C          0000        0.0000         0.00         0.00         0.00
61312     Open skull for drainage                C            C          0000        0.0000         0.00         0.00         0.00
61313     Open skull for drainage                C            C          0000        0.0000         0.00         0.00         0.00
61314     Open skull for drainage                C            C          0000        0.0000         0.00         0.00         0.00
61315     Open skull for drainage                C            C          0000        0.0000         0.00         0.00         0.00
61316     Implt cran bone flap to abdo           C            C          0000        0.0000         0.00         0.00         0.00
61320     Open skull for drainage                C            C          0000        0.0000         0.00         0.00         0.00
61321     Open skull for drainage                C            C          0000        0.0000         0.00         0.00         0.00
61322     Decompressive craniotomy               C            C          0000        0.0000         0.00         0.00         0.00
61323     Decompressive lobectomy                C            C          0000        0.0000         0.00         0.00         0.00
61330     Decompress eye socket                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
61332     Explore/biopsy eye socket              C            C          0000        0.0000         0.00         0.00         0.00
61333     Explore orbit/remove lesion            C            C          0000        0.0000         0.00         0.00         0.00
61334     Explore orbit/remove object            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
61340     Subtemporal decompression              C            C          0000        0.0000         0.00         0.00         0.00
61343     Incise skull (press relief)            C            C          0000        0.0000         0.00         0.00         0.00
61345     Relieve cranial pressure               C            C          0000        0.0000         0.00         0.00         0.00
61440     Incise skull for surgery               C            C          0000        0.0000         0.00         0.00         0.00
61450     Incise skull for surgery               C            C          0000        0.0000         0.00         0.00         0.00
61458     Incise skull for brain wound           C            C          0000        0.0000         0.00         0.00         0.00
61460     Incise skull for surgery               C            C          0000        0.0000         0.00         0.00         0.00
61470     Incise skull for surgery               C            C          0000        0.0000         0.00         0.00         0.00
61480     Incise skull for surgery               C            C          0000        0.0000         0.00         0.00         0.00
61490     Incise skull for surgery               C            C          0000        0.0000         0.00         0.00         0.00
61500     Removal of skull lesion                C            C          0000        0.0000         0.00         0.00         0.00
61501     Remove infected skull bone             C            C          0000        0.0000         0.00         0.00         0.00
61510     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61512     Remove brain lining lesion             C            C          0000        0.0000         0.00         0.00         0.00
61514     Removal of brain abscess               C            C          0000        0.0000         0.00         0.00         0.00
61516     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61517     Implt brain chemotx add-on             C            C          0000        0.0000         0.00         0.00         0.00
61518     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61519     Remove brain lining lesion             C            C          0000        0.0000         0.00         0.00         0.00
61520     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61521     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61522     Removal of brain abscess               C            C          0000        0.0000         0.00         0.00         0.00
61524     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61526     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61530     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61531     Implant brain electrodes               C            C          0000        0.0000         0.00         0.00         0.00
61533     Implant brain electrodes               C            C          0000        0.0000         0.00         0.00         0.00
61534     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61535     Remove brain electrodes                C            C          0000        0.0000         0.00         0.00         0.00
61536     Removal of brain lesion                C            C          0000        0.0000         0.00         0.00         0.00
61537     Removal of brain tissue                C            C          0000        0.0000         0.00         0.00         0.00
61538     Removal of brain tissue                C            C          0000        0.0000         0.00         0.00         0.00
61539     Removal of brain tissue                C            C          0000        0.0000         0.00         0.00         0.00
61540     Removal of brain tissue                C            C          0000        0.0000         0.00         0.00         0.00
61541     Incision of brain tissue               C            C          0000        0.0000         0.00         0.00         0.00
61542     Removal of brain tissue                C            C          0000        0.0000         0.00         0.00         0.00
61543     Removal of brain tissue                C            C          0000        0.0000         0.00         0.00         0.00
61544     Remove & treat brain lesion            C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   63 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
61545     Excision of brain tumor                C            C          0000        0.0000         0.00         0.00         0.00
61546     Removal of pituitary gland             C            C          0000        0.0000         0.00         0.00         0.00
61548     Removal of pituitary gland             C            C          0000        0.0000         0.00         0.00         0.00
61550     Release of skull seams                 C            C          0000        0.0000         0.00         0.00         0.00
61552     Release of skull seams                 C            C          0000        0.0000         0.00         0.00         0.00
61556     Incise skull/sutures                   C            C          0000        0.0000         0.00         0.00         0.00
61557     Incise skull/sutures                   C            C          0000        0.0000         0.00         0.00         0.00
61558     Excision of skull/sutures              C            C          0000        0.0000         0.00         0.00         0.00
61559     Excision of skull/sutures              C            C          0000        0.0000         0.00         0.00         0.00
61563     Excision of skull tumor                C            C          0000        0.0000         0.00         0.00         0.00
61564     Excision of skull tumor                C            C          0000        0.0000         0.00         0.00         0.00
61566     Removal of brain tissue                C            C          0000        0.0000         0.00         0.00         0.00
61567     Incision of brain tissue               C            C          0000        0.0000         0.00         0.00         0.00
61570     Remove foreign body, brain             C            C          0000        0.0000         0.00         0.00         0.00
61571     Incise skull for brain wound           C            C          0000        0.0000         0.00         0.00         0.00
61575     Skull base/brainstem surgery           C            C          0000        0.0000         0.00         0.00         0.00
61576     Skull base/brainstem surgery           C            C          0000        0.0000         0.00         0.00         0.00
61580     Craniofacial approach, skull           C            C          0000        0.0000         0.00         0.00         0.00
61581     Craniofacial approach, skull           C            C          0000        0.0000         0.00         0.00         0.00
61582     Craniofacial approach, skull           C            C          0000        0.0000         0.00         0.00         0.00
61583     Craniofacial approach, skull           C            C          0000        0.0000         0.00         0.00         0.00
61584     Orbitocranial approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61585     Orbitocranial approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61586     Resect nasopharynx, skull              C            C          0000        0.0000         0.00         0.00         0.00
61590     Infratemporal approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61591     Infratemporal approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61592     Orbitocranial approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61595     Transtemporal approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61596     Transcochlear approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61597     Transcondylar approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61598     Transpetrosal approach/skull           C            C          0000        0.0000         0.00         0.00         0.00
61600     Resect/excise cranial lesion           C            C          0000        0.0000         0.00         0.00         0.00
61601     Resect/excise cranial lesion           C            C          0000        0.0000         0.00         0.00         0.00
61605     Resect/excise cranial lesion           C            C          0000        0.0000         0.00         0.00         0.00
61606     Resect/excise cranial lesion           C            C          0000        0.0000         0.00         0.00         0.00
61607     Resect/excise cranial lesion           C            C          0000        0.0000         0.00         0.00         0.00
61608     Resect/excise cranial lesion           C            C          0000        0.0000         0.00         0.00         0.00
61609     Transect artery, sinus                 C            C          0000        0.0000         0.00         0.00         0.00
61610     Transect artery, sinus                 C            C          0000        0.0000         0.00         0.00         0.00
61611     Transect artery, sinus                 C            C          0000        0.0000         0.00         0.00         0.00
61612     Transect artery, sinus                 C            C          0000        0.0000         0.00         0.00         0.00
61613     Remove aneurysm, sinus                 C            C          0000        0.0000         0.00         0.00         0.00
61615     Resect/excise lesion, skull            C            C          0000        0.0000         0.00         0.00         0.00
61616     Resect/excise lesion, skull            C            C          0000        0.0000         0.00         0.00         0.00
61618     Repair dura                            C            C          0000        0.0000         0.00         0.00         0.00
61619     Repair dura                            C            C          0000        0.0000         0.00         0.00         0.00
61623     Endovasc tempory vessel occl           T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
61624     Transcath occlusion, cns               C            C          0000        0.0000         0.00         0.00         0.00
61626     Transcath occlusion, non-cns           T            T          0081       42.2664       1,948.48     4,442.62     5,092.26
61630     Intracranial angioplasty               E            3          0000        0.0000         M01          M01          M01
61635     Intracran angioplsty w/stent           E            3          0000        0.0000         M01          M01          M01
61640     Dilate ic vasospasm, init              E            3          0000        0.0000         M01          M01          M01
61641     Dilate ic vasospasm add-on             E            3          0000        0.0000         M01          M01          M01
61642     Dilate ic vasospasm add-on             E            3          0000        0.0000         M01          M01          M01
61680     Intracranial vessel surgery            C            C          0000        0.0000         0.00         0.00         0.00
61682     Intracranial vessel surgery            C            C          0000        0.0000         0.00         0.00         0.00
61684     Intracranial vessel surgery            C            C          0000        0.0000         0.00         0.00         0.00
61686     Intracranial vessel surgery            C            C          0000        0.0000         0.00         0.00         0.00
61690     Intracranial vessel surgery            C            C          0000        0.0000         0.00         0.00         0.00
61692     Intracranial vessel surgery            C            C          0000        0.0000         0.00         0.00         0.00
61697     Brain aneurysm repr, complx            C            C          0000        0.0000         0.00         0.00         0.00
61698     Brain aneurysm repr, complx            C            C          0000        0.0000         0.00         0.00         0.00
61700     Brain aneurysm repr, simple            C            C          0000        0.0000         0.00         0.00         0.00
61702     Inner skull vessel surgery             C            C          0000        0.0000         0.00         0.00         0.00
61703     Clamp neck artery                      C            C          0000        0.0000         0.00         0.00         0.00
61705     Revise circulation to head             C            C          0000        0.0000         0.00         0.00         0.00
61708     Revise circulation to head             C            C          0000        0.0000         0.00         0.00         0.00
61710     Revise circulation to head             C            C          0000        0.0000         0.00         0.00         0.00
61711     Fusion of skull arteries               C            C          0000        0.0000         0.00         0.00         0.00
61720     Incise skull/brain surgery             C            C          0000        0.0000         0.00         0.00         0.00
61735     Incise skull/brain surgery             C            C          0000        0.0000         0.00         0.00         0.00
61750     Incise skull/brain biopsy              C            C          0000        0.0000         0.00         0.00         0.00
61751     Brain biopsy w/ct/mr guide             C            C          0000        0.0000         0.00         0.00         0.00
61760     Implant brain electrodes               C            C          0000        0.0000         0.00         0.00         0.00
61770     Incise skull for treatment             C            C          0000        0.0000         0.00         0.00         0.00
61790     Treat trigeminal nerve                 T            T          0220       17.3203        798.47      1,820.54     2,086.75
61791     Treat trigeminal tract                 T            T          0206        5.4011        248.99       567.71       650.72

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   64 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
61793     Focus radiation beam                   B            B          0000       0.0000          0.00         0.00         0.00
61795     Brain surgery using computer           S            S          0302       4.6992         216.63       493.93       566.16
61850     Implant neuroelectrodes                C            C          0000       0.0000          0.00         0.00         0.00
61860     Implant neuroelectrodes                C            C          0000       0.0000          0.00         0.00         0.00
61863     Implant neuroelectrode                 C            C          0000       0.0000          0.00         0.00         0.00
61864     Implant neuroelectrde, add’l           C            C          0000       0.0000          0.00         0.00         0.00
61867     Implant neuroelectrode                 C            C          0000       0.0000          0.00         0.00         0.00
61868     Implant neuroelectrde, add’l           C            C          0000       0.0000          0.00         0.00         0.00
61870     Implant neuroelectrodes                C            C          0000       0.0000          0.00         0.00         0.00
61875     Implant neuroelectrodes                C            C          0000       0.0000          0.00         0.00         0.00
61880     Revise/remove neuroelectrode           T            T          0687      19.1962         884.94      2,017.71     2,312.76
61885     Insrt/redo neurostim 1 array           S            S          0039      194.9690       8,988.07    20,493.19    23,489.87
61886     Implant neurostim arrays               T            T          0315      312.3876      14,401.07    32,835.06    37,636.46
61888     Revise/remove neuroreceiver            T            T          0688      42.8588        1,975.79     4,504.89     5,163.63
62000     Treat skull fracture                   C            C          0000       0.0000          0.00         0.00         0.00
62005     Treat skull fracture                   C            C          0000       0.0000          0.00         0.00         0.00
62010     Treatment of head injury               C            C          0000       0.0000          0.00         0.00         0.00
62100     Repair brain fluid leakage             C            C          0000       0.0000          0.00         0.00         0.00
62115     Reduction of skull defect              C            C          0000       0.0000          0.00         0.00         0.00
62116     Reduction of skull defect              C            C          0000       0.0000          0.00         0.00         0.00
62117     Reduction of skull defect              C            C          0000       0.0000          0.00         0.00         0.00
62120     Repair skull cavity lesion             C            C          0000       0.0000          0.00         0.00         0.00
62121     Incise skull repair                    C            C          0000       0.0000          0.00         0.00         0.00
62140     Repair of skull defect                 C            C          0000       0.0000          0.00         0.00         0.00
62141     Repair of skull defect                 C            C          0000       0.0000          0.00         0.00         0.00
62142     Remove skull plate/flap                C            C          0000       0.0000          0.00         0.00         0.00
62143     Replace skull plate/flap               C            C          0000       0.0000          0.00         0.00         0.00
62145     Repair of skull & brain                C            C          0000       0.0000          0.00         0.00         0.00
62146     Repair of skull with graft             C            C          0000       0.0000          0.00         0.00         0.00
62147     Repair of skull with graft             C            C          0000       0.0000          0.00         0.00         0.00
62148     Retr bone flap to fix skull            C            C          0000       0.0000          0.00         0.00         0.00
62160     Neuroendoscopy add-on                  T            T          0122       6.9179         318.92       727.14       833.47
62161     Dissect brain w/scope                  C            C          0000       0.0000          0.00         0.00         0.00
62162     Remove colloid cyst w/scope            C            C          0000       0.0000          0.00         0.00         0.00
62163     Neuroendoscopy w/fb removal            C            C          0000       0.0000          0.00         0.00         0.00
62164     Remove brain tumor w/scope             C            C          0000       0.0000          0.00         0.00         0.00
62165     Remove pituit tumor w/scope            C            C          0000       0.0000          0.00         0.00         0.00
62180     Establish brain cavity shunt           C            C          0000       0.0000          0.00         0.00         0.00
62190     Establish brain cavity shunt           C            C          0000       0.0000          0.00         0.00         0.00
62192     Establish brain cavity shunt           C            C          0000       0.0000          0.00         0.00         0.00
62194     Replace/irrigate catheter              T            T          0427      10.0109         461.50      1,052.25     1,206.11
62200     Establish brain cavity shunt           C            C          0000       0.0000          0.00         0.00         0.00
62201     Brain cavity shunt w/scope             C            C          0000       0.0000          0.00         0.00         0.00
62220     Establish brain cavity shunt           C            C          0000       0.0000          0.00         0.00         0.00
62223     Establish brain cavity shunt           C            C          0000       0.0000          0.00         0.00         0.00
62225     Replace/irrigate catheter              T            T          0427      10.0109         461.50      1,052.25     1,206.11
62230     Replace/revise brain shunt             T            T          0224      41.1421        1,896.65     4,324.45     4,956.80
62252     Csf shunt reprogram                    S            S          0691       2.5464         117.39       267.65       306.79
62256     Remove brain cavity shunt              C            C          0000       0.0000          0.00         0.00         0.00
62258     Replace brain cavity shunt             C            C          0000       0.0000          0.00         0.00         0.00
62263     Epidural lysis mult sessions           T            T          0203      10.0965         465.45      1,061.24     1,216.43
62264     Epidural lysis on single day           T            T          0203      10.0965         465.45      1,061.24     1,216.43
62268     Drain spinal cord cyst                 T            T          0212       2.7712         127.75       291.28       333.87
62269     Needle biopsy, spinal cord             T            T          0685       6.0034         276.76       631.02       723.29
62270     Spinal fluid tap, diagnostic           T            T          0204       2.2667         104.49       238.25       273.09
62272     Drain cerebro spinal fluid             T            T          0204       2.2667         104.49       238.25       273.09
62273     Inject epidural patch                  T            T          0206       5.4011         248.99       567.71       650.72
62280     Treat spinal cord lesion               T            T          0207       6.0140         277.25       632.13       724.57
62281     Treat spinal cord lesion               T            T          0207       6.0140         277.25       632.13       724.57
62282     Treat spinal canal lesion              T            T          0207       6.0140         277.25       632.13       724.57
62284     Injection for myelogram                N            N          0000       0.0000          0.00         0.00         0.00
62287     Percutaneous diskectomy                T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
62290     Inject for spine disk x-ray            N            N          0000       0.0000          0.00         0.00         0.00
62291     Inject for spine disk x-ray            N            N          0000       0.0000          0.00         0.00         0.00
62292     Injection into disk lesion             T            T          0212       2.7712         127.75       291.28       333.87
62294     Injection into spinal artery           T            T          0212       2.7712         127.75       291.28       333.87
62310     Inject spine c/t                       T            T          0207       6.0140         277.25       632.13       724.57
62311     Inject spine l/s (cd)                  T            T          0207       6.0140         277.25       632.13       724.57
62318     Inject spine w/cath, c/t               T            T          0207       6.0140         277.25       632.13       724.57
62319     Inject spine w/cath l/s (cd)           T            T          0207       6.0140         277.25       632.13       724.57
62350     Implant spinal canal cath              T            T          0223      28.5636        1,316.78     3,002.32     3,441.34
62351     Implant spinal canal cath              T            T          0208      42.5200        1,960.17     4,469.28     5,122.81
62355     Remove spinal canal catheter           T            T          0203      10.0965         465.45      1,061.24     1,216.43
62360     Insert spine infusion device           T            T          0226      72.5804        3,345.96     7,628.93     8,744.49
62361     Implant spine infusion pump            T            T          0227      155.0431       7,147.49    16,296.58    18,679.59
62362     Implant spine infusion pump            T            T          0227      155.0431       7,147.49    16,296.58    18,679.59
62365     Remove spine infusion device           T            T          0221      31.0536        1,431.57     3,264.04     3,741.34

