Fee Schedule 12 13 by 2yrZJ3

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									           SCCB Medical Fees ‘13 - ‘13
CPT CODE   DESCRIPTION OF SERVICE                          FEE
           Enucleation of eye W/implant, muscle
 65103     not attached to implant                        469.19

           Enucleation of eye w/implant, muscles
 65105     attached to implant                             517.99

           Cornea, Excision or transposition of
 65420     Pterygium; without graft                        311.03

 65730     Keratoplasty, Penetrating (Non-Aphakia)        754.53

 65755     Keratoplasty, Penetrating (in pseudophakia)     761.32

 V2785     Corneal Tissue                                2 ,880.00

 65850     Laser Trabeculoplasty; One or more              523.57

 66170     Trabeculectomy (Surgical Filtering)             724.53

 66180     Aqueous Shunt to extra ocular reservoir         723.63

 66630     Iridectomy; sector for Glaucoma                 346.36

 66821     Yag Laser – one or more sessions                117.14

           Extracapsular Cataract Extraction lens
 66982     W/IOL Complex                                  661.11

 66984     Extracapsular Cataract Extraction W/IOL        473.73
        Intra Vitrealm Injection or
67028   Pharmacologic Agent                       132.30

J9035   Avastin                                   59.84

        Vitrectomy, Mechanical, Pars Plana
67036   Approach                                  595.99

67039   Vitrectomy, W/Focal Endolaser             762.69

67040   Vitrectomy W/Endolaser Pan Retinal        880.43

        Vitrectomy W/removal of preretinal
67041   cellular membrane                        825.40

        Vitrectomy W/removal of internal
67042   limiting membrane                        946.31

        Vitrectomy W/removal of sub-retinal
67043   membrane                                992.28

        Sclera Buckling W/Vitrectomy W-WO
67108   Air/Gas                                 999.00

        Retinal repair by Sclera Bucking or
67112   Vitrectomy                              824.09

        Retina Repair of complex retinal
67113   detachment                              1,086.28
        Photocoagulation, Laser or Xenon ARC,
67210   Focal                                    429.38
CPT CODE            DESCRIPTION OF SERVICE               FEE

 67221     Photo Dynamic Therapy                         184.95

 67225     Photo Dynamic Therapy (second eye)            19.34

           Destruction of extensive or progressive
 67227     retinopathy                                   372.58

           Photocoagulation, Pan Retina (PRP) (up
 67228     to 6 months same eye)                         732.72

 67250     Scleral reinforcement w/o graft               482.55

 67255     Scleral Reinforcement with graft              515.89

 76512     “B” Scan (with or without Superimposed non-   64.90
           quantitative A-Scan)
76512-26   W/Interpretation                              36.25

 76513     Anterior segment ultrasound, “B” Scan          59.33
76513-26   W/Interpretation                               24.94

 76514     Corneal Pachymetry, unilateral or
           bilateral                                      9.11
76514-26   W/Interpretation                               6.69
 76519     Ophthalmic ”A” Scan                            50.86
76519-26   Interpretation                                 20.93

 92002     Ophthalmological services (new patient)        49.48

 92004     Comprehensive Eye Exam – New patient          93.50
CPT CODE          DESCRIPTION OF SERVICE           FEE

 92012     Intermediate Exam Established Patient    52.13

           Comprehensive Exam, established
 92014     patient                                  76.26

 92015     Determination of Refractive State        24.65

 92020     Gonioscopy (not part of exam)            17.67

 92025     Computerized corneal topography          22.59
92025-26   Interpretation                           13.28

 92083     Goldmann Visual Fields                   52.29
92083-26   Interpretation                           19.03

 92133     Scanning Computerized Ophthalmic
92133-26   (OCT) Interpretation                     26.41

 92134     Scanning Computerized Ophthalmic
92134-26   (OCT Retina) Interpretation              26.41

 92136     Master A-Scan Power Calculation          53.91
92136-26   Interpretation                           20.93

 92235     Flourescein Angiogram W/Photography     83.69
92235-26   Interpretation                          31.45

 92250     Fundus Photography                      47.03
92250-26   Interpretation                          16.58
CPT CODE          DESCRIPTION OF SERVICE                 FEE

 99212     Level II Follow Up; Establish Patient          27.05

 99213     Level III Follow Up; Established Patient       45.37

 99214     Level IV Follow Up; Established Patient        68.36

 99215     Level V Follow Up; Established Patient         92.14

 99243     Initial Office Consultation                    91.41

 99244     Initial Office Consultation                   136.16



                Outpatient Hospital Fees
           Enucleation w/Implant muscle not
 65103     attached to implant                         1,585.73

           Enucleation of eye w/implant, muscle
 65105     Attached to eye                             1,585.73

 65420     Cornea, Excision or transposition of
           Pterygium; without graft                      822.23

 65710     Keratoplasty (Cornea Transplant Lamellar)   2,936.54

 65730     Keratoplasty; Penetrating (non=aphakia)     2,936.54

           Keratoplasty; Penetrating
 65755     (in pseudophakia)                           2,936.54
65850   Trabeculectomy                                 1,339.05

65855   Trabeculoplasty Laser (one or more sessions)     822.23

66180   Aqueous Shunt to extra ocular reservoir        1,585.73

66630   Iridectomy; sector for Glaucoma                1,585.73

66821   Yag Laser – one or more sessions               1,339.05

66982   Extra capsular cataract removal                 975.00

        Cataract Extraction with Primary
66984   Insertion of Intraocular Lens                    975.00

        Vitrectomy, mechanical, pars plana
67036   approach                                       1,339.05

        Vitrectomy, with focal endolaser
67039   photocoagulation                               1,339.05

        Vitrectomy, with endolaser panretinal
67040   photocoagulation                               1,339.05

        Vitrectomy, with removal of pre-retinal
67041   cellular membrane                              1,339.05

        Vitrectomy, with removal of internal
67042   limiting membrane                              1,339.05

        Vitrectomy, with removal of sub-retinal
67043   membrane                                       1,339.05
        Repair of retinal detachment – sclera
67107   bucking w/without implant                    1,339.05

        Repair retinal detachment with
67108   vitrectomy – any method                      1,339.05

        Repair of retinal detachment by
67110   injection of air or other gas                1,339.05

        Repair of retinal detachment by sclera
67112   buckling or vitrectomy                       1,339.05

67113   Repair of complex retinal detachment         1,339.05

              “For Use of Laser Machine “
         Only use when a PRP laser is done in a
67228        hospital or outpatient facility           125.00

             AUDIOLOGICAL EVALUATION
        Comprehensive audiometry threshold
92557   evaluation                                     35.17

92591   Hearing aid examination                        46.55

                   MEDICAL EXAM
99205   Medical Exam                                  145.99

                      ANESTHESIA
        Anesthesia
        This is an estimation, once the invoice is
        received it will be adjusted                  150.00
 SCCB fees are updated July 1 of each year and will remain in
  effect until June 30th of the next year.



 If you have any questions or a code that is not listed on this list,
  contact Winn Davis for further assistance.

								
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