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   65 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
62367     Analyze spine infusion pump            S            S          0691        2.5464        117.39       267.65       306.79
62368     Analyze spine infusion pump            S            S          0691        2.5464        117.39       267.65       306.79
63001     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63003     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63005     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63011     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63012     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63015     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63016     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63017     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63020     Neck spine disk surgery                T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63030     Low back disk surgery                  T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63035     Spinal disk surgery add-on             T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63040     Laminotomy, single cervical            T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63042     Laminotomy, single lumbar              T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63043     Laminotomy, add’l cervical             C            C          0000        0.0000         0.00         0.00         0.00
63044     Laminotomy, add’l lumbar               C            C          0000        0.0000         0.00         0.00         0.00
63045     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63046     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63047     Removal of spinal lamina               T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63048     Remove spinal lamina add-on            T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63050     Cervical laminoplasty                  C            C          0000        0.0000         0.00         0.00         0.00
63051     C-laminoplasty w/graft/plate           C            C          0000        0.0000         0.00         0.00         0.00
63055     Decompress spinal cord                 T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63056     Decompress spinal cord                 T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63057     Decompress spine cord add-on           T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63064     Decompress spinal cord                 T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63066     Decompress spine cord add-on           T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63075     Neck spine disk surgery                T            T          0208       42.5200       1,960.17     4,469.28     5,122.81
63076     Neck spine disk surgery                C            C          0000        0.0000         0.00         0.00         0.00
63077     Spine disk surgery, thorax             C            C          0000        0.0000         0.00         0.00         0.00
63078     Spine disk surgery, thorax             C            C          0000        0.0000         0.00         0.00         0.00
63081     Removal of vertebral body              C            C          0000        0.0000         0.00         0.00         0.00
63082     Remove vertebral body add-on           C            C          0000        0.0000         0.00         0.00         0.00
63085     Removal of vertebral body              C            C          0000        0.0000         0.00         0.00         0.00
63086     Remove vertebral body add-on           C            C          0000        0.0000         0.00         0.00         0.00
63087     Removal of vertebral body              C            C          0000        0.0000         0.00         0.00         0.00
63088     Remove vertebral body add-on           C            C          0000        0.0000         0.00         0.00         0.00
63090     Removal of vertebral body              C            C          0000        0.0000         0.00         0.00         0.00
63091     Remove vertebral body add-on           C            C          0000        0.0000         0.00         0.00         0.00
63101     Removal of vertebral body              C            C          0000        0.0000         0.00         0.00         0.00
63102     Removal of vertebral body              C            C          0000        0.0000         0.00         0.00         0.00
63103     Remove vertebral body add-on           C            C          0000        0.0000         0.00         0.00         0.00
63170     Incise spinal cord tract(s)            C            C          0000        0.0000         0.00         0.00         0.00
63172     Drainage of spinal cyst                C            C          0000        0.0000         0.00         0.00         0.00
63173     Drainage of spinal cyst                C            C          0000        0.0000         0.00         0.00         0.00
63180     Revise spinal cord ligaments           C            C          0000        0.0000         0.00         0.00         0.00
63182     Revise spinal cord ligaments           C            C          0000        0.0000         0.00         0.00         0.00
63185     Incise spinal column/nerves            C            C          0000        0.0000         0.00         0.00         0.00
63190     Incise spinal column/nerves            C            C          0000        0.0000         0.00         0.00         0.00
63191     Incise spinal column/nerves            C            C          0000        0.0000         0.00         0.00         0.00
63194     Incise spinal column & cord            C            C          0000        0.0000         0.00         0.00         0.00
63195     Incise spinal column & cord            C            C          0000        0.0000         0.00         0.00         0.00
63196     Incise spinal column & cord            C            C          0000        0.0000         0.00         0.00         0.00
63197     Incise spinal column & cord            C            C          0000        0.0000         0.00         0.00         0.00
63198     Incise spinal column & cord            C            C          0000        0.0000         0.00         0.00         0.00
63199     Incise spinal column & cord            C            C          0000        0.0000         0.00         0.00         0.00
63200     Release of spinal cord                 C            C          0000        0.0000         0.00         0.00         0.00
63250     Revise spinal cord vessels             C            C          0000        0.0000         0.00         0.00         0.00
63251     Revise spinal cord vessels             C            C          0000        0.0000         0.00         0.00         0.00
63252     Revise spinal cord vessels             C            C          0000        0.0000         0.00         0.00         0.00
63265     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63266     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63267     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63268     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63270     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63271     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63272     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63273     Excise intraspinal lesion              C            C          0000        0.0000         0.00         0.00         0.00
63275     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00
63276     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00
63277     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00
63278     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00
63280     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00
63281     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00
63282     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00
63283     Biopsy/excise spinal tumor             C            C          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   66 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
63285     Biopsy/excise spinal tumor             C            C          0000       0.0000          0.00         0.00         0.00
63286     Biopsy/excise spinal tumor             C            C          0000       0.0000          0.00         0.00         0.00
63287     Biopsy/excise spinal tumor             C            C          0000       0.0000          0.00         0.00         0.00
63290     Biopsy/excise spinal tumor             C            C          0000       0.0000          0.00         0.00         0.00
63295     Repair of laminectomy defect           C            C          0000       0.0000          0.00         0.00         0.00
63300     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63301     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63302     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63303     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63304     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63305     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63306     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63307     Removal of vertebral body              C            C          0000       0.0000          0.00         0.00         0.00
63308     Remove vertebral body add-on           C            C          0000       0.0000          0.00         0.00         0.00
63600     Remove spinal cord lesion              T            T          0220      17.3203         798.47      1,820.54     2,086.75
63610     Stimulation of spinal cord             T            T          0220      17.3203         798.47      1,820.54     2,086.75
63615     Remove lesion of spinal cord           T            T          0220      17.3203         798.47      1,820.54     2,086.75
63650     Implant neuroelectrodes                S            S          0040      50.8322        2,343.36     5,342.97     6,124.26
63655     Implant neuroelectrodes                S            S          0061      93.4063        4,306.03     9,817.94    11,253.59
63660     Revise/remove neuroelectrode           T            T          0687      19.1962         884.94      2,017.71     2,312.76
63685     Insrt/redo spine n generator           T            T          0222      192.4950       8,874.02    20,233.15    23,191.80
63688     Revise/remove neuroreceiver            T            T          0688      42.8588        1,975.79     4,504.89     5,163.63
63700     Repair of spinal herniation            C            C          0000       0.0000          0.00         0.00         0.00
63702     Repair of spinal herniation            C            C          0000       0.0000          0.00         0.00         0.00
63704     Repair of spinal herniation            C            C          0000       0.0000          0.00         0.00         0.00
63706     Repair of spinal herniation            C            C          0000       0.0000          0.00         0.00         0.00
63707     Repair spinal fluid leakage            C            C          0000       0.0000          0.00         0.00         0.00
63709     Repair spinal fluid leakage            C            C          0000       0.0000          0.00         0.00         0.00
63710     Graft repair of spine defect           C            C          0000       0.0000          0.00         0.00         0.00
63740     Install spinal shunt                   C            C          0000       0.0000          0.00         0.00         0.00
63741     Install spinal shunt                   T            T          0228      46.4126        2,139.62     4,878.43     5,591.79
63744     Revision of spinal shunt               T            T          0228      46.4126        2,139.62     4,878.43     5,591.79
63746     Removal of spinal shunt                T            T          0109      11.1714         515.00      1,174.23     1,345.93
64400     N block inj, trigeminal                T            T          0204       2.2667         104.49       238.25       273.09
64402     N block inj, facial                    T            T          0204       2.2667         104.49       238.25       273.09
64405     N block inj, occipital                 T            T          0204       2.2667         104.49       238.25       273.09
64408     N block inj, vagus                     T            T          0204       2.2667         104.49       238.25       273.09
64410     N block inj, phrenic                   T            T          0206       5.4011         248.99       567.71       650.72
64412     N block inj, spinal accessor           T            T          0206       5.4011         248.99       567.71       650.72
64413     N block inj, cervical plexus           T            T          0204       2.2667         104.49       238.25       273.09
64415     N block inj, brachial plexus           T            T          0204       2.2667         104.49       238.25       273.09
64416     N block cont infuse, b plex            T            T          0204       2.2667         104.49       238.25       273.09
64417     N block inj, axillary                  T            T          0204       2.2667         104.49       238.25       273.09
64418     N block inj, suprascapular             T            T          0204       2.2667         104.49       238.25       273.09
64420     N block inj, intercost, sng            T            T          0204       2.2667         104.49       238.25       273.09
64421     N block inj, intercost, mlt            T            T          0206       5.4011         248.99       567.71       650.72
64425     N block inj, ilio-ing/hypogi           T            T          0204       2.2667         104.49       238.25       273.09
64430     N block inj, pudendal                  T            T          0204       2.2667         104.49       238.25       273.09
64435     N block inj, paracervical              T            T          0204       2.2667         104.49       238.25       273.09
64445     N block inj, sciatic, sng              T            T          0204       2.2667         104.49       238.25       273.09
64446     N blk inj, sciatic, cont inf           T            T          0206       5.4011         248.99       567.71       650.72
64447     N block inj fem, single                T            T          0204       2.2667         104.49       238.25       273.09
64448     N block inj fem, cont inf              T            T          0204       2.2667         104.49       238.25       273.09
64449     N block inj, lumbar plexus             T            T          0204       2.2667         104.49       238.25       273.09
64450     N block, other peripheral              T            T          0204       2.2667         104.49       238.25       273.09
64470     Inj paravertebral c/t                  T            T          0207       6.0140         277.25       632.13       724.57
64472     Inj paravertebral c/t add-on           T            T          0206       5.4011         248.99       567.71       650.72
64475     Inj paravertebral l/s                  T            T          0207       6.0140         277.25       632.13       724.57
64476     Inj paravertebral l/s add-on           T            T          0206       5.4011         248.99       567.71       650.72
64479     Inj foramen epidural c/t               T            T          0207       6.0140         277.25       632.13       724.57
64480     Inj foramen epidural add-on            T            T          0207       6.0140         277.25       632.13       724.57
64483     Inj foramen epidural l/s               T            T          0207       6.0140         277.25       632.13       724.57
64484     Inj foramen epidural add-on            T            T          0207       6.0140         277.25       632.13       724.57
64505     N block, spenopalatine gangl           T            T          0204       2.2667         104.49       238.25       273.09
64508     N block, carotid sinus s/p             T            T          0204       2.2667         104.49       238.25       273.09
64510     N block, stellate ganglion             T            T          0207       6.0140         277.25       632.13       724.57
64517     N block inj, hypogas plxs              T            T          0204       2.2667         104.49       238.25       273.09
64520     N block, lumbar/thoracic               T            T          0207       6.0140         277.25       632.13       724.57
64530     N block inj, celiac pelus              T            T          0207       6.0140         277.25       632.13       724.57
64550     Apply neurostimulator                  A            3          0000       0.0000          M01          M01          M01
64553     Implant neuroelectrodes                S            S          0225      250.8484      11,564.11    26,366.68    30,222.22
64555     Implant neuroelectrodes                S            S          0040      50.8322        2,343.36     5,342.97     6,124.26
64560     Implant neuroelectrodes                S            S          0040      50.8322        2,343.36     5,342.97     6,124.26
64561     Implant neuroelectrodes                S            S          0040      50.8322        2,343.36     5,342.97     6,124.26
64565     Implant neuroelectrodes                S            S          0040      50.8322        2,343.36     5,342.97     6,124.26
64573     Implant neuroelectrodes                S            S          0225      250.8484      11,564.11    26,366.68    30,222.22
64575     Implant neuroelectrodes                S            S          0061      93.4063        4,306.03     9,817.94    11,253.59

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   67 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
64577     Implant neuroelectrodes                S            S          0061      93.4063        4,306.03     9,817.94    11,253.59
64580     Implant neuroelectrodes                S            S          0061      93.4063        4,306.03     9,817.94    11,253.59
64581     Implant neuroelectrodes                S            S          0061      93.4063        4,306.03     9,817.94    11,253.59
64585     Revise/remove neuroelectrode           T            T          0687      19.1962         884.94      2,017.71     2,312.76
64590     Insrt/redo perph n generator           T            T          0222      192.4950       8,874.02    20,233.15    23,191.80
64595     Revise/remove neuroreceiver            T            T          0688      42.8588        1,975.79     4,504.89     5,163.63
64600     Injection treatment of nerve           T            T          0203      10.0965         465.45      1,061.24     1,216.43
64605     Injection treatment of nerve           T            T          0203      10.0965         465.45      1,061.24     1,216.43
64610     Injection treatment of nerve           T            T          0203      10.0965         465.45      1,061.24     1,216.43
64612     Destroy nerve, face muscle             T            T          0204       2.2667         104.49       238.25       273.09
64613     Destroy nerve, spine muscle            T            T          0204       2.2667         104.49       238.25       273.09
64614     Destroy nerve, extrem musc             T            T          0204       2.2667         104.49       238.25       273.09
64620     Injection treatment of nerve           T            T          0203      10.0965         465.45      1,061.24     1,216.43
64622     Destr paravertebrl nerve l/s           T            T          0203      10.0965         465.45      1,061.24     1,216.43
64623     Destr paravertebral n add-on           T            T          0207       6.0140         277.25       632.13       724.57
64626     Destr paravertebrl nerve c/t           T            T          0203      10.0965         465.45      1,061.24     1,216.43
64627     Destr paravertebral n add-on           T            T          0207       6.0140         277.25       632.13       724.57
64630     Injection treatment of nerve           T            T          0206       5.4011         248.99       567.71       650.72
64640     Injection treatment of nerve           T            T          0206       5.4011         248.99       567.71       650.72
64650     Chemodenerv eccrine glands             T            T          0204       2.2667         104.49       238.25       273.09
64653     Chemodenerv eccrine glands             T            T          0204       2.2667         104.49       238.25       273.09
64680     Injection treatment of nerve           T            T          0207       6.0140         277.25       632.13       724.57
64681     Injection treatment of nerve           T            T          0203      10.0965         465.45      1,061.24     1,216.43
64702     Revise finger/toe nerve                T            T          0220      17.3203         798.47      1,820.54     2,086.75
64704     Revise hand/foot nerve                 T            T          0220      17.3203         798.47      1,820.54     2,086.75
64708     Revise arm/leg nerve                   T            T          0220      17.3203         798.47      1,820.54     2,086.75
64712     Revision of sciatic nerve              T            T          0220      17.3203         798.47      1,820.54     2,086.75
64713     Revision of arm nerve(s)               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64714     Revise low back nerve(s)               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64716     Revision of cranial nerve              T            T          0220      17.3203         798.47      1,820.54     2,086.75
64718     Revise ulnar nerve at elbow            T            T          0220      17.3203         798.47      1,820.54     2,086.75
64719     Revise ulnar nerve at wrist            T            T          0220      17.3203         798.47      1,820.54     2,086.75
64721     Carpal tunnel surgery                  T            T          0220      17.3203         798.47      1,820.54     2,086.75
64722     Relieve pressure on nerve(s)           T            T          0220      17.3203         798.47      1,820.54     2,086.75
64726     Release foot/toe nerve                 T            T          0220      17.3203         798.47      1,820.54     2,086.75
64727     Internal nerve revision                T            T          0220      17.3203         798.47      1,820.54     2,086.75
64732     Incision of brow nerve                 T            T          0220      17.3203         798.47      1,820.54     2,086.75
64734     Incision of cheek nerve                T            T          0220      17.3203         798.47      1,820.54     2,086.75
64736     Incision of chin nerve                 T            T          0220      17.3203         798.47      1,820.54     2,086.75
64738     Incision of jaw nerve                  T            T          0220      17.3203         798.47      1,820.54     2,086.75
64740     Incision of tongue nerve               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64742     Incision of facial nerve               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64744     Incise nerve, back of head             T            T          0220      17.3203         798.47      1,820.54     2,086.75
64746     Incise diaphragm nerve                 T            T          0220      17.3203         798.47      1,820.54     2,086.75
64752     Incision of vagus nerve                C            C          0000       0.0000          0.00         0.00         0.00
64755     Incision of stomach nerves             C            C          0000       0.0000          0.00         0.00         0.00
64760     Incision of vagus nerve                C            C          0000       0.0000          0.00         0.00         0.00
64761     Incision of pelvis nerve               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64763     Incise hip/thigh nerve                 T            T          0220      17.3203         798.47      1,820.54     2,086.75
64766     Incise hip/thigh nerve                 T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
64771     Sever cranial nerve                    T            T          0220      17.3203         798.47      1,820.54     2,086.75
64772     Incision of spinal nerve               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64774     Remove skin nerve lesion               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64776     Remove digit nerve lesion              T            T          0220      17.3203         798.47      1,820.54     2,086.75
64778     Digit nerve surgery add-on             T            T          0220      17.3203         798.47      1,820.54     2,086.75
64782     Remove limb nerve lesion               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64783     Limb nerve surgery add-on              T            T          0220      17.3203         798.47      1,820.54     2,086.75
64784     Remove nerve lesion                    T            T          0220      17.3203         798.47      1,820.54     2,086.75
64786     Remove sciatic nerve lesion            T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
64787     Implant nerve end                      T            T          0220      17.3203         798.47      1,820.54     2,086.75
64788     Remove skin nerve lesion               T            T          0220      17.3203         798.47      1,820.54     2,086.75
64790     Removal of nerve lesion                T            T          0220      17.3203         798.47      1,820.54     2,086.75
64792     Removal of nerve lesion                T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
64795     Biopsy of nerve                        T            T          0220      17.3203         798.47      1,820.54     2,086.75
64802     Remove sympathetic nerves              T            T          0220      17.3203         798.47      1,820.54     2,086.75
64804     Remove sympathetic nerves              C            C          0000       0.0000          0.00         0.00         0.00
64809     Remove sympathetic nerves              C            C          0000       0.0000          0.00         0.00         0.00
64818     Remove sympathetic nerves              C            C          0000       0.0000          0.00         0.00         0.00
64820     Remove sympathetic nerves              T            T          0220      17.3203         798.47      1,820.54     2,086.75
64821     Remove sympathetic nerves              T            T          0054      25.1321        1,158.59     2,641.64     3,027.92
64822     Remove sympathetic nerves              T            T          0054      25.1321        1,158.59     2,641.64     3,027.92
64823     Remove sympathetic nerves              T            T          0054      25.1321        1,158.59     2,641.64     3,027.92
64831     Repair of digit nerve                  T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
64832     Repair nerve add-on                    T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
64834     Repair of hand or foot nerve           T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
64835     Repair of hand or foot nerve           T            T          0221      31.0536        1,431.57     3,264.04     3,741.34
64836     Repair of hand or foot nerve           T            T          0221      31.0536        1,431.57     3,264.04     3,741.34

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   68 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
64837     Repair nerve add-on                    T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64840     Repair of leg nerve                    T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64856     Repair/transpose nerve                 T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64857     Repair arm/leg nerve                   T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64858     Repair sciatic nerve                   T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64859     Nerve surgery                          T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64861     Repair of arm nerves                   T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64862     Repair of low back nerves              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64864     Repair of facial nerve                 T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64865     Repair of facial nerve                 T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64866     Fusion of facial/other nerve           C            C          0000        0.0000         0.00         0.00         0.00
64868     Fusion of facial/other nerve           C            C          0000        0.0000         0.00         0.00         0.00
64870     Fusion of facial/other nerve           T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64872     Subsequent repair of nerve             T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64874     Repair & revise nerve add-on           T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64876     Repair nerve/shorten bone              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64885     Nerve graft, head or neck              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64886     Nerve graft, head or neck              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64890     Nerve graft, hand or foot              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64891     Nerve graft, hand or foot              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64892     Nerve graft, arm or leg                T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64893     Nerve graft, arm or leg                T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64895     Nerve graft, hand or foot              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64896     Nerve graft, hand or foot              T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64897     Nerve graft, arm or leg                T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64898     Nerve graft, arm or leg                T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64901     Nerve graft add-on                     T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64902     Nerve graft add-on                     T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64905     Nerve pedicle transfer                 T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64907     Nerve pedicle transfer                 T            T          0221       31.0536       1,431.57     3,264.04     3,741.34
64999     Nervous system surgery                 T            1          0000        0.0000         0.00         0.00         0.00
65091     Revise eye                             T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65093     Revise eye with implant                T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
65101     Removal of eye                         T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65103     Remove eye/insert implant              T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65105     Remove eye/attach implant              T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65110     Removal of eye                         T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65112     Remove eye/revise socket               T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65114     Remove eye/revise socket               T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65125     Revise ocular implant                  T            T          0240       18.0194        830.69      1,894.02     2,170.98
65130     Insert ocular implant                  T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
65135     Insert ocular implant                  T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
65140     Attach ocular implant                  T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65150     Revise ocular implant                  T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
65155     Reinsert ocular implant                T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
65175     Removal of ocular implant              T            T          0240       18.0194        830.69      1,894.02     2,170.98
65205     Remove foreign body from eye           S            S          0698        1.2378        57.06        130.11       149.13
65210     Remove foreign body from eye           S            S          0698        1.2378        57.06        130.11       149.13
65220     Remove foreign body from eye           S            S          0698        1.2378        57.06        130.11       149.13
65222     Remove foreign body from eye           S            S          0698        1.2378        57.06        130.11       149.13
65235     Remove foreign body from eye           T            T          0233       14.6645        676.03      1,541.39     1,766.78
65260     Remove foreign body from eye           T            T          0236       16.9771        782.64      1,784.46     2,045.40
65265     Remove foreign body from eye           T            T          0237       28.7866       1,327.06     3,025.76     3,468.21
65270     Repair of eye wound                    T            T          0240       18.0194        830.69      1,894.02     2,170.98
65272     Repair of eye wound                    T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65273     Repair of eye wound                    C            C          0000        0.0000         0.00         0.00         0.00
65275     Repair of eye wound                    T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65280     Repair of eye wound                    T            T          0236       16.9771        782.64      1,784.46     2,045.40
65285     Repair of eye wound                    T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
65286     Repair of eye wound                    T            T          0232        6.9204        319.03       727.40       833.77
65290     Repair of eye socket wound             T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
65400     Removal of eye lesion                  T            T          0233       14.6645        676.03      1,541.39     1,766.78
65410     Biopsy of cornea                       T            T          0233       14.6645        676.03      1,541.39     1,766.78
65420     Removal of eye lesion                  T            T          0233       14.6645        676.03      1,541.39     1,766.78
65426     Removal of eye lesion                  T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65430     Corneal smear                          S            S          0698        1.2378        57.06        130.11       149.13
65435     Curette/treat cornea                   T            T          0239        7.0583        325.39       741.90       850.38
65436     Curette/treat cornea                   T            T          0233       14.6645        676.03      1,541.39     1,766.78
65450     Treatment of corneal lesion            S            S          0231        1.9167        88.36        201.46       230.92
65600     Revision of cornea                     T            T          0240       18.0194        830.69      1,894.02     2,170.98
65710     Corneal transplant                     T            T          0244       38.2309       1,762.44     4,018.45     4,606.06
65730     Corneal transplant                     T            T          0244       38.2309       1,762.44     4,018.45     4,606.06
65750     Corneal transplant                     T            T          0244       38.2309       1,762.44     4,018.45     4,606.06
65755     Corneal transplant                     T            T          0244       38.2309       1,762.44     4,018.45     4,606.06
65760     Revision of cornea                     E            1          0000        0.0000         0.00         0.00         0.00
65765     Revision of cornea                     E            1          0000        0.0000         0.00         0.00         0.00
65767     Corneal tissue transplant              E            1          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   69 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
65770     Revise cornea with implant             T            1          0000        0.0000         0.00         0.00         0.00
65771     Radial keratotomy                      E            1          0000        0.0000         0.00         0.00         0.00
65772     Correction of astigmatism              T            1          0000        0.0000         0.00         0.00         0.00
65775     Correction of astigmatism              T            1          0000        0.0000         0.00         0.00         0.00
65780     Ocular reconst, transplant             T            1          0000        0.0000         0.00         0.00         0.00
65781     Ocular reconst, transplant             T            1          0000        0.0000         0.00         0.00         0.00
65782     Ocular reconst, transplant             T            1          0000        0.0000         0.00         0.00         0.00
65800     Drainage of eye                        T            T          0233       14.6645        676.03      1,541.39     1,766.78
65805     Drainage of eye                        T            T          0233       14.6645        676.03      1,541.39     1,766.78
65810     Drainage of eye                        T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65815     Drainage of eye                        T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65820     Relieve inner eye pressure             T            T          0232        6.9204        319.03       727.40       833.77
65850     Incision of eye                        T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65855     Laser surgery of eye                   T            T          0247        5.0255        231.68       528.23       605.47
65860     Incise inner eye adhesions             T            T          0247        5.0255        231.68       528.23       605.47
65865     Incise inner eye adhesions             T            T          0233       14.6645        676.03      1,541.39     1,766.78
65870     Incise inner eye adhesions             T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65875     Incise inner eye adhesions             T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65880     Incise inner eye adhesions             T            T          0233       14.6645        676.03      1,541.39     1,766.78
65900     Remove eye lesion                      T            T          0233       14.6645        676.03      1,541.39     1,766.78
65920     Remove implant of eye                  T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
65930     Remove blood clot from eye             T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66020     Injection treatment of eye             T            T          0233       14.6645        676.03      1,541.39     1,766.78
66030     Injection treatment of eye             T            T          0232        6.9204        319.03       727.40       833.77
66130     Remove eye lesion                      T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66150     Glaucoma surgery                       T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66155     Glaucoma surgery                       T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66160     Glaucoma surgery                       T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66165     Glaucoma surgery                       T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66170     Glaucoma surgery                       T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66172     Incision of eye                        T            T          0673       29.0835       1,340.75     3,056.97     3,503.98
66180     Implant eye shunt                      T            T          0673       29.0835       1,340.75     3,056.97     3,503.98
66185     Revise eye shunt                       T            T          0673       29.0835       1,340.75     3,056.97     3,503.98
66220     Repair eye lesion                      T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
66225     Repair/graft eye lesion                T            T          0673       29.0835       1,340.75     3,056.97     3,503.98
66250     Follow-up surgery of eye               T            T          0233       14.6645        676.03      1,541.39     1,766.78
66500     Incision of iris                       T            T          0232        6.9204        319.03       727.40       833.77
66505     Incision of iris                       T            T          0232        6.9204        319.03       727.40       833.77
66600     Remove iris and lesion                 T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66605     Removal of iris                        T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66625     Removal of iris                        T            T          0232        6.9204        319.03       727.40       833.77
66630     Removal of iris                        T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66635     Removal of iris                        T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66680     Repair iris & ciliary body             T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66682     Repair iris & ciliary body             T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66700     Destruction, ciliary body              T            T          0233       14.6645        676.03      1,541.39     1,766.78
66710     Ciliary transsleral therapy            T            T          0233       14.6645        676.03      1,541.39     1,766.78
66711     Ciliary endoscopic ablation            T            T          0233       14.6645        676.03      1,541.39     1,766.78
66720     Destruction, ciliary body              T            T          0233       14.6645        676.03      1,541.39     1,766.78
66740     Destruction, ciliary body              T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66761     Revision of iris                       T            T          0247        5.0255        231.68       528.23       605.47
66762     Revision of iris                       T            T          0247        5.0255        231.68       528.23       605.47
66770     Removal of inner eye lesion            T            T          0247        5.0255        231.68       528.23       605.47
66820     Incision, secondary cataract           T            T          0232        6.9204        319.03       727.40       833.77
66821     After cataract laser surgery           T            T          0247        5.0255        231.68       528.23       605.47
66825     Reposition intraocular lens            T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
66830     Removal of lens lesion                 T            T          0232        6.9204        319.03       727.40       833.77
66840     Removal of lens material               T            T          0245       13.0344        600.89      1,370.05     1,570.38
66850     Removal of lens material               T            T          0249       27.6388       1,274.15     2,905.11     3,329.92
66852     Removal of lens material               T            T          0249       27.6388       1,274.15     2,905.11     3,329.92
66920     Extraction of lens                     T            T          0249       27.6388       1,274.15     2,905.11     3,329.92
66930     Extraction of lens                     T            T          0249       27.6388       1,274.15     2,905.11     3,329.92
66940     Extraction of lens                     T            T          0245       13.0344        600.89      1,370.05     1,570.38
66982     Cataract surgery, complex              T            T          0246       23.3185       1,074.98     2,451.01     2,809.41
66983     Cataract surg w/iol, 1 stage           T            T          0246       23.3185       1,074.98     2,451.01     2,809.41
66984     Cataract surg w/iol, 1 stage           T            T          0246       23.3185       1,074.98     2,451.01     2,809.41
66985     Insert lens prosthesis                 T            T          0246       23.3185       1,074.98     2,451.01     2,809.41
66986     Exchange lens prosthesis               T            T          0246       23.3185       1,074.98     2,451.01     2,809.41
66990     Ophthalmic endoscope add-on            N            N          0000        0.0000         0.00         0.00         0.00
66999     Eye surgery procedure                  T            1          0000        0.0000         0.00         0.00         0.00
67005     Partial removal of eye fluid           T            T          0237       28.7866       1,327.06     3,025.76     3,468.21
67010     Partial removal of eye fluid           T            T          0237       28.7866       1,327.06     3,025.76     3,468.21
67015     Release of eye fluid                   T            T          0237       28.7866       1,327.06     3,025.76     3,468.21
67025     Replace eye fluid                      T            T          0237       28.7866       1,327.06     3,025.76     3,468.21
67027     Implant eye drug system                T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67028     Injection eye drug                     T            T          0235        4.7925        220.93       503.74       577.40
67030     Incise inner eye strands               T            T          0236       16.9771        782.64      1,784.46     2,045.40

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   70 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
67031     Laser surgery, eye strands             T            T          0247        5.0255        231.68       528.23       605.47
67036     Removal of inner eye fluid             T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67038     Strip retinal membrane                 T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67039     Laser treatment of retina              T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67040     Laser treatment of retina              T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67101     Repair detached retina                 T            T          0236       16.9771        782.64      1,784.46     2,045.40
67105     Repair detached retina                 T            T          0248        4.7199        217.59       496.11       568.65
67107     Repair detached retina                 T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67108     Repair detached retina                 T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67110     Repair detached retina                 T            T          0236       16.9771        782.64      1,784.46     2,045.40
67112     Rerepair detached retina               T            T          0672       36.8773       1,700.04     3,876.17     4,442.98
67115     Release encircling material            T            T          0236       16.9771        782.64      1,784.46     2,045.40
67120     Remove eye implant material            T            T          0236       16.9771        782.64      1,784.46     2,045.40
67121     Remove eye implant material            T            T          0237       28.7866       1,327.06     3,025.76     3,468.21
67141     Treatment of retina                    T            T          0235        4.7925        220.93       503.74       577.40
67145     Treatment of retina                    T            T          0248        4.7199        217.59       496.11       568.65
67208     Treatment of retinal lesion            T            T          0236       16.9771        782.64      1,784.46     2,045.40
67210     Treatment of retinal lesion            T            T          0248        4.7199        217.59       496.11       568.65
67218     Treatment of retinal lesion            T            T          0236       16.9771        782.64      1,784.46     2,045.40
67220     Treatment of choroid lesion            T            T          0235        4.7925        220.93       503.74       577.40
67221     Ocular photodynamic ther               T            T          0235        4.7925        220.93       503.74       577.40
67225     Eye photodynamic ther add-on           T            T          0235        4.7925        220.93       503.74       577.40
67227     Treatment of retinal lesion            T            T          0236       16.9771        782.64      1,784.46     2,045.40
67228     Treatment of retinal lesion            T            T          0248        4.7199        217.59       496.11       568.65
67250     Reinforce eye wall                     T            T          0240       18.0194        830.69      1,894.02     2,170.98
67255     Reinforce/graft eye wall               T            T          0237       28.7866       1,327.06     3,025.76     3,468.21
67299     Eye surgery procedure                  T            1          0000        0.0000         0.00         0.00         0.00
67311     Revise eye muscle                      T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67312     Revise two eye muscles                 T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67314     Revise eye muscle                      T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67316     Revise two eye muscles                 T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67318     Revise eye muscle(s)                   T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67320     Revise eye muscle(s) add-on            T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67331     Eye surgery follow-up add-on           T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67332     Rerevise eye muscles add-on            T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67334     Revise eye muscle w/suture             T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67335     Eye suture during surgery              T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67340     Revise eye muscle add-on               T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67343     Release eye tissue                     T            T          0243       22.0338       1,015.76     2,315.97     2,654.63
67345     Destroy nerve of eye muscle            T            T          0238        2.6031        120.00       273.61       313.62
67350     Biopsy eye muscle                      T            1          0699        8.9556         0.00         0.00         0.00          X
67399     Eye muscle surgery procedure           T            1          0000        0.0000         0.00         0.00         0.00
67400     Explore/biopsy eye socket              T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67405     Explore/drain eye socket               T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67412     Explore/treat eye socket               T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67413     Explore/treat eye socket               T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67414     Explr/decompress eye socket            T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67415     Aspiration, orbital contents           T            T          0240       18.0194        830.69      1,894.02     2,170.98
67420     Explore/treat eye socket               T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67430     Explore/treat eye socket               T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67440     Explore/drain eye socket               T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67445     Explr/decompress eye socket            T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67450     Explore/biopsy eye socket              T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67500     Inject/treat eye socket                S            S          0231        1.9167        88.36        201.46       230.92
67505     Inject/treat eye socket                T            T          0238        2.6031        120.00       273.61       313.62
67515     Inject/treat eye socket                T            T          0238        2.6031        120.00       273.61       313.62
67550     Insert eye socket implant              T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67560     Revise eye socket implant              T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67570     Decompress optic nerve                 T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
67599     Orbit surgery procedure                T            1          0000        0.0000         0.00         0.00         0.00
67700     Drainage of eyelid abscess             T            T          0238        2.6031        120.00       273.61       313.62
67710     Incision of eyelid                     T            T          0239        7.0583        325.39       741.90       850.38
67715     Incision of eyelid fold                T            T          0240       18.0194        830.69      1,894.02     2,170.98
67800     Remove eyelid lesion                   T            T          0238        2.6031        120.00       273.61       313.62
67801     Remove eyelid lesions                  T            T          0239        7.0583        325.39       741.90       850.38
67805     Remove eyelid lesions                  T            T          0238        2.6031        120.00       273.61       313.62
67808     Remove eyelid lesion(s)                T            T          0240       18.0194        830.69      1,894.02     2,170.98
67810     Biopsy of eyelid                       T            T          0238        2.6031        120.00       273.61       313.62
67820     Revise eyelashes                       S            S          0698        1.2378        57.06        130.11       149.13
67825     Revise eyelashes                       T            T          0238        2.6031        120.00       273.61       313.62
67830     Revise eyelashes                       T            T          0239        7.0583        325.39       741.90       850.38
67835     Revise eyelashes                       T            T          0240       18.0194        830.69      1,894.02     2,170.98
67840     Remove eyelid lesion                   T            T          0239        7.0583        325.39       741.90       850.38
67850     Treat eyelid lesion                    T            T          0239        7.0583        325.39       741.90       850.38
67875     Closure of eyelid by suture            T            T          0239        7.0583        325.39       741.90       850.38
67880     Revision of eyelid                     T            T          0233       14.6645        676.03      1,541.39     1,766.78
67882     Revision of eyelid                     T            T          0240       18.0194        830.69      1,894.02     2,170.98

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   71 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
67900     Repair brow defect                     T            T          0240       18.0194        830.69      1,894.02     2,170.98
67901     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67902     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67903     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67904     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67906     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67908     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67909     Revise eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67911     Revise eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67912     Correction eyelid w/implant            T            T          0240       18.0194        830.69      1,894.02     2,170.98
67914     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67915     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67916     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67917     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67921     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67922     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67923     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67924     Repair eyelid defect                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
67930     Repair eyelid wound                    T            T          0240       18.0194        830.69      1,894.02     2,170.98
67935     Repair eyelid wound                    T            T          0240       18.0194        830.69      1,894.02     2,170.98
67938     Remove eyelid foreign body             S            S          0698        1.2378        57.06        130.11       149.13
67950     Revision of eyelid                     T            T          0240       18.0194        830.69      1,894.02     2,170.98
67961     Revision of eyelid                     T            T          0240       18.0194        830.69      1,894.02     2,170.98
67966     Revision of eyelid                     T            T          0240       18.0194        830.69      1,894.02     2,170.98
67971     Reconstruction of eyelid               T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67973     Reconstruction of eyelid               T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67974     Reconstruction of eyelid               T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
67975     Reconstruction of eyelid               T            T          0240       18.0194        830.69      1,894.02     2,170.98
67999     Revision of eyelid                     T            1          0000        0.0000         0.00         0.00         0.00
68020     Incise/drain eyelid lining             T            T          0240       18.0194        830.69      1,894.02     2,170.98
68040     Treatment of eyelid lesions            S            S          0698        1.2378        57.06        130.11       149.13
68100     Biopsy of eyelid lining                T            T          0232        6.9204        319.03       727.40       833.77
68110     Remove eyelid lining lesion            T            T          0699        8.9556        412.85       941.32      1,078.97
68115     Remove eyelid lining lesion            T            T          0240       18.0194        830.69      1,894.02     2,170.98
68130     Remove eyelid lining lesion            T            T          0233       14.6645        676.03      1,541.39     1,766.78
68135     Remove eyelid lining lesion            T            T          0239        7.0583        325.39       741.90       850.38
68200     Treat eyelid by injection              S            S          0230        0.7902        36.43        83.06        95.20
68320     Revise/graft eyelid lining             T            T          0240       18.0194        830.69      1,894.02     2,170.98
68325     Revise/graft eyelid lining             T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
68326     Revise/graft eyelid lining             T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68328     Revise/graft eyelid lining             T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68330     Revise eyelid lining                   T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
68335     Revise/graft eyelid lining             T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68340     Separate eyelid adhesions              T            T          0240       18.0194        830.69      1,894.02     2,170.98
68360     Revise eyelid lining                   T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
68362     Revise eyelid lining                   T            T          0234       22.0521       1,016.60     2,317.90     2,656.84
68371     Harvest eye tissue, alograft           T            1          0000        0.0000         0.00         0.00         0.00
68399     Eyelid lining surgery                  T            1          0000        0.0000         0.00         0.00         0.00
68400     Incise/drain tear gland                T            T          0238        2.6031        120.00       273.61       313.62
68420     Incise/drain tear sac                  T            T          0240       18.0194        830.69      1,894.02     2,170.98
68440     Incise tear duct opening               T            T          0238        2.6031        120.00       273.61       313.62
68500     Removal of tear gland                  T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68505     Partial removal, tear gland            T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68510     Biopsy of tear gland                   T            T          0240       18.0194        830.69      1,894.02     2,170.98
68520     Removal of tear sac                    T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68525     Biopsy of tear sac                     T            T          0240       18.0194        830.69      1,894.02     2,170.98
68530     Clearance of tear duct                 T            T          0240       18.0194        830.69      1,894.02     2,170.98
68540     Remove tear gland lesion               T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68550     Remove tear gland lesion               T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
68700     Repair tear ducts                      T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68705     Revise tear duct opening               T            T          0238        2.6031        120.00       273.61       313.62
68720     Create tear sac drain                  T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
68745     Create tear duct drain                 T            T          0241       23.1681       1,068.05     2,435.20     2,791.29
68750     Create tear duct drain                 T            T          0242       30.3478       1,399.03     3,189.86     3,656.30
68760     Close tear duct opening                S            S          0698        1.2378        57.06        130.11       149.13
68761     Close tear duct opening                S            S          0231        1.9167        88.36        201.46       230.92
68770     Close tear system fistula              T            T          0240       18.0194        830.69      1,894.02     2,170.98
68801     Dilate tear duct opening               S            S          0698        1.2378        57.06        130.11       149.13
68810     Probe nasolacrimal duct                S            S          0231        1.9167        88.36        201.46       230.92
68811     Probe nasolacrimal duct                T            T          0240       18.0194        830.69      1,894.02     2,170.98
68815     Probe nasolacrimal duct                T            T          0240       18.0194        830.69      1,894.02     2,170.98
68840     Explore/irrigate tear ducts            S            S          0231        1.9167        88.36        201.46       230.92
68850     Injection for tear sac x-ray           N            N          0000        0.0000         0.00         0.00         0.00
68899     Tear duct system surgery               S            1          0000        0.0000         0.00         0.00         0.00
69000     Drain external ear lesion              T            T          0006        1.5100        69.61        158.72       181.92
69005     Drain external ear lesion              T            T          0008       16.2953        751.21      1,712.80     1,963.26
69020     Drain outer ear canal lesion           T            T          0006        1.5100        69.61        158.72       181.92

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   72 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
69090     Pierce earlobes                        E            1          0000        0.0000         0.00         0.00         0.00
69100     Biopsy of external ear                 T            T          0019        4.1481        191.23       436.01       499.76
69105     Biopsy of external ear canal           T            T          0253       16.0740        741.01      1,689.54     1,936.60
69110     Remove external ear, partial           T            T          0021       14.9984        691.43      1,576.48     1,807.01
69120     Removal of external ear                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
69140     Remove ear canal lesion(s)             T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
69145     Remove ear canal lesion(s)             T            T          0021       14.9984        691.43      1,576.48     1,807.01
69150     Extensive ear canal surgery            T            T          0252        8.1033        373.56       851.74       976.29
69155     Extensive ear/neck surgery             C            C          0000        0.0000         0.00         0.00         0.00
69200     Clear outer ear canal                  X            X          0340        0.6137        28.29        64.51        73.94
69205     Clear outer ear canal                  T            T          0022       19.5716        902.25      2,057.17     2,357.99
69210     Remove impacted ear wax                X            X          0340        0.6137        28.29        64.51        73.94
69220     Clean out mastoid cavity               T            T          0012        0.8477        39.08        89.10        102.13
69222     Clean out mastoid cavity               T            T          0253       16.0740        741.01      1,689.54     1,936.60
69300     Revise external ear                    T            1          0000        0.0000         0.00         0.00         0.00
69310     Rebuild outer ear canal                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69320     Rebuild outer ear canal                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69399     Outer ear surgery procedure            T            1          0000        0.0000         0.00         0.00         0.00
69400     Inflate middle ear canal               T            T          0251        2.0789        95.84        218.51       250.47
69401     Inflate middle ear canal               T            T          0251        2.0789        95.84        218.51       250.47
69405     Catheterize middle ear canal           T            T          0252        8.1033        373.56       851.74       976.29
69420     Incision of eardrum                    T            T          0251        2.0789        95.84        218.51       250.47
69421     Incision of eardrum                    T            T          0253       16.0740        741.01      1,689.54     1,936.60
69424     Remove ventilating tube                T            T          0252        8.1033        373.56       851.74       976.29
69433     Create eardrum opening                 T            T          0252        8.1033        373.56       851.74       976.29
69436     Create eardrum opening                 T            T          0253       16.0740        741.01      1,689.54     1,936.60
69440     Exploration of middle ear              T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
69450     Eardrum revision                       T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69501     Mastoidectomy                          T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69502     Mastoidectomy                          T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
69505     Remove mastoid structures              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69511     Extensive mastoid surgery              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69530     Extensive mastoid surgery              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69535     Remove part of temporal bone           C            C          0000        0.0000         0.00         0.00         0.00
69540     Remove ear lesion                      T            T          0253       16.0740        741.01      1,689.54     1,936.60
69550     Remove ear lesion                      T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69552     Remove ear lesion                      T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69554     Remove ear lesion                      C            C          0000        0.0000         0.00         0.00         0.00
69601     Mastoid surgery revision               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69602     Mastoid surgery revision               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69603     Mastoid surgery revision               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69604     Mastoid surgery revision               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69605     Mastoid surgery revision               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69610     Repair of eardrum                      T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
69620     Repair of eardrum                      T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
69631     Repair eardrum structures              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69632     Rebuild eardrum structures             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69633     Rebuild eardrum structures             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69635     Repair eardrum structures              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69636     Rebuild eardrum structures             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69637     Rebuild eardrum structures             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69641     Revise middle ear & mastoid            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69642     Revise middle ear & mastoid            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69643     Revise middle ear & mastoid            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69644     Revise middle ear & mastoid            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69645     Revise middle ear & mastoid            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69646     Revise middle ear & mastoid            T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69650     Release middle ear bone                T            T          0254       23.3114       1,074.66     2,450.26     2,808.56
69660     Revise middle ear bone                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69661     Revise middle ear bone                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69662     Revise middle ear bone                 T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69666     Repair middle ear structures           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69667     Repair middle ear structures           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69670     Remove mastoid air cells               T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69676     Remove middle ear nerve                T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69700     Close mastoid fistula                  T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69710     Implant/replace hearing aid            E            3          0000        0.0000         M01          M01          M01
69711     Remove/repair hearing aid              T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69714     Implant temple bone w/stimul           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69715     Temple bne implnt w/stimulat           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69717     Temple bone implant revision           T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69718     Revise temple bone implant             T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69720     Release facial nerve                   T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69725     Release facial nerve                   T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69740     Repair facial nerve                    T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69745     Repair facial nerve                    T            T          0256       37.0000       1,705.70     3,889.07     4,457.76
69799     Middle ear surgery procedure           T            1          0000        0.0000         0.00         0.00         0.00

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   73 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
69801     Incise inner ear                       T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69802     Incise inner ear                       T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69805     Explore inner ear                      T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69806     Explore inner ear                      T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69820     Establish inner ear window             T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69840     Revise inner ear window                T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69905     Remove inner ear                       T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69910     Remove inner ear & mastoid             T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69915     Incise inner ear nerve                 T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69930     Implant cochlear device                T            T          0259      393.7337      18,151.12    41,385.35    47,437.04
69949     Inner ear surgery procedure            T            1          0000       0.0000          0.00         0.00         0.00
69950     Incise inner ear nerve                 C            C          0000       0.0000          0.00         0.00         0.00
69955     Release facial nerve                   T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69960     Release inner ear canal                T            T          0256      37.0000        1,705.70     3,889.07     4,457.76
69970     Remove inner ear lesion                C            C          0000       0.0000          0.00         0.00         0.00
69979     Temporal bone surgery                  T            1          0000       0.0000          0.00         0.00         0.00
69990     Microsurgery add-on                    N            N          0000       0.0000          0.00         0.00         0.00
70010     Contrast x-ray of brain                S            S          0274       2.9160         134.43       306.50       351.32
70015     Contrast x-ray of brain                S            S          0274       2.9160         134.43       306.50       351.32
70030     X-ray eye for foreign body             X            X          0260       0.7296         33.63        76.69        87.90
70100     X-ray exam of jaw                      X            X          0260       0.7296         33.63        76.69        87.90
70110     X-ray exam of jaw                      X            X          0260       0.7296         33.63        76.69        87.90
70120     X-ray exam of mastoids                 X            X          0260       0.7296         33.63        76.69        87.90
70130     X-ray exam of mastoids                 X            X          0260       0.7296         33.63        76.69        87.90
70134     X-ray exam of middle ear               X            X          0261       1.2416         57.24        130.50       149.59
70140     X-ray exam of facial bones             X            X          0260       0.7296         33.63        76.69        87.90
70150     X-ray exam of facial bones             X            X          0260       0.7296         33.63        76.69        87.90
70160     X-ray exam of nasal bones              X            X          0260       0.7296         33.63        76.69        87.90
70170     X-ray exam of tear duct                X            X          0264       3.4542         159.24       363.07       416.16
70190     X-ray exam of eye sockets              X            X          0260       0.7296         33.63        76.69        87.90
70200     X-ray exam of eye sockets              X            X          0260       0.7296         33.63        76.69        87.90
70210     X-ray exam of sinuses                  X            X          0260       0.7296         33.63        76.69        87.90
70220     X-ray exam of sinuses                  X            X          0260       0.7296         33.63        76.69        87.90
70240     X-ray exam, pituitary saddle           X            X          0260       0.7296         33.63        76.69        87.90
70250     X-ray exam of skull                    X            X          0260       0.7296         33.63        76.69        87.90
70260     X-ray exam of skull                    X            X          0261       1.2416         57.24        130.50       149.59
70300     X-ray exam of teeth                    X            X          0262       0.8019         36.97        84.29        96.61
70310     X-ray exam of teeth                    X            X          0262       0.8019         36.97        84.29        96.61
70320     Full mouth x-ray of teeth              X            X          0262       0.8019         36.97        84.29        96.61
70328     X-ray exam of jaw joint                X            X          0260       0.7296         33.63        76.69        87.90
70330     X-ray exam of jaw joints               X            X          0260       0.7296         33.63        76.69        87.90
70332     X-ray exam of jaw joint                S            S          0275       3.4927         161.01       367.12       420.80
70336     Magnetic image, jaw joint              S            S          0335       5.0997         235.10       536.03       614.41
70350     X-ray head for orthodontia             X            X          0260       0.7296         33.63        76.69        87.90
70355     Panoramic x-ray of jaws                X            X          0260       0.7296         33.63        76.69        87.90
70360     X-ray exam of neck                     X            X          0260       0.7296         33.63        76.69        87.90
70370     Throat x-ray & fluoroscopy             X            X          0272       1.3291         61.27        139.70       160.13
70371     Speech evaluation, complex             X            X          0272       1.3291         61.27        139.70       160.13
70373     Contrast x-ray of larynx               X            X          0263       1.6979         78.27        178.47       204.56
70380     X-ray exam of salivary gland           X            X          0260       0.7296         33.63        76.69        87.90
70390     X-ray exam of salivary duct            X            X          0263       1.6979         78.27        178.47       204.56
70450     Ct head/brain w/o dye                  S            S          0332       3.1608         145.71       332.23       380.81
70460     Ct head/brain w/dye                    S            S          0283       4.2921         197.87       451.14       517.11
70470     Ct head/brain w/o & w/dye              S            S          0333       5.1053         235.35       536.62       615.09
70480     Ct orbit/ear/fossa w/o dye             S            S          0332       3.1608         145.71       332.23       380.81
70481     Ct orbit/ear/fossa w/dye               S            S          0283       4.2921         197.87       451.14       517.11
70482     Ct orbit/ear/fossa w/o&w/dye           S            S          0333       5.1053         235.35       536.62       615.09
70486     Ct maxillofacial w/o dye               S            S          0332       3.1608         145.71       332.23       380.81
70487     Ct maxillofacial w/dye                 S            S          0283       4.2921         197.87       451.14       517.11
70488     Ct maxillofacial w/o & w/dye           S            S          0333       5.1053         235.35       536.62       615.09
70490     Ct soft tissue neck w/o dye            S            S          0332       3.1608         145.71       332.23       380.81
70491     Ct soft tissue neck w/dye              S            S          0283       4.2921         197.87       451.14       517.11
70492     Ct sft tsue nck w/o & w/dye            S            S          0333       5.1053         235.35       536.62       615.09
70496     Ct angiography, head                   S            S          0662       4.9944         230.24       524.96       601.73
70498     Ct angiography, neck                   S            S          0662       4.9944         230.24       524.96       601.73
70540     Mri orbit/face/neck w/o dye            S            S          0336       5.8678         270.51       616.76       706.95
70542     Mri orbit/face/neck w/dye              S            S          0284       6.2342         287.40       655.28       751.10
70543     Mri orbt/fac/nck w/o & w/dye           S            S          0337       8.5070         392.17       894.17      1,024.92
70544     Mr angiography head w/o dye            S            S          0336       5.8678         270.51       616.76       706.95
70545     Mr angiography head w/dye              S            S          0284       6.2342         287.40       655.28       751.10
70546     Mr angiograph head w/o&w/dye           S            S          0337       8.5070         392.17       894.17      1,024.92
70547     Mr angiography neck w/o dye            S            S          0336       5.8678         270.51       616.76       706.95
70548     Mr angiography neck w/dye              S            S          0284       6.2342         287.40       655.28       751.10
70549     Mr angiograph neck w/o&w/dye           S            S          0337       8.5070         392.17       894.17      1,024.92
70551     Mri brain w/o dye                      S            S          0336       5.8678         270.51       616.76       706.95
70552     Mri brain w/dye                        S            S          0284       6.2342         287.40       655.28       751.10
70553     Mri brain w/o & w/dye                  S            S          0337       8.5070         392.17       894.17      1,024.92

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   74 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
70557     Mri brain w/o dye                      S            S          0336       5.8678        270.51       616.76        706.95
70558     Mri brain w/dye                        S            S          0284       6.2342        287.40       655.28        751.10
70559     Mri brain w/o & w/dye                  S            S          0337       8.5070        392.17       894.17       1,024.92
71010     Chest x-ray                            X            X          0260       0.7296        33.63        76.69         87.90
71015     Chest x-ray                            X            X          0260       0.7296        33.63        76.69         87.90
71020     Chest x-ray                            X            X          0260       0.7296        33.63        76.69         87.90
71021     Chest x-ray                            X            X          0260       0.7296        33.63        76.69         87.90
71022     Chest x-ray                            X            X          0260       0.7296        33.63        76.69         87.90
71023     Chest x-ray and fluoroscopy            X            X          0272       1.3291        61.27        139.70        160.13
71030     Chest x-ray                            X            X          0260       0.7296        33.63        76.69         87.90
71034     Chest x-ray and fluoroscopy            X            X          0272       1.3291        61.27        139.70        160.13
71035     Chest x-ray                            X            X          0260       0.7296        33.63        76.69         87.90
71040     Contrast x-ray of bronchi              X            X          0263       1.6979        78.27        178.47        204.56
71060     Contrast x-ray of bronchi              X            X          0263       1.6979        78.27        178.47        204.56
71090     X-ray & pacemaker insertion            X            X          0272       1.3291        61.27        139.70        160.13
71100     X-ray exam of ribs                     X            X          0260       0.7296        33.63        76.69         87.90
71101     X-ray exam of ribs/chest               X            X          0260       0.7296        33.63        76.69         87.90
71110     X-ray exam of ribs                     X            X          0260       0.7296        33.63        76.69         87.90
71111     X-ray exam of ribs/chest               X            X          0261       1.2416        57.24        130.50        149.59
71120     X-ray exam of breastbone               X            X          0260       0.7296        33.63        76.69         87.90
71130     X-ray exam of breastbone               X            X          0260       0.7296        33.63        76.69         87.90
71250     Ct thorax w/o dye                      S            S          0332       3.1608        145.71       332.23        380.81
71260     Ct thorax w/dye                        S            S          0283       4.2921        197.87       451.14        517.11
71270     Ct thorax w/o & w/dye                  S            S          0333       5.1053        235.35       536.62        615.09
71275     Ct angiography, chest                  S            S          0662       4.9944        230.24       524.96        601.73
71550     Mri chest w/o dye                      S            S          0336       5.8678        270.51       616.76        706.95
71551     Mri chest w/dye                        S            S          0284       6.2342        287.40       655.28        751.10
71552     Mri chest w/o & w/dye                  S            S          0337       8.5070        392.17       894.17       1,024.92
71555     Mri angio chest w or w/o dye           B            B          0000       0.0000         0.00         0.00          0.00
72010     X-ray exam of spine                    X            X          0260       0.7296        33.63        76.69         87.90
72020     X-ray exam of spine                    X            X          0260       0.7296        33.63        76.69         87.90
72040     X-ray exam of neck spine               X            X          0260       0.7296        33.63        76.69         87.90
72050     X-ray exam of neck spine               X            X          0261       1.2416        57.24        130.50        149.59
72052     X-ray exam of neck spine               X            X          0261       1.2416        57.24        130.50        149.59
72069     X-ray exam of trunk spine              X            X          0260       0.7296        33.63        76.69         87.90
72070     X-ray exam of thoracic spine           X            X          0260       0.7296        33.63        76.69         87.90
72072     X-ray exam of thoracic spine           X            X          0260       0.7296        33.63        76.69         87.90
72074     X-ray exam of thoracic spine           X            X          0260       0.7296        33.63        76.69         87.90
72080     X-ray exam of trunk spine              X            X          0260       0.7296        33.63        76.69         87.90
72090     X-ray exam of trunk spine              X            X          0261       1.2416        57.24        130.50        149.59
72100     X-ray exam of lower spine              X            X          0260       0.7296        33.63        76.69         87.90
72110     X-ray exam of lower spine              X            X          0261       1.2416        57.24        130.50        149.59
72114     X-ray exam of lower spine              X            X          0261       1.2416        57.24        130.50        149.59
72120     X-ray exam of lower spine              X            X          0261       1.2416        57.24        130.50        149.59
72125     Ct neck spine w/o dye                  S            S          0332       3.1608        145.71       332.23        380.81
72126     Ct neck spine w/dye                    S            S          0283       4.2921        197.87       451.14        517.11
72127     Ct neck spine w/o & w/dye              S            S          0333       5.1053        235.35       536.62        615.09
72128     Ct chest spine w/o dye                 S            S          0332       3.1608        145.71       332.23        380.81
72129     Ct chest spine w/dye                   S            S          0283       4.2921        197.87       451.14        517.11
72130     Ct chest spine w/o & w/dye             S            S          0333       5.1053        235.35       536.62        615.09
72131     Ct lumbar spine w/o dye                S            S          0332       3.1608        145.71       332.23        380.81
72132     Ct lumbar spine w/dye                  S            S          0283       4.2921        197.87       451.14        517.11
72133     Ct lumbar spine w/o & w/dye            S            S          0333       5.1053        235.35       536.62        615.09
72141     Mri neck spine w/o dye                 S            S          0336       5.8678        270.51       616.76        706.95
72142     Mri neck spine w/dye                   S            S          0284       6.2342        287.40       655.28        751.10
72146     Mri chest spine w/o dye                S            S          0336       5.8678        270.51       616.76        706.95
72147     Mri chest spine w/dye                  S            S          0284       6.2342        287.40       655.28        751.10
72148     Mri lumbar spine w/o dye               S            S          0336       5.8678        270.51       616.76        706.95
72149     Mri lumbar spine w/dye                 S            S          0284       6.2342        287.40       655.28        751.10
72156     Mri neck spine w/o & w/dye             S            S          0337       8.5070        392.17       894.17       1,024.92
72157     Mri chest spine w/o & w/dye            S            S          0337       8.5070        392.17       894.17       1,024.92
72158     Mri lumbar spine w/o & w/dye           S            S          0337       8.5070        392.17       894.17       1,024.92
72159     Mr angio spine w/o&w/dye               E            3          0000       0.0000         M01          M01           M01
72170     X-ray exam of pelvis                   X            X          0260       0.7296        33.63        76.69         87.90
72190     X-ray exam of pelvis                   X            X          0260       0.7296        33.63        76.69         87.90
72191     Ct angiograph pelv w/o&w/dye           S            S          0662       4.9944        230.24       524.96        601.73
72192     Ct pelvis w/o dye                      S            S          0332       3.1608        145.71       332.23        380.81
72193     Ct pelvis w/dye                        S            S          0283       4.2921        197.87       451.14        517.11
72194     Ct pelvis w/o & w/dye                  S            S          0333       5.1053        235.35       536.62        615.09
72195     Mri pelvis w/o dye                     S            S          0336       5.8678        270.51       616.76        706.95
72196     Mri pelvis w/dye                       S            S          0284       6.2342        287.40       655.28        751.10
72197     Mri pelvis w/o & w/dye                 S            S          0337       8.5070        392.17       894.17       1,024.92
72198     Mr angio pelvis w/o & w/dye            B            B          0000       0.0000         0.00         0.00          0.00
72200     X-ray exam sacroiliac joints           X            X          0260       0.7296        33.63        76.69         87.90
72202     X-ray exam sacroiliac joints           X            X          0260       0.7296        33.63        76.69         87.90
72220     X-ray exam of tailbone                 X            X          0260       0.7296        33.63        76.69         87.90
72240     Contrast x-ray of neck spine           S            S          0274       2.9160        134.43       306.50        351.32

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   75 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
72255     Contrast x-ray, thorax spine           S            S          0274        2.9160       134.43        306.50       351.32
72265     Contrast x-ray, lower spine            S            S          0274        2.9160       134.43        306.50       351.32
72270     Contrast x-ray, spine                  S            S          0274        2.9160       134.43        306.50       351.32
72275     Epidurography                          S            S          0274        2.9160       134.43        306.50       351.32
72285     X-ray c/t spine disk                   S            S          0388       12.1712       561.09       1,279.31     1,466.39
72295     X-ray of lower spine disk              S            S          0388       12.1712       561.09       1,279.31     1,466.39
73000     X-ray exam of collar bone              X            X          0260        0.7296       33.63         76.69        87.90
73010     X-ray exam of shoulder blade           X            X          0260        0.7296       33.63         76.69        87.90
73020     X-ray exam of shoulder                 X            X          0260        0.7296       33.63         76.69        87.90
73030     X-ray exam of shoulder                 X            X          0260        0.7296       33.63         76.69        87.90
73040     Contrast x-ray of shoulder             S            S          0275        3.4927       161.01        367.12       420.80
73050     X-ray exam of shoulders                X            X          0260        0.7296       33.63         76.69        87.90
73060     X-ray exam of humerus                  X            X          0260        0.7296       33.63         76.69        87.90
73070     X-ray exam of elbow                    X            X          0260        0.7296       33.63         76.69        87.90
73080     X-ray exam of elbow                    X            X          0260        0.7296       33.63         76.69        87.90
73085     Contrast x-ray of elbow                S            S          0275        3.4927       161.01        367.12       420.80
73090     X-ray exam of forearm                  X            X          0260        0.7296       33.63         76.69        87.90
73092     X-ray exam of arm, infant              X            X          0260        0.7296       33.63         76.69        87.90
73100     X-ray exam of wrist                    X            X          0260        0.7296       33.63         76.69        87.90
73110     X-ray exam of wrist                    X            X          0260        0.7296       33.63         76.69        87.90
73115     Contrast x-ray of wrist                S            S          0275        3.4927       161.01        367.12       420.80
73120     X-ray exam of hand                     X            X          0260        0.7296       33.63         76.69        87.90
73130     X-ray exam of hand                     X            X          0260        0.7296       33.63         76.69        87.90
73140     X-ray exam of finger(s)                X            X          0260        0.7296       33.63         76.69        87.90
73200     Ct upper extremity w/o dye             S            S          0332        3.1608       145.71        332.23       380.81
73201     Ct upper extremity w/dye               S            S          0283        4.2921       197.87        451.14       517.11
73202     Ct uppr extremity w/o&w/dye            S            S          0333        5.1053       235.35        536.62       615.09
73206     Ct angio upr extrm w/o&w/dye           S            S          0662        4.9944       230.24        524.96       601.73
73218     Mri upper extremity w/o dye            S            S          0336        5.8678       270.51        616.76       706.95
73219     Mri upper extremity w/dye              S            S          0284        6.2342       287.40        655.28       751.10
73220     Mri uppr extremity w/o&w/dye           S            S          0337        8.5070       392.17        894.17      1,024.92
73221     Mri joint upr extrem w/o dye           S            S          0336        5.8678       270.51        616.76       706.95
73222     Mri joint upr extrem w/dye             S            S          0284        6.2342       287.40        655.28       751.10
73223     Mri joint upr extr w/o&w/dye           S            S          0337        8.5070       392.17        894.17      1,024.92
73225     Mr angio upr extr w/o&w/dye            E            3          0000        0.0000        M01           M01          M01
73500     X-ray exam of hip                      X            X          0260        0.7296       33.63         76.69        87.90
73510     X-ray exam of hip                      X            X          0260        0.7296       33.63         76.69        87.90
73520     X-ray exam of hips                     X            X          0261        1.2416       57.24         130.50       149.59
73525     Contrast x-ray of hip                  S            S          0275        3.4927       161.01        367.12       420.80
73530     X-ray exam of hip                      X            X          0261        1.2416       57.24         130.50       149.59
73540     X-ray exam of pelvis & hips            X            X          0260        0.7296       33.63         76.69        87.90
73542     X-ray exam, sacroiliac joint           S            S          0275        3.4927       161.01        367.12       420.80
73550     X-ray exam of thigh                    X            X          0260        0.7296       33.63         76.69        87.90
73560     X-ray exam of knee, 1 or 2             X            X          0260        0.7296       33.63         76.69        87.90
73562     X-ray exam of knee, 3                  X            X          0260        0.7296       33.63         76.69        87.90
73564     X-ray exam, knee, 4 or more            X            X          0260        0.7296       33.63         76.69        87.90
73565     X-ray exam of knees                    X            X          0260        0.7296       33.63         76.69        87.90
73580     Contrast x-ray of knee joint           S            S          0275        3.4927       161.01        367.12       420.80
73590     X-ray exam of lower leg                X            X          0260        0.7296       33.63         76.69        87.90
73592     X-ray exam of leg, infant              X            X          0260        0.7296       33.63         76.69        87.90
73600     X-ray exam of ankle                    X            X          0260        0.7296       33.63         76.69        87.90
73610     X-ray exam of ankle                    X            X          0260        0.7296       33.63         76.69        87.90
73615     Contrast x-ray of ankle                S            S          0275        3.4927       161.01        367.12       420.80
73620     X-ray exam of foot                     X            X          0260        0.7296       33.63         76.69        87.90
73630     X-ray exam of foot                     X            X          0260        0.7296       33.63         76.69        87.90
73650     X-ray exam of heel                     X            X          0260        0.7296       33.63         76.69        87.90
73660     X-ray exam of toe(s)                   X            X          0260        0.7296       33.63         76.69        87.90
73700     Ct lower extremity w/o dye             S            S          0332        3.1608       145.71        332.23       380.81
73701     Ct lower extremity w/dye               S            S          0283        4.2921       197.87        451.14       517.11
73702     Ct lwr extremity w/o&w/dye             S            S          0333        5.1053       235.35        536.62       615.09
73706     Ct angio lwr extr w/o&w/dye            S            S          0662        4.9944       230.24        524.96       601.73
73718     Mri lower extremity w/o dye            S            S          0336        5.8678       270.51        616.76       706.95
73719     Mri lower extremity w/dye              S            S          0284        6.2342       287.40        655.28       751.10
73720     Mri lwr extremity w/o&w/dye            S            S          0337        8.5070       392.17        894.17      1,024.92
73721     Mri jnt of lwr extre w/o dye           S            S          0336        5.8678       270.51        616.76       706.95
73722     Mri joint of lwr extr w/dye            S            S          0284        6.2342       287.40        655.28       751.10
73723     Mri joint lwr extr w/o&w/dye           S            S          0337        8.5070       392.17        894.17      1,024.92
73725     Mr ang lwr ext w or w/o dye            B            B          0000        0.0000        0.00          0.00         0.00
74000     X-ray exam of abdomen                  X            X          0260        0.7296       33.63         76.69        87.90
74010     X-ray exam of abdomen                  X            X          0260        0.7296       33.63         76.69        87.90
74020     X-ray exam of abdomen                  X            X          0260        0.7296       33.63         76.69        87.90
74022     X-ray exam series, abdomen             X            X          0261        1.2416       57.24         130.50       149.59
74150     Ct abdomen w/o dye                     S            S          0332        3.1608       145.71        332.23       380.81
74160     Ct abdomen w/dye                       S            S          0283        4.2921       197.87        451.14       517.11
74170     Ct abdomen w/o & w/dye                 S            S          0333        5.1053       235.35        536.62       615.09
74175     Ct angio abdom w/o & w/dye             S            S          0662        4.9944       230.24        524.96       601.73
74181     Mri abdomen w/o dye                    S            S          0336        5.8678       270.51        616.76       706.95

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   76 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
74182     Mri abdomen w/dye                      S            S          0284        6.2342       287.40        655.28       751.10
74183     Mri abdomen w/o & w/dye                S            S          0337        8.5070       392.17        894.17      1,024.92
74185     Mri angio, abdom w orw/o dye           B            B          0000        0.0000        0.00          0.00         0.00
74190     X-ray exam of peritoneum               X            X          0264        3.4542       159.24        363.07       416.16
74210     Contrst x-ray exam of throat           S            S          0276        1.4693       67.73         154.44       177.02
74220     Contrast x-ray, esophagus              S            S          0276        1.4693       67.73         154.44       177.02
74230     Cine/vid x-ray, throat/esoph           S            S          0276        1.4693       67.73         154.44       177.02
74235     Remove esophagus obstruction           S            S          0296        2.2684       104.57        238.43       273.30
74240     X-ray exam, upper gi tract             S            S          0276        1.4693       67.73         154.44       177.02
74241     X-ray exam, upper gi tract             S            S          0276        1.4693       67.73         154.44       177.02
74245     X-ray exam, upper gi tract             S            S          0277        2.2951       105.80        241.24       276.51
74246     Contrst x-ray uppr gi tract            S            S          0276        1.4693       67.73         154.44       177.02
74247     Contrst x-ray uppr gi tract            S            S          0276        1.4693       67.73         154.44       177.02
74249     Contrst x-ray uppr gi tract            S            S          0277        2.2951       105.80        241.24       276.51
74250     X-ray exam of small bowel              S            S          0276        1.4693       67.73         154.44       177.02
74251     X-ray exam of small bowel              S            S          0277        2.2951       105.80        241.24       276.51
74260     X-ray exam of small bowel              S            S          0277        2.2951       105.80        241.24       276.51
74270     Contrast x-ray exam of colon           S            S          0276        1.4693       67.73         154.44       177.02
74280     Contrast x-ray exam of colon           S            S          0277        2.2951       105.80        241.24       276.51
74283     Contrast x-ray exam of colon           S            S          0276        1.4693       67.73         154.44       177.02
74290     Contrast x-ray, gallbladder            S            S          0276        1.4693       67.73         154.44       177.02
74291     Contrast x-rays, gallbladder           S            S          0276        1.4693       67.73         154.44       177.02
74300     X-ray bile ducts/pancreas              X            X          0263        1.6979       78.27         178.47       204.56
74301     X-rays at surgery add-on               X            X          0263        1.6979       78.27         178.47       204.56
74305     X-ray bile ducts/pancreas              X            X          0263        1.6979       78.27         178.47       204.56
74320     Contrast x-ray of bile ducts           X            X          0264        3.4542       159.24        363.07       416.16
74327     X-ray bile stone removal               S            S          0296        2.2684       104.57        238.43       273.30
74328     X-ray bile duct endoscopy              N            N          0000        0.0000        0.00          0.00         0.00
74329     X-ray for pancreas endoscopy           N            N          0000        0.0000        0.00          0.00         0.00
74330     X-ray bile/panc endoscopy              N            N          0000        0.0000        0.00          0.00         0.00
74340     X-ray guide for GI tube                X            X          0272        1.3291       61.27         139.70       160.13
74350     X-ray guide, stomach tube              X            X          0263        1.6979       78.27         178.47       204.56
74355     X-ray guide, intestinal tube           X            X          0263        1.6979       78.27         178.47       204.56
74360     X-ray guide, GI dilation               S            S          0296        2.2684       104.57        238.43       273.30
74363     X-ray, bile duct dilation              S            S          0297        5.0977       235.00        535.82       614.17
74400     Contrst x-ray, urinary tract           S            S          0278        2.5559       117.83        268.65       307.93
74410     Contrst x-ray, urinary tract           S            S          0278        2.5559       117.83        268.65       307.93
74415     Contrst x-ray, urinary tract           S            S          0278        2.5559       117.83        268.65       307.93
74420     Contrst x-ray, urinary tract           S            S          0278        2.5559       117.83        268.65       307.93
74425     Contrst x-ray, urinary tract           S            S          0278        2.5559       117.83        268.65       307.93
74430     Contrast x-ray, bladder                S            S          0278        2.5559       117.83        268.65       307.93
74440     X-ray, male genital tract              S            S          0278        2.5559       117.83        268.65       307.93
74445     X-ray exam of penis                    S            S          0278        2.5559       117.83        268.65       307.93
74450     X-ray, urethra/bladder                 S            S          0278        2.5559       117.83        268.65       307.93
74455     X-ray, urethra/bladder                 S            S          0278        2.5559       117.83        268.65       307.93
74470     X-ray exam of kidney lesion            X            X          0263        1.6979       78.27         178.47       204.56
74475     X-ray control, cath insert             S            S          0297        5.0977       235.00        535.82       614.17
74480     X-ray control, cath insert             S            S          0296        2.2684       104.57        238.43       273.30
74485     X-ray guide, GU dilation               S            S          0296        2.2684       104.57        238.43       273.30
74710     X-ray measurement of pelvis            X            X          0261        1.2416       57.24         130.50       149.59
74740     X-ray, female genital tract            X            X          0264        3.4542       159.24        363.07       416.16
74742     X-ray, fallopian tube                  X            X          0264        3.4542       159.24        363.07       416.16
74775     X-ray exam of perineum                 S            S          0278        2.5559       117.83        268.65       307.93
75552     Heart mri for morph w/o dye            S            S          0336        5.8678       270.51        616.76       706.95
75553     Heart mri for morph w/dye              S            S          0284        6.2342       287.40        655.28       751.10
75554     Cardiac MRI/function                   S            S          0336        5.8678       270.51        616.76       706.95
75555     Cardiac MRI/limited study              S            S          0336        5.8678       270.51        616.76       706.95
75556     Cardiac MRI/flow mapping               E            3          0000        0.0000        M01           M01          M01
75600     Contrast x-ray exam of aorta           S            S          0280       20.4187       941.30       2,146.21     2,460.04
75605     Contrast x-ray exam of aorta           S            S          0280       20.4187       941.30       2,146.21     2,460.04
75625     Contrast x-ray exam of aorta           S            S          0280       20.4187       941.30       2,146.21     2,460.04
75630     X-ray aorta, leg arteries              S            S          0280       20.4187       941.30       2,146.21     2,460.04
75635     Ct angio abdominal arteries            S            S          0662        4.9944       230.24        524.96       601.73
75650     Artery x-rays, head & neck             S            S          0280       20.4187       941.30       2,146.21     2,460.04
75658     Artery x-rays, arm                     S            S          0279        8.6988       401.01        914.33      1,048.03
75660     Artery x-rays, head & neck             S            S          0668        6.3104       290.91        663.29       760.28
75662     Artery x-rays, head & neck             S            S          0280       20.4187       941.30       2,146.21     2,460.04
75665     Artery x-rays, head & neck             S            S          0280       20.4187       941.30       2,146.21     2,460.04
75671     Artery x-rays, head & neck             S            S          0280       20.4187       941.30       2,146.21     2,460.04
75676     Artery x-rays, neck                    S            S          0280       20.4187       941.30       2,146.21     2,460.04
75680     Artery x-rays, neck                    S            S          0280       20.4187       941.30       2,146.21     2,460.04
75685     Artery x-rays, spine                   S            S          0280       20.4187       941.30       2,146.21     2,460.04
75705     Artery x-rays, spine                   S            S          0668        6.3104       290.91        663.29       760.28
75710     Artery x-rays, arm/leg                 S            S          0280       20.4187       941.30       2,146.21     2,460.04
75716     Artery x-rays, arms/legs               S            S          0280       20.4187       941.30       2,146.21     2,460.04
75722     Artery x-rays, kidney                  S            S          0280       20.4187       941.30       2,146.21     2,460.04
75724     Artery x-rays, kidneys                 S            S          0280       20.4187       941.30       2,146.21     2,460.04

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   77 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
75726     Artery x-rays, abdomen                 S            S          0280       20.4187       941.30       2,146.21     2,460.04
75731     Artery x-rays, adrenal gland           S            S          0280       20.4187       941.30       2,146.21     2,460.04
75733     Artery x-rays, adrenals                S            S          0668        6.3104       290.91        663.29       760.28
75736     Artery x-rays, pelvis                  S            S          0280       20.4187       941.30       2,146.21     2,460.04
75741     Artery x-rays, lung                    S            S          0279        8.6988       401.01        914.33      1,048.03
75743     Artery x-rays, lungs                   S            S          0280       20.4187       941.30       2,146.21     2,460.04
75746     Artery x-rays, lung                    S            S          0279        8.6988       401.01        914.33      1,048.03
75756     Artery x-rays, chest                   S            S          0279        8.6988       401.01        914.33      1,048.03
75774     Artery x-ray, each vessel              S            S          0279        8.6988       401.01        914.33      1,048.03
75790     Visualize A-V shunt                    S            S          0279        8.6988       401.01        914.33      1,048.03
75801     Lymph vessel x-ray, arm/leg            X            X          0264        3.4542       159.24        363.07       416.16
75803     Lymph vessel x-ray,arms/legs           X            X          0264        3.4542       159.24        363.07       416.16
75805     Lymph vessel x-ray, trunk              X            X          0264        3.4542       159.24        363.07       416.16
75807     Lymph vessel x-ray, trunk              X            X          0264        3.4542       159.24        363.07       416.16
75809     Nonvascular shunt, x-ray               X            X          0263        1.6979       78.27         178.47       204.56
75810     Vein x-ray, spleen/liver               S            S          0279        8.6988       401.01        914.33      1,048.03
75820     Vein x-ray, arm/leg                    S            S          0668        6.3104       290.91        663.29       760.28
75822     Vein x-ray, arms/legs                  S            S          0668        6.3104       290.91        663.29       760.28
75825     Vein x-ray, trunk                      S            S          0279        8.6988       401.01        914.33      1,048.03
75827     Vein x-ray, chest                      S            S          0279        8.6988       401.01        914.33      1,048.03
75831     Vein x-ray, kidney                     S            S          0279        8.6988       401.01        914.33      1,048.03
75833     Vein x-ray, kidneys                    S            S          0279        8.6988       401.01        914.33      1,048.03
75840     Vein x-ray, adrenal gland              S            S          0280       20.4187       941.30       2,146.21     2,460.04
75842     Vein x-ray, adrenal glands             S            S          0280       20.4187       941.30       2,146.21     2,460.04
75860     Vein x-ray, neck                       S            S          0668        6.3104       290.91        663.29       760.28
75870     Vein x-ray, skull                      S            S          0668        6.3104       290.91        663.29       760.28
75872     Vein x-ray, skull                      S            S          0279        8.6988       401.01        914.33      1,048.03
75880     Vein x-ray, eye socket                 S            S          0668        6.3104       290.91        663.29       760.28
75885     Vein x-ray, liver                      S            S          0280       20.4187       941.30       2,146.21     2,460.04
75887     Vein x-ray, liver                      S            S          0279        8.6988       401.01        914.33      1,048.03
75889     Vein x-ray, liver                      S            S          0280       20.4187       941.30       2,146.21     2,460.04
75891     Vein x-ray, liver                      S            S          0279        8.6988       401.01        914.33      1,048.03
75893     Venous sampling by catheter            N            N          0000        0.0000        0.00          0.00         0.00
75894     X-rays, transcath therapy              S            S          0297        5.0977       235.00        535.82       614.17
75896     X-rays, transcath therapy              S            S          0297        5.0977       235.00        535.82       614.17
75898     Follow-up angiography                  X            X          0263        1.6979       78.27         178.47       204.56
75900     Arterial catheter exchange             C            C          0000        0.0000        0.00          0.00         0.00
75901     Remove cva device obstruct             X            X          0263        1.6979       78.27         178.47       204.56
75902     Remove cva lumen obstruct              X            X          0263        1.6979       78.27         178.47       204.56
75940     X-ray placement, vein filter           S            S          0297        5.0977       235.00        535.82       614.17
75945     Intravascular us                       S            S          0267        2.5543       117.75        268.48       307.74
75946     Intravascular us add-on                S            S          0266        1.5883       73.22         166.95       191.36
75952     Endovasc repair abdom aorta            C            C          0000        0.0000        0.00          0.00         0.00
75953     Abdom aneurysm endovas rpr             C            C          0000        0.0000        0.00          0.00         0.00
75954     Iliac aneurysm endovas rpr             C            C          0000        0.0000        0.00          0.00         0.00
75956     Xray, endovasc thor ao repr            C            C          0000        0.0000        0.00          0.00         0.00
75957     Xray, endovasc thor ao repr            C            C          0000        0.0000        0.00          0.00         0.00
75958     Xray, place prox ext thor ao           C            C          0000        0.0000        0.00          0.00         0.00
75959     Xray, place dist ext thor ao           C            C          0000        0.0000        0.00          0.00         0.00
75960     Transcath iv stent rs&i                S            S          0668        6.3104       290.91        663.29       760.28
75961     Retrieval, broken catheter             S            S          0668        6.3104       290.91        663.29       760.28
75962     Repair arterial blockage               S            S          0668        6.3104       290.91        663.29       760.28
75964     Repair artery blockage, each           S            S          0668        6.3104       290.91        663.29       760.28
75966     Repair arterial blockage               S            S          0668        6.3104       290.91        663.29       760.28
75968     Repair artery blockage, each           S            S          0668        6.3104       290.91        663.29       760.28
75970     Vascular biopsy                        S            S          0668        6.3104       290.91        663.29       760.28
75978     Repair venous blockage                 S            S          0668        6.3104       290.91        663.29       760.28
75980     Contrast xray exam bile duct           S            S          0297        5.0977       235.00        535.82       614.17
75982     Contrast xray exam bile duct           S            S          0297        5.0977       235.00        535.82       614.17
75984     Xray control catheter change           X            X          0263        1.6979       78.27         178.47       204.56
75989     Abscess drainage under x-ray           N            N          0000        0.0000        0.00          0.00         0.00
75992     Atherectomy, x-ray exam                S            S          0279        8.6988       401.01        914.33      1,048.03
75993     Atherectomy, x-ray exam                S            S          0279        8.6988       401.01        914.33      1,048.03
75994     Atherectomy, x-ray exam                S            S          0279        8.6988       401.01        914.33      1,048.03
75995     Atherectomy, x-ray exam                S            S          0279        8.6988       401.01        914.33      1,048.03
75996     Atherectomy, x-ray exam                S            S          0279        8.6988       401.01        914.33      1,048.03
75998     Fluoroguide for vein device            N            1          0000        0.0000        0.00          0.00         0.00          X
76000     Fluoroscope examination                X            X          0272        1.3291       61.27         139.70       160.13
76001     Fluoroscope exam, extensive            N            N          0000        0.0000        0.00          0.00         0.00
76003     Needle localization by x-ray           N            1          0000        0.0000        0.00          0.00         0.00          X
76005     Fluoroguide for spine inject           N            1          0000        0.0000        0.00          0.00         0.00          X
76006     X-ray stress view                      X            1          0260        0.7296        0.00          0.00         0.00          X
76010     X-ray, nose to rectum                  X            X          0260        0.7296       33.63         76.69        87.90
76012     Percut vertebroplasty fluor            S            1          0274        2.9160        0.00          0.00         0.00          X
76013     Percut vertebroplasty, ct              S            1          0274        2.9160        0.00          0.00         0.00          X
76020     X-rays for bone age                    X            1          0260        0.7296        0.00          0.00         0.00          X
76040     X-rays, bone evaluation                X            1          0261        1.2416        0.00          0.00         0.00          X

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   78 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
76061     X-rays, bone survey                    X            1          0261       1.2416         0.00         0.00         0.00           X
76062     X-rays, bone survey                    X            1          0261       1.2416         0.00         0.00         0.00           X
76065     X-rays, bone evaluation                X            1          0261       1.2416         0.00         0.00         0.00           X
76066     Joint survey, single view              X            1          0260       0.7296         0.00         0.00         0.00           X
76070     Ct bone density, axial                 S            1          0288       1.2216         0.00         0.00         0.00           X
76071     Ct bone density, peripheral            S            1          0282       1.5934         0.00         0.00         0.00           X
76075     Dxa bone density, axial                S            1          0288       1.2216         0.00         0.00         0.00           X
76076     Dxa bone density/peripheral            S            1          0665       0.6381         0.00         0.00         0.00           X
76077     Dxa bone density/v-fracture            X            1          0260       0.7296         0.00         0.00         0.00           X
76078     Radiographic absorptiometry            X            1          0260       0.7296         0.00         0.00         0.00           X
76080     X-ray exam of fistula                  X            X          0263       1.6979        78.27        178.47       204.56
76082     Computer mammogram add-on              A            1          0000       0.0000         0.00         0.00         0.00           X
76083     Computer mammogram add-on              A            1          0000       0.0000         0.00         0.00         0.00           X
76086     X-ray of mammary duct                  X            1          0263       1.6979         0.00         0.00         0.00           X
76088     X-ray of mammary ducts                 X            1          0263       1.6979         0.00         0.00         0.00           X
76090     Mammogram, one breast                  A            1          0000       0.0000         0.00         0.00         0.00           X
76091     Mammogram, both breasts                A            1          0000       0.0000         0.00         0.00         0.00           X
76092     Mammogram, screening                   A            1          0000       0.0000         0.00         0.00         0.00           X
76093     Magnetic image, breast                 B            1          0000       0.0000         0.00         0.00         0.00           X
76094     Magnetic image, both breasts           B            1          0000       0.0000         0.00         0.00         0.00           X
76095     Stereotactic breast biopsy             X            1          0264       3.4542         0.00         0.00         0.00           X
76096     X-ray of needle wire, breast           X            1          0263       1.6979         0.00         0.00         0.00           X
76098     X-ray exam, breast specimen            X            X          0260       0.7296        33.63        76.69        87.90
76100     X-ray exam of body section             X            X          0261       1.2416        57.24        130.50       149.59
76101     Complex body section x-ray             X            X          0263       1.6979        78.27        178.47       204.56
76102     Complex body section x-rays            X            X          0264       3.4542        159.24       363.07       416.16
76120     Cine/video x-rays                      X            X          0272       1.3291        61.27        139.70       160.13
76125     Cine/video x-rays add-on               X            X          0260       0.7296        33.63        76.69        87.90
76140     X-ray consultation                     E            1          0000       0.0000         0.00         0.00         0.00
76150     X-ray exam, dry process                X            X          0260       0.7296        33.63        76.69        87.90
76350     Special x-ray contrast study           N            N          0000       0.0000         0.00         0.00         0.00
76355     Ct scan for localization               S            1          0283       4.2921         0.00         0.00         0.00           X
76360     Ct scan for needle biopsy              S            1          0283       4.2921         0.00         0.00         0.00           X
76362     Ct guide for tissue ablation           S            1          0333       5.1053         0.00         0.00         0.00           X
76370     Ct scan for therapy guide              S            1          0282       1.5934         0.00         0.00         0.00           X
76376     3d render w/o postprocess              X            X          0340       0.6137        28.29        64.51        73.94
76377     3d rendering w/postprocess             S            S          0282       1.5934        73.46        167.48       191.97
76380     CAT scan follow-up study               S            S          0282       1.5934        73.46        167.48       191.97
76390     Mr spectroscopy                        E            3          0000       0.0000         M01          M01          M01
76393     Mr guidance for needle place           S            1          0335       5.0997         0.00         0.00         0.00           X
76394     Mri for tissue ablation                S            1          0335       5.0997         0.00         0.00         0.00           X
76400     Magnetic image, bone marrow            S            1          0335       5.0997         0.00         0.00         0.00           X
76496     Fluoroscopic procedure                 X            1          0000       0.0000         0.00         0.00         0.00
76497     Ct procedure                           S            1          0000       0.0000         0.00         0.00         0.00
76498     Mri procedure                          S            1          0000       0.0000         0.00         0.00         0.00
76499     Radiographic procedure                 X            1          0000       0.0000         0.00         0.00         0.00
76506     Echo exam of head                      S            S          0265       0.9930        45.78        104.37       119.64
76510     Ophth us, b & quant a                  S            S          0266       1.5883        73.22        166.95       191.36
76511     Ophth us, quant a only                 S            S          0266       1.5883        73.22        166.95       191.36
76512     Ophth us, b w/non-quant a              S            S          0266       1.5883        73.22        166.95       191.36
76513     Echo exam of eye, water bath           S            S          0266       1.5883        73.22        166.95       191.36
76514     Echo exam of eye, thickness            X            X          0340       0.6137        28.29        64.51        73.94
76516     Echo exam of eye                       S            S          0265       0.9930        45.78        104.37       119.64
76519     Echo exam of eye                       S            S          0266       1.5883        73.22        166.95       191.36
76529     Echo exam of eye                       S            S          0265       0.9930        45.78        104.37       119.64
76536     Us exam of head and neck               S            S          0266       1.5883        73.22        166.95       191.36
76604     Us exam, chest, b-scan                 S            S          0266       1.5883        73.22        166.95       191.36
76645     Us exam, breast(s)                     S            S          0265       0.9930        45.78        104.37       119.64
76700     Us exam, abdom, complete               S            S          0266       1.5883        73.22        166.95       191.36
76705     Echo exam of abdomen                   S            S          0266       1.5883        73.22        166.95       191.36
76770     Us exam abdo back wall, comp           S            S          0266       1.5883        73.22        166.95       191.36
76775     Us exam abdo back wall, lim            S            S          0266       1.5883        73.22        166.95       191.36
76778     Us exam kidney transplant              S            1          0266       1.5883         0.00         0.00         0.00           X
76800     Us exam, spinal canal                  S            S          0266       1.5883        73.22        166.95       191.36
76801     Ob us < 14 wks, single fetus           S            S          0266       1.5883        73.22        166.95       191.36
76802     Ob us < 14 wks, add’l fetus            S            S          0265       0.9930        45.78        104.37       119.64
76805     Ob us >/= 14 wks, sngl fetus           S            S          0266       1.5883        73.22        166.95       191.36
76810     Ob us >/= 14 wks, addl fetus           S            S          0266       1.5883        73.22        166.95       191.36
76811     Ob us, detailed, sngl fetus            S            S          0267       2.5543        117.75       268.48       307.74
76812     Ob us, detailed, addl fetus            S            S          0266       1.5883        73.22        166.95       191.36
76815     Ob us, limited, fetus(s)               S            S          0265       0.9930        45.78        104.37       119.64
76816     Ob us, follow-up, per fetus            S            S          0265       0.9930        45.78        104.37       119.64
76817     Transvaginal us, obstetric             S            S          0266       1.5883        73.22        166.95       191.36
76818     Fetal biophys profile w/nst            S            S          0266       1.5883        73.22        166.95       191.36
76819     Fetal biophys profil w/o nst           S            S          0266       1.5883        73.22        166.95       191.36
76820     Umbilical artery echo                  S            S          0096       1.6020        73.85        168.39       193.01
76821     Middle cerebral artery echo            S            S          0096       1.6020        73.85        168.39       193.01

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   79 of 171
State of Wyoming Oupatient Prospective Payment System                                                                            Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                               Critical
                                               October                                               General     Children's                Change
                                                           WY 2007                                                             Access
  CPT/                                           2006                             APC Relative       Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                   Hospital
 HCPCS                                          Status                              Weight          Outpatient   Outpatient                 2006
                                                           Indicator                                                          Outpatient
                                              Indicator                                                Fee          Fee                   Schedule
                                                                                                                                 Fee
                                             (FYI Only)
76825     Echo exam of fetal heart               S            S          0671        1.6763          77.28         176.20       201.96
76826     Echo exam of fetal heart               S            S          0697        1.5121          69.71         158.94       182.18
76827     Echo exam of fetal heart               S            S          0671        1.6763          77.28         176.20       201.96
76828     Echo exam of fetal heart               S            S          0697        1.5121          69.71         158.94       182.18
76830     Transvaginal us, non-ob                S            S          0266        1.5883          73.22         166.95       191.36
76831     Echo exam, uterus                      S            S          0267        2.5543          117.75        268.48       307.74
76856     Us exam, pelvic, complete              S            S          0266        1.5883          73.22         166.95       191.36
76857     Us exam, pelvic, limited               S            S          0265        0.9930          45.78         104.37       119.64
76870     Us exam, scrotum                       S            S          0266        1.5883          73.22         166.95       191.36
76872     Us, transrectal                        S            S          0266        1.5883          73.22         166.95       191.36
76873     Echograp trans r, pros study           S            S          0266        1.5883          73.22         166.95       191.36
76880     Us exam, extremity                     S            S          0266        1.5883          73.22         166.95       191.36
76885     Us exam infant hips, dynamic           S            S          0265        0.9930          45.78         104.37       119.64
76886     Us exam infant hips, static            S            S          0266        1.5883          73.22         166.95       191.36
76930     Echo guide, cardiocentesis             S            S          0268        1.0460          48.22         109.95       126.02
76932     Echo guide for heart biopsy            S            S          0268        1.0460          48.22         109.95       126.02
76936     Echo guide for artery repair           S            S          0268        1.0460          48.22         109.95       126.02
76937     Us guide, vascular access              N            N          0000        0.0000           0.00          0.00         0.00
76940     Us guide, tissue ablation              S            S          0268        1.0460          48.22         109.95       126.02
76941     Echo guide for transfusion             S            S          0268        1.0460          48.22         109.95       126.02
76942     Echo guide for biopsy                  S            S          0268        1.0460          48.22         109.95       126.02
76945     Echo guide, villus sampling            S            S          0268        1.0460          48.22         109.95       126.02
76946     Echo guide for amniocentesis           S            S          0268        1.0460          48.22         109.95       126.02
76948     Echo guide, ova aspiration             S            S          0268        1.0460          48.22         109.95       126.02
76950     Echo guidance radiotherapy             S            S          0268        1.0460          48.22         109.95       126.02
76965     Echo guidance radiotherapy             S            S          0268        1.0460          48.22         109.95       126.02
76970     Ultrasound exam follow-up              S            S          0265        0.9930          45.78         104.37       119.64
76975     GI endoscopic ultrasound               S            S          0266        1.5883          73.22         166.95       191.36
76977     Us bone density measure                X            X          0340        0.6137          28.29         64.51        73.94
76986     Ultrasound guide intraoper             S            1          0266        1.5883           0.00          0.00         0.00          X
76999     Echo examination procedure             S            1          0000        0.0000           0.00          0.00         0.00
77261     Radiation therapy planning             B            B          0000        0.0000           0.00          0.00         0.00
77262     Radiation therapy planning             B            B          0000        0.0000           0.00          0.00         0.00
77263     Radiation therapy planning             B            B          0000        0.0000           0.00          0.00         0.00
77280     Set radiation therapy field            X            X          0304        1.7323          79.86         182.08       208.71
77285     Set radiation therapy field            X            X          0305        3.9335          181.33        413.45       473.91
77290     Set radiation therapy field            X            X          0305        3.9335          181.33        413.45       473.91
77295     Set radiation therapy field            X            X          0310       13.8818          639.95       1,459.12     1,672.48
77299     Radiation therapy planning             X            1          0000        0.0000           0.00          0.00         0.00
77300     Radiation therapy dose plan            X            X          0304        1.7323          79.86         182.08       208.71
77301     Radiotherapy dose plan, imrt           X            X          0310       13.8818          639.95       1,459.12     1,672.48
77305     Teletx isodose plan simple             X            X          0304        1.7323          79.86         182.08       208.71
77310     Teletx isodose plan intermed           X            X          0305        3.9335          181.33        413.45       473.91
77315     Teletx isodose plan complex            X            X          0305        3.9335          181.33        413.45       473.91
77321     Special teletx port plan               X            X          0305        3.9335          181.33        413.45       473.91
77326     Brachytx isodose calc simp             X            X          0304        1.7323          79.86         182.08       208.71
77327     Brachytx isodose calc interm           X            X          0305        3.9335          181.33        413.45       473.91
77328     Brachytx isodose plan compl            X            X          0305        3.9335          181.33        413.45       473.91
77331     Special radiation dosimetry            X            X          0304        1.7323          79.86         182.08       208.71
77332     Radiation treatment aid(s)             X            X          0303        2.8241          130.19        296.84       340.25
77333     Radiation treatment aid(s)             X            X          0303        2.8241          130.19        296.84       340.25
77334     Radiation treatment aid(s)             X            X          0303        2.8241          130.19        296.84       340.25
77336     Radiation physics consult              X            X          0304        1.7323          79.86         182.08       208.71
77370     Radiation physics consult              X            X          0304        1.7323          79.86         182.08       208.71
77399     External radiation dosimetry           X            1          0000        0.0000           0.00          0.00         0.00
77401     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77402     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77403     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77404     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77406     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77407     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77408     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77409     Radiation treatment delivery           S            S          0300        1.4660          67.58         154.09       176.62
77411     Radiation treatment delivery           S            S          0301        2.2056          101.68        231.83       265.73
77412     Radiation treatment delivery           S            S          0301        2.2056          101.68        231.83       265.73
77413     Radiation treatment delivery           S            S          0301        2.2056          101.68        231.83       265.73
77414     Radiation treatment delivery           S            S          0301        2.2056          101.68        231.83       265.73
77416     Radiation treatment delivery           S            S          0301        2.2056          101.68        231.83       265.73
77417     Radiology port film(s)                 X            X          0260        0.7296          33.63         76.69        87.90
77418     Radiation tx delivery, imrt            S            S          0412        5.3573          246.97        563.11       645.45
77421     Stereoscopic x-ray guidance            S            S          1502        1.2603     *    58.10         132.47       151.84
77422     Neutron beam tx, simple                S            S          0301        2.2056          101.68        231.83       265.73
77423     Neutron beam tx, complex               S            S          0301        2.2056          101.68        231.83       265.73
77427     Radiation tx management, x5            B            B          0000        0.0000           0.00          0.00         0.00
77431     Radiation therapy management           B            B          0000        0.0000           0.00          0.00         0.00
77432     Stereotactic radiation trmt            B            B          0000        0.0000           0.00          0.00         0.00
77470     Special radiation treatment            S            S          0299        5.7678          265.90        606.25       694.90

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                      80 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
77499     Radiation therapy management           B            1          0000        0.0000        0.00          0.00         0.00
77520     Proton trmt, simple w/o comp           S            S          0664       15.9286       734.31       1,674.26     1,919.08
77522     Proton trmt, simple w/comp             S            S          0664       15.9286       734.31       1,674.26     1,919.08
77523     Proton trmt, intermediate              S            S          0667       19.0566       878.51       2,003.04     2,295.94
77525     Proton treatment, complex              S            S          0667       19.0566       878.51       2,003.04     2,295.94
77600     Hyperthermia treatment                 S            S          0314        5.5840       257.42        586.93       672.76
77605     Hyperthermia treatment                 S            S          0314        5.5840       257.42        586.93       672.76
77610     Hyperthermia treatment                 S            S          0314        5.5840       257.42        586.93       672.76
77615     Hyperthermia treatment                 S            S          0314        5.5840       257.42        586.93       672.76
77620     Hyperthermia treatment                 S            S          0314        5.5840       257.42        586.93       672.76
77750     Infuse radioactive materials           S            S          0301        2.2056       101.68        231.83       265.73
77761     Apply intrcav radiat simple            S            S          0312        5.5674       256.66        585.19       670.76
77762     Apply intrcav radiat interm            S            S          0312        5.5674       256.66        585.19       670.76
77763     Apply intrcav radiat compl             S            S          0312        5.5674       256.66        585.19       670.76
77776     Apply interstit radiat simpl           S            S          0312        5.5674       256.66        585.19       670.76
77777     Apply interstit radiat inter           S            S          0312        5.5674       256.66        585.19       670.76
77778     Apply interstit radiat compl           S            S          0651       11.1948       516.08       1,176.69     1,348.75
77781     High intensity brachytherapy           S            S          0313       13.0202       600.23       1,368.55     1,568.67
77782     High intensity brachytherapy           S            S          0313       13.0202       600.23       1,368.55     1,568.67
77783     High intensity brachytherapy           S            S          0313       13.0202       600.23       1,368.55     1,568.67
77784     High intensity brachytherapy           S            S          0313       13.0202       600.23       1,368.55     1,568.67
77789     Apply surface radiation                S            S          0300        1.4660       67.58         154.09       176.62
77790     Radiation handling                     N            N          0000        0.0000        0.00          0.00         0.00
77799     Radium/radioisotope therapy            S            1          0000        0.0000        0.00          0.00         0.00
78000     Thyroid, single uptake                 S            S          0389        1.4276       65.81         150.06       172.00
78001     Thyroid, multiple uptakes              S            S          0389        1.4276       65.81         150.06       172.00
78003     Thyroid suppress/stimul                S            S          0392        3.5231       162.41        370.31       424.46
78006     Thyroid imaging with uptake            S            S          0390        2.4663       113.70        259.23       297.14
78007     Thyroid image, mult uptakes            S            S          0391        2.7803       128.17        292.24       334.97
78010     Thyroid imaging                        S            S          0390        2.4663       113.70        259.23       297.14
78011     Thyroid imaging with flow              S            S          0390        2.4663       113.70        259.23       297.14
78015     Thyroid met imaging                    S            S          0406        4.1397       190.84        435.12       498.75
78016     Thyroid met imaging/studies            S            S          0406        4.1397       190.84        435.12       498.75
78018     Thyroid met imaging, body              S            S          0406        4.1397       190.84        435.12       498.75
78020     Thyroid met uptake                     S            S          0399        1.5039       69.33         158.07       181.19
78070     Parathyroid nuclear imaging            S            S          0391        2.7803       128.17        292.24       334.97
78075     Adrenal nuclear imaging                S            S          0391        2.7803       128.17        292.24       334.97
78099     Endocrine nuclear procedure            S            1          0000        0.0000        0.00          0.00         0.00
78102     Bone marrow imaging, ltd               S            S          0400        3.9160       180.53        411.61       471.80
78103     Bone marrow imaging, mult              S            S          0400        3.9160       180.53        411.61       471.80
78104     Bone marrow imaging, body              S            S          0400        3.9160       180.53        411.61       471.80
78110     Plasma volume, single                  S            S          0393        3.4467       158.89        362.28       415.26
78111     Plasma volume, multiple                S            S          0393        3.4467       158.89        362.28       415.26
78120     Red cell mass, single                  S            S          0393        3.4467       158.89        362.28       415.26
78121     Red cell mass, multiple                S            S          0393        3.4467       158.89        362.28       415.26
78122     Blood volume                           S            S          0393        3.4467       158.89        362.28       415.26
78130     Red cell survival study                S            S          0393        3.4467       158.89        362.28       415.26
78135     Red cell survival kinetics             S            S          0393        3.4467       158.89        362.28       415.26
78140     Red cell sequestration                 S            S          0393        3.4467       158.89        362.28       415.26
78185     Spleen imaging                         S            S          0400        3.9160       180.53        411.61       471.80
78190     Platelet survival, kinetics            S            S          0392        3.5231       162.41        370.31       424.46
78191     Platelet survival                      S            S          0392        3.5231       162.41        370.31       424.46
78195     Lymph system imaging                   S            S          0400        3.9160       180.53        411.61       471.80
78199     Blood/lymph nuclear exam               S            1          0000        0.0000        0.00          0.00         0.00
78201     Liver imaging                          S            S          0394        4.3107       198.72        453.10       519.35
78202     Liver imaging with flow                S            S          0394        4.3107       198.72        453.10       519.35
78205     Liver imaging (3D)                     S            S          0394        4.3107       198.72        453.10       519.35
78206     Liver image (3d) with flow             S            S          0394        4.3107       198.72        453.10       519.35
78215     Liver and spleen imaging               S            S          0394        4.3107       198.72        453.10       519.35
78216     Liver & spleen image/flow              S            S          0394        4.3107       198.72        453.10       519.35
78220     Liver function study                   S            S          0394        4.3107       198.72        453.10       519.35
78223     Hepatobiliary imaging                  S            S          0394        4.3107       198.72        453.10       519.35
78230     Salivary gland imaging                 S            S          0395        3.7696       173.78        396.22       454.16
78231     Serial salivary imaging                S            S          0395        3.7696       173.78        396.22       454.16
78232     Salivary gland function exam           S            S          0395        3.7696       173.78        396.22       454.16
78258     Esophageal motility study              S            S          0395        3.7696       173.78        396.22       454.16
78261     Gastric mucosa imaging                 S            S          0395        3.7696       173.78        396.22       454.16
78262     Gastroesophageal reflux exam           S            S          0395        3.7696       173.78        396.22       454.16
78264     Gastric emptying study                 S            S          0395        3.7696       173.78        396.22       454.16
78267     Breath tst attain/anal c-14            A            3          0000        0.0000        M01           M01          M01
78268     Breath test analysis, c-14             A            3          0000        0.0000        M01           M01          M01
78270     Vit B-12 absorption exam               S            S          0392        3.5231       162.41        370.31       424.46
78271     Vit b-12 absrp exam, int fac           S            S          0392        3.5231       162.41        370.31       424.46
78272     Vit B-12 absorp, combined              S            S          0392        3.5231       162.41        370.31       424.46
78278     Acute GI blood loss imaging            S            S          0395        3.7696       173.78        396.22       454.16
78282     GI protein loss exam                   S            S          0395        3.7696       173.78        396.22       454.16
78290     Meckel’s divert exam                   S            S          0395        3.7696       173.78        396.22       454.16

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                   81 of 171
State of Wyoming Oupatient Prospective Payment System                                                                            Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                               Critical
                                               October                                               General     Children's                Change
                                                           WY 2007                                                             Access
  CPT/                                           2006                             APC Relative       Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                   Hospital
 HCPCS                                          Status                              Weight          Outpatient   Outpatient                 2006
                                                           Indicator                                                          Outpatient
                                              Indicator                                                Fee          Fee                   Schedule
                                                                                                                                 Fee
                                             (FYI Only)
78291     Leveen/shunt patency exam              S            S          0395        3.7696           173.78       396.22       454.16
78299     GI nuclear procedure                   S            1          0000        0.0000            0.00         0.00         0.00
78300     Bone imaging, limited area             S            S          0396        3.9921           184.04       419.61       480.97
78305     Bone imaging, multiple areas           S            S          0396        3.9921           184.04       419.61       480.97
78306     Bone imaging, whole body               S            S          0396        3.9921           184.04       419.61       480.97
78315     Bone imaging, 3 phase                  S            S          0396        3.9921           184.04       419.61       480.97
78320     Bone imaging (3D)                      S            S          0396        3.9921           184.04       419.61       480.97
78350     Bone mineral, single photon            X            X          0260        0.7296           33.63        76.69        87.90
78351     Bone mineral, dual photon              E            3          0000        0.0000            M01          M01          M01
78399     Musculoskeletal nuclear exam           S            1          0000        0.0000            0.00         0.00         0.00
78414     Non-imaging heart function             S            S          0398        4.2038           193.80       441.86       506.47
78428     Cardiac shunt imaging                  S            S          0398        4.2038           193.80       441.86       506.47
78445     Vascular flow imaging                  S            S          0397        2.0829           96.02        218.93       250.95
78456     Acute venous thrombus image            S            S          0397        2.0829           96.02        218.93       250.95
78457     Venous thrombosis imaging              S            S          0397        2.0829           96.02        218.93       250.95
78458     Ven thrombosis images, bilat           S            S          0397        2.0829           96.02        218.93       250.95
78459     Heart muscle imaging (PET)             S            S          0306       13.4521           620.14      1,413.95     1,620.71
78460     Heart muscle blood, single             S            S          0398        4.2038           193.80       441.86       506.47
78461     Heart muscle blood, multiple           S            S          0377        6.6729           307.62       701.39       803.95
78464     Heart image (3d), single               S            S          0398        4.2038           193.80       441.86       506.47
78465     Heart image (3d), multiple             S            S          0377        6.6729           307.62       701.39       803.95
78466     Heart infarct image                    S            S          0398        4.2038           193.80       441.86       506.47
78468     Heart infarct image (ef)               S            S          0398        4.2038           193.80       441.86       506.47
78469     Heart infarct image (3D)               S            S          0398        4.2038           193.80       441.86       506.47
78472     Gated heart, planar, single            S            S          0398        4.2038           193.80       441.86       506.47
78473     Gated heart, multiple                  S            S          0376        5.0315           231.95       528.86       606.20
78478     Heart wall motion add-on               S            S          0399        1.5039           69.33        158.07       181.19
78480     Heart function add-on                  S            S          0399        1.5039           69.33        158.07       181.19
78481     Heart first pass, single               S            S          0398        4.2038           193.80       441.86       506.47
78483     Heart first pass, multiple             S            S          0376        5.0315           231.95       528.86       606.20
78491     Heart image (pet), single              S            S          0306       13.4521           620.14      1,413.95     1,620.71
78492     Heart image (pet), multiple            S            S          0307       41.7549          1,924.90     4,388.86     5,030.63
78494     Heart image, spect                     S            S          0398        4.2038           193.80       441.86       506.47
78496     Heart first pass add-on                S            S          0399        1.5039           69.33        158.07       181.19
78499     Cardiovascular nuclear exam            S            1          0000        0.0000            0.00         0.00         0.00
78580     Lung perfusion imaging                 S            S          0401        3.3166           152.90       348.61       399.58
78584     Lung V/Q image single breath           S            S          0378        5.4064           249.24       568.27       651.36
78585     Lung V/Q imaging                       S            S          0378        5.4064           249.24       568.27       651.36
78586     Aerosol lung image, single             S            S          0401        3.3166           152.90       348.61       399.58
78587     Aerosol lung image, multiple           S            S          0401        3.3166           152.90       348.61       399.58
78588     Perfusion lung image                   S            S          0378        5.4064           249.24       568.27       651.36
78591     Vent image, 1 breath, 1 proj           S            S          0401        3.3166           152.90       348.61       399.58
78593     Vent image, 1 proj, gas                S            S          0401        3.3166           152.90       348.61       399.58
78594     Vent image, mult proj, gas             S            S          0401        3.3166           152.90       348.61       399.58
78596     Lung differential function             S            S          0378        5.4064           249.24       568.27       651.36
78599     Respiratory nuclear exam               S            1          0000        0.0000            0.00         0.00         0.00
78600     Brain imaging, ltd static              S            S          0402        5.1709           238.38       543.51       622.99
78601     Brain imaging, ltd w/flow              S            S          0402        5.1709           238.38       543.51       622.99
78605     Brain imaging, complete                S            S          0402        5.1709           238.38       543.51       622.99
78606     Brain imaging, compl w/flow            S            S          0402        5.1709           238.38       543.51       622.99
78607     Brain imaging (3D)                     S            S          0402        5.1709           238.38       543.51       622.99
78608     Brain imaging (PET)                    S            S          1513       19.3242     *     890.85      2,031.17     2,328.18
78609     Brain imaging (PET)                    E            1          0000        0.0000            0.00         0.00         0.00
78610     Brain flow imaging only                S            S          0402        5.1709           238.38       543.51       622.99
78615     Cerebral vascular flow image           S            S          0402        5.1709           238.38       543.51       622.99
78630     Cerebrospinal fluid scan               S            S          0403        3.5015           161.42       368.04       421.86
78635     CSF ventriculography                   S            S          0403        3.5015           161.42       368.04       421.86
78645     CSF shunt evaluation                   S            S          0403        3.5015           161.42       368.04       421.86
78647     Cerebrospinal fluid scan               S            S          0403        3.5015           161.42       368.04       421.86
78650     CSF leakage imaging                    S            S          0403        3.5015           161.42       368.04       421.86
78660     Nuclear exam of tear flow              S            S          0403        3.5015           161.42       368.04       421.86
78699     Nervous system nuclear exam            S            1          0000        0.0000            0.00         0.00         0.00
78700     Kidney imaging, static                 S            S          0404        3.6558           168.53       384.26       440.45
78701     Kidney imaging with flow               S            S          0404        3.6558           168.53       384.26       440.45
78704     Imaging renogram                       S            1          0404        3.6558            0.00         0.00         0.00          X
78707     Kidney flow/function image             S            S          0404        3.6558           168.53       384.26       440.45
78708     Kidney flow/function image             S            S          0405        4.1493           191.28       436.13       499.91
78709     Kidney flow/function image             S            S          0405        4.1493           191.28       436.13       499.91
78710     Kidney imaging (3D)                    S            S          0404        3.6558           168.53       384.26       440.45
78715     Renal vascular flow exam               S            1          0404        3.6558            0.00         0.00         0.00          X
78725     Kidney function study                  S            S          0389        1.4276           65.81        150.06       172.00
78730     Urinary bladder retention              X            X          0340        0.6137           28.29        64.51        73.94
78740     Ureteral reflux study                  S            S          0404        3.6558           168.53       384.26       440.45
78760     Testicular imaging                     S            1          0404        3.6558            0.00         0.00         0.00          X
78761     Testicular imaging/flow                S            S          0404        3.6558           168.53       384.26       440.45
78799     Genitourinary nuclear exam             S            1          0000        0.0000            0.00         0.00         0.00
78800     Tumor imaging, limited area            S            S          0406        4.1397           190.84       435.12       498.75

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                      82 of 171
State of Wyoming Oupatient Prospective Payment System                                                                            Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                               Critical
                                               October                                               General     Children's                Change
                                                           WY 2007                                                             Access
  CPT/                                           2006                             APC Relative       Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                   Hospital
 HCPCS                                          Status                              Weight          Outpatient   Outpatient                 2006
                                                           Indicator                                                          Outpatient
                                              Indicator                                                Fee          Fee                   Schedule
                                                                                                                                 Fee
                                             (FYI Only)
78801     Tumor imaging, mult areas              S            S          0406        4.1397          190.84        435.12       498.75
78802     Tumor imaging, whole body              S            S          0406        4.1397          190.84        435.12       498.75
78803     Tumor imaging (3D)                     S            S          0406        4.1397          190.84        435.12       498.75
78804     Tumor imaging, whole body              S            S          1508       10.9224     *    503.52       1,148.05     1,315.93
78805     Abscess imaging, ltd area              S            S          0406        4.1397          190.84        435.12       498.75
78806     Abscess imaging, whole body            S            S          0406        4.1397          190.84        435.12       498.75
78807     Nuclear localization/abscess           S            S          0406        4.1397          190.84        435.12       498.75
78811     Tumor imaging (pet), limited           S            S          1513       19.3242     *    890.85       2,031.17     2,328.18
78812     Tumor image (pet)/skul-thigh           S            S          1513       19.3242     *    890.85       2,031.17     2,328.18
78813     Tumor image (pet) full body            S            S          1513       19.3242     *    890.85       2,031.17     2,328.18
78814     Tumor image pet/ct, limited            S            S          1514       21.0045     *    968.31       2,207.78     2,530.62
78815     Tumorimage pet/ct skul-thigh           S            S          1514       21.0045     *    968.31       2,207.78     2,530.62
78816     Tumor image pet/ct full body           S            S          1514       21.0045     *    968.31       2,207.78     2,530.62
78890     Nuclear medicine data proc             N            N          0000        0.0000           0.00          0.00         0.00
78891     Nuclear med data proc                  N            N          0000        0.0000           0.00          0.00         0.00
78999     Nuclear diagnostic exam                S            1          0000        0.0000           0.00          0.00         0.00
79005     Nuclear rx, oral admin                 S            S          0407        3.8758          178.67        407.39       466.96
79101     Nuclear rx, iv admin                   S            S          0407        3.8758          178.67        407.39       466.96
79200     Nuclear rx, intracav admin             S            S          0407        3.8758          178.67        407.39       466.96
79300     Nuclr rx, interstit colloid            S            S          0407        3.8758          178.67        407.39       466.96
79403     Hematopoietic nuclear tx               S            1          0000        0.0000           0.00          0.00         0.00
79440     Nuclear rx, intra-articular            S            S          0407        3.8758          178.67        407.39       466.96
79445     Nuclear rx, intra-arterial             S            S          0407        3.8758          178.67        407.39       466.96
79999     Nuclear medicine therapy               S            1          0000        0.0000           0.00          0.00         0.00
80048     Basic metabolic panel                  A            3          0000        0.0000           M01           M01          M01
80050     General health panel                   E            3          0000        0.0000           M01           M01          M01
80051     Electrolyte panel                      A            3          0000        0.0000           M01           M01          M01
80053     Comprehen metabolic panel              A            3          0000        0.0000           M01           M01          M01
80055     Obstetric panel                        E            3          0000        0.0000           M01           M01          M01
80061     Lipid panel                            A            3          0000        0.0000           M01           M01          M01
80069     Renal function panel                   A            3          0000        0.0000           M01           M01          M01
80074     Acute hepatitis panel                  A            3          0000        0.0000           M01           M01          M01
80076     Hepatic function panel                 A            3          0000        0.0000           M01           M01          M01
80100     Drug screen, qualitate/multi           A            3          0000        0.0000           M01           M01          M01
80101     Drug screen, single                    A            3          0000        0.0000           M01           M01          M01
80102     Drug confirmation                      A            3          0000        0.0000           M01           M01          M01
80103     Drug analysis, tissue prep             N            N          0000        0.0000           0.00          0.00         0.00
80150     Assay of amikacin                      A            3          0000        0.0000           M01           M01          M01
80152     Assay of amitriptyline                 A            3          0000        0.0000           M01           M01          M01
80154     Assay of benzodiazepines               A            3          0000        0.0000           M01           M01          M01
80156     Assay, carbamazepine, total            A            3          0000        0.0000           M01           M01          M01
80157     Assay, carbamazepine, free             A            3          0000        0.0000           M01           M01          M01
80158     Assay of cyclosporine                  A            3          0000        0.0000           M01           M01          M01
80160     Assay of desipramine                   A            3          0000        0.0000           M01           M01          M01
80162     Assay of digoxin                       A            3          0000        0.0000           M01           M01          M01
80164     Assay, dipropylacetic acid             A            3          0000        0.0000           M01           M01          M01
80166     Assay of doxepin                       A            3          0000        0.0000           M01           M01          M01
80168     Assay of ethosuximide                  A            3          0000        0.0000           M01           M01          M01
80170     Assay of gentamicin                    A            3          0000        0.0000           M01           M01          M01
80172     Assay of gold                          A            3          0000        0.0000           M01           M01          M01
80173     Assay of haloperidol                   A            3          0000        0.0000           M01           M01          M01
80174     Assay of imipramine                    A            3          0000        0.0000           M01           M01          M01
80176     Assay of lidocaine                     A            3          0000        0.0000           M01           M01          M01
80178     Assay of lithium                       A            3          0000        0.0000           M01           M01          M01
80182     Assay of nortriptyline                 A            3          0000        0.0000           M01           M01          M01
80184     Assay of phenobarbital                 A            3          0000        0.0000           M01           M01          M01
80185     Assay of phenytoin, total              A            3          0000        0.0000           M01           M01          M01
80186     Assay of phenytoin, free               A            3          0000        0.0000           M01           M01          M01
80188     Assay of primidone                     A            3          0000        0.0000           M01           M01          M01
80190     Assay of procainamide                  A            3          0000        0.0000           M01           M01          M01
80192     Assay of procainamide                  A            3          0000        0.0000           M01           M01          M01
80194     Assay of quinidine                     A            3          0000        0.0000           M01           M01          M01
80195     Assay of sirolimus                     A            3          0000        0.0000           M01           M01          M01
80196     Assay of salicylate                    A            3          0000        0.0000           M01           M01          M01
80197     Assay of tacrolimus                    A            3          0000        0.0000           M01           M01          M01
80198     Assay of theophylline                  A            3          0000        0.0000           M01           M01          M01
80200     Assay of tobramycin                    A            3          0000        0.0000           M01           M01          M01
80201     Assay of topiramate                    A            3          0000        0.0000           M01           M01          M01
80202     Assay of vancomycin                    A            3          0000        0.0000           M01           M01          M01
80299     Quantitative assay, drug               A            1          0000        0.0000           0.00          0.00         0.00
80400     Acth stimulation panel                 A            3          0000        0.0000           M01           M01          M01
80402     Acth stimulation panel                 A            3          0000        0.0000           M01           M01          M01
80406     Acth stimulation panel                 A            3          0000        0.0000           M01           M01          M01
80408     Aldosterone suppression eval           A            3          0000        0.0000           M01           M01          M01
80410     Calcitonin stimul panel                A            3          0000        0.0000           M01           M01          M01
80412     CRH stimulation panel                  A            3          0000        0.0000           M01           M01          M01
80414     Testosterone response                  A            3          0000        0.0000           M01           M01          M01

                                                     6c8f5f7c-2002-4b04-a227-9afc3e5cff01.xls                                      83 of 171
State of Wyoming Oupatient Prospective Payment System                                                                         Updated   12/20/06
Procedure Code List
Effective Date: 2007

Conversion Factors:
  $46.10 General Acute Care Hospitals
 $105.11 Children's Hospitals
 $120.48 Critical Access Hospitals

Medicare's 2007 National Conversion Factor    61.468



                                              Medicare
                                                                                                                            Critical
                                               October                                            General     Children's                Change
                                                           WY 2007                                                          Access
  CPT/                                           2006                             APC Relative    Hospital     Hospital               from 9-22-
                   Description (short)                       Status      APC                                                Hospital
 HCPCS                                          Status                              Weight       Outpatient   Outpatient                 2006
                                                           Indicator                                                       Outpatient
                                              Indicator                                             Fee          Fee                   Schedule
                                                                                                                              Fee
                                             (FYI Only)
80415     Estradiol response panel               A            3          0000       0.0000          M01          M01          M01
80416     Renin stimulation panel                A            3          0000       0.0000          M01          M01          M01
80417     Renin stimulation panel                A            3          0000       0.0000          M01          M01          M01
80418     Pituitary evaluation panel             A            3          0000       0.0000          M01          M01          M01
80420     Dexamethasone panel                    A            3          0000       0.0000          M01          M01          M01
80422     Glucagon tolerance panel               A            3          0000       0.0000          M01          M01          M01
80424     Glucagon tolerance panel               A            3          0000       0.0000          M01          M01          M01
80426     Gonadotropin hormone panel             A            3          0000       0.0000          M01          M01          M01
80428     Growth hormone panel                   A            3          0000       0.0000          M01          M01          M01
80430     Growth hormone panel                   A            3          0000       0.0000          M01          M01          M01
80432     Insulin suppression panel              A            3          0000       0.0000          M01          M01          M01
80434     Insulin tolerance panel                A            3          0000       0.0000          M01          M01          M01
80435     Insulin tolerance panel                A            3          0000       0.0000          M01          M01          M01
80436     Metyrapone panel                       A            3          0000       0.0000          M01          M01          M01
80438     TRH stimulation panel                  A            3          0000       0.0000          M01          M01          M01
80439     TRH stimulation panel                  A            3          0000       0.0000          M01          M01          M01
80440     TRH stimulation panel                  A            3          0000       0.0000          M01          M01          M01
80500     Lab pathology consultation             X            X          0433       0.2493         11.49        26.20        30.04
80502     Lab pathology consultation             X            X          0342       0.1450          6.68        15.24        17.47
81000     Urinalysis, nonauto w/scope            A            3          0000       0.0000          M01          M01          M01
81001     Urinalysis, auto w/scope               A            3          0000       0.0000          M01          M01          M01
81002     Urinalysis nonauto w/o scope           A            3          0000       0.0000          M01          M01          M01
81003     Urinalysis, auto, w/o scope            A            3          0000       0.0000          M01          M01          M01
81005     Urinalysis                             A            3          0000       0.0000          M01          M01          M01
81007     Urine screen for bacteria              A            3          0000       0.0000          M01          M01          M01
81015     Microscopic exam of urine              A            3          0000       0.0000          M01          M01          M01
81020     Urinalysis, glass test                 A            3          0000       0.0000          M01          M01          M01
81025     Urine pregnancy test                   A            3          0000       0.0000          M01          M01          M01
81050     Urinalysis, volume measure             A            3          0000       0.0000          M01          M01          M01
81099     Urinalysis test procedure              X            1          0000       0.0000          0.00         0.00         0.00
82000     Assay of blood acetaldehyde            A            3          0000       0.0000          M01          M01          M01
82003     Assay of acetaminophen                 A            3          0000       0.0000          M01          M01          M01
82009     Test for acetone/ketones               A            3          0000       0.0000          M01          M01          M01
82010     Acetone assay                          A            3          0000       0.0000          M01          M01          M01
82013     Acetylcholinesterase assay             A            3          0000       0.0000          M01          M01          M01
82016     Acylcarnitines, qual                   A            3          0000       0.0000          M01          M01          M01
82017     Acylcarnitines, quant                  A            3          0000       0.0000          M01          M01          M01
82024     Assay of acth                          A            3          0000       0.0000          M01          M01          M01
82030     Assay of adp & amp                     A            3          0000       0.0000          M01          M01          M01
82040     Assay of serum albumin                 A            3          0000       0.0000          M01          M01          M01
82042     Assay of urine albumin                 A            3          0000       0.0000          M01          M01          M01
82043     Microalbumin, quantitative             A            3          0000       0.0000          M01          M01          M01
82044     Microalbumin, semiquant                A            3          0000       0.0000          M01          M01          M01
82045     Albumin, ischemia modified             A            3          0000       0.0000          M01          M01          M01
82055     Assay of ethanol                       A            3          0000       0.0000          M01          M01          M01
82075     Assay of breath ethanol                A            3          0000       0.0000          M01          M01          M01
82085     Assay of aldolase                      A            3          0000       0.0000          M01          M01          M01
82088     Assay of aldosterone                   A            3          0000       0.0000          M01          M01          M01
82101     Assay of urine alkaloids               A            3          0000       0.0000          M01          M01          M01
82103     Alpha-1-antitrypsin, total             A            3          0000       0.0000          M01          M01          M01
82104     Alpha-1-antitrypsin, pheno             A            3          0000       0.0000          M01          M01          M01
82105     Alpha-fetoprotein, serum               A            3          0000       0.0000          M01          M01          M01
82106     Alpha-fetoprotein, amniotic            A            3          0000       0.0000          M01          M01          M01
82108     Assay of aluminum                      A            3          0000       0.0000          M01          M01          M01
82120     Amines, vaginal fluid qual             A            3          0000       0.0000          M01          M01          M01
82127     Amino acid, single qual                A            3          0000       0.0000          M01          M01          M01
82128     Amino acids, mult qual                 A            3          0000       0.0000          M01          M01          M01
82131     Amino acids, single quant              A            3          0000       0.0000          M01          M01          M01
82135     Assay, aminolevulinic acid             A            3          0000       0.0000          M01          M01          M01
82136     Amino acids, quant, 2-5                A            3          0000       0.0000          M01          M01          M01
82139     Amino acids, quan, 6 or more           A            3          0000       0.0000          M01          M01          M01
82140     Assay of ammonia                       A            3          0000       0.0000          M01          M01          M01
82143     Amniotic fluid scan                    A            3          0000       0.0000          M01          M